We Are in the Midst of This Coronavirus Outbreak—Now What?

There’s at least one trial of the vaccine going on already in humans, I think in China. They had more candidates than we did. It’s very hard to get scientific data from China to the west. So that’s an ongoing issue as well. And they had multiple candidates for both therapeutics and vaccines. And that vaccine work will be ongoing. I just saw this morning, in fact, another candidate. And some really good immunology about another way that the virus exposes itself to the human immune system that might be another place that you can grab hold of, literally and metaphorically, in terms of the science and make a vaccine out of that. But all that work takes time. And you want it to take time because you want the drugs to be both safe and effective.

NT: I believe there are two human trials, the China one and the Moderna one. And I was just reading in the World Health Organization that they’re doing a summary. There are 54 possible candidates for vaccines, so I would imagine that given the value of vaccines a lot of work will be coming very quickly.

Let’s go to the first question from the audience. What percentage of people infected with the coronavirus are asymptomatic, how infectious are they, and for how long? And how big of a problem is this?

AR: This is a huge and scientifically fascinating question, and a kind of scary one. A way to think about this broadly, the way epidemiologists think about this when they’re modeling, is there are populations of people who are divided into susceptible, exposed, infected, and then recovering. You either recover or you die.

When somebody who is infectious comes into contact with somebody who’s susceptible, they may well get infected. And the question is, how much time passes between when you have the virus in you, when you’re infected, and then when you are able to give it to other people.

What it does seem like in studying the early parts of the outbreak in particular places is that from somewhere between one and five days, depending on the paper you’re reading, before you start to show overt signs that would make you realize you’re sick, you are still able to transfer the virus to other people through droplets that come out of your mouth and nose when you’re coughing or speaking.

The question is whether you don’t feel sick at all, or whether you might feel a little bit sick, but you’re still sort of the walking ill. All of us have had the experience of feeling not great but taking some medicine and going to work or being out in the world. In fact, one of the researchers who studied this said that he thinks up to 10 percent of all people in any given moment are walking around feeling not really that good.

He did a model that suggested that in China in the early days of the outbreak there, possibly as many as 86 percent of the infections were from people who were what he described as ‘undocumented infections.’ They might not necessarily be asymptomatic, but nobody had checked them out.

And in Singapore, where they’ve been very good at tracking the individual clusters of cases, 6 percent of the locally acquired cases were from asymptomatic or pre-symptomatic people.

So it’s really important because people who don’t know that they’re sick and are out in the world might be spreading the disease around. If you feel okay to be out, that’s how it spreads.

NT: And then the flip side is if you think you have had it, how long until you’re no longer infectious? What we’re hearing is 14 days, but we don’t know that for sure.

AR: This is one of the reasons that not having enough tests is such a problem. The course of the illness is different for different people as well. And it’s very possible that some people get sick with this to such a mild extent that they might have felt like they were sick earlier in the year, and got over it, and might never have had symptoms. Nobody knows. And without the right testing, we can’t find out.

NT: Let’s talk real about how long we’re going to be isolated. Until next year, when there’s a vaccine?

AR: This is a huge question that public health experts, epidemiologists, modelers, and public officials are trying to answer all the time. Because if you remove social distancing measures when the disease is still out there then the disease comes back.

One recent study of this said that this could be going on in an oscillating frequency—basically social distancing lifts, disease comes back, and so on—out as far as 2022, which is a chilling date. Right now we’re riding this exponential curve up. What you might start to see as we get to the other side of that is some intermediate version of social distancing where some things begin to be allowed. That would slow things down enough so that you’re not in pandemic response mode. You can get back to something more like containment and follow that up. And that’s what’s going on in some of the Asian countries and regions right now.

NT: What we’re seeing in China, Taiwan, Singapore, other countries is people are starting to go outside again, are starting to go back to work. But everybody is wearing masks. There are thermal imaging sensors as you go into buildings, people’s temperatures are being checked all the time. Everybody is following social distancing. They are very aware of the possibility that it comes back.

