Harvard T.H. Chan School of Public Health Department of Epidemiology seminar by Jeremy Labrecque, PhD, MSc (Assistant Professor of Epidemiology and Causal Inference, Erasmus MC, Rotterdam) on 'dark causal inference' — implied but unstated causal reasoning that pervades epidemiology — the misuse of 'association' language, and gaps in teaching causal reasoning.

Harvard T.H. Chan School of Public Health Department of Epidemiology seminar by David Jones, MD, PhD (Chair, Department of the History of Science, Harvard; Professor of Epidemiology) on the sixty-year history of 'mortality displacement' — the contested idea that pollution crises kill people already close to death — and its implications for policy.

Observational data have become a popular source of evidence for causal effects when no randomized controlled trial exists, or to supplement information provided by those. In practice, a wide range of designs and analytical choices exist, and one recent approach relies on the target trial emulation framework. This framework is particularly well suited to mimic what could be obtained in a specific randomized controlled trial, while avoiding time-related selection biases. In this abstract, we present how this framework could be useful to emulate trials in malignant melanoma, and the challenges faced when planning such a study using longitudinal observational data from a cohort study. More specifically, two questions are envisaged: duration of immune checkpoint inhibitors, and trials comparing treatment strategies for BRAF V600-mutant patients (targeted therapy as 1st line, followed by immunotherapy as 2nd line, vs. immunotherapy as 2nd line followed by targeted therapy as 1st line). Using data from 1027 participants to the MELBASE cohort, we detail the results for the emulation of a trial where immune checkpoint inhibitor would be stopped at 6 months vs. continued, in patients in response or with stable disease.

After more than 4 million deaths worldwide, the ongoing vaccination to conquer the COVID-19 disease is now competing with the emergence of increasingly contagious mutations, repeatedly supplanting earlier strains. Following the near-absence of historical examples of the long-time evolution of infectious diseases under similar circumstances, models are crucial to exemplify possible scenarios. Accordingly, in the present work we systematically generalize the popular susceptible-infected-recovered model to account for mutations leading to repeatedly occurring new strains, which we coarse grain based on tools from statistical mechanics to derive a model predicting the most likely outcomes. The model predicts that mutations can induce a super exponential growth of infection numbers at early times, which self-amplify to giant infection waves which are caused by a positive feedback loop between infection numbers and mutations and lead to a simultaneous infection of the majority of the population. At later stages -- if vaccination progresses too slowly -- mutations can interrupt an ongoing decrease of infection numbers and can cause infection revivals which occur as single waves or even as whole wave trains featuring alternative periods of decreasing and increasing infection numbers. Our results might be useful for discussions regarding the importance of a release of vaccine-patents to reduce the risk of mutation-induced infection revivals but also to coordinate the release of measures following a downwards trend of infection numbers.

COVID-19 non-pharmaceutical intervention (NPI) policies have been one of the most important and contentious decisions of our time. Beyond even the "normal" inherent difficulties in impact evaluation with observational data, COVID-19 NPI policy evaluation is complicated by additional challenges related to infectious disease dynamics and lags, lack of direct observation of key outcomes, and a multiplicity of interventions occurring on an accelerated time scale. Randomized controlled trials also suffer from what is feasible and ethical to randomize as well as the sheer scale, scope, time, and resources required for an NPI trial to be informative (or at least not misinformative). In this talk, Dr. Haber will discuss the challenges in generating useful evidence for COVID-19 NPIs, the landscape of the literature, and highlight key controversies in several high profile studies over the course of the pandemic. Chasing after unknowables poses major problems for the metascience/replicability movement, institutional research science, and decision makers. If the only choices for informing an important topic are "weak study design" vs "do nothing," when is "do nothing" the best choice?

The SARS-CoV-2 pandemic is awash in data, including daily, spatially-resolved COVID case data, virus sequence data, patients `omics data, and mobility data. Journals are now also awash in studies that make use of quantitative modeling approaches to gain insight into the geographic spread of SARS-CoV-2 and its temporal dynamics, as well as studies that predict the impact of control strategies on SARS-CoV-2 circulation. Some, but by no means all, of these studies are informed by the massive amounts of available data. Some, but by no means all, of these studies have been useful — in that their predictions revealed something beyond simple back of the envelope calculations. To summarize some of these findings, in this symposium, we will address questions such as: What do we want from models of disease spread? What can and should be predicted? Which data are the most useful for predictions? When do we need mechanistic models? What have we learned about how to model disease spread from unmet and/or conflicting predictions? The workshop speakers will explore these questions from different perspectives on what data need to be considered and how models can be evaluated. As at other TMLS workshops, each speaker will deliver a 10-minute talk with ample time set aside for moderated questions/discussion. We expect the talks to be provocative and bold, while respecting different perspectives.

This presentation will include a brief resume of research in older populations led from Cambridge that have informed current clinical understanding and policy regarding services and prevention for and of dementia. These population studies have more recently been ‘re-purposed’ with enthusiasm from participants into a trial platform, and this also has enabled ongoing follow-up by telephone during the COVID pandemic. Although there are no formal outputs from these latter developments general impressions will be shared.

Recently a powerful example of a replicating nano-machine entered our society. In principle, it’s just a normal disease, that one attempts to model with 3 or 4 simple coupled equations with 2 important parameters: a timescale, and a replication factor (the famous R0). Then one tries to guess how changes in society change R0 and perhaps adopt some more or less strong lock-down measures. However, this virus has more “personality” than that. It behaves differently in different persons, and persons behave differently. Presumably, only a few of us infect a lot, while most do not infect so much. This assumption is supported by the observation that couples living together only infect each other with about 15 percent probability, indicating that most infected people are not really infectious. I will discuss this and other aspects of Covid-19 in the perspective of models that describe heterogeneous individuals in a society. In particular, we suggest that limiting superspreading opportunities is a cost-effective strategy to mitigate Covid-19.