Promising COVID-19 Therapeutics: From Remdesivir to Human Convalescent Plasma

By Stevie Kiesel, Biodefense PhD Student

The constant flood of headlines decrying the US response to COVID-19 paints a bleak picture. From muddled messages at many levels of government to failures at ramping up contact tracing, from the breakdown in procuring enough personal protective equipment to a cultural resistance to wearing face masks, the US is rightly coming under scrutiny for its efforts to recover from the human and economic toll of this pandemic. But among the barrage of bad news are promising stories that are often overlooked. To draw attention to two potential safe and effective therapies for COVID-19, the American Society for Microbiology held a virtual briefing titled “From Remdesivir to Human Convalescent Plasma: Understanding COVID-19 Therapeutic Development.” Dr. Mark Denison from Vanderbilt University Medical Center discussed his work on two antiviral therapeutics, while Dr. Arturo Casadevall of the Johns Hopkins School of Public Health reviewed his work on convalescent plasma therapies.

            Dr. Denison covered two antivirals that have so far shown promising results against COVID-19: remdesivir and EIDD-2801. Remdesivir was originally developed to treat Ebola Virus Disease (EVD), and while its effectiveness against EVD was limited, it did appear promising against coronavirus diseases such as SARS and MERS in animal studies. Both remdesivir and EIDD-2801 are nucleoside analogs that interfere with viral RNA synthesis. Viruses must enter a cell and replicate in order to survive. Once inside a cell, the virus will undergo translation and process proteins, replicate itself within the cell (what Dr. Denison calls “making virus factories”), copy the virus RNA genome, and then assemble and release the new virus to continue spreading throughout the host. These nucleoside analogs interrupt the process of copying the virus’ RNA genome.

            In addition to their mechanism of action, these antivirals have other important similarities. Both potentially inhibit multiple coronaviruses (more study is needed to confirm); both have been proven to prevent disease and lessen disease severity when used early (in animal models); and both have been declared safe for human use. However, remdesivir is given intravenously, while EIDD-2801 is an oral drug. Options for antivirals given in multiple administration routes is important because while remdesivir may be given intravenously to patients in more critical condition in the hospital, EIDD-2801 can be prescribed for treatment at home. Both antivirals are available for human trials; EIDD-2801 is currently undergoing clinical testing, while remdesivir has been approved and provided for use in certain areas. Obviously, supply will outpace demand for these types of treatments for some time.

            Dr. Casadevall then reviewed his work on the National COVID-19 Convalescent Plasma Project. Convalescent plasma is the liquid in the blood that holds blood cells; it can be obtained from donors through standard blood transfusion practices. Plasma from recovered patients contains antibodies that can neutralize a virus. For example, a recovered COVID-19 patient would donate their blood, and the virus-neutralizing antibodies found in their plasma would be extracted to make a therapy that can be used for prophylaxis (shortly after exposure to the coronavirus to prevent the virus taking hold) or therapeutically (to lessen the symptoms and/or duration of illness in a COVID-19 patient).

Convalescent plasma treatment has a long history of treating various diseases, such as the 1918 influenza epidemic, polio, mumps, measles, Argentine hemorrhagic fever, SARS, and MERS. We have learned that plasma can be an effective therapy for infectious diseases, particularly when administered early and in sufficient quantities for the particular agent being targeted. Dr. Casadevall believed early in the outbreak that convalescent plasma therapies had promise, and on March 1 he published an op-ed to bring attention to this possibility. Research into convalescent plasma therapies for COVID-19 soon picked up, and by March 27 the first US patients were treated with this therapy in Houston, Texas. Shortly after, the FDA expanded access to convalescent plasma treatment for COVID-19 patients, and by mid-April more than 1,000 medical centers offered this treatment option. Today, over 2,500 centers do so. China, Italy, Spain, and the United Kingdom have also seen success with convalescent plasma treatments. Italy, for example, has reported a 50% reduction in mortality in COVID-19 patients treated with convalescent plasma therapy when administered before admittance to an intensive care unit. Additional data from other countries will be made available in the coming weeks. Although the safety and efficacy of this treatment is not yet proven, Dr. Casadevall argues that there are positive signs: historical data, theoretical support based on antibody action, and early data during the pandemic.

