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  • NATURE PODCAST

Coronapod: The Surgisphere scandal that rocked coronavirus drug research

Noah Baker, Amy Maxmen and Richard Van Noorden discuss the latest COVID-19 news.

In this episode:

00:52 Testing disparities

As testing capacities increase, it is clear that not everyone has equal access. But grassroots organisations are trying to correct this inequity. We hear about one researcher’s fight to get testing to those below the poverty line in California.

09:04 The hydroxychloroquine saga continues

As a high profile study in the Lancet is retracted, the first data from clinical trials is coming in and it is not encouraging. We discuss the murky future of hydroxychloroquine as a COVID drug.

News: High-profile coronavirus retractions raise concerns about data oversight

12:31 Will the Surgisphere scandal erode trust in science?

A questionable dataset from a mysterious company has forced high-profile retractions and thrown doubt over drug trials and public health policies. What will the fallout be and can researchers weather the storm?

23:23 Back in the lab

As lockdowns ease, researchers are starting to go back to the lab. But with various restrictions in place, what does science look like in the new normal?

News: Return to the lab: scientists face shiftwork, masks and distancing as coronavirus lockdowns ease

Careers: Coronavirus diaries: back to the lab again

Never miss an episode: Subscribe to the Nature Podcast on Apple Podcasts, Google Podcasts, Spotify or your favourite podcast app. Head here for the Nature Podcast RSS feed.

doi: https://doi.org/10.1038/d41586-020-01790-y

Transcript

Noah Baker, Amy Maxmen and Richard Van Noorden 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 you know 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.

Noah Baker

Hello, and welcome to Episode 13 of Coronapod. My name is Noah Baker and joining me after a few weeks away is Amy Maxmen, senior reporter in the Bay Area in the States. Hi, Amy.

Amy Maxmen

Hi.

Noah Baker

And also on the line is Richard van Noorden, Features Editor here at Nature.

Richard Van Noorden

Hello.

Noah Baker

So Amy, you're back. And one of the things we're going to talk about this week is one of your very favourite topics, which is testing. Now we've talked about testing a lot and for good reason. It's very, very important. But recently the sort of dialogue on testing is changing. And more things are coming out of the woodwork. Last week on Coronapod Nidhi Subbaraman and Richard and I spoke about the way that Coronavirus is disproportionately affecting people of colour, testing is also disproportionately available to people of colour. And this is something that you've been looking at more generally, the disparities and the access to testing in various communities. And one particular person who is trying to change that and how she's doing it. Tell us a bit more.

Amy Maxmen

So yes, a lot of tests are now coming online in California, I always get updates from the health department that more and more groups are doing drive thru testing, for example, a Google spin off called Verily they're offering testing. But I've been worried because number one, does everybody have access to these tests that are coming online and also, it's not just about the test, but also about the entire follow up what kind of happens next, because that's really how you're going to stop transmission. So that's why I reached out to Noha Aboelata. She's the founder of Roots Community Health Alliance in Oakland, California. That's the city kind of right next to where I live. And I actually got connected with her because one of the six labs she's working with is the one at University of California, Berkeley. But I was interested because I saw that she had reached out to them because she had a huge number of people that she serves, I think they see roughly between like 6,000 people a year, around 10,000 people in total, and they've been around since 2008. And they serve people who are all below the poverty line in Oakland, and also in some surrounding cities, and more than 85% of the people that they serve are of African descent. So what she's really concerned about is making sure that tests reach these folks and also, that she can follow up with them in a way that's really going to change these big disparities in COVID that we're seeing.

Noah Baker

So what are the challenges that Noha is facing when it comes to trying to get tests to the right people.

Amy Maxmen

So she brought up the issues about access as far as reaching the centres in a car or, you know, not having an identification card if that was required or not having an email address, but even when people did have these things, they might be reluctant to share them. Because there's some mistrust in that community.

Noah Baker

And I've heard a little bit of the interview that you did with her. And one other thing that she raised as a potential thing that could cause mistrust in these communities is research practices of people that have gone to those communities to gather health data. We actually have a clip.

