A Frank Talk About Testing, Vaccines, and Twitter Trolls

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In the age of coronavirus, everyone is suddenly an expert on virology or epidemiology — or is pretending they are on Twitter. STAT News’ senior writer on infectious diseases, Helen Branswell, is the real thing: A reporter who has been on the beat for 20 years, including covering the SARS outbreak. As early as December 31, Branswell was raising concerns on Twitter about a mysterious new outbreak in China. Her feed has been a go-to source for dispassionate parsing of the research and news developments on the coronavirus, earning her almost 100,000 new followers since that initial tweet. I caught up with her on Wednesday morning about what people have gotten wrong about COVID-19 and what she still wants to know. This is a condensed version of our conversation. 

There is a lot of mystery still around this virus. What are the things that still perplex you or confuse you? What would you love to find out now?
I would like a lot of places to do serology testing to find out how many people have actually been infected. Blood testing. Countries are testing to greater or lesser degrees and finding and reporting confirmed cases, but we don’t really know if there are people who are being missed because they have such mild illness that they never hit the radar of health authorities. In the beginning in China, you had to have pneumonia to be diagnosed as a case. If you’re looking for people who have pneumonia you’re not going to find the people who don’t have pneumonia. There’s a suspicion based on the way diseases usually function that there’s a range, a spectrum of illness, and a portion of that spectrum isn’t being captured in the current numbers. Which would be a really good thing in terms of giving us a much better idea of what percentage of people who catch this actually die. Just knowing that somebody’s being infected, it could be useful at a point to know. You could say, maybe it’s safe for you to do stuff that other people can’t do.

We don’t have those kinds of tests yet. They’re being developed. China apparently has a couple. Singapore has developed one. The CDC has developed a couple, but they’re still in the experimental phase. Once those are ready to be used, people can go and look in places like Wuhan or Seattle and say, okay, let’s enroll a couple thousand of people who haven’t been diagnosed as a case, and see if they actually have antibodies for this. That’s really important. The sooner we get it the better.

I’ve read that there are family clusters in China where they found people who are asymptomatic the entire time, and they only found them because they had gotten other family members very sick. How should we be thinking about people who are asymptomatic forever?
Well, that’s kind of where I was getting at with serology. That would be picking up people who were truly asymptomatic. We don’t yet have a good handle on that. It’s really hard to find them in the midst of an outbreak. If you’re looking at a household because you’ve been led there by the fact that you have a case, you may test someone while they still have the virus in their system. One of the things that the WHO has said about some of those asymptomatic cases from China, from those studies you’re talking about, is that they think that many of them later went on to have symptoms. There were some data from Italy published [this week] in JAMA and they have a pie chart, cases by severity, they have a 6.7 percent showing no symptoms. That’s just one data point, and I don’t know that that’s representative of what other people are seeing or how they even found those cases, but looking for people who didn’t get sick is important because we need to know how widely this is spread and to get a better handle on the denominator of the outbreak.

As someone who’s looking at these primary sources and talking to researchers all the time, how are you figuring out what information to heed? Is it different from how it might normally be?
This one is different because of the rise of preprint servers. 

Can you explain what that means? 
Historically, when scientists or researchers wrote a paper and submitted it to a journal for publication, they couldn’t talk about it publicly except at medical conventions before publication or it wouldn’t get published. Typically things never reached journalists until they had been truly peer-reviewed and had the imprimatur of whatever journal was publishing them.

In recent years there’s been a movement to share data more quickly because that process can be quite slow and data can be locked up for quite a long time. Some of the journals have allowed people to post studies before they’ve been vetted to preprint servers and other scientists can look at them and comment on them. Those are being used very widely now. Anybody who has a paper on this is posting it on a preprint server, more or less, and they are being reported on effectively as maybe not much different than a published peer-review paper. I would say probably in the main it’s been useful because you need to be able to share information quickly in a circumstance like this, but sometimes the papers are just obviously wrong or controversial or whatever. And there have been several instances where people put up papers that garnered a lot of attention and were major distractions, and in the end not particularly helpful.

Can you give me an example?
I hate to do it. But there was a story about whether snakes were the source animal. And everyone got wild about, Was it snakes in the market in Wuhan? To me, that was such a distraction. One, it was hard to visage how respiratory pathogens would travel from a snake to human upper airways in large numbers. But more importantly at that point, people were arguing about this at a point when it was very clear that regardless where the pathogen had come from, it was a human virus now. It wasn’t spreading from snakes to people; it was spreading from people to people.