Both Dr. Denison and Dr. Casadevall highlighted the likelihood that COVID-19 represents the new normal in emerging infectious diseases. Scientists have discovered a great number of coronaviruses in bats that could make the jump from bats to humans just as COVID-19 did. To combat this threat, research should be undertaken now to better understand zoonotic viruses and to develop antivirals that are broadly effective against coronaviruses. According to Dr. Denison, antiviral development should have several goals: a variety of routes of administration (oral, inhalation, and intravenous); a high barrier to resistance; safety; stability; scalability; and affordability. While COVID-19 has taught a great many lessons on how the US and countries around the world can improve their pandemic preparedness, this webinar highlighted the important research that must remain a priority not just at the height of the pandemic but as the world moves forward.

Viruses and Violence: How COVID-19 Has Impacted Extremism

By Stevie Kiesel, Biodefense PhD Student

It has become a cliché to point out the massive scale of change being wrought by COVID-19. From the toll in human lives to economic hardship to the impact on mental health, life has changed immensely since earlier this year. There are so many questions about how we recover and what changes are permanent. Even as COVID-19 looms as a threat to global health, other security issues cannot be overlooked. Therefore, I will examine how extremist groups understand and exploit the pandemic and how their operations have changed because of it. In April 2020, the Tony Blair Institute acknowledged that “extremist groups are beginning to recognize the scale of the COVID-19 pandemic, seeing opportunities to exploit fears, exacerbate tensions and mobilize supporters while government are occupied with trying to address COVID-19.” Extremists across the ideological spectrum have incorporated the pandemic into their messaging and their operations, though groups have differed on just what COVID-19 means and how to best exploit the pandemic and its resultant unrest.

Jihadist groups have primarily seen the pandemic as an opportunity to regain territory and expand their influence while governments are consumed with pandemic response and a rapidly deteriorating economic situation, according to European Union Counter-Terrorism Coordinator Gilles de Kerchove. However, there has been one incident of a jihadist plot to use the coronavirus as a biological weapon. Two men were arrested in Tunisia for encouraging men infected with COVID-19 to gain access to Tunisian security forces and cough, sneeze, or spit on them. One man admitted that he attempted to carry out this plan, but he was thwarted by security measures. There have also been isolated incidents of discussion about intentionally spreading coronavirus, either with live vectors or corpses, but overall COVID-19’s main operational impact on jihadist groups appears to be the opportunity it presents to strike at government forces while their resources are already stretched thin.

Far-right extremists (FREs) have “gone much further in directly exploiting the COVID-19 pandemic.” For example, FREs on social media have suggested that anyone who becomes infected with COVID-19 should attempt to spread the virus at synagogues, law enforcement offices and other government buildings, public transportation, retail stores, and neighborhoods with high minority populations. Suggested methods of spreading the virus include coughing, sneezing, and spitting on people or inanimate objects (like door handles and elevator buttons) and collecting bodily fluids in a spray bottle then spraying the fluids on frequently touched objects.

FREs have also viewed stay-at-home orders and other government-mandated pandemic prevention measures as unacceptable violations of their liberty. An inconsistent and oftentimes incoherent federal messaging strategy encouraged the proliferation of conspiracy theories of either the implementation of an authoritarian government regime or a coup orchestrated by the President’s political opponents, depending on who you ask. Indeed, some FREs have called the stay-at-home orders “medical martial law.” In this vein, Bradley Bunn was arrested by the FBI for possession of four pipe bombs while on his way to an armed protest against public health restrictions at the Colorado State Capitol. He later told investigators that he planned to use the bombs against anyone who tried to take his weapons.

Author compilation of popular coronavirus memes on FRE social media

Just as some messaging and recruitment tactics among jihadis and FREs share similarities, so, too, have these groups showed similar themes in their rhetoric and activities surrounding COVID-19. For example, both groups have espoused a great deal of antisemitism as it relates to the pandemic. The Pakistani Taliban and US far-right conspiracy theorists have both argued that COVID-19 was engineered by Jewish people as part of a plot to achieve world domination.

Another point of ideological consistency between these two groups lies in the philosophy of accelerationism. Broadly and as it applies to political extremism, accelerationist thinkers disavow non-violent political processes as a means to achieve change; the ends they seek often involve a dramatic reimagining of society, and incremental change will never accomplish these ends. For jihadis, this means tearing down existing governments and replacing them with a caliphate. Since March 2020, the Islamic State has increased its armed activities in areas where it believes governments are weak and encouraged recruits to “capitalize on the fear, ensuing chaos, and stress caused by COVID-19 by conducting attacks throughout afflicted and vulnerable populations in Europe and the United States.” Far-right accelerationists similarly believe that society must be fundamentally destroyed and replaced. The most popular accelerationist ideology among the far right posits that a genocidal race war will be waged, resulting in the creation of a white ethno-state. While some believe that this race war is inevitable and will come about on its own, others believe that they must spark the race war through violence.

