Pandora Report: 4.24.2020

by spopescu, posted in Pandora Report

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Counting Calories in COVID-19

by spopescu, posted in Commentary

By Rachel-Paige Casey

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

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

Recent Developments in White Supremacist Terrorism

by spopescu, posted in Commentary

By Stevie Kiesel

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

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

Pandora Report: 4.17.2020

by spopescu, posted in Pandora Report

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

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

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

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

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

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

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

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

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

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

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

Pandora Report: 4.10.2020

by spopescu, posted in Pandora Report

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

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

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

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

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

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

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

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

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

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

Pandora Report: 4.3.2020

by spopescu, posted in News

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

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

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

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

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

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

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

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

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

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

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

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

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

Acute & Chronic Economic Considerations of COVID-19

by spopescu, posted in Commentary

Rachel-Paige Casey

An Infected Economy

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

Predictions

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

Pandora Report: 3.27.2020

by spopescu, posted in News

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

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

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

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

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

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

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

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

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

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

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

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

 

Pandora Report: 3.20.2020

by spopescu, posted in Pandora Report

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

by spopescu, posted in Pandora Report

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.