All things CoronaVirus

[Trinity]

Steve Hilton said the cure was worse than the disease on Fox Weekend nonsense, Continuing the irresponsible behavior by the Murdoch network. Trump tweeted it. All caps. Perhaps as bad a decision as invading Iraq in 2003.

[DocBarrister]

These people are about to try to lift social distancing. No way in hell are people going back to business as usual in one week. We were the last place to go social distancing, and not even the whole country, and we will be the first to exit.

Hopefully we will exit these policies soon.

Kuda,

Hopefully we understand the threat and how to keep the population safe soon. The sooner that happens, the sooner we can get back to some sense of normalcy.

I'm sort of thinking that flattening the curve will actually lengthen the amount of time we have to live like this.
Also, lengthens that amount of time that elderly people have to try to shelter themselves from society.

Do you understand that what you’re saying is that we should allow more people to get infected and die, and more quickly?

We shouldn’t even begin to discuss relaxing restrictions until we get clear signs that we’re on the downside of the curve. No indication of that at all. The cases and deaths are still accelerating.

Confirmed cases are over 44,300 (more than 10,000 new cases today) and nearly 150 more deaths. No signs of slowing down.

DocBarrister

[RedFromMI]

Peter Brown wrote: ↑
Mon Mar 23, 2020 5:06 pm
Whether or not you agree with Ginn’s arguments for, say, reopening schools, people like Ginn are asking some important and detailed questions about what we know about the progress of the coronavirus.

Peter Brown wrote: ↑
Mon Mar 23, 2020 5:06 pm
But it is unhelpful and hazardous to ignore the real, human costs of protracted lockdowns, which will require increasily strong justifications the longer they drag on.


Peter Brown wrote: ↑
Mon Mar 23, 2020 5:06 pm
Which if you allow yourself to read and not burn books, was his thesis.

Pete -- That Ginn guy's ideas and argument just suck. That isn't censorship by the lefties. It is the free marketplace of ideas, after review/reflection, deciding that the guy doesn't know what-the-fork he's talking about. And because of the bull shirt assymetry principle, it is a lot easier to create the bull shirt than to (rightly) debunk.

In contrast, this guy (a doc at Yale) makes a somewhat similar argument. But his arguments are just a lot better and (by the way) he's much more qualified. TBD what the marketplace of ideas will say about his take. FYI, I have no idea what Dr. Katz's politics are. But I'd note that his oped was published by the commie pinko NY Times (and later amplified by NYT's Tom Friedman).

So please retire the tired partisan ax grinding. If you want to engage over ideas, bring it. And if I disagree with you, it will be because of your facts or logics. Not your partisan slant.

Let me know your thoughts on Katz's views. I myself am quite concerned about the economic cost of curing this disease.

https://www.nytimes.com/2020/03/20/opin ... Position=2

I’m supposed to debate you when your deeply reflective summary of Ginn is: ‘his ideas suck’?

There appear to be some very bright Silicon Valley tech peers of his who have come to his paper’s defense.

Shouldn’t we ask you your academic and professional qualifications first before I assume your ability to qualify others is just?

Also, I don’t subscribe to the NYT; copy and paste please.

OK - this is going to be long, but here is the twitter response of Carl Bergstrom, professor of theoretical and evolutionary biology at UW in Seattle (degree from Stanford). Highly respected, and has published a text on Evolution, devised the journal ranking number eigenfactor, and won the SPARC Innovation Award for the eigenfactor work.

Twitter link (if you want to see his pictures, which I will describe): https://twitter.com/CT_Bergstrom/status ... 0559503360

1. I hate to invest precious time on taking apart the atrocious @aginnt article pictured below, but it is getting too much traction here and even in traditional media.

This thread could be far longer than it is, but I'm doing my best to only discuss the most glaring flaws.
{pic of world COVID-19 map from jhu}

2. The introduction should be blaring red warning to any thinking person.

The author begins by disputing that *context matters*. Without the background to put information in context, all the data in the world are not defense against misinterpretation.
{pic highlights the quote: You don't need a special degree to understand what the data says and doesn't say}

3. You can give me all the stock market data in the world; I don't have the background to make the best use of it because I fundamentally do not understand how the market works or how to take advantage of that understanding.

Infectious disease epidemiology is no different.

4. *Information gets lost in translation.* The author claims to be an expert in making products go viral. I suppose that field has borrowed some ideas from epidemiology. Now he's trying to back-infer how epi works from what he knows about that area. It doesn't work that way.

5. Imagine Shakespeare run through google translate into Japanese, then translated back to English by someone who'd never heard of Shakespeare. So much depth would be missing.

Same here. We end up with loose neologisms like "virality" instead of a solid theoretical framework.

6. The author discusses the apparent decline in daily growth rate irrespective of control measures. He begins with some truism about small numbers being easy to move; this is irrelevant in the face of the exponential growth that he stresses in literally the previous sentence.
{pic of the opening of the section that claims it is spreading but not accelerating} my comment - already proven wrong by further data

7. He fails to see that this drop in apparent growth rates is heavily driven by left censoring and shifts in testing strategy. Testing started at different times in different countries, was influenced by case density, and early-on, tests individuals in all stages of disease.

