May 2020 - The Epidemiology Monitor

Modeller Estimates Of Cumulative COVID-19 Deaths In The US Now Projected At 143,357 By August 4, 2020

In This Issue

US Ranks Fifth In Deaths Per Million First Projections

The Institute for Health Metrics and Evaluation (IMHE) released an updated estimate for the cumulative number of deaths in the US projected to occur by August 4, 2020. That number is 143,357, a number which has increased over time as the modelling has improved and the realities of the disease have become more apparent.

Initially, the Seattle based group had projected approximately 82,000 deaths, a number much lower that the projected number from modellers at the Imperial College in London.

- Modeller con't on page 2

Dismay That CDC Is Not Front And Center In The Fight Against The Pandemic Is Growing More Intense Sidelining The Agency Said To Be Costing Lives Premier Public Health Agency

At first, concerns about the absence of the CDC Director and other agency leaders at White House public briefings about the COVID-19 pandemic were shared quietly “within the family” between epidemiologists and other public health professionals. Then, in mid-April, former CDC Director Tom Frieden published an op-ed in the New York Times, stating “Just when American most needs its guidance on the pandemic, the country’s top public health experts do not appear to be guiding, and are certainly not communicating our response.”

May 2020

Also, Ashish Jha, director of the Harvard Global Health Institute, writing this month in STAT News said “during this pandemic when timely, nationwide information is the lifeblood of our response, the CDC has largely disappeared.” He called CDC “the premier public health agency in the world”, and asserted “Americans are suffering and dying because CDC’s voice is absent.”

- CDC cont'd on page 8 •

Volume Forty One •

Number Five

-3Jury Still Out On The Swedish Strategy -5Epidemiologist Offers Key Points on COVID-19 -12Epidemiologists in the News -14Notes on People -15Marketplace

-Modeller cont'd from page 1 The Epidemiology Monitor ISSN (0744-0898) is published monthly

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Those numbers were widely reported to have influenced both the US and UK decisions to adopt drastic social distancing measures. They indicated that 2.2 million deaths in the US and 510,000 deaths in the UK could occur without any social distancing measures at all.

Since that scenario was judged unlikely, the Imperial group subsequently revised their estimates downward to 1.1-1.2 million deaths in the US and 250,000 in the UK taking social distancing into account.

Potential Revisions The IMHE estimate now has almost doubled since the first estimates were released in March. And it is possible the estimates will have to be revised upwards again depending on what happens to the testing, tracing, and isolation strategy that has been recommended across the board by public health professionals. Few areas have created the full infrastructure they will need. According to the IHME, “it is worth noting that the full effects of recent actions to ease social distancing policies, especially if robust containment measures have yet to be fully scaled up, may not be fully known for a few weeks due to the time periods between viral exposure, possible infection, and full disease progression.” In short, the final cumulative number of deaths could grow even larger.

“Ensemble Model”

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In what is called a COVID-19 forecast hub, Nicolas Reich and colleagues at the University of Massachusetts have curated 36 models from 20 teams of highly respected infectious disease

forecasters. “Forecasting COVID-19 is a completely different ballgame because we can’t rely on 20 years of public health surveillance data like we have for flu,” Reich says. The hub has implemented what it calls an “ensemble” forecast which they claim offers a more accurate picture of the future than any single model can project. They estimate that even though the US weekly count of deaths will continue its current downward trend from approximately 10,000 deaths per week now to 7,000 per week by early June, the cumulative number of deaths is projected to exceed 110,000 by June 13.

Country Comparisons To put these statistics in perspective, it is useful to compare the number of deaths in the US with other countries.

We selected the top ten countries with the largest number of confirmed cases from the WorldoMeter website. (See Table on page 7). The US accounts for approximately 30% of all cases worldwide. The nine other countries account for 39% of cases so that altogether the top ten countries which account for only 5% of the 213 countries being tracked account for just over two thirds of all cases.

