There are about 4000 ICU beds in England, the plan is to provide about 15000 (I think). What is ICU? It is a nursing/medical team that has the training to handle very poorly people plus the key equipment such as the ventilator and monitors and an oxygen supply. The whole aim of the modelling is to implement social distancing and behaviour changes that can help reduce the peak ICU demand below that kind of number. This will be done by stretching the epidemic curve over a longer time. Meanwhile people are working very hard to test antivirals to help treat people, and to develop a vaccine - but that takes a longer time because of the need for human testing. The ICU number is difficult to achieve mainly on account of staff, given that many will themselves get ill. Factories are being retooled to build ventilators. We have about 12 weeks to go before the peak.
If you need hospitalisation you will be isolated from the rest of the population in any event. If you need ICU and do not get it you may well die. The higher estimates you may have seen in the press on possible mortality numbers are based on a ‘do nothing’ scenario in which the epidemic peaks rapidly and completely swamps the number of ICU available - the Italy experience.
Alan
> On 20 Mar 2020, at 15:04, Molle, Andrea <[log in to unmask]> wrote:
>
> Forgive my naïve question but is resource allocation even possible in this scenario? How likely and fast can ICU units be relocated. Wouldn’t be better to have a model who can first ‘predict’ (for lack of better term) who is more likely to need an ICU bed and push to isolate them from the rest of the population? And secondly help with triage decision on hospitalized case?
>
> From: News and discussion about computer simulation in the social sciences <[log in to unmask]> On Behalf Of Claudio Cioffi
> Sent: Friday, March 20, 2020 7:51 AM
> To: [log in to unmask]
> Subject: Re: [SIMSOC] How can disease models be made useful?
>
> External Message
>
> While national-level statistics, while useful and essential for understanding the state of the nation as whole, they are not what is need for providing local help. Dissagregation is necessary, down to real operational levels. If estimates of bed spaces and staff and other resources is what you really need, then consider tessellating the entire area/landscape containing the N hospital/facilities venues. Each tessellated polygon is then an approximation of the N actual “jurisdictions". A geospatial ABM with sufficient resolution could then be created, similar to Epstein’s smallpox model (or similar others), but more specialized for each jurisdiction and containing actual GIS layers.
> Here in the US a major problem has been the lack of sufficient compliance by relatively “younger agents”, in part due to the earlier miscommunication on the low infection rate for young people. That was inaccurate. This situation may be improving with the closing of beaches and other public recreation areas, but it may simply move noncompliance (social defection) to other areas (private homes, clubs, etc). So useful ABMs should also draw on collective action science as well as social network structures (different today from what they were a months ago) to provide more informed estimates of future trajectories.
>
> Claudio
>
>
> On Mar 20, 2020, at 10:30 AM, Penn, Alan <[log in to unmask]> wrote:
>
> On the question of prediction, to be helpful in this situation some kind of prediction is needed. For example, the Imperial model makes ‘predictions’ about the possible growth in numbers over time. If I am in charge of planning the bed spaces and staff resources in the NHS this is exactly what I need. The way these thing work is that the modellers vary their parameters between the range of values that current data from earlier phases of the epidemic - eg. in China and Italy - suggest might be reasonable best/worst/likely numbers, and use this to give the resource planners some idea of what they are working with in the form of best case worst case median scenarios..
>
> I am afraid that if I can only give qualitative outcomes of a model, that limits its usefulness. Possibly still useful - eg whether to expect a single peak or a secondary peak - might be a useful qualitative outcome.
>
> In this situation people try not to over estimate the accuracy of their models. And policy makers are very aware that they are having to make decisions without full knowledge, but all that you can ask for is best state of the art knowledge and some kind of sensitivity or error estimate, and clarity on what the sources of these errors are and what one mght do to improve on that.
>
> Alan
>
>
> On 20 Mar 2020, at 11:54, Claudio Cioffi <[log in to unmask]> wrote:
>
> I agree. The models published in the Washington Post a few days ago seem to have gone a long way towards showing the public (and some policymakers) how the future can be determined by different specific behaviors and policies. Physical distancing and personal hygiene are demonstrably superior to other options. This is good and certainly worthwhile disseminating to the public. More models like these are helpful.
> Also, quantitative monitoring of the empirical infection rate (the classical curve that is still rising in most countries) is another concept that seems to be getting across. An area where ABMs could help would be with less aggregated, sub-national or regional models of the disaster, since this is by no means uniformly distributed within countries. Such local models should include how the polity (system of policy authorities and governance) is working, since this is not a purely biological process.
>
> Best spring wishes to all
> Claudio
>
> –––
> Claudio Cioffi-Revilla, Ph.D., D.Sc.Pol.
