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New Ebola outbreak detected in northwest Democratic Republic of the Congo; WHO surge te... - 0 views

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  • The Government of the Democratic Republic of the Congo announced today that a new outbreak of Ebola virus disease is occurring in Wangata health zone, Mbandaka, in Équateur province. The announcement comes as a long, difficult and complex Ebola outbreak in eastern Democratic Republic of the Congo is in its final phase, while the country also battles COVID-19 and the world’s largest measles outbreak. Initial information from the Ministry of Health is that six Ebola cases have so far been detected in Wangata, of which four have died and two are alive and under care. Three of these six cases have been confirmed with laboratory testing. It is likely more people will be identified with the disease as surveillance activities increase. “This is a reminder that COVID-19 is not the only health threat people face,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General. “Although much of our attention is on the pandemic, WHO is continuing to monitor and respond to many other health emergencies.”This is the Democratic Republic of the Congo’s 11th outbreak of Ebola since the virus was first discovered in the country in 1976. The city of Mbandaka and its surrounding area were the site of Democratic Republic of the Congo’s 9th Ebola outbreak, which took place from May to July 2018. “It’s happening at a challenging time, but WHO has worked over the last two years with health authorities, Africa CDC and other partners to strengthen national capacity to respond to outbreaks,” said Dr Matshidiso Moeti, WHO Regional Director for Africa. “To reinforce local leadership, WHO plans to send a team to support scaling up the response. Given the proximity of this new outbreak to busy transport routes and vulnerable neighbouring countries we must act quickly.”WHO is already on the ground in Mbandaka supporting the response to this outbreak, as part of capacity built during the 2018 outbreak. The team supported the collection and testing of samples, and reference to the national laboratory for confirmation. Contact tracing is underway. Work is ongoing to send additional supplies from North Kivu and from Kinshasa to support the government-led response. A further 25 people are expected to arrive in Mbandaka tomorrow. WHO is also working to ensure that essential health services are provided to communities despite these emergency events.The Democratic Republic of the Congo’s 10th outbreak of Ebola, in North Kivu, South Kivu and Ituri provinces, is in its final stages. On 14 May 2020, the Ministry of Health began the 42-day countdown to the declaration of the end of that outbreak. New outbreaks of Ebola are expected in the Democratic Republic of the Congo given the existence of the virus in an animal reservoir in many parts of the country. 
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A Deadly Coronavirus Was Inevitable. Why Was No One Ready? - WSJ - 0 views

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shared by Javier E on 13 Aug 20 - No Cached
  • When Disease X actually arrived, as Covid-19, governments, businesses, public-health officials and citizens soon found themselves in a state of chaos, battling an invisible enemy with few resources and little understanding—despite years of work that outlined almost exactly what the virus would look like and how to mitigate its impact.
  • Governments had ignored clear warnings and underfunded pandemic preparedness. They mostly reacted to outbreaks, instead of viewing new infectious diseases as major threats to national security. And they never developed a strong international system for managing epidemics, even though researchers said the nature of travel and trade would spread infection across borders.
  • Underlying it all was a failure that stretches back decades. Most everyone knew such an outcome was possible. And yet no one was prepared.
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  • Last year, a Chinese scientist he worked with published a specific forecast: “It is highly likely that future SARS- or MERS-like coronavirus outbreaks will originate from bats, and there is an increased probability that this will occur in China.”
  • Humans today are exposed to more deadly new pathogens than ever. They typically come from animals, as global travel, trade and economic development, such as meat production and deforestation, push people, livestock and wildlife closer together
  • Scientists knew infectious disease outbreaks were becoming more common, with 2010 having more than six times the outbreaks of pathogens from animal origins than in 1980, according to data in a study by Brown University researchers.
  • Yet plenty was left undone, in areas including funding, early-warning systems, the role of the WHO and coordination with China. A big chunk of U.S. funding went toward protecting Americans against a bioterror attack. Government funding for pandemics has come largely in emergency, one-time packages to stop an ongoing outbreak.
  • She said a better solution would be to fund public health more like national defense, with much more guaranteed money, year in, year out.
  • “Will there be another human influenza pandemic?” Dr. Webster asked in a paper presented at an NIH meeting in 1995. “The certainty is that there will be.”
  • Experts including Dr. Webster were particularly concerned about the potential for spillover in southern China, where large, densely populated cities were expanding rapidly into forests and agricultural lands, bringing people into closer contact with animals. Two of the three influenza pandemics of the 20th century are thought to have originated in China.
  • Dr. Webster and others warned it could re-emerge or mutate into something more contagious. With U.S. funding, he set up an animal influenza surveillance center in Hong Kong. The WHO, which hadn’t planned for pandemics before, started compiling protocols for a large-scale outbreak, including contingency plans for vaccines.
  • At a dinner back in the U.S., he remembers one guest saying, “Oh, you really needed to have someone in the U.S. to be impacted to really galvanize the government.”
  • That “drove home the reality in my own mind of globalization,” said Dr. Fukuda. SARS showed that viruses can crisscross the globe by plane in hours, making a local epidemic much more dangerous.
  • The WHO’s director-general, Gro Harlem Brundtland, publicly criticized China. The government under new leaders reversed course. It implemented draconian quarantines and sanitized cities, including a reported 80 million people enlisted to clean streets in Guangdong.
  • By May 2003, the number of new SARS cases was dwindling. It infected around 8,000 people world-wide, killing nearly 10%.
  • After SARS, China expanded epidemiologist training and increased budgets for new laboratories. It started working more closely in public health with the U.S., the world’s leader. The U.S. CDC opened an office in Beijing to share expertise and make sure coverups never happened again. U.S. CDC officials visiting a new China CDC campus planted a friendship tree.
  • In Washington in 2005, a powerful player started driving U.S. efforts to become more prepared. President George W. Bush had read author John M. Barry’s “The Great Influenza,” a history of the 1918 flu pandemic
  • Mr. Bush leaned toward the group of 10 or so officials and said, “I want to see a plan,” according to Dr. Venkayya. “He had been asking questions and not getting answers,” recalled Dr. Venkayya, now president of Takeda Pharmaceutical Co. ’s global vaccine business unit. “He wanted people to see this as a national threat.”
  • Mr. Bush launched the strategy in November, and Congress approved $6.1 billion in one-time funding.
  • The CDC began exercises enacting pandemic scenarios and expanded research. The government created the Biomedical Advanced Research and Development Authority to fund companies to develop diagnostics, drugs and vaccines.
  • A team of researchers also dug into archives of the 1918 pandemic to develop guidelines for mitigating the spread when vaccines aren’t available. The tactics included social distancing, canceling large public gatherings and closing schools—steps adopted this year when Covid-19 struck, though at the time they didn’t include wide-scale lockdowns.
  • A year after the plan was released, a progress report called for more real-time disease surveillance and preparations for a medical surge to care for large numbers of patients, and stressed strong, coordinated federal planning.
  • A European vaccine makers’ association said its members had spent around $4 billion on pandemic vaccine research and manufacturing adjustments by 2008.
  • The $6.1 billion Congress appropriated for Mr. Bush’s pandemic plan was spent mostly to make and stockpile medicines and flu vaccines and to train public-health department staff. The money wasn’t renewed. “The reality is that for any leader it’s really hard to maintain a focus on low-probability high-consequence events, particularly in the health arena,” Dr. Venkayya said.
  • In the U.S., President Barack Obama’s administration put Mr. Bush’s new plan into action for the first time. By mid-June, swine flu, as it was dubbed, had jumped to 74 countries. The WHO officially labeled it a pandemic, despite some evidence suggesting the sickness was pretty mild in most people.
  • That put in motion a host of measures, including some “sleeping” contracts with pharmaceutical companies to begin vaccine manufacturing—contracts that countries like the United Kingdom had negotiated ahead of time so they wouldn’t have to scramble during an outbreak.
  • In August, a panel of scientific advisers to Mr. Obama published a scenario in which as many as 120 million Americans, 40% of the population, could be infected that year, and up to 90,000 people could die.
  • H1N1 turned out to be much milder. Although it eventually infected more than 60 million Americans, it killed less than 13,000. In Europe, fewer than 5,000 deaths were reported.
  • The WHO came under fire for labeling the outbreak a pandemic too soon. European lawmakers, health professionals and others suggested the organization may have been pressured by the pharmaceutical industry.
  • France ordered 94 million doses, but had logged only 1,334 serious cases and 312 deaths as of April 2010. It managed to cancel 50 million doses and sell some to other countries, but it was still stuck with a €365 million tab, or about $520 million at the time, and 25 million extra doses.
  • The WHO had raised scares for SARS, mad-cow disease, bird flu and now swine flu, and it had been wrong each time, said Paul Flynn, a member of the Council of Europe’s Parliamentary Assembly and a British lawmaker, at a 2010 health committee hearing in Strasbourg.
  • Ultimately, an investigation by the council’s committee accused the WHO and public-health officials of jumping the gun, wasting money, provoking “unjustified fear” among Europeans and creating risks through vaccines and medications that might not have been sufficiently tested.
  • “I thought you might have uttered a word of regret or an apology,” Mr. Flynn told Dr. Fukuda, who as a representative of the WHO had been called to testify.
  • Back in Washington, scientist Dennis Carroll, at the U.S. Agency for International Development, was also convinced that flu wasn’t the only major pandemic threat. In early 2008, Dr. Carroll was intrigued by Dr. Daszak’s newly published research that said viruses from wildlife were a growing threat, and would emerge most frequently where development was bringing people closer to animals.
  • If most of these viruses spilled over to humans in just a few places, including southern China, USAID could more easily fund an early warning system.
  • “You didn’t have to look everywhere,” he said he realized. “You could target certain places.” He launched a new USAID effort focused on emerging pandemic threats. One program called Predict had funding of about $20 million a year to identify pathogens in wildlife that have the potential to infect people.
  • Drs. Daszak, Shi and Wang, supported by funds from Predict, the NIH and China, shifted their focus to Yunnan, a relatively wild and mountainous province that borders Myanmar, Laos and Vietnam.
  • One key discovery: a coronavirus resembling SARS that lab tests showed could infect human cells. It was the first proof that SARS-like coronaviruses circulating in southern China could hop from bats to people. The scientists warned of their findings in a study published in the journal Nature in 2013.
  • Evidence grew that showed people in the area were being exposed to coronaviruses. One survey turned up hundreds of villagers who said they recently showed symptoms such as trouble breathing and a fever, suggesting a possible viral infection.
  • Over the next several years, governments in the U.S. and elsewhere found themselves constantly on the defensive from global viral outbreaks. Time and again, preparedness plans proved insufficient. One, which started sickening people in Saudi Arabia and nearby
  • On a weekend morning in January 2013, more than a dozen senior Obama administration officials met in a basement family room in the suburban home of a senior National Security Council official. They were brainstorming how to help other countries upgrade their epidemic response capabilities, fueled by bagels and coffee. Emerging disease threats were growing, yet more than 80% of the world’s countries hadn’t met a 2012 International Health Regulations deadline to be able to detect and respond to epidemics.
  • The session led to the Global Health Security Agenda, launched by the U.S., the WHO and about 30 partners in early 2014, to help nations improve their capabilities within five years.
  • Money was tight. The U.S. was recovering from the 2008-09 financial crisis, and federal funding to help U.S. states and cities prepare and train for health emergencies was declining. Public-health departments had cut thousands of jobs, and outdated data systems weren’t replaced.
  • “It was a Hail Mary pass,” said Tom Frieden, who was director of the CDC from 2009 to 2017 and a force behind the creation of the GHSA. “We didn’t have any money.”
  • At the WHO, Dr. Fukuda was in charge of health security. When the Ebola outbreak was found in March 2014, he and his colleagues were already stretched, after budget cuts and amid other crises.
  • The United Nations created a special Ebola response mission that assumed the role normally played by the WHO. Mr. Obama sent the U.S. military to Liberia, underscoring the inability of international organizations to fully handle the problem.
  • It took the WHO until August to raise an international alarm about Ebola. By then, the epidemic was raging. It would become the largest Ebola epidemic in history, with at least 28,600 people infected, and more than 11,300 dead in 10 countries. The largest outbreak before that, in Uganda, had involved 425 cases.
  • Congress passed a $5.4 billion package in supplemental funds over five years, with about $1 billion going to the GHSA. The flood of money, along with aggressive contact tracing and other steps, helped bring the epidemic to a halt, though it took until mid-2016.
  • Global health experts and authorities called for changes at the WHO to strengthen epidemic response, and it created an emergencies program. The National Security Council warned that globalization and population growth “will lead to more pandemics,” and called for the U.S. to do more.
  • r. Carroll of USAID, who had visited West Africa during the crisis, and saw some health workers wrap themselves in garbage bags for protection, started conceiving of a Global Virome Project, to detect and sequence all the unknown viral species in mammals and avian populations on the planet.
  • Billionaire Bill Gates warned in a TED talk that an infectious disease pandemic posed a greater threat to the world than nuclear war, and urged world leaders to invest more in preparing for one. The Bill & Melinda Gates Foundation helped form a new initiative to finance vaccines for emerging infections, the Coalition for Epidemic Preparedness Innovations.
  • Congress established a permanent Infectious Diseases Rapid Response Fund for the CDC in fiscal 2019, with $50 million for that year and $85 million in fiscal 2020.
  • In May 2018, John Bolton, then President Trump’s national security adviser, dismantled an NSC unit that had focused on global health security and biodefense, with staff going to other units. The senior director of the unit left.
  • It pushed emerging disease threats down one level in the NSC hierarchy, making pandemics compete for attention with issues such as North Korea, said Beth Cameron, a previous senior director of the unit. She is now vice president for global biological policy and programs at the Nuclear Threat Initiative.
  • Deteriorating relations with China reduced Washington’s activities there just as researchers were becoming more certain of the threat from coronaviruses.
  • Dr. Carroll had earlier been ordered to suspend his emerging pandemic threats program in China.
  • Dr. Carroll pitched to USAID his Global Virome Project. USAID wasn’t interested, he said. He left USAID last year. A meeting that Dr. Carroll planned for last August with the Chinese CDC and Chinese Academy of Sciences to form a Chinese National Virome Project was postponed due to a bureaucratic hang-up. Plans to meet are now on hold, due to Covid-19.
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Nine Days in Wuhan, the Ground Zero of the Coronavirus Pandemic | The New Yorker - 0 views

