POST 268. August 23, 2022. PANDEMICS. “The Covid-19 pandemic has been a lesson in speed — the speed at which a novel virus among humans can spread, the speed at which it can rack up fatalities and cripple economies, the speed at which vaccines can be designed and produced, the speed at which misinformation can undermine public health. Amid all that rapidity is a different kind of speed, which drives the rest, like an engine spinning the cars on a nauseating carnival ride: the speed of viral evolution…”

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The coronavirus, like many other viruses of its ilk (RNA viruses with highly changeable genomes), evolves fast. It has adapted quickly to us. Now arises the crucial question of whether humans and human ingenuity can adapt faster.

Unless the answer is yes, we face a long, doleful future of continued suffering. Some experts reckon the toll of endemic Covid might be somewhere from 100,000 to 250,000 deaths every year, just in the United States. Millions of lives depend on whether human science, human governance and human wisdom can outpace the ingenuity of SARS-CoV-2, a relatively simple but enterprising agent consisting of four structural proteins plus an RNA genome.

Charles Darwin said the mechanisms of evolution never move quickly, but Darwin didn’t know about viruses. “That natural selection will always act with extreme slowness, I fully admit,” he wrote in “On the Origin of Species,” published in 1859. The first virus discovered, tobacco mosaic virus, didn’t come to scientific attention until decades later. As evolutionary theory developed from Darwin’s work and throughout much of the 20th century, it drew mostly on evidence from fields such as paleontology, biogeography, embryology and comparative anatomy — visible patterns that can reveal slow changes over long stretches of time. Those data are generally far less useful for measuring evolution when it happens fast.

But we have a new form of evidence for evolution: the sequencing and comparison of genomes. Whiz-bang machines do the sequencing — reading out the genetic code, letter by letter — and powerful computers help do the comparing, and it’s all much faster and cheaper…

The world needs that leadership, broadening and paying for sequencing surveillance of this coronavirus and its changes, everywhere the virus goes. But we need much more…

We need ambitious seroprevalence studies (screening of blood samples for evidence of past infection) that will help scientists learn how many undetected infections have occurred. What’s the real case total in each country and around the world? We need farsighted and well-funded research on vaccine platforms that can be quickly adapted for use against whole classes of newly emerged pathogens, not just hurried efforts to create a booster for the latest variant. We need a universal coronavirus vaccine and a universal influenza vaccine, although neither — given the formidable capacity of those viruses to evolve — may be achievable.

More simply, we need temperature-stable and needle-free vaccines that can reduce the problems of vaccine refusal in high-income countries and vaccine unavailability in low-income countries that are hot. We need better antiviral drugs, even for rare but dangerous viruses (such as Nipah virus), entailing development efforts that may never be profitable for pharmaceutical companies.

…we need investments toward much better ventilation and air filtration in our public buildings, reducing the spread of the coronavirus and other airborne pathogens…

All of us should take note. We have 12 million snapshots of this thing in motion — which is enough, at the standard cinema projection rate of 24 frames per second, to make a movie of SARS-CoV-2 evolution 138 hours long. But because evolutionary biology is a descriptive science, not a predictive one, we still don’t know how the story might end. Probably it doesn’t end at all. And the genomic epidemiologists, as smart as they are, can’t save us from what’s still coming. We have to save ourselves.” (A)

“The recent explosion of monkeypox cases in countries where the infection had not previously spread, coupled with the COVID-19 pandemic, has underscored the rising threat of emerging viruses in the 21st century.

An infectious disease is described as emerging when it is new on the global scene, when its infection agent has changed to become more transmissible or more dangerous or when it is rapidly spreading through new regions.” (B)

“Rabies caused by the Rabies lyssavirus and Australian Bat lyssavirus is one of the earliest reported and the deadliest pandemics in the history of mankind in 500 BCE Louis Pasteur and Emile Roux developed a vaccine for rabies in 1885…

Plague caused by the bacteria Yersinia pestis, is also an example of an old pandemic. In 541 CE this disease took over Europe, Asia, and North America resulting in the death of approximately 30–50 million people (half of the world’s population at the time)…

Smallpox (Variola major and Variola minor) had been described several centuries ago in China and India. Smallpox was of great concern in the 15th century. With the arrival of the Spanish in the Caribbean, diseases like Measles (caused by a virus from the paramyxovirus family), Bubonic Plague (caused by the bacteria Y. pestis), and Smallpox invaded, resulting in the death of nearly 90% of the population because people did not have immunity against the disease (Reynolds and Damon, 2016). However, in May,1796, Edward Jenner developed a vaccine against smallpox.

