Pandora Report: 3.27.2020

Welcome to your weekly source for all things health security! While Italy is struggling with a high COVID-19 death rate, here’s a bit of good news- the last Ebola patient was discharged in the DRC. In need of a good laugh and a fan of the show The Office? Check out this video on pandemic response as an episode.

GHSA Next Generation Network – Responding to Wuhan
Formed in 2014, this group of global health security researchers and professionals is working across the globe to combat the outbreak. Curious about how to participate? There are some simple things you can do right now to help. The first is to help NextGen with its social media communications. NextGen members are in a unique position to serve as trusted sources of information. “You can follow us on Twitter (@nextgenghs) and retweet or tag us in your #COVID19 tweets. You can also use the hashtag #VirtualHighFivesSaveLives to help campaign for social distancing. The next thing you can do is listen to and spread our podcast, especially our COVID-19 Special, to help people understand what is happening and how we can work together to address the issue.” Check out the NextGen mentorship program or learn about what members are doing in the field of COVID-19 response via the COVID-19 Survey and join the Working Group and WhatsApp group.

Learning from Previous CoV Outbreaks
GMU Biodefense doctoral student HyunJung (Henry) Kim is shedding some light on how we can learn from South Korea’s COVID-19 efforts, but also how South Korea learned strategies from previous MERS-CoV outbreaks. “Korea’s response to Covid-19 is highlighting a strong public health approach to reigning in the outbreak, one that provides a lesson for the rest of the world. For the country’s health officials, however, it’s a lesson they learned the hard way. Korea’s traumatic experience with a 2015 outbreak of Middle East Respiratory Syndrome, or MERS, paved the way for many of the successful strategies the government is deploying this time around.” Kim also discussed how the United States can learn from South Korea and Japan – “It seems evident that South Korea gives more weight to actively searching for and diagnosing coronavirus cases in order to break the chain reaction of disease transmission. At the same time, Japan has focused on building the public health equivalent of a firewall around the country to prevent the influx of coronavirus from overseas. Close scrutiny reveals that both pandemic prevention strategies—South Korea’s active search and Japan’s firewall approach – have advantages and disadvantages.”

Assessing Trump’s COVID-19 Approach – Q&A With Public Health Expert Saskia Popescu 
From the frontlines of healthcare and epidemiology response, GMU Biodefense alum Saskia Popescu discusses how hospitals are responding and what the real implications of poor pandemic response look like. “The harder aspects of disease mitigation and response are having those tough conversations with people about how it’s really important for you to stay home when you’re sick. People don’t like being inconvenienced. And that’s why it’s so challenging and frustrating sometimes, because if people were really good about staying home when they’re sick and engaging in social distancing and infection control measures like hand hygiene and not touching their face, that would be very, very impactful to outbreak response at this point. I think focusing on that travel ban, that travel association is a moot point now. The disease is pretty much everywhere.”

Operation 50/50: List of Women Health Security Experts Now Available 
Women in Global Health (WGH), and Women of Color Advancing Peace and Security (WCAPS) have partnered to crowdsource a list of female health security experts, intended to address the glaring lack of women represented in the global response to the current coronavirus (COVID-19) outbreak. The list, dubbed “Operation 50/50”, is now available on the WCAPS and WGH websites for organizations seeking leadership for outbreak response efforts, as well as press members seeking outbreak-related commentary. Check out the list and you might see some familiar GMU Biodefense names.

 U.S. Government COVID-19 Response Plan and How An Exercise Should’ve Been The Writing On The Wall 
The recently released USG COVID-19 Response Plan via HHS is now available online. The plan includes a risk assessment, critical considerations, roles and responsibilities, and a ton of information on sustainment and communication/coordination. On March 11, the reported noted that – “For the majority of people, the immediate risk of being exposed to the virus that causes COVID – 19 is thought to be low. There is not widespread circulation in most communities in theUnited States.” More interesting, it notes that a pandemic will last 18 months or longer and could include multiple waves of illness. Check out the report and how it utilizes a pandemic severity assessment framework, but also the approach the U.S. is taking to mitigate further spread. The irony though, is that an exercise last year actually shed light on some of the vulnerabilities we are currently experiencing. You might have seen a few recent reports on the Crimson Contagion exercise hosted by the National Biodefense Science Board however, we actually wrote on this late last year in the Pandora Report, which you can read here. “The exercise was intended to deal with a virus outbreak that starts overseas and migrates to the US with scant allocated resources for outbreak response and management, thereby forcing the Department of Health and Human Services (HHS) to include other agencies in the response.” The truth is that this exercise should’ve been an indicator of what was to come. As we noted in our report, one of the findings was that “The medical countermeasures supply chain and production capacity are currently insufficient to meet the needs of the country in the event of pandemic influenza”. Exercises like these are particularly important as they bring together key stakeholders to identify critical vulnerabilities and opportunities for improvement, which is why so many are frustrated by the fact that DHS opted to stop updating its annual models of pandemics in 2017.