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shared by Javier E on 10 Oct 20 - No Cached
  • By now, with worldwide infections at thirty-five million and counting, and with near-total silence on the part of the Chinese government, the market has become a kind of petri dish for the imagination.
  • One common Chinese conspiracy theory claims that the U.S. Army deliberately seeded the virus during the 2019 Military World Games, which were held in Wuhan that October. On the other side of the world, a number of Americans believe that the virus was released, whether accidentally or otherwise, from the Wuhan Institute of Virology, whose research includes work on coronaviruses.
  • There’s no evidence to support these theories, and even the prevalent animal-market connection is unclear. There weren’t many wildlife dealers in the market—about a dozen stalls, according to most published reports—and Wuhan natives have little appetite for exotic animals.
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  • There are three hundred and twenty-one testing locations in the city, and the system is so extensive that in June, when Beijing suffered an outbreak, Wuhan hospitals sent seventy-two staffers to the capital to help with tests.
  • When Wuhan was sealed, the strategy of isolation was replicated throughout the city. Housing compounds were closed and monitored by neighborhood committees, with residents going out only for necessities.
  • Toward the end of the first month, the guidelines were tightened further, until virtually all goods were delivered. On February 17th, Fang Fang wrote, “Everyone is now required to remain inside their homes at all times.”
  • Meanwhile, approximately ten thousand contact tracers were working in the city, in order to cut off chains of infection, and hospitals were developing large-scale testing systems. But isolation remained crucial: patients were isolated; suspected exposures were isolated; medical workers were isolated.
  • Zhang said the experience of working through the pandemic had left him calmer and more patient. He drove more carefully now; he wasn’t in such a rush.
  • I often asked Wuhan residents how they had been personally changed by the spring, and there was no standard response. Some expressed less trust in government information; others said they had increased faith in the national leadership.
  • Wuhan had most recently reported a locally transmitted symptomatic case on May 18th. It’s the most thoroughly tested city in China: at the end of May, in part to boost confidence, the government tried to test every resident, a total of eleven million.
  • I never met a cabdriver who had been swab-tested less than twice, and a couple had been tested five times. Most of the cabbies had no relatives or friends who had been infected; swabbing was simply required by the city and by their cab companies.
  • “I tend to take a charitable view of countries that are at the beginning stage of epidemics,” Jennifer Nuzzo, an epidemiologist at the Johns Hopkins Center for Health Security, told me, in a phone conversation. According to her, it’s unrealistic to expect that any country could have stopped this particular virus at its source. “I’ve always believed that this thing was going to spread,” she said
  • The physician who handled testing told me that, on average, his hospital still recorded one positive for every forty thousand exams. Most of these positives were repeat patients: after having been infected during the initial run of the virus, they recovered fully, and then for some reason, months later, showed evidence of the virus again. So far, most of the positives had been asymptomatic, and the physician saw no indication that the virus was spreading in the city.
  • In town, there were few propaganda signs about the epidemic, and Wuhan newspapers ran upbeat headlines every morning (Yangtze Daily, August 29th, front page: “STUDENTS DO NOT HAVE TO WEAR MASKS IN SCHOOLS”). Movie theatres were open; restaurants and bars had no seating restrictions. At the Hanyang Renxinghui Mall, I saw barefaced kids playing in what may have been one of the last fully functioning ball pits on earth, a sight that seemed worthy of other headlines (“CHILDREN DO NOT HAVE TO WEAR MASKS IN WUHAN BALL PITS”).
  • Across town, colleges and universities were in the process of bringing back more than a million students. Wuhan has the second-highest number of students of any city in China, after Guangzhou.
  • Wuhan memories remained fresh, and the materials of documentation were also close at hand. People sometimes handed over manuscripts, and they took out their phones and pulled up photographs and messages from January and February. But I wondered how much of this material would dissipate over time.
  • In town, I met two Chinese journalists in their twenties who were visiting from out of town. They had been posted during the period of the sealed city: back then, anybody sent to cover events in Wuhan had to stay for the long haul.
  • One was a director of streaming media whom I’ll call Han, and he had found that government-run outlets generally wanted footage that emphasized the victory over the disease, not the suffering of Wuhan residents. Han hoped that eventually he’d find other ways to use the material. “It will be in the hard drive,” he said, tapping his camera.
  • After that, Yin reported on a number of issues that couldn’t be published or completed, and she often talked with scientists and officials who didn’t want to say too much. “One person said, ‘Ten years later, if the climate has changed, I’ll tell you my story,’ ” Yin told me. “He knew that he would be judged by history.” She continued, “These people are inside the system, but they also know that they are inside history.”
  • Such fare is much more popular in Guangdong, in the far south. It’s possible that the disease arrived from somewhere else and then spread in the wet, cool conditions of the fish stalls. A few Wuhan residents told me that a considerable amount of their seafood comes from Guangdong, and they suggested that perhaps a southerner had unwittingly imported the disease,
  • When I spoke with scientists outside China, they weren’t focussed on the government’s early missteps
  • In time, we will learn more, but the delay is important to the Communist Party. It handles history the same way that it handles the pandemic—a period of isolation is crucial. Throughout the Communist era, there have been many moments of quarantined history: the Great Leap Forward, the Cultural Revolution, the massacre around Tiananmen Square. In every case, an initial silencing has been followed by sporadic outbreaks of leaked information. Wuhan will eventually follow the same pattern, but for the time being many memories will remain in the sealed city.
  • Wafaa El-Sadr, the director of ICAP, a global-health center at Columbia University, pointed out that Chinese scientists had quickly sequenced the virus’s genome, which was made available to researchers worldwide on January 11th. “I honestly think that they had a horrific situation in Wuhan and they were able to contain it,” she said. “There were mistakes early on, but they did act, and they shared fast.”
  • For much of El-Sadr’s career, she has worked on issues related to AIDS in the United States, Africa, and elsewhere. After years of research, scientists eventually came to the consensus that H.I.V. most likely started through the bushmeat trade—the first human was probably infected after coming into contact with a primate or primate meat.
  • El-Sadr views the coronavirus as another inevitable outcome of people’s encroachment on the natural world. “We are now living through two concomitant massive pandemics that are the result of spillover from animal to human hosts, the H.I.V. and the COVID pandemics,” she wrote to me, in an e-mail. “Never in history has humanity experienced something along this scale and scope.”
  • There’s a tendency to believe that we would know the source of the coronavirus if the Chinese had been more forthcoming, or if they hadn’t cleaned out the Huanan market before stalls and animals could be studied properly.
  • Yiwu He, the chief innovation officer at the University of Hong Kong, told me that the C.N.B.G. vaccine has already been given to a number of Chinese government officials, under an emergency-use approval granted by the authorities. “I know a few government officials personally, and they told me that they took the vaccine,” he said, in a phone conversation. He thought that the total number was probably around a hundred. “It’s middle-level officials,” he said. “Vice-ministers, mayors, vice-mayors.”
  • Daszak believes the virus probably circulated for weeks before the Wuhan outbreak, and he doubts that the city was the source. “There are bats in Wuhan, but it was the wrong time of year,” he told me. “It was winter, and bats are not out as much.”
  • His research has indicated that, across Southeast Asia, more than a million people each year are infected by bat coronaviruses. Some individuals trap, deal, or raise animals that might serve as intermediary hosts. “But generally it’s people who live near bat caves,”
  • Daszak said that he had always thought that such an outbreak was most likely to occur in Kunming or Guangzhou, southern cities that are close to many bat caves and that also have an intensive wildlife trade.
  • He thinks that Chinese scientists are probably now searching hospital freezers for lab samples of people who died of pneumonia shortly before the outbreak. “You would take those samples and look for the virus,” he said. “They’ll find something eventually. These things just don’t happen overnight; it requires a lot of work. We’ve seen this repeatedly with every disease. It turns out that it was already trickling through the population.”
  • Daszak is the president of EcoHealth Alliance, a nonprofit research organization based in New York. EcoHealth has become the target of conspiracy theorists, including some who claim that the virus was man-made. Daszak and many prominent virologists say that anything created in a lab would show clear signs of manipulation.
  • There’s also speculation that the outbreak started when researchers accidentally released a coronavirus they were studying at the Wuhan Institute of Virology. But there’s no evidence of a leak, or even that the institute has ever studied a virus that could cause a COVID-19 outbreak.
  • “Scientists in China are under incredible pressure to publish,” Daszak said. “It really drives openness and transparency.”
  • He has spent a good deal of time in Wuhan, and co-authored more than a dozen papers with Chinese colleagues. “If we had found a virus that infected human cells and spread within a cell culture, we would have put the information out there,” he said. “In sixteen years, I’ve never come across the slightest hint of subterfuge. They’ve never hidden data. I’ve never had a situation where one lab person tells me one thing and the other says something else. If you were doing things that you didn’t want people to know about, why would you invite foreigners into the lab?”
  • In April, President Trump told reporters that the U.S. should stop funding research connected to the Wuhan Institute of Virology. Shortly after Trump’s comments, the National Institutes of Health cancelled a $3.7-million grant to EcoHealth, which had been studying how bat coronaviruses are transmitted to people.
  • I asked Daszak why, if he has such faith in the openness of his Wuhan colleagues, the Chinese government has been so closed about other aspects of the outbreak. He said that science is one thing, and politics something else; he thinks that officials were embarrassed about the early mistakes, and in response they simply shut down all information.
  • At the beginning of July, China National Biotec Group, a subsidiary of a state-owned pharmaceutical company called Sinopharm, completed construction of a vaccine-manufacturing plant in Wuhan. The project began while the city was still sealed. “That’s the politically correct thing to do,” a Shanghai-based biotech entrepreneur told me. “To show the world that the heroic people of Wuhan have come back.”
  • But Peter Daszak, a British disease ecologist who has collaborated with the Wuhan Institute of Virology for sixteen years on research on bat coronaviruses, told me that it’s typical to fail to gather good data from the site of an initial outbreak. Once people get sick, local authorities inevitably focus on the public-health emergency. “You send in the human doctors, not the veterinarians,” he said, in a phone conversation. “And the doctors’ response is to clean out the market. They want to stop the infections.”
  • Pharmaceutical executives have also been expected to lead the way, like the construction manager who donned P.P.E. in order to escort his workers into the patient ward. “Every senior executive at Sinopharm and C.N.B.G. has been vaccinated,” He said. “Including the C.E.O. of Sinopharm, the chairman of the board, every vice-president—everyone.” The Chinese press has reported that vaccinations have also been administered to hundreds of thousands of citizens in high-risk areas around the world.
  • In the West, China’s image has been badly damaged by the pandemic and by other recent events. The country has tightened political crackdowns in Hong Kong and Xinjiang, and, in May, after Australia called for an investigation into the origins of the virus, China responded furiously, placing new tariffs and restrictions on Australian goods ranging from barley to beef.
  • But He believes that the situation is fluid. “All of these feelings can turn around quickly,” he told me. “I think that once China has a vaccine, and if they can help other countries, it can make a huge difference.”
  • There’s also a competitive element. “China wants to beat America,” He said. He believes that the C.N.B.G. vaccine will receive some level of approval for public use by the end of October. “Chinese officials are thinking that Donald Trump might approve a U.S. vaccine before the election,” he said. “So their goal is to have a vaccine approved before that.”
  • No matter how quickly the Chinese develop a vaccine, or how effectively they have handled the pandemic since January, it’s unlikely to make Westerners forget the mistakes and misinformation during the pandemic’s earliest phase.
  • Some of this is due to a cultural difference—the Chinese response to errors is often to look forward, not back. On January 31st, Fang Fang commented in her diary, “The Chinese people have never been fond of admitting their own mistakes, nor do they have a very strong sense of repentance.” It’s often hard for them to understand why this quality is so frustrating for Westerners. In this regard, the pandemic is truly a mirror—it doesn’t allow the Chinese to look out and see themselves through the eyes of others.
  • The pandemic illuminates both the weaknesses and the strengths of the Chinese system, as well as the relationship between the government and the people. They know each other well: officials never felt the need to tell citizens exactly what happened in Wuhan, but they understood that American-level casualties would have been shocking—given China’s population, the tally would have been more than a million and counting.
  • In order to avoid death on that scale, the government also knew that people would be willing to accept strict lockdowns and contribute their own efforts toward fighting the virus.
  • In turn, citizens were skilled at reading their government. People often held two apparently contradictory ideas: that the Party lied about some things but gave good guidance about others. More often than not, citizens could discern the difference. During the pandemic, it was striking that, when the Chinese indulged in conspiracy theories, these ideas rarely resulted in personally risky behavior, as they often did in the U.S.
  • Perhaps the Chinese have been inoculated by decades of censorship and misinformation: in such an environment, people develop strong instincts for self-preservation, and they don’t seem as disoriented by social media as many Americans are.
  • Early in the year, I corresponded by WeChat with a Wuhan pharmacist who worked in a hospital where many were infected. On February 26th, he expressed anger about the early coverup. “My personal opinion is that the government has always been careless and suppressed dissent,” he wrote. “Because of this, they lost a golden opportunity to control the virus.”
  • In Wuhan, we met a few times, and during one of our conversations I showed him what he had written in February. I asked what he would do now if he found himself in Li Wenliang’s position, aware of an outbreak of some unknown disease. Would he post a warning online? Contact a health official? Alert a journalist?The pharmacist thought for a moment. “I would tell my close friends in person,” he said. “But I wouldn’t put anything online. Nothing in writing.”
  • I asked if such an event would turn out differently now.“It would be the same,” he said. “It’s a problem with the system.”
  • He explained that, with an authoritarian government, local officials are afraid of alarming superiors, which makes them inclined to cover things up. But, once higher-level leaders finally grasp the truth, they can act quickly and effectively.
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Shanghai's Omicron Outbreak Corners Chinese Leader - WSJ - 0 views

