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

By Stevie Kiesel, Biodefense PhD Student

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

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

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

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

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

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

Pandora Report: 6.19.2020

Commentary – Viruses and Violence: How COVID-19 Has Impacted Extremism

Stevie Kiesel, a Biodefense PhD student, shares her insight on the how the COVID-19 pandemic is impacting extremist behavior. Extremist groups are using the pandemic largely to regain territory and expand their sphere of influence; however, there have been attempts to exploit the virus as a bioweapon. Kiesel’s analysis focuses on Jihadist groups and far-right extremists, both of which are using the pandemic to bolster their recruitment and radicalization strategies. Read Kiesel’s commentary here.

Hear, see, and speak no COVID: Why the Trump administration is bungling the response to the pandemic

Dr. Gregory Koblentz, Director of the Biodefense Graduate Program, and Dr. Saskia Popescu, Alumna of the Biodefense Graduate Program and hospital epidemiologist, recently published an article in the Bulletin of the Atomic Scientists about the failure of the administration to appropriately utilize scientific expertise in its COVID-19 response activities. Koblentz and Popescu assert that the administration has been “deaf, dumb, and blind” during this catastrophe that has already claimed over 100,000 lives in the US. The pre-existing gap between science and policy has been ripped open by the Trump administration. An important lesson learned from this pandemic is the “importance of sound scientific advice and providing public health agencies with the independence to formulate and implement evidence-based policies to respond to threats to health security.” Read Koblenz and Popescu’s article here.

Keeping Up with COVID-19: An Update on Vaccine Development

The race to develop an efficacious and safe COVID-19 vaccine endeavors to reach an unprecedented timeline for FDA approval. The US government established Operation Warp Speed (OWS) to develop a vaccine by the end of the calendar year, a process which usually takes 10-15 years. Challenges regarding the desired speedy timeline may inhibit the ideal due date of OWS for a COVID-19 vaccine; however, scientists are seeing some hopeful signs that we can efficiently produce a safe and effective vaccine.

Unfortunately, predicting the timeline of an effective and safe human vaccine, verified via a phase 3 clinical trial, is extremely difficult. To shorten the timeline of phase 3 clinical trials, the Food and Drug Administration (FDA) can authorize the use of a vaccine based on its immune correlate of protection (ICP): a type and amount of immunological response that correlates with vaccine-induced protection against an infectious disease and that is considered predictive of clinical efficacy. A vaccine can receive accelerated approval if vaccinated subjects present with levels of neutralizing antibodies (proteins that block viruses from infecting cells) that, at least, match the levels of naturally infected subjects. Regrettably, there is a lack of certainty regarding the level of neutralizing antibodies necessary to guarantee immunity. The ICP shortcut is favored by pharmaceutical companies who hope to persuade the FDA to soon approve their vaccines, at least for the vaccination of high-risk individuals for fear of dual attacks of influenza and COVID-19 this coming winter. Other scientists caution against the use of proxies such as ICP to determine approval of COVID-19 vaccine due to the uncertainty about immunity and the rocky track record of vaccines for other diseases that have been approved using proxies for efficacy and safety.

On a cheerier note, many experts are optimistic about a successful COVID-19 vaccine because so much effort and money are being poured into its development. Dr. John Mascola, director of the Vaccine Research Center at the National Institute of Allergy and Infectious Diseases, is hopeful that because our natural immune system is clearing the virus for many patients, a vaccine that closely mimics a natural infection will likely work. Luckily, SARS-CoV-2 has not significantly mutated, thus far, and this stability increases the likelihood of developing an vaccine that works well against the virus. Also, the vaccine need not be 100% effective, either in terms of preventing sickness or preventing infection. A vaccine that can significantly reduce sickness or disease severity along with lowering hospitalizations would be a win against the virus. According to Dr. Paul Offit of the Children’s Hospital of Philadelphia, a vaccine candidate worthy of approval should be 50% effective against symptoms and 70% effective against moderate to severe disease.

We Ran the CDC. Here’s How to Talk to the Public in a Health Crisis

Two former directors of the Centers for Disease Control and Prevention (CDC) wrote a commentary urging public health officials to greatly improve their public health communications to the public. Throughout the COVID-19 pandemic, communications from public health officials in the US and abroad have often failed to be accurate, transparent, and reliable. The authors cite the contradictory statements about asymptomatic transmission from WHO’s Maria Van Kerkhove as the latest communication fiasco. They fear that such communication failures coupled with regular disregard for the scientific expertise of those at the CDC are undermining the institutions we need to positively impact public health. To improve communication, public health officials at the federal, state, and local levels must be: truthful and accurate, informed and current, aware of the audience, cautious of communication minefields, willing to quit or face termination. Health communicators play a “vital and visible leadership role” and they serve as the “backbone of the public health response.”