Noha Aboelata

A lot of research practices, seek to sort of come into community get information and then leave and then you never hear from folks again. And that is something that I think our community has gotten really accustomed to and is rightfully mistrustful of. So I think those are some of the underlying things.

Noah Baker

That surprised me as well, because I've heard people talk and you know, we talked a little bit on Coronapod last week about how there could be distrust in the healthcare system, but all the way down to people that are trying to learn about these communities, the way that they do that is also causing mistrust within communities and therefore maybe a lack of willingness to engage with health care or to engage with testing.

Amy Maxmen

Exactly. And that was sort of why she said that, that's why it's so important that if you're, say, you know, Verily just to name one example, or any other group that's offering testing, even if your intentions are great, and you think I'll put a tent up, you know, I'll even go to this community in East Oakland, and I'll put up a tent and I'll put my banner on it, people might not come there. So that's why she says, you know, it's really important for these testing groups, and for the city of Oakland or health officials to work through grassroots organisations like her own that have been in these communities for more than a decade. So it's important to work with them, because communities already trust them, they know them, they know who to complain, to, they know to who to get results from. So that's why she feels like she's filling an essential gap here.

Noah Baker

And so what is it that they're actually doing? You know, you say that they're trying to get into these communities, how are they doing it? Where are they doing it?

Amy Maxmen

So they've got like a few different places to offer testing. One is they've got sort of brick and mortar clinics that they've set up that have been serving people's health needs for a long time. They also work out of some youth shelters. They work out of some homeless shelters. They also have a street medicine team, where they have an RV that's been remodelled where they offer medical care out of that. So now they have testing there. They've also set up walk-up testing sites. This includes in the parking lot of a church and other walk-up testing sites in Oakland and some other cities. So far, she let me know that they've tested more than 3,200 people. And for example, at one of their walk-up sites in Oakland, they're getting an almost 15% positivity rate.

Noah Baker

That's really high.

Amy Maxmen

Yeah, it's super high.

Noah Baker

And I think this is a really interesting project for this particular relatively small area of the West Coast of the United States. But are there other projects like this around the world trying to tackle this problem of testing disparity?

Amy Maxmen

I don't know about around the world, but I do know, in the US, there's a lot of grassroot groups like this, that really work hard on these disparities. For example, I imagine this was something that was happening because I know these groups exist, so all I had to do was kind of look for the one in my own neighbourhood.

Richard Van Noorden

When you compare to the testing done in other countries, like China testing all 11 million people in Wuhan, it just seems that the United States has simply not spending enough on testing but I suppose we all know that. But it just struck me when I'm listening to you talking about this particular effort.

Amy Maxmen

Well, I should say, I think what's interesting to me is, so it's certainly a matter of how many tests but also this issue of really directing efforts in a way that smart I think, is going to make a big difference, because just simply putting up tents with lots of testing isn't going to do it, which was kind of interesting. What's kind of weird is a lot of what she was saying just I kept getting flashbacks, again, to, you know, my reporting on Ebola in DRC. And there, there was a lot of issues with people not trusting Ebola responders who were from outside of the community. So not even just people from, you know, outside of the Congo, but also people who are Congolese, but from across the country from Kinshasa. So there was a lot there that was about very long standing feelings of neglect and abuse, and they didn't take well to outsiders just coming in and saying they're there for a good purpose. And they were skeptical but for very good reasons.

Noah Baker

We talked on last week's Coronapod about the increased likelihood of infection for people of colour, and also the increased likelihood of poor outcomes of death as a result of infection from COVID-19. I'm just very cognizant, while you're speaking that 15% of the people that Noha has testing is a very, very high percentage, is she concerned about what this could mean for outcomes for these people, especially if they have limited access to healthcare following that positive test?

Amy Maxmen

Yeah, she's definitely concerned. And you know, her main goal right now is getting that number down. You know, I first reached out to her three or four weeks ago. So that was the first time we talked, and at that point, she was getting between 8 to 12% positive. So it's actually gone up.

Noah Baker

And of course, one of the things that's happening right now, as well as the pandemic is the is the recent protests that are all over the world in support of the Black Lives Matter movement. Now this has particular relevance to the communities that she's working in. as well. And one of the things that you asked is whether or not she has any particular feelings about those in her position. As someone that's trying to test and correct these disparities.

