The Next Time

As we continue to fight the current covid pandemic caused by the SARS-CoV-2 virus, it’s not too early to begin thinking about the next pandemic.  I’ve been mulling this over for a while, and I was prompted to write this post by a twitter thread from Michael Baym.

Michael wrote about some work that he and Kaylee Mueller started, early in the pandemic, to develop a rapid colorimetric assay for covid.  They decided to curtail their work, however, when the personal risk of continuing to work in the lab seemed too great. But Michael is now wisely looking ahead, thinking about what science can do to respond even more quickly to the next pandemic.

Last February, as most of the world was just waking up to the threat posed by covid, I wrote a post with words of wisdom for pandemic preparedness. The words were written by a former Secretary of the US Department of Health and Human Services, Michael O. Leavitt, in 2007, who at that time was especially concerned about the potential for an influenza pandemic. He said: “Everything we do before a pandemic will seem alarmist. Everything we do after a pandemic will seem inadequate. This is the dilemma we face, but it should not stop us from doing what we can to prepare.”

So congratulations, and thanks, to Michael and all the others who are looking ahead. But really, all of us need to look and think ahead, using our hearts as well as our minds. 

Almost exactly a year ago, I was very worried about how hard this country would be hit by the pandemic.  I wrote:  “I think it is entirely possible, maybe even likely, that Europe will get hit harder by the coronavirus than China has been hit, and the US may get hit even harder than Europe.” 

I suggested that a number of epidemiological and sociopolitical issues would contribute to the United States being especially hard hit by the pandemic.  Among the former, “China’s outbreak started from a single point source in Wuhan … The US, meanwhile, has gotten many independent seeds both from China and from Europe … hundreds or even thousands of smoldering embers at first, most growing unseen and uncontained …”  Among the latter, “here in the US, we have deep social divisions, widespread skepticism of expertise (often fed by those divisions), an extremely complex political landscape with federal, state, & municipal layers of government … and many independent-minded people who are inclined to disregard advice and instructions—a wonderful attitude some of the time, but an exceptionally dangerous attitude during a pandemic.”

My worries about the next pandemic have been leaning to the problems of social division and disregard for evidence.  As terrible as this pandemic has been, the next one could be worse … even much worse.  How will people react if the next pandemic is 10 times more deadly than covid?  What if the next outbreak causes disproportionate mortality in kids or young adults?  Would the (mostly) right-wing denialists still refuse masks? Would anti-vaxxers (on the left & right) still oppose vaccination?

So, Michael Baym is right to be thinking ahead, as was Michael O. Leavitt. As a nation, we need to commit resources to support science (including the basic sciences that lead to breakthroughs in medicine) as well as our often neglected public-health system.  But we also need to find ways to come together as people, to overcome the sometimes willful ignorance, and to discuss things in a meaningful, non-conspiratorial way. 

Science and public-health workers can only do so much. The rest is up to all of us to protect ourselves, our families, and our communities from covid … and from the next pandemic … and from ourselves.

An Engineering Perspective on Accelerating Vaccine Distribution

by Daniel Lenski

Key Points:

• We can continuously prioritize vaccination of the most at-risk populations, and at the same time immediately offer remaining vaccine doses to lower-priority recipients.
• We can plan for optimal inter-dose timing for 2-dose vaccines without holding back half the supply of those vaccines.
• We can build a system to maintain consistent levels of availability and prioritization in all regions of the country for the months and years it will take to produce enough vaccines for near-universal immunization.
• The field of industrial engineering offers well-studied and proven techniques to accomplish this.

---

The rapid design, development, and validation of multiple safe and highly effective vaccines for COVID-19, by scientists in the US and around the world, has been a stunning achievement. Our challenge has now pivoted to the task of inoculation against this pandemic disease.  How quickly can we produce and deliver sufficient vaccines to maximize protection of life and health, offering the hope of returning to more normal lives and economies? 

