Tag: Feat-Apr20

Reopening Requires Science

An Interview with Dr. Greg Gelembiuk by Dayna Long

Dr. Gelembiuk is a scientist in Madison. He is also a member of the Community Response Team, which seeks to reduce police use of force and to establish more oversight and accountability over police. He was appointed to the Police Department Policy & Procedure Review Ad Hoc Committee in 2019.

DL: Folks in Madison might be more familiar with your scientific approach to police accountability and reform than they are with your actual career as a scientist. I was hoping you might tell me a little bit about your background and your work and how it’s prepared you to follow the science around COVID-19?

GG: I’m a scientist. My doctorate is in Integrative Biology with a minor in Statistics. I worked in virology and oncology for about two decades, predominantly working on DNA tumor viruses. Then subsequently I’ve worked predominantly on evolution and genetics of invasive species. So I’ve got background in a wide variety of areas in the life sciences, including a great deal of background in virology.

DL: So I have no scientific background, like a lot of people. But at the start of this crisis I was checking the Department of Health Services website and Public Health Madison & Dane County website pretty much every day to look at the numbers. But I realized over time that they didn’t mean that much to me and I so want to hear from you. How useful are those numbers? Should they be taken with a grain of salt and is there something meaningful in those numbers that people can take away from them? 

GG: They shouldn’t be taken with a grain of salt. However, they also represent a gross underestimate because of undertesting. The actual number of infections is probably roughly an order of magnitude higher than the confirmed number of infections. And undertesting also means that a lot of deaths due to Covid-19 are not being recorded.

I’ll also mention that I was highly critical of Public Health Madison & Dane County (PHM & DC) at the outset because back in mid-March, they seemed predominantly concerned with reassuring Madison. They had an online poster. The main feature of the poster was a big fat zero, that we had zero cases here, and then accompanying text saying that we were at low risk. This was at a point when I was pressing for immediate enactment of social distancing policies and in my view, PHM & DC was entirely failing to fill its proper role at that point. Any epidemiologist recognized that we were about to be hit and that there probably already was community spread going on here. And yet that was not the messaging that PHM & DC was providing. 

DL: Have your feelings about folks going to those websites changed at all? Is it useful for me as a person living in Madison to look at the number of cases or the number of deaths every day?

GG: Deaths are a lagging indicator. If you track the trend of cases that will tell you something. Now again I’ll note that we’re grossly undertesting and constraints on test availability will distort the curve. But still the trajectory of the curve will give you some important information. 

DL: My understanding as a person following the news was that a lot of people will not even know that they have COVID-19. It seems like a large number of people may not have symptoms at all. But what you’ve been saying is that that’s maybe not the case and that over time more people have had symptoms than was initially reported. What’s your understanding of that picture at this point? 

GG: With COVID-19, some fraction of people will be true asymptomatics — they’ll never experience symptoms. Now those people may actually have, for example, lung damage if you look with a CT scan, but they won’t be feeling any symptoms yet they’re contributing to transmission. There’s another large segment of people who will be pre-symptomatic, will be transmitting the virus, but will not yet be experiencing symptoms. So for example, the World Health Organization (WHO) noted that looking at numbers from China that people who were tested and were found to be positive and at the time were asymptomatic, about three-quarters of them went on to develop symptoms. 

The fraction of true asymptomatics who will never develop symptoms is not yet well established. It’s somewhere probably in the range between 7% and 40%. Right now my ballpark guess would be maybe about a quarter (25%). But there are a lot of other people who are pre-symptomatic, so temporarily not experiencing symptoms but then will go on to develop them.  

The most important take home from all that is that much of the transmission, about half, is from people who, at the time, are not experiencing symptoms. Right now, all of our testing is of people who are experiencing symptoms and usually testing is only available to those who are experiencing severe symptoms. That’s a problem. Because if you don’t test asymptomatics – if you don’t test in a ubiquitous manner – testing all people at pretty high frequency – then you’re not going to be able to suppress the virus. 

DL: Right, because you can’t track the spread then. That makes sense. 

GG: Right. There’s some very good public health plans that are coming out. One from Paul Romer, also one from the Rockefeller Foundation, there are good plans for suppressing it with a combination of ubiquitous testing and intensive contact tracing. That’s where we have to go. That’s what South Korea did, very successfully. That’s what we’ve failed to do so far. 

