The more people who are in this, the more people who add their phone to the fight against COVID, the more protection we all get, she said. So everyone should do it. And the sky's the limit or the population is the limit.
The service exchanges tokens with nearby phones that also have the program running and are within six feet of one another for at least ten minutes. The app uses push notifications and Bluetooth to share the token information, which do not contain personal identifying information, according to the health department.
If a person tests positive for COVID-19, theyre able to share that information through the app which will then notify others about possible exposure, but will not indicate who the person is with COVID-19.
People cant lie about their test results, Tuneberg said. After receiving a positive test result they will get a link from a public health professional that allows them to access the app, answer a few questions and the app will notify people who may have been exposed. That link only works once.
Because of privacy concerns, Tuneberg said the state has opted out of collecting certain data points like user locations or demographic information.
We felt it was much more important to protect privacy first and have less data on the state's side because we really want more people to enable the service, and the research we did found that the less tracking data, actually no tracking data, was the way to facilitate the highest level of adoption, Tuneberg said. It was a trade-off we really wanted because we'd rather save lives than have great data.
At least we know more now, I offer. This is not false reassurance. We know that masks and distancing, testing and contact tracing, can prevent spread. Though there is no magic bullet for this disease, we know that a simple inexpensive steroid seems to save lives. The data for remdesivir, the antiviral so many families sought so desperately early on, are less clear, but it is likely helpful for some patients particularly early on in their disease course.
Perhaps more important, we have learned what doesnt work. We no longer rush to intubate earlier than we would in other diseases. For those patients who do need intubation, we recognize that meticulous critical care itself the daily drudgery of managing volume status and checking labs and titrating ventilator settings is a lifesaving intervention. Indeed, recent studies have demonstrated a significant drop in mortality among hospitalized patients with the virus. This should give us reason to be hopeful.
But mortality is not the only outcome that matters. We have also learned that infection with the coronavirus can bring with it a host of prolonged, debilitating symptoms now termed long-haul Covid even for those with only mild disease. And the impact of this virus is not isolated to those who are infected. I think of the rest of the patients in the hospital, their long and lonely admissions. I think of the families who struggle with our visitor policies, the pain of having to tell them that their loved one is critically ill but because the patient is not actively dying, the family cant spend the night. To say nothing of the cost to the elderly and isolated. I cared for a man recently who lived alone and had barely left his home in about six months. Only after he died did I realize that our central lines and breathing tube and finally chest compressions might have been the only physical contact he had felt since the spring. The true cost of this pandemic will not be measured in a body count.
So we control what we can. Looking ahead to the possibility of another surge here in the Northeast, as the cold air drives us indoors, we refine our protocols and procedures. We arrange schedules. We make cautious plans to see the people we love. We laugh when we can, even if nothing is actually funny, because that is better than the alternative.
A few days after my overnight shift, I check in on the patient list in the unit. The elderly man has worsened despite our most current therapies, and he is now intubated in the intensive care unit. As I read through his notes, I feel it all rush through me, the anticipation and the dread and the frustration and sadness of avoidable suffering. I close my eyes and I find myself thinking again of those brown bags of personal protective equipment. I hope that we will not need to make room for more.
Daniela J. Lamas is a critical care doctor at Brigham and Womens Hospital in Boston.
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A surge in new cases of coronavirus in the midwest continues, as Donald Trump plans multiple rallies in the region and presidential rival Joe Biden heads out to campaign in Georgia.
Researchers at Johns Hopkins University recorded 60,789 new cases in the US on Monday, not far off all-time highs reached at the weekend. Total cases have surpassed 8.6m, with more than 225,000 deaths.
Trump continues to bleed political support from the perception that he does not take the virus seriously. Despite that, on Monday night he held a ceremony at the White House for the supreme court justice Amy Coney Barrett, which was reminiscent of an earlier event linked to an outbreak of Covid-19 that infected the president himself.
Trump, Barrett, her husband, Jesse Barrett, and the supreme court justice Clarence Thomas appeared outside the White House without masks for a ceremonial swearing-in.