COVID-19 Reports from the BioWeapons Prevention Project

Since 2006, the BioWeapons Preventions Project (BWPP) and Richard Guthrie teamed up to produce daily reports from intergovernmental meetings of the Biological Weapons Convention (BWC). As the impacts of COVID-19 continue to arise, this team is providing an additional series of reports that delves into lessons (hopefully) to be learned from past BWC activities, and discusses the responses to the COVID-19 pandemic as well as examines impacts of the pandemic on future BWC activities. These reports are available here.

Data Integrity in COVID-19

The COVID-19 pandemic response has been fraught with inaccuracies and mistakes. Rebekah Jones, a data scientist for the Florida State Health Department, was fired last month; she helped develop Florida’s COVID-19 data portal. After her termination, she created her own COVID-19 dashboard using data that the former superiors wanted her to manipulate to make the number of coronavirus cases appear significantly lower. Her refusal to falsify her findings instigated her dismissal. Jones’ untainted dashboard shows that only 2 Florida counties are ready for the next phase of reopening, a conclusion that her former bosses at the Health Department did not accept. In another abuse of data, Vice President Mike Pence urged governors to spread the misleading claim that the rises in COVID-19 infections are primarily due to increased testing. According to a data analysis by the New York Times, in over a dozen states, the rates of positive cases are outpacing the increase in the average number of tests. Pence also characterized these surges in cases as “marginal.” Data from the CDC show a decrease in coronavirus hospitalizations nationally, but an increase in positive cases, and the number of coronavirus-related deaths could increase as more data are collected.

OpenSmartEDU: Tools & Resources for Higher Education Operations in COVID-19

Johns Hopkins Center for Health Security, the Council for Higher Education Accreditation (CHEA), and Tuscany Strategy Consulting (TSC) collaborated to develop a free resource, OpenSmartEDU, to “guide colleges and universities in planning operating strategies for both the near- and long-term amid the many challenges of COVID-19.” This resource boasts 3 planning tools: the COVID-19 Planning Guide and Self-Assessment for Higher Education, the Johns Hopkins Center for Health Security Self-Assessment Calculator, and the Higher Education Planning Tool. The COVID-19 Planning Guide and Self-Assessment for Higher Education is a practical planning tool to help institutions in two ways: (1) poses four central questions to determine if an institution is prepared to reopen for each of the major COVID-19 Phases and (2) outlines leadership, cross-functional, and functional workgroups to support comprehensive planning efforts. The Guide also provides additional guidelines, resources, and media reports to aid institutional planning. The Self-Assessment Calculator is an interactive Excel spreadsheet designed to help institutions identify and understand their baseline risk and the possible impacts that major countermeasures may have on their risk scores. The Higher Education Planning Tool (coming soon) will allow institutions to assign work, develop timelines, and incorporate important considerations in a live and centrally-located worksheet that available to multiple stakeholders.

Bat-Borne Virus Diversity, Spillover and Emergence

A recent article in Nature Reviews Microbiology discusses the latest advancements and findings regarding bat-borne viruses, considers current gaps in knowledge, and outlines the potential paths for future research, outbreak response activities, and prevention efforts. The majority of human viral pathogens are zoonotic and developed via cross-species transmission. Several human viruses – Ebola virus, Marburg virus, Nipah virus, Hendra virus, severe acute respiratory syndrome coronavirus (SARS), and Middle East respiratory coronavirus (MERS) – have been linked to different bat species. Despite this list, the fields of bat virus ecology and molecular biology remain nascent and largely unexplored, compromising our ability to anticipate and prepare for the next outbreak of a bat-borne virus. Read the article here.

Viruses and Violence: How COVID-19 Has Impacted Extremism

By Stevie Kiesel, Biodefense PhD Student

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

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

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

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

Author compilation of popular coronavirus memes on FRE social media

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

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

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

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

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

Pandora Report: 6.12.2020

Dr. Andy Kilianski in Operation Warp Speed

Dr. Andy Kilianski, an adjunct professor in the GMU Biodefense Graduate Program, is one of the newly appointed experts leading the Department of Defense’s arm of Operation Warp Speed (OWS). Operation Warp Speed is a public-private partnership created to efficiently facilitate the development, manufacturing, and distribution of COVID-19 countermeasures. Kilianski was appointed as the subject matter expert in “security and assistance” for this fast-moving Manhattan Project-style initiative. According to Gregory Koblentz, director of the Biodefense Graduate Program, “Strengthening cyberbiosecurity is a vital element of our national effort to develop new vaccines and therapeutics against COVID-19. Kilianski’s appointment is a perfect illustration of how the biodefense program tries to bridge the gap between science and policy.” At the start of June, OWS announced five COVID-19 vaccine candidates: Moderna’s mRNA1273, AstraZeneca and Oxford University’s AZD1222, a candidate from Johnson & Johnson, a candidate from Merck, and Pfizer and BioNTech’s BNT162.

