Sharon writes:

Greetings Dr. Racaniello, 

Recently, I was surprised to hear about a practice that was recommending maraviroc to all comers with Covid-19 inpatients in a nearby state reporting anecdotal success. After hearing this, I vaguely recalled a brief comment from one of the TWiV podcasts but couldn’t manage to retrace my steps (maybe I dreamed it). I could not find much specifically on maraviroc and it does not seem to be under any active/registered trial on It seemed to be an idea borrowed from leronlimab, an Igg4 anti-CCR5 under study for HIV that is now also being pursued for treatment of severe Covid-19.

Is anyone at TWiV aware of any trials looking at specifically maraviroc for decreasing the severity of Covid-19? And, could you help explain how both might work in modulating the immune response? Or directing me back to the podcast that discussed it… Curious on your thoughts and insights into these claims.

Thank you for your time, and podcasts,


Sharon Chi, DO, PGY 5

Infectious Diseases Fellow

George Washington University

Bill writes:


I have Ph.D in microbiology but have no medical training.

I have a question, directed at Daniel. During a recent episode where you listed your day-to-day busy work life there was no time slot listed for keeping up with the latest medical and scientific literature on SARSCoV2 and covid-19, yet since you are taking about preprints and discussing the literature on the podcast you must somehow be finding time to read the deluge of information.

I am mostly interested in how new discoveries that come to light get translated into patient care during a pandemic. Reading about the origins of  SARSCoV2  is interesting from a scientific perspective, but I doubt it has any impact on individual patients.

Two examples:

1. Proning patients – you mentioned a proning team in the hospital – how was this information disseminated to the point where a decision was made to do this? Is this per doctor, per hospital unit, per hospital, per hospital system, or per city?

2. Use of remdesivir. During the episode where you discussed both the Lancet paper about the 

Chinese study, and the information released by NIAID, you seemed to indicate concern about negative outcomes and side effects. Yet recently you said your hospital is starting to use it. How and what information was used to make that decision on patient use in the hospital

I am mostly interested in the following: I assume that keeping up with the medical and scientific literature during a pandemic is more akin to fighting a war, trying to get information from the front lines, allocating resources correctly to fight the enemy, dealing with a lack of information, or even misinformation from the enemy. Would it have helped during the early part of the pandemic to have doctors in China, or Italy, directly talking to doctors in the USA prior to the massive surge here? Would routine and ongoing conversations have more quickly shaped patient care from those actively treating patients to those soon to be doing so? I cannot imagine scouring preprints and the news media is the best way to stay abreast of this information on a day to day basis unless you have a dedicated staff to do so. Dr. Fauci has staff to handle this, but do frontline ICU doctors?

Stay safe

Bill K

Jeff writes:

I am a very new listener and you may have covered this, but my question is if people with well treated (no viral load) HIV patients without other underlying disease are at increased, normal or decreased risk of morbity or mortality related to SARS 2 infection? 



Palm Springs, California

Rhona writes:

I started listening to TWIV when working in Organ Transplantion studies at Novartis,  so I could try understanding CMV and the Hepatitis viruses. I had gotten far with my silly Hospitality and Tourism BA. I applied for a MSc in Translational Medicine at Edinburgh University, online.  My bosses had to write and confirm I was more than capable to do a Master’s degree designed for doctors to learn about Translational Research.  It took 2.5 years online;  only 7 people completed it. I was the only woman to complete and got it with Distinction. Admittedly husband was not impressed at my research and writing on Honeymoon.  

TWIV kept me convinced that my path, although never infectious diseases,  was the right one. 

Thanks to you, Rich, Dickson, Kathy,  Brianne and everyone for keeping me inspired.  I may be stuck in rare diseases for a while but Transplantation, and reducing the need for them , or helping to reduce virus led rejection, antibody mediated rejection, less destructive immunosuppression for recipients is my passion.  

Keep on being grumpy,  making us smile and laugh.  I have become grumpy too. Too many Covidiots. 

Best regards Rhona

Lauriel writes:

Hello TWiVers, 

Just read this story in the NYT about a successful contact tracing program in Paterson, NJ. Hopefully, their experience can help inform other cities who are determined to have a successful re-opening in the next few months. The story also made me think about the other ways an effort like this could be important. The tracers remain in contact with the people they are asking to stay in quarantine by having daily phone calls with them. This way they can help answer questions about the virus, the disease, and also put people in contact with local resources. Kinda like a social worker who can help people during a time of uncertainty. 

