Ali H. Mokdad began tracking COVID-19 nine months ago when the deadly virus showed up first in Washington state because that is his job.
In a phone interview on Thursday, Mokdad, a professor of health metrics sciences at the Institute for Health Metrics and Evaluation at the University of Washington, said he and his colleagues had been tracking the numbers and transmission factors well before the rest of the country caught up.
Naturally, the initial concern at IHME was the university’s medical center. “We were the first to stop elective surgeries; we were the first to recall retired physicians [with virus experience],” Mokdad said.
Washington state led the country with the first confirmed case in January when a man who had traveled to China turned up with a then-mysterious respiratory infection.
Because Washington was initially ground zero in the U.S., and with IHME focused on the metrics related to the spread and morbidity, it wasn’t long before Mokdad and his team were working with other states and countries. By March 22, Mokdad, who began as a researcher at the Centers for Disease Control in 1990 before joining IHME, said, “We were doing the work for every country in the world.”
In 2017, the Bill and Melinda Gates Foundation contributed to laying the groundwork for IHME to serve as a leader in improving world health outcomes with a $279 million commitment to the organization.
“IHME provides critical data about global health trends that can empower policymakers worldwide to identify better solutions in the fight against disease,” Bill Gates said at the time.
The release from the Gates Foundation explained, “Among its work, IHME publishes the annual Global Burden of Disease study, (GBD) a systematic, scientific effort to quantify the magnitude of health loss from all major diseases, injuries and risk factors by age, sex and population.” It goes on to state, “IHME is now considered the trusted source for The World Bank, the United States Agency for International Development, The National Institutes of Health, the Wellcome Trust and a range of other national and global organizations.”
In explaining how IHME’s report arrived at the startling statement, “Under the most likely of IHME’s scenarios, the nations with the highest per capita total deaths would be the U.S. Virgin Islands, the Netherlands and Spain,” Mokdad said researchers start with the number of positive cases and, using a well-defined metric, are able to extrapolate the actual infection rate. From there, researchers compared the number to the population by 100,000 people and came up with the dire prediction.
Mokdad also explained the factors that can move the number of deaths either up or down.
“The more testing, the more the numbers come down.” But the more mobility in a community, the numbers go up, he said. Travel, population density and weather also affect outcomes. The number one factor that is widely held to be the most important one is whether or not people wear masks and social distance.
IHME Director Dr. Christopher Murray said in the report, “We are facing the prospect of a deadly December, especially in Europe, Central Asia and the United States. But the science is clear and the evidence irrefutable: mask-wearing, social distancing and limits to social gatherings are vital to helping prevent transmission of the virus.”
Mokdad, who is Lebanese, spoke on Thursday about the failure of his homeland to put measures in place, especially around travel and airports, which lead to a startling rise in recent cases.
A BBC article from May said, “The rise in the number of new cases [in Lebanon] has partly been attributed to infected expatriates arriving from overseas on repatriation flights.”
Mokdad said, “Lebanon did a poor job,” which has resulted in an enormous spike since the country began to ease restrictions in May. “Four or five hundred new cases a day,” he said.
While Gov. Albert Bryan Jr. and the V.I. Health Department have been inclined to talk about the spread of the virus in terms of “close contact” and “community spread” while downplaying travel in and out of the territory as causal for the exponential rise in cases that caused the second shutdown of non-essential business on Aug. 18, which was lifted Tuesday, the USVI’s numbers correspond to the territory flinging open its doors to tourism in June.
Mokdad said the problem is, if testing is not done at airports with nasal swabs that provide almost instant results, there is no way to trace whether or not the virus is coming in via travelers.
Furthermore, contact tracing, which got off to a slow start, is proving to not be particularly effective or trustworthy. A July 31 New York Times article said, “Contact tracing, a cornerstone of the public health arsenal to tamp down the coronavirus across the world, has largely failed in the United States; the virus’s pervasiveness and major lags in testing have rendered the system almost pointless.”
The IHME report clearly states there are things that can be done to dramatically decrease the number of deaths expected by the end of the year.
The Institute modeled three scenarios:
– A “worst-case” in which mask usage stays at current rates and governments continue relaxing social distancing requirements, leading to 4 million total deaths by the end of the year;
– A “best-case” of 2 million total deaths if mask usage is near-universal and governments impose social distancing requirements when their daily death rate exceeds 8 per million; and
– A “most-likely” scenario that assumes individual mask use and other mitigation measures remain unchanged, resulting in approximately 2.8 million total deaths.
It is the 8 per million rate that Mokdad said was used to determine the deaths per 100,000 people that has the USVI leading the per capita rate worldwide. That won’t change, he said.
But measures taken by communities will definitely affect the number of deaths. The report indicates a best case where the USVI sees a range of between 39.4 deaths and 514.6 deaths, or a worst case scenario that can range between 51 and 520 deaths. The best and worst case for the USVI are almost identical and both have a huge potential range of deaths, from tens of deaths to more than 500 deaths.
Mokdad explained in a follow up email, “Due to small numbers, the confidence interval is wide, and as we project more into the future, the confidence interval gets wider. It is like when you project a hurricane path – the further forward in time the wider the confidence interval,” he wrote, adding, “The most important message here is that wearing masks will reduce the estimate compared to not. The CI will intersect, and this is the case for other countries too.”
There have been 19 deaths attributed to COVID in the territory as of publication.
Mokdad said that though the IHME predictions are large and vary widely, serious increases are expected due to the weather. “The cases will increase rapidly as we go into pneumonia season.” He said the V.I. season is short compared to other places like New York. “It is starting soon but will only last for a month or so.”
Anecdotally, Mokdad said in Lebanon people disembarking from planes were tested, but since the results were not immediately available, “people left the airport and started hugging and kissing their family members.”
“Lebanon is now testing with BCA [the tests developed early in the pandemic in Germany] nasal swabs at the airport and making travelers pay for the tests.”
Mokdad said he has not left his home since January other than to go to a nearby park.
Editor’s note: The IHME forecast model is not universally accepted and had been widely criticized in a number of academic publications and news outlets.