8. Next, inferences about "virality" and "viral capacity". I suppose he means "transmissibility". If so, we've spent 20 years developing sophisticated statistical methods to detect changes in transmissibility. With noisy, aggregate data this back-of-envelope stuff doesn't cut it.
{pic of section of paper where Ginn claims he can see stuff in the noisy data}

9. Disaggregating data is essential to provide context, especially for transmission processes. That the virus can cross national boundaries does nothing to negate the importance of spatial structure and within-country analysis. Aggregating data obscures critical patterns.
{pic of section of Ginn paper where he argues by slicing per country the data is less useful}

10. I hate to ascribe to malice what can be adequately explained by incompetence, but using this lie to sweep away the disaggregated data is such utter nonsense that I wonder how a silicon valley guy could make this claim by mistake.

11. Then there's the bell curve business. If Hernstein and Murray gave the term a bad name, Ginn says "hold my beer".

Most things in nature follow a bell curve, so viruses do too? Not science exactly. And do most things? What about log-normals? Exponentials? Etc etc etc.
{pic of start of section: Watch the Bell Curve} my comment: not all statistics are bell curve - and this is a complex system of coupled processes that cannot be reduced to this

12. But that's not the worst part. We have literally over a century's history of mathematical modeling epidemic progression. Some look somewhat bell-like. Others don't. It depends on the circumstances, details of the virus, behavior of the population, interventions, etc.

13. [pause to take beta-blockers]

14. This is unsubstantiated bullshiRt. IF the bell-curve were a "law of nature", it shouldn't necessarily apply to the vast range of human responses that people take to stop epidemics. Yet this assertion is supported with data from places where interventions slowed things down.
{pic of Italy data}

15. Wait, are already breaking the data down by country? We were cautioned against that as being misleading just a few paragraphs ago!

16. Ah, Farr's law. I don't know how the author could have more effectively discredited himself to the epidemiology community with any two other words. It's an old rule-of-thumb that suggests epidemics take a bell-curve shape.
{pic of Farr's Law ref in Ginn paper}

17. When I teach ID epidemiology OR data science, I tend to have my students read this 1990 paper as a cautionary tail against non-mechanistic modeling. documents.aidswiki.net/PHDDC/BREG.PDF
{pic of abstract of referenced paper}

It uses Farr's law to predict the size of the HIV epidemic.

18. The authors conclude that the HIV epidemic will encompass roughly 200,000 cases before fading away in the mid 1990s. This graph is from the original paper. You can't make this shiRt up.
{curve from that paper, which shows the peak of the bell curve nearly there} my comment - look up how many people have died from AIDS

19. Next up a very, very basic fallacy about the effect of flattening the curve. Almost *any* reasonable epidemiological model you use, from SIR to all sorts of fancy spatial PDE or agent-based approaches, will show that decreasing transmission rate decreases total epidemic size.
{pic from Ginn paper showing flattening the curve, with area preserved}

20. This is common sense, as well as first-chapter-of-the-epidemiology-textbook stuff.

It was also sadly predictable. See my note about severe #DKE19 strains, a day before @aginnt's medium post: twitter.com/CT_Bergstrom/s…
Carl T. Bergstrom @CT_Bergstrom
Replying to @CT_Bergstrom

Not in the report, but particularly virulent strains include "The areas under curve should be the same, dumbass!", "What's so hard about estimating CFR?", and "Who needs the Harvard School of Public Health when you've got Elon Musk?"

21. This claim needs citation. I am unaware of CDC plans that involve allowing the majority of the country to be infected. Because the author may be cherry-picking here, I won't call it an outright lie. But it's not the position of the organization that we allow this to happen.
{pic of claim from Ginn paper}

22. Next the author claims that COVID19 will "burn off" in the summer, and quotes a paper from Beijing economists, posted to social science preprint server.

Science is not a like a high school English essay, where you get to cherry-pick the quotes that support your point.
{pic of start of that section in Ginn paper}

23. There's a big literature on the seasonality of respiratory disease, and consensus is that we have little grounds for optimism regarding #COVID19.

@mlipsitch, an leading expert who advanced our understanding of flu seasonality, is admirably concise: ccdd.hsph.harvard.edu/will-covid-19-…
{pic of conclusion of Lipsitch: (tl;dr)Probably not}

24. This is just misleading. Being tested is not the same as thinking you are positive. Did your doctor ever order a rapid flu test or strep culture or a chest x-ray for pneumonia? When you did, did you think YOU were positive? Same deal with COVID19, esp in places like S. Korea.
{pic of section saying 93% of those tested think they are positive}

25. This single piece of bait-and-switch should be more than enough to discredit the entire article. @aginnt claims that only 1% of cases are severe, and then shows a data graphic suggesting that 19% are severe or worse (critical).

How on earth does he draw that conclusion?
{pic from Ginn paper starting with the statement of 1% followed by a graph at 19%}

26. He says "cases" in the headline, but "everyone who is tested" in the text. These are very different denominators, given the low positive rate he was just trumpeting about in the previous section.

If a mistake rather than deliberate bullshiRt, it's amazingly sloppy.

