"Finally,” Andy exclaimed. "A way to make the pandemic just like sports!”
OK, I never said that. But I’ll admit I got a little nostalgic when state leaders revealed the Unified Response Scoreboard last month, the official way they will track the battle against the pandemic. A scoreboard? That’s what I used to do in the good ol' days before March 11, as a beat writer covering the Utah Jazz (which I still do).
But, well, real life is more complicated than sports. And as much as I’m glad we’re tracking key data points, this scoreboard, updated each Thursday with the previous week’s data, is an incomplete, imperfect representation of what we should be striving for. And to the extent that it does show the status of our fight against the coronavirus, it shows that we’re not making headway, at least when it comes to improving the health of the state.
Let me show you what I mean. Feel free to follow along with the state’s scoreboard with me.
The big goals
The state’s scoreboard is split into two parts: the master goals and then various secondary goals.
The two master goals are keep the state’s case fatality ratio below 1% and reduce the monthly unemployment rate below 4.5%. Right now, it’s doing just one: the case fatality rate is at 0.61%. But the September unemployment rate jumped to 5%. The August rate was 4.1%.
On the face of it, those goals make sense. An effective response should seek to maximize health and minimize those who are unemployed.
But I have a problem with using case fatality ratio to measure improved health in our community. Health is not what case fatality ratio measures: it is simply Utah’s deaths divided by the total number of cases. That means mathematically, there are two ways to improve your case fatality ratio: decrease the number of deaths (great!), or increase the number of people who test positive (not great).
Now, you can make an argument that this incentivizes the state to expand its testing, whereas otherwise it may have fallen trap to the “no testing, no problem” narrative some right-wingers have pushed. But it also incentivizes the state to not worry about or even encourage cases among those relatively unlikely to die — the young, those without preexisting conditions, etc. That’s problematic, because those people spread the disease to those who are more susceptible to serious illness. And that’s exactly what we’ve seen in recent weeks: high numbers of cases among young people, a delay as it spreads to older populations, and then increased death.
Quite frankly, I also have a problem with the 1% target goal for the fatality ratio: I don’t think Utah could get it above 1% if it tried. The truth is Utah has the youngest population in the nation, by a wide margin. It also has probably the healthiest population in the nation, even once you adjust for the young age. Utah also has a high percentage of citizens with health insurance. Take all of that and then add the improving therapies doctors and scientists have provided and I don’t think we’ll see Utah’s case fatality ratio ever get close to 1% from here on out.
The state’s response doesn’t have much to do with that, it’s just the nature of the demographics and natural scientific progression of treatment. It’s being born on third base and thinking you hit a triple. That we’re currently excelling in the case fatality ratio despite the sustained coronavirus spike in cases and deaths shows exactly how broken it is as a quality measurement.
A better and far more obvious goal to pursue would be to minimize the number of deaths overall. Even then, as Dr. Angela Dunn pointed out on a Twitter thread discussing case fatality ratio on Thursday, death isn’t the only bad outcome from getting the coronavirus.
The secondary health goals
The state’s unified response team also set up secondary health goals. The good news is that these are more logical benchmarks, but the bad news is the state isn’t accomplishing them.
For example, one is to reduce the number of overall cases — keep it at under 400 per day. That’s a rough one with the state’s average now above 1,200.
The response team also wants to create an effective contact tracing apparatus, one that can trace 75% of Utah’s cases back to a known contact. Such a goal also has the benefit of reducing danger for people in the community who don’t know anyone currently infected. It takes time to contact trace each infected person, and I’m sure those contact tracers are working hard, despite some people actively refusing to participate. But the state isn’t making progress toward that 75% goal in recent weeks.
Another great goal: the state wants to make it so 90% of people get their coronavirus tests back in under 24 hours. On this goal, we’re nowhere close: only 30% are getting their results back that quickly, nor can you say there’s a great trend toward getting tests back faster. This is a real failure of our current system.
The response team is also seeking to reduce the share of cases that our Hispanic and Pacific Islander communities face. Those two groups have been disproportionately affected by the virus so far. But the state’s goals are still skewed — for example, it is shooting for 34% of cases to be Hispanic ones, but only 14.2% of Utah’s citizens are Hispanic. In my mind, equality should be the goal here.
Regardless, we have seen improvements here: the disease is less disproportionately impacting those races than before.
It’s also clear from the data that the state’s past approach of begging people to wear masks did nor result in increased mask usage. Mask compliance is still well under the goal of 80%.
The state also wants to improve its response with high-risk individuals, including those in long-term care facilities. And here too, it’s hard to point to progress. For example, the state has a goal of under 100 high-risk cases per day. We’re currently around 300 high-risk cases per day. The state wants there to be fewer than 10 long-term care facilities with active coronavirus cases. Instead, there are more than 40.
And finally, it wants to limit the size of outbreaks overall. Any outbreak of COVID-19 is bad, but those outbreaks with 10 or more cases can get especially out of hand. And so far, we’ve fallen short of the state’s 90% target there.
You can tell that we’re failing our pandemic goals just from the number of cases we’ve had in the last month, but the scoreboard reveals all of the different ways we’re falling short.
Secondary economy goals
More economic goals have been achieved than health goals.
We have made progress on healing Utah’s economy. We have seen unemployment claims continue to fall since the early stages of the pandemic.
Some of the decrease in claims is because people have exhausted their benefits and some because people are out there trying to find jobs. That partially explains the jump in the unemployment rate from 4.1% to 5% — more people entered the job market. But there were also 24,300 jobs cut in hotels, restaurants, and bars in Utah in the month of September as the summer ends.
It’ll be interesting to see how these metrics change over the fall and winter. Most of the economic data that comes in lags our coronavirus reporting system, so we don’t have a terrific idea of how increased cases recently have changed these numbers. In general, places that have had big coronavirus spikes, like Utah is currently experiencing, felt economic consequences as people are less confident in visiting businesses.
That being said, it looks like Utah’s business outreach programs are working. Last week, 2,628 businesses were reached by the state’s business safety employees to discuss and provide tips on how to best achieve safe workplace operations, well above the 1,700 business goal. The state received 12.1 million impressions on its InUtah campaign, which uses federal funds to try to attach Utah consumers to safe businesses. That, too, well exceeds the goal of 2.5 million impressions.
You can argue the programs are working to prevent viral spread in Utah’s businesses. The bad news is that Utah’s workplace cases are well above the target goal of 70 per week. But at least they’re a smaller share of cases than they were earlier in the pandemic.
Another secondary goal is to get Utahns enrolled in various short-term and certificate job training programs, so that they can use this time to improve their job skills. And here, again, Utah’s exceeding expectations: 12,797 Utahns have enrolled, compared to a goal of 4,500. That includes those taking advantage of Utah’s Learn And Work program from the governor’s office.
This review of the state’s own goals shows why Gov. Gary Herbert decided to dump the color-coded restriction rules and impose tougher restrictions this week. Clearly, the fight against the pandemic is being lost at the moment. We’ll see how the move to broad mask requirements and smaller gatherings impacts that battle — and keep an eye on the Unified Response Scoreboard, just as Utah’s leaders are.
Andy Larsen is a data columnist who is focusing on the coronavirus. He is also one of The Salt Lake Tribune’s Utah Jazz beat writers. You can reach him at firstname.lastname@example.org.