What did we learn from COVID-19 models?

By Sibel Eker, researcher in the IIASA Energy Program

IIASA researcher Sibel Eker explores the usefulness and reliability of COVID-19 models for informing decision making about the extent of the epidemic and the healthcare problem.

© zack Ng 99 | Dreamstime.com

In the early days of the COVID-19 pandemic, when facts were uncertain, decisions were urgent, and stakes were very high, both the public and policymakers turned not to oracles, but to mathematical modelers to ask how many people could be infected and how the pandemic would evolve. The response was a plethora of hypothetical models shared on online platforms and numerous better calibrated scientific models published in online repositories. A few such models were announced to support governments’ decision-making processes in countries like Austria, the UK, and the US.

With this announcement, a heated debate began about the accuracy of model projections and their reliability. In the UK, for instance, the model developed by the MRC Centre for Global Infectious Disease Analysis at Imperial College London projected around 500,000 and 20,000 deaths without and with strict measures, respectively. These different policy scenarios were misinterpreted by the media as a drastic variation in the model assumptions, and hence a lack of reliability. In the US, projections of the model developed by the University of Washington’s Institute for Health Metrics and Evaluation (IHME) changed as new data were fed into the model, sparking further debate about the accuracy thereof.

This discussion about the accuracy and reliability of COVID-19 models led me to rethink model validity and validation. In a previous study, my colleagues and I showed that, based on a vast scientific literature on model validation and practitioners’ views, validity often equates with how good a model represents the reality, which is often measured by how accurately the model replicates the observed data. However, representativeness does not always imply the usefulness of a model. A commentary following that study emphasized the tradeoff between representativeness and the propagation error caused by it, thereby cautioning against an exaggerated focus on extending model boundaries and creating a modeling hubris.

Following these previous studies, in my latest commentary in Humanities and Social Sciences Communications, I briefly reviewed the COVID-19 models used in public policymaking in Austria, the UK, and the US in terms of how they capture the complexity of reality, how they report their validation, and how they communicate their assumptions and uncertainties. I concluded that the three models are undeniably useful for informing the public and policy debate about the extent of the epidemic and the healthcare problem. They serve the purpose of synthesizing the best available knowledge and data, and they provide a testbed for altering our assumptions and creating a variety of “what-if” scenarios. However, they cannot be seen as accurate prediction tools, not only because no model is able to do this, but also because these models lacked thorough formal validation according to their reports in late March. While it may be true that media misinterpretation triggered the debate about accuracy, there are expressions of overconfidence in the reporting of these models, even though the communication of uncertainties and assumptions are not fully clear.

© Jaka Vukotič | Dreamstime.com

© Jaka Vukotič | Dreamstime.com

The uncertainty and urgency associated with pandemic decision-making is familiar to many policymaking situations from climate change mitigation to sustainable resource management. Therefore, the lessons learned from the use of COVID models can resonate in other disciplines. Post-crisis research can analyze the usefulness of these models in the discourse and decision making so that we can better prepare for the next outbreak and we can better utilize policy models in any situation. Until then, we should take the prediction claims of any model with caution, focus on the scenario analysis capability of models, and remind ourselves one more time that a model is a representation of reality, not the reality itself, like René Magritte notes that his perfectly curved and brightly polished pipe is not a pipe.

References

Eker S (2020). Validity and usefulness of COVID-19 models. Humanities and Social Sciences Communications 7 (1) [pure.iiasa.ac.at/16614]

Note: This article gives the views of the author, and not the position of the Nexus blog, nor of the International Institute for Applied Systems Analysis.

COVID19 – Let’s Not Forget the Humans

By Nicole Arbour, external relations manager in the IIASA Communications and External Relations department

As Canadian expats in Austria, one of the things that has particularly struck my family and I is the orderliness with which the country is dealing with the pandemic. As quarantine policies were put into place, we saw panic toilet paper hoarding in other countries, but here in Austria people were (amazingly) compliant and seemed to obey instructions and timelines provided by the authorities. We never worried about our basic needs.  Grocery stores were always well stocked, public transit was always there and on time – and masks were readily available when required as physical barrier to protect others.

