Anne Strainchamps (00:00):
It's To the Best of Our Knowledge, I'm Anne Strainchamps. We're in the midst of the largest vaccine rollout of our lives. A turning point, we hope. Who will get it first, and will it work? It's complicated, medically, logistically, philosophically.
The only completely effective method ...
To protect the health of the nation.
... is vaccination by proper technique. With a potent vaccine. Vaccine. Vaccine.
Vitally important to all of us. Vaccine.
Ilan Kedan (00:49):
In March, I remember, I saw a volunteer receiving a vaccine for COVID, and I thought, "Man, that is amazing. I want to be a part of that."
Anne Strainchamps (01:07):
Ilan Kedan is cardiologist at Cedars-Sinai Hospital in Los Angeles. He was among the first to volunteer for a COVID-19 vaccine trial. Another volunteer is Christina Lombardi. She's an epidemiologist at Cedars-Sinai, and also Ilan's wife.
Christina Lombardi (01:25):
I was a little hesitant at first, because I knew that there may be some small amount of risk.
Is it absolutely safe?
Christina Lombardi (01:31):
It was all so new and things were moving so fast. By the time the fall came, the numbers started going up again, and I started thinking, "Gosh."
Will there be enough vaccine for large-scale use this summer?
Christina Lombardi (01:46):
What can I do to advance the vaccine?
A safe and effective vaccine.
Christina Lombardi (01:51):
They scheduled me for my first visit to come in.
Ilan Kedan (01:57):
On my first visit, there were still COVID cases everywhere, every day. It was very prevalent. The staff were nervous. I was nervous. Labs were drawn, eight vials. It's a fair amount of blood.
Check the skin area carefully.
Ilan Kedan (02:12):
I'm sitting in the room. They leave me by myself in there. Then they enter with this needle, and I'm thinking to myself, "After that syringe is emptied into my muscle in my shoulder, there's not going back."
Our bodies must create defenses.
Christina Lombardi (02:35):
I gave blood. I had a pregnancy test. I had a nasal swab test for COVID.
Christina Lombardi (02:42):
I had a brief physical exam.
Ilan Kedan (02:46):
They say, "Turn your head. Look at the other wall, because this might hurt."
The site should remain fully exposed.
Ilan Kedan (02:52):
They jab me. They inject me.
A properly performed vaccination should not bleed freely.
Ilan Kedan (02:59):
I have to make a joke at that moment, "Oh, thanks for the placebo. That was nice."
Christina Lombardi (03:06):
They gave me the shot. It was very easy and straightforward.
The system becomes a battleground between the force of health and disease.
Ilan Kedan (03:16):
Then I took a second to breathe and think about it, because there might not be many opportunities in our lives where we can say, "That is just something that's going to make a difference in the world for millions of people."
Anne Strainchamps (03:36):
This week we're taking you behind the scenes in the search for immunity to COVID-19, talking with people who volunteered for vaccine trials and to scientists and reporters who have been tracking it. Among the places in the U.S. hardest hit with COVID-19, Los Angeles is at the top. At Cedars-Sinai Hospital there, Ilan Kedan and Christina Lombardi, a married couple, both doctors, volunteered to take part in two separate medical trials for the vaccine. Their friends of producer Shannon Henry Kleiber, and she wanted to know how it went.
Shannon Henry Kleiber (04:20):
One of the first things I thought about when I heard this married couple, cardiologist and epidemiologist, decided to both do separate vaccine trials, you have a seven-year-old daughter, and I thought, did you ever wonder, "Should one of us do it and not the other?" How did being a parent play into this?
Christina Lombardi (04:39):
I think for me I wanted to wait and see what Ilan's experience was first, in case something did happen. I felt a little scared, what would happen to my daughter if I were sick, if I weren't able to take care of her. We don't have family locally. That's one of the reasons I decided to wait a little bit and take my time to make the decision.
Ilan Kedan (05:00):
I felt like it was an opportunity to demonstrate role modeling at some level, that I'm not afraid. It's an opportunity for her to see firsthand what I mean when I say I'm going to make a commitment to helping others on a larger scale, on a population level.
Shannon Henry Kleiber (05:21):
You actually think it was the vaccine though, right?
Ilan Kedan (05:24):
Yes. Within about two hours, my arm started to get a little bit sore. I thought, "Man, they were just too aggressive with that needle," but the soreness persisted. We were hanging out outside. It was a beautiful evening in September in Los Angeles. It was a long week. I was thinking, "Man, I just want to sit down here for a little bit. I'm a little bit tired." That's not a normal response for me. That, in addition to a few other symptoms I would say, led me to believe that that's not a placebo.
Shannon Henry Kleiber (06:04):
Do you think you're immune now?
Ilan Kedan (06:06):
Yeah. I feel pretty much 95% confident that I am protected.
Shannon Henry Kleiber (06:11):
How does it change your everyday life?
