problem solving covid 19

Americans coped with pandemic using problem solving, emotional support

Alessandro Biascioli / iStock

A survey of 1,000 Americans assessing positive and negative coping skills during the pandemic shows that people fared better when focused on problem solving and planning during times of uncertainty.

As part of the study, published yesterday in PLOS One , participants engaged in an online survey to assess how they dealt with stressful life events (SLEs), coping strategies, and the physical and psychological health domains of quality of life (QOL) during COVID-19. The 25- to 30-minute survey was conducted in August 2021 on Prolific, a web-based survey recruitment platform.

Survey respondents were mostly White (73%), equally divided among men and women, with a mean age of 44. Half were married or cohabitating.

More stressors led to more avoidance behaviors

Using 16 questions, the authors identified three patterns for coping with SLEs: problem-focused coping, emotional-focused coping, and avoidant coping.

Problem-focused coping included four items relating to the use of informational support. Emotion-focused coping included six items using emotional support, humor, and religion. And avoidant coping had six items relating to self-distraction, substance use, and behavioral disengagement.

Respondents answered the coping questions using a 5-point Likert scale, noting how they had coped with particular stressors over the last year.

The mean number of SLEs reported by respondents was 1.6, with a range of 0 to 18. The three most common SLEs reported in the sample were a decrease in financial status, followed by personal injury or illness, and a change in living conditions.

Problem- and emotional-focused coping helped

For all respondents, problem-focused coping and emotion-focused coping were significantly related to higher levels of QOL, whereas avoidant coping was associated with lower QOL, the authors said. More life stressors correlated to using more avoidant coping skills.

As the pandemic instigated or exacerbated a wide range of unexpected and unpredictable stressors, such as personal illness, illness and deaths of loved ones, and unemployment, we posit that the use of emotion-focused coping was likely helpful in navigating these situations.

"Previous research, most of which was conducted pre-pandemic, has demonstrated inconsistent findings regarding the relationship between emotion-focused coping and QOL, with many studies pointing to a negative association between these two constructs," the authors said. They hypothesize that emotional coping served people well during the pandemic because it helped them handle uncertainty.

"As the pandemic instigated or exacerbated a wide range of unexpected and unpredictable stressors, such as personal illness, illness and deaths of loved ones, and unemployment, we posit that the use of emotion-focused coping was likely helpful in navigating these situations," the authors said.

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Solving both the short- and long-term COVID-19 crises

Subscribe to global connection, mahmoud mohieldin and mahmoud mohieldin professor, department of economics - cairo university, egypt, executive director - international monetary fund, special envoy on financing the 2030 agenda for sustainable development - united nations michael kelleher michael kelleher director of external affairs - 2blades foundation, former advisor - world bank group, former special assistant to president barack obama - united states government.

April 14, 2020

The global COVID-19 health and economic crisis compels us to act in the short-term—in the here and now. We can’t look away from the human health consequences without giving our best efforts to lessen the suffering of those infected.

On the economic side, there is also great pain that must be assuaged. Some people are even using the “ D-Word ” to describe our unique predicament, with no widely agreed-upon solutions, and central bankers feeling the need to reassure markets that they are not running low on ammunition .

Multilateral organizations such as the World Bank and IMF have abruptly retooled and turned their focus completely toward this new global challenge, making sweeping changes in their agenda, engineering relief from debt service , and making substantial new investments in disaster response . The IMF estimates the total fiscal crisis relief is now at $8 trillion . The United Nations is also urging debt relief , while organizing a coordinated response and sending technical and material assistance to dozens of countries . The EU is stepping up with a large stimulus bill . Even a divided U.S. Congress agreed to spend $2 trillion for its crisis response.

However, poor nations, including those not yet experiencing high infection rates, will find it much more difficult to find the resources to climb out of this predicament. Low- and middle-income nations will benefit from multilateral assistance, but as infection rates rise, these nations may be disproportionately affected since 93 percent of the world’s informal employment is in emerging and developing countries . Helping these workers may require novel approaches, such as cash transfers , which have been used with success in other crisis situations, while some nations are offering tax relief to spur business activity, and others recommend wage subsidies and adjustments to credit guarantees and loan terms.

Of course, we have no choice but to act. Yet what happens when the crisis is over? There will likely be another Cassandra-like report which foreshadows the next crisis, begging our future selves to act in our own self-interest and to invest in solutions to problems that will confront us soon enough. Yet we rarely act to forestall or lessen the next crisis.

It’s not like we haven’t seen (a milder version of) this movie before: 15 years ago after SARS; and five years ago after the Ebola outbreak. Both times we diverted our attention just long enough to deal with the immediate needs, and then ignored the careful high-level post-mortem reports that laid out key decisionmaking and investments that would help us respond to future, perhaps much bigger challenges in the future like COVID-19.

Yet, buried in those not quite dusty post-mortem reports is a guidebook that shows us the way to serve both our short-term and long-term needs: to invest in the Sustainable Development Goals (SDGs).

The 17 SDGs provide a pathway for us to “ build back better ” after the COVID-19 crisis, according to U.N. Secretary-General António Guterres. These global goals urge us to address challenges in poverty, health, inequality, and many other areas, while vowing to leave no one behind, with a deadline of 2030.

Many of the SDGs both address the current crisis as well as longer-term needs, including:

• Good health and well-being (SDG3). Right now the World Health Organization and other partners are supporting government COVID-19 responses , including testing, isolating, and caring for confirmed cases, while also tracing and quarantining people who have come in close contact with the infected. Over the long term, each country needs a health system that can deliver quality, essential health care and preventative services to everyone . They also need the capacity to perform future disease surveillance and diagnosis to rapidly identify, treat, and contain outbreaks, so that the human and economic costs are lessened.
• Water and sanitation (SDG6). To slow down the transmission of COVID-19 people need to wash or sanitize their hands . Yet today 3 billion people do not have access to even basic handwashing facilities at home , largely because they lack access to clean water, which increases their vulnerability to disease and ill health. Longer term, we must achieve universal access to safe and affordable drinking water and adequate sanitation for all in order to slow down the spread of infection and improve the health of all people.
• Ending hunger (SDG2). In many parts of the developing world, school closures mean the loss of children’s meals. In addition, global supply chains and trade have been disrupted , not just for food, but for agriculture inputs that support food production, exacerbated by the substantial number of workers idled due to COVID-19. Now is the time to act for long-term food security by making investments in technology that can improve agriculture productivity and the incomes of small-scale farmers.
• Decent work and economic growth (SDG8). According to the International Labour Organization (ILO), the  COVID-19 crisis  is expected to wipe out 6.7 percent of working hours globally in the second quarter of 2020— equivalent to 195 million full-time workers . The ILO and others are urging that countries offer at least a basic level of social protection to as many people as possible, as soon as possible. Longer term, countries need to make investments to sustain per capita economic growth, productivity, and entrepreneurship, to support formalization and growth of micro-, small- and medium-sized enterprises, including through access to financial services.
• Quality education (SDG4). According to the United Nations Educational, Scientific and Cultural Organization (UNESCO), COVID-19 has forced an estimated 1.5 billion learners to stay at home . UNESCO is supporting governments for distance learning, scientific cooperation, and information support. Longer-term support means that we need to make sure all children—especially girls—are in school and reaching literacy and numeracy targets, and are given greater access to secondary and tertiary education, as well as vocational training, while all should be served by well-trained teachers.

These are just a handful of examples of a comprehensive and applicable framework to enable us to achieve these goals while fighting poverty in an inclusive and sustainable way. Yet these COVID-related SDGs require adequate financing to respond to the crisis and also to make investments that can help us to become resilient to the ever-present threats.

This crisis has shown us the enormous economic and human costs of ignoring our own best advice to stave off the next crisis. This time, let’s do the right thing and deliver.

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Infectious disease

How COVID-19 has changed the culture of science

C&EN spoke to researchers and scientific leaders about the good, the bad, and the uncertain ways that life has changed because of the pandemic, in the lab and beyond

By bethany halford , laura howes , andrea widener, january 25, 2021 | a version of this story appeared in volume 99, issue 3.

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The pandemic has cost lives and livelihoods, but many scientists C&EN spoke to were positive about the future. Here are some of the reasons why.

Science and scientists in the spotlight

Support nonprofit science journalism C&EN has made this story and all of its coverage of the coronavirus epidemic freely available during the outbreak to keep the public informed. To support us: Donate Join Subscribe

Ever since the first genome sequence of the novel coronavirus was released to the world in February 2020, science has been supercharged. The speed and volume of discovery over the past year have been remarkable, with researchers managing to unravel the molecular details of the virus, understand how it spreads and who is most at risk, and invent tests, drugs, and vaccines to tackle it. The public has seen what scientists can do under pressure.

Throughout 2020, clinical trial data regularly garnered headlines, and certain academics emerged as authoritative voices of the pandemic.

“There’s a group of people who have become almost household names,” says Holden Thorp, chemist and editor in chief of the Science family of journals. Early on, Pall Thordarson, a chemist at the University of New South Wales in Sydney, became a viral sensation for explaining how something as simple as washing your hands can protect against infections. In Germany, podcasts about the pandemic by virologist Christian Drosten, who developed the first diagnostic test for SARS-CoV-2, became must-listens for the German-speaking public. And Anthony Fauci, director of the US National Institute of Allergy and Infectious Diseases, emerged as the steady source of advice in the US and overseas—he also became a popular icon, with his image appearing on T-shirts, socks, and coffee mugs.

Scientists who spoke to C&EN believe that the reputation of the pharmaceutical industry, in particular, has improved during the pandemic, as the public closely followed the development of vaccines. Companies’ rapid mobilization also highlighted that science is collaborative, works across borders, and is performed by diverse teams. “Hopefully, this will be seen more unambiguously as a triumph for science,” Thorp says.

And the public has gotten an up-close view of the people who do science, says Freeman Hrabowski III , president of the University of Maryland, Baltimore County. “This is a chance for the world, but particularly for those of us in American society, to see people who are from working- and middle-class families going to the top in science and helping humankind. This is an opportunity for our chemists and life scientists to be making the point that this work is for all of us—for women, for people of color, for first-generation college students—and you can make a difference.” The attention could inspire the next generation of scientists—hopefully a more diverse one.

People are influenced by their life experiences and what excites them, says Malika Jeffries-EL, a chemistry professor and associate dean of the Graduate School of Arts and Sciences at Boston University. “We’re going to have a huge surge of interest in things like immunology and fields related to viruses and vaccine development.”

Science itself has advanced dramatically in the last year, with discoveries rolling out at breathtaking speed. Terms like “space race” have been used to describe the rapid development of vaccines, but Francis Collins, director of the US National Institutes of Health, points out that scientists also made impressive strides in developing diagnostics , establishing testing capacity, and expanding our fundamental understanding of the virus.

“We did science in ways that people did not think we could, driven by this sense of urgency, which we all say that every day counts,” Collins says. “This is a pandemic that is taking lives and destroying economies, and there’s no excuse for anybody arguing for delay.”

Collaborations and data sharing

The year 2020 also saw more scientists embrace preprints—articles published before peer review—and data sharing across borders and disciplines.

“The preprint server business has been given a giant boost from this,” says Derek Lowe, a pharmaceutical chemist and author of the popular In the Pipeline blog.

According to the Dimensions COVID-19 data set , researchers have published over 38,000 SARS-CoV-2 preprints since the beginning of 2020. James Wilsdon, a professor of research policy at the University of Sheffield, says the pandemic has shown that when “the stakes are really high,” researchers can work quickly and create better systems for disseminating data. The real question, he says, is whether those changes in publishing behavior will remain postpandemic.

More generally, researchers see the way that scientists have cooperated as a huge positive. Moderna’s COVID-19 vaccine , for example, could not have been developed so quickly—it went from discovery to distribution in a mere 11 months—had the company not had a long-standing partnership with researchers at the NIH. And big pharma firms have been collaborating with one another to find novel antivirals for this pandemic and the next one, sharing expertise and data in unprecedented ways. Open-science collaborations have also sprung up between academic groups, such as the COVID Moonshot effort, which is screening potential antivirals at facilities in England and Israel.

Collins at the NIH says most of his time last year was spent “trying to bring together all of the partners that could accelerate progress, and making sure that any of the barriers to those kinds of partnerships got knocked down.” And researchers from all sectors “were completely willing to share and work together in fashions that traditionally have been more difficult.”

Related: Chemists rethink work travel

“I’m hoping that this emphasis on international collaborations will continue in the research community,” says Magdalena Skipper, editor in chief of Nature . “But I hope it will also be taken up as an example beyond the research community itself,” she adds, noting that while scientists have collaborated on a global scale, policy makers have worked much more locally.

Much of that collaboration has naturally occurred in the virtual world, opening up opportunities for partnerships that otherwise might not have materialized. As Marie Heffern of the University of California, Davis, points out, setting up a cross-institutional collaboration is now just a matter of arranging a video call. Group leaders can meet and discuss projects or take part in conferences they normally couldn’t have attended. At the same time, postdocs and students have been able to interact more readily with big-name academics through online meetings.

University of Michigan chemistry professor Alison Narayan points to a virtual biocatalysis meeting she set up with researchers at Merck & Co. and the University of Manchester. The regular meeting has grown to include almost 500 people and is “a wonderful platform for students to present their science,” Narayan says, adding that she wants to continue these meetings after the pandemic.

“When you have a pressing need, like the worst pandemic in 102 years, it does require organizing science in new, creative, and productive ways,” the NIH’s Collins says. “And that has been amazing to see happening and to have some role pushing forward.”

Flexibility and support at work

Stay-at-home orders forced a marked increase in flexible working, which in turn showed that work can still be accomplished when people are not in the lab. In the face of these challenges, scientists got creative about keeping up their work.

For some, working from home has increased productivity and raised awareness of other people’s personal challenges. “When you’re on a Zoom call, you see someone’s whole world,” Narayan says. That experience can be eye opening for mentors and colleagues and bring a person’s needs to the forefront.

Merck & Co. chemist Rebecca Ruck says flexible working has taught her and her colleagues how to be more creative. “I hope that affords people—men, women, everybody—greater flexibility in how they work,” she says. Luis Echegoyen, president of the American Chemical Society in 2020, says the productivity of his team at the University of Texas at El Paso actually increased, as members finally had the time for papers and review articles that had been waiting for someone to write them (ACS publishes C&EN). His small group published 15 articles or reviews in 2020, including 3 in the Journal of the American Chemical Society . “That’s an immediate, positive consequence of the pandemic in our group,” Echegoyen says.

Professors are also learning how to use technology to support student learning and to train the next generation of researchers. Where some in-person teaching was allowed, many universities prioritized lab sessions over classroom seminars or lectures, moving more instruction online. Where all teaching went remote, science departments adapted by designing lab work that could be done at home. Other professors built online versions of practical experiments.

Moving classes online with short notice was a daunting challenge that made building rapport and community more difficult—particularly for newer students who may have met their teachers only virtually. Professors say some students have understandably struggled with this shift, but online instruction can improve digital literacy and time management , thus helping prepare students for work after university.

Many teachers are taking a more “flipped classroom” approach by asking students to watch videos and read specific texts before class. The class is then used for active learning and problem solving rather than a lecture, says Mary Boyd, provost and chemistry professor at Berry College. She praises the community of educators that has built up to support best practices and online teaching strategies. “That’s been pretty great,” Boyd says.

Some of the pandemic’s negative impacts may be short lived, while others are likely to reverberate for years.

Science has long struggled to reflect the diversity of the world it serves. Less than 5% of people who earned PhDs in chemistry in the US in 2018 were Black, according to the Open Chemistry Collaborative in Diversity Equity. And recent data show a dearth of people of color and women working as professors in chemistry departments at top schools. The pandemic has only amplified those problems. Because COVID-19 has disproportionately affected communities of color, many worry that it will prevent people from those communities from getting college or advanced degrees. And more women than men have been sidelined in their education and careers as they took on the lion’s share of extra childcare duties associated with lockdowns.

“The pandemic has been a magnifier of inequality,” Berry College’s Boyd says. Challenges range from finding a quiet workspace in small or overcrowded households to having to defer education altogether to help with family or to earn money, as many lost jobs. While much of the world has moved online for classes and conferences, those without reliable internet access or technology have often been left behind.

Zakiya S. Wilson-Kennedy, the assistant dean for diversity and inclusion and a chemistry education professor at Louisiana State University, agrees that the pandemic has magnified inequities. “The transition to online learning has offered this opportunity for disruptive innovation, but the ability to take advantage of this time is very economically driven,” she says

When Wilson-Kennedy considers the ways 2020 affected the culture of science, she points to not just the pandemic but the Black Lives Matter movement and the increase of deadly hurricanes resulting from climate change. “Black and Brown communities, economically disadvantaged folks, and our working poor are disproportionately impacted by all of these,” she says. Because of that, Wilson-Kennedy wonders how we will “cultivate the talents of young people who are passionate about answering these challenges, knowing that even right now, we have a host of folks who have talent but who have different levels of access to education.” If we are going to have sustainable change around supporting diversity in the scientific workforce and in academia, she says, “we have to be extremely intentional about it.”

“Universities were already starting to have a slow awakening about the fact that the status quo is not effectively serving everybody,” Boston University’s Jeffries-EL says. “I think people are starting to have an honest conversation about what is really the issue in the pipeline,” she adds. Sara D. Leonhardt, a professor of chemical ecology at Technical University of Munich, says, “The problems we had before—which were always there—will be even more severe in the future because of the pandemic. I think that’s the really ugly part.” Leonhardt organized an open letter signed by researchers in Germany who argue that the German government needs to support early-career researchers by listening to more-diverse sources of advice, prioritizing opening childcare, and committing to extra financial support in the wake of the pandemic. She is concerned there has been little awareness of how unequally the pandemic has affected different groups—specifically women, those with child- or elder-care duties, and people of color.

Even if the obvious effects of the pandemic on these scientists last only a year—fewer publications or grants, for instance—the impact could be dramatic, Science ’s Thorp says. As an example, he cites the 2008 recession , which derailed careers for years and pushed many out of science entirely. “Almost every time we’ve had some kind of severe problem, it’s always magnified whatever inequities were there to start.”

The next generation of scientists

Anyone who works at the bench knows that there’s just no way to make up for the time lost in the lab during this pandemic. And while that reality is tough on all bench scientists, the situation is particularly acute for assistant professors just starting their labs, postdoctoral scholars with contracts that are just a year or two long, and undergraduates who are missing out on laboratory experiences.

Heffern at UC Davis worries about how the pandemic lockdowns have upset her lab’s momentum. When you’re working toward tenure, such interruptions in research and creating a team can set back early-career researchers .

Related: International students deserve recognition and support

“Postdocs are all about productivity in a short period of time,” UTEP’s Echegoyen says. With such short contracts, these scientists are losing some of the most important years for establishing their careers. “The most disruptive part that I can see of this for science is the future,” he says.

Some fear that pandemic-related productivity gaps will be perceived poorly by funding agencies. “In the short term, obviously funders and others need to make sure we’re not unfairly discriminating against those who haven’t been pumping out grant proposals,” the University of Sheffield’s Wilsdon says.

Another fear is that budgets will shrink because of economic factors and that much of the remaining funding will be funneled into COVID-19-related work. “You can sort of frame the challenge now in terms of the dangers of COVID-ization of research funding,” Wilsdon says. There are questions about how to fund research as well as how to balance the funding so that important areas don’t lose out.

