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Health Care

Did We See This Coming?

A worker sets up beds at the Hongshan Stadium to convert it into a makeshift hospital following an outbreak of the new coronavirus in Wuhan, Hubei Province, China, February 4, 2020. (China Daily via Reuters)

Happy Passover — it’s a good time to celebrate one’s ancestors surviving times of plagues — and I hope you’re enjoying Holy Week as best you can at home. Today we’ve got a fascinating warning about research into coronaviruses and SARS dating back to Obama’s second term and ties back to Wuhan; an unusual report suggesting that a part of the U.S. government saw the outbreak emerging in November; and yet another awful decision from New York City mayor Bill de Blasio.

A Warning about the Risk of SARS-Like Coronaviruses in Bats from the Late Obama Years

Look back to a decision by the U.S. National Institutes of Health, back on October 16, 2014:

The White House Office of Science and Technology Policy announced  that the U.S. government will undertake a deliberative process to assess the risks and benefits of certain gain-of-function (GOF) experiments with influenza, SARS, and MERS viruses in order to develop a new Federal policy regarding the funding of this research. During this deliberative process, U.S. government agencies will institute a pause on the funding of any new studies involving these experiments. For purposes of the deliberative process and this funding pause, “GOF studies” refers to scientific research that increases the ability of any of these infectious agents to cause disease by enhancing its pathogenicity or by increasing its transmissibility among mammals by respiratory droplets.

NIH has funded such studies because they help define the fundamental nature of human-pathogen interactions, enable the assessment of the pandemic potential of emerging infectious agents, and inform public health and preparedness efforts. These studies, however, also entail biosafety and biosecurity risks, which need to be understood better. 

During this pause, NIH will not provide new funding for any projects involving these experiments and encourages those currently conducting this type of work — whether federally funded or not — to voluntarily pause their research while the government determines how to proceed.

The NIH elaborated on the ruling in a statement to NPR: “These three agents that are subject to the pause share the characteristics of not only being human health threats — causing in some instances significant morbidity and mortality, as you know — but furthermore having the potential to be the agents of a pandemic because they are transmitted easily by respiratory droplets. So experiments that would make them even more pathogenic in mammals (and hence potentially in people) were concerning enough to warrant placing those experiments under the pause until their risks and benefits could be better characterized.”

That pause on funding remained in place until December 2017. Francis Collins was the director of NIH at both the announcement of the pause and the ending of the pause. He declared when the pause ended, “we have a responsibility to ensure that research with infectious agents is conducted responsibly, and that we consider the potential biosafety and biosecurity risks associated with such research. I am confident that the thoughtful review process laid out . . . will help to facilitate the safe, secure, and responsible conduct of this type of research in a manner that maximizes the benefits to public health.” NIH put together a ton of reports, statements, symposiums, and other work attempting to calculate the right balance between the potential benefit of the research and the potential risk to scientists and the general public through mishandling of contagious viruses.

The safety and security of potentially dangerous viruses and substances was at the forefront of federal officials’ minds that year. In June 2014, the U.S. Centers for Disease Control and Prevention determined they had unintentionally exposed personnel to potentially viable anthrax. In July, the U.S. Food and Drug Administration found samples of smallpox, dengue, and spotted fever just sitting in a storage room.

But there was a project that did not pause, and argued it was effectively “grandfathered in” under the old rules before the pause. The National Institutes of Health concurred with this assessment. This was that particular project:

Ralph Baric, an infectious-disease researcher at the University of North Carolina at Chapel Hill, last week (November 9) published a study on his team’s efforts to engineer a virus with the surface protein of the SHC014 coronavirus, found in horseshoe bats in China, and the backbone of one that causes human-like severe acute respiratory syndrome (SARS) in mice. The hybrid virus could infect human airway cells and caused disease in mice, according to the team’s results, which were published in Nature Medicine.

They developed a hybrid virus combining the traits of SARS and other another type of coronavirus. Articles at the time suggested some virologists weren’t so sure the benefits of the research were worth the risk.

But other virologists question whether the information gleaned from the experiment justifies the potential risk. Although the extent of any risk is difficult to assess, Simon Wain-Hobson, a virologist at the Pasteur Institute in Paris, points out that the researchers have created a novel virus that “grows remarkably well” in human cells. “If the virus escaped, nobody could predict the trajectory,” he says.

One of the quotes from Baric in 2015 is chilling from the perspective of today:

“Studies have predicted the existence of nearly 5,000 coronaviruses in bat populations and some of these have the potential to emerge as human pathogens,” said senior author Ralph Baric, PhD, a professor of epidemiology at the UNC Gillings School of Global Public Health and professor of microbiology and immunology the UNC School of Medicine and world-renowned expert in coronaviruses. “So this is not a situation of ‘if’ there will be an outbreak of one of these coronaviruses but rather when and how prepared we’ll be to address it.”

Fourteen other scientists worked with Baric on this project — mostly others at UNC, but also from the Switzerland Institute of Microbiology and Harvard Medical School. And two of the scientists, Xing-Yi Ge and Zhengli-Li Shi, worked at the Key Laboratory of Special Pathogens and Biosafety, Wuhan Institute of Virology, Chinese Academy of Sciences, Wuhan, China.

