The
Washington Post
The peak
On the attack
In the
one month since the first U.S. coronavirus death,
America has become a country of uncertainty.
New
cases of infection and casualties continue multiplying.
New York and Louisiana hospitals are grappling with a flood of patients that
threatens to overwhelm their health-care systems. Meanwhile, the president and
political conservatives are increasingly agitating to end drastic restrictions meant
to buy time and save lives.
Running
beneath it all, in a continuous loop through our national psyche, are basic
questions leaders are struggling to answer: When can we safely lift these quarantines?
How many people could die if we do it too early? Just how dangerous will
this pandemic turn out to be? And what exactly should be our next step?
This is
why epidemiology exists. Its practitioners use math and scientific principles
to understand disease, project its consequences, and figure out ways to survive
and overcome it. Their models are not meant to be crystal balls predicting
exact numbers or dates. They forecast how diseases will spread under different
conditions. And their models allow policymakers to foresee challenges,
understand trend lines and make the best decisions for the public good.
But one
factor many modelers failed to predict was how politicized their work would
become in the era of President Trump, and how that in turn could affect their
models
In
recent days, a growing contingent of
Trump supporters have pushed the narrative that health experts are
part of a deep-state plot to hurt Trump’s reelection efforts by damaging the
economy and keeping the United States shut down as long as possible. Trump
himself pushed this idea in the early days of the outbreak, calling warnings on
coronavirus a kind of “hoax” meant to undermine him.
The
notion is deeply troubling, leading health experts say, because what the
country does next and how many people die depend largely on what evidence U.S.
leaders and the public use to inform their decisions. Epidemiologists worry
their research — intended to avert massive deaths in situations exactly like
this pandemic — will be dismissed by federal leaders when it is needed most.
The peak
 |
| St. Louis endured two catastrophic episodes during the 1918 flu pandemic. (Library of Congress) |
So much
of the coming months and our country’s timeline depends on the peak of the
coronavirus’s spread — its steepness, length and timing.
But
here’s the thing about peaks: You often can’t tell where they are until you’re
already past them, on your way down the other side.
And in
a country as big as the United States, the peak will be not so much a single
curve as it will the sum of many curves — as the outbreak spreads to different
cities and regions at different times.
Nonetheless, a new model released
Thursday by the University of Washington’s School of Medicine is one of the
first to forecast a national peak. It projects that the peak in daily U.S.
deaths will arrive in mid-April, and the tail end of that curve, subsiding
below 10 daily deaths, will arrive by the first week of June.
But
that projection comes with huge caveats because of estimations and assumptions
that have to be built into the calculation, given how much is still unknown
about the disease covid-19.
The
model — created by the university’s Institute for Health Metrics and Evaluation
— assumes, for example, that all remaining states that have not enacted strict
restrictions on residents will do so in the next week once they see how grave
the situation is in areas like New York.
But
Florida Gov. Ron DeSantis (R) has refused to issue orders for people to stay at
home. Alabama’s governor has similarly resisted. And this week, Mississippi’s
governor issued an order defining almost all businesses as “essential” —
including auto repair, bars and restaurants.
The
Washington model assumes the entire country will maintain these strict
restrictions until summer. But Trump has increasingly made clear he wants to
reopen parts of the country by Easter on April 12. And on Thursday, Trump
unveiled a plan to identify specific counties that he thinks should reopen
soon.
The
University of Washington model predicts that this first wave of infections will
end by summer (with subsequent waves a possibility) and that the death toll
during this initial period will range from 38,000 to 162,000 — a lower
projection than some earlier models. But the actual death count in coming
months will largely depend on how badly hospitals are overwhelmed and whether
they receive supplies like ventilators that they desperately need.
On Thursday
night, Trump cast doubt on experts’ projections on those as well. “I have a
feeling that a lot of the numbers that are being said in some areas are just
bigger than they’re going to be,” Trump told Fox
News host Sean Hannity in a phone interview. “I don’t believe you need 40,000
or 30,000 ventilators. You know, you go into major hospitals, sometimes they’ll
have two ventilators, and now all of a sudden they’re saying, ‘Can we order
30,000 ventilators?’”
