Science Friday - COVID Near You Citizen Science, Fact-Check Your Feed. March 27, 2020, Part 1

Episode Date: March 27, 2020

These days, our newsfeeds are overloaded with stories of the coronavirus. This week, Science Friday continues to dig into the facts behind the speculation—the peer-reviewed studies and reports published by scientists investigating the virus. But what we know—and don’t know—about the new virus is changing daily, making it hard to keep up. Everyone, for example, wants to know more about possible therapies for treating COVID-19 patients. After President Trump publicly speculated about the tried and true antimalarial drug, hydroxychloroquine, his endorsement sent governors, doctors, and the worried public scrambling to get their hands on the drug. But is there any science to back-up this claim? And what about remdesivir, the antiviral drug that has been used to treat a handful of patients, and is now the subject of several new drug trials? Angela Rasmussen, associate research scientist and virologist at the Columbia Mailman School of Public Health joins Science Friday once again to break down the science behind the stories. As suspected and confirmed cases of COVID-19 skyrocket in the United States, testing availability remains limited, leaving people wondering if their cough is something to worry about. But testing isn’t just a balm for anxiety—public health officials need data about how far the new virus has spread to make decisions about how to best protect people, and where to send critical resources, like masks and gowns. Accurate information is the frontline of defense, but scientists still have pressing questions about the novel disease. For instance, how many people who are infected actually have symptoms? If you do have symptoms, how likely are you to get severely sick? Until we are able to test both healthy and symptomatic people at scale, citizen science can help fill the gaps in tracking who has COVID-19. And the public health team that launched Flu Near You to track seasonal flu symptoms is now doing just that: soliciting your symptoms in the Covid Near You project. Covid Near You co-founder John Brownstein of Boston Children’s Hospital explains what questions the project may help answer, and what trends Covid Near You will track—including why this data is so valuable to public health efforts. Sign up at www.covidnearyou.org to report how you’re feeling—whether you’re healthy or have symptoms. Subscribe to this podcast. Plus, to stay updated on all things science, sign up for Science Friday's newsletters.

This is Science Friday. I'm Ira Flato. Just a note, due to the need for social distancing this week, we won't be taking calls during this edition of Science Friday, which was pre-recorded earlier in the week. One of the biggest issues in the U.S. when it comes to the COVID-19 pandemic is testing, getting more tests produced, and the struggle to get one if you need it. But what exactly is the science and technology behind those PCR-tops? tests. How do they work? Maggie Kerth is here to fill us in on that story and other COVID headlines from this week. She is senior science reporter for 538.com based in Minneapolis. Welcome to Science Friday. Welcome back. Thank you so much for having me. Let's talk about this coronavirus. It's made up of RNA, and that is what the tests are analyzing. Can you give us a little thumbnail on that?

Yeah. So the tests are all, it turns out, the ones that we've been using for the past few weeks at any rate, are all based around the same technology. That's true here. It's true in other countries. And basically what's going on is that a medical professional sticks a swab way, way, way, way up the back of your nose. And then they take that biological gunk in technical terms. And they first have to isolate viral material, the RNA, out of that goo, separating it off from mucus, random cells. And RNA is sort of like, you can imagine it is like half of a ladder.

So if DNA is like a twisted ladder, RNA is sort of like that split in half. And so the first thing that they have to do is turn RNA into DNA. That's called reverse transcription. And it's something that can be done with what amounts to science kits that researchers buy from scientific supply companies. They do that. And then the next step is something called polymeria. chain reaction, which is a long-established technology and method used for multiplying the numbers of DNA fragments that you have so that you have enough that you can actually study.

And a big part of what makes the test that we have from the CDC different from, you know, the ones that they're using with the World Health Organization is what specific fragments of the virus that causes COVID-19 that's a virus that. they're looking for when they do this replication step. That's actually the thing that makes it different. It's not different technology. It's not, you know, different methodology. It's just looking for these different sort of fingerprints of the virus. And so I can see with so many steps and so many different, the swabs, the vials, everything else, if you have a shortage, if you have a blockage someplace, that could stop creating the tests altogether, right? Right. So it turns out that what

is actually slowing down our testing in the U.S. at this point isn't really anything that has to do with the technology itself. It has to do with supplies of all the things that you need for the technology. And that includes everything from the nasal swabs to the chemicals that are used to do the reverse transcription and the PCR to just healthcare workers to run these tests. How come South Korea was able to do, what, a quarter of a million people so quickly? And they have the drive-through testing stations. What is taking us so long to catch you up there? Honestly, it sounds like the biggest thing is that we haven't had a serious outbreak, a serious pandemic affect us since the 1960s.

