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8 Questions From a Disease Detective on the Pandemic’s Origins 8 Questions From a Disease Detective on the Pandemic’s Origins
(5 days later)
For decades, Dr. Daniel R. Lucey, an infectious disease specialist at Georgetown University, has crisscrossed the globe to study epidemics and their origins. His attention now is on the Covid-19 pandemic, which first came to public notice late last year in Wuhan, China. Its exact beginnings are sufficiently clouded that the World Health Organization has begun a wide inquiry into its roots. The advance team is to leave for China this weekend, and Dr. Lucey has publicly encouraged the health agency to address what he considers eight top questions.For decades, Dr. Daniel R. Lucey, an infectious disease specialist at Georgetown University, has crisscrossed the globe to study epidemics and their origins. His attention now is on the Covid-19 pandemic, which first came to public notice late last year in Wuhan, China. Its exact beginnings are sufficiently clouded that the World Health Organization has begun a wide inquiry into its roots. The advance team is to leave for China this weekend, and Dr. Lucey has publicly encouraged the health agency to address what he considers eight top questions.
“It’s not a legitimate investigation if the team doesn’t ask them,” Dr. Lucey said in a recent interview. He cited public reports and scientific articles as starting points for his queries, adding that Beijing “has never come out and answered these questions.”“It’s not a legitimate investigation if the team doesn’t ask them,” Dr. Lucey said in a recent interview. He cited public reports and scientific articles as starting points for his queries, adding that Beijing “has never come out and answered these questions.”
Clear answers, Dr. Lucey said, would cast light on how the deadly pathogen spread so rapidly and, perhaps, how exactly the outbreak began. China has not been forthcoming with information, and the Trump administration has inflamed the situation with threats and bullying. It has charged, without presenting evidence, that the microbe jumped to humans from a Wuhan lab. On Tuesday, after long threatening to do so, the administration began formal steps to end its W.H.O. membership.Clear answers, Dr. Lucey said, would cast light on how the deadly pathogen spread so rapidly and, perhaps, how exactly the outbreak began. China has not been forthcoming with information, and the Trump administration has inflamed the situation with threats and bullying. It has charged, without presenting evidence, that the microbe jumped to humans from a Wuhan lab. On Tuesday, after long threatening to do so, the administration began formal steps to end its W.H.O. membership.
A student of epidemics, Dr. Lucey has traveled to Asia, Africa, the Americas, Europe and the Middle East, at times as a caregiver. In 2014, working for Doctors Without Borders, he treated Ebola patients in Liberia. He posed his eight questions last month in a post for his blog, which he writes for the Infectious Diseases Society of America. The post came in response to an announcement by Tedros Adhanom Ghebreyesus, director general of the W.H.O., that the agency would be sending a team to China to investigate the pathogen’s source — a move long sought by the Trump administration.A student of epidemics, Dr. Lucey has traveled to Asia, Africa, the Americas, Europe and the Middle East, at times as a caregiver. In 2014, working for Doctors Without Borders, he treated Ebola patients in Liberia. He posed his eight questions last month in a post for his blog, which he writes for the Infectious Diseases Society of America. The post came in response to an announcement by Tedros Adhanom Ghebreyesus, director general of the W.H.O., that the agency would be sending a team to China to investigate the pathogen’s source — a move long sought by the Trump administration.
“We can fight the virus better when we know everything about the virus, including how it started,” Mr. Ghebreyesus said on June 29 at a regular briefing in Geneva. In May, the World Health Assembly, the W.H.O.’s top decision-making body, passed a resolution calling on the agency to work with other international groups to identify the “source of the virus and the route of introduction to the human population.”“We can fight the virus better when we know everything about the virus, including how it started,” Mr. Ghebreyesus said on June 29 at a regular briefing in Geneva. In May, the World Health Assembly, the W.H.O.’s top decision-making body, passed a resolution calling on the agency to work with other international groups to identify the “source of the virus and the route of introduction to the human population.”