Far-right accelerationist ideology inspired a March 2020 attack that was fortunately thwarted while the suspect was en route to his target. Timothy Wilson had been planning a vehicle-borne improvised explosive device (IED) attack before the pandemic; he had considered targets such as a nuclear plant, an Islamic Center, a synagogue, and Walmart headquarters. However, Wilson ultimately moved up the date for the planned attack and changed his target to a Missouri hospital center. According to an FBI joint intelligence bulletin, Wilson “cited the likely increased impact and media attention on the health sector during the coronavirus pandemic as a reason to accelerate the timing and selection of a healthcare facility.” The modern extreme right is characterized by a decentralized structure, with individuals often “operating alone but…tied together through virtual communities on the Internet.” Wilson had been active in a number of communities that espoused accelerationist and neo-Nazi ideologies; he had communicated with members of the now-defunct neo-Nazi group Atomwaffen Division and expressed sympathies for a similar group, The Base.

A final noteworthy similarity between jihadist and far-right groups is the impact the pandemic has had on their recruitment and radicalization strategies. As more people are stuck inside, socially isolated, and many experiencing economic hardships, both types of groups have increased their online presence and tailored their materials toward this new reality. These groups often have their own culture and inside references. For example, FREs began calling the corona-virus “corona-chan,” referencing it reverentially for its potential to sow chaos. Between February and March 2020, the term was used over 13,000 times on 4chan and saw a 375% increase in interactions on Reddit and a 1,920% increase in interactions on Facebook. Before the pandemic, “corona-chan” was not a term with any other meaning. This means that increased interactions occurred because people were engaging with far-right social media.

Unfortunately, just as indicators show that engagement with extremist communities online is on the rise, counter-extremism programs are reporting less engagement. A United Kingdom counter-radicalization program called Prevent has reported that referrals to the program have fallen by about 50%. Even as more people are at home, online, and isolated, fewer people are reaching out for help to escape the radicalizing influence of extremist groups from across the ideological spectrum.

Violent Non-State Actors and COVID-19: Challenge or Opportunity?

By Stevie Kiesel, Biodefense PhD Student

While government bureaucracies are lumbering through their response to the COVID-19 pandemic, how are non-state criminal and terrorist organizations’ operations being impacted? Have lockdowns and physical distancing guidelines hindered their ability to recruit, radicalize, and plan and conduct operations, or are these historically flexible and adaptable organizations taking advantage of pandemic conditions? A May 26 Wilson Center event, “Violent Non-State Actors and COVID-19: Challenge or Opportunity?” shed some light on this question.

On the first panel, three experts discussed how transnational criminal organizations have adapted to current conditions. Dr. Duncan Wood, the Director of the Wilson Center’s Mexico Institute, described how cartels have responded to border shutdowns and supply chain issues. Partial border closures and increased police presence to enforce physical distancing orders have made it more difficult to (1) obtain necessary precursor chemicals for drugs like methamphetamine and (2) move drugs north and money south. Despite these disruptions, cartels have been flexible, shifting their transportation method and the drugs they are selling. Now, more shipments are arriving in the U.S. by sea, and fentanyl is becoming even more widely available in the U.S. because supply chain issues reduced the availability of heroin and methamphetamines but not fentanyl.

Eric Olson, a global fellow at the Wilson Center, highlighted an important trend that cartels as well as terrorist groups engage in whenever a state is weakened. In the absence of a state providing social services and security, violent non-state actors (VNSAs) have often stepped in to exploit that void. VNSAs as diverse as Hezbollah, Japanese organized crime network yakuza, Peruvian terrorist group Sendero Luminoso (Shining Path), and the Sinaloa cartel have throughout history provided resources to local communities in an effort to win hearts and minds and increase their influence in a territory. During the pandemic, VNSAs are poised to step in and provide resources and security if the state fails to do so. A botched pandemic response can also erode the legitimacy of the state, creating a vacuum that VNSAs could fill.

