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PANDEMIC Qs Fauci’s straight talk To many watching the White House press brief ngs on the coronavirus pandemic, veteran expert has become the voice of science and reason on how the country should respond. He made national news this week for his careful but candid assessment to Science’s Jon Cohen of the challenges of working for President during the crisis. “When you’re dealing with the White House, sometimes you have to say things one, two, three, four times, and then it happens. So, I’m going to keep pushing,” says Fauci, longtime director of the National Institute of Allergy and Infectious Diseases. His full interview is at https://scim.ag/QAFauci. Dutch models of COVID-19 are designed to help prevent overloading of hospitals and the need to transfer patients.

Q: The first question everyone has is how CORONAVIRUS Downloaded from are you? A: Well, I’m sort of exhausted. But other than that, I’m good. I mean, I’m not, to my With COVID-19, modeling takes knowledge, coronavirus infected. To my knowledge, I haven’t been f red [laughs].

on life and death importance http://science.sciencemag.org/ Q: How are you managing to not get fired? A: To [Trump’s] credit, even though we Epidemic simulations shape national responses disagree on some things, he listens. He goes his own way. He has his own style. By Martin Enserink and Kai Kupferschmidt pended on their work. Entire cities and coun- But on substantive issues, he does listen tries have been locked down based on hastily to what I say. acco Wallinga’s computer simulations done forecasts that often haven’t been peer are about to face a high-stakes real- reviewed. “It’s a huge responsibility,” says Q: You’ve been in press conferences where ity check. Wallinga is a mathemati- epidemiologist of the Johns things are happening that you disagree with, cian and the chief epidemic modeler Hopkins University Center for Health Se- at the National Institute for Public curity, who co-authored a report about the is that fair to say? on April 8, 2020 A: Well, I don’t disagree in the substance. Health and the Environment (RIVM), future of outbreak modeling in the United It is expressed in a way that I would not Jwhich is advising the Dutch government on States that her center released this week. express it, because it could lead to some what actions, such as closing schools and Just how influential those models are be- misunderstanding about what the facts are businesses, will help control the spread of came apparent over the past 2 weeks in the about a given subject. the novel coronavirus in the country. . Based partly on modeling The Netherlands has so far chosen a work by a group at Imperial College London, Q: You’re standing there saying nobody softer set of measures than most Western the U.K. government at first implemented should gather with more than 10 people European countries; it was late to close its fewer measures than many other countries— and there are almost 10 people on the stage schools and restaurants and hasn’t ordered not unlike the strategy the Netherlands is [and] more than 10 journalists. a full lockdown. In a 17 March speech, Prime pursuing. Citywide lockdowns and school A: I know that. I’m trying my best. Minister Mark Rutte rejected “working end- closures, as China initially mandated, “would I cannot do the impossible. lessly to contain the virus” and “shutting result in a large second epidemic once mea- down the country completely.” Instead, he sures were lifted,” a group of modelers that Q: We’ve had all this pandemic opted for “controlled spread” of the virus advises the government concluded in a state- preparedness. What went wrong? while making sure the health system isn’t ment. Less severe controls would still reduce A: I think we’ll have to wait until it is over and swamped with COVID-19 patients. He called the epidemic’s peak and make any rebound we look back before we can answer that. It’s on the public to respect RIVM’s expertise less severe, they predicted. almost like the fog of war. After the war is on how to thread that needle. Wallinga’s But on 16 March, the Imperial College over, you then look back and say, “Wow, this models predict that the number of infected group published a dramatically revised plan, as great as it was, didn’t quite work people needing hospitalization, his most model that concluded—based on fresh data once they started throwing hand grenades important metric, will taper off next week. from the United Kingdom and Italy—that at us.” Obviously, testing [for the new But if the models are wrong, the demand even a reduced peak would fill twice as coronavirus] is one clear issue that needs for intensive care beds could outstrip sup- many intensive care beds as estimated pre- to be relooked at. Why were we not able ply, as it has, tragically, in Italy and Spain. viously, overwhelming capacity. The only to mobilize on a broader scale? But I don’t COVID-19 isn’t the first infectious disease choice, they concluded, was to go all out on think we can do that right now. I think it’s scientists have modeled— and Zika are control measures. At best, strict measures j premature. We really need to look forward. recent examples—but never has so much de- might be periodically eased for short pe- LONDON COLLEGE ANGUS/IMPERIAL THOMAS PHOTO:

1414 27 MARCH 2020 • VOL 367 ISSUE 6485 sciencemag.org SCIENCE

Published by AAAS riods, the group said (see graphic, below). In their review of U.S. outbreak model- TOXICOLOGY The U.K. government shifted course within ing, Rivers and her colleagues note that days and announced a strict lockdown. most of the key players are academics with It’s not that the science behind epidemic little role in policy. They don’t typically New mercury modeling is controversial. Wallinga uses “participate in the decision-making pro- a well-established model that divides the cesses … they sort of pivot into a new world Dutch population into four groups, or com- when an emergency hits,” she says. Rivers compound partments in the field’s lingo: healthy, sick, argues for the creation of a National Infec- recovered, or dead. Equations determine tious Disease Forecasting Center, akin to how many people move between compart- the National Weather Service. It would be spotted in mass ments as weeks and months pass. “The the primary source of models in a crisis and mathematical side is pretty textbook,” he strengthen outbreak science in “peacetime.” says. But model outcomes vary widely de- Policymakers have relied too heavily poisoning pending on the characteristics of a patho- on COVID-19 models, says , gen and the affected population. a expert at the University of Chemical found in 60-year- Because the virus that causes COVID-19 is Edinburgh. “I’m not really sure whether old cat brain reopens debate new, modelers need estimates for key model the theoretical models will play out in real parameters. Wallinga is now confident that life.” And it’s dangerous for politicians to over Minamata disaster the number of new caused by trust models that claim to show how a little- each infected person when no control mea- studied virus can be kept in check, says By Joshua Sokol

