SARS
The Lab Leak Theory” on YouTube
Licorice Shown To Kill SARS And Other Lethal Viruses
Licorice has a rich and ancient history of use as a medicine, being rooted in Indian, Chinese, Greek and Egyptian traditions, alike. Technically a legume, related to beans and peas, its sweetness results from the presence of glycyrrhizin, a compound 30-50 times sweeter than sugar. This compound is what gave licorice its name, which derives from the Greek word γλυκύρριζα (glukurrhiza), meaning “sweet” (gluku) “root” (rrhiza). But glycyrrhizin’s properties don’t end with its sweetness; it is also one of the most powerful antiviral compounds ever studied.
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A study on glycyrrhizin’s inhibitory activity against SARS-associated coronovirus published inLancet in June of 2003, received little mainstream media coverage, despite its profound importance to human health. Mind you, only a few months before this the World Health Organization issued a press release (April 16, 2003) stating the recent outbreak of lethal Sudden Acute Respiratory Syndrome (SARS) in Asia was caused by the same coronoviruses used in this study. With the world still reeling from global SARS hysteria and “preparedness,” i.e. stockpiling pharmaceuticals like Ribavirin despite their well-known lack of effectiveness, you would think more attention would have been paid to promising research of this kind…
In the groundbreaking Lancet study, titled “Glycyrrhizin, an active component of liquorice roots, and replication of SARS-associated coronavirus,” German researchers summarized their intention in the following manner:
“The [recent] outbreak of SARS warrants the search for antiviral compounds to treat the disease. At present time, no specific treatment has been identified for SARS-associated coronavirus infection.”
And here is what they found:
“We assessed the antiviral potential of ribavirin, 6-azauridine, pyrazofurin, mycophenolic acid, and glycyrrhizin against two clinical isolates of coronavirus (FFM-1 and FFM-2) from patients with SARS admitted to the clinical centre of Frankfurt University, Germany. Of all the compounds, glycyrrhizin was the most active in inhibiting replication of the SARS-associated virus. Our findings suggest that glycyrrhizin should be assessed for treatment of SARS.” [emphasis added]
Licorice’s potent antiviral properties are not limited to SARS-associated coronaviruses, but have also been studied in connection with another epidemic/pandemic capable and potentially lethal virus: influenza.
In an animal study dating all the way back in 1997 and published in the journal Antibacterial Agents and Chemotherapy, titled: “Glycyrrhizin, an active component of licorice roots, reduces morbidity and mortality of mice infected with lethal doses of influenza virus,” researchers found that when mice were administered glycyrrhizin at 10mg/kg body weight (the equivalent of 680 mg for a 150lb adult), they all survived a series of ten 50% lethal injections. The control group, on the other hand, only survived an average of 10.5 days, with no survivors by day 21, the end of the experiment.
Even more remarkable, when the splenic T cells from the glycyrrhizin-treated mice were transferred to mice exposed to the same lethal doses of influenza virus, 100% survived, compared to 0% for the control mice inoculated with naive T cells or splenic B cells and macrophages from glycyrrhizin-treated mice. The researchers discovered that glycyrrhizin’s powerful, life-sparing effects against lethal doses of influenza were a result of the compound increasing interferon gamma production by T cells.
In order to fully understand these findings, we must look at the question of safety first. Licorice is still commonly perceived as a “dangerous herb,” due to its ability to stimulate blood pressure elevations in susceptible individuals when consumed excessively; but considering the relatively higher toxicity of most drugs, this perception must be taken with a grain of sea salt. On the other hand, it is important to exercise caution when using licorice, or any herb, for medicinal purposes, and ideally obtaining the assistance of a medical herbalist who can work with conventional health practitioners, whenever possible.
In the United States glycyrrhizin is still classified as “Generally Recognized As Safe,” when used as a flavoring agent, but not as a sweetener. It has also been removed from most “licorice” candies, substituted with with the similarly-tasting but taxonomically unrelated anise. In the European Union the recommendation is for people to consume no more than 100 mg a day, which is the equivalent of 50 grams of licorice sweets, and in Japan, where glycyrrhizin is often used as a sugar substitute, a recommended limit is set at 200 mg a day. This should give you a sense for what a commonly considered safe, daily dose is, and puts a 600 mg “therapeutic” dose in perspective.
