Masks Aren’t for Mental Health

By Madeline Roty

The COVID-19 pandemic has had a dramatic impact on physical health, but it is also taking a less obvious toll on our mental health. Based on my background in nursing, I know that physical and mental health are interdependent, and it is difficult to promote one without the other. For example, mental health disorders have been linked with an increased risk for cardiovascular disease. While the negative impact of COVID-19 on mental health has been acknowledged in the media and scholarly literature, the pandemic represents an opportunity to normalize conversations about mental health which has been stigmatized for far too long. But as people have rushed to buy cleaning supplies and personal protective equipment to protect their physical health and the health of others, I have also witnessed friends and family neglect their own mental well-being. Masks will not protect your mental health. In fact, masking your feelings will harm your mental health.
I have been fortunate; my family and friends have been healthy and safe. Like many people, I have had classes moved online, plans cancelled, and a job restructured. I thought that if people are experiencing far worse suffering than mine, why should my problems matter? Then I got a phone call from a friend. She said she had had a really hard month, but she didn’t tell me earlier because it didn’t seem like a big deal with everything else going on in the world. Then another friend called, overwhelmed by the little stresses that had accumulated over time because she thought they weren’t important in the grand scheme of things. That’s when it struck me. Many people I know were not taking the time to acknowledge the impact of the pandemic on their mental health. Instead they were dismissing their personal feelings because other people were suffering more or because it seemed selfish. Continue reading “Masks Aren’t for Mental Health”

Relearning Forgotten Lessons About Infection Prevention

By Saskia Popescu, PhD

I knew early on that the COVID-19 pandemic would hit the United States hard. In healthcare, it’s no longer a matter of if but rather when and for how long. Thanks to globalization, every city in America is twenty-four hours away from any outbreak in the world. My role as a senior infection prevention epidemiologist has taught me that there are warning signs before cases even reach our hospital, let alone American soil. The mask shortages that began well before cases were climbing in the United States, was one such canary in the coal mine.

These lessons were burned into the brains of infection preventionists in 2014 when Ebola was spreading across west Africa and the Dallas Ebola cluster changed the face of U.S. healthcare and biodefense forever. I still remember the daily scramble to update personal protective equipment (PPE) educational tools and get enough materials to train my frontline staff. Those were 16-hour days followed by multiple pages and calls throughout the night. And did I mention that I had a wedding scheduled in the midst of it all? Fitting for an infectious disease nerd though, right? Continue reading “Relearning Forgotten Lessons About Infection Prevention”

Pandora Report: 5.1.2020

Launching The Coronavirus Chronicles 
It has been three months since the World Health Organization declared that the novel coronavirus now known as SARS-CoV-2 posed a public health emergency of international concern. Not since the “Spanish Flu” of 1918 has the world experienced a pandemic of the scope and severity caused by the SARS-CoV-2 coronavirus. Since SARS-CoV-2 first emerged, the faculty, students, and alumni of the Biodefense Graduate Program at the Schar School of Policy and Government have been working on the front lines, behind the scenes, and on the home front to respond to this unprecedented pandemic. After we heard some amazing stories from Biodefense students and alumni about how the COVID-19 pandemic had presented new personal and professional challenges and how they had been able to contribute, in ways large and small, to the pandemic response, the editors of The Pandora Report decided that these stories needed a wider audience. The Coronavirus Chronicles is a collection of stories, based on the personal and professional experiences of the faculty, students, and alumni of the Biodefense Graduate Program, about life during the pandemic. We hope these stories help the public better understand the challenges posed by COVID-19 and how current and former members of the Biodefense Graduate Program have responded to these challenges and contributed to the pandemic response at the local, national, and international levels. The first installment of The Coronavirus Chronicles features three stories by Biodefense students and alumni. Biodefense PhD alumna Jennifer Osetek explains how she juggles multiple roles from working for the Coast Guard to teaching public health emergency preparedness to being a mom and Saskia Popescu discusses the challenges of infection prevention on the frontlines in hospitals. Finally, master’s student Madeline Roty highlights the importance of protecting your mental health as well as your physical health during the pandemic. New stories will be added to The Coronavirus Chronicles on a regular basis and new installments will be featured in future issues of The Pandora Report. If you are a student or alumni of the Biodefense Graduate Program and would like to contribute a story, please email us at biodefense@gmu.edu.

In Memoriam – Julian Robinson
The CBW world got a bit dimmer with the loss of Julian Perry Robinson on April 22. Julian was an avid researcher and contributor to the world of CBW nonproliferation, inspiring generations to study and work in biodefense. “A chemist and lawyer by training, Julian was a member of the SIPRI research staff during 1968–71 and the focal point of the work on CBW, which included the excellent six-volume series of books The Problem of Chemical and Biological Warfare (1971–76). During this period he was also responsible for groundbreaking reports on CBW issues published by the UN Secretary-General and the World Health Organization.  All of these provided essential inputs into the negotiation of the Biological Weapons Convention which was opened for signature in 1972.”

Health Security Articles by Our Editorial Team
The latest issue of Health Security includes two articles by the Pandora Report’s managing editor Saskia Popescu and associate editor Rachel-Paige Casey. Both articles can be found here. Popescu co-authored the article “Restricted and Uncontained: Health Considerations in the Event of Loss of Containment During the Restricted Earth Return of Extraterrestrial Samples” with Betsy Pugel and Syra Madad. Currently, the scope of a satisfactory public health response to the release of biological material is limited to biological vectors with known pathogenicity and virulence; however, the scope should be expanded to include the release of biological material with unknown pathogenicity and virulence. The recent return of extraterrestrial samples from Mars, a planet which may harbor life, instigates the renewed framing of a public health response, particularly for an accidental release of a such novel and mystifying material. The article poses a set of question relating to the initial public health and healthcare response in the event that extraterrestrial samples are accidentally released from failures in biological containment mechanisms. These questions ask how the public health community prepares for such an event; what can be done to confine, decontaminate, and collect the material; and how will the public be prepared. Casey co-authored the article “Conflict and Cholera: Yemen’s Man-Made Public Health Crisis and the Global Implications of Weaponizing Health” with Christine Crudo Blackburn and Paul E. Lenze, Jr. The 2016-17 cholera epidemic in Yemen was, prior to COVID-19, the largest disease outbreak in modern history. Conservative estimates found that the number of suspected cases exceeded 1 million and, within the first 8 months of the outbreak, there were over 2,000 confirmed deaths. Although cholera is an ancient disease that continues to plague many countries, Yemen’s outbreak had several unique features. The outbreak, which disseminated at an unprecedented pace, was directly linked to the country’s ongoing armed conflict. This article assesses what the cholera outbreak in Yemen reveals about the connection between infectious disease and conflict, the targeting of healthcare infrastructure as a modern warfare tactic, and the implications of a strategy of infrastructure destruction have for global health security.

Spore Wars
The COVID-19 pandemic has increased fears of both another naturally-occurring disease event and a bioweapons attack. The Trump administration released a National Biodefense Strategy in 2018, but it also dismantled directorate of the National Security Council that focused on health security and biodefense, and it proposed budget cuts to the laboratory network that tests for biological threats. between FY2015 and FY2019, funding for civilian biosecurity dropped 27% to a number $1.61 billion lower than the bill for buying Black Hawk helicopters. Dr. Gregory Koblentz, Director of the Biodefense Graduate Program, spoke to how the pandemic has, frighteningly, showcased that the US public health infrastructure is comprehensive broken or overtaxed. In other words, we have now exposed a critical vulnerability that may be provide incentive for a bioterrorist. This vulnerability extends beyond public health and the beyond the US borders; the US and global economy may now have targets on their backs.

The Saga Continues: Disinformation and Conspiracy Theories about the Origins of COVID-19
As the COVID-19 pandemic continues and the nations of the world still struggle to stop the spread and protect their people and economies, the desire for a boogie man persists. Conspiracy theories abound about the suspected surreptitious origins of the SARS-CoV-2 virus that plagues the world. Despite a bevy of experts denying the possibility that the coronavirus is the result of biological warfare and genetic analyses showing that this virus is not human-made, the shoddy hypothesis has a following of believers. In the Washington Post, Dan Kaszeta, a specialist in chemical and biological defense, provides further insight into the illegitimacy of the theories that the pandemic is the product biological warfare. Beyond the lack of evidence of human tampering, the inducement of a pandemic threatens the safety and security of the perpetrator’s own people, thereby disincentivizing the release of a pandemic-inducing bioweapon. There is no therapeutic or vaccine against this coronavirus that would engender protection of one’s own or a friendly population to the releaser. Further, the spread of disinformation relating to the pandemic is now being coined as a concurrent “infodemic.” One of the newest conspiracy theories is that the 5G network either transmits the coronavirus directly or weakens the immune system to imbue susceptibility to the virus. What will be tomorrow’s half-baked coronavirus conspiracy hoax?

