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)

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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?

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

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

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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.

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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

From Ancient Reservoirs

“The insidious emergence of HIV/AIDS and the lack of due attention by policymakers illustrate how some outbreaks that start subtly can grow to global proportions if they are not aggressively addressed early on.” — Dr Anthony Fauci

The Infectious Diseases Society of America recognizes climate change as a global health emergency and calls for policies responding to the intrinsic links between warming temperatures and rising sea levels and epidemic and pandemic events as well as other infectious disease threats to public and individual health. — IDSA

The climate system of our world envelopes it.

It represents the state of our atmosphere, our oceans, and the frozen regions we rely on. It interacts with and influences all things living here on Earth.

The present changes we now experience due to a climate in crisis are far-reaching. Disruptive to the balance of life itself. Harmful or even demolishing to ecosystems. Driving species of all kinds into new environments after their old safe places have been changed, disrupted, or taken away.

This is a story that we have become sadly familiar with as the burning of fossil fuels keeps dumping heat-trapping carbon into our atmosphere — resulting in rising seas, melting ice, stronger storms, worsening droughts, expanding heat, and far larger and more dangerous wildfires.

Global examples of emerging infectious diseases NIH

Global examples of emerging and re-emerging infectious diseases. Even before COVID-19, they were growing more numerous. Back in the early 1990s, this map showed just one illness — HIV. To humans, quite a few are now rather new. Others are re-emerging. Many are influenced by the climate crisis in various ways. Image source: Three Decades of Responding to Disease Outbreaks — NIH.

But there is one aspect of our changing climate that is often nuanced and overlooked — how the climate crisis can influence the spread of disease itself. How a disrupted global climate can drive sickness up out of the ancient reservoirs that have harbored it throughout the ages. How it can help accelerate the spread of new illness, make us more susceptible to sickness, or cause the re-emergence of previously well-contained diseases. Given the present context of a global pandemic caused by an entirely new illness — COVID-19 — it’s crucial to take a look at generally how harmful interactions with the natural world, particularly through climate crisis, are increasing risks of new and re-emerging diseases.

Reservoirs as Illness Havens

For what we know of as illness is also a kind of life.

Bacteria are micro-organisms. Viruses are pseudo-life and life-altering. And parasites are living things that dwell within or upon other living things. Climate change can generate or worsen such illnesses by directly affecting their environments as well. Creating the conditions that facilitate the transfer of diseases from typical ranges — called reservoirs — to new hosts. Developing pathways for expanded or new (novel) infections.

An illness reservoir is any person, animal, plant, soil or substance in which an infectious agent normally lives and multiplies. A harbor for the bacteria, viruses, or parasites that cause disease.

Human beings are reservoirs for certain diseases. These could be living humans or the dead — long buried and held dormant in ancient frozen tundra for hundreds or even tens of thousands of years. It is possible that the devastating illness smallpox (Variola virus), which was recently considered eradicated, may still be harbored by frozen dead humans entombed in the permafrost. That permafrost is now thawing as the Arctic heats up.

Animals can also be reservoirs — rabies, for example, lives in bats, raccoons, skunks, and foxes. Cholera is a bacteria that lives in water. It can also live in humans and zooplankton. And there is a link between the spread of Cholera and the loss of water security — which the climate crisis risks. Anthrax lives in herd animals like sheep and reindeer. Because it is capable of developing spores, Anthrax can survive for decades in the bodies of dead reindeer and the climate crisis produced thaw of permafrost has already resulted in new outbreaks of this illness in herd animals and, in rarer possible cases, human beings. Dengue fever is a nasty virus harbored by both humans and mosquitoes. And it is worth noting for diseases which cause illness and loss of life in human beings that mosquitoes — whose range can be greatly altered by changes in climate — weigh quite heavily.

Zoonosis — The Transfer of Illness From Animals to Humans

During recent years, human beings have unfortunately seen the emergence of numerous new or novel illnesses. Many of these illnesses have arisen as the result of mistreatment of nature. Our disruption of the natural world and harmful or abusive relationships with animals appears to have done double duty in getting us ill. For a good share of the nastier new ailments have arisen as the result of zoonosis — or the transfer of diseases that previously affected only animals to human beings — involving such harmful acts.

The harmful bushmeat trade in Africa is thought to be the origin of the novel HIV virus transferring from its original reservoir in primates as SIV before mutating into a stronger illness in humans during the 20th Century to become common from the 1980s onward. Though there is little clear and present evidence that the jump from animals to humans for HIV was directly influenced by the climate crisis, the link between harmful industry and disease transfer is a bit close for comfort here. It is also worth noting that those living with HIV are among the most vulnerable to increasing extreme weather events and related disruption of human habitat and support systems driven by the climate crisis.

