Behavioral studies in era of COVID-19 raise new concerns about diversity

"The digital divide is undoubtedly going to get worse during this pandemic," says Emory psychologist Stella Lourenco. "This is a huge problem for ensuring equal access to education and to work, not just for ensuring diversity in scientific research."

By Carol Clark

The COVID-19 pandemic is accelerating an ongoing trend in cognitive psychology to conduct human behavioral experiments online.

“The world has been growing increasingly digital for a while,” says Stella Lourenco, a developmental psychologist at Emory University. “The global pandemic has turbo charged the move towards virtual connection in most areas of life, including psychology research.”

While the Internet offers a powerful tool for collecting data during a time of social distancing, it also raises new concerns regarding the diversity of study participants. Trends in Cognitive Sciences published an opinion piece outlining these concerns, authored by Lourenco and Arber Tasimi, a developmental psychologist at Stanford University who will be joining the Emory faculty in August.

The authors warn that as more research moves online, a growing lack of Internet access among low-income and minority communities may reduce the diversity of study samples, which would limit the ability to generalize scientific findings. As unemployment soars, more people may be forced to choose between paying their rent and buying food or paying for Internet service.

“The digital divide is undoubtedly going to get worse during this pandemic,” Lourenco says. “This is a huge problem for ensuring equal access to education and to work, not just for ensuring diversity in scientific research.”

In their opinion piece, Lourenco and Tasimi urge scientists and grant-funding agencies to join lobbying efforts for government subsidies for Internet service, and “perhaps even advocate for universal availability of Internet access, which is essential for living and operating in contemporary times.”

In some ways, the challenges to diversity presented by the pandemic are a new twist on an old problem, Lourenco says. In recent years, concerns were raised that participants in some in-person psychology studies were mainly college students who are younger than the general population and also tend to be better educated and from higher-income backgrounds and industrialized countries.

A move towards online experiments of human subjects, using crowdsourcing tools such as Amazon Mechanical Turk, was helping alleviate this problem. Online experiments can allow researchers to tap large numbers of participants in an efficient and cost-effective way. “With crowdsourcing tools, you can potentially reach adults from all over the United States, and in other countries, as long as they have Internet access,” Lourenco says.

Children present unique research challenges, Lourenco says, so studies involving them have remained largely in-person. For instance, children tend to grow restless more quickly than adults when they are asked to sit in front of a computer to perform tasks for experiments.

The pandemic, however, is driving more child development laboratories to go online for the first time, Lourenco notes. Platforms such as the Parent and Researcher Collaborative, an online crowdsourcing tool where labs can post studies for families to participate in, are providing infrastructure to support this trend.

As more studies go online, the pandemic is likely impacting Internet access among some groups. In the pre-pandemic era, even low-income people without home Internet might be able to visit a library, a coffee shop or even the parking lot of a restaurant with free wireless service to connect to high-speed Internet. The current situation makes those scenarios less likely to occur.

And the current situation may represent the start of “a new normal,” Lourenco and Tasimi write, “in which threats of disease may require long-term social distancing practices and may differentially impact those in low-income and minority communities.”

They recommend that researchers strive to provide temporary Internet connection to low-income participants, by purchasing mobile hotspots that could be mailed to them or dropped off at their homes. They also recommend that more scientific journals require authors to report detailed demographic information of study participants, whether the studies are conducted online or in person.

They further recommend considering the development of more mobile laboratories, equipped with personal protective equipment and disinfection protocols. Portable labs would allow off-site testing to reach participants in low-income and minority communities.

“I hope that the pressure that the pandemic puts on behavioral research will ultimately create positive changes in the field,” Lourenco says. “Ultimately, it highlights the need to become more sensitive about the demographics of participants involved in psychological studies and about any claims that are made about the generalization of data.”

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Scientists identify chemicals in noxious weed that 'disarm' deadly bacteria

"Nature is the best chemist, hands down," says Emory ethnobotanist Cassandra Quave, shown with berries from the Brazilian peppertree. The plant is native to South America where traditional healers in the Amazon have used it as a treatment for skin infections. 

