Good scientific voices on reopening
May 25, 2020 11:19 AM   Subscribe

I'm confused about reopening. Are there good scientific explanations or good people to follow on Twitter who talk about this a lot? Do you want to explain it to me?

California has re-opened a lot of businesses, including daycares. We're currently deciding whether to go back. Isn't the virus just going to immediately gain steam again?

Is the theory "well, even it goes back to doubling every 2-3 days, there are so few cases that very few people will be infected?" If so, why don't we hear more about the number of cases per capita?

We hear about testing and tracing, but -- doesn't that simply not work due to asymptomatic / presymptomatic spread? (If you knew to get tested, you'd know to stay home.) Tracing works when there are very few cases, and the cases are known. But right now there is still a lot of community transmission, isn't there?

I've been impressed with California's decision making generally, so I'm hopeful that I'm just not up to speed about why they are making this decision, but I don't understand this part.
posted by slidell to Health & Fitness (18 answers total) 19 users marked this as a favorite
 
Zeynep Tufekci has been an incredible voice on COVID since the very first case in January, well worth a follow. It's my understanding that most places in North America that are reopening now are doing so because it's not economically possible to stay shut down.

https://twitter.com/zeynep
posted by Cpt. The Mango at 11:21 AM on May 25 [2 favorites]


Twit
Former FDA director Scott Gottlieb.
Former Ebola Official Jeremy Konyndyk.

The opening plan Gottlieb helped compose, and the CDC's now-released-once-shelved 63 page plan are both available to states as guidance. These are the slowest, highest standard plans for phased reopening. No state is using either one. Notably, neither plan published concrete numbers for gates or phases.

Gottlieb's plan had starting criteria. First and foremost, a state should have 14 continuous days of declining new cases. No state has met that yet (maybe NY?). The trick is, one extra case and a thirteen day streak ends and a new measurement period begins.

Pod
Vincent Racaniello's This Week in Virology. Serious science by scientists; a lot i will never get. But, lots of useful info for a layperson too. Including commentary on the public health response. Big TeTrIs fans ( Test Trace Isolate). They talk about the scaling of tracing, and seem to think everyone's making that harder than it needs to be. You can't trace everyone - but you don't have to. Determine incidents of close, continuous exposure.

Web
The Atlantic offers the best reportage. Ed Yong is killing it.
posted by j_curiouser at 11:51 AM on May 25 [4 favorites]


Propublica article on the science
posted by crunchy potato at 12:12 PM on May 25 [1 favorite]


So why are there no objective numerical criteria, does anyone know? If there were a thousand new cases / day on Day 20 and by Day 34, that'd fallen to 9980 cases / day, why would you reduce restrictions at that point? I'm not saying that's the case, just that I don't understand any of this.
posted by slidell at 1:47 PM on May 25 [2 favorites]


Politico explores How summer could determine the pandemic’s future in the United States, including interviews with public health experts and a discussion of some of the political issues that appear to be complicating the discussion.

The Harvard T.H. Chan School of Public Health publishes ongoing news updates that feature public health experts, and Johns Hopkins offers a Coronavirus Resource Center that includes animated maps depicting Where are COVID-19 cases increasing? and graphs depicting cumulative cases and How is the outbreak growing?

A previous AskMe that may be helpful is: Pandemic Twitter Updates, and similarly, there is a previous FPP with a discussion that links to a wide range of Twitter resources: Pandemic science is out of control

I also very much recommend Ed Yong at the Atlantic, including Our Pandemic Summer, Why the Coronavirus Is So Confusing, and America’s Patchwork Pandemic Is Fraying Even Further.
posted by katra at 2:02 PM on May 25 [6 favorites]


It’s difficult to have a specific number of cases as that will vary across a population, plus other variables (say ability to maintain social distancing, access to care, population at risk, etc.). The aim is generally to have the R0 down so that the spread is lower/slower.
posted by stillmoving at 2:16 PM on May 25 [2 favorites]


If there were a thousand new cases / day on Day 20 and by Day 34, that'd fallen to 9980 cases / day, why would you reduce restrictions at that point?

