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April 20th, 2020:

Are we sure we’re using the right models?

Let’s check our assumptions before we do anything dumb.

Be like Hank, except inside

A widely followed model for projecting Covid-19 deaths in the U.S. is producing results that have been bouncing up and down like an unpredictable fever, and now epidemiologists are criticizing it as flawed and misleading for both the public and policy makers. In particular, they warn against relying on it as the basis for government decision-making, including on “re-opening America.”

“It’s not a model that most of us in the infectious disease epidemiology field think is well suited” to projecting Covid-19 deaths, epidemiologist Marc Lipsitch of the Harvard T.H. Chan School of Public Health told reporters this week, referring to projections by the Institute for Health Metrics and Evaluation at the University of Washington.

Others experts, including some colleagues of the model-makers, are even harsher. “That the IHME model keeps changing is evidence of its lack of reliability as a predictive tool,” said epidemiologist Ruth Etzioni of the Fred Hutchinson Cancer Center, who has served on a search committee for IHME. “That it is being used for policy decisions and its results interpreted wrongly is a travesty unfolding before our eyes.”

The IHME projections were used by the Trump administration in developing national guidelines to mitigate the outbreak. Now, they are reportedly influencing White House thinking on how and when to “re-open” the country, as President Trump announced a blueprint for on Thursday.

The chief reason the IHME projections worry some experts, Etzioni said, is that “the fact that they overshot” — initially projecting up to 240,000 U.S. deaths, compared with fewer than 70,000 now — “will be used to suggest that the government response prevented an even greater catastrophe, when in fact the predictions were shaky in the first place.”

That could produce misplaced confidence in the effectiveness of the social distancing policies, which in turn could produce complacency about what might be needed to keep the epidemic from blowing up again.

[…]

“This appearance of certainty is seductive when the world is desperate to know what lies ahead,” Britta Jewell of Imperial College and her colleagues wrote in their Annals paper. But the IHME model “rests on the likely incorrect assumption that effects of social distancing policies are the same everywhere.” Because U.S. policies are looser than those elsewhere, largely due to inconsistency between states, U.S. deaths could remain at higher levels longer than they did in China, in particular.

While other epidemiologists disagree on whether IHME’s deaths projections are too high or too low, there is consensus that their volatility has confused policy makers and the public.

See here and here for previous mentions of the IHME. As you may recall, I noted the very wide error bars on its numbers, which tends to be overlooked in the way the stories about this model were written. The IHME is the model that Greg Abbott has used for his reopening plan, so the fact that its projections can change significantly as new data comes in should be of concern. Plus, you know, the whole we are bad at testing thing. However you look at it, the data is noisy, and there’s evidence to suggest there are a lot more people out there with the virus than our level of testing has had the ability to detect. Which is to say again, there’s a lot we just don’t know yet. We shouldn’t rely on one view of the data for our understanding of what is happening, in the same way that we should not rely on any one single poll to understand what is happening in a given election.

Abbott and Paxton continue to play politics with abortion

This is exactly the problem with that Fifth Circuit ruling.

Right there with them

Though Gov. Greg Abbott loosened a ban on nonessential surgeries, he said Friday it would be up to courts to decide if his order restores access to abortions — the subject of a weekslong legal brawl — as the state continues to combat the coronavirus pandemic.

“Ultimately, obviously that will be a decision for courts to make,” Abbott said, adding, that an allowance for abortion is “not part of this order. The way that the order is written is in terms of what doctors write about the type of treatment that is provided.”

The Republican governor issued an order last month barring medical procedures that are not “immediately medically necessary” to preserve protective equipment and hospital beds for coronavirus patients. His directive extends through April 21 and Abbott said Friday the restrictions would be relaxed starting April 22.

But Attorney General Ken Paxton has declared Abbott’s first order applies to all abortions except those needed to protect the life or health of the woman. The near-total ban prompted a lawsuit from abortion providers, who accused state officials of political opportunism and argued the procedure does not usually require hospitalization nor extensive protective gear.

See here for the last entry. This is exactly what I meant when I said that if all it takes is a declaration of an emergency for the state to shutter abortion clinics, then there is no right to abortion in Texas and the law as it now exists is a sham. Abbott is on the one hand saying that we can start easing up on shutdown orders and we have plenty of hospital capacity (not that abortion has anything but a negligible effect on that), but hey, it’s not up to him to decide whether any of this means that reproductive health care can go back to its usual business even if other medical services that are deemed “non-essential” can resume. It’s cynical and chickenshit on his part, and it again shows that there has to be some kind of consistency. And it again shows why the Fifth Circuit sucks.

The NBA is still looking for its way back

Nobody really knows what the next couple of months look like.

On the eve of what would have been the start of the postseason, NBA commissioner Adam Silver on Friday said he could not predict when, if or how it would resume its season or even when the league might know.

