Daniel Markus | Vox Our world has too much noise and too little context. Vox helps you understand what matters. 2020-04-24T19:06:33+00:00 https://www.vox.com/authors/daniel-markus/rss https://platform.vox.com/wp-content/uploads/sites/2/2024/08/vox_logo_rss_light_mode.png?w=150&h=100&crop=1 Daniel Markus <![CDATA[Could contact tracing bring the US out of lockdown?]]> https://www.vox.com/2020/4/24/21234762/apple-google-contact-tracing-coronavirus-lockdown 2020-04-24T15:06:33-04:00 2020-04-24T16:30:00-04:00
Healthcare workers test people at a COVID-19 testing tent setup outside the Brockton Neighborhood Health Center in downtown Brockton, Massachusetts, on April 23. | Barry Chin/Boston Globe via Getty Images

South Korea and the United States reported their first cases of Covid-19 on the same day. Yet while most Americans remain under stay-at-home orders, many in South Korea are doing what seems unthinkable in the US — returning to their offices.

South Korea has often been touted as rolling out one of the best national responses to the coronavirus, and the country’s approach has been comprehensive. All passengers that arrive at Incheon Airport — South Korea’s hub for international flights — receive mandatory temperature checks and must download the country’s coronavirus app, where they report any changes in their symptoms (or lack thereof) every single day.

This app is an important part of South Korea’s effort at contact tracing: the effort to find and notify every person who comes in contact with someone who tests positive for Covid-19. And a few weeks ago, Apple and Google announced that they were developing software that would enable contact tracing apps in the US. How might this technology change the trajectory of the US coronavirus crisis? 

In this episode of Reset, host Arielle Duhaime-Ross talks with Stat News reporter Sharon Begley about how digital contact tracing is our best hope of emerging from lockdown, and why we didn’t start working on it sooner.

A lightly edited transcript of their conversation follows.

Subscribe to Reset wherever you get your podcasts, including Apple Podcasts, Google Podcasts, Spotify, and Stitcher. You can check out our guide to news of the coronavirus outbreak here and listen to other Vox podcasts on the topic here.

Arielle Duhaime-Ross

There are a lot of ways in which the US has been sort of playing catch-up in its response to the pandemic. Is that the case with contact tracing?

Sharon Begley

It is the case with contact tracing for the basic reason that experts in contact tracing, and also in infectious disease, have forever believed and argued that contact tracing does not work with a respiratory disease. And the reason experts told us that contact tracing would not work with respiratory diseases is that respiratory diseases spread too easily — air is a lot easier to come into contact with than someone else’s blood — and that they also spread too quickly. So from the get-go, this country has not even attempted to do serious contact tracing. We didn’t try it in the first cases in the state of Washington. We didn’t try it after cases appeared in California, [we] certainly have not tried it since cases appeared on the East Coast. And in addition, contact tracing is immensely laborious. You need an army of thousands of people to do it.

Arielle Duhaime-Ross

But right now, contact tracing is being touted as one of the ways that we’ll eventually be able to sort of reopen the country. Why are we seeing this shift in the way that people are talking about this?

Sharon Begley

Because of what happened in other countries. In South Korea, in particular, in Singapore, both of which had very, very early cases, not surprising given their proximity to China, that’s what they did. Those countries did contact tracing. It worked. And suddenly that opened the eyes of experts who said, no, no, it could never be done.

Arielle Duhaime-Ross

So wait, does that completely change the way that we look at respiratory illnesses like this?

Sharon Begley

It really does. You know, just as with the recognition that face masks actually can help, all sorts of assumptions about respiratory diseases are being rewritten and, in fact, overturned as a result of what we’re seeing in this pandemic.

Arielle Duhaime-Ross

Okay, so, in all the plans that we are seeing to reopen the country, to reopen the United States, how important is contact tracing going to be?

Sharon Begley

Everybody who has looked at this — academics, officials in other countries — say that this will be the only way that the country can be reopened, that we can have an exit from the very strict social distancing [and] physical distancing that we’ve had for the last month and a half. You know, whether it’s the governors talking about how to figure this out, testing and contact tracing is at the center of all of those plans. And the sequence is, test, in other words, you have to identify people who carry the virus, trace their contacts, you isolate people, and you hope that works.

Arielle Duhaime-Ross

I can’t help but notice that you’re not talking about antibody testing. You’re not talking about vaccines. I guess that’s sort of surprising, probably for a lot of people hearing this, that contact tracing and not these future things that we’re hoping will happen will be central to this approach.

Sharon Begley

You know, the reason I’m not emphasizing vaccines now is because there’s not going to be a vaccine in this calendar year. As far as serology testing, [that is], the blood tests that identify if somebody has antibodies to this coronavirus, that absolutely can play a role in reopening the economy. But, you know, let’s look at the numbers. … The country has some 350 million people. If you’re only going to let go back to life, back to work, people who have survived their Covid-19 infection, that’s not going to give you the numbers that you need. The reason you need testing and contact tracing is that you want a whole lot more people to be able to go back to their stores and their workplaces and their factories and be able to safely ride the subway and all of those things. So it can’t be only the blood tests for the antibodies.

Arielle Duhaime-Ross

Okay, so what do we need to do to implement a successful contact tracing program for Covid-19, and what are the obstacles?

Sharon Begley

So here’s the problem. As we were saying earlier in the experts’ objection to contact tracing for a respiratory virus, it has to be done fast. On average, to identify a person’s contacts — just to identify them, let alone to track them down — takes something like 12 hours of asking, “Where were you? What were you doing? What was it like there?” So that’s an average.