On Tuesday, Trump traveled to a rally in Michigan and planned to go on to events in Wisconsin and Nebraska the same day, on a pre-election blitz across three states where cases are rising most steeply. New daily cases in Michigan have more than doubled in the last week, while Nebraska has one of the highest rates of test positivity in the nation at 21.5% over the last week, according to Johns Hopkins.
Wisconsin, one of the most important electoral prizes, where the Democratic governor has asked Trump previously not to hold rallies that could spread coronavirus, broke one-day state records on Tuesday in Covid-19 deaths and cases as state officials told residents to stay home, wear a mask, and implored them to cancel travel and social gatherings.
The state had 64 deaths due to the virus and 5,262 new cases over the last 24 hours, state officials said during an afternoon news conference.
Thousands of supporters attended a Trump rally last week in Waukesha, Wisconsin, for which a local rural activist group rented out a billboard reading Trump Covid Superspreader Event, with an arrow.
Local doctors urged the president not to hold a rally on Tuesday evening in western Wisconsin.
Returning to Wisconsin, repeating a reckless, risky event like a packed campaign rally is just asking for trouble, said Robert Freedland, an ophthalmologist in La Crosse and state representative for the Committee to Protect Medicare, according to a local media report.
In all likelihood, my colleagues in La Crosse will be putting on their N95 masks and dealing with the impacts of Trumps super-spreader event long after he leaves. It is dangerous and its unacceptable, Freedland said.
But the plea was likely to fall on unsympathetic ears in the Trump campaign, just as similar pleas did when the president held a rally in Janesville in the state earlier this month.
Meanwhile, Joe Biden delivered speeches with social distancing measures in place in Georgia, which has recorded fewer than 1,000 cases a day over the last seven days and where test positivity is at 7.2%.
While Covid-19 hotspots are proliferating across the US, the states undergoing the most serious increases are Illinois, Texas, Wisconsin, Tennessee and California, according to Johns Hopkins.
The vice-president, Mike Pence, who continues to campaign despite having been in close contact with confirmed Covid-19 cases including his chief of staff, planned to speak in North Carolina and South Carolina on Tuesday.
Bidens running mate, Kamala Harris, planned to speak in Nevada, where most voters vote early and Democrats are in a tough fight to keep the state blue.
Elections officials across the country have issued health safety guidelines for voters planning to visit polling sites in person.
The city of Green Bay, Wisconsin, advised voters to wear a mask, wash hands and maintain 6ft distance. In Michigan, the secretary of state issued personal protective equipment to all poll workers. More than half the teams in the National Basketball Association have taken steps to convert their facilities into safe polling places.
In states such as Texas that do not have a mask mandate, officials advised voters to take extra precautions.
To prevent becoming infected from someone who has Covid and is not wearing a mask, be sure to wear a mask to the polling site that is of sufficient quality to protect not only others, but also yourself, Erin Carlson, the director of graduate public health programs at the University of Texas at Arlington, told Mirage News.
Also, remember to carry your own black pen, stylus and hand sanitizer. If you dont have a stylus, bring a wipe to wipe down the polling booth touchscreen before you use it.
Residents in the border city of El Paso have been urged to stay home for two weeks as coronavirus cases threaten to overwhelm some hospitals, potentially keeping some voters away from polls.
We are in a crisis stage, said El Paso county judge Ricardo Samaniego.
China appears to have comprehensively lost the international battle for hearts and minds over its handling of coronavirus with most people believing it was responsible for the start of the outbreak and was not transparent about the problem at the outset.
The findings come from the YouGov-Cambridge Globalism Project, a survey of 26,000 people in 25 countries, designed with the Guardian.
It is the widest survey of global public opinion on Chinas handling of the pandemic, and the overwhelmingly negative attitude will disappoint Chinese diplomats, who have expended huge energy to deflect blame and paint the country as altruistically helping others to recover.
Overall, the poll suggests there is a receptive global audience for the next US president, if he chooses, to construct an international alliance to challenge Chinas growing political dominance, and to question the moral values of its leadership. There is no sense in the findings, however, that the US would be able to exploit its handling of the crisis to take on that leadership role.
