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Taking the pandemic’s temperature

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thermometer


Last March, as covid-19 ripped through communities across the country, Inder Singh, MBA ’06, SM ’07, realized he had information that could help officials respond.

For years Singh’s company, Kinsa Health, had tracked fevers using data from its network of thousands of smartphone-­connected thermometers. As the potential scope of the covid-19 outbreak became clear, Singh subtracted the typical cold and flu numbers gathered in years past from the company’s graphs.

“What’s left over are unusual fevers, and we saw hot spots across the country,” Singh says. “We observed six years of data and there’d been hot spots, but nothing like we were seeing in early March.”

Kinsa’s team realized that the data offered a more immediate view of illness than test results. Within days they made it publicly available. Then on Saturday, March 14, Singh got on a call with the former head of the US Food and Drug Administration, the physician-researcher responsible for Taiwan’s successful covid-19 response, and Nirav Shah, a physician who is the former New York state health commissioner.

“Inder showed us this map, and he said, ‘I think this is covid-19 in the community,’” recalls Shah, who now sits on Kinsa’s board of directors. “All three of us were like, ‘It’s lighting up in Texas and Florida—we don’t see any covid [hot spots] there. Obviously your stuff is wrong.’” Two weeks later, the first surges in cases started being reported out of Texas and Florida.

Since then, Kinsa has been working to help US efforts to understand and contain the virus. Its data is being used by officials in at least five states and five cities, thousands of research groups, prominent media outlets, and organizations including the NBA, which used Kinsa’s thermometers during the isolation of its players and coaches to finish the 2019-2020 season. 

Kinsa’s FLUency Program, an initiative started in 2013 to help schools combat the seasonal flu, laid the foundation for Kinsa’s data collection. Today the company is working with more than 4,000 schools, accounting for about 5% of the nation’s public elementary schools.

“By the time the CDC [US Centers for Disease Control] gets the data, it has been processed, deidentified, and people have entered the health system to see a doctor,” says Singh, who is Kinsa’s CEO. “There’s a huge delay from when someone contracts an illness to when they see a doctor. The current health-care system only sees the latter; we see the former.”

Finding a path

Singh, who earned undergrad degrees in economics and engineering at the University of Michigan, was introduced to the world of infectious disease during graduate studies at the Harvard Kennedy School of Government. Although he’d started college intent on becoming an astronaut, as a grad student he spent time in different parts of Africa working on initiatives to prevent the spread of diseases like malaria and AIDS.

Singh’s first exposure to MIT came while he was back in Cambridge.

“I remember I interacted with some MIT undergrads. We brainstormed some social-impact ideas,” he recalls. “A week later I got an email from them saying they’d prototyped what we were talking about. I was like, ‘You prototyped what we talked about in a week?’ I was blown away, and it was an insight into how MIT is such a doer campus. It was so entrepreneurial.”

Soon Singh enrolled in the interdisciplinary Harvard-MIT Program in Health Sciences and Technology, earning his master’s and MBA degrees while working with leading research hospitals in the area. He then got what he describes as a dream job at the Clinton Health Access Initiative (CHAI), brokering deals between pharmaceutical companies and poor countries to lower the cost of medicines for AIDS, malaria, and tuberculosis. The role opened his eyes to several shortcomings in the global health system.

“The world tries to curb the spread of infectious illness with almost zero real-time information about when and where disease is spreading,” he says. “The question I posed to start Kinsa was ‘How do you stop the next outbreak before it becomes an epidemic if you don’t know where and when it’s starting and how fast it’s spreading?’”

Thermometers for change

With the insight that better data was needed to control infectious diseases, Singh founded Kinsa in 2012. In order to get that data, the company needed a new way of providing value to families when someone was ill.

“The behavior in the home when someone gets sick is to grab the thermometer,” Singh says. “We piggybacked off of that to create a communication channel to the sick, to help them get better faster.”

A year later, the company launched the FLUency Program, which became the vehicle for Kinsa to get millions of thermometers into communities around the country. The company relies on donations and government grants to hand out its thermometers to schools that serve primarily poor families.

Kinsa’s thermometers link to an app that considers age, temperature, and symptoms to help users decide if they should seek medical attention. The app also incorporates community illness levels into its guidance—informing parents, for instance, if other students in their child’s grade have come down with the flu. 

