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Covid-19 Peak Projections and Ventilator Shortfalls

T_R_Oglodyte

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First, do no harm?
Not sure how that helps. If you throw up your hands in the air and say there are no data that we can use to make decisions, then how do you know what decision does no harm? If you're trying to implement quarantine, how do you know whether the impacts of imposing quarantine aren't more harmful than the health benefits? If you're trying to decide what to do with a stock of ventilators, are you doing harm by holding on to them, so that you aren't chancing harm if your caseload turns up high, or are you doing harm by not sending them someone else where that might possibly need them?

You can't implement "do no harm" without making an effort to project the impacts of decision making,

I submit that the better way to do decision is first to defer making a decision as long as you can so that you can do the best job possible collecting and reviewing information. One key principle of "Do no harm" is don't act in haste. That includes understanding the range of uncertainty and error in the information, and a sensitivity analysis to know what variables or factors have the biggest influence on the outcome. Then you make your decision using that information, taking into consideration errors and uncertainties. The alternative is to simply wing it, making decisions off the cuff.

We've certainly seen plenty of both types of decision-making during the pandemic, and throughout the world.
 
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Cornell

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And your better model is????
What a silly response . In my professional life I manage a team of analytic professionals in a project-based industry. At the completion of large projects we have "debrief" meetings where we discuss what went well, what didn't go so well. I always tell my team "You don't need to have the solutions or answers to what didn't go well, but that shouldn't stop you from voicing your opinion on what needs improvement".

I have been a statistician in the market research industry for close to 30 years now and some of that time has involved forecasting models. If I had given a client a model whose predictions had so much variability (like in the IHME models) or were so incredibly wrong, we would lose that client permanently. And we are dealing the manufacturing of widgets, not peoples lives, the entire US economy, and livelihoods.

As a result of this IHME model, we have a massive segment of the US population so fearful and panicked that they cannot imagine re-opening society. Even though we have flattened the curve and proven that our hospital system has not been taxed at all, I hear all of the time "Well, if we loosen restrictions this virus will be rampant and then our medical system will be overrun". This type of thinking is a reaction to the irresponsible predictions that our public was sold on. The damage to the collective mindset in this country is immense.

Some may find the IMHE model "interesting" or fun to look at . I find it dangerous and I am going to do all I can to speak out about the massive collateral damage that it has created.
 

TravelTime

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@Cornell I have a question about the models. In the beginning, they said up to 2 million or so people could die. Then they revised it down to 120,000 to 240,000. Now it is 60,000. The rationale I have heard as to why the projections went down is that it is because of social distancing and the closing of all the businesses and public places. Proponents of the closings and SIP/SAH orders have said if we did not close everything down and require people to stay home, that we would have had millions of Americans dying and the health care system would have been over run. So now the governments are patting themselves on the back for doing the right thing and scaring us all into staying home and shutting our businesses. What are your thoughts about the rationale for the closings and SIP/SAH orders? Do you think we would have had millions of deaths without these policies?
 

Cornell

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@TravelTime No , I don't think we would have had millions of deaths without these SIP/SAH policies. I honestly don't know what the IHSE is doing w/their input data or assumptions to reduce their projections, but their model and estimates have always accounted for social distancing. So their massive, dire predictions always included that as part of their model. I have tripled-checked that assumption.

I just watched POTUS's briefing where he was discussing opening up society and sure enough, I heard one of the reporters fear-mongering with a question like "so if we open up the economy aren't we going to have lots of new cases?".

The other part of this whole scenario that makes me insane is that the American public was sold on the concept of shutting down (I think most people were led to believe 2-3 weeks) to flatten the curve. I think society as a whole was willing to do that as a collective goal. However - now everyone is so scared that the mindset has turned into "preventing all new cases" , which is just unrealistic. We were to SIP / SAH to spread OUT the cases so our hospital system could accommodate. We accomplished that goal - I don't think there is ANY debating that.
 

T_R_Oglodyte

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If you're going to presume to lecture me about a "silly response", then will you grant me the same privilege to say the same about your response? If your qualification to make that pronouncements is that "In my professional life I manage a team of analytic professionals in a project-based industry", might you be willing to consider that there might be other people who manage analytic professionals in project-based industries, where decisions need to be made on the basis of inaccurate or incomplete information, and thus are equally qualified to determine what is a "silly response"?

What I deal with professionally has everything to do with public health exposures. I've been doing this for over forty years. I have worked for public health agencies, and later as a consultant to government and industry. I have personally been in a position where I have been the person who has received information on actual or presumed public exposure information, and have been responsible for making recommendations to senior governmental officials on what should be done with that information. I had to make decisions on the best information available. Often, working with toxicologists, we had to construct some kind of exposure assessment model, often incorporating some broad assumptions. When you have 4-hour deadlne to come up with an answer, you work with the best information you can get your hands on inside of two hours. And then spend two hours working up your model.