The survey shows that in every country surveyed, apart from China, the public overwhelmingly believe that coronavirus was first detected in China. Nigeria had the highest rate (98%), closely followed by Greece and South Africa (97%) and Spain (96%). The countries with the lowest rates, apart from China, were Saudi Arabia, where 83% thought China was responsible, and the US (84%).
By contrast, only 52% of respondents in China believe that coronavirus was first detected in the country and just over one in 10 (12%) of respondents in China said they did not know when asked in which country the virus was first detected. Just under a third of these respondents believe the virus was first detected in the US.
Majorities in most countries also do not believe the Chinese government was transparent about coronavirus when it was first detected in the country at the end of 2019.
In Great Britain, four in five respondents believe that the Chinese authorities tried to hide the truth. Japan (84%) followed by Spain (82%) has the highest rate of respondents who believe the Chinese authorities tried to hide the truth, but the numbers are similar through the EU.
The public is less certain whether China sought to punish the doctors that first detected the virus, but majorities in every European country surveyed, save Greece, think China either definitely or probably sought to do so.
China will likely be disturbed that majorities in South Africa and Nigeria thought the country went to the extreme of punishing doctors. China has often regarded Africa as one of its more stable sources of political support.
Large numbers in many countries, often a fifth, say they simply do not know if doctors were targeted, an issue that is likely to be explored by the World Health Organizations external inquiry into the virus outbreak.
Many also blame the Chinese government by saying it could have prevented the spread of the virus. In Great Britain, 67% of respondents believe that the international spread of the virus could have been prevented if the Chinese government had responded more quickly.
Opinion is divided about the country that has shown the most global leadership in the crisis, but the predominant finding is that no single country is singled out for this accolade.
Within China, nearly nine out of 10 respondents claim their government has shown the most global leadership. However, this view is hardly reflected globally with negligible numbers in Europe praising China.
The number of respondents praising China range from Sweden (1%), Great Britain (1%) Germany (2%), Australia (2%) and Japan (3%). In Thailand and Egypt more than a fifth cite China, but the most striking finding is how few people can point to any country as showing leadership.
A few countries praise Germany, but no country is seen as an inspirational leader. Only in Nigeria and the US did more than a fifth single out US leadership.
The Tampa International Airport has started coronavirus testing for passengers with a boarding pass or proof of a reservation for a flight in the near future. Danny Valentine/Hillsborough County Aviation Authority hide caption
The Tampa International Airport has started coronavirus testing for passengers with a boarding pass or proof of a reservation for a flight in the near future.
For people who are itching to travel, airlines are working hard to offer reassurance. They're requiring masks, disinfecting airplane cabins between flights and using hospital-grade HEPA air filtration systems. Airlines are also touting a recent study that shows that modern aircraft ventilation systems help prevent the spread of the coronavirus and suggests the probability of spreading and contracting the coronavirus on even a packed airline flight is low.
Now they're offering one more thing in hopes of putting travelers' minds at ease about flying: testing for the coronavirus at the airport, before you board your flight. The tests are allowing some travelers to reschedule and take vacations they had to cancel or postpone months ago.
Matt Battiata and his wife and four kids had to postpone a dream vacation to Hawaii's lush landscapes and sparkling beaches back in March, when the island state began requiring every traveler to self-quarantine for 14 days upon arrival. That essentially shut down tourism there. After all, who would want to fly all the way to Hawaii just to be trapped in their hotel room for two weeks?
But the Battiata family finally landed at Honolulu's airport last week.
"We're just happy to be able to come and visit," Battiata said after presenting proof of the family's negative coronavirus tests to airport workers on the first day Hawaii reopened to those who test negative for the coronavirus.
"We got a rapid test, it took about 30 minutes, you know, a nasal swab test," Battiata said, adding that "everybody's clear, yeah, so we're very excited."
Airlines are excited, too, to get paying customers back on their planes, so they're helping facilitate coronavirus testing for travelers heading to certain destinations, like Hawaii. And some are even offering on-the-spot, rapid response testing at the airport before passengers go through security.
