Podcast Extra: Coronavirus - science in the pandemic

Host: Nick Howe

I’m currently at home recording this podcast, probably for the same reason that many of you are at home – the coronavirus. Now, I’m one of the lucky ones. I can work from home and I haven’t been infected so far, but in a small or large way, the coronavirus (SARS-CoV-2) has affected and will affect everyone. Daily, I find myself scrolling through the news to try and get some sense of what can be done. One thing is clear though, front and centre of the response of this pandemic is the role of scientists.

Interviewee: Jamie Lloyd-Smith

Certainly, not a dull moment to be in the business.

Interviewer: Nick Howe

This is Jamie Lloyd-Smith, an epidemiologist from the University of California, Los Angeles.

Interviewee: Jamie Lloyd-Smith

My academic brain is, you know, this is a fascinating event. This is the type of event that I’ve been studying and thinking about for decades and here is it. It’s happening and it is an exciting and fascinating thing from that point of view. With that said, both from my own individual interest and from a sort of global public health interest, it’s also this unfolding catastrophe.

Interviewer: Nick Howe

Here at Nature, we’re talking to scientists like Jamie every day from institutions all over the world. In this Podcast Extra, we’ll be hearing from Jamie and others like him as they battle to fight the outbreak. What is it like to answer the global call for science in the wake of the coronavirus?

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Interviewer: Nick Howe

First off, we’re going to Washington State in the United States, by many accounts, the epicentre of the US outbreak, and the lab of Lea Starita, a genomicist at the University of Washington. Lea is a sequencer. She normally works with flu genomes, but since the outbreak, she’s been adapting to help tackle the coronavirus. During her reporting, Amy Maxmen visited Lea and took a recorder with her. You’ll hear Amy asking questions from time to time. Here’s Lea.

Interviewee: Lea Starita

So, obviously, it was starting as a flu project. We’ve actually produced something like a quarter of the world’s flu genomes in the last year and a half. That gave us this infrastructure that we’re now kind of pivoting towards COVID-19.

Interviewer: Amy Maxmen

So, what do you have to do right now, like this past week, knowing that you’re going to be doing a bunch more sequencing. What are you doing right now?

Interviewee: Lea Starita

Spending a shit load of money.

Interviewer: Nick Howe

Lea and her colleagues have been given a US$5 million grant from the Gates Foundation to transform their lab into a coronavirus sequencing centre, processing more samples and helping diagnose people that have the disease. When Amy spoke to them, their lab benches were full of boxes of untested samples, which they need to work through more rapidly. But it isn’t just as simple as working harder.

Interviewer: Amy Maxmen

Because what do you need?

Interviewee: Lea Starita

We need another extraction robot, we need more people. I’m trying to build an automated sample sectioning system with a company that makes robots, like automated robots, so that maybe a robot can take apart all of the boxes that we need.

Host: Nick Howe

Robotic sequencers are fast and efficient, but sequencing isn’t the bottleneck right now.

Interviewee: Lea Starita

The rate limiting stuff right now is that I need humans to basically touch every single sample that comes in, right?

Interviewer: Amy Maxmen

I can’t believe it. So, you have to rapidly hire people – that’s the bottleneck?

Interviewee: Lea Starita

Yeah, exactly. Once it comes here, I mean these guys have the capacity to do like thousands of genomes a week, it’s not a problem. It’s just like getting to this step is the hard part.

Host: Nick Howe

Lea hopes to be able to ramp up capacity to be able to test 1,000 samples a day. This would help identify positive cases but also put people’s minds at ease knowing that they might now have the virus. But diagnosing cases is just one piece of the puzzle. Ultimately, researchers also want to also help slow the spread of the virus, and that’s what we’re talking about next. We’ll be heading to Italy, the hardest hit country outside of China. Stay tuned.

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Host: Nick Howe

Four months after the first cases in Wuhan, China, the virus has spread to more than 100 countries. Previous viral outbreaks like SARS or H1N1 flu have also spread widely, but with COVID-19, something is different. Here’s Jamie Lloyd-Smith again.

Interviewee: Jamie Lloyd-Smith

Unfortunately, it seems like this virus is sort of in a sweet spot or not sweet spot where it is quite transmissible, quite hard to contain, and it is inflicting significant mortality and morbidity. And this virus, a respiratory virus against which there is no population immunity, which is able to transmit through relatively casual contacts, and if it can do asymptomatic transmission, these are all the factors that we worry about most in terms of giving rise to a pathogen which is very hard to contain.

Host: Nick Howe

Containment has certainly proved difficult, and few countries are as aware of this as Italy, where tens of thousands have been infected. Flavia Riccardo, an epidemiologist from the Italian National Institute of Health has been involved in Italy’s response from the very beginning.