Vaccine manufacturers AztraZeneca, Pfizer, and Moderna expect to produce enough vaccine to inoculate only one-third of the world’s population in 2021,^[1] and the US expects to receive enough to inoculate only 50 million Americans by the end of March.^[2]  Production will certainly limit the rate at which we can achieve a high level of immunity in our populations, but the slow roll-out of vaccination in the USA underscores how much we must also optimize delivery.

As of January 11, 25.5 million doses have been provided by the US government, but only 9 million doses (35%) have been injected into the arms of willing and available recipients.^[3] Vaccine stockpiles continue to grow, indicating clearly that delivery, not manufacture, is currently the bottleneck. Delays have been ascribed to insufficient guidance and funding for states and cities, limited and confusing schedules for vaccination appointments, and confusion about current prioritization schemes.  In an example of the floundering, one week ago New York governor Andrew Cuomo instituted harsh penalties both for providers who vaccinated ineligible recipients and for providers who allowed doses to expire or otherwise go to waste. These requirements of maximally efficient utilization and strict prioritization are both logical and important, but they are inevitably in tension with each other. In the absence of clear and simple guidance for how to resolve this conflict, it is unsurprising that these dual mandates have led to a very low pace of vaccination in New York.

How should a program of mass vaccination operate amid a deadly pandemic? What should its goal be, day in and day out, from individual vaccine providers to cities and states to the country as a whole? The goal, as I see it, is to get vaccine doses into every willing recipient^[4] while consistently ensuring that the most vulnerable, at-risk groups have prioritized access, and at the same time dispensing vaccines as fast as they can be produced.  A vial of vaccine sitting in a freezer for days or weeks, awaiting the arrival of a high-priority recipient, does no good for anyone. In contrast, vaccinating any human right away will eliminate a vector for the spread of the disease, and move all of us one step closer to ending the pandemic.

The field of industrial engineering can provide us with crucial techniques and tools to sustain a balance between rapid delivery and prioritization for the months and years ahead.  From 2015-2020, I worked with semiconductor factories in the US and around the world providing advice and software.  Our services addressed problems such as: maximizing throughput by identifying and removing bottlenecks in multi-step processes; making efficient use of scarce resources, including time, labor, and raw materials; prioritizing completion of urgently-needed output; and adhering to constraints in the relative timing of critical steps to ensure quality and reliability.

The problems of vaccine delivery are strikingly similar: for maximum efficacy, the Pfizer vaccine’s two doses should be delivered 21-28 days apart^[5]; it’s critical to vaccinate at-risk groups early on^[6]; all currently approved vaccines require storage and transportation in expensive deep freezers, must be thawed in multi-dose batches, and expire wastefully if not dispensed quickly.

The tradeoff between prioritization and maximally efficient use of time and materials, illustrated by Governor Cuomo’s orders, is a glaringly obvious one to industrial engineers. If a strict sequential order is followed, the next recipient may not be available in time to use the next vaccine dose (leading to expiration and waste), while giving the vaccine on a purely first-come-first-served basis will maximize utilization but hinder rapid access for the highest-priority recipients. It is clear, however, that some members of high-priority vulnerable groups are either unable or hesitant to receive COVID-19 vaccination right now, while some members of low-priority populations are willing and eager to receive it immediately, but cannot due to lack of both eligibility and information about availability. Industrial engineering offers simple mechanisms to achieve an efficient and dynamic balance between these competing demands, such as by creating multiple priority queues at each vaccination provider and switching from higher- to lower-priority recipients immediately when the former are not present.

Experience from manufacturing can also clarify the problem of delivering second doses with optimal timing. Available quantities of Pfizer and Moderna vaccines in the USA were effectively halved by the initial plan to reserve a second dose of vaccine for each patient as soon as their first dose is administered. Some experts have recently suggested distributing all available 2-dose vaccines as first doses,^[7] reasoning that rapidly dispensing single doses will save more lives than a predictable but slow pace of second doses, while virologists warn that the reduced efficacy of single doses could have grave consequences in the longer term, by allowing vaccine-resistant variants of the SARS-CoV-2 virus to evolve and spread. In fact, neither reserving second doses nor abandoning their correct timing is necessary. Because future delivery of vaccine supplies to the USA is relatively predictable (at least in terms of the lower bound), an optimal steady-state solution is for providers to limit the rate at which they dispense first doses to half the rate at which they expect to receive future doses, which will leave them with sufficient supplies to consistently vaccinate patients returning for their second doses during the optimal time window.^[8]

