pandemic – The Pandora Report

Pandora Report 3.22.2024

March 22, 2024March 22, 2024 by dkellogg97, posted in Pandora Report

Happy Friday! This week’s Pandora Report covers progress on the ninth round of negotiations on a Pandemic Accord and proposed amendments to the International Health Regulations, Murthy v. Missouri and the evolving threat of health and medical misinformation, a recently launched Senate biodefense and life science research investigation, EPA’s warnings about cyberattacks against the United States’ water infrastructure and more.

Global Leaders Call for Urgent Agreement on a Pandemic Accord

More than 100 global leaders have made a call “to press for an urgent agreement from international negotiators on a Pandemic Accord, under the Constitution of the World Health Organization, to bolster the world’s collective preparedness and response to future pandemics,” according to a recent WHO press release. It comes as member states of the WHO look to finalize an agreement that would amend the 2005 International Health Regulations (IHR), which will be considered by the World Health Assembly in May. David P. Fidler explains what is at stake during this ninth round of deliberations in a recent piece for CFR’s Think Global Health, writing in part “WHO documents on the negotiations, along with commentary parsing the talks, indicate that WHO member states have much to do in a short period to deliver final drafts of a pandemic agreement and amended IHR to the World Health Assembly. Unresolved issues include problems that have long confounded global health governance, including equitable access to pharmaceutical products, financing for public health capacity-building, and government accountability. Even if the negotiations achieve breakthroughs on those problems, the task of turning reforms on paper into reality in practice confronts a world in which solidarity is increasingly in short supply.”

The letter challenges those who argue such amendments will harm national sovereignty, reading in part, “A new pandemic threat will emerge; there is no excuse not to be ready for it. It is thus imperative to build an effective, multisectoral, and multilateral approach to pandemic prevention, preparedness, and response. Given the unpredictable nature of public-health risks, a global strategy must embody a spirit of openness and inclusiveness. There is no time to waste, which is why we are calling on all national leaders to redouble their efforts to complete the accord by the May deadline.”

“Beyond protecting countless lives and livelihoods, the timely delivery of a global pandemic accord would send a powerful message: even in our fractured and fragmented world, international cooperation can still deliver global solutions to global problems.”

SCOTUS Hears Case Concerning Social Media Platforms, Pandemic Misinformation

The Supreme Court heard arguments this week in Murthy v. Missouri, a case concerning the First Amendment and whether the Biden administration violated the right to freedom of expression in its communications with social media companies regarding COVID-19-related misinformation. The lawsuit, one of 26 filed against the administration by former Missouri Attorney General Eric Schmitt, alleges that the Biden administration was “…working with social media giants such as Meta, Twitter, and YouTube to censor and suppress free speech, including truthful information, related to COVID-19, election integrity, and other topics, under the guise of combating ‘misinformation.”

NYT‘s Dani Blum explains how this has refocused attention on misinformation and its evolving nature, writing in part “Health hacks not backed by science have spread widely on social media platforms. The same kinds of conspiracy theories that helped to fuel vaccine hesitancy during the Covid-19 pandemic are now undermining trust in vaccines against other diseases, including measles, as more people have lost con fidence in public health experts and institutions. And rapid developments in artificial intelligence have made it even harder for people to tell what’s true and what’s false online.”

Blum continues, writing “Misinformation commonly includes “fake experts,” according to Sander van der Linden, a professor of social psychology in society at Cambridge who researches misinformation. These are either people making health claims who do not have any medical credentials, or doctors making statements about topics that they are not experts in. “You wouldn’t want to go to an ear and nose doctor to do a heart operation,” he said. “Is this a vaccine expert, or is this a doctor who actually does no research and has no expertise on vaccinations?”’

The effects of this are being keenly felt by healthcare providers. Amanda Johnson, a primary care physician in New York City, told USA Today about her approach to working with patients who have fallen victim to such information, saying “(Frustration) doesn’t get us anywhere. I think those conversations are more likely to go poorly if you take it as a personal affront.”

The same article explains further that “She has talked about misinformation with patients, some of whom have even asked her to review social media posts they’ve seen. The most animated responses come from patients who believe they’re losing control or having something forced on them, said Johnson, who also leads NYC Health + Hospitals’ AfterCare program for New Yorkers recovering from COVID-19 or living with long COVID.”

“Many people are disparaging or dismissive when talking about people who believe misinformation, but it can happen to anyone, said Sedona Chinn, an assistant professor in the life sciences communication department at the University of Wisconsin-Madison.”

Senate Homeland Security and Governmental Affairs Committee Announces Bipartisan Biodefense and Life Science Research Investigation

In a statement this week, the Senate Homeland Security and Governmental Affairs Committee announced, “U.S. Senators Gary Peters (D-MI) and Rand Paul (R-KY), Chairman and Ranking Member of the Homeland Security and Governmental Affairs Committee, announced a joint investigation of national security threats posed by high-risk biological research and technology in the U.S. and abroad. Peters and Paul plan to hold hearings and conduct government-wide oversight on areas including high-risk life science research, biodefense, synthetic biology, biosafety and biosecurity lapses, early warning capabilities for emerging outbreaks or possible attacks, and potential origins of the COVID-19 pandemic. This bipartisan oversight effort will assess and identify measures to mitigate longstanding and emerging risks and threats that may result in serious biological incidents – whether deliberate, accidental, or natural. The investigation will also seek to increase transparency and strengthen oversight of taxpayer-funded life sciences research, laboratories in the U.S. and abroad, and detection of biological threats.”

This is likely to add fire to efforts to impose new restrictions on contracted Chinese research firms like WuXi AppTec, as highlighted by Axios. At the same time, this will likely further reveal partisan divides on the topic, particularly given Paul’s emphasis on the Biden administration’s alleged efforts to conceal critical information about the COVID-19 pandemic.

EPA Confirms China- and Iran-Backed Hackers Are Targeting US Drinking Water Systems

“The country’s water systems are being hit with an increasing number of nation-state cyberattacks, according to the US Environmental Protection Agency (EPA),” explains a recent news article. In a recent letter to governors from EPA Administrator Michael Regan and National Security Adviser Jake Sullivan, the pair wrote ‘“We need your support to ensure that all water systems in your state comprehensively assess their current cybersecurity practices.”’ They also emphasized that, in many cases, “even basic cybersecurity precautions, are not present at water treatment facilities, urging that this “can mean the difference between business as usual and a disruptive cyberattack.”

CNN reports that “The EPA will also set up a “task force” to “identify the most significant vulnerabilities of water systems to cyberattacks,” among other pressing issues, Regan and Sullivan said in their letter. The Biden officials invited state homeland security and environmental officials to a meeting to discuss cybersecurity improvements needed in the water sector.”

This comes after industrial equipment at multiple water facilities in the US was hacked late last year, displaying an anti-Israel message, according to US officials. The administration blamed the Iranian government for these attacks. Hackers backed by the Chinese state have also recently infiltrated US water facilities, in “…a hacking campaign that the Biden administration worries Beijing could use to disrupt critical infrastructure in the event of a conflict with the US. China denies the allegations.”

US Hosts Launch for New Foreign Ministry Channel for Global Health Security

Recently, the US Department of State announced that Ambassador John Nkengasong – U.S. Global AIDS Coordinator and Senior Bureau Official for Global Health Security and Diplomacy, overseeing the Department’s Bureau for Global Health Security and Diplomacy – hosted a day-long discussion program to help plan priorities and review lines of efforts for the recently created Foreign Ministry Channel for Global Health Security.

The Department’s press statement explains that “The Channel builds on the 2022-2023 COVID-19 Pandemic Prioritized Global Action Plan for Enhanced Engagement (GAP). The meeting is the first in a series of regular engagements between senior officials within Ministries of Foreign Affairs to focus diplomatic attention and action on critical global health security priorities. The foreign ministries, and participants from other ministries, will build on progress in this first meeting to elevate global health security issues as a national security imperative, enhance pandemic preparedness, and advance concrete global health security deliverables. Participants will collaborate on global efforts to:

Strengthen pandemic prevention and early-warning capacities
Address misinformation and disinformation on health issues, and leverage emerging technologies to strengthen global health security
Mitigate the human health impacts of climate change utilizing the One Health approach, which recognizes the interconnectedness of human, animal, and environmental health
Enable sustainable medical countermeasures for health emergencies
Enhance diplomatic workforce capacity on health security.”

“‘Lab Leak’ Proponents at Rutgers Accused of Defaming and Intimidating COVID-19 Origin Researchers”

Jocelyn Kaiser covers a recent formal complaint filed with Rutgers University regarding the conduct of molecular biologist Richard Ebright and microbiologist Bryce Nickels, both employed by the university. Kaiser explains in the news piece for Science, “But now, their targets have had enough. A dozen scientists filed a formal complaint with Rutgers yesterday alleging that the two faculty members have violated the university’s policies on free expression by posting “provably false” comments that are often defamatory, and that some of their actions could even threaten scientists’ safety.”

Pandora Report 4.14.2023

April 14, 2023 by dkellogg97, posted in Pandora Report

This week is a big one! We kick off congratulating Biodefense MS alumna Aurelia Berisha for her work as a Presidential Management Fellow before getting into recent updates on the Biden administration’s pandemic policy, China distancing itself from UN efforts to study wet markets and other high-risk locations in Asia, and more. There are also plenty new publications and upcoming events in this issue, including a book talk hosted by the Schar School covering Lessons From the COVID War: An Investigative Report.