Also, it is important to consider that even when the glycyrrhizin is isolated and concentrated pharmaceutically, its relative toxicity is extraordinarily low, when compared to antiviral drugs like Ribavirin.
According to the federally mandated Material Safety Data Sheets (MSDS) provided by the manufacturers on pharmaceutically extracted glycyrrhizin and the drug Ribavirin, the former is 30 times less toxic than the later (the mouse oral 50% lethal dose is 9818 mg/kg versus 300 mg/kg for Ribavirin). It is important to understand, also, that when complexed in the whole root or powdered root form, glycyrrhizin will be treated differently by the body. It will be released slower, will have naturally occurring factors which may attenuate adverse effects, and therefore should be considered safer than the MSDS on isolated glycyrrhizin reflects.
Also consider that glycyrrhizin is much cheaper…
A 200 mg dose of Ribavirin from an online discount pharmacy costs approximately 4 dollars.
Let’s take a 1 pound bag of Frontier brand Licorice sticks, which costs $10, and which contains approximately 7% glycyrrhizin or the equivalent of 13,440 milligrams of glycyrrhizin per pound. This is also the equivalent of sixty-seven 200 mg servings. If I bought sixty-seven 200mg pills ofRibavirin it would cost me 268 dollars. So, that’s 26.8 times the price of the glycyrrhizin found in licorice. In both cases, the natural compound is approximately 30 times less toxic and less expensive, and let us not forget, in the SARS/licorice study, Ribavirin didn’t even work. So, it is potentially infinitely more effective. Hmmm. I wonder which I would choose if faced with an impending pandemic virus? A drug with low availability, exceedingly high costs and toxicity, and which doesn’t work, versus a time-tested, safe, affordable and highly effective herb?
The reason, of course, why licorice will never be used as an FDA-approved medicine is because it would take at least 800 million dollars of upfront capital to fund the preclinical and human clinical studies necessary to get it to that point.
MERS May Be A Concern But It’s Not SARS.
Unlike SARS, MERS is no pandemic virus
Source: Wikipedia; Modifications: Jason Tetro
Over the last week, the number of human patients suffering from Middle East Respiratory Syndrome (MERS) has grown significantly bringing fears of a possible SARS-like spread of the disease and the potential for the development of a pandemic. Although this may be perceived as crying wolf, the concern is indeed justified albeit not to that extent. The problem lies in the apparent unanswered questions with respect to this epidemic. Without information on epidemiology, transmission, route of entry and infection control, public health officials simply cannot offer a perspective on the future of this disease.
Yet there are answers to be found. Over the nearly two years since the causative virus, the MERS coronavirus (MERS-CoV) was identified, researchers have gained significant insight into the ongoing epidemic. They have also seen just how this virus compares with SARS and the answer always appears to be the same. While MERS is a bad actor, it is no SARS and most likely will not cause a pandemic.
The first comparison is epidemiological. MERS appears to be a respiratory disease with the potential for other complications including diarrhea, muscle and joint pain, kidney injury and organ failure. There are quite a few similarities with SARS however a closer look at the progression of infection shows these two are not at all alike.
SARS is a two-stage infection requiring up to several weeks of incubation before symptoms begin. When they hit, the person remains ambulatory for upwards of ten days to three weeks. Then, when the second stage occurs, the patient inevitably requires hospitalization and in some 10% of cases, death occurred. MERS, on the other hand, requires only about 5 days for onset of symptoms (although periods of up to two weeks have been seen) and there appears to be only one stage. When symptoms begin, especially in severe cases, the person is all but debilitated and requires rapid medical attention. Death occurs in about a quarter of the population although those numbers continue to drop.
The reason for this reduction in mortality stems from the rise of either mild or asymptomatic MERS infection in healthy individuals. The median age of death is about 52 years of age and most severe cases occur in people with underlying conditions such as diabetes, renal failure, heart disease and immunosuppression. This suggests MERS may not be a perfect pathogen and normal healthy individuals may be able to fight off infection. In comparison, SARS infected people uniformly and equally as deadly; the median age of death was closer 43 years. Some did exhibit lower levels of infection, possibly due to prior infection and there were some who simply did not exhibit any symptoms.
The next comparison lies in the spread of the two viruses and how best to control it. SARS was easily transmitted in the environment while MERS continues to require close contact with an infected person or animal. Some may feel this might change allowing MERS to be spread just as rapidly. Yet the biological differences between the two means of infection suggest this may be unlikely.
