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The big conversation is around the 60,000 death toll model, so today I had confidential conversations with the modelers. I can share some of he details from my learnings without attribution.

There is no topic more sensitive than what the death toll will be from Covid-19. And we feel like we get bounced around with new projections. Of course the different numbers cause people from the variety of factions to respond differently; “it’s working” or “see this is overblown” or “big numbers are alarmist.”

The numbers in the model are important in helping us understand what is working. They should not be seen as projections. They also make assumptions about human behavior that can’t be known (as you will see).

The current state of things: Trump previously said the death toll was headed to 100k — 200k. Scientists in the White House are still holding that. But a new model the White House, and many other people are paying attention to, are now saying 60k. There is also a secret “Grand Princess” model I will touch on.

Trump has said the death toll “could have been” 2 million. And the Imperial College put out higher numbers. First question: If it comes out at 60k or 100k–200k, how could people have been so wrong? Or if it comes out higher, how could people be so wrong?

The answer? This is exactly how exponential math works. If 1 person infects 2.3 people on average, after 10 cycles 4,100 are infected. But if one person infects only 1.3 people on average, only 14 people are infected.

This is why we architected they #StayHome campaign. Because the difference is dramatic. It’s why people look foolish to skeptics. When Cuomo said New York could need 30,000 hospital beds, he said “I hope they call me alarmist.” Nobody predicting higher numbers wants to be right.

Here’s what I can tell you about the 60,000 projection:

  • The first projection was on one city. Now it includes 16, including European cities. More data with sustained social distance.
  • It assumes states that have not done social distancing don’t have outbreaks.
  • It assumes no cross state travel .
  • It assumes R0 (“R-naught”, or the infection rate of the disease) goes to below 1. Meaning instead of one person infecting 2.3 or 1.3 people on average, they infect less than 1 on average. That would crush the virus.
  • It assumes we don’t let up on social distancing. This is a critical assumption.
  • It assumes states don’t open until they have less than 10 cases.
  • It assumes all this is over in August.
  • It assumes no international travel.
  • It assumes there are no overruns on hospital beds.

There is a lot to criticize in any model. And while a lot of the President’s supporters view this as a sign that we’ve won, others can find a lot to critique. To be fair, you have to make some assumptions in any model, but I will tell you some of the critiques I heard:

  • The model not dynamic, it just runs multiple cases.
  • It is already proving wrong in New York.
  • The steady state assumption on length of people staying home is not viable.
  • It assumes no second wave comes before a vaccine (this is tough to imagine).
  • It assumes a lot of testing is ready to go that isn’t.

So those are the criticisms. And if the criticisms are right, then 60k will be higher. If the model shows numbers that go down, that is a good signal that our actions are working. I think the right view is that if we sustain current activities we are saving lives.

The other consideration in the model is that people are highly compliant. A separate person told me this:

  • 60% of people in Queens are compliant (that concerned me).
  • 33% in Montgomery, AL are compliant (that frightened me too).

There are other models with different assumptions — one says 90,000. Others say 100–200k. The Diamond Princess model (which is a straight line assumption of what happened on the ship) says 400k. Again, slight changes in our behavior or relaxation of laws could make the number much higher. Being 10% off could make you 1000% wrong.

Yesterday, I also did a call with members of Congress along with Scott Gottlieb MD. We each provided a 10 minute briefing on where we sit and what a Congress’s priorities need to be.

Scott talked about how our current period may lead to events over the summer to events over the Fall. He and a few others published a new paper today that’s worth looking at. It indicates about what things would look like in August.

Scott and Farzad Mostashari MD (along with others) discuss what is labeled a surveillance system. What does that mean, a surveillance system? I think the term can be interpreted in a destructive way.

Surveillance systems are used to track public health issues. Part of it is looking for hot spots with a lot of data. In 2004 the drug Vioxx was increasing the risk of heart attacks. Surveillance was needed to help find the problem.

You can also monitor individuals on a case by case basis. This is only relevant when an outbreak is contained. If you do it right you pinpoint someone with virus and close a circle around who they are in contact with and quarantine.

To do all of this, you need a public health workforce, some technology to monitor, abundant diagnostic testing, and a way of paying for it. We’re a long way from there. Particularly the ability to test in abundance. And it will require all of us to participate.

For my part, I covered the five things Congress should prioritize right now. It‘s consistent with Scott’s view of the world but talks about the specific details that Congress should act on. There are comprehensive details at US of Care.

I have been pushing particularly hard for a payment to go to our frontline health care workers as part of the COVID-4 package. I think it has some momentum but have to keep pushing.

I STRONGLY recommend you read this piece by alice wong. I’ve talked about making the disability community a priority. Alice’s story tells you why. Action from Congress must address a set of issues salient to protecting 60M+ Americans with disabilities:

I also talked to Governor Phil Murphy, who is at ground zero in New Jersey. My question for him was primarily; What do you need and how are you doing it? And how are you working with both Trump and the Cuomo? He agreed to let me record the whole thing for In The Bubble, including strategizing I would normally write about.

It’s a rare conversation at a rare point in history. As the state with the second worst death toll, he needs help from all quarters. You can listen here:

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