So South Korea had a brush with a cousin virus of COVID-MERS, MERS, back in 2015. And it wasn't a huge outbreak there, but it was enough to, you know, put the fear of God into the leaders of that country. And they started having plans ready to go. They started having these chemicals in strong supply. And they were ready when this hit. Well, there has been talk about developing a home test kit. Would this also tax the supply if we had these things? It depends on what kinds of kits ended up being used. There are a lot of different kinds of ways that you can do tests for viruses. Some of them are, you know, based on these reverse transcription and PCR setups. But if you're doing something at home, it would be unlikely to be based around that,

since most of us don't have the technical equipment at our houses. But one of the things that we know about tests that are, you know, very fast done in doctor's offices for things like the flu, is that they have a higher percentage of things like false positives, false negatives. So that's something that if you have a home kit test kit, you're probably going to have a little bit more of a risk of. It's all about tradeoffs. I get you. We initially heard that the coronavirus struck older people, but there's interesting news from in California. Half of the cases are in younger people? That seems to be the case. Yeah, that's what their governor is saying. It ends up being really

interesting. I mean, we look at nationwide cases. You're still talking about a very lopsided, hockey stick sort of pattern where the older you are, the more likely you are to have, you know, had symptoms to have been hospitalized, to have died. But there are a lot of younger people who seem to be getting this, too. And there has been back and forth about whether you should take ibuprofen to treat the COVID-19 symptoms. What's the latest on that debate? So this is one of these things that I think is interesting about a, you know, national emergency news situation is that you kind of get into that sort of fog of war place

where it's hard to understand what's really happening because you're so busy living right in the middle of it. And that's definitely an issue with this pandemic. You know, there have been some of these small studies that have prompted big responses by the media and by the public. and then they turn out to not be as reliable as we sort of first thought. So last week, the French health minister had announced that people diagnosed with COVID-19 should avoid ibuprofen. That was based apparently on four young people who had developed more severe symptoms after they'd taken it.

And it's not a totally unreasonable idea. The British Medical Journal noted that there have been at least two large trials in the past that provided some evidence supporting the idea that ibuprofen can exacerbate. other kinds of respiratory illnesses. But right now, other researchers are saying there's not really any evidence that SARS-CoV-2 is doing that with ibuprofen. So even the World Health Organization, which several media outlets had cited as saying you should avoid ibuprofen, is now saying they never said that. And they're, in fact, consider ibuprofen to be safe for COVID patients. We've been hearing stories about some of the companies that make one thing are stepping up to

make something to help combat this epidemic. And one of those, you know, is hand sanitizer, which is in short supply. There's a story that some distilleries, they make alcohol, right? They're stepping up to help make hand sanitizers. Well, yeah, you know, ethanol is the basic ingredient needed for hand sanitizers. And a lot of distilleries are sort of realizing, hey, we have a lot of this. And the distilleries, as a couple of trade publications, I've read have pointed out are not particularly losing money right now. So they're trying to find ways to give back to the community. And the reports that I've read about this, a lot of these different distilleries all around the country are kind of looking at this as a charity thing.

And they're either donating the supplies of the hand sanitizer, they're making to local hospitals or providing it as a pay what you can sort of, you know, system. It's interesting about this to me is that it's not a completely simple process for them. They have all this ethanol, but it has to be denatured. So they have to kind of add some chemicals to make it unfit for human consumption, which isn't something they're used to doing. And they also had to get a hold of, you know, these other key ingredients like glycerin and hydrogen peroxide and even just, you know, the plastic containers to hold the stuff that they don't normally have on hand. So they have to spend money to sort of retool a bit?