Ilan Kedan (06:14):
That's an interesting question. I've thought about it. I still go to work with the goggles and the N-95 mask. I still eat in a private space with the door closed and nobody else in there, wash my hands obsessively. In that respect, I haven't really changed that much. In some ways I feel like I got to the party before everybody else, and there's nobody here yet. It is a strange feeling. I have a lot of confidence walking around. I feel like I have antibodies, but nobody's here yet. I'm excited and eager to share the experience of being immune with the rest of humanity.
Shannon Henry Kleiber (07:01):
Christina, you're two of the first people in the world to potentially receive the vaccine. Do you feel the same way as Ilan or do you feel a little more emboldened?
Christina Lombardi (07:11):
I don't. I had a different experience than Ilan. I didn't have any symptoms after my injection. I didn't have any redness or pain in my arm. That's led me to believe that I probably got the placebo. I still feel excited to be part of the trial. I know that my data, even if I am in the placebo group, my data will help to show that the vaccine is safe and effective hopefully for others.
Shannon Henry Kleiber (07:40):
Ilan, you're training patients with COVID right now. Can you tell us a story maybe of one patient to give us a sense of how these are individuals and not just numbers?
Ilan Kedan (07:50):
Yes. What have I seen? I've seen just the utter, I don't want to get too graphic, but the utter look of terror on someone's face who's having air hunger, who can't get enough oxygen. They know that they're running you out of time. They're looking you in the eye. There's little you can do to help. Their lungs are failing them. It's part of maybe what led me to participate in a research trial with unknown information and unknown effect. It's going to be a generational kind of thing, I think, for our generation and the generations that were touched by this.
Shannon Henry Kleiber (08:41):
Christina, what are your hopes for the future? What do you want us all to collectively take away from this experience?
Christina Lombardi (08:48):
I hope that people will see how important the vaccine is for themselves and their families and for the entire society. It's critical for people to take the vaccine so that we can end the pandemic. I'm very hopeful about the future. I hope that people will take the vaccine.
Anne Strainchamps (09:18):
Ilan Kedan is a cardiologist at Cedars-Sinai Hospital in Los Angeles. His wife, Christina Lombardi, is an epidemiologist there. They were talking with Shannon Henry Kleiber.
Anne Strainchamps (09:33):
It's amazing that we're even at this point, that there is actually a vaccine for COVID-19. It feels like the virus has been here forever. Do you even remember when you first heard about it?
China has identified the cause of the mysterious pneumonia outbreak in Wuhan City, and it's from the same family that caused the deadly SARS epidemic 17 years ago.
Sarah Zhang (10:00):
I remember first seeing a couple of reports in late December or in early January, cases of pneumonia connected to the Wuhan seafood market.
Anne Strainchamps (10:09):
Sarah Zhang, staff writer for the Atlantic.
Sarah Zhang (10:12):
I actually remember having a conversation with my editor at the very beginning of the year, just saying, "Oh, what should we cover this year?"
Symptoms similar to pneumonia.
Sarah Zhang (10:22):
I was like, "Oh, there's this virus in China." We're like, "Oh yeah, maybe it's a thing."
It's also since been detected in Thailand and Japan.
Sarah Zhang (10:32):
It was actually interesting comparing my reaction with my parents, who are more closely linked to people in China. In January and February I remember my parents being worried about our relatives in China.
An international response.
Sarah Zhang (10:46):
My aunt is a health care worker, and they were making sure does she have enough PPE. I knew people who were sending masks to China. Then in two months, there were literally people who sent back those very same masks when the virus started hitting the United States.
For Americans who are watching this, how serious is this? What's keeping you up at night?
Sarah Zhang (11:08):
We were hearing about everything that was happening in Wuhan, but it felt very distant and it felt like something that could never happen here.
The five individuals in the United States who were-
Sarah Zhang (11:19):
It wasn't until Italy I think that people in the West realized now this is not something that's contained to China, it's going to get out.
Transmission from one to another.
Sarah Zhang (11:31):
I've thought a lot about our inability to believe something was going to happen until it actually happens.
A bit more serious. Right now in the United States the situation still is a low risk for the [inaudible 00:11:40].
Anne Strainchamps (11:43):
Sarah Zhang. She's been tracking the virus and the search for immunity from the beginning. We'll hear more from her next. It's To The Best Of Our Knowledge, from Wisconsin Public Radio and PRX.
Anne Strainchamps (12:06):
Science writer Sarah Zhang started covering COVID-19 for the Atlantic at about the same time people in the U.S. were first hearing of it. Over the past year her stories have been about microbes, saying goodbye to dying patients over Zoom, and what it's been like covering the pandemic as a Chinese American. She's now deep into the vaccine beat, tracking one of the biggest public health challenges in history, mass immunization.
Sarah Zhang (12:33):
What the whole pandemic has taught me is that science can move really, really quickly. We've learned so much about this virus in a year, but the things that really matter in public health, getting public to listen, communicating, those things are hard. The science alone is not enough.
