RECAP: Recently, a private citizen provided Dane Undivided with approximately 500 pages of internal PHMDC Data Team meeting minutes from 2020 and 2021. This exposé series focuses one of the most troubling themes uncovered in those documents: the rising rate of breakthrough cases in Dane County, and the reluctance of PHMDC to communicate this reality to citizens in an open and transparent manner.
Part 1: Discusses February through May 2021 and establishes PHMDC's pattern of silence on breakthroughs.
Part 2, Minutes from June 21, 2021, uncovers the PHMDC Data Team's private but growing concern over exponential growth in breakthroughs amongst confirmed cases.
Part 3, below, covers much of July 2021. As breakthrough rates skyrocket, PHMDC is forced to address the issue publicly but remain more concerned about protecting key narratives than coming clean with the public.
Ready? Let's roll...
July 6, 2021
A non-Data Team PHMDC staff member, Ali, has reached back to the Data Team, expressing thanks for receipt of an updated version of the same data table on breakthrough cases initially presented and discussed in the June 21st meeting.
Ali has checked in with PHMDC's COVID investigators. Yes,...they, too, "are seeing a lot of breakthrough infections." The updated table, in fact, now records a 27% breakthrough percentage for the completed month of June, more than two times May's percentage.
Ali poses a series of perceptive questions:
"Does it matter when someone was vaccinated? ... [A]re you more likely to have a breakthrough infection if you were vaccinated in December? From what I've read, there isn't any evidence that the immunity from COVID vaccines wears off over time, but we are wondering if that is what we are seeing in Dane County.
We now know, of course, that a six-month window of efficacy is about the most anyone can expect out of the COVID therapeutics before needing a booster, and that their "protection" potentially comes at a high cost. So, it's interesting to see these investigators putting pieces together, essentially in real time.
Ali asks one last pertinent question:
Would [Variants of Concern] be a confounder? All VOCs except P1 aren't supposed to impact breakthrough.
Dane County's COVID investigators, then, have begun to wonder all on their own if PR assertions about perfect vaccine performance were, well...[fill in the blank]. The Data Team, however, delves no deeper. It instead moves on to other topics.
July 13, 2021
The Data Team finally starts working to get out in front of the growing breakthrough rates. A blog post is mentioned--likely this one, published the following day, in which vaccine efficacy continues to be played up, while the breakthrough problem is minimized. ("Nothing to see here folks. Move along.") The blog post even notes that the CDC no longer tracks breakthroughs--if you can believe that. But, shhhh! Let's not tell anyone that the PHMDC Data Team is secretly tracking breakthroughs...with growing concern.
July 22, 2021
Referencing a page on the Virginia.gov website, the Data Team considers the possibility of adding a "Cases by Vaccination Status" metric to the PHMDC COVID Dashboard:
Helpful in continuing to convey the big picture? Or, adding to communication challenges around base rate bias?
Ah...Transparency or no transparency? THAT is the question! And the answer is...?
Focus on breakthrough disease instead of cases? Put it on the snapshot, not the dashboard. (emphasis theirs)
Breakthrough cases have much less clinical relevance than hospitalizations/deaths.
QI could be more complex because hard to tell if vaccinated people were hospitalized due to COVID. [Data Analyst Brittany Grogan] has done hospitalization QI back to the beginning of May, so that's what could be presented.
So, no transparency, then...and certainly not on the dashboard.
At this point, the Data Team's hesitancy hardly surprises. What's truly rich is the hypocrisy of the justifications the team uses not to visualize breakthrough cases on the single most visible channel they possess for reporting COVID-related data--the dashboard:
Challenges in communicating base rate biases: This excuse probably bears on what's called the "base rate fallacy," in which a more general base rate gets ignored in favor of individuated information (e.g., how the public might stop paying attention to overall cases should PHMDC post specifics about breakthroughs). If my theory's correct, this may be the only time in approximately two years that the Data Team found itself intent on focusing public attention on a low overall summer case rate.
Focus on breakthrough disease, not cases. From Day One of the COVID debacle, PHMDC has emphasized CASES. Yet, when case type suddenly becomes inconvenient, actual disease matters more. Hmmm...
Hospitalizations and deaths have more relevance than breakthrough cases: For nearly two years, voices far more prominent than mine have shouted into the wind that hospitalizations and deaths remain the best gauges of threat level. Yet the Data Team wants to consider breakthroughs only in relationship to hospitalizations and deaths. Never mind that breakthroughs potentially have troubling implications that might bear upon hospitalizations and deaths.
Hard to tell if hospitalizations/deaths are due to COVID: This from a team that for two years has happily complied with CDC guidelines to foster an opaque mishmash by lumping together all things COVID --"by COVID," "with COVID," "possibly COVID." Now they want to draw distinctions...? Will wonders never cease...
July 27, 2021
Running down a list of unaddressed communications items from a meeting the previous day, the Data Team notes:
Haven't gotten questions about breakthroughs, but when we do, stating 44% are breakthroughs is going to be tough.
The problem is getting significantly worse...not better.
Discussion about that 44% ensues--all in the context of communications, of course:
Messaging before have [sic] been "breakthroughs remain rare"--is this still accurate?Why are breakthroughs increasing? Does it mean vaccines are less effective?
