Pandora Report: 1.31.2020

ASM Biothreats
Missed the 2020 ASM Biothreats conference? Next week we’ll have you updated with our coverage across multiple talks, panels, and the highlights of this top conference on all things biological. GMU biodefense graduate students will be providing detailed accounts of these discussions at a pivotal time in international health. “ASM Biothreats is a one-of-a-kind meeting offering professionals in biodefense, biosecurity and biological threats the opportunity to exchange knowledge and ideas that will shape the future of this emerging field. ASM Biothreats offers a unique program that explores the latest developments and emerging technologies in the industry.”

Update: 2019-nCoV
If you have turned on any news channel or navigated to news website, you most certainly encountered a number of discussions about the ongoing coronavirus outbreak originating in Wuhan, China. The WHO was alerted on New Years Eve of this novel pathogen causing pneumonia-like illness and chaos increasingly ensued over the continuing weeks. This mysterious pathogen was identified as a coronavirus (think SARS and MERS) and is currently dubbed “2019-nCoV.” As the disease spreads globally, the WHO is launching a Global 2019-nCoV Clinical Data Platform for Member States to contribute anonymized clinical data that can inform the public health clinical response. On 30 January, the Emergency Committee on the 2019-nCoV under the International Health Regulations (IHR 2005) reconvened to determine if the outbreak constitutes a Public Health Emergency of International Concern (PHEIC), and, if so, what recommendations and actions should be made to manage it. Thursday evening, the Committee announced declaration of a PHEIC for the 2019-nCov outbreak. As of 28 January, there are confirmed cases in China, Nepal, the Republic of Korea, Japan, Sri Lanka, Viet Nam, Thailand, Cambodia, Malaysia, Singapore, United Arab Emirates, Australia, France, Germany, Finland, Canada, and the United States. Within the United States, there are 5 confirmed cases in Washington, California, Arizona, and Illinois as well as an additional 92 suspected cases awaiting diagnostic results. Currently, there are 165 persons located in the US under investigation for 2019-nCoV infection. On Thursday, public health officials reported that the husband of the case identified in Chicago, had tested positive for the disease. This marks a second-generation of cases, or transmission, within the U.S. There are also reports of people running to buy face masks in the U.S., leaving concern for shortages. Experts have been quick though to note that these are not needed as transmission is not widespread within the United States and that hand hygiene is most effective this time of year. GMU Biodefense doctoral alum Saskia Popescu recently spoke to CNN on this, noting that “Wearing a surgical mask helps you prevent sharing your germs if you’re sick,” Saskia Popescu, a hospital epidemiologist and infection prevention expert, told CNN. “Surgical masks do not seal around the face, so while they offer some protection, it’s the N95 mask that offers the most protection.” The CDC released an updated travel warning to its most severe yet – Warning Level 3 – urging travelers to avoid all nonessential travel to China. According to the WHO, the latest figures (30 January) for the outbreak are:

  • 7,818 confirmed cases worldwide
  • 7,736 confirmed cases in China
  • 170 deaths worldwide
  • Global Risk Assessment: High

Experts from the University of Hong Kong estimate the true total number of cases in Wuhan to be about 44,000, and they predict this figure could double by the start of February. The city is already under an unprecedented quarantine and hospitals are overrun as the epidemic intensifies. GMU biodefense graduate program director Dr. Gregory Koblentz recently spoke about the importance of promoting education, not travel bans as coronavirus concerns spread. “Widespread travel bans are ineffective and even counterproductive,” said Koblentz, a professor at George Mason University’s Schar School of Policy and Government and an expert on biodefense and biosecurity. “The idea that you can quarantine the entire population of large cities is just not feasible.” If people want to travel, they will find a way to travel, but they will be secretive about it, said Koblentz. “Then when they do get sick, they will avoid seeking medical attention because they don’t want to get in trouble,” said Koblentz. “A travel ban basically means that people will avoid getting help and notifying public health authorities, and the spread of the virus will continue, undetected.” Instead, Koblentz recommended that health officials work to get the public on their side by communicating with them about the symptoms and when to seek medical care.