Now, given how widely it’s spread, there needs to be some kind of technological innovation to be able to test that large a number. That innovation is already well under way. There’s a protocol called SwabSeq that would allow really large, population-scale testing. One lab tech using that protocol could test a thousand samples a day. If you actually use an automated system, like robotic systems, you could test a hundred thousand in a day and that’s just with one machine operated by one tech. I’ve been arguing that this needs to be implemented ASAP and that it would be good to have a pilot program here in Madison. You could test, for example, first responders and healthcare workers since they’re the people who are most likely to transmit if they’re infected, as an initial pilot. It would also be good to include all staff and residents of nursing homes, given their vulnerability. Other methods such as testing using a surface plasmon resonance approach would take slightly longer to work out and deploy at scale, but would allow for cheap, quick testing of everyone with results in only a few minutes.

DL: Is science also susceptible to pressure by politicians and businesses and their interests? What are some examples you’ve seen of that sort of thing during the COVID-19 crisis? 

GG: Oh yeah. Science is, unfortunately, susceptible to this. A perfect example is the recent, terrible quality studies that have come out from a group at Stanford. That includes a study of seroprevalence (the level of a pathogen in a population, as measured in blood serum) in Santa Clara County and a study of seroprevalence in Los Angeles County. This group is doing incredibly poor science. If you look at their paper on Santa Clara County, there were simple math errors. There were errors in design, it wasn’t randomized. There were major problems with how they were recruiting people. People who believed they’d been exposed to COVID-19 were much more likely to enter this study. And they lied to recruit test subjects and violated informed consent requirements. Their confidence intervals were just inherently wrong. They were using technology that has not been adequately vetted and that is known to give a high false positive rate. 

A lot of people seem to misunderstand the logic of epidemiology. The social distancing we’re doing now – all that does is temporarily freezes in place the situation where infection has not swept through the population. That buys us time. It doesn’t resolve the situation. 

So what they’re putting out is a hot mess. And yet it got a lot of coverage. It got an article in the New York Times where the reporter failed to interview any of the numerous scientists who were pointing out that this study was actually complete trash. [Their study] was widely publicized by conservative media, claiming that Covid-19 was no worse than the flu. Now one of the interesting things I’ll note is that when the same group released the initial tech report that described their Los Angeles study, the place where it was first published was the conservative GOP blog RedState. Now it’s very telling that these scientists chose to first release their publication there. What you’re seeing in some cases like this is far outside the norms of how science is supposed to operate. 

So you do have a problem with political pressure affecting the science and the public’s understanding of the science. You can see what’s happening with the CDC. I have enormous respect for Dr. Fauci, but you can tell that he has to toe the line to a certain extent and he’s not able to speak entirely freely, to the point where he has had to basically fall on his sword at times. Meanwhile the CDC had been, to a large extent, gutted by the Trump Administration driving out scientists by budget cuts from the current administration. The quality of the work that the CDC has done recently is far inferior to the quality of the work it’s historically done. So yeah, political pressures can have an enormous impact – an unfortunate impact – on the science. 

DL: Given the potential for science to be distorted for political means, one of my concerns for myself and for other workers is understanding when it’s actually safe to go back to work, because our priorities, like staying healthy and safe, aren’t the same as our employers’ priorities. We’re already seeing a lot of pressure from the Republican party in our state to reopen. Do you have any advice for folks about evaluating the situation for themselves? What things need to happen before we reach a point where that’s a realistic and safe thing for non-essential workers?

GG: The only way that that could happen is with a program of ubiquitous testing, intensive contact tracing, and then quarantine. Without that, it’s not going to be safe to go back to work. There’s going to hopefully be a vaccine but the earliest I would expect a vaccine availability is maybe eighteen months. 

A lot of people seem to misunderstand the logic of epidemiology. The social distancing we’re doing now – all that does is temporarily freezes in place the situation where infection has not swept through the population. That buys us time to do other things like testing, contact tracing, developing better therapy, developing a vaccine. That buys us time. It doesn’t resolve the situation. 

As soon as social distancing is relaxed, the epidemic which has basically been frozen in place at a lower number, will then again take off in an exponential fashion sweeping through the population. There seems to be this widespread misunderstanding that as numbers have plateaued or if numbers are going down, then you can reopen. From an epidemiological perspective, that is wrong. That makes absolutely no sense. You cannot safely reopen, you cannot safely resume your old practices and your usual work conventions until you’ve really suppressed the virus. 

