Tuesday, May 5, 2020

Cuomo's science trumps Trump's gut - truth wins out over truthiness

Jennifer Rubin at the Washington Post contrasts two different approaches to controlling COVID–19 in Andrew Cuomo gets it right: Govern by science, not your gut.

How many times have we heard President Trump say he just has a “feeling” or that his “gut feeling” is superior to expert, evidenced-based data? A lot. That “feeling” — whether it’s about North Korean leader Kim Jong Un’s intentions or the economy or the 2018 midterms — has often been wrong. During the coronavirus epidemic, however, his preference for emotion and feelings can cost lives.

It does not have to be that way. New York’s Gov. Andrew M. Cuomo (D) did not mention Trump by name at his news conference on Monday. He did, however, implicitly set up a contrast between Trump (and his minions) and himself when it comes to gradually reopening the economy, schools and public places. Cuomo insisted you have to act with “the best information you have, learning from the lessons you have … which means, don’t act emotionally.” He continued on: “Don’t act because ‘I feel this, I feel that.’ … Forget the anecdotal, forget the atmospheric, forget the environmental, forget the emotional. Look at the data. Look at the measurements. Look at the science. Follow the facts.”

That is as good a model of government decision-making as you will hear, and a complete repudiation of the unscientific (or anti-scientific), impulsive style of political theater now in vogue with many Republicans. “Feelings,” in their mind, take the place of facts. Are facts missing to show the virus was created in a laboratory? Well, he’s got a feeling. No facts to suggest this is all going to “disappear”? Trump has a feeling. Indeed, almost without fail, when he says he has a feeling about something, you can bet there is no evidence for it or that the evidence points in the opposite direction.

Thousands of lives hang in the balance depending upon how elected leaders make their decisions. Trump operates without data (Liberate Michigan!). New York, Cuomo explained, does the opposite: “The rate of transmission goes up, stop the reopening, close the valve, close the valve right away. So, reopen businesses, do it in phases and watch that rate of transmission. It gets over 1.1, stop everything immediately.” Methodical, fact-driven and emotion-free decision-making is called for when the problem — a virus — is a natural phenomenon incapable of being spun, bullied or ignored.

What is that “1.1”? A short tutorial on the rate of transmission is appended.

It is not good enough to say, “We have enough tests for everyone!” First, it is not true. Second, it gives no guidance to states as to how they can responsibly reopen. Cuomo explained, “You have to be prepared to do 30 tests for every 1,000 residents. New York is doing more tests than any country in the state by far.” While as a state New York is doing more than any state per capita, “it doesn’t matter what we’re doing statewide. To open a region, that region has to have a testing capacity of 30 per 1,000.” Likewise, on contact tracing, there must be 30 contact tracers for every 100,000 residents before a region can reopen.

If we are going to reopen the business and return to something approaching normal, we have to be prepared to put facts first. Measure the data. Act on the data. Readjust on the data. Such a rational approach to governance is entirely beyond Trump’s capabilities, which is one reason he is uniquely unfit to govern during a health emergency.

For the tutorial, read more here.

These excerpts are from a healthline.com article, What Is R0? Gauging Contagious Infections.

R0, pronounced “R naught,” is a mathematical term that indicates how contagious an infectious disease is. It’s also referred to as the reproduction number. As an infection is transmitted to new people, it reproduces itself.

R0 tells you the average number of people who will contract a contagious disease from one person with that disease. It specifically applies to a population of people who were previously free of infection and haven’t been vaccinated.

For example, if a disease has an R0 of 18, a person who has the disease will transmit it to an average of 18 other people. That replication will continue if no one has been vaccinated against the disease or is already immune to it in their community.

What do R0 values mean? Three possibilities exist for the potential transmission or decline of a disease, depending on its R0 value:

  • If R0 is less than 1, each existing infection causes less than one new infection. In this case, the disease will decline and eventually die out.
  • If R0 equals 1, each existing infection causes one new infection. The disease will stay alive and stable, but there won’t be an outbreak or an epidemic.
  • If R0 is more than 1, each existing infection causes more than one new infection. The disease will be transmitted between people, and there may be an outbreak or epidemic.

Importantly, a disease’s R0 value only applies when everyone in a population is completely vulnerable to the disease. This means:

  • no one has been vaccinated
  • no one has had the disease before
  • there’s no way to control the spread of the disease

This combination of conditions is rare nowadays thanks to advances in medicine. Many diseases that were deadly in the past can now be contained and sometimes cured.

So with respect to COVID–19:

  • no one has been vaccinated - check! It’s a novel disease.
  • no one has had the disease before - check! It’s a novel disease.
  • there’s no way to control the spread of the disease - check! This is true if we do not follow safe practices - personal hygiene (washing hands) and social distancing and contact tracking. In principle if we DO follow guidelines for infection prevention, then R0 should fall below 1.0.

The R0 for COVID–19 is a median of 5.7, according to a study published online in Emerging Infectious Diseases … The 5.7 means that one person with COVID–19 can potentially transmit the coronavirus to 5 to 6 people …

The study authors say active surveillance, tracking the contacts of people who contracted the coronavirus, quarantine, and strong physical distancing measures are needed to stop the coronavirus from being transmitted.

Where those steps have been practiced, such as in New Zealand and Australia, the rate of infection has been drastically reduced. With no new cases being reported in New Zealand, R0 must be 0.

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