Coronapod: Troubling news

Benjamin Thompson

Welcome to Coronapod.

Noah Baker

In this show, we’re going to bring you Nature’s take on the latest COVID-19 developments.

Benjamin Thompson

And we’ll be speaking to experts around the world about research during the pandemic.

Amy Maxmen

I really don’t know how this plays out. We also don’t know a ton about this virus, so there’s so many open questions. I just have a really hard time making predictions because I don’t know how the outbreak is going to change.

Benjamin Thompson

Hi, I’m Benjamin Thompson. Welcome to episode five of Coronapod. I’m still here in my South London basement, and we’ve just heard that the lockdown in the UK seems to be extended for another three weeks so I could be here for a while longer. But thankfully, on Coronapod, I’m not on my own. I’m joined by Noah Baker and Amy Maxmen. How are you both doing?

Noah Baker

I quite enjoy this bit of a Thursday.

Amy Maxmen

I’m good. How are you? So fun talking to you guys.

Benjamin Thompson

Noah, how have you been getting on? So, week five of the lockdown for us here – how is rural Kent?

Noah Baker

Rural Kent is very much the same as rural Kent has ever been before. From where I’m sitting nothing is changing, but outside the world is moving at a pace and from inside this little bubble I’m trying to keep track of what’s happening outside, which is changing quickly.

Amy Maxmen

I can’t remember if I even said this to you last night but I meant to. Basically, I got this email from a couple of researchers that heard our podcast last week and decided to do this massive survey of what bottlenecks either labs that want to test or labs that are trying to test are hitting, and so far, they’re at like 4,000 people right now.

Noah Baker

That’s really cool. I love hearing that people are responding to the show. Do you know how they’re doing it? Is it just an online survey and they’re just emailing it out to people?

Amy Maxmen

It’s a SurveyMonkey survey. They got the email addresses of all of the principal investigators that have gotten grants from the NIH and mailed it to all of them. And so, of course, most of them are like, ‘No, I’m not doing testing because I don’t have a lab,’ right, but there’s a number that do and then they kind of break down if they want to do it, and they’ve gotten tons – I think like hundreds – of comments too that are also really interesting.

Noah Baker

Do they have a plan about what they’re going to do with that? I mean are they sharing that data widely or what’s the idea?

Amy Maxmen

They shared it with me.

Noah Baker

Laughs.

Amy Maxmen

They have a masterplan here. I think they’re hoping to get it seen, and I think they really took this call for coordination really seriously. So, one of the questions they ask is, ‘Do you think the NIH would be a good body to coordinate these efforts?’ And I think the majority of people who have testing capability said, ‘Yes’.

Noah Baker

Interesting.

Amy Maxmen

So, I think they have some plans to sort of like, once it gets some publicity, to then kind of put it in front of the right people.

Noah Baker

Do you think that the NIH is likely to respond, or is that a little bit out of your wheelhouse?

Amy Maxmen

I’m not them so I really don’t know, but I think for my story I talked to lots of people, but by no means did I talk to 4,000 people, so pretty cool.

Benjamin Thompson

Well, that sounds cool and something for us to keep an eye on, certainly. But for today, let’s talk about one of the biggest stories of the week and that is, of course, the US President Donald Trump announcing that he’s looking to withhold funding for the WHO. Amy, what are the headlines here?

Amy Maxmen

Well, I think the headlines kind of across the board from every top public health specialist I’ve ever talked with and people who study global health, people who are policy health analysts, I think they unanimously think this is a terrible idea, and I can kind of break down why in a couple of ways. One reason is the accusation that the WHO didn’t warn the President. I think you can go back and look at the World Health Organization situation reports and their first report on 5 January said since 31 December they had heard of these cases, they’re concerned that there’s not enough information, but even so, they said with this unknown pneumonia, it has to be watched carefully. Then on 23 January, they announced that there was definitely human-to-human transmission and that the coronavirus was likely to be exported from China to other countries and then it could spread locally in those countries. A little while later, by late January, they sounded the highest alarm that they can – that’s called a public health emergency of international concern. It’s listed under the International Health Regulations. This is a set of wonky legal rules that 196 countries and regions agreed to about a decade ago, which basically means this is a big freaking deal.

