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How Are You Feeling? Surveys Aim to Detect Covid-19 Hot Spots Early How Are You Feeling? Surveys Aim to Detect Covid-19 Hot Spots Early
(32 minutes later)
JERUSALEM — Teams of epidemiologists and computer scientists on three continents have started mass population surveys to try to get ahead of the coronavirus and ensure that scarce diagnostic tests, and even scarcer ventilators, are sent where they can do the most good.JERUSALEM — Teams of epidemiologists and computer scientists on three continents have started mass population surveys to try to get ahead of the coronavirus and ensure that scarce diagnostic tests, and even scarcer ventilators, are sent where they can do the most good.
More than two million people in Britain and 150,000 Israelis have already completed simple questionnaires, and many are updating their answers daily. Analysts of the data — including symptoms of Covid-19 and test results, as well as risk factors and demographics — say they have been able to identify incipient outbreaks days ahead of the authorities.More than two million people in Britain and 150,000 Israelis have already completed simple questionnaires, and many are updating their answers daily. Analysts of the data — including symptoms of Covid-19 and test results, as well as risk factors and demographics — say they have been able to identify incipient outbreaks days ahead of the authorities.
Three groups in the United States — led by Massachusetts General Hospital, the Massachusetts Institute of Technology and Weill Cornell Medicine in New York — are now vying to attract enough survey participants nationwide to detect impending hot spots.Three groups in the United States — led by Massachusetts General Hospital, the Massachusetts Institute of Technology and Weill Cornell Medicine in New York — are now vying to attract enough survey participants nationwide to detect impending hot spots.
In Israel, where artificial-intelligence experts at the Weizmann Institute of Science have played a leading role in the effort, computer models that were fed the results of questionnaires accurately predicted surges in cases in cities like Bnei Brak, Jerusalem and Beersheva five days in advance, researchers said.In Israel, where artificial-intelligence experts at the Weizmann Institute of Science have played a leading role in the effort, computer models that were fed the results of questionnaires accurately predicted surges in cases in cities like Bnei Brak, Jerusalem and Beersheva five days in advance, researchers said.
The questionnaires, which are web or app based, ask people about their medical histories and risk factors, and then about symptoms. In Israel, a bot prompts users to choose from a menu including coughing, sore throat, shortness of breath, fatigue and a loss of taste or smell, and then asks for a temperature reading from the last 24 hours.The questionnaires, which are web or app based, ask people about their medical histories and risk factors, and then about symptoms. In Israel, a bot prompts users to choose from a menu including coughing, sore throat, shortness of breath, fatigue and a loss of taste or smell, and then asks for a temperature reading from the last 24 hours.
“Imagine, if the Ministry of Health had acted on that information, maybe they could have saved more spreading of the virus,” said Eran Segal, a computational biologist at Weizmann who is spearheading the project.“Imagine, if the Ministry of Health had acted on that information, maybe they could have saved more spreading of the virus,” said Eran Segal, a computational biologist at Weizmann who is spearheading the project.
Forecasting areas of infection would allow officials to flood those places with testing capacity, Dr. Segal said. And it would allow doctors to better marshal their scant resources.Forecasting areas of infection would allow officials to flood those places with testing capacity, Dr. Segal said. And it would allow doctors to better marshal their scant resources.
“Every time they test somebody and it’s negative, it’s a wasted test,” he said. “You want to get positives, act on it, and isolate people.”“Every time they test somebody and it’s negative, it’s a wasted test,” he said. “You want to get positives, act on it, and isolate people.”
The Israeli survey, in six languages, began by word of mouth, Dr. Segal said. But this week, Israel’s largest H.M.O., Clalit, sent text messages to its 4.5 million subscribers pleading with them to participate.The Israeli survey, in six languages, began by word of mouth, Dr. Segal said. But this week, Israel’s largest H.M.O., Clalit, sent text messages to its 4.5 million subscribers pleading with them to participate.
“Help save your loved ones and yourself,” it said.“Help save your loved ones and yourself,” it said.
In Britain, researchers said the disease had advanced so fast that it was already pointless to use survey results to steer tests for the virus; rather, the results are helping pinpoint where ventilators and mobile intensive-care units should be positioned, according to Tim Spector, a professor of genetic epidemiology at King’s College, London.In Britain, researchers said the disease had advanced so fast that it was already pointless to use survey results to steer tests for the virus; rather, the results are helping pinpoint where ventilators and mobile intensive-care units should be positioned, according to Tim Spector, a professor of genetic epidemiology at King’s College, London.
