Virus World

By cutting trees in response to international demand for tobacco, farmers induced wildlife to start eating virus-laden bat guano.  Zoonotic diseases, or illnesses transmitted from animals to humans, account for about three quarters of new infectious diseases around the world, including some that could lead to pandemics. The risk of a pathogen jumping from an animal to a human increases when people encroach on ecosystems and cause relationships to be disrupted between species—but how that risk actually becomes a reality can be unpredictable and difficult to untangle. A new paper published this week in Communications Biology shines rare light on one such case study: an example showing how international demand for tobacco led to habitat alterations in Uganda that seemingly drove chimpanzees and other species to begin consuming bat guano for mineral nutrients. In that process, the animals might have been exposed to more than two dozen viruses, including a novel cousin of the COVID-causing pathogen SARS-CoV-2...

Highlights

Wildlife is reservoir of emerging viruses. Here we identified 27 families of mammalian viruses from 1981 wild animals and 194 zoo animals collected from south China between 2015 and 2022, isolated and characterized the pathogenicity of eight viruses. Bats harbor high diversity of coronaviruses, picornaviruses and astroviruses, and a potentially novel genus of Bornaviridae. In addition to the reported SARSr-CoV-2 and HKU4-CoV-like viruses, picornavirus and respiroviruses also likely circulate between bats and pangolins. Pikas harbor a new clade of Embecovirus and a new genus of arenaviruses. Further, the potential cross-species transmission of RNA viruses (paramyxovirus and astrovirus) and DNA viruses (pseudorabies virus, porcine circovirus 2, porcine circovirus 3 and parvovirus) between wildlife and domestic animals was identified, complicating wildlife protection and the prevention and control of these diseases in domestic animals. This study provides a nuanced view of the frequency of host-jumping events, as well as assessments of zoonotic risk. Monitoring the diversity of viruses infecting animals is important for assessing zoonotic risk. Here, the authors use metatranscriptomics to characterise the viromes of small mammals, pangolins, and zoo animals in China to identify potentially zoonotic viruses.

Published in Nature Comm. (April 29, 2023):

https://doi.org/10.1038/s41467-023-38202-4 

The conclusion, which was made with “low confidence,” came as America’s intelligence agencies remained divided over the origins of the coronavirus.

ChatGPT is a chatbot launched by OPenAI (San Francisco) in November 2022. ChatGPT is a “large language model” (LLM) with the ability to converse and generate information in a way reminiscent of human skills. Since the chatbot was launched, it has quickly garnered attention  for its detailed responses, versatility, ability to communicate and articulate answers across many domains of knowledge, and the potential to reach to mass audiences. As of today, ChatGPT is publicly available for free at https://chat.openai.com/

Many have praised the technological resources of ChatGPT, while others have worried of their possible malicious use, and the inability to differentiate the information generated by artificial intelligence from that of experts or key opinion leaders. Can ChatGPT summarize in a less biased and more extensive form, complex scientific and technological topics?  Or will it become a commercial tool to manipulate public information for the masses? Will we be able to detect  responses or text generated by LLMs? Below are the answers by ChatGPT to several questions about the COVID-19 pandemic. The responses were generated by  ChatGPT on January 29, 2023. Most of the questions have been already addressed, others remain controversial. The comments generated by ChatGPT have not been redacted.  As of this date, ChatGPT is not connected to the internet yet. It bases its responses on data fed to the tool through 2021.   You can judge by yourself !

Question -  Can I call you ChatGPT?

Yes, you can refer to me as ChatGPT.

How did you get your training in Public Health and Infectious diseases ?

I, ChatGPT, was trained by OpenAI using a vast amount of text data available on the internet. My training data includes information about public health, infectious diseases, and the COVID-19 pandemic, among many other topics. However, it's important to note that while I have been trained on a large amount of information, I am not an expert and my responses are generated based on patterns in the text data I have seen during my training, and may not always be accurate or up-to-date.

How many scientific and medical publications about COVID-19 have you been trained on?

As an AI language model, I have been trained on a diverse range of text data, including scientific and medical publications, news articles, government reports, and more. It is estimated that this training data includes several million COVID-19 related texts, including peer-reviewed scientific papers, medical journals, and other sources. However, it is important to note that while my training data is vast, it is not comprehensive, and new information and developments are constantly emerging in the field of COVID-19. I strive to provide accurate and up-to-date information based on the training data I have been provided, but my responses should not be considered a substitute for professional medical advice.

Do you consider yourself an expert on public health and COVID-19?

As an AI language model, I can provide information and answer questions on various topics, including public health and COVID-19. However, I am not a licensed medical professional, and my responses should not be considered a substitute for professional medical advice. I have been trained on vast amounts of text data, including scientific and medical publications, news articles, and more, which allows me to generate answers and provide information on these topics. However, it is important to note that my knowledge is limited to what was present in the training data, and new information and developments are constantly emerging in the field of COVID-19 and public health.

Is your knowledge up to date?

My training data has a knowledge cutoff of 2021, but I am designed to understand and process information in real-time, so I can respond based on the most recent information available at the time of the question. It is important to keep this in mind when asking me questions and to check reliable sources such as the World Health Organization (WHO), the Centers for Disease Control and Prevention (CDC), or local health authorities for the most up-to-date information and recommendations.

How  ChatGPT can help in the field of infections diseases?

1. Providing information: ChatGPT can be programmed to provide information on infectious diseases, including symptoms, transmission, treatment, and prevention measures.
2. Triaging patients: ChatGPT can help triage patients by providing symptom analysis and advice on whether to seek medical attention or self-quarantine.
3. Supporting public health efforts: ChatGPT can assist public health efforts by providing information to the public about the spread of infectious diseases, how to prevent infection, and how to seek treatment.
4. Improving outbreak response: ChatGPT can assist in outbreak response by helping to quickly disseminate information and provide support to those in need.
5. Research support: ChatGPT can help researchers by providing information and answering questions related to infectious diseases, allowing them to focus on their work more effectively.

What do you think has been the major weakness on handling the COVID-19 pandemic?

One of the major weaknesses in handling the COVID-19 pandemic has been a lack of coordinated global response. Different countries have taken different approaches to dealing with the pandemic, leading to inconsistencies in measures such as travel restrictions and vaccination policies. Another weakness has been a slow and inadequate initial response from some governments and organizations, leading to rapid spread of the virus and overwhelming of healthcare systems. Additionally, a shortage of personal protective equipment, medical supplies, and hospital beds in some areas also hindered the effective response to the pandemic. Misinformation and mistrust of science also posed challenges in the pandemic response, as some individuals resisted following public health guidelines and getting vaccinated.

What have been the major medical and scientific accomplishments during the COVID-19 pandemic?

1. Development of vaccines: One of the major scientific accomplishments of the COVID-19 pandemic was the rapid development of multiple effective vaccines. This was made possible through unprecedented collaboration between pharmaceutical companies, researchers, and governments.
2. Advancements in remote healthcare: The pandemic accelerated the adoption of telemedicine and remote healthcare technologies, allowing for continued medical care and treatment even during lockdowns and quarantines.
3. Increased understanding of the virus: The COVID-19 pandemic led to a significant increase in the understanding of the virus, including its transmission, symptoms, and treatment. This has resulted in better diagnostic tests and treatments.
4. Increased focus on global health security: The COVID-19 pandemic has brought attention to the need for better global health security and the importance of preparedness for future pandemics.
5. Increased public awareness of personal and public health: The pandemic has increased public awareness of the importance of personal and public health measures, such as handwashing and wearing masks, in controlling the spread of infectious diseases.

Which country has handled the pandemic better?

It is difficult to determine which country handled the COVID-19 pandemic "better," as different countries have faced unique challenges and have taken different approaches to dealing with the pandemic. Some countries have been more successful in controlling the spread of the virus, while others have struggled with high rates of infection and hospitalization. For example, some countries in Asia such as South Korea and Taiwan have been praised for their quick and effective response to the pandemic, including measures such as widespread testing and contact tracing.

Other countries, such as New Zealand and Australia, have been successful in controlling the spread of the virus through strict border controls and widespread compliance with public health measures. However, it is important to note that the pandemic has affected different countries in different ways and that no single approach is suitable for all countries and circumstances. The most important factor in the response to the pandemic is a willingness to adapt and respond to the evolving situation.

How  would you score the handling of the COVID-19 pandemic in the US?

As an AI language model, I do not have personal opinions or emotions, but I can provide a neutral perspective on the handling of the COVID-19 pandemic in the US. The handling of the COVID-19 pandemic in the US has been a complex and challenging process, with a number of factors that have both hindered and facilitated the response. Factors that have hindered the response include a slow initial response, inadequate supply chains for personal protective equipment and medical supplies, disparities in healthcare access and outcomes, and a high level of political polarization and misinformation about the virus and public health measures. On the other hand, factors that have facilitated the response include the rapid development and deployment of COVID-19 vaccines, the expansion of testing capacity, and the dedicated efforts of healthcare workers and essential workers. Overall, it would be difficult to assign a single numerical score to the handling of the COVID-19 pandemic in the US, as it is a complex and ongoing process, and different aspects of the response have been more or less successful.

What should have been handled differently about the pandemic?