SARS and other less virulent coronaviruses rely on receptors found throughout the respiratory tract. They can easily cause infection through aerosols and droplets. MERS on the other hand, infects through interaction with a protein called dipeptidyl peptidase 4 (DPP4) although it is also known as adenosine deaminase complexing protein 2 (ADCP2) and cluster of differentiation 26 (CD26). As the multiple aliases suggest, this molecule is found in many locations within the body and performs a variety of functions including cell movement as well as regulation of blood sugar and cardiac functions.
There is, however, one place DPP4 cannot be found: the upper respiratory tract. Studies have shown the protein can only be found in the lower respiratory region including the bronchi, blood vessels and submucosal glands. As a result of this, MERS infection simply cannot happen in the same way as SARS. The only means possible– at least via this route – is through deep inhalation of the virus, achievable solely through close contact with an infected person or animal. With this light shed on the situation, it is easy to see that this interaction can easily be prevented through either social distancing or by wearing a mask.
MERS does have another possible route for infection leading to an even greater concern. The virus may still gain entry through the gastrointestinal tract where DPP4 can be found in abundance. To date there is only limited data on the impact of ingestion of viruses in laboratory cell cultures. Yet a recent case in Malaysia linked to drinking camel milk may suggest this link may have credence. Should this be the case, the virus may spread systemically through the body without the involvement of the lungs. This would, however, change the focus of the virus from airborne to primarily foodborne. Control would be more intensive than wearing a mask yet could be achieved by ensuring the virus is killed either through cooking or pasteurization prior to being consumed.
The final aspect of MERS biology relevant to its spread is its survival in the environment. Studies on other coronaviruses have shown survival on surfaces for hours to days. That being said, it’s also relatively easy to kill with heat, disinfectants and even detergents. This clearly shows the importance of infection control measures, such as hand hygiene and regular surface cleaning to prevent spread.
The data suggest the pandemic fears regarding MERS may not be necessary. Due to the biological nature of the virus, its receptor for infection, its routes for spread and the relative ease of necessary disinfection measures, there is every indication this virus can be controlled and infections prevented. Yet, while the science is relatively clear, the future of MERS remains in doubt.
Research can only offer the best means possible to keep the virus at bay. But ensuring that these actions are taken requires an even harder threshold and one that may be the root cause of the problems: behavior. As seen before with SARS, avian flu and Ebola, promoting and enforcing human actions to minimize the risks is nearly impossible, even in trained individuals. Yet as long as compliance remains poor, whether in healthcare or in public, the chances for infection will continue. While the current spike in cases is most likely not indicative of a future trend, it is a reminder that even a virus not entirely suited for humans, such as MERS, can indeed cause significant disease burden and unfortunately cause a number of needless deaths.
Bat virus clues to origins of Sars.
Researchers have found strong evidence that the Sars virus originated in bats.
Two novel Sars-like coronaviruses were found in Chinese horseshoe bats which are closely related to the pathogen that infects humans.
Critically, the viruses infect human cells in the same way, binding to a receptor called ACE2.
This suggests coronaviruses could transfer directly from bats to humans, rather than via an intermediate species like civets as was previously thought.
The results are reported in the journal Nature.
According to Gary Crameri, virologist at CSIRO and an author on the paper, this research “is the key to resolving the continued speculation around bats as the origin of the Sars outbreaks”.
This Sars-like coronavirus is around 95% genetically similar to the Sars virus in humans, the research shows. And they say it could be used to develop new vaccines and drugs to combat the pathogen.
The viruses use the same basic route into human cells as Sars
The Sars outbreak between November 2002 and July 2003 resulted in more than 8,000 worldwide cases and more than 770 deaths. This, along with the ongoing endemic of the Mers-coronavirus demonstrates the threat to humans from novel coronaviruses.
Dr Peter Daszak is the president of the EcoHealth Alliance and an author on the paper published in Nature. He said: “Coronaviruses evolve very rapidly. The ones we are seeing are exquisitely evolved to jump from one species to another, which is quite unusual for a virus. So the big question is why are they emerging now?”
At wildlife markets in China other animals and humans come into close proximity with bats, creating an ideal environment for the virus to jump between species. Also, those hunting in or living near bat caves have a significant risk of infection from such viruses, which are excreted in bat faeces.