“I liken this to a radar,” he said. “Two weeks before the bombs get dropped, you can actually work out what’s going to happen — not based on what happened in China, but actually seeing what’s happening on the ground here. That’s what’s going to save lives: the fact that you can plan where to put your mobile I.C.U.s.”“I liken this to a radar,” he said. “Two weeks before the bombs get dropped, you can actually work out what’s going to happen — not based on what happened in China, but actually seeing what’s happening on the ground here. That’s what’s going to save lives: the fact that you can plan where to put your mobile I.C.U.s.”
Dr. Spector, the director of the TwinsUK Registry, a nationwide research cohort of 15,000 twins, rolled out the British survey to that group on March 24, and it spread by word of mouth. Within five days, he said, the tally of unique participants had surpassed two million, with the “Covid Symptom Tracker” app jumping to the No. 1 health-related download in Britain's Apple Store and the No. 4 app of any kind.Dr. Spector, the director of the TwinsUK Registry, a nationwide research cohort of 15,000 twins, rolled out the British survey to that group on March 24, and it spread by word of mouth. Within five days, he said, the tally of unique participants had surpassed two million, with the “Covid Symptom Tracker” app jumping to the No. 1 health-related download in Britain's Apple Store and the No. 4 app of any kind.
The survey is popular, but not as evenly distributed as health experts might like. People over 70 years old are underrepresented, which is not a surprise, given the app-based distribution. And women are participating at roughly twice the rate of men. “They are more altruistic, in the U.K.,” Dr. Spector said, laughing.The survey is popular, but not as evenly distributed as health experts might like. People over 70 years old are underrepresented, which is not a surprise, given the app-based distribution. And women are participating at roughly twice the rate of men. “They are more altruistic, in the U.K.,” Dr. Spector said, laughing.
Over all, he said, the respondents in Britain are acting out of concern for the National Health Service and “a feeling that they’re doing something for the community.” But he also said that people who reported already having tested positive for the virus seemed to grasp at the survey as “a way to express their symptoms.”Over all, he said, the respondents in Britain are acting out of concern for the National Health Service and “a feeling that they’re doing something for the community.” But he also said that people who reported already having tested positive for the virus seemed to grasp at the survey as “a way to express their symptoms.”
“If they don’t go to hospital, nobody seems to care about them,” Dr. Spector said.“If they don’t go to hospital, nobody seems to care about them,” Dr. Spector said.
Surveys are not the only unconventional way that scientists are trying to detect the spread of the virus: A maker of smart thermometers says it is tracking the contagion in real time by mapping fevers in American households.Surveys are not the only unconventional way that scientists are trying to detect the spread of the virus: A maker of smart thermometers says it is tracking the contagion in real time by mapping fevers in American households.
In Britain, the survey suggested that loss of taste and smell could be more predictive of a positive test result than self-reported fever, fatigue or loss of appetite, Dr. Spector said. That could be of critical importance to health workers who may still be going to work despite experiencing a loss of taste or smell, but isolating themselves based on other symptoms, he said.In Britain, the survey suggested that loss of taste and smell could be more predictive of a positive test result than self-reported fever, fatigue or loss of appetite, Dr. Spector said. That could be of critical importance to health workers who may still be going to work despite experiencing a loss of taste or smell, but isolating themselves based on other symptoms, he said.
But he emphasized that much was still to be learned.But he emphasized that much was still to be learned.
“This data’s still wet,” Dr. Spector said. “We have teams of people working on the analysis to try and get stuff out that’s going to be of critical importance for the health service.”“This data’s still wet,” Dr. Spector said. “We have teams of people working on the analysis to try and get stuff out that’s going to be of critical importance for the health service.”
Unlike countries with national health systems, the United States, with its atomized health industry, poses a difficult challenge in reaching enough respondents to track the epidemic at the local level.Unlike countries with national health systems, the United States, with its atomized health industry, poses a difficult challenge in reaching enough respondents to track the epidemic at the local level.
“So we need to develop creative solutions,” said Andrew Chan, an epidemiologist at Massachusetts General and professor of immunology and infectious diseases at Harvard.“So we need to develop creative solutions,” said Andrew Chan, an epidemiologist at Massachusetts General and professor of immunology and infectious diseases at Harvard.
Dr. Chan’s team, which is adapting the British app for the United States, has joined with Stand Up to Cancer, tapping its list of 1.5 million cancer patients and their relatives. It is also drawing on a research cohort of about 51,000 female nurses across the country.Dr. Chan’s team, which is adapting the British app for the United States, has joined with Stand Up to Cancer, tapping its list of 1.5 million cancer patients and their relatives. It is also drawing on a research cohort of about 51,000 female nurses across the country.