You may recognize Zhengli Shi as the Chinese researcher nicknamed “Bat Woman” for her work with the animals.

Apparently, some folks look at this sequence of events and conclude that SARS-CoV-2 is bioengineered. As laid out in previous newsletters and articles, too many virologists, biologists, and genome researchers say that simply cannot be the case with the virus that is attacking the world right now. The “engineering” would be too difficult to hide, and other genomic researchers would see the metaphorical “fingerprints” of the alteration of naturally occurring traits.

But what this does tell us is that the Obama administration and U.S. National Institutes of Health were sufficiently worried about scientists working on these types of viruses, and the risk of an accidental release of one of these viruses, to halt federal funding for this research. They were also sufficiently worried about an accidental release to encourage anyone not taking federal funding to halt their work as well. They had good reason to be; in addition to the cases at the U.S. CDC and FDA, the Chinese CDC’s National Institute of Virology in southern Beijing had accidentally released SARS. Twice. The “pause” on funding remained in place for the remainder of the Obama administration, and wasn’t lifted until a year into the Trump presidency.

But the research on bats and coronaviruses continued at the Wuhan Institute of Virology, where the declarations and funding leverage of the National Institutes of Health held no sway. And that research continues at the institute to this day.

The evidence pointing to a lab accident is circumstantial, and the argument that SARS-CoV-2 had to pass through pangolins before transferring to humans appears to be a compelling piece of counterevidence. But I recognize that the skeptics of the lab-accident theory have been forced by circumstances into a position that is inherently unpopular right now: They have to argue that at least in this particular situation, the Chinese government is not lying.

Just When Were the First Cases and First Reports of COVID-19?

I find this story from ABC News really interesting, although it doesn’t quite match other information about this outbreak:

As far back as late November, U.S. intelligence officials were warning that a contagion was sweeping through China’s Wuhan region, changing the patterns of life and business and posing a threat to the population, according to four sources briefed on the secret reporting.

The report was the result of analysis of wire and computer intercepts, coupled with satellite images. It raised alarms because an out-of-control disease would pose a serious threat to U.S. forces in Asia, forces that depend on the National Center for Medical Intelligence’s work.

I have no reason to doubt ABC’s reporting, and no reason to think their sources are lying, exaggerating, or misremembering dates.

At least as far as the official record — in this case, the medical journal The Lancet, “The symptom onset date of the first patient identified was Dec 1, 2019. None of his family members developed fever or any respiratory symptoms. No epidemiological link was found between the first patient and later cases.”

One of these sources must be incorrect. Either there were symptoms, patients, and some sort of official communications about a new viral outbreak in the Wuhan region in November, before that December 1 date for first onset of symptoms in the first patient identified, or the National Center for Medical Intelligence has the wrong dates.

If the NCMI has wire and computer intercepts indicating a viral outbreak in November, this means the Chinese government hid the truth even longer than we thought. The Chinese CDC said “a cluster of pneumonia cases with an unknown cause occurred in Wuhan starting on December 21, 2019.” The Chinese government did not admit that the virus was being transferred from one human to another until January 20.

New York City Had Some Extra Ventilators, but Then . . .

New York City mayor Bill de Blasio has managed to make just about every wrong decision regarding this epidemic. ProPublica reports that Mike Bloomberg had worried about an infectious disease crisis in the city, particularly after SARS and avian flu. In 2006 and 2007, New York City bought “a few hundred ‘disaster-ready’ ventilators” — less than all the city would need, but at least an effort to address the gap. But maintaining the stockpile stopped being a priority for the city government:

VersaMed was acquired by GE Healthcare in 2008 and the company discontinued the line of ventilators New York had bought, Lanza, the city health department spokesman, told ProPublica. “This was beyond our control but had a direct impact on cost and viability of maintaining a stockpile.” Annual maintenance costs for the 500 VersaMed ventilators, which includes replacing batteries and degrading parts, ran over $100,000 per year, Lanza said, adding that the ventilators were ultimately auctioned off by the city. It’s not clear who bought the devices and for how much. A GE spokeswoman said the city had a service contract for the ventilators that expired sometime between 2014 and 2016, and added that the company still has customers with service contracts for the same model ventilator.

Hospitals were also reluctant to spend money to store machines and protective equipment that they did not need for day-to-day operations.

When this is over, we’re going to have a lot of intense arguments about what constitutes a foreseeable risk and what constitutes a “black swan” event — a giant, sweeping, and often destructive change that appears with little or no warning.

ADDENDA: Because we need it, here are things that are still going on, despite the coronavirus and quarantines: Passover and Easter gatherings are happening at home this week, Pixar released Onward to Disney Plus, ESPN is moving up its docuseries about Michael Jordan five weeks to April 19, the NFL Draft will still begin with teams picking from home on April 23, a portion of the PGA Tour will get started in autumn, and there are rumors that more big movies will go straight to streaming. The country has 13 drive-in theaters that are still showing movies in a safe manner. The country has thousands of drive-through restaurants. We will get through this.


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