sures are taken—which epidemiologists Harvard University epidemiologist William Downloaded from

call R0—is just over two. And he trusts data Hanage. “It’s like, you’ve decided you’ve got to he city of Minamata, Japan, is dotted showing that 3 to 6 days elapse between the ride a tiger,” he says, “except you don’t know with monuments commemorating vic- moment someone is infected and the time where the tiger is, how big it is, or how many tims of an industrial mass poisoning they start to infect others. tigers there actually are.” decades ago. High in the hills, a small From a 2017 survey of the Dutch popu- Models are at their most useful when stone memorial honors other deaths—

lation, the RIVM team also has good es- they identify something that is not obvi- of cats sacrificed in secret to science. http://science.sciencemag.org/ timates of how many contacts people of ous, says Adam Kucharski, a modeler at TNow, after restudying the remains of one of different ages have at home, school, work, the London School of Hygiene & Tropical those cats, a team of scientists is arguing, and during leisure. Wallinga says he’s least Medicine. One valuable function, he says, controversially, that the long-standing expla- confident about the susceptibility of each was to flag that temperature screening nation for the tragedy is wrong. age group to and the rate at which at airports will miss most coronavirus- No one questions the root cause of the people of various ages transmit the virus. infected people. disaster, which at minimum poisoned more Compartment models assume the popu- There’s also a lot that models don’t cap- than 2000 people: mercury in a chemi- lation is homogeneously mixed, a reason- ture. They cannot anticipate, say, an ef- cal factory’s wastewater that was dumped able assumption for a small country like the fective antiviral that reduces the need for into Minamata Bay and taken up by sea- Netherlands. Other modeling groups don’t hospital beds. Nor do most models factor in food eaten by fishermen and their families.

use compartments but simulate the day-to- the anguish of social distancing, or whether At first, the chemical form of the mercury, on April 8, 2020 day interactions of millions of individuals. the public obeys orders to stay home. In which ultimately killed many of its victims Such models are better able to depict hetero- Hong Kong and Singapore, “It’s 2 months and left many babies with severe neuro- geneous countries, such as the , already [of such measures], and people are logical disorders, was unknown. But in 1968, or all of Europe. The World Health Organi- really getting very tired,” says University of the Japanese government blamed methyl- zation organizes regular calls for COVID-19 Hong Kong modeler Gabriel Leung. Recent mercury, a common byproduct of mercury modelers to compare strategies and out- data suggest the virus may be spreading pollution. Many studies supported that comes, Wallinga says: “That’s a huge help in faster again in both cities, putting them on conclusion, finding methylmercury spikes reducing discrepancies between the models the brink of a major outbreak, he adds. in shellfish, bay sludge, and even hundreds SCIENCE that policymakers find difficult to handle.” Long lockdowns to slow a disease have of umbilical cords from babies delivered catastrophic economic im- during the time. But methylmercury is not pacts and may devastate pub- the culprit, says Ingrid Pickering, an x-ray Modeling a bleak future lic health themselves. “It’s a spectroscopist at the University of Saskatch- U.K. control measures could be let up once in a while, a model suggests, three-way tussle,” Leung says, ewan. “Our work is indicating that it’s some- until demand for intensive care unit (ICU) beds hits a threshold. “between protecting health, thing else”: an unusual mercury compound protecting the economy, and that may say little about the broader threat Strict control measure period 1200 protecting people’s well-being of mercury pollution. and emotional health.” Minamata has long been a vivid case The economic fallout isn’t study of mercury’s dangers. The metal is 800 something epidemic models toxic on its own, but it becomes far more address, says Ira Longini, a dangerous when bacteria in natural envi- modeler at the University of ronments convert it into methylmercury, 400 —but that may have an organic compound, readily absorbed by

Weekly ICU cases to change. “We should prob- living tissues, that can be concentrated and 0 ably hook up with some eco- passed up food chains. Since the 1990s, May September January May September nomic modelers and try to scientists have argued that the Chisso j GRAPHIC: IMPERIAL COLLEGE COVID-19 RESPONSE TEAM, ADAPTED BY C. BICKEL/ C. BY ADAPTED TEAM, RESPONSE COVID-19 COLLEGE IMPERIAL GRAPHIC: 2020 2020 2021 2021 2021 factor that in,” he says. chemical factory in Minamata produced

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Published by AAAS With COVID-19, modeling takes on life and death importance Martin Enserink and Kai Kupferschmidt

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