Say a vaccine is finally achieved. Is 100% safe and tested for 18 months. What happens next? Is it like Contagion (lottery) or how do we vaccinate the whole world? Will there be some sort of bracelet to identified the vaccinated?

Say a vaccine is finally achieved. Is 100% safe and tested for 18 months. What happens next? Is it like Contagion (lottery) or how do we vaccinate the whole world? Will there be some sort of bracelet to identified the vaccinated?

Nita: What happens next depends in part on the data. Has it been tested on children? Who are considered the most vulnerable at that time? What is the safety data on the vaccine? What is the effectiveness of the vaccine?Let’s assume it’s safe and effective. But it’s in limited supply. Principles of bioethics would suggest that we ought to give it first to those that are the most in need (e.g. most likely to be exposed, most likely to become critically ill as a result). We ought also to consider those populations on whom it was tested and ensure that those who exposed themselves to risk to enable the development of the vaccine can also benefit from it.

Buz: First, understand - no vaccine is 100% safe.  many of the side effects may not be revealed until after extensive use.  You ask a question to which we don't yet know the answers.  Will it be paid for by the govt and offered free to all?  Will it be available only to people with insurance?  Are there sub-populations who are more at risk for adverse events?  Will the manufacturers be able to meet demand? Will all of the required ingredients be available in the US or will we be dependent on foreign supply?  Sorry to answer the question with more questions.

Thomas: With respect to the question of identifying the vaccinated, it presents a tricky question. In China, they are now utilizing an app which identifies individuals who have had the disease - this creates a new class system at some level. Those in the green in the color code system are able to go to restaurants, use the subway, etc.; others are subject to monitoring if they violate quarantine orders. Others are denied and may be subject to further monitoring. States have the authority to require immunization to attend schools, and universities create similar policies. We'll have to wait and see what actions are taken when a vaccine comes to market, but this will almost certainly have some variance and poke the bear of inequity in ways that aren't hard to imagine.

To jump on to Nita's train of thought, since we also see this pandemic impact communities on the margins with far greater impact while they have far more limited access to care and appropriate housing, we may also consider those factors as we roll out a vaccine to insure a hotspot there doesn't become an enormous outbreak more generally

My question about this is, what are we going to do with those who refuse the vaccine? Are we going to force them to be vaccinated against their will? Because that seems like a line I really hope we don’t cross

Buz: With a virus as contagious as COVID-19,  no understanding of what level of herd immunity will create community safety, and no effective antigen test which will accurately predict immunity and contagion, people who refuse vaccines will have to be quarantined

Thomas: We do actually require vaccination in some cases - many states impose such requirements with respect to school age children with limited opt-outs, as do employers, universities and other organizations. It's unlikely that everyone would be mandated to do so, but given how novel this is we should also expect novel policy directives and structures at both the state and federal level.

In many other instances we have while not requiring vaccination, had widespread acceptance of vaccination, largely because individuals understood the impact of these diseases first hand. Current generations don't remember measles, whooping cough, you name it. Because of that and relaxing standards based on demands for individual choice we have seen multiple recent outbreaks of diseases like measles which was at one point eradicated in many countries, US included. The public health based social contract seems to be fraying - even further now in light of protests against shelter in place rules. But the only way we can protect the vulnerable is with wider herd immunity. This may be a moment where we strengthen the bonds and responsibilities Americans owe each other, and that may mean reframing what we require of one another, including vaccination. Penalties for not vaccinating might range from limited access to social activities to social shaming, which may be the real force that gets individuals to agree to vaccination. But seeing so much death during this crisis may be the other force that limits resistance.

What techniques or approaches can science communicators use to effectively educate or persuade people who are inclined to see science as inherently biased, if not outright false? How can ethical or sound policy be implemented in the absence of data, either because resources to obtain it are constrained or the results are treated as suspicious?

Ariana: Part 1- In regards to techniques for scicommers to help educate and inform the public, all good guidelines for science communication are in play and even more critical now. One of the biggest things is making sure that the data and the numbers are explained in a way that is relatable and makes sense. As well as describing things in terms that are familiar. Explanations of things such as "why we need to wear masks" and relating it to things that we encounter or do in our daily lives are helpful. Additionally, there have been some excellent examples of actually explaining the meaning behind the graphs and numbers that are being tossed around. It is important to note that in all likelihood, you have no control over how someone responds. But you can try to understand why they think what they think and respond in kind. For example, there was a recent survey that looked at what activities people felt safe doing, but it is important to understand what safety means to folks as well as why they want to do those activities in the first place, and then describing the science related to those responses.