In Tacoma WA, it’s currently 56oF (13oC), partly cloudy and a bit breezy with winds at 12 mph.

Last I wrote, I had recently moved from academia to industry and I must say that I love it. Looking forward to a time when y’all can go back to talking about non-coronavirus topics like some of the systemic problems in academia that need to be address in order for young scientists to thrive. In the meantime, please keep up your important work! This is my go to for accurate coronavirus information and I’ve been directing people to your podcast as often as I can. Thank you for being a voice of reason during this pandemic. 


Maria-Isabel writes:

Dear Vincent, 

I am a BIG Phan of the TWiV, TWiM, TWiP, and Immune! Alone during long lab hours your discussions keep me motivated, and exercising my scientific critical thinking!

I am writing from planet phage -the gateway to bacteriology- to share with you our project! I am a PhD student at the Rohwer Lab at San Diego State University, where we are looking for volunteers to swab the surfaces of their homes in San Diego County and send them to us to perform RTqPCR, LAMP, metagenomics, and metatranscriptomics. You can read more about our project here: 

Please help us spread the word by sharing the link where people can apply to get a kit sample their homes and feel free to use our #swab4corona in Twitter

Keep up with your great work! Your podcasts are vital, now more than ever!

Maria-Isabel Rojas

Twitter: @marisabelroj

Norm writes:

Test trace and isolate – really?

We are not going to eliminate this virus.  Get over it.  Billions of people have been exposed.  You will have to stop any of them from coming to the US and US citizens never leaving their country.  For years!

You guys OK with that?

I really like that Norway, Denmark and Finland may allow travel between each other.  Unsaid is they cannot go anywhere else nor can anyone visit them.

Yesterday NY had 3000 new cases.  How in the world are you identify everyone these people were in contact with for the last 14 days???  And then trace them?  What if they forget?  What if they don’t want to tell you?  What if they rode a subway?  What if they don’t know the people they were close to?  What if the people you “isolate” don’t want to stay isolated, like say, Neil Ferguson???

How are you going to test, trace and isolate people who do not come into the country legally?

You are living in a fantasy world.

We will all be Sweden whether we want to or not.


Joel writes:

Hi all,

Just a quick thank you for taking the time to make these podcasts. Icant tell you how much I appreciate a consistent source of factual information with as little bias as possible.

With all the vaccine talk I’ve started thinking about the logistics ofthe actual rollout once we get a vaccine. I know true antivax is a minority but a quick search for surveys showed a concerning percentage of the US population has limited trust in vaccines. There was a Harvard study that surveyed public opinion on mandatory childhood vaccines. Only 54% of adults thought vaccines were “very safe” and only 37% reported a trust in public health agencies (the survey questions and methodology are listed on the press release linked if you’re interested).

This was concerning to me because with this virus requiring a fairly high percentage to reach herd immunity, any sizable portion of people refusing the vaccine can be very dangerous for the rest of us. Do you all have any opinions on this topic? Is it even a real concern when faced with a pandemic? If it gets down to it could the US be able to implement a mandatory adult vaccine without riots?

Thank you and I look forward to post-pandemic episodes where we canlearn about more than just covid!


Matt writes:

Dear Vincent, Kathy and Rich

This article in Wired suggests that SARS-COV2 might invade the brain.

Do we really know that it is only mucosal and can’t get into the blood or other organs? This article in TiNS suggests that other coronaviruses can infect the brain.

I think this would be very rare indeed given that we aren’t hearing much if anything about COVID-encephalitis or virus (as opposed to RNA “litter”) in CSF. It worries me that if overstated by the media this sort of story might make people too fearful, when actually the risks are very low for most.

I’m a long time twiv listener and former virologist…

With best wishes


Micheal writes:


I am not involved with virology or pandemic studies.  I do have a background in emergency medicine (EMT-Intermediate both rural Texas and Wilderness), as well as a background in database programming and data analysis.

My question is related to the ACE2 increase from cigarette smoke.  Would this also pertain to smoke or other airborne irritants (e.g.: industrial pollution, long-term exposure to wildfire smoke) as well?  I live in Northern Minnesota, it was a dry winter and spring and wildfire season is approaching.



Philip writes:

Dear Professor Racaniello and team at Twiv.

