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Coronavirus Is Forcing Medical Research to Speed Up Coronavirus Is Forcing Medical Research to Speed Up
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As scientists race to understand the coronavirus, the process of designing experiments, collecting data and submitting studies to journals for expert review is being compressed drastically. What typically takes many months is happening in weeks, even as some journals are receiving double their normal number of submissions. Science, one of the world’s most selective research outlets, published the structure of the spiky protein that the virus uses to enter host cells — crucial knowledge for designing a vaccine and antiviral drugs — nine days after receiving it, according to Holden Thorp, the journal’s editor in chief. “It’s the same process going extremely fast,” he says. Is there precedent in Science’s 140-year history? “Not that anybody can remember.”As scientists race to understand the coronavirus, the process of designing experiments, collecting data and submitting studies to journals for expert review is being compressed drastically. What typically takes many months is happening in weeks, even as some journals are receiving double their normal number of submissions. Science, one of the world’s most selective research outlets, published the structure of the spiky protein that the virus uses to enter host cells — crucial knowledge for designing a vaccine and antiviral drugs — nine days after receiving it, according to Holden Thorp, the journal’s editor in chief. “It’s the same process going extremely fast,” he says. Is there precedent in Science’s 140-year history? “Not that anybody can remember.”
For both experts and laypeople, being able to access dependable health advice has never felt more important, or challenging. The World Health Organization has described a “massive ‘infodemic’ — an overabundance of information, some accurate and some not — that makes it hard for people to find trustworthy sources and reliable guidance when they need it.” Indeed, in recent weeks, new research has emerged that complicates such basic questions as who should wear face masks and when; what degree of physical separation is safe; and how the virus primarily spreads.For both experts and laypeople, being able to access dependable health advice has never felt more important, or challenging. The World Health Organization has described a “massive ‘infodemic’ — an overabundance of information, some accurate and some not — that makes it hard for people to find trustworthy sources and reliable guidance when they need it.” Indeed, in recent weeks, new research has emerged that complicates such basic questions as who should wear face masks and when; what degree of physical separation is safe; and how the virus primarily spreads.
As a practice, science continuously interrogates and refines our understanding. “The answer is never so simple as ‘Masks work or masks don’t.’ It’s going to be ‘Under what conditions do masks have an effect?’ and ‘How much of an effect do they have?’ ” says Brian Nosek, executive director of the Center for Open Science. “The questions that we want answers to are much more complicated than the evidence that we have at any one moment.” The problem is that now we want those answers to be definitive and fast.As a practice, science continuously interrogates and refines our understanding. “The answer is never so simple as ‘Masks work or masks don’t.’ It’s going to be ‘Under what conditions do masks have an effect?’ and ‘How much of an effect do they have?’ ” says Brian Nosek, executive director of the Center for Open Science. “The questions that we want answers to are much more complicated than the evidence that we have at any one moment.” The problem is that now we want those answers to be definitive and fast.
That demand for conclusiveness highlights longstanding tensions over the role of a scientific journal. Should it be an arbiter of facts or a generator of new ideas? A keeper of the historical record or a predictor of the future? A private channel for scientists to communicate with one another or a megaphone with which they can reach the public? Or all of the above? “I think this whole pandemic has very much changed our view of ourselves,” says Richard Horton, the editor in chief of the British medical journal The Lancet. “We feel very much that we are publishing research that is literally day by day guiding the national and global response to this virus. And that is both daunting and full of considerable responsibility, because if we make a mistake in judgment about what we publish, that could have a dangerous impact on the course of the pandemic.”That demand for conclusiveness highlights longstanding tensions over the role of a scientific journal. Should it be an arbiter of facts or a generator of new ideas? A keeper of the historical record or a predictor of the future? A private channel for scientists to communicate with one another or a megaphone with which they can reach the public? Or all of the above? “I think this whole pandemic has very much changed our view of ourselves,” says Richard Horton, the editor in chief of the British medical journal The Lancet. “We feel very much that we are publishing research that is literally day by day guiding the national and global response to this virus. And that is both daunting and full of considerable responsibility, because if we make a mistake in judgment about what we publish, that could have a dangerous impact on the course of the pandemic.”
