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I listened intently to the President’s briefing Tuesday. This was the briefing in which the President and his team were outlining the compelling data that persuaded the President that the shuttering of businesses remain important through the end of April. The data presented were basically threefold: The alternative looks of the epidemic with and without aggressive measures, the IHME chart on epidemic projections for the US with aggressive measures, and the contrast in case growth (controlled for population) between states that started early on aggressive measures (Washington and California) with states that did not (New York and New Jersey).
@cliffbrown included the video of the briefing in his post:“I’m a cheerleader for America”
Here are screen grabs of the 3 charts:
Featured prominently in Dr. Birx’s presentation was the IHME model from the University of Washington. No doubt many people watching heard about it for the first time. We on Ricochet have been discussing it since I posted Day 68: COVID-19 Comorbidity. As has been discussed there are questions about its predictive power. But for policymakers (in the absence of a better tool), the question becomes is it plausible? Are the predictions of the IHME model plausible even though it has to be refined as more data becomes available?
The White House press corps continues to be a miserable group of ideologically driven numbskulls. If they were doing their job the IHME model would not be new to them and they would have spotted the obvious question that I pose in the title post: When will this be over? And there were hints in the presentation that the press never picked up on. First hint: in the chart that the White House put up to contrast the non-intervention versus intervention case — flattening the curve — the endpoint for intervention stretches the epidemic out in time. In other words, the epidemic burns out more quickly if you do nothing than if you try to intervene. So why would you intervene? The White House says “to save lives” but here they are being a little cagey.
Will spreading out the epidemic reduce the number of people who will die from COVID-19, all things being equal? The answer is technically “no” but all things are not equal. If you had an epidemic for which we were fully prepared with whatever efficacious treatments could be applied, then the death rate would be whatever it would be regardless of how long it went on. What was missing for this epidemic was preparation. On day one there was no universal testing protocol, no vaccine, insufficient PPE for both health workers and the public, and no maximally efficacious treatment protocol. So spreading the epidemic out in time buys us weeks to catch up as best we can. No vaccine, but better treatment protocols and improved PPE for the health workers (and the public at some point).
But in another sense the White House is completely accurate when it says spreading the epidemic out in time will save lives: It will save the lives of people in need of treatment for trauma and from diseases other than COVID-19. If the health system is broken by the demands of the epidemic, then more people die from all causes, not just the epidemic disease. What President Trump, then, was persuaded about was that we need the month of April to save the health care system. And that saving the health system was sufficiently important that the economy should be sacrificed for another couple of weeks.
The second hint about how long the epidemic will go on was in the IHME death data. Again, the chart showed the tail going out into July. Maybe today the press is digging into the data and seeing what I inserted at the top of this post: the IMHE projection of when the last death from COVID-19 will be recorded from this current outbreak.
Will the economy be shut down until no more deaths are recorded? No. The irony is that the state with the worst epidemic response will be the lead indicator that it is OK to start re-opening the economy. New York is projected to record its last death from COVID-19 on May 10; California is projected to record its last death from COVID-19 on July 1. In order to record that last death, there will be a decline in the daily growth of cases and death. For New York, it will be as pronounced in the decline as in the rise because its slope is closer to the non-intervention model. Therefore, the signal for decline will be stronger and sooner. Places like California the signal will be weaker and later.
Whether it is the IHME model specifically that the White House is looking to, or simply its plausibility that is useful, is unknown. But the model has to get better as more data is gathered. In the meantime, the shelter-in-place orders will continue. Locally our County order has been updated and extended to May 3. But…and this is a big but…the clarifications they have made as to what are ESSENTIAL BUSINESSES and what are permitted MINIMUM BASIC OPERATIONS for non-essential businesses portend broader economic activity than what the initial order envisioned.
[Note: Links to all my CoVID-19 posts can be found here.]Published in