I am in Kyoto where it is about 25C. I think that is about 75F, but I don’t know for sure. All I know is that 90F is hot. 

Youtube directed me to your Virology course lectures at Columbia, and I watched them all. Youtube found Twiv for me, so that is great. I haven’t had time to listen all the podcasts, but I hope to soon. 

I am in Kyoto, Japan and I have family in Canada and in Sweden, and friends in the US. Our experiences of the outbreak have been quite dramatically different, I feel. 

Professor Yamanaka from Kyoto University mentioned on NHK that BCG, the old vaccine against TB, might be a Factor X that is reducing the impact of Covid19. I had heard about this a few weeks ago, but people said it was too early in the outbreak to tell, and it was just a correlation.  But it seems to be holding even now. 

BCG vaccination coverage in Japan is >99% of the population. Other parts of Asia, and India, and Africa have some levels of BCG vaccination, and there seems to be lower impact of the outbreak. South Korea and Taiwan have long standing BCG programs as well. China has BCG but had a break during the cultural revolution. 

It appears that if older citizens have received BCG, that is to say that the BCG program is long standing, the severity of the outbreak is reduced quite dramatically as in Taiwan, Japan, South Korea, and Singapore. This is just a correlation but it appears to be a strong one. 

My understanding is that there are 12 studies focussing BCG and Covid under way now, and they are focussed on healthcare providers who have never previously received BCG.

I wanted to ask if there is a way to study people who have received BCG and recovered from Covid19 to see if there is some difference in their bodies’ immune responses as compared to BCG- patients who have recovered. i.e.,  Are there some tell-tale indications that the BCG+ patients had a different or more robust response to the infection. 

Here is some background on the experience of the outbreak here: 

The approach in Japan has been to detect outbreak clusters, and trace and isolate and quarantine the contacts. But hardly any testing outside of this was done.  A hard lockdown like in Europe isn’t possible here, lots of people were still commenting, but schools were closed, and most shops were closed. 

Over the past month or so a national emergency was declared, and people really stayed home and the city centres emptied out, so quite dramatic scenes of a deserted Tokyo. Wearing masks has always been part of life here, personal hygiene very good, I feel. Social distancing is rather difficult in most cities, but people tried, I think. 

According to the statistics on NHK, the total number of cases (that appears to be cases that received medical care) is 16,433 plus 712 people on the cruise ship. 

There have been 784 deaths plus 13 from the cruise ship. 12,286 patients have been released from hospital. 653 from the cruise ship have been released. 

This is for the whole country over the whole outbreak.  The population of Japan is about 126 million. We now are down to less than 50 new cases per day for the whole country.  In giant cities like Osaka new cases are down to zero each day.  This is all in Japanese, but please trust me.

The standard for ending the emergency situation in Tokyo is to have less than 0.5 new cases per 100,000 population for a week. Which I think they will reach soon. 

With thanks for introducing viruses and virology to a wide audience. I will be an amateur virologist for the rest of my life. 

With thanks and warm regards 



Kyoto, Japan. 

Rich writes:

Hi TWiVers!

A while back, i remember hearing that testing of hospital workers was being done as ‘block testing’, swabbing a group of people and doing one test… Then if it comes back positive, individually testing the members of the group…

How reliable is this?  How many people can you test at once?  And how reliable is the test in spotting the one positive in group?

Could block testing be one of the ways to massively increase testing capacity, and a way for schools, businesses to practically test everyone with a higher frequency, such that new infections could be spotting much quicker?

Say in a school, each class could be tested at the start of every day… Could it be possible to test 30 students in one go, and make daily testing viable???

And perhaps if saliva is a viable option, that would greatly simplify the whole procedure (As mentioned in 616).

Listening to 616, and wearing my Mechanical Engineering hat, i think that the way the airflow, A/C, aerosols were being thought of working, was that the virus was travelling, circulating though the A/C unit, meaning that HEPA filters would be of use…  But i’m thinking that another mechanism of the A/C aiding the spread is just by the ‘wind’, moving the air, such that droplets, aerosols, are carried further… so away from the infected, downwind to another that could then be infected, but would otherwise be considered at a ‘safe’ distance.  So any fan, draught, wind, in a room full of spread out people, might increase the transmission rate.  So would it be safer where there was no wind, draft, or perhaps the exhausts from A/C units could be fitted with diffusers, to eliminate focused air movement, making it much more subtle.