Noha Aboelata

Almost all of the disparities that we see in our community can be traced back to systemic inequities. This was why Roots was created really in the first place, is to sort of overcome some of this and help address some of these systemic barriers and also to identify them and bring them to light. And so it's really positive that these things are being recognised, I think, in a new way right now, but we're also obviously worried from a transmission standpoint about the gatherings and things like that. And so we're really encouraging our community to come and get tested if you think you've been exposed at all, and we really just want everyone to stay vigilant.

Noah Baker

Which I think is a very pragmatic response.

Amy Maxmen

Yeah, her sentiment is similar to like most of the public health people I know, which is that they understand the sentiment behind these protests is so important to public health so they understand where they're coming from.

Noah Baker

Okay, so I'm going to move on here to talk about another story, which doesn't seem to be able to stop developing. And that's the ongoing saga for the drugs hydroxychloroquine and chloroquine. So, Richard and I spent an entire episode of Coronapod trying to unpick what was going on with chloroquine a couple of weeks ago. And there was a lot to say, after a study came out in The Lancet, which caused mass confusion around the world, the WHO paused chloroquine trials, there were countries like France, which banned the use of chloroquine as a treatment. Everything went into uproar. And we mentioned some potential scepticism about the paper and some problems. Since we talked about this, a whole bunch more has happened. And that paper has now been retracted. And all of the data that it's used that came from this particular private organisation called Surgisphere has been thrown into question. Amy, I know you've got lots to say on chloroquine, but I'm gonna ask Richard quickly, can you give us an update on where we are with chloroquine.

Richard Van Noorden

Yeah, so with hydroxychloroquine itself, we can essentially just scrub clean these papers which have fallen into complete disrepute been retracted. The company involved Surgisphere has wiped its website. And it's really very unclear as we can go on to talk about whether any data existed at all. So let's try and put that out of our minds. There have been at least three studies that have come out of randomised clinical trials now on hydroxychloroquine, one British one in hospitalised patients, and they looked at the data early because to see what was going on, and they saw that it didn't reduce death in the patients who got the hydroxychloroquine. So they're stopping that arm of their trial. And two other trials, which also were randomised trials for people taking it if they'd been in close contact with someone who has the virus. Well, that didn't reduce infection either. So it's still potentially possible, there are still some other randomised trials going on, that perhaps you could take it at an even earlier stage before you'd even been in contact with someone who’d been infected some kind of pre-exposure prophylaxis effect. And some of those trials are still going on, but it is not looking very promising for hydroxychloroquine.

Noah Baker

And one of the places that hydroxychloroquine has been in the news most in the world has been in the States, and that's in large part due to President Trump's endorsement of the drug very, very early on. Amy, what's the reaction been like to the latest instalments of the chloroquine saga in the States?

Amy Maxmen

You know, from what I know from where I'm standing, I worry a lot of people's responses are based on their political positions, I guess so that's sort of what's worried me. It's either like, 'See, I told you Trump's drug doesn't work' or 'See Trump's drug works and you're just trying to pooh-pooh this because you don't like Trump', which I find dismaying. So either way, I think the response from you know, many scientists are we need to actually have good data here. And the messages that the public are getting are quite confusing also. And I think that that doesn't help the situation at all.

Noah Baker

And I guess what's making the situation even more confusing is that there is also this dataset on this kind of blockbuster Lancet study that was then retracted, which we can, you know, wipe clean and ignore now, the data set behind that has been called into question completely. And that's led to people looking at other drugs ivermectin, there was another research paper looking into ivermectin that was based on this data. Richard, Surgisphere, what's going on?

