A Possible Vaccine, But When?

Today, news broke that one of about a dozen vaccine candidates for COVID-19 passed Phase I trials in human beings. And the results, according to the vaccine manufacturer Moderna, were rather optimistic. As with any such announcements, we should probably remain cautious and not overstate any potential news. But it is somewhat good news nonetheless.

Messenger RNA Vaccine

The new vaccine candidate, produced by Moderna in partnership with the National Institutes of Health, is a messenger RNA vaccine. In Phase I trials starting earlier this year, the vaccine was tested on 45 people. This first set of test participants for Moderna’s trial COVID-19 vaccine was broken into three groups. Each group received a different dose of the vaccine. All groups received both an initial shot and a booster shot a month later.

Messenger RNA vaccine

A new messenger RNA vaccine produced by Moderna is entering Phase II trials for COVID-19. Messenger RNA provides a new approach to vaccination — signalling the immune system directly to produce specific antibodies. Such vaccines show promise for dealing with typically difficult to vaccinate illnesses such as flu and some forms of cancer. Image source: PHG.

Moderna is producing and testing a messenger RNA vaccine to target the virus for SARS-CoV-2 in a new approach. A particular immunization process that provides a kind of RNA that tells immune cells what specific kinds of antibodies to build. Such messenger RNA vaccines have advantages in that they are often faster and cheaper to produce than other kinds of vaccines and can directly communicate to the immune system a given infection-fighting need. Messenger RNA vaccination has shown promise in tackling some of the most difficult to vaccinate illnesses such as flu and even some forms of cancer.

Good Results in Phase I Trial — Moving to Phase II

In Moderna’s Phase I COVID-19 trial, results included expressed coronavirus antibodies in all test participants, the presence of neutralizing antibodies in laboratory cell tests, and only minor side effects. All test participants showed immunogenicity — the ability to produce antibodies capable of fighting COVID-19. This is a key step in vaccine viability. Further, 8 test subjects were more closely examined in a laboratory environment. Each of these subjects were found to possess antibodies capable of preventing COVID-19 infection. These neutralizing antibodies bind to the virus, disabling its ability to attack human cells. Finally, the company reported that the vaccine produced no serious side effects. Minor side effects included — redness at the injection site, headache, fever and flu-like symptoms. None lasted for more than a day.

Though Moderna’s vaccine produced promising results in the laboratory, it is not yet known if the vaccine is capable of producing immunity in real world environments. To this end, the FDA has granted Moderna approval to move on to Phase II trials. Moderna plans to test an additional 600 participants during Phase II — of which about 300 are older than 55 — to help determine the vaccine’s practical viability. In Phase II trials, vaccine developers typically test thousands. But given the fact that COVID-19 is so lethal — killing thousands of people each day worldwide — Moderna’s Phase II trial is being accelerated based on critical need for a life-saving vaccine.

It is expected that Phase III trials will begin in July if the vaccine continues to show viability following Phase II. Phase III is the final phase before a vaccine is approved for general public use. Phase III typically involves many thousands of participants.

Some Questions Raised About Moderna’s Announcement

Though Moderna’s announcement may provide a greatly desired spark of hope for an eventual, if somewhat longer term, resolution to the present pandemic, questions about the announcement have been raised by some in the medical reporting community. STAT — an American health oriented news site run by John W. Henry who owns the Boston Globe — recently reported some of these concerns. Primarily, so far, it appears that Moderna has, as yet, not provided enough data for a full peer review of its vaccine by the public community of experts. STAT also raised the question of whether the other 37 participants in the study produced binding antibodies (Moderna has not yet clarified this point — only stating that 8 participants showed binding antibodies). Another issue is time-frame for vaccine durability. STAT notes that study participants produced antibodies two weeks after vaccination. So, as yet, we have no information regarding the issue of how long Moderna’s vaccine results in a protective antibody response. All the issues raised by STAT are worth considering and provide good reason to remain cautious about early COVID-19 vaccine announcements.

Public Availability Still Many Months Away

Regardless of whether or not Moderna’s particular vaccine candidate proves valid, the time-frame for the public availability of any vaccine, even in the best case, would be the end of 2020. Dr. Anthony Fauci stated that it would take 12-18 months to develop a vaccine and have it widely available on the market in the best case scenario. Moderna representatives have estimates that follow similar timelines — stating that market availability is likely to take until January through June of 2021.

And this is if things go well. If both Phase II and Phase III trials are a success and the laboratory demonstrated viability that Moderna claims is validated in a real-world environment.

If things do go well, it’s possible that Phase III trials could be conducted in a manner that targets highest risk populations so as to have some impact on preventing infection and reducing loss of life due to COVID-19. There is historical precedent for limited vaccine use in this manner — as occurred during the 1957 H2N2 flu pandemic. At that time limited vaccine doses were targeted for greatest effect during late 1957. But this could only happen in the presence of effective testing to determine hot spot regions and communities. So the broader Phase III trials could start to target those populations in a meaningful way if such a practice were determined to be safe, humane, and effective by health experts.

Nevertheless, such a capability is still months away in the best case and a broader publicly available vaccine is unlikely before year end at the earliest. So let’s not get too far ahead of ourselves. That said, it is nice to be able to share a bit of qualified good news in this difficult time.

(UPDATED to include new information from STAT and to further apply journalistic standards.)

Social Distancing and Waiting Until It’s Safe Enough to Re-open

“US governors seeking to relax public health restrictions on the activity of people and businesses are acting prematurely and risk inciting a second, more damaging wave of infections from the coronavirus pandemic, public health experts have warned.” — The Guardian

“How to proceed? The U.S. urgently needs to restart, but no economy can function if an infectious disease like COVID-19 continues to sicken the workforce and keep customers to a trickle.”  — From an Article in Time compiling expert recommendations on how to restart the U.S. economy in the midst of a mass COVID-19 outbreak.

“Even in the hardest-hit places [in the U.S.], fewer than 1 in 10 people have been infected. So not only could COVID-19 come roaring back, but it could get five times or close to 10 times worse than it is now. The only way forward is to suppress cases and clusters of cases rapidly.” — Dr. Tom Frieden, former director of the U.S. Centers for Disease Control and Prevention (CDC)

******

Let’s acknowledge one simple fact. Staying at home to fight a pandemic and to save hundreds of thousands to millions of lives is in itself painful. It can be hard for many reasons. It’s necessary. But, historically, it has been fraught with social difficulty. So as we resolve ourselves not to waver, we should not disparage how difficult the task is.

It comes with economic sacrifice. Preventing loss that would have been even worse if a deadly illness broke out more fully, amplified, and overwhelmed both society-based and healthcare-related systems. But it is sacrifice nonetheless.

It results in social isolation that many have difficulty tolerating. It can be stuffy, stultifying, even claustrophobic. Many of us rely on our contacts with our fellow human beings to maintain emotionally healthy lives. Stay at home thus costs us in less quantitative but very palpable ways for this reason.

In a larger sense it grinds down the body of the human world. It puts civilization into a self-induced collapse into coma. For these reasons and others — it is hard. It requires an effort of collective will to maintain. And it can become tempting to fall prey to messages of false confidence during times of intense social distancing and isolation aimed at saving lives.

Social Distancing — a Sometimes-Necessary Improvement on a Response to Deadly Illnesses that Goes Back Centuries

Historically, though effective, such isolation to prevent death from illness has been difficult to maintain, tricky to time, and vulnerable to resurgent loss of life resulting from the erosion of societal will to maintain isolation for a period long enough to keep deadly illnesses under control. In the mid-to-late 20th Century, as vaccines, antibiotics, and other pharmaceutical treatments became more effective at controlling illness, reduction of illness-resulting contacts became mostly a secondary tool in preventing loss of life. But with the emergence of novel illnesses like HIV, Ebola, and SARS, various forms of isolation and infection prevention through reducing harmful contacts returned. And to prevent loss of life on a far greater scale, social distancing itself has re-emerged during the time of COVID-19 (SARS-CoV-2).

Seattle Police Wearing Masks During the 1918 Flu Pandemic

Seattle police wearing masks during the 1918 flu pandemic. Those who didn’t wear masks at the time were called ‘mask slackers.’ In addition to wearing masks, many cities conducted lockdowns in an attempt to prevent illness spread. Early relaxation of lockdowns at the time often resulted in surging rates of infection. Image source: Seattle Police, 1918.

When was the last time society really isolated itself in way similar to the extent we see today during COVID-19? We have to go back to the various quarantine and lock-down strategies deployed during the 1918-1919 flu pandemic a century ago. Back then, events were similar. Masks became widespread. The illness presented a high virulence and risk of loss of life. Cities enacted lockdown proceedures. Some of them opened too soon without other effective disease interventions only to see the deadly illness re-surge in subsequent waves of infection.

But isolation and quarantine itself has roots that reach back much further. All the way to the days of the Black Plague in Italy during the 14th Century. Even then, health ministers had learned that this disease was coming to Venice on ships (specifically from a disease reservoir in infected rats and fleas, but they didn’t know that at the time). They imposed a 40 day wait period or quarantine — derived from the Italian word quaranta for the number 40 — for ships coming to their port in order to contain the spread of the illness.

Other isolation measures were established due to suspicions that the disease was carried from person to person on a ‘pestilential air.’ Captains from ships with plague were spoken to through a window to reduce contact. Infected persons were sent to a quarantine island. All measures enacted to protect the larger population of Venice.

Plague is more specifically transmitted by flea bites, body fluid contact or the consumption of infected animal tissue in the case of bubonic plague, and through infected droplets spread by cough in the case of pnemonic plague. Still, the archaic form of social distancing in Italy was useful in containing and lessening disease outbreaks in the absence of effective pharmaceutical interventions in the form of vaccinations or treatments. It later became widespread across Europe and the world.

These responses come with a cost. They are disruptive. They force people into states of detainment — voluntary or otherwise. Movements are restricted. During quarantines, we lose contacts with our fellows. According to an article on The Science of Social Distancing published on The American Society for Microbiology website:

An organized community response to infection is most critical in the absence of pharmaceutical treatments and cures, but varying levels of political, ethical and socioeconomic controversy have long accompanied these practices.

As difficult as it can be, absent other measures to prevent illness spread, to cure lethal and virulent illness, or to substantially reduce their harmful impact, social distancing, isolation, and quarantine can become necessary to save lives.

How Social Distancing Measures Have Reduced Loss of Life — Reduced Spread, Amplification Prevented, Hospital Supports Preserved

Social distancing works on a number of levels. The first is that it reduces infections by preventing the contacts needed for an illness to spread. Reduced infection rate in a virulent illness like COVID-19 also generally reduces death. It’s basic math that if an illness that has an average case fatality rate of 3.4 percent, as indicated by WHO, is limited to say 100,000 cases where they would otherwise be 1 million, then the total number of deaths is reduced by more than 30,000. For the U.S., the observed case fatality rate is unfortunately much higher than this WHO stated average — on April 30 at around 5.78 percent. This might be due to the fact that the WHO estimate for confirmed case fatality is low, or it might be due to the fact that the U.S. is detecting more life threatening cases, or it may be due to the fact that in places like New York City, the disease has been given space to amplify, to become more deadly. Likely, the presently higher U.S. confirmed case fatality rate is due to some combination of these factors and related considerations. But it is also worth noting that the U.S. case fatality rate is still below a present global average of around 7.1 percent and China’s case fatality rate of around 6 percent (April 30, 2020 figures).

As a second factor, social distancing reduces the ability of an illness like COVID-19 to become more deadly through pure density of infectious particles alone. For if such an illness spreads enough, its deadliness can amplify. What this means is that so many people become ill that infectious material becomes very common in the local environment. This produces generally larger doses of disease when people become exposed. It can produce both multiple lower level exposures that result in a higher infectious dose load over time and the increased potential for much larger single infectious dose loads during encounters with the infectious agent. And larger doses of harmful agents are often more lethal. With COVID-19 there is evidence that this is the case. A recent New York Times piece written by Dr. Rabinowtz and Dr. Bartman noted — “As with any other poison, viruses are usually deadlier in larger amounts.”

The third way social distancing works to reduce lethality in a modern society is by protecting life-saving hospital support. In the instance of COVID-19, ICU cases presently (April 30, 2020) show about a 50 percent mortality. But without ICU care made available, almost all those people needing that support would perish. In other words, people are put on breathing machines because there is a period of time in which the illness removes their ability to breathe on their own — requiring advanced life support. Remove that advanced level of care for many because the need overwhelms availability and the result is that the death rate from the illness again jumps higher.

Hundreds of Thousands Saved

As a result, present social distancing measures in the U.S. and around the world have together reduced loss of life by tens to hundreds of thousands or more. In the U.S. alone, a terrible early national response by the Trump Administration to COVID-19 resulted in widespread weaknesses in infectious disease defense enabling widespread outbreaks, at least some viral amplification, and a pathway that according to CDC would have resulted in between 1.5 and 2.2 million deaths through August without social distancing and stay at home policies. Actions primarily taken by governors across the U.S. in response to rising outbreaks, great risk of loss of life, and related public fear. Now, after this wave of aggressive social distancing, we have the potential to reasonably limit deaths to around 90,000 to 240,000 over the same timeframe (through August 2020). If we manage things responsibly and we are lucky. For the month of April alone, deaths have likely been reduced from a potential of around 150,000 to 350,000 to the present range of around 56,000 to 90,000 when excess deaths likely caused by COVID-19 are included (we won’t know fully for a while due to the up to a two month lag in death certificate completion). This is still a terrible toll. But what we can say is that it would have been much worse if we hadn’t acted.

(Governor Whitmer of a Michigan slammed by COVID-19 cases extended her stay at home order until mid-May last week. This week, armed protesters bringing with them the threat of political violence pushed to force Michigan to re-open early, threatening public health.)

