Pandora Report: 3.20.2020

Policy vs. Pandemics: Polarization and Public Health Emergency Preparedness
Could there be a better time to discuss partisanship in pandemic response? Join us virtually on March 26th from 6-7:30pm EST. Due to the COVID-19 pandemic, this event will be held as a live webinar instead of an in-person talk. Blackboard Collaborate Ultra works best with Google Chrome and does not work with Internet Explorer. Participants will be able to use the “Raise Hand” function in Blackboard Collaborate to ask questions at the end of Dr. Myer’s prepared remarks. Everyone who registers for the webinar will receive a 30% discount on his book. This webinar will be recorded and the video will be posted to the YouTube channels for The Pandora Report and the Schar School of Policy and Government. Event info -The sweeping effects of the COVID-19 pandemic on the social, economic, and political framework of the United States highlights the vital importance of a resilient public health infrastructure. In the aftermath of this pandemic, the United States will need to reconsider its approach to biosurveillance, public health emergency preparedness, intergovernmental coordination, and the development of countermeasures in advance of the next health crisis. In the past, such efforts have been hindered by partisan polarization between Republicans and Democrats, even as some crucial public health emergency policy was only made possible through bipartisan cooperation. While considering lessons from the past, this discussion will address bipartisan efforts to move forward on approaches to protect the American people in the future, such as the implementation of the National Biodefense Strategy. Dr. Nathan Myers is an associate professor of political science and public administration at Indiana State University. His research interests include public health policy, U.S. executive branch politics and administration, emergency planning and preparedness, and regulation of biotechnology. He is the author of Pandemics and Polarization: Implications of Partisan Budgeting for Responding to Public Health Emergencies(Lexington Books, 2019). Register for the event here. Keep reading for an in-depth interview with Dr. Myers.

Summer Workshop on Pandemics, Bioterrorism, and Global Health Security
From July 13-16, 2020, GMU Biodefense will be hosting a workshop on all things global health security. Leaders in the field will be discussing hot topics like 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.

Modeling SARS-CoV-2
A model for the spread of the SARS-CoV-2 virus for the Eclipse Spatio-Temporal Epidemiological Modeler (STEM) framework has been produced Dr. James Kaufman of IBM Research Almaden. The model divides the population into four compartments: people susceptible to the disease, those who have the disease but don’t show symptoms, people infected and showing symptoms, and those who have recovered or died, from the population. When plugged into STEM, various hypothetical scenarios can be generated using the modeling framework. For example, the model could allow researchers to study the effect of the presence of pre-symptomatic infectious individuals on the spread of the virus. In particular, the model, which can be downloaded for free from the STEM website, comes with a pre-built scenario of SARS-CoV-2 global outbreak which includes a travel shutdown in or out mainland China after 60 days of the pandemic. Additional scenarios can be built using the framework to model other public health interventions, including quarantine, global travel restrictions, and the implementation of various vaccination policies.

Risks, Trade-offs, and Responsible Science
Dr. Gregory Koblentz, GMU’s Biodefense Graduate Program Director, and Dr. Fillipa Lentzos, Senior Research Fellow at King’s College London, published an article in 2016 showcasing the heightening safety and security risks as the number of laboratories and scientists working on dangerous pathogens and toxins increases substantially. These risks are greater today than even three years ago as technological innovations and improvements in synthetic biology continue at a record rate. Beneficially, leaps in synthetic biology enable quicker and deeper research into pathogens in order to reduce their collective risk to humanity. But this comes at a cost that must be balanced. Recent articles in The New Yorker and the Bulletin of the Atomic Scientistsdebate the benefits and risks associated with increasing laboratory facilities and capabilities, and reference the expertise of Koblentz and Lentzos.  The “biodefense boom,” ongoing since the turn of the century, increases risk in four primary areas: biosecurity, biosafety, dual-use research of concern (DURCs), and compliance with the Biological Weapons Convention (BWC). These risks must be weighed into any decisions regarding new or advanced laboratories, especially those for extremely virulent pathogens that require stringent safety and security to prevent misuse, theft, or accidental release. The authors urge biodefense policymakers to regularly evaluate the risk trade-off as they make decisions about prevention, preparedness, and response to existing and emerging biological threats. To that end, Koblentz and Lentzos encourage responsible science, recommend forming a BWC science advisory group to develop well-defined international guidelines managing DURC, establish a Confidence Building Measures working group, guarantee that biodefense activities are subject to strict biosafety and biosecurity regulations supported by

COVID-19 Pandemic Updates
Every day feels a bit longer during the midst of the COVID-19 pandemic especially as so many are working remotely or actively quarantining to help prevent the spread of SARS-CoV-2. For many in healthcare, the overwhelming amount of people coming into emergency departments is stressing the system even more – New York City public health syndromic surveillance data found that ED visits for adults seeking care for influenza-like-illness is 50% higher than the last three years of flu, however this is likely “care-seeking behavior – not all COVID.” As many cities initiate restaurant and bar limitations, there has been increased focus on the role of the CDC and how their messages and efforts have been somewhat sidelined. “The CDC, which has come under fire because of protracted delays in the rollout of agency-developed test kits, has not conducted its own telephone briefings for reporters in more than a week. Recent CDC recommendations on school closures and mass gatherings were overtaken by different guidelines issued by the coronavirus task force, creating confusion, experts and officials said.” Tom Inglesby of the Johns Hopkins Center for Health Security noted that “It is confusing for the public to have CDC say no gatherings of more than 50 people, and the next day, the task force says no gatherings of more than 10 people If the information has changed, tell everyone why. Let’s make sure everyone is on the same page.” Many are underscoring though, that the continued funding cuts to critical agencies, like the CDC, and the disbanding of the White House’s National Security Council Directorate for Global Health Security and Biodefense, created a perfect storm that would leave the United States vulnerable to biological threats and limited response. NTI’s Dr. Beth Cameron discusses the impact here, noting that “When President Trump took office in 2017, the White House’s National Security Council Directorate for Global Health Security and Biodefense survived the transition intact. Its mission was the same as when I was asked to lead the office, established after the Ebola epidemic of 2014: to do everything possible within the vast powers and resources of the U.S. government to prepare for the next disease outbreak and prevent it from becoming an epidemic or pandemic. One year later, I was mystified when the White House dissolved the office, leaving the country less prepared for pandemics like covid-19. The U.S. government’s slow and inadequate response to the new coronavirus underscores the need for organized, accountable leadership to prepare for and respond to pandemic threats.” In response, National Security Advisor Bolton has been quick to defend his decision though, claiming streamlining, while many feel that this was just poor prioritization of global health security. The truth is that that there have been several warnings of what might happen in this situation, including government exercises. One in particular was the “Crimson Contagion” exercise, held last year by DHHS, which simulated an influenza pandemic. If that name sounds familiar, it’s because we reported on the event late last year. In an effort to tackle the pandemic and community-level response, experts are working to commit to COVID-19 efforts, like the biomedical meeting held this week in Boston. In building response, should we look to those countries that have already dealt with COVID-19? GMU Biodefense student HyunJung (Henry) Kim asks what lessons we can learn from Japan and South Korea for the coming cases. “For example, Japan and South Korea have taken very different approaches to restrictions on travelers from China. Since February 1, Japan has denied entry to foreign nationals who had visited China’s Hubei province, which includes a home of Wuhan city, and later, on February 13, expanded that travel ban to eastern provinces including Zhejiang province. In contrast, South Korea does not prevent the entry of any foreigners who had visited China.” Lessons learned will be critical now, as hospitals in the United States struggle with supplies and additional cases are identified via growing testing capabilities. The capabilities of our healthcare system are limited and now is the time, as so many have pointed out, to reinforce social distancing, staying home when you’re sick, and engaging in infection prevention basic. Flattening the curve can help preserve hospital capacity and capabilities. “Just 11 weeks into a pandemic crisis expected to last months, the nightmare of medical equipment shortages is no longer theoretical. Health-care workers, already uneasy about their risk of infection amid reports of colleagues getting sick and new data showing even relatively young people may become seriously ill, are frustrated and fearful.” Despite a need to start developing strategies for vaccines, facilities previously funded to help rapidly develop medical countermeasures are sitting it out. Having $670 million invested into these four sites, none of the locations though (Florida, Maryland, North Carolina and Texas) “have developed or are close to delivering medicines to counter the outbreak, according to records, government officials and others familiar with the facilities. Instead of leading the rush to find and mass manufacture a vaccine or lifesaving treatment, two of the sites are taking no role, while the other two expect to conduct small-scale testing of potential coronavirus vaccines.” Don’t miss the Global Health Security Agenda’s COVID-19 Chair, Roland Driece’s statement on the role of GHSA2024 in the pandemic, here.

MITRE’s Recommendations to Stop COVID-19
The MITRE Corporation’s infectious disease analytics team published a white paper comprising recommendations of specific actions that US leaders should immediately take to quell the COVID-19 pandemic. Many of MITRE’s recommendations revolve around continuing to encourage and incentivize social distancing through non-pharmaceutical interventions (NPIs). MITRE estimates that we must reduce the human-to-human contact rate of Americans by 90% to stop COVID-19. These NPI include immediately closing all schools; incentivizing remote work among the private center enterprise; immediately closing establishments for social gatherings (restaurants, bars, theaters, concert and sports venues); and incentivizing individuals to remain at home except for those with emergent medical needs or those who are part of the maintenance of critical infrastructure. Beyond social distancing, recommendations also encompass support for sanitary maintenance of transport and logistics operations, financial support to counteract sudden losses in income and/or business revenue, and travel restrictions into and out of the US until the pandemic passes. The full white paper with its 14 detailed recommendations is available here.

Interview with Nathan Myers, PhD
Dr. Nathan Myers is an associate professor of political science and public administration at Indiana State University. His research interests include public health policy, US executive branch politics and administration, emergency planning and preparedness, and regulation of biotechnology. He is the author of Pandemics and Polarization: Implications of Partisan Budgeting for Responding to Public Health Emergencies (Lexington Books, 2019). GMU’s Biodefense, MPA, and MPP programs are hosting a webinar with Dr. Myers focusing on his new book and the ongoing pandemic. In advance of his presentation, an interview with Dr. Myers took a number of twists and turns about preparedness politics and its role in COVID-19, in terms of US preparedness and response. Or lack thereof. Myers emphasizes the need for a One Health approach to preparedness policies and actions. Additionally, he advocated that the relationship between health and socioeconomic status be considered in preparedness policies and actions. In the thick of responding to a crisis, we must all pull together to do what is necessary to contain and mitigate the threat. Before such a crisis emerges is when political debates establish the degree to which America will be prepared. To this end, there is a long and important history of bipartisan actions on issues of public health emergency preparedness (PHEP) and biodefense: passage of the Pandemic and All-Hazards Preparedness Act (PAHPA), enactment of select reforms recommended by the Bipartisan Commission on Biodefense, and the development of the National Biodefense Strategy. An area of budding bipartisanship is the One Health movement. The One Health approach to health policy issues emphasizes the symbiosis between human health, animal health, and the environment – improving the health of one creates a ripple effect improving the health of the other two.  The COVID-19 pandemic, along with previous health emergencies over the last 20 years, have highlighted the need to recognize the public health implications of policy domains outside the traditional preparedness and response framework. This may require confronting the health security implications of some highly partisan issues. For example, the Zika virus outbreak, a vector-borne infectious disease, supports a strong relationship between climate change and human health. It is encouraging that both Republican and Democrats have been embracing the One Health framework, as it highlights the interconnectedness of several policy domains. However, Republicans and Democrats remain deeply divided on the degree to which humans affect climate change and the level at which climate change affects human health. Ebola showed that access to affordable and reliable health care can make the difference between containment and outbreak, as people may not go for treatment or be turned away. Income inequality is a driver of continuing inequities in health care and a risk factor across a range of communicable and non-communicable diseases. Zika highlighted access issues regarding contraception and abortion services around the world. It is important to keep in mind that the largest burden from caring for Zika-affected children falls on poor women in Brazil and other Latin American nations. If reproductive services are restricted, nations, including the US, must be prepared to offer economic and social assistance to help women who give birth to children with profound physical or developmental disabilities. COVID-19 is highlighting the fact that we need to provide a safety net for vulnerable groups like low-wage, working parents who are likely to experience loss of income and/or increased child care expenses during a public health emergency. Strategic bipartisan discussions need to come to grips with not only how emergency preparedness and response is funded, but also how we fund basic public health services. Population health should be regarded as not only on par with individual medical care, but as a matter of national security. Myers expects that the COVID-19 pandemic will result in bipartisan improvements in technocratic areas like disease surveillance and the development of countermeasures. Hopefully, improvements in incorporation of a One Health framework, efforts to improve population health, and measures to counteract the disproportionate burden emergencies place on out lower income households are forthcoming as well. After the immediate danger is passed, elected officials must address some tough political questions related to US preparedness and response for the next emergency. As many have noted, public health and how we address infectious disease is political. So, politicians must find a way to come together and answer hard political questions about how we avoid policy obstacles to managing public health emergencies in the future.