Interviewee: Flavia Riccardo

We were in the unfortunate situation of having our first case with no travel history and no known contact with the confirmed global cases.

Host: Nick Howe

Italy did not find ‘patient zero’ – the first person who imported the virus into the country – and that made it much harder to control. By the time Flavia and her colleagues could react, the virus was already spreading fast.

Interviewee: Flavia Riccardo

When we found our case and we looked for contacts, we found a lot of positives. So, we were in a moment in which we caught it, we saw it for the first time, we photographed, if you like, the situation when this had been going on for some time, and this made it harder for us to stop it.

Host: Nick Howe

Italy reacted quickly to contain the outbreak, implementing social distancing, quarantining cities, and eventually the entire country, very literally ensuring people are not close together.

Interviewee: Flavia Riccardo

And this is affecting really everything. You have to stop shaking hands, you have to keep a distance from people, not bunch together, avoid being at the same coffee machine. Coming to work, of course, you have to be careful about distancing, you have to be careful about washing your hands all the time. When you go into a meeting, making sure that there’s not too many people in that room, keeping the windows open, avoiding the lift, taking the stairs. There are a number of small things that we need to engrain into the way we do things.

Host: Nick Howe

And Flavia thinks this approach is working. Cases appear to be slowing in some regions.

Interviewee: Flavia Riccardo

But we’ll need to wait to see the timespan of about a couple of weeks what effect we have today, so we have to monitor the situation and move as we go. Unfortunately, it’s not a thing that’s overnight. We have to be also prepared to be in a situation of response for a few months at least.

Host: Nick Howe

Waiting and seeing is not always that easy, especially when such measures may cause upheaval in people’s lives.

Interviewee: Flavia Riccardo

I have a daughter that is now in another part of the region with my parents and I can’t see her and I can’t see my parents because they’re over 70.

Host: Nick Howe

But Flavia is sure that social distancing is necessary, and she hopes people will stick with it and that other countries can learn from Italy’s experience. The key, she says, is communication.

Interviewee: Flavia Riccardo

We really have to translate some of the science into layman’s language, trying to explain why we’re giving that recommendation, why we can’t expect a certain result.

Host: Nick Howe

The strategies proposed by epidemiologists like Flavia and Jamie are devised and tested using models, simulations which allow them to virtually play out possible future scenarios.

Interviewee: Jamie Lloyd-Smith

One of the great applications of models is that you can do all these thought experiments, like here’s what an outbreak looks like, and then layering on various hypothetical control policies to see, to try to give guidance or at least to enable policymakers to have information about that part of the equation. Clearly, people in policymaker roles are always balancing much more, like human rights and freedom and economics and all those other dimensions which are outside the domain of our models, but you can at least say, well, if you did do this, here’s how much we think it would help.

Host: Nick Howe

Transitioning from research to policy is a tricky manoeuvre. There’s pressure to make quick decisions, but incomplete information leads to an ever-changing picture of what the virus is and how it spreads. And as different countries employ a range of strategies, it’s hard to know what’s most effective. So, what should policymakers be doing? Are they getting it right and what lessons can we learn for future outbreaks? That’s up next. Stay tuned.

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Host: Nick Howe

As the coronavirus outbreak spreads further and further, governments worldwide are implementing policies to slow or contain the virus, from hygiene advice to travel bans, from cancelling cultural events to quarantining entire cities. One common approach has been to start screening travellers for signs of the disease, but according to Jamie Lloyd-Smith, that’s probably not that effective.

Interviewee: Jamie Lloyd-Smith

People are doing fever screening as a means of assessing should we let this person off the cruise ship or whatever, and fever screening is being applied in all kinds of contexts across all kinds of societies, so I think it is important to put as much scientific heft as your able to behind the message that that is a very faulty tool.

Host: Nick Howe

Researchers are finding out more everyday about how the virus is transmitted between people. But it does seem clear that it can spread before people even show symptoms.

Interviewee: Jamie Lloyd-Smith

Inherently, every disease has an incubation period, so there’s a period of time before you show your symptoms, and that’s conventionally been the concern, that these non-contact thermometers aren’t perfect and people who are doing it all day long, it will be a bit error-prone. Many people won’t have developed their symptoms yet and increasingly, we still don’t really understand what fraction of people never show symptoms of that sort, but it could easily be tens of percent of people don’t ever show those symptoms and so they’re inherently not screenable by those means. There’s just too many cases that don’t trigger the alarm because they don’t have conspicuous symptoms.

Host: Nick Howe

There are ways to try and catch asymptomatic cases, but even these show unclear levels of success.

