Pandora Report: 5.1.2020

Launching The Coronavirus Chronicles 
It has been three months since the World Health Organization declared that the novel coronavirus now known as SARS-CoV-2 posed a public health emergency of international concern. Not since the “Spanish Flu” of 1918 has the world experienced a pandemic of the scope and severity caused by the SARS-CoV-2 coronavirus. Since SARS-CoV-2 first emerged, the faculty, students, and alumni of the Biodefense Graduate Program at the Schar School of Policy and Government have been working on the front lines, behind the scenes, and on the home front to respond to this unprecedented pandemic. After we heard some amazing stories from Biodefense students and alumni about how the COVID-19 pandemic had presented new personal and professional challenges and how they had been able to contribute, in ways large and small, to the pandemic response, the editors of The Pandora Report decided that these stories needed a wider audience. The Coronavirus Chronicles is a collection of stories, based on the personal and professional experiences of the faculty, students, and alumni of the Biodefense Graduate Program, about life during the pandemic. We hope these stories help the public better understand the challenges posed by COVID-19 and how current and former members of the Biodefense Graduate Program have responded to these challenges and contributed to the pandemic response at the local, national, and international levels. The first installment of The Coronavirus Chronicles features three stories by Biodefense students and alumni. Biodefense PhD alumna Jennifer Osetek explains how she juggles multiple roles from working for the Coast Guard to teaching public health emergency preparedness to being a mom and Saskia Popescu discusses the challenges of infection prevention on the frontlines in hospitals. Finally, master’s student Madeline Roty highlights the importance of protecting your mental health as well as your physical health during the pandemic. New stories will be added to The Coronavirus Chronicles on a regular basis and new installments will be featured in future issues of The Pandora Report. If you are a student or alumni of the Biodefense Graduate Program and would like to contribute a story, please email us at biodefense@gmu.edu.

In Memoriam – Julian Robinson
The CBW world got a bit dimmer with the loss of Julian Perry Robinson on April 22. Julian was an avid researcher and contributor to the world of CBW nonproliferation, inspiring generations to study and work in biodefense. “A chemist and lawyer by training, Julian was a member of the SIPRI research staff during 1968–71 and the focal point of the work on CBW, which included the excellent six-volume series of books The Problem of Chemical and Biological Warfare (1971–76). During this period he was also responsible for groundbreaking reports on CBW issues published by the UN Secretary-General and the World Health Organization.  All of these provided essential inputs into the negotiation of the Biological Weapons Convention which was opened for signature in 1972.”

Health Security Articles by Our Editorial Team
The latest issue of Health Security includes two articles by the Pandora Report’s managing editor Saskia Popescu and associate editor Rachel-Paige Casey. Both articles can be found here. Popescu co-authored the article “Restricted and Uncontained: Health Considerations in the Event of Loss of Containment During the Restricted Earth Return of Extraterrestrial Samples” with Betsy Pugel and Syra Madad. Currently, the scope of a satisfactory public health response to the release of biological material is limited to biological vectors with known pathogenicity and virulence; however, the scope should be expanded to include the release of biological material with unknown pathogenicity and virulence. The recent return of extraterrestrial samples from Mars, a planet which may harbor life, instigates the renewed framing of a public health response, particularly for an accidental release of a such novel and mystifying material. The article poses a set of question relating to the initial public health and healthcare response in the event that extraterrestrial samples are accidentally released from failures in biological containment mechanisms. These questions ask how the public health community prepares for such an event; what can be done to confine, decontaminate, and collect the material; and how will the public be prepared. Casey co-authored the article “Conflict and Cholera: Yemen’s Man-Made Public Health Crisis and the Global Implications of Weaponizing Health” with Christine Crudo Blackburn and Paul E. Lenze, Jr. The 2016-17 cholera epidemic in Yemen was, prior to COVID-19, the largest disease outbreak in modern history. Conservative estimates found that the number of suspected cases exceeded 1 million and, within the first 8 months of the outbreak, there were over 2,000 confirmed deaths. Although cholera is an ancient disease that continues to plague many countries, Yemen’s outbreak had several unique features. The outbreak, which disseminated at an unprecedented pace, was directly linked to the country’s ongoing armed conflict. This article assesses what the cholera outbreak in Yemen reveals about the connection between infectious disease and conflict, the targeting of healthcare infrastructure as a modern warfare tactic, and the implications of a strategy of infrastructure destruction have for global health security.