“We are not in position to make any decision and it’s unclear when we will be,” Silver said after the league held its annual spring Board of Governors meeting on Friday.

“I don’t mean to send any signals about the likelihood or not of restarting the season. All I can say is we’re still at a point where we don’t have enough information to make a decision.”

Quoting Disney CEO Robert Iger, who made a presentation to the Board of Governors, Silver said decisions were “about data, not the date.”

With that in mind, Silver could not even predict when decisions would have to be made because of the uncertainty in dealing with the coronavirus pandemic. He said many formats to play regular-season games and a postseason would be considered and that the league would be willing to delay the start of next season if necessary.

Still, even the factors that would have to be weighed to attempt to salvage the 2019-20 season showed how difficult it will be to resume the season that had been suspended on March 11.

“We’re looking for the number of new infections to come down,” Silver said. “We’re looking for the availability of testing on a large scale. We’re looking for the path we’re on potentially for a vaccine. And we’re looking at antivirals. On top of that, we’re paying close attention to what the CDC is telling us on a federal level and what these various state rules are that are in place.

“There’s a lot of data that all has to be melded together to help make these decisions. That’s part of the uncertainty.”

See here for some background. I’m less interested in the particulars, which includes something similar to the MLB games-in-a-bubble idea, than I am with the basic concept that no one has any idea when things will return to something sufficiently resembling “normal”. Right now, we’ve got the Governor talking about “reopening the economy”, and we’ve got whackjobs filing lawsuits and engaging in socially-undistanced protests over stay-at-home orders, all of whom want to more or less pretend that things are fine and we can all go back to going about our business. We also have these multi-billion-dollar enterprises, like the NCAA and major sports leagues, who would also very much like to get back to their own business of making money but have to take into account the very real risk to the health of their players, their employees, their fans, and so on. These leagues will act in their own self-interest, but that self-interest is balanced against other forces, which includes the players’ and officials’ unions, and the local governments where their teams are. The fact that a entity like the NBA, which is seeing the calendar run out on its current season, cannot say when it might be able to play its games again tells me more about our ability to “reopen the economy” than any crony-laden gubernatorial task force ever could.

Coronavirus and delivery workers

There’s a very obvious answer for this.

Couriers delivering online orders of household essentials have become a lifeline for Houstonians hunkering down at home to slow the spread of the novel coronavirus.

But a growing number of workers responsible for getting packages to consumers are falling sick, leaving those remaining on the job worried for their lives.

“When I’m walking into work, it’s nerve-wracking,” said a truck driver for FedEx Freight in Cypress who wished to remain anonymous because the worker feared retaliation from the company. “I don’t want to miss work because I’m a single parent, but I’m afraid I’m gonna catch something.”

Package delivery workers have been thrust into the front lines of the global fight against the coronavirus as millions of Americans under stay-at-home orders turn to online shopping to get canned goods, medicine and household supplies. Workers who fulfill these online orders and deliver them say they are risking their lives to ensure consumers’ home shelves are well-stocked.

At least 24 package workers in the Houston area — including 19 Amazon, three UPS and two FedEx workers — have been diagnosed with COVID-19, according to internal company communication obtained by the Chronicle, interviews with employees and media reports. COVID-19 is the respiratory illness caused by the new strain of coronavirus.

Representatives of Amazon, FedEx and UPS declined to disclose the number of employee cases, citing company policies and employee privacy concerns. Each of the companies insisted they are taking steps to protect workers.

This story would have been a lot more useful if we had any idea how many total employees we were talking about, so we could compare the rate of infection of this group of people to the Harris County population as a whole. (Which, to be sure, we are undercounting, but it’s the best we can do.) I don’t say this to cast any doubt on the seriousness of the problem or to downplay the concerns of the workers, but because knowing where the virus is more prevalent is valuable and can help with the fight against it. Identifying and isolating localized hot spots is going to be a key part of the next phase of mitigating this pandemic. Everything we can learn that will move that forward is huge.

The glaringly obvious point to make here is that workers like these who have no choice but to be out in public are exactly the people that we need realtime, universal testing for. The scariest thing about this virus is that you can’t tell who has it, and anyone (yourself included) could be out there spreading it without knowing it. But if we can test for it, that goes a long way towards ensuring the safety of the people who cannot socially distance themselves. If you have to show up somewhere to work, you need and deserve to know that everyone else who is there with you is virus-free. The fact that I have to point this out more than a month into this pandemic is just mind-boggling, and as clear a sign of the federal government’s complete unpreparedness and failure to respond that you can get. It’s beyond appalling that the people we are all counting on to keep us fed, healthy, safe, and otherwise taken care of cannot be cared for themselves in this most basic way. I don’t know what else there is to say.