Interviewee: Jamie Lloyd-Smith

There are these sorts of questionnaires of have you been in contact with someone who has COVID-19, and if they know it and if they choose to self-declare then that’s another way you can catch people independent of their symptoms, but I think most people don’t know, particularly given the level of diagnosis, and based on our earlier analysis of flu pandemic data, many people may not choose to disclose if they do know.

Host: Nick Howe

Researchers like Jamie are learning more and more about which interventions might prove effective every day. But to be effective, measures still need to be implemented by governments. I reached out to Claire Wenham from the London School of Economics, who specialises in the politics of health emergencies and outbreaks.

Interviewee: Claire Wenham

Policy matters here. The way governments respond to an outbreak has a direct impact on the trajectory of the disease transmission within countries. We’ve only got to look at the difference between somewhere like South Korea and the USA at the moment. South Korea’s policy which was transparency with communication, testing everybody, minimalising social contact, social distancing meant that they were able to get a real hold on what the disease looked like in their country, who had it, and now they’ve been able to reduce transmission accordingly. Now, the opposite approach is to kind of bury your head in the sand and pretend there isn’t a problem, which is what we’re seeing in the US and what we saw in Iran a few weeks ago.

Host: Nick Howe

In the United States, cases have grown by the hundreds per day in the last week, and even that is considered by many as an underestimate. Since this was recorded, the USA has stepped up its response, including limiting gatherings of ten people or more. Just before I spoke to Claire, the USA had shut down travel from Europe, but Claire thinks that even this may be more of a political tool rather than one that combats the virus.

Interviewee: Claire Wenham

It will appease voters, right. It will make the general population of the US think he’s got our back, he’s doing something, he’s protecting Americans above all.

Host: Nick Howe

In fact, across the world, Claire says that international agreements set out to guide countries on how to deal with pandemics have largely been ignored.

Interviewee: Claire Wenham

What we’ve seen in this instance is that actually, the international health regulations haven’t been adhered to and actually there have been several breaches where governments have taken much more protectionist positions, and so I think this tells us that at the time of a crisis, actually, governments tend to focus on their own rather than they do of a kind of collective responsibility to global health security, and that can’t be that surprising, right? We as citizens from whatever country we are, we expect our government to look after us as their number one priority.

Host: Nick Howe

But if advice isn’t followed, can we rely on international collaboration to stymie the spread?

A prescient question when you take into account that this virus could disproportionately affect lower-income countries, which often rely on help and donations from wealthy nations to combat this kind of crisis. Such cooperation was key to prevent the spread of Ebola, for example. But even recommended advice can have difficult consequences. Claire thinks measure such as closing down schools and social distancing can affect women disproportionately.

Interviewee: Claire Wenham

Most frontline healthcare workers, somewhere between 70 and 90% globally, are women, and they’re the ones on the frontline of responding to an outbreak. We need to make sure that their differential needs are met. And then social distancing measures to respond to outbreaks such as closure of schools. Well, who’s taking up that additional care if suddenly your children can’t go to school. Societal norms would tell us that would be women who are going to pick up that labour, so then what does that mean for their own jobs, their own job security, their own economic security?

Host: Nick Howe

Claire argues that the kind of social upheaval we’re seeing was predicted by social scientists, but she hopes that for the next outbreak, and there will be one, lessons will be learned.

Interviewee: Claire Wenham

We need to think much more holistically about outbreak prevention and about pandemic preparedness, and about what can we do to mitigate against these potential impacts of outbreaks, both primary direct impacts and direct impact on population but also the broader impacts on economy, social structures, individuals. And I think the key thing for me is that actually, maybe we need to understand that outbreaks aren’t just for epidemiologists and aren’t just for virologists, but you need to have that social science expertise in the room as well.

Host: Nick Howe

Since the beginning of the outbreak, researchers worldwide have quickly kicked into action, sometimes transforming their research, sometimes trying to help their country fight the outbreak or sometimes just trying to make sense of it all. And all the time, remember, researchers aren’t just studying this outbreak – they’re feeling it too.

Interviewee: Jamie Lloyd-Smith

In some sense, it’s horrible to watch this inexorable progression, and you can sort of see it coming and perhaps before it even happens you’re like, oh no, this has all the traits of a real problem.’ It’s a very real concern. As a parent and as a child, there are a lot of people who I care about who may be put at risk.

Host: Nick Howe

In this podcast extra, you heard from Jamie Lloyd-Smith, Lea Starita, Flavia Riccardo and Claire Wenham. The interviews were recorded by Amy Maxmen, Anna Nagle and me. The show was also produced by me with edits from Noah Baker. As the pandemic continues, we’re going to keep bringing you stories from the scientific world, but we also want to hear from you. Has your research been impacted by the pandemic? Has your lab had to close? Do get in touch with your stories @NaturePodcast or email us on podcast@nature.com. I’ve been Nick Howe. Thanks for listening.