Biodefense Alumna Lands Prestigious Presidential Management Fellowship

“Aurelia Berisha has always been interested in public service to have an opportunity to make a positive difference in the community and other people’s lives. Now, she has that opportunity in her new role as a Program and Management Analyst at the United States Department of Agriculture (USDA) through the highly competitive Presidential Management Fellowship (PMF) program.”

“Berisha, a native of Chesapeake, Virginia, graduated from George Mason University in 2017 with her bachelor of science degree in biology and worked for a few years as a medical technologist. After the onset of the Covid-19 pandemic, Berisha became interested in strengthening biosafety and biosecurity in the U.S. and enrolled in the Schar School of Policy and Government’s highly ranked Master of Biodefense program, from which she graduated in 2021. While taking classes at Mason Square, Berisha heard about the PMF Program through several professors, including biodefense adjunct professors Ashley Grant and Andrew Kilianski, who encouraged her to apply.”

Read more about Aurelia’s PMF placement and time in the Biodefense MS program here on the Schar School site.

President Biden Signs Bill Ending COVID-19 Emergency

President Biden signed a bill immediately ending the COVID-19 national emergency this week. Previously Biden indicated he planned to extend both the national and public health emergencies until May 11. However, House Republicans soon thereafter pushed bills to end both emergencies immediately. The new law from this week only ended the national emergency despite recent statements from the White House saying these proposals “would be a grave disservice to the American people,” that would “create wide-ranging chaos and uncertainty throughout the health care system.”

Politico explains that “Despite this, Biden told Senate Majority Chuck Schumer last month that he did not plan to veto it — marking the second time in recent weeks that the president has signaled opposition to a Republican-sponsored bill, only to later decline to veto it.”

However, in the last week, 101,437 new cases of COVID-19 were reported in the United States, along with 1,327 new deaths and 1,874 new hospitalizations. With just 16.7% of the American population fully vaccinated with updated boosters, the pandemic is not over and there is a major risk in pulling federal funding for things like these boosters. With the US short about 80,000 public health professionals and the administration dragging its feet on standing up the Congressionally-instructed pandemic response office, it is hard to see the utility in ending these emergencies now.

In better news, the Biden administration is launching a $5 billion+ program aimed at accelerating the development of new coronavirus vaccines and treatments to address future challenges with COVID-19 and other coronaviruses. Dan Diamond writes of the initiative in the Washington Post ““Project Next Gen” — the long-anticipated follow-up to “Operation Warp Speed,” the Trump-era program that sped coronavirus vaccines to patients in 2020 — would take a similar approach to partnering with private-sector companies to expedite development of vaccines and therapies. Scientists, public heath experts and politicians have called for the initiative, warning that existing therapies have steadily lost their effectiveness and that new ones are needed.”

“Officials note that several coronavirus-driven outbreaks in the past two decades, including severe acute respiratory syndrome coronavirus in 2002 and Middle East respiratory syndrome in 2012, have spurred worries about the potential for future health crises related to the viruses. That said, a universal coronavirus vaccine could take years to develop; researchers have sought unsuccessfully for decades to create such a vaccine against influenza.”

China Sits Out On UN Wet Market Survey Project

This week, Reuters reported that the United Nations told the outlet that China will not be participating in a project to survey wet markets and other facilities across Asia considered to be at high risk of spreading infectious diseases. This was despite long-running talks with Beijing about engagement in the project. The article explains “Four Asian countries – China, Thailand, Vietnam and Laos – were initially selected for the survey by the scientific advisory committee of the project, called the Safety across Asia For the global Environment (SAFE), because they host multiple facilities presenting risks of animal-to-human disease transmission, the UN official said.”

While China’s National Forestry and Grasslands Administration initially showed interest and engaged in talks about the project, the organization has since withdrawn and refused to answer media questions about the project. Importantly, “China’s public security organs have handled more than 70,000 criminal cases involving wild animals from 2020-2022, confiscating 1.37 million wild animals in the process, state news agency Xinhua has reported.”

WHO Makes Progress on Draft Pandemic Accord

In a recent press release, the WHO said “Countries of the World Health Organization have mapped out how negotiations on a global accord on pandemic prevention, preparedness and response will move forward with a view to presenting a draft accord for approval by the World Health Assembly in May 2024.”

“Ending Thursday, discussions on the draft pandemic accord took place during the fifth meeting of the Intergovernmental Negotiating Body (INB), which includes WHO’s 194 countries…Countries agreed to keep a window open for additional written proposals until 22 April and that those proposals will be compiled with all others made over recent weeks into a package that will be made available to all drafting group participants.”

“In parallel with the pandemic accord negotiations, governments are also discussing more than 300 amendments to the International Health Regulations (2005) (IHR) in an effort to strengthen those regulations and make the world safer from communicable diseases while ensuring greater equity in the global response to public health emergencies.”

“Governments have been working to ensure consistency and alignment across the INB and IHR processes. The proposed IHR amendments will also be presented to the World Health Assembly in 2024, and would together, with a future pandemic accord, provide a comprehensive, complementary, and synergistic set of global health agreements.”

“Economic Security and the U.S. Department of Homeland Security”

This new RAND Corporation Perspective was co-authored by Dr. Daniel Gerstein, an alumnus of the Biodefense PhD program and current Schar School adjunct professor, and Douglas Ligor. They write in their summary “The U.S. Department of Homeland Security’s (DHS’s) contributions to U.S. economic security and, by extension, the economy itself are often misunderstood and undervalued. The country’s economic prosperity depends increasingly on the flow of goods and services, people and capital, and information and technology across U.S. borders — both visible and invisible.”

“The challenges the United States faces from an interconnected world have never been more significant. As witnessed during the coronavirus disease 2019 (COVID-19) pandemic, the American public has been affected greatly, and many of these challenges are rooted in previously unforeseen vulnerabilities to the U.S. economy. To ensure its economic security now and in the future, the United States should ensure both continued global economic leadership and security of its key economic advantages. To this end, the United States must continue to lead in trade, technology, information systems, innovation, human capital acquisition (through both education and immigration), and travel. These are all areas in which DHS is uniquely postured to support, facilitate, and promote U.S. economic leadership.”

“DHS plays a crucial role in proactively identifying and addressing the harmful influence on U.S. economic actors or sectors that would result in a geopolitical disadvantage to the United States and limit U.S. persons, companies, or entities from prospering in the global economy. This Perspective describes DHS’s role in supporting economic security now and into the future. It begins by describing the evolving strategic environment and concludes by examining DHS’s critical role in economic security.”

“Research with Exotic Viruses Risks a Deadly Outbreak, Scientists Warn”

In this feature for the Washington Post, David Willman and Joby Warrick discuss ongoing fears about the risks posed by seeking out viruses that may one day be able to spread in human populations, starting first with recounting concerns about research in Southeast Asia in the 2010s. They then write “Three years after the start of the coronavirus pandemic, a similar reckoning is underway among a growing number of scientists, biosecurity experts and policymakers. The global struggle with covid-19, caused by the novel coronavirus, has challenged conventional thinking about biosafety and risks, casting a critical light on widely accepted practices such as prospecting for unknown viruses.”

“A Post examination found that a two-decade, global expansion of risky research has outpaced measures to ensure the safety of the work and that the exact number of biocontainment labs handling dangerous pathogens worldwide, while unknown, is believed by experts to bein the thousands.”

They also feature Dr. Gregory Koblentz, Director of the Biodefense Graduate Program at George Mason, and his work with the Global Biolabs project: “Global Biolabs, the advocacy group, found that nearly 1 in 10 BSL-4 labs operating in other countries score poorly in international rankings for lab safety. In some cases, labs were constructed without local regulations or meaningful oversight of the handling of dangerous pathogens, or “even a well-established culture of responsible research,” said Gregory Koblentz, a co-author of the Global Biolabs report and the director of the biodefense graduate program at George Mason University’s Schar School of Policy and Government.”

“Most countries lack the sophisticated controls needed to prevent dangerous viruses or bacteria from being misused or diverted for illicit purposes, he said. “This is a major blind spot in global surveillance for future biological threats,” Koblentz said.”

“Expanding on Future Biological Weapons Convention Verification: An Interview with Dr. Piers Millett”

The Council on Strategic Risks’ Dr. Dan Reagan interviews Dr. Piers Millett, Executive Director, International Biosecurity & Biosafety Initiative for Science, in this piece covering the future of the BWC and its verification. Reagan writes in part “Across the biodefense community, there was a significant sense of uneasiness heading into the Ninth Review Conference of the Biological Weapons Convention (BWC), held in Geneva at the end of 2022. This was largely due to the stalled progress of previous review conferences, coupled with the current state of affairs shaped by Russian disinformation and concerns about non-compliance. Luckily, the result of the conference was generally positive, and there is renewed focus on how verification of compliance with the convention might be pursued in the future. To prepare for the Tenth Review Conference, a working group was established to address seven topics, including “measures on compliance and verification.”’

“The last time the BWC significantly addressed the technical aspects of verification was the 1991-1994 Ad Hoc Group of Governmental Experts to Identify and Examine Potential Verification Measures. The result was the VEREX Report, which offered potential measures for on-site and off-site verification, emphasizing that multiple measures would be needed for an effective review of compliance. Between 1995-2001, the Ad Hoc Group worked on drafting a binding resolution for verification within the BWC, which ultimately was shuttered after rejections in 2001 by the President George W. Bush administration.”

