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A fiasco in the making? As the coronavirus pandemic takes hold, we are making decisions without reliable data

  • 1.  A fiasco in the making? As the coronavirus pandemic takes hold, we are making decisions without reliable data

    Posted 03-23-2020 09:24
    I'd like to know your professional reactions John Ioannidis' article last week.  see link below:


    https://www.statnews.com/2020/03/17/a-fiasco-in-the-making-as-the-coronavirus-pandemic-takes-hold-we-are-making-decisions-without-reliable-data/

    ------------------------------
    David Stokar
    [Principal Statistician]
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  • 2.  RE: A fiasco in the making? As the coronavirus pandemic takes hold, we are making decisions without reliable data

    Posted 03-24-2020 07:00
    ​It is always important to carefully reflect and Ensure that various, potentially conflicting viewpoints are confronted. That's essential to science. In that sense, there is a lot to say for slow science. That last thing is true in normal times, peace times.

    This is not peace time! We are cutting corners on medicinal development, on vaccine development, etc. Policy decisions are taken that impact states, countries, regions, continents, on partial and variable data. Fortunately, there is a huge body of knowledge regarding the mathematical and statistical dynamics of properties. There is knowledge about SARS, MERS, and, further back in time but extremely relevant, the Spanish flu. Study the Philadelphia versus Saint Louis versus Denver response, for example.

    The only defense we have is our brainpower right now, knowledge and creativity.We should all roll up our sleeves, study, think, look at matters from different angles. There are examples of statisticians in marketing bureaus that are pushing their regular work to the side and start working on the pandemic. The more, the better, as long as it can be organized properly, of course.

    Yes, corners are cut. But if Wald would not have done that in world war II circumstancs, we would not have had sequential trials. If classical clinical trials procedures were followed in the earlier days of the AIDS epidemic, we might not have had cocktail therapy!

    The patients with 80% of their lungs incapacitated are not interested whether the malaria antivarial they are getting has been tested for its effectiveness in corona yes or no - they will be ready to try it!

    The dynamics of this epidemic are well known. After a slow start, like a diesel train, it becomes high speed rail!

    When New York City will be facing North-Italian situations, we will all be happy that people will have been working relentlessly to implement social distancing measures, to work hard towards antivirals, vaccins, and specific/sensitive diagnostics.

    These are war-like times. When they are over, we can read and argue in detail about Ioannidis' article. Being cautious and avoid decisions emotionally taken is a good thing. But other than that, let's get back to work, there is plenty to do.



    ------------------------------
    Geert Molenberghs
    Professor
    Universiteit Hasselt & Katholieke Universiteit Leuven
    ------------------------------



  • 3.  RE: A fiasco in the making? As the coronavirus pandemic takes hold, we are making decisions without reliable data

    Posted 03-24-2020 07:38
    To put it mildly, I am disappointed by Professor Ioannidis article. Of course we are making decisions without reliable data.  We don't have a choice.  Even the highest quality sources of data, such as the Diamond Princess cruise have confidence intervals for important disease parameters that span an order of magnitude.  For instance, efforts to project the infection fatality ratio from the Diamond Princess onto the demographics in China yield IFRs with a 95% confidence interval spanning 0.2%-1.2%.  The implications of being on the lower end are quite different from that of being on the upper end.  We need to do whatever possible to buy time to gather more and better data.

    However, it's quite clear, that taking extreme measures to lower the rate of infection is appropriate.  The hospitalization rate is several times that of the fatality rate, and many more deaths should be expected if hospitals are filled to capacity.  The parameter to consider in evaluating the impact of social distancing and economic disruption, isn't a noisy, and likely biased estimate of the fatality rate from historical data, but the counterfactual: what would be expected absent advanced supportive care.  The lower end of this interval implies a tragedy of immense magnitude.

