NATURE PODCAST

Coronapod: The race to expand antibody testing

The role of antibody tests in controlling the pandemic, how public-health spending could curtail an economic crisis, and the efforts of the open hardware community.

Benjamin Thompson, Noah Baker, and Amy Maxmen discuss the latest COVID-19 news.

In this episode:

02:08 Betting on antibodies

Antibody tests could play a key role in understanding how the virus has spread through populations, and in ending lockdowns. We discuss concerns over their reliability, how they could be used, and the tantalising possibility of immunity.

News: The researchers taking a gamble with antibody tests for coronavirus

10:25 Economy vs public health, a false dichotomy

Jim Yong Kim, former president of the World Bank, argues that strong investment in public health is crucial to halt the ongoing pandemic and to prevent a global financial crisis. We discuss his work with US governors to massively increase contact tracing, and his thoughts on how researchers can help steer political thinking.

News Q&A: Why the World Bank ex-chief is on a mission to end coronavirus transmission

19:00 One good thing this week

Our hosts talk about staying positive, and pick a few things that have made them smile in the last 7 days, including a tiny addition to the team, a newspaper produced by children in lockdown, and a gardening update.

Six Feet of Separation, the newspaper staffed by kids

22:51 Open hardware

Researchers are stepping up efforts to design and produce ventilators and personal protective equipment for frontline medical staff. We hear how the open hardware movement is aiding these efforts, and the regulations that teams need to consider if their designs are to make it into use.

Technology Feature: Open science takes on the coronavirus pandemic

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Transcript

Benjamin Thompson, Noah Baker, and Amy Maxmen discuss the latest COVID-19 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

Welcome to episode six of Coronapod. I’m Benjamin Thompson, once more in the South London basement and today, my recording studio is being used for its actual and original purpose as a clothes-drying vehicle, so I am surrounding by laundry. But I’m joined, once again, by Noah Baker and Amy Maxmen. Noah and Amy, hi.

Amy Maxmen

Hi.

Noah Baker

Hello, how are we all doing this week?

Amy Maxmen

I’m doing okay. I have to say the news is bumming me out. The news is bumming me out.

Noah Baker

So, today, there’s just been some announcements, which I find interesting, from the UK government. I was just watching another press briefing and Matt Hancock, our health secretary, has just announced that we are going to be hiring 18,000 people to do contact tracing and extending all of the testing capacity to every essential worker and their families, which they can apply for by tomorrow, I think, which seemed like a big step forward. I can’t quite help but wonder whether or not they’re doing this to distract from the fact that they haven’t managed to get to their 100,000-tests-a-day target that they promised a little while ago, but I’m interested, in particular, that they are saying they’re going to really start pushing contact tracing.

Amy Maxmen

Well, that’s excellent news. I guess similar here. Massachusetts already put US$44 million into a budget to hire 1,000 contact tracers. Ohio is talking about it, New York City, New Jersey – I’ve seen a few announcements like this – and the CDC just put out a guidance about what the essentials are for contact tracing. So, as you know, I’ve been hollering about this since like the beginning of the outbreak, but it’s great that we’re catching on.

Noah Baker

And I think one thing that goes with this sort of increase in contact tracing is a particular type of testing that is becoming a bit of a hot button topic at the moment, and I know we’ve talked about testing a lot all the time on Coronapod, but this is actually a type of testing we haven’t discussed much. So, mostly we’ve been talking about these PCR-based tests, but now there’s a lot of discussion about what are called antibody tests – in some cases, point-of-care tests – that are much quicker and they work in a different way and they have a bit of a different function, and that’s one of the things you’ve been looking into a lot this week, right, Amy?

Amy Maxmen

Yeah, definitely. I’d say you can kind of put these into two different groups in your mind. So, the PCR-based test, that looks for the genetic sequence of the virus, so we’re looking for the virus. And the antibody tests are looking for our immune response, so they’re not detecting the virus, their detecting what our immune system does in response, so it requires sort of more interpretation, and that’s where things get a little bit fuzzy.

Benjamin Thompson

What sort of advantages do these tests have over the PCR test. You’ve said that they work in different ways and look at different things, but what advantages does this sort of antibody approach have?