Spore Wars
The COVID-19 pandemic has increased fears of both another naturally-occurring disease event and a bioweapons attack. The Trump administration released a National Biodefense Strategy in 2018, but it also dismantled directorate of the National Security Council that focused on health security and biodefense, and it proposed budget cuts to the laboratory network that tests for biological threats. between FY2015 and FY2019, funding for civilian biosecurity dropped 27% to a number $1.61 billion lower than the bill for buying Black Hawk helicopters. Dr. Gregory Koblentz, Director of the Biodefense Graduate Program, spoke to how the pandemic has, frighteningly, showcased that the US public health infrastructure is comprehensive broken or overtaxed. In other words, we have now exposed a critical vulnerability that may be provide incentive for a bioterrorist. This vulnerability extends beyond public health and the beyond the US borders; the US and global economy may now have targets on their backs.

The Saga Continues: Disinformation and Conspiracy Theories about the Origins of COVID-19
As the COVID-19 pandemic continues and the nations of the world still struggle to stop the spread and protect their people and economies, the desire for a boogie man persists. Conspiracy theories abound about the suspected surreptitious origins of the SARS-CoV-2 virus that plagues the world. Despite a bevy of experts denying the possibility that the coronavirus is the result of biological warfare and genetic analyses showing that this virus is not human-made, the shoddy hypothesis has a following of believers. In the Washington Post, Dan Kaszeta, a specialist in chemical and biological defense, provides further insight into the illegitimacy of the theories that the pandemic is the product biological warfare. Beyond the lack of evidence of human tampering, the inducement of a pandemic threatens the safety and security of the perpetrator’s own people, thereby disincentivizing the release of a pandemic-inducing bioweapon. There is no therapeutic or vaccine against this coronavirus that would engender protection of one’s own or a friendly population to the releaser. Further, the spread of disinformation relating to the pandemic is now being coined as a concurrent “infodemic.” One of the newest conspiracy theories is that the 5G network either transmits the coronavirus directly or weakens the immune system to imbue susceptibility to the virus. What will be tomorrow’s half-baked coronavirus conspiracy hoax?

Special Issue of Intelligence and National Security
The Journal of Intelligence and National Security released a Special Issue on Global Health Security, introduced with an article by Filippa Lentzos (a friend of GMU Biodefense), Michael Goodman, and James Wilson. Their article provides an overview of the health security threat spectrum: deliberate disease outbreaks, emerging infectious diseases and natural disease outbreaks at the other, and accidental disease events created by the significant scientific advances in the abilities to modify genes and microorganisms. Additionally, it traces how the perceptions about biological and health security threats have changed and expanded with outbreaks of naturally-occurring diseases, recognition of the unintended consequences of research, laboratory accidents, negligence, and emerging technologies. The authors argue that the traditional intelligence community must better engage with non-IS stakeholders and broaden its cadre to include new sources of intelligence in order to strengthen global health security and health intelligence. The Special Issue is an effort to encourage the development of a “multidisciplinary, empirically-informed, and policy-relevant approach to intelligence-academia engagement in global health security that serves both the intelligence community and scholars from a broad range of disciplines.” Read the full article here and all the articles in this Special Issue are open access.

COVID-19 MCM Update
The latest scientific study findings of potential COVID-19 therapeutics are a mixed bag of good news and bad news. Gilead’s remdesivir, an antiviral drug developed to treat hepatitis C and Ebola virus disease, shows no benefit to coronavirus patients according to a clinical trial conducted in China. This finding was accidentally revealed, but additional studies on the effects of remdesivir for coronavirus patients await their own conclusions. Conversely, Dr. Anthony Fauci, the top infectious disease expert for the US government, recently stated that data from another clinical trial is showing a positive effect from remdesivir in cutting a patient’s time to recovery. GEN’s list of front-runners for therapeutics and vaccines against COVID-19 currently includes 19 candidates; remdesivir remains on that list. In encouraging news, the COVID-19 pandemic has underscored the argument for supporting the development of a panviral drug. A panviral drug works broadly within or across viral families to incapacitate them. Such a drug is extraordinarily difficult to design because viruses hijack a host’s cellular machinery to survive and propagate; however, targeting a virus’s functions in a host cell may also negatively impact that cell’s normal function. Fortunately, researchers are starting to discover ways around that problem by refining which processes an antiviral drug targets.