Anne Strainchamps (12:49):
The vaccine in production now, these are mRNA vaccines. How are those different from the familiar standards, smallpox, polio, diphtheria?
Sarah Zhang (13:01):
Traditional vaccines work by essentially giving you a little piece of the virus so that your immune system can recognize. You might think of it as a Wanted poster. Traditionally this would be in the form of a inactivated virus or a weakened virus or maybe even just a fragment of a virus. mRNA vaccines, they actually give you the instructions to print out the Wanted poster. The mRNA is basically a little molecule that is instruction for your body to make the spike protein that is on the outside of the coronavirus capsule. It's all these little spikes. It's how it enters the cell. It's a really important piece of the virus itself.
Sarah Zhang (13:38):
The way the mRNA vaccine works is that it's encased in a little protective bubble of fat, which helps get it inside your cells, and once the mRNA's inside your cell, gives your body the instruction to make that spike protein. With that spike protein, your body is able to recognize, "Oh, this is something foreign going on. Let me make antibodies against it. Let me stimulate immune response against it." By the time you actually see a virus, it's primed and ready to go. The instructions mRNA disappear after a while, so does the spike protein itself, and all you're left with is this immune memory. There's no way to get sick. There's no way to get COVID from getting the vaccine.
Anne Strainchamps (14:18):
Because you're never being injected with COVID.
Sarah Zhang (14:20):
Exactly. You're just getting injected with a really small piece of the virus that by itself can't infect you.
Anne Strainchamps (14:26):
People who have gotten the vaccine already have reported that there can be some, I don't know if I want to call them severe side effects, but strong side effects, worse than the usual sore arm you get from the flu vaccine.
Sarah Zhang (14:40):
Yeah, it has a bit of a kick.
Anne Strainchamps (14:44):
Almost thinking like a cocktail.
Sarah Zhang (14:48):
It's one of those things that will fortify you for the future. The technical term is reactogenicity. What that means is that it stimulates a strong immune response. That can feel like getting sick, because when you get a fever, when you get a sore throat, when you feel achy, that's actually all caused by your immune response. It's not necessarily caused by the virus or the pathogenic self. The same thing is happening when you get a vaccine. It's that it stimulates a immune response.
Anne Strainchamps (15:16):
Is it actually a good sign? Does it mean that your body is developing the immunity, it's working?
Sarah Zhang (15:21):
Yeah. It means that the immune system is gearing up the action and ready to do its job.
Anne Strainchamps (15:26):
In the meantime, there's not enough vaccine for everyone. Even those who can get it will need more than one dose before they're fully immune. It's not like a magic bullet.
Sarah Zhang (15:36):
Anne Strainchamps (15:37):
You wrote this great piece recently talking about this period of time as vaccine purgatory. Can you explain what you meant?
Sarah Zhang (15:47):
We're about to enter this new phase, where some people are going to have the vaccine, other people aren't going to have access to it yet. Once you get the vaccine, it's a little bit unclear how immune are you, can vary person to person. You don't really know. I think we're just going to be in this period of flux where we're waiting for a vaccine, but there's not enough. I described it as purgatory. As purgatory goes, I think one of the biggest questions is how long this is going to last. As we're seeing over the past month, it's also going to take a long time to actually get these vaccines into arms.
Anne Strainchamps (16:20):
What would the people in the public health community, what would be your best-case scenario? Would it be that the federal government just takes this over and the army moves in and sets up clinics everywhere and administers the vaccine?
Sarah Zhang (16:35):
I think it's actually a little bit hard to say, because I think that is certainly very efficient. I think people in public health community are also worried about if it's the army setting up these mass vaccination clinics, are people going to trust that, or will they prefer to get their vaccine from their local doctors office, with a doctor that they already know? There's a bit of a tension between doing things as quickly and efficiently as possible and doing things a while that builds trust and feels fair. I don't know if there's really a right answer. I think that's part of what we're seeing right now is that every community is trying to figure it out for themselves.
Anne Strainchamps (17:08):
Then what happens if we wind up with some places, some states, some cities, where everybody's vaccinated, and there are other places where very few people are vaccinated?
Sarah Zhang (17:21):
We keep talking about herd immunity as if it's a national thing, but it's actually a local thing, because it's possible, as you say, to have everyone vaccinated in one town, but maybe the next town over, there are still enough people who are vulnerable to COVID that an outbreak can break out. I think the fact that we're going to have this patchwork means that, first of all I think COVID is so widespread that the virus is probably never going to go away. It's going to be with us, to some extent, like the flu, every year. You're probably going to see bigger outbreaks in places where fewer people have been vaccinated. This just might be in addition to flu season we're going to have COVID season every year.
Anne Strainchamps (18:00):
That's so strange to think about, and also to think about folks in Silicon Valley are all going to be super vaccinated before everybody else versus a neighborhood in Detroit. Do you worry about that kind of inequality?
