How 700 Epidemiologists Are Living Now, and What They Think Is Next | Hacker News Reader

How 700 Epidemiologists Are Living Now, and What They Think Is Next

nytimes.com

59 pointsimartin2k93 comments

> Of 23 activities of daily life that the survey asked about, there were only three that the majority of respondents had done in the last month: gathering outdoors with friends; bringing in mail without precautions; and running errands, like going to the grocery store or pharmacy.

> Almost none said they had attended a sporting event, play or concert; met up with someone they didn’t know well; or attended a wedding or funeral.

> Three-quarters of respondents said they planned to spend Christmas, Hanukkah or other winter holidays only with members of their household, or not celebrate at all, similar to how they spent Thanksgiving.

> Most scientists say around 70 percent of the population will need to be immune for the United States to reach herd immunity, when the virus slows down significantly or stops.

A reminder: 70% number is probably based on the estimates of R_0~3.0 for Covid-19 (1-1/3). Even with partial vaccination some activities can be carefully resumed as long as R_t stays under 1.0.

> But epidemiologists are a very cautious group.

No... they are the correct norm of cautious, it's the rest of us that are blithely charging around recklessly with wild abandon. It's like how on Star Trek they were always beaming to new planets in their regular uniforms with no spacesuits or anything. The gimmick or conceit there was that the transporter filtered out nasty bugs during rematerialization. Until we have "magic" bug filters jet-setting is a disease vector.

People are talking about "returning to normal" but there's no normal to return to: mass international rapid transit is not normal. Huge cities with millions of people are not normal. Nothing about the last ~N centuries is normal (for whatever value of N up to about 120 or so? Younger Dryas happened about 12Ky ago, eh? The Potbelly Hill dates from around the 10th millennium BCE[1]. Somewhere around there we started in with farms and cities. This has been the blink of an eye in evolutionary and geological timeframes. Everything we're doing is new and radical!)

What I'm getting at is this: this won't be the last virus. Remember swine flu? SARS? Ebola? Zika? Hantavirus? Heck, Lyme? Polio is making a comeback, that's the one that paralyses children.

We keep expanding into new wilderness. The "attack surface" of humanity is growing exponentially.

There's no normal to go back to.

(I really do hate to be such a downer, but I just don't see a lot of people taking the long view. Everyone is understandably eager to get back to pretending that viruses don't exist, but they do. Connect the goddamned dots.)

[1] Göbekli Tepe https://en.wikipedia.org/wiki/G%C3%B6bekli_Tepe

> There's no normal to go back to.

I mean, sure, if you define "normal" as something other than what was there before, okay, but then it becomes a moot point. There is a clear meaning to what "normal" means when people say it, and it's "whatever we were doing before".

Who defines what "normal" really is, anyway?

That's what I mean, what we were doing before was exponential growth and the Industrial Revolution resulting in, specifically, mass international travel and huge numbers of people crammed together into mega-cities. The recent viral outbreaks aren't a one-off: they are the beginning of the new normal. We're victims of our own success.

Their predictions of future human behavior are bunk. First, look at the heterogeneity in behavior across the epidemiologists - indoor dining, hanging out without social distancing and going to gyms! This lack of consensus indicates that epidemiologists do not think alike and hence that field is not a settled science. Second, life has mostly returned the normal in the far east where they have successfully contained the virus so far. This is before a vaccine. Human beings have short memories otherwise humans would not indulge in repeated destructive behavior on an individual (alcoholism) or societal level (bubbles, mass hysteria). Finally, after past pandemics like the Spanish flu, life did return to normal. The great depression more scarred human behavior than the Spanish flu ever did.

Epidemiologists are essential during a pandemic to help us understand the virus, the properties of its spread and build models of human behavior along with risks/costs. We need to factor in their input along with advice from others. However, the notion that Epidemiologists are the best mediators of our behavior during and after this epidemic has been falsified. Why?

Exhibit 1: Masking

The consensus at the beginning of the pandemic and through most of the summer was that masks are not essential because we lack the evidence of it. Folks like Taleb et.al, Zeynep, Balaji, Howard et.al in the US who understand complex systems argued for masks back in Jan/Feb. This skepticism of masking because of lack of evidence probably bumped up death count by 50-90%.

