Some scientists are taking a DIY coronavirus vaccine, and nobody knows if it’s legal or if it works

Preston Estep was alone in a borrowed laboratory, somewhere in Boston. No big company, no board meetings, no billion-dollar payout from Operation Warp Speed, the US government’s covid-19 vaccine funding program. No animal data. No ethics approval.

What he did have: ingredients for a vaccine. And one willing volunteer.

Estep swirled together the mixture and spritzed it up his nose.

Nearly 200 covid-19 vaccines are in development and some three dozen are at various stages of human testing. But in what appears to be the first “citizen science” vaccine initiative, Estep and at least 20 other researchers, technologists, or science enthusiasts, many connected to Harvard University and MIT, have volunteered as lab rats for a do-it-yourself inoculation against the coronavirus. They say it’s their only chance to become immune without waiting a year or more for a vaccine to be formally approved.

Among those who’ve taken the DIY vaccine is George Church, the celebrity geneticist at Harvard University, who took two doses a week apart earlier this month. The doses were dropped in his mailbox and he mixed the ingredients himself.

Church believes the vaccine designed by Estep, his former graduate student at Harvard and one of his proteges, is extremely safe. “I think we are at much bigger risk from covid considering how many ways you can get it, and how highly variable the consequences are,” says Church, who says he has not stepped outside of his house in five months. The US Centers for Disease Control recently reported that as many as one-third of patients who test positive for covid-19 but are never hospitalized battle symptoms for weeks or even months after contracting the virus. “I think that people are highly underestimating this disease,” Church says.

Harmless as the experimental vaccine may be, though, whether it will protect anyone who takes it is another question. And the independent researchers who are making and sharing it might be stepping onto thin legal ice, if they aren’t there already.

A simple formula

The group, calling itself the Rapid Deployment Vaccine Collaborative, or Radvac, formed in March. That’s when Estep sent an email to a circle of acquaintances, noting that US government experts were predicting a vaccine in 12 to 18 months and wondering if a do-it-yourself project could move faster. He believed there was “already sufficient information” published about the virus to guide an independent project.

Estep says he quickly gathered volunteers, many of whom had worked previously with the Personal Genome Project (PGP), an open-science initiative founded in 2005 at Church’s lab to sequence people’s DNA and post the results online. “We established a core group, most of them [from] my go-to posse for citizen science, though we have never done anything quite like this,” says Estep, also the founder of Veritas Genetics, a DNA sequencing company.

To come up with a vaccine design, the group dug through reports of vaccines against SARS and MERS, two other diseases caused by coronaviruses. Because the group was working in borrowed labs with mail-order ingredients, they wouldn’t make anything too complicated. The goal, says Estep, was to find “a simple formula that you could make with readily available materials. That narrowed things down to a small number of possibilities.” He says the only equipment he needed was a pipette (a tool to move small amounts of liquid) and a magnetic stirring device.

In early July, Radvac posted a white paper detailing its vaccine for anyone to copy. There are four authors named on the document, as well as a dozen initials of participants who remain anonymous, some in order to avoid media attention and others because they are foreigners in the US on visas.

The Radvac vaccine is what’s called a “subunit” vaccine because it consists of fragments of the pathogen—in this case peptides, which are essentially short bits of protein that match part of the coronavirus but can’t cause disease on their own. Subunit vaccines already exist for other diseases such as hepatitis B and human papillomavirus, and some companies are also developing subunits for covid-19, including Novavax, a biotechnology company which this month secured a $1.6 billion contract from Operation Warp Speed.

To administer its vaccine, the Radvac group settled on mixing the peptides with chitosan, a substance from shrimp shells, which coats the peptides in a nanoparticle able to pass the mucous membrane. Alex Hoekstra, a data analyst with an undergraduate degree in biology who previously volunteered with the PGP, and who also squirted the vaccine up his nose, describes the sensation as, “like getting saline up your nose. It’s not the world’s most comfortable feeling.”

Does it work?

A nasal vaccine is easier to administer than one which must be injected and, in Church’s opinion, is an overlooked option in the covid-19 vaccine race. He says only five out of about 199 covid vaccines listed as in development use nasal delivery, even though some researchers think it’s the best approach.

A vaccine delivered into the nose could create what’s called mucosal immunity, or immune cells present in the tissues of the airway. Such local immunity may be an important defense against SARS-CoV-2. But unlike antibodies that appear in the blood, where they are easily detected, signs of mucosal immunity might require a biopsy to identify.

Don Wang administers a do-it-yourself nasal vaccine against the coronavirus on April 26 at an undisclosed Boston location.

ALEX HOEKSTRA

George Siber, the former head of vaccines at Wyeth, says he told Estep that short, simple peptides often don’t lead to much of an immune response. Moreover, Siber says, he doesn’t know of any subunit vaccine delivered nasally, and he questions whether it would be potent enough to have any effect.

When Estep reached out to him earlier this year, Siber also wanted to know if the team had considered a dangerous side-effect, called enhancement, in which a vaccine can actually worsen the disease. “It’s not the best idea—especially in this case, you could make things worse,” Siber says of the effort. “You really need to know what you are doing here.”

He isn’t the only skeptic. Arthur Caplan, a bioethicist at New York University Langone Medical Center, who saw the white paper, pans Radvac as “off-the-charts looney.” In an email, Caplan says he sees “no leeway” for self-experimentation given the importance of quality control with vaccines. Instead, he thinks there is a high “potential for harm” and “ill-founded enthusiasm.”

Church disagrees, saying the vaccine’s simple formulation means it’s probably safe. “I think the bigger risk is that it is ineffective,” he says.

So far, the group can’t say if their vaccine works or not. They haven’t published results showing that the vaccine leads to antibodies against the virus, which is a basic requirement for being taken seriously in the vaccine race. Church says some of those studies are now underway in his Harvard laboratory, and Estep is hoping mainstream immunologists will assist the group. “It’s a little bit complicated, and we are not ready to report it,” Estep says of the immune responses seen so far.

A question of risk

Despite the lack of evidence, the Radvac group has offered the vaccine to a widening circle of friends and colleagues, inviting them to mix the ingredients and self-administer the nasal vaccine. Estep has now lost count of exactly how many people have taken the vaccine. “We have delivered material to 70 people,” he says. “They have to mix it themselves, but we haven’t had a full reporting on how many have taken it.”

One of the Radvac white paper’s co-authors is Ranjan Ahuja, who volunteers as an events manager for a nonprofit foundation that Estep started to study depression. Ahuja has a chronic condition that puts him at heightened risk from covid-19. Although he can’t say whether the two doses he took have given him immunity, he feels it’s his best chance of protection until a vaccine is approved.

Estep believes taking the peptide vaccine, even if it’s unproven, is a legitimate way to reduce risk. “We are offering one more tool to reduce the chance of infection,” he says. “We don’t suggest people change their behavior if they are wearing masks, but it does provide potentially multiple layers of protection.”

“If you are just making it and taking it yourself, the FDA can’t stop you.”

By distributing directions and even supplies for a vaccine, though, the Radvac group is operating in a legal gray area. The US Food and Drug Administration (FDA) requires authorization to test novel drugs in the form of an investigational new drug approval. But the Radvac group did not ask the agency’s permission, nor did it get any ethics board to sign off on the plan.

Estep believes Radvac is not subject to oversight because the group’s members mix up and administer the vaccine themselves, and no money changes hands. “If you are just making it and taking it yourself, the FDA can’t stop you,” says Estep. The FDA did not immediately respond to questions about the legality of the vaccine.

Estep says the group did seek legal advice and its white paper begins with extensive disclaimers, including a statement that anyone who uses the group’s materials takes “full responsibility” and must be at least 18 years old. Among those who Estep says advised the group is Michelle Meyer, a lawyer and ethics researcher at Geisinger Health System, in New York. In an email, Meyer declined to comment.

Given the international attention on covid-19 vaccines, and the high political stakes surrounding the crisis, the Radvac group could nevertheless find itself under scrutiny by regulators. “What the FDA really wants to crack down on is anything big, which makes claims, or makes money. And this is none of those,” says Church. “As soon as we do any of those things, they would justifiably crack down. Also, things that get attention. But we haven’t had any so far.”

Self-experimentation

According to Siber, experimenting on oneself with covid-19 vaccines wouldn’t have any chance of winning ethics approval at any university in the US. But he acknowledges there is a tradition among vaccinologists of injecting themselves as a quick and cheap way to get data. Siber has done so himself on more than one occasion, though not recently.

