As Death Panel podcast prepares to record "Covid Year Four," co-hosts Beatrice Adler-Bolton, Artie Vierkant, and Abby Cartus discuss what is left of national covid data following the end of the public health emergency, how what's left has become so thoroughly abstracted, and how the CDC prioritizes representing deaths as an abstract percentage even as the official death count has been over 1,000 a week since August.

Find the NVSS data sheet mentioned early in the episode here: www.cdc.gov/nchs/nvss/vsrr/covid19/index.htm

Transcript by Kendra Kline. (Kendra is currently accepting freelance transcript work — email her if you need transcripts!)

Death Panel 0:00
[ Intro music ]

Beatrice Adler-Bolton 0:32
Welcome to the Death Panel. To support the show, become a patron. We are entirely listener supported and couldn't do any of this without you. So thank you. So if you'd like to become a patron, you can do that at patreon.com/deathpanelpod. We do two episodes a week and the Monday bonus is the thank you just for patrons. And if you'd like to help us out a little bit more, share the show with your friends, post about your favorite episodes, pick up a copy of Health Communism at your local bookstore, pre-order Jules' new book coming in January, called A Short History of Trans Misogyny, or request them both at your local library, and follow us @deathpanel_.

So today, I am not feeling awesome. Just a heads up. I'm chronically ill, as some of our listeners may know, and I've been on this like one medication for my disease for over a decade, until this April when my insurance denied it. So this is now month nine of not having access to my meds.

Artie Vierkant 1:28
God.

Beatrice Adler-Bolton 1:28
Yeah. My body is a bit of a mess and such a mess, actually, that I finally have proof of my disease because I got so sick while they were denying my medication that finally my bloodwork biocertified me. Yeah, I've got my biomarkers now. So you know, I'm — my equilibrium is off. I'm flaring right now. But today is a really important episode. So I wanted to be here anyways, but apologies if I'm a little loopy. Fortunately —

Artie Vierkant 1:58
You always say that and then —

Abby Cartus 2:00
And you're always fine.

Artie Vierkant 2:00
No one could possibly tell. That is the benefit of an audio medium, I suppose.

Beatrice Adler-Bolton 2:04
That is, that is. I mean, if we had to be on camera for the show, everyone would definitely know. But —

Abby Cartus 2:10
[laughing] No.

Beatrice Adler-Bolton 2:11
Fortunately, my two amazing co-hosts, Abby and Artie are here today. This is, again, a really important episode about what is going on with COVID right now and the social construction of knowledge using data and data visualization. So joining me today are my co hosts, Artie Vierkant.

Artie Vierkant 2:28
Hello.

Beatrice Adler-Bolton 2:28
And of course, this episode truly could not happen without the one and only Abby Cartus.

Abby Cartus 2:33
[laughing] Hi.

Beatrice Adler-Bolton 2:34
So, you know, I've warned you all that I'm not feeling well today. But you know, I'm setting that aside and want to be here sort of regardless of how I feel, because what we need to talk about today is really super important, not just for the sick people like me, but for all of us, because COVID is a problem for every one of us still. Ironically, it's especially a problem for people who think it's no big deal. But anyways, we are heading into winter. And as we have covered on the show many times in the past, while COVID is not a seasonal disease - it circulates year round - winter typically so far has been the worst time of year for mortality. So while the official figures of COVID deaths right now might not be as shocking or extreme as in past years, what we're going to talk about today is how that official number is really constructed. And what, if anything, we kind of know about what's going on with COVID deaths right now.

Artie Vierkant 3:30
And how completely abstracted it's become.

Abby Cartus 3:32
Mhm, mhm.

Beatrice Adler-Bolton 3:32
Yes, yes. As we've been preparing for COVID Year Four, the latest in our annual pandemic year in review series, coming out first for patrons on Monday, December 11th, we've had to grapple with a very difficult question, which is what data on COVID is even still reliable. With so much dismantled, with so little to work with, what do we actually even know right now? And what are we, for lack of a better word, sort of engaged in an elaborate game of like public make believe around right now? You know, these kinds of like fantasies of surveillance that we've talked about pale in comparison to the actual public health data collection and reporting that we're working with in the real world. Since the end of the public health emergency, the CDC no longer calculates its two competing COVID transmission metrics, the confusingly named Community Transmission level, and Community level system that we've talked about many times. That was the red map that got turned sherbert, so —

Artie Vierkant 4:30
Or pastel, depending.

Beatrice Adler-Bolton 4:30
Or pastel, yeah. We'll talk about that in this episode. And really, we're sort of, you know, entering uncharted territory. It's more like a 2020 re-do, but this time we're intentionally going into a COVID winter with like no picture of what's going on. The CDC still collects death data, though slower and patchier than before, which we're going to talk about. And I think I've even mentioned this on mic before, how this has been something that for me has been really confusing, but when you look at most of the public facing materials for the CDC, it's now mostly reporting deaths as this percentage change week on week number. So we're gonna get into that in detail. And I think twice, Abby, I've already begged you to walk me through this today, but we're going to go further. And of course, as we'll also talk about today, you know, this episode is being recorded and released in early December 2023. And about a week ago, the CDC released a new map. Oh boy, yes, they made the new map again.

Abby Cartus 4:36
[laughing]

Beatrice Adler-Bolton 4:45
And in this one, they did finally put up a national wastewater dashboard. But the catch is that, well —

Artie Vierkant 5:26
It's all blue.

Beatrice Adler-Bolton 5:41
Yeah, this map shows the entire country in shades of calming blue, even for the highest case counts. And it's also not like a ton of new data collection points have been added. So yeah, it's a whole thing. So today, in some ways, is a sort of preamble to COVID Year Four. We're going to talk about what we know. But mostly actually, we're gonna talk about what we don't know, and what COVID data actually still exists now. You know, what's really important to understand is that again, over the last few years, the federal government in the United States has made the COVID data picture more and more abstract. And we need to, I think, start by talking about how many people are actually dying a week right now in the official count. It's been about 1,000 COVID deaths a week in the US since August. And since part of what we're talking about today is like the inability to have some material sense of where COVID is, and how that's been constructed, like I think starting with where are we actually at right now is really important.

Artie Vierkant 6:43
Yeah. So as Bea said, as many of you, I think, will know, we have COVID Year Four coming up. I've been working on this for a few weeks already. And if all goes according to plan, as Bea mentioned, we'll have this up in the patron feed on Monday, Monday, the 11th. And this year, I think felt a little different to prepare for though. I don't think it's a spoiler to say that a lot of the story we're going to be walking through in COVID Year Four is to sort of look back at the last year of the COVID response as essentially how the Biden administration sort of shut the lights off on almost everything, you know, abstracted where it could and stopped certain things like data collection, that Bea mentioned, where it could. And then so there's this really key part of that, right, that Bea is mentioning, which is the data picture. So we kind of decided to spin that into its own informal discussion, which is this, today. So as Bea mentioned, we're going to talk like a little bit through the data, in part because COVID Year Four is already packed with events and policy shifts. I'll trust you guys to, for instance, not spoil for Phil and Jules, but my notes for Covid Year Four are already over 20,000 words, so I'm not sure what I'm going to do with that.

Beatrice Adler-Bolton 7:53
Oh my god [laughing].

Artie Vierkant 7:54
So in any case, you know, as Bea is mentioning, as I was preparing for it, I was — we had this question, right? Like, fuck, what the fuck do we even know about COVID anymore? Not in the sense of COVID itself. Obviously, we know it's still bad. We know it's killing and disabling a lot of people. And that basically it's all over the place. But we used to have more numbers for this and more kind of metrics. And I'll acknowledge, obviously, I think this has to be said too, you know, we've never known how much Long COVID either, like, we — except that there are — you know, there are various different studies with, you know, different good guesses that you can find, that make it clear that there are a lot of people, quite a lot, I mean, millions of people with Long COVID. But you know, that's like the biggest question mark, always, of all of us, it sort of always has been. But there are things that we used to be much more clear on. And I think, you know, most emblematic of this sort of data shift is if you go to the CDC website right now — we'll talk about the wastewater stuff in a minute, because that blue map is offensive. The blue part is especially offensive, I suppose. The fact that — like, it's good that there's a wastewater map, but like, it's all blue, so I don't know what to tell you.

Abby Cartus 9:00
Pick a better color ramp.

Artie Vierkant 9:02
But I think most emblematic of this kind of data shift is that if you go to the CDC website right now, the main public facing information for things like deaths and hospitalization shows percentage changes week on week. And so, you know, for instance, if I go to CDC's website right now, I can see that weekly hospitalizations are a full 10% higher than they were the previous week, up to about 20,000 people hospitalized for COVID each week, which is a lot. But that's something, you know, we can kind of click through and even in the most public facing information, you can click through and find it. Similarly, you can see that deaths are up 2.5%. But like, what does that mean?

