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Synthetic Genetic Shakespeares

Examining the implications of science and technology

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Synthetic Genetic Shakespeares

Synthetic Genetic Shakespeares is an opinion blog. Unless otherwise noted, I declare no competing scientific or financial interests regarding the topics examined. All rights reserved.

Cosmic Contrarians Blame COVID-19 on Halley’s Comet

Did a scientist predict a pandemic was imminent immediately before COVID-19 emerged in China (1)?  Yes, but to put it politely, the specific observations and deductions that underpinned that prediction are radically out of line with conventional opinion.

Viruses From Outer Space?

The scientist claimed to have correctly prognosticated pandemic was on the way is Dr. N. Chandra Wickramasinghe (1).  In subsequent publications (2, 3) he and coauthors claim both the COVID-19 and the 2002 SARS pandemics commenced after the Earth was seeded with virus-harboring debris from Halley’s Comet.

 

OLYMPUS DIGITAL CAMERA

 

Some meteorites harbor complex organic molecules inviting the logical extrapolation that under the right circumstances living organisms might make some far-flung journeys through space as well.  Although hypothetical, the general tenets of panspermia have been persistent and now seem to have broad general support in the scientific community.  So, was the correct warning of imminent pandemic a visionary deduction based on solid scientific evidence?  While critical of the conclusions and interpretations of infectious disease experts, Dr. Wickramasinghe and his colleagues issued some additional, quite specific and testable, predictions regarding the future course of the COVID-19.  How well will they match up with on-the-ground events as the pandemic follows its course?          

Spectacular Speculations

Halley’s Comet has intrigued Dr. Wickramasinghe and a key colleague (2-4) for many years, but connecting October fireballs to disease agent seeding events from that particular celestial body is tentative.  While an annual meteor shower associated with Halley’s Comet debris occurs in October, other showers are also predictably active within that same time frame, leaving some doubt about the true origins of the fireballs. 

Assuming for the moment, Halley’s Comet was the source of the bolides correlated with pandemics, the next question involves the genesis of the viruses.  How did both distinct types of coronaviruses, SARS-CoV and SARS-CoV-2, come to be entrained within that comet and seed out separately?  Coronaviruses require living host cells to reproduce, when were conditions on Halley’s Comet conducive to the production of what must have been prodigious quantities of these viruses?  How much time had elapsed before the debris flung off by the comet ended up as a bolide in Earth’s atmosphere and how could easily-inactivated enveloped viruses have survived inimical conditions of space and perilous journeys through hazardous environmental conditions on Earth in numbers and physical condition competent to produce disease?

Contradictions and Questions

The authors write in one manuscript Abstract (2) the novel coronavirus SARS-CoV-2 arrived as a pure culture in cometary debris dispersed over China.  However, a few sentences later in the Introduction the infalling bolide material is described not as a pure culture, but a mixture of bacteria and viruses.  The condition of the presumed inoculum is important because it has bearing on how many viruses could have been seeded by the bolide.  Given that human SARS-CoV-2 infections can be markedly decreased by social distancing measures, the original numbers dispersed randomly in the atmosphere – thousands of kilometers away from points of first disease outbreaks – must have been stupendous.  No meteorite samples of this bolide exist for study and although such a situation is certainly not unexpected, it does make it impossible to decide whether the bolide material dispersed over China was pure virus culture, a mix of bacteria and viruses or contained no complex biotic structures at all.    

The authors postulate cometary bolide debris-contaminated environments were the terrestrial reservoirs for coronavirus pandemics.  These assertions leave unclear why for both the COVID-19 (2) and 2002 SARS (3) pandemics the geographically most proximate locations to presumptive meteor seeding events, presumably the most heavily tainted sites, were spared as these diseases first emerged weeks later and thousands of kilometers to the south in limited sites in China.  The deadly dust harboring SARS-CoV-2 finally settled out in a single distant Chinese city, as some of it was circumnavigating the planet to hit far-flung places like Mont Blanc (2) without apparent diminishment in disease-production potency.  This proposed world-wide atmospheric dispersal mechanism weakens the case any causal link exists between putative cometary bolide sightings and later pandemic emergence.  With pandemics first beginning so far in both space and time from the presumed source bolide events and then globe-hopping unpredictably (2), the authors try to have it both ways and strain to somehow maintain a link to Halley’s Comet.          

If massive environmental deposition of virus-laden cometary dust was the dominant disease agent reservoir, why, instead of draining out of the atmosphere over several years (2), did the 2002 SARS outbreak terminate with the virus going extinct in nature?  How could quarantine and isolation measures ever suppress the SARS-CoV-2 outbreak in the presumably heavily contaminated epicenter of Wuhan (3). 

The authors predict (2) the COVID-19 outbreak in China will terminate in a few weeks when the “entire population of China” has been “sub-clinically affected” and herd immunity established.  Putting aside questions about why SARS-CoV-2 infections would suddenly become less virulent, this bizarre prognostication is directly testable and it will be interesting to see whether it is confirmed or refuted by ongoing studies.  If this prediction is true, China, perhaps the entire world, could abandon development of a SARS-CoV-2 vaccines, dispense with monitoring and do away with travel restrictions.  The environmental deposition model also suggests some of that settled out deadly dust ought to be collectable in hot spots like Wuhan, Mont Blanc, Iran, etc.  Unless the viruses which survived untold eons in outer space, rained down on Earth after a bolide explosion and persisted suspended for weeks in the atmosphere are now suddenly inactivated, those contaminated areas might remain a lethal threat to tourists for some time.       

