Category Archives: Politics

COVID-19, Politics, Science and Politics

Walking the Arete between science and Trump

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Being a scientist working with Trump under public scrutiny has to be like walking along a arête, a knife like ridge between two mountain peaks. Falling over one side is loosing one’s position (and influence) by clearly contradicting Trump, even when he is wrong. Falling over the other side is saying something that is questionable scientifically, thereby loosing ones credibility, in order to pacify Trump. It seems as if one of the key scientists (Dr. Birx) may have fallen off the ridge on the side of trying to justify Trump’s optimism. If so, we should question everything she says.  Credibility is hard to gain, and easy to loose.

Whom am I to say?

This is a hard thing for me to write. I am not an epidemiologist. In any per review in an epidemiological journal, I would not qualify as a reviewer. So  I am out of my discipline , I admit it.  The scientist in me (Physicist) says, I am not qualified to judge, so rather than risk my own credibility I should remain silent.  Credibility is hard to acquire, and easy to loose, and is the currency of the successful scientist.   But in this pandemic the risk of staying silent perhaps outweighs the risk of losing ones credibility.  I also need to walk an arête.
 
On the other hand,  as a computational physicist I find I can read the technical literature on the mathematics of epidemiological  modeling and understand it. In fact, my work in modeling physical systems (from graduate student thru retirement) involved far more involved mathematics than is present in at least the basic epidemiological models based on differential equations.  Some of the models developed are impressive team efforts.  The simpler, well known, epidemiological models can give plenty of insight.  
 
My weakness with the modeling is in correlating policy to the mathematical constants in the equations. This is made more difficult  because the analysis of COVID-19 is still in process.   Perhaps it is even more difficult to know societies response to the various public policies.   

Misleading statements on Attack Rate

Dr. Birx suggested that the models are inaccurate and overstate the threat of Covid-19.   If you like you can see a video of her presentation on 3/26/2020 here
 
I have a few questions about her presentation:
 
“In no country to date have we seen an attack rate over 1 in 1,000” (1:04 in the above video).  
 
First, what is the definition of attack rate?  If I go by the CDC’s online self study course, which also agrees with other authors. 
 
 
“Incidence proportion is the proportion of an initially disease-free population that develops disease, becomes injured, or dies during a specified (usually limited) period of time. Synonyms include attack rate, risk, probability of getting disease, and cumulative incidence. Incidence proportion is a proportion because the persons in the numerator, those who develop disease, are all included in the denominator (the entire population).” {I added the Bold}
 
Now the population needs to be specified, and she did, a country.  But the period also needs to be specified.  She added “to date.” When you are in the middle of the pandemic the attack rate “to date” doesn’t tell you much!  What you would like to know is how large the attack rate will become!   However, the statement was almost certainly not true when she said it.  
 
Italy, on 3/25/2020 had 74,386 cases with a population of 60.5 million or an attack rate of 1.2 per thousand.   This data is from the John Hopkins tacking website on 3/25/2020 at 1:12 pm.  The same number is in the World Health Organization Special Report number 66.
 
 
Worse than being wrong, this is highly misleading.  Few countries have yet been through the entire pandemic sequence.  So the number for Italy has already risen.  Right now (3/28/2020 2:30 pm) Italy has 92,472 cases for “to date” attack rate of 1.53 per thousand and rising.
 
Restricting the geography to country allows for a larger denominator and lower rates.   Why does this matter?  New York city (population: 8.7 million) the evening before her talk,3/25/2020 had 20,011 cases according to the John Hopkins site.   This is 2.3 per thousand and climbing!  Now that has climbed to 29,158 so the “to date” attack rate is 3.34 per thousand and climbing.   
 
In addition, in the US we are not testing everyone with symptoms.  So the figures for New York City are lower that the actual number of infections.  It takes time for symptoms to emerge.  So the current testing measures what has happened a few days ago (or longer). 
 
Ironically at 4:13 she acknowledges that some of us will look up the numbers (yup) and that we will only find “small countries” that will top 1 in 1,000.   She didn’t do her homework, even though between 1:41 and 1:57 she talks about Italy.
 
At best her statement wasn’t up to date (she should have checked).  At worst it was deliberately misleading. 

Can 20% of the Population become infected?

She suggested that models that predict that 20% of the US could be infected were over estimating the problem.  (2:11)  She didn’t actually say that, but it was surely implied.  Just before that was a general downplaying of the accuracy of the models, and assertions that they were not predicting the correct behavior.
 