The strength of traditional academic journals, compared with other means of broadcasting scientific knowledge, is that they have the expertise to interrogate the validity of highly specialized experimental methods and the accuracy of the resulting data — and also make the importance of new findings clearer in context. That means getting relevant experts to review papers, which is especially difficult when dealing with a novel pathogen. Many of those who have gained expertise in Covid-19 are also in the thick of trying to stop it. “What we can say with confidence is the best available evidence is what’s coming through the journals,” Nosek says. “But the best available evidence is far, far short of certainty,” he adds — and the decisions that we make about the evidence have “to embrace the uncertainty.”The strength of traditional academic journals, compared with other means of broadcasting scientific knowledge, is that they have the expertise to interrogate the validity of highly specialized experimental methods and the accuracy of the resulting data — and also make the importance of new findings clearer in context. That means getting relevant experts to review papers, which is especially difficult when dealing with a novel pathogen. Many of those who have gained expertise in Covid-19 are also in the thick of trying to stop it. “What we can say with confidence is the best available evidence is what’s coming through the journals,” Nosek says. “But the best available evidence is far, far short of certainty,” he adds — and the decisions that we make about the evidence have “to embrace the uncertainty.”
To make potentially life-or-death research available as quickly as possible, many publishers of elite journals with hefty paywalls, including Science, The Lancet, JAMA and The New England Journal of Medicine, have made coronavirus content free online. Thorp says he and others have also encouraged researchers to post their submissions to so-called preprint servers, where anyone can access them, before review. “Then, we’re not deciding whether the world should or should not have the information,” he says. “What we’re deciding is whether this is an important part of the scientific record that should have the endorsement of our peer-review process.”To make potentially life-or-death research available as quickly as possible, many publishers of elite journals with hefty paywalls, including Science, The Lancet, JAMA and The New England Journal of Medicine, have made coronavirus content free online. Thorp says he and others have also encouraged researchers to post their submissions to so-called preprint servers, where anyone can access them, before review. “Then, we’re not deciding whether the world should or should not have the information,” he says. “What we’re deciding is whether this is an important part of the scientific record that should have the endorsement of our peer-review process.”
By definition, however, it’s difficult to say whether a preprint is “reliable and dependable and true,” says Peter Drotman, the editor in chief of Emerging Infectious Diseases, a journal published by, but editorially independent from, the Centers for Disease Control and Prevention. (It has always been open access.) On the other hand, researchers sharing preliminary work may be helping the scientific community as a whole collaborate more efficiently and effectively — for instance, by enabling researchers to rapidly confirm and build on one another’s findings rather than unnecessarily duplicating experiments.By definition, however, it’s difficult to say whether a preprint is “reliable and dependable and true,” says Peter Drotman, the editor in chief of Emerging Infectious Diseases, a journal published by, but editorially independent from, the Centers for Disease Control and Prevention. (It has always been open access.) On the other hand, researchers sharing preliminary work may be helping the scientific community as a whole collaborate more efficiently and effectively — for instance, by enabling researchers to rapidly confirm and build on one another’s findings rather than unnecessarily duplicating experiments.
Scientific journals consider their audience to be other scientists, not the general public. But the scientific journal as we know it was actually born because of popular demand for information during a pandemic.Scientific journals consider their audience to be other scientists, not the general public. But the scientific journal as we know it was actually born because of popular demand for information during a pandemic.
In the early 1820s, a smallpox outbreak struck Paris and other French cities. A new vaccine was in existence at the time, but reports varied about how effective it was. A powerful medical institution in Paris, the Académie de Médecine, gathered its members to discuss what advice it should issue to the nation. Historically, such meetings were held privately, but the French Revolution had ushered in a new era of government accountability, and journalists were allowed to attend. The scientific debate they relayed upset some members of the Académie, which had hoped to make a clear, unified statement, says Alex Csiszar, an associate professor of the history of science at Harvard University. In response, the Académie sought to regain control of its message by publishing its own weekly accounts of its discussions, which evolved into the academic journals we know today.In the early 1820s, a smallpox outbreak struck Paris and other French cities. A new vaccine was in existence at the time, but reports varied about how effective it was. A powerful medical institution in Paris, the Académie de Médecine, gathered its members to discuss what advice it should issue to the nation. Historically, such meetings were held privately, but the French Revolution had ushered in a new era of government accountability, and journalists were allowed to attend. The scientific debate they relayed upset some members of the Académie, which had hoped to make a clear, unified statement, says Alex Csiszar, an associate professor of the history of science at Harvard University. In response, the Académie sought to regain control of its message by publishing its own weekly accounts of its discussions, which evolved into the academic journals we know today.