Issuing a call to action to launch an upper atmosphere extraterrestrial disease agent surveillance program (2), the authors claim the monitoring effort might typically offer a 1-2 year lead time to prepare before infalling pathogens settle out and unleash mayhem.  An interesting proposition, but how does the proposal square with what transpired with two of the most disruptive pandemics in modern human history?  Because neither the 2002 SARS nor COVID-19 pandemics conformed to the claimed typical settle-out lead time as the presumptive meteor seeding events were followed by disease outbreaks only a few weeks later (3), this does not appear to a good investment of research funds.  In addition, this pattern is hard to reconcile with the proposed regular seasonal atmospheric deposition of disease agents like the common cold rhinoviruses and coronaviruses, influenza viruses and RSV which reliably peak every Winter and recede in Spring (3).  Why would some viruses be regularly replenished and spread like clockwork each Winter, others require 1-2 years to settle out and drain from the atmosphere while SARS-CoV-2 turns up “remarkably close on the heels of a cometary bolide” (2)?     

Dr. Wickramasinghe and his collaborators have compiled a decades-long publication record in the panspermia realm complete with a bevy of iconoclastic disease epidemic causality and periodicity claims (2-6).  Whooping cough epidemic peaks are claimed to correspond directly and precisely with the orbital period of Comet Encke (4) even though its physical distance from Earth varies widely during these journeys around our sun.  In contrast, SARS and COVID-19 pandemics were deduced to have been seeded not by the passage of the much longer orbital period Halley’s Comet itself, but instead are linked to one of its two associated annual meteor showers, the one in October.  This gives the impression the group takes disease outbreak data and crafts just-so celestial explanations for them post hoc.     

Failure to Set in Context

 

How does the Stardust Mission which collected materials from comet Wild-2 and interplanetary space for direct examination (7) comport with a previous deduction that bulk of particles ejected from Halley’s and other comets are bacteria (4)?  Do the authors boldly predict forthcoming asteroid sample return missions will reveal enormous quantities of viable bacterial cells and viruses?  Are they warning sample return missions from comets and asteroids pose dire threats to human and animal life?  If their hypotheses are correct, meteorite collections must be a hotbed of lethal microbial pathogens and meteorite hunting one of the most dangerous occupations on Earth.

 

Meteorite box2

A box of unauthenticated meteorites sold wholesale at the Tucson Fossil and Gem Show

 

It is hard to reconcile previously published (4-6) mechanistic hypotheses of epidemic disease outbreaks and extraterrestrial virus seeding with the current round of claims and these discrepancies are not discussed.  Past work correlated influenza pandemics directly with peak sunspot activity, hypothesizing the atmospheric transit and deposition of cometary particles about the size of viruses were favored at those times by intense solar winds (5).  However, the emergence of COVID-19 coincided with a period of minimal sunspot activity (8).  Has the idea of a direct sunspot-pandemic virus correlation been abandoned or is there another explanation why some enveloped RNA viruses consistently required big sunspot assists to reach us while another one apparently did not?  Perhaps a more parsimonious explanation is that researchers rearrange their explanations as necessary to be consistent with a long favored hypothesis that Halley’s comet is the source of deadly viruses.

 

(1) Anonymous.  2020.  Leading Scientist Predicted Pandemic on November 25, 2019.  The Cosmic Tusk, 23 March 2020.  https://cosmictusk.com/wickramasinghe-predicted-coronavirus-pandemic-in-november-2019/

(2) Chandra Wickramasinghe et al. 2020. Comments on the Origin and Spread of the 2019 Coronavirus.  Virology: Current Research 4:1, 2020, 6 March 2020. https://www.hilarispublisher.com/open-access/comments-on-the-origin-and-spread-of-the-2019-coronavirus.pdf

(3) Chandra Wickramasinghe et al. 2020. Predicting the Future Trajectory of COVID-19. Virology: Current Research 4:1, 2020, 13 April 2020.  https://www.hilarispublisher.com/open-access/predicting-the-future-trajectory-of-covid19.pdf

(4) F. Hoyle. 1986.  Halley’s Comet and Others: The Bacterial Star Shells.  Journal of the Royal Society of Medicine 79(12):691-693.  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1290563/?page=1

(5) F. Hoyle and N. C. Wickramasinghe. 1990.  Sunspots and Influenza. Nature 343:304.

(6) Stuart Millar. 2000. Flu Comes From Outer Space, Claim Scientists.  The Guardian, 18 January 2000. https://www.theguardian.com/science/2000/jan/19/spaceexploration.medicineandhealth

(7) NASA.  Dust from Comets and Interstellar Space. https://curator.jsc.nasa.gov/stardust/index.cfm

(8) Tom Metcalfe.   First New Sunspots in 40 Days Herald Coming Solar Cycle. LiveScience.com, 8 January 2020.  https://www.livescience.com/new-sunspot-solar-cycle-begins.html

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The Binnall of America Coronavirus Special Report Series Winds Down

Friday, May 22, 2020, Tim Binnall will air his tenth Special Report on Coronavirus.  A live Blog Talk Radio program produced every week since March 13 when the U.S. began to lock down, the reports followed fast moving coronavirus pandemic news.  The complete recorded episode series is available as free downloads (1). 

Sensing this pandemic has become an unfortunate collective new normal, Tim will return the Binnall of America: Audio podcast to more familiar subjects as this complex and unpredictable situation grinds ahead slowly.  I thank Tim for letting me help out with these shows and the live audience members for their call-in and chat room questions and comments.

Unwelcome Insights

The novel coronavirus causing COVID-19 can only move with human help, yet it is decimating lives and livelihoods with mind-boggling speed across the world.  We understand how to control it, but it is now clear humankind will be forced to accommodate this microscopic monster in our midst for an uncomfortably long time.

