Insights on the most - Swiss Re

Please note that any views and opinions expressed by speakers at the Summit do not necessarily reflect those of Swiss Re or Palantir.

Insights on the most effective policy measures

BLOCK 2

Submit your questions to:https://sli.do | #HIPPOCRATES


Agenda Time Name Institution Topic

00:10 Daniel Meier Swiss Re An epidemiologist perspective: Overview of more effective measures against the pandemic

04:47 Dr. David W. F. Huang (Ambassador of Taiwan to Switzerland)

Goverment of Taiwan

COVID-19 in Taiwan

09:58 Geoffrey Horrell Refinitiv Machine Learning for COVID-19 – new risk and opportunity insight

13:39 Michael Li MIT DELPHI: Modeling the COVID-19 Crisis

17:47 Holly Wiberg MIT COVID-19 mortality prediction: a data-driven risk assessment tool

21:59 Agni Orfanoudaki MIT Personalized Prescription of ACEI/ARBs for Hypertensive COVID-19 Patients

26:03 Stefano Rensi Stanford Therapeutic Interventions

29:54 Christoph Nabholz Swiss Re Long-term COVID-19 health effects

33:48 Sarah Jones YouGov / Imperial College

Covid-19 attitudes and compliance

38:20 Manfred Tautscher Sinus Institut Applications of the Milieu model based on research

42:43 Noam Perski Palantir Accelerating data driven public policy in the Covid era

53:00 Russ Altman Stanford Panel 2


An epidemiologist perspective: Overview of more effective measures against the pandemic

Daniel Meier / Swiss Re



Measures against the pandemic


COVID-19 in Taiwan

Dr. David W. F. Huang / Representative of Taiwan



Current Situation


On 10. 11. 2020:

• 1 New Case• 580 Positive Cases• 7 Deaths• 528 Recuperated

Cases


Taiwan’s Key success factors

SARS experience Information Transparency Timely Border Control Advanced medical technology Central Epidemic Command Center Good Resource Allocation Smar Community transmission prevention Good etiquette of Citizens



Machine Learning for COVID-19 – new risk and opportunity insight

Geoffrey Horrell / Refinitiv



The challenge

COVID-19

Increased Market

Uncertainty

Increased Company

Activity

Increased News

Volumes

Increased Noise –

Irrelevant Information

• Keeping-up with relevant and meaningful COVID-19 news presents challenges

• Reuters reported over 150,000 news articles mentioning COVID-19 from Nov - Aug 2020!

• Economists, investment analysts and traders need to be able to track the positive and negative impact of events

• But the speed and volume of developments reported in the news makes it difficult



• Refinitiv Labs built a Machine Learning Natural Language Processing model to automatically track the pandemics impact on companies.

• Automatically determines whether a news article contains a COVID-19 risk or opportunity for the companies or industries mentioned

• Tracks risk and opportunity trends over time, and compares company results against peers

• Pre-trained with 2.7 million relevant words from the Refinitiv News Archive and 7,500 annotated articles and leveraging Googles state of the art word embedding model – BERT.

The solution



Company search results displaying relevant news headlines with identified risks and opportunities.



Time-series charts comparing company and peer risks and opportunities. Plus some peer fundamentals.



DELPHI: Modeling the COVID-19 Crisis

Michael Lingzhi Li | MIT Operations Research CenterJoint work with H. Tazi Bouardi, O. Skali Lami, T. Trikalinos, N. Trichakis, and D. Bertsimas



Modeling the COVID-19 Crisis

Key decision makers need to manage expectations and plan amid uncertainty in the COVID-19 pandemic

The complexity of modeling this epidemic is unprecedented Data Scarcity Governmental Interventions Treatments and Vaccination

Goal: Develop accurate model for COVID-19 incidence and mortality to aid governments and organizations for decision-making



S I R

1. Compartmental Epidemiological Model

1I. Adaptive Optimization with Dynamic Parameters

I1I. Policy-Driven Scenario Analysis

𝑑𝑑𝑑𝑑𝑑𝑑𝑑𝑑

= −𝛼𝛼𝛼𝛼(𝑑𝑑)𝑑𝑑𝑆𝑆

𝑑𝑑𝑑𝑑𝑑𝑑𝑑𝑑

= 𝑚𝑚(𝑑𝑑)(𝑈𝑈 + 𝐻𝐻 + 𝑄𝑄)