AR: That’s right. Part of the reason that many of those regions were very aware of the possibilities of this coming in the first place was that they had been through this with SARS, which killed far fewer people but had significant effects on places like Singapore and Taiwan. One of the things that’s happening in those countries now is that while they were able to do containment, as they started to lift some of their social distancing measures they started to get re-importation of cases from other places so now they’re having to do containment again to respond to that. That’s not even the second wave of exponential growth coming back with social distancing. They’re still on the upswing.

NT: Are Trump’s projections of 100,000 to 250,000 deaths based on everyone following social distancing and staying at home, or are they based on the mixed application we see now?

AR: After a long period of either underplaying what most public health researchers thought was going to happen or not discussing projections with any kind of specificity, the White House released these numbers at a briefing. But then they were not really forthcoming about where they had gotten those numbers from. Other public health researchers think that that estimation probably comes from a group in Washington State. If you can believe those sort of horrifying numbers, that’s kind of a best case outcome with almost Wuhan-like lockdown and social distancing measures with everybody in every state following those.

But the White House didn’t say where their data was coming from, they didn’t say which model they were using, they didn’t say which estimations of what outcomes they were looking at, so it’s very hard to know what they actually meant. The informed speculation is that that is a number that requires every state, every locality, to essentially do what the Bay Area has done and is doing and what other places are starting to do now. People need to stay home if they can.

NT: One of the consequences of this crisis is that at the end, ideally we will all be a lot better at math—excellent at modeling!

Let me ask you a question that I’ve gotten from three or four people: can the virus mutate, and if you get it once can you get it again?

AR: This is a novel coronavirus—coronavirus of the kind of virus it is, novel means this is the first time anybody’s had it. The first time people saw it was in late November in China. So, these questions are still unknown. It looks like a very slow mutating virus, which means that once you have it you probably have immunity for some amount of time. Is that a year, is that seven years? Nobody knows yet because no human being has ever had this virus for a year or seven years.

That kind of science, though, really bodes well for developing therapeutics and a vaccine. There were case studies that suggested that people could be reinfected and it seems more likely that those were a result of some error in testing or a mistake in the methodology. So far, there’s nothing that says that once people have recovered they get it again.

NT: There appears to be evidence that the virus mutates less than other viruses, suggesting there’s a decent chance if you get it once you will you will remain unable to get it and it will not mutate into something worse. One of the things that optimists have been saying is that they expect over time it will mutate into something less dangerous.

AR: I don’t know how to calculate the odds of how bad or good a mutation might be and which subpopulations of the virus would go in which direction. You might remember The Andromeda Strain, a Michael Crichton story about a virus from space, where at the end, if I remember right, it all evolves into something that doesn’t hurt people anymore. One of the things that makes epidemiologists crazy about that famous science fiction story is that all of the virus evolves at the same time.

I suppose there could be different populations. But the most infectious population of those would be the one that would spread. The thing that happens with the flu every year, for example, is that it mutates and changes. It has these regions. The seasonal flu vaccine attempts to keep up with those sorts of changes. Sometimes it does better, sometimes it does worse. So far this virus does seem to act a little bit more like a chicken pox in the sense that once you have it you don’t get it again. That’s what it looks like now.

NT: Let me ask you my favorite question so far: Do viruses have sentience?

AR: This is so great! Forgive me for getting all excited at a grim time, but this is the kind of thing that drives the most basic of this research. A virus is a package of genetic material inside an envelope that helps it get into the things that can then get hijacked to make more virus. The kind of language that many people often use is, well, the virus wants to infect people and what the virus is trying to do is infect as many people as possible to make more of itself to reproduce. But of course the virus doesn’t want anything.