Arielle Duhaime-Ross

Twelve hours is a really long time. To be clear, that’s a long interview.

Sharon Begley

That’s a long interview. Probably not sitting in one place for all that time, but going back to the person to say, “Wait, are you sure you weren’t here or there? And what about this block of time when you forgot where you were?” So it’s very time-consuming to do that with just plain old analog human beings. The estimates are that the United States would need at least 100,000 tracers, possibly as many as 300,000. And, of course, we’re going to pay these people and value them and encourage them. So, you know, you’re probably looking at …  upwards of 3.6 billion … dollars just to do that. And absolutely, it’s worth it. But that’s the order of magnitude that you’re talking about in terms of effort.

Arielle Duhaime-Ross

So it sounds like doing contact tracing with human interviewers will be expensive and time-consuming. And now we’re seeing lots of attempts to automate this process with technology. So in theory, how could technology help?

Sharon Begley

The technology that’s being discussed can be basically instantaneous. The way many of these systems would work is, again, you opt-in. And the opting in means that … you would … get an alert saying, “Yes, you came into close contact with someone. We think you should now isolate yourself for 14 days.” If you can get through those two weeks without symptoms, then that casual passing by the person did not infect you. That can be done virtually, instantaneously — certainly, you know, faster than human contact tracers. And the hope is that by doing it that quickly, you can snuff out any transmission chains that might crop up.

Arielle Duhaime-Ross

Right, because to be clear, it’s not just reducing the time of that 12-hour interview. It’s also reducing the time that it takes to contact the people that the person has been in touch with by just making it automated and automatic.

Sharon Begley

A group at Oxford university in the UK did model this. And they found that if you can accelerate how quickly you find, you diagnose cases, and trace their contacts, then you can ease up on social distancing to a degree that nothing else will enable you to do.

Arielle Duhaime-Ross

So could a tech solution for contact tracing work in the US in a widespread way?

Sharon Begley

So it’s always dicey to talk about a technological fix. But in this case, again, as with so much in Covid-19, we have other countries that have shown us the way. Singapore, South Korea, they used everything from security camera footage to smartphone tracing. Israel rolled out a system like this. What’s important to remember is that success does not mean zero cases. Success means that we do not have another instance where we overwhelm our hospitals and have the horrible situations that we’ve all seen, in especially New York hospitals. Bottom line, you can have way, way less than 100 percent opt-in and still have a really good chance of catching any incipient new infections after we’re over the current wave.

]]> Daniel Markus <![CDATA[How the coronavirus pandemic will affect an entire generation of students]]> https://www.vox.com/2020/4/23/21233042/coronavirus-online-learning-teachers-students 2020-04-23T17:42:57-04:00 2020-04-23T16:30:00-04:00
Ellie Lyons, an elementary school teacher, meets with her Natick first-grade students on Google Meet from her home in Brookline, Massachusetts, on March 27. She has converted the backdrop of her bedroom into a makeshift first-grade classroom to make her students more comfortable. | David L. Ryan/Boston Globe via Getty Images

Every morning, Michelle Martin-Sullivan rises with her toddler and begins her biggest task of the day: making contact with all her students, who are scattered among the foothills of rural eastern Kentucky. Some she calls by phone, others she chats with over text, and some she sees in class on Zoom.

Like teachers across the US, Martin-Sullivan is working remotely, and the transition has proved difficult almost everywhere. Rollouts of online portals have been plagued with technical issues in many districts, while others have struggled to distribute devices like laptops and iPads amid shortages from suppliers. 

For Martin-Sullivan, though, the issues often go deeper than teaching itself. Many of her students are essential workers at stores like Walmart and have begun picking up extra shifts to support their families. Other students, as well as some teachers, don’t have internet access at all.

“Teachers … have been conducting their phone calls and check-ins with students from random parking lots, like church parking lots, the Walmart parking lot, [or] just anywhere that you can get wifi,” she says.

The results of these struggles with distance learning will remain unclear for some time. Many standardized tests have been delayed or canceled, which means school districts won’t get data on their students’ progress. 

On this episode of Reset, we explore how the pandemic might affect students going forward, and how long those effects could last.

According to Matt Barnum, a national reporter for the education news site Chalkbeat, traumatic effects have big impacts on students’ lives, both on how much they learn and long-term factors like college enrollment rates and income.

“There’s this idea that children are resilient. They’ll just bounce back from whatever you throw at them. And from a research perspective, that’s just not the case,” he says. “We know that things can affect students, both good or bad. We know that early trauma can affect students for bad. We know that a high-quality teacher or access to early childhood education can affect students for good in the long term. So I think it’s not unreasonable to think that this is going to have long-run negative effects.” 

Still, there are ways that policymakers can decrease these negative impacts, as Barnum explained. Research shows that one easy way to help students catch up is to add extra instructional time to the end of the school day or make the school year longer.

“We have evidence from research: There is a study in Florida that when low-performing schools extended the school day, students did better on state tests. We have another study in Louisiana showing that summer school helps students who are struggling in reading,” he says. “And so it just makes a whole lot of sense that if you want to make up for missed instruction, you should just make up for missed instruction.”

For students who have struggled more than their peers, some experts have suggested that the federal government should fund an “army” of recent college graduates to tutor students — with the added benefit of helping prop up a dismal job market.

Finally, students will also likely need emotional support when they go back to school. Aside from the interruption to their education, they may know people who got sick or died from Covid-19.

“If schools want to hit the ground running academically, they also probably need to be thinking about addressing the trauma that students may have faced. Presumably the best way to deal with that is to have trained professionals in schools, who can work with students to talk this through and support them in this,” Barnum says.

