Shasta County’s Disease Detectives And the Fight Against COVID-19

Over the early months of 2022, Shasta County’s COVID-19 positivity rate soared as the Omicron variant spread. For county epidemiologists it was yet another leg of what has been a multi-year sprint to keep up with an unpredictable and deadly virus. Shasta Scout went inside Public Health to learn more about the disease detectives whose quiet diligence is slowing COVID’s spread.

2.3.2022 5:17 am: An earlier version of this article incorrectly stated Shasta County’s 2021 death rate in comparison to California’s. Shasta County’s 2021 death rate is currently known to be almost twice as high as California’s state-wide rate for 2021, as we correctly cited in a data table in the article. We have archived this important correction. You can see our corrections policy here and submit a correction here.

Almost two years ago, when COVID first appeared in Shasta County, local epidemiologists already had a full workload: tracking, monitoring, and providing education and resources around important health issues like smoking, Alzheimer’s, sexually transmitted diseases and opioid-use problems. But with the onset of a global pandemic that’s taken the lives of over 500 Shasta County residents in the last two years, their work has expanded exponentially.  

Epidemiologists are public health scientists who investigate the patterns and causes behind diseases and injuries through research and data. Their findings reduce public health risks by informing government policy-making and educating the community. Locally, their work has become much more public and central to community life as COVID-19’s profound effects on Shasta County have taken center stage, thrusting the often quiet and unassuming data scientists into a more crucial role, and into the public’s eye.

As community members have caught hold of data usually only of interest to health scientists, the epidemiologists have faced a huge new challenge: how to communicate complex numbers and patterns they spent years learning to study in a way the rest of the community can understand.

“There’s a difficulty of trying to convey the level of risk that is shown to us by the math,” Daniel Walker, Shasta County’s Supervising Epidemiologist, said “but without necessarily emphasizing the numbers themselves.” That’s because those detailed numbers often cause confusion, he said, playing into fears caused by viral misinformation to create further opposition to COVID-19 precautions and restrictions. 

Epidemiologists are also facing another challenge. Provoked by COVID-19 misinformation, some members of the community have become hostile to the work of public health. Public comments at board of supervisor meetings have called for the resignation or firing of Shasta County’s Public Health Officer, Dr. Karen Ramstrom, who oversees local health regulations and threats against Dr. Ramstrom have, at times, been serious enough to lead to extra police patrols near her home.

Kerri Schuette, a branch director for Shasta County’s Health and Human Services Agency (HHSA) says the visible and political nature of the work in recent years has been a big change. “No one even knew what an epidemiologist was until two years ago,” she said. Now, in the face of public scrutiny and often angry community opinions, Schuette stays focused on the clarity of purpose she shares with her team: protecting the health and lives of community members.

Unfortunately, Walker says, community confusion and anger have made his job, and hiring to fill vacant staff positions on his team, more difficult at a time when the workload is already overwhelming. “We came into this position wanting to serve the community,” Walker said, “It’s hard when the community doesn’t feel like what we’re doing is valid or worthwhile.”

Walker said he and the others on the epidemiology team continue their work despite community complaints and opposition, “because we know its purpose. We know that we’re giving out the most accurate and correct information that we can.”

Epidemiology is vital to public health work but it’s often not well understood. Here’s what epidemiologists do, and why it matters.

Epidemiology Includes Research, Data Analysis, and Education

Left to right: Epidemiologists Jeff Van Audsall and Sarah Adams, Epidemiology Supervisor Daniel Walker and former Shasta County Epidemiologist Rene Santana

In Fiscal Year 21/22, Kerri Schuette says, Shasta County’s epidemiology team cost the county $572,000 or 0.5% of the overall Health and Human Services Agency (HHSA) budget.

The team regularly collaborates to examine COVID data and evaluate and recommend how data science can best be communicated both locally and regionally. They also review local hospitalizations and deaths to identify which of them were actually due to COVID-19.

It’s work they’re clearly proud of, in their quiet, determined way. “Epidemiology is the science of asking the right questions,” said county epidemiologist Sarah Adams. “What we do is take all of the available information and essentially put it through a filter. We try to figure out what data is most important to look at, what is most central to the story, and what we can use in order to get the whole picture of what’s going on.” 

The team, which currently includes 3 epidemiologists and one supervisor, three of whom have masters in public health but still make less than $80K annually, are the quiet minds collecting and mining the COVID-19 data that determines much of how the county allocates resources and educates the public.

By viewing that data through the lens of scientific analysis they provide the public and decision-makers with an overarching story, one that explains how public health policies and resources around individual factors like testing, can affect an entire population and its sub-groups.

Graphics from the Cal-Cat statewide modeling and planning COVID website.

Across California, CalCat, a state assessment and modeling website, is used by both regional and local epidemiologists to inform responses to the pandemic. Local epidemiologists also analyze which of those state-provided modeling predictions are most in line with Shasta County data in order to form predictions on what might lie just ahead in the county’s fight against COVID. 

This kind of modeling, which is based on data and the latest science about COVID, informs the ongoing county-wide pandemic response, allowing officials to prepare for expected surges in hospitalization and helping to ensure necessary supplies arrive in time to respond to increases in COVID-19. 

The caveat, Adams said, is that the models are “always a projection, the best guess.”

Complex Data, Useful for Scientists, Can Lead To Confusion and Misinformation

“If I get vaccinated can I still get sick and die?” The answer is “yes … but” said Shasta County epidemiologists, who explain that while anyone can die from COVID-19, it’s important to understand how risk levels vary depending on vaccination status. 

Trying to provide the community with an understanding of those risk factors has been challenging, they said, because many struggle to understand the complex data that’s become public in response to COVID-19.