A virus is a verb. A virus does a thing. What it does is it infects other cells and then those cells make more virus. There’s no collective intelligence at work here. Viruses are infinitesimally smaller even than bacteria, which are infinitesimally smaller than us. There’s some notion that the entire microbiome in a person is more cells of them than us and so there’s some collective version of sentience that makes up who we are as humans. But viruses exist almost in a world unto themselves. They are riding us to do something. But all we ever see of it is they take over our cells to make more virus. I don’t think they’re thinking about it when they do it. Which is kind of implacable and terrifying when you think about it as well.

NT: Let’s go to one of the big questions that WIRED will be covering for months and years, which is the trade off between how we respond to the virus and our privacy. I read a paper in Science that said quarantines aren’t going to work, social distancing isn’t going to work, what we recommend is that somebody design an app that tracks your location and that sends you an automatic alert when you have been near someone who has tested positive.

Phone companies know where your phone is at all times. It has a harder time tracking people indoors than it does outdoors, but the phone will know who you’ve been near and therefore if it knows who’s been exposed. It can determine your risk. There are a couple steps before this could happen. But do you think it will happen, and would you be okay with it happening?

AR: It’s already happening. In Hong Kong, you get a smartphone app when you come in. Many of the Asian countries and regions are instituting 14-day quarantines when you show up in the country, even if you’re from there, and you have to register on your phone and they monitor your location.

Would I be okay with it? The thing that innovators in this country have been so good at for the last 20 years, for all of the time that you and I have spent at WIRED, is coming up with useful solutions to these exact kinds of problems. There has to be a way to anonymize enough privacy but also let people know something is going on. I have to think there’s a technological solution to this specific issue.

Read all of our coronavirus coverage here.

NT: What we’ve seen over the last 20 years is they’re very good at coming up with solutions in public and also very good at eroding our privacy in ways that we don’t care about for no good. And so this would be eroding privacy for good!

AR: That’s the next jump to it, too, is that I’d much rather they erode my privacy for this than to sell me stuff.

NT: This is a big thing that’s in the news today: Please provide the latest on research about the virus spreading via breathing and talking. We know it spreads when you cough, but if it spreads while we talk that’s a whole other problem.

AR: There’s a cluster of cases that’s famous now of a singing group. Nobody was symptomatic and they were all six feet apart. But many if not all of them are sick. A couple of them have died. The hypothesis here is that when you’re singing, one of the things you’re doing is making sure you expel as much air as you possibly can out of your lungs. Part of what happens in the early phases of infection seems to be that the virus gets most resident in the upper respiratory system. So as you’re talking you’re expelling air from the lungs and through the mouth, and that carries droplets that have the virus in them. That does seem to be the latest thinking: In the early pre-symptomatic days the virus is also in the exact place where when you’re talking and breathing you’re expelling it.

The implication of that question is, does that mean this virus is airborne? And then the question is whether everybody should be wearing some kind of mask. These are all very controversial—people are still trying to understand these things at the same time that they’re trying to institute measures that control the spread of the virus. And that’s why there’s some social pressure to switch to wearing masks, to keep whatever is in you from getting out. The question of whether it could be in anybody at any time and just talking to them from six feet away makes you more vulnerable than you would have been otherwise? That doesn’t seem to be where this is, but the concerns about it are there. It’s starting to look like many state governments, local governments, and perhaps even the White House are going to say people need to be wearing masks when they’re outside to keep whatever is in them from going outward.

NT: Do we need masks? Obviously there’s a shortage of masks, and they need to go to medical professionals first. At some moment, God willing, you will be able to buy masks again. When that moment comes, should we wear them when we go out?

AR: Two things happened. First people rightly made a connection between the places in the world that did a better job early on in dealing with the pandemic than the United States and also said that in those places a lot of people do wear masks. Mostly the surgical or cloth kind, not N95 masks, which are highly specialized with filtration textiles—an electrostatically charged, non-woven, very technical textile. People expect that those should be reserved for use as personal protective equipment for healthcare workers.