Being forced to conform with stay-at-home orders may have offered many persons a rare opportunity for beneficial introspection.  Perhaps some of those insights will result in positive change.  Notwithstanding a need to find the positives in a bad situation, we may also have observed something interesting about the human condition.  As we begin to return to normal activities and argue over how to proceed, I suggest the pandemic may have inadvertently killed off a frequently repeated notion about human behavior in response to a threat.

Speaking in 1987 about the threat of war, President Ronald Reagan stated the following (2):           

“I occasionally think how quickly our differences worldwide would vanish if we were facing an alien threat from outside this world.”

 I suggest that the SARS-CoV-2 pandemic represents something as close to an existential alien threat humankind has experienced in modern times.  How did we meet the challenge?  Scientists isolated and characterized this deadly new virus down to the molecular level with incredible speed.  However, instead of unity forged through an urgent need to defeat a common enemy, we saw leaders issue self-serving denials, make wild accusations, promote unproven preventative treatments, build unrealistic expectations about vaccines and fan the flames of opportunistic political polarization.

The U.S. COVID-19 pandemic death toll will exceed 100,000 in a matter of days.  Trapped in a terrible state where agreed-on facts are few with opinions molded by political party preferences more than reality, unless this virus fades away with the summer and never returns, we face extremely difficult days ahead.  Everyone will need to decide how best to navigate the risks.

Looking ahead, I suggest that Tim take the coronavirus pandemic response as a point of departure to discuss a few of its paranormal studies implications.  The idea that intelligent aliens will help us has received yet another blow.  Maybe the UFO buff’s classic retort to Fermi’s Paradox; that the dearth of evidence for intelligent aliens reflects not absence, but stealth (3) is true. This unsatisfying non-signal reveals unknown and unseen beings do have designs on our planet and play a quiet waiting game as humanity self-destructs.  Or possibly the producers of the Ancient Aliens TV show are more on target.  Intelligent aliens have visited, but departed long ago and with good reason. 

Best wishes to all.

Playground

(1) Binnall of America: Audio http://www.binnallofamerica.com

(2) Steve Hammons.   Reagan’s 1987 UN Speech on ‘Alien Threat’ Resonates Now.  CultureReady Blog, 29 July 2015.  http://www.cultureready.org/blog/reagans-1987-un-speech-alien-threat-resonates-now

(3) Mark Neal.   Preparing for Extraterrestrial Contact.  Risk Management 16(2):63-87.

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The Coronavirus Pandemic Triggers Political Doomsday

Is the coronavirus pandemic the horrible consequence of nefarious scientific activities?  Who would do such a thing and why?  Answers vary depending on where you live.

Who Would be Working with That Thing?

Hit hard by the SARS outbreak of 2002-03 and more recently combatting a costly epidemic of African swine fever virus (in pigs), it is possible Chinese scientists consider the early identification of potentially threatening pathogens like SARS-CoV-2 a top research priority.  To accomplish that task it would be necessary to acquire samples from wild animal reservoirs and perhaps attempt to culture some of the viruses they harbor, many unknown to science.  A strategy outlining that type of proactive public health-protective research has been described (1).  Perhaps Chinese scientists were engaged in similar systematic efforts to discover dangerous viruses in local circulation and develop the means to mitigate incubating zoonotic viral agents before they could emerge to produce full-fledged pandemics.  If they were trying to decrease or eliminate the potential threat of future pandemics, it would have been reasonable for scientists to be conducting investigations with coronaviruses in general and possibly SARS-CoV-2 in particular.     

The SARS virus, SARS-CoV, is known to have escaped from laboratories multiple times (2).  Making the presumption that scientists were working on the virus with an intent to safeguard public health, maybe this new coronavirus is just as slippery as the SARS agent and got out of control as well.  It sounds reasonable, but creating that tidy story requires accepting multiple hypotheses are correct.  Because Chinese authorities have not been forthcoming in several ways, trust is limited.  What a series of events transpiring in a laboratory, if any, had to do with our pandemic predicament is guesswork.

The natural reservoir(s) of SARS-CoV-2 has not been established with certainty, but the current scientific community consensus opinion is that this virus was circulating naturally in wild animals and accidentally invaded humans (3). Unfortunately, with lingering suspicions about the virus itself as well as uncertainties regarding the exact wellsprings of the COVID-19 pandemic, vastly different explanatory accounts – backed with alternative facts – have sufficient latitude to persist.      

Claims, Blame  and Doomsday

Is SARS-CoV-2 a bioweapon?  How did this coronavirus pandemic begin?  These questions currently produce contradictory answers.  The World Health Organization (WHO), maintains the objective evidence reveals SARS-CoV-2 is not an engineered weapon (3).  A Chinese account blames the coronavirus pandemic on the U.S. Army (4), while U.S. officials point back to China (5).  Despite globalization and interconnected communications, each of these claims has found receptive audiences.  Misgivings and the ill will they foster already seem to be producing fallout (6).        

Winning hearts and minds concerning the coronavirus pandemic origins is important; establishing a solid public consensus activities were nefarious or negligent might incite a flood of lawsuits seeking compensation or induce consumer boycotts.  In addition, nurturing an explanatory story in which the bad guy is someone else may have clear political utility.  With verifiable facts in short supply, an increasing sense of frustration and mounting death tolls, laying blame and stirring emotions may look like winning strategic moves. 

In the grip of global calamity, world leaders have triggered their Doomsday messaging systems.    

