Public Health Officer Dr. Wilma Wooten speaks at a San Diego County news conference on the coronavirus, March 19, 2020. (Zoë Meyers/inewsource)

Since the beginning of August, public comment during County Board of Supervisors and San Diego City Council meetings has seen more and more residents calling on elected officials to end the local state of emergency that was put in place at the beginning of the pandemic. 

Those going before decision-makers say that the threat of COVID-19 is no longer there, instead asserting that the vaccine should be at the center of concern regarding severe illness — not the virus itself.

Why this matters

Misinformation has complicated efforts to mitigate the spread of COVID-19, creating confusion about what facts are available and undermining trust in medicine. Experts say misinformation has pernicious effects, influencing individuals to engage in riskier health behaviors that could lead to severe disease or death.

These, mostly anti-vaccination advocates, have been using data from the county on loss of life to back up their claim, arguing that issues with the vaccine’s safety and effectiveness are illustrated by figures suggesting that vaccinated and boosted individuals have accounted for the majority of the deaths over the last few months.

An inewsource analysis shows such rhetoric is untrue: Unvaccinated individuals have had the highest death rates this year, so far.

Compared to those who have received the COVID vaccine, unvaccinated San Diegans have seen a death rate that is four times higher than those who are considered fully vaccinated and nine times higher than those who received at least one booster.

Public health experts stress that context, such as population size, are important factors to consider when interpreting available county data.

“Data can be manipulated in a lot of different ways and data without context can be especially difficult to interpret,” said Dr. Michael Gisondi, vice chair of education for the Department of Emergency Medicine at Stanford University. 

Gisondi and others say that claims based on an analysis of official data without understanding these additional facts are examples of misinformation — or information that is misleading, false or inaccurate.

Misinformation has been a pervasive issue for officials since the beginning of the pandemic, impeding public health efforts to combat the virus by undermining trust in medical institutions and influencing individuals to engage in riskier health behaviors.

With shifts nationwide away from government intervention to mitigate further spread of COVID, disseminating credible and factual information to individuals to enable them to make decisions about their health has become increasingly important, which county officials say is complicated by the circulation of misinformation.

“The assertion regarding the deaths is being promoted by advocates who well understand that selecting this statistic out of context can lead to false conclusions,” county spokesperson, Michael Workman, said in an email. “Those who have cherry-picked percentage data to argue against the effectiveness of the vaccine are doing so intentionally.”

COVID Deaths in San Diego

Interpretations of county-reported data have gained traction on social media over the last few weeks stating that the majority of COVID-related deaths since April have been among those who have received two or more doses of the vaccine. 

These statements have frequently implied that the shot is ineffective at reducing severe outcomes, which is what the vaccine was intended to do. 

Most of these claims seem to be based simply on the sum of numbers relating to deaths by vaccination status, pulled from the weekly COVID watch report published by the county.

inewsource analyzed this report and several other county data sources to understand the extent that vaccination status has impacted severe outcomes, such as death.

For the months between April 1 and Aug. 20, inewsource identified 153 COVID-related deaths recorded by the county across their various dashboards — 57 of which were unvaccinated, 42 were considered fully vaccinated, and 54 had received a booster shot.

Public health experts say that taking a “purist approach” to look at these numbers regarding groups with different population sizes would be a misinterpretation of the data. Looking at rates, they say, is a much better way to analyze differences between these groups.

“You’d never use raw numbers or percentages of total deaths to compare populations of different sizes,” said Dr. Corinne McDaniels-Davidson, director of the San Diego State University Institute for Public Health. 

“That would be like saying that most of the deaths that happen in California and Alaska happen in California,” she continued. “Of course they do…the population of California is exponentially larger than that of Alaska.”

inewsource’s analysis of county-reported COVID deaths found that unvaccinated individuals have seen higher rates of death adjusted for population size compared to vaccinated and boosted individuals.

This year through August, unvaccinated individuals accounted for 55 percent of the 929 COVID-related deaths, with fully vaccinated and boosted individuals accounting for 31 percent and 15 percent respectively.

Approximately 80 percent of people living in San Diego County are considered fully vaccinated — meaning they completed the original two-dose series for Moderna or Pfizer, or received the one-dose Johnson & Johnson vaccine — with about 59 percent of eligible residents having received a booster.

When adjusted for population size, unvaccinated individuals saw about 77 deaths per 100,000 — a rate that is four times higher than vaccinated individuals and nine times higher than those who received at least one booster shot.

The pandemic has especially impacted older San Diegans, making up the majority of deaths from COVID despite having a smaller population in the county. 

Mortality rates for those over the age of 45 jumped about 30 percent between 2019 and 2020, becoming the third leading cause of death after the beginning of the pandemic. Mortality data is not available yet for 2021 and 2022.

