Hospital outbreak of COVID among a highly vaccinated population

7,287 Views | 70 Replies | Last: 3 yr ago by G. hirsutum Ag
abram97
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AG
From the Discussion part of the paper -

We have investigated a nosocomial COVID-19 outbreak involving the SARS-CoV-2 Delta variant among a highly vaccinated population. The attack rate among exposed individuals reached 23.3% in patients and 10.3% in staff, with 96.2% vaccination rate among exposed individuals. Moreover, several transmissions probably occurred between two individuals both wearing surgical masks, and in one instance using full PPE, including N-95 mask, face shield, gown and gloves.


In a recent publication by Bernal et al., the effectiveness of full vaccination with the Comirnaty vaccine against the Delta variant was high, although lower than against the Alpha variant (88% vs 93.7%) [9]. This was not the experience in Israel, with a rapid increase in cases since June 2021 despite a high vaccination rate [1].
Although reports of breakthrough infections are increasing [10-12], this communication emphasizes several points. It challenges the assumption that high universal vaccination rates will lead to herd immunity and prevent COVID-19 outbreaks. This was probably true for the wild-type SARS-CoV-2 virus, but in the outbreak described here, 96.2% of the exposed population was vaccinated. Infection advanced rapidly (many cases became symptomatic within 2 days of exposure), and viral load was high. Another accepted view is that, when facing a possible mismatch between the SARS-CoV-2 variant and vaccine or waning immunity, the combination of vaccine and face mask should provide the necessary protection. Although some transmission between staff members could have occurred without masks, all transmissions between patients and staff occurred between masked and vaccinated individuals, as experienced in an outbreak from Finland [12].



https://www.eurosurveillance.org/content/10.2807/1560-7917.ES.2021.26.39.2100822
No material on this site is intended to be a substitute for professional medical advice, diagnosis or treatment. See full Medical Disclaimer.
CondensedFogAggie
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How many times do we have to repeat that the vaccine isn't a force field?

OF COURSE germs/virus/bacteria can and will get into your body. THEN your immune system kicks in and tries to fight it off.

And of course this paper doesn't list how many of those infected were sent to the ICU and died, which i what the vaccine is supposed to prevent.

Let me know when we develop a vaccine that's effectively a force field, I'll travel to the creator via instant transporter
amercer
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So the vaccines were 90% effective against delta for the staff (presumably younger and in better health) and 76% effective for the patients (presumably not in great health since they are in a hospital).

That actually seems better than what has been reported for the Pfizer shot and the delta variant.
Duncan Idaho
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out of curiosty what is your speciality?
fullback44
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abram97 said:

From the Discussion part of the paper -

We have investigated a nosocomial COVID-19 outbreak involving the SARS-CoV-2 Delta variant among a highly vaccinated population. The attack rate among exposed individuals reached 23.3% in patients and 10.3% in staff, with 96.2% vaccination rate among exposed individuals. Moreover, several transmissions probably occurred between two individuals both wearing surgical masks, and in one instance using full PPE, including N-95 mask, face shield, gown and gloves.


In a recent publication by Bernal et al., the effectiveness of full vaccination with the Comirnaty vaccine against the Delta variant was high, although lower than against the Alpha variant (88% vs 93.7%) [9]. This was not the experience in Israel, with a rapid increase in cases since June 2021 despite a high vaccination rate [1].
Although reports of breakthrough infections are increasing [10-12], this communication emphasizes several points. It challenges the assumption that high universal vaccination rates will lead to herd immunity and prevent COVID-19 outbreaks. This was probably true for the wild-type SARS-CoV-2 virus, but in the outbreak described here, 96.2% of the exposed population was vaccinated. Infection advanced rapidly (many cases became symptomatic within 2 days of exposure), and viral load was high. Another accepted view is that, when facing a possible mismatch between the SARS-CoV-2 variant and vaccine or waning immunity, the combination of vaccine and face mask should provide the necessary protection. Although some transmission between staff members could have occurred without masks, all transmissions between patients and staff occurred between masked and vaccinated individuals, as experienced in an outbreak from Finland [12].



https://www.eurosurveillance.org/content/10.2807/1560-7917.ES.2021.26.39.2100822
this story is starting to repeat itself in highly vaccinated areas, regardless of where people stand on all this, what cannot be denied is that the data is starting to come out, all the confusion for everyone will come into focus soon, some of us will be wrong, others way wrong, some will be correct, it will be nice when we all understand this and can agree on what the course of action really should be
03_Aggie
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amercer said:

So the vaccines were 90% effective against delta for the staff (presumably younger and in better health) and 76% effective for the patients (presumably not in great health since they are in a hospital).

