In his Nov. 11 commentary, Kevin Roche's statement that 44% of the people who recently died from COVID-19 in Minnesota were vaccinated may have misrepresented the effectiveness of the vaccine ("Time to face hard truths and get on with life — virus and all," Opinion Exchange). This percentage requires context to be fully understood — specifically, the prevalence of vaccination. With 92% of the people who are 65 and older — and 74% of those 18 and older — fully vaccinated, most of Minnesota's adults are vaccinated. While they have a very low risk of COVID-19 deaths, the fully vaccinated are a large majority of Minnesota's population and will thus represent a significant proportion of those who die because the vaccine is not 100% protective. Because those older than 65 years are at highest risk of COVID-19 death and because over 90% of them are fully vaccinated, Roche's report that 44% of those who died from the virus were vaccinated really reflects the high prevalence of vaccination in the highest risk group and the protection afforded by the vaccination. If the vaccine had no effect, we would expect that 80-90% of those who died had been vaccinated. The relevant information for someone considering vaccination is what the risks of serious illness or death are by vaccination status. Such data are available from the Minnesota Department of Health (MDH).

From May 2 to Oct. 3, for those at highest risk (i.e., 65 years and older), MDH reports the rate of hospitalization was 127.2/100,000 for unvaccinated and 8.7/100,000 for vaccinated people, representing almost 15 times higher risk for unvaccinated seniors. For people 65 and older, the rate of death for unvaccinated people (29.3/100,000) was 16 times higher than that of vaccinated people (1.8/100,000).

Roche thus neglected a fundamental consideration: If an exposure is very common, as COVID-19 vaccination is, and is not 100% protective, then the exposed (in this case, the vaccinated) will contribute cases and deaths. To understand the benefit of the vaccines, one must look at risks among the vaccinated and the unvaccinated.

Wendy Hellerstedt, St. Paul

The writer is an epidemiologist and professor emerita of the University of Minnesota School of Public Health.


Many have bemoaned the political nature of COVID-19-related public health decisionmaking. This is misguided. We need more politics, not less.

We do not live in an unelected technocracy. It is the duty of our elected representatives to absorb expert opinion and balance it against the wishes of their constituents. This is necessary because many experts, especially those in medical and scientific fields, are trained to optimize for a single or a limited number of variables. This is undesirable in scenarios where public health decisionmaking can have unexpected second and third-order effects.

Dr. Anthony Fauci and state Health Commissioner Jan Malcolm are not labor economists, childhood-development experts or supply-chain engineers. They are undoubtedly biased toward the noble goal of limiting deaths or otherwise negative individual health outcomes from COVID-19 infection. But despite pronouncements to the contrary, these are not the only factors that are considered when crafting a public pandemic response. It is absolutely crucial that we consider the opinions of those experiencing pandemic-related job turmoil or are concerned about social development of children who have been masked and isolated for much of the past two years. This is accomplished only through the messy and often uncomfortable exercise of American mass politics.

Brian J. Krause, Minneapolis


When it comes to how to proceed and get on with life after (actually during) COVID, the Star Tribune Thursday opinion submission by Kevin Roche definitely struck a chord. It was a dissonant chord, but a chord nevertheless.

I know when I want epidemiology, infectious disease or bioethics expertise, it never occurred to me to call my broker or attorney.

When it comes to striking chords, the Star Tribune half page feature of COVID "expertise" advice from a health care investor, who was unfortunate enough to have worked as general counsel for UnitedHealth Group (of disgraced CEO Bill McGuire infamy), this chord added a C-sharp to COVID's C.

Simply declaring something over before it is over runs afoul of Yogi Berra's "it ain't over until it's over" phrase. One can't simply turn back the clock (or "backdate," in McGuire SEC parlance) to a time before the international pandemic ravaged the world as we know it.

To be clear, declaring a deadly pandemic "over" just because it's inconvenient and impacts one's investment portfolio seems shortsighted and incomplete to me. But epidemiology and infectious diseases aren't my area of expertise either.

Nick Dolphin, Minneapolis


What's the actual level of support?

Prof. emeritus Thomas Sibley made some interesting and important points about the Minneapolis mayoral election ("A mathematician's addendum," Readers Write, Nov. 6.) Mathematicians have proved that no voting system is perfect and any can be manipulated by strategic voting — which blatantly was the case this year when two leading candidates urged voters not to cast a second- or third-place vote for Mayor Frey, even if he was one of their sincere choices.

It is worth expanding on a term mentioned at the end of Sibley's letter — "approval voting." Under this alternate voting system, if a voter approves of more than one candidate, he/she can vote for more than one, without ranking them. This system values consensus over intensity/partisanship.

Approval voting (each voter to cast two or three unranked votes) was discussed at the Constitutional Convention as a method of popular election that would favor selecting a consensus president. Approval voting (two unranked votes) was then written into the original Electoral College. Approval voting has been used by the Catholic Church to elect popes; it is used today in Fargo and St. Louis. So, there is pedigree and currency for this approach.

Applying this standard, Jacob Frey is clearly the consensus choice of the voters of Minneapolis. He received 85,095 first-, second- or third-place votes, which means 59% of all those who voted in the election supported him in some way. This is 14,426 votes less than Frey's official total — these are all Kate Knuth voters who had ranked Frey second or third but whose preferences were not reflected in the official vote. In comparison, Knuth received a total of 69,113 first-, second- and third-place votes, which was 48% of the total votes cast. Again, Knuth's ranked-choice vote did not reflect the full scope of her support, since many who ranked Knuth second or third had ranked Frey first.

Under approval voting, more than one candidate can receive a majority of the votes. In this case, however, Frey was both the consensus choice of the voters and the only majority choice of the voters. To help diminish partisanship — a goal of both ranked-choice voting and approval voting — perhaps the results of elections should be reported and discussed both in terms of the formal outcome under ranked-choice voting rules — which, as this election shows, strictly speaking do not always guarantee a "majority" winner — and in terms of the result under approval voting — what percent of the total electorate actually approve of this candidate?

Mark Bohnhorst, Minneapolis

The writer is a retired public sector attorney.


City forgot to tell some constituents

Kudos to the city of Minneapolis for its notice to residents (months in advance) as to the end date for yard waste collection ("No extension for city yard waste pickup," Nov. 11). Why didn't they also notify the trees to drop their leaves well before that time, so we homeowners could meet Minneapolis' unbending deadline for yard waste collection?

Karen Hansen, Minneapolis

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