SARS illnesses (of which COVID-19 is a subset) and Ebola are also novel viruses in humans. As with HIV, they are likely zoonotic illnesses. This means they originated in animal host reservoirs but, through some process of contact, transferred to human beings. These viruses are still rather mysterious in that they presently have unconfirmed reservoirs. But both are reasonably suspected to be harbored by animals — with tropical and subtropical bats relatively high on the list.

With Ebola in particular (we’ll talk about some similarities between Ebola and SARS due to suspect reservoirs in the next chapter), there is a bit of an ominous interaction with the climate crisis. New modeling produced in Nature Communications suggests that under the present pathway of global heating, Ebola epidemics in Africa could occur once every 10 years — or almost twice as often as they do at present. This is because the bats and other animals that are thought to harbor the virus are expected to be driven by warming temperatures into new areas — expanding the epidemic-prone region by 20 percent.

Expanding Heat

The heating function of the climate crisis is very well understood. And, early-on, scientific research from world health and climate agencies identified the risk that more global heat posed to expanding illness. In particular, mosquitoes which are both reservoirs and vectors (agents of disease transfer) for numerous harmful illnesses are seeing their ranges greatly expand as the world heats up.

Mosquito-borne infection is an ancient and well-known threat to humankind. But it has thankfully been relegated to warmer climates. Despite knowing little about mosquito-borne Malaria, the Roman aristocrats of antiquity did know they could avoid infection by retreating to villas in the cooler hills. Away from where mosquitoes were plentiful. Unfortunately, the climate crisis is driving heat, and the mosquitoes that come with it, both uphill and into higher latitudes.

A single populous species of mosquito — Aedes aegypti — can spread four serious illnesses. They include Dengue Fever, Zika virus, Chikunyunga and Yellow Fever. As global heating continues to be driven by fossil fuel burning, the range of this mosquito is expected to greatly expand. How much depends on how rapidly we halt fossil fuel burning and transition to clean energy (or not). But a business as usual (worst case) fossil fuel burning scenario in which the clean energy transition continues to be hobbled will bring this so-called jungle fever carrier to the Arctic by the 2080s (see image above).

There are over 3,500 species of mosquito. Most are relegated to warmer climates. In addition to the illnesses mentioned above, these insects also carry Malaria and West Nile virus among many others. And as the climate heats up, their range and their ability to transfer diseases among humans will expand.

But mosquitoes are not the only disease reservoir and disease vector species now on the move as a result of the disruption caused by climate crisis. There are many. Some which we probably don’t yet know about.

Receding Cold

If tropical heat spreading northward bringing with it flights of mosquitoes and displacing other disease carriers presents one illness expansion problem, the ongoing thaw of cold regions presents another. In particular, there is evidence that the Arctic has locked away numerous ancient illnesses that could be released in the thaw produced by climate crisis.

The Variola virus which causes Smallpox may well be sequestered in the various graves and burial mounds scattered throughout the Asian and European north. A study conducted in the 1990s detected fragments of smallpox DNA in the remains of Stone Age humans as well as people who were known to have died from smallpox during the 19th Century. Though smallpox was considered eradicated from human beings, long deceased humans frozen in the Arctic may serve as a reservoir that results in potential new infections. If such a reservoir exists, the Arctic thaw produced by the climate crisis will disturb it.

Other pathogens that may still be harbored by dead humans frozen the Arctic includes the 1918 Spanish flu (H1N1) which was found in frozen regions of Alaska. In 2007, scientists discovered Spanish flu RNA in the body of an Inuit woman who’d been buried for 75 years in the permafrost.

Anthrax is a bacteria-caused infectious disease that typically afflicts herd animals such as sheep and reindeer. But Anthrax can pass to humans that are exposed to the bacteria. In 2016, 2,000 reindeer became infected with Anthrax in the Yamal Peninsula region of Siberia. Nearby, it is thought that a reindeer killed by anthrax decades before thawed out, spreading the bacteria into the lands where the reindeer grazed. These reindeer then spread the illness to a number of human beings, including a 12 year old boy who died.

The potential for the release of both known and other as-yet unknown infectious agents from the thawing regions of our world have generated concern among top researchers. Jean-Michel Claverie a professor of microbiology at Aix-Marseilles University recently noted to BBC:

“Following our work and that of others, there is now a non-zero probability that pathogenic microbes could be revived, and infect us. How likely that is is not known, but it’s a possibility. It could be bacteria that are curable with antibiotics, or resistant bacteria, or a virus. If the pathogen hasn’t been in contact with humans for a long time, then our immune system would not be prepared. So yes, that could be dangerous.”