That actually seems better than what has been reported for the Pfizer shot and the delta variant.


"Presumably."
CondensedFogAggie
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fullback44 said:

abram97 said:

From the Discussion part of the paper -

We have investigated a nosocomial COVID-19 outbreak involving the SARS-CoV-2 Delta variant among a highly vaccinated population. The attack rate among exposed individuals reached 23.3% in patients and 10.3% in staff, with 96.2% vaccination rate among exposed individuals. Moreover, several transmissions probably occurred between two individuals both wearing surgical masks, and in one instance using full PPE, including N-95 mask, face shield, gown and gloves.


In a recent publication by Bernal et al., the effectiveness of full vaccination with the Comirnaty vaccine against the Delta variant was high, although lower than against the Alpha variant (88% vs 93.7%) [9]. This was not the experience in Israel, with a rapid increase in cases since June 2021 despite a high vaccination rate [1].
Although reports of breakthrough infections are increasing [10-12], this communication emphasizes several points. It challenges the assumption that high universal vaccination rates will lead to herd immunity and prevent COVID-19 outbreaks. This was probably true for the wild-type SARS-CoV-2 virus, but in the outbreak described here, 96.2% of the exposed population was vaccinated. Infection advanced rapidly (many cases became symptomatic within 2 days of exposure), and viral load was high. Another accepted view is that, when facing a possible mismatch between the SARS-CoV-2 variant and vaccine or waning immunity, the combination of vaccine and face mask should provide the necessary protection. Although some transmission between staff members could have occurred without masks, all transmissions between patients and staff occurred between masked and vaccinated individuals, as experienced in an outbreak from Finland [12].



https://www.eurosurveillance.org/content/10.2807/1560-7917.ES.2021.26.39.2100822
this story is starting to repeat itself in highly vaccinated areas, regardless of where people stand on all this, what cannot be denied is that the data is starting to come out, all the confusion for everyone will come into focus soon, some of us will be wrong, others way wrong, some will be correct, it will be nice when we all understand this and can agree on what the course of action really should be

Data is out, nobody who knows anything about medicine and statistics is confused, anti vaxxers are wrong almost every single time, correct course of action has long since been defined.
abram97
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AG
You seem to be very confident in your knowledge and very close minded about other people's data/thoughts on the matter.
No material on this site is intended to be a substitute for professional medical advice, diagnosis or treatment. See full Medical Disclaimer.
Stringfellow Hawke
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AG
Posted it before and will repost now. Myself and other medics worked the 18 months without a vaccine and wearing standard isolation or N95 masks. Since being required to become vaccinated, number of infections have increased as well as admissions to ICU.

The only thing that makes sense is the vaccine is making things worse as opposed to making things better.

Just my opinion.
ORAggieFan
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Stringfellow Hawke said:

Posted it before and will repost now. Myself and other medics worked the 18 months without a vaccine and wearing standard isolation or N95 masks. Since being required to become vaccinated, number of infections have increased as well as admissions to ICU.

The only thing that makes sense is the vaccine is making things worse as opposed to making things better.

Just my opinion.

The vaccine that has way less people hospitalized and dying is what's making things worse?
Gordo14
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Stringfellow Hawke said:

Posted it before and will repost now. Myself and other medics worked the 18 months without a vaccine and wearing standard isolation or N95 masks. Since being required to become vaccinated, number of infections have increased as well as admissions to ICU.

The only thing that makes sense is the vaccine is making things worse as opposed to making things better.

Just my opinion.


Peak anecdotal evidence right here.
NASAg03
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Maybe this scientific evidence is more convincing:

https://link.springer.com/article/10.1007/s10654-021-00808-7?fbclid=IwAR38IMIdNndQHkEKPx2MVDcQladf0o2uWatwHZLKn7DBOM7eLpjKrFxB8w0

Study in the European Journal of Epidemiology. 68 countries and 2947 counties in the US.

No correlation between vaccination rates and covid cases. Actually, the data seems to indicate quite the opposite: higher vaccination rates are associated with higher cases per capita.