Can 20% of the United State become infected?   Of course we cannot fully know the what will happen in the United States, much of that depends on how we react to the situation.    We can look at the ordinary flu data to see if it is POSSIBLE for 20% to become infected.  Again lets go back to the CDC website.
 
 
This is directly from the website (3/28/2020)
 
“A 2018  CDC  study  published  in  Clinical  Infectious  Diseases  

looked at the percentage of the U.S. population who were sickened by flu using two different methods and compared the findings. Both methods had similar findings, which suggested that on average, about 8% of the U.S. population gets sick from flu each season, with a range of between 3% and 11%, depending on the season.

Why is the 3% to 11% estimate different from the previously cited 5% to 20% range?

The commonly cited 5% to 20% estimate was based on a study that examined both symptomatic and asymptomatic influenza illness, which means it also looked at people who may have had the flu but never knew it because they didn’t have any symptoms. The 3% to 11% range is an estimate of the proportion of people who have symptomatic flu illness.”

We vaccinate people for the flu.  Looking around the web perhaps 50% of the population gets a flue shot.  However there is no vaccine for the current SARS-CoV-2 virus.  So the 3% to 20% range of the number above is more like 6% to 40% of the population that is not  vaccinated.  It should be noted that the H1N1 pandemic in 2009 is estimated to have effected 19.9% of the population.  

https://academic.oup.com/cid/article/52/suppl_1/S13/498323

(see last paragraph before the summary)

So yes, 20%  of the population COULD (not will, COULD) become infected.  It is our job to prevent that.

Again, her statements are at best misleading, playing down the dangers that we confront.

60% to 70% in 8 to 12 weeks is …. (3:46-3:59)

Dr. Birx closes with a statement about no models show 60% to 70% of the US affected within the next 8-12 weeks. Let me start this off by saying that I do not think that the pandemic will get that bad in the US. I have faith that enough people will act appropriately to prevent this. Notice I didn’t base my comment on models. Non the less, we should parse the numbers and ask if this is possible.

Before Dr. Brix spoke John Hopkins reported 68,572 confirmed cases in the US. The population of the United States is roughly 327 million. 70% of that is 229 million. Thus the number of cases would have to grow by a factor of 4,768 (327,000,000/68,572). If (and its a very big if) we were to continue to grow exponentially this would require a little over 12 doublings. (212 = 4,096).  12 doubling in 12 weeks is one doubling a week.  Is that possible?  Take a look at the data yourself from the WHO, plot it up in excel and fit an exponential to it.  So yes, IF the current trends continue, this is mathematically possible.  Is it likely? Only if we are very foolish and twiddle our thumbs, refusing to change our behavior, while the epidemic runs through the country.  

My issue with Dr. Birx’s statement is the potential that it be interpreted as saying: we don’t have to worry.   But with Trump’s wanting to start the company up, and Dr. Birx as his adviser, this is the wrong message to send. At Best Dr. Birx should have qualified the statement by indicating whose models she was considering.

Be concerned, but funnel that concern into actions that help.  Practice social distancing, wash your hands and do it right, know the symptoms and if you have them, self isolate.  We can do this, but not without some self sacrifice and effort.

The Biggest Issue

Perhaps the biggest problem with Dr. Birx’s statements is she hasn’t shown us her data.   Perhaps she would make the argument that she was only talking about the one study she mentioned.  But she inferred much more.

Scientists are data based.   If a scientist is unwilling to show the data, then they cannot be taken seriously.  Statements about models that are hidden from public view are not to be trusted.  A scientist is obligated to share their work, their data, and their reasoning so that others can examine, and critique their work.  Any scientist that makes statements about the data, that they are unwilling to submit to per review, are not to be trusted.  Period, end of story, drop the mic.  It is per-review that puts the disinfectant of public disclosure on ones work.  

Conclusion

I morn the loss of a trust worthy insider in the Trump inner circle.  Perhaps this was all a show to keep her job, thinking that she can  more good in her job than outside.  But until proven otherwise, I will treat anything that Dr. Brix says with a bit of suspicion.  That doesn’t mean that anything she say is false.  It just means we need independent verification before we can believe what she says.

Sadly a scientific colleague may have fallen off the arête, and I don’t have a rope to throw to her.