The chance to speed up research makes self-experimentation tempting even today. There have been reports of Chinese scientists taking their own covid-19 vaccines. Hans-Georg Rammensee, of the University of Tubingen, in Germany, says he injected a covid-19 peptide vaccine into his abdomen earlier this year. It caused a bump the size of a ping-pong ball and a profusion of immune cells through his blood.

Rammensee, who cofounded the company CureVac, says he did it to avoid red tape and quickly get some preliminary results about a vaccine being developed at his university. He says it was acceptable to do so because he is a “renowned expert in immunology” and understood the risks and implications of his action. “If someone like me who knows what he is doing [does it], it’s fine, but it would be a crime for a professor to tell a postdoc to take it,” Rammensee said in a phone interview. He claims Germany has no clear rules on the subject, leaving self-experiments in a gray zone of actions which, as he puts it, “are not forbidden and which are not allowed.”

Because more people are involved in the Radvac project, it may be viewed differently by authorities, who could decide the group is in fact operating an unsanctioned clinical trial. In recent weeks, Estep and other Radvac members have started to publicize their work and contact acquaintances to encourage them to participate.

“He called me and said ‘Do you want it?’ and I said ‘no.’”

“It’s real, he’s a solid scientist, but I wouldn’t do what he is doing,” said one executive to whom Estep offered the vaccine. The executive asked to remain anonymous because he doesn’t want to be associated with the effort. According to the executive, “He called me and said ‘Do you want it?’ and I said ‘no.’ ‘Do you want me to send you some?’ I said ‘No, I am not going to do anything with it, so don’t waste it on me.’ I told him, ‘The less I know, the better.’”

Whether or not regulators step in, and even if the vaccine proves to be a dud, the DIY covid-19 vaccine is already changing the attitudes of those who’ve taken it. Hoekstra says that since twice spraying the formulation into his nose, he moves through an “unsafe” world differently.

“I am not licking doorknobs,” says Hoekstra, who joined the group after departing his day job due to the shutdown. “But it’s an amazingly surreal experience knowing that I may have an immunity to this constant danger [and] that my continued existence through this pandemic will be a useful dataset. It lends a level of meaning and purpose.”

I asked Hoekstra if I could join the group and get the vaccine, too. “Consider the invitation open,” he said.

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It’s too late to stop QAnon with fact checks and account bans

Twitter is perfect as a megaphone for the far right: its trending topics are easy to game, journalists spend way too much time on the site, and—if you’re lucky—the President of the United States might retweet you.

QAnon, the continuously evolving pro-Trump conspiracy theory, is good at Twitter in the same way as other successful internet-native ideologies—using the platform to manipulate information, attention and distribution all at the same time. On Tuesday, Twitter took a step aimed at limiting how successful QAnon can be there, including taking down about 7,000 accounts that promote the conspiracy, designating QAnon as “coordinated harmful activity,” and preventing related terms from showing up in trending and search results.

“We will permanently suspend accounts Tweeting about these topics that we know are engaged in violations of our multi-account policy, coordinating abuse around individual victims, or are attempting to evade a previous suspension,” Twitter announced. The company added that they’d seen an increase in those activities in recent weeks. 

The New York Times reported that Facebook was planning to “take similar steps to limit the reach of QAnon content on its platform” next month, citing two employees of the company who spoke anonymously. On Friday, TikTok blocked several hashtags related to QAnon from search results.

This most recent push to limit QAnon’s reach follows two high-profile campaigns driven by QAnon. First American model and celebrity Chrissy Teigen, who has more than 13 million followers on Twitter, was the target of an intense harassment campaign, then more recently, QAnon accounts were instrumental in spreading a bogus human trafficking conspiracy theory about the furniture marketplace Wayfair. The claims spread from Twitter’s trending bar to Instagram and TikTok accounts promoting the conspiracy theory to their followers.

“That activity has raised the profile of the very long-standing problem of coordinated brigading. That kind of mass harassment has a significant impact on people’s lives,” said Renee DiResta, research manager at the Stanford Internet Observatory and an expert in online disinformation. 

But Twitter proficiency is only one small part of why QAnon wields influence, and just one example of how platforms amplify fringe beliefs and harmful activity. To actually stop QAnon, experts say, would take a lot more work and coordination. That is, if it’s even possible.  

An omniconspiracy

QAnon was born in late 2017 after a quip President Donald Trump made in a press conference about a “calm before the storm” spawned a series of mysterious posts on 4chan attributed to “Q,” predicting the coming arrest of Hillary Clinton. Although that didn’t happen, “Q” continued to post, claiming to know all about a secret plan led by Trump to arrest his enemies. 

“QAnon has its origin in a multiplatform conversation that started off on social media, in a pseudonymous environment, where there’s no consequence for speech,” says Brian Friedberg, a senior researcher at the Harvard Shorenstein Center’s Technology and Social Change Project. The posts have moved from one site to another following bans, and now appear on a messageboard called 8kun.

The posts have attracted followers who spend their time interpreting these messages, drawing conclusions, and leading campaigns to make the messages more visible. Some QAnon adherents have led coordinated harassment campaigns against journalists, rival online communities, celebrities, and liberal politicians. Others have shown up at Trump rallies wearing “Q” themed merchandise. The president has retweeted Q or conspiracy theory-related Twitter accounts dozens of times, although it’s an open question how aware he is of what Q is, beyond a movement that supports his presidency on the internet. And there have been multiple incidents of real-life violence linked to QAnon supporters. 

The traditional understanding of QAnon was that its ideas are spread by a relatively small number of adherents who are extremely good at manipulating social media for maximum visibility. But the pandemic made that more complicated, as QAnon began merging more profoundly with health misinformation spaces, and rapidly growing its presence on Facebook. 

At this point, QAnon has become an omniconspiracy theory, says DiResta—it’s no longer just about some message board posts, but instead a broad movement promoting many different, linked ideas. Researchers know that belief in one conspiracy theory can lead to acceptance of others, and powerful social media recommendation algorithms have essentially turbocharged that process. For instance, DiResta says, research has shown that members of anti-vaccine Facebook groups were seeing recommendations for groups that promoted the Pizzagate conspiracy theory back in 2016. 

“The recommendation algorithm appears to have recognized a correlation between users who shared a conviction that the government was concealing a secret truth. The specifics of the secret truth varied,” she says. 

Researchers have known for years that different platforms play different roles in coordinated campaigns. People will coordinate in a chat app, message board, or private Facebook group, target their messages (including harassment and abuse) on Twitter, and host videos about the entire thing on YouTube.  

In this information ecosystem Twitter functions more like a marketing campaign for QAnon, where content is created to be seen and interacted with by outsiders, while Facebook is a powerhouse for coordination, especially in closed groups. 

“Q” has made many incorrect predictions, and continues to advance the belief that there is a ‘deep state’ plot against Donald Trump.

Reddit used to be a mainstream hub of QAnon activity, until the site started clamping down on it in 2018 for inciting violence and repeated violations of its terms of service. But instead of diminishing its power, QAnon simply shifted to other mainstream social media platforms where they were less likely to be banned. 

This all means that when a platform acts on its own to block or reduce the impact of QAnon, it only attacks one part of the problem. 

Friedberg said that, to him, it feels as if social media platforms were “waiting for an act of mass violence in order to coordinate” a more aggressive deplatforming effort. But the potential harm of QAnon is already obvious if you stop viewing it as a pro-Trump curiosity and instead see it for what it is: “a distribution mechanism for disinformation of every variety,” Friedberg said, one that adherents are willing to openly promote and identify with, no matter the consequences.  

“People can be deprogrammed”

Steven Hassan, a mental health counselor and an expert on cults who escaped from Sun Myung Moon’s Unification Church, known as the “Moonies”, says that discussing groups like QAnon as solely a misinformation or algorithmic problem is not enough. 

“I look at QAnon as a cult,” Hassan says. “When you get recruited into a mind control cult, and get indoctrinated into a new belief system…a lot of it is motivated by fear.” 

“They’ve had three years of almost unfettered access to develop and expand.”

“People can be deprogrammed from this,” Hassan says. “But the people who are going to be most successful doing this are family members and friends.” People who are already close to a QAnon supporter could be trained to have “multiple interactions over time” with them, to pull them out. 

If platforms wanted to seriously address ideologies like QAnon, they’d do much more than they are, he says.

First, Facebook would have to educate users not just on how to spot misinformation, but also how to understand when they are being manipulated by coordinated campaigns. Coordinated pushes on social media are a major factor in QAnon’s growing reach on mainstream platforms, as recently documented by the Guardian, over the past several months. The group has explicitly embraced “information warfare” as a tactic for gaining influence. In May, Facebook removed a small collection of QAnon-affiliated accounts for inauthentic behavior. 