Exhibit 2: Epidemiology Models

The models have been greatly off and as a modeler in an unrelated field, I could see the heterogeneity in the model predictions across models and intra-model volatility. When a bunch of models differ, the question is not which is right but are they all wrong? A lot of the models like the one from Imperial had predictions that moved by a lot and never converged to the observed behavior.

"...look at the heterogeneity in behavior across the epidemiologists - indoor dining, hanging out without social distancing and going to gyms! This lack of consensus indicates that epidemiologists do not think alike and hence that field is not a settled science.

Scientists exhibiting different personal behaviors has very minimal connection to scientific consensus. Is settled science that smoking causes lung disease and yet some doctors smoke. Just because you know what the "safe" behavior is doesn't mean you're going to do it. And if the question is, which of these have you done and not which of these do you think is safe to do, then the question isn't about best practices at all.

I wish they would state what a "minority" of the epidemiologists is. 345 (slightly under half), that's a lot different in my mind to say, 7.

These epidemiologists have some strange priorities in life. Only about 3% of them would have, if needed, attended a wedding or funeral. Ten times as many would have gone for a haircut.

Maybe they are better at assessing risk and understand the risk involved in attending a wedding or funeral.

A haircut exposes them to probably one person in close contact, with precautions like masks. A wedding or funeral has potentially a large number of close contacts and presents ethical issues of supporting the event even if the epidemiologist participating will take personal precautions.

All this tells you is that they believe weddings and funerals are likely higher risk than getting a haircut. I would agree that's a sensible assessment.

The question though was what they had personally done.

I am a bit surprised haircut was so high, not because a haircut is likely especially risky but because--to me--it seems so unnecessary, especially without being out and about a lot. Going to a dentist for a cleaning or whatever is maybe higher risk (more contact but medical professionals) but it also seems more important to stick with your schedule than getting your hair cut is.

(Their answers also are presumably influenced by how frequently they would normally do the activities in question as well as the degree to which they're available at the moment. During normal times I'd be much more likely to have recently flown someplace than gone to a wedding or even a live sporting event.)

If a funeral involved just two people, as does a haircut, more may have been down to attend.

I think we’ve gotta start thinking about how to make people more comfortable with living freely post-vaccine. I’ve always been concerned about this as a downside of the “this is a super terrible disease” messaging - there’s a huge range of outcomes where the disease spread is merely mitigated rather than halted, and we’ve trained a lot of high-conscientiousness people to not accept that as a success. When I see experts talking about how they won’t ever go back to normal, I’m concerned about how much of the population will get stuck in that rut with them.

The experts are full of it if they say they’ll never return to normal. This is akin to saying “I’m never drinking again” after waking up with a hangover. Humans are programmed to quickly forget rare or non-recurring negative stimuli. It’s called fear extinction, and it does its job very well to keep us taking risks and seeking reward.

Epidemiologists likely do know something about human behaviour.

One quote from this article:

“For some, it has gone back to normal, and because of this, it will be two to three years before things are back to normal for the cautious, at least in the U.S.”

Isn't that partly just a prediction of vaccine production/uptake/effectiveness rates?

After all, if the world can only produce 2 billion doses of vaccine a year it'll be a few years before international travel is back to normal.

Some of the people surveyed may even have responded before vaccine clinical trial results came out...

In the US, the rate of passport holding is pretty low.. life can return to “normal” here without a lot of international travel. Those who travel internationally may be a different subset when it comes to “back to normal”.

Edit: “According to Census and State Department data, 21.4 million passports were issued in 2016, which is the most ever. That means 42 percent of Americans hold a passport, a growth of 15 percent since 2007. In 1990, only four percent of Americans had one.”

It's also not like international travel is zero at the moment, although it's certainly way down. Although I don't know for sure, I expect to be traveling internationally next fall.

I’d like to travel, but I’ll wait until it’s defensibly sane. It’s not like I want to visit other places that are locked down, too.

I don't know the date it changed but you didn't used to need a passport to go to Mexico or Canada. (Technically you just need a passport card today but birth certificate is no longer enough.)

Making all vaccine testing data and study details publicly available might be a good start.

Why should our goal be a return to normal? Why not normalize wearing masks during flu season or when you have a cold? Why not mandate payments to let contagious workers stay home rather than spread infection all the time, not just during a pandemic? Why not mandate flu vaccines to attend school or take public service jobs?

