A worldwide monkeypox outbreak

“The worldwide monkeypox outbreak began in early May 2022. Since then, more than 15,000 cases of monkeypox have been identified across more than 60 countries. Disease caused by the monkeypox virus typically involves a few days of fever and lymph node swelling followed by a rash, which can leave scars. Most cases in the current outbreak have resolved without hospitalization or the need for medication. As of July 20, there have been five deaths, all of them in Africa.
Monkeypox is related to the smallpox virus, and immunity to smallpox is protective against monkeypox. But as of 1980, smallpox has been eradicated in humans, and vaccinations against smallpox have grown rare — and human cases of monkeypox have been on the rise.

With monkeypox, the world faces a very different situation than in the early days of Covid-19. Monkeypox, unlike SARS-CoV-2, is a known quantity. We have more tools to prevent and treat it — far more than we did for Covid-19 at the outset of the pandemic — and both public health and the general public have had a lot of practice taking measures to prevent infections from spreading.”

We Don’t Need a White House Monkeypox ‘Coordinator.’ We Just Need the Vaccines.

“We’re up to about 3,600 known cases of monkeypox in the United States, according to the Centers for Disease Control and Prevention (CDC). That’s more than double the number of cases from just two weeks ago.

As the federal government struggles to distribute vaccines where they’re needed, The Washington Post reports that the White House is thinking of declaring a public health emergency and naming a “White House coordinator” to oversee the response.

The public response should be: Please don’t. Please just get the vaccines to local public health agencies and let them deal with it. Because right now, that’s about half the problem that’s causing monkeypox to spread.

Red tape from the Food and Drug Administration (FDA) and the CDC left more than a million monkeypox vaccine doses stuck in storage in Denmark, and then another roll of red tape made it incredibly difficult for doctors to prescribe an alternative monkeypox treatment because it’s still in clinical trials.

As a result, local health agencies have had to carefully portion out vaccines to the highest-risk citizens—and they’re still running out. In Los Angeles, the county Public Health Department will only administer to people who are infected, people who have had high-risk contact (typically sex) with somebody who is infected, and then gay or bisexual men or trans people who fit in one of the [certain] categories”

“Fortunately, monkeypox’s spread has still remained pretty limited even as it has grown. The percentage of growth seems huge because we’re dealing with a fairly low baseline. And though monkeypox is not technically a sexually transmitted disease—it is spread through contact with the rashes and lesions created by the virus as well as through saliva—this particular version of monkeypox has been pretty resistant so far to being spread through methods other than sexual contact.”

Can we stop the next pandemic by seeking out deadly viruses in the wild?

“Critics — including researchers who study biosecurity and biosafety — argue it doesn’t really pass a cost-benefit analysis. In some ways, virus hunting is looking for a needle in a haystack — the handful of viruses that might cross over to humans amid tens of thousands that won’t — when we don’t even know how to tell needles from hay, or what to do with a needle once we identify one.
And some experts are raising another, even sharper question: What if viral discovery is not just an ineffective tactic but a terrible idea, one that might not only fail to prevent the next pandemic but potentially even make it more likely?”

“Monitoring the interface between humans and animals for pandemic prevention has value, particularly when the programs are narrowly targeted at certain objectives: say, a focus on reducing spillover, or surveillance of potential animal infections, or studying viruses that have already spilled over into humans. Research published last month in Nature projects that global warming could drive 4,000 viruses to spread for the first time between mammals, including potentially humans and animals, by 2070, underscoring the changing threat from zoonotic spillovers.

But if the risks of virus hunting are higher than the odds of a virus crossing over into humans and sparking a pandemic naturally, then viral discovery doesn’t just look inefficient. It looks like a bad idea.”

How to supercharge vaccine production for the next pandemic

“But it’s one thing to come up with a vaccine, and entirely something else to manufacture it on a mass scale. That’s where the world has stumbled and where concerted planning now can make sure we’re prepared for the future. If we’re to have a better chance to fight the next pandemic — and there will be a next one — the US needs to build on these vaccine tech innovations and make investments to establish permanent facilities producing mRNA and adenovirus vaccines.”

“that slack won’t arrive naturally.

Weber, the former assistant secretary of defense for biodefense, has pushed for what he dubs a “10 + 10 Over 10” plan to prevent biological threats in the future. It is essentially a big government investment that could enable the kind of infrastructure necessary to have gotten to full vaccine availability in the US in, say, one or two months, not five.

The plan calls for $10 billion in additional annual funding for the Department of Defense, and another $10 billion per year for the Department of Health and Human Services, devoted to anticipating pandemic and other biological risks, for at least 10 years.

With that funding, government could finance the infrastructure for year-round vaccine manufacture.”