New Guidance for Decision Makers on Assessing COVID-19 Data

The newly established Societal Experts Action Network (SEAN) of the National Academies of Sciences, Engineering, and Medicine (NASEM) produced a rapid expert consultation to guide leaders using COVID-19 measurements, such as hospitalizations and number of confirmed cases, to better understand the disease’s spread in their regions. SEAN connects decision makers with researchers in the social, behavioral, and economic sciences to relay evidence-based expert guidance regarding local, state, and federal policies and responses related to COVID-19. This guide was created to facilitate insight into the strengths and weaknesses of COVID-19 data by applying 5 criteria to 7 types of data available to support decision making. The goal is to guide decision-makers toward the data type most appropriate to answer each of their questions, and then to use that data effectively. The 7 data types are the number of confirmed cases, hospitalizations, emergency department visits, reported confirmed COVID-19 deaths, excess deaths, the fraction of viral tests that are positive, and representative prevalence surveys (viral and antibody tests). The 5 criteria are representativeness; bias; uncertainty, and measurement and sampling error; time; and space. Read the full guide here.

The Military and Pandemics: Early Lessons and Future Actions

This week, the Center for Strategic and International Studies (CSIS) hosted an online event to discuss the major steps taken by the US military toward augmenting the civilian medical system while simultaneously sustaining its own operations. This discussion focused on lessons learned, the possibility of restructuring military services to improve future responses to events such as pandemics. Panelists included Lieutenant General David Barno (Ret.) from Johns Hopkins University School of Advanced International Studies, Nora Bensahel from Johns Hopkins University School of Advanced International Studies, and Melanie Marlowe from the CSIS International Security Program.

The overarching theme and point of agreement across the three panelists was the inevitability of major changes in direction, priorities, and budget of the US military. Regarding the budget, the Department of Defense (DoD) should expect a significant drop that likely requires scaling back or eliminating large legacy programs and the shrinking of active duty forces. Barno expects priorities to shift from an external focus on protecting Americans to protecting Americans at home as the cyber and space domains continue to surpass the land, air, and sea domains. The traditional defense barriers placed around the world by the US military are ill-equipped to protect those on US soil, as we are currently experiencing in the COVID-19 pandemic. Additionally, Barno anticipates that the reserve component of the military will play a bigger role now as it is essentially a dual-purpose force that helps provide food and supplies and augments civilian medical efforts in national emergencies along with its more soldierly objectives. Bensahel stressed the fact that the COVID-19 pandemic is the greatest catastrophe to hit the US since World War II; the death toll from COVID-19 now exceeds that of all US military deaths in overseas events since World War II. She also asserts that national security will now be redefined as Americans shift their notion of national security as susceptible to outside threats, like state or non-state actors, to susceptible to intangible threats. Americans will think more of their own personal security. Marlowe maintains that the military should not be the linchpin responder in a national emergency, such as a pandemic, but that the civilian sector should be the primary responder. As a support to the civilian efforts to contain the spread of the virus and treat infected individuals, the US military erected field hospitals, moved important cargo, evacuated US citizens from other nations, and provided hospital ships. In summary, the US military is about to undergo significant changes in its resources and objectives as the pandemic alters the meaning and parameters of national security. View the recording of this event here.

Soviet, Chinese, and North Korean False Allegations of Biological Weapons Use During the Korean War

During the Korean War, the USSR, China, and North Korea accused the US of using biological weapons against enemies. After the construction of the Richard Lugar Center for Public Health Research, the first high containment laboratory in the Republic of Georgia, the Kremlin accused Lugar Center, along with other US-backed laboratories, of producing biological weapons. Throughout the ongoing COVID-19 pandemic, mudslinging accusations that SARS-CoV-2 is a biological weapon are being flung from many China, Iran, Russia, and the United States. China has carried on a disinformation campaign against the US using unfounded claims that the US military introduced the new virus into Wuhan last fall during the Military World Games. Iranian officials have insistently promoted conspiracy theories that COVID-19 is a biological weapon created by the US to target Iran and its pharmaceutical industry. Russia has bolstered the claims of Iran by peddling their conspiracies on social media platforms. US officials have accused China of sabotaging the R&D efforts of Western nations toward developing a COVID-19 vaccine. False allegations of bioweapons use are injurious geopolitical tactics that degrade the legitimacy and authority of the Biological and Toxin Weapons Convention (BTWC). The BTWC is a multilateral arms control treaty signed by 183 countries that bans the development, stockpile, production, and transfer of biological agents and toxins. False claims of BTWC violations weaken the treaty regime by compromising the efficacy of international cooperation and collaboration against tangible threats of bioterrorism.