United Airlines was first to announce on-the-spot preflight testing, which it offers only at San Francisco's airport for Hawaii-bound travelers. For results in 15 minutes, it costs you $250, on top of the airfare. There are also less expensive drive-up or clinic testing options, which provide results usually in less than 48 hours.
United and other airlines have worked with Hawaii public health officials to make sure the tests meet the state's requirements for accuracy and reliability.
United Airlines was the first to announce on-the-spot preflight testing, which it offers only at San Francisco's airport for Hawaii-bound travelers. Courtesy of United Airlines hide caption
United Airlines was the first to announce on-the-spot preflight testing, which it offers only at San Francisco's airport for Hawaii-bound travelers.
Other airlines are now offering coronavirus testing, too, including American, JetBlue and Hawaiian. And some airports are getting into the coronavirus testing game, too.
"We do the test right here in the main terminal," says Joe Lopano, CEO of Tampa International Airport. "We only test travelers, so you have to have either a boarding pass or proof of a reservation for a flight in the near future."
And Lopano says the testing "is not just destination specific or airline specific. Any traveler going anywhere on any airline can get the test."
The Tampa airport is offering two kinds of tests.
"The rapid test, which will give you results in 15 minutes, costs $57," Lopano says. "And then the more accurate PCR test costs $125 and you get your results within 48 hours."
Lopano says some people will take the rapid test on the day they're flying to have some reassurance before visiting friends and family, while those going to specific destinations that require travelers to test negative less than three days before arrival will come to the airport a day or two ahead of time to take the more reliable PCR test.
"You know, this pandemic is a threat to our business, so we have to find a way to work through it," Lopano says. "[The coronavirus testing] helps. It's not the ultimate solution which a vaccine would be. We want to be proactive. We have to be part of the solution on this virus."
Other airports offering preflight coronavirus testing include Newark, New York's JFK, Hartford and Oakland, which is offering testing for Hawaii-bound travelers for free.
"What the airlines and airports are trying to do is remove every possible obstacle people have when they start to think about taking a trip," says Henry Harteveldt, president and travel industry analyst for the Atmosphere Research Group, a travel industry research firm. "They want to make it as easy for people to travel and to travel confidently."
But public health experts say not all rapid response tests are equal, and some are not all that accurate.
"Most of the rapid tests that are inexpensive and can be done frequently and easily have a lower sensitivity," says Mercedes Carnethon, an epidemiologist and professor of pulmonary and critical care at Northwestern University's Feinberg School of Medicine. "And what that means is that the likelihood that they will actually identify a positive case in an asymptomatic individual is fairly low."
"You can get a negative test but in fact, a day or two later, your viral levels can surge and then you're really quite infectious," Carnethon says. She adds that she fears on-the-spot, rapid result testing may give travelers "a false sense of security," especially those coming from areas where the number of coronavirus cases are surging again, who may then believe that they are coronavirus-free, when they still may be carrying the virus.
"I don't see a reality in which you can test your way out of the behaviors that are directly related to preventing the spread of the disease," Carnethon says, pointing to high profile events, such as the White House Rose Garden ceremony where President Trump announced he was nominating Amy Coney Barrett to the Supreme Court. "Much was made over statements that everyone was tested and tested negative before they were able to come. And yet we see transmission."
Nonetheless, a growing number of airline, travel industry and business groups are calling for widespread pre-flight coronavirus testing to eliminate the need for travel bans and quarantines, in an effort to jump start an industry decimated by the pandemic. Industry figures show that domestic air travel is down more than 60% from pre-pandemic levels and international travel is down 78%.
The U.S. Chamber of Commerce, the U.S. Travel Association, the International Air Transport Association, Airlines for America, airline employee unions and others are calling on the Trump Administration, state governors and several foreign countries "to pursue a risk-based and data-driven approach to coronavirus testing which would obviate the need for quarantines and travel bans so that the travel network can be safely reopened."
The group say 18 states currently have some kind of quarantine requirement in place for travelers from out of state. The U.S. still bans entry by nearly all non-U.S. citizens who recently were in China, the United Kingdom, Ireland, Brazil, Iran and parts of Europe. And nearly all of Europe still prohibits most U.S. travelers from entering.
