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Scientist says anti-epilepsy drug can be repurposed for Covid-19, writes to ICMR to test it – ThePrint

Posted: March 29, 2020 at 6:58 pm

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New Delhi:A leading scientist at the International Centre for Genetic Engineering and Biotechnology (ICGEB) in New Delhi has found that valproic acid, an anti-epilepsy drug, can be repurposed and used for acute cases of Covid-19.

The scientist, Neel Sarovar Bhavesh, has written to the director general of the Indian Council of Medical Research (ICMR), the apex body in the field, to test valproic acid at the National Institute of Virology in Pune or any ICMR lab to find a quick solution to the coronavirus crisis.

The ICGEB is part of the research consortium working to find a cure and vaccine for Covid-19.

Valproic acid is an approved drug, whose patent expired recently. It is sold under brand names such as Depacon and Stavzor to treat epilepsy. The University of California has also validated the ICGEBs research findings it lists valproic acid as one of the molecules for repurposing and testing for use against the Covid-19 virus.

Also read: AI identifies potential drugs and a DNA vaccine in the works latest on Covid-19

Bhavesh, the head of transcriptional regulation at ICGEB, told ThePrint: We have performed high-throughput virtual screening (HTVS) of 1.2 million small molecules from the four databases, and later performed Energy calculation and molecular binding simulation. We found that valproic acid CoA may be repurposed to inhibit the RNA-dependent RNA polymerase of the virus.

We have written to the DG ICMR to test this molecule on cell culture and animal testing facilities, in combination with potent binding blocking molecules. Currently no one in India outside the NIV and ICMR has access to the Covid-19 virus, Bhavesh said.

About 1,100 strains of the novel coronavirus have been sequenced from around the world. We (in India) have around 700 confirmed positive cases, but only two virus sequences are available at the NIV. These sequences are different from each other, he explained.

Bhavesh revealed that after the publication of the ICGEB research, multinational pharmaceutical company GlaxoSmithKline contacted them.

However, Bhavesh said theres an urgent need for cooperation from government bodies like the ICMR and the NIV in terms of giving researchers access to the virus strains in India to test on.

There should be synchronisation in testing and developing. If NIV or any another research institution finds success, lots of patients can be cured and saved. The need of the hour is to find the solution. The NIV must cooperate with other institutions more generously, he said.

A day before, Union Biotechnology Secretary Renu Swarup also said in an interview that early solutions for the novel coronavirus can be found from repurposed drugs, and that developing new drugs would take time.

Also read: Old drugs, new trials hopes pinned on HIV, malaria, ebola, TB vaccines to fight Covid-19

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Planet Earth Report Scientists Stranded at Sea to Unknown Limits of Human Athletic Performance – The Daily Galaxy –Great Discoveries Channel

Posted: March 29, 2020 at 6:58 pm

Planet Earth Report provides descriptive links to headline news by leading science journalists about the extraordinary discoveries, technology, people, and events changing our knowledge of Planet Earth and the future of the human species.

We Are Nowhere Close to the Limits of Athletic Performance Genetic engineering will bring us new Bolts and Shaqs. For many years I lived in Eugene, Oregon, writes Stephen Hsu for Nautil.us, also known as track-town USA for its long tradition in track and field. Each summer high-profile meets like the United States National Championships or Olympic Trials would bring world-class competitors to the University of Oregons Hayward Field. It was exciting to bump into great athletes at the local cafe or ice cream shop, or even find myself lifting weights or running on a track next to them. One morning I was shocked to be passed as if standing still by a woman running 400-meter repeats. Her training pace was as fast as I could run a flat out sprint over a much shorter distance.

Significance of Pangolin Viruses in Human Pandemic Remains Murky Scientists havent found evidence that the new coronavirus jumped from pangolins to people, but they do host very similar viruses, writes James Gorman for the New York Times. Pangolins, once suspected as the missing link from bats to humans in the origin of the coronavirus pandemic, may not have played that role, some scientists say, although the animals do host viruses that are similar to the new human coronavirus.

The Pandemic Has Grounded Humankind Space missions around the world are on holda poignant reminder of how COVID-19 has upended civilization, writes Marina Koren for The Atlantic.

The spread of the coronavirus will be exponential which is bad. But its inevitable decline will also be exponential, which is good, writes Seth Shostak, Senior Astronomer at SETI.org. In the case of the coronavirus, the growth in the number of infected persons will inevitably be exponential, at least for a while. Thats because the rate of new infections clearly depends on the number of people who are already contagious. The resulting tally of the infected will increase very rapidly as is typical of exponential growth. Note that its not that the number is large, but only the behavior of the growth rate that merits the designation exponential.

Scientists Are Stuck on an Ice-Locked Ship in the Arctic Due to Coronavirus Organizers of the MOSAiC expedition are determining the best way to bring a relief crew to the ship without spreading the virus, which could leave roughly 100 scientists and crew on board for an extra six weeks, reports Maddie Stone for Motherboard Science.

Pablo Escobars Hippos Fill a Hole Left Since Ice Age Extinctions -Invasive herbivore mammals seem to restore functions missing in some food webs and ecosystems since the Pleistocene era, writes Asher Elbein for the New York Times. When Pablo Escobar died in 1993, the Colombian drug kingpins four adult African hippopotamuses were forgotten. But the fields and ponds along the Magdalena River suited them. One estimate puts their current population at 50 to 80 animals: By 2050 there may be anywhere from 800 to 5,000 in a landscape that never before knew hippos.

Stranded at sea cruise ships around the world are adrift as ports turn them away, reports The Guardian. A Guardian analysis of ship tracking data has found that, as of Thursday, at least ten ships around the world carrying nearly 10,000 passengers are still stuck at sea after having been turned away from their destination ports in the face of the Covid-19 pandemic. Some of the ships are facing increasingly desperate medical situations, including one carrying hundreds of American, Canadian, Australian and British passengers, currently off the coast of Ecuador and seeking permission to dock in Florida.

Recent Planet Earth Reports

CIA & Birth of Conspiracy Theories to Mystery of Coronavirus Origins

Melting Tibetan Glacier Could Release Ancient Unknown Viruses to Epic Stone-Age Voyage

Graveyard of Giant Spaceships to Fourth Atomic Spy at Los Alamos

Cyborgs Will Lead Us to an Intelligent Universe to a New Force of Nature

Russias Futuristic Tech to Tiny Lab-Size Wormhole Could Shatter Our Sense of Reality

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Planet Earth Report Scientists Stranded at Sea to Unknown Limits of Human Athletic Performance - The Daily Galaxy --Great Discoveries Channel

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TAILOR-PCI: Using Genetic Testing to Guide Antiplatelet Therapy Post-PCI Misses Goal to Cut Rate of Cardiovascular Events in Half – Cath Lab Digest

Posted: March 29, 2020 at 6:57 pm

WASHINGTON (Mar 28, 2020) - An international clinical trial that used genetic testing to guide which antiplatelet medication was given to patients following percutaneous coronary intervention (PCI) did not meet its stated goal for cutting in half the incidence of serious adverse cardiovascular events, such as heart attack and stroke, in the year following the procedure. However, researchers reported a 34% reduction in these adverse events at one year, as well as a significant reduction in the number of events per patient, according to study results presented at the American College of Cardiologys Annual Scientific Session Together with World Congress of Cardiology (ACC.20/WCC).

The primary endpoint of TAILOR-PCIthe largest cardiology trial to test the effectiveness of using genetic testing to guide treatment choicewas to demonstrate a 50% reduction at one year in the combined rate of death, heart attack, stroke, a blood clot in a stent (stent thrombosis) or a recurrent heart attack-like presentation. While the trial missed this mark, researchers observed a 34% drop in these events in the year following PCI. The trial also revealed a statistically significant 40% reduction in the total number of events per patient receiving genetically guided treatment compared with patients who received standard treatment.

Although these results fell short of the effect size that we predicted, they nevertheless provide a signal that offers support for the benefit of genetically guided therapy, with approximately one-third fewer adverse events in the patients who received genetically guided treatment compared with those who did not, said Naveen L. Pereira, MD, professor of medicine at the Mayo Clinic in Rochester, Minnesota, and co-principal investigator of the study.

Pereira added that a post hoc analysis, performed after the researchers knew the studys results, found a nearly 80% reduction in the rate of adverse events in the first three months of treatment among patients who received genetically guided therapy compared with those who did not. This period immediately after PCI is when patients are at the highest risk for adverse events, he said.