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shared by Javier E on 08 Apr 22 - No Cached
  • China’s top leaders believe that confining residents to their homes during outbreaks is the most effective way to keep death rates low and avoid overwhelming the country’s healthcare system.
  • Wu Zunyou, chief epidemiologist at the Chinese Center for Disease Control and Prevention, said at a public forum in November that China would have had about 260 million Covid-19 cases and more than three million deaths if it had adopted looser restrictions similar to those in the U.S. and U.K.
  • China has reported fewer than 260,000 cases and less than 5,000 deaths, compared with 80 million confirmed cases and nearly a million deaths in the U.S.
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  • The economic and social costs of the Chinese strategy have climbed with the rise of more easily transmitted variants. Retail sales, tourism and manufacturing have suffered from residential lockdowns, business closures and travel bans. A population that largely supported zero-Covid measures early on has tired of tight limits on the routines of daily life.
  • Her food is running low, she said. On Monday, Ms. Wang got her first food delivery from the government: two zucchini, a carton of milk, 10 sausages, noodles and a can of Spam. “As someone who hasn’t been infected by the virus, my biggest question is, ‘How long do we have to endure such lack of freedom?’ ” she said.
  • Before the latest outbreak, Mr. Xi and other top officials saw Shanghai as a model for China’s long-term goal of living with the virus, according to the people close to government decision-making. 
  • Shanghai, run by a close ally of Mr. Xi, never had serious problems. The few cases that had surfaced in the past two years were secured with limited apartment and neighborhood closures. Unlike the rest of China, mask-wearing wasn’t widely adopted by city residents.
  • in undisclosed comments to members of the Politburo Standing Committee, Mr. Xi made clear that China couldn’t back down from its stringent Covid approach, even if it meant slower economic growth, according to a person close to decision-making who was briefed on the remarks.
  • Then an influx of visitors arrived from Hong Kong, hoping to escape an outbreak there. Many stayed at a Shanghai hotel where officials say the virus spread in early March to the staff and beyond. At the time, city authorities said wide-ranging lockdowns wouldn’t be necessary.
  • A few days later, Shanghai initiated a two-stage lockdown. Speaking at a teleconference with other infectious-disease experts around that time, Mr. Wu, China CDC’s chief epidemiologist, said Shanghai didn’t act decisively enough in the latest outbreak and missed its chance to control the outbreak,
  • In Shanghai, people with Covid-19 are confined to home, and access to medical care for those with other illnesses has been limited. Food deliveries, arranged by local authorities, have been delayed in some neighborhoods, according to interviews with more than a dozen residents.
  • Local officials have reported no Covid-related fatalities. The Journal learned that at least two elder-care hospitals have been battling an outbreak, with more than 20 deaths at one of the facilities.
  • Thousands of users of Weibo, China’s Twitter-like social media platform, have shared stories of people with life-threatening illnesses such as cancer unable to get treatment, adding to citywide feelings of helplessness.
  • “Fighting all the previous variants was like putting out a forest fire, it can be done,” said Michael Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota. “But Omicron is like the wind. How do you stop the wind?”
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Opinion | The Pandemic Probably Started in a Lab. These 5 Key Points Explain Why. - The... - 0 views

www.nytimes.com/...covid-lab-leak.html pandemic origin covid china lab history investigation
shared by Javier E on 04 Jun 24 - No Cached
  • a growing volume of evidence — gleaned from public records released under the Freedom of Information Act, digital sleuthing through online databases, scientific papers analyzing the virus and its spread, and leaks from within the U.S. government — suggests that the pandemic most likely occurred because a virus escaped from a research lab in Wuhan, China.
  • If so, it would be the most costly accident in the history of science.
  • The SARS-like virus that caused the pandemic emerged in Wuhan, the city where the world’s foremost research lab for SARS-like viruses is located.
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  • Dr. Shi’s group was fascinated by how coronaviruses jump from species to species. To find viruses, they took samples from bats and other animals, as well as from sick people living near animals carrying these viruses or associated with the wildlife trade. Much of this work was conducted in partnership with the EcoHealth Alliance, a U.S.-based scientific organization that, since 2002, has been awarded over $80 million in federal funding to research the risks of emerging infectious diseases.
  • Their research showed that the viruses most similar to SARS‑CoV‑2, the virus that caused the pandemic, circulate in bats that live roughly 1,000 miles away from Wuhan. Scientists from Dr. Shi’s team traveled repeatedly to Yunnan province to collect these viruses and had expanded their search to Southeast Asia. Bats in other parts of China have not been found to carry viruses that are as closely related to SARS-CoV-2.
  • When the Covid-19 outbreak was detected, Dr. Shi initially wondered if the novel coronavirus had come from her laboratory, saying she had never expected such an outbreak to occur in Wuhan.
  • The SARS‑CoV‑2 virus is exceptionally contagious and can jump from species to species like wildfire. Yet it left no known trace of infection at its source or anywhere along what would have been a thousand-mile journey before emerging in Wuhan.
  • The year before the outbreak, the Wuhan institute, working with U.S. partners, had proposed creating viruses with SARS‑CoV‑2’s defining feature
  • The laboratory pursued risky research that resulted in viruses becoming more infectious: Coronaviruses were grown from samples from infected animals and genetically reconstructed and recombined to create new viruses unknown in nature. These new viruses were passed through cells from bats, pigs, primates and humans and were used to infect civets and humanized mice (mice modified with human genes). In essence, this process forced these viruses to adapt to new host species, and the viruses with mutations that allowed them to thrive emerged as victors.
  • Worse still, as the pandemic raged, their American collaborators failed to publicly reveal the existence of the Defuse proposal. The president of EcoHealth, Peter Daszak, recently admitted to Congress that he doesn’t know about virus samples collected by the Wuhan institute after 2015 and never asked the lab’s scientists if they had started the work described in Defuse.
  • By 2019, Dr. Shi’s group had published a database describing more than 22,000 collected wildlife samples. But external access was shut off in the fall of 2019, and the database was not shared with American collaborators even after the pandemic started, when such a rich virus collection would have been most useful in tracking the origin of SARS‑CoV‑2. It remains unclear whether the Wuhan institute possessed a precursor of the pandemic virus.
  • In 2021, The Intercept published a leaked 2018 grant proposal for a research project named Defuse, which had been written as a collaboration between EcoHealth, the Wuhan institute and Ralph Baric at the University of North Carolina, who had been on the cutting edge of coronavirus research for years. The proposal described plans to create viruses strikingly similar to SARS‑CoV‑2.
  • Coronaviruses bear their name because their surface is studded with protein spikes, like a spiky crown, which they use to enter animal cells. The Defuse project proposed to search for and create SARS-like viruses carrying spikes with a unique feature: a furin cleavage site — the same feature that enhances SARS‑CoV‑2’s infectiousness in humans, making it capable of causing a pandemic. Defuse was never funded by the United States.
  • owever, in his testimony on Monday, Dr. Fauci explained that the Wuhan institute would not need to rely on U.S. funding to pursue research independently.
  • While it’s possible that the furin cleavage site could have evolved naturally (as seen in some distantly related coronaviruses), out of the hundreds of SARS-like viruses cataloged by scientists, SARS‑CoV‑2 is the only one known to possess a furin cleavage site in its spike. And the genetic data suggest that the virus had only recently gained the furin cleavage site before it started the pandemic.
  • Ultimately, a never-before-seen SARS-like virus with a newly introduced furin cleavage site, matching the description in the Wuhan institute’s Defuse proposal, caused an outbreak in Wuhan less than two years after the proposal was drafted.
  • When the Wuhan scientists published their seminal paper about Covid-19 as the pandemic roared to life in 2020, they did not mention the virus’s furin cleavage site — a feature they should have been on the lookout for, according to their own grant proposal, and a feature quickly recognized by other scientists.
  • At the Wuhan Institute of Virology, a team of scientists had been hunting for SARS-like viruses for over a decade, led by Shi Zhengl
  • In May, citing failures in EcoHealth’s monitoring of risky experiments conducted at the Wuhan lab, the Biden administration suspended all federal funding for the organization and Dr. Daszak, and initiated proceedings to bar them from receiving future grants. In his testimony on Monday, Dr. Fauci said that he supported the decision to suspend and bar EcoHealth.
  • Separately, Dr. Baric described the competitive dynamic between his research group and the institute when he told Congress that the Wuhan scientists would probably not have shared their most interesting newly discovered viruses with him. Documents and email correspondence between the institute and Dr. Baric are still being withheld from the public while their release is fiercely contested in litigation.
  • In the end, American partners very likely knew of only a fraction of the research done in Wuhan. According to U.S. intelligence sources, some of the institute’s virus research was classified or conducted with or on behalf of the Chinese military.
  • In the congressional hearing on Monday, Dr. Fauci repeatedly acknowledged the lack of visibility into experiments conducted at the Wuhan institute, saying, “None of us can know everything that’s going on in China, or in Wuhan, or what have you. And that’s the reason why — I say today, and I’ve said at the T.I.,” referring to his transcribed interview with the subcommittee, “I keep an open mind as to what the origin is.”
  • The Wuhan lab pursued this type of work under low biosafety conditions that could not have contained an airborne virus as infectious as SARS‑CoV‑2.
  • Labs working with live viruses generally operate at one of four biosafety levels (known in ascending order of stringency as BSL-1, 2, 3 and 4) that describe the work practices that are considered sufficiently safe depending on the characteristics of each pathogen. The Wuhan institute’s scientists worked with SARS-like viruses under inappropriately low biosafety conditions.
  • ​​Biosafety levels are not internationally standardized, and some countries use more permissive protocols than others.
  • In one experiment, Dr. Shi’s group genetically engineered an unexpectedly deadly SARS-like virus (not closely related to SARS‑CoV‑2) that exhibited a 10,000-fold increase in the quantity of virus in the lungs and brains of humanized mice. Wuhan institute scientists handled these live viruses at low biosafety levels, including BSL-2.
  • Even the much more stringent containment at BSL-3 cannot fully prevent SARS‑CoV‑2 from escaping. Two years into the pandemic, the virus infected a scientist in a BSL-3 laboratory in Taiwan, which was, at the time, a zero-Covid country. The scientist had been vaccinated and was tested only after losing the sense of smell. By then, more than 100 close contacts had been exposed. Human error is a source of exposure even at the highest biosafety levels, and the risks are much greater for scientists working with infectious pathogens at low biosafety.
  • An early draft of the Defuse proposal stated that the Wuhan lab would do their virus work at BSL-2 to make it “highly cost-effective.” Dr. Baric added a note to the draft highlighting the importance of using BSL-3 to contain SARS-like viruses that could infect human cells, writing that “U.S. researchers will likely freak out.”
  • Years later, after SARS‑CoV‑2 had killed millions, Dr. Baric wrote to Dr. Daszak: “I have no doubt that they followed state determined rules and did the work under BSL-2. Yes China has the right to set their own policy. You believe this was appropriate containment if you want but don’t expect me to believe it. Moreover, don’t insult my intelligence by trying to feed me this load of BS.”
  • SARS‑CoV‑2 is a stealthy virus that transmits effectively through the air, causes a range of symptoms similar to those of other common respiratory diseases and can be spread by infected people before symptoms even appear. If the virus had escaped from a BSL-2 laboratory in 2019, the leak most likely would have gone undetected until too late.
  • One alarming detail — leaked to The Wall Street Journal and confirmed by current and former U.S. government officials — is that scientists on Dr. Shi’s team fell ill with Covid-like symptoms in the fall of 2019. One of the scientists had been named in the Defuse proposal as the person in charge of virus discovery work. The scientists denied having been sick.
  • The hypothesis that Covid-19 came from an animal at the Huanan Seafood Market in Wuhan is not supported by strong evidence.
  • In December 2019, Chinese investigators assumed the outbreak had started at a centrally located market frequented by thousands of visitors daily. This bias in their search for early cases meant that cases unlinked to or located far away from the market would very likely have been missed
  • To make things worse, the Chinese authorities blocked the reporting of early cases not linked to the market and, claiming biosafety precautions, ordered the destruction of patient samples on January 3, 2020, making it nearly impossible to see the complete picture of the earliest Covid-19 cases. Information about dozens of early cases from November and December 2019 remains inaccessible.
  • A pair of papers published in Science in 2022 made the best case for SARS‑CoV‑2 having emerged naturally from human-animal contact at the Wuhan market by focusing on a map of the early cases and asserting that the virus had jumped from animals into humans twice at the market in 2019
  • More recently, the two papers have been countered by other virologists and scientists who convincingly demonstrate that the available market evidence does not distinguish between a human superspreader event and a natural spillover at the market.
  • Furthermore, the existing genetic and early case data show that all known Covid-19 cases probably stem from a single introduction of SARS‑CoV‑2 into people, and the outbreak at the Wuhan market probably happened after the virus had already been circulating in humans.
  • Not a single infected animal has ever been confirmed at the market or in its supply chain. Without good evidence that the pandemic started at the Huanan Seafood Market, the fact that the virus emerged in Wuhan points squarely at its unique SARS-like virus laboratory.
  • With today’s technology, scientists can detect how respiratory viruses — including SARS, MERS and the flu — circulate in animals while making repeated attempts to jump across species. Thankfully, these variants usually fail to transmit well after crossing over to a new species and tend to die off after a small number of infections
  • investigators have not reported finding any animals infected with SARS‑CoV‑2 that had not been infected by humans. Yet, infected animal sources and other connective pieces of evidence were found for the earlier SARS and MERS outbreaks as quickly as within a few days, despite the less advanced viral forensic technologies of two decades ago.
  • Even though Wuhan is the home base of virus hunters with world-leading expertise in tracking novel SARS-like viruses, investigators have either failed to collect or report key evidence that would be expected if Covid-19 emerged from the wildlife trade. For example, investigators have not determined that the earliest known cases had exposure to intermediate host animals before falling ill.
  • No antibody evidence shows that animal traders in Wuhan are regularly exposed to SARS-like viruses, as would be expected in such situations.
  • In previous outbreaks of coronaviruses, scientists were able to demonstrate natural origin by collecting multiple pieces of evidence linking infected humans to infected animals
  • In contrast, virologists and other scientists agree that SARS‑CoV‑2 required little to no adaptation to spread rapidly in humans and other animals. The virus appears to have succeeded in causing a pandemic upon its only detected jump into humans.
  • it was a SARS-like coronavirus with a unique furin cleavage site that emerged in Wuhan, less than two years after scientists, sometimes working under inadequate biosafety conditions, proposed collecting and creating viruses of that same design.
  • a laboratory accident is the most parsimonious explanation of how the pandemic began.
  • Given what we now know, investigators should follow their strongest leads and subpoena all exchanges between the Wuhan scientists and their international partners, including unpublished research proposals, manuscripts, data and commercial orders. In particular, exchanges from 2018 and 2019 — the critical two years before the emergence of Covid-19 — are very likely to be illuminating (and require no cooperation from the Chinese government to acquire), yet they remain beyond the public’s view more than four years after the pandemic began.
  • it is undeniable that U.S. federal funding helped to build an unprecedented collection of SARS-like viruses at the Wuhan institute, as well as contributing to research that enhanced them.
  • Advocates and funders of the institute’s research, including Dr. Fauci, should cooperate with the investigation to help identify and close the loopholes that allowed such dangerous work to occur. The world must not continue to bear the intolerable risks of research with the potential to cause pandemics.
  • A successful investigation of the pandemic’s root cause would have the power to break a decades-long scientific impasse on pathogen research safety, determining how governments will spend billions of dollars to prevent future pandemics. A credible investigation would also deter future acts of negligence and deceit by demonstrating that it is indeed possible to be held accountable for causing a viral pandemic
  • Last but not least, people of all nations need to see their leaders — and especially, their scientists — heading the charge to find out what caused this world-shaking event. Restoring public trust in science and government leadership requires it.
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Deadliest Ebola Outbreak on Record Is Over, W.H.O. Says - The New York Times - 0 views