I didn’t notice this point being addressed… So thought to ask.



Brit, living in Bali.

Jon writes:

Dear professors,

For background, I’m a mathematical physicist by training, but I invest in small biotechs as a hobby.    I remember first hearing about mRNA vaccines on a TWIV circa 2012 when I was driving to the Buffalo airport, and surprising my brother-in-law (a prof at MD Anderson in infectious disease) that something like that could work.

However, I have a bone to pick with you guys about your coverage of Moderna’s decision to issue its press release.  For reasons not widely appreciated in academia, brief press releases of so-called “top line data” are a standard and necessary practice, not something that Moderna has schemed up.

Unlike academic researchers, publicly traded companies are ethically and legally bound to consider at what point withholding trial results becomes unfair to either new or existing shareholders, especially when issuing new shares, as Moderna is now doing.   (The $483M the government is chipping in sounds like a lot, until you consider that they are already ramping up in a hurry to manufacture 1B doses/year, all of them still subject to clinical risk.)  Furthermore, as you know, a full release may jeopardize the investigator’s ability to publish the results or present them at academic conferences. (Note that this study was conducted in collaboration with the National Institute of Allergy and Infectious Disease).

The relevant legal issues are explained in the security and exchange commission (SEC) exceptions to the embargo policy of the annual American Society of Clinical Oncology annual conference website.  The conference website states:

After the abstract is submitted to and prior to the abstract information being publicly released in conjunction with an ASCO Meeting, the author, coauthors, sponsor of the research, journalists, and others must not

* make the information public, or provide it to others who may make it public (such as news media),

* publish or present the information or provide it to others who may publish or present it,

* use the information for trading in the securities of any issuer, or provide it to others who may use it for securities trading purposes.

with an exception for minimal “top line” data releases required to fulfill SEC regulations

SEC [securities and exchange commission] Exceptions

A publicly traded company may determine that it is legally required to disclose certain data or other information from a confidential abstract in advance of the public release date to satisfy requirements of the U.S. Securities and Exchange Commission or a corresponding regulatory body in a country where the company’s stock is traded (collectively, “SEC”). This need typically arises when there is a substantial likelihood that the information would be considered by a reasonable investor in the company to significantly alter the total mix of information made available to the investor.

In general, the abstract is still eligible for inclusion in the ASCO Meeting provided that the company submits to ASCO, in advance of the release, a letter signed by the company’s legal counsel that contains the abstract title, indicates the format/nature of the public disclosure, and advises that (a) public disclosure of the information is necessary for the company to comply with applicable securities laws, and (b) the information disclosed is the minimum necessary for such compliance…..

The emphasis was added by me.  So professors shouldn’t blame the corporate world for the brevity of press releases, unless they’re willing to forgo giving presentations!   Science and Nature are also well-known sticklers as well.

More vitally, in the case of COVID-19 we are no longer waiting for phase 3 data to be published before we build factories and ramp up production.  It is therefore is entirely appropriate from an economic viewpoint that investors and others get an early peek at the interim data to decide where to allocate capital.  (I also worry that hackers will get at the data for insider trading if it isn’t released publicly ASAP.)

I should also point out that the company gave a fascinating and still-available 1-hour public webcast (slides + audio, slides only)  to discuss the release, which included a Q&A from big investment companies.   Later that day there was another webcast from an investor conference, again publicly available.  Don’t be put off by the websites asking for an email, just put “small investor” in the “occupation” box (and a fake email address if you like) and they won’t bother you.  (I presume their lawyers might have required them to collect email addresses in case they accidentally made a gross misrepresentation, because I’ve never gotten spam from such webcasts in the companies I follow.)   



Tom writes:

I just listened to your latest podcast (#56) and, as usual, I really enjoyed the discussion.  Thank you for what you do.  I do wish though you would make an effort to refrain from political comments.  In the podcast, when you bemoaned the fact that politics is encroaching on the science, I couldn’t have agreed more.  And yet, within minutes you were injecting politics into the discussion when you stated Mike Pompeo was lying when he said he had seen evidence indicating the virus may have escaped from a lab.  Given that you could not possibly know what information sources he has access to which you don’t, there’s no way you could possibly know whether he was lying or not.  You just don’t have enough data to support such a conclusion.  As a scientist, I know you must agree.  You obviously have a right to your political opinion but a science based podcast is not the place for it.  Your colleague on the podcast was correct when he said these things were best left for the cocktail hour.