Special Issue of Intelligence and National Security
The Journal of Intelligence and National Security released a Special Issue on Global Health Security, introduced with an article by Filippa Lentzos (a friend of GMU Biodefense), Michael Goodman, and James Wilson. Their article provides an overview of the health security threat spectrum: deliberate disease outbreaks, emerging infectious diseases and natural disease outbreaks at the other, and accidental disease events created by the significant scientific advances in the abilities to modify genes and microorganisms. Additionally, it traces how the perceptions about biological and health security threats have changed and expanded with outbreaks of naturally-occurring diseases, recognition of the unintended consequences of research, laboratory accidents, negligence, and emerging technologies. The authors argue that the traditional intelligence community must better engage with non-IS stakeholders and broaden its cadre to include new sources of intelligence in order to strengthen global health security and health intelligence. The Special Issue is an effort to encourage the development of a “multidisciplinary, empirically-informed, and policy-relevant approach to intelligence-academia engagement in global health security that serves both the intelligence community and scholars from a broad range of disciplines.” Read the full article here and all the articles in this Special Issue are open access.

COVID-19 MCM Update
The latest scientific study findings of potential COVID-19 therapeutics are a mixed bag of good news and bad news. Gilead’s remdesivir, an antiviral drug developed to treat hepatitis C and Ebola virus disease, shows no benefit to coronavirus patients according to a clinical trial conducted in China. This finding was accidentally revealed, but additional studies on the effects of remdesivir for coronavirus patients await their own conclusions. Conversely, Dr. Anthony Fauci, the top infectious disease expert for the US government, recently stated that data from another clinical trial is showing a positive effect from remdesivir in cutting a patient’s time to recovery. GEN’s list of front-runners for therapeutics and vaccines against COVID-19 currently includes 19 candidates; remdesivir remains on that list. In encouraging news, the COVID-19 pandemic has underscored the argument for supporting the development of a panviral drug. A panviral drug works broadly within or across viral families to incapacitate them. Such a drug is extraordinarily difficult to design because viruses hijack a host’s cellular machinery to survive and propagate; however, targeting a virus’s functions in a host cell may also negatively impact that cell’s normal function. Fortunately, researchers are starting to discover ways around that problem by refining which processes an antiviral drug targets.

The Trump Effect – International Institutions
From UNESCO to the Human Rights Council, and now the WHO, President Trump isn’t much of a fan of international institutions. “Global institutions are supposed to help facilitate cooperation during crises, but this time they’ve left nations to their own devices. That’s a departure from the past, and many experts suggest that it’s largely driven by the U.S.’s absence. ‘This makes the U.S. weaker, not stronger,‘ said Greg Koblentz, an associate professor at the Schar School of Policy and Government at George Mason University. ‘This will either lead other countries to try and use these crises to push their own agendas, or everyone will be on their own and you’re going to get a zero-sum competition among countries competing for scarce resources and hording supplies and not sharing data, because the mechanisms for facilitating cooperation and burden sharing and information sharing will have fallen apart’.” Since the news of President Trump’s plans to halt U.S. funding to the WHO, many have pointed out that his frustrations with the international institution aren’t excuses for why the U.S. has performed so poorly in responding to COVID-19. Jeremy Konyndyk noted “First off, the decision to pause funding to the organization that is coordinating the global fight against a pandemic in the middle of a pandemic is hugely damaging. If they do move forward with fully cutting off funding, that doesn’t just disrupt COVID response; it disrupts a lot of different things the U.S. government relies on WHO to do, like polio eradication, or cholera in Yemen, or extinguishing the Ebola outbreak in eastern Congo.”

The Right Way to Reopen the Economy According to GMU’s Pearlstein
Steven Pearlstein, a GMU Schar School professor and Pulitzer Prize-winning business and economics columnist, briefly outlined his recommendations on reopening the US economy. The upshot of Gerstein’s article is that getting Americans back to work after the coronavirus lockdown should not be a politicized process, but one that focuses on protecting Americans while restarting the US economy. The sooner we can safely return to normal life, the better. He outlines several general principles for reopening the economy, but points out that decisions and policies should be tailor-made to a region, industry, or institution to maximize success. For instance, regarding special funding programs, workers should be prioritized over investors and low-wage workers should be prioritized over high-wage workers. In general, lenders can afford to wait for their money, whereas workers and suppliers cannot. Given that a large chunk of white-collar workers can work from home but many blue-collar workers lack that luxury, low-wage workers should be the first to receive help as they are more likely to have lost most, if not all, of their income under the social distancing measures. No matter what decisions are made, tradeoffs are inevitable. There is no perfect solution without some hiccups or shortcomings. So, the key question is how do we reopen in a way that minimizes costs and risks to public health?

Preventing CBW Proliferation In the Age of COVID-19
How are the OPCW, BCW, and 1540 committees working to combat biological and chemical weapons during the pandemic? Richard Cupitt, Senior Fellow and Director of the Partnerships in Proliferation Prevention program at Stimson and Adjunct Faculty at GMU Biodefense, has provided a review of how each nonproliferation organization is working during this time. Cupitt notes of the BWC, “Not surprisingly, many national governments have entertained the need to adopt and implement the BWC and contribute to its strengthening.  And the requests for assistance have increased enormously according to several sources (although which requests, if any, that have gone to the BWC is confidential).” He emphasizes that for those like the OPCW, adjustments have been made to work remotely while maintaining a critical presence. Moreover, the economic recession will likely mean cuts to the budgets of many nations, which could impact the financial obligations of States parties to these international organizations.

Opportunity to support CBRN Research: The University of Maryland’s Integrated Discovery of Emerging and Novel Technologies (IDENT) Project Team Invites You to Join 
GMU Biodefense MS alum Alexandra Williams, Junior Researcher at the Unconventional Weapons Technology Division of the National Consortium for the Study of Terrorism and Responses to Terrorism (START) at UMD, is the co-research lead for the IDENT project and is inviting you to join. “This project has allowed me to apply the knowledge and experience I gained at GMU to conduct hands-on biodefense research and support US government CBRN mission space.” The IDENT Project seeks to develop a repeatable and scalable process for the discovery of emerging or disruptive technologies that may impact the Countering Weapons of Mass Destruction (CWMD) mission space. The project is sponsored by the Defense Threat Reduction Agency (DTRA) and is being designed and implemented by an interdisciplinary research team from the University of Maryland, ABS Consulting Group (ABSG), and the University at Albany (State University of New York). The IDENT Project team would like to invite rising and leading experts in the fields of biological and chemical defense to participate in the IDENT Knowledge Hub. The Knowledge Hub, a core component of the IDENT system, is a distributed, collaborative online software platform that includes broad horizon scanning and iterative-structured elicitation functionalities. The platform is also designed to incorporate additional expertise as needed through brief semi-structured probing interviews. If you would like to join the network of experts participating in the Knowledge Hub, refer a colleague, a fellow classmate, or would like more information about this effort, please reach out to Ms. Salma Bouziani at Bouziani@umd.edu and we are happy to provide you with any additional information.

Epic Fail: Why the US Wasn’t Prepared for the Coronavirus Pandemic
Daniel Gerstein, a graduate of the Biodefense PhD program and a senior policy researcher at the RAND Corporation, published an article in the Bulletin of the Atomic Scientists about why the US was not prepared for the coronavirus pandemic. The current administration largely failed to arrange a strong and timely response to COVID-19. The factors in this epic failure include, but are not limited to, inadequate biosurveillance systems, a disjointed emergency response network, and poor management of supply chain disruptions. Gerstein encourages a makeover for the emergency response system that lowers reliance on the federal government for a quick and effective response to outbreaks. In fact, certain state governments are already forming pacts to coordinate their responses to the outbreak and, perhaps, bypass the federal government. The pandemic has exposed the fissures in the national preparedness and response systems, which will require reconfiguring by relearning the lessons of crisis response and emergency management. Read Gerstein’s full article here.

Pandemic Pets?
First it was a sick tiger and now a new study from the CDC has reported that two pet cats living in separate ares of New York State have tested positive for SARS-CoV-2. “In the NY cases announced today, a veterinarian tested the first cat after it showed mild respiratory signs. No individuals in the household were confirmed to be ill with COVID-19. The virus may have been transmitted to this cat by mildly ill or asymptomatic household members or through contact with an infected person outside its home.Samples from the second cat were taken after it showed signs of respiratory illness. The owner of the cat tested positive for COVID-19 prior to the cat showing signs. Another cat in the household has shown no signs of illness.” No word on if hairballs are considered fomites…

News of the Weird
Got chickens? You’re in good shape against COVID-19 according to a Swedish city. The city of Lund is “spreading chicken manure in its central park in an effort to deter crowds gathering for a festival. Tens of thousands of people usually descend on southern city to celebrate Walpurgis Night, which is marked across Scandinavia. But officials want to keep people away because of the coronavirus outbreak. There is no lockdown in Sweden, where data show most people have taken to voluntary social distancing.” For residents of Lund, they have emphasized that with the stench of chicken manure, who would want to sit and have a beer?

