Viewpoint: COVID-19 Modeling: Lies, Damn Lies and Statistics

We have now received our fourth projection on deaths.  I’m not sure if it will be right or wrong, but the others have proven to not be correct, so I’m not hopeful for this one.  That is actually good news because the last projection doubles the number of expected deaths to 134,475 by Aug 4, 2020.¹

In severe epidemics, let alone pandemics, the numbers become very political and governments seldom want to take responsibility.²This was true with the United States’ response to the 1918 epidemic with President Woodrow Wilson seldom, if ever, mentioning the epidemic in public speeches and communications.³

We know far too little about COVID-19. Reported deaths have crossed the 72,000 threshold and will almost certainly go much higher⁴. But projections are difficult to do since there are so many unknowns.

President Trump has stated in a May 5, 2020 interview that the recent dire projection of 3000 deaths a day by June 1assumes no mitigation practices. Of course, some degree of mitigation will continue to happen. And there are additional factors which are seldom talked about.

The first is population density, the cities in the Northeast have densely packed populations which set the stage for rapid spread. In New York City, the rates are starting to decrease, bringing hope that the pandemic is abating in the United States.

Seasonality is another possible factor. Both the common cold and seasonal flu epidemics burn out in the summer months. Epidemiological, COVID-19 disease hotspots correlate with colder climates.⁵After a few minutes of sun exposure the virus starts to die⁶; this was a strategy in the 1918 Spanish Flu epidemic where patients and hospital beds were lined up outside. But others are quick to point out that MERS, another coronavirus, had no difficulty spreading in Saudi Arabia in August.⁷This is a large unknown and for now we can hope that the warm weather will negatively impact the spread of this pathogen.

Air Pollution is also felt to be a factor, with viral RNA being found on air pollution particles.⁸Of course, this is similar to finding dinosaur DNA in a mosquito, it does not mean you found a live dinosaur. But this concern has been bolstered by a recent Harvard Study which found COVID-19 to be concentrated in areas with higher air pollution.⁹We have seen massive decreases in air pollution with the planetary response to this virus. Regardless of its effects on the spread of the COVID-19 virus, this is a benefit to both ourselves and our planet.

The opening of our economy is another factor. But just because we declare the economy open does not mean it will. It is treated as a switch, but it is not. People who practice social distancing will do so, and those who don’t will probably not start. A new Boston Globe, WGBH News poll from Massachusetts found that more than 7 in 10 residents will not be comfortable engaging in activities such as going to movies, riding public transportation or attending sporting events once the restrictions are rolled back.¹⁰And a recent PBS/NPR Maris poll found that 80% felt opening restaurants for restaurant eating was a bad idea.¹¹

As long as a segment of the population frequent stores and exercise their “rights” not to wear masks, then others will be leery of patronage and just order over Amazon. It is easier and safer.

Finally, there is a report of a new strain which has a mutation on the virus’s attachment and cell entry protein, Spike D614G. This mutation makes the virus more contagious than the original. This strain started in Europe and then spread to the United States, becoming the dominate strain by mid-March. Most vaccines target this attachment protein and it is feared that this mutation will also allow those who have been infected with the original strain to become re-infected and vaccines may also need to be modified.¹²

Thus, your guess is as good as mine as to what will happen. Will the opening of the economy result in a huge increase in cases caused by decreased social distancing and a more virulent virus or will cases decrease with the public continuing to abide by safe habits and possible mitigation of the epidemic by warm humid weather and a decrease in air pollution? Only time will tell, but regardless of the outcome we need to prepare our healthcare staff and stockpile supplies for the fall, when many of the best experts are predicting a second wave. 

References:

(1)  IHME.  COVID-19 Projections.  https://covid19.healthdata.org/united-states-of-america   
    
(2)  Kavanagh K.  Collective ignorance and government timidity are public health threats.  Los Angeles Times.  May 16, 2019.  https://www.latimes.com/opinion/op-ed/la-oe-kavanagh-epidemics-health-public-policy-20190516-story.html  
   
(3)  Felten E.  How Woodrow Wilson Let Flu Deaths Go Viral in the Great War.  RealClear Investigations.  April 8, 2020.  https://www.realclearinvestigations.com/articles/2020/04/08/how_woodrow_wilson_let_death_run_viral_in_the_great_war_123047.html  
   
(4)  World O Meter.  https://www.worldometers.info/   
    
(5)   Katz D.  IHV Researchers Use Climate to Predict Spread of COVID-19.  Mar. 13, 2020.  https://www.umaryland.edu/news/archived-news/march-2020/researchers-predict-potential-spread-and-seasonality-for-covid-19-.php    
     
(6)  Cunningham, PW.  The Health 202: Sunlight does kill the coronavirus. But not in the way Trump suggested.  The Washington Post.  April 27, 2020.  https://www.washingtonpost.com/news/powerpost/paloma/the-health-202/2020/04/27/the-health-202-sunlight-does-kill-the-coronavirus-but-not-in-the-way-trump-suggested/5ea5993e88e0fa3dea9c2b24/   
    
(7)   Le Page M. Will heat kill the coronavirus?  New Scientist.  Feb. 22, 2020.  Vol. 245(3270).  https://www.sciencedirect.com/science/article/pii/S0262407920303778    
  
(8) Setti L, Passarini F, et al.  SARS-Cov-2 RNA Found on Particulate Matter of Bergamo in Northern Italy: First Preliminary Evidence.  medRxiv.  April 24, 2020.   https://www.medrxiv.org/content/10.1101/2020.04.15.20065995v2    
   
(9) Wu X and Nethery RC.  COVID-19 PM2.5    A national study on long-term exposure to air pollution and COVID-19 mortality in the United States.  Harvard University.  https://projects.iq.harvard.edu/covid-pm      
   
(10)  McGrane V.  Feeling economic pinch, Mass. Residents remain resolute in battling coronavirus, new poll finds.   https://www.bostonglobe.com/2020/05/05/metro/feeling-economic-pinch-massachusetts-residents-remain-resolute-battling-coronavirus-new-poll-finds/    
     
(11)  4/29: NPR/PBS NewsHour/Marist Poll Results & Analysis.  Marist Poll. April 29, 2020.   http://maristpoll.marist.edu/4-29-npr-pbs-newshour-marist-poll-results-analysis/#sthash.n2bzD9Ff.ym1VICor.dpbs   
     
(12)  Vartabedian R. A mutant corona virus has emerged, even more contagious than the original, study says.   Chicago Tribune News Service (LA Times Story).  May 5, 2020.  https://www.chicagotribune.com/coronavirus/sns-mutant-more-contagious-coronavirus-has-emerged-20200505-lr5pctceo5bltbh2mjkiajbxwq-story.html