Amy Maxmen

With the antibody test, there’s the rapid ones, where you can get an answer in, say, 10-15 minutes. So, they’re fast and also, they’re cheaper and also, they’re kind of easier to use. So, you don’t need to be in a lab that has the latest equipment. You don’t need to have somebody necessarily run it that has a whole background. It’s just a pinprick of blood. They look like a pregnancy test and you get a little band that shows up. Do you have one class of antibodies – IgM – or another class of antibodies called IgG. And then there’s also ones that require more lab equipment. They have to be conducted in labs. Kind of one advantage to those is, one, you can look at the levels of antibodies. Another advantage to those is that a lot of the machines are high throughput, so you could do, say, 1,000 tests at a time. I actually don’t know if that’s the right number, but you can do it all at once, so once you get there, you can do a ton of them at the same time.

Benjamin Thompson

Well, what happens next then? How can these antibody tests be used and what’s the plan?

Amy Maxmen

There’s sort of like two ways in which they may or may not be helpful. One, are these studies that are trying to see what’s the number of people in a population that are infected. So, knowing that a lot of people haven’t been tested by PCR, can we get a sense of how many people have even been infected in the past based on the fact that they have generated antibodies? So, it’s kind of on a population study level. And I also looked pretty deeply into using the tests on an individual level, so actually testing a person and then telling them what kind of antibodies they have and what it may mean. In some cases, they’re being used just to really screen people, and that’s also controversial.

Noah Baker

Okay, so these population-level tests, these tests that aren’t designed to diagnose people but really are designed to get an understanding of how the virus spreads in an entire population, to give that kind of top-level view, what’s the deal there? How are they working?

Amy Maxmen

At first, this was considered the un-controversial use of these, but what’s interesting is suddenly they’ve become very controversial. I looked at like a bunch of studies in different areas, and the minute these studies started coming out this past week, Twitter was alive with researchers talking about reasons why you can’t just take that as a firm number. One of the problems that has come up is the accuracy of these tests. If you want to know how many false positives you get and how many false negatives you get, you want to run it x number of times and confirm it, and the problem is that kind of vetting hasn’t been done for a lot of the tests. So, you have to at first glance guess, ‘Okay, so, let’s say you think 100 people are infected, how many of those are false positives?’ And researchers have picked through it and saying with this false positive rate, a lot of these aren’t even real. So, number one, the results could be wrong. Another problem, there was like this study in Santa Clara where researchers recruited people through ads on Facebook, but the pushback against that study, in addition to this fear about false positives, is that the people they recruited aren’t a random sampling. So, the people who are most likely to ask for testing are those who have symptoms or have some reason to think that they’re at higher risk, so it’s not a random sample. It’s people who are more likely to be positive, so that’s another problem. I hope these are going to get better. I just heard about a study that’s going to be launching in Berkeley where they’re going to do a randomised sampling of people based on the census, so it would get around that problem. So, I think there is a lot of promise in these studies, but the first ones out of the gates have been flawed. Oh, another complaint that I’ve heard from a lot of researchers is that they’re put out in preprints and in press releases that don’t get into the fine details that you want to know – what’s the false positive rate, for example.

Noah Baker

So, that’s this population-level use. There’s also very big claims being made about how antibody tests could fit in on an individual level, in particular with trying to end lockdowns and lift social distancing. Boris Johnson, our prime minister in the UK, described them as a ‘game-changer’. I don’t think scientists are all agreed that they are going to be a game-changer.

Amy Maxmen

Yeah, so I would say same thing here at one of the recent White House press briefings. Dr Fauci and Dr Birx both said that antibodies and that also these antigen tests – another kind of blood test – that these are going to be useful tools in the response. So, I think they say that they’re going to be useful, but it’s not quite clear exactly how.

Noah Baker

Yeah, it’s not been totally clear about how exactly this might play out, but there are certainly loads of ideas being thrown around about the potential of these antibody tests. So, first off, you’ve got the possibility that in an environment where people can’t access PCR-based tests for whatever reason, an antibody test could be a quick and cheap way of screening people. Now, there are lots of arguments against that – accuracy, things we’ve already mentioned – but the argument, I suppose, is that at least one some test is better than no test. People disagree – that’s in itself a relatively controversial opinion – but perhaps an even bigger and more controversial possibility is that these antibody tests could detect a particular type of antibody, IgG or immunoglobulin G, which could – and I emphasise ‘could’ there – impart some degree of immunity to the virus, and that could be a big deal.