The Pandemic Cholera, a bacterial infection caused by bacterium Vibrio cholerae, started in the Bengal region of India between 1817 and 1824.

The Spanish Influenza pandemic is considered to be one of the most lethal pandemics of the Modern Age. The 1889–1890 pandemic influenza is the most important antecedent and is particularly interesting due to its similarities and differences with respect to the later Spanish Influenza…

Acquired immunodeficiency syndrome (AIDS) is a chronic, potentially life-threatening condition caused by the Human Immunodeficiency Virus (HIV). HIV is a type of lentivirus, which targets T-cells in the immune system. AIDS was first identified in the 1980s (Rambaut et al., 2004). It is one of history’s worst pandemics..

Coronavirus was first identified in 1965. In 1975, a group of virologists working on infectious animal virus found a new strain of the virus. This newly discovered infectious virus was named coronavirus (corona indicating the crown-like appearance of the surface projections) and was later authoritatively acknowledged as other sorts of viruses (Kahn and McIntosh, 2005; Tyrrell et al., 1975)…

The history of pandemic disease is said to follow a trend recurring every 100 years, starting from the great plague of Marseille in 1720, the cholera pandemic in 1820, the deadly Spanish flu of 1920, to the very recent pandemic of COVID-19. It could be that these viruses and bacteria mutate with time and somehow find ways to infect human cells.” (C)

“The human population seems to face an ebb and flow with pandemics that has restricted existence. While the world was brought to a standstill in the past two years due to the deadly novel coronavirus, now the emergence of newer viruses has raised alarm.

The global surge of monkeypox cases has forced the World Health Organisation (WHO) to declare the same a pandemic.

Does this tell a grim tale of the potential threat that the emerging viruses possess in the 21st century?

Here’s a look at all the emerging viruses in the 21st century.

Covid-19

Covid-19 emerged towards the later half of 2019 in Wuhan city of China. It is caused by a new coronavirus, SARS-CoV-2. The virus has progressed into multiple mutations therefore making it significantly difficult to arrest the spread globally. The virus killed more than 6.2 million people according to a tally to the end of May by the US Johns Hopkins University…

MERS

Detected in 2012 in Saudi Arabia, the Middle East Respiratory Syndrome (MERS) is a viral respiratory disease caused by a new coronavirus transmitted via camels…

SARS

Severe acute respiratory syndrome (SARS), also a coronavirus, emerged in southern China in late 2002. It is believed to have been transmitted from bats to humans via a civet—a mammal whose meat is sold in Chinese markets…

Ebola

First identified in 1976 in the Democratic Republic of Congo (then Zaire) the virus, whose natural host is the bat, has since set off series of epidemics in Africa, killing around 15,000 people…

Marburg

First identified in 1967 in Germany and the former Yugoslavia after research on imported African green monkeys, the Marburg virus is from the same family as Ebola and leads to the death of around one in two of those infected. The worst outbreak killed 329 people in Angola in 2005…

Zika, chikungunya, dengue

These three viruses produce similar, flu-like symptoms and are transmitted through mosquito bites. Cases exploded in the early 2000s in parallel with a spike in the population of tiger mosquitos.

The zika virus, first discovered in 1947 in a monkey in Uganda, caused its first epidemic in Micronesia in 2007 before exploding in Latin America in 2015, notably in Brazil.

Chikungunya spread in Africa from 2004 and reached the Indian Ocean as well as Asia before reaching the Caribbean from 2013 prior to a 2015 outbreak in Latin America. It causes fever and joint pain which generally subside after a few days or sometimes weeks.

Dengue, which primarily occurs in tropical and sub-tropical regions, is often mild, but can be fatal in rare cases.” (D)

“Intermittent outbreaks of infectious diseases have had profound and lasting effects on societies throughout history. Those events have powerfully shaped the economic, political, and social aspects of human civilization, with their effects often lasting for centuries. Epidemic outbreaks have defined some of the basic tenets of modern medicine, pushing the scientific community to develop principles of epidemiology, prevention, immunization, and antimicrobial treatments.” (E)

