Pandora Report: 6.11.2021

June is National Pet Preparedness Month! The FDA approved a new drug for the treatment of smallpox. The SARS-CoV-2 virus is here to stay.

Pet Preparedness Month

June is National Pet Preparedness Month! Pet parents should include animals in emergency plans: have an evacuation plan, microchip your pet, and develop a buddy system. You can also build a kit for your pet with food, water, medicine, a first aid kit, grooming items, and a photo of you with your pet. As the summer heat sets in, remember to keep your pet hydrated and do not leave them in a hot car. Also, mind hot pavement for their paws!

A new article in Disaster Medicine and Public Health Preparedness explores the evidence regarding the use of trained dogs to detect COVID-19 infections. Detection dogs are a promising non-invasive, efficient, and cost-effective screening method for SARS-CoV-2 infection. Read the article here.

Science & Tech Spotlight: Digital Vaccine Credentials

Digital vaccine credentials can confirm that a person has been vaccinated or tested negative for COVID-19. They can be a tool to reduce the disease’s spread, and allow travel and other activities to resume safely. Users of such credentials can provide their COVID-19 information on a mobile device through a secure, digital code for fast and contactless scanning. Airports and other venues could process larger numbers of people more quickly with these credentials than with paper vaccine cards. However, challenges that may limit the use of these credentials include concerns about the security and privacy of users’ health data. Read the full report from the US Government Accountability Office (GAO) here.  

HHS Launches First Venture Capital Partnership to Develop Transformative Technologies to Combat Future Pandemics, Other Health Emergencies

Through the BARDA Ventures program, the Biomedical Advanced Research and Development Authority (BARDA – part of the HHS Office of the Assistant Secretary for Preparedness and Response – is launching a partnership with the nonprofit organization Global Health Investment Corporation (GHIC) to accelerate development and commercialization of technologies and medical products needed to respond to or prevent public health emergencies, such as pandemics, and other health security threats. Through this partnership, BARDA intends to provide GHIC with a minimum of $50 million over five years with potential for up to $500 million over 10 years. GHIC will launch a global health security fund with matching capital from other investors. This partnership will allow direct linkage with the investment community and establish sustained and long-term efforts to identify, nurture, and commercialize technologies that aid the US in responding effectively to future health security threats.

FDA Approves Drug to Treat Smallpox

The Food and Drug Administration (FDA) approved Tembexa (brincidofovir) to treat smallpox. Though smallpox was eradicated in 1980, there are worries that it could be deployed as a bioweapon. The disease spreads via direct contact among humans and symptoms arise 10-14 days after infection. Symptoms include fever, exhaustion, headache, backache, and the telltale rash consisting of small, pink bumps progressed to pus-filled sores before it crusts over and scars. As an eradicated disease, the efficacy of Tembexa was evaluated in animals infected with viruses that are closely related to the variola virus, and was determined by measuring animals’ survival at the end of the studies. Efficacy and safety were adequate for FDA approval. The most common side effects are diarrhea, nausea, vomiting, and abdominal pain.

Gene Drives Are What’s Next

The next meeting of the Novel and Exceptional Technology and Research Advisory Committee (NExTRAC), a federal advisory committee that provides recommendations to the NIH Director and a public forum for the discussion of the scientific, safety, and ethical issues associated with emerging biotechnologies, will be held on 25 June 2021. The meeting will discuss a Draft Report of the Gene Drives in Biomedical Research Working Group, which was prepared in response to the charge given by the NIH Director at the December 2019 NExTRAC meeting to “consider whether existing biosafety guidance is adequate for contained laboratory research utilizing gene drive technology” and “outline conditions (if any) under which NIH could consider supporting field release of gene drive modified organisms.”

Review of Recounting the Anthrax Attacks

Dr. R. Scott Decker is a retired supervisory special agent for the Federal Bureau of Investigation (FBI) and he published the book, Recounting the Anthrax Attacks: Terror, the Amerithrax Task Force, and the Evolution of Forensics in the FBI. Al Mauroni, director of the US Air Force Center for Strategic Deterrence Studies, wrote a review of the book, dubbing it “a valuable book for understanding how the FBI developed its case for the Amerithrax investigation, not just for the legal community that engages in bioterrorism cases, but for the defense community that engages in the policy aspects of this issue.” The FBI eventually attributed the anthrax attacks to Bruce Ivins, a research scientist working at the Army’s Fort Detrick laboratories. Read the review here.