Ever since the outbreak erupted late last year in central China, the global rumor mill has buzzed with speculation and conspiracy theories. Experts have ruled out the idea that the pathogen was concocted as a bioweapon. They agree that it began as a bat virus that probably evolved naturally in another mammal to become adept at infecting and killing humans. But so far, after months of concentrated research at sites and laboratories in China and elsewhere around the globe, no clear intermediary has come to light.Ever since the outbreak erupted late last year in central China, the global rumor mill has buzzed with speculation and conspiracy theories. Experts have ruled out the idea that the pathogen was concocted as a bioweapon. They agree that it began as a bat virus that probably evolved naturally in another mammal to become adept at infecting and killing humans. But so far, after months of concentrated research at sites and laboratories in China and elsewhere around the globe, no clear intermediary has come to light.
The first three of Dr. Lucey’s eight questions center on the Wuhan wet market — a sprawling marketplace that sold fresh fish and meat before being shut down. It was initially viewed as the viral point of origin. That idea was quickly thrown into doubt when a study by Chinese scientists reported that roughly a third of the earliest hospitalized victims — including the first — had never visited the market. In a May blog, Dr. Lucey quoted the head of China’s Center for Disease Control as ruling it out as the pandemic’s place of origin. The market, the Chinese health official said, “is just another victim.”The first three of Dr. Lucey’s eight questions center on the Wuhan wet market — a sprawling marketplace that sold fresh fish and meat before being shut down. It was initially viewed as the viral point of origin. That idea was quickly thrown into doubt when a study by Chinese scientists reported that roughly a third of the earliest hospitalized victims — including the first — had never visited the market. In a May blog, Dr. Lucey quoted the head of China’s Center for Disease Control as ruling it out as the pandemic’s place of origin. The market, the Chinese health official said, “is just another victim.”
Hundreds of environmental samples were reportedly collected at the wet market, producing 33 positive results, but few details have been made public. Dr. Lucey asks: Were any of the positive results linked to human infections? And from what kinds of surfaces — doorknobs, cutting boards, sewage, garbage trucks — were the samples collected? So far, none of the reported positive tests have come from animals.Hundreds of environmental samples were reportedly collected at the wet market, producing 33 positive results, but few details have been made public. Dr. Lucey asks: Were any of the positive results linked to human infections? And from what kinds of surfaces — doorknobs, cutting boards, sewage, garbage trucks — were the samples collected? So far, none of the reported positive tests have come from animals.
His fourth question widens the scope of investigation to other markets in Wuhan and across China. Were any samples collected from animals “now known to be susceptible to the virus” — including cats, tigers, mink and ferrets? (Ferrets are routinely used to gauge the transmissibility of human flu viruses.) He also asks about pangolins, which were initially considered a possible intermediary in the human outbreak.His fourth question widens the scope of investigation to other markets in Wuhan and across China. Were any samples collected from animals “now known to be susceptible to the virus” — including cats, tigers, mink and ferrets? (Ferrets are routinely used to gauge the transmissibility of human flu viruses.) He also asks about pangolins, which were initially considered a possible intermediary in the human outbreak.
Dr. Lucey’s fifth question addresses a detailed report in The South China Morning Post, published in Hong Kong, that identified an early human coronavirus case on Nov. 17 in Hubei province. The province is the size of Washington State, and Wuhan is its capital. In March, Dr. Lucey wrote a blog post about the report, which described the virus’s rapid spread in Hubei, based on information that the report said came from the government. Now, Dr. Lucey is urging the investigators from the World Health Organization to determine where each of these early Hubei cases were reported, if indeed they occurred, and whether any other “documented or suspected” human infections may have occurred even earlier.Dr. Lucey’s fifth question addresses a detailed report in The South China Morning Post, published in Hong Kong, that identified an early human coronavirus case on Nov. 17 in Hubei province. The province is the size of Washington State, and Wuhan is its capital. In March, Dr. Lucey wrote a blog post about the report, which described the virus’s rapid spread in Hubei, based on information that the report said came from the government. Now, Dr. Lucey is urging the investigators from the World Health Organization to determine where each of these early Hubei cases were reported, if indeed they occurred, and whether any other “documented or suspected” human infections may have occurred even earlier.
The sixth and seventh questions go to whether the deadly pathogen leapt to humans from a laboratory. Although some intelligence analysts and scientists have entertained that scenario, no direct evidence has come to light suggesting that the coronavirus escaped from one of Wuhan’s labs.The sixth and seventh questions go to whether the deadly pathogen leapt to humans from a laboratory. Although some intelligence analysts and scientists have entertained that scenario, no direct evidence has come to light suggesting that the coronavirus escaped from one of Wuhan’s labs.