© Luca Santilli | Dreamstime.com

Expert opinions, governments, and publics are making it clear that there is no one-size-fits-all solution to this pandemic.  What works in Austria might not be what worked for South Korea; and likely not the same as what works in other parts of Europe.  Consider the Canadian landscape.  There is huge variation in sociopolitical and cultural dynamics between and within provinces and territories.  What works for some parts of Canada (virtual home schooling, grocery shopping) is impossible for others (Canada’s North).  Cultural norms (multigenerational living, child/elder care) vary across the vast landscape. The “At Home on the Land” initiative – aimed at the particular needs of Indigenous communities is an example of a culturally-grounded way to address the pandemic. Finding solutions isn’t always as intuitive as we might like.

Humans tend to look for the easiest way out – we want simple solutions to complex problems.  We don’t seem to want to think about the problems, we want them magically disappear. And thinking “outside of the box” isn’t always appreciated.  Hand washing, clean water and the advent of antibiotics have made enormous leaps in our ability to tackle public health outbreaks – significant results. Where the bubonic plague is estimated to have killed 30%-60% of Europe’s population in the Middle Ages, modern outbreaks are now quickly identified and contained (were you even aware of the 2017 outbreak in Madagascar?). Understanding transmission routes has significantly impacted public health outcomes.  The identification of tainted water as a vector for cholera transmission by John Snow led to the advent of modern epidemiology. But, as we find solutions to larger challenges, those that remain are more complex with increasing numbers of variables making solutions harder to come by.

There is some global agreement: lots of testing, quick results/containment, use of masks/physical barriers for community protection, social distancing, data collection. However, certain measures work better in some jurisdictions than others. What policies and practices are working and why are they working in these contexts?  What is applicable in different contexts?

Our current global situation, has reminded me of a presentation I saw on the 2014 Ebola outbreak (Professor Melissa Leach, IDS), and how important it is to remember the human factor in crises. She discussed how the key elements that made the Ebola pandemic so persistent – despite the best efforts of global public health engagement – was a/the failure to understand how historic context, trust, cultural dynamics played into the spread of the virus. Those providing interventions did not appreciate how historic context (i.e. post-colonialism, slavery, medical testing scandals) and mistrust in the intentions of Western interventions factored into the willingness of the local population to accept the solutions provided. Awareness of social structures, influencers and leaders, and co-creation were also important to developing solutions that would be adopted by affected communities.

Evidence is more than the numbers of tests, infections and deaths. It is understanding the social context of communities, society writ large, and how they interact within and between.  It’s about understanding historical context and how it feeds into local culture, social interactions and trust relationships.  It’s about community dynamics, power struggles and the struggle for some to meet basic survival needs.  It’s about timing of decision-making, political landscapes and different ways of leading.  As with many of our global challenges, it’s a complex and multifaceted systems problem – in which the human factor is a huge driver.

As we strive for solutions to this global crisis – bring on innovation, research and science funding. We will need these – but please, also bring along those who study the complexity that is humanity: epidemiologists, anthropologists, economists, ethicists, political scientists, sociologists, futurists, etc. In an era where evidence is being questioned, fake news is rampant and anti-science sentiments are strong, it is crucial that we remember that one piece to engaging with this and the world’s other wicked problems is our relationships with our communities – the ones we are trying to protect. Public trust, built on understanding of the importance of human dynamics is key to broad acceptance and uptake. Solutions need to be palatable to society, or they won’t be adopted.

As we focus on the virus, let’s not forget the humans.

Note: This article gives the views of the author, and not the position of the Nexus blog, nor of the International Institute for Applied Systems Analysis. Link to original post: https://sciencepolicy.ca/news/save-covid19-lets-not-forget-humans

The Cercedilla Manifesto: Advocating for more environmentally and socially sustainable research meetings

By Raquel Guimaraes, postdoc in the IIASA World Population Program, and Debbora Leip, an alumnus of the IIASA Advanced Systems Analysis Program

IIASA researcher Raquel Guimaraes and former research assistant Debbora Leip encourage the support of the Cercedilla Manifesto, arguing that it is high time for the scientific community to take responsibility and set an example by making research meetings more sustainable.

