New pieces, new projects

And still haunted by the basics

I have two pieces out this week. The first one is a piece in the New York Times about the lack of systematic data and dearth of large-scale clinical trials, and how it is hindering our fight against the pandemic in many dimensions.

To overcome the fog of war, the Prussian general and military theorist Carl von Clausewitz called for “a sensitive and discriminating judgment” as well as “skilled intelligence to scent out the truth.” He knew that since decisions will have to be made with whatever information is available in the face of an immediate threat, it’s crucial to acquire as much systematic evidence as possible, as soon as possible.

In the current crisis, that has often been difficult.

These days, some experts grapple for answers on Twitter. They might be trying to figure out the effect of a vaccine booster shot by reverse engineering a bar chart in a screenshot from Israel’s Ministry of Health, or arguing with one another about confounding factors or statistical paradoxes.

Why this stumbling in the fog? It may seem like we’re drowning in data: Dashboards and charts are everywhere. However, not all data is equal in its power to illuminate, and worse, sometimes it can even be misleading.

The second piece is a review of airborne transmission of respiratory viruses published in Science—the team is mind-blowing and I’m just honored to be a co-author.

The review has a lot of fascinating details about the science of airborne transmission and aerosols, and is written at a relatively high-level (since it’s a review) so you might find it interesting even if this is far from your fields.

I’ve learned a huge deal from my co-authors and other experts in this field in the past 18 months—just the bits about different sites of aerosol production, with changes the size distribution of the particles which in turn shapes where they can end up when they’re inhaled can and should help change our understanding of many aspects of respiratory disease. (The smaller they are, the deeper they can travel, which in turn influences the severity and progression of disease).

Just look at this figure:

Fascinating and interesting as it all is, I still cannot get over the HBO documentary on Diamond Princess where, essentially by the 9th of February 2020, the ship’s doctor had concluded there had to be presymptomatic transmission, and it was clear as day that there was substantial airborne transmission. 

You can read the articles themselves, but I’ve been thinking about something larger in the context of both, a topic that has come up in this newsletter before—the role of existing basic science.

Check out this thread by Michael Mina (with whom I’ve co-authored before).

That thread above is from November 2020, when the initial vaccine trials were reported.

You can see how Michael goes through… the basics. As he says, the results are amazing. Vaccine manufacturers picked the right protein to target (not as easy as it appears now). But the immunity against symptomatic efficacy may eventually wane, but the immune system is not just about that (something I’ve written about before). The T and B-cells will likely continue to protect against severe disease, he points out.

And that’s why we have to carefully monitor what’s going on, to be able to catch such changes when and if they happen.

Yes, the basics.

As I’ve written before, there were three key pieces one needed to know early on for effective mitigation: airborne transmission, overdispersion and presymptomatic transmission. All three were apparent, at the latest towards the end of February and early part of March just from the epidemiology. As Michael Mina has repeatedly told me and has written: this was a textbook virus. That doesn’t mean there isn’t much to learn, data to collect or that a pandemic is difficult to manage. It just means that, as Mina points out, there are no big surprises, like HIV—a retrovirus that forced textbooks to be rewritten.

And yet here we are.

I’ve been thinking a lot about this: the institutional, epistemological and societal failures that held us back despite, on paper, we had all the pieces in place. Our science has never been better in many ways. The world is awash in wealth. Our technology is advancing all the time. And yet…

Subscribers of this newsletter know that I’ve been mulling a book—I think it may be time, though I’m still thinking through the details and focus. (Expect an open thread this Sunday). 

You also may have seen an announcement, or noticed a change at the end of my New York Times piece: I’m now a regular columnist there. 

Both of these will bring changes to this newsletter (though there will be a transition period—details to come with more discussion on the Sunday open thread). 

To start with, I’ve turned off paid subscriptions. If you were a monthly subscriber, you aren’t being billed anymore (though you will keep receiving these). I don’t have everything completely worked out yet, but this newsletter will become part of the to-be-announced book project. 

Ideally, I’d write a book that’s something that is more on the reflective and analytical side than the many (some excellent!) historical accounts of the pandemic that are already out. Such books are usually a hard-sell: people tend to like psychological, narrative driven stories more than we like sociological ones. But I know there is interest in the latter. Well, at least I am interested in it! I have some notes and ideas and some parts written out, but I need to figure out the exact focus, especially since there’s so much!

If you want a refund because if you subscribed recently (or heck for any reason) just respond to this email with the word “refund” anywhere and I’ll issue one. (Or just type “donate” and I’ll donate it to a group supporting refugees somewhere in the world).  I cannot say a big enough big thank you to everyone who’s been a subscriber of this newsletter so far, and I am mulling ideas on how to continue the kind of feedback/community that has formed here in the next phase.  

So there will be a transition period and more details (as I figure them out). There are also some personal reasons this makes sense for me now. I might also be on social media less, as I figure out the book proposal and then the manuscript. I don’t plan to disappear, but might pull back a little from the day-to-day to get my thoughts/research together on the big picture and reflective analysis.

Fall is around the corner, and depending on how it all goes, it’s likely going to be a period of transition for this pandemic as well, from the acute phase into the endemic. This will no doubt bring about new challenges, but some aspects of this may become easier. I hope we can use this to try to figure out what happened, and why, and most importantly how to turn things around so that we aren’t caught like this again. Pandemics are just one kind of systemic risk we face, globally and nationally.

And such problems do not solve themselves.