27. Oh, and in the study that provided these numbers, "mild" cases included pneumonia short of hospitalization in a setting where hospitals are already overcrowded.

Mild doesn't mean your ordinary cold.

28. Lastly on this point, I hate to go all MS-PAINT on you, but....
{pic where he circles the 1% claim, and draws to another circled datum that 2.3% died with the letters What the heck!!!}

29. An aside: I realize that John Ioannides is trying to be clever and contrarian and has a hammer and damned if this pandemic doesn't look like a nail, but his latest STAT piece is just chumming the swimming beach for this particular kind of shark.
{pic of bio of Ioannides}

30. [Deep breath]

It looks like this piece has now been taken down by Medium. I'm going to stop now, even though I'm only about half way thought. If it comes back to haunt us, I'll continue the thread.

Thanks for reading, and stay safe out there.

31. So the piece has moved on to another right wing conspiracy-sphere website recently banned from Twitter for unfounded personal attacks on a scientist.

Should I continue to go through the article, or get back to my positive efforts (modeling, sci comm) around the crisis?
{included poll}

32. Thank you so much to everyone who took the time to vote on the poll. I've been working on other disease modeling efforts this evening, and my twitter feed has been swamped by newly-formed troll accounts. I'll return to this tomorrow if necessary. Take care everyone!

Yeah - his ideas suck!

[Typical Lax Dad]

Compelling

[Typical Lax Dad]

We eclipsed 100 deaths today. 111. We should be good next week.

[Peter Brown]

Steve Hilton said the cure was worse than the disease on Fox Weekend nonsense, Continuing the irresponsible behavior by the Murdoch network. Trump tweeted it. All caps. Perhaps as bad a decision as invading Iraq in 2003.

The left has 100 national networks, newspapers, and cable stations to watch/read, but all they ever do is comment on Fox broadcasts.

[a fan]

I’m more fascinated by the Left’s embrace of totalitarianism vis suppression of speech and information. Sorry but that intrigues me!

Another word you don't understand. Totalitarianism means the State does the suppression, not, you know, experts in a field mocking some dumb*ss on the internet.

When someone who knows zippo about infections diseases blathers nonsense....and an expert in infectious diseases tells him to shut up, you're making the situation worse, because people like Pete Brown believe they guy's nonsense "deserves consideration".....you think this this is totalitarianism?

Wanna hear my lecture on aerodynamics? I haven't read a single book on it. Should I give a lecture, and wait for Boeing's designers to spend a few hours mulling over my "ideas" on the subject? And if the Boeing engineers tell me I don't know what I'm talking about, shut up.....should I cry and call them totalitarians?

Where do you come up with this stuff?

Tell me when the Right accosts a press secretary at a restaurant or a majority leader in his driveway, or a google engineer who says something positive about the left, or shoots up a group of Democrats at a softball game. I’ll wait!

Oh right. Because the American right would never go in and, I don't know, mow down black parishioners in a church because they have nothing better to do?

What world are you living in where you have concluded the left is the source of all evil in the world, and the right are shiny knights that save the pwetty princesses? Is it true that only registered Democrats are in prison? And Democrats are mean to animals for no reason?

Inquiring minds want to know. You really seem to have the world figured out.

[RedFromMI]

Here is another twitter one, relating to the call for getting back to business sooner rather than later, but a Hopkins guy (director of Center for Health Security there)

Tom Inglesby (just before 7:30 pm tonight)

In last 24 hrs there've been prominent US voices calling for a stop to social distancing, citing rationale that they're worse than impact of COVID itself. It’s worth looking very closely at that claim, where we are in US COVID epidemic and what happens if we stop. 1/x

COVID has been spreading w/ exponential growth in US for some time, and we're just beginning to get an understanding of how extensively. There
are nearly 40,000 cases recognized in the US as of today, w/ ~100 deaths today. A few weeks ago, we had recognized 70 cases total. 2/x

Some hospitals have said publicly that within a week they will not have ventilators to treat everyone with COVID anymore. 3/x

There continue to be big diagnostic limitations. Shortages in reagents, swabs. Don’t have rapid diagnostics in many hospitals yet, so it can be days before doctors and nurses can find out if a pt in front of them has COVID. 4/x

We don’t have capacity to diagnose many of the COVID cases that are not sick enough to be in the hospital, so those numbers aren’t counted in our national totals. 5/x

There continues to be terrible shortages in the masks that health care workers need to keep from getting sick with this disease. 6/x

How do we gain time to let hosps get more supplies & prepare for high number of pts? How do we lower the speed of spread of COVID in US? How do we lower odds that ICUs will run out of vents, hospitals run out of space? The answer for now is large scale social distancing.7/x

In Asia, we've seen these interventions work to lower pace of the epidemic, lower numbers of critically ill, lower the number of people who get COVID. In Asia where big social distancing measures have been in place for two months, they have had very strong impact. 8/x

In Asia they've slowed the disease by slowing social interaction. Left to its own, this disease spreads from 1 person to about 2.5 people, and then they do the same, and so on. For this disease to stop, we need to make it so that the avg person spreads it to <1 other person. 9/x

