The Washigtnon Post - 03.04.2020

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friday, april 3 , 2020. the washington post eZ M2 A


the coronavirus pandemic


BY WILLIAM WAN,
JOSH DAWSEY,
ASHLEY PARKER
AND JOEL ACHENBACH

Leading disease forecasters,
whose research the White House
used to conclude 100,000 to
240,000 people will die nation-
wide from the coronavirus, were
mystified when they saw the ad-
ministration’s projection this
week.
The experts said they don’t c hal-
lenge the numbers’ validity but
said they don’t know how the
White House arrived at them.
White House officials have re-
fused to explain how they generat-
ed the figure — a death toll bigger
than the United States suffered in
the Vietnam War or the 9 /11 terror-
ist attacks. T hey have not p rovided
the underlying data so others can
assess its reliability or provided
long-term strategies to lower that
death count.
Some of President Trump’s top
advisers have expressed doubts
about the estimate, according to
three White House officials who
spoke on the c ondition o f anonym-
ity because they were not autho-
rized to speak publicly. There have
been fierce debates inside the
White House about its accuracy.
At a task force meeting this
week, according to two officials
with direct knowledge of it, Antho-
ny S. Fauci, director of the National
Institute of Allergy and Infectious
Diseases, told others there are too
many variables at play in the pan-
demic to make the models reliable:
“I’ve looked at all the models. I’ve
spent a lot of time on the models.
They don’t tell you anything. You
can’t really rely upon models.”
Robert Redfield, director of the
Centers for Disease Control and
Prevention, and the vice presi-
dent’s office have similarly voiced
doubts about the projections’ ac-
curacy, the three officials said.
Jeffrey Shaman, a Columbia
University epidemiologist whose
models were cited by the White
House, said his own work on the
pandemic doesn’t go far enough
into the future to make predic-
tions akin to the White House
fatality forecast.
“We don’t have a sense of what’s
going on in the here and now, and
we don’t k now what people will do
in the future,” he said. “We don’t
know if the virus is seasonal, as
well.”
The estimate appeared to be a
rushed affair, s aid Marc Lipsitch, a
leading epidemiologist and direc-
tor of Harvard University’s Center
for Communicable Disease Dy-
namics. “They contacted us, I
think, on a Tuesday a week ago,
and asked for answers and feed-
back by Thursday, basically 24
hours,” he said. “My initial re-
sponse was we can’t do it that fast.
But we ended up providing them
some numbers responding to very
specific scenarios.”
Other experts noted that the
White House didn’t even explain
the time p eriod the death estimate
supposedly captures — just the
coming few months, or the year-
plus it will take to deploy a vaccine.
Almost the entirety of what the
public knows about the death pro-
jection was presented on a single
slide a t a briefing Tuesday from the
White House coronavirus task
fo rce. A White House representa-
tive said the task force has not
publicly released the models it
drew from out of respect for the
confidentiality of the modelers,
many of whom approached the
White House unsolicited and sim-
ply want to continue their work
without publicity.
A representative for Fauci did
not respond to a request for com-
ment. A spokeswoman for Vice


President Pence declined to com-
ment. On a Thursday call with
conservative leaders, Pence said it
was “difficult” t o view the models
but “the president thought it was
important to share with the Amer-
ican people.”
Among epidemiologists, the es-
timate raised m ore questions than
it answered — not just about meth-
odology and accuracy but about
purpose.
The primary goal of such mod-
els amid an outbreak is to allow
authorities to game out scenarios,
foresee challenges and create a
coherent, long-term strategy —
something some experts worry
doesn’t exist within the White
House.
“I wish there were more of a
concerted national plan. I wish it
had started a month and a half a go,
maybe two months ago,” Shaman
said.
Natalie Dean, a biostatistician
who was not involved in the White
House effort but is working on
coronavirus vaccine evaluation
with the World Health Organiza-
tion, pointed out that “the whole
reason you create models i s to help
you make decisions. But you have
to actually act on those projections
and answers.”