We now know from clinical practice and other studies that antiplatelet drug therapy is critical during the first three months after PCI, he said. This finding suggests that the lions share of the benefit of genetically guided therapy may occur during this high-risk period. Because this wasnt a pre-planned analysis, we cant draw firm conclusions from it, but it merits further study.

Patients with arterial blockages who undergo PCIthe insertion of a stent or stents to prop arteries openare commonly prescribed the antiplatelet medication clopidogrel, along with aspirin, for a year after the procedure to help prevent blood clots that can cause heart attack, stroke and other complications. However, studies have suggested that people who have a genetic variant in a liver enzyme known as CYP2C19 are unable to fully metabolize clopidogrel, reducing the effectiveness of the medication and leaving them at increased risk of developing blood clots and serious adverse cardiovascular events. Such patients may be good candidates to receive alternative antiplatelet medication.

In the U.S., about 30% of people carry the genetic variant that makes them less capable of metabolizing and, hence, activating clopidogrel, Pereira said. The proportion increases to 50% among people of Asian heritage. A simple-to-perform genetic test can identify whether a patient carries the abnormality, Pereira said. However, no prospective clinical trials have shown that outcomes are better for patients who have the abnormality when the test is used to guide their treatment. For this reason, guidelines published by the American College of Cardiology and the American Heart Association do not currently recommend that patients be tested for the abnormality before being prescribed clopidogrel, Pereira added.

The TAILOR-PCI trial was designed to fill this knowledge gap. The trial enrolled 5,302 patients who had been treated for an arterial blockage with one or more stents. Their median age was 62 years, and 75% were men. Patients were randomly assigned either to a group that was tested for the genetic variant affecting clopidogrel metabolism or to a group that received standard treatment without genetic testing. In the first group, 35% of patients were found to have the genetic variant and were prescribed another antiplatelet medication, ticagrelor, while those without it got clopidogrel. In the second group, everyone was prescribed clopidogrel. Patients were enrolled at 40 medical centers in the U.S., Canada, Mexico and South Korea and followed for one year.

Among patients who carried the genetic variant, the primary endpoint occurred in 35 (4%) in the group that received genetically guided treatment, compared with 54 (5.9%) in the conventionally treated group at one year.

Pereira said that the reduction in the number of adverse events per patient also has important clinical implications. Multiple adverse events represent a higher burden on the patient, so it is encouraging to see a significant reduction in cumulative events with genetically guided therapy, he said.

Among patients with the genetic variant, there were no differences in the safety endpoint of TIMI major bleeding (fatal bleeding, bleeding in the brain or any bleeding that requires medical assessment or treatment) or minor bleeding between those receiving genetically guided treatment (16 patients, 1.9%) and those in the conventional treatment arm (14 patients, 1.6%) at one year.

Pereira said that recent improvements in the standard of care following PCI may have contributed to the trial not achieving its primary endpoint. When the TAILOR-PCI trial was designed in 2012, around 10% to 12% of patients who received a stent could be expected to have a major adverse event, such as a heart attack, stroke or stent thrombosis, within a year. Over the course of the trial, the standard of care evolved through greater use of drug-coated stents and other treatments, which reduced the expected rate of adverse events in a year to about 5%. This change in technology substantially improved care for patients, but at the same time may have made it more difficult for the trial to reach its goal of a 50% reduction in adverse events with the number of patients enrolled, Pereira said.

No special expertise in laboratory testing is required to perform the genetic test, Pereira said. In the trial, the tests were done by study coordinators who did not have a background in laboratory medicine and who were able to perform the tests in a consistent, reproducible fashion after receiving brief training.

The next step, he said, will be to analyze the cost effectiveness of genetically guided therapy. The National Heart, Lung, and Blood Institute has also funded an extended follow-up study to evaluate the effect of genotype guidance beyond the 12-month follow-up period of TAILOR PCI.

This study was funded by the Mayo Clinic in collaboration with the National Heart, Lung, and Blood Institute. Spartan Bioscience, Inc, supplied the genetic tests used.

ACC.20/WCC will take place March 28-30, bringing together cardiologists and cardiovascular specialists from around the world to share the newest discoveries in treatment and prevention. Follow @ACCinTouch, @ACCMediaCenter and #ACC20/#WCCardio for the latest news from the meeting.

The American College of Cardiology envisions a world where innovation and knowledge optimize cardiovascular care and outcomes. As the professional home for the entire cardiovascular care team, the mission of the College and its 54,000 members is to transform cardiovascular care and to improve heart health. The ACC bestows credentials upon cardiovascular professionals who meet stringent qualifications and leads in the formation of health policy, standards and guidelines. The College also provides professional medical education, disseminates cardiovascular research through its world-renowned JACC Journals, operates national registries to measure and improve care and offers cardiovascular accreditation to hospitals and institutions. For more, visit acc.org.

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TAILOR-PCI: Using Genetic Testing to Guide Antiplatelet Therapy Post-PCI Misses Goal to Cut Rate of Cardiovascular Events in Half - Cath Lab Digest

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Scientists Discover That a Squid Can Edit Its Own Genetic Code – Futurism

Posted: March 29, 2020 at 6:57 pm

Tentacle Hack

The next generation of genetic medicine may be inspired by a bizarre genetic trick that a small squid species uses to edit its own genome on the fly.

The longfin inshore squid can edit the RNA inside its nerve cells, Wired reports, meaning that it can drastically alter the behavior of its biological machinery as needed perhaps to help the animal rapidly adapt to new environments. Its a bizarre discovery, and one that could potentially lead to better genetic treatments for humans.

Researchers from the Marine Biological Laboratory found that the squid alters the RNA within its axons instead of the DNA within its nuclei, according to research published Monday in the journal Nucleic Acids Research. Thus far, its the only animal known to do so.

RNA editing is a hell of a lot safer than DNA editing, lead researcher Joshua Rosenthal told Wired. If you make a mistake, the RNA just turns over and goes away.

Because it happens outside the nucleus, RNA editing would be an improvement over modern genetic treatments, Wired reports. To gene-hack a patient with CRISPR, the new genetic information needs to breach not only a cells membrane but also the membrane of that cells nucleus to reach its DNA.

But it will be some time before medical doctors start to use the longfin inshore squids weird gene-hacks on people. For now, researchers still arent even sure why, exactly, the squid alters its genes.

READ MORE: Squids Gene-Editing Superpowers May Unlock Human Cures [Wired]

More on gene-hacking: George Church Told us Why Hes Listing Superhuman Gene Hacks

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Scientists Discover That a Squid Can Edit Its Own Genetic Code - Futurism

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8 strains of the coronavirus are circling the globe. Here’s what clues they’re giving scientists. – USA TODAY

Posted: March 29, 2020 at 6:57 pm

An epidemiologist answers the biggest questions she's getting about coronavirus. Wochit

SAN FRANCISCO At least eight strains of the coronavirus are making their way around the globe, creating a trail of death and disease that scientistsare tracking by their genetic footprints.

While much is unknown, hidden in the virus's unique microscopic fragments are clues to the origins of its original strain, how it behaves as it mutates and which strains are turning into conflagrations while others are dying out thanksto quarantine measures.

Huddled in once bustling and now almost empty labs, researchers who oversaw dozens of projects are instead focused on one goal:tracking the currentstrains of the SARS-CoV-2 virus that cause the illness COVID-19.

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Labs around the world are turning their sequencing machines, most about the size of a desktop printer, to the task ofrapidly sequencing the genomes of virus samples taken frompeople sick with COVID-19.The information is uploaded to a website called NextStrain.org that shows how the virus is migrating and splitting into similarbut new subtypes.

While researcherscaution they'reonly seeing the tip of the iceberg, the tiny differences between the virus strains suggest shelter-in-place orders are working in some areas and thatno one strain of the virus ismore deadly than another. They also say it does not appear the strains will grow more lethal as theyevolve.

The virus mutates so slowly that the virus strains are fundamentally very similar to each other, said Charles Chiu, a professor of medicine and infectious disease at the University of California, San Francisco School of Medicine.

A map of the main known genetic variants of the SARS-CoV-2 virus that causes COVID-19 disease. The map is being kept on the nextstrain.org website, which tracks pathogen evolution.(Photo: nextstrain.org)

Investigation:How federal health officials mislead states and derailed the best chance at containment.