With summer research experiences and internships for undergraduate and high school students canceled for 2020 and likely for 2021, several researchers point to the lasting impact those lost opportunities for research experience will have on the chemistry pipeline. “That’s usually where the premed students decide they actually want to be chemists,” the University of Michigan’s Narayan says.

Merck’s Ruck echoes that concern. “Without that hands-on experience, will these students ever fall in love with chemistry?” she says. “I worry that that will have implications for the overall talent flow into the field.”

Politicization of science

Followers of the climate change movement know that politicization of science isn’t new. But the pandemic has made the human toll of this phenomenon much more immediate, with people refusing to wear masks on the advice of politicians and the White House suppressing scientific discourse.

“By politicizing science, we denied the fundamental tools that we needed to tackle a biological and social problem,” says Jeremy Levin, CEO of Ovid Therapeutics and chairman of the Biotechnology Innovation Organization. We’re now seeing the consequence in loss of life, economic upheaval, and other untold suffering, he says. “I think the denial of the validity of science and the politicization of it will be held against us for decades to come.”

Thorp at Science says researchers haven’t done a good job of describing the scientific process to the public, which is why it’s been so easy for science to become politicized . Take the shifting guidance on face masks. Officials first advised against wearing them out of concern that supplies would become stretched and that the priority should be that health-care workers get masks. Then, as scientists learned more about the airborne transmission of COVID-19 and the ability for asymptomatic people to spread the disease, they urged people to wear masks to protect others. Later, scientists learned that masks also provide protection to the wearer.

“If you’re a scientist, that makes perfect sense,” Thorp says. “If you’re out there in the public, just consuming sound bites, that makes it look like we don’t know what we’re talking about. And that’s a product of the fact that it’s much easier to just tell people that science is this textbook full of stuff that you have to memorize and not a process and a way of thinking that’s carried out by people.”

Scientists haven’t done the hard work of explaining how the scientific method is connected to important scientific advances, Thorp says. Instead, he adds, “we bring them their new drug or their better Wi-Fi or their profitable companies.”

The Unknown

Not all the dramatic changes—positive or negative—might last. Experts weighed in on the biggest uncertainties.

Travel and meetings

Prepandemic, many principal investigators were rarely in the lab; they were often on the road, giving talks or attending meetings. The pandemic stopped travel overnight.

The University of Michigan’s Narayan had given 17 talks in the first 2 months of 2020 as part of her “tenure tour”—visiting schools before she applied for tenure. “What this has taught me is that I don’t need to be traveling constantly,” says Narayan, who now expects to be more selective about her travel. “That’s maybe better for me personally, and better for my family and my research group.”

Virtual talks have many advantages. More people can attend, including those who might not otherwise get to hear from a Nobel Prize winner or other high-profile scientists. They make it easier for smaller schools to get big-name speakers, are a vast saving for cash-strapped organizations, and are much better for the environment.

“In South America, we are far from everywhere,” says Ana Flávia Nogueira, a chemistry professor at the University of Campinas. So the move to virtual conferences has widened access for her students because they don’t have to pay for travel, and fees for online meetings tend to be lower. At the same time, she says, the most important aspect of attending conferences for her is the ability to make personal connections with other scientists with whom she might collaborate. That’s tough to do online. Nogueira thinks that the investments made in online meetings mean that many future conferences will be a hybrid of virtual and in-person events.

But “there are certain aspects of collaboration and connection that are much, much harder to achieve purely through online interaction,” the University of Sheffield’s Wilsdon says.

You can rarely see your audience on Zoom, and you can’t make the same personal connections with potential students or collaborators. That’s especially concerning for early-career scientists, who are supposed to be meeting people and building their lab’s reputation. “COVID has really made that quite difficult,” UC Davis’s Heffern says.

Online meetings are so easy to schedule that everyone does it. “In June and July it was an invitation a day,” Echegoyen at UTEP says. “You realize that all of a sudden people have gotten trigger happy.”

Lack of travel has also been a mixed bag for scientists who have family responsibilities—especially women. Less travel can mean more time with your family, but it can also make working harder if you are expected to do childcare. “If you are still at home, you’re expected to do all the home things even while you’re technically working because you’re at a conference,” Berry College’s Boyd says. “You don’t get the separation that you would get.”

So what is the fate of conferences? Boyd has yet to see a way to do virtual conferences well. The talks themselves are just as good—maybe better, she admits—but sitting in front of a screen all day is tiring. And “we miss the important part of attending a conference, which is the networking and getting to know other people,” she says.

But Merck’s Ruck says that in many cases, what individual scientists lose online is made up for by increased access for people who might not be able to travel.

In 2019, the Empowering Women in Organic Chemistry conference had 180 attendees at its inaugural, in-person event. In 2020, the online version attracted 800 people from all over the globe. Ruck, who helps organize that meeting, thinks that most conferences will be a hybrid of in-person and online going forward.

“I’m going to be very content to give many more talks from my living room,” Ruck says.

Echegoyen says it’s going to take a long time before people feel comfortable going to an event with 15,000 to 20,000 people, like a typical ACS meeting. But he thinks some new technology will make virtual meetings more palatable. “I think we’re going to come out of it changed, that’s for sure.”

Distanced lab culture

Almost all faculty and students were hit hard by the pandemic, but the work and productivity of lab scientists probably suffered most. Research labs worldwide shut down or at a minimum operated on vastly altered schedules. At some universities and research centers, only lab work directly related to COVID-19 was allowed to continue.

“We had to redirect a lot of the scientific energy towards this pressing global pandemic,” while at the same time keeping safe those who remained in person, Collins says. That was true at the NIH’s Maryland campus, where most labs, including Collins’s, shut down. “And that doesn’t turn out so well if you’re somebody who needs a lab bench, so we did lose momentum for things that weren’t directly related to COVID,” he says.

When labs did open, it was often in small groups with distance required between lab members. Normally bustling benches were limited to one or two people. And lab mates couldn’t run into each other in the hallway or share their latest successes and failures as they happened.

That has removed a lot of the spontaneity that is a regular part of making discoveries, Heffern says.

But limited time in the lab has forced people to think carefully about how they’re using that time. “My students are getting a lot better at planning experiments and analyzing their data,” she says.

Shifts have also made research teams work together more closely—you have to carefully plan to hand off an experiment to a colleague at the end of your day, according to the University of Michigan’s Narayan. “Ultimately, I think those skills are going to serve people really well in their training and launching into different careers,” she says. This will also help move chemistry away from the idea that “you should be chained to your hood 24 hours a day, 7 days a week,” she adds.

Stability of schools

Academic institutions worldwide have undoubtedly been changed by the pandemic. Beyond shutting down labs, many moved classes online as the pandemic spread and remained completely or partially remote for the rest of the year. That put many US schools that were no longer getting fees for residence halls or meal plans in a financially precarious position.

If schools can open their campuses in fall 2021, “the ones that had money will probably be OK,” Thorp says. “And the ones that ran out of money? A lot of those are going to have a hard time recovering.”

Schools with endowments or consistent government support should be able to cover losses. But those that rely on tuition to pay salaries and fund their day-to-day operations don’t have that safety net.

Many students dropped out or deferred enrollment, which put tuition-reliant schools in a tough position. The enrollment decline has been especially precipitous among international students, who often pay full tuition but have no way to get to the US during a pandemic. At the same time, universities have had to shut down medical services, facility rentals, sports events, and other revenue streams that keep their campuses functioning.

In addition, Echegoyen says, students are questioning paying the same tuition and fees when classes are fully or partially online. “Will a whole new economic model evolve for universities?” he wonders.

No matter what happens, “there’s going to be a lot of belt tightening” at tuition-driven universities, Echegoyen says. In many cases, administrators and lab technicians were the first to face furloughs and cuts. But prolonged hiring freezes will mean that many graduate students and postdocs won’t be able to find their first academic positions. “A lot of people are going to find themselves without jobs,” Echegoyen says.

Most at risk for job losses and cuts might be universities that rely on their medical schools and associated hospitals for support. The pandemic has caused many to curtail outpatient clinical and elective procedures, the NIH’s Collins says. “No question about it, it is going to take a long time for universities to recover.”

This story was updated on Feb. 1, 2021, to correct the affiliation of Pall Thordarson. He works at the University of New South Wales in Sydney, not the University of Sydney.

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Goats and Soda

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The Coronavirus Crisis

6 solutions to beat covid-19 in countries where the usual advice just won't work.

Malaka Gharib

The fight against coronavirus will not be won until every country in the world can control the disease. But not every country has the same ability to protect people.

For low-income countries that struggle with weak health systems, large populations of impoverished people and crowded megacities, "there needs to be a very major adaptation" to the established measures we've been using to fight COVID-19, says Dr. Wafaa El-Sadr , an epidemiologist and director of ICAP, a global health organization at Columbia University.

The COVID-19 playbook that wealthy nations in Europe, Asia and North America have come to know — stay home as much as possible, keep a six foot distance from others, wash hands often — will be nearly impossible to follow in much of the developing world.

"I think they're trying, but it's not easy," El-Sadr says. "Ministries of health are working, partnering with international organizations to try to innovate — and hopefully, if the innovation works, it can be scaled up."

Here are some of the solutions now being tried.

Fly in tons of medical gear

Problem: Countries in the developing world face massive shortages of medical gear like personal protective equipment, says Avril Benoit, executive director of Doctors Without Borders. And the cutback in commercial flights has made it difficult to bring in equipment.

Solution: The U.N. has launched what it's calling "solidarity flights" – hiring charter planes to airlift millions of face masks, face shields, goggles, gloves, gowns and other supplies. On April 14 , the U.N. dispatched an Ethiopian Airlines charter flight from Addis Ababa full of COVID-19 gear to transport to countries in need.

"This is by far the largest single shipment of supplies since the start of the pandemic, and we will ensure that people living in countries with some of the weakest health systems are able to get tested and treated," said Dr. Ahmed Al-Mandhari, WHO regional director for the Eastern Mediterranean in a statement .

Assessment: "In the short run, a program like this is fine so long as we're dealing with an acute event," says El-Sadr. "Without [supplies like] PPE, you're at risk of losing your scarce and precious health workforce — and you want to protect them at any cost."

But hiring chartered flights to deliver any kind of aid – instead of commercial flights – is expensive, says Manuel Fontaine, director of emergency programs at UNICEF. The U.N. is calling on donors to provide $350 million to continue this program; so far, it has received $84 million.

Create safe havens for the sick and elderly

Problem: How do you protect the most vulnerable individuals in crowded cities and refugee camps? And how do you keep infected individuals from spreading the disease?

Solution: Health authorities are trying out a somewhat controversial strategy: separating the sick and those at high risk, moving them from the homes where they might live alone or with an extended family into vacant homes or taking over facilities previously used for other purposes, such as learning centers. The people being targeted include the elderly and those with preexisting health conditions that make them susceptible to COVID-19 — as well as the homeless.

The strategy has been cited by several health researchers as a practical way to control the spread of disease in densely packed communities. Francesco Checchi of the London School of Tropical Health and Medicine wrote a paper on the subject , and Dr. Paul Spiegel of Johns Hopkins University, in another paper , recommended this as a potential solution in refugee settings.

Assessment: In his paper, Spiegel warns that the strategy of isolating these groups are "novel and untested." And thus far, in parts of the developing world where the strategy has been rolled out, it has had mixed results.

Shah Dedar, an aid worker with the humanitarian group HelpAge, says that religious and community leaders among the Rohingya refugees in Bangladesh don't like the idea of taking the sick or the elderly from the families who might care for them. But "elderly men and women with chronic diseases [who lived alone] were very much keen to the idea and appreciated the initiative," says Dedar.

While HelpAge was able convince local Rohingya leaders to give it a try, Spiegel of Johns Hopkins University says that this may not always be possible. In the case of a severe outbreak, aid workers may have to forcibly separate populations, whether the community approves or not. And he warns that this shielding measure is no guarantee it will keep the virus at bay — it could spread within these facilities, as has happened at some nursing homes in the U.S.

And in Cape Town, South Africa, conditions in a homeless "camp" set up by the government have prompted complaints from the residents about close contact and lack of sanitation — and a call from Doctors Without Borders to shut it down.

Get out of town

Problem: Some citizens are afraid of staying in big cities where social distancing is hard to maintain and outbreaks are more likely to spread.

Solution: Those who have family in ancestral homelands are traveling back to stay in these rural environments – it's happened in countries ranging from Bangladesh to Italy.

Assessment: Both government officials and citizens have criticized this exodus, saying that it puts elderly people in those rural environments at risk if the city dwellers might be contagious yet asymptomatic or presymptomatic.

The other downside of fleeing to these more remote areas, says El-Sadr, is that "health care services are less likely to be available."

That said, El-Sadr notes that this kind of population shift can be a good strategy in an area where transmission within a community has not yet occurred but is deemed likely. This could be a "way that people can have more of an ability to survive, to make a living, get social support [if they are sick], get more access to food, where they can socially distance more readily."

Get the police involved

Problem: Social distancing is hard to enforce in densely populated low-income countries.

Solution: Many governments around the world have turned to the police to ensure that people stay home — and hand out punishments to those who aren't following the lockdown rules. In India, for example, people who violate the lockdown could face up to a year in prison. Others in the country have faced unusual punishments, such as writing "I am very sorry" 500 times, according to an NPR report .

Assessment: Unfortunately, there have been reports of officers using physical violence to keep people in their homes in several countries, including India, Bangladesh and the Philippines. In Kenya, the violence has resulted in public outcry , with citizens calling for more civility from its police force. "This is no way to fight a coronavirus epidemic," tweeted a Kenya-based journalist.

Reinvent factories so they can make medical equipment

Problem: More supplies to fight COVID-19 are needed.

Solution: Get factories to switch gears and respond to the coronavirus.Kenya's textile industry has pivoted to making masks and protective equipment. The Kitui County Textile Center (KICOTEC) has shifted from sewing chef's whites and school uniforms to turning out face masks and scrubs for healthcare workers. Kenya's state-owned oil company is now making hand sanitizer, which it says it is distributing for free.

In South Africa, the state-owned missile manufacturer Denel , has been working to design and build ventilators, and to convert armored trucks into ambulances. The government has launched an initiative called the National Ventilator Project , which calls for companies to build 10,000 ventilators by the end of June, using locally available parts and materials.

Similar efforts are underway in Nigeria, where the government announced that they're working with car companies to manufacture locally-made ventilators.

Assessment:

In Kenya, KICOTEC turning out 30,000 surgical masks a day, according to Kenya's Ministry of Health . Kenya's petroleum company has produced more than 80,000 gallons so far, and plans to make at least 600,000 gallons more.

But WHO projects that countries will need millions of masks, goggles and other supplies to protect healthcare workers and citizens while mounting a response to COVID-19.

So local manufacturing can only partly fill the gap. But local authorities believe it is critical: "We're trying to build up local capacity to ensure that the critical facilities, the beds and ventilators, respirators could be made available within the country," says Adaeze Oreh, a senior official in Nigeria's Ministry of Health, "So we're not constrained by international travel restrictions, border closures and relying on imports."

Set up handwashing stations

Problem: Public health officials globally stress the importance of frequent hand-washing in the fight against COVID-19. In low- and middle-income countries, however, 35% of people lack regular access to soap and water, according to WHO .

"The health workers say we must wash our hands," said Zukwisa Qezo, a 47-year-old mother of two who lives in the Cape Town township to NPR . "But with what?! The city must bring us soap."

Solution: To improve the ability for people to clean their hands, WHO advises that hand hygiene stations — either with soap and water or with alcohol-based hand sanitizer — to be placed at the entrances of buildings, and in transport hubs such as bus and train stations. The system can be as simple as two buckets — one filled with chlorinated water, and one to catch the wastewater.

Assessment: Public hand-washing stations, which were effective in the fight against Ebola, are being resurrected in countries such as Liberia and Sierra Leone, NPR reports . Doctors Without Borders reports that their volunteers are setting up hand washing points in many of the settings they operate in, including migrant camps in Nigeria and health facilities in Mozambique.

Science leads the response to COVID-19. These 25 scientists are tackling the other global challenges

Introducing the Class of 2020 Young Scientists Image:  Photo by Drew Hays on Unsplash

.chakra .wef-1c7l3mo{-webkit-transition:all 0.15s ease-out;transition:all 0.15s ease-out;cursor:pointer;-webkit-text-decoration:none;text-decoration:none;outline:none;color:inherit;}.chakra .wef-1c7l3mo:hover,.chakra .wef-1c7l3mo[data-hover]{-webkit-text-decoration:underline;text-decoration:underline;}.chakra .wef-1c7l3mo:focus,.chakra .wef-1c7l3mo[data-focus]{box-shadow:0 0 0 3px rgba(168,203,251,0.5);} Alice Hazelton

Martha chahary.

.chakra .wef-9dduvl{margin-top:16px;margin-bottom:16px;line-height:1.388;font-size:1.25rem;}@media screen and (min-width:56.5rem){.chakra .wef-9dduvl{font-size:1.125rem;}} Explore and monitor how .chakra .wef-15eoq1r{margin-top:16px;margin-bottom:16px;line-height:1.388;font-size:1.25rem;color:#F7DB5E;}@media screen and (min-width:56.5rem){.chakra .wef-15eoq1r{font-size:1.125rem;}} Global Health is affecting economies, industries and global issues

.chakra .wef-1nk5u5d{margin-top:16px;margin-bottom:16px;line-height:1.388;color:#2846F8;font-size:1.25rem;}@media screen and (min-width:56.5rem){.chakra .wef-1nk5u5d{font-size:1.125rem;}} Get involved with our crowdsourced digital platform to deliver impact at scale

Stay up to date:, global health.

• Scientists have maximum visibility in the COVID-19 response, while proposing solutions to other global challenges, from climate change to cybersecurity, poverty to pandemics, and food technologies to fracking.
• The World Economic Forum created the Young Scientists Community in 2008, to engage leaders with science and the role it plays in society. The class of 2020 represents 25 researchers at the forefront of scientific discovery from 14 countries across the world.

The COVID-19 crisis has highlighted science’s vital role in society. Science will provide us with an “exit strategy” from the pandemic when a vaccine is finally developed but until then, scientists are helping to understand the origins of the virus, how it spreads, what treatment(s) are most effective and indeed if a cure is possible.

Scientists have maximum visibility right now as different groups of people turn to them looking for answers. COVID-19 aside, science proposes solutions to the myriad of other global challenges facing society, from climate change to cybersecurity, poverty to pandemics, and food technologies to fracking.

Have you read?

Here’s how ‘science diplomacy’ can help us contain covid-19, bill gates explains how the world can use science to tackle the crisis.

That’s part of the reason why the World Economic Forum created the Young Scientists Community in 2008, to engage leaders with science and the role it plays in society. Science is no longer a specialist concern. It is the driving force behind the highest-level decisions on global governance and policy-making, while also informing the individual choices people make about how they want to live and what changes they want to make.

Today we announce our Class of 2020 Young Scientists, representing 25 exceptional researchers at the forefront of scientific discovery from 14 countries across the world.

From chemical oceanography to child psychology and artificial intelligence, these brilliant young academics are joining a community whose aims are to:

• Communicate cutting-edge research and position science discourse within the context of scientific evidence.
• Develop leadership skills and a fuller understanding of global, regional and industry agendas.
• Build a diverse global community of next-generation scientific leaders, committed to engaging in collaborations related to collectively identified issues.

Responding to the COVID-19 pandemic requires global cooperation among governments, international organizations and the business community , which is at the centre of the World Economic Forum’s mission as the International Organization for Public-Private Cooperation.

