How to Prevent the Next Pandemic—Asterisk

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@ref:: How to Prevent the Next Pandemic—Asterisk
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2023-10-25 asteriskmag.com - How to Prevent the Next Pandemic—Asterisk

Book cover of "How to  Prevent the Next  Pandemic—Asterisk"

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I also have a bit of a security mindset. In cybersecurity there’s a saying: any system vulnerable to accidents is helpless against deliberate attack. Wherever it came from, SARS-CoV-2 was an accident. It was either a natural or accidental release, but it was not deliberate, because anything deliberate would be more severe. That suggests that if and when we learn how to build harmful things with pandemic-class capabilities, we’re going to be in trouble. Lots of people are going to be able to cause pandemic-class events, and the rest of us are not going to be able to do much to defend against them.
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The problem is there are around three to four pandemics per century that cause a million or more deaths, just judging from the last ones — 1889, 1918, 1957, 1968 and 2019. There’s probably at least 100 times as many pandemic-capable viruses in nature — it’s just that most of them never get exposed to humans, and if they do, they don’t infect another human soon enough to spread. They just get extinguished.What that means is if you identify one pandemic-capable virus, even if you can perfectly prevent it from spilling over and there’s zero risk of accidents, you’ve prevented 1/100 of a pandemic. But if there’s a 1% chance per year that someone will assemble that virus and release it, then you’ve caused one full pandemic in expectation. In other words, you’ve just killed more than 100 times as many people as you saved.
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In addition to identifying pandemic-capable viruses, the other form of dangerous research is so-called gain of function, which is probably better termed virus transmissibility enhancement research. This is where scientists take viruses that are bad at transmitting human to human, but really good at killing you if they infect you, then try to engineer and evolve them to be more transmissible.
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So why hasn’t it happened? The capability, thankfully, isn’t there yet, but at some point it will be. And that’s the hardest part: everything we do to try to keep this knowledge locked away is a matter of buying time. All we can do is delay. There are too many advances happening in too many different areas of biology to lock away that capability indefinitely. We’re going to have to deal with a world where there are instructions for making pandemic agents that are accessible to researchers who can acquire the necessary DNA comprising the genome of that agent.
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- [note::"Creating a pandemic-level virus is inevitable, so all that matters is that we're ready for it when it comes"]

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The international community has agreed that nuclear weapons must never fall into the hands of non-state actors or terrorist groups. Pandemic viruses can kill more people than any nuclear weapon. Therefore, the same logic demands that we keep them out of the hands of terrorists.
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Right now most scientists are really not going to notice if the thing that they’re working on happens to provide the key that will allow individuals to murder millions. USAID’s DEEP VZN program had never considered the possibility that the viruses that they discover and post on their rank-ordered list by threat level would be misused.
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- [note::Perhaps there should be more training for scientists around safeguarding against potential misuses of their research]

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Your next question: what do we do to stop it? I’m speaking here from the perspective of an agent that could conceivably cause civilizational collapse. Suppose COVID had a 90% mortality rate. I can imagine people refusing to go out. That’s good for curtailing the spread of the pathogen, but people need food and water and power at a minimum. We probably need law enforcement too — some kind of order.Society could still function without health care in an extreme emergency. Many people would die without the health care system, yes, but we can do without it. But the people who are responsible for producing and distributing food, water and power absolutely must be willing to keep doing their jobs. That means that we have to give them good enough protective equipment.So we need 30 million suits of protective equipment that requires zero training that can be delivered to them all within days, and that will reliably keep them from getting infected with anything that we think is nasty enough to warrant this kind of response.
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- [note::This is a question I had earlier - how do you feed millions of people with a reduced workforce during a high lethality pandemic?]

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There’s a couple of ways of doing it. The simplest version is a headpiece that ideally has complete plastic all the way across the front so you can see the face, covers the back of the head, and has some sort of clasp around the neck. It doesn’t need to be very tight because you’re creating positive pressure by pumping air through a HEPA filter into the inside. We can probably improve it by adding, say, LEDs that emit ultraviolet light to help sterilize the air going through. It needs to be comfortable. Ideally it needs to be stylish — you want as many people to be willing to wear it as possible, certainly in the early days. And it needs to be possible to take it off without self-contaminating and then infecting yourself. There also needs to be some way of sterilizing the equipment so that you can wear it again the next day — germicidal light is our best bet.
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And that is our other best defense. Low-wavelength light between 200 and 230 nanometers is germicidal. It destroys viruses and bacteria, but it doesn’t appear to hurt multicellular organisms because it’s absorbed by proteins. Preliminary studies suggest even high exposures to this kind of light are safe. If we were to install these low-wavelength lights indoors, continuously and at a background level, under the current safety guidelines, it would reduce the amount of aerosolized pathogen in the air by 99% inside of five minutes. It could basically eliminate most aerosol- and contact-based transmission. What it wouldn’t do is hit aerosols and the respiratory droplets from person-to-person transmission.
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But it’s incredibly promising because anything sufficient to prevent a serious future pandemic could probably also prevent the vast majority of the pathogens that infect us day-to-day. If we can actually harden our spaces to make them immune to transmission of pandemic viruses, then we’ve also just eliminated virtually all infectious disease. U.S. employers lose $300 billion a year to lost productivity from illness, specifically from infectious agents. That’s $300 billion a year that could be saved.
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- [note::Interesting point - equipping indoor spaces with anti-viral measures is a win-win both in terms of pandemic preparedness and general public health.. and there are promising economic incentives to drive the adoption of these technologies.]

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On the whole, I think the FDA does a reasonable job of balancing benefits and risks for standard things, but in an emergency situation like a pandemic when you have to move fast — because every day you delay many thousands of people are dying — you just can’t afford to have the same people governing the response. I don’t think there’s a human psyche on the planet that could manage that rapid flip. I would really like to see a separate system where power is formally transferred once an emergency is declared to people whose job it is to wait around and plan for emergencies.
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- [note::This is what I'm really interested in - how do you leverage technology to ensure optimal collaboration during pandemic-level events?]