A Context of General Disturbance

Overall, it is likely that there are more numerous climate influences to disease transfer than mere heating and thawing. The general disturbance to the natural world generated by more extreme fires and floods, by instances of flash drought, and even by the mechanism of rising seas is likely to displace more disease reservoirs, creating previously unknown illness transmission potentials.

As far as our general scientific knowledge of illness related to or influenced by the climate crisis at this time, what we see now is likely the tip of the proverbial iceberg. And, as with all things climate crisis related, we require more research, more knowledge-sharing, more general public support of scientific discovery to pull back the veil on this particular new threat. So in conclusion of this chapter on the climate crisis relationship to human illness, we’ll depart with a statement from the World Health Organization:

Changes in infectious disease transmission patterns are a likely major consequence of climate change. We need to learn more about the underlying complex causal  relationships, and apply this information to the prediction of future impacts, using more complete, better validated, integrated, models.

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

Introduction — Climate of Pandemic

Electron microscope image of first COVID-19 case in US. Viral particles are colored blue. Image source: CDC.

Climate change currently contributes to the global burden of disease and premature deaths (very high confidence). — IPCC

 

One disease.

Just a single nasty bug. COVID-19.

An illness resulting from the virus SARS-CoV-2.

That’s all it took to bring global civilization to a grinding, crashing, train-wreck like halt. Not a collapse. But more of a rational-fear freeze.

And now here we are, 3.38 billion souls at least, sheltering at home or under some form of confinement. Waiting in isolation as medical professionals struggle to keep a growing flood of our fellow human beings — in hospitals or triage tents — alive and breathing. For COVID-19 kills by essentially filling our lungs up with viral glass like nodules and fluid due to the body’s defensive immune response. This is the social climate of our presently distanced public life. A fearful Climate of Pandemic.

How did we get here? How do we get out? And how might the increasingly disturbed Earth system climate have influenced the spread of this particularly nasty illness? Most important of all, how can we make ourselves more aware, more alert, and more resilient to illnesses like COVID-19 in the future?  That is the scope of Climate of Pandemic. An exploration we will undertake here over the coming weeks as this particularly vicious illness ripples across our world.

Why is this important? For one, now more than ever before, we all have a civic and moral duty to listen to and understand the science in all its stripes. Not to deny science. This is not just because we live in a world under siege by the harmful influence of climate crisis. A crisis that, by its very nature, is clastic and fragmental to many structures of our world that we all rely on for life, health, and well-being. One that through various destructive processes multiplies risks to individuals and societies. It is also because we live in what Carl Sagan referred to as A Demon Haunted World. One in which scientific ignorance and superstition — denial — is actively promoted by some leaders as a false alternative to fact and reason.

Science is our candle in the darkness in a rising wind. It can give us a predictive indicator of what may be in store as a result of the climate crisis and its coordinate pandemic crisis. In that understanding, it can provide a guide to make the crisis and its related offspring and out-castings less damaging through various actions. And if we listen to science, we can act to save lives and life support systems — both human and environmental — now.

The climate crisis itself stretches to contain a very broad diversity of threats. Some of these threats it directly causes. Others, as is likely the case with COVID-19, it influences in a number of ways to make them more dangerous or potentially more likely to spread. Cause and influence are both important threat relationships of the climate crisis. But they are also important to distinguish.

This does not mean that influence should be overly diminished. For example, the climate crisis influences the strength of hurricanes. It does not cause a hurricane. But if a hurricane is influenced in such a way that in the present climate it is now a category 5 storm where it would once have been a category 2 storm, then the climate crisis influence is a seriously destructive one.

I suspect that the influence relationship between climate and disease is similarly substantial. Perhaps not with COVID-19 particularly. But maybe so. Or maybe somewhere in between. The nuanced degree a known unknown at this time. But one that the process of scientific discovery will likely unravel more for us as we look closer. In any case, the broader context given by IPCC indicates that the climate crisis already is a major contributor to the global burden of disease.

So it is important to be clear that the climate crisis did not cause COVID-19. The illness existed before, likely in bats and in civets or in pangolins and civets. But it may have provided impetus for the illness to amplify in bats or pangolins and to spread through other species ultimately to humans. And the drivers of the climate crisis such as air pollution from fossil fuel burning or its upshots such as wildfires, extreme heat, and extreme weather may have also amplified the illness’s impact once it did make the leap into humans.

All are subjects we’ll dive into more deeply later in this work.

For now, we are going to take a step back from COVID-19 itself and look more broadly at the scientific understanding of how the climate crisis impacts diseases in general and presents a higher risk of deadly illnesses making their way into the human population. Because when it comes to understanding larger threats, context is often everything.