Whether government officials will take any of these actions remains to be seen. But policy options that can help students through the pandemic exist. The question is mostly whether governments — especially during a massive economic downturn — will make them happen.

Subscribe to Reset on Apple Podcasts, Stitcher, Spotify, or wherever you listen to podcasts.

]]> Daniel Markus <![CDATA[Your food delivery app comes at a cost to restaurants]]> https://www.vox.com/2020/4/9/21215096/takeout-delivery-apps-fees-coronavirus 2020-04-09T14:16:20-04:00 2020-04-09T14:20:00-04:00
Aquitane Restaurant in Boston on April 3. | Barry Chin/Boston Globe via Getty Images

In March, just a few days before a looming stay-at-home order would take effect in Chicago, restaurateur Nick Kokonas faced a terrifying prospect: empty dining rooms at his restaurants.

“There will be no reservations in the United States of America. What do we do?”

For Kokonas, the answer was to almost totally reinvent both of his businesses. In addition to his five restaurants employing almost 300 people, which include the highly experimental Alinea — where a meal can easily cost upwards of $250 a person — he also runs Tock, a reservation app for fine dining restaurants. 

Both quickly pivoted to takeout and delivery. Alinea began offering beef Wellington and coq au vin for takeout at only $35 per plate, and Kokonas’ employees at Tock worked around the clock to retool the reservation app into a new pickup and delivery ordering system called Tock To Go. 

According to Kokonas, the pivot has worked. Alinea has been able to rehire more than half of its 84 staff members, and the restaurant is earning about 75 percent of its normal revenue. Tock To Go has seen a surge of new restaurants joining the platform.

“We have over 850 [restaurants] that are in the process of coming on board, really as fast as they can get their kitchens going again. And we have great success stories. It’s not just the high-end places like n/naka, you know, selling bento boxes in Los Angeles. … There’s a small restaurant … that emailed us and said ‘when we were busy before the pandemic, we would do $3,000 to $4,000 a day in sales. And I just hired three more cooks because we’re doing $20,000 a day in sales.’” 

But Tock’s new platform is puny compared to the dominant apps in the food-delivery world. Seamless alone has 12,000 restaurants, 40 times more than Tock To Go. And these apps that facilitate delivery during the pandemic, like UberEats, DoorDash, and GrubHub, are the same ones bleeding restaurants dry.

On this episode of Reset, we look at how restaurants are turning to delivery platforms to survive the pandemic.

If you want to support your favorite restaurants during the pandemic, here’s what Eater’s Caleb Pershan suggests: “If you want to go get takeout yourself and feel healthy and comfortable enough to do it, it’d be best if you call the restaurant directly so that that large cut isn’t taken by a third-party delivery app. Maybe they’ll be able to deliver food themselves. Go straight to the restaurant in any way you can, either by calling them or by going to their website. If you do use a third-party app to get a delivery, tip handsomely.”

Subscribe to Reset on Apple Podcasts, Stitcher, Spotify, or wherever you listen to podcasts.

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]]> Daniel Markus <![CDATA[Is the coronavirus airborne? It’s complicated.]]> https://www.vox.com/2020/4/7/21212663/coronavirus-airborne-covid-19-pandemic-podcast 2020-04-08T11:51:51-04:00 2020-04-07T17:20:00-04:00

A single case of measles can cause 12-18 other cases, because measles is “airborne” — particles of the virus linger in spaces for hours after sick people breathe or cough them out. This characteristic is uncommon, and it makes the measles virus one of the most infectious known to humans. Because airborne diseases spread so quickly, civilians and scientists alike have been nervously wondering: Is the SARS-CoV-2 coronavirus airborne?

The answer, however, is complicated. First, not everyone agrees on what airborne means. The WHO and many infectious disease researchers use a highly specific definition for “airborne” that’s not intuitive to most people. This leads to situations such as this: The CDC has recommended Americans wear face masks in certain public settings to prevent catching or spreading the disease, even though the coronavirus might not meet the CDC’s definition of airborne. 

Second, the evidence needed to declare the coronavirus officially “airborne” could take years to gather, while possibly endangering people. After a large choir in Washington rehearsed together, 45 of the 60 members got sick, even though nobody was symptomatic at the time.

On an episode of Reset, host Arielle Duhaime-Ross spoke to science writer Roxanne Khamsi about the origins of the “airborne” debate, and whether we should stop using the term altogether. Below, we’ve shared a lightly edited transcript of their conversation.

Subscribe to Reset on Apple Podcasts, Stitcher, Spotify, or wherever you listen to podcasts.

Arielle Duhaime-Ross

What exactly does airborne mean?

Roxanne Khamsi 

So there is not a great answer to that question. I think that you can take a very simplistic view, which means airborne means something is in the air. I mean, if you open the dictionary, that’s what it means. … But a lot of virologists and especially a lot of public health officials have the idea that something is airborne if it is spread by aerosol and not by droplet. Now, you’re wondering, like, what is the difference between droplets and aerosols, right? 

Arielle Duhaime-Ross 

Yeah, that is 100 percent what I’m thinking right now.

Roxanne Khamsi 

So traditionally, public health officials, at least recently, have been defining the droplet as something that’s like a ball of mucus and virus and salts that is larger than five microns in diameter that you’re kind of coughing up or spewing out. And anything smaller than that could be an aerosol that floats around … in the air because it’s lighter. Imagine like a feather or like floating in the air.

Arielle Duhaime-Ross 

Okay, so there are large droplets that can float around in the air, and there are fine aerosols that last longer in the air. That’s the distinction?

