Friday, April 10, 2020

Bad Models, Politics Kills, Learning

A FB responder to the excellent PL report said the following:

"Look up how CDC estimates the burden of seasonal influenza in the U.S. and then look up their post-mortem guidelines for handling Covid-19. It's interesting when you approach it from the position of having to create models, especially under pressure, with flawed and/or limited data."
My methodology (below) as I thought of this ... I THINK what the FB responder may be trying to say is "well, the reporting / models might not be right, but it is really hard".  

Well, yes ... "Predictions are hard to make, especially about the future", AND, the map/models are NEVER reality/the territory! 

SO, in pretty much every case prior  to this Corona,  FIRST, "we do no, or minimal harm" ... like we isolate the elderly / vulnerable, we start doing randomized testing and observe hot spots, we take "reasonable measures" to isolate those hot spots ... and we keep doing that randomized testing to get an increasingly accurate ACTUAL death rate, and with increasing knowledge we continue to adapt, making adjustments as we learn. 

So the really big question is WHY NOT THIS TIME? 

So I read CDC methodology for estimate of seasonal flu burden ... in summary:
  • It's complicated
  • It's slow so we keep revising it 
  • Since we keep revising it, comparisons with past numbers may not be valid. 
  • We do a lot of "adjustments" whenever we want, based on our changing "assumptions, models. etc" and especially to justify our existence and get more funding (we REALLY hope they don't consider that last part very much!) 
Really short summary -- "trust us" ... no matter what changes we make.

Then I read https://www.cdc.gov/coronavirus/2019-ncov/downloads/COVID-19-Persons-Under-Investigation-and-Case-Report-Form-Instructions.pdf ... most interesting to me was that they changed the reporting on the 15th of March to get rid of "presumed". 

I've looked at CDC reporting on H1N1 in the past ... summary "to calculate the burden of 2009 pandemic influenza A (pH1N1) in the United States, we extrapolated from the Centers for Disease Control and Prevention's Emerging Infections Program laboratory-confirmed hospitalizations across the entire United States, and then corrected for under-reporting. From 12 April 2009 to 10 April 2010, we estimate that approximately 60.8 million cases (range: 43.3-89.3 million), 274,304 hospitalizations (195,086-402,719), and 12,469 deaths (8868-18,306) occurred in the United States due to pH1N1. Eighty-seven percent of deaths occurred in those under 65 years of age with children and working adults having risks of hospitalization and death 4 to 7 times and 8 to 12 times greater, respectively, than estimates of impact due to seasonal influenza covering the years 1976-2001. In our study, adults 65 years of age or older were found to have rates of hospitalization and death that were up to 75% and 81%, respectively, lower than seasonal influenza. These results confirm the necessity of a concerted public health response to pH1N1.

So, H1N1 had a much greater impact on the young than Covid-19, as of today, total US deaths reported are 18K ... HEAVILY (like 89% + skewed to 70+ age) -- which makes "how you report" a very critical factor (PL post). As of today we are just short of .5 million cases, vs the 60 million final total for H1N1 . 

It isn't hard to find much higher estimates for H1N1 ,,, this CDC source says 10x, or 200K deaths WW.

Here is a great article on the likely extreme overstatement of Covid-19 deaths. Again, WHY are many WW heath organizations looking to overstate Covid -19 deaths, while in comparison, I think we can be pretty certain that China is vastly under-reporting for obvious reasons. 

We all need to be aware of Japan ... as of today their death rate is .8 per million compared to our 54 and Spain's 342. Those are VERY different numbers, therefore HUGE opportunities for learning! 

That is my biggest concern here, that we LEARN! Socialism and open borders KILL

The Socialist-led government of Pedro S├ínchez reacted late and clumsily. The country lacked essential equipment. Ventilators, protective clothing for doctors and coronavirus tests are still only just being sourced. China has gone from villain to saviour, as equipment and tests pour in – much of it brokered by the same Chinese immigrant community that has closed shops and shut itself away to avoid a racist backlash.

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