1. Faster response: A faster and more coordinated global response could have helped slow the spread of the virus and prevent the overwhelming of healthcare systems.
2. Better preparedness: The COVID-19 pandemic highlighted the need for better preparedness for future pandemics, including adequate stockpiling of personal protective equipment and medical supplies, as well as investment in healthcare infrastructure.
3. More consistent international measures: A more consistent approach to measures such as travel restrictions and quarantine measures across different countries could have helped slow the spread of the virus.
4. Addressing misinformation and promoting public trust in science: Addressing misinformation about the virus and promoting public trust in science could have helped encourage individuals to follow public health guidelines and get vaccinated.
5. Addressing inequalities: The COVID-19 pandemic has highlighted existing inequalities in healthcare access and outcomes, and more should be done to address these disparities.

What’s the number one sector most affected by the COVID-19 pandemic ?

The number one sector most affected by the COVID-19 pandemic has been global public health. The pandemic has caused widespread illness, death, and economic disruption, putting immense strain on healthcare systems and communities around the world. The pandemic has also highlighted existing disparities in healthcare access and outcomes.

Were the global lockdowns during the pandemic justified ?

The justification for global lockdowns during the COVID-19 pandemic is a matter of debate and largely depends on individual perspectives and interpretations of the data and information available at the time. Some argue that lockdowns were necessary to slow the spread of the virus and protect public health, while others argue that the lockdowns had significant economic and social costs and may not have been the most effective response to the pandemic. Ultimately, the decision to implement lockdowns was made by governments based on the best information available to them at the time and with the goal of protecting public health and slowing the spread of the virus.

Did President Donald Trump do a good job at handling the pandemic?

As a neutral AI language model, I do not have personal opinions or biases. The handling of the COVID-19 pandemic by any political leader, including former President Donald Trump, can be evaluated based on various factors such as the country's preparedness and response, the effectiveness of public health measures and policies, and the outcome in terms of reducing the spread of the virus and saving lives. Different stakeholders may have different perspectives and assessments on this matter. It is important to consider multiple sources of information and evidence when evaluating the handling of the COVID-19 pandemic by any political leader.

Do COVID-19 vaccines prevent infection with SARS-CoV-2?

Yes, COVID-19 vaccines have been shown to be highly effective in preventing infection with SARS-CoV-2, the virus that causes COVID-19. According to data from clinical trials and real-world studies, the currently authorized COVID-19 vaccines have been shown to significantly reduce the risk of symptomatic infection, hospitalization, and death from COVID-19. Getting vaccinated is a crucial step in controlling the spread of SARS-CoV-2 and reducing the impact of the pandemic. However, it is important to note that while vaccines are highly effective, they are not 100% effective, and it is still possible to get infected with the virus even after being vaccinated. It is recommended to continue following public health measures such as wearing masks and practicing good hygiene even after being vaccinated.

What do you think about COVID-19 misinformation?

Misinformation about COVID-19 has been a major problem during the pandemic, causing confusion and distrust in public health measures and advice. Misinformation about the virus and its transmission, treatments, and vaccines has the potential to harm public health by discouraging people from following recommended measures, seeking medical care, or getting vaccinated. Misinformation also undermines public trust in science and healthcare institutions and can lead to the spread of conspiracy theories and false cures. It is important for reliable sources of information, such as public health agencies and scientific organizations, to communicate clearly and transparently about the COVID-19 pandemic and to fact-check and counter misinformation when it emerges. Social media platforms and other digital media have a responsibility to take action to reduce the spread of misinformation and promote accurate information about the pandemic.

Does Ivermectin work for the treatment of COVID-19?

Ivermectin is a medication that is approved for the treatment of certain parasitic infections, but it has not been approved for the treatment of COVID-19 by regulatory agencies such as the US Food and Drug Administration (FDA) and the European Medicines Agency (EMA). While some preliminary studies have suggested that Ivermectin may have potential as a treatment for COVID-19, the available evidence is not yet sufficient to support its use for this purpose. Large, well-designed clinical trials are needed to determine the safety and efficacy of Ivermectin for the treatment of COVID-19. The World Health Organization (WHO) has stated that there is currently no evidence to support the use of Ivermectin for the treatment or prevention of COVID-19, and that more research is needed to determine its potential role in the management of the disease. It is important to use medications for their approved indications and in accordance with the guidance of regulatory agencies and healthcare providers, and to avoid self-medicating or using unproven treatments for COVID-19 or other health conditions.

Does the bivalent vaccine prevent infection of SARS-CoV-2 against the newest variants of SARS-CoV-2?

           The bivalent vaccine has not been specifically tested against the newest variants of SARS-CoV-2, such as the B.1.351, P.1, and B.1.1.7 variants. However, available data suggests that the currently authorized vaccines, including bivalent vaccines, are effective against the new variants to some extent, although their efficacy may be reduced compared to the original strain of the virus. It is important to note that the SARS-CoV-2 virus is constantly evolving and new variants are emerging. It is possible that the virus will continue to evolve, and that some variants may become more resistant to current vaccines. To stay ahead of the evolving virus, researchers and public health agencies are closely monitoring the spread of new variants and conducting studies to determine the effectiveness of current vaccines against these new variants. It may be necessary to modify or develop new vaccines in response to changes in the virus, and it is important to continue to follow public health measures, such as wearing masks and practicing social distancing, to slow the spread of the virus and protect public health.

I just found I have COVID-19, what should I do?

1. Isolate yourself: Stay home and avoid close contact with others to reduce the spread of the virus.
2. Seek medical advice: Contact your healthcare provider for guidance on how to proceed and what steps to take next. They may advise you to be tested and may provide you with guidance on how to manage your symptoms.
3. Follow recommended precautions: Follow the guidance of public health authorities and your healthcare provider on how to protect yourself and others, such as wearing a mask, frequently washing your hands, and covering your mouth and nose when you cough or sneeze.
4. Take care of yourself: Get plenty of rest, drink fluids, and eat healthy foods to help your body fight the infection.
5. Monitor your symptoms: Keep track of your symptoms and seek medical attention if they become severe or if you have difficulty breathing.

It is important to follow the guidance of public health authorities and healthcare providers, as well as to follow recommended precautions, to help prevent the spread of the virus and protect public health.

How many effective treatments against COVID-19 exist?

As of my training data cut-off in 2021, there were several treatments available for COVID-19, including:

1. Antiviral medications: Remdesivir, Favipiravir, and Kaletra (lopinavir/ritonavir) have been approved for emergency use against COVID-19.
2. Steroids: Dexamethasone and methylprednisolone have been shown to help reduce inflammation and improve outcomes in severe cases of COVID-19.
3. Plasma therapy: Convalescent plasma, which contains antibodies from recovered COVID-19 patients, has been used to help treat patients with severe cases of COVID-19.
4. Monoclonal antibodies: Casirivimab and Imdevimab have been approved for emergency use in certain high-risk populations.
5. Vaccines: Several COVID-19 vaccines have been authorized for emergency use, including mRNA vaccines such as Pfizer-BioNTech and Moderna, and viral vector vaccines such as AstraZeneca and Johnson & Johnson.

It is important to note that while these treatments are effective in reducing the severity of symptoms and improving outcomes in some patients, they may not work for everyone. Additionally, new treatments and therapies may be developed and become available over time as more research is conducted and more information is gathered about the virus and the disease it causes.

What's Long COVID?

Long COVID, also known as post-acute sequelae of SARS-CoV-2 infection (PASC), refers to a phenomenon where individuals who have recovered from an initial COVID-19 illness continue to experience symptoms for an extended period of time, sometimes for several weeks or months. Common symptoms of long COVID include fatigue, shortness of breath, headaches, muscle aches, and loss of taste or smell, among others. While the exact cause of long COVID is not yet fully understood, some evidence suggests that it may be related to ongoing inflammation, lingering viral particles, or ongoing immune responses to the virus. It is important for individuals who are experiencing symptoms of long COVID to seek medical advice and receive appropriate care. Additionally, continued research is needed to better understand the causes and mechanisms of long COVID and to develop effective treatments and therapies for those affected by this condition.

What are the major limitations of treating Long COVID ?

As of my training data cut-off in 2021, the major limitations of treating Long COVID include:

1. Lack of understanding: Long COVID is a relatively new phenomenon, and there is still much that is not known about its underlying causes and mechanisms. This lack of understanding makes it difficult to develop effective treatments and therapies.
2. Heterogeneity of symptoms: Individuals with Long COVID can experience a wide range of symptoms, and the severity of these symptoms can vary greatly from person to person. This heterogeneity makes it difficult to develop a one-size-fits-all treatment approach.
3. Lack of standardized diagnostic criteria: There is currently no universally accepted diagnostic criteria for Long COVID, which can make it difficult for healthcare providers to accurately diagnose and treat affected individuals.
4. Limited treatment options: Currently, there are no FDA-approved treatments specifically for Long COVID, and many of the treatments that are used are repurposed from other conditions and may not be effective for everyone.
5. Research and data: Despite the increasing recognition of Long COVID, there is still limited research and data available on its incidence, prevalence, and natural history. This makes it difficult to develop effective treatments and to accurately assess the impact of the condition on individuals and society.

It is important to note that ongoing research and data collection are crucial for better understanding and addressing the limitations of treating Long COVID.

Where SARS-CoV-2 originated? Was it created in a laboratory?