 

Pandora Report: 3.13.2020

Summer Workshop on Pandemics, Bioterrorism, and Global Health Security
From July 13-16, 2020, GMU Biodefense will be hosting a workshop on all things health security, from anthrax to Zika. Leaders in the field will be discussing hot topics like 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.

Policy vs. Pandemics: Polarization and Public Health Emergency Preparedness
Curious about partisanship in pandemic response? Join us at 6pm on March 26th for this event that is now virtual (log-in instructions to follow here). Political polarization is being blamed for many areas of dysfunction in the U.S. government, and the response to infectious diseases is not immune to this concern. This presentation will discuss how a lack of cooperation between Democrats and Republicans has hindered the ability of the nation to carry out essential public health emergency response functions, such as biosurveillance and the development and deployment of medical countermeasures. Particular attention will be given to bipartisan efforts to move forward with public health preparedness efforts, such as the implementation of the National Biodefense Strategy, in light of the challenges posed by the global coronavirus pandemic.  Dr. Nathan Myers is an associate professor of political science and public administration at Indiana State University. His research interests include public health policy, U.S. executive branch politics and administration, emergency planning and preparedness, and regulation of biotechnology. He is the author of Pandemics and Polarization: Implications of Partisan Budgeting for Responding to Public Health Emergencies(Lexington Books, 2019). Register for the event here

GMU Schar School Biodefense PhD and Master’s Open Houses – Moving to Virtual
UPDATE: While we originally had two great opportunities to learn more about GMU Biodefense graduate degrees – the PhD Open House on Wednesday March 18th at 7pm in Arlington, and the March 26th Master’s Open House, at 6:30pm, both events are cancelled and we will be providing virtual opportunities in the near future. Please stay tuned for more updates here.

COVID-19 – A Pandemic and Problems
This week the WHO finally declared the SARS-CoV-2/COVID-19 outbreak a pandemic. On Wednesday, President Trump addressed the nation regarding COVID-19 with an attempt to calm the country regarding healthcare costs and employees/businesses impacted. “The dramatic centerpiece of Trump’s speech was a ban on travelers from Europe entering the U.S. for 30 days. In theory, this might at least prevent new cases from coming to the U.S. and seeding outbreaks. But many experts think it is far too late for that.” Over 125,000 cases have been reported, and nearly 1,300 cases have been identified in the United States as of Wednesday. Several states have declared emergencies and the CDC is discouraging people of older age and with chronic conditions related to the heart, lungs, or diabetes, to stay home if there are outbreaks in their communities, as there is an increased risk for severe disease should they acquire SARS-CoV-2. The U.S. State Department has issued a Global Level 3 Health Advisory, which “advises U.S. citizens to reconsider travel abroad due to the global impact of COVID-19. Many areas throughout the world are now experiencing COVID-19 outbreaks and taking action that may limit traveler mobility, including quarantines and border restrictions. Even countries, jurisdictions, or areas where cases have not been reported may restrict travel without notice.” A new risk assessment by the European Center for Disease Control (ECDC) noted that “It advised countries to quickly shift to mitigation strategies to protect vulnerable people and prevent overwhelmed hospitals. Reports of dire conditions in hospitals in Italy’s hot spots have been circulating on social media for the past few weeks and are now appearing in medical journal and media reports. The ECDC acknowledges that high numbers of patients needing ventilation have exceeded intensive care unit (ICU) capacity in some healthcare facilities in northern Italy.” Testing for the disease is ramping up in the U.S., but still quite slowly, meaning that not all people wanting the test will get it as it depends on clinical presentation and epidemiological risk factors. The challenge though, is that this is still influenza season and for many, there is concern about what to do if you have a fever and cough. Check out guidance here and GMU Biodefense alum Saskia Popescu’s comments -“Because this is such a novel situation, people want a novel approach to handling it. They want a novel way to better isolate themselves or some crazy new hand-hygiene technique,” says Saskia Popescu, senior infection prevention epidemiologist at HonorHealth, a health system in Phoenix. “That’s just not the case. These are tried and true methods — we just need to be really vigilant with them.” Worried about dating and intimacy during the outbreak? Here are some good recommendations on love in a time of COVID-19. “It’s okay to cancel a date because you don’t feel great, and the person you’re canceling with should be happy about that. But in honesty, it’s okay to encounter other humans in the wild. We are not at a point yet where you need to lock yourself in your house and never see another human.”

Pathogens on a Plane
Airports and airplanes are dreaded areas during any kind of outbreak, endemic or novel. In light of the ongoing pandemic, researchers Christopher Robertson and Keith Joiner at the University of Arizona suggest that airlines require vaccination for all passengers or require proof of medical exemption. Unfortunately, a vaccine for COVID-19 is yet to exist and the vaccine would not counteract the exposure from unidentified cases of infection, especially given incubation periods. If a vaccine for an infectious disease of concern is unavailable to the public or nonexistent, then the vaccination requirement will serve little purpose in quelling its spread. That said, there is certainly room for improvement regarding the precautions and measures taken against infectious disease spread from air travel. Dr. Nereyda Sevilla, graduate of the GMU Biodefense PhD Program, focused her dissertation on the transmission and risks of airplane-borne infectious diseases. Sevilla’s research analyzed the impact of air travel on the spread of pneumonic plague, a disease with a high mortality rate. Her results indicate that transmission via air travel depends on the type of disease, specifically, its duration of illness. Nereyda makes the following recommendations: (1) expand the definition of close contact on aircraft, (2) require health contact information with all plane tickets purchases, (3) expand self-sanitizing measures, (4) improve travel alerts and advisory notices during the ticket sales process, (5) perform temperature checks on a limited and random basis, and (6) improve crisis communication.

Myanmar’s Chemical Weapons Program
GMU’s Biodefense Program Director Dr. Gregory Koblentz and master’s student Madeline Roty  encourage the US to help Myanmar come clean about its chemical weapons program in a new article. Myanmar’s secret chemical weapons program, now believed to be inactive, is a commonly underacknowledged topic, even by the US government. It was not until early 1988, 5 years after intelligence arose about Myanmar seeking to product chemical weapons, that the US publicly accused Myanmar of developing chemical weapons. The motivation and objective of the clandestine weapons program remains unclear, but speculation includes defense or offense measures against domestic insurgencies or neighboring countries.  Despite its continued denial of the program, Myanmar seems to be moving toward transparency with its willingness to address concerns about its adherence (or lack thereof) to the Chemical Weapons Convention. Recent reporting of chemical weapons deployment by the Myanmar military remain unconfirmed but suspected. This is especially concerning given the persecution of the minority Rohingya, likely targets of all kinds of weapons. In an optimistic turn, last month, the country hosted a US delegation of experts to discuss the CWC, an important step toward transparency. Hopefully, for both its status among the liberal international order and the safety and security of its people, Myanmar will choose a path of openness about its chemical weapons programs.

NPT’s Uncertain 50th Birthday
5 March 2020 marked the 50th anniversary of the Nonproliferation Treaty (NPT) entrance into force, and the 25thanniversary of its indefinite extension.  The NPT is an international treaty aimed at preventing the spread of nuclear weapons and related technology, promote cooperation for peaceful uses of nuclear energy, and work toward comprehensive nuclear disarmament. Advocates of the NPT can boast that only 13 states have ever possessed nuclear weapons and, of those, 4 disarmed in a nuclear reversal. Opponents of the NPT can highlight the growing threat of non-NPT nuclear weapons possessors (India, Israel, Pakistan) and states of immediate proliferation concern(Iran, DPRK, Syria). This year will also see a quinquennial Review Conference for the NPT, to be held at the United Nations in New York City and attended by representatives from the 191 states that are party to the treaty. Unfortunately, the upcoming Review is anticipated to be disastrous as members without nuclear weapons remain dissatisfied that 5 member states (US, UK, France, China, and Russia) continue to maintain their nuclear weapons stockpiles, and more members consider nuclear hedging as part of their national security strategies. The upcoming Review will provide further insight on the state of the nuclear weapons non-proliferation norms regime.

Pandemics and Podcasts
This week we’ve got two great podcasts for you – the first is from Foreign Policy and entitled (appropriately) Don’t Touch of Your Face. “On the last day of 2019, China reported an unusual outbreak in Wuhan, a port city with a population of 11 million. Within two months, the disease would spread to almost every continent on the globe and kill thousands of people. From Foreign Policy, a podcast about the extent of the COVID-19 contagion, the threat it poses, and what countries are doing to contain it. Join FP’s James Palmer and Amy Mackinnon as they track the spread of the virus and explore what it means for people’s everyday lives.” Our second podcast to share is Authors of Mass Destruction, which “focused on helping authors write great stories while getting the details right. Tune in for interviews with leading experts on weapons of mass destruction and emerging technologies, author interviews, technical modules, and reviews of what TV shows and movies get right and wrong. The podcast will help authors who write about mass destruction develop impactful ideas for their page-turning plots and provide tips for conducting research.” Don’t miss the recent podcast with GMU Biodefense alum Saskia Popescu on bioweapons, healthcare preparedness, and everything from Ebola to antimicrobial resistance.

 

 

Pandora Report: 3.6.2020

COVID-19 Continues
As of 5 March, there are 99 confirmed cases as well as 10 COVID-related deaths in the US. Among the 50 States, 13 are reporting cases: Arizona, California, Florida, Georgia, Illinois, Massachusetts, New Hampshire, New York, North Carolina, Oregon, Rhode Island, Washington, and Wisconsin. The global case count is approaching 100,000 and the death toll is just under 3,300. Now, 79 countries are presenting with coronavirus cases. As the pandemic unfolds, conspiracy theories and misconceptions persist, but financial support for the response grows and the progress made in pandemic preparedness unveils itself.

As the outbreak crests into a pandemic, the onslaught of information and advice, both accurate and baseless, intensifies at a commensurate rate. Conspiracy theories claiming that COVID-19 is the result of bioterrorism perpetrated by either the Unites States against China or by China in an effort to wage war against the United States been espoused and then rejected. These fantastic claims are unsupported given the lack of evidence within the virus’s genome that it is the product of bioengineering; COVID-19 is a zoonotic disease. Beyond its origins, the internet is overrun with faulty advice about protecting oneself from the virus. To combat these inaccuracies, the WHO published a myth busters page for COVID-19 with quick facts and clarifications for coronavirus-related topics ranging from prevention folklore to treatment misconceptions. For example, neither dousing yourself in alcohol nor submerging yourself in a hot bath are effective in killing the virus. Though delicious as an addition to whipped butter, garlic does prevent COVID-19 infection. According to NewsGuard, an online tool that assesses the credibility of news and information websites, the barrage of myths and misinformation regarding the pandemic dwarfs reliable information. For instance, Zero Hedge, a site that supported the fabrication that coronavirus was a bioweapon stolen from Canada, had 2.1 million social media engagements over the last 3 months; however, the CDC’s website had less than 200,000 social media engagements over the same time frame. NewsGuard’s Coronavirus Misinformation Tracking Centerfound almost 100 sites publishing false information about COVID-19 in the US, UK, Italy, Germany, and France.