“The twenty-first century has already recorded more than ten major epidemic or pandemic virus emergence events, including the ongoing and devastating coronavirus disease 2019 (COVID-19) pandemic. As viral disease emergence is expected to accelerate, these data dictate a need for proactive approaches to develop broadly active family-specific and cross-family therapeutics for use in future disease outbreaks. Emphasis should focus not only on the development of broad-spectrum small-molecule and antibody direct-acting antivirals, but also on host-factor therapeutics, including repurposing previously approved or in-pipeline drugs. Another new class of therapeutics with great antiviral therapeutic potential is RNA-based therapeutics. Rather than only focusing on known risks, dedicated efforts must be made toward pre-emptive research focused on outbreak-prone virus families, ultimately offering a strategy to shorten the gap between outbreak and response. Emphasis should also focus on orally available drugs for outpatient use, if possible, and on identifying combination therapies that combat viral and immune-mediated pathologies, extend the effectiveness of therapeutic windows and reduce drug resistance. While such an undertaking will require new vision, dedicated funding and private, federal and academic partnerships, this approach offers hope that global populations need never experience future pandemics such as COVID-19.” (F)

“Nearly three dozen people in China have been sickened by a newly identified virus from the same family as the deadly Nipah and Hendra viruses, though there’s no evidence the pathogen can be transmitted from person-to-person.

The virus, named Langya henipavirus or LayV, was found thanks to an early detection system for feverish people with a recent history of exposure to animals in eastern China. The patients — mainly farmers — also reported fatigue, cough, loss of appetite and aches, with several developing blood-cell abnormalities and signs of liver and kidney damage. All survived.

Among the 35 patients, 26 were infected only with LayV, according to a report published in the New England Journal of Medicine. There was no evidence they had been in close contact or had a common exposure history, suggesting human infection may be sporadic, the researchers said. Tests detected the virus in 27% of shrews, a known vector for similar henipaviruses, suggesting the small, furry mole-like mammals may be a natural reservoir, they said.” (G)

“If Covid-19 probably would have overwhelmed even the most effective public-health bureaucracy, monkeypox — which as of now is mostly spread through close human contact, especially sexual contact, and for which we already have a vaccine — offered a chance to replay the Covid outbreak at a milder degree of difficulty. Yet the same kinds of bureaucratic failure were repeated — too little testing early on, too little interagency coordination, too little preparation for what should have been predictable challenges.

And then along with these failures came an absurd ideological spectacle, in which health officials agonized about how to state the obvious — that monkeypox at present is primarily a threat to men who have sex with men — and whether to do anything to publicly discourage certain Dionysian festivities associated with Pride Month. As the suffer-no-fools writer Josh Barro has exhaustively chronicled, public-health communication around monkeypox has been an orgy of euphemism and wokespeak, misleading and baffling if you don’t understand what isn’t being said.

This, too, has repeated Covidian failures. The political anxiety about saying or doing anything that might appear to stigmatize homosexuality mirrors the great public-health abdication to the George Floyd protests — in which a great many members of an expert community that had championed closures and lockdowns decided to torch their credibility by endorsing mass protests because the cause seemed too progressive to critique.

In each case what’s been thrown over is neutrality — the idea that public health treats risky behaviors equally, regardless of what form of expression they represent. In June of 2020 and again in June of 2022, the message from important parts of public health officialdom has been that the rules bind only some groups — Orthodox Jews holding funerals, say, or parents hoping to find an open playground — while leaving others liberated if their political cause is just or the risk of stigma seems too high…

It’s bad news for what remains of this pandemic: The collapse of the coronavirus vaccination effort, for instance, has spread well beyond Trump country, with many parents especially inclined to regard all public health edicts with suspicion.

And it’s worse news for the next crisis. Because speaking for myself, as a citizen with a personal interest in medical controversy, when I read the kind of blathering, newspeak-infused monkeypox advisories that Barro highlights, all I can think is: I can never trust anything these people say again.” (K)

“The U.S. seemed ready for the monkeypox outbreak. It had vaccines and treatments that are effective and experts had studied the virus for decades.

Yet the U.S. response has fallen short. The country cannot use millions of vaccine doses it owns because they were not bottled for distribution. The available vaccines and medications remain out of reach for a vast majority of Americans — a result of poor communication by federal officials and of other bureaucratic barriers.

Monkeypox is not very deadly, so this is not a Covid-level catastrophe. But the flawed response suggests that, nearly three years after Covid first appeared, the U.S. is still unprepared for the next deadly pandemic.

The C.D.C. director, Rochelle Walensky, acknowledged that much yesterday. She called for her agency to be overhauled after an external review found it had failed to respond quickly and clearly to Covid. She faulted the agency for acting too much like an academic institution that was focused on producing “data for publication” instead of “data for action.”