Politics

Thoughts on Preventing and Responding to School Shooting

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My prayers and heart go out to the families and friends of the victims of the latest mass shootings.  I have been struggling with an appropriate constructive response to this tragedy.  Nothing we do can bring back all the lives that have been lost in all the mass shootings.   Now the youth are leading the way in the fight to prevent such tragedies in the future, this is a hopeful and wonderful response as it is their future.   It is always with the youth that our hope for the future finds it best expression.  As I get older I see my role shifting to enabling the next generation.  One way this can happen is to provide encouragement.  To the youth I say, thank you, stay the course, keep heart, and remain dedicated to the task, especially when it seems your task seems hopeless, it isn’t.  Another way of helping is to provide our best thoughts and insight for their consideration, an effort to pass down the best we have to offer, not as a mandate, not as an agenda or assignment, but as something for them to ponder.  It should be our hope that they will take where we start and move beyond it, creating something better than we could create.  This post is my best current thought on the matter.

People are searching for a single legislative solution to the problem.  Legislation is clearly needed.  However, it seems unlikely to me that any single change will result in the elimination of mass shootings in the United States.  Rather I believe that there needs to be a collection of changes and legislation to at least minimize the possibility of mass shootings.  These changes need to include: prevention, planning, preparation, training, practice, execution,  evaluation, and modification.

Prevention: Every mass shooting event that is prevented is one less event to which we need to respond.  Prevention means: maximizing the chance that someone who wants to commit an act of indiscriminate violence is identified and confronted, once identified making sure they are denied access to the guns or other items necessary to carry out the plan, and making sure they get  the support necessary to resolve the issues.  Prevention means dealing with the issues in the schools and society at large that trigger the desire to commit an act of indiscriminate violence.  But prevention alone is unlikely to be 100% effective.  We still have car accidents, murders, and act of violence.  People will get angry, guns are likely to remain available in spite of any regulations, background checks etc.  Prevention needs to include training those who come into contact with the at risk individual to identify individuals likely to consider acts of violence.  Prevention will include procedures for collection of data, the dissemination of data, and the ability to act on the data.  Prevention will include preventing at risk individuals from getting access to items they need to carry out their plans. Part of this should involve deciding what items the public can purchase and what items they cannot.  Everything should be on the table.

Planning:  Prevention is unlikely to be 100% effective.  We plan for fires with fire departments, medical emergencies with ambulances and hospitals, and snow with snowplows.  Similarly we need to plan, in advance, for our response when someone with intent to kill indiscriminately gets access to the tools to carry out their desires.

Preparation:  No amount of planning will be effective unless we prepare for the execution of the plan.  For just one example, if teachers are to sequester the students in a classroom, then their needs to be an effective way of locking the door from the inside quickly, in such a way that the shooter cannot enter but the police can.  The door needs to be strong enough that bullets cannot enter the classroom ….

Training: Those involved in the response need to be trained in their expected roles and actions.  No amount of planning and preparation will be effective if those involved do not know what is expected of them and know the procedures necessary to carry out the expectations.  These responses need to be automatic which leads us to:

Practice:  In an emergency situation we often run on instinct.  That instinct can be effective or ineffective.  Practice can make the response automatic so that the right thing is done during the confusion of the actual event.  Without practice and preparation the response may become ineffective.  Practice also involves some sort of  the simulation of the event.

Execution:  When the time comes, the plan needs to be successfully implemented.

Evaluation:  After the incident the response needs to be evaluated.  Even if the execution of the plan was successful an evaluation still needs to be performed.  There are some of the questions that need to be asked:  What worked, what didn’t work, were there barriers to execution, was the preparation adequate, what changes would make the response more effective, what could have been done to prevent the incident in the first place.  These questions allow for the accumulation of best practices, issues that need addressing, and modifications that might make the entire sequence more effective.

Modification:  Evaluations will not lead to improvement unless the evaluations leads to modifications of the system.  When it becomes apparent that modifications would be effective, they need to be implemented.   After implementation the entire process needs to be gone through again.

As I listen to people talk about the problem of gun violence in schools it seems most speakers put the emphasis on one or two of these items.  I have come to the conclusion that dealing effectively with the problem will involve addressing each of these areas.  We do this in other areas where failure involves catastrophic consequences.  We need to take shootings in school with the same seriousness, or even more seriousness, than other potentially catastrophic events; at the national, state, and regional levels.   Taking it seriously involves; study, legislation, funding, and the desire and will of all those who can have an impact on the schools.

Again my prayers and heart go out to all those who grieve,  My encouragement goes out to the young people who are working so hard to make a difference.   Perhaps the biggest thing each of us can do is to vote out of office all those who do not take this problems seriously enough to look for and implement solutions that are effective on multiple levels.

2/22/2018

Edited for grammar and clarity 2/24/2018