But let's mandate vaccines because that will eliminate covid...
Stringfellow Hawke
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Gordo14 said:

Stringfellow Hawke said:

Posted it before and will repost now. Myself and other medics worked the 18 months without a vaccine and wearing standard isolation or N95 masks. Since being required to become vaccinated, number of infections have increased as well as admissions to ICU.

The only thing that makes sense is the vaccine is making things worse as opposed to making things better.

Just my opinion.


Peak anecdotal evidence right here.


Ask yourself what has changed since Covid began. I'll hang up and listen.
Stringfellow Hawke
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ORAggieFan said:

Stringfellow Hawke said:

Posted it before and will repost now. Myself and other medics worked the 18 months without a vaccine and wearing standard isolation or N95 masks. Since being required to become vaccinated, number of infections have increased as well as admissions to ICU.

The only thing that makes sense is the vaccine is making things worse as opposed to making things better.

Just my opinion.

The vaccine that has way less people hospitalized and dying is what's making things worse?


It seems that is the logical conclusion.
CondensedFogAggie
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abram97 said:

You seem to be very confident in your knowledge and very close minded about other people's data/thoughts on the matter.

After looking into and debunking seeming an endless list of made up fraudulent data from twitter clickbait scammers, you get a pretty low opinion of anti vaxxers.

Made even worse that its costing lives.

Another 10 thousand Americans dead from Covid the last week.
CondensedFogAggie
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NASAg03 said:

Maybe this scientific evidence is more convincing:

https://link.springer.com/article/10.1007/s10654-021-00808-7?fbclid=IwAR38IMIdNndQHkEKPx2MVDcQladf0o2uWatwHZLKn7DBOM7eLpjKrFxB8w0

Study in the European Journal of Epidemiology. 68 countries and 2947 counties in the US.

No correlation between vaccination rates and covid cases. Actually, the data seems to indicate quite the opposite: higher vaccination rates are associated with higher cases per capita.



But let's mandate vaccines because that will eliminate covid...


Yet another terrible paper

It's one week of data (Aug 26 to Sep 2) compared to the previous 7 days (Aug 18 to 25). So "no relationship over a single week over week period" is a more accurate framing. Looking at rates this late in the pandemic is a bad metric under any set of conditions, since the standard model of population infection says that, for R_t>1 the higher R_t is, the earlier your epidemic is over.

They also compared infection rate differences across different counties, which all have vastly different cultures and policies. For example, this does not even attempt to characterize mitigation efforts: Israel got rid of nearly all restrictions before delta hit, the same cannot be said for many unvaccinated countries.

These type of unconditional mean comparisons are done holding all else constant. If we know there is non-equivalency of the underlying factors, holding stuff constant is a useless exercise.

Tamu has a world class stats department, perhaps they can teach some basic stats to these authors.

Of course, those on Twitter and Facebook with zero knowledge of stats won't read nor understand this papers fallacies and just spread it.
Diyala Nick
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Stringfellow Hawke said:

ORAggieFan said:

Stringfellow Hawke said:

Posted it before and will repost now. Myself and other medics worked the 18 months without a vaccine and wearing standard isolation or N95 masks. Since being required to become vaccinated, number of infections have increased as well as admissions to ICU.

The only thing that makes sense is the vaccine is making things worse as opposed to making things better.

Just my opinion.

The vaccine that has way less people hospitalized and dying is what's making things worse?


It seems that is the logical conclusion.


This has to be a troll.
Stringfellow Hawke
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AG
Diyala Nick said:

Stringfellow Hawke said:

ORAggieFan said:

Stringfellow Hawke said:

Posted it before and will repost now. Myself and other medics worked the 18 months without a vaccine and wearing standard isolation or N95 masks. Since being required to become vaccinated, number of infections have increased as well as admissions to ICU.

The only thing that makes sense is the vaccine is making things worse as opposed to making things better.

Just my opinion.

The vaccine that has way less people hospitalized and dying is what's making things worse?


It seems that is the logical conclusion.


This has to be a troll.


[Wrong forum for the political rhetoric. - Staff]
BlackGoldAg2011
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NASAg03 said:

Maybe this scientific evidence is more convincing:

https://link.springer.com/article/10.1007/s10654-021-00808-7?fbclid=IwAR38IMIdNndQHkEKPx2MVDcQladf0o2uWatwHZLKn7DBOM7eLpjKrFxB8w0

Study in the European Journal of Epidemiology. 68 countries and 2947 counties in the US.

