Surveying diseases with new technology
2 March 2021
COVID-19, cardiovascular disease, diabetes... Tove Fall’s speciality is dealing with large amounts of data in advanced genetics, and asking tricky questions that can amplify knowledge of the major diseases of our time and how they can be treated. It all began with veterinary training at the Swedish University of Agricultural Sciences in Uppsala.
Right now, Tove Fall’s research on COVID-19 is what mainly fills her days. In real time, the CRUSH COVID project is monitoring developments in the Uppsala region, and providing useful data for planning initiatives to stop the spread of infection. In this collaboration with Region Uppsala, new data are released to the region, its inhabitants and the media weekly.
In April 2020, she co-founded the COVID Symptom Study (CSS), in collaboration with Lund University and King’s College London. The study participants self-report their symptoms, using an app that has over 205,000 users in Sweden.
Both these research projects are based on collecting copious amounts of information and presenting it to the relevant government agencies and the population, to provide an up-to-date picture of the spread of infection.
“For those trying to get the infection under control, it’s important to know what it’s like. The more information they have, the better decisions they can make,” says Fall.
In CRUSH COVID, it was seen that until October, relatively few people were tested in areas where the nearest testing site was a long way away, and in residential areas of lower socioeconomic status. Since then, the region has partially revised its strategy. There is now a mobile test unit, there are mobile testing teams, and sites have opened in more residential areas.
Evaluation of these various initiatives is under way in the project.
“You can’t suppress this infection without keeping track of it. First, it’s a matter of getting some idea of how many people are infected in households and workplaces. Then you can see trends over time. You can ask, for instance, how many people are traced in four days. In November, that figure was down to 5 per cent; now, it’s gone up to 60 per cent.”
Fall made an early start on researching COVID-19 and its spread. In March 2020, she had the idea of starting an app study to monitor symptoms in the population. She found that one study of this kind was being launched in the UK that month: the COVID Symptom Study.
Around the same time, researchers at Lund University had already begun the process of starting a Swedish part of the study. Just like Fall, they were diabetes researchers; so at the end of April she joined them in initiating the project in Sweden. They had an outstanding response, and rapidly gained 100,000 participants. By early June, they had 90,000 daily reports coming in. The number has fallen since then, but still forms a good basis for research.
“Now we’re going to focus on diabetes and COVID-19. The app’s used not only in Sweden, but in the UK and US as well. So now there are four and a half million participants, about three per cent of whom have diabetes.”
Fall was recently chosen as Alumna of the Year by the Swedish University of Agricultural Sciences (SLU), where she had done both her undergraduate and doctoral studies. After completing her PhD thesis about dogs and diabetes in 2009, she was keen to carry on doing research and teaching.
She successfully applied for a postdoctoral position at Karolinska Institute, where she worked with researchers Nancy Pedersen, head of the Swedish Twin Registry, and Erik Ingelsson, who was running an EU project on genetics, obesity and diabetes.
Three years later, Ingelsson was recruited to Uppsala University. Fall had been living in Uppsala since her doctoral studies, and she accompanied him to the Department of Medical Sciences. Since 2012, when she was personally awarded her first major grant, she has been able to cover her own costs.
“I’m very happy here in Uppsala. There’s such a vast amount of expertise around. In CRUSH COVID, five departments – in epidemiology, media and communications, limnology, IT, public health and caring sciences – are working together. It’s so cool!”
Today she leads a research group of 15. This means that, besides the COVID-19 projects, she is engaged in other exciting ones, such as an EU project on intestinal flora and its possible influence on atherosclerosis.
“There, I have two wonderful postdocs, who’ve been able to work more independently this year, and two doctoral students. They make it great!”
This project, too, involves huge amounts of data. The source is the Swedish Cardiopulmonary Bioimage Study (SCAPIS) cohort, 30,000 strong, from whom samples are collected. Fall’s study comprises 10,000 participants.
“In Malmö and Lund, each participant has submitted a stool sample and we’ve genome-sequenced all the samples and then matched them with the bacterial DNA. Then we can see which bacteria they’re carrying and what functions the bacteria have,” says Fall.
She seems to adjust to her various research projects with ease. But becoming a researcher was by no means a self-evident choice. The Young Academy of Sweden recently published the book Forskardrömmar (“Dreams of Research”), which tells the stories of 60 children who later had research careers. Fall is one of those portrayed in the book, and in the picture she is sitting at a computer.
“We had a lot of computers at home. My Dad’s a language professor, and Mum has a PhD and has worked as a translator and librarian. But I didn’t want to go in for research. I thought it seemed very boring and theoretical. I wanted to do something practical.”
As a horse girl who loved animals and being out in nature, Fall chose veterinary training. So she moved to Uppsala, the only place in Sweden where it was on offer.
“I thought working with dogs and cats was fun, and I did a degree project on cats and endocrinology. Then I realised that was my thing – burying myself in a subject for six months.”
After her spell as a small-animal veterinarian, SLU got in touch and invited Fall to apply for a PhD position. Thus, she became a researcher after all ‒ and seems to have landed on her feet, fair and square. As an epidemiologist in the habit of handling large volumes of data, she is open to multiple research questions.
“I have a toolbox with various skills. One’s using registers; another is doing genetic analysis. Then questions that interest me and other people crop up. That’s how I felt when the COVID pandemic came. Who wants my tools now? How can I help? Working on these two major studies is tremendous fun.”
Facts: Tove Fall
Title: Professor of Molecular Epidemiology. Member of the Young Academy of Sweden.
Currently: Often appears in the media as an expert on COVID-19 and the spread of infection. Named Veterinarian of the Year 2020 and SLU’s Alumna of the Year 2021.
In my spare time: “I’m involved in the children’s leisure activities and various associations. I play the piano with my son. I enjoy being out with the dog, and skiing and cycling. I like spending time with friends and family.”
Latest book read: Henrik Brändén’s Immunförsvaret och viruset ‒ att förstå coronapandemin (“The immune system and the virus: Understanding the coronavirus pandemic”).
Get my best ideas: “When I’m out walking the dog.”
What drives me as a researcher: “Benefit to society. I want to do something worthwhile, but also to do things properly. Seeing young researchers grow is stimulating, too. As a child, I hated school group projects. But as an adult I’ve become much more of a team player.”
What inspires me: “Stories about people who, have overcome obstacles in one way or another, believed in their cause, and gone on fighting for it. Among Nobel laureates, there are lots of stories like that.”