“Along the way, multiple experts have been working to develop ideas for how verification could be pursued. In a recent article, Feasibility of On-Site Verification, experts across academia, private industry, and non-government organizations addressed the modern considerations for a potential BWC verification protocol. In our efforts at the Council on Strategic Risks to raise the profile of such work, I recently spoke with co-author Dr. Piers Millett, who currently serves as the Executive Director of the International Biosecurity & Biosafety Initiative for Science (IBBIS).”

“What’s a Chemical Weapon? A Global Weapons Treaty Could Use Some Clarity”

Lennie Phillips addresses some points of confusion regarding the CWC in this piece for the Bulletin of the Atomic Scientists, writing in part “What is a chemical weapon? The Chemical Weapons Convention (CWC), the international treaty banning chemical weapons, recognizes that chemicals have both beneficial and malign uses and takes a nuanced approach to defining chemical weapons and their use. It is within these nuances that, in many cases, non-governmental groups have claimed use of chemical weapons against them or the people they represent. Are these claims based on ignorance of what is classed as use of chemical weapons? Are they indeed cases where chemical weapons have been used or merely attempts to grab headlines? Conversely, have the alleged perpetrators used chemicals for reasons that wouldn’t violate the treaty, or have they hidden within in the middle of the treaty’s nuances and masked deliberate use of chemical weapons, perhaps on the pretense that there is a gray area?”

“Reconciling Discrepancies in the International Trade of Dual-use Chemicals: The Potential of Blockchain Technology”

This recent issue brief from the Stimson Center discusses how blockchain technology may help address discrepancies in declared quantities of dual-use chemicals transferred internationally: “Under Article VI of the Chemical Weapons Convention, States Parties are required to submit an annual declaration to the Organisation for the Prohibition of Chemical Weapons including the quantities of dual-use chemicals they have imported and exported across national borders. However, the complexities of global chemical trade and uneven national implementation of the Convention, including the lack of harmonization across industry reporting on chemical transfers, has contributed to an increasing number of discrepancies in States Parties’ declarations. The Stimson Center’s MATCH Project explores how blockchain technology can streamline reporting on chemical transfers between industry and national authorities and reduce the risk of discrepancies while improving the ability of national authorities to accurately track the movement of dual-use chemical weapons precursors as they are transferred between countries.”

“Biosecurity Risk Assessment in the Life Sciences: Towards a Toolkit for Individual Practitioners”

Dr. Mirko Himmel recently published this report with the Stockholm International Peace Research Institute: “There are a number of potential risks and unintended consequences associated with research at the intersection of biological sciences and emerging technologies, including the risk of misuse for malicious purposes. While there are established biorisk management approaches to dealing with these dangers, gaps remain. This paper focuses on the role of individual practitioners in contributing to a larger culture of biosafety and biosecurity. It presents a proposed toolkit that involves a risk assessment process and strategies to manage potential risks. The paper outlines ways to motivate practitioners to proactively take responsibility for considering and managing the biorisks associated with their work, aiming to close the knowledge gap by equipping scientists with appropriate tools to implement a comprehensive biorisk mitigation strategy at the practical level. It concludes by deploying the approach using a potential application from nanobiotechnology for demonstration purposes and considers next steps.”

“Preparing for the Next Pandemic in the Era of Antimicrobial Resistance”

The US Presidential Advisory Council on Combating Antibiotic-Resistant Bacteria recently released this report discussing how the United States should prepare for the next pandemic with consideration for AMR in mind. The report summary explains in part “It is with this underlying premise of immediate action that the PACCARB presents this report with a total of 14 recommendations…The PACCARB has identified four major areas in which improvements can strengthen our preparedness for future PHEs and reduce the toll of resistant infections now and during a PHE. In each of these areas, investments in steady-state capabilities and capacities are needed to help address the current rise in AMR infections and to respond to the next PHE quickly and effectively.”

“Antimicrobial Resistance: An Opportunity to Save Millions of Lives and Transform the Field”

This report was recently published by Dr. Akhil Bansal for the AMR Funding Circle with support from Schmidt Futures: “This report, which is the culmination of conversations with over 100 experts in the field and supported by Schmidt Futures, a philanthropic initiative co- founded by Eric and Wendy Schmidt, considers AMR from a bird’s eye perspective and identifies areas that are currently being overlooked and where there are opportunities for outstripped positive impact. The recommendations that this report makes, which are summarised below, have not been conceived of with a specific client in mind, but suggests which stakeholders might be best placed to[.]”

What We’re Listening To 🎧

Interventions to Reduce Risk for Pathogen Spillover and Early Disease Spread to Prevent Outbreaks, Epidemics, and Pandemics

In this CDC Podcast “Dr. Neil Vora, a physician with Conservation International in Arlington, Virginia, and Sarah Gregory discuss pathogen spillover and ways to reduce the risk of spillover events.”

Lessons From the COVID War: An Investigative Report

book-talk-save-the-date Download

ASPR TRACIE Roundtable: Lessons Learned in Healthcare Communications

“Healthcare and public health entities have learned many lessons about communicating to their personnel and the public after three years of responding to the COVID-19 pandemic and concurrent emergencies. The U.S. Department of Health and Human Services (HHS) Administration for Strategic Preparedness and Response Technical Resources, Assistance Center, and Information Exchange (ASPR TRACIE) invites you to this webinar where speakers representing a wide range of stakeholders and jurisdiction types (national, large/urban, regional, and rural/tribal) will share their perspectives on how they integrated these lessons into current and future responses. Topics will include channels used for outreach and continued engagement, strategies for reaching different community and cultural groups and countering rumors, and working with partners to create complementary messaging.”

This event will take place virtually on April 20 at 3 pm EST. Register here.

Training Course: Achieving Data Quality and Integrity in Maximum Containment Laboratories

From FDA and UTMB: “This popular course offers a unique opportunity for the regulatory and scientific communities to discuss complex issues in an interactive environment and identify and share best practices for ensuring data quality and integrity in BSL-4 facilities.”

“The week-long, data quality course is designed to help researchers who conduct studies intended to support approval under the Animal Rule, which may be used to grant marketing approval of certain products when human challenge studies would not be ethical or feasible.”

“The course includes expert lectures and hands-on laboratory activities conducted in BSL-2 and BSL-4 training laboratories to emphasize the differences between biosafety levels, and the complexity of conducting laboratory activities in a BSL-4 environment. An online training module on GLP regulations (21 CFR Part 58) is included as a course pre-requisite.”

This course will take place April 24-28 in Bethesda and Frederick, MD OR virtually. Registration ends today (April 14), so act quickly!

Online Event: Civil Society at the 5th CWC Review Conference

From the CWC Coalition: “The Fifth Five-Year Review Conference (RC-5) for the 1997 Chemical Weapons Convention will be held in the Hague from May 15-19, 2023.”

“At the CWC RevCon, member states and the broader chemical weapons disarmament community will gather to assess past achievements, treaty implementation and compliance, and discuss plans to strengthen the CWC in the years ahead.”

“You are invited to join a virtual discussion on the upcoming Fifth Five-Year CWC Review Conference (RC-5), major issues to be addressed, and the role of civil society and non-governmental organizations.”

“We will be joined by Elisabeth Waechter, Head of Public Affairs at the OPCW. Paul Walker, the Chair of the CWC Coalition, will moderate.”

This event will take place on April 26 at 10 am EST. Register here.

National Biodefense Science Board Public Meeting

The NBSB will meet virtually on May 4 at 2 pm EST to discuss lessons from COVID-19 and will present recommendations on several topics, including collection, analysis, and sharing of operational health data, uses of virtual healthcare during disaster response, and disaster response challenges specific to rural and underserved communities. Register here.

Virtual Workshop: Prioritizing Actions for Epidemic and Pandemic Preparedness

From the National Academies: “Please join us May 4 & 18, 2023 from 8 a.m. to 12 p.m. ET for a virtual symposium examining how to strengthen the evidence-based prioritization of epidemic and pandemic preparedness and response capabilities.

The symposium will convene global health planning stakeholders, including those in government and academia, and across health- and non-health sectors to:

Review assessment tools and how, independently and together, they relate to national action planning.
Gain insight into how countries and organizations currently select priorities in funding for epidemic prevention, detection, and response.
Assess evidence for effective prioritization approaches to building disease surveillance and risk communication capabilities.
Identify governance structures that can support robust and reliable systems for epidemic and pandemic preparedness and response investments.

This symposium is in collaboration with the Division on Earth and Life Studies. Learn more about this workshop by visiting the event webpage.”

Nobel Prize Summit-Truth, Trust and Hope

Taking place May 24-26 this year in DC and virtually, this Nobel Prize Summit asks “How can we build trust in truth, facts and scientific evidence so that we can create a hopeful future for all?”

“Misinformation is eroding our trust in science and runs the risk of becoming one of the greatest threats to our society today.”

“Join us at this years’ Nobel Prize Summit which brings together laureates, leading experts and you in a conversation on how we can combat misinformation, restore trust in science and create a hopeful future.”

Learn more and register here.

Gordon Research Conference: Cross-Cutting Science Facilitating Collaboration Across the Threat-Science Research Community

“The Nonproliferation, Counterproliferation and Disarmament Science GRC is a premier, international scientific conference focused on advancing the frontiers of science through the presentation of cutting-edge and unpublished research, prioritizing time for discussion after each talk and fostering informal interactions among scientists of all career stages. The conference program includes a diverse range of speakers and discussion leaders from institutions and organizations worldwide, concentrating on the latest developments in the field. The conference is five days long and held in a remote location to increase the sense of camaraderie and create scientific communities, with lasting collaborations and friendships. In addition to premier talks, the conference has designated time for poster sessions from individuals of all career stages, and afternoon free time and communal meals allow for informal networking opportunities with leaders in the field.”