Beyond the failure to balance between rapidly dispensing available vaccines and prioritizing them, along with a sub-optimal approach to reserving second doses, vaccine distribution in the USA appears gummed up by a pernicious combination of insufficient information about when and where COVID-19 vaccines are available, and complex paperwork and administrative requirements.^[9]

If the incoming Biden administration were to ask me to design a plan for rapid distribution of COVID-19 vaccine, my proposal would include the following elements:

• A national database to track vaccine inventory and rates of dispensation at the level of each provider, in near real-time. This will be crucial for determining the appropriate rates at which to resupply providers with more vaccine doses, so as to sustain and maintain inventory of vaccines across the country without developing geographical and temporal imbalances in inventory.
• First-come-first-served vaccine dispensation at the level of individual providers, with the crucial addition of multiple queues for patient intake, so that the most vulnerable can always receive the vaccine before others, no matter when they decide to get it.
• Training for all vaccination providers to implement the queuing system uniformly and consistently, along with minimal and consistent administrative requirements.
• A website to track wait times for each queue, at each provider, in near real-time. The availability of wait times at nearby locations will likely be crucial to motivate a continuous high rate of vaccine delivery, by allowing many Americans to seek out the vaccine on short notice when wait times are short for their eligibility cohorts.

Ending the COVID-19 pandemic through mass vaccination will present an extraordinary range of challenges for physicians, public health officials, scientists, politicians, and society at large. The tools of industrial engineering certainly cannot help with many of these challenges; however, they can help us achieve and sustain one crucial goal at all scales: getting vaccine doses into every available, willing human being as fast as they can be produced, while continuously ensuring that the most vulnerable people have the most rapid and streamlined access to the vaccine. I know that President-Elect Joe Biden’s COVID-19 task force will include epidemiologists, physicians, and virologists.^[10] I would encourage him also to appoint experts in industrial engineering and operations research, who can provide strategic guidance and tactical advice to speed up and smooth out nationwide vaccine distribution.

---

Appendix: A Specific Proposal

If the incoming Biden administration were to ask me to design a national vaccination program with the above goal of dispensing vaccines as rapidly as they are manufactured, while also continuously guaranteeing preferential access to prioritized populations, here’s what I’d propose. To simplify, I’ll assume that our present vaccine distribution bottlenecks are indeed overwhelmingly a “last mile” problem,^[11] and that there are no major logistical impediments to reliably delivering vaccine supplies to providers anywhere in the country within timescales of 1-2 weeks.

First, establish a national database of vaccine-dispensing providers, and a mechanism to log daily inventory for each provider. Apportion newly-manufactured vaccine among the states and territories, and from there down to the level of individual providers. The first round of apportionment will take some guesswork; in the interests of speed and simplicity, my strong inclination would be to apportion the first round simply by population. Subsequent rounds should be adjusted up and down based on past demand and current inventory, in order to prevent geographical and temporal imbalances in inventory.

Second, each provider should dispense vaccines on a first-come-first-served basis, but with multiple priority queues with extremely simple selection criteria. Age is the simplest and most easily documented criterion, and so I have used only that below. Other criteria, such as health-risk factors, occupation, and race or ethnicity have been proposed. However, more complex prioritization runs the risk of slowing down the process for everyone^[12], by turning “eligibility determination” into the rate-limiting step. Something like the following:

• Monday-Wednesday: 6 queues. One for recipients over 80 years age, one for 70+, one for 60+, one for 50+, one for 40+, and one for everyone else.
• Thursday: 5 queues. 80+, 70+, 60+, 50+, everyone else.
• Friday: 4 queues. 80+, 70+, 60+, everyone else.
• Saturday: 3 queues. 80+, 70+, everyone else
• Sunday: 2 queues. 80+, everyone else.