The SARS-CoV-2 virusfirst began causing illness in China sometimebetween mid-November and mid-December. Its genome is made up of about 30,000 base pairs. Humans, by comparison, have more than 3 billion. So fareven in the virus's most divergent strainsscientists have found only 11 base pair changes.

That makes iteasy to spot new lineages as they evolve, said Chiu.

The outbreaks are trackable. We have the ability to do genomic sequencing almost in real-time to see what strains or lineages are circulating, he said.

So far, mostcases on the U.S. West Coast are linked to a strainfirst identified in Washington state. It may have come from a man who had been in Wuhan, China, the virus epicenter, and returned home on Jan. 15. It is only three mutations away from the original Wuhan strain, according to work done early in the outbreakby Trevor Bedford, a computational biologist at Fred Hutch, a medical research center in Seattle.

On the East Coast there are several strains, including the one from Washington and others that appear to have made their way from China to Europe and then to New York and beyond, Chiu said.

Death rate soars in New Orleans coronavirus 'disaster' that could define city for generations

Charles Chiu, MD, PhD, director of the UCSF-Abbott Viral Diagnostics and Discovery Center, inserts a tray of Universal Transport Medium (UTM) or vials for the collection, transport, maintenance and long term freeze storage of viruses into a Biomatrix sorter that the Chiu Lab will be using, starting Monday to study the genes of the Coronavirus.(Photo: Susan Merrell/UCSF)

This isnt the first time scientists have scrambled to do genetic analysis of a virus in the midst of an epidemic. They did it with Ebola, Zika and West Nile, but nobodyoutside the scientific community paid much attention.

This is the first time phylogenetic trees have been all over Twitter, said Kristian Andersen, a professor at Scripps Research, a nonprofit biomedical science research facility in La Jolla, California, speaking of the diagrams that show the evolutionary relationships between different strains of an organism.

The maps are available on NextStrain, an online resource for scientists that uses data from academic, independent and government laboratories all over the world to visually track the genomics of the SARS-CoV-2 virus. It currently represents genetic sequences of strains from 36 countries on six continents.

While the maps are fun, they can also be little dangerous said Andersen. The trees showing the evolution of the virus are complex and its difficult even for experts to draw conclusions from them.

Remember, were seeing a very small glimpse into the much larger pandemic. We have half a million described cases right now but maybe 1,000 genomes sequenced. So there are a lot of lineages were missing, hesaid.

The basics on the coronavirus: What you need to know as the US becomes the new epicenter of COVID-19

COVID-19 hitspeople differently, with some feeling only slightly under the weather for a day, others flat on their backs sick for two weeks and about 15% hospitalized. Currently, an estimated1% of those infected die. The rate varies greatly by country and experts say it is likely tied to testing rates rather than actual mortality.

Chiu says it appears unlikely the differences are related to people being infected withdifferent strains of the virus.

The current virus strains are still fundamentally very similar to each other, he said.

The COVID-19 virus does not mutate very fast. It does so eightto 10 times more slowly than the influenza virus, said Anderson, making its evolution rate similar to other coronaviruses such asSevere Acute Respiratory Syndrome (SARS) and Middle East Respiratory Syndrome (MERS).

Its also not expected tospontaneously evolve into a form more deadly than it already is to humans. The SARS-CoV-2 is so good at transmitting itself between human hosts,said Andersen,it is under no evolutionary pressure to evolve.

Chius analysis shows Californias strict shelter in place efforts appear to beworking.

Over half of the 50 SARS-CoV-2 virus genomes his San Francisco-based lab sequenced in the past two weeks are associated with travel from outside the state. Another 30% are associated with health care workers and families of people who have the virus.

Only 20% are coming from within the community. Its not circulating widely, he said.

Thats fantastic news, he said, indicating the virus has not been able to gain aserious foothold because of social distancing.

It's like a wildfire, Chiu said. A few sparks might fly off the fire and land in the grass and start new fires. But if the main fire is doused and itsembers stomped out, you can kill offan entire strain.In California, Chiu sees a lot of sparks hitting the ground, most coming from Washington,but they're quickly being put out.

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An example wasa small cluster of cases in Solano County, northeast of San Francisco. Chius team did a genetic analysis of the virus that infected patients there and found it was most closely related to a strain from China.

At the same time, his lab was sequencing a small cluster of cases in the city of Santa Clara in Silicon Valley. They discovered the patients there had the same strain as those in Solano County. Chiu believes someone in that cluster had contact with a traveler who recently returned from Asia.

This is probably an example of a spark that began in Santa Clara, may have gone to Solano County but then was halted, he said.

The virus, he said, can be stopped.

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China is an unknown

So far researchers dont have a lot of information about the genomics of the virus inside China beyond the fact that it first appeared in the city of Wuhan sometime between mid-November and mid-December.

The viruss initial sequence was published on Jan. 10 by professor Yong-Zhen Zhang at the Shanghai Public Health Clinical Center. But Chiu says scientists dont know if there was justone strain circulating in China or more.

It may be that they havent sequenced many cases or it may be for political reasons they havent been made available, said Chiu. Its difficult to interpret the data because were missing all these early strains.

Researchers in the United Kingdom who sequenced the genomes of viruses found in travelers from Guangdong in south China found those patients strains spanned the gamut of strains circulating worldwide.

That could mean several of the strains were seeing outside of China first evolved there from the original strain, or that there are multiple lines of infection. Its very hard to know, said Chiu.

There's a new symptom of coronavirus, docs say: Sudden loss of smell or taste

While there remain many questions about the trajectory of the COVID-19 disease outbreak, one thing is broadly accepted in the scientific community: Thevirus was not created in a lab but naturally evolved in an animal host.

SARS-CoV-2s genomic molecular structure thinkthe backbone of the virus is closest to a coronavirus found in bats. Parts of its structure also resemble a virus found in scaly anteaters, according to a paper published earlier this month in the journal Nature Medicine.

Someone manufacturing a virus targetingpeople would have started with one that attacked humans, wrote National Institutes of Health Director Francis Collinsin an editorial that accompanied the paper.

Andersen was lead author on the paper. He said it could have been a one-time occurrence.

Its possible it was a single event, from a single animal to a single human, and spread from there.

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Precision Medicine, Nanotechnology and the Rise of the Robot Now. Powered by – Now. Powered by Northrop Grumman.

Posted: March 29, 2020 at 6:57 pm

Since then-President Obamas announcement in early 2015, precision medicine has been an even bigger buzzword in medical research. Its one of those terms you hear frequently, but what exactly is it? And what makes it so important for future health care?

Its both, but definitely not average. The term replaces the older description, personalized medicine. Although they mean roughly the same thing, precision medicine is the preferred term for developing treatment and preventive medicine for individuals based on genetic, environmental and lifestyle factors. In translation: instead of a one-size-fits-all approach for an average patient, the precision approach looks at individual variability when mapping out the treatment plan that has the best chance of success. Doctors base the drug choices on the individual patients genetics.

So, apart from maximizing success, what makes precision medicine so important?

Consider cancer, one of the short-term goals outlined in Mr. Obamas 2015 initiative. Characterizing a patients cancer helps clinicians design an effective treatment plan. Tissue profiling reveals cell markers that are useful when choosing chemotherapeutic drugs. For example, breast cancers that overexpress the HER2 receptor respond very well to trastuzumab (Herceptin) treatment, whereas those with abundant estrogen receptors respond better to hormone therapy. This kind of approach can also customize treatment for other conditions.

How do doctors know what works?

Omics is shorthand for a suite of biotechnologies devoted to uncovering the secrets of the genome (DNA), the proteome (proteins), the transcriptome (how genes translate into proteins) and more. Essentially, omics researchers study the basic machinery of the cell and how growth, aging, disease and nutrition affect it. These technologies underpin most research into precision medicine. By studying thousands of individuals, researchers build a picture of health, disease and risk.

Cataloging the genomic information from thousands of individuals in large population cohorts, and then matching it up with health, environmental and lifestyle records shows genes associated with specific diseases. In tumors, it shows how sensitive they are to chemotherapy.

Omics technology is advancing very rapidly and generating vast amounts of data. Sequencing a persons genome first took almost 10 years and $3 billion; current next generation sequencing (NGS) instruments will whiz through around 18,000 individuals or more in a year. Proteomics technology is catching up rapidly.