Great. But surgical masks or cloth masks that you make home with any number of inserts that you can put in them? We had fights about this on the WIRED slack. Some of us, and I tend to be in this camp, find that science more equivocal than others do. And then the question is, well, how equivocal does it have to be before you just say people should wear masks anyway, and if it helps, it’s probably not going to hurt.

The question is, for some small fragment of people, that the act of taking it on and off may make them more likely to be infected. But if keeping the mask on keeps other people from being infected maybe that’s the right trade off. Like I said, I’m much more equivocal about this than some of my colleagues, much less people out in the world. But I think we’re going to end up wearing masks anyway. I think that that is about to become a social change that Covid-19 has on American society.

NT: I will say that, personally, when masks are available I will be wearing one in public.

At first, people were saying the elderly were most vulnerable. Now we’re seeing that’s not the case. Do we know who is most vulnerable beyond the immunosuppressed? Is it truly random?

And that’s closely followed by the question, how can we have had more and more reports and younger people dying in Europe and North America? In fact, even more specifically in the south of the United States in the recent news compared to in the beginning the reports in Asia?

AR: It’s increasingly difficult to keep up with the demographics. It is still, as I understand it, the case that the majority of deaths are in older people in our population, 70 and up. What has changed, seemingly, in Europe and the United States is that the hospitalizations, the critical cases have started to include younger people into their 30s and 40s. And then also coverage has emphasized some outliers. So, for example, tragically, an infant child younger than one year old, a teenager in California.

But I think that there’s some difference between critical case curves and death curves here. Now, that’s terrifying in itself. And what researchers don’t yet understand is why some people have a worse course of disease than others. Are they pre-existing conditions? Is it immunosuppression? Is it difference in lung capacity? There are hypotheses that involve the way that the virus actually gets into cells; that perhaps some people’s cells express more of the proteins that provide the gateway into the cells than others. And those things are still not known. Those different populations of who ends up a critical case and who ends up dying are different from country to country, and that may be because people experienced different conditions in those countries. Which populations are more likely to have been smokers, perhaps, because that the critical course involves syndromes in the lungs and then sometimes ultimately in the heart. Which populations live in cities and are exposed to more pollution? Nobody knows any of this yet.

I think those numbers are going to change also because the populations are getting bigger. Initially, the population that people had that they could study to try to understand what was going on was just Wuhan and the surrounding areas. Which is huge, but it was just them. So then you start to expand to other parts of the world and now European people in Western Europe, people in the United States, and the majority of the people who have had the disease now are in the United States. So just having a bigger population changes the way the population responds, because you have different conditions.

NT: This leads to a really thorny ethical question, right? As we learn more about who is most likely to die or face terrible conditions, it seems like younger people are indeed less susceptible though the data in the West may be worse than in the East. It seems like men are more likely to die than women. So as we learn more about this there comes the question of whether we should do what are called challenge trials, whether you should have people who volunteer, for the service of vaccine testing, to be given the virus as a way to accelerate the way vaccine testing happens.

I read a paper about this and the argument was that this would be a good thing. It would accelerate vaccine development. And then the paper says, actually, it wouldn’t really increase risk of death if you were to limit it to people who are likely to get the virus anyway because they live in urban areas and may get it at some point, and are likely to not have a terrible reaction because they are in a low risk group, and then therefore by volunteering for the test they will be given the best possible health care. So actually, the volunteers may not have a higher risk of death from the virus than non volunteers. That’s the argument in the paper. Adam, respond to it both logically and morally.

AR: So, logically, what you would like to be able to do is have an interestingly diverse population of people exposed to the virus in controlled settings so you can trace the course of how the virus proceeds through them as a population and also individually, and then potentially use those outcomes for research pursuing a vaccine. And also immunological therapies, monoclonal antibodies especially, which right now are the thing that I’m more hopeful about.

And even ethically, if you could find a way to really feel like everybody had the most informed consent possible to this—to really explain to people, look, there’s a chance because of who you are and what we think, how this works, you could die from this or get really, really sick—you may be able to think about an ethical way for those folks to consent. Maybe an IRB (institutional review board) that reviews how we’re going to do human trials, would say, well, the situation is pretty great, maybe we can do it.

