New Coronavirus News from 24 Jul 2020

Trump 'owes us an apology.' Chinese scientist at the center of COVID-19 origin theories speaks out [Science Magazine, 24 Jul 2020]

By Jon Cohen

The coronavirus pandemic has thrust virologist Shi Zhengli into a fierce spotlight. Shi, who’s been nicknamed “Bat Woman,” heads a group that studies bat coronaviruses at the Wuhan Institute of Virology (WIV), in the city in China where the pandemic began, and many have speculated that the virus that causes COVID-19 accidentally escaped from her lab—a theory promoted by U.S. President Donald Trump. Some have even suggested it could have been engineered there.

China has forcefully rejected such claims, but Shi (pronounced SHIH) herself has said very little publicly.

Now, Shi has broken her silence about the details of her work. On 15 July, she emailed Science answers to a series of written questions about the virus’ origin and the research at her institute. In them, Shi hit back at speculation that the virus leaked from WIV. She and her colleagues discovered the virus in late 2019, she says, in samples from patients who had a pneumonia of unknown origin. “Before that, we had never been in contact with or studied this virus, nor did we know of its existence,” Shi wrote.

“U.S. President Trump’s claim that SARS-CoV-2 was leaked from our institute totally contradicts the facts,” she added. “It jeopardizes and affects our academic work and personal life. He owes us an apology.”

Shi stressed that over the past 15 years, her lab has isolated and grown in culture only three bat coronaviruses related to one that infected humans: the agent that causes severe acute respiratory syndrome (SARS), which erupted in 2003. The more than 2000 other bat coronaviruses the lab has detected, including one that is 96.2% identical to SARS-CoV-2—which means they shared a common ancestor decades ago—are simply genetic sequences that her team has extracted from fecal samples and oral and anal swabs of the animals. She also noted that all of the staff and students in her lab were recently tested for SARS-CoV-2 and everyone was negative, challenging the notion that an infected person in her group triggered the pandemic.

Shi was particularly chagrined about the 24 April decision by the U.S. National Institutes of Health (NIH), made at the White House’s behest, to ax a grant to the EcoHealth Alliance in New York City that included bat virus research at WIV. “We don’t understand [it] and feel it is absolutely absurd,” she said.

Science shared Shi’s responses—available here in full (PDF)—with several leading researchers in other countries. “It’s a big contribution,” says Daniel Lucey of Georgetown University, an outbreak specialist who blogs about SARS-CoV-2 origin issues. “There are a lot of new facts that I wasn’t aware of. It’s very exciting to hear this directly from her.”

Shi’s answers were coordinated with public information staffers at the Chinese Academy of Sciences, of which WIV is part, and it took her 2 months to prepare them. Evolutionary biologist Kristian Andersen of Scripps Research says he suspects Shi’s answers were “carefully vetted” by the Chinese government. “But they’re all logical, genuine, and stick to the science as one would have expected from a world-class scientist and one of the leading experts on coronaviruses,” Andersen says.

However, Richard Ebright, a molecular biologist at Rutgers University, New Brunswick, who from the early days of the pandemic has urged that an investigation look into the possibility that SARS-CoV-2 entered humans through a laboratory accident, was decidedly unimpressed.
“Most of these answers are formulaic, almost robotic, reiterations of statements previously made by Chinese authorities and state media,” Ebright says.

Shi’s responses come at a time when questions about how the pandemic began are increasingly causing international tensions. Trump frequently calls SARS-CoV-2 “the China virus” and has said China could have stopped the pandemic in its tracks. China, for its part, has added an extra layer of review for any researchers who want to publish papers on the pandemic’s origins and has asserted without evidence that SARS-CoV-2 may have originated in the United States.Calls for an independent, international probe into the origin questions are mounting, and China has invited two researchers from the World Health Organization to visit the country to discuss the scope and scale of a future mission. They are now in China working through those details. Lucey says Shi’s answers to Science’s questions could help guide the investigation team. (Here are related questions Science has suggested the mission should address.)

A virus hunter

Peter Daszak of the EcoHealth Alliance has worked with Shi for more than 15 years. He describes her as social, open, and something of a goodwill ambassador for China at international meetings, where she converses in both French and English. (She’s also a renowned singer of Mandarin folk songs.) “What I really like about Zhengli is that she is frank and honest and that just makes it easier to solve problems,” he says.

Born in Henan province in central China, Shi studied at Wuhan University and WIV, then earned a Ph.D. in France at the University of Montpellier II. She returned to WIV in 2000. Initially, the vast majority of her research focused on viruses in shrimp and crabs, and her papers all appeared in specialty publications such as Virologica Sinica and the Journal of Fish Diseases.

But in 2005, a study she published in Science with Daszak and other researchers from China, Australia, and the United States became a turning point in her career. The paper reported the first evidence that bats harbored coronaviruses closely related to the lethal virus that jumped from civets to humans and caused the worldwide outbreak of SARS in 2003.

With NIH funding, Daszak has continued to work with Shi and her WIV team to trap wild animals and take samples to hunt for more coronaviruses. They have published 18 more papers together about viruses discovered in bats and rodents. Shi is “is extremely driven to produce high-quality work,” Daszak says. “She will go out in the field, and gets involved in the work, but her real skills are in the lab, and she’s one of the best I’ve worked with in China, probably globally.”

Shi told Science her lab was thrust into the pandemic on 30 December 2019, the day her team first received patient samples. “Subsequently, we rapidly conducted research in parallel with other domestic institutions, and quickly identified the pathogen,” she wrote.

It didn’t long take for suspicions and rumors to arise. They spread on China’s social media sites and then in the United Kingdom’s Daily Mail and The Washington Times in the United States. On 2 February, Shi posted a note on her own social media site that said SARS-CoV-2 was “nature punishing the uncivilized habits and customs of humans,” and she was willing to “bet my life that [the outbreak] has nothing to do with the lab.” Partly as a show of support for Shi, Daszak and 26 other scientists from eight countries outside of China published a statement of solidarity with Chinese scientists and health professionals in The Lancet in February. In a 17 March Nature Medicine paper that analyzed SARS-CoV-2’s genetic makeup, Andersen and other evolutionary biologists argued against it being engineered in a lab.

Yet the possibility that her lab had played a role worried Shi, she revealed in a March Scientific American profile that briefly touched on origin questions. “She frantically went through her own laboratory’s records from the past few years to check for any mishandling of experimental materials, especially during disposal,” the story said. None of the sequences of bat viruses her lab had found closely matched SARS-CoV-2, the article noted. “That really took a load off my mind,” she told Scientific American. “I had not slept a wink for days.”

No accident

In her written answers to Science, Shi explained in great detail why she thinks her lab is blameless. WIV has identified hundreds of bat viruses over the years, but never anything close to SARS-CoV-2, she says. Although much speculation has centered on RaTG13, the bat virus that most closely resembles SARS-CoV-2, differences in the sequences of the two viruses suggest they diverged from a common ancestor somewhere between 20 and 70 years ago. Shi notes that her lab never cultured the bat virus, making an accident far less likely.

Some suspicions have focused on a naming inconsistency. In 2016, Shi described a partial sequence of a bat coronavirus that she dubbed 4991. That small part of the genome exactly matches RaTG13, leading some to speculate that Shi never revealed the full sequence of 4991 because it actually is SARS-CoV-2. In her replies, Shi explained that 4991 and RaTG13 are one and the same. The original name, she says, was for the bat itself, and her team switched to RaTG13 when they sequenced the entire virus. “We changed the name as we wanted it to reflect the time and location for the sample collection,” she said, adding that TG stands for Tongguan (the town in Yunnan province where they trapped that bat) and 13 is short for the year, 2013.

That’s “a very logical explanation,” says Edward Holmes, an evolutionary biologist at the University of Sydney who co-authored the Nature Medicine paper with Andersen. Shi’s reply also clarified to him why 4991 held such little interest to her team that they didn’t even bother to sequence it fully until recently: That short genetic sequence was very different from SARS-CoV, the virus that caused the 2003 SARS outbreak. “In reading this the penny dropped: Of course, they would have been mainly interested in bat viruses closely related to SARS-CoV, because this virus emerged and caused a human epidemic … not some random bat virus that is more distant,” Holmes says.

Shi mentioned several other factors that she says exonerate her lab. Their research meets strict biosafety rules, she said, and the lab is subject to periodic inspections “by a third-party institution authorized by the government.” Antibody tests have shown there is “zero infection” among institute staff or students with SARS-CoV-2 or SARS-related viruses. Shi said WIV has never been ordered to destroy any samples after the pandemic erupted and she was sure the virus didn’t come from the Wuhan Center for Disease Control and Prevention—or another lab in the city—either: “Based on daily academic exchanges and discussion, I can rule out such a possibility.”