𝑑𝑑𝑈𝑈𝑑𝑑𝑑𝑑 = λ 1 − 𝑝𝑝𝑑𝑑 𝑆𝑆

DELPHI: Compartmental, Adaptive, and Policy-Driven



DELPHI is a Top Performer Among the Best

1. DELPHI is one of few models that predict for all 6 populated continents.

2. DELPHI is consistently the best-performing model for deaths in USA 1 month out.

3. DELPHI predicted the exponential worsening of the pandemic in United Kingdom, Russia, South Africa, Brazil, India more than two weeks in advance.



DELPHI Demonstrates the Effectiveness of Lockdown

Takeaway: Mild social restrictions alone are insufficient to counteract

the spread of COVID-19

100%

87%

67%

48%42%

24%

No Measure Restrict MassGatherings

Restrict MassGatherings,Businesses

Restrict MassGatherings,

Schools

Restrict MassGatherings,

Schools, Work

Lockdownγ(

t)

𝑅𝑅0 = 1



>75% of Deaths Avoidable if Lockdown Started 1wk Early

-100%

-90%

-80%

-70%

-60%

-50%

-40%

-30%

-20%

-10%

0%

Perc

enta

ge D

ecre

ase

in D

eath

s

The policy-driven approach in DELPHI enables us to understand “what-if” policy scenarios

Up to 250,000 (~75%) direct-cause deaths till June avoidable if lockdown restrictions were implemented one week earlier



Managing the Pandemic: Vaccine Trial Design

Since May, DELPHI has been guiding Johnson & Johnson for trial location selection for leading single-dose candidate Ad26.Cov2.S.

DELPHI-guided location selection resulted in >2x improvement in baseline incidence up to October, potentially halving time to results

Goal: Conduct vaccine trials in locations with highest future incidence to minimize time to results



Outlook: Pandemic Likely Stays Beyond 2021 Q1

>80MTotal Detected Cases

>2MConfirmed Deaths

>250kDaily Cases

Global Active Cases Q1 2021Prediction Q1 2021


covidanalytics.io

[email protected]

http://mlli.mit.edu/

[email protected]


Manuscript: Forecasting COVID-19 and Analyzing the Effect of Government Interventions. Under Review at Operations Research.

Thank you!



COVID-19 mortality prediction:a data-driven risk assessment toolHolly Wiberg | MIT Operations Research CenterJoint work with D. Bertsimas, G. Lukin, L. Mingardi, O. Nohadani, A. Orfanoudaki, and B. Stellato


MotivationEarly in the pandemic: rapid rise of COVID-19 cases globally, but lack of understanding of clinical risk factors at an individual level.

Initial work focuses on descriptive analysis of risk factors in small cohorts.

Limitations to early work: Patient risk is nonlinear. Unclear how risk factors generalize to broader

populations.Please note that any views and opinions expressed by speakers at the Summit do not necessarily reflect those of Swiss Re or Palantir.




Personalized Risk Estimation for COVID Patients

Goal: develop a machine learning model to predict patient outcomes through a single risk score that can facilitate triage decisions and inform patient care.

1. Curate data from multiple hospitals from the US and Europe.

2. Leverage state-of-the-art methods in machine learning.

3. Incorporate clinical expertise from leading doctors treating COVID-19 patients.

Models Clinical Expertise

Patient Data

Decisions



1. Curate international, multi-center database.


Patient Data

Decisions

Important to test model on diverse populations before deploying in new clinical settings.



2. Leverage state-of-the-art machine learning methods.


Patient Data

Decisions

X% Risk

XGBoostModel

Cohort N AUCTraining Set 2755 94.7

Testing Set 307 90.19

Hellenic CSG 323 87.45

Seville 219 91.62

Hartford Hospital 323 80.66



3. Incorporate clinical expertise.


Patient Data

Decisions

SHAP framework offers interpretability and insight into risk drivers for mortality.

Enables clinical engagement: builds credibility and model trust to enable adoption.