This conference will take place July 9-14 in Ventura, CA. Learn more and register here.

Disarmament and Non-Proliferation of WMD 2023 Training Programme

“The global non-proliferation norms regarding the use and proliferation of weapons of mass destruction are under pressure. The threat posed by nuclear, chemical and biological weapons has reached levels of urgency not seen since the Cold War. Consequently, there is a growing demand for professionals with the necessary legal, technical and policy expertise to tackle the challenges of today’s non-proliferation and disarmament agenda. Register now for the fourteenth training programme on disarmament and non-proliferation of weapons of mass destruction, co-organised with the Organisation for the Prohibition of Chemical Weapons (OPCW) on 18 to 22 September 2023 in The Hague.”

CDC Laboratory Leadership Service Application Open

The CDC’s Laboratory Leadership Services (LLS) program is currently accepting applications through June 1. Designed as a companion to the Epidemic Intelligence Service, this service was launched in 2015 and aims to train lab-oriented public health professionals. “The LLS fellowship provides a one-of-a-kind training experience for laboratory scientists who are ready to apply their expertise inside and outside of the lab, ultimately preparing them to be the next generation of public health laboratory leaders who work to protect public health. Fellows conduct cutting-edge research, support rapid response to disasters and disease outbreaks, help investigate emerging health threats, and enhance the laboratory systems and practices that are essential for public health. LLS seeks laboratory scientists looking to take their careers to the next level while doing work that delivers real benefits to communities across the country.” Learn more and apply here.

Weekly Trivia Question

You read the Pandora Report every week and now it’s time for you to show off what you know! The first person to send the correct answer to biodefense@gmu.edu will get a shout out in the following issue (first name last initial). Our question this week is: “In the 2011 film Contagion, Dr. Erin Mears (played by Kate Winslet) is an officer in which CDC program?”

Shout out to Sam R. for correctly answering last week’s trivia. Our question was: “The Forced Evolutionary Virus was developed by the the West Tek Corporation’s NBC Division in what popular video game franchise?” The answer is the Fallout franchise.

The Hidden Pandemic: COVID-19’s Impact on Antimicrobial Resistance

May 2, 2022 by dkellogg97, posted in Commentary

By Theresa Hoang, Biodefense MS Student

Introduction

The COVID-19 global pandemic has threatened public health security by adversely altering the health of patients and overwhelming hospital systems throughout the world. Not only is COVID-19 a global health threat, but antimicrobial resistance (AMR) is a public health crisis too. AMR happens when microbes become resistant to antimicrobials that are designed to kill them.[1] AMR contributes to healthcare-associated infections (HAI) in patients, which spreads within healthcare facilities and throughout the community and environment.[2] The CDC reports that “each year in the U.S., at least 2.8 million people are infected with antibiotic-resistant bacteria or fungi, and more than 35,000 people die as a result.”¹ AMR is a serious public health concern, especially during the pandemic, because experts have noted that COVID-19 may have reversed the progress on reducing AMR by creating a “perfect storm” for antibiotic-resistant infections in healthcare settings.[3] How has the COVID-19 pandemic impacted AMR in clinical patients, and why is it important? This issue is important because it affects patients, who are undergoing antibiotic treatments, and healthcare systems that are trying to prevent the spread of AMR. The current literature has discussed extensively the direct and indirect effects of the COVID-19 pandemic on AMR. A group of authors focuses on the increase of secondary drug-resistant infections and how they are affecting COVID-19 patients. Another group discusses the deterioration of healthcare systems allowing AMR transmission to escalate. Other authors analyze the disruption of antibiotic stewardship and its adverse effects during the pandemic. To fight against this growing pandemic, patients should work together with their healthcare providers to learn about the troubling effects of AMR and how to prevent it from spreading by practicing enhanced antimicrobial stewardship.

Secondary Drug-Resistant Infections from AMR

The surge in AMR during the pandemic has resulted in a rise of secondary drug-resistant infections. The three drug-resistant microorganisms that will be discussed are methicillin-resistant Staphylococcus aureus (MRSA), carbapenem-resistant Enterobacterales (CREs), and Candida auris.

**Scanning Electron Micrograph of MRSA (from CDC)**

Methicillin-resistant Staphylococcus aureus

MRSA is commonly spread in healthcare facilities and communities, and it can cause staphylococcus infections that are usually difficult to treat because of its resistance to some antibiotics.[4] Segala et. al explain that, during the pandemic, MRSA co-infections have increased significantly in COVID-19 patients who were admitted to intensive care units (ICUs).[5] “Up to 86.4% of all COVID-19 patients admitted to the ICU received a wide spectrum antibiotic therapy,” which helps treat against a vast majority of co-infections, including MRSA.⁵ However, exposing patients to these unnecessary antibiotics in a combination therapy can induce AMR. In another case study completed in Italy on mechanically ventilated patients, researchers compared the proportion of ventilator associated pneumonia (VAP) due to MRSA, between COVID-19 patients and non-COVID-19 patients.⁵ They found VAP rates were significantly higher in COVID-19 patients due to receiving a broad spectrum antibiotic therapy. Their findings also suggest there is higher rate of MRSA colonization and environmental contamination in COVID-19 ICUs.⁵ MRSA has not only evolved to become more resistant to antibiotics, but it continues to spread and colonize in healthcare facilities and other communities, in addition to infecting COVID-19 patients at increasing rates.

**Infographic of the Risk of CRE Infections (from CDC)**

Carbapenem-Resistant Enterobacterales (CREs)

Carbapenem-resistant Enterobacterales (CREs), formerly known as CR Enterobacteriaceae and nicknamed “Nightmare bacteria,” are a large group of different types of Gram-negative bacteria, such as Escherichia coli (E. coli) and Klebsiella pneumoniae, that commonly causes multiple infections in humans and in healthcare settings. CREs also develop resistance to a group of antibiotics called carbapenems.[6] CRE infections are spread from person-to-person by infecting or colonizing people (without causing infections or symptoms), specifically contact with wounds or stool, and through medical devices that have not been properly cleaned.[7]

CREs are a threat to public health because they are difficult to treat and are resistant to almost all available antibiotics.⁶ Their resistance comes from producing carbapenemases, which are enzymes that spread to other germs and cause resistance in carbapenems, rendering them ineffective.⁴ The CDC states that high levels of antibiotic resistance in CREs necessitate more toxic and less effective treatments, harming patient outcomes.⁷

Studies have shown that CRE infections are increasing among COVID-19 patients. According to a recent review on CRE infections during the pandemic, “secondary infections caused by CR-Klebsiella pneumoniae (Cr-Kp) show high prevalence of co-infection in COVID-19 patients.”⁵ Researchers have noticed that CR-Kp colonization and infections were associated with a high mortality rate in COVID-19 patients and increased use of antimicrobial agents.⁵ This represents a significant challenge for both infection control and clinical practice because as new antibiotics continue to be overused, CRE infections continue to rise and manifest in healthcare facilities and throughout communities.

Candida auris

Candida auris is an emerging multidrug-resistant (MDR) yeast that brings severe infections and spreads easily between hospitalized patients and nursing home residents through skin-to-skin contact.⁴ It can also cause invasive infections by entering the bloodstream, and even cause wound and ear infections.[8] Moreover, C. auris can trigger outbreaks in healthcare settings by contaminating hospital surfaces and medical equipment, especially if they are used for COVID-19 critical care. This indicates that patients are at high risk of C. auris colonization and infections.[9]

C. auris is an extreme public health threat to communities, and it has become a more serious concern during the pandemic. Since some patients with severe COVID-19 have required intubation and other invasive devices, they are put at a higher risk of C. auris infections; the pandemic may have contributed to an increase in these cases.[10] In another report from the CDC, 39 cases of C. auris have appeared in Florida during the pandemic that were attributed to “unconventional personal protective equipment (PPE) practices and environmental contamination.”[11] Risk factors like these have caused critically ill COVID-19 patients with C. auris infections to stay longer at ICUs and require antifungal drugs for long periods of time.⁵ This proves that improper and extended use of PPE has played a role in self-contamination and transmission of C. auris among COVID-19 patients.⁵ To prevent C. auris from spreading, especially among COVID patients, it must be detected immediately and IPC practices must be implemented.

Overall, the three different pathogens share a common goal, which is to induce AMR and increase secondary infections among patients. These drug-resistant microorganisms are a few out of the many other agents that have impacted patients during the COVID-19 pandemic.

AMR Implications for Healthcare Systems

Additionally, during the COVID-19 pandemic, the exacerbation of healthcare systems has increased transmission of AMR. Studies have shown that the rise of AMR in healthcare facilities was caused by a variety of factors, such as prolonged stays in the ICU,[12] overcrowding,[13] “contaminated PPE, increased workload among hospital staff, and prolonged glove usage.”[14] Furthermore, “shortages of PPE, staff shortages, fatigue, and deployment of inexperienced staff members with only basic training” are other factors that may contribute to the increased risk of AMR.[15] These determinants not only led to a surge in AMR, but also increases in morbidity, mortality, and healthcare costs for patients.¹⁴

To reduce AMR from escalating any further, Rawson et. al propose that social distancing, increased hand hygiene practice, and pre-emptive discharge of patients and cancellation of routine procedures are potential interventions that healthcare systems can implement during the pandemic.¹³ In addition, Knight et. al mention “enhanced infection prevention and PPE usage and control measures, in response to the COVID-19 pandemic, will help prevent infections and limit the spread of AMR.”¹⁵Therefore, better health infrastructure and enhanced IPC measures set in place mean minimization of AMR amongst patients.