DHS Pandemic Models Sidelined Since 2017
In 2017, the Department of Homeland Security (DHS) shelved the program that maintained annual models of how a pandemic could disrupt America’s critical infrastructure. These models were the foundations of reports drafted to direct policymakers toward areas that would require immediate attention and help in the event of a pandemic. Such areas include transportation and hospital systems. According to Politico, the models consisted primarily of computer simulations that estimate the interactions among millions of Americans and the US infrastructural systems. The parameters of the models were varied to simulate the impacts based on losses in the workforce due to illness or isolation; a valuable consideration given the situation we are currently facing with over 3 million Americans out of work and COVID-19 illness spreading across those in our health workforce and other critical areas. Reportedly, this program, operational from 2005 to 2017, was halted due to a bureaucratic dispute over its utility. In the midst of the COVID-19 pandemic, the value of this program is indisputable. Resources like the DHS pandemic models and analyses may have provided greater insight and enabled swifter decision-making in our current predicament. Perhaps now, the value and criticality of preparedness will be appreciated so that we may better plan for the next biological event.

A New Kind of Domestic Terrorism
As panic and fear abound with the COVID-19 pandemic, pettiness and folly are amplifying into acts that may soon be considered criminal offenses and subject to terrorism laws. A Wegmans shopper in New Jersey was just charged with making a terroristic threat in the third degree – a felony offense – after he deliberately coughed toward grocery staff and claimed to be infected with coronavirus. This act was reported to be the shopper’s response to the request that he move further away from the employee, respecting the social distancing recommendation. Later, a different man in New Jersey coughed at policy and medical personnelwhile being arrested for domestic violence. In response to such behaviors, US Deputy Attorney General, Jeffrey A. Rosen, sent a memo to law enforcement and federal prosecutors warning them to monitor threats to spread the coronavirus. The memo stated that these acts could be prosecuted under federal terrorism laws given that the virus is a biological agent. Rosen explicitly stated that threats or efforts to use COVID-19 as a weapon in any way will not be abided. The memo also addresses other potential crimes related to the pandemic, ranging from advertisement and sales of fake therapeutics and tests to illegally stockpiling scarce products like medical supplies. The full memo can be found here.

US COVID-19 Outbreak Updates
This week the White House COVID-19 task force had to ask those who recently left New York City, to quarantine for 14 days due to the high infection rate within the city. The WHO recently stated that the U.S. could be the new global epicenter of the pandemic, just as India was announcing a nationwide lockdown. More cases are being reported every day, but according to the CDC, there were over 68,440 cases as of Thursday. The U.S. has now surpassed Italy and China as the viral hotspot. New York is especially being hit hard and as the healthcare infrastructure continues to struggle with PPE challenges, many industries are working to donate and manufacture additional supplies. There is worrisome news from New York City that many of the hospitalized COVID-19 patients requiring intensive care are less than 50 years of age. In addition to the growing epidemiological data shedding light on clinical manifestations and case counts, the magnitude of supply chain challenges has been astounding. As the U.S. works to respond to growing case counts, limited testing, and a nervous healthcare infrastructure, many wonder about the true ability for the country to respond to a pandemic. “They also underscore long-standing problems with the health-care system and the lack of preparedness that has resulted from years of governmental neglect, said Saskia Popescu, an epidemiologist with Honor Health, a Phoenix hospital system (and GMU Biodefense alum). ‘This outbreak has revealed systemic weaknesses, but also the challenges of national preparedness built on private industry and how that often means some hospitals are more prepared than others and the desperate need to really strengthen national health-care biopreparedness,’ she said.” Despite quarantine and shutdown efforts only occurring recently, President Trump wants to open the U.S. back up, which counters much of what public health experts have voiced, especially since outcomes due to recent interventions won’t be seen in the case counts for weeks.

