News & Views from Quarantine

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You can read my previous pandemic blog posts from April 6, April 2, March 22-25, March 19-21, and March 14-18. As always, you should take everything you read on the internet with a healthy dose of skepticism, and I am not an epidemiologist. But I try to provide relevant evidence from credible sources and use my scientific/statistical training to summarize the highlights of pertinent research with a side of editorialization.


Data viz of COVID-19 spread in the U.S. since January 2020 by University of Michigan PhD Candidate Marlena Duda

Where to go for resources:

  • The COVID-19 Health Literacy Project has translated health information 30+ languages
  • A curated list of COVID-19 resources by Research Stash for researchers but there are lots of interesting things like the COVID-19 Refund Tracker for consumers.
  • A science communicator I have followed for a while, Dr. Samantha Yammine, is thoroughly covering COVID-19 topics on her website
  • Another science communicator I follow, Dr. Susanna Harris, outlines how she decides to believe a source. The highlights:
    Do they say they can prove something? Are they using “always” or “never”? :triangular_flag_on_post:
    Are they citing sources or explaining why they have the necessary expertise? :heavy_check_mark:
    Can they admit their mistakes or update the audience when new info comes in? :heavy_check_mark:
  • I’ve written about science coming out of pre-prints from biorxiv or medrxiv. These studies are great to keep policy-makers, health care providers, and other scientists aware of the most recent information, but they haven’t undergone the thorough peer review that typically occurs during the process of publishing scientific findings. A former colleague of mine, Dr. Jedidah Carlson now at the University of Washington created the COVID-19 Preprint Index which allows users to search and navigate pre-prints. A statistical method called dimensionality reduction is used to sort the papers’ keywords so they are grouped by topic (e.g. vaccines, models). You can note their Altmetric Attention Score to see which preprints are most popular.
  • Another app has been launched to help researchers track and understand COVID-19 symptoms. The added bonus is for each signup they will donate a meal to people in need. Read more here. And here is the research app I highlighted previously.
  • Some scientists hosted a COVID-19 Discussion on Reddit on Wednesday, April 8. They answered questions from the general public and had lots of discussion about potential pharmaceutical approaches, albeit a bit technical.
  • National Institute of Mental Health Director Dr. Joshua Gordon and National Institute Director Francis Collins discussed dealing with stress, anxiety, and grief during the pandemic. You can read or watch their conversation and there are mental health resources at the bottom.
  • The CDC is constantly updating the clinical guidance for management of COVID-19 patients with lots of scientific evidence (>70 studies). This is for clinicians but could be a good resource for those interested.
  • Network modeling by scientists at the University of Washington demonstrates why you shouldn’t even visit just one friend even though I know we’re all eager to do so. Show this to your friends to explain why every additional connection that we can postpone will save lives.
  • Support local businesses and health care workers with Frontline Foods in 41 cities and counting

Why this research matters:

  • Belgian and Dutch engineers released a white paper concerning optimal distancing between individuals during movement (walking, running, biking). While 1.5 meters or 6 feet is a good rule of thumb for people standing apart, these engineers’ simulations show a greater distance should be maintained during activity. The risk of contamination by large microdroplets is greatest when walking or running directly behind another person and 4-5 meters (13-16 feet) should be maintained to avoid moving through this cloud of particles. This work hasn’t been released on a typical pre-print server so I’m unable to evaluate the findings based on the reactions of other experts. Based on this work, I think it’s good to consider maintaining maximum physical distance and keeping 6 feet as our “worst case scenario” of proximity.

