Forge Friday Roundup - May 1, 2020

May 1, 2020

In today’s Roundup: challenges for app-based contact tracing; parsing remdesivir trial results (and how they’re communicated); integrating data to support palliative care; data shows disparate impact of COVID across NYC; e-cig study casts doubt on hypothetical cardiovascular benefit; understanding how COVID mutates and spreads; childhood immunization rates plummet; calls to boost CDC, WHO resources and independence; issues created by unregulated mobile health research; some surgical masks exposing medical personnel to greater risk; much more:

 Hubble Space Telescope image of red nebula (NGC 2014) and blue nebula (NGC 2020) in the Large Magellanic Cloud, a satellite galaxy of the Milky Way. Image credit: NASA, ESA and STScI
Image credit: NASA, ESA and STScI
  • Some cosmic perspective, courtesy of NASA’s Jet Propulsion Laboratory: “The OJ 287 galaxy hosts one of the largest black holes ever found, with over 18 billion times the mass of our Sun. Orbiting this behemoth is another black hole with about 150 million times the Sun's mass. Twice every 12 years, the smaller black hole crashes through the enormous disk of gas surrounding its larger companion, creating a flash of light brighter than a trillion stars - brighter, even, than the entire Milky Way galaxy.”
  • Cosmic perspective, part 2 (plus some gratuitous beauty): Happy 30th birthday to the Hubble Space Telescope.
  • If you’re one of the many penned up and hemmed in by social distancing and shelter-in-place mandates, Outside Online has some symptomatic relief for your cabin fever in the form of a curated series of live outdoor webcams that offer reassurance that the larger world still exists.
  • Who needs words when you’ve got moves like Buster? (Buster Keaton supercut courtesy @DaneshMike).
  • This research paper has it all: dinosaurs, giant sea monsters, and a “robotic flapping apparatus.” Meet Spinosaurus aegypticus, as described in a new Nature paper by Ibrahim and colleagues (and described in this video) that reveals the enormous theropod as largely or totally aquatic predator.

  • “During the last decade, a tremendous amount of capital has been invested to better integrate information technology into healthcare. This includes development of technologies to promote utilization of palliative and hospice services. However, no coordinated strategy exists to link such efforts together to create a cohesive strategy that transitions from identification of patients through receipt of services.” In an article published in the American Journal of Public Health, Nicolla and colleagues describe SIDE, an approach to ensuring the efficient flow of needed information to the entire “ecosystem” of care surrounding patients with serious illness.
  • “The immediate use and successful application of digital technology to tackle a major, global public-health challenge in 2020 will probably increase the public and governmental acceptance of such technologies for other areas of healthcare, including chronic disease in the future.”  A commentary article published in Nature Medicine in late March by Daniel Shu Wei Ting, Lawrence Carin, Victor Dzau, and Tien Y. Wong looks at how digital technologies and machine learning can be deployed for best effect amid the COVID-19 pandemic while also providing the foundation for a more durable digital infrastructure for healthcare, research, and public health (H/T @rusincovitch).
  • “You can use technology to track the virus, but you can still give people the freedom of choice, and, in doing that, people trust that the technology is for virus tracking and not for any other purposes. I think it is essential that we show that we really mean it when we say that you should be able to trust technology when you use it, that this is not a start of a new era of surveillance.” The New Yorker’s Isaac Chotiner interviews Margrethe Vestager, the Danish politician who heads up the EU’s antitrust enforcement, about what lies ahead for big tech in a world changed by the coronavirus pandemic.
  • The Open AI project debuts Jukebox, a neural net that generates pop music pastiches in a variety of different genres and styles. As MIT Technology Review explains: “Computer-generated music has been a thing for decades and AIs already have impressive examples of orchestral classical and ambient electronic compositions in their back catalog. But it is much easier for a machine to generate something that sounds a bit like Bach than the Beatles…Despite being simpler, pop songs are different.”
    Old-fashioned vinyl-record jukebox standing against a brick wall. Image credit: bady qb via Unsplash
    Image credit: bady qb via Unsplash
  • At the Journal of the American Medical Informatics Association, a qualitative study by Watson and colleagues finds that despite significant activity and enthusiasm, academic medical centers are still grappling with the challenges of implementing and maintaining machine learning applications. The authors also posit some key steps for overcoming these issues (H/T @rusincovitch).
  •  “We are constantly revising the way we listen to the city, and for at least a century our aural capacities have been growing in the direction of urban surveillance and public health. With technology, we track sounds over greater distances, at different timescales and intervals, discerning patterns and aberrations that are often encoded as symptoms, so that we (or our public officials) can diagnose problems and apply cures…. Through these soundings, we grasp the city’s internal mechanics, assess the materiality of its parts, analyze its rhythms. And those two domains, surveillance and health, are increasingly entwined with a third, machine intelligence.” At Places Journal, anthropologist Shannon Mattern probes the complex relationships between technology, health, and the built environment – particularly as revealed through the act of listening.
  • Back to dreaming of electric sheep? “The US Patent and Trademark Office (USPTO) has ruled that artificial intelligence systems cannot be credited as an inventor in a patent, the agency announced earlier this week. The decision came in response to two patents — one for a food container and the other for a flashing light — that were created by an AI system called DABUS.” The Verge’s Jon Porter reports on a legal ruling that bars AI systems from being assigned patents for new inventions.