The groups say "the continued restrictions on international travel and differing state and international quarantine policies are hampering the recovery of the U.S. economy."
From the start of the pandemic, supercomputing research has been targeting one particular protein of the coronavirus: the notorious S or spike protein, which allows the virus to pry its way into human cells and thus enables its infection of the human body. As a result, finding ways to attack or neutralize the spike protein is the cornerstone of much of the research on COVID-19 vaccines and therapeutics but that research is complicated by the extraordinarily computationally intensive tasks of simulating the spike proteins various forms and binding vast numbers of molecules to those forms. Now, a duo of researchers from the University of California, Berkeley, and Istanbul Technical University are using supercomputing at the Texas Advanced Computing Center (TACC) to elucidate the most minute movements of the spike protein.
Spike protein-adjacent simulations have been near-ubiquitous in supercomputer-powered coronavirus research and the researchers know where they fit into that crowded landscape. Many groups are attacking different stages of this process, said Mert Gur, vice dean of the mechanical engineering department at Istanbul Technical University, in an interview with TACCs Aaron Dubrow. Our initial goal is to use molecular dynamics simulations to identify the processes that happen when the virus binds to the host cell.
Essentially, this involves four steps: first, the spike protein opens; second, it binds to the ACE2 receptor on a human cell; and third, that binding transforms the spike protein, which is split in two; and finally, the split spike protein forces the host cell to admit viral RNA. While the broad strokes of this process have been known since early in the year, the finer details of the movements of the spike protein between its fixed states have remained shrouded in relative mystery.
Gur and his colleague Ahment Yildiz, an associate professor of physics and molecular cell biology at UC Berkeley used an allocation on TACCs Stampede2 supercomputer (obtained through the COVID-19 HPC Consortium) to study these intermediary forms. A Dell EMC system, Stampede2 is equipped with Intel Xeon Phi CPUs and rates at 10.7 Linpack petaflops, placing it 21st on the most recent Top500 list of the worlds most powerful supercomputers. Yildiz and Gur performed all-atom simulations of the spike protein on Stampede2 and the results were illuminating.
We showed that the S protein visits an intermediate state before it can dock to the receptor protein on the host cell membrane Gur said. This intermediate state can be useful for drug targeting to prevent the S protein to initiate viral infection.
But the research went beyond just finding these intermediary states. The researchers worked to identify the individual amino acids that stabilize each state, aiming to find a way to introduce roadblocks in the physical changes of the spike protein.
If we can determine the important linkages at the single amino acid level which interactions stabilize and are critical for these confirmations it may be possible to target those states with small molecules, Yildiz said. Its a computationally demanding process, but the predictive power of this approach is very powerful.
The initial findings of this research, which have already been published in the Journal of Chemical Physics, were validated using lab experiments.
To read the reporting by TACCs Aaron Dubrow, click here.
Some survivors of Covid-19 carry worrying signs that their immune system has turned on the body, reminiscent of potentially debilitating diseases like lupus and rheumatoid arthritis, a new study has found.
At some point, the bodys defense system in these patients shifted into attacking itself, rather than the virus, the study suggests. The patients are producing molecules called autoantibodies that target genetic material from human cells, instead of from the virus.
This misguided immune response may exacerbate severe Covid-19. It may also explain why so-called long haulers have lingering problems months after their initial illness has resolved and the virus is gone from their bodies.
The findings carry important implications for treatment: Using existing tests that can detect autoantibodies, doctors could identify patients who might benefit from treatments used for lupus and rheumatoid arthritis. There is no cure for these diseases, but some treatments decrease the frequency and severity of flare-ups.
Its possible that you could hit the appropriate patients harder with some of these more aggressive drugs and expect better outcomes, said Matthew Woodruff, an immunologist at Emory University in Atlanta and lead author of the work.
The results were reported Friday on the preprint server MedRxiv, and have not yet been published in a scientific journal. But other experts said the researchers who carried out the study are known for their careful, meticulous work, and that the findings are not unexpected because other viral illnesses also trigger autoantibodies.