“The key is that these facilities need to be active during non-pandemic times, otherwise their expertise and readiness could deteriorate.”

“Pharmaceutical companies are not going to go this big on their own, and there’s no guarantee that the government will fund them sufficiently without pressure. In 2020 — during the pandemic — the Trump administration cut the DOD’s chemical and biodefense programs by 10 percent, with much of the cuts going to the vaccine component of the budget. To set this vision in motion, the US needs to not just reverse cuts like that but spend much more, in line with Weber’s $20 billion per year proposal.”

Why some labs work on making viruses deadlier — and why they should stop

“The scientists who do this kind of research argue that we can better anticipate deadly diseases by making diseases deadlier in the lab. But many people at the time and since have become increasingly convinced that the potential research benefits — which look limited — just don’t outweigh the risks of kicking off the next deadly pandemic ourselves.”

The meat we eat is a pandemic risk, too

““Factory farms are the best way to select for the most dangerous pathogens possible,” said Rob Wallace, an evolutionary biologist at the Agroecology and Rural Economics Research Corps in St. Paul, Minnesota. To explain why, he offered a crash course in zoonotic transmission, from the point of view of the pathogen.
“If you’re a pathogen in a host,” Wallace said, “you don’t want to kill your host too fast before you can get into the next host — otherwise you’re cutting off your own line of transmission. So there’s a cap on how much of a badass you can be. The faster you replicate, the more likely you end up killing your host before the next host can come along.”

If you’re deep in the wilderness or on a small farm, you (the pathogen) are not going to regularly come across hosts, so you’ve got to keep your virulence, or harm inflicted on the host, pretty low so that you don’t run out of hosts. “But if you get into a barn with 15,000 turkeys or 250,000 layer chickens, you can just burn right through,” Wallace said. “There’s no cap on your being a badass.”

This is part of why factory farms are a bigger risk for zoonotic outbreaks than the natural world or small farms.

The biologist added that because we’re increasingly trading poultry and livestock across international borders, we’re ramping up the danger even more. Strains that were previously isolated from each other on opposite sides of the world can now recombine.

“Take influenza,” Wallace said. “It has a segmented genome, so it trades its genomic parts like card players on a Saturday night. Usually, most hands are not too terrible, but some hands come out much more dangerous. An increase in the rate of recombination means an explosion in terms of the diversity of pathogens that are evolving.”

The world has already seen a really frightening example of this. Between 1997 and 2006, highly pathogenic strains of H5N1 bird flu were linked to poultry farms in China.

“Our entire understanding of how bad a pandemic could potentially be changed in 1997 with the emergence of the H5N1 avian influenza virus. All of a sudden, there was a flu virus that was killing over half the people it infected,” Greger said.

When people became infected with H5N1, it had a 60 percent mortality rate. For comparison, experts estimate that Covid-19’s mortality rate is probably somewhere in the neighborhood of 1 percent to 3 percent, though these estimates continue to evolve and vary widely by country and by age. (If you’re wondering why H5N1 didn’t become as big a deal as Covid-19, it’s because it mostly infected poultry rather than people; it wasn’t as good at infecting humans as the coronavirus unfortunately is.)”

“The other pandemic risk associated with factory farms has to do with “highly drug-resistant forms of bacterial pathogens,” as Shah put it — that is, antibiotic resistance.

When a new antibiotic is introduced, it can have great, even life-saving results — for a while. But as we start to use and overuse antibiotics in the treatment of humans, crops, and animals, the bacteria evolve, with those that have a mutation to survive the antibiotic becoming more dominant. Gradually, the antibiotic becomes less effective, and we’re left with a disease that we can no longer treat.”

““We have abundant evidence documenting the fact that when you put animals in crowded, unsanitary conditions and use low-dose antibiotics for disease prevention, you set up a perfect incubator for spontaneous mutations in the DNA of the bacteria,” said Robert Lawrence, a professor emeritus of environmental health at John Hopkins University.

“With more spontaneous mutations,” he explained, “the odds increase that one of those mutations will provide resistance to the antibiotic that’s present in the environment.” Those resistant bacteria could become strains that spread all over the world. “That’s the biggest human health risk of factory farms.””

” factory farming presents us with a double bacterial risk. Say a bacterial outbreak emerges among chickens. The poultry can pass that bacteria on to us humans, causing serious infection. We’d normally then want to use antibiotics to treat that infection, but precisely because we’ve already overused antibiotics on our farmed animals, the bacteria may be resistant to the antibiotic. If the infection happens to be one that transmits well between people, we can end up with an untreatable bacterial pandemic.”

“Laborers in meat plants are typically stationed very close together along processing lines, which makes social distancing all but impossible.”

“We can absolutely have a meat production system that is better for human health, the climate, and animal welfare — if we’re willing to abandon factory farming.

