Whether it’s rebuilding pinball machines, launching a new web app for a healthcare startup or tracking virus case numbers, Seth Steele has a special affinity for looking beneath the surface to understand how complicated things work.

Over the course of being interviewed for this story, Steele said part of the struggle for average citizens is getting detailed questions answered by the government. The Tennessee Lookout forwarded Steele’s five biggest questions about Metro’s COVID-19 data and its reopening plan to the Health Department. The questions and answers are below.

1. Is Metro still committed to its original reopening plan? Does every metric have to be in green in order for the city to advance to phase 4?

Dr. Alex Jahangir, co-chair of Metro’s coronavirus task force: We are committed to the reopening plan. This is still a new virus, and as we have learned more about it our team has adjusted the plan as necessary. As stated in several of our press conferences, one metric isn’t the end-all be-all, and it’s not necessary for every metric to be in the green to advance, just as it’s not necessary for every metric to be in the red to regress. We look at the key metrics as a whole when we make decisions, and pay close attention to some metrics that aren’t even a part of the roadmap. For example, each week we update the doubling rate and cumulative attack rate, two metrics that don’t have a color-coded section on the reopening, but give us important information about the state of COVID-19 in the community.

2. Why is the actual transmission rate number not included in the city’s daily COVID-19 updates?

Health Dept. spokesman Matt Peters: The transmission rate used in the key metrics is calculated by Vanderbilt. That value is published and updated each day at 9:30am on ASafeNashville.org on the Reopening Key Metrics page (just below the graphs.)

3. The health department’s most recently available data shows a dramatic increase in suspected overdose deaths, and people under 45 are especially being hit. Is the city factoring this into its response to COVID-19? Is overdose data being shared with the coronavirus response task force?

Jahangir: The health department makes sure my team on the Board of Health and the public is aware of the overdose problem Nashville is facing, along with many other issues that the community is dealing with. We take into account how the response to COVID-19 affects our community in a variety of ways, including how it impacts those fighting addiction. We were aware the overdose problem had been getting worse for years, and we took that knowledge into our discussions and planning for our COVID-19 response. In fact, one of first people involved in the COVID-19 response is an epidemiologist who has been focusing on the overdose situation in Nashville for the past year and a half, so the overdose situation in particular is something that’s been front-of-mind for us throughout the COVID-19 response.

4. Can the health department tell us what is the “cycle threshold/cycle value” for what its lab contractors use to determine a positive test? This is an issue receiving new scrutiny nationally, because many governments and their lab partners were counting someone as positive even if the viral load in their system was so low they wouldn’t actually be contagious.

Peters: The cycle threshold does vary by lab and can even vary by platform. The lab we use for our PCR tests holds accreditations from the State,  College of American Pathologists (CAP) and the Joint Commission, in addition to the Clinical Laboratory Improvement Act (CLIA), signifying their adherence to national standards for testing. That said, we are only using PCR lab testing in our Assessment Centers. There are other types of testing (such as antigen testing) where a positive may not indicate a true infectious case. Likewise, someone who has had a positive PCR and after 10 days they are no longer infectious but could have a positive PCR for up to a month or longer but not be infectious during that time. We do not count these as new cases when they are reported to us in individuals who have been positive in the last 90 days.

5. COVID-19 patients appear to account for a very small percentage of the patients in hospital beds or ICU beds. With that in mind, why is the reopening metric the total percentage of beds available, instead of the percentage of beds occupied by COVID+ patients? It seems that on many days, the city would be below its own threshold even if there were no COVID+ patients in hospital beds.

Peters: When it comes to hospital capacity, an unavailable bed is an unavailable bed, whether its taken by a COVID-19 patient or otherwise. If the hospitals fill up, it impacts everyone who needs care, whether it be for COVID-19 or for any other reason. In watching the response around the world, we’ve seen how quickly a hospital can fill up if an outbreak gets especially bad. For that reason, we look at capacity as part of our collection of reopening metrics to get a sense of how well the healthcare system can respond if the COVID situation in Nashville were to get significantly worse.

His love of pinball machines – fixing them, refurbishing them, playing them, collecting them – led Steele to open a pinball-themed bar called No Quarter in East Nashville two years ago. Steele said pinball machines became his outlet in the evenings after days spent working at his computer building web apps.

“I spent all day and night working for tech startups,” Steele said. “I wanted to do something with my hands, and pinball gave me the same problem solving challenge. With pinball machines, I love cleaning them, fixing them. I like that more than playing.”

His hobby grew when he started inviting friends over to play the machines and over time No Quarter emerged as the focal point of a small, but avid pinball community.

Steele became one of dozens of Nashville entrepreneurs whose businesses were shut down after the deadly tornado ripped through town on March 2. Steele thinks a gas line explosion, caused by the tornado, tore a hole in the building that houses No Quarter. His bar suffered broken windows, a ripped apart roof and water damage.

Steele was in the thick of rebuilding the bar when the pandemic hit Nashville, prompting Mayor John Cooper to issue an executive order on March 20 that blocked bars and restaurants from serving patrons inside their establishments. Subsequent health orders limited capacities inside bars like No Quarter.