Understanding the origins of infectious diseases like Sars could help scientists tackle future infectious viruses before they emerge, through knowing where they are likely to arise and which families of virus we are most vulnerable to, and taking action to prevent initial infection.
Dr Daszak said it would cost “about $1.5bn to discover all the viruses in mammals. I think that would be a great investment because once you have done it, you can develop vaccines and get ready with test kits to find the first stage of emergence and stop it.”
Influenza A (H7N9) and the Importance of Digital Epidemiology.
On March 31, 2013, Chinese health officials notified the World Health Organization of three cases of human infection with novel influenza A (H7N9). Since then, 132 people have been infected, 37 of them fatally , To date, there is no evidence of ongoing human-to-human transmission. However, a number of characteristics of this virus are cause for heightened attention.
First, the human population has not been exposed on a large scale to hemagglutinin 7 (H7) and neuraminidase 9 (N9) antigens in recent times and therefore most likely lacks immunity against this strain. Second, initial analyses of viral genome sequences suggest signs of adaptation to mammals — such as the ability to attach to respiratory tissue and to replicate at mammalian body temperatures1 — which could facilitate human-to-human transmission. Third, because the virus has low pathogenicity in birds, its presence is difficult to detect in bird flocks by symptomatic surveillance alone. Testing of more than 20,000 people with influenza-like illness in China revealed only six cases of H7N9 infection, suggesting that there are not widespread mild cases of H7N9.2
Public health officials on the ground continue to focus substantial resources on assessing and mitigating the pandemic potential of this virus strain. Although these efforts are critical for understanding the evolving public health situation, since there are limited resources available, intelligence for assessing the threat must come from a wide range of data sources. Though relatively new, digital disease surveillance is an increasingly powerful tool that complements traditional approaches.3
In this and other outbreaks, digital disease surveillance has supplemented the critical laboratory studies and work in the trenches by public health officials and epidemiologists, by leveraging widespread use of the Internet, mobile phones, and social media.3 Many of these added insights come from the general population, whose access to technology enables rapid information flow. In 2013, there are 6.8 billion cell-phone subscribers; 2.7 billion people are online; and by the end of the year, there will be more than 2 billion mobile broadband subscriptions worldwide. A large percentage of the online population publicly shares information on social media services: in both the United States and China, for example, more than half the population with access to the Internet uses social media services.
Digital data can be used in at least four ways for studying infectious-disease dynamics. First, they can be used for early detection of disease outbreaks. This capacity was illustrated most recently in China, when a hospital employee uploaded an image of the medical record of a patient with H7N9 infection to Sina Weibo, a popular Chinese social network similar to Twitter. The post was promptly deleted, but it appears to have accelerated the government’s acknowledgment of four new cases (see figure, Panel B). More generally, because digital surveillance is not limited by the hierarchies of traditional public health infrastructure, geographic communication barriers, and geopolitical obstacles, it has improved the timeliness of outbreak detection substantially in recent years.4
Second, these data can be used to continuously monitor disease levels. With proper filtering by automated systems (see the Journal‘s H7N9 HealthMap tracking system [http://healthmap.org/h7n9]), analyst-driven systems (e.g., the Global Public Health Intelligence Network of Canada), vigilant journalists on Twitter (e.g., Crawford Kilian [@Crof] and Helen Branswell [@HelenBranswell]), and crowd-sourced systems (e.g., FluTrackers and ProMED-mail), informal data sources such as news media, e-mail lists, blogs, and social media can complement formal public health surveillance by offering real-time clues to disease dynamics. Internet-based surveillance systems provided important early epidemic intelligence during the 2003 outbreak of severe acute respiratory syndrome (SARS) and the 2009 H1N1 influenza pandemic, enhancing transparency by rapidly publicizing outbreak information.3
Third, Internet-based data from social media can be used to assess disease-relevant health-related behaviors and sentiments relevant to disease control. During the H1N1 pandemic, sentiments about vaccination extracted from Twitter were shown to correlate well geographically with subsequent vaccination coverage throughout the United States.5 Such analyses could provide important information to aid in planning and in the distribution of limited resources, as well as improving public health communications efforts.
Fourth, these data provide researchers with an additional method for examining the period before an outbreak came to light. Despite international agreement that transparency is critical during an outbreak, accusations of delayed reporting are common and can be difficult to dispel. Time-series analysis of the volume of influenza-related searches on the Chinese Web search engine Baidu shows a low level of activity in the months leading up to the first announced H7N9 cases, which suggests that widespread unreported outbreaks were not festering before the announcement.