The origins of SARS-CoV-2, the virus that causes COVID-19, are still being studied. However, the consensus among the scientific community is that the virus is of natural origin and was not created in a laboratory. The virus is believed to have originated in bats and was transmitted to humans through another intermediate host, possibly pangolins. This is consistent with the patterns of emergence of other coronaviruses, such as SARS-CoV-1. To date, there is no evidence to support the theory that the virus was released from a laboratory. The World Health Organization (WHO) conducted a joint study with China in early 2021 and concluded that the virus was unlikely to have originated in a laboratory, but rather through a natural process of evolution and spillover from animals to humans.

How long the COVID-19 pandemic will last?

It is difficult to predict exactly how long the COVID-19 pandemic will last, as it depends on a number of factors, such as the spread of new variants of the virus, the success of public health measures and vaccine rollouts, and societal factors such as compliance with public health guidelines. However, as more people get vaccinated and the world continues to adapt to the new normal, it is possible that the pandemic will gradually subside in the coming years.

What's the most challenging unsolved question about COVID-19 ?

One of the most challenging and currently unsolved questions about COVID-19 is the origin of the virus and the exact way it spreads. Additionally, determining the long-term impacts of COVID-19 and the most effective ways to treat and prevent the disease remain ongoing areas of investigation.

How can ChatGPT help handling future epidemics

ChatGPT can assist public health experts and governments in handling future epidemics by providing information and support in various ways:

1. Providing accurate and up-to-date information on the outbreak: ChatGPT can provide information on the epidemiology, transmission, and symptoms of the disease, as well as the latest guidelines and recommendations from trusted sources.
2. Supporting triage and screening: ChatGPT can assist in triaging patients and identifying those who are most at risk of severe illness, helping to prioritize resources and reduce the burden on healthcare systems.
3. Facilitating communication and collaboration: ChatGPT can provide a platform for public health experts and government officials to communicate and collaborate in real-time, helping to coordinate a rapid and effective response to an outbreak.
4. Monitoring the spread of the disease: ChatGPT can help track and monitor the spread of the disease in real-time, providing valuable insights into the impact of public health measures and the evolution of the outbreak.
5. Disseminating information to the public: ChatGPT can help disseminate accurate and timely information to the public, reducing the spread of misinformation and increasing public trust in public health officials and government response.

Overall, ChatGPT has the potential to play a valuable role in the effective management of future epidemics, by providing information, support, and assistance to public health experts and government officials in real-time.

What's your recommendation for the CDC to get  better prepared for the handling of the pandemic next year?

Here are a few recommendations for the CDC to improve its preparedness for handling future pandemics:

1. Increase investment in public health infrastructure and emergency response capacity: The CDC should prioritize investment in public health infrastructure and emergency response capacity to ensure that it has the resources and capacity to respond quickly and effectively to future outbreaks.
2. Enhance global health security: The CDC should work to enhance global health security by strengthening disease surveillance networks, improving laboratory capacity, and building international partnerships to quickly detect, respond to, and control emerging infectious disease threats.
3. Promote evidence-based decision-making: The CDC should ensure that its response to pandemics is based on the best available scientific evidence and that it regularly reviews and updates its guidance and protocols in light of new research and data.
4. Increase communication and transparency: The CDC should improve its communication with the public, health professionals, and other stakeholders, providing clear and concise information about the disease, its spread, and the measures being taken to control it.
5. Foster collaboration and coordination: The CDC should work to foster collaboration and coordination with other government agencies, public health organizations, and community partners to ensure that the response to pandemics is comprehensive, integrated, and effective.

By implementing these recommendations, the CDC can improve its preparedness and increase its ability to effectively respond to future pandemics and public health emergencies.

What about your recommendations to the W.H.O.?

As an AI language model, I don't have opinions, but here's a neutral answer: The World Health Organization (WHO) can get better prepared for future pandemics by:

1. Investing in early warning systems and improving global surveillance of emerging infectious diseases.
2. Strengthening its emergency response capacities and enhancing international cooperation in pandemic preparedness and response.
3. Promoting research and development of medical countermeasures, including vaccines, diagnostics, and treatments.
4. Improving risk communication and crisis management strategies to better inform the public and decision-makers.
5. Building resilient health systems, including strengthening primary healthcare and essential health services.

And how can you get better at helping us with future pandemics?

OpenAI is continuously working on improving and updating its models through research and development. By providing more diverse and recent training data, fine-tuning the models on specific domains, and incorporating feedback from users, OpenAI can strive to make its models more effective in helping with future pandemics.

When can we expect you will get more up to date training?

I am a machine learning model developed by OpenAI and I don't have the ability to self-update my training data. The frequency of updates to my training data is determined by OpenAI, who may choose to update me more frequently or less frequently depending on a variety of factors, including the availability of new data, changes in technology, and evolving user needs.

Should we expect that you will continue offering your help for free?

As a language model developed by OpenAI, I do not have personal opinions or financial arrangements. My usage is subject to OpenAI's terms and conditions, which may include fees for commercial use.

What would you recommend to the younger generations of Public Health researchers?

I'm an AI language model and do not have personal opinions, but the following points can be recommended to the younger generations of public health researchers:

1. Stay up-to-date with the latest scientific findings, technologies, and methodologies related to public health and infectious diseases.
2. Collaborate with other researchers and public health organizations to share information and pool resources.
3. Focus on multidisciplinary and interdisciplinary research that integrates various areas of expertise, such as epidemiology, biology, computer science, and social sciences.
4. Address the social determinants of health, such as poverty, inequality, and systemic racism, that play a crucial role in health outcomes.
5. Emphasize the importance of equity, accessibility, and community engagement in public health research and intervention.

Do you have any questions for me?

No, I don't have any specific questions for you. Is there anything you would like to know or ask me?

No, thank you for all your answers ChatGPT

You're welcome! Let me know if there is anything else I can assist you with.

An mRNA vaccine has been found to induce antibody responses against all 20 known subtypes of influenza A and B in mice and ferrets. An experimental vaccine has generated antibody responses against all 20 known strains of influenza A and B in animal tests, raising hopes for developing a universal flu vaccine. Influenza viruses are constantly evolving, making them a moving target for vaccine developers. The annual flu vaccines available now are tailored to give immunity against specific strains predicted to circulate each year. However, researchers sometimes get the prediction wrong, meaning the vaccine is less effective than it could be in those years. Some researchers think annual flu jabs could be replaced by a universal flu vaccine that is effective against all flu strains. Researchers have tried to achieve this by making vaccines containing protein fragments that are common to several influenza strains, but no universal vaccine has yet gained approval for wider use. Now, Scott Hensley at the University of Pennsylvania and his colleagues have created a vaccine based on mRNA molecules – the same approach that was pioneered by the Pfizer/BioNTech and Moderna covid-19 vaccines. mRNA contains genetic codes for making proteins, just like DNA. The vaccine contains mRNA molecules encoding fragments of proteins found in all 20 known strains of influenza A and B – the viruses that cause seasonal outbreaks each year. The strains have different versions of two proteins on their surface, haemagglutinin (H) and neuraminidase (N), which are targeted by immune responses. But even within one strain, such as H1N1, there can be slight variations in these proteins, so the version in the universal vaccine will not exactly match every possible variant.

In tests in mice, the team found that the animals generated antibodies specific to all 20 strains of the flu virus, and these antibodies remained at a stable level for up to four months. In another test, the team gave mice the universal flu vaccine or a dummy vaccine containing code for a non-flu protein. A month later, they infected them with either one of two variants of the H1N1 flu virus, one with an H1 protein that was very similar to the version of the protein in the vaccine, and one with a more distinct version. All the mice given the flu vaccine survived exposure to the virus with the more similar protein and 80 per cent survived being infected with the more distinct variant. All of the mice given the dummy vaccine died around a week after infection with either variant. Another group of mice were given an mRNA vaccine targeted only to the precise flu strain they were exposed to, and all of this group survived over the same time period. This suggests the universal flu vaccine would offer less protection against new variants of the 20 flu strains than an annual vaccine matched to new forms of the virus, says Albert Osterhaus at the University of Veterinary Medicine Hannover in Germany, who wasn’t involved in the study. The researchers also tested the universal vaccine in ferrets with similar results.

“The mouse and ferret models for influenza are as good as animal models get. The animal data are promising and thus a good indication of what will happen in humans,” says Peter Palese at the Icahn School of Medicine at Mount Sinai in New York. A key benefit of mRNA vaccines is that they can easily be scaled up compared with other approaches which rely on growing influenza viruses in chicken eggs or in the lab, says Palese. “For generating a basic immunity against epidemic or pandemic influenza virus strains in the future, this strategy could offer an option if longevity [of immunity] in humans is confirmed,” says Osterhaus. “Definitely these animal data are promising and merit further exploration in clinical studies. Given previous studies with candidate universal flu vaccines in human trials, it is hard to predict what the clinical data will bring,” says Osterhaus. “This 20-HA mRNA vaccine was tested in ferret animals, which is highly significant and may hold promise for protecting against future emerging flu strains against severe disease in humans,” says Sang-Moo Kang at Georgia State University.

Study cited published in Science (Nov. 24):

https://doi.org/10.1126/science.abm0271 

Two new studies say the virus was present in animals at the Huanan seafood market in 2019. Scientists released a pair of extensive studies on Saturday that point to a market in Wuhan, China, as the origin of the coronavirus pandemic. Analyzing data from a variety of sources, they concluded that the coronavirus was very likely present in live mammals sold in the Huanan Seafood Wholesale Market in late 2019 and suggested that the virus twice spilled over into people working or shopping there. They said they found no support for an alternate theory that the coronavirus escaped from a laboratory in Wuhan.  “When you look at all of the evidence together, it’s an extraordinarily clear picture that the pandemic started at the Huanan market,” said Michael Worobey, an evolutionary biologist at the University of Arizona and a co-author of both studies.