COVID death rates for those over 45 during the months of April through August of this year fell by about 80 percent compared to 2020 — when there was no vaccine. Overall deaths have also significantly decreased since the same time last year, falling by approximately 60 percent. At the time about 60 percent of San Diegans were considered fully vaccinated.

One of the primary voices raising the issue of deaths over the last few months, social media influencer Shaun Fredrickson, did not directly contest inewsource’s analysis, he argued that it’s difficult to explain any decreases in the number of deaths between years by vaccine use.

“There’s no study that’s been done observing two people, one fully vaccinated and one fully unvaccinated, who are like twins, where you can have a case study to verify (the vaccine’s effectiveness),” he said.

Fredrickson continued asserting that it is also difficult to jump to conclusions as he said there has been no research done on individuals who engaged in alternative COVID treatments, such as changes to dietary or physical health regimes, use of Ivermectin — an antiparasitic drug — and Hydroxychloroquine — a drug used to treat malaria and lupus.

However, there have been studies on Ivermectin and Hydroxychloroquine for COVID care.

Tested in a clinical trial setting, both were found to be ineffective at preventing serious illness in COVID patients, prompting the Food and Drug Administration to recommend against use for the virus. Use of Hydroxychloroquine alone was also found to cause adverse health issues such as heart problems, liver failure, and increased mortality.

Fredrickson, however, doubled down: “Claiming that because the vaccine has been injected in so many people, it must be working…that’s fallacious.” 

“If the death rate dropped randomly in 2022, why would we associate it with the vaccine?” he said. “Why would we not associate it with exercise or diet…How do we not associate it with the keto diet? How do we just blanket give this credit to the vaccine?”

Experts would agree that context is important to understand why there might have been decreases in the number of deaths this year so far and that it’s difficult to know the full extent that the vaccine has impacted rates of severe outcomes.

However, they said that it’s more likely that factors such as availability of vaccines, mutations of the virus, and antiviral treatments like Paxlovid have had the most impact on trends compared to individual diet choices. 

“There is no doubt that vaccinations have saved lives and prevented hospitalizations,” Workman said on behalf of the county. “(But) deaths are only one measure of the severity of the pandemic. It continues to disrupt families, businesses, leave growing numbers of people with long COVID and endanger individuals who are immunocompromised or otherwise at greater risk.”

What does the COVID vaccine do?

A frequent argument made by those like Fredrickson, who are promoting these kinds of incomplete interpretations of county-reported data, is that the vaccine is ineffective due to the fact that people are still dying despite being considered “fully vaccinated.”

“Regardless of the number of people that are in each of those categories, it doesn’t really matter,” Fredrickson said in reference to a question about inewsource’s analysis. “(Officials said) ‘you take it, you won’t die or get sick.’ And the problem lies in the fact that people still are dying.”

Experts say that is a common complaint which stems from a misunderstanding of what the COVID vaccine is designed to do: to decrease the likelihood of hospitalization and death — not entirely prevent it from happening.

An employee of the Imperial County Public Health Department prepares to administer the COVID-19 vaccine on Dec. 18, 2020. (Courtesy of Imperial County)

“There are some vaccines that do a great job of protecting against infection, but there are some that aren’t necessarily designed to do that,” McDaniels-Davidson said. “The thing that they were looking for (with the COVID vaccine) was protection against severe disease and death. Not necessarily against infection.”

Each vaccine is unique, with the makeup and goal of protection differing depending on the virus and its structure. Very few vaccines have the ability to induce “sterilizing immunity,” which is the ability to completely stop infection, given how difficult it is to achieve.

Research shows that the COVID vaccine is effective in minimizing the risk of hospitalization or death, in some cases protecting against a symptomatic infection — though asymptomatic or a mild illness still remains a possibility.

One analysis of eighteen studies on the vaccine found that protection against severe disease remained at about 90 percent five months after the last dose of the original series. 

Timing of when a person was infected is crucial to contextualize how this might have impacted severe outcomes, given that the vaccine wanes over time and new mutations change how the virus behaves in a community.

Some experts look to the Omicron surge as the best example of this: Case numbers during the wave were significantly higher compared to any other point during the pandemic, yet hospitalizations and deaths appeared to lower. At the time, scientists speculated that the variant was a less virulent strain, but estimated death rates during that time reached levels near those of the Delta wave.

Scientists are still trying to figure out exactly what this means in terms of Omicron’s lethality as a virus, but given the strain’s transmissibility experts say there could have been significantly more deaths had there not been fairly widespread vaccine coverage.

“We don’t know what we would’ve done had we not had a vaccine,” Gisondi said. “The vaccine attenuated symptoms (of Omicron) for most people. Some people were going to die, despite the vaccine, but I think there’s many more who would have (died) without it.”

Misinformation and the pandemic

Since the onset of the pandemic, misinformation — or information that is false, inaccurate or misleading — surrounding COVID-19 has been a major obstacle to public officials and experts, sowing confusion that has undermined efforts to mitigate the spread of the virus.  

In July 2021, U.S. Surgeon General Vivek Murthy issued a health advisory warning that the spread of misinformation is a “serious threat” to overall public health. A month later, San Diego County followed suit, declaring COVID-19 misinformation as an urgent public health matter in a resolution passed with a 3-2 vote by the Board of Supervisors.

Experts call the current landscape of information surrounding COVID-19 an “infodemic,” which is defined by the World Health Organization as the availability of too much information, too quickly, about a problem that is often unreliable. 

Gisondi, who specializes in research regarding the intersection of social media and medicine, explains that these “infodemics” have a wider impact on health-seeking behaviors — or any action taken by an individual when they might perceive themselves as ill or at-risk for illness including wearing a mask if needed, visiting a physician when sick, and ensuring that a person is up-to-date with their vaccines.

“Particularly on social media platforms, so much of (what’s available) is misinformation that it dilutes accurate information,”said Gisondi. “It gets harder for accurate information to get to individuals when there’s so much clouding the picture.”

“The COVID-19 infodemic, specifically, is fueled by social media,” he continued. “Still today it has deadly effects. It causes people to not get vaccinated. It causes riskier behaviors (that contribute to a) higher likelihood of infection.”

Social media has played a major role in propelling these false or misleading statements into public discourse throughout the pandemic, particularly as more individuals turn away from traditional news organizations as their primary source of information. 

But given the speed at which content is propagated and shared on these platforms, misinformation often goes without accountability or fact-checking.

While there can be benefits to discussion through these channels, platforms have faced intense scrutiny over the last few years for not doing enough to protect users against the spread of false information.

Studies of social media platform’s handling of information have found significant gaps in their efforts to combat inaccurate information, despite often having detailed policies in place and technological systems at their disposal that can help identify and debunk false claims.

One such instance of this occurred last year, when Facebook was found partially responsible for allowing one group, the World Doctors Alliance, to continually post misinformation and disinformation — which is false information shared with malintent — with little to no repercussions.

A case study of Facebook’s response to the World Doctors Alliance found that pages relating to the group grew by about 13,215% between Jan. 2020 and July 2021, with a majority of the content shared containing inaccurate, conspiratorial, or misleading claims. 

According to the report published by a UK-based think tank, Facebook’s fact checking system only flagged posts by the organization 189 times across its pages, with no other divisive action taken by the platform to address misinformation spread by the group and its members.

Inaction like failing to identify a post that is using correct information — such as facts relating to hospital funding and the number of deaths relative to vaccination status — to come to an incorrect or misleading conclusion about the pandemic allowed misinformation propped up by the group to flourish.

Beyond fact-checking processes, social media algorithms have also played a role in the furthering of the misinformation sphere. Used to create a personalized feed based on what a person likes, algorithms often create silos of information that can amplify sources with low credibility and make it harder for correct information to get to an individual.

“People make decisions about their health based on all sorts of beliefs and influences,” Gisondi said. “Many influencers are trusted sources of information for (people) — either individuals or organizations that they’ve put their trust in over the years. If those folks spread a falsehood, then that falsehood…it’s believed.”

San Diego County Supervisor Nathan Fletcher speaks at a news conference on the coronavirus pandemic. To his right is then-Board of Supervisors Chairman Greg Cox, March 19, 2020. (Zoë Meyers/inewsource)

Several of the posts shared by social media users regarding the recent claims about COVID deaths in San Diego County, including Fredrickson — who has 30 thousand followers on Instagram — and local media organization KUSI, were flagged for using accurate information to allude to the vaccine’s ineffectiveness.  

However, this has proven to be not enough to address the issue, as re-shares and additional posts by other users continue to fuel anti-vaccination rhetoric based on misconceptions about what available county data illustrates.

Given the severity and pervasiveness of the issue, combating the vast array of misinformation available on the internet continues to be one of the main focuses of those in public health.

While health agencies have struggled to effectively communicate information about the virus to the general public since the beginning of the pandemic, messaging has become an increasingly pertinent for officials, as the country has moved toward policies that shift mitigation efforts away from government intervention onto individuals.

“I do think that misinformation and the lack of clear communication is still a problem,” McDaniels-Davidson said. “There has been poor communication (particularly) from the federal government about what we know, what we don’t and how people can protect themselves.”

“We still have between four and five hundred people dying every single day (across the country) from this disease,” she continued. “I don’t think people can be proactive about their own health and about others’ health unless they fully understand the scope of the problem.”

Type of Content

News: Based on facts, either observed and verified directly by the reporter, or reported and verified from knowledgeable sources.

Danielle Dawson is a former reporting intern for inewsource through a partnership between the Columbia University Graduate School of Journalism and the Institute for Nonprofit News. Originally from San Diego, she joined the newsroom after graduating from Columbia University with a master’s degree in...