Labs that presumably had strict biosafety rules have had accidents: The SARS virus escaped from several labs after the global outbreak was contained in 2003. And even if everyone in the institute tested negative for the virus today, an infected person could have left WIV months ago. Still, Holmes says, the answers are “a clear, comprehensive, and believable account” of what occurred at WIV.

Mysterious origins

But then where did the virus come from? Shi is unsure but concurs with the scientific consensus that it originated in bats and jumped to humans either directly or, more likely, via an intermediate host.

When the outbreak surfaced, Wuhan health officials believed the jump occurred at the Huanan Seafood Wholesale Market because many of the first known COVID-19 patients had links to it. Shi’s lab tested samples from the market and found RNA fragments from the virus in “door handles, the ground and sewage,” she wrote—but not in “frozen animal samples.”

However, two papers published in late January revealed that up to 45% of the first confirmed patients—including four of the five earliest cases—did not have any ties to the market, casting doubt on the theory that it was the origin. Shi agrees: “The Huanan seafood market may just be a crowded location where a cluster of early novel coronavirus patients were found.”

Researchers from WIV and Huazhong Agricultural University didn’t find the virus in samples from farmed animals and livestock taken around Wuhan and in other places in Hubei province, she wrote. Shi added that many years of surveillance in Hubei have never turned up bat coronaviruses close to SARS-CoV-2, which leads her to believe the jump from animals to humans happened elsewhere.

Shi Zhengli’s team takes samples from bats trapped in the wild. The team never found SARS-CoV-2, the pandemic virus, in bats, Shi says.

ECOHEALTH ALLIANCE

Andersen would like more specifics. Limiting the search at the market to “frozen” animal samples is an “obvious gap,” he says: “What were these? Did they look at any live animals? I’m still a bit puzzled by the statement that the only role of the market was that it was a crowded location, yet so many of the environmental samples were positive so early on.”

Shi provided few details on China’s efforts to pin down the origin. “Many groups in China are carrying out such studies,” she wrote. “We are publishing papers and data, including those about the virus’s origins. We are tracing the origin of the virus in different directions and through multiple approaches.”

Daszak supports the push for an international research effort—which he cautions could take years—and says Shi’s group should play a prominent role in it. “I hope and believe that she will be able to help WIV and China show the world that there is nothing to these lab escape theories, and help us all to find the true origins of this viral strain,” he says.

Shi ended her answers to Science on a similar note. “Over the past 20 years, coronaviruses have been disrupting and impacting human lives and economies,” she said. “Here, I would like to make an appeal to the international community to strengthen international cooperation on research into the origins of emerging viruses. I hope scientists around the world can stand together and work together.”

3 Scenarios for How the Pandemic Could Change US Health Care [Harvard Business Review, 24 Jul 2020]

by David Blumenthal , Eric C. Schneider , Shanoor Seervai and Arnav Shah

Confusion reigns concerning the future course and consequences of the novel coronavirus pandemic in the United States. But one thing is certain: The health care system that emerges from the pandemic will not be the same. The question is, how will it be transformed? We attempt to answer that by posing alternative scenarios based on assumptions about key parameters that can heavily influence how the pandemic evolves. The analysis makes clear that in its pending stimulus package, Congress needs to take steps to prevent potentially long-lasting damage that Covid-19 may inflict on the health care system.

Three factors will prove most critical to the pandemic’s future: the public’s use of non-pharmaceutical interventions (NPIs) such as facial coverings and physical distancing; the availability, efficacy, and public acceptance of one or more vaccines; and the availability and efficacy of anti-viral therapies. There are obviously dozens of other possible influences on the course of the pandemic such as whether “herd immunity” might someday slow the spread. But these three factors have the greatest potential to decisively alter the course of Covid-19 in the United States and elsewhere if we succeed in instituting one or more of them.

To explore how the pandemic may evolve, we posit three scenarios with respect to these three factors:
1. A dream case in which everything goes as well as could reasonably be expected.
2. A catastrophic case in which everything goes badly.
3. A middle case in which some things go well, but others don’t.

In evaluating the consequences of these scenarios for the nation’s health care system, we make one important additional assumption: The linchpin for a return to the health care system’s pre-pandemic “normal” state lies with the nation’s ability to assure the safety of segments of the population that are most vulnerable to the pandemic, especially the elderly and the chronically ill. These groups comprise the 5% of the population that consumes 50% of health care resources. Only when they feel safe to venture out will health care institutions experience a vigorous recovery in demand for their services. While telehealth can partially compensate for the falloff in the use of services, it will go only so far. It cannot replace hips or knees, do colonoscopies, or insert cardiac stents.

Scenario 1: The Dream Case

It plays out as follows:
1. By September 1, governors and other political leaders have widely and aggressively implemented NPIs throughout the United States with strong public compliance.
2. By November 1, highly effective anti-virals have reduced the mortality from Covid-19 among the elderly to the level of influenza: less than 1% of those infected.
3. By January 1, at least one vaccine equivalent in efficacy to smallpox or measles is available for widespread use.
4. By July 1, 60% of the American public is vaccinated, including most high-risk individuals, creating effective herd immunity.
5. By December 1, 2021, the pandemic is declared over in the United States.

This highly optimistic scenario suggests that by early fall, viral transmission will be falling rapidly throughout the United States and that by late fall or early winter, it will be low enough for high-risk groups to feel safe. At that point, demand for health care services should begin to grow rapidly, accelerating with the arrival of effective therapies and a vaccine. Within 12 months, the health care system should be experiencing inpatient and outpatient volumes that equal or exceed pre-pandemic levels.

However, the health care system that returns to “normal” in 12 months will likely be different from the system of February 2020. A significant number of financially-weak hospitals and clinical practices will have closed their doors or merged with strong local institutions that have the capital to ride out the pandemic storm. There will be fewer primary care practices, community health centers, rural hospitals, independent small and moderate size hospitals, inner-city safety-net hospitals, and money-losing services of all types. Large systems will have grown larger and more dominant in local markets. The weak will be weaker and the strong stronger.

The market power of dominant local health care organizations may grant them even more leverage to negotiate higher prices from local payers in the future. Patients will have reduced choice of providers. The national capacity to offer effective primary care — the key to prevention and control of chronic illness — will be diminished, at least in the short term.
Scenario 2: The Catastrophe

Little works. What does isn’t implemented. The current failure to impose NPIs in the South and West persists, and even in areas like the Northeast, an exhausted populace balks at local shutdowns required to address outbreaks of novel coronavirus imported from elsewhere in the United States. No treatments more potent than Remdesivir and Dexamethasone materialize; nor does a vaccine that is safe and effective. The pandemic rages unchecked in current hotspots and reignites in the North and East. The U.S. health care system is overrun by Covid-19 cases to the exclusion of most other care. Field hospitals spring up everywhere. but demand still exceeds capacity. The United States steadily exhausts its supply of health care workers, personal protective equipment (PPE), testing supplies, and drugs. As the economy struggles, millions more Americans lose employment and their employer sponsored insurance. Population herd immunity proves illusory or far in the future.

This dismal picture suggests that demand for health care services other than Covid-19 care will remain at fractions of pre-pandemic levels for the foreseeable future. Compounding the reluctance of high-risk groups to visit health care facilities will be the swelling ranks of the uninsured. The result will be bankruptcy of large numbers of provider organizations and practices absent hundreds of billions of dollars of ongoing governmental support.

Such aid will constitute the creeping nationalization of the health care system. The failure of employer-sponsored insurance may create the national will for universal public insurance. The health care system that emerges after five years could resemble European models of public ownership and insurance more than the current largely-private enterprise.
Scenario 3: The Patchwork Middle

By September 1, half of states have effectively implemented NPIs, but adherence erodes over time in many areas because of partisanship, fatalism, or fatigue. An effective anti-viral regimen is available by January 1, which lowers mortality among high-risk groups to less than 1% among the healthy elderly and less than 10% among those with underlying conditions. An apparently safe vaccine is available on July 1, 2021, but it is only 60% effective in preventing infection and requires an annual booster. Because of its low efficacy and known side effects (equivalent to flu vaccine) or a lack of trust in the vaccine, only about 50% of Americans choose to get vaccinated over the following six months.