Right now the only practical means for doing that in the short term is ubiquitous testing and extensive contact tracing. 

DL: And we don’t have that in Wisconsin, of course.

GG: No. In fact, it’s not happening anywhere in the US. It’s not close to happening anywhere in the US. For this to happen properly in the US we will need roughly around thirty million tests done a day. That’s possible with the technology that I was mentioning earlier, with a logistical system set in place to really collect and process the samples. So basically you need a situation where, for example, everybody is spitting in a tube and sending it to a test center and tests are being run on [the samples] and you do that, maybe, every week or so. 

DL: Have you taken a look at the Badger Bounce Back Plan? What do you think of that? 

GG: Okay, one – I feel some sympathy for the Evers administration given the pressure they’re under, given that the Republicans are now appealing the Stay At Home order to the State Supreme Court. However, the plan as written is garbage. If you look at the plan it does not follow the logic of epidemiology at all. The gating criteria the state is using to determine if we can begin reopening under the plan is a decrease across a fourteen day period in the number of new cases. That’s insane. 

If you’re at a very high level and you decrease for fourteen days, you’re still at a very high level off the ground. It’s basically equivalent to someone who jumped out of a plane with a parachute, the parachute has slowed their fall, and then they say, “Oh. For a period of time my fall has been slower so I’ll take the parachute off now.” It’s crazy. 

You know, another criteria in the plan is that there’s been some progress made on the amount of testing. That means nothing. What does it mean to make some progress on the amount of testing? You do a dozen more tests in a week and that’s criteria for reopening? The plan makes no scientific sense. Any reopening plan should be using the World Health Organization criteria, which are well thought out and fully scientifically defensible.

I’ll mention one other thing. I’ve written correspondence to Evers office. There’s been no reply. There was a letter that I and ten other scientists from the University of Wisconsin, predominantly professors, wrote to the Governor’s office – and sent it to his Chief of Staff as well as the staff for Mandela Barnes. And there’s been zero reply. Among other things, the letter pointed to what needed to be done with testing and also suggested that Evers administration should tap scientists, including UW scientists, to set up a scientific advisory panel, which is really needed, especially if you look at the Badger Bounce Back Plan. 

I feel sympathy for Evers and want to see substantial support for Evers given the pressure from Republicans. But the only way to deal with this properly is to actually follow the science. 

DL: What developments in the science around COVID-19 are you looking for? Are there sources that you feel good about that lay people could also follow along with? 

GG: Scientific developments that I’m looking at: improvements in therapies; progress on potential vaccines, though again, that won’t come out for a very long time; looking at improvements in modeling that can provide more accurate projections. Clinically, improvements in testing methodologies, new developments in serology testing. Those are a few of the things that I’m tracking and that people should keep an eye out for. 

There are a lot of good sources out there. I would recommend people follow Carl T Bergstrom on Twitter. He’s often got very good analysis. And there are a lot of other scientists on Twitter who are providing good, meaningful analysis: Natalie Dean, Jennifer Nuzzo, Eric Topol, and Mark Lipsitch are some examples. As far as online magazines, the journal Nature is good; Science Magazine is good. There’s a lot of stuff that people can access that really can speak to a mass audience and that provide good analysis and helps people understand what’s going on. 

Carl Bergstrom especially cuts through the bullshit. And there’s a lot of bullshit out there right now. Like the IHME model, for example, is trash. Yet that has been treated as the most influential model in the US. But it’s fundamentally flawed, it’s not really an epidemiological model at all. It’s based on assumptions that are known to be totally incorrect. Its predictions – on expected number of deaths, on dates to expect peaks, etc. – have consistently been very wrong in both the U.S. and other nations. No-one should be using or referencing it. And Bergstrom has provided very trenchant analysis of the flaws in that model, as well as analysis of a lot of other relevant science.

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Red Madison is grateful to Dr. Gelembiuk for his contributions and encourages more scientists and healthcare professionals to share their knowledge about COVID-19 and help workers navigate pressure to reopen in unsafe conditions. If you are interested in sharing your perspective with Red Madison, you can send us an email at redmadison (at) googlegroups (dot) com.