While the US is first in the absolute number of cases, its reported case rate per million population (5,058) is lower than that of Spain (6,040). In terms of deaths per million population, which may be a more reliable measure of impact since it is not influenced by level of testing, the US at 299 ranks fifth in the top ten countries with the most reported cases. The rate in Germany at 100 is lower than other comparable European countries.

- Modeller con't on page 7

Jury Still Out On Whether Or Not The Swedish “Soft Containment” Strategy Against COVID-19 Is The Right One Many countries hard hit with COVID19 outbreaks have applied harsh social distancing measures to flatten or decrease their epidemic curves.

Thousands of lives may have been saved if initial predictions from epidemiologic models were accurate at the time. However, the economic and social consequences have been severe, and some publics are anxious to resume a normal life. In the US, some states are reopening their economies sooner than what public health authorities are recommending.

All Eyes On Sweden Countries which undertook harsh, mandatory social distancing measures are keen to discover if the significantly less harsh approaches taken in Sweden can offer any guidance about the best way forward from here. Many are looking for the right balance between retaining strict measures to save lives and allowing people to return to more normal lives.

Swedish Strategy What more specifically has been the Swedish strategy and is it a success story? Does it provide lessons? The following article was written after reviewing multiple articles and interviews by Swedish and other officials.

The main features of the control measures in Sweden were to encourage social distancing without requiring it.

The allowable crowd size was limited, however, restaurants and businesses were allowed to stay open and children

below secondary school age were allowed to stay in school. People were encouraged to work from home, and sick persons were advised to stay home from work with pay.

Travel was discouraged.

Goals The economic and social disruption appear to have been significantly less in Sweden than in the US and somewhat less than other European countries. This strategy is often referred to as a “herd immunity” strategy, but in fact is more a byproduct of the Swedish approach than its primary purpose, according to Anders Tegnell, the country’s lead epidemiologist.

“The Swedes understood from the outset that any control measures had to be sustainable..."

Sustainablility The Swedes understood from the outset that any control measures had to be sustainable, that is, feasible and acceptable over the longer term since no vaccine was considered likely to appear for months or even years. The main goal was to avoid overwhelming the health system, however, this is precisely the risk entailed by their voluntary, soft containment strategy. Without adequate constraints on social interactions, cases could climb dramatically and overwhelm the health care system. Even in the best case scenario, one could expect that Sweden would have to accept a certain number of preventable deaths in the short term that would be avoided in other countries adopting - Sweden cont'd on page 4

“...one could expect that Sweden would have to accept a certain number of preventable deaths..."

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-Sweden cont'd from page 3 harsher measures. This has not been stated publicly in multiple media accounts reviewed by the Epi Monitor.

Success?

“The answer is that it is too soon to tell."

Has the strategy succeeded? The answer is that it is too soon to tell.

There are some features of the Swedish situation which suggests that their gamble has paid off for now in that they have avoided social and economic disruption on a large scale. However, the deaths per 100,000 in Sweden are much higher than in neighboring Scandinavian countries. As stated above, some of these excess deaths should have been anticipated as the result of a softer containment strategy.

By themselves, they do not point to a failure of the Swedish strategy, at least not yet, but they may reflect a more fatalistic or realistic streak in the Swedish mindset.

Nursing Home Deaths

“...other countries with harsh measures may have only postponed some deaths..."

At least 50% of the deaths in Sweden have been in nursing home residents, according to Tegnell, and there was an admitted failure to prevent introduction and proper management of cases in these facilities. A stricter lockdown strategy might have prevented more COVID-19 infections and reduced the chances of introductions into a high risk population. Still if the nursing home deaths are excluded, Sweden’s death rate is still several fold higher than neighboring Scandinvavian countries.

(See table on page 11).

Epidemic Curve

weekly case count is decreasing according to Tegnell from 90 to 70 or less per week. The first reported antibody study on approximately 1000 persons from the Stockholm area found that only 7.3% have antibody, much lower than the 25% Tegnell has estimated might have been produced by their less strict strategy.