I do think part of the argument that you’re seeing as well is do you really learn what you need to learn from that kind of experiment? Do you need to do that kind of experiment to learn what you need to learn, which is the virology, the immunology of the response. And I think that that’s why, for example, some of the molecular approaches to coming up with vaccines and other therapies are interesting to folks, because they suggest that you don’t have to do that kind of challenge testing, like building the most sophisticated clinic in the world and putting those people in it to say we’re going to give you a virus and see what happens. Especially because bioscience has a really bad history of those kinds of things where people didn’t have informed consent about it. The evolution of bioethics as a field came in large measure out of doing those kinds of experiments in less than ethical ways and the horrible outcomes that resulted.

NT: I’ve been listening to an audiobook called Ten Drugs tracing the history of drug development through time. And one of the things that’s so extraordinary is that much of drug development comes from the wealthy and famous testing potential drugs on their children in dire situations. But also the number of tests that got carried out on prisoners and orphans. Which is not what you want to have happen.

Let me go to a big question here: What country has had the best response to the virus so far? And what lessons can we learn from them?

AR: South Korea, I think, is probably the far and away winner looking at that curve. One thing that you can learn is that it’s good to have scientists in positions of political authority as well. South Korea, Singapore, Hong Kong, Taiwan—these places that experienced the brunt of SARS built a public health infrastructure that was ready for a respiratory pandemic to emerge out of China and would come to them first.

The United States knew that was possible as well. I’ve got reports going back 20 years that say this is what’s going to happen and what will happen when it does is we won’t have enough PPEs, we won’t have enough ventilators, there won’t be centralized authority, and a lot of people are going to get sick and die. Those reports go back to before anthrax, after September 11. They certainly happened to a great extent after SARS and MERS. And H1N1.

What’s different is that the United States listened, and then stopped listening. And in those other countries, as soon as this started to happen all of their alarms went off. So places like Taiwan, for example, linked their national health care database to their immigration database. In South Korea, as soon as they started to have cases they did huge contact tracing efforts. Singapore posted data on every single cluster: here’s the person who we followed, here’s who they infected, here’s who they followed. You can follow these trees and see what part of the city state they live in. South Korea got almost everybody. They missed one, which is what happens when you do contact tracing, some always get through. They missed one and that person turned out to be a superspreader so they had another blossoming of cases. And now they’re seeing more cases, especially with re-importation and then some community spread again.

But the unfortunate thing about this is that the lessons that those places teach, we’re now past that time. Because what they were able to do was effectively handle containment.

They saw this thing coming and they contained it. The phase that we’re in now is mitigation or management. That’s what we’re trying to do. That’s what social distancing is. We’re past containment. We’d like to get back there.

NT: But containment is still potentially a policy in cities where there have not been breakouts.

AR: Yeah, potentially. That requires a few things to be in place in advance, though. One of them is testing which places don’t have. One of them is a funded and trained public health infrastructure. To have people who actually go out into the community, knock on doors, and say, hey, we think this person was in contact with you, were they? And those people have to be in PPEs. Public health in the United States is largely run through the states and then through localities. And I’ve seen reports, it’s been denuded in the last 10 years of funding and personnel. They’ve lost hundreds of millions of dollars and tens of thousands of people so that infrastructure doesn’t exist to do that kind of containment. You’d have to build that in as well. And right now, those cities are trying to get ready for the wave. Cities all over the country, if they’re preparing correctly, are focusing their attention on getting their hospitals ready, on building tent hospitals, on building shelters for the homeless and potential emergency pop-up hospitals in convention centers. So they’re getting prepared for a mitigation response, not the containment response that they would have to do in advance of that.

NT: WIRED has traditionally been a magazine about optimism. Change is good. We cover an area west of California called the future. And here that has not been our role. The optimists are the ones who downplayed it in January, February. WIRED has very much been extremely realistic here and in fact has been warning since very early on about the dire threats and the steps we need to take.

