This is a bit different approach to my usual State of Affairs. While I present current cases, hospitalizations, deaths, and vaccinations, I still try and answer two pressing questions along the way: What is happening in Europe? Are vaccines not working?
Vermont deserves more attention in my opinion. 98% of people >65 are vaccinated. 81% >12 have had at least one dose. It's difficult to get much better than that short of going full Austria.
The low covid deaths (1 per day?) are encouraging, but why are excess deaths increasing in tandem with the case rates?
Vermont averages 106 deaths per week in a normal year. Their cases bottomed out in July, credit given to the vaccine. Since then there has been even more uptake in vaccines, yet cases continue to climb, and deaths have as well. In the month of September the average was now at 144 deaths per week. That is the single highest running 4-week number of deaths pre or post pandemic. I am talking all-cause mortality here, as excess deaths are a great indicator of whether we are counting right.
Since the first week of July total deaths in the state continues to trend above average - 25% more deaths than expected. This is up through October 2nd, as the CDC data lags ~6 weeks. Put another way, in the 14 week period of July 1st - October 2nd there were 1800 deaths in Vermont when there "should" have been just 1400. The week of 9/18 there were a total of 172 deaths, the single highest deaths in a week ever for the state.
The premise that Vermont is seeing 25% more deaths than expected because 1% of the over 65 population isn't vaccinated seems implausible. Meanwhile the lowest vaccinated state, West Virginia, has been close to expected average deaths since April.
What are possible explanations?
- Deaths rising in some other category (accidents, cancer, heart disease, etc) - We won't have this information for quite awhile, we can rule out accidents for now as those have the longest lag and aren't fully represented in the data yet.
- Deaths concentrated in the small number of unvaccinated people under the age of 65, but this seems unlikely given the CFR for Delta is still around the same as Alpha among unvaccinated.
While there are low vaccination rates amongst children , every death of a child makes national news so we would likely hear if dozens of children were dying in Vermont every week.
- Some other illness in Vermont causing the 25% increase in deaths, which happens to have same seasonality as Covid cases. Probably unlikely but cannot rule out.
- The effectiveness of the vaccines was overstated, and closer to our Flu Vaccine efficacy. I know this is considered heresy, but I this feels like the most likely explanation. It would also explain why so many highly vaccinated states and countries continue to see increases in cases and all-cause mortality (California, like Vermont, also seeing a 25% increase in all-cause deaths).
Any other ideas?
Regarding the Spiegel article used for the source, I am also not seeing quite as much correlation with vaccine uptake compared to regionality/seasonality.
Portugal is being used as example of "doing it right" with their 85% vaccination rate. But their cases had already plummeted to less than 700 per day in March 2021, which at that point they had only had <10% fully vaccinated the population. Back then, the credit for the drop was given to vaccinating 10%. They hit their low of 310 cases/day in mid May, but then cases once again started to climb even as vaccines were administered before peaking on July 21st, then steadily dropping once again.
Das Spiegel article using Oct 7th - Nov 7th data to show just how well Portugal is doing. But since that was published, in the 7 days since, cases in Portugal have continued to rise. Are they going to see another wave? Maybe, maybe not.
I love your writing Katelyn, and did the paid subscription as soon as I realized you were on Substack, but I encourage you to weigh competing hypothesis' and scrutinize the data better.
(My all mortality and excess calculations based on these):
Thanks for this post. I noticed you mentioned off-ramps in multiple posts lately. Why is this on your mind? What do you mean when you say off-ramps? How can off-ramps be in the discussion while we remain well-beyond an endemic state with COVID-19?
I still use local case numbers make decisions. < 10/100k per day and I will occasionally eat out indoors during non-peak times with vaxxed friends. <3/100k per day and I won't worry too much about masking. FWIW I'm 65 y.o. otherwise healthy boosted Pfizer.
Attended an indoor, poorly ventilated wedding reception (CO2 > 2000!). Got rapid tested 3 days later after returning home before visiting 85 y.o. in-laws.
As a Vermonter, I will chime in to say that many of us have stood by, increasingly horrified, as our Republican governor refuses to re-implement an indoor mask mandate. Our transmission levels have been well above CDC recommended levels for indoor masking, yet Phil Scott thinks that Vermonters will "exercise personal responsibility" and "do the right thing". In reality, most people are not masking in public indoor settings. I know the hospitalization/death rates are relatively low, but we are really letting the more vulnerable members of our population down and showing exactly what happens when governments don't "follow the science" as Phil Scott once said he would do.