For a certainty, there are a number of the irrational, harmful, and downright terrorist-like armed ‘protests’ coming from the Trump-backing right-wing echo-chamber at present holding ‘make America sicker again’ rallies. Saying just the opposite — that social distancing didn’t work. That it wasn’t needed. That herd immunity alone would have created the reduction in death rates that we have seen because we acted (see experts blast right wing supported herd immunity theory). To, as with climate change denial, generate anti-factually premised arguments that if listened to create false perceptions, false confidence and that risk degrading the effectiveness of action supported by medical professionals and disease fighting experts. Now, these same voices threaten to erode rationality and turn us away from the implementation of life-saving methods as we look toward reopening in a responsible, measured fashion. One more likely to actually help the economy that, itself, relies on health and public confidence in health to function.

Reopening Responsibly Without Proven Pharmaceutical Interventions — Testing, Tracing, Isolating

Fortunately, for modern societies, absent proven effective vaccines or treatments, we still have methods at our disposal for reducing disease outbreaks and limiting spread outside of and in conjunction with social distancing. I touched on these methods in the earlier chapters about South Korea’s effective early COVID-19 containment operation and in the chapter on COVID-19 testing in the United States.

As we look to start reopening, testing, contacts tracing and isolation again, according to disease experts, becomes necessary to ensure the safety of populations. CDC had identified this need as early as mid April stating:

The director for the Centers for Disease Control and Prevention said Monday [April 13] that in order for the country to reopen, swift testing for people who have the virus and for people who might be immune to the virus will need to be available.

However, we are still seeing notable limits in the number of available high-accuracy test kits relative to the number of infections. Present test rates of around 220,000 per day, while numerically high, is still likely not adequate given that the U.S. population is about 330 million (a ten to one negative to positive result is recommended by experts as a benchmark, the U.S. is at 6 to 1 at present suggesting a need to almost double the daily testing rate), that the viral load is a high enough fraction of the present population to represent a serious threat of much larger outbreaks if left unchecked, that the virus is so highly transmissible, and that people possessing antibodies have at best an uncertain immunity at present.

US Testing

To effectively manage present levels of infection, U.S. testing capacity needs to about double. However, if early or slipshod reopening results in expanded cases, the ability for the U.S. to test, trace, and isolate will again fall behind. Image source: Our World in Data.

As a result, COVID-19 presents a number of challenges for governors wishing to reopen states. The first is that the mentioned viral load in the U.S. now is quite high. We have more than a million confirmed cases as of April 30. We are looking at around 860,000 active cases at present. Dividing the active cases by the existing population shows that about 1 in 400 people have been detected with illness infection in the United States. In addition, COVID-19 is known to produce asymptomatic infections. These asymptomatic cases are still most often in addition to the detected fraction because the continued lower availability of test kits in the U.S. means that most tests are still given to people with symptoms. Asymptomatic cases are also suspected of being transmissible carriers of COVID-19. And the asymptomatic fraction for this illness, based on recent studies, may be rather large, comparable to seasonal flu (which ranges from 12 to 85 percent in virological and serological studies but is typically cited at 20 to 50 percent).

Such a large viral load in the general populace, uncertain levels of infected immunity with a potential for reinfection, and evidence of at least a decent-sized asymptomatic fraction presents a quandry for health officials looking to safely reopen states and to protect the general population. That said, and given what we know, we can work to effectively deploy resources to protect the public as states look to start re-opening.

Reopening Under CDC Guidance and Aggressively Taking on the Virus — Setting Public Safety as the Top Priority

The first key step, according to health experts, is to not re-open while viral cases and hospital cases are still expanding. Reopening should occur according to CDC guidelines following a two week reduction in cases. Since cases are still at plateau or are still expanding in many states, this would suggest that rational re-opening timeframes for most regions run from mid-May to mid-June. However, this range is provisional based on expected viral drop-off rates. And COVID-19 has tended to linger for longer than expected in some regions. Opening earlier risks larger outbreaks. And the history of opening while cases are still rising without other effective interventions is full of stark examples (see lack of quarantines allowed 1918 flu to spread and grow).

The second step is to, according to CDC, widely deploy available testing. Ideally, this testing will be broad enough to effectively detect, trace and isolate a majority of the cases. CDC guidance appears to assume it will be. However, given that the U.S. is not at the recommended 10 to 1 negative to positive test threshold, there is evidence that test shortages are still an issue. Therefore, like Maryland Governor Larry Hogan directed yesterday, testing resources may need to be deployed in a more targeted manner. For example, Hogan indicated that highest risk case clusters are occurring in meat packing facilities and in nursing homes.

As an example, Hogan’s action of aggressively deploying available testing, contacts tracing and isolation for those hot spots produces a greater opportunity to reduce risk of expanding infection and loss of life. Also Maryland’s example of setting up drive-through testing centers when test kits are available for people with symptoms, along lines similar to those of the South Korea model, provides a secondary, targeted containment infrastructure. It is worth noting that Hogan is departing from his earlier tact of adhering strongly to expert advise on reopening timelines. Hogan presently plans to reopen as soon as hospitalized cases plateau for two weeks — rather than according to the two week case reduction recommendation by CDC. This particular facet does increase risk to Marylanders.

In the absence of available test kits, temperature screening in workplace and other environments is an available option to increase infection contaiment. This is a broader brush approach. And it does not detact the assymptomatic fraction of cases. But it does help to contain the most highly infectious instances. CDC provides a useful set of guidelines for conducting such screening here.

In addition, provision of protective barriers, increased ventilation, and face coverings for persons in any re-opened public work environments according to CDC guidance would help to limit contacts and disease spread. People in workplaces, social gatherings, using mass transportation, and in many aspects of life and work would help to prevent loss of life during any reopening scenario by following such CDC guidance as well.

Other Considerations — Start and Stop, Effective Communication, Doing Real Work to Build Trust

Finally, considering the continuing great risk to public health, reopening may need to start and stop. Meaning that if infections increase, reopened sectors may need to shut down again to limit disease spread. These response shut-downs could be total or staggered — escalating and de-escalating based on observed changes in outbreaks.

Overall, the idea is to respond to the virus in a smart, flexible manner that both protects the public and generates the real confidence needed to get the economy up and running. Listening to infectious disease expects, healthcare leaders, CDC, local leaders and the general public will be crucial in this regard. On the one end, specific knowledge and concerns provided by health and disease experts saves lives, and on the other end, local leaders and the public will give an understanding as to whether communities and individuals feel they have been protected during any re-opening. This communication with the public both gauges public confidence, which is necessary in any reopening, and increases state leadership’s responsibility to protect lives.

Daily U.S. Deaths COVID-19

Daily U.S. COVID-19 deaths are on a long plateau. Whether they go up or down depends in large part on if reopening is rushed and botched, or cautious and effective. Image source: Worldometers.

Potentially helpful infectious disease treatments and new pharmaceutical interventions may aid in any reopening strategy by reducing stress on hospitals, potentially reducing loss of life, and helping to increase public confidence. But at this time it is important to consider that none of the present potential interventions, as yet, is a silver bullet. So the effectiveness of any new treatments should not be over-stated in a way that undermines trust.

We are entering a tricky time fraught with danger. But if we are wise, cautious, and fortunate, we may begin to climb out of this terrible pandemic. Hasty, reactionary responses that ignore the advice of health experts, however, carry with them a high risk of worsened tragedy and even more terrible loss of life than we have already experienced.

Up Next: A Possible Vaccine, But When?

No COVID-19 Didn’t Stop the Climate Crisis, But It’s Interacting with it in a Bad Way

As we stand in the grips of one major global crisis, one whose first wave of mass casualties may finally be starting a merciful down-slope (on April 27, 2020), it’s important not to lose sight of the other, larger, one. Yes, I’m talking about the Climate Crisis. And as I mention it, I would be remiss to fail to note that one is not like the other. In particular, the climate crisis is much worse when measured over longer time scales and taken in total.

In an April 21 address ahead of Earth Day, U.N. Secretary-General António Guterres stated:

“Currently, all eyes are on the COVID-19 pandemic, the biggest test the world has faced since the Second World War. We must work together to save lives, ease suffering, lessen the shattering economic and social consequences, and bring the disease under control. But, at the same time, let us not lose focus on climate change. The social and economic devastation caused by climate disruption will be many times greater than the current pandemic.”

The reason is that the climate crisis is on a path of escalating damage and danger so long as we continue burning fossil fuels. One that does not relent if the carbon emission itself does not permanently abate. One that in the broader sense is capable of spinning off multiple sub-crises or harmfully amplifying and influencing others. Or in a sense that is in a micro-way more specific to the present pandemic, as we touched on early in this web-book, climate crisis can help to worsen and spread new infectious diseases.

COVID-19, Air Pollution, Deforestation, Warm Weather Illnesses, and Health Systems Impacted by the Climate Crisis

In the context of the present COVID-19 pandemic, the climate crisis, and its driver (fossil fuel based pollution), produces a number of harmful infectious illness interactions that are worth pointing out. Namely, the air pollution that drives the climate crisis can increase the death rate from COVID-19, the deforestation that also helps to drive the climate crisis can serve as a driver for the emergence of new coronavirus based illnesses like COVID-19, that COVID-19, like Ebola is a novel infectious illness from a typically warmer weather region, and that the climate crisis has deleterious impacts on the global health system that challenges our ability to manage such a wide-ranging pandemic outbreak. As we’ll glimpse below, COVID-19’s interaction with climate change denial and its related anti-science bent, has also been particularly harmful.

Second Hottest January through March on Record for 2020

A larger update for the climate crisis, however, takes in a couple of basic data points that show we are still on a very damaging and destructive climate pathway. One that the COVID-19 based economic slowdown and related temporary reductions of emissions by itself cannot halt (more on this later). A path we won’t effectively depart from unless we exit the COVID-19 pandemic by enabling a rapid transition to clean energy and a related follow-on effort to draw down excess atmospheric carbon.

NASA GISS First Quarter 2020

First quarter of 2020 was the second hottest on record according to NASA GISS. Image source: NASA.

The first key climate crisis data point we’ll explore in this installment is provided by the climate experts at NASA GISS, headed by Dr Gavin Schmidt. And it comes in the form of a global surface temperature analysis for the first quarter of 2020. For, according to NASA, during the months of January through March of 2020 global surface temperatures averaged about 1.19 degrees Celsius above 20th Century baseline measures. This is about a 1.41 degree Celsius departure above 1880s averages. Quite a bit higher than the past five year baseline at 1.15 C hotter than 1880s averages and just 0.06 C below the record hot first quarter of 2016. It is also disturbingly close to the IPCC identified first climate threshold mark at 1.5 C. A threshold which we are probably still about a decade and a half away from breaching over a five year average time-frame along the present fossil fuel burning pathway. But it’s still not fun seeing us so close to it at present.

With such an opener, 2020 may not become a new record hot year. Somewhat less likely given no El Nino is expected, but possible. And if it does, it would spell more trouble. We’ll wait for confirmation on the 2020 temperature trend coming from NASA GISS and Dr Gavin Schmidt — who has dutifully provided publicly helpful annual temperature path projections during recent years. Regardless, 2020 will likely come uncomfortably close to another record hot year. And such continuing severe global heat is certainly within a well-established trend of longer-term heating.

Atmosphere Still Filling up with Carbon

Of course the primary driver of climate crisis is fossil fuel burning and related emissions of greenhouse gasses into the Earth’s atmosphere. Emissions that have temporarily slowed down — possibly by as much as 5-10 percent for 2020 according to this report by Carbon Brief — but have not halted. And emissions would have to slow down by a lot more and for a lot longer to start having a positive impact on the Earth’s climate system.

According to Glen Peters, research director at CICERO:  “Even if there is a slight decrease in global fossil CO₂ emissions in 2020, the atmospheric concentration of CO₂ will continue to rise. The atmosphere is like a (leaky) bathtub, unless you turn the tap off, the bath will keep filling up with CO₂.” A statement of basic facts that climate change deniers who attack science are even now trying to confuse (see this scientist’s statement to clarify).

 

Not only are top voices at CICERO chiming in on the issue of climate crisis and a COVID-19 related temporary economic slow-down. But recently the World Meteorological Organization issued its own statement on the matter noting —  the economic and industrial downturn as a result of the Coronavirus pandemic is not a substitute for concerted and coordinated climate action.

Climate Science Deniers Continue to Publicly Demonstrate a Dangerous Incompetence on COVID-19

We could give flight to reason and join in the ranks of science deniers who ignore and refute experts at places like CICERO and the World Meteorological Organization.  Basically the same set of people who downplay or attack the advice of experts (like those at the World Health Organization) and ignore facts at our own and everyone else’s peril (but we won’t). We could listen to people like the current occupant of the White House (but we don’t). A known climate science denier who’s also spent months attacking public health experts and defunding key disease fighting groups while also peddling questionable COVID-19 treatments like hydroxychloroquine of unproved, potentially harmful, effectiveness. Who on Thursday, April 23rd appeared to publicly suggest injecting disinfectants (like Windex and Bleach) into our bodies as a valid way to fight COVID-19 infection (Do not do this! It can kill you!).

Trump later walked his ridiculous and dangerous statements back, while blaming his usual scape-goat — the free press — for his own brazen incompetence. But his most recent fact-free and literally dangerous circus show again put public health at risk with the potential to drive some of those who take his statements verbatim to inflict harm upon themselves. It also precipitated public health advisories from officials and the makers of Bleach and Windex advising people to, well, not take the President’s apparent advice. We could put ourselves at further risk by listening to his quackery-defending supporters, now lifting up a familiar gas-lighter chorus to try to tell us what we all saw happen didn’t, and related cohorts. But this form of self-harm follower-ship, or of even entertaining it, is proving to be a very, very bad idea. For the tendency here to deny the science on one threat — COVID-19, that those clinging to a certain political ideology are incapable of managing responsibly — is apparently related to their inability to perceive the larger threat of climate crisis.

CO2 Strikes Above 416 Parts Per Million During April of 2020

So instead we will just do the smart, rational thing and listen to the actual experts (I know many of us already do, but unfortunately and increasingly obviously some still do not) — world-class scientists who have spent their lives researching the Earth’s climate system. Scientists like Dr Michael E Mann, Dr Katherine Hayhoe, Dr Terry Hughes, Dr Stefan Rahmstorf, Dr Peter Gleick, Dr Gavin Schmidt, Dr Eric Rignot and so many more. And the atmospheric greenhouse gas indicators for the climate crisis that these scientists follow are still heading in the wrong direction. Still building up. Still providing more heat trapping capacity for the Earth’s atmosphere and larger climate system.