No correlation between vaccination rates and covid cases. Actually, the data seems to indicate quite the opposite: higher vaccination rates are associated with higher cases per capita.



But let's mandate vaccines because that will eliminate covid...
first of all, you are an engineer, so you should know better and feel ashamed of yourself for showing a trendline on that scatter plot. the only conclusion to be taken from that plot is that there is no correlation in the observed data. don't post this kind of garbage and make the A&M school of engineering look dumb. [/rant]




back on topic to the OP though, after reading the study linked, here are a few of the other take aways:
  • once the outbreak was discovered they did a full set of contact tracing and identified 248 exposures (151 staff and 97 patients) with a much higher attack rate in the patient group as noted in the OP. this makes sense since as noted in the study "The patient population was considerably older than staff and all patients had comorbidities:" this just reaffirms what we all know, comorbidities are a big deal. we also know that older and more comorbidities has seen the vaccine be less effective than healthier groups (hence the booster recommendations)
  • Of the 248 exposures, 238 were fully vaccinated and 10 were not. of the diagnosed cases, 38 were in the fully vaccinated group, and 4 were in the not fully vaccinated group. This means there was a 40% attack rate in group not fully vaccinated and 16% in the group that was. this is still higher that the medical staff average, so a lot of that elevated attack level in the vaccinated group is likely due to age and health risks.
  • This all boils down to the vaccine having a 60% efficacy against infection in a population where 40% were already highly at risk of getting severe covid due to medical conditions and age.



TLDR: when you look at the data discussed in this study, it all points to the vaccine being highly effective at limiting the spread of COVID.



Joe Boudain
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I don't think the vaccine does a great job of limiting the spread of covid, only that so much fewer people even realize they have covid because they're asymptomatic.

It seems to do a great job of keeping Covid from being more than a nuisance in a huge portion of the population, especially those sub 70.

The problem is the entire assbackward way the vaccine's have been marketed by the government, and the huge swings and misses by Fauci and co (remdesivir being the biggest).

03_Aggie
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BlackGoldAg2011 said:

NASAg03 said:

Maybe this scientific evidence is more convincing:

https://link.springer.com/article/10.1007/s10654-021-00808-7?fbclid=IwAR38IMIdNndQHkEKPx2MVDcQladf0o2uWatwHZLKn7DBOM7eLpjKrFxB8w0

Study in the European Journal of Epidemiology. 68 countries and 2947 counties in the US.

No correlation between vaccination rates and covid cases. Actually, the data seems to indicate quite the opposite: higher vaccination rates are associated with higher cases per capita.



But let's mandate vaccines because that will eliminate covid...
first of all, you are an engineer, so you should know better and feel ashamed of yourself for showing a trendline on that scatter plot. the only conclusion to be taken from that plot is that there is no correlation in the observed data. don't post this kind of garbage and make the A&M school of engineering look dumb. [/rant]




back on topic to the OP though, after reading the study linked, here are a few of the other take aways:
  • once the outbreak was discovered they did a full set of contact tracing and identified 248 exposures (151 staff and 97 patients) with a much higher attack rate in the patient group as noted in the OP. this makes sense since as noted in the study "The patient population was considerably older than staff and all patients had comorbidities:" this just reaffirms what we all know, comorbidities are a big deal. we also know that older and more comorbidities has seen the vaccine be less effective than healthier groups (hence the booster recommendations)
  • Of the 248 exposures, 238 were fully vaccinated and 10 were not. of the diagnosed cases, 38 were in the fully vaccinated group, and 4 were in the not fully vaccinated group. This means there was a 40% attack rate in group not fully vaccinated and 16% in the group that was. this is still higher that the medical staff average, so a lot of that elevated attack level in the vaccinated group is likely due to age and health risks.
  • This all boils down to the vaccine having a 60% efficacy against infection in a population where 40% were already highly at risk of getting severe covid due to medical conditions and age.



TLDR: when you look at the data discussed in this study, it all points to the vaccine being highly effective at limiting the spread of COVID.






So how do you differentiate the impact of the vaccine v. Age and natural health? Seems when the healthy group has lower rates it's attributed the the vaccine but when the older group has higher rates it's because of their age and comorbidities.