Coronavirus: Asymptomatic Transmission Still an ‘Open Question’

Along with numerous other uncertainties persisting in the COVID-19 pandemic, the question of the disease’s transmission from asymptomatic patients is the latest to rouse media attention. Dr. Maria Van Kerkhove is an infectious disease epidemiologist who serves as the WHO’s technical lead on the Covid-19 pandemic clarified that the actual rates of asymptomatic transmission are not yet known. Van Kerkhove’s clarification came just a day after her statement in an 8 June Press Conference that asymptomatic transmission is quite rare. At present, the data are not conclusive on the risk of asymptomatic spread. Adding insult to injury, there is confusion regarding the definition of an asymptomatic case. Though some cases of the virus are truly asymptomatic, the term is also applied to patients that have simply not begun to present with symptoms; some patients are in labeled as asymptomatic when they are actually presymptomatic. Asymptomatic cases are those that never present with symptoms, whereas presymptomatic cases are those individuals who test positive when they are symptom-free but later show them. These contradicting statements from the WHO are especially concerning given that research from different entities are finding that asymptomatic patients could be the cause of as much as half of the spread. The Office of National Statistics in the United Kingdom has been routinely testing a sample of its population, finding that of those individuals testing positive for COVID-19, less than one-third report “any evidence of symptoms” at the time of testing. The uncertainty and contradicting statements regarding asymptomatic transmission leave the public and its decision-makers in a pickle: are asymptomatic cases fueling the spread of COVID-19, and, if so, how do we adjust our response efforts?

Coronavirus Vaccine Tracker

The New York Times published a Coronavirus Vaccine Tracker that provides updates on the status of vaccine candidates that have reached human trials as well as a selection of candidates in cell or animal testing. Vaccine candidates must make it through four important stages before regulatory approval: (1) Preclinical Testing in animals, (2) Phase I Safety Trials using a small number of human subjects, (3) Phase II Expanded Trials with hundreds of human subjects, and (4) Phase III Efficacy Trials with thousands of subjects. Normally, the process to approval is quite sluggish; however, under emergent conditions, there are options to accelerate a viable candidate to approval. The Tracker categorizes vaccine candidates as genetic, viral vector, protein-based, and whole-virus. View the Tracker here.

Pandora Report: 6.5.2020

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

Stevie Kiesel, a Biodefense PhD Student, attended a Wilson Center webcast discussing the challenges and opportunities for non-state actors around the world during the COVID-19 pandemic. Experts on the panel include the Honorable Jane Harman, Dr. Duncan Wood, Eric Olson, Michael Kugelman, Dr. Louise Shelley, and Marina Ottaway. Read Kiesel’s event summary here.

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

Yong-Bee Lim, a Biodefense PhD Candidate, attended a webinar about the future threat of bioweapons given the ongoing pandemic, preparedness for the intentional use of bioweapons, and strategies for countering disinformation. Expert panelists include the Honorable Andrew C. Weber, GMU Alumna Dr. Saskia Popescu, Dr. Alexander Titus, and Max Brooks. Read Lim’s event summary here.

Master’s and Certificate Virtual Open House Library

For anyone who missed the virtual open house or would like to revisit the event, the video recordings of the Schar School program directors are available in the Master’s and Certificate Virtual Open House Library! Here, you will also find the application link and additional information about the Schar School and its research. For any questions, contact the Schar School Graduate Admissions Office at schar@gmu.edu.

US “Withdrawal” from WHO

At the end of May, the administration announced its withdrawal from the World Health Organization (WHO) citing the body’s protection of China during the early stages of the COVID-19 pandemic as the final straw. This withdrawal follows the April decision to halt US funding to WHO. This decision has sparked outrage among the public health and biodefense communities. A statement from Ernest J. Moniz and Beth Cameron of the Nuclear Threat Initiative (NTI) warns that termination of the US-WHO relationship will “significantly impair the international response to the COVID-19 pandemic, threaten American and global health, and undermine international security.” Instead, they encourage the administration to assume a leadership role in “strengthening the WHO’s ability to reduce biological risks, detect threats early, and respond rapidly and effectively.” The supposed withdrawal does not consider the gap the US will leave open in the international community, providing an opening for another global powerhouse, like China, to better secure its values and agendas. Additionally, there is uncertainty as to the legality of withdrawal from WHO, because the US is one of the state members of the WHO Constitution. According to Harold Hongju Koh of the Yale Law School, the administration lacks the legal ability to withdraw the US from the WHO and there are actions that can be undertaken by Congress or public health advocates to prevent a withdrawal if a method of legal withdrawal is found.

Point of View: Bioengineering Horizon Scan 2020

Horizon scanning is a type of foresight methodology in which systematic investigation is used to detect early signs of weak signals indicating potential change.  This methodology aims to identify the opportunities and threats associated with technological, regulatory, and social changes. This article posted in Genetics and Genomics reports results of a new horizon scan for bioengineering based on inputs from an international group of 38 participants. The authors identified 20 issues identified in the scan that are likely to realized within the next 5 years, 5-10 years, or 10+ years. These issues span several topics such as the regulation of genomic data, increased philanthropic funding, malicious uses of neurochemicals, crops for changing climates, and agricultural gene drives. Early identification of these issues is important for researchers, policy-makers and the general public.