George Mason University’s Dr. Louise Shelley predicted that transnational criminal organizations will readily adapt to changes caused by the pandemic. Several characteristics of organized crime will facilitate this adaptation. Organized crime is generally a cash-heavy endeavor, which can be a huge advantage during a crisis. People and small businesses are suffering, and governments’ responses may not be adequate to help people keep their jobs and help small businesses stay afloat during lockdowns. Related to Eric Olson’s point about VNSAs filling vacuums left by state responses to the pandemic, Dr. Shelley argued that criminal organizations, rich in cash, could step in and provide relief to communities. This brings people and businesses under the thumb of the criminal organization, with effects that may not be felt immediately but that represent a fundamental shift of power to criminal organizations.

Dr. Shelley also noted that as transnational criminal organizations are cut off from their traditional supply chains, they will move to the cyber realm, and countries are not prepared to meet this threat. We have already seen a significant rise in child exploitation online as more traditional methods of human trafficking are impacted by lockdowns. The pandemic will also provide new criminal opportunities that can be facilitated online. For example, illicit medical supplies and pharmaceuticals that are newly in demand can easily be sold online, as long as supply chains remain intact. Additionally, there has been a rise in identity theft and other fraudulent activities aimed at stealing state resources intended to provide pandemic relief. The Washington state unemployment fund in particular has experienced a massive problem with identity theft, wherein identities of Washington state residents have been stolen and sold on the dark web. Criminals purchase these identities and use them to file for relief funds. Dr. Shelley argued that the U.S. remains vulnerable to cybercrime because of the decentralized nature of the government and a lack of coordination among relevant agencies.

During the second panel, Deputy Director of the Wilson Center’s Asia Program Michael Kugelman and Wilson Center Middle East Fellow Dr. Marina Ottaway discussed how VNSAs in the Middle East have been impacted by COVID-19. Michael Kugelman continued the conversation about non-state actors providing support to local communities in the absence of a strong state by discussing the Taliban’s activities during COVID-19. The pandemic, he argued, poses a small challenge to the Taliban but offers a larger opportunity to expand their reach. The challenge is that COVID-19 could potentially take out a large number of Taliban fighters, who live in close quarters and who train heavily together in the spring. However, Mr. Kugelman believes this is a minor challenge because of the Taliban’s strong position at the moment: the Taliban controls a sizeable amount of territory, and the U.S. is winding down operations in the region. More likely is that the Taliban uses COVID-19 as an opportunity to win local hearts and minds as the Afghanistan government fumbles its pandemic response. Indeed, the Taliban’s recent public messaging has focused on providing information about the pandemic and assurances that local citizens will be cared for and health care workers will be given access to all Taliban-controlled areas. The Special Inspector General for Afghanistan Reconstruction released a report at the end of April warning that a combination of poor healthcare infrastructure, malnutrition, and ongoing conflicts could lead to a health disaster. If this comes to pass, it will provide an opportunity for the Taliban to provide services and undermine the Afghan government.

Finally, Dr. Ottaway described how the Islamic State believes that because governments are distracted by COVID-19 and afraid of committing troops, now is an opportune time to increase the pace and severity of attacks. This rhetoric has been borne out by escalating attacks in Syria and Iraq since COVID-19 was declared a pandemic, with a 69% increase in ISIS’s armed activities in April 2020. The full impact of COVID-19 may not be known for years after the pandemic ends, but one important space to watch is how groups accustomed to rapidly changing conditions adapt and respond. Where do they see opportunities, and how can governments respond to this new environment?

If you missed this webinar, you can view the recording here.

The Future Bioweapons Threat: Lessons from the COVID-19 Pandemic

By Yong-Bee Lim, Biodefense PhD Candidate

Introduction

On May 28th, the Council on Strategic Risks hosted a timely webinar to discuss The Future Bioweapons Threat: Lessons from the COVID-19 Pandemic. This webinar brought together a diverse panel of experts areas from weapons of mass destruction (WMD), film and media, biotechnology and data science, and public heath to discuss how the pandemic highlights existing gaps in addressing natural and potentially man-made biological threats; and understanding the obstacles and potential solutions to address future man-made and natural biological threats.