One genome generates around 780 MB of data out of around 30 terabytes of raw NGS data; typical proteome datasets run into many gigabytes in size. Studying thousands of individuals for population studies generates terabytes of data approximately 40, according to one article. And that takes a lot of processing power to analyze for clinically relevant results more than can be done manually, so biomathematicians develop algorithms and other software tools to tease the answers from the digital soup. Bioinformatics for storing and accessing electronic health records is vital for precision medicine research. Furthermore, IT systems such as the Northrop Grumman-supported MedDRA initiative encode health information consistently ensure that data banks can talk to each other, with advances in cybersecurity ensuring patient privacy despite the cross talk.

Yes. Just think of where all that data comes from.

Population studies are as big as they sound; the Million Veteran Program collects biosamples from U.S. veterans, around 400,000 so far. It aims to generate omics data that in conjunction with information on health, lifestyle and environment will translate into clinical practice. Thats a lot of samples to handle, store and analyze.

Furthermore, microelectronics advances mean that omics instruments handle more samples at a faster rate. Next-generation sequencers such as the Illumina HiSeq and the Thermo Fisher Ion Torrent use chip-based and semiconductor technology to decode genomic materials. A simple flash of fluorescence or change in pH zaps DNA base pair information into a digital format much faster than old-school gel-based Sanger sequencing.

In order to exploit the speed of these tools, robotic handling manages everything from sample aliquots for biobank storage, to 384-well plate assay wrangling. Their speed and automation bring faster results with fewer errors.

Robotic or automated workflows are also important for nanotechnology and microfluidics where the miniaturization that reduces instrument footprint and sample volume also precludes manual input. Even though they will benefit from precision medicine, our clumsy fingers and thumbs are not as welcome in the lab as they once were.

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Next-generation GMO crops poised to make major contributions to sustainable farming and medicine – Genetic Literacy Project

Posted: March 29, 2020 at 6:57 pm

Transgenic cropshave been planted in different countries for over twenty years, starting from 1996. About 191.7 million hectares were planted in 2018 to transgenic crops with high market value, such asherbicide tolerant soybeans,maize,cotton, andcanola; insect resistant maize, cotton, potato, andrice; and virus resistant squash and papaya. Withgenetic engineering, more than one trait can be incorporated or stacked into a plant. Transgenic crops with combinedtraitsare also available commercially.

To date, commercial GM crops have delivered benefits in crop production, but there are also a number of products in the pipeline that will make more direct contributions to food quality, environmental benefits, pharmaceutical production, and non-food crops.

Examples of these products include triple stack trait biotech rice with better yield amidst abiotic stresses, biotech chestnut tree with resistance to chestnut blight, biotech citrus greening resistant citrus, potato enriched with beta carotene, biofortified sorghum, bacterial (Xanthomonas) wilt resistant banana, Bunchytop virus resistant banana, insect resistantwheat, among others.

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Emory Coronavirus Treatment Submitted to FDA – The Emory Wheel

Posted: March 29, 2020 at 6:57 pm

Ayushi Agarwal, Copy Editor

On Thursday, Drug Innovation Ventures at Emory (DRIVE) submitted an Investigational New Drug (IND) application to the Food and Drug Administration (FDA) for their experimental COVID-19 treatment, EIDD-2801.

EIDD-2801 is an antiviral compound that directly attacks coronaviruses in the lungs. The compound, a nucleoside analogue, deceives the virus into attaching and injecting its genetic information into a false host.

CEO of DRIVE, director of the Emory Institute for Drug Development (EIDD) and Professor of Pharmacology George Painter (72C, 77G) and his team have been working on the oral therapy for over five years and in the past month partnered with biotechnology company Ridgeback Biotherapeutics. The original purpose behind the treatment was to combat influenza, but Painter said the medicine can also be used to treat COVID-19 and other coronavirus strains. The novel coronavirus outbreak has brought the opportunity to find a partner and accelerate FDA approval to DRIVEs process.

[Ridgeback is] well suited to us because they deal with emerging infectious disease, Painter said. At a certain point, the structure of a university really isnt the optimal place to develop a drug. There are various procedures for the university that are not very compatible with moving quickly.

Ridgeback Biotherapeutics have an exclusive license of the intellectual property over the compound. If approved by the FDA, Ridgeback can develop, commercialize and sell EIDD-2801.

DRIVE and Emory get milestone payments and royalties, Painter said. A lot of that will come back to DRIVE and be put right back into its effort to identify and develop critical medicines for unmet medical needs.

Over the past three years, Painter and his team have gathered an enormous amount of data, which they have been working on compiling in the past few months.

The IND application is titled The Use of EIDD-2801 for the Treatment of Influenza and consists of hundreds of hyperlinked research reports about the compound.

After an IND application is submitted, the FDA must respond within 30 days. However, Painter predicts that the FDA will respond sooner because of COVID-19s exigent danger. Although there is no official communication from FDA stating an accelerated approval process, Painter assured that he and his team have been in frequent contact with the FDA about their response.

Painter hopes that in three to four weeks, the treatment will be tested on patients in the form of clinical trials, off-label medicines and trial basis. EEID-2801 will first be tested on healthy volunteers and later on COVID-19 patients if initial testing succeeds.

Amid the Universitys closure, Painters lab is only allowed to operate with essential personnel. However, Painters team is carrying out critical maintenance on lab equipment.

Painter emphasized the imperative group effort of this process, stating that, a lot of people put in long hours, many more than they had to, in order to get this out the door.

A lot of credit to a lot of people, Painter said. Lets just cross our fingers and hope it works.

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Coronavirus vaccine: when will it be ready? – The Guardian

Posted: March 29, 2020 at 6:57 pm

Even at their most effective and draconian containment strategies have only slowed the spread of the respiratory disease Covid-19. With the World Health Organization finally declaring a pandemic, all eyes have turned to the prospect of a vaccine, because only a vaccine can prevent people from getting sick.

About 35 companies and academic institutions are racing to create such a vaccine, at least four of which already have candidates they have been testing in animals. The first of these produced by Boston-based biotech firm Moderna will enter human trials imminently.

This unprecedented speed is thanks in large part to early Chinese efforts to sequence the genetic material of Sars-CoV-2, the virus that causes Covid-19. China shared that sequence in early January, allowing research groups around the world to grow the live virus and study how it invades human cells and makes people sick.

But there is another reason for the head start. Though nobody could have predicted that the next infectious disease to threaten the globe would be caused by a coronavirus flu is generally considered to pose the greatest pandemic risk vaccinologists had hedged their bets by working on prototype pathogens. The speed with which we have [produced these candidates] builds very much on the investment in understanding how to develop vaccines for other coronaviruses, says Richard Hatchett, CEO of the Oslo-based nonprofit the Coalition for Epidemic Preparedness Innovations (Cepi), which is leading efforts to finance and coordinate Covid-19 vaccine development.

Coronaviruses have caused two other recent epidemics severe acute respiratory syndrome (Sars) in China in 2002-04, and Middle East respiratory syndrome (Mers), which started in Saudi Arabia in 2012. In both cases, work began on vaccines that were later shelved when the outbreaks were contained. One company, Maryland-based Novavax, has now repurposed those vaccines for Sars-CoV-2, and says it has several candidates ready to enter human trials this spring. Moderna, meanwhile, built on earlier work on the Mers virus conducted at the US National Institute of Allergy and Infectious Diseases in Bethesda, Maryland.

Sars-CoV-2 shares between 80% and 90% of its genetic material with the virus that caused Sars hence its name. Both consist of a strip of ribonucleic acid (RNA) inside a spherical protein capsule that is covered in spikes. The spikes lock on to receptors on the surface of cells lining the human lung the same type of receptor in both cases allowing the virus to break into the cell. Once inside, it hijacks the cells reproductive machinery to produce more copies of itself, before breaking out of the cell again and killing it in the process.

All vaccines work according to the same basic principle. They present part or all of the pathogen to the human immune system, usually in the form of an injection and at a low dose, to prompt the system to produce antibodies to the pathogen. Antibodies are a kind of immune memory which, having been elicited once, can be quickly mobilised again if the person is exposed to the virus in its natural form.

