Commentary – Countering New Threats to the Homeland: The Future of the Department of Homeland Security

By DeeDee Bowers, Biodefense MS Student

Since its creation in November of 2002 prompted by the September 11, 2001 terrorist attacks, the Department of Homeland Security (DHS) has been an all-encompassing entity for protecting America from threats to national security. After almost two decades, the national security landscape has changed, and the role of DHS has been challenged and must evolve. As Charles Darwin once stated, survival of the fittest does not refer to the ones that are the strongest or smartest but rather the ones most adaptable to change. If DHS is going to continue to thrive, regardless of the presidential administration in place, it must adapt from the landscape it was born into to the current unpredictable times of 2020 and beyond.

Black swan events, or unpredictable events, require a new perspective and imagination within DHS in order for it to better handle the responsibilities of protecting the American people. During the Gulf War, the American Military displayed a strong force to deter our enemies from confronting America on the modern battlefield. Non-state actors instead chose to take alternative actions to inflict damage on America using commercial airliners and the US Postal Service.  Since the early 2000s, threats to America now encompass the “homeland security enterprise.” The homeland security enterprise is a partnership between state, local, tribal, and territorial (SLTT) governments, private sectors, the public, and the federal government. The homeland security enterprise now has the enormous undertaking of assuring security of the homeland from events such as terrorist attacks through nonmilitary means, natural disasters, immigration concerns, cybersecurity threats, election security, and pandemics such as COVID-19. All of this must be done in a tactful way to instill confidence in the American people that DHS can indeed adapt to the threats of the time while in a highly politicized environment and remain apolitical.

Former Secretaries of DHS Michael Chertoff, Jeh Johnson, and Janet Napolitano spoke during the Atlantic Council’s webinar to share their thoughts on how the DHS will or should evolve. All agreed that a more stable appointment by the presidential administration would be necessary for quality DHS operation and response. In addition, Secretary Jeh Johnson, suggested an apolitical administration to remind Americans of all of DHS’s goals and a change in policy direction would be necessary to include more threats. Experts such as Thomas Fanning, and Amy Rall suggested these threats include biological as illustrated by COVID-19, physical assaults on critical infrastructure, and cybersecurity concerns such as ransomware. Fanning also stressed that vulnerabilities due to ignorance may gain clarity through the homeland security enterprise, where the less restricted private sector works in close collaboration with DHS to convey joint security. In addition, Fanning, recommended a national campaign to inform and teach the public about how to protect themselves from threats they may not be aware of. In the beginning of the webinar, Max Brooks, described how the strength of the American society and governmental departments such as DHS come from the American people whom are presently fractured. To overcome this, Brooks suggested “new ideas [to combat future threats] are useless without the courage to champion them and a society to support these champions.”

Pandora Report: 8.14.2020

Commentary – COVID-19 Data and Modeling: Applications and Limitations

Biodefense PhD student Stevie Kiesel discusses the importance of well-represented statistics and the danger of misrepresented statistics in COVID-19. Kiesel also provides her insights on the recently published Government Accountability Office (GAO) report, COVID-19 Data Quality and Considerations for Modeling and Analysis. Read Kiesel’s commentary here.

Beirut Explosions

On 4 August 2020, two explosions involving over 2,700 tons ammonium nitrate occurred in Beirut, Lebanon, a tragedy that has killed over 200 people and impacted several thousand more. Ammonium nitrate is chemical compound that is often used as a component in explosive formulas for mining, quarrying, and civil destruction. The chemical had been in storage for the last 6 years in a warehouse that likely combusted after a nearby fire reached it. The blast is one of the largest industrial accidents involving the explosive compound. The disaster is exacerbated by the lack of available medical care for those injured, either due to hospitals near the blast site that suffered damage or medical facilities already stretched thin under the demands of COVID-19. Additionally, the port in Beirut and the country’s primary grain silo were destroyed, so the entire nation will face economic consequences from the explosions. Lebanon now faces a several concurrent crises impacting their public health, economy, and political stability.

US Seizes Fake Website, Cryptocurrency Assets from Terrorist Groups

The US seized of millions of dollars in cryptocurrency assets is the largest ever of terrorist organizations’ cryptocurrency accounts. The seizure also included fake websites, such as FaceMaskCenter.com, that claimed to sell protective equipment like fake N95 masks and 4 Facebook pages. This was part of an interagency operation targeting the financial foundations of 3 terrorist networks: al Qaeda and the al-Qassam Brigades, Hamas’s military wing, and the Islamic State in Iraq and the Levant. The entities involved in the operation include the US attorney’s office in Washington, the Federal Bureau of Investigation (FBI), the Internal Revenue Service (IRS), and the Department of Homeland Security (DHS). The case could help justify a desire by the US Department of Treasury to tighten regulations on the cryptocurrency sector.

