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Allan Thoen's avatar

You know what would go a long way towards answering a lot of these questions, like long covid and more? If everyone's medical records were kept in longitudinal consolidated databases, that can be aggregated, searched with algorithms to spot trends and correlations, etc.

Why don't we have that? In significant part because of overblown privacy fears that get the cost-benefit analysis wrong, loading up the cost side with vague, theoretical, hypothetical fears and dismissing likely concrete benefits.

The government is too hobbled and bureaucratic to get it done, though the recent interoperability rules for medical records are a big step towards making it possible for private companies to do it. Since the government can't/won't do this itself, it should get out of the way and focus on removing barriers and helping private companies do it responsibly, such insurance companies and vertically integrated IDNs. There's an enormous public health payoff if this can get done.

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James C.'s avatar

In the beginning of the pandemic, NIH issued a few NOSIs (Notice of Special Interest) for proposals on broad questions of SARS-CoV-2, including molecular biology and etiology. These dried up within a couple of months, even before their expiration as the small amount of money allocated was already spent. Now the only NOSIs are around downstream effects of COVID, messaging to underserved populations, and the like - nothing on biology or new treatments: https://grants.nih.gov/grants/guide/COVID-Related.cfm#active

In 2020, I submitted an R21 (two-year grant for exploratory research - $275k) to NIH on one of the SARS-CoV-2 proteins, for which we had a couple of publications already. It wasn't funded with the feedback being "there's already too many people working on this". Totally fair on the merits, but you might have thought in the first year of the pandemic that NIH would have wanted more people turning their research to SARS-CoV-2.

Talking to others, mine was a common experience. A collaborator had already developed a promising small-molecule inhibitor that not only worked in vitro against the virus, it even worked in a small humanized mice trial. They submitted an R01 (typical 5-year NIH research grant - ~$2m) proposal, which was not funded with typical stock criticisms.

Now, I don't want this to come off as a "woe is me" post; this isn't to say that my or my collaborator's proposals should have been funded no questions asked! But it's not just us. Having been on the other side of the equation, reviewing proposals for NIH in the last year, I can say there was no special attention paid to COVID-related proposals (if anything, it was more like an eye-roll at yet another one).

Maybe this is kind of self-serving, but it seems a bit tragic to me that after spending trillions of dollars to manage and mitigate the effects of COVID, we can't shake loose even a few billion for basic research.

Addendum: I have defended NIH before as the best way to decide what projects should be funded, and I still contend it's significantly better than the private grants that a lot of people are fond of. My complaint is that the high-level decision makers (e.g., Congress) didn't really prioritize SARS-CoV-2 research.

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