    ------------------------------
    Andrew McDavid
    Biostatistics and Computational Biology
    University of Rochester
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  • 4.  RE: A fiasco in the making? As the coronavirus pandemic takes hold, we are making decisions without reliable data

    Posted 03-24-2020 09:47
    Andrew, I think you missed the major point of the article.  Moving on from the Diamond Princess - it is critical that we all use up-to-date data and check our impulses to  assume the worst without balancing them with rational thought that is based on current data that we can use to alter our strategy (perhaps we can use the word pivot).  We don't want to harm ourselves as much or worse by damaging the economy so much because the consequences of that are also supremely important.

    ------------------------------
    David Stokar
    [Principal Statistician]
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  • 5.  RE: A fiasco in the making? As the coronavirus pandemic takes hold, we are making decisions without reliable data

    Posted 03-24-2020 10:07
    ​Data are accruing, indeed. It is good to look at what is currently happening with hospital capacity and human resources in the North of Italy. It is one of the best organized regions in terms of medical care in Europe. Yet, it is being exhausted, medical staff is coming in from other countries, in particular... China and Russia. That is because neighboring countries are feeling the heat, too.

    The best strategy is the Chinese: suppression. A short period in a confined region that is sverely restricted in terms of people's movement. The disruption to the economy is then limited in both space and time.

    In Italy, we see convoys, night after night, of army trucks with corpses, because even the cemeteries cannot handle the number of case fatalities. Thinking about it in a coolheaded fashion, this is not the worst problem, but rather the stong pressure on the hospital system (hospitalized cases; ICU cases).

    China's economy is recovering, fortunately, because they are bringing to us here in Europe the mouth masks and medical equipment that we so badly need. They will be doing the same towards North America, soon, hopefully.

    ------------------------------
    Geert Molenberghs
    Professor
    Universiteit Hasselt & Katholieke Universiteit Leuven
    ------------------------------



  • 6.  RE: A fiasco in the making? As the coronavirus pandemic takes hold, we are making decisions without reliable data

    Posted 03-24-2020 09:55
    Also note, NY State is wisely opening up a special hospital at the Javitz Center specifically for the new patients.  (And we didn't have to put on a horse-and-pony show by building a hospital in 10 days - We will do it in one day).  This is so much smarter than sending patient to existing hospitals where the infection will spread like wildfire and kill the most vulnerable patients.  We've all heard the warnings about overloading the hospital system but I don't hear anyone talking about the amazing flexibility we have to control this epidemic using our knowledge and capacity to adjust to crises.   We must calibrate our reactions to not overreact and kill the patient. (p.s.  that was an analogy)

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    David Stokar
    [Principal Statistician]
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  • 7.  RE: A fiasco in the making? As the coronavirus pandemic takes hold, we are making decisions without reliable data

    Posted 03-24-2020 07:46
    A very nice article.

    it sounds like the biggest need right now is studies following a random sample of the population to assess incidence, prevalence, and outcome rates.

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    Jonathan Siegel
    Director Clinical Statistics
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  • 8.  RE: A fiasco in the making? As the coronavirus pandemic takes hold, we are making decisions without reliable data

    Posted 03-24-2020 08:02
    ​That is absolutely correct! That kind of thinking is the spirit, thanks!

    ------------------------------
    Geert Molenberghs
    Professor
    Universiteit Hasselt & Katholieke Universiteit Leuven
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  • 9.  RE: A fiasco in the making? As the coronavirus pandemic takes hold, we are making decisions without reliable data

    Posted 03-24-2020 09:07
    I find it helpful to focus on the age distribution when thinking about the risk of disease COVID-19 versus the risk to life as we know it with the shutdown of the economy.  I find this article helpful in that regard. https://jamanetwork.com/journals/jama/fullarticle/2763667

    ------------------------------
    James Rosenberger
    Professor Emeritus of Statistics
    Pennsylvania State University and NISS
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  • 10.  RE: A fiasco in the making? As the coronavirus pandemic takes hold, we are making decisions without reliable data

    Posted 03-24-2020 09:41
    James, thank you for posting that article.  That is the article where I got my data from and why I chose 40.

    However, I think the data is from March 17th (unless they've updated it without me knowing).  It is critical to update that data on a regular (weekly or every 3 days?) basis.  Major decisions with enormous consequences depend on it.