COVID-19–Related Infodemic and Its Impact on Public Health: A Global Social Media Analysis

A new study published in The American Journal of Tropical Medicine and Hygiene analyzes the infodemic of COVID-19 information. An infodemic is “an overabundance of information—some accurate and some not—that makes it hard for people to find trustworthy sources and reliable guidance when they need it.” An infodemic is comprised of rumors, stigmas, and conspiracy theories and monitoring social media data is the best method for tracking these inaccuracies in real time in order to help “dispel misinformation and reduce stigma.” Islam et al. extracted COVID-19–related misinformation shared on online platforms – fact-checking agency websites, Facebook, Twitter, and online newspapers – and assessed their impacts on public health. The researchers identified 2,311 reports of rumors, stigma, and conspiracy theories in 25 languages from 87 countries. Claims covered illness, transmission and mortality (24%), control measures (21%), treatments (19%), as well as causes of disease including the origin (15%), violence (1%), and miscellaneous (20%). Eighty-two percent of the analyzed claims were false. These findings are quite concerning because of the potentially serious health implications of misinformation fueled by rumors, stigma, and conspiracy theories.

The COVID-19 Global Response Index

Foreign Policy Analytics released its COVID-19 Global Response Index, which provides an assessment of government responses to the pandemic for 36 countries. This is the first effort to “to track national leaders’ responses in critical policy areas, including public health directives, financial responses, and fact-based public communications.” Additionally, the Index tracks policy response on an ongoing basis. The Index and country profiles are based on data tracked from 31 December 2019 through 1 August 2020. The composite score of the Index contains major policy choices and actions and it reflects government decisions and actions to contain the spread of the virus and to provide financial support during the financial shock. This project was developed with expertise from social scientists, public health experts, and top epidemiologists working at the forefront of the pandemic response.

Virtual Workshop: Airborne Transmission of SARS-CoV-2

The National Academies of Science, Engineering, and Medicine (NASEM) is offering a virtual workshop about the airborne transmission of SARS-CoV-2 on 26-27 August 2020. This workshop is from the Environmental Health Matters Initiative and will delve into the rapidly evolving science on the transmission of the virus that causes COVID-19.” The event will serve as an opportunity for interdisciplinary discussion, explanations about the basic foundational science, and clarification of terminology used differently among the relevant fields, all in relation to the state of the science on SARS-CoV-2 transmission. Register here.

Tracking Lost Healthcare Workers in COVID-19

Among the gaps in the COVID-19 information is the lack of limited availability of data regarding frontline healthcare workers and their risk of contracting the novel virus. A new article in The Lancet by Nguyen et al. assessed the risk of COVID-19 among front-line healthcare workers compared to the general public and estimated the effect of personal protective equipment (PPE) on risk. The authors conducted a prospective, observational cohort study in the United Kingdom and the United States of the general community and frontline healthcare workers using self-reported data from the COVID Symptom Study smartphone application from late March to late April 2020. They found that compared with the general population, frontline healthcare workers in the UK and the US were at higher risk for reporting a positive COVID-19 test. In the US, a joint database, Lost on the Frontline, created by The Guardian and Kaiser Health News has catalogued over 900 healthcare workers who have perished from COVID-19. The Lost on the Frontline database was created to count, verify, and memorialize every US healthcare worker – doctor, nurse, paramedic, hospital custodian, administrator, support staff – who dies during the pandemic. At present, the project has added the profiles of 167 workers to the database. The database also tracks the disparities among lost frontline workers. For instance, among those 167 profiles, the majority were people of color and nearly one-third were reported to have had inadequate PPE. Anesthesiologist Claire Rezba started tracking lost healthcare workers by tracking news reports and recent obituaries. Rezba posts memorials on her COVID-19 Physicians Memorial and, similar to the Lost on the Frontlines database, has posted 900 names of US healthcare workers who died from COVID-19. To stop the growing count of healthcare worker deaths to COVID-19, healthcare systems must ensure adequate availability of PPE and develop improved strategies to protect healthcare workers from COVID-19.

NACCHO Releases Comprehensive Survey of US Local Health Department Funding, Programs, and Partnerships

The National Association of County and City Health Officials (NACCHO), an organization that represents the country’s 3,000 local health departments, released its 2019 National Profile of Local Health Departments report. The report is drafted every three years as a census of local health departments regarding the “state of local health department funding, workforce programs, and partnerships, as well as how these factors have changed over time.” The latest profile includes the impacts of COVID-19 on local health departments. The key findings include: (1) workforce capacity is down, (2) resources are limited, and (3) services have been impacted by the demands of the pandemic. Read the full report here.

The Era of DNA Database Hacks is Here

Last month, GEDMatch, an online DNA database that generates DNA profiles for genetic testing services, was breached. The hackers seemed to have gotten their hands on user emails, to which they sent out phishing emails in order to steal the passwords of recipients. The motivation of the hack is not yet clear; the culprits may have been targeting passwords, emails, or credit card information, or they have been seeking access to genealogical data or genetic information. Of course, this attack has likely compromised users’ trust of in the database, a valuable law enforcement tool for solving cold cases, such as the Golden State Killer case. Even if these hackers were not specifically after genetic data, the incident highlights the risk of insufficient privacy protection and security of such sensitive information. Genetic data is “valuable if you know how to use it,” according to genealogist and genetic privacy advocate Dr. Leah Larkin. In the online world of today, companies who maintain databases containing sensitive information should improve their cybersecurity to better protect their customers.

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.