These big social distancing measures take time to work. The impact of big interventions in Wuhan China took about 3 wks to start to reverse things. And then everyday after the situation got better. In the US, we're about 7 to 10 days into this, depending on the state.10/x

To drop all these measures now would be to accept that COVID pts will get sick in extraordinary numbers all over the country, far beyond
what the US health care system could bear. 11/x

Many models report that health care systems will be completely overwhelmed/collapse by the peak of cases if major social distancing is not put in place. 12/x

If a health care system in a given community stops working, can no longer provide care to the ill, the case fatality rate for COVID will be far higher than 1% - we would not be able to care for some or all of the expected 5% of recognized cases that get critically ill. 13/x

Beyond that, if hospitals were completely overwhelmed, they may struggle to provide even oxygen for some or many of the 15% of recognized cases expected to be “severely ill”. let alone provide care for other life threatening conditions. 14/x

Anyone advising the end of social distancing now, needs to fully understand what the country will look like if we do that. COVID would spread widely, rapidly, terribly, could kill potentially millions in the yr ahead with huge social and economic impact across the country. 15/x

Before considering big changes to social distancing measures now, we should as quickly as possible get to strongest possible position for COVID response – we're no where near that now. We'll need rapid Dxs in place almost every location where a pt can be seen for care.16/x

We'll need extraordinary quantity, reserve+production lines of masks, PPE so that shortages at hosps and clinical sites around country are no longer possible. We'lll need to have more vents on the way. We'll need capacity to provide med care to many more that we can now.17/x

We'll need to reduce the # of cases to such a low level that we could again do contact tracing & isolation of cases around the country (as they can in many countries in Asia now). 18/x

We will need system of screening at airports so that no person comes into the country with the disease without being diagnosed and isolated. 19/x

We'll need a serology test that can be used to identify those that have been infected and recovered already, and to know how prevalent disease is in the US. We would hopefully have therapies developed and in a quantity that we can treat at least the sickest pt w COVID. 20/x

Once we have those things in place, it would be a far less risky time to take stock of social distancing measures in place and consider what might gradually be reduced with trial and error. We would have learned more about the experience in Asia as they try to do that.21/x

For now we need to keep production running, doctors offices working, groceries, pharmacies, banks open. It is ok to have science informed dialogue about which businesses need to be closed vs what can stay open in some way if social distancing can be put in place in them.22/x

But we need to press ahead for now w closed schools, mass telecommuting, no gatherings, strong advisory to stay home unless you need to go out – all are needed to slow this epidemic. 23/x

We also need to put every conceivable econ program in place to help those being hurt by these social distancing measures. And move ahead rapidly to get our country far better prepared to cope w COVID before people recommend we abandon our efforts to slow this virus. 24/x

[Peter Brown]

Red. Posting an entire War and Peace article qualifies you as having deep TDS. Same with that esteemed biologist.

How’s about seeing how it all plays out? You guys are like the Catholic Church arresting Galileo for heresy for believing the earth revolves around the sun. You’ve got the same puritanical passion and intolerance.

[Peter Brown]

I’m more fascinated by the Left’s embrace of totalitarianism vis suppression of speech and information. Sorry but that intrigues me!

Another word you don't understand. Totalitarianism means the State does the suppression, not, you know, experts in a field mocking some dumb*ss on the internet.

When someone who knows zippo about infections diseases blathers nonsense....and an expert in infectious diseases tells him to shut up, you're making the situation worse, because people like Pete Brown believe they guy's nonsense "deserves consideration".....you think this this is totalitarianism?

Wanna hear my lecture on aerodynamics? I haven't read a single book on it. Should I give a lecture, and wait for Boeing's designers to spend a few hours mulling over my "ideas" on the subject? And if the Boeing engineers tell me I don't know what I'm talking about, shut up.....should I cry and call them totalitarians?

Where do you come up with this stuff?

Tell me when the Right accosts a press secretary at a restaurant or a majority leader in his driveway, or a google engineer who says something positive about the left, or shoots up a group of Democrats at a softball game. I’ll wait!

Oh right. Because the American right would never go in and, I don't know, mow down black parishioners in a church because they have nothing better to do?

What world are you living in where you have concluded the left is the source of all evil in the world, and the right are shiny knights that save the pwetty princesses? Is it true that only registered Democrats are in prison? And Democrats are mean to animals for no reason?

Inquiring minds want to know. You really seem to have the world figured out.

Galileo meets the Catholic Church’s opprobrium. Poor Aaron Ginn, he really needs to keep his thoughts to himself. The experts have weighed in and the verdict delivered.

Sigh.

[Typical Lax Dad]

Red. Posting an entire War and Peace article qualifies you as having deep TDS. Same with that esteemed biologist.

How’s about seeing how it all plays out? You guys are like the Catholic Church arresting Galileo for heresy for believing the earth revolves around the sun. You’ve got the same puritanical passion and intolerance.

You have it backwards. Galileo relied on the scientific method.

[RedFromMI]

Red. Posting an entire War and Peace article qualifies you as having deep TDS. Same with that esteemed biologist.