    ------------------------------
    David Stokar
    [Principal Statistician]
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  • 11.  RE: A fiasco in the making? As the coronavirus pandemic takes hold, we are making decisions without reliable data

    Posted 03-24-2020 08:57
    Isn't it critical to determine if the infection  (and death rate) is much lower or even insignificant for younger people (<40 - as the data from China and Italy seems to be showing already)? I think we need to keep on top of the data very carefully lest we be shooting ourselves in the leg.  For example if the data shows that younger people (say 40 and under) are relatively safe then all those people should go back to work immediately to avert a tremendous disaster in the making.

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    David Stokar
    [Principal Statistician]
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  • 12.  RE: A fiasco in the making? As the coronavirus pandemic takes hold, we are making decisions without reliable data

    Posted 03-24-2020 09:12
    ​This was the consideration in Belgium to keep the schools open. It didn't happen though. Case fatality and even the need for critical care is virtually non-existent in the 0-9 years group; it increases a bit but very little until about 40, indeed. However, these groups do become infected and, this is the thing, infect others. The reproductive number would be detrimentally hampered if the <40 years of age group would go back to work like that, unless they are sealed off of anyone older.

    ------------------------------
    Geert Molenberghs
    Professor
    Universiteit Hasselt & Katholieke Universiteit Leuven
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  • 13.  RE: A fiasco in the making? As the coronavirus pandemic takes hold, we are making decisions without reliable data

    Posted 03-24-2020 09:35
    That's exactly what I'm suggesting - keep 'older' people quarantined but yet let 'younger' people go back to work and provide for the others while keeping older people under strict quarantine (they will want to anyhow as they are by far the most vulnerable).  Additionally most 'younger' people have already been in self quarantine for 14 days which should be sufficient.  We can't all stay in quarantine for an unlimited period of time.

    This way the economy can slowly get started again and we can avert economic disaster.

    ------------------------------
    David Stokar
    [Principal Statistician]
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  • 14.  RE: A fiasco in the making? As the coronavirus pandemic takes hold, we are making decisions without reliable data

    Posted 03-25-2020 18:39
    David Stoker said, 
    "Isn't it critical to determine if the infection  (and death rate) is much lower or even insignificant for younger people (<40 - as the data from China and Italy seems to be showing already)? I think we need to keep on top of the data very carefully lest we be shooting ourselves in the leg.  For example if the data shows that younger people (say 40 and under) are relatively safe then all those people should go back to work immediately to avert a tremendous disaster in the making."
     
    The situation does not seem to be that simple. In particular, there is considerable opinion that although many younger people have only mild symptoms when they contract the COVID19 virus, they can still be very contagious. Thus, for public health reasons, they should only be allowed to go back to work immediately if their work does not involve contact with other people -- and. in particular, does not involve contact with people in the age range where infection is likely to be much more serious. 


    ------------------------------
    Martha Smith
    University of Texas
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  • 15.  RE: A fiasco in the making? As the coronavirus pandemic takes hold, we are making decisions without reliable data

    Posted 03-25-2020 19:47
    I repeat myself, younger people should be able to go back to work whilst older people stay in quarantine.

    ------------------------------
    David Stokar
    [Principal Statistician]
    ------------------------------



  • 16.  RE: A fiasco in the making? As the coronavirus pandemic takes hold, we are making decisions without reliable data

    Posted 03-26-2020 01:47
    ​Absolutely not! A total and very strict lockdown is the only thing that can save the US at this time. If your proposal would be followed, the younger generation will spread the virus like wildfire and automatically also affect the older generation. It will lead to 60-70% of the entire population infected, with a mortality rising from 1% to 4% at least because of a completely overwhelmed health care system. It won't be a stress test for the Healthcare system, it will destroy it.

    We are living through the epidemic here in Belgium and the rest of Europe. We are better off than our neighboring countries, because we took strict measures early on. But please look at the data of Italy, Spain, and look at what happens in their hospitals! Italy, Spain, Belgium, the Netherlands are not third world countries. We have a health care system much much better than the US (I am sorry to say), but it is breaking down in Italy and Spain.

    So, please stop repeating this! What you are proposing is catastrophic.