Beatrice Adler-Bolton 9:41
Yeah, like from what?

Artie Vierkant 9:43
Like seriously, what the fuck does that —

Beatrice Adler-Bolton 9:44
Well, and you can't compare it to the early points in the pandemic, most importantly, like —

Abby Cartus 9:47
Right, they don't have the previous weeks, and they don't have the numbers associated with previous weeks. So it's like, oh, last week, it was up 3%, and this week, it's up 2% from whatever the number was last week.

Artie Vierkant 9:59
There's like not even a complicated graph. There's like an arrow with no —

Abby Cartus 10:03
There's an arrow that's pointing down.

Artie Vierkant 10:05
Right [laughing].

Beatrice Adler-Bolton 10:06
What better administrative burden than before you can look at this and understand where COVID deaths are, you have to sit down and do some math.

Artie Vierkant 10:13
Right. But so I just want to — I just want to pause here with this note, which is, you know, one of the reasons I'm saying this is because if you've heard COVID Year Three, for example, you'll know that in that year in review, which was us looking back at 2022, one of the things I did every month was shout out the death figures, including breakthrough death percentage of those that we had information for, by the way, which that dataset has — there's no information for 2023 anymore. So you know, I wish — I wish I could have that information to say for COVID Year Four, but I just won't. But you know, that —

Beatrice Adler-Bolton 10:46
They nerfed us this year.

Artie Vierkant 10:49
I mean, yeah, basically. But you know, my question for you is basically, can you imagine if I had simply said at the end of every month in COVID Year Three, okay, so January 2022, deaths were 7% higher than they were in December. Like that means fucking nothing, you know what I mean?

Beatrice Adler-Bolton 11:03
It means nothing. Dematerialized.

Artie Vierkant 11:05
But, what we're getting to, and this is really important, Bea mentioned this also at the top, you know, that — all that being said, the CDC does still produce deaths data, actually. So not only are we going to be sharing these, we also are going to — I'm gonna read these in COVID Year Four also, but I'm gonna read them sort of like for certain months in that episode, and here, I'm gonna — we're gonna kind of have a concentrated conversation about it for the main feed. But basically, the CDC does still collect and produce and put out publicly, a data set of COVID deaths, but not in such a way where you would know it, right. They don't highlight this. It's difficult to find. I'll throw to you, Abby, in a second, and you can tell us like the process that you went through, you know, what you think about all of this, since you're the one who found this even. But, you know, basically, because it's so buried, I'm going to do the rather unusual step of in the description of this episode, there is a direct link to the CDC NVSS, National Vital Statistics — is that what it's called, National Vital —

Abby Cartus 11:06
Mhm, National Vital Statistics System.

Artie Vierkant 11:09
Yeah, National Vital Statistics System Data Sheet for COVID deaths. I'm gonna link to that in the episode description. I will also do that for COVID Year Four too, so if you've, you know, been wondering where to find the actual number of COVID deaths that the CDC is reporting, not some weird percentage change week on week bullshit.

Abby Cartus 12:30
With an arrow pointing down [laughing] even though.

Artie Vierkant 12:32
Right. Here's your URL right there in the episode description.

Beatrice Adler-Bolton 12:38
We don't normally link to spreadsheets.

Artie Vierkant 12:41
Right.

Abby Cartus 12:42
[laughing] I don't know why the hell not.

Beatrice Adler-Bolton 12:44
Fair.

Artie Vierkant 12:44
And, you know, so that'll be there unless the CDC changes the URL, in which case, if you're listening to this in the future, and they've done that, I don't know what to tell you except for, it probably proves the points we're going to be talking about later in the episode [laughter].

Beatrice Adler-Bolton 12:58
They've nerfed us again, y'all.

Artie Vierkant 13:00
But so really quickly, let me just go through — just at the top, I want to make sure that we talk through these death numbers really quick. So again, we're going to talk a lot more in a minute about how these are calculated. Some of the ways that these could possibly be either an undercount, or at least we know that there are kind of holes in the reporting. Some states have like really weird uneven reporting about this. And we know the requirements are different. So I'll just say, you know, again, we're sticking, sticking pretty safe here. We're just saying this is what the CDC is reporting. And so just as sort of a preamble, because the CDC buries these behind a percentage change indicator, you know, again, I would be surprised if many people, even among some of our listeners, are aware that after sort of a brief dip below 1,000 deaths a week by the official count, we have been above 1,000 deaths a week, again, every week since August. And I'll note, if you're looking at this NVSS data sheet, while I'm talking about this, on — you know, if you've pulled it up or something while I'm talking, as we'll talk about in a second, these data lag, especially compared to the method where we used to get death information. So if you're looking at like the most recent two weeks, those tend to be lower, and then they get updated over, you know, a couple — a couple of weeks later, so.

Abby Cartus 14:19
Yeah, it's provisional — it's what's called provisional death counts, so. Yeah.

Artie Vierkant 14:22
Right. But so in fact, the lowest recorded death figure of all year came the week of July 8th, where the CDC reported 488 COVID deaths that week. As I mentioned, though, since August, we've had over 1,000 COVID deaths a week in the US, so I'm just going to read those out.

• The week ending August 26th, there were 1,037 COVID deaths.

• Ending September 2nd, 1,170 deaths.

• The week ending September 9th, 1,290 deaths.

• September 16th, 1,378 deaths.

• September 23rd, 1,385 deaths.

• September 30th, 1,409 deaths.

So all told, that's about 5,462 deaths in September.

• The week ending October 7th saw 1,339 deaths.

• The week ending October 14th saw 1,268 deaths.

• October 21st, 1,311 deaths.

• October 28th, 1,228 deaths.

For about 5,146 deaths in October. And I'm only going to read sort of the two most recent weeks for November that we have data for that appears to have been more tabulated, but so:

• Week ending November 4th, 1,143 deaths.

• Week ending November 11th, 1,190 deaths.

So, you know, I think it's safe to say, you know, I think this is kind of what I assumed was going on, although I think the fact that this is — that this is the amount of deaths that are happening even as tabulated by the CDC, and they're just — they're not saying anything about it, other than this, you know, percent change indicator, I think is a huge problem. You know, it's a huge — it's almost — it's just, it's so — it's insulting, first of all, but it's also I think, frankly, just a little too on the fucking nose for everything that we've been saying this whole time in terms of like, they're clearly just trying to sweep this under the rug and make it appear like it's no big deal. And one of the best ways to do that is to take the actual number away, that's being reported. So that, for instance, not only when you go to the CDC, but when you go to like the New York Times for as long as they're still, you know, reporting that, they're going to be — they show the percent change indicator, just like the CDC.

Beatrice Adler-Bolton 16:49
What were the number of deaths for the second week of September again?

Artie Vierkant 16:53
1,378.

Beatrice Adler-Bolton 16:55
That's the week that Biden — when Jill Biden was positive, and Biden walked into that press briefing without the mask on, and was like, oh, don't tell them that I wasn't wearing it.

Artie Vierkant 17:04
Yep.

Beatrice Adler-Bolton 17:04
That's that week.

Artie Vierkant 17:05
Yep.

Beatrice Adler-Bolton 17:06
Insulting.

Artie Vierkant 17:07
In any case, maybe while we just kind of sit with that, I wonder if like, Abby, you could talk us through like — because I had a lot of these questions for you, too. Like alongside COVID Year Four, kind of in tandem, I've been — you know, like Abby and I have been kind of going back and forth talking about these figures and figuring out what exactly we know, for like a couple of weeks. And like, I'm wondering, I guess, if maybe Abby, you could talk through like how the process of how these death figures become these statistics, if that makes sense?

Beatrice Adler-Bolton 17:39
Like where we got these numbers from, like show our work.

Artie Vierkant 17:41
Yeah. Like we know — I alluded earlier to the fact that there are like holes in the data sheet. Some states are reporting in strange ways. But also, these are —

Beatrice Adler-Bolton 17:52
Only the official one.

Artie Vierkant 17:52
Like as of the end of the public health emergency too, the sort of data source for these changed, the data source for deaths changed. So I wonder if you could walk us through some of that?

Abby Cartus 18:03
Yeah, yeah, totally. So the data source for deaths sort of changed.

Artie Vierkant 18:09
Okay.

Abby Cartus 18:09
What's confusing about this is that there are kind of two things going on at the same time that I think kind of feed back into and sort of reinforce one another. The first thing that's going on is something that's going on with the actual process of like data collection. And since the end of the public health emergency, there have been some important changes to like what data are collected, and how the data are collected, that are affecting the picture that we're able to get of COVID transmission. And I'll get into that in just a second. And then the second thing that's going on is with how the data that is still being collected is being sort of packaged and visualized and presented to the public. And as you've mentioned several times, Artie, you know, the CDC is increasingly representing information about COVID as just like abstract symbols, you know what I mean, or like numbers that are really abstracted from the underlying number. So to start, I guess, kind of from the first prong of this, there are two really important sources of case and like death data that have just been like discontinued since the end of the public health emergency. The first of these is the electronic laboratory reporting. So that was like electronic transmission of test results to state health authorities and the CDC and whatever.