www.nytimes.com/...ebola-who.html new york times US outbreak
shared by johnsonma23 on 15 Jan 16 - No Cached
  • Deadliest Ebola Outbreak on Record Is Over, W.H.O. Says
  • DAKAR, Senegal — The World Health Organization declared on Thursday the end to the deadliest Ebola outbreak on record, which killed and sickened tens of thousands of people in West Africa, even as it cautioned that more flare-ups of the disease were likely.
  • recent chain of cases in Liberia was snuffed out, marking the first time since the start of the epidemic two years ago that Guinea, Liberia and Sierra Leone
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  • Margaret Chan, the director general of the World Health Organization, hailed the “monumental achievement” in curbing the outbreak
  • United Nations said, killed more than 11,300 people and infected more than 28,500. At the height of the outbreak
  • “our work is not done, and vigilance is needed to prevent new outbreaks.”
  • The risk, although significant, was low, he said. The new cases had occurred on average 27 days apart, but there have been none since mid-November
  • The three West African countries now have the world’s biggest pool of expertise in handling Ebola and greater professionalism, confidence and resources for dealing with it, he said.
  • Sierra Leone was declared free of Ebola transmission in November and Guinea at the end of December; Liberia was declared Ebola-free in May but then reported a few new cases.
  • Beating back Ebola is among the few tangible achievements that senior United Nations officials cite as an example of global cooperation
  • “Relative to its significance to global humanity, there is no issue that gets less attention,” said Lawrenc
  • “Frankly, this has not been on the A-list of global problems in the way that nuclear proliferation, or terrorism, or global climate change has been,
  • Investing roughly $4.5 billion a year to improve health systems, advance research, and strengthen the abilities of the World Health Organization and other bodies could avoid $60 billion in losses in the event of a pandemic, the commission concluded.
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Tests Show Genetic Signature of Coronavirus That Likely Infected Trump - The New York T... - 0 views

www.nytimes.com/...trump-covid-19-genome.html US trump pandemic gop covid-19 coronavirus-tracing white-house
shared by aidenborst on 02 Nov 20 - No Cached
  • President Trump’s illness from a coronavirus infection last month was the most significant health crisis for a sitting president in nearly 40 years. Yet little remains known about how the virus arrived at the White House and how it spread
  • The administration did not take basic steps to track the outbreak, limiting contact tracing, keeping cases a secret and cutting out the Centers for Disease Control and Prevention. The origin of the infections, a spokesman said, was “unknowable.”
  • The journalists, Michael D. Shear and Al Drago, both had significant, separate exposure to White House officials in late September, several days before they developed symptoms. They did not spend any time near each other in the weeks before their positive tests.
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  • The study reveals, for the first time, the genetic sequence of the virus that may have infected Mr. Trump and dozens of others, researchers said.
  • In a study released on Thursday, the C.D.C. cited genetic sequencing and intensive contact tracing that documented an super-spreading event at a high school retreat in Wisconsin.
  • The genomes believed by these researchers to be connected to the White House outbreak do not identify a recent geographic source, in part because they are unusual.
  • The results show that even weeks after it was identified, the White House outbreak would be better understood by sequencing samples of more people who were infected.
  • Viruses constantly mutate, picking up tiny, accidental alterations to their genetic material as they reproduce. Few mutations alter how a virus functions. But by comparing patterns of mutations across many genetic sequences, scientists can construct family trees of a virus, illuminating how it spreads.
  • But the Trump administration is not known to have conducted its own genetic analysis of people infected in the outbreak. The White House declined to respond to questions on genetic sequencing of Mr. Trump and the cluster of aides and officials who tested positive or became ill.
  • Scientists not involved in the research who reviewed the results agreed with the conclusion that the two samples sharing rare mutations strongly suggested they are part of the same outbreak.
  • “These genomes are probably going to be identical or nearly identical to the genome that infected the president,” said Michael Worobey, head of the department of ecology and evolutionary biology at the University of Arizona.
  • For months, the White House minimized the threat of the virus and eschewed basic safety precautions at official events, like wearing a mask or keeping people six feet apart.
  • At least 11 people who attended a Rose Garden celebration on Sept. 26 for Judge Barrett, which included an indoor event without masks, became infected with the coronavirus, including Mr. Trump.
  • The work is convincing, and it is the best way to piece together the progression of such an outbreak, said David Engelthaler, head of the infectious disease branch of the Translational Genomics Research Institute in Arizona, where he and colleagues have sequenced thousands of genomes to track the spread of the coronavirus, including devastating outbreaks at Native American reservations in the state.
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Scientists Predicted the Coronavirus Pandemic - The Atlantic - 0 views

www.theatlantic.com/...613003 pandemic prediction science epidemiology china Covid-19
shared by Javier E on 15 Jun 20 - No Cached
  • The now-prophetic words could be found at the end of a research paper published in the journal Clinical Microbiology Reviews in October of 2007: “The presence of a large reservoir of SARS-CoV-like viruses in horseshoe bats, together with the culture of eating exotic mammals in southern China, is a time bomb.”
  • The warning—made nearly 13 years ago and more than four years after the worrying first wave of severe acute respiratory syndrome, or SARS, killed nearly 800 people globally—was among the earliest to predict the emergence of something like SARS-CoV-2, the virus behind the current COVID-19 pandemic.
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  • Dogged by skepticism and inconsistent funding, these coronavirus researchers were stymied from developing treatments and vaccines for SARS—many of which could have been helpful in the current crisis.
  • Another similarly affected researcher was Brenda Hogue, a virologist at Arizona State University in Tempe. Hogue had devoted her career to studying coronaviruses, focusing on the protein machinery that drives their assembly. After SARS, she and her colleagues turned part of their attention toward developing a vaccine. But when the funding dropped off in 2008, she said, the vaccine went into limbo “and we put our efforts into other directions.”
  • to some experts whose business it is to hunt potential pathogens before they spill over into human populations, the many years spent not girding for a serious coronavirus outbreak were tragically—and unnecessarily—wasted.
  • “We were out there on the ground after SARS, working on coronaviruses with Chinese colleagues in collaboration,” said Peter Daszak, president of the EcoHealth Alliance, a New York–based nonprofit group that took part in a large federally funded effort, called Predict, to hunt for new pandemic viruses in wildlife in 31 countries, including China. That program was famously defunded last fall, just before the SARS-CoV-2 outbreak began.
  • “But we were the only group of western scientists,” Daszak added. “How can we be the only people looking for these viruses when there was such a clear and present danger?”
  • when SARS emerged in late 2002, there was initially “general disbelief among medical people that a coronavirus could be the basis of such a huge outbreak.”
  • As that epidemic spread, an influx of new researchers crowded the field. More grants were awarded, and funding started to climb. “Everyone wanted to know where the virus had come from,” said Ralph Baric, a microbiologist at the University of North Carolina’s Gillings School of Global Public Health. Initial findings pointed to wild civets and raccoon dogs sold for meat and pelts, respectively, in Chinese markets. Later evidence began to implicate horseshoe bats as the original source of the infections. Some researchers whose pre-SARS careers had been grounded in basic coronavirus biology began working on therapies and vaccines—and they made steady progress for several years.
  • funding declines hobbled individual investigators who weren’t part of these larger consortia. Pharmaceutical companies that develop vaccines and therapies scaled back on coronavirus research, too. Within a few years after the SARS outbreak, public health funding agencies both in the United States and abroad “no longer regarded coronaviruses as a high public health threat compared to other diseases,” Saif wrote in an email.
  • Then on May 12, The Wall Street Journal reported that the Chinese government was responding in kind, “by stalling international efforts to find the source of the [SARS-CoV-2] virus amid an escalating U.S. push to blame China for the pandemic.”
  • To demonstrate that a particular virus is actually harmful to people, scientists need to isolate and culture the microbe and show it infects human cells in the lab
  • Led by virologist Zheng-Li Shi, the Wuhan team reported in 2013 that this particular virus, called WIV1, binds with ACE2 in civet and human cells, and then replicates efficiently inside them. “That was the red flag,” Saif said. Earlier evidence suggested that direct contact with these bats could lead to viral spillover in humans. “Now there was proof of that.”
  • hen cases of those diseases fell off, public-health responders shifted to other viral emergencies such as Ebola and Zika, and coronavirus research funding dropped sharply.
  • They created a hybrid microbe by attaching the spike protein from SHC014 to the genetic backbone of a SARS-like virus that was previously adapted to grow in mice. Called a chimera—an organism containing cells with more than one genotype—this lab-made microbe had no problem binding with ACE2 and infecting human cells. Baric’s research team concluded that like WIV1, any SARS-like viruses outfitted with the SHC014 spike could pose cross-species threats to people.
  • Baric acknowledged the risky nature of the research but emphasized the safety protocols. “In general, we don’t know the transmissibility or virulence potential of any bat viruses or chimeras,” Baric said in an email message. “Hence it’s best to keep and work with them under biosafety level 3 laboratory conditions to maximize safety.”
  • Baric also pointed out that a chimera would display a genetic signature “that says what it is.” The adjoining parts of a chimera segregate discreetly in a logical pattern.
  • A genetic analysis of the chimera produced in his lab, for instance, “would come out to be mouse-adapted SARS everywhere but the spike, which is SHC014.” Similar logical patterns are absent in SARS-CoV-2, indicating that the virus that causes COVID-19 evolved naturally.
  • ven as Baric and others were generating lab evidence that more SARS-like viruses were poised for human emergence, another outbreak—in pigs, not people—provided another strong and recent signal: Some 25,000 piglets were killed by a coronavirus in the Guangdong province of China, starting in 2016. That virus, too, was found in horseshoe bats, and Buchmeier described the outbreak as both a major cross-species spillover and a warning shot that was never really picked up by the broader public-health community.
  • The EcoHealth Alliance, which had been part of the Predict effort, maintained its own collaboration with the Wuhan Institute of Virology using funds supplied by the National Institutes of Health. But on April 24, the Trump administration—which is investigating whether SARS-CoV-2 escaped accidentally from the Wuhan Institute, an allegation that’s been broadly discredited—directed the NIH to cut off that support.
  • The bats had been trapped in a cave in Kunming, the capital of the Yunnan province. At least seven other SARS-like strains were present in that same colony, leading the researchers to speculate that bat coronaviruses remained “a substantial global threat to public health.”
  • To disease experts, the bickering is a worrying—perhaps even astonishing—indicator that at least some global leaders still aren’t hearing what they have to say about the threat of coronaviruses, and Baric asserted that the ongoing pandemic exposes the need for better communication between countries, not less. “That is absolutely key,” he said. “Critical information needs to be passed as quickly as possible.”
  • Many other warnings would follow.Indeed, evidence of a looming and more deadly coronavirus pandemic had been building for years. Yet experts who specialize in coronaviruses—a large family of pathogens, found especially in birds and mammals, that can cross over to humans from other mammals and cause varying degrees of illness—struggled to convince a broader audience of the risk
  • the number of coronavirus-research grants funded by the National Institutes of Health—which had increased from a low of 28 in 2002 to a peak of 103 in 2008—went into a tailspin.
  • Though support for coronavirus research spiked a bit with the MERS outbreak in 2012, the increase was short-lived. Since that outbreak was quickly contained, the disease didn’t raise wider concerns and grant opportunities declined further.
  • Ironically, just as funding for drugs and vaccines was drying up, evidence that other coronavirus threats lurked in wildlife was only getting stronger
  • Ten years would pass, however, before researchers could show there were other SARS-like viruses in nature that also bind with ACE2. The evidence came from a team based at the Wuhan Institute of Virology
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How Coronavirus Overpowered the World Health Organization - WSJ - 1 views