April CO2

The seasonal carbon dioxide trend for the past two years as measured at the Mauna Loa Observatory shows continuing increases driven by fossil fuel burning. Image source: The Keeling Curve.

At this time, atmospheric CO2 is hitting above a 416 parts per million average on a weekly basis. This is well above anything seen in at least the last 2.6 to 5.3 million years and likely since the Middle Miocene 15-17 million years ago. According to the real experts at NOAA, this greenhouse gas is the primary driver of the present Earth System heating we now observe (see the Earth Systems Research Lab’s Greenhouse Gas Index Page).

So both heat and its big driver CO2 are still heading in the wrong direction. And, no, the fossil fuel burning tap into the tub didn’t stop running, it just turned down a bit. Hopefully permanently — but that will depend on what kind of economic stimulus we provide to help get us out of this crisis. Particularly for what kinds of energy systems we decide to stimulate to help get the global economy back up and running (clean energy to help stop the climate crisis and business as usual fossil fuel burning to keep making it worse) when the COVID-19 pandemic ultimately abates.

Up next: Social Distancing and Waiting Until It’s Safe Enough to Re-Open

It’s Everywhere Now — COVID-19 A Global Viral Wildfire

It moved like a fire.

First flickering in China during December.

There it evaded detection early-on. The Chinese government demurring to provide reports on the virus for crucial days. Then it grew and grew. Expanding to the point that it raged to terrifying size in China during January and February.  Evoking a sudden, serious and locally effective lock-down even as the Chinese government coordinated with world health bodies on what had now become a large and deadly-serious threat to both national and global security.

COVID-19 Leaps China’s Fire Break

China and world health bodies built up a kind of infectious disease fire break meant to contain the new virus. By the end of February, China’s own initial case numbers had rocketed to just below 80,000. The largest novel infectious disease outbreak of its kind in at least three decades. But the viral fire wasn’t finished. In fact, it was just getting started.

Fort McMurray Wildfire

Like wildfires, viruses can rage out of control once they escape containment — forcing large-scale mitigation to save lives. Unfortunately, this is exactly what happened in the case of COVID-19. Above image is of the climate crisis worsened Fort McMurray wildfire of 2016. Image source: Government of Alberta.

Like a climate crisis amplified blaze, the initial outbreak size was immense. It cast highly infectious sparks in all directions. It presented a much greater opportunity for infection spread than the first SARS outbreak in 2002-2003, than subsequent MERS outbreaks, or during the Ebola outbreak. Even in the best of circumstances, the viral fire had become so large that it would have been difficult to fight from mid-February onward.

Multiple Conflagrations During February and March

Tightly packed ships, travelers on airlines, persons in large gatherings became super spreaders of the new viral fire. South Korea, then Iran, then Italy saw large outbreaks in February through early March. But smaller numbers bearing viral fire were moving elsewhere. And if containment mostly succeeded after a hard fight in the areas that were diligent, and ready, and equipped and lucky, it failed in places where leaders were lackadaisical or too slow, or who brutishly suppressed inconvenient information and science, or who were overconfident and didn’t take the threat seriously, or who lacked or sabotaged response and containment capability, or who were just unlucky.

The viral fire was canny. It found weaknesses. It mercilessly exploited them. It spread rapidly through these weak points to other regions. On March 11, 2020, the World Health Organization declared COVID-19 to be a global pandemic. By the end of March worldwide cases had expanded to more than ten times China’s initial load — hitting just over 860,000 by the last day of March. The illness’s capacity to spread had expanded by an order of magnitude. Even more grim, the loss of souls was beginning to mount as well — with deaths from the virus rising to 43,000 by this time.

Running Toward the Flames — U.S. Outbreak Becomes Largest in the World

But despite its vicious pace of expansion, overconfidence still appeared to sway many right-wing heads of state, media personalities, and government leaders. Downplaying of the viral threat was still prevalent through mid-March and even as shut-downs began to take hold some were already calling it an over-reaction. Others showed an amazing insane propensity to run toward the viral fire or urge their followers to do the same. Trump and fellows on the right in the U.S. peddled the false hope of silver bullet treatments like chloroquine putting many people at increased risk of deadly health complications like cardiac arrest. Politicians like Florida Congressman Matt Gaetz, who wore a gas mask to mock a COVID-19 vote in Congress, and British Prime Minister Borris Johnson would show cavalier attitudes toward social distancing — later coming down with the infection. In the case of Johnson, his battle with COVID-19 would go critical — putting him in the emergency room for the fight of his life.

global distribution of cases

Visual of global distribution of COVID-19 cases on April 24, 2020. Note that U.S. case numbers are the highest of any nation. This is true for mortality numbers as well. Image source: Worldometers.

So overconfidence itself became one of the biggest weak points for the viral fire to exploit. For the United States, the overconfidence would prove crucial as a containment failure there allowed the viral fire to explode into the largest national outbreak anywhere. Presenting serious risks both to U.S. and global citizens. In March and April, a rapid U.S. spread would ultimately result in about a million cases in the U.S. alone (as of this writing, on April 23rd, the U.S. total is 850,000 with the growth ranging between 25,000 and 30,000 cases per day). About one in every four hundred U.S. citizens would become hosts to the viral wildfire before May. The toll in lives would be serious — approaching 60,000 by April’s end for the U.S. alone (more than 48,000 U.S. deaths on April 23rd with between 1,100 and 2,700 more deaths each day). This as governors like Georgia’s Brian Kemp unwisely sought to relax stay at home policies early against the advice of health experts as daily infection rates were still near peak levels. The failures of overconfidence and not listening to experts being a hard lesson to unlearn for many — particularly those on the political right. Overall, the United States’ outbreak would be the largest first wave event anywhere on the globe — surpassing China’s initial explosion by more than an order of magnitude.

Large Viral Fires Everywhere — Including Hot Brazil

The story was similar in Europe where states like the, at first lackadaisical under Borris Johnson, U.K. and a seemingly unlucky Spain and France would see massive outbreaks to add to Italy’s major event. Germany would experience its own major outbreak. But containment efforts for that state would prove more diligent and effective. Total cases in these five countries would roughly equal that of the U.S. by the end of April — adding almost another million (also at about 850,000 on April 23rd but growing at around 15,000 cases per day which is considerably slower than the U.S. growth rate).

Large outbreaks in Russia, Saudi Arabia, Turkey, and Brazil would further feed into the global conflagration as May approached. With these four countries hosting about 210,000 cases as of April 23rd, but growing at a rate of about 12,000 cases per day combined. Brazil’s own large outbreak of about 46,000 by April 23rd also carried with it a warning. Spokespersons on COVID-19 have often assumed that it, like the flu, maintained a seasonal nature in which infection spread more rapidly at cold times of year, but that hot times would prove protective. The virus’s response to temperature may well be more complex and nuanced. Repeatedly, experts have cautioned that COVID-19 cold weather prevalence assertions are somewhat dubious and unproven. Notably the virus emerged from tropical and subtropical environments. So hot weather may have a limited ability to curtail infection rates. And Brazil’s own large outbreak has occurred in a hot weather region during a hot time of year. Showing that the virus is capable of rapid spread during hot, summer-like conditions.

Global COVID-19 case and death totals

By April 23rd, global case numbers and deaths continued to increase on at a steep rate with little sign of abatement. More than 185 nations had seen COVID-19 cases and the likelihood of subsequent viral waves remained high. Image source: Worldometers.

Including all outbreaks, by mid-to-late April, the fire had taken in 213 countries, areas and territories. On April 23rd, about two million, seven hundred thousand people had been infected across the globe. The case rate was growing by about 80,000 each day (2.4 million per month). And of those confirmed with infection, about 190,000 or seven percent had died. A grim tally that continued to swell by 5,000 to 8,000 each day. Showing the world would likely see a quarter million lost from the virus by some time in early May.

More Waves Could Follow

COVID-19 had defied expectation both for its ability to spread and for its apparent lethality. A disease capable of super-spread that is at present apparently seventy times more deadly than the seasonal flu among detected cases (See John’s Hopkins data on case fatality for individual countries here).  Something that given present data is potentially capable of producing a global impact that is the worst seen from an infectious illness outbreak since the deadly flu Pandemic of 1918-1919 if it breaks out more fully. This all just as the first wave of viral fire is passing over the globe. And until a cure or a very effective treatment is found, the virus now exists in a high enough global density to produce multiple subsequent waves of infection even if the first wave is abated (it presently is ongoing). A virus that appears to be capable of defying the conventional understanding of seasonality. And one that is extraordinarily transmissible and tricky to contain.

(UPDATED)

Up Next: No COVID-19 Didn’t Stop the Climate Crisis, But it’s Interacting with in in a Bad Way

The Trouble With Testing Part 1 — “No Responsibility at All”

“The White House is now home to an inattentive, conspiracy-minded president. We should not underestimate what that could mean.” — The Atlantic in a special report on U.S. pandemic preparedness during the July/August 2018 issue

“Anybody that wants a test can get a test. That’s what the bottom line is… and the tests are all perfect, like the letter was perfect. The transcription was perfect, right?” — Donald Trump on March 6 as U.S. was suffering a major shortage of COVID-19 test kits. 

“I take no responsibility at all.” — Donald Trump when asked if he felt any responsibility for the persistent lags in U.S. testing capability on March 13. 

“President Trump continues to falsely state that everyone who needs a COVID-19 test can get one.” — In an NPR interview conducted on April 2. 

“Two and a half months after the first reported coronavirus case in the US, America still doesn’t have the capacity that it needs to track all cases…” — Vox.

*****

The need for testing during a virus epidemic is directly related to the number of infected persons. If the outbreak is small, the need for testing is also proportionately smaller. And if the outbreak is large, then the need for testing is subsequently much larger.

Ironically, the more testing happens early on, the more cases are identified early on, the more contacts are traced and isolated early on, the more the virus is ultimately contained and the lower the follow-on need for tests. The inverse is also true. The less testing, identifying, and containing of pandemic illness early on, the more tests will later be needed.

A failure to test, trace and isolate in the U.S. early on resulted in a massive COVID-19 outbreak necessitating nationwide mitigation. 1 in 5 people tested in the U.S. are still showing up as positive as of April 20th — indicating that tests are generally still occurring only for high risk persons and not for the broader population. Image source: Our World in Data.

Because less testing, identification and containment means an illness like COVID-19 can expand undetected, exponentially, and with far less constraint. Each failure to respond to this nasty disease pushes us up the scale in the need for a still greater response in the form of testing, isolation, sanitation, and ultimately mitigation. And if leadership is incapable of providing that response in a continuous escalation, then we end up with an ever-expanding disaster. That’s what we face here in the U.S. Because here a national leadership under Trump that utterly lacks responsibility is showing its dramatic incapacity.

A Question of Responsibility

What is responsibility? At its root — response. In a disaster, swift, decisive, and effective response is what it takes to prevent an expanding and uncontainable cascade of harm, economic loss, and loss of life. Without leadership responsibility, a sense of duty to the persons under leadership’s charge and a willingness to answer to others, to positively absorb criticism, to act, to overcome barriers in order to make effective action possible, then crisis and disaster response itself will be set up to fail.

In the context of COVID-19, U.S. leadership failure by a corrupt and incompetent Trump Administration has weighed heavily in loss of life and well-being. Specifically, the Administration’s failure to take the responsibility necessary to provide the tests Americans need has been a critical aspect of this failure.

Test Development Timeline in a Global Context

Unlike South Korea which took swift action and outran global COVID-19 testing capability, the U.S. response under Trump in the form of deploying viable test kits, has lagged it.

On December 30 and 31 of 2019, China and WHO had identified pnemonia-like cases of a new illness. By January 10-12 of 2020, China released the new disease (later called SARS-CoV-2 for the virus or COVID-19 for the illness the virus causes) genome to the world. Within just a few days, German scientists, using SARS-CoV as a reference, had developed a test that could identify a unique portion of the SARS-CoV-2 virus’s DNA. On January 17, the World Health Organization (WHO) adopted the German-based test, published the guidelines for developing the test, and began working with private companies to rapidly produce those tests and distribute them. As other agencies developed new tests, WHO would also publicly provide the new formulas. For example, WHO published China’s test development formula one week later on January 24.

The importance of WHO action at this stage was threefold. First, it provided information on how to manufacture an effective test. In other words, any country could take the WHO-provided information and use it to mass produce its own tests. Like South Korea, they could then independently coordinate with medical industry to get the production chain rolling. Unlike South Korea, they no longer needed to independently develop one. A test formula was now publicly available. Second, the WHO began to manufacture test kits to send out to other nations who requested them. These manufactured kits provided physical samples of the published testing formula — making it easier for manufacturers in other countries to validate and reproduce. Third, WHO served as an agency that mass produced tests. This helped to provide tests to those who were unable to provide for themselves. By March 16, two months later, WHO alone had produced 1,500,000 tests and sent kits out to 120 countries.

The gene assay of SARS-CoV provided by Olfert Landt to the World Health Organization in January. This assay would result in an easily producible test that many nations would use to contain their COVID-19 outbreak. Image source: WHO.

Independently, the German firm that provided the first test protocol adopted by WHO was also shipping out tests to other countries. In mid-January, New Zealand, who decided the WHO-published test formula was good enough and the need for more immediate access to tests was greater than the need to independently produce one at home, ordered the Germany-developed kits. The kits were subsequently shipped. And New Zealand was provided with tests ahead of the outbreak that later occurred. In other words — they were prepared. Australia and a number of other countries made the same decision — also ordering their test kits from overseas. Olfert Landt’s firm, the German Agency that developed the first COVID-19 test protocol adopted by WHO, alone was shipping out 1,500,000 tests per week by late February of 2020.