Now those same journals tend to be too specialized for general readers to grasp easily, making the concept of “open access,” as far as the public is concerned, “more of an idea than a reality,” Csiszar says. Nevertheless, the current pandemic has certainly increased both the readership of scientific journals and their citations in the press. Before January, the most-read article in Emerging Infectious Diseases, a 2006 study, had 20,000 views. The current most-viewed article, also from 2006, has more than 480,000 views: It gives instructions for making your own “simple respiratory mask” from a T-shirt.Now those same journals tend to be too specialized for general readers to grasp easily, making the concept of “open access,” as far as the public is concerned, “more of an idea than a reality,” Csiszar says. Nevertheless, the current pandemic has certainly increased both the readership of scientific journals and their citations in the press. Before January, the most-read article in Emerging Infectious Diseases, a 2006 study, had 20,000 views. The current most-viewed article, also from 2006, has more than 480,000 views: It gives instructions for making your own “simple respiratory mask” from a T-shirt.
Updated June 16, 2020Updated June 16, 2020
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.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.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.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.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.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.
Mass protests against police brutality that have brought thousands of people onto the streets in cities across America are raising the specter of new coronavirus outbreaks, prompting political leaders, physicians and public health experts to warn that the crowds could cause a surge in cases. While many political leaders affirmed the right of protesters to express themselves, they urged the demonstrators to wear face masks and maintain social distancing, both to protect themselves and to prevent further community spread of the virus. Some infectious disease experts were reassured by the fact that the protests were held outdoors, saying the open air settings could mitigate the risk of transmission.Mass protests against police brutality that have brought thousands of people onto the streets in cities across America are raising the specter of new coronavirus outbreaks, prompting political leaders, physicians and public health experts to warn that the crowds could cause a surge in cases. While many political leaders affirmed the right of protesters to express themselves, they urged the demonstrators to wear face masks and maintain social distancing, both to protect themselves and to prevent further community spread of the virus. Some infectious disease experts were reassured by the fact that the protests were held outdoors, saying the open air settings could mitigate the risk of transmission.
States are reopening bit by bit. This means that more public spaces are available for use and more and more businesses are being allowed to open again. The federal government is largely leaving the decision up to states, and some state leaders are leaving the decision up to local authorities. Even if you aren’t being told to stay at home, it’s still a good idea to limit trips outside and your interaction with other people.States are reopening bit by bit. This means that more public spaces are available for use and more and more businesses are being allowed to open again. The federal government is largely leaving the decision up to states, and some state leaders are leaving the decision up to local authorities. Even if you aren’t being told to stay at home, it’s still a good idea to limit trips outside and your interaction with other people.
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.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.
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 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.)
Taking one’s temperature to look for signs of fever is not as easy as it sounds, as “normal” temperature numbers can vary, but generally, keep an eye out for a temperature of 100.5 degrees Fahrenheit or higher. If you don’t have a thermometer (they can be pricey these days), there are other ways to figure out if you have a fever, or are at risk of Covid-19 complications.Taking one’s temperature to look for signs of fever is not as easy as it sounds, as “normal” temperature numbers can vary, but generally, keep an eye out for a temperature of 100.5 degrees Fahrenheit or higher. If you don’t have a thermometer (they can be pricey these days), there are other ways to figure out if you have a fever, or are at risk of Covid-19 complications.