On a cheerier note, resource support for the COVID-19 response is growing. The World Bank just announced a support package that will make immediately available up to $12 billion in financing for country response needs. This funding is intended to support response and lessen the impacts of COVID-19 as well as provide policy advice and technical assistance. Similarly, the US Congress approved $8.3 billion in emergency spending for coronavirus response, specifically for the research and development of vaccines, therapeutics, and diagnostics. Current funding will support the current response activities but also aid in the preparedness for the next big outbreak. Though it is easier to wag fingers and berate preparedness failures, impressive improvements have been made over the last 20 years toward stronger preparedness, response, infection control, and policy. Health Security is using this pandemic as a chance to reflect on the progress made toward outbreak preparedness since the turn of the century. This special release features 10 articles that span lessons from SARS, quarantine, economic impacts of infectious disease outbreaks, health information communication, public health policy, and preparedness.

News of the Weird
As the chaos and anxiety grow amidst the COVID-19 pandemic, shortages of staple items abound. As the old adage goes, desperate times call for desperate – and puzzling – measures. A newspaper outlet in Australia, NT News, published its latest issue with an additional eight pages to serve as emergency toilet paper for its subscribers. Australians are among the many people stocking up on groceries and household essentials as the pandemic continues, leaving many such items, like toilet paper, unavailable. In fact, some stores are instigating quotas on these products to prevent frenzies from shortages and price gouging by stockpilers. Similarly, the surge in demand for hand sanitizer means that stores are straining to maintain stock levels, so some customers are turning to DIY options. Unfortunately, homemade sanitizer, experts warn, must be precisely formulated to be effective. For example, an effective hand sanitizer must contain at least 60% alcohol content for efficacy, which also makes the substance quite harsh on skin. Instead of turning to Pinterest and YouTube, prevent disease transmission by thoroughly washing hands with soap and water. This is an easy yet underutilized preventive tactic given WebMD’s latest tweet stating that only 31% of men and 65% of women wash their hands after using the restroom. WYH.

Highlights from Dr. Gerstein’s Book Talk
This week, Dr. Daniel Gerstein, graduate of the GMU Biodefense PhD program, was the featured speaker in the Center for Security Policy Studies (CSPS) Speaker Series. Gerstein spoke on his new book, The Story of Technology: How We Got Here and What the Future Holds, discusses the swift proliferation and inescapable influence of technology in human societies. His lunchtime presentation illuminated the perils of technology but also the benefits. Beyond his latest publication, Gerstein talked about his career accomplishments, noting the critical role his Schar School education played in his later successes. He is currently a senior policy researcher at the RAND Corporation, and previously served in the US Department of Homeland Security (DHS) as Under Secretary (Acting) and Deputy Under Secretary in the Science & Technology Directorate. Current students in the Biodefense master’s program found the presentation informative and inspirational as they prepare to soon launch their careers as in the field.

Upcoming Event: Policy vs. Pandemics with Dr. Nathan Myers
On 26 March 2020, GMU’s Biodefense, MPP, and MPA Programs are co-sponsoring an event featuring Dr. Nathan Myers – Policy vs. Pandemics: Polarization and Public Health Emergency Preparedness. Dr. Nathan Myers is an associate professor of political science and public administration at Indiana State University. His research interests include public health policy, U.S. executive branch politics and administration, emergency planning and preparedness, and regulation of biotechnology. He is the author of Pandemics and Polarization: Implications of Partisan Budgeting for Responding to Public Health Emergencies (Lexington Books, 2019). Political polarization is being blamed for many areas of dysfunction in the U.S. government, and the response to infectious diseases is not immune to this concern. This presentation will discuss how a lack of cooperation between Democrats and Republicans has hindered the ability of the nation to carry out essential public health emergency response functions, such as biosurveillance and the development and deployment of medical countermeasures. Particular attention will be given to bipartisan efforts to move forward with public health preparedness efforts, such as the implementation of the National Biodefense Strategy, in light of the challenges posed by the global coronavirus pandemic. Light refreshments will be served for attendees and books will be available for purchase. Register for the event at here.

 

Pandora Report: 2.28.2020

Welcome to your favorite weekly source for all things biodefense! We’ll be doing a shorter, slightly delayed newsletter next week, but rest assured, your source for global health security news will be back in full force on March 13th. Fortunately, we’ve got a registration page for you to reserve a spot (with an early-bird registration discount!) for the 2020 workshop on Pandemics, Bioterrorism, and Global Health Security: From Anthrax to Zika.

Experts Examine COVID-19 and an Unsettling Response by the Chinese Government
Missed the Coronavirus and Its International Ramifications February 21st event at GMU? Here’s a great recap. While the lively discussion was even-tempered, the information imparted about the global health crisis was often staggering. No less than a longtime veteran of international health emergencies—including investigating Japan’s nuclear reactor crisis—is alarmed. “This is an astonishing outbreak,” said senior vice president of the Center for Strategic and International Studies Stephen Morrison, director of the center’s Global Health Policy Center. “What we think we know today could change tomorrow.”

International Security Crisis Reader
This week’s International Security Crisis Reader covers biosecurity and the global Covid-19 pandemic. An article by our own Dr. Gregory Koblentz, Director of the Biodefense Graduate Program at GMU, is a featured piece. Koblentz’s Spring 2010 article, “Biosecurity Reconsidered: Calibrating Biological Threats and Responses,” describes how biosecurity arose as a critical component of the international security agenda, scrutinizes the contending definitions and conceptualizations of biosecurity, and outlines a taxonomy of naturally-occurring and human-made biological threats to international security. Other featured articles cover HIV/AIDS amidst the conflict in Africa, globalization and biosecurity, and intelligence assessments for biosecurity threats. The Crisis Reader can be found here.

SARS-CoV-2/COVID-19 Pandemic Updates
This week has been non-stop in terms of COVID-19 news and cases. From possible community spread in California, and  8,400 people being monitored, to a state of emergency being called in certain counties, there’s been a lot going on. On Thursday evening, the CDC revised the criteria to guide evaluation of patients under investigation for COVID-19 – this now expands to those with symptoms and travel to an affected area (China, Iran, Italy, Japan, and South Korea), as well as those with severe acute respiratory illness requiring hospitalization without a source of exposure. A whistle blower recently came forward and “is seeking federal protection after complaining that more than a dozen workers who received the first Americans evacuated from Wuhan, China, lacked proper training or protective gear for coronavirus infection control.” On Wednesday President Trump gave a press conference on the pandemic, breaking from what senior public health officials have said about the likelihood for additional cases in the United States. Vice President Pence has also been tasked with leading the COVID-19 response in the U.S., however there was concern on Thursday regarding the communication channels that are now being put in place. Shortages and communication gaps within response has been problematic in recent weeks, with comments of disruption being left to air without more guidance. Many are wondering how they can prepare though and experts have worked to dispel fear but also encourage general preparedness measures. GMU biodefense alum Saskia Popescu recently spoke on this, noting that “‘A lot of preparedness is planning ahead of time,”’ Popescu said.’“Practice makes permanent. If I have a plan, that means I don’t have to panic.’ ‘The most important thing right now is to remain calm,’ she said. ‘Remember, we don’t have that many cases in the U.S., and prevention strategies for this coronavirus are not new. We’ve been doing them for years’.” You can also hear her speak on NPR’s On Point with Jeremy Konyndyk regarding preparedness in the United States. Cases have continued to grow outside of China as Italy, South Korea, and Iran all report many infections. As COVID-19 cases spring up more and more outside of China, thoughts of containment have moved to mitigation. There has been increasing attention to the economic impact of the pandemic, and the UBS Chief Investment Office recently noted “While the situation in China appears to be improving, the next two weeks will be important in determining whether the authorities in Europe and elsewhere can quickly contain the outbreak, or whether there is a further rapid spread of the virus.The full impact on economic activity from the COVID-19 epidemic remains in a state of flux.” Moreover, they note that “In a risk case where containment in China takes much longer or the spread abroad significantly worsens, further reductions to growth would have to be made.” Realistically, how does one keep China’s economy running with 750 million in quarantine? Public trust has been hard hit and overstressed public health/healthcare systems aren’t helping. “The good news for Xi and the party at the moment is a decline in reported new cases and deaths nationwide (the vast majority in Hubei). The bad news, however, is that Hubei’s horrors have tarnished the trust many Chinese had in their officials’ ability to safeguard citizens’ lives and livelihoods.” Realistically, this also calls into attention the travel bans that despite continued use, fail to be truly effective. From discouraging transparency to the realistic issues in focusing on symptoms during respiratory virus season, these efforts appear more taxing than helpful. The economic impact of the outbreak will continue to be a topic of conversation though, as President Trump scrambles to downplay the stock market losses this week.

Synthetic Biology Surprise: Synthesis of Vaccinia Virus
Dr. Gregory D Koblentz, the Director of the Biodefense Graduate Program at Schar School of Policy and Government at George Mason University, published an article this week in the Bulletin of the Atomic Scientists about a frightening feat in biotechnology that remains unnoticed amidst the chaos of Covid-19. In January, Tonix Pharmaceuticals discreetly announced that it had successfully synthesized the vaccinia, the virus used for the smallpox vaccine, in a press release about a poster it presented at an American Society for Microbiology conference. Tonix’s “achievement” was sought after despite serious concerns from several biosecurity experts, many of whom raised criticism of the firm’s synthesis of horsepox virus in 2017. Of grave concern is the utility of synthesized vaccinia as the benefits do not outweigh the risks. In fact, synthesis is unnecessary for researching vaccinia as samples are widely available.  Any claims that Tonix’s work was intended to help develop an improved or safer smallpox vaccine are undercut by the recently licensed JYNNEOS vaccine, a 3rd generation smallpox vaccine developed by Bavaria Nordic. The resources and skills needed to synthesize even complicated viruses are becoming more readily available as synthetic biology and the flourishing bioeconomy lower costs and simplify processes. Unfortunately, the lack of regulations and oversight for DNA synthesis, whether in the name of peaceful research or otherwise, is not matching pace with its accessibility to scientists and DIY bio-users. This is yet another example of the possibilities – both beneficial and detrimental – made reality by synthetic biology, and the risks of puny safeguards for its tools and data.

Upcoming Event: The Story of Technology by Daniel Gerstein, PhD
On 4 March 2020, the CSPS Speaker Series is hosting Dr. Daniel Gerstein, a GMU Biodefense PhD alumnus, to discuss his new book, The Story of Technology: How We Got Here and What the Future Holds. The book examines the rapid proliferation and pervasive influence of technology in human societies. Dr. Gerstein is a senior policy researcher at the RAND Corporation, and he has served in the Department of Homeland Security as Under Secretary (Acting) and Deputy Under Secretary in the Science and Technology Directorate. Dr. Gerstein will be joined by Ellen Laipson, Director of the Master’s in International Security program and CSPS, and Dr. Gregory Koblentz, Director of the Biodefense Program. The event will take place at Noon in Room 113 of Van Metre Hall. Drinks and cookies will be provided. Register here.

Opportunities with the GHSA Next Gen Network
The Global Health Security Agenda’s Next Generation Network just announced its 2020 theme: Inclusive Expansion. Toward that, applications for the Next Gen Mentorship Program are open until 18 March and matches will be announced on 2 April. Apply here for the Mentorship Program. Additionally, leadership positions are available as regional coordinators; apply here. Other opportunities include helping to translate documents into multiple languages. To assist, email your name and language proficiencies to the coordinator at nextgenghsa@gmail.com. For more information on the Global Health Security Agenda click here and for more information on the GHSA Next Generation Network click here.

Covering COVID-19: What do you need to know?
Don’t miss this March 10th event hosted by the Association of Health Care Journalists. The COVID-19 outbreak story is evolving quickly and there are many unknowns about the epidemic, including how contagious the virus is, its mortality rate and whether there is undetected spread occurring outside of China. Providing accurate information to the public is more important than ever in this moment of uncertainty. Hear a panel of infectious disease experts and a journalist explain what is known, what to watch out for, where to find trusted resources and how to combat misinformation and confusion. Speakers include: Maryn McKenna, independent journalist, author; Senior Fellow of the Center for the Study of Human Health at Emory University. Michael Osterholm, Ph.D., M.P.A., director, Center for Infectious Disease Research and Policy. Saskia Popescu, senior infection preventionist at Honor Health, ELBI Fellow, and managing editor of Pandora Report.