Traditionally, immunisation has been achieved using live, weakened forms of the virus, or part or whole of the virus once it has been inactivated by heat or chemicals. These methods have drawbacks. The live form can continue to evolve in the host, for example, potentially recapturing some of its virulence and making the recipient sick, while higher or repeat doses of the inactivated virus are required to achieve the necessary degree of protection. Some of the Covid-19 vaccine projects are using these tried-and-tested approaches, but others are using newer technology. One more recent strategy the one that Novavax is using, for example constructs a recombinant vaccine. This involves extracting the genetic code for the protein spike on the surface of Sars-CoV-2, which is the part of the virus most likely to provoke an immune reaction in humans, and pasting it into the genome of a bacterium or yeast forcing these microorganisms to churn out large quantities of the protein. Other approaches, even newer, bypass the protein and build vaccines from the genetic instruction itself. This is the case for Moderna and another Boston company, CureVac, both of which are building Covid-19 vaccines out of messenger RNA.

Cepis original portfolio of four funded Covid-19 vaccine projects was heavily skewed towards these more innovative technologies, and last week it announced $4.4m (3.4m) of partnership funding with Novavax and with a University of Oxford vectored vaccine project. Our experience with vaccine development is that you cant anticipate where youre going to stumble, says Hatchett, meaning that diversity is key. And the stage where any approach is most likely to stumble is clinical or human trials, which, for some of the candidates, are about to get under way.

Clinical trials, an essential precursor to regulatory approval, usually take place in three phases. The first, involving a few dozen healthy volunteers, tests the vaccine for safety, monitoring for adverse effects. The second, involving several hundred people, usually in a part of the world affected by the disease, looks at how effective the vaccine is, and the third does the same in several thousand people. But theres a high level of attrition as experimental vaccines pass through these phases. Not all horses that leave the starting gate will finish the race, says Bruce Gellin, who runs the global immunisation programme for the Washington DC-based nonprofit, the Sabin Vaccine Institute.

There are good reasons for that. Either the candidates are unsafe, or theyre ineffective, or both. Screening out duds is essential, which is why clinical trials cant be skipped or hurried. Approval can be accelerated if regulators have approved similar products before. The annual flu vaccine, for example, is the product of a well-honed assembly line in which only one or a few modules have to be updated each year. In contrast, Sars-CoV-2 is a novel pathogen in humans, and many of the technologies being used to build vaccines are relatively untested too. No vaccine made from genetic material RNA or DNA has been approved to date, for example. So the Covid-19 vaccine candidates have to be treated as brand new vaccines, and as Gellin says: While there is a push to do things as fast as possible, its really important not to take shortcuts.

An illustration of that is a vaccine that was produced in the 1960s against respiratory syncytial virus, a common virus that causes cold-like symptoms in children. In clinical trials, this vaccine was found to aggravate those symptoms in infants who went on to catch the virus. A similar effect was observed in animals given an early experimental Sars vaccine. It was later modified to eliminate that problem but, now that it has been repurposed for Sars-CoV-2, it will need to be put through especially stringent safety testing to rule out the risk of enhanced disease.

Its for these reasons that taking a vaccine candidate all the way to regulatory approval typically takes a decade or more, and why President Trump sowed confusion when, at a meeting at the White House on 2 March, he pressed for a vaccine to be ready by the US elections in November an impossible deadline. Like most vaccinologists, I dont think this vaccine will be ready before 18 months, says Annelies Wilder-Smith, professor of emerging infectious diseases at the London School of Hygiene and Tropical Medicine. Thats already extremely fast, and it assumes there will be no hitches.

In the meantime, there is another potential problem. As soon as a vaccine is approved, its going to be needed in vast quantities and many of the organisations in the Covid-19 vaccine race simply dont have the necessary production capacity. Vaccine development is already a risky affair, in business terms, because so few candidates get anywhere near the clinic. Production facilities tend to be tailored to specific vaccines, and scaling these up when you dont yet know if your product will succeed is not commercially feasible. Cepi and similar organisations exist to shoulder some of the risk, keeping companies incentivised to develop much-needed vaccines. Cepi plans to invest in developing a Covid-19 vaccine and boosting manufacturing capacity in parallel, and earlier this month it put out a call for $2bn to allow it to do so.

Once a Covid-19 vaccine has been approved, a further set of challenges will present itself. Getting a vaccine thats proven to be safe and effective in humans takes one at best about a third of the way to whats needed for a global immunisation programme, says global health expert Jonathan Quick of Duke University in North Carolina, author of The End of Epidemics (2018). Virus biology and vaccines technology could be the limiting factors, but politics and economics are far more likely to be the barrier to immunisation.

The problem is making sure the vaccine gets to all those who need it. This is a challenge even within countries, and some have worked out guidelines. In the scenario of a flu pandemic, for example, the UK would prioritise vaccinating healthcare and social care workers, along with those considered at highest medical risk including children and pregnant women with the overall goal of keeping sickness and death ra tes as low as possible. But in a pandemic, countries also have to compete with each other for medicines.

Because pandemics tend to hit hardest those countries that have the most fragile and underfunded healthcare systems, there is an inherent imbalance between need and purchasing power when it comes to vaccines. During the 2009 H1N1 flu pandemic, for example, vaccine supplies were snapped up by nations that could afford them, leaving poorer ones short. But you could also imagine a scenario where, say, India a major supplier of vaccines to the developing world not unreasonably decides to use its vaccine production to protect its own 1.3 billion-strong population first, before exporting any.

Outside of pandemics, the WHO brings governments, charitable foundations and vaccine-makers together to agree an equitable global distribution strategy, and organisations like Gavi, the vaccine alliance, have come up with innovative funding mechanisms to raise money on the markets for ensuring supply to poorer countries. But each pandemic is different, and no country is bound by any arrangement the WHO proposes leaving many unknowns. As Seth Berkley, CEO of Gavi, points out: The question is, what will happen in a situation where youve got national emergencies going on?

This is being debated, but it will be a while before we see how it plays out. The pandemic, says Wilder-Smith, will probably have peaked and declined before a vaccine is available. A vaccine could still save many lives, especially if the virus becomes endemic or perennially circulating like flu and there are further, possibly seasonal, outbreaks. But until then, our best hope is to contain the disease as far as possible. To repeat the sage advice: wash your hands.

This article was amended on 19 March 2020. An earlier version incorrectly stated that the Sabin Vaccine Institute was collaborating with the Coalition for Epidemic Preparedness Innovations (Cepi) on a Covid-19 vaccine.

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How the Pandemic Will End – The Atlantic

Posted: March 29, 2020 at 6:57 pm

Editors Note: The Atlantic is making vital coverage of the coronavirus available to all readers. Find the collection here.

Three months ago, no one knew that SARS-CoV-2 existed. Now the virus has spread to almost every country, infecting at least 446,000 people whom we know about, and many more whom we do not. It has crashed economies and broken health-care systems, filled hospitals and emptied public spaces. It has separated people from their workplaces and their friends. It has disrupted modern society on a scale that most living people have never witnessed. Soon, most everyone in the United States will know someone who has been infected. Like World War II or the 9/11 attacks, this pandemic has already imprinted itself upon the nations psyche.

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A global pandemic of this scale was inevitable. In recent years, hundreds of health experts have written books, white papers, and op-eds warning of the possibility. Bill Gates has been telling anyone who would listen, including the 18 million viewers of his TED Talk. In 2018, I wrote a story for The Atlantic arguing that America was not ready for the pandemic that would eventually come. In October, the Johns Hopkins Center for Health Security war-gamed what might happen if a new coronavirus swept the globe. And then one did. Hypotheticals became reality. What if? became Now what?

So, now what? In the late hours of last Wednesday, which now feels like the distant past, I was talking about the pandemic with a pregnant friend who was days away from her due date. We realized that her child might be one of the first of a new cohort who are born into a society profoundly altered by COVID-19. We decided to call them Generation C.

As well see, Gen Cs lives will be shaped by the choices made in the coming weeks, and by the losses we suffer as a result. But first, a brief reckoning. On the Global Health Security Index, a report card that grades every country on its pandemic preparedness, the United States has a score of 83.5the worlds highest. Rich, strong, developed, America is supposed to be the readiest of nations. That illusion has been shattered. Despite months of advance warning as the virus spread in other countries, when America was finally tested by COVID-19, it failed.

Anne Applebaum: The coronavirus called Americas bluff

No matter what, a virus [like SARS-CoV-2] was going to test the resilience of even the most well-equipped health systems, says Nahid Bhadelia, an infectious-diseases physician at the Boston University School of Medicine. More transmissible and fatal than seasonal influenza, the new coronavirus is also stealthier, spreading from one host to another for several days before triggering obvious symptoms. To contain such a pathogen, nations must develop a test and use it to identify infected people, isolate them, and trace those theyve had contact with. That is what South Korea, Singapore, and Hong Kong did to tremendous effect. It is what the United States did not.

