Show us the model Driving the Narrative

Bradley Tanner, MD, ME, MBA
April 10, 2020

Show us the current model driving the existing narrative, the assumptions, and predictions. Show us how the model succeeded in predicting the future and where it failed.

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They tell us to accept and believe in a model and in figures yet do not give us full access to that model so we can inspect it. This approach is a classic "trust me" strategy based on authority. It assumes an ignorant populace cannot understand. At best, this is demeaning and insulting. At worst, this is manipulative and dangerous. At the absolute worst, there is no real model, and the emperor has no clothes. There is no plan, no numbers, no strategy, just faith. We are potentially following a policy not based on science at all but on a hunch. Without a publicly available model vs. vague number and charts, we won't know.

We do know that the initial model of the CDC and WHO used a transmission model based on how many people would statistically be infected by one person. It also assumed that the number in the population that was infected was far lower, and the number of new infections would grow exponentially from that small number based on that statistic. It was an excellent idea and underlay the logic of modeling.

Unfortunately, assumptions fall apart in a highly transmissible virus. First, highly transmissible viruses can vary widely in how they spread. One person can spread it to another or 100s (e.g., the Boston Convention or a Cruise Ship). It depends on many factors, density, viral load, personal behavior, surfaces, etc. A model that reduces all those variables to one number is subject to failure. From the clean graph, it appears their model has such a number that does not vary over time or place. Second, the assumption that a highly transmissible virus has not spread is illogical. China knew it spread and locked down an entire 70 million city for months and imposed draconian measures to enforce it. So the number of "possible" infections to start with when the epidemic began in Washington is critical. What was their number? We don't know. But we can assume it was low since they were proponents of the "stop the virus" strategy.

In this case, we were all told the worst possible scenario based on old data from the imperial college of London. They gave us a $100,000 to $280,000 figure, which caused extreme panic and compliance from the public. And now they are revising the number down to 60,000. The danger of a single narrative is when there is a change in the numbers, then the only possible explanation is that narrative. Because there is a single narrative there is only one possible explanation. They explain that people were more compliant than they predicted. Of all the variables that could explain it, only that one makes sense. The conclusion: Social distancing worked! This conclusion is simplistic. The CDC is arguing that the intervention and the model they used was not wrong; the model just had an incorrect assumption. But at its core, it is still proven correct.

Part of the model does make sense. If your model is to reach herd immunity as fast as possible without overstressing the health care system, you do indeed want to keep vulnerable individuals from getting infected and suffering from the worst ravages of the disease all at once. But that aim might have been accomplished by targeting those most at risk due to location and living density or personal factors rather than blanket bans. But we will never know.

Additionally, if rapid herd immunity was the model, there may have been value in speeding up the dissemination of the virus among lower-risk populations at the early stages versus telling young, healthy people to stay at home. They could have gotten infected, or they may already have been infected and kept our country running while the vulnerable hid from the virus. In essence, we did that with delivery people and grocery store clerks; we could have done that for all of them and not force them into unemployment and created a need for trillions of dollars in relief.

The current CDC model and their instruction are still flawed, just like the original tests and the original model. Cognitive inertia is driving the CDC and our viral response, not a consideration of all the possible explanations. It is still pushing a "stop the virus" scenario where as long as we keep up its social distancing narrative, we can continue to drive down deaths. And now they are pushing for masks so we can feel even more isolated. So now masks are a good idea? What kind of scientists are they? Why should we trust people who keep changing the solution? Perhaps we should stop believing their model.

It is disturbing that the ongoing recommendation is to stay the course, add masks, further limit exposure when the numbers are dropping? What is the logic now of slowing the virus since clearly deaths are plateauing? Is the goal to somehow "stop" the virus? The answer is, sadly, yes.

We see the same mistake from the world health organization, which continues to tell us not to relax. That would make no sense if they believed in herd immunity. Since that deaths are starting to level off or even decrease in European states, there is no reason to keep up the pressure in the West. In the herd immunity model, we should be backing off slowly and increasing the rate at which we recover from this infection. A West that recovered from the pandemic will be well equipped financially and socially to assist the developing world since the pandemic is undoubtedly going to grow there.

The CDC and government never bought into the "slow the virus" narrative leading to herd immunity. They told us we were supposed to suffer so we could flatten the curve to protect the health care system. But that was never the real goal. They are not interested in allowing the infection to proceed. The goal has been and remains a "defeat the virus" or "stop the virus" model, aka the China Containment Model. We are stuck with a stubborn insistence that we can contain and stop the virus to "avoid" (not merely) delay deaths, and this should be done at all costs. This choice is disturbing because it perpetuates the cost of the response to the virus and likely has no impact on the metric driving all decisions - deaths.

To be clear, we can drive done the number of new infections, but we won't drive down deaths as those numbers seem to be driven by herd immunity. The only explanation counter to herd immunity is non-herd immunity. In this delusion, the virus is out there and can get us, but we have somehow stopped it. As discussed elsewhere, this a fantasy. In China, in Italy, and the consistent numbers of deaths refute it. This strategy cannot be our only strategy; it has too much risk that it is simply wrong. If we are to continue to follow the "better safe than sorry" policy, then a "stop the virus" strategy is far too risky and must be discarded.