    I am sorry for the strong language and, as Always, feel free to disagree, but let us revisit them on April 1 and April 10. If I am totally wrong (which I hope, honestly), I buy a round of drinks for the entire ASA :-).



    ------------------------------
    Geert Molenberghs
    Professor
    Universiteit Hasselt & Katholieke Universiteit Leuven
    ------------------------------



  • 17.  RE: A fiasco in the making? As the coronavirus pandemic takes hold, we are making decisions without reliable data

    Posted 03-26-2020 09:50
    My original post was as a question (and I meant the follow up as a question too). 

    Also, I agree that initially a total 'lockdown' was necessary - the question (to ask it another way) is - how much evidence do we need so that younger people can go back to work and help transition to "regular" times?  I think everyone can agree that a total lockdown indefinitely is not feasible (for obvious reasons). 

    How much evidence do we need to decide that younger people are "safe" to resume normal business.  Again I'm not saying older people - they can remain in quarantine and serviced or aided by healthy pre-screened non-virus carrying young people.

    ------------------------------
    David Stokar
    [Principal Statistician]
    ------------------------------



  • 18.  RE: A fiasco in the making? As the coronavirus pandemic takes hold, we are making decisions without reliable data

    Posted 03-27-2020 07:23
    Geert,

    I fully agree. In my opinion, the explanation can be made simple by just looking at current mortality rates:
    Italy 10 %
    Germany 0.5%
    Wuhan epicenter 12%
    Wuhan milder areas 1%
    (Mizumoto & Chowell 2019; https://fortune.com/2020/03/25/germany-italy-coronavirus-death-rates/)
    The difference is that the Italian health system already collapsed. And the German numbers might go up to a similar magnitude as with Italy if the German health system also collapses.
    Furthermore, we need to distinguish between fatalities and "just" ICU patients. It seems that the younger are able to survive if properly treated in an ICU. However, there are already many young people that require oxygen or even ICU treatment.

    We can only beat the epidemic with social distancing as the virus spreads out in a very effective way from the upper respiratory tract.

    Andreas

    ------------------------------
    Prof. Dr. Andreas Ziegler
    Medizincampus Davos
    Davos
    Switzerland
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  • 19.  RE: A fiasco in the making? As the coronavirus pandemic takes hold, we are making decisions without reliable data

    Posted 07-28-2020 15:55
    Now that JSM time is coming, I so much wished that Geert M was wrong, so that he would buy us all drinks...

    Unfortunately, the catastrophe is upon us all.

    Vaccines are needed and treatments are needed -- i hope that all statisticians are helping one way or another.




    ------------------------------
    Eva Petkova
    NYU School of Medicine
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  • 20.  RE: A fiasco in the making? As the coronavirus pandemic takes hold, we are making decisions without reliable data

    Posted 03-26-2020 11:08
    A couple of things.

    1.How do you identify the false positives IF (and that is a big if) people can carry the virus without any symptoms of illness?

    2. And for those that recommend  people <40 go back to work if they have no contact with older people, HOW do you enforce that AND how do you prevent ageism in the future?

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    Michael Mout
    MIKS
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  • 21.  RE: A fiasco in the making? As the coronavirus pandemic takes hold, we are making decisions without reliable data

    Posted 03-24-2020 10:19
    I believe that Iceland has carried out and continues to carry out randomized testing on its general population. See

    https://cleantechnica.com/2020/03/21/iceland-is-doing-science-50-of-people-with-covid-19-not-showing-symptoms-50-have-very-moderate-cold-symptoms/

    It would seem to me that public health departments in collaboration with the appropriate ASA resources could develop protocols for similar testing. This of course assumes that reliable testing devices are in fact available. No small assumption. One key element that should also factor into any analysis of the data has to be the reliability of the testing device itself. Up til now the only controversies I have heard about the devices has concerned the number available and the length of time needed to evaluate the results. The false positive and false negative rates need to be evaluated as well.