I mean, I do get why a lower incidence would lead to a lessening of restrictions, for some level of "low." What I mean more is, if the pattern shows a sustained high transmission rate, even under a high degree of social restrictions, why would the fact that it was somewhat lower than the peak transmission rate lead to a major reduction in restrictions? It reminds me of this meme.
posted by slidell at 2:16 PM on May 25


why would the fact that it was somewhat lower than the peak transmission rate lead to a major reduction in restrictions?

Racism.
posted by katra at 2:20 PM on May 25 [3 favorites]


So why are there no objective numerical criteria, does anyone know?

I have been keeping a careful eye out for that, and why 'recommendations?' The best I can come up with so far is: it gives politicos wiggle room. They can a) say that they're 'only recommendations' b) that they are letting local powers decide and c) don't have verifiable criteria to be called on.

Pushes the heat down the food chain. Even the local powers never provide numbers (head scratch). But I'm a cynic. Going further...

It didn't take long to figure out that when a governor says, "we're using the phased recommendations", it doesn't mean they're using Gottlieb's or the CDC's. It means they're using internal plans - whatever bullshit that is. Picking phase dates without any verifiable criteria announced in advance. It's when the heat gets hot, from either powerful constituents or up the chain.

Fwiw, my two cents. I am dumb. Picking experts is hard. All else being equal, I go with 'This Week in Virology'.

This guy, who also seems reasonable, made some rules for us, given that states, counties, and cities are basically doing whatever the fuck they want.
posted by j_curiouser at 3:25 PM on May 25 [1 favorite]


As more people recover or were asymptomatic the number of people who could be infected continues to go down. There's no doubt that it effects different people different ways, around 1/3 of cases are nursing homes where regardless of other things are infirm, confined, and in an environment where transmission is easy among at high-risk. Antibody tests have shown that a larger than thought percentage of population had covid and didn't notice. Signs point to immunity at least for a while after recovery whether asymptomatic or not. Drug trials are starting to show results. We've narrowed down a bit the best treatment and can test. Masks and caution are doing good. Transmission is being narrowed down. Some countries did pretty well, there's chatter about a Tuberculosis (TB) vaccine that is used in some countries (not the US/Europe) that seems to keep cases and mortality down. Places that had it before we did have sorta started getting back to new normal, places that got it after we did are still heading for rough times.

The math is roughly logistic exponential growth: Exponential growth and epidemics. and when you can keep R₀<1 you're on the good side of the equation.

Oh, also in California (LA County) and eh, I think I'll stay home a bit longer but not insanely crazy WTF let's open thing up.
posted by zengargoyle at 3:45 PM on May 25


After a third read, there's this...it seems like you are looking for scientific support for these actions. I mean, there has to be some system behind it, right? Some math somewhere? No. Sadly, I have to tell you, nowhere in the legitimate space of pandemic response science is there anyone who thinks this is even a little bit reasonable. There is real science and math, but it all says stay closed. Scientists say, wtf? You're killing more people!

There's a tripod of expertise: basic scientists (virologists), public health experts (epidemiologists), and clinicians (MDs who diagnose and treat). None of them support reopening now, anywhere. (outside some small groups of extreme crazies, mostly non-infectious disease MDs who were already Cheetoh donors when their group was created.)

The hard fact to swallow is: 1-2k deaths per week is ok with the current government. It's. Fine.

This status quo is fine. Stocks will come back. The Rs aren't pretending or hiding it. They're bragging about what a good job they did. This. Is. Fine. They're done with it for now.