These queues should literally be lines that people who want the vaccine wait in, clearly marked according to the age criteria. During operating hours, patients should be free to join the appropriate queue at any time. Providers should accept and vaccinate all available patients from higher-priority queues before accepting any from lower-priority queues, but should immediately switch over to lower-priority queues if a higher-priority queue is empty. Example: it’s Tuesday, and there are 10 people in the 80+ queue, 30 in the 70+ queue, and 100 in the everyone-else queue. Providers should vaccinate all of the 80+ patients, then immediately start vaccinating all of the 70+ patients, then immediately start vaccinating “everyone else.” If two more 80+ patients arrive after that initial queue has emptied, they would be accepted and vaccinated immediately. Available vaccine doses should be logged daily to the national database. Acceptance of patients from each queue should be logged in real-time so that it’s possible to publish intake rates in real-time for each and every provider.^[13]

This scheme is intended to achieve the following results:

1. No matter when a higher-priority person decides to get vaccinated, they’ll be able to get it with less waiting than all lower-priority individuals.
2. Lower-priority individuals will not have to wait to receive the vaccine unless higher-priority recipients are waiting for it right now.
3. Wait times will be relatively measurable and predictable, encouraging people to drop in and get vaccinated when lines are short, and stay home when lines are long for their priority groups.
4. Vaccine will be dispensed continuously during the operating hours of each provider, ensuring minimal wasted or expiring doses. (Round-the-clock operation should be able to eliminate this entirely.)
5. This weekly cycle is intended to prevent overcrowding of lower-priority patients if there’s sustained high demand from higher-priority groups. For example, given the above prioritization scheme, few 35 year-olds will want to line up on Tuesdays. However, those who do will probably have very good reasons to endure a long wait for the possibility of vaccination, e.g. an immune-compromised family member. By later in the weekly cycle, the wait times and intake rates for the younger age groups should be more predictable based on previous days.

---

^[1]    https://www.nature.com/articles/d41586-020-03370-6

^[2]    https://www.nytimes.com/live/2020/12/15/world/covid-19-coronavirus

^[3]    https://www.nytimes.com/interactive/2020/us/covid-19-vaccine-doses.html

^[4]    Appropriately spaced when 2 doses are required, and excepting those with contraindications.

^[5]    https://www.biopharma-reporter.com/Article/2021/01/07/WHO-weighs-in-on-COVID-19-vaccine-second-dose-delay

^[6]    Modeling from Israel indicates that vaccinating the most vulnerable 7.5% of the population would reduce overall death rates by 75%. https://twitter.com/dwallacewells/status/1340397154683269123

^[7]    https://www.washingtonpost.com/opinions/2021/01/03/its-time-consider-delaying-second-dose-coronavirus-vaccine/

^[8]    This problem gets more complex when the rate of future availability is unpredictable, or when there’s a large build-up of current inventory.

^[9]    https://www.newsweek.com/senior-citizens-wanting-covid-vaccine-face-51-step-online-registration-process-1560622

^[10] https://www.forbes.com/sites/judystone/2020/11/09/president-elect-biden-names-new-covid-19-task-force–whats-the-enthusiasm-about/?sh=723ade8a458f

^[11]   https://www.reuters.com/article/health-coronavirus-vaccine-challenges-tr/analysis-covid-19-vaccines-raise-hope-but-the-last-mile-challenge-looms-idUSKBN28P124

^[12] https://www.wsj.com/articles/vaccination-by-age-is-the-way-to-go-11610476439?mod=hp_opin_pos_3

^[13]  Let’s say it’s Monday at 10 am. I should be able to pull up a page for the pharmacy at the corner of 10th & Elm street, and see that in the last hour:
80+ queue: 12 patients accepted, est. 2 currently in line (→ ~10 minute wait time)
everyone-else queue: 24 patients accepted, est. 20 currently in line (→ ~50 minute wait time)

---

Five More Years

The E. coli long-term evolution experiment (LTEE) began in 1988, and it has run for over 32 years with only occasional interruptions. The latest interruption, of course, reflects the temporary closure of my lab during the ongoing coronavirus pandemic. Fortunately, one of the advantages of working with bacteria is that we can freeze population samples and later revive them, which will allow us to resume their daily propagation when it is prudent to do so.  Indeed, we’ve frozen samples of all 12 populations throughout the LTEE’s history, allowing “time travel” to measure and analyze their fitness trajectories, genome evolution, historical contingencies, and more.