And second, Hassan recommends that platforms stop people from descending into algorithmic or recommendation tunnels related to QAnon, and instead feed them with content from people like him, who have survived and escaped from cults—especially from those who got sucked into and climbed out of QAnon. 

Friedberg, who has deeply studied the movement, says he believes it is “absolutely” too late for mainstream social media platforms to stop QAnon, although there are some things they could do to, say, limit its adherents’ ability to evangelize on Twitter. 

“They’ve had three years of almost unfettered access outside of certain platforms to develop and expand,” Friedberg says. Plus, QAnon supporters have an active relationship with the source of the conspiracy theory, who constantly posts new content to decipher and mentions the social media messages of Q supporters in his posts. Breaking QAnon’s influence would require breaking trust between “Q,” an anonymous figure with no defining characteristics, and their supporters. Considering “Q’s long track record of inaccurate predictions, that’s difficult, and, critical media coverage or deplatforming have yet to really do much on that front. If anything, they only fuel QAnon believers to assume they’re on to something. 

The best ideas to limit QAnon would require drastic change and soul searching from the people who run the companies on whose platforms QAnon has thrived. But even this week’s announcements aren’t quite as dramatic as they might seem at first: Twitter clarified that it wouldn’t automatically apply its new policies against politicians who promote QAnon content, including several promoters who are running for office in the US.

And, Friedberg said, QAnon supporters were “poised to test these limitations, and already testing these limitations.” For instance, Twitter banned certain conspiracy-affiliated URLs from being shared, but people already have alternative ones to use. 

In the end, actually doing something about that would require “rethinking the entire information ecosystem,” says Diresta. “And I mean that in a far broader sense than just reacting to one conspiracy faction.”

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If you’re over 75, catching covid-19 can be like playing Russian roulette

Are you hiding from covid-19? I am. The reason is simple: the high chance of death from the virus. 

I was reminded of the risk last week by this report from the New York City health department and Columbia University which estimated that on average, between March and May, the chance of dying if you get infected by SARS-CoV-2 was 1.45%.

That’s higher than your lifetime chance of getting killed in a car wreck. That’s every driver cutting you off, every corner taken too fast, every time you nearly dozed off on the highway, all crammed into one. That’s not a disease I want to get. For someone my mother’s age, the chance of death came to 13.83% but ranged as high as 17%. That’s roughly 1 in 6, or the chance you’ll lose at Russian roulette. That’s not a game I want my mother to play.

The rate at which people are dying from the coronavirus has been estimated many times and is calculated in different ways. For example, if you become an official covid-19 “case” on the government’s books, your death chance is more like 5%, because you’re sick enough to have sought out help and to have been tested. 

But this study instead calculated the “infection fatality ratio,” or IFR. That’s the chance you die if infected at all. This is the real risk to keep in view. It includes people who are asymptomatic, get only a sniffle, or tough it out at home and never get tested. 

Because we don’t know who those people who never got tested are, IFR figures are always an estimate, and the 1.45% figure calculated for New York is higher than most others, many of which fluctuate around 1%. That could be due to higher rates of diabetes and heart disease in the city, or to estimates used in the study. 

It’s also true that your personal odds of dying from covid-19 will differ from the average. Location matters—cruise ship or city—and so do your sex, your age, and whether you have preexisting health conditions. If you’re in college, your death odds are probably lower by a factor of a hundred, though if you’re morbidly obese, they go back up. Poor health—cancer, clogged arteries—also steeply increase what scientists call the “odds ratio” of dying. 

The biggest factor, though, is age.  I looked at the actuarial tables, and the chance of death for a man in my age group (I’m 51) is around 0.4% per year from all causes. So if I get covid-19, my death chance is probably three times my annual all-cause annual risk (since I am a man, my covid-19 risk is higher than the average). Is that a chance I can live with? Maybe, but the problem is that I have to take that extra risk right now, all up front, not spread out over time where I can’t see or worry about it. 

Tbh, these % don’t help me. More useful would be a list of comparable risks associated with common behaviours that I uncritically accept. Do you know of any examples?

— Andrew Harmer (@andrew_harmer) July 1, 2020

On Twitter, some readers complained that average risks don’t tell them much about how to think or act. They have a point. What’s a real-life risk that’s similar to a 1.45% chance of dying? It wasn’t easy to think of one, since mathematically, you can’t encounter such a big risk very often. Skydiving, maybe?  According to the US Parachute Association, there’s just one fatality for every 220,301 jumps. It would take 3,200 jumps to equal the average risk of death from covid. 

Risk perceptions differ, but it’s the immense difference in IFR risk for the young (under 25) and the elderly (over 75) that really should complicate the reopening discussion. Judging from the New York data, Grandpa’s death chances from infection are 1,000 times that of Junior. So yes, we need schools to keep kids occupied, learning, and healthy. And for them, thank goodness, the chances of death are very low. But reopening schools and colleges has the ugly side effect that those with the lowest risk could be, in effect,  putting a gun to the head of those with the highest (although there is still we do not know about how transmissible the virus is among children).

Decent odds

The virus is now spreading fast again in the US, after the country failed to settle on a strong mitigation plan. At the current rate of spread—40,000 confirmed cases a day (and maybe five to 10 times that in reality)—it’s only two years until most people in the US have been infected. It means we’re pointed toward what, since the outset, has been seen as the worst-case scenario: a couple of hundred million infected and a quarter-million deaths. 

By now you might be wondering what your own death risk is. Online, you can find apps that will calculate it, like one at covid19survivalcalculator.com, which employs odds ratios from the World Health Organization.  I gave it my age, gender, body mass index, and underlying conditions and learned that my overall death risk was a bit higher than the average. But the site also wanted to account for my chance of getting infected in the first place. After I told it I was social distancing and mostly wearing a mask, and my rural zip code, the gadget thought I had only a 5% of getting infected. 

I clicked, the page paused, and the final answer appeared: “Survival Probability: 99.975%”. 

Those are odds I can live with. And that’s why I am not leaving the house.

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How Reddit kicked off a day of bans for Trump and the far right

The news: Early on Monday, Reddit banned r/The_Donald, a once-notorious pro-Trump forum, for repeated rule-breaking. CEO Steve Huffman announced that it was just one of 2,000 subreddits banned by the site as it institutes rule changes designed to make the platform less accommodating to hateful and abusive communities.

The other news: Later in the day, livestreaming video service Twitch announced that it had temporarily suspended President Trump’s account for rebroadcasting comments about Mexican immigrants that broke its “hateful conduct and harassment policies.” 

The other, other news: YouTube, meanwhile, followed by banning several far-right and racist creators, including white supremacists David Duke, Richard Spencer, and Stefan Molyneux. 

Better late than never? Monday’s bans were preceded by policy changes at Twitter and Facebook that shifted, to a degree, how the platforms handle rule-breaking behavior by accounts linked to the president and the far right. r/The_Donald was once a core organizing point for the pro-Trump internet, with a record of bringing extremist content in front of bigger and bigger audiences. In late 2016, Huffman limited the reach of the subreddit after it figured out how to get the site’s algorithms to promote pro-Trump content. By then, r/The_Donald members were already involved in spreading the Pizzagate conspiracy theory, and volunteer moderators had asked Huffman to do more to fight the abuse and harassment their communities faced from r/The_Donald members. 

But will it do anything? In reality, r/The_Donald had been nearly dormant for months, as the Washington Post noted—and most of the other banned subreddits were tiny or inactive. A few others were notable, however, including r/ChapoTrapHouse, associated with the left-wing podcast of the same name; and r/gendercritical, a “feminist” subreddit with more than 60,000 members that regularly promoted transphobic views.

Still, the swift sequence of bans and suspensions was a moment reminiscent of August 2018, when conspiracy theorist Alex Jones was banned from most mainstream social media sites over the space of a few days. Traffic to his Infowars website dropped significantly as a result, and it is now around a third of where it was in 2018, according to online traffic monitor SimilarWeb.

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A drug that cools the body’s reaction to Covid-19 appears to save lives

In an advance towards conquering covid-19, doctors in Michigan say an antibody drug may sharply cut the chance patients on a ventilator will die.

The problem: The pandemic viral disease is infecting millions and for those who end up on a ventilator in an ICU, the odds are grim. More than half are dying.

The drug: Doctors at the University of Michigan set out to control the haywire immune reaction that pushes some covid-19 patients into a death spiral. To do it, they gave 78 patients on ventilators the drug tocilizumab, which blocks IL-6, a molecule in the body that sets off a reacting to an infection. (The drug is sold by Roche under the tradename Acterma.)