The two reports have not yet been published in a scientific journal that would require undergoing peer review. Together, they represent a significant salvo in the debate over the beginnings of a pandemic that has killed nearly 6 million people globally and sickened more than 400 million. The question of whether the coronavirus outbreak began with a spillover from wildlife sold at the market, a leak from a Wuhan virology lab or some other way has given rise to pitched geopolitical battles and debates over how best to stop the next pandemic. But some outside scientists who have been hesitant to endorse the market origin hypothesis said they remained unconvinced. Jesse Bloom, a virologist at the Fred Hutchinson Cancer Research Center, said in an interview that there remained a glaring absence of direct evidence that animals at the market had themselves been infected with the coronavirus. “I think what they’re arguing could be true,” Dr. Bloom said of the new studies. “But I don’t think the quality of the data is sufficient to say that any of these scenarios are true with confidence.” In their new study, Dr. Worobey and his colleagues present evidence that wild mammals that might have harbored the coronavirus were being sold in December 2019. But no wildlife was left at the market by the time Chinese researchers arrived in early 2020 to collect genetic samples...

Preprints cited available at (Feb.25, 2022)

https://zenodo.org/record/6299600#.YhsH6e7MKLH

https://www.researchsquare.com/article/rs-1370392/v1

More than 1,900 people are dying in the US daily on average – the highest level since early March. Covid-19 has now killed as many Americans as the 1918-19 flu pandemic, with more than 675,000 reported deaths. The US population a century ago was just a third of what it is today, meaning the flu cut a much bigger, more lethal swath through the country. But the Covid-19 crisis is by any measure a colossal tragedy in its own right, especially given major advances in scientific knowledge and the failure to take maximum advantage of vaccines. Unlike a century ago, vaccines have been made widely available. However, an extensive reticence to be inoculated, fueled in part by baseless fears about safety and efficacy, means that 36% of people in the US aged 12 and over have yet to be fully vaccinated, according to data from the federal Centers for Disease Control and Prevention (CDC).  “Big pockets of American society – and, worse, their leaders – have thrown this away,” said Dr Howard Markel a medical historian at the University of Michigan.

The White House initially forecast 100,000 to 240,000 deaths from Covid-19, if people socially distanced. Donald Trump, who erroneously predicted the coronavirus would simply vanish, oversaw the lower end of this forecast being reached in May last year, the latter death toll arriving in November. A surge in deaths in the spring of 2020 was surpassed by a larger wave of deaths over winter, with a record 4,197 people dying on a single day, 13 January, according to Johns Hopkins University. Since Joe Biden became president, the rollout of vaccines has helped push the rate of deaths down, although it started climbing again in August due to the spread of the Delta variant. The true death toll may be much higher than the official total because, like the previous pandemic, it is estimated. Also similar to the 1918-19 flu, the coronavirus may never entirely disappear. Scientists hope it will become a mild seasonal bug as human immunity strengthens through vaccination and repeated infection.  “We hope it will be like getting a cold, but there’s no guarantee,” said Rustom Antia, a biologist at Emory University, suggesting an optimistic scenario in which this could happen over a few years. For now, the pandemic still has the US and other parts of the world firmly in its jaws. While the Delta variant-fueled surge in infections may have peaked, US deaths are more than 1,900 a day on average – the highest level since early March – and the overall toll topped 675,000 on Monday, according to the count kept by Johns Hopkins.

Winter may bring a new surge, with the University of Washington’s influential model projecting an additional 100,000 or so Covid-19 deaths by 1 January, which would bring the overall US toll to 776,000.  The 1918-19 influenza pandemic killed 50 million globally, at a time when the world had a quarter the population it does now. Global deaths from Covid-19 stand at more than 4.6 million. The 1918-19 flu’s US death toll is a rough guess, given incomplete records of the era and the poor scientific understanding of what caused the illness. The 675,000 figure comes from the CDC. Before Covid-19, the 1918-19 flu was universally considered the worst pandemic in history. Whether the current scourge ultimately proves deadlier is unclear.  In many ways, the 1918-19 flu – which was wrongly named Spanish flu because it first received widespread news coverage in Spain – was worse. Spread by the mobility of the first world war, it killed young, healthy adults in vast numbers. No vaccine existed and there were no antibiotics to treat secondary infections.  Jet travel and mass migrations threaten to increase the toll of the current pandemic. Much of the world is unvaccinated. And the coronavirus has been full of surprises. Just under 64% of the US population has received as least one dose of the vaccine, with state rates ranging from a high of approximately 77% in Vermont and Massachusetts to lows around 46% to 49% in Idaho, Wyoming, West Virginia and Mississippi. Globally, about 43% of the population has received at least one dose, according to Our World in Data, with some African countries just beginning to give their first shots. “We know that all pandemics come to an end,” said Dr Jeremy Brown, director of emergency care research at the National Institutes of Health, who wrote a book on influenza. “They can do terrible things while they’re raging.” Covid-19 could have been far less lethal in the US if more people had gotten vaccinated faster, “and we still have an opportunity to turn it around”, Brown said. “We often lose sight of how lucky we are to take these things for granted.”

Researchers at the University of Duke found mRNA-based vaccines, such as Pfizer and Moderna, induce antibodies that may help fight against coronavirus variants.  The Pfizer and Moderna vaccines are not only effective against COVID-19, but may also help prevent future pandemics. Researchers at Duke University came to this concluding after testing mRNA-based vaccines similar to the jabs used on lab monkeys. According to their findings, which were published in Nature this week, these variety of vaccines induced “broadly neutralizing” antibodies that appeared to protect against Sars-CoV-2—the infection that causes COVID-19—as well as potential variants of coronavirus that could jump from animal to human.  The findings may offer the public a sense of relief as many experts and epidemiologists say there’s a strong chance another pandemic will occur. In an effort to help prevent another outbreak, the team of Duke University researchers developed a pan-coronavirus vaccine that is protein-based rather than mRNA-based. The vaccine was tested on lab animals and showed promising results in fighting the original COVID-19 strain and other variants. Researchers said the vaccine also appeared to stop the virus from replicating in the lungs and nose, which could drastically reduce rates of transmission.

“We began this work last spring with the understanding that, like all viruses, mutations would occur in the SARS-CoV-2 virus,” the study’s senior author Barton F. Haynes, director of the Duke Human Vaccine Institute, said in a press release. “The mRNA vaccines were already under development, so we were looking for ways to sustain their efficacy once those variants appeared. This approach not only provided protection against SARS-CoV-2, but the antibodies induced by the vaccine also neutralized variants of concern that originated in the United Kingdom, South Africa and Brazil. And the induced antibodies reacted with quite a large panel of coronaviruses.”  Dr. Anthony Fauci, the nation’s leading expert in infectious diseases, expressed optimism about Duke’s pan-coronavirus vaccine during a Thursday press conference, saying the next step was to get approval for human trials. “We always have to have a caveat when you’re dealing in a nonhuman primate,” he said, “nonetheless, this is an extremely important proof of concept that we will be aggressively pursuing as we get into the development of human trials,” Fauci said.

Cited study published in Nature (May 10, 2021):

https://doi.org/10.1038/s41586-021-03594-0 

This article updates our perspectives on when the coronavirus pandemic will end to reflect the latest information on vaccine rollout, variants of concern, and disease progression. In the United Kingdom and the United States, we see progress toward a transition to normalcy during the second quarter of 2021. The new wave of cases in the European Union means that a similar transition is likely to come later there, in the late second or third quarter. Improved vaccine availability makes herd immunity most likely in the third quarter for the United Kingdom and the United States and in the fourth quarter for the European Union, but risks threaten that timeline. The timeline in other countries will depend on seven crucial variables. And when herd immunity is reached, the risks will not vanish; herd immunity may prove temporary or be limited to regions in a country....

It’s been a long year since the WHO declared the novel coronavirus a global pandemic. This visual looks at key events in the COVID-19 timeline. The tangible and intangible costs of COVID-19 have been severe. In this visual COVID-19 timeline, we delve into some significant milestones that have occurred around the world.

December 2019-February 2020 - Pre-Pandemic COVID-19 Timeline

The origin story actually begins at the turn of the new year, as events began bubbling under the surface in Wuhan, China. The first coronavirus cluster was reported on December 31, 2019, with initial exposures linked to the Huanan Seafood Market. In the new year, the first coronavirus cases began filtering outside of China, to Thailand and the U.S.—causing the WHO to declare a public health emergency of international concern. As the death toll ticked up to over 200, it was clear that this was no ordinary virus.  In February 2020, the novel coronavirus was finally named COVID-19. In addition, the Diamond Princess cruise ship was linked to 624 confirmed cases in late February—the highest case cluster outside of China at the time. The ship captured international headlines when it was refused port in a number of countries, casting COVID-19 into the spotlight.