Noah Baker

There have been some criticisms of the WHO about pushing China on transparency and so on, but in many ways, that’s not really completely relevant to whether or not Trump’s decision now is a positive or a negative one. Regardless of that criticism, this is not the way to respond.

Amy Maxmen

To pull funding from them is a really terrible idea in the middle of an outbreak. It’s kind of a bad idea in general. Already, the WHO’s budget is about a sixth of the US CDC’s budget per year. Now, they break their budget up in different ways, but let’s say it’s roughly around US$2.2 billion. For that, in addition to dealing with the pandemic, they’re also handling various other things such as the measles outbreak in the Democratic Republic of Congo, cholera in Yemen. The reason I’ve seen people from the WHO whenever I’ve gone on reporting trips in Africa is because they’re often working pretty closely with government on things like strengthening the health system and fighting tuberculosis, malaria, things like this. So, anyway, besides all of those other duties, there is the immediate concerns of the pandemic, so we really need the WHO, right now, to be a global body that’s going to help distribute supplies and also think about clinical protocols in places where we might not have some of the great drugs that we’re trying out right now.

Noah Baker

I think one of the things that is particularly difficult for all researchers and doctors at the moment is knowing exactly what to push forward with other than the basics of test and contact trace – the things that we’ve talked about before. In terms of treating the virus and understanding the virus, one big fundamental problem we’ve got right now is that we don’t really know that much about what this virus is doing inside the body, and it’s something that I think we haven’t talked about on this podcast yet and I thought we could touch on – what we do know and what we don’t know so far about how COVID-19 is killing people, essentially. What it is that may be happening to people when they get infected with the disease.

Amy Maxmen

So, I don’t know the exact biology of the virus and what it’s doing within the body, but I can say that when it comes to treating it, there’s kind of a couple of schools of thought here. So, there’s sort of the idea that there’s what happens in the early phase of an infection, like when somebody is first infected by the virus and what the virus is doing, and then what happens once the immune response kicks in from a person, and then also what happens as the disease progresses and you start to have organs failing or respiratory failure.

Noah Baker

Okay, so maybe just for some context before we go any further, I’m just going to list off a few top lines about what we do and don’t know right now about the coronavirus. So, we know that it’s a respiratory condition and that the lungs are really the key battleground for this, although it can affect other organs, especially at later stages. We know that other coronaviruses like SARS in the past have killed off cilia cells and damaging those cells can cause a build-up of liquid and debris in the lungs, and it’s possible that this coronavirus is doing the same thing and that’s what’s leading to shortness of breath. But we also know that there have been some early indications that this virus is not the only thing that is causing damage and that there actually could be this ramped up immune response as well.

Amy Maxmen

This week in Nature, Heidi Ledford had a great piece where she looked at how some of the trials that are ongoing now, and actually some of the ones that were also happening in China, were using anti-inflammatory drugs because there’s some data showing that the inflammatory response actually is something that kills people towards the end, that there can be sort of a big cytokine storm that happens, and that’s part of what can really cause damage to people.

Benjamin Thompson

Yeah, you mentioned the phrase ‘cytokine storm’ there. That is, of course, when your immune system essentially goes into hyper drive, right, to try and respond to a viral infection deep in the lungs, and it ends up doing more damage, more inflammation and killing lung cells than maybe the virus does itself.

Amy Maxmen

Yeah, so, people have used steroids and interferons and other immune-modulating drugs to kind of dampen the immune response, but the problem with doing that is that then the immune response is not fighting the virus, so then you could have the reverse problem where the virus then goes up.

Noah Baker

And as of yet, there just hasn’t been enough research to really know where this stands and so doctors are having to make calls. I mean it’s hard for doctors to be able to do this. Clinicians have been talking to Nature saying when you’re standing at the foot of someone’s bed, you just want to do something. You’re seeing them struggling to stay alive, and as of yet, no one’s quite sure what the right drugs to be using are.

Amy Maxmen

So that’s sort of the issue right there, and some people are trying to pair these immune-modulating drugs with antiviral drugs, so that could be one way around it, but it’s really complicated.

Benjamin Thompson

And it seems like there’s some other intricacies for this infection as well. A lot of sort of lung infections either infect the upper or lower parts of the lung, and it seems to be that upper respiratory tract ones tend to me milder but they spread better whereas lower respiratory tract infections tend to be worse. It seems that this virus can infect both, which is something that maybe hasn’t been seen before, certainly with related viruses, other sort of coronaviruses.