“That’s important because parents question what’s going around,” Singh says. “For the most part everything starts the same way: a cough, maybe a spike in fever. But what is it? Strep throat? Common cold? Flu? Covid-19? Now you have more context.”

Kinsa’s HealthWeather website lets anyone check real-time covid risk by zip code; it draws from fever data collected by the company’s smart thermometers, symptoms entered on its app, and covid case data collected by Johns Hopkins University.

CHRISTIE HEMM KLOK (DEVICE); KINSA (SCREEN)

The data generated by the thermometers is also anonymized and aggregated for officials like school nurses, who can help prevent the spread of disease in classrooms by reminding parents to keep their kids home if they are sick or by encouraging teachers to disinfect surfaces more often.

In California, Fresno began equipping families in each of its 60 elementary schools with thermometers in 2019. Kinsa looked at the number of student absences in schools with more and less participation in the program and found that students missed 8% fewer days in schools where more families had thermometers, a pattern school officials also noticed.

“Students miss less school because we’re not exposing as many kids to illness,” says Jane Banks, the head of school nurses for the Fresno public schools. “We’re educating and intervening in real time when we see any outbreak, or anything that’s off.” In the fall, she was talking with Kinsa about how Fresno might use the thermometers to help bring students back to the classroom in phases once schools got the green light. 

In Laguna Niguel, California, the Community Roots charter school distributed the thermometers to all students’ families after beginning the school year with online instruction. When the school shifted to in-person learning, it required students arriving on campus each day to show school officials their negative fever results through the Kinsa app. While of course being fever-free can’t guarantee that a student is covid-free, the daily temperature readings at home at least made it possible to keep symptomatic students away from healthy students. As of the beginning of December, Community Roots was the only elementary school open for five-day classroom instruction in Orange County. 

“I interacted with some MIT undergrads. We brainstormed some social-impact ideas. A week later I got an email from them saying they’d prototyped what we were talking about. I was like, ‘You prototyped what we talked about in a week?’ I was blown away.”

Singh says the only thing holding the FLUency Program back is funding: an additional 13,000 schools have applied to participate, but Kinsa hasn’t found enough donors. “We are adamant that we don’t charge the public schools,” he says.

Kinsa’s fever data has proved useful beyond school settings as well. In the Orlando “bubble” the NBA used to finish its 2019-2020 season, every player, ref, media person, and staff member began each day with a reading from Kinsa’s thermometer. If someone showed a higher temperature than average, the NBA’s health and safety team, which included doctors and epidemiologists, would call the person to do an assessment. John DiFiori, the NBA’s director of sports medicine, told USA Today the daily temperature check was “really the foundation” of the league’s approach to keeping everyone safe.

Kinsa has also made information about local outbreaks available to anyone—not just those with the app. In November, the company launched a tool on its HealthWeather website that lets anyone in the US view a real-time risk score for the level of contagious illness in a given zip code. The idea is to make checking local illness levels as easy as viewing local weather forecasts.

Fever data is not a perfect proxy for covid-19 infection. It can do only so much to help authorities contain the virus because people can be asymptomatic but still contagious, cautions Joseph Frassica, a professor of the practice at MIT’s Institute for Medical Engineering and Science (IMES) as well as the head of Philips Research North America. Younger populations are more likely to be asymptomatic if infected, he says, which particularly limits the usefulness of student testing systems that rely on temperature data alone.

That said, he thinks that combining fever data with the questionnaires on Kinsa’s app is a great way to track symptomatic covid-19 cases, and Kinsa’s widespread thermometer distribution means that its maps are a fairly good indicator of covid-19 in communities. Kinsa says that between March 1 and November 1 of 2020, it captured nearly 15 million fever readings and 1.7 million symptom inputs.

“Kinsa’s approach of collecting data from connected thermometers is an important one and actually very useful for detecting geographies where there’s an increase or decrease in the incidence of fever—and, in the year of covid-19, the incidence of covid-19,” says Frassica, who has worked on building predictive models for covid-19 through IMES and is not affiliated with Kinsa Health.

Filling a void

Last spring, New Orleans city officials were working overtime in a struggle that was playing out across the US. The city had organized a covid-19 response team to establish community testing sites, procure protective equipment, educate the public, and take other steps to curb the spread of the disease.