Even as the experiment is on ice, the lab team continues to analyze recently collected data, prepare papers that report their findings, and make plans for future work. Their analyses use data collected from the LTEE itself, as well as from various experiments spun off from the LTEE.  Nkrumah Grant is writing up analyses of genomic and phenotypic aspects of metabolic evolution in the LTEE populations.  Kyle Card is examining genome sequences for evidence of historical contingencies that influence the evolution of antibiotic resistance. Zachary Blount is comparing the evolution of new populations propagated in citrate-only versus citrate + glucose media. Minako Izutsu is examining the effects of population size on the genetic targets of selection, while Devin Lake is performing numerical simulations to understand the effects of population size on the dynamics of adaptive evolution.  So everyone remains busy and engaged in science, even with the lab temporarily closed.

Today, I’m excited to announce two new developments.  First, the National Science Foundation (NSF) has renewed the grant that supports the LTEE for the next 5 years. This grant enables the continued propagation of the LTEE lines, the storage of frozen samples, and some core analyses of the evolving populations. The grant is funded through the NSF’s Long Term Research in Environmental Biology (LTREB) Program, which “supports the generation of extended time series of data to address important questions in evolutionary biology, ecology, and ecosystem science.” Thank you to the reviewers and program officers for their endorsement of our research, and to the American public and policy-makers for supporting the NSF’s mission “to promote the progress of science.”

Second, Jeff Barrick joins me as co-PI on this grant for the next 5 years, and I expect he will be the lead PI after that period.  In fact, Jeff and his team will take over the daily propagation of the LTEE populations and storage of the sample collection even before then. I’m not planning to retire during the coming grant period. Instead, this transfer of responsibility is intended to ensure that the LTEE remains in good hands for decades to come. In the meantime, Jeff’s group will conduct some analyses of the LTEE lines even before they take over the daily responsibilities, while my team will continue working on the lines after the handoff occurs.

Several years ago I wrote about the qualifications of scientists who would lead the LTEE into the future: “My thinking is that each successive scientist responsible for the LTEE would, ideally, be young enough that he or she could direct the project for 25 years or so, but senior enough to have been promoted and tenured based on his or her independent achievements in a relevant field (evolutionary biology, genomics, microbiology, etc.). Thus, the LTEE would continue in parallel with that person’s other research, rather than requiring his or her full effort, just like my team has conducted other research in addition to the LTEE.”

Jeff is an outstanding young scientist with all of these attributes. Two years ago he was promoted to Associate Professor with tenure in the Department of Molecular Biosciences at the University of Texas at Austin.  He has expertise in multiple areas relevant to the LTEE including evolution, microbiology, genomics, bioinformatics, biochemistry, molecular biology, and synthetic biology. He directs a substantial team of technicians, postdocs, and graduate students, which will provide ample coverage for the daily LTEE transfers (including weekends and holidays). Last but not least, Jeff has participated in the LTEE and made many contributions to it including:

• Participated in propagating the LTEE lines and related activities while he was a postdoc in my lab from 2006 to 2010.
• Authored many papers using samples from the LTEE, including almost all of them that have analyzed genome sequences as well as several recent papers examining the genetic underpinnings of the ability to use citrate that evolved in one lineage.
• Developed the open-source breseq computational pipeline for comprehensively identifying mutations that distinguish ancestral and evolved genomes.