  • Thursday saw a flurry of news about findings from clinical trials of Gilead’s antiviral drug remdesivir, which has been the focus of intense interest as a possible COVID-19 therapy. First, a Chinese study by Wang and colleagues was reported in Lancet. In this study, a randomized trial of 237 patients assigned in a roughly 2:1 ratio of remdesivir vs placebo, the authors reported no statistically significant improvement in time to clinical improvement. Nearly simultaneously, the National Institute of Allergy and Infectious Disease reported via public appearances and press releases on NIAID and NIH websites that a randomized clinical trial of remdesivir in more than 1000 participants had shown statistically significant benefit in time to clinical improvement; however, the trial has not yet been peer-reviewed or published, and detailed study data are not currently available. The news has sparked both excitement and caution, and Health News Reviews documents and critiques the public push-and-pull that has resulted from the mixture of enthusiasm about a potentially efficacious therapy versus a series of potentially contradictory results – results that are presently hard to compare and evaluate in the absence of peer-reviewed publication and full access to detailed study data. At In the Pipeline, Derek Lowe adds some further context for the recent findings, and what can and cannot be reasonably construed from them at this stage.
    Close-up photograph of a person, partially hidden in shadow, picking out a single reddish jigsaw puzzle piece out of a pile of blue ones. Image credit: Ryoji Iwata via Unsplash
    Image credit:  Ryoji Iwata via Unsplash
  • “The substantial variation in the rates for COVID-19 hospitalizations and deaths across the New York City boroughs is concerning. The Bronx, which has the highest proportion of racial/ethnic minorities, the most persons living in poverty, and the lowest levels of educational attainment had higher rates of hospitalization and death related to COVID-19 than the other 4 boroughs.” A research letter by Wadhera and colleagues published in JAMA examines the distribution of hospitalizations and deaths due to COVID across the five boroughs of New York City, and finds substantial differences associated with geography and socioeconomic factors.
  • “Widespread contact tracing will be key to the next phase of our coronavirus response, but the U.S. is severely behind….As with diagnostic testing, the U.S. missed its chance to do this before the coronavirus caseload got too high.” An Axios brief summarizing the current state of US contact tracing efforts reveals the unfolding of a patchwork approach largely driven by some state-level efforts – and with no overarching plan to amass and deploy the needed personnel and resources.
  • “The Centers for Disease Control and Prevention recently said lower-grade surgical masks are “an acceptable alternative” to N95 masks unless workers are performing an intubation or another procedure on a COVID patient that could unleash a high volume of virus particles….But scholars, nonprofit leaders and former regulators in the specialized field of occupational safety say relying on surgical masks — which are considerably less protective than N95 respirators — is almost certainly fueling illness among front-line health workers, who likely make up about 11% of all known COVID-19 cases.” Kaiser Health News’ Shefali Luthra and Christina Jewett document the risks facing frontline medical personnel from the use of inadequate personal protective equipment (PPE).
  • “It’s here that talk of fast-tracking the timeline meets the messiness of real life: What if a promising vaccine actually makes it easier to catch the virus, or makes the disease worse after someone’s infected?” In an interactive timeline article in the New York Times, Stewart Thompson turns a critical eye on assurances that COVID vaccine will be ready for use within a span of months to a year – and walks readers through the steps (and attendant risks) of a greatly accelerated vaccine development and testing process.
  • “We found that chronic e‐cigarette use, alone or in conjunction with combustible cigarette use, was associated with a similar impairment of selected arterial stiffness measures. There is no evidence from our study that e‐cigarettes are a harm reduction tobacco product as compared with combustible cigarettes.” Although e-cigarettes have frequently been touted as healthier alternative to traditional cigarettes, a recently published research article by Fetterman and colleagues in the Journal of the American Heart Association suggests that they may be similarly problematic when it comes to cardiovascular health.
  • “The parts with few mutations are more brittle. Mutations in those parts may destroy the coronavirus by causing catastrophic changes to its proteins. Those essential regions may be especially good targets for attacking the virus with antiviral drugs.” Pathogen’s progress: a beautiful and informative New York Times infographic explainer by Jonathan Corum and Carl Zimmer traces the SARS-CoV-2 coronavirus as it hops around the globe, slowly mutating as it goes.
  • “Though inmates were spaced out in the dining hall, Williams said the bunk beds they slept in were not six feet apart. She wrote that women started hoarding bleach because there was a shortage of hygiene products at one point. Others started crocheting T-shirts together to make masks before prison staff distributed cloth masks. Before being released home, Williams asked if she could be tested for the virus. She was told ‘no.’” An article by North Carolina Health News’ Taylor Knopf reports on measures put in place to stem the spread of coronavirus at the NC Correctional Institution for Women, where 80 of 185 women in a minimum-security unit have tested positive for the virus.
  • “As parents around the country cancel well-child checkups to avoid coronavirus exposure, public health experts fear they are inadvertently sowing the seeds of another health crisis. Immunizations are dropping at a dangerous rate, putting millions of children at risk for measles, whooping cough and other life-threatening illnesses.” The New York Times’ Jan Hoffman raises the alarm about a decidedly unwelcome side effect of the coronavirus pandemic – a precipitous drop in rates of childhood immunization.