Artie Vierkant 19:42
Like there was a federal data reporting requirement that said that private labs had to report positive COVID cases.

Abby Cartus 19:49
Yes. During the public —

Artie Vierkant 19:51
And that went away after — yeah, exactly. That went away with the termination of the public health emergency.

Abby Cartus 19:55
Exactly. Yeah. HHS had like the authority to require that all of these labs report their COVID test results. Now this like electronic laboratory reporting, that's like an important priority for CDC. It really is a good thing, you know, like it improves the transmission of health information, not just for COVID. You know, Rochelle Walensky was always complaining about, [goofy Rochelle Walensky voice] oh, we've got all these health departments that are receiving data by fax, can you believe that? And, you know, this electronic reporting is obviously a lot faster, it's a lot more accurate, it's a lot more sort of interoperable with different data systems, but they have just sort of gotten rid of this for COVID with the end of the PHE, or of the public health emergency. So that, you know, that was where we got the data about transmission, like actual community transmission of COVID. You know, obviously, that data is not perfect, it became less perfect and less representative as more and more people started using at home tests, but you know, that was underpinning the community levels system, you know, the beautiful fields of green that we all remember. And that has now gone away. Another thing that has gone away is what's called — okay, I always forget. The acronym is ACDC, I think it's aggregated cases and deaths counts. And this was kind of like a — my sense is that this was done because it's a little bit more timely than sort of waiting for the death reporting process via death certificates, which I'll talk about in a second. But this like ACDC was essentially an automated scrape, like the CDC would just like scrape information, you know, daily, weekly, or whatever from state health department websites and dashboards, and things like that. And so that was, I think, like, a little bit more of like an up to the minute picture of cases and deaths that was just being collected from all these disparate sources on the Internet. And that has been discontinued. Now, the CDC very confusingly says that since this has been discontinued, the source of the death data, mortality data for COVID has changed. But the source I don't think — I actually don't think that the source of data has changed because the source of death data all kind of comes from death certificates. And, you know, we have this system of death reporting in the United States that is federalized.

Artie Vierkant 22:27
Do you think that they mean that like the interlocutor between the death certificates and how they then get reported up to the CDC has changed?

Abby Cartus 22:36
I don't think so. I just think it means — I could totally be wrong, but I think it means that they're just no longer doing these scrapes from these like state and health department websites, and stuff like that, which I mean, there probably isn't much data. I feel like a lot of states and jurisdictions have stopped updating these dashboards anyway. So there's probably not really anything to scrape. So the underlying death data, though, I mean, it would be the same data, you know, that like the process is kind of the same in all 50 states for reporting deaths, although there are some like limitations for this. So I can — I mean, would it be helpful, do you want me to just kind of go through very quickly, like the process of how like a death certificate becomes —

Artie Vierkant 23:21
Yeah, how does a death certificate become a statistic, I suppose.

Abby Cartus 23:24
Yeah, yeah. Schoolhouse — I always love to joke about Schoolhouse Rock with stuff like this. It's like, oh, it goes through like a whole process, like how a bill becomes a law. So okay, death reporting is done at the state level. So someone dies, like, let's say a person dies of COVID in Pennsylvania. The cause of death is determined by the certifier, you know, there are all these different people that fill out death certificates. The certifier is usually a physician, a medical examiner or coroner. They will fill out, you know, the underlying cause of death. That death certificate will then be registered with like the town or the city, the county, where the person died. That triggers the Social Security Administration to be notified, I think, that death records become coupled with birth records. And then once that happens, you know, all these municipalities, like cities, towns, whatever, transmit death certificates up to the state, you know, whatever the state Vital Statistics Office is. The state Vital Statistics Office probably like, you know, cleans, cleans the data up and then transmits it to the National Vital Statistics System and then the states can also share it with like the National Center for Health Statistics like the CDC, whatever. So the National Vital Statistics System is just kind of like sucking up, like hoovering up these death certificates that are coming in through the state. And the process of completing a death certificate is like not without error or not without inaccuracy. But it's very hard to say like where the inaccuracies come in. I know that there's some like published literature out there showing that up to like, I don't know, 40%, like almost half of death certificates completed in like an academic hospital have an error in the cause of death. The cause of death kind of has these different components. There are also —

Artie Vierkant 25:24
I know also even that there was like a — not to be referencing this, but like in terms of just how widely known it is that it's like, you know, by no means a foolproof system basically, I think there's even like a John Oliver on this that talks about how three quarters of death investigations are done by coroners who are not required — like coroners are, generally speaking, not required to have any medical training. So there's that.

Abby Cartus 25:51
Yeah, this comes up a lot. Like this comes up a lot actually in the sort of like epidemiologic literature, like research on cause of death reporting for like fatal overdoses, because any type of like accidental death will sort of trigger, you know, a medical examiner or a coroner investigation, and there's a lot showing that like, you know, the cause of death, the accuracy of the underlying cause of death really varies depending on who is filling out the death certificate, you know, like, whether it's like the medical examiner or the coroner, there's like regional variations in that. So that's basically how it happens. But yeah, that's basically how a COVID death becomes a death statistic. Now, you know, as I said, there are many, many opportunities, and it's hard to say, because, you know, every municipality, like every small jurisdiction, every hospital has like different people that are doing this certification process, and then like transmitting to the state and then nationally, but the underlying — you know, so it's hard to say how that is going, you know, how accurate like the the coding of COVID as an underlying cause of death is like across this vastly heterogeneous country of ours.

Artie Vierkant 27:06
Right. Which then in itself gets like passed to states who then — I know that, for instance, like New York state made a big show of saying that they were going to make sure that they combed through really carefully to like disaggregate "deaths with COVID" versus "deaths from COVID" when they do their reporting up or something, you know, that kind of stuff.

Abby Cartus 27:26
Yeah. And I mean, maybe they did. I mean, I would be surprised.

Artie Vierkant 27:30
Right, I'm not sure of the degree.

Abby Cartus 27:31
If they actually had the resources to commit to like, to do that.

Artie Vierkant 27:35
Yeah.

Abby Cartus 27:35
But, you know what I mean.

Artie Vierkant 27:36
I'm just saying, this is something like that the Governor, Kathy Hochul, said more than a year ago or something, that's all, I'm just noting.

Beatrice Adler-Bolton 27:36
So a fantasy of surveillance right there.

Abby Cartus 27:44
Totally.

Artie Vierkant 27:44
What we're getting to is basically that, like we're saying these figures, but this is just like — these are the ones that are just the like totally verified ones. It's like entirely possible, even likely that they're an undercount, right?

Abby Cartus 27:58
Yeah, yeah. I mean, it's definitely — it's almost certain that they're an undercount, you know what I mean, but it's hard to say, because it's so — the process of who is filling these things out is so heterogeneous, it's really hard to say, or to make an educated guess about like, oh, how much are we possibly under-counting, you know what I mean.

Artie Vierkant 28:19
Totally. Especially, because as of like the end of September, the CDC no longer publishes an excess deaths estimate that it was doing.

Beatrice Adler-Bolton 28:26
I just want to say that, you know, I know that there's like a line that we're treading here, where we're trying to be really deliberate basically about describing what can't be known.

Artie Vierkant 28:38
Right.

Beatrice Adler-Bolton 28:39
Technically speaking, because what we're critiquing is like, yes, there is a point of discussion that is like a common agreed upon point among people who give a shit about COVID that like those death numbers are probably not accurate. But there is a bigger belief that we're up against here, which is that those death numbers are accurate to a tee and reliably present us a picture.

Artie Vierkant 29:01
Or inflated, in fact, yeah, which is a different belief, yeah, that other people have.

Beatrice Adler-Bolton 29:05
Or inflated, right, which is a whole other can of worms, right.

Abby Cartus 29:08
A whole other thing.

Beatrice Adler-Bolton 29:08
But what we're specifically pushing up against here, right now, is that broad belief that we have the technology and the resources and the data infrastructure, to have this perfect picture of what's going on, at such a level to even determine that, for example, those numbers could be overinflated and that we really need to do "with/for" distinction, because otherwise, we're gonna have really messy data. Like that "with/for" claim, you know, the kind of like, are people being hospitalized "with COVID," or "for COVID?" Like, is it an incidental infection and they really broke their leg? Did they die of a heart — like those kinds of nitpicking, parsing arguments that many of us have spent so much time pushing back on throughout the pandemic, I hope that those are laid bare for as like baseless and ridiculous as they are, right, to the — like in the kind of line that we're treading here, where we're trying to make very clear the limits of our perception of what is going on, like through data.

