New Hampshire and Vermont: What explains the growing differences in the #covid19 epidemics in the bi-state region? This is the question that I’ve been asked all week. Here are five key differences I see in their #covid19 responses (short thread):

Background: VT/NH both stemmed early #covid19 surges despite their proximity to the spring’s largest global outbreak and succeeded in sustaining low infection rates into summer and early fall. Both states saw an increase in cases beginning in late fall.

1/ Responsive Public Health Measures
Vermont rapidly instituted targeted public health measures to address the primary drivers of #covid19 transmission with the clear goals of keeping schools open and protecting vulnerable populations.

NH came into the fall with more limited public health measures in place and has resisted instituting further measures beyond a mask mandate (11/20). The state has framed further action as a choice between full lockdowns (with school closures) and doing nothing.

2/ Clear State Guidance
VT has state guidance that is responsive to changing epidemiology and evidence. Local institutions, including schools and businesses, have played key role in implementing/adapting state guidance as serve as mechanisms for accountability.

NH’s state guidance is much more limited in scope and has not evolved as quickly in response to changing epidemiology and evidence. Community responses are robust but play out in absence of the public health measures that were critical to NH’s early success.

2/ Protect Vulnerable Populations
Vermont has consistently prioritized vulnerable populations as part of its state response through a combination of policy, programmatic and targeted action. https://twitter.com/juliaoftoronto/status/1329470074101657602?s=20

NH, like most states, has had much weaker supports in place at state level for vulnerable populations. Efforts to protect vulnerable populations are more often led by health systems, social service agencies, and community-based groups.

3/ Messaging
NH’s leadership describes increases in transmission and the subsequent outbreaks in its LTCF and other congregate settings as inevitable. This has limited public debate on opportunities for state-led policy responses to avert these outcomes.

VT’s messaging has consistently communicated a dual sense of hope and agency—communities hear that their actions matter, that it is possible to shape the trajectory of the pandemic, and that their actions will lead to meaningful benefits.

4/ Rapid Response
VT has rapidly mobilized outbreak response teams and resources, including additional staffing, to address emergent challenges, including LTCF outbreaks. Data suggest that it has mitigated the impacts of these outbreaks in highly vulnerable settings better.

NH’s outbreak responses tend to be more reliant on institutional resources and local supports. These local responses are often vigorous; however, they lack the human and material resources needed (ie additional staffing).

5/Schools
VT has consistently prioritized schools as a goal of its response. It adopted more extensive statewide guidance and has restricted other activities to achieve educational continuity. Schools have played key roles as public health messengers.

NH has more narrow school guidance in place and has favored a strategy of local control on opening/closing decisions. It has called upon schools to stay open amid rising community transmission but has not yet used additional public health measures to suppress it.

What else? Additional contributing factors to the growing divergences in NH/VT’s responses include, but are not limited to, differences in the states’ underlying public health infrastructure, political culture, geography, and economies.