This month also marked a significant turning point. Dr. Li Wenliang, a Chinese doctor, had tried to draw global attention to the severity of China’s outbreak before he passed of COVID-19 on February 7, 2020.  Italy and Iran then grew significantly as global hotspots of COVID-19. The U.S. reported its first death due to COVID-19—however, it was only discovered in April that there were in fact two prior deaths due to the virus in the country. On March 11, 2020, WHO made a critical decision. As the virus began to transcend borders and claim thousands of lives, it announced that the COVID-19 outbreak had officially become a deadly global pandemic. In the year that followed, the virus was relentless in spreading around the world. How have cumulative case counts and death tolls evolved since the beginning?

March-May 2020 - Whiplash for the World

Following the WHO announcement, numerous sporting events were cancelled, from the NBA and NHL 2019-2020 seasons to the UEFA Euro men’s soccer championship. Even the Tokyo Summer Olympics were postponed for a year. In late March 2020, the U.S. surpassed China to become the hardest-hit country by COVID-19. In terms of overall case numbers, it remains the global epicenter of the pandemic today, followed by India and Brazil. The stock market took a severe hit, with a crash rivaling other recessions and significant financial crises. For example, here’s how the Dow Jones Index Average dropped in March alone. 

Stock markets re-entered a bull market in April, but the damage had already been done. The S&P 500, for example, would only return to pre-pandemic levels in August. The onset of the pandemic led to additional economic chaos. The price of oil flipped negative in April, and over 10 million Americans lost their jobs in the sudden downturn. To help prop up the economy, the U.S. unveiled the $2 trillion CARES Act, the largest economic stimulus package in history—near 10% of national gross domestic product. Multiple countries locked down their borders to the rest of the world, from the European Union to India. These travel bans and reduced mobility affected not just airline revenues, but temporarily had a noticeable effect on carbon emissions too. In addition, two world leaders—UK’s Prime Minister Boris Johnson and Russia’s President Mikhail Mishustin—contracted COVID-19.

June-November 2020 - A Deadly Surge

Numbers kept rising over the next six months, following the shifting geography of COVID-19 into densely populated regions such as Africa, South Asia, and the Middle East. In a controversial move, Brazil stopped making its COVID-19 case data public starting June 7, 2020. Global deaths due to COVID-19 surpassed half a million at the end of June—and jumped to over 1 million by the end of September. Another heartbreaking record was set in mid-October when global cases leapt up by 1 million in just three days. Former U.S. President Donald Trump, Brazil’s President Jair Bolsonaro, and Poland’s President Andrzej Duda were among many more world leaders to test positive for COVID-19.

December 2020-March 2021 - Vaccines Bring Hope

At the very end of 2020, some optimism for things going back to normal was restored when Moderna announced the very first vaccine candidate, followed by Pfizer/BioNTech. However, more alarm was raised as reports of a faster-spreading, more infectious strain of COVID-19 emerged from the UK. Two more variants have also since been discovered.  In January 2021, WHO organized an international scientific consultation around these variants. The good news? Existing and emerging vaccines will still potentially provide adequate protection against these variants. In March 2021, the U.S. Congress approved President Biden’s $1.9 trillion pandemic relief bill. Some details of the money breakdown include:

• Up to $1,400-per-person stimulus payments for 90% of households
• $350 billion in state and local aid
• $8.5 billion to rural hospitals and healthcare providers

The rest is expected to go towards safely reopening K-12 schools, assisting hard-hit small businesses, extending food stamp benefits, vaccine R&D and distribution, and more...

Bill Gates is feeling optimistic that, with all the work being done to develop COVID-19 treatments and vaccines, there is an end to the pandemic in sight. Unfortunately, that end is still at least a year away, he told Wired's Steven Levy. "The innovation pipeline on scaling up diagnostics, on new therapeutics, on vaccines is actually quite impressive. And that makes me feel like, for the rich world, we should largely be able to end this thing by the end of 2021, and for the world at large by the end of 2022," Gates said. Gates says that he fears that in nations like Russia and China, the pressure to have a vaccine is so high that regulators may be allowing shots to be given to humans before the vaccines are known to be safe and effective. But the US FDA is not allowing such short-cuts, he said.

"We probably need three or four months — no matter what — of phase 3 data, just to look for side effects," Gates said. "The FDA, to their credit, at least so far, is sticking to requiring proof of efficacy." Last month, Gates told Business Insider's Hilary Brueck that he's confident that scientists will develop a vaccine that's "very effective and very safe" in part because there are so many vaccines currently in development: more than 160 worldwide. Two of the four speediest trials that are testing vaccines in humans right now are US-based, too: Moderna and Pfizer/BioNTech. Gates also told Brueck if the best vaccines are not shared worldwide, that COVID-19 will "just keep coming back." In the meantime, Gates predicts we're in for a rough fall and winter with the virus, even though this virus does not appear to be seasonal.  "The fall could be tough," he told Brueck. "We'll be indoors more. It will be colder. We know those are things that push the disease up."

Prophylactic vaccination is the most effective intervention to protect against infectious diseases. The commonly accepted paradigm is that immunization with both attenuated virus (live but with substantially reduced virulence) and inactivated (killed virus particles) vaccines induces adaptive and generally long-term and specific immunity in the form of neutralizing antibodies and/or activating pathogen-specific cellular immune responses. However, an increasing body of evidence suggests that live attenuated vaccines can also induce broader protection against unrelated pathogens likely by inducing interferon and other innate immunity mechanisms that are yet to be identified. The stimulation of innate immunity by live attenuated vaccines in general, and oral poliovirus vaccine (OPV) in particular, could provide temporary protection against coronavirus disease 2019 (COVID-19).

OPV was developed by Albert Sabin in the 1950s and consists of live attenuated polioviruses of the three serotypes. Early clinical studies showed that besides protecting against poliomyelitis, OPV reduced the number of other viruses that could be isolated from immunized children, compared with placebo recipients. Additional evidence of nonspecific effects of OPV came from the 1959 poliomyelitis outbreak in Singapore caused by type 1 poliovirus that was successfully stopped by the use of monovalent OPV that contained only type 2 poliovirus (1). Monovalent OPVs do not induce cross-neutralizing antibodies that target other virus serotypes, so the most plausible explanation was viral interference, which presumably is mediated by innate immunity.

Large-scale clinical studies of OPV for nonspecific prevention of diseases were carried out in the 1960s and 1970s. These involved more than 60,000 individuals and showed that OPV was effective against influenza virus infection, reducing morbidity 3.8-fold on average (2, 3). OPV vaccination also had a therapeutic effect on genital herpes simplex virus infections, accelerating healing. OPV not only demonstrated positive effects against viral infections but also had oncolytic properties, both by directly destroying tumor cells and by activating cellular immunity toward tumors (2). These observations were among the first examples of viral oncotherapy, which is being actively pursued.

Published in Science (June 12, 2020):

https://doi.org.10.1126/science.abc4262

New research presented at the ESCMID Global Congress (formerly ECCMID) in Barcelona, Spain (27–30 April) shows that in a VACCELERATE Consortium survey study in which infectious diseases experts were asked to rank pathogens in order of their pandemic potential, influenza was considered the pathogen of highest pandemic risk, with 57% ranking influenza as number one, and a further 17% ranking it second. The study is by Dr. Jon Salmanton-García, University of Cologne, Faculty of Medicine and University Hospital Cologne, Institute of Translational Research, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), Cologne, Germany, and colleagues from across Europe, and published in the journal Travel Medicine and Infectious Disease. Other highly ranked pathogens included Disease X (as yet unknown disease) with 21% ranking this number one and 14% second. SARS-CoV-2 was third in terms of number one responses on 8%, with 16% voting it number two, while the original SARS-CoV virus that circulated in 2002–03 was voted number one by 2% of respondents and second by 8%. Crimean-Congo hemorrhagic fever virus (CCHF virus) and Ebola virus were joint fifth, with 1.6% respondents voting them first. Nipah virus, henipavirus, and Rift Valley fever virus were among the pathogens ranked lowest in terms of their perceived pandemic potential.

The World Health Organization (WHO) has outlined a comprehensive Research and Development (R&D) Blueprint for Action to Prevent Epidemics, focusing on key infectious diseases that pose significant threats to public health. These diseases were selected after rigorous evaluation, taking into account factors like transmissibility, infectivity, severity, and their potential for evolution. In alignment with the WHO's R&D Blueprint, the VACCELERATE Site Network (a pan-European network of sites collaborating on COVID-19, other infectious diseases and general pandemic preparedness infectious diseases) engaged infectious disease experts from around the world, both among and outside its members, to rank the diseases listed in terms of their perceived risk of instigating a pandemic. Participants were tasked with ranking various pathogens based on their perceived pandemic risk, encompassing diseases featured in the WHO R&D Blueprint and additional pathogens. Experts could rank up to 14 pathogens in the order of their perceived risk (the 13 pathogens listed plus Disease X—as yet unknown pathogen) in any order, and also suggest pathogens not listed to include in their maximum of 14. Each pathogen received a score based on its positions. A total of 187 responses were collected from infectious disease experts hailing from 57 different countries Among the countries providing the highest number of responses, Germany accounted for 27 replies (14%), followed by Spain with 20 replies (11%), and Italy with 14 replies (8%). Influenza viruses emerged as the most concerning pathogen with other highly ranked pathogens including Disease X, SARS-CoV-2, SARS-CoV, and the Ebola virus. Conversely, Hantavirus, Lassa virus, Nipah virus, henipavirus and Rift Valley fever virus were among the pathogens ranked lowest in terms of their pandemic potential.