“When you get too far into the weeds with numbers,” Walker said, “people get kind of lost and confused and that’s where conspiracy theories seem to take a lot of root.“  

It turns out, epidemiologists said, that too much data actually seems to spike misinformation.

While epidemiologists undergo careful and thorough training in data assessment that allows them to scientifically determine risk levels and help plan population-wide responses, most community members are just beginning to understand new ways of thinking about complex data in the midst of a scary pandemic. 

For example, early in the pandemic, individuals frequently confused data related to influenza and pneumonia deaths with similar-sounding but quite different numbers related to COVID deaths, local epidemiologists say, thinking similar-sounding percentages (0.1% death rate for influenza and pneumonia and 2–2.5% death rate for COVID), were basically the same/ But those numbers, the epidemiologists point out, are actually hugely different, indicating that COVID death rates are 20–25 times higher than those for the flu. 

In response to this tendency to misunderstand, Walker said they’ve worked to communicate the risks associated with COVID without focusing too much on complex details. “When you give a specific,” he said, “but then there’s something you can fudge, then it seems to encourage the mindset that something must be wrong with these numbers, someone must be tricking us.” 

Misinformation Leads to Vaccine Resistance and Increases Deaths

The epidemiology team told Shasta Scout that while they find the public’s confusion understandable, resistance to the COVID-vaccine among Shasta County residents is also difficult for them to accept.

That’s because the regional and national vaccine efficacy data is so very clear. As of February 16, 2022, California data indicates fully vaccinated and boosted individuals are 11.7 times less likely to be hospitalized from COVID-19 and 17 times less likely to die from the disease. Those are real numbers, driven by real data, that could save lives if they’re believed.

But in Shasta County, vaccine misinformation has contributed to hesitancy, which has sharply decreased vaccination rates. County-wide, as of February 18, only 52.8% of county residents ages 5 or older are fully vaccinated. Compare that to California’s state-wide vaccination rate of 75.6% and you understand why Shasta County’s COVID death rate is also so much higher than California’s. During 2021, Shasta County residents were almost twice as likely to die from COVID-19 as other Californians, on average. And during a point-in-time count in October, local news documented Shasta County’s death rates at 6 times the state-wide death rates.

Data provided by Shasta County HHSA, sourced here. 

These sobering statistics on the importance of vaccination are difficult for the local epidemiology team to take in. “We’re very passionate about the topic of vaccinations” said HHSA Branch Director Schuette. “It’s very frustrating to all of us who’ve been working on this response for almost two years now.”

COVID Responses Follow National “Playbook” for Disease Response

Conspiracy theories linking virus mandates and restrictions to global population control ignore the ongoing and well known science behind the field of public health and the steps that have long been taken to reduce pandemic risk. 

“So if you imagine a scenario in which we have a new flu that’s a lot more dangerous, spreading very quickly and not covered by vaccines,” Adams said, “we have a playbook nationally that we’ve laid out for that sort of thing and things to follow, and that playbook is the same one we ended up using for COVID.” Adams was referencing a 69-page National Security Council document that outlines how the government should respond to a pandemic.

The pandemic playbook’s contents, serve as a rebuke to widely-believed conspiracy theories that government COVID-19 responses are the work of powerful bad actors intent on global domination. The text, written in 2016, long before COVID entered the world’s consciousness, underlines the seriousness of pandemic threat and the corresponding thoroughness that must govern federal, state and local responses.

“The U.S. government will use all powers at its disposal to prevent, slow or mitigate the spread of an emerging infectious disease threat,” the pandemic playbook reads, in a section which seems to foretell the new kinds of government control and interference in daily life that have been enacted California-wide during this pandemic.  

According to some national officials, the specificity of the pandemic playbook was designed to “eliminate the fog of war” and “piecemeal thinking” during a national public health battle such as the one we’re in now. 

Data > Anecdotal Evidence

Much of the misinformation and confusion about COVID-19 that spread so easily can be traced back to community members believing anecdotal evidence rather than relying on data. But anecdotal evidence, or stories based on personal experience, tell very little of the story, especially with a disease that’s affecting a global population. We might know several people who’ve gotten COVID after being vaccinated, but that doesn’t mean the vaccine isn’t effective for preventing deaths and hospitalizations.

That’s why we have data, Walker said, to show us the true picture of what’s happening when the picture is too big and complex to understand without it and when our limited world view skews our understanding of how COVID might impact others.

The epidemiology team easily acknowledges that data science does have the potential for errors. They say they work hard to prevent mistakes by consistently double-checking each other to provide improvements in analysis and statistical methods, and to search for potential biases that could interfere with the science. 

Walker said data scientists can fall prey to the same mistakes as everyone else. “Sometimes we hear stories or things happen anecdotally that lead us to believe one thing,” he said, but then when we look at the full story, all the data, and we analyze it, many times it proves us wrong.”

Being proved wrong by data is an opportunity to listen and learn from objective numbers and analysis in order to create better health outcomes for Shasta County, Schuette said. “Data doesn’t always tell us the story that we’re expecting to hear,” Schuette said, “but that’s a good thing.”

Flatly rejecting the idea that’s been floated by some community members, that politics influences epidemiological work, Schuette said: “I have never asked any of them if they are Republican, Democratic, conservative or liberal, because it doesn’t matter,” she said. “They are experts in data.”

This is the first in a Shasta Scout miniseries on epidemiology, a subset of county public health. Our COVID coverage is currently supported by a grant from the United Way of Northern California. Grant funding does not impact Shasta Scout’s editorial independence.

Do you have feedback on how we are covering COVID-19 or other topics?  Email us, or join the community conversation at Shasta Scout’s Facebook page. Do you have a correction to this story? Submit it here.

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