© La Fabrika Pixel S.l. | Dreamstime.com

The research community widely agrees that strong action is needed to counteract the climate crisis that is currently taking place. Nevertheless, scientists regularly meet at conferences that are often far from sustainable. Problems range from participants flying to attend events, to unnecessary gadgets and gifts handed out at the meetings, and unsustainable catering at conference dinners. In light of the current public debate on environmental and social sustainability, we call on scientists to take a leading role in changing their work practices towards more sustainable habits, starting with research meetings.

In April 2020, Alberto Sanz-Cobena and several colleagues published an article titled Research meetings must be more sustainable in Nature Foods. They presented the Cercedilla Manifesto with 12 sustainability decisions as guidelines for organizers and attendees of research meetings (see Figure 1). The starting point of the manifesto is to question whether a physical meeting is indeed necessary. If organizers decide that it is, there is still the question of whether each single attendee really needs to physically join the conference. Often, remote participation can be equally efficient if a technical solution is provided by the organizers. Furthermore, if a decision to conduct a physical meeting is taken, organizers have to consider what food will be served.

The authors state that excessive amounts of food and food waste are very common at meetings, which makes a change of mindset towards better food management very important, not only for climate change, but for many other environmental threats. In our opinion, this point has so far been neglected in public debate.

Figure 1: Twelve points to enhance the sustainability of research meetings as proposed by the Cercedilla Manifesto (Sanz-Cobena et al., 2020), which is based on a co-creative approach to the production, provision, and consumption of food and services at scientific meetings, and is inspired by Sustainable Development Goal 12 (See also: https://www.openpetition.eu/petition/online/cercedilla-manifesto-research-meetings-must-be-more-sustainable)

Given the urgency for climate change action and the need for individuals to play an active role – with research scientists taking the lead – we assert that it is urgent to start changing our habits and setting an example regarding environmental and social sustainability in research meetings. Indeed, many of us take it for granted that to meet and discuss our work, we must travel. Most attendees do not even question that unnecessary gadgets and gifts are distributed or that opulent dinners are provided.

We hope that the Cercedilla Manifesto will raise awareness about the fact that good scientific output often does not require a physical meeting by providing a conceptual framework for change in this regard. If we support the manifesto, we stand a chance to lower the barrier to dare deviating from currently applied practices. The 12-sustainability decisions were designed by specialists to serve as a reference for anybody who wishes to organize/attend a sustainable meeting.

In the current situation brought about by the global COVID-19 crisis, almost everybody has experienced that remote conferences are not only possible, but also efficient – sometimes even more so than a physical meeting would have been. First, it saves time in terms of travel. Second, it may be more inclusive by allowing people to attend, who would not have had the opportunity to join otherwise, be it for financial, family, or other reasons. In addition, remote meetings provide additional features, like a chat function that could add another discussion layer.

Of course, remote meetings also have their limitations: informal in-person meetings during coffee breaks, for example, can enhance networking and free discussions, and sometimes contribute significantly to a meeting’s outcome. Virtual meetings also face several other challenges, such as participation by attendees from different time zones, or poor internet connections. These issues could however easily be addressed by spreading the meeting over more days, in such a way that the need for attendance outside of acceptable time slots is minimized, and by investing saved traveling costs into better equipment.

Let us learn from this experience and not go ‘back to normal’ after the COVID-19 crisis. We should take this as an opportunity to speed up change and tackle the other global crisis of climate change!

You can find the petition at openpetition.eu/!cercedillamanifesto. We encourage you to share and support this initiative.