Pandora Report: 2.21.2020

Happy Friday Biodefense Gurus! We have a packed edition of the Pandora Report this week, but before we begin – don’t forget to register and reserve your spot for the “Coronavirus & International Security” panel event this evening in Arlington, VA. The CSPS Distinguished Speaker Series event will be at 5pm and you can find more information and register here.

GMU Biodefense Summer Workshop on Pandemics, Bioterrorism, and Global Health Security
We’re excited to announce the summer dates for the workshop: Pandemics, Bioterrorism, and Global Health Security: From Anthrax to Zika. This three and a half-day workshop will be held in Arlington, VA, from July 13-16, 2020. Registration links and speaker information will be provided in the coming weeks. We hope you’ll join us for this immersive and engaging workshop with some of the top minds in the biodefense world, where we’ll discuss everything from synthetic biology to MCM, antibiotic resistance, and the current outbreak of COVID-19.

CW Use in Syria – Atrocities and Accountability 
We’ve got the scoop on a brand new article by GMU Biodefense graduate program director and professor Dr. Gregory Koblentz in Nonproliferation Review regarding Assad regime use of chemical weapons. International efforts to hold the government of President Bashar al-Assad accountable for the use of chemical weapons in the Syrian civil war have entered a new phase. For the first time, the Organization for the Prohibition of Chemical Weapons (OPCW), the international organization responsible for implementing the 1993 Chemical Weapons Convention, has been empowered to identify the perpetrators of chemical attacks in Syria. The Investigation and Identification Team (IIT), which was formed to conduct the OPCW’s new attribution mission, has announced its intention to investigate and identify the perpetrators of nine chemical attacks in Syria, including the April 7, 2018, attack in Douma. This article reviews recent efforts to attribute chemical attacks in Syria, describes what we know about the nine incidents to be investigated, discusses what to expect during the next phase of the attribution process, and offers insights into how the international community can move beyond attribution to accountability. An annex to the article summarizes what is known about the Syrian government officials, military commanders, and chemical-warfare scientists suspected of being responsible for these attacks. As Koblentz notes, “Without attribution, there can be no accountability. Without accountability, the atrocities will continue: if not by the hand of Assad, then by others emboldened by his ability to use outlawed weapons to hold onto power.” You can read the article here, which builds upon his previous research on Syria’s chain of command for the use of chemical weapons and international efforts to hold the regime accountable for these attacks.

Reaping What You Sow: The Case for Better Agroterrorism Preparedness
GMU Biodefense MS student Stevie Kiesel is pulling back the curtain on this all too forgotten aspect of biodefense – agroterrorism. “An attack on the food supply gives the perpetrating group several benefits. First, the psychological and economic effect of targeting food supplies would be substantial. Such an effect could have a powerful pull with a group such as al Qaeda, who has shown interest in biological weapons and in targeting US economic strength. Second, and related, this type of attack would be relatively low cost when compared to the economic effects it could cause. Third, similar to other forms of terrorism, agroterrorism can allow a weaker group to lessen the power imbalance between themselves and the state they are targeting. Fourth, some groups may turn to agroterrorist tactics because these attacks ‘do not harm humans directly and may therefore be more easily justified’.” Read more of Stevie’s highly engaging and relevant article here.

SARS-CoV-2/COVID-19 Outbreak Updates
As of Thursday evening, there have been 76,214 cases and 2,247 deaths related to COVID-19. From the realm of synthetic biology, many are rushing to recreate SARS-CoV-2 from its DNA code. Since it only took a few weeks to get the genetic sequence of the virus, many researchers are hoping to start ordering copies of genes to build it for efforts like diagnostic testing and vaccine development. On another front, one of the biggest topics has been that of cruise ships…One in particular, the MS Westerdam, finally docked and passengers/crew disembarked in Cambodia. Unfortunately, following the release of passengers, one was later found to have the disease, which has prompted concern as people have begun their travels home. The other, the Diamond Princess ship, finally saw its passengers allowed to leave the controversial ship-based quarantine. 621 (20% of the people onboard) of those on the ship tested positive for the virus. “Those passengers who have been declared free of the virus and are leaving the ship for the first time in two weeks face a confusing array of circumstances. Many will be forced to undergo a 14-day quarantine upon their return home — reflecting a lack of trust in the effectiveness of the ship’s quarantine. Others can remain in Japan under their own recognizance but are still barred from returning home for two weeks.” Here is a good timeline of the outbreak onboard and how the ship was initially placed into quarantine on February 4th after 10 people onboard tested positive. Passengers being flown back to the U.S. have been sharing their account of the experience, but as these two cruise ships provide unique examples of outbreak response, it sheds light on the limitations of quarantine and challenges of public health efforts during the COVID-19 outbreak. “Based on what is known so far, Cambodia’s approach is preferable to quarantining people aboard a ship where the virus is spreading, said Saskia V. Popescu, GMU Biodefense alum and senior infection prevention epidemiologist for HonorHealth, a hospital system in Phoenix. But that requires educating passengers about reporting symptoms and self-isolating if necessary, and having public health authorities in home countries closely monitor those who have returned. It includes quickly tracing the contacts of anyone who develops the infection. ‘I think we can say if you’re going to quarantine people, doing it on a cruise ship is not the best place,’ Popescu said.” In the face of these exhaustive efforts to respond to the disease, conspiracy theories have been a frustrating distraction – Chinese labs have noted that these often hurt efforts to curb the virus and scientists around the world have been working to condemn rumors and conspiracy theories regarding the origin of the virus. “A group of 27 prominent public health scientists from outside China is pushing back against a steady stream of stories and even a scientific paper suggesting a laboratory in Wuhan, China, may be the origin of the outbreak of COVID-19.” Senator Tom Cotton continues to push such conspiracy theories. The Federation of American Scientists (FAS) has a new initiative regarding the outbreak, known as the Coronavirus Project. The project focuses on debunking misinformation and providing accurate information from qualified researchers and scientists. “Since late 2019, information about the infectious Coronavirus has been trickling out from sources around the web. But not all information is created equal. Some of this information comes from science and medical professionals, who have years of experience in epidemiology. Some comes from unreliable anonymous internet accounts, bad actors, and hoaxers.” Despite these distractions, a paper in The Lancet recently emphasized the support for scientists, public health professionals, and medical professionals in China combatting the disease. “We have watched as the scientists, public health professionals, and medical professionals of China, in particular, have worked diligently and effectively to rapidly identify the pathogen behind this outbreak, put in place significant measures to reduce its impact, and share their results transparently with the global health community. This effort has been remarkable.” In times like these, the global health security community truly comes together to address common vulnerabilities and enhance strengths.

The Economic Impacts of COVID-19
The ongoing outbreak of coronavirus has already infected over 75,000 people and taken over 2,000 lives. The newly dubbed COVID-19 outbreak originated and remains strongest in China, but the economic effects of the it is already rippling across the globe. As an outbreak disseminates and intensifies, the labor force shrinks (at least temporarily), supply chains fracture, international mobility of persons and products decelerates or ceases altogether, and spending and investment decline. Though the full magnitude of economic effects from the outbreak can only be speculated upon at this point, the downward economic trends have begun. The sectors most impacted and at highest risk, thus far, are technology, oil, apparel, retail, tourism, and automobiles. The losses in production from Chinese manufacturing of key inputs and final products are critical drivers of the losses we are seeing and will continue to see across the globe. These items include iron, steel, aluminum, textiles, cement, chemicals, toys, electronics, and many more. According to the latest Statista Infographics Bulletin, global shipments of various tech products are expected to fall by 4.5 to 16% in this first quarter of the year. China is the world’s primary producer and exporter of textiles, so the fall in Chinese textile production will impact the global apparel and retail markets. Global oil demand is falling for the first time in over a decade as global transit drops from diminished trade and travel. Travel bans are, of course, squelching international tourism and costing travel hot spots to lose revenue. This is compounded as major events that attract troves of visitors are cancelled in response to COVID-19 fears. For instance, projections from the UN’s International Civil Aviation Organization expect Japan to lose $1.3 billion and Thailand to lose $1.2 billion in tourism revenue just in this first quarter. Due to the travel bans and the general disinclination to travel at the moment, US tourism from Chinese visitors will take a compounding hit in addition to the losses from the ongoing trade war with China. Relatedly, global airline revenues are predicted to drop by $4-5 billion in the first quarter of 2020 due to flight cancellations. Automobile makers are closing plants in China as the much-needed inputs such as steel and aluminum are shrinking the availability of parts. As ground zero, China is suffering the most so far. China’s growth rate is expected to drop from 6% to 4.5% in the first quarter of 2020. As the infection sweeps through the Chinese labor force, factories are shutting down or lowering output capacity, slowing the flow of parts and final products from China. Virtually all countries are and will be impacted by the break in the supply chain as a result of reduced output from China. The absence of a single small component may render a final product unachievable.  As supply falters across various sectors and products reliant on Chinese manufacturing, we should anticipate a rise in those prices. On the other hand, China is one of the largest markets for US products, especially Apple electronics and fashion items, so we should anticipate a significant decline in demand from that large consumer base as spending shrinks among the Chinese population. The Severe Acute Respiratory Syndrome (SARS) outbreak in China in 2003 provides a rough analogue on which to base predictions of the economic impacts of COVID-19. Virulence was highest from November 2002 to July 2003, and that nine month period was all the time needed for the disease to infect almost  8,500 people and kill over 800 people globally. Lee and McKibbin estimate the total economic cost of the 2003 SARS epidemic to be around $40 billion. The geographic dissemination of COVID-19 is currently akin to that of 2003 SARS with cases concentrated in China and small clusters popping up in Asia, Australia, Europe, and North America. The COVID-19 mortality rate is much lower at 2% versus 10%; however, the total number of coronavirus cases after just a couple months greatly surpasses the total case count for SARS at over 75,000. Though the loss of life may, thankfully, be much less severe with COVID-19, the adverse economic impacts of this outbreak may greatly surpass that of SARS. In 2020, we are more of a global economy than in 2003 and supply chains for a cornucopia of products are spread across nations and even continents, so a kink in one place catalyzes a domino effect across borders and industries. Unfortunately, there is no end in sight for COVID-19 as we approach March; therefore, the hits to the global economy will continue to spread across sectors and countries, as well as grow in severity. Only time will tell the full scale and spectrum of adverse economic effects instigated by COVID-19.

The 2021 Nuclear Weapons National Security Budget Proposal
The 2021 budget proposal exemplifies the continuing shift in the US nuclear posture toward a renewed nuclear arms race. This month, President Trump sent Congress a proposed Fiscal Year 2021 budget request of $740.5 billion for national security, 95% of which is for the Department of Defense. The clear priority of the proposed budget is the expansion of investment in and capabilities of US nuclear weapons. The proposal requests almost $29 billion, a 16% increase from the previous year, for the modernization of the US nuclear weapons arsenal. In addition to the $29 billion for modernization, the proposal includes other related items that would bring the total nuclear weapons budget to about $50 billion. The bump in nuclear weapons investment comes at the cost of shrinking most other security and defense programs. This should come as no surprise given Trump’s proclivity for nuclear strength as evidence by his late 2016 tweet, “must greatly strengthen and expand its nuclear capability until such time as the world comes to its senses regarding nukes.” Despite recommendations that DOD dedicate more resources on challenges from strategic rivals, namely China and Russia, the proposal outlines cuts to such programs. For example, the Navy is preparing for a significant reduction in funding for new warships. Lawrence J Korb, former Assistant Secretary of Defense for Logistics and Materiel Readiness, recommends that the administration extend the New Strategic Arms Reduction Treaty (START) with the Russians and resume negotiations. This would renew efforts toward reducing nuclear arsenals and enable the allocation of limited resources to programs that make our country and the world safer.

GAO Report – National Biodefense Strategy
The Government Accountability Office (GAO) has released a new report – “National Biodefense Strategy: Additional Efforts Would Enhance Likelihood of Effective Information”. You can access it here, but the report notes that “There are a number of challenges, however, that could limit long-term implementation success. Among other things, there was no documented methodology or guidance for how data are to be analyzed to help the enterprise identify gaps and opportunities to leverage resources, including no guidance on how nonfederal capabilities are to be accounted for in the analysis. Many of the resources that compose national capabilities are not federal, so enterprise-wide assessment efforts should account for nonfederal capabilities.” Moreover, the report points out that agency officials struggled to identify how decisions were made and there generally lacked a clear process or series of roles for joint-decision making, “As a result, questions remain about how this first-year effort to catalogue all existing activities will result in a decision-making approach that involves jointly defining and managing risk at the enterprise level.”