I don’t think those kind of changes are what they mean. Many of the quotes seem to be expressing reluctance to socialize or be in large groups.

Perhaps more importantly, I think “let’s never go back to normal” is catastrophically bad messaging for those kinds of changes. A lot of people are desperate to go back to normal as they understand it; if we tell them “let’s never go back to normal”, they’ll tell us to shove it, even if they would have been fine with masking when you’re sick and excited about mandatory sick leave.

Uh, you've gotta do the exact opposite: you have to make people aware that they will have to wear masks and maintain social distancing even after the vaccine, for who knows how long.

Will depend on vaccine adoption, availability, etc.

Makes you wonder if stricter measures shouldn't have been taken right after the initial spread, just like many countries did and are currently in economic recovery.

But I think this is a good reflection of the attitude I’m concerned about. If you don’t know how long people should maintain social distancing, how can we tell whether it’s the right decision and how much compliance can we really expect?

It is the right decision for an highly infectious virus, that's passed through via small particles like aerosols and affects your respiratory system.

I know that no government has came forward to say it: but the decision to live with this virus was probably the most stupid mistake of the past 100 years, and comes in the time where politics and politicians were already seen for bad leadership and for being detached from the everyday reality.

For example, in my country, Portugal, we've been struggling with this and some weeks ago stricter measures were set in place - that came very late, after the national health system was on the verge of collapsing... what's the decision for the time of the year where most mobility is registered, Christmas?

"Let's stop the measures for 2 days, but be careful."

I shit you not. The most critical time for spread is when they let everyone go to each other homes.

The reason is simple, so no one can say they didn't let us celebrate Christmas, and they warned us to be careful - this is politics, it's not dealing with a pandemic and an health system on the verge of colapse.

---

So replying to your question, until there's no spread it's the right decision. Because living with the virus isn't good for the economy, and proof is countries with the virus controlled or with little to no cases, are in economic recovery (like we needed that data to know this, but still, there's something).

Having a disease ravage a country, kill friends and family, while the government does almost nothing to help, with millions upon millions of people say it’s a hoax or conspiracy, tends to have that effect on people.

The consequences of living in a failed state are something very few Americans are equipped to deal with using anything besides denial or extreme precaution. Maybe we can ask some people who survived Russia in the 90s what the right course of action should be.

In what way is the current situation in the US even remotely similar to the collapse of the USSR?

When ussr collapsed there were periods of complete anarchy such as working for the railroad that the ussr guaranteed workers pay and pension. Suddenly it was on the states to decide how to handle that. Someone’s lively hood was ripped from underneath them and they had to continue working for nothing if they even had a job to go back to.

That seems very similar to people today who have an eviction looming over their head in a few weeks and no job to go back to.

Another example is 1932 America during depression times. Hardship is all around us, step off social media for a minute..

Unemployment exists, so the situations are basically the same?

Take your own advice.

Miles long breadlines, widespread homelessness, mass deaths from disease and despair, an indifferent, ravenous oligarch class, enough money spent to solve all these problems on pointless war in literally the exact same place where the USSR conducted a pointless war that bankrupted them...

Epidemiologists are the experts, I'm baffled why so many people are asking physicians about coronavirus.

Physicians are not scientists, they aren't supposed to make policy decisions.

It goes to show how few people understand what Science is and probably more dangerously that Medical is mistakenly thought as Science. (Medical is older than the scientific revolution,it's a hybrid of Tradition/Authority/Art/Science)

Epidemiologists are also MDs. And epidemiology also is a hybrid of the kind you mention. Dogmas exist in every science, and although it is true that clinical medicine is far behind other disciplines regarding getting rid of dogmas, things are improving steadily.

Epidemiologists don't always understand better regarding what to do in practice. They understand things in their own manner shaped by their profession and that's exactly what we ask of them.

Some are MDs, but most have a Ph.D or MPH (Master of Public Health) instead or in addition to a MD. Epidemiology is a science and one that is not well covered in medical schools.

Epidemiology is a science as much as for instance infectiology is a science. An aggregate of best practices relying only partially on hard (experimental or mathematical) science. For example IMO, the Bradford Hill criteria are backed by informal reasoning and although seemingly trivially logical, are very much dogmatic in nature.