Sarah Zhang (18:15):
Yeah. I think one of the things that vaccine experts will talk about is that the people who can most advocate for themselves, who say they want the vaccine, are often not necessarily the people who most need the vaccine. The priority population is people who are elderly, people who are frontline workers, but also people who can't get to a vaccine clinic. They have to work during the day. They can't take time off to go get vaccinated. If you're elderly or home-bound, how are you going to go out and get vaccinated? I think public health departments have a really big challenge in that the last 20, 30% of people is going to be a lot harder than the first 20 or 30% of people.
Anne Strainchamps (18:54):
Thinking back over the big lessons of all of this, and big challenges, one of them it seems to me is just how much uncertainty there has been this whole way through, and maybe that's always through in science stories, but it's a lot easier to handle the mystery of a black hole than the mystery of a virus that could kill you.
Sarah Zhang (19:17):
I'm so glad you asked that, because I feel like the past, what, year, have been about learning how to live with uncertainty and how to make decisions with imperfect information. I have gotten so many questions like, "Is this thing safe to do? If I do this and this and this, can I go visit my grandparents?" Maybe the way to think about this has never been this is completely safe or completely not safe, it's always going to be what is the matter of risk you're willing to take. It's hard. It's hard to be like, "We don't know," but we don't know doesn't mean absolutely nothing. It means we have some amount of prior knowledge based on experience with other viruses, based on what we've known about how this virus spreads so far. I think learning how to make decisions with imperfect knowledge is what we've all had to do over this past year. Actually, that's what we're doing all the time in our lives is just that we often expect science to have a clear answer and we don't. This is the fact of life. We live with having to make decisions based on uncertain information.
Anne Strainchamps (20:18):
I can imagine this horrible feeling of helplessness. As you say, how many articles can you put out saying, "Stay the hell home," and yet people don't?
Sarah Zhang (20:30):
I think my colleagues and I definitely got to a point where it did feel that way, I think especially around Thanksgiving when it was quite clear what was going to happen if lots of people were going to travel, but then people are understandably very fed up with the pandemic and want to have some moment of joy and semblance of normalcy. Fortunately for me, for the past few months, I've been covering vaccines, which is actually something where things are happening and there is optimism. I think the question in everyone's mind at this point is just, "When is this going to be over?" Vaccines are going to be a big part of that. At least I get to write about the piece that looks at the end rather than just at this indeterminable present.
Anne Strainchamps (21:15):
It's funny, this just seems like a perfect example, this conversation, in that it seems like every time it feels like we've made some progress or there's a reason to be hopeful, something else smashes that down, like the second strain of the virus comes along. Are you still hopeful? How do you manage to stay that way?
Sarah Zhang (21:36):
Am I still hopeful? I'm probably going to get married this year.
Anne Strainchamps (21:43):
Sarah Zhang (21:44):
We're not going to have a big wedding or anything. I think I am hopeful that our lives six months, a year from now, are going to look quite a lot more normal than they are right now. I think the vaccines, because honestly, as I said, they're just so much better than anyone really expected, I think that really did give me a good dose of optimism that there is an end to this. I'm clear-eyed about the challenges that are ahead, but that's just really wonderful news. I think we should revel in that for a moment.
Anne Strainchamps (22:13):
Sorry. My pandemic puppy is barking. I hope there will be an it's all over moment. Do you have in mind even a little thing where you'll feel like, "Okay, it's over."
Sarah Zhang (22:32):
Yeah, probably when I eat at a restaurant, inside a restaurant again and it feels normal and I'm not worried about is everyone here wearing a mask. I probably will get a vaccine this year. I'm really looking forward to that.
Anne Strainchamps (22:52):
That was Sarah Zhang. She's a staff writer for the Atlantic Magazine. A lot of people are looking forward to getting the vaccine, others will opt to wait, and some regard the whole subject of vaccines with suspicion, like the government, the medical establishment, and the pharmaceutical industry.
Eula Biss (23:19):
My son is fully vaccinated, but there's one immunization on the standard schedule that he didn't receive on time.
Anne Strainchamps (23:27):
Eula Biss is the author of On Immunity: An Inoculation.
Eula Biss (23:31):
This was meant to be his very first shot, the Hep B administered to most babies immediately after birth. In the months before my son was born, while I was teaching at the university and hauling a used crib through the snow and moving bookshelves to make room for the crib, I began spending my evenings reading articles about immunization. I was already aware before I became pregnant of some fears around vaccination, but I was not prepared for the labyrinthine network of interlocking anxieties I would discover during my pregnancy, the proliferation of hypotheses, the minutia of additives, the diversity of ideologies. Finding the reach of my subject had far exceeded the limits of my late-night research by the time my baby was due. I visited the pediatrician I had chosen to be my son's doctor. A number of friends had offered his name when I asked for a recommendation, and so had my midwife, who referred to him as "left of center." When I asked the pediatrician what the purpose of the hep B vaccine was, he answered, "That's a very good question," in a tone that I understood to mean this was a question he relished answering. Hep B was a vaccine for the inner city, he told me, designed to protect the babies of drug addicts and prostitutes. It was not something, he assured me, that people like me needed to worry about.