Someone might reasonably ask if the LTEE will work in the same way when it is moved to another site. The answer is yes: the environment is simple and defined, so it is readily reproduced. Indeed, I moved the LTEE from UC-Irvine to MSU many years ago, the lab has moved between buildings here at MSU, and we’ve shared strains with scientists at many other institutions, where measurements and inferences have been satisfactorily reproducible. As an additional check, Jeff’s team at UT-Austin ran a set of the competition assays that we use to measure the relative fitness of evolved and ancestral bacteria, and we compared the new data to data that we had previously obtained here at MSU. The two datasets agreed well, in line with the inherent measurement noise in assessing relative fitness. Fitness is the most integrative measure of performance of the LTEE populations, and it is potentially sensitive to subtle differences in conditions. These results provide further evidence that, when the time comes, the LTEE can continue its journey of adaptation and innovation in its new home.

Evolve, LTEE, evolve!

Meetings Large and Small

In this post, I will explain why it is important not only that we cancel large conferences and other events, we should also curtail medium and even small gatherings that are non-essential.

Joshua Weitz has done a great service by explaining how the probability that one or more participants in an event is infected scales with the size of the gathering. In brief, even when the vast majority of people are not infected, the chance that somebody is infected goes up as the number of participants gets larger. I think most people are also now coming to grips with the rapid growth of this outbreak, which means that a meeting with relatively low risk today might be a very bad idea a month from now.

But does this mean that medium-sized and small events can proceed without worry? No. Let me explain why even these events should be reduced to the bare minimum that are essential. Most of my readers are fellow scientists, so what follows is cast in the language of conferences and departmental seminars—but hopefully others can relate these to similarly sized gatherings in their own lives.

Ok, to begin. You’re very pleased to hear that the conference you had planned to attend next month was canceled. With 10,000 attendees, and with infections doubling every week, it was clearly smart to cancel such a large conference. But your departmental research seminar is attended by only 100 people. Surely that can safely continue, right?

If only your department had a seminar, and if it was a one-time event, then sure, why not. However, there are 25 other departments around the country in your field of study alone, and each of the departments has planned 4 weekly talks over the coming month.  Seen in that light, it’s like that large conference of 10,000 — except that its 25 x 4 = 100 events with 100 attendees each. In other words, there are 10,000 potential transmissions of the viral infection.

In general, as event sizes get larger (more participants), the frequency and number of those events becomes smaller.  I don’t have data to back this up (maybe somebody does), but I’d bet that the number of small gatherings increases even faster than the number of participants falls off.  For example, for every conference of 10,000 people, I expect there are even more than 100 meetings of 100 people.

Therefore, reducing non-essential gatherings of all sizes should be part of our individual and collective efforts at social distancing. It’s no fun, I know. But it’s one of the best ways we can ward off this beast of a virus, and thereby protect our colleagues, our friends and families, and our communities.

[This image shows the actor Rowan Atkinson (aka Mr. Bean). It is used here under the doctrine of fair use.]

The Lenski Lab Health Plan for the New Coronavirus Outbreak

The future is unknown, as it always is.  We do know that the SARS-CoV-2 virus is spreading around the globe, but we don’t know how many people will be infected.  Some experts are predicting that something like half of the adult population will be infected, although not all at the same time.  We also know that many cases are relatively mild (like a cold or the usual flu), and some infections may be asymptomatic. However, we also know that some other cases—perhaps 20% or so—are very serious, and some of those are life-threatening.

See MSU’s coronavirus page for University policy, information, and advice.

What can we do, as individuals and a lab group, to protect ourselves, our families, each other, our communities, and our research?  Here are my current thoughts, with an emphasis on activities related to our laboratory and our academic setting.

1/ If you haven’t done so already, get your flu shot. It won’t protect against the coronavirus, and it doesn’t provide perfect protection against the influenza virus, but it will reduce the chance of getting the flu (and save health-care resources for others in need).

2/ Make sure you and your household are prepared for a period of self-isolation or quarantine lasting 2 weeks, or perhaps longer.  This means stocking up on food staples and, importantly, any medicines that you and your household need.  For medicines, I suggest having at least a full month’s supply, maybe longer, in case there are disruptions to availability.  Talk to your doctor about extending prescriptions or any other special needs you might have.