A little bit, yeah. Yeah, and that always costs money and it always takes some time. There are all different types of drugs being named as potential treatments, even if their effectiveness is not confirmed, but that hasn't stopped people from trying to get these drugs, right? And they're creating shortages, aren't they? Right. I mean, this is another thing where you kind of get some of that fog of war stuff happening,

where there was a French study involved less than 30 people, and it suggested that this one common malaria treatment might be effective against the novel coronavirus, which then led President Trump to tout the drug as a likely miracle cure, and then, you know, all of a sudden you have people kind of making a run on this drug at pharmacies. And what has sort of happened is that even though there's not really much evidence at all to support the idea of using this, you have the public stockpiling it. And some of that stockpiling apparently is being done by doctors themselves who are writing prescriptions for themselves and family members

and buying up everything that the pharmacies have in stock, which is a really big problem because besides treating malaria, this drug is also used as a treatment for lupus. So cutting off the supply to lupus patients could mean even more people with these chronic illnesses that make them more susceptible to COVID-19. Yeah, and if people start, are experimenting on themselves with drugs, who knows what some of these side effects would be? Right. I mean, there's also the sort of problem where chemistry can sound like it's the same thing

and not be the same thing at all. And there was one case in Arizona where a man died because he had tracked down a similar sounding chemical compound to the one from that French study. but what he had found was instead a industrial chemical used to clean parasites out of fish tanks. People are desperate. They do desperate things in desperate times. Fear is a hell of a motivator. We're going to talk more, actually, about debunking some of these treatments right after the break so people can hang around. But I'm glad you stuck around, Maggie, to talk about these really interesting topics. Thank you for taking time to be with us again, as usual.

Yeah, thank you for having me. Maggie Kerth, the senior science reporter for 538.com based in Minneapolis. When we come back, we're going to return to fact-check your feed. We're going to dig into the studies and reports behind the news chatter over coronavirus treatments. Some of the stuff will get into in great detail that we talked about now, so stay with us. We'll be right back after this. This is Science Friday. I'm Ira Flato.

And now we return to a topic we've visited before. how to fact-check your coronavirus feed. Our Facebook, Twitter, and Apple news feeds are so overloaded with stories of the virus right now. It's hard to separate truth from rumor. Add to that, we're hearing how much scientists still don't know about testing and treatment of COVID-19. So this week, we're continuing to dig into the evidence behind the speculation, the published studies and reports by scientists coming up with real data about this virus. And this time, we're looking into the therapies for treating COVID-19 patients.

For example, President Trump has publicly speculated about the benefits of using a tried and tested anti-malarial drug, hydroxychloroquine, to treat patients. That endorsement has sent governors, doctors, and worried public scrambling to get their hands on the drug. But what is the evidence to back up the claim? And what about remdesivir? the antiviral drug that has been used to treat a handful of patients and is now the subject of several new drug trials. Joining us once again to clarify the science behind the various possible treatments, Dr. Angela Rasmussen,

assistant research scientist and virologist at the Columbia Mailman School of Public Health. Dr. Rasmussen, thanks for joining us again. Thanks for having me back, Ira. And just a note to our listeners, because we are all practicing social distancing, we won't be taking your calls today during this edition of Science Friday, which is being pre-recorded. Let's talk briefly first about the studies that have come out. Most of them are in pre-print archive. What does that mean? So pre-print archives are a way that has been developed over the last couple years for scientists to put their manuscripts out into the public domain prior to them undergoing peer

review. And it's really important that we have peer review. And it's really important that we have peer review. articles because we need to make sure that when something is being published and presented as authoritative scientific data, that it has been reviewed by a group of other knowledgeable scientists who can assess the quality of that work, the types of controls that are used, what conclusions are being made from the work. But it's also, that process can take a long time. So the preprint servers are a way for people to get the data out there right now so that other people can analyze it, can take a look at it, and review it. But the problem with that is that when people who may not be as knowledgeable about the model systems that are being used or the science

that's being discussed, read them, there can be misinterpretations because, again, they haven't been through peer review, so they may not be 100% final. So that's, so to speak, the drug is not ready for prime time yet. That's correct. And that's what we're seeing for many of these. these drug studies. So many of them are very promising in that they show possible efficacy, but so far we haven't seen any pre-print articles that describe the type of clinical trial that's needed to assess whether a drug is or is not effective against COVID-19. Okay, let's walk through some of these drugs. Let's talk first about the drug from desivir. It has been in the news for a few weeks, an antiviral that was tried on earlier, viruses like