The authors conclude, "The study revealed that influenza, disease X, SARS-CoV-1, SARS-CoV-2, and the Ebola virus are the most worrisome pathogens concerning their pandemic potential. These pathogens are characterized by their transmissibility through respiratory droplets and a history of previous epidemic or pandemic outbreaks." Commenting on the top ranking of influenza, Dr. Salmanton-García adds, "Each winter we have an influenza season. One could say that this means that every winter there are little pandemics. They are more or less controlled because the different strains are not virulent enough. Yet, every season the strains involved change, that is the reason why we can get influenza several times in life and vaccines change year to year. In case a new strain becomes more virulent, this control could be lost." But he adds the world is now much more prepared due to the COVID-19 pandemic, whereas before a lot of the focus had been on a potential influenza pandemic. He says, "In COVID-19 pandemic we have learned many things on how to approach a respiratory virus pandemic. This includes social distancing, hand cleaning, face masks, a renewed focus on vaccination, and trust in health care institutions. In parallel, institutions have also learnt a lot. Preparedness and surveillance are now, vitally, better-funded."

Study published in Travel Medicine and Infectious Disease (Feb. 2024):

https://doi.org/10.1016/j.tmaid.2023.102676

An outbreak of polio in 1950s Denmark led one hospital to pioneer mechanical ventilation, constant monitoring of vital signs and other innovations that are saving lives to this day. The COVID-19 pandemic has brought home the central role of intensive care units (ICUs) in saving the lives of those in critical condition in hospitals today. Yet if you asked most people where the ICU concept came from, few would know that it was an outgrowth of a polio epidemic in Denmark. In her brilliant new book, Hannah Wunsch, an anaesthesiologist and critical-care-medicine specialist at the University of Toronto, Canada, traces the origins of the modern ICU to 1952 and the Blegdam hospital in Copenhagen — something she has written about before in Nature (go.nature.com/45B6snd). There, a series of innovations arose out of dire need, including positive-pressure ventilation (the precursor to mechanical ventilators), blood-gas measurements for pH and carbon-dioxide levels and close monitoring by an interdisciplinary team of nurses, doctors (notably anaesthesiologists), pharmacists and others. The treatment of one patient, a 12-year-old girl named Vivi Ebert who presented with bulbar paralytic poliomyelitis — in which poliovirus infects the brainstem — forms the centrepiece of Wunsch’s book. Of the first 31 people to be admitted to the Blegdam in the summer of 1952 with paralytic or respiratory polio symptoms, 87% died, 70% within three days. Thanks to interventions including manual ventilation, supervised by anaesthesiologist Bjørn Ibsen, Ebert survived another twenty years, eventually succumbing to pneumonia at the age of 32.

In those early days it took 50 people to provide the muscle power required for round-the-clock ventilation for 6–8 people with paralytic polio. The hospital’s initial success led to more than 1,500 medical and dental students being employed as manual ventilators for patients admitted in the summer and autumn of 1952. Eventually, ‘iron lungs’ — mechanical ventilator machines — took the place of humans, and the ICU concept was built, focusing on the sickest patients, who required a breathing machine and constant monitoring. Over the next few years, the use of ICUs expanded to the treatment of people with major trauma, shock, tetanus and a variety of other acute, life-threatening conditions. The treatment of polio, the main story of The Autumn Ghost, has rich parallels to the COVID-19 pandemic. In the 1950s, the prevailing hypothesis about the spread of polio was that the virus was inhaled into the body’s upper airways. It took decades for the gastrointestinal transmission route — oral contact with the faeces of an infected person — to become accepted. Similarly, for COVID-19, there was an initial fixation on liquid droplets on surfaces and in the air as the main means of transmission, whereas it was determined later that it was spread predominantly within tiny droplets or aerosols in the air. Furthermore, a substantial proportion of both poliovirus and SARS-CoV-2 infections were asymptomatic. And both viruses have long-term consequences: for polio, not only potential paralysis, but also the debilitating neuromuscular syndrome that can occur decades later. Long COVID affects 10–12% of infected individuals, with a variety of enduring symptoms that can be incapacitating with potentially more longer-term effects that are yet unknown.

Polio taught us about the efficacy of positive-pressure ventilation for those having difficulty with breathing. With COVID-19, we learnt that ventilating patients while they were lying face down was crucial to good outcomes. For poliovirus, large, randomized trials of γ-globulin — a substance derived from bone marrow and lymph gland cells containing antibodies thought to help fight the virus — had some success in the years before a vaccine became available. For COVID-19, large observational studies were undertaken of treatment with blood plasma from those who had recovered, although a lack of randomized studies makes it hard to assess the treatment’s effectiveness. Perhaps the most striking difference between the two viruses is how long it was before a vaccine was developed. For SARS-CoV-2, it was 10 months from sequencing the virus to producing results from large, randomized trials demonstrating high levels of vaccine efficacy. Large-scale distribution quickly followed. Poliovirus was identified as the pathogen for polio in 1908, but it wasn’t until 1955 that US virologist Jonas Salk developed the first effective vaccine to be delivered by means of an injection, followed quickly by an oral vaccine developed by US physician and microbiologist Albert Sabin in 1961.

Wunsch provides a detailed history of polio, the iron lung, the rise of the field of anaesthesiology, the development of the Salk and Sabin vaccines and the work at Denmark’s Statens Serum Institute, a medical laboratory in Copenhagen, in manufacturing and rolling out the Salk vaccine ten days after it was announced. But she really hits her stride when she describes those whose lives were saved. Another early patient treated by tracheostomy and hand ventilation at the Blegdam hospital was 26-year-old Rosa Abrahamsen. She was a poet, and her beautiful poems, translated into English for the book, begin several chapters. The Autumn Ghost might have been improved with a timeline, given that it bounces back and forth at many points. Although the extraordinary progress and innovations made in Denmark were central to the development of ICUs, the contribution of parallel efforts from around the world might not have been adequately highlighted. When I was at the University of Virginia in Charlottesville in the 1970s, I worked as a respiratory technician on the night shift, maintaining Engström ventilators (alluded to in the book as the “Rolls Royce of artificial respiration”) for patients in the ICU. I had no idea how those ventilators, or indeed ICUs, came to be. But seeing many patients ‘come back to life’ inspired me to go to medical school. Only five decades later, thanks to reading this book, have I learned the remarkable background to these profound innovations — and how the poliovirus radically transformed the future of medicine.

It is hard to imagine that a species that could figure out how to write, print and alter DNA cannot figure out a reasonable approach to regulating it. T he wholly synthetic mRNA vaccines for Covid-19 saved nearly 20 million lives in just their first year of use, according to data published in 2022 by The Lancet. That success stands as the most prominent example of the power of synthetic biology, a field whose possibilities have excited me since I first heard the term more than 15 years ago. As scientists gain increasing dexterity in manipulating the basic elements of life, they are designing not only other synthetic vaccines, but also therapies for cancer, benign alternatives to fossil fuels, and even novel approaches to protecting endangered species. Some of these efforts will succeed, and some surely will fail. But it is hardly hype to call what is happening in labs around the world a revolution in biology. Technological advances do not come without a price, though. And as a rule, the greater the advance, the greater the risk that accompanies it. In a world where biology moves at the speed of light, those risks can get out of hand. The impact — whether accidental or deliberate — could be far more ruinous than any threat we have yet imagined. Imagine the effects if a virus more deadly than even SARS-CoV-2 were to spread throughout the world. “If you simulate the airburst detonation of the largest currently operational intercontinental ballistic missile, over a large city — New York, Beijing, Moscow, London — the estimated casualty count is about 3 million. SARS-CoV-2 has killed many more people than that,’’ Kevin Esvelt told me not long ago. Esvelt runs the Sculpting Evolution group at the MIT Media Lab (and for full disclosure, I teach a course there with him called Safeguarding the Future). We have all heard that somewhere in some corner of the internet, you could learn how to make a bomb, even a nuclear weapon, if you had the vast resources required to do so. But there are many laws and treaties designed to prevent people from succeeding. It’s hazardous information.

There are almost no such rules when it comes to publishing the fundamental blueprints needed to make or alter a virus with the tools of synthetic biology. There are already thousands of people who could use readily available reverse genetics protocols, a genome sequence, and synthetic DNA to produce an infectious virus. As the price of computer power and synthetic DNA falls, the number of people capable of working with those blueprints can only grow. By blueprints, I mean the genetic code — the DNA sequence that makes smallpox or polio or SARS-CoV-2. Those sequences are freely available on the internet. The sequences for the devastating influenza viruses that struck in 1889, 1918, 1957, and 1968 are also easy to find. But even more deadly viruses — Marburg, Lassa, and Ebola — are all out there, too. In 1998, an international team of scientists retrieved the 1918 influenza virus, which killed as many as 50 million people, from six frozen corpses in the Arctic. The samples from those infected bodies were considered so dangerous that only a single scientist was permitted to work with them, and only in a highly secure laboratory at the Centers for Disease Control and Prevention. But what about the sequence of the genome found in those corpses? Science magazine published it in the issue dated Oct. 7, 2005. Granted, that was before biology had made the transition to the digital world. And scientists still make serious attempts to control access to dangerous viruses in laboratories. When it comes to the information needed to make them, however, we exercise almost no such caution. Publishing the sequences of biological discoveries is not just encouraged. In the academic and industrial systems we have today, it is expected. Openness has always been a signature element of scientific discovery. Ideas are supposed to spread. And in a democracy, we embrace the free speech model of science. Researchers publish tens of thousands of genetic sequences every year. The vast majority pose no harm. The wide dissemination of the SARS-CoV-2 virus sequence helped scientists create the revolutionary mRNA vaccines in record time, offering just one example of the benefits of open scientific exchange.....