Created an online application for physicians• Offer models with and without lab values based on

information available to end-user. • Personalized SHAP plot gives insight into individual

risk contributions.• Link: covidanalytics.io/mortality_calculator

Prospective Validation• Model has been implemented in the EMR of Seville’s

hospital system.• Plan to validate performance going forward.

Clinical Integration


https://www.covidanalytics.io/mortality_calculator

covidanalytics.io

[email protected]

hwiberg.github.io

[email protected]


Thank you!Manuscript: Bertsimas et al. COVID-19 Mortality Risk Assessment: An International Multi-Center Study. Minor Revision at PLOS One.



Personalized Prescription of ACEI/ARBs for Hypertensive COVID-19 Patients

Agni Orfanoudaki| MIT Operations Research CenterJoint work with D. Bertsimas, A. Orfanoudaki, Holly Wiberg, et al.


Drug Repurposing for the Treatment of COVID-19 Patients


Dexamethasone

Remdesivir

Chloroquine/HydroxychloroquineCorticosteroids

Antiviral Agents (lopinavir/ritonavir)

Antibodies

Convalescent Plasma Transfusion

ACE inhibitors/ARBs



ACE inhibitors (ACEI) & Angiotensin-Receptor Blockers (ARBs)ACEI/ARBs are commonly prescribed to treat high blood pressure and heart problems.

Initially, there was concern regarding potential side-effects related the use of these drugs for COVID-19 patients.

Multiple clinical investigations from various countries showed that neither ACEIs nor ARBs were associated with an increased risk of in-hospital death or severe COVID-19.

Can ACEI/ARBs be beneficial for specific groups of COVID-19 patients with hypertension?



Can we personalize the use of ACE/ARBs for COVID-19 patients?

Suppose that Jane is admitted at the hospital due to COVID-19.




Should we prescribe ACE/ARBs to Jane?




We take a look at her clinical admission values and medical history.




We process the data to standardize its format and impute the missing values.




We use multiple machine learning models to estimate what will happen to Jane under both scenarios.




We prescribe to Jane ACE/ARBs only if our models suggest that they will decrease her chances of dying or experiencing any complications.




Goal: To develop and validate a prescriptive algorithm that identifies whether an individual diagnosed with hypertension is likely to benefit from the use of

ACE/ARBs for COVID-19 treatment



Data: An international cohort of patients



Comparison of Treatment Patterns

Patients with cardiovascular disease benefit the most.

Patients with low oxygen saturation levels are more likely to suffer with ACEI/ARBs.



Clinical Integration

We bridge the gap with practitioners by offering an online interface• Transparent application that

shows the recommendations of every model

• Link: covidanalytics.io/treatments


https://www.covidanalytics.io/treatments

covidanalytics.io

[email protected]

www.mit.edu/~agniorf/

[email protected]


Thank you!Manuscript: Personalized Prescription of ACEI/ARBs for Hypertensive COVID-19 Patients. Under Review at Health Care Management Science.



TherapeuticInterventions

Stefano Rensi / Stanford



Proven Effective Therapeutics

1. Remdesivir

2. Dexamethasone



Remdesivir

Overview• Intravenous drug• Targets viral replication• Originally developed for Ebola• Approved by FDA Oct 22, 2020• Mixed record in clinical trials

PLACE IMAGE HERE



Dexamethasone

Overview• Corticosteroid• Targets host inflammation• Approved for many indications• Strong efficacy signal in trials

PLACE IMAGE HERE



Communication ChannelsFormal and informal channels for info sharing• Publications• Seminars• Proposals / Applications• Professional Networks

Purpose of communication• Dissemination of policy• Generation of policy



Long-term COVID-19 health effects

Christoph Nabholz / Swiss Re



Life & Behaviour R&D team

PLACE IMAGE HERE

We power Swiss Re to build and maintain

a decisive commercial edge through

advanced research and forecasting

• Dr Christoph Nabholz

Head Life & Behaviour R&D

• Francesca Tamma

Head Behaviour Research

• Priya Dwarakanath

Head Life Research & Forecasting



Swiss Re Institute • Superior research driving better

decisions.• We share our risk knowledge in

re/insurance through our publications, data sets, client programmes and conferences.