Even so, given the wet market’s downgrading in the investigation, “It is important to address questions about any potential laboratory source of the virus, whether in Wuhan or elsewhere,” Dr. Lucey wrote in his blog post.Even so, given the wet market’s downgrading in the investigation, “It is important to address questions about any potential laboratory source of the virus, whether in Wuhan or elsewhere,” Dr. Lucey wrote in his blog post.
To that end, he urges the W.H.O. investigators to look for any signs of “gain of function” research — the deliberate enhancement of pathogens to make them more dangerous. The technique is highly contentious. Critics question its merits and warn that it could lead to catastrophic lab leaks. Proponents see it as a legitimate way to learn how viruses and other infectious organisms might evolve to infect and kill people, and thus help in devising new protections and precautions.To that end, he urges the W.H.O. investigators to look for any signs of “gain of function” research — the deliberate enhancement of pathogens to make them more dangerous. The technique is highly contentious. Critics question its merits and warn that it could lead to catastrophic lab leaks. Proponents see it as a legitimate way to learn how viruses and other infectious organisms might evolve to infect and kill people, and thus help in devising new protections and precautions.
Updated July 7, 2020
The coronavirus can stay aloft for hours in tiny droplets in stagnant air, infecting people as they inhale, mounting scientific evidence suggests. This risk is highest in crowded indoor spaces with poor ventilation, and may help explain super-spreading events reported in meatpacking plants, churches and restaurants. It’s unclear how often the virus is spread via these tiny droplets, or aerosols, compared with larger droplets that are expelled when a sick person coughs or sneezes, or transmitted through contact with contaminated surfaces, said Linsey Marr, an aerosol expert at Virginia Tech. Aerosols are released even when a person without symptoms exhales, talks or sings, according to Dr. Marr and more than 200 other experts, who have outlined the evidence in an open letter to the World Health Organization.
Common symptoms include fever, a dry cough, fatigue and difficulty breathing or shortness of breath. Some of these symptoms overlap with those of the flu, making detection difficult, but runny noses and stuffy sinuses are less common. The C.D.C. has also added chills, muscle pain, sore throat, headache and a new loss of the sense of taste or smell as symptoms to look out for. Most people fall ill five to seven days after exposure, but symptoms may appear in as few as two days or as many as 14 days.
Scientists around the country have tried to identify everyday materials that do a good job of filtering microscopic particles. In recent tests, HEPA furnace filters scored high, as did vacuum cleaner bags, fabric similar to flannel pajamas and those of 600-count pillowcases. Other materials tested included layered coffee filters and scarves and bandannas. These scored lower, but still captured a small percentage of particles.
A commentary published this month on the website of the British Journal of Sports Medicine points out that covering your face during exercise “comes with issues of potential breathing restriction and discomfort” and requires “balancing benefits versus possible adverse events.” Masks do alter exercise, says Cedric X. Bryant, the president and chief science officer of the American Council on Exercise, a nonprofit organization that funds exercise research and certifies fitness professionals. “In my personal experience,” he says, “heart rates are higher at the same relative intensity when you wear a mask.” Some people also could experience lightheadedness during familiar workouts while masked, says Len Kravitz, a professor of exercise science at the University of New Mexico.
The steroid, dexamethasone, is the first treatment shown to reduce mortality in severely ill patients, according to scientists in Britain. The drug appears to reduce inflammation caused by the immune system, protecting the tissues. In the study, dexamethasone reduced deaths of patients on ventilators by one-third, and deaths of patients on oxygen by one-fifth.
The coronavirus emergency relief package gives many American workers paid leave if they need to take time off because of the virus. It gives qualified workers two weeks of paid sick leave if they are ill, quarantined or seeking diagnosis or preventive care for coronavirus, or if they are caring for sick family members. It gives 12 weeks of paid leave to people caring for children whose schools are closed or whose child care provider is unavailable because of the coronavirus. It is the first time the United States has had widespread federally mandated paid leave, and includes people who don’t typically get such benefits, like part-time and gig economy workers. But the measure excludes at least half of private-sector workers, including those at the country’s largest employers, and gives small employers significant leeway to deny leave.