Pandemics and Podcasts
There are a lot of great podcasts in the infectious disease and biodefense world, so we’ll be spotlighting a few from time to time. Our first is the Next Generation GHS episode from last week, in which GMU Biodefense MS alum Jessica Smrekar sat down to discuss COVID-19. You can listen to it here. Jessica noted that “It was great sitting down with Jono and Taylor to hash out this rapidly developing COVD-19 outbreak in light of Jono’s book, The End of Epidemics: The Looming Threat to Humanity and How To Stop It. We discussed at length the weak links in local, national, and international health structures that leave us vulnerable to disease outbreaks and how we can remedy these in the future. Jono’s book outlines 7 specific actions that, if taken, could reduce these gaps and allow us to create a safer world. We explored the problems we face in developing strong, resilient health systems and how these actions work to solve those problems. Though the COVID-19 outbreak really highlights that we are not where we should be to keep our world safe, Jono expressed ‘the NextGen Group and your leadership and the fact we have such a mobilized network worldwide makes me optimistic. I think we’re building a really powerful network, both internationally and at the national level. And it’s that network of capable, informed, engaged people, who really do care about having a safer world, I think that’s what makes me feel optimistic’.”

News of the Weird
Video games and outbreaks – apparently they go hand in hand. Virus games are growing in popularity right now, in the middle of the COVID-19 outbreak, especially that of Plague, Inc. “Plague Inc. and Pandemic may have a certain morbid appeal in the time of the coronavirus. But they have more than that to offer, many experts and players agree. ‘I can certainly understand the hesitation around this — no one wants to trivialize the very real human suffering that this coronavirus has brought with it,’ said Leacock, Pandemic’s creator. ‘But the reality is that playing helps us process the world around us, and people may be turning to these games now for that reason’.”

Outbreak Dashboard 
Qatar has reported a new MERS-CoV case, marking the fourth case since December. The DRC outbreak of Ebola has now reached 3,443 cases with over 330 suspected cases under investigation.

Pandora Report: 2.14.2020

To our amazing readers, we hope you’re having a lovely Friday and a happy Valentine’s Day! Did you know the CDC estimates that every year in the United States, more than 300,000 people cope with Trypanosoma cruzi infections (Chagas disease) due to those pesky kissing bugs.

The Coronavirus and Its International Ramifications
Don’t miss this February 21st event at GMU’s Van Metre Hall in Arlington, VA at 5pm -The CSPS Distinguished Speaker Series Presents: Coronavirus & International Security featuring: Steve Morrison, Ashely Grant, and Ketian Zhang. Join CSPS for a panel discussion on the broad implications of the coronavirus crisis, the role of the international community in global health management, and the implications for China, US-China relations, and East Asian security. The panel will be moderated by Ellen Laipson, CSPS Director. The event is free to the public but please register here to reserve your spot.

2019-nCoV/COVID-19 Outbreak Updates
The outbreak of COVID-19 has been quite the whirlwind so far. Case counts are changing so rapidly, that on Wednesday evening, over 60,000 cases were reported and by Thursday, it was well over 64,000. In quite possibly some of the worst timing, the HHS Budget in Brief was released this week, which revealed proposed funding cuts to CDC’s Public Health Preparedness and Response program by $25 million, as well as ASPR’s Hospital Preparedness Program. The CDC’s Global Health Security efforts might get an extra $50 million, which might not feel like much as their Emerging Zoonotic Infectious Disease programs and funding for the Epidemiology and Laboratory Capacity program are taking a huge hit.  While many were concerned about the rapid spike in cases as China sacked a senior city health official, the rise was due to a change in reporting definition, which was broadened to account for those without lab confirmation but meeting clinical definition. The United States now has 14 confirmed cases. The second case of the novel coronavirus among the U.S. evacuees from Wuhan, China, was also confirmed on Wednesday in the San Diego quarantine site. Earlier this week, the World Health Organization (WHO) announced the naming of the disease – COVID-19. The virus, previously known as 2019-nCoV, will be referred to as SARS-CoV-2 per the International Committee on Taxonomy of Viruses, meaning that SARS-CoV-2 is the virus that causes the COVID-19 illness/disease in humans. The role of healthcare transmission has been increasingly brought up, as roughly 500 healthcare workers were diagnosed by mid-January in Wuhan. The JAMA study recently released found that 41% of the 138 hospitalized cases they studied in Wuhan, were related to healthcare transmission. As the world struggles with personal protective equipment (PPE) supplies, the CDC has provided guidance to hospitals regarding the shortages that impact healthcare worker safety. GMU Biodefense doctoral alum Saskia Popescu recently wrote on the U.S. healthcare system’s readiness during this time – “For hospital officials, preparing for cases of coronavirus infection means not only ensuring they have adequate supplies, but also the right processes put in place for the rapid identification and isolation of potential patients—which can be challenging during a patient surge.” More concerning, the CDC announced that their rollout of the COVID-19 diagnostic tests will be delayed across the U.S. Also, the cruise ship that has been quarantined for what’s felt like weeks now is finally being allowed to dock and its passengers to disembark in Cambodia.

Bipartisan Commission on Biodefense- Next Evolution: Overhauling Key Elements of Biodefense 
The Bipartisan Commission on Biodefense is hosting this March 18, 2020 event “to inform our continuing assessment of biodefense programs with structural challenges that impede the government’s ability to safeguard the Nation. Topics to be discussed at this meeting include the: Select Agent Programs, BioWatch Program, and Hospital Preparedness Program.” RSVP here by March 13. Registration is required and attendance is free. This event will also be webcast (registration for webcast is encouraged). Lunch and refreshments will be provided. WEBCAST WILL GO LIVE just before 10:00 a.m. on March 18.

News of the Weird
Have you ever wondered what an authentic plague mask looked like? Now you can get a glimpse via the German Museum of Medical History as they are showing off a 16th century plague doctor mask here. “The mask had glass openings in the eyes and a curved beak shaped like a bird’s beak with straps that held the beak in front of the doctor’s nose. The mask had two small nose holes and was a type of respirator which contained aromatic items. The beak could hold dried flowers (including roses and carnations), herbs (including mint), spices, camphor, or a vinegar sponge. The purpose of the mask was to keep away bad smells, known as miasma, which were thought to be the principal cause of the disease, before it was disproved by germ theory.”

Center for Health Security Announces New ELBI Fellows
The Johns Hopkins Center for Health Security has announced the new class of fellows for the Emerging Leaders in Biosecurity Initiative (ELBI).  “As the current novel coronavirus epidemic shows, preparing for and responding to biological threats requires talented people from a range of fields working together to take on many complicated challenges,” said Tom Inglesby, MD, director of the Center. “Our 2020 Emerging Leaders fellows are the rising leaders who will be part of preparing for and responding to biological threats in our future, and we are very excited to work with them in the year ahead.”

“The Present and Future Promise of Synthetic Biology” at CSIS
Last week, the Center for Strategic and International Studies (CSIS) launched its Synthetic Biology: The Ongoing Technology Revolution Series with an inaugural forum. The speakers included Dr. Diane DiEuliis, Senior Research Fellow at National Defense University; Dr. Gigi Gronvall, Senior Scholar and Associate Professor at Johns Hopkins Center for Health Security; and Dr. Jason Kelly, Founder of Ginkgo Bioworks. Synthetic biology, SynBio for short, encompasses the concepts, methods, and tools that enable the creation or modification of biological organisms; it traverses the fields of biology, chemistry, engineering, and computer science. Several emerging technologies, such as artificial intelligence and CRISPR, along with emerging technology companies, such as SynLogic and Evolva, were discussed as boons for a variety of sectors. Further, the exponential improvement in computers, especially in programming, bolsters other technologies and efficiencies in the field. SynBio is growing for industrial, military, personal, and amateur uses. The methods by which a variety of products – medicines, tires, makeup, and more – are made is updating to use more efficient and less extractive means thanks to these tools. Some defense specific technologies mentioned were the LALO tactical boot made from Susterra propanediol, BioBricks made from algae, and structural composite materials derived from a polymer resin matrix. Personalized medicine, such as CAR-T cell therapy cancer treatment, caters to the specific and unique set of characteristics of a patient and her/his health needs. There are a number of advantages to SynBio, but the risks cannot be ignored. As these tools and methods become more available and accessible to more people and groups, the risk of dual-use research of concern (DURC) swells. Specifically, we now must recognize that the misuse and abuse of emerging technologies is no longer limited to states and large groups as DIY biology enables virtually any individual capable of creating or modifying an organism. The sticky situation created by DURC is the continued and encouraged advancement of synthetic biology while also discontinuing and discouraging its misuse and abuse. But, how do we quantify the benefits versus the risks of a new or improved technology? And, by whom? These are questions with currently elusive answers; however, the field of SynBio will not slow so that policy can catch up. There exist some barriers and bottlenecks to the safe and appropriate use of the outputs of SynBio. There is often some level of strategic confusion around a new output, especially given that lack of a one-to-one replacement of old for new. This means that a new technology may not comprehensively replace an old one. Relatedly, best practices are yet to arise and a set of international standards and norms remains unclear. Additionally, the bioeconomy remains largely unmeasured, leaderless, and underappreciated in risk assessment and mitigation. The lack of regulatory standards for any new and incomparable product or process can cripple its advancement and adoption, a current problem for SynBio as well as the bioeconomy in general. On the bright side, there are solutions to these barriers and bottlenecks. Investments in early stage R&D for cutting-edge programming, like that for the Human Genome Project, would provide widespread support to new biotechnologies. Of the same vein, we should target investment in particularly promising innovations like advanced materials and distributed manufacturing. Most importantly, expanding the openness in the life sciences as a whole will gain us more in security than we will lose. A recording of the forum can be accessed here.

2019-2020 Flu Season: CDC Preliminary Burden Estimate
While much attention has been to COVID-19, the CDC just released their preliminary estimate for this flu season and it’s no wonder hospitals are feeling overwhelmed. 22-31 million flu illnesses, 10-15 million flu medical visits, between 210,000-370,000 flu hospitalizations, and 12,000-30,000 flu-related deaths. This data provides a good reminder for why vaccination is so important and basic infection control measures -hand hygiene, staying home when you’re sick, cough etiquette, etc.

Rogue Scientists and Deadly Pathogens?
It’s not surprising that the current COVID-19 outbreak is bringing about questions related to synbio and screening gaps that leave potentially damning vulnerabilities. What would happen if you asked a lab to send you the genetic code to the influenza strain that caused the 1918/1919 pandemic? “What if I sent them the instructions for a new disease that I have reason to believe is dangerous? What if I was doing legitimate research, but my lab didn’t adhere to modern safety standards? The answer is that a few DNA synthesis companies will send me what I asked for, with no screening to check whether they’re sending out a pathogen that ought to be carefully controlled. (Synthetic DNA is not a live virus, of course; I’d have to be a talented biologist with specialized knowledge, lots of resources, and access to expensive tools to use it maliciously.)” Screening though, presents its own challenges as DNA is a dual-use technology and tool, and we have existing policies set in place to avoid potentially dangerous events. “So new screening — and new regulations backing the international use of that screening — is needed. The aim of a new screening regime should be to ensure that requests for DNA are checked to determine whether they contain prohibited, dangerous sequences, without adding too much to the expense of screening and without slowing down legitimate researchers, who should be able to access DNA for their projects cheaply and quickly.”

Pandora Report: 2.7.2020

ASM Biothreats – Full Coverage
It’s our favorite time of year – sharing detailed summaries of some of the top discussions, presentations, and panels from the 2020 ASM Biothreats conference. Check out the landing page here, which will give you an overview of our GMU Biodefense students who attended and brief descriptions and links to their work. Since this conference took place as the 2019-nCoV outbreak was growing into a PHEIC, these talks are very timely and critical to response and future preparedness efforts. From diagnostic innovations to MSF efforts during outbreaks, this was one of the best years yet – we also have coverage of NIAID Director Dr. Fauci’s talk on coronavirus infections. Don’t miss out on our detailed review of this wonderful conference.