Artie Vierkant 30:10
Right. I think — I think that Long COVID advocates have done a really good job of pointing this out for a long time, especially with stuff like, you know, pointing to situations like someone gets — you know, someone with Long COVID, maybe no longer has a acute COVID infection, dies of a cardiac complication or something like that. And then, you know, that death is not recorded as a COVID death. That death is recorded as cardiac whatever, right. Please continue, Abby. Sorry.

Abby Cartus 30:41
Well, this is interesting because uh, maybe I shouldn't even like launch into this. But there is an NVSS document, there was like a Vital Statistics Reporting Guidance document that NVSS put out in 2020 for people that fill out death certificates for how to certify COVID deaths. And I know that that document has been expanded this year to include how to certify like deaths from post acute sequelae of COVID, you know, aka Long COVID. I don't remember what it says, or how good it is. But yeah, I'm not trying to be so like view from nowhere about it. But there are just like severe limitations on what we can know, and even on what we can make an educated guess about. And that just like simply sucks. Like I don't think that's right at all.

Artie Vierkant 31:34
Totally.

Abby Cartus 31:34
Like, I don't think that we, or other advocates, or anyone really, should be in this situation of having to try to piece this shit together from these really obscure, like hard to find datasets on the CDC website and things like that. But I think that part of the mystification — like I don't know, there's a little bit of mystification because there still are — like I think perhaps, unfortunately, for the Biden White House, and the Biden CDC, like death reporting is something that happens.

Artie Vierkant 32:06
Right. They can't make death certificates go away.

Abby Cartus 32:10
They can't make death certificates go away. And like the death certificates that are recorded in these provisional counts, like they have COVID-19 somewhere on that, you know what I mean? Like, that's basically what we can say is like, COVID-19 is like an important cause of death, like enough so that they're being captured in these provisional counts. And like that has not — that process has not changed and like didn't change with the end of the public health emergency. But it feels like maybe some of this other data stuff and like these mystifications and how the data are being presented, is perhaps intentional, you know what I mean? Like, perhaps like a maneuver to make it seem like we actually have less information about COVID deaths than we really do, or to minimize them or hide them.

Artie Vierkant 32:56
I mean, the shift to a percentage change. That seems like a pretty blatant, intentional, you know.

Abby Cartus 33:01
I mean, that is just like aggressive, you know what I mean? As like a — you know, I am not — I'm not a science communicator.

Artie Vierkant 33:08
As a scientist.

Abby Cartus 33:09
As a scientist. But like as a person who went to grad school with a lot of dorks, you know what I mean, who were like trying to gild their parachute [Artie laughing] with like a fake career in sci-comm, you know, and I mean, these are the types of people that are running CDC, and it's just like, okay, everyone knows that this is just like, it's the data equivalent of like crossing your arms in front of your chest, you know what I mean?

Artie Vierkant 33:33
Totally.

Abby Cartus 33:33
It's just like totally meant to just like repulse people and repel people and make the numbers that exist like totally, totally meaningless, even though like, you know, with transmission, we straight up just don't have the numbers, like with deaths, we do have the numbers. Yeah, but they're being presented in this incredibly aggressive and offputting and difficult to understand way. And it's not like, I don't know, the CDC, I've read a lot of like documents about changes to like COVID data collection after the end of the public health emergency. And the CDC keeps saying that all these other like data sources that they still have, you know, they have some sentinel reporting, they've got some you know, they've got COVID-NET, which looks at COVID outcomes among like hospitalized patients. They've got some datasets that kind of track, you know, like emergency department admissions, or I guess, confirmed COVID diagnoses among like emergency department admissions. And in all the documents that they put out, they kind of say, like, oh, yeah, this is great, you know, this is how we — this is how we do surveillance now, you know, this like — this percent — they're, they're — sorry, I'm fumbling for what I'm trying to say, and I'm getting so offended that like my thoughts are collapsing in on themselves, but they're saying that all these other indicators that are like nowhere near as good as transmission, you know what I mean, like indicators of transmission, this like electronic laboratory reporting. They're like, well, these are all just completely fine and, you know, these are suitable alternatives to what we had before, which they completely are not, they give us a totally different picture that is much less clear. And I've also — you know, like they're doing the percentage change week on week. And they're also — like, they're bragging about how they have all these new metrics and new data sources. And I'm like, this isn't a fucking new metric, like you just added a column to this dataset where you're calculating the percentage of all of the deaths in the United States that COVID deaths were for that week. And that — I mean, that's a real thing that's in the provisional death counts is like, oh, okay, COVID deaths are X percent now.

Artie Vierkant 35:36
Well, and that's how it's most commonly reported now.

Abby Cartus 35:39
I know. And it's like, once again, what is the purpose here other than to minimize the ongoing burden of like COVID morbidity we have no idea about, you know what I mean, except through these very abstracted indicators of like, people getting admitted to the emergency department. But you know, what is the purpose of presenting it this way, as a percentage of the total, if not to make it seem — yeah, if not to minimize just this ongoing burden of mortality. It's really spectacular work, but it's not spectacular scientific work, you know what I mean? And as like sci-comm, it couldn't be — it couldn't be any more like misleading and minimizing, I don't think.

Beatrice Adler-Bolton 36:25
I really appreciate that point, Abby. And I mean, maybe this is like too much of a — it's not really an aside, but what I can't stop thinking about while you're talking is this one quote I flagged from Ellen Samuels' book, Fantasies of Identification, and they’re talking about like blood quantum and the Indian Health Service, the United States, and the way that they like track and catalog blood quantum data. And the book is great, I highly recommend it. But this is a passage where Samuels is talking about DNA, the kinds of like Genetic Lottery, Kathryn Paige Harden-style extrapolation about…

Abby Cartus 37:06
Oy vey.

Beatrice Adler-Bolton 37:07
You know, genetic traits and heritability that echo and hearken back to the era of eugenics. So Samuels, and so it sort of points to like — well, yeah, I'll just read the quote:

"And yet fantasies of identification have never really been about science. They are about culture, about politics, about the rule of law and the unruliness of bodies. What DNA has to tell us about how our bodies work and how our identities are shaped is still largely unknown, but the power of DNA and the cultural imaginary, what Sarah Franklin and Jackie Stacey call the "genetic imaginary" has already formed the basis for 20th and 21st century fantasies of identification that bear a striking resemblance to those preceding fantasies based on less reputable scientific claims. Indeed, the very fact that genetics is comparatively reliable science seems to provoke even more extreme and expansive fantasies about it. Genetic essentialism, the idea that DNA offers a master key to human identity and has already penetrated culture and politics to an astounding degree, considering the acknowledgement by geneticists that they have only scratched the surface of genomic knowledge. … If we recall the wistful yearning for a definitive mark of identity in the 19th century, and the search that led from birthmarks to fingerprints, we can understand why and how DNA began to be deployed for identification while it was still in its very early stages of being discovered, much less understood. Desire drives fantasy, fantasy demands realization, realization produces material effects. Science, in these cases, functions not as the basis for these effects, but merely as their justification."

Abby Cartus 38:40
I love that, and what I — what's so — I don't know, what I want people to take away from this or reflect on as a result of this conversation, and what I think that quote that you just read illuminates so beautifully is that data, we have this idea that like data exist, and that like data are like facts about the world, you know, that we are simply recording or writing down. But data are, in actuality, active social constructions, you know, and the process of socially constructing data, like whether it's genetic data, like COVID data, whatever, is ongoing and is very, very tied up in these kind of like social and political relationships, you know, and I think that what we are — I don't know, I think what we're kind of witnessing right now is the active construction, or maybe deconstruction as the case may be, of COVID data as like an entity by the Biden administration, and it kind of echoes — okay, I don't know if this is like the right place for this.

Artie Vierkant 39:51
Go for it.

Abby Cartus 39:52
I don't know if this is the right place for this anecdote. But as I've been like preparing for this episode, I've been thinking a lot about this — taking, you know, just winding the clock all the way back to my favorite time and place, the Industrial Revolution in England [laughing]. But there was kind of a high profile controversy in the industrial – or during the Industrial Revolution in England between Edwin Chadwick who was like the dude who's responsible for sanitation, like for sewer construction, but also the dude who was the administrator of this like awful reformed poor law, you know, that was so stingy and like not providing relief whatsoever, like really just punishing people that were, you know, working in factories at this time. There was a big controversy between —

Artie Vierkant 40:41
Bog standard for the poor laws, yeah.

Abby Cartus 40:43
Yeah, yeah, exactly. This dude, Chadwick and this other guy named Farr, who was kind of a statistician, and he was sort of like the cause of death certifirer, and he got into kind of a big — you know, there's a lot of like politics around this and like career politics and stuff, but this guy, Farr, got into a big spat with Chadwick. I think it was like letters that were published in a newspaper, you know, so like 1840s, whatever. But the spat was about basically whether it was possible for people to die of starvation in England. And Edwin Chadwick, who was administering this awful poor law and for whom, you know, the —

Artie Vierkant 41:27
Let me guess, couldn't be. Not possible.