Im not surprised, but its interesting to see that its really happening, said Akiko Iwasaki, an immunologist at Yale University. Its possible that even moderate to mild disease may induce this kind of antibody response.
For months it has been clear that the coronavirus can cause the immune system to run amok in some people, ultimately wreaking more damage to the body than the virus itself. (Dexamethasone, the steroid President Trump took after his Covid diagnosis, has proved effective in some people with severe Covid to tamp down this over-exuberant immune response.)
Viral infections cause infected human cells to die. Sometimes the cells die a quiet death but sometimes, and especially in the throes of severe infection, they can blow up, strewing their innards. When that happens, DNA, normally cloistered in coiled bundles inside the nucleus, is suddenly scattered and visible.
In the typical response to a virus, cells known as B immune cells make antibodies that recognize pieces of viral RNA from the virus and lock onto them.
But in conditions like lupus, some B cells never learn to do this and instead produce autoantibodies that glom onto DNA debris from dead human cells, mistaking them for intruders. Something similar may be happening in patients with Covid-19, the research suggests.
Anytime you have that combination of inflammation and cell death, there is the potential for autoimmune disease and autoantibodies, more importantly, to emerge, said Marion Pepper, an immunologist at the University of Washington in Seattle.
Dr. Woodruff and his colleagues reported earlier this month that some people with severe Covid-19 also have such unrefined B immune cells. The finding prompted them to explore whether those B cells make autoantibodies.
In the new study, the researchers looked at 52 patients within the Emory health care system in Atlanta who were classified as having either severe or critical Covid-19, but who had no history of autoimmune disorders.
They found autoantibodies that recognize DNA in nearly half of the patients. They also found antibodies against a protein called rheumatoid factor and others that help with blood clotting. Among the top half of the most seriously ill patients, more than 70 percent had autoantibodies against one of the targets tested, Dr. Woodruff said.
Its not just that these patients have an autoimmune-like immune response, he said. Its that those immune responses are coupled with actual true testable clinical auto-reactivities.
Some of the autoantibodies the researchers identified are associated with blood flow problems, noted Ann Marshak-Rothstein, an immunologist and lupus expert at the University of Massachusetts, Worcester.
Its very possible that some of the coagulation issues that you see in Covid-19 patients are being driven by these kinds of immune complexes, she said.
If the autoantibodies do turn out to be long-lasting, she said, they may result in persistent, even lifelong, problems for Covid-19 survivors.
You never really cure lupus they have flares, and they get better and they have flares again, she said. And that may have something to do with autoantibody memory.
Dr. Marshak-Rothstein, Dr. Iwasaki and dozens of other teams are closely studying the immune response to the coronavirus. Given the ease of testing for autoantibodies, it may soon become clear whether the antibodies were identified only because the researchers went looking for them, or whether they represent a more permanent alteration of the immune system.
Its not clear to me what it all means at this point, Dr. Pepper said. Its going to take a little bit of time to understand if this is something thats going to lead to downstream pathology.
An employee takes a pile of chairs inside a closing bar on the Place du Capitole in Toulouse, France on Saturday. Coronavirus cases in the country just topped a million, and there's a new government-imposed curfew. In large parts of the France you can't be out after 9 p.m. Fred Scheiber/AFP via Getty Images hide caption
An employee takes a pile of chairs inside a closing bar on the Place du Capitole in Toulouse, France on Saturday. Coronavirus cases in the country just topped a million, and there's a new government-imposed curfew. In large parts of the France you can't be out after 9 p.m.
The U.S. looks poised to exceed its summer peak, when the country averaged as many as 65,000 cases a day for a 10-day stretch in late July. The seven-day average of cases is now more than 69,000, according to the COVID Tracking Project.
The situation is similar in Europe, which just logged more new cases than any week so far.
Cases are rising in North Dakota faster than any other state. Fargo Mayor Tim Mahoney recently imposed a mask mandate there.
NPR's Will Stone reports on the growing outbreak in the Midwest, where some hospitals may not be able to handle an influx of COVID-19 patients.