Ebola. The news reports sound hopeful, but what does preliminary data show on this? So, preliminary data, as far as I'm aware, that has been published about remdesivir, is either in vitro, meaning it's done in cultured cells, or is based on data from non-human primates that were infected with MERS coronavirus, which is a related coronavirus that causes a similar type of disease. In non-human primates, infected with MERS, Remdesivir was effective at reducing viral loads and clinical illness. So the theory is that remdesivir could potentially work as well for treating COVID-19. Remdesivir is a fairly broad spectrum antiviral, so there's no reason why it wouldn't work

against COVID-19, SARS-Coronavirus 2. But we also had promising data showing that it would work for Ebola and in a clinical trial with Ebola-divirus disease patients in the demographic. Republic of Congo, it had no impact on clinical outcome for those patients. So this really is just hopeful speculation at this point until we have real data to back it up. That's correct. I mean, certainly it's beyond speculation, I'd say just because the data does indicate in a non-human primate model, which are usually thought of as sort of the gold standard for evaluating drugs and people, that, you know, the data with MERS does. does suggest that it can have an effect in vivo in an animal on a related coronavirus,

but again, we won't know until we complete a controlled, randomized clinical trial. And can you give us any idea of what a timeline would be for this? That depends somewhat on when these trials started. I know that as early as January, there was discussions about beginning a remdesivir trial in China. There was quite a lot controversy actually because there were some patent issues with the actual chemical that Remdesivu is and some stuff going on with the Chinese government and the patent system. So I think that those trials have been going on. I don't know at what point they will decide that they have collected enough trial data from enough patients to publish. But I would imagine

that the timeline is going to be as accelerated as possible. So I would, guess probably sometime within the next eight weeks. That sounds optimistic, terrific. Let's move on to the next drug. Last week, President Trump said the anti-malarial drug, hydroxychloroquine, showed, quote, tremendous promise in treating the virus. Where is he getting that information from? That's largely based on a couple different studies that were preprints. Actually, two preprints and one a study that was a press conference given by a Chinese government official. So there was a study in China recently done looking at chloroquine phosphate that was a controlled trial in which they compared patients who were treated with chloroquine phosphate,

which is a very closely related chemical to hydroxychloroquine, and looked at outcome for those patients. And it's available as a preprint, but it's only the full papers in Chinese. So you need to use Google Translate to read it. But in that study, it showed no difference between the treatment groups. So that suggested that chloroquine wasn't effective. However, the caveat there is that it was a very small trial with only 30 patients total. Also, there was a study out of France that's available in a preprint that looks at hydroxychloroquine. with azithromycin, which is an antibiotic. And I don't know what the rationale was for including azithromycin other than to potentially discourage secondary bacterial infections. But that study

did show that hydroxychloroquine and azithromycin could potentially treat coronavirus. However, what's important to note about that study is it was very small, only 20 patients, and there was no control group. So it's very difficult. to assess efficacy, if not impossible to assess efficacy, when you don't have a control to compare it to. So while that data, again, is promising, we can't make any conclusions about hydroxychloroquine and or xithromycin until that's evaluated in a more rigorous clinical trial. Let's move on to some other topic in related case. The White House is saying, quote, well, if it doesn't hurt, why not try it? So are there any side effects of taking a

hydroxychloroquine as a preventive treatment? So there are side effects. Some people can have some fairly serious cardiac side effects from taking those drugs. In addition, one other harmful thing that's not really related to side effects, but has to do with the availability of that medication, is that the hydroxychloroquine is used to treat other conditions, rheumatoid arthritis and lupus. and people who are taking that have reported that in some places there are now shortages. So it actually is harmful using an untested drug, even if there are no side effects,

when you could be taking those drugs away from people who are already taking them and already need to take them for an unproven reason. In addition, I've also read that there may be potential drug interactions between azithromycin and hydrochloroquine that could be quite serious. So that's another thing to consider. It's definitely not correct to say that there's no harm in trying because these drugs are safe. Chloroquine has been used for a long time and its safety profile is well understood, but that doesn't mean that it's completely risk-free to take the drug.

So are there studies combining the two that we'll find out these things? So the World Health Organization is coordinating a variety of clinical trials of hydroxychloroquine. I think that's with azithromycin, as well as remdesivir, as well as the HIV protease inhibitors that have been also suggested to work, although a recent study suggests that they don't. So those trials are all underway at multiple sites across the country and around the world. Let me go to a tweet from Lisa who asks, how about convalescent transfusions? This very old treatment sounds promising, at least until a vaccine is developed. I think she's talking about antibody treatments, which go way back, right? They do.