The panelists included the Honorable Andrew C. “Andy” Weber, Senior Fellow at the Council on Strategic Risks and the former Assistant Secretary of Defense for Nuclear, Chemical, and Biological Defense Programs at the Pentagon; Max Brooks, the author of World War Z and Devolution, as well as a Nonresident Fellow at The Modern War Institute and the Atlantic Council; Dr. Alexander Titus, Chief Strategy Officer at the Advanced Regenerative Manufacturing Institute (ARMI) and Senior Fellow at the Council on Strategic Risks; and George Mason’s very-own Dr. Saskia Popescu, Senior Infection Preventionist and Epidemiologist at HonorHealth and Adjunct Professor at Mel and Enid Zuckerman College of Public Health at the University of Arizona.

The event was moderated by Dr. Natasha E. Bajema, Founder and CEO of Nuclear Spin Cycle Publishing and Senior Fellow at the Council on Strategic Risks; and Christine Parthemore, CEO of the Council on Strategic Risks.

Gaps in Biopreparedness and Biodefense

One main area the panelists and moderators focused on was understanding how the failures to detect, mitigate, and respond to COVID-19 may make a future biological weapon attack more likely. Mr. Weber warned how easily COVID-19 has spread through naval ships and other branches of the armed services, which enhances the allure of weaponizing biology to undermine operational readiness. Mr. Weber also argued that the cheapness and ease of developing biological weapons make them even more alluring in the modern day. These incentives, in turn, weaken deterrence against the use of offensive biological weapons.

Mr. Brooks echoed Mr. Weber’s thought and added how the superiority of U.S. conventional forces drives adversaries to find indirect ways to engage in conflict. Mr. Brooks noted that the ease of development and use of biological weapons makes it potentially attractive to use in a variety of situations – from deploying weapons at ports to shut down trade to even targeting American citizens to erode morale in the military.

Dr. Popescu expanded the conversation to include how the pandemic shed light on gaps in public health and its ability to detect, respond to, and recover from a large-scale bio-event. She highlighted how public health is expected to achieve the ideal (such as having testing every individual) in a reality where there are only a finite number of tests available, and a finite number of facilities and individuals to administer them. Dr. Popescu added preparedness is a difficult sell to senior hospital administrators since it requires private companies like hospitals to permanently assume additional overhead.

Dr. Titus discussed how the perception of technology as an end in and of itself, rather than a means to enhancing an organization’s mission, has slowed the adoption of emerging technologies like synthetic biology and big data science. These delays have significantly cost the U.S. in its ability to deter, detect, mitigate, respond to, and recover from biological events. Dr. Titus presented how the relationship between biotechnology development and application is not a one-to-one relationship: a biotech development that allows a more efficient way to produce molecules of interest in yeast cells does not mean that technology has to be limited to a single molecule of interest. Rather, he viewed investment and development in biotechnology as an opportunity to mitigate infinite threats with infinite capabilities.

Obstacles and Solutions to Future Biothreats

One major obstacle all the panelists discussed was the issue of sustained efforts and funding. All the panelists pointed out how money is thrown at an issue in any crisis setting. This includes biological events like Amerithrax in 2001 and the Ebola outbreak from 2014 – 2016. However, biodefense suffers significantly once the crisis passes and the funding streams dry up. Therefore, panelists argued that funding alone was insufficient to meet the biothreats challenges of the future – current and future Administrations need to consider biothreats a priority, with stable funding streams to match.

Mr. Weber highlighted his personal experiences as the former Assistant Secretary of Defense for Nuclear, Chemical, and Biological Defense Programs during the Obama administration to display the bureaucratic and administrative complexities of addressing biothreats both domestically and internationally. He particularly emphasized a need to increase interagency communications and cooperation within the Department of Defense as well as other agencies to implement an all-hands approach to deal with future biological events.

Mr. Brooks saw a growing gap between citizens and policymakers as a major obstacle. Compared to the American citizens in the past, he viewed current citizens as disengaged from serious issues like biothreats and that this disengagement was encouraged, whether deliberately or not, by U.S. leadership. Mr. Brooks thought it was essential to bridge this gap, increase biodefense education, and cultivate buy-in from citizens if policymakers want to take concrete steps towards a safer world. He drew from his vast experience in helping shape the social consciousness to suggest making biodefense topics more tangible and impactful to the average citizen through fiction books, television shows, and movies, and recruiting influential celebrities as spokespeople for biodefense causes.