Pandora Report: 3.27.2020

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

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

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

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

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

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

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

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

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

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

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

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

 

Pandora Report: 11.27.2015

We hope you’re having a lovely holiday week and recovering from a day of full of tryptophan overload! This week we’re starting off with a look at the Government Accountability Office’s review of the BioWatch program. We’re discussing another panel review of the WHO Ebola response efforts, the role of tacit knowledge in bioweapons development, and how the Beagle Brigade is fighting bioterrorism one belly-rub at a time. Fun history fact Friday: on November 26, 1940, President Franklin Roosevelt declared the government would bar strikes “at plants under government contract to provide war materials for the US military and its allies” and on November 25, 1915, Albert Einstein published his equations on the Theory of General Relativity!

Government Accountability Office Finds BioWatch Unreliable
The BioWatch program was introduced in 2003 to perform active environmental surveillance for potential bioweapon use. The struggle has been to accurately discern between organisms that are naturally occurring and those that are being intentionally released. With several false alarms, the program has been under heavy scrutiny. Timothy M. Persons, chief scientist of the Government Accountability Office (GAO), states that authorities “need to have assurance that when the system indicates a possible attack, it’s not crying wolf. You can’t claim it works”. DHS official Jim H. Crumpacker, points out that the system is used as an early warning and there is an inherent level of uncertainty and limitation. The report (published in October but not publicly released until November 23, 2015), which you can read here, states that from 2003-2014, BioWatch made 149 mistaken detections that were “false positives”. The report says that “GAO recommends DHS not pursue upgrades or enhancements for Gen-2 until it reliably establishes the system’s current capabilities.”

Expert Review of Ebola Outbreak Response
A 19 member review panel, convened by the Harvard Global Health Institute and the London School of Hygiene and Tropical Medicine, reviewed the Ebola outbreak response as a gateway to “public debates alongside reports on outbreak response and preparedness”. Led by Dr. Peter Piot, one of the scientists to discover Ebola in 1976, the group pointed to several issues needing attention on a global scale. Findings pushed for the WHO to reorganize their disease outbreak functions and streamline processes to “avoid political pressure, build country core capacities, and ensure adequate funding”. The ten suggested reforms heavily emphasize the importance of core capacities within countries to be able to detect and respond to outbreaks. Strengthening a country’s capacity to do surveillance, response, and prevention is crucial in reducing the risk of multi-national outbreaks that spread like wildfire. The report also suggests incentives for early outbreak reporting and more science-based justifications for economic impacts like travel restrictions, etc.

Tacit Knowledge and the Bioweapons Convention
GMU Biodefense Professor, Dr. Sonia Ben Ouagrham-Gormley, takes on the August 2015 Biological Weapons Convention and the exciting inclusion of tacit knowledge in bioweapons development. Dr. Ben Ouagrham-Gormley has contributed heavily to the field of biodefense, specifically on the role that tacit knowledge plays as a key determinant of bioweapons development. In past nonproliferation efforts, tacit knowledge has been widely neglected. Tacit knowledge “consists of unarticulated skills, know-how, or practices that cannot be easily translated into words, but are essential in the success of scientific endeavors.” Simply put, it takes more than a manual or YouTube video to truly perform a scientific experiment, etc. Tacit knowledge is seen in scientists that have spent years not only learning, but experiencing the quirks and challenges of performing experiments. The lessons of failed endeavors, teachings of fellow scientists, and instincts built by years of experience, are all components in tacit knowledge. Dr. Ben Ouagrham-Gormley points to the role tacit knowledge has played in the history of failed bioweapons programs (state and non-state). While some analysts believe the advancing biotechnologies will “de-skill” the field and lower the bar for bioweapons development, Dr. Ben Ouagrham-Gormley highlights that tacit knowledge is a massive roadblock. Pointing towards the new focus on tacit knowledge, she notes that this will only help “advance key mandates of the bioweapons convention, naming the assessment of new technologies, the improvement of national implementation, and the strengthening of cooperation among member states.”

The New Line of Biodefense: Adorable Dogs

Courtesy of BarkPost
Courtesy of BarkPost

There are few times when I get to combine a love of rescue dogs and biodefense nerdom and fortunately, today is that day! The Beagle Brigade is a group of rescue beagles that have been specially trained “to sense for items used for bioterror which include contraband money, pests, and unlawful wildlife”. Even more, the Beagle Brigade is part of the USDA’s Animal and Plant Health Inspection Service (APHIS). They work in baggage-claim areas at international airports, wearing green jackets, to help identify any meat, animal byproducts, fruit, or vegetables that could be carrying any diseases or pests that have the potential to cause a devastating outbreak in the US. They’ve been specially trained to pick up “restricted” (fruit, vegetable, etc.) versus non-restricted items and have a 90% success rate! I think we can safely say the Beagle Brigade wins the award for “most adorable biodefense strategy”.

Genetically Engineered Mosquitoes Battle Malaria 
Recently published work shows how researchers used “a controversial method called ‘gene drive’ to ensure that an engineered mosquito would pass on its new resistance genes to nearly all of its offspring – not just half, as would normally be the case.” These “mutant mosquitoes” are engineered to resist the parasite that causes malaria infections. This particular work solves the issue that many were facing when it came to passing down resistant genes through a species. While this may mark the end of a long battle against malaria, many are pointing to the ethical and dual-use concerns of such work. The growing concern surrounds the high speed of such technological innovation and the lagging of regulatory and policy guidelines, especially regarding work in wild populations. The potential to alter an entire ecosystem has many concerned over the ramifications of such work. The research team is currently working to prepare mosquitoes for field tests, however they are non-native mosquitoes.