U.S. — All Testing Eggs Slow-Walked into one Trump-Shrunken Basket

In the U.S., the Centers for Disease Control, a crucial public health protection organ, had long suffered budget cuts and diminishment under Trump. As noted before, each of Trump’s budgets had requested reduced funding for CDC and his attacks on the Affordable Care Act also degraded U.S. disease fighting capability. His removal of Obama’s Pandemic Task Force had cut off a federal limb that could have helped stop the virus in its tracks overseas, but if it did get out could have also coordinated infectious disease response at home and abroad, cut red tape, and sped the availability of materials such as test kits for the U.S. public.

Perhaps as equally pivotal, though, was Trump’s choice of director — Robert Redfield — to head CDC. Redfield, unlike many of Trump’s appointees, was certainly a professional with many years of experience in his field. One who spent 30 years researching HIV and for 20 years served in the U.S. Army Medical Corps. Redfield was, arguably though, far from a great choice to head the agency responsible for fighting disease in the U.S. He was embroiled in a controversy over an HIV vaccination trial in the 1990s in which he was accused of manipulating data. Redfield has also been criticized for allowing his strong religious beliefs to interfere with his medical views. Peter Lurie from the Center for Science in the Public Interest, a consumer advocacy group expressed this concern about Redfield’s appointment: “What one would get in Robert Redfield is a sloppy scientist with a long history of scientific misconduct and an extreme religious agenda.”

In choosing the controversial Redfield, Trump also passed over Anne Schuchat — a career public servant whose experience dealing with Anthrax in the U.S., Ebola in West Africa, and SARS in China made her an ideal choice for CDC head. In other words, an infectious disease expert with exactly the kind of experience to handle an illness like COVID-19. That’s what the people of the United States didn’t get from Trump. What we got was something that we’ve come to expect from a corrupt and incompetent Administration — at best a political appointee with professional credentials but also possessed of a questionable and often partisan-charged past, at worst the same but with no professional standing whatsoever.

As it happened, on the same day that WHO had published Olfert Landt’s test kit formula on its website, January 17, a sapped CDC in the U.S. announced that it had developed its own preliminary test for COVID-19. They’d decided to work on their own test. This decision was guided in part by regulation — and much of it for good reason. We didn’t want to open the door to fraudulent tests. But it was also a decision that occurred in the context of a global health emergency. And leadership from the top could have worked to ensure the protective needs of regulation were adhered to while still providing back-up options if the CDC-sponsored test kit development occurred too slowly or didn’t produce a usable test soon enough.

In other words, they could have cut red tape to enable medical industry in the U.S. to produce coordinate tests. Like South Korea, they could have called together industry heads and provided organization and guidance. Something a dedicated pandemic response team, had it been in place, could have helped to accomplish. Something a CDC head with novel pandemic chops like Anne Schuchat would have recognized the need for. CDC could have worked to validate those tests in conjunction with its own test. It could have used one of a number of WHO-validated formulas for these coordinate tests. It could have set up teams to work to validate multiple sets of tests to determine which ones were effective. It could have worked to set up contingency surge production if more tests were needed (as happened in South Korea and elsewhere).

The bio of Anne Schuchat — the kind of infectious disease expert that the U.S. is capable of fielding to head an effective pandemic response. The kind of expert the Trump Administration has repeatedly passed over in favor of less effective leaders. Image source: CDC.

Such a layered strategy did not develop at CDC under Redfield as head. At first, and for many weeks after, the decision by leadership was to support one testing regime and then to in a laissez faire way, ignore the fact that other agencies such as FDA ended up using existing regulation to defend it and to (unintentionally) stymie the independent development of effective tests in the U.S. In other words, through lack of response adequate to the threat of COVID-19, Trump’s CDC head put all their testing eggs into one basket.

Making Our Own Unluck

It all could have still worked out. The U.S. could have been lucky. The CDC test could have worked effectively. It could have arrived in time to help stop the virus. It could have arrived in enough numbers to meet the testing need. It could have been targeted to the regions that needed it most. Trump’s Redfield CDC hadn’t increased their likelihood of that success, though. They had greatly increased the opportunity for failure. And given that self-infliction of a worsened set of odds, things did not go well.

Development of the CDC test notably lagged behind the rest of the world. By January 21, the U.S. saw its first confirmed case of COVID-19. It was of a man who’d flown back from Wuhan, China and entered the U.S. on January 15. But it took another week — until January 28th for the CDC to provide its own test kit formula to WHO — 11 days later than Germany, four days later than China, and weeks after South Korea had developed an effective test protocol. Fully two weeks after the virus had arrived on U.S. shores.

It wasn’t until February 5 — fully 19 days after CDC’s first test protocol was announced — that a CDC under Trump had shipped 200 test kits to more than 100 public health labs across the U.S. These tests were enough to test 60,000 – 80,000 people if the kits proved effective. By the same time, WHO had shipped 250,000 tests that had already been validated. Globally, on February 5, confirmed cases had risen to above 28,000. In the U.S., 12 cases had been confirmed with cases springing up Washington State, Illinois, Wisconsin, California, Massachusetts, and Arizona. Given what we know about COVID-19, actual numbers were probably already much greater than these early confirmations indicated.

The virus had arrived on U.S. shores and CDC had scrambled to send out these test kits. But the test deployment would ultimately prove to be seriously problematic. The trouble with these U.S. tests ended up being four-fold. First, that they had not yet (by February 5) been validated and many would later prove useless. Second, there weren’t enough to meet demand. Third, many came too late. And fourth, test kit distribution was not targeted or weighted to the regions of highest need. Why the U.S. CDC response was so much slower and so poorly coordinated compared to those of other nations has not fully been explained. Nor has it been fully explained why many of the tests that CDC ultimately provided would fail. But this failure was arguably a major reason why COVID-19 would break out to such a great extent in the U.S. Why the U.S. would experience the worst first wave outbreak of this novel deadly illness. Because what ultimately happened was a serious failure to contain the illness once it reached our shores. To perform that detection, contacts tracing and isolation that was proving so useful in places like South Korea.

So by early February, CDC had shipped out about 200 test kits to public health labs across the country. Each kit contained enough material to test between 300 to 400 patients. But because kits were evenly distributed, places with much higher populations, places like public health labs in New York City which would later experience a devastating outbreak, only received enough testing material to test between 300-400 patients at that time. That’s 300-400 tests for a public health lab serving a city of 8.4 million souls.

According to a report from Kaiser:

The kits were distributed roughly equally to locales in all 50 states. That decision presaged weeks of chaos, in which the availability of COVID-19 tests seemed oddly out of sync with where testing was needed.

Another problem was that the test kits that were shipped out often proved faulty — lacking critical components that hobbled kits ability to produce results. So from February 5 to mid February — for about ten days or so — public health labs across the country were put in the position where they needed to validate CDC test kits. And, in most cases, the validation of a useful kit did not occur. By mid-February only about six public health labs had access to reliable tests. But the Trump-appointed CDC director Robert Redfield was at the time entrenched, defending those tests. He insisted that CDC had developed a “very accurate test.”

Global distribution of COVID-19 cases on February 20, 2020. Image source: World Health Organization.

At this point the official number of cases stood at 15. But we know that those numbers were growing unchecked. Mainly because the CDC test kits would prove inadequate. On February 24th, U.S. confirmed cases had jumped to 53 and health experts were saying that community spread was happening in the U.S. On the same day, The Association of Public Health Laboratories sent a plea letter to the FDA asking if states could develop their own testing protocols independent of the CDC. In a few days, FDA reversed its previous position of defending CDC tests as a national standard and allowed states to begin producing their own tests. By February 29, after 43 days, the CDC tests had only been used 472 times. An astonishingly small number compared to the 60,000 to 80,000 that the original test kits should have represented. The U.S. confirmed case total stood at 68. But hundreds more people had already been infected by the illness in the U.S. We just didn’t have much of a way to know who or where because the CDC-backed testing regime ended up being so abysmal.

March Explosion

In the race between testing to track the illness and COVID-19’s in-built imperative to grow beyond our control in the U.S., the virus was winning. It had gotten a big head start of about a month and a half.

By early March, as the number of tests in the U.S. was finally starting to expand, in large part due to rapid production of tests within states and independent of the Trump-hobbled CDC, U.S. confirmed case totals were rapidly shooting upwards. On March 7, confirmed U.S. cases had hit 435. Redfield on the same day noted about the CDC tests: “We found that, in some of the states, it didn’t work. We figured out why. I don’t consider that a fault. I consider that doing quality control. I consider that success.”

By the end of March the U.S. COVID-19 case total would be the largest in the world. This would necessitate a nationwide lockdown as containment failed risking hundreds of thousands of deaths. Image source: Worldometers.

In one more week, confirmed cases would multiply nearly sevenfold — hitting 2,770 by March 14. Tests were finally starting to work and be produced in larger numbers. But for the U.S., a new worrying statistic was starting to become evident — the number of positive cases per test was notably high. In total about 1 out of every 4-5 people receiving a test were testing positive. This was due to the fact that the primary location for U.S. testing was hospitals and emergency rooms. The U.S. did not have widespread dedicated test facilities like South Korea. So most people who got a test were already very ill. All of this was an indication that the U.S. barely understood even the tip of the COVID-19 iceberg that the country was slamming up against.

By March 21, the number of COVID-19 cases had again exploded — hitting 24,345 or nearly ten times their number from the prior week. States such as Washington, New York, and California were testing thousands of people per day now. And a disturbing understanding of the U.S. disease curve was starting to emerge. A model produced by the Imperial College in London projected that as many as 2.2 million people in the U.S. could die if the U.S. did not move strongly to mitigate the spread of the virus.

Moving To Mitigation as Virus Outruns Containment in a Big Way

Unlike testing, contacts tracing, and isolation, mitigation involves serious constraints on activity within the impacted regions. In effect it would mean lockdowns or stay at home orders for much of the nation. A kind of freeze placed on society and economies in order to reduce mass loss of life. We say reduce, because the mass casualty event for the U.S. had already gotten well out of the bag. Tens of thousands would already lose their lives as a result. The question now was between tens of thousands and hundreds of thousands or millions along with a smashed U.S. hospital system.

By March 31, U.S. cases had again exploded to nearly 190,000. Even more tragically, already more than 4,000 souls had been lost due to the virus. A Trump Administration that had promised to provide 27 million tests by that time had only seen the U.S. testing 1 million. And a good portion of these tests were provided not by the CDC or the federal government under Trump, they were provided by states who were forced to scramble to fill the yawning vacuum of a failed federal testing, contacts tracing and isolation response.

Most U.S. states now have more than 1,000 COVID-19 cases. Many now have more than 10,000 cases. The U.S. total will likely near 1 million by the end of April. This massive outbreak has forced large scale mitigation in which most states remain under stay at home orders. Image source: CDC.

Now states would have to step in again. This time to provide the mitigation necessary to prevent about 2.2 million deaths across the U.S., California’s Gavin Newsom issued a stay at home order on March 19, New York’s Governor, Andrew Cuomo, made a similar order just a day later on March 20th, Washington State’s order came on March 25th, Maryland’s own stay at home order began on March 30th. By the end of March, fully 42 states had issued a stay at home policy. A policy that would remain in place for many weeks to come. Containment had failed in a dramatic way. Testing still lagged well behind the need. People who wanted tests still couldn’t get them. And as U.S. COVID-19 case numbers climbed toward 1 million in April, testing would continue to lag the need for it in most places.

The result was a full-on move to mitigate COVID-19’s spread. But the failure to provide enough tests would still haunt the U.S. And a new issue with testing would emerge as debates on how to restart a hobbled U.S. economy in the presence of a widespread and terrible virus that had wafted its way into all corners of our nation would again emerge. Sadly, this debate would continue to include a tone of irrational defiance to advice provided by experts and to the larger threat posed by a deadly and as yet incurable illness from the Trump Administration and its political supporters.

(UPDATED)

Up next: It’s Everywhere Now — COVID-19 A Global Viral Wildfire

 

 

Effective Containment — How South Korea’s First Coronavirus Wave was Halted

“Testing on its own will not stop the spread of SARS-CoV-2. Testing is part of a strategy. The World Health Organization recommends a combination of measures: rapid diagnosis and immediate isolation of cases, rigorous tracking and precautionary self-isolation of close contacts.” — COVID-19 Epidemic in Switzerland.

“South Korea has emerged as a sign of hope and a model to emulate. The country of 50 million appears to have greatly slowed its epidemic … Behind its success so far has been the most expansive and well-organized testing program in the world…” — Science Magazine.

“We acted like an army.” — Lee Sang-won, an infectious diseases expert at the South Korea Centers for Disease Control in a statement to Reuters.

*****

If U.S. leadership, under Trump, failed to initially prepare for, recognize, respond to, and effectively communicate to the public on the issue of COVID-19, there was a whole new set of failures surrounding the issue of infectious disease containment. Specifically involving the federal provision of enough tests to the public and to various infectious disease and emergency response agencies to stop a rapidly mounting COVID-19 threat. This failure is a part of the larger response failure by Trump and his administration. In particular, this containment failure was so crucial that it deserves a separate mention (next chapter).

But before we dig into the Trump Administration’s specific failure to provide the tests needed to conduct a successful disease outbreak containment, to gain an accurate picture of the disease outbreak during mitigation, or to provide any hope for an effective reopening of the economy following any successful mitigation, it’s helpful to look at the response of a nation that did manage a successful containment of COVID-19’s first wave. For a rapid response by South Korea, primarily through mass production of tests and subsequent contacts tracing and isolation, squashed what could have been a much more substantial first wave outbreak and ultimately managed to greatly limit new daily cases.

Testing and Containment

Detection and identification of cases, testing which according to CDC is an essential tool for detecting infectious agents, isolation of confirmed cases, contacts tracing, and isolation of confirmed contacts. In a single sentence, this basically defines a strategy of novel infectious disease outbreak containment (based on CDC’s after action reports on SARS response and CDC’s FAQ on SARS).

Epidemic phases and response

Epidemic phases and response interventions. Detection and containment are key responses. Availability of testing is critical for this phase of infectious disease response. Image source: World Health Organization.