Updated June 30, 2020
Common symptoms include fever, a dry cough, fatigue and difficulty breathing or shortness of breath. Some of these symptoms overlap with those of the flu, making detection difficult, but runny noses and stuffy sinuses are less common. The C.D.C. has also added chills, muscle pain, sore throat, headache and a new loss of the sense of taste or smell as symptoms to look out for. Most people fall ill five to seven days after exposure, but symptoms may appear in as few as two days or as many as 14 days.
Scientists around the country have tried to identify everyday materials that do a good job of filtering microscopic particles. In recent tests, HEPA furnace filters scored high, as did vacuum cleaner bags, fabric similar to flannel pajamas and those of 600-count pillowcases. Other materials tested included layered coffee filters and scarves and bandannas. These scored lower, but still captured a small percentage of particles.
A commentary published this month on the website of the British Journal of Sports Medicine points out that covering your face during exercise “comes with issues of potential breathing restriction and discomfort” and requires “balancing benefits versus possible adverse events.” Masks do alter exercise, says Cedric X. Bryant, the president and chief science officer of the American Council on Exercise, a nonprofit organization that funds exercise research and certifies fitness professionals. “In my personal experience,” he says, “heart rates are higher at the same relative intensity when you wear a mask.” Some people also could experience lightheadedness during familiar workouts while masked, says Len Kravitz, a professor of exercise science at the University of New Mexico.
The steroid, dexamethasone, is the first treatment shown to reduce mortality in severely ill patients, according to scientists in Britain. The drug appears to reduce inflammation caused by the immune system, protecting the tissues. In the study, dexamethasone reduced deaths of patients on ventilators by one-third, and deaths of patients on oxygen by one-fifth.
The coronavirus emergency relief package gives many American workers paid leave if they need to take time off because of the virus. It gives qualified workers two weeks of paid sick leave if they are ill, quarantined or seeking diagnosis or preventive care for coronavirus, or if they are caring for sick family members. It gives 12 weeks of paid leave to people caring for children whose schools are closed or whose child care provider is unavailable because of the coronavirus. It is the first time the United States has had widespread federally mandated paid leave, and includes people who don’t typically get such benefits, like part-time and gig economy workers. But the measure excludes at least half of private-sector workers, including those at the country’s largest employers, and gives small employers significant leeway to deny leave.
So far, the evidence seems to show it does. A widely cited paper published in April suggests that people are most infectious about two days before the onset of coronavirus symptoms and estimated that 44 percent of new infections were a result of transmission from people who were not yet showing symptoms. Recently, a top expert at the World Health Organization stated that transmission of the coronavirus by people who did not have symptoms was “very rare,” but she later walked back that statement.
Touching contaminated objects and then infecting ourselves with the germs is not typically how the virus spreads. But it can happen. A number of studies of flu, rhinovirus, coronavirus and other microbes have shown that respiratory illnesses, including the new coronavirus, can spread by touching contaminated surfaces, particularly in places like day care centers, offices and hospitals. But a long chain of events has to happen for the disease to spread that way. The best way to protect yourself from coronavirus — whether it’s surface transmission or close human contact — is still social distancing, washing your hands, not touching your face and wearing masks.
A study by European scientists is the first to document a strong statistical link between genetic variations and Covid-19, the illness caused by the coronavirus. Having Type A blood was linked to a 50 percent increase in the likelihood that a patient would need to get oxygen or to go on a ventilator, according to the new study.
The unemployment rate fell to 13.3 percent in May, the Labor Department said on June 5, an unexpected improvement in the nation’s job market as hiring rebounded faster than economists expected. Economists had forecast the unemployment rate to increase to as much as 20 percent, after it hit 14.7 percent in April, which was the highest since the government began keeping official statistics after World War II. But the unemployment rate dipped instead, with employers adding 2.5 million jobs, after more than 20 million jobs were lost in April.
If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. (Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.)
If you’ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others.
Starting with those audiences, Dr. Chan said, offers added benefits: Both cancer patients and health workers are at particular risk.Starting with those audiences, Dr. Chan said, offers added benefits: Both cancer patients and health workers are at particular risk.
In the M.I.T.-led project, researchers are preparing to promote a survey app that they developed with the help of engineers from Pinterest, the image-sharing site, whose co-founder, Ben Silbermann, was a high school classmate in Des Moines of Feng Zhang, a biochemist leading the M.I.T. survey effort.In the M.I.T.-led project, researchers are preparing to promote a survey app that they developed with the help of engineers from Pinterest, the image-sharing site, whose co-founder, Ben Silbermann, was a high school classmate in Des Moines of Feng Zhang, a biochemist leading the M.I.T. survey effort.
Dr. Zhang said that he and his colleagues hit on the idea for the surveys just after they began working from home a few weeks ago. One of them, who had been a student of Dr. Segal’s in Israel, saw mention of the Israeli survey project, and the two groups began to coordinate.Dr. Zhang said that he and his colleagues hit on the idea for the surveys just after they began working from home a few weeks ago. One of them, who had been a student of Dr. Segal’s in Israel, saw mention of the Israeli survey project, and the two groups began to coordinate.