Dr. Popescu expressed concerns about communicating accurate information to the general public and a need to make this information that captures the general public’s attention. She also warned of potentially unscrupulous salesmen and armchair experts – individuals and companies that may exploit COVID-19 misinformation to sell “snake-oil” products ranging from sensationalist information to harmful cures, remedies, and cleaning agents to citizens. Finally, she strongly emphasized the need to discuss topics ranging from safer practices to operating in an ever-changing, uncertainty-filled environment as states begin to re-open after months of having citizens shelter in place.

Dr. Titus, along with other members of the panel, highlighted how inadvertent and deliberate misinformation is a major obstacle to getting buy-in and creating a plan of action to address biothreats. He, much in line with Dr. Popescu, noted that science communication alone is not sufficient to deal with misinformation campaigns on platforms like Twitter and Facebook. He asserted that disinformation spreads because it provides pay-offs to the recipient that factual information delivered in a dry, technical manner fails to deliver on. Compared to journal papers and books that experts often operate in, Dr. Titus noted that as little as 280 characters (2 tweets) is sufficient to sow doubt. Dr. Titus advocated for experts to find new ways to communicate with the public – new ways that do not require expertise to understand what experts are communicating.

Conclusion & Consensus

What is clear is the U.S. has a long way to go in addressing biological threats from natural and man-made sources. Further, the U.S. needs to adapt to new realities – a time where citizens’ trust of government is significantly lower, where citizens actively protest experts and their recommendations, and where misinformation is one tap on a smartphone away. And while the solutions are difficult to implement, the panelists and moderators of this timely webinar all believe that the end goal is worth it: a potential world where biological threats are a relic of history, as opposed to the unavoidable fate of humanity’s future.

Public Policy in the Pandemic Age: How COVID-19 Is Reshaping Our Government, Economy, and Society

By Stevie Kiesel, Biodefense PhD Student

On May 20th, the George Mason University Schar School of Policy and Government hosted a webinar to discuss Public Policy in the Pandemic Age: How COVID-19 is Reshaping Our Government, Economy, and Society. Moderated by Biodefense Program Director Dr. Gregory Koblentz, this panel brought together experts in economics, presidential leadership, emergency management, and disease transmission to discuss public health response strategies; the economic impact of lockdowns and physical distancing; polarization; the role of state and local governments; and potential longer-term implications of COVID-19. Panelists included GMU Professor of Public Policy Dr. Maurice Kugler, GMU Associate Professor Dr. Jeremy Meyer, GMU Director for Extramural Projects Dr. Tonya Neaves, and Aerospace Physiologist Dr. Nereyda Sevilla.

Panelists described a variety of failures in the U.S. response to COVID-19, from the late implementation of physical distancing measures to insufficient testing capacity to inconsistent messaging and a lack of a coordinated strategy at the federal level. Dr. Mayer presented data on the number of tests being conducted per million people in a variety of countries; he found that low levels of testing in the U.S. blinded policymakers and scientists to the scope of the outbreak. Testing delays combined with uncoordinated federal messaging and a lack of a coherent national strategy set the U.S. on a path to failure that would see cases skyrocket at a rapid pace.

Dr. Kruger highlighted the economic challenges and dangers associated with lockdown policies that many countries put in place because they failed to enact physical distancing measures earlier in the outbreak. Lockdowns were meant to be used as a tool to flatten the curve, prevent a catastrophic surge of patients stressing hospital systems, and give the U.S. time to ramp up testing capacity. As many parts of the country prepare to lift lockdowns, the danger that the government did not adequately prepare during this time is high. As we saw recently in Wuhan, China when they emerged from lockdown, additional cases must be met with a massive testing capacity to contain a second wave. Dr. Kugler spoke favorably of the strategies implemented by South Korea, Germany, and Switzerland that involve massive testing and targeted care and isolation. While such a strategy has fewer drawbacks, particularly economic drawbacks, than lockdowns, Dr. Kugler believes that the U.S. does not have the resources, personnel, technology, and strategic vision to successfully implement a similar course of action.

Dr. Mayer makes the interesting point that, generally, in moments of national crisis, polarization is (at least briefly) reduced and the president enjoys a significant boost in his approval rating. Yet with COVID-19, Trump has had a noticeably smaller “crisis approval surge” than other presidents. Trump himself is likely partially to blame for this effect, because he has used the pandemic as a wedge to achieve political goals. His rhetoric has generally not invoked national unity, but has stoked opposition to his rivals. Dr. Mayer argues that polarization makes us more vulnerable and less able to recover quickly from a crisis. A point Dr. Kugler made seems to reinforce this idea—lockdown measures take a much greater toll on low-income Americans who are out of work and who have very few options to fall back on. How many of you reading this are teleworking? This “digital divide” is furthering the very economic inequality that has historically increased Americans’ susceptibility to polarizing messages.