It’s used when there’s a new illness outbreak that can’t be effectively treated or cured and when that illness represents a significant threat to life, well being, and a functioning society. In recent years, detection and containment was effective in halting both the first SARS outbreak in 2002 and 2003 and the major Ebola outbreak of 2013-2016. Containment is itself only as effective as the ability to positively identify — often best done through symptoms screening by astute healthcare professionals and testing — a majority of the active cases and to, through contacts tracing, identify each person contacted by the infected individual(s) and to isolate all those involved. If there are not enough tests to measure the number of people infected, if the information management resources do not exist to trace contacts, and if isolation of cases and contacts is not conducted in an effective manner, then containment is unlikely to succeed.

Containment should not be confused with mitigation. But it can be used alongside mitigation as part of a comprehensive strategy of disease response. Mitigation is a strategy to be used either in conjunction with containment of a large outbreak or when containment fails and a widespread outbreak begins to result in disease amplification and/or presents a threat to the effective functioning of healthcare infrastructure. Mitigation often involves social distancing — which is, in effect, the pre-emptive isolation of large sections of society to reduce contacts and to slow disease spread (we’ll talk more about mitigation in a later chapter).

Contact Tracing

Testing and positively identifying cases enables a second aspect of infectious disease containment — contact tracing. This practice can identify cases quickly and, in conjunction with isolation, prevent illness spread. Image source: CDC and CFCF.

Testing and containment is very important in its own right. It can stop an illness in its tracks. It can save thousands, tens of thousands, hundreds of thousands, or even millions of lives. In the present context of the COVID-19 pandemic, containment has succeeded where testing was widely available and when contacts tracing and isolation was conducted effectively. And in the worst outbreaks — such as in the U.S. — containment failed, in large part, due to lack of the capacity to conduct a large number of tests. This failure resulted in a greater outbreak which froze the economy and required large-scale mitigation to slow disease spread, maintain the ability of hospitals to function, and to reduce loss of life from millions to tens or hundreds of thousands.

South Korea — Learning Hard Lessons From MERS

The story of South Korea’s successful response to the first wave of COVID-19 pandemic begins back in 2015 when MERS was producing a global outbreak of new infectious illness. MERS was another novel disease similar to SARS in that it impacted the human respiratory system and resulted in high death rates. It emerged from yet another climatologically hot region — the Middle East. And MERS was still another novel coronavirus. One also with an ultimate origin in bats. However, MERS is thought to have a zoonosis due to harmful interactions between humans and camels. How MERS spread to camels from bats and then to humans remains somewhat unclear. Though it is thought that the consumption of poorly cooked camel meat is a likely vector for transfer of this new illness to human beings.

MERS was far more deadly than SARS — resulting in mortality in about 1/3 of those infected. Its geographic region of origin was the Middle East. And since the time when MERS was first identified in 2012, approximately 2519 individual infections have been reported on a global basis.

MERS MAP

A map of MERS transmission and outbreaks. Human outbreak areas shown in red and blue. Note South Korean outbreak in upper right. Image source: WHO.

In 2015, South Korea had its own tough brush with MERS. At the time, a South Korean businessman became ill after a trip to three countries in the Middle East. He sought treatment at three South Korean health facilities before he was diagnosed with MERS and put under isolation. But his contacts over the interim period ultimately resulted in 184 MERS infections within South Korea and 38 deaths. During this period, South Korea conducted a major response effort to contain the horrifying illness. The prospect of a major epidemic sent alarm signals through the country, slowed its economy, and traumatized the public. In response, South Korea produced a, then major, testing, contacts tracing, and isolation response in order to contain the illness. In the end, over 17,000 people were quarantined in an effort that ultimately quashed the outbreak.

Alertness, Training, and an Early Response

Pneumonia-type illnesses appear to have ingrained themselves on the collective consciousness of South Koreans during recent years. The 2015 MERS outbreak was viewed by many as a wake-up call. But the earlier 2002-2003 SARS outbreak and a general understanding of the risks of new coronaviruses appear to have made their cultural mark as well.

Back in December of 2019, according to reports from Reuters, two dozen top infectious disease experts in South Korea conducted a tabletop exercise. The scenario was oddly prophetic — a family becomes infected with a pnemonia-like illness after a trip to China. In the scenario, the new illness could have been a new form of influenza or a coronavirus like MERS or SARS. The exercise left its mark. And the lessons learned from it would be crucial to South Korea’s rapid escalation.

Just one month later, South Korea was organizing a response to an actual coronavirus pandemic emerging from China. And they were about as ready as they would ever be due to a combination of preparation, concern, and apparent luck.  On December 30 of 2019, China and WHO collected and analyzed samples of the novel coronavirus and then communicated first findings. And on January 4th, just five days later, South Korea’s infectious disease experts had access to a test methodology to positively identify COVID-19 cases. This was three days before China had genetically identified the new virus, it was five days before Chinese scientists uploaded a copy of SARS-CoV-2’s genome into an international repository. On January 9th they began lab testing for COVID-19.

They’d learned their lesson from MERS — quick response was absolutely necessary. And top experts still had the recent tabletop exercise fresh on their minds. But they still didn’t have a commercial, mass producible, test. The early testing methodology was slow. It could only manage a small number of cases at a time. As the disease began to rapidly expand in China, South Korean infectious disease experts feared they’d need something that was easily replicated on a mass scale.

On January 27th, South Korean infectious disease control personnel had detected just four cases of COVID-19 but they feared an epidemic. And their fears were rational. They’d experienced the explosive growth of MERS just a handful of years earlier and experts were starting to get hints that COVID-19 was a deceptive illness capable of both eluding detection and rapid expansion without widespread testing and isolation. On the same day, South Korean CDC officials summoned 20 heads of the nation’s medical industry. Their goal — turn South Korea’s lab test into a mass-produced, easy to use, diagnostic test. Just one week later, a diagnostic test produced by one of these companies was approved by South Korea’s CDC.

Lee Sang-won, infectious diseases expert at Korea’s Centers for Disease Control and Prevention, noted to Reuters — “We acted like an army.”

From Testing to Containment — South Korea’s Close Call

The problem with containing a disease like COVID-19 is that it is capable of seriously explosive spread. A single person infected with this illness who gets into a tightly packed setting with a large group or that moves rapidly from person-to-person can become what in disease parlance is known as a super-spreader. On February 18, just 11 days after South Korea had approved a commercially mass-producible test for COVID-19, a woman presenting symptoms who would represent South Korea’s 31st official case tested positive.

She was 61 years of age and, like many of us, she was a social person who delighted in her community. Part of her community was a rather large mega-church — the Shincheonji megachurch in Daegu, about 240 kilometers southeast of Seoul. When her contacts were traced it was found that she attended two services — one on February 9th and another on February 16th. At the time, she was already feeling slightly ill. In the church — 500 attendees would sit, tightly packed, through each 2 hour service.

South Korea Coronavirus Cases

Infection curve for South Korea shows a major spike in cases during late February and early March, then a rapid flattening that experts attribute to mass testing and isolation enabled by widely available tests for people with symptoms. Image Source: Worldometers.

From February 17 through 29, South Korea experienced an explosion of cases jumping from 31 to 3150. The vast majority of these new cases came from members of the Shincheonji megachurch. At this point, South Korea’s outbreak was the largest outside of mainland China. It was an outbreak that threatened to overwhelm the nation of 51 million people. South Korea’s 130 disease detectives were initially swamped by the Shincheonij-centered outbreak. More than 80 percent of patients with respiratory symptoms from this single outbreak were testing positive and the resources of South Korea’s traditional CDC response force was chiefly focused on this one cluster.

South Korea’s disease response teams were reeling. And without the earlier prep-work, they would have surely failed. As it was, South Korea just barely responded in time to prevent a much larger outbreak.

Responsible Governance Leads to Disease-Fighting Success

South Korea’s fast-tracked testing, contacts tracing and isolation system arrived in late February and rapidly expanded into March. This fast-tracking provided a key new disease response capability exactly when it was needed. By the end of February, just as its outbreak was ramping up, widespread road-side testing centers were opened. These centers were specifically set up to manage infected persons. Staff had personal protective equipment (PPE). They’d been trained in proper infection containment and sanitation protocols. And, in total, these centers were capable of testing thousands of people each day.

Drive Through Testing South Korea

One of South Korea’s many drive-through testing centers. At this location, healthcare professionals wearing personal protective equipment (PPE) administer a COVID-19 test. Image source: Government of South Korea.

In addition, specialized government isolation centers were opened for persons infected with COVID-19 — adding an outside capacity that reduced stress to hospitals. People who tested positive were required to download an app on their phone that traced their past movements and contacts. These contacts were also required to download the phone app and to self-isolate. Violators of the self-isolation policy were fined a 2,500 dollar equivalent.

This larger second line of defense enabled South Korea’s health officials to capture cases and conduct larger isolation outside of the initial disease cluster. A massive public health defense infrastructure that effectively sprang up overnight in response to the illness. One that ultimately prevented larger spread, wider sickness, increased illness amplification and death, and a need for even larger resource allocation to fight the disease. A national resource that would prove crucial.

Looking at South Korea’s infection curve, you can see how effective South Korea’s policy of rapid response containment has been. The results speak for themselves. They should count themselves fortunate for the responsiveness and responsibility displayed by their national government and leading healthcare professionals. Their first wave infection curve would have been much worse without it. It could have looked like Italy, or worse, the United States.

(UPDATED — Clarification on South Korea research testing timeline vs China’s COVID-19 research and coordination with WHO.)

Up Next: The Trouble With Testing Part 1 — “No Responsibility at All”

Denial, Defunding, Downplaying — First COVID-19 Leadership Failures

“Decades of climate denial now appear to have paved the way for denial of Covid-19 by many on the right, according to experts on climate politics.” — Inside Climate News.

“The Democrats are politicizing the coronavirus… and this is their new hoax.” — Donald Trump.

“Just left the Administration briefing on Coronavirus. Bottom line: they aren’t taking this seriously enough. Notably, no request for ANY emergency funding, which is a big mistake. Local health systems need supplies, training, screening staff etc. And they need it now.” — Democratic Senator Chris Murphy

“Now, I want to tell you the truth about the coronavirus … Yeah, I’m dead right on this. The coronavirus is the common cold, folks.” — Rush Limbaugh

“It’s going to disappear. One day, it’s like a miracle, it will disappear.” — Donald Trump

“President Donald Trump has repeatedly undermined science-based policy as well as research that protects public health.” — the Environmental Data and Governance Initiative.

*****

In the ancient story, the prophet goes to confront the king. The prophet says — the Babylonians are coming, we must prepare, we must try to save our people. And the king says — I don’t believe it.

This is tragic. But it is also a dramatic failure of leadership and of a leader’s basic responsibility to protect those she or he serves. Because the point where disaster becomes inevitable is not when news of danger arrives. The point where disaster becomes inevitable, in the face of great danger, is when leadership sabotages itself and everything that relies on it. In the ancient story, the king’s denial is the death-knell for his civilization.

Science Denial As Climate Crisis Enabler

In America, we’ve done our best to remove ourselves from the curse of kings and their blind, cowardly, selfish pride that can hurt so many. But we are not immune to it. Far from it, with the political right now enamored with a novel authoritarianism, we are intensely vulnerable at this moment in history.

It is a vulnerability that we have seen play out again and again in the context of the climate crisis. With Inhoffe’s snowball in Congress, with Trump calling climate change a Chinese hoax during the 2016 election, with the thousands of false climate messages sent out by organizations like the Heartland Institute, with the ongoing attacks on climate scientists coming from platforms like Fox News, right-wing talk radio, and social media.

Even worse, we’ve seen this vulnerability of playing to unfettered and corrupt authority mutate into the climate crisis denial policies — huge subsidies for fossil fuels, erosion or removal of pollution controls, removing clean vehicle standards, hobbling or delaying clean energy systems like wind, solar, and EVs, smearing helpful policies like the Green New Deal, misinforming the public on the efficacy of climate solutions, attacking IPCC findings even while working to water down IPCC messaging, and attacking helpful global climate policies like Paris from every angle imaginable. In this way, a politics of denial becomes a platform both for harmful policy and for harmful behavior.

Anti-Science Denial Becomes Bludgeon 

A new vulnerability emerged with COVID-19. A kind of right wing systemic weakness resulting from years of failure to listen to experts and to support the institutions that protect both those of us in the U.S. and people around the world from the ravages of a wave of emerging and re-emerging infectious illness. This vulnerability became visible as China was grappling with a monstrous outbreak during December of 2019 and January of 2020. It became still more apparent during February as COVID-19 threatened to go global, to strike deeply into the U.S. population as well. And by March the various failures of the Trump Administration would result in the U.S. suffering the worst of any nation from COVID-19’s global first wave.

But the failures of leadership that paved the way for COVID-19 to rapidly expand began months and years before. It began with anti-science and anti-public-health Trump-lackey-type Republicans taking control of the executive branch of the United States.

Sabotaging Global and US Pandemic Preparedness

The story of the Trump Administration’s erosion and removal of key U.S. and global protections in the time before the Coronavirus outbreak is extensive. We will touch on some of its highlights here. In short, the removal of protections was deep, it was systemic, and it arose from both the Administration and its supporters’ operating ideology which included actively eroding national and global institutions. It also centered on Trump himself — who seemed unwilling to listen to even his own followers, taking any seeming or perceived contradiction as an insult. Moreover, presented with facts, Trump has repeatedly seemed to consider them an affront to him personally. In this case, Trump and his loyal and unquestioning followers targeted the very institutions aimed at keeping our populations well.

2018 was the first fiscal year budget request by the Trump Administration. This graph by Kaiser is one indicator of how much Global Health was de-prioritized in the transition from Obama to Trump. Image source: Kaiser.

According to reports from Foreign Policy, in 2018 the Trump Administration fired the government’s entire pandemic response chain of command. This included the management infrastructure for pandemics within the White House. An observation that has been broadly validated.

In 2018, the Trump Administration also sought deep cuts in a program called the Global Health Security Agenda (GSHA). The program was aimed at shoring up other countries ability to detect pathogens. The GHSA aimed to set up a global early warning system for new outbreaks of infectious diseases.