3/ If you develop symptoms of a cold or flu—even mild symptoms—please stay at home and don’t come into the office or the lab.  We don’t want you to spread the infection.  Just email the group list to let us know what’s up, and work from home on your writing and reading if you feel up to it. You won’t impress me, or anyone, by trying to work while you’re sick.

4/ If a member of your household becomes ill, see and follow point 3 above.

5/ Let’s all start practicing more restrained physical interactions, and thus set good examples not only among ourselves but also for our colleagues and friends. That means skipping hugs and handshakes, for the time being.  Instead, you might put your own hands together and bow your head slightly to greet or congratulate someone. Or maybe an elbow bump, if you really must make contact.  Foot bumps are apparently another new thing, too.

6/ Be prepared to stop your lab work on short notice.  In the meantime, I guess March might be a good time to get a week-long or two-week experiment done, before the epidemic grows too large (if it does).  However, I suggest holding off, for the time being, on any plan to start a large and/or long experiment.

7/ Speaking of long experiments, you will recall that we have a certain long-term experiment in our lab.  The LTEE will soon hit 73,500 generations, at which time the samples will be frozen as usual.  After that date, I’d like population samples to be frozen more often, say, every 2 or 3 weeks.  Just freeze away a copy of each population (no need to plate cells)—basically, so we have samples to restart in the event that people get sick, or if the university should at some point curtail certain activities for a while.

8/ Be prepared to cancel your attendance at scientific conferences and other academic or social events as new information arises. Even if an event organizer decides to push ahead, you don’t have to go if you feel it is risky for you personally. As an aside, I recommend delaying purchases of airfares until an event is closer in time, given the current uncertainty.  (Refundable tickets on most airlines are very expensive, and other tickets have restrictions.)  Hotel reservations can usually be cancelled on shorter notice (a day or week, check to be sure), but not if they were booked through a discounter.

9/ And maybe the hardest advice of all is to practice good personal hygiene. Cover your mouth with your forearm or the inside of your elbow when you cough or sneeze unexpectedly.  (If you know you’re sick, then you should have disposable tissues handy. Use those to cover your nose and mouth completely, and dispose of a tissue after one use.) If you find yourself coughing or sneezing repeatedly, see point 3 above. Wash your hands thoroughly [Click that link, with the sound on, and stay for the end!] after you’ve touched shared surfaces, especially before eating. And most difficult of all, avoid touching your own face.  This coronavirus can survive for hours as tiny droplets on surfaces, which we may inadvertently touch (“fomite transmission”). Then, when we touch our mouth, nose, or eyes, we can infect ourselves.

10/ ADDED: Follow the news, and get your news from trustworthy, reliable sources. If it becomes clear that infections are spreading locally, or even if you are just concerned about that possibility, then avoid crowded public venues. (But this does not mean that you should follow the news obsessively, as that can be exhausting. h/t Carl Bergstrom.)

11/ ADDED: If you do isolate yourself, whether because of illness or concern, make sure to maintain frequent social contact with your family, friends, and the lab via phone, email, or whatever works best for you. Don’t let physical isolation and loneliness make you feel miserable. We are all stronger together, even if we might have to be physically apart.

12/ ADDED: Please read these Words of Wisdom, regarding preparedness for infectious disease outbreaks, from Michael Leavitt, a former Secretary of Health and Human Services.

13/ ADDED:  This one is for those of you in science or other relevant scholarly fields.  Do you have data in your lab notebooks and/or on computers accessible only in the lab?  Are the datasets ones that you might need for your analyses and writing if, say, you end up confined at home for a few weeks?  If so, I recommend that you copy it (but only if it’s allowed in the case of certain types of sensitive data!) by scanning it and/or copying it to your personal computer. That way, you can use it while working from home if you decide, or are required, to do so.

Take care everyone.  Please let me know of any errors, omissions, and practical suggestions.