    ------------------------------
    Michael Sack Elmaleh
    Principal
    Michael Sack Elmaleh CPA, CVA
    ------------------------------



  • 22.  RE: A fiasco in the making? As the coronavirus pandemic takes hold, we are making decisions without reliable data

    Posted 03-25-2020 08:52
    fyi - testing data from South Korea can be found here: http://ncov.mohw.go.kr/en/bdBoardList.do?brdId=16&brdGubun=161&dataGubun=&ncvContSeq=&contSeq=&board_id=

    The website from the Korean ministry of health also gives the numbers of tested specimen on its frontpage: http://ncov.mohw.go.kr/en/
    According to this, 2.7% of tests have been positive so far (March 25, 12 am).
    For Germany e.g., this can e.g. be estimated by the number of tests paid for by health insurances, as it is (to my knowledge) not required by laboratories to report negative test results. However, according to testing practices recommended by Robert Koch Institute, there has been a strong bias towards testing persons that have been in potential contact with Covid19 cases until yesterday. This policy has been revoked as of march 24, 2020. (https://www.rki.de/DE/Content/InfAZ/N/Neuartiges_Coronavirus/Massnahmen_Verdachtsfall_Infografik_DINA3.html).


    ------------------------------
    Christian Graf
    Dipl.-Math.
    Qualitaetssicherung & Statistik

    "To call in the statistician after the experiment is done may be no more than asking him to perform a post-mortem examination: he may be able to say what the experiment died of."

    Ronald Fisher in 'Presidential Address by Professor R. A. Fisher, Sc.D., F.R.S. Sankhyā: The Indian Journal of Statistics (1933-1960), Vol. 4, No. 1 (1938), pp. 14-17'
    ------------------------------



  • 23.  RE: A fiasco in the making? As the coronavirus pandemic takes hold, we are making decisions without reliable data

    Posted 03-25-2020 11:41
    For South Korea - where can we get the breakdown by age group and co-morbidities? These are critical pieces of information.

    ------------------------------
    David Stokar
    [Principal Statistician]
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  • 24.  RE: A fiasco in the making? As the coronavirus pandemic takes hold, we are making decisions without reliable data

    Posted 03-30-2020 01:52
    The most comprehensive collection I've found so far is on github here: https://github.com/beoutbreakprepared/nCoV2019

    A comprehensive discussion of data sources is here:  https://ourworldindata.org/coronavirus

    Best regards,
    Christian

    ------------------------------
    Christian Graf
    Dipl.-Math.
    Qualitaetssicherung & Statistik

    "To call in the statistician after the experiment is done may be no more than asking him to perform a post-mortem examination: he may be able to say what the experiment died of."

    Ronald Fisher in 'Presidential Address by Professor R. A. Fisher, Sc.D., F.R.S. Sankhyā: The Indian Journal of Statistics (1933-1960), Vol. 4, No. 1 (1938), pp. 14-17'
    ------------------------------



  • 25.  RE: A fiasco in the making? As the coronavirus pandemic takes hold, we are making decisions without reliable data

    Posted 03-25-2020 16:09
    Having read the Searchinger, LaManita, and Douglas opinion piece (Wash. Post, 3/24/2020) before seeing the Ioannidis 3/17 article, I find it interesting to see someone (finally) mention random sampling and screening of the general population as an alternative to diagnostic testing of those with symptoms or massive testing of the population, a recommendation that Searchinger et. al. say would cost many billions of dollars. As an IT civilian in the early 1990's, I recall the challenges of testing volunteer blood donors for HTLV, HIV, and HCV, and, much later, for West Nile Virus. Though very different in many respects from the fast moving COVID-19 pandemic, all of these health crises also have a much in common. Specimen collection has to be done systematically with careful accessioning and exacting quality control to link them precisely to donors, tests, and test results, as well as paradata such a GPS geographic coordinates. Because early tests tests have to be calibrated for the maximum feasible sensitivity, a screening phase has to precede a confirmatory testing phase. In the case of the COVID-19 virus, PCR-based genetic testing appears to offer the better choice for initial screening. It has to reduce false non-matches to acceptable levels. A second phase of more accurate genetic testing and serology testing corrects for false positives. Serologic testing would also detect individuals that have survived the infection and have antibodies but low viral load. Two of the main medical consultants on the COVID-19 team have had extensive experience with blood donation screening tests and know about specimen collection and screening protocols. Specimen collection should have had the highest priority. Concerns about the accuracy of diagnostic tests appear to have caused much delay and confusion. The number of cases appears to increase fastest in cities and states that have expanded the number of tests conducted. One would think from listening to news reports that cases are a function of tests.

