Anecdote: On March 10, 2020 I watched a February 28, 2020 lecture by Dr. Amesh Adalja with Johns Hopkins Center for Health Security that currently has 51,000 views.
[...] Be alert, wash your hands a lot where you’re in areas where there’s a lot of common touch surfaces you might be touching, avoid sick people as much as you can, but there’s not much else you can do at this point.
He also said wearing masks would be going overboard in response to a question if people should buy masks. He said he travelled internationally “yesterday” (which would have been February 9th if the video was uploaded the day of the lecture) and didn’t wear a mask. He said he saw people wearing masks with their noses out or with masks around their neck (implying it wouldn’t be effective to tell people to wear masks?) and also that it’s uncomfortable to wear an N95 for too long, so he wouldn’t recommend the general public to wear a mask unless sick (in which case “maybe” they should wear a surgical mask).
I think his prediction and advice should probably be judged negatively and reflect poorly on him / Center for Health Security, but I’m not sure how harshly he/ CHS should be judged.
Edit: Also, at 42:10 he said “I do think that it’s not containable in any country, it just appears to be so now.” I think this was also wrong, since clearly some countries have managed to avoid major outbreaks.
He said he travelled internationally “yesterday” (which would have been February 9th if the video was uploaded the day of the lecture) and didn’t wear a mask.
This seems totally okay to me, FWIW. In most places (e.g., London or the US), it would have seemed a bit overly cautious to wear masks before the end of February, no?
I think his prediction and advice should probably be judged negatively and reflect poorly on him / Center for Health Security, but I’m not sure how harshly he/ CHS should be judged.
I generally agree with that, but it’s worth noting that it was extremely common for Western epidemiologists to repeat the mantra “you cannot do what Asian countries are doing; there’s no way to contain the virus.”
I don’t have any inside information about why CHS made the choices it did, but my naive view is that I agree with your comment that mistakes like these should reflect poorly on CHS. CHS’s core competency may be more in the area of pandemic preparedness than dealing with the pandemic once it’s already here, but their experts were quoted in the media a TON last spring and had significant ability (= responsibility) to shape the public conversation about COVID, particularly in the US. And yet lots and lots of people far less credentialed than CHS epidemiologists had correctly figured out by the first week of March that it was smart to wear a mask and to avoid being around others more than was absolutely necessary. It was left to pop-up initiatives led by non-medical experts like #Masks4All to upend the conventional wisdom about masks that had been propagated by the WHO and CDC. I feel like CHS ought to have been well positioned to challenge the prevailing narrative and was instead getting in the way at a time when it really mattered.
“And yet lots and lots of people far less credentialed than CHS epidemiologists had correctly figured out by the first week of March that it was smart to wear a mask”
Not sure how much this is an answer—as I said in a different response, the question isn’t whether CHS was right (much less right about one specific thing,) but whether they did better overall than the other policy-influencing organizations.
Fwiw, my vague memory is that some other people at CHS, including Tom Inglesby (the director) did better than Adalja. I think Inglesby’s Twitter was generally pretty sensible though I don’t have time to go back and check. I’d guess that, like most experts, he was too pessimistic about travel restrictions, though. Maybe masks, too?
I do think CHS should get some credit for arguing for taking pandemic response very seriously early on. For example, I think Tom had some tweets arguing for pulling out all the stops on manufacturing more PPE in January 2020.
Note—I’m a bit biased since I was working on biorisk at Open Phil the first time Open Phil funded CHS.
I think the key question for CHS, or even Amesh specifically, is whether they outperformed other organizations, and by how much—i.e. were investments in CHS positive contributions to response overall. And they / he could have done almost arbitrarily bad in February, and still overall have vastly outperformed the alternatives.
And I think that it’s clear that CHS’s work was impactful in increasing preparedness in the US, even if the level of preparedness was far short of what was needed.
(Note that I have personal biases about this, and know many of the people at CHS.)
To be fair, the Johns Hopkins Center isn’t just Adalja. I’m not aware of the list of things they do, but for instance, they kept an updated database in the early stage of the virus outbreak that was extremely helpful for forecasting!
Adalja also confidently predicted the infection fatality rate for the rest of 2020 to be around 0.6% (on the Sam Harris podcast) despite thinking the virus can’t be contained (if true, this would have led to more ICU beds and oxygen shortages in lots of places). In reality, the IFR was more like 0.9% or higher for countries like the US and UK. Probably it was lower for countries with younger demographics, but I don’t even think Adelja was basing his estimates on that.