Richard Van Noorden

Surgisphere was this, is this company in Illinois. And when I say company, it may only have one employee or it may have several who knows, but it was set up in the early 2000s. Initially, it seemed to be doing medical textbooks and then it kind of went sideways into this hospital data. And its CEO Sapan Desai was saying that it had all of this electronic health records from hospitals. And when COVID-19 hit, he was saying that this data could be analysed to see what happened to patients instead of having all these trials. So a number of papers came out before the hydroxychloroquine one came out, there was one on some heart drugs in the New England Journal of Medicine from this dataset, hundreds of hospitals, tens of thousands of patients, apparently all this data, there was one on as you say, an anti-parasitic drug called ivermectin that was only issued as a preprint. Not a peer review paper. And that was saying that this drug could be helpful. Then there was this hydroxychloroquine study, supposedly on 96,000 patients from hospitals and people sort of looking at this and saying, well, is that possible that you've collected all that data? People were saying, 'I rang up some hospitals and they say they haven't worked with you haven't heard of you'. And ultimately, this all went to an independent audit, or so the Lancet and the NEJM said, and then Surgisphere said that they couldn't provide any of this data or even any of the agreements with the hospital to third party auditors for confidentiality reasons. So at this stage, the other authors said, 'Well, we don't have any confidence in these findings anymore and these papers have to be retracted'. The ivermectin paper was simply pulled as a preprint from the SSRN, a preprint server. So it hasn't really ever been retracted because it was never exactly published. And that unfortunate positions led to its own concern because ivermectin has become very popular in South America partly as a result of this paper. The Peruvian government included ivermectin in its national treatment guidelines, a few days after a white paper cited this preprint. And Bolivia has also added ivermectin to its treatment guidelines. This is all from a researcher called Carlos Shakur of the Barcelona Institute for Global Health who raised some questions about this preprint. He's running a clinical trial of ivermectin, and he says, well, this paper is basically meaningless now, but there's no high-profile journals saying it was wrong and there's no retraction mechanism. And he's saying he gets texts every day from people saying ‘My family member has been infected. I can get some ivermectin. It's intended for use in animals, not people. But could you tell me what dose to use?’ You know, he's really worried about this. And people are very desperate. And he said, you know, this could all lead to misuse. And these papers on treatments aren't the only thing that's had to be been retracted. The African Federation for Emergency Medicine, which is a non-profit organisation, worked with Surgisphere to develop a sort of scoring tool for severity for COVID-19. And the idea was, if you're a clinician, you could put in what your patient had, and it will tell you how to allocate your limited resources like oxygen or a mechanical ventilator. And they've had to basically pull that and say, we're sorry, we ever promoted it, because it looks like a lot of the data that was apparently based on, well, we don't know did this data exists that did not exist. We have no idea. Really, the whole thing is completely baffling.

Amy Maxmen

How often does it happen for big clinical trials? How often does it happen that they use third party… because a lot of people use these like contract research organisations, things like that. How often does it happen that people don't review the data?

Richard Van Noorden

Yeah. Well, David Smith, he's an infectious disease specialist at the University of California, he's running a trial of hydroxychloroquine. He said, it's not uncommon for studies with large datasets, not really to have external scrutiny of the raw data, so he was saying, well, you know, this can happen. It's just that when the paper is expected to have really important impacts like this one, it maybe should have been reviewed more carefully, because of its, you know, immediate medical effect. I mean, if you think about it, the NEJM one, which was published much earlier at the beginning of May, that might have happily trotted on for a long time and never been retracted at all, if people hadn't started looking at it, because The Lancet paper was so high profile and so immediately attacked by outside critics. Now the other frustrating thing is that the journals themselves aren't really saying anything about the peer review process. NEJM said the article had external peer review and statistical review, and scientific and manuscript editing. But they won't reveal any details even of how long the article spent in peer review. And nor will The Lancet which most journals at least say. Now Science have said on Twitter that they've been told that the articles spent a month each in peer review, they haven't said who told them this. So that suggests that the peer review was fast, but it was not exactly rushed. But we don't know officially, and the journals aren't saying and the NEJM said that we're reviewing our procedures, including how we assess research, analysing large data sets based on electronic medical record data. So maybe we'll see some changes come out of this. Maybe we'll see journals insisting on some kind of certification or more checks about the validity of these big data sets.

Noah Baker

I kind of I want to... You know, there's a part of me that wants to get weirdly excited about this because it's like some kind of strange scientific soap opera with the levels of stuff. But you know, I also don't really want to get excited about it like as juicy gossip because these this has really real impacts on public health and people's health. This is not doing good things for the institution of science right now.