  • “…the effort faces several major barriers, including that approximately 1 in 6 Americans do not have smartphones, which would be necessary for running any apps produced by the initiative. Rates of smartphone ownership are much lower among seniors, who are particularly vulnerable to the ravages of covid-19…Among the 82 percent of Americans who do have smartphones, willingness to use an infection-tracing app is split evenly, with 50 percent saying they definitely or probably would use such an app and an equal percentage saying they probably or definitely would not.” The Washington Post reports on polling that suggests that an ambitious joint effort by Apple and Google to use smartphones for digital contact tracing faces significant headwinds (H/T @BraveBosom). Meanwhile, Ashkan Soltani, Ryan Calo, and Carl Bergstrom, writing at Brookings’ Tech Stream, express skepticism that such app-based tracing can suffice for contact tracing efforts (H/T @DrSherryPagoto). A group of Johns Hopkins researchers and public health experts provide yet another perspective on an approach to contact tracing that would make use of digital technologies, although as a “force multiplier” to augment on-the-ground efforts. 
  • “Air travel is down more than 90 percent from this time last year. Then, the TSA was prodding more than 2 million people a day through body scanners and x-ray machines. Earlier this week, the total was only 130,000—itself up from even lower depths a few weeks ago. It will be a long, slow climb back to pre-coronavirus passenger numbers. And the price for getting there could mean a significantly smaller American airline industry.” Wired’s Alex Davies reports on the harm that the COVID pandemic may inflict on the air travel industry – harm that may prove long-lasting.
  • “Space-exploration delays are a tiny drop in the bucket of cancellations around the world. But they show how the pandemic has upended civilization more clearly than the postponement of important conferences or even the Summer Olympics have. Space exploration has long been seen as a marker of human ambition, a testament to our capacity to think beyond our earthly existence—and then actually loft ourselves toward the skies. As the threat of COVID-19 compels people to stay indoors, it also locks us in our own planet.” The Atlantic’s Marina Koren examines how the coronavirus pandemic’s reverberations are reaching as far as outer space.

Headquarters building of the US Centers for Disease Control and Prevention, near Emory University, Atlanta, Georgia. Image credit: Nrbelex via nl.en.wikipedia
Image credit: Nrbelex at nl.en.wikipedia (CC BY-SA 2.5)
  • “Since the beginning of the Covid-19 pandemic, the CDC has been inexplicably absent, and Americans are suffering and dying for it.” In a blunt editorial at STAT News, Harvard Global Health Institute Director Ashish K. Jha urges that that the U.S. Centers for Disease Control and Prevention resume its role as a global health leader in responding to the ongoing COVID pandemic.
  • “Governments have the WHO they deserve, an agency hobbled by chronic underfunding and weak political backing. It is little wonder that successive WHO directors-general have found it difficult to speak truth to power. With the devastating toll COVID-19 is taking across the world, it is past time to give the people of the world the WHO they deserve.” In an editorial at JAMA Health Forum, Lawrence O. Gostin lays out a series of steps for building a more effective and responsive World Health Organization.
  • “As the coronavirus wreaks havoc with hospital finances, wealthy hospitals sitting on millions or even billions of dollars are in a competitive stampede against near-insolvent hospitals for the same limited pots of financial relief. Those include the $175 billion bailout fund Congress allotted for health care providers as part of two recent coronavirus packages and loans from private banks.” Kaiser Health News’ Jordan Rau shines a light on the prospects facing safety-net hospitals coping with COVID stresses with thin or nonexistent margins and reserves, versus their wealthier counterparts.
  • A recent supplemental issue of the Journal of Law, Medicine and Ethics is devoted in its entirety to the problems of unregulated research conducted via mobile devices.
  • “Health system leaders and policy makers should take the lead in addressing these alarming disparities. In the short run, policy makers and leaders of health systems and health plans should heed calls by national medical organizations to expediently release racial and ethnic demographic data on COVID-19 infection and mortality. These data are necessary to accurately measure disparities and inform additional testing, medical resources, and ultimately preventative vaccination.” The disproportionate impact of the COVID-19 pandemic according to race, ethnicity, and other socioeconomic factors is also the focus of a JAMA Health Forum article by Essien and Venkataramani.