Eula Biss (24:56):
All that this doctor knew of me then was what he could see. He assumed, correctly, that I didn't live in the inner city. It didn't occur to me to clarify for the doctor that though I live in the outer city of Chicago, my neighborhood is very much like what some people mean when they use the term inner city. In retrospect, I am ashamed by how little of his racial code I registered. Relieved to be told that this vaccine was not for people like me, I failed to consider what exactly that meant.
Anne Strainchamps (25:28):
That's Eula Biss reading from On Immunity: An Inoculation. It's the book she wrote about why vaccination triggers so much anxiety. Steve Paulson talked with her when it first came out. That was back when anti-vaxxing, chicken pox parties, and measles outbreaks were in the news.
Steve Paulson (25:45):
Eula, why do you think so many people are scared of vaccinations, even people who are educated and usually trust what scientists tell us?
Eula Biss (25:53):
Probably the one that I find most often when I'm talking to other parents is just a deep suspicion and mistrust of the government and the medical system. Since vaccine recommendations are made through a collaboration between the government and the medical system, parents feel reluctant to follow those guidelines.
Steve Paulson (26:17):
Obviously this is a subject that hit home for you, going back to when you were pregnant and when your son was very young, should you give him all the prescribed vaccinations? Were you worried about the MMR vaccine that some people believe leads to autism?
Eula Biss (26:34):
When I started this research, I didn't know enough to be worried about a particular vaccine. I knew almost nothing. All I knew was that I'd heard that some people had concerns, and that made me wonder whether I should look into the subject. I think by the time I learned that there were concerns about the MMR, I'd already read the research that revealed that those concerns were unfounded, in science at least. That one, it was not a particular concern for me. Actually, the fears of autism were perhaps the easiest fears to lay to rest for me. That research I did rather quickly and efficiently. Compared to some of the more diffuse fears, fears that there's some sort of pharmaceutical corruption that's contributing to the number and kind of vaccines we give, that fear is harder to research than a specific fear about a specific vaccine causing a specific disease.
Steve Paulson (27:34):
You're suggesting that the fears are probably not really about the medical risk. There's something else going on here.
Eula Biss (27:41):
Oh yeah. I don't think so. After spending a lot of time with the subject, I think part of what is so confusing about this subject and gets us confused almost every time we discuss it in public discourse is that we conduct this conversation using medical terms and using scientific terms, using language from science and information from scientific inquiry, but it's not about medicine or science, as far as I can tell. I think it's about other preoccupations, our feelings about government and government oversight and regulation. There's also feelings about environmental pollution that come into this. There's feelings about the history of sexism in medicine that come into this subject. More often than not, what we're really talking about when we're talking about this subject of vaccination is something extra medical.
Steve Paulson (28:41):
Part of the issue is what you should do for your own children and what you're doing for the common good. It would seem that that's part of the problem here is some people are basically getting a free ride, because so many other people are getting the vaccines.
Eula Biss (28:59):
I think there is something a little misleading in that line of thinking, in that by the numbers you aren't necessarily better off not vaccinating your child. If you look at the risk of getting a side effect from a vaccine versus the risk that a unvaccinated child runs of getting an infectious disease, the risk of getting the infectious disease is still higher than the risk of suffering a side effect. I feel very strongly about the kind of altruistic reasons to vaccinate. I do think that when you make the decision not to vaccinate, you're making a decision not just for your child, but for everyone that your child's going to be in contact with. That's one reason in my mind to vaccinate. You don't need to be altruistic to see a good reason to vaccinate either. I think that there's also self-serving reasons to use this technology.
Steve Paulson (29:59):
There are a few countries like Nigeria and Pakistan that have real problems with certain diseases like polio. If everyone got vaccinations, they could probably wipe out polio, but there has been a lot of resistance to getting vaccines. It would seem in some cases, at least in Pakistan, there might be good reasons for people to be mistrustful of the health care workers there. The CIA used a fake vaccination campaign to try to find Osama bin-Laden.
Eula Biss (30:27):
The idea to use a fake vaccination campaign to try to track down Osama bin-Laden was astonishingly poorly planned. This was in a region where there's already some suspicion of Western medicine and of government interference in people's lives. It's also in a region where there's a lot of instability, economic and political instability. When we used vaccination as a form of espionage, we really broke an important link of trust and did some real damage in that region. This is tragic not just for this country of course, but for all the neighboring countries and really ultimately the world, in that polio does not obey our borders or our national distinctions. It moves through populations quite quickly and easily. Anywhere where there's a disruption in vaccination coverage, polio will move fairly quickly into that population. Very soon after vaccination was disrupted in Pakistan, polio moved into Syria. There were of course political and economic reasons why vaccination was disrupted there. There was a vulnerable population, and polio began paralyzing children in Syria almost immediately.
