Intro: What follows is the second block of a series of daily posts that I am putting up on facebook, and have been asked to put up here for wider access. The first block, covering days 1-14 is here. I’m not going to post each one separately (it would drive my followers mad), but I’ll probably start a new one every week or so to minimise endless scrolling. As you’ll twig from the title, I’m picking positives wherever possible. The COVID-19 situation isn’t positive, it’s absolutely dire. But as well as the frontline medical professionals there are a lot of very busy scientists working away on this in the background who I think we should pay tribute to. Best wishes to everyone at this difficult time.
Statement of interest: I am not, and never have been, medically qualified. I have an undergraduate degree and PhD in human physiology. This was more than 20 years ago, and since then I’ve worked in other disciplines. Consequently whilst I am comfortable reading the medical literature and distilling it into a few simple sentences, I am not going to comment in any detail on any of the science I’m referring to, and all of the posts will be short. Seeing as my blog posts are usually far too long and geeky, you’ll be glad of this… But I will always state my reference and provide a link. This last bit is important!
Moments of reprieve, day 30
Moments of reprieve, day 30. All models are wrong, but some are useful (quote from George Box who was a shit hot statistician). Not a journal paper today, but a very readable article on how to model a pandemic.
Moments of reprieve, day 29
The expected impact of lockdown. Yeah, it’s dull and we would much rather be out and about. Simple images, from the Imperial College group, showing the predicted impact of lockdown on infections (which we don’t in practice know because of our lack of testing capacity) and numbers of deaths (which we know a bit more accurately). Model is proving fairly accurate. So we stay at home until the geeks come up with an exit strategy.
Moments of reprieve, day 28
Dodgy livers that aren’t. The main clinical features of COVID-19 relate to poor lung function. However, the blood markers that indicate liver dysfunction also look pretty concerning. However, it seems like these are simply a feature of the immune response itself, and that the virus doesn’t have significant impacts on the liver. [This isn’t an advertisement for drinking too much; if you knacker your liver with booze; liver damage will cause you to be immune-suppressed].
Moments of reprieve, day 27
Sorry, I forgot! And now it’s late and I don’t want to read about covid. So here is a romp of otters (yes, that really is the collective noun for otters!) enjoying hanging out with orangutans. (several more cute photos if you click on the link!).
Moments of reprieve, day 26
Not feeling like reading about COVID-19 today, so instead, seeing as we are naming hospitals after Florence Nightingale, did you realise that she was an excellent statistician and was using infographics in the 1850’s as a means of convincing army officers with no medical knowledge that living conditions for soldiers were strongly influencing death rates? Readable summary of a truly badass woman here.
Moments of reprieve, day 25
We know that staying at home and reducing social contacts is a good way of reducing the spread of COVID-19. But how good? Some Chinese scientists have looked at mobility data and travel histories and compared the spatial distribution of COVID-19 cases before and during lockdown. The study will doubtless be repeated now lockdown is easing. Understanding movement of people and how it might create hotspots of new COVID-19 cases is key to understanding how to reduce current restrictions in the medium term.
Moments of reprieve, day 24
Taking a break from science today. Great article by Arundhati Roy. “Historically, pandemics have forced humans to break with the past and imagine their world anew. This one is no different. It is a portal, a gateway between one world and the next. We can choose to walk through it, dragging the carcasses of our prejudice and hatred, our avarice, our data banks and dead ideas, our dead rivers and smoky skies behind us. Or we can walk through lightly, with little luggage, ready to imagine another world. And ready to fight for it.”
Moments of reprieve, day 23
Ethics today, on what it means to protect the NHS. An easy read, it’s not a journal paper. Clickbait if you need it: “From an ethical perspective, we must recognise the interdependence of our social relationships. None of us can survive alone. None of us has succeeded alone. We all need each other”
Moments of reprieve, day 22
COSMO (Covid-19 Snapshot Monitoring). Behavioural change is a key component of the response to COVID-19. However, in the face of a perceived lack of consistency, competence, fairness, objectivity, empathy, or sincerity in the response to the crisis, behavioural change is difficult to sustain. In light of this the WHO have come up with a standard protocol on measuring risk perception, preventative behaviours and public trust. Some countries are using this protocol on a weekly basis to gauge the public mood and refine messaging to maximise its impact. If we don’t understand how people respond to the messages they are getting, we can’t plan the next phase of our strategy because we won’t know the likelihood of compliance. It shouldn’t be a surprise to anybody that blame culture is more likely to create problems than solve them.