In July of 2019, the Trump Administration told an infectious disease expert then in China whose job it was to assist Chinese disease response and to facilitate information sharing between the U.S. and China during a disease outbreak that her job was defunded. This caused her to leave her post. Overall, the Trump Administration dramatically reduced disease response capability in China. According to The Guardian, 11 CDC staffers charged with disease response were cut to three people, while 39 workers who supported them were reduced to 11 people.

In addition, Trump Admin budget requests have asked for a reduction in CDC funding by 15-20 percent for each of the past years. Coordinately, Trump’s attempts to defund the Affordable Care Act would have reduced CDC funding by a further 8 percent. Congress (primarily due to the efforts of Democrats) ultimately restored funding removed in Trump’s budgets. So these cuts did not fully occur. That said, the attempted cuts show the Trump Administration’s preference for disease preparedness erosion. In the end, Trump leadership was still corrosive to the CDC. According to a report provided by the Environmental Data and Governance Initiative:

“President Donald Trump has repeatedly undermined science-based policy as well as research that protects public health. That undermining has eroded our government’s capacity to respond to the coronavirus — from the White House itself to the labs and offices of the Centers for Disease Control (CDC), the federal government’s lead agency for science-based public health. The Trump administration’s widely-reported disbanding of the National Security Council’s directorate charged with global health has, according to many experts, hobbled the United States’ efforts against this pandemic.”

It was a hobbling that not only made the U.S. less prepared, it also set the global field — allowing any new epidemic outbreak to proceed undetected longer, to expand more rapidly into epidemics due to lack of disease response personnel, it disrupted global communications on the issue of illness, and it cost us dearly in both needed response time and lives of those who would not have been infected otherwise.

Ignoring the Severity of the Threat and Confusing the Public

The Trump Administration’s adversarial relationship with the front line soldiers in the global war on infectious disease early-on quickly morphed to a brazen denial of both the threat posed by the disease itself and the need for a strong response once it did emerge.

The timeline for these initial response failures — both a failure to take the threat of the virus seriously and communicate that seriousness to the public and the failure to provide adequate testing (next two chapters), contacts tracing, containment and isolation early on — occurred during January, February, and early to mid-March of 2020 as the disease first mostly ravaged China, then appeared overseas at first in large numbers in places like South Korea (high case numbers were, in part, due to an aggressive testing regime resulting in a clearer outbreak picture there) and then Iran with small numbers of cases elsewhere. By the end of February, it was clear that Italy was seeing uncontrolled spread of COVID-19 as well (with around 2,000 reported cases at the time). And by early-to-mid March it was apparent that both the US and large swaths of Europe were in the same boat.

Painting False Comparisons with Seasonal Flu and “Moving to Zero” in a Few Days — Trump’s Long March of Misstatement

Trump’s downplaying statements began in January and continued on through mid-March. On January 22nd, Trump stated to CNBC “We have it totally under control, It’s one person coming in from China, and we have it under control. It’s going to be just fine.” This initial major statement came notably late — weeks after first warnings (December 31) from China and WHO, and five days after CDC, in an almost unprecedented move, sent 100 disease screeners to U.S. airports. Trump’s statement was also apparently contradictory to CDC’s own statement on January 21st in which Dr. Nancy Messonnier noted “We do expect additional cases in the United States and globally.”

On January 23rd, CDC advisers reported to CNN that they were concerned that China hadn’t released enough basic epidemiological data about the virus. The next day, Trump apparently contradicts CDC again tweeting his praise for the Chinese government’s transparency and saying “China has been working very hard to contain the Coronavirus. The United States greatly appreciates their efforts and transparency. It will all work out well…” By the next day, on January 25, there are 1,000 global confirmed cases of COVID-19. By the 26th of January, China reported that the disease can infect people and be contagious before displaying symptoms.

On January 30, 7 cases have been confirmed in the United States but the country is starting to show its woeful lack of testing capability (more on this later), the World Health Organization declared a public health emergency of international concern, the U.S. State Department issued a ‘do not travel’ warning for China. Trump states on the same day: “We think we have it very well under control. We have very little problem in this country at this moment — five — and those people are all recuperating successfully.” This under-counted the official number and stood in contradiction to WHO and U.S. State Department warnings. On January 31, Trump barred many travelers from China. The Administration will later hold up this single, disorganized, inadequate by itself, and too late in retrospect action, as a ‘strong response.’ According to the New York Times, more than 430,000 Chinese still made it to the U.S. despite Trump’s travel ban (40,000 of which arriving after the ban was instated). Trump would later try to turn the blame for the virus onto the Chinese people, in statements that many described as race-baiting and which were reported to have set off a wave of acts of violence against Asian people living in the U.S.

By February 6, the virus was rapidly spreading with 25,000 known cases worldwide. In the following days, Trump would show stunning, and unfounded, optimism stating on February 7 that China will be successful in fighting the virus “especially as the weather starts to warm & the virus hopefully becomes weaker, and then gone.” Infectious disease experts on the same day noted that there wasn’t yet any evidence that warmer weather would slow the virus. On February 10 and 12, Trump would repeat this unproven information stating: “looks like, by April, you know, in theory, when it gets a little warmer, it miraculously goes away.” And “as I mentioned, by April or during the month of April, the heat, generally speaking, kills this kind of virus.”

Local counties, city and state governments, were often forced to contradict myths spread directly from Trump about COVID-19 as a matter of public health and a life-saving measure. Image source: McLean County Health Department.

By February 19, the WHO was now tracking more than 75,000 confirmed cases globally. By February 24, the White House was requesting 2.5 billion in emergency aid funding due to COVID-19. At this point, there were 51 confirmed cases in the U.S. But actual cases were probably far more extensive as U.S. testing capability remained well behind the infection curve. Trump’s statement on this day was also rosy despite a very grim global and U.S. picture starting to emerge: “The Coronavirus is very much under control in the USA. We are in contact with everyone and all relevant countries. CDC & World Health have been working hard and very smart. Stock Market starting to look very good to me!” It’s also at this point that Trump began his counter-productive increased obsession over the stock market. On February 25, CDC again showed how out of touch Trump was with reality on the ground by stating that it expected to see both community spread and thousands of deaths in the U.S.

By February 26, Trump seemed bound and determined to overwhelm the dutiful reporting of infectious disease experts with utter nonsense. He made an odd comparison between COVID-19 and the flu and then he claimed that U.S. cases would be down to zero in a couple of days. For the sake of accuracy, infectious disease experts estimated COVID-19 lethality to be 10-40 times worse than the seasonal flu (as of this writing the disease has killed more than 100,000 people globally, more than 18,000 in the U.S., is the leading cause of death today in the U.S., and has a present global case fatality rate of around 6 percent or 60 times worse than typical flu). It’s also worth noting that at a time when the official CDC case count was 58, Trump falsely claimed the number was 15. Trump’s full statement is worth reading as an example of how delusional the deniers of scientific fact can become and how damaging such delusion is to our lives: “I want you to understand something that shocked me when I saw it that — and I spoke with Dr. Fauci on this, and I was really amazed, and I think most people are amazed to hear it: The flu, in our country, kills from 25,000 people to 69,000 people a year. That was shocking to me. And, so far, if you look at what we have with the 15 people and their recovery, one is — one is pretty sick but hopefully will recover, but the others are in great shape. But think of that: 25,000 to 69,000. … And again, when you have 15 people, and the 15 within a couple of days is going to be down to close to zero, that’s a pretty good job we’ve done.”

The next day, on February 27, there were 60 confirmed U.S. cases of COVID-19. Trump at this time was still living in the cloud of his self induced denial euphoria. His statement for the day was: “It’s going to disappear. One day it’s like a miracle, it will disappear.” On February 29 the refrain for Trump continued at the Conservative Political Action Conference in Maryland when he stated: “And we’ve done a great job… Everything is really under control.” Later it was confirmed that an attendee at the same conference tested positive for COVID-19. On the same day, health officials announced the first official COVID-19 death in the U.S. Later on the 29th, Trump would claim that: “we have far fewer cases of the disease then even countries with much less travel or a much smaller population.” Of course this statement would later be proven dramatically false as U.S. cases jumped to highest in the world on a numerical basis (as of this writing, U.S. cases are now rapidly closing in on half a million).

By early March, cases were notably surging in the U.S., but testing capability still lagged, so only the most severe or high profile infections were accounted for. Regardless, on March 4, 217 cases were confirmed in the U.S. On the same day, Trump was telling people: “Yeah, I think where these people are flying, it’s safe to fly. And large portions of the world are very safe to fly. So we don’t want to say anything other than that.” At this point such statements were directly risking life — it was like telling people to go to the beach in a category 5 hurricane. Conservative followers of Trump would make similar irresponsible statements risking harm to those who listened to them in the weeks and months to follow. It’s also worth noting that the coronavirus denial messages had extended to Trump’s flu comparison by this time as well. A poll conducted by Vox from mid-March found that 90 percent of Fox viewers felt it was safe to go out even as experts were increasingly recommending stay at home policies. But looking at this litany of Trump statements, it’s little wonder how many developed such a false sense of security.

To round out this account of live-action denial, on March 6 Trump began to downplay the lack of testing availability claiming: “Anybody that wants a test can get a test. … The tests are all perfect, like the letter was perfect, the transcription was perfect, right?” This as many Americans with symptoms were forced to wait in long lines only to be turned away when asking for a test. And by March 9, Trump is again making the false equivalency comparison with the seasonal flu: “So last year 37,000 Americans died from the common flu. It averages between 27,000 and 70,000 per year. Nothing is shut down, life & the economy go on. At this moment there are 546 confirmed cases of CoronaVirus, with 22 deaths. Think about that!”

We’ll pick up the thread of Trump misstatement in a later chapter. For now, we will mercifully break from his ongoing and delusional screed to take a look at how the Administration failed so miserably to provide the much-needed test kits that could have helped to contain COVID-19 in the U.S. even as the disease rapidly spread. To look at what could have been and to try to learn from the successful responses of other nations.

(UPDATED to include more information on Trump’s China travel ban in late January.)

Up Next: Effective Containment — How South Korea’s First Coronavirus Wave was Halted

COVID-19 First Outbreak — Viral Glass-Like Nodules in Lungs

“The chances of a global pandemic are growing and we are all dangerously underprepared.” — World Health Organization in a September 18, 2019 statement mere months before the COVID-19 outbreak.

“There’s a glaring hole in President Trump’s budget proposal for 2019, global health researchers say. A U.S. program to help other countries beef up their ability to detect pathogens around the world will lose a significant portion of its funding.” — From a 2018 NPR news report

*****

During recent years the world has swelled with new and re-emerging infectious illnesses. Ebola, HIV, and SARS were among the worst. And many were accelerated, worsened or enabled through various harmful interactions with the living world to include deforestation, the bush meat trade and the climate crisis. But these illnesses were not the only ones. Between 2011 and 2018, the World Health Organization had tracked 1,483 epidemics worldwide including SARS and Ebola. These illnesses had forced human migration, lost jobs, increased mortality, and major disruption to the regions impacted. In total 53 billion dollars in epidemic related damages were reported.

COVID-19 Lungs

Comparison of lungs of a Wuhan patient who survived COVID-19 — image A-C — to those of a patient who suffered death from the illness — image D-F. Both image sets show the tell-tale ground glass like opacities of COVID-19 in lungs. Image source: Association of Radiologic Findings.

By late 2019, before the present pandemic, a sense of unease had appeared to settle upon the global health, threat analysis, and infectious disease response community. The Global Preparedness Monitoring Board (GPMB) convened a joint World Bank and WHO meeting during September. The meeting brought with it a kind of air of dread. At the time, various climate change related crises were raging around the world and the general sense was that the human system had become far more fragile in the face of an increasingly perturbed natural world. At the conference, members spoke uneasily about past major disease outbreaks like the 1918 influenza pandemic that killed 50 million people. About how we were vulnerable to that kind of potential outbreak in the present day.

“While disease has always been part of the human experience, a combination of global trends, including insecurity and extreme weather, has heightened the risk… The world is not prepared,” GPMB members warned. “For too long, we have allowed a cycle of panic and neglect when it comes to pandemics: we ramp up efforts when there is a serious threat, then quickly forget about them when the threat subsides. It is well past time to act.”

And they had reason to be uneasy, for even as global illnesses were on the rise in the larger setting of a world wracked by rising climate crisis, reactionary political forces in key nations such as the United States had rolled back disease monitoring and response capabilities. It basically amounted to a withdrawal from the field of battle against illness at a time when those particular threats were rising and multiplying. And the responding statements of increasingly loud concern coming from health experts and scientists, ignored or even muzzled by the brutally reactionary Trump Administration, would end up being devastatingly prophetic.

Live Animal Markets Again Suspect

“We do not know the exact source of the current outbreak of coronavirus disease 2019 (COVID-19). The first infections were linked to a live animal market, but the virus is now primarily spreading from person to person.” — CDC.

*****

If the story of how SARS first broke out in 2002-2003 is not fully understood, then we know even less today about how the second strain of SARS (SARS-CoV-2 or COVID-19) made its way into the human population. What we do know is that the disease is closely associated to a coronavirus found in bats, that the disease transferred from bats or animals ecologically associated with bats and the virus (such as pangolins or civets) to humans through some vector, and that live animal markets remain high on the suspect list.  According to recent scientific reports, an intermediate host such as a pangolin, a civet, a ferret, or some other animal like the ones sold in wet markets probably played a role. Chinese health experts also identified a seafood and wildlife market in Wuhan as the original source of the new illness in January.

Regardless of its zoonotic genesis, COVID-19 made its leap into the human population sometime during late November or early December of 2019 in Wuhan, China where it began to spread. At first the spread was relatively slow. Or it seemed slow, due to the fact that the initial source of the infection was small — possibly just one person. But viral spread operates on an exponentiation expansion function. And like its cousin SARS-CoV, COVID-19 was quite transmissible — generating about 2.2 persons infected for each additional new illness.

Wuhan Suffers First Outbreak

At the time, no-one really knew how rapidly the illness spread. Some early reports of the disease seemed to indicate that it was easy to contain. That it wasn’t very transmissible. These accounts would prove dramatically wrong in later weeks. But this early confusion  about the risk posed by COVID-19 did hint at its nasty, sneaky, back and forth nature. About how it lulled the unprepared and the overconfident into a sense of false security early on. It also would later show that slower responses to the illness in its ramp-up phase would prove devastating.