      Injecting political opinions into a science podcast is so jarring and inappropriate, especially when those opinions are not supported by data.  Please stop doing this.  If your podcast weren’t so excellent in every other respect I would just delete it from my library and move on.  But it’s too good for that, which is why I’ve taken the time to write. Thank you.

Mark writes:

Dear Professor Racaniello et al.,

I write with a small correction to the email criticizing the Institute for Health Metrics and Evaluation (IHME) model that Professor Racaniello read on the most recent episode of TWiV (Episode 614). I am not in any way affiliated with the IHME, but I am, like the Institute, affiliated with the University of Washington, not the University of Wisconsin, which the otherwise-punctilious writer of the letter incorrectly identified as the IHME’s host institution. 

Anyway, many thanks for making your entertaining virology lectures accessible via YouTube. Thanks also to you and your co-hosts for the extremely informative podcast, from another Mark working in an academic field (music history) that ostensibly has very little to do with virology. I too have enjoyed toggling back and forth between grumpy and un-grumpy Professor Racaniello over the past few months. 

Best wishes,


Owen writes:

Hi TWiV team,

I’m a Master’s student currently working in a rotavirus lab. You actually interviewed my PI, Sarah McDonald, on a previous TWiV. I find myself constantly commiserating with my scientist friends about the ridiculousness of thinking SARS-CoV2 came from a lab. Everyone in science, not just virologists, can appreciate how hard it is to get anything to work in the lab. I’ve spent 90% of my time in lab troubleshooting why my assays didn’t work. The idea that someone could have engineered the current virus is absolutely ludicrous. Sometimes it feels like we can barely rescue wild type viruses, let alone viruses we’ve introduced mutations to! You’ve had a lot of comments giving simple explanations of this, and I thought I’d give my example. I like to equate making a virus in a lab like making a campfire or a fire for a grill. Sometimes it’s really hard for you to get a fire going. Sometimes you can’t get it going at all, and if you do it gets blown out by the tiniest wind. However, viruses that evolve in nature from different selective pressures are like the wild fires in Australia and can spread far and wide with massive destructive force. I know that at least the people around me understand this since they’ve seen from me the struggle that is doing science. Despite how hard it is, nothing can compare to finally getting that tiny campfire to light!

Hoping to start my PhD program on time at the University of Wisconsin-Madison in the fall and continue working on RNA viruses! Thank you all so much for this podcast. It is so helpful and the first thing I recommend to people that come to me with questions.

All the best,

Owen (she)

Lad writes:

Dear Vincent,

In TWiV 613 you referenced the need for a person to acknowledge the limits of their knowledge and Rich read a quotation from Socrates.  Also a famous movie line from Dirty Harry (Clint Eastwood) in Magnum Force (1973) “A Man’s Got to Know His Limitations”.

I was introduced to your program by my son, Gregory, and have become an ardent listener. I very much appreciate TWiV and the knowledge you, the team, and guests are sharing with the broader community.

Thank you!


Owen writes:

Hello again Twiv.

I wrote to you in mid March seeking advice for protecting my immune compromised mother. I think your viewership correspondence was peaking, and hence my email might have been skipped. I bear no grudge. I hope that you may be able to answer this question I ask now; my mother is fine and well – this question is not about her. This question is a shorter one; you can probably comment generally and perhaps riff on it on your show.

With the technology we possess today to do work without the need to be in the physical presence of others, what opinions might you be able to share on the subject of telework promising a society that is better able to endure pandemics like the one we are now experiencing. Do you perhaps think that society might be dragging a chain, favouring the maintenance of an economic model made redundant by technology, and hence unnecessarily increasing the transmission of viruses and other communicable pathogens.

Thanks for taking the time,


Lenni writes:


I am a recent listener to your excellent podcasts. When I saw this calculator (posted May 13, 2020) on the DHS website, I wondered what the experts would make of the instrument and its usefulness.

Thank you for all you are doing to educate and inform.

Lenni B. Benson

Distinguished Professor of Immigration and Human Rights Law;  Founder Safe Passage Project Clinic

New York Law School

Jakob writes:

Dear TWIVers!

I’m a long time listener to TWIV and have enjoyed listening to you while working in the lab. In the fall I finished my PhD-studies on Cholera toxin, but have since retired from science to become a software engineer. A safer career with better hours for a father of two, so family first!