> University Professor Emeritus, George Mason University
> Affiliated Faculty Member, Institute for a Sustainable Earth
> Jefferson Science Fellow, National Academy of Sciences
> Fellow, AAAS American Association for the Advancement of Science
>
> Research Gate: https://secure-web.cisco.com/1gcl8cvF9tPyupY7LMQwn9cu4C5N9jqDm5LMjcsnsJB5hOvjIotXLujv_lbboE4aupgj1sBbWUdw2lvyUSuVq9csQhBKQ6lpMfszc7IZG8iJGI6txeI0wBXazX35DVH-YCG1xiIoVhzhV439TIRmwQyVxWRyAq4Mgq_IJjSGkJrFc51gqtwQiUV08n5D3Mytj09AYWDo_mdettOyQlLslh-VKVarLLxqjbhrO4BoBVjtfbZyfwh7UbqPAU36l02us2Px0oZ26dZ0S37iAmWOmZ4q4wX5TbbVgvdnRipKyvKZh5Ke-1c6VqpEk8bKS3fZs_e-p8CCyPNbrXi6qYfCP0NMTTz_yLOjNYIGZz3aaf5LrcpHx2swdiC9UDVFJh22f1DSjX6QR2uqUCe7g2YkXXmK5Y248vOW5lwTe7zfc97M_j_AWgMx1w7TXKnm9eTuEgQom-MuDdb2G2OQzvxqpZQ/https%3A%2F%2Fwww.researchgate.net%2Fprofile%2FClaudio_Cioffi
> Academic page: https://socialcomplexity.gmu.edu/faculty/csc-faculty-dr-cioffi/
> National Academies page: http://secure-web.cisco.com/1IWeKLNVSF7833jSuj74NxGtbitttSkLouT4CCPHcxo0qH_MVaTTHS5ywC3fmd6KIGjaTkB2wBBGxuTAfo6_8XbWL8OMpG9rRpIXvk9P9660-dCVpfp4hvydJ1le4ck8MIHllW-uWoZlQyejtMwf__q6zQnNZhRR0_Lb8hHwaZRSUrm7WCNx_7BOzEx6ccK9sTcKmeTyJTv26PtgkG36fTiBrSwV-klocp3FxkgT7MbreqZDoZWtZchbnRj3kABFXWlW8zAbyzTOLCarsamqAaHohsSUMRnb4Im3Tg_mn1egsSok0HG0DFBgSu4l6fR3lO-nFvtqaphqTZ80qW3FhZbDkoY3l1R8w4v1gHAlqp-6GdBsyE_QbKPZ6myvs4CTboDLb7g17muYSviOXk4hc5svOIYpXN0O4yp9qh1Z-iz59qdAquIt3mTdeAgaP6xCa/http%3A%2F%2Fsites.nationalacademies.org%2FPGA%2FJefferson%2FPGA_046486
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>
>
>
> On Mar 20, 2020, at 7:40 AM, Klaus G. Troitzsch <[log in to unmask]> wrote:
>
> ... but still then, grounding a model in newly collected data (even if they were precise, valid and whatsoever) would not allow for PREDICTION! The best that could be achieved would be a tentative forecast of several possible futures, given policy makers implement strategies described in such a model but even then most of these possible futures will not occur, but we could talk about scenarios for which precautions could be taken. But will any model results be available before the pandemic is over (as most past pandemics lasted only several months or years ...).
>
> Best
> Klaus
> Prof. (i.R.) Dr. Klaus G. Troitzsch
> Schillerstraße 26
> 79713 Bad Säckingen
> oder
> Aeussere Dorfstrasse 39
> 3718 Kandersteg, Schweiz
> Telefon +49 7761 9982074/5 bzw. +41 33 6750166
>
> [log in to unmask]
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> https://secure-web.cisco.com/1QP_UviehK96IbdCpBRh22EJlYNFbPPOT5rqGVxm3g5_kI6JhYfnRqtFjCe2ocZcCEBlmYzZSJxwXNEVHqqLLHPFFxQaPv17bkZsW_pZIgdu-koChP04UFBM8rBMbvdewlz6sexoYy7u1XA_Zplfeuauv324l2UrYQ4IFamAlcqJg_sE4pex33QU8XDNNLvY-3N78bpJtBmXOD2DOSfBS7vKaSQOb4-ILezZbb8_HtQxZgdL7a4ZmS8blIvxo4-UILpipow8MZUP5qyXhl24WHzNs0P0YvlnWoixlCn8lAfHP_8VZSaHxG7WVQpRn6ntaQlCIe3SxDTSSd2s5EbtXrcAomuCsLhL46psD3WcnVPmTiVx4m7MS7RpBnv7WmSZQeSGUmJhpFfQ8CAYedL5-MqoJfKomRihA6q6gaXfgRlAUrKzGzy67MOh1fSo7_tKm/https%3A%2F%2Fklausgtroitzsch.academia.edu%2F
> On 20.03.20 12:26, Garry Sotnik wrote:
>
> I agree. Only static and cyclical systems can be predicted. Complex and adaptive systems cannot be, and using historical data to validate models of complex adaptive systems ignores the potential absence of old drivers and presence of new ones. I'd say grounding a model in newly collected data and validating the results against theory in psychology and sociology would be the way to go.