• We produce and support risk research across Swiss Re and partner organisations.

• In doing so, we foster greater resilience across society.

PLACE IMAGE HERE

https://www.swissre.com/coronavirus



Long-term effects on COVID-19 survivors• COVID-19 is a disease we have yet to

fully understand. • Most people who contract it will

experience a moderate to asymptomatic infection.

• But some survivors will suffer potentially serious long-term conditions.

• What does this mean for insurers and society?

Source: Nat Metab 2, 572–585 (2020). https://doi.org/10.1038/s42255-020-0237-2


https://doi.org/10.1038/s42255-020-0237-2


What we need to watch out for• The global scale of COVID-19 suggests there will be millions of survivors with long-term conditions.

• Their symptoms fall into various groups, including ventilation recovery, organ damage, increased frailty, posttraumatic stress disorder, and those with unpredictable post-virus fatigue symptoms.

• Insurers may see claims for additional healthcare, costs for rehabilitation, lost earnings, care costs for increased frailty and possibly increased mortality from organ damage.

• Insurers should look at their long-term claim trends and anticipate the scars COVID-19 will leave on the health of COVID-19 survivors



“We have to face reality - never before have we reached herd immunity via natural infection with a novel virus, and SARS-CoV-2 is unfortunately no different.”

Kristian Andersen, immunologist at the Scripps Research Institute in La Jolla, California



False promise of COVID-19 herd immunity?

• Can we reach heard immunity? New findings provide evidence of variable waning in antibody positivity over months rather than years.Sweden’s case fatality rate, which is based on the number of known infections, is also at least three times those of Norway and nearby Denmark.

• Should COVID-19 be left to spread among the young and healthy?COVID Symptom Study suggests 14% are ill for 4 weeks, 5.1 for 8 weeks and 2% for 12+ weeksLong COVID affects 10% of symptomatic 18-49 year olds, rising to 22% of over 70sPotential to transmit increases with age, and adolescents are just as likely to transmit as adults



Covid-19 attitudes and compliance

Sarah Jones / YouGov


The global pandemic has highlighted national and cultural differences in response

For compliance, law persuades more than messaging on key behaviors

Covid-19 is global, but a one size fits all solution doesn’t work

We show willingness to improve our behaviors, but our actions don’t always match up

ICL YouGov Study: 413,000 participants, 29 countries, 42m datapoints collected

Do European countries differ in preventative behaviours compliance?

The most adhered-to preventative measure is hand washing.

The most polarised is mask wearing

There is large variation with 4% in Sweden report wearing a mask compared with 96% in Spain

In the UK 34% report always working from home, compared to 12% in Denmark

49% of respondents in the UK reported avoiding having guests over, compared to just 16% in Denmark.

Week of 4 Oct Thinking about the last 7 days how often have you… ? (% of respondents who reported “Always” following each measure)

Low High

% Always

Asian countries are by far the most willing to be facemask compliant –numbers exceed 50% in every category for almost every age group

Across Europe and North America compliance substantially increases with age

The single biggest influence across all categories is the law

Outside of Asia facemask compliance comes from laws, not advice

How willing or not are you to wear a face mask or covering if … ?

When would you be very willing to wear a mask?

33%

41%46%

54%58%

61%

30%

37%40%

29%

36% 38%

0%

10%

20%

30%

40%

50%

60%

70%

80%

16-39 40-59 60+

Europe Your government advised that you should It was the law to do so

Most people around you wear one International organizations advised that you should

62% 63%56%

62% 64% 64%57% 58%

49%

59% 58%

49%

0%

10%

20%

30%

40%

50%

60%

70%

80%

16-39 40-59 60+

APAC

Face mask usage grew dramatically when the rules changed

Thinking about the last 7 days… how often have you taken the following measures to protect yourself or others from coronavirus (COVID-19)?

