As the country fitfully reopens, many of the crucial decisions about risk in this pandemic move from the national to the personal. All of us face previously simple decisions that now have life-or-death consequences. Do I go out to eat? Do I visit Nana in the nursing home? Do I send my kids to school? We must answer these questions, not only individually, but also for our circle of family and friends who may have different risks.
Until a fully effective vaccine is developed and distributed, we will have to adjust to gradations of safety—but that’s just what we do whenever we take on risks.
We accept the risk of driving, but we scale our risk to our tolerance and our circumstances. Some of us may hit 75 mph on the freeway, but not in a built-up neighborhood. We know that doing so would put ourselves and others at unacceptable risk, backed by the threat of legal penalties for violating those risk standards.
When we drive, we can easily assess risk because the hazards are plain to see. We drive more slowly on icy roads and in rainstorms than on a bright summer day.
We need the same sort of information for the coronavirus, but instead, millions of people are having to make decisions about risks from COVID-19 without vital information. It’s as if we’re driving without knowing if the surface is dry pavement or ice, or whether we’re on the freeway or in a neighborhood.
There are crucial tools that the life sciences and technology industries can provide to help us all resume life as safely as feasible. Other than vaccines and medicines, the top of the research agenda for COVID-19 should be tools to help determine and mitigate the risks we all face.
Personalized risk assessment tools
First, we need a personalized, real-time, 360-degree risk assessor. Apple and Google are working on platforms for contact tracing, and those could be helpful for public health—but what we really need for our personal risk assessment is hyperlocal information that’s easy to understand and act upon.
It’s as if we’re driving without knowing whether we’re on the freeway or in a neighborhood.”
We should be aiming for the simplicity of the weather widgets on our smartphones. If someone sees an icon on their screen indicating a 60% chance of rain, they may either decide to carry an umbrella or take the chance of getting soaked, but either way, they have immediately accessible information with a simple UX that allows them to make an informed decision. For COVID-19, the “weather forecast” needs to integrate hyperlocal data on disease prevalence and the density of people in the immediate environment, as well as personal variables such as our underlying medical conditions and those of family members.
Digital biomarkers to gauge infection
Second, we need a better proxy for infection than temperature and a more workable protocol for frequent testing than nasal swabs. Although temperature checks are currently the best tool for quickly gauging infection, they are imperfect measures of transmissibility, since emerging evidence shows that the peak of infection for this stealth virus occurs just prior to the onset of fever. Frequent testing with rapid availability of results is a vital part of containing the virus. Anyone who has had a stick pushed up their nose for the current test will not relish undergoing that procedure routinely—and getting test results can take as much as a week or so, defeating the purpose of the testing.
A variety of “digital biomarkers”—from voice analysis, to social media language variability, to thermal imaging—is now being explored for their potential to provide early warning of COVID-19. One of these possible digital biomarkers is from my colleagues at Klick Labs, who have developed an analytical spirometer that can detect changes in respiration composition over time. Originally developed as a way to help in the diagnosis and treatment of asthma, the spirometer can now be tested as a possible rapid diagnostic for COVID-19. While these digital biomarkers may not have the precision of a PCR test, they are noninvasive and can be used with much higher frequency on large populations with potentially immediate results.
Exploring the role of genetics
Third, we need a better understanding of the interplay between a person’s genetic makeup and their susceptibility to infection and illness. As an architect of the federal law banning genetic discrimination, I am acutely aware of the potential for harm if this information is misused—but giving us private information on our own risk profile could help save lives. Gene variants have been shown to affect the pathogenicity of viruses ranging from influenza to RSV to HIV, so it would be unexpected if COVID-19 did not show similar variability. The evidence for such linkages is currently fragmentary but will expand as we gain more data about the virus.
To be most effective, these new technology tools have to rest on a foundation of science-driven public policy. Some states have reopened in disregard of public health data and are now seeing skyrocketing case counts. Even where science-driven rules are in place, many individuals disregard public health advice, putting themselves and those around them at greater risk. Technology can inform our risk assessments, but even the best technology can’t overcome poor choices.
In many circumstances we’ve been left to figure out what risks we will take. We deserve the chance to do so with the best information possible. Our lives, our mental health, and our economic security depend on it. America has squandered the chance to be a global leader in responding to the pandemic, but perhaps it’s not too late to lead the world in developing the tools to allow us to live as fully and safely as possible in this very abnormal new normal.
David C. Bowen, PhD, is senior vice president for policy and advocacy at Klick Health and formerly served as health policy director for the Senate Committee on Health, Education, Labor and Pensions.