The result: The doctors say in a preprint that patients who got the drug were 45% less likely to die than those who didn’t. But there’s a big caveat to the result, which is that the doctors knew which patients got the drug, and which didn’t. Their picks could have been biased— people more likely to improve anyway, for example—so further studies are needed.

Emerging cocktail: In late May, Roche said it would start a trial to combine its IL-6 blocker combined with remdesivir, an antiviral drug with modest benefits that got emergency approval in the US for treating covid-19. That drug is meant to block the virus from replicating.

By combining the two drugs, doctors may be closing in on a cocktail able to cut the death rate from the virus, a step that would help society return to normal.

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Twitter fact checks a misleading Trump tweet for the first time

The news: Twitter added a fact checking label to two tweets from US President Donald Trump’s Twitter account on Tuesday. The tweets from @realDonaldTrump (the president’s popular personal account that also serves as his main social media presence) claimed that mail-in voting would be “substantially fraudulent” and lead to a “Rigged Election.”  It is the first time that Twitter has labeled tweets from his account in this way. 

What Twitter did: Twitter introduced new warning labels and fact checking messages earlier this month for tweets containing false or misleading information, including from world leaders. The labels on Trump’s tweets encourage users to “get the facts about mail-in ballots” and link to a Twitter-curated summary of the false claims and what third-party fact-checkers have to say about it. Since announcing the policy, Twitter has mainly applied these labels to tweets containing potentially harmful misinformation about covid-19.

There is NO WAY (ZERO!) that Mail-In Ballots will be anything less than substantially fraudulent. Mail boxes will be robbed, ballots will be forged & even illegally printed out & fraudulently signed. The Governor of California is sending Ballots to millions of people, anyone…..

— Donald J. Trump (@realDonaldTrump) May 26, 2020

Why it took so long: Twitter has been reluctant to enforce its own rules against Trump’s tweets in the past. Although Trump has tweeted and retweeted many seemingly rule-breaking, a few loopholes protected him, including exceptions for tweets from government entities and considerations for the “newsworthiness” of an otherwise rule-breaking tweet. Last year, Twitter announced that, in rare cases, it would limit the reach of tweets from large accounts held by government officials that were in violation of its rules. The covid-19 “infodemic” has forced most social media platforms to change how they enforce their rules as potentially dangerous misinformation about the pandemic spreads.

What about Trump’s other misleading tweets? Over the past several days, the president has tweeted several other things that appeared to violate Twitter’s policies. Last Wednesday, Trump falsely tweeted that Nevada was sending out “illegal” vote-by-mail ballots, and promised to “hold up” funding to Nevada and Michigan if they pursued mail ballots for the presidential elections. Those tweets, according to Twitter at the time, did not violate their policies against election misinformation because they didn’t directly try to dissuade people from voting. The platform’s election integrity policies prohibit using Twitter for “the purpose of manipulating or interfering in elections or other civic processes.”

Twitter also declined to take action against some of Trump’s tweets promoting a false conspiracy theory suggesting that MSNBC host Joe Scarborough was, while serving in congress, responsible for the death of an intern in 2001. In fact, investigators found no evidence of foul play, and there is no mystery surrounding the cause of death. The widow of the staffer wrote a letter to Twitter CEO Jack Dorsey last week asking him to remove the tweets. After the letter was published in the New York Times on Tuesday, Twitter released a statement saying that they were “deeply sorry about the pain these statements” caused, and that they were “working to expand existing product features and policies so we can more effectively address things like this going forward, and we hope to have those changes in place shortly.”

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Public policies in the age of digital disruption

We are witnessing a new wave of technological progress with enormous potential to profoundly transform our societies. Together with globalization, climate change, demographic transformations, and the risk of pandemics such as covid-19, digital disruption is generating far-reaching changes in the global economy. Economic growth is almost exclusively a feature of industrial revolutions and is relatively recent in human history. The social adaptation to the structural changes that technology has brought about has generally been slow, making it a reasonably smooth process. In the case of the digital revolution, however, there are already some signs of a much more abrupt disruption in businesses, markets and societies, reducing the time of response to deal with the new challenges. The success of this response will determine our societies’ capacity to improve productivity, create employment, and grow in an inclusive way.

The efficiency and quality of the welfare state and institutions is essential to guarantee equal opportunities first, and then provide a safety net for individuals facing unexpected adverse situations.

The digital revolution does not call for heightened optimism about the ability of robots or of artificial intelligence to fully substitute us in our jobs while we enjoy more leisure and higher levels of income. Nor does it call for the pessimism of those who think we are heading for massive technological unemployment and bound to lose our livelihood to robots. There is no call for utopias or dystopias. As in previous industrial revolutions, there is nothing inexorable or predetermined about the effects of the digital revolution. Some societies will be successful because they will be able to make the most of the opportunities created by these changes to social welfare. At the other extreme, those countries which fail to adequately manage this process well may see an increase in unemployment and inequality, with sluggish or stagnant productivity. Well-designed public policies in four key areas will be required to strengthen the positive effects of technological change:

1. Education and new digital skills. New occupations increasingly require a capacity for analytical reasoning, critical thinking, creativity, originality and initiative, personal leadership, social influence, and emotional intelligence. Language command, social and technical skills, along with the ability to manage and coordinate teams and projects, are also important. It is essential to continue learning and skills development , and public policies must ensure high-quality programs that meet these new needs and provide companies and workers the opportunity to continue their training and acquire new skills for the duration of their professional careers.
2. Policies for a new labor market. It is essential to remove barriers to job creation, investment, innovation, and growth; to increase legal certainty in labor relations; to strike a balance between labor market flexibility and employment security for workers in the gig economy; to facilitate the financing of startups; and to simplify and improve labor regulations to make them more efficient.
3. Competition and regulations in goods and services markets. As well as closing the digital divide, public policies should prevent new sectors and firms from gaining excessive market power that limits competition and innovation to the detriment of social welfare. Competition policies must be reshaped to closely monitor changing market conditions and ensure there is effective competition between firms. Measures that can be used to achieve this objective include the diffusion of technological advances and patents to facilitate the entry of new competitors and the financing of startups; the protection of consumer rights; access to small and medium-sized firms to big data, supercomputers, and cloud computing; and data sharing, when permitted by data owners.
4. Equal opportunities and redistribution. The efficiency and quality of the welfare state and institutions is essential to guarantee equal opportunities first, and then provide a safety net for individuals facing unexpected adverse situations. Societies that are already doing better in terms of equal opportunities and ex-post redistribution have a head start when it comes to facing the challenges of digital revolution inequality.

Used wisely, new technologies can be placed at the service of these policies to identify new needs, design solutions, deploy measures quickly and efficiently, streamline processes, reduce costs and improve services, evaluate results, or select their beneficiaries.

There are reasons to be optimistic about the future, but only if our societies can properly manage the changes, promote economic growth, and provide a welfare state that adapts to new individual and collective needs. It is very likely that some countries will do this more successfully than others. The social impact of new technologies will depend on how the new challenges are managed. In this process of change, there is no trade-off between fairness and efficiency: societies that can design a welfare state that works more efficiently will make the most of new technologies to increase social welfare, while at the same time attaining lower levels of inequality and greater intergenerational equity.

Read the full article.

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Maybe it’s time to retire the idea of “going viral”

For years we’ve been using the phrase “gone viral” to describe something that becomes wildly popular on the internet. But it strikes a different note in the middle of a global pandemic, especially when the viral content is about an actual virus that is killing people. It’s even worse when you’re talking about “viral” content containing dangerous misinformation and conspiratorial thinking about such a virus—like Plandemic, the documentary that got millions of views on Facebook and YouTube last week before the platforms started removing it.

These past few months I’ve started catching myself whenever I write or speak about something “going viral,” searching for another way to put it. A couple of weeks ago, I started wondering whether we should even be using the word in this figurative way at all anymore. Turns out I am not alone.

“I’ve stopped myself with that expression,” Peter Sokolowski, a lexicographer and editor at large at the dictionary publisher Merriam-Webster, told me. Then Sokolowski asked one of his colleagues, computational linguist Ben Mericli, to help figure out whether other people were pulling back on using the internet sense of “viral” as well.

To do that, Mericli picked four phrases that usually refer to biological viruses (viral disease, viral infection, viral load, viral fever) and four phrases that usually refer to internet content (go viral, viral video, viral post, viral photo). He looked at their frequency in a large database of news articles from January 1 to April 30 this year and then compared that with the same period of time in 2019.

The results were pretty clear: figurative use of “viral” has clearly decreased this year as literal uses of “virus” have gone way up. “Since the outbreak, viral has just been used more often in general, with the increase owed entirely to literal use,” he said in an email. “So in that sense I suppose it’s even more striking that the figurative numbers are down.”