Roxanne Khamsi 

Right. And if you trace back where they came up with this, it goes back to these equations from the 1930s where people were trying to figure out tuberculosis and how it spread. So we’re talking about a really antiquated point of view on these things. I asked the WHO, how do you know that this [coronavirus] isn’t airborne? How do you know it’s only in droplets? And I did not get a good answer from them.

Arielle Duhaime-Ross 

So why are some scientists still saying that we don’t know if the virus that causes Covid-19 is airborne?

Roxanne Khamsi 

Because we don’t. The thing is, we actually don’t have evidence to say whether it’s airborne or not. In a normal setting, I mean, in settings where people are getting intubated and that’s kind of spewing this thing into the air, even the WHO says there is a risk of it being airborne in those situations, but we’re operating in an absence of evidence.

Arielle Duhaime-Ross 

What I’m getting from you is that … you can’t tell me right now whether it is or it’s not. We just don’t know. 

Roxanne Khamsi 

Exactly. So the people I spoke with who witnessed SARS almost 20 years ago and dealt with that public health disaster, they’re saying that we should operate on the precautionary principle, that this is more easily airborne than we’re saying it is or assuming it is because it technically does travel in the air. So it is, quote unquote, airborne.

Arielle Duhaime-Ross 

So is this just a language thing? Is it just that most virologists think of something being airborne as being transmitted through fine aerosols as opposed to large droplets?

Roxanne Khamsi 

Completely. We’re talking about a failure of language, in my opinion. So we’re talking about a word that is failing us because it can’t really capture all the nuances of the different situations. If you’re standing in front of an ocean and you feel the splash of the huge droplets of Seaspray, those are pretty big droplets, but it’s the wind that’s carrying it to your face. So could we not consider those airborne? I think that’s what a lot of the people that study this type of transmission are saying.

Arielle Duhaime-Ross 

Why do you think understanding this whole airborne situation when it comes to Covid-19 — and the virus that causes it — why do you think that’s important? 

Roxanne Khamsi 

I think it’s important to understand how easily transmissible this virus is in the air, first and foremost for public health workers. If we say, as the CDC said, it’s okay to wear bandanas in some … situations if you’re encountering patients or whatnot, I think that’s a problem.

[Note: The CDC has advised health care professionals on contingency plans for personal protective equipment, saying that workers may use homemade masks such as a bandana or scarf “for care of patients with COVID-19 as a last resort.” The CDC adds that homemade masks are not considered protective equipment.]

]]> Daniel Markus <![CDATA[How the coronavirus works inside your body]]> https://www.vox.com/2020/3/26/21195347/coronavirus-covid-19-symptoms-reset-podcast 2020-03-26T15:55:42-04:00 2020-03-26T13:50:00-04:00
A patient with flu-like symptoms checks a CT scan in Kolkata, India, on March 21, 2020. | Avishek Das/SOPA Images/LightRocket via Getty Images

The virus responsible for the pandemic that has engulfed the globe — sickening almost half a million and killing more than 20,000 worldwide — is one of hundreds in the family of coronaviruses. Yet before the current outbreak, coronaviruses were poorly studied. They mostly circulate among animals, and in the few cases where they have infected humans, they’ve mostly caused symptoms of the common cold. And previous outbreaks of coronaviruses have been comparatively small. SARS and MERS together killed fewer people overall than this virus did in less than two months.

But now, understanding coronaviruses has become crucial as this one, SARS-CoV-2, continues to spread. And a big part of that understanding will come from looking at the virus itself. So what do we know about this coronavirus so far, on a microscopic level? How does the virus work? And how does that impact what it does to the human respiratory system? How does it kill people?

Listen to the full episode of Reset to hear host Arielle Duhaime-Ross talk with the Atlantic’s Ed Yong about how SARS-CoV-2 infects people and what it does to the human body.  

The transcript of their conversation that appears below has been edited for length and clarity.

Subscribe to Reset wherever you get your podcasts, including Apple Podcasts, Google Podcasts, Spotify, and Stitcher. You can check out our guide to news of the coronavirus outbreak here and listen to other Vox podcasts on the topic here.

Arielle Duhaime-Ross

What is up with this specific coronavirus? Why is it so good at spreading and infecting humans? Do we actually know that? 

Ed Yong

I would say that we don’t. But I think based on what we know, we can at least try to put together a plausible hypothesis. The thing that especially makes this virus hard is that it seems to have a long incubation time between first infecting a new person and then causing symptoms during which it seems to be able to transmit to a new host. And, specifically, the reason why its capacity to spread before symptoms is bad is that it allows it to really move around the world and within a country before people understand where it is. 

Arielle Duhaime-Ross

But is there a specific reason why it is so good at infecting humans specifically? Because this thing originated in animals, right?

Ed Yong

You’re right. Based on the structure of the virus, it seems that there are a few possible qualities that allow it to spread so easily. It seems to stick to our cells more strongly and more readily. And it seems to be able to infect cells throughout a wider part of the airways.

So the virus is basically a … ball with these proteins called spike proteins on the surface. Those spikes recognize and latch onto a protein called ACE2, which is found on the surface of our cells, and like a key fitting into a lock that is the first step to launching an infection. This is also what the original SARS virus did. It had spikes, which latched onto ACE2. But the specific shape of the spikes on this new virus, SARS-CoV-2, those spikes are much better at latching onto ACE2 they are a closer fit to the ACE2 protein.

What that means is that maybe it is easier for the virus to attach itself to our cells and maybe that might mean that it takes a lower dose of virus to begin an infection. Again, this is all pretty speculative, but it makes sense given the tight fit between those two molecules. 

