The most strongly Republican areas of the country are sparsely populated which should make it harder for a virus to spread, but despite this a higher and steadily growing percentage of COVID-19 deaths are suffered in counties where Trump did especially well when compared to the densely populated counties that were friendliest to Joe Biden. David Leonhardt, who has been tracking these results for the New York Times, says that October showed the worst disparity yet.

The gap in Covid’s death toll between red and blue America has grown faster over the past month than at any previous point.

In October, 25 out of every 100,000 residents of heavily Trump counties died from Covid, more than three times higher than the rate in heavily Biden counties (7.8 per 100,000). October was the fifth consecutive month that the percentage gap between the death rates in Trump counties and Biden counties widened.

There is a simple explanation for this: “almost 40 percent of Republican adults remain unvaccinated, compared with about 10 percent of Democratic adults.”

At this point, the Republican Party has grown so skeptical of vaccinations that they’re attacking Sesame Street’s Big Bird for giving the same pro-vaccination message he’s been providing since 1972. The Orlando Sentinel reports that Florida “pediatricians are worried that pandemic disruptions and vaccine politicization could threaten progress against measles, whooping cough and other illnesses once thought to be nearly eradicated.” And it’s a national problem.

Health Department statistics illustrate the drop-off. Vaccination coverage for 2-year-olds served by county health departments fell from 93.4% to 79.3% during the pandemic. A state official called the 14-point drop “alarming” in a June memo.

The insurance company, Blue Cross Blue Shield, sounded the alarm nationally, reporting 40% of parents and guardians it surveyed in 2020 said their children missed vaccinations because of the pandemic.

With schools closed or remote-only, and parents reluctant to make doctor’s visits, it’s understandable that a lot of kids didn’t get vaccinated during the first year of the pandemic. But an increased (and partisan) level of vaccine avoidance is going to stick with us now for a very long time, and it could get worse.

The Republicans decided that vaccination mandates are tyrannical and it’s their patriotic duty to defend freedom by resisting. This is a simple legacy of Trump’s decision to treat the COVID-19 pandemic as a political threat rather than a public health crisis. The more he was justly attacked for his handling of the crisis, the more his supporters sought to defend his rhetoric and his actions, and to see expert advice as a partisan effort to undermine Trump’s reelection chances. Science and medicine became their political foes.

Conservatives have always struggled with the concept of collective sacrifice and collective action. In their minds, society is composed of atomized individuals who succeed or fail entirely through their own effort and merits. It’s difficult for them to embrace the idea that you might get vaccinated less to protect yourself than to protect your neighbor. But until Trump and COVID-19 came along, they seemed to be fine with schools mandating vaccinations for things like measles and mumps.

As Leonhardt points out, the worst of the pandemic may be over. Promising new antiviral treatments from Pfizer and Merck should reduce the death rate, especially for the unvaccinated, so the disparity in COVID-19 mortality between Trump and Biden counties may go away. But we’ll probably see a persistent gap in childhood vaccinations for other diseases.

If Trump had treated the outbreak of COVID-19 like a rational person, this would not have occurred. Now the damage is permanent.