2019-nCoV Outbreak Updates: From Quarantine to PPE Supply Chain Concerns 
It seems like every day is overloaded with new information about the 2019-nCoV outbreak. The rapid pace of information has helped in some ways but hurt in others – from those acting as experts to hastily published papers that grabbed headlines but were fundamentally flawed. Over 50,000 flights to China have been cancelled amid fear of the outbreak and the U.S. is still employing travel bans. Late Thursday, the CDC announced that it would be distributing testing kits to help expand laboratory capacity. “Initially, about 200 test kits will be distributed to U.S. domestic laboratories and a similar amount will be distributed to select international laboratories. Each test kit can test approximately 700 to 800 patient specimens.” The latest case counts are changing frequently, but as of Thursday evening there were 30,818  confirmed. 11 cases have been identified in the United States, fueling concern regarding PPE and other healthcare supplies. Maryn McKenna recently spoke to these issues as mask shortages could potentially spread globally, especially since most of the world’s supply come from China. “95 percent of the surgical masks used in the US and 70 percent of the respirators—thicker, tight-fitting masks that offer better protection against viruses—are made overseas. That leaves the mask supply vulnerable to labor disruption if a pandemic sickens manufacturing workers, as well as to flat-out diversion if a government decides to keep its own stock at home. ‘This is 100 percent a vulnerability,’ says Saskia Popescu, a biosecurity expert who is the senior infection-prevention epidemiologist in an Arizona hospital system. ‘Personal protective equipment is always going to be a problem when there is an outbreak of something novel, because public health guidance will be unclear at first and there will be a run on supplies. Masks being made offshore is one more stress on the system’.” The FDA announced on February 4th that they had issued “an emergency use authorization (EUA) to enable emergency use of the Centers for Disease Control and Prevention’s (CDC) 2019-nCoV Real-Time RT-PCR Diagnostic Panel. To date, this test has been limited to use at CDC laboratories; today’s authorization allows the use of the test at any CDC-qualified lab across the country.” As cases grow, small clusters challenging public health efforts have sprung up, like a cruise ship being held in Yokohama as Japanese health authorities screen and quarantine passengers following the confirmation that ten people aboard have the disease. China has also been sending in spray trucks of bleach to help the outbreak, which has baffled many. “The truth is that coronaviruses have really poor survivability on surfaces,” Saskia Popescu, a senior infection prevention epidemiologist who works at a Phoenix-based healthcare system, told Insider. “This is an organism that is generally spread through respiratory droplets. So that cough, that sneeze, and yes, your hands can get contaminated and then you touch your eyes, your mouth, and things like that.” She said the widespread use of disinfectants like bleach which is what was being used in truck sprayers in at least one Chinese city, Yichang, according to a local report is “a little over the top.” The Bipartisan Commission on Biodefense will be hosting a February 10th even – Containing the Coronavirus: Challenges to Thwarting the Outbreak, from 1:30pm- 3:30pm and can be attended in person or via webcast. “Panel participants will offer their perspectives on the role of the federal government in managing the crisis, the lack of transparency by the Communist Chinese Government, implications for U.S national security, and how the country can better prepare for when the next pandemic strikes.”

Bioweapons, Secret Labs, and the CIA: Pro-Kremlin Actors Blame the US for Coronavirus Outbreak
As the 2019-nCov outbreak rages and experts around the world work to identify its causes and quell its spread, the Atlantic Council’s Digital Forensic Research Lab (DFRL) reports that pro-Kremlin actors are blaming the United States of America for this expanding public health emergency. Specifically, these actors purport that the US employed bioweapons to disseminate the virus in China; however, this theory is, unsurprisingly, gaining little traction. Russia and its fringe members possess a history of wielding disinformation as a tactic against the US. For example, in 1983, Russia launched Operation Infektion, which falsely claimed that the AIDS virus was developed in a clandestine US bioweapons laboratory. Related theories continue to pop up from various Russia-based outlets as well as Russian YouTube channels with tales that the US designed the virus with the intent of sabotaging China’s economy from within its borders. These narratives implicate supposed US bioweapons programs, the CIA, and the Richard Lugar Center for Public Health Research in Tbilisi as the origins of the fictitious nefarious plot. Regardless of the spuriousness of these claims, this latest disinformation campaign serves as a strong “reminder of Russia’s long history of employing anti-U.S. influence operations during public health crises.”

Event Summary: Battling Insecurity, Mistrust, and Disease
GMU Biodefense PhD student Greg Witt recently attended an event hosted by the Nuclear Threat Initiative (NTI) and is providing us with a detailed account of the critical conversations on battling insecurity. The event was a follow-on to a series of technical workshops hosted by NTI and the Africa Centres for Disease Control and Prevention (Africa CDC) as part of the Initiative to Strengthen Biosecurity and Biosafety, which aims to resolve safety and security gaps related to biological threats in Africa. Opening remarks were delivered by NTI Co-Chair and Chief Executive Officer Ernest Moniz, who highlighted the complex, intertwined relationship between conflict and infectious disease and the consequent risks this connection poses to international and health security in Sub-Saharan Africa. Dr. Moniz described a tabletop exercise conducted by NTI and partner institutions as part of the 2019 Munich Security Conference, in which a fictional country in the midst of domestic unrest experienced a deliberate terrorist attack utilizing a highly-lethal biological agent. The results of this simulation were, in his words, “eye-opening, and not in a good way.” Read his full summary here.

One Health Advocacy: Education and Policy in Action – Webinar
Join the International Student One Health Alliance as we learn from Drs. Deborah Thomson and George Lueddeke about advocating for One Health through education and policy. Deborah Thomson, DVM is from the United States and is a One Health curriculum developer and the American Veterinary Medical Association’s Congressional Science and Engineering Policy Fellow. Her presentation will be “Non-Traditional One Health in Action.” This event will be held from 9am ET on Sunday, February 9th. You can register here.

Outbreak Updates
There has been one additional case of Ebola in the DRC in recent days. The outbreak has now infected 3,427 people. The CDC has released Week 4 flu data (ending January 25), with a large number of states experiencing high influenza-like illness activity. “Visits to healthcare providers for influenza-like illness (ILI) increased from 5.1% last week to 5.7% this week.”

Pandora Report: 1.31.2020

ASM Biothreats
Missed the 2020 ASM Biothreats conference? Next week we’ll have you updated with our coverage across multiple talks, panels, and the highlights of this top conference on all things biological. GMU biodefense graduate students will be providing detailed accounts of these discussions at a pivotal time in international health. “ASM Biothreats is a one-of-a-kind meeting offering professionals in biodefense, biosecurity and biological threats the opportunity to exchange knowledge and ideas that will shape the future of this emerging field. ASM Biothreats offers a unique program that explores the latest developments and emerging technologies in the industry.”

Update: 2019-nCoV
If you have turned on any news channel or navigated to news website, you most certainly encountered a number of discussions about the ongoing coronavirus outbreak originating in Wuhan, China. The WHO was alerted on New Years Eve of this novel pathogen causing pneumonia-like illness and chaos increasingly ensued over the continuing weeks. This mysterious pathogen was identified as a coronavirus (think SARS and MERS) and is currently dubbed “2019-nCoV.” As the disease spreads globally, the WHO is launching a Global 2019-nCoV Clinical Data Platform for Member States to contribute anonymized clinical data that can inform the public health clinical response. On 30 January, the Emergency Committee on the 2019-nCoV under the International Health Regulations (IHR 2005) reconvened to determine if the outbreak constitutes a Public Health Emergency of International Concern (PHEIC), and, if so, what recommendations and actions should be made to manage it. Thursday evening, the Committee announced declaration of a PHEIC for the 2019-nCov outbreak. As of 28 January, there are confirmed cases in China, Nepal, the Republic of Korea, Japan, Sri Lanka, Viet Nam, Thailand, Cambodia, Malaysia, Singapore, United Arab Emirates, Australia, France, Germany, Finland, Canada, and the United States. Within the United States, there are 5 confirmed cases in Washington, California, Arizona, and Illinois as well as an additional 92 suspected cases awaiting diagnostic results. Currently, there are 165 persons located in the US under investigation for 2019-nCoV infection. On Thursday, public health officials reported that the husband of the case identified in Chicago, had tested positive for the disease. This marks a second-generation of cases, or transmission, within the U.S. There are also reports of people running to buy face masks in the U.S., leaving concern for shortages. Experts have been quick though to note that these are not needed as transmission is not widespread within the United States and that hand hygiene is most effective this time of year. GMU Biodefense doctoral alum Saskia Popescu recently spoke to CNN on this, noting that “Wearing a surgical mask helps you prevent sharing your germs if you’re sick,” Saskia Popescu, a hospital epidemiologist and infection prevention expert, told CNN. “Surgical masks do not seal around the face, so while they offer some protection, it’s the N95 mask that offers the most protection.” The CDC released an updated travel warning to its most severe yet – Warning Level 3 – urging travelers to avoid all nonessential travel to China. According to the WHO, the latest figures (30 January) for the outbreak are:

  • 7,818 confirmed cases worldwide
  • 7,736 confirmed cases in China
  • 170 deaths worldwide
  • Global Risk Assessment: High

Experts from the University of Hong Kong estimate the true total number of cases in Wuhan to be about 44,000, and they predict this figure could double by the start of February. The city is already under an unprecedented quarantine and hospitals are overrun as the epidemic intensifies. GMU biodefense graduate program director Dr. Gregory Koblentz recently spoke about the importance of promoting education, not travel bans as coronavirus concerns spread. “Widespread travel bans are ineffective and even counterproductive,” said Koblentz, a professor at George Mason University’s Schar School of Policy and Government and an expert on biodefense and biosecurity. “The idea that you can quarantine the entire population of large cities is just not feasible.” If people want to travel, they will find a way to travel, but they will be secretive about it, said Koblentz. “Then when they do get sick, they will avoid seeking medical attention because they don’t want to get in trouble,” said Koblentz. “A travel ban basically means that people will avoid getting help and notifying public health authorities, and the spread of the virus will continue, undetected.” Instead, Koblentz recommended that health officials work to get the public on their side by communicating with them about the symptoms and when to seek medical care.

Speculation abounds about the zoonotic origin of the virus, but the prevailing theory (at the moment) points toward bats as the culprit. The source location of the outbreak is the Huanan seafood market in Wuhan, which did not sell bat meat, so speculation continues. It is possible that another animal provided the channel to human infection. Previous conjecture that snakes are the origin is under criticism as it remains unclear if coronaviruses can infect snakes. Additionally, experts reject the fringe theory that the outbreak is a consequence of accidental release of biological weapons research samples housed in the Wuhan Institute of Virology. Richard Ebright, a professor of chemical biology at Rutgers University, stated the virus’s genome and properties do not indicate that it is the product of engineering. Stay tuned to the Pandora Report for updates on the progression of the 2019-nCov outbreak.

Of Quarantine and robots: How China and the U.S. Are Working to Combat Coronavirus
GMU Biodefense PhD alum Saskia Popescu recently wrote on the efforts by both the Chinese and the U.S. in responding to and preventing transmission of the 2019-nCoV. From quarantine to travel screenings, Popescu discusses the pros and cons, but also breaks down the opportunities within U.S. response. “The first case of the coronavirus in the United States received wide news coverage, and rightly so. But the Providence Regional Medical Center in Everett, Wash., used some extreme techniques to treat the patient, a man in his 30s who’d travelled to Wuhan. He was taken from an urgent care to the hospital in a negative-pressure transportation device called an ISOPOD that’s more often associated with Ebola care and put into an isolation room, where the hospital used a robot to treat him to reduce health care worker exposure. At this point, though, these extra precautions aren’t required. The Centers for Disease Control and Prevention notes that health care workers caring for patients with coronavirus should protect themselves with a gown, gloves, eye protection, and an N95 mask, which can filter out most airborne particles. If the Everett hospital wanted to use its robot and ISPOD to test its capabilities and protocols, it should have communicated this more clearly–to keep from confusing other health care providers about the advice of federal officials.”

