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Abstract How does the state of American federalism explain responses to COVID-19? State-by-state variations to the COVID-19 pandemic illustrate the political dynamics of “kaleidoscopic federalism,” under which there is no single prevailing principle of federalism. In the COVID-19 pandemic, features of kaleidoscopic federalism combined with shortcomings in the public health system under the Trump administration, leading to fragmented responses to the pandemic among the states. Federalism alone does not explain the shortcomings of the United States’ response to the pandemic. Rather, the fragmented response was driven by state partisanship, which shaped state public health interventions and resulted in differences in public health outcomes. This has sobering implications for American federalism because state-level partisan differences yield different and unequal responses to the pandemic. 

In Spring/Summer 2020, most individuals living in the United States experienced several months of social distancing and stay-at-home orders because of the coronavirus (COVID-19) pandemic. Clinicians, restaurant cooks, cashiers, transit operators, and other essential workers (EWs), however, continued to work outside the home during this time in order to keep others alive and maintain a functioning society. In the United States, EWs are often low-income persons of color who are more likely to face socioeconomic vulnerabilities, systemic racism, and health inequities. To assess the various impacts of COVID-19 on EWs, an online survey was distributed to a representative sample of individuals residing in six states during May/June 2020. The sample included 990 individuals who identified as EWs and 736 nonessential workers (NWs). We assessed differences between EW and NW respondents according to three categories related to health equity and social determinants of health: (1) demographics (e.g. race/ethnicity); (2) COVID-19 exposure risk pathways (e.g. ability to social distance); and (3) COVID-19 risk perceptions (e.g. perceived risk of contracting COVID-19). EWs were more likely to be Black or Hispanic than NWs and also had lower incomes and education levels on average. Unsurprisingly, EWs were substantially more likely to report working outside the home and less likely to report social distancing and wearing masks indoors as compared to NWs. EWs also perceived a slightly greater risk of contracting COVID-19. These findings, which we discuss in the context of persistent structural inequalities, systemic racism, and health inequities within the United States, highlight ways in which COVID-19 exacerbates existing socioeconomic vulnerabilities faced by EWs.