Wednesday, 1 April 2020

Corona Virus Update: need for speed in funding and publication, virus arrival, from pandemic to endemic (part 23)

Prof. Dr. Christian Drosten
For me an interesting part of the Corona Virus Update Podcast was a critique of the scientific funding and scientific publishing system by Christian Drosten. Working on a better (and potentially faster) post-publication peer review system, this is of interest to me. The rest can skip to a discussion on the evidence for when the virus arrived in Europe, in the light of many anecdotal claims the virus arrived much earlier. And we finish off with why Drosten expects the SARS-CoV-2 virus to become endemic, that is stay forever.

A large part of the podcast was about a new research network of university hospitals to coordinate research on SOVID-19 in Germany. I presumed this was not too interesting for people outside of Germany, but readers interested in clinical research can try to read an automatic translation of the beginning of the German transcript.

In episode 23, science journalist Korinna Hennig of the German public radio station NDR Info interviews virologist Prof. Dr. Christian Drosten of Charite research hospital in Berlin. He was intimately involved in the research on the first SARS virus and produced the WHO test for the SARS-CoV-2 virus. The podcast has become one of the most listened to podcasts in Germany in just a few episodes and is my main source of nerdy info on Corona.

Question the whole system

From talking about the new German network for clinical COVID-19 research, Drosten moves to problems the normal funding system has given the speed that is necessary to fight the pandemic. In the past universities and research institutes had their own resources, but nowadays most of the funding flows via research projects (third party funding). This means that research proposals have to be written, reviewed and assessed. Only a small part of these proposals lead to funding and writing them thus binds much time that is nowadays no longer spend on science. Politicians like this system because they can feel that this looks like a free market, while in reality there is no market, science is a global public good.

Also the publishing system is not able to provide information fast enough. Normally one would write a solid manuscript, because only the best ones are accepted, they are reviewed, which takes a few months, updated, reviewed, etc. There is no time for that now. So the manuscripts are simply uploaded on manuscript server on the internet and can be downloaded by any scientist before they are reviewed by peers. These manuscripts are called preprints, as if they are to be printed in a journal (and as if most journals would still be printed on paper), but many will likely never pass review.

That was my take. Here is Christian Drosten:

Christian Drosten:
Our big problem in research, in the implementation of actual directly necessary scientific investigations - I am now not speaking about long-term basic research projects, I am talking about very specific questions: This new drug, is it helping or not? Will we know in a month? It would be good to know in a month.

In this situation, we can absolutely no longer afford to launch complicated applications, where we are competing fiercely for pots of money that may be wrongly dimensioned, and where it is no longer possible to organise the review of these applications. The reviewers are themselves scientists. But they are then themselves involved in these outbreaks.

In research funding, the more international and the more grandiose the whole thing becomes, the more this leads to a phenomenon that the qualification for obtaining such research funds is no longer necessarily the fact that one is really working on the problem, but that can lead to a situation where those who have specialised in obtaining research funds and not in treating these patients actually get the research funds. The qualification for obtaining such research funds is no longer necessarily the fact that one is really working on the problem, but that can lead to a situation where those who have specialised in obtaining research funds and not in treating these patients actually get the research funds.
Korinna Hennig:
That is anyway a big problem in scientific work, that it is said that this third-party funding has also become more and more important and eats away at an increasing proportion of the researchers in their actual everyday work.
Christian Drosten:
We see in the current scientific activity on the epidemic that the raising of third-party funds is no longer possible in its time frame. We urgently need other mechanisms for directing money to where it is really needed and where it can really be used. And where time is not stolen from those who treat and research patients.

We have exactly the same in the publishing market. There, too, we see that important information is difficult to communicate in the classic publication system. This entire information market is changing at the moment. We always discuss the preprints here in the podcast, and I always say they are preprints. We can do this here because I know my way around quite well, because I have been working on exactly this topic for many years and always understand immediately or frequently relatively quickly whether a study is really really solid and provides really new information. Or whether what is written in the headline or in the abstract sounds strong, but is in fact dead in the water.

This is something that is achieved in the normal publication process through an elaborate and drawn-out peer review process. But what we are seeing here at the moment is that the epidemic is moving much faster than the publication system is able to process the information. It is already difficult enough to collect the information while doing clinical research on patients. If, on top of that, the compilation of information is not sufficient because the results are submitted to a journal, but it is held up by reviewers who sometimes ask good questions, but sometimes ask these questions too late because they themselves are completely underwater and do not have time to review. And because they partly - let's say with a competitive idea - delay work, we know that everywhere. That is one of the weaknesses of the peer review system.

Then at some point we get into a situation where we have to question the whole system, where we really have to say: Can we actually afford such a system in such a situation? And we are currently seeing a huge flood of important publications appearing in these preprint servers, and they are coming from China. The colleagues there in China who have carried out clinical research and described their patients are only now able to subsequently evaluate what they have observed.

And the place where we see this first is in these preprint servers. You have to be very damn careful. Because in addition to many high-quality publications, which I also highlight from time to time in this podcast, there is a lot of dead wood.

When did the virus arrive in Germany and Europe?

Korinna Hennig:
More and more listeners are now emailing us with the question: Is it really impossible that the virus has not been around in Europe and Germany for some time?
Christian Drosten:
We've been getting a lot of requests lately from people saying, "I had this condition in December." ... I've had contacts where people have said: "I work for a large automotive supplier, and not the one that is known [in Starnberg]. ... "We had exactly the same thing. We also had visitors from China. And we also had a wave of infection afterwards and whole families got sick. Shouldn't we send samples?" So I always said: "Yeah, sure, send serum samples. We'll test it."

And in none of these cases have we ever found any evidence - with all these anecdotal investigations that we have conducted so far in Germany.

Also looking at the viral sequences it doesn't really look like it was there before mid-January in Europe. I remain open to this possibility, I'd like to add. I don't want to rule out this. But we, and others as well, from whom we know, have not found any evidence yet.

From pandemic to endemic

Korinna Hennig:
You said that you assume that SARS-CoV-2 will become endemic, i.e. that it will remain here permanently as a respiratory virus and not disappear completely at some point. Why are you so sure about that?
Christian Drosten:
Well, because it simply is spreading so far. Also because we can assume that a complete infection of the population will occur. In other words, we must assume that 60 or 70 percent of the population will be infected before the pandemic spread stops.

Then, of course, the rest will be subsequently infected, so that will continue to be the case after the infection. And then we will have the same starting conditions [for the new Corona virus] as for the other endemic corona viruses. And they also manage to keep population niches open and to develop them and then reinfect the children who are born after the infection in order to keep them in the population. Nobody can say for sure at the moment whether this virus will remain in the end or not. Everything looks very much like it.

Other podcasts

Part 28: Corona Virus Update: exit strategy, masks, aerosols, loss of smell and taste.

Part 27: Corona Virus Update: tracking infections by App and do go outside

Part 26: Corona Virus Update on Vaccines: clinical trials, various types, for whom and when.

Part 22: Corona Virus Update: scientific studies on cures for COVID-19.

Part 21: Corona Virus Update: tests, tests, tests and how they work.

Part 20: Corona Virus Update: Case-tracking teams, slowdown in Germany, infectiousness.

Part 19: Corona Virus Update with Christian Drosten: going outside, face masks, children and media troubles.

Part 18: Leading German virologist Prof. Dr. Christian Drosten goes viral, topics: Air pollution, data quality, sequencing, immunity, seasonality & curfews.

Related reading

The Corona Virus Update podcast and its German transcript. Part 23.

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