The health system in Sweden has not been overwhelmed and the Intensive Care Units have not exceeded 80% of their capacity. Tegnell suggests that Sweden could expect to have a smaller second wave of COVID-19 in the fall and winter if the virus remains endemic or returns later in the year. But now this prediction seems ill-founded if antibody levels in the population remain in single digits.

Sweden As Model?

The big unanswered question is whether the lower death rates in other Scandinavian countries which took drastic measures will eventually rise to catch up with the death rate in Sweden which took a less strict approach. For now, their rates are lower. In theory, other countries with harsh measures may have only postponed some deaths that will come later if population level immunity is truly significantly lower after the first wave of cases.

Feasibility Is Sweden’s volunteer strategy coupled with guidance from health officials workable in other countries?

The question about the rightness or wrongness of the Swedish strategy may be moot if other countries could not

At present, the epidemic curve or

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- Sweden cont'd on page 10

Infectious Disease Epidemiologist Offers Key Points To Consider About COVID-19 In Extensive USA Today Interview Michael Osterholm, the epidemiologist director of the Center for Infectious Disease Research and Policy at the University of Minnesota is a frequent spokesperson on television and in other media on topics related to the COVID-19 pandemic.

Osterholm prides himself in offering what he calls “straight talk” about the pandemic and he often has a different perspective on current events in epidemiology.

He was interviewed in mid-May by the Editorial Board at USA Today and provided answers to a long list of questions. Many of his answers offered useful metaphors and insightful points to consider about the pandemic. Some of these useful metaphors and points to consider are described below, including selected excerpts from the interview.

Danger of a Second Wave To better explain his concern about the danger from a second wave next fall, Osterholm indicated that in most areas of the country the estimated percentage of persons with a history of COVID-19 is in the single digit range.

Unfortunately, population level or herd immunity will have to reach 6070% in the opinion of most experts before the US is protected from large numbers of infections.

According to Osterholm, “Think what we have to go through. This damn virus is going to keep going until it affects everybody that it possibly can.”

Leadership & Plan Missing One of the themes that has been struck

by Osterholm over and over again in his many interactions with the media is the question of leadership and another is the lack of a coordinated plan.

Seasonality One of the questions on everyone’s mind is whether or not COVID-19 will manifest a marked seasonality this coming summer as does influenza virus and other respiratory illnesses. If it does, we assume this will give everyone a breather and will be welcome news. Not Osterholm. He told USA Today “Right now the thing that scares me more than anything is that suddenly, in the next two months, cases in the US suddenly drop off dramatically… It would give people a premature sense of euphoria… but to me it would look a lot better if we kept in this slow burn…If we have a big fall peak, it’ll redefine us as we are as a modern society.”

“If we have a big fall peak, it’ll redefine us as we are as a modern society.”

He told USA Today, “I have a major, major concern about leadership right now. We’re not where we need to be, either from an execution standpoint or understanding the problem. We’re just in the second inning of a nine-inning game…My job is not to scare people out of their wits, it’s to scare them into their wits.”

Tradeoffs

“My job is not to scare people out of their wits, it’s to scare them into their wits.”

A major tension throughout the pandemic has been the tradeoff between the public health benefits of control measures and the benefits of maintaining the economy. According to Osterholm, “This shouldn’t be - Osterholm cont'd on page 6

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-Osterholm cont'd from page 5 dollars or lives. This should be, how do we integrate both and bring them together? How do we make tough choices? That’s not happening. That’s leadership again…It’s not a partisan issue. It shouldn’t be.” He adds, “We’ve been out there trying to get this discussion going, and it just falls on deaf ears because it’s too hard.”

“…we’re not driving this tiger, we’re riding it…“

"We don’t have enough of a way of sharing.”

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Lack of Readiness One of the perplexing elements of what has taken place in the decision of many states to loosen their social distancing measures is that they have done so without having in place the testing, tracing, and tracking infrastructure that public health officials have been saying the US will need if it is to effectively contain new cases as they emerge after a decline in cases takes place.