When a crop duster crash lands into a canal that supplies drinking water, I've been the person on the line who has had to offer information about what actions should be taken and what notices should be made to the public. Or imagine having test results from a drinking water sample that shows bacterial contamination. But that sample was taken 72 hours ago. Does that represent the water quality that is currently being delivered to customers? Do we tell people to not use drink the water? What are the uncertainties - what is the error?

I've gone through the dangerous nonsense of Superfund Public Health Evaluations, which is a process that I've always thought was deliberately designed to make people think that they were going to prematurely die of cancer because they happened to drive by the site. I've had to do risk assessments based on the assumption of that someone was going to harvest wild watercress growing by a creek, and have watercress for dinner every day of their life for 70 years. I actually bailed out of doing that work because even though it was lucrative, I could no longer participate in such inanity.

So please understand that when I see something such as the IHME model in use for public health decision making, it's actually much better than most of the stuff I information I typically had at hand when I was involved in making those kinds of evaluations. Even with the error bars

*************

And I might add that you've managed to avoid the quite legitimate question. Pretend that you are the person advising people who have to made decisions. What are you going to tell them? How would you advise them to make decisions? Understand that saying we don't have enough information to give you advice is not a possibility. Because if you don't give advice, they are going to obtain advice from someone who is less qualified than you. And how would it would be better to have decision makers basing decisions on input from someone who is less-qualified?

**************

So I repeat - if you throw out the IHME, what do you propose a replacement? Because for you to say that we should throw information out, without offering a better alternative, is a silly response to the real-life situation for someone who is actually engaged in real-time public health decision-making.

I have been a statistician in the market research industry for close to 30 years now and some of that time has involved forecasting models. If I had given a client a model whose predictions had so much variability (like in the IHME models) or were so incredibly wrong, we would lose that client permanently. And we are dealing the manufacturing of widgets, not peoples lives, the entire US economy, and livelihoods.

I don't think you appreciate a key difference. In most marketing, the "No Go" decision is an option. How would the situation change if "No Go" is not an option. A "Go" decision must be made among the options that are on the table. Collecting more data or refining the model is not an option.

.
 
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Cornell

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@T_R_Oglodyte Ok - great. You win. Your professional credentials are superior to mine and more important.

NOTHING you can say will change my mind that the IHME model has been incredibly wrong and we has had massive collateral damage.
 

T_R_Oglodyte

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@T_R_Oglodyte Ok - great. You win. Your professional credentials are superior to mine and more important.

NOTHING you can say will change my mind that the IHME model has been incredibly wrong and we has had massive collateral damage.
I'm not the one who is arguing credentials. In my comments I tried to focus on facts, information, and analysis. You are the one who trotted out credentials as a rationale for why we should give more credence to your responses. I only responded as I did because you resorted to credentials as a reason why people should trust you. And, given that, perhaps the community should be aware that your credentials are not unique. I harbor no illusions about altering your opinion. I've been around for too many years, and have been involved with too many people such as you, to expect that.

Now if you want to set aside technical credentials and talk about issues, then I await your response to what you believe would be better way to provide advice to someone who actually has to make a real time decision.
 
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T_R_Oglodyte

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@T_R_Oglodyte Love your "go/no go" addition to response. Unbelievably condescending and patronizing.
You are totally correct. I apologize for being patronizing and condescending. I don't await your apology, but I will accept if offered, just as I hope you accept mine.
 
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T_R_Oglodyte

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@T_R_Oglodyte Ok - great. You win. Your professional credentials are superior to mine and more important.

NOTHING you can say will change my mind that the IHME model has been incredibly wrong and we has had massive collateral damage.
I don't believe I ever said that IHME has not created massive collateral damage. Nor have I said that it did create massive collateral damage, I don't think I've asserted anything one way or another. I have said that it appears to be the best information available, and that the modelers have been careful to include error ranges in their work so that a decision maker has some sense of the underlying uncertainties. Meanwhile, you have consistently said it was a bad framework, while studiously ducking from offering any better basis for decision-making.

It's patently easy now to look back in hindsight and say that there was massive collateral damage. But it should be recognized that at the time those decisions were made there was reason to believe, based on the best information available, that collateral damage could have occurred in either direction.
 
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Cornell

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@T_R_Oglodyte Considering that you say things like this to me "I've been around for too many years, and have been involved with too many people such as you " (whatever the hell that means), I have nothing more to say to you on this subject. I don't need to be talked down to. And one more thing -- you can't DEMAND people to provide answers to your directives in an online forum.
 

T_R_Oglodyte

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@T_R_Oglodyte Considering that you say things like this to me "I've been around for too many years, and have been involved with too many people such as you " (whatever the hell that means),
Your are totally correct. That was an intemperate statement, and reading my post now I can see where I was totally out of line. One of those posts where I would have been better off walking away for a bit before posting. Please accept my apologies.
@T_R_Oglodyte And one more thing -- you can't DEMAND people to provide answers to your directives in an online forum.
You are absolutely right. I have no right to DEMAND an answer. But I think I am within reason to ask what you would provide as an alternative.
 
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