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In the face of great uncertainty and a global crisis from COVID-19, mathematical and epidemiologic COVID-19 models proliferated during the pandemic. Yet, many models were not created with the explicit audience of policymakers, the intention of informing specific scenarios, or explicit communication of assumptions, limitations, and complexities. This study presents a case study of the roles, uses, and approaches to COVID-19 modeling and forecasting in one state jurisdiction in the United States. Based on an account of the historical real-world events through lived experiences, we first examine the specific modeling considerations used to inform policy decisions. Then, we review the real-world policy use cases and key decisions that were informed by modeling during the pandemic including the role of modeling in informing planning for hospital capacity, isolation and quarantine facilities, and broad public communication. Key lessons are examined through the real-world application of modeling, noting the importance of locally tailored models, the role of a scientific and technical advisory group, and the challenges of communicating technical considerations to a public audience.

Introduction: Recent findings outline negative effects of brain insulin signaling on memory due to hyperinsulinemia. We investigated the association between insulin resistance (IR) with AD and dementia., Methods: Later life Japanese men (N = 1544, mean age = 79.9 years) with normal cognitive function were followed from exam 4 to 5 of the Kuakini Honolulu Asia Aging Study. Subjects underwent physical exams, blood draws, and neuropsychological testing. IR status was determined at exam 4 using the McAuley and HOMA indices. Subjects with prevalent diabetes and dementia were excluded. Incident dementia and AD cases were determined at exam 5., Results: IR was associated with decreased odds of AD and dementia using both IR indices. Carriers of the APOE ε4 allele had 15% increased odds of AD and dementia., Discussion: Our findings provide insight regarding possible inverse relationship between IR and AD in elderly Japanese men, and support biologic studies showing short term hyperinsulinemia improves memory and cognitive function., (Copyright © 2019 Elsevier B.V. All rights reserved.)