How’s about seeing how it all plays out? You guys are like the Catholic Church arresting Galileo for heresy for believing the earth revolves around the sun. You’ve got the same puritanical passion and intolerance.

See how it all plays out - millions dead, huh?

And this guy is an expert. This has nothing to do with Galileo and the church.

You wanted to know why some of us think the Ginn piece just sucks. It is because even I could find lots of problems with Ginn's fast and loose use of data. And I said so in my first response to your post.

Your answer is to call us names. It is because you don't really have an argument - Ginn's work sucks.

And actually having read War and Peace, what I posted isn't anywhere near that size.

[tech37]

Here is another twitter one, relating to the call for getting back to business sooner rather than later, but a Hopkins guy (director of Center for Health Security there)

Tom Inglesby (just before 7:30 pm tonight)

In last 24 hrs there've been prominent US voices calling for a stop to social distancing, citing rationale that they're worse than impact of COVID itself. It’s worth looking very closely at that claim, where we are in US COVID epidemic and what happens if we stop. 1/x

COVID has been spreading w/ exponential growth in US for some time, and we're just beginning to get an understanding of how extensively. There
are nearly 40,000 cases recognized in the US as of today, w/ ~100 deaths today. A few weeks ago, we had recognized 70 cases total. 2/x

Some hospitals have said publicly that within a week they will not have ventilators to treat everyone with COVID anymore. 3/x

There continue to be big diagnostic limitations. Shortages in reagents, swabs. Don’t have rapid diagnostics in many hospitals yet, so it can be days before doctors and nurses can find out if a pt in front of them has COVID. 4/x

We don’t have capacity to diagnose many of the COVID cases that are not sick enough to be in the hospital, so those numbers aren’t counted in our national totals. 5/x

There continues to be terrible shortages in the masks that health care workers need to keep from getting sick with this disease. 6/x

How do we gain time to let hosps get more supplies & prepare for high number of pts? How do we lower the speed of spread of COVID in US? How do we lower odds that ICUs will run out of vents, hospitals run out of space? The answer for now is large scale social distancing.7/x

In Asia, we've seen these interventions work to lower pace of the epidemic, lower numbers of critically ill, lower the number of people who get COVID. In Asia where big social distancing measures have been in place for two months, they have had very strong impact. 8/x

In Asia they've slowed the disease by slowing social interaction. Left to its own, this disease spreads from 1 person to about 2.5 people, and then they do the same, and so on. For this disease to stop, we need to make it so that the avg person spreads it to <1 other person. 9/x

These big social distancing measures take time to work. The impact of big interventions in Wuhan China took about 3 wks to start to reverse things. And then everyday after the situation got better. In the US, we're about 7 to 10 days into this, depending on the state.10/x

To drop all these measures now would be to accept that COVID pts will get sick in extraordinary numbers all over the country, far beyond
what the US health care system could bear. 11/x

Many models report that health care systems will be completely overwhelmed/collapse by the peak of cases if major social distancing is not put in place. 12/x

If a health care system in a given community stops working, can no longer provide care to the ill, the case fatality rate for COVID will be far higher than 1% - we would not be able to care for some or all of the expected 5% of recognized cases that get critically ill. 13/x

Beyond that, if hospitals were completely overwhelmed, they may struggle to provide even oxygen for some or many of the 15% of recognized cases expected to be “severely ill”. let alone provide care for other life threatening conditions. 14/x

Anyone advising the end of social distancing now, needs to fully understand what the country will look like if we do that. COVID would spread widely, rapidly, terribly, could kill potentially millions in the yr ahead with huge social and economic impact across the country. 15/x

Before considering big changes to social distancing measures now, we should as quickly as possible get to strongest possible position for COVID response – we're no where near that now. We'll need rapid Dxs in place almost every location where a pt can be seen for care.16/x

We'll need extraordinary quantity, reserve+production lines of masks, PPE so that shortages at hosps and clinical sites around country are no longer possible. We'lll need to have more vents on the way. We'll need capacity to provide med care to many more that we can now.17/x

We'll need to reduce the # of cases to such a low level that we could again do contact tracing & isolation of cases around the country (as they can in many countries in Asia now). 18/x

We will need system of screening at airports so that no person comes into the country with the disease without being diagnosed and isolated. 19/x

We'll need a serology test that can be used to identify those that have been infected and recovered already, and to know how prevalent disease is in the US. We would hopefully have therapies developed and in a quantity that we can treat at least the sickest pt w COVID. 20/x

Once we have those things in place, it would be a far less risky time to take stock of social distancing measures in place and consider what might gradually be reduced with trial and error. We would have learned more about the experience in Asia as they try to do that.21/x

For now we need to keep production running, doctors offices working, groceries, pharmacies, banks open. It is ok to have science informed dialogue about which businesses need to be closed vs what can stay open in some way if social distancing can be put in place in them.22/x

But we need to press ahead for now w closed schools, mass telecommuting, no gatherings, strong advisory to stay home unless you need to go out – all are needed to slow this epidemic. 23/x

We also need to put every conceivable econ program in place to help those being hurt by these social distancing measures. And move ahead rapidly to get our country far better prepared to cope w COVID before people recommend we abandon our efforts to slow this virus. 24/x

If this Ingelsby guy is correct, it just goes to show how inept and unprepared our healthcare system is and has been in the face of pandemics. This goes way back...who should be blamed?

