More on why the FT presentation of the data undermines the position I have taken — and why I still hold that position.

1. The successes from the FT presentation (China, S. Korea) clearly relied on a combination of testing and contact tracing to control the pandemic.

1/N
2. So there is no question in my mind that *if* contact tracing is possible, trace and isolate or trace, test, and isolate can succeed, even with this virus.

2/N
3. The open question is what policy can succeed if contact tracing is impossible, as seems to be the case in US.

For evidence that contact tracing is failing, see this tweet from June:

In NYC, only 37% of known positives offered even 1 contact.

3/N

4. A reasonable person can either:

(i) keep trying to persuade more people in the US to cooperate; or

(ii) identify policies that can work even when contact tracing is impossible.

The debate between backers of (i) and (ii) must take place, even if it ruffles feathers.

4/N
5. In debate between exortation about contact tracing vs. other options, participants must agree that the answer depends on questions of fact, not moral assertions about right and wrong.

QN of fact 1: Is persuasion working?

QN of fact 2: Are there viable alternatives?

5/N
6. I wish it were not so, but the evidence seems clear that in the US and the UK now, persuasion by experts is not succeeding. If anything, it is back-firing.

The public is rebelling against “preachy” expert exhortation that they perceive to be ondescending.

6/N
7. Evidence that experts persuasion is failing:

- Backlash against economic experts in the Brexit vote.

- Growth of the anti-vax movement despite unified expert exhortation re value of vaccines.

- In this pandemic, masks as political statement.

7/N
8. Reasonable people can disagree about why experts lost their legitimacy and how we might recover.

But in the next 6 - 12 months, there is no reason to expect a dramatic change.

To save lives and livelihoods, It is a fact that the we experts must work around.

8/N
9. And as experts, we must consider the evidence that bears on two possibilities:

- More expert exhortation will not make contact tracing feasible in the US.

- More expert exhortation might further erode what little legitimacy the experts possess.

9/N
10. My claim has been that:

a) a policy of test and isolate, with zero contact tracing can reduce R;

b) it can be used with other policies that reduce R, such as wearing masks and restricting daily activities;

and c) …

10/N
and

c) holding some target value of R constant, more frequent testing allows fewer restrictions on daily activities

11/N
To summarize:

Claim 1: Public spending on contact tracing has a value that depends on the social context.

12/N
Claim 2: In the United States today, the benefit per $ spent on contact tracing is likely to be far smaller than the benefit per $ spent on some version of test and isolate modeled on the successes in NBA, and such universities as Cornell, Harvard, NYU, …

13/N
Claim 3: More expert exhortation is likely to do little to move the US social context toward the type of context in China and S. Korea where contact tracing did work well and might further undermine the legitimacy of the experts.

14/N
I hope we have a new administration that succeeds.

I am terrified that frustrated experts will send it on a kamikaze mission that gives expert exhortation the force of law.

Claim 4: This use of the law will not restore expert legitimacy and might destroy our democracy

15/N
Claim 5: Experts are not entitled to legitimacy. We always had to earn it. Now, we have to earn it back.

16/16

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More from @paulmromer

15 Oct
To @CT_Bergstrom, @mlipsitch and others whom I respect:

- I agree that the GB plan for surrender appeals to a WH that would like a justification for having done nothing.

I agree that adopting the GB plan would be a horrible mistake.

But …

1/N
@CT_Bergstrom @mlipsitch But note the asymmetry.

- There is a GB plan. I could explain it to my mother.

- If the GB plan is terrible (and it is) then there must exist a better plan. Why can’t the critics explain what that better plan is?

2/N
@CT_Bergstrom @mlipsitch - Why does the specificity of the attack on the GB plan turn to mush when it is time to outline the alternative?

Quoting from their oped '“Flatten the curve” was a good idea ... and it still is. ‘ I cannot explain that plan to my mother.

3/N
Read 15 tweets
10 Sep
It is strikiing how much of his reputation for journalistic integrity @DouthatNYT was willing to trade away for a chance to claim that Trump’s pandemic response was mediocre. 1/N

nytimes.com/2020/09/05/opi…
@DouthatNYT bc "You’ll be more likely to predict a nation’s pandemic toll if you know where it’s located …”

he compares outcomes in the US with those in Brazil, Mexico, and Peru.

Did he think that readers would not notice that he just happened to omit any comparison to Canada? 2/N
@DouthatNYT Over at Vox.com, @germanrlopez noticed. 3/N

And this is only the start.

vox.com/future-perfect…
Read 9 tweets
17 Jul
Junk Science Corrupts Everything it Touches

Jane Brody writes about testing today in NYTimes. Reporting these issues is hard because there are people in academic positions -- supposed experts -- who intentionally mislead.

Let’s take this in steps. 1/N

nytimes.com/2020/07/13/wel…
To start, consider this masterpiece of misleading opacity from the Brody article:

#1: "Even four days after close contact with a person who is shedding the novel coronavirus, 40 percent of tests that come back negative will likely be false.” 2/N
We can tell how this is supposed to make the reader feel -- "oh dear, tests are really bad, a waste of time.” At the level of feelings seems to work.

But what assertion of fact were you trying to make with this sentence?

And can you provide a reference?

I’ll wait. 3/N
Read 4 tweets
3 Jul
The Most Important Policy Decision In Our Lifetimes

In a week dominated by horrible news, there are signs that the Senate may make the right choice when it passes a new response to the pandemic in July: 0/18
1. The Feds are moving past denial:

"Asked why the administration’s stance has changed now, Dr. Fauci referred to the alarming rise in infections nationwide. 'Obviously, things are not going in the right direction,' he said." 1/18

quotes wo source from nytimes.com/2020/07/01/hea…
2. Data is forcing a switch from dogmatic polemics in support of contract tracing to pragmatic questions about what will work: 2/18

Read 19 tweets
26 May
The Public Should Ignore Both Skepticism About Testing in Wuhan and Recommendations for Repeated Lockdowns; and Scientists Should Take Care

A thread that will lead to this ...
1/
Conclusion: When they

(i) dismiss policies with benefits that exceed cost by orders of magnitude, and

(ii) bless an endless cycle of lockdown and reopening,

scientists are observationally equivalent to madmen and fools.
/2
It is all too easy for people with knowledge of such disciplines as virology and epidemiology to overreach when they opine on policies for managing the pandemic.
3/
Read 27 tweets
8 May
Why is there still a swab bottleneck?

What steps do you have to follow if you want to use the more precise saliva samples to avoid the bottlenecks created by those pesky nasalpharangeal swabs but do it in the way that the FDA allows: 0/5
1. "Collection of saliva specimens is limited to patients with symptoms of COVID-19”

[SO no testing for asymptomatic spreaders.] 1/5
2. “...and should be performed in a healthcare setting under the supervision of a trained healthcare provider”

[But surely telemedicine counts for purposes of supervision? Actually, no. Physical presence.]. 2/5
Read 5 tweets

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