So, what do you see as the potential silver linings in the tragedy of the coronavirus pandemic? What are the long term societal health benefits that may come out of this tragedy? Clearly at WIRED we have learned all kinds of things that will be adaptable to our future work as journalists. Tell me about the big things that are going to come to society that may be positive after this incredible tragedy.

AR: I do have some hopes here. One of them is to see a reimagining of our health and public health systems in the same way that Asian countries or regions did after SARS. To understand, now the vulnerabilities are stark. The fact that people don’t have access to care. The fact that public health and prevention is not a priority. The fact that we don’t have enough resources for people who need them. The fact that not only are the poorest and oldest and sickest the most vulnerable and most likely to be harmed financially and physically, but all of us are vulnerable. Because of systems, not just because of a scary new virus. There are ways to build systems that would make this virus not as scary and we haven’t built those. So maybe now we will.

I also think that the economic consequences of the widespread shutdown have been tremendous obviously. Huge numbers of employment. And small businesses especially being affected and going out of business. And that’s tremendously painful but this has also allowed people to see cities in a new light. This is a particular interest of mine: to understand, for example, what happens when cities don’t have as many cars in them.

One of the problems with social distancing is we told people, you have to put six feet between each other. Now when people go outside, they realize there’s not enough room on sidewalks to put six feet between each other because the sidewalks are narrow because we built all these places for cars! Now that the cars are less plentiful and the bridges are less full and the congestion is not as bad and the air is cleared up over cities like Los Angeles, you start to understand that we built these entire infrastructures around dangerous technologies and they don’t have to be that way. So I think maybe we can start to see it structuring the society that’s more resilient for smaller businesses rather than these giant transnational companies that want to send things to us in boxes, that’s more resilient for public health reasons.

And maybe this is me being emotionally vulnerable but I have these hopes that now we can all be understanding of what it is to have a more tenuous connection to our society and to what governments can and should offer as a safety net for all of us. To understand how hard it is when we don’t know where our paycheck is coming from. We don’t know if we’re going to be able to take care of our loved ones, when we’re scared that we’re going to be sick and won’t be able to do anything about it. This is something that the most vulnerable members of our society and frankly the poor and people of color have experienced to a greater extent than people in kind of the over classes. And now all of us are experiencing it together and I hope that the sensitivity to those things will change our psychology as well as our system.

NT: I hope so too. There are a couple of industries that will be completely transformed. The way we practice medicine: the rise of telemedicine has been fascinating to watch and will be extremely beneficial. Online education. Right now my three little kids right there are homeschooling on iPads, on Zooms with their teachers right now, but the fact that none of them has come charging in on this call in a penguin costume suggests that that is actively working. So online education seems to be another thing that will be transformed. Journalism will be transformed.

Let me ask a small, specific question that is very particular to my life. When we are running in the woods and crossover with another runner, since we are both breathing, can we get infected by the air? Should we run with masks?

AR: You are a world class long distance runner. Would it work?

NT: I think you probably could run with a bandana over your mouth. I think you’d probably be getting enough oxygen, you could certainly breathe through your nose. Obviously it’s going to limit your ability to breathe well. I actually have never tested it. What do you think, should I wear a mask when I run?

AR: If you’re distance running by yourself out in the forest, I probably not. But I’ve seen the kind of crowds that exist at the beginning of a marathon. Those are very close together. Will we be able to have those kinds of events? Will we ever see one of those starting lines at a marathon again?

NT: There’s no way that the starting line of a major marathon could exist in anything like the stage we’re in. But you could also have staggered starts. But let’s get to questions that more people are concerned about. Tell me a little bit more about herd immunity. There was a very brief moment where the UK Government said we’ll just do herd immunity and then they quickly changed course. But what does it mean, and how do we get it?