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

2020-03-30 2020-04-27 2020-05-25 2020-06-29 2020-08-03 2020-08-31 2020-10-12

Always Not at all

40%

30%

9%

12%

7%

7%

22%

33%

16%

4%

20%

10%

15%

30%

0% 5% 10% 15% 20% 25% 30% 35% 40% 45%

I don't have any symptoms

Most other people are not wearing them

People would think I had Covid-19

I think only sick people should wear them

Coronavirus / COVID19 is not dangerous for me

It is unlikely that I will get Coronavirus / COVID19 in the future

Masks are not effective in preventing the spread of Covid-19

North America 16-39Europe 16-39

Not personally having symptoms, the biggest driver for younger people’s resistance to wearing a mask

Europeans are more affected than North Americans by peer pressure – others not wearing a mask + other people thinking they would have it

North Americans however are far more likely to question the value in wearing a mask

Why are you currently not wearing a mask or face covering when you go outside? Please tick all that apply

The annual World Happiness Report attributes the differences over time and between countries to good health, income and the quality of social environment

Following the Netherlands, the Nordic countries have the highest reported life satisfaction of European countries surveyed. The UK has the lowest in the region

Vietnam has the highest reported life satisfaction of Asian countries surveyed

Korea has the lowest recorded score of surveyed countries

The Cantril ladder - a proxy for life satisfaction

Weeks Sept 6 - Oct 4

Asia Steadily Comes Back on Public Transport; Europe Backing Away Again

Survey response (%)

Always

Survey response (%)

Always

Lockdown Fatigue in Europe Now: Nowhere Near April Levels of Avoid Mixing in Homes

Survey response (%)

Always

Anxiety and Depression – Strong Association with Age29 Countries

National average life satisfaction compared to Covid-19 death ratesAsia and the west,

a contrasting picture

Asian countries have the lowest death rates per 100k and a wide range of happiness.

The happiest among the western industrial countries are also generally those with higher confidence in public institutions.

Cantril Ladder scores by country and cumulative Covid-19 deaths per 100,000 as of Sep 6

The US lags behind the European nations in both current compliance, and intended compliance

The UK and Italy show the greatest intent to improve in social distancing

Germany aside we see better adherence to face masks compliance compared to social distancing

Compliance -Across the board, society shows a willingness to do better in the future

Current = Over the past month, how strictly have you been following current WHO guidelines? (Showing Strictly + Very Strictly)

Future = Over the next few months, do you think you will follow current WHO guidelines more or less strictly than you have been? (Showing: the same or better)

85%88%

92%94%

96%98%

88%91%

75%

80%

85%

90%

95%

100%

Wearing a face mask

Face masks: Current compliance ‘V’ intent

US - Current US - Future UK Current UK- FutureItaly Current Italy - Future DE - Currently DE - Future

81%

88%

85%

94%

84%

98%

88%

91%

75%

80%

85%

90%

95%

100% Social distancing: Current compliance ‘V’ intent


Manfred Tautscher / Sinus Institut

Sinus-Meta-Milieus®Understanding people based on their values



Society underwent a seismic shift since the ‘60es

The Rich andthe Beautiful

The MiddleClass

Blue Collars

From a simple society... … to a complex system



Sinus-Meta-Milieus: „Groups of like-minded” people

► with similar value orientation and social situation

Soci

al S

tatu

s

Basic Values





PerformersIntellectualsEstablished

Sensation-Oriented

ModernMainstream

Traditionals

CosmopolitanAvantgarde

Consumer-Materialists

AdaptiveNavigators

Soci

al S

tatu

s

Basic Values





Sensation-Oriented

ModernMainstream

Traditionals



AdaptiveNavigators

Soci

al S

tatu

s

Basic Values





Sensation-Oriented

ModernMainstream

Traditionals



AdaptiveNavigators

Soci

al S

tatu

s

Basic Values





Sensation-Oriented

ModernMainstream

Traditionals



AdaptiveNavigators

Soci

al S

tatu

s

Basic Values









► .. lifestyle and likings► .. “open mindedness”► .. approach to “responsibility”

with similar communication patterns





Sensation-Oriented

ModernMainstream

Traditionals



AdaptiveNavigators

Soci

al S

tatu

s

Basic Values



Accelerating data driven public policy in the Covid era

Noam Perski / Palantir Technologies



Panel 2Russ Altman / Stanford


Documents

Insights on the most - Swiss Re