Though digital epidemiology as an enabler of disease surveillance across political, cultural, and linguistic borders carries many advantages, it’s not without its challenges. The dynamics of information spread are inherently different from the dynamics of disease spread. In the days immediately following the first reports of a few cases of a new disease, the volume of news reports and social media posts typically spikes dramatically (see figure, Panel A), because during that period most information is new and potentially relevant and therefore of high interest to the public. After some time, information saturation sets in, and public interest wanes, even as the number of new cases continues to rise. For newly emerging diseases with initially few cases, the social media data are typically dominated by news reports rather than first-person accounts of symptoms by sick individuals — a situation that differs markedly from that during recurring epidemics such as seasonal influenza. In the early phase of an outbreak, this effect makes it challenging for digital epidemiology to provide intelligence for early detection of cases of disease. Both human assessment and computational algorithmic intelligence are required to meet the challenge of extracting information from data sets that are both extremely large and noisy.
In addition, information retrieval itself can be difficult. Consider Sina Weibo, which can be a particularly challenging platform for harvesting information. Posts are censored at a reportedly rapid rate, with 5% of deletions happening within 8 minutes, and 30% within 30 minutes. Because of concerns about censors, some Sina Weibo users rely on metaphors (seehttp://chinadigitaltimes.net/space/Introduction_to_the_Grass-Mud_Horse_Lexicon for an interesting glossary of terms used in the past), making it challenging for outsiders to follow what they’re talking about. For example, in Chinese, the eponymous “grass-mud horse” sounds like an obscene phrase and indirectly references the Communist party. The phrase has evolved to mean an Internet-savvy person who dislikes and seeks to circumvent government censorship.
Despite these challenges, the recent outbreaks of H7N9 influenza and the Middle East respiratory syndrome coronavirus (MERS-CoV) infections illustrate the strengths of digital disease surveillance. In the case of H7N9, such surveillance has enhanced transparency and helped public health officials to understand the outbreak more fully. Although information was sparse in the MERS-CoV outbreak, digital disease surveillance proved its usefulness: the initial MERS-CoV case reports came to light through ProMED-mail (www.promedmail.org/direct.php?id=20120920.1302733). Since the SARS outbreak, the world has seen substantial progress in transparency and rapid reporting. The extent of these advancements varies, but overall, digital disease surveillance is providing the global health community with tools supporting faster response and deeper understanding of emerging public health threats.
Health officials are aware of the catastrophic potential of pandemics. The potential for widespread infections with MERS-CoV outside of Saudi Arabia and the potential reemergence of H7N9 during next year’s influenza season demand that digital disease surveillance be a part of the response.
Source: NEJM
DEADLY VIRUS VANISHES FROM TEXAS LABORATORY.
Well, it seems to have happened again. A small vial of a potentially deadly strain known as the Guanarito virus has went missing from the University of Texas Medical Branch in Galveston. It is not known how long the vial has been unaccounted for so it is anyone’s guess as to where it is and what has been done with it.
The virus was discovered missing when an unidentified “official” noticed that one out of five vials was missing, even though they are “locked” in a bio-hazard freezer. As soon as it was noticed the CDC (Centers for Disease Control and Prevention) was notified of the risk. It has been a week since it has been reported and we have heard very little about this potential hazard, in fact it was hardly reported at all despite the curious circumstances behind the incident. Why would a vial of a potentially dangerous virus be missing from a U.S laboratory and who would want something so hazardous in their possession?
The Guanarito virus is part of a family of diseases that were discovered to have caused several deadly outbreaks in Venezuela and the government has made it a priority to study it, hence why the virus was apparently locked inside of a Texas University bio-hazard freezer in the first place. The reason the government has prioritized this virus to be studied is because “it can potentially be used by terrorists in a contagion attack”. Therfore, reports of this virus being “potentially” dangerous is likely because if the individual or organization that possesses the vial has ill intentions it can be used to cause an outbreak on a targeted population. It would not be hard for an insider of any given enemy government to enroll in a class at a University to have access and obtain deadly viruses to use on the American population. If this were to happen, it is unknown how severe the consequences could be which is why these “deadly” strains should be studied in more secure locations, and not on University campuses. This would significantly decrease the risk of something like this happening. In fact, “deadly” viruses should never be at a school in the first place, as it should be high level graduates that have access to these materials as opposed to people who are not even in the field yet. This is just one example of how to avoid risks like this from occurring in the future.