“For 75 years, C.D.C. and public health have been preparing for Covid-19, and in our big moment, our performance did not reliably meet expectations,” Walensky said….

Nearly three years into Covid, the U.S. is still not ready for the next pandemic. The C.D.C. is moving to remedy some of the problems plaguing the country’s public health system. Those changes, along with the broader lessons from Covid and monkeypox, could be the difference between another deadly pandemic and a crisis averted.” (L)

“The omicron subvariant known as BA.5 was first detected in South Africa in February and spread rapidly throughout the world. As of the second week of July, BA.5 constituted nearly 80% of COVID-19 variants in the United States.

Soon after researchers in South Africa reported the original version of the omicron variant (B.1.1.529) on Nov. 24, 2021, many scientists – including me – speculated that if omicron’s numerous mutations made it either more transmissible or better at immune evasion than the preceding delta variant, omicron could become the dominant variant around the world.

The omicron variant did indeed become dominant early this year, and several sublineages, or subvariants, of omicron have since emerged: BA.1, BA.2, BA.4 and BA.5, among others. With the continued appearance of such highly transmissible variants, it is evident that SARS-CoV-2, the virus that causes COVID-19, is effectively using classic techniques that viruses use to escape the immune system. These escape strategies range from changing the shape of key proteins recognized by your immune system’s protective antibodies to camouflaging its genetic material to fool human cells into considering it a part of themselves instead of an invader to attack…

BA.5 will not be the end game. As the virus continues to circulate, this evolutionary trend will likely lead to the emergence of more transmissible variants that are capable of immune escape.

While it is difficult to predict what variants will arrive next, we researchers cannot rule out the possibility that some of these variants could lead to increased disease severity and higher hospitalization rates. As the virus continues to evolve, most people will get COVID-19 multiple times despite vaccination status. This could be confusing and frustrating for some and may contribute to vaccine hesitancy. Therefore, it is essential to recognize that vaccines protect you from severe disease and death, not necessarily from getting infected.

Research over the past two and a half years has helped scientists like me learn a lot about this new virus. However, many unanswered questions remain because the virus constantly evolves, and we are left trying to target a constantly moving goal post. While updating vaccines to match circulating variants is an option, it may not be practical in the short term because the virus evolves too quickly. Vaccines that generate antibodies against a broad range of SARS-CoV-2 variants and a cocktail of broad-ranging treatments, including monoclonal antibodies and antiviral drugs, will be critical in the fight against COVID-19.” (M)

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DR. FAUCI TO RETIRE

“Dr. Anthony Fauci, who played a critical role in steering humanity through the two pandemics of our time, AIDS and COVID-19, announced Monday he is stepping down from his role in the federal government.

As of December, he will leave the position he’s held for 38 years as the director of the National Institute of Allergy and Infectious Diseases, as well as his job as chief of the NIAID Laboratory of Immunoregulation, and his role as Chief Medical Advisor to President Joe Biden.” (N)

“Fauci was a leading figure in not just the fight against the coronavirus but also diseases like Zika and, of course, AIDS. What do you think he’ll be most remembered for — his battles against Donald Trump, or the other stuff?

I think Fauci will be remembered for the twin infectious disease outbreaks that have, in a sense, served as bookends to his public-service career: AIDS and the coronavirus pandemic.

Both times, he became controversial. But they turned out very differently for him.

During the early days of the AIDS epidemic, as so many gay men were dying, they were also protesting Fauci, calling him a murderer and a killer. He brought them into his fold and befriended many of them. He would be the first to tell you that it changed him; it made him more sensitive to the patient’s point of view.

Fauci is a master of navigating Washington’s nexus of science and politics. But even he couldn’t escape the polarization of Donald Trump. With Covid, I think he will simply be remembered as a polarizing figure — a hero and a brilliant scientist and public servant to some, but a symbol of bureaucracy run amok to others.” (O)

“Now this is not the end. It is not even the beginning of the end. But it is, perhaps, the end of the beginning.” Winston Churchill

PREQUELS

POST 52. October 18, 2020.  ZIKA/ EBOLA/ CANDIDA AURIS/ SEVERE FLU/ Tracking. “… if there was a severe flu pandemic, more than 33 million people could be killed across the world in 250 days… Boy, do we not have our act together.” —”- Bill Gates. July 1, 2018

https://doctordidyouwashyourhands.com/2020/10/post-52-october-18-2020-zika-ebola-candida-auris-severe-flu-tracking-if-there-was-a-severe-flu-pandemic-more-than-33-million-people-could-be-killed-across-the-world-in-250/

