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Posts Tagged ‘pandemic

How COVID-19 impacts public education in low income communities

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By Brittany Sincox, B.S.

Source: Pixabay

In the midst of a global pandemic, how students are educated has drastically changed. While zoom meetings, google classrooms, and online exams may seem accessible during this high-technology age, COVID-19 has created even more educational barriers for low-income students. In low income neighborhoods in Washington D.C., school administrators struggled to get online access for all students for nearly six weeks. Across the entirety of D.C., 11% of students do not have access to high speed internet at home. However, a 2019 general household study revealed an astonishing difference between internet access in DC’s wealthiest and poorest wards. Ward 8 has the lowest median income at $31,954 and only 46% of Ward 8 homes have high speed internet access, while 86% of homes in Ward 3 with a median income of $122,680 have high speed internet. While adapting to online learning presents a challenge for teachers and students everywhere, these issues with attendance and technology accessibility are not as prevalent in higher income neighborhoods. 

Aside from technological access issues, teachers are increasingly worried about the holistic impact on a low income student’s life after converting to online schools. Even when students have access to online school platforms, attendance is less than 50% in low income schools according to teachers surveyed by the Washington Teachers Union. Some teachers reported that their students work in restaurants or landscaping to aid families during the financial crisis COVID-19 has caused, leading to less time in classrooms and higher infection risk to these families. Food scarcity is yet another area of concern. While Food and Nutrition Services offers a “Pandemic EBT” program similar to SNAP benefits for children on free and reduced lunch programs, DC didn’t begin distributing benefits to these families until May 22nd, more than 2 months after schools were initially shut down. Additionally, special education and ESL teachers have concerns for the lack of individualized attention and schoolwork help these students are able to receive due to conversion to online platforms. Nearly all areas of student life have been impacted due to COVID-19, and low income families are being stretched thin to accommodate this new era of online learning. 

With a second wave of COVID-19 infections and lockdowns becoming imminent, schools need to prepare for continued online learning. However, the cost of the pandemic on schools alone makes it difficult to further invest in advancing online education platforms. estimates that Washington D.C. faces an additional $24 million in costs for the 2020-2021 school year due to time lost this previous school year, not including the potential need to supply materials like laptops/tablets to student to access online learning easily. Teachers are adapting to online learning without increased funding by increasing community through online platforms such as Facebook groups, Reddit forums, and online teaching resources. The goal is to share tips, lesson plans, and train each other through technological hurdles. However, teachers are quickly becoming overwhelmed and burnt out as these low-cost methods of distance teaching simply aren’t enough. Some schools have considered adding specific positions for distance learning management and buying better online resources for students, but with an economic recession on the horizon and a greater need for public school funding one can only ask: where will this money come from?

            D.C.’s Mayor Bowser proposed a $15 million budget cut to the metropolitan police department for the upcoming fiscal year following recent protests from the Black Lives Matter movement. The movement is calling for reallocation of police funding to public schools, healthcare, and housing opportunities for black and low income communities. This has been partially achieved in Los Angeles, when the LA Unified’s Board of Education cut $25 million from school police forces to instead support the needs of black and low income students in the upcoming school year. However, it is clear that the current budget reallocations will not be able to meet the high projected costs of COVID-19 on public education. It is difficult to foresee how a simultaneous global pandemic and historic civil rights movement will continue to impact the educations of low income students, but it is urgent for schools and local governments to adapt and enact new policies to increase accessibility to prevent these students from falling further behind. 

Written by sciencepolicyforall

July 10, 2020 at 3:52 pm

Science Policy Around the Web June 2nd, 2020

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By Andrew Wright, BSc

Image by Free-Photos from Pixabay 

 Sixth mass extinction of wildlife accelerating, scientists warn 

new analysis published in the Proceedings of the National Academy of Sciences (PNAS) has examined the number of terrestrial vertebrates on the verge of extinction. In examining 29,400 species, researchers found that 515 of them have fewer than 1,000 individuals (the metric for “critically endangered”) and roughly half of those have fewer than 250. Most of these species have lost their geographic range and are nearing an irreversible collapse within the next 20 years, which could have profound effects on their respective environments as their ecological utility is permanently wiped out.