Kinda seems like a heads I win and tails you lose deal.
Duncan Idaho
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BlackGoldAg2011 said:

NASAg03 said:

Maybe this scientific evidence is more convincing:

https://link.springer.com/article/10.1007/s10654-021-00808-7?fbclid=IwAR38IMIdNndQHkEKPx2MVDcQladf0o2uWatwHZLKn7DBOM7eLpjKrFxB8w0

Study in the European Journal of Epidemiology. 68 countries and 2947 counties in the US.

No correlation between vaccination rates and covid cases. Actually, the data seems to indicate quite the opposite: higher vaccination rates are associated with higher cases per capita.



But let's mandate vaccines because that will eliminate covid...
first of all, you are an engineer, so you should know better and feel ashamed of yourself for showing a trendline on that scatter plot. the only conclusion to be taken from that plot is that there is no correlation in the observed data. don't post this kind of garbage and make the A&M school of engineering look dumb. [/rant]





Pfft. Next you are going to suggest some kind of correlation between a nation's vaccination rate and their ability to do adequate testing.
BlackGoldAg2011
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AG
03_Aggie said:

So how do you differentiate the impact of the vaccine v. Age and natural health? Seems when the healthy group has lower rates it's attributed the the vaccine but when the older group has higher rates it's because of their age and comorbidities.

Kinda seems like a heads I win and tails you lose deal.
From this study you can't. The authors might be able to but they didn't provide enough data for us to do it. You would have to know the full breakdown of vaccinated vs un-vaccinated in the staff group and the patient group, as well as the case count in each of those now 4 groups. we don't have that data, so i just did the analysis on the aggregate. thats where i got my 60%. i then assume that if this aggregate group had been healthier and/or younger the numbers would be better since we know younger/healthier tend to have stronger immune responses to the vaccine.

also, with only 10 unvaccinated in this aggregate group, trying to split the study out into the 4 groups, you run the risk of 1 of those groups not having enough people in it to be statistically useful. 10 is already pretty small. so the data here is limited in how granular your conclusions can be, but overall it points to the vaccine working.
BlackGoldAg2011
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Duncan Idaho said:

BlackGoldAg2011 said:

NASAg03 said:

Maybe this scientific evidence is more convincing:

https://link.springer.com/article/10.1007/s10654-021-00808-7?fbclid=IwAR38IMIdNndQHkEKPx2MVDcQladf0o2uWatwHZLKn7DBOM7eLpjKrFxB8w0

Study in the European Journal of Epidemiology. 68 countries and 2947 counties in the US.

No correlation between vaccination rates and covid cases. Actually, the data seems to indicate quite the opposite: higher vaccination rates are associated with higher cases per capita.



But let's mandate vaccines because that will eliminate covid...
first of all, you are an engineer, so you should know better and feel ashamed of yourself for showing a trendline on that scatter plot. the only conclusion to be taken from that plot is that there is no correlation in the observed data. don't post this kind of garbage and make the A&M school of engineering look dumb. [/rant]





Pfft. Next you are going to suggest some kind of correlation between a nation's vaccination rate and their ability to do adequate testing.
gunan01
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Duncan Idaho said:

out of curiosty what is your speciality?
It's weird he won't answer your question. Probably a psychiatrist or something.
badbilly
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https://vermontdailychronicle.com/2021/09/30/76-of-september-covid-19-deaths-are-vaxxed-breakthroughs/

As seen in Israel and the UK, as vaccination rates go up, the vaccinated have the higher death tolls. I'll put my natural immunity up over any of your vaccines.
gunan01
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badbilly said:

https://vermontdailychronicle.com/2021/09/30/76-of-september-covid-19-deaths-are-vaxxed-breakthroughs/

As seen in Israel and the UK, as vaccination rates go up, the vaccinated have the higher death tolls. I'll put my natural immunity up over any of your vaccines.
this has been debunked many times on this forum. Basically their vaccinated rates are so high that the absolute numbers are going to show higher absolute death numbers in vaccinated folks. Because there are few unvaccinated left to get sick and die!