So far, the evidence seems to show it does. A widely cited paper published in April suggests that people are most infectious about two days before the onset of coronavirus symptoms and estimated that 44 percent of new infections were a result of transmission from people who were not yet showing symptoms. Recently, a top expert at the World Health Organization stated that transmission of the coronavirus by people who did not have symptoms was “very rare,” but she later walked back that statement.
Touching contaminated objects and then infecting ourselves with the germs is not typically how the virus spreads. But it can happen. A number of studies of flu, rhinovirus, coronavirus and other microbes have shown that respiratory illnesses, including the new coronavirus, can spread by touching contaminated surfaces, particularly in places like day care centers, offices and hospitals. But a long chain of events has to happen for the disease to spread that way. The best way to protect yourself from coronavirus — whether it’s surface transmission or close human contact — is still social distancing, washing your hands, not touching your face and wearing masks.
A study by European scientists is the first to document a strong statistical link between genetic variations and Covid-19, the illness caused by the coronavirus. Having Type A blood was linked to a 50 percent increase in the likelihood that a patient would need to get oxygen or to go on a ventilator, according to the new study.
If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. (Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.)
If you’ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others.
Debate over its wisdom erupted in 2011 after researchers announced success in making the highly lethal H5N1 strain of avian flu easily transmissible through the air between ferrets, at least in the laboratory.Debate over its wisdom erupted in 2011 after researchers announced success in making the highly lethal H5N1 strain of avian flu easily transmissible through the air between ferrets, at least in the laboratory.
In his blog, Dr. Lucey asks “what, if any,” gain-of-function studies were done on coronaviruses in Wuhan, elsewhere in China, or in collaboration with foreign laboratories.In his blog, Dr. Lucey asks “what, if any,” gain-of-function studies were done on coronaviruses in Wuhan, elsewhere in China, or in collaboration with foreign laboratories.
“If done well scientifically, then this investigation should allay persistent concerns about the origin of this virus,” he wrote. “It could also help set an improved standard for investigating and stopping the awful viruses, and other pathogens, in the decades ahead.”“If done well scientifically, then this investigation should allay persistent concerns about the origin of this virus,” he wrote. “It could also help set an improved standard for investigating and stopping the awful viruses, and other pathogens, in the decades ahead.”
Finally, Dr. Lucey asks the W.H.O. team to learn more about China’s main influenza research lab, a high-security facility in Harbin, the capital of China’s northernmost province. In May, he notes, a Chinese paper in the journal Science reported that two virus samples from Wuhan were studied there in great detail early this year, including in a variety of animals. It reported that cats and ferrets were highly susceptible to the pathogen; dogs were only mildly susceptible; and pigs, chickens and ducks were not susceptible at all.Finally, Dr. Lucey asks the W.H.O. team to learn more about China’s main influenza research lab, a high-security facility in Harbin, the capital of China’s northernmost province. In May, he notes, a Chinese paper in the journal Science reported that two virus samples from Wuhan were studied there in great detail early this year, including in a variety of animals. It reported that cats and ferrets were highly susceptible to the pathogen; dogs were only mildly susceptible; and pigs, chickens and ducks were not susceptible at all.
In his travels, Dr. Lucey went to Brazil to study the Zika virus; to Madagascar to study pneumonic plague; to Jordan to study the Middle East respiratory syndrome, or MERS; and to Guangzhou, China, to study severe acute respiratory syndrome, or SARS. He said his wide travels over the decades had informed his current inquiry.In his travels, Dr. Lucey went to Brazil to study the Zika virus; to Madagascar to study pneumonic plague; to Jordan to study the Middle East respiratory syndrome, or MERS; and to Guangzhou, China, to study severe acute respiratory syndrome, or SARS. He said his wide travels over the decades had informed his current inquiry.
In an email, he added that the World Health Organization was aware of his eight questions and had given him “good feedback.”In an email, he added that the World Health Organization was aware of his eight questions and had given him “good feedback.”
Dr. Lucey likened his queries to the process of unlocking a large building. “The key thing is to open the door,” he said in the interview. “Where you go once you get inside, that’s beyond me.”Dr. Lucey likened his queries to the process of unlocking a large building. “The key thing is to open the door,” he said in the interview. “Where you go once you get inside, that’s beyond me.”
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