[Cooter]

Beyond that, if hospitals were completely overwhelmed, they may struggle to provide even oxygen for some or many of the 15% of recognized cases expected to be “severely ill”. let alone provide care for other life threatening conditions. 14/x

How do they know it is 15%, if they don't know how many current cases there are in the US right now?

[RedFromMI]

Beyond that, if hospitals were completely overwhelmed, they may struggle to provide even oxygen for some or many of the 15% of recognized cases expected to be “severely ill”. let alone provide care for other life threatening conditions. 14/x

How do they know it is 15%, if they don't know how many current cases there are in the US right now?

Current numbers from worldwide data are near that amount. Does not really matter if 10%, 15%, 20% if you reach the limit so your hospitals are so full no one else can get care, no matter the illness. Then more people die who would have likely lived were there capacity to heal them.

[RedFromMI]

Beyond that, if hospitals were completely overwhelmed, they may struggle to provide even oxygen for some or many of the 15% of recognized cases expected to be “severely ill”. let alone provide care for other life threatening conditions. 14/x

How do they know it is 15%, if they don't know how many current cases there are in the US right now?

Current numbers from worldwide data are near that amount. Does not really matter if 10%, 15%, 20% if you reach the limit so your hospitals are so full no one else can get care, no matter the illness. Then more people die who would have likely lived were there capacity to heal them.

[a fan]

Galileo meets the Catholic Church’s opprobrium.

Yeah. The State. Threatening death. Get it? Not the same an an expert in the field telling some dumb kid to shut up, as it might get people killed.

So in the middle of a national crisis (sort of a salient bit of context), you think it's "neat" that some idiot is throwing around his "ideas" on coronavirus that idiots are taking seriously...and you think wanting this idiot to shut up is the same thing as the Catholic Church threatening to put Galileo to death over his ideas?

[DocBarrister]

Peter Brown wrote: ↑
Mon Mar 23, 2020 5:06 pm
Whether or not you agree with Ginn’s arguments for, say, reopening schools, people like Ginn are asking some important and detailed questions about what we know about the progress of the coronavirus.

Peter Brown wrote: ↑
Mon Mar 23, 2020 5:06 pm
But it is unhelpful and hazardous to ignore the real, human costs of protracted lockdowns, which will require increasily strong justifications the longer they drag on.


Peter Brown wrote: ↑
Mon Mar 23, 2020 5:06 pm
Which if you allow yourself to read and not burn books, was his thesis.

Pete -- That Ginn guy's ideas and argument just suck. That isn't censorship by the lefties. It is the free marketplace of ideas, after review/reflection, deciding that the guy doesn't know what-the-fork he's talking about. And because of the bull shirt assymetry principle, it is a lot easier to create the bull shirt than to (rightly) debunk.

In contrast, this guy (a doc at Yale) makes a somewhat similar argument. But his arguments are just a lot better and (by the way) he's much more qualified. TBD what the marketplace of ideas will say about his take. FYI, I have no idea what Dr. Katz's politics are. But I'd note that his oped was published by the commie pinko NY Times (and later amplified by NYT's Tom Friedman).

So please retire the tired partisan ax grinding. If you want to engage over ideas, bring it. And if I disagree with you, it will be because of your facts or logics. Not your partisan slant.

Let me know your thoughts on Katz's views. I myself am quite concerned about the economic cost of curing this disease.

https://www.nytimes.com/2020/03/20/opin ... Position=2

I’m supposed to debate you when your deeply reflective summary of Ginn is: ‘his ideas suck’?

There appear to be some very bright Silicon Valley tech peers of his who have come to his paper’s defense.

Shouldn’t we ask you your academic and professional qualifications first before I assume your ability to qualify others is just?

Also, I don’t subscribe to the NYT; copy and paste please.

OK - this is going to be long, but here is the twitter response of Carl Bergstrom, professor of theoretical and evolutionary biology at UW in Seattle (degree from Stanford). Highly respected, and has published a text on Evolution, devised the journal ranking number eigenfactor, and won the SPARC Innovation Award for the eigenfactor work.

Twitter link (if you want to see his pictures, which I will describe): https://twitter.com/CT_Bergstrom/status ... 0559503360

1. I hate to invest precious time on taking apart the atrocious @aginnt article pictured below, but it is getting too much traction here and even in traditional media.

This thread could be far longer than it is, but I'm doing my best to only discuss the most glaring flaws.
{pic of world COVID-19 map from jhu}

2. The introduction should be blaring red warning to any thinking person.

The author begins by disputing that *context matters*. Without the background to put information in context, all the data in the world are not defense against misinterpretation.
{pic highlights the quote: You don't need a special degree to understand what the data says and doesn't say}

3. You can give me all the stock market data in the world; I don't have the background to make the best use of it because I fundamentally do not understand how the market works or how to take advantage of that understanding.

Infectious disease epidemiology is no different.

4. *Information gets lost in translation.* The author claims to be an expert in making products go viral. I suppose that field has borrowed some ideas from epidemiology. Now he's trying to back-infer how epi works from what he knows about that area. It doesn't work that way.