References:

Sanz-Cobena A, Alessandrini R, Bodirsky BL, Springmann M, Aguilera E, Amon B, Bartolini F, Geupel M, et al. (2020). Research meetings must be more sustainable. Nature Food 1, 187–189.  DOI: 10.1038/s43016-020-0065-2

Frisch B, & Greene C (2020). What it takes to run a great virtual meeting. Harvard Business Review. https://hbr.org/2020/03/what-it-takes-to-run-a-great-virtual-meeting?ab=hero-subleft-3

Note: This article gives the views of the author, and not the position of the Nexus blog, nor of the International Institute for Applied Systems Analysis.

Reducing COVID-19 vulnerability in Latin America and the Caribbean

By Raquel Guimaraes, postdoc in the IIASA World Population Program

IIASA postdoc Raquel Guimaraes writes about efforts by the scientific community to encourage governments in Latin America and the Caribbean to increase COVID-19 test coverage to reduce vulnerability.

© Kukhunthod | Dreamstime.com

Together with a group of demographers from Latin America and the Caribbean (LAC), and endorsed by more than 250 individuals from the academic community, I contributed to a statement urging governments, the World Health Organization, and the Pan American Health Organization, to take immediate action to drastically increase the coverage of COVID-19 tests in the region. This call for action was disseminated by the British Society for Population Studies, Asociación Latino Americana de Población, Sociedad Mexicana de Demografía, Associação Brasileira de Estudos Populacionais, and the Population Association of America, among other important institutions.

I joined this initiative by invitation from Dr. Enrique Acosta and other colleagues, because I firmly believe that the prospects for the COVID-19 pandemic in the LAC region are rather dramatic. Several studies document that, apart from being globally recognized for its high levels of economic and social inequality, the region also suffers from institutional coordination failures and poor governance, a lack of appropriate resources, and presents a unique epidemiological and demographic profile of its population that escalates the negative prospects of the pandemic. I wanted to explore in more detail why these features of LAC are a source of major concern and require immediate action.

Social and economic inequality in LAC will hamper the enforcement of social distancing and isolation measures, which have proven to mitigate the COVID-19 epidemic in other settings. More than half of the population is in the informal labour market and does not have access to social safety nets. For those covered by the social security system, the benefits already proposed by a few governments of the region such as Brazil, fall short of the daily needs of families. In addition to economic inequality, social inequality, which leads to a high degree of cohabitation between adults and the elderly, increases the exposure of those with the highest risk of complications and death.

In addition, with the closure of schools, children who do not have access to day-care centres and the public- or private education system, often rely on the help of their grandparents, which again brings greater vulnerability to families. Not to mention that these children won’t have ensured their learning opportunities, because their parents are often working and not able to home-school them, thus compromising their education outcomes.

Moreover, LAC is facing a rapid demographic transition and aging process, which is temporarily increasing the prevalence of a young population, meaning that the population age-structure of potential infected individuals differs from that of other settings. However, unlike the more developed countries, LAC’s epidemiologic transition, that is, the transition in which the prevalence of infectious diseases is “substituted” by chronic and degenerative diseases, is not complete. Paradoxically, the region exhibits both the prevalence of diseases that have long been eradicated in more developed contexts (such as malaria, dengue, and tuberculosis) and diseases of richer countries (such as hypertension, diabetes, and neoplasms).

On top of all the above-mentioned vulnerabilities, crisis-management efforts in the region are uncoordinated, and lacking transparency and commitment. Taking Brazil as an example: while some mayors and governors adopt measures of social isolation and prevention against COVID-19, parts of the federal executive power not only disdain the problem, but encourages the population not to meet the requirements established by the Ministry of Health. Such conflicting rules are bound to cause misunderstandings among the LAC population. The COVID-19 pandemic is a crucial moment for institutional coordination to ensure the effective management of the crisis.

As an important and urgent call to action for the pandemic in the region, myself and other LAC researchers are calling for an increase in test coverage and measures of social isolation. As reported in the non-specialized media under the slogan “help to flatten the curve”, social isolation allows the rate of contagion of the virus to be reduced, in order to prevent overloading the capacity of the health system. Existing literature documents that while the virus does not cause major damage to health for the majority of infected persons, it brings a high cost to the health system. Furthermore, the impacts on the later lives of individuals who were hospitalized due to the disease are not yet known. Not to mention, of course, the human tragedy and the costs in terms of lives lost to the disease.