Part 2 - It is difficult for policy to be effectively responsive to what is currently happening if it is being decided data either because we are still finding the data and doing experiments, or because the results are in doubt. One of the difficulties with science is the need for repetition for confirmation. In this case, since we are still rapidly working to figure out this virus, treatments, vaccines,etc., we are in a realm where we are relying on science moving quickly, expert assessment/analysis of related experiences, what is happening regarding COVID-19 in other places, and models that help us predict what is going to happen given different variables. These models, which are informed by expertise from many areas (public health, economics, behavior) are enabling us to make decisions here. Regarding this data being under suspicion, this is another space where good science communication and science expressed clearly and diligently to policymakers can help us with this. Additionally, as members of the public, you yourselves can get informed from accessing the science about this pandemic that is out there and getting in touch with your governor or congresspeople.

Do you personally support challenge trials to speed COVID vaccine development?

To me, it seems that with healthy, young, willing volunteers, there will be very few fatalities and each one will compare to thousands of deaths prevented by faster vaccine rollout. The choice seems obvious to me, although it's still generating a lot of controversy. We ask firefighters to enter burning buildings, soldiers to go on patrols, and policemen to raid drug dens, how is this form of willing endangerment any more ethically dubious?

Thomas: I don't think it's a simple yes or no regarding support for human challenge trials. Generally, opinion on human challenge trials has been to restrict them to diseases that we have effective treatment for, like cholera, when we want to evaluate new vaccines, but we know we can treat the disease. We still have not engaged in challenge trials for HIV even though it's treatable. COVID has no reliable treatment. And even in pretty young, healthy people new evidence of risk not yet before considered is becoming relevant - such as life-altering strokes in patients in their 30s and 40s. We have to think about what informed consent to engage in that research looks like when we're still learning, and also how we might take care of those who sign up and who might be left disabled because of it - will they be care for for a lifetime? There are also lots of different ways to use challenge trials - are you identifying only the best vaccine options? Are you trying to get something to market immediately or more quickly? The details matter.

Had the pandemic task force not been fired a year ago, do you think we would be facing the same catastrophe we are now?

Buz: You have to believe that more preparation would have reduced illness and death.  More test; more PPE; more ventilators - all of which could have/were anticipated and would have helped.

How long before the second wave starts if the states start opening up?

Buz: We know that the disease will continue to spread when we relax restrictions, but we don't know how quickly or to whom.  We don't know who has already had the disease (not enough testing) and whether they become immune if they have. Concentrations of vulnerable populations (eg nursing homes) which had been isolated, but do become infected will cause dramatic spikes.

Thomas: A lot of the conversation around the second wave refers back to our experience with the Spanish influenza. In that case we only got a taste of what was to come in early spring. But in the late summer and fall of 1918, we saw something more virulent and devastating, with far more deaths. This is one example of what might happen. We will also be dealing with influenza in the fall, and if that second wave does happen it will be more tricky to separate cases of COVID from season flu. We also may have a long haul ahead of us where we don't see a huge drop off.

Special guest answer from our SciPol.org team: Dr. Sarah Rispin-Sedlak: Right now, if we look at the United States outside of New York, we are actually still in the first wave. Deaths from COVID-19 are continuing to rise in the remainder of the country, so if individual states start to open up now, they may actually exacerbate the first wave.

Can you explain some of the decisions that hospitals and governments are making in regards to the disabled population during this epidemic. I have seen in some places that they are allowing hospitals to remove someone's own ventilator that they may have arrived with and use it on other patients. I've read claims from the disability community that many hospital are inaccessible, and are not providing the same level of care to disabled peoples, especially those without an advocate. Where does ethics come in for those at risk? Are people with preconsisting conditions being deprioritized?

Nita: At least in the conversations that I have been a part of, ethics boards have been concerned about ensuring the difficult choices that have to be made with respect to rationing of resources such as ventilators should not be done in a discriminatory way. At the same time, there are certain conditions that may make a person less likely to survive intensive life-sustaining interventions such as being on a ventilator for a long period of time. The protocols being used and that are being put into place to consider ethical distribution of resources  can and should be devised in a way to ensure that they are not done in a discriminatory way. Many hospitals are following this recommendation by White and Lo: https://jamanetwork.com/journals/jama/fullarticle/2763953

1. What is your opinion on origins of the virus?
2. How badly is it mutating?
3. How likely it is that it will return in near future.