Amy Maxmen

And that’s sort of the golden ticket that everybody’s hoping for. We don’t know if it’s there yet. It’s immunoglobulin G, IgG. It could be that those are going to be protective, so that you don’t get infected by the same thing twice. Some, I would say maybe even the minority, of scientists are convinced that this is going to play a big role. The research team that I actually visited 1 March in the US in Seattle, they’re the ones that like ramped up testing kind of quietly in February back before the CDC was letting other people test, and now they’ve ramped up antibody testing. They’re really betting on this.

Benjamin Thompson

It is a bit of a gamble, though. It seems that researchers are divided over whether you will be able to get any sort of long-term immunity if it’s weeks, months, years, if at all.

Amy Maxmen

It’s a total gamble, and this gets back to what happens in an outbreak, and I don’t think it’s any accident that when I talk to people I know that I was talking with back when I was reporting on Ebola, a lot of those people are willing to take on a little bit more risk. They in no means want to harm people, so you don’t want to tell somebody they’re protected when they’re not, but maybe they’re willing to take on a little bit more risk because they see how quickly the outbreak spreads. But yes, like you said, I’ve also talked to other people who are also extremely good scientists who say, ‘No, we should wait,’ so it’s a division.

Noah Baker

Another thing that isn’t clearly known is whether or not, yeah, you may have these antibodies, but you might still be infectious. You don’t know if you’re still shedding bits of virus at that point, so just because you maybe can’t be infected doesn’t mean you aren’t still shedding off virus from your nose or somewhere else and so you may be infecting others.

Amy Maxmen

That’s absolutely true. There’s so many unknowns. I mean you can test positive with an antibody test and be infected, and we know so little about the shedding question, right? I think that’s another one. I think there’s signs that PCR might test positive and then negative and then positive, so you could be shedding in between. There’s just a lot of uncertainty.

Noah Baker

One other thing that I thought would be interesting to discuss this week, Amy – in fact, Ben and I both were discussing this earlier in the week – is we’ve talked a lot about the ways that we can try to decrease the number of people that are being infected or dying or reduce the burden on healthcare systems and so on, but one big thing that’s happening all the time is there’s also a burden on economies, on governments, on how things are going to function going forward, how things are functioning right now. It’s something we don’t talk about very much in this podcast, but that’s really important and it’s something that you also have been looking into this week. You interviewed Jim Yong Kim who is the ex-chief of the World Bank. He’s also one of the founders of Partners in Health which is a group that we’ve talked about on this show before, a public health organisation. And he was, I think it’s fair to say, quite vocal. Tell us about that interview.

Amy Maxmen

Yeah, well, I wanted to talk to Jim Yong Kim because I wanted to hear about the public health response from somebody that also knows about economics because I think one mistake I’m hearing a lot in the US is just sort of the two things pitted against each other, like either we fight the outbreak or we save the economy. I don’t know about the UK, but there’s kind of a movement here to say, ‘Let’s save the economy and let some people die, but save the economy,’ and I don’t know if that’s a dichotomy. I think it’s wrong to say, ‘No, the economy is not important, health is,’ because the economy is also important.

Noah Baker

Fundamentally, his argument was that in order to protect economies and prevent a global financial crash and a really significant one, the very first thing we need to do is get the outbreak under control. You can’t just let people die. And you recorded some of this conversation and we actually have a bit of it here.

Amy Maxmen

Great.

Jim Yong Kim

I’m a finance guy, and it makes absolutely no sense to keep putting trillions of dollars into stimulus and not put hundreds of billions of dollars into the thing that will stop the financial crisis. The thing that will stop the financial crisis is to get the virus under control. The argument I’m making is that great if there’s a vaccine, great if COVID is temperature sensitive, though it seems to be doing just fine in very warm temperatures right now, great if all those things happen. But we have to assume that they won’t happen, and the only way down the mountain is to implement the full public health response and still, still, people are trying to find all kinds of ways of saying, ‘No, you actually don’t have to do all of that.’

Noah Baker

That really grabbed me when I heard that. It was something about the way, maybe the passion in his voice, that really affected me, actually, when I first heard that recording.

