Modeling COVID-19 disease processes by remote elicitation of causal Bayesian networks from medical experts.

BACKGROUND: COVID-19 is a new multi-organ disease causing considerable worldwide morbidity and mortality. While many recognized pathophysiological mechanisms are involved, their exact causal relationships remain opaque. Better understanding is needed for predicting their progression, targeting therapeutic approaches, and improving patient outcomes. While many mathematical causal models describe COVID-19 epidemiology, none have described its pathophysiology. METHODS: In early 2020, we began developing such causal models. The SARS-CoV-2 virus's rapid and extensive spread made this particularly difficult: no large patient datasets were publicly available; the medical literature was flooded with sometimes conflicting pre-review reports; and clinicians in many countries had little time for academic consultations. We used Bayesian network (BN) models, which provide powerful calculation tools and directed acyclic graphs (DAGs) as comprehensible causal maps. Hence, they can incorporate both expert opinion and numerical data, and produce explainable, updatable results. To obtain the DAGs, we used extensive expert elicitation (exploiting Australia's exceptionally low COVID-19 burden) in structured online sessions. Groups of clinical and other specialists were enlisted to filter, interpret and discuss the literature and develop a current consensus. We encouraged inclusion of theoretically salient latent (unobservable) variables, likely mechanisms by extrapolation from other diseases, and documented supporting literature while noting controversies. Our method was iterative and incremental: systematically refining and validating the group output using one-on-one follow-up meetings with original and new experts. 35 experts contributed 126 hours face-to-face, and could review our products. RESULTS: We present two key models, for the initial infection of the respiratory tract and the possible progression to complications, as causal DAGs and BNs with corresponding verbal descriptions, dictionaries and sources. These are the first published causal models of COVID-19 pathophysiology. CONCLUSIONS: Our method demonstrates an improved procedure for developing BNs via expert elicitation, which other teams can implement to model emergent complex phenomena. Our results have three anticipated applications: (i) freely disseminating updatable expert knowledge; (ii) guiding design and analysis of observational and clinical studies; (iii) developing and validating automated tools for causal reasoning and decision support. We are developing such tools for the initial diagnosis, resource management, and prognosis of COVID-19, parameterized using the ISARIC and LEOSS databases.

BARD: A Structured Technique for Group Elicitation of Bayesian Networks to Support Analytic Reasoning.

In many complex, real-world situations, problem solving and decision making require effective reasoning about causation and uncertainty. However, human reasoning in these cases is prone to confusion and error. Bayesian networks (BNs) are an artificial intelligence technology that models uncertain situations, supporting better probabilistic and causal reasoning and decision making. However, to date, BN methodologies and software require (but do not include) substantial upfront training, do not provide much guidance on either the model building process or on using the model for reasoning and reporting, and provide no support for building BNs collaboratively. Here, we contribute a detailed description and motivation for our new methodology and application, Bayesian ARgumentation via Delphi (BARD). BARD utilizes BNs and addresses these shortcomings by integrating (1) short, high-quality e-courses, tips, and help on demand; (2) a stepwise, iterative, and incremental BN construction process; (3) report templates and an automated explanation tool; and (4) a multiuser web-based software platform and Delphi-style social processes. The result is an end-to-end online platform, with associated online training, for groups without prior BN expertise to understand and analyze a problem, build a model of its underlying probabilistic causal structure, validate and reason with the causal model, and (optionally) use it to produce a written analytic report. Initial experiments demonstrate that, for suitable problems, BARD aids in reasoning and reporting. Comparing their effect sizes also suggests BARD's BN-building and collaboration combine beneficially and cumulatively.

Individuals vs. BARD: Experimental Evaluation of an Online System for Structured, Collaborative Bayesian Reasoning.

US intelligence analysts must weigh up relevant evidence to assess the probability of their conclusions, and express this reasoning clearly in written reports for decision-makers. Typically, they work alone with no special analytic tools, and sometimes succumb to common probabilistic and causal reasoning errors. So, the US government funded a major research program (CREATE) for four large academic teams to develop new structured, collaborative, software-based methods that might achieve better results. Our team's method (BARD) is the first to combine two key techniques: constructing causal Bayesian network models (BNs) to represent analyst knowledge, and small-group collaboration via the Delphi technique. BARD also incorporates compressed, high-quality online training allowing novices to use it, and checklist-inspired report templates with a rudimentary AI tool for generating text explanations from analysts' BNs. In two prior experiments, our team showed BARD's BN-building assists probabilistic reasoning when used by individuals, with a large effect (Glass' Δ 0.8) (Cruz et al., 2020), and even minimal Delphi-style interactions improve the BN structures individuals produce, with medium to very large effects (Glass' Δ 0.5-1.3) (Bolger et al., 2020). This experiment is the critical test of BARD as an integrated system and possible alternative to business-as-usual for intelligence analysis. Participants were asked to solve three probabilistic reasoning problems spread over 5 weeks, developed by our team to test both quantitative accuracy and susceptibility to tempting qualitative fallacies. Our 256 participants were randomly assigned to form 25 teams of 6-9 using BARD and 58 individuals using Google Suite and (if desired) the best pen-and-paper techniques. For each problem, BARD outperformed this control with very large to huge effects (Glass' Δ 1.4-2.2), greatly exceeding CREATE's initial target. We conclude that, for suitable problems, BARD already offers significant advantages over both business-as-usual and existing BN software. Our effect sizes also suggest BARD's BN-building and collaboration combined beneficially and cumulatively, although implementation differences decreased performances compared to Cruz et al. (2020), so interaction may have contributed. BARD has enormous potential for further development and testing of specific components and on more complex problems, and many potential applications beyond intelligence analysis.