Since its launch on 11 March, the Forum’s COVID Action Platform has brought together 1,667 stakeholders from 1,106 businesses and organizations to mitigate the risk and impact of the unprecedented global health emergency that is COVID-19.

The platform is created with the support of the World Health Organization and is open to all businesses and industry groups, as well as other stakeholders, aiming to integrate and inform joint action.

As an organization, the Forum has a track record of supporting efforts to contain epidemics. In 2017, at our Annual Meeting, the Coalition for Epidemic Preparedness Innovations (CEPI) was launched – bringing together experts from government, business, health, academia and civil society to accelerate the development of vaccines. CEPI is currently supporting the race to develop a vaccine against this strand of the coronavirus.

By joining Forum events, engaging in personal and professional learning modules and sharing experiences with each other, we’re looking forward to working with the Class of 2020 Young Scientists to help leaders from the public and private sector engage more meaningfully with science and in doing so, help these amazing young researchers become stronger ambassadors for science.

Here are the World Economic Forum’s Young Scientists of 2020:

From Africa:

Sarah Fawcett (University of Cape Town, South Africa, South African): Sarah researches the role of ocean chemistry and biology in climate, as well as the impacts of human activities on marine environments.

Salome Maswime (University of Cape Town, South Africa, South African): Salome seeks to understand surgical health systems and causes of maternal death during caesarean section in poorly resourced areas to improve surgical care across populations.

From the Americas:

Gao Wei ( California Institute of Technology, USA, Chinese): Gao Wei develops skin-interfaced wearable biosensors that will enable analytics through sweat rather than blood, leading to non-invasive and real-time analysis and timely medical intervention.

Francisca Garay (Pontificia Universidad Católica de Chile, Chile, Chilean): Francisca is studying what are the most basic building blocks of the universe by developing technologies to accelerate and enhance the capabilities of particle accelerators.

Diego Garcia-Huidobro (Pontificia Universidad Católica de Chile, Chile, Chilean): Diego uses human-centred design methods to develop sustainable and scalable community-level health interventions in Chile.

Jennifer Ronholm (McGill University, Canada, Canadian): Jennifer is working to strengthen the microbiome of agricultural animals to resist infections in the absence of antibiotics, with the aim of reducing the spread of antimicrobial resistance.

Stefanie Sydlik (Carnegie Mellon University, USA, American): Stefanie designs new materials that stimulate the body's healing response to enable the regeneration of natural bone as an alternative to metal implants currently used to heal bone injuries.

Fatma Zeynep Temel (Carnegie Mellon University, USA, Turkish): Fatma uses mathematical models and physical prototypes to test and explore biologically inspired designs, leading to the development of small-scale robots and sensors

Lee Sue-Hyun (Korea Advanced Institute of Science and Technology, South Korea, Korean): Sue-Hyun researches how memories are recalled and updated, and how emotional processes affect human memory, to inform therapeutic interventions for mental disorders.

Meng Ke (Tsinghua University, China, Chinese): Meng Ke seeks to understand the socio-economic causes of population ageing and declining fertility rates to suggest what public policy measures and innovations can be used to address them.

Shi Ling (Hong Kong University of Science and Technology, China, Chinese): Shi Ling researches the vulnerability of cyber-physical systems to protect safety-critical infrastructures – such as power utilities and water transportation systems – from attacks.

Sho Tsuji (University of Tokyo, Japan, Japanese): Sho Tsuji seeks to understand how an infant’s social environment affects language acquisition – a key predictor of future literacy – to inform culturally sensitive, science-based, societal interventions.

Wu Dan (Zhejiang University, China, Chinese): Wu Dan is researching technological advances in MRI techniques to improve its ability to detect tumours and stroke, as well as monitor foetal brain development.

Yi Li (Peking University, China, Chinese): Yi Li researches social-communicative impairments in children with autism in China to develop more precise screening and diagnosis, as well as innovative treatment approaches in the country.

Ying Xu (Chinese Academy of Sciences, China, Chinese): Ying Xu’s research focuses on enhancing China's low-orbit Beidou navigation satellite system, which could lead to advances in the commercial aerospace industry

From Europe:

Celeste Carruth (ETH Zurich, Switzerland, American): Celeste is developing a new 2D ion trap experiment for quantum information processing that is expected to be more reliable and cheaper to scale up than competing technologies and aims to lead to breakthrough quantum computing results.

Nicola Gasparini (Imperial College London, United Kingdom, Italian): Nicola is developing novel technologies to treat severe and incurable vision problems caused by degeneration of the retina, which affects almost 200 million people worldwide.

Joe Grove (University College London, United Kingdom, British): Joe investigates how viruses enter human cells and evade the immune system to reveal new biology and inform the design of future vaccines.

Philip Moll (Ecole Polytechnique Fédérale de Lausanne, Switzerland, German): Philip is developing new methods to make micro-scale modifications to material structures with the potential to improve quantum computing.

Mine Orlu (University College London, United Kingdom, British): Mine is designing patient-tailored pharmaceutical and healthcare technologies that contribute to healthy and independent ageing across the life course.

Michael Saliba (University of Stuttgart, Germany, German): Michael is developing inexpensive, stable and highly efficient perovskite solar cells that will enable the acceleration of sustainable energy technology.

Andy Tay (Imperial College London, United Kingdom, Singaporean): Andy is developing new technology and materials to engineer immune cells, tissues and systems, with the aim of preventing and treating cancer.

Jan Dirk Wegner (ETH Zurich, Switzerland, German): Jan develops novel artificial intelligence methods to analyse large-scale environmental data and accelerate humanity’s ability to solve ecological problems

From the Middle East:

Joseph Costantine (American University of Beirut, Lebanon, Lebanese): Joseph’s research leverages electromagnetism to design a new generation of wireless communication systems, biomedical sensors and wirelessly powered devices through radio frequency energy harvesting.

Joanna Doummar (American University of Beirut, Lebanon, Lebanese): Joanna seeks to better understand complex underground drainage systems, known as karst aquifers, to better address and solve national water quality and quantity challenges.

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Students use active learning to solve COVID-19 problems

By dave winterstein.

The pervasive effects of the COVID-19 pandemic can leave us all feeling powerless at times. Students in the course Engineering Processes for Environmental Sustainability (BEE 2510) took back some power during the fall semester by addressing critical problems related to pandemic.

Instructors Jillian Goldfarb , assistant professor of biological and environmental engineering in the College of Agriculture and Life Sciences (CALS), and Alex Maag, postdoctoral associate with Cornell’s Active Learning Initiative , assigned students to solve problems related to COVID-19, from the logistics of vaccine storage and transportation, to the disinfection of public spaces, and the sanitation and reuse of personal protective equipment (PPE).

Using the pandemic as the context for a student project was not without challenges, and the instructors hesitated to ask students to focus on an issue that might be a source of pain or uncertainty for some.

“We were nervous about assigning a COVID-19-related project,” Goldfarb said, “but the way we approached it empowered students to feel like there were solutions to these problems.”

Their approach hinged on the critical step of building a sense of community, Maag added.

First Goldfarb and Maag had the class work on group problem-solving by assigning various smaller tasks during class discussions. As students became comfortable working with each other in teams, they eventually were ready to work in groups on the final project.

The community-building exercises paid off. The students produced technical reports that proposed creative, efficient and technically sound solutions to PPE shortages and vaccine distribution.

Both instructors were impressed with the degree to which the class of primarily second-year students applied a broad range of concepts covered in the course.

“Students did a lot of outside-the-box thinking on the projects,” Maag said. “As a gateway course, the class is very broad in scope so we can’t go very deep into any one topic, but they took nearly all the concepts from class and connected them in their reports.”

“We were nervous about assigning a COVID-19-related project, but the way we approached it empowered students to feel like there were solutions to these problems.” Jillian Goldfarb

One group used geomapping to optimize vaccine distribution across the country. Another contacted their hometown hospitals to ask about PPE shortages as they developed requirements for designing sanitizing equipment.

Goldfarb also noted that the project inspired students’ passion for thinking about possible solutions and applying what they learned in class to areas about which many of them knew very little.

“The students were surprised by how much the introductory engineering knowledge they gained in this class could be so widely used to solve these problems,” she said, “and that will give them confidence as they go forward.”

Goldfarb and Maag developed their assignment with support from a 2019 grant from the Active Learning Initiative, through which the Department of Biological and Environmental Engineering is helping undergraduates apply their knowledge to complex current issues.

The project was funded by CALS and a gift from Alex ’87 and Laura Hanson ’87. The Active Learning Initiative, developed within the College of Arts and Sciences with help from the Hansons, is supported by Cornell’s Office of the Vice Provost for Academic Innovation and the Center for Teaching Innovation (CTI).

For more information on the initiative, contact CTI .

Dave Winterstein is a communication specialist in the Center for Teaching Innovation.

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COVID-19 related interdisciplinary methods: Preventing errors and detecting research opportunities

Ariel l. rivas.

a Center for Global Health, School of Medicine, University of New Mexico, Albuquerque, NM, United States

Marc H.V. van Regenmortel

b University of Vienna, Austria; and Higher School of Biotechnology, University of Strasbourg, and French National Research Center, France

More than 130,000 peer-reviewed studies have been published within one year after COVID-19 emerged in many countries. This large and rapidly growing field may overwhelm the synthesizing abilities of both researchers and policy-makers. To provide a sinopsis, prevent errors, and detect cognitive gaps that may require interdisciplinary research methods, the literature on COVID-19 is summarized, twice. The overall purpose of this study is to generate a dialogue meant to explain the genesis of and/or find remedies for omissions and contradictions.

The first review starts in Biology and ends in Policy. Policy is chosen as a destination because it is the setting where cognitive integration must occur. The second review follows the opposite path: it begins with stated policies on COVID-19 and then their assumptions and disciplinary relationships are identified. The purpose of this interdisciplinary method on methods is to yield a relational and explanatory view of the field –one strategy likely to be incomplete but usable when large bodies of literature need to be rapidly summarized.

These reviews identify nine inter-related problems, research needs, or omissions, namely: (1) nation-wide, geo-referenced, epidemiological data collection systems (open to and monitored by the public); (2) metrics meant to detect non-symptomatic cases –e.g., test positivity –; (3) cost-benefit oriented methods, which should demonstrate they detect silent viral spreaders even with limited testing; (4) new personalized tests that inform on biological functions and disease correlates, such as cell-mediated immunity, co-morbidities, and immuno-suppression; (5) factors that influence vaccine effectiveness ; (6) economic predictions that consider the long-term consequences likely to follow epidemics that growth exponentially; (7) the errors induced by self-limiting and/or implausible paradigms, such as binary and reductionist approaches; (8) new governance models that emphasize problem-solving skills, social participation, and the use of scientific knowledge; and (9) new educational programs that utilize visual aids and audience -specific communication strategies. The analysis indicates that, to optimally address these problems, disciplinary and social integration is needed.

By asking what is/are the potential cause(s) and consequence(s) of each issue, this methodology generates visualizations that reveal possible relationships as well as omissions and contradictions. While inherently limited in scope and likely to become obsolete, these shortcomings are avoided when this ‘method on methods’ is frequently practiced. Open-ended, inter-/trans-disciplinary perspectives and broad social participation may help researchers and citizens to construct, de-construct, and re-construct COVID-19 related research.

1. Introduction

Aiming at detecting possible omissions and/or contradictions, as well as issues that may require additional research, the COVID-19 related literature is summarized following an inter-/trans-disciplinary and non-reductionist approach. We believe non-reductionist approaches to be more effective than some of the strategies in current use. This report is also motivated by three shortcomings that may influence the handling of this pandemic: (i) the lack of a common language across disciplines; (ii) the ultra-rapid growth of scientific publications in the last three decades; and (iii) a pandemic with features not observed in more than a century.

Research publications have grown very rapidly. In 2020, the Web of Science repored + 8,700,000 published articles, i.e., more than 23,000 per day. What, in principle, was desirable, is now a serious problem: as the number of studies grows, it is less likely that any person can remain updated in her/his own field [1] .

Such an outcome may have devastating consequences when a pandemic occurs. One year after COVID-19 emerged, more than 130,000 studies have been published. To prevent useful information being ignored, the COVID-19 literature needs to be continually summarized.

In recent years, numerous calls asking for health-related policy integration have been made which included warnings emphasized by the WHO as early as 1979 [2] , [3] . To improve decision-making, integration is crucial: more valid policies may require additional research as well as the elimination of ineffective interventions.

Given their focus on integration, inter-/trans-disciplinary analyses are well suited for detecting inconsistencies. In contrast, uni- (and even some multi-) disciplinary studies may miss problems only identified when a broader perspective is adopted. This distinction matters because, when a problem remains unsolved even after the best available knowledge has been utilized, it is clear that new (and problem-specific) knowledge should be generated.

To foster inter-/transdisciplinary knowledge integration, bibliometric analysis is helpful [4] . When a topic known to be associated with two or more fields shows few publications that cross-reference such fields, it is likely that new and specific knowledge may be needed.

Insufficient attention to COVID-19 related policy integration is suggested when just one thousandth of all COVID-19 publications address the topic of policy integration (see Table 1 ). Poor communication strategies between researchers, decision-makers and/or citizens may result in low numbers of studies involving vaccination efficacy, vaccination coverage, vaccination effectiveness, immunology, geography, as well as public behavior [5] .

An example of bibliometric analysis.

2. II First review: from Biology to Policy

2.1. herd immunity.

The method we applied pursues research integration [6] . Because it offers an opportunity to explore many disciplines, the first review focuses on ‘herd immunity’ ( Fig. 1 ).

The first review: from Biology to Policy. Approximately thirty topics –some of them partially overlapping– were reviewed. When related, some needs, contradictions and/or omissions were identified (topics identified in red). For example, vaccine effectiveness cannot be estimated unless the percentage of the population vaccinated is known, as well as the local geo-demographic structure –which includes dynamics ─ e.g., the temporal mobility of specific social groups ─ , as well as geographically specific connecting structures ─ e.g., road/railroad networks. The lines shown here only illustrate one possible relationship. A dialogical (combinatorial) process involving many disciplines and social perspectives is likely to uncover many other relationships. (For interpretation of the references to colour in this figure legend, the reader is referred to the web version of this article.)

‘Herd immunity’ –a concept that emerged in veterinary medicine– reflects the historical emphasis veterinary medicine has assigned to populations or herds [7] . This concept was coined between the end of the XIX and the beginning of the 20th century, which is the time period when viruses and leukocytes were discovered [8] .

Herd immunity means population immunity . It refers to sub-populations that achieve protection even when they are not directly immunized. For instance, when a new virus reaches a nursing home where immuno-compromised individuals (e.g., HIV patients) interact with immunized ones (e.g., healthcare personnel), the virus is prevented from replicating: immuno-compromised individuals are protected because immunized individuals act as a barrier.

Herd immunity may refer to: (i) the proportion of immune individuals within a population; (ii) the expected threshold (minimal proportion) of immune individuals that would reduce the size of an epidemic; and (iii) the immune profile expected to protect a population from re-infections [9] . Herd immunity differs from ‘herd effect.’ While the former describes the proportion of subjects with immunity in a given population, the latter is the reduction of infection in the unimmunized segment as a result of immunizing a proportion of the population [10] .

Disease-induced (or ‘natural’) herd immunity may lead to devastating consequences: it has been estimated that more than 30 million COVID-19 deaths may occur before herd immunity can be achieved [11] . That is why vaccination-induced (not epidemic-induced) herd immunity is considered a more realistic aim.

Is there any evidence of herd immunity? While not yet documented in the case of COVID-19, it has been reported in other infections. For example, Japanese children vaccinated against influenza may have protected elderly people who were not vaccinated [12] . While supported by the data, this inference does not inform on the strains of influenza virus reported in the years children were vaccinated against influenza. Such data matter because the degree of matching between the vaccine strain and the viral strain found in seasonal outbreaks influences vaccine effectiveness, ranging from zero to 70% protection [13] , [14] , [15] .

Herd immunity may be influenced by many factors, including efficacy , coverage, and effectiveness [16] , [17] , [18] . Vaccine efficacy differs from vaccine effectiveness . While the former [19] refers to findings observed under experimental conditions, vaccine effectiveness describes the reduction of infection that follows an immunization delivered with normal storage and usual administration processes to an unselected population in their usual environment [19] , [20] . Vaccine effectiveness is the net vaccine efficacy after field conditions are taken into account, which include coverage (percentage of the population that is vaccinated), the immune status of the population, viral spread and logistics that influence the vaccination, e.g., the cold chain [21] , [22] . Variations in viral strains and vaccination history also influence vaccine effectiveness [23] .

Insufficient geographical vaccine coverage may explain why vaccine effectiveness differs from vaccine efficacy: studies conducted in Africa have shown that, even when the same vaccine coverage is observed, settings that differ in geographical structure may yield different rates of vaccine effectiveness [24] . Because humans are not homogeneously distributed in space, population and geographical heterogeneity also influence vaccine effectiveness [25] .

Due to immunosuppression , populations that show identical coverage may also differ in vaccine effectiveness [26] . In addition, transmission (the average number of susceptible individuals infected by the average infected person, also known as the ‘reproductive number’ or R 0 ) should be considered. For example, when, on average, an infected individual infects three susceptible people (R 0  = 3), the estimated threshold required to achieve herd immunity is 67%; i.e., to stop an epidemic with such a transmission, vaccination should cover 2/3 of the population and 100% of the vaccinated individuals should develop protective immunity [12] .

2.2. Immunological considerations

However, the previous description does not fully account for variations in the immune system of individuals. For instance, not all vaccinated individuals develop a protective immune response and numerous factors may affect the outcome, such as the gut microbiota [27] .

Interactions among leukocytes may explain infection outcomes better than reductionist methods [28] , [29] . Cross-reactive memory T cells may influence disease severity [30] .

Because SARS-CoV-2 is immunosuppressive [31] , novel testing should explicitly estimate immunosuppression . New tests may also consider the clinical diversity of COVID-19 presentations, which may express at least three immune profiles [32] . Unlike other ‘common cold’-related diseases (in which the humoral response may suffice to achieve protection), both antibody-mediated and cell-mediated immunity are needed to protect against SARS-CoV-2 [33] .

To account for immunosuppression, the analysis of co-morbidities is crucial. Hence, clinical trials that ignore co-morbidities may not be valid [34] . In addition, vaccine trials that exclude large sob-populations –such as children, who are likely disseminators of SARS-CoV-2 but are not always symptomatic– may lack representativeness and, consequently, yield not only erroneous but also counterproductive results. When vaccine trials do not include children, vaccination strategies may require unrealistically high coverage levels [35] , [36] .

The route of immunization is also important. Because SARS-CoV-2 is a mucosal pathogen, a more robust immune response against this virus is more likely to be induced by the respiratory mucosa than by the parenteral route of vaccination [37] , [38] , [39] . The fact that none of the COVID-19 vaccines utilizes aerosols may be a source of concern ( Fig. 1 ).

Omissions may also be consequential. If new tests measured cell-mediated immunity in real time, they could evaluate vaccinations as well as anti-viral drugs, which are not tested in all countries where they are used [40] . Such new tests could also describe mucosal responses [41] .

2.3. Virological considerations

Zoonoses are diseases transmitted from non-human hosts to humans. Although many viruses are potentially zoonotic, their ability to induce epidemics is unknown  [42] . About 50% of the ∼ 1400 pathogens that affect humans also infect non-human species. Of those, about one third is composed of RNA viruses. Measles, for instance, emerged as a human pathogen, one millennium ago –probably from bovine rinderpest [43] . Smallpox is an even older pathogen: it evolved from camelpox about 4000 years ago [44] .