Osterholm notes in his interview that “Four weeks ago we had everybody agreeing that we’re going to reopen once we have 14 days of reduced occurrence of illness. Then, when it got another couple of weeks along and that wasn’t happening, we just threw all that out the window without ever saying we did.”

Riding the Tiger When it comes to controlling the pandemic, the point is often made that because SARS-CoV-2 is a new virus, there is no easy way out of this challenge short of developing a safe and effective vaccine. Osterholm makes this point about the difficulty of controlling the situation by saying “…we’re not driving this tiger, we’re riding it…We are not going to determine the course of this pandemic beyond potentially flattening some of the peaks or in some ways limiting high-risk people from

potentially getting infected and having bad outcomes.”

Contact Tracing Not A Panacea Osterholm is one of the few epidemiology commentators to point out the difficulties of implementing the much touted contact tracing that will need to be done effectively to contain cases. That’s because contact tracing only works when you have a relatively small and manageable number of cases.

According to Osterholm, “Once you see a big escalation in cases, you’ll be having contacts by the many thousands and thousands and thousands, and it’s just not going to work…It’s not a panacea.”

A recent report documenting that a new vaccine being developed by Moderna has shown an immune response similar to that of persons who have recovered from COVID-19 is good news on the vaccine front. There are multiple scientific challenges that will need to be overcome to successfully create and test a safe and effective vaccine. However, there are also many ethical and practical issues that will need to be addressed.

According to Osterholm, we have no plan in place for what to do once a vaccine is in hand. “What if the Chinese get the vaccine first? What if we get it first? Will we share it with anybody?

Boy, I’m going to tell you right now, the answer I’m getting out of this administration is “hell no”. Well then, why would the Chinese want to share a vaccine with us? Why would the Europeans want to share vaccine?...We don’t have enough of a way of sharing.”

- Osterholm con't on page 7

-Osterholm cont'd from page 6 D-Day Like Plan Needed He adds using another analogy, “If there was ever a time that we need to have a unified response plan, and I know this sounds trite, I liken it to DDay. I want my Eisenhower right now with every allied country around the table and when Ike calls it, it goes.

That's what we need right now. We need a D-Day plan. We don't have it.

different countries marching to their own drummer. To me, that's the biggest challenge that nobody is talking about. The R&D is huge. Safety is huge. But in the end the biggest tragedy would be to have a vaccine and not be able to get it used in the way it should be used.”

“...the biggest tragedy would be to have a vaccine and not be able to get it used in the way it should be used.”

To read the interview in full, visit https://bit.ly/2XoXMy2

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I worry we're going to have all these

-Modeller cont'd from page 2

#

Country, Other

Total Cases

Total Deaths

Tot Cases/ 1M pop

Deaths/ 1M pop

World

5,452,471

345,068

700

44.3

1

USA

2

Population

1,673,301

98,824

5,058

299

330,801,130

Brazil

352,523

22,288

1,660

105

212,401,542

3

Russia

344,481

3,541

2,361

24

145,928,144

4

Spain

282,370

28,678

6,040

613

46,752,950

5

UK

259,559

36,793

3,826

542

67,849,102

6

Italy

229,858

32,785

3,801

542

60,470,714

7

France

182,469

28,332

2,796

434

65,258,794

8

Germany

180,084

8,371

2,150

100

83,756,505

9

Turkey

155,686

4,308

1,848

51

84,242,466

10

India

137,991

4,013

100

3

1,378,566,974

Source: Worldometer May 24, 2020

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-CDC cont'd from page 1 Depolitization

"... the lack of CDC direct communication is 'denying a worried public straight talk'..."

Rich Besser, former acting director CDC and now at the Robert Wood Johnson Foundation said it a recent video chat that Americans are not hearing from CDC about best practices in this pandemic. He called for depoliticizing the information provided to the public and agreed that it was “detrimental” to American public health not to be receiving these regular briefings.