As my colleagues Alexis Madrigal and Robinson Meyer have reported, the Centers for Disease Control and Prevention developed and distributed a faulty test in February. Independent labs created alternatives, but were mired in bureaucracy from the FDA. In a crucial month when the American caseload shot into the tens of thousands, only hundreds of people were tested. That a biomedical powerhouse like the U.S. should so thoroughly fail to create a very simple diagnostic test was, quite literally, unimaginable. Im not aware of any simulations that I or others have run where we [considered] a failure of testing, says Alexandra Phelan of Georgetown University, who works on legal and policy issues related to infectious diseases.

The testing fiasco was the original sin of Americas pandemic failure, the single flaw that undermined every other countermeasure. If the country could have accurately tracked the spread of the virus, hospitals could have executed their pandemic plans, girding themselves by allocating treatment rooms, ordering extra supplies, tagging in personnel, or assigning specific facilities to deal with COVID-19 cases. None of that happened. Instead, a health-care system that already runs close to full capacity, and that was already challenged by a severe flu season, was suddenly faced with a virus that had been left to spread, untracked, through communities around the country. Overstretched hospitals became overwhelmed. Basic protective equipment, such as masks, gowns, and gloves, began to run out. Beds will soon follow, as will the ventilators that provide oxygen to patients whose lungs are besieged by the virus.

Read: The people ignoring social distancing

With little room to surge during a crisis, Americas health-care system operates on the assumption that unaffected states can help beleaguered ones in an emergency. That ethic works for localized disasters such as hurricanes or wildfires, but not for a pandemic that is now in all 50 states. Cooperation has given way to competition; some worried hospitals have bought out large quantities of supplies, in the way that panicked consumers have bought out toilet paper.

Partly, thats because the White House is a ghost town of scientific expertise. A pandemic-preparedness office that was part of the National Security Council was dissolved in 2018. On January 28, Luciana Borio, who was part of that team, urged the government to act now to prevent an American epidemic, and specifically to work with the private sector to develop fast, easy diagnostic tests. But with the office shuttered, those warnings were published in The Wall Street Journal, rather than spoken into the presidents ear. Instead of springing into action, America sat idle.

Derek Thompson: America is acting like a failed state

Rudderless, blindsided, lethargic, and uncoordinated, America has mishandled the COVID-19 crisis to a substantially worse degree than what every health expert Ive spoken with had feared. Much worse, said Ron Klain, who coordinated the U.S. response to the West African Ebola outbreak in 2014. Beyond any expectations we had, said Lauren Sauer, who works on disaster preparedness at Johns Hopkins Medicine. As an American, Im horrified, said Seth Berkley, who heads Gavi, the Vaccine Alliance. The U.S. may end up with the worst outbreak in the industrialized world.

Having fallen behind, it will be difficultbut not impossiblefor the United States to catch up. To an extent, the near-term future is set because COVID-19 is a slow and long illness. People who were infected several days ago will only start showing symptoms now, even if they isolated themselves in the meantime. Some of those people will enter intensive-care units in early April. As of last weekend, the nation had 17,000 confirmed cases, but the actual number was probably somewhere between 60,000 and 245,000. Numbers are now starting to rise exponentially: As of Wednesday morning, the official case count was 54,000, and the actual case count is unknown. Health-care workers are already seeing worrying signs: dwindling equipment, growing numbers of patients, and doctors and nurses who are themselves becoming infected.

Italy and Spain offer grim warnings about the future. Hospitals are out of room, supplies, and staff. Unable to treat or save everyone, doctors have been forced into the unthinkable: rationing care to patients who are most likely to survive, while letting others die. The U.S. has fewer hospital beds per capita than Italy. A study released by a team at Imperial College London concluded that if the pandemic is left unchecked, those beds will all be full by late April. By the end of June, for every available critical-care bed, there will be roughly 15 COVID-19 patients in need of one. By the end of the summer, the pandemic will have directly killed 2.2 million Americans, notwithstanding those who will indirectly die as hospitals are unable to care for the usual slew of heart attacks, strokes, and car accidents. This is the worst-case scenario. To avert it, four things need to happenand quickly.

Read: All the presidents lies about the coronavirus

The first and most important is to rapidly produce masks, gloves, and other personal protective equipment. If health-care workers cant stay healthy, the rest of the response will collapse. In some places, stockpiles are already so low that doctors are reusing masks between patients, calling for donations from the public, or sewing their own homemade alternatives. These shortages are happening because medical supplies are made-to-order and depend on byzantine international supply chains that are currently straining and snapping. Hubei province in China, the epicenter of the pandemic, was also a manufacturing center of medical masks.

In the U.S., the Strategic National Stockpilea national larder of medical equipmentis already being deployed, especially to the hardest-hit states. The stockpile is not inexhaustible, but it can buy some time. Donald Trump could use that time to invoke the Defense Production Act, launching a wartime effort in which American manufacturers switch to making medical equipment. But after invoking the act last Wednesday, Trump has failed to actually use it, reportedly due to lobbying from the U.S. Chamber of Commerce and heads of major corporations.

Some manufacturers are already rising to the challenge, but their efforts are piecemeal and unevenly distributed. One day, well wake up to a story of doctors in City X who are operating with bandanas, and a closet in City Y with masks piled into it, says Ali Khan, the dean of public health at the University of Nebraska Medical Center. A massive logistics and supply-chain operation [is] now needed across the country, says Thomas Inglesby of Johns Hopkins Bloomberg School of Public Health. That cant be managed by small and inexperienced teams scattered throughout the White House. The solution, he says, is to tag in the Defense Logistics Agencya 26,000-person group that prepares the U.S. military for overseas operations and that has assisted in past public-health crises, including the 2014 Ebola outbreak.

This agency can also coordinate the second pressing need: a massive rollout of COVID-19 tests. Those tests have been slow to arrive because of five separate shortages: of masks to protect people administering the tests; of nasopharyngeal swabs for collecting viral samples; of extraction kits for pulling the viruss genetic material out of the samples; of chemical reagents that are part of those kits; and of trained people who can give the tests. Many of these shortages are, again, due to strained supply chains. The U.S. relies on three manufacturers for extraction reagents, providing redundancy in case any of them failsbut all of them failed in the face of unprecedented global demand. Meanwhile, Lombardy, Italy, the hardest-hit place in Europe, houses one of the largest manufacturers of nasopharyngeal swabs.

Read: Why the coronavirus has been so successful

Some shortages are being addressed. The FDA is now moving quickly to approve tests developed by private labs. At least one can deliver results in less than an hour, potentially allowing doctors to know if the patient in front of them has COVID-19. The country is adding capacity on a daily basis, says Kelly Wroblewski of the Association of Public Health Laboratories.

On March 6, Trump said that anyone who wants a test can get a test. That was (and still is) untrue, and his own officials were quick to correct him. Regardless, anxious people still flooded into hospitals, seeking tests that did not exist. People wanted to be tested even if they werent symptomatic, or if they sat next to someone with a cough, says Saskia Popescu of George Mason University, who works to prepare hospitals for pandemics. Others just had colds, but doctors still had to use masks to examine them, burning through their already dwindling supplies. It really stressed the health-care system, Popescu says. Even now, as capacity expands, tests must be used carefully. The first priority, says Marc Lipsitch of Harvard, is to test health-care workers and hospitalized patients, allowing hospitals to quell any ongoing fires. Only later, once the immediate crisis is slowing, should tests be deployed in a more widespread way. This isnt just going to be: Lets get the tests out there! Inglesby says.

These measures will take time, during which the pandemic will either accelerate beyond the capacity of the health system or slow to containable levels. Its courseand the nations fatenow depends on the third need, which is social distancing. Think of it this way: There are now only two groups of Americans. Group A includes everyone involved in the medical response, whether thats treating patients, running tests, or manufacturing supplies. Group B includes everyone else, and their job is to buy Group A more time. Group B must now flatten the curve by physically isolating themselves from other people to cut off chains of transmission. Given the slow fuse of COVID-19, to forestall the future collapse of the health-care system, these seemingly drastic steps must be taken immediately, before they feel proportionate, and they must continue for several weeks.