Ben Mericli/Merriam-Webster.

Although it seems logical, this decrease isn’t actually a given: plenty of words with medical or epidemiological origins are able to cohabitate in our language with their original or literal meanings, Sokolowski said. For example, both laughter and a disease can be “contagious” or “infectious.” Sometimes people don’t even realize they’re using a word with such roots.

“When people say vitriol they don’t know they’re echoing a chemical compound that burns human skin,” he said (vitriol was originally a term for sulfuric acid). But “viral” is different; the meanings are related but not the same. We have viral stories about viral infections, and we know what both mean. “It’s possible that these two words are used in such similar contexts in similar writing that it is a bad choice,” Sokolowski said.

But as I spoke to other people about their own usage, I realized that whether the current situation lasts or not, there are other reasons to question whether “viral” is appropriate language for content on the internet.

Manipulated popularity

 “Viral” outrage, “viral” videos, “viral” posts, and “viral” moments have been part of the language of internet culture since its beginnings. The term itself comes from viral marketing, which started in pre-social-media times with advertising agencies that promoted whisper campaigns or tried to manufacture word of mouth. But once it shifted online, “virality” dropped the connotation of having been engineered by people who were experts at getting your attention and became something more accessible and democratic: a flash cartoon spread because it was funny, a fail video because it triggered schadenfreude, a blog post because it was insightful. “Viral” became a way of implicitly signifying that something was worthy on its own merits of sharing, of media coverage, and of your attention.

But this sense of emergent, authentic popularity isn’t necessarily real: algorithms incentivize content that people are going to engage with, accelerating its spread, and people have gotten really good at manipulating how social media works in order to spread bad or potentially dangerous material. There are plenty of examples, and despite efforts to stop the flow of extreme views and misinformation, the strategies designed to hijack your attention keep working. Deep down, people should know this by now.

Plandemic spread from the antivaccine fringes because there was a deliberate push for attention by coronavirus conspiracy theorists—who exploited the way social-media culture is intended to function. They were wildly successful. For the past several weeks, well-known antivaccine personalities have been attracting millions of views by giving interviews to other YouTubers with bigger followings, creating content that boosts right-wing outrage about the lockdown, and then using their well-established online networks to get that content shared widely.

“There’s nothing to protect you”

Whitney Phillips, an assistant professor of communication and rhetorical studies at Syracuse University, researches how misinformation and extreme ideas are amplified to reach bigger and bigger audiences, particularly by media coverage. She co-wrote a book with Ryan Milner this year that employs ecological metaphors—for instance, pollution—to help explain the digital universe in which bad information spreads.

“We need to think differently about our information ecosystem,” Phillips told me. “The metaphors we use can help shape our thinking on our responsibility.”

“Viral” could be a good metaphor for the spread of misinformation, Phillips told me, if only people used it correctly. “But they’re not,” she said. And that’s particularly true for the journalists who produce stories about trending misinformation.

“There’s this tendency to talk about it as if we stand outside it,” Phillips said. But we don’t:  “If you’re writing a story about a particular disinformation campaign, you become a carrier for that virus.” Same goes for those who share it, whether to endorse, mock, or condemn. In other words, people may think they’re protected from the potential harm that misinformation on the internet can bring, but many are asymptomatic carriers of that information into spaces where it can devastate.

“There’s no PPE,” Phillips said. “It doesn’t exist. There’s nothing to protect you when you write about it and read about it.”

The discomfort that I’m feeling describing something like Plandemic as viral, then, has some grounding. But it’s not that the word itself is bad, or even that it’s an inherently insensitive metaphor, although it may feel that way right now. The problem stems from how we’ve fooled ourselves into believing that “virality” is something we can observe without being part of—that we’re immune to the problem of dangerous misinformation if we don’t believe it, when in fact we are the carriers helping it spread.

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“The first day was really hard”: Life as a contact tracer

As American states weigh the possibility of reopening services in the face of the covid-19 pandemic, the demand for contact tracing—helping track down and isolate potential carriers of the virus—will get even larger. We spoke to people working as contact tracers across America to understand what it’s like, what they’re seeing, and what might be coming next.

Jana De Brauwere, 44, San Francisco

When San Francisco’s Department of Public Health asked if anyone in the library system would want to join the city’s contact tracing program, I said yes right away. From the description, it seemed like a perfect match for our skills as librarians, as well as our mission: providing people with information that they and their families need.

I underwent a week of extensive training, during which I learned about the procedures, software, and privacy rules, and shadowed experienced contract tracers. My first shift started on Sunday, and I’ll be working 20 to 25 hours each week on the program while continuing to perform other duties, remotely, for the library system.

The main job is to contact people who have been exposed to the coronavirus by a person who has tested positive. The majority of our contacts right now speak only Spanish, so a lot of the librarians have to use translators, which can take a lot longer. It’s not my first language—that’s Czech—but I do speak Spanish, so I’ve been able to take more of those calls and feel like I’ve been able to help. I probably call 15 to 25 people per shift, and conduct full interviews with four or five.

“Some people are a little suspicious. I understand that, the mistrust of the government… but it’s too bad.”

Most of the people I interact with are really grateful that we’re reaching out. They have a lot of questions that we can provide answers for.

Some people are a little suspicious. Some people hang up after I ask for their date of birth and address. I understand that, the mistrust of the government, having grown up under communism. But it’s too bad. I feel like they can benefit from this information: how to quarantine themselves, how they can protect their families, and what kind of support is available.

Probably 50%, maybe 60%, of the contacts that I call on my shift don’t answer. Some don’t have voicemail set up. But I leave a message when I can, and several people called me back yesterday.

The first day was really hard. You’re following the script, inputting data, and talking to people, all at once. It’s more multitasking than I’m used to. But it’s gotten easier, and there have been times where I feel like I’ve been able to build their trust. Sometimes you have to assure them you’re calling to help them, you’re working on their behalf; it’s not the government trying to go after them.

It’s been a positive experience for me because I’ve learned a lot of new things, and because I’ve seen how people can pull together in times of need. People from across departments, medical students, librarians, staff from the city attorney’s office—all bringing different skill sets to the challenge.

Robert Bramson, 79, Massachusetts

Before this I was retired, but now I work 40 hours a week as a clinical investigator in Massachusetts. I call patients who have been diagnosed with covid-19 and ask a lot of questions: How do they feel? Do they have food? Can they isolate at home? Who did they have contact with 48 hours prior to their positive test? I enter this information into our computer system, and our contact tracers follow up with all the contacts named.

“The tracking process is new, and confusion is expected. We make mistakes, but we learn.”

I started in April, after the state put out the call for people with a health-care background to help track the outbreak. I had enjoyed practicing medicine for over 40 years, working at the Massachusetts General Hospital and the Children’s Hospital in Boston, until I retired 10 years ago. I elected to answer the call to do infectious-disease tracking, but it requires an enormous amount of labor. The call was for 1,000 employees to track virus contacts; 25,000 people answered.

Our goal is to slow the spread of the virus to buy time for researchers to develop a vaccine or an effective drug treatment. The tracking process in Massachusetts is new, and confusion is expected as new hires like me learn how to do things. We make mistakes, but we learn. People work around the clock to make the process go faster, smoother. On more than one occasion I have heard a sigh of relief and a “Thank you” when I told a patient that I would be calling back each day to check on their status. That “Thank you” reminds me why I loved medicine.

Robert Bramson is the father of Elizabeth Bramson-Boudreau, the CEO and publisher of MIT Technology Review. Nobody in this article was paid for their contribution.

Jade Murray, 22, Utah

I’m currently working for a rural local health department in Utah—I just graduated with my degree in public health. My job is to check on individuals, monitor their signs and symptoms, temperatures, and then answer questions on their diagnosis or how their recovery process looks after the 14-day quarantine period that they’re under. 

Today I have about 20 cases, and it usually takes me about two or three hours a day to contact everybody, chat with them, and answer any questions they might have. The numbers are manageable, but one of the limiting factors there is that people are already not moving around as much as they would have done. 

“We don’t really know if they’re staying at home, or if they are still going out. You have to believe that they’re complying.”

The hardest thing can be getting people to keep giving responses over the 14-day period. And as far as getting them to comply with your recommendations, obviously they have their own autonomy—we can’t control what they’re doing. But we don’t really know if they’re staying at home, or if they are still going out because they still feel okay. You have to believe that they’re complying; give them the recommendations and hope that they are taking those daily actions. I’ve had a couple of individuals that have pushed back, or where you can tell they’re not really interested in giving me feedback. But I haven’t had anyone reject us completely.