Of those species with between 1,000 and 5,000 individuals, 84% live in an area that overlaps the critically endangered, meaning there is the potential for a domino-like effect. For example, a paper from PNAS in 2015 demonstrated that overhunting of sea otters in the mid-1700s led to the extinction of the Stellar’s sea cow.  Since sea otters fed on urchins that in-turn fed on the kelp environments in which the sea cows lived, the elimination of the otters led to over-feeding on kelp and precipitated the loss of a seemingly unrelated species.  

The worst-affected global regions are those that are increasingly heavily populated and where ongoing environmental destruction is occurring unabated, namely tropical Asia and South America where deforestation has actually been accelerating as attention has been pulled towards the ongoing COVID-19 pandemic. While there is still room for a comprehensive solution, according to the authors, “…the window of opportunity is almost closed. We must save what we can, or lose the opportunity to do so forever[…]it is something that humanity cannot permit, as it may be a tipping point for the collapse of civilization. What is at stake is the fate of humanity and most living species.”

(Damian Carrington, The Guardian

What a US exit from the WHO means for COVID-19 and global health

On May 29th, the President of the United States Donald Trump announced that US would be withdrawing from the World Health Organization (WHO) and severing its relationship with the international organization, chiefly accusing it of a faulty coronavirus response and leniency with China. While it is unclear whether the President can unilaterally pull out of the WHO without congressional approval, he does have the authority to pull US funding to the organization that made up 15% of its revenue last year. In place of this funding, reports from the State Department suggest the replacement would be a domestically run initiative called the President’s Response to Outbreaks (PRO) and would cost roughly $2.5 billion in new and transferred appropriation. This new office would also subsume programs run by USAID. This is mirrored by the introduction of a Senate bill called the “Global Health Security and Diplomacy Act of 2020” that calls for $3 billion in appropriations overseen by political appointment. 

Critics of this move suggest that a new office would conflict with existing international programs and muddy a cohesive response. As Kelly Lee, a global health researcher at Simon Fraser University put it, “You can’t just show up in Afghanistan and start vaccinating people.” Others pointed to the ongoing Ebola outbreak as an example of where there is little response apart from that provided by the WHO, particularly in regions with ongoing violence or negative sentiments against the US. Furthermore, in those areas where the US solely funds programs, they are often coordinated by the WHO.  Lee also notes that there could be a loss of expertise and knowledge sharing should US researchers and international researchers be deprived of collaborative avenues supported by the WHO.

Finally, pulling out of the WHO altogether may weaken US control over the global health agenda. Contrary to the US President’s apparent intent, this could in effect grant countries like China a path to take over in both in funding and decision-making.    

(Amy Maxmen, Nature)

Written by sciencepolicyforall

June 3, 2020 at 9:50 am

The good, the bad or the ugly? – The relationship between the U.S. and China prior and during Covid-19

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By Julia Lederhofer, PhD

Image by mohamed Hassan from Pixabay 

From a trade war to an increasingly adversarial pandemic response, the U.S. and China find themselves in an increasingly strained diplomatic relationship. With every hurdle — either naturally arising or self-inflicted — both nations’ instinct is to blame the other. Can both countries leave their pride and nationalism behind and foster a spirit of cooperation, or is the world fated for another cold war?

Since the Maoist revolution and China’s embrace of communism in 1949, the two nations have pursued antithetical world orders. Ensuing diplomatic relations ranged from tense standoffs to a complex mix of antagonistic diplomacy, growing rivalry, and economic interdependence. After over half a century, the U.S.-China relationship has evolved into a normalized trade relation – punctuated by then president Bill Clinton signing the U.S.-China Relations Act in October 2000. In 2001, China joined the World Trade Organization. By 2010, China was the world’s second largest economy. It trailed only the US, and economic forecasts predicted even the unequaled American economy would be surpassed by 2027. Unsurprisingly, tensions between China and the West arose.