How to Reopen America

COVID-19 has crippled US businesses, reducing the economy to a condition not seen since the Great Depression nearly a century ago. Since pandemic reached our soil, public health experts have stressed the need to practice social distancing and comply with shelter-in-place orders in order to flatted the infection curve and reduce the number of COVID-19 hospitalizations and fatalities. Despite these directives and mandates, the impacts of the pandemic on public health, the economy, governance, and social wellbeing have been tremendous. The Brookings Institution just released a report analyzing how to reopen America and how to address fundamental issues. The experts who compiled this report present several ideas for protecting for protecting public health, restarting the overall economy, and improving social well-being. Read the full report here.

“The CDC Waited its Entire Existence for this Moment,” What Went Wrong?

A recent article in the New York Times outlines the critical missteps of the Centers for Disease Control and Prevention (CDC) that weakened the US response to the COVID-19 pandemic. The article cites issues outdated technology, a lack of data, slow bureaucratic movement, conflicting guidelines, and a lack of cohesion within the administration as key factors contributing to the hampered response. Now, as the country initiates reopening, the CDC continues to struggle to provide clear and timely guidance relating to COVID-19. Mistrust is growing toward the once exalted health agency, even as the need for their direction and information remains. Read the full article here.

Did the SARS-CoV-2 virus arise from a bat coronavirus research program in a Chinese laboratory? Very possibly.

Milton Leitenberg, the first American recruited to work at the Stockholm International Peace Research Institute (SIPRI), discusses the still unknown origin of the SARS-CoV-2. Leitenberg asserts that there is not enough hard evidence to definitely claim that virus originated as a result of natural evolution or as an escapee of coronavirus bat research; the evidence is circumstantial thus far. There are two virology institutes in Wuhan that have conducted sizable projects on novel bat viruses and other animals have been infected with these viruses for research purposes. Unfortunately, laboratory accidents and the subsequent escape of dangerous pathogens are rather commonplace around the world. Suspiciously, Beijing has worked to obscure the origins of the pandemic with disinformation and withholding information. Given factors such as these, there is a possibility that the virus is the product of some type of laboratory accident. Calls continue for an international commission independent of the WHO to investigate the origins of the virus, whether it be zoonotic spillover or naturally-occurring; however, Leitenberg doubts the realization of such a commission. At present, the data indicate that SARS-CoV-2 is “uniquely adapted” to infect human hosts, but they do not provide any definitive insight into its conception.

The Council of Europe continues working to enhance international co-operation against terrorism, including bioterrorism

As the pandemic continues, the Council of Europe Committee on Counter-Terrorism (CDCT) is continuing its work to improve international cooperation against terrorism, both “traditional” and biological. Though the CDCT does not possess any concrete evidence of an elevated risk of a bioterrorism attack, it pledges to continue its efforts in developing legal standards, facilitating contacts between competent authorities, and organizing a coordinated and strong response to emerging threats. The CDCT encourages coordinated responses to bioterrorism threats, a variety of expert responders, and health and legal monitoring based on common surveillance systems for case detection. More resources from the CDCT regarding response to terrorism threats can be found here.

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

By Stevie Kiesel, Biodefense PhD Student

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

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

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

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

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

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

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

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

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

By Yong-Bee Lim, Biodefense PhD Candidate

Introduction

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

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

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

Gaps in Biopreparedness and Biodefense

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

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

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

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

Obstacles and Solutions to Future Biothreats

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

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

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

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

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

Conclusion & Consensus

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

Pandora Report: 5.29.2020

Exploring the Frontiers of Innovation to Tackle Microbial Threats

The National Academies of Sciences, Engineering, and Medicine (NASEM) released proceedings from a workshop, dubbed Exploring the Frontiers of Innovation to Tackle Microbial Threats, help in December 2019. The workshop occurred, fittingly, in the same month as the birth of SARS-CoV-2, the viral agent of the COVID-19 pandemic the world is currently besieged by. This 1.5-day workshop of the Forum on Microbial Threats examined key developments in scientific, technological, and social innovations against microbial threats: diagnostics, vaccine development, antimicrobial therapies, nonpharmaceutical interventions, and disease surveillance tools. The proceedings outline important lessons learned, particularly regarding spurred innovations, from the poliovirus eradication campaign as well as the the on-the-ground work to quell Ebola virus disease outbreaks in West Africa and the Democratic Republic of the Congo. Dr. Rick Bright, the former director of the Biomedical Advanced Research and Development Authority (BARDA), moderated the panel on incubating R&D through novel ecosystems. The output also includes content from panels regarding systematic approaches to motivate innovations in antimicrobial resistance R&D, barriers to access and use of innovations, and strategies to overcome barriers to innovation uptake. The full report can be found here.