The president’s models
At Tuesday’s briefing, Trump
unveiled the government’s pro-
jected death count, saying it was
based on data “that has been, I
think, brilliantly put together.”
The coordinator of Trump’s cor-
onavirus task force, Deborah Birx,
projected a slide with a high-arc-
ing mountain showing the worst-
case scenario: 1 .5 million to
2.2 million deaths if Americans
and the government did n othing
to stop the virus. A nd a smaller hill
with 100,000 to 240,000 deaths if
measures such as social distancing
are taken.
Birx said the projection was
based on five or six modelers, in-
cluding from Imperial College in

Britain and Harvard, Columbia
and Northeastern universities. “It
was their models that created the
ability to see what these mitiga-
tions could do, how steeply they
could depress the curve,” Birx s aid.
But two models appeared to
have been particularly influential:
the one by Imperial College and
one from the Institute for Health
Metrics and Evaluation at Univer-
sity of Washington (IHME).
At a news briefing Sunday, Birx
explained the process: Her task
force i nitially reviewed the w ork of
12 models. “Then we went back to
the drawing board over the last
week or two, and worked from the
ground up, utilizing actual report-
ing of cases,” Birx said. “It’s the way
we built the HIV model, the TB
model, the malaria model. And
when we finished, the other group
that was working in parallel —
which we didn’t know about,” re-
ferring to the IHME group.
The IHME model said that esti-
mated deaths through this sum-
mer would total 38,000 to 162,
— a lower projection than many
others and beneath the White
House’s o wn estimate. But because
of its lower figure and Birx’s com-
ments, experts believe it to be a
main source for the White House’s
best-case scenario of 100,000 to
240,000 deaths.
The White House appeared to
rely on Imperial College for its
worst-case scenario. That study
estimated as many as 2.2 million
U.S. deaths if no action was taken,
1.1 million deaths if moderate miti-
gation strategies were adopted,
and an unspecified number if
drastic measures were taken.
But as the s tatistician’s refrain
goes: A model is only a s good as the
assumptions it is built on.

Baked-in assumptions
Knowing the assumptions built
into the White H ouse officials’ p ro-
jected number could tell us a lot:
exactly how c ontagious and deadly
they believe the virus to be. It also

would reflect their beliefs on how
the federal government and states
will behave in coming months and
whether they will do enough to
make a difference.
The IHME model assumes ev-
ery state will quickly impose stay-
at-home orders, which some
states, including Alabama and
Missouri, have yet to do. It also
assumes the country will maintain
these restrictions until summer.
But Trump has extended the White
House’s restrictions until only
April 30 and made clear he wants
to reopen the country as soon as
possible.
Another key question is what
time period the White House’s
100,000-to-240,000 projection
covers. Imperial College’s worst-
case scenario calculated the toll
exacted by the virus over a couple
of years. But if the White House’s
projection covers o nly the n ext few
months, like the IHME model
does, t he true death toll will almost
certainly be larger because Ameri-
ca will probably see additional
waves of covid-19 until a vaccine is
deployed.
And it is important to note,
experts say, that the IHME model
differs from most epidemiological
models — another reason its d eath
estimate is lower.
Epidemiological projections
are often based on the Susceptible
Infectious Recovered model (SIR).
It is a mathematical way to repre-
sent three different populations in
an outbreak: those vulnerable to
infection, t hose who are infectious
and those g radually removed from
the equation by death or recovery.
IHME, h owever, took a different
approach. It is a statistical model
that takes the trending curve of
deaths from China, for example,
and “fits” that curve to emerging
death data from cities and coun-
ties to predict what might come
next.
“It’s a valuable tool, providing
updated state-by-state projec-
tions, but it is inherently optimis-

tic because it assumes that all
states respond as swiftly as China,”
said Dean, a biostatistician at Uni-
versity of Florida.
In an interview earlier this
week, the head o f the IHME group,
Christopher Murray, said his mod-
el was created for a different pur-
pose from Imperial College’s.
“The reason we created our
model is to help hospitals plan.
How many beds you’ll need, how
many ventilators, when the peak is
likely coming,” Murray said. The
purpose of Imperial’s model “is to
make people realize government
intervention is crucial and what
would happen without that.”