Strangelove

 

(1) Jennifer Kahn.   How Scientists Could Stop the Next Pandemic Before It Starts.  The New York Times, 21 April 2020.

https://www.nytimes.com/2020/04/21/magazine/pandemic-vaccine.html?smid=tw-share

(2) Martin Furmanski.   Threatened Pandemics and Laboratory Escapes: Self-Fulfilling Prophesies.  Bulletin of the Atomic Scientists, 31 March 2014.  https://thebulletin.org/2014/03/threatened-pandemics-and-laboratory-escapes-self-fulfilling-prophecies/

(3) Emma Farge and Stephanie Nebehay.   Coronavirus Very Likely of Animal Origin, No Sign of Lab Manipulation: WHO.  Reuters, 21 April 2020.  https://www.reuters.com/article/us-health-coronavirus-who-virus/coronavirus-very-likely-of-animal-origin-no-sign-of-lab-manipulation-who-idUSKCN223180

(4) Edward Wong, Matthew Rosenberg and Julian E. Barnes.   Chinese Agents Helped Spread Messages that Sowed Virus Panic in the U.S., Officials Say.  The New York Times, 22 April 2020.

https://www.nytimes.com/2020/04/22/us/politics/coronavirus-china-disinformation.html

(5) Mario Parker.   Trump Suggests China May be ‘Knowingly Responsible’ for Virus.  Bloomberg, 18 April 2020.

https://www.bloomberg.com/news/articles/2020-04-18/trump-suggests-china-may-be-knowingly-responsible-for-virus

(6) David Brunnstrom.    Pompeo Warns U.S. May Never Restore WHO Funding.  Reuters, 23 April 2020. https://reut.rs/2Y5C2t3

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Into the Wild – Preventing Pandemics Before They Start

Getting back to normal after this coronavirus pandemic will be an extended process that that may be disrupted by disease resurgence and unwelcome returns to activity restrictions (1).  Many believe the key to our final release from frustrating and expensive confinement periods lies in the creation of a preventative vaccine.

Looking Ahead

Although they could not have predicted SARS-CoV-2 would be the specific cause, our current pandemic predicament was no surprise to scientists.  As the struggle to control COVID-19 unfolds, researchers are thinking about the future and how to avoid repeating mistakes of the past (2).  Spurring their efforts is a stark reality – the pandemics of the future are already brewing.

Scientists have the capability to recognize and characterize emerging viruses like SARS-CoV-2 quickly.  The ability to determine genomic sequences in short order has enabled the creation of reliable diagnostic tests as well as facilitating efforts to track the origins of the virus.  This detailed understanding will allow for the creation of direct acting-antiviral agents as well as identify key molecules to target for future vaccines.

These technical accomplishments are impressive, but the campaign against the COVID-19 pandemic has been hamstrung by the terrible fact that the causative virus had a head start.  To avoid repeating this situation in the future, scientists are devising ways to mitigate and possibly prevent pandemics of the future through proactive research and development efforts. 

The Slow March to a Coronavirus Vaccine

A vaccine(s) may turn out to be the ultimate salvation from this coronavirus pandemic, but this will come on line at a maddeningly slow pace.  There are reasons to be optimistic a vaccine targeting SARS-CoV-2 can be created, but prior to general use scientists must slog through time-consuming processes to prove their formulations are safe and effective.  Past history with the first measles vaccines reminds us to be mindful that logically-targeted vaccines can not only fail to protect recipients, they might make the situation worse.  In addition, it remains unclear how long immunity to coronavirus will persist after immunization and how well the vaccine will work across a diverse population.  We should anticipate success, but must realize a coronavirus vaccine could turn out to be far from a miracle preventative treatment.   

Into the Wild  

The realities of vaccine production requirements mean this approach will always be too slow to keep pace with emerging pandemics, driving scientists to propose proactive research to identify potential dangerous disease agents circulating in wild animal reservoirs and create specific countermeasures before they manifest as disastrous outbreaks (2).  This surveillance and suppression readiness strategy could make huge contributions to public health protection in the future.

To shift an unfavorable situation in our favor, pandemic preppers may wish to consider launching vaccination programs directed toward key reservoir animals in the wild as a strategy to prevent future human disease outbreaks.  Raboral V-RG and ONRAB  were developed to vaccinate wild animal rabies reservoir species to prevent the spread of this deadly disease to humans or our companion/herd animals.  Perhaps some circulating zoonotic viruses identified to pose potential threats to human health could be suppressed using similar baiting strategies to deliver immunizing vaccines in the wild thereby interdicting pathogens before they find their way into us. 

Coyote

 

Although safety/efficacy testing and environmental use approvals would still be necessary, perhaps the processes for vaccines destined to be used solely in animals would be streamlined.  In addition, any method that obviates the need for mass immunizations of human populations will prevent consequential problems due to adverse medical events along with the daunting issues of scale-up and distribution.        

No matter the strategy, one thing that may work against far-sighted pandemic prevention-focused scientists is that averting problems is often an under-appreciated endeavor.  It might be hard to explain to the cost-conscious funders of the future that nothing happening meant your strategy succeeded, not that it can be abandoned.  Like it or not, it is inevitable we and those who come after us will pay the pandemic price one way or another.  

(1) Gideon Litchfield.   We’re Not Going Back to Normal.  MIT Technology Review, 17 March 2020.  https://www.technologyreview.com/2020/03/17/905264/coronavirus-pandemic-social-distancing-18-months/

(2) Jennifer Kahn.   How Scientists Could Stop the Next Pandemic Before It Starts.  The New York Times, 21 April 2020.  https://www.nytimes.com/2020/04/21/magazine/pandemic-vaccine.html?smid=tw-share

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Wait a Minute! Didn’t We Already Pay for This?

Getting past the coronavirus pandemic with the tools currently at hand could be a long and frustrating process punctuated by disease resurgence and returns to restrictions (1, 2).  Many believe the key to a final release from repeated rounds of suffocating confinement and worry lies in the creation of a preventative vaccine. 