Amy Maxmen

I’ve heard also people talking about at what phase of it. So, as far as the early phase of an infection, there’s this drug, chloroquine, which, of course, deservedly, I think a lot of researchers are nervous about because it’s been treated like it’s a cure when there’s not nearly enough data to suggest such a thing. It’s very early stages. However, there’s a few trials that are looking at could chloroquine be useful in the very beginning of an infection, for example, in health workers who have recently been infected but haven’t yet developed the disease, so it’ll be interesting to see how that plays out.

Benjamin Thompson

Yeah and actually, chloroquine is something that’s going to appear later in the show when Shamini Bundell has been looking at risks and how people are communicating risks about things and obviously, chloroquine has got a lot of coverage over the internet.

Amy Maxmen

Yeah, this is a funny little story that I didn’t know. We had a researcher who is really fascinating. She kind of works on how misinformation and disinformation can go viral. She’s at Harvard. Her name is Joan Donovan. She wrote a commentary for us in our World View section. She tracked that actually one avenue of chloroquine making it into the mainstream is that there were a lot of tweets within the technology community, and then it got tweeted by Elon Musk. It was a Google doc written by somebody who said that he was a Stanford advisor, and then after Elon Musk tweeted this Google doc that said chloroquine was a cure, then Fox News invited this Stanford advisor on where they talked about chloroquine. Later, Stanford wrote Fox News and said we don’t know who this person is. He’s definitely not an advisor. We’ve never heard of his name. But at that point, already we started getting tweets from various people like Giuliani and then after that, Trump continued to say that chloroquine is looking really good.

Benjamin Thompson

Well, as I understand it, clinical trials of this are ongoing. Have you heard anything about how they’re getting on or any results from this all?

Amy Maxmen

I have not heard results from clinical trials. I did talk to a researcher this week who told me one thing that she’s noticed. So, she’s involved with a kind of nationwide trial in the US to evaluate the antiviral drug remdesivir, and what she was saying was one problem they’ve had is that in hospitals they’re having a hard time recruiting people into their trial for remdesivir because chloroquine can now be used off-label. This is an old malaria drug. It’s hardly even used for malaria anymore. It’s used for other things like lupus. But anyway, people are now coming into the hospital saying they want chloroquine. Also, doctors want to help people. They want to be able to treat them with something, so there’s a lot off off-label prescription of chloroquine, and that means that a lot of these people don’t want to stop taking chloroquine so that they can then be enrolled into a clinical trial where they get remdesivir or a placebo – at least, that’s the trial as it is right now – and so it might actually take away from trials that will give us the evidence we need. It might even take away from trials on chloroquine because if people are taking chloroquine right away then they can’t enrol on a trial where they’re randomised to be in one arm or the other.

Benjamin Thompson

It seems like there is a lot more fundamental biology and molecular biology that is yet to be done that will tell us so much more about what this virus is and what it does as well.

Amy Maxmen

Just sort of stepping back from everything, I think one thing that no matter what sort of field of this you’re talking about with this coronavirus is a lot of this is about how do clinicians and scientists deal with uncertainty in data when there’s a real need to act, and people will vary on that. There’s not one person being right. There’s not one path forward being right. Some people are going to be on the side of it’s uncertain but we have to do something. Other people are going to be really nervous about that. But the reality is there’s a lot of unknowns right now.

Benjamin Thompson

Right, let’s pivot to the one happy thing then, from talking about ‘Oh god, how are we going to do this.’ Okay, right.

Noah Baker

I think we can just do it and then we can always add a link in later if we need to.

Amy Maxmen

And I don’t think it’s a terrible thing to do. As reporters, we want to acknowledge the bad things, but that doesn’t mean that everything is bad, and I think that’s okay to say.

Noah Baker

It feels like you’ve trained yourself well after years of reporting on epidemics to maintain a positive outlook.