For the health care system, the implications are highly variable geographically. In areas with effective NPI regimens and high vaccination rates, viral transmission rates are very low by the end of 2021, but localized outbreaks are an ongoing threat. Vulnerable groups feel safe and gradually resume use of health care services starting in the fall of 2021, and by the spring of 2022, volumes of health care services have reached a steady state but are still 5% to 10% below pre-pandemic levels because of persisting sporadic viral transmission. Some local areas are tantalizingly close to achieving a localized dream scenario.

But in other locations, with poor NPI compliance and vaccination rates, the situation more closely resembles the catastrophic scenario. There, demand for services remains persistently low and provider bankruptcies and closures are widespread. For locations in-between, demand settles in at about 20% below pre-pandemic levels for the foreseeable future.

Overall the American health care system is significantly less capable than before the pandemic but is not as widely impaired as in the catastrophic scenario. In some areas, health care providers are heavily dependent on government aid and downsize dramatically to contain expenses; in other areas, the system is stable but consolidated with diminished primary care capacity, as in the Dream scenario.

The striking thing about these three scenarios is that under any of them, the U.S. health care system emerges very different from its pre-pandemic state and is hobbled in different ways. Even under the dream scenario, the loss of safety net institutions and increased inequities will require some type of government response. For advocates of European-style publicly-managed health care systems with universal coverage, the catastrophic scenario may offer the prospect of a more equitable and potentially more efficient system emerging from the ashes.
However, the price of failing to control the pandemic in lives and treasure will be huge.
Under any likely future, the health care system will emerge from the pandemic less capable and smaller. The federal government can mitigate some adverse effects by supporting now — in its pending stimulus package — the critical services that are most at risk: primary care practices and safety-net institutions, including community health centers, critical access hospitals, and other providers in rural areas.

It can also confront the growing problem of non-competitive health care markets that will likely grow in number under almost any scenario. This would involve more aggressive enforcement of anti-trust authorities and/or the regulation of prices where competition has ceased to exist.
For the catastrophic scenario, the government will have to plan massive investments to shore up the health care system on a scale never before contemplated in the United States.

When it comes to the future of a health system grappling with an unprecedented crisis, hoping for the best is not a strategy. It would be wise to act now to minimize long-term damage to the nation’s health care enterprise.

Ecology and economics for pandemic prevention [Science, 24 Jul 2020]

Authored by Andrew P. Dobson, Stuart L. Pimm, Lee Hannah, Les Kaufman, Jorge A. Ahumada, Amy W. Ando, Aaron Bernstein, Jonah Busch, Peter Daszak, Jens Engelmann, Margaret F. Kinnaird, Binbin V. Li, Ted Loch-Temzelides, Thomas Lovejoy, Katarzyna Nowak, Patrick R. Roehrdanz, Mariana M. Vale

For a century, two new viruses per year have spilled from their natural hosts into humans (1).
The MERS, SARS, and 2009 H1N1 epidemics, and the HIV and coronavirus disease 2019 (COVID-19) pandemics, testify to their damage. Zoonotic viruses infect people directly most often when they handle live primates, bats, and other wildlife (or their meat) or indirectly from farm animals such as chickens and pigs. The risks are higher than ever (2, 3) as increasingly intimate associations between humans and wildlife disease reservoirs accelerate the potential for viruses to spread globally. Here, we assess the cost of monitoring and preventing disease spillover driven by the unprecedented loss and fragmentation of tropical forests and by the burgeoning wildlife trade. Currently, we invest relatively little toward preventing deforestation and regulating wildlife trade, despite well-researched plans that demonstrate a high return on their investment in limiting zoonoses and conferring many other benefits. As public funding in response to COVID-19 continues to rise, our analysis suggests that the associated costs of these preventive efforts would be substantially less than the economic and mortality costs of responding to these pathogens once they have emerged.

Reducing Deforestation

Tropical forest edges are a major launch-pad for novel human viruses. Edges arise as humans build roads or clear forests for timber production and agriculture. Humans and their livestock are more likely to contact wildlife when more than 25% of the original forest cover is lost (4), and such contacts determine the risk of disease transmission. Pathogen transmission depends on the contact rate, the abundance of susceptible humans and livestock, and the abundance of infected wild hosts. Contact rates vary with the perimeter (the length of the forest edge) between forest and nonforest. Deforestation tends to create checkerboards, whereupon we see a maximum perimeter at a 50% level of forest conversion. Thereafter, the abundance of domestic animals and humans rapidly exceeds that of wild animals, so although we expect transmission to decline, the magnitude of any resultant outbreak is higher (4). Habitat fragmentation complicates this because it increases the length of the perimeter. Roadbuilding, mining and logging camps, expansion of urban centers and settlements, migration and war, and livestock and crop monocultures have led to increasing virus spillovers. Hunting, transport, farming, and trade of wildlife for food, pets, and traditional medicine compound these routes of transmission and closely track deforestation. For example, bats are the probable reservoirs of Ebola, Nipah, SARS, and the virus behind COVID-19. Fruit bats (Pteropodidae in the Old World, the genus Artibeus in the New World) are more likely to feed near human settlements when their forest habitats are disturbed; this has been a key factor in viral emergence in West Africa, Malaysia, Bangladesh, and Australia (5–7).

The clear link between deforestation and virus emergence suggests that a major effort to retain intact forest cover would have a large return on investment even if its only benefit was to reduce virus emergence events. The largest-scale example of directed deforestation reduction comes from Brazil between 2005 and 2012. Deforestation in the Amazon dropped by 70%, yet production of the region's dominant soy crop still increased (8). International contributions, complemented by an Amazon Fund, of about $1 billion supported land-use zoning, market and credit restrictions, and state-of-the-science satellite monitoring. Brazil's program reduced forest fragmentation and edge at a lower cost than could have been achieved by carbon-pricing approaches (9).

Several estimates of the effectiveness and cost of strategies to reduce tropical deforestation are available (8, 9). At an annual cost of $9.6 billion, direct forest-protection payments to outcompete deforestation economically could achieve a 40% reduction in areas at highest risk for virus spillover [see supplementary materials (SM)]. Multiple payment-for-ecosystem-services programs demonstrate the effectiveness of this approach. At the low end, widespread adoption of the earlier Brazil policy model could achieve the same reduction for only $1.5 billion annually by removing subsidies that favor deforestation, restricting private land clearing, and supporting territorial rights of indigenous peoples. All require national motivation and political will. Strong public support for similar deforestation-prevention policies may emerge in other countries recovering from COVID-19's devastation.

Wildlife Trade Spillover

Global demand for wildlife causes people to enter forests to collect wildlife for sale in markets in urban and rural areas. In cities, where people have diverse options for protein, bushmeat is a luxury bought to show status, and occasionally for cultural reasons. COVID-19 is the huge price society now pays for such encounters with wild species.

Wildlife markets and the legal and illegal wildlife trade bring live and dead wild animals into contact with hunters, traders, consumers, and all those involved in this commerce. Trade follows global consumer demand. The United States is one of the biggest global importers of wildlife, including for the massive exotic pet industry (10). The transit conditions, lack of health screening at import, and warehouses that store animals before and after import are similar to live animal markets, all conducive to spreading diseases.

Some countries have wildlife farming industries intended to prevent overhunting of wild species while meeting market demands for protein and appealing to cultural traditions. In China, wildlife farming is a ∼$20 billion industry employing some 15 million people (11). With the February 2020 announcement by the Standing Committee of the National People's Congress of a ban on wildlife consumption for food and related trade in China, there are ongoing discussions on phasing out this industry. The justification is that it creates risks for disease emergence and that the health and safety regulations associated with farming wild animals are often insufficient. Laws to ban the national and international trade of high-risk disease reservoir species, and the will to sustain their enforcement, are necessary and precautionary steps to prevent zoonotic disease. Regulations must keep primates, bats, pangolins, civets, and rodents out of markets.

International conventions such as the Convention on International Trade in Endangered Species of Fauna and Flora (CITES) deal with only a part of the problem. They, regional networks, and national agencies monitoring wildlife trade and enforcing regulations are severely underfunded. Regional wildlife enforcement networks (WENs) could be strengthened to form part of an effective response frontier to future pandemic prevention. The annual budget of one WEN, hosted by the Association for Southeast Asian Nations, is $30,000 (see SM). CITES's annual budget is a mere $6 million. Its secretariat has recently stated that zoonotic diseases are outside of CITES's mandate; they are certainly outside its current budget. Helping to prevent the next outbreak might include raising WENs' budgets for regional responses while at the same time developing globally coordinated protocols to increase the WENs' capacity in wildlife health screening. Although there is no global agency with a remit to conduct surveillance on the wildlife trade, we estimated the costs of such an effort by considering the annual operating budget of the World Organization for Animal Health (OIE), which has a remit to assess disease risk in livestock trade without conducting testing. We then added costs of large-scale disease surveillance in wildlife, scaled to the global volume of wildlife trade (see SM).

