The White House has issued the following Gating Protocols.
We will examine them in some detail. They are vague, difficult to interpret,
and generally lack any specificity. They are as follows:
Proposed State or Regional Gating Criteria
Satisfy Before Proceeding to Phased Comeback
SYMPTOMS
Downward trajectory of influenza-like illnesses (ILI)
reported within a 14-day period
AND
Downward trajectory of covid-like syndromic cases
reported within a 14-day period
CASES
Downward trajectory of documented cases within a 14-day
period
OR
Downward trajectory of positive tests as a percent of
total tests within a 14-day period (flat or increasing volume of tests)
HOSPITALS
Treat all patients without crisis care
AND
Robust testing program in place for at-risk healthcare
workers, including emerging antibody testing
Let us examine them in some detail. They divide it into
three classes; Symptoms, Cases, and Hospitals.
1. SYMPTOMS: We assume that they mean to look at some
as yet unspecified 14 day window, assuming contiguous days and in step one we
must:
Downward trajectory of influenza-like illnesses (ILI)
reported within a 14-day period
AND
Downward trajectory of covid-like syndromic cases
reported within a 14-day period
Step 1:
First, what are the influenza like illnesses and who reports
them and how are they recorded on a daily basis. We know that reporting is rant
with errors. A report may be delayed by weeks so there is no currency. Second,
what is downward trend, a 14 day moving average showing a negative value? How
negative? Again the timing or reports is so poor that manipulation is easy.
Now what are COVID like symptoms as compared to ILI. They
both present the same initially yet the reporting is confused. Perhaps that is
why they selected an AND gate here.
2. CASES: The next gate is stated as follows:
Downward trajectory of documented cases within a 14-day
period
OR
Downward trajectory of positive tests as a percent of
total tests within a 14-day period (flat or increasing volume of tests)
Here we have serious issues. Who gets tested and why. The
Santa Clara example is that if we do wide area testing of either RNA or Ab
which we must do we will see an explosion of positives, all non-symptomatic. Thus
are we speaking of symptomatic cases or positive tests. The logic seems to
state the latter. Namely if we see a downward trend in documented cases do we
mean individuals with symptoms and positive tests? The second part we hopefully
want to see rise as we test more and thus is meaningless. Let us return to the
first. What is the definition of a "documented case"? Words mean
something. These words mean nothing. Or they can mean anything.
3. HOSPITALS: This is the final set of hurdles stating:
Treat all patients without crisis care
AND
Robust testing program in place for at-risk healthcare
workers, including emerging antibody testing
The treatment may seem clear but the term "crisis"
may mean something different to everyone. Clearly NYC was in a crisis. What
then is the metric to determine crisis?
Robust testing is critical not just for hospital workers.
Yet this may mean something. Does "robust" mean universal? How do we
know it when we see it? Again ambiguous.
Overall these make for good PowerPoint charts but leave
great ambiguity in specifics.
Here are the other issues:
1. How do we apply these regionally? By county, SMAs, Zip
Codes or what. Do the Governors make decisions and are they even competent to
do so?
2. The data integrity is a major issue. The data is delayed
in time, often lacking in detail, and may be in error.
3. Transparency is essential. Once we select data, once we
select metrics, once we collect data, it MUST be made publicly available so
people can see what is happening. Otherwise it is another Three Card Monty game.
4. Consistency is critical. Is the metric for New York the
same for New Jersey? Is the metric for Atlantic County the same as Bergen?
Overall these are laudable goals. Yet they grossly lack any
specificity. What must be measured, how, what auditing can be done, what is the
transparency etc.
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