www.wsj.com/...ak-for-coronavirus-11598625537 WHO politics history pandemic crisis reforms policy
shared by Javier E on 25 Oct 20 - No Cached
  • The WHO spent years and hundreds of millions of dollars honing a globe-spanning system of defenses against a pandemic it knew would come. But the virus moved faster than the United Nations agency, exposing flaws in its design and operation that bogged down its response when the world needed to take action.
  • The WHO relied on an honor system to stop a viral cataclysm. Its member states had agreed to improve their ability to contain infectious disease epidemics and to report any outbreaks that might spread beyond their borders. International law requires them to do both.
  • Time and again, countries big and small have failed to do so. The WHO, which isn’t a regulatory agency, lacks the authority to force information from the very governments that finance its programs and elect its leaders
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  • years of painstakingly worded treaties, high-level visits and cutting-edge disease surveillance—all meant to encourage good-faith cooperation—have only bitten around the edges of the problem.
  • “It can’t demand entry into a country because they think something bad is happening.”
  • Nearly 200 countries were counting on an agency whose budget—roughly $2.4 billion in 2020—is less than a sixth of the Maryland Department of Health’s. Its donors, largely Western governments, earmark most of that money for causes other than pandemic preparedness.
  • In 2018 and 2019, about 8% of the WHO’s budget went to activities related to pandemic preparedness
  • It took those experts more than four months to agree that widespread mask-wearing helps, and that people who are talking, shouting or singing can expel the virus through tiny particles that linger in the air. In that time, about half a million people died.
  • To write its recommendations, the WHO solicits outside experts, which can be a slow process.
  • the agency’s bureaucratic structure, diplomatic protocol and funding were no match for a pandemic as widespread and fast-moving as Covid-19.
  • As months rolled on, it became clear that governments were reluctant to allow the U.N. to scold, shame or investigate them.
  • In particular, The Wall Street Journal found:
  • * China appears to have violated international law requiring governments to swiftly inform the WHO and keep it in the loop about an alarming infectious-disease cluster
  • —there are no clear consequences for violations
  • * The WHO lost a critical week waiting for an advisory panel to recommend a global public-health emergency, because some of its members were overly hopeful that the new disease wasn’t easily transmissible from one person to another.
  • * The institution overestimated how prepared some wealthy countries were, while focusing on developing countries, where much of its ordinary assistance is directed
  • Public-health leaders say the WHO plays a critical role in global health, leading responses to epidemics and setting health policies and standards for the world. It coordinates a multinational effort every year to pick the exact strains that go into the seasonal flu vaccine, and has provided public guidance and advice on Covid-19 when many governments were silent.
  • The world’s public-health agency was born weak, created in 1948 over U.S. and U.K. reluctance. For decades, it was legally barred from responding to diseases that it learned about from the news. Countries were required to report outbreaks of only four diseases to the WHO: yellow fever, plague, cholera and smallpox, which was eradicated in 1980.
  • SARS convinced governments to retool the WHO. The next year, delegates arrived in the Geneva palace where the League of Nations once met to resolve a centuries-old paradox: Countries don’t report outbreaks, because they fear—correctly—their neighbors will respond by blocking travel and trade.
  • Nearly three times that amount was budgeted for eradicating polio, a top priority for the WHO’s two largest contributors: the U.S. and the Bill & Melinda Gates Foundation.
  • “Everybody pushed back. No sovereign country wants to have this.”
  • China wanted an exemption from immediately reporting SARS outbreaks. The U.S. argued it couldn’t compel its 50 states to cooperate with the treaty. Iran blocked American proposals to make the WHO focus on bioterrorism. Cuba had an hourslong list of objections.
  • Around 3:15 a.m. on the last day, exhausted delegates ran out of time. The treaty they approved, called the International Health Regulations, imagined that each country would quickly and honestly report, then contain, any alarming outbreaks
  • In return, the treaty discouraged restrictions on travel and trade. There would be no consequences for reporting an outbreak—yet no way to punish a country for hiding one.
  • The treaty’s key chokepoint: Before declaring a “public health emergency of international concern,” or PHEIC, the WHO’s director-general would consult a multinational emergency committee and give the country in question a chance to argue against such a declaration.
  • Delegates agreed this could give some future virus a head start but decided it was more important to discourage the WHO from making any unilateral announcements that could hurt their economies.
  • Over the next few years, emergency committees struggled over how to determine whether an outbreak was a PHEIC. It took months to declare emergencies for two deadly Ebola epidemics
  • On Jan. 3, representatives of China’s National Health Commission arrived at the WHO office in Beijing. The NHC acknowledged a cluster of pneumonia cases, but didn’t confirm that the new pathogen was a coronavirus, a fact Chinese officials already knew.
  • That same day, the NHC issued an internal notice ordering laboratories to hand over or destroy testing samples and forbade anyone from publishing unauthorized research on the virus.
  • China’s failure to notify the WHO of the cluster of illnesses is a violation of the International Health Regulations
  • China also flouted the IHR by not disclosing all key information it had to the WHO
  • The WHO said it’s up to member states to decide whether a country has complied with international health law, and that the coming review will address those issues.
  • While Chinese scientists had sequenced the genome and posted it publicly, the government was less forthcoming about how patients might be catching the virus.
  • WHO scientists pored over data they did get, and consulted with experts from national health agencies, including the CDC, which has 33 staff detailed to the WHO.
  • Then a 61-year-old woman was hospitalized in Thailand on Jan. 13.
  • The next day, Dr. van Kerkhove told reporters: “It’s certainly possible that there is limited human-to-human transmission.” MERS and SARS, both coronaviruses, were transmissible among people in close quarters. Epidemiological investigations were under way, she said.
  • On Jan. 22, a committee of 15 scientists haggled for hours over Chinese data and a handful of cases in other countries. Clearly, the virus was spreading between people in China, though there was no evidence of that in other countries. The question now: Was it mainly spreading from very sick people in hospitals and homes—or more widely?
  • The committee met over two days, but was split. They mostly agreed on one point: The information from China “was a little too imprecise to very clearly state that it was time” to recommend an emergency declaration,
  • On Jan. 28, Dr. Tedros and the WHO team arrived for their meeting with Mr. Xi
  • Leaning across three wooden coffee tables, Dr. Tedros pressed for cooperation. In the absence of information, countries might react out of fear and restrict travel to China, he repeated several times throughout the trip. Mr. Xi agreed to allow a WHO-led international team of experts to visit. It took until mid-February to make arrangements and get the team there.
  • China also agreed to provide more data, and Dr. Tedros departed, leaving Dr. Briand behind with a list of mysteries to solve. How contagious was the virus? How much were children or pregnant women at risk? How were cases linked? This was vital information needed to assess the global risk, Dr. Briand said
  • Back in Geneva, Dr. Tedros reconvened the emergency committee. By now it was clear there was human-to-human transmission in other countries. When it met on Jan. 30, the committee got the information the WHO had been seeking. This time the committee recommended and Dr. Tedros declared a global public-health emergency.
  • President Trump and New York Gov. Andrew Cuomo both assured constituents their health systems would perform well. The U.K.’s chief medical officer described the WHO’s advice as largely directed at poor and middle-income countries. As for keeping borders open, by then many governments had already closed them to visitors from China.
  • The WHO shifted focus to the developing world, where it believed Covid-19 would exact the heaviest toll. To its surprise, cases shot up just across the border, in northern Italy.
  • the WHO’s health emergencies unit should report to the director-general and not member states, and its budget should be protected so it doesn’t have to compete with other programs for money.
  • If there were one thing the WHO might have done differently, it would be to offer wealthier countries the type of assistance with public-health interventions that the WHO provides the developing world
  • the WHO’s warning system of declaring a global public-health emergency needs to change. Some want to see a warning system more like a traffic light—with color-coded alarms for outbreaks, based on how worried the public should be
  • Emergency committees need clearer criteria for declaring a global public-health emergency and should publicly explain their thinking
  • The WHO should have more powers to intervene in countries to head off a health crisis
  • Lessons learned
  • Implementing many of those ideas would require herding diplomats back for another monthslong slog of treaty revisions. If and when such talks begin, new governments will likely be in place, and political priorities will float elsewher
  • “Unfortunately, I’m very cynical about this,” he said. “We are living through cycles of panic and neglect. We’ve been through all of this before.”
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Experts fear coronavirus will become a pandemic - The Washington Post - 0 views

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  • There are outbreaks. There are epidemics. And there are pandemics, where epidemics become rampant in multiple countries and continents simultaneously. The novel coronavirus that causes the disease named covid-19 is on the verge of that third, globe-shaking stage
  • Amid an alarming surge in cases with no clear link to China, infectious disease experts believe the flulike illness may soon be impossible to contain
  • the language coming from the organization’s Geneva headquarters has turned more ominous in recent days as the challenge of containment grows more daunting.
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  • “The window of opportunity is still there, but the window of opportunity is narrowing,” WHO Director General Tedros Adhanom Ghebreyesus said on Friday. “We need to act quickly before it closes completely.”
  • At the beginning of any disease outbreak, public health experts painstakingly trace the contacts of every person who becomes sick. The experts build a family tree of possible illness, with branches that include anyone who might have shaken hands with, or been sneezed on by an infected person
  • with confirmed infections approaching 80,000 people, contact tracing on a case-by-case basis could soon be impractical.
  • “What we find is that this virus is going to be very difficult to contain,” said Jeffrey Shaman, an infectious disease researcher at Columbia University and co-author of the study posted Monday. “Personally, I don’t think we can do it.”
  • The word ‘pandemic’ invokes fear, but it describes how widespread an outbreak may be, not its deadliness.
  • “I think we should assume that this virus is very soon going to be spreading in communities here, if it isn’t already, and despite aggressive actions, we should be putting more efforts to mitigate impacts,”
  • The virus would be easier to contain if people who are contagious were obviously so, as was the case with SARS, which started an outbreak that burned itself out in 2003. But the new virus appears to spread among people who in some cases are not noticeably sick.
  • among the more than 600 passengers from the Diamond Princess cruise ship who have tested positive, about half had no obvious symptoms.
  • If the coronavirus becomes a true pandemic, a large proportion of the human population — a third, a half, two-thirds even — could become infected
  • Harvard epidemiologist Marc Lipsitch estimates that 40 to 70 percent of the human population could potentially be infected by the virus if it becomes pandemic. Not all of those people would get sick
  • The novel coronavirus may be particularly suited for stealth community transmission since its symptoms can be indistinguishable from those of a cold or flu, and testing capabilities are still being ramped up.
  • Experts estimate it takes about a week for the number of people infected in a given community to double. Based on that, it would likely take several weeks for a new infection cluster to be picked up by a local health department
  • By mid-March, he estimated, officials should know if there is community transmission and a true pandemic.
  • “I want to be clear that we are not seeing community spread here in the United States yet,” she said Friday. “But it’s very possible, even likely, that may eventually happen.”
  • “If a large number of countries are unsuccessful in preventing sustained multi-generation transmissions, then we could witness the next pandemic.”
  • A pandemic is a line in the sand, and every expert has a slightly different definition for when an outbreak crosses it. Generally, it means that there are self-sustaining lines of infection in multiple countries and continents — where the family tree of possible illness begins to encompass the entire population.
  • I think we’re not in as dire straits as we might be, and that’s because everyone is pulling together internationally.”
  • Public health experts are devising strategies on how to conserve N95 respirators, specialized masks that are in a limited supply amid surging demand.
  • “Extrapolating from some of the numbers we’ve seen on the impact to the health care system in China, it means we’ll have to surge fast.”
19More

Germany's coronavirus death rate is lower than Italy, China, Spain, France - The Washin... - 0 views

www.washingtonpost.com/...a-a156-0048b62cdb51_story.html germany pandemic response italy korea
shared by Javier E on 25 Mar 20 - No Cached
  • In Italy, 9.5 percent of the people who have tested positive for the virus have succumbed to covid-19, according to data compiled at Johns Hopkins University. In France, the rate is 4.3 percent. But in Germany, it’s 0.4 percent.
  • The biggest reason for the difference, infectious disease experts say, is Germany’s work in the early days of its outbreak to track, test and contain infection clusters. That means Germany has a truer picture of the size of its outbreak than places that test only the obviously symptomatic, most seriously ill or highest-risk patients.
  • Germany, with 31,150 cases at midday Tuesday, appeared to have a larger outbreak than France, with 20,149. But the higher death rate in France implies there were more undiagnosed cases there. France’s outbreak could be larger than Germany’s.
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  • “At the beginning, when we had relatively few cases, when it came to finding them and isolating them, we did quite well in Germany,”
  • Initially, at least, the country’s health authorities tracked infection clusters meticulously. When an individual tested positive, they used contact tracing to find other people with whom they had been in touch and then tested and quarantined them, which broke infection chains
  • Germany’s high diagnostic capacity had “secured us an extreme lead . . . in the detection of the epidemic.”
  • But he cautioned against complacency, and said the death rate would increase: “We are no exception.”
  • As community spread became prevalent, infection chains in some cases became impossible to trace. Some doctors said they had no choice but to send people seeking tests back home to call jammed coronavirus hotlines because they lacked protective equipment to conduct them safely.
  • With cases growing exponentially, health authorities have moved on to ordering social distancing and banning mass events. Federal states have restricted gatherings outside the home to a maximum of two people.
  • outh Korea, which has been praised as a model for responding to the outbreak, has a death rate of 1.2 percent.
  • “In South Korea, there’s been a longer duration of infections, so we can’t really compare,” he said. “We have lots of newly positive cases. They didn’t have the chance to die yet.”
  • Busse said Germany is more comparable to Norway. The Scandinavian country is at a similar point in its outbreak, it’s also worked to test and contain cases, and it also has a death rate of 0.4 percent.
  • a period of exponential growth might be slowing, but cautioned that it was too early to say, given fluctuations in data. He said the picture should be clearer by Wednesday.
  • many initial cases had clear links to overseas travel.
  • the German outbreak started with large numbers of young people — “people who came back from holidays.”
  • Lauterbach said he expected Germany’s death rate to rise as more vulnerable segments of society are infected.
  • Because testing is not universal, and many people with the coronavirus might never be diagnosed, a true death rate is impossible to ascertain. But experts say the rate is likely to be significantly higher in countries such as Spain and Italy, where care is collapsing.
  • With more intensive care beds and ventilators than most other European nations and early measures to prevent the spread of the virus, Lauterbach said, he didn’t see Germany turning into Italy or Spain. Still, he has been advocating for wider restrictions.
  • “I think with all things considered, Germany will do reasonably well in this first round of a long fight,”
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Taiwan Is Beating the Coronavirus. Can the US Do the Same? | WIRED - 0 views

www.wired.com/...navirus-can-the-us-do-the-same taiwan pandemic response strategies
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  • it is natural enough to look at Taiwan’s example and wonder why we didn’t do what they did, or, more pertinently, could we have done what they did?
  • we keep seeing the culturally embedded assumption that East Asian-style state social control just won’t fly in the good old, individualist, government-wary, freedom-loving United States.
  • The New York Times: People in “places like Singapore … are more willing to accept government orders.” Fortune: “There seems to be more of a willingness to place the community and society needs over individual liberty.” Even WIRED: “These countries all have social structures and traditions that might make this kind of surveillance and control a little easier than in the don’t-tread-on-me United States.”
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  • we see the classic “Confucian values” (or “Asian values”) argument that has historically been deployed to explain everything from the economic success of East Asian nations to the prevalence of authoritarian single-party rule in Asia, and even, most recently, China’s supposed edge in AI research.
  • So, yeah, kudos to Taiwan for keeping its people safe, but here in America we’re going to do what we always do in a crisis—line up at a gun store and accuse the opposing political party of acting in bad faith. Not for us, those Asian values.
  • But the truth is that Taiwan, one of Asia’s most vibrant and boisterous democracies, is a terrible example to cite as a cultural other populated by submissive peons
  • Taiwan’s self-confidence and collective solidarity trace back to its triumphal self-liberation from its own authoritarian past, its ability to thrive in the shadow of a massive, hostile neighbor that refuses to recognize its right to chart its own path, and its track record of learning from existential threats.
  • There is no doubt that in January it would have been difficult for the US to duplicate Taiwan’s containment strategy, but that’s not because Americans are inherently more ornery than Taiwanese
  • It’s because the United States has a miserable record when it comes to learning from its own mistakes and suffers from a debilitating lack of faith in the notion that the government can solve problems—something that dates at least as far back as the moment in 1986 when Ronald Reagan said, “The nine most terrifying words in the English language are: ‘I’m from the government and I’m here to help.’”
  • The Taiwan-US comparison is the opposite of a clash of civilizations; instead, it’s a deathly showdown between competence and incompetence.
  • To be fair, there are some cultural aspects of East Asian societies that may work in Taiwan’s favor
  • There is undeniably a long tradition in East Asia of elevating scholars and experts to the highest levels of government,
  • The country’s president Tsai Ingwen, boasts a PhD from the London School of Economics, and the vice president, Chen Chien-jen, is a highly regarded epidemiologist
  • The threat of SARS put Taiwan on high alert for future outbreaks, while the past record of success at meeting such challenges seems to have encouraged the public to accept socially intrusive technological interventions.
  • First, and most important was Taiwan’s experience battling the SARS outbreak in 2003, followed by the swine flu in 2009
  • “Taiwan actually has a functioning democratic government, run by sensible, well-educated people—the USA? Not so much.”)
  • Taiwan’s commitment to transparency has also been critical
  • In the United States, the Trump administration ordered federal health authorities to treat high-level discussions on the coronavirus as classified material.
  • In Taiwan, the government has gone to great lengths to keep citizens well informed on every aspect of the outbreak, including daily press conferences and an active presence on social media
  • “Do not forget that Taiwan has been under China’s threat constantly,” wrote Wang Cheng-hua, a professor of art history at Princeton, “which has raised social consciousness about collective action. When the collective will supports government, then all of the strict measures implemented by the government make sense.”
  • Over the past quarter-century, Taiwan’s government has nurtured public trust by its actions and its transparency.
  • The democracy activists who risked their lives and careers during the island nation’s martial law era were not renowned for their willingness to accept government orders or preach Confucian social harmony
  • some of the current willingness to trust what the government is telling the people is the direct “result of having experienced the transition from an authoritarian government that lied all the time, to a democratic government and robust political dialogue that forced people to be able to evaluate information.”
  • Because of the opposition of the People’s Republic of China, Taiwan is not a member of the United Nations or the World Health Organization
  • “The reality of being isolated from global organizations,” wrote Tung, “also makes Taiwanese very aware of the publicity of its success in handling a crisis like this. The more coverage from foreign media, the more people feel confident in government policy and social mobilization.”
  • Given what we know about Taiwan’s hard-won historical experience, could the US have implemented a similar model?
  • The answer, sadly, seems to be no
  • it would be impossible for the US to successfully integrate a health care database with customs and travel records because there is no national health care database in the United States. “The US health care system is fragmented, making it difficult to organize, integrate, and assess data coming in from its various government and private-sector parts,”
  • more tellingly, continued Fidler, “the manner in which the United States has responded to Covid-19 demonstrates that the United States did not learn the lessons from past outbreaks and is struggling to cobble together a semblance of a strategy. ”
  • There’s where the contrast between the United States and Taiwan becomes most salient. The US is not only bad at the act of government but has actively been getting worse.
  • But Taiwan’s own success at building a functional democracy is probably the most potent rebuke to the Asian values thesis.
  • But over that same period, powerful political and economic interests in the US have dedicated themselves to undermining faith in government action, in favor of deregulated markets that have no capacity to react intelligently or proactively to existential threats.
  • And instead of learning from history, US leaders actively ignore it, a truth for which there could be no better symbolic proof than the Trump administration’s dismantling of the National Security Council pandemic office created by the Obama administration in the wake of the Ebola outbreak
  • Finally, instead of seeking to keep the public informed to the best of our ability, some of our political leaders and media institutions have gone out of their way to muddy the waters.
  • In Taiwan, one early government response to the Covid-19 outbreak was to institute a fine of $100,000 for the act of spreading fake news about the epidemic.
  • In the US the most popular television news network in the country routinely downplayed or misrepresented the threat of the coronavirus, until the severity of the outbreak became too large to ignore.
  • If there is any silver lining here, it’s that the disaster now upon us is of such immense scope that it could finally expose the folly of the structural forces that have been wreaking sustained havoc on American governmental institutions
  • So maybe we are finally about to learn that competence matters, that educated leaders are a virtue, and that telling the truth is a responsibility
  • Americans might have to learn this the hard way, like we did in Hong Kong and Singapore.”
  • We’re about to find out how hard it’s going to be. But will we learn?
58More