Restricting access to wildlife for food and other uses must consider indigenous peoples and those in remote communities for whom wildlife provides essential protein. In some parts of the world, reliance on migratory wildlife such as caribou and salmon motivates stewardship of large expanses of habitat. Although the right to traditional diets should be upheld, people can nonetheless be at risk from harvesting wildlife. These are food security issues that governments and development agencies should confront. Where needed, they must include education and awareness on animal handling, sanitation, and disease transmission as well as sustainable wildlife management and support to develop village-level alternative foods. Legal hunting and marketing of wildlife that meets basic nutritional requirements sustainably can be regulated to reduce the risk of emerging pandemics. Over time, culturally sensitive measures could ensure indigenous people's access to healthy diets and reduce pandemic risks.

Early Detection and Control

There is substantial underreporting of exposure to zoonotic diseases. Correcting this would provide major opportunities for prevention. Nipah virus was discovered in 1998, originating in fruit bats, and caused a massive outbreak of respiratory illness in pigs and lethal encephalitis in people in Malaysia (6). Sentinel surveillance in Bangladesh hospitals revealed multiple annual case clusters and outbreaks with an average case fatality rate of 70%.

Similarly, SARS and COVID-19 emerged as outbreaks of respiratory disease in Guangdong and Wuhan, China, respectively. Serological surveys of people in rural Yunnan province showed that 3% had antibodies to similar virus species from their principal reservoir, horseshoe bats (Rhinolophus spp.) (12).

To quantify and reduce the risk of spillover of pathogens requires viral discovery in wildlife and testing of human and livestock populations in regions of high disease emergence risk. For example, the Wellcome Trust VIZIONS program tested wildlife, humans, and livestock for known pathogens in rural Vietnam. The U.S. Agency for International Development (USAID) PREDICT project analyzed the spillover of viruses in people with high wildlife contact in 31 countries.
PREDICT included community education programs to raise awareness of zoonotic risk and reduce contact with wildlife. It worked to prevent spillover through identification of high-risk behaviors and used serology surveys to examine seasonal patterns of risk. Interventions included use of bamboo skirts to reduce Nipah virus contamination of palm sap, increased biosecurity at livestock farms to reduce wildlife-livestock-human contact, promotion of handwashing, and wearing of personal protective equipment when in close contact with wildlife. It reduced the capacity of wildlife to shed virus at interfaces by closing high-risk bat caves.

Costs of measures to prevent spillover vary. USAID PREDICT spent $200 million over 10 years.
This cost compares favorably with the $1.2 billion for the Global Virome Project, a 10-year project designed to identify 70% of the unknown potentially zoonotic viruses in wildlife globally.
Although we have proof of concept for the discovery of disease with potential for emergence, for the identification of active spillover, and for programs that reduce risk, research is needed to quantify the return on investment for these programs. Pilot programs should prioritize indicators that allow better assessment of the costs and benefits of risk reduction (see SM).

After spillover, a second critical window of opportunity is the prevention of larger outbreaks (2). Early cases of HIV/AIDS, hantavirus pulmonary syndrome, Nipah virus, SARS, and COVID-19 went undetected for weeks, months, or years (HIV) before pathogen identification. Lags in identification have decreased, but this varies geographically. In lower-income countries, large outbreaks with substantial mortality often go undiagnosed, particularly when symptoms mimic those of other known diseases. Pilot projects are under way in clinics in many rural regions to identify the etiology of cases with similar symptoms (syndromic surveillance). For example, a pilot project costing $200,000 per year for syndromic surveillance for Nipah virus in Bangladesh hospitals resulted in a factor of 3 increase in the detection of spillover events (13).
The U.S. National Institute of Allergy and Infectious Diseases is launching a series of Centers for Research in Emerging Infectious Diseases. Contracts for this work are expected at $1.5 million per year, focusing on specific high-risk viral zoonoses in emerging disease hotspots.
Detection and control programs targeting outbreaks in their early stages would result in considerable savings by reducing morbidity and mortality. A priority is to identify indicators of risk reduction as pilot programs roll out and to calculate the costs, cost savings, and benefits of expanding them.

Farmed Animal Spillover

Livestock are critical reservoirs and links in emergent diseases. H5N1 influenza came across the human-wildlife interface (wild bird → poultry → human transmission chain), as did H1N1 influenza (bird → pig → human). Many livestock-linked outbreaks have reached the cusp of pandemic emergence, such as Nipah virus (fruit bat → pig → human) and swine acute diarrhea syndrome coronavirus (bat → pig) (14). These links are well recognized and are the focus of pandemic prevention packages proposed by the U.S. Congress (H.R. 3771). There are well-researched veterinary health plans such as the World Bank's One World One Health farm biosecurity intervention program, designed to reduce H5N1 influenza risk. With costs in the tens of billions of dollars, proposals dealing with livestock's roles in pandemics are among the most advanced and ambitious of those being seriously considered. We have known about these risks longer (e.g., influenza) and can control farm biosecurity more easily than wildlife contact in trade or at forest edges.

Conclusions

The actions we outline can help to prevent future zoonotic pandemics before they start.

Monitoring alone would realize substantial cost savings, even in the context of pandemic outbreaks much less severe than COVID-19 (14). The gross estimated costs of the actions we propose total $22 to $31 billion per year (see the table). Reduced deforestation has the ancillary benefit of around $4 billion per year in social benefits from reduced greenhouse gas emissions, so net prevention costs range from $18 to $27 billion per year. In comparison, COVID-19 has shown us the immense potential cost of a pandemic. The world may lose at least $5 trillion in GDP in 2020, and the willingness to pay for the lives lost constitutes many additional trillions (see SM). These costs exclude the rising tally of morbidity, deaths from other causes due to disrupted medical systems, and the loss to society of foregone activities due to social distancing.

To justify the costs of prevention, a year's worth of these preventive strategies would only need to reduce the likelihood of another pandemic like COVID-19 in the next year by about 27% below baseline probability in the most likely scenario, even ignoring the ancillary benefits of carbon sequestration. We explored eight alternative scenarios with varied assumptions drawn from the highest and lowest values of both prevention costs and pandemic damages, and assuming that extreme pandemics occur either once every 100 years or once every 200 years. In all scenarios but one, prevention need only reduce the probability of a pandemic by less than half, and in one case the break-even percent probability reduction is as low as 12% (see SM). We estimate the present value of prevention costs for 10 years to be only about 2% of the costs of the COVID-19 pandemic.

We recognize that we have provided no more than a sketch of the key components of an economically feasible set of ecological pandemic prevention strategies. Limits on the availability of information limit our ability to conduct a more exhaustive analysis. Instead, we tally readily available information to evaluate how likely it is that an investment of the costs of pandemic prevention would yield positive net benefits to the world. Our calculations are conservative in the direction of making it hard to find that prevention is likely to be worthwhile—and yet that is our finding. Future studies could narrow uncertainties in the costs and efficacy of those strategies and pinpoint the most cost-effective suite of actions. A full cost-benefit analysis of pandemic prevention could track the flows of prevention costs over time, allow for intertemporal dependences, and model the pandemics prevented as products of a distribution of disease events that are not all as severe as COVID-19. Our findings make clear that this research effort is warranted, because the net benefits of stopping pandemics before they start could be enormous.

We recognize that as the world emerges from the COVID-19 pandemic, economic priorities may shift to deal with soaring demands from unemployment, chronic diseases, bankruptcies, and severe financial hardship of public institutions. Nonetheless, there is substantial evidence that the rate of emergence of novel diseases is increasing (2, 3) and that their economic impacts are also increasing. Postponing a global strategy to reduce pandemic risk would lead to continued soaring costs. Given the barrage of costly emerging diseases in the past 20 years, we urge that stimulus and other recovery funding include the strategies we have laid out to reduce pandemic risk. Society must strive to avoid some of the impacts of future pandemics.

