“Flattening the Curve” is a deadly delusion →
[EDIT: hello SSC readers! This is a post I wrote quickly and with the expectation that the reader would fill in some of the unstated consequences of my argument. So it’s less clear than I’d like. My comment here should hopefully clarify things somewhat.]
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[EDIT2: people seem really interested in my critique of the Gaussian curve specifically.
To be clear, Bach’s use of a Gaussian is not the core problem here, it’s just a symptom of the core problem.
The core problem is that his curves do not come from a model of how disease is acquired, transmitted, etc. Instead they are a convenient functional form fitted to some parameters, with Bach making the call about which parameters should change – and how much – across different hypothetical scenarios.
Having a model is crucial when comparing one scenario to another, because it “keeps your accounting honest”: if you change one thing, everything causally downstream from that thing should also change.
Without a model, it’s possible to “forget” and not update a value after you change one of the inputs to that value.
That is what Bach does here: He assumes the number of total cases over the course of the epidemic will stay the same, whether or not we do what he calls “mild mitigation measures.” But the estimate he uses for this total – like most if not all such estimates out there – was computed directly from a specific value of the replication rate of the disease. Yet, all of the “mild mitigation measures” on the table right now would lower the replication rate of the disease – that’s what “slowing it down” means – and thus would lower the total.
I am not saying this necessarily means Bach is wrong, either in his pessimism about the degree to which slowing measures can decrease hospital overloading, or in his preference for containment over mitigation. What I am saying is this: Bach does not provide a valid argument for his conclusions.
His conclusions could be right. Since I wrote this, he has updated his post with a link to the recent paper from Imperial College London, whose authors are relatively pessimistic on mitigation.
I had seen this study yesterday, because an acquaintance in public health research linked it to me along with this other recent paper from the EPIcx lab in France, which is more optimistic on mitigation. My acquaintance commented that the former seemed too pessimistic in its modeling assumptions and the latter too optimistic. I am not an epidemiologist, but I get the impression that the research community has not converged to any clear conclusion here, and that the range of plausible assumptions is wide enough to drive a wide range of projected outcomes. In any case, both these papers provide arguments that would justify their conclusions if their premises were true – something Bach does not do.
P. S. if you’re still curious what I was on about w/r/t the Gaussian, I recommend reading about thin-/heavy-/exponential-tailed distributions, and the logistic distribution as a nice example of the latter.]
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I’ve seen this medium post going around, so I’ll repost here what I wrote about it in a Facebook comment.
This article simply does not make sense. Here are some of its flaws:
- It assumes the time course of the epidemic will have a Gaussian functional form. This is not what exponential growth looks like, even approximately. Exponential growth is y ~ e^x, while a Gaussian’s tail grows like y ~ e^(-x^2), with a slower onset – the famous “light tails” of the normal distribution – and a narrow, sudden peak. I don’t know why you’d model something that infamously looks like y ~ e^x as though it were y ~ e^(-x^2), even as an approximation, and the author provides no justification.
- Relative to a form that actually grows exponentially, most of the mass of a Gaussian is concentrated right around the peak. So the top of the peak is higher, to compensate for the mass that’s absent from the light tails. Since his conclusions depend entirely on how high the peak goes, the Gaussian assumption is doing a lot of work. [EDIT: I no longer think Bach would have drawn a different qualitative conclusion if he had used a different functional form. See the step function argument from ermsta here.]
- No citation is provided for 40%-to-70% figure, just the names and affiliations of two researchers. As far as I can tell, the figure comes from Marc Lipsitch (I can’t find anything linking it to Christian Drosten). Lipsitch derived this estimate originally in mid-February using some back-of-the-envelope math using R0, and has since revised it downward as lower R0 estimates have emerged – see here for details.
- In that Lipsitch thread, he starts out by saying “Simple math models with oversimple assumptions would predict far more than that given the R0 estimates in the 2-3 range (80-90%),” and goes on to justify a somewhat lower number.
The “simple math” he refers to here would be something like the SIR model, a textbook model under which the fraction S_inf of people never infected during an epidemic obeys the equation R_0 * (S_inf - 1) - ln(S_inf) = 0. (Cf. page 6 of this.)
Indeed, with R_0=2 we get S_inf=0.2 (80% infected), and with R_0=3 we get S_inf=0.06 (94% infected). So I’m pretty sure Lipsitch’s estimate takes the SIR model as a point of departure, and goes on to postulate some extra factors driving the number down.
But the SIR model, like any textbook model of an epidemic, produces solutions with actual exponential growth, not Gaussians! There is no justification for taking a number like this and finding a Gaussian that matches it. If you believe the assumptions behind the number, you don’t actually believe in the Gaussian; if you believe in the Gaussian (for some reason), you ought to ignore the number and compute your own, under whatever non-standard assumptions you used to derive the Gaussian.
- What’s more, he doesn’t say how his plotted Gaussian curves were derived from his other numbers. Apparently he used the 40%-70% figure together with a point estimate of how long people spend in the ICU. How do these numbers lead to the curves he plotted? What does ICU duration determine about the parameters of a Gaussian? Ordinarily we’d have some (simplified) dynamic model like SIR with a natural place for such a number, and the curve would be a solution to the model. Here we appear to have a curve with no dynamics, somehow estimated from dynamical facts like ICU duration.
- Marc Lipsitch, on his twitter, is still pushing for social distancing and retweeting those “flatten the curve” infographics. I suppose it’s conceivable that he doesn’t recognize the implications of his own estimate. But that is a strong claim and requries a careful argument.
I don’t know if Lipsitch has read this article, but if he has, I imagine he experienced that special kind of discomfort that happens when someone takes a few of your words out of context and uses them to argue against your actual position, citing your own reputation and credibility as though it were a point against you.