Finally, imperative and immediate action against COVID-19 in LAC will depend on the widespread and low-cost application of tests. This is required because the former rigorous isolation measures mentioned above are highly ineffective if not accompanied by aggressive strategies to detect cases of COVID-19. This highlights the relevance of data collection to better inform policymakers and provide researchers with clear diagnoses of the conditions in the region.

References:

Deaton A (2013). Cap. 3. Escaping death in the Tropics. In The Great Escape: Health, Wealth, and the Origins of Inequality. Princeton University Press.

Hoffman K, & Centeno MA (2003). The Lopsided Continent: Inequality in Latin America. Annual Review of Sociology, 29(1), 363–390. https://doi.org/10.1146/annurev.soc.29.010202.100141

Khemani S, Ferraz C, Finan FS, Johnson S, Louise C, Abrahams SD, Odugbemi AM, Dal Bó E, & Thapa D (2016). Making politics work for development: Harnessing transparency and citizen engagement (Policy Research Report). The World Bank. http://documents.worldbank.org/curated/en/268021467831470443/Making-politics-work-for-development-harnessing-transparency-and-citizen-engagement

Pérez CC, & Hernández AL (2007). Latin–American public financial reporting: Recent and future development. Public Administration and Development, 27(2), 139–157. https://doi.org/10.1002/pad.441

Note: This article gives the views of the author, and not the position of the Nexus blog, nor of the International Institute for Applied Systems Analysis

Explaining the COVID-19 outbreak and mitigation measures

Raya Muttarak, Deputy Program Director, IIASA World Population Program

Raya Muttarak writes about what we have learnt about the COVID-19 outbreak so far, and how collective mitigation measures could influence the spread of the disease.

© Konstantinos A | Dreamstime.com

Since the outbreak of COVID-19 in Wuhan, China back in January, we have learnt a lot about the virus: we know how to detect the symptoms, and a vaccination is currently being developed. However, there are still many uncertainties:

We for example don’t know enough about the disease’s fatality rate – mainly because we don’t precisely know how many people are infected, which is the denominator. We also don’t know exactly how the virus spreads. Generally, it is assumed that the virus spreads from person-to-person through close contact (within about 1 meter) and through respiratory droplets produced when an infected person coughs or sneezes. It is also thought that COVID-19 can spread from contact with contaminated surfaces or objects.

In addition, knowledge about the timing of infectiousness is still uncertain. There is evidence that the transmission can happen before the onset of symptoms, although it is commonly thought that people are most contagious when they are most symptomatic. This information is crucial, because if we know the timing patterns of the transmission, we could adopt better measures around when to quarantine an infected person.

Lastly, we don’t yet know whether the spread of the disease will slow down once the weather gets warmer.

What is currently happening in Iran, Italy, Japan, and South Korea may be unique to these countries, but it is more than likely that most countries will eventually experience the spread of COVID-19. In this regard, epidemiologists have estimated that in the absence of mitigation measures, in the worst-case scenario, approximately 60% of the population would become infected. In February, Nancy Messonnier, the director of the Centers for Disease Control and Prevention’s National Centre for Immunization and Respiratory Diseases in the US, warned that “It’s not so much of a question of if this will happen anymore, but rather more of a question of exactly when this will happen.”

We learnt from an epidemiological transmission model that public efforts to curb the transmission of the disease should be directed towards flattening the epidemic curve. This is crucial, since the treatment of severe lung failure caused by COVID-19 requires ventilators to help patients breathe in intensive care units (ICUs). Not a single country in the world has the capacity to absorb the large number of people who would need intensive care at the same time. Experience from Italy shows that about 10% of all patients who test positive for COVID-19 require intensive care. Although efforts have been made to increase ICU capacity, the rapidly growing number of infected patients is overloading the healthcare system. Measures to reduce transmission in order to slow down the epidemic over the course of the year will therefore significantly mitigate the impact of COVID-19.