Emergent viral infections in humans have been increasingly recognized in the last four decades [45] . They seem to be triggered by climate and weather change, changing ecosystems, economic development and land use, human demographics, international travel and commerce, breakdown of public health measures as well as poverty and social inequality.

Rodents, birds, mosquitoes and bats are major vectors of infectious diseases. Bats are now considered to be major reservoirs of numerous emerging human epidemics, including Ebola, rabies, SARS-Cov, MERS-Cov and SARS-CoV-2 [46] , [47] .

The fact that bats exposed to RNA viruses show no or negligible signs of inflammation while the same viruses may be lethal in humans have led to hypothesize that these viruses may trigger, in humans, an aberrant immune activation [48] , [49] . Because COVID-19 does not fit the established definition of a zoonosis, it is classified as an emerging viral disease [50] .

2.4. Immunology and pathology

To understand both immunology and pathology , the immune responses of bats against viruses should be analyzed. Bat anti-viral immunity relies on low inflammation but high efficacy of interferon -based defenses, which allow them to harbor numerous viruses (including SARS-CoV-2) without showing signs of disease [46] , [47] .

SARS-CoV-2 immumodulates the human IFN system, leading to substantial non-symptomatic transmission, during which the viral load increases without facing a major inflammatory response. Later, a hyper-inflammatory response is elicited, which may be insufficient to clear the virus but may cause tissue damage (an auto-immune response).

The hyper-inflammation (‘cytokine storm’) observed in the second stage of COVID-19 patients presenting with severe disease is associated with high levels of pro-inflammatory cytokines, including IL-6 [51] , [52] . While, in children, COVID-19 resembles Kawasaki syndrome –another auto-immune disorder associated with increased IL-6–, in adults it shows similarities with the cytokine release syndrome [53] .

In severe COVID-19, macrophages are recruited and activated to the site of infection, together with T cells. Once the endothelium is damaged, coagulopathies follow, the lung parenchyma is destroyed, and multi-organ (septic shock-like) failure may occur –in part facilitated by a viral-induced suppression of type I and III interferons to clear the virus [54] .

Therefore, COVID-19 is a two-stage disease. It is characterized by an immune disorder that, early, reveals immunosuppression and, later, expresses hyper-inflammation [55] .

2.5. Personalized ( ‘n-of-1′ ) assessments

The clinical heterogeneity of COVID-19 and the limitations of group-based studies has renewed an old discussion: should patients be treated as groups or individuals? Ultimately, patient-specific information, specific for a given disease stage, is needed. This is what ‘n-of-1′ studies (personalized trials) offer. They are pre-/post designs with a sample size ( n ) = 1. They collect longitudinal data from the same person, before and after a therapy is prescribed [56] , [57] , [58] .

2.6. The role of geographical analysis

Optimized vaccine allocation depends on the geographical context [59] . Because geography may influence vaccination coverage [60] –and coverage influences vaccination effectiveness–, classic assumptions on the validity of the herd immunity concept –such as randomness– are not necessarily valid. In contrast, Pareto’s ‘80:20’ distributions may occur, i.e., ∼80% of all infections may occur in ∼ 20% of all locations [61] . Pareto’s ‘80:20’ ratio has been observed in epizootics affecting farm animals and in humans affected by COVID-19 [62] , [63] , [64] , [65] .

The ‘80:20’ pattern is a central concept of Network Theory –a field that views epidemic dissemination as a process described by networks, i.e., sets of circles (‘nodes’) linked by lines (‘edges’). Non-geographically explicit studies have suggested the use of network-based immunizations , which may protect with fewer (35% less) vaccinations [66] , [67] . If, instead of assumed data and assumed theories (non-geographical models that assume the most important node is always located at the center of the network), Network Theory was applied using actual and dynamic geo-referenced data, it could be possible to analyze the role of the connecting structures used by people, e.g., the road network [63] , [64] . Because geo-referenced connectivity data can distinguish sites that differ epidemiologically (epidemic ‘nodes’), it is theoretically possible and technologically feasible to integrate the concepts originated in Network Theory with those of high-resolution, geo-epidemiological analysis, and achieve protection earlier, at lower costs and more effectively: instead of random vaccinations (those aiming at a 67% coverage –the threshold expected to achieve herd immunity), vaccinating, first, the critical 20% of the population (Pareto’s most influential epidemic nodes), might stop epidemics earlier.

Differentiating space from geography is also relevant and so is distinguishing high-resolution (low scale) from aggregate (high scale) geographical data. While every geographical datum is spatial, the reverse is not necessarily true. This is so because spatial data may be simulated (and, therefore, not all the relationships that occur in Nature may be included). In contrast, geographical data are what they are and always include relationships that –using current technologies– can be measured with high precision. Therefore, the analysis of small geographical units (neighborhoods of a city or small counties, that is, high-resolution data) can generate studies that support cost-effective, site-specific interventions. In contrast, the analysis of aggregate data (e.g., state- or country-level data) loses granularity and induces more costly and less effective interventions [68] . When local, geo-referenced data are considered and vaccine effectiveness is estimated together with cost-benefit analyses, faster and less costly results can be achieved, over longer periods of time: geo-referenced based planning of routine immunizations may be more cost-effective than non-georeferenced planning [69] , [70] . In the absence of geo-referenced data analysis, predictions on herd immunity may be erroneous [40] .

Mobility is one example of geo-demographic interactions. High mobility (e.g., increased migration) promotes a rapid waning of vaccine efficacy and, consequently, decreases herd immunity [71] . Interactions between human mobility and geographical heterogeneity also influence outcomes; e.g., when a quarantine restricts mobility, disease incidence diminishes [72] .

Together, this review reveals a major difference between the original concept of ‘herd immunity’ and its human equivalent: while domestic farm animals usually move in or out of their farm just once in their lives, humans are extremely mobile. Because farm animal populations tend to be static and closed, they can be easily measured. In contrast, human populations are open, heterogeneous, highly mobile and, consequently, hard to measure. Hence, the vaccination effectiveness-related ‘herd immunity’ is a problematic concept ( Fig. 1 ). Thus, it is not surprising that most countries seem to lack explicit procedures that translate herd immunity into concrete policies –our search only found one study that integrated such concepts [73] .

While population and spatial heterogeneities should be investigated [74] , [75] , the literature does not report efforts aimed at generating and disseminating local (high-resolution), temporal, geo-referenced epidemiologic data. This is a major source of errors: without such data, no site-specific policy can be planned and executed.

2.7. Detecting silent disease spreaders, even with limited testing

Estimates on herd immunity may also be erroneous when asymptomatic or presymptomatic cases remain undetected and, subsequently, infect susceptible individuals. On average, a-/pre-symptomatic cases may explain half of all cases [76] . Even if they represent a small percentage of the population, undetected cases, over a few weeks, will generate an exponential epidemic growth. When epidemics grow exponentially, the time available to plan and execute control measures may be extremely brief [77] . Thus, the critical problem is not the magnitude of the (static) estimated herd immunity but its dynamics, i.e., the likelihood of non-symptomatic infected individuals to encounter susceptible individuals. When viral spread is not controlled, a few days may suffice for an epidemic to grow exponentially and generate colossal losses in lives, regardless of predictions on epidemic ‘preparedness’ [78] .

The available evidence supports the view that the best policy is the one that can be deployed rapidly and achieve results before the epidemic starts to grow exponentially. Otherwise, policies will fail –and do it so at a very large (and unprecedented) scale. While earlier studies predicted that global economic losses attributed to COVID-19 ranged between 5 and 10% of the annual Gross Domestic Product (GDP), recent estimates calculate such losses (for the US) as approximately 90% of the current GDP [79] , [80] .

Vice versa, saving lives is an ethical obligation and an optimal business: less than 10 US billion dollars may suffice to protect all health workers from low and middle income countries, save 2.2 million lives, and generate 755 US billion dollars. This policy results in a very high ‘return on the investment’: for each dollar spent, ∼ 78 dollars would be gained [81] .

3. II The second review: from Policy to Biology

To complement the analysis that covered concepts ranging from biology to policy, the second review is based on the policy promoted by WHO: ‘test/treat/isolate.’ This policy is centered on the notion that ‘the most effective way to prevent infections and save lives is breaking the chains of transmission’ [82] , [83] , Fig. 2 ). The first step of this policy involves testing.

The second review: from Policy to Biology and other sciences Approximately thirty topics –some of them partially overlapping– were reviewed. When related, some needs, contradictions and/or omissions were identified (topics identified in red). For example, a method that assumes only two alternatives exist (e.g., ‘infection-negative’ or –positive’) but does not consider disease stages and/or temporal changes (such as ‘recently infected, not yet under recovery’, ‘recently infected, under recovery’, and ‘not recently infected, under recovery’) is likely to induce errors: it will confound three or more biological conditions into only two classes. The lines shown here only illustrate one possible relationship. A dialogical (combinatorial) process involving many disciplines and social perspectives is likely to uncover many other relationships. (For interpretation of the references to colour in this figure legend, the reader is referred to the web version of this article.)

3.1. In search of a testing policy

This second review supports the need for official policies on diagnostics. In spite of WHO emphasis on ‘test/treat/isolate’, many nations (including several countries with + 100 million inhabitants) do not seem to have a testing policy [84] , [85] , [86] , [87] . In 2020, at least three countries promoted only the testing of symptomatic (not asymptomatic) cases. When this policy was compared across six countries, only two countries revealed explicit policies on testing, isolation, and treatment of cases. Several countries did not consider travel history in their contact tracing systems. Other omissions included non-enforced isolations or recommendations that could be violated without repercussions, such as isolation at home. Contradictions were also detected: some countries provided testing free of charge but treatment was not provided [88] .

Testing silent (non-symptomatic) cases requires an explicit policy that, to materialize, needs new data collection systems [89] , [90] . It may be concluded that not testing silent COVID-19 cases may, alone, explain the unabated duration of this pandemic.

3.2. In search of tests that capture silent disease spreaders –choosing whom to test, where and when

One likely explanation for not testing non-symptomatic infections is the lack of consensus on ‘screening’ tests [91] . Originally meant to be implemented on volunteers suspected to be healthy (asymptomatic cases), these tests seem synonymous with those used in ‘surveillance.’ They only differ from ‘diagnostic’ tests in reference to the health status of the people being tested: diagnostic tests are performed on individuals suspected to be ill.

To detect asymptomatic patients, tests that provide explanatory (function-related) information may be needed. One example of such tests is the assessment of macrophage activation [92] .

The indeterminacy of screening tests affects who decides and who benefits [91] . The need to identify non-symptomatic cases also involves a separate problem: how to identify silent cases when the available resources can only test, at best, a minor fraction of the population. Therefore, the first challenge of the triad proposed by WHO is to develop new metrics –such as test positivity –, followed by a system that produces valid and usable results even when only a minor proportion of the population is tested. To be solved, this problem requires the inclusion of, at least: (i) geographical information systems (GIS) and (ii) cost-benefit analysis [89] , [90] .

3.3. In search of valid systems –which may include numerous steps and several disease stages

To be effective, the assumptions upon which testing is based should be explicitly analyzed. They are those associated with the ‘2 × 2 table’ paradigm –a model originated in 1947.

This is a table with four cells that estimate (a) whether testing results are true or false, and (b) whether they indicate an infection-negative or –positive condition [93] . Given its four possibilities (a true ‘positive’, a true ‘negative’, a false ‘positive’, or a false ‘negative’), this is a static and binary paradigm: it ignores time and assumes only two outcomes may occur.

This can be a major source of errors. Because infections are always dynamic processes and, over time, they reveal at least four stages (namely an early infection; a late infection without recovery; a late infection with recovery; and no infection), this paradigm may lead to confusion: similar values of the same variable may indicate opposite health situations. Vice versa, dissimilar values of the same variable may correspond to the same situation. Thus, the ‘2 × 2′ epidemic model tends to misclassify data and induce errors [94] , [95] .

When the questions are posed in binary terms but the answers include more than two alternatives, errors are likely [96] . When, in addition, a static model is applied to dynamic data, errors and omissions will follow. Because interactions among individuals are rarely random in geo-demographic contexts [97] , assumptions should be explicitly validated. To that end, exploring geo-demographic contexts as they are (not as they are assumed to be) is essential. Given the numerous concerns on the assumptions considered in COVID-19 related forecasting, probabilistic models should also be validated [98] , [99] . Similarly, the usability of the reproductive number (R o ) –which lacks geo-referenced coordinates and, therefore, cannot be ascribed to specific, small geographical units –, may need to be reconsidered [100] .

3.4. Micro- and macro-scale connections

To evaluate herd immunity, micro-level (high-resolution, non-aggregate) geo-epidemio-immuno-virological data are needed. In contrast, high aggregate (macro-level) herd immunity are not always protective, as the following case shows. In October of 2020, in Manaus, Brazil, 76% of the population had sero-converted against SARS-CoV-2 –a 9% higher level than the herd immunity level expected to protect [12] . Yet, a new epidemic wave was reported [101] , [102] .

The Manaus case illustrates two problems: (i) aggregate (state- or country-wide) herd immunity may be irrelevant when the local (micro-level) situation is not factored in; and (ii) in the absence of geo-epidemiological data, numerical analyses on COVID-19, alone, may be erroneous. Although many countries have built COVID-19 related data collection systems [103] , [104] , there are no reports of countries that report high-resolution, geo-epidemiological data.

3.5. From problem-solving, to policy coherence, to audience-specific, visual communications

Data, information, knowledge and interpretation are different concepts [105] . Decision-making bodies need interpretation –not just data. Thus, problem identification is key.

Unlike the well-structured problems typical of academic settings, COVID-19 is an ill-defined, ‘inverse’, complex, dynamic and interdependent set of problems. Such problems may conflict with one another and share their sources of causation [106] , [107] , [108] , [109] .

Given the ill-defined nature of COVID-19, communications aimed at fostering problem-solving skills are needed. In addition, efforts that promote innovation are necessary [110] . Ultimately, the coherence of governance systems should be evaluated and/or built.

Because conflicts between goals and rules tend to occur in systems that emphasize command and control functions, new models aim at polycentrism and participation [111] , [112] . These recent approaches seek preventing the far-reaching –although totally avoidable– problems that frequently affect governance systems, as the following cases document.

A study of 24 countries has shown that, in many countries, the advisory and decision-making body tended to be the same, transparency was rarely observed, the diversity of disciplines included in such bodies was rather narrow, citizen participation was not emphasized and communication campaigns did not explain the scientific foundation of the decisions adopted [113] , [114] . Another example refers to governmental corruption in the distribution of vaccines –a risk warned by the United Nations which, unfortunately, has materialized [115] , [116] , [117] .

Perhaps the worst type of problems –because it leads to long-term, devastating consequences– is that grounded on simplistic (reductionist) worldviews, such as letting an algorithm determine who should be vaccinated –an approach that prevented more than 99% of the medical workers with daily and direct exposure to COVID-19 from being vaccinated [118] . This case also shows a major omission: the lack of a society-wide system that, in order to identify and solve problems that affect everybody, brings together numerous disciplines and social groups.

Instead of assuming natural resources are infinite –an illusion that destroys habitats and promotes the emergence of pandemics–, non-anthropocentric, non-binary, pro ‘One Nature’ governance systems are needed [119] . New, audience-specific communications are also required, e.g., when epidemic exponential growth is expressed as doubling times (rather than growth rates) and time gained (not ‘cases avoided’) is emphasized, understanding increases [120] .

Centralizing information inputs and decentralizing messages has been recommended [121] . Visualizations also matter: when ill-problems are encountered, visual aids support problem-solving [122] . They help problem-solvers to detect not only individual (or partial) problems but also the overall (complex) problem that should be solved ( Fig. 3 ).

Functional and structural relationships of a system meant to identify and solve COVID-19 related problems or needs . A six-element system is described, which includes: (1) a data collection sub-system; (2) new metrics appropriate to estimate whether testing is capturing silent (non-symptomatic) cases (e.g., test positivity); (3) biomedically interpretable information (e.g., new tests that, rapidly, inform on cell-mediated immunity); (4) geo-referenced coordinates; (5) explicit validation; and (6) cost-effective policy-making. This system may have both circular and transversal connections, which may show other trajectories (arrows).

To stop this pandemic, both creativity and innovation are required [102] . When incentives are introduced to promote changes, crises may help remove obsolete paradigms [123] .

This report shows examples on how ill-defined problems that require interdisciplinary inputs and social participation may be addressed. A six-step guide identifies (i) the need to be met/problem to be solved; (ii) one predominant approach currently utilized; (iii) a likely fallacy of such an approach; (iv) a possible remedy or solution; and (v and vi) a list of relevant disciplines and social groups, whose performance should be evaluated ( Fig. 4 , Fig. 5 , Fig. 6 ).

Disciplinary and social contents –example I: tests that offer explanatory information on biomedical functions . A six-step process shows a guide meant to determine the minimal number of disciplines or social groups needed to solve an ill-defined problem. (1) the need is determined; (2) one (or more) predominant approach/es is/are described; (3) (one (or more) likely consequence(s) is/are identified; (4) a possible remedy or solution is outlined; (5) a list of disciplines/social groups relevant to/affected by the need is reported; (6) a tentative list is identified and their effectiveness to achieve the goal/solve the problem should be integrated and evaluated.

Disciplinary and social contents –example II: optimal (cost-effective) data collection systems. A six-step process shows a guide meant to determine the minimal number of disciplines or social groups needed to solve an ill-defined problem. (1) the need is determined; (2) one (or more) predominant approach(es) is/are described; (3) (a) major consequence(s) (systemic or paradigm-level) fallacy(ies) is/are identified; (4) a possible remedy or solution is outlined; (5) a list of disciplines/social groups relevant to/affected by the need is reported; (6) a tentative list is identified and their effectiveness to achieve the goal/solve the problem should be integrated and evaluated.

Disciplinary and social contents –example III: assignment and evaluation of vaccinations. A six-step process shows a guide meant to determine the minimal number of disciplines or social groups needed to solve an ill-defined problem. (1) the need is determined; (2) one (or the) predominant approach is described; (3) (a) major consequence(s) (systemic or paradigm-level) fallacy(ies) is/are identified; (4) a possible remedy or solution is outlined; (5) a list of disciplines/social groups relevant to/affected by the need is reported; (6) a tentative list is identified and their effectiveness to achieve the goal/solve the problem should be integrated and evaluated.

4. Conclusions

Findings identify nine partially interdependent omissions, contradictions, needs, and/or issues that require additional research and/or new policies: [1] national data collection systems, which should be geo-referenced, accessible to the public, subject to independent evaluations, and updated on daily basis; [2] new metrics that capture the progression of epidemics –especially those that help detect non-symptomatic cases, e.g., test positivity ; [3] new cost-benefit oriented approaches that compensate for the absence of universal testing (even with limited testing, they should demonstrate that silent viral spreaders can be rapidly identified); [4] biologically interpretable, personalized, new tests should measure cell-mediated immunity, co-morbidities and immuno-suppression; [5] factors that influence vaccines ( efficacy , coverage , effectiveness ) should be estimated with actual (geo-bio-epidemiological) data, not assumptions; [6] economic perspectives should take into account the protracted (several years long) likely consequences of epidemics that grow exponentially; [7] binary as well as reductionist approaches should be avoided, e.g., decisions should not be limited to either ‘control’ or ‘eradication’ –they may coexist and three or more alternatives may apply; [8] new governance models may be required, which emphasize problem-solving, social participation, and use of valid scientific knowledge over centralization; and [9] new visually explicit, educational programs with audience -specific communication strategies may be instrumental in this innovation -oriented process.