Press Briefings The last CDC press briefing on the pandemic was on March 19 and efforts to restart them have been rebuffed by the White House, according to media reports. Two former CDC employees, Bruce Weniger and Chin-Yih Ou published an essay on Medium saying the lack of CDC direct communication is “denying a worried public straight talk from what has been the world’s premier public-health agency.”

Lancet Editorial

"... further erosion of the CDC will harm global cooperation in science and public health..."

Also, a recent editorial in the Lancet titled “Reviving The US CDC” states the Trump administration's further erosion of the CDC will harm global cooperation in science and public health, as it is trying to do by defunding WHO. A strong CDC is needed to respond to public health threats, both domestic and international, and to help prevent the next inevitable pandemic.

Why Low Profile One possible explanation for CDC’s absence was the ubiquitous media presence of the NIH’s Anthony Fauci

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whose knowledge and experience with infectious diseases are widely respected. With a non-partisan reputation and a clear focus on the science, having Fauci in a prominent role communicating with the public was reassuring to many laypersons as well as scientists.

Yet Fauci’s knowledge and experience has come from leading a research institution, and NIH does not have CDC’s relationships with state and local health departments, a tradition of holding regular briefings during evolving outbreaks, and a large cadre of disease detectives with a respected reputation for responding effectively to outbreaks in all parts of the world.

Points of Tension However, as time goes on, it becomes clearer that there are multiple points of tension between CDC and the White which might better explain CDC being prevented from playing its rightful role in fighting the pandemic.

Some of these reasons have been described in multiple media accounts, including the following: 1. It seems clear that the leadership in Washington is not interested in developing a coordinated national plan for addressing the different pandemic challenges. This is so despite multiple pleas to do so from leading epidemiologists such as Minnesota’s Michael Osterholm and others. Putting CDC in charge would signify a federal level commitment and obligation.

2. The White House is questioning the validity of the death counts being reported by the Mortality Statistics Branch in CDC’s National Center - CDC con't on page 9

-CDC cont'd from page for Health Statistics. Claims are being made that deaths are being overcounted when expert opinion is that the US is actually underestimating the deaths from COVID-19.

In an interview with the Daily Beast, the chief of that activity at CDC said “The system can always get better. But if we’ve learned anything it’s that we’re seeing some of these individuals who have died of the virus slip through the cracks…It’s not that we’re overcounting.”

3. Another tension is the limited guidance on reopening different sectors of American society which has been published by the CDC. After early versions of the guidance with specific recommendations were leaked to the press, a revised and much less specific version was published on the CDC website, according to the Washington Post. Now a more detailed guidance document is available, but this document, is nothing like what we are accustomed to seeing from CDC, according to Weniger .

Interviewed on the Rachel Maddow show, he said the new guidance is complicated, inconsistent, and full exceptions to exceptions. In his opinion, CDC personnel must be embarrassed to see it.

4. Criticisms of Robert Redfield, the CDC Director, are also beginning to surface such as those in the Washington Post recently. Redfield is accused of being an ineffective communicator and a weak leader not in control of his agency and not on a par with others in the struggles within the White House environment.

5. There is an ideological struggle

according to the former CDC employees between those who believe government has a constitutional role to play in promoting the general welfare and those who place more faith on the private sector. In this category appears to be the recent award of a contract to a Pittsburgh company to collect data from hospitals which is already being reported to the CDC Healthcare Reporting Network.

Richard Jackson, professor emeritus at UCLA and a former CDC Center Director told the Post, “it is unprecedented that you’d set up a competing system separate from CDC."

“...it is unprecedented that you’d set up a competing system separate from CDC."

Painful moment According to Jha, “this must be a painful time for the many extraordinary career scientists who continue to work at the agency. But it's a painful moment for the American people too and with deadly consequences. Real CDC leadership— clear, science based guidance, effective coordination of states, and public transparency of data---is absolutely essential for confronting and getting clear of this crisis.” He concludes, “The CDC was once the world’s greatest public health agency. We need that CDC back, and we need it now.”