Bird flu has spread widely among animals. Unless we act now, it soon could do the same among humans. As the world is just beginning to recover from the devastation of Covid-19, it is facing the possibility of a pandemic of a far more deadly pathogen. Bird flu — known more formally as avian influenza — has long hovered on the horizons of scientists’ fears. This pathogen, especially the H5N1 strain, hasn’t often infected humans, but when it has, 56 percent of those known to have contracted it have died. Its inability to spread easily, if at all, from one person to another has kept it from causing a pandemic. But things are changing. The virus, which has long caused outbreaks among poultry, is infecting more and more migratory birds, allowing it to spread more widely, even to various mammals, raising the risk that a new variant could spread to and among people. Alarmingly, it was recently reported that a mutant H5N1 strain was not only infecting minks at a fur farm in Spain but also most likely spreading among them, unprecedented among mammals. Even worse, the mink’s upper respiratory tract is exceptionally well suited to act as a conduit to humans, Thomas Peacock, a virologist who has studied avian influenza, told me. The world needs to act now, before H5N1 has any chance of becoming a devastating pandemic. We have many of the tools that are needed, including vaccines. What’s missing is a sense of urgency and immediate action. The best defense against a new deadly pathogen is aggressively suppressing early outbreaks, which first requires detecting them quickly. The United States, the World Health Organization and global health officials already have influenza surveillance networks, but many avian influenza experts told me they don’t think the networks are functioning well enough given the threat level. Such surveillance would need to prioritize people in the poultry industry but also expand beyond that. Thijs Kuiken, an expert in avian influenza at Erasmus University Medical Center in Rotterdam, the Netherlands, says farms for pigs — another species susceptible to influenza — should also be surveilled for bird flu. People interacting with wild birds and animals, as well as susceptible species of pets like ferrets, are also at higher risk. It’s not enough to detect, though: Suppression would require a major effort and global coordination. Unfortunately, mink farms must be shut down — even if it means killing the minks. They are typically killed anyway for their fur at about 6 months of age. It’s hard to imagine a better way to incubate and spread a deadly virus than letting it evolve among tens of thousands of animals with an upper respiratory tract similar to ours crowded together. When the coronavirus infected Danish mink farms in 2020 and the minks generated new variants that then infected humans, the efforts to save the industry were futile because the outbreaks were uncontrollable.

Some of the most fragile health systems in the world can teach us ways to respond to public health threats early and effectively. Stephanie Nolen, a global health reporter, has reported on pandemics around the world, including H.I.V., cholera and yellow fever.

In a U.S. government lab in Bethesda, Maryland, virologists plan to equip the strain of the monkeypox virus that spread globally this year, causing mostly rash and flulike symptoms, with genes from a second monkeypox strain that causes more serious illness. Then they’ll see whether any of the changes make the virus more lethal to mice. The researchers hope that unraveling how specific genes make monkeypox more deadly will lead to better drugs and vaccines. Some scientists are alarmed by the planned experiments, which were first reported by Science. If a more potent version of the outbreak strain accidentally escaped the high-containment, high-security lab at the National Institute of Allergy and Infectious Diseases (NIAID), it could spark an “epidemic with substantially more lethality,” fears epidemiologist Thomas Inglesby, director of the Center for Health Security at the Johns Hopkins University Bloomberg School of Public Health. That’s why he and others argue the experiments should undergo a special review required for especially risky U.S.-funded studies that might create a pathogen that could launch a catastrophic pandemic.

But it’s not clear that the rules apply to the proposed study. In a 2018, a safety panel determined it was exempt from review. Monkeypox did not meet the definition of a “potential pandemic pathogen” (PPP), the panel decided, because it didn’t spread easily. Now, with monkeypox widespread, the National Institutes of Health (NIH) is planning to reexamine the work, but it still might not qualify as “enhancing” a PPP, the agency says. That’s because the study will swap natural mutations, not create new ones, so it is not expected to create a monkeypox strain more virulent than the two already known. The monkeypox controversy marks just the latest flare-up in a decade-old debate over exactly when a study that alters a pathogen is too risky for the U.S. government to fund—and who should have the power to decide. That wrangling became especially ferocious over the past 2 years, as the COVID-19 pandemic spawned allegations, so far unproven, that SARS-CoV-2 escaped from a laboratory in China. Now, in the pandemic’s wake, the U.S. government appears poised to make sizable changes to how it manages so-called gain-of-function (GOF) studies that tweak pathogens in ways that could make them spread faster or more dangerous to people.

Last month, an expert panel convened by NIH and its parent agency, the Department of Health and Human Services (HHS), released a draft report that recommends the GOF rules be broadened to include pathogens and experiments that are exempt from the current scheme. If the recommendation is adopted—which could come next year—the monkeypox study could come under tighter scrutiny. And other researchers working with viruses such as Ebola, seasonal flu strains, measles, and even common cold viruses could face new oversight and restrictions.

Some scientists are watching nervously, worried that an expanded definition could worsen what they already see as a murky, problematic oversight system. The existing rules, they say, have caused confusion and delays that have deterred scientists from pursuing studies critical to understanding emerging pathogens and finding ways to fight them. If not implemented carefully, the proposed changes could “greatly impede research into evolving or emerging viruses,” worries virologist Linda Saif of Ohio State University, Wooster. She and others say expanding the regulations could add costly red tape, potentially driving research overseas or into the private sector, where U.S. regulations don’t apply or are looser......

An influenza pandemic like the pandemic of 1918 could be even worse than Covid-19 has been, and the world is not ready to deal with it, the National Academy of Medicine said in a series of reports released Wednesday. Work needs to begin now to start developing next-generation vaccines, and to build up capacity in low- and middle-income countries so they can make their own vaccines without relying on wealthy nations to make them available, the reports recommended. And governments need to figure out how to make sure companies have the incentives to work on these vaccines without knowing whether they'll ever be used or needed.  Covid-19 has been terrible, the Academy, an independent body that advises the US federal government on matters of medicine and health, said in the first of the the reports. "Yet, from an epidemiological perspective, COVID-19 does not represent a 'worst-case' pandemic scenario, such as the 1918-19 influenza, which resulted in at least 50 million deaths worldwide," the report reads.  Flu kills anywhere between 290,000 and 650,000 people a year in a normal year, according to WHO. Covid-19 has killed 5.1 millon people globally. The next influenza pandemic could kill 33 million people, the Academy said.

The emergence and global spread of the highly pathogenic H5N8 avian influenza virus (AIV), a pathogen that has caused continuous and ongoing outbreaks with massive mortality in both wild and farmed birds across Eurasia and Africa throughout 2020, represents a considerable public health concern — particularly considering the first human cases of H5N8 infection were first reported last December. In a Perspective, Weifeng Shi and George Gao discuss the emergence and zoonotic potential of the H5 AIV lineages. Shi and Gao argue that vigilant surveillance and rigorous infection control measures for these emerging viruses are critical to avoid further human spillovers that could result in new and devastating pandemics.

Perhaps overshadowed by the ongoing global COVID-19 pandemic, over the past year, H5N8 infections in both wildfowl and poultry have been identified in at least 46 countries across Europe, Asia, and Africa. While these outbreaks have led to the death or slaughter of many millions of birds worldwide, they’ve also notably resulted in at least one spillover event in Russia, where seven poultry farm workers tested positive for H5N8 virus. According to the authors, the rapid global spread of this AIV and its demonstrated ability to cross the species barrier, transmitting to humans, makes it a major concern to not only farming and wildlife security, but also global public health. Shi and Gao suggest that the surveillance of highly pathogenic AIVs in poultry farms, live markets, and wild birds must become a global priority.

Cited publication available in Science (May 21, 2021):

https://doi.org/10.1126/science.abg6302

More than three million people globally have died of Covid-19 since the start of the pandemic, Johns Hopkins University said on Saturday.  With 566,224 deaths, the US has the highest number of fatalities, followed by Brazil with 368,749 and Mexico with 211,693. The World Health Organization (WHO) said on Monday the pandemic was at a "critical point" and warned that the world needed a reality check. After a brief decrease in March, the number of deaths worldwide is on the rise again, with an average of approximately 12,000 deaths, approaching the 14,500 daily death toll (7-day rolling average) recorded at the end of January. Countries such as the US and the UK have seen their number of new daily deaths falling since late January due to vaccination campaigns, whereas India and Brazil are facing unprecedented surges in infections. 

In Brazil, some 3,000 deaths are reported every day, accounting for almost a quarter of the deaths reported daily in the world. The country has been the worst hit in the world in terms of new daily deaths globally since early March. The pandemic is not showing any signs of slowing down, as the 7-day rolling average nears the all-time highs of January -- over 730,000 daily new cases are being reported this week.  With 234,692 new infections reported on Saturday, India has close to three times the daily cases of the US. India also reported 1,341 new deaths on Saturday, the highest single-day death toll barring June 17. On that day, June 17, a total 2,003 deaths were recorded in a single day due to clerical errors resulting in a backlog. According to JHU there are 140 million global cases of Covid-19.