References and Notes
1.↵M. Woolhouse, F. Scott, Z. Hudson, R. Howey, M. Chase-Topping, Philos. Trans. R. Soc. B 367, 2864 (2012).
2.↵J. O. Lloyd-Smith et al., Science 326, 1362 (2009).
3.↵K. E. Jones et al., Nature 451, 990 (2008).
4.↵C. L. Faust et al., Ecol. Lett. 21, 471 (2018).
5.↵J. Olivero et al., Sci. Rep. 7, 14291 (2017).
6.↵J. R. C. Pulliam et al., J. R. Soc. Interface 9, 89 (2012).
7.↵R. K. Plowright et al., Proc. R. Soc. B 278, 3703 (2011).
8.↵D. Nepstad et al., Science 344, 1118 (2014).
9.↵J. Busch, J. Engelmann, Environ. Res. Lett. 13, 015001 (2017).
10.↵K. F. Smith et al., Science 324, 594 (2009).
11.↵Report on Sustainable Development Strategy of China's Wildlife Farming Industry (Consulting Research Project of Chinese Academy of Engineering, 2017) [in Chinese].
12.↵N. Wang et al., Virol. Sin. 33, 104 (2018).
13.↵B. Nikolay et al., N. Engl. J. Med. 380, 1804 (2019).
14.↵E. H. Chan et al., Proc. Natl. Acad. Sci. U.S.A. 107, 21701 (2010).

Ecology and economics for pandemic prevention [Science, 24 Jul 2020]

Authored by Andrew P. Dobson, Stuart L. Pimm, Lee Hannah, Les Kaufman, Jorge A. Ahumada, Amy W. Ando, Aaron Bernstein, Jonah Busch, Peter Daszak, Jens Engelmann, Margaret F. Kinnaird, Binbin V. Li, Ted Loch-Temzelides, Thomas Lovejoy, Katarzyna Nowak, Patrick R. Roehrdanz, Mariana M. Vale

For a century, two new viruses per year have spilled from their natural hosts into humans (1).
The MERS, SARS, and 2009 H1N1 epidemics, and the HIV and coronavirus disease 2019 (COVID-19) pandemics, testify to their damage. Zoonotic viruses infect people directly most often when they handle live primates, bats, and other wildlife (or their meat) or indirectly from farm animals such as chickens and pigs. The risks are higher than ever (2, 3) as increasingly intimate associations between humans and wildlife disease reservoirs accelerate the potential for viruses to spread globally. Here, we assess the cost of monitoring and preventing disease spillover driven by the unprecedented loss and fragmentation of tropical forests and by the burgeoning wildlife trade. Currently, we invest relatively little toward preventing deforestation and regulating wildlife trade, despite well-researched plans that demonstrate a high return on their investment in limiting zoonoses and conferring many other benefits. As public funding in response to COVID-19 continues to rise, our analysis suggests that the associated costs of these preventive efforts would be substantially less than the economic and mortality costs of responding to these pathogens once they have emerged.

Reducing Deforestation

Tropical forest edges are a major launch-pad for novel human viruses. Edges arise as humans build roads or clear forests for timber production and agriculture. Humans and their livestock are more likely to contact wildlife when more than 25% of the original forest cover is lost (4), and such contacts determine the risk of disease transmission. Pathogen transmission depends on the contact rate, the abundance of susceptible humans and livestock, and the abundance of infected wild hosts. Contact rates vary with the perimeter (the length of the forest edge) between forest and nonforest. Deforestation tends to create checkerboards, whereupon we see a maximum perimeter at a 50% level of forest conversion. Thereafter, the abundance of domestic animals and humans rapidly exceeds that of wild animals, so although we expect transmission to decline, the magnitude of any resultant outbreak is higher (4). Habitat fragmentation complicates this because it increases the length of the perimeter. Roadbuilding, mining and logging camps, expansion of urban centers and settlements, migration and war, and livestock and crop monocultures have led to increasing virus spillovers. Hunting, transport, farming, and trade of wildlife for food, pets, and traditional medicine compound these routes of transmission and closely track deforestation. For example, bats are the probable reservoirs of Ebola, Nipah, SARS, and the virus behind COVID-19. Fruit bats (Pteropodidae in the Old World, the genus Artibeus in the New World) are more likely to feed near human settlements when their forest habitats are disturbed; this has been a key factor in viral emergence in West Africa, Malaysia, Bangladesh, and Australia (5–7).

The clear link between deforestation and virus emergence suggests that a major effort to retain intact forest cover would have a large return on investment even if its only benefit was to reduce virus emergence events. The largest-scale example of directed deforestation reduction comes from Brazil between 2005 and 2012. Deforestation in the Amazon dropped by 70%, yet production of the region's dominant soy crop still increased (8). International contributions, complemented by an Amazon Fund, of about $1 billion supported land-use zoning, market and credit restrictions, and state-of-the-science satellite monitoring. Brazil's program reduced forest fragmentation and edge at a lower cost than could have been achieved by carbon-pricing approaches (9).

Several estimates of the effectiveness and cost of strategies to reduce tropical deforestation are available (8, 9). At an annual cost of $9.6 billion, direct forest-protection payments to outcompete deforestation economically could achieve a 40% reduction in areas at highest risk for virus spillover [see supplementary materials (SM)]. Multiple payment-for-ecosystem-services programs demonstrate the effectiveness of this approach. At the low end, widespread adoption of the earlier Brazil policy model could achieve the same reduction for only $1.5 billion annually by removing subsidies that favor deforestation, restricting private land clearing, and supporting territorial rights of indigenous peoples. All require national motivation and political will. Strong public support for similar deforestation-prevention policies may emerge in other countries recovering from COVID-19's devastation.

Wildlife Trade Spillover

Global demand for wildlife causes people to enter forests to collect wildlife for sale in markets in urban and rural areas. In cities, where people have diverse options for protein, bushmeat is a luxury bought to show status, and occasionally for cultural reasons. COVID-19 is the huge price society now pays for such encounters with wild species.

Wildlife markets and the legal and illegal wildlife trade bring live and dead wild animals into contact with hunters, traders, consumers, and all those involved in this commerce. Trade follows global consumer demand. The United States is one of the biggest global importers of wildlife, including for the massive exotic pet industry (10). The transit conditions, lack of health screening at import, and warehouses that store animals before and after import are similar to live animal markets, all conducive to spreading diseases.

Some countries have wildlife farming industries intended to prevent overhunting of wild species while meeting market demands for protein and appealing to cultural traditions. In China, wildlife farming is a ∼$20 billion industry employing some 15 million people (11). With the February 2020 announcement by the Standing Committee of the National People's Congress of a ban on wildlife consumption for food and related trade in China, there are ongoing discussions on phasing out this industry. The justification is that it creates risks for disease emergence and that the health and safety regulations associated with farming wild animals are often insufficient. Laws to ban the national and international trade of high-risk disease reservoir species, and the will to sustain their enforcement, are necessary and precautionary steps to prevent zoonotic disease. Regulations must keep primates, bats, pangolins, civets, and rodents out of markets.

International conventions such as the Convention on International Trade in Endangered Species of Fauna and Flora (CITES) deal with only a part of the problem. They, regional networks, and national agencies monitoring wildlife trade and enforcing regulations are severely underfunded. Regional wildlife enforcement networks (WENs) could be strengthened to form part of an effective response frontier to future pandemic prevention. The annual budget of one WEN, hosted by the Association for Southeast Asian Nations, is $30,000 (see SM). CITES's annual budget is a mere $6 million. Its secretariat has recently stated that zoonotic diseases are outside of CITES's mandate; they are certainly outside its current budget. Helping to prevent the next outbreak might include raising WENs' budgets for regional responses while at the same time developing globally coordinated protocols to increase the WENs' capacity in wildlife health screening. Although there is no global agency with a remit to conduct surveillance on the wildlife trade, we estimated the costs of such an effort by considering the annual operating budget of the World Organization for Animal Health (OIE), which has a remit to assess disease risk in livestock trade without conducting testing. We then added costs of large-scale disease surveillance in wildlife, scaled to the global volume of wildlife trade (see SM).

Restricting access to wildlife for food and other uses must consider indigenous peoples and those in remote communities for whom wildlife provides essential protein. In some parts of the world, reliance on migratory wildlife such as caribou and salmon motivates stewardship of large expanses of habitat. Although the right to traditional diets should be upheld, people can nonetheless be at risk from harvesting wildlife. These are food security issues that governments and development agencies should confront. Where needed, they must include education and awareness on animal handling, sanitation, and disease transmission as well as sustainable wildlife management and support to develop village-level alternative foods. Legal hunting and marketing of wildlife that meets basic nutritional requirements sustainably can be regulated to reduce the risk of emerging pandemics. Over time, culturally sensitive measures could ensure indigenous people's access to healthy diets and reduce pandemic risks.
Early Detection and Control

There is substantial underreporting of exposure to zoonotic diseases. Correcting this would provide major opportunities for prevention. Nipah virus was discovered in 1998, originating in fruit bats, and caused a massive outbreak of respiratory illness in pigs and lethal encephalitis in people in Malaysia (6). Sentinel surveillance in Bangladesh hospitals revealed multiple annual case clusters and outbreaks with an average case fatality rate of 70%.