Amy Maxmen

It’s interesting you say that. It really did to me as well, and another part of it is he talked about this is worse than the last financial crisis. So, what he’s been doing kind of quietly in the background for a while now, and something we talked about in my interview, is he’s been approaching governors of different states and trying to persuade them and also give them a plan, and he actually did that in Massachusetts and I think they’re the first to really not just say they’re going to do it but really already start. The idea is they’re going to, when somebody tests positive, they’re hiring these people who are going to call that person, get their contacts and then phone call their close contacts, explain to them how to quarantine, and then check in with them. And they’re also going to look into how can you isolate people if they’re living in a shared facility. So, it’s fine if somebody’s got a house with two bathrooms or something – no big deal – but if somebody’s in a nursing home or a homeless shelter, can they rent out motels so that they can isolate people that way? So, his thing is to say, ‘This is expensive, this is hard, but other countries have done it. China did it. South Korea did this. Countries have done this. We can do this, and there’s a model for it.’ And he’s thinking, ‘Alright, if I show that this is how it happens in Massachusetts, other places might adopt it.’

Benjamin Thompson

I got a sense that he was saying, ‘Do something.’ This is obviously a very difficult thing to do, a very expensive thing to do, but if you can prove that you’re making an effort, that other people might sort of come along for the ride, as it were, or follow suit.

Amy Maxmen

Yeah, that was his response because I had asked him, I said, I’m listening to a lot of smart people writing op-eds and things like that about what we have to do, so I just asked, ‘What’s your advice for researchers who want to have their voices heard?’

Noah Baker

Yeah, we have a clip of that too. Here’s Jim Yong Kim.

Jim Yong Kim

I think it’s very hard to convince others to do things that are complicated, that are difficult, that are labour-intensive, that get you into incredible complexity. I think it’s hard to convince people to do something like that unless you’ve done it yourself or at least started doing it.

Noah Baker

I think we’ve mentioned in this podcast, and it’s something that we’ve been discussing among the editors at Nature, about the link between scientists and policy and how researchers are directly impacting people’s lives in a way that maybe scientists aren’t used to, and that is advice that I don’t think your average researcher is used to hearing – ‘Just go ahead and do it.’ It took me off guard hearing someone say that that directly.

Amy Maxmen

Yeah, I know, and you can get into all sorts of trouble that way too, right? So, you want to do something, you also want to do it within the realms that are legal. You don’t want to do something outside of getting ethical approval and you don’t want to be completely irresponsible, so there is a fine line there. I don’t want to be encouraging everybody with a PCR machine to run a testing operation. So, there are regulations for a reason. There’s ethical review boards for a reason. Those things are important. They shouldn’t be overlooked. Somebody like Jim Yong Kim, he also has a lot of connections and he’s done this before, so I think they went through channels. He didn’t just go ahead in Massachusetts and start doing contact tracing himself. He went to governors to say, ‘Come on, I’ve got a plan in place. These are the people that we’re going do to this thing with.’ So, he came to them with sort of a complete plan. I think maybe that’s a key here too.

Noah Baker

How much do you think that someone like Jim Yong Kim will have an impact? He is a voice that has a lot of experience. He used to be the president of the World Bank. People listen to him. Do you think that him speaking out about this kind of thing might be the kind of thing that could influence governments? I mean certainly, he’s already influencing governors.

Amy Maxmen

I am hopeful. I’m also, frankly, nervous because, at least in the US, I’m seeing that solid public health and scientific advice is suddenly getting mixed up in politics, and that really scares me because I don’t want to make this a thing of, ‘if you’re on this side of politics you believe this about health and if you’re on this side you believe this’ – that’s very, very bad. So, I think that’s the movement that could be pretty detrimental here. But hopefully, this is something that leaders will start listening to.

Benjamin Thompson

I mean one thing that governments often do listen to is economic forecasts. What did he tell you about what could happen to the world’s economy?

Amy Maxmen

He was really worried about it, and that’s one thing I liked as well – he wasn’t somebody that was saying, ‘Don’t worry, it’s only money.’ He was saying, ‘No, money really, really matters,’ so that was something I wanted to hear from him as well, to hear his take on that. I’m not sure if you have a clip of that part of it, but he was probably more articulate than I am on it.

Jim Yong Kim

It means that food security is going to be fundamentally in question. In other words, people will starve to death. It means that aid budgets will completely dry up, that there will be no more aid coming in. It means utter disaster for developing countries. It means utter disaster, and I think that we all have to think very hard about what we can do to prevent that.