It's true that many epidemiologists are not MDs, though. I formulated my thoughts badly in that regard.

ree2OSS says>"Epidemiologists are the experts"<

Epidemiology of COVID-19 has been a train wreck. Indeed we must ask if epidemiology is a science at all.

Interviewing 700 epidemiologists is a fool's errand providing no useful information. One might as well simplify the selection criteria and interview 700 (or better, simply 30) people of above-average intelligence.

ree2OSS says>"Physicians are not scientists, they aren't supposed to make policy decisions."<

I agree with the first sentence but not with the second. Most medical organizations/hospitals/institutions/clinics are headed up by physicians who make policy decisions all day long.

“Interviewing 700 epidemiologists is a fool's errand providing no useful information.”

Do you seriously believe there is “no useful information” from such an exercise? None? Methinks you are being facetious.

I agree you shouldn’t necessarily follow what they say they do, but even realizing there is a diversity of responses among those who have some formal training is surely of some value. Especially among the target audience of the NYT that tends to believe what an authority tells them more than the average American.

> Physicians are not scientists

Neither are epidemiologists.

> they aren't supposed to make policy decisions.

Scientists don't make policy decisions either. Politicians do.

> It goes to show how few people understand what Science is

Ain't that the truth.

> Scientists don't make policy decisions either. Politicians do.

Even politicians aren't that good at solving this issue clearly.

It's because centralization is bad at responding to the needs of individuals.

> The reason that this top-down bureaucratic management approach does not work is because the knowledge we need to plan is local, widely dispersed, and held by individuals. Hayek’s point, which won him Nobel honors in 1974, was that there is no such thing as a centralized repository of knowledge from which epidemiologists, policy-makers, or anyone else “in charge” can pull any required data at any time and then — poof — solve societal problems. He further warned that we must treat economic problems differently from scientific problems. Truer words have not been spoken regarding how we should think about the COVID-19 pandemic. Successfully containing COVID-19 is a problem that both requires scientific investigation and economic thinking.

https://spectator.org/covid-experts-shutdowns/

Most people don't really understand that.

Even relatively informed people don't understand that physicians aren't members of the scientific class and in practice are closer to car mechanics than fuel chemists.

A person with a DMA, DPA, or a DMM are all still called "Doctor" colloquially, but not people with a JD.

A Doctorate of Science should by the sound of it be the one that members of the science class have, not a PhD, but it curiously represents both an award that's equivalent, beyond, and less than a PhD depending on who awards it and how it's awarded -- and is curiously often the degree of choice for medical doctors and other health practitioners but almost never the degree for chemists, biologists, physicists or other sciences.

Most people don't even know there are doctorate degrees other than PhD.

>Most people don't even know there are doctorate degrees other than PhD

I think you sort of answered why institutions often award a PhD rather than ScD/DSc/etc. (And there are some related examples related to Masters degrees.) If there's an industry job opening for a PhD, how many ScD resumes end up getting filtered out because the candidate doesn't have the "right" degree? I've definitely heard this type of thing on occasion from graduates who don't or at least didn't award the standard degrees. Even my undergraduate degree isn't quite "normal" (SB vs. BS) so I use the standard form on my resume not that it matters at this point.

I can't remember at the moment, either Harvard or John Hopkins was phasing out the ScD because it didn't have the "brand" recognition of the PhD and for years both degrees had exactly the same programs.

Tl;dr it will take a lot longer than most people expect to get back to ‘normal’. Summer 2021 being normal is a maybe at best.

The article said “many years”. Summer 2021 is a pipe dream. Early 2022 is a very optimistic possibility.

The US likely has something like 50 million people with acquired immunity (14.5 million have tested positive) and another 50 million people are slated to be vaccinated by March (this estimate is assuming weeks after the second doses), with tens of millions more each following month, so it can be sometime next year that the pandemic is waning here.

I’m skeptical that vaccine production and distribution will in the US will scale that well. I certainly hope that it will happen, but given that the country has failed on just about every other pandemic related front tempers my perspective.

The cold chain for the Pfizer vaccine is tougher, but otherwise it's not radically different than flu vaccination (we do ~150 million of those each year in the US). The production estimates are coming from the vaccine companies also, so less likely to be victims of the administrative decline.