    The US Census Bureau, the National Center for Health Statistics, and other statistical agencies have refined stratified sampling plans and data collection methods for the purpose of obtaining nationally representative samples of the US population from randomly selected samples of residential addresses. These samples support estimates with far less uncertainty than the estimates based on sketchy data that we have now. The costs of stratified random sampling should reduce the urgency of general population testing and produce as accurate estimates for moderately small areas of the country as well as overall. Repeated sampling dramatically reduces the number of specimens that need to be collected. The cost savings could reduce the costs to the order of millions instead of billions. It seems a natural way for statisticians to bring accumulated knowledge and methodology in their field to serve the national interest.

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    S. Hermansen
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  • 26.  RE: A fiasco in the making? As the coronavirus pandemic takes hold, we are making decisions without reliable data

    Posted 03-25-2020 19:03
    Sigmund said in his post:

    "Concerns about the accuracy of diagnostic tests appear to have caused much delay and confusion. The number of cases appears to increase fastest in cities and states that have expanded the number of tests conducted. One would think from listening to news reports that cases are a function of tests."

    Elon Musk's tweet citing an 80% false positive rate was based on this citation:

    [Potential False-Positive Rate Among the 'Asymptomatic Infected Individuals' in Close Contacts of COVID-19 Patients] - PubMed


    There are a number of implications of broad testing with a procedure that yields a high false positive rate:

    1. As Sigmund implies the correlation between the number of positive cases and the amount of testing may be due to the fact that there are  many false positives.
    2. If there are a large number of false positives then the mortality rate might be significantly higher than what is being reported simply because the denominator should be reduced to remove the false positives.
    3. The percentage of supposedly "asymptotic" individuals who have tested positive may  turn out  to be asymptotic precisely because they do not really have the virus..

    It would seem to me that if there are two different testing protocols then comparison of the results using the same samples should shed some light on this. Plus of course retesting on the same individuals at different time intervals might also yield indications of the consistency of the tests. I assume that this is being done. Or has been done.

    Also should'nt some Bayeseans sit down with test designers, virologists and device manufacturers and carefully analyze the different ways in which false positives could result in order to derive some educated priors. Then update the priors using the results of comparative and iterative testing. 

    It seems inconceivable to me that the individual experts who design and implement these tests could possibly have developed and distributed tests that have so a high a false positive rate. Or maybe the virus itself has a footprint that makes it harder to correctly identify than previously identified viruses.



     







    ------------------------------
    Michael Sack Elmaleh
    Principal
    Michael Sack Elmaleh CPA, CVA
    ------------------------------



  • 27.  RE: A fiasco in the making? As the coronavirus pandemic takes hold, we are making decisions without reliable data

    Posted 03-26-2020 09:52
    The original post was a quote from the article but I meant to reword it to be as a question - 'Are we making decisions...'?

    ------------------------------
    David Stokar
    [Principal Statistician]
    ------------------------------



  • 28.  RE: A fiasco in the making? As the coronavirus pandemic takes hold, we are making decisions without reliable data

    Posted 03-27-2020 10:43
    From Sigmund's post:

    "In the case of the COVID-19 virus, PCR-based genetic testing appears to offer the better choice for initial screening. It has to reduce false non-matches to acceptable levels. A second phase of more accurate genetic testing and serology testing corrects for false positives. Serologic testing would also detect individuals that have survived the infection and have antibodies but low viral load."

    In terms of who should go back to work in a group setting and when, age should not be the delineating factor. Instead, we should test for antibodies so that those that have survived COVID-19 (whether they were originally tested or not) are selected first. Although we are still working hard to understand this virus, there is evidence that those who contracted it are immune for a period of time (perhaps 1-2 years). This would provide the community with precious time to develop a vaccine. 