Amy Maxmen

I’ve got a story if that’s helpful. So, I’m mainly in my own brain because I’m at home alone, so this is not a thing I’ve seen, but this is random and I can say what I want sometimes. So, my good thing is kind of a memory I had and I think it’s relevant now. So, I was in Sierra Leone for a few months during the Ebola outbreak, so I obviously think about those times a lot lately. So, when I was in Sierra Leone, it was December 2014. This was the peak of the Ebola outbreak and it was Christmas, and for me, that’s kind of a weird thing because, first of all, I don’t really celebrate Christmas. It’s not my religion. And then on top of that, it’s my birthday, and I was planning on just like hanging out in my room under my mosquito net reading a book, but I had told to head of the situation room, the kind of control centre for how the Ebola response was going, I had told him it was my birthday the next day when we talked, which was Christmas Eve. So, he knew it was my birthday and he called that day and he was like, you know what, I want you to come over and I’m sitting in the backyard with my family and we’re celebrating Christmas. And I was like alright, I guess I will. So, I came over and I kind of, in my head, I was just thinking about the story. I’m like, good, I haven’t gotten a lot of time with this guy, maybe I’ll get to do some reporting, so I came with all my reporting stuff. But he was just in the backyard with a couple of people, very mellow because it’s Ebola time and nobody was allowed to have any celebrations whatsoever, but they were all just back there. They were listening to some reggae and it turned out they weren’t Christian either, so we just sort of hung out in the backyard and just like relaxed and talked and it was just sort of a moment of kind of human kindness and togetherness in this time that was definitely terrible, that we all knew was terrible, but we just took a moment to kind of appreciate each other and appreciate the things that we could.

Noah Baker

I think my one good thing this week is a similar thing. Instead of in the past I’ve been bringing up big projects that have happened and creativity and things that I thought were funny but this week, one of the things that’s really impacted me was my shopping trip to our local supermarket. So, I go once a week. I shop for the whole family that I’m staying with because I am the only one that can drive that is not a particularly high-risk person in this household. And my previous shopping trip before this one was quite stressful. I was actually knocked to the ground by someone who was having a bit of a panic attack and there was a lot of shouting and it was really terrifying. And this time I went and the supermarket introduced a one-way system and people seemed to have calmed down and there were people being so… small acts of a kindness made a really big difference to me on my stressful shopping trip at 8 o’clock on a Wednesday morning. People were saying ‘You go first,’ and ‘Why don’t you have that packet of pasta and I’ll have a different one,’ and it was really, I don’t know, strangely heart-warming for me.

Amy Maxmen

That’s great.

Benjamin Thompson

It’s a good time to be kind to each other. And I’ve got one about a gentleman who has been incredibly kind to a lot of people and, Amy, you might not have heard this one but it’s been doing the rounds in the press here in the UK. This is a 99-year-old WWII veteran. His name is Captain Tom Moore and it’s his 100^th birthday at the end of the month and to try and raise £1,000 for the NHS Charities to help frontline workers and what have you, he was going to do 100 laps of his garden. So, he’s got a 25-metre garden. He was going to do 100 laps and try and raise £1,000. And what I’ll say is thing has kind of snowballed. He actually finished his 100 laps this week, but let me just get the figure up here. So, he wanted to try and raise £1,000. He actually has raised, at time of recording, £15,418,129.96.

Amy Maxmen

Oh my gosh. That’s a lot.

Benjamin Thompson

I know, right. It’s amazing. £15 million!

Amy Maxmen

That’s amazing.

Benjamin Thompson

I’ll put up the links in the show notes. Some of the quotes from him, he just seems like an amazing guy. So, hats off to him and happy birthday to him for a few weeks.

Amy Maxmen

That’s incredible.

Noah Baker

Absolutely.

Benjamin Thompson

Well, let’s end it there this week then, both. Join me again next week, will you, please? I’m sure there’ll be lots more to talk about. So, Amy and Noah, thanks very much.

Noah Baker

Thanks Ben.

Amy Maxmen

Thanks.

Benjamin Thompson

More from Amy and Noah next week. Up next though, if you go onto any newspaper website right now, it’s very likely that you’ll see a host of graphs and percentages and stats related to the COVID-19 outbreak. Reporter Shamini Bundell has been investigating the research of how to best communicate complex data during a pandemic.

Shamini Bundell

It’s a science communicator’s dream – suddenly, everyone is interested in learning about science. Unfortunately, the reason is because in the midst of a pandemic, accurate scientific information can save lives, and equally, misinformation can kill. How to communicate information effectively with the public is something that’s always been important for science, but the researchers who study this kind of communication are finding themselves in increasing demand as governments and other organisations around the world wonder how best to inform the public of the huge amount of information relating to COVID-19.