Pandora Report: 4.24.2020

Summer Workshop Cancellation
We are so grateful for all the interest in the workshop over the years, but regretfully have decided to cancel the 2020 workshop due to the ongoing COVID-19 pandemic. In the interest of public health, George Mason University has cancelled all on-campus events through mid-August. We hope you and your family stay healthy and safe. If you are working on the response to COVID-19, we would like to thank you for your hard work and dedication to global health security. We are confident that the 2021 workshop will offer critical insights into the causes and consequences of this pandemic and a renewed passion for biodefense efforts. We hope to see you at next summer’s workshop and thanks to all for their interest.

‘Understanding and Surviving a Pandemic’ A Week of Scholarly Webinars
From April 27-May 1, 2020, you can enjoy a daily virtual event with a range of experts on the implications of the COVID-19 pandemic. Each day, a panel of experts from the Schar School of Policy and Government at George Mason University, guest practitioners, and elected officials will examine a different aspect of the coronavirus crisis, from politics to health care to intelligence. Mark J. Rozell, dean of the Schar School, will host the programs. The virtual sessions are open to the public and may be followed by a question and answer period, if time allows. See below for topics, times, and viewing information. Don’t miss the Tuesday event on infection control and surge capacity with Biodefense doctoral alum Saskia Popescu. You can read about the events and register for each webinar here.

Schar School Event- Public Policy in the Pandemic Age: How COVID-19 is Reshaping our Government, Economy, and Society
Join the Schar School Faculty, Alumni, Schar Alumni Chapter, and Dean Mark Rozell for an engaging virtual panel on the future of public policy post COVID-19 – COVID-19: How the Pandemic is Reshaping our Government, Economy, and Society. This virtual event will be held from 2-3:30pm EST on Wednesday, May 20, 2020. The COVID-19 pandemic is presenting unprecedented challenges to the United States and the rest of the world. Not since the “Spanish Flu” of 1918 have we experienced a pandemic of this scale and severity. Aside from the steep and growing human toll of the outbreak, virtually every aspect of our personal and professional lives are being affected. The sheer breadth of issues impacted by COVID-19 is overwhelming: public health, medicine, government, the economy, international trade, education, national security, politics, and technology, to name just a few. The effects of the pandemic are also magnified by existing cleavages within our society ranging from hyperpartisanship to racial disparities to socioeconomic inequalities. You can read more about our distinguished panel members and register for the event here.

Recent Developments in White Supremacist Terrorism
GMU Biodefense doctoral student Stevie Kiesel discusses a security threat that we might be overlooking right now.  Steve notes that while the national focus has correctly shifted to the threat from COVID-19, other national security threats have not gone away. On the contrary, domestic and international terrorist groups view the pandemic as a chance to sow chaos and strike at their vulnerable enemies. The Voice of Hind, a magazine supportive of the Islamic State and published in India, recently called on supporters to “use this opportunity to strike [nonbelievers] with a sword or a knife or even a rope…[and] fill the streets with their blood.” Closer to home, on March 24, Timothy Wilson accelerated his plan to deploy a vehicle-borne improvised explosive device to cause mass casualties. Recognizing an opportunity to use the pandemic as a force multiplier, Wilson was on his way to his target—a crowded Missouri hospital—when he was intercepted by the FBI. Wilson had been the subject of a domestic terrorism investigation for his “violent extremist” ideology that was “motivated by racial, religious, and anti-government animus.” Read more here.

Counting Calories in COVID-19
GMU Biodefense doctoral student Rachel-Paige Casey discusses COVID-19 implications for food shortages, American food culture, and what widespread stay-at-home orders mean for our diets. “To assuage any panic, the outlook for domestic food production – namely in cereals, meat, and dairy – remains sufficient despite reduced production. A recent announcement by Robert Johansson, USDA Chief Economist in Food and Nutrition, confirms that the United States possesses sufficient quantities of food to feed our population and maintain much of its exports. Anxiety averted and assuaged, patience is needed as our food value and supply chains adapt to abrupt changes in demand. Additionally, the agricultural and food processing sectors need time to adjust operations to increase safety measures (for its workers and customers) and to fulfill changes in consumer preferences.” Read more here.

OPCW Confirms Syrian Sarin Chemical Weapon
The Organisation for the Prohibition of Chemical Weapons (OPCW) published its First Report by the Investigation and Identification Team (IIT), which strongly linked the Syrian government to the March 2017 sarin and chlorine attacks on a rebel town. Specifically, in March 2017, three projectiles – two containing sarin and one containing chlorine – were dropped from aircraft of the Syrian Arab Air Force into Ltamenah in northern Syria. According to Dr. Gregory Koblentz, Dirrector of the Biodefense Graduate Program and member of the Scientists Working Group on Chemical and Biological Security, the IIT’s use of multiple methods provided “damning evidence” of that the sarin was developed by the Syrian government. Unfortunately, the IIT does not have the authority to issue sanctions against Syria as punishment. Kenneth D. Ward, US ambassador to the OPCW, assured that the use of chemical weapons will not be tolerated by the United States, which will seek to hold Syria accountable.

COVID-19 and International Security Podcast
Have you heard the latest Power Problems podcast episode? You can listen to Dr. Greg Koblentz of George Mason University as he joins Emma Ashford and Trevor Thrall to talk about the international security implications of the coronavirus pandemic. This is an engaging and insightful podcast that discusses national security in the age of pandemics and how we govern in a crisis, let alone reconsidering biosecurity and a recalibration of our efforts during biological threats. As Koblentz reiterates, “This pandemic should be a wake-up call to the national security community that its time to rethink its priorities. Instead of obsessing about great power competition, we should be more focused on defeating our microscopic enemies. When great powers compete over global health, the only winners are the viruses.”

The “Best People” for Pandemic Response? Vaccine Expert Leaves BARDA While Labradoodle Breeder Leads HHS COVID-19 Efforts
From critical vacancies to questionable personnel choices, this week has been another shaky one for the White House. And no, we’re not referring to comments about injecting disinfectants into the body to prevent COVID-19… On Wednesday, a startling shakeup occurred- Dr. Rick Bright was removed from his position as director of BARDA. Not one to go quietly, Bright released a statement stating that leadership pressured him to look more into hydroxychloroquine despite concerns. “I believe this transfer was in response to my insistence that the government invest the billions of dollars allocated by Congress to address the Covid-19 pandemic into safe and scientifically vetted solutions, and not in drugs, vaccines and other technologies that lack scientific merit,” he said in his statement. “I am speaking out because to combat this deadly virus, science — not politics or cronyism — has to lead the way.” Unfortunately, this wasn’t the only shake-up in how the U.S. is responding to COVID-19. Despite President Trump stating that he only hires the best people, it turns out that the aide of HHS Secretary Alex Azar, was tapped to take over COVID-19 response for the agency despite his lack of experience in public health and a track record for…dog-breeding. “The aide, Brian Harrison, had joined the department after running a dog-breeding business for six years. Five sources say some officials in the White House derisively called him ‘the dog breeder.’ Azar’s optimistic public pronouncement and choice of an inexperienced manager are emblematic of his agency’s oft-troubled response to the crisis. His HHS is a behemoth department, overseeing almost every federal public health agency in the country, with a $1.3 trillion budget that exceeds the gross national product of most countries.” GMU Biodefense graduate program director Dr. Gregory Koblentz emphasized these key personnel vulnerabilities in this 2017 OpEd and the implications for biodefense.

The World vs. COVID-19: Potential Models for Stymying the Spread of COVID-19
Michael Krug, a soon-to be-graduate of the Biodefense MS program, was recently hired on by HHS’s Office of Global Affairs as a Global Health Officer for the Office of Pandemics & Emerging Threats. As a budding biodefense professional, the Pandora Report reached out to Krug for his thoughts on his upcoming career and how the GMU Biodefense Graduate Program helped him land his new role. “The Biodefense Program at GMU helped hone my policy knowledge on several topics significant to my work now, including global health policy, health security, and international norms. The program’s proximity to Washington, DC enabled me to find meaningful work experience, to go along with the robust policy-oriented curriculum. One of the reasons I joined the Office of Global Affairs (OGA) at HHS was to help support the core efforts and expertise that strengthen global health priorities. The OGA promotes coordination and partnership between all levels of governments, international and non-governmental organizations. Together these efforts highlight the importance of global health and raise awareness to the health risks around the world. In this interconnected world, I felt as though the OGA provided me the greatest opportunity to make a resounding impact on the global health field.” Krug recently published an article for GMU’s Center for Security Policy Studies about strategies and countermeasures for stymy the continued spread of COVDI-19, citing South Korea and Washington state as examples. Please read Krug’s latest article here.