Rare? Zoom out population-level. Yes, rare. Vaccinated denominator is the important number. Day to day, less so. It also depends on risk levels--crowded indoor spaces. Places high risk for COVID are also riskier for breakthrough infections. The amount of COVID + Delta has increased the risk picture.
Before we were doing lock downs [sic], masking, etc. otherwise we would have had more hospitalizations and deaths. Need to buy time to not overwhelm health systems until vaccinations. Now we're not doing anything, and cases have remained low.
11 people hospitalized + vaxed is a low number.
If you're vaccinated...do a risk assessment? Is this a message now?
CDC has said yesterday that Ct values are the same for breakthrough and non-breakthrough infections. This means that vax'ed people can transmit most likely. CDC is studying to what degree this is possible.
Highly recommend masking in ?public spaces ?all spaces? High-risk contacts of vaccinated people. Breakthroughs are increasing because of delta. If you have symptoms, you can transmit. Haven't seen an increase in serious outcomes. Purpose its [sic] that me as a vac'ed person doesn't spread to an immunocompromised [person]. Is this a permanent recommendation or based on case levels. Expand potential group of at-risk people to include vaccinated older folks, not just immunocompromised.
July 29th Data Snapshot
Just two days later, we can see how the above dialogue shakes out in practical terms. The Data Team devotes a full page to breakthrough cases in its July 29th Data Snapshot. [NOTE: All 2021 Data Snapshots have been archived into a single PDF link since this post was originally written. I have changed the link accordingly as of 12/22/22. Scroll through the full 2021 PDF to get to the Snapshot in question.] Despite the exponential growth pattern the've been tracking and 44% breakthroughs among July confirmed cases, the team embraces a "breakthroughs-are-rare" approach. The truth is heavily cloaked behind age-adjustments, rates per 100,000, and a colorful but highly misleading double-line graph.
I'll let Eleos cover rate inflation. You and me, let's pay close attention to that line graph.
It's an established expectation that PHMDC Data Snapshots cover the previous two weeks of data, in this case, July 12th - July 25th. Most people looking at this graph will thus assume that's the period this graph represents. However, looking at the fine print along the x-axis tells us that it actually covers the five and a half months from February 7th through July 25. Viewers won't likely notice the dates in tiny print. It's the giant, spiky, blue mountains of unvaccinated cases towering over and across the x-axis that make the visual impression.
Here's the problem...The extended timeline necessarily results in most charted cases being among the unvaccinated...because, for much of the time represented here, MOST OF DANE COUNTY WAS YET UNVACCINATED.
PHMDC points out neither the graph's extended date range nor the impacts of age-adjustment and rates per 100,000 on the two case lines. The admission in the paragraph above that cases are rapidly increasing among both unvaccinated and unvaccinated cases? Well, a picture is worth a thousand words, but a picture of a thousand words isn't worth much. With the graph and the scary rates to dazzle viewers, how many will read closely enough to find what's buried in the text?
Meanwhile, that little orange spike that's started to rise at the right side of the graph...? Barely noticeable, right? And even it is explained away in an unconcerned tone:
"With more than 67% of our population...fully vaccinated, we can expect an increasing proportion of...daily new cases...among people who are fully vaccinated, especially with the highly transmissible Delta variant circulating."
Normal. Expected. Nothing to see here, folks.
Reading between the lines, though, it's a quiet whisper that the COVID shots not only have a failure rate but may not work against variants as advertised. That whisper grows just slightly louder further down the page, as PHMDC admits that vaccinated people can likely spread COVID. But even here the team minimizes and misdirects. Pointing at a wildly deceptive scatter graph (to which Eleos has determined to dedicate an entire upcoming post), PHMDC injects a logical fallacy:
"We can see that there are far more samples from the unvaccinated group--this is expected because unvaccinated people are more at risk of getting COVID."
WHOA! More unvaccinated samples does not necessarily mean unvaccinated people were (or are) more at risk. Perhaps more unvaccinated people just showed up to be tested. No surprise there. At this point most vaccinated people still believed they were fully protected.
Nowhere does this Snapshot include a forthright word about the exponential growth in COVID breakthroughs discussed in Data Team meeting minutes for months. Nowhere does it state the high percentages to which those breakthroughs had risen among confirmed cases. And in no way does it openly give the public a chance to understand and weigh the full potential implications of any such information. Instead, it's all about damage control...maintaining a narrative.
Summing up Part 3
I want to be absolutely clear in my own communication about what what I've shared here: The total number of identified breakthroughs was indeed still relatively low in late July, but as the PHMDC Data Team well knew, breakthrough numbers were growing exponentially among confirmed cases, not remaining flat. By July 2021, the Data Team privately acknowledged that breakthroughs had hit an alarming 44%...in the middle of summer, while case loads relatively low, and 67% of the eligible county population said to be vaccinated.
In point of fact, The Data Team's months-long refusal to share these facts openly with the public reveals a profound ethical failure. Why...? Because what they knew had serious implications concerning the effectiveness, worthiness, and risks of the COVID vaccines. Every Dane County resident had a right to know what the Data Team did...and to factor that information into key health-related decisions, such as whether to:
Receive an initial COVID injection
Complete a COVID injection series
Subject one's children, elderly parents, or immunocompromised family members to COVID injections
Instead, even while it pretended to confront the breakthrough issue, PHMDC kept the public in the dark. Meanwhile, its push to vaccinate continued on, unabated.
Think I'm done? Not even close. More coming in Part 4. Stay tuned...
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