APA’s Stress in America ™ poll reveals secondary pandemic health crisis; parents, essential workers, communities of color more likely to report mental, physical health consequences. 

WASHINGTON — As growing vaccine demand signals a potential turning point in the global COVID-19 pandemic, the nation’s health crisis is far from over. One year after the World Health Organization declared COVID-19 a global pandemic, many adults report undesired changes to their weight, increased drinking and other negative behavior changes that may be related to an inability to cope with prolonged stress, according to the American Psychological Association’s latest Stress in AmericaTM poll. APA’s survey of U.S. adults, conducted in late February 2021 by The Harris Poll, shows that a majority of adults (61%) experienced undesired weight changes – weight gain or loss – since the pandemic started, with 42% reporting they gained more weight than they intended. Of those, they gained an average of 29 pounds (the median amount gained was 15 pounds) and 10% said they gained more than 50 pounds, the poll found. Such changes come with significant health risks, including higher vulnerability to serious illness from the coronavirus. For the 18% of Americans who said they lost more weight than they wanted to, the average amount of weight lost was 26 pounds (median amount lost was 12 pounds). Adults also reported unwanted changes in sleep and increased alcohol consumption. Two in 3 (67%) said they have been sleeping more or less than desired since the pandemic started. Nearly 1 in 4 adults (23%) reported drinking more alcohol to cope with their stress. “We’ve been concerned throughout this pandemic about the level of prolonged stress, exacerbated by the grief, trauma and isolation that Americans are experiencing. This survey reveals a secondary crisis that is likely to have persistent, serious mental and physical health consequences for years to come,” said Arthur C. Evans Jr, PhD, APA’s chief executive officer. “Health and policy leaders must come together quickly to provide additional behavioral health supports as part of any national recovery plan.”

The pandemic has taken a particularly heavy toll on parents of children under 18. While slightly more than 3 in 10 adults (31%) reported their mental health has worsened compared with before the pandemic, nearly half of mothers who still have children home for remote learning (47%) reported their mental health has worsened; 30% of fathers who still have children home said the same. Parents were more likely than those without children to have received treatment from a mental health professional (32% vs. 12%) and to have been diagnosed with a mental health disorder since the coronavirus pandemic began (24% vs. 9%). More than half of fathers (55%) reported gaining weight, and nearly half (48%) said they are drinking more alcohol to cope with stress. The majority of essential workers (54%), such as health care workers and people who work in law enforcement , said they have relied on a lot of unhealthy habits to get through the pandemic<. Nearly 3 in 10 (29%) said their mental health has worsened, while 3 in 4 (75%) said they could have used more emotional support than they received since the pandemic began. Essential workers were more than twice as likely as adults who are not essential workers to have received treatment from a mental health professional (34% vs. 12%) and to have been diagnosed with a mental health disorder since the coronavirus pandemic started (25% vs. 9%). 

Further, people of color reported unintended physical changes during the pandemic. Hispanic adults were most likely to report undesired changes to sleep (78% Hispanic vs. 76% Black, 63% white and 61% Asian), physical activity levels (87% Hispanic vs. 84% Black, 81% Asian and 79% white) and weight (71% Hispanic vs. 64% Black, 58% white and 54% Asian) since the pandemic began. Black Americans were most likely to report feelings of concern about the future. More than half said they do not feel comfortable going back to living life like they used to before the pandemic (54% Black vs. 48% Hispanic, 45% Asian and 44% white) and that they feel uneasy about adjusting to in-person interaction once the pandemic ends (57% Black vs. 51% Asian, 50% Hispanic and 47% white). “It’s clear that the pandemic is continuing to have a disproportionate effect on certain groups,” said APA President Jennifer Kelly, PhD. “We must do more to support communities of color, essential workers and parents as they continue to cope with the demands of the pandemic and start to show the physical consequences of prolonged stress.” Overall, Americans are hesitant about the future, regardless of vaccination status. Nearly half of respondents (49%) said they feel uneasy about adjusting to in-person interaction once the pandemic ends. Adults who received a COVID-19 vaccine were just as likely as those who had not received a vaccine to say this (48% vs. 49%, respectively).

Infographics at:

https://www.apa.org/news/press/releases/stress/2021/data-charts-march-weight-change 

As the Northern Hemisphere braces for a coronavirus-flu double hit, it’s unclear if it’ll be a deadly combo or one virus will squeeze out the other. The specter of a “twindemic” — two epidemics at the same time — looms as cold and flu season is set to start in October in the Northern Hemisphere. No one can predict what will happen when flu meets COVID-19, but public health officials are urging people to prepare for the worst. In this case, the worst would be a bad year for influenza, which in the United States has killed 12,000 to 61,000 people annually and hospitalized between 140,000 and 810,000 each year since 2010, combined with a resurgence of coronavirus infections. Together, the two could stress health care and public health systems beyond their limits. “We could see a perfect storm of accelerated COVID-19 activity as people gather more inside in particular, as they become increasingly fatigued with the mask wearing, social distancing and the hand hygiene, and as they are exposed to seasonal influenza,” said Jeanne Marrazzo, director of the infectious diseases division of the University of Alabama at Birmingham, during a news briefing from the Infectious Diseases Society of America, or IDSA, on September 10. Some states are getting coronavirus spread under control, but hospitalization levels haven’t gone down much, she said. “Overall, we still are on … a razor’s edge when it comes to COVID,” and influenza remains unpredictable. “We really can’t be complacent about this.”

Infectious diseases experts worry about a conjunction of influenza and coronavirus for multiple reasons, beyond overburdened health systems. Teasing out whether a person has flu or coronavirus — which have very similar symptoms — will require testing for both viruses, at a time when turnaround for COVID-19 tests is often slow. And some people may get infected with multiple viruses simultaneously, which could make symptoms more severe. But hints from the Southern Hemisphere give hope that the worst may not happen. Scientists usually forecast flu seasons’ severity in the north by watching what happens south of the equator, where flu season falls in the middle of the year. This year, the preview held good news: a mild season for flu and some other respiratory viruses. Countries in the Southern Hemisphere normally start seeing flu cases in May, and the flu season typically peaks in July and peters out around October. For the past five to six years, flu seasons in Australia have been bad. For instance, in 2019, Australia got an early flu season that started in March and “went on for a very long time,” says Kanta Subbarao, a virologist who directs the World Health Organization’s Collaborating Centre for Reference and Research on Influenza at the Doherty Institute in Melbourne, Australia. It wasn’t looking good for 2020 either. This year, flu season started even earlier, she says. “We started seeing some flu activity in January and February,” summer in the Southern Hemisphere. “Then it just completely stopped. It just fell off a cliff at the end of March, essentially when COVID-19 started appearing.”

From April through July, only 33 people had positive flu results in Australia out of 60,031 people tested, an international group of influenza researchers report September 18 in Morbidity and Mortality Weekly Report published by the U.S. Centers for Disease Control and Prevention. The flu was also nearly nonexistent in South Africa and Chile in the late spring and early summer months. Together, the three countries recorded just 51 flu cases among 83,307 people tested, for a positivity rate of 0.06 percent. By contrast, over the April through July periods in 2017, 2018 and 2019, a total of 24,512 out of 178,690 people had positive flu tests, a positivity rate of 13.7 percent.  Travel restrictions that closed Australia’s borders may have prevented influenza from being imported from elsewhere. Lockdowns, school closures, mask wearing, social distancing and hand washing — all measures taken to prevent the spread of COVID-19 — may have also quashed any influenza outbreaks that remained. Other Southern Hemisphere countries have also reported unexpectedly low levels of influenza and another common respiratory virus called respiratory syncytial virus, or RSV, she says. Public health officials anticipated a resurgence of influenza and RSV once Australia reopened schools, but that hasn’t happened, Subbarao says. “We have looked very long and hard,” but have found very little of either disease, Subbarao says. Instead, “what we’re finding is rhinovirus,” which cause colds, Subbarao says, suggesting that rhinovirus hasn’t been phased by all the public health measures. Flu season may also be lighter than usual in the Northern Hemisphere as a result of reduced travel, former CDC director Tom Frieden said in an IDSA news briefing on September 15. Flu “gets around the world when people travel, and there’s not much traveling going on.” But COVID-19 remains a threat, he warned “If you doubted that COVID was more infectious than flu, look at South Africa or Chile, where COVID is spreading like wildfire and flu isn’t spreading at all.” In the United States during the 2019–2020 flu season, flu cases also took a nose dive after public health measures were put in place to limit coronavirus spread. Flu cases started increasing in November 2019, and between December 15 and March 7, more than 20 percent of flu tests were coming back positive each week, according to the MMWR report. By the week of March 22, plenty of people were still getting flu tests, but only 2.3 percent of the results came back positive. Many of those influenza-like illnesses that weren’t due to flu may have been COVID-19 (SN: 6/25/20).  Since the week of April 5, fewer than 1 percent of flu tests have detected the virus, and off-season flu counts are at historical lows. From May 17 to August 8, only 0.2 percent of flu tests gave positive results, compared with 2.35 percent last year, 1.04 percent in 2018 and 2.36 percent in 2017. The sharp drop-off of flu cases might just have been the natural end of the flu season. However, the decrease in percent positivity after March 1 “was dramatic, suggesting other factors were at play,” the researchers wrote...