Pandemics and Social Networks: Influencer Dr. Eric Feigl-Ding on COVID-19 Messaging in the Age of Twitter

Eric Feigle - Ding

[ Music ]

Female: We lcome to Conversations on Health C are with Mark Maselli and
Margaret Flinter, a show where we speak to the top thought leaders
in health innovation, health policy, care delivery and the great minds
who are shaping the healthcare of the fu ture.

This week Mark and Margaret speak with Dr. Eric Feigl e - Ding ,
Epidemiologists and Senior Fellow at the Federation of American
Scientists , a global policy think tank dedicated to using science and
scientific analysis to make the world more secure. A lo ng time Harvard
R esearcher and Professor he ha s established a significant presence on
Twitter, monitoring COVID - 19 data trends and addressing COVID - 19
misinformation , around disease spread , new variants and vaccines .

Lori Robertson also checks in , Managing Editor of FactCheck .org looks
at misstatements spoken about health policy in the public domain
separating the fa ke from the facts . We end with a bright idea that’s
improving health and well - being in everyday lives.

If you have comments, please email us at [email protected] or
find us on Facebook, Twitter, or wherever you listen to podcasts. And y ou can also hear us by asking Alexa to play the program. Now stay
tuned for our interview with Dr. Eric Feigle - Ding here o n
Conversations on Health Care.

Mark Masselli: We're speaking today with Dr. Eric Feigle - Ding , Epidemiologist , Health
Economist and Senior Fellow at the Federation of American Scientists
a global policy think tank , dedicated to using science and scientific
analysis t o make the world more secure. He established a significant
presence on Twitter to monitor COVID - 19 data trends and to address
COVID - 19 misinformation.

Margaret Flinter: Dr. Feigl e - Ding established the first g eo - social network public alert
system for toxic drinking water in the country. He ha s published
numerous papers and several books including Poison Pills : The Untold
Story of the Vioxx Drug Scandal . He served for 16 years as Professor
and Researcher at Harvard Medical School and the Harvard T . H . Chan
School of Public Health until last year . And he was one of the first
scientists in the United States to issue a dire warning about the coming pandemic. Dr. F eigle - Ding, we welcome you. And thank you
for joining us on Conversations on Health Care .

D r. Eric Feigle - Ding: Thank you , very happy to be here.

Mark Masselli: And Eric, I want to pull the thread on what Margaret just said that you were early scientist to identify that this coming pandemic was going
to be very deadly, highly transmissible. How did you identify it so early? What was the datasets that you were seeing? Take us back a
year ago , w hat was the data feed that you looked at to make this

Eric Feigle - Ding

analysis?

Dr. Eric Feigle - Ding: Right, there was a very turbulent time . In January 2020, nobody was
ce rtain about anything . The only certainty was the uncertainty and
the crazy rollercoaster of information. And so there was a lot of noise,
and I have relatives in China. So normally, when there i s chatter on
Chinese social media, it follows a pattern in whi ch often times, the
G overnment is very aggressive about censoring something, if they
really don't like it. But when something is chaotic, and they're not
censoring it fully, it means that there is something real going on. And
politically, they don't know w hat to make of it. So which means that
the signals of all these testimonies of people dying, hospitals being
flooded, they're real. And I think that the ear to the ground plus when
we saw the preprints coming out . The question is you can't shout at
the roo ftop with just internet rumors. So when the preprints came
out, and there was a showing that (inaudible 00:03:32) which is quite
large, and later on, it was confirmed to be 3.8. We knew that this is
real. And so we had to prepare.

But in certain ways, I th ink academia traditionally is very conservative.
It doesn't want to declare something is causal or something is true
until irrefutable mountain body of evidence is there. But in terms of
pandemic action and awareness, every single day matters a nd every
sin gle moment in which you take an earlier action, you could actually
curb the epidemic.

So there i s a preponderance of anecdotal data, there is now study
supporting it. And though we may not be absolutely sure about
everything, the signal is now jumping out . And I decided to declare,
the Holy Mother of God, it's going to be a thermonuclear level
pandemic, because I saw the stories and anecdotes coming out of
China, were not isolated, it was quite a preponderance.

