When Mandarin Class behaviors undermine trust

A fascinating epistemic case study.

You’re a veterinarian. https://t.co/VOjozE60RP

— Sean Davis (@seanmdav) July 31, 2021

It appears that Sean Davis is correct.  Dr. Debby Burnett is indeed a trained, licensed and practicing veterinarian.   She has a secondary career as a physical therapist.  She is pictured, masked up, in an empty physical therapy room.  She says in her tweet:

I work on the COVID floor at my hospital. It's full. 

The entire floor + the ICU are at capacity w/ COVID patients — almost all unvaccinated.

Our district has one of the lowest vaccination rates because our rep Lauren Boebert spreads lies & misinformation about the vaccine.

What is the truth here?  It is complicated by the fact, not immediately obvious in the tweet, that Burnett is running against an incumbent and that she is politicizing a medical issue in pursuit of political ends.

Is the first statement, "I work on the COVID floor at my hospital" true?

Hard to tell.  A veterinarian cannot treat Covid-19 cases but she is clearly implying that she is working on Covid patients.  I can see only two ways for this statement to have a possible means of being true.  She might, as a physical therapist, work on the same floor where the Covid treatment center is located.  It seems unlikely, though remotely conceivable, that she does work as a physical therapist in the Covid treatment center.  

How about "It's full" and "The entire floor + the ICU are at capacity w/ COVID patients"?  Let's unwrap this to get at the truth.  She works at the Cheyenne Regional Medical Center, in Wyoming with a rated 222 bed capacity.  Cheyenne City has a population of about 64,000 though CRMC probably serves a somewhat larger population than just the city.  As of July 30th, Cheyenne had 33 cases and a rolling 7-day average of 24 cases of Covid-19.  Hospitalizations is a harder number to nail down but it appears that CRMC had 24 Covid hospitalizations as of July 20th.  In terms of deaths, there have been four deaths since February 24th and a rolling 7-day average of 0 deaths.  

We know that CRMC has 222 beds.  How many are dedicated to Covid treatment?  I can't find an answer to that.  However, from this report, we know that only 68% of inpatient beds are occupied and only 55% of ICU beds are occupied.  This compares to the peak in November 2020 when the numbers were 89% and 88% respectively.  However, that peak load was because the number of beds available were reduced from 250 to 190 for a month for reasons I cannot determine.

At the end of July 2020, with a bed capacity of 250, CRMC was running at 61% inpatient beds occupied and 90% of ICU beds occupied.  However there were only 14 ICU beds then compared to 25 now. Compared to a year ago 2020, overall all-treatment bed use has increased marginally from 61% to 68% but ICU bed use has plunged from 90% to 55% utilization.  

2017, pre-Covid-19,  average hospital bed utilization was 66%, not materially different from CRMC's current 68%.  Average US ICU occupancy rate just pre-Covid in March, 2020 was 63% compared to CRMC's lower utilization rate of 55% today. 

How about "Almost all unvaccinated"?  Almost certain to be true for Cheyenne given that it is true for the US.  42% of Wyoming is vaccinated compared to 56% for the US.  The more people who are vaccinated and the more people who have had Covid-19 and survived (and therefore with natural immunity), there are fewer people at risk.  Vaccinated with subsequent infection are a very low number of cases.  Therefore, of course, the bulk of infections must be coming from those who are not currently vaccinated.

Where is the data on "Our district has one of the lowest vaccination rates because our rep Lauren Boebert spreads lies & misinformation about the vaccine?"  Vaccine refusal and vaccine hesitancy are both multi-causal in nature and no one has made the case that a singular factor (such as Lauren Boebert) will have a determinative affect on outcomes.  If one believed that politician's statements affect large swarths of the electorate, then Burnett would need to address the fact that a year ago, Biden and Harris were both disavowing the vaccines developed under Trump as being dangerous and unreliable.  Since Burnett does not specify what lies and misinformation are being spread, it is impossible to evaluate this claim. 

How is Burnett doing so far?

"I work on the COVID floor at my hospital" - She seems to be indicating that she is a physician who works in the Covid unit of her hospital.  That is clearly untrue.  She is a veterinarian and physical therapist.  She might have visibility on the Covid unit activity by being in its proximity but she is not a physician nor does it appear likely she works in the Covid unit.  Untrue.

 "It's full" - It can't be completely ruled out that there might have been an hour or a day where there might have been a backlog or complete capacity utilization.  But that is extremely unlikely given the weekly reported capacity utilization of all beds of 68% and the weekly reported capacity utilization of ICU beds of 55% for her hospital.   Untrue.  

 "The entire floor + the ICU are at capacity w/ COVID patients" - Almost certainly untrue; see above stats.  Untrue.

 "Almost all unvaccinated." - Almost definitionally true.  The more people who have been vaccinated plus the number who have already had Covid-19 (and are therefore mostly immune), the more the remaining cases must be among the unvaccinated.  True.

"Our district has one of the lowest vaccination rates because our rep Lauren Boebert spreads lies & misinformation about the vaccine." - Almost certainly false.  Vaccine refusal and vaccine hesitancy have multi-causal origins.  In particular, among the vaccine hesitant, the plurality are Democrats.   Republicans are only a small portion of the vaccine hesitant issue.    Untrue.  

Again and again, research is finding distrust to be a primary barrier among the vaccine hesitant and the vaccine refusers.  Burnett is tweeting out a message consisting of five empirical claims, of which four are definitively or nearly certainly untrue.  Burnett is also casting her tweet in a partisan political context, further driving division and reducing trust.  

Is not inherent in her tweet but Burnett cannot help but be tarred by the attitude of her fellow alarmists - a markedly classist disdain.  The claim is repeatedly made that the vaccine hesitant and the vaccine refusers are Republicans and less intelligent, poorer, less educated, etc.  This is clearly is more a class issue than necessarily a partisan issue.  I would wager that Administration, Congressional, Judicial leaders at the Federal, State and Local levels probably have vaccination rates at least in the 80s and are much closer ton one another (across the political divide) than either are to the national average.  

Disdain of the Mandarin Class for the average American is strong.  Burnett being a white collar professional, reinforces the latent class dimension of this hectoring campaign for vaccination.  

While Burnett cannot be faulted that she is striking the same dismissive hectoring tone so many others are using, she can be held to account for truthful communication.  As it stands, it appears she is substantially deceptive (not a physician, not likely to be involved in Covid-19 treatment, not likely that the hospital is full as she claims, no deaths) and using the concerns about a possible spike in cases as the foundation for a partisan attack.  Exactly the behavior which drives people to distrust the government and the Mandarin Class.  She is fueling the very problem of which she is complaining.

Or so it appears based on the known facts.