So, is anyone ever going to tell us anything about 0-4 vaccines? How is it ethical to withhold a life-saving preventative from an entire population, half of whom have never lived outside of a pandemic and are too young to mask?
YLE, In my opinion, it is more important than ever to count cases especially when we are frustrated by fuzzy data. As you stated " The bigger question is: How do we use cases to inform policy?" If the data does not appear to make sense as suggested in "State of Affairs: Europe..." you focused on EU surge in cases that appeared to correlate well with vaccination rates. But you also identified outliers and you zeroed in on Germany. Sharpening the focus on regions shed some light on the spike in cases in Germany. And indeed, sub-regional focus may be needed, i.e. small area analysis is important to identify outbreaks, clusters, etc. for effective contact-tracing.
And sometimes when we count cases we are asking the wrong question when trying to establish causation. For example, the surge of cases in the EU was a little surprising to me when considering how advanced the EU and member countries were at digital documentation of vaccination or recent negative Covid -19 test result that was part of a digital "passport." But much to my surprise, I recently learned that "recovered from Covid-19" i.e. natural immunity qualifies for being Covid-protected on the EU Digital Covid Certificate.
That indeed raises a number of other important questions - that requires counting cases. And in the U.S., this requires more testing and more genetic sequencing. And yes, better data will inform better policy.
Have you heard anything about the possibility of boosters for kids 12+? For those who got vaccines as soon as they were approved, they are looking at 6 months in very early December. I haven't heard even a whisper about boosters for this age group.
Although supposedly the teens had a more robust response to the vaccines than adults, I would still think that if protection wanes over time, it wanes for everyone. I would really like to see the teenagers have as much protection as possible and I am curious about timing of a booster for this group.
Thank you so much for this. You spell it out very succinctly. If I had a dollar for every person I had heard say that vaccinated people are spreading the virus, I would be rich. Yes, vaccinated people CAN spread the virus, but your numbers show that it is still the unvaccinated that we need to be concerned about. I am glad we have the booster and that people are getting it, but I really want the holdouts to get their first vaccine. Now if only I can get people to read your column!
Vermont deserves more attention in my opinion. 98% of people >65 are vaccinated. 81% >12 have had at least one dose. It's difficult to get much better than that short of going full Austria.
The low covid deaths (1 per day?) are encouraging, but why are excess deaths increasing in tandem with the case rates?
Vermont averages 106 deaths per week in a normal year. Their cases bottomed out in July, credit given to the vaccine. Since then there has been even more uptake in vaccines, yet cases continue to climb, and deaths have as well. In the month of September the average was now at 144 deaths per week. That is the single highest running 4-week number of deaths pre or post pandemic. I am talking all-cause mortality here, as excess deaths are a great indicator of whether we are counting right.
Since the first week of July total deaths in the state continues to trend above average - 25% more deaths than expected. This is up through October 2nd, as the CDC data lags ~6 weeks. Put another way, in the 14 week period of July 1st - October 2nd there were 1800 deaths in Vermont when there "should" have been just 1400. The week of 9/18 there were a total of 172 deaths, the single highest deaths in a week ever for the state.
The premise that Vermont is seeing 25% more deaths than expected because 1% of the over 65 population isn't vaccinated seems implausible. Meanwhile the lowest vaccinated state, West Virginia, has been close to expected average deaths since April.
What are possible explanations?
- Deaths rising in some other category (accidents, cancer, heart disease, etc) - We won't have this information for quite awhile, we can rule out accidents for now as those have the longest lag and aren't fully represented in the data yet.
- Deaths concentrated in the small number of unvaccinated people under the age of 65, but this seems unlikely given the CFR for Delta is still around the same as Alpha among unvaccinated.
While there are low vaccination rates amongst children , every death of a child makes national news so we would likely hear if dozens of children were dying in Vermont every week.
- Some other illness in Vermont causing the 25% increase in deaths, which happens to have same seasonality as Covid cases. Probably unlikely but cannot rule out.
- The effectiveness of the vaccines was overstated, and closer to our Flu Vaccine efficacy. I know this is considered heresy, but I this feels like the most likely explanation. It would also explain why so many highly vaccinated states and countries continue to see increases in cases and all-cause mortality (California, like Vermont, also seeing a 25% increase in all-cause deaths).
Any other ideas?
Regarding the Spiegel article used for the source, I am also not seeing quite as much correlation with vaccine uptake compared to regionality/seasonality.