Margaret Flinter: Well, Eric, obviously we kno w so much more now about how the virus
is transmitted, how it makes people sick , kill some people , spread s
through entire communities. And it's very painful to look back and see
how that information as it was evolving was denied or even vilified. It
must h ave been unbelievably frustrating. And I a m curious to what
extent do you feel like you were able to get the message out there ,
organi z e people , get people taking action, even if it wasn't happening
at the national level.

Dr. Eric Feigle - Ding: And last ye ar was so frustrating because the lack of federal leadership
in United States clearly contributed to the lack of early action , in
terms of lockdowns , in terms of testing , in terms of PPE organi z ation,
and now we are also see ing it play out in vaccine rollo ut. I didn't
reali z e until later, but there were people who heard , there were
people who in Australia, New Zealand, who said they heard it in Asia
because back then it was originally Asia , who was reacting the fastest.

Eric Feigle - Ding

And also the Maryland Governor h is of fice directly reached out later
that summer and said, “ Your message was heard loud and clear. ”
Maryland was one of the states that ordered PPE and testing around ,
as they the circumvented the White House , to do it.

So I think, hopefully, it was heard by mo re people, the preponderance
of data , preponderance of concern . A nd in terms of me shouting, it's
not that effective compared to WHO , to declare a Public Health
Emergency I nternational Concern . They soon did. And then in terms
of declaring a pandemic, they didn't do until March, I think, mid -
March. But in terms of declaring these kinds of emergencies, it was
such a critical thing because countries have to prepare. And you also
need to literally take a wartime mobili z ation . But I think people need
to keyed w hat basically Dr. Mike Ryan said that “ Perfection is the
enemy of the good ” , especially in a pandemic response.

Mark MassellIi: You know I do want to pick up on your statement earlier that there
was a lack of leadership on so many levels right , here in the United
States , on testing . PPE , on vaccine rollout and the like. And I want to
sort of connect it to the really impressive work you've done on social
media . We have about 400,000 followers today, talk about the role of
social media has played during the e volving pandemic and sharing
information. That's not always spot on , but it's very relevant. I want to
connect that to your assessment of the leadership we now have in
place, right , b ecause as Dr. Fauci has said, he's been liberated, right, in
terms of spe aking out.

So sort of connect the work you did on social media when there was
that vacuum a nd how do you assess the leadership? And then what's
the continued role in social media?

Dr. Eric Feigle - Ding: Right, I think social media plays more and more of a r ole as we know .
It can also be a source of great misinformation. Like
H ydroxychloroquine , I do not know how that blew up , but clearly the
science was not there. And we did lots of randomi z ed trials, yet it kept
perpetuating. And I was one of the first tryi ng to push back against
Hydroxychloroquine . And I was attacked by Right wing mob in terms
of advocating against it , because there was no evidence for that. And
then there i s also other things.

I think social media shows that misinformation can lead to dang erous
outcomes, not just the false beliefs that ma sks don't work , the false
beliefs and the natural herd immunity, which is incredibly dangerous
a nd there's dangerous movies like the P l andemic c onspiracy movie.
And then now of course, the riots , the Insurr ection Riots on January 6,
against the Capitol . A lot of that was fomented by leaders and dark
social media groups.

And so we know that what happens in social media, the

Eric Feigle - Ding

c onversations spill over in real life, which makes it even more critical
we fight aga inst that. And we did an analysis at FAS , and we analy z e d
that the ‘ Scott Atlas ’ herd immunity whenever he was talking about
herd immunity, half of all pro - natural herd immunity was actually
done by bots. We actually have shown that because these bots were
retweeting and tweeting faster than humanly possible.

And, I was one of those who were the leading advocates fighting
against it. We know that fighting against misinformation is so key. I
really felt for Dr. Fauci , he couldn't speak up as vocally as he wa nted
to you know, he admitted that . But I'm really glad he is able to now .

And so hopefully social media, we can take a step back. But we know
that even if Trump isn't on Twitter, we know that it is literally a living
engine that can fuel things in the re al world . And people not wearing
masks , mask denialism is just clearly one clear product that has led to
the p andemic being much worse than it could be.