So everybody's familiar with blood transfusions, plasma transfusions. The plasma is the part of your blood. that's the liquid part with no cells in it. And that's where your antibodies are when you separate blood in the laboratory. So the idea here is to take plasma from people who have survived and recovered from COVID-19, assuming that they will have antibodies in their blood that can enactive the virus. Taking that plasma and putting it into a patient who is sick may be able to help reduce their viral loads and reduce the severity of their disease. this is being being seriously considered, correct?

Yes, I believe that trials are going to start imminently. For a while, we were playing catch-up. A number of groups around the world have been trying to develop assays to identify patient antibodies and to characterize the immune response that those antibodies provide. Florian Kramer at the Mount Fine I School of Medicine and Marion Kutman, Bart Hagmans at Erasmus Medical Center in the Netherlands, have both developed Eliza's, which is a type of assay that looks for these antibodies that are specific to SARS coronavirus too. Those assays both are out in preprint right now. They both appear to be very specific and sensitive for those types of antibodies. So we are now going to be able to start screening patients and begin these. these trials and treating patients, which in New York can't come a moment too soon. Could we be screening the general public also for people who have had it and recovered it and maybe not even know it? I mean, there are limited numbers of tests. I don't imagine there

are enough tests to go about doing that. Yeah, that's a type of study called a zero surveillance study, and that is almost certainly going to be done. And it's especially important for COVID-19 to do that because the testing capacity has been so low that there are probably thousands, if not even millions, possibly of cases that were unrecognized and undiagnosed at the time that we really need to identify in order to determine how prevalent this virus was in our community. That's especially relevant if this becomes something that's seasonal and that we're dealing with regularly. We need to know who has immunity to the virus so that we can inform people the proper way about what they should be doing.

I'm Ira Flato. This is Science Friday from WNYC Studios. In case you're just joining us, I'm talking with Dr. Angela Rasmus, an assistant research scientist and virologist at the Columbia Mailman School of Public Health. What about, here's another tweet that came in. What about high dose vitamin C? I see posts that this is being tested in New York City, a doctor in Florida, is offering offering IV vitamin C treatments to boost immune systems. What do you say, doctor?

Any truth there? Well, there is truth that people are talking about this as a potential therapy. And I know that some hospitals, a hospital system in New York has reported that they are actually doing this, where they're infusing people with high-dose vitamin C. In general, vitamin C is pretty safe. where where this is a problem is it's not clear to me anyways that the the high dose vitamin C infusions are being done as part of an actual clinical trial to look at whether or not it's effective they're they're pretty much just saying well it's probably not going to hurt um so let's let's give this a try based on some studies from almost 10 years ago that suggests that vitamin C reduces the duration of common cold symptoms um we just we just don't know if that's the case yeah So much to ask so little time. We're also seeing reports about using HIV treatment, some data published in the New England Journal.

Yeah, a study was done because some groups in Thailand had reported that using these protease inhibitors successfully treated one patient who recovered from COVID. Previously, they'd been shown in vitro to be active against original SARS coronavirus. So they decided to try these in 200 patients in China. And the long story short is that there was no significant difference in clinical outcomes. So no patients survived in excess compared to control patients. So that suggested that those drugs didn't work. But I believe that those drugs are being still looked at in these WHO clinical trials that are ongoing to look at it in a larger set of patients. And one final question.

Do you think it's the job of research scientists to push back about vague or incorrect information that may be coming out of the government or that people just don't understand or reading it on social media? I think that's very important. And this week we've seen at least one situation that exemplifies that. There was a couple in Arizona that took some fish tank cleaner because it had chloroquine phosphate in it. And the surviving woman, the man died, the woman survived. She said to the media that they did that because the president had recommended in his press briefings that chloroquine was a miracle

drug and a game changer, et cetera. So it can be very, very harmful for incorrect, inaccurate information to be passed down by the government because they have so much authority and credibility. So it's critical that scientists speak up when things like that happened because it literally can save lives. Dr. Rasmussen, thank you for speaking up with us today. And good luck to you. Thank you so much, Ira. It was a pleasure being here. Nice to have you.

Dr. Angela Rasmussen, Assistant Research Scientist and Virologist at the Columbia Mailman School of Public Health. And if you have a question or a suggestion for future topics, you'd like us to fact-check surrounding the coronavirus, you can tweet us at SciFri with the hashtag fact-check my feed. After the break, if you're anxiously checking the coronavirus symptoms these days, we have something productive you can do as a citizen scientist. Stay with us. This is Science Friday. I'm Ira Flato.