SciPol.org Brian Langloss:

1. It more than likely originated in animals. Bats are a strong contender for the source given they meet a number of conditions that make them ideal hosts, such as their tendency to be carriers of a large number of viruses and regular interactions with people. I think it's still a bit open whether it underwent natural selection to become the current disease in the animal host itself or transferred to humans and then underwent natural selection.
2. There has been some concern about the rate of mutation and the potential for various strains. At this point, scientists are  tracking genetic changes of the virus in real time (there are good sources to see this) and it appears that it is mutating at a steady and predictable pace.
3. Return as in having a yearly cycle like the flu? I think it's hard to tell at this point. The timing of the efforts to reduce spread overlap with when we'd see flu die down. So it'll be hard what aspects of this are from yearly cycles vs. efforts to reduce spread. As for returning, we'll have to see if/how it reemerges in the fall.

A friend just made me watch this horrible "documentary" called Plandemic under the guise that it's just another valid perspective. As an educator and engineer, best available science is my life. Ordinarily I just avoid arguing with people that watch this stuff, but I feel a moral obligation to discuss this pandemic with my friend. How do I respond when he says my sources of scientific papers and experts are just as valid as fringe scientists and doctors like those presented in this video?

Not a direct answer to your question, but Ariana brings this documentary up in a different reply

I’ve noticed a surge of conspiracy theories and general distrust in the medical information the government provides. What do you recommend can be done against this, is it a major threat to properly dealing with the pandemic and can the harm it causes be quantified in anyway?

Jory: I think that there are always going to be conspiracy theories and people spreading them.  And, in times of a pandemic, where there is a lot more public curiosity, fear and misunderstanding, some of these theories are going to gain more traction.  What is important is that people stick with reliable, trusted sources, such as the CDC (Centers for Disease Control), the NIH (National Institutes for Health) or WHO (World Health Organization).

Ariana adds that this article might also be helpful.

Why do we hear so little about Corona on the African continent? Are there fewer cases? Or is it just because of lacking media coverage? Also do we know anything about how the virus behaves in warmer/colder regions?

Ariana: I don't have a full answer to this question in regards to Africa, but the fact that we aren't hearing as much isn't because they are experiencing a lack in cases. There was recently an interesting article in Nature magazine that was written by the head of their CDC (https://www.nature.com/articles/d41586-020-01265-0) and it starts with statistics about what the case count is like there, "The first case of COVID-19 in Africa was reported in Egypt on 14 February 2020. Since then, 52 countries in Africa have reported more than 30,000 cases and about 1,400 deaths from the new coronavirus. This count is likely to be an underestimate..." It goes on to describe the inequities between testing capabilities in Africa compared to other places as a platform to talk about a plan moving forward that brings awareness to what is happening there and brings them into the fold. This is an example of how in general western news coverage is terrible about paying attention and covering things going on in Afria and in the developing world.

Sarah: The initial assumption was that illness from the virus would drop off with the advent of warmer weather in the spring. But from the beginning, as the virus spread out from China and Italy, it became apparent that community spread was rapid even in warm climates.  The National Academy of Sciences has said there is not enough evidence to show that the virus will be less virulent in warmer, more humid climates (as others sometimes are), though we will know more about that over the summer. For now we should assume that lower numbers in Africa have more to do with the  factors that Dr. Eily mentions above.

Uncertainty seems to be one of the pernicious hallmarks of this pandemic-- while experts try to gain ground on swift data collection to base decisions, uncertainty, misinformation, and contradictory reports swirl through society. Questions about the effectiveness of PPEs, to origins of the virus, and now concerns about second spikes due to potentially premature opening of communities leave most people with a troubled task to make informed risk decisions based out of highly uncertain information. Given such ample uncertainty and misinformation, how can we, as individuals and as a society, better communicate about COVID-19 to increase salience among the wider populous?

Ariana: Getting a handle on uncertainty is a really important aspect of this pandemic and our response to it! Wonderful question to ask. It does present ample ground for misinformation to rear its ugly head which is one of the reasons the term "infodemic" is being thrown around to acknowledge the issues being caused alongside the disease itself. When it comes to what you and what society can do to limit the harmful effects of misinformation, we need more emphasis on science communication and clarity in how we explain things, transparency in where uncertainty lies & how we are actively solving problems in real time, and how we monitor/inspect the information we consume. Being savvy in regards to media literacy is as equally important as scientists being trained to communicate well. There have been many efforts to increase media literacy in certain groups in the public sector, and those need to be boosted--especially now.