Realigning the conventional routes of transmission: an improved model for occupational exposure assessment and infection prevention
GMU Biodefense doctoral alum Chris Brown is addressing the very real challenges of occupational exposure assessments, which couldn’t come at a better time as we learn about more healthcare-related COVID-19 cases. “Current recommendations for standard and transmission-based precautions in place for patients who are suspected or known to be infected or colonized with infectious agents are best suited to prevent the transfer of micro-organisms to other patients – that is, to prevent the acquisition of a healthcare-associated infection, rather than to protect the healthcare worker from self-contamination resulting in a potential occupationally acquired infection. This article reviews current recommended infection prevention and control practices and offers a framework for better protection and controls from an occupational health point of view. We offer a model with two exposure routes – contact and aerosol – resulting from work activities and environments, shifting the focus away from particular pathogenic micro-organisms’ typical methods for spreading to patients or to other non-workers in hospital and community settings.” Read more here.

ASPR’s Activities
The office of the Assistant Secretary for Preparedness and Response (ASPR) is housed in the Department of Health and Human Services (HHS) and was established by the created under the Pandemic and All Hazards Preparedness Act (PAHPA) in 2006. The ASPR manages the Strategic National Stockpile (SNS) of medical supplies, personal protective equipment (PPE), medicines, and devices for life-saving care in an emergency situation. In the COVID-19 response, the SNS has distributed PPE (N95 respirators, surgical and face masks, face shields, gloves, and disposable gowns) in all 50 states to help subdue the transmission of COVID-19; it has also provided ventilators to areas with critical need. The SNS, in conjunction with its federal partners, is coordinating logistics operations to optimize all available resources to support the COVID-19 response. HHS launched the ASPR Technical Resources, Assistance Center, and Information Exchange (TRACIE) to “meet the information and technical assistance needs of regional ASPR staff, healthcare coalitions, healthcare entities, healthcare providers, emergency managers, public health practitioners, and others working in disaster medicine, healthcare system preparedness, and public health emergency preparedness.” TRACIE covers healthcare coalitions, CBRN, health care system partners and medical surge, the Emergency Preparedness Requirements for Medicare and Medicaid Participating Providers and Suppliers (CMS EP Rule), hurricanes, disaster behavioral health, mass violence, infectious diseases, drug shortages and scarce resources, and emergency medical services (EMS). TRACIE’s COVID-19 page highlights the resources developed and identified to aid ongoing response and recovery operations.

COVID-19 Testing: Possibilities, Challenges, and Ensuring Equity (NAS)
This week, the National Academies of Sciences and the American Public Health Association hosted a webinar about COVID-19 testing and its equity issues. The presenters provides an update on the state of testing for COVID-19, explained the types of data that will be provided by different tests under development, discussed how that data can inform plans to ease social distancing, and described the equity issues that must be considered access testing and how we can ensure equal access for all. The panel experts included moderator David Relman, MD, Professor of Microbiology and Immunology at Stanford University; Jill Taylor, PhD, Director of the Wadsworth Center for the New York State Public Health Department; Ashish Jha, MD, MPH, Director of the Harvard Global Health Institute; and Georges C. Benjamin, MD, Executive Director of the American Public Health Association. Notes and slides for this and related events are available here. The panel covered situational awareness of diagnostics and surveillance, FDA-approved and EUA-approved molecular and serology assays for testing, the accuracy and reliability of existing tests, ongoing studies for new diagnostics, and, of course, the inequities of the current testing strategy. Diagnostics, using any type of test, need to provide data and insight about active SARS-CoV-2 infections, stage of infection, symptom level (or asymptomatic), contagiousness, prognosis, clinical needs, and acquired immunity.  Surveillance systems need to provide data and insight about acquired immunity, susceptibility, geographic and temporal factors for infection, and the efficacy of intervention measures. The slow and meager early response efforts of the US were seen in the lack of testing infrastructure, an insufficiency that persists weeks later. The high positive rate (about 20-22%) of US diagnostic testing signals that testing coverage is inadequate as many other nations who have expanded their testing network see positive rates under 10%. There are two camps about the number of tests per day that are needed to achieve reasonable containment of the virus in the US: 500,000/day or 10-30 million/day. The 500,00 tests per day recommendation is probably the only attainable option. Beyond reaching that figure, testing needs to be economically accessible to all subpopulations that are currently struggling to get testing or care. At present, the coronavirus test is covered by the federal government; however, the cost of the appointment and the proceeding care are not, which is a major obstacle for Americans that lack sufficient insurance coverage or a nearby care facility. Dr. Benjamin pointed out that current public health messaging campaigns are focused on television and social media platforms that are not accessible to everyone, but neglects using the radio as a platform for PSAs and information. Additionally, some of the innovations are only applicable certain groups; drive-thru testing sites are a novel option but only for those who own a car. Dr. Benjamin also recommends using locally trusted messengers, such as faith leaders, for public health communication. The aforementioned health inequities are not new occurrences but are of critical concern as we try to combat COVID-19. If we can quickly and adequately enhance our testing strategy to scale up testing and expand accessibility to underrepresented subpopulations, we should finally be able to contain the virus enough to slowly and safely start resuming “normal” life.

Cascading Economic Impacts of the COVID-19 Outbreak in China
The US-China Economic and Security Review Commission released a Staff Research Report on the economic impacts of COVID-19 in China. China’s late response to the originally-localized outbreak in Wuhan province led the Chinese government to unforce lockdowns across the country, crippling economic activity. With respect to the COVID-19 pandemic, the Commission found that China suffered, and continue to grapple with, obstructed demand in energy and retail items, stalled production and exports, supply chain disruptions. The Chinese supply chain disruptions are impacting global supply chains, and the US is seeing the effects. These interruptions in economic activity are also the result of intentional freezes by Chinese policymakers in an attempt to curtail the spread of the virus while maintaining supply-side efforts to support businesses; this attempt is largely considered a failure. The ultimate result of China’s slow yet extreme response measures is a deceleration of international economic activity. The International Monetary Fund (IMF) now forecasts a 3% global GDP contraction in 2020. The IMF estimate is somewhat optimistic as it relies on the assumptions that pandemic subsides and other support will be enacted in most countries during the second quarter of 2020 and economic activity will mostly resume in the latter half of this year. The full report is available here.

OHSS Webinar – Wildlife trade: the social, cultural, and political stakes
The One Health Social Sciences Initiative is hosting a webinar on April 30, 2020 from 11am-12:30pm EST, with two experts in zoonotic epidemics in an inter-disciplinary dialogue about the social, cultural, and political stakes of eliminating the wildlife trade and, in particular, the role of “wet markets”.  Dr. Laura Kahn and Dr. Christos Lynteris will be the speakers of this engaging event. As the potential breeding ground for the current worldwide COVID-19 pandemic, epidemiologists, public health officials, and wildlife conservationists have called for shutting down these markets. However, as a central means of sustenance for many communities around the world, the full impacts of closing the markets and necessary strategies to address them will be addressed. Register for this free event here.

Counting Calories in COVID-19

By Rachel-Paige Casey

As panic seized the nation, most Americans rushed to their local grocery store and saw, perhaps for the first time, bare shelves. Despite the immediate fear of food shortages, the empty shelves were the result of a suddenly overloaded food supply chain that struggled to replenish inventories at rate commensurate to the grocery (and toilet paper) stockpiling. The US boasts an exceptionally efficient food production system; indeed, 40% of all food produced and grown within our borders is never eaten. As logistics networks hustle to quicken supply chains to grocers and other food retailers, a question lingers: Will the United States run out of food if the pandemic and its countermeasures persist much longer?

To assuage any panic, the outlook for domestic food production – namely in cereals, meat, and dairy – remains sufficient despite reduced production. A recent announcement by Robert Johansson, USDA Chief Economist in Food and Nutrition, confirms that the United States possesses sufficient quantities of food to feed our population and maintain much of its exports. Anxiety averted and assuaged, patience is needed as our food value and supply chains adapt to abrupt changes in demand. Additionally, the agricultural and food processing sectors need time to adjust operations to increase safety measures (for its workers and customers) and to fulfill changes in consumer preferences. Continue reading “Counting Calories in COVID-19”

Recent Developments in White Supremacist Terrorism

By Stevie Kiesel

While the national focus has correctly shifted to the threat from COVID-19, other national security threats have not gone away. On the contrary, domestic and international terrorist groups view the pandemic as a chance to sow chaos and strike at their vulnerable enemies. The Voice of Hind, a magazine supportive of the Islamic State and published in India, recently called on supporters to “use this opportunity to strike [nonbelievers] with a sword or a knife or even a rope…[and] fill the streets with their blood.” Closer to home, on March 24, Timothy Wilson accelerated his plan to deploy a vehicle-borne improvised explosive device to cause mass casualties. Recognizing an opportunity to use the pandemic as a force multiplier, Wilson was on his way to his target—a crowded Missouri hospital—when he was intercepted by the FBI. Wilson had been the subject of a domestic terrorism investigation for his “violent extremist” ideology that was “motivated by racial, religious, and anti-government animus.”