An audience of one
For the past decade, the federal
government has been nurturing a
group of about 50 epidemiologists
and math modelers at u niversities.
The U.S. government launched the
effort when it became apparent
that U.S. expertise in disease mod-
eling was outstripped by
E ngland’s world-class experts,
said Dylan George, a former
Obama administration official at
the White House Office of Science
and Te chnology Policy who was
involved in that effort.
Since January, the CDC has
been working with that larger
group of m odeling teams b ut it has
been unclear, especially in recent
weeks, how much the White
House was listening to their data.
The handful of projections the
task force has plucked from the
group and used in White House
discussions, administration offi-
cials s aid, are s ometimes deployed
with an audience of one in mind:
Trump.
Officials have said the Imperial
College’s eye-popping 2.2 million
death projection convinced
Trump to stop dismissing the out-
break and take it more seriously.
Similarly, officials said, the new
projection of 100,000 to 240,
deaths i s what convinced Trump to
extend restrictions for 30 days and

abandon his push to reopen parts
of the United States by Easter,
which m any health experts believe
could have worsened the out-
break.
But what remains unclear and
alarming to many modelers is
whether the White House is using
their data to create a coordinated,
coherent long-term strategy.

What’s the plan?
Such a national strategy is criti-
cal because of the lag time in data
that comes with outbreaks.
Any numbers today — con-
firmed cases, hospitalizations and
deaths — lag two to three weeks
behind how the virus is spreading.
So decisions made by authorities
based on that present-day data are,
almost by definition, reactive and
potentially come too late.
To get ahead of a virus like this
one, authorities must use projec-
tions of the future to act in the
present.
A White House official who
spoke on the c ondition o f anonym-
ity because the official was not
authorized to speak publicly said
the administration has long-term
plans and has been addressing
those concerns in the b riefings.
“Repurposing a [car] plant to
make ventilators is great, but hon-
estly — I’m n ot one to cast stones —
but it could have been done earli-
er,” said Shaman, the Columbia
University epidemiologist whose
models have been reviewed by the
White House.
But Shaman doesn’t think the
White House’s death projection is
too low, nor does he think it’s too
late to act decisively.
“I think we can come in under
100,000 deaths. I do,” he said.
“The jury is not yet in on this.”
william.wan@washpost.com
josh.dawsey@washpost.com
ashley.parker@washpost.com
joel.achenbach@washpost.com

Lena h. sun contributed to this
report.

Some Trump advisers doubt White House’s dire estimates of virus deaths


Jabin botsford/the Washington Post
President T rump and members of the coronavirus task force during a briefing Tuesday, during which the president said 100,000 to 24 0,000 Americans could die of the virus.

BY DAN LAMOTHE
MISSY RYAN
AND PAUL SONNE

The Navy on Thursday r emoved
the captain of an aircraft carrier
crippled by the coronavirus, two
days after a blunt letter the officer
wrote warning the service of the
need to get more sailors off the
vessel created a furor.
Navy Capt. Brett Crozier, the
commanding officer of the USS
Theodore Roosevelt, was relieved
of command at the direction of
acting Navy secretary Thomas
Modly.
The Navy had become increas-
ingly convinced that Crozier was
involved in leaking t he letter t o the
news media to force the service to
address his concerns over the out-
break on his ship, a defense official
said, speaking on the condition of
anonymity because of t he s ensitiv-
ity of the issue.
Modly said that C rozier showed
“poor judgment” by sending the
letter by email to 20 or 30 people.