How the White House Coronavirus Response Went Wrong - The Atlantic - 0 views

www.theatlantic.com/...613591 pandemic US response history analysis system failure
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  • oping with a pandemic is one of the most complex challenges a society can face. To minimize death and damage, leaders and citizens must orchestrate a huge array of different resources and tools.
  • I have heard military and intelligence officials describe some threats as requiring a “whole of nation” response, rather than being manageable with any one element of “hard” or “soft” power or even a “whole of government” approach. Saving lives during a pandemic is a challenge of this nature and magnitude.
  • “If he had just been paying attention, he would have asked, ‘What do I do first?’ We wouldn’t have passed the threshold of casualties in previous wars. It is a catastrophic failure.”
  • ...55 more annotations...
  • Aviation is safe in large part because it learns from its disasters. Investigators from the U.S. National Transportation Safety Board go immediately to accident sites to begin assessing evidence. After months or even years of research, their detailed reports try to lay out the “accident chain” and explain what went wrong
  • with respect to the coronavirus pandemic, it has suffered by far the largest number of fatalities, about one-quarter of the global total, despite having less than one-20th of the world’s population.
  • What if the NTSB were brought in to look at the Trump administration’s handling of the pandemic? What would its investigation conclude?
  • This was a journey straight into a mountainside, with countless missed opportunities to turn away. A system was in place to save lives and contain disaster. The people in charge of the system could not be bothered to avoid the doomed course.
  • Timelines of aviation disasters typically start long before the passengers or even the flight crew knew anything was wrong, with problems in the design of the airplane, the procedures of the maintenance crew, the route, or the conditions into which the captain decided to fly. In the worst cases, those decisions doomed the flight even before it took off. My focus here is similarly on conditions and decisions that may have doomed the country even before the first COVID-19 death had been recorded on U.S. soil.
  • What happened once the disease began spreading in this country was a federal disaster in its own right: Katrina on a national scale, Chernobyl minus the radiation. It involved the failure to test; the failure to trace; the shortage of equipment; the dismissal of masks; the silencing or sidelining of professional scientists; the stream of conflicting, misleading, callous, and recklessly ignorant statements by those who did speak on the national government’s behalf
  • As late as February 26, Donald Trump notoriously said of the infection rate, “You have 15 people, and the 15 within a couple of days is going to be down close to zero.” What happened after that—when those 15 cases became 15,000, and then more than 2 million, en route to a total no one can foretell—will be a central part of the history of our times.
  • 1. The Flight Plan
  • the most important event was the H5N1 “bird flu” outbreak, in 2005. It originated in Asia and was mainly confined there, as the SARS outbreak had been two years earlier. Bush-administration officials viewed H5N1 as an extremely close call. “
  • Shortly before Barack Obama left office, his administration’s Pandemic Prediction and Forecasting Science and Technology Working Group—yes, that was a thing—released a report reflecting the progress that had been made in applying remote-sensing and AI tools since the early days of Global Argus. The report is freely available online and notes pointedly that recent technological advances “provide opportunities to mitigate large-scale outbreaks by predicting more accurately when and where outbreaks are likely to occur, and how they will progress.”
  • “Absolutely nothing that has happened has been a surprise. We saw it coming. Not only did we see it, we ran the models and the gaming exercises. We had every bit of the structure in place. We’ve been talking about a biohazard risk like this for years. Anyone who says we did not see this coming has their head in the sand, or is lying through their teeth.”
  • The system the government set up was designed to warn not about improbable “black swan” events but rather about what are sometimes called “gray rhinos.” These are the large, obvious dangers that will sooner or later emerge but whose exact timing is unknown.
  • other U.S. leaders had dealt with foreign cover-ups, including by China in the early stages of the SARS outbreak in 2002. Washington knew enough, soon enough, in this case to act while there still was time.
  • During the Obama administration, the U.S. had negotiated to have its observers stationed in many cities across China, through a program called Predict. But the Trump administration did not fill those positions, including in Wuhan. This meant that no one was on site to learn about, for instance, the unexplained closure on January 1 of the city’s main downtown Huanan Seafood Wholesale Market, a so-called wet market
  • “It was in the briefings by the beginning of January,” a person involved in preparing the president’s briefing book told me. “On that there is no dispute.” This person went on: “But knowing it is in the briefing book is different from knowing whether the president saw it.” He didn’t need to spell out his point, which was: Of course this president did not.
  • To sum up: The weather forecast showed a dangerous storm ahead, and the warning came in plenty of time. At the start of January, the total number of people infected with the virus was probably less than 1,000. All or nearly all of them were in China. Not a single case or fatality had been reported in the United States.
  • 2. The Air Traffic Controllers
  • In cases of disease outbreak, U.S. leadership and coordination of the international response was as well established and taken for granted as the role of air traffic controllers in directing flights through their sectors
  • in normal circumstances, its location in China would have been a plus. Whatever the ups and downs of political relations over the past two decades, Chinese and American scientists and public-health officials have worked together frequently, and positively, on health crises ranging from SARS during George W. Bush’s administration to the H1N1 and Ebola outbreaks during Barack Obama’s.
  • One U.S. official recalled the Predict program: “Getting Chinese agreement to American monitors throughout their territory—that was something.” But then the Trump administration zeroed out that program.
  • “We had cooperated with China on every public-health threat until now,” Susan Shirk, a former State Department official and longtime scholar of Chinese affairs at UC San Diego, told me. “SARS, AIDS, Ebola in Africa, H1N1—no matter what other disputes were going on in the relationship, we managed to carve out health, and work together quite professionally. So this case is just so anomalous and so tragic.” A significant comparison, she said, is the way the United States and the Soviet Union had worked together to eliminate smallpox around the world, despite their Cold War tensions. But now, she said, “people have definitely died because the U.S. and China have been unable to cooperate.”
  • What did the breakdown in U.S.-Chinese cooperation mean in practice? That the U.S. knew less than it would have otherwise, and knew it later; that its actions brought out the worst (rather than the merely bad) in China’s own approach to the disease, which was essentially to cover it up internally and stall in allowing international access to emerging data; that the Trump administration lost what leverage it might have had over Chinese President Xi Jinping and his officials; and that the chance to keep the disease within the confines of a single country was forever lost.
  • In addition to America’s destruction of its own advance-warning system, by removing CDC and Predict observers, the Trump administration’s bellicose tone toward China had an effect. Many U.S. officials stressed that a vicious cycle of blame and recrimination made public health an additional source of friction between the countries, rather than a sustained point of cooperation, as it had been for so many years.
  • “The state of the relationship meant that every U.S. request was met with distrust on the Chinese side, and every Chinese response was seen on the American side as one more attempt to cover up,”
  • Several officials who had experience with China suggested that other presidents might have called Xi Jinping with a quiet but tough message that would amount to: We both know you have a problem. Why don’t we work on it together, which will let you be the hero? Otherwise it will break out and become a problem for China and the whole world.
  • “It would have taken diplomatic pressure on the Chinese government to allow us to insert our people” into Wuhan and other disease centers, Klain said. “The question isn’t what leverage we had. The point is that we gave up leverage with China to get the trade deal done. That meant that we didn’t put leverage on China’s government. We took their explanations at face value.”
  • 3. The Emergency Checklist
  • The president’s advance notice of the partial European ban almost certainly played an important part in bringing the infection to greater New York City. Because of the two-day “warning” Trump gave in his speech, every seat on every airplane from Europe to the U.S. over the next two days was filled. Airport and customs offices at the arrival airports in the U.S. were unprepared and overwhelmed. News footage showed travelers queued for hours, shoulder to shoulder, waiting to be admitted to the U.S. Some of those travelers already were suffering from the disease; they spread it to others. On March 11, New York had slightly more than 220 diagnosed cases. Two weeks later, it had more than 25,000. Genetic testing showed that most of the infection in New York was from the coronavirus variant that had come through Europe to the United States, rather than directly from China (where most of the early cases in Washington State originated).
  • Aviation is safe because, even after all the advances in forecasting and technology, its culture still imagines emergencies and rehearses steps for dealing with them.
  • Especially in the post-9/11 era of intensified concern about threats of all sorts, American public-health officials have also imagined a full range of crises, and have prepared ways to limit their worst effects. The resulting official “playbooks” are the equivalent of cockpit emergency checklists
  • the White House spokesperson, Kayleigh McEnany, then claimed that whatever “thin packet of paper” Obama had left was inferior to a replacement that the Trump administration had supposedly cooked up, but which has never been made public. The 69-page, single-spaced Obama-administration document is officially called “Playbook for Early Response to High-Consequence Infectious Disease Threats and Biological Incidents” and is freely available online. It describes exactly what the Trump team was determined not to do.
  • What I found remarkable was how closely the Obama administration’s recommendations tracked with those set out 10 years earlier by the George W. Bush administration, in response to its chastening experience with bird flu. The Bush-era work, called “National Strategy for Pandemic Influenza” and publicly available here, differs from the Obama-era playbook mainly in the simpler forms of technology on which it could draw
  • consider the one below, and see how, sentence by sentence, these warnings from 2005 match the headlines of 2020. The topic was the need to divide responsibility among global, national, state, and community jurisdictions in dealing with the next pandemic. The fundamental premise—so widely shared that it barely needed to be spelled out—was that the U.S. federal government would act as the indispensable flywheel, as it had during health emergencies of the past. As noted, it would work with international agencies and with governments in all affected areas to coordinate a global response. Within its own borders it would work with state agencies to detect the potential for the disease’s spread and to contain cases that did arise:
  • Referring to the detailed pandemic playbooks from the Bush and Obama administrations, John R. Allen told me: “The moment you get confirmation of a problem, you would move right to the timeline. Decisions by the president, actions by the secretary of defense and the CDC, right down the list. You’d start executing.”Or, in the case of the current administration, you would not. Reading these documents now is like discovering a cockpit checklist in the smoking wreckage.
  • 4. The Pilot
  • a virtue of Sully is the reminder that when everything else fails—the forecasts, the checklists, the triply redundant aircraft systems—the skill, focus, and competence of the person at the controls can make the difference between life and death.
  • So too in the public response to a public-health crisis. The system was primed to act, but the person at the top of the system had to say, “Go.” And that person was Donald Trump.
  • n a resigned way, the people I spoke with summed up the situation this way: You have a head of government who doesn’t know anything, and doesn’t read anything, and is at the mercy of what he sees on TV. “And all around him, you have this carnival,”
  • “There would be some ballast in the relationship,” this person said. “Now all you’ve got is the trade friction”—plus the personal business deals that the president’s elder daughter, Ivanka, has made in China,
  • 5. The Control Systems
  • The deadliest airline crash in U.S. history occurred in 1979. An American Airlines DC-10 took off from O’Hare Airport, in Chicago—and just as it was leaving the ground, an incorrectly mounted engine ripped away from one of the wings. When the engine’s pylon was pulled off, it cut the hydraulic lines that led from the cockpit to the control surfaces on the wings and tail. From that point on, the most skillful flight crew in the world could not have saved the flight.
  • By the time the pandemic emerged, it may have already been too late. The hydraulic lines may already have been too damaged to transmit the signals. It was Trump himself who cut them.
  • The more complex the organization, the more its success or failure turns on the skill of people in its middle layers—the ones who translate a leader’s decision to the rest of the team in order to get results. Doctors depend on nurses; architects depend on contractors and craftsmen; generals depend on lieutenants and sergeants
  • Because Donald Trump himself had no grasp of this point, and because he and those around him preferred political loyalists and family retainers rather than holdovers from the “deep state,” the whole federal government became like a restaurant with no cooks, or a TV station with stars but no one to turn the cameras on.
  • “There is still resilience and competence in the working-level bureaucracy,” an intelligence-agency official told me. “But the layers above them have been removed.”
  • Traditionally, the National Security Council staff has comprised a concentration of highly knowledgeable, talented, and often ambitious younger figures, mainly on their way to diplomatic or academic careers.
  • “There is nobody now who can play the role of ‘senior China person,’” a former intelligence official told me. “In a normal administration, you’d have a lot of people who had spent time in Asia, spent time in China, knew the goods and bads.” Also in a normal administration, he and others pointed out, China and the United States would have numerous connective strands
  • The United States still possesses the strongest economy in the world, its military is by far the most powerful, its culture is diverse, and, confronted with the vicissitudes of history, the country has proved resilient. But a veteran of the intelligence world emphasized that the coronavirus era revealed a sobering reality. “Our system has a single point-of-failure: an irrational president.” At least in an airplane cockpit, the first officer can grab the controls from a captain who is steering the aircraft toward doom.
  • Every president is “surprised” by how hard it is to convert his own wishes into government actions
  • Presidents cope with this discovery in varying ways. The people I spoke with had served in past administrations as early as the first George Bush’s. George H. W. Bush came to office with broad experience in the federal government—as much as any other president. He had been vice president for eight years, a CIA director, twice an ambassador, and a member of Congress. He served only four years in the Oval Office but began with a running start. Before he became president, Bill Clinton had been a governor for 12 years and had spent decades learning and talking about government policies. A CIA official told me that Clinton would not read his President’s Daily Briefs in the morning, when they arrived, but would pore over them late at night and return them with copious notes. George W. Bush’s evolution from dependence on the well-traveled Dick Cheney, in his first term, to more confident control, in his second, has been well chronicled. As for Obama, Paul Triolo told me: “By the end of his eight years, Obama really understood how to get the bureaucracy to do what he wanted done, and how to get the information he needed to make decisions.” The job is far harder than it seems. Donald Trump has been uninterested in learning the first thing about it.
  • In a situation like this, some of those in the “regular” government decide to struggle on. Others quit—literally, or in the giving-up sense
  • The ‘process’ is just so chaotic that it’s not a process at all. There’s no one at the desk. There’s no one to read the memos. No one is there.”
  • “If this could happen to Fauci, it makes people think that if they push too hard in the wrong direction, they’ll get their heads chopped off. There is no reason in the world something called #FireFauci should even exist. The nation’s leaders should maintain high regard for scientific empiricism, insight, and advice, and must not be professionally or personally risk averse when it comes to understanding and communicating messages about public safety and health.”
  • Over nearly two decades, the U.S. government had assembled the people, the plans, the connections, and the know-how to spare this nation the worst effects of the next viral mutation that would, someday, arise. That someday came, and every bit of the planning was for naught. The deaths, the devastation, the unforeseeable path ahead—they did not have to occur.
  • The language of an NTSB report is famously dry and clinical—just the facts. In the case of the pandemic, what it would note is the following: “There was a flight plan. There was accurate information about what lay ahead. The controllers were ready. The checklists were complete. The aircraft was sound. But the person at the controls was tweeting. Even if the person at the controls had been able to give effective orders, he had laid off people that would carry them out. This was a preventable catastrophe.”
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Norovirus is almost impossible to stop - The Atlantic - 0 views

