Community

School Started on the First

It’s that time of the year again. Classes at Trego School started on Wednesday, September 1st. The Back to School BBQ will be held on Friday, September 10th.

School enrollment at the start of the school year is nearing 30 students. With a fourth classroom teacher hired, class size averages about 7 students per class (7.25 to be more precise).

The district was able to use part of the district’s ESSR (covid relief funds) to fund the hiring of that fourth teacher, a decision made to help keep class sizes small. While classrooms are still multi-grade, most classrooms hold only two grades.

The official count for this year’s enrollment isn’t actually in- for funding purposes, the count happens only twice a year. The first is in October. If enrollment reaches thirty, the amount of funding the school receives will increase.

Looking at the broader trend, we last discussed Trego School enrollment back in January.

Data as of January 2021

This year’s start of 29 is a bit lower than January’s 31. Not a steep decline, but the trend merits watching.

Community

You Need to Check the Experts’ Math

This offers a perspective on covid survival rates, but screws up some simple statistics:

0-1920-4950-6970+
100.000%100.000%100.000%100.000%
-99.997%-99.98%-99.5%-94.6%
0.003%0.02%0.5%5.4%
100% – Survival Rate= Infection Fatality Rate.

It’s official data.  It purports to be from CDC.  The author implies possession of a MD.

The math is screwed up.  By a factor of 100.  I learned the difference between decimals and percentages in the fifth or sixth grade – this isn’t a mistake at a graduate stats level, or even freshman stats. It appears someone releasing official data screwed up.  We need to check the math even on official data.

This site https://lincolnmtcovid.com/ has local numbers – and you can contrast them against the CDC statistics:

The local numbers show some anomalies when we compare and contrast them with CDC statistics.  The Libby area shows a cumulative 1,190 cases (in a population of 9,772  that’s 12.2%).  North County shows 467 cases (in a population of 6,470 that’s 7.2%) and Troy shows 258 cases (in a population of 3,435 that’s 7.5%). 

Lincoln County death rates can’t be contrasted with the CDC percentages – the tyranny of small numbers makes it impossible.  That said, in the 70+ age range that the CDC figures identify as a (corrected) 5.4% infection fatality rate, Lincoln County’s charts show 24 deaths in 311 cases – 7.8% – 44% more fatalities than national statistics.  The 3 deaths in the 50-69 age range, with 557 total cases work out amazingly close to the national 0.5% infection fatality rate.

There’s not enough data for me to infer causality.  It is good to have local data available – and I do wonder why the infection rate is higher in Libby.  Checking the math when you can is a good idea.

A Science for Everyone, Community

Other Vaccine Effectiveness

I got the Covid vaccine as soon as I could.  I think I might have been vaccinated earlier but for the manner in which the local government picked folks to vaccinate – I wasn’t sitting by the phone when the call came in, and that healthy, outdoors behavior put me a couple weeks later than I wanted.

I’m one of the people who was in line for the polio vaccine – and it wasn’t far out of the experimental stage.  A classmate who is with you in kindergarten one day, then gone, and the dread word polio makes for a willingness to step up for vaccination.  As a kid, I didn’t know that the Salk vaccine was only 65% effective against one strain, and about 90% effective against the others.  Multiplication and division were still challenges back then – but I got the vaccine.

I don’t need a perfect vaccine – the vaccine is to improve my odds.  I get flu vaccinations, and the table from CDC https://www.cdc.gov/flu/vaccines-work/past-seasons-estimates.html shows how that works.   The important part is “Adjusted Overall VE (%)

Table. Adjusted vaccine effectiveness estimates for influenza seasons from 2004-2018