In 2012 the U.S., EU and Japan filed a request for consultations with China at the World Trade Organization because of their restrictions on exporting earth metals. They stated that China violated international trade norms. In the following years, then U.S. President Barack Obama and the Chinese President Xi Jinping agreed on establishing a new type of relationship for the U.S. and China. Their aim was to ease the U.S./China tense relationship by solving bilateral, regional and global issues in a friendly manner. In 2017, the U.S. Commerce Secretary Wilbur Ross unveiled a ten-part agreement between Beijing and Washington, which contained the expansion of trade products like beef, poultry and electronic payments. However, the countries did not address other trade issues that were still unresolved from the Barack Obama era, like aluminum, steel or car parts. In 2018, President Donald Trump changed course from his predecessor by announcing extensive tariffs on Chinese imports, which lead to a U.S.-China Trade War escalation. Fast forward to May 2019, the Trump administration continued to sweep tariffs from 10 to 25 percent on $200 billion worth of Chinese goods. China reciprocated by increasing tariffs on $60 billion worth of American goods. Days after the heated discussion, the Trump administration banned U.S. companies from using foreign-made telecommunications equipment, as they believe that they could threaten national security. Many think that this was a move to target Huawei. Moreover, Huawei was added to the foreign entity blacklist by the U.S. Commerce Department. Tensions between the U.S. and China continued, but early in January 2020, President Trump and the Chinese Vice Premier Liu He signed the ‘Phase One’ Trade Deal agreement, a final breakthrough in the almost two year trade war between the two big fish. The deal lowered, amongst other things, some of the U.S. tariffs on Chinese imports and commits China to buying an additional $200 billion worth of American goods over the next two years. The years-long trade war that threatened the entire global economy finally had an end in sight. The positive undercurrent of two once again friendly superpowers, however, would be short lived. The world quickly entered a new economic, and health, crisis – the COVID-19 Pandemic. 

Beginning in the Chinese city of Wuhan in December 2019, the novel coronavirus quickly spread, leading the World Health Organization (WHO) to declare a global pandemic in March (11th, 2020). China and the U.S. were quick to blame each other as the pandemic worsened. China leveled the claim that the U.S. military brought the virus to China, while President Trump accused China of not reporting the “Chinese virus” earlier, therefore failing to prevent the pandemic. The Trump administration turned its ire towards the WHO. The Trump administration cut funding and alleged the international organization showed bias towards China. By April, the drama ventured into the absurd. The Trump administration reported that they have evidence that the Coronavirus was human made in a Chinese laboratory and purposely released. In response, Beijing published an article denying everything from claims that they under-reported case numbers, to allegations the virus spread from eating bats. In China’s eyes, they were merely the first to suffer from the virus. China portrays itself as a model in how to combat the virus and offers the world a source of medical equipment. Whether any of the political grandstanding by either side has convinced their own citizens, let alone the outside world, remains to be seen. Outside of their respective homelands both countries’ claims fall on deaf ears. The general consensus holds China responsible for mishandling the early stages of the outbreak, as well as outright denials, withholdings and cover-ups. The U.S.’s claim that the virus was produced in a lab has been repeatedly debunked, and the move to cut WHO funding has been met with widespread criticism. 

The coronavirus has pushed the U.S.-China relationship, the most important world’s powerful economic relationship, to a precipice, with the ‘Phase One’ Trade Deal agreement dangling over the edge. The mudslinging over the origins of the coronavirus will not help and will only distract from the challenging health crisis, which is coupled with the biggest hit to the global economy since the Great Depression. Both China and the U.S. cannot risk any further destabilization of their economies and must look to rebuild trust. The first major test could come as early as December 2022. Under the Phase One agreement, China is committed to buying $200 billion additional goods and services on agriculture, energy and manufacturing. Due to the pandemic, China will almost certainly miss this target by December 2022. The U.S.’s response will dictate the future. Time will tell if both countries’ leaders are willing to end the blame game and begin to restore trust. The truth of the early days of the pandemic outbreak may never be known, but one can only hope that both political leaders will be able to forget their conflicts for the name of peace and prosperity for the whole world.

Written by sciencepolicyforall

May 29, 2020 at 10:13 am

The Use of COVID-19 Prediction Models in Guiding Policy Decisions

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By Amanda Perofsky, PhD

Image by Arek Socha from Pixabay 

Models are essential tools for estimating biological aspects of pathogens, how diseases will spread, and the impacts of policies and interventions. Indeed, there is a two-decade history of utilizing mathematical and computational approaches for public health, particularly for preventing and controlling outbreaks of emerging pathogens and informing intervention strategies (Viboud et al. 2018). Recent examples include the 2009 H1N1 influenza pandemic and the MERS (2014-2016), Ebola (Western Africa: 2014-2016; Democratic Republic of Congo: 2018-present), and Zika (2015-2016) epidemics. Since the 2009 H1N1 pandemic, government agencies have organized infectious disease challenges to formally engage the disease modeling community and improve forecasting performance for both endemic and emerging pathogens, such as seasonal influenzadenguechikungunya, and Ebola. Soon after the novel coronavirus SARS-CoV-2 emerged in Wuhan, China in late 2019, researchers participating in the US Centers for Disease Control and Prevention’s annual challenge to predict seasonal flu activity mobilized to produce short-term forecasts of COVID-19 deaths for the United States. 

