With an apparent U-turn on case levels, although I am still suspicious about testing and data issues, I assumed the briefing this week would be dire and foreboding, and it didn’t disappoint. The commissioner opened with an extended monologue about how bad things are looking. It is interesting how incapable of learning the people, from the Governor and Commissioner on down, in the state responsible for the epidemic are. Here is the essence of the briefing–be afraid, be afraid, be afraid. Be guilty, guilty, guilty, shamed, shamed, shamed that you aren’t doing your part to protect others. Vaccinate, vaccinate, vaccinate and pay no attention to that man behind the curtains indicating that breakthrough events are driving current cases, hospitalizations and deaths. And when all else fails, mask, mask, mask.
And they wonder why people are done with all this. They have no credible understanding of the epidemic and no credible plan for how to deal with it rationally. But I give them credit for trying to interject some humor into the briefing, even if unintentionally. The commissioner said they were committed to giving accurate and transparent data. Took me a while to stop rolling on the floor. They have to be beaten over the head to provide even the most basic data on very important topics like breakthroughs and reinfections and we get nothing meaningful on what really drives hospitalizations and death attribution.
And since we are headed into another holiday season, Kris Errorsperson had to deliver a lecture on how little fun we should have and whether we should even think about getting together. Expect holiday grimness for weeks. Jeremy Olson pushed hard on the breakthrough data and whether this is really an epidemic of unvaxed, but he just was met with complete evasiveness. We did hear that the vaxed have to do more to protect themselves and others. We heard blaming on Delta, which is not true. We would be seeing the same wave with any other variant. We heard that people who aren’t vaxed have no protection, which isn’t true if you have been infected and a lot of Minnesotans who aren’t vaccinated have been.
We got concerns about hospital capacity, but no mention of vaccine mandates for hospital workers that are a major cause of staffing limitations. I have also heard from health care professionals working at hospitals that it isn’t the number of patients, but ridiculous CV-19 protocols that cause problems. And finally, in response to a question we learned that the DOH has a little humility, there was acknowledgment that no one really understands why waves occur in certain places at certain times. Now if you could just take that next step and acknowledge that there probably is very little we can do about those waves, including apparently vaccinating high proportions of the population. So let’s move on.
I think people are just stunned to realize that a very substantial proportion of events now are in the fully vaxed. And I want to be very careful to say that just because this is true, doesn’t mean vaccines aren’t working or beneficial in containing the effects of epidemic. You have to consider carefully what data tells you and looked at in different ways it tells you different things. Dave Dixon and I are very cognizant of this and try to present multiple analyses and put them in context. We are obviously limited in what we present to the data we are given by the state or can force them to release. And methodologically, the most important thing is to always, always be sure you are identifying all variables which may impact the outcome of your analysis.
In the context of breakthrough events, all we were initially given was data by date of report. Since that is all we had, we could only focus on comparing the breakthrough events reported to all events reported in the same time period. We tried to guess about relative lags in reporting, but we really had no good sense of that. Then about a week ago the DOH indicated that the lag was roughly four weeks and we were able to give a better sense of actual proportion of events over time. That was startling, not just for the percent of events that were among the fully vaxed, but how it was growing over time. Finally we got some information with actual dates of events, although it is as yet incomplete, and we got some age data, which is critical. More analysis to come.
The look at proportions of events really has very limited value. It serves mostly as a check on the notion that this is an epidemic of the unvaxed. Far more revealing are case rates–what proportion of breakthrough cases result in hospitalization or death and compare those to non-breakthrough case rates. And this should ideally be broken down by age. This helps understand vaccine effectiveness and since age is obviously such a factor in serious disease, you can understand vaccine effectiveness by age group.
Per capita rates or rates of events in a given population are also important. So comparing rates in the vaxed and unvaxed populations, comparing rates in various age groups, comparing across vaccines, this has tremendous utility in understanding vaccine effectiveness and epidemic trends. Variation in those rates over time is also important. And one very important and usually missing piece in analyses of vaccine effectiveness is the role of time since last dose. Ideally you would have that variable for every person. The same is true in trying to compare the effect of prior infection.
So what I would love to have, and DOH has every bit of this data or can easily access it, is a master spreadsheet that for every person has their age; if vaxed, the date of each dose and vaccine received; if ever infected, the date of infection, and for each infection in the person, the date of that infection (to detect reinfections and breakthroughs); whether the person was hospitalized and when for each hospitalization in the person; and whether they died and when. With that spreadsheet you could calculate relative risks on a days of exposure basis and you could do all the case rates and per capita rates. So, we have demanded that DOH provide that. If, as the Commissioner said, they were really committed to data accuracy and transparency, they would have provided this information from the very start.