Avoid Ambiguity of Expectations

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

https://www.whitehouse.gov/openingamerica/

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.