By December through mid-January, Wuhan was dealing with an uptick in pneumonia-like infections. Having experienced SARS illness before, the region was put on alert after getting days of indicators that all was not right. These response efforts have been criticized as slow. How it happened is also opaque. One reason is that China was rather close-lipped about the outbreak’s rise on its soil at first. But another reason (an arguably much greater one) for this lack of clarity is due to the fact that many U.S. disease monitors charged with providing reports about the infectious disease situation on the ground in China and various other countries were removed by the Trump Administration in the years and months leading up to the outbreak.

Despite not providing a clear early picture of the outbreak, China did start to rapidly and effectively respond during December and January. In December, researchers received samples of the disease which they identified as a new coronavirus infection — naming it SARS-CoV-2. Once samples were available, both China and the World Health Organization (WHO) swiftly and dutifully produced tests to detect the illness. As of late January of 2020, China had 5 tests for COVID-19. At the same time, WHO began deploying tests to countries and by February the global health agency had shipped easily produce-able tests to 57 countries. This early availability of testing capability provided by WHO would prove crucial to the effective infectious disease responses of many countries in the follow-on to China’s disease outbreak.

Viral Glass Like Nodules in Lungs

Back in Wuhan and in larger China, it was becoming apparent both how deadly and how transmissible the new SARS was. From mid January 23 through February 18 — over a mere 26 days — the number of reported cases rocketed from around a hundred to more than 75,000. About ten times the total cases of the first SARS outbreak in 2002-2003. This even as China shut down large regions of the country, putting the whole Wuhan region on lock-down, and setting up dedicated COVID-19 testing and treatment centers. Notably, the new SARS-CoV-2 had become not only a serious threat to China. It was now a significant threat to the globe — one unprecedented in the past 100 years. A threat on a scale that disease experts had warned of during late 2019. One that if it broke out fully was more than capable of mimicking the 1918 flu pandemic’s impact and death tally.

China COVID-19 Cases

After rapid growth in COVID-19 cases in China, a strong national response has limited the first wave of outbreak in that highly populous country to just over 80,000. Image source: WorldoMeters.

The disease, which had first been seen by some as mild and easy to contain, had taken hold to great and grim effect. It produced direct and serious damage to people’s lungs. China’s dedicated mass testing centers quickly adapted to look for the tell-tale and devastating signature of COVID-19’s progress in the human body. A kind of viral glass like set of nodules that appeared plainly in scans of victims lungs.

As devastating as the disease was to individual bodies, it hit community bodies hard as well, producing mass casualties as about 15 percent of all people infected ended up in the hospital. A large number of these hospitalized cases required intensive care support (ICU) with ventilators and intubation to assist breathing. This put healthcare workers at great risk of infection themselves — because as with SARS — COVID-19 was not containable in the hospital setting without protective gear and masks (PPE). Early indications were that the lethality rate in China was around 2-3 percent or 20 to 30 times worse than the seasonal flu. Present closed reported case mortality for China now stands at 4 percent with 3,333 souls lost.

The progress of COVID-19 in an infected person was itself rather terrifying. Its ‘milder’ expression resulting in severe flu and pneumonia like symptoms with a number of other bodily responses to include serious spikes in blood pressure along with a manic variance in symptom severity. In hospital cases, victims often struggled to breathe to the point that they required oxygen. If the disease progressed, it produced serious inflammation — filling up lungs with fluid requiring support with machines for breathing. Late stage COVID-19 also attacked the body’s organs with inflammation, resulting in a need for multi-organ support in the worst cases.

Massive Outbreak of a Terrifying Illness

It was a nasty, terrible thing. It brought China to its knees — despite what ended up being a strong overall response by the country. At present, China is still recovering, still going slow with certain sectors of its economy despite limiting new cases to less than 100 per day.

The first outbreak in China was extraordinary in number of persons infected. So large as to be extremely difficult to contain through a well managed global response. But the response from key nations like the U.S. was not well managed. So through various contacts and travel vectors within the human system, this serious illness made its way out to the rest of the world. For the diligent contacts tracing and isolation, the early detection and response by international disease experts that had contained Ebola and the first SARS outbreak had been both hobbled and overwhelmed.

Up Next: Denial, Defunding, Downplaying — First COVID-19 Leadership Failures

The Emergence of Severe Acute Respiratory Syndrome (SARS)

“The message we are getting is if we don’t take care of nature, it will take care of us.” — Elizabeth Maruma Mrema, Acting UN Executive Secretary on the Convention on Biological Diversity.

“It boggles my mind how, when we have so many diseases that emanate out of that unusual human-animal interface, that we don’t just shut it down. I don’t know what else has to happen to get us to appreciate that.” — Dr. Anthony Fauci on live animal markets, aka wet markets, in Asia and elsewhere. 

“The term wet market is often used to signify a live animal market that slaughters animals upon customer purchase.” — X. F. Xan

“This is a serious animal welfare problem, by any measure. But it is also an extremely serious public health concern.” — Kitty Block, President and CEO of the Humane Society of the United States.

*****

As we come closer to the present time, to the present COVID-19 Climate of Pandemic, we run into illnesses that are more mysterious. HIV, for example, has been the object of intense investigation and scrutiny for many decades now. So the level of knowledge about how HIV emerged is quite rich. Less so with Ebola, but that infection is still moderately well understood.

SARS — Another Novel Illness

With the newer SARS illness — short for severe acute respiratory syndrome, the well of scientific understanding from which we can draw is far more shallow. But it is certainly relevant. For the present global pandemic which now has paralyzed our entire civilization and which threatens to take so many of our lives resulted from the second strain of human SARS to emerge in our world.

What we do know is that the SARS virus is another new zoonotic illness. The first strain of SARS broke out in a 2002 epidemic in China that then rapidly spread. It emerged from a family of coronaviruses. A set of viruses that typically cause mild respiratory infections in humans. But SARS virus is not mild. It is quite often severe — resulting in hospitalization in a high proportion of cases. It also shows a much higher lethality rate than typical illness.

SARS comes from a lineage, like HIV and Ebola, that had previously thrived in the hotter regions of the globe. It was harbored in tropical and subtropical animal reservoirs. It emerged at a time when animal sicknesses were likely amplified by direct environmental stresses caused by forest clear cutting, human encroachment, and the broader sting inflicted by the climate crisis. The novel awakening of SARS was, finally, yet another case where harmful contact with sick animals resulted in a transfer of a new illness to human beings. 

Coronaviruses in Hot-Bodied Bats in a Hot Weather Region

The first strain of human SARS illness was genetically traced back to a coronavirus ancestor in horseshoe bats — a tropical and subtropical bat species — in 2002 by Chinese researchers. Like the Ebola Virus and HIV before it, SARS-like illness circulated through various species in tropical and sub-tropical environments in a traditional reservoir long before transferring to human beings.

 

Horseshoe bat primary range

The primary range of horseshoe bats is paleo-tropical. Horseshoe bats, according to genetic research, are an animal reservoir of SARS virus. Image source: Paleo-tropical environment.

Studies note that bats are a reservoir for a great diversity of coronaviruses. The bat anatomy is a warm one in a hot weather environment — subject to constant exercise and exertion in regions where it’s not easy to cool off. Elevated body temperature is a traditional mechanism for fighting infection. So these viruses have to constantly adapt and mutate to keep hold in the bat population.

At some point, one particular strain of coronavirus jumped out of the bat population and into another animal species. A paper in the Journal of Virology suggests that the genetic split from bat cornaviruses and SARS occurred some time around 1986 or 17 years before the 2002-2003 outbreak. At that time, it is thought that this hot weather illness from hot-bodied bats had moved to another, intermediary, animal host.

SARS in the Little Tree Cats — Palm Civets

The first emergence of SARS is thought to have occurred when palm civets — a kind of Southeast Asian tree cat — consumed coronavirus inflected horseshoe bats. The civets typically dine on tree fruits. But as omnivorous creatures they also eat small mammals. In this case, civets are thought to have eaten sick bats and become sick themselves.

Himalay_Palm_Civet
The Palm Civet of Southeast Asia — hunted as bush meat for the Asian wet markets. A practice suspected for transferring SARS from bats to humans. Image source: Black Pearl, Commons.

Palm civets live throughout much Southeast Asia. Inhabiting a swath from India eastward through Thailand and Vietnam, running over to the Philippines and southward into Indonesia. A tree-dwelling creature, they prefer primary forest jungle habitats. But they are also found in secondary forests, selectively logged forests, and even parks and suburban gardens. All of which overlap the environment of horseshoe bats and their related coronavirus reservoir.

The leap from bats to civets and its development into SARS probably didn’t occur suddenly. Many civets probably consumed many sick bats over a long period of time before the coronavirus changed enough to establish itself. But at some point in the 1980s, this probably occurred.

From that point it took about 17 years for the virus to make its first leap into humans. How the virus likely made this move is eerily familiar — taking a similar route to the devastating HIV and Ebola illnesses.

Wet Markets — Butcheries For Asian Bush Meat

A major suspect for the source of this particularly harmful contact is the Chinese wet market system. A wet market is little more than a trading area that contains, among other things, live and often exotic animals for sale as food. A person entering a wet market is confronted with thousands confined live animals. They can point to a particular animal and a wet market worker will butcher the creature on the spot.

It’s literally a very bloody business. The butchering occurs in open air. Blood and body fluids can and often do splatter anywhere. As a result, the floors are typically wet from continuous drippage and, usually partial, cleaning — which is how the market derives its name.

Palm civets can often be found in wet markets as food in China. Trappers for the wet markets range the Southeast Asian jungles bringing in civets by the thousands. The civets were reservoirs for SARS virus. They were slaughtered in the messy markets. People were exposed. In 2002 and in 2019 they got sick.

Though palm civets have been identified by many avenues of research as a likely source of SARS, raccoon-dogs — whose meat was sold in wet markets — were also shown to be SARS type virus carriers. These animals have a similar diet to that of civets, share their habitat and were similarly vulnerable to infection from the bats. In addition, pangolins — a kind of scaly anteater — have been identified as a possible carrier of the SARS-CoV-2 virus. And pangolin meat is also sold for consumption in Vietnam and China.

Given our knowledge of how zoonotic illnesses move in animal populations, it’s possible that multiple species are involved in the ecology of SARS and related coronaviruses. In essence, there is a strange and ominous similarity between wet markets in Asia and the bush meat trade in Africa. They are both means of moving jungle meats from animals (who may be reservoirs for novel illnesses) in tropical regions into the human population. Often in a fashion in which the treatment and preparation of the meats to be consumed is haphazard and unregulated.

First SARS Outbreak — 2002-2003

Ultimately, the disease percolating through likely stressed natural systems found its way into the human population in late 2002. The epicenter was Guangdong Province in China where the highest proportion of early SARS cases by a significant margin (39 percent) showed up in people in the live animal food trade. In other words, people who butchered animals or worked closely with those who butchered animals.

The initial infections, which were traced back to November in China, resulted in spikes of pneumonia incidents in local hospitals. The cause — a then unknown illness that was later called SARS. SARS was another terrifying illnesses. Its symptoms could emerge rapidly or slowly over a couple of days or weeks. It could mimic flu-like symptoms before suddenly surging into a terribly lethal illness that attacked the lungs — rendering victims unable to breathe under their own power. At first, case fatality rates (the percentage of people who died as a result of SARS) ranged from 0-50 percent. The ultimate recorded fatality rate from the initial outbreak in 2002 would settle at 9.6 percent or about 100 times more lethal than seasonal flu.

SARS cases 2002 2003 outbreak

Cumulative reported SARS-CoV cases during the 2002-2003 outbreak. Note that early case reporting was incomplete. Image source: Phoenix7777 and WHO.

From the point of early infections, patients then passed on the virus to healthcare workers and others. Though SARS was not as crazy lethal as HIV and Ebola on an individual basis, it was quite infectious. Meaning it was much easier to pass on to others than either of those earlier emerging zoonotic illnesses. This higher transmission rate resulted in a greater risk that more people would fall ill from SARS over a shorter period of time — exponentially multiplying the virus’s lethal potential.

Transmission to workers in hospitals and care facilities was notable as typical sanitation procedures were not enough to limit virus spread. In hospital settings, the transmission rate for this first SARS illness (the number of people each infected person then got sick) was between 2.2 and 3.7. Outside of sanitized settings, the transmission rate ranged from 2.4 to 31.3. A particularly highly infectious patient, called a super-spreader, resulted in a mass spread of illness to workers at Sun Yat-sen Memorial Hospital in Guangzhou during January of 2003 and subsequently to other parts of China’s hospital system. Masks and protective gowns (PPE) were ultimately shown as necessary to contain SARS infection in hospitals.

China’s early failures to report on the 2002 SARS outbreak resulted in a somewhat delayed international response. But by early 2003, the World Health Organization was issuing warnings, advisories and guidance. Disease prevention agencies within countries issued their own responses including diligent contact tracing and isolation protocols. The containment response both within and outside of China was thus in full swing by early 2003. This action likely prevented a much broader pandemic. That said, a total of 8,096 cases were reported — 5,327 inside China and 2,769 in other countries. With the vast majority of cases occurring in China, Hong Kong, Taiwan, Canada, Singapore and Vietnam. In total, out of the 8,096 people reported infected during this first SARS outbreak, 774 or 9.6 percent, perished.

SARS-CoV-2 Tsunami on the Way

Unfortunately, infectious diseases show no mercy to fatigued and degraded infectious disease responses. They lurk. They mutate. In their own way, they probe our defenses. They are capable of breaking out to greater ranges when diligence, ability, or will to protect human life wanes among leaders. And a smattering of SARS cases reported during the 2000s following the 2002-2003 outbreak continued as a reminder of its potential. So as with HIV and Ebola, we face waves of illness with SARS. With the next outbreak resulting in a global pandemic that will likely infect millions and kill tens to hundreds of thousands during 2019-2020.