Arielle Duhaime-Ross

Okay, so the first thing is that this virus is better than previous coronaviruses at sticking to our cells. What’s the second thing?

Ed Yong

Once that first attachment is made, the spike protein must be split into two separate halves in order for the infection to continue. With the original SARS virus, that split did not happen very easily. But with this new virus, it can be done by an enzyme called Furin, which cuts the two halves apart, and Furin notably is widespread. It’s made by the human body and it’s found in a lot of different types of tissues. And, again, that might be important for explaining some of the weird characteristics of this virus.

Arielle Duhaime-Ross

Like what?

Ed Yong

Most respiratory viruses tend to infect either the upper or the lower airways. If they infect the upper airways, they spread very easily, but they tend to cause mild illnesses like a runny nose or what have you. If they infect the lower airways, they tend to cause more severe illness like pneumonia, but they are also harder to spread. SARS-CoV-2 seems to infect both sites, and maybe that’s because it relies on that widespread Furin enzyme and maybe that might explain some of its sneakiness. Maybe it spreads easily when it infects the upper airways before then moving to the lower ones to cause more severe illness. 

Arielle Duhaime-Ross

It kind of sounds like it’s just very good at what it does. So what are the odds of having a coronavirus that has this particular combination of traits? 

Ed Yong

Whenever a new threat like this happens, there are always conspiracy theories about whether the new pathogen was designed or engineered to infect humans. And certainly it does nothing to quell those theories when you hear that it’s so well adapted to infecting human cells. It sounds improbable that a virus that was lurking in some wild animal should have exactly those right traits and then somehow managed to find its way into a human body. But there are a lot of coronaviruses out there that we don’t know about. And I think that’s the reality of the world that a lot of us don’t understand, that wild animals harbor millions, maybe billions of different kinds of coronaviruses.

Even though the odds that any one of them might infect us very well and cause a pandemic of the kind we’re seeing are very low, it actually becomes a reasonably likely scenario given how many possible viruses there are out there. This seems to be the one that, by pretty bad luck, had the right combination of traits to effectively and stealthily spread among human hosts. 

Arielle Duhaime-Ross

Part of what makes this coronavirus pandemic so scary is that it’s killed a lot of people. What exactly does this virus do in the human body? 

Ed Yong

So, again, we’re left to speculate a little bit based on a combination of medical experience from people around the world, the results of, I think, only one autopsy to date, and then our understanding of what similar viruses like SARS have done in the past.

So this is a likely scenario. It may not be a 100 percent accurate one, but it’s sort of the best of what we’ve got right now. The virus seems to infect cells in the airways. It gets into those cells, reproduces, and then makes more copies of itself, causing the cells to die. Dying cells slough off from the airways and carry the virus down into the lungs where the infections proceed even further. So now you’ve got a bunch of dead cells; you’ve got a fluid building up in the lungs. All of these can cause problems for people who are infected making it more difficult to breathe. 

Arielle Duhaime-Ross

Is that the reason why having ventilators has suddenly become so important? 

Ed Yong

This is absolutely why ventilators are really important. The virus causes havoc in the respiratory system and makes it more difficult for people to breathe. … But the really serious problems seem to occur not just as a consequence of the infection itself but because of the body’s attempt to fight that infection. So the immune system will typically mount some kind of defense against the virus. But in some cases, that defense goes berserk. So the immune system radically overreacts and launches what is known as a cytokine storm.

And those kinds of reactions, that cytokine storm, are pretty common for a lot of new and severe infections. We saw them with the 1918 flu pandemic. We saw them with, I think, the 2009 flu pandemic. A lot of these new emerging infections cause the immune system to overreact because nothing like them has ever been encountered by an immunologically naive population before. And that overreaction drives a lot of the more severe symptoms that we see among the most severe cases of Covid-19. 

Arielle Duhaime-Ross

I’m glad you brought up the more severe cases, because, as we all know, some people experience mild fever and chills and they eventually get over it while others are being hospitalized right now. Do we know the reason why some people are affected so strongly while others are not? 

Ed Yong

I would say that unfortunately, we don’t. Certainly, age seems to be a factor in that. Older people are at greater risk of more severe illness and, sadly, of dying from the disease. We don’t really know why that is. It might just be that older people are less able to mount an efficient initial immune response against the virus.

But there are almost certainly other factors at work here. We know that even within an age group, some people are more likely to get severe disease than others. Maybe that has something to do with their genetics. I think that’s very likely. It might have to do with, for example, the initial amounts of virus that they are exposed to.

A lot of younger people who seem to be doing really badly are health care workers who might be exposed to much higher levels of virus because they’re treating people who are very sick.

Other aspects of the immune system, like people’s preexisting degree of immunity — not to this virus, but just in terms of how well their immune system is working — that might have an impact. There are lots of possible variables, and we don’t know which one of those is important right now, which means that we only have a very crude understanding of who is at risk and who is not.

]]> Allegra Frank Daniel Markus <![CDATA[How the coronavirus rumor mill can thrive in private group chats]]> https://www.vox.com/2020/3/5/21165238/coronavirus-rumors-myths-facebook-whatsapp-podcast 2020-03-05T17:57:09-05:00 2020-03-05T18:00:00-05:00
A traveler wears a medical mask at Grand Central Station on March 5, 2020, in New York City. | David Dee Delgado/Getty Images

With the Covid-19 coronavirus outbreak still so new, fear of the death and disruption it could cause rapidly mounting, and treatments for it still a big question mark, rumors and misinformation about the outbreak are starting to spread.

A wary public might be especially susceptible to believing unverified rumors about how the outbreak began (nope, the new coronavirus wasn’t created in a lab) or taking misguided measures to protect themselves (unless you’re sick or caring for someone who is, face masks aren’t the answer!). And buying into alarmist falsehoods can be dangerous.