The threat from white supremacist terrorism has surged in recent years, and the US has been grappling with how to address this threat. In September 2019, the Department of Homeland Security issued its Strategic Framework for Countering Terrorism and Targeted Violence, which explicitly acknowledged that “[t]here has been a concerning rise in attacks by individuals motivated by a variety of domestic terrorist ideologies, such as racially- and ethnically-motivated violent extremism, including white supremacist violent extremism [and] anti-government and anti-authority violent extremism.” And in February 2020, FBI Director Wray testified to Congress that the FBI “elevated to the top-level priority racially motivated violent extremism so it’s on the same footing in terms of our national threat banding as ISIS and homegrown violent extremism.” The FBI’s domestic terrorism investigation of Timothy Wilson, an accelerationist vehicle bomber, which thwarted a potentially devastating attack, shows that this new emphasis is not misplaced. Continue reading “Recent Developments in White Supremacist Terrorism”

Pandora Report: 4.17.2020

A Strategic Vision for Biological Threat Reduction: The U.S. Department of Defense and Beyond
The Committee on Enhancing Global Health Security through International Biosecurity and Health Engagement Programs of the National Academies of Sciences, Engineering, and Medicine (NAS) published its 5-year strategic vision for international health security programs along with its findings and recommendations regarding how to optimize the impact of the Department of Defense (DOD) Biological Threat Reduction Program (BTRP) in achieving its mission for biosafety and biosecurity. Since BTRP is just one of the many US government programs involved in international health security engagement, coordination across the government and with its international partners is critical to achieving the biosafety and biosecurity mission of improving capacity to detect, diagnose, and respond to dangerous pathogens and other biological threats. Though BTRP is not the only cog in the biodefense wheel, it is a vital one, and, as such, should be granted “as much geographic and programmatic flexibility as possible to understand and address broadly the biosafety and biosecurity needs of its partner nations as the program serves US interests.” The 5-year vision aims to develop a durable interagency mechanism, encompassing BTRP and its DOD partners, that tackles the entire set of biological threats and risks affecting US military forces, foreign interests, and homeland. The proposed interagency mechanism would work to disrupt, mitigate, or eliminate risks as efficiently and effectively as possible by the agency or agencies befitting the needs of the mission. Their seven primary recommendations for BTRP include establishing stronger relationships with the combatant commands, CDC, NIH, and other relevant governmental partners; selecting technical engagement professionals to represent the USG; and acquiring more scientific expertise within its staff to proactively engage with the broader scientific community to improve its understanding of technical and scientific developments in emerging infectious diseases. Read the full consensus study report with its detailed findings and recommendations here.

COVID-19 Updates: From WHO to Healthcare Worker Infections
There have been over 600,000 cases and 24,582 deaths in the United States, while the worldwide case count has surpassed 2 million. This week, the CDC released new research via the Morbidity and Mortality Weekly Report (MMWR) regarding healthcare worker cases of COVID-19, shedding light on data gaps and the need to understand the impact of potential healthcare exposures and PPE challenges. “Of 9,282 U.S. COVID-19 cases reported among HCP, median age was 42 years, and 73% were female, reflecting these distributions among the HCP workforce. HCP patients reported contact with COVID-19 patients in health care, household, and community settings. Most HCP patients were not hospitalized; however, severe outcomes, including death, were reported among all age groups.” Of the 315,000 cases reviewed, data on job role was only available for 16%, and of those with occupational data, 19% were healthcare workers. 55% of those healthcare worker cases reported exposure to a confirmed case in a healthcare setting, while fewer noted community exposures, which is likely due to testing gaps. As GMU Biodefense alum and infection prevention epidemiologist Saskia Popescu noted, “This data is really helpful because it’s giving us those first indicators of health care worker risks and exposures,” says Dr. Saskia Popescu, an epidemiologist at a large health system in Phoenix. “But ultimately we need to be collecting more on this because we have to understand the failures, so we can correct them in the future.” In Washington, D.C., President Trump has worked to shift blame of COVID-19 response to The WHO, noting that the administration would be halting funding for the organization. “In effect, Mr. Trump was accusing the world’s leading health organization of making all of the mistakes that he has made since the virus first emerged in China and then spread rapidly. As of Tuesday, there had been about two million cases of the virus worldwide, and nearly 125,000 deaths. In the United States, there have been over 600,000 cases and 25,000 deaths from the virus.” These announcements come just as more light is shed on the woefully inadequate testing within the U.S.

Faculty Spotlight: VOA (Korean Service)
Earlier this week, Dr. Gregory Koblentz, Director of the Biodefense Graduate Program, was interviewed for and quoted in an article published by the Korean VOA outlet about the latest use of the Defense Production Act (DPA) to produce 39 million N-95 masks in the next 90 days. Koblentz points out that the DPA will do little to overcome the shortage in diagnostic kits because the lack is not the result of underutilized production capacity but the result of the difficulty in producing safe and reliable tests. Koblentz also acknowledges the potential abuse of the president’s powers via the employment of the DPA. Specifically, since the conclusion of the Cold War, the lawful definition of defense has been increasingly broadened to include “matters not directly related to armed conflict.” In fact, President Trump recently commented that he would stop exports of PPE based on the DPA. The full article is available here.

Global Health Security & National Security 
On Wednesday, April 15, 2020, more than 2,494 Americans died of COVID-19 according to Johns Hopkins School of Public Health. That is more deaths than occurred on December 7, 1941. Global health security is national security. Sadly, this pandemic and the U.S. response has showed how many gaps we have in national security. Oona Hathaway of Just Security noted “As devastating as the terrorist attacks of 9/11 were, the death toll of COVID-19 is already higher in New York state alone, where more than 4,000 had reportedly died as of April 5. The overall U.S. death toll from coronavirus is now close to 10,000. Estimates suggest that the final death toll could be well over 100,000. Indeed, President Donald Trump recently suggested that 100,000 American deaths would mean’“we all together have done a very good job’. If one believes, as I do, that the fundamental goal of a national security program should be to protect American lives, then we clearly have our priorities out of place. Just as the 9/11 attacks led to a reorientation of national security policy around a counterterrorism mission, the COVID-19 crisis can and should lead to a reorientation of national security policy.” As GMU professors Dr. Gregory Koblentz and Dr. Michael Hunzeker noted last week, the COVID-19 outbreak on the USS Theodore Roosevelt forced the ship’s commander to temporarily scale back operations and now, the USS Ronald Reagan is reporting positive COVID-19 cases and may have no option but to follow the lead of the Roosevelt. These events are warnings to our national security apparatus that pandemic diseases are clear and present threat to our Nation and her allies and interests. Koblentz and Hunzeker urge the US to recognize this threat and adjust to it with urgency and intensity. For more, Koblentz and Hunzeker’s article is available here.

Internal Savings from the Pentagon
According to DefenseNews, DoD identified $5.7 billion in funding – referred to as “savings found through efficiencies” – based on an internal review of the fourth-estate offices, which comprise all the defense agencies not associated with either a service or a combatant command. This funding will be reallocated to new priorities: nuclear modernization, the new US Space Force, hypersonic weapons, artificial intelligence, missile defense, 5G communications technologies, and response force readiness. Mark Esper, the Secretary of Defense, plans to find more savings by continue the review in FY22. Secretary Esper has empowered Lisa Hershman, the department’s chief management officer, to play the role of service secretary for the fourth estate offices, by overseeing their budget development process. Presently, the so-called savings and associated reallocations do not require any terminations, as retirements will free up some of that money; however, personnel reductions remain an option for FY22. Read the full article here.

Embrace Experimentation in Biosecurity Governance
A recent article in Science Magazine implores the scientific and policy communities to rethink and expand the concept of biosecurity governance with the inclusion of new assumptions about the relationships between biology, security, and society. This rethinking will enable improvements in biosecurity governance and in its implementation. Classical governance of biology concentrates on risk management and dual-use research of concern; however, as we are realizing as a global community, not all threats and risks can be precisely foreseen and, therefore, mitigated. Policy lags behind developing tools, like CRISPR, and the potential dual-use dangers they create, both of which are growing at an accelerating rate over the last decade. In an effort to close this gap, the Potential Pandemic Pathogen Care and Oversight policy was established to assess the circumstances under which such research is ethical, but there are no systematic and consistent reviews of the policy’s implications. The onus of biosecurity is increasingly falling to scientists with little training and information about how to assess safety and security concerns of their research. The authors recommend an experimental approach to biosecurity governance in which assessments of research are systematic, transparent, and flexible. Experimentation along with better data collection and sharing are critical for developing a “robust and adaptive governance system.” The full article can be found here.