Stories You May Have Missed:

  • Stories From A Biodefense PhD Student- GMU Biodefense PhD student, Craig Wiener, discusses his journey from master’s student to PhD candidate. Craig explains what sparked his interest in not only biodefense, but GMU’s program, and how that’s translated into real-world experiences. “Mason has provided me the depth and breadth of knowledge that I needed to converse with senior policymakers, technologists, and scientists,” he says. “It bridged the gap between science and policy so I could be respected in both worlds because I knew what I was talking about.”
  • East Bronx Legionnaires’ Outbreak Traced to Psychiatric Center–  The New York City Health Department announced that the cooling tower at  the Bronx Psychiatric Centre was the likely source of the break that hit East Bronx earlier this fall. Samples from four cases matched those taken from the water tower. Remediation and disinfection is being performed on the water tower.
  • Liberia Reports Death of Boy – A boy who was part of the family cluster of Ebola cases in Liberia, has died of the disease. The 15-year-old boy was one of the three confirmed cases reported on November 20th, which marked the end of the Ebola-free period for Liberia since September 3rd. There are currently 153 contacts and 25 healthcare workers being monitored.

Pandora Report: 11.20.2015

Much has happened since we reported last week, and with so many tragedies that have occurred, we look towards future preparedness efforts to prevent such misfortunes. The French Prime Minister warned on Thursday, “we must not rule anything out, there is also the risk from chemical or biological weapons.” French emergency medical services are also being supplied with sarin gas antidotes. Check out the CBRN Policy Brief by Dr. Garza, GMU Biodefense Affiliate Research Scientist and former Assistant Secretary for Health Affairs and Chief Medical Officer at the Department of Homeland Security. Dr. Garza provides an extensive look into US federal preparedness, which will be increasingly relevant given the Paris attacks and ISIS interest in chemical weapons. In looking towards the future, we’re celebrating World Antibiotic Awareness/Get Smart About Antibiotics Week to better appreciate the importance of microbial stewardship. Do you ever find yourself reading the Pandora Report and wondering, “all this biodefense stuff is so fascinating, I wonder how I could go more of it?” Good news, GMU has an entire Master’s program (and PhD if you really want to venture down the rabbit hole) in Biodefense! Fun History Fact Friday: On November 19, 1863, President Abraham Lincoln gave the Gettysburg Address at the dedication of the military cemetery in Gettysburg, Pennsylvania.

World Antibiotic Awareness Week 2015
Whether you want to call it the World Antibiotic Awareness Week (via WHO) or Get Smart About Antibiotics Week (via CDC), the importance of antimicrobial stewardship can’t go unnoticed. The threat of antibiotic resistance is growing and we can all play a vital role in stopping it. Did you know in the US alone, 2 million people a year become infected with an antibiotic resistant organism? At least 23,000 people a year will die as a result of resistant organisms. There is a growing list of infections that are becoming harder to treat, like tuberculosis, pneumonia, gonorrhea, etc. The CRE outbreak earlier this year is just one example of a highly resistant and deadly multi-drug resistant organism (MDRO). While many think global health security issues are acts of bioterrorism and lab safety failures (which they are!), the threat of MDRO’s is also a looming danger. Imagine a world where we have no effective antibiotics. Pretty scary, isn’t it? The WHO provided recommendations for healthcare workers and policymakers, but here are a few things you can do:

  • always take the full prescription (don’t just stop when you feel better!)
  • Have left-over antibiotics? Don’t take them.
  • Don’t share antibiotics.
  • Prevent infections before they happen – wash your hands, use safe food practices, avoid close contact with sick individuals, and keep your vaccinations up to date!

GMU Master’s in Biodefense
Have a passion for biodefense and global health security? Hoping to take your education and experience to the next level? GMU’s MS in Biodefense can help bridge those gaps. Did I mention we also have an online biodefense MS? Our program connects the worlds of science and policy, furthering students’ understanding of the complexities within global health security through classes on homeland security, biodefense strategy, specific threat agents, etc. One of our graduates, Kathleen Danskin, is actually working with GAP Solutions Inc., supporting the US Department of Health and Human Services (HHS) Office of the Assistant Secretary of Preparedness and Response (ASPR). Kathleen’s experience is a perfect example of GMU’s multifaceted approach to biodefense and support for work experience. The MS in Biodefense requires the completion of 36 credits (18 credits of core classes like those listed above, 9-15 credits in a field of specialization, electives, and 3 credits in a Capstone Course). Perhaps one of the program’s greatest strengths is its faculty. They’re not only subject matter experts with an amazing range of experiences and knowledge, but also extremely supportive and encouraging of their students. If you happened to miss our Open House on Wednesday, check out our recorded webcast that specifically discusses the Biodefense MS program. If you plan to apply, make sure to get your Spring 2016 application in by December 1st!