By Carol Clark

Scientists have identified specific compounds from the Brazilian peppertree — a weedy, invasive shrub in Florida — that reduce the virulence of antibiotic-resistant staph bacteria. Scientific Reports published the research, demonstrating that triterpenoid acids in the red berries of the plant “disarm” dangerous staph bacteria by blocking its ability to produce toxins.

The work was led by the lab of Cassandra Quave, an assistant professor in Emory University’s Center for the Study of Human Health and the Emory School of Medicine’s Department of Dermatology. The researchers’ laboratory experiments provide the first evidence that triterpenoid acids pack a punch against methicillin-resistant Staphylococcus aureus, known as MRSA.

The Brazilian peppertree (Schinus terebinthifolia), native to South America, is also abundant in Florida, where it forms dense thickets that crowd out native species. “It is a noxious weed that many people in Florida hate, for good reason,” Quave says. “But, at the same time, there is this rich lore about the Brazilian Peppertree in the Amazon, where traditional healers have used the plant for centuries to treat skin and soft tissue infections.”

Brazilian peppertree

Quave, a leader in the field of medical ethnobotany and a member of the Emory Antibiotic Resistance Center, studies how indigenous people incorporate plants in healing practices to uncover promising candidates for new drugs.

The Centers for Disease Control and Prevention calls antibiotic resistance “one of the biggest public health challenges of our time.” Each year in the U.S., at least 2.8 million people get antibiotic-resistant infections, leading to more than 35,000 deaths.

“Even in the midst of the current viral pandemic of COVID-19, we can’t forget about the issue of antibiotic resistance,” Quave says. She notes that many COVID-19 patients are receiving antibiotics to deal with secondary infections brought on by their weakened conditions, raising concerns about a later surge in antibiotic-resistant infections.

In 2017, the Quave lab published the finding that a refined, flavone-rich mix of 27 compounds extracted from the berries of the Brazilian peppertree inhibits formation of skin lesions in mice infected with MRSA. The extract works not by killing the MRSA bacteria, but by repressing a gene that allows the bacteria cells to communicate with one another. Blocking that communication prevents the cells from taking collective action, which essentially disarms the bacteria by preventing it from excreting the toxins it uses to damage tissues. The body’s immune system then stands a better chance of healing a wound.

That approach is different from the typical treatment of blasting deadly bacteria with drugs designed to kill them, which can help fuel the problem of antibiotic resistance. Some of the stronger bacteria may survive these drug onslaughts and proliferate, passing on their genes to offspring and leading to the evolution of deadly “super bugs.”

For the current paper, the researchers wanted to narrow down the scope of 27 major compounds from the berries to isolate the specific chemicals involved in disarming MRSA. They painstakingly refined the original compounds, testing each new iteration for its potency on the bacteria. They also used a series of analytical chemistry techniques, including mass spectrometry, nuclear magnetic resonance spectroscopy and X-ray crystallography to gain a clear picture of the chemicals involved in the anti-virulence mechanism.

The results showed that three triterpenoid acids worked equally well at inhibiting MRSA from forming toxins in a petri dish, without harming human skin cells. And one of the triterpenoid acids worked particularly well at inhibiting the ability of MRSA to form lesions on the skin of mice. The researchers also demonstrated that the triterpenoid acids repressed not just one gene that MRSA uses to excrete toxins, but two genes involved in that process.

“Nature is the best chemist, hands down,” Quave says. She adds that weeds, in particular, tend to have interesting chemical arsenals that they may use to protect them from diseases so they can more easily spread in new environments.

The research team plans to do further studies to test the triterpenoid acids as treatments for MRSA infections in animal models. If those studies are promising, the next step would be to work with medicinal chemists to optimize the compounds for efficacy, delivery and safety before testing on humans.

“Plants are so incredibly complex chemically that identifying and isolating particular extracts is like picking needles out of haystacks,” Quave says. “When you’re able to pluck out molecules with medicinal properties from these complex natural mixtures, that’s a big step forward to understanding how some traditional medicines may work, and for advancing science towards a potential drug development pathway.”