Responding to COVID-19 While Reopening A Nation
As America works to “reopen” and loosen restrictions, many have warned that it must not be done too soon or too quickly. On Thursday, Present Trump announced plans to reopen the country – emphasizing criteria for relaxing restrictions in phases that did not include dates and left much to governors. The U.S. is still struggling with widespread access to rapid diagnostics, which many cite as a necessity prior to relaxing national restrictions. Focus has been of late on antibody testing and the potentially for post-infection immunity, which isn’t as easy as people might assume. “The unknowns begin with how much an immune response to SARS-CoV-2—the virus that causes COVID-19—tells us. Early studies suggest the production of IgM and IgG in COVID-19 patients typically occurs between 7 and 11 days after exposure, with IgM antibodies appearing first, followed by IgG antibodies. The presence of these antibodies, which respond to specific antigens on the surface of the SARS-CoV-2 virus, indicate that a person has been exposed and their immune system has reacted. But does that necessarily mean a person is immune to getting re-infected?” As we look to serology and the potential of re-opening efforts, experts have emphasized the incremental relaxation and that there will likely be spikes that occur, requiring contact tracing and isolation efforts. As Ed Yong of The Atlantic asked – when will things go back to normal? “The options are limited. Early inaction left the U.S. with too many new cases, and just one recourse: Press a societal pause button to buy enough time for beleaguered hospitals to steel themselves for a sharp influx in patients. This physical-distancing strategy is working, but at such an economic cost that it can’t be sustained indefinitely. When restrictions relax, as they are set to do on April 30, the coronavirus will likely surge back, as it is now doing in Singapore, China, and other Asian states that had briefly restrained it.” The truth is, and as the White House plan notes, many things need to occur prior to restrictions fully being relaxed and not just better diagnostics, but also a healthcare infrastructure that isn’t overwhelmed and without critical resources, ability to do contact tracing, and continued decline in cases and community transmission.

Good News: Vanquishing the Virus
As some much-needed good news, GEN’s tally of vaccines and treatments under development against COVID-19 has reached 161 candidates and counting. GEN divided the medical countermeasure candidates into four aptly named categories based on current developmental and clinical progress: front runners, definitely maybes, keeping an eye on, and too soon to tell. To date, there are 18 front runners, 17 definitely maybes, 70 candidates they are keeping an eye on, and 56 candidates whose efficacies are too soon to tell. The categorized lists are available here.

Roadblocks to Infection Prevention Efforts in Health Care: SARS-CoV-2/COVID-19 Response
Infection prevention epidemiologist and GMU Biodefense PhD alum Dr. Saskia Popescu discusses challenges to healthcare infection prevention efforts while combatting COVID-19. ” Lessons from the 2003 SARS-CoV outbreak in Toronto and 2015 MERS-CoV outbreak in South Korea have unveiled the critical role that hospitals play in outbreaks, especially of novel coronaviruses. Their ability to amplify the spread of disease can rapidly fuel transmission of the disease, and often those failures in infection prevention and general hospital practices contribute to such events. While efforts to enhance infection prevention measures and hospital readiness are underway in the United States, it is important to understand why these programs were not able to maintain continued, sustainable levels of readiness. History has shown that infection prevention programs are primarily responsible for preparing hospitals and responding to biological events but face understaffing and focused efforts defined by administrators. The current US health care system, though, is built upon a series of priorities that often view biopreparedness as a costly endeavor. Awareness of these competing priorities and the challenges that infection prevention programs face when working to maintain biopreparedness is critical in adequately addressing this critical infrastructure in the face of an international outbreak.” Read more of her article here.

Inventions Birthed by Necessity 
GMU Biodefense PhD alum Dr. Daniel Gerstein is evaluating some of the innovations and invention that the COVID-19 pandemic is stimulating. “If necessity is the mother of invention, the new coronavirus is quickly birthing a lot of innovations. Parts of U.S. society may be forever changed by this pandemic. As of 13 April 2020, the United States had over 550,000 confirmed cases and nearly 22,000 deaths, with emergency preparedness and response agencies preparing for much more to come. Combinations of social distancing, home quarantine, closure of schools and universities, and case isolation are now being extensively practiced. Creativity is being implemented each day to overcome response barriers to those at work and meet the needs of those asked to stay at home.” Read Dr. Gerstein’s article here.

Upcoming Virtual Event: Synthetic Biology and National Security: Risks and Opportunities (Part 2 of 2)
On 21 April 2020 at 1:00 pm, Center for Strategic and International Studies (CSIS) is hosting the second part of its Synthetic Biology: The Ongoing Technology Revolution Series. The series covers several important topics within synthetic biology: present and future potential as a critical emerging technology; economic and societal implications; national security opportunities and risks; and implications for emerging technology policy. This online event features Dr. Megan Palmer, Senior Research Scholar at the Center for International Security and Cooperation at Stanford University; Dr. Alexander Titus, the Chief Strategy Officer of the Advanced Regenerative Manufacturing Institute; and Dr. Rocco Casagrande, the Founder and Managing Director of Gryphon Scientific. The event will be available to view here.

Pandora Report: 4.10.2020

National Security in the Age of Pandemics
This week, Dr. Gregory Koblentz, Director of the Biodefense Program, and Dr. Michael Hunzeker, Associate Director of the Center for Security Policy Studies, published a commentary asserting that pandemic preparedness cannot be improved if it becomes another item on the military’s infinite laundry list of missions and threats. The COVID-19 outbreak on the USS Theodore Roosevelt forced the ship’s commander to temporarily scale back operations it so that its crew could isolate themselves and later resume their duties after subduing the infection. Now, the USS Ronald Reagan is reporting positive COVID-19 cases and may have no option but to follow the lead of the Roosevelt. These events are warnings to our national security apparatus that pandemic diseases are clear and present threat to our Nation and her allies and interests. Koblentz and Hunzeker urge the US to recognize this threat and adjust to it with urgency and intensity. For more, Koblentz and Hunzeker’s article is available here.

Summer Workshop on Pandemics, Bioterrorism, and Global Health Security 
Are you registered for the summer workshop yet? From July 13-16, 2020, GMU Biodefense will be hosting a three and a half-day workshop on all things global health security. Leaders in the field will be discussing hot topics like COVID-19, pandemic preparedness, vaccine development, medical countermeasures, synthetic biology, and healthcare response to COVID-19. This is also a great networking opportunity as past participants come from a range of government agencies, NGOs, universities, think tanks, and foreign countries. Don’t miss out on the early-bird discount for this immersive workshop – you can register here.

Syria’s Chemical Weapons Attacks
The Organisation for the Prohibition of Chemical Weapons (OPCW) published its First Report by the Investigation and Identification Team, which strongly linked the Syrian government to the March 2017 sarin and chlorine attacks on a rebel town. Specifically, in March 2017, three projectiles – two containing sarin and one containing chlorine – were dropped from aircraft of the Syrian Arab Air Force into Ltamenah in northern Syria. In total, these weapons affected at least 106 individuals. The Washington Post reported on these findings and our own Dr. Gregory Koblentz, Director of the Biodefense Program, stated that strong evidence for attribution is the first concrete step toward punishing such violations of international laws and agreements. The OPCW is not a judicial body with the ability to determine and punish criminal acts, so action must be taken by the Executive Council and the Conference of the States Parties to the Chemical Weapons Convention, the United Nations Secretary-General, and the international community. The full report is available here.

Smartphones and Contact Tracing
Contact tracing is a vital piece to not only public health response, but also helping “reopen” the country (keep reading for more insight into this). Unfortunately, it’s quite time and resource intensive and with widespread transmission and not enough public health resources, this can limit our capabilities. Some countries though, are looking to employe technology into contact tracing – “In Singapore, a country that’s turned to cellphone contact tracing, an app called TraceTogether uses Bluetooth to log when a user’s phone encounters another phone that has the app. If someone tests positive for COVID-19, he or she can easily submit a log of all the other people (and their phones) that he or she came in contact with in the last 21 days.” GMU’s HyunJung Kim has recently discussed this approach in South Korea – noting that “The disclosure of epidemic information is very significant for disease prevention and control, because we experienced the failure of disease control and prevention during the MERS of 2015,” HyunJung Kim, a PhD student in biodefense at George Mason University who has written about Korea’s public health system, says. “Information … makes people more comfortable because they can avoid and detour the areas/hospitals where infected people visited.” On the other hand though, such tech has ethical implications. Kelly Hills, Co-Principal of Rogue Bioethics noted that “We really have to keep our guard up against surveillance technologies that could be abused with very little effort, especially since these technologies are almost always going to be used against our most marginalized communities.” Damien P Williams, PhD candidate in the Department of Science, Technology, and Society at Virginia Tech recently noted that “First and foremost, supposedly anonymized tracking data sits alongside facial recognition as technologies which, in the current formulation of Western society, have no non-oppressive, non-exploitable use. Things developed and deployed in times of heightened fear and concern will very likely become every day violations.” Williams further stated that “Such a tool simply reinforces the trend toward surveillance technologies which are both insidiously abusive and also disproportionately leveraged against already-marginalized communities, as it has been the case with technologies and research in this vein, for literally centuries.” Where do you land on the topic?