CDC calculates vaccine effectiveness estimates through the U.S. VE Network

Influenza SeasonReferenceStudy Site(s)No. of PatientsAdjusted Overall VE (%)95% CI
2018-19Flannery 2020 WI, MI, PA, TX, WA3,2542921, 35
2017-18Rolfes 2019 WI, MI, PA, TX, WA8,4363831, 43
2016-17Flannery 2019 WI, MI, PA, TX, WA74104032, 46
2015-16Jackson 2017 WI, MI, PA, TX, WA68794841, 55
2014-15Zimmerman 2016 WI, MI, PA, TX, WA93111910, 27
2013-14Gaglani 2016 WI, MI, PA, TX, WA59995244, 59
2012-13McLean 2014 WI, MI, PA, TX, WA64524943, 55
2011-12Ohmit 2014 WI, MI, PA, TX, WA47714736, 56
2010-11Treanor 2011 WI, MI, NY, TN47576053, 66
2009-10Griffin 2011 WI, MI, NY, TN67575623, 75
2008-09UnpublishedWI, MI, NY, TN67134130, 50
2007-08Belongia 2011 WI19143722, 49
2006-07Belongia 2009 WI8715222, 70
2005-06Belongia 2009 WI34621-52, 59
2004-05Belongia 2009 WI76210-36, 40

The important thing is that, in 15 years of data, the best record the vaccine had was 60% effectiveness.  The worst was down to 10% effectiveness.  If I’m playing blackjack, and I can get a 10% edge, that’s good.  If I can get a 60% edge, that’s great.  I don’t expect a vaccine -particularly one that had a rushed development-  to be 100%.

Smallpox was ended with a vaccine that was about 95% effective – “Effective smallpox vaccines have a vaccinia titer of approximately 108 pock-forming units per mL, and more than 95% of individuals develop a ‘take’ with neutralizing antibodies after primary vaccination. “ It’s worth remembering that it took several centuries to develop that vaccine.

Vaccines are more a statisticians game, or a gambler’s science.  Today’s polio vaccine is about as close to 100% effective as you can get.  The vaccines aren’t magic bullets – but they are better bullets.  It may take a while – but I’m betting the Coronavirus vaccines will become increasingly effective.  The problem is that the scientists are working on better vaccines, and politicians and administrators are working on press releases.

Demography

The Excess Death Data is Available from the CDC

The Center for Disease Control has compiled and released the excess death data for 2020 that gives us a better handle on Covid.  The first charts give a bit of a handle on what was happening:

There are a couple of interesting conclusions – first is that about a third of the excess deaths are not due to covid.  The second is that either the virus treats hispanic and black people different than whites, or that there are intervening variables or spurious correlations.  First, let’s look at the charts by age cohorts

They confirm that Covid was a greater threat to older folks than younger – just like the statistics have been showing us. Next, let’s look at the charts by race and hispanic ethnicity:

I’m not real sure about the relationship based on hispanic ethnicity – one of my colleagues qualifies as hispanic, but mostly Apache ancestry.  Gina is hispanic, but both parents were born in Spain.  Heck, genetically I have some Spanish or Portuguese ancestry, and my people otherwise come from Scotland and points north of there.  On the other hand, I’m waiting for the research that explains the extreme deaths in the category.

The lower left chart shows that the disease did not hit the white population so hard – which intrigues me because that is the oldest of the groups.  I’ll be waiting for more data before I make any inferences.

So click the link, read the CDC article, and start wondering – what hit us half as hard as covid at the same time?

Demography

Where Covid Fits in the Demographic Transition Model

The first stage of the demographic transition model includes high birth rates and high death rates – and infectious diseases dominate – for example, the black death was a highly infectious disease that killed millions in Europe – if memory serves, 60% of Venice died, and about a third of Italy’s population.  The 90% fatalities in Constantinople suggests that it was worse in cities.  A time of a life expectancy of around 30 years, because so many died young.  I’m not certain how effective the masks of the time were in combating the disease transmission.

The second stage includes infectious diseases – such as cholera – that could be controlled by sanitation.  Models don’t always fit as well as we would like – at the same time that public health and improved sanitation was getting a handle on cholera, smallpox vaccination was becoming a norm.   It was 1832 when Congress passed the Indian Vaccination Act, ordering the army to vaccinate the Indians.  Typhoid Mary remains in our vocabulary, a woman who showed no outward sign of infection, but spread typhoid wherever she cooked.  In her case, she was basically incarcerated because of her infection (and she kept escaping).  Stage 2 of the demographic transition is characterized by fewer pandemics, and life expectancy may rise as high as 50 years.  Our masking, quarantines and isolation are public health techniques developed in the second stage of demographic transition.  John Snow’s removal of the Broad Street pump handle was very effective at reducing the waterborne cholera transmission.