First authors of the current paper are Huaqiao Tang — a former visiting scholar at Emory and a veterinarian at Sichuan Agricultural University in China — and Gina Porras, an Emory post-doctoral fellow. In addition to senior author Quave, co-authors include Francois Chassagne and James Lyles, who are both members of the Quave lab; John Basca, director of Emory’s X-ray Crystallography Center; and Alexander Horswill and Morgan Brown from the University of Colorado School of Medicine.

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Global experts call for mental health science to combat pandemic's impacts

Emory anthropologist Carol Worthman is among 25 mental health experts who issued a call for global action on mental health science surrounding the COVID-19 pandemic.

By Carol Clark

The outbreak of severe acute respiratory syndrome (SARS) in 2003 infected about 8,000 people and killed hundreds. Although SARS was stamped out relatively quickly, and before it could spread globally, it left a lingering impact. One study found that most SARS survivors in two major hospitals had high levels of psychological distress a year after the outbreak.

“Just surviving the pandemic was not the end of the story,” says Carol Worthman, professor of anthropology at Emory University. “And the COVID-19 pandemic is much more pervasive than SARS. It affects everybody, worldwide. Even those who do not get COVID-19 will have to live with the fallout.”

Worthman is among 25 mental health experts who issued a call for global action on mental health science surrounding the COVID-19 pandemic, recently published by The Lancet Psychiatry. In a position paper, they stress the immediate need for creating neuro-psychological databases concerning the pandemic’s impacts on brain health, mental health and overall well-being. These databases are needed to support evidence-based responses to the pandemic and to develop longer-term strategies to promote mental health and well-being.

Even as nations mobilize to treat patients, develop drugs and vaccines, and salvage economies, coordinated efforts on a similar scale are needed for mental health, Worthman says. Her research focuses on how cultural and social factors interact with human health, for better or for worse.

“We’re used to thinking about physical diseases and mental illnesses as two separate things,” Worthman says, “but the two actually go hand-in-hand. Mental illness doesn’t just affect the lives of individuals, but the lives of those around them. And like a virus, mental illness is invisible, in a way, and can be even harder to test and screen for.” Before the pandemic, depression already ranked in the top 10 causes of poor health worldwide and had climbed to the top four health problems related to healthy years of life lost.

The impacts of the lockdowns and social isolation on the mental health of vulnerable people are among the key questions that need to be tackled in an international response to COVID-19, the experts write. Their paper also stresses the need to research the best ways to move people to follow the advice of public health messages without unduly increasing stress and anxiety.

“People are especially hurting right now, they’re suffering, and they’re looking for ways to feel better,” Worthman says. “If we don’t develop pro-social ways to help people cope now and, in the future, we’re going to be living with the consequences for a long time.”

She points out that the 1918 flu pandemic, following on top of the first world war, helped set the stage for the social disruption and sense of hopelessness that fueled political movements and nationalism leading to the second world war.

One critical need is to gather data and develop strategies to support people currently working in high-intensity, high-risk settings during the pandemic, such as healthcare workers. “Burnout and higher suicide rates among healthcare providers had already been a growing problem for years,” Worthman says.

She cites the mental health effects of massive unemployment as another critical area. “Work is a huge part of peoples’ identities, not to mention their livelihoods,” she says. “Depression, anxiety, stress and lack of control are all things that undermine resilience. What can we do to help people stay resilient when they’re losing their sense of dignity and self-worth and predictability for their futures?”

Youth and adolescent mental health is another vital area to consider, Worthman says. “Young people are having to watch a remapping of the social-economic political world and try to find their way through it. Their future is our future and they need to be part of the solution. How do we mobilize youth to help them make their future as great as possible? Do we make supporting youth as important as saving airlines and other industries?”

COVID-19 is revealing and widening existing fault lines in social, economic and political systems. “We now have the challenge and opportunity to heal those ruptures even as we seek to heal ourselves of COVID-19,” Worthman says.

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