5. Imagine Shakespeare run through google translate into Japanese, then translated back to English by someone who'd never heard of Shakespeare. So much depth would be missing.

Same here. We end up with loose neologisms like "virality" instead of a solid theoretical framework.

6. The author discusses the apparent decline in daily growth rate irrespective of control measures. He begins with some truism about small numbers being easy to move; this is irrelevant in the face of the exponential growth that he stresses in literally the previous sentence.
{pic of the opening of the section that claims it is spreading but not accelerating} my comment - already proven wrong by further data

7. He fails to see that this drop in apparent growth rates is heavily driven by left censoring and shifts in testing strategy. Testing started at different times in different countries, was influenced by case density, and early-on, tests individuals in all stages of disease.

8. Next, inferences about "virality" and "viral capacity". I suppose he means "transmissibility". If so, we've spent 20 years developing sophisticated statistical methods to detect changes in transmissibility. With noisy, aggregate data this back-of-envelope stuff doesn't cut it.
{pic of section of paper where Ginn claims he can see stuff in the noisy data}

9. Disaggregating data is essential to provide context, especially for transmission processes. That the virus can cross national boundaries does nothing to negate the importance of spatial structure and within-country analysis. Aggregating data obscures critical patterns.
{pic of section of Ginn paper where he argues by slicing per country the data is less useful}

10. I hate to ascribe to malice what can be adequately explained by incompetence, but using this lie to sweep away the disaggregated data is such utter nonsense that I wonder how a silicon valley guy could make this claim by mistake.

11. Then there's the bell curve business. If Hernstein and Murray gave the term a bad name, Ginn says "hold my beer".

Most things in nature follow a bell curve, so viruses do too? Not science exactly. And do most things? What about log-normals? Exponentials? Etc etc etc.
{pic of start of section: Watch the Bell Curve} my comment: not all statistics are bell curve - and this is a complex system of coupled processes that cannot be reduced to this

12. But that's not the worst part. We have literally over a century's history of mathematical modeling epidemic progression. Some look somewhat bell-like. Others don't. It depends on the circumstances, details of the virus, behavior of the population, interventions, etc.

13. [pause to take beta-blockers]

14. This is unsubstantiated bullshiRt. IF the bell-curve were a "law of nature", it shouldn't necessarily apply to the vast range of human responses that people take to stop epidemics. Yet this assertion is supported with data from places where interventions slowed things down.
{pic of Italy data}

15. Wait, are already breaking the data down by country? We were cautioned against that as being misleading just a few paragraphs ago!

16. Ah, Farr's law. I don't know how the author could have more effectively discredited himself to the epidemiology community with any two other words. It's an old rule-of-thumb that suggests epidemics take a bell-curve shape.
{pic of Farr's Law ref in Ginn paper}

17. When I teach ID epidemiology OR data science, I tend to have my students read this 1990 paper as a cautionary tail against non-mechanistic modeling. documents.aidswiki.net/PHDDC/BREG.PDF
{pic of abstract of referenced paper}

It uses Farr's law to predict the size of the HIV epidemic.

18. The authors conclude that the HIV epidemic will encompass roughly 200,000 cases before fading away in the mid 1990s. This graph is from the original paper. You can't make this shiRt up.
{curve from that paper, which shows the peak of the bell curve nearly there} my comment - look up how many people have died from AIDS

19. Next up a very, very basic fallacy about the effect of flattening the curve. Almost *any* reasonable epidemiological model you use, from SIR to all sorts of fancy spatial PDE or agent-based approaches, will show that decreasing transmission rate decreases total epidemic size.
{pic from Ginn paper showing flattening the curve, with area preserved}

20. This is common sense, as well as first-chapter-of-the-epidemiology-textbook stuff.

It was also sadly predictable. See my note about severe #DKE19 strains, a day before @aginnt's medium post: twitter.com/CT_Bergstrom/s…
Carl T. Bergstrom @CT_Bergstrom
Replying to @CT_Bergstrom

Not in the report, but particularly virulent strains include "The areas under curve should be the same, dumbass!", "What's so hard about estimating CFR?", and "Who needs the Harvard School of Public Health when you've got Elon Musk?"

21. This claim needs citation. I am unaware of CDC plans that involve allowing the majority of the country to be infected. Because the author may be cherry-picking here, I won't call it an outright lie. But it's not the position of the organization that we allow this to happen.
{pic of claim from Ginn paper}

22. Next the author claims that COVID19 will "burn off" in the summer, and quotes a paper from Beijing economists, posted to social science preprint server.

Science is not a like a high school English essay, where you get to cherry-pick the quotes that support your point.
{pic of start of that section in Ginn paper}

23. There's a big literature on the seasonality of respiratory disease, and consensus is that we have little grounds for optimism regarding #COVID19.