Margaret Flinter: Well, Eric, you're a senior fellow at the Federation of American
Scientists, which is the global think tank that started way back in 1945
by the scientists who worked on the Manhattan Project, which
developed the nuclear bomb in a very positive way. We have our own
in that M anhattan Project now, which has been the race to develop
the COVID - 19 vaccine and we are so happy to see them now coming
into our communities and into our states to do the work that only
they can do.

But we want to ask you who've lived through this entire year w hat do
you say now to people who still question safety and e fficacy of the
vaccines . In layman's terms , how do you communicate to people, the
safety and the efficacy when there i s still so much misinformation as
we talked about a moment ago , c oming out .

Dr. Eric Feigle - Ding: Y eah, I think it's understandable that p eople are concerned about
vaccine given how much again, the misinformation and confusing
information that they heard . And also that previously vaccines always
took many more years than it took this year in which we arrived with
vaccine in 10 months. But I want to emphasi z e first of all, we haven't
seen a pandemic like this in over 100 years . The technology has
gotten incredibly, incredibly better . We're able to synthesi z e new
vaccines in as little as six weeks before entering the testing. And of
course, the funding out there is just incredible, it is an unprecedented
amount of funding billions , tens of billions of dollars, that normally,
we would have ever se en medical research for one disease.

So I think that people have to reali z e , and also, we're finding the
efficacy results faster. Unfortunately, because infections are so rapid
and high o ften times, these trials take over a year, because there's not
that many infections. But with the pandemic raging, we can get

Eric Feigle - Ding

results and efficacy and safety results much faster. And I think people
also don't understand that the concept of vaccine versus a placebo is
that if you see, say, 5% of people having an adverse event, but you
see it in both the placebo and the vaccine, that means it's not related
to the vaccine.

An d I think people have trouble understanding that because we've
done an analysis that if you vaccinate 10 million people within two
months, you're going to see about 4000 heart attacks, 4000 strokes,
and thousands of cancers and about 10,000 deaths, especia lly if you
start immuni z ing the elderly. And so we have to reali z e there will be a
lot of stories, anecdotes of people who got the vaccination and die.
But we know from the data that there is a natural rate of death, and
the vaccine is definitely safe for all these severe outcomes. But what
the vaccine is good for is preventing the infection which you have,
again 95% divergence with the two mRNA vaccines .

Now that people are getting more versed in all this a nd this is what
the importance of science educatio n and social media education is
because you can hear one thing on a news, but oftentimes you're not
able to ask further questions. But if you engage on social media, and
explain, in a very understandable way as not just medical journals I
think it builds t rust. And I think social media can be used for a power
for good to build trust in vaccines.

Mark MassellIi: We're speaking today with Dr. Eric Feigl e - Ding , Epidemiologist , Senior
Fellow at the Federation of American Scientists, a global think tank
dedicate d to using science and scientific analysis , to make the world
more secure. He was a professor and researcher at Harvard.

Eric, I want to go back to your prescient year ago. And right now we
have the variants that are out there. And I guess, this is not a m edical
term, they're scaring the heebie - jeebies out of many people, because
the more we hear the less we know.

On one hand, you have the UK variant, which at some point sounded
like it was the vaccine could manage it. And then you're hearing that
the South African variant might be a little more challenging . But still
manageable by the vaccine , b ut at the same time, M o derna says, “ Oh,
by the way, we're already starting to develop a booster shot ” which
probably doesn't leave a lot of comfort in people's minds .

Can you clear up some of the mystery around the variants , just how
people should be thinking about it? And what are some good sources
of information a nd the reality is we may see more mutations,
particularly as we haven't vaccinated enough people to prev ent this
virus from mutating .

Dr. Eric Feigle - Ding: Right . So the UK variant also known as B . 1 . 1 . 7, was identified, I would

Eric Feigle - Ding

say, actually, because UK does a lot of sequencing. And one of the
things we learned early on , “ no testing no pandemic ”. In here it 's also
similar “ No sequencing, no mutations ” , and UK found it early, but we
quickly found additional variants in South Africa , in Brazil .