Eula Biss (31:53):
This is one of the reasons that this conversation about whether we're going to vaccinate or not is in fact not just a national conversation but a global conversation. What we as individuals do with our bodies affects our immediate communities, but it also affects the world community. It affects the places where we travel. It affects people that we never even anticipate coming into contact with.
Anne Strainchamps (32:29):
That's Eula Biss, talking with Steve Paulson. Her book is called On Immunity: An Inoculation. That last point is one of the big lessons of any pandemic, that in some ways we're all vectors, transmitting germs and ideas from one person to the next in countless unseen ways. Disease prevention means learning how to track that transmission. We know that, thanks in part to British physician Ronald Ross. He won a Nobel Prize in 1902 for his work on malaria.
Public enemy number one, Anopheles, the malaria mosquito.
Perhaps you'd like to know how you can defend yourself.
Adam Kucharski (33:45):
I think Ronald Ross did a couple of really important pieces of work. One was establishing that mosquitoes spread malaria.
Only the female carries the disease.
Adam Kucharski (34:00):
Then he did some mathematical work to try and demonstrate that you could control malaria by controlling mosquitoes.
Off she flies in search of another drink of blood, this time choosing a healthy person.
Adam Kucharski (34:14):
I think at the time, people had this common wisdom, if there's any mosquitoes, there's going to be malaria. You can't get rid of every single mosquito in a country.
She jabs her beak into his skin and pumps up the blood, swallowing with malaria parasites. Destroy the mosquito and you will wipe out the disease.
Adam Kucharski (34:33):
Ross used these simple conceptual motives to show that actually, as long as you reduce mosquito numbers sufficiently, then even if there was a few infections, they wouldn't be able to [inaudible 00:34:42] transmission. It was really a new way of looking at epidemics. It's now one that's central to a lot of the work we do to try and understand outbreaks.
All right, men, now we can begin the fight.
Steve Paulson (35:00):
Now Ross and this other mathematician, Hilda Hudson, came up with a theory that they called the Theory of Happenings. What is that?
Adam Kucharski (35:08):
I think it's a wonderful term for what they wanted to be a very general way of thinking about contagion. The world is full of what they called happenings. Something happens to one person, and then it happens to another person in some connected way. It might be something like a disease where you get it, you spread it to someone else. It might be a belief, a behavior. They developed all of these mathematical frameworks for thinking about processes that spread from one person to another. A lot of these would much later be rediscovered. Marketing people would find very similar shaped outbreaks when they looked at the adoption of people buying VCRs, for example.
Anne Strainchamps (35:53):
Coming up, Adam Kucharski on the rules of contagion and how everything, from disease to disinformation, spreads. I'm Anne Strainchamps. It's To The Best Of Our Knowledge, from Wisconsin Public Radio and PRX.
Anne Strainchamps (36:15):
One of the go-to experts on the COVID pandemic over the past year has been Adam Kucharski. He's the British epidemiologist who uses mathematical models to calculate and even predict the virus's spread. Now that's pretty amazing all by itself, but it's even more so when you think about how many things go viral. Not just disease, but financial bubbles, gun violence, conspiracy theories, not to mention sea shanties on TikTok. Contagion, it turns out, is not random. There are principles that govern it. Steve Paulson caught up with Kucharski to talk about the rules of contagion.
Steve Paulson (36:54):
What do you consider to be the biggest unanswered question so far about this pandemic?
Adam Kucharski (36:59):
I think one of the big questions is the role that people with no symptoms or very mild symptoms play in transmission, because that would tell us a lot, for example, about young children in schools, the risks that they pose. The things like flu, schools contribute a lot to driving the outbreak dynamics. It seems to be less the case for this virus. Obviously, given that that's such an enormously disruptive measure, to close schools for months, knowing more about that would be incredibly useful. I think that also just translates to the question of where infection's occurring, that we have a lot of data from Asian countries that had it under control and had a lot of social distancing in place, but we don't have so much data actually on where and how infections are happening when everyone is going back to normal.
Steve Paulson (37:44):
You have such an unusual background as you approach this whole question of how to think about pandemics. You are both an epidemiologist, and you're also a mathematician by training. I guess I wonder why mathematical models are so helpful in understanding pandemics, including this one, COVID-19.
Adam Kucharski (38:02):
I think for me, mathematical model is a really useful way of laying out the knowledge we have about an infection. I think really anyone who comes out with a claim about how an outbreak is working or comes out with a proposal for a control measure is implicitly using a conceptual model. If you say contact tracing is going to definitely solve this if we have 50% of cases traced, then mathematically you can lay that out and you can say, "It's this many contacts, if it takes this long to trace them, how many are we actually going to pick up before transmission's happened?" You can really just work through and see the plausibility of that.