Similarly, SARS and COVID-19 emerged as outbreaks of respiratory disease in Guangdong and Wuhan, China, respectively. Serological surveys of people in rural Yunnan province showed that 3% had antibodies to similar virus species from their principal reservoir, horseshoe bats (Rhinolophus spp.) (12).

To quantify and reduce the risk of spillover of pathogens requires viral discovery in wildlife and testing of human and livestock populations in regions of high disease emergence risk. For example, the Wellcome Trust VIZIONS program tested wildlife, humans, and livestock for known pathogens in rural Vietnam. The U.S. Agency for International Development (USAID) PREDICT project analyzed the spillover of viruses in people with high wildlife contact in 31 countries.
PREDICT included community education programs to raise awareness of zoonotic risk and reduce contact with wildlife. It worked to prevent spillover through identification of high-risk behaviors and used serology surveys to examine seasonal patterns of risk. Interventions included use of bamboo skirts to reduce Nipah virus contamination of palm sap, increased biosecurity at livestock farms to reduce wildlife-livestock-human contact, promotion of handwashing, and wearing of personal protective equipment when in close contact with wildlife. It reduced the capacity of wildlife to shed virus at interfaces by closing high-risk bat caves.

Costs of measures to prevent spillover vary. USAID PREDICT spent $200 million over 10 years.
This cost compares favorably with the $1.2 billion for the Global Virome Project, a 10-year project designed to identify 70% of the unknown potentially zoonotic viruses in wildlife globally.
Although we have proof of concept for the discovery of disease with potential for emergence, for the identification of active spillover, and for programs that reduce risk, research is needed to quantify the return on investment for these programs. Pilot programs should prioritize indicators that allow better assessment of the costs and benefits of risk reduction (see SM).

After spillover, a second critical window of opportunity is the prevention of larger outbreaks (2). Early cases of HIV/AIDS, hantavirus pulmonary syndrome, Nipah virus, SARS, and COVID-19 went undetected for weeks, months, or years (HIV) before pathogen identification. Lags in identification have decreased, but this varies geographically. In lower-income countries, large outbreaks with substantial mortality often go undiagnosed, particularly when symptoms mimic those of other known diseases. Pilot projects are under way in clinics in many rural regions to identify the etiology of cases with similar symptoms (syndromic surveillance). For example, a pilot project costing $200,000 per year for syndromic surveillance for Nipah virus in Bangladesh hospitals resulted in a factor of 3 increase in the detection of spillover events (13).
The U.S. National Institute of Allergy and Infectious Diseases is launching a series of Centers for Research in Emerging Infectious Diseases. Contracts for this work are expected at $1.5 million per year, focusing on specific high-risk viral zoonoses in emerging disease hotspots.
Detection and control programs targeting outbreaks in their early stages would result in considerable savings by reducing morbidity and mortality. A priority is to identify indicators of risk reduction as pilot programs roll out and to calculate the costs, cost savings, and benefits of expanding them.

Farmed Animal Spillover

Livestock are critical reservoirs and links in emergent diseases. H5N1 influenza came across the human-wildlife interface (wild bird → poultry → human transmission chain), as did H1N1 influenza (bird → pig → human). Many livestock-linked outbreaks have reached the cusp of pandemic emergence, such as Nipah virus (fruit bat → pig → human) and swine acute diarrhea syndrome coronavirus (bat → pig) (14). These links are well recognized and are the focus of pandemic prevention packages proposed by the U.S. Congress (H.R. 3771). There are well-researched veterinary health plans such as the World Bank's One World One Health farm biosecurity intervention program, designed to reduce H5N1 influenza risk. With costs in the tens of billions of dollars, proposals dealing with livestock's roles in pandemics are among the most advanced and ambitious of those being seriously considered. We have known about these risks longer (e.g., influenza) and can control farm biosecurity more easily than wildlife contact in trade or at forest edges.

Conclusions

The actions we outline can help to prevent future zoonotic pandemics before they start.
Monitoring alone would realize substantial cost savings, even in the context of pandemic outbreaks much less severe than COVID-19 (14). The gross estimated costs of the actions we propose total $22 to $31 billion per year (see the table). Reduced deforestation has the ancillary benefit of around $4 billion per year in social benefits from reduced greenhouse gas emissions, so net prevention costs range from $18 to $27 billion per year. In comparison, COVID-19 has shown us the immense potential cost of a pandemic. The world may lose at least $5 trillion in GDP in 2020, and the willingness to pay for the lives lost constitutes many additional trillions (see SM). These costs exclude the rising tally of morbidity, deaths from other causes due to disrupted medical systems, and the loss to society of foregone activities due to social distancing.

To justify the costs of prevention, a year's worth of these preventive strategies would only need to reduce the likelihood of another pandemic like COVID-19 in the next year by about 27% below baseline probability in the most likely scenario, even ignoring the ancillary benefits of carbon sequestration. We explored eight alternative scenarios with varied assumptions drawn from the highest and lowest values of both prevention costs and pandemic damages, and assuming that extreme pandemics occur either once every 100 years or once every 200 years. In all scenarios but one, prevention need only reduce the probability of a pandemic by less than half, and in one case the break-even percent probability reduction is as low as 12% (see SM). We estimate the present value of prevention costs for 10 years to be only about 2% of the costs of the COVID-19 pandemic.

We recognize that we have provided no more than a sketch of the key components of an economically feasible set of ecological pandemic prevention strategies. Limits on the availability of information limit our ability to conduct a more exhaustive analysis. Instead, we tally readily available information to evaluate how likely it is that an investment of the costs of pandemic prevention would yield positive net benefits to the world. Our calculations are conservative in the direction of making it hard to find that prevention is likely to be worthwhile—and yet that is our finding. Future studies could narrow uncertainties in the costs and efficacy of those strategies and pinpoint the most cost-effective suite of actions. A full cost-benefit analysis of pandemic prevention could track the flows of prevention costs over time, allow for intertemporal dependences, and model the pandemics prevented as products of a distribution of disease events that are not all as severe as COVID-19. Our findings make clear that this research effort is warranted, because the net benefits of stopping pandemics before they start could be enormous.

We recognize that as the world emerges from the COVID-19 pandemic, economic priorities may shift to deal with soaring demands from unemployment, chronic diseases, bankruptcies, and severe financial hardship of public institutions. Nonetheless, there is substantial evidence that the rate of emergence of novel diseases is increasing (2, 3) and that their economic impacts are also increasing. Postponing a global strategy to reduce pandemic risk would lead to continued soaring costs. Given the barrage of costly emerging diseases in the past 20 years, we urge that stimulus and other recovery funding include the strategies we have laid out to reduce pandemic risk. Society must strive to avoid some of the impacts of future pandemics.

'Our epidemic could exceed a million cases' — South Africa's top coronavirus adviser [Nature.com, 24 Jul 2020]

by Linda Nordling

Salim Abdool Karim says the country must rediscover its community spirit to deal with a coming surge in infections.

From the coronavirus pandemic’s first months, the World Health Organization warned that Africa’s health systems would struggle to cope if the virus began to spread on the continent.

That prediction is starting to be realized, as Nature has reported from Guinea, Liberia and Sierra Leone. But more than half of the continent’s 780,000 reported cases are in South Africa.

Initially, a hard five-week lockdown from 27 March helped to keep numbers low, but that became economically ruinous as 3 million South Africans lost their jobs. The official death toll stands at 6,000, but as with other countries, this is likely to be an undercount, according to the South African Medical Research Council.

The government had been easing restrictions to restart the economy, but has again closed schools for four weeks. Health minister Zweli Mkhize has urged citizens to admonish family and friends who are not adhering to social distancing, mask-wearing or hand washing.

Nature spoke to Salim Abdool Karim, an epidemiologist and chair of the health ministry’s scientific advisory committee. A veteran of the AIDS crisis, Karim talks about his hopes and fears, and why he thinks South Africa’s ubuntu tradition — of communities looking out for each other — is key to the country’s response.

South Africa’s present situation looks dire. How did the country get here?

We had our first case on 5 March. In the first three weeks after that we had a rapidly growing epidemic; the cases were doubling every two days. We were on the same trajectory as the United Kingdom at that time. By declaring a state of disaster, closing the country’s borders, and implementing the lockdown on 27 March, we slowed the transmission to a doubling time of 15 days. We didn’t have the early peak that countries like the United Kingdom had. If we hadn’t implemented these measures, we would have had the situation we have now back in April.