On the attack
 |
| Deborah Birx, White House coronavirus response coordinator, speaks at a Thursday news briefing |
The attacks from Trump supporters against epidemiologists
ratcheted up several bars on Thursday as pundits on the political right took
aim at one of the world’s leading epidemiologists, Neil Ferguson of Imperial
College in Britain.
Ferguson
had co-written a paper this
month estimating 510,000 deaths in England and 2.2 million in the United States
— if those countries did not take drastic actions. The paper’s conclusions were
so chilling that they launched leaders in both countries into action. The next
day, Trump abruptly stopped encouraging Americans to go on with their lives and began urging
them instead to work from home and not meet in groups of more than 10.
Since
then, Trump has flipped back to wanting workers back at their jobs — framing it
as a decision between saving the U.S. economy or a handful of lives. And his
supporters have followed, attacking Ferguson online.
After
Ferguson gave new testimony to British officials Wednesday, they hailed it as
evidence that Ferguson and other experts were overselling the coronavirus
threat. Fox News host Laura Ingraham wrongly stated that in his testimony
Ferguson’s projection had been “corrected.” The chyron on her show Thursday
night stated, “Faulty models may be skewing COVID-19 data.”
“Today
— this is what our instinct was — the lead researcher did an about-face on
those terrifying projections, the very projections that drove so much of our
response,” Ingraham claimed on her show.
A Wall
Street Journal columnist wrote that the revision “raises serious questions
about the radical countermeasures inspired by public-health experts like Mr.
Ferguson.” Even one of Trump’s coronavirus task force coordinator, Deborah
Birx, seemed to lean into the questioning of
Ferguson. “I’m sure many of you saw the recent report out of the U.K. about
them adjusting,” Birx said. “If you remember, that was the report that said
there would be 500,000 deaths in the U.K. and 2.2 million deaths in the United
States.
They’ve
adjusted that number in the U.K. to 20,000. So half a million to 20,000. We’re
looking into this in great detail to understand that adjustment.”
But in
fact, Ferguson had not revised his projections in his testimony, which he made clear in
interviews and Twitter. His earlier study had
made clear the estimate of 500,000 deaths in Britain and 2.2 million in the
United States projected what could happen if both took absolutely no action
against the coronavirus. The new estimate of 20,000 deaths in Britain was a
projected result now that Britain had implemented strict restrictions, which
this week came to include a full lockdown.
But the
argument over models in some ways is beside the point, said Natalie Dean, a
biostatistician at the University of Florida. “The models are planning tools,
but it doesn’t take a genius to look at what’s happening in Italy and realize
that we’re on the same trajectory,” said Dean, who is working on coronavirus
vaccine evaluation with the World Health Organization. “That should be enough
to tell us we need to be doing more in reaction.”
A warning from pandemics past
One
clear warning from epidemiology of past pandemics is the danger of lifting
restrictions — as Trump wants to do in two weeks — too soon.
A
seminal 2007 paper shows
what happened in several U.S. cities when they eased restrictions too soon
during the 1918 flu pandemic. Those cities believed they were on the other side
of the peak, and, like the United States today, had residents agitating about
the economy and for relaxing restrictions.
Once
they lifted them, however, the trajectory of those cities soon turned into a
double-humped curve with two peaks instead of one.
This chart shows the double-humped peaks of deaths during the
1918 flu in St. Louis. The city imposed strict restrictions early on but
loosened them under pressure from its citizens, only to see deaths jump again.
(Courtesy of JAMA and Howard Markel)
Two peaks means you get the
overwhelmed hospitals, the death and destruction, without that flattening
benefit people were trying so hard to achieve with arduous restrictions.
“Knowing
when to release the throttle is hard. There’s is no button that says push me
now,” said Howard Markel, a historian and physician at the University of
Michigan who co-wrote the 2007 paper along with a top CDC official, Martin
Cetron. “But the trick is to be patient, not to jump the gun. Otherwise, all
that happens is you get more cases, more deaths and everything you worked so
hard for with those restrictions just goes to waste.”
One of
the perpetual frustrations of trying to prevent disease rather than curing it
is that it’s often difficult for the public to appreciate the disasters you
help them avoid.
“The
problem is there’s no metric for prevention. How many cases you avoid. How many
lives you save,” Markel said. “That’s why it’s so hard to stay the course but
so important, too.”