On May 1 we got our release to open the economy again, so businesses are allowed to be open to groups of 20 individuals or less. I think in this next coming month there might be more to do with the new positive cases. I would assume numbers could increase with the reopening of the economy; we have a game plan going both directions, but we’re hoping for a positive outcome.  

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This man assembled his own covid antibody tests for himself and his friends

In Portland, Oregon, earlier this spring, a programmer named Ian Hilgart-Martiszus pulled out a needle and inserted it into the arm of social worker Alicia Rowe as she squinted and looked away. He was testing for antibodies to the coronavirus. He’d gathered 40 friends and friends of friends, and six homeless men too.

As a former lab technician, Hilgart-Martiszus knew how to do it. Despite extensive debate over the accuracy of blood tests for coronavirus antibodies and how they should be used, by March anyone with a credit card and some savvy could order “research only” supplies online and begin testing.

“I am just doing it at home. This is total citizen science,” he says. Pretty much everyone who has had the sniffles or a fever in the last few months wants to know if was really covid-19.

Ian Hilgart-Martiszus draws blood from a volunteer to test for covid-19 antibodies.

MICHAEL MCNAMARA

On April 6, Hilgart-Martiszus posted results of what he dubbed the nation’s “first community serum testing” survey for covid-19, complete with figures and a description of how he did it. He’d beaten out big medical centers by weeks. His data indicated one positive case and three suspected ones.

The DIY effort put him, for a few days, into the forefront of the search for antibodies, blood proteins which form in response to covid-19 and are a telltale indication you’ve been infected. There are now dozens of surveys under way by blood banks and hospitals, and Quest Diagnostics has an online portal where people can try to make an appointment for a blood draw. A physician still has to approve the order.

Just one month ago, though, this type of information was hard to come by. Hilgart-Martiszus, annoyed by criticism of President Trump’s coronavirus response by what he calls the media “echo chamber,” figured that he would try to “fill the void” with actual data. He adds that he is skeptical of big government and “political officials comfortably receiving a salary and advocating to keep the economy closed.”

The mayor of Portland, Ted Wheeler, he slams as #trashyted.

Hilgart-Martiszus, whose day job is in real-estate planning for a sporting goods chain, first built a computer dashboard in March to predict hospitalizations in Oregon. He emailed a copy to his boss, who told him the company didn’t want to be involved.

By then, though, Hilgart-Martiszus was developing bigger plans. By March, scientific supply companies had begun advertising kits to probe human blood serum for antibodies to the distinctive “spike” protein on the virus. He paid $550 each to get some from the Chinese supplier GenScript.

Most research is carried out by universities or companies under a firm framework of rules. Two weeks after Hilgart-Martiszus posted his results, for instance, his old employer, Providence Health Care services, announced its own much larger serum study, drawing blood from 1,000 people in one day, according to news reports. While Hilgart-Martiszus’s study didn’t have the bells and whistles, or any kind of approval, he couldn’t resist reminding them who was first: “Looks like my old research institute will publish the second antibody study in Oregon. Can’t wait to see how their results compare.”

In Oregon drawing someone else’s blood is legal for anyone who knows how, says Charles “Derris” Hurley, a former pharmacist who says he fronted Hilgart-Martiszus $2,000 to purchase testing supplies. “I said, ‘Let’s go ahead and try this—if we learn something we learn something, and if we don’t we don’t,’” he says. “We are of the attitude that everyone should be tested.”

To take part in the project, Hurley drew blood from his wife, Jan Spitsbergen, a PhD microbiologists who tends zebrafish at Oregon State University, and she drew his. “She was a lot better at it,” he says.

Hilgart-Martiszus used the most accurate kind of antibody test, called an ELISA, which requires some equipment and know-how. He put the blood from his volunteers into special tubes, letting it clot for about 45 minutes. Next he spun it in a centrifuge for 10 minutes and used a pipette to suction off the serum, a clear liquid where the antibodies would be. Then he added dilution buffer and let it incubate with the chemicals he’d bought online on a plastic plate with 96 wells. The liquid would change color if antibodies were present.

To measure the readout from the wells, he needed a machine to scan the plate, which he managed to borrow from a nearby university. This particular test looks for IGG antibodies, a type that would be expected to appear about two weeks after infection.

In 40 tests, it was Hurley whose blood showed the strongest signal for antibodies to the virus—many times higher than anyone else’s. “If you look at Ian’s printout, I am the one that stands out like a sore thumb,” says Hurley.

It was the potential explanation for a mystery ailment Hurley suffered in mid-December. He’d come down with an unusual cold. He felt fatigued and had red eyes. Then his wife got sick in January and stayed in bed for two weeks. Plus, they’d had a Chinese exchange student living with them at the time. “We started talking more and more—‘We need to have some kind of test, something is wrong,’” he recalls.

Hurley believes he had covid-19, but if he did, that would mean the illness was circulating in the US a month earlier than is widely known (the first official American case was recorded in January near Seattle). As of May 2, the Oregon Health Authority says, there have been 2,579 cases and 104 deaths in the state, making it among those least affected.

Hurley says his positive result is not enough for him to resume his normal routine. “I follow social distancing,” he says. “I guess I want to have more verification and have some idea how long immunity lasts.”

Hilgart-Martiszus asked everyone to tell him if they’d been sick. That included Rowe, the social worker from Portland. “I had a cold in February, and I really hoped that I had gotten it out of the way, but no such luck.” She came up negative.

Demand for antibody tests remains high. After Hilgart-Martiszus posted his results to the web, “he was inundated with requests from all over the world,” says Spitsbergen. A hospital wanting to test its medical staff reached out to him. So did a fire department wanting to test 100 people.

With all the new attention, Hilgart-Martiszus says he’s trying to play by the rules and is not collecting any more blood at the moment. He’s instead working with Oregon State University to create a larger, more formalized study, with approval from an ethics board. He launched a crowdfunding campaign and a website where he’s developing plans to let anyone send in blood for testing.

“I told the first group, don’t take this as a clinical diagnosis—it’s not. It’s research,” he says. “I just pushed it out there.” Now he’s telling people he can’t test them right away, at least until he gets his paperwork in order. “It sucks to wait to help people,” he says, “but with all of the regulations, it’s too risky to test strangers.”

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Doctors are now social media influencers. They aren’t all ready for it.

When President Trump suggested during a press conference that doctors should look into treating covid-19 patients with an “injection inside” of disinfectant, “or almost a cleaning,” Austin Chiang, a gastroenterologist at Thomas Jefferson University Hospital in Philadelphia, knew he had to react. 

In his lab coat and scrubs, a stethoscope draped around his neck, and staring directly into the camera, Chiang sat in front of a news headline about Trump’s comments and mimicked screaming. 

“I promise I won’t pretend to know how to run a country if you don’t pretend to know how to practice medicine,” Chiang wrote on the screen. The video, posted shortly after Trump’s comments, quickly gained tens of thousands of views.

Chiang is one of a new generation of doctors and medical professionals who have built online followings on platforms like TikTok, Instagram, and Youtube.  Their medical credentials give their thoughts on the virus added weight. 

@austinchiangmd/TikTok

While doctors made famous by TV have had to apologize for downplaying the virus and suggesting that losing some lives was an acceptable cost for re-opening schools, some of the new doctor-influencers are positioning themselves differently. At their best, this wave of doctor-influencers can combat misinformation by making responsible medicine sound almost as exciting as the scores of medical conspiracy theories, exaggerated claims, and snake oil promises that spread rapidly online. 

For some, it’s a gap that was waiting to be filled. Natural healing personalities peddling dubious information were “early adopters” of social media, says Renee DiResta, a researcher with the Stanford Internet Observatory who studies health disinformation.  By the time platforms like Facebook and YouTube began cracking down on bogus health claims, they were already selling “cures” in natural healing Facebook groups, racking up millions of views on YouTube, and showing up in Google results. 

“They sell their ‘cures’ using the same techniques that brands use to sell shoes,” DiResta says. “With an added layer of mystique via framings that suggest elite knowledge, like ‘The cure THEY don’t want you to know about!’” 

Science-based medical professionals are playing catch-up. 

The internet’s ‘black hole’ of expertise

“I actually think that the lack of quality physicians on social media has led to the rise of social influencers pedaling miraculous cures and detox teas and all that,” says Mikhail Varshavski, a.k.a. “Doctor Mike,” a family physician in New Jersey who has more than 5 million subscribers on YouTube. Until recently, he added, personality-driven medical social media has “just been sort of this black hole where doctors aren’t there because they don’t want to be perceived as unprofessional and as a result, misinformation thrives.” 

But online fame for doctors and nurses comes with risks that are only heightened by the importance of their  job. And as more and more medical professionals jump online to help guide the public and combat misinformation, there’s an additional risk that they become part of the problem they’re trying to fight. 

