Five Years Ago, Five Years from Now
It has been five long years since the emergence of SARS-CoV-2 as a US public health threat. It will be a longer five years if we don’t protect independent scientific and public health expertise.
On March 10, 2020, after having worked for a period of 6 weeks intensively on an emerging coronavirus from Wuhan, I decided to post a figure and brief explanation on Twitter that encapsulated what I viewed as a real-time risk to public health. It was around this time, late in the evening in Midtown Atlanta where I worked out the last of the details of the code and decided to click post.
The figure and code were meant to address a problem posed to me by a friend: what was the risk that one or more individuals might be infectious in a group of size 10, 50, 100, 1000, or more? At the time, there were still very few confirmed cases in the United States. In a country of 330 million, what could the risk really be?
The answer: really risky.
Since late January 2020, I had been working with colleagues on two key features of the novel coronavirus outbreak – (i) how many people were typically infected by each infected individual; (ii) how relevant was asymptomatic transmission to the strength of transmission. Indeed, the asymptomatic transmission route was particularly worrisome. When individuals have no symptoms then they are less likely to take precautions and can unwittingly attend events and infect not just a few people, but many people. That also meant that gatherings could inadvertently lead to widespread transmission, not just at Biogen, but at gatherings throughout the United States.
The resulting figure depicted isoclines of equivalent risk, combining the size of events (on the x-axis) with scenarios for the number of circulating infections in the US at the time (on the y-axis). The point of the tweet, as can be seen below was that plausible scenarios accounting for under-ascertainment of cases could mean a substantial risk of exposure at events that were at the time commonplace. The tweet went ‘viral’ in its own way. The screenshot below includes both the figure and the scope of reactions.
I am a scientist, first and foremost. I had thought the figure could help, but my account was not one with a built-in audience. The reaction was evidence that this kind of synthesis of epidemic data had a place in public discourse. As an avid political news follower, I appreciated the fact that Josh Marshall of Talking Points Memo was one of the earliest to recognize the figure and spread the news of its relevance to a broader audience.
From a technical point of view, the calculations were not difficult, they represented the results one gets from a biased coin flip – the bias is the relatively small chance that someone is infected. The problem is that large crowds mean many flips – and eventually the coin comes up the wrong way and someone in the crowd is infectious. I disclosed at the time that I had made simplifying assumptions with significant limitations. But the graph and its isoclines did do something vital: they connected plausible estimates of documented cases and under-ascertainment with a real-world question. The graph didn’t report cases per 100,000 people (a term that few think about in their daily life) but instead, presented risk in a way that felt tangible to the decisions people were making at the time.
This credo – connect epidemic data to questions that were relevant to real-world decisions – became central to choices I made along with my group and collaborators in what became a nonstop, multiyear effort to confront the pandemic.
Eventually we built a website that converted that tweet into an interactive map that provide more than 60 million risk estimates to more than 16 million distinct visitors. We collaborated on the development and support of an asymptomatic testing campaign that eventually delivered more than 500,000 free tests to the Georgia Tech community, with a focus on the period from Fall 2020 return to the widespread availability of vaccines in late Spring 2021. And I continued to do basic research on epidemic dynamics, speak to the public, work with decision makers, and support a multidisciplinary team whose work on viral dynamics had been turned on its head.
It has been a long five years.
What was then a novel coronavirus became a devastating pandemic. More than 1.2 million lives lost in the US alone and impacts on health and socioeconomic well-being. The miracle of vaccines. A long period of recovery. The crushing realization that many tens of millions in the US would choose not to be fully vaccinated even as billions worldwide never had the chance to make a choice.
It is hard to cut through this fog. I have tried. I wrote a book on ways that asymptomatic transmission can lead to better individual outcomes but far worse outcomes for populations as a whole. It takes longer than a substack (or two) to explain the narrative thread and evidence, though a synopsis does appear in a November 2024 Scientific American essay that already seems quaint.
Because despite having built up many capabilities to confront pandemics, despite the miracle of vaccines (developed and distributed when Pres. Trump was in office), and despite the potential to do even more to improve the quality of indoor air, to enable data-driven decision making, and to build robust response frameworks that break through the false dichotomy that we must choose between public health or the economy, we now face something else entirely.
Amidst a national measles epidemic and the threat of avian influenza, we face a comeuppance by individuals with grievances starting at the top, many of whom badly misjudged the threat of COVID-19 but rather than concede their mistake, have doubled down, and have decided to rewrite history and destroy institutions. They are now undermining public health expertise, dismantling American leadership in science, and politicizing the very nature of how the US does science.
This path – if we follow it – will end badly, not just for science and scientists, but for all of us. However, the future is yet to be written. It is in our hands, even now.
But if we do not assert scientific independence, if we do not reaffirm that the US is great because we have aspired to advance the rule of law and not to be ruled by law, if we do not demand that our elected officials recommit to a separation of powers and democratic norms, and if we do not take back our government from an unelected business owner who does not have the public interest at heart, then we will not just have a long five years ahead — we will face many more years of loss.
Each of us will face a fog more unsettling than that which we are emerging from. The viruses to come will not take a break. The multidrug resistant microbes will not notice the tweets about cod liver oil. The feedback loops that change ocean currents or ecosystems will not follow the party line. And that is the problem with deciding that the data should fit the narrative.
Misjudging important things comes with grave consequences.
I have no problem understanding your cogently written post. However, many of the biased and even more of the undereducated in society will not even access the post or any others like it. The biased and undereducated individuals that I encounter daily claim that they don’t need to know such things and therefore the information doesn’t matter. They also claim that there is only fake news. Fewer than 5% of the people that I work with would or could read your post. We are doomed. Btw - I work in healthcare.
The Prez is doing no one favors by shutting down scientific agencies… by not allowing the CDC and others to have outgoing missives.
I wonder all the time “what is going on out there, that we aren't allowed to know?”
Those cuts were not due to fraud or abuse, nor were they just to save us money.
The Prez doesn't want another pandemic to ruin his “legacy.” The doofus thinks when tens of thousands begin to die that he can decree it fake news.
This is scary.