How are you feeling today? Did you take your temperature yet? If you're in an area with a lot of known coronavirus cases, maybe you're doing that regularly. I know I am up here in the New York City area, doing it like twice a day. But maybe you're looking out for other symptoms besides a fever. How about a sore throat, that famous cough,

or even just swollen glands? Mark and New York State called into our SciFri Vox Pop app to describe the symptoms he experienced in the last couple of weeks. I had a sore throat, labor breathing, no fever, but just not every other symptom for the coronavirus. It's been two weeks, and I still have a bit of labor breathing. As testing continues to lag behind in the United States, there's something you can still do to help public health officials keep track of the spread.

Yes, it's time for some citizen science with a project called COVID near you, and it's as simple as talking about how you're feeling. Here to explain more is John Brownstein, COVID Near You, co-founder and chief innovation officer at Boston Children's Hospital. And if you want to participate, you can go to sciencefriety.com slash COVID near you. And please report how you're feeling early and often. Welcome to Science Friday. Great to be here. Give us a thumbnail sketch of how this works.

What are the basis? What is COVID near you? How do I help? Yeah, so essentially we've been crowdsourcing symptoms now getting close to a decade. Actually, we started a first project in 2011 called Flew Near You. And this is actually around the movie Contagion. I think everybody's watching that movie right now. And we had this idea that we could start to really bring what we say the public and public health, right?

Get insights about what was happening in the community with symptoms that people are feeling before they ever touch their health care provider. Think about it. most of the illness that we're seeing right now, people are not actually going to see a provider. They're staying home trying to get better, isolating themselves. Of course, we don't have testing. Imagine you could build a community of people that are reporting symptoms and giving us an accurate picture of what's happening around the world. If you think about it right now, you know, we have a very limited view about what's happening in the community. And if we can get people to

contribute to give us their symptoms, try to understand what's happening, we can start doing a better job of understanding hotspots, understanding emergence, seeing if we're getting better as a society, especially as we're waiting for testing to really come into play. Okay, so I go there and I just tell you how I'm feeling, and is it just once or do I continually update this? We're looking for feedback from people continuously, right? Because of course, you might be healthy one day, another day you might get sick. We would definitely want to know that. On the same trend, if you're sick right now, we'd love to know if you've recovered and we'd love to be healthy. And we'd love to know if you got to test because what we're trying to do is map symptoms to testing. So the more

data that we can pull, the better. And we're making this all available publicly. The data is out there for people to see who in their zip code is experiencing symptoms, who's been tested positive. And ultimately, it's about sort of making the public a real stakeholder in public health. So you also want to, just to clarify, you want to hear from people who are not sick, too, right? not just people who are feeling sick to participate. Absolutely. We need a good denominator, right? Because if we just get people that are reporting illness,

we have no idea about the underlying population. But if we get people reporting regardless of how they're feeling, we can build a denominator to come up with a rate of illness in a particular community, much more valuable than just people reporting illness. So you have a map of people who have coughs, people who don't have coughs, and people who have positive tests. So what do you do with that information?

And why is that so useful? We're trying to encourage people to do a better job of social distancing, giving them a real perspective of what they're actually trying to do. It's very hard, right? It's hard to, if you're home healthy, it's hard to understand. Well, if you give a picture of what's happening in the community or maybe adjacent communities, you're more likely to see sort of the value of reporting. The other side of it is the aggregate data can be incredible.

incredibly helpful to the public health at large, local public health but also federal. They're trying to understand resource allocation, trying to understand where to implement testing. They're trying to understand where hotspots are emerging, right? We know that New York city right now is a big hotspot. Where is the next hotspot going to emerge? This data can give that insight that we so desperately need. Don't the hospitals already know by talking with each other where the hotspots are? You know, you think in a perfect world, there would be so much exchange of information. That is actually a core issue of our underlying health system around interoperability. Now, there are major initiatives to try to fix interoperability,

to get data to share. But also think about this. You know, the hospitalizations that we're seeing are just the tip of the iceberg in terms of actual illness. Most people are getting sick from COVID or not actually ones that are getting hospitalized. They're not having any interactions with the health system. So how do you start to understand what's really going on in the community? it's not going to be from looking at health care data, it's from looking at what people are experiencing themselves. And self-report represents a huge opportunity. Interesting. So you collect the data. Do you share it with other people who analyze it, or are you doing the analysis? So we have a team of epidemiologists at the hospital in Harvard Medical School, but we're also working closely with government

agencies. Now, we're not sharing any identifiable information, but the idea is, of course, in aggregate, to be able to share the information so that public health can respond appropriately, that's the data that can be incredibly useful. But it's very similar to the data that we're already posting publicly directly on the web that everyone can see. You know, we've been hearing and watching on the news people looking for equipment, whether they're ventilators or what, and then saying, you know, let's send it, we don't have enough of them.

