Not long after the world learned that President Donald Trump had lost his reelection bid, states began issuing a new round of crackdowns and emergency declarations against the surging coronavirus.
Taking action this time were Republican governors who had resisted doing so during the spring and summer. Now they face an increasingly out-of-control virus and fading hope that help will come from a lame-duck president who seems consumed with challenging the election results.
President-elect Joe Biden has promised a more unified national effort once he takes office on Jan. 20, and pressure is building on Congress to pass a new financial relief package. But with record hospitalizations and new cases, many governors have decided they can't afford to wait.
"I don't know any governor who's sitting there waiting for the knight to come in on the horse," said Lanhee Chen, a fellow at the Hoover Institution and a former senior health official in President George W. Bush's administration. "There's no way for these guys to just sit and wait. The virus and the crisis is getting worse hour by hour, day by day."
As new measures trickle out across states, public health policy experts worry many don't go far enough. For those states attempting to impose meaningful restrictions, their success depends on cooperation from a population with pandemic fatigue. And people may be reluctant to curtail their holiday gatherings.
Residents of many conservative states don't acknowledge the depth of the health problem, especially given Trump and some of his allies have stressed the crisis is being overplayed and will end quickly.
The bottom line is that many people just aren't sufficiently scared of the virus to do what must be done to stop the spread, said Rodney Whitlock, a health policy consultant and former adviser to Sen. Chuck Grassley (R-Iowa).
"You're dealing with folks there who definitely put liberty over everything else because they're not afraid enough," Whitlock said. "Even in the face of cases, even in the face of people around them getting it. They're just not afraid."
Among the first governors to act was outgoing Utah Gov. Gary Herbert. The day after The Associated Press called the presidential election for Biden on Nov. 7, the Republican announced Utah's first-ever statewide mask mandate and clamped down on social gatherings and other activities until Nov. 23.
"All of us need to work together and see if there's a better way," Herbert said in a news conference.
Republican and Democratic governors alike followed with measures of their own in Colorado, Iowa, Michigan, Nebraska, New York, Ohio, Oregon, Pennsylvania, Washington and other states. Strategies included partial lockdowns, limits on crowds, canceling in-person classes for schools and reducing hours and capacity for bars and restaurants.
Health policy experts largely agree that the virus's spread, not the end of the election, is what's driving these changes — though the end of the campaign season does take political pressure off governors inclined to issue COVID-preventive policies.
"It's much easier to act when you don't have attention on you than when you do, but I would hope that the action is taking place regardless of what the political circumstances are," Chen said.
No state has yet resorted to the sort of full lockdowns enacted in the spring, which resulted in mass business closures and layoffs and sent the economy crashing.
Christopher Adolph, an associate professor at the University of Washington, and his team with the university's COVID-19 State Policy Project have been studying states' responses to the pandemic. Some states have made a show of taking action, without much substance behind it, he said. For example, Alaska Gov. Mike Dunleavy, a Republican, declared an emergency on Nov. 12 — but only recommended, not ordered, that people wear masks and maintain social distance.
Other governors first took small steps only to follow up with tighter restrictions. In Iowa, for example, Republican Gov. Kim Reynolds, who opposed mask mandates during the presidential campaign, initially announced that all people over age 2 would be required to wear masks at gatherings of certain sizes. On Nov. 16, she issued a simpler but stricter three-week statewide mask mandate.
North Dakota Gov. Doug Burgum, a Republican, also ordered mandatory face coverings for the first time. Hospitals there have been reporting they have more patients than capacity, and the state has been leading the country in new per capita COVID cases.
At the very least, each state should make it clear that people must not gather indoors, Adolph said. Restaurants, bars, gymnasiums and large indoor events should be closed, he said, and gatherings inside people's homes should not happen.
"We're not seeing enough clear, broadly communicated, well-stated, unambiguous policies," Adolph said.
An exception is Herbert, one of two governors who will leave office in January. The two-term Utah governor will turn over the reins to his current lieutenant governor, Spencer Cox, who has been a part of the state's response to the pandemic since the beginning. Both Republicans have promised a smooth, seamless transition between administrations.
The nation's other lame-duck governor is Montana's Steve Bullock, a Democrat. But unlike Herbert, the term-limited Bullock will be replaced by a governor from a different party. Republican U.S. Rep. Greg Gianforte defeated Bullock's lieutenant governor, Mike Cooney, in the Nov. 3 election. And Bullock lost his bid for the U.S. Senate.
Bullock said in a Nov. 12 news conference that he would not take additional COVID-intervention measures without a federal aid package to blunt the economic fallout. Five days later, he reversed himself to expand a previous mask requirement and limit capacity and hours in bars, restaurants and other entertainment venues.
Gianforte has not directly answered whether he would continue Bullock's restrictions. When asked, the governor-elect has spoken instead of personal responsibility and reopening the economy while protecting the most vulnerable people. In July, he referenced the unfounded hope that the virus would be slowed by the U.S. reaching "herd immunity" by the end of the year.
Another obstacle is that a district judge essentially ruled Bullock's mask mandate unenforceable. State health department lawyers had asked District Judge Dan Wilson to enforce the mandate against five businesses accused of flouting the measure.
"The businesses and the owners have been put on the front line of implementing a state policy that has more exceptions than directives and would be about as effective in bailing water from the leaky boat of our present health circumstances as would a colander," the judge said in denying the request.
That leaves Bullock with the task of managing a crisis in his final weeks of office with local officials already looking past him to a new administration.
In Flathead County, where the five businesses were sued for violating the mask mandate, local leaders were already chafing from what they saw as Bullock's heavy hand.
"He has angered a lot of people in Flathead County," County Commissioner Randy Brodehl, a Republican, said of Bullock. "He didn't come here, he didn't talk to us."
Bullock's troubles show that even if governors take measures to stem the spread of COVID-19, they may still have a difficult time persuading people to go along with them. That's particularly an issue in the Upper Midwest and the Rocky Mountains, libertarian-leaning COVID hot spots where the medical infrastructure is already strained.
Some Trump supporters have followed the president's lead in downplaying the virus and others are fatigued after months of isolation and precautions, said Whitlock.
In rural and conservative areas, people protest that COVID measures come at the expense of their personal freedom and their ability to earn a living, and some feel as though they're being talked down to by mask advocates and public health officials, Whitlock said.
It's going to take smart and consistent messaging to change attitudes — but that means more than Biden telling people to wear masks once he takes office, Whitlock added.
"Everybody has to own it," he said. "You have to scream at the top of your lungs at the protests, at the celebrations, at the football games, at the concerts. It has to be, 'Stop it!'"
This article was reprinted from khn.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.