Unfortunately, like the rest of the country, New Orleans had to rely on testing data to track the virus. That made it more likely that people would spread the disease before they knew they were infected.

The mayor’s office had been in touch with Kinsa about the company’s thermometers, but the city was in no position to buy them anytime soon.

Then a Kinsa employee called the mayor’s office to say the company had found a donor, and 25,000 thermometers were coming free of charge. They arrived at city hall on June 24. Over the next few weeks, the thermometers were given out to low-income families, who are generally more vulnerable to the worst symptoms of covid-19. Many of the recipients didn’t previously have a thermometer in their home. Kinsa’s app gave the families information about the spread of the disease in their communities and helped them take steps to mitigate its spread. It also gave city officials new, real-time information about community health.

“If I know what’s going on in the community, I can respond better as a parent, I can respond better as a school leader, I can respond better as a school nurse,” Singh says. “When you know where and when symptoms are starting and how fast they’re spreading, you can empower local individuals, families, communities, and governments.” 

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The Download: a long covid app, and California’s wind plans

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The Download: a long covid app, and California’s wind plans


1 The Twitter Files weren’t the bombshell Elon Musk billed them as 
His carelessness triggered the harassment of some of Twitter’s content moderators, too. (WP $)
+ The files didn’t violate the First Amendment, either. (The Atlantic $)
+ Hate speech has exploded on the platform since he took over. (NYT $)
+ Journalists are staying on Twitter—for now. (Vox)
+ The company’s advertising revenue isn’t looking very healthy. (NYT $)

2 Russia is trying to freeze Ukrainians by destroying their electricity 
It’s the country’s vulnerable who will suffer the most. (Economist $)
+ How Ukraine could keep the lights on. (MIT Technology Review)

3 Crypto is at a crossroads
Investors, executives, and advocates are unsure what’s next. (NYT $)
+ FTX and the Alameda Research trading firm were way too close. (FT $)
+ It’s okay to opt out of the crypto revolution. (MIT Technology Review)

4 Taylor Swift fans are suing Ticketmaster
They’re furious they weren’t able to buy tickets in the botched sale last month. (The Verge)

5 The internet is having a midlife crisis
What is it for? And more importantly, who is it for? (Slate $)
+ Tim Berners-Lee wanted the internet to have an ‘oh, yeah?’ button. (Slate $)

6 We need a global deal to safeguard the natural world
COP15, held this week in Montreal, is our best bet to thrash one out. (Vox)
+ Off-grid living is more viable these days than you may think. (The Verge)

7 What ultra-dim galaxies can teach us about dark matter  
We’re going to need new telescopes to seek more of them out. (Wired $)
+ Japanese billionaire Yusaku Maezawa has some big plans for space. (Reuters)
+ A super-bright satellite could hamper our understanding of the cosmos. (Motherboard)
+ Here’s how to watch Mars disappear behind the moon. (New Scientist $)

8 An elite media newsletter wants to cover “power, money, and ego.”
It promises unparalleled access to prolific writers—and their audiences. (New Yorker $)
+ How to sign off an email sensibly. (Economist $) 

9 The metaverse has a passion for fashion 👗
Here’s what its best-dressed residents are wearing. (WSJ $)

10 We’ve been sending text messages for 30 years 💬
Yet we’re still misunderstanding each other. (The Guardian)

Quote of the day

“There is certainly a rising sense of fear, justifiable fear. And I would say almost horror.”

—Pamela Nadell, director of American University’s Jewish Studies program, tells the Washington Post she fears that antisemitism has become normalized in the US, in the light of Kanye West’s recent comments praising Hitler.

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California’s coming offshore wind boom faces big engineering hurdles

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California’s coming offshore wind boom faces big engineering hurdles


Research groups estimate that the costs could fall from around $200 per megawatt-hour to between $58 and $120 by 2030. That would leave floating offshore wind more expensive than solar and onshore wind, but it could still serve an important role in an overall energy portfolio. 

The technology is improving as well. Turbines themselves continue to get taller, generating more electricity and revenue from any given site. Some research groups and companies are also developing new types of floating platforms and delivery mechanisms that could make it easier to work within the constraints of ports and bridges. 

The Denmark-based company Stiesdal has developed a modular, floating platform with a keel that doesn’t drop into place until it’s in the deep ocean, enabling it to be towed out from relatively shallow ports. 