Abby Cartus 41:29
Couldn't be, exactly. Well, yeah. For him, the idea that people were dying of starvation on this meager poor relief was a huge political problem. And for this other guy, Farr, you know, he was really interested. I think he actually spent a lot of his career getting into like the classification of, you know, causes of deaths and working out the causal sequence that leads to a death. And so, you know, Chadwick's position was, no, no, no, no, like, you know, this person died of consumption, you know, or this person died of pneumonia, or this person died of this, that and the other thing. Like, you cannot say that these people died of starvation. And Farr was like, well, yeah, but like all these people are starving, you know what I mean? So, like, whether you die of consumption, or pneumonia, or whatever, like the fact of the matter is that you might not — these people might not have died of these things had they not been incredibly weakened by chronic malnutrition and starvation, which, you know, I mean, the parallels between public health in the Industrial Revolution and today are many, but I think, just to like, I don't know, loop back to what — or some of what you were getting at with that quote that you read, I think there are — like, yeah, there are like fantasies in the public imagination that, you know, even that these data — yeah, the data that we collect, or that we have, or that we can access, like that there're somehow kind of like faithful records of an underlying natural reality that's outside of social relations, and, you know, economic relations and things like that. But that is totally not the case. And that's like never, ever been the case. You know, like it's — especially at this level that we're talking about, you know, like of population health or whatever, like, it really matters what we are saying that people are dying of, basically, and it really matters how the process of the data that we're collecting, it matters how that process is happening.

Artie Vierkant 43:28
Totally.

Abby Cartus 43:28
And that that informs — yeah, anyway. Sorry, I'm getting — now I'm getting too like, you know, trippy, just like talking endlessly but —

Artie Vierkant 43:33
No, no, no. No, this is good. I have something for this.

Beatrice Adler-Bolton 43:47
No, I'm so here for it.

Artie Vierkant 43:47
Can I do West Virginia?

Beatrice Adler-Bolton 43:38
Oh yeah. Please do West Virginia.

Artie Vierkant 43:40
So I mean, all of these I think are really important points. And I think one of the ways that I've been thinking about this, specifically, when you look at this data reporting question, and the way that the CDC has — the CDC and the Biden administration have been communicating about the pandemic over the course of the last couple of years, I feel like it's really important to understand at least the story of the sort of data picture of COVID as an intentional campaign of abstraction. The way I've been thinking about this is that you could quite succinctly, I think, tell a story about the pandemic in — and not just about the pandemic, but about the sociological construction of the end of the pandemic, as we've been talking about it as, you can tell a story about this in three images, which are, you know, the first image would be the all red everywhere, bright red Community Transmission map, that measured like actual COVID transmission that was in place and like really prominently publicly available until like February 25th, 2022, the day that they released the Community Levels map, the CDC released that, which then itself is the second image, right, the like pastels, like slightly more cheery but also all the metrics underlying it have been changed, you know, map, the Community Levels map with all of its relaxing colors. And finally, the one that we've been talking about just earlier that we just kind of alluded to, that is the new wastewater map that, you know, where the color grading goes from calming light blue to calming slightly darker blue, right?

Abby Cartus 45:22
Yeah. Next year, it's just going to be a single Zapf Dingbat [laughing].

Artie Vierkant 45:27
Right. I mean, you know, as soon as I saw the wastewater map, I was like, God, I feel like — I don't remember if this was on mic or not, but I feel like we made a joke when the Community Levels map was released, like, what's the next one gonna be, all green or something? It's like almost the same thing [Abby laughing]. Blue is actually smarter, actually, it's like more insidious, because…

Abby Cartus 45:44
Oh yeah.

Artie Vierkant 45:45
…You know, green is like — I feel like green is like so on the nose or something, like call it whatever. Anyway.

Beatrice Adler-Bolton 45:52
It looks like it's been passed through more layers of like management consulting meetings to come down with like exactly that right tone of blue too, you know?

Abby Cartus 46:00
Economic Endemicity Blue. It's like the Pantone color of the year.

Artie Vierkant 46:07
Absolutely.

Beatrice Adler-Bolton 46:07
Oh my god.

Artie Vierkant 46:08
But so, all of this, as we were preparing for this, it made me think of a story that I was like, okay, obviously, this can't — I can't put this in COVID Year Four, because this is — this happened much longer before that. But let me just kind of dial — I'm going to take us on, just to maybe conclude through sort of maybe probably a lot of the end of this episode, I want to take us down kind of a rabbit hole into the past, to an often forgotten story of COVID data manipulation, for the purposes of pushing reopening.

Abby Cartus 46:39
I forgot about this 'til I saw it in your _ in like your show notes. I was like, oh my god.

Artie Vierkant 46:45
So maybe this will get you both in the mood for COVID Year Four, where I think it's not a spoiler to say, you're going to have to sit through a lot of me reading direct quotes.

Beatrice Adler-Bolton 46:55
That's why we love you.

Artie Vierkant 46:57
But this is something different though. So for this, we're going to turn back the clock to fall 2020, the first year of the pandemic, long before anything we're talking about in Covid Year Four or today. So other than obviously, this is not going the clock back quite to the beginning of industrial England or whatever, but you know.

Abby Cartus 47:16
That's what I'm here for [laughing].

Artie Vierkant 47:17
Not quite that far. But so I have just a couple of things I'm gonna draw from the primary sources for this, just to tell a little story. So in July 2020, Harvard Global Health Institute debuted what it called its COVID Risk Level Map, which I feel like is kind of the EHR heat level map.

Abby Cartus 47:19
I remember that too, oh my god.

Artie Vierkant 47:30
Like kind of the big initial, like here's how you…

Abby Cartus 47:39
It was huge.

Artie Vierkant 47:39
Here's how you like — we draw our corollary from the like orange threat system or whatever, for airport security or something. And we like translate that onto a heat map for COVID transmission.

Abby Cartus 47:53
There were clear transmission benchmarks, though, like this much means, you know, that you're in green, and this much means you're in yellow.

Artie Vierkant 48:00
Yeah, and that's what I'm gonna get into, right. So, here's how that map, the Harvard Global Health Institute's COVID Risk Level Map was described in a July 2020 article from Time Out,

"Live reports from the WHO, USA Fact, OWID and Bing COVID Tracker fuel the data behind the project, which ranks each area by four colors: green, yellow, orange, and red. Green counties boast less than one case per 100,000 people and are considered 'on track for containment.'"

Um.

Beatrice Adler-Bolton 48:30
[laughing]

Abby Cartus 48:30
I love to be on track for containment.

Artie Vierkant 48:34
I had to pause when I saw the word containment. Like containment, though? I mean, when's the last time you heard that word? My god.

Beatrice Adler-Bolton 48:40
I know, right?

Artie Vierkant 48:42

"Yellow ones, yellow counties are home to less than 10 cases per 100,000. References community spread. Orange areas are under 'accelerated spread categories,' having between 10 to 24 cases per 100,000 people. And red counties — red was 25 cases per 100,000 residents."

For context, I'm just gonna say, just to show how much the goalposts have shifted. This is no longer the Time Out piece, by the way, obviously. To show just how much the goalposts have shifted, by the way, by February of 2022, when the CDC debuted the Community Level system, the Community Level system made it so that method of counting transmission required literally 100 cases per 100,000 to even count towards the calculation. So that's how much more — that's how like far the goalposts were shifted. Anyway. So why am I talking about this, Right? Well, if you're a long-time listener, and I mean like long, long, long, long-time listener, you might remember something we talked about way back in 2020, which was how the state of West Virginia adopted this particular Harvard map, but graced it with some highly creative flourishes. And I'm gonna kind of like bring us through some of this, but I just think this story is really interesting as this kind of example of like — I just feel like it rhymes with so many of the changes in the levels of abstraction that the CDC has done in the intervening years since. So anyway, rather than describe this whole event myself, I'm going to do the didactic archives thing, and let the coverage speak, let like old coverage speak for me, again, for just a second. But also because just I find this like reporting that I'm about to read from a fascinating historical document at this point, and this is something that I remember like — I remember we talked about it. We had a much smaller audience then, so I imagine a lot of people listening to this won't have heard this, but also like, I remember that this didn't really break through. This was a big story in West Virginia, but it didn't really break through national news coverage.

Beatrice Adler-Bolton 50:44
You would have had to be in like the first 1,000 or 2,000 people to ever listen to Death Panel to have heard that episode.

Artie Vierkant 50:49
Yeah. So this is from an outlet in West Virginia called Mountain State Spotlight from September 18th, 2020. The headline is, "The governor ‘tweaked’ a Harvard COVID map. Their experts say the state’s changes are flawed," and I'm gonna read some from this piece.