Simple statistics…..
badbilly
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gunan01 said:

badbilly said:

https://vermontdailychronicle.com/2021/09/30/76-of-september-covid-19-deaths-are-vaxxed-breakthroughs/

As seen in Israel and the UK, as vaccination rates go up, the vaccinated have the higher death tolls. I'll put my natural immunity up over any of your vaccines.
this has been debunked many times on this forum. Basically their vaccinated rates are so high that the absolute numbers are going to show higher absolute death numbers in vaccinated folks. Because there are few unvaccinated left to get sick and die!

Simple statistics…..


Exactly, I never claimed otherwise. The vaccine will not prevent death as is often claimed here. It does a poor job against variants and as such, it should never be mandated.
Duncan Idaho
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My money is on podiatry only because the only other medical professional I know offline that is a flumer or trying to talk people out of getting vaccinated is a podiatrist.
gunan01
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badbilly said:

gunan01 said:

badbilly said:

https://vermontdailychronicle.com/2021/09/30/76-of-september-covid-19-deaths-are-vaxxed-breakthroughs/

As seen in Israel and the UK, as vaccination rates go up, the vaccinated have the higher death tolls. I'll put my natural immunity up over any of your vaccines.
this has been debunked many times on this forum. Basically their vaccinated rates are so high that the absolute numbers are going to show higher absolute death numbers in vaccinated folks. Because there are few unvaccinated left to get sick and die!

Simple statistics…..


Exactly, I never claimed otherwise. The vaccine will not prevent death as is often claimed here. It does a poor job against variants and as such, it should never be mandated.
Lol you claimed EXACTLY otherwise. Also, the vaccine absolutely helps to reduce deaths.
badbilly
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AG
gunan01 said:

badbilly said:

gunan01 said:

badbilly said:

https://vermontdailychronicle.com/2021/09/30/76-of-september-covid-19-deaths-are-vaxxed-breakthroughs/

As seen in Israel and the UK, as vaccination rates go up, the vaccinated have the higher death tolls. I'll put my natural immunity up over any of your vaccines.
this has been debunked many times on this forum. Basically their vaccinated rates are so high that the absolute numbers are going to show higher absolute death numbers in vaccinated folks. Because there are few unvaccinated left to get sick and die!

Simple statistics…..


Exactly, I never claimed otherwise. The vaccine will not prevent death as is often claimed here. It does a poor job against variants and as such, it should never be mandated.
Lol you claimed EXACTLY otherwise. Also, the vaccine absolutely helps to reduce deaths.


No I didn't. Once again, as the vaccinated population grows, they will become more of the deaths. Yes, that has been show through data in the UK and Israel. Why? Because the vaccine does not prevent death. But at least you admit it doesn't prevent death.
Duncan Idaho
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As more people started wearing seatbelts the percentage of people dying while wearing seatbelts increased. Why? Because seatbelts don't prevent death
03_Aggie
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Duncan Idaho said:

As more people started wearing seatbelts the percentage of people dying while wearing seatbelts increased. Why? Because seatbelts don't prevent death


So at point do you take a step back and say we still have an issue with people dying in auto accidents, seat belt or no seat belt? Do we not care anymore because "well more people are wearing seatbelts."
Nosmo
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AG
badbilly said:

gunan01 said:

badbilly said:

gunan01 said:

badbilly said:

https://vermontdailychronicle.com/2021/09/30/76-of-september-covid-19-deaths-are-vaxxed-breakthroughs/

As seen in Israel and the UK, as vaccination rates go up, the vaccinated have the higher death tolls. I'll put my natural immunity up over any of your vaccines.
this has been debunked many times on this forum. Basically their vaccinated rates are so high that the absolute numbers are going to show higher absolute death numbers in vaccinated folks. Because there are few unvaccinated left to get sick and die!

Simple statistics…..


Exactly, I never claimed otherwise. The vaccine will not prevent death as is often claimed here. It does a poor job against variants and as such, it should never be mandated.
Lol you claimed EXACTLY otherwise. Also, the vaccine absolutely helps to reduce deaths.


No I didn't. Once again, as the vaccinated population grows, they will become more of the deaths. Yes, that has been show through data in the UK and Israel. Why? Because the vaccine does not prevent death. But at least you admit it doesn't prevent death.
https://www.covid-datascience.com/post/israeli-data-how-can-efficacy-vs-severe-disease-be-strong-when-60-of-hospitalized-are-vaccinated



This would strongly suggest that the vaccine prevents deaths.
Duncan Idaho
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But not 100% of deaths. So it is clearly not worth taking or encouraging. /S
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