UTMB director Scott Weaver said that “Guanarito has been responsible for causing deadly diseases within the South American country (Venezuela)”. The symptoms of the missing virus (aside from death, as it has been classed as “deadly”), is a severe hemorrhagic fever which could lead to death. Essentially, your brain starts to bleed which can lead to death if not treated and since it is still being studied as a priority it is unknown if there is a cure for this virus. If you have ever watched the movie “Outbreak”, it has a similar plot to this real life event as a virus is released on the public that causes the exact symptom, “hemorrhagic fever”. It was also showing on television around the time the vial was reported to be missing. Coincidence?
The UTMB said that there was no security breach or break-in at the Texas facility, nor did they “believe” there was evidence of foul play and that the vial “could have” simply been broken during the labs cleaning process, all answers indicating they are clearly unsure of what exactly happened.
It is not clear if we will ever find out the answers as to where it could have ended up however the government wanted it studied due to it’s potential for being used by terrorists and this is a huge red flag for anyone who has followed the course of history even the slightest. Lyme disease was also released from a U.S laboratory (Plum Island) and was developed by a Nazi scientist who escaped persecution in a CIA plot called Project Paperclip, and was rewarded a new life in America to work on bio-hazard studies. He is now known for introducing Lyme disease on the population of the world as it escaped the laboratory in a similar unknown breach as the recent incident in Texas.
Worth noting is that in December of 2012, an unknown epidemic hazard was announced in Northern Ontario in a report by the Family Survival Protocol. This report stated:
“A woman was found dead on a Via Rail passenger train early Saturday morning. The company says the Vancouver-to-Toronto train stopped near Parry Sound, Ont., because four passengers were showing flu-like symptoms. Emergency crews boarded the train and confirmed that a woman who Via Rail described in a news release as elderly had died. The other three passengers were taken to hospital for treatment, according to the news release. The train was about six hours late getting to Toronto, according to the release. The train had left Vancouver on Christmas Day night. Via said a quarantine was placed on the two rooms the passengers were in, which is part of their standard procedures. It’s not believed anyone else was in those compartments, which will be sterilized. Health officials say it’s not believed that other passengers or the train’s crew were exposed to those taken off the train, which had 200 passengers and 13 crew members on board. The local coroner was trying to determine the cause of death and the Ontario Provincial Police say the woman’s identity was being withheld until all family members were notified.”
Similarly, in more recent reports (March 2013) it was claimed that a deadly new “Coronavirus” has been spreading throughout the Asia and Europe and has claimed lives in the Middle East, China, and has since worked its way North claiming lives in the UK as well. This virus is similar to, yet more deadly than SARS and originated from the Middle East.
“The SARS coronavirus infected very few animal cell lines. It was finally traced to bats and civets. But we may have a very hard time, as this new virus seems to be much more promiscuous,”, stated Yuen Kwok-yung, a microbiologist at the University of Hong Kong. “The SARS coronavirus infects very few human cell lines. But this new virus can infect many types of human cell lines, and kill cells rapidly…If the new virus mutates further, it could cause a deadly pandemic” he warned.
One question remains…Why do laboratories “create” deadly viruses again? It just does not make any sense to me whatsoever.
10 years on, the world still learns from SARS.
With eerie coincidence, a new coronavirus has emerged on the tenth anniversary of the SARS outbreak. Carrie Arnold looks at how the 2003 outbreak shaped disease surveillance and response.
In early 2003, Hong Kong virologist Malik Peiris thought several of his patients with severe pneumonia at Queen Mary Hospital were yet more human cases of avian influenza. Patients did not respond to antibiotics, and the severity of the illness was consistent with H5N1 influenza, which was then circulating in the area. Rumours abounded that a similar severe pneumonia was being found in nearby Guangdong, on mainland China, which only raised suspicions of a major influenza outbreak. Public health officials were bracing themselves for what they were sure was the next big pandemic.
They got their pandemic, but it was not influenza. It was an entirely new disease that would ultimately be called SARS. The disease outbreak showed the infectious disease community just how unprepared it was for a major pandemic.