Things such as fact checking, looking at the author/creator of content, examining their affiliate organizations, their track record, checking the date on things, etc., can help. For example, with the "Plandemic" video that has been making the rounds, many experts have been posting responses that go through minute-by-minute and debunk the things that are being said with resources and explanations for what is wrong in the video.

This is one place where social media giants could help us in regards to how their platforms are a space for information to make the rounds, and they are regularly in the news in ethical discussions about what their responsibility is in combating misinformation.

Ethically, how do we separate and justify the restrictions imposed on Americans and their livelihoods (in the case of, for example, small business owners shut down indefinitely) due to COVID-19 from the lack of restrictions for other communicable diseases such as influenza?

Nita: Honestly, I struggled with this one in the beginning myself. Particularly since we lost a daughter to RSV, and there are no restrictions on society even though it rears its head every year. We ought to encourage a lot of the practices that have come into effect for influenza (such as handwashing, good hygiene practices, etc.), given the its annual toll on human lives. And influenza is relatively well characterized (even though there are annual variations in strains and its impact on society). There are some treatments available, and there is a somewhat effective vaccine that is available. With COVID-19, however, there are a lot of unknowns. And in light of the predicted toll on human lives, particularly at a time that healthcare systems may already be close to capacity due to influenza and other respiratory illnesses given the season that its spread began. With COVID-19, the expected toll on human lives in much greater than in any given year with influenza. It seems to spread more easily and have a higher mortality rate. But again, these are some of the many unknowns. It also comes at a time that is on top of influenza. Which means that the compounded effect would overwhelm our health care systems. The risk/benefit calculus with influenza alone is different than with COVID-19 on top of those illnesses. So the extremely restrictive measures may not make sense for influenza on an annual basis. But society will likely take much more aggressive measures toward personal hygiene going forward.

Thomas: In many cases, we limit individual rights in meaningful ways to insure the general good. For example, I can't just go out and sell a medication to make money that is unproven or dangerous. This is an example of utilitarian ethics, which tries to maximize the overall benefit, versus principalism which would say individual liberty is the most important value to consider and that we should always defer to it. Over time policies react to possibilities and realities like this. In many cases it comes down to a cost benefit and we are seeing that play out in the current political dialogue.

I have two distinct questions. First is probably to doctors Eily and Weintraub as it concerns the border between effective communication and ethics. Since the beginning of this crisis there has been several public announcements in my country and in several other countries that wearing masks is not only unnecessary but even discouraged among general public. The reasons given are different, varying from "lets leave them to medical professionals who need them most" to Finland's "Do not wear masks, they are inefficient and home-made ones may be dangerous as you breath in cloth fibers". It seems to me that these messages are usually not clear whether they mean masks are inefficient protecting wearer from infection or protecting others from his/her (asymptomatic) infection. It is certainly harming peoples trust in their ability to use masks to avoid infecting others. Do you think this is ethical and efficient communication to suggest people not wear masks because they will not work and are even harmful? It seems to me that if this were the case, medical professionals would not be using them too. It seems to me real reason is avoiding panic-buying that reduces medical professionals' ability to acquire masks, but the real reason gets lost in messaging resulting in misinformation and reduced trust in officials' honesty or competency.

The second question is about data and privacy. We have quite a lot of digital medical information collected about each citizen in our country (Estonia). Yet privacy laws protect it to such extent that local municipalities have not been able to get information whether they have an active case in their borders or not. Only information available is to which highest administrative division is the person officially registered in (not very helpful and also inaccurate, as people often live elsewhere). Even researchers have not been able to get location data about infected cases. It is somewhat understandable, as our country is so small (1 million people) that 69 year old male in Järva-Jaani township may already be enough information to identify him by random university research assistant. In your opinion what are the effective information collecting and sharing practices that help local municipalities in dealing with a break-out of sickness but leave people's privacy protected? Currently we rely too much on overworked National Health Agency to coordinate tracking who have just one data analyst on payroll...

Jory: Regarding your first question, I am inclined to agree with you. I think the most important issue with masks early on was the concern about the supply chain and making sure health professionals had all the PPE (personal protective equipment) they needed. If the messaging had focused just on that, there would have been less confusion. Whether or not masks are truly effective/protective for the general public is a separate question and one for which the answer is less clear. But, mixing that message in with the one about the supply chain for medical professionals just led to confusion. It’s a good reminder that good communication involves a clear, consistent message backed by evidence. Of course, it is extraordinarily hard to ensure the consistency of message when so many people have a voice (especially via the various social media tools that are available to people), so mixed messaging is unfortunately inevitable.