Disruption of Antimicrobial Stewardship

Disruption of antibiotic stewardship is another problem that needs to be addressed with the rise of AMR driven by COVID-19. Antimicrobial stewardship (AMS) is “promoting the appropriate use of antimicrobials, improving patient outcomes, reducing AMR, and decreasing spread of infections caused by multidrug-resistant organisms (MDROs).”[16] However, AMS has not been emphasized enough during the pandemic. For instance, researchers are concerned that increased antibiotic use during the pandemic could enhance the long-term threat of AMR.[17] Popescu states that “misuse and overprescribing of antibiotics, poor stewardship, and generalized lack of surveillance,” are some reasons why AMR continues to be a public health problem.[18]

Moreover, misinformation on antibiotic use (whether it is low public awareness or increased consumption of them) is another factor that may enhance the rise and spread of AMR.[19] For example, Arshad et. al explain that 44% of respondents to a population survey in Australia assumed that antibiotics could treat or prevent COVID-19, and university students in Jordan who believed in conspiracy theories around COVID-19 also thought antibiotics can cure it.[20] Additionally, clinical uncertainty about the disease process and pathology of an infection can increase antibiotic use. “When clinicians do not have all the necessary information to truly understand what is happening to the patient, they tend to prescribe more antibiotics.”¹⁷ Altogether, these factors can increase the spread of AMR and disrupt AMS.

In contrast, Toro-Alzate et. al argue that “telemedicine consultations could be useful to educate patients on improving antibiotic use.”¹⁹ But at the same time, they mention how telemedicine can also increase over-prescription of antibiotics due to physicians’ decision making.¹⁹ Because they are not with patients in-person, healthcare providers tend to misdiagnose more often and not order as much lab tests with these remote services.

**#BeAntibioticsAware: Do I really need antibiotics? (from CDC)**

Another AMS strategy is using social media to manage online media campaigns that combat misinformation of antibiotic use. Some organizations, such as WHO and Nigeria Centre for Disease Control, correct antimicrobial misinformation and discuss ineffectiveness of antibiotics as a treatment for COVID-19 by using their digital platforms.²⁰ Taking everything into consideration and how the pandemic impacted the public health community, AMS must be further improved and emphasized among patients and healthcare providers to reduce AMR.

Are Hospital Stays of COVID-19 Patients (with AMR) Longer than Those of Non-COVID Patients?

The literature does not yet analyze the question of whether the length of hospital stays for COVID-19 patients with AMR are longer compared to hospital stays of non-COVID-19 patients. One study has claimed that AMR has led to adverse consequences for patients, including “more prolonged hospital admissions.”[21] Srinivasan mentions and compares the patient discharge data and AMR rates between patients with influenza-like illness and COVID-19.¹¹ Yet, the data between patients with flu and COVID-19 were collected at different time frames.

Source: CAPT Arjun Srinivasan, MD, USPHS (CDC PowerPoint)

In the current literature, there is no evidence and comparison recorded between hospital stays of COVID-19 and non-COVID patients during the pandemic, over the same time period. Considering that the surge in AMR has been driven by the pandemic, and that it has caused ill patients to stay at hospitals based on their conditions, it is hypothesized that COVID-19 patients with AMR have stayed at the hospitals much longer than non-COVID patients during the pandemic. To examine this gap, further research needs to be conducted by attempting to gather data through a survey and compare hospital stay rates between COVID-19 and non-COVID patients from different hospitals in the Northern Virginia area. This would also explore the critical steps needed to treat patients with AMR and to mitigate its transmission before discharging patients.

Conclusion

Antibiotics save lives but any time antibiotics are used, they can induce side effects and lead to AMR.⁴ Along with the rise in AMR, COVID-19 has compounded this issue, creating more challenges for patients and hospital systems to overcome. The surge of secondary infections among patients, the exacerbation of hospital infrastructures, and the disruption of antimicrobial stewardship are the results of COVID-19’s impact on AMR.

Bibliography

Arshad, Mehreen, Syed Faisal Mahmood, Mishal Khan, and Rumina Hasan. 2020. “COVID-19, Misinformation, and Antimicrobial Resistance.” BMJ371 (November): m4501. https://doi.org/10.1136/bmj.m4501.

CDC. 2021. “Candida auris.” Centers for Disease Control and Prevention. July 19, 2021. https://www.cdc.gov/fungal/candida-auris/index.html.

CDC. 2021. “CRE: Healthcare-Associated Infections (HAI).” Centers for Disease Control and Prevention. April 7, 2021. https://www.cdc.gov/hai/organisms/cre/index.html.

CDC. 2021. “Patients | CRE | HAI”. Centers for Disease Control and Prevention. February 18, 2021. https://www.cdc.gov/hai/organisms/cre/cre-patients.html.

CDC. 2020. “What Exactly Is Antibiotic Resistance?” Centers for Disease Control and Prevention. March 13, 2020. https://www.cdc.gov/drugresistance/about.html.

CDC. 2020. “Where Antibiotic Resistance Spreads.” Centers for Disease Control and Prevention. March 10, 2020. https://www.cdc.gov/drugresistance/about/where-resistance-spreads.html.

Centers for Disease Control and Prevention (U.S.). 2019. “Antibiotic Resistance Threats in the United States, 2019.” Centers for Disease Control and Prevention (U.S.). https://doi.org/10.15620/cdc:82532.

Jul 27, Chris Dall | News Reporter | CIDRAP News | and 2021. n.d. “CDC Reports Two Outbreaks of Pan-Resistant Candida Auris.” CIDRAP. Accessed October 6, 2021. https://www.cidrap.umn.edu/news-perspective/2021/07/cdc-reports-two-outbreaks-pan-resistant-candida-auris.

Chowdhary, Anuradha, and Amit Sharma. 2020. “The Lurking Scourge of Multidrug Resistant Candida Auris in Times of COVID-19 Pandemic.” Journal of Global Antimicrobial Resistance 22 (September): 175–76. https://doi.org/10.1016/j.jgar.2020.06.003.

“COVID-19 & Antibiotic Resistance | CDC.” 2021. June 8, 2021. https://www.cdc.gov/drugresistance/covid19.html.

Hsu, Jeremy. “How Covid-19 is Accelerating the Threat of Antimicrobial Resistance.” BMJ: British Medical Journal (Online) 369, (May 18, 2020). http://dx.doi.org.mutex.gmu.edu/10.1136/bmj.m1983.

Knight, Gwenan M., Rebecca E. Glover, McQuaid C. Finn, Ioana D. Olaru, Gallandat Karin, Quentin J. Leclerc, Naomi M. Fuller, et al. 2021. “Antimicrobial Resistance and COVID-19: Intersections and Implications.” ELife 10. http://dx.doi.org/10.7554/eLife.64139.

Majumder, Md Anwarul Azim, Sayeeda Rahman, Damian Cohall, Ambadasu Bharatha, Keerti Singh, Mainul Haque, and Marquita Gittens-St Hilaire. 2020. “Antimicrobial Stewardship: Fighting Antimicrobial Resistance and Protecting Global Public Health.” Infection and Drug Resistance 13: 4713–38. http://dx.doi.org/10.2147/IDR.S290835.

Manning, Mary Lou, Edward J. Septimus, Elizabeth S. Dodds Ashley, Sara E. Cosgrove, Mohamad G. Fakih, Steve J. Schweon, Frank E. Myers, and Julia A. Moody. 2018. “Antimicrobial Stewardship and Infection Prevention—Leveraging the Synergy: A Position Paper Update.” American Journal of Infection Control 46 (4): 364–68. https://doi.org/10.1016/j.ajic.2018.01.001.

Popescu, Saskia. 2019. “The Existential Threat of Antimicrobial Resistance.” Bulletin of the Atomic Scientists 75 (6): 286–89. https://doi.org/10.1080/00963402.2019.1680053.

Rawson, Timothy M, Luke S P Moore, Enrique Castro-Sanchez, Esmita Charani, Frances Davies, Giovanni Satta, Matthew J Ellington, and Alison H Holmes. 2020. “COVID-19 and the Potential Long-Term Impact on Antimicrobial Resistance.” Journal of Antimicrobial Chemotherapy 75 (7): 1681–84. https://doi.org/10.1093/jac/dkaa194.

Segala, Francesco Vladimiro, Davide Fiore Bavaro, Francesco Di Gennaro, Federica Salvati, Claudia Marotta, Annalisa Saracino, Rita Murri, and Massimo Fantoni. 2021. “Impact of SARS-CoV-2 Epidemic on Antimicrobial Resistance: A Literature Review.” Viruses 13 (11): 2110. https://doi.org/10.3390/v13112110.

Srinivasan, Arjun. “The Intersection of Antibiotic Resistance (AR), Antibiotic Use (AU), and COVID-19.” Centers for Disease Control and Prevention. February 10, 2021. https://www.hhs.gov/sites/default/files/antibiotic-resistance-antibiotic-use-covid-19-paccarb.pdf.

Sun Jin, Louisa and Fisher, Dale. 2021. “MDRO Transmission in Acute Hospitals during the COVID-19 Pandemic.” Wolters Kluwer Health, Inc. (34) 4: 365–371.

Toro-Alzate, Luisa, Karlijn Hofstraat, and Daniel H de Vries. 2021. “The Pandemic beyond the Pandemic: A Scoping Review on the Social Relationships between COVID-19 and Antimicrobial Resistance.” International Journal of Environmental Research and Public Health 18 (16): 1–20. https://doi.org/10.3390/ijerph18168766.