Scientists Under Duress An indication of just how painful a time it is for many at CDC, NIH, and other agencies is the recent decision to terminate an NIH grant to the ECOHealth Alliance, a private research organization doing work on coronaviruses. According to our sources at NIH, these researchers are doing the best research on coronaviruses. Yet because of - CDC con't on page 10

“The CDC was once the world’s greatest public health agency. We need that CDC back, and we need it now.”

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1

"... a complete divorce of politics from public health might not be feasible anytime soon."

"...'fake news' and misinformation have had little influence on the Swedish population..."

-CDC cont'd from page 9

-Sweden cont'd from page 4

misinformation about the relationship with the research facility in Wuhan and because of unproven theories about the true origins of the virus, the NIH grant was terminated without due process.

make the Swedish strategy work.

The grant cancellation was recently the subject of a special expose report on 60 Minutes. When the best researchers in the world have their work cancelled for political rather than scientific reasons, then you can understand the difficult environment that our government scientists are working in, said the NIH source.

In a recent op-ed in the NY Times, Seema Yasmin, a former CDC Epidemic Intelligence Service (EIS) Officer concluded by saying, "Given the complex relationship between American public health law, regulations and epidemiology, a complete divorce of politics from public health might not be feasible anytime soon. But week after week, as Covid-19 has killed almost as many Americans a day as the Sept. 11 attacks, our best response against the pandemic demands unleashing the top disease detectives in the world and fully applying their advice. E.I.S. officers were trained to fight this battle, and no one should stand in their way.” ■

Context Matters As Tegnell has acknowledged, context is crucial. He states clearly that the Swedish approach would not have been a good idea in countries that were hard hit to begin with or became aware of cases only relatively late after importation.

What about the best strategy going forward when case counts have declined significantly.

The voluntary approach may only be feasible in a country where the level of trust in government and health officials is high. Evidence for this is that “fake news” and misinformation have had little influence on the Swedish population, according to Tegnell. Thus, the Swedes may have had the luxury of taking a longer view because they did not miss as many early cases and did not have the pressure to do something drastic to prevent an anticipated wave of new cases. It was their intention from the outset to implement what they thought would be sustainable measures acceptable in a trusting population that values personal responsibility and is likely to heed public health guidance.

Collaboration Key For Unity

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Also, the Swedes have a history of working together in different segments of the health system, so that achieving a unified strategy was possible even though local jurisdictions make final decisions. Tegnell did not agree that having a decentralized system such as in the US was antithetical to achieving - Sweden con't on page 11

-Sweden cont'd from page 10 a unified national strategy since that outcome is what Sweden has created beforehand on other topics and it replicated that unity in the present pandemic situation.

Coronavirus cases and deaths in Scandinavian countries and the US Source Worldometer, May 24, 2020 â–

Rank

Cases

Deaths

Case Ratio per 1M

Death Rate per 1M

Sweden

25

33,459

3,998

3,315

396

Denmark

45

11,360

562

1,962

97

Norway

50

8,349

235

1,541

43

Finland

58

6,592

307

1,188

55

US

1

1,673,301

98,824

5,058

299

Country

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Epidemiologists In The News

“I think there’s a chance we might have done better by doing nothing at all..."

[Editor’s Note: As stated last month, no other event in our lifetimes has called upon the knowledge, experience, and expertise of epidemiologists as frequently as the COVID-19 pandemic. Everywhere we turn, epidemiologists are forecasting estimated cases and deaths, being interviewed on television, writing editorials and op-ed articles, and answering questions for a wide variety of audiences. Below is a sample of news items involving epidemiologists from around the world. ]

Opposed To Lockdowns Sunetra Gupta, professor of theoretical epidemiology at Oxford University, said in an interview on UnHerd that she is opposed to lockdowns. She added that “I think there’s a chance we might have done better by doing nothing at all, or at least by doing something different , which would have been to pay attention to protecting the vulnerable.” Gupta points out “Different countries have had different lockdown policies, and yet what we’ve observed is almost a uniform pattern of behavior which is highly consistent with the SIR model. To me that suggests that much of the driving force here was due to the build up of immunity.” In other words, that is to say, not due to the social distancing or decreased exposures.