(TBC, this isn’t as big a mistake compared to other statements or compared to Ioannidis who completely disgraced himself throughout 2020 and ongoing, but I find it worth pointing out because I remember distinctly that, at the time when Adalja said this, there was a lot of fairly strong evidence for higher IFRs, including published estimates. I thought 0.6% seemed [edit]hard to defend, though I don’t remember how much he flagged that there’s a substantial chance it’s significantly higher. Importantly, it would have been higher than it actually turned out to be, if Adalja had been right about “the virus can’t be contained.”)
Was the prediction for infection fatality rate (IFR) or case fatality rate (CFR)? And high-income or all countries? Globally, the CFR is 2% (3.7M/173M), but the IFR is <0.66%, because <1/3 of cases were detected.
IFR (but back in February/March 2020, a lot of people called everything “CFR”). I think he was talking about high-income countries (that’s what my 0.9% estimate for 2020 referred to – note that it’s lower for 2020+2021 combined because of better treatment and vaccines). I’d have to look it up again, but I doubt that Adalja was talking about a global IFR that includes countries with much younger demographics than the US. It could be that he left it ambiguous.
Ah. If global IFR is worse than rich-countries’ IFR, that seems to imply that developing countries had lower survival rates, despite their more favourable demographics, which would be sad.
It’s still unclear, and the developing world detection and survival rates are a bit uncertain. I think you could probably get a decent approximation by looking at test positivity rates and testing volume compared to death rates over time in different countries, but I’m not going to put together the model to do it.
We’re doing something related with IFR estimates by age at 1DaySooner, but using seroprevalence data, i.e. only where there is really good data for the estimate. I don’t have results of that yet.
that seems to imply that developing countries had lower survival rates, despite their more favourable demographics, which would be sad.
This isn’t impossible because there seems to be a correlation where people with lower socioeconomic status have worse Covid outcomes, but I still doubt that the IFR was worse overall in developing countries. The demographics (esp. the proportion of people age 70-80, and older) make a huge difference.
But I never looked into this in detail, and my impression was also that for a long time at least, there wasn’t any reliable data.
From excess deaths in some locations, such as Guayaquil (Ecuador), one could rule out the possibility that the IFR in developing countries was incredibly low (it would have been at least 0.3% given plausible assumptions about the outbreak there, and possibly a lot higher).
Anecdote: On March 10, 2020 I watched a February 28, 2020 lecture by Dr. Amesh Adalja with Johns Hopkins Center for Health Security that currently has 51,000 views.
In the lecture, he predicted:
He said the virus was not containable and that we shouldn’t be trying to quarantine people to contain it.
A few minutes later, he said:
He also said wearing masks would be going overboard in response to a question if people should buy masks. He said he travelled internationally “yesterday” (which would have been February 9th if the video was uploaded the day of the lecture) and didn’t wear a mask. He said he saw people wearing masks with their noses out or with masks around their neck (implying it wouldn’t be effective to tell people to wear masks?) and also that it’s uncomfortable to wear an N95 for too long, so he wouldn’t recommend the general public to wear a mask unless sick (in which case “maybe” they should wear a surgical mask).
I think his prediction and advice should probably be judged negatively and reflect poorly on him / Center for Health Security, but I’m not sure how harshly he/ CHS should be judged.
Edit: Also, at 42:10 he said “I do think that it’s not containable in any country, it just appears to be so now.” I think this was also wrong, since clearly some countries have managed to avoid major outbreaks.
This seems totally okay to me, FWIW. In most places (e.g., London or the US), it would have seemed a bit overly cautious to wear masks before the end of February, no?
I generally agree with that, but it’s worth noting that it was extremely common for Western epidemiologists to repeat the mantra “you cannot do what Asian countries are doing; there’s no way to contain the virus.”
It’s actually worse than that. As I discovered when researching COVID giving opportunities for the FRAPPE donor group last year, Johns Hopkins experts explicitly recommended against wearing DIY masks in early March (a position reversed by the end of the month) and were not discouraging people from pressing ahead with travel plans as late as March 6. Sanjay had a phone call with them about a year ago in which he confronted them about these reversals, and they offered a sort of half-hearted defense.
I don’t have any inside information about why CHS made the choices it did, but my naive view is that I agree with your comment that mistakes like these should reflect poorly on CHS. CHS’s core competency may be more in the area of pandemic preparedness than dealing with the pandemic once it’s already here, but their experts were quoted in the media a TON last spring and had significant ability (= responsibility) to shape the public conversation about COVID, particularly in the US. And yet lots and lots of people far less credentialed than CHS epidemiologists had correctly figured out by the first week of March that it was smart to wear a mask and to avoid being around others more than was absolutely necessary. It was left to pop-up initiatives led by non-medical experts like #Masks4All to upend the conventional wisdom about masks that had been propagated by the WHO and CDC. I feel like CHS ought to have been well positioned to challenge the prevailing narrative and was instead getting in the way at a time when it really mattered.