Benjamin Thompson

I mean fairly damning, right?

Amy Maxmen

It is. It really is.

Noah Baker

And it’s not even like it’s a surprise. I think that I know those things, but still, it’s sobering when you hear it. It still punches you every time you hear this.

Amy Maxmen

When you hear it from an expert, I have to say I feel exactly the same. It’s one thing when I talk with my friends about things, but to hear from somebody who knows because of the positions he’s been in, that’s a whole other thing. It’s similar to when I’ve been watching the coronavirus since it started, but in the US, to me, this kind of began 1 March. That was when we knew that community transmission was taking place. Right around then, when I talked to a person that was doing a lot of testing, one of the scientists that just was like, ‘Let’s do it!’, the stuff we’ve been talking about. When she told me, this is widespread community transmission and it’s been going on for a long time, I had that same reaction, and even though I had suspected as much, just to hear someone that’s in the front seat saying it, that was a different feeling.

Benjamin Thompson

Amy, on a personal level, let’s say if you are receiving this kind of bad news every time you go out to do a reporting trip, how does that affect you? How do you try and keep yourself going, in all seriousness, because there hasn’t been a huge amount of good news thus far coming out of this outbreak, right?

Amy Maxmen

I’d be lying if I said I’m fine. I’m definitely not able to sleep a full night anymore. It’s freaky. It’s freaky. And then the other side of it is this is why I’m working hard to report on it because my own personal disposition is this is the thing that I do and I’m freaked about this thing.

Noah Baker

Yeah, I think that’s kind of what I do as well. Another thing I do is – this is going to be the best transition in the history of podcasts – think about one good thing this week.

Amy Maxmen

Laughs.

Benjamin Thompson

Yes, well, we each have obviously got our one good thing, and I think I went first last week, but Noah, why don’t you go first this week? What have you got? What has diverted you in the last seven days?

Noah Baker

I’m going first and Ben is giving me the privilege of going first because I have actually stolen one that affected both of us this week, which is one of our fellow members of our team, today, became a father for the first time. So, his son, he’s born, he’s healthy, he’s happy, and it’s wonderful. It’s lifted our whole team.

Amy Maxmen

That’s great.

Benjamin Thompson

Yeah, hear, hear. Amy, what about you? What stood out to you this week?

Amy Maxmen

Well, one piece of joy I have is I was sharing a kind of office space with a bunch of writers in the Bay Area before we stopped going into the office, but one of them is somebody named Chris Colin and he’s a journalist and he started this newspaper for children at home. And so, I get his issues of the newspaper. It’s called Six Feet of Separation, and it is so adorable and charming, and I thought I would maybe read a couple of quick entries. So, it’s all of these kids that write for it. So, this is in issue number two. I’ll read one column called Reflections, by Dylan Belgard, aged 6,

Knock Knock.

Who’s There?

Lettuce.

Lettuce who?

Lettuce outside.

Please… seriously… when is this over?

I really want to see my friends

But I like that I haven’t had to bathe in a week.

Noah Baker

Amazing.

Amy Maxmen

You can put this in the show notes. You flip through it. It’s really beautiful. I think it’s like their editorial guideline is, ‘Yes.’ There’s other ones. There’s reviews of mum’s dinners, things like that, and also very sincere poems and things like this. Anyway, it’s adorable and it makes me happy to look at it.

Noah Baker

It’s really adorable.

Benjamin Thompson

I’m going to throw in one and it’s super flippant this week actually, and I am quite lucky that I do have access to a bit of shared space outside my flat, and so I’ve been trying to grow some vegetables to try and be as self-sufficient as I can be, which won’t be very self-sufficient at all. But there’s been a conflict going on in the back garden with me and the squirrels. They keep digging up my seed potatoes, but I think I’ve finally bettered them. They may have won the battle but I think I have won the war, so join me again in a few weeks to see just how far through they have lasted and whether I can get anything up to one or more meals out of them.

Amy Maxmen

Congratulations.

Noah Baker

Yeah, really, that’s the big victory this week, I have to say.

Benjamin Thompson

That’s the big story of the week, right?