Putting the Global in Global Health Security
Dr. Stephen Redd, Director of the CDC’s Office of Public Health Preparedness and Response, writes about a holistic approach to global health security. Dr. Redd discusses the challenges of improving both domestic and global health security “by preventing avoidable epidemics, detecting threats early, and responding rapidly and effectively to any public health event.” The 2014 Ebola outbreak brought the realities of emerging infectious diseases and global outbreaks to the frontline of US concerns. This particular outbreak emphasized the importance of surveillance and response on a global scale. A disease outbreak in one country can quickly stretch beyond the borders of another. Dr. Redd points out that epidemics know no boundaries and we must stop thinking of outbreaks in terms of individual country responsibilities. Mirroring these sentiments, I believe the concept of One Health plays a growing role in global health security and our future practices. Dr. Redd notes that the US must continuously adapt to prepare for these threats. As emerging infectious disease outbreak occur, the role of spillover between the human, animal, and environmental sources makes prevention, surveillance, and response that much more vital.

Officials: IS Is Determined to Develop Chemical Weapons
Iraqi and US intelligence officials are reporting that the Islamic State group is on the quest to develop chemical weapons. Sources state that they are setting up branches specifically for chemical weapon efforts and experimentation. This wouldn’t be a far reach considering IS was reported to use mustard gas in Syria against Kurdish fighters. Intelligence officials are also pointing to IS efforts of finding and employing chemical weapons experts from a range of international venues. “Still, U.S. intelligence officials say they don’t believe IS has the technological capability to produce nerve gas or biological agents, and that the militants were more likely to harm themselves trying to make them. A European official privy to intelligence on the extremist group’s programs agreed, saying so far even IS production of mustard gas was in small quantities and of low quality.”

Public Health Emergency Medical Countermeasures Enterprise (PHEMCE) 2016 Stakeholders Workshop
PHEMCE helps coordinate Federal efforts to better prepare the US with medical countermeasures to combat CBRN and EID threats. Attend their January 6-7, 2016 workshop at the NIH Natcher Conference Center to address where we’re at and how we can work to be better prepared in the future.

Stories You May Have Missed:

  • Paris Attacks Point to Preparedness Needs GMU Biodefense alum, Dr. Daniel M. Gerstein, discusses the preparedness fallout of the 11/13 Paris attacks. While many news outlets are reporting on the attacks, Dr. Gerstein addresses the collective roles for homeland security and how strategies like “DHS’s ‘see something, say something’ campaign provides recognition of the importance of individual vigilance and reporting of suspicious behavior.”17779_lores
  • CDC Lowers Initial Chipotle E coli Case Count– Public health officials working on the outbreak associated with Chipotle restaurants in Washington and Oregon have dropped the case count from 50 to 37. Officials stated that “the CDC is now only reporting ill people that have been confirmed by PulseNet as being infected with the outbreak strain of E coli 026.” Of the 37 cases, 13 have been hospitalized.
  • Ebola Drug Protects Mice- FDA-approved Gamma interferon is showing promise in studies by University of Iowa researchers. When given 24 hours before or after exposure to the virus, it was able to fully protect mice from death from Ebola. While the team is still working to see how late the gamma interferon can be given after exposure, the success so far as a prophylaxis and post-exposure treatment is a huge breakthrough. With reports of a new case in Liberia, an effective ebola drug will be necessary to help stop the outbreak.
  • Cameroon is Experiencing a Measles and Cholera Outbreak There have been 858 documented measles cases, with a surge in the past six weeks. The Mokolo health district has experienced the greatest number of cases (587). 36 cases of cholera have also been reported over the last four weeks. Public health officials are working to contain both outbreaks.
  • Hawaii Dengue Fever Update- The National Guard has been called in to assist with the Dengue fever outbreak as case numbers hit 79 infections.

 

The Candidates on Nonproliferation Part III

The Candidates on Nonproliferation – Part 3
By Greg Mercer

I initially set out to write this as a candidate-by-candidate look at what the 2016 crop had to say about an issue near and dear to Biodefense students’ hearts: nonproliferation. As it turns out, though, not many candidates have well-developed stances on highly specific policy issues (or any issues, depending on how serious a candidate we’re talking about) more than a year from the general election. Lucky for us though, there’s been a major nonproliferation news event to drive the foreign policy debate: the Iran nuclear deal. So this is a rundown of what’s been said and is being said about nonproliferation and WMD policy in the 2016 election.

See part 1 here
And part 2 here

I’m spending even more time on campaign sites to see what the 2016 election looks like for nonproliferation.

This time, I’ll take a look at top Democrat contenders. In contrast to the Republicans, most Democrats support the Iran deal, and generally tend to favor international arms control regimes.

Hillary Clinton:
In the Democratic debate, Hillary Clinton named loose nukes among the paramount threats to the US.  This issue is commonly understood to hinge on loose radiological material from the former Soviet Union (which is notoriously poorly controlled) and other states maintaining poor control of their nuclear weapons.  The Associated Press recently released an investigation into the Moldovan nuclear black market and Islamic extremists.  She has also strongly endorsed the Iran deal, and has a unique role in the debate, having helped to implement sanctions and launch negotiations with Iran as former Secretary of State.  The Politico story linked notes that she was more hawkish than Obama on Iran in the past.  (Her support of the Iraq War in Congress has been a recurring talking point for opponents).  Now, though, their views seem to be pretty closely aligned.  Hillary’s national security issues page also leans heavily on her experience at the State Department (in addition to being pretty relentlessly on-brand).  Among the usual issues- ISIS, Russia, Israel, the Iran deal- is a very interesting one: “Highly contagious diseases are a constant threat. Warmer and drier conditions caused by global climate change, along with our increasingly interconnected world, enable germs to spread more quickly across the globe. America must remain vigilant and do more to prevent and contain outbreaks.”   This is an uncommonly specific stance, and is placed alongside cyberattacks and climate change to make up an emerging threats triumvirate.  So far, though, there hasn’t been much elaboration on actual policy options to combat this threat, or what makes it a defense issue versus, say, an international development one.

