My hot take is that Birx and other White House experts are being deliberately vague on their methodology because they know the “reopen the economy!” contingent will tear it apart if they reveal it. Not because it’s wrong, necessarily, but because all models can be attacked as resting on faulty assumptions. They’re models! They’re forecasts of an unknowable future. We go through this all the time with something as simple as polling when we obsess over whether a sample included too few Republicans to model the electorate accurately.
Consider the case of the Imperial College model of the coronavirus outbreak versus the Oxford model. The Imperial College model assumes that a relatively small percentage of the population is infected; if that’s true then we can expect a long gory slog until a vaccine is available as the contagion spreads gradually and consumes more victims. The Oxford model assumes that the virus has spread further and more quickly than any of us realize; it’s deadly only in rare cases, and we’re already well on our way towards herd immunity. The epidemic won’t last nearly as long as everyone fears.
Which model is right? Who the hell knows? They’re models! We won’t have a good idea until random antibody testing can be done.
The point is, if the White House model were less opaque, critics of the “shut it all down” strategy would doubtless attack its assumptions as unrealistic, whatever its assumptions happened to be. Normally that would be fine. But since Trump trusts what he sees on “Hannity” more than what he hears from accomplished epidemiologists, all it would take is a few segments on Fox primetime featuring some skeptic of the model attacking its assumptions point by point for Trump to junk social distancing and start pushing everyone to get back to work. Secrecy about methods is terrible for science — it’s why peer review exists — but Birx, Fauci, and the rest may be calculating that it’s preferable under the circumstances due to the president’s … unorthodox habits of consuming information, shall we say.
White House officials have refused to explain how they generated the figure — a death toll bigger than the United States suffered in the Vietnam War or the 9/11 terrorist attacks. They have not provided the underlying data so others can assess its reliability or provided long-term strategies to lower that death count…
The estimate appeared to be a rushed affair, said Marc Lipsitch, a leading epidemiologist and director of Harvard University’s Center for Communicable Disease Dynamics. “They contacted us, I think, on a Tuesday a week ago, and asked for answers and feedback by Thursday, basically 24 hours,” he said. “My initial response was we can’t do it that fast. But we ended up providing them some numbers responding to very specific scenarios.”
Other experts noted that the White House didn’t even explain the time period the death estimate supposedly captures — just the coming few months, or the year-plus it will take to deploy a vaccine.
Almost the entirety of what the public knows about the death projection was presented on a single slide at a briefing Tuesday from the White House coronavirus task force. A White House representative said the task force has not publicly released the models it drew from out of respect for the confidentiality of the modelers, many of whom approached the White House unsolicited and simply want to continue their work without publicity.
Birx has said that five or six different models influenced the White House’s model but the two most influential are clearly the Imperial College’s and the IHME’s, which is available online and which I’ve linked before. There are a few wrinkles with that one, though. For starters, it only projects the next four months, not what a second wave this fall might look like. (In their defense, there are so many uncertainties over the next six months that a fall projection might be useless.) For another, per WaPo, it uses the “trending curve of deaths from China” as a template for how the outbreak might peak and recede in U.S. cities. Except that the data from China isn’t reliable. And needless to say, no American cities will be getting a draconian Wuhan-style lockdown in the name of containing the disease.
The IHME model also assumes that U.S. states will continue to enforce aggressive social distancing measures for the next several months, which is uncertain, to put it mildly. Put all that together and it’s clear that their current projection of 93,000+ deaths before August is optimistic. The White House model may have set an upper bound of 240,000 because that’s simply a more realistic estimate of what this will look like given how Americans are likely to behave, especially as they begin to chafe against extended lockdowns. The “reopen the economy” crowd wants to believe that the White House model is exaggerating the likely death toll to scare Trump into into shutting down but it’s just as likely that the model is deliberately optimistic because they don’t want the public to freak out about what this will look like in practice. (The upper bound of the Imperial College model was 2.2 million dead, remember.) It’s scary enough envisioning 240,000 dead. Imagine a number twice that size.
In fact, one epidemiologist does imagine a number precisely double that size. His estimate was 480,000 dead, a figure he thought was conservative.
Models are models, though. “I’ve looked at all the models. I’ve spent a lot of time on the models. They don’t tell you anything. You can’t really rely upon models,” said Anthony Fauci at a meeting last week, according to WaPo. The X factors are too large for certainty, from how much distancing Americans will tolerate to whether and when therapeutic drugs will arrive to even something as basic as access to testing data. “I’m still missing 50 percent of the data from reporting,” Birx said yesterday. “I have 660 [thousand] tests reported in. We’ve done 1.3 million.” How are we supposed to properly model a disease when we’re missing half the data from our best diagnostic tool?
I think Birx, Fauci, and the other experts are trying to walk a fine line between making sure the population understands how serious this is and not wanting to clue them in just yet as to how long their lives will be disrupted for fear that people will despair and/or throw up their hands and give up on social distancing. The hard reality is that until a therapeutic drug is available, it just won’t be safe to be out and about:
“The administration has consistently shown a desire to underplay the severity of whatever is coming. And they’re constantly adjusting that — as it becomes harder to deny the reality will be worse than what they’ve conditioned people for,” said Jeremy Konyndyk, a senior policy fellow at the Center for Global Development…
“If we want to be able to — as I think we need to — turn our economy back on in a safe way, we need to be able to do that sort of thing at scale,” Konyndyk said. “And we do not have anywhere close to the public health infrastructure that’s needed to pull that off.”…
“What the means is we have to be patient. By the end of April shouldn’t be anyone’s consideration at this point,” he said. “We have to assume at the very least this is going through May.”
Through May at the very least. Two weeks from now it’ll be “through June at the very least.” Which, actually, would be in line with Trump’s own timeline: Before he spent a few days talking about reopening for Easter, he warned people at a White House press briefing that it might take until July or August for the virus to fully “wash through” the country. We can’t spend the next three months barricaded in our homes, though. People need to eat. What do we do?
Here’s Scott Gottlieb wishcasting for a therapeutic drug and a contact tracing system, sooner rather than later. We should all try to enjoy the relative political quiet of this month, as grim as the scenes in New York are. At the moment more or less everyone agrees on the strategy — stay home, hope that the epidemic peaks and begins to fade, then plot a way forward. Next month, when the full extent of the economic wreckage is better known and people are restless that things don’t seem to be improving quickly enough, will come the reckoning.
"As we come down the epidemic curve there's going to continue to be a low level of spread," says @ScottGottliebMD. "If we don't get control of this we could have another epidemic in the fall, and that's why we need a very aggressive surveillance system and a therapeutic." pic.twitter.com/66cAOTp7wu
— Squawk Box (@SquawkCNBC) April 3, 2020