As depicted in Fig. 1 , Fig. 2 , Fig. 3 , Fig. 4 , Fig. 5 , Fig. 6 , this epidemic is a multi-causal, dynamic and interdependent process in which no individual problem is solved unless all other problems are also solved. Because the perceived occurrence of these challenges may differ two or more weeks from one another, the resolution any one problem may require many fields and social groups. Because the topics here analyzed are so few, readers are invited to continuously review and expand the list of topics that should guide COVID-19 research and policy.

5. Author statement

Both authors have read and approved the final version of the manuscript and neither author has conflicts of interest to report. This manuscript has not been submitted to any other journal and it has not been funded by any institution –whether private or public– of any country.

Problem solving in the time of coronavirus pandemic

Affiliation.

• 1 Department of Medical Biology and Central Electron Microscope Laboratory, University of Pécs Medical School, Pécs, Hungary.
• PMID: 34472686
• PMCID: PMC8652933
• DOI: 10.1002/bmb.21571

Problem solving, multiple-choice question-based educational tools have been used for decades in molecular cell biology courses at the University of Pécs Medical School, Pécs, Hungary. A set of these tests was published in Biochemistry and Molecular Biology Education between 2002 and 2015. Such tests using an experimental approach help students to understand how living cells function. Besides being tools of education, they can be used for examination purposes as well to assess higher levels of intellectual skills (interpretation and problem solving) acquired by the students. The test presented in this paper is based on parts of an original publication in which the authors described seminal observations on the function of a viral protein in the infection process of SARS-CoV-2. The test is aimed at helping the students to understand the methods used in the experiments, to analyze the data and to draw conclusions from them regarding certain aspects of the mechanism of coronavirus infection.

Keywords: SARS-CoV-2; coronavirus infection; problem-based learning; problem-solving test; protein synthesis; viruses.

© 2021 International Union of Biochemistry and Molecular Biology.

• COVID-19 / epidemiology*
• COVID-19 / virology
• Education, Medical / methods*
• Molecular Biology / education
• Problem Solving*
• SARS-CoV-2 / isolation & purification

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• Published: 30 June 2021

The COVID-19 wicked problem in public health ethics: conflicting evidence, or incommensurable values?

• Federica Angeli   ORCID: orcid.org/0000-0003-4010-3103 1 ,
• Silvia Camporesi   ORCID: orcid.org/0000-0003-4135-1723 2 &
• Giorgia Dal Fabbro 3  

Humanities and Social Sciences Communications volume  8 , Article number:  161 ( 2021 ) Cite this article

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• Social policy

While the world was facing a rapidly progressing COVID-19 second wave, a policy paradox emerged. On the one side, much more was known by Autumn 2020 about the mechanisms underpinning the spread and lethality of Sars-CoV-2. On the other side, how such knowledge should be translated by policymakers into containment measures appeared to be much more controversial and debated than during the first wave in Spring. Value-laden, conflicting views in the scientific community emerged about both problem definition and subsequent solutions surrounding the epidemiological emergency, which underlined that the COVID-19 global crisis had evolved towards a full-fledged policy “ wicked problem ”. With the aim to make sense of the seemingly paradoxical scientific disagreement around COVID-19 public health policies, we offer an ethical analysis of the scientific views encapsulated in the Great Barrington Declaration and of the John Snow Memorandum, two scientific petitions that appeared in October 2020. We show that how evidence is interpreted and translated into polar opposite advice with respect to COVID-19 containment policies depends on a different ethical compass that leads to different prioritization decisions of ethical values and societal goals. We then highlight the need for a situated approach to public health policy, which recognizes that policies are necessarily value-laden, and need to be sensitive to context-specific and historic socio-cultural and socio-economic nuances.

Competing goals and conflicting values in the COVID-19 wicked problem

At the time of writing (November 2020), while the world is facing a rapidly progressing COVID-19 second wave, and governments are rushing towards the reintroduction of restrictive measures, the consensus that almost monolithically surrounded the lockdown decisions—or slight variations of the same formula—in Spring 2020, is visibly breaking apart. Roughly 6 months into the pandemic, a paradox emerges. On the one hand, we have more evidence about the mechanisms underpinning the transmission, morbidity and mortality related to Sars-CoV-2. On the other hand, how such knowledge should be translated into containment policies is subject of fierce debates. In particular, a polarization of views started to emerge within the scientific community, vividly illustrated by the Great Barrington Declaration (Kulldorff et al., 2020 ; Lenzer, 2020 ) on the one side and the John Snow Memorandum (Alwan et al., 2020 ; John Snow Memorandum, 2020 ) on the other side. The Great Barrington Declaration was authored by Dr. Sunetra Gupta (University of Oxford), Dr. Jay Bhattacharya (Stanford University), and Dr. Martin Kulldorff (Harvard University), and was written and signed at the American Institute for Economic Research in Great Barrington, Massachusetts, on October 4th 2020. The document is co-signed by a further 44 medical and public health scientists and medical practitioners working in the US, Canada, Israel, Germany, India, New Zealand, and Sweden. The declaration advocates against lockdown measures to favor a containment approach based on a focused protection of the vulnerable, whilst allowing the segments of the population nominally at lower risk of COVID-related complications to resume normal life, thus favouring population-level natural immunity. The John Snow Memorandum was published in the Lancet on October 15th, 2020 as a reaction to the Great Barrington declaration, and was authored by a team of 31 scientists from the UK, Switzerland, US, Canada, Germany, France, Australia. The memorandum’s aim was to lay out empirical evidence to justify restrictive lockdown-like measures to prevent the uncontrolled spread of the virus and the subsequent collapse of healthcare systems.

Such value-laden, conflicting views about both problem definition and problem solution are typical of policy “ wicked problems ” (Alford and Head, 2017 ), a construct that increasingly applies to the COVID-19 global crisis. The pandemic has created a context in which multiple urgent, interdependent societal goals simultaneously exist, which generates a fundamental problem of prioritization of one aspect over another (Camporesi and Mori, 2020 ). Such goals can be identified in the short-term reduction of COVID-19 morbidity and mortality, the mitigation of long-term social repercussions of containment policies (rising social inequalities, mental health issues due to social isolation, intergenerational conflicts) and financial adverse consequences, in the form of severe economic recessions, and subsequent rise in unemployment, poverty levels, and social tensions (Angeli and Montefusco, 2020 ; Camporesi, 2020 ). We are currently witnessing how such prioritization choices generate conflicting stakeholder views about what the problem is (e.g., catastrophic death toll vs potential economic meltdown) and the related solutions (e.g., lockdown measures vs softer mechanisms of virus control). A full-fledged wicked problem has now arisen. However, while wicked problems are normally associated with policy choices, the polarization of views has now permeated the scientific community and the very process of translation of evidence into policy advice, therefore illustrating—perhaps more than ever before—the evolution from value-free to value-laden science.

The prioritization of the shorter-term goals of reduction of COVID-19-related morbidity and mortality in the Spring of 2020 first wave resulted in a multiplicity of policy interventions’ bundles in different countries. These interventions shared similarities in the way they restricted individual freedoms (Camporesi, 2020 ) and varied in their combination of school closures, limitations on pubs’ and restaurants’ opening times, use of face coverings, restrictions of socialization opportunities or individual mobility (Angeli and Montefusco, 2020 ). Now, as evidence about modes of contagion and manifestations of the disease accumulates, the debate about how to use the scientific evidence to inform policy has reached the stage of a polarized conflict. The shift away in narrative from the “we are all in this together” (United Nations, 2020 ), to the “focused protection” (Kulldorff et al., 2020 ) shows that the COVID -19 wicked policy problem requires more in-depth ethical considerations. In this piece, we offer an ethics-driven view of scientific advice for COVID-19 policy formulation, to illustrate how specific ethical prisms can lead to different—even polar opposite—views on containment policies. In this sense, we highlight the importance of ethics in decision-making and in the process of translating evidence into policy design (Oliver and Boaz, 2019 ). Our analysis also aims to provide an interdisciplinary interpretative lens, as it addresses the problem of how decision-makers attend to multiple objectives in space and time—a well-known area of research in management studies (Cyert and March, 1963 ; Ocasio, 1997 ; Rerup, 2009 ), by theoretically drawing on the field of public health ethics (Abbasi et al., 2018 ), and public policy formulation in the context of wicked problems (Head, 2008 ; Waddell, 2016 ).

Conflicting policy viewpoints: different priorities to different values

Conflicting values are commonplace in the context of managerial decision-making (e.g., Levinthal and Marengo, 2020 ) and in public health, especially in relation to the management of infectious diseases (Ortmann et al., 2016 ). Compulsory vaccination represents one emblematic example, in which individual freedom is restricted to favor the public good, by way of boosting heard immunity towards specific pathogens (Dawson et al., 2007 ). Public health policies revolve, although often implicitly, around a compass of three key values, namely utility, liberty, and equity/equality. The principle of utility aims at maximizing a certain value “X” for the greatest number of people. Public health policies aim at maximizing population health. In the context of measures aimed at the containment of disease outbreak, ensuring population health translates into reducing the disease transmission, morbidity and mortality, whether through vaccination, natural herd immunity, or restrictive measures aimed at reducing/modifying citizens’ socialization and interaction patterns, mobility and hygiene practices. Liberty is generally understood as the freedom to live one’s own life free from interference from others. Although there are two main understandings of liberty, a negative (liberty to act free from interference), and a positive one (liberty to shape one’s own life according to one’s own values, and to have the opportunity to do so beyond and above the lack of others’ interference) (Berlin, 1969 ) in the context of public health, liberty is generally conceptualized as negative liberty. Equity/equality is a value that is recognized as salient for public health policies, but also of difficult operationalization and implementation. Egalitarianism is the theory that aims at ensuring a fair distribution of benefits and harms across a given population, and hence to maintain distributive justice. Equity and equality are often used as synonyms in public health ethics, however, they point to different—even opposite—concepts. Equity is a normative concept, grounded in distributive justice, while that is not necessarily the case for equality (i.e. not all health inequalities are unfair) (Braveman and Gruskin, 2003 ). In the context of public health policies, equity means equal opportunity and implies that resources should be distributed in ways most likely to produce a fair distribution of harms and benefits across all segments of the population. This often implies that societal groups should not be offered the same services (as it would be in the case of equal treatment) but rather should receive differential care according to their differential needs. We will focus in this piece on equity rather than equality.

Even if not explicitly acknowledged, the values of utility, liberty and equity underpin any public (health) policy decision, including those aimed at containing the COVID-19 emergency. According to a pluralistic approach to public health policy (Selgelid, 2009b , 2009a ) these three values should all be considered as independent, socially legitimate public goals. Effective public health policies are then tasked to find creative ways to pursue all of them at the same time, through trade-offs that are socially and culturally acceptable. This is naturally easier said, than done. What creates a broad spectrum of public policy approaches in response to the COVID-19 pandemic is the different weight associated by different decision-makers—and also by scientists—to the three value dimensions of the ethical compass, resulting in different trade-off points. The recently published Great Barrington Declaration and John Snow Memorandum exemplify two situations in which, provided the same available scientific evidence, this is interpreted and translated by scientists into polar opposite advice with respect to COVID-19 containment policies. We argue that such views can be best understood in light of a different ethical compass that leads to different prioritization decisions. We can assume that signatories to both memoranda obviously want to reduce COVID-19 morbidity and mortality, want to mitigate its socio-economic repercussions, are concerned about restrictions of personal freedom and increasing surveillance, appreciate the differential impact of the policies across the population. However, the signatories assign a different weight to each of the three values of utility, liberty and equity, hence appraising the available scientific evidence with a different, value-laden ethical prism. The fact that the process of normative weighting assigned to empirical data remains implicit creates a polarization that is only apparently based on disagreements about empirical evidence.

The Great Barrington declaration takes a stance against restrictive measures aimed at controlling the community spread of the virus and instead proposes to focus policies and societal resources towards “focused protection” of the older demographics—notably those who are several times more likely to die from COVID-19 or to suffer from long-lasting complications. According to the signatories, this approach would also favor the development of herd immunity, hence further shielding the older people from the possibility of contracting the disease. This position has sparked a strong reaction from the signatories of the John Snow Memorandum, which highlights instead that the herd immunity arguments based on the assumption that natural infection from the virus will boost lasting protective immunity are flawed and lack supporting evidence. Moreover, the uncontrolled spread of Sars-CoV-2 within communities would lead to an excessive burden on healthcare systems and workers, and compromise the diagnosis and treatment of several acute and chronic conditions, with long-lasting-negative repercussions. As a consequence, the John Snow Memorandum argues that it is important to extend social distancing, targeted restrictions of mobility and socialization, face coverings and strengthened hygiene practices to the whole population.

With its emphasis on “focused protection” the Great Barrington declaration prioritizes values of liberty and equity, as it views the wide imposition of restrictive measures as violating individual freedom in a way that is unfair to the less vulnerable individuals, such as the young generations. The herd immunity argument—widely decried by the scientific community (Aschwanden, 2020 ) and public opinion alike (The Guardian, 2020 )—is highly controversial, and mostly for an ethical rather than a scientific reason. The technical possibility that a population develops natural protection from the infection exists, however, for Sars-CoV-2 it is unclear what the threshold is as this depends on the transmission rate and how long the immunity could last (Fontanet and Cauchemez, 2020 ). Although from a technical point of view the pursuit of (short-term) herd immunity is not, in theory, an unattainable policy goal, there is widespread societal consensus that it would be an unacceptable policy goal from an ethical point of view, in the absence of improved patient management and in the absence of optimal shielding of individuals at risk of severe complications. In the absence of these two key factors, current modeling of transmission dynamics predict that letting Sars-CoV-2 epidemic run its course without non-pharmaceutical interventions (i.e., social distancing, facemasks, heightened hygiene measures) would lead to catastrophic consequences in terms of death toll, both direct from COVID-19, and indirect, due to the overwhelming burden on the healthcare systems (hospital capacity) (Brett and Rohani, 2020 ).

The signatories of the John Snow Memorandum are in fact more concerned with utility, namely the short-term reduction of COVID-19-induced mortality and morbidity and the long-term health outcomes of delayed treatments. Interestingly, by problematizing the definition of “vulnerable” individuals, John Snow supporters implicitly defend the egalitarianism of their position, as evidence is still scant around the reasons underpinning the wide individual variation in COVID-19 adverse outcomes—with some developing grave complications until death and other showing only mild symptoms or remaining completely asymptomatic. Concluding that everyone is equally at risk, the John Snow Memorandum implicitly assumes that it is fair for restrictive measures to be applied to everyone, therefore leaning towards a solution geared towards equality rather than equity. Instead, the Great Barrington Declaration implicitly proffers that vulnerability to the virus is only one aspect that should be taken into account. Vulnerabilities within the population instead should be specified taking into account vulnerability towards negative repercussion of the economic recessions—such as BAME minorities in the UK (Institute for Fiscal Studies, 2020 ), as well vulnerability towards the negative effects of lockdown-induced isolation and alienation, as in adolescents (Lee, 2020 ). The prioritization of short-term gains in terms of physical health with respect to impeding longer term socio-economic disadvantage and mental health consequences therefore becomes less straightforward.

Contextualizing values and policies in time and space

In dealing with a highly complex situation—a wicked problem—such as the COVID-19 pandemic, it is important to understand how values—hence societal goals—are formulated and understood, and the influence of temporality. The value of utility can be specified short-term, as the reduction in the number of COVID-19-related deaths at a given time. However, a more encompassing, forward-looking view will also consider the total number of COVID-19-induced deaths in the medium-long run. The need to prioritize COVID patients in the hospital will necessarily lead to other collateral deaths because of missed appointments and delayed surveillance or surgeries (Maringe et al., 2020 ). Economic recession is widening inequalities and increasing poverty levels (Kirby, 2020 ; Van Lancker and Parolin, 2020 ), while the mental health repercussions induced by isolation especially in young people might lead to forms of addiction and depression (Lee, 2020 ). While deaths from the infectious disease are short-term, indirect casualties that will occur down the line need to be taken into account. Public health policies cannot afford the myopic mistake of discounting the future, a well-known individual cognitive bias (Trout, 2007 ). The public health ethics framework also demands that the management of infectious diseases outbreaks follows the key principle of proportionality in restricting individual freedoms to promote the public good (World Health Organization, 2020 ). This means that, as epidemiological and clinical evidence becomes more conclusive on the disease’s transmission, prevention and diagnosis patterns (Manigandan et al., 2020 ), on the variability of health outcomes (Chen et al., 2020 ), on the effect of non-pharmaceutical interventions to reduce community spread (Li et al., 2020 ), and on the long-term consequences of lockdown measures such as school closures (Bayham and Fenichel, 2020 ; Viner et al., 2020 ), the same restrictive policies might not be as suitable, justified or acceptable as they were in the early stage of the pandemic. This principle is implicit in the Great Barrington declaration.

What degree of personal infringement of liberty is justified? This is where ethics comes in. Expert groups will offer a range of possible ethically justified policies, but, we argue, it is the policymakers’ task to do the normative weighting and to decide which policy approach is best suited to the local socio-economic, socio-cultural and socio-political context (Angeli and Montefusco, 2020 ). While in some national settings the Great Barrington Declaration proposal could be more attuned to the existing social dynamics, individual mindsets, healthcare infrastructure and economic development, in other contexts the prescription of the very same proposal would not be applicable nor recommended, while the solutions proposed by the polar opposite John Snow Memorandum could be more suitable. For example, a policy of focused protection is not practical in settings—such as Italy—where intergenerational exchange is very high, grandparents often babysit grandchildren and even share living space with younger generations. A focused protection approach, which also aims at achieving high levels of community spread of the disease in less vulnerable societal segments, will likely lead to higher burden on the healthcare system, which is only sustainable in settings where healthcare infrastructures are strong and widely accessible, and focused protection of vulnerable segments of the population (i.e shielding) is feasible. In a similar way, restrictions to individual freedom are more difficult to implement in countries where personal liberty is culturally highly valued, and where utility—intended as the public good—comes second. A case in point is the use of face coverings, which, despite mounting evidence related to the importance of the measure to prevent COVID-19 transmission (Cheng et al., 2020 ; Lyu and Wehby, 2020 ), remains highly debated (Martin et al., 2020 ). It is not by chance that more individualistic cultures such as the United States, the United Kingdom or the Netherlands (Hofstede, 1983 ), have seen a more patchy and less widespread imposition of such measures (Royal Society, 2020 ; Statista, 2020 ), combined with higher societal resistance and rising social tensions (CNN, 2020 ).

Finally, questions of equity and justice. Public health measures aimed at containing an infectious disease outbreak should take into account to what degree the measures are disproportionately affecting certain groups of the population. This is where the concept of vulnerability comes in and where it can be used to operationalize the equity principle. Defining who qualifies as vulnerable is difficult, but by no means impossible, as research ethics literature demonstrates. One approach that we think could be well suited here is the layered approach to vulnerability (Luna, 2019 , 2014), which is context dependent, and dynamic. One could identify, for example, the following three layers of COVID-19 related vulnerability:

A biological axis: likelihood of developing severe/critical symptoms after contracting COVID-19. Evidence widely supports that older people and people with pre-existing co-morbidities are at higher risk of COVID complications;

Socio-economic axis: likelihood of being severely affected by restrictive measures. Studies have highlighted how disadvantaged groups and communities (such as BAME minorities in the UK) are disproportionally more severely hit by the economic crisis ensuing from lockdown measures;

Mental health axis: likelihood of developing severe mental health repercussions related to containment policies. School closures and extended lockdown periods have increased mental health issues in the population, with children and adolescents at particularly high risk.