The third Stage is the stage of degenerative and man-made diseases – picture how cigarettes fit in with lung cancer and heart disease.  Just living longer increases your chances of dying from a degenerative disease.  Infant mortality drops, and life expectancy is pretty much in the mid-fifties.  The public health approach here is to change unhealthy behaviors like smoking while relying on medical research to counteract degenerative diseases.   The term “safe sex” comes from a public health program to reduce AIDS (HIV).  When it works, and it has, we move into the fourth stage of demographic transition.

Stage 4 – where we are in the US today – shows an increase in degenerative diseases, better medical care, and a life expectancy that exceeds 70 years. 

It is no wonder that Covid took everyone by surprise – in Stage 4, we’re used to having pandemics under some form of control – our top 3 causes of death are heart disease, cancer and accidents.  The Corona virus came in with an approach that complemented our stage in the demographic transition model – a pandemic that killed in a relationship to the age of the infected.  Probably the first clue was the word “comorbidity” becoming so much of the vocabulary.  This time we hit a pandemic that worked in combination with the degenerative diseases.  A disease that matches an aging population.  A disease that needed a stage 4 response.  Lacking that stage 4 response, we’ve spent the year responding as we did to diseases during the second stage of demographic transition.

Another Stage 4 pandemic will develop – after all, we have a stage 4 population as an incubator.  We may even develop new strategies for dealing with it.

Community, Demography

The Useable data on Covid

Figuring out the data to use is important.  On May 9, 1864, Union General John Sedgwick said “They couldn’t hit an elephant at this distance” three separate times.  After the third statement, he became the highest ranking Union officer to die in battle.  He was missing a couple relevant pieces of information – first, the Confederates had snipers with Whitworth rifles, and second, at 800 yards, the Whitworths were making 12 inch groups – far smaller than an elephant.

It’s similar with Covid – each of us is like General Sedgwick, not knowing which piece of data is relevant, or even exists.  Some data ties in blood types.  I’m not certain it is data we can use.  Death and age combine to give us the most solid data that we have – and it may be of some use.  Statista provides this information, as of January 9. 2021, for the US.

AgeNumber of Deaths
Under 134
1-421
5-1455
15-24510
25-342,196
35-445,742
45-5415,558
55-6438,830
65-7470,230
75-8490,744
85+105,673

As you look at these numbers, it’s probably worth remembering that over 50 million Americans are over 65 years old – where most of the casualties are.  Soon we’ll have the 2020 census, but until then the 2010 census data is usable – a bit low, but usable.  The tragic loss of 55 kids under 4 comes from over 20 million population in the 0 – 4 age cohort.  The 105,673 deaths of people 85 and over comes from a cohort of 5½ million.

If you want to calculate the years of life lost to covid, the social security life tables are available at: https://www.ssa.gov/oact/STATS/table4c6.html  Still, we’re dealing with big data – and, as I realized when I was being treated for colon cancer, the most important thing about your life expectancy isn’t the number for your age, it’s which side of the median you’re on. 

The data shows that Covid’s deadliness increases with the age of the person it infects.  The data isn’t adequate to show either the probability of being infected or missing the virus.  It’s easy to describe the statistics of the Spanish Flu – but most of the data was compiled and available by 1920.  This article describes how Gunnison, Colorado isolated their way out of the Spanish Flu: Isolation worked well for Gunnison. 

The folks at APM Research Lab have calculated out death rates by race – and their study is worth a look, despite the problem that race is more a social construct than genetically identifiable.  Here’s some of their data (as of January 5).

“These are the documented, nationwide actual mortality impacts from COVID-19 data (aggregated from all available U.S. states and the District of Columbia) for all race groups since the start of the pandemic.