Richard Van Noorden

Yeah. And some trials of hydroxychloroquine were halted because of this paper, and many of them have been restarted, but not all. So it's had a real impact on some trials. And yeah, I think it rightly leads to less trust in science, really.

Amy Maxmen

I forgot to mention we were talking about Dr Noha, so she was talking about kind of the historical mistrust of communities for the health system. But she also said another big factor here is mistrust in kind of in general right now around COVID health messaging. So she was saying all of these conflicting things that keep coming out 'chloroquine's great', 'chloroquine doesn't work' or 'there's no spread between asymptomatic people' and 'there is spread from asymptomatic people', the way this lands for the general public maybe isn't such a charming academic debate as it might be on Twitter, it's actually just really confusing. And she was saying, people are really just sort of questioning what to believe. And they're at this point, even sometimes figuring out what they're going to do based on their own thinking, because they're not sure what science is saying, what's just politics, and the combination is actually a really bad effect for just even basic messages to the public.

Richard Van Noorden

Well, I mean, absolutely, everyone is disagreeing with each other. And it's not even that the evidence itself is hard to interpret, which it is, it's that people are even disagreeing on their most rigorous and best ways to interpret it, and aren't even agreeing on the uncertainty in which to couch their findings. That makes it really difficult for anyone to know what the research findings are, and you can see how the discussion is really clouded very quickly.

Amy Maxmen

So what do you say to kind of general public non-scientists who just feel like what can they even listen to? What advice should they even listen to? Or what should they believe? Like, should they completely stop believing in, you know, a test result? Because we know that there's inaccuracies in tests or which treatment is good, should they tune out? I don't know. What do you say to that?

Richard Van Noorden

Yeah. It's so frustrating. I mean, you would say the World Health Organization but the World Health Organization's messaging has not been brilliant lately. On Monday, Maria Van Kerkhove said that transmission from asymptomatic people seem to be, quote, 'very rare'. And she's sort of corrected herself to say, Well, okay, we don't really have the answers to know whether the transmission by people who never show symptoms, is very rare that that did happen quite quickly. So I would still say listen to the WHO, because I can't really think of other authorities that are at least trying to get the message right. I mean, it's really quite a shame that even the companies making some of these tests for COVID-19 are really being very selective about the data they present on accuracy of their tests.

Amy Maxmen

I wonder if this is something I tell myself when I see studies, if I find myself really liking the result, I almost feel like it's doubly important that I look at like the data for it and just sort of question myself on it because I feel like people are jumping on that. For example, you know, I wrote about survivor blood early in this outbreak, which is now being tested in a number of trials. And an investigator who's working on that sent me a paper on convalescent plasma for COVID-19 in Africa, and especially in Burkina Faso, and came up with there's something like a 50% improvement. I don't want to spread that around because when I looked at the data, it was in no way like ‘there's x many patients and this is how many recovered’ It was like they had sort of modelled numbers to bring it up to that result. There was a lot of math that happened to get there. And none of the data was there as far as ‘here's the number of patients that got better in 11 days versus 21 days’ or something like that. So I immediately was like, I don't even know what this paper is saying. I think that's just something I think of myself.

Noah Baker

That's a good rule of thumb. If I like it, or maybe if I really don't like it, either way round strong feelings either way more reason to double down on the data

Amy Maxmen

Because it's more reasons that people are like, see, cos scientists love their theories, they really do. Scientists fall in love with it, they think is correct. And there's a little bit of bias there.

Noah Baker

Usually, we will do one good thing, but I actually think we've talked so much and there's so much fascinating stuff there that maybe I might just eschew the one good thing this week. Are we happy with that?

Amy Maxmen

Sounds good to me.

Richard Van Noorden

Sure. The only good thing I have is the Oxford are in the playoffs of League One. So I don't think we need to mention that.

Noah Baker

I don't even really know what that means.

Richard Van Noorden

It means the British football, the British football divisions voted to end their season early.

Noah Baker

Yeah.

Richard Van Noorden

Anyway, whatever. Let's not get into it.