The spread of misinformation is already commonplace on social media, where the sharing of content from biased sources frequently outpaces whatever fact-checking and moderation safeguards are in place. Which is why coronavirus myths are starting to crop up on both Facebook and Twitter, along with YouTube and TikTok and messaging apps like WhatsApp.

YouTube videos advertising the “truth” about the virus are showing up in people’s recommended video feeds, and there are millions of tweets alleging that the US government played a role in creating the virus. Your aunt’s best buddy that you are friends with on Facebook with could very well be sharing a highly questionable article about how coronavirus will definitely kill you soon, right this moment. (Go check your Facebook feed. I’ll wait.)

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There are a lot of things we genuinely don’t know yet about the coronavirus, and for the makers of those platforms, distinguishing the right details from the wrong ones is a difficult process. That difficulty multiples when the misinformation is dispersed in private groups.

For example: Anti-vaxxers regularly gather in invite-only Facebook groups to share damaging rhetoric about vaccinations, which can later make its way to the feeds of Facebook users who aren’t in those groups. The contained anti-vaxx group is harder to police than the general newsfeed, allowing misinformation to proliferate. There are reports that similar groups are now circulating hoax-like content about the coronavirus, sending users panicking behind closed doors for reasons that may not be based in reality.

Facebook, Twitter, YouTube, and TikTok have all pledged to stop these posts from traveling widely, according to Recode. In the case of Facebook specifically, CEO Mark Zuckerberg published a lengthy statement on March 3, pledging that Facebook will flag any info that needs to be fact-checked, and that it will also block ads from shady enterprises attempting to prey on people’s fears. The extent to which any of these companies can adequately prevent misinformation from spreading remains unseen, but the commitment is encouraging.

But with private messages and group chats, where friends and family members might discuss everything from gossip to more serious matters, successful moderation of health crisis fear-mongering can seem impossible.

The rumors on messaging apps sometimes make their way offline like they’re part of a game of telephone. A link shared in one group can easily be passed along by one of its members to another group, and another, until there are numerous people who don’t even use WhatsApp who stopped going to that restaurant in Chinatown where they’re sure a cook had coronavirus.

The sourcing for these stories is usually non-existent — that’s how rumors work — but their ramifications are heavy. East Asian-owned businesses are losing customers as a result, according to recent reports from the New York Times and the Los Angeles Times. That’s in large part due to xenophobia surrounding the coronavirus. But in some cases, it’s because patrons of these businesses are themselves spreading stories that aren’t based in fact.

In one bizarre but poignant case reported by Matthew Kang at Eater, several specific restaurants in Los Angeles’s Koreatown neighborhood have seen business drop off by over 50 percent, thanks to a rumor spread via KakaoTalk.

KakaoTalk is an app similar to WhatsApp that’s popular among Korean speakers both in South Korea and the US; users from both countries shared a simplistic Instagram screenshot across the platform, an image that named places an allegedly infected flight attendant visited during a layover in Los Angeles. The post set off hysteria that eating at those restaurants could cause coronavirus infections, and suddenly, many Koreans in L.A. were avoiding them en masse. There was no truth to any part of the story, but hearsay overpowered reality; such is the power of the group chat groupthink.

But therein lies the problem: Although it’s not encrypted to the same extent that WhatsApp is, KakaoTalk is similarly private and similarly unmoderated. Social media companies can control content on their public platforms to some extent, but when it comes to private messages, DMs, and group chats, the right to privacy works against attempts to prevent false info that might be going around.

So should social media companies be stepping in to stop people from (sometimes unknowingly) spreading rumors that obscure the truth about an impending global crisis? Or is the onus on the people in the group chats?

These aren’t easy or simple questions to answer. But in Thursday’s episode of Recode’s podcast Reset, I spoke to someone who tried their best. Russell Brandom is a policy editor at The Verge, where he covers regulatory practices in politics, technology, culture, and beyond. Below is a lightly edited segment of our conversation, in which we discussed where responsibility lies to blunt dangerous misinformation from spreading in private messages and group chats.

Allegra Frank

There are a lot of gray areas when it comes to enforcing freedom of speech on social media. And one place where I feel like it’s especially tricky is with insular communities, like encrypted and private channels and websites — such as Facebook groups and messaging apps.

In these places, there isn’t moderation to the same extent that there is on more public platforms like YouTube, Twitter, Facebook. There can’t be, because it would be a violation of privacy to have companies surveil our messages. So could misinformation be more harmful and easily spread in these encrypted messaging apps, where there isn’t that same moderation scale as on more publicly visible timelines?

Russell Brandom

The way that I think about it is that censorship is kind of this dirty word, like, you say it and people straighten up. But in a very basic sense, if someone is trying to say something in a channel, and you’re like, maybe don’t say that, that’s censorship. That doesn’t have to be bad, though. I think that censorship is less harmful as you get to the bigger and bigger channels.

If you’re going on national broadcast news and everyone with an antenna can get it and you’re using public airwaves to share misinformation, then it makes sense for there to be this higher standard of what is acceptable speech. If someone is sharing incorrect information in a video that’s going on YouTube, and it’s going to be promoted algorithmically to millions of people, it actually does make sense that YouTube should be the one taking responsibility for what it’s promoting in that way.

[The situation gets trickier] when you get into these encrypted group chats. Say it’s a one-on-one thing — I’m just going to pick up my phone and send this link about the coronavirus to you, Allegra. What if the messaging app is then going to say, “No, you’re not allowed to send that link”? That seems messed up. 