Noah Baker

So, Amy, we’ll get to see your incredible newspaper for children in the show notes. Ben and me don’t really have things we can share in the show notes this week but people should remember, of course, that everything we’ve talked about this week, Nature’s also covering in its news section. So, look in the show notes where you’ll be able to find information and more details on there to read Amy’s stories, as well as stories by various of our other colleagues who are all going hell for leather to try to get stuff out and get stuff to you.

Benjamin Thompson

Absolutely, and, well, let’s call it for this week then. Amy and Noah, thank you so much for joining me.

Noah Baker

Cheers, Ben.

Amy Maxmen

Thank you. It’s always a pleasure.

Benjamin Thompson

Throughout the COVID-19 pandemic, there have been ongoing shortages in the vital equipment needed by frontline healthcare workers. Up next, reporter Julie Gould has been hearing from researchers using their expertise to help address this shortfall.

Julie Gould

In order to help fight against the COVID-19 pandemic, some researchers and scientists are changing their focus entirely from their day-to-day work to produce much needed personal protective equipment, diagnostics and ventilators to help the frontline workers treat COVID-19 patients. This has been made possible as a result of the open hardware movement, and the open hardware community makes sure that the blueprints of scientific research equipment and physical tools are published openly for anybody to use, access and edit. But the big question is, is it worth the time? Can small groups of people or people with just one or two 3D printers really make a difference on a large scale? Madiha Zahrah Choksi is a Research and Learning Technologies Librarian from Columbia University in New York City. She manages the 3D printing library there, and just over a month ago she was approached by Pierre Elias, a cardiology fellow at the Columbia University Hospital, to see if she had the capability to print face shields that the frontline medical workers were so desperately in need of.

Madiha Zahrah Choksi

If this was a normal day at the office, I would say, ‘Yeah, I’d happily see you by tomorrow or the next day,’ but campus had been closed for about four to five days by the time I heard from him, and so I didn’t know what to do. I didn’t even know how I could make this happen.

Julie Gould

Madiha jumped into action and started emailing senior university staff. She was quickly given permission to take the 3D printers and all of the chemicals she needed home. She then went to an office supply store to pick up glue, tape and elastic bands, and got to work to produce prototypes.

Madiha Zahrah Choksi

Once I handed these off to Pierre, he said, ‘These are amazing, I’m going to go test these out with my unit and I’m going to get right back to you.’ He got back to me within a few hours and said, ‘Can you do like 1,000 of these?’ That was just like the moment that it became very real and that I knew that I had to start pushing this out to social media, to my colleagues, to get all the hands on deck that I could.

Julie Gould

At this point, through various connections, Madiha joined forces with the local 3D printing production company who have the 3D printers and a community partner who have donated their space on a 24/7 basis so that the whole team could scale things up.

Madiha Zahrah Choksi

To date, we’ve done just under 13,000 face shields to over 50 hospitals, clinics and other frontline groups, such an EMT and paramedics, and we’re continuing to go strong.

Julie Gould

But it’s not just the PPE that the open hardware community is producing. Pre-pandemic, medical devices like ventilators were solely produced by specialist medical device companies. Now, there are several smaller-scale groups who are trying to redesign the ventilator based on minimum requirements that governments have asked for. Jenny Molloy is a research fellow at the University of Cambridge, and she studies the application of open source approaches and local manufacturing for research tools in biology. She also co-founded the Gathering for Open Science Hardware and has experience of working with regulatory bodies to make sure medical devices and tests meet health and safety regulations. Now, understandably, when developing something as vital as a ventilator, things have to be done properly.

Jenny Molloy

Some of these machines are regulating breathing. They’re actually forcibly pressurising air in a way that could harm the patient if it’s done incorrectly. That’s an invasive procedure and there the regulations are much stricter, and so I’d say that some of the projects are not thinking about this in great detail. There’s a lot of focus on the engineering and getting something that functionally works, but maybe without considering the broader context of the types of regulations that are in place. Some projects are taking it extremely seriously and are very much involving regulators from the very start to understand what they need to do, involving lawyers from the start to get to grips with potentially the intellectual property situation but more importantly things like product liability that they need to consider.

Julie Gould

Paula Collins is part of a team that has made sure that their work considers all of those things. Paula is a physicist at CERN who normally works on the LHCb experiment, which studies the differences between matter and antimatter. Over the last few years, she and her team have been working on upgrading the devices for the detector which was due to reopen next year, but on the 20 March, CERN shut down all its activities and went on a full-scale lockdown as part of the fight against COVID-19. Once locked out of the lab, Paula and her team found a way to help. They discovered that the physics of a ventilator is incredibly similar to the physics that they use on the LHCb detector at CERN.