Great initiative!! Thank you for taking the time to respond...

How do you think this pandemic will change the overall stance of lawmakers and policymakers on the idea of a comprehensive administrative databses used more actively by governments?

We already saw news about attempts to involve social media giants in "contact tracing"!!!

After all this pass, hopefully with the least damage possible to humanity, do you expect governments to start considering some form of hybrid version of the "Social Scoring" systems recently introduced in China?

On the same note, how do expect the debate about the government's deliberate and active utilization of behavioral economics theories on "Nudging" for example.

Regards,

Waleed

Guest from the SciPol.org Team, Sarah Rispin-Sedlak:

We are seeing an upsurge tech companies actively sharing data they already collect on us for business purposes with the public health community--epidemiologists, researchers, public health officials.  We should be concerned to the extent any of that is not sufficiently anonymized and disaggregated and then remains in the hands of public health officials.  And certainly this should spur us to have a serious conversation about creating a legal framework around data privacy, under what circumstances tech companies can share this data with the government, and what the government may do with it when acquired.  But I don't think we'll see a major move in this country toward the type of contact tracing now being seen in Taiwan, Israel and South Korea.  First, legal and constitutional protections would probably seriously slow down such an effort, at the very least. Second, there would be a major public outcry.  Third, app-based contact tracing is not the panacea that some people say it is, as it requires at least 70-75% buy in to be effective.  And a recent Washington Post poll showed that the majority of Americans would NOT be willing to participate in such an effort, which, all indications are, would render it ineffective.

Buz: Watching Apple and Google dance over what will and won't be included in their contact tracing app demonstrates the conflicting interests well.  They are being battered by the privacy community for the current design (ie relying solely on Bluetooth connections) and on the other side by the public health community for not using other location data and cell tower infor which would make the app more effective.  The privacy/civil liberties problem is that once the capability is well developed, it can/will be used for other purposes (eg tracking political dissidents an who they meet).

I'm seeing a massive influx of popular press articles based on preprint servers like biorxiv.

Is there a danger in the public equating preprints with peer reviewed papers? There haven't been any disasters yet, but if a widely reported preprint is turfed by the peer review process, might this undermine confidence in the scientific establishment?

What responsibility do journalists have to educate the public about the scientific process when using such source material?

Jory: It’s a really interesting and important question.  I think that there is more emphasis than ever before on getting information out quickly, and the preprint approach is a way of doing that.  But as you point it, it comes with a risk of releasing inaccurate or misleading information (that would normally be spotted during peer-review).  I don’t think there is an easy answer to that, but a good place to start would be by journalists helping the general public understand the difference between a preprint and an article that has undergone peer review.  And, journalists should be very clear on the source (pre-print server or peer-reviewed journal) when reporting on new research.

Thank you for being here and doing this. If you could design the national reopening strategy, what would it look like?

Sarah: First, the bare minimum for beginning the process of opening back up would be for each state to have enough hospital beds to accommodate all COVID-19 patients, for the number of COVID-19 patients being treated in hospitals in that state to be steady or falling for at least two weeks, and for deaths from COVID-19 to be steady or falling for at least two weeks. In the absence of universal testing, and because we are still ramping up testing, hospitalization numbers and deaths are our only real gauge of the progress of the epidemic, and our progress in fighting it.  If I had a magic wand, in the mean time, I would mobilize the national government to use the Defense Production Act to ensure the manufacture and distribution of enough test kits to test millions of people on a weekly basis. Once we start (slowly, incrementally) allowing more economic activity, we would have to  engage in constant, widespread testing of those who interact with non-family members on a regular basis, and be prepared to close things back down if and when numbers of COVID-19 victims start to rise again. But also, while I had that handy-dandy magic wand, I would create a magic method of allowing all day cares, schools and camps to reopen without spreading the virus, so that parents can return to work.  Sadly, no such magic exists.

Thank you for your answer!

Thank you for the question!

Hello! Thanks so much for doing this! A bit of context - I’m an engineering PhD Student and am working toward ethical AI and emerging tech policy. It’s always exciting to find other groups who are doing this work! A few questions along those lines:

What have your experiences been like working at the intersection of policy, ethics, scicomm, and science?

What advice can you give someone trying to go into this field?

What techniques have you found effective in overcoming fear or willful ignorance about topical / sensitive topics?

In a public health context, which technology has the most potential to cause secondary harms? (E.g. privacy)

Guest response from our SciPol.org lead editor, Andrew Pericak:

We’re always excited to hear of current students interested in getting more involved in science and tech policy issues! If you’re in the US, your campus may have a student science policy group, and they may be affiliated with the National Science Policy Network. They’re a great resource, and they’ll even help you establish a student group if one doesn’t exist on your school. Otherwise, the general advice we give is there is no single, correct “path” to getting involved with science/tech policy; whatever you can do currently as a student to learn about or be involved in science policy work now will help as you start seeking for jobs.

A lot depends on where you see yourself ending up—if you see yourself becoming faculty at a university, you can still be involved with science policy by keeping yourself informed of the latest developments, attending public meetings or hearings by government agencies, submitting comments on science/tech policy issues, talking about policy with your students, or even working with your university’s government relations office to testify in front of lawmakers. If you see yourself working in government or industry, many organizations really value the opinions of somebody with scientific training, even on policy issues, since you’ve been trained with a detailed, methodical way of thinking that really benefits good, evidence-based policy.

Finally — remember that policy isn’t just what happens in government, but any sort of decision made by an institution that affects people’s livelihoods. Your university makes a lot of policies for its students/faculty/staff, for example, that are surely affecting you, and many of those policies require science/tech understanding or training (for instance, some universities are starting to allow research labs to open again, even if other employees are still working at home.) So think broadly about where you want to apply your training!

Some shifts to policies and systems are only achieved through extreme events that force change.

This pandemic is perhaps the most extreme event I can remember in my lifetime. What changes do you think we'll see maintain in society going forward? Is Telehealth here to stay? Are we going to see things that were once prohibitive because of legal or logistical challenges be the new norm?

Buz: The use of telemedicine was facilitated and dramatically increased because of a series of temporary state and federal waivers and regulatory changes.  Some may not last. Eg most of the telehealth platforms are not HIPAA compliant and do not provide adequate longterm health data privacy concerns.  The short term compromise was acceptable but probably not longterm.

Thomas: I think one thing that may arise from this pandemic may be a more serious consideration of questions around the "digital divide", or the idea that we have widely varying access to the internet depending on things like our socioeconomic status, or where we live. As we see folks forced to shelter in place this has been a central theme,  it's clear that this conversation is not over. Especially with respect to schools, this is a huge issue right now and basic access to education. I think when we come out of this, or as we continue to move through it we will see a diverse set of policy makers push for equalizing access to internet, and perhaps even its morphing into a commodity that we see of more as a utility like water or electricity.

Whose your favorite Avenger?

Nita: Is that even a close question? It's clearly Iron Man.

Ariana: Wakanda Forever

Thomas: Shelter in Place has led me to Wolverine like nails at the moment...but Wakanda forever.

Jory: I’m probably not qualified to chime in, because the only two superhero movies I’ve seen are Wonder Woman and Black Panther, and the only reason I chose to see those was because I liked that they were empowering under-represented (in superhero movies, at least) minorities!

SciPol.org Team Mentions:

Sarah: Does Elsa count?

Brian Langloss: Spider-man is mine

How can we address the discordance of public reaction to recommendations like mask-wearing for all? I see reactions ranging from people flat out refusing and those who take it up happily only to abandon all other precautions. How likely are cloth masks/other alternative face coverings recommended by CDC to reduce transmission rates in a meaningful way? Also may have the FDA discouraging mask wearing for the first several weeks of outbreak lead to avoidable spread?

Nita: There are a few questions in here, and I’ll try to address them in turn. Let’s start with the first one, which is mask-wearing for all. There is interesting historical data on this one, that with mask-wearing in particular, society seems to grapple with this restriction more than others. Some have posited that there is something about face covering that impacts human interactions in a way that makes it particularly difficult to accept. But public reaction can likely be explained by a number of things, ranging from concerns about impact on individual liberty, to a lack of understanding about the benefit of mask wearing, to poor communication by leaders about the science and rationale underlying mask wearing, to mistrust of science, to mistrust of public officials (particularly given early missteps about communication about masks).

The data is somewhat mixed on how effective cloth masks are, and this is in part because there are so many variables in cloth mask wearing. Such as the many different materials being used, the variation in the fit of masks, the behavior of individuals wearing those masks, etc. But at least for all the data I’ve seen, it doesn’t hurt (so long as you’re using safe materials with adequate breathability, and it’s not causing you to touch your face much more often, etc.), and likely helps. How much it helps is still unclear and will vary based on all of the above variables.

As for what would have happened if there weren’t early mis-steps with respect to recommendations on mask wearing, I wish we could quantify it. But I thought the Surgeon General’s tweet on this was utterly maddening and very poor science communication.

To what extent does economic impact weigh into epidemiological policy advisories? Surely epidemiologists aren't economists as well, even if the math is similar, is any group taking a multidisciplinary approach to policy advisory that includes robust economic analysis?

To expand on this idea, we already have a problem in the US with a rising incidence of deaths of dispair^[1] , and there is a link between a person's economic position and life expectancy ^[2] . So it follows for a lot of people I know that if we let this become too big an economic hit, we will be making things substantially worse as more people will die and we will all be more poor too. What is your groups thoughts on this sort of analysis?

[1] https://www.npr.org/2020/03/18/817687042/deaths-of-despair-examines-the-steady-erosion-of-u-s-working-class-life [2] https://jamanetwork.com/journals/jama/article-abstract/2513561

Thomas: This is an incredibly hard question. The insurance industry has for a long time used economic values to determine payments, we use similar data in courts when we talk about wrongful deaths and damage awards for many types of injury. But that being said, we don't often aggressively consider a cost benefit when we think about public health outbreaks, but this pandemic has forced us to in new ways because of how widespread it is. What do you place in the costs column - what is your mother's death worth? How about if she's not working but the glue of your family? What about the benefits? Right now there are so many unknowns that it is difficult to answer even whether we want to answer these types of questions. Much of the political debate going on right now is centered on whether we are willing to make such a calculation as some seek to reopen the economy.

Do you guys have any new information related to your field of study that is positive or optimistic? I keep feeling like reopening early among other poor decision making is actually going to keep me away from seeing my girlfriend even longer. I really could use some positive info that makes me feel like I might be able to kiss her again sooner rather than later!

Ben: Our experts have signed off for the night, but your question resonates with me, so I wanted to comment. Our team asks ourselves this same question daily. It seems to affect everyone differently and to different degrees, but everyone is effected. And we're each looking for that silver lining. Specific news about the virus fluctuates so rapidly that it's hard to find even ground, even when there is a success to celebrate.

Instead, I think most of us look elsewhere for the break. We're thankful for the technology (and recognize its many flaws) that has allowed us to have some semblance of contact in virtual space that simply wouldn't have been possible a decade or two ago. We also try to celebrate the little adaptations that wouldn't have happened otherwise. For instance, getting a unique glimpse into our coworkers lives now that we're constantly "live from home." This NYT Op-ed touches on this idea. This just wouldn't have happened with everyone reporting to the office as usual.

For me, the early and continued examples of society uniting under isolation were so encouraging and I try to look for it and appreciate it. For instance the effect of #FlattenTheCurve trending is a huge win for Science Communication and social media. On a wonderfully human note, this viral video of a Spanish fitness instructor holding classes from their balcony for their community showed how people are working to get through this together, despite so much stress in the media and on social media. Then there are new online opportunities popping up everywhere, many free, like these free online courses from the MOMA. I reached out to a loved one who I can't see right now suggesting we take a course together to create opportunity for more interaction.

None of this could possibly replace being physically separated from our loved ones. But thank you for diligently practicing social distancing. I wish I had more concrete data or could see the headline that says "we have the cure!" and share it with you, so we can stop living in uncertainty. Meanwhile, keep running the marathon. We will get through this.

1. Is it true that COVID-19 is really a “great equalizer”? I read in the Atlantic that some ethnic groups, especially African-Americans, are getting higher rates of infection and death than others because our immune systems are products of our early childhood environments.
   1. In the short term- should health policy focus on protecting vulnerable demographics such as African Americans during this pandemic? is there anything that vulnerable POC should do to protect themselves?
   2. In the long term- do you think that this pandemic has exposed the deep seated health inequalities that pervade America? What policy measures are public health policy experts proposing to help alleviate all the socioeconomic issues- housing discrimination, poverty, environmental racism- that cause health inequalities? Are social and health policy conflating?
2. For Dr. Weintraub- how do you think the power of language has shown itself during this pandemic? Do you think that people only started panicking when the WHO declared it as a pandemic because it sounded scarier?

Thanks so much. I'm a high schooler and I have always been tremendously interested in public health. I am looking forward to reading your answers.

Jory: Question #2 is a great question…thanks for asking! The challenge in responding to your question is that asking how “people” reacted suggests that there is a uniform response, but of course, this pandemic is reminding us that there are almost as many opinions and attitudes as there are people in the world! As with everything else, there have been a range of responses. I think some people probably panicked as soon as word started coming out of China that there was a new pathogen emerging, while a good percentage of the public is still remaining calm and rational to this day. This is a very scary time, so it is understandable that people might be prone to panicking, but one of the things the medical experts said (appropriately) from the very beginning was that people shouldn’t panic, but should take it seriously and prepare. There is no doubt, though, that the language people use is EXTREMELY important and powerful in determining how public understanding and perception are shaped, so officially declaring it a pandemic certainly had an impact on people. It’s a good reminder to all scientists, science communicators, members of the media, policy makers, etc. that language is extremely powerful.

Duke student here! What do you think will be the plan for colleges for fall semester- In-person or online classes only?

Nita: Hi Duke student! Great to connect with you here! I think that universities will have a hybrid approach to classes in the fall. And I think that to the extent that there are classes that are online, that they will look fundamentally different than the classes that were stood up this spring semester. With notice and planning, most academics I know are trying to learn quickly innovative strategies to take advantage of the opportunity to rethink how they engage students and guide learning.

Maybe this is best directed to Dr. Weintraub given it’s heavily science communication related:

We have seen the standard push of anti-vax/scepticism info during COVID-19 and it does not appear to be weakening, but rather spreading at a pace to which (I feel) the scientific community is not currently positioned to defend itself from.

If you agree, what are some realistic changes that you would like to see to the way peer-reviewed information is communicated which might help change this?

Our experts have signed off, but I'll pass this along to Jory to see if he might answer later on!

Do you believe we should have laws that allow for the prosecution of snake oil salesmen and people who spread lies about false cures and the like?

Nita: Yes and at least in this country, we do. The FTC often cracks down on these, as does the FDA when in their jurisdiction.

Given that we already accept many risks that lead to deaths like car accidents, how do policy makers weigh that factor when deciding what amount of risk is too much? For example, if the amount of deaths due to coronavirus is only slightly higher than the flu, how much risk should we take to open the economy? I guess I'm mostly interested in how risk analysis is used.

Nita: This is a great question. I'm not an expert on risk, but Duke Science & Society, we also house the Duke Center on Risk, which is headed up by my colleagues Jonathan Weiner and Mark Borsuk. They are hosting a Coronavirus Conversation at Science & Society soon (check these out on our website). And this is exactly in their wheelhouse to address.

Sarah: Our government has, for decades, conducted risk analysis based on the idea (roughly) that we proceed with plans when the benefits outweigh the costs, and stop when the costs outweigh the benefits. Cost-benefit analysis lies at the heart of our administrative state. To many people's dismay, we actually quantify the value of human lives to do this. But in this context of this pandemic, we don't have the time to do formal cost-benefit analysis.  We (and by this I mean our decision makers in federal and state government) are making decisions based on a rough analysis of cost and benefit as they go along.  To understand what is driving our massive response to the coronavirus, we have to look at the costs not just of the number of deaths that we have had (70k and counting), but also the costs of the deaths we have avoided, the costs of having our hospitals overwhelmed by and unable to handle the COVID  cases we have had and will have, etc.

This is such a great question. Our experts had to sign-off, but I'll follow up with them to see if anyone wants to field this one later!

Dr. Farahany. Couple questions.

What are your thoughts on over arching ethical frameworks, such as utilitarianism, deontology etc. Any preferences? Do you see any problems with either rigidity or circumstantality requirements for applying ethical systems to technical issues in bioethical problems?

If a bio/medical ethics professor was looking for interesting contemporary topics for their syllabus, what would you recommend?

Nita: To the first question, personally, I tend to think of myself as a consequentialist, but I don’t think that adopting a rigid framework either makes sense or necessarily helps you with a decision-making framework. Practical ethics requires translation from principles, which are often high-level and general, to decision-making, which is often fact and context specific. It’s very helpful to know your own “priors” but it’s important to not spend all your time in that high-level of generality, if you want to have an impact and be able to integrate ethics into decision-making.

To the 2nd question: Check out our classes for Summer II at Duke Science & Society! A ton of great contemporary topics to include.

Do you think some medical professionals throughout the world might be holding back on reporting case/death numbers to 'protect' their own population (or the rest of the world) from knowing how bad it is?

Nita: I think that there is both unintentional underreporting and likely intentional underreporting that is occurring by governments in some parts of the world.