Mathematical and computational approaches are especially critical during the coronavirus disease 2019 (COVID-19) pandemic, due to uncertainties regarding biological and immunological aspects of SARS-CoV-2 infection, the logistical hurdles in accurately estimating COVID-19 infectionsprevalence, and mortality in communities, and the immense health, economic, and societal impacts of the pandemic. As a consequence, the COVID-19 pandemic has sparked efforts by numerous research groups to forecast cases, hospitalizations, and deaths and predict how public health interventions will alter epidemic trajectories. These models have significant policy implications as decision makers in government, public health, and health care seek to swiftly minimize cases and deaths, allocate limited medical resources, avoid hospital surges, and mitigate the socioeconomic upheaval caused by the pandemic. 

Models are inherently simplified versions of complex biological, epidemiological, and social processes and can vary widely in terms of methodologies, assumptions, uncertainties, conclusions, and policy recommendations. Various COVID-19 prediction models aim to capture epidemic dynamics from a global scale down to the resolution of countries, states, counties, or cities and are used to inform decision making on a range of time horizons, from days to weeks to months. 

The three main modeling and computational approaches for predicting COVID-19 epidemic dynamics include: 

1. SIR/SEIR compartmental models sort individuals into susceptible (S), exposed (E), infected (I), and recovered (R) compartments and use differential equations to dictate how individuals move through these compartments. Given the epidemiologic and virologic evidence for SARS-CoV-2 transmission from asymptomatic and pre-symptomatic people (Furukawa et al. 2020), many COVID-19 SIR/SEIR models subdivide the infected compartment into asymptomatic and symptomatic individuals. Hospitalized, ICU, and death compartments are also typically incorporated, as these are the main indicators that inform COVID-19 public health decisions. For example, researchers at Columbia University have built a metapopulation SEIR model to simulate COVID-19 transmission within and among US counties and to make daily and short-term projections of incidence, hospitalizations, and deaths. 

Modelers make assumptions concerning the number of individuals that initially fall into each compartment and the rate of flow between compartments. These flows are governed by different parameters, such as the period of time it takes one infected person to infect another person (“the serial interval”), contact rates between individuals, the average number of infections caused by one infected person (“the basic reproduction number” or “R0”), the rates at which different demographic groups recover and die, and whether protective immunity after recovery is long-lasting or waning. The values for several of these parameters were unknown at the beginning of the COVID-19 pandemic and remain difficult to quantify until we have more comprehensive surveillance data and knowledge concerning the SARS-CoV-2 transmission process. For example, the relative incidence of asymptomatic to symptomatic infections and whether asymptomatic infection confers protective immunity continue to be key uncertainties and affect the number of tests required for testing-based interventions. To minimize the impact of incomplete data and erroneous assumptions, modelers typically perform sensitivity analyses, in which they tweak initial conditions and parameter values across several model runs.

2. Agent-based models  (ABMs) use real-world data to create synthetic populations of individual “agents” (i.e., people) with realistic spatial and sociodemographic characteristics and then simulate disease spread in these populations over discrete time steps. Agent-based models examine the role of individual-level processes in generating population-level dynamics and are useful for modeling counterfactual outcomes in the face of complexity (Marshal and Galea 2015). However, like SIR/SEIR models, they are reliant on assumptions concerning the infection process and the timing and effectiveness of different interventions and policies, such as social distancing and stay-at-home measures. The Institute for Disease Modeling’s Covasim (COVID-19 Agent-based Simulator) incorporates age structure and population size, transmission networks in households, schools, workplaces, and communities, age-specific disease outcomes, and within-host viral dynamics to project cases and peak hospital demand. Northeastern University’s Global Epidemic and Mobility Model (GLEAM) is a hybrid SIR-ABM model that simulates 3200 subpopulations worldwide, and mobility between these subpopulations, to describe and project the spread of COVID-19 in the United States.