AR: It means something a little different than leaders of the UK and United States have meant. What it means is that if you have enough people who are immune to a pathogen then it doesn’t spread as quickly or as widely. The pathogen doesn’t jump as quickly from individual to individual. So it doesn’t get to the ones who are the most vulnerable. The herd that all of us are in with each other, the togetherness of the world, protects itself as a collective.

What they meant in the UK and what President Trump meant here when he said maybe we can ride it out is that you would just let Covid-19 spread as widely as possible. Because we haven’t had the testing, we don’t know what the denominator is. We don’t know how many people had it already. All we know is confirmed cases and how many people get critically ill and die. That’s really, really bad. It looks terrible. But it’s possible that in fact many, many more of us had it in January and were fine. So the idea is maybe you should let the disease spread as it would without doing anything. And some number of people would recover and then all of us would have some immunity and then it would be less likely to spread later.

What seems to be the case is that the reason the UK turned away from that is that the modelers at Imperial College said if you do that millions and millions of people in the UK will die. It was a model, that was the worst case. But when you bring that model to a national leader, they go, okay, maybe we’re not going to do it that way. Let’s hold the line until we can get a therapy and a vaccine. And that same model seems to have been put in front of the President and the coronavirus task force. And they were like, Whoa, whoa, whoa, we’re not going to do that here.

NT: The way I’ve often thought about it, you have a chance to avoid the virus by social distancing, maybe you won’t get it on you. You don’t touch the subway pole, you’re less likely to get it if you wear gloves. Then there’s a whole bunch of things you can do once it gets on you to keep it from getting in you. You wash your hands. You don’t touch your face. Then, once it gets in you, there’s a chance it won’t get down your lungs and won’t start replicating in you. Maybe it’s based on your immune system. Maybe it’s based on luck.

I’ve always assumed that if it does start replicating, it’s pretty much the same. But now I’ve been reading more about viral load. If you’ve been exposed to a lot of it, you are likely to have a worse case. So it’s not just that it gets in and starts replicating. But if more of it gets in you’re in a worse situation. Is that correct?

AR: I think so. I hesitate to use these kinds of metaphors. But if you have a fortress that you’re trying to defend, if the bad guys send two people, even if they make it inside you can maybe deal with them versus sending 20,000 troops. There is some response that the immune system can deal with some low number of the virus, or you’d get less sick than if you are healthcare workers who are exposed to huge amounts of people who are very sick and who are doing procedures that potentially expose them to a lot of the virus like an intubation. It’s why they needed PPEs.

So yes, it does seem to be the case that if you end up in a situation where you have a lot of droplets full of a lot of virus it becomes harder for the body to fight it off and potentially the infection gets worse more quickly. Then there are variations on how your immune system responds to it.

And then part of the problem is that one of the ways that this disease kills people is that a person’s immune system becomes hyperactive. There’s a hyperactive immune response called a cytokine storm that can potentially also be bad where the immune system gets over-triggered.

NT: Peer review is so important in science, but most of the papers that are coming out on this are not peer reviewed. How is this going to change publication collaboration in scientific literature? What are the risks and the benefits?

AR: This has been tremendous for something called pre-prints. Tremendously good scientists have been publishing tremendously good work very quickly, essentially having post publication peer review. They put out work and the rest of the scientific community reads it and decides whether or not to use it. Some of those papers have been retracted. Some of those papers have turned out not to be solid. That’s what happens in science, often that happens behind the curtain.

The curtain has been opened here. I don’t think it closes again. And I think in a fast new situation like this the scientific situation is different at the end of the day than it was at the beginning of the day most days of the week. And that’s because of a pre-print infrastructure and an online infrastructure that allows researchers to get their work out there very quickly in a time of emergency. I don’t think that’s changing. That’s not going back.

NT: There are a couple people asking if we can do these on a more regular basis. Adam, are you free next week?

AR: I’d be happy to do it. And I will say that many of my colleagues have been doing tremendous work too, and I hope we can get some of them here. This has been an all hands piece of work. It’s the story of our time.

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