Juliette Kayyem: The crisis could last 18 months. Be prepared.

Persuading a country to voluntarily stay at home is not easy, and without clear guidelines from the White House, mayors, governors, and business owners have been forced to take their own steps. Some states have banned large gatherings or closed schools and restaurants. At least 21 have now instituted some form of mandatory quarantine, compelling people to stay at home. And yet many citizens continue to crowd into public spaces.

In these moments, when the good of all hinges on the sacrifices of many, clear coordination mattersthe fourth urgent need. The importance of social distancing must be impressed upon a public who must also be reassured and informed. Instead, Trump has repeatedly played down the problem, telling America that we have it very well under control when we do not, and that cases were going to be down to close to zero when they were rising. In some cases, as with his claims about ubiquitous testing, his misleading gaffes have deepened the crisis. He has even touted unproven medications.

Away from the White House press room, Trump has apparently been listening to Anthony Fauci, the director of the National Institute of Allergy and Infectious Diseases. Fauci has advised every president since Ronald Reagan on new epidemics, and now sits on the COVID-19 task force that meets with Trump roughly every other day. Hes got his own style, lets leave it at that, Fauci told me, but any kind of recommendation that I have made thus far, the substance of it, he has listened to everything.

Read: Grocery stores are the coronavirus tipping point

But Trump already seems to be wavering. In recent days, he has signaled that he is prepared to backtrack on social-distancing policies in a bid to protect the economy. Pundits and business leaders have used similar rhetoric, arguing that high-risk people, such as the elderly, could be protected while lower-risk people are allowed to go back to work. Such thinking is seductive, but flawed. It overestimates our ability to assess a persons risk, and to somehow wall off the high-risk people from the rest of society. It underestimates how badly the virus can hit low-risk groups, and how thoroughly hospitals will be overwhelmed if even just younger demographics are falling sick.

A recent analysis from the University of Pennsylvania estimated that even if social-distancing measures can reduce infection rates by 95 percent, 960,000 Americans will still need intensive care. There are only about 180,000 ventilators in the U.S. and, more pertinently, only enough respiratory therapists and critical-care staff to safely look after 100,000 ventilated patients. Abandoning social distancing would be foolish. Abandoning it now, when tests and protective equipment are still scarce, would be catastrophic.

Read: Americas hospitals have never experienced anything like this

If Trump stays the course, if Americans adhere to social distancing, if testing can be rolled out, and if enough masks can be produced, there is a chance that the country can still avert the worst predictions about COVID-19, and at least temporarily bring the pandemic under control. No one knows how long that will take, but it wont be quick. It could be anywhere from four to six weeks to up to three months, Fauci said, but I dont have great confidence in that range.

Even a perfect response wont end the pandemic. As long as the virus persists somewhere, theres a chance that one infected traveler will reignite fresh sparks in countries that have already extinguished their fires. This is already happening in China, Singapore, and other Asian countries that briefly seemed to have the virus under control. Under these conditions, there are three possible endgames: one thats very unlikely, one thats very dangerous, and one thats very long.

The first is that every nation manages to simultaneously bring the virus to heel, as with the original SARS in 2003. Given how widespread the coronavirus pandemic is, and how badly many countries are faring, the odds of worldwide synchronous control seem vanishingly small.

The second is that the virus does what past flu pandemics have done: It burns through the world and leaves behind enough immune survivors that it eventually struggles to find viable hosts. This herd immunity scenario would be quick, and thus tempting. But it would also come at a terrible cost: SARS-CoV-2 is more transmissible and fatal than the flu, and it would likely leave behind many millions of corpses and a trail of devastated health systems. The United Kingdom initially seemed to consider this herd-immunity strategy, before backtracking when models revealed the dire consequences. The U.S. now seems to be considering it too.

Read: What will you do if you start coughing?

The third scenario is that the world plays a protracted game of whack-a-mole with the virus, stamping out outbreaks here and there until a vaccine can be produced. This is the best option, but also the longest and most complicated.

It depends, for a start, on making a vaccine. If this were a flu pandemic, that would be easier. The world is experienced at making flu vaccines and does so every year. But there are no existing vaccines for coronavirusesuntil now, these viruses seemed to cause diseases that were mild or rareso researchers must start from scratch. The first steps have been impressively quick. Last Monday, a possible vaccine created by Moderna and the National Institutes of Health went into early clinical testing. That marks a 63-day gap between scientists sequencing the viruss genes for the first time and doctors injecting a vaccine candidate into a persons arm. Its overwhelmingly the world record, Fauci said.

But its also the fastest step among many subsequent slow ones. The initial trial will simply tell researchers if the vaccine seems safe, and if it can actually mobilize the immune system. Researchers will then need to check that it actually prevents infection from SARS-CoV-2. Theyll need to do animal tests and large-scale trials to ensure that the vaccine doesnt cause severe side effects. Theyll need to work out what dose is required, how many shots people need, if the vaccine works in elderly people, and if it requires other chemicals to boost its effectiveness.

Even if it works, they dont have an easy way to manufacture it at a massive scale, said Seth Berkley of Gavi. Thats because Moderna is using a new approach to vaccination. Existing vaccines work by providing the body with inactivated or fragmented viruses, allowing the immune system to prep its defenses ahead of time. By contrast, Modernas vaccine comprises a sliver of SARS-CoV-2s genetic materialits RNA. The idea is that the body can use this sliver to build its own viral fragments, which would then form the basis of the immune systems preparations. This approach works in animals, but is unproven in humans. By contrast, French scientists are trying to modify the existing measles vaccine using fragments of the new coronavirus. The advantage of that is that if we needed hundreds of doses tomorrow, a lot of plants in the world know how to do it, Berkley said. No matter which strategy is faster, Berkley and others estimate that it will take 12 to 18 months to develop a proven vaccine, and then longer still to make it, ship it, and inject it into peoples arms.

Read: COVID-19 vaccines are coming, but theyre not what you think

Its likely, then, that the new coronavirus will be a lingering part of American life for at least a year, if not much longer. If the current round of social-distancing measures works, the pandemic may ebb enough for things to return to a semblance of normalcy. Offices could fill and bars could bustle. Schools could reopen and friends could reunite. But as the status quo returns, so too will the virus. This doesnt mean that society must be on continuous lockdown until 2022. But we need to be prepared to do multiple periods of social distancing, says Stephen Kissler of Harvard.

Much about the coming years, including the frequency, duration, and timing of social upheavals, depends on two properties of the virus, both of which are currently unknown. First: seasonality. Coronaviruses tend to be winter infections that wane or disappear in the summer. That may also be true for SARS-CoV-2, but seasonal variations might not sufficiently slow the virus when it has so many immunologically naive hosts to infect. Much of the world is waiting anxiously to see whatif anythingthe summer does to transmission in the Northern Hemisphere, says Maia Majumder of Harvard Medical School and Boston Childrens Hospital.

Second: duration of immunity. When people are infected by the milder human coronaviruses that cause cold-like symptoms, they remain immune for less than a year. By contrast, the few who were infected by the original SARS virus, which was far more severe, stayed immune for much longer. Assuming that SARS-CoV-2 lies somewhere in the middle, people who recover from their encounters might be protected for a couple of years. To confirm that, scientists will need to develop accurate serological tests, which look for the antibodies that confer immunity. Theyll also need to confirm that such antibodies actually stop people from catching or spreading the virus. If so, immune citizens can return to work, care for the vulnerable, and anchor the economy during bouts of social distancing.

Scientists can use the periods between those bouts to develop antiviral drugsalthough such drugs are rarely panaceas, and come with possible side effects and the risk of resistance. Hospitals can stockpile the necessary supplies. Testing kits can be widely distributed to catch the viruss return as quickly as possible. Theres no reason that the U.S. should let SARS-CoV-2 catch it unawares again, and thus no reason that social-distancing measures need to be deployed as broadly and heavy-handedly as they now must be. As Aaron E. Carroll and Ashish Jha recently wrote, We can keep schools and businesses open as much as possible, closing them quickly when suppression fails, then opening them back up again once the infected are identified and isolated. Instead of playing defense, we could play more offense.