The Trump Effect – International Institutions
From UNESCO to the Human Rights Council, and now the WHO, President Trump isn’t much of a fan of international institutions. “Global institutions are supposed to help facilitate cooperation during crises, but this time they’ve left nations to their own devices. That’s a departure from the past, and many experts suggest that it’s largely driven by the U.S.’s absence. ‘This makes the U.S. weaker, not stronger,‘ said Greg Koblentz, an associate professor at the Schar School of Policy and Government at George Mason University. ‘This will either lead other countries to try and use these crises to push their own agendas, or everyone will be on their own and you’re going to get a zero-sum competition among countries competing for scarce resources and hording supplies and not sharing data, because the mechanisms for facilitating cooperation and burden sharing and information sharing will have fallen apart’.” Since the news of President Trump’s plans to halt U.S. funding to the WHO, many have pointed out that his frustrations with the international institution aren’t excuses for why the U.S. has performed so poorly in responding to COVID-19. Jeremy Konyndyk noted “First off, the decision to pause funding to the organization that is coordinating the global fight against a pandemic in the middle of a pandemic is hugely damaging. If they do move forward with fully cutting off funding, that doesn’t just disrupt COVID response; it disrupts a lot of different things the U.S. government relies on WHO to do, like polio eradication, or cholera in Yemen, or extinguishing the Ebola outbreak in eastern Congo.”

The Right Way to Reopen the Economy According to GMU’s Pearlstein
Steven Pearlstein, a GMU Schar School professor and Pulitzer Prize-winning business and economics columnist, briefly outlined his recommendations on reopening the US economy. The upshot of Gerstein’s article is that getting Americans back to work after the coronavirus lockdown should not be a politicized process, but one that focuses on protecting Americans while restarting the US economy. The sooner we can safely return to normal life, the better. He outlines several general principles for reopening the economy, but points out that decisions and policies should be tailor-made to a region, industry, or institution to maximize success. For instance, regarding special funding programs, workers should be prioritized over investors and low-wage workers should be prioritized over high-wage workers. In general, lenders can afford to wait for their money, whereas workers and suppliers cannot. Given that a large chunk of white-collar workers can work from home but many blue-collar workers lack that luxury, low-wage workers should be the first to receive help as they are more likely to have lost most, if not all, of their income under the social distancing measures. No matter what decisions are made, tradeoffs are inevitable. There is no perfect solution without some hiccups or shortcomings. So, the key question is how do we reopen in a way that minimizes costs and risks to public health?

Preventing CBW Proliferation In the Age of COVID-19
How are the OPCW, BCW, and 1540 committees working to combat biological and chemical weapons during the pandemic? Richard Cupitt, Senior Fellow and Director of the Partnerships in Proliferation Prevention program at Stimson and Adjunct Faculty at GMU Biodefense, has provided a review of how each nonproliferation organization is working during this time. Cupitt notes of the BWC, “Not surprisingly, many national governments have entertained the need to adopt and implement the BWC and contribute to its strengthening.  And the requests for assistance have increased enormously according to several sources (although which requests, if any, that have gone to the BWC is confidential).” He emphasizes that for those like the OPCW, adjustments have been made to work remotely while maintaining a critical presence. Moreover, the economic recession will likely mean cuts to the budgets of many nations, which could impact the financial obligations of States parties to these international organizations.

Opportunity to support CBRN Research: The University of Maryland’s Integrated Discovery of Emerging and Novel Technologies (IDENT) Project Team Invites You to Join 
GMU Biodefense MS alum Alexandra Williams, Junior Researcher at the Unconventional Weapons Technology Division of the National Consortium for the Study of Terrorism and Responses to Terrorism (START) at UMD, is the co-research lead for the IDENT project and is inviting you to join. “This project has allowed me to apply the knowledge and experience I gained at GMU to conduct hands-on biodefense research and support US government CBRN mission space.” The IDENT Project seeks to develop a repeatable and scalable process for the discovery of emerging or disruptive technologies that may impact the Countering Weapons of Mass Destruction (CWMD) mission space. The project is sponsored by the Defense Threat Reduction Agency (DTRA) and is being designed and implemented by an interdisciplinary research team from the University of Maryland, ABS Consulting Group (ABSG), and the University at Albany (State University of New York). The IDENT Project team would like to invite rising and leading experts in the fields of biological and chemical defense to participate in the IDENT Knowledge Hub. The Knowledge Hub, a core component of the IDENT system, is a distributed, collaborative online software platform that includes broad horizon scanning and iterative-structured elicitation functionalities. The platform is also designed to incorporate additional expertise as needed through brief semi-structured probing interviews. If you would like to join the network of experts participating in the Knowledge Hub, refer a colleague, a fellow classmate, or would like more information about this effort, please reach out to Ms. Salma Bouziani at Bouziani@umd.edu and we are happy to provide you with any additional information.