"In August, Governor Jim justice introduced West Virginia's parents, teachers and coaches to a new Saturday night ritual, refreshing a state website for updates to the color coded map that would determine whether ball fields and school houses would be open the following week. State officials modeled the map after one developed by the Harvard Global Health Institute, which places counties into one of four risk levels: green, yellow, orange, or red, based on the number of COVID-19 cases per capita. The map developed by West Virginia's Department of Health and Human Resources looks similar to the Harvard map, lending a veneer of academic rigor to the state's school reopening plans."

Remember, this is like September 2020.

"But the two maps are never the same."

The Harvard map and West Virginia's map.

"West Virginia officials have relied on outdated data, raised the cut off that determines each county's risk level, and altered the methodology for determining the total number of cases. Dr. Thomas Tsai"

Who's described in this article as a health policy researcher and surgeon at Harvard.

"Dr. Thomas Tsai said the goal of the Harvard team, made up of ethicists, policy researchers and public health experts, was to create a single clear metric that could be used by cities and counties across the country to assess the extent of the coronavirus outbreak. 'Everyone was talking about reopening using different terminology, different levels of color coding, and it was one of our goals to develop a consensus,' he said."

Article continues,

"But that scientific consensus proved incompatible with the desires of West Virginia leaders who wanted to get athletes back onto the field and students back into school as quickly as possible. For weeks, the most obvious similarity between the two maps has been the color palette and even that disappeared when Governor Justice alchemized five orange counties into gold on Tuesday."

They'll explain more on this later, but what they're saying is, Governor Jim Justice decided to re-label five counties as a new color, gold, signifying less COVID protections. Anyway.

Abby Cartus 53:12
[laughing] God, I forgot about the gold.

Artie Vierkant 53:15
Right? It continues,

"On August 14th, 2020, Justice announced the school alert system as a way to determine where it was safe to bring students back into the classroom. Counties that were green and yellow would be able to offer in person instruction. Counties that were orange and red, where the metric determined there was a high risk of community spread with the virus, would be virtual only. During the announcement, Marsh explained the map's origins, 'We're really going off the Harvard Global Health Institute model. And this is a model that's really generated by public health experts,' he said."

Abby Cartus 53:46
Oh, honey [laughing].

Artie Vierkant 53:46

"But the fundamental differences between the Harvard and West Virginia metric were immediately obvious. On Justice's map, the state was largely green. On Harvard's, it was still awash in orange and yellow. West Virginia leaders had raised the cut-offs determining the point at which counties had enough cases to qualify them for more risky colors. Counties were green, minimal community transmission, with up to seven cases per 100,000 residents, and yellow up to 15. In Harvard's metric, the cut-offs were one and 10, respectively."

Article continues,

"After the metric was announced, Kanawha County Commissioner Ben Salango, a Democrat who is challenging Justice in the upcoming gubernatorial election, held a press conference to accuse the governor of fudging the numbers and distorting reality. By that afternoon, following Justice's own press conference in which he attacked the media's 'saber rattling' as 'ridiculous,' the state's map had been changed to a hue closer to the Harvard metric."

So they changed the color back.

"The cut offs for red and orange were synced with Harvard."

Once again, and I know this is like — this is like a longer quote than any of the ones that I'm going to read in COVID Year Four, by the way, but I just — again, such an amazing document. So anyway.

Beatrice Adler-Bolton 55:02
I'm just kind of — I've left my body a little bit.

Abby Cartus 55:07
I'm experiencing weird like time compression? Dilation? I don't know what it is, but like, I remember so vividly when all of this happened. And it was so outrageous. Like it was so outrageous three years ago.

Artie Vierkant 55:21
Well, and changing the cut-offs now is basically exactly what — again, you know, exactly what the CDC did later.

Abby Cartus 55:26
Well yeah, I know. Now, it's just the MO of, you know, every state, the federal government, the CDC, everything. But back then, I mean, it was outrageous. Yeah.

Beatrice Adler-Bolton 55:36
I mean, this is — this is like how normalization works, though, right?

Artie Vierkant 55:41
I'm gonna — I'm just gonna pick up again, still, this is this piece from West Virginia's Mountain State Spotlight, from September 2020. Okay, so again, to recap, they've been called out on the fact that they've changed the thresholds for where a county passes from one color to the next, adjusting them to make it so it requires more spread to, you know, do public health interventions or to have recommendations go in place. So then it continues,

"But there were still significant differences. Throughout August, the case numbers in Fayette County reported by the state's Department of Health and Human Resources had lagged behind the numbers published by Harvard and The New York Times. By the end of the month, West Virginia was reporting a seven day moving average of just over 10 cases per 100,000 residents. Fayette County was now in the orange, but just barely. According to Harvard, the county had moved deep into the red and had nearly five times more cases than the numbers reported by West Virginia itself. The reason, the Mount Olive Correctional Complex, the state prison in Fayette County had reported an outbreak, nearly 14% of the prison's inmates came down with the virus. But prisoners and nursing home residents are not included in the West Virginia metric. And until August 17th, staff members of those institutions had been counted only as half a case, 'because those individuals are not in the community,' according to a press release from DHHR."

So yeah, I mean, we'll get back to this. But of course, you know, this is this classic, like, oh, that's not — I mean, the "it's not part of the community" — sorry, I want to get through the rest of this, though, and then we can talk about this.

Abby Cartus 55:56
The "half case" is a really beautiful innovation.

Artie Vierkant 57:28
Yeah. Not in the community. Just to round this out, it continues,

"Officials have not just changed metrics. Sometimes they ignore them. The state has a COVID-19 data review panel, which includes Marsh and the state's top public health officials. The panel reviews case numbers and has the final say on each county's risk designation. Last week, the panel downgraded Monroe County from red to orange despite the county remaining above the 25 cases per 100,000 cut-off because the panel 'concluded the level of COVID-19 transmission in Monroe County was improving.'"

So again, totally subjective choice.

Beatrice Adler-Bolton 58:08
It feels like it's better. That works.

Artie Vierkant 58:10
It continues,

"And Calhoun County remained in the yellow with its schools opened last week despite having enough cases to qualify as orange. Marsh said that the panel reviewed case reports from the county and determined the outbreak was confined to 'an extended group of people who were immediately quarantined.'"

Abby Cartus 58:28

[laughing] Yes, I mean, that is typically the medium of an outbreak is an extended group of people.

Artie Vierkant 58:38
They go for comment,

"'We're not trying to actually change what the data is. We're trying to make sure the data is accurate and trying to make sure the data is accurately assessed,' said Marsh."

Abby Cartus 58:49
Oh really? Is that what you're doing?

Artie Vierkant 58:53
Sounds familiar.

Beatrice Adler-Bolton 58:54
Accurate to your desires?

Artie Vierkant 58:56

"On Tuesday, Justice announced yet another change on the map. He added another category, gold…"

This is the one we were talking about:

"…gold, a color chosen by Justice, that effectively lifted the restrictions on five of the eight red and orange counties"

Abby Cartus 59:10
So like West Virginia Football guy.

Artie Vierkant 59:13

"Effective immediately, those counties would be allowed to hold in person classes. The next day, Justice announced nearly 80 infected students now quarantined on WVU's campus, West Virginia University, would be treated as a single case. He said that change 'moves us more toward the finish line' and that prior reported numbers may have been 'somewhat skewed.'”

To round this out. I'm gonna go to a different piece of reporting about this thing in specific. So this is about the schools thing and brings us back to this thing of like treating a congregate facility, any congregate facility, as though it's like one case. So this is from WV News, West Virginia, September 16th, 2020.

"Most West Virginia University students who test positive for COVID-19 will soon be counted as a single case, Governor Justice said Wednesday. West Virginia University students living in on-campus housing who test positive will be required to move into Arnold Apartments for at least 10 days, which will allow them to be considered as being in a 'congregate setting.' All of the positive cases among populations living in congregate settings, such as nursing homes and correctional facilities, count as a single case toward a county's 7 day or 14 day cumulative average of new cases of the virus."

That's under West Virginia's changes to this Harvard metric.

"The change in how WVU cases are counted is intended to reduce the impact of the university's positive cases on the rest of Monongalia County, Jim Justice said."

Apologies to any of our listeners in West Virginia if I have gotten any of these pronunciations wrong, by the way. The final thing, quote from Jim Justice,

"'We have a population with students who come into a county and all of a sudden that county is flooded maybe with positives, and that county is skewed or biased in a way that hurts the county's ability to go to school, or play sports or whatever,' he said. 'It hurts them. So we've been trying to figure out what is fair.'"

Again, that is a quote from West Virginia Governor, Jim Justice. Now, couple things.

Abby Cartus 59:17
Classic Cabela's redneck energy from Jim Justice.

Beatrice Adler-Bolton 1:01:01
I am seeing, seeing red right now.

