23 September 2020 — 1056 mdt

Montana's data reporting system is mediocre

Covid-19 is surging out of control in Montana

 Updated  1805 mdt. From March through early June, Montana’s response to the SARS-cov-2 coronavirus was among the nation’s most effective. Now, as the plot below displays, Montana’s new case rate per million persons is rising and is higher than the mean national case rate.

Equally concerning: (1) the Covid Tracking Project, the nation’s best aggregator of Covid-19 test results, gives Montana only a “C” for coronavirus reporting, and (2) the Kaiser Health News, edited by former emergency room physician Elizabeth Rosenthal, reports that Montana does not break out PCR Covid tests from antigen Covid tests.

This plot is complicated because it uses two different methods to smooth the day-to-day differences (caused by turbulence in the reporting system) in the number of new cases.

The 7-day rolling means — the blue lines — are the averages of the last seven days. Simple rolling means are intuitively understandable and widely used. Unfortunately, they are also highly sensitive to outliers.

Therefore, I’ve added LOESS weighted smoothing, a more sophisticated (and computationally intensive) method that is much less affected by outliers. The LOESS lines — red — probably present the more accurate picture of national and Montana trends.

Neither the 7-day rolling means nor the LOESS lines predict future case rates. They simply reduce noise so that the signals about what has happend stand out more clearly.

What accounts for Montana’s upswing in new cases?

Six things, I believe.

First, schools have opened and more people are doing things that carry risks of contracting the virus: but nonessential activities such as football (never a social distancing sport) have not been shut down to compensate for the increased risk from essential activities.

Second, compliance with Montana’s mask-up mandate is spotty and far too low because there is neither an effective enforcement mechanism nor a deterrent level penalty for noncompliance.

Third, after living with the coronavirus for six months, many Montanans seem to have forgotten how dangerous Covid-19 is; that there’s still no vaccine for it, no medicine that cures it. That leads to additional risk taking, sometimes unknowningly.

Fourth, our political and community leaders are delivering mixed messages on Covid-19. Gov. Bullock and his administration, while not aggressive enough on enforcing Montana’s mask-up mandate, take the virus seriously and have acted accordingly.

But President Trump, our Covid Bungler in Chief, has denigrated masking-up, deliberately minimized how dangerous and lethal the virus is, and encouraged his supporters to behave recklessly.

Fifth. Libertarians and some religious leaders, scientific fact notwithstanding, argue that masking-up and social distances are unconstitutional restrictions on personal freedom (they are not).

Sixth. Some business owners, out of conviction or greed, and/or both, are not encouraging their customers to mask-up and compelling their employees to mask-up and to mask-up correctly.

Covid-19 cases in the Flathead are skyrocketing

Until this week, Montana’s highest per capital Covid rates were in eastern and southeastern Montana, especially in Yellowstone, Rosebud, and Big Horn Counties. Now, as reported by the Flathead Beacon’s Andy Vivano and the Daily InterLake’s Kianna Gardner, Flathead County’s Covid-19 count is skyrocketing. They also report the county’s health department is understaffed, overwhelmed, and are losing the struggle to report new cases to the state in a timely manner:

Montana’s Covid-19 reporting system is weak

The Covid Tracking Project, organized by The Atlantic, collects Covid-19 reports from all 50 states, the District of Columbia, Puerto Rico, and two territories. The numbers the project provides are the data used by the New York Times, the Washington Post, and I believe, Johns Hopkins University, for their analyses of the coronavirus.

The project awards grades for data quality. Most states receive an "A" or "B." Here’s the project’s summary for "C" student Montana:

♦ ♦ ♦ ♦ ♦

The project’s report on Montana should be read in conjunction with KHN’s story on the lack of antigen test reporting and the confusion created when reporting entities do not distinguish antigen tests from PCR tests.

Clearly, Montana needs to do better. But Montana will not, cannot, do better until it:

Allocates more money to reporting data. Hire more people, train them better, equip them with good computers and software. If necessary, use emergency powers to transfer to public health all money for high school and college sports.

Discards its public health officials’ prepandemic mindset that patient privacy is a higher priority than fully informing the public. Title II of HIPPA is far more flexible during a pandemic than most realize. Its privacy requirements can be loosened, even waived, to serve the greater good. Other statutes addressing pandemics provide similar flexibility.

There is no reason to release a patient’s medical records, but releasing information that identifies, directly or indirectly, a person as having tested positive for the virus, can serve the greater good without harming that patient. The social opprobrium that attends a case of a sexually transmitted disease does not attend a case of Covid-19.

Public health (and school) officials who refuse to discard, or are incapable of discarding, their prepandemic mindsets, are akin to peacetime generals who fail on the battlefields because they subordinate what’s important in war to things, such as spit-shined shoes, that are important in peace.

Let’s publicly track quarantined and positive people

I would have no problem from a civil liberties standpoint of equipping all persons who have tested positive or are in quarantine with an GPS tracker emitting location signals that would show up as bright red dots on a smartphone app so that the places those people are could be avoided.

Summer’s gone, winter and the flu season are coming on (I got my flu shot last week). Montana must do better, and do better quickly, or it will need to change its nickname from The Treasure State to The Big Covid Distaster State.