I’m a Swedish citizen and listening to the letters in TWIV-614 I felt the need to further make the case for why we are not completely crazy over here 🙂 It is certainly true that we do have much higher death rates than our neighboring countries and I think that it is clear to everyone why. I would still argue that just under 4000 dead from the current pandemic is far from catastrophic in light of historic pandemics without prior immunity. I would also like to add that every death is a heavy loss for family and friends and no Swede is oblivious to this. The “Swedish model” is not callously disregarding the deaths that have occurred so far, but sees them in the light of an alternative cost. And not cost as in just dollars or euros but as cost to our society and our way of life.

How many lives will be lost as direct and indirect consequence of shutting down our modern global economy? You may think what you like about the current economic system, but it puts food on all of our tables. In the west we are likely to be able to weather harder times without mass starvation. But what happen to the factory workers in developing countries when the enormous demand for “new stuff” suddenly disappears? Likely they will be out of a job and thereby any means to provide for their families. I suspect mass starvation will follow and or the loss of opportunity for the factory worker to send his or her kinds to school. Will better-off countries send need help while they themselves face severe economic depression? Hopefully we will but who can say what we will do…

But as Sweden is a tiny country with a large economic dependence on export, and most other countries are shutting down more forcefully, I fear that the Swedish attempt to prevent economic depression is doomed to fail. If we are to employ the TETRIS method I fear that it will severely restrict the economy similar to what is happening right now. I do not believe that we will lose many more lives as a consequence of playing TETRIS until we have a vaccine. 

Well I have made my case and I hope that it will clarify the Swedish strategy (at least how I as a regular citizen understand it). It is true that we have a strong consensus culture in Sweden and that people are punished unfairly for speaking out against the majority view. This is of course not good, but being unjustly attacked does not impact if your opinion or statement is right or wrong. I think that the critics are right in that Sweden could have done much more to prevent the spread of the virus. I just think that in doing so, we would be in a worse situation, and i think that we see the effects of this around the world. 

I would also like to add that most of our covid-deaths have occurred at elderly-homes. From my time working in such a home I know that several of the residents are on a “no-resuscitation-list” which means that they only want to receive palliative care in the case of an heart attack or sever illness, like covid. This might very well explain whey not all sever covid-cases receive intensive care, and is far more likely than that they were left to die in spite of medical capacity. 

Finally, I would like to know your thoughts on this paper ( Unfortunately it is behind a paywall 🙁 Can it be so that the T-cell response to other corona viruses help some avoid severe disease in cases where an antibody titer is not detected? And could it be that we in our quest to get SARS-covid-2 specific tests miss that people just have high titers of antibodies that are cross reactive? The theory here is that a reactivation of a previously activated B-cell will have precedence and “win the race” for production of antibodies to combat the viral infection. They win since the clonal B-cell expansion (maybe 2 days) is much quicker that de novo B-cell activation (at lest 7 days), and will thus become far more prevalent.

In my eyes it looks like we might be closer to heard immunity than we thought, although I realize that the data is very “pre-clinical”, and may not tell us anything about the real disease.

Sorry for long email and opinionated content. Thank you again for a great podcast! 🙂

Best from Sweden, (12 C and sunny)


Carolina writes:


Thanks (again) for all that you do, and for being a solid voice of reason in these crazy conspiracy-themed times (keep up the grumpiness!).

I am a virologist from Sweden, currently living and working in the US. Although I have spent a greater part of my life away from Sweden than in it, I still have a considerable amount of family and friends that have remained loyal to their country, which I stay in touch with. And, I do follow Swedish news and occasional press briefings -particularly in these recent times.

I have appreciated the added nuance that you brought to the topic of what is going on in Sweden in episode 614. I have a few additional thoughts of things that I find are distinctly different in the Swedish approach compared to other countries.

1. The officials of the public health agency of Sweden insist on promulgating the message that SARS-CoV-2 -infected people do not transmit disease prior to development of clinical signs of disease. The official guidelines are “stay at home if you feel sick”, which is clearly as good advice as it can get for people who need to otherwise be at work. But, I think that the strong adherence to the concept of lack of pre-clinical transmission has strongly influenced point 2 (below).