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  • Disinfection is back.
  • “Bleach is my friend right now,” says Annette Cameron, a pediatrician at Yale School of Medicine, who spent the first half of this week spraying and sloshing the potent chemical all over her home. It’s one of the few tools she has to combat norovirus, the nasty gut pathogen that her 15-year-old son was recently shedding in gobs.
  • norovirus has seeded outbreaks in several countries, including the United Kingdom, Canada, and the United States. Last week, the U.K. Health Security Agency announced that laboratory reports of the virus had risen to levels 66 percent higher than what’s typical this time of year. Especially hard-hit are Brits 65 and older, who are falling ill at rates that “haven’t been seen in over a decade.”
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  • The U.S. logs fewer than 1,000 annual deaths out of millions of documented cases
  • this is more a nauseating nuisance than a public-health crisis. In most people, norovirus triggers, at most, a few miserable days of GI distress that can include vomiting, diarrhea, and fevers, then resolves on its own; the keys are to stay hydrated and avoid spreading it to anyone vulnerabl
  • norovirus is the most common cause of foodborne illness in the United States.)
  • the virus is far more deadly in parts of the world with limited access to sanitation and potable water.
  • Still, fighting norovirus isn’t easy, as plenty of parents can attest. The pathogen, which prompts the body to expel infectious material from both ends of the digestive tract, is seriously gross and frustratingly hardy. Even the old COVID standby, a spritz of hand sanitizer, doesn’t work against it—the virus is encased in a tough protein shell that makes it insensitive to alcohol.
  • At an extreme, a single gram of feces—roughly the heft of a jelly bean—could contain as many as 5.5 billion infectious doses, enough to send the entire population of Eurasia sprinting for the toilet.
  • norovirus mainly targets the gut, and spreads especially well when people swallow viral particles that have been released in someone else’s vomit or stool.
  • direct contact with those substances, or the food or water they contaminate, may not even be necessary: Sometimes people vomit with such force that the virus gets aerosolized; toilets, especially lidless ones, can send out plumes of infection
  • If the spittle finding holds for humans, then talking, singing, and laughing in close proximity could be risky too.
  • Once emitted into the environment, norovirus particles can persist on surfaces for days—making frequent hand-washing and surface disinfection key measures to prevent spread
  • Handshakes and shared meals tend to get dicey during outbreaks, along with frequently touched items such as utensils, door handles, and phones.
  • One 2012 study pointed to a woven plastic grocery bag as the source of a small outbreak among a group of teenage soccer players; the bag had just been sitting in a bathroom used by one of the girls when she fell sick the night before.
  • Once a norovirus transmission chain begins, it can be very difficult to break. The virus can spread before symptoms start, and then for more than a week after they resolve
  • Once the virus arrives, the entire family is almost sure to be infected. Baldridge, who has two young children, told me that her household has weathered at least four bouts of norovirus in the past several years.
  • Roughly 20 percent of European populations, for instance, are genetically resistant to common norovirus strains. “So you can hope,” Frenck told me. For the rest of us, it comes down to hygiene
  • Altan-Bonnet recommends diligent hand-washing, plus masking to ward off droplet-borne virus. Sick people should isolate themselves if they can. “And keep your saliva to yourself,” she told me.
  • The family fastidiously scrubbed their hands with hot water and soap, donned disposable gloves when touching shared surfaces, and took advantage of the virus’s susceptibility to harsh chemicals and heat. When her son threw up on the floor, Cameron sprayed it down with bleach; when he vomited on his quilt, she blasted it twice in the washing machine on the sanitizing setting, then put it through the dryer at a super high temp
  • After three years of COVID, the world has gotten used to thinking about infections in terms of airways. “We need to recalibrate,” Bhumbra told me, “and remember that other things exist.”
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Polio outbreak in Syria: War is keeping the world from eradicating polio. - 0 views

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  • The World Health Organization has confirmed an outbreak of polio in Syria, the country’s first since 1999
  • Though health groups still say polio could be eradicated entirely by 2018, recent outbreaks in Pakistan and Somalia are making this more likely. (The threats of violence against health workers in Pakistan aren’t helping matters.)
  • Polio also isn’t the only disease being kept alive by political violence. Guinea worm, a painful parasite once common in Africa and Asia, was thought to be on the verge of eradication, but health workers warned earlier this year that violence in Mali could hamper efforts to eliminate it entirely.
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  • In both cases, it’s been demonstrated that science has the means to wipe these diseases out, if only politics didn’t keep getting in the way
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The killer disease with no vaccine - BBC News - 0 views

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  • Since the beginning of the year, Nigeria has been gripped by an outbreak of a deadly disease. Lassa fever is one of a number of illnesses which can cause dangerous epidemics, but for which no vaccine currently exists.
  • Lassa fever is not a new disease, but the current outbreak is unprecedented, spreading faster and further than ever before. Health workers are overstretched, and a number have themselves become infected and died.
  • About 1% of cases are thought to be fatal, but women who contract the disease late in pregnancy face an 80% chance of losing their child, or dying themselves. 1081 suspected cases (1 January - 25 February) 317 confirmed cases 14 health care workers affected in six states
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  • Outbreaks can be influenced by seasonal weather conditions, which affect the numbers of the virus's natural host - the multimammate rat.
  • Most people catch Lassa fever from anything contaminated with rat urine, faeces, blood or saliva - through eating, drinking or simply handling contaminated objects in the home.
  • It is likely that a vaccine could be found for Lassa - reducing the possibility of an outbreak becoming a global health emergency - but as with other epidemic diseases that mainly affect poorer countries, progress has stalled.
  • Vaccine development is a long, complex and costly process. This is especially true for emerging epidemic diseases, where a prototype vaccine can usually only be tested where there is an outbreak.
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UK troops fear Covid-19 outbreak in 'cramped' barracks lockdown | UK news | The Guardian - 0 views

www.theguardian.com/...reak-cramped-barracks-lockdown culture crisis
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  • Three hundred soldiers recalled to a barracks in Aldershot this week have complained they are being locked down without sufficient hygiene essentials amid concerns that their cramped conditions could lead to a coronavirus outbreak.
  • Although thousands of troops have been placed on standby to help tackle the coronavirus crisis, frustrated soldiers in Aldershot said it was not clear why they had been recalled to “essentially an open prison”.
  • “We even have a dozen or so people within camp who are self-isolating through showing symptoms, and no effort is being made for them to receive medical treatment at all. They’re just being told to stay in their rooms and if they have to smoke they’re to smoke out of their window.”
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  • But concerns are growing in some quarters of the armed forces that the military is not practising physical distancing and could be at risk of spreading coronavirus when it is most needed, while images are circulating on social media of forces personnel conducting physical training in large groups.
  • An email from a commanding officer in the Royal Engineers seen by the Guardian says: “Where we can respect social distancing in the training environment we should seek to do so.” But it adds: “This will not always be possible, pleased [sic] be relaxed about this.”
  • Soldiers in the Grenadier Guards have single-person rooms, the army source added, and special arrangements such as staggered mealtimes had been arranged to help distance people while they are on standby at barracks. “Soldiers are used to keeping good hygiene: there are rigorous hand-washing routines for instance,” the source said.
  • It was impossible in practice to minimise contact with “people living in what are essentially university-style dormitories that have a shared kitchen and shared washing machines and dryers which obviously present considerable risk of cross-contamination. No cleaning equipment has been provided such as hand sanitisers for personal use, so people are having to share their own limited stock.”
  • An MoD spokesperson said: “We are well prepared for the outbreak of coronavirus, and have well-rehearsed plans in place for dealing with health matters. All our people have been reminded of the guidance issued by Public Health England, which is the same advice for the general population.”
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Epidemics expert Jonathan Quick: 'The worst-case scenario for coronavirus is likely' | ... - 0 views

www.theguardian.com/...an-quick-q-and-a-laura-spinney epidemic pandemic disease politics crisis emergency
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  • n 2018 global health expert Jonathan D Quick, of Duke University in North Carolina, published a book titled The End of Epidemics: The Looming Threat to Humanity and How to Stop It. In it he prescribed measures by which the world could protect itself against devastating disease outbreaks of the likes of the 1918 flu, which killed millions and set humanity back decades. He is the former chair of the Global Health Council and a long-term collaborator of the World Health Organization (WHO).
  • The worst case is that the outbreak goes global and the disease eventually becomes endemic, meaning it circulates permanently in the human population.
  • If it becomes a pandemic, the questions are, how bad will it get and how long will it last? The case fatality rate – the proportion of cases that are fatal – has been just over 2%, much less than it was for Sars, but 20 times that of seasonal flu.
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  • If the worst-case scenario comes true, are there still things we can do to minimise the pandemic’s impact?Absolutely. We can mobilise more health officials and keep engaging the public, implementing sensible travel controls and ensuring that frontline health workers have ready access to diagnostic tests and are vigilant – that they don’t send anyone who may have been exposed home without testing them, for example
  • Was an epidemic like that of Covid-19 inevitable?From a biological standpoint an outbreak of a novel pathogen was inevitable, but this one happened in the worst place at the worst time. Wuhan is a big city and a crossroads,
  • is in people’s minds – even though the risk of another one is real. I’ve written about a hypothetical situation in which a new and dangerous pathogen emerges, a vaccine is developed, and you still get a pandemic, because large numbers of millennials refuse the vaccine. In the US, 20% of millennials believe that vaccines cause autism.
  • You have said that time and trust are critical to good epidemic management. What do you mean?The delay between the frontline health workers noticing something unusual, in the form of an emerging disease, and that information travelling up the line to central decision-makers is critical. To illustrate that, a 2018 simulation that the Gates Foundation conducted of a flu pandemic estimated that there would be 28,000 after one month, 10 million after three months, and 33 million after six months. The virus used in that simulation was more contagious and deadly than Covid-19 – though they are both respiratory viruses – but the example shows how all epidemics grow exponentially. So if you can catch an epidemic in the first few weeks, it makes all the difference.
  • The problem is bad information. As my students often remind me, news tends to be behind paywalls, while fake news is free.
  • y (GHS) Index – that scores countries on six dimensions: prevention, detection, response, health system, risk environment and compliance with international standards. No country scores perfectly on all six. China has detected and responded to this epidemic pretty well, though its health system is now stretched beyond capacity, but it is weak on prevention
  • How well is the US prepared?The US ranks high on the GHS index, but is still unprepared for a severe pandemic, should one happen. Malfunctioning coronavirus tests have frustrated public health labs and delayed outbreak monitoring. Supplies of masks, suits and other protective material for health workers are running low in the midst of a moderately severe flu season.
  • Since the creation of a much-needed public health emergency preparedness fund in the aftermath of 9/11, its budget and the public health functions it supports have been steadily reduced. This is the mentality that left the world vulnerable to the devastating 2014 outbreak of Ebola in west Africa – that is, close the fire department and cancel the fire insurance as nobody’s house or factory has burned down lately. It’s time we learned that the bugs never stop mutating and crossing over to humans.
  • What exactly should we be doing faster?Fewer than one in three countries are close to being prepared to confront an epidemic, which leaves the vast majority of the world’s population vulnerable.
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Getting Down to Planning the Next Year and the Interim New Normal | Talking Points Memo - 0 views