FAS Announces the COVID-19 Rapid Response Task Force

The Federation of American Scientists (FAS) announced the launch of its COVID-19 Rapid Response Task Force, an amalgamation of dozens of scientists and experts from across the United States. The Task Force is being established as a resource for federal and state legislators as well as other policymakers seeking sound scientific information regarding COVID-19 related topics. Such topics span biomedical research needs, diagnostic test development, and contact tracing challenges, all of which are important to reopening while containing the virus. The Task Force provides an open channel of communication to experts in numerous areas of need.

Student Spotlight: Laura Schmidt Denlinger

Schar School Biodefense PhD student Laura Schmidt Denlinger was promoted to the role of Deputy Team Chief for Counterproliferation Programs in the State Department Bureau of International Security and Nonproliferation‘s Office of Cooperative Threat Reduction (ISN/CTR). As such, she coordinates CTR capacity-building programs that strengthen foreign partners’ ability to implement United Nations Security Council Resolutions regarding WMD proliferation by North Korea and Iran, as well as the Chemical Security Program, Partnership for Nuclear Threat Reduction Program, and other lines of effort to counter emerging WMD proliferation threats.

GHSA Chair COVID-19 Statement

Dr. Roland Driece, Chair of the Global Health Security Agenda, recently provided a statement on the ongoing COVID-19 pandemic and the role of the GHSA2024. Emphasizing the role of international coordination and unification of efforts from governments to NGOs, Driece noted that this event should not be seen as an indicator that our efforts to prepare have failed, but rather that “Because of the work of GHSA, we have more information than in any previous outbreak about which countries have the most prepared systems, and where the international community needs to direct assistance. As countries and partners work to respond to spread of COVID-19, national plans supported by the International Health Regulations and Joint External Evaluations are guiding action and providing resources for decision making, prioritisation, and actions.” Through the extraordinary efforts of everyone ranging from lab to information systems, this naturally occurring event coordinated to respond and it will require the continued investment in preparedness to response and prevent future pandemics.

New Evidence on Disease Dynamics

The raging pandemic has spurred a deluge of interesting new and early release articles in Emerging Infectious Diseases, a journal published by the Centers for Disease Control and Prevention (CDC). A study transmission examining a cluster of COVID-19 cases associated with a shopping mall in Wenzhou, China indicated indirect transmission of the causative agent, likely via contaminated objects, virus aerosolization in confined spaces, or spread from close contact with asymptomatic infected persons. Another research team collected information on individual case reports and domestic travel across China to estimate important epidemiological measures, such as the disease’s incubation period and R0. Specifically, they found that in the early days of the outbreak, the doubling time was 2.3-3.3 days and the median R0 could hit 5.7, numbers that support the criticality of surveillance, contact tracing, and social distancing to slow transmission. A third study confirmed asymptomatic and human-to-human transmission via close contacts in family and hospital settings, information useful for practice in clinical diagnosis and treatment. Relatedly, further research found evidence supporting the transmission of SARS-CoV-2 while an infected patient was presymptomatic or asymptomatic. Transmission of the virus from presymptomatic and asymptomatic cases impacts the types of public health interventions needed to contain the virus. An analysis of coronavirus patients from Vietnam indicated that the virus was transmitted from a traveler from China. Additionally, an asymptomatic patient showed viral shedding, more evidence that transmission can occur in the absence of clinical signs and symptoms. An article examining transmission from a presymptomatic attendee at a meeting in Germany found evidence that the disease was further transmitted via handshaking and face-to-face contact. Read all these articles here.

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

Stevie Kiesel, a Biodefense PhD Student, attended a GMU webinar featuring a discussion among a panel of experts regarding public health response strategies, economic impacts of lockdown, and potential longer-term implications of COVID-19. The panel included experts in economics, presidential leadership, emergency management, and disease transmission. Read the full commentary here.

 

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

By Stevie Kiesel, Biodefense PhD Student

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

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

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

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

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

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

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

Pandora Report: 5.22.2020

Congrats to GMU Biodefense Graduates and Award Recipients!
While they won’t get to walk across the stage and celebrations are being done virtually, we are so proud of our new Schar School Biodefense graduate students who have completed their studies and are already out on the frontlines working to combat COVID-19. Our new PhD graduates are Ashley Hess, Margaret Midyette, Katherine Paris, and Saskia Popescu. New graduates of the MS program include Daniel Cooper, Edward Cope, Joseph DeFranco, Michael Krug, Alexandra Pugh, Georgia Ray, and Hwa Yun. We’re also excited to announce that Maliheh Bitaraf, Diana Ciricean, and John Kisko have just completed their Biodefense certificates. Congrats! During this graduation, three students are presented with Graduate Student Awards and we’re proud to announce that Michael Krug is the 2020 Outstanding Biodefense MS Student, Saskia Popescu is the Outstanding Biodefense PhD Student, and Yong-Bee Lim has received the Frances Harbour Award. Read more about our recipients here.