Hope is not a strategy. A certain percent of the population will have a lethal case of the disease and die; the only factor that varies is when. As an aside, we accept this risk in the opioid epidemic and the obesity epidemic, yet we have made minimal changes to reverse deaths. Opioid treatment is still challenging to come by, and the number of obese citizens continues to increase. Cars still kill people, and guns are the most common cause of suicide. Flu regularly kills about 30,000 to 70,000 citizens every year. If we can accept those realities (and many more), than we can agree that this virus is going to kill a certain number of people.

It's time for cognitive inertia to stop aside, look at the data, and realize that it better supports rapidly progressing to herd immunity. We need to keep telling ourselves that if we are merely slowing the virus, the total numbers of death don't change only the numbers on the nightly news. Intelligently speeding up herd immunity in a world where hospitals can cope won't increase deaths and allows us to return to normal.

We must reject ongoing social destabilizing and dehumanizing solutions proposed by the CDC and our government. Extending the broad-based lockdowns is not following the "protect the healthcare system" model despite arguments earlier that flattening the curved to protect the healthcare system was the primary goal. The major goal was not to protect the healthcare system because now that it's protected. We are continuing to destroy the economy and people's lives.

With the current government narrative, we are trying to complete a containment model after the fact and spread out the misery and death as long as possible. This approach might succeed with a different virus or if a solution we're on the near horizon, but the high transmissibility and symptomatic carriers argue against this strategy. We've seen from other countries that the virus continues to spread due to the health care system and other actions, and this will not stop no matter what we do at a personal level. As we get further into lockdown, there's going to be more and more of a need for activity to ensure the ongoing supply of material and food and pharmaceuticals.

We must reject the insistence of keeping the controls in place now that we are no longer at risk of the overwhelming healthcare system. We must reject any implication that we can pursue a containment strategy because although it makes the numbers look good in the short term, failure is likely. Instead, we can relax controls with the understanding that deaths and hospitalizations and new cases will continue to exist whether we do anything or not.

Look out for the next lie, that they believed in herd immunity all along. The decisions made are not consistent with that assumption, nor are the estimates of deaths or the behavior once the hospital system had reached a point where it could handle admissions. They did not drive infections at a significantly fast rate that was just below what the hospital system can handle. If they are going to claim that they were pursuing herd immunity, it makes little sense to avoid social distancing among people at low risk and among people who did not have active symptoms. Their exposure allows the virus would spread as fast as possible among those populations. If herd immunity were now the goal, they would support infections but with low doses of viruses so the individual would start with the smallest number of viruses and would have the time to develop an antibody response before the virus had to duplicated too much. If they don't follow the conclusions of herd immunity now, then their claiming to support it is continuing a strategy of misinformation.

It's very convenient for the CDC and the government to change their narrative to say they were correct all along. Still, their behavior argues that they were attempting a “stop the virus” strategy similar to what New Zealand China and Russia are trying. They are slowly coming to realize that it failed. When it failed, they will likely change the narrative and admit that their model may not be able to stop the virus. Yet, at the core, there is an ongoing hope to "stop the virus."

The WHO will also likely change its narrative later on and say yes, they were in favor of herd immunity, and this strategy of telling countries that they need to maintain the strict controls was somehow consistent with that. Don't believe them either. Both organizations have been vague and slow and unwilling to put out full information based on their models.

The CDC, the government, and the world health organization deserve blame, but not for the pandemic. The virus deserves blame. Herd immunity argues that no matter what we did, the outcome was likely to be the same. They deserve responsibility for pushing a narrative that guided the response to the pandemic. This mistake is what they must be held accountable for. They sold a "one death is too many" narrative. They pushed a "we can stop this" narrative. Both were ruinous to the lives of people and economies of countries. In the future, we cannot let medical people alone determine how we respond to pandemics since their view of what is essential is skewed and can lead to follow a failed model. Broader, legal, constitutional, economic, mathematical, and social input would have allowed a more thoughtful review of benefits and costs and enabled an intelligent discussion of various models. In the West, again we're not going to save additional lives by slowing the spread, we're going to have to accept that some of the deaths are going to happen earlier than they would if we delay the inevitable. And the speed allows us to help out the undeveloped world as the virus spreads

The important lesson is a single narrative is dangerous and that we can't in the future fall prey to crises that asked us all to believe and trust in a single narrative. It's too easy to include a revisionist history where the folks of a single narrative revised what they said and revise their models and explanations to match the eventual reality. Had the CDC allowed for a second narrative, we would have been able to easily see from the beginning which narrative was a better predictor of the eventual outcome. We would have guidance going forward both during the crisis as well as in the next crisis to tell us what is the more effective strategy.

The next time we cannot trust them on their word; we must demand transparency and accountability when their model fails.

Their model failed us; we cannot allow them to keep changing what they say. It's time for them to admit they followed a single narrative, and it was flawed. And in all likelihood, the current one is flawed. As before, show us your full model, it's assumptions, the plan based on it, and your projections. And let others propose their narrative and their models. And let the best win.

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