Erie and Niagara counties chose different responses to the Covid surge. The results were mixed

Erie County imposed an indoor mask mandate on Nov. 22, while Niagara County supported a philosophy of personal responsibility.

With the surge now heading in the opposite direction, a look at data from that period shows some difference, notably in deaths per capita. But other metrics present a more complicated picture.

And what numbers do not show is the many other ways in which residents of the two counties are different, with some data suggesting that Niagara County's demographics contributed to worse outcomes.

During the surge period, Niagara County saw 64 deaths for every 100,000 residents, compared with 55 deaths for every 100,000 Erie County residents.

Niagara County leaders say the difference in numbers is small and cannot be attributed to a mandate.

"If you’re looking at the 12-week period that you chose, we had about one more death per week," Niagara County Legislature Chairwoman Rebecca J. Wydysh said. "I would never minimize the loss of life, of course – all those losses were traumatic to our community – but statistically speaking, I don’t see that as a discernible difference."

Daniel J. Stapleton, Niagara County's public health director, agreed.

"I believe that if anybody makes statements or interprets these numbers to say there’s a significant difference in the risk of death from Covid between residents of Niagara and Erie counties, they are misinforming the public," he said.

The data sets do not demonstrate "significant risk" of death, but a comparatively higher risk of death in recent months. Since the start of the pandemic, Erie County's death rate actually supersedes Niagara County's. Since the pandemic started, Erie County has had more Covid-19-related deaths, per capita. For every 100,000 residents, Erie County had 266 deaths, compared with 258 for Niagara County, based on a Buffalo News analysis of recent Census population and state death data.

But this includes the period before wide vaccine availability. Since then, a greater proportion of Niagara County residents appear to have fallen victim to the more contagious Covid-19 variants, particularly the highly transmissible Omicron variant.

A comparison of positive test rates between the two counties offers more of a mixed bag. From Thanksgiving week until Christmas, Niagara County's positive test rate per 100,000 residents was higher than Erie County's, when looking at the data as a seven-day rolling average. But from Christmas through the first week of January, Erie County's surge rose faster and peaked several days sooner than Niagara County's.

Niagara County's post-surge recovery has also lagged behind Erie County's, though the gaps largely closed after mid-January. 

The vaccination factor

In Erie County, 67% of residents are considered fully vaccinated, compared with 65% of Niagara County residents, based on state vaccination and 2020 U.S. Census population figures. A similar gap exists between the two counties when it comes to booster shots.

"At the end of the day, vaccination always trumps everything," said Dr. Thomas Russo, infectious disease specialist for the University at Buffalo's Jacobs School of Medicine and Biomedical Sciences.

While the percentage gap in vaccinations is modest, even a smaller difference can have a larger impact on infections and death rates, given the size of the population, he said.

When it comes to those 65 and older, according to the U.S. Centers for Disease Control and Prevention, both counties have the same vaccination rate of 88%, though booster shots for those 65 and older is lower and shows the same 2 percentage-point gap, with Erie County having the edge.

The fact that older adults have similar vaccination levels suggest other factors are at play when it comes to understanding the comparative recent death rates of the two counties, Russo said. 

Demographic differences

Niagara County residents are older and, by some measures, poorer than Erie County's, according to the U.S. Census. Health experts note that age is a major indicator of vulnerability to severe Covid-19-related illnesses, especially among those who remain unvaccinated.

The median age for a Niagara County resident is 43, five years older than the median age for a resident of Erie County, according to Census figures.

The majority of all Covid-19-related deaths are among seniors. The 2020 census showed that in Niagara County, 19.5% of residents are over 65, compared to 18.4% in Erie County,

Community wealth may be a factor, as well, since that is often tied to health outcomes and access to high-quality medical care. The median annual income for Niagara County is $3,000 less than for Erie County, though Erie County has a higher percentage of residents living in poverty, 13.2% compared with 11.7% for Niagara County.

Both Erie and Niagara counties rank low on statewide county health rankings, though comparatively, Erie County's health index is slightly higher.

Behavior, mandates and access to testing play a part

Other influencing factors may account for differences in health outcomes between the counties. These would include community compliance with health safety recommendations and mandates; easy access to Covid-19 testing and vaccination; and the implementation of other proactive public health efforts.

"Quantitating those is much more difficult," Russo said.

Erie County Health Department spokeswoman Kara Kane pointed to the county's strong access to Covid-19 testing. Erie County leaders generally have touted their public health response efforts.

"We can’t speak to Niagara County data, but for Covid-19 testing, the number of tests performed and availability/convenience of Covid-19 testing could affect the positivity rate and potential differences among counties," she said.

Wydysh said Niagara County leaders have been demanding greater testing access for months so that residents who test positive can take steps to isolate and keep others safe.

"We continually asked for a testing center to be opened here in Niagara County," she said. "I’m glad that we finally got it, but it should have happened sooner."

County differences in political affiliation and the rural-versus-urban landscape may also influence compliance with recommended health safety measures.

Niagara County has a greater proportion of Republicans and rural and suburban residents than Erie County. Studies have found that U.S. residents who consider themselves Republican or live in a rural setting are less likely to comply with public health recommendations for social distancing, mask wearing and vaccination.

Combining these factors, surveys have shown, yields even greater likelihood that government public health measures will be greeted with skepticism over compliance.

However, based on state Health Department vaccination data by ZIP codes, Wydysh noted that Niagara County's least vaccinated areas are in heavily Democratic Niagara Falls.

Differences in a public health mandate philosophy were reflected in how county leaders chose to address the last Covid-19 surge. Erie County Executive Mark Poloncarz has cited the county's mask mandate as a reason for the improving picture there.

Although Niagara County did not follow Erie County in imposing a mask mandate in November, when Gov. Kathy Hochul imposed a statewide indoor mask mandate a month later, it applied to Niagara, as well. Wydysh told The Buffalo News she's not criticizing Poloncarz's approach, but that both Erie and Niagara county leaders did what was best for their own communities.