Bernie Sanders:
In 2009, Bernie Sanders echoed President Obama’s call for “a world without nuclear weapons.”  While this obviously hasn’t happened, Sanders released a statement calling for an end to the production of weapons-grade uranium and stopping the spread of nuclear weapons.  In March of 2015, Sanders cosponsored a bill to reduce American spending on nuclear weapons by $100 billion over 10 years (in grand Congressional naming convention, the Smarter Approach to Nuclear Expenditures Act, aka SANE).  A House and Senate version have been introduced, but are part of a much larger budget fight.  Sanders’ issues page supports the Iran deal, though it interestingly says the “agreement is not perfect,” but ultimately concludes that it is a far superior option to military action. As usual, Sanders officially gives his support to Obama and Secretary of State Kerry’s negotiations.  This page also does the thing where a first-person snippet introduces a long set of third-person position statements, but the personal statement highlights Sanders’ votes against the first and second Gulf Wars.  This casts him pretty clearly as anti-military intervention to prevent proliferation, but with the caveat that it remains an option.  There is also a separate, editorial-style section on just the Iran Deal, which offers more detail about uranium and centrifuge reductions.  Once again, it calls war “the last option.”  Much of Sanders’ campaign so far has hinged on economic and social issues, however, and he even said in the most recent debate that climate change is the most pressing national security threat.  When looking for threats to security, Sanders mostly looks beyond weapons of mass destruction.

Continue reading “The Candidates on Nonproliferation Part III”

Pandora Report 9.25.2015

You didn’t think a Papal visit would slow us down, did you? Even in the event of a zombie apocalypse, we GMU Biodefense folks would still find a way to get out the weekly report – perhaps pigeon carrier? Until that happens, don’t forget to check us out on Twitter! This week saw a lot of great focus on collaborations to fight public health threats like antimicrobial resistance and epidemics. Schools in Chicago were closed for concerns over Legionnaires’ disease, yours truly provided a piece on Ebola infection prevention, and we have a wonderful opportunity to contribute to World Medical & Health Policy regarding women’s health on a global stage.

Learned Lessons from Ebola in the US
Sylvia Burwell, Secretary of Health & Human Services, discusses the clinical complexity and reality that “our clinical approach to treating Ebola in a hospital setting posed different challenges.” Several key US health experts weighed in on the pivotal first patient, Thomas Duncan, to unknowingly bring Ebola to the US. The implications for healthcare and preparedness sent a tidal wave of response across US hospitals. Dr. Tom Frieden, director of the Centers for Diseases Control and Prevention (CDC), also highlights three main lessons from not only the cases in Dallas, but also the Ebola epidemic as a whole. He points to the necessity of a strong surveillance and response system, need for rapid international aid, and better infection control in hospitals….which segues beautifully into our next story.

The Infection Prevention Angle of the 2014 Ebola Crisis
Reports and analyses from a range of responders to the crisis have been trickling out for several months now, but there’s a constant in all of them – infection control. Given my background and experiences in this field, I wanted to take our readers down the rabbit hole of what exactly it was like to be an Infection Preventionist during this time. A hopeful start to a series of pieces on this subject, it will give you a taste of not only the daily struggles, but the brevity of what potential Ebola patients meant for US healthcare preparedness.

Partnerships to Support Antibiotic Development
564px-Penicillin_Past,_Present_and_Future-_the_Development_and_Production_of_Penicillin,_England,_1943_D16963The ASPR’s (Office of the Assistant Secretary for Preparedness and Response) Biomedical Advanced Research and Development Authority (BARDA) is part of a larger initiative to use Other Transaction Authority (OTA – flexible advanced research and development funding instruments) to start developing business relationships between government and private industry. The relationships are mutually beneficial, allowing both parties to invest and develop products for biodefense and the growing threat of antibiotic resistance. Given the slowing of new antibiotic development, this joint agreement comes at a pivotal time for antimicrobial resistance efforts.

Three Chicago-area Schools Close in Response to Legionnaires’ Disease Concerns
Three schools in the Illinois U-46 district were shut down on Wednesday and Thursday after cooling tower test results showed “higher than normal levels of Legionella bacteria”. The OSHA recommended threshold is no higher than 1,000 CFU/ml (colony-forming units per milliliter) and with the outbreak among residents of the Illinois Veteran’s Home, it’s not surprising to see many water towers being frequently tested, etc. The important thing to note is that Legionella pneumophila infections are a result of the intensity of the exposure and the immune status of the exposed person. Legionella can’t be totally eradicated from the water supply and a majority cooling towers will contain some amount of growth.