Whether through accumulating herd immunity or the long-awaited arrival of a vaccine, the virus will find spreading explosively more and more difficult. Its unlikely to disappear entirely. The vaccine may need to be updated as the virus changes, and people may need to get revaccinated on a regular basis, as they currently do for the flu. Models suggest that the virus might simmer around the world, triggering epidemics every few years or so. But my hope and expectation is that the severity would decline, and there would be less societal upheaval, Kissler says. In this future, COVID-19 may become like the flu is todaya recurring scourge of winter. Perhaps it will eventually become so mundane that even though a vaccine exists, large swaths of Gen C wont bother getting it, forgetting how dramatically their world was molded by its absence.

The cost of reaching that point, with as few deaths as possible, will be enormous. As my colleague Annie Lowrey wrote, the economy is experiencing a shock more sudden and severe than anyone alive has ever experienced. About one in five people in the United States have lost working hours or jobs. Hotels are empty. Airlines are grounding flights. Restaurants and other small businesses are closing. Inequalities will widen: People with low incomes will be hardest-hit by social-distancing measures, and most likely to have the chronic health conditions that increase their risk of severe infections. Diseases have destabilized cities and societies many times over, but it hasnt happened in this country in a very long time, or to quite the extent that were seeing now, says Elena Conis, a historian of medicine at UC Berkeley. Were far more urban and metropolitan. We have more people traveling great distances and living far from family and work.

After infections begin ebbing, a secondary pandemic of mental-health problems will follow. At a moment of profound dread and uncertainty, people are being cut off from soothing human contact. Hugs, handshakes, and other social rituals are now tinged with danger. People with anxiety or obsessive-compulsive disorder are struggling. Elderly people, who are already excluded from much of public life, are being asked to distance themselves even further, deepening their loneliness. Asian people are suffering racist insults, fueled by a president who insists on labeling the new coronavirus the Chinese virus. Incidents of domestic violence and child abuse are likely to spike as people are forced to stay in unsafe homes. Children, whose bodies are mostly spared by the virus, may endure mental trauma that stays with them into adulthood.

Read: The kids arent all right

After the pandemic, people who recover from COVID-19 might be shunned and stigmatized, as were survivors of Ebola, SARS, and HIV. Health-care workers will take time to heal: One to two years after SARS hit Toronto, people who dealt with the outbreak were still less productive and more likely to be experiencing burnout and post-traumatic stress. People who went through long bouts of quarantine will carry the scars of their experience. My colleagues in Wuhan note that some people there now refuse to leave their homes and have developed agoraphobia, says Steven Taylor of the University of British Columbia, who wrote The Psychology of Pandemics.

But there is also the potential for a much better world after we get through this trauma, says Richard Danzig of the Center for a New American Security. Already, communities are finding new ways of coming together, even as they must stay apart. Attitudes to health may also change for the better. The rise of HIV and AIDS completely changed sexual behavior among young people who were coming into sexual maturity at the height of the epidemic, Conis says. The use of condoms became normalized. Testing for STDs became mainstream. Similarly, washing your hands for 20 seconds, a habit that has historically been hard to enshrine even in hospitals, may be one of those behaviors that we become so accustomed to in the course of this outbreak that we dont think about them, Conis adds.

Pandemics can also catalyze social change. People, businesses, and institutions have been remarkably quick to adopt or call for practices that they might once have dragged their heels on, including working from home, conference-calling to accommodate people with disabilities, proper sick leave, and flexible child-care arrangements. This is the first time in my lifetime that Ive heard someone say, Oh, if youre sick, stay home, says Adia Benton, an anthropologist at Northwestern University. Perhaps the nation will learn that preparedness isnt just about masks, vaccines, and tests, but also about fair labor policies and a stable and equal health-care system. Perhaps it will appreciate that health-care workers and public-health specialists compose Americas social immune system, and that this system has been suppressed.

Aspects of Americas identity may need rethinking after COVID-19. Many of the countrys values have seemed to work against it during the pandemic. Its individualism, exceptionalism, and tendency to equate doing whatever you want with an act of resistance meant that when it came time to save lives and stay indoors, some people flocked to bars and clubs. Having internalized years of anti-terrorism messaging following 9/11, Americans resolved to not live in fear. But SARS-CoV-2 has no interest in their terror, only their cells.

Years of isolationist rhetoric had consequences too. Citizens who saw China as a distant, different place, where bats are edible and authoritarianism is acceptable, failed to consider that they would be next or that they wouldnt be ready. (Chinas response to this crisis had its own problems, but thats for another time.) People believed the rhetoric that containment would work, says Wendy Parmet, who studies law and public health at Northeastern University. We keep them out, and well be okay. When you have a body politic that buys into these ideas of isolationism and ethnonationalism, youre especially vulnerable when a pandemic hits.

Graeme Wood: The Chinese virus is a test. Dont fail it.

Veterans of past epidemics have long warned that American society is trapped in a cycle of panic and neglect. After every crisisanthrax, SARS, flu, Ebolaattention is paid and investments are made. But after short periods of peacetime, memories fade and budgets dwindle. This trend transcends red and blue administrations. When a new normal sets in, the abnormal once again becomes unimaginable. But there is reason to think that COVID-19 might be a disaster that leads to more radical and lasting change.

The other major epidemics of recent decades either barely affected the U.S. (SARS, MERS, Ebola), were milder than expected (H1N1 flu in 2009), or were mostly limited to specific groups of people (Zika, HIV). The COVID-19 pandemic, by contrast, is affecting everyone directly, changing the nature of their everyday life. That distinguishes it not only from other diseases, but also from the other systemic challenges of our time. When an administration prevaricates on climate change, the effects wont be felt for years, and even then will be hard to parse. Its different when a president says that everyone can get a test, and one day later, everyone cannot. Pandemics are democratizing experiences. People whose privilege and power would normally shield them from a crisis are facing quarantines, testing positive, and losing loved ones. Senators are falling sick. The consequences of defunding public-health agencies, losing expertise, and stretching hospitals are no longer manifesting as angry opinion pieces, but as faltering lungs.

After 9/11, the world focused on counterterrorism. After COVID-19, attention may shift to public health. Expect to see a spike in funding for virology and vaccinology, a surge in students applying to public-health programs, and more domestic production of medical supplies. Expect pandemics to top the agenda at the United Nations General Assembly. Anthony Fauci is now a household name. Regular people who think easily about what a policewoman or firefighter does finally get what an epidemiologist does, says Monica Schoch-Spana, a medical anthropologist at the Johns Hopkins Center for Health Security.

Such changes, in themselves, might protect the world from the next inevitable disease. The countries that had lived through SARS had a public consciousness about this that allowed them to leap into action, said Ron Klain, the former Ebola czar. The most commonly uttered sentence in America at the moment is, Ive never seen something like this before. That wasnt a sentence anyone in Hong Kong uttered. For the U.S., and for the world, its abundantly, viscerally clear what a pandemic can do.

The lessons that America draws from this experience are hard to predict, especially at a time when online algorithms and partisan broadcasters only serve news that aligns with their audiences preconceptions. Such dynamics will be pivotal in the coming months, says Ilan Goldenberg, a foreign-policy expert at the Center for a New American Security. The transitions after World War II or 9/11 were not about a bunch of new ideas, he says. The ideas are out there, but the debates will be more acute over the next few months because of the fluidity of the moment and willingness of the American public to accept big, massive changes.

One could easily conceive of a world in which most of the nation believes that America defeated COVID-19. Despite his many lapses, Trumps approval rating has surged. Imagine that he succeeds in diverting blame for the crisis to China, casting it as the villain and America as the resilient hero. During the second term of his presidency, the U.S. turns further inward and pulls out of NATO and other international alliances, builds actual and figurative walls, and disinvests in other nations. As Gen C grows up, foreign plagues replace communists and terrorists as the new generational threat.

One could also envisage a future in which America learns a different lesson. A communal spirit, ironically born through social distancing, causes people to turn outward, to neighbors both foreign and domestic. The election of November 2020 becomes a repudiation of America first politics. The nation pivots, as it did after World War II, from isolationism to international cooperation. Buoyed by steady investments and an influx of the brightest minds, the health-care workforce surges. Gen C kids write school essays about growing up to be epidemiologists. Public health becomes the centerpiece of foreign policy. The U.S. leads a new global partnership focused on solving challenges like pandemics and climate change.

In 2030, SARS-CoV-3 emerges from nowhere, and is brought to heel within a month.

Listen to Ed Yong discuss this story on an episode of Social Distance, The Atlantics podcast about living through a pandemic:

Subscribe to Social Distance on Apple Podcasts or Spotify (How to Listen)

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How the Pandemic Will End - The Atlantic

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