South Africa and Brazil one have a special mutation that seems to
evade the antibodies from previous convalescent pat ients, as well as
the vaccine . A lthough I would say that evasion of a vaccine antibodies
is actually weaker than the evasion of convalescence, because we
know that the vaccine is stronger, provides a stronger immunity than
those with previous infection, wh ich is a good thing and a reason to
take the vaccine .

The vaccine provides, especially the mRNA ones, pro vide 95%. If you
see a small drop, I would just say it's probably 5 %, 10%, 15% drop
max. And just for perspective, before we have any vaccine, we were
just hoping and praying . We would have one vaccine of 50%. The fact
that we ended up with a 95% , two 95% vaccine, I think that's really
great news.

But what drives varian ts is if you have people who are
immunocompromised and take too much monoclonal antibo dies ,
overuse of convalescent plasma, it's also a driver. And this is
controversial because a one dose vaccine out of two , instead of both
of them, actually yield us partial immunity, that allows the virus to
mutate, which worries a lot of people because U K can't even
guarantee everyone will get their second shot within 12 weeks when
they should have gotten it within four.

But the good thing is that the vaccine does work, we can update the
vaccine as necessary. And we're getting really good at that. And
the re's something still called public health measures, mask wearing ,
distancing, and especially attention to the fact that the viruses is an
aerosol airborne , recogni z ing that will allow us to reduce the
transmission fast enough until the vaccine rates are hi gh enough to
protect all of us.

So vaccines will be ultimately our solution. But until we get to high
enough vaccination rate, which we know for the world will take some
time, we still have to do very careful distancing, and control
measures.

Margaret Flin ter: Well, Eric, I was stunned to read that Australia announced that it ha s
had zero new cases , i n the last 10 days , it seems almost unbelievable.
And as you say, we have these tools available to us , w e have the
vaccine now . We have masking, we have social distancing, we have
testing to monitor , we have contact tracing, as well. Is it even possible
to imagine that we might see a day within the next few years where
we can say zero new cases in the last 10 days? Or do you anticipate

Eric Feigle - Ding

that even with widespread vaccination that this is going to be the kind
of infection that we see hotspots and pockets around the country
r eally for several years to come . What's your sense of that , i s it
possible to really extinguish it?

Dr. Eric Feigle - Ding: Well, for I think this year, it will still be quite a while until we defeat it
down to a very, very low level. The ultimate question is, will we
extinguish it for good like smallpox or will it become endemic in which
it becomes a seasonal virus. And I think that is simply a cho ice of our
sheer political willpower, and public health funding levels to achieve
it.

Obviously, the last mile into fully extinguish the last 1% of the cases
will be obviously a lot harder than the early number of cases. But this
is what we want. Do we wan t to live with this virus as a virus that
comes and goes, most adults will have immunity from some sort, but
children will carry it every once in a while, because they don't have
previously seen this virus before. And, of course, it hits an elderly
person who was unlucky ? O r do we want to get rid of it for good?

Defeating smallpox was especially the last pockets of smallpox were
not easy. D . A. Henderson he led the initiative and what they did was
for every outbreak, they quickly lockdown the ir village or t own and
immun iz ed everyone , hyper - immuni z ed everyone and quarantine d
the whole town , until they're sure that is gone. And then they did that
from place to place , village to village until they extinguished it.

Do we have the willpower to do that? If you hav e good leadership and
state corporation of course, yes, we can. But if we don't have the
willpower, the political will and the social will to do it, then it will
become a resident virus long term. And this is why the zero - COVID
approach, I believe in New Z ealand and Australia and 14 day
quarantine for anyone entering the country, which we do not have in
this country, for example, is what is needed, but it is a matter of
political will.

Mark MassellIi: Margaret, you were mention ing Australia and I have some friends
who are doing musical theatres because that's the only place that you
can sort of launch them , but they have a very strict standard. If it goes
above that the whole thing is shut down.