Sorry.
posted by j_curiouser at 3:52 PM on May 25 [16 favorites]


Erin Bromage, from the rules link above, for example:
It seems many people are breathing some relief, and I’m not sure why. An epidemic curve has a relatively predictable upslope and once the peak is reached, the back slope can also be predicted. We have robust data from the outbreaks in China and Italy, that shows the backside of the mortality curve declines slowly, with deaths persisting for months. Assuming we have just crested in deaths at 70k, it is possible that we lose another 70,000 people over the next 6 weeks as we come off that peak. That's what's going to happen with a lockdown.
So without a lockdown, worse.
posted by j_curiouser at 4:02 PM on May 25 [1 favorite]


Virologist Angie Rasmussen:
Though we know much more about #SARSCoV2 than we did in January, there are major questions that still need to be answered. We still don’t even know basic things about transmission, viral replication, immunity, etc. We are still dealing with a high level of uncertainty.

I understand that people are uncomfortable with uncertainty. Scientists engaged in public health struggle constantly with balancing uncertainty with a need to take action. This is more nuanced than being “right” or “wrong.”
posted by spamandkimchi at 4:29 PM on May 25 [2 favorites]


Jennifer Nuzzo, DrPH @JenniferNuzzo (May 21): @WHO has advised governments that before reopening, the percentage of #COVID19 tests that are positive should remain <5>

Dr. Saskia Popescu @SaskiaPopescu (May 25): Our IPC team gets a text/email alert for each new positive COVID-19 PCR result and lately it's felt like an indicator for the situation in AZ. For a state that just reopened, the phrase I've been using this weekend for the alerts is “damn near continuous". Ugh.
posted by spamandkimchi at 4:42 PM on May 25 [2 favorites]


This is all opinion but in a similar spot (Ontario) this is what I’ve come to.

I do think our politicians are, by and large, trying to make decisions based on science and health official recommendations. However, I think that as the entire world grapples with this complex thing, the complexity tends to wear them down. Eventually the pressure to reopen (perceived economic and social benefits) tips the balance. If cases were skyrocketing, they’d close. If they were zero, they’d open.im between...just as the rational decider is a bit of a myth in economics, so the purely scientific decider is rare here in North America.We have not selected for that in our democratic voting.

In my area, Toronto, all three leaders - Federal, Provincial, Municipal - have made irrational decisions to not adhere to strict public health rules - a cottage trip, a family visit, and being in a crowd without a mask. I’ve been musing on this a lot. I want to trust these people to do the best possible job given the situation. But they don’t have the impulse control god gave green apples. And then I realized... this is in part the toxicity of much of our culture. We have not elected the most rational of leaders. We have chosen impulsive people. Sometimes known as “decisive” or “ strong” or “leaders of change.)

Asking which finely detailed evidence they are using is...unrealistic*

So where there is wriggle room...they choose optimism or narcissism or whatever their default setting is. Quite honestly I’ve overall been pleasantly surprised with their humans-first rhetoric and response, even if it is imperfect. But these are not the men (in my case) who will forever make the most cautious choices. The cautious people did not survive the political process.

(With the possible exception of John Tory.)

* I think ultimately we may find that countries that keep death tolls low are either lucky, or being led by risk-averse people or operating in risk-averse traditions. New Zealand has a tragic racist shooting, they ban those weapons. They see a pandemic, they stop travel and lock down. That kind of thing. This too is simplistic.
posted by warriorqueen at 8:14 PM on May 25 [1 favorite]


Have you seen this New Yorker article by Atul Gawande? It's long but very helpfully lays out information about what practices can help minimize risk as more and more places start re-opening.
posted by aka burlap at 8:06 AM on May 26 [1 favorite]


I reside in Canada, so I follow the political host Steve Paikin -- lately he has been interviewing and conversing with a lot of scientists, economists, and professors about reopening the economy in Canada. Also, not to mention the whole Canada-US Border closure conflict as well:

https://www.tvo.org/theagenda
posted by RearWindow at 11:48 AM on May 26


The admin owns the death count being ok, and moves to a PR campaign to frame it publically as "just one of those things":
The Washington Post quoted a former Trump administration official familiar with White House thinking on Monday as saying that “they’re of the belief that people will get over it or if we stop highlighting it, the base will move on and the public will learn to accept 50,000 to 100,000 new cases a day.”
posted by j_curiouser at 8:29 AM on July 8


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