As bleak a picture of our current situation as this may have painted, the panelists suggested steps the U.S. can take starting today to improve the response. For example, Dr. Kugler describes a testing strategy that would allow physical distancing measures to be relaxed. This strategy involves testing 23 million Americans every day, so that every American is tested on a roughly biweekly basis. While there are many questions about whether the U.S. can ramp up capacity and coordinate this level of testing, Dr. Kugler identifies five key criteria that will make such a policy successful: harnessing a wide range of laboratories’ capabilities, making data open source so that the private sector can fully mobilize, implementing robust oversight capabilities, establishing clear and effective lines of communication, and developing a strategy that defines a clear, simple, and achievable target.

Testing is just one part of the strategy the U.S. needs. Dr. Neaves highlighted the importance of state and local governments to this pandemic response; these leaders have stepped in to fill a vacuum left by the absence of national strategy and coordination. Dr. Neaves praised the regional partnerships that states have developed, and she argued that state governors should write an after-action report describing their successes and challenges, as well as those of the federal government’s. Such a report developed by a bipartisan group of governors will be key for improving pandemic response in the future and rebuilding the social capital and trust that the U.S. response to COVID-19 has eroded.

Finally, Dr. Sevilla made an important point about how the lessons we learned and the precautions we put in place because of COVID-19 could benefit the U.S. in unanticipated ways. For example, physical distancing measures, increased use of masks, reduced crowding, and increased handwashing could reduce the transmission of common pathogens, such as the flu virus. This prediction emphasizes the wide range of benefits that can be realized by prioritizing public health. Whether the U.S. next faces a natural or intentionally released outbreak from an emerging or well-known pathogen, broad-based improvements in public health infrastructure can bring benefits. The U.S. should prioritize improving laboratory capacity; bolstering state and local capabilities; helping medical systems prepare for a sudden surge in patients; and training in disease recognition the doctors and nurses who will be on the frontlines of the next outbreak.

Heroes are Human Too: The Toll of COVID-19 on the Mental Health of Healthcare Workers

By Madeline Roty

Since 1949, May has been Mental Health Month. This May, as the COVID-19 pandemic continues, mental health has become especially relevant and demands increased awareness and action. On April 26th, Dr. Lorna Breen, an emergency room physician working on the frontlines in New York City, died by suicide. Her death drew attention to the toll the pandemic places on the mental health of healthcare workers. The United Nations recently published a policy briefin which they advocated for action to protect mental health and acknowledged healthcare workers as a vulnerable population. Though information is still emerging about the impact of COVID-19, initial data indicate that almost half of healthcare workers are experiencing negative mental health effects related to the COVID-19 pandemic. Recognizing that virus outbreaks contribute to increased psychological distress and burnout in healthcare workers, Kisely et. al. conducted a rapid review and meta-analysis of 59 papers from previous epidemics, including SARS, MERS, Ebola, and Influenza Type A, as well as COVID-19. This rapid review identifies predisposing factors, protective factors, and helpful strategies to prevent and manage psychological distress in all healthcare professionals in any clinical setting. The findings of this study and its implications, limitations, and importance are discussed and used to make recommendations to better protect healthcare workers. Continue reading “Heroes are Human Too: The Toll of COVID-19 on the Mental Health of Healthcare Workers”

COVID-19 Reopening and Recovery: Proposed Plans for the US

By Rachel-Paige Casey

Throughout April, strategies regarding the reopening of the US economy and its associated public health factors were published by the White House with the Centers for Disease Control and Prevention (CDC), the Center for Health Security at Johns Hopkins University, the Rockefeller Foundation, and the Edmond J Safra Center for Ethics at Harvard University. The four strategies discussed here either outline phases for resuming activity or describe systems to enable and assist safe reopening. All these plans consider the importance of testing to continue slowing the spread of COVID-19 as normal life gradually resumes. Other nations, such as South Korea, have successfully built high-capacity testing and tracing infrastructures in the wake of COVID-19. Unfortunately, the US has failed to develop its own robust testing and tracing system. At present, US testing capacity has plateaued at about 150,000 tests per day, equating to a little over 1 million tests per week, a figure deemed insufficient by experts in public health and medicine. Continue reading “COVID-19 Reopening and Recovery: Proposed Plans for the US”

Groundhog Day 2020

Jomana F. Musmar, MS, PhD, Public Health Advisor in the Office of Infectious Diseases and HIV/AIDS Policy within the Office of the Assistant Secretary for Health, U.S. Department of Health and Human Services.