Those orders meant that when Steele tried to use his insurance policy to cover his business losses from the tornado, he was out of luck. His insurance company argued that the city’s lockdown orders in response to the pandemic meant his business wouldn’t be making much money anyway. That meant Steele was reimbursed a fraction of his lost revenue.

It was that wrestling match with his insurance company that prompted Steele to dig into Metro’s COVID-19 statistics. A self-described political progressive who backed Bernie Sanders for president and embraced early stay-at-home orders and mask mandates, Steele wanted to understand why Cooper’s administration issued health orders that cost his business money and his six employees their jobs.

Motivated to save his business and to understand the city’s response to the pandemic, Steele drew on his professional experience working with healthcare data and a passion for complicated problem solving to become an unlikely watchdog of Nashville’s COVID-19 stats.

The numbers didn’t add up

As he dug into the data, what Steele found troubled him.

As Steele pored over the stats, he was left with more questions than answers. How did Metro calculate its daily transmission rate? How did hospital bed availability compare to similar months before the pandemic even hit? How was the city deciding whether to advance to the next reopening phase when its own metrics weren’t being met? Why were patients with viral loads so low they couldn’t possibly be contagious counted as positive cases?

If the healthcare data being used to make government decisions that shut down businesses and left people unemployed, Steele believed the numbers should be transparent and support just drastic measures.

Like most people, Steele was frightened when the virus came, especially watching the death toll suffered by New York and other states in the northeast. He wore a mask, used hand sanitizer, socially distanced.

“I was still terrified in April,” Steele recalled. “I was like, “What is this? I don’t know anything.’ I didn’t want to leave the house. I was terrified. But I started digging into the data and seeing what was going on.”

Steele’s research led him to the conclusion that Nashville’s lockdown orders went too far.

This was only confirmed when the Tennessee Lookout reported in early August that Metro’s contact tracing efforts had tied just 80 cases out of approximately 20,000 to bars and restaurants. Contact tracing does come with caveats, since out-of-town tourists contracting the virus on lower Broadway might never be known to the city’s health department, and the city could not keep up with contact tracing during the onslaught of cases this summer.

“The article made me do a double-take on everything,” Steele said. “We’re doing all of this over 80 cases?”

Steele kicked his research into overdrive, creating databases to track Metro’s daily reporting numbers, studying medical research about the viral load in COVID-19 testing samples and what constitutes a positive test.

Steele, 38, began posting to social media and lending his advice to another informal Nashville COVID-19 watchdog group called A Smarter Nashville. Steele said that at the same time the city obsessed over lower Broadway’s bars, neighborhood bars like his suffered and their employees were left out of work. It was a double-whammy for two of Steele’s employees at No Quarter because their second jobs revolved around the touring live music industry, which has also been decimated by the pandemic.

When statistics became political

Steele said that at the same time he was digging into data posted to Metro’s COVID-19 information site – the same data the city said it would use to determine when to advance to its next reopening phase – he noticed members of the media and Metro Council members were not questioning the healthcare numbers. Yet this data is so essential it was used to determine when he could reach 25 percent of 50 percent of capacity inside his bar.

When he questioned the data to friends, they accused him of being a supporter of President Trump and denying the severity of COVID-19. Steele felt his questions were principled: why does the reopening plan use hospital bed capacity as a metric, even though on some days the region would not meet its goal of 20 percent availability even if there were no COVID-19 patients hospitalized. Why did the city reopening plan focus on transmission rate, yet not log the previous days’ transmission rates so the public could track the progress?

Was the city looking at other data, such as the rise in deaths of young people from overdoses, or the increase in alcohol abuse?

“I think it’s sort of opened my eyes about how we all sort of bubble off,” Steele said. “I heard people who wanted to argue with me. I wouldnt say we had heated discussions, but more discussions that go nowhere.

“They assume it’s a MAGA Trumper who doesn’t think COVID is dangerous.”

Steele’s girlfriend Cassie Rice said the emotional investment Steele has put into following the COVID-19 stats has taken a toll on him. But, she said she’s proud he’s been willing to speak up.

“He’s just a very lovable and nice person,” Rice said, adding that when Steele gets passionate about something, he goes all in. “Not everyone would go into the details that he’s going into. There are clearly other small businesses that are passionate about this and are frustrated about how it’s being handled. He’s standing up for them.”

As Metro has progressed in its reopening to phase three and loosened capacity restrictions on bars, Steele’s watchdog focus has shifted to transparency in the numbers himself. Steele said he discussed his insurance issues with Councilwoman Emily Benedict, who passed his situation onto the Cooper administration. Steele said he appreciated Cooper’s staff trying to connect him to an attorney who could help. 

Steele said the important thing moving forward is that people study the data that will continue to be relied upon to determine when businesses can reopen and how quickly Nashville’s economy rebounds. 

“The issue is transparency. Just be honest,” Steele said about Nashville’s COVID-19 stats.