The very things that help Austin Chiang reach a younger audience on TikTok can, if he’s not careful, undermine the trust his audience has in medical professionals. You have to be funny to connect on TikTok without seeming cringey or out of touch with the culture of the app. And you have to maintain that balance without crossing a line into unethical behavior. There have been, for instance, medical professionals who have used TikTok to mock their patients. And even those with the best of intentions and accurate information can find themselves in trouble when they move to a new medium.

“How do we present ourselves online without eroding the public’s trust in us?” Chiang told me. “There’s a lot of people out there who are new to the platform and who will throw something up there without thinking it through.” 

Good intentions gone wrong

Take Jeffrey VanWingen, a doctor who runs a private family practice in western Michigan. He wanted to help the public when he stood in his kitchen before work, filming a video in his scrubs that he believed the world needed to see: “PSA: Grocery Shopping Tips in COVID-19.” It was March 24; the governor of his state was going to issue shut down orders the following day. VanWingen is not an epidemiologist or a food safety expert, but he did know sterile techniques that, he believed, could be modified to help people keep the coronavirus from coming into their homes along with their groceries.

Although he knew that the risk of someone getting sick from touching groceries was likely very low (grocery shopping’s main risk these days comes from the other people in the store with you), “even very low is not negligible. It’s not nothing. And, and I think my goal was to empower people to help keep their risk of acquiring covid-19 airtight,” he says.

VanWingen’s 13-minute video demonstrated procedures for disinfecting different types of food, as his calm voice guided viewers through dumping food into “clean” containers, disinfecting packaging, and washing produce. The video was shared widely on social media, and passed between friends in email chain letters, as a panicked public looked for something they could do to have some control over the spread of a terrifying virus. The video, the first ever on his month-old YouTube channel, gained 25 million views and counting. But the video is also, at points, misleading. 

You should not, as VanWingen initially suggested, wash your produce in soap and water—it’s better to just rinse fruits and vegetables in cold water because soap residue can cause digestive issues. And his suggestion to leave groceries outside or in the garage for a few days before bringing them into your home needed a clarification that this would not be a safe procedure for perishable goods. 

VanWingen lobbied YouTube to let him edit the video and remove the portion with potentially harmful advice, but there wasn’t much he could do aside from take the whole thing down. He decided against that, instead littering the video’s description with updates linking to new and more accurate information. But, he says, he still stands by the majority of the advice in the video. 

“If you associate Dr. VanWingen with misinformation, that weighs on me extremely heavily,” he says. Compared to others, he says, his mistake was innocent and would be unlikely to have dire consequences. “There are doctors that I’ve seen that are promoting, like for instance, hydroxychloroquine and maybe even promoting fear,” he says, referring to the unproven and, according to the FDA, potentially dangerous covid-19 treatment that was promoted by President Trump. “That is certainly not where I would see myself coming from. ” 

“There are doctors I’ve seen promoting hydroxochloroquine and maybe even promoting fear.”

And the people who can get views for a medical message on social media aren’t necessarily the ones most qualified to craft it. Eric Feigl-Ding, an epidemiologist who now has a large following on Twitter thanks to his evocative tweets about Covid-19, has found his expertise and analysis questioned by other epidemiologists. 

Varshavski, that is Doctor Mike, became YouTube’s go-to medical expert after a 2015 Buzzfeed article about his Instagram account dubbed him the “hot doctor.” And although he often stresses to his audience that “expert opinion,” including his, is “the lowest form of evidence,” his viewers fans are more likely to trust what he says in his videos than they are to track down and read a randomized controlled study on the same topic. That’s not necessarily a bad thing, if the information is sound and clearly presented—and he described his role during the pandemic as essentially turning himself into a mouthpiece and platform for the CDC, WHO, and leading experts in the field.   

But it’s easy to lose that balance. 

“If you are a doctor and you’re popular and people look to you for guidance, and you believe your expert opinion without any kind of research to substantiate it outweighs that of the guidance from the CDC and WHO, you’ve crossed the line,” he says. 

And that’s the central challenge: people will turn to the internet for information during a health crisis, whether it’s their own or one facing the entire world. But the best, most accurate information isn’t always packaged and optimized in a way that is appealing to a curious public searching for certainty. For every CDC video about the latest studies on the coronavirus, there’s someone out there claiming to be the one person out there willing to tell you what “doctors don’t want you to know.” That gets combined with a president who is amplifying potentially dangerous ideas so that they become significant news stories. 

Doctors becoming brands

There’s another challenge faced by these doctor-influencers, too: branding and money. Personalities like Doctor Mike can make accurate information interesting by becoming influencers, but they also have to figure out a way to do that without falling into ethical quicksand. 

People become famous online by becoming human brands. But “turning ourselves into brands can also drive people in a different direction,” said Chiang. “Some people out there are aligning us with big pharma already. The last thing they want to see is that we are selling a product or idea.” 

Varshavski, like many content creators, takes sponsors for his Instagram and YouTube accounts, but said he has to make sure that those sponsorships don’t look like medical endorsements. Chiang, who also serves as the Chief Medical Social Media officer for his hospital, has to carefully screen which TikTok challenges he participates in, and the songs he uses with them, to avoid associating his image and that of his profession with something offensive or tasteless. Chiang is informative on TikTok, but he does it while engaging effectively with how people already use the app. And that’s not always something doctors are capable of—or interested in—trying to learn how to do.  

“Historically there’s never been any sort of teaching in medical training in how to communicate on a public level with our communities and our patients,” said Chiang.

Online fame takes maintenance and skill to a degree that most people underestimate. And, especially for doctors and other people who work in fields that are targets of disinformation, there are some more serious risks. Chiang points out that some companies will simply steal content from medical professionals on social media and use them to sell their products. And, battling medical misinformation online can make those who believe it angry, potentially endangering the personal safety of doctors who try to take it on. 

But Chiang and Varshavski say thesay that the risks are worth it, especially if having more doctors online helps people find better information about their health. 

And, as doctors who are both on the internet and treating real patients, they can see how misinformation impacts their patients first-hand. Varshavski treated five covid-19 patients in one recent weekend with mild symptoms, and each asked for hydroxychloroquine, a risky possible treatment that can cause serious heart issues in some patients. Some told Varshavski that they heard about the treatment on TV. 

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The global AI agenda: Asia-Pacific

This report is part of “The global AI agenda,” a thought leadership program by MIT Technology Review Insights examining how organizations are using AI today and planning to do so in the future. Featuring a global survey of 1,004 AI experts conducted in January and February 2020, it explores AI adoption, leading use cases, benefits, and challenges, and seeks to understand how organizations might share data with each other to develop new business models, products, and services in the years ahead.

Within Asia-Pacific, how do executives see AI playing out in their business? What are the main use cases thus far, and what challenges do they face in AI deployment? The main findings of the report are as follows:

• Some 56% of Asian respondents to our survey had deployed AI in their operations by 2017, compared with less than a third of North American respondents and 35% on average across other regions. By 2019, nearly 96% of Asian respondents reported AI deployments, above the 85% average of respondents from the other regions.

• While AI is certainly a widely used technology, it is still at the fringes of many business processes. In line with the global trend, nearly half of survey respondents expect AI to be used in between 21% and 30% of business processes in three years’ time. A further 24% expect AI to touch up to 40% of business processes.

• Our survey finds that enterprises in Asia are using AI most extensively today in IT management (selected by 62% of respondents as a top-three area for AI), followed by customer service and research and development. The area where AI is set to grow the fastest by 2022 is across sales and marketing departments.

• Asia-Pacific is ahead of other regions in using AI for purposes such as the personalization of products and services and determining pricing. These trends are likely connected to the region’s leadership in e-commerce. Research company eMarketer estimates e-commerce across Asia-Pacific grew 25% in 2019 (faster than all other regions) to reach $2.271 trillion, representing 64.3% of global e-commerce spending.

• The greatest benefits achieved thus far have been in improved risk management, accelerated time to market, and better management decision-making capabilities. Within these areas, Asia is seeing greater success than other regions.

Download the full report.

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How to manage a pandemic

My first taste of coronavirus panic came early one morning in January. An email with the heading important information please read arrived from our son’s elementary school, just minutes before we put him on the bus. The parents of one of his teachers, who had recently returned from China, had been infected—Singapore’s cases 8 and 9, as it turned out—and the teacher in question was being quarantined.

Singapore was among the first countries to suffer an outbreak. In the months since, it has been at once reassuring and unnerving to watch its journey from an early hot spot to a kind of haven state, holding out doggedly against an invader that has infiltrated so many others.