Age, gender and race remain transversal axes here, as the approach rejects applying the label of vulnerability to specific groups. That does not mean that is impossible to define who is vulnerable, contrary to the John Snow memorandum positions. However, who counts as vulnerable to COVID-19 will change depending on the context, over time and through what layers one decides to look at this question. While in the first COVID-19 wave the priority has been given to the biological axis, the attention is, in the second COVID-19 wave, importantly shifting towards socio-economic and mental health aspects.

With the purpose of illustrating the longitudinal evolution over time of value prioritization, and its cross-sectional, cross-country variation, we have selected a number of containment measures that can reflect how the values of liberty, equality and utility are incorporated into scientific advice and then translated into policy. Restrictions to individual freedom can be appreciated for example through the presence of restrictions to jogging activities; the presence of a ban on amatorial sports activities; the extent of face coverings obligations, the restrictions on household mixing, and whether a social bubble is allowed. The value of equity can be operationalized into whether the measures have been prescribed to the whole population indistinctively or whether there has been a differential application to more or less vulnerable sub-groups, or taking into account the different morbidity and mortality levels across regions. This aspect can be appreciated by considering whether restrictions have been imposed nationally or following a regionalization rationale; whether face coverings have been prescribed also to children under 11, notably less amenable to infect, get infected and develop severe symptoms from COVID-19; whether specific measures have been adopted to strengthen protection of older demographics; whether youth sport activities have been allowed; whether business closures have been imposed indistinctively or have instead followed an occupational health risk assessment. Finally, utility can reflect into governments’ advocacy practices, namely the presence of a stay-at-home advice, the emphasis of COVID-19 as a burden for healthcare workers and systems, the clear and frequent communication of COVID-19 epidemic progression, the level of surveillance and sanctioning of non-compliant individual behaviors. We have considered the presence/absence as well as the strength of the above aspects at the highest point of first and second wave of COVID-19, in Italy and in the United Kingdom. As restriction levels, timing and the combination varied across England, Scotland, Wales and Northern Italy, we focused on England.

Table 1 represents the comparison of measures between COVID-19 first and second wave in the two countries, as derived from the original policy documents. Based on the nature of the containment measures, and the effect to which they reflected values of equity, utility and liberty, we computed scores on each dimension, for each country across the two waves, on a total of 20 points for each value dimension.

We then plotted the results in Fig. 1 . The graphs highlight how values are differentially embedded into containment policies trough context- and time-specific trade-offs. The figure highlights how two countries started from very different positions, with measures in Italy in the first wave almost entirely guided by utility (public health) considerations, with strong restrictions of individual freedoms and little appreciation of differences in vulnerability levels across populations and regions. In the second wave, we notice the evolution of Italian policies towards more consideration for liberty and equity value dimensions. England has experienced a similar evolution, albeit starting from a much more libertarian stance. Its policies show an evolution towards liberty and equity considerations against a slight reduction of utility-focused measures.

Evolution of the value trade-off embedded in the COVID-19 containment policies promulgated in Italy and in England, during the first and the second pandemic wave (until December 2020).

Conclusions

Public health policies—and particularly those aimed at the containment of a highly infectious disease such as COVID-19—revolve around a compass of moral values, which are often implicitly given different weights by both policymakers and scientific advisors. Both the understanding of these values, and the normative weighing of the values will always necessarily be context dependent, and dynamic. Public health policies should aim to consider to what degree the proposed measures aimed to preserve the public good are socio-culturally acceptable in restricting individual freedom, in what way they disproportionately affect certain groups of the population, according to what aspect of vulnerability is most relevant. An approach of situated policy is therefore most salient, which promotes policymaking that is attuned with idiosyncrasies that are both spatial (the socio-cultural and socio-economic local context) and temporal (given the rapid evolution of COVID-related scientific evidence). A situated approach to policymaking in the context of wicked problems reflects that there cannot be a one-size-fits-all approach to COVID-19 public health policies.

Our analysis has aimed to propose an ethics-driven perspective to better comprehend how evidence is used to inform policymaking and how disagreement on policy can emerge within scientific communities. In doing so, we have offered an interdisciplinary view at the intersection between management studies, public policy and bioethics disciplinary boundaries. Whilst the debate around evidence-based policymaking has been a core focus of science and technology studies (Frickel and Moore, 2006 ), this commentary offers an alternative perspective that is less concerned with the politics of science—hence the influence on knowledge production of socio-political factors and power dynamics (Hoppe, 2005 )—and is instead more focused on how evidence is filtered through a situated ethical prism to inform policymakers’ prioritization decisions. The recognition that policymaking is shaped by socio-contextual factors and that policymakers engage into processes of interpretation of evidence in light of their knowledge, norms and values and towards their economic and political goals is not new (Sohn, 2018 ). This commentary suggests, however, that an ethical perspective is salient to understand such processes, that interestingly affect not only policymakers but also prominent representatives of the scientific community. Our analysis thus highlighted how evidence-based public health containment measures to address the pandemic can be ethically justifiable and understood through a clear and transparent understanding of the values underpinning policy decisions, and the evolution of acceptable trade-offs over time.

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Angeli, F., Camporesi, S. & Dal Fabbro, G. The COVID-19 wicked problem in public health ethics: conflicting evidence, or incommensurable values?. Humanit Soc Sci Commun 8 , 161 (2021). https://doi.org/10.1057/s41599-021-00839-1

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2024 Global Health Equity Challenge

Vaccines to combat Coronavirus (SARS-CoV-2)

Mr. OLINTO JOSÉ ROSALES GUTIÉRREZ

Our organization.

TECNO SABER 3000 CA

What is the name of your solution?

Provide a one-line summary of your solution..

Innovation and Technology at the service of Health.

In what city, town, or region is your solution team headquartered?

In what country is your solution team headquartered.

• Venezuela, RB

What type of organization is your solution team?

For-profit, including B-Corp or similar models

Film your elevator pitch.

What specific problem are you solving.

According to the Pan American Health Organization, coronaviruses (CoV) are a large family of viruses that can cause a variety of conditions, from the common cold to more serious illnesses, such as the coronavirus that causes Middle East respiratory syndrome (MERS-CoV) and severe acute respiratory syndrome (SARS-CoV). A novel coronavirus (CoV) is a new strain of coronavirus that has not previously been identified in humans. The new coronavirus, now known  as2019-nCoV or COVID-19, had not been detected before the outbreak was reported in Wuhan, China, in December 2019 .

Coronaviruses can be transmitted from animals to humans (zoonotic transmission). Based on extensive studies, we know that SARS-CoV was transmitted from civet to humans and that there has been transmission of MERS-CoV from dromedary camels to humans. In addition, other coronaviruses are known to be circulating among animals, but have not yet infected humans.

According to the World Health Organization; Coronavirus disease (COVID-19) is an infectious disease caused by the SARS-CoV-2 virus. Most people infected with the virus will experience mild to moderate respiratory illness and recover without requiring special treatment. However, some will become severely ill and require medical attention. Older people and those with underlying illnesses, such as cardiovascular disease, diabetes, chronic respiratory disease or cancer, are more likely to develop severe illness. Anyone, of any age, can contract COVID-19 and become seriously ill or die.

According to the global data and business intelligence platform known as Statista; as of August 2, 2023, about 769 million cases of coronavirus (SARS-CoV-2) have been reported worldwide (See graph below). The coronavirus that originated in the Chinese city of Wuhan has spread to all countries in Europe and the world.

On the same global platform; the statistic shows the number of deaths caused by SARS-CoV-2, worldwide as of August 8, 2023. As of that day, approximately seven million deaths due to the virus had been counted, of which 5,272 occurred in China, the place where the virus originated. However, the Asian country is no longer the territory where the new coronavirus has claimed the most lives. The United States leads the ranking with close to 1.2 million deaths, followed by Brazil with around 704,795 deaths.

The best way to prevent and slow transmission is to be well informed about the disease and how the virus is spread. Protect yourself and others from infection by staying at least one meter away from others, wearing a tight-fitting mask, and washing your hands or cleaning them with an alcohol-based hand sanitizer frequently. Get vaccinated when it is your turn and follow local guidelines.

The virus can spread from the mouth or nose of an infected person in small liquid particles when coughing, sneezing, talking, singing or breathing. These particles range from larger respiratory droplets to the smallest aerosols. It is important to adopt good breathing practices, for example, coughing into the inside of a flexed elbow, and to stay home and self-isolate until you recover if you feel unwell.

What is your solution?

Our company has chosen to work on the development of vaccines based on antigens (proteins, molecules or segments of molecules), which are produced by the intestinal microbiota (bacteria of the human intestine) and have the ability to eliminate viruses, these antigens are tolerated by the human body.

Our vaccine is based on a line of research developed over the years that formalizes the finding of the existence of a mutualistic relationship between human beings and the intestinal microbiota that not only benefits man with the assimilation and degradation of nutrients that belong to the food that enters the digestive tract, but also allows it to deploy and play an outstanding role as an additional organ that contributes to the improvement and diversity in the capacity of the innate and adaptive immune response of our species.

Our vaccine will be obtained from antigens (Any protein or molecule) of the tolerogenic type secreted by the intestinal microbiota of patients with covid-19 who are asymptomatic or who do not develop the disease or only have mild symptoms of it, the candidate bacteria to be selected to obtain these antigens will be identified with the help of Artificial Intelligence software trained with parameters determined in previous research reported in the specialized literature.

The tolerogens obtained in principle will be substances that by their molecular structure can activate or catalyze an immune response in the individual and may also possess the ability to combat pathogens (specifically viruses) through chemical, biochemical and physiological processes, among which may be mentioned:

i. Tolerogens with the property of degrading the virus envelope in such a way as to strip it and expose the proteins present in its capsid; which would imply facilitating the activation and action of the cells of the innate and adaptive immune system to eliminate the pathogen.

ii. Tolerogens with the property of degrading the virus capsid so as to unprotect the viral genome; which would imply facilitating the activation and action of the cells of both the innate and adaptive immune system to eliminate the pathogen.

iii. Tolerogens that perform (after crossing the viral capsid or envelope) a function equivalent to the action of nucleases that affect and destroy the viral genome.

iv. Tolerogens that perform the function of inhibiting viral glycoproteins and preventing viral infectivity.

v. Tolerogens capable of interfering with the binding of viral particles to host cell membranes.

vi. Tolerogens capable of inhibiting a cellular receptor or factor required for viral replication.

vii. Tolerogens that block specific virus-encoded enzymes and proteins that are produced in host cells and are essential for viral replication but not for normal host cell metabolism.

viii. Tolerogens that act in a manner similar to interferons and result in the arrest of viral replication without compromising normal host cell function.

ix. Tolerogens with adjuvant properties that activate and catalyze antigen-presenting cells of the immune system to enhance immunogenicity, generating a kind of self-vaccination process in the host.

x. Tolerogens with antibody-equivalent properties.

https://youtu.be/aHlDDeG5SiM?s...

Who does your solution serve, and in what ways will the solution impact their lives?

According to the United Nations; By 2022; two years after the outbreak of the coronavirus, the global response has only highlighted the differences between rich and poor countries, and within countries themselves among the most vulnerable, a study by the UN development agency shows. Inequity in vaccines, in addition to prolonging the pandemic, slowed the economic recovery of entire countries and jeopardized global labor markets, public debt payments and the ability of countries to invest in other priorities.

In a new study released this month, the United Nations Development Programme (UNDP) shows that only a tiny proportion of COVID-19 vaccines have been administered in developing countries, leading to a widening gap between rich and poor countries. In September 2021, the World Health Organization (WHO) set the ambitious global target of vaccinating 70% of the global population by mid-2022. At that time, just over 3% of people in low-income countries had been vaccinated with at least one dose, compared to 60.18% in high-income countries. Six months later, the world is nowhere near the target.

The total number of vaccines administered has increased enormously, but so has the inequity in their distribution: of the 10.7 billion doses delivered worldwide, only 1% have reached low-income countries. This means that 2.8 billion people worldwide are still waiting to receive their first vaccine. Inequity in vaccination jeopardizes the safety of all and is largely responsible for the growing inequalities both between and within countries.

By 2022; two years after the outbreak of the COVID-19 pandemic, the poorest countries were finding it harder than ever to recover economically, labor markets are suffering, public debt remains persistently high and there is little left in the coffers to invest in other priorities. The United Nations Development Programme  study shows that most of the most vulnerable countries in terms of COVID-19 vaccination are in sub-Saharan Africa, such as Burundi, the Democratic Republic of Congo and Chad, where less than 1% of the population has received the full immunization schedule. Outside Africa, Haiti and Yemen have not yet reached 2% coverage.

All viruses change over time, and this includes the virus that causes COVID-19. ". Equal access to a COVID-19 vaccine is the key to defeating new variants of the SARS-CoV-2 virus with the capacity to generate a new and deadly spike in cases, which will challenge healthcare systems worldwide. This cannot be a race in which only a few win, and that is why once our vaccine is developed and validated, we will not affiliate to the COVAX Mechanism, which is an important component of the solution, as it ensures that all countries can benefit from access to the largest portfolio of candidates in the world and from a fair and equitable distribution of vaccine doses.

Adherence to the COVAX Mechanism gives all countries the best opportunity to protect the most vulnerable members of their populations, which in turn gives the world the best opportunity to mitigate the consequences of this pandemic for individuals, societies and the global economy.

How are you and your team well-positioned to deliver this solution?

During the last 20 years our vaccine proposal has gone through stages of maturation and development; although the Covid-19 disease pandemic started at the end of 2019 in the Chinese city of Wuhan, our initial target (and the one we are still working on) was viruses associated with chronic viral infections characterized by continuous, prolonged viral shedding; examples are congenital rubella virus infection or persistent hepatitis B or C.

Due to economic reasons and capacity of execution of our goals, we have always developed our tests and studies, focusing on level 2 biosafety practices, which are applicable to clinical, diagnostic and teaching laboratories and in facilities where broad-spectrum microorganisms of moderate risk, present in the community and associated with human diseases of varying severity, are handled. Hepatitis B virus is a representative microorganism of this containment level.

Over many years, international scientific research has identified several hundred different viruses capable of infecting humans. Viruses that primarily infect humans are usually spread by the respiratory route and by enteric excretions. Blood collected for transfusion is screened for several. Many viruses are transmitted by rodent or arthropod vectors, and bats have recently been identified as hosts for many mammalian viruses, including some responsible for certain serious human infections (e.g., SARS-CoV-2). Given the immense health emergency caused by the Covid-19 pandemic and its marked social and economic consequences, we thought it appropriate to direct all the experience and knowledge accumulated and developed so far towards the combat and containment of the new SARS-CoV-2 pathogen.

On the other hand, our company for years among its many advances has managed to specialize in the area of programming and software development; we have worked in programming areas ranging from computer programs for control and use of electronic and robotic interfaces, to the development of educational and interactive software for use and entertainment on the user's computer.

To learn more see the link:  https://youtu.be/1LkntBrSF-g

To learn more see the link: https://solve.mit.edu/challeng...

This experience has allowed us to develop our own machine learning algorithm capable of detecting alternatives to antibiotics among drugs with other uses. The intestinal microbiota with its 100 trillion microorganisms and more than 5,000 species of bacteria, implies a complex system with millions of variables to consider, which is why Artificial Intelligence is required, using algorithms and mathematical models to process large amounts of data and make decisions based on patterns and rules established through machine learning, which is the ability of a machine to learn autonomously from data without being specifically programmed to do so. In this way AI can improve its accuracy and efficiency over time.

Specifically, the artificial intelligence we are developing is aimed, among other variants, at image analysis software, search engines or systems for the recognition of the bacteria to be studied through the observation of microscopic samples obtained from commercial intestinal microbiota tests, so that the algorithms detect and classify the bacteria based on characteristics that are helpful for bacterial identification, such as: size, morphology and types of groupings.

Which dimension of the Challenge does your solution most closely address?

Which of the un sustainable development goals does your solution address.

• 1. No Poverty
• 3. Good Health and Well-Being
• 9. Industry, Innovation, and Infrastructure
• 16. Peace, Justice, and Strong Institutions
• 17. Partnerships for the Goals

What is your solution’s stage of development?

Please share details about why you selected the stage above..

Intestinal flora or microbiota is the group of bacteria that live in the intestine, in a symbiotic relationship of both commensal and mutualistic type. This group is part of the normal microbiota. The great majority of these bacteria are not harmful to health and many are beneficial, so this intestinal microbiota is important for the health of the organism. It is estimated that humans have about two thousand different bacterial species within them, of which only one hundred can be harmful.1 Many animal species are very closely dependent on their intestinal flora. For example, without it, cows would not be able to digest cellulose, nor termites to feed on wood, since it is not they themselves, but their intestinal flora, that are capable of processing this type of food. In humans, the dependence is not so radical, but it is important.

Sometimes they help in the absorption of nutrients and form a complex ecosystem that regulates itself and keeps itself in balance. On other occasions they are essential for the synthesis of certain compounds, such as vitamin K and some of the B complex. They also have side effects, such as the production of gases, responsible for the characteristic odor of feces. Some of them can cause infections of any severity. The adult flora is influenced by a series of intrinsic (intestinal secretions) and extrinsic (aging, diet, stress, antibiotics and foods with prebiotic components or with probiotic organisms) factors. It regenerates periodically, excreting the dead microorganisms through the feces.

the intestinal microbiota comprises 100 trillion microorganisms, within which there are at least 6,000 species of bacteria. These have about 3 million genes. The gut microbiota can weigh up to two kilograms. Only one third of the microbiota is common among humans. The remaining two thirds are specific to each individual. The Human Microbiome Project has identified only 30% of the gut microbiota. Alterations in the microbiota are called "dysbiosis" and are associated with various diseases. Currently, many scientists around the world are working to decipher the genome of the microbiota and to understand the extent of the influence of this new organ.

From a technological point of view we can guarantee that we already have artificial intelligence software mature enough to tackle the immense task of selecting candidate bacteria in a relatively short time (two months) compared to traditional techniques that would take years or decades to subsequently perform biochemical studies on culture samples to obtain tolerogens that can play the role of vaccine candidates for the so-called preclinical studies, the aim of which is to collect a series of preliminary data that will be applied in subsequent phases. These studies are carried out on animals, generally starting with small mammals with a fast reproduction cycle, such as rodents, and then moving on to larger animals, such as pigs or primates. This activity will be carried out in alliance with specialized laboratories in the world which have been formally selected and with which we are in talks for this purpose.

The great danger of the coronavirus lies in the loss of control due to its relentless transmissibility. Especially by people who do not show respiratory symptoms or fever, so they do not know if they are infected: the so-called "silent" transmitters. Gastrointestinal symptoms can play a key role in stopping the spread. Several phases take place in the course of COVID-19. Sixty percent of those infected were found to have intestinal problems such as diarrhea, vomiting or abdominal pain in the early stages of the disease. This was days before respiratory symptoms or even pneumonia were detected. When infected persons present with intestinal symptoms, coronavirus infection is not suspected. Therefore, they are not tested. This represents a huge risk factor in transmissibility.

At the onset of the disease, the virus begins to replicate and infect cells of different body systems. This can cause intestinal dysfunction, changes in the bacterial flora and acute systemic inflammation. As the disease progresses, the virus does not need to replicate and the most potent inflammatory cascade breaks out, accompanied by respiratory problems and fever. People who presented with intestinal symptoms in the early stages were the ones who developed the most complications in later stages.

