# ICCAI talk

I gave a talk at the International Conference on Complex Acute Illness (ICCAI) with the title Forecasting COVID-19. I talked about some recent work with FDA collaborators on scoring a large number of publicly available epidemic COVID-19 projection models and show that they are unable to reliably forecast COVID-19 beyond a few weeks. The slides are here.

# Why it is so hard to forecast COVID-19

I’ve been actively engaged in trying to model the COVID-19 pandemic since April and after 5 months I am pretty confident that models can estimate what is happening at this moment such as the number of people who are currently infected but not counted as a case. Back at the end of April our model predicted that the case ascertainment ratio ( total cases/total infected) was on the order of 1 in 10 that varied drastically between regions and that number has gone up with the advent of more testing so that it may now be on the order of 1 in 4 or possibly higher in some regions. These numbers more or less the anti-body test data.

However, I do not really trust my model to forecast what will happen a month from now much less six months. There are several reasons. One is that while the pandemic is global the dynamics are local and it is difficult if not impossible to get enough data for a detailed fine grained model that captures all the interactions between people. Another is that the data we do have is not completely reliable. Different regions define cases and deaths differently. There is no universally accepted definition for what constitutes a case or a death and the definition can change over time even for the same region. Thus, differences in death rates between regions or months could be due to differences in the biology of the virus, medical care, or how deaths are defined and when they are recorded. Depending on the region or time, a person with a SARS-CoV-2 infection who dies of a cardiac arrest may or may not be counted as a COVID-19 death. Deaths are sometimes not officially recorded for a week or two, particularly if the physician is overwhelmed with cases.

However, the most important reason models have difficulty forecasting the future is that modeling COVID-19 is as much if not more about modeling the behavior of people and government policy than modeling the biology of disease transmission and we are just not very good at predicting what people will do. This was pointed out by economist John Cochrane months ago, which I blogged about (see here). You can see why getting behavior correct is crucial to modeling a pandemic from the classic SIR model

$\frac{dS}{dt} = -\beta SI$

$\frac{dI}{dt} = \beta SI - \sigma I$

where $I$ and $S$ are the infected and susceptible fractions of the initial population, respectively. Behavior greatly affects the rate of infection $\beta$ and small errors in $\beta$ amplify exponentially. Suppression and mitigation measures such as social distancing, mask wearing, and vaccines reduce $\beta$, while super-spreading events increase $\beta$. The amplification of error is readily apparent near the onset of the pandemic where $I$ grows like $e^{\beta t}$. If you change $\beta$ by $\delta \beta$, then the $I$ will grow like $e^{\beta t+\delta \beta t}$ and thus the ratio is growing (or decaying) exponentially like $e^{\delta \beta t}$. The infection rate also appears in the initial reproduction number $R_0 = \sigma/\beta$. From a previous post, I derived approximate expressions for how long a pandemic would last and show that it scales as $1/(R_0-1)$ and thus errors in $\beta$ will produce errors $R_0$, which could result in errors in how long the pandemic will last, which could be very large if $R_0$ is near one.

The infection rate is different everywhere and constantly changing and while it may be possible to get an estimate of it from the existing data there is no guarantee that previous trends can be extrapolated into the future. So while some of the COVID-19 models do a pretty good job at forecasting out a month or even 6 weeks (e.g. see here), I doubt any will be able to give us a good sense of what things will be like in January.