The C.D.C. has recommended that all Americans wear cloth masks if they go out in public. This is a shift in federal guidance reflecting new concerns that the coronavirus is being spread by infected people who have no symptoms. Until now, the C.D.C., like the W.H.O., has advised that ordinary people don’t need to wear masks unless they are sick and coughing. Part of the reason was to preserve medical-grade masks for health care workers who desperately need them at a time when they are in continuously short supply. Masks don’t replace hand washing and social distancing.The C.D.C. has recommended that all Americans wear cloth masks if they go out in public. This is a shift in federal guidance reflecting new concerns that the coronavirus is being spread by infected people who have no symptoms. Until now, the C.D.C., like the W.H.O., has advised that ordinary people don’t need to wear masks unless they are sick and coughing. Part of the reason was to preserve medical-grade masks for health care workers who desperately need them at a time when they are in continuously short supply. Masks don’t replace hand washing and social distancing.
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.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.
If you’re sick and you think you’ve been exposed to the new coronavirus, the C.D.C. recommends that you call your healthcare provider and explain your symptoms and fears. They will decide if you need to be tested. Keep in mind that there’s a chance — because of a lack of testing kits or because you’re asymptomatic, for instance — you won’t be able to get tested.If you’re sick and you think you’ve been exposed to the new coronavirus, the C.D.C. recommends that you call your healthcare provider and explain your symptoms and fears. They will decide if you need to be tested. Keep in mind that there’s a chance — because of a lack of testing kits or because you’re asymptomatic, for instance — you won’t be able to get tested.
What this sudden growth in scientific engagement will mean over the long term is an open question. Thorp worries about a backlash if people perceive scientists to have overpromised solutions to the pandemic. “It is difficult to share progress with adequate caveats about how long things might take or whether they will work at all,” he wrote in a March editorial. “This is not just fixing a plane while it’s flying — it’s fixing a plane that’s flying while its blueprints are still being drawn.”What this sudden growth in scientific engagement will mean over the long term is an open question. Thorp worries about a backlash if people perceive scientists to have overpromised solutions to the pandemic. “It is difficult to share progress with adequate caveats about how long things might take or whether they will work at all,” he wrote in a March editorial. “This is not just fixing a plane while it’s flying — it’s fixing a plane that’s flying while its blueprints are still being drawn.”
Then again, if government officials had heeded available science sooner, we might not be on that plane at all. On Jan. 31, The Lancet published a paper forecasting a global pandemic and asserting that “preparedness plans should be readied for deployment at short notice, including securing supply chains of pharmaceuticals, personal protective equipment, hospital supplies and the necessary human resources to deal with the consequences of a global outbreak of this magnitude.” Britain’s National Health Service “didn’t take any of those actions,” Horton has written. U.S. health agencies and the White House didn’t, either.Then again, if government officials had heeded available science sooner, we might not be on that plane at all. On Jan. 31, The Lancet published a paper forecasting a global pandemic and asserting that “preparedness plans should be readied for deployment at short notice, including securing supply chains of pharmaceuticals, personal protective equipment, hospital supplies and the necessary human resources to deal with the consequences of a global outbreak of this magnitude.” Britain’s National Health Service “didn’t take any of those actions,” Horton has written. U.S. health agencies and the White House didn’t, either.
None of that, of course, is within our individual control. So in addition to following public-health guidelines, how can nonscientists engage with studies, or news that cites studies, to help them protect their health? Checking sources is important: Heed information that comes from respected journals. But also remember that even the best peer-reviewed advice is likely to change — and change again. That’s how science works, and now it’s working faster than ever. If we put our faith in a single conclusion, it’s easy to feel distressed when it’s amended. If we trust the process, imperfect though it is, we’re better prepared to change with it, which is the most we can hope to do.None of that, of course, is within our individual control. So in addition to following public-health guidelines, how can nonscientists engage with studies, or news that cites studies, to help them protect their health? Checking sources is important: Heed information that comes from respected journals. But also remember that even the best peer-reviewed advice is likely to change — and change again. That’s how science works, and now it’s working faster than ever. If we put our faith in a single conclusion, it’s easy to feel distressed when it’s amended. If we trust the process, imperfect though it is, we’re better prepared to change with it, which is the most we can hope to do.