A transmission model with and without intervention.
Source: CDC. (2007). Interim Pre-pandemic Planning Guidance: Community Strategy for Pandemic Influenza Mitigation in the United States—. Centers for Disease Control and Prevention.

The figure above shows the distribution of infectious cases with and without intervention. If the outbreak peak can be delayed, this allows the health system and healthcare professionals to bring the number of persons that require hospitalization and intensive care in line with the nation’s capacity to provide medical care. To flatten the epidemic curve and lower peak morbidity and mortality, calls for both government response and individual actions.

We will have to follow the protocol of the Austrian Health Ministry, but certain practices such as social distancing, washing hands, and avoiding gathering in crowded places, can help reduce the transmission of the disease. While it is true that young and healthy people are less likely to get sick and die from COVID-19, they can still be a virus carrier and thus transmit the disease to other vulnerable subgroups of the population, such as older people and those with underlying health conditions. An article recently published in The Lancet provides helpful information to better understand the current situation and explains why fighting against COVID-19 will take collective action.

Reference:

Anderson R, Heesterbeek H, Klinkenberg D, & Hollingsworth T (2020). How will country-based mitigation measures influence the course of the COVID-19 epidemic? The Lancet 0(0) DOI: 10.1016/S0140-6736(20)30567-5

Note: This article gives the views of the author, and not the position of the Nexus blog, nor of the International Institute for Applied Systems Analysis.

African cities are critical to global climate mitigation

By Chibulu Luo, PhD student at the University of Toronto (Civil Engineering) and 2016 Young Scientists Summer Program (YSSP) participant.

Luo’s recent publication in the Journal of Cleaner Production considers the needs of the poorest and most vulnerable communities when exploring policy insights for Dar es Salaam’s  energy transition.

Global discourse on sustainability rarely focuses on the Africa region as a key player in the global transition towards a cleaner low-carbon energy future. Filling this critical gap in the research is what has stimulated my doctoral studies.

Dar es Salaam © Timwege | Dreamstime

According to a recent report from the International Energy Agency, the Africa region contributed only 3.7% towards global energy-related GHG emissions in 2018, which perhaps explains why the region has remained largely ignored in current research on energy. However, with colleagues at the University of Toronto and Ontario Tech University, I assert that the growth of large cities such as Dar es Salaam should be critically considered in global efforts on climate change mitigation. My recently published paper estimates to the year 2050, the potential changes in residential energy use and GHG emissions in Dar es Salaam, among Africa’s most populous and fastest-growing cities. Like many African cities,contributes little to global GHG emissions; however, our paper projects a substantial increase in future emissions by the year 2050 – up to 4 to 24 times– which is quite overwhelming. According to our findings, this jump in emissions is due to a higher urban population in 2050 (expected to triple from 5 million in 2015, to as much as 16 million in 2050), and increased energy access and electricity consumption.

In developing these future estimates, we used the Shared-Socio-Economic Pathways (SSPs), developed by IIASA researchers, as a guiding narrative. While there may be some uncertainties with projecting GHG emissions pathways several years into the future, our findings could derive insights to the emissions pathways of other large African cities, and the critical role that these cities can play in global efforts to achieve the 1.5-degree, or even, 2-degree global warming target.

© Chibulu Luo

I first heard about the SSPs as a participant in the IIASA YSSP in 2016; this period was a tremendous time of growth and reflection in terms of my research direction. The opportunity to work amongst such a talented group of scientists in a collaborative environment and on issues that are globally relevant was an unforgettable experience. I especially enjoyed working with colleagues in the IIASA Risk and Resilience Program, where some of my early research ideas were formulated. At that time, I focused largely on resilience measures for infrastructure development in African cities, including Dar es Salaam.

 

 

Note: This article gives the views of the author, and not the position of the Nexus blog, nor of the International Institute for Applied Systems Analysis.

More updates from IIASA alumni or information on the IIASA network may be found here.