ABSA International – Risk Group Database App
The Association for Biosafety and Biosecurity (ABSA) just released their new International Risk Group Database app, which allows users to work offline and access the ABSA database via their mobile device. The ABSA International Risk Group Database consists of international risk group classifications for bacteria, viruses, fungi, and parasites. In many countries, including the United States, infectious agents are categorized in risk groups based on their relative risk. Depending on the country and/or organization, this classification system might take the following factors into consideration: pathogenicity of the organism; mode of transmission and host range; availability of effective preventive measures (e.g., vaccines); availability of effective treatment (e.g., antibiotics); and other factors.

Doomsday Clock
The Bulletin of the Atomic Scientists released their 2020 Doomsday Clock statement and revealed that the clock is now closer than ever at 100 seconds to midnight. The Doomsday Clock is “universally recognized indicator of the world’s vulnerability to catastrophe from nuclear weapons, climate change, and disruptive technologies in other domains.” This year’s statement highlights two coexisting existential threats to humanity: nuclear war and climate change. Adding insult to injury, these threats are exacerbated by cyber-enabled information warfare, which continues to advance in efficiency and capability. The last year saw the dissolution or undermining of several key arms control treaties aimed at quelling the risk of nuclear war – the Joint Comprehensive Plan of Action (JCPOA) and Intermediate-Range Nuclear Forces (INF) Treaty, for example. Iran, the DPRK, and Russia remain major dangerous players in the nuclear game. On a more positive note, awareness of the adverse effects of climate change swelled over 2019; however, governmental action to counter climate change left much to be desired. The Bulletin implores leaders and citizens to take thoughtful and actionable steps to lessen these threats:

  • US and Russian leaders can return to the negotiating table to reach an agreement on nuclear arms and other arsenals
  • The nations of the world should publicly rededicate themselves to the temperature goal of the Paris climate agreement (limiting warming below 2 degrees Celsius higher than the preindustrial level)
  • US citizens should demand climate action from their government
  • The United States and other signatories of the JCPOA cooperate to curb nuclear proliferation in the Middle East
  • The international community should commence multilateral discussions to create norms of domestic and international behavior that discourage and punish the misuse of science

Alumni Spotlight – NextGen GHSA
A new piece published on the Next Generation Global Health Security Network was co-authored by Anthony Falzarano, Stephen Taylor, Kate Kerr and Jessica Smrekar, graduates of GMU’s MS in Biodefense program (Taylor Winkenfeld is also an author). This Op-Ed, “We Preach Prevention, WHO Practices Response,” chastises the sluggish response of the WHO to the ongoing 2019-nCov outbreak originating in Wuhan, China. China’s President Xi Jinping instituted a mass quarantine of 50 million people, yet the WHO has yet to declare this outbreak a Public Health Emergency of International Concern (PHEIC), which helps mobilize funding and political will toward outbreak response efforts. In fact, the committee that makes such a declaration met on 30 January, weeks after the start of the outbreak. The WHO possesses a history of delayed action, such as with the current Ebola outbreak in the Democratic Republic of Congo. The authors suggest that the delay in PHEIC declaration for the 2019-nCov outbreak is founded in fear of political and economic impacts, especially given the “reach of the Chinese global engine.” This outbreak is yet another example and, hopefully, lesson waiting and watching cannot be the default response to tragic events, especially ones that harm public health, regardless of the political, economic, and social issues that complicate decision-making and action.

The Ethics of Acquiring Disruptive Military Technologies
Technological innovation – especially in human enhancement, artificial intelligence, and cyber tools – continues at an accelerating rate and yield a significant effect on combat by reducing risk to soldiers and civilians, but also broadening the spectrum of actors capable of chasing policy goals through military methods. An article by C. Anthony Pfaff published in the Texas National Security Review expands the discussion about emerging and advancing technologies to include the ethics of disruptive military technologies. Disruptive technologies in a military context are defined as “technologies or sets of technologies applied to a relevant problem in a manner that radically alters the symmetry of military power between competitors, which then immediately outdates the policies, doctrines and organization of all actors.” These technologies necessitate changes in soldier training and identity as well as the relationship between society and soldiers. A technology is considered disruptive based on its attributes’ interactions with a specific community of users in a specific environment. The author outlines a framework to evaluate the moral effect, necessity, and proportionality of technologies to determine if and how they should be developed and deployed. This framework includes consideration for moral autonomy, justice, well-being, transfer of technology, and, of course, the civilian-military relationship. The author recommends eight measures and policies to maintain ethical conditions for developing disruptive technologies ranging from managing the transfer of technologies to greater society to accounting for soldier well-being.  Pfaff’s full article detailing his analysis, framework, and recommendations is available here.

Considering Pediatrics During CBW Preparedness and Response
Often during measures to prepare for a chemical or biological weapons attack, it can be easy to forget about the unique care that children and neonates require. A new article in Physicians New Digest discussed this very critical nuance to CBW preparedness, highlighting the CW attacks in Syria by the Assad regime against civilians, included children, underscoring the need for pediatricians. Often, medical countermeasures require very specific dosages or are contraindicated in children, which poses a very unique challenge for responders. “In chemical attacks, for example, children may be disproportionately affected because they would take in more contaminated air, food and fluids relative to their body weight than adults, said co-author Carl Baum, MD, FACMT, FAAP, a former AAP Council on Environmental Health executive committee member who now serves on the Council on Disaster Preparedness and Recovery executive committee. ‘Children also spend more time closer to the ground, where toxic substances can settle. And they have a relatively larger body-surface area, which makes chemicals that touch the skin more dangerous for them,’ Dr. Baum said.” Children might also have high respiratory rates or present differently, which puts them at an increased risk for both inhalation of a CB agent, but also delays in medical care or diagnostics. The authors highlighted the importance of including pediatricians in preparedness efforts to ensure children have triage and treatment protocols in the event of a CBW attack.

News of the Weird
Sure, the novel coronavirus is in the news a lot right now, but where does beer come into the picture? Unfortunately the whole “corona” portion of the name has been throwing people off. “In the United States, Google Trends calculated that 57% of the people that searched one of those terms searched for “beer virus,’ and the remaining 43% searched for ‘corona beer virus.’ States like Hawaii, New Mexico and Kansas are searching ‘beer virus’ more, whereas states like South Carolina, Colorado and Arizona are searching ‘corona beer virus’ more”

Pandora Report: 1.24.2020

ASM Biothreats Coverage
With this three-day conference just around the corner, you’ll want to make sure not to miss our coverage in the coming weeks. GMU Biodefense has been sending graduate students to attend ASM Biothreats since 2016 and we’re always excited to share their insights into the presentations and discussions. Check out our previous coverage here, which will provide you with detailed accounts of this conference and the timely conversations that will likely take place surrounding the 2019-nCoV outbreak.

The Novel Coronavirus Bubbles Out of China 
As the first case of 2019-nCoV was identified in the United States this week, questions continued to bubble up regarding the transmission mechanisms and if human-to-human transmission will be sustained. On Wednesday, the WHO met to discuss a declaration of a PHEIC (public health emergency of international concern) as cases spilled into Japan, Thailand, and South Korea, and case counts surpassed 830 infections and 17deaths. Interestingly, as the emergency committee was split on the decision, it was pushed to review again on Thursday and just before, China decided that the city of Wuhan would effectively have a cordon sanitaire, or quarantine. Ezhou and Huanggang have bene added to this list as of Thursday. Mid-day on Thursday, the WHO announced that they would not be declaring the outbreak a PHEIC. WHO situation reports can be found here. Moreover, as news of infection in 14 healthcare workers, it’s a reminder of previous coronavirus outbreaks. With the news of the Wuhan closure, it draws similarities to the quarantine efforts tried by Toronto in the SARS-CoV outbreak, which were considered widely ineffective and frustrating to the community. While each outbreak requires unique control measures, it is important to also note that it is challenging to truly know the case facility rate at this point in the outbreak, and that sudden bursts of identified cases are likely a result of surveillance efforts. As this outbreak has evolved in recent days though, the initial statements of “there has not been sustained human-to-human transmission” have been questioned. Beyond the initial worries about information sharing from the Chinese that were reminiscent of SARS-CoV, the role of healthcare and super-spreaders has been re-established. Chinese media has been quick though, to deny superspreading events. In 2003, the spread of SARS-CoV throughout Toronto taught us several lessons about not only importation of cases due to international travel, but also how super-spreaders in the right environments, like a hospital, can cause devastating outcomes. A lesson learned from Toronto too, is that of the importance of enhanced infection prevention measures and the questionable efficacy of quarantine efforts..not to mention the importance of communication, both between healthcare/public health, but also to the public. Flash forward nearly 10 years and a novel coronavirus was again causing problems…this time, beginning in Saudi Arabia. Spreading across 27 countries since it was first identified in 2012, MERS-CoV is another lesson in novel diseases and the role of One Health. MERS-CoV gave us new insights in not only why the WHO won’t declare an outbreak a PHEIC, but also a hard lesson in how hospitals can amplify an outbreak. In particular, the 2015 outbreak in South Korea, where it is estimated that 91-99% of cases were related to healthcare transmission and 83% of transmission events were tied to five superspreaders. Health system components like multiple patients per hospital room, family involvement in care, and hospital shopping, encouraged the spread of disease. In Saudi Arabia, small outbreaks have consistently happened since 2012, with links to not only camels, but also hospitals in which busy emergency departments and delays in isolation helped spread the disease. In fact, since 2013, most of the cases have been in Saudi Arabia and 19.1% have been in healthcare workers. There are many lessons to be learned from these previous outbreaks of novel coronaviruses, but as of now there are several discussions that need to happen – with a lower case fatality rate (CFR), will emergency measures need to be taken? How effective is airport screening, especially for international flights in the middle of respiratory virus season? As this outbreak is quickly unfolding and we learn new components to the virus daily, a few things are certain though – efforts have been swift (sequencing of the virus took only a matter of weeks), and the Chinese have worked to maintain diligent information sharing and outbreak investigations..not to mention to amazing and rapid efforts of international public health workers. Also, when we provide people with information, these efforts might prove to be just as effective as screening measures as the first case of 2019-nCoV within the U.S. was not identified through this route, but rather by some one who alerted to the outbreak and sought medical care, informing their healthcare provider of relevant travel history. Here are some valuable sources – regarding what we know and don’t know,  the implications of the quarantine for people in Wuhan, and fatality details.

Vulnerable Hospitals and Federal Funding Cuts for Biopreparedness
GMU Biodefense doctoral alum and infection preventionist Saskia Popescu discusses the tiered hospital approach to special pathogens and how despite its imperfections, the cut to funding should be taken seriously. Despite the flaws with the existing tiered system for dealing with special pathogens, it’s a more comprehensive and better resourced approach than what was in place before the 2014-2016 Ebola epidemic. As it stands, Congress has funded the 10 advanced treatment facilities and the National Ebola Training and Education Center but not the 60 treatment centers included in the tiered network. (The nearly 5,000 frontline hospitals never got much federal funding for their special pathogen-related efforts.) Trump signed the bill into law in December.

Redefining Neuroweapons: Emerging Capabilities in Neuroscience and Neurotechnology
Joseph DeFranco, a graduate of the GMU Biodefense MS program, recently co-authored an article about the emerging capabilities in neuroscience and neurotechnology that may enable new types of neuroweapons. Neuroscience and neurotechnology – lovingly nicknamed neuroS/T – are interwoven fields with research and development spanning medicine and military uses. Neuroscience is the study of the developmental processes, structures, functions, and of the brain and nervous system. The field is often referred to in the plural as neurosciences because of its cross-disciplinary nature encompassing molecular biology, developmental biology, physiology, anatomy, cytology, chemistry, mathematics, engineering, linguistics, computer science, medicine, and psychology. Neurotechnology produces a variety of tools, outputs, and substances that affect or probe the nervous system. DeFranco, DiEuliis, and Giordano consider the swift timeline for advancement in neuroS/T and the dual-use potential of such advancements in warfare, intelligence, and national security (WINS) applications. Certain neuroS/T advancements such as gene editing methods and nanoparticles can modify the central nervous system, providing significant utility and application for WINS. Existing pitfalls in international biological and chemical weapons conventions include the lack of consideration for existing and emerging neuroS/T outputs. Frankly, the inventions of neuroS/T are the redheaded step-child of these treaties, as none claim to cover it. The growth of “neurodata” is another important issue as biology becomes increasingly digitized. Though these data can prove immensely helpful in medicine and performance, they also have the potential to be used to target or alter specific individuals or groups. These data, as with all data, are vulnerable to cyberattacks or nefarious surveillance. Based on these benefits and risks of emerging neuroS/T, the authors outline a series of recommendations to either rectify existing insufficient oversight and governance or develop strong oversight and governance for the future.