The reasons why SARS-CoV-2 causes more pathology in some people than in others remain unknown. Even so, there are patients who manage to clear the virus without developing symptoms, suggesting that a strengthened immune system may hold the key to understanding and overcoming viral infection. In this context, identifying non-respiratory symptoms associated with COVID-19 as early as possible could stop the spread.

The main gateway for SARS-CoV-2 invasion is the angiotensin-converting enzyme 2 (ACE2) receptors that are expressed in the lungs, but are also found in the intestines. Coronavirus entry results in increased inflammation that causes alterations in the intestinal flora. These can aggravate the so-called systemic cytokine storm or hyperinflammation in the most severe patients. Most Covid-19 comorbidities such as obesity, hypertension, cardiovascular disease, diabetes and old age are associated with decreased microbial diversity.

As for Covid-19 studies show that the entry of coronavirus produces an increase in inflammation that causes alterations in the intestinal flora. The lower the diversity of bacteria in the intestinal microbiota, the greater the inflammatory response. Therefore, we would expect a worse prognosis of COVID-19.If we can identify which bacteria orchestrate the course of the disease we might be able to predict the severity and prognosis of COVID-19.  A couple of studies with a very small group of hospitalized patients identified that coronavirus altered patients' gut microbes in relation to the severity of COVID-19. Similar studies are also needed in the asymptomatic or mildly symptomatic population. To identify which intestinal bacteria in SARS-CoV-2 infected individuals are associated with inflammatory markers and viral load. If we can establish which bacteria are associated with symptomatology, we could interfere and modify the abundance of these bacteria to protect against the severity of COVID-19.

Microorganisms inhabit the human intestine mediating the metabolic, physiological and immune functions of the host. Therefore disturbances in this symbiont ecosystem can lead to some diseases. In addition, disease states cause secondary changes in the gut microbiota. Knowledge of all the factors that determine the composition of the microbiota in healthy conditions is essential to decipher the nature of disease states and the development of therapeutic strategies against them. The intestinal microbiota has been associated by several studies to functions such as the metabolism of some carbohydrates, specialization of the immune system and control of the growth of endothelial cells especially of the colon (colonocytes). This last function is very important for the control of cancer in this area, since the bacteria, when metabolizing foods rich in fiber, release butyric acid that is involved in the differentiation of the cells of the large intestine and induces apoptosis, which is important to eliminate non-functional cells that may be cancerous and to mitigate inflammation.

Gut bacteria sense and degrade certain specific polysaccharides of the plant cell wall by means of specific membrane protein complexes, thus enhancing human digestive capabilities. Some types of bacteria possess an arsenal of enzymes for the digestion of complex carbohydrates such as cellulose, hemicellulose and pectin that form plant cell walls. Bacteria break these complex carbohydrates into simple sugars, which are in turn fermented to create short-chain fatty acids that human cells can then use to make the fatty acids.

Functions associated with intestinal flora Carbohydrate metabolism. Micrograph of a human T lymphocyte (also called a T cell) from the immune system of a healthy donor. These short fatty acids contribute 10% of the calories required by the human body. Polysaccharides such as starch, oligosaccharides and some sugars that are not absorbed by the body during metabolism are digested by the various bacteria in the intestine. As a consequence of this carbohydrate metabolism and its fermentation, gas and flatulence with characteristic fecal odors are produced.

The intestinal flora plays an important role in the specialization of the lymphoid tissue associated with the mucosa of the intestine. These bacteria are responsible for showing lymphocytes (specifically T lymphocytes) which strains are useful to the body and which ones allow them to better recognize invading antigens. In this way, the bacteria housed in the intestine specialize the immune system to favor their survival, which decides which bacteria will be the predominant ones in the microbiota. This is one of the reasons why neonates must be very carefully nourished, since the first bacteria that lodge in the intestine will adapt their microenvironment to favor their own survival, and this could affect the implantation of other essential bacteria in the normal human microbiota.

On the other hand, the intestinal ecosystem is made up of three main components in permanent contact and with complex interactions: host cells, intestinal bacteria and nutrients. Most of the microflora do not adhere directly to the wall, but live in biofilms associated with food particles, mucus or exfoliated cells.

Mucus lubricates and protects the intestinal epithelium from bacteria and the action of digestion. It is composed of mucins capable of selectively or indiscriminately trapping bacteria. The mucin polymers that constitute the mucus contain glycoproteins, the carbohydrate portion of which consists of traces of different sugars: fucose, galactose, N-acetylglucosamine, N-acetylgalactosamine and sialic acid. This carbohydrate portion serves as a nutrient for the microflora, but also as a receptor for microbial toxins and as a surface protein. There is individual genetic control of this carbohydrate repertoire and it is one of the ways by which host genes can utilize the behavior of intestinal microbes.

The immune system of healthy individuals is highly activated in response to dietary antigens, pathogens and normal flora. This results in highly activated Peyer's patch lymphocytes, an abundance of CD8+ T cells in the epithelium and CD4+ T and IgA plasma cells in the lamina propria. Data from animal studies make it clear that it is the normal flora that triggers this response, not pathogens or food antigens. Studies on the mucosal immune system of newborns allow conclusions similar to those obtained from studies with germ-free animals. At birth there are already Peyer's patches, but they have only primary B-cell follicles. Germinal centers appear after a few weeks. The number of intraepithelial lymphocytes is low at birth, but reaches normal values within a few months, especially those of the αβ subclasses. IgA plasma cells are absent at birth, but increase in the first year of life; also in normal individuals the bacteria in the feces are coated with IgA.

The host is isolated and protected from potentially toxic intestinal contents by a unique layer of intestinal epithelial cells. The collaboration between commensal bacteria and the intestinal epithelium helps to create a complex ecosystem, with modification of the cell biology of the host epithelium. A characteristic of this relationship is that a response occurs against enteropathogenic organisms, whereas it does not occur against microorganisms of the indigenous flora. The ultimate mechanism is not known. In circumstances of chronic intestinal inflammation, as occurs in IBD, this homeostasis may break down and agents of the usual microbial flora may become pathogenic. The combined action of a series of receptors present in the extracellular membrane known as toll-like receptors (TLRs) and a family of intracellular protein sensors (nucleotide-binding oligomerization domain/ caspase recruitment domain [NOD/ CARD] is required to detect microbial molecular signals and for the induction of the immune response aimed at maintaining or restoring homeostasis in the host. There are more than 10 TLRs and more than 20 NODs, of which the specific ligand is known for only a few. In recent years it has been discovered that also commensal bacteria act by activating these TLRs, and that this interaction is necessary to maintain the structural integrity of the intestinal mucosa. Many questions remain to be answered: What is the physiological impact of TLR activation by non-pathogenic bacteria? Which TLR-dependent activation pathways and genes are involved in intestinal homeostasis and, conversely, which ones promote intestinal inflammation?

Finally, the intestinal immune system, also known as gut-associated lymphoid tissue (GALT), is responsible for processing antigens that interact with the intestinal mucosa and for disseminating the immune response. There are two separate compartments in the GALT: the inductive sites, where the immune response is initiated after stimulation by an antigen, and the effective sites, which are responsible for executing and terminating the immune response. Peyer's patches would be inductive sites, whereas the intestinal epithelium would behave as an effective site. In addition to the lymphocytes of Peyer's plaques (B-2 cells) there are other peritoneal lymphocytes (B-1 cells) that have inductive action. In the intestinal mucosa two types of lymphocyte populations are distinguished: a) lymphocytes of the lamina propria, and b) intraepithelial lymphocytes, located between the enterocytes along the villi.

Antibody synthesis requires the cooperation of three cell lines. Antigen presenting cells (dendritic cells, B cells and macrophages) are able to capture the antigen, digest it and present it to Th cells. Activated Th cells act on B cells by means of excreted cytokines. Depending on the type of signal, the B cell produces a type of antibody (immunoglobulin [Ig] G, IgA or IgE).There are several types of Th cells that are differentiated according to the cytokine profile excreted. Th1 cells primarily produce interferon alpha (IFN-α) and lead to ineffective antibody production by the B cell (IgG2). Th1 cells are primarily involved in cell-mediated immunity. In contrast, Th2 cells secrete a different type of cytokines that directly influence antibody production by the B cell (IgG1). The two populations are mutually exclusive. The differentiation of T lymphocytes to Th1 or Th2 depends on specific signals. Thus, macrophages and dendritic cells are involved in Th0 to Th1 differentiation by IL-12 and cytolytic lymphocytes perform their role by producing IFN-α.To avoid fetal rejection during pregnancy, the fetus is maintained in a Th2 context and must develop Th1 after birth. The mechanism that triggers this switch is unknown, although intestinal bacteria may be an important factor. Failure to make this switch to Th1 in the neonatal period can lead to allergy problems.

Unlike other mucosa, the intestinal immune system has to distinguish not only between self and non-self, but also between dangerous foreign antigens and food antigens and respond accordingly. Exactly how this mechanism develops is not known, but in part it involves the careful selection of appropriate lymphocyte populations and cytokine expression. The important role of secretory IgA in the exclusion of antigens from the intestinal lumen must also be considered. These features indicate that the development and expression of the intestinal immune system differs greatly from systemic immunity.

Why are you applying to Solve?

Our company wishes to continue this research to finally obtain vaccine candidates in order to move on to the 4 phases of clinical development; to determine if the drug or vaccines are suitable for distribution. In contrast, the fourth and final phase evaluates the actual efficacy of the vaccine or drug on a large number of people vaccinated or treated with the drug. In each phase the product must receive, from the competent health authority, the approval of the results presented before advancing to the next phase. That is why we want to incorporate the Best University in the World, the Massachusetts Institute of Technology; its great human talent and technological and research capacity to help accelerate, concretize and coordinate all the initiatives necessary to achieve the goals that will allow us to successfully reach and complete the 4 phases of the clinical development of our vaccine candidates.

We also hope that by participating in MIT Solve, this prestigious award will value the significant impact of our initiatives, visualizing the positive changes of our solution for people and their communities. We are aware of the significant financial investments required to obtain our vaccines so we hope that MIT Solve will open doors for our solution to receive collaborations, partnerships and additional funding from various stakeholders such as investors, philanthropists and organizations (public and private).

In which of the following areas do you most need partners or support?

• Business Model (e.g. product-market fit, strategy & development)
• Financial (e.g. accounting practices, pitching to investors)
• Human Capital (e.g. sourcing talent, board development)
• Legal or Regulatory Matters
• Monitoring & Evaluation (e.g. collecting/using data, measuring impact)
• Technology (e.g. software or hardware, web development/design)

Who is the Team Lead for your solution?

OLINTO JOSÉ ROSALES GUTIÉRREZ

Solution Team

The Solve team will review your report and remove any inappropriate content.

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There is no doubt that today’s business challenges are more complex and global than ever, but I still see my peers and business leaders using the same strategies that worked for them years ago. Aspiring new business owners often sink millions into innovations and marketing plans that never get off the ground, and overlook simple details that cost them time, energy, and success.

For example, many businesses are currently struggling with getting their employees back to the office for work, to improve business productivity, accountability, and customer satisfaction. In fact, this challenge clearly has personal team considerations, as well as business implications. Many people prefer the flexibility and comfort of working from home, outweighing results and growth.

I’m not sure if the real problem here is business process or people management, or both, but there is certainly much room for error on both sides. As a consultant, I found some good strategies for not solving the wrong problem in a recent book, “ Solve the Real Problem ,” by Roger L. Firestien, PhD., from Buffalo State University, Innovation Resources, and other roles.

He has real credentials in academia, as well as problem-solving and innovation experiences with many businesses around the world. He offers some key recommendations that I also espouse for how to zero in on the root challenge and not waste large amounts of time and money you cannot afford:

1. Creative questions are key to problem definition. Focus on chains of fact-finding questions and judgement or decision questions to bring out solution ideas. In all cases, defer judgment and avoid excuses like “I don’t have time.” One good question can generate whole new fields of inquiry and can prompt changes in entrenched thinking.

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Creative questions are also useful for exploring new business ideas. Just remember that solving customer problems is the challenge here, rather than internal problems. The process and the results are the same – starting with creative questions to find the real opportunity.

2. Adopt a more effective problem-solving mindset. Analyze your habitual approach to problem solving and be prepared to challenge your own assumptions. Avoid settling for symptoms as the problem or jumping to conclusions based on poor information or your own biases. Sometimes we get in our own way and end up working on the wrong thing.

This strategy also applies to new opportunities for customer growth as well as organizational problems. I still see too many technologists whose mindset is focused on the beauty of their innovation, rather than the problem it solves for customers.

3. Don’t trust or act on your first impression. We all make wrong judgments on first impressions, especially with recurring problems or with people who are of a different nationality, race, and ethnicity. First impressions are usually wrong, especially if they are made in an emotional environment, under time constraints, or with too little information.

4. Get an outside perspective with no agenda. The best way to get an outside perspective is to tap into people who run in circles different from your own. Look for “creative catalysts” who can provide a fresh perspective on the problem and potential solutions. Beware of experts in the relevant technology who may have their own biases.

5. Look for the bigger picture, not minutiae. Make sure that you don’t become unable to see the “forest for the trees” by looking only at a few details of the problem. Consciously step back and take a broader view of the challenge ahead. This approach also builds alignment with related perspectives and issues, and results in better long-term solutions.

In the real world, my experience is that none of these strategies will work without conscientious business leadership, committed team members, a positive business model, and a viable customer opportunity. Your team also needs the creativity skills and training to properly diagnose problems and challenges, generate solutions, and put these solutions into action.

I encourage all of you to recognize that every business in today’s world will encounter challenges and world-class problems. Thus it behooves all of us to continuously update our business problem-solving strategies, support a culture of innovation, and keep moving forward in your quest to make the world a better place, and enjoy the journey to get there.

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Polluting rivers, beaches and the ocean: How can Trinidad solve its plastics problem?

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Plastic pollution blocks rivers, chokes oceans and makes its way into the food chain as microplastics. It’s a global environmental crisis, and Small Island Developing States are especially vulnerable, having to cope with detritus washing up on their beaches, as well as the waste they generate themselves. 

The Maraval river winds its way through Port of Spain, the capital of Trinidad & Tobago, reaching the sea at Invaders Bay, the evocative name of the site where British troops landed in the late 18 th Century. 

Today, the area is heavily built up, and construction has begun on a large-scale project that is expected to see hotels, housing and shops spring up on the oceanfront. Another by-product of development is plastic pollution; on the day that UN News went to the Maraval River, a steady stream of waste could be seen floating downstream, including water bottles, detergent containers and even a discarded yoga ball aimlessly bobbing around.

Countries like Trinidad are extremely vulnerable to the impacts of plastic pollution. They are heavily dependent on imports and receive tonnes of plastic every day. In Trinidad alone, around 129,000 metric tonnes of plastic are brought into the country every year. 

Trinidad has limited resources to treat the waste, which directly affects tourism and fishing, two important elements of the country’s economy; tourists don’t want to relax on beaches covered in waste, and marine litter can damage fish stocks and boats. 

Coastal communities can suffer from reduced income and employment while shouldering clean-up operation costs. On top of that, there’s an increased risk of flooding due to blocked stormwater systems and drainage, meaning higher clean-up costs, and increased maintenance for water infrastructure.

From bust to boom

Dealing with the problem might appear to be an overwhelming task, but in Trinidad, the UN is working with local organizations to not only collect the waste, but also find ways to reuse it in ways that benefit local communities.

At Invaders Bay, a group of volunteers from environmental consulting firm Coastal Dynamics have stretched a boom across both banks of the Maraval River. This traps most of the detritus and stops it from reaching the ocean. In just one week, hundreds of plastic items are pushed up against the boom, almost enough to reach both sides of the river, a visually arresting indicator of the amount of waste that is pouring down Trinidad’s waterways on a daily basis.

“The Maraval is a thoroughfare of plastic,” said Frank Teelucksingh, a Trinidadian oceanographer and the director of Coastal Dynamics. “This is just one example. During the wet season, the rain washes all the plastic off the land, into the rivers and then the sea. There are dozens and dozens of rivers in Trinidad, and they don’t yet have booms stopping the plastic from flowing into the ocean”.

Mr. Teelucksingh explained that the pilot project, which receives funding from the UN’s Green Environment Fund, also has an educational aspect, in a country where, he says, the population doesn’t trust the water from the tap, and doesn’t have a history of responsibly disposing water bottles and other waste. Mr. Teelucksingh is in discussion with the government and UN to scale up the project to many more of Trinidad’s rivers. 

But, whilst this might remove the plastic out of the water, it won’t solve the wider problem: Only around 10 per cent of plastic in Trinidad is recycled, and the remaining 90 per cent is discarded either in landfills, waterways or elsewhere in the environment. 

The UN in Trinidad is attempting to make a dent in these stark figures, by developing upcycling projects that involve collecting discarded waste, and turning it into useful products that can benefit local communities and the country at large. 

A concrete solution

In the village of Kernaham, a farming community on the east coast of Trinidad, UN News met Sharda Mahabir, an environmental expert at the UN Development Program ( UNDP ) in Trinidad and Tobago, beside a greenhouse which appeared to be made of wood. In fact, it is constructed entirely of waste plastic.

“Plastic lumber is made of all kinds of waste, including high density plastic like bleach bottles, fabric softener bottles, and plastic bags,” explained Ms. Mahabir. “We combine all of these different types of plastics into an extruded product, which looks like wood”.

The lumber is made at a factory in Arima, near Port of Spain, where sacks of plastic are taken to large shredders to be cut into multi-coloured pieces, the size of breakfast cereal. The raw materials are mostly containers made from types of plastic that can’t be recycled and, therefore, have no commercial value. Many other types of plastic, such as industrial sheeting, and even car interiors, are also stacked up, ready to be broken down, melted, and converted into strong and durable building materials that have been turned into a range of products, such as benches, tables, and window frames.

Ms. Mahabir was keen to demonstrate another way to use the shredded material and prevent it from adding to the microplastic pandemic: concrete. She introduced UN News to  members of a group for vulnerable women in Kernaham, who were adding shredded plastic to gravel, to bind together sand and water and create “sequestered concrete” as a way of trapping plastic, and removing it from the environment.

“The women collect plastics on the beach and from their own communities, and then process them in such a way that they can make products out of it,” said Ms. Mahabir. “They're making plant pots, benches and pavers. As well as the environmental benefits, they are creating extra income for themselves”.

“I started this group because of the poverty level in my community,” explained Omatie Rampersad, the President of the Kernaham/Cascadoux Women’s Group. “We also have a lot of plastic pollution in the area, it goes into the streams, causes flooding and, when we burn it, it pollutes the air. 

We want to have a clean environment, and we want to empower women by helping them to become financially sustainable. We also want to educate our people and the surrounding communities on how to dispose of plastics properly. We are trying our best to show the whole country how we can deal with this problem.”

An international plastics treaty

From 23 to 29 April, delegates from around the world are meeting in Ottawa, Canada, to continue negotiations on the development of a legally binding agreement that will bring the international community closer to finally being able to get to grips with plastic pollution, particularly in the marine environment.

Speaking at the opening session of the meeting, Inger Andersen, the head of the UN Environment Programme ( UNEP ), expressed her hope that the talks will lead to a reduction in the production of problematic waste, and more investment in solid waste management and recycling.

Ms. Mahabir agreed with these aims and added that, on top of education, more research and development investment is needed to create alternatives to the kinds of plastics that are ubiquitous in most societies.