‘I Can’t Turn My Brain Off’: PTSD and Burnout Threaten Medical Workers
Though health care workers were already vulnerable to depression and suicide, the additional stress of COVID-19 further threatens their mental health as signs of stress- and trauma-related disorders rise. This New York Times piece by Jan Hoffman highlights how our health care heroes are hurting under the weight and losses from COVID-19. In tandem, a commentary by GMU’s own Madeline Roty describes the criticality of prioritizing the mental health of health care workers in and out of crises. The recent suicides of Dr. Lorna Breen and EMT John Mondello are heart-wrenching wakeup calls about the insufficient resources and support for the mental health of medical workers. Existing resources have experienced a surge in demand since the pandemic started as workers struggle with increased duties ands stress regarding the care of their patients, while being denied sufficient access to PPE and proper training for new policies and protocols. Additionally, workers suffer from the disconnect between themselves and their social networks – families, friends, and physical contact with both. The therapeutic power of a loving hug is no longer an option at the end of a grueling, and likely long, shift. The full article is available here.

The Coronavirus Chronicles
We recently introduced our new series, The Coronavirus Chronicles, which is a collection of stories, based on the personal and professional experiences of the faculty, students, and alumni of the Biodefense Graduate Program, about life during the pandemic. From lab safety to parenting and even healthcare work, The Coronavirus Chronicles have detailed the lives of so many of our students and alumni working in COVID-19 response. We hope these stories help the public better understand the challenges posed by COVID-19 and how current and former members of the Biodefense Graduate Program have responded to these challenges and contributed to the pandemic response at the local, national, and international levels. This week, we’re launching a new story by biodefense graduate student Madeline Roty, who discusses the psychology effects of virus outbreaks. As you read above, this is a very real issue and extends beyond healthcare workers. Roty notes that “Fear of infecting others and time in quarantine or isolation contribute to psychological distress. Some healthcare workers have been forced to quarantine due to exposure to the virus or isolate after becoming infected. Many others are choosing to adhere to a modified quarantine in which they go to work but separate themselves from family, even in the absence of a known exposure.” Read her analysis into mental health and outbreaks here

The Future Bioweapons Threat: Lessons from the COVID-19 Pandemic
Looking for a webinar to discuss lessons learned from COVID-19 and the implications for bioweapons threat analysis? The Council on Strategic Risks (CSR) is thrilled to present its first LIVE webinar on May 28 from 3:00-4:30pm EST, which will examine the future bioweapons threat from the perspective of the COVID-19 pandemic. Panelists include Max Brooks, author of World War Z and Devolution, Nonresident Fellow at The Modern War Institute and Atlantic Council, Honorable Andrew C. “Andy” Weber, Senior Fellow at Council on Strategic Risks, former Assistant Secretary of Defense for Nuclear, Chemical, and Biological Defense Programs at the Pentagon, GMU Biodefense alum Dr. Saskia Popescu, Epidemiologist and Senior Infection Preventionist, HonorHealth, and Dr. Alexander Titus, Chief Strategy Officer, Advanced Regenerative Manufacturing Institute and Senior Fellow at Council on Strategic Risks. Register for event here.

Everyone Wins from Vaccine Cooperation
In a time of increasing finger-pointing, the best chance we have at a SARS-CoV-2 vaccine is likely through international coordination and cooperation. Dr. Kendall Hoyt, friend of GMU Biodefense, worked with Susan Athey and Michael Kremer to discuss the critical need for vaccine cooperation on international levels. Vaccine R&D isn’t easy and frankly, incurs a lot of risk. “The best way to manage these risks is to collaborate. Multilateral investment in a diversified portfolio of vaccine candidates would help to scale up production capacity as soon as a vaccine’s safety and efficacy have been established. Provided that much remains unknown about the novel coronavirus, we estimate that an investment of about $145 billion (.17% of world GDP) would be ideal, but that a program just half that size would yield substantial benefits. Although the United States and China are pursuing individual investment strategies, both could still advance their own national interests through international collaboration, either by way of the ACT Accelerator or via pooled contracts negotiated directly between countries and firms.” As the authors emphasize, global coordination doesn’t just reduce risk through managing supply chain disruptions, but also ensures export controls don’t interfere and ultimately, the benefits can be more broadly distributed.

Planning for a COVID-19 Vaccination Program
A commentary published in the Journal of the American Medical Association (JAMA), a group of medical doctors at Children’s National Hospital urge the public health community to initiate a proactive educational campaign to inoculate both the general public and health care workers against misinformation about the imminent COVID-19 vaccine. More specifically, this campaign should engage via traditional (television, radio, print ads) and social media platforms immediately to monitor, counter, and prevent the dissemination of false beliefs regarding the forthcoming COVID-19 vaccine.  The authors recommend four steps to promote widespread public acceptance of the vaccine: (1) rapid and equitable distribution of a vaccine immediately after confirmation of its efficacy and safety; (2) any plan for mass vaccination should address probable hurdles to vaccine acceptance using “linguistically and culturally competent messaging”; (3) public health leaders should design a robust COVID-19 vaccine educational campaign that incorporates social and traditional media, with foci on countering misinformation and leveraging the popularity of influencers; and (4) front line health care workers should be trained on how to convey strong recommendations for COVID-19 vaccine uptake. The article is available to read for free here.