talkingpointsmemo.com/...ear-and-the-interim-new-normal pandemic strategies response planning
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  • Put simply, we won’t be able to get back to even a semi-normal social and economic life until we have a system in place that will prevent us from rapidly falling right back into a cycle of more outbreaks, lockdowns, deaths in the tens of thousands and economic shocks.
  • We will need a system of mass surveillance testing to give us real time visibility into the current prevalence of the disease and keep numbers low enough to make contact tracing at a vast scale possible.
  • Without this kind of data and early warning system our society will be like a plane flying in a cloud bank with all the instruments on the blink.
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  • we need to see the course of this crisis in three parts.
  • First is the initial outbreak which we hope we’re getting some handle on. But there won’t be a return to a real normal until there’s a widely available vaccine or very effective treatments for COVID-19
  • in the best case scenario we face what I’ll call Phase Two of the crisis – a lengthy period after the initial outbreak in which the challenge will be to get back to an Interim New Normal until vaccines or treatments come online
  • The third phase will be the arrival of an effective vaccine that can finally in some sense end at least the epidemiological crisis.
  • So Phase One: Initial Outbreak. Phase Two: Sustaining an Interim New Normal. Phase Three: Vaccines and/or robust Treatments arrive and the crisis ends.
  • Another key concept: Testing isn’t all the same. One form of testing is diagnostic, tests you give to a particular person to guide their treatment.
  • The other is surveillance testing, testing to measure and manage the prevalence of the diseas
  • You can’t go back to even a semblance of normal economic and social life until you have an integrated, national system of surveillance testing in place that will give us a good shot at avoiding a rolling series of outbreaks and lockdowns for another year.
  • A great system in one state and a crappy one next door won’t cut it.
  • some building blocks are clear. The first is building a robust and vast system of testing across the country, both testing for infection and testing for antibodies
  • You also need a system of data collection and analysis that allows all those tests to be analyzed to granularly measure the prevalence and possible spread of the disease, both nationally and on the local level
  • You also need to keep the scale of infection low enough that contact tracing of new infections is at all possible.
  • Conventional contact tracing alone with armies of disease detectives probably isn’t up to the challenge, at least not on its own. That is why there’s already extensive discussions of using big data and geolocation tracking on cell phones to do some of this work at scale
  • A lot of that discussion has focused on taking something China did with mobile applications and adapting it to our social mores and laws. Put simply, you download an app. You say you’re healthy. If you get sick and test positive you tell the app. The app has recorded your movements over the last two weeks and a lot of other peoples. Once I test positive, the people who’ve been in close proximity to me get alerted and told they should get tested.
  • This is a very blunt instrument version of contact tracing. But unlike conventional contact tracing which operates with disease detectives, phone calls and interviews it can potentially be done at scale and almost instantaneously.
  • Ezra Klein published a look at a number of the proposed plans for this Phase Two/Interim New Normal and he found all of them almost totally unworkable. They all involve levels of technical capacity, privacy intrusion and political will that seem almost fantastical
  • we’ll either do one of these plans or all stay in our houses for a year or engage in the truly fantastical approach of going about life as usual while hundreds of thousands of Americans are dying and our national health care system collapsing around us.
  • The reality is that we’ll likely get some mix of all three. But knowing the alternatives helps focus our attention not on the seeming impossibility of these strategies but the fact that we need to get down to the business of planning and implementing them.
  • Phase Two is much more complicated. It is what everyone involved in any sort of public policy needs to be focusing on right now. Unfortunately the federal government has shown very, very little ability to mount any kind of coherent, national response.
  • And the President is focused on finding a date and calling an all clear as soon as possible.
60More

Warnings Ignored: A Timeline of Trump's COVID-19 Response - The Bulwark - 0 views

thebulwark.com/ne-of-trumps-covid-19-response timeline trump response pandemic history policy politics
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  • the White House is trying to establish an alternate reality in which Trump was a competent, focused leader who saved American people from the coronavirus.
  • it highlights just how asleep Trump was at the switch, despite warnings from experts within his own government and from former Trump administration officials pleading with him from the outside.
  • Most prominent among them were former Homeland Security advisor Tom Bossert, Commissioner of the Food and Drug Administration Scott Gottlieb, and Director for Medical and Biodefense Preparedness at the National Security Council Dr. Luciana Borio who beginning in early January used op-eds, television appearances, social media posts, and private entreaties to try to spur the administration into action.
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  • what the administration should have been doing in January to prepare us for today.
  • She cites the delay on tests, without which “cases go undetected and people continue to circulate” as a leading issue along with other missed federal government responses—many of which are still not fully operational
  • The prescient recommendations from experts across disciplines in the period before COVID-19 reached American shores—about testing, equipment, and distancing—make clear that more than any single factor, it was Trump’s squandering of out lead-time which should have been used to prepare for the pandemic that has exacerbated this crisis.
  • What follows is an annotated timeline revealing the warning signs the administration received and showing how slow the administration was to act on these recommendations.
  • The Early Years: Warnings Ignored
  • 2017: Trump administrations officials are briefed on an intelligence document titled “Playbook for Early Response to High-Consequence Emerging Infectious Disease Threats and Biological Incidents.” That’s right. The administration literally had an actual playbook for what to do in the early stages of a pandemic
  • February 2018: The Washington Post writes “CDC to cut by 80 percent efforts to prevent global disease outbreak.” The meat of the story is “Countries where the CDC is planning to scale back include some of the world’s hot spots for emerging infectious disease, such as China, Pakistan, Haiti, Rwanda and Congo.”
  • May 2018: At an event marking the 100 year anniversary of the 1918 pandemic, Borio says “pandemic flu” is the “number 1 health security issue” and that the U.S. is not ready to respond.
  • One day later her boss, Rear Adm. Timothy Ziemer is pushed out of the administration and the global health security team is disbanded
  • Beth Cameron, former senior director for global health security on the National Security Council adds: “It is unclear in his absence who at the White House would be in charge of a pandemic,” Cameron said, calling it “a situation that should be immediately rectified.” Note: It was not
  • January 2019: The director of National Intelligence issues the U.S. Intelligence Community’s assessment of threats to national security. Among its findings:
  • A novel strain of a virulent microbe that is easily transmissible between humans continues to be a major threat, with pathogens such as H5N1 and H7N9 influenza and Middle East Respiratory Syndrome Coronavirus having pandemic potential if they were to acquire efficient human-to-human transmissibility.”
  • Page 21: “We assess that the United States and the world will remain vulnerable to the next flu pandemic or large scale outbreak of a contagious disease that could lead to massive rates of death and disability, severely affect the world economy, strain international resources, and increase calls on the United States for support.”
  • September, 2019: The Trump Administration ended the pandemic early warning program, PREDICT, which trained scientists in China and other countries to identify viruses that had the potential to turn into pandemics. According to the Los Angeles Times, “field work ceased when funding ran out in September,” two months before COVID-19 emerged in Wuhan Province, China.
  • 2020: COVID-19 Arrives
  • anuary 3, 2020: The CDC is first alerted to a public health event in Wuhan, China
  • January 6, 2020: The CDC issues a travel notice for Wuhan due to the spreading coronavirus
  • Note: The Trump campaign claims that this marks the beginning of the federal government disease control experts becoming aware of the virus. It was 10 weeks from this point until the week of March 16 when Trump began to change his tone on the threat.
  • January 10, 2020: Former Trump Homeland Security Advisor Tom Bossert warns that we shouldn’t “jerk around with ego politics” because “we face a global health threat…Coordinate!”
  • January 18, 2020: After two weeks of attempts, HHS Secretary Alex Azar finally gets the chance to speak to Trump about the virus. The president redirects the conversation to vaping, according to the Washington Post. 
  • January 21, 2020: Dr. Nancy Messonnier, the director of the National Center for Immunization and Respiratory Disease at the CDC tells reporters, “We do expect additional cases in the United States.”
  • January 27, 2020: Top White House aides meet with Chief of Staff Mick Mulvaney to encourage greater focus on the threat from the virus. Joe Grogan, head of the White House Domestic Policy Council warns that “dealing with the virus was likely to dominate life in the United States for many months.”
  • January 28, 2020: Two former Trump administration officials—Gottlieb and Borio—publish an op-ed in the Wall Street Journal imploring the president to “Act Now to Prevent an American Epidemic.” They advocate a 4-point plan to address the coming crisis:
  • (1) Expand testing to identify and isolate cases. Note: This did not happen for many weeks. The first time more than 2,000 tests were deployed in a single day was not until almost six weeks later, on March 11.
  • (3) Prepare hospital units for isolation with more gowns and masks. Note: There was no dramatic ramp-up in the production of critical supplies undertaken. As a result, many hospitals quickly experienced shortages of critical PPE materials. Federal agencies waited until Mid-March to begin bulk orders of N95 masks.
  • January 29, 2020: Trump trade advisor Peter Navarro circulates an internal memo warning that America is “defenseless” in the face of an outbreak which “elevates the risk of the coronavirus evolving into a full-blown pandemic, imperiling the lives of millions of Americans.”
  • January 30, 2020: Dr. James Hamblin publishes another warning about critical PPE materials in the Atlantic, titled “We Don’t Have Enough Masks.”
  • January 29, 2020: Republican Senator Tom Cotton reaches out to President Trump in private to encourage him to take the virus seriously.
  • Late January, 2020:  HHS sends a letter asking to use its transfer authority to shift $136 million of department funds into pools that could be tapped for combating the coronavirus. White House budget hawks argued that appropriating too much money at once when there were only a few U.S. cases would be viewed as alarmist.
  • Trump’s Chinese travel ban only banned “foreign nationals who had been in China in the last 14 days.” This wording did not—at all—stop people from arriving in America from China. In fact, for much of the crisis, flights from China landed in America almost daily filled with people who had been in China, but did not fit the category as Trump’s “travel ban” defined it.
  • January 31, 2020: On the same day Trump was enacting his fake travel ban, Foreign Policy reports that face masks and latex gloves are sold out on Amazon and at leading stores in New York City and suggests the surge in masks being sold to other countries needs “refereeing” in the face of the coming crisis.
  • February 4, 2020: Gottlieb and Borio take to the WSJ again, this time to warn the president that “a pandemic seems inevitable” and call on the administration to dramatically expand testing, expand the number of labs for reviewing tests, and change the rules to allow for tests of people even if they don’t have a clear known risk factor.
  • Note: Some of these recommendations were eventually implemented—25 days later.
  • February 5, 2020: HHS Secretary Alex Azar requests $2 billion to “buy respirator masks and other supplies for a depleted federal stockpile of emergency medical equipment.” He is rebuffed by Trump and the White House OMB who eventually send Congress a $500 million request weeks later.
  • February 4 or 5, 2020: Robert Kadlec, the assistant secretary for preparedness and response, and other intelligence officials brief the Senate Intelligence Committee that the virus poses a “serious” threat and that “Americans would need to take actions that could disrupt their daily lives.”
  • February 5, 2020: Senator Chris Murphy tweets: Just left the Administration briefing on Coronavirus. Bottom line: they aren't taking this seriously enough. Notably, no request for ANY emergency funding, which is a big mistake. Local health systems need supplies, training, screening staff etc. And they need it now.
  • February 9, 2020: The Washington Post reports that a group of governors participated in a jarring meeting with Dr. Anthony Fauci and Dr. Robert Redfield that was much more alarmist than what they were hearing from Trump. “The doctors and the scientists, they were telling us then exactly what they are saying now,” Maryland Gov. Larry Hogan (R) said.
  • the administration lifted CDC restrictions on tests. This is a factually true statement. But it elides that fact that they did so on March 3—two critical weeks after the third Borio/Gottlieb op-ed on the topic, during which time the window for intervention had shrunk to a pinhole.
  • February 20, 2020: Borio and Gottlieb write in the Wall Street Journal that tests must be ramped up immediately “while we can intervene to stop spread.”
  • February 23, 2020: Harvard School of Public Health professor issues warning on lack of test capability: “As of today, the US remains extremely limited in#COVID19 testing. Only 3 of ~100 public health labs haveCDC test kits working and CDC is not sharing what went wrong with the kits. How to know if COVID19 is spreading here if we are not looking for it.
  • February 24, 2020: The Trump administration sends a letter to Congress requesting a small dollar amount—between $1.8 billion and $2.5 billion—to help combat the spread of the coronavirus. This is, of course, a pittance
  • February 25, 2020: Messonier says she expects “community spread” of the virus in the United States and that “disruption to everyday life might be severe.” Trump is reportedly furious and Messonier’s warnings are curtailed in the ensuing weeks.
  • Trump mocks Congress in a White House briefing, saying “If Congress wants to give us the money so easy—it wasn’t very easy for the wall, but we got that one done. If they want to give us the money, we’ll take the money.”
  • February 26, 2020: Congress, recognizing the coming threat, offers to give the administration $6 billion more than Trump asked for in order to prepare for the virus.
  • February 27, 2020: In a leaked audio recording Sen. Richard Burr, chairman of the Intelligence Committee and author of the Pandemic and All-Hazards Preparedness Act (PAHPA) and the Pandemic and All-Hazards Preparedness and Advancing Innovation Act (reauthorization of PAHPA), was telling people that COVID-19 “is probably more akin to the 1918 pandemic.”
  • March 4, 2020: HHS says they only have 1 percent of respirator masks needed if the virus became a “full-blown pandemic.”
  • March 3, 2020: Vice President Pence is asked about legislation encouraging companies to produce more masks. He says the Trump administration is “looking at it.”
  • March 7, 2020: Fox News host Tucker Carlson, flies to Mar-a-Lago to implore Trump to take the virus seriously in private rather than embarrass him on TV. Even after the private meeting, Trump continued to downplay the crisis
  • March 9, 2020: Tom Bossert, Trump’s former Homeland Security adviser, publishes an op-ed saying it is “now or never” to act. He advocates for social distancing and school closures to slow the spread of the contagion.
  • Trump says that developments are “good for the consumer” and compares COVID-19 favorably to the common flu.
  • March 17, 2020: Facing continued shortages of the PPE equipment needed to prevent healthcare providers from succumbing to the virus, Oregon Senators Jeff Merkeley and Ron Wyden call on Trump to use the Defense Production Act to expand supply of medical equipment
  • March 18, 2020: Trump signs the executive order to activate the Defense Production Act, but declines to use it
  • At the White House briefing he is asked about Senator Chuck Schumer’s call to urgently produce medical supplies and ventilators. Trump responds: “Well we’re going to know whether or not it’s urgent.” Note: At this point 118 Americans had died from COVID-19.
  • March 20, 2020: At an April 2nd White House Press Conference, President Trump’s son-in-law Jared Kushner who was made ad hoc point man for the coronavirus response said that on this date he began working with Rear Admiral John Polowczyk to “build a team” that would handle the logistics and supply chain for providing medical supplies to the states. This suggestion was first made by former Trump Administration officials January 28th
  • March 22, 2020: Six days after calling for a 15-day period of distancing, Trump tweets that this approach “may be worse than the problem itself.”
  • March 24, 2020: Trump tells Fox News that he wants the country opened up by Easter Sunday (April 12)
  • As Trump was speaking to Fox, there were 52,145 confirmed cases in the United States and the doubling time for daily new cases was roughly four days.
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