Steve Paulson (38:39):
What are the different factors that you plug into a mathematical model when it comes to assessing the trajectory of a pandemic?
Adam Kucharski (38:47):
In terms of assessing the trajectory, two key values we look at are the magnitude of transmission from person to person, so we often capture this [inaudible 00:38:55] reproduction number, so just the average number of new cases generated by an existing case. Then we also look at time scale. We call this [inaudible 00:39:03] the time between one person sharing symptoms and the person they infect. These two things together, one gives you the amount of growth at each step, and then the other tells you how quickly those steps are occurring.
Steve Paulson (39:15):
I want to get a sense of your own background, because it's so interesting. You have a personal history in mathematics, and then you became an epidemiologist, but wasn't there a point where you nearly went into finance?
Adam Kucharski (39:27):
I did, yes. I think in that period of 2007, 2008, pretty much everyone new who was studying maths was lured into that as a potential job. A lot of people ended up doing internships, and I ended up spending summer 2008 on a trading floor. That was obviously a pretty dramatic time.
Steve Paulson (39:46):
Wait, you were there in 2008, just as the world came tumbling down?
Adam Kucharski (39:50):
Yes. It was about a week or so after I finished [inaudible 00:39:54] went under, which is, I assure you, unrelated. It was fascinating. It was also just fascinating seeing the rumors and the speculation about how contagion was spreading through the industry. I think a lot of people by that point had a very clear idea that several banks had some very bad investments on their books, but it wasn't clear who had what and who owed what and who had what risk. Ultimately I decided I wanted to go into public health and pursue that. Around the same time actually, a lot of epidemiologists were starting to work with central banks, because a lot of the features that were driving those really huge financial problems in 2008 could be traced back to network properties which STD researchers had been studying in the '80s. There were these characteristics of the financial network which were really very helpful from the point of view of spreading contagion.
Steve Paulson (40:49):
Can you walk us through that? I'm going back to 2008. What was the makeup of that financial contagion?
Adam Kucharski (40:57):
The few features of financial networks that really helped things spread widely, or as widely as they did, one is a network feature where you have loops. Imagine you have a network where you can only get infected through one connection. In that way it's much easier to manage your risk, because if you keep an eye on that connection, if you understand where the infection might be coming to you, that's something you can manage. If you have a network with a lot of hidden loops and hidden connections, it's much harder to understand how the risk is going to be spread, because you might not be connected to a specific bank that's in trouble, but others might be, and then you might be connected to him, and you've got all these hidden roots through which you are going to be exposed as well. The network was really foot of these kind of features.
Steve Paulson (41:44):
How does that play into the housing bubble that seemed to have led to the economic crash in 2008?
Adam Kucharski (41:51):
The housing bubble was really feeding into a lot of these mortgage products, and those investments really have treated the world as a series of unconnected events. I think that was true of the financial system at the time, that a lot of focus was on banks as individuals and what they were doing, rather than how they were linked up. There wasn't really enough accounting for the fact that if you had say one person defaulting on a mortgage, that may be connected to something that means that other people are going to be defaulting as well. If you've constructed your investment on the assumption those things aren't that interconnected, you're going to get hit far harder. It's the equivalent with contagion, that if you're looking at a disease outbreak, at individual cases that are unrelated, you're missing a huge part of the picture.
Steve Paulson (42:35):
There are also social contagions. One is for instance gun violence. It's interesting to think about it in terms of contagion. How does that fit into this model?
Adam Kucharski (42:46):
You could view violence as these random, sporadic events, but a lot of work is showing that they are linked to clearly defined networks of perhaps gangs that relate to each other or people who have been arrested through similar situations or those retaliatory attacks. They've estimated that for every hundred shootings you have in Chicago, there's about 60 that are follow-on attacks through contagions. In other words, the reproduction number is about 0.6. This also gives you potential routes through which you can start to control these things, because if you have an understanding of this contagion process, then potentially you can go in and intervene, because if you know that certain links are going to potentially spark follow-on attacks, then if you can prevent that transmission step happening, then that can have an effect on reducing the outbreak, whereas if you just view these events as completely random, you wouldn't be able to develop that kind of strategy.
Steve Paulson (43:46):
It makes me also wonder about school shootings, which has been such a big feature of American life over the last couple of decades, the alienated kid who goes into his school and shoots it up. It seems to be a kind of copycat behavior. Does this fit into your contagion model as well?
Adam Kucharski (44:03):
There have been studies looking at that exact feature of those shootings, but again, it indicates the importance to understand what might be driving that. Is it media reporting? Is it coverage of these things? There's a lot of evidence, for example, reporting of suicides can spark followup contagion events.
Steve Paulson (44:20):
That's really interesting. I think for someone like me who works in the media, our responsibility in what news we communicate, and even if we think it's just reporting the facts, those ideas can foster terrible actions.