Even achieving something comparable to prior year’s flu vaccination would not bring us anywhere close to the herd immunity threshold though. I’m not as concerned with production of the vaccine itself as the logistics involved. I find it hard to believe that a country that otherwise can’t deliver the basic protective necessities to frontline workers is suddenly going to pull out a logistical miracle out of their hats.

Something like 5 or 10 million people are acquiring natural immunity each week right now (it's maybe not that high, but there are 1 million+ positive tests each week, with quite high positivity rates, which indicates testing isn't sufficient to find all cases). It's a grim statistic, but the raging spread of the virus is accelerating the timetable for reaching herd immunity.

140 million vaccinated (approx the number of flu vaccinations administered last year) + tens of millions with natural immunity does put us close to the herd immunity threshold (the number of people that have immunity from an infection has big error bars of course, and there will likely be overlap)

Test positivity does not map one to one with people. If someone takes two tests, you get two positives.

Also, acquired immunity might not be forever. Could be possible to get reinfected.

And you have a very optimistic understanding of how many vaccines can be manufactured and distributed, I would guess.

The 14.5 million are cases that have been identified with a positive test. There are certainly more people that have been infected than that, the only question is how many.

Distributed, probably so. I don't see any reason to doubt the manufacturers statements yet, and I'm not including the potential/likely J&J vaccine.

And while we don't know how long acquired immunity lasts, it's pretty clear that it lasts a good while (it's still a freak occurrence when someone tests positive after recovering from a first infection).

It seems right now we're at 10-15% positivity on PCR. And I think that probably maps onto society... So there's a vague guess how many will test positive with PCR.

Unfortunately a PCR result at a 35 cycle threshold (which the vast majority of tests in the U.S. are) does not prove that a person was infected and has immunity, only that there was exposure that is detectable. It may never even have entered the bloodstream.

Only antibody testing will show if there was a immune response and if there is immune memory. We're not doing that at scale.

It’s not going to scale at all. There were three hour lines just this month to get the rapid test, and we’re months into this.

Unless the federal government gets real with it, and releases an app that leverages scheduling systems to mass coordinate a roll out, this too will be a clusterfuck. The healthcare administrative staff (your standard hospital/clinical administrative staff) is not innovative enough at the moment to adapt to the challenge.

No Politicians framed the issue like this. Canceling school in 3 month bursts is a political move because it's much harder to tell a generation of parents their kids won't return to school for 2-3 years.

Shame on our politicians, shame of Fauci for not making this clear.

Another source that wasn’t paywalled for me

https://news.yahoo.com/700-epidemiologists-living-now-think-...

FYI you can read this article (and a lot of the NYT) by simply creating an account, it's painless and free.

I fail to understand why I was downvoted for linking a no-nagging source of the same article.

> The epidemiologists have almost entirely avoided other parts of pre-pandemic life — including activities that many Americans are doing now. Almost none said they had attended a sporting event, play or concert; met up with someone they didn’t know well; or attended a wedding or funeral.

Sorry, where are these people living where it’s even possible to do these things?

Are you asking in the sense, how are they accomplishing this, or how are they even given the choice of this? Because in the US, a lot of those things are still on the table.

Well Europe has people in soccer/football stadiums. The US has people in football(American style) in stadiums. The states has "famously" had several country music concerts that, well probably not a wise idea to attend, were packed.

And I feel pretty confident saying that practically every country on the face of hte planet has atleast one wedding a day.

I mean, I've been to 4 funerals over the summer and I live in Canada.

Where are you that there are no funerals or visitations to attend?

I see you don’t live in the south. Just got off a FaceTime with my sister in law who is currently at a farmers market with her kids. I am intrigued how others would respond to this, I just had to watch on in disbelief (these kind of actions are the norm down here)

I'd amend "south" to "rural" because I think it's similar in Montana and Ohio

Farmers markets were allowed and well-trafficked, even during lockdown, in every state I'm familiar with.

It's not a "farmers market" but the local small farm stand and other local farm store type places have been open all summer where I live in the Northeast. Why wouldn't they be if grocery stores are open?

Lack of social distancing but that is put on the visitors to maintain 6ft. In reality no one does because muh apples.

I see the same behavior in supermarkets too. It’s like we can’t be inconvenienced even temporarily because apples..

There are drive-in concerts in my city in the US. Weddings are allowed to be held outdoors. Some states have allowed limited spectators of professional sports.

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