In participating regions, you'll also hear a local news segment that will help you make sense of what's going on in your community.
Email us at considerthis@npr.org.
This episode was produced by Brianna Scott Lee Hale, and Brent Baughman. It was edited by Sami Yenigun with help from Wynne Davis. Additional reporting from Eleanor Beardsley. Our executive producer is Cara Tallo.
Minnesota Governor Tim Walz and the state's top health officials have urged residents to not be anything other than vigilant as the state's virus statistics continue to soar.
"Just because we want it over, does not make it over," Walz said Monday.
The governor called on Minnesotans to avoid large gatherings and to continue practicing social distancing. He added that the next couple of months will be crucial in the fight against the virus.
"We need to take action right now," he said.
Minnesota has seen a surge in COVID-19 cases since the start of the month, with health officials reporting at least 20 days where newly-reported infections were over 1,000. Two days saw totals breach 2,000 new cases.
With a 70% spike in hospitalizations in the last month, health officials worry about what's to come. The state hit a new daily high for hospitalizations with 614 the highest since May.
On Monday, President Trump's Administration announced that the U.S. Department of Health and Human Services is sending 1,690,00 Abbott BinaxNow COVID-19 antigen tests to Minnesota. The rapid point of care tests, which can diagnose coronavirus infection in as little as 15 minutes, will be distributed at the discretion of Gov. Walz "to support testing K-12 students, teachers, nursing home patients and staff, higher education, critical infrastructure, first responders, and other priorities as he deems fit."
Having to adapt to different situations throughout my life prepared me [for] a different virus, saysAkiko Iwasaki of Yale University.
By Jennifer Couzin-FrankelOct. 27, 2020 , 10:40 AM
Sciences COVID-19 reporting is supported by the Pulitzer Center and the Heising-Simons Foundation.
Until this year, Akiko Iwasaki had never had tubes of human blood delivered to her lab. We were mostly working with mouse models, says the Yale University immunologist, who speaks precisely and thoughtfully. We used to look at the data and contemplate it. Then COVID-19 struck, and such unhurried musings flew out the window. In a matter of weeks, Iwasaki overhauled her research to launch a slew of studies on how the new virus, SARS-CoV-2, takes its toll on patients. She and her nearly two dozen lab members know their discoveries could impact people falling sick right now. Every minute counts.
In the months since, she has produced a string of high-profile papers in which she has redirected her expertise in the immune system, honed in mice, to questions such as why men are more likely than women to fare poorly if infected and how immune responses in hospitalized patients can help predict their prognosis. Now, she is turning her attention to long-haulers, people who suffer a bout with the virus and dont fully recover.
Iwasaki has had decades of practice adapting to new circumstances. As a child growing up in rural Japan, she dreamed of becoming a poet, turned off science by her physicist fathers immersion in his profession. Wed go on vacation and hed bring papers with him, she says, laughing. I thought, What kind of life is this? But when a high school teacher hooked her on math, she began to reconsider. Soon after, 9 months as an exchange student in Canada left her itching to escape the expectations for a woman in Japanese societymarry a nice man and have a family. Her mother, who worked at a local radio station, had endured jeers from co-workers for sticking with the job while raising three children. Knowing how much she stood up for always has stayed with me, Iwasaki says.
So she reimagined her future, embracing science and leaving Japan. She enrolled as an undergraduate at the University of Torontofalling hard for immunology her senior year thereand stayed on for graduate school. Twenty years ago she founded her lab at Yale, where she studies how the body responds to and combats viruses. Having to adapt to different situations throughout my life, she says, prepared me [for] a different virus.
The shift called for new science, new collaborations, and new skills. In February, Iwasakis lab joined a universitywide testing effort for SARS-CoV-2 led by Albert Ko, Nathan Grubaugh, and Anne Wyllie at Yales School of Public Health. Alice Lu-Culligan, a graduate student of Iwasakis who had been studying the immune system during pregnancy in mice, recalls the scramble. Lab members scouted for supplies such as swabs and equipment. We were going around our floor, to the neighboring labs, seeing how many PCR [polymerase chain reaction] machines they had, Lu-Culligan says. It was full-on sprint mode, collaboration and chaos.