Adam Kucharski (44:35):
I think it's something that the people who come from are aware of as well around things like this information, and unpleasant content that spreads online and fringe political views. There are increasingly groups who have a good knowledge of how this process works and how they can get things manipulated.
Steve Paulson (44:53):
We seem to be swimming in a world of misinformation now, or as some people would call it, fake news. Suppose Facebook or Twitter hired you to stop the spread of false information. What would you do?
Adam Kucharski (45:07):
One of the things that really stood out from a lot of the misinformation that was circulating over the last years on the political side is where it's best to target control. I think in the past some people have had a sense that you can just remove all the harmful, bad stuff online. That's the equivalent for a disease of saying, "Let's just find all the cases, and then we solve the problem." Of course you can't do that for infectious disease. People know that you have to try and reduce opportunities for it spreading or you have to try and ideally reduce susceptibility. That's what I think a number of platforms have started to do. For example, Pinterest a few years ago started to change how search results were being presented and how people were being exposed to information, because they'd acknowledged that it was impossible to get rid of absolutely every piece of harmful information, but they could change how people might be exposed to it. Similarly, WhatsApp made changes to their system about how much sharing could happen. I think one thing that's striking about the coronavirus outbreak is how many platforms are now presenting preemptive information. If you search for COVID or coronavirus, you'll be preemptively exposed to more reliable information sources. I think the difficulty when it's things like [inaudible 00:46:18] information is platforms have obviously been far more reluctant to fact check things or issue very public corrections.
Steve Paulson (46:24):
Now we've been talking about contagion basically as something terrible. Bad things happen, diseases spread, misinformation is distributed around, but also good ideas can come to public attention. How do new ideas take off? Why do certain ideas suddenly take over the world?
Adam Kucharski (46:44):
Obviously people have a lot of value on things that are new and things that are useful. There's also again been a lot of nice work trying to understand how you get those things to spark, because particularly one of the big distinctions between a biological device and an idea is often a biological device, you can get it from one person. An idea you might not fully take on board until several people have told you about it. That means the structure of the network you need to get those kind of innovations to take off is different, because it might not be that you can go and tell your idea to one person and it will cause an outbreak. You might need to work out how to build some local amplification, for example, within a company within certain groups and build that momentum and then also have those longer, more widespread links that enable it to spread more widely.
Steve Paulson (47:29):
There's also this idea of the influential person. One person you write about is Jonah Peretti, who was a grad student in the MIT Media Lab who basically mastered the art of making an idea go viral. Can you tell us about him?
Adam Kucharski (47:44):
Yeah. While he was a student, he got this huge amount of attention, because he tried to get some personalized trainers from Nike and asked them to be printed with the word sweatshop, and then got into this email exchange with the company, because they didn't want to fulfill that order for him. He ended up forwarding it to some people, and it forwarded on and forwarded on. It went viral. Then media started picking it up and started amplifying it. Then he went to work for this startup, that were really trying to essentially allow him freedom to try and create contagious content. He played around with what makes something spread. He found that things like generating controversy and jumping on new stories and thinking about some of the connections and motivating factors that cause people to spread stuff, and had a lot of success doing it, and ended up forming Buzzfeed, essentially putting a lot of these ideas into practice. Some of the metrics that they would use have direct epidemiological analogs. He worked with a lot of network scientists, trying to evaluate how contagious certain bits of content were.
Steve Paulson (48:45):
It makes me wonder if we can spread good news or spread happiness, spread positivity. Can we do that?
Adam Kucharski (48:53):
I'd like to think we can, and we can hopefully do it more. I think there are features of contagious content which unfortunately do favor, in some cases, harmful information. Particularly content that triggers things like anger, things like disgust, often have that advantage, but there are indications that strong emotions on the other side, so things like wonder and awe, a story about cool science, for example, might spread very widely. A lot of the studies that are being done online, have done historically, is around how to get people to click stuff and retweet stuff. When studies have actually looked at is that making people happier and healthier, there doesn't always seem that there's that much evidence, that yeah, it might generate more engagement, but the users aren't really getting that much out of it. I think we need to have more focus and studies actually asking how do we make these things better for people and actually what's the outcome interested in. Are we interested in just stuff getting clicked or do we want that to have a positive impact on people's lives? I think designing research to get at that more fundamental question is going to be really important.
Anne Strainchamps (49:59):
Adam Kucharski is an epidemiologist at the London School of Hygiene and Tropical Medicine, and author of the Rules of Contagion. You can read Steve's full interview with him in Nautilus Magazine. The link is on our website at ttbook.org. Thanks for listening today. The production team for To The Best Of Our Knowledge is based in Madison, Wisconsin. Shannon Henry Kleiber produced this hour, with help from Charles Monroe-Kane, Angelo Bautista, and Mark Riechers.
Anne Strainchamps (50:39):
Our technical director and sound designer is Joe Hardtke. Our executive producer is Steve Paulson. I'm Anne Strainchamps. Stay safe. Stay healthy. We'll talk again next time.
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