[Coronavirus news clips]

Alexandra Freeman

We are being bombarded with daily counts of deaths, daily cases, worldwide trends.

Shamini Bundell

This is Alexandra Freeman.

Alexandra Freeman

All of this is described in numbers or in graphs, and it’s really important for people to be able to understand it.

Shamini Bundell

Alexandra works at the Winton Centre for Risk and Evidence Communication at the University of Cambridge in the UK, where she looks at how numbers are communicated. And it turns out, when it comes to risk, the way you present the numbers can really alter people’s perception. For example, Alexandra looked at ways to share the results of genetic tests. She found that if a person’s likelihood of developing a genetic condition was expressed as a percentage – you have a 20% chance of developing the condition – someone might think that’s unlikely. But if it’s expressed as a frequency – 20 out of every 100 people who have this gene go on to develop the condition – then it’s suddenly perceived as more likely.

Alexandra Freeman

And the psychological explanation for this is generally because you start really imagining in your mind those 20 times where it might happen, and if it’s quite a significant, scary thing that might happen, those 20 times loom quite large in your imagination.

Shamini Bundell

Alexandra’s recommendation is that anyone who needs to communicate risk should put their figures in both formats to balance out the bias in people’s reactions. But one big problem with the figures around COVID-19 is that no one’s sure exactly what those figures are. Whether it’s the chance of death, the risk of infection or the methods of transmission, there’s a lot we don’t fully understand yet. Heidi Larson from the London School of Hygiene and Tropical Medicine in the UK is also interested in how to effectively communicate, in particular, when the facts you’re communicating aren’t certain.

Heidi Larson

The biggest critical factor in the information landscape around COVID-19 is the uncertainty. It’s very different when you have a situation like vaccines where there is misinformation against very clear and decisive scientific information. In this case, we don’t have that.

Shamini Bundell

So, how can you communicate facts and figures when you’re not really sure what they are? According to Heidi, one mistake that authorities sometimes make is to wait until there is some certainty before saying anything. But this can create worry.

Heidi Larson

If you’ve ever been stuck in a subway that stops and you’re not getting any information and it gets longer and longer, just hearing the voice of someone saying, ‘We’re currently stopped at a red signal due to technical difficulties. I’ll get back to you as soon as I have more information.’ Something that gives you some clue, even if it’s an uncertain one, helps calm people.

Shamini Bundell

Alexandra Freeman also thinks that ongoing and honest communication is important, and that people in governments and scientific organisations should listen to the research on this.

Alexandra Freeman

One of the things we hear a lot is that people are nervous of communicating uncertainty because people feel that it will undermine trust.

Shamini Bundell

Her team has conducted a study on how different kinds of messages change the public’s trust in the person delivering the message.

Alexandra Freeman

We found that if you communicate uncertainty as precisely as you can, so if you say, for instance, ‘We think it’s around 15%, but there’s some uncertainty so it could be between 13-17%,’ then that doesn’t undermine people’s trust. But if you are more vague about it – ‘It could be a bit higher, it could be a bit lower’ – then that does undermine people’s trust a bit more.

Shamini Bundell

Alexandra says it’s important to be upfront about uncertainty and as precise about it as possible. When it comes to information about coronavirus, vague or misunderstood advice can be very dangerous.

Heidi Larson

We tend to divide the world into fact and fiction, when, in fact, there’s a huge amount of ambiguous information in the middle.

Shamini Bundell

Heidi gave the example of chloroquine, a drug that various people, including Donald Trump, have described as potential treatment for COVID-19. Now, it’s true that researchers are testing whether chloroquine is effective, but that’s not the whole picture.

Heidi Larson

There was a couple in the US who drank something that cleaned their fish tank because they saw that it had chloroquine phosphate in it, and the husband died and the wife became extremely ill.

Shamini Bundell

Part of the reason for this tragic event is that people everywhere are desperate for information about possible dangers and possible cures and ways to avoid catching the disease, and if that information isn’t available or isn’t communicated, then some people turn to less reliable sources.

[Coronavirus fake news clips]

Sander van der Linden

My mum sends me fake news from Facebook and wonders if this is real or not.

Shamini Bundell

This is Sander van der Linden.