Small Groups, Big Weapons: The Nexus of Emerging Tech and WMD Terrorism
A paradigm shift in recent years has seen non-state actors enhance their capabilities to utilize WMDs. A new report from the Combating Terrorism Center at West Point, is shedding light on the changes to capital, infrastructure, and intellectual capacity that are aiding this shift. “The commercialization of emerging technologies is reducing the financial, intellectual, and material barriers required for WMD development and employment. This report surveys three emerging technologies—synthetic biology, additive manufacturing (commonly known as 3D printing), and unmanned aerial systems—and examines the nexus of each with nuclear, biological, and chemical weapons agent proliferation. It examines how non-state actors might use these emerging technologies to overcome traditional barriers against the development and employment of WMD.” You can access the report here.

Inadequate PPE Distribution & Hospital Experiences Responding to COVID-19: A U.S. Survey 
Just how well are hospitals managing the current pandemic? Not well. A survey by the HHS Office of the Inspector General (OIG) across U.S. hospitals from March 23-27, revealed some sobering insight into the challenges of COVID-19 response. 323 hospitals across 46 states chatted with the OIG on this (at least the hospital administrators did…). At a glance, the findings aren’t surprising – severe shortages of testing supplies, extended waits for results, widespread shortage of PPE, challenges maintaining adequate staffing and hospital capacity to treat patients, shortages of critical supplies and materials, and changing/sometimes inconsistent guidance. “Hospitals reported that changing and sometimes inconsistent guidance from Federal, State, and local authorities posed challenges and confused hospitals and the public. Hospitals reported that it was sometimes difficult to remain current with Centers for Disease Control and Prevention (CDC) guidance and that they received conflicting guidance from different government and medical authorities, including criteria for testing, determining which elective procedures to delay, use of PPE, and getting supplies from the national stockpile. Hospitals also reported concerns that public misinformation has increased hospital workloads (e.g., patients showing up unnecessarily, hospitals needing to do public education) at a critical time.” This is an insightful and telling report about the current challenges hospitals are facing in the U.S., not only in responding to COVID-19, but also preparing for it. Unfortunately, this isn’t the only report regarding inadequate supplies and distribution of PPE and vital medical supplies across the U.S. to various states. A new document has been released from HHS on the insufficient distribution of these critical pieces to healthcare response. “Only 11.7 million N95 respirator masks have been distributed nationwide—less than 1% of the 3.5 billion masks that the Trump Administration estimated would be necessary in the event of a severe pandemic. Only 7,920 ventilators have been distributed from the stockpile, even though a recent survey of 213 mayors—which did not include New York City, Chicago, or Seattle—identified a total estimated need of 139,000 ventilators.” Moreover, the report notes that the Strategic National Stockpile has made its last shipment of PPE for states as it now has 10% left, which will be reserved for federal workers and not distributed to states.

When Can We “Reopen” the U.S.? 
The U.S. has over 427,000 cases and 14,696 deaths related to COVID-19, but many of us have been wondering, when will we be able to go back out to restaurants and congregate in public? The answer though, isn’t so simple and frankly, contingent upon a lot of factors like rapid testing and the ability to do contact tracing. First– “Number one: any given state that’s considering relaxing social distancing should have a demonstrated downward trend in cases over the two weeks prior. And we need to get better at being able to evaluate trend data across the country. Ultimately it would be good to have more data that would allow decision makers to be able to look at neighboring states and make sure they’re congruent with others in the region.” Beyond this and a sustained reduction in cases, we need widespread availability of PPE for healthcare workers. An adequately supplied healthcare infrastructure is critical and we must support healthcare workers as they face an onslaught of cases across the U.S.

Biodefense and Pandemic Policy
With each week, we learn more about ignored messages, red flags, and exercises that shed light on the very real failures in pandemic preparedness/response we are living right now. From the disbanding of the NSC global health security team to the failures in following the 69-page pandemic playbook, there have been several missteps and delays in the administration’s response. “The playbook was designed ‘so there wasn’t piecemeal thinking when trying to fight the next public health battle,’ said one former official who contributed to the playbook, warning that ‘the fog of war’ can lead to gaps in strategies.” Pandemic preparedness is no easy task, but many are looking at previous presidential responses to biological threats as an indicator that what we’re seeing now isn’t ideal. Within the most recent International Affairs journal, there is a reading list regarding global health crises that shed light on behavior norms and response measures during such events. In this collection, you’ll see GMU Biodefense professor and graduate program director Gregory Koblentz’s review of the Obama administration’s strategy for countering biology threats. “This strategy represents a shift in thinking away from the George W. Bush administration’s focus on biodefence, which emphasized preparing for and responding to biological weapon attacks, to the concept of biosecurity, which includes measures to prevent, prepare for and respond to naturally occurring and man-made biological threats.” The current COVID-19 pandemic will be a pivotal moment in biodefense and biosecurity policy, hopefully guiding future efforts and investments into pandemic preparedness.

Student Spotlight: PREDICT-ing the Next Pandemic?
Michael Krug, a second-year student in the Biodefense MS program, November 2019 article highlights the critical need for comprehensive and quick biosurveillance tools to aid in pandemic preparedness. Last week, the decision was made to end USAID’s PREDICT project. PREDICT was established in 2009 to help develop wide-ranging detection capabilities; it was a component of the early-warning system. the project identified 1,200 viruses – including 160 novel coronaviruses – with the potential to induce a pandemic. Beyond identification, the project trained and supported staff across 60 foreign laboratories, such as the Wuhan Institute of Virology. Krug points out that the dissolution of PREDICT is an unfortunate reversal away from the US goal of slowing the emergence (or reemergence) of infectious diseases. This week, the LA Times reported on the termination of PREDICT, corroborating the echoed Krug’s sentiments and shared the announcement that the PREDICT program was just extended through September so that it can assist in the COVID-19 response.

Why Giving Americans Checks Makes Sense
In response to the March 22 column by Steven Pearlstein stating that providing funds to every American would be a bad idea, you can now read a rebuttal here. Included in this list of respondents is GMU Biodefense professor Sonia Ben Ouagrham-Gormley, who noted that “The plan to send money to every American may not be economically sound in normal circumstances, but it is an appropriate response to the economic hardships caused by this pandemic. And it could help curb the spread of the disease. True, many people will maintain their income, but what about the short-term burden people will face because of the pandemic? What about the employee who already lost her job and needs to care for her children? What about elderly people who have no one to rely on and who cannot stock up on food? These people need cash now to face the additional (temporary) economic burden caused by the epidemic. More important, they need it now to heed the Centers for Disease Control and Prevention’s guidelines: Stay home for a long enough period to break the transmission chain of the disease.”

Pandora Report: 4.3.2020

Not even a pandemic can stop your weekly dose of biodefense news. We’d like to take a moment to thank all who are working in COVID-19 response – from healthcare workers to those in lab, public health, and everyone working in essential services, thank you for all you do!

Summer Workshop on Pandemics, Bioterrorism, and Global Health Security 
Are you registered for the summer workshop yet? From July 13-16, 2020, GMU Biodefense will be hosting a three and a half-day workshop on all things global health security. Leaders in the field will be discussing hot topics like COVID-19, pandemic preparedness, vaccine development, medical countermeasures, synthetic biology, and healthcare response to COVID-19. This is also a great networking opportunity as past participants come from a range of government agencies, NGOs, universities, think tanks, and foreign countries. Don’t miss out on the early-bird discount for this immersive workshop – you can register here.

Updating the CWC: How We Got Here and What is Next
Make sure to check the April 2020 edition of Arms Control Today as GMU Biodefense Graduate Program Director (and CW/BW guru) Dr. Gregory Koblentz has a new article with Stefano Costanzi. Russia’s attempted assassination of Sergei Skripal in Salisbury, United Kingdom with a Novichok nerve agent in March 2018 triggered the first-ever update of the Chemical Weapons Convention (CWC). In November 2019, parties to the CWC agreed to add Novichok agents, as well as carbamate nerve agents, to the Schedule 1 list of chemicals subject to the treaty’s most stringent declaration and verification requirements. The article describes the process that led to the first ever modification to the treaty and offers some recommendations for strengthening the treaty’s coverage of these nerve agents. For more detailed technical information on Novichok agents and further background on the Schedule 1 revision process, please refer to our article, “Controlling Novichoks After Salisbury: Revising the Chemical Weapons Convention Schedules,” which was published in The Nonproliferation Review in September 2019.