Up Next: COVID-19 First Outbreak — Viral Glass-Like Nodules in Lungs

 

Harmful Contacts with our Living Earth and Redounding Shots Across the Bow

About two-thirds of all infectious diseases in humans have their origins in animals. Scientists say the ability of a virus to mutate and adapt from animals to the human system is very rare, but the expansion of the human footprint is making that rare event much more likely. — Jeff Berardelli

Contact — the state or condition of physical touching.

Harmful or unwanted contact — an assault.

Redound (archaic) — to come back upon; rebound on.

*****

How do you get sick from a virus? In the most simple sense, the virus touches your skin, your eye, the inside of your mouth, your blood or some other part of your body. It makes contact. Then it gets inside to do its damage. Often, this is through some action that you take. Some voluntary, some involuntary. Breathing, moving, picking up objects, putting contaminated clothes or blankets on or venturing into environments where other carriers of the virus can touch you. Or even, in a broader sense, disturbing the virus carriers and changing their environment is such a way that makes it easier for them to literally come to your home community to roost.

Contact.

In the last chapter we briefly explored how the world houses many, many potential, new, and re-emerging illnesses. Kept away from humans in mostly safe or remote places. We also briefly looked at how those illnesses are expanding. In this chapter, we will take a deeper dive into the second part. To look at how some harmful elements and activities within of our civilization have wrecked some of those safe places, how they’ve gotten us into what amounts to a brutal embrace with the places and beings in living nature that are reservoirs to those illnesses. How in this epic and global struggle, often bad actions and behaviors have shaken some illnesses loose. How it’s all gotten many of us sick.

That’s our present and recent history. One of harmful contact. Of touching and grasping for things best left undisturbed. And how it’s getting worse. How the general disturbance is rippling outward and bounding back.

We’re living in a time of an explosion of new illness or the re-emergence of old illnesses previously thought contained onto the global scene. How this has happened first became a major part of the discussion among health and epidemic experts since around the 1980s. For at the time, we experienced one of our initial major warnings that diseases may be dedounding onto expanding global civilization. And this first warning came from a terrifying new illness. For HIV humbled a global health corps that until that point had seen a long string of victories arising from the advances in medical science during the 19th and 20th Centuries.

HIV — Major Warning Shot to the Global Health System

HIV heralded an ominous new era. One where victory against infectious illness was less certain or at least came much slower and at a much higher price than earlier medical science victories might have given us hope for. One in which disrupted, damaged, or harmfully contacted life (and its supports) appears to return a toll on humankind as various enormous and harmful activities spread — burning, deforesting, killing and eating, and polluting their way across the globe.

virus3d rendering of a virus

3D rendering of HIV. Image source: National Foundation for Infectious Diseases.

Since its first outbreak as a pandemic during the early 1980s, HIV has infected over 75 million people of which around 32 million have died as a result of an illness that jumped to human beings from primates. Many deaths occurred early in the pandemic outbreak as first treatments were mostly ineffective. But even today HIV kills between 500,000 and 1,100,000 people each year (770,000 during 2018).

HIV originated in the broader African rainforests. There its progenitor reservoir existed as semian immuno deficiency virus (SIV) in the great apes and monkeys of the jungle for more than 10,000 years. All without transferring to humans until very recently. Our best present understanding is that the ultimate zoonosis occurred due to the bush meat trade in Africa which produced multiple contacts between SIV in apes and the blood of humans.

Hunting, Rubber and Bush Meat

The story of the bush meat trade is one that should be eerily familiar to those researching the climate crisis. Because it is also a story of forced displacement of human populations which then results in a harmful interaction with the natural world and subsequent damaging upshots. In the period from around the 1880s to the 1920s, sub-saharan Africans were forced from their native rural homes in droves as waves of Europeans descended on the jungles of Africa.

The Europeans wanted elephant tusks from the hunting trade to be sent home to Europe. They wanted rubber vine sap for industrial uses. They wanted to commoditize the jungle for these and other products. But often the Europeans didn’t have the manpower or local knowledge to conduct effective hunting expeditions into the jungle without the help of native populations. And they needed a local labor force for the rubber vine trade. Tribal Africans were pressed into service for the expeditions and the industrial exploitation of jungle plant products, often at the point of a gun.

This was a kind of mass invasion of the jungle in which abused and often under-nourished natives needed a new food source to survive. Rural subsistence agriculture wasn’t a possibility for a constantly mobile porter in an elephant hunting expedition. Nor was it for rubber plant harvesters or those newly impressed into factory work in burgeoning cities.

Bushmeat

“At this bushmeat market in Pointe Noire, a butchered chimpanzee is shown in the middle of the photograph, along with other smoked and fresh meat. It has been theorized that SIV moved from chimpanzees and sooty mangabeys to humans—evolving into pathogenic HIV-1 and HIV-2 respectively–through exposure to primate blood, most likely as a result of the bushmeat trade. The HIV-1 group M epidemic likely began in the region of Kinshasa, Democratic Republic of Congo. Although wild chimpanzees are not found in the immediate vicinity of Kinshasa, the city is situated on the Congo River, which allowed for the easy transport of SIV-infected bushmeat and of infected humans from rural to urban areas.” Image and caption source: Physicians Research Network and the Goldray Consulting Group.

So a kind of shadow trade in bush meat arose. Porters on hunting expeditions would opportunistically kill and butcher the jungle animals they came into contact with to supplement their diets. It was an ironic and ominous outgrowth of the abuse handed down to the native Africans by the Europeans. It was almost as if they’d been corrupted by the hunting and killing they were forced to take part in such that it became a new means of survival for them.

The Monster that Lives in the Jungle and the Monster that Lives in Us

Various strains of SIV lived in the blood of apes and monkeys in Cameroon and Sierra Leone. Porters and laborers driven into the jungle killed and ate their hominid relatives to survive the European expansion into Africa and its subsequent exploitation. Hunted chimps and monkeys fought back. They bit. They flung feces. Tired porters and laborers hunting chimps after endless hours of work made mistakes. They missed when cutting chimp meat off of bones. They under-cooked bloody meat. They cut themselves with bloody knives containing the blood of their hominid fellows. The SIV living in the blood of the monkeys and apes its way into the blood of the porters and laborers. It happened many, many times.

At first, SIV was a mild virus in humans. It didn’t live well in the new host. But viruses are weird. Like life, they mutate. They change. They adapt to new environments. If there is one prime directive a virus has in its intrinsic design it is to self-replicate. At some point in all the butchering and eating and messy cutting or in the conflicts between the people hunting the apes and monkeys for food and the fighting creatures struggling for very existence, there was an SIV transmission into humans that caught fire. Changing from the mild SIV to the raging and lethal human immuno-deficiency virus that we know today.

It had to have happened multiple times. We know this, in part, because there are not one but two progenitor strains of HIV — HIV 1 which links back to apes and chimps in the Cameroon region and HIV 2 which links back to Sooty Mangabays in the Sierra Leone and Ivory Coast region. A grim bit of evidence pointing to how widespread the harmful contact was that resulted in the virus’s leap into humans. The point in time at which the consistent leap was made is thought to have occurred in the pre-World War 2 period — possibly as early as 1908.

Once the leap happened, the machine of exploitation in Africa that the colonialists had set up then served to help spin the virus out into the broader human population. Industrial centers and related communities had sprung up around the animal products and jungle harvesting trades. And in those centers prostitution of various kinds was rampant. Already established human illness such as syphilis, chlamydia and gonorrhea became widespread in Africa. These illnesses assisted the spread of HIV into hundreds of people by the mid 20th Century. This created a consistent viral HIV reservoir in humans from which the major pandemic later emerged.

Ebola — Novel Jungle Hemorrhagic Fever

If HIV was the first known serious illness to arise through harmful human interactions with ancient tropical and subtropical disease reservoirs, it became sadly apparent early on that it would not be the last. More human beings were coming into contact with the old animal disease reservoirs moving from previously sequestered habitats than before.

Ebola cdc

An electron microscope image of Ebola virus. Image source: CDC.

Cities were extending into the jungles, animals carrying illnesses foreign to humans were moving into those cities. Deforestation and slash and burn agriculture was displacing them, driving them. And in most new places that the animals moved there were human beings as well. A new harmful interaction, the climate crisis driven by fossil fuel burning, was also beginning to heat up the world. This served as a new pathway for expansion — increasing the habitable range for creatures used to hot weather and typically averse to cooler climes. This greatly increased and continues to increase the spatial range of tropical and semi-tropical illnesses capable of infecting people.

Of the jungle fevers that arise from the hot regions of the world, that are carried by animals that live in this heat, the viral hemorrhaigc fevers are perhaps some of the most terrifying. Like HIV, they are seriously lethal — tricking the body’s immune response in a way that enables them to multiply out of control. Directly attacking the body’s linings, they thus cause such great cell death that they effectively blow holes in tissue. This breaks down the body’s integrity causing loss of fluid and ultimately bloody hemorrhage.

From Viral Brush-fire to Conflagration

The first instances of Ebola occurred in 1976— in Sudan and then in Zaire. These initial infection outbreaks were highly lethal and terrifying to the local populations effected. Of the 284 people suffering from the Sudan strain of the virus, 151 died. In Zaire, 280 out of the 318 infected souls (88 percent) perished. For a relatively short-lasting infection, Ebola was amazingly lethal. Though later, less deadly strains emerged, many of the outbreaks to follow would continue to kill a surprising number of those afflicted. Presently, the World Health Organization estimates the lethality rate for Ebola, overall, at 50 percent. Sudan and Zaire both hosted different strains (SUDV and EBOV) of the same virus — Ebola — which was named after the river region from which it emerged.

It is still not fully known how the deadly Ebola virus first made its leap into humans from animals. But it is well known that tropical fruit bats, porcupines, and primates — yes our poor hominid relatives again — can carry the virus. As with HIV, the harmful bush meat trade is one of the key suspects. Although with Ebola, there are many other possible modes of zoonosis from animals to humans.

The virus is more transmissible than HIV, though less so than many other illnesses, such that direct contact with blood, secretions, organs or other bodily fluids of infected people or animals, and with surfaces and materials (like bedding and clothing) contaminated with these fluids can result in sickness. It is thought that eating fruits partially eaten by fruit bats, food contaminated by bat or other infected animal feces, or consuming bush meat are all means of animal to human transfer of the illness.

Ebola Jungle Ecology CDC

Initially, the bush meat trade was a prime suspect for transmission of Ebola to human beings. Presently, it’s understood that other contacts with infected animals or their bodily fluids may transmit the virus. Also, at first, Ebola primarily impacted areas bordering the jungle. But in recent outbreaks, major population centers have been impacted. Image source: Ebola Virus Ecology — CDC.

Notably corpses of both humans and animals who were killed by the illness remain infectious for some time — requiring special burial. The disease typically spreads from human to human through direct contact with the blood, semen, saliva, vomit or other body fluid of infected persons. Surfaces contaminated by these fluids are also a means of infection. The virus is thankfully fragile in air, but splashing with droplets can transfer illness. And the virus is known to live in droplets on surfaces for up to 3 days.

After Ebola first burst onto the scene in 1976, there was a long hiatus of epidemic outbreaks in humans. Some thought, hopefully, that the disease had faded back into its tropical environs. But in 1995, nearly two decades after its first emergence, the virus broke out among humans in Zaire again — this time infecting 315 and killing 254. Subsequent outbreaks occurred every five years or so leaping to Uganda in 2000 (425 cases, 224 deaths), the DRC in 2003 (143 cases, 128 deaths), again in DRC in 2007 of a less lethal strain (149 cases, 37 deaths) and in 2012 in both Uganda and DRC yet again in three separate outbreaks (Uganda — 31 cases, 21 deaths; DRC — 57 cases, 29 deaths).

Thus far, outbreaks of the novel illness had been relatively small if intense viral brushfires. And, though lethal, the virus was thought be inhibited in transmission. A major outbreak spanning from 2013 through 2016 would belie that impression. Looking back, the illness had mostly been confined to small settlements bordering jungle regions in the 1976 to 2012 timeframe. But in 2013 and 2014 the virus, possibly through the enlarging span of its animal reservoirs, penetrated into more densely populated urban and city environments. From these more packed regions the virus would explode to rage out of control for years — consuming many thousands of human lives.

The West African outbreak which would hitherto dwarf all previous episodes of Ebola began in late 2013. Then, a one year old child perished from Ebola infection from an unknown source. Afterward, the disease rapidly spread through her community in Guinea, out into the local region and then on through the nearby countries of Liberia and Sierra Leone. What precipitated was a global health emergency that reached catastrophic proportions by summer of 2014 with the virus overwhelming the medical capacity of impacted countries. At this point the illness threatened to go global — with a handful of cases leaping to neighboring countries in Africa and even transferring overseas. But intense contact tracing and strict isolation both inside and outside the virus hot zone was largely responsible for preventing further spread.

By the end of the outbreak in 2016, an estimated 28,646 infections had occurred of which 11,323 were reported to have died. Ebola had risen from the ranks of a fringe if rather scary illness cropping up on the outer edges of society to an illness striking directly at the bones of global civilization. It had shown its ominous potential.

Subsequent outbreaks in 2017 and 2018 in DRC and Equateur Province mirrored previous less widespread infections. But a new outbreak that began in 2018 in the Kivu region of DRC and extends to today is considered a global health emergency by WHO. This particular outbreak as of 29 March, 2020 is reported to have infected 3453 people of which 2273 have died.

Warning Shots Across the Bow

Both Ebola and HIV served as early warning shots across the bow of global civilization. Visible signals that the risk of catastrophic emergence of new infectious illness was on the rise. That our harmful contacts with the natural world were the primary source of this rising risk. And that many, many more human souls may be at stake. These two novel illnesses were not the only major emergences to occur in this time. In fact, a plethora of new and re-emergent sicknesses have come onto the global scene over the past four decades. But they both represented the ominous character of the larger risk human beings now faced. They also foreshadowed the follow-on emergence of SARS into a major global pandemic — which we’ll be talking about in the next chapter.N

(Up Next — The Emergence of Severe Acute Respiratory Syndrome)

%d bloggers like this: