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Podcast: The long path to a post-pandemic reality

MIT Technology Review’s editor-in-chief Gideon Lichfield explains the key testing and tracing measures we’ll need before we can even think about easing social distancing.

April 22, 2020
Mr Tech | Rob Sheridan

Deep Tech is a new subscriber-only podcast that brings alive the people and ideas our editors and reporters are thinking about. Episodes are released every two weeks. We’re making this episode—like much of the rest of our coronavirus coverage—free to everyone.

We can probably stay sheltered in our homes, collectively flattening the curve of coronavirus infections, for several more weeks—maybe a few more months if we must. But for the sake of our mental health, not to mention that of the global economy, we can’t stay cooped up for the 12 to 18 months that it might take to create and validate vaccines or drugs that are effective against SARS-CoV-2.

So how do we safely roll back the current social-distancing measures? The emerging consensus is that it will happen region by region as falling infection rates allow, and with protective measures that include massively scaled-up diagnostic testing, contact tracing, and antibody testing to see who’s immune. Here in the US, as Gideon Lichfield explains in this episode of Deep Tech, we’re only at the beginning of those efforts.

Show Notes and Links

This is what it will take to get us back outside, April 12, 2020

Social distancing until 2022?! Hopefully not, April 15, 2020

We’re not going back to normal, March 17, 2020

Episode Transcript

Gideon Lichfield: The new normal will be that we are used to the idea that in some cases, being able to move around freely is dependent on us being able to show that we're healthy.

Wade Roush: Even as we all stay sheltered in place to limit the spread of the coronavirus, we’re beginning to think about how to restart the country, while keeping everyone safe, and keeping the pandemic-induced recession from spiraling into a depression. 

Gideon: And there will be a greater acceptance, I think, of that kind of public health monitoring. That could be a good thing if data are collected in a responsible way … and if it leads to better healthcare for everybody, then I think that could be a positive outcome. That's the positive scenario. The negative one would be that we come out of this with covid vanquished, but without having really learned any of the lessons from it and that we're just as vulnerable when the next pandemic hits.

Wade Roush: Today on the program, MIT Technology Review’s editor in chief Gideon Lichfield walks us through what kinds of technologies and public health measures would be needed to safely end the social distancing phase of the pandemic, and move us into a new phase when some of us can venture, very gingerly, back to work or back to school. I’m Wade Roush, and this is Deep Tech.

[Deep Tech theme music]

[Audio montage]

Wade Roush: If you get outdoors here in Boston, the sound of the coronavirus pandemic is the sound of cars going 50 miles per hour on a stretch of road where there’d normally be gridlock. It’s the sound of a bus going by with maybe two passengers on board. It’s the sound of an empty subway train. It’s the sound of spring returning to an empty park, and a weed whacker trimming the edges of an empty yard.

And most importantly, it’s the sound of no people anywhere. Well, except this guy.

Driver in parked car: What in the world is that thing? 

Wade Roush: It’s a shotgun microphone. Just doing some recording. 

Wade Roush: Here at Technology Review, the newsroom is empty too, because everybody is working from home. But it’s fair to say that the magazine’s entire operation has been rebuilt over the past few weeks to report on the coronavirus pandemic, and on the big question of when we can all get back outside and reinhabit those empty spaces.

We’re exploring the big unknowns: When will we have a vaccine against the virus or a drug to blunt its effects? How long can we afford to keep the economy in what amounts to a medically induced coma? And what tools do we have for reviving it?

Gideon Lichfield has been trying to synthesize some of these ideas in a series of larger essays for the magazine. And last week I reached him at his home in Cambridge, Massachusetts, to ask him to walk me through what would have to happen in order to safely restart the economy. He made it clear how tricky that’s going to be—and why no matter what we do, the world isn’t going to look the same as it did before this pandemic.

Gideon recorded himself on his phone in his coat closet and I did the same from my own closet.  

Wade Roush: Gideon, can you explain why we can't just go back to the old normal?

Gideon Lichfield: So at the moment we have a pandemic that has spread through some proportion of the population. We don't know how many people. It could be 1 percent. It could be 10 percent. There's still a lot of uncertainty about just how many people have already caught it and simply don't know. But what we do know is that, number one, it's going to take at least 12 to 18 months to develop a vaccine. It probably won't take that much less time to come up with an effective drug. There's a chance that certain drugs that already exist will prove to be reasonably effective against covid 19. But so far, there isn't a lot of strong evidence that they are. And so the chances are that we have to keep the curve flattened, as they say, keep the level of infections reasonably low up until the point when we actually can treat it or vaccinate people against it. So what does keeping the curve low mean? Well, it's what we all know today. Social distancing. It means trying to minimize contact with people as much as possible. Now, here's the problem. Can we really stay cooped up in our houses for twelve to 18 months? Well, that would be really hard and it is going to destroy the economy, which is already suffering very, very badly. So I think the question that we have to look at now is what are the measures that we could take that would allow us to gradually start coming back into the open, mix socially to a certain extent, go to our workplaces to a certain extent, but keep the disease at bay whilst we wait for a drug or a vaccine?

Wade Roush: I think we're seeing a lot of writers and commentators and policy thinkers asking how and when this period of hunkering down is going to end, finally.

Gideon Lichfield: The problem is we can’t still put a date on it. In China, they did very, very strict lockdown in Wuhan for, I think about 70 days from the moment when they decided to lock the place down. And that was when there were still only a few hundred deaths. And that was much more strictly enforced than any of the shutdowns have been in the U.S. To imagine that the U.S. would be able to get back to a trickle of cases as China did in anything less than 70 days, is obviously not realistic. I don't see it as conceivable that we will be beginning to flatten the curve enough to start letting people out before middle or end of June.

Wade Roush: In the last week or two, different groups of experts have been floating different scenarios for how we're going to turn the economy back on while also minimizing the risk that the pandemic would flare up again. And the plans differ in their specifics, but they also have a lot of common elements. And I just wondered if you could maybe walk us through those and focus on the measures that you think are most necessary and most sensible—and most likely to get us out of our houses.

Gideon Lichfield: So there are a few key things that we would need to do in order to be able to get out of our houses as long as there isn't a drug or a vaccine. And the one is we need to be testing people at a much, much greater rate than we are at the moment. So the US, the last I looked was testing about 150,000 people a day. And by some estimates, specifically there's an estimate out of the Edmond J. Safra Center for Ethics at Harvard University, putting the number of daily tests that have to happen at anywhere from two and a half million to tens of millions.

Gideon Lichfield: And the thinking there is you want to be able to test people frequently enough that if somebody has the virus and they don't know it, they don't have symptoms or the symptoms are very mild, you catch them before they've infected more than one other person. That means probably testing people every few days if you really want to blanket the entire population. And the idea that would be when somebody has tested, then if they test positive, you can contact everybody that they have been in touch with in the previous few days and say to them, hey, you've been exposed. Go get tested or quarantine yourself.

Wade Roush: We have a long way to go to get anywhere close to the levels of testing that would be required under any of these scenarios. We just aren't there yet. What's the pathway between the world we're in today and the world we'd need to have in order to do testing on that scale?

Gideon Lichfield: Yeah, there's a long path to travel. You would need to massively scale up testing capacity. You need to develop new kinds of tests, ones that can be done and get the results, preferably in a few minutes. You need to scale up the capacity for doing them, whether it's in hospitals or in laboratories or even in workplaces. You need an infrastructure for recording those results, making sure they're recorded accurately and stored somewhere. At the moment, it's not clear how all of that would come about. You would need a massive investment and you would need to create a testing infrastructure, whether that's private sector or public sector, that simply doesn't exist today.

Wade Roush: Number two on Gideon’s list of required measures is contact tracing. That’s standard practice in epidemic management and infectious disease control. And the manual way to do it is if somebody tests positive, you ask them to reconstruct where they’ve been and who they’ve seen in the last few days. Then you call up all of those people and do the same thing. But in many parts of the US it’s too late for that approach—the pandemic is already raging through the population too fast. Which is why many people are now thinking about how we can use our mobile devices to automate the process. I asked Gideon to explain the basics of a smartphone-based contact tracing system.

Gideon Lichfield:  Since so many of us are carrying phones in our pockets, the phone is an obvious way to track who you've been with. But there are different ways to do it. And some of them are a lot more Big Brother-ish, intrusive surveillance than others. So in Israel, for example, what they're doing is the domestic intelligence agency, which can track people's movements via cell towers, and it uses that for tracking terrorists. It's now making that data available for public health authorities to track people who have been in touch with someone who has been infected with coronavirus. There is a different way to do it, which is called peer to peer tracking. And this is what they're doing in Singapore, for example. But the idea there is that your phone, if you have the app installed, it will identify any other phones nearby that have got the app installed using Bluetooth, because phones have their Bluetooth receivers on it at a low level and they can they can pick up signals from other nearby phones and then it swaps a token with the other phone. And it's simply, that token simply says, you know, this person, if you all or some other person later test positive for the virus and you put something about the result into that app, the phone identifies, it registers all of the tokens that it has picked up from other people in the previous two weeks or so. And it sends out a notification to the health ministry that says, hey, this person who tested positive has been in touch with all of these people in the last two weeks. And then the health ministry notifies them.

Wade Roush: A rare, almost unprecedented collaboration is going on in Silicon Valley between Apple and Google to create operating system hooks for exactly these kinds of apps. So that's a big step. It seems like that would accelerate this whole process, and it makes it feel a little more inevitable.

Gideon Lichfield: Yeah, I think that the move by Apple and Google is very interesting because what they've done is simply create a framework that allows Android phones and Apple phones to swap data with each other in a seamless way. Somebody still has to build the apps, the contact tracing apps that use this data swapping capability. But by doing this, they're creating the infrastructure that makes it possible. And what Apple and Google also say is that later on, they're going to actually build a contact tracing up into the operating system. And if they do that, then that would pretty much guarantee that everybody who has a smartphone would then have this app or this capability installed on their phone. They would still need to opt into using it. It wouldn't just be automatically turned on, but it would increase the chances that a large number of people would use this. And if a large enough number of people use it, then it means that people are getting warnings when they have been exposed to the coronavirus, and that helps contain it.

Wade Roush: I imagine adoption of such a system would go up if it were paired with some kind of incentive, like, you don't get to go back to work unless you've installed this app.

Gideon Lichfield: Right. So you could definitely imagine all sorts of ways in which people would be essentially pressured to install the app or to take tests. So employers could enforce this. Public transportation could and could enforce this. Maybe you have to show that code in order to get onto the subway like you do in China right now or to enter a restaurant. There are all sorts of ways in which you could create this kind of, effectively, segregation, if we're going to be honest about it. But it would be a thing whereby, yes, if you want to have the benefits of being able to move around freely in society, you have to take these measures.

Gideon Lichfield: I think the really difficult thing is going to be implementing a system like this in a way that doesn't simply amplify the inequities in American society. So I've seen that in Massachusetts, for instance, the state has adopted guidelines on who should be given a ventilator if there's a shortage of ventilators. And they have various criteria like, you know, how many years of life you're likely to have left, for example. And what's your likelihood of survival based on, you know, how many preexisting conditions you have? Those criteria naturally discriminate against people of color because people of color have historically had higher rates of pre-existing conditions, of health problems and lower quality health care and shorter life expectancies. And so as a result, these criteria, which are meant to be blind and objective and simply give people who have the most chances of surviving the best shot at getting a ventilator. These criteria end up systemically discriminating against people of color. And so the same thing is likely to happen if you have a system which says only people who already immune or who are getting tested are allowed to move around or to go back to work or to go to certain places, because inevitably the communities where the virus is more prevalent, those are the ones that are less likely to be able to pass those tests. I don't really know what is a way that you can compensate for that at the moment.

Wade Roush: Gideon says the third big thing that would help us all get back outside and back to work is antibody testing.

Gideon Lichfield: So if people have had the coronavirus and they've developed antibodies, then you would if you were able to test them and find out who has got the antibodies, meaning who is immune, then those people might be allowed to go out because they wouldn't be at any, in any danger of getting the disease or infecting other people. And widespread antibody testing would also give you a better sense for how many people around the country have already had it and maybe just didn't even know about it.

Wade Roush: What's your understanding of how close we are to having a reliable, scalable antibody testing infrastructure?

Gideon Lichfield: We're not nearly as close as we'd like to be. Britain famously ordered millions of at home antibody test kits and then discovered that actually they wouldn't do the job well enough. Here's the problem with antibody testing. An antibody test has something called the level of specificity, which is how accurate it is in determining that an antibody is the coronavirus antibody and not something else. A lot of these tests have something like a 95 percent specificity. And what that means is 95 times out of 100, when they test positive, when they show positive results for an antibody, it’s the coronavirus antibody. But the other 5 percent of the time they've picked up an antibody from some other virus and misidentified that as coronavirus. Now, why is that a problem? Because If you are trying to test people to find out if they're immune and if that's safe to let out, back into the population, if 5 percent of those people are getting a positive result which says, hey, this person is immune, but it's actually not coronavirus, but for some other virus, then you're letting those people out into the population when in fact, they're not immune. So that's a real problem. You need to get tests which are way more accurate than they are right now and then distribute those very widely. So at the moment, we don't have anything like that.

Wade Roush: Try to cast your view ahead by 18 months, or say, two years. Assume that by then there is a vaccine and the pandemic is in effect vanquished. In that future, what do you think will be the lasting changes from the pandemic, from the experience that we have been through? What do you think the new normal will feel like?

Gideon Lichfield: Well, I think the new normal will be that—and this is this is if things go right—the new normal will be that we are used to the idea that in some cases, being able to move around freely is dependent on us being able to show that we're healthy. And there will be a greater acceptance, I think, of that kind of public health monitoring. That could be a good thing if data are collected in a responsible way and shared in a responsible way and the public health benefits are clear. And if the systemic inequities in the US are somehow compensated for, and if it leads to better healthcare for everybody, then I think that could be a positive outcome. That's the positive scenario. The negative one would be that we come out of this with covid vanquished, but without having really learned any of the lessons from it and that we're just as vulnerable when the next pandemic hits.

Wade Roush: Thank you for talking with me, Gideon. This has been, I won't say uplifting, but it's been educational.

Gideon Lichfield: Thank you.

Wade Roush: That’s it for this edition of Deep Tech. This is a podcast we’re making exclusively for MIT Technology Review subscribers, to help bring alive the ideas our reporters are thinking and writing about. But like the rest of the magazine’s coronavirus coverage, we’re making this episode free for everyone.

Deep Tech is written and produced by me and edited by Michael Reilly and Jennifer Strong. Our theme is by Titlecard Music and Sound in Boston. I’m Wade Roush. Thanks for listening, and we hope to see you back here for our next episode in two weeks.