Vidyarthi, Ashima Jain, Arghya Das, and Rama Chaudhry. 2021. “Antimicrobial Resistance and COVID-19 Syndemic: Impact on Public Health.” Drug Discoveries & Therapeutics 15 (3): 124–29. https://doi.org/10.5582/ddt.2021.01052.

[1] CDC. 2020. “What Exactly Is Antibiotic Resistance?” Centers for Disease Control and Prevention. March 13, 2020. https://www.cdc.gov/drugresistance/about.html.

[2] CDC. 2020. “Where Antibiotic Resistance Spreads.” Centers for Disease Control and Prevention. March 10, 2020. https://www.cdc.gov/drugresistance/about/where-resistance-spreads.html.

[3] “COVID-19 & Antibiotic Resistance | CDC.” 2021. June 8, 2021. https://www.cdc.gov/drugresistance/covid19.html.

[4] Centers for Disease Control and Prevention (U.S.). 2019. “Antibiotic Resistance Threats in the United States, 2019.” Centers for Disease Control and Prevention (U.S.). https://doi.org/10.15620/cdc:82532.

[5] Segala, Francesco Vladimiro, Davide Fiore Bavaro, Francesco Di Gennaro, Federica Salvati, Claudia Marotta, Annalisa Saracino, Rita Murri, and Massimo Fantoni. 2021. “Impact of SARS-CoV-2 Epidemic on Antimicrobial Resistance: A Literature Review.” Viruses 13 (11): 2110. https://doi.org/10.3390/v13112110.

[6] CDC. 2021. “CRE: Healthcare-Associated Infections (HAI).” Centers for Disease Control and Prevention. April 7, 2021. https://www.cdc.gov/hai/organisms/cre/index.html.

[7] CDC. 2021. “Patients | CRE | HAI”. Centers for Disease Control and Prevention. February 18, 2021. https://www.cdc.gov/hai/organisms/cre/cre-patients.html

[8] CDC. 2021. “Candida auris.” Centers for Disease Control and Prevention. July 19, 2021. https://www.cdc.gov/fungal/candida-auris/index.html.

[9] Chowdhary, Anuradha, and Amit Sharma. 2020. “The Lurking Scourge of Multidrug Resistant Candida Auris in Times of COVID-19 Pandemic.” Journal of Global Antimicrobial Resistance 22 (September): 175–76. https://doi.org/10.1016/j.jgar.2020.06.003.

[10] Jul 27, Chris Dall | News Reporter | CIDRAP News | and 2021. n.d. “CDC Reports Two Outbreaks of Pan-Resistant Candida Auris.” CIDRAP. Accessed October 6, 2021. https://www.cidrap.umn.edu/news-perspective/2021/07/cdc-reports-two-outbreaks-pan-resistant-candida-auris.

[11] Srinivasan, Arjun. “The Intersection of Antibiotic Resistance (AR), Antibiotic Use (AU), and COVID-19.” Centers for Disease Control and Prevention. February 10, 2021. https://www.hhs.gov/sites/default/files/antibiotic-resistance-antibiotic-use-covid-19-paccarb.pdf.

[12] Vidyarthi, Ashima Jain, Arghya Das, and Rama Chaudhry. 2021. “Antimicrobial Resistance and COVID-19 Syndemic: Impact on Public Health.” Drug Discoveries & Therapeutics 15 (3): 124–29. https://doi.org/10.5582/ddt.2021.01052.

[13] Rawson, Timothy M, Luke S P Moore, Enrique Castro-Sanchez, Esmita Charani, Frances Davies, Giovanni Satta, Matthew J Ellington, and Alison H Holmes. 2020. “COVID-19 and the Potential Long-Term Impact on Antimicrobial Resistance.” Journal of Antimicrobial Chemotherapy 75 (7): 1681–84. https://doi.org/10.1093/jac/dkaa194.

[14] Sun Jin, Louisa and Fisher, Dale. 2021. “MDRO Transmission in Acute Hospitals during the COVID-19 Pandemic.” Wolters Kluwer Health, Inc. (34) 4: 365–371.

[15] Knight, Gwenan M., Rebecca E. Glover, McQuaid C. Finn, Ioana D. Olaru, Gallandat Karin, Quentin J. Leclerc, Naomi M. Fuller, et al. 2021. “Antimicrobial Resistance and COVID-19: Intersections and Implications.” ELife 10. http://dx.doi.org/10.7554/eLife.64139.

[16] Manning, Mary Lou, Edward J. Septimus, Elizabeth S. Dodds Ashley, Sara E. Cosgrove, Mohamad G. Fakih, Steve J. Schweon, Frank E. Myers, and Julia A. Moody. 2018. “Antimicrobial Stewardship and Infection Prevention—Leveraging the Synergy: A Position Paper Update.” American Journal of Infection Control 46 (4): 364–68. https://doi.org/10.1016/j.ajic.2018.01.001.

[17] Hsu, Jeremy. “How Covid-19 is Accelerating the Threat of Antimicrobial Resistance.” BMJ: British Medical Journal (Online) 369, (May 18, 2020). http://dx.doi.org.mutex.gmu.edu/10.1136/bmj.m1983.

[18] Popescu, Saskia. 2019. “The Existential Threat of Antimicrobial Resistance.” Bulletin of the Atomic Scientists 75 (6): 286–89. https://doi.org/10.1080/00963402.2019.1680053.

[19] Toro-Alzate, Luisa, Karlijn Hofstraat, and Daniel H de Vries. 2021. “The Pandemic beyond the Pandemic: A Scoping Review on the Social Relationships between COVID-19 and Antimicrobial Resistance.” International Journal of Environmental Research and Public Health 18 (16): 1–20. https://doi.org/10.3390/ijerph18168766.

[20] Arshad, Mehreen, Syed Faisal Mahmood, Mishal Khan, and Rumina Hasan. 2020. “COVID-19, Misinformation, and Antimicrobial Resistance.” BMJ 371 (November): m4501. https://doi.org/10.1136/bmj.m4501.

[21] Majumder, Md Anwarul Azim, Sayeeda Rahman, Damian Cohall, Ambadasu Bharatha, Keerti Singh, Mainul Haque, and Marquita Gittens-St Hilaire. 2020. “Antimicrobial Stewardship: Fighting Antimicrobial Resistance and Protecting Global Public Health.” Infection and Drug Resistance 13: 4713–38. http://dx.doi.org/10.2147/IDR.S290835.

Pandora Report: 5.1.2020

May 1, 2020May 1, 2020 by spopescu, posted in Pandora Report

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: 4.10.2020

April 10, 2020April 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: 2.28.2020

February 28, 2020February 28, 2020 by spopescu, posted in Pandora Report

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

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

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

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

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

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

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

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

Pandora Report: 2.14.2020

February 14, 2020February 14, 2020 by spopescu, posted in Pandora Report

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: 1.24.2020

January 24, 2020January 24, 2020 by spopescu, posted in Pandora Report

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

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

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

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

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

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

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

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

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

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

Pandora Report: 11.15.2019

November 15, 2019November 15, 2019 by spopescu, posted in Pandora Report

We’re back and we’ve got quite a packed newsletter for you, so grab a beverage and get ready for the warm fuzzies of biodefense news.

Failing to PREDICT the Next Pandemic
A few weeks back, it was announced that funding for the PREDICT program would cease after $207 million was sunk into the initiative. GMU biodefense MS student Michael Krug has provided a deep-dive into what PREDICT worked towards, the debated success, and what its cancellation means. “However, even with the billions of dollars spent on ensuring a robust global biosurveillance network, it remains unknown if this network can predict what the next disease will be or where the next outbreak will occur.” Read more here.

An Antibiotic Eclipse – Scenario or Future?
GMU Biodefense doctoral alum and infection preventionist Saskia Popescu discusses the looming threat of antibiotic resistance and what a future with little to no treatment options would look like. From dwindling options for secondary infections related to influenza to declining surgeries, a future without antibiotics is dim. Popescu highlights what this looks like and how we’re quickly approaching it through both the drying antibiotic pipeline, but also limited surveillance, and challenges in changing both stewardship and infection control measures. The existential threat of antimicrobial resistance is very real and Popescu provides a scenario portraying the economic and human costs that antimicrobial resistance could impose on society 30 years from now, if it is not addressed soon. You can read the full article here. This is an especially relevant topic as the CDC just released new data, finding that annually, 2.8 million resistant infections and 35,000 related deaths occur in the United States. The CDC report notes that “However, deaths decreased by 18 percent since the 2013 report. This suggests that prevention efforts in hospitals are working. Yet the number of people facing antibiotic resistance in the United States is still too high.”

Event Recap – People, Pigs, Plants, and Planetary Pandemic Possibilities
If you happened to miss this November 5th event, no worries – GMU biodefense doctoral student Stevie Kiesel has provided an in-depth summary of the panel and discussions. Kiesel notes that the panel had insightful discussions on the need to understand local context and empower people and local public health communities. Local context is important for combating misinformation and getting a more accurate understanding of conditions on the ground. For example, the public health community must understand why a country may be disincentivized to report a disease outbreak in its early stages, when it is more easily controlled. Authoritarian governments who maintain tight messaging control may not want to admit to an active outbreak, or the economic drawbacks of announcing an outbreak may be so severe that leaders try to hide what’s going on. You can read more here.