Speculation abounds about the zoonotic origin of the virus, but the prevailing theory (at the moment) points toward bats as the culprit. The source location of the outbreak is the Huanan seafood market in Wuhan, which did not sell bat meat, so speculation continues. It is possible that another animal provided the channel to human infection. Previous conjecture that snakes are the origin is under criticism as it remains unclear if coronaviruses can infect snakes. Additionally, experts reject the fringe theory that the outbreak is a consequence of accidental release of biological weapons research samples housed in the Wuhan Institute of Virology. Richard Ebright, a professor of chemical biology at Rutgers University, stated the virus’s genome and properties do not indicate that it is the product of engineering. Stay tuned to the Pandora Report for updates on the progression of the 2019-nCov outbreak.

Of Quarantine and robots: How China and the U.S. Are Working to Combat Coronavirus
GMU Biodefense PhD alum Saskia Popescu recently wrote on the efforts by both the Chinese and the U.S. in responding to and preventing transmission of the 2019-nCoV. From quarantine to travel screenings, Popescu discusses the pros and cons, but also breaks down the opportunities within U.S. response. “The first case of the coronavirus in the United States received wide news coverage, and rightly so. But the Providence Regional Medical Center in Everett, Wash., used some extreme techniques to treat the patient, a man in his 30s who’d travelled to Wuhan. He was taken from an urgent care to the hospital in a negative-pressure transportation device called an ISOPOD that’s more often associated with Ebola care and put into an isolation room, where the hospital used a robot to treat him to reduce health care worker exposure. At this point, though, these extra precautions aren’t required. The Centers for Disease Control and Prevention notes that health care workers caring for patients with coronavirus should protect themselves with a gown, gloves, eye protection, and an N95 mask, which can filter out most airborne particles. If the Everett hospital wanted to use its robot and ISPOD to test its capabilities and protocols, it should have communicated this more clearly–to keep from confusing other health care providers about the advice of federal officials.”

ABSA International – Risk Group Database App
The Association for Biosafety and Biosecurity (ABSA) just released their new International Risk Group Database app, which allows users to work offline and access the ABSA database via their mobile device. The ABSA International Risk Group Database consists of international risk group classifications for bacteria, viruses, fungi, and parasites. In many countries, including the United States, infectious agents are categorized in risk groups based on their relative risk. Depending on the country and/or organization, this classification system might take the following factors into consideration: pathogenicity of the organism; mode of transmission and host range; availability of effective preventive measures (e.g., vaccines); availability of effective treatment (e.g., antibiotics); and other factors.

Doomsday Clock
The Bulletin of the Atomic Scientists released their 2020 Doomsday Clock statement and revealed that the clock is now closer than ever at 100 seconds to midnight. The Doomsday Clock is “universally recognized indicator of the world’s vulnerability to catastrophe from nuclear weapons, climate change, and disruptive technologies in other domains.” This year’s statement highlights two coexisting existential threats to humanity: nuclear war and climate change. Adding insult to injury, these threats are exacerbated by cyber-enabled information warfare, which continues to advance in efficiency and capability. The last year saw the dissolution or undermining of several key arms control treaties aimed at quelling the risk of nuclear war – the Joint Comprehensive Plan of Action (JCPOA) and Intermediate-Range Nuclear Forces (INF) Treaty, for example. Iran, the DPRK, and Russia remain major dangerous players in the nuclear game. On a more positive note, awareness of the adverse effects of climate change swelled over 2019; however, governmental action to counter climate change left much to be desired. The Bulletin implores leaders and citizens to take thoughtful and actionable steps to lessen these threats:

  • US and Russian leaders can return to the negotiating table to reach an agreement on nuclear arms and other arsenals
  • The nations of the world should publicly rededicate themselves to the temperature goal of the Paris climate agreement (limiting warming below 2 degrees Celsius higher than the preindustrial level)
  • US citizens should demand climate action from their government
  • The United States and other signatories of the JCPOA cooperate to curb nuclear proliferation in the Middle East
  • The international community should commence multilateral discussions to create norms of domestic and international behavior that discourage and punish the misuse of science