Disclaimer: This narrative does not represent the views of the U.S. Department of Human Health Services. They only represent Jomana Musmar’s personal perspectives and experiences.

Daniel Tiger sings about handwashing in the background while tiny hands covered in peanut butter attempt to give mommy a new hairstyle, all while I’m taking a 1-hour conference call and typing out action items to work on the following day. This is our new normal, multitasking at its finest. When chatter about a novel coronavirus in Wuhan first began in late 2019, the numbers didn’t make sense and my biodefense training immediately triggered the notion that any day now, it’s going to be in our backyard. We’ve learned about preparedness and resilience from SARS, H1N1, Amerithrax, and the tragedies of 9/11, but the transmissibility, high rate of infection, and unpredictable mortality rate for this particular pathogen make it scarier than these past experiences. While my training and expertise prepared me for the tsunami of response activities nationwide, I wasn’t prepared for the impact it would have on our daily lives, especially on my family. My husband, an ER physician who has been on the front-lines seeing COVID-19 patients in 18-hour shifts, my 81-year old mother who is in the highest risk category for COVID-19 and my fun-loving, 24-hour it’s-circus-time kids, all need my attention and all the time. We are the definition of a full-on frontline responder, high-risk of infection-type home. My mother needs frequent grocery deliveries to circumvent her urge to drive out and do her own shopping. Because of the possibility that my husband might bring home an unwanted biological ‘guest,’ my fear that one of us might get infected but be asymptomatic until the dreaded symptoms emerge keeps me up every night. Did my daughters just cough? Was it wet or dry? Is that a fever? Is my throat dry or is it allergies? Can I drop off my mother’s groceries or should I wipe down every single item I touched? The questions are endless. The juggle to sustain a daily ‘norm’ for all of us while realizing the reality of where we are and what’s to come has been a struggle, but we’re figuring it out day by day.  Continue reading “Groundhog Day 2020”

A Day in the Life of a Molecular Biologist

By Travis Swaggard

I am a Senior Biologist working for a Repository in Manassas VA that stores and handles various microorganisms, media products, and cell lines. We also grow and culture viruses, that now include SARS-CoV-2, to develop products that can be sold to clinical laboratories, academia, and pharmaceutical companies for biomedical research and diagnostic testing.  My work since COVID-19 became a pandemic and a serious threat to global health has focused almost entirely on testing different regions of the SARS-CoV-2 genome from synthetically derived sections of the virus. This is done using the same technique used to screen clinical samples in hospitals and laboratories, known colloquially in our field as qPCR, or quantitative polymerase chain reaction. This is the same methodology used in the testing kits provided by the CDC. Most undergraduate molecular biology students (and, perhaps even high schoolers specializing in AP biology coursework) should understand this technique fairly well: using the same principles of traditional PCR, a region of DNA (or RNA, in the case of SARS-CoV-2) is targeted using specialized primers that complement the RNA sequence. From there, under specific temperatures, a polymerase enzyme will add nucleotides using the primers as a guide. A special molecular probe is also included that will emit fluorescence, but only when the enzyme has completed polymerization of the target region of RNA. Continue reading “A Day in the Life of a Molecular Biologist”

Research Labs Aren’t Ready for Social Distancing

By Current Biodefense Graduate Student (wishing to stay anonymous)

As the scientific community ramps up for more intensive research efforts in the field of COVID-19 vaccine research, the larger question of how to conduct laboratory research under social distancing conditions remains unaddressed. For example, the National Institute for Allergy and Infectious Disease has announced their strategic plans for COVID-19 research, which are heavily dependent on benchwork and animal studies.   And both basic research fields and industry are now subject to unprecedented pressure to compress established timelines for development of new medical countermeasures.  These timelines have traditionally been held as necessary for vigorous demonstration of efficacy and safety of new drugs and vaccines before licensure for use in human populations. Continue reading “Research Labs Aren’t Ready for Social Distancing”