“And yet lots and lots of people far less credentialed than CHS epidemiologists had correctly figured out by the first week of March that it was smart to wear a mask”
Not sure how much this is an answer—as I said in a different response, the question isn’t whether CHS was right (much less right about one specific thing,) but whether they did better overall than the other policy-influencing organizations.
Fwiw, my vague memory is that some other people at CHS, including Tom Inglesby (the director) did better than Adalja. I think Inglesby’s Twitter was generally pretty sensible though I don’t have time to go back and check. I’d guess that, like most experts, he was too pessimistic about travel restrictions, though. Maybe masks, too?
I do think CHS should get some credit for arguing for taking pandemic response very seriously early on. For example, I think Tom had some tweets arguing for pulling out all the stops on manufacturing more PPE in January 2020.
Note—I’m a bit biased since I was working on biorisk at Open Phil the first time Open Phil funded CHS.
I think the key question for CHS, or even Amesh specifically, is whether they outperformed other organizations, and by how much—i.e. were investments in CHS positive contributions to response overall. And they / he could have done almost arbitrarily bad in February, and still overall have vastly outperformed the alternatives.
And I think that it’s clear that CHS’s work was impactful in increasing preparedness in the US, even if the level of preparedness was far short of what was needed.
(Note that I have personal biases about this, and know many of the people at CHS.)
To be fair, the Johns Hopkins Center isn’t just Adalja. I’m not aware of the list of things they do, but for instance, they kept an updated database in the early stage of the virus outbreak that was extremely helpful for forecasting!
If you’re referring to what I think you are, it was a different group at Hopkins
Oh, you’re probably right then!
In case anybody’s curious: https://coronavirus.jhu.edu/map.html
Adalja also confidently predicted the infection fatality rate for the rest of 2020 to be around 0.6% (on the Sam Harris podcast) despite thinking the virus can’t be contained (if true, this would have led to more ICU beds and oxygen shortages in lots of places). In reality, the IFR was more like 0.9% or higher for countries like the US and UK. Probably it was lower for countries with younger demographics, but I don’t even think Adelja was basing his estimates on that.
(TBC, this isn’t as big a mistake compared to other statements or compared to Ioannidis who completely disgraced himself throughout 2020 and ongoing, but I find it worth pointing out because I remember distinctly that, at the time when Adalja said this, there was a lot of fairly strong evidence for higher IFRs, including published estimates. I thought 0.6% seemed [edit]hard to defend, though I don’t remember how much he flagged that there’s a substantial chance it’s significantly higher. Importantly, it would have been higher than it actually turned out to be, if Adalja had been right about “the virus can’t be contained.”)
Was the prediction for infection fatality rate (IFR) or case fatality rate (CFR)? And high-income or all countries? Globally, the CFR is 2% (3.7M/173M), but the IFR is <0.66%, because <1/3 of cases were detected.
IFR (but back in February/March 2020, a lot of people called everything “CFR”). I think he was talking about high-income countries (that’s what my 0.9% estimate for 2020 referred to – note that it’s lower for 2020+2021 combined because of better treatment and vaccines). I’d have to look it up again, but I doubt that Adalja was talking about a global IFR that includes countries with much younger demographics than the US. It could be that he left it ambiguous.
Here’s the Sam Harris podcast in question; I haven’t re-listened to it yet.
Seems unlikely that <1/3 of all cases were detected at this point, since the recent outbreaks had far higher detection rates than the initial ones.
Ah. If global IFR is worse than rich-countries’ IFR, that seems to imply that developing countries had lower survival rates, despite their more favourable demographics, which would be sad.
It’s still unclear, and the developing world detection and survival rates are a bit uncertain. I think you could probably get a decent approximation by looking at test positivity rates and testing volume compared to death rates over time in different countries, but I’m not going to put together the model to do it.
We’re doing something related with IFR estimates by age at 1DaySooner, but using seroprevalence data, i.e. only where there is really good data for the estimate. I don’t have results of that yet.
This isn’t impossible because there seems to be a correlation where people with lower socioeconomic status have worse Covid outcomes, but I still doubt that the IFR was worse overall in developing countries. The demographics (esp. the proportion of people age 70-80, and older) make a huge difference.
But I never looked into this in detail, and my impression was also that for a long time at least, there wasn’t any reliable data.
From excess deaths in some locations, such as Guayaquil (Ecuador), one could rule out the possibility that the IFR in developing countries was incredibly low (it would have been at least 0.3% given plausible assumptions about the outbreak there, and possibly a lot higher).