Pandemic Policy: Time To Take A Page Out Of The Arms Control Book
Rebecca Katz is holding back no punches in her latest article on the broken policy approaches we have to international outbreak accountability, and frankly, it’s long overdue. Full disclosure, the first line is one of my favorites – “Last month, the World Health Organization (WHO) was reduced to the equivalent of playground pleading: ‘But you promised!’” Katz highlights that in the face of countries failing to meet their obligations within the International Health Regulations (IHR), the WHO has little recourse to act and frankly, the path to accountability isn’t particularly clear. Ultimately, this problem could be solved though, if instead of rewriting the IHR, we modeled such treaties in the image of the Biological Weapons Convention (BWC) to help convene regular review conferences, discuss developments, and establish a regulatory response that could help drive accountability. “As the former US representative to the BWC, Charles Flowerree, wrote, treaties ‘cannot be left simply to fend for themselves’.”

The 5th Annual Pandemic Policy Summit at Texas A&M University
GMU Biodefense doctoral student Rachel-Paige Casey has provided an in-depth review of this important summit earlier this week. The objective of each Summit is to convene researchers, medical professionals, practitioners, private sector experts, NGO representatives, and political leaders to examine issues in pandemic preparedness and response, health security, and biodefense. The foci of this year’s Summit were the promises and perils of technology; BARDA leadership through its history and today; the effect of the anti-vaccine movement on pandemic preparedness and response; and ongoing outbreaks. Key discussions included the inadequacy of biopreparedness, worries regarding emerging biotechnologies, the modern vaccine hesitancy movement in the US, and the leadership and future of BARDA. You can read more about the summit here.

Catalyst- A Collaborate Biosecurity Summit
Don’t miss this February 22, 2020 event in San Francisco. “Catalyst will be a day of collaborative problem-solving for a broad range of people invested in the future of biotechnology, including synthetic biologists, policymakers, academics, and biohackers. We aim to catalyze a community of forward-looking individuals who will work together to engineer a future enhanced by biology and not endangered by it.The summit is free to attend for everyone accepted, and the application only takes a few minutes. We expect participants to come from diverse backgrounds, and welcome applicants who do not work professionally in biosecurity or biotechnology, who are early in their careers, and who are skeptical of how biosecurity discussions are typically framed. You can apply to attend here.

Firehosing – the Antivaxxer Strategy for the Transmission of Misinformation
Researchers Christopher Paul and Miriam Matthews of Rand introduced this idea in 2016 and it’s proving to be pretty accurate for how anti-vaccine advocates are pushing out their opinions. Lucky Tran of The Guardian recently made the link between antivaxxers and the strategy of firehosing, which entails a massive flow of disinformation to overwhelm the audience. Just like it sounds, firehosing involves pushing out as many lies as frequently as possible to overwhelm people with information and making it nearly impossible for a logical response to combat that much disinformation. Tran stumbled across this application by seeing it on a television show with anti-vaccine influencers like Jay Gordon and he employed this strategy. “Anti-vax influencers such as Jay Gordon and Andrew Wakefield can keep repeating disproved claims – and in the case of Wakefield, doing so despite having had his medical license revoked – because their lying effectively debases reality and gains them followers and fame in the process.” The Rand study can be found here, which originally discussed firehosing in the context of Russian propaganda – as it has two “distinctive features: high numbers of channels and messages and a shameless willingness to disseminate partial truths or outright fictions. In the words of one observer, ‘[N]ew Russian propaganda entertains, confuses and overwhelms the audience’.” In the face of this relatively new tactic, there is a desperate need to remove false anti-vaccine content from social media and websites, and to put more pressure on media and news platforms to not provide support for such guests/conversations.

Crowd-Control Weapons – Are They Really Non-Lethal?
The term “non-lethal” or “less-than-lethal” gets thrown around a lot when it comes to crowd/riot-control weapons but just how non-lethal are these methods if they’re overused? Physicians for Human Rights (PHR) dug into this very issue because frankly, the use of these weapons is quite common and if they’re not used properly, or with the proper training, they can be devastating. Routine use or misuse of agents like tear gas can be deadly. The PHR conducted several investigations into their use by governments in Bahrain, Georgia, Kashmir, Turkey, and other countries and ultimately, what they found was some pretty startling misuse that can result in long-term health outcomes or even death. They put together a report and factsheets on specific “non-lethals” like acoustic weapons, rubber bullets, stun grenades, tear gas, and even water cannons. Within each factsheet, you can read about the history, how they work, device types, health effects, legality of use, and considerations and policy recommendations. Within the report, they reviewed usage of the weapons including things like people who suffered injuries or even death. As protests occur in China, the use of sonic weapons for crowd control are a very real reminder of the fine line we walk when using “non-lethals”.

Ebola Outbreak Updates and Vaccine Approval
This week, the European Medicines Agency (EMA) approved the V920 vaccine for Ebola Virus Disease (EVD) and it is already being administered in the Democratic Republic of the Congo. The ongoing EVD outbreak in the Democratic Republic of the Congo (DRC) started in August 2018 and has now exceeded 3,000 cases and 2,000 deaths. Since the 2014-15 outbreak in West Africa, advances in medical research produced new vaccination and therapeutic options. The V920 vaccine, developed and produced by Merck, was tested during the outbreak and showed a 97% efficacy rate and protects against the Zaire species, which is the strain responsible for the current outbreak. Johnson-and-Johnson is also beginning trials for its investigational EVD vaccine. Johnson-and-Johnson’s vaccine requires two doses, a barrier for patient compliance, and does not contain any antigens from the Ebola Bundibugyo species of the virus. Dr. Dan Lucey, professor of medicine at Georgetown University, wrote an editorial in the British Medical Journal about the new treatments for EVD. Dr. Lucey’s article reviews the findings and shortcomings of the four-arm randomized controlled trial (RCT) evaluating the efficacy of four potential EVD treatments: ZMapp, remdesivir, mAb114, and REGN-EB3. The RCT was discontinued when a strict statistical threshold for decreased mortality was reached REGN-EB3, a monoclonal antibody drug. The punchline for the efficacy of REGN-EB3 is that it is efficacious if administered during the early stage of the disease but not as the diseases progresses. Lucey recommends continuing research on EVD treatments that are successful at later stages of the diseases. Last but not least, the article applauds the rigor and difficulty of this randomized-controlled trial given it was conducted during the outbreak, making it a precedent-setting achievement.

GMU Biodefense Alum Changing the Face of Aerospace Physiology
We’re excited to share some of the achievements of one of GMU’s biodefense alum – Nereyda Sevilla, a May 2017 doctoral graduate in Biodefense, who is a civilian aerospace physiologist for the Defense Health Agency working as Acting Director of the Military Health System Clinical Investigations Program. She was also recently awarded the Air Force Medical Service Biomedical Specialist Civilian of the Year Award and the Air Force Meritorious Service Medal. If you’d like to see more of Nereyda’s hard work in action, check out the article she and the Spatiotemporal Epidemiologic Modeler (STEM) Team published in the Sept 2019 edition of Health Security, “STEM: An Open Source Tool for Disease Modeling.” (Volume 17, Number 4, 2019).

Phase 3 Trial of Modified Vaccinia Ankara Against Smallpox
In the last Pandora Report, we discussed the FDA approval of the new smallpox vaccine JYNNEOS, that was tested by USAMRIID. The vaccine, developed by biotechnology company Bavarian Nordic, will enter the market under the name JYNNEOS. You can read about the Phase 3 efficacy trial of JYNNEOS (a modified vaccinia Ankara, MVA) as a possible vaccine against smallpox in the latest New England Journal of Medicine. GMU Biodefense professor and director of the graduate program, Dr. Gregory Koblentz noted that one of the key findings of this Phase 3 efficacy trial is that even though the FDA has approved a two-dose regimen for MVA (since it is a non-replicating vaccine that uses an ), a single dose of MVA provided the same level of protection as a single dose of the replicating vaccinia vaccine ACAM 2000. “At day 14, the geometric mean titer of neutralizing antibodies induced by a single MVA vaccination (16.2) was equal to that induced by ACAM2000 (16.2), and the percentages of participants with seroconversion were similar (90.8% and 91.8%, respectively).” An additional advantage of MVA over ACAM 2000 is that the former can be administered by a subcutaneous injection while the latter requires scarification through the use of a bifurcated needle. The article concludes that “No safety concerns associated with the MVA vaccine were identified. Immune responses and attenuation of the major cutaneous reaction suggest that this MVA vaccine protected against variola infection.”

Key Global Health Positions – A Who’s Who in the U.S. Government
Have you ever wondered who helps support global health within the U.S. government? The Kaiser Family Foundation (KFF) has created a substantial list on not only the positions, but also who (if anyone) is occupying them. From the Department of Health and Human Services to the Department of the Treasury, you’ll want to utilize this list to not only realize the scope of global health efforts within the USG, but also who you might need to get in touch with.

Stories You May Have Missed:

African Swine Fever Continues to Spread in Asia – Unfortunately, this outbreak isn’t showing signs of letting up… “The update shows new outbreaks in Vietnam, Cambodia, Laos, the Philippines, South Korea and on the Russian side of the Chinese border reported during the first week of November. Meanwhile, formal confirmation is awaited of ASF outbreaks in Indonesia. The FAO reports that more than 4,500 pigs are said to have died in 11 regencies/cities in North Sumatra. Dead pigs were also found in a river. FAO is liaising with the Indonesian authorities to ‘confirm the cause and explore needs’.”