@mlipsitch, an leading expert who advanced our understanding of flu seasonality, is admirably concise: ccdd.hsph.harvard.edu/will-covid-19-…
{pic of conclusion of Lipsitch: (tl;dr)Probably not}

24. This is just misleading. Being tested is not the same as thinking you are positive. Did your doctor ever order a rapid flu test or strep culture or a chest x-ray for pneumonia? When you did, did you think YOU were positive? Same deal with COVID19, esp in places like S. Korea.
{pic of section saying 93% of those tested think they are positive}

25. This single piece of bait-and-switch should be more than enough to discredit the entire article. @aginnt claims that only 1% of cases are severe, and then shows a data graphic suggesting that 19% are severe or worse (critical).

How on earth does he draw that conclusion?
{pic from Ginn paper starting with the statement of 1% followed by a graph at 19%}

26. He says "cases" in the headline, but "everyone who is tested" in the text. These are very different denominators, given the low positive rate he was just trumpeting about in the previous section.

If a mistake rather than deliberate bullshiRt, it's amazingly sloppy.

27. Oh, and in the study that provided these numbers, "mild" cases included pneumonia short of hospitalization in a setting where hospitals are already overcrowded.

Mild doesn't mean your ordinary cold.

28. Lastly on this point, I hate to go all MS-PAINT on you, but....
{pic where he circles the 1% claim, and draws to another circled datum that 2.3% died with the letters What the heck!!!}

29. An aside: I realize that John Ioannides is trying to be clever and contrarian and has a hammer and damned if this pandemic doesn't look like a nail, but his latest STAT piece is just chumming the swimming beach for this particular kind of shark.
{pic of bio of Ioannides}

30. [Deep breath]

It looks like this piece has now been taken down by Medium. I'm going to stop now, even though I'm only about half way thought. If it comes back to haunt us, I'll continue the thread.

Thanks for reading, and stay safe out there.

31. So the piece has moved on to another right wing conspiracy-sphere website recently banned from Twitter for unfounded personal attacks on a scientist.

Should I continue to go through the article, or get back to my positive efforts (modeling, sci comm) around the crisis?
{included poll}

32. Thank you so much to everyone who took the time to vote on the poll. I've been working on other disease modeling efforts this evening, and my twitter feed has been swamped by newly-formed troll accounts. I'll return to this tomorrow if necessary. Take care everyone!

Yeah - his ideas suck!

Guys like Aaron Ginn are sometimes called “growth hackers.” But there’s an older term that describes them perfectly:

Propagandist.

DocBarrister

[a fan]

If this Ingelsby guy is correct, it just goes to show how inept and unprepared our healthcare system is and has been in the face of pandemics. This goes way back...who should be blamed?

Everyone in Congress who thinks that governing is a sport. McConnell, by far. Pelosi, not far behind. We already know Trump's work to dismantle Gov. agencies he doesn't understand.

And everyone who thinks socialism or government infrastructure is bad, and should be cut because they think "the free market should handle it".

[jhu72]

3/23/2020 per capita numbers (past 24 hrs from roughly 7:30 3/22/20 pm to 7:30 pm 3/23/20)

Interesting information follows:

US Cases per Capita --> 13.1 per 100,000
US Deaths per Capita --> 1.6 per million

States with highest per capita infection (per 100,000)
--> New York 107.3; 32% higher than yesterday's rate
--> New Jersey 32.0; 48% higher than yesterday's rate
--> Washington 26.2; 0% higher than yesterday's rate
--> Louisiana 25.2; 40% higher than yesterday's rate
--> District of Columbia 17.0; 17% higher that yesterday's rate
--> Michigan 13.3; 28% higher that yesterday's rate
--> Vermont 12.0; 45% higher that yesterday's rate
--> Connecticut 11.6; 84% higher that yesterday's rate
--> Massachusetts 11.3; 20% higher that yesterday's rate
--> Colorado 10.4; 25% higher that yesterday's rate
--> Illinois 10.1; 22% higher that yesterday's rate

Only 17 states have death rates of more than 1 per million (5 new since yesterday)
--> Washington 12.5 per million – no change
--> New York 8.1 per million
--> Vermont 8.0 per million – more than doubled overnight
--> Louisiana 7.5 per million – almost doubled overnight
--> New Jersey 3.0 per million – more than doubled overnight
--> District of Columbia 2.8 per million – doubled overnight
--> Connecticut 2.8 per million – doubled overnight
--> Georgia 2.4 per million
--> Michigan 1.5 per million
--> Nevada 1.3 per million
--> Massachusetts 1.3 per million - NEW
--> Colorado 1.2 per million
--> Oregon 1.2 per million
--> South Dakota 1.1 per million
--> South Carolina 1.0 per million - NEW
--> Indiana 1.0 per million - NEW
--> California 1.0 per million - NEW

US deaths in the last 24 hours is 27% greater than the deaths for the previous 24 hours
US new cases in the last 24 hours is 30% greater than the new cases in the previous 24 hours

One new state has joined the club, recording their first death in the past 24 hours
--> New Hampshire

Notes:
-- Hell broke loose today. The list of states with significant infections nearly doubled. Those with previous infections just grew bigger infections. The number of states with death rates exceeding 1 per million grew by 5 and many of the states on the list doubled their death rates.
-- One note of really good news – Washington state hardly moved, either in infection rate or death rate. Could this be a turn?? It had given a signal the end of last week that a turn might be instore.