Allegra Frank

Right, because as private citizens, we’re not comfortable with the moderation options that are more analogous to surveillance. So is it on us to vet and stop the spread of mistruths? I mean, I think the answer Facebook would give us is yes. But what is the responsibility of users, specifically, to actually try tamping down on this misinformation — when it comes to something as broadly dangerous and impactful as global health crises, at least?

Russell Brandom

I don’t know that just bystander intervention is really a good strategy. Is it enough if I’m going to sit down with my loopy aunt and have a real talk about the things she’s sharing on the internet? I mean, that’s fine. I’m less troubled by someone sharing something that’s false than sharing something that could hurt someone. And that’s a lot of what we’re talking about when we talk about misinformation, is that your child could get measles and get horribly sick. It’s not just that someone has this belief that I consider incorrect. There’s concrete harm that’s directly related to the thing they’re sharing.

That’s also [true] if someone shares something that could inflame existing societal tensions that result in this mob violence. If someone is sharing something that’s going to make people freak out and panic about coronavirus and then do something that will hurt themselves or others — that, to me, always feels more urgent.

And even if the sender resists when the people they shared those coronavirus myths or other incendiary links with respond to debunk the claims, the sender has to understand where those people are coming from. They’re coming from a place of concern for others rather than just being like, “You’re an idiot. I hold very different political beliefs than you.”

Allegra Frank

It seems that ultimately, misinformation is such a big problem in this day and age, and we’re still trying to figure out the best way to combat it. So the most we can do is, I think, continue having these conversations.

To hear us talk more about the nature and damage of misinformation in the wake of the coronavirus — as well as more on the story of how KakaoTalk scared people away from Koreatown businesses, from Eater LA’s Matthew Kang — listen to the full episode.

]]> Daniel Markus <![CDATA[CRISPR’s co-developer on the revolutionary gene-editing technology’s past — and its future]]> https://www.vox.com/2020/2/28/21154930/jennifer-doudna-crispr-gene-editing-babies 2020-04-02T13:02:10-04:00 2020-02-28T10:10:00-05:00
CRISPR acts like a pair of DNA scissors. | Javier Zarracina/Vox

Jennifer Doudna will be the first to tell you that she didn’t invent CRISPR, but she did help start the CRISPR revolution. In 2012, she was part of a small group of researchers at the University of California Berkeley who showed that CRISPR technology can be used to edit the genetic code of just about any organism quickly and precisely.

CRISPR gets its name from DNA fragments found in many bacteria. When bacteria successfully fight off invaders like viruses, they chop up the outside genetic material and store it as CRISPR sequences, creating a “database” of invader genes. Whenever a potential threat arrives, the bacteria can send defense enzymes (called Cas proteins) to search for CRISPR sequences in the invader; if one is found, the enzymes chop up its genetic material, killing it.

Doudna and her team realized that by giving Cas proteins genetic material resembling that of an invading organism, the proteins will cut DNA in a targeted, scalpel-like fashion. In the hands of scientists, the tool has radically simplified gene editing, the process of altering the biological instruction manual of living organisms. 

After just eight years since its discovery, gene editing with CRISPR is still a very experimental technique. But the results so far have been promising: Researchers have used CRISPR to treat muscular dystrophy and Alzheimer’s disease in mice, fight drug-resistant bacteria, and create tastier tomatoes. 

But editing human DNA is where the use of CRISPR becomes more controversial. 

We’re starting to see early and positive results from preliminary trials of sickle cell therapies in humans. But as much as CRISPR has produced promising medical advances, the power of this gene-editing tech has a darker side.  

Just a few months ago, Chinese scientist He Jiankui received a three-year jail sentence after using CRISPR to edit the genes of human embryos, twin girls who were born in November 2018. 

In this episode of Reset, host Arielle Duhaime-Ross talks with Jennifer Doudna about the promise and peril in CRISPR’s future, what’s next, and how we can edit our genes safely and responsibly.

The transcript of their conversation that appears below has been edited for length and clarity.

Arielle Duhaime-Ross 

Let’s talk about using CRISPR in humans. Where do you stand on this? How should we think about using CRISPR on people? 

Jennifer Doudna 

It’s very important to appreciate that there are fundamentally two different ways that CRISPR can be used clinically. When we say clinically, we’re talking about using it in human patients. 

One of those ways is to use CRISPR in embryos, and if we do that, then it creates changes to the DNA of embryos that become part of that individual.  

The other way to use CRISPR clinically is to use it in individuals. That means changing DNA in the cells of an individual, not in a way that becomes heritable by future generations, but just in a way that affects that individual patient. 

That’s something that from the very beginning I have been a proponent of, because of the potential to correct disease-causing mutations. 

What I’ve been really vocal about avoiding is the former situation where you would use CRISPR to create heritable changes. I’ve called initially for moratoria on that and more recently for global regulation around that. 

Arielle Duhaime-Ross 

So there are a few human clinical trials happening right now using CRISPR, and one in particular is a treatment for sickle cell anemia. To be clear, this treatment doesn’t make a change in people’s DNA that could be passed down to future generations. So when you hear that there are promising early results coming out of that trial, how do you feel? 

Jennifer Doudna 

Deeply moved, because I think for any of us working in science, the idea that our work could someday help someone with a health care situation that they and their families are facing, that’s really why we do our work. So I feel very excited about the potential of the technology. 

Of course, I’m cautious. I want to make sure that it proceeds in a very appropriate, regulated fashion, and these trials that we’re seeing the early announcements for right now are going exactly down that path.