Obstacles and Complications

Vaccines may turn out to be our ultimate coronavirus salvation, but compared to the fast spread of the pandemic they will come at a maddeningly slow pace.  Scientists must first discover key points to attack the virus, then go on to prove their formulations that successfully hit their specific targets are safe and effective.  Past history with measles reminds us to be mindful that logically-targeted vaccines can not only fail to protect recipients, they may make the situation worse.         

There are more complications.  The virus causing COVID-19, officially designated SARS-CoV-2, is new to science and although several lines of evidence suggest persons mount immune responses after infection, some observations suggest we cannot assume solid immunity to re-infection after exposure will be guaranteed in everyone (3).  Further, it is unclear how long after recovery patients remain solidly immune to this coronavirus.  That makes it impossible to estimate how long a vaccine(s) will provide effective protection.

Stimulating Coronavirus Countermeasures Research

Multiple parallel efforts to discover therapeutic agents and create vaccines or immunotherapies to control coronavirus are now underway.  To help move matters along as quickly as possible, some of this basic research is being performed as private-public partnerships.  As these efforts come to fruition, new anti-viral treatments and preventative vaccines will be mass-produced and marketed. 

Government funding reduces risks to speed the essential basic research to create new coronavirus control products, but the tasks do not end there.  The scale-up and mass production efforts are also going to demand innovation and more, likely much more, manufacturing equipment infrastructure and technical staff.  In order to assure life-saving products will be available in the quantities needed, at affordable prices, more subsidies may be required.

Wait a Minute!

This emerging situation leads to an interesting question; doesn’t marketing diagnostic tests, treatments or vaccines developed with public funding force citizens to pay twice for these products (4)?  This is a great question to ask at this difficult moment as well as how, hopefully rare, unforeseen adverse events due to use of these new products in the general population will be assessed (5) and mitigated.  Government funding serves to shepherd research at the fastest pace and incentivize private industry to take on the mass production work in such a way the public will be able to benefit from these products.  In order to assure citizens receive the full measure of benefit from these public investments, our leaders must attach specific conditions for funding.

 

 

(1) Gideon Litchfield.   We’re Not Going Back to Normal.  MIT Technology Review, 17 March 2020.  https://www.technologyreview.com/2020/03/17/905264/coronavirus-pandemic-social-distancing-18-months/

(2) Grace Moon. South Korea’s Return to Normal Interrupted by Uptick in Coronavirus Cases.  NBC News, 5 April 2020.  https://www.nbcnews.com/news/world/south-korea-s-return-normal-interrupted-uptick-coronavirus-cases-n1176021

(3) Stephen Chen.   Coronavirus: Low Antibody Levels Raise Questions About Reinfection Risk.  South China Morning Post, 7 April 2020 via Yahoo Newshttps://sg.news.yahoo.com/coronavirus-low-antibody-levels-raise-123035025.html?soc_src=social-sh&soc_trk=tw

(4) Louise Kyle.   The Public Is Funding the Hunt for a COVID-19 Vaccine. Big Pharma Shouldn’t Cash In.  The Tyee, 15 April 2020.   https://thetyee.ca/Opinion/2020/04/15/COVID19-Vaccine-Access/

(5) Centers for Disease Control and Prevention and U.S. Food and Drug Administration. Vaccine Adverse Event Reporting System.  https://vaers.hhs.gov

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The Coronavirus Pandemic Aftermath – The Long Road to Recovery

The current coronavirus crisis will eventually come to an end.  However, it may be quite a while before life gets back to normal.

The Patchwork Pandemic Response

Cities and states reacted to the COVID-19 pandemic at different times and with varying degrees of intensity.  Efforts to slow the emergence of infections through restrictions on commerce and activities were imposed much earlier in some areas than others.  At the time of writing (8 April 2020) several states still have not issued mandatory shelter-in-place orders. 

It is clear the new coronavirus invaded regions of the U.S. at different times and is propagating at unique rates.  In essence the way the virus attacked and was responded to leaves us facing not one nation-wide event, but a patchwork of unsynchronized localized epidemics.  This turns out to have been a fortunate circumstance as it allows for sharing of scarce medical equipment resources as the pandemic washes over the nation.  However, the way the pandemic unfolded will have a legacy effect on how it will ultimately unwind.  Although anxious to revive economic activity, not every part of the nation will be able to reverse restrictions at the same moment.

A Sneaky Virus Poses Uncertain Dangers

It is unclear how long restrictions on personal liberty must be kept in place to safeguard the public health (1).  If controls are lifted too soon, regions where the pandemic seems to be ebbing might see a local disease resurgence (2).  In addition, as long as the virus circulates in other parts of the nation, sparking new outbreaks due to importation of active cases is also a possibility. 

Maybe we will get a break if the onset of warm weather decreases coronavirus activity (3).  Unfortunately, if it occurs, a decline in disease is not necessarily the end of the COVID-19 problem.  With so few persons resistant to it, the new coronavirus may circulate at low levels throughout the summer and return with cooler weather.  Worst case is that the current pandemic is the herald wave of a far bigger event that will commence at the end of summer.               

Public health authorities do not have an accurate count of how many persons have been killed by the new coronavirus (4).  A considerable fraction of SARS-CoV-2 infections produce mild or fully asymptomatic disease and the emerging consensus is that this virus is transmitted by persons without obvious signs or symptoms of illness.  This makes drops in hospitalizations or deaths attributable to coronavirus incompletely reliable signs the pandemic has ended.

New Assessment Tools

Tracking the true scope and dynamics of the COVID-19 pandemic will require testing beyond the current program serving urgent clinical diagnostic needs (5).  The upcoming focus will involve deployment of simple-to-use tests to detect the presence of coronavirus antibodies.  In principle, antibody tests identify persons who have recovered from the infection and are immune to future infection by the same coronavirus.  In addition, antibody tests will also reveal individuals who experienced mild or asymptomatic infections. 