He did not directly accuse Crozier
of leaking t he letter b ut noted that
it appeared i n Crozier’s h ometown
newspaper.
“I could reach no other conclu-
sion than that Capt. Crozier had
allowed the complexity of his chal-
lenge with the covid breakout on
his ship to overwhelm his ability
to act professionally, when acting
professionally was w hat was n eed-
ed most at t he time,” Modly said at
the Pentagon. “We do and we
should expect m ore from the com-
manding officers of our aircraft
carriers.”
Modly added a few minutes lat-
er that he did not mean to insinu-
ate that he knew Crozier leaked
the l etter and b elieved t he captain
“did what he thought was in the
best interest of the safety and the
well-being o f his crew.”
But Modly said the letter, first
reported by the San Francisco
Chronicle on Tuesday, under-
mined more senior Navy leaders
and could have emboldened ad-
versaries of the United States in

the Pacific region. Modly said that
Crozier had been told that he
could communicate directly with
Modly’s o ffice.
“It creates a panic, a nd it creates
the perception that t he N avy is not
on the job, the government’s not
on the job, and it’s just not true,”
Modly said.
Modly said the decision to re-
move Crozier was his, and that he
received no pressure from the
White House on the issue. He said
that he notified Defense Secretary
Mark T. Esper of his plan on
Wednesday afternoon and that E s-
per indicated he would support
him.
The Navy’s t op officer, A dm. Mi-
chael Gilday, stood alongside the
acting secretary as he made the
announcement. Gilday said h e has
called for an investigation across
all naval forces in the Pacific to
examine the i ssue.
Crozier, who has not responded
to requests for comment, sent the
letter dated Monday decrying the
pace at which the service was re-

moving sailors from the ship in
Guam amid a coronavirus out-
break. Crozier asked that 90 per-
cent of the crew, comprising more
than 4,800 sailors, be removed to
allow for testing, quarantining
and disinfecting o f the ship.
“Decisive action i s required. Re-
moving the majority of personnel
from a deployed U.S. nuclear air-
craft carrier a nd isolating them for
two weeks may seem like an ex-
traordinary measure,” he wrote.
“We are not at war. Sailors do not
need to die. If we do not act now,
we are failing to properly take c are
of our most trusted asset — our
sailors.”
Modly said that Crozier created
some panic by suggesting that
sailors could die. All of the sailors
who have tested positive so far
have had either moderate or mild
flu symptoms, or no symptoms at
all, Modly s aid.
Some 113 members of the crew
had t ested positive as o f Thursday,
Modly said, predicting that “hun-
dreds” u ltimately could. B y far, it is

the U.S. military’s largest corona-
virus outbreak to date in the pan-
demic.
The captain will soon be re-
placed by the ship’s former com-
manding officer, Capt. Carlos Sar-
diello, who already has been select-
ed for promotion to rear admiral.
Family members of sailors
aboard the Theodore Roosevelt
had expressed growing concern
before the letter’s p ublication that
the N avy was moving t oo slowly i n
getting sailors o ff t he ship.
The mother of a sailor who test-
ed positive for the virus and was
evacuated from the ship said she
and most commenters in closed
Facebook groups for family mem-
bers of t he crew b acked Crozier.
“My husband and I are still
grateful that he a sked for help, and
said that what was going on w asn’t
adequate. In our eyes, he saved I
don’t know how many people on
his ship,” t he mother said, speak-
ing on the condition o f anonymity
to avoid identifying her child.
Modly’s decision, first reported

by Reuters, comes one day after
Modly said t hat there w as nothing
wrong with Crozier’s writing the
letter but that leaking it to the
media “would be something that
would violate the principles of
good o rder a nd discipline.”
“How it got out i nto the media I
don’t know,” Modly said. “I don’t
think anyone w ould ever k now.”
Gilday and Modly both said
Wednesday that they encouraged
commanders to continue raising
their concerns. About 1,000 sail-
ors must remain on the ship at all
times to man weapons, nuclear
reactors and other sensitive
equipment, and s ome 2 ,700 would
be off the ship for testing and
quarantining within days, the
Navy said.
“We’re not looking to shoot the
messenger here,” Gilday had said
of Crozier on Wednesday.
dan.lamothe@washpost.com
missy.ryan@washpost.com
paul.sonne@washpost.com

Julie tate contributed to this report.

Carrier captain who highlighted outbreak on ship is relieved of command

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