The Forever Virus: A Strategy for the Long Fight Against COVID-19

The SARS-CoV-2 virus is here to stay. The novel coronavirus cannot be eradicated, because it infects over a dozen different species. Due to vaccine supply shortages and vaccine hesitancy, global herd immunity is “unreachable.” Even if every human on the planet could be vaccinated today, the virus would persist in various animal species. That said, vaccination must remain a primary goal in order to contain the disease. Though many hoped that the virus would be the cause of a short-term crisis, it is proving to be a chronic crisis against a very resilient pathogen. This is, in part, a result of many nations failing to heed the early warning signs and take the threat seriously, allowing grave damage to occur. “As a wealthy, powerful, and scientifically advanced country, the United States is optimally positioned to help lead the long fight against COVID-19.” And, in order to do this, the US must repair its reputation as a global public health leader. Beyond US leadership and support, the entire global framework for pandemic response needs a reboot. A recent report recommends elevating pandemic preparedness and response to the highest levels of the United Nations via the creation of a “global health threats council.” This council would be led by heads of state, separate from the World Health Organization, and “charged with holding countries accountable for containing epidemics.”  

Dr. Rick Bright, Senior Vice President of Pandemic Prevention & Response at The Rockefeller Foundation, is among the contributors of this piece. Bright is also among the distinguished faculty for the upcoming Pandemics and Global Health Security Workshop hosted by the Biodefense Graduate Program.

The “Legal Epidemiology” of Pandemic Control

The centrality of law as a public health intervention has been undeniable during the COVID-19 pandemic. In just the first half of 2020, more than 1,000 laws and orders were issued by federal, state, and local authorities in the United States in an effort to reduce disease transmission. Legal interventions include stay-at-home orders, mask mandates, and travel restrictions, as well as more particular rules for business operations, alcohol sales, curfews, and health care. Given their heavy use, importance, and obvious socioeconomic side effects, and the social and behavioral complexities of their implementation, one might have expected the National Institutes of Health (NIH), other research funders, and the research community to jump to the work of determining the right mix, intensity, and enforcement approaches of legal restrictions to control transmission with the least and most equitably distributed harms. No organized research program emerged. Funding for scientific evaluation of legal effects and public health systems research was paltry, at a time when hundreds of thousands of lives, the socioemotional development of millions of children, and billions of dollars in economic activity directly depended on questions about control measures, enforcement methods, the organization of the health system, and the many ways in which law was immediately influencing vulnerability, resilience, and social behavior. It is past time for a broad recognition in our health system that law is a ubiquitous treatment, one to which hundreds of millions of people are routinely exposed. The imperative is to scale up the infrastructure for at least three kinds of research: study of the mechanisms, effects, side effects, and implementation of laws designed to influence health, such as COVID control measures; research on how the legal infrastructure of the US health system — the allocation of powers and duties, as well as limits on authority — influences the effectiveness of the system; and perhaps most important for addressing health equity, studies of how laws that may appear to have no health purposes — such as the tax code, minimum wage, and labor rules — shape the social determinants of health.

The COVID Lab-Leak Hypothesis: What Scientists Do and Don’t Know

Most scientists say SARS-CoV-2 probably has a natural origin, and was transmitted from an animal to humans. However, a lab leak has not been ruled out, and many are calling for a deeper investigation into the hypothesis that the virus emerged from the Wuhan Institute of Virology (WIV), located in the Chinese city where the first COVID-19 cases were reported. On 26 May, US President Joe Biden tasked the US Intelligence Community to join efforts to find SARS-CoV-2’s origins, whatever they might be, and report back in 90 days. Scientists don’t have enough evidence about the origins of SARS-CoV-2 to rule out the lab-leak hypothesis, or to prove the alternative — that the virus has a natural origin. Many infectious-disease researchers agree that the most probable scenario is that the virus evolved naturally and spread from a bat either directly to a person or through an intermediate animal. Most emerging infectious diseases begin with a spillover from nature, as was seen with HIV, influenza epidemics, Ebola outbreaks and the coronaviruses that caused the SARS epidemic beginning in 2002 and the Middle East respiratory syndrome (MERS) outbreak beginning in 2012. In theory, COVID-19 could have come from a lab in a few ways. Researchers might have collected SARS-CoV-2 from an animal and maintained it in their lab to study, or they might have created it by engineering coronavirus genomes. In these scenarios, a person in the lab might have then been accidentally or deliberately infected by the virus, and then spread it to others — sparking the pandemic. There is currently no clear evidence to back these scenarios, but they aren’t impossible. Read the breakdown of knowns and unknowns here.