COVID-19: Where Are We and Where Do We Need to Go?
Despite only being three months in 2020, it seems like the COVID-19 pandemic has made this feel like the longest year yet. There’s still much work to be done though and it is often important to take a moment and look back at what’s happened and how we got to this point. The New York Times created this extremely detailed visual story of how the virus got out despite travel restrictions. By analyzing the movement of people, it shows out the SARS-CoV-2 pandemic occurred. Ed Yong recently wrote on how the pandemic will end and some of the most surprising roadblocks that have occurred-  like testing. For many in global health security, there are inherent challenges we identify when doing simulations, but the considerable lack of testing was not one ever considered. Pulling from many experts (you’ll see a few familiar names), Yong addresses the very complexities of this pandemic and a hard truth in that we should’ve seen this coming. “A global pandemic of this scale was inevitable. In recent years, hundreds of health experts have written books, white papers, and op-eds warning of the possibility. Bill Gates has been telling anyone who would listen, including the 18 million viewers of his TED Talk. In 2018, I wrote a story for The Atlantic arguing that America was not ready for the pandemic that would eventually come. Hypotheticals became reality. ‘What if?’ became ‘Now what?'” Helen Branswell from STAT also recently wrote on what we’ve learned and what we still need to know. “The world has been warned about this over and over again. In the mid-2000s, when it looked like a very dangerous bird flu virus, H5N1, might trigger a pandemic, experts including Michael Osterholm, of the University of Minnesota’s Center for Infectious Diseases Research and Policy, warned of the possibility of disaster when it comes to the supply of protective equipment for health workers, essential drugs, and other goods. And here we are.”

Developing Medical Countermeasures (MCM)
There’s been a lot of talk regarding the use of malarial drugs, hydroxychloroquine and chloroquine, as treatments for COVID-19 following President Trump’s comments in recent press conferences. Unfortunately, this isn’t aligning with medical experts. “The study referenced by Trump, and other studies done so far of potential treatments for Covid-19, are small and hastily designed even by the standards of Phase 1 studies.” The comments/tweets by President Trump have been concerning many as supplies of the drugs, often used to treat lupus, are starting to take a hit and the suggestion of efficacy encourages misuse, which resulted in the death of a man in Arizona taking a form of chloroquine. In terms of developing treatment and prevention MCMs, SynBioBeta has recently partnered with Leaps by Bayer to develop a great visual timeline for what this process looks like.

The Deterioration of USAMRIID
Since the Cold War era, the US Army Medical Research Institute for Infectious Diseases (USAMRIID) has been the nation’s premier biodefense laboratory. RIID’s remarkable history includes its roles in subduing several outbreaks since its inception: Venezuelan equine encephalitis virus in South Texas in 1971, Rift Valley Fever in Egypt in 1977, Hantavirus in the southwest in 1993, and Ebola in Reston, Virginia in 1990, as well as in Africa in 1995. In contrast, RIID has not been considered especially active in the efforts to thwart the ongoing pandemic, likely as a result of bad blood from Amerithrax, inconsistent leadership, recent budget cuts, and dissatisfaction with external micromanagement by the Defense Threat Reduction Agency (DTRA). Though the lab contributed to the analysis of the mailed letters and contaminated areas from the 2001 anthrax attacks, the accusation by the FBI that the Amerithrax culprit was one of RIID’s scientists sunk its status and morale. This accusation cascaded into the closing of high-containment labs, dismissal of experienced employees, and the departure of senior scientists across Fort Detrick. Since the Amerithrax accusation, mismanagement and underfunding further deteriorated the status and outputs of RIID. Over the last decade, RIID has been through five commanders, most of whom were not research scientists equipped with the knowledge to fully understand the lab’s work. For many scientific research entities, funding has become unstable and RIID suffers from this as well. DTRA is responsible for chemical and biological defense research under the Department of Defense (DoD), and it provides a third of RIID’s budget. As a primary funder for RIID, DTRA has gradually micromanaged the lab through actions such as abolishing a research unit that developed medical countermeasures against toxins commonly used by domestic terrorists. Beyond the aforementioned issues, RIID is no longer luring young scientists for employment and almost 40% of its staff consists of contractors, who are especially reliant on stable funding streams to maintain projects. According to National Defense Magazine, Army medical experts are working in partnership with public and private organizations on several potential vaccines for COVID-19. A vaccine would protect both our soldiers and out civilian population from the novel virus. As of 20 March, the Army has 21 soldiers, 6 government civilians, 10 contractors, and 8 family members confirmed with COVID-19 infection; thousands of lives have already been lost across the world and over 1,000 lost in the US. It is most unfortunate that an infectious disease research entity that was once one of nation’s most experienced and erudite is in such a state of disarray that its ability to contribute to the ongoing crisis is weakened. We are in an emergency that requires scarce expertise and capabilities to aid in the swift development of efficacious and safe medical countermeasures. USAMRIID is yet another example of the failure to maintain and utilize some of our most productive and successful resources that could have helped the US prepare for and better respond to the COVID-19 pandemic.


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