  • A report published in the journal Science with research by Harvard epidemiologists made headlines yesterday for its conclusion that prolonged or social distancing may be needed into 2022. They modeled transmission using estimates of seasonality (e.g. viral disease transmission tends to decrease overall in the summer), immunity (duration of immunity from antibodies in people who have already fought the infection), and cross-immunity (the possibility that exposure to existing mild to moderate coronavirus strains may provide protection against SARS-CoV-2). They looked at several different scenarios, for example the one time social distancing we are experiencing now, of various durations, both with and without virus seasonality. They also considered intermittent social distancing in a world with our current critical care capacity in the nation’s hospitals and with extended capacity. There are plenty of limitations thoughtfully outlined in the discussion, for example, it is unknown how long an infected person will maintain immunity (that’s why serology testing to understand this is so important). These scenarios will change in the presence of vaccines or other interventions such as aggressive contact tracing and quarantine. The authors conclude the total incidence of the virus through 2025 will depend on the duration of immunity and the cross-immunity with other coronaviruses. A key paragraph emphasizes why this research is important:

    “Intermittent distancing may be required into 2022 unless critical care capacity is increased substantially or a treatment or vaccine becomes available. The authors are aware that prolonged distancing, even if intermittent, is likely to have profoundly negative economic, social, and educational consequences. Our goal in modeling such policies is not to endorse them but to identify likely trajectories of the epidemic under alternative approaches, identify complementary interventions such as expanding ICU capacity and identifying treatments to reduce ICU demand, and to spur innovative ideas to expand the list of options to bring the pandemic under long-term control”

  • An antiviral that can be taken in pill form, EIDD-2801, is showing some promise. NPR covered this and the research was published in Science Translational Medicine. β-D-N4-hydroxycytidine (aka NHC, EIDD-1931) is an antiviral known to work against RNA viruses like influenza and Ebola and it was “potently antiviral” (i.e. it worked) against SARS-CoV-2 and other related coronaviruses in infected cell lines and primary human airway cell cultures (what we would call in vitro). A prodrug, which means it is converted to the active drug inside the body, of EIDD-1931 called EIDD-2801 was already optimized for use as a medicine for humans. They tested EIDD-2801 in mice who were infected with a mouse-adapted version of SARS-CoV and found it was “potently antiviral”, but clinical benefit was best when administered ~24 hours after infection. They concluded that more research was needed, but any research on coronavirus treatments is relevant for this pandemic and future ones. While we should temper our expectations for EIDD-2801 becoming an immediately useful therapeutic, all new scientific evidence in this space is inching us forward.

Who I’m following:

What I’m reading:

  • Science writer Ed Yong’s piece for The Atlantic about what reopening the U.S. in the midst of an ongoing pandemic will look like. As epidemiologist Dr. Michael Osterholm is quoted: “This isn’t about the next couple of weeks, this is about the next two years.”
  • The COVID-19 diary of a New York Emergency Room doctor. It’s a long read and I’m not through it all, but I believe it is an important perspective to hear.
  • An opinion piece for the NY Times by epidemiologists illustrating the cost of waiting to contain the pandemic. As they say, “The absolute numbers are largely beside the point. No model is a crystal ball, and there is far too much uncertainty in the trajectory of the U.S. epidemic to conclude that a certain prediction will be borne out. What matters more is the relative effect of moving earlier rather than later in trying to contain the spread.”
  • Investigative journalism by the Washington Post showing the State Department was worried about safety measures at Wuhan Institute of Virology in 2018. I think it’s important to note that the science still holds that this virus was not engineered or purposely manipulated, and all evidence points to it originating from a bat. This new evidence sounds like it is plausible that the virus could have infected someone due to human error, improper equipment, or poor institutional support during the very important study of the natural virus in a Biosafety Level 4 lab. We should also be vigilant to not let this fuel ugly xenophobia or cause international conflict. Understanding viral origins are important, but I would hate for this to be used to do more harm during a global crisis.

An important addition to this final point from April 23, 2020. NPR is reporting that virus researchers who are experts in this kind of lab work say “there is virtually no chance that the new coronavirus was released as a result of a laboratory accident in China or anywhere else.” I weight this evidence more strongly than the previously reported tenuous evidence about laboratory problems from China.