So I'm wondering a couple of things. (1) , what's the level of i mmunity
that people get when they get the virus ? And we know that they're
going to be on kids . We know that they're still haven't gotten the end
that they need to start a new clinical trial. But talk about that,
because at the end of the day, we're probabl y go ing to have to get a
vaccine. Even if its low lethality for kids, we're probably go ing to want
to develop a vaccine on that. So a couple of things about going on
there. But, take them --

Eric Feigle - Ding

Dr Eric Feigle - Ding: That's a really good question. So first of a ll, the children's vaccine
question . We will have it, it just takes longer, because what they need
to do is adjust the dosing for kids , because kids range from 15 year
olds down to toddlers. And the dosing has to been very, very precise.
And then of course there's some countries like China, where they
think they will probably get pediatric vaccine trial data returned by
March . While some of the others countries, it will take longer likely
in to the summer.

And as opposed to the immunity, the immunity, first of all depends,
well, first of all, are there going to be more evolution and mutations
of the virus? If so, we clearly, it's shown that the Brazil and South
Africa variants that can invade antibodies, if we have those, we're
going to be in a little trouble , because past infection will not prevent it
entirely.

In fact, in the South Africa Study, half the people who were previously
infected and tested with the new virus, they had complete immune
escape from those people's blood, which means it had no effect o n
half of the people. And so they're susceptible to reinfection. And
that's what the South Africa, CDC declared. But in general, assuming if
we don't have new hyper mutations that cause this significant drift or
escape from the immune system, we should be protected pretty well.
But again, some people are severe, and those who have severe cases
develop stronger antibodies, those who had mild asymptomatic cases,
oftentimes weaker antibodies. So in terms of previous infection, it's a
very hodgepodge uncertaint y.

But a vaccine gives you a constant high dosing . And the mRNA
vaccines are designed to pump out a high , high number of these spike
proteins for you to recogni z e. And they're more effective than
monoclonal antibodies because it teaches you , how to recogni z e all of
the spike protein. And so that's why all the data in the Phase 1, Phase -
2 trials, and these new mutation studies show that the vaccine has
stronger immune response than past convalescent patients.

So again, natural herd immunity is not the best w ay to go in addition
to the risks of it, but especially for protection, long term vaccines are
the best. And vaccines can be updated. And we will have the new data
for children very soon, too.

So we're live in a brave new world, I'm glad in certain ways th e
pandemic didn't hit 10 , 15 years ago. I'm glad in certain ways we
should be grateful that we in a world that has Zoom technology that
can keep half the economy going and collaborat e across all distances
of the world. And we have the technology to produce such high
advanced vaccines so quickly, and at such precision.

Margaret Flinter: We've been speaking today with Dr. Eric Feigl e - Ding, Epidemiologist

Eric Feigle - Ding

and Senior Fellow at the Federation of American Scientists learn more
about his work by going to FA S for F ederation of American scientists
fas .org/experts/eric - feigl - di n g Or follow him on Twitter @ DrEricD i ng.

Eric, we want to thank you for your tenacity and tackling the
mountain of emerging pandemic information and the clarity with
which you communicated it ou t , for giving us all a glimpse at the
rapidly evolving science around this incredible pandemic a nd for
joining us today on Conversations on Health Care .

Dr Eric Feigle - Ding: Thank you so much.

[Music]

Mark Masselli: At C onversations on Health Care we want our audience to be truly in
the know when it comes to the facts about healthcare reform and
policy . Lori R obertson is an award winning journalist and Managing
Editor of F act C heck .org a nonpartisan, nonprofit consumer advocate
for voters that aim to reduce the level of deception in U . S . politics.
L ori , what have you got for us this week?

Lori Robertson: As Coronavirus cases spiked in December , states began vaccinating
individuals throughout the United States. Let's look at how the
vaccines are being administ ered and what we know about their
safety ? So far, the Food & Drug Administration has authori z ed two
vaccines, one from Pfizer and BioNTech and another from M o derna.
Both require two doses and had an efficacy of 94% or higher in clinical
trials. States can make their own decisions on prioriti z ation, but most
are following guidance from the Cent e rs for Disease Control and
Prevention Advisory Committee on Immuni z ation Practices , which
concluded that the first vaccines should go to the nation's 21 million
healt hcare personnel and 3 million residents of long - term care
facilities. The next prioriti z ed groups include those 75 years of age and
older and frontline essential workers. Following that are people
between the ages of 65 and 74 a nyone younger who has a high - risk
medical condition and additional essential workers.