Early commentary in the West focused on the failings of China’s autocratic system, which hid the severity of Wuhan’s outbreak—at what we now know to be catastrophic cost. The more the epidemic has spread, the more it has become clear that Western liberal democracies have badly mishandled it too, ending up with severe outbreaks that could—perhaps—have been avoided.

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Yet it makes little sense to view the coronavirus as some kind of perverse vitality test for liberal and authoritarian regimes. Instead we should learn from the countries that responded more effectively—namely, Asia’s advanced technocratic democracies, the group once known as the “Asian Tigers.” In the West the virus exposed creaking public services and political division. But Hong Kong, Japan, and South Korea have managed better, while Singapore and Taiwan have kept the disease almost entirely under control, at least for now.

Lessons learned

Partly this shows the benefits of experience. The Asian “technocracies,” as geopolitical thinker Parag Khanna dubs them, all suffered SARS outbreaks beginning in 2002, as well as more recent minor scares, such as H1N1 in 2009. These experiences, bruising at the time, helped government planners think through contingencies, developing outbreak management plans and stockpiling essential goods. Taiwan accumulated millions of surgical masks, coveralls, and N95 respirators for medical staff, and kept tens of millions more for the public.

“Your test is positive. The ambulance will arrive there in 20 minutes. Pack your stuff.”

It was also thanks in part to SARS that Asian countries understood the need for rapid action, as Leo Yee Sin, head of the NCID, noted back in early January. At that point, covid-19 was still being referred to as a “mystery pneumonia.” Around the region, passengers on flights from affected parts of China were given mandatory temperature checks. As the crisis deepened, those flights were canceled, and then borders were closed entirely. Not every country followed quite the same model of response: Hong Kong and Japan shut their schools early, while Singapore kept its open. But all acted quickly, in coordinated responses led by experts.

There were new treatment centers too, including Singapore’s National Centre for Infectious Diseases (NCID), a 330-bed facility opened just last year, which stands a 10-minute drive from my office. A friend—Singapore’s case 113—ended up there for weeks in March, having caught the virus on a trip to Europe and begun to feel symptoms on his flight back home. He was first taken to the center for a test—“The scene was pretty post-apocalyptic, with everyone in plastic suits with big goggles and masks, in rooms filled with plastic partitions”—but was sent home to isolate and await results. He got a call back a few hours later. “They told me, ‘Your test is positive,’” he remembered, while still in isolation at the center in late March. “The ambulance will arrive there in 20 minutes. Pack your stuff.”

Technology mattered too. China deployed extensive and invasive surveillance to bring the virus’s spread under control, pushing tech giants to track and monitor hundreds of millions of citizens. New apps proliferated, notably the Alipay Health Code, which assigned users a rating of green, yellow, or red, based on their personal health records with the company. The app, which shared information with Chinese police and other authorities, in effect decided who was quarantined at home and who was not.

Asia’s democracies often took more basic routes, monitoring and managing the outbreak with tools no more advanced than phones, maps, and databases. Singapore in particular rolled out an admired contact tracing system, in which centralized teams of civil servants tracked down and contacted those who might have been affected. Their calls could be shocking. One minute you were oblivious at work; the next minute the Ministry of Health was on the phone, politely informing you that a few days before you had been in a taxi with a driver who subsequently fell ill, or sitting next to an infected diner at a restaurant. Anyone getting such a call was sternly instructed to sprint home and self-isolate.

What made this possible was that anyone infected could be grilled for hours. “They sat me down and interrogated me about my travel: every day, minute by minute,” my friend told me. “Where did I go? Which taxi did I take? Who was I with? For how long?” The process of tracking and tracing was laborious but produced impressive results. Nearly half of the roughly 250 people infected in Singapore by mid-March first learned that they were at risk when someone from the government called and told them.

Just as efficient was South Korea’s testing regime, which in January forced local medical companies to work together to develop new kits and then rolled them out aggressively, allowing planners to keep track of the pandemic’s spread. South Korea had tested about 300,000 people by late March, roughly as many as the United States had managed by then, but in a country with a population one-sixth as large.

Clear communication

Transparency was another factor, though perhaps a less expected one in Asia’s more autocratic societies. True, media coverage early on was more muted and respectful in countries like Japan and Singapore than in places like the UK, where aggressive reporting highlighted all manner of details that public authorities might have preferred to play down, such as contingency plans to open up a morgue in London’s Hyde Park.

Nonetheless, open communication from governments has been a consistent pattern in Asia’s more successful responses. Singapore put prominent front-page advertisements in the media, including early campaigns to try to stop citizens with no symptoms from buying up surgical masks and causing shortages for those who needed them. Taiwan and South Korea provided reliable and open data to citizens, along with regular social-media briefings.

As the pandemic worsened, I took a trip to the United States, sure to be the last for quite some time—departing through the forests of temperature checks and body heat scanners that by then lined the corridors of Changi Airport.

For the week I was away, I got calmly factual updates pinged to my phone roughly three times a day from the Singaporean government via WhatsApp, giving details about new infections and what the authorities were doing in response.

This focus on open information was another lesson taken from earlier crises. During the SARS crisis, as well as the 2015 outbreak of Middle East respiratory syndrome (MERS), administrations in countries like South Korea were criticized for hiding information and damaging public trust. This time they appear to have concluded that frequent updates from politicians and health experts were a more effective technique against viral misinformation.

This is not to pretend that everything has been perfect. Japan messed up its response to the arrival of the Diamond Princess cruise ship in Yokohama, and—like the US—has faced persistent questions since about its own lack of testing equipment.

Hong Kong’s government was widely criticized too, in the aftermath of recent street protests that badly eroded public confidence. Hong Kong’s citizens, however, have shown extraordinary willingness to self-isolate—which may in part be because they distrust the state’s ability to solve the crisis, not because they meekly follow government orders.

Indeed, the examples of Hong Kong and Taiwan, itself a rambunctious democracy, give the lie to the notion that Asian nations have succeeded in this crisis because their citizens are more likely to do as they are told than free-spirited Italians or North Americans.

This idea has uncomfortable echoes of an older, racist debate about so-called “Confucian” cultures, which thinkers like the US political scientist Samuel Huntington described as hierarchical, orderly, and tending to value harmony over competition. As with talk of “Chinese flu” or sudden outbreaks of Sinophobia on American street corners, this line of thinking tells us little about why some countries performed well and others did not.

Preparation is key

Only last October, the Economist Intelligence Unit produced a lengthy report ranking nations by global epidemic preparedness. The US came top, followed by Britain and the Netherlands; Japan and Singapore were 21st and 24th, respectively. However this league table was compiled, it seems to have proved entirely wrong.
Asia has provided many examples of policies that worked—from China’s speedy hospital construction to South Korea’s aggressive testing to Singapore’s contact tracing and open public communication—while in the West, governments that seemed well situated to deliver a swift response have been found wanting.

The thread uniting the countries that did well was that, whether democratic or not, they were strong, technocratically capable states, largely unhampered by partisan divisions. Public health drove politics, rather than the other way around.

Western liberal economies neglected the kind of state capacity in public health and pandemic preparedness that Asian states have quietly been building up.

The truth of this is likely to be cruelly revealed as the virus spreads elsewhere around Asia, and in particular to places like India and sub-Saharan Africa, where state capacity is notoriously weak.

Many such countries have tried to lock down their populations, as the advanced economies did before them. But even if they can slow the virus’s spread, they do not have the benefit of strong health systems, let alone the kind of testing and contact tracing regimes that kept much of Asia safe.

This Asian advantage in competence might not endure into forthcoming phases of the covid-19 crisis, as focus shifts to managing a dramatic economic recession—an area where many Western administrations have recent experience in the wake of the 2008 crash. Governments like those of Britain and the US have already unveiled sizable stimulus packages. But it is undeniable that as they struggled to recover from that financial crisis, Western liberal economies neglected the kind of state capacity in areas like public health and pandemic preparedness that Asian states have quietly been building up. Coronavirus was a test, and the world’s supposedly most advanced nations have all too visibly failed.

All this is damaging to the global reputation of the United States in particular. It was only in 2014 that Barack Obama’s administration managed to lead a global response to an Ebola outbreak in western Africa. Now, six years later, Donald Trump has barely been able to organize a response in his own country.

China is already using this fact to suggest the superiority of its autocratic model of government.

That would be a bad lesson to draw. What matters instead is a new divide between two kinds of countries: those with states that can plan for the long term, act decisively, and invest for the future, and those that cannot.

James Crabtree is an associate professor of practice at the Lee Kuan Yew School of Public Policy at the National University of Singapore. He is author of The Billionaire Raj.

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