Pandora Report: 10.11.2019

October 11, 2019 by spopescu, posted in Pandora Report

GMU Biodefense Graduate Program Open House
Have you considered expanding your education and experiences through a graduate degree in biodefense? Learn more about our MS (online and in-person) and PhD programs in our upcoming Open Houses! The Master’s Open House will be held on Thursday, October 17th at 6:30pm at our Arlington campus, and the PhD Open House will be on Thursday, November 7th, at 7pm at the Fairfax campus. We invite you to learn more about our programs by attending an open house. You will have the opportunity to discuss our graduate programs with program directors, faculty, admissions staff, current students, and alumni. The current schedule is reflected below, but be sure to sign up for emails from the Schar School’s Graduate Admissions Office to be notified of future admissions events!

What Can We Glean from a Bean: Ricin’s Appeal to Domestic Terrorists
GMU biodefense doctoral student Stevie Kiesel breaks down the use of ricin and its application as an agent of domestic terror. “Just as policymakers have been slow to acknowledge and act upon the threat of domestic CBRN terrorism, timely extant research on the issue is scarce as well. In this article, I focus on ricin as an agent of domestic terror. As government agencies acknowledge the threat domestic terrorism poses, policymakers and law enforcement should take ricin seriously as a potential weapon. To understand the plausibility of ricin’s use as a weapon, I reviewed a number of journal articles, news articles, and court records from 1978 through 2019 and compiled data on 46 incidents of ricin acquisition and/or use. Of these 46 incidents, 19 could be credibly tied to terrorism, 19 were not related to terrorism, and 8 were unclear. The most common motivation after terrorism was murder (10 instances). Of the 19 terrorist incidents, 58% were committed by extreme right-wing terrorists, a term that here encompasses the following ideologies: neo-Nazi/neo-fascist, white nationalist/supremacist/separatist, religious nationalist, anti-abortion, anti-taxation, anti-government, and sovereign citizen.”

GMU One Health Day Panel Discussion Save the date for this November 5th event sponsored by the GMU Next Gen Global Health Security Network and the GMU Biodefense Discussion Group. “One Health Day is November 3 – Connecting Human, Animal, and Environmental Health. One Health is the idea that the health of people is connected to the health of animals and our shared environment. Learn why One Health is important and how, by working together, we can achieve the best health for everyone. [CDC} Did you know that animals and humans often can be affected by many of the same diseases and environmental issues? Some diseases, called zoonotic diseases, can be spread between animals and people. More than half of all infections people can get can be spread by animals – a few examples include rabies, Salmonella, and West Nile virus.” On November 5th, you can listen to the panel from 5-7:10pm in Van Metre Hall at the GMU Arlington Campus. Panel members include Michael E. von Fricken, PhD, MPH GMU Global Health and Community Health Security, Dr Jason Hanson, DVM, PhD, DACVPM, Associate Editor at Program for Monitoring Emerging Diseases, Willy A. Valdivia-Granda, CEO, ORION INTEGRATED BIOSCIENCES, INC., and Dr Taylor Winkleman, DVM, CEO, Winkleman Consulting, LLC. “This panel will discuss emerging ONE HEALTH approaches through the various lens of their real world experiences in the world of Global and Community Health, national security arenas, and the international biodefense security domain. Discussions and interactions with the audience will address insightful views of innovation and emerging technology developments for biodefense leveraging data mining, genomics of infectious diseases, implementation of algorithms for the development of medical countermeasures against known and unknown biothreats, one health biosurveillance challenges in detecting infectious diseases, and strategies for integrating the efforts of health security professionals and biotech experts working together to improve the health of people, animals — including pets, livestock, and wildlife —as well as the environment. Common types of professionals involved in One Health work include disease detectives, human healthcare providers, veterinarians, physicians, nurses, scientists, ecologists, as well as policy makers.”

Ebola Outbreak Updates
After two weeks of halted response efforts due to security concerns, things are resuming in the DRC. “The WHO said though the decline in cases is encouraging and gains have been made in the response, several challenges remain and that the current trends should be interpreted with caution.” On Wednesday, case counts reached 3,207 with 2,144 deaths and 441 suspected cases being investigated. There was concern over a Swedish patient admitted for Ebola testing, but results have come back negative.

Biosafety Levels in Laboratories – Whats the Difference?
We throw around the term “BSL-4” around a lot, but how well do you actually know the different biosafety levels? “The United States is home to several types of laboratories that conduct medical research on a variety of infectious biological agents to promote the development of new diagnostic tests, medical countermeasures, and treatments. To promote safe medical research practices in laboratories studying infectious agents, the Centers for Disease Control and Prevention (CDC) and the National Institutes of Health have established four BSLs. The levels consist of requirements that have identified as protective measures needed in the laboratory setting to ensure the proper management of infectious agents to avoid accidental exposure or release into the environment. The BSL designations, ranked from lowest to the highest level of containment, are BSL-1, BSL-2, BSL-3, and BSL-4. The BSL designations outline specific safety and facility requirements to achieve the appropriate biosafety and biocontainment. The BSL is assigned based on the type of infectious agent on which the research is being conducted. The CDC has designed an infographicto help visualize the differences between each level. Each level builds on the previous level, adding additional requirements.”

African Swine Fever: An Unexpected Threat to Global Supply of Heparin
In a conversation I never thought I’d have in healthcare…the outbreak of African swine fever (ASF) is hitting heparin supplies at a global level – what a prime example of One Health! “Since August 2018, China has culled more than one million pigs in efforts to contain the spread of ASF within the country. Widespread culling of pigs consequently affects the supply of raw materials needed to produce heparin, which is derived from mucosal tissues in pig intestines. Heparin is a critical anticoagulant drug used to treat and prevent the formation of blood clots in blood vessels in healthcare. As pig herds continue to become infected and culled, should the United States form contingency plans in the event of a heparin shortage?”

Getting Ahead of Candida auris
“As IDWeek 2019 continued into the weekend, there was no shortage of information for those seeking to prevent and control infectious diseases. For many of us, the threat of antimicrobial resistance has been a major challenge and one for which guidance is desperately needed. Challenging organisms, like Candida auris, make infection prevention efforts in health care that much more difficult and patient care intrinsically more dangerous. In a presentation at the meeting, the presenting author and medical epidemiologist, Snigdha Vallabhaneni, represented the US Centers for Disease Control and Prevention (CDC), while co-authors included experts from health care and public health from California, Connecticut, and CDC. Researchers emphasized that over 1600 patients have been identified in the United States to have C auris infections or colonization. Of those confirmed cases, risk factors were identified, which include high-acuity post-acute care admissions – like long-term acute care hospitalizations, colonization with carbapenemase-producing organisms (CPOs), or hospitalization abroad.”

2019 White House Summit on America’s Bioeconomy
“On October 7, 2019, The White House hosted the Summit on America’s Bioeconomy. The Summit marked the first gathering at The White House of our Nation’s foremost bioeconomy experts, Federal officials, and industry leaders to discuss U.S. bioeconomy leadership, challenges, and opportunities. The bioeconomy represents the infrastructure, innovation, products, technology, and data derived from biologically-related processes and science that drive economic growth, improve public health, agricultural, and security benefits. Bioeconomy outputs are incredibly diverse, and future applications limitless in terms of both application and value, including new ways to treat cancer; enable novel manufacturing methodologies for medicines, plastics, materials, and consumer products; create pest and disease resistant crops; and support DNA-based information systems that can store exponentially more data than ever before. Advances realized over the past two decades have resulted from the unique U.S. innovation ecosystem and the convergence between biology and other disciplines and sectors, such as nanotechnology and computer science. The U.S. bioeconomy – spanning health care, information systems, agriculture, manufacturing, national defense, and beyond – is growing rapidly with increasing impact on our Nation’s vitality and our citizens’ lives. Biotechnology represents 2% of the U.S. GDP, or $388 billion. To remain a world leader in the bioeconomy, the U.S. must foster an ecosystem that puts innovative research first in addition to promoting a strong infrastructure, workforce, and data access framework.”

Social Media and Vaccine Hesitancy As of this year, vaccine hesitancy is listed one of the WHO’s 10 big threats to global health. Vaccine hesitancy is the foot-dragging or refusal to vaccinate yourself or your children, when vaccines are available. Social media are platforms for the dissemination of both accurate and inaccurate information regarding vaccine safety and benefits. Unfortunately, vaccine content shared on social media is overwhelmingly anti-vaccine material and often lacking scientific or medical evidence. According to Ana Santos Rutschman at Saint Louis University, malicious bots are being used to more efficiently disseminate vaccine misinformation on these platforms. Fortunately, major platforms are instituting policies to curb the spread of vaccine misinformation and support the spread of accurate information from credible sources. Though misinformation remains abundant online, these new policies are promising steps toward eliminating erroneous data. Santos Rutschman “believe[s] social media can and should be redesigned to facilitate the promotion of accurate vaccine information.”

Stories You Might Have Missed:

UK Report Cites Lack of AMR Progress-“A paper issued yesterday by policy institute Chatham House concludes that not enough progress has been made on recommendations from a series of reports that alerted the world to the rising threat of antimicrobial resistance (AMR). The AMR Review, commissioned in 2014 by former UK Prime Minister David Cameron and chaired by British economist Lord Jim O’Neill, outlined the threat of AMR to global public health and highlighted the potential costs of inaction in eight separate reports issued over 2 years. Among the highlights from the first AMR Review paper were two startling figures—that drug-resistant infections could cause the deaths of 10 million people by 2050 and could cost the global economy up to $100 trillion if the problem was not addressed in the coming years.”

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