POST 142. March 15, 2021. CORONAVIRUS. “Candida auris is a superbug, a pathogen that can evade drugs made to kill it—and early signs suggest the COVID-19 pandemic may be propelling infections of the highly dangerous yeast. That’s because C. auris is particularly prominent in hospital settings, which have been flooded with people this year due to the coronavirus.”

https://doctordidyouwashyourhands.com/2021/03/post-142-march-15-2021-coronavirus-candida-auris-is-a-superbug-a-pathogen-that-can-evade-drugs-made-to-kill-it-and-early-signs-suggest-the-covid-19-pandemic-may-be-propelling-inf-2/

POST 261. July 14, 2022. CORONAVIRUS+. A trifecta of threats which could breach hospital capacity again! – BA.5, monkeypox, & drug-resistant infections (Acinetobacter and Candida auris)

https://doctordidyouwashyourhands.com/2022/07/post-261-july-14-2022-coronavirus-a-trifecta-of-threats-which-could-breach-hospital-capacity-again-ba-5-monkeypox-drug-resistant-infections-acinetobacter-and-candida-auris/

(A) We Are Still in a Race Against the Coronavirus, By David Quammen, https://www.nytimes.com/2022/08/10/opinion/coronavirus-evolution-vaccines.html

(B)The emerging viruses of the 21st century, https://medicalxpress.com/news/2022-06-emerging-viruses-21st-century.html

(C)          Threat, challenges, and preparedness for future pandemics: A descriptive review of phylogenetic analysis based predictions, by Amanpreet Behl, https://www.sciencedirect.com/science/article/pii/S1567134822000144

(D)          As pandemics plague 21st century, know about emerging viruses: MERS, SARS, Ebola, Marburg, https://www.livemint.com/science/news/as-covid-zika-monkeypox-plague-21st-century-here-s-everything-to-know-of-the-emerging-viruses-11657275227323.html

(E)          Brief History of Pandemics (Pandemics Throughout History), https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7123574/

(F)           Developing therapeutic approaches for twenty-first-century emerging infectious viral diseases, by Rita M. Meganck & Ralph S. Baric, https://www.nature.com/articles/s41591-021-01282-0

(G)Dozens in China Infected With New ‘Langya’ Virus Carried by Shrews, By Michelle Fay Cortez, https://www.bloomberg.com/news/articles/2022-08-10/dozens-in-china-sickened-by-new-virus-likely-coming-from-shrews

(H) Poliovirus detected in wastewater samples in New York City, health officials say, By Kristina Sgueglia and Jen Christensen, https://www.cnn.com/2022/08/12/health/polio-wastewater-nyc/index.html

(I) With new guidance, CDC ends test-to-stay for schools and relaxes COVID rules, by WILL STONE and Pien Huang, https://www.npr.org/sections/health-shots/2022/08/11/1116991600/with-new-guidance-cdc-ends-test-to-stay-for-schools-and-relaxes-covid-rules

(J) There’s just one drug to treat monkeypox. Good luck getting it., By Apoorva Mandavilli, https://www.spokesman.com/stories/2022/aug/06/theres-just-one-drug-to-treat-monkeypox-good-luck-/

(K) The C.D.C. Continues to Lead From Behind, By Ross Douthat, https://www.nytimes.com/2022/08/13/opinion/cdc-monkeypox-covid.html?referringSource=articleShare

(L) America’s Pandemic Failures, By German Lopez, https://www.nytimes.com/2022/08/18/briefing/monkeypox-cdc-walensky-covid.html?smid=nytcore-ios-share&referringSource=articleShare

(M) How the Omicron Subvariant BA.5 Became a Master of Disguise – and What It Means for the Current COVID-19 Surge, by Dr. Suresh V. Kuchipudi, https://www.nifa.usda.gov/about-nifa/impacts/how-omicron-subvariant-ba5-became-master-disguise-what-it-means-current-covid-19

(N) Fauci to step down in December after decades of public service, by RICHARD HARRIS, https://www.npr.org/sections/health-shots/2022/08/22/930873868/fauci-to-step-down-in-december-after-decades-of-public-service

(O) How America will remember Fauci, By Blake Hounshell and Sheryl Gay Stolberg, https://www.nytimes.com/2022/08/22/us/politics/dr-fauci-career.html