Mass deployment of rapid coronavirus antibody testing will enable epidemiologists to determine the true extent of the COVID-19 pandemic and provide informed estimates as to the proportion of the population immune to future infection by the SARS-CoV-2 virus.  This information will be vital for decision-makers tasked with declaring when shelter-in-place orders may be rescinded safely.  In addition, persons harboring antibodies may be certified to return to work without concern they will transmit the virus to others. 

The Uncertain Path Forward

A consensus as to how to mitigate the COVID-19 pandemic and treat its many victims is only emerging through hard experience.  Much remains to be discovered.  At the moment we presume infection with SARS-CoV-2 produces a fully protective antibody response.  If antibodies from survivors are used to treat seriously ill patients or antibody testing profiles serve as the deciding factor in whether to release public activity restrictions or allow persons to return to work, we are betting lives on that presumption being correct.  It may not be.  Small scale studies suggest that not all COVID -19 patients produce fully protective antibodies and may be subject to re-infection (6).  While experience with other viruses reveals an antibody response after infection often produces long-lasting immunity, that is not a universal rule.  Immunity to re-infection is not always persistent over time and some agents such as human immunodeficiency virus (HIV) induce strong antibody responses that fail to save the patient. 

As communities decide when and how to relax controls, the gaps in our knowledge mean vigilant surveillance for disease resurgence will be essential.   The COVID-19 pandemic may have come at us fast, but we must understand it may take a long time for it to leave. 

Searchlight

(1) Gideon Litchfield.   We’re Not Going Back to Normal.  MIT Technology Review, 17 March 2020.  https://www.technologyreview.com/2020/03/17/905264/coronavirus-pandemic-social-distancing-18-months/

(2) Grace Moon. South Korea’s Return to Normal Interrupted by Uptick in Coronavirus Cases.  NBC News, 5 April 2020.  https://www.nbcnews.com/news/world/south-korea-s-return-normal-interrupted-uptick-coronavirus-cases-n1176021

(3) Robin McKie.   Scientists Ask: Could Summer Heat Help Beat COVID-19?  The Guardian, 5 April 2020.  https://www.theguardian.com/world/2020/apr/05/scientists-ask-could-summer-heat-help-beat-covid-19?CMP=share_btn_tw

(4) Sarah Kliff and Julie Bosman.   Official Counts Understate the U.S. Coronavirus Death Toll.  The New York Times, 5 April 2020. https://nyti.ms/2JIkmuS

(5) Andrew Joseph.   The Next Frontier in Coronavirus Testing: Identifying the Full Scope of the Pandemic, Not Just Individual Infections.  Stat News, 27 March 2020.  https://www.statnews.com/2020/03/27/serological-tests-reveal-immune-coronavirus/

(6) Stephen Chen.   Coronavirus: Low Antibody Levels Raise Questions About Reinfection Risk.  South China Morning Post, 7 April 2020 via Yahoo Newshttps://sg.news.yahoo.com/coronavirus-low-antibody-levels-raise-123035025.html?soc_src=social-sh&soc_trk=tw

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Running Out of Luck – The History of Our Pandemic Future?

On December 31, 2019, the World Health Organization (WHO) was notified a novel coronavirus infection of humans had been discovered in Wuhan, China.  Less than 90 days later the outbreak was declared to have become a global a pandemic (1).

It is true no one could have specifically predicted the new coronavirus, SARS-CoV-2, would spark a pandemic until that event had actually come to pass.  However, the fact that we are under constant threat of such zoonotic (animal-to-human) disease catastrophes like COVID-19 has been appreciated for years (2).  The world has experienced both close calls and flat-out disasters with public health menaces such as AIDS, SARS and Ebola.  Like COVID-19, in addition to being deadly these extremely different viruses share another critical feature; they leaped out of wild animal reservoirs into human populations and spread widely.

A partial tally of notable zoonotic disease events reveals major threats to public health have emerged frequently over the decades.  In addition to the animal viruses transmitted to humans listed below, large-scale epidemics in flock and herd animals which produced tremendous economic losses have also occurred.  

  • 1981 – HIV/AIDS
  • 1999 West Nile virus encephalitis
  • 2002 SARS
  • 2009 Influenza H1N1 (pandemic strain)
  • 2012 MERS
  • 2014 Ebola virus disease outbreak (West Africa)
  • 2015 Zika virus (in the Americas)

 

A History of Future Pandemics

When the current COVID-19 pandemic finally plays out, assessing its hard lessons to avoid or control the inevitable pandemics of the future will be in order.  Although it may be convenient for some to claim our current predicament could not possibly have been foreseen, such assertions are only partially true.  Undertaking efforts to bolster the global disease surveillance capacity to detect emerging agents as early as possible and developing faster vaccine production technologies to stave off the next pandemic will be advisable.  In addition, re-thinking how we source and mass produce our food animals is in order.  As we have seen, the infectious disease roulette wheel keeps spinning and eventually we always run out of luck.           

Presentation1

 

(1) Helen Branswell and Andrew Joseph.   WHO Declares the Coronavirus Outbreak a Pandemic.  Stat News, 11 March 2020.  https://www.statnews.com/2020/03/11/who-declares-the-coronavirus-outbreak-a-pandemic/

(2) Kai Kupferschmidt.  Chinese Bats May be Carrying the Next SARS Pandemic.  Wired, 31 October 2013. https://www.wired.com/2013/10/bats-next-sars-pandemic/

 

 

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A Controlled Voluntary Infection Strategy to Stop the COVID-19 Pandemic?