Alumni Spotlight – NextGen GHSA
A new piece published on the Next Generation Global Health Security Network was co-authored by Anthony Falzarano, Stephen Taylor, Kate Kerr and Jessica Smrekar, graduates of GMU’s MS in Biodefense program (Taylor Winkenfeld is also an author). This Op-Ed, “We Preach Prevention, WHO Practices Response,” chastises the sluggish response of the WHO to the ongoing 2019-nCov outbreak originating in Wuhan, China. China’s President Xi Jinping instituted a mass quarantine of 50 million people, yet the WHO has yet to declare this outbreak a Public Health Emergency of International Concern (PHEIC), which helps mobilize funding and political will toward outbreak response efforts. In fact, the committee that makes such a declaration met on 30 January, weeks after the start of the outbreak. The WHO possesses a history of delayed action, such as with the current Ebola outbreak in the Democratic Republic of Congo. The authors suggest that the delay in PHEIC declaration for the 2019-nCov outbreak is founded in fear of political and economic impacts, especially given the “reach of the Chinese global engine.” This outbreak is yet another example and, hopefully, lesson waiting and watching cannot be the default response to tragic events, especially ones that harm public health, regardless of the political, economic, and social issues that complicate decision-making and action.

The Ethics of Acquiring Disruptive Military Technologies
Technological innovation – especially in human enhancement, artificial intelligence, and cyber tools – continues at an accelerating rate and yield a significant effect on combat by reducing risk to soldiers and civilians, but also broadening the spectrum of actors capable of chasing policy goals through military methods. An article by C. Anthony Pfaff published in the Texas National Security Review expands the discussion about emerging and advancing technologies to include the ethics of disruptive military technologies. Disruptive technologies in a military context are defined as “technologies or sets of technologies applied to a relevant problem in a manner that radically alters the symmetry of military power between competitors, which then immediately outdates the policies, doctrines and organization of all actors.” These technologies necessitate changes in soldier training and identity as well as the relationship between society and soldiers. A technology is considered disruptive based on its attributes’ interactions with a specific community of users in a specific environment. The author outlines a framework to evaluate the moral effect, necessity, and proportionality of technologies to determine if and how they should be developed and deployed. This framework includes consideration for moral autonomy, justice, well-being, transfer of technology, and, of course, the civilian-military relationship. The author recommends eight measures and policies to maintain ethical conditions for developing disruptive technologies ranging from managing the transfer of technologies to greater society to accounting for soldier well-being.  Pfaff’s full article detailing his analysis, framework, and recommendations is available here.

Considering Pediatrics During CBW Preparedness and Response
Often during measures to prepare for a chemical or biological weapons attack, it can be easy to forget about the unique care that children and neonates require. A new article in Physicians New Digest discussed this very critical nuance to CBW preparedness, highlighting the CW attacks in Syria by the Assad regime against civilians, included children, underscoring the need for pediatricians. Often, medical countermeasures require very specific dosages or are contraindicated in children, which poses a very unique challenge for responders. “In chemical attacks, for example, children may be disproportionately affected because they would take in more contaminated air, food and fluids relative to their body weight than adults, said co-author Carl Baum, MD, FACMT, FAAP, a former AAP Council on Environmental Health executive committee member who now serves on the Council on Disaster Preparedness and Recovery executive committee. ‘Children also spend more time closer to the ground, where toxic substances can settle. And they have a relatively larger body-surface area, which makes chemicals that touch the skin more dangerous for them,’ Dr. Baum said.” Children might also have high respiratory rates or present differently, which puts them at an increased risk for both inhalation of a CB agent, but also delays in medical care or diagnostics. The authors highlighted the importance of including pediatricians in preparedness efforts to ensure children have triage and treatment protocols in the event of a CBW attack.

News of the Weird
Sure, the novel coronavirus is in the news a lot right now, but where does beer come into the picture? Unfortunately the whole “corona” portion of the name has been throwing people off. “In the United States, Google Trends calculated that 57% of the people that searched one of those terms searched for “beer virus,’ and the remaining 43% searched for ‘corona beer virus.’ States like Hawaii, New Mexico and Kansas are searching ‘beer virus’ more, whereas states like South Carolina, Colorado and Arizona are searching ‘corona beer virus’ more”

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