Sander van der Linden

She showed me a Facebook post of a video of some Chinese scientists who were prosecuted for fraud as it relates to grant applications. That was real. But then the fake news around it was that there was this COVID-19 bar below it suggesting that they were arrested because they’ve engineered COVID-19.

Shamini Bundell

Sander also works at the Winton Centre for Risk and Evidence Communication and has a particular interest in the spread of fake news.

Sander van der Linden

What’s interesting is that misinformation spreads much like a virus. Some research has shown that fake content spreads faster and deeper than true content.

Shamini Bundell

Sander suggests that the most successful pieces of misinformation tend to have certain elements in common.

Sander van der Linden

It needs to be novel, newsworthy, often it needs to be emotional, impersonate some credible authority of some sort of something that looks convincing, and then that gets re-shared and re-shared and then it sort of gains its own truth value. One of the ways in which we judge information to be true or false is by how often we come across it.

Shamini Bundell

Many tech and social media companies have announced new policies for trying to stop the spread of fake news. For example, by flagging or removing suspicious content. But Sander and his team are interested in a more proactive method.

Sander van der Linden

Fact checking is all good and well, but you’re always behind the curve, it doesn’t scale easily, you constantly have to come up with a debunking story. It’s very difficult, and one of the problems is that once people are exposed to a myth or falsehood, it lodges in your memory and it’s very difficult to correct. Even when you correct it, people continue to rely on the myth and we know that from lots of research. So, we thought prevention is better than cure. It’s better to get there first.

Shamini Bundell

His team developed a game called Bad News that teaches people how to make the most effective fake news using common techniques and elements found in viral misinformation. Their research, published last year, found that playing the game and taking on the role of a fake news creator made participants more sceptical of fake news. While the Bad News game, which is also available online, started off using examples including flat Earth theories and anti-vaccination sentiments, it’s now also incorporating COVID-19-related stories. When trying to tackle fake news surrounding the epidemic or when trying to communicate risk or influence behaviour, there’s a huge amount of pre-COVID-19 research that could be relevant when used to inform decisions. It can still be difficult though to anticipate what the public will do. For example, in the UK, Sander says the government was worried about implementing a lockdown too soon as they thought the public would at some point get tired of the restrictions, an idea called behavioural fatigue.

Sander van der Linden

I mean I’ve been fairly critical of the idea of behavioural fatigue. This was something that informed the UK government’s policy, at least in part, and the evidence for that was very weak from behavioural science. In fact, now we’re seeing people are capable of staying inside and complying.

Shamini Bundell

In fact, along with a number of behavioural scientists, Sander signed an open letter to the UK government questioning the evidence around behavioural fatigue. The letter emphasises the importance of an evidence-based approach to policy, and Sander thinks the government could do more to gather evidence before making decisions.

Sander van der Linden

Ideally, the government should test and empirically evaluate the messages that they put out there, even when they are in an urgent situation. You could potentially do that within a matter of days. So, take the hand washing example. There has been some concern that if you early on tell people to wash their hands, people suffer from what we call single-action bias, so you do one thing and then you think that that’s enough and you don’t consider the seriousness of the issue, but we could have tested that.

Shamini Bundell

The way Sander sees it, the science of communication has a big part to play in combatting this epidemic.

Sander van der Linden

There’s not enough consultation on the communication of risk in evidence, and so much of this crisis is a human, psychological crisis as much as it is a biological crisis, so it’s a bit surprising how little attention is being paid to the actual communication of it.

Shamini Bundell

That was Sander van der Linden from the Winton Centre for Risk and Evidence Communication. You also heard from his colleague Alexandra Freeman and from Heidi Larson of the London School of Hygiene and Tropical Medicine. You can find the fake news game Sander mentioned at getbadnews.com, and there’s a version for kids at getbadnews.com/junior.

Benjamin Thompson

That’s it for this edition of Coronapod. For all the latest news on the outbreak, head over to nature.com/news. We’re back again next week, and there’ll be a corona-free edition of the regular Nature Podcast on Wednesday. Don’t forget you can reach out to us on Twitter – we’re @NaturePodcast – or on email – podcast@nature.com. And why not let us know how your research is doing during the lockdown? Until next time, I’ve been Benjamin Thompson. Thanks for listening. Stay safe.