Noah Baker

Okay, well, coming up we've got a whole bunch of examples of scientists that are going back to the lab and how that's working for them. Stay tuned for that. But for now I'll let Amy and Richard go and I'll draw this part of the show to an end. So Amy, Richard, thank you so much for joining me today.

Amy Maxmen

Thanks a lot. Bye.

Richard Van Noorden

Thanks.

Noah Baker

Finally, this week reported Julie Gould has taken to Twitter to find out how researchers around the world are getting on as labs and universities gradually start to reopen. Here's Julie.

Julie Gould

As lockdown eases across the world, scientists are preparing to return to the lab, but it won't be business as usual. COVID-19 haven't vanished and precautions need to be taken. Malú Tansey is the director of the Center for Translational Research in Neurodegenerative Disease at the University of Florida, and her lab is being used as a guinea pig for the wider University of Florida research lab system. In early May, the university powers-that-be approached Malú to see if her centre could draft a plan that would help get the lab opened again to research in a staged manner that the rest of the research labs at the university could also use. The six people task force took 20 days to get things sorted. This involves sourcing PPE, putting a shift system in place to keep capacity at a certain level. And it involved some gaffer tape.

Malú Tansey

Picture a supermarket that has different aisles. It has one big corridor, say in the middle, and you can go in two different directions. But then you can go into each and every aisle up and down the aisle with your cart.

Julie Gould

Pre-pandemic this supermarket/laboratory is an open lab space where between 12 to 14 research groups, each with between six to 20 lab members would work and collaborate. Pre-pandemic her lab would also be incredibly busy, several people to a bay people coming in and out walking in any direction. Camaraderie was strong. Science was a team effort and greetings would fly across the room. It had a lot of energy. Post pandemic, and now that lockdown is easing, things are a little bit different.

Malú Tansey

We had to make those aisles one-way instead of two-ways and the main corridor is two-ways but you have to stay to the right or stay to the left. And we had to turn certain corridors just one-way. And so we put gaffer tape down the middle so that people would not run into each other. And we had to put arrows on the walls on the outer corridors to make sure that those became one-way. And you know, it required a little bit of a culture change. But so far, so good.

Julie Gould

As of June 1, Malú's lab was given the go ahead to relax the rules a little, instead of 500 square feet per person in the lab, the spacing has been reduced to 250 square feet per person. So although this sounds like a positive move back towards a pre-pandemic normal, it does come with some additional challenges.

Malú Tansey

I think it's going to be difficult to get back into the lab and resist the urge to be very chatty and to be very talkative and we've known from studies that talk shouting contributes to viral spread. So it will be a challenge and it will be important for people to understand that they need to keep their voice down a little bit and, and resist the urge to talk too much. But I still think that it's important to have scientific discussions. And if you keep your distance and you change your mask and use your PPE properly, I think it should be, you know, still safe.

Julie Gould

Now going from shared spaces to shared equipment. Many research laboratories use shared equipment, it's very common, some labs are set up for that particular purpose. And this is important now that laboratories will be used again. In the UK, the Prime Minister Boris Johnson announced that researchers will be able to return to work from the 13th of May 2020. Several guidelines were put in place, but one notable bit was that the UK Government had advised that shared equipment shouldn't be used where possible. And for obvious reasons for many labs, this just isn't an option. Alessandro Esposito is a group leader at the MRC Cancer Unit at the University of Cambridge in the UK and his team develops new imaging technologies for cancer research. And so part of Alessandro's work is to also advise the imaging facilities at the institute on operational procedures as well as health and safety. And one of the most common imaging tools in science is the microscope. And making these available for researchers to use safely is important, but also very difficult.

Alessandro Esposito

Either on purpose because it's how we operate microscopes or by accident, we can transfer viral particles from the microscope to us. And because there are some parts of the microscopes that are particularly delicate, that could be damaged for constant cleaning with solvents like the eyepieces, we will put clingfilm that can be therefore disposable. This particular measure is something that is going to bother the users because it's not going to be certainly comfortable and perhaps will be perceived as unnecessary because there will be also eye protections that the users will have to wear. But this is how we will start waiting for further evidence from other facilities.