COVID Crush Game

"...this is getting awfully close to genocide by default.”

Malia Jones, a social epidemiologist at the University of Wisconsin-Madison Applied Population Lab has created with her web developer colleague Caitlin Bourbeau a new game to simulate the transmission of COVID-19. Called COVID Crush, the game allows players to try out different physical distancing interventions to see what impact they have in a population of 1,000 people represented by dots in the game. Readers can watch a video on how to play the game here: https://bit.ly/3egGZnG

“Mass Death By Public Policy”

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Greg Gonsalves, Yale epidemiologist was the subject of a report in the Huffington Post over his statements on Twitter stating that the anticipated deaths from COVID-19 constitute “mass death by public policy”. Gonsalves asserted this because he believes that what is happening in the US is purposeful, considered negligence, omission, and failure to act by our leaders. Commenting on the higher risk of death among people of color, Gonsalves said “this is getting awfully close to genocide by default.” Can leaders be held accountable under international law, he asked.

- News con't on page 13

-News cont'd from page 10 Two Million Deaths Anticipated Jayaprakash Muliyil, considered India’s leading epidemiologist and Chairman of the Scientific Advisory Committee of the National Institute of Epidemiology, told Outlook India in an interview that there will be two million deaths in India if a substantial lifting of the lockdown takes place. Despite these large absolute numbers, it represents a low rate, he said. India has a population of 1,360 million people. Because of the different age structure of the Indian population, Muliyil predicted that the rate of death will be lower in India than elsewhere despite the large number of deaths.

“...there will be two million deaths in India if a substantial lifting of the lockdown takes place."

“Simply An Epidemiologist” Anthony Fauci, Head of the National Institute of Allergy and Infectious Disease has been garnering headlines for weeks. In the process of advising the President, he has created a fan base as well as a host of critics because he has at times disagreed with the President in public. In a colorfully worded article in the NY Post, Rich Lowry says of Fauci, “He is neither the dastardly bureaucratic mastermind imposing his will on the country that his detractors on the right make him out to be, or the philosopher-king in waiting that his boosters on the left inflate him into. He’s simply an epidemiologist, one who brings considerable expertise and experience to the table, but at the end of the day, his focus is inevitably and rightly quite narrow.”

“He’s simply an epidemiologist..."

Missing: A Plan To Reclose Marc Lipsitch, professor of epidemiology at Harvard was interviewed by JAMA to ask about his predictions for the course of the pandemic in the US for the summer and beyond. Lipsitch said “Almost every government is talking about lifting control measures. Not every government, but many, because of the economic burdens. Given the fairly high caseloads that we have in the US, that’s a really risky thing to do right now… Jurisdictions may learn more about which tactics work best in mitigating transmission during this period and may learn whether some mitigation tactics such as school closings are valuable…But the downside is that many jurisdictions will have a plan to open up but not a plan to reclose, leading to more situations like New York, New Orleans, and Detroit where there’s extreme strains on the health care.” https://bit.ly/2A8wcwJ

"... the downside is that many jurisdictions will have a plan to open up but not a plan to reclose..."

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Notes on People Do you have news about yourself, a colleague, or a student?

Please help The Epidemiology Monitor keep the community informed by sending relevant news to us at this address for inclusion in our next issue. people@epimonitor.net

Appointed: Caitlin Pedati, Iowa state epidemiologist, to President Trump’s White House Coronavirus Task Force. Pedati, a 34 year old pediatrician by training, has become a very public figure during the pandemic. She recently visited President Trump in the Oval Office with Iowa Governor Kim Reynolds and was asked to join the Task Force after that meeting, according to press accounts.