Biden Would Slash Pentagon Money for Pandemic Prevention

President Biden proposed halving the Pentagon’s budget for the leading US government program for preventing, detecting, and responding to global disease outbreaks – the Biological Threat Reduction Program. The Biological Threat Reduction Program “finds and fights emerging global diseases that can threaten US troops and, ultimately, the world’s population.” This is a move that “even the White House’s staunchest allies on Capitol Hill oppose as the nation continues to grapple with the COVID-19 pandemic.” The proposed cut arose despite the assessment of US intelligence agencies and scientists that “pandemics will become increasingly common and as COVID-19 still rages in many countries and hangs on in America.” “The US military has been a leader in research and development of coronavirus vaccines and in disseminating them,” and the Pentagon plans to spend $500 million in FY22 on COVID-19 response and preparedness for future pandemics, despite the funding slash.  

COVID-19 Air Traffic Visualization

The RAND Corporation released a report, COVID-19 Air Traffic Visualization: COVID-19 Cases in China Were Likely 37 Times Higher Than Reported in January 2020, which presents strong evidence that China’s reported COVID-19 caseload was undercounted by a factor of nearly 40. In this report — one of several from a RAND Corporation team examining the role of commercial air travel in the coronavirus disease 2019 (COVID-19) pandemic — researchers use RAND’s COVID-19 Air Traffic Visualization (CAT-V) tool to estimate the likely number of infections in China in early 2020. The tool combines COVID-19 case data from Johns Hopkins University with detailed air travel data from the International Air Transport Association. From December 31, 2019, to January 22, 2020, China reported a daily average of 172 cases of COVID-19 among its residents. This number of confirmed cases was equivalent to just one per 8.2 million residents in the country per day. Using the detailed flight data over that same period of time, it was determined that the five countries most at risk of importing COVID-19 from China were, in descending order of risk, Japan, Thailand, South Korea, the United States, and Taiwan. But far fewer than 8.2 million passengers flew from China to the five countries over that 23-day period. Just more than 1 million passengers flew from China to Japan and Thailand each, while slightly more than 750,000 flew to South Korea, 500,000 flew to the United States, and fewer than 400,000 flew to Taiwan (as illustrated in the map below). Thus, all of these passengers from China totaled fewer than 3.7 million, for an expected COVID-19 exportation rate of less than one case to all five of these countries combined. However, COVID-19 cases were already being reported in all five countries during this time. This trend would be exceedingly unlikely given the low reported case count in China. Read the report here.

Why Contact Tracing Couldn’t Keep Up with The US COVID Outbreak

A survey from NPR and the Johns Hopkins Center for Health Security found that many state health departments are “winding down the contact tracing programs they scrambled to grow last year.” Even though coronavirus infections are tapering off in most parts of the country, public health experts recommend maintaining a smaller workforce able to stay on top of ongoing outbreaks. This is a significant change from last winter when the US suffered from a shortage of people to respond and deliver case investigation and contact tracing. Adriane Casalotti of the National Association of County and City Health Officials likened the scramble to find these workers as “trying to build the plane while flying it.” Beyond the lack of personnel, there was an absence of federal leadership and communication from authorities (namely, the Centers for Disease Control and Prevention as well as the White House). Additionally, there did not exist a uniform approach for contact tracing programs. Low responsiveness was another challenge. An analysis of 14 contact tracing programs from June to October 2020 published in JAMA Network Open found that “no contacts were reported for two-thirds of persons with laboratory confirmed COVID-19 because they were either not reached for an interview or were interviewed and named no contacts.” A recent poll by the Harvard TH Chan School of Public Health and the Robert Wood Johnson Foundation found that only 52% of Americans trust the CDC, while the numbers for state and local health departments were even lower. Distrust also inhibited the utility of digital tools for contact tracing. For instance, in Utah, an app called Healthy Together used GPS location for contact tracing, but much of the population was uninterested in using it and unwilling to download it.  

BSL-4 Laboratories

Recently, Dr. Filippa Lentzos of King’s College London & Dr. Greg Koblentz of George Mason University launched GlobalBioLabs.org, an interactive web-based map of global Biosafety Level-4 facilities and biorisk management policies. Lentzos shared that the aim of the project is to “increase public knowledge about Biosafety Level 4 labs, and importantly, to strengthen national and international virus management policies.” Regardless of the origin of SARS-CoV-2, the risk of laboratory accidents and incidents rises as the number of laboratories in the world expands. The new map includes 59 laboratories, the majority of which are in Europe. Only 17 of the 23 countries that house BSL-4 laboratories have national biosafety associations or are members of international partnerships. The primary concern is that an accident could trigger the next pandemic. Watch a recording of the webinar launching the site here.

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