Breakdowns of the year.

What went wrong in the world of science.

Scientists call 'endemic' message premature.

As pandemic restrictions lift, virus tracking and preparation for next variant may suffer.

Survivors′ burden

A review. The lungs are ground zero in serious infections by the SARS-CoV-2 coronavirus. But scientists and physicians are realizing that in the minority of people who become gravely ill, the disease′s reach can extend to many organs including the heart and blood vessels, kidneys, gut, and brain. The virus′ damage may be due to direct invasion of some organs. But a catastrophic, overzealous immune response to infection known as a cytokine storm is likely responsible for some patients′ rapid downhill slide. And an increased tendency of the blood to clot, leading to strokes and other complications, also seems to be playing a role. This snapshot surveys the state of knowledge about how the coronavirus does its damage throughout the body, with the caveat that scientists′ understanding is imperfect and changing fast.

Pandemic could add noise to clinical trial data

Myron Cohen has run clinical trials through hurricanes and civil unrest. Now, the infectious disease researcher at the University of North Carolina, Chapel Hill, who co-leads a network of HIV prevention trials, is trying to persevere through coronavirus lockdowns. Some trials are continuing, he says, because “stopping would be of grave consequence” to participants. Study teams have shipped protective equipment to clinical trial sites, secured permits where necessary for participants to leave home, and arranged private transportation to avoid public buses. Hundreds of clinical trials have paused new enrollment during the pandemic (Science, 20 March, p. 1289). But like Cohen, investigators across diverse fields have managed to keep treating enrolled patients who might benefit from experimental therapies. Now, research teams are contemplating how the pandemic might insert itself into their results. Could effects of the outbreak—including less consistent follow-up visits, reduced movement, or poorer mental or physical health—blur the statistical signals of a treatment's risks and benefits?

Would everyone wearing face masks help us slow the pandemic?

As cases of coronavirus disease 2019 (COVID-19) ballooned last month, people in Europe and North America scrambled to get their hands on surgical masks to protect themselves. Health officials jumped in to discourage them, worried about the limited supply of masks for health care personnel. “Seriously people-STOP BUYING MASKS!” began a 29 February tweet from U.S. Surgeon General Jerome Adams. The World Health Organization and U.S. Centers for Disease Control and Prevention (CDC) have both said that only people with COVID-19 symptoms and those caring for them should wear masks. But some health experts, including the director of the Chinese Center for Disease Control and Prevention, think that’s a mistake. Health authorities in parts of Asia have encouraged all citizens to wear masks in public to prevent the spread of the virus, regardless of whether they have symptoms. And the Czech Republic took the uncommon step last week of making nose and mouth coverings mandatory in public spaces, prompting a grassroots drive to hand make masks.

Cellphone tracking could help stem the spread of coronavirus. Is privacy the price?

“IT IS POSSIBLE TO STOP THE EPIDEMIC.” That’s the message splashed atop a website built by a University of Oxford team this week to share new research on the spread of the novel coronavirus. Below that hopeful statement comes a big caveat: To stop the virus’ spread, health officials need to find and isolate the contacts of infected people—lots of them—and fast. Such contact tracing is a mainstay of infectious disease control. But the Oxford team is one of several now advocating for a new approach: tapping into cellphone location data to track the spread of infection and warn people who may have been exposed.

Clinical trials press on for conditions other than COVID-19. Will the pandemic’s effects sneak into their data?

Myron Cohen has run clinical trials through hurricanes and civil unrest. Now, the infectious disease researcher at the University of North Carolina, Chapel Hill, says he and his colleagues are in a new situation: trying to carry out large, international trials in the midst of coronavirus lockdowns. Cohen co-leads a network of HIV prevention trials, some of which have paused during the pandemic. But for other studies, he says, “stopping would be of grave consequence” to participants. So study teams have bought and shipped protective equipment to personnel at clinical trial sites, secured special permits where necessary for trial participants to leave their homes for medical visits, and arranged their private transportation to avoid public buses. Not all clinical trials have had to go through such logistical gymnastics. But across diverse fields, investigators have managed to keep treating patients who might benefit from experimental therapies. Slowdowns and pauses in recruiting new participants will delay results—but for many studies, data are still flowing in.