Epic Fail: Why the US Wasn’t Prepared for the Coronavirus Pandemic
Daniel Gerstein, a graduate of the Biodefense PhD program and a senior policy researcher at the RAND Corporation, published an article in the Bulletin of the Atomic Scientists about why the US was not prepared for the coronavirus pandemic. The current administration largely failed to arrange a strong and timely response to COVID-19. The factors in this epic failure include, but are not limited to, inadequate biosurveillance systems, a disjointed emergency response network, and poor management of supply chain disruptions. Gerstein encourages a makeover for the emergency response system that lowers reliance on the federal government for a quick and effective response to outbreaks. In fact, certain state governments are already forming pacts to coordinate their responses to the outbreak and, perhaps, bypass the federal government. The pandemic has exposed the fissures in the national preparedness and response systems, which will require reconfiguring by relearning the lessons of crisis response and emergency management. Read Gerstein’s full article here.

Pandemic Pets?
First it was a sick tiger and now a new study from the CDC has reported that two pet cats living in separate ares of New York State have tested positive for SARS-CoV-2. “In the NY cases announced today, a veterinarian tested the first cat after it showed mild respiratory signs. No individuals in the household were confirmed to be ill with COVID-19. The virus may have been transmitted to this cat by mildly ill or asymptomatic household members or through contact with an infected person outside its home.Samples from the second cat were taken after it showed signs of respiratory illness. The owner of the cat tested positive for COVID-19 prior to the cat showing signs. Another cat in the household has shown no signs of illness.” No word on if hairballs are considered fomites…

News of the Weird
Got chickens? You’re in good shape against COVID-19 according to a Swedish city. The city of Lund is “spreading chicken manure in its central park in an effort to deter crowds gathering for a festival. Tens of thousands of people usually descend on southern city to celebrate Walpurgis Night, which is marked across Scandinavia. But officials want to keep people away because of the coronavirus outbreak. There is no lockdown in Sweden, where data show most people have taken to voluntary social distancing.” For residents of Lund, they have emphasized that with the stench of chicken manure, who would want to sit and have a beer?

Pandora Report: 2.14.2020

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

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

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

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

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

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

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

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

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

Pandora Report: 1.31.2020

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

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

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

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

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

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

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

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

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

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

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

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

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

Pandora Report: 1.24.2020

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

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

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

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

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

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

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

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

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

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

 

Ailments and Age Groups: What Makes Illness Age Dependent?

By Chris Healey

An uncommon and underreported virus has affected children in states across America. State health departments around the country have reported an unusual number of enterovirus D68 infections this season. Many hospitalizations – but no deaths – have been reported.

Enterovirus D68 was first isolated in California in 1962 from four children with pneumonia. Enteroviruses generally inflict a wide range of symptoms, but species D68 almost exclusively affects the respiratory system. D68 also shares genetic similarity with rhinoviruses—the viral species responsible for the common cold.

Past outbreaks of enterovirus D68 have occurred mostly in children. Although health experts aren’t sure why children are vulnerable to the illness relative to other age groups, the answer probably lies with the immune system. Age effects immune function. In prepubescence, the immune system is immature and naïve toward host threats. In old age, deterioration of essential immune system tissues – such as bone marrow – contribute to immune system decline.

Due to dampened immunity in childhood and late adulthood, illness is more common – and more often fatal. However, one historical exception stands out: the Spanish Flu of 1918.

Flu subtypes undergo antigenic drift, a process resulting in subtle genetic changes prompting the need for new flu vaccines each year. However, the Spanish Flu of 1918 was a result of dramatic genetic change called antigenic shift. The result was a new subtype to which the population had no immunity.

Many health experts consider the Spanish Flu of 1918 the worst pandemic in history – with at least 40 million deaths worldwide. By comparison, the Black Death was responsible for 25 million deaths. The Spanish Flu pandemic was caused by a direct transmission of influenza subtype H1N1 from bird to human.

The Spanish Flu of 1918 was unique because of its W-shaped mortality curve. When Spanish Flu mortality among age groups are plotted on an x-y axis – with x as age groups and y as specific death rate – the graph shows there were more deaths among the 18-to-40-age group than any other. That trend is unusual – 18-to-40 age groups typically have the highest immune function of all age groups, providing the greatest defense against pathogens.
For the Spanish Flu, the immune system actually worked against the host. The immune system reacted so violently to the novel Spanish Flu that it damaged the host more than the flu infection itself, leaving those with the strongest immune systems – ages 18-to-40 – most grievously affected.

 

Image Credit: Fox6Now