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Xihong Lin: On the Front Lines of COVID-19 Research

1 September 2022 No Comment
Kim Gilliam, ASA Marketing and Communications Coordinator

    In January 2020, the World Health Organization announced a mysterious coronavirus-related pneumonia in Wuhan, China, the capital and largest city in Hubei Province. Very quickly, Wuhan made the extraordinary move to shut down access to the city and isolate its population of 11 million from the rest of the country.

    Xihong Lin, biostatistics and statistics professor at Harvard University, became concerned about her former post-doctoral fellow, Chaolong Wang, who was on faculty at the Tongji School of Public Health at the Huazhong University of Science and Technology in Wuhan. She texted to check in on him and his family.

    Wang shared that he and a colleague were analyzing the Wuhan COVID-19 data. Lin says, “We already had a case in Seattle and one in Boston, so intuition told me this disease might spread and I decided to join them on this research. As spread can happen very quickly, one must react very quickly, otherwise—as we know—it will be hard to control.”

    The research was a steep learning curve for Lin and Wang because they did not have an infectious disease background, but people who did were part of the team. “We were learning on the fly, but we were determined because we could see this becoming a public health emergency that could have a devastating impact on the world. The team members worked day and night with the goal of sharing the findings to help the world understand what happened in Wuhan and the steps it took to control the outbreak,” says Lin.

    A preprint of their work was posted on MedRxiv on March 8, 2020, and distributed worldwide. It was later published in JAMA and Nature and featured in a “behind-the-paper” story in Nature Portfolio.

    Educating Harvard and Beyond on COVID-19

    By the end of February, Lin had a meeting with Harvard leadership. She shared the major epidemiological findings of the research and Wuhan’s public health intervention approaches to fighting COVID-19. “At the time, Harvard was contemplating what do with its students considering the COVID threat. I was glad that our Wuhan study findings were helpful to the university in these critical early days. Harvard was among the first to send students home,” says Lin.

    On March 13, the last day before Harvard went remote, Lin gave a Zoom webinar to the Harvard community about the Wuhan study findings. “I emphasized that, without public health interventions, COVID-19 was very transmissible. I presented the containment steps Wuhan took—from the city lockdown to quarantine and isolation. I also highlighted the extensive personal protective equipment (PPE) used by medical personnel in Wuhan, which included face shields, and indicated that the PPE used by US health professionals was insufficient.”

    Lin’s slides were widely distributed that weekend and, by Monday, there was a national campaign for PPE by physicians. “There was no COVID PPE protocol in place for physicians, and there was not enough PPE to meet their needs,” says Lin. “Many physicians reached out to me and were worried, as they were not required to wear masks and did not know what type of PPE was appropriate.”

    Xihong Lin is flanked by her postdoctoral fellows and student mentees at the Harvard T.H. Chan School of Public Health in 2018.

    A postdoc in Lin’s lab translated the PPE guidelines used in Wuhan from Chinese to English, and her new physician friends edited and shared them with their community. “Back then, physicians didn’t know what to wear—a surgical mask or the N-95,” Lin says. “We now know. It was amazing to see how a little statistical talk could spur this kind of effort to help the community.”

    Lin soon had the media reaching out. She received many invitations for interviews from major media outlets on the Wuhan study findings and strategies to battle the pandemic. “One of the challenges was how to effectively communicate our findings to the general public and policymakers. I hope the ASA can provide media training for statisticians in the future, as public communication skills are very important,” says Lin.

    She clearly remembers a BBC Radio 4 interview in which she was told by the host before going on the air that the people listening to the show were families with children eating breakfast. She also testified before the UK Parliament’s Science and Technology Committee on COVID-19 response in April 2020. “I learned that I needed to convey what the data showed about COVID but communicate without jargon, says Lin. “I had to keep the message simple, short, and focused so the audience can understand in two minutes.”

    Lin was then asked to serve on the COVID-19 Massachusetts State Task Force. She worked with the members to develop recommendations for Gov. Charlie Baker on testing, isolation, quarantine, and contact tracing, in which the state invested a significant amount of money. She also worked with the Broad Institute of MIT and Harvard, a biomedical and genomic research center, on COVID testing. Testing capacity was extremely low then and, working together, the Broad took COVID testing capacity from zero to more than 35 million people by July 2022.

    “It was hard to believe that a shortage of testing swabs was a significant problem in spring 2020,” Lin says. She found herself taking a masterclass in logistics. Working in tandem with various people, businesses, and the state of Massachusetts, swabs and PPE were shipped their way after passenger planes were converted into cargo flights from China. “It was truly a team effort, and everyone went out of their way to make it happen,” recalls Lin.

    ‘Let the Data Speak’ Is Not Enough …

    One of the big challenges was global implementation of the containment strategies. “The implementation science is critical,” says Lin. “Based on the research, we knew the effective public health intervention strategy that works, and the WHO and many public health researchers were onboard, but the problem is many of the containment strategies are not one-size-fits-all. Implementation can vary from one country to another and one culture to another.”

    “The data science is important, but it’s not enough,” says Lin. “People’s behaviors are very difficult to change. Even if you have the data that shows the intervention works, including something as simple as wearing a mask. Implementing them in the real word is hard.

    “If biostatisticians and statisticians want to make an impact in the world, we must learn how to effectively communicate with the policymakers and the general public on scientific findings, build public trust, and engage them in implementing these recommendations. We also need to work with all the stakeholders to ensure implementations are country and region specific. We can have the most beautiful data findings, but if they cannot be implemented, it will be impossible to have an impact.”

    Lin’s postdoctoral fellows Corbin Quick and Rounak Dey later took a lead in developing and applying epidemic dynamic modeling methods for analysis of the US COVID-19 data. Their work was published in JASA as a discussion paper. They found the US COVID-19 data had many complications.

    Lin sees the need for improvements in data collection and reporting infrastructure. Public health research relies on access to good data and the ability for research teams to share data and collaborate. She says, “If we don’t invest in public health infrastructure, we suffer and the price we pay is big.”

    Although the last few years have been challenging for Lin, the collaborative work has been incredibly gratifying. “Everyone was a volunteer, and so many jumped in without thinking about receiving credit. They just wanted to help. There was an amazing community spirt,” says Lin.

    She adds she was excited by how many people in the general public became interested in science during the pandemic. When she posted her preprint on the Wuhan study on Twitter, she gained thousands of followers in a brief time. She also earned the blue verified badge on the platform, which lets people know an account of public interest is authentic, notable, and active. Be sure to follow Xihong Lin at @XihongLin.

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