The COVID-19 Pandemic: March Madness, predicting the future, and EthiopiaMar 22, 2021
“March Madness” has started. For those who think the March Madness might be some sort of mental health problem, there is some truth in that thought—an obsessive need to track 63 (+4) basketball games. For those not familiar with the term, the reference is to the 64-team college basketball playoffs to determine the national champion. There is an annual ritual of forecasting the winners of each of the games; this is often done by groups in offices of friends and sometimes with cash stakes. I have failed miserably at forecasting the winners and no longer participate—a reminder of the quotation: “It is difficult to make predictions, especially about the future.” Its origin is not certain, being variably attributed to Niels Bohr, Yogi Berra, Mark Twain, and others.
The quotation fits well with decisions now being made concerning the course of the pandemic. Immunity is increasing as vaccination increases and pressure is rising for easing restrictions as the pandemic has abated substantially in much of the United States. Was Texas Governor Abbott’s March 2 Order a case of March Madness or a good set of guesses about the COVID-19 bracket? Here in Colorado, changes are now anticipated in the COVID-19 dial that would lighten restrictions and give more autonomy to the counties. That would start on March 24. The basketball March Madness ends on April 5. By then, we will have some sense about the “winners” in the COVID-19 championship. That is also the day when Colorado’s current mask mandate expires.
As the pandemic has evolved over time, the information needs for managing it have changed as have the questions approached by modeling. An article by Wu and others in the March 15 issue of Nature Medicine addresses “nowcasting” of epidemics of novel pathogens. I had not previously used this term, which refers to forecasting on a very short basis in meteorology. For Wu et al., “epidemic nowcasting broadly refers to assessing the current state by understanding key pathogenic, epidemiologic, clinical and socio-behavioral characteristics of an ongoing outbreak.” Extended to Colorado, we want to “nowcast” the consequences of potential changes in the COVID-19 dial. Will there be a general spillover on the behavior of Coloradans, for example? The paper reads as a “greatest hits” of milestones passed already in the pandemic. Its lifecycle of nowcasting needs is useful. Its concluding recommendation calling for a “system” to cover the cycle is on-target.
Last week, I wrote about the rising prejudice against Asians and, since then, eight people, including six Asians, were shot in Georgia. In Ethiopia, the worst consequence of prejudice is playing out with relatively little global notice—the genocide of the Tigrayans. Over the last decade, I have worked collaboratively in Ethiopia, and also in Rwanda, Uganda, and Kenya, in an NIH-funded program of research and capacity-building in environmental and occupational health. My partner in this effort is Kiros Berhane, a Tigrayan and graduate of Addis Ababa University. After receiving his doctorate in biostatistics at the University of Toronto, he spent a post-doc year with Scott Zeger and myself at Johns Hopkins and later, we were colleagues at the University of Southern California when we began these collaborations in Eastern Africa.
From Kiros and from my own trips to Ethiopia, I have learned about the country’s complicated social and political structure of multiple ethnic groups that have competed over time for dominance. The Tigrayans maintained government leadership from 1991 (after overthrowing a Marxist military dictatorship in a coalition that included four major organizations) until the election of the current Prime Minister Abiy Ahmed in 2018. He hails from a mixed ethnic origin of the two largest ethnic groups: Oromo and Amhara. He seemed off to a good start, ending the schism with Eritrea and receiving the 2019 Nobel Peace Prize for this accomplishment. But his last two years have been marked by an increasing move towards dictatorial suppression of political dissent and persecution of ethnic groups throughout the country. The most recent target, the Tigrayans, are the victims of what appears to be a targeted “ethnic cleansing.” The hallmarks are there: destruction of property, displacement, rape, and murder. News is infrequent with the internet shut down since November and little reporting. Kiros, a poet-biostatistician, composed the powerful words below. The Biden Administration is concerned, but there is not enough international pressure.
(to the rape victims of Tigray)
My dear young sister …
In the middle of the night, through the plasma window
Your cry spells agony, your plight casts a dark shadow
And I am frozen dead, dazed and immobile
Frustrated with anger, my mouth tasting bile
My beautiful Tigrayan sister …
I shuddered to listen to it, your horrid story of rape
With my mind in contortion, my mouth wide agape
I know you are broken, puzzled by tragedy fallen upon
How beings resembling humans, could be devils with weapon
Hush young sister …
Swimming across the oceans, piercing the mountains
riding the mighty waves, galloping vast plains
I feel your cry is for me, reaching out in despair
Unable to comprehend, your mind beyond repair
Hush young flower …
You were a budding rose, biding time to bloom
A sight for sore eyes, the anti-thesis of gloom
How did it come to pass, that you wilted under torture
demon-humans roaming, uprooting your bright future
Hush beautiful sister …
I know you were a seed, planted with love and care
Cared for with tenderness, with so much promise to share
While your eyes tell me, your world has hit a bottom
What you are going through, I can only barely fathom
Hush little sister …
Words of comfort feel hollow, so better left unspoken
Only solutions would matter, hands to mend the broken
So here are my tears for now, for a smiling girl I saw before
Now a victim of hate, her innocence no more
- © Kiros Berhane (March 2021)
I can’t resist providing two recommendations for superb fiction based in Ethiopia. One is Cutting for Stone by physician-author Abraham Verghese, set in a time of political turmoil. The other, The Shadow King by Maaza Mengiste, unfolds at the time of the Italian invasion of Ethiopia in 1935.
Watch for what the future brings us.
Jonathan Samet, MD, MS
Dean, Colorado School of Public Health