(Up Next — From Ancient Reservoirs)

Climate of Pandemic — Announcement and Contents

Image of COVID-19, or coronavirus 2 (SARS-CoV-2) which is a sudden acute respiratory syndrome type virus, created at the Centers for Disease Control and Prevention (CDC). Image source: CDC.

 

Scribbling through a Global Pandemic

The present tragedy of the COVID-19 Pandemic has impacted us all. For my own part, I am now at home under quarantine with my wife. This is a decision I have made to protect myself, my family, and my fellows here in Maryland, America, and across the world.

As many of you know, I had taken a long hiatus from climate writing to help promote clean energy as a response to the climate crisis. I did this by using the Uber rideshare platform, driving a Tesla, and sharing conversations with riders of all stripes — from business and government leaders to everyday people — as a way of raising grass roots awareness about the climate crisis and directly showing that solutions are available now to everyone.

I feel that these conversations were very effective. That I helped both raise awareness in the local community as well as among leaders and decision makers. I’ve found that it is so much easier to convey concern and caring through the medium of direct interpersonal contact vs mere words written on an electronic page or even the more adept but still far removed from the heart-to-heart media provided here on the interwebs.

But life has a way of catching up with us. Particularly at a time when our world is being shaken to its very roots by forces unwisely unleashed. We are all now isolated out of necessity. Out of safety. Out of responsibility for our fellow human beings.

Duty in Exile

So this is my task in exile — Climate of Pandemic. A combined special report and web book. A project that will explore the breadth and depth of the global coronavirus emergency. Take an in-depth look at how climate change may have helped to shake it out of an ancient viral reservoir. Reveal how the brash and brutish politics of climate change denial encapsulated the failed leadership that enabled the virus to spread like wildfire. And look at how experts are concerned that more pandemic threats may be on the way due to the great shaking up of the natural system that the climate crisis is now inflicting on our world (hopefully, I’ll be able to pick up on some other climate writing as well, but this will be my special focus for the time being).

Of course, in piercing this subject, we will likely drift into direct reporting on the emergency itself — dipping into the realms of epidemic science and disaster response. That’s OK! Because we should understand that the basic value of climate crisis response lies in both our understanding of inter-related contexts out of a sense of holistic responsibility to our world and its inhabitants.

What follows is the table of contents with links to each chapter in the new special report. At present, I have seventeen planned. But given how we are living in such uncertain and tragic times that might well expand. New links will be provided as each chapter is written. And upcoming installments will have the parenthetical (in progress) label. To quick-link this table of contents, you can click the Climate of Pandemic illustration on this blog’s side-bar and get right to catching up or reading an update.

Best to you all! Please stay safe! Please care for your loved ones! And please remember that caring for our world is also providing that much needed care and response as well.

 

Climate of Pandemic Contents:

 

  1. Introduction — Climate of Pandemic
  2. From Ancient Reservoirs
  3. Harmful Contacts with our Living Earth and Redounding Shots Across the Bow
  4. The Emergence of Severe Acute Respiratory Syndrome (SARS)
  5. COVID-19 First Outbreak — Viral Glass-Like Nodules in Lungs
  6. Denial, Defunding, Downplaying — First COVID-19 Leadership Failures
  7. Effective Containment — How South Korea’s First Coronavirus Wave was Halted
  8. The Trouble with Testing Part 1 — “No Responsibility at All”
  9. It’s Everywhere Now — COVID-19 A Global Viral Wildfire
  10. No COVID-19 Did Not Stop the Climate Crisis — But it’s Interacting with it in a Bad Way
  11. Social Distancing and Waiting Until It’s Safe Enough to Re-Open
  12. A Possible Vaccine, But When?
  13. The Trouble with Testing Part 2 — Dubious Interpretations of Antibody Studies Risk More False Confidence (pending)
  14. Approaching 100,000 Official Fatalities in the U.S. Alone (pending)
  15. What is the Real Mortality Rate? We Won’t Know For Sure Until It’s Over (pending)
  16. Large Outbreak in Brazil (pending)
  17. False Silver Bullets: The Unscientific and Life-Risking Peddling of Hydroxychloroquine (pending)
  18. Firing Another Top Expert — This One a Specialist in Vaccination (pending)
  19. Success in Germany — More Evidence that Containment Can Work if Managed Well (pending)
  20. Frozen Economies, Worries About Food (pending)
  21. Reopening Safely (?) In the Presence of COVID-19 (pending)
  22. Risks for Subsequent Waves of Illness; Dual Respiratory Illness Outbreak Potential? (pending)
  23. COVID-19 Oil Crash (pending)
  24. No Cure For Climate Crisis, But a Clean Energy Recovery Can Be (pending)
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