Artie Vierkant 1:01:27
Jim Justice is a Republican. But the fact that this is similar to what the CDC did in the intervening years, I think, is pretty damning.

Abby Cartus 1:01:42
Oh, absolutely.

Beatrice Adler-Bolton 1:01:43
No, thank you for walking us through that, Artie. And I'm sorry we were so unruly. It's just, I felt like — yeah, I felt like I fell out of time, and I experienced every stage of rage that I have experienced since the beginning of the pandemic through to today, over again, while you were reading those, because it really is this kind of ominous foreshadowing when you look back at it now, you know, like, it's so many echoes of like the week of February 21st, 2022.

Artie Vierkant 1:02:12
25th.

Beatrice Adler-Bolton 1:02:14
Well, that's the Friday. The week started with Rochelle Walensky, on Andy Slavitt's show on the Monday, saying masks are the Scarlet Letter of the pandemic. Then on Thursday, the research impact memo leaked that said that this polling firm, which was advising Biden going into the midterm elections, called Impact Research, wrote this memo that was dated the 24th, that later came out, that said, the administration needed to understand that "the more we talk about the threat of COVID and onerously restrict people's lives because of it, the more we turn them against us." And then on Friday of that week, the 25th is, you know, in the Friday dump.

Artie Vierkant 1:02:54
God, that was all the same week?

Abby Cartus 1:02:57
Damn.

Beatrice Adler-Bolton 1:02:54
That was all the same fucking week. That's when the map was shifted, and we lost the Community Transmission level map. And the case number scales went from being like — it was so ridiculous, the previous low indicator —

Abby Cartus 1:02:59
The map turned green overnight.

Beatrice Adler-Bolton 1:03:11
It turned to green overnight. Okay, so I went back to my notes. “Previously, on the Community Transmission level system, a 7 day average test positivity rate of 100 cases per 100,000 people would qualify a county to be rated high risk. So, as of like that map switch over on the 25th, the new metric now so substantially de-emphasizes case counts to the point that cases are not basically a factor at all in risk calculation until a county crosses the new threshold of 200 cases per 100,000 people, twice the level that previously qualified as high risk…” Now, at that level, there wasn't even a recommendation of masks anymore, right? And that had been twice as high as the previous high level on the old system.

Abby Cartus 1:03:54
And it was combined, that indicator was weirdly combined, you know, the number of cases, if I recall correctly, was combined with an indicator about hospital capacity, you know what I mean? So they both, you know, were kind of shifting the threshold for transmission, and they were also kind of like coupling it to this other indicator, you know what I mean, that's temporarily out of sync with the first one, you know, so that's like — that's many moves of like abstraction and mystification in one. Anyway, I'm sorry to interrupt you.

Beatrice Adler-Bolton 1:04:27
No, no, my old notes continue: “…this new low level of transmission states that unless hospitals are over 15% occupied by COVID-19 patients in the county, the CDC does not recommend masking indoors. That is 20 times the previous low indicator and double the previous high indicator.”

Abby Cartus 1:04:49
Wild.

Beatrice Adler-Bolton 1:04:50
Yeah. Well, that's what I — I mean, reading back through this 2020 scenario, right, like the echoes of every move the Biden administration has played out, right, are in that one moment, right, like counting all of the college students as one case, because you're cramming them into one dorm. You know, the congregate facilities are not a part of the community, but they're separate, you know, the — oh my gosh.

Artie Vierkant 1:05:20
Which, by the way, just to — I think very important to say, obviously, congregate facilities, especially prisons, jails, nursing homes, have been a driver of spread, a huge and disproportionate place where the impact of COVID has been felt. And I would just add, I mean, you know, for example, nursing homes — to talk about one congregate facility for a second, nursing homes, something like only 1% of the US population lives in nursing homes, or lives in nursing homes at any given time. But they have accounted for something like 20% of all COVID deaths so far. And also, like, on the prisons and jails thing, I think it's like really important to mention that all this stuff that we're talking about, about the Biden administration and states rushing to reopen, how they rushed to undo as many policies and programs as they could, generally speaking, prisons and jails have basically done the opposite, right? Like at the beginning of the pandemic, they used COVID as a justification to further crackdown on incarcerated people on the inside and make their policies even more draconian than they already were. And, you know, I don't mean in terms of like — this wasn't in — this wasn't done for the purpose of like protecting people, just to be clear, it's not like protecting people was the goal. It was just like in terms of justifying incarceration getting worse. And by and large, those policies are still in place, right? If you ask someone who's on the inside, or someone who has been incarcerated in the last couple of years, you know, they will tell you that what is understood as a COVID lockdown, what a COVID lockdown means to them means something very different from what all the right-wingers and liberals complain about, and something entirely different from the like — even the pay people to stay home stuff that libs used to laugh off as unrealistic and too expensive and stuff, so. Just has to be said.

Beatrice Adler-Bolton 1:07:16
Yeah. Well, and now we have our latest map, which is all blue. I mean, this wastewater data map.

Abby Cartus 1:07:23
Yeah, do we want to talk about wastewater?

Beatrice Adler-Bolton 1:07:24
Boy, where do we start on this one? I mean, so earlier this week, right, we have the new — this new map released by the CDC, which is coding the entire country in basically dark blue through kind of a light teal, and then white with grey for no data. And it basically blankets each state in a color and gives you not like a county breakdown, but a state level kind of measurement of, very high, which is dark blue and darker blue, high, which is medium dark blue and kind of darkish, teal, moderate, that's teal and light teal, low, that's pastel teal, and mint green, and minimal that's pastel mint and white, and then insufficient data, which is gray. And now again, this is not broken down by county. So each state gets one color.

Abby Cartus 1:08:18
Which is so — I mean, first, just right off the bat, and I genuinely don't know the answer to this, but how meaningful is something like a state level wastewater, like COVID RNA measurement? Like, I'm really wondering how that is calculated? Because it seems to me that you can quantify the amount of like COVID RNA in wastewater from like, a municipal, you know, or like a particular water system?

Beatrice Adler-Bolton 1:08:51
Yes.

Abby Cartus 1:08:52
And so I'm not sure, like there must be some process for aggregating and like perhaps weighting, you know what I mean, if there are multiple wastewater — you know, if there are multiple water systems with wastewater testing in a state, like, how is that done? Again, you know, this is like the — like what is — what's going on behind the scenes here? Like, how are they deriving this figure that they're then slapping a color on?

Beatrice Adler-Bolton 1:09:18
Yes. I mean, that's a very important question, because if you go to CDC.gov's COVID data tracker under their wastewater surveillance page, you can see the version of the map that's the older version of the wastewater map that used to be the only one that was available before this new blue one came out, and that one shows you pinpointed where each collection point is and how many collection points there are. So some states you know, have two, three, sorry, like, you know, twelve, four. I think Louisiana has four, it looks like.

Computer Generated Voice Over (UK Daniel) 1:09:57
Beatrice meant Georgia, not Louisiana. She will correct this in a moment.

Beatrice Adler-Bolton 1:10:03
You know, this is not — there's broad coverage in certain states, but even in a big state like New York, like I'm seeing huge parts of western New York that are just a hole, right?

Abby Cartus 1:10:13
Well, and, you know, since you mentioned Louisiana, again, this is how, you know, the social processes by which data are constructed, you know, we tend to take evidence of this social construction process as bias, when, in fact, it's reliable evidence about how the world is. Because there are many, many — like, I'm just thinking that there is risk of bias in these wastewater data, because there are a lot of people in the United States who have septic systems, particularly in the US South.

Beatrice Adler-Bolton 1:10:52
Yep.

Artie Vierkant 1:10:52
Totally.

Abby Cartus 1:10:53
And are not hooked into like a wastewater system. Particularly these, you know, very rural, very poor areas of the South, you know, and so you can see how — I mean, this is, this is like how the sausage of health, you know, so-called "health disparities" gets made, you know what I mean, because, where — you know, where is the surveillance indicator for these places where people aren't hooked into like a big municipal system?

Beatrice Adler-Bolton 1:11:18
Well, and I'll just say, as someone who's lived in the South, I said Louisiana, and I said, that doesn't sound right, and I'm blind, so let me double check. It was actually Georgia that I was talking about, because it would be ridiculous for the state of Louisiana that has one of the largest freshwater waterways to only have like four water treatment collection points, that would be wild. But still, as you're saying, Abby, one, this is collecting from only people who are hooked into the sewer grid. Two, there are 19,000 registered cities, towns, municipalities in the United States. There are 1,728 wastewater sampling sites. And there are only 1,195 of those sites that the CDC says are sites with current data, so.

Artie Vierkant 1:12:07
That's a lot of holes.

Beatrice Adler-Bolton 1:12:08
That's a lot, that's a lot, that's a lot of holes. That's a lot of extrapolating from an average that only speaks to specific — and okay, let's say, all right, well, how many big towns and cities, right, because a lot of them are small? 3,000+ have over 10,000 people, so we're covering maybe a third of the cities in the United States that have 10,000 people or more in them? Like, this is not something that you can make a whole statewide color map with.