Dr. Andrew Kilianski: Professor, Scientist, and Security Expert
Dr. Andrew Kilianski, an adjunct professor in the Schar School of Policy and Government’s Biodefense Graduate Program, is among the newly appointed experts leading the Department of Defense’s contribution to Operation Warp Speed, a public-private partnership to accelerate the development, manufacturing, and distribution of vaccines, therapeutics, and diagnostics for use against COVID-19. Specifically, Dr. Kilianski was appointed the subject matter expert leading DOD’s support in the area of Security and Assistance for this new Manhattan Project-style initiative. His role will presumably relate to defending vaccine researchers and pharmaceutical firms against cyberespionage threats. US and British cybersecurity agencies have issued multiple warnings about attempts by countries such as China and Iran to hack universities and private firms in order to steal intellectual property related to research on COVID-19 medical countermeasures. According to Dr. Gregory Koblentz, Director of the Biodefense Graduate Program at the Schar School, “Strengthening cyberbiosecurity is a vital element of our national effort to develop new vaccines and therapeutics against COVID-19. Dr. Kilianski’s appointment is a perfect illustration of how the Biodefense program tries to bridge the gap between science and policy.” Dr. Kilianski has been teaching courses on viral threat agents and biosurveillance for the Biodefense program since 2016. When the COVID-19 pandemic forced George Mason, and universities around the country, to shift to online teaching, Dr. Kilianski was already in the middle of teaching his virology course online. The Biodefense Graduate Program rotates all of its courses between being offered online and in-person, enabling students anywhere in the world to complete the entire Master’s degree online. The flexibility offered by online courses is not only good for students, but also allowed Dr. Kilianski to continue teaching even while he faced increased demands at work for his expertise. When classes resume in the fall, Dr. Koblentz noted, “Dr. Kilianski will be able to bring unique insights back into the classroom. Not everyone gets a professor with that kind of experience.” Since 2019, Dr. Kilianski has served as the Chief Intelligence Officer (CIO) for Chemical, Biological, Nuclear, and Radiological (CBRN) Defense for the Department of Defense. His previous work at DOD encompassed weapons of mass destruction, infectious diseases, and emerging biotechnology. Prior to joining DOD, Dr. Kilianski was a National Academy of Sciences Fellow with the US Army at Edgewood Chemical Biological Center, where he conducted cutting-edge research on integrated biosurveillance and the identification and characterization of novel agents that threaten warfighters. Dr. Kilianski earned his PhD in Microbiology and Immunology from Loyola University Medical Center where he specialized in the study of coronaviruses. His scientific research has been published in an array of notable journals such as PLoS Pathogens, Journal of Virology, and Emerging Infectious Diseases. His research included the discovery of virus-host interactions necessary for coronavirus pathogenesis and research on vaccines and antiviral agents against the Severe Acute Respiratory Syndrome (SARS) and Middle East Respiratory Syndrome (MERS) coronaviruses.

A Healthy Dose of Realism: Stopping COVID-19 Doesn’t Start with the WHO
Dr. Frank Smith III, the director of the Cyber and Innovation Policy Institute (CIPI) at the US Naval War College, encourages a renewed viewpoint on the COVID-19 response and how to make progress. Smith proposes that states, leaders, and organizations abandon their mud-slinging behaviors toward the World Health Organization (WHO) and, instead, focus on leveraging international partnerships and cooperation to combat COVID-19. According to Smith, the WHO is a relatively weak entity that bows to the will of powerful states, thereby echoing the balance of power in the world. Instead of throwing stones at the WHO, focus should shift to power nation-states that can act swiftly and significantly. He encourages concerted action between the United States and China, following the footsteps of the unprecedented collaboration between the US and Russia in the smallpox eradication campaign. The full article is available here.

STGlobal Consortium Seeking Graduate Students for STS/STP Conference
The STGlobal Consortium is now seeking graduate student volunteers to serve on the planning committee for our 2021 STS/STP conference, to be held in April 2021 in Washington, DC.  As you may know, the STGlobal Conference is a student-run and student-focused conference focused on the societal and policy aspects of science and technology, including such related concerns as sustainability, science communication, and science education.  Programming will include opportunities for graduate students to present and receive feedback upon research in a friendly and collaborative environment; workshops for development of research and professional skills; and opportunities to connect with students, professionals, and organizations working in the aforementioned areas. Service on the planning committee offers students a valuable opportunity to gain experience in the organization and facilitation of an academic conference, as well as to communicate and collaborate with other students in their fields from across the United States and the world.  If you know any graduate students who might be interested in serving this year, please pass on this message to them directly; and please feel free to disseminate this communication among your networks.  Students who wish to participate should email contact@stglobal.org for further information.