As Iwasakis lab was helping Grubaughs group sequence viral genomes from early patients in Connecticut to mapthe spread there and across the United States, she launched a separate study to examine patients immune responses. She recruited 113 people with COVID-19 at Yale New Haven Hospital and redeployed expertise in her lab to make the project happen. Postdoctoral fellow Carolina Lucas had been studying the mosquito-borne chikungunya virus, and her project was housed in a biosafety level 3 lab at the university, the kind used for hazardous pathogens. Akiko asked me to coordinate this, says Lucas, who quickly agreed.
Every few days, the team collected samples from the nose, throat, and blood of patients. There were all these weird immune responses being engaged, Iwasaki says. In severe cases, the immune system churned out a flood of cytokine proteins. Lucas, Iwasaki, and others found four immune signatures thatappeared to correlatewith later outcomes. That paper appeared inNaturein July.
Swiftly, the scientific questions mushroomed. In mid-March, the Yale hospital treated a woman with COVID-19 who was in her second trimester of pregnancy. The woman lost her fetusand a private tragedy became interwoven with urgent questions about whether the virus could infect the placenta and pose a danger to the pregnancy. A collaborator of Iwasakis secured permission to collect the placenta, and late one night, Lu-Culligan retrieved it. Until that moment, the only placentas Lu-Culligan had seen belonged to mice. This is big and bloody, she says, and as she stared at it under a biosafety hood, Im thinking, I dont know what Im doing here.
In that case, the virus had indeed infected the placenta, and Lu-Culligan began to collaborate with Yale obstetricians to recruit women delivering at the hospital who were positive for the virus to study their placentas, too. That paper is nearing completion.
Meanwhile, Iwasaki began to investigate sex differences and found themale immune system is more likely to spark a harmful inflammatory responseto the virus, whereas in women, T cells that fight it off are activated more robustly. These distinctions, she reported in an August paper inNature, might help explain why men who are infected tend to fare worse than women.
Iwasakis juggling act impresses her colleagues. Shes made it seem so effortless, even though I know its probably not effortless at all, says Angela Rasmussen, a virologist at Columbia Universitys Mailman School of Public Health. Iwasakis husband, Ruslan Medzhitov, is also a well-known Yale immunologist (they discuss COVID-19 while walking their dog), and the pair has two daughters, ages 11and 13. Iwasaki fears the pandemic is widening the gender gap in science as women face disproportionate pressure to support their children when schools are closed. Her husband drives their daughters to in-person school each morning, but with COVID-19 cases climbing, she wonders how much longer schools will be open.
Solutions to a COVID-19fueled gender gap in science are elusive, she says, other than to really have a different mindset about evaluating progress in science during this time. Iwasaki has long advocated for female and minority scientists on Twitter, where she has 80,000 followers. In one post, she minced no words in advising female scientists who worry about pregnancy torpedoing a job interview: If they dont welcome you with open arms and offer child care options, they dont deserve you.
Her advocacy goes beyond rhetoric. Lu-Culligan met Iwasaki at a luncheon for women in science at Yale, while struggling with bullying and harassment in another lab. Iwasaki said, We have to get you out of there, Lu-Culligan recalls. A few months later, the young scientist abandoned more than 2 years of graduate work to start over with Iwasakilater learning that she wasnt the first person her new mentor had rescued from a miserable experience elsewhere.
Nearly 9 months into the pandemic, lab life has settled downsomewhat. Iwasakis latest passion is long-haulers who cant shake symptoms like fatigue and brain fog. Volunteers find her via word of mouth. The project faces hurdles, though: Iwasaki is hunting for a facility to draw blood from her volunteers, who are still symptomatic and potentially contagious. With many competing studies, such space is at a premium and she hasnt yet been able to secure any. Shes also racing to apply for grants to fund the project.
We really want to get to the bottom of whats going on, she says impatiently. Until thenalong with so many other researchersshell be in overdrive.