“The de-intensification of the livestock industry would go a long way toward reducing pandemic risk,” Greger said. “I mean decreasing long-distance live animal transport, moving toward a carcass-only trade, and having smaller and less-crowded farms. Basically, the animals could use a little social distancing, too.””

“We also need to reintroduce more biodiversity into our farms. Raising animals that are slightly different from each other genetically (rather than selecting for specific genes) will build in immunological firebreaks to help prevent the spread of infectious diseases”

Before Trump’s inauguration, a warning: ‘The worst influenza pandemic since 1918’

“The briefing was intended to hammer home a new, terrifying reality facing the Trump administration, and the incoming president’s responsibility to protect Americans amid a crisis. But unlike the coronavirus pandemic currently ravaging the globe, this 2017 crisis didn’t really happen — it was among a handful of scenarios presented to Trump’s top aides as part of a legally required transition exercise with members of the outgoing administration of Barack Obama.”

“The Trump team was told it could face specific challenges, such as shortages of ventilators, anti-viral drugs and other medical essentials, and that having a coordinated, unified national response was “paramount” — warnings that seem eerily prescient given the ongoing coronavirus crisis.”

“But roughly two-thirds of the Trump representatives in that room are no longer serving in the administration. That extraordinary turnover in the months and years that followed is likely one reason his administration has struggled to handle the very real pandemic it faces now, former Obama administration officials said.”

“Obama aides, in op-eds and essays ripping the Trump administration’s handling of the coronavirus, officially called COVID-19, have pointed to the Jan. 13, 2017, session as a key example of their effort to press the importance of pandemic preparedness to their successors.
In a Friday op-ed, Susan Rice, Obama’s national security adviser, blasted Trump for comments such as “you can never really think” that a pandemic like the coronavirus “is going to happen.” She mentioned the 2017 session as one of many instances of the Obama administration’s efforts to help its successor be ready for such a challenge. She also slammed the Trump team for dismantling the National Security Council section that would play a lead role in organizing the U.S. response to a global pandemic.”

“Lisa Monaco, Obama’s homeland security adviser, explained the thinking behind the January 2017 session in a recent essay for Foreign Affairs. “Although the exercise was required, the specific scenarios we chose were not,” she wrote. “We included a pandemic scenario because I believed then, and I have warned since, that emerging infectious disease was likely to pose one of the gravest risks for the new administration.””

“The Trump campaign, like the rest of America, was shocked to win the November 2016 election. Soon afterward, Trump cast aside his team’s transition prep work that had happened already and started over; some of his aides described tossing carefully collected binders full of possible personnel picks into trash bins. It was days, sometimes weeks, before his nominees and their aides showed up to meet the people they were replacing — if they did so at all — or to engage in transition meetings. Obama aides said they left detailed memos for their successors, but that quite often it appeared those memos were never read. Many on the Obama side were genuinely surprised that so many actually showed up for the Jan. 13, 2017, exercise, and there were expectations that some would skip it. On the Obama side, several agencies were represented by their second-in-command at the meeting for reasons including a belief that Trump’s principals wouldn’t show.
The gathering was held to satisfy a requirement in a 2016 law that updated the procedures around presidential transitions to require, among other things, that the outgoing administration “prepare and host interagency emergency preparedness and response exercises.” Obama also mentioned it in a 2016 executive order laying out his transition goals.”

“some Obama aides who attended said they were left with the impression that many of the Trump aides showed up to simply check off a box more than to learn. The impression was boosted in part because the transition overall was going so poorly. Several Trump nominees had barely even spoken to their Obama counterparts.”

““The problem is that they came in very arrogant and convinced that they knew more than the outgoing administration — full swagger,” one former Obama administration official who attended said.”

“Asked whether information about the pandemic exercise reached the president-elect, a former senior Trump administration official who attended the meeting couldn’t say for sure but noted that it wasn’t “the kind of thing that really interested the president very much.”
“He was never interested in things that might happen. He’s totally focused on the stock market, the economy and always bashing his predecessor and giving him no credit,” the person said. “The possibility things were things he didn’t spend much time on or show much interest in.
“Even though we would put time on the schedule for things like that, if they happened at all, they would be very, very brief,” the former official continued. “To get the president to be focused on something like this would be quite hard.”
Anything associated with Obama or his administration was also a no-go zone for Trump aides. If you brought them up, “that would be an immediate rejection, like, ‘Why are they even here? Why the fuck did you ask them?’””

America’s shamefully slow coronavirus testing threatens all of us

“Accurate testing is critical to stopping an outbreak: When one person gets a confirmed diagnosis, they can be put in isolation where they won’t spread the disease further. Then their contacts can be identified and put into quarantine so they don’t spread the virus if they’ve become infected, too.”