Maybe we can send what we have to the hottest hotspots and then move them, move them around the country, would this kind of help that? Exactly. So what we're trying to do is give early insights into what's happening. If you think about it, when you're in a situation where you're needing ventilators, you're already well into the epidemic, right? So the severe cases represent a future, you know, not the present. So the first step in the community is having underlying illness, mild illness,

that is bubbling up. If you get insight, then you can already make resource allocation, to prepare for that future of severe cases that you will eventually arrive. And that's why it's so important to get this sort of early window, this early wave of illness through these tools. We have a listener, Sam and Kentucky, who called into our Science Friday Vox Pop app with this question. I want to know, how are they able to give us accurate statistics for how many people are infected if they're not testing everybody who's symptomatic.

A legitimate question, was it not? Absolutely legitimate question. You know, what we're doing is something called syndromic surveillance, getting symptoms and a case definition of symptoms to understand likely COVID. Now, we can't diagnose COVID just based on symptoms. We need testing. But the signals in that data, you're going to have, with enough people reporting, you're going to get signals in that data that accurately reflect what's happening in the community.

We know that flu is coming down because lab testing shows that we have less and less flu circulate. So if we have spikes in these symptoms, they can be attributed to COVID. Even if we can't guarantee it, it gives us real sort of indicator, sort of canary in the coal mine type view of what's taking place. Can you separate then, you know, symptoms for the regular flu versus COVID? There's case definitions that are different for flu and COVID. Obviously, we're seeing a lot of shortness of breath and very, you know, different types of elements.

We're still trying to understand the symptomology. But absolutely, there's important differences that we can separate out. But they're both respiratory illnesses at the end of the day. Let's give out that link. You have the link where people can go to? Yes, it's sciencefriiday.com slash COVID near you. Okay, well, we'll repeat that a few times so we can get enough people because I want to get enough people to you. And in that sense, how many people are you aiming for?

I mean, we would love a million people in this system. system, that's, that's, you know, the ultimate goal because that gives us highly granular data. But if we can bump ourselves up to, you know, to anywhere near that with this community, which I know is so engaged, I mean, it will do a huge amount of good to really being able to combat COVID. Well, let's give a preview to people who want to use the site. They go to the site. What will they see? So they're going to see a map of reported cases that look like COVID.

so symptoms that the symptoms set that we think is resembles COVID. And then they'll see people actually reporting confirmed cases because some people are getting tested. So you'll see places around the country where people have had positive tests. And then you'll see the reporting function. So people can report whether they're healthy or sick. And if they report if they're sick,

then they can pick from a list of symptoms like fever and cough and shortness of breath. And then we're going to collect a little bit of demographic data because we want to understand how COVID is impacting different age groups and gender and geographies. And then we're going to collect mobile phone information so that we can stay in touch, get insights about how people have recovered, whether they got a positive test, and also eventually disseminate information about resources and data about what's happening in their community. And how long will you be going on with this project?

Well, we will go on and on. I mean, so we've been running flu near you now, getting close to 10 years, and COVID near you is an offshoot, but eventually, you know, these things merge into one sort of, you know, real platform where we keep people engaged because honestly, right, we have coronavirus now. We will see other respiratory pathogens emergent communities, and the best thing we can do is to have these systems ready, not trying to build in the moment of a pandemic, but actually have capacity from the outset. Yeah, so this is really a good citizen science project.

I mean, in my view, this is one where you're really contributing to something valuable in terms of response. But it's also, you know, it's giving data back because people can educate themselves and make informed decisions for themselves and their family. I know you also work on a project called HealthMap, which saw evidence of the coronavirus is, what, as early as December when we first heard about it in Europe and China. Tell us about that. So we've been running in parallel a sister site called HealthMap.org, which is a tracking tool for emerging infectious diseases around the world.