I’ve still seen people claiming that this is because the Chinese people were eating bat soup, but if I read correctly, there were cases before the seafood-market outbreak. 
I thought it was pretty obvious even in early January that focusing all the attention on the seafood market was like looking for your keys under the streetlight. It did not tell you that there weren’t cases elsewhere. I think a lot of time was lost as a consequence of that.

I noticed in your Twitter bio that you said you block conspiracy theorists and racists. Is that new to this virus, or does it predate it? 
Until recently, I have been part of a community of science writers and scientists and people who are interested in science who communicate and converse about ideas on Twitter. And then every once in a while someone would pop up and call me an idiot and I would block them. In the last two and a half months, though, my Twitter following has exploded. Many of the people who are showing up now are worried and looking for information, but there are lots of people who — I don’t even know if they’re real people or bots — there’s a lot of name hurling. People who insist China can’t be trusted on anything. Who are just stirring up trouble. I block them.

When you put that you block for racism in your bio, was it specifically referring to that?

As reporters, many of us are used to working from home. Since the virus, have you moved from social distancing to self-isolation? 
I had always worked at home from time to time, but we all are now. I’m actively trying to be prudent about the number and nature of contacts I have with people. If you’re sick, you can’t work, and it’s important that I be working right now.

How do you avoid burnout when this is going to be such a long-running story?
I have no idea. None of us have ever been in the place we are now. We don’t know when it resolves and how it resolves. It’s a lot.

Is there anything you do to take a break, or is there no time for that? 
I like to cycle. Yesterday, in the evening before it got dark, [I went] for a nice long bike ride. That was helpful. Yesterday was not a very productive day for me. I hit a bit of a wall, so I did what I could and today’s another day.

I’ve noticed that officials in the U.S. are starting to move their language away from “this will be a few weeks” to “no one knows how long it’s going to last.” How do you see the long term, as of this morning? Is this going to be social distancing forever? Or at least until we have a meaningful vaccine?
I don’t know. I don’t know what the world can sustain. I don’t know what the virus is going to do. I’m not one of those who’s putting a lot of stock that warmer weather is going to make this go away. It’s circulating in places that are warm now, so I don’t see why that would be. I don’t know and that’s one of the reasons why doing antibody studies, trying to get a sense of how many people are infected, is going to be really important. If it turns out there’s a lot more infection than we know, that can be plugged into models that would give people a sense of where this might go.

This is not a “weeks” thing. That is clear. A vaccine is going to take a lot longer than the projections are currently estimated.

You mean longer than 18 months?
Oh, I think likely, yeah.

Is that just people being overly optimistic?
A while back when the major manufacturer Sanofi got involved, it is really one of the biggest vaccine manufacturers, it said it thought three years was probably the best it could shoot for if everything was on track. Some of the groups that are in a race to develop a vaccine are using different technologies that could work faster, but most of them are smaller companies and a number of them don’t currently have their own facilities to produce vaccines at commercial scale. They could come up with a vaccine that works and is safe, but you still have to figure out how to make it in billions of doses. I very much hope I’m wrong on this, but I think it’s going to take a while.

How would you compare the U.S.’s response to other countries so far? 
The testing fiasco is a tragedy … I don’t feel like I have a really clear picture on why it took so long and why somebody didn’t understand that waiting for the CDC’s test to be improved was a dangerous loss of time. And that tests should have been imported from somewhere else. The consequences of not testing are playing out in Seattle and New York City and probably Boston and many other places now. South Korea has had a very explosive outbreak. Somehow the virus was imported and got into a religious sect there that has a very large congregation. And the people in it apparently had a lot of close contact with each other. And as of yesterday they had recorded about 8,400 cases total, but they have been really aggressive at trying to find other cases. At the end of February they reported 900 cases in a single day, but yesterday they were down to 84. They’ve really driven down the infection because they were able to test over a quarter million people.

Has life gone back to normal there though? If they stop doing what they’re doing, will it just come back? 
I can’t tell you that. They only had 84 cases yesterday but they still have 84 cases. Even if you stop local transmission you are at risk at having an outbreak from another country. China yesterday reported a single case of COVID-19 in Hubei province. It was the second day in a row they had only one domestically acquired case of COVID-19. It’s extraordinary. But they had 12 imported cases yesterday. And they’ve had 155 imported cases so far. Even if you put out your outbreak, sparks could still fall off another country’s outbreak.

So testing is necessary, but not sufficient to make it go away.
Short of a supremely effective vaccine, there is no one single thing that will make this go away.

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A Frank Talk About Testing, Vaccines, and Twitter Trolls