On December 31, 2019, the World Health Organization (WHO) was notified a novel coronavirus disease of humans had been discovered in Wuhan, China.  A containment strategy appeared viable for a time (1), but it became clear the virus had escaped control and the COVID-19 outbreak has been formally declared to be a pandemic (2).  The WHO is now warning the U.S. could become a new coronavirus infection epicenter (3). 

Lock Down or Let It Go?

Not every nation facing this coronavirus pandemic is adopting the same control strategies.  While many have enacted strict containment policies, the Netherlands is pursuing a less restrictive path that might end up building sufficient ‘herd’ immunity to suppress future disease transmission (4).  Provided the health care system is capable of handling a surge of seriously ill patients, this strategy may work, although the full cost in morbidity and mortality will only become clear after the fact.

The Controlled Voluntary Infection Approach

Dr. Douglas Perednia published a call to achieve control of the coronavirus threat by dusting off an old idea once used to manage German measles (rubella) (5).  Before the advent of vaccines preventing disease caused by the rubella virus, children were often deliberately exposed to others known to have active infections.  These ‘rubella parties’ were intended to pass the virus through families and the local community as quickly as possible.  Although not done with an aim to squelch transmission throughout the whole of society, virus parties were once an important control measure for German measles. 

The rubella parties of old hinged on well-established facts about the disease (6) and the situations prevailing more than 50 years ago.  German measles infections were generally mild and the virus was not as easily transmitted as measles or chickenpox.  The strange thing was rubella virus was dangerous specifically because it failed to infect so many children and induce immunity in them.  The rubella virus is a potent teratogen and it is a potential menace if susceptible mothers who escaped infection during their childhoods contract the virus during the first trimester of pregnancy.  Under such unfortunate circumstances the risk is great the babies may suffer a wide range of defects such as cataracts, heart malformation or hearing impairment.  Back in the day when no vaccines or treatments were available rubella virus circulated freely to produce large pandemics with millions of infections (6).  Since it generally caused only mild disease, holding rubella parties and thereby getting the infections out of the way in a deliberate fashion seemed a reasonable alternative to shift the odds in favor of mothers not becoming infected while pregnant.

A National Controlled Voluntary Infection Effort to Stop Coronavirus?

Dr. Perednia suggests undertaking an effort to deliberately expose persons to COVID-19 could help control the current pandemic (5).  The basic idea is similar to the rubella parties, only this time with a far more ambitious aim to quickly build up high enough levels of solid immunity in the general population to make it more likely future coronavirus infections fizzle out rather than sparking epidemics.  In a sense volunteer infections would be a forced march to herd immunity like that possibly being employed in the Netherlands (4).

The approach would be to expose low-risk volunteers to COVID-19 and documenting successful immune conversion with an antibody test.  Suppressing the pandemic by lock downs and social distancing has a major flaw; most persons remain uninfected and do not have active immunity against the virus.  Once social distancing rules are relaxed, there is a risk the disease transmission will rebound.  If enough people volunteer to be infected, the resulting herd immunity might stop the threat of rebounds.

The Big Assumption Behind the No Big Deal Concept 

The logic for using a controlled voluntary infection to decease the coronavirus threat is compelling.  However, for prospective volunteers, there are a few things to consider:

Although claims COVID-19 is no big deal because it is just like influenza, much remains to be clarified about this new disease.  The COVID-19 death rate is obviously only provisional, ideas as to which patient demographics are most at risk are evolving as cases mount.  The ability to predict disease risk level is minimal and persons volunteering to be infected with this new coronavirus must accept they are agreeing to put themselves into an unpredictable situation.

Will It actually Work?

Will project coordinators be able to find reliably diagnosed active COVID-19 cases where and when they want them to start disease transmissions?  For the moment, let’s assume it will be possible to identify patients able to transmit COVID-19 or safely mass produce coronavirus preparations that will reliably produce human  infection and induce solid immunity on recovery.  It is unclear what level of herd immunity will suffice to prevent future epidemics.  Will that require 30%, 60% or higher proportions of the overall population be immune?  It will be challenging to succeed unless the endpoint goal is known accurately.  That leads to another question; will there be enough low-risk demographic volunteers, perhaps many millions of them, to reach an epidemic-suppressing endpoint?  

Volunteers will need to be carefully screened.  Persons with immunocompromise due to cancer chemotherapy, transplants, or AIDS as well as those receiving some treatments for rheumatoid arthritis and inflammatory bowel disease are under increased risk from coronavirus infections.  There are no definitive estimates, but this high-risk group alone could be 10 million persons in the U.S.  That implies that provisions will have to be made to ensure all volunteers infected with COVID-19 must be isolated, monitored and supported – for periods of 2 weeks – to avoid unintentionally spreading the virus to high-risk persons.  That promises to be a huge challenge if success depends on infecting millions of persons.

Maybe Not Now

One thing prospective volunteers may wish to think over is how a national mass deliberate exposure effort will be staged.  For both ethical and practical reasons, a nationwide effort to perform voluntary controlled virus infections with the COVID-19 agent must be well coordinated.  First, before it can even commence, the current surge of hospitalized persons in the system must be allowed to pass through and the systems allowed to recover and restock.  The reason is simple, we cannot predict with certainty who is at low risk.  Some volunteers might need intensive medical interventions should adverse reactions develop after infection with the COVID-19 disease agent and if all the beds and intensive care units in the area are filled that may be impossible.  Carefully staging mass exposure events to prevent overrunning medical facilities seems essential.

To prospective volunteers – choose wisely.