Assuming that those trials pan out, the big question will be how do we make sure that this technology is affordable and accessible to people that need it? That’s really the challenge that I’m now thinking more and more about and working on at the Innovative Genomics Institute. 

Arielle Duhaime-Ross 

You were one of the first people to hear about what the Chinese scientist He Jiankui did. He created the world’s first babies genetically edited with CRISPR, those two twin girls. Can you tell me the story of hearing about that for the first time? 

Jennifer Doudna 

So this goes back to the fall of 2018. I had been organizing the second International Summit on Human Genome Editing, which was scheduled to take place in November of 2018 in Hong Kong. And right before that meeting started, I received an email that had the subject line “Babies Born.” It was from Dr. He Jiankui and it was a very short message explaining that he and his colleagues had done clinical work to introduce embryos whose DNA had been altered with CRISPR to create a pregnancy that resulted in the birth of twin girls with altered genomes in China. And immediately, of course, this raised many questions about both the science and the ethics of what had been done. 

Arielle Duhaime-Ross 

So what happened next? You received this email and then what? 

Jennifer Doudna 

I flew out that night to Hong Kong so I would have a little bit of extra time before the meeting got started, and I ended up meeting with Dr. He before the meeting got started. He was already scheduled to be a speaker at that conference, and so when we met, we talked about what he was planning to present and also just trying to understand what had been done, first of all, and also why. What was his motivation? Why undertake something like this at this time? 

Arielle Duhaime-Ross 

Were you satisfied with the answer? 

Jennifer Doudna 

Well, I guess what was really kind of surprising to me honestly at the time was that although it seemed very clear to me and our colleagues that the work that had been done was really inappropriate for a number of reasons and really unethical.

This was not something that had really seemed to have occurred to him. He seemed to see himself more as a pioneer, somebody who was the first to bring this to people that might want to use it that way. 

Arielle Duhaime-Ross 

What would it take for you to feel comfortable about a clinical trial that would change a person’s DNA in a way that would allow that change to be passed on to that person’s offspring? 

Jennifer Doudna 

I think first and foremost, one would have to identify a real medical need for that and that real need is, right now, certainly, difficult to identify. But I think going forward, if there are real situations where an honest assessment says changing DNA is truly the best option for this family, for their children, etc., I think one would have to really want to have a whole pipeline of regulatory guidelines and a pathway for proceeding that would ensure safety of that kind of application. You would want to be able to follow their health outcomes over the course of their lifetime, especially in the early days of using the technology like that. 

Arielle Duhaime-Ross 

Do you often think about the potential ways that this technology down the line could end up being used? Do you often worry about things like eugenics? 

Jennifer Doudna 

I think that’s frankly right now still at the level of science fiction. It’s not something that’s going to happen anytime soon. That being said, I think it’s important that we right now grapple with the reality that we have in our hands a tool that in principle does enable that. It does allow control of genes and control of genes in families, and I think that it’s essential that we be tackling that issue right now, not running from it, but saying, look, this is a powerful tool. It has this potential and we need to already be thinking about how it could be used safely and how we appropriately regulate it. 

Arielle Duhaime-Ross 

Some people are very excitedly talking about CRISPR as a technology that could be used to prevent certain conditions, and I want to ask you about folks with disabilities. You sometimes hear people talk about “fixing deafness,” “fixing” conditions like dwarfism, and folks who are part of that community really get worried when they hear those things, because not everyone feels like they need to be fixed. They don’t feel broken. Where do you stand on that? 

Jennifer Doudna 

Your question really to me brings up broader considerations about … fundamentally, what does it mean to be human? What does it mean to embrace the diversity that we see across human cultures, human societies? To me, that’s one of the real joys of life.

So I think that to take it to an extreme, you could imagine a world where human beings have been sort of homogenized in a way, and we have a standard set of genes that we want people to inherit. Again, that’s really in the realm of science fiction. 

But I think imagining that helps to put in perspective what we’re really talking about here, a situation where suppose that in the next decade or two, parents could go to an in vitro fertilization clinic and they could choose from a menu of genes.

Would this be a good thing or not? What if we could eliminate deafness, for example? Would that be a good thing or would it eliminate some of the richness from the world? It’s a hard question to answer, and I think it has to remain in the hands of individuals at some level.

Arielle Duhaime-Ross 

When you hear these people talk about things like eliminating deafness … do you have a position? Have you figured out how you feel about this truly? 

Jennifer Doudna 

I think it’s a very individual choice to me. If you’re asking me if I were a prospective parent and this was a decision that I needed to make about my child, what would I do? Boy, that’s a hard one.

I have a wonderful son, and I see all the quirks that he has and things that just make him a wonderful person, and I think there’s a joy to that. 

At the same time, if you knew ahead of time somehow that I had a genetic disorder that I knew he would be inheriting in some way and I could prevent it, well, I think, of course, as a parent, I would have that desire to prevent it.

I think these are some of the really interesting and really challenging questions that are now in front of us given that we have a technology that in principle, at least … will provide some of that type of capability to people. It’s a really profound and really interesting question, but it’s hard to answer. 

Arielle Duhaime-Ross 

Do you think that we’re going slow enough with CRISPR?

Jennifer Doudna 

Boy, how to answer that. I guess the first thing I would say is that, the technology is so enabling for scientists that there’s no way to put the genie back in the bottle, at least at the level of research. And then, of course, at a whole different level, there’s the very tangible opportunities to affect people in positive ways that suffer from genetic disease. That is very exciting.

So I guess in the end, I don’t think it’s moving too fast. But I do think it’s moving fast for sure, and that it really does make it imperative that the scientific community deal right up front with the various challenges that we face to make sure it’s used safely.

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