“SARS changed the spirit of things”, said Isabelle Nuttall, director of WHO’s the Global Capacities Alert and Response Unit. “It showed us that anything can happen anywhere.”
As an infectious disease physician at a major Hong Kong hospital, Peiris was one of the people at the centre of the SARS epidemic. His team identified and isolated the coronavirus that causes SARS, and his clinical expertise helped to control the hospital-based spread of the virus. Through hard work and international efforts led by physicians like Peiris and public health agencies like WHO, the SARS outbreak was halted less than a year after it began.
“We learned that any infectious disease outbreak anywhere in the world today could be a problem for the whole world tomorrow”, Peiris told TLID. “These lessons were reinforced by the influenza pandemic of 2009, although that turned out to be less severe.”
Perhaps one of the largest stumbling blocks to bringing SARS under control was an initial lack of transparency from Chinese authorities. When the first reports of a new pneumonia striking Guangdong began to emerge, the government did not step in to notify physicians, public health agencies, or other governments in the area.
At the time, WHO rules only required the reporting of four diseases: yellow fever, cholera, plague, and smallpox. Since the early SARS cases were clearly none of these, no government was under any sort of official obligation to notify WHO about them. Nuttall noted that this was a huge loophole of the existing health regulations. By the time SARS got too big to ignore, it had already spread far beyond the borders of Guangdong, making the disease much harder to contain.
Also missing was the laboratory capacity needed to detect and identify such emerging pathogens. Peiris noted that some of the areas where SARS hit the hardest—Hong Kong, Singapore, Toronto—had adequate biosafety facilities to run the appropriate tests. Other areas, like Cambodia and Vietnam, simply did not have that capability. If SARS had emerged in more resource-poor areas, he said, it could have taken a lot longer to bring the outbreak under control.
As a result of these poignant lessons, WHO officials decided to formally update the International Health Regulations (IHRs), a legally binding agreement. Public health officials had realised, even before SARS, that the IHR mandatory reporting requirements of only four diseases were inadequate. Arguments and ideas were continually bounced around but never enacted. In 2003, the SARS outbreak and ongoing low-level transmission of H5N1 avian influenza provided the impetus for WHO to act, Nuttall explained.
The new IHRs that were voted on in 2005 and began to be legally enforced in 2007 encapsulate many of the lessons epidemiologists and infectious disease physicians have learned during SARS. The IHRs form a sort of map or template of what countries and local communities need to do to be on the lookout for infectious disease outbreaks, and how they should respond when one of these outbreaks is detected. To start, the new IHRs give broader powers to WHO to investigate infectious disease threats and communicate them to the world, even without the support of local or national government. They also broaden the types of sources that WHO can use to begin an outbreak investigation.
Previously, a request for WHO involvement had to go through official government channels. In the case of SARS, the Chinese authorities did not request help or even notify WHO of the unusual cluster of pneumonia cases. WHO had heard about these cases through unofficial channels, but, because of stipulations in the older IHRs, they could not formally intervene, only watch and wait. Now, WHO can use these unofficial reports and even relevant newspaper articles as justification to intervene should it be warranted.
Improved laboratory capacity is also at the core of the new IHRs. The regulations require all countries to have infectious disease laboratories to test samples and do other routine surveillance tasks. “A lot of what we do to detect disease is really just boring old surveillance”, said John Oxford, a virologist working at Retroscreen Virology.
As boring as surveillance may be, Oxford noted, it is the key to identifying disease outbreaks from any source. Nuttall, too, cites this as one of the cornerstones of the new IHR. Although countries have until the end of 2013 to come into compliance with these regulations, many countries have asked for additional time to assemble the necessary resources.
Another power newly given to WHO in the revised IHR is their ability to do risk assessments and communication. One of the major reasons governments hesitate to inform the international community about disease outbreaks in their borders is the potential effect on trade and tourism. SARS was tremendously disruptive to business in Canada, China, and other parts of southeast Asia. People postponed or cancelled travel to these areas to avoid contracting the virus. Although these fears are certainly understandable, researchers know now that much of SARS transmission was centred in hospitals and health-care facilities, not by casual contact in everyday settings.
“It can be a delicate balance between sharing information and sparking panic”, said James Hughes (Emory University), former director of the National Center for Infectious Diseases at the CDC. “In today’s world, it’s not possible for countries to keep secrets for very long. It’s an incentive that favors early reporting.”
