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There are people who build and grok models (A) and people who build epidemiological models (B) and then people who built epidemiological models of infectious di
by haltingproblem 7y ago
There are people who build and grok models (A) and people who build epidemiological models (B) and then people who built epidemiological models of infectious diseases (C).
It is a common error for folks in set A to believe that they can understand models built by folks in set C. It is a subtle but serious error for folks in set B to believe they can understand models by set C e.g. John Katz of Yale who is a doctor focusing on diets and wrote a woefully misguided article in the NY Times.
Roughly, I find the confounding factors about models about the current epidemic seem to the following:
1- 1% of the population severely affected etc. (see: Diamond Princess). What they fail to appreciate is that the Diamond Princess was an enclosed environment and the outbreak was controlled and limited to the population on board. In the general population, a virus with an R0 of 3 will infect 50,000+ people in 10 infection steps.
2- What most people miss is the collision of the 1% severity with the capacity of the medical system. This second-order effect is something hard to understand. 1% of the US is 3.6 million. Even if 10% of those cases turn up at the ER in the same year and occupy the beds for 2 weeks each it will be a disaster.
3- #1 and #2 interacts with life as usual demands on the health care system – accidents, heart attacks, strokes, etc. to create third order effects – more deaths as there are no beds and no personnel to deal with them.
4- PPE running short and causing infections amongst medical personnel leading to their quarantine, hospitalization or death (Wuhan, Italy, Spain) decimates their ranks and accentuates the stress on the health care system……. 20% of lost capacity translates to some fraction more deaths and more stress on the rest of the medical population.
I am sure there are factors I have missed.
We have seen many contrarian viewpoints. None of these contrarian thinkers make any concrete suggestions (Ionnadis, Katz, Friedman, Gillespie, Hanson) except making ominous predictions to how wrong we are and we need more data. Meanwhile ER doctors say this is the worst they have ever seen and bodies keep piling up. These contrarian thinkers provide no simulations of how saving the economy will lead to lesser deaths. Just hand waving and finger jabbing.
The contrarians seem to think that the playbook to deal with the epidemic has been improvised. Or that this is something modelers are thinking up on the fly. These playbooks have existed for decades with very good understanding of the dynamics and were used during SARs, Ebola and heck even back during the Spanish Flu. What seems to be lacking was parameters specific to Covid-19. Its R0, CFR, co-morbidities, etc.
The reason Taiwan, Korea and Singapore were able to act so decisively and fast was that they just dusted of the SARs playbook and knew almost exactly what to do. Taiwan enforced the first measures in early Jan.
I will take the word of the viral epidemiologists over the contrarian's armchair speculations and continue to overreact. I recommend you should too.
- hcknwscommenter 7y agoWell put. And conservatively stated. Re: point 2, your "in the same year" is what we likely face with high levels of social distancing. What's even more alarming is what happens if we stop the shut downs and "go back to work." That's a guaranteed disaster. You mention 50,000 people in ten steps. That number grows to millions in just a few additional steps.