Meanwhile, San Francisco startup Aikido Technologies is developing a way of shipping turbines horizontally and then upending them in the deep ocean, enabling the structures to duck under bridges en route. The company believes its designs provide enough clearance for developers to access any US port. Some 80% of these ports have height limits owing to bridges or airport restrictions.

A number of federal, state, and local organizations are conducting evaluations of California and other US ports, assessing which ones might be best positioned to serve floating wind projects and what upgrades could be required to make it possible.

Government policies in the US, the European Union, China, and elsewhere are also providing incentives to develop offshore wind turbines, domestic manufacturing, and supporting infrastructure. That includes the Inflation Reduction Act that Biden signed into law this summer.

Finally, as for California’s permitting challenges, Hochschild notes that the same 2021 law requiring the state’s energy commision to set offshore wind goals also requires it to undertake the long-term planning necessary to meet them. That includes mapping out a strategy for streamlining the approval process.

For all the promise of floating wind, there’s little question that ensuring it’s cost-competitive and achieving the targets envisioned will require making massive investments in infrastructure, manufacturing, and more, and building big projects at a pace that the state hasn’t shown itself capable of in the recent past.

If it can pull it off, however, California could become a leading player in a critical new clean energy sector, harnessing its vast coastal resources to meet its ambitious climate goals.

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How Twitter’s “Teacher Li” became the central hub of China protest information

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How Twitter’s “Teacher Li” became the central hub of China protest information


It’s hard to describe the feeling that came after. It’s like everyone is coming to you and all kinds of information from all over the world is converging toward you and [people are] telling you: Hey, what’s happening here; hey, what’s happening there; do you know, this is what’s happening in Guangzhou; I’m in Wuhan, Wuhan is doing this; I’m in Beijing, and I’m following the big group and walking together. Suddenly all the real-time information is being submitted to me, and I don’t know how to describe that feeling. But there was also no time to think about it. 

My heart was beating very fast, and my hands and my brain were constantly switching between several software programs—because you know, you can’t save a video with Twitter’s web version. So I was constantly switching software, editing the video, exporting it, and then posting it on Twitter. [Editor’s note: Li adds subtitles, blocks out account information, and compiles shorter videos into one.] By the end, there was no time to edit the videos anymore. If someone shot and sent over a 12-second WeChat video, I would just use it as is. That’s it. 

I got the largest amount of [private messages] around 6:00 p.m. on Sunday night. At that time, there were many people on the street in five major cities in China: Beijing, Shanghai, Chengdu, Wuhan, and Guangzhou. So I basically was receiving a dozen private messages every second. In the end, I couldn’t even screen the information anymore. I saw it, I clicked on it, and if it was worth posting, I posted it.

People all over the country are telling me about their real-time situations. In order for more people not to be in danger, they went to the [protest] sites themselves and sent me what was going on there. Like, some followers were riding bikes near the presidential palace in Nanjing, taking pictures, and telling me about the situation in the city. And then they asked me to inform everyone to be cautious. I think that’s a really moving thing.

It’s like I have gradually become an anchor sitting in a TV studio, getting endless information from reporters on the scene all over the country. For example, on Monday in Hangzhou, there were five or six people updating me on the latest news simultaneously. But there was a break because all of them were fleeing when the police cleared the venue. 

On the importance of staying objective 

There are a lot of tweets that embellish the truth. From their point of view, they think it’s the right thing to do. They think you have to maximize the outrage so that there can be a revolt. But for me, I think we need reliable information. We need to know what’s really going on, and that’s the most important thing. If we were doing it for the emotion, then in the end I really would have been part of the “foreign influence,” right? 

But if there is a news account outside China that can record what’s happening objectively, in real time, and accurately, then people inside the Great Firewall won’t have doubts anymore. At this moment, in this quite extreme situation of a continuous news blackout, to be able to have an account that can keep posting news from all over the country at a speed of almost one tweet every few seconds is actually a morale boost for everyone. 

Chinese people grow up with patriotism, so they become shy or don’t dare to say something directly or oppose something directly. That’s why the crowd was singing the national anthem and waving the red flag, the national flag [during protests]. You have to understand that the Chinese people are patriotic. Even when they are demanding things [from the government], they do it with that sentiment. 

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