Although new diseases like SARS tend to have the splashiest headlines and garner the most media attention, most of the diseases that affect the largest numbers of people are the plagues we have known about for years, if not centuries. “By far, most of the outbreaks we see are from known pathogens”, Nuttall said. Still, this does not mean that an as yet unseen virus cannot cause major problems. 30 years ago, HIV was still a strange, emerging virus.
Some of the best ways to combat these diseases, emerging or otherwise, are not splashy and sexy, either, notes Oxford. During SARS, airports deployed heat sensors to measure fever of passengers. Though fancy and expensive, they did little to stop the spread of the virus.
“The best thing to do during any disease outbreak is ensuring people wash their hands. Although we know this, most of us still aren’t very good about it”, Oxford said. The money spent on this expensive equipment would have been better spent, in Oxford’s opinion, on sinks, soap, and running water, along with better personal protective equipment for health-care workers.
The H1N1 influenza outbreak in 2009 was perhaps the first main test of the new IHR. Officials from WHO and the larger public health community said that the new guidelines were successful. The Mexican government reported the outbreak quickly, and teams around the world worked together to track and respond to the virus.
“We also saw Mexicans being stigmatised, and then, with the term ‘swine flu’, the pork industry was stigmatised”, Hughes said. The ongoing risk of stigma and blame is one of the many needs for effective risk communication. When the public understands what is really going on, they can better respond to the actual threats from the disease and respond appropriately.
Other emerging viruses, like the coronavirus causing severe pneumonia in the Middle East and UK, continue to help test and refine the usefulness of the IHRs. Despite its eerie emergence almost a decade after SARS, this new coronavirus is only distantly related to is more notorious relative, and its much less efficient at spreading from person to person. Thus far, researchers have seen no large clusters of cases that indicate it will be a larger threat, although that could change at any time.
“It’s a recurrent lesson in infectious disease—expect the unexpected”, Hughes said.
Even as this story went to press, officials in China are reporting cases of a rare H7N9 avian influenza that has so far made 24 people ill, killing seven. Each outbreak, Nuttall says, helps the infectious disease community learn and better respond to future outbreaks.
Source: Lancet
Emerging risk of H7N9 influenza in China.
4 years after the global pandemic of H1N1 influenza, a new type of avian influenza, H7N9, is emerging in mainland China. It was first reported in Shanghai on Feb 19, 2013. As of April 17, 2013, a total of 77 cases of H7N9 human infection have been confirmed, including 16 deaths. 30 cases, including 11 deaths, have been confirmed in Shanghai; 20 cases, including two deaths, in Jiangsu province; 21 cases, including two deaths, in Zhejiang province; three cases, including one death, in Anhui province; one case in Beijing; and two cases in Henan province.1, 2
The H7N9 virus is a new influenza virus subtype, and it has not been included in the statutory infectious disease surveillance reporting system of China. No vaccine has been launched yet. The source of H7N9 human infections is unclear, but based on past experience and epidemiological investigation, H7N9 virus might be carried by poultry, in their secretions or excretions. About 40% of the patients have not been in contact with poultry before. China’s official media, quoting Gregory Hartl (a WHO spokeperson), stated that although transmission of H7N9 virus between human beings has not been reported yet, there is a risk that mutations in the virus could ease the spread. Moreover, men who are smokers are a susceptible group because of their pulmonary dysfunction associated with smoking.3
The incubation period of the H7N9 virus is generally less than 7 days. Patients usually present with flu-like symptoms, such as fever, and cough with little phlegm, which can be accompanied by headache, muscle aches, and general malaise. Patients with severe progression of the disease manifest severe pneumonia, with body temperature over 39°C and difficulty breathing. The disease can progress rapidly, accompanied by acute respiratory distress syndrome, mediastinal emphysema, septic shock, disturbance of consciousness, and acute kidney injury.
H7N9 virus has attracted much attention. Chinese officials have actively responded to the infection, and introduced prevention and control measures. Shanghai, Nanjing, and some other places have suspended live poultry transactions and prohibited the entry of exotic live poultry. However, it is still a great challenge for the Chinese Government to control the infection. Unlike the SARS (severe acute respiratory syndrome) epidemic 10 years ago, H7N9 virus does not show signs of human-to-human transmission, and isolation of patients would not limit the transmission. Immediate culling of infected poultry is an effective measure. But more efforts must be made to prevent further spread of the infection.
Source: lancet
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