How much worse is it likely to get?

Since there are communities in South Africa where social distancing and frequent hand washing is not feasible, mainly in informal settlements, I am expecting the number of cases to rise substantially, possibly exceeding a million. I thought that this would occur within 2–3 months of the first case.

What surprised you about how slowly the epidemic was progressing?

I expected the epidemic to take off big time in Gauteng [a small, densely populated province that includes Johannesburg and Pretoria] in late April as we eased the lockdown. Gauteng has so many travellers, so much density — this is the New York of Africa. I was completely wrong! Instead, the first large outbreak was in Cape Town. But we always thought that when it eventually did hit Gauteng it was going to grow, and that’s what we’re seeing now. The president is talking about a “storm” — we are seeing 5,000 to 6,000 new cases in Gauteng per day. Even so, our epidemic is smaller than I thought it would be by now. I had thought that by May, we would be reaching serious numbers.

To what extent was the slow spread due to ‘exceptional’ factors such as Africa’s young population, or its climate? Or is it a result of limited testing?

I never believed that Africa was exceptional. But I don’t have the answer. There is no reason why this epidemic should not have spread faster in some countries, such as Nigeria. Some people say it’s because those countries don’t test enough. But even if you don’t test, you still will see an increase of hospital admissions and deaths. So that’s not the real reason. At the moment, it’s an enigma. The reason will reveal itself in due course.

The South African government, like many others, says it locked down to buy time to prepare the health system, rather than to stop the virus from spreading. Is this true?

Yes, the primary goal of the South African COVID-19 response is to slow the spread of infections to enable the health system to prepare and cope better. This would not necessarily equate to fewer infections. Containment was still on the table early on, but it was a long shot.
We didn’t really think of it as a realistic option. Of course, we hoped South Africa would end up having some ‘mojo’ that would protect it better than other countries. But the reality of South Africa dictates otherwise. Large parts of our country do not have the ability to institute social distancing and for people to wash their hands regularly. So, we had to plan that we would not be able to contain it, while hoping that we would. But when I presented the likely scenario to politicians and later to the public around Easter, I explained that we had to face “a difficult truth” — that we were not likely to be able to contain the virus, and that the spread would probably rise exponentially as we eased lockdown restrictions. It was really difficult to say that to the entire nation.

How are politicians taking to science advice, considering South Africa’s history of political leaders doubting that HIV causes AIDS?

There is a better relationship between science and politics now, it’s been very different. Neither Cyril Ramaphosa [South Africa’s president] nor the people we deal with like Mkhize ever denied that this was a serious issue. They wanted to hear what we thought, they drew on our experience. But they were making their own decisions. We are advisers, and they make the calls.

Are you worried that South Africans might not get access to new COVID-19 treatments and a vaccine, if and when one is developed?

I had hoped we would be more involved in developing Covid-19 vaccines in South Africa. We have the capacity, built from HIV where we are front runners. The reason I say this is that when you play a leading role like that, you have a seat at the table where decisions are made about the vaccine, and its distribution. Unfortunately, because we came to the epidemic late — it had already been through China, Europe, North America — we have had to take a supporting role in vaccines.

We would just have added one more vaccine candidate, and there are lots already. So, without a seat at the table, we will always be at a disadvantage and we’ll have to wait our turn. The way things are going right now, the US is probably going to want to take the first 200–300 million doses and then leave the rest for the rest of the world to distribute equally. It is good to know that the World Health Organization is facilitating this process.

What happens now?

We are ‘building the ship as we are sailing it’. This virus exposes the fault lines in our society.
But I think when we get to a point where sufficient numbers of people have a relative, or family member, or someone in their neighbourhood who has been sick or died from the virus, individuals are moved to collective action so that they can stand united again. When the problem didn’t seem so serious, when the lockdown slowed transmission, people questioned the restrictions as those of a nanny state. But I think we are going to realize pretty soon that the best protection we have from this virus is ubuntu — a South African word that means ‘I am because you are’. I am safe because you are safe. I saw that in HIV, when people saw the deaths of those close to them, it pushed a change in behaviour. We as a country are built on the principle of ubuntu. We have to rediscover that, or we won’t defeat this virus.

China May Have Eyed Coronavirus Research at Shuttered Houston Consulate, Officials Say [Foreign Policy, 24 Jul 2020]

BY JACK DETSCH, AMY MACKINNON

China’s efforts to use the Houston consulate to steal science and technology secrets were “particularly aggressive and particularly successful,” Trump administration indicates.

China may have been using its now-closed consulate in Houston as a base of operations for industrial espionage as it seeks to be the first to hit the market with a vaccine for the novel coronavirus, Trump administration officials indicated on Friday.

The Houston facility is near the largest medical complex in the world and a bevy of research universities and critical infrastructure projects. Officials said the consulate has been used at least 50 times in the past 10 years to help recruit members of the Thousand Talents Program, China’s effort to target top Chinese and foreign experts from around the world in cutting-edge fields to bring their skills back to Beijing.

In recent years, China has made a concerted effort to leap ahead in scientific research and technology by targeting Chinese nationals and foreign experts. Chinese Consulate officials in Houston had been directly involved in communications with researchers and guided them on what information to collect, the officials said.

“From where I sit and you look at what happened with the corona outbreak in China in 2019, they have been very clear about their intent to be the first to the market with a vaccine, and the medical connections here aren’t lost on me,” a senior State Department official told reporters on Friday. “The medical connection in Houston is also pretty specific.” It was not immediately clear what trade secrets China was able to target from the facility.

On Friday, China retaliated for the closure of its U.S. consulate, ordered by the State Department on Tuesday, by ordering the closure of the U.S. consulate in Chengdu, China. U.S. officials did not clarify whether Chinese consular officers would leave the Houston facility by the Friday deadline.

Also on Friday, the U.S. effort to push back against Chinese spying took another step forward, after American authorities arrested a fugitive Chinese researcher and uniformed officer of China’s Air Force who was hunkered down in the Chinese consulate in San Francisco. Juan Tang is likely to appear in U.S. District Court on Friday, after the FBI earlier this week arrested three other individuals charged with visa fraud and lying about working for China’s People’s Liberation Army.

Like other consular facilities, the Houston consulate had been long used as a base of operations for Chinese intelligence services, officials said, because of their status as sovereign territory within the United States. But a senior intelligence official said that science and technology intelligence collectors from the Houston area were “particularly aggressive and particularly successful.” Earlier this month, FBI Director Christopher Wray said that the agency opens a new Chinese espionage case approximately every 10 hours.

In July 2019, a Houston businessman, Shan Shi, was found guilty of conspiring to steal trade secrets from a Texas company that makes drilling equipment for the oil industry. Shi, a naturalized U.S. citizen, was acquitted of conspiring to conduct economic espionage on behalf of China.

Fauci calls COVID-19 a 'pandemic of historic proportion,' like 1918's flu [Catholic News Service, 24 Jul 2020]

By Juan Carlos Ramirez

PHOENIX (CNS) -- There is no denying the fact "this is a pandemic of historic proportion," Dr. Anthony Fauci told students at Jesuit-run Georgetown University in a recent online webinar focused on young people's risks and responsibilities in mitigating the spread of COVID-19.

"I think we cannot deny that fact. It is something that when we look back in history, it will be comparable to what we saw in 1918," he said, referring to the deadly influenza epidemic that lasted from February 1918 to April 1920 and infected 500 million people around the world.

Fauci is director of the National Institute of Allergy and Infectious Diseases at the National Institutes of Health and a member of the White House Coronavirus Task Force, established Jan. 29.

After the World Health Organization declared COVID-19 a pandemic March 11, a national emergency was declared in the United States, leading to a shutdown of all but what government officials declared to be essential services, like grocery stores and Home Depot and other big-box stores. Public celebration of Mass in Catholic churches and services in other houses of worship were among numerous events that had to be canceled for months.

In recent weeks a majority of states have gradually opened up, but the number of confirmed cases of COVID are now spiking around the country.

Fauci said the increases in cases might have a correlation with the reopening of states and the younger culture.

The challenge the country is facing right now is the resurgence of infections in the South and Southwestern parts of the country, Fauci said, adding, "We are seeing record numbers of cases mostly among young individuals, which strongly suggests a link (with) attempting to reopen."

According to the Johns Hopkins Coronavirus Resource Center, as of midday July 24 there are currently over 4 million positive cases in the U.S. and over 144,000 deaths. The numbers are leading the world in both categories.