2. The same officials strongly discourage the use of face masks for anyone other than HCWs that are directly in contact with suspect or confirmed COVID-19 patients. They claim this is due to “the lack of scientific evidence in support of protection provided by wide spread mask usage”. This also applies to HCWs in “non-COVID-19” settings. This particularly caught my attention as my father, who is in cancer treatment and a representative of the “high risk population” by more than one cause (and lives in Stockholm county, the Swedish “epicenter”), went to the local health care center for a blood draw, and the phlebotomist was not wearing any PPE other than the standard gloves. I am also thinking this part (no PPE unless dealing with confirmed/suspect cases) may have had substantial impact on how COVID-19 made it in to the majority of care home facilities for the elderly, which seems to be “the great big question” that no one can figure out as visits to these facilities by family and friends was banned quite early on. 

Another thing that has caught my eye has been widespread promulgation of outcomes of mathematical modeling based on very limited data suggesting that herd immunity will be reached within the near future (at least in Stockholm). Although I am not an epidemiologist, I find it very hard to believe that the Swedish seroprevalence could far surpass levels reported from e.g. New York and Spain. Occasionally these models were also admittedly biased as serosurveys had been anonymized to the extent that known COVID-19 cases that had been sampled for potential plasma donation had been included in the anonymized/”random” serosurvey data. 

I am seriously torn as I have a lot respect for the Public Health Agency of Sweden and the work that they normally do. I definitely do not adhere to the elsewhere communicated notion of those officials as being “talent less”.  But, it does seem that they may be failing in updating policies and guidelines as more scientific knowledge is gained (specifically in regards to the occurrence of  pre-clinical transmission and the potential value of face masks). It would seem that their strategy, at least as communicated, is highly focused on preventing a second wave, rather than minimizing the impact of the currently still ongoing first wave.

I know that more wide-spread serosurveys from hopefully more representative cohorts are underway. I am very interested in seeing the outcome of those.

Keep up the good work!

Otto writes:

Dear TWIV, 

Thank you for an excellent podcast. I think you deserve a lot of praise for your coverage of this pandemic, but also criticism: 

Since I’m not an epidemiologist or virologist or have a relevant degree in this subject I can only speak based on my subjective critical thinking which I hope can shed some light on the situation here in Sweden.

I was quite shocked when I heard the letter from “Worried about Sweden” in TWIV 614 because several of the claims are false or definitely not something that should have seen the light of day in a respected scientific podcast. A peer-review of the letter would have been appropriate before reading it, if it should have been read at all.

I sincerely hope that you would make an attempt to give an accurate and objective view on the Swedish strategy by inviting the state epidemiologist Dr. Anders Tegnell to the podcast. He was recently interviewed in The Daily Show with Trevor Noah. There are also other relevant experts, without connection to the authority or the “22 researchers” such as Professor Agnes Wold or Dr. Emma Frans.

Finally, I would like to add, in response to the letter from “Worried about Sweden”:

* The deaths per million is indeed high in Sweden. But cherry-picking data based on a 3-day average comparing countries who may be in different phases in the pandemic is not a fair comparison. If we should compare countries it should be done at the end of the pandemic and not now.

* The so called “22 researchers” that have expressed a critical concern in media have also been found making false and inappropriate claims. Such as: cherry-picking data to compare Sweden and Italy, using input to the Imperial College model as an outcome of the model and maybe worst: calling the officials “talent-less”. There can of course be relevant discussions of the lack of debate in Sweden regarding to the pandemic response. But as 22 researchers should know that if they would like to make an impact they should use their voice as scientists and contribute to the state of knowledge. Unfortunately, they have been less prone to correct their faulty claims than to seek more media attention. Several models that predicted the Swedish health care system to be flooded have also failed to predict the rather stable situation in Sweden right now.

* The letter refers to the media source which is a radical nationalist news source known for having connections to Russian intelligence and repeatedly spreading fake news.

Best regards

Otto Emanuelsson

Gothenburg, Sweden

Rose writes:

Hello Twivvers! I love your show and it restores my faith in humanity when it occasionally wavers. I want to let you know that statistics quoted in one of the letters you read on episode 614 were completely wrong. The deaths per million in Sweden are NOT worse than Italy, U.K., or the U.S. and I think it is very important that erroneous statistics be corrected on air, instead of just read. I’ve attached a screenshot of the stats as of today. Listeners trust you so much that an error not corrected will assumed to be true. 

Thank you for all your hard work. 


Los Angeles, CA