Dave Blake, PhD Profile picture
Sep 9, 2020 12 tweets 2 min read Read on X
A thread on the Sturgis study. I want to focus on one point - how can they find 266k cases are linked to Sturgis? Here is the study. 1/ ftp.iza.org/dp13670.pdf
Counties were categorized in terms of their inflow of pings to Sturgis. How many cell-phone pings (of origin in that county) occurred in Sturgis during the festival, compared to the prior two weeks? There were five different levels of inflow, in descending order. 2/
Next, relative, and absolute, high to low inflow counties had the LOG of their COVID19 cases plotted by weeks. All three of the highest ping county groups has increases starting about three weeks after the event. Low ping county groups had decreases. Changes were significant. 3/
Group boundaries were not uniform. The highest ping groups (outside SD) had 400+ pings but were only 7 counties. 30 to 400 pings were 526 counties. 20-30 pings were 216 counties. 10-20 pings were 437 counties. 1-10 pings were 672 counties, 0 pings were 1386 counties. 4/
For certain I would make the authors justify such apparently arbitrary boundaries. Make them equal population totals, or equal number of counties, or quintiles of pings, or anything that doesn't look so arbitrary. 5/
The bottom two groups are flat or declining, looks suspiciously like a p-hack to me. 6/
Nonetheless, the effect in the other counties are strong and really unprobable (p approaching zero) for the moderate high outflow counties. Highest inflow groups looks underpowered. Third highest a marginal statistically. But five groups, five time points, each with a p value..7/
Marginal hits are not good enough - experiment wide alpha demands p<0.002 by Bonferroni. Now let's move on - how do they reach the 266k conclusion? 8/
They simply apply the group mean change to the number of cases in each county. No worries here. The 266k however, stands on the dubious five group analysis with arbitrary boundaries. It really should not be that hard to regress based all counties involved. 9/
I would have done that first. They probably did also. With thousands of counties, there is lots of statistical power. There is some statistical power in there, but I am suspicious there is also some p-hacking and the 266k is accordingly inflated. 10/
Even so, I would think a VERY large number would be the answer from a more rigorous analysis. The weird grouping just causes me to SMH. 11/
The cost value leans on other economical analysis that says cases have total costs of $46k. No argument there. That's it. That's the tweet. 12/12

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More from @_stah

Jan 3, 2023
Sorry for those who really want the COVID-19 graphs, I am checking them. We have a disease burden about 50% higher than a normal flu season (most active 3 months), and we are likely close to our seasonal high in the next week or two. Hospitals are not like last year.

1/
What can an individual do?

1) Get vaccinations up to date. These are REALLY high cost/benefit shots. I got my fourth about six week ago.
2) Wear an N95 in crowded indoor settings. Especially homes (which are by design poorly ventilated).
2/
3) Use MERV-13 filters designed for the airspace. The combination of N-95 respirators and air filters can reduce the chances of infection 100-fold in most circumstances. If you wear a mask, you can expect 20-fold reduction in risks.

3/
Read 4 tweets
Sep 1, 2022
Atlanta Medical Center is closing. This choice, by their owners, occurred because it is not profitable, and it is not profitable because it provides free health care to too large a portion of uninsured Georgians.
1/
This profit/uninsured problem exists because hospitals must serve people in need regardless of their ability to pay, and in some cases 40% of a hospital's patients will be uninsured. So hospitals play games to try to minimize their uninsured patient fraction.
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In 2014, Obamacare passed. It included a Medicaid expansion. The federal reimbursement rates for procedures would be cut. And, the federally funded Medicaid expansion would reduce the number of uninsured by about a factor of two. It was a breakeven proposition.
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Read 8 tweets
Jun 20, 2022
US COVID-19 cases, census, and deaths. In this plot, these three lines were aligned in amplitude for their peaks in January. The idea is that shifts between cases, census, and deaths, would show by relative line height today. We are near the national peak for this wave.
1/
Census is up a little for this wave, the ratio between deaths and cases are about the same as late January. Case Fatality Ratio is also about the same.
2/
State by state, we are not seeing the census push system-wide hospital stress (would be over 50 on this plot), although some areas are having issues. Some of our divisions have multiple attendings out right now with case positives.
3/
Read 4 tweets
Feb 27, 2022
@JasonSalemi I think the CDC move is actually in the right direction. Omicron featured huge problems, but among the positives were a five-fold decline in CFR. Which implies a five-fold reduction in disease burden per case.
1/
@JasonSalemi Which doesn't matter much when cases are several times higher than prior peaks.

But what happens when cases drop precipitously to levels below prior peaks? That five-fold reduction in disease burden per case really starts to matter.
2/
@JasonSalemi It implies hospital burdens, caused by cases today, will be quite negligible in most of the US, which reduces the value of protections. Everything would be scaled down.

Five-fold.
3/
Read 6 tweets
Feb 26, 2022
Interesting thoughts on Sars-COV-2. As the pandemic progressed, people generated ever increasing proportions of the population that needed resistance to generate an Rt under 1 (a temporary herd immunity), because it was assumed R0 was rising.

What if they were mostly wrong?
1/
The evidence is now emerging that MOST of the increased transmissibility of Sars-COV-2 came from shorter intervals from a person infected to a secondary attack (the next person in the transmission chain).
2/
For example, estimates for the April 2020 transmission were an R0 of 2-3, and a serial interval of 5.2 days.

Alpha had a serial interval of 4.5 days

Delta was 3.3 days

Omicron was 2.2 days.
An R0 of 2 at 2.2 days would look like an R0 of 5.1 at 5.2 days.
3/
Read 6 tweets
Dec 27, 2021
US COVID-19 cases, census, and deaths. Again. Rt for hospitalizations is nearly one, about to decline. Some states with delta outbreaks and early omicron outbreaks are shown in thread.
🧵 1/
New York state. Census was climbing over a month before omicron onset, and is now preparing to turn. It is important to distinguish census from hospitalizations (of which there are many). The hospital average length of stay for omicron is MUCH shorter.
2/
CT, same story.
3/
Read 4 tweets

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