Among the states that began reopening in the past few weeks, Arizona, California, Florida and Texas in particular have seen the biggest spikes in confirmed cases of the coronavirus, as Fauci noted.

Among the top-10 counties with the most confirmed cases, Florida and Texas each have two counties in the list: Miami-Dade and Broward counties in Florida, which have been at No. 5 and No. 8 on the list, and Harris (which is home to Houston) and Dallas counties in Texas, at No. 6 and No. 10.

"Our challenge today, tomorrow and the next week is to try to contain these outbreaks and get us back on the track of not only being able to contain but also to open safely," Fauci added.

Dr. Scott Atlas, a senior fellow at Stanford University's Hoover Institution, sees no correlation between the reopening of states and the increase in cases, attributing the rise to large public demonstrations taking place since May 25, the day George Floyd died while in police custody.

"By the way, they (the numbers) do not correlate, in a time sense, with the reopening of states," said Atlas. "If you look at the timing, it is just a misstatement and false narrative. The reality is that it might correlate to the recent massive demonstrations. Suffice it to say that the majority of cases come from younger healthier people."

In Arizona, for example, 61% COVID-19 cases are in people under 45, public health officials said. In Texas' two largest counties, Harris and Dallas, about half of the new cases have been in people under 40.

Fauci, Atlas and others agree that younger people, on average, are less likely to become severely ill and die of the disease, but they can spread it to older, more vulnerable people.

Atlas also said the increase in the number of ICU beds being occupied is not related to increase of positive COVID cases but with reinstallation of medical care for non-COVID patients.

"When you look at Texas, 90-plus percent of ICU beds are occupied, but only 15% are COVID patients," said Atlas.

Regardless of different perspectives on what's causing the spike, states have been reinstating restrictions, while also urging the public to continue to adhere to social-distancing and mask-wearing protocol.

For example, California Gov. Gavin Newsom issued a July 13 directive that 30 counties, which account for 80% of the state's population, must close indoor operations of restaurants, bars, movie theaters, family entertainment centers, museums, fitness centers and places of worship, among other entities.

In keeping with new directives, the Archdiocese of Los Angeles announced July 13 it will discontinue indoor Masses and other liturgical services, effective immediately.

San Francisco Archbishop Salvatore J. Cordileone, like his fellow bishops in the state, is recommending Catholics participate in Mass remotely via livestreaming, receive a "spiritual Communion," meditate on the Sunday readings and pray the rosary.

In Florida, Gov. Ron DeSantis said his state is "not going back" to widespread shutdowns. He has not issued a statewide mask mandate, but most jurisdictions have called on the public to wear a facial covering when in stores or other public venues.

As of July 11, Texas Gov. Greg Abbott had rolled back some of his reopening plan. The state has a mask order requiring all residents to wear a face covering over the nose and mouth in public.

Besides requirements for face coverings, other directives that have become common place around the country include social distancing, limits on gatherings, hand-sanitizing procedures, and when it comes to houses of worship, best practices for disinfecting pews and other areas of worship spaces, in places where public celebration of the Mass has resumed with limited crowd capacity.

"If a church cannot be sanitized according to the cleaning and disinfection norms, church gatherings may not resume there," the Diocese of El Paso, Texas, says on its website. “Similarly, if a liturgical celebration or event cannot maintain the social distancing norms, it may not take place."

One of the most debated issues right now around the country during this ongoing pandemic is whether, when fall comes, schools should open and hold in-classroom lessons, or stick to online distance learning, or do carryout some hybrid of the two.

Fauci said the main goal is to have the children in school, but that goal must be modified in different regions of the United States based on the status of COVID-19 in those regions.

"As a general principle, we should try as best as possible to keep the children in school for the reasons that the unintended downstream ripple affect consequences of keeping the kids out of school and the impact on working families could be profound," he explained in the webinar.

"However, that is going to vary from where you are in the country and the dynamics of the outbreak are in your particular region," Fauci added. "Although the fundamental principle is there, the one other guiding principle and is overriding is the safety and welfare of the children and teachers."

Medical experts urge US to shut down and start over as coronavirus cases surpass 4 million [CNN, 24 Jul 2020]

By Madeline Holcombe

(CNN)As the US hit a sobering 4 million cases of Covid-19 and the rising daily rate of confirmed cases and hospitalizations suggest the virus is far from under control, medical experts are urging political leaders to shut down the country and start over to contain the pandemic.

At least 4,038,748 coronavirus cases and 144,304 deaths have been recorded in the United States, according to data from Johns Hopkins University. As the numbers climb, more than 150 prominent US medical experts, scientists, teachers, nurses and others have signed a letter to political leaders urging them to shut down the country and start over to contain the surging coronavirus pandemic.

"Right now we are on a path to lose more than 200,000 American lives by November 1st. Yet, in many states people can drink in bars, get a haircut, eat inside a restaurant, get a tattoo, get a massage, and do myriad other normal, pleasant, but non-essential activities," the letter said.
Coronavirus is set to become a leading cause of death in the US, Centers for Disease Control and Prevention mortality statisticians told CNN via email Thursday.

Microsoft co-founder Bill Gates also sounded the alarm Thursday during a CNN coronavirus town hall.

"Infection rates in the US are deeply troubling because the summer, when it's warmer, when people are outdoors more, actually it's easier to reduce the infection than it's going to be out in the fall," said Gates, who is helping fund the development of coronavirus vaccine efforts through his Bill and Melinda Gates Foundation. "So we're in a very tough situation."

How states are handling major outbreaks

Cases are starting to plateau in the four states that have seen large increases, Dr. Deborah Birx, the White House Coronavirus Task Force coordinator, said Friday.

"We're already starting to see some plateauing in these critical four states that have suffered under the last four weeks -- so Texas, California, Arizona and Florida, those major metros and throughout their counties." Birx said on NBC's "Today" show.

Birx compared what's been going on in these states to the outbreak in New York in the spring, adding "it's very serious and it's very real."

States across the country are struggling with local outbreaks.
New Mexico, Hawaii and Missouri all reported records for new daily cases Thursday.

For the fourth straight day, Los Angeles County reported more than 2,000 additional confirmed cases, Health Officer Muntu Davis announced in a news briefing.

And officials in Alaska have begun isolating, monitoring and caring for 96 employees of a seafood processing plant in Seward, according to a news release from the Alaska Department of Health and Social Services. CNN has reached out to the company, OBI Seafoods, for comment.

Citing an increasing rate of transmission, Washington Gov. Jay Inslee announced the state is tightening restrictions on restaurants, bars, fitness centers, movie theaters, weddings and funerals.

"If we let the virus get even more control, it will have an even more devastating impact over the long term in our economy, and certainly in our health, and the very lives of our loved ones," he said at a news conference.

Where the new school year stands

The resurgence in cases, and likely ongoing presence of the virus, has ignited debate about how to proceed with the new school year.

New Mexico Gov. Michelle Lujan Grisham announced Thursday that the state will delay in-person learning through at least Labor Day as cases break records in the state.

By contrast, Tennessee Gov. Bill Lee said his state will introduce a plan to reopen schools Tuesday.

"Our kids need to be in school because kids not only academically are suffering, emotionally, mental health. ... There are a number of working families who need for their children to be in school so they can continue to work. There's a lot of reasons why schools can be and should be open. So long as we do that in a way that protects teachers and protects students at the same time we believe we can do," Lee said.

New guidance from the CDC is strongly in favor of sending students back to the classroom, saying that available evidence shows that coronavirus does not possess as great a risk to children. With the services and instruction offered in school, the CDC guidance said virtual learning can be a disadvantage to American students.

"It can lead to severe learning loss, and the need for in-person instruction is particularly important for students with heightened behavioral needs," the CDC statement said.

Learning more on risks to mothers and infants

Researchers are still learning how the virus impacts certain groups, with results sometimes changing earlier guidance.

New guidance from the American Academy of Pediatrics released Wednesday said that mothers infected with the virus can safely stay in the same room as their newborns if safety measures are taken.

"What we now know is the risk of the newborn becoming infected around the time of birth is low when safety precautions are taken to protect the baby," said lead author of the guidance Dr. Karen Puopolo in a statement. "In fact, the risk in the short-term appears to be no greater if mother and infant room-in together using infection control measures compared to physical separation of the infant in a room separate from the mother."

A study published Thursday in The Lancet Child & Adolescent Health supported that guidance.

Researchers reported no cases of viral transmission among 120 babies born to 116 Covid-positive mothers, even when both shared a room and the mothers breastfed.