Profiled: Chen Chien-jen, Vice President of Taiwan, epidemiologist, and expert on viruses in the New York Times on May 9, 2020. Calling him Taiwan’s weapon against coronaviruses, he navigates both the world of politics and science. He told the Times, “Evidence is more important than playing politics.” Because of his experience with SARS in 2003, he helped prepare Taiwan for the next outbreak. So far, in a population of almost 24 million people next to China, Taiwan has recorded only 441 cases and 7 deaths.

Volunteer: Sanjiv Baxi, with a New York City hospital to help treat COVID-19 patients. Baxi is an infectious disease physician, and adjunct professor who teaches epidemiology at University of California, San Francisco. He is a member of the Air Force Reserve and volunteered to help New York meet the surge of patients. He told a military publication, “One can read about how bad it is and see the numbers, but witnessing the amount of suffering is a different experience.”

Profiled: Linda Bell, South Carolina state epidemiologist, by the Greenville News.

Bell, a physician and a former CDC EIS officer, has served as state epidemiologist for about 8 years. Her role during the coronavirus pandemic is said to be on a much bigger stage with a much bigger audience. According to the paper, she’s answered hundreds of questions, punctuated with a signature style that is both polite and direct.”

Resigned: Neil Ferguson, UK epidemiologist, from his country’s Scientific Advisory Group for Emergencies. Ferguson helped create a model of the coronavirus pandemic which influenced both the UK and the US to take drastic social distancing measures to save lives. According to media accounts, he resigned because he violated social distancing rules he helped bring about by allowing a reported lover to visit his home.

Near Term Epidemiology Event Calendar Every December The Epidemiology Monitor dedicates that issue to a calendar of events for the upcoming year. However that often means we don't have full information for events later in the year. Thus an online copy exists on our website that is updated regularly.

To view the full year please go to: http://www.epimonitor.net/Events Alternately you can view individual months online:

JUNE JULY AUGUST

VIRUS UPDATES FOR PENDING EVENTS We are attempting to update our online epi event calendar to reflect cancellations and postponements. Many organizations have yet to update their event information.

If your organization has made decisions please let us know so we can keep our calendar as clean as possible. Thank you - mailto:events@epimonitor.net

Two Assistant Professors - Epidemiology The Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh invites applications for a two full-time faculty positions at the level of Assistant Professor outside the tenure stream. We seek team scientists who are interested in developing their own independent program of research and who have the potential of sustained research funding. The faculty members will join a multi-disciplinary academic department with an extensive collaborative research portfolio and a robust teaching program in the School’s fully accredited programs. The successful candidates will be expected to establish and maintain a strong record of collaborative research, extramural funding, and publications; participate in the teaching and mentoring of master’s and doctoral students within the Department of Epidemiology; and contribute to the mission of the Graduate School of Public Health through service. Salary will be commensurate with the candidate’s background and experience.

Applications will be reviewed until position is filled. Please apply at http://join.pitt.edu. Please attach a letter of intent, curriculum vitae, a statement of current and future research directions, and the names of three references to your online application. The University of Pittsburgh is an Affirmative Action/ Equal Opportunity Employer and values equality of opportunity, human dignity and diversity, EOE, including disability/vets.

ASSISTANT PROFESSOR OF EPIDEMIOLOGY (AGING) Position #0139502 This is a full-time faculty position at the level of Assistant Professor outside the tenure stream. The position is available immediately and requires a doctoral degree in epidemiology or a related discipline with post-doctoral training in epidemiology. Preference will be given to candidates who have expertise in the epidemiology of aging and nutrition.

ASSISTANT PROFESSOR OF EPIDEMIOLOGY (REPRODUCTIVE HEALTH) Position #0139508 This is a full-time faculty position at the level of Assistant Professor outside the tenure stream. The position is available immediately and requires a doctoral degree in epidemiology or a related discipline with post-doctoral training in epidemiology. Preference will be given to candidates who have expertise in the epidemiology of reproductive health and health disparities.

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