Dr. Zhang and Dr. Segal are already taking their project to other corners of the globe: A white paper they drafted has co-authors in Argentina, Canada, Estonia, Germany, Luxembourg, Slovenia, Sweden and Switzerland.Dr. Zhang and Dr. Segal are already taking their project to other corners of the globe: A white paper they drafted has co-authors in Argentina, Canada, Estonia, Germany, Luxembourg, Slovenia, Sweden and Switzerland.
One area of difference among the surveys concerns privacy.One area of difference among the surveys concerns privacy.
The British survey allows people to volunteer personal information, and Dr. Spector said it might become possible to tie in the survey results to the National Health Service’s database. The Massachusetts General project allows cancer patients in clinical trials to provide contact information for their study physicians if they choose, “to let them know if they are developing symptoms,” Dr. Chan said.The British survey allows people to volunteer personal information, and Dr. Spector said it might become possible to tie in the survey results to the National Health Service’s database. The Massachusetts General project allows cancer patients in clinical trials to provide contact information for their study physicians if they choose, “to let them know if they are developing symptoms,” Dr. Chan said.
But the Israeli questionnaires ask only the name of a respondent’s street, not the house number. And Olivier Elemento, director of Weill Cornell’s Englander Institute for Precision Medicine in New York, said its own survey, which includes a dashboard so respondents can see how the data is used, was deliberately collecting only county-level information.But the Israeli questionnaires ask only the name of a respondent’s street, not the house number. And Olivier Elemento, director of Weill Cornell’s Englander Institute for Precision Medicine in New York, said its own survey, which includes a dashboard so respondents can see how the data is used, was deliberately collecting only county-level information.
“We want people to feel they can participate without any fear of being identified,” he said.“We want people to feel they can participate without any fear of being identified,” he said.
The researchers acknowledge without hesitation that surveys completed by laypeople without corroboration by scientists or physicians will lack the precision of more methodical research. But they say widespread participation will produce enough data to largely overcome the effects of personal variations.The researchers acknowledge without hesitation that surveys completed by laypeople without corroboration by scientists or physicians will lack the precision of more methodical research. But they say widespread participation will produce enough data to largely overcome the effects of personal variations.
“Given the speed of the pandemic, we don’t have the luxury of waiting to validate every report we get in from a participant,” said Dr. Chan, the epidemiologist at Massachusetts General. “We need to act quickly.”“Given the speed of the pandemic, we don’t have the luxury of waiting to validate every report we get in from a participant,” said Dr. Chan, the epidemiologist at Massachusetts General. “We need to act quickly.”
David D. Celentano, chairman of epidemiology at the Johns Hopkins Bloomberg School of Public Health, praised the efforts to gather data. “In the U.S., where we had so little testing till last week, we’ve been completely blind,” he said. “We have no idea where the epidemic is.”David D. Celentano, chairman of epidemiology at the Johns Hopkins Bloomberg School of Public Health, praised the efforts to gather data. “In the U.S., where we had so little testing till last week, we’ve been completely blind,” he said. “We have no idea where the epidemic is.”
Dr. Celentano cautioned that “people who are going to pay attention to their phone and do this every day are probably either the worried well or people who are experiencing symptoms, so you’ll have a very biased sample.”Dr. Celentano cautioned that “people who are going to pay attention to their phone and do this every day are probably either the worried well or people who are experiencing symptoms, so you’ll have a very biased sample.”
Still, he said, however flawed, the surveys could be “very useful for targeting where to put health services.”Still, he said, however flawed, the surveys could be “very useful for targeting where to put health services.”
Or, as Mr. Segal put it: “The rule of big numbers means we don’t need to be super-super-accurate. We just need to be able to rank this region over that region.”Or, as Mr. Segal put it: “The rule of big numbers means we don’t need to be super-super-accurate. We just need to be able to rank this region over that region.”
While they are racing now to overtake the coronavirus, the researchers say their survey tools could, alas, come in handy again.While they are racing now to overtake the coronavirus, the researchers say their survey tools could, alas, come in handy again.
“This has been a lesson in the limitations of our ability to respond as epidemiologists,” Dr. Chan said of the coronavirus. “We need to develop tools that will allow us in the future to respond more quickly to data collection and analysis in real time. Because this may not be the last pandemic.”“This has been a lesson in the limitations of our ability to respond as epidemiologists,” Dr. Chan said of the coronavirus. “We need to develop tools that will allow us in the future to respond more quickly to data collection and analysis in real time. Because this may not be the last pandemic.”