“Maybe there's some plant, some tropical tree or fruit that could be converted into a biodegradable plastic. We want to encourage the younger generation to consider taking up the sciences that are required to develop these potential alternatives. 

Until then, we have to find ways to deal with the problem, and this is what our programmes are addressing. We also need to address the economic angle; there's a lot of unemployment in Trinidad, and we want to see if upcycling can generate jobs. Every piece of furniture built in the plastic lumber factory has been sold, helping to support more livelihoods. I hope that an agreement can be reached in Ottawa, one that encourages the private sector to invest more in recycling, and funds ways to effectively clean up and capture plastic waste pollution”.

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Student holds multiple number 1 spots in his state for Rubik’s Cube solving

BANGOR, Maine ( WABI /Gray News) - Ever since the Rubik’s Cube was invented 50 years ago, it has inspired countless other twisty puzzles and a community of speed solvers.

One of those solvers is Aedan Bryant, who had no idea what picking up his sibling’s Rubik’s Cube one day as a preteen would lead to.

“Early 2017, I got back into it and started getting faster. And then later that year is when I went to my first competition,” Bryant said.

Bryant said there are countless iterations of twisty puzzles inspired by the traditional 3x3 Rubik’s Cube.

“My favorite? Well, at the moment, it’s probably the clock,” he said. “I’ve been getting back into it. There have been some new methods that have come out, so I’ve been learning those. My favorite event is Fewest Moves, where you get an hour to try and find the shortest solution to a scramble.”

Bryant ranks first in Maine in the Fewest Moves competition.

Another one of his 11 total top state rankings include a single-solve for the 2x2 cube, which he completed in less than a second.

He’s even held a world record in his career: an 11.43-second solve of the Face-Turning Octahedron, an eight-sided puzzle.

“I got really interested in that over COVID-19,” Bryant said. “There weren’t any competitions because of the pandemic, so it allowed me to take some time to practice an event that wouldn’t really be in competitions, and I ended up getting the fastest time for that. And I held it for a couple of years, and then I got beaten earlier this year.”

Bryant now travels around the country for events and has even competed in the 2022 North American Championships in Toronto.

He said having a network of friends that far-reaching was exactly what he needed when he moved from Virginia to Maine while in high school.

“Definitely, yeah, cubing was basically all I did at that time,” Bryant said. “So yeah, and then also having the friends in the cubing community because I didn’t really have any friends where I moved to. So, being able to go to competitions and see friends there was very nice.”

Bryant is now a sophomore at The University of Maine studying computer engineering. With his schooling, he doesn’t have as much time to practice as he used to.

If he needs a break from studying, however, he’ll pick up one of his 200 or so puzzles and start twisting.

“I think anybody can learn how to do it, and it’s a lot of fun,” Bryant said. “So, if you have some time, some patience, then I recommend looking up some YouTube videos and learning how to solve it. And then, of course, competitions if you get interested enough to go faster. It’s a lot of fun.”

Anyone interested in speed solving can learn directly from Bryant through his YouTube channel , which is filled with information about the game and tutorials.

Copyright 2024 WABI via Gray Media Group, Inc. All rights reserved.

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United Methodists open first top-level conference since breakup over LGBTQ inclusion

The United Methodists will hold their first General Conference since thousands of U.S. congregations left the denomination over failure to enforce bans on LGBTQ clergy and same-sex marriages. Progressive delegates will attempt to overturn these bans. (AP Video/Jessie Wardarski)

The Rev. Tracy Cox of First United Methodist Church and members of her congregation pray for Tracy Merrick, who will attend the United Methodist General Conference as a delegate representing Western Pennsylvania, as well as Anais Hussian and Joshua Popson who will also be in attendance, Sunday, April 14, 2024, in Pittsburgh. Hussian is a reserve delegate and Popson will be advocating for LGBTQ inclusion with the Love Your Neighbor Coalition. Many, including Rev. Cox, hope that this is the year they change longstanding bans on LGBTQ clergy and same-sex marriage. (AP Photo/Jessie Wardarski)

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The Rev. Tracy Cox of First United Methodist Church gives a sermon on Sunday, April 14, 2024, in Pittsburgh. Three members of her church are set to attend the United Methodist General Conference in Charlotte, N.C. Many, including Rev. Cox, hope that this is the year they change longstanding bans on LGBTQ clergy and same-sex marriage. (AP Photo/Jessie Wardarski)

FILE - The Rev. K Karen, left, of St. Paul & St. Andrew United Methodist Church in New York joins other protesters in song and prayer outside the United Methodist Church’s special session of the general conference in St. Louis, Tuesday, Feb. 26, 2019. Since 2019, the denomination has lost about one-fourth of its U.S. churches in breakup focused in large part on whether to accept same-sex marriage and ordination of LGBT clergy. (AP Photo/Sid Hastings, File)

Thousands of United Methodists are gathering in Charlotte, North Carolina, for their big denominational meeting, known as General Conference.

It’s a much-anticipated gathering . Typically it is held every four years, but church leaders delayed the 2020 gathering until now due to the COVID-19 pandemic.

This year, the 11-day gathering runs from April 23 to May 3. Among those assembling are hundreds of voting delegates — the United Methodists from across the globe who were elected to represent their regional church body — though as many as one-quarter of international delegates are not confirmed as able to attend. The delegates, half clergy and half lay Methodists, are the decision makers at General Conference.

WHAT HAPPENS AT GENERAL CONFERENCE?

General Conference — the only entity that can speak for the entire denomination — is a business meeting where delegates set policy, pass budgets and address other church-wide matters. It’s the only body that can amend the United Methodist Book of Discipline, which includes church law. It also includes Social Principles, which are non-binding declarations on social and ethical issues. There’s worship and fellowship, too.

IS THERE SOMETHING UNIQUE ABOUT THIS YEAR’S MEETING?

Yes. This will be the first General Conference since more than 7,600 mostly conservative congregations left the United Methodist Church between 2019 and 2023 because the denomination essentially stopped enforcing its bans on same-sex marriage and having “self-avowed practicing homosexuals” serving as clergy and bishops.

WILL THE GENERAL CONFERENCE LIFT THOSE LGBTQ-RELATED BANS THIS YEAR?

It’s possible. The delegates in Charlotte are expected to vote on whether to eliminate them. Similar efforts have failed in years past, but with the election of more progressive delegates and the departure of many conservatives, supporters of removing the bans are optimistic.

WHAT OTHER KEY ISSUES ARE UP FOR CONSIDERATION?

— Disaffiliations : The rules that allowed U.S. congregations to leave between 2019 and 2023. It allowed them to leave with their properties, held in trust for the denomination, under friendlier-than-normal legal terms. Some want similar conditions for international churches and for U.S. churches that missed the 2023 deadline.

—Regionalization: A proposal to restructure the denomination into regional conferences around the world, rather than having distinct names for U.S. and other jurisdictions. It would define the role of regions more precisely and put American congregations into their own regional body. Under this proposal, all regions would be able to adapt church policies to their local contexts, including those on marriage and ordination.

—Budgets: Because of all the disaffiliations, the conference will vote on a much-reduced budget proposal for the coming years.

HOW IS THE CONFERENCE STARTING OFF?

New York Area Bishop Thomas Bickerton, president of the denomination’s Council of Bishops, addressed the recent schism head-on in feisty remarks during Tuesday’s opening worship, which included music and Communion.

Bickerton spoke of his recent visit to a Texas conference that had lost more than half its congregations and said those remaining were committed to rebuilding the church. He said those at the General Conference should be doing the same – not continuing the controversy.

“Are you committed to the revitalization of the United Methodist Church?” Bickerton said to applause. “Are you here to work for a culture marked by compassion, courage, and companionship? … If you can’t agree to that, what are you doing here anyway? Maybe, just maybe, you’re in the wrong place.”

He alluded to criticism of the denomination during the disaffiliation debates and said it was holding on to its core beliefs.

“Don’t you tell us that we don’t believe in Scripture,” he said. “Don’t you tell us that we don’t believe in the doctrine of the church. And Lord have mercy, don’t tell us that we don’t believe in the resurrection of Jesus Christ. … We have got to rebuild the church and we’ve got to do it together.”

WHERE ARE THE DELEGATES COMING FROM?

Though thousands of Methodists with be attending the conference, there are only 862 official voting delegates, from the following regions of the church:

• 55.9% from the U.S.

• 32% from Africa

• 6% from the Philippines

• 4.6% from Europe

• 1.5% from concordant (affiliated) churches

WILL THEY ALL BE THERE?

No. As of last week, only about three-quarters of international delegates were confirmed as able to attend, the Commission on the General Conference reported Thursday. The other quarter includes 27 delegates unable to get visas or passports, others who couldn’t attend for various reasons, and 62 delegates still unconfirmed. African groups have strongly criticized denominational officials, faulting them for delays in providing necessary paperwork and information and raising questions about whether African conferences will accept voting results from the conference.

However, denominational officials defended their work Tuesday, telling the General Conference that visa requirements are stricter than in the past, that some regional conferences hadn’t followed correct procedures in sending reserve delegates — and that some would-be delegates received invitations sent by “an unauthorized person or people.” Delegates now must wear picture badges amid heightened scrutiny that their credentials are authentic. The conference overwhelmingly approved a resolution “to make every effort to listen to and carefully consider voices from regions that are underrepresented.”

HOW ARE CONGREGATIONS PREPARING?

That varies widely, but those long active in the movement to repeal LGBTQ bans are focused strongly on the conference. First United Methodist Church in Pittsburgh, for example, held a commissioning service on April 14 for three members attending the conference in varying capacities. “It will be deeply meaningful for me personally to vote for those changes,” said member Tracy Merrick, who will be a delegate.

WHAT ARE UNITED METHODISTS, ANYWAY?

They’re part of a larger worldwide family of Methodists and other groups in the tradition of 18th century British Protestant revivalist John Wesley, who emphasized evangelism, holy living and social service. They hold many beliefs in common with other Christians, with some distinct doctrines. United Methodists traditionally ranged from liberal to conservative. They were until recently the third largest and most widespread U.S. denomination. Methodist missionaries planted churches worldwide, which grew dramatically, especially in Africa. Some became independent, but churches on four continents remain part of the United Methodist Church.

HOW MANY UNITED METHODISTS ARE THERE?

5.4 million in the United States as of 2022, but that will decline significantly due to 2023 disaffiliations.

4.6 million in Africa, Asia and Europe. That’s lower than earlier estimates but reflects more recent denominational reports.

SOURCES: General Council on Finance and Administration and other United Methodist entities.

Associated Press religion coverage receives support through the AP’s collaboration with The Conversation US, with funding from Lilly Endowment Inc. The AP is solely responsible for this content.

Can a new dream city solve California’s affordable housing problem? | The Excerpt

On a special episode (first released on April 25, 2024) of The Excerpt podcast: For the past five years, a small group of Silicon Valley investors has spent nearly a billion dollars quietly buying up over 50,000 acres of farmland in northern California. The goal? To create an ambitious new California dream city, something that hasn’t been done in America for over a century. The California Forever project aims to create a livable, workable, walkable city that puts working families at the heart of its design, creating new housing for up to 400,000 people. Skeptics abound, but could this be the solution to one of California’s most intractable problems? The city’s designated architect, urban planner Gabriel Metcalf, joins The Excerpt to discuss the hurdles and possibilities of developing an entirely new city.

Hit play on the player below to hear the podcast and follow along with the transcript beneath it.  This transcript was automatically generated, and then edited for clarity in its current form. There may be some differences between the audio and the text.

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Hello and welcome to The Excerpt, I'm Dana Taylor. Today is Thursday, April 25th, 2024, and this is a special episode of The Excerpt.

For the past five years, a small group of Silicon Valley investors spent nearly a billion dollars quietly buying up over 50,000 acres of farmland in Northern California. The goal, to create an ambitious new California dream city, something that hasn't been done in America for over a century. The California Forever Project aims to create a livable, workable, walkable city that puts working families at the heart of its design, creating new housing for up to 400,000 people. Skeptics abound, but could this be the solution to one of California's most intractable problems, affordable housing? Here to help me dig into it, is urban planner, Gabriel Metcalf, the city's designated architect.

Gabe, thanks for joining me.

Thank you for having me.

So let's start with why you're here. How did you first hear of the project and what was it that convinced you to sign on?

I guess the real reason I'm here is because I love cities. I think cities are in a way humanity's greatest invention, and I've spent my whole career working on making cities work better. But the great cities of America have run into a big problem, they have all gotten super expensive. They've gotten so expensive. They have stopped performing their historical role of bringing all kinds of people together because it's gotten to be that only people who have a lot of money can get in.

I guess it started to seem to me that part of the problem is that all of the places that are walkable are places that existed 100 years ago, and that the problem is that we have lost the art of making new cities, making new walkable places. If we could figure out a way to make new cities, new walkable places, again, it might take the pressure off and help places like San Francisco, where I'm sitting right now, might help them not have such intense pressure on them. And so I obviously was not the only one thinking along these lines. When I got offered the chance to come be the head of planning for this project, I jumped at it.

So what's the vision here in a nutshell?

Yeah, in a nutshell we're talking about a community on 17,500 acres of land in Eastern Solano County, which is in the Bay Area. It has room for up to 400,000 people. The first phase would be 50,000. We are proposing a mixed use compact, medium density community. So it's not single family suburbia. It's not Manhattan. It's in between, medium density. And while many people I think are most excited about its contribution to housing supply and what that could do for California, it's really important to us that this is not only about housing. This is very much about providing an economic engine for part of the Bay Area that has been left behind by some of the job creation that's happened in other parts. And the vision is for this to very much be a mixed use community. So shops and schools, industry, office, civic uses, sports, entertainment, everything that would be part of a small city.

Gabe, before we move on from housing, as I mentioned in my intro, one of California's biggest problems is the lack of affordable housing. How does the group plan on keeping it affordable?

If you have enough money to afford to live in San Francisco or the East Bay where Berkeley and Oakland are, then great. Good for you. Cities that developed organically over centuries will always be really interesting. They're wonderful. Our business thesis is that there are a bunch of people who would love to live in a city but cannot afford places like San Francisco. And so in essence, our idea is to try to offer urbanism at a more affordable price point. We have funding commitment in the ballot measure that people will be voting on in November that provides 400 million for affordable housing on the first phase, and then it just keeps going up after that. So if we did the full build out of 400,000 people, it would be $3.2 billion invested in affordable housing.

The project's website talks about the theory of new urbanism as an inspiration for the city plan. What distinguishes this style and why do you think it will be effective here?

Yeah. Well, the new urbanists were really pioneers starting in the 1970s of the attempt to rediscover really timeless principles of urbanism, smaller streets, building more compactly, designing around the pedestrian rather than the automobile. And so I certainly take a lot of inspiration from what they did. I think they were pioneers.

Infrastructure will obviously be a huge issue to tackle. Water, sewage, transportation, et cetera will all need to be created from scratch and be fully in place before people move in. But how will those systems be funded?

Yeah. Well, we have to pay for them, and it's inherent in a new town strategy is that you pay less for the land, but you pay more because you have to build all of the infrastructure. It's a big part of the planning work that we're working on this year and next year. Water, power, wastewater, transportation. One thing that's important is we try to phase it so we don't have to build the full capacity for 400,000 people day one. You just have to stay ahead of the growth of the city. You have to have enough infrastructure for the phase you're working on. We're doing a lot of work right now on what the needs are for the first 50,000 people.

The plan also talks about access by proximity. As a central tenant of the new city, what does that mean and how will it be implemented?

Yeah. Access by proximity is a phrase we just mean it's contrasted, I suppose, with access by movement. So instead of needing to get 30 miles to your job or in some cases 10 miles to the store, having a lot of those things close at hand so you can just walk. It's the best transportation solution. It's way better for the environment. It saves everybody money. And it actually provides a lot of the joy of city life. It's being able to walk to a great local shopping street, so the densities and the street network in the city plan are being laid out to make it really easy to get to all that stuff. That's what access by proximity means.

The plan also talks about creating streets that fulfill dual roles. I'm trying to picture it, but also what are those roles and what does this mean in practice?

Streets are really interesting. They are both an infrastructure system to facilitate movement, but they're also public spaces. And if you think about the great cities, I mean maybe if any of your viewers have been to European cities, that experience of being out in public and just enjoying city life, we're really trying to emphasize that part of streets. And so, it is a balancing act because you have to allow movement, but by keeping speeds slower, by putting in wide sidewalks and street trees, by having really interesting buildings built right up to the sidewalk. All of those kind of traditional urban features, the goal is to make it be really a joy to be out in public enjoying city life on a stroll.

The project aims to create up to 15,000 new jobs. What industries are going to support those jobs?

In the long run we aim to attract way more jobs than 15,000. But in the first phase, 15,000 is what we're aiming for. A few sectors we're focused on. One is defense-related industries that are excited about the chance of being in the same county as Travis Air Force Base. Second are companies that are innovating in the space of constructing housing where we might be able to be a big customer for them, and the chance to scale up new techniques to build at lower cost could be a big industry. Companies that want to be in the Bay Area for innovation, but need the room because they're building things in physical space, not just software, are a really good fit for us. So that could be in all kinds of industries that are at the intersection of innovation and the real world. And I should say also that all the regular jobs of teachers and cops and chefs that go along with any population are important too. Planning for those.

Gabe, you're in charge of design. Who's going to be in charge of zoning and regulation? Is that going to be investors? The county? A new city agency? Who's in charge here?

It's a few different phases of how that works. There is a voter initiative that will be voted on this November by the voters of Solano County that will put in place high-level zoning, high-level building standards, so things like densities and heights and kind of basic uses, what's allowed to go where. After that the next phase is more detailed planning, a full environmental impact report, and working toward a detailed development agreement with the county board of supervisors that will spell out in much more detail all of the design standards and things like that.

As I mentioned earlier, there's been quite a bit of backlash against the plan. The mayor of nearby Fairfield recently shared with The Daily Beast that of the hundreds of messages she's received regarding the project, 95% are opposed to it. How do you win over those people?

We have half a year now to make the case about what the benefits are to current residents of Solano County. So we are spending a lot of time in the community, talking to people one-on-one in small groups. It's always controversial, especially in California it's always controversial when people are proposing to build things, and that's, I suppose, one of the reasons why it's been hard to manage growth in California. But I think the tide is really changing on that, and there are a lot of people who understand that in order to solve the problems people care about, whether that's switching to renewable energy to deal with climate change or getting more housing built to deal with affordability, we have to build. And so we will be making that case and then we'll see. We'll see in November if we were successful or not.

What happens if voters reject this ballot initiative?

I don't know the answer to that because we have a mindset of planning for success. But we will, I suppose, regroup, have some hard conversations, have some honest conversations with people in the county, and try to figure out a way forward. And there are really some timeless principles that we are drawing on.

Who gets the first crack at housing? Or are you not that far yet?

One of the things I hope is that the first housing might go to some of the construction workers that built the housing. It's an idea we've talked about a lot. That's absolutely one of our goals is that the people who work in the community and the people who build the community can afford to live in the community. But wouldn't it be nice if its building trades members and carpenters union members who are themselves the first residents? I think that would be a beautiful symbolism.

Gabe, thank you for being on The Excerpt.

Thanks to our senior producers, Shannon Rae Green and Bradley Glanzrock for their production assistance. Our executive producer is Laura Beatty. Let us know what you think of this episode by sending a note to [email protected]. Thanks for listening. I'm Dana Taylor. Taylor Wilson will be back tomorrow morning with another episode of The Excerpt.