Moments of reprieve, day 21
Comorbidities that aren’t; how to treat patients with multiple conditions. Clinicians are rapidly assembling lists of other medical conditions that make treatment of patients with COVID-19 more complicated or are likely to result in worse outcomes. These are known as comorbidities. However what we hear less about in the news is the conditions that don’t seem to impact. And there is an increasing list of those too. Amongst the most surprising are asthma and COPD (chronic obstructive pulmonary disease). People with these conditions seem to be under-represented in deaths from COVID-19. Nobody quite knows why at this stage. [Please stay at home, don’t go out and do a life or death experiment on this].
Moments of reprieve, day 20
I don’t feel like reading about COVID-19 this weekend, but there is lots of other cool science happening, so today’s nugget is a report of teaching detection dogs to sniff out a disease that affects orange trees. The dogs detect the disease before it produces any visible signs on the foliage, and it is quicker and more economic than laboratory tests. Lots of geeky detail in the link, but there are also nice videos of dogs snuffling around citrus trees and getting super excited when they find an infected one.
Moments of reprieve, day 19
Llamas. Yes, you did read that right. Llamas can suffer from coronaviruses just like we can. This team isolated the antibodies from a llama and unfortunately discovered they weren’t effective against COVID-19. In order to understand why, they worked out the 3D structure of the llama antibodies. In an impressive bit of 3d jigsaw puzzle solving they realised that if they bound together the llama antibody with a human antibody, it would probably bind to COVID-19. They were right. Another potential therapy, and a better understanding of the way in which antibodies can bind to COVID-19.
Moments of reprieve, day 18
Brute force drug targeting. When designing drugs to kill viruses, one approach is to look at all the points of interaction between the virus and human cells, to see where these interactions can be disrupted. This team took the COVID gene sequence, expressed all of the proteins that make up the virus and then worked out what proteins from human cells these viral proteins could potentially bind to. They found over 300 points of interaction. They then trawled the current inventories of drugs in use, to see whether we have existing drugs that can disrupt these interactions between virus proteins and human proteins. Turns out there’s about 70 drugs already in use that meet this criteria. They’re now working on testing these drugs for their activity against COVID-19 directly. It is mindblowing how such a massive bit of work has been undertaken in the timescale. By a team of 80 odd scientists across 30 or so university departments.
Moments of reprieve, day 17
Symptom tracking apps and why they’re useful. In normal times health and symptom tracking apps can be wildly inaccurate, induce anxiety and are a data protection nightmare. But these are not normal times. You’ll probably have seen the COVIDradar symptom checking app. Because we have a woefully low testing capacity in the UK, we have almost no idea of how many people have COVID-19 or have recovered from it. As individuals we need to behave both as if we have it, and don’t want to give it to anyone else, and also as if we haven’t had it, and don’t want to catch it. Anything else is irresponsible. But mass data collection on what types of symptoms people have, the demographics these people are in, geographical hotspots, and the extent to which this later maps on to antibody testing, is going to be crucial information. At the point at which the geeks are deciding when and how to ease movement restrictions and how this relates to testing, this information is going to be invaluable. 1.5 million downloads in 2 days! Read about it in BMJ, download it here.
Moments of reprieve, day 16
Moments of reprieve, day 16. Avoided deaths. The team at Imperial College (who were behind the model that caused the abrupt change in UK policy) have refined their model to estimate the impact of lockdown measures in various countries in Europe. Taking the number of deaths and the dates at which various levels of intervention (social distancing, banning public events etc) occurred, they have calculated that around 38,000 deaths have been avoided in Italy, and 16,000 in Spain. It is too early to usefully apply the model to calculate avoided UK deaths, because of the time it takes for the slowing of the rate of infection caused by lockdown to translate into fewer deaths. Stay home, stay well. xxx
Moments of reprieve, day 15
Animal models of disease. A feature of medical research that nobody likes talking about is the use of experimental animals. In the case of COVID-19, we are using a back catalogue of drugs designed to treat other viruses, that were extensively tested on animals in the past. Meanwhile, animal models for COVID-19 are being developed. Since we know the protein on the cell surface that the virus binds to, we can look for animals whose cells also have this protein. Macaque monkeys are a potential option, albeit a particularly difficult one ethically. Now it’s been reported that COVID-19 in golden hamsters is very similar to the disease in humans. Hamsters are a well studied animal, and this is probably the least worst option for vaccine and drug development.