We do this through machine learning and AI and doing this in many different languages to look for signs of outbreaks. And this is through mining of local news, chat rooms, blog, social media, where we're looking for signs of something sort of unusual happening. In late December, we saw a cluster of respiratory illness around a seafood market. in Wuhan through a local Chinese source. We also had collaborators that were looking in WeChat and Weibo, Chinese social media sites that were talking about this illness. And we were flagging this to our collaborators at WHO and really started ramping up our surveillance beginning

in January. Ultimately, we ended up building this, you know, massive line list of cases for the globe to try to create as good a data set as possible to feed mathematical models that do forecasting, that really build projections of where we're headed. And so, you know, this data, whether it's data from HealthMap or COVID near you, the data itself is so valuable to feed into models because the better data you have, the better model outputs you have to understand, you know, the trajectory of disease. And of course, everyone's asking, you know, how will this peak? When will this end?

The better data we have, the more accurate we can make our estimates. Just a reminder, if you're just listening, tuning in right now. now. I'm talking with John Brownstein, COVID-Near-U, co-founder and chief innovation officer at Boston Children's Hospital on Science Friday from WNYC Studios. I just saw on the news the other night something called Healthweather.us, where there's a company, I think it's called Kinsa, that makes thermometers, you know, oral thermometers that broadcast your temperature out onto the internet so that they can crowdsource where people are getting a higher fever. Are you familiar with that?

Yeah, I'm familiar with Kinza. It's part of sort of an ecosystem of smart thermometers that are out there from the market. And they're interesting because it's not just you're collecting your data, but you can feed that data into an app and an aggregate. Doing a map of fevers around the country is incredibly valuable. You know, there's a range of different tools that are out there, smart thermometers. There's wearables like a smart ring called URA or,

a risk ban called whoop. All of these are collecting temperature and associated symptoms. Again, those kind of tools become incredibly valuable in aggregate. You hope that some of that data becomes more available for analytics, the broad academic community, as well as CDC and other public health so they can ultimately see the most value in the data. But it's exciting to see this sort of broad set of information streams that are becoming available to sort of all sort of trend. triangulated around what's happening in the community.

And now I know that you work in a hospital in Boston where there are also a large number of coronavirus patients. Can you give me an idea of what the mood is like there? Yeah. Well, listen, I mean, it's both, you know, a challenging time, but it's also amazing to see our health care systems working together. A lot of cross collaboration, a lot of attempts at innovation. We have this amazing project where we're trying to build a 95 mask. from a few dollars in parts. So really a lot of ingenuity at the same time. Frontline healthcare is sort of completely overwhelmed

in getting to capacity. So it's stressful and anxious, but at the same time, I mean, we're seeing some of the best of humanity as well. And your project is something that people who, we're all at home now, or most of us, we're looking for something to do besides watch movies. And your project, A citizen science project is something people can participate and feel like they are helping out some way.

You can COVID and chill, then you can Netflix and chill. Yes. Enter the data, you know, a few seconds. You're actually doing something. And then, yes, you can stream your favorite TV show. All right. Let me just remind everybody how to do that. To participate, go to science friday.com slash COVID near you.

science Friday.com slash COVID near you, and you can report how you're feeling. You don't have to be feeling badly, right, John? No, yeah. We want everyone to report. Everybody should report. It's easy to do. And we wish you great luck, Dr. Brownstein, in your efforts here because it's something we really all could use.

Well, thank you so much. Thank you for taking time to be with us today. Dr. John Brownstein, co-founder of the COVID-Near you. Citizen Science Project, Chief of Innovation at Boston Children's Hospital. That's about all the time we have for this hour. Charles Berkwurst is our director. Our producers are Alexa Lim, Christy Taylor, Katie Feather, and Kathleen Davis. We had technical and engineering help today from Rich Kim, Kevin Wolf, and Lisa Goslin.

BJ Leideman composed our theme music. And if you missed any part of this program or you would like to hear it again, subscribe to our podcasts or ask a smart speaker to play Science Fridays. So every day now is Science Friday. And on our Science Friday VoxPop app, we want to keep fact-checking your feed. What have you seen reported about coronavirus that you think needs a closer look?

Send us your questions on the Science Friday VoxPop app wherever you get your apps. You can also email us, SciFri at ScienceFriD.com. I'm Ira Flato.