All of this means vaccine doses are unlikely to become available to the
general public for several more months. As for side effects, trial data
show that many people experience pain at the site of i njection,
fatigue, joint or muscle pain, headache, chills or fever. These reactions
are more likely after the second dose , given several weeks after the
first , and more common and severe in younger people. The FDA
recommends that those who have had a serio us allergic reaction to a
previous dose of either vaccine skip the shot.

The CDC is also investigating and has advised that anyone who has
previously experienced Anaphylaxis be monitored for a half hour after
getting the shot. Everyone else should be monit ored for 15 minutes.

Eric Feigle - Ding

And that's my fact check for this week. I'm L ori Robertson, Managing
Editor of FactCheck .org .

Margaret Flinter: FactCheck.org is committed to factual accuracy from the country's
major political players and is a project of the Annenberg Public Policy
Center at the University of Pennsylvania. If you have a fact that you'd
like checked, email us at C HCR adio .com we'll have F act C heck.org ’s
Lori Robertso n , check it out for you here on C onversations on H ealth
C are.

[Music]

Mark Masselli: Each week C onversations highlights a bright idea about how to make
wellness a part of our communities and everyday lives .

One in five Americans will suffer a diagnosable mental health
condition in a given year, and most often don't seek treatment. For
those wit h serious mental health conditions , t he consequences can be
devastating. Seeing a rise in mobile apps aimed at behavioral health
entering the marketplace, University of Washington researcher , Dror
Ben - Zeev thought a comparative effective analysis study wou ld be a
good idea.

Dror Ben - Zeev: The three year comparative effectiveness trial , having a head - to - head
comparison between a mobile health intervention for people with
serious mental illness called FOCUS , and more traditional clinic - based
group interventio n called W RAP or Wellness Recovery Action
Planning. So it's conducted at a clinic setting. So the study really gets
at some of the core differences between mobile health and clinic -
based care . Is there something about the mobile health approach that
would make it more accessible or less accessible ?

Mark Masselli: More than 90% of the mobile app group engaged in the online
program, which was a series of text messages, offering coping
strategies and self - monitoring of symptoms, along with weekly call - ins
with a behavioral health clinician .

Dror Ben - Zeev: The second thing we wanted to see is after people complete care,
what are their subjective ratings of their experience and treatment ,
are they satisfied with both intervention? And probably the most
important piece of the study are the clinical outcomes. So we
measure to see whether involvement in both interventions for 12
week period , would that create some sort of difference in psychiatric
symptom severity, and 90% of the individuals who were randomi z ed
into the mobile health arm , actually went on to meet a mobile health
specialist , to describe the app to them and train them how to use it.
And whereas in the clinic - based arm, we saw that only 58% of the
participants assigned to that clinic - based intervention e ver made it in
for a single session.

Eric Feigle - Ding

Mark Masselli: Ben - Zeev says this suggests that mobile therapies may provide a
useful tool for clinicians having trouble getting those with serious
mental health issues, to engage with the clinical interventions.

Dror B en - Zeev: So we know that the very existence of a group can be quite helpful.
But for others, the interaction is anxiety provoking . When it comes to
the clinical outcomes , i n both intervention arms people improved,
both in terms of reduction in their sympto ms and the distress
associated with symptoms and improvements in their recovery .

Mark Masselli: A targeted mobile app aimed at facilitating access to clinical care for
those experiencing serious mental illness symptoms, improving access
to intervention for behavioral health needs. Now that's a bright idea.

[Music]

Mark Masselli: You've been listening to Conversations on Health Care. I'm Mark
Masselli.

Margaret Flinter: And I'm Margaret Flinter.

Mark Masselli: Peace and Health .

[Music]

Female : Conversations on Health Care is recorded at WESU at Wesleyan
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