Call for Papers – Women’s Health in Global Perspective
Papers sought for a special issue and workshop of World Medical & Health Policy on “Women’s Health in Global Perspective,” to contribute to understanding and improve policy related to women’s health and wellbeing.  Forces ranging from the economic to the climactic have human repercussions whose genesis and solutions demand consideration of their global context.  A wealth of recent research and inquiry has considered the particular plight of women, who often suffer disproportionately from lack of education, compromised nutrition, poverty, violence and lack of job opportunities and personal freedom.  The Workshop on Women’s Health in Global Perspective will consider the broad ranging social determinants of health on a global scale that importantly influence health outcomes for women everywhere, which in turn has implications for economic, political and social development.
Abstract submission deadline (250 words): October 16, 2015 
Contact: Bonnie Stabile, Deputy Editor, bstabile@gmu.edu
Notification of selected abstracts: November 13, 2015
Workshop March 3rd, 2016
Completed papers due: March 11, 2016

Stories You May Have Missed:

  • Personal Microbial Cloud – researchers found that a person’s microbiome form a cloud around them, allowing scientists to identify a specific person just by sampling their microbial cloud. Food for thought: would this be our microbial cloud version of a fingerprint?
  • C. Difficile Drug Success – Researchers at Stanford University School of Medicine were successful in their ability to get rid of the deadly gastrointestinal toxin via a drug that didn’t focus on the organism, Clostridium difficile, but rather the toxin itself. C. difficile is responsible for 250,000 hospitalizations and 15,000 deaths per year while costing the US more than $4 billion in healthcare expenses. Yay for successful treatments!
  • EC, EU, and WHO Work To Better Share Private Drug Data – The European Commission, European Medicines Agency, and World Health Organization are working to “step up coordination” on EU medicines regarding safety, quality, and efficacy of new drug candidates. The first step in solving a problem is recognizing you have one, right? The new focus on global public health threats is one we can all appreciate!
  • WHO Makes Changes to Southern Hemisphere Flu Vaccine – The WHO committee recommended changes for two of the three trivalent influenza vaccines for the Southern Hemisphere next year due to changes in the circulating viral strains. They suggested using H1N1, H3N2 an A/Hong Hong/4801/2014-like virus, and for influenza B, the Brisbane/60/2008-like virus. In the quadrivalent vaccine, they recommended adding the influenza B Yamagata lineage component, with the A/H1N1 strain staying.

Ebola 2014: The Infection Preventionist Perspective

By Saskia Popescu

Unlike many infectious diseases, especially ones with a relatively small number of occurrences, the Ebola outbreak that started in 2014 received a sensational amount of attention. While many in public health keep tabs on outbreaks (thanks ProMed!), it’s not uncommon for the rest of society to remain blissfully unaware unless the bug comes knocking on their front door. I’ve been captivated with Ebola (now called Ebola Virus Disease, or EVD) since a young age after Richard Preston’s sensational book, The Hot Zone got passed to me during a family vacation. The first whispers and later emails of the surging cases in West Africa were pretty astounding in early 2014. Usually these outbreaks occur in small blips and then die off a few weeks or months later. I was working in Infection Prevention & Control at a pediatric hospital at the time and, like many, didn’t think too much about the outbreak pertaining to the US and even if it did, our infection control practices should be able to handle an organism that required Contact/Droplet isolation. I put some updates in our monthly newsletter and continued to watch as West Africa became overwhelmed with EVD.

Like many public health issues, no one really starts hitting the panic button until a disease shows up and you’re scrambling (and trust me, most of the time, you find out retrospectively) to do damage control. The IP (infection prevention) world started to get worried in late July when Emory University Hospital accepted and began treatment the first two EVD patients transported into the US from their field assignments in West Africa. Questions about isolation and practices were asked, but again, no one really worried too much since these patients were flown directly to Emory due to their special infectious disease isolation unit. Suddenly, on September 30th, 2014 a media storm announced that a patient being treated at Texas Health Presbyterian Hospital in Dallas, Texas, was positive for EVD. I can personally tell you, this is when the proverbial crap hit the fan for just about every healthcare facility and IP in the US. A visiting your emergency department, being sent home, and then coming back with a highly infectious disease that few physicians know well enough to suspect, let alone diagnose or treat, is pretty much the equivalent of an IP nightmare. So what could we do?

