I was just reading this paper and there are several references to Nebraska as an outlier in its COVID death rate:
We also conducted robustness checks where we exclude the state of Nebraska, as there appear to be inconsistencies in reporting of COVID-19 death incidence. Nebraska has a noticeably lower death incidence than the surrounding states of Kansas and South Dakota, and in line with California, a state with one of the lowest death incidences, as shown also in other diagrams of the Johns Hopkins data for the states of the US, for example on the webpage 91-divoc.
and
One notable exception is Nebraska, which exhibited a disproportionately low COVID-19 death incidence compared to neighboring states. We were unable to identify any clear confounding factors for this anomaly, which underscores the complexity of the pandemic and the many variables at play. Further research is required to fully understand the intricate interactions between geographic, environmental, and social factors that influence the spread and impact of SARS-CoV-2.
Maybe I’m being uncharitable, but the first thing that comes to mind is the possibility that politicians or public health officials suppressed the death incidence in Nebraska. Is there research or other information out there on Nebraska’s anomalous COVID death rate?
COVID-19 data in Nebraska, which already has been scarce since the state stopped publishing a dashboard of information at the end of June, has become even scarcer.
The expiration of an executive order on Saturday means Nebraska’s health districts can no longer publicly report COVID-19 statistics, such as case numbers and vaccinations, for counties with fewer than 20,000 people.
…
Of Nebraska’s 93 counties, only 17 have at least 20,000 people. And five of the state’s 19 health districts don’t contain a single county with at least 20,000 people, meaning they can no longer report data on any of their individual counties.
Even in health districts that include larger counties, it’s greatly affecting the way they can report COVID-19 data.
The Panhandle Public Health District, for example, which covers 12 counties, now can only report individual county information for one of them. It announced Monday that it is dropping its COVID-19 risk dial because of that.
That makes it sound like the executive order was what was enabling them to report the numbers, and once the executive order expired, they had to stop. But what made them stop? Was there some other law that the executive order was somehow overriding?
It has to do with HIPAA privacy protections and identifiable information that could tie report statistics back to individual patients:
2. All geographical subdivisions smaller than a State, including street address, city, county, precinct, zip code, and their equivalent geocodes, except for the initial three digits of a zip code, if according to the current publicly available data from the Bureau of the Census: (1) The geographic unit formed by combining all zip codes with the same three initial digits including license plate numbers contains more than 20,000 people; and (2) The initial three digits of a zip code for all such geographic units containing 20,000 or fewer people is changed to 000.
I believe this is the referenced executive order signed by then-Nebraska Governor (now US Senator) Pete Ricketts:
I’m not sure what that means. The executive order created an exception to the HIPAA “Safe Harbor” and similar state laws which restricted reporting of even anonymized health data from counties with populations of under 20,000 people specifically to permit the reporting of COVID-19 deaths. (These wee created specifically to protect the privacy and safety of patients with AIDS.) The failure to renew the order, which had an effectivity lasting until only “30 days after the lifting of the COVID-19 state of emergency” caused the dropping of reporting from low population counties; this occurred on June 30, 2021 so the last reporting would have been at the end of July in that year, prior to the SARS-CoV-2 ‘Omicron‘ wave in late 2021 and early 2022. You could argue that Ricketts prematurely ended the state of emergency at it was prior to FDA approval of the Pfizer–BioNTech vaccine in August 2021 (and broader availability only later that year) but at that point many states were dropping COVID-19 protections so Nebraska wasn’t exceptional in that regard.
I assumed it was a reference to Ricketts’ Trumpist political leanings. But the executive order wasn’t the problem, and letting it expire post-crisis was just returning reporting to be inline with prior HIPAA and Nebraska state law ‘safe harbor’ protections. It does explain, at least in part, why the relatively sparsely populated Nebraska had lower reporting of deaths (at least, after July 2021) but there were also many cases of states ‘juking the stats’ to change deaths attributed to COVID-19 into other causes to minimize the magnitude of the pandemic and undermine public health measures intended to limit contagion. The paper cited by the o.p. is unclear on whether the observation correlates to the expiration of the executive order as it brackets the period from January 2020 through March 2022.
The boundary file of the US counties was obtained from the 2018 cartographic boundary files provided by US Census Bureau 44. This study focuses on the contiguous US, excluding Alaska and Puerto Rico. As a result, this study includes 2776 contiguous counties. Notably, many counties in Nebraska were excluded due to missing data, so little to no inferences were made regarding these counties.
Would it be fair to say that short of the people involved in the decision in Nebraska government at the time discussing their motivations; we won’t know how intentional or unintentional the choice was?
