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July 13, 2020

Give Us the Damned Facts

Who was patient zero?

We were warned that Spring Break partying in Florida months ago would spread Covid-19 through the nation. Did it? Despite all the contact tracing which is being done (yes, there should be even more), I haven’t seen any study of how often people coming back from Spring Break were patient zero who brought the virus back to their communities. If you’ve seen such a study, please point me to it. If we had clear facts of damage that partying did (assuming there was damage), then there might be less harmful partying now. On the other hand, not seeing the data makes one suspect that the prediction did not come true and reduces the effectiveness of further warnings.

Shortly after there was a huge party or series of parties (I wasn’t invited so I don’t know which) at Lake of the Ozarks. Disapproving TV footage was shown around the world. The behavior certainly looked foolish and reckless. How many infections can be traced to that partying? I haven’t heard and it’s hard to imagine why not. Contact testing of the infected should lead us back to patient or party zero for a particular cluster.

The next major experiment in risk were protests around the nation. Some people said the cause was worth the risk. Others disagreed. The incubation period of C19 is two weeks. Shouldn’t we now know how much attending the various protests increased risk? Correcting for demographics, how much more likely was a protestor to have the virus than a non-protestor? We need this information to shape our future behavior, not just so one side or the other can say “I told you so”.

Then there was Trump’s bust of a rally INSIDE in Tulsa. Logically even more risky than an outdoors event. We heard immediately that some in the Trump entourage tested positive for the virus before or right after the event. But what happened to the attendees? Even though there were far fewer than planned, they didn’t socially distance or keep their masks on. I saw one article on the NY Times saying that cases in rural Oklahoma (where it is assumed Trump supporters came from) were increasing after the event, which is not inconsistent with infection at the event but is hardly proof. In fact, the article says, cases were increasing in these zip codes before the event. Does contact tracing lead back to the event or not? Somebody must know.

It’s unlikely that political bias is leading to suppressing this information. The right would love to attribute increased cases to the protests; the left and perhaps much of the middle would like proof that Trump was wrong to have his rally.

We have solid data that new infectees, on the average, are younger and younger. We know that young people are reckless and like to hang out. Sex and distancing are antithetical. There is strong suspicion that newly opened bars are a nexus for spread among young people. The theory makes sense. But where’s the data? We should be seeing maps of how the virus spread from bar to bar. Where are the maps? More data might persuade more people (not all) to take precautions. More data would make the decision to close bars again more palatable or might show us that they are not as dangerous as would guess they are.  More data might show that some types of bars are more dangerous than others.

Most of the data I’m asking about lives in State Health Departments. One reason they give for NOT releasing more of it is patient privacy. Here in Vermont where there are, so far, very few cases, it might be possible to guess who has the disease if a workplace or bar were named. In ordinary times we try to protect patient privacy; if you’re sick, no one knows but your doctor and Google. These are not ordinary times; we are doing a lot of things we don’t ordinarily do. We need data to guide our decisions even if privacy is compromised.

For example, Vermont has restricted who can visit the state without quarantining. We have among the lowest infection rates in the nation and haven’t had a C19 death in weeks. On a given day we have only one to three people hospitalized with the virus. We have adequate test and trace facilities, at least for our low infection rate. It’s hard to tell to what extent we owe our success to the measures we’ve taken and how much we owe to low population density. In a state highly dependent on tourism dollars, how quickly to allow unrestricted visits is a critical decision. I think our governor and our health department have done an excellent job in the crisis; but I still want to see the data they are using to make their decisions. Our cases pop up in clusters; how often was patient zero in the cluster a tourist, a Vermonter who traveled out of state, or someone apparently infected by a latent pool of asymptomatic infection already in state?

Granted, BTW, that in Vermont data based on very small numbers must be taken with several grains of statistical salt. Nevertheless, our state leaders say that they are responding to the data; I believe them; I’d like to see the data they are using to make these decisions.

Nationwide the reluctance to share data may partially be based on how inconclusive that data is. We obviously don’t understand as much as we’d like to about how the virus spreads and why it often doesn’t when you’d think it should. Our leaders may be afraid that we will make unwise decisions based on incomplete and inconclusive data. Some will. If there were no significant detected increases in cases from the Ozark parties, will people conclude that all partying is OK? Some will. Some may say that outdoors seems safer than indoors. If protesting outside is relatively safe, will we have more protests? Maybe, but that’s a decision we get to make. If the Trump Tulsa rally can’t be shown to have increased infection, will Trump get reelected? I think there are more important reasons why he shouldn’t and won’t. But we still need the data.

Part of the recent intolerance for debate has resulted in the dangerous idea that only “useful” data should be released. “Useful” data is data that gets people to act the way you want them to. For example, two reasons given for the World Health Organization and the CDC not recommending masks earlier than they did are: 1) people might have bought up all the masks that were badly needed by medical personnel; 2) people might have thought that they didn’t have to hunker down if they could just wear a mask. I wear a mask to protect others pending more data on effectiveness. More people would willingly wear masks if they didn’t believe they were being manipulated by selective release of data.

With luck and an enormous amount of work, we’ll have an effective vaccine in six months. We must make sure people take it. I think it should be mandatory. Before we come to that showdown, public trust must be earned back by releasing data whether it is “useful” or not. Give us the damned facts!

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