AIW

(1) The Editorial Board.   Stop the Wuhan Coronavirus. Nature, 21 January 2020.  https://www.nature.com/articles/d41586-020-00153-x

(2) Helen Branswell and Andrew Joseph.   WHO Declares the Coronavirus Outbreak a Pandemic.  Stat News, 11 March 2020.  https://www.statnews.com/2020/03/11/who-declares-the-coronavirus-outbreak-a-pandemic/

(3) Emma Farge and Sanjeev Miglani.   U.S. Could be Next ‘Virus Epicenter’ as India Locks Down, Global Recession Looms.  Reuters, 24 March 2020.  https://www.reuters.com/article/us-health-coronavirus/u-s-could-become-coronavirus-epicenter-uk-locks-down-olympics-in-doubt-idUSKBN21B1RJ

(4) Maya Rostowski and Hind Hassan.   The Netherlands is Letting a Lot of People Get Sick to Try to Beat Coronavirus. Vice, 24 March 2020.    https://www.vice.com/en_us/article/939mez/the-netherlands-is-letting-a-lot-of-people-get-sick-to-try-to-beat-coronavirus

(5) Douglas Perednia. How Medical ‘Chickenpox Parties’ Could Turn the Tide of The Wuhan Virus.  The Federalist.com, 25 March 2020.  https://thefederalist.com/2020/03/25/how-medical-chickenpox-parties-could-turn-the-tide-of-the-wuhan-virus/

(6) Tatiana Lanzieri et al. Manual for the Surveillance of Vaccine-Preventable Diseases. Chapter 15: Congenital Rubella Syndrome. Centers for Disease Control and Prevention. https://www.cdc.gov/vaccines/pubs/surv-manual/chpt15-crs.html

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Novel Coronavirus – Underestimating a Dangerous Enemy

On December 31, 2019, the World Health Organization (WHO) was notified a novel coronavirus infection of humans had been discovered in Wuhan, China.  A containment strategy appeared viable for a time (1), but less than 90 days later the outbreak was formally declared to be a pandemic (2).

No Big Deal?

Although the U.S. has developed a sophisticated test to detect coronavirus infections, its roll out has been slow.  That unfortunate situation leaves public health authorities in the dark as to where the disease is most prevalent currently and will impede their ability to mitigate its potentially serious impacts.  But, is this new coronavirus outbreak just like influenza which, for the most part, causes little public concern?

The CDC has a web page which tallies the current (2019-2020 season) influenza activity (3). As of March 13, 2019, the mid-range of the estimates are:  

40 million persons have been infected or are ill with influenza

450,000 hospitalizations

35,000 deaths – a current case fatality rate estimate of 0.08%

Toting up the deaths attributable to influenza is tricky, because they often follow a secondary bacterial pneumonia and take time to occur.  The current estimate seems to be in line with recent flu seasons, a total incidence of just under 0.1%. In other words, 99% of people who get the flu survive, so, in the larger scheme of things, it’s no big deal.

Apples and Oranges

The problem with the no big deal conclusion is that the novel coronavirus is not equivalent to influenza.  Experience is limited, but a conservative estimate is that 10% of coronavirus infections will produce severe disease requiring medical intervention with an overall case fatality rate of 1%.  If coronavirus actually infects 40 million persons, at a conservatively estimated base death rate of 1%, roughly 400,000 people may die.  That might be a best-case prediction.  

If coronavirus parallels the current influenza outbreak it might produce 40 million cases with 4.5 million of those persons needing hospitalization.  Depending on how fast a coronavirus epidemic unfolds, it could easily overwhelm the capacity of the medical system to provide life-saving supportive care.  That may increase the death rate of this infection.

The Influenza situation is simply not a good model for what an uncontrolled outbreak of coronavirus might do.  The reason is that we work diligently to prevent influenza disease and deaths by promoting pre-season vaccinations of the most vulnerable.  In addition, several treatments like Tamiflu, Relenza and Peramivir are available to rescue seriously ill patients.  And some influenza deaths are probably prevented by supportive respiratory treatments.  The situation with coronavirus is stark; there will be no vaccine to prevent it, there are no drugs to manage serious infections, and, if an epidemic comes on quickly, many patients who might otherwise have been saved will be lost if medical facilities are overwhelmed. 

An inability to offer protection by vaccines or drugs leaves persons with immunocompromise due to cancer chemotherapy, transplants, AIDS or some treatments for rheumatoid arthritis and inflammatory bowel disease at greatly increased risk from coronavirus infections.  There are no definitive estimates, but this high-risk group could be 10 million persons in the U.S.  Further, the limited experience with this new disease makes it difficult to predict whether patients recover fully or are debilitated.  Unfortunately, observations suggest severe consequences are possible in some coronavirus patients with cardiovascular disease (4).

In short, equating two such different situations may lead us to seriously underestimate the pain a coronavirus epidemic might inflict.  Unlike influenza, there is no means to prevent coronavirus infections or treat those that become severe.  Part of the reason seasonal influenza is considered no big deal is that for decades medical professionals have taken proactive steps to keep it in check.  Unless we take quick actions to slow this coronavirus epidemic, we will see how bad an uncontrolled virus disease can get.

Stay safe. 

Flames

 

(1) The Editorial Board.   Stop the Wuhan Coronavirus. Nature, 21 January 2020.  https://www.nature.com/articles/d41586-020-00153-x

(2) Helen Branswell and Andrew Joseph.   WHO Declares the Coronavirus Outbreak a Pandemic.  Stat News, 11 March 2020.  https://www.statnews.com/2020/03/11/who-declares-the-coronavirus-outbreak-a-pandemic/

(3) CDC influenza data estimates of influenza situation 2019-2020 – https://www.cdc.gov/flu/about/burden/preliminary-in-season-estimates.htm

(4) Ying-Ying Zheng et al. COVID-19 and Cardiovascular System.   Nature Reviews Cardiology, 5 March 2020.  https://www.nature.com/articles/s41569-020-0360-5

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