  • 1 in 595 Indigenous Americans has died (or 168.4 deaths per 100,000)
  • 1 in 735 Black Americans has died (or 136.5 deaths per 100,000)
  • 1 in 895 Pacific Islander Americans has died (or 112.0 deaths per 100,000)
  • 1 in 1,000 Latino Americans has died (or 99.7 deaths per 100,000)
  • 1 in 1,030 White Americans has died (or 97.2 deaths per 100,000)
  • 1 in 1,670 Asian Americans has died (or 59.9 deaths per 100,000)
  • Indigenous Americans have the highest actual COVID-19 mortality rates nationwide—about 2.8 times as high as the rate for Asians, who have the lowest actual rates.

Data is data.  There’s not a lot of difference between Latino and White rates. 

Community

Board of Health Meeting: Reports, Vaccines, and more

In a meeting that lasted the better part of three hours, the board of health appointed officers, selected a candidate to recommend to the commissioners for replacing a board member, heard reports and answered questions.

After an hour and forty minutes (when the audience had, admittedly, started to thin substantially), reports began.

Team 56: It’s not entirely clear why Team 56 reports to the health board, or what their precise relationship to the board is. However, it was reported to the board that Team 56 delivered masks to high schools, “spread kindness, not covid” posters, as well as delivered thank you notes and balloon bouquets to the ER staff.

Covid Response Report: Jeff Peterson (yes, this is the same Jeff Peterson that the board recommended the commissioners appoint to the board) reported on the work he’s doing for the county (on contract). It sounds as though most of Peterson’s time has been spent filming videos for the website. The current focus is on frequently asked questions and “translating the science”.

Medical Provider Summary: Provided by board member Dr. Sara Mertes. Many of the first responders have received their first vaccine and the second will be administered soon. The vaccine used was the Moderna vaccine, and they hope to be administering vaccines to the community in the next several weeks.

Covid 19- Vaccinations– The county health department is working with clinics and hospital to put together a central list so that when vaccines arrive, people will be on the list for vaccines. They are prioritizing age and underlying conditions. The public can call the health department to get on the list, and the county will ask only for age and name (though information about a qualifying health condition could be provided). While there is a CDC program people can opt into for tracking symptoms/side-effects, it’s totally optional.

They were very blunt on the current states of vaccines in Lincoln County. They county has no idea how many vaccines we will receive, where they will arrive, or when. We can, however, expect that it will be the Moderna vaccine.

ChemPACK plan– No changes, but the plan is reviewed annually. This is part of the emergency medical counter measure plan. The chempack is a CDC owned cache containing nerve agent antidotes. Board approved the plan.

Liaison (George Jamison, county representative, leaving the board in order to devote more time as a volunteer with the asbestos program ): The PEN regulation– property valuation notification process- was formally adopted last March. One of the provisions was deferment on when it would become effective. This evening’s action item was to make it effective, as of February 1st. This regulation will impact the folks down in the Libby Asbestos Superfund Site.

Health Officer: Dr. Black spoke. He stated that while vaccines are not that far away, it’ll take time to get enough people vaccinated in the community. Dr. Black imagined looking at people’s faces with out masks in 6 or 7 months, but says we won’t be there until we get 80% of people vaccinated. He thinks that a high participation in vaccination will be necessary in order to get back to normal.

At 8:40, Jim Seifert discussed the rating system he’d proposed at the last meeting. He had decided not to put it on the agenda. One reason is that the health department is already overwhelmed and he didn’t want to add to their burden. He says he still believes that if one hospitalization or one death would be prevented, a rating system would be worthwhile. However, implementation would take several months and the vaccine is coming out.

Proposed update to operating procedures– tabled (It’s getting late. The room is cold)

Public Comment:

DC Orr: DC Orr critiqued Dr. Black’s response to someone’s question on vaccine safety (Dr. Black responded to a question by telling the person asking to read the vaccine studies). DC Orr suggests that Dr. Black could present on the topic. He also noted that the board is not familiar with its bylaws and did not follow the rules of order. He suggests they read a handbook on board membership. He then asked why Team 56, not being a governmental unit, was on the Agenda. Quoting Jim Seifert at the previous meeting, he described Seifert’s words as “demonizing” the community and called for him to apologize.