>
> On Fri, Mar 20, 2020 at 7:21 AM BYRNE, DAVE S. <[log in to unmask]> wrote:
> My response to Brian's useful set of questions is to say that in any development of a complex system such as the interaction of the social and economic systems in relation to public health there are multiple possible futures. The value of modelling is that models of whatever form are useful heuristic tools for exploring the implications of what might happen in relation to different sets of governance interventions. I think of such interventions as control parameters which can operate to determine (in the sense of set boundaries not exact specification) the future state of the system. That seems to be what the UK government in a very faffing about way has been doing in response to the implications of the Imperial College model. BUT in our neo-liberal sort of society there is still an extreme reluctance to interfere with market systems whereas what is needed is in effect a command economy as operated in the UK during WWII. That seems to be what is being done in various EU states. We probably need rationing, conscription of fit young adults - particularly CV survivors with immunity - for essential public service roles and emergency construction and conversion contracts let for more hosipital provision and follow Spain and nationalize all private hospitals. Did this before in effect with WWII Emergeny Hospital Service which morphed into the NHS.
>
> David Byrne Ph.D., FAcSS
>
> see my recent book:
>
> Class after Industry: a complex realist approach
>
> https://www.palgrave.com/gb/book/9783030026431
> From: News and discussion about computer simulation in the social sciences <[log in to unmask]> on behalf of CASTELLANI, BRIAN C. <[log in to unmask]>
> Sent: Friday, March 20, 2020 11:07 AM
> To: [log in to unmask] <[log in to unmask]>
> Subject: Re: [SIMSOC] How can disease models be made useful?
>
> These are all excellent points! The posts this week have got me really thinking. One question I have been thinking about (as my colleagues and friends and family have been asking me as well) is this: is the goal of modelling to make predictions? Or, is the goal is help us think better? In other words, ABMS and microsimulations and all such models are not particularly great at telling us what exactly will happen, but they do seem rather good at telling us what things might happen and how we might respond and so forth. In other words, they seem better when used as learning tools. And that is, it seems to me, exactly what the Imperial College model did: it challenged a certain way of thinking that probably really helped, even if its predictions were not exact. Anyway, not pressing this point too much, but just something i have been wondering. Probably wrong, but thought I would share it. Also, I hope I did not create a false dualism there.
>
>
> ---------------------------------------------------------
> Brian Castellani, PhD. FAcSS
> Professor of Sociology
> Durham University, UK
>
> Adjunct Professor of Psychiatry
> Northeastern Ohio Medical University, USA
>
> Co-Editor, UK
> International Journal of Social Research Methodology
>
> Co-Editor, Routledge, UK
> Complexity in social science series
>
> Personal website
>
>
> From: News and discussion about computer simulation in the social sciences <[log in to unmask]> on behalf of Penn, Alan <[log in to unmask]>
> Sent: 20 March 2020 11:01
> To: [log in to unmask] <[log in to unmask]>
> Subject: Re: [SIMSOC] How can disease models be made useful?
>
> Scott,
>
> precisely - what we need to know in policy - which is where I now am - is what action can I take that makes a difference. In this case that reduces the number of ICU cases at the peak to below the number that can feasibly be made available.
>
> It all turns around compliance with social distancing. Ideally we need understand what behavioural nudges might be most effective in reducing contacts.
>
> Alan
>
>
> On 20 Mar 2020, at 10:55, Scott Moss <[log in to unmask]> wrote:
>
> I wonder if it would be useful and give some focus to the discussion to address the reasons for thinking that our modelling would be useful in these conditions.
>
> I have two reasons for raising this issue.
>
> The first is that the forecasting of events using social models is, at best, dismal. No econometric model has ever correctly forecast a major economic event such as a turning point in the trade cycle. In nearly three decades of modelling, neither I nor anyone else I know has correctly forecast specific events with agent-based models -- though I would love to see some counter-examples, It is therefore not surprising to me that the Imperial College model produced only "garbage forecasts” or that simulations produce wholly implausible steady states.
>
> My second reason for raising this issue is that, if I understand these matters aright, the "lever" for curtailing the duration or delaying the peak of the epidemic is to reduce the reproduction number, Ro, below 1 which only means that each infected person infects on average fewer than one other person. Do you need a model to tell you that isolation and social distancing is how to do that in the absence of a vaccine?
>
> Any means of reducing Ro without vaccination obviously requires a change in social and individual behaviour. Consequently, if our modelling is to be of use in this (and arguably most) cases, it should help policy-makers to form a useful understanding of prevailing behaviour and the social pressures and incentives to change that behaviour and a means of evaluating likely policy impacts.
>
> Unless you disagree with the above, I would argue that the most useful discussion we could have right now is about how we can model inducements to behavioural change in a way that will enhance the understanding of those who are devising policies to reduce Ro.
>
>
> --
> Scott Moss
> Brookfold
> The Wash
> Chapel en le Frith
> High Peak
> UK SK23 0QW
>
> t: +44 (0)1663 750913
> m: +44 (0)776 968 9991
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