Julie Gould

The top down approach for managing the pandemic in the UK is very different to how other countries have done it. In Japan for example, the main government doesn't have the power to enforce any lockdown measures by law. Instead, it makes suggestions, it offers advice, and the leaders of each city or prefecture can decide if and how to use this. This is made for a slow and somewhat haphazard response to the pandemic according to John Hernlund, the vice director of the Earth Life Science Center at the Tokyo Institute of Technology in Japan. Now his particular University has set up an alert level system that will dictate who can come onto campus with level four being complete lockdown and level one being back to pre-pandemic normal.

John Hernlund

It looks like all the universities in Japan have some sort of system of levels of alerts and I think they were instructed to come up with such systems and to apply them as appropriate to what's happening with outbreak. However, each university as far as I can tell, has very different guidelines and rules and the numbers on the system that do not correspond to the same severity of alerts at each institution. So, and they've been coming up with the guidelines, kind of as they go, rather than having some fixed way of doing things from the start and then changing.

Julie Gould

Now that the national state of emergency has been lifted in Tokyo, the Tokyo Institute of Technology is allowing more people onto campus, but is still trying to minimize the number of people coming in.

John Hernlund

This is driven by the friction of paperwork. So they would limit the number of people coming into the campus by requiring them to fill out many forms. And these forms have to be collated and put together by the entire institute or department and then forward it to a vice president for approval. And so this looked like a pretty daunting process. So that scared actually many people away from wanting to even go to the labs unless they really needed to do so. So then people are being asked to take their temperatures before they come onto the campus. And there they can take a shot of the temperature on their thermometer and show it to the guard at the entrance to the campus. However, I found I could walk in the back entrance to the campus and nobody's there checking or monitoring. So it doesn't seem to be super strictly, it's more of a matter of I think, discouraging people from coming to campus unless they need to go there for some specific reason.

Julie Gould

One thing that does remain consistent across the world when it comes to reopening labs is safety first, but if that's the case, and you're limited to the number of people allowed into the lab at any one time as a result, how do you make sure that people adhere to the safety rules? This is one of the biggest challenges says Alessandro Esposito from Cambridge University.

Alessandro Esposito

Health and safety has to be based on trust. Like in all environments, even in research laboratories, there are those people that are a little bit more easy-going, let's say with rules, I would assume that they will never put themselves in danger or others in danger, but they may underestimate occasionally risk and there is other people that is overly concerned about risk even if the environment is safe and then there is the bulk of people in the middle. So yes, the actions that we are going to take is clear rules messages on doors. Also speaking about having good behaviours, good behaviours in terms of the health and safety proper cleaning gloves using gloves, PPEs, but also good behaviour with others to be polite to ask if people is not respecting the rules, to tell.

Julie Gould

For Malú Tansey from the University of Florida. The biggest challenge is making sure that all staff keep an accurate log of when they've been into the lab. This is really important for tracking and tracing after an outbreak. But it is a change which may take researchers a bit of getting used to.

Malú Tansey

Normally the culture of academia is you go in you do your work, and we don't clock in, right? They're not hourly employees. And so we don't… we're not watching the clock. I certainly don't, I don't really care what time somebody comes in as long as they get their work done. And so when you ask them to do that, I think the concern is that we care how many hours they work. We don't really care how many hours of work we just need to know when the overlap happened. If anybody becomes sick.

Julie Gould

Here's Alessandro again.

Alessandro Esposito

And eventually it is going to be down to good leadership and to make sure that they will be ready to resolve potential conflict that will be between users.

Noah Baker

If you want to read more about the challenges facing researchers who are returning to the lab. There's a story on nature.com that you should check out. I'll put a link in the show notes. And with that, we've come to the end of another episode of Coronapod. Do join us again next week and remember that there's a coronavirus free episode of the Nature Podcast going up every week on Wednesdays, you can find that on all the usual pod catchers. And if you want to get in touch with us about anything we've talked about on this show, then don't hesitate to take to your keyboard. You can find us on Twitter @naturepodcast or email us podcast@nature.com. Until next week, thanks for listening and stay safe.

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