Paula Collins

So, we saw that there was an incredible match between the kinds of things that we had been doing in our lab and the kinds of things which were needed and by this, I mean highly regulated gaseous control systems. So, we have already been building that for our experiments a huge degree of automation and control. So, in our experiments, we remotely control thousands of devices that have to operate reliably and safely and sometimes you can’t intervene, and that’s exactly what you need to do a ventilator design. So, we had to very quickly put together a proposal, with which we could convince the CERN management that this idea had some potential about it, and then happily they were convinced and they gave us access on Friday 27 March at lunchtime and by late that evening, just using pieces that were lying around in the lab, we put together something already that could push air in and out again, and at that moment, we knew that the idea was sound and we just never looked back.

Julie Gould

Over the next three weeks, the team worked non-stop to build several prototypes and tested them against a mechanical lung. This is the stage that they’re in now, and they hope it will complete soon. Should this device meet regulations, the team will have something that is capable of being medically approved within the next two weeks. And to make sure this happens, the team have had to be flexible.

Paula Collins

The regulations are actually pretty clearly laid out in the documents which have been provided by various governments and agencies. So, they have put out these documents that have an explicit list of what they’d like to see included, what is not necessary to include for a ventilator in this crisis. Now, the regulations that they put out very quickly also have been changing, so as more information gets in about COVID, and we’re tracking that very closely and any changes that we see, we incorporate it.

Julie Gould

The long hours have been hard for Paula and the team, but she believes that they were perfectly placed to create this ventilator, and hopes that it will benefit the international community during this pandemic.

Paula Collins

Within the team, many of the challenges that we faced in building a particle physics detector, I think back on little problems that were solved, things that were discussed, it almost feels like it was all leading up to this moment. All of that preparation made it possible for this to happen so fast in such a small space of time. So, I feel incredibly emotional about this project and I want to make sure that it succeeds.

Julie Gould

Not everyone in the open hardware community is aiming to produce equipment for the frontline. Some people are just playing with designs, trying to see if they can improve on existing ideas. But just because these things don’t make it to the patients and healthcare professionals, doesn’t mean that the idea and technical documentation created are wasted, says Jenny Molloy from the University of Cambridge.

Jenny Molloy

And this is absolutely the core strength of open hardware is that we always build on projects that come before us, and so it might be that one of these projects that for whatever reason didn’t quite scale and make it into a clinic now during the pandemic, it still produces a useful valve or a useful module that could be incorporated into another device. And I think if you don’t make your designs openly available, then that project effectively dies without having so much of an impact, so I think that is one of the strengths of putting stuff out there openly.

Julie Gould

I asked Jenny if she had any advice on how anyone who wanted to contribute to this pandemic by creating some much-needed medical equipment could do so.

Jenny Molloy

I think just reach out to people who do know this space. If you’re in a university, there probably are people in your technology transfer or commercialisation office who have some knowledge of this space, but that’s likely to be more related to commercialisation and intellectual property, but ask around. I mean some places, if you’re fortunate enough to be in a city that is a kind of tech or biotech centre, there will be people who have these regulatory expertise and quality assurance expertise that can at least talk you through it so that you understand the complexities of doing this type of thing. So, I think it’s new territory for a lot of people and maybe just a little patience. Although we’re all wanting to do something as quickly as possible, we don’t want to do something unless it’s safe and so there has to be an element of walking before you run.

Benjamin Thompson

You can read more about how researchers are stepping up and making medical equipment in the technology feature over on the Nature website, and I’ll put a link to that in the show notes. That’s all for this week. As always, you can reach out to us on Twitter –@NaturePodcast – or on email – podcast@nature.com – with your stories of how your research has been affected by the pandemic. So far, we’ve heard about researchers adapting RNA extraction techniques in Jordan and from a team in Norway who are developing and producing reagents for coronavirus tests. Keep those stories coming. There’ll be a coronavirus-free edition of the regular Nature Podcast on Wednesday, and we’ll be back with episode seven of Coronapod next Friday. I’ve been Benjamin Thompson. Stay safe.