An Infected Economy: Acute & Chronic Economic Considerations of COVID-19
GMU Biodefense doctoral student Rachel-Paige Casey is tackling the painful economic and financial aspects of COVID-19 in her commentary, An Infected Economy, which you can read here. “The commonly recited statement that COVID-19 knows no bounds is not confined to its effects on individual or population health; it is also the instigator of our current and growing economic woes. Prior to COVID-19, it was well-established that an outbreak of a reemerging or novel disease with high communicability would ravage the US economy, along with global economy. A combination of industry shut downs to reduce disease transmission and panic-induced risk averse behavior among consumers and producers turns a pandemic into a pestilence for the economic health of countries and their people. Just as the high probability of a pandemic was foreseen so to were the economic effects of such an event. As the Washington Post stated, COVID-19 is no black swan, nor is it an event for which we were not given warning shots.” Keep reading here.

ASPR TRACIE COVID-19 Resources 
ASPR has now released a Novel Coronavirus Resource Page which provides people with vetted resources to tackle the ongoing pandemic. Within the site, people can find planning resources, federal websites, technical assistance requests, ASPR TRACIE-developed resources, and more. This is a great resource for preparedness efforts and can help a wide range of people looking to enhance preparedness across multiple sectors. They also encourage sharing of info – “If you have any COVID-19 promising practices, plans, tools, or templates to share with your peers, please visit the ASPR TRACIE Information Exchange COVID-19 Information Sharing Page (registration required) and place your resources under the relevant topic area.”

A Frontline Guide for Local Decision-Makers
To help unwind the web of confusion and chaos, a COVID-19 Frontline Guide for Local Decision-Makers was drafted by experts from the Nuclear Threat Institute, the Center for Global Health Science and Security at Georgetown University, and Talus Analytics. The Guide outlines 7 key objectives for local decisionmakers:

  1. Activate Emergency Operations Center and establish a whole-of-community incident management structure
  2. Understand the real-time spread of COVID-19 in your community
  3. Slow and reduce transmission
  4. Focus protection on high-risk groups
  5. Reinforce and expand health system surge capacity to sustain healthcare operations and avoid high mortality
  6. Expand risk communication and community engagement
  7. Mitigate economic and social consequences

They also provide several questions regarding progress to track an area’s improvement in response measures. The contributors for the Guide encourage and welcome feedback. The Guide is available here.

Policy vs. Pandemics: Polarization and Public Health Emergency Preparedness
Did you miss the virtual event last week? Check out our YouTube channel here for the recording. Last week, Dr. Nathan Myers, author of Pandemics and Polarization: Implications of Partisan Budgeting for Responding to Public Health Emergencies, gave a virtual presentation at GMU. Dr. Myers’ book was written to be a wakeup call about the politicization of preparedness crippling our efforts to prepare for and respond to pandemics. The book focuses on surveillance, coordination, and countermeasures as key tools for pandemic preparedness and response. Dr. Myers’ book is available here in hardcover and Kindle formats.

Cautionary Results from the Dark Winter Simulation
In 2001, the now-called Center for Health Security at Johns Hopkins University and the Center for Strategic and International Studies designed and hosted a tabletop exercise, “Dark Winter.” Participants in the simulation included US officials and senior policymakers, and it was conducted to assess how senior leaders would respond to a biological weapons attack. The agent in Dark Winter is smallpox. The lessons drawn from the simulated pandemic foreshadowed the struggles we are currently facing with COVID-19. Participants questions and concerns from the exercise ran the gamut. How many Americans are infected? How many are exposed? Where are they located? What health resources are available to treat them? Should any health resources be voluntary or required? Should these resources be provided by local, statewide, or national entities? How should they be enforced? Who will staff pop-up clinics and hospitals? retired Air Force Col. Randall Larsen, one of the designers of the exercise, described as “uncannily accurate.” Exercises like Dark Winter are valuable tools that illuminate important gaps for when an event occurs in reality. Similar to Crimson Contagion, a USG-organized pandemic exercise held last year, which we covered here, these events are indicators for overall pandemic preparedness and response. Hopefully, these lessons will be better heeded as we continue to respond to COVID-19 and as we prepare for the next outbreak. The full article is available here.

BioD Student Spotlight: HyunJung Kim
HyunJung Kim, a BioD PhD student, was recently quoted in a Vox article about the resurgence of COVID-19 cases in Japan. Kim spoke to the importance of personal hygiene and social responsibility in disease prevention. He also pointed out his concerns regarding Japan’s border control approach. Japan limited the entry of foreigners from virus-infections regions; however, many loopholes exist to and foreigners are not the only risk factor for introducing the disease to a population. In South Korea, the majority of cases were introduced by its own citizens returning from trips abroad. The full article is available here.

COVID-19 PPE Challenges and Hard-hit Cities 
New York City is being hit hard by the COVID-19 pandemic with over 42,000 cases and 1,096 fatalities. There have been reports of patients lining the hallways, staff working tirelessly to take care of people, and many of the critically ill patients being of younger age. For many, this is an early warning of what’s to come and how we need to prepare for a surge of patients. In the past week, there has also been a renewed focus on community use of masks and conversations on “airborne” transmission. Ed Yong of The Atlantic recently discussed the controversy and how changing guidance left many confused. “A handful of studies have offered preliminary answers. One team of researchers blasted virus-laden fluids into a rotating cylinder to create a cloud of aerosols. They found that the virus remained stable for several hours within that cloud, raising fears about its ability to persist in ambient air. But as the researchers have noted, the study’s experimental setup was artificial. It doesn’t reflect ‘what’s occurring when you’re just walking down the street,’ says Saskia Popescu of George Mason University, who specializes in infection control and who was not involved in the study. ‘It’s more akin to medically invasive procedures like intubation, which run the risk of aerosolizing the virus, and are unique to the health-care setting.'” These questions have become even more prevalent as mask shortages continue to plague healthcare facilities. Many are reviewing decontamination and reuse efforts for respirators, which the CDC recently provided guidance and communication on. Unfortunately, masks are just the tip of the iceberg when it comes to supply chain issues across the U.S. – from ventilators to gowns, and even disinfecting wipes, things are increasingly becoming strained. These needs go beyond items though and it’s important that we also look to the workforce that supports not only healthcare and public health efforts, but also essential services.

Thoughts on Reopening America from a BioD Alumnus
Daniel M. Gerstein, a graduate of the Biodefense PhD program, is a senior policy researcher at the RAND corporation. This week, Dr. Gerstein and Dr. James Giordano from Georgetown University published an op-ed about the criticality of quick and reliable diagnostic testing in the COVID-19 pandemic. Most experts agree that a vaccine or effective antiviral for COVID-19 is unlikely to be developed for 12-18 months. This is quite a complication as we try to flatten the curve and return to normal life. The authors suggest focusing on diagnostics and grouping populations. Accurate and reliable testing is crucial to containing disease transmission and protecting especially susceptible sub-populations. Current tests take too long to yield a result; we need a real-time, point-of-care diagnostic tool that quickly provides doctors and patients with accurate results. In terms of categorization, they identify three groups: currently infected individuals, vulnerable individuals (such as the elderly), and individuals exposed to or infected with coronavirus and recovered. This grouping will help determine the possibility of reinfection, enable risk-based approaches, and better prioritize testing. Gerstein and Giordano’s full article is available here.

Acute & Chronic Economic Considerations of COVID-19

Rachel-Paige Casey

An Infected Economy

The commonly recited statement that COVID-19 knows no bounds is not confined to its effects on individual or population health; it is also the instigator of our current and growing economic woes. Prior to COVID-19, it was well-established that an outbreak of a reemerging or novel disease with high communicability would ravage the US economy, along with global economy. A combination of industry shut downs to reduce disease transmission and panic-induced risk averse behavior among consumers and producers turns a pandemic into a pestilence for the economic health of countries and their people. Just as the high probability of a pandemic was foreseen so to were the economic effects of such an event. As the Washington Post stated, COVID-19 is no black swan, nor is it an event for which we were not given warning shots.

Predictions

In September 2019, mere months before the arrival of the novel coronavirus in Wuhan, the Council of Economic Advisers published a report, which estimated the substantial health and economic losses the US would face as a result of pandemic influenza, another highly communicable virus. In 2018, the Worldwide Threat Assessment of the US Intelligence Community found that a “novel strain of a virulent microbe that is easily transmissible between humans continues to be a major threat,” and listed pathogens H5N1 and H7N9 influenza and MERS-CoV as potential culprits. Until bureaucracy-fueled abandonment in 2017, the Department of Homeland Security maintained annually updated models that estimated the infrastructural damage wrought by a pandemic. Beyond predictions, the 2019 Global Health Security Index forewarned the US, as well as the rest of the world, that pandemic preparedness is lacking. Continue reading “Acute & Chronic Economic Considerations of COVID-19”