Update: Ebola in the DRC
The current Ebola outbreak in the Democratic Republic of the Congo (DRC) is the second largest of its kind with over 1,600 cases from 2018 to mid-2019. This outbreak is mired in the exacerbating effects of conflict. Beyond the almost natural increase in disease transmission in a warzone, the DRC sees targeted attacks against medical workers there to quell the outbreak. Recent research focuses on the effects of violence on Ebola disease incidence. Mueller and Rebmann assessed the relationship between attacks targeting aid workers and the incidence of Ebola during the 2018-19 DRC outbreak in the North Kivu and Ituri provinces, regions characterized by violence. Findings from the analysis showed that the relationship between targeted violence against aid workers and disease incidence may be explained etiologically and logistically given the harmful impact on operations from the targeting of facilities, supply lines, and personnel. Wannier et al. quantified the effects of conflict on disease transmission using transmission rates between health zones that have versus have not experienced recent conflict events during the EVD outbreak. The mean overall R (reproduction number) of the total outbreak was 1.11, the average R for regions unaffected by recent violence was 0.61-0.86, and the average R for regions affected by recent violence was 1.01-1.07. These results indicate conflict contributes to increased transmission of Ebola in this outbreak. Wells et al. provides a timeline and ethnographic appraisal of the violence and disease in eastern DRC using data and information regarding the period from 30 April 2018 to 23 June 2019. Additionally, the authors constructed a model to quantify the strife prior to a conflict event and its ensuing impact on disease control activities in order to reveal the influence of war on the persistence of an epidemic. The gist of this trio of studies is that the Ebola outbreak is being exacerbated by the ongoing violence in eastern DRC as well as the attacks on the personnel in the field to respond to the outbreak.

Epidemics in Movies and Social Response
Need a break from the constant stream of coronavirus news? In perhaps one of our more favorite articles, a research team looked to the way films illustrate epidemics to the public. The authors note that there are two ways these films affect society – ” fear leading to a breakdown in sociability and fear stimulating preservation of tightly held social norms. The first response is often informed by concern over perceived moral failings within society, the second response by the application of arbitrary or excessive controls from outside the community.” If you’re a fan of outbreak or infectious disease themes in films, this is a great article to read on everything from Dallas Buyers Club to Contagion.

How much Should the Public Be Told About Risky Virus Research?
This is definitely a great way to start a fun dinner discussion with your favorite biodefense folks! Nell Greenfieldboyce recently discussed the NSABB meeting that started on Thursday and will conclude today. The news of a new coronavirus outbreak surely will add to this conversation and the future research that will study this novel disease. The argument regarding research on potential pandemic pathogens and gain-of-function experiments is one that has been going on for years. The conversations don’t just stop at if these experiments should exist and what they look like, but also about the publication of such information and just how much should be shared publicly. A new framework for evaluating potential experiments has already had three proposals – two made it and one is currently under review. “There’s a lot of interest out there in how these reviews get done, notes Wolinetz, but “it’s a little bit tricky, because all of these discussions are happening before funding decisions are made. Under current rules and regulations in the government, those conversations, pre-award conversations, are protected.” That’s to ensure, for example, that someone’s idea for a novel experiment doesn’t get stolen by another researcher. It also lets reviewers be candid in their critiques. What’s more, if a proposed study was deemed too alarming to fund, it might not make sense to make that idea available to all. On the other hand, some biosecurity experts argue that the public needs to know who is evaluating the risks and benefits and exactly what their reasoning is.” Confidence-building measures, like including a range of voices and disciplines into this decision-making process, are all ideas that have been raised during this process. Inclusion of risk-mitigation efforts and communication strategies are also measures that several researchers have emphasized. As Dr. Tom Inglesby noted though, “once we publish the mechanisms for making pathogens more dangerous —potentially ‘pandemic dangerous’ — we can’t take that information back. That information will be out there online for good.”

Patient Proximity to Farms and Increased Risk for C-diff Colonization
Talk about a One Health relationship – imagine living close to a livestock farm and having an increased risk for a diarrheal illness? That’s exactly what a new study is showing. The authors found that “the independent effect of residential distance to livestock farms was substantial; regardless of health care exposure, the probability of colonization more than doubled for those living 1 mile from a livestock farm compared with those living 50 miles from a livestock farm. Specifically, the probability of colonization increased from 6.5% among those living 50 miles from a livestock farm to 15.7% among those with previous hospitalization and from 4% to 10.6% among those without a recent hospitalization.”  Comorbidities played a factor in those patients admitted to a non-hematology/oncology unit, increasing the odds of colonization by more than 4 times.

Genetic Modification Could Protect Soldiers from Chemical Weapons
Despite bans on the development and deployment of chemical weapons, their use in conflict continues. Current treatment options are picky as they must be administered immediately and may not be satisfactorily efficacious; however, US Army researchers recently made a breakthrough in toxicant protection for soldiers. Specifically, the researchers developed a type of gene therapy that allows mice to create their own “nerve agent–busting proteins,” which provide protection against the agents, possibly for months. Though this therapy bears the potential for human use, it is risky. Such risks include the development of an adverse immune response to the introduced protein. Lead biochemist Nageswararao Chilukuri called the experiment of a “proof of principle” study. The long-short of the experiment is the livers of mice were reprogrammed as factories pushing out a “bioscavenger” enzyme that quickly incapacitate nerve agents. The team recently reported that the mice survived nine customarily lethal injections for six weeks, a promising but preliminary result.

USAMRIID 2019 Lab Protocol Failures and Findings 
Last year it was announced that the USAMRIID lab at Fort Detrick was temporarily shut following CDC inspections that found failures in their practices. “The lab itself reported that the shutdown order was due to ongoing infrastructure issues with wastewater decontamination, and the CDC declined to provide the reason for the shutdown due to national security concerns.” Documents that were recently obtained found that those violations initially reported were only a handful, but many were labeled as “serious” including – “The CDC reported that an individual partially entered a room multiple times without the required respiratory protection while other people in that room were performing procedures with a non-human primate on a necropsy table. ‘This deviation from entity procedures resulted in a respiratory occupational exposure to select agent aerosols,’ the CDC wrote.” You can read more here on these findings and the serious observations that were identified, triggering the lab’s temporary closure.

 

Pandora Report: 1.17.2020

Happy Friday! We’re glad to start the weekend with a healthy dose of all things biodefense. Before we get too far down the nCoV-2019 rabbit hole…Senator Dianne Feinstein recently wrote a letter to DHHS regarding steps the department is taking to protect the U.S. against pandemics.

ASM Biothreats 
It’s almost that time of year and if you can’t make the January 28-30 ASM Biothreats conference, don’t worry – we’ll have great coverage. GMU Schar School Biodefense is sending graduate students to the conference to report out on these three days of all things biothreats. Check out previous years of our coverage here, where we provide detailed overviews of the talks and events. “ASM Biothreats is a one-of-a-kind meeting offering professionals in biodefense, biosecurity and biological threats the opportunity to exchange knowledge and ideas that will shape the future of this emerging field. ASM Biothreats offers a unique program that explores the latest developments and emerging technologies in the industry.”

AI Weapons
The end of 2019 and the start of 2020 sees an uptick in discussion regarding artificial intelligence-driven weapons. Three of the world’s biggest plays – the United States, Russia, and China – are all strongly indicating that artificial intelligence (AI), considered a transformative technology, will be dominant in their respective national security strategies. Recent headlines on the topic include terms like “killer robots” and “Terminator-style war.” Indubitably, we are in an era of rapid and momentous technological advancement and discovery; however, the true application of these technologies is fairly narrow and now necessarily nefarious. Larry Lewis, a senior advisor for the State Department in the Obama administration and a member of the US delegation in the UN deliberations on lethal autonomous weapons systems, recently published an article in the Bulletin of the Atomic Scientists about the utility of AI in reducing the collateral damage of war. Lewis spent the last decade working to reduce the civilian casualties in war, and he found that such casualties were largely the result of inaccurate indicators regarding civilian presence or the misclassification of civilians as combatants. Though military applications of AI include autonomous weapons, this technology can also be employed to optimize automated processing to detection and as a decision aid to helping personnel interpret complex or vast sets of data. Though discussion tends toward the risks of AI technology, especially its military applications, Lewis endorses adding a new facet to the discussion that focuses on the benefits of AI technology in minimizing civilian casualties in warfare.

nCOV-2019 and the Wuhan Outbreak
The past few weeks have been busy with the news of this novel coronavirus cluster in Wuhan, China. Following the identification of it as a novel strain and the temporary name of nCoV-2019, public health authorities have been working to better understand the epidemiological aspects of the virus and how we can prevent further transmission. News of a case in Thailand, following travel to the affected region in China, quickly spread as it meant that cases were no longer contained in China. Interestingly, the Chinese woman whose infection was detected after her arrival in Thailand, had no exposure to the market that is considered to be the epicenter of the outbreak. “A new statement from the World Health Organization (WHO) today had several new details, including that the woman had not visited the Wuhan seafood market, which also sold live animals such as chickens, bats, and marmots, where most patients are thought to have been exposed. However, she reported regularly visiting a local fresh market before her symptoms began on Jan 5. That illness onset is later than that of the others infected in the outbreak, which ranged from Dec 8 to Jan 2, according to a Jan 12 update from the WHO. The incubation period for nCoV-2019 isn’t known, and authorities closed the seafood market on Jan 1.” 182 contacts are being monitored related to this case and eight febrile travelers at the Suvarnabhumi Airport have been isolated and tested (all were negative). Japan also confirmed their first case in a 30-year-old man who tested positive following a visit to Wuhan. On Thursday, officials released more information regarding a second family cluster in Wuhan (likely exposed via the same source), as well as findings from environmental testing at the market in Wuhan.

Antibiotic Tolerance Can Affect Combo Treatments, Study Finds
A team of scientists in Israel found evidence that antibiotic resistance in microbes may render combination therapies ineffective, a long-held fear that may now be reality. Combination drug therapy is a commonly used clinical method for treating infections caused by resistant microbes and to prevent the progression of resistance. This team monitored the evolution of Staphylococcus aureus strains in patients undergoing combination treatment and exposed the swift emergence of tolerance mutations trailed by the emergence of resistance. Tolerance mutation in antibiotics is a general term “used to describe the ability, whether inherited or not, of microorganisms to survive transient exposure to high concentrations of an antibiotic without a change in the MIC, which is often achieved by slowing down an essential bacterial process,” whereas antibiotic resistance is “the inherited ability of microorganisms to grow at high concentrations of an antibiotic, irrespective of the duration of treatment, and is quantified by the minimum inhibitory concentration (MIC).” After the discovery of tolerance to combination treatments in the S. aureus case, the scientists were able to expand the finding by measuring bacterial growth in Escherichia coli after drug combinations from four different antibiotic classes. Isolates with tolerance to norfloxacin and ampicillin promoted resistance in some of the combinations for treating E. coli. Therefore, the authors conclude that “rescue of resistance mutations by tolerance is a general phenomenon that may have crucial implications for the evolution of resistance in patients treated with combinations of antimicrobials.” A short article summarizing the study can be found here and the original publication can be found here.

WHO- Urgent Health Challenges for the Next Decade
The World Health Organization has released their list for the new decade – which was “developed with input from our experts around the world, reflects a deep concern that leaders are failing to invest enough resources in core health priorities and systems.” The list does not place challenges by priority, as they are all urgent and includes elevating health in the climate debate, delivering health in conflict and crisis, making healthcare fairer, expanding access to medicines, stopping infectious diseases, and more. Within each challenge, the WHO discusses what it is and what they are doing to help correct it.

Outbreak Dashboard 
While much attention has been to the novel coronavirus outbreak, more Ebola cases have been identified in the DRC. The latest situation report from The Who reports 8 new cases, including 3 in Beni.