First, I should say that every hospital with an IP team (most of them have at least one IP) experienced a massive level of panic, anxiety, and stress dedicated to avoiding this, so please, give them a pat on the back. I am fortunate that my IP team consists of not only enthusiastic, ridiculously talented and intelligent people, but they know how to respond to crisis in the flip of a switch. We quickly pulled together a committee to encompass all people that would play a role in the preparedness and response of an EVD patient. Fortunately, by this time, Emory had released an extremely helpful document that discussed their experiences and lessons learned. We met our committee (now filled with people from environmental services, facilities, nursing, medical staff, infectious disease, emergency preparedness, the emergency department, and many others) with this document and everything else the Centers for Disease Control and Prevention (CDC) had on EVD response. For many, the difficulty laid in where do we put this patient, what designated staff will care for them, and what will we do with the waste? You pretty much need to have a specific process for both your emergency department if there is a suspected case, but also a designated wing you can move patients out of and move this potential EVD patient into. Without going too much into detail, one of the trickier components became the PPE (personal protective equipment) and waste process of a potential patient. CDC PPE recommendations were changing almost daily (or at least that’s how it felt). Information was changing so rapidly it was a constant cycle of checking their website, talking with peers, and attempting to update instructional handouts and training tools for staff incase we happened to get a potential patient. Historically, EVD PPE recommendations came from outbreaks in Africa with little access to the equipment and capabilities we’re used to in the US. The ability to intubate a patient or insert a central line opened up a Pandora’s box of potential transmission scenarios, leading to difficulty in establishing a solid PPE process. Acquiring the PPE was another struggle. Our materials management team worked tirelessly to find the ever changing products we would need to not only have PPE kits in our emergency department and urgent cares, but also to sustain care for a patient for several days. The sustainability was a huge concern as staff were changing in and out of PPE every 45 minutes due to heat exhaustion and CO2 build-up from the N-95 masks. Once we were able to obtain the PPE, and this was a constantly changing cycle to follow CDC recommendations, training went into effect. One of the greatest struggles was training enough staff to have a proficient understanding of an extremely complex (and dangerous) process. The unique part about EVD PPE practices is that you utilize a buddy system with a checklist – something healthcare workers are not used to and something we had to remind them of (don’t try and memorize this)! We did several drills involving patients projecting a mixture of chocolate syrup and glitterbug to not only prepare healthcare staff, but also show their cross contamination when doffing the PPE.

Courtesy of USA Today
Courtesy of USA Today

The PPE struggles were one small piece of this EVD pie. Many IP’s could probably write a novel about the struggles and random problems that came up during this time. Our ridiculously long days were filled with preparedness meetings, educational trainings, hospital-wide communication, worried calls from people and staff (the comical relief of people calling to ask for an EVD vaccine but refusing to get their flu shot showcases the ridiculousness of what we experienced), educating physicians on signs and symptoms, identifying routes for patient transportation, and coordinating surveillance mechanisms like electronic mandatory travel history (from the affected countries) questions and alerts in the intake process of patients from the emergency department or urgent cares. The simple truth is that the US became so panicked and so obsessed with a disease no one really worried about a few months before, the amount of preparedness that was initiated simply couldn’t be maintained for an extended period of time. Emergency departments and hospitals are comprised of some of the most hardworking and intelligent people you’ll ever meet, but I can honestly say, something like what happened in Dallas could’ve happened in any hospital. Healthcare is an imperfect system and while we struggle to make it better and more robust, it always comes down to overworked staff and communication gaps. My experiences as an IP during the EVD 2014 outbreak, while exhausting, were truly eye opening to the ability of our healthcare infrastructure to respond to such an event. It revealed a lot of gaps in our practices and the state of our preparedness, but overall, it highlighted the growing need for better disease surveillance, preparedness, and attention to biosecurity.

 

Pandora Report 9.11.15

Miss us? Good news – the Pandora Report weekly update is back! With a new school year comes new faces and some organizational change-up. Dr. Gregory Koblentz is now the Senior Editor of Pandora Report and Saskia Popescu (yours truly) will be taking over from Julia Homstad as the Managing Editor. I come from the world of epidemiology, public health, and infection control. Having just started in the GMU Biodefense PhD program, I look forward to venturing down the rabbit hole that is the Pandora Report!

There’s been some pretty fascinating news over the past few weeks, so let’s try and catch up…

Lab Safety Concerns Grow 

Our very own Dr. Gregory Koblentz, director of the GMU Biodefense program, was interviewed by USA Today regarding the lab security issues that now involve mislabeled samples of plague. “Since there are now concerns about the biosafety practices at multiple DoD labs there needs to be an independent review of the military’s biosafety policies and practices,” Koblentz said Thursday. He said the Critical Reagents Program is an important biodefense resource. “It’s crucial that all problems with handling and shipping inactivated samples be resolved quickly so the program can resume its important role in strengthening U.S. biopreparedness.”

Reviving a 30,000-Year-Old Virus…Isn’t This How the Zombie Apocalypse Starts?

You may recall last year that French scientists stumbled across a 30,000-year-old virus frozen in the Siberian permafrost. Considered to be a “giant virus” (doesn’t that give you a warm, fuzzy feeling inside?), this is actually the fourth ancient, giant viral discovery since 2003. The new plan is to try to revive the virus in order to better study it.

Dr. Claverie told Agency France-Presse, “If we are not careful, and we industrialise these areas without putting safeguards in place, we run the risk of one day waking up viruses such as smallpox that we though were eradicated.” Given the recent concerns over biosafety lab specimen transport, we’re all curious to see how this new organism, coined “Frankenvirus”, turns out!

Cucumbers and A Multi-State Salmonella Outbreak

CDC updates regarding the Salmonella Poona outbreak reveal the brevity of the potentially contaminated product. As of September 9th, there have been two deaths, 70 hospitalizations, and 341 confirmed cases across 30 states. Perhaps the most worrisome is that 53% of affected individuals are children under the age of 18. While the produce company, Andrew & Williamson, issued a voluntary recall of their “slicer” or “American cucumber on September 4th, there have been 56 additional cases reported since then. Isolated samples from cucumbers in question were found in Arizona, California, Montana, and Nevada. The California Department of Public Health issued a warning and pictures of the affected cucumbers. 

Stories You May Have Missed: