The Washigtnon Post - 03.04.2020

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.”

[email protected]

[email protected]

[email protected]

[email protected]

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.

[email protected]

[email protected]

[email protected]

Julie tate contributed to this report.

Carrier captain who highlighted outbreak on ship is relieved of command