Portugal is being used as example of "doing it right" with their 85% vaccination rate. But their cases had already plummeted to less than 700 per day in March 2021, which at that point they had only had <10% fully vaccinated the population. Back then, the credit for the drop was given to vaccinating 10%. They hit their low of 310 cases/day in mid May, but then cases once again started to climb even as vaccines were administered before peaking on July 21st, then steadily dropping once again.
Das Spiegel article using Oct 7th - Nov 7th data to show just how well Portugal is doing. But since that was published, in the 7 days since, cases in Portugal have continued to rise. Are they going to see another wave? Maybe, maybe not.
I love your writing Katelyn, and did the paid subscription as soon as I realized you were on Substack, but I encourage you to weigh competing hypothesis' and scrutinize the data better.
(My all mortality and excess calculations based on these):
2014-2019
https://data.cdc.gov/NCHS/Weekly-Counts-of-Deaths-by-State-and-Select-Causes/3yf8-kanr
2020-2021
https://data.cdc.gov/NCHS/Weekly-Provisional-Counts-of-Deaths-by-State-and-S/muzy-jte6
Thanks for this post. I noticed you mentioned off-ramps in multiple posts lately. Why is this on your mind? What do you mean when you say off-ramps? How can off-ramps be in the discussion while we remain well-beyond an endemic state with COVID-19?
I still use local case numbers make decisions. < 10/100k per day and I will occasionally eat out indoors during non-peak times with vaxxed friends. <3/100k per day and I won't worry too much about masking. FWIW I'm 65 y.o. otherwise healthy boosted Pfizer.
Attended an indoor, poorly ventilated wedding reception (CO2 > 2000!). Got rapid tested 3 days later after returning home before visiting 85 y.o. in-laws.
As a Vermonter, I will chime in to say that many of us have stood by, increasingly horrified, as our Republican governor refuses to re-implement an indoor mask mandate. Our transmission levels have been well above CDC recommended levels for indoor masking, yet Phil Scott thinks that Vermonters will "exercise personal responsibility" and "do the right thing". In reality, most people are not masking in public indoor settings. I know the hospitalization/death rates are relatively low, but we are really letting the more vulnerable members of our population down and showing exactly what happens when governments don't "follow the science" as Phil Scott once said he would do.
So, is anyone ever going to tell us anything about 0-4 vaccines? How is it ethical to withhold a life-saving preventative from an entire population, half of whom have never lived outside of a pandemic and are too young to mask?
YLE, In my opinion, it is more important than ever to count cases especially when we are frustrated by fuzzy data. As you stated " The bigger question is: How do we use cases to inform policy?" If the data does not appear to make sense as suggested in "State of Affairs: Europe..." you focused on EU surge in cases that appeared to correlate well with vaccination rates. But you also identified outliers and you zeroed in on Germany. Sharpening the focus on regions shed some light on the spike in cases in Germany. And indeed, sub-regional focus may be needed, i.e. small area analysis is important to identify outbreaks, clusters, etc. for effective contact-tracing.
And sometimes when we count cases we are asking the wrong question when trying to establish causation. For example, the surge of cases in the EU was a little surprising to me when considering how advanced the EU and member countries were at digital documentation of vaccination or recent negative Covid -19 test result that was part of a digital "passport." But much to my surprise, I recently learned that "recovered from Covid-19" i.e. natural immunity qualifies for being Covid-protected on the EU Digital Covid Certificate.
https://ec.europa.eu/info/live-work-travel-eu/coronavirus-response/safe-covid-19-vaccines-
europeans/eu-digital-covid-certificate_en
That indeed raises a number of other important questions - that requires counting cases. And in the U.S., this requires more testing and more genetic sequencing. And yes, better data will inform better policy.
Alan Brownstein
Cold Spring, NY
Additional information updated daily: https://www.worldometers.info/coronavirus/country/us/
Hello, Dr. Jetelina:
Have you heard anything about the possibility of boosters for kids 12+? For those who got vaccines as soon as they were approved, they are looking at 6 months in very early December. I haven't heard even a whisper about boosters for this age group.
Although supposedly the teens had a more robust response to the vaccines than adults, I would still think that if protection wanes over time, it wanes for everyone. I would really like to see the teenagers have as much protection as possible and I am curious about timing of a booster for this group.
I'd love any insight you have on this. Thank you!
Thank you so much for this. You spell it out very succinctly. If I had a dollar for every person I had heard say that vaccinated people are spreading the virus, I would be rich. Yes, vaccinated people CAN spread the virus, but your numbers show that it is still the unvaccinated that we need to be concerned about. I am glad we have the booster and that people are getting it, but I really want the holdouts to get their first vaccine. Now if only I can get people to read your column!