Abby Cartus 1:12:37
Well, exactly.

Beatrice Adler-Bolton 1:12:38
Sorry.

Abby Cartus 1:12:38
Even if — there are ways, you know what I mean, there are ways, there are like sampling techniques that you can use, you know, so that you can use like a small sample of something to represent, you know, much bigger — you know, like political polling makes use of these methodologies and whatever. But I feel like wastewater is a little bit, it's hard to do that with because like — and I feel like these are just challenges with wastewater in general, like the wastewater mix in every water system is totally different, like the number of people and animals as well, you know, like contributing to the viral load of a watershed is like constantly changing. And it's not the same between different places. And so, I feel like the CDC is always saying this, like, oh, you know, like, we're collecting data from all these different wastewater sites, you know, and that's giving us a good picture. And it's like, ehhh, like you're saying that because yes, like, in theory, sampling, you know, representative sampling is something that can be done, but I am a little bit — I'm like not quite believing that you really can do something like that with something like wastewater that is so heterogeneous, you know what I mean, and just depends on so many like dynamic factors all the time.

Beatrice Adler-Bolton 1:13:55
Well, and are we saying only people in large cities who have implemented wastewater data surveillance systems deserve to know how much COVID is circulating around them?

Abby Cartus 1:14:04
Yeah, that's exactly what we're saying.

Beatrice Adler-Bolton 1:14:04
Like that is what we're saying, where we've — I mean, the other thing that really frustrates me about this system is if we think about this conceptually, right, like before, yes, we were basing it on hospitalizations in some part, which was a lagging indicator with the Community Level system, the pastel map. The Community Transmission Level system was more based on testing, pure testing numbers. But wastewater surveillance is not based on pure testing or a combination of testing and hospitalizations. It's based on passive surveillance. So none of the people who are shedding, who are being recorded as cases are necessarily aware that they have COVID. We have no proof of that.

Abby Cartus 1:14:48
No one's — no one's being recorded as cases.

Beatrice Adler-Bolton 1:14:52
Well, and nobody's being notified, oh, hey — it's not like we can say oh, hey, like our wastewater surveillance systems saw that someone in your house has COVID.

Abby Cartus 1:15:01
No, no, no.

Beatrice Adler-Bolton 1:15:01
Here's a call from your DWP. Like, that's not how it works, right?

Abby Cartus 1:15:06
Exactly, yeah.

Beatrice Adler-Bolton 1:15:07
So this is like a perfect sort of, you know, COVID fantasy map that we've got going on, because it's a passive surveillance system, so it's not imposing on people, you know, it's not reminding people. But it is purporting to show a metric that gives you a sense of what the spread is in each state.

Artie Vierkant 1:15:28
And then coding it in all blue, importantly.

Beatrice Adler-Bolton 1:15:30
Coding it in all blue, in an inoffensive, calming color.

Abby Cartus 1:15:34
In therapist office blue, yeah.

Beatrice Adler-Bolton 1:15:35
That's not imposing.

Abby Cartus 1:15:36
Meditation app blue.

Beatrice Adler-Bolton 1:15:38
What did you call it? Economic Endemicity Blue?

Abby Cartus 1:15:40
Yeah [laughing]

Beatrice Adler-Bolton 1:15:42
You know, which is beautiful. Perfect. No notes. Right. And so, what we have here is actually an elaborate fantasy that they are providing us with accurate information about the pandemic, that stands in for the fact that —

Abby Cartus 1:15:58
Yeah, that this is just as good as lab reporting, as transmission maps.

Beatrice Adler-Bolton 1:16:04
Right. What we're working with here is not anything near robust, anything near comprehensive, anything near definitive, nor as a sort of social construction does it communicate anything about like what your actual sort of COVID risk is other than for, you know, let's say, people who live in, you know, about 800 cities in the United States.

Artie Vierkant 1:16:25
Places that are very well surveilled. No, I mean, I think this is kind of the thing, it's especially with so much other stuff taken away, you know, I'll take — I'll take another metric, obviously. But you know, we have to be real about what the limitations of that metric are.

Abby Cartus 1:16:39
Wastewater is good, I think we should have it, you know, like, I'm in favor of wastewater surveillance, but we need to be clear about what it is and is not.

Artie Vierkant 1:16:46
Yeah. I mean, but wastewater data is best in relation to other metrics, some of which are metrics that we are intentionally not doing anymore, things that the CDC allowed to drop. And this is why, you know, I think, you know, I think this gets back to kind of my biggest kind of general point about especially why this kind of got spun into its own conversation separate from COVID Year Four, which is like this sort of intentional push towards increasing abstraction, and — like increasing abstraction about what is or is not actually happening with any given COVID metric. Abby, I apologize if this is like the — apologies if this is the point that you're about to bring in, but I'll just attribute it to you, I think, when we were talking about this before, like, as we were kind of planning this, you said something to the effect of like, it almost seems like it's intentional that the only data sources that they are allowing us to have leave us with like little to do but conjecture. I mean, like the type of conjecture that we were doing earlier in this episode, like being really specific about well, you know, there are all these limitations, what do we really know? I don't — you know. There are so many things about the way that the data reporting has changed that make it so much more difficult, and in some cases, with certain things, impossible to tell, to point to a possible in any way to agree upon reality of what's happening right now. And, you know, that seems pretty clearly like it was part of the project of what the Biden COVID response has been, you know?

Abby Cartus 1:18:29
Yeah, absolutely. I think it's — it's interesting, and I don't think it's an accident that we, as individual people, have become progressively more and more responsibilized to manage the threat of COVID ourselves, you know, with the implication, you know, the rhetoric is always like, oh, well, you do this by being a super informed — you know, a super informed person and, like know your risk and, you know, use all this stuff. As that's been happening, this progressive retrenchment of the information that's even being collected about COVID, and then, you know, obviously this like weird process of abstraction, you know, those things have been proceeding at the same time, kind of in parallel to the point where, yeah, I feel like we are just kind of limited to trying to make educated guesses from what we have, which is not great.

Artie Vierkant 1:18:34
So well, that's a bummer, but you know, in any case, I suppose I'm gonna just close this one, I'll just go ahead and say join us for COVID Year Four, which I promise is low in conjecture and high on didactic receipts [laughter]. I really — I truly, for those listening, who have like gotten this far in the episode may or may not — you know, people listen out of order sometimes, may or may not have listened to COVID Year Four already, some of you, by the time you're hearing this, I do hope you appreciate it. I've been working on it a lot.

Abby Cartus 1:20:01
Can attest.

Beatrice Adler-Bolton 1:20:02
Yes.

Artie Vierkant 1:20:03
Still have quite a bit to do on it. We've got all of us quite a bit to do on it and to record it, but I think — I think it's going to be a very good one.

Beatrice Adler-Bolton 1:20:12
Yeah. You definitely pulled like a Tim Rogers on this one. It's, uh, long.

Artie Vierkant 1:20:15
Yeah, I'm entering my — I'm entering my auteur era. But anyway, yeah, so join us for that on Monday, the story of sort of fall 2022 and what we have experienced thus far of 2023, in the sociological production of the end of the pandemic, and thank you all for listening.

Beatrice Adler-Bolton 1:20:36
Yeah, and if all goes well, this will be the very first episode with all five of us on at the same time.

Abby Cartus 1:20:41
[gasping]

Artie Vierkant 1:20:41
You're gonna jinx it. You're gonna jinx it if you say that.

Beatrice Adler-Bolton 1:20:43
Well, you know, I think that's a good place to leave it.

Abby Cartus 1:20:46
It's called manifesting.

Beatrice Adler-Bolton 1:20:47
It is manifesting, right. This is a good spot to leave it. We have a lot of work to do for COVID Year Four. To support the show, become a patron at patreon.com/deathpanelpod, to get access to our second weekly bonus episode and entire back catalogue of bonus episodes. Sincerely, truly, deeply from the bottom of our hearts, patrons, thank you so much. I really am not sure how any of the work that we've done this year would have been possible without your support. So really deeply appreciate it. And cheers to another year of talking through the horrors together, right. And if you'd like to help us out a little bit more, share the show with your friends, post about your favorite episodes, pick up a copy of Health Communism at your local bookstore, pre-order a copy of Jules' new book coming in January, called A Short History of Trans Misogyny, or request them both at your local library, and follow us @deathpanel_.

As always, Medicare for All now.

Artie Vierkant 1:21:49
Free Palestine.

Beatrice Adler-Bolton 1:21:50
Free Palestine. Solidarity forever. Stay alive another week.

Death Panel 1:21:55
[ Outro music ]

Transcript by Kendra Kline. (Kendra is currently accepting freelance transcript work — email her if you need transcripts!)