    As for some sort of random sampling for prevalence in the community, that would be ideal if we could also take into account various testing strategies, population density, social distancing measures, etc in the analysis. Testing for antibodies could provide this information as well as prepare us for the next phase of staggered return to work protocols.

    However, first we need to get a handle on it and prevent wider spread. In communities where spread is beginning, testing should be deployed with contact tracing and isolation protocols. To my knowledge, none of this is happening here in the US, yet it is vital to containment in communities where there is not yet widespread illness. 

    Robyn


    ------------------------------
    Robyn Ball
    Computational Scientist
    The Jackson Laboratory
    ------------------------------



  • 29.  RE: A fiasco in the making? As the coronavirus pandemic takes hold, we are making decisions without reliable data

    Posted 03-29-2020 19:26
    Dr. Fauci has himself  recently published an editorial that reviews a downward revision of projected coronavirus mortality based on early Chinese data.
    https://www.nejm.org/doi/full/10.1056/NEJMe2002387

    which has received almost no press attention.

    The problem with mass screening of any kind, is that tests may be subject to high rates of false positives which may considerably raise the estimated incidence of disease, in the absence of clear  followup pathological analysis.  Currently the FDA is not regulating laboratory tests for the virus,  and the guidelines for testing are very fluid, making parameter estimates extremely difficult.

    Some points have been made by  Dr. Wodarg, https://www.wodarg.com/

    in that we should be looking at (1) time series analyses to detect excess morbidity and mortality in this season.
    and (2) the relationship between extent and type of testing and morbidity and mortality estimates.






    ------------------------------
    Elizabeth Smith
    Statistician
    ------------------------------



  • 30.  RE: A fiasco in the making? As the coronavirus pandemic takes hold, we are making decisions without reliable data

    Posted 03-30-2020 10:45
    Elizabeth,

    Thank you for posting the latest article/editorial by Dr. Fauci.  In addition, I'd like to draw your attention to an article published by Dr. Shashua:
    https://medium.com/amnon-shashua/can-we-contain-covid-19-without-locking-down-the-economy-2a134a71873f

    Importantly, he writes about how to evaluate which mitigation stategy is working.  See the section titled: The Risk-based Selective Quarantine Model: How do we Know Whether it is Safe?

    I am looking forward to comments.

    ------------------------------
    David Stokar
    [Principal Statistician]
    ------------------------------



  • 31.  RE: A fiasco in the making? As the coronavirus pandemic takes hold, we are making decisions without reliable data

    Posted 03-31-2020 13:44

    I think there are some good points to be made regarding testing bias, comparative mortality rates, and the effect these have on current actions.

    I also think it highlights a very good time for the academic community to step back and consider what we know, what we need to know, what we need to communicate, and why.

    That we have little good data (and are unlikely to soon have) regarding COVID-19 is perhaps moot in terms of addressing current concerns. Good data collection now means better decisions next time. What we absolutely know now is that it is a virus spread by respiratory secretions, there have been many throughout history. As was suggested by others, the SARS database from a few years ago might give the best guesses as far as what to expect. Just like in previous outbreaks, the keys to physical survival are good hygiene, low population density, and a strong immune system/ good overall health. I have not yet seen guidelines on what steps an individual might take for economic survival which seems perhaps a larger source of current panic. You might get sick, but you definitely can't find toilet paper and are quickly running out of money for rent.

    As a statistician, my thoughts for this round of data collection would not only be randomized sampling but a broader range of information and longer follow up to recognize the interconnectedness of such events- i.e. did you lose your home/ apartment or drop health insurance to pay for basic needs?



    ------------------------------
    Shalese Fitzgerald
    University of Arkansas for Medical Sciences
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  • 32.  RE: A fiasco in the making? As the coronavirus pandemic takes hold, we are making decisions without reliable data

    Posted 07-28-2020 15:49
    Hi David,
    here is something new that might give you some answers:
    https://www.buzzfeednews.com/article/stephaniemlee/ioannidis-trump-white-house-coronavirus-lockdowns

    ------------------------------
    Eva Petkova
    NYU School of Medicine
    ------------------------------