Trista Gillmore: Trista Gillmore, as Lincoln County Public Health Nurse would like to answer people’s questions about mRNA vaccines and provided her email (she may need a few days to answer questions): tgilmore@lincolncounty.org

Diane Watson: Diane Watson noted that the website for the county health department states that it says the public has 7 days to submit questions if they want them discussed at the meeting. She asked when the agenda and minutes would be posted?

The board clarified that the agenda must be posted 48 hours (2 days) in advance of the meeting but will be posted at least the Friday before the meeting). Draft minutes are always posted with the agenda.

While there seemed to be some confusion on how to answer the question (the problem of having to ask questions 7 days in advance of the meeting with the agenda not yet posted). Finally, Jan Ivers (board chair) explained that it is what the board is looking at with revising operating procedure number 2.

With that, the meeting was adjourned. The meeting times have been changed to 6 pm on Tuesdays, the second Tuesday of the month. The next meeting will be February 9th.

Community

Board Member representing 4.7% of County Proposed County-Wide Grading of Businesses on Mask Compliance

How does someone representing 4.7% of the county end up proposing something for the entire county (with 14.3% of the voting power)? To examine that, we’ll look at the County Board of Health. But, if you’re more interested in what Mr. Seifert had to say about giving businesses A/B/C/D ratings, watch the video or read about the meeting!

Is the Lincoln County Board of Health a fair representation of Lincoln County? Are some sections of the county better represented than others? Under-representation has been a common complaint, and with Board Member Jim Seifert of Troy proposing county wide grading of businesses, it’s worth looking at.

Mr. Seifert is the Board Member appointed to represent Troy. In 2010 (alas, no 2020 census data yet) the area he represents had a population of 938. That’s 4.7% of the 19,980 people living in Lincoln County.

If representation on the County Board of Health were distributed evenly, by population, we would expect Mr. Seifert to have 4.7% of the vote. However, as one of a seven member board, he has 14.3% of the vote.

Looking at the Health Board as a whole (using the information available on the county website) we see:

Area% of County PopulationMembers on Board of Health% of Vote on Board of Health
Troy4.7%1 ( Jim Seifert)14.3 %
Eureka5.2%1 (Debra Armstrong)14.3 %
Libby13.2%4 (Jan Ivers, Laura Crismore, Sara Mertes, George Jamison)57.1 %
Elsewhere76.9 %Josh Letcher (West Kootenai) 14.3 %
Locations for members were taken from the phone book when not stated on the county’s website

The Board of Health doesn’t represent the population of Lincoln County evenly. Far more of the vote is associated with “urban” areas than rural.

The Board of Health, with three members designated to represent the urban areas, is designed to unequal in representation. That’s 42.9 % of the votes on the Board of Health going to represent 23.1% of the population!

The remaining board members are one county commissioner and three appointed as county representatives. Could the board be more equal, with respect to the rural areas? Definitely.

But what about regions? Is North county represented fairly? Is it possible for the board to represent the county fairly? Could the board be designed so that it did? Next week!

Demography

Vaccination by the Pyramid

The term “population pyramid” goes back to a time when plotting populations by age really did produce a triangle, with a large base of young people and each older age cohort narrowing, until there were very few at the top.  As diseases became more controlled, and birth control entered the picture, the population pyramids changed shape,  The pyramid below is for the US in 2010.

(Data from http://www.proximityone.com/chartgraphics.htm )

Now, if we look at covid death rates by age cohort, Florida’s governor released survival rates back in September:

The numbers for the age cohorts are below – no need to extrapolate from the bars in the pyramid.  We’ll just take the complement of the survival rates, assume the vaccine is 100% effective, and calculate the potential lives saved in each cohort.

AgePopulationDeath RateLives Saved by Vaccination
70+22.8 million5.4%1,502,967
50-6985.8 million0.5%429,045
20-49127.5 million0.02%2,550
0-1983.3 million0.003%250
The Death Rate is 100% minus the survival rate for each age group. Lives Saved by Vaccination is the population of the age group multiplied by the death rate.

If everyone over the age of 70 were vaccinated (and the vaccine worked perfectly) 1,502,967 Lives would be saved. If everyone under the age of 20 were vaccinated, 250.

No editorializing here – just simple addition and multiplication with data from the census.  I know where I would put the first vaccinations if I had a limited supply.