3. Curve-fitting/extrapolation models such as the Institute for Health Metrics and Evaluation (IHME) model, are statistical models that do not model the person-to-person disease transmission process itself. For example, the IHME model uses reported deaths for countries outside of the US where the COVID-19 pandemic has already hit. It then examines where the US falls on that mortality curve and applies statistical approximations to forecast future death counts, assuming that systematic variation across locations is due to the timing of social distancing measures and that other differences are explained by random effects. Unlike SIR/SEIR models and ABMs, statistical models are not reliant on difficult-to-estimate epidemiological parameters, such as R0. However, because they can only estimate the initial wave of cases, statistical approaches are not suitable for projecting longer-term epidemiological dynamics. Despite criticism from the scientific community concerning the validity of the curve-fitting/extrapolation approach for long-term projections and IHME’s forecaststhe White House has relied on the IHME model as a national guide for projecting peaks in deaths and hospital demands

Given the sparsity of data on SARS-CoV-2 transmission, the effectiveness of different public health interventions, and population behavior once interventions are relaxed, there are broad uncertainty bands in model projections, and even models with similar objectives and methodologies can produce disparate estimates. Some forecasting models assume existing interventions and population behavior will continue through the projected period whereas others make assumptions concerning how interventions and social distancing will change in the future. Thus, it is important for decision makers to not rely on a single model for projections and to understand the key assumptions underlying each model. Nicholas Reich, a biostatistician at University of Massachusetts Amherst, and colleagues have recently combined sixteen mortality forecasts from different disease modeling groups to produce national “ensemble” forecasts for one to four-week horizonswhich are released weekly by the CDC. Reich plans to start evaluating the accuracy of individual models so that more accurate models are weighted more heavily in ensemble projections. Though estimates for national models are now converging due to increasing data availability and an overall decrease in daily COVID-19 cases across locations, forecasts will likely diverge again in the coming weeks as social distancing measures are relaxed in many US states

Katriona Shea, a theoretical ecologist at Penn State University, and colleagues advocate a systematic approach beyond ensemble forecasts, in which contributions from multiple groups are leveraged to support decision making (Shea et al. 2020). Shea and colleagues’ proposed process entails applying formal expert elicitation methods to generate and synthesize ideas across multiple models and to share important insights among research groups. A decision theoretic framework is applied to account for uncertainties within and between models and to achieve well-defined policy objectives. Their research team was recently awarded a Grant for Rapid Response Research (RAPID) from the National Science Foundation to immediately implement this process to inform COVID-19 policy. By utilizing the many research groups already producing forecasts, this strategy should be straightforward to implement and produce more robust results from the existing process of CDC’s COVID-19 forecasting collaboration. 

The dynamic circumstances surrounding the COVID-19 pandemic and “patchwork” of highly-localized outbreaks and government responses make it difficult for modelers to produce forecasts beyond a few weeks. Thus, there is a less coordinated effort to predict longer-term epidemiological dynamics. While the COVID-19 pandemic has increased interactions between modelers and decision makers, these interactions can be tense and difficult because social distancing measures are economically costly and policy decisions are not based solely on public health outcomes. Despite these challenges, models are essential for addressing questions related to disease spread and resource management. As the pandemic progresses, models should also play fundamental roles in supporting decisions related to triggering and relaxing social distancing and lockdown measures, the delivery of widespread testing, clinical trial designs, and vaccination strategies (Currie et al. 2020). 

Written by sciencepolicyforall

May 22, 2020 at 12:38 pm

Science Policy Around the Web April 30th, 2020

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By Ken Farabaugh, PhD

Image by MiroslavaChrienova from Pixabay

We’re repeating one of the worst mistakes of the Ebola outbreak in the hunt for a coronavirus cure

In 2014, Dr. Kent Brantly was the first American infected with Ebola. He was also the first American to recover from Ebola, after treatment with the experimental drug ZMapp. He was the face of “The Ebola Fighters,” Time Magazine’s person of the year. Four years and a second Ebola outbreak later, controlled drug trials demonstrated that ZMapp was not an effective treatment for the disease. A major issue that delayed this finding was that many prominent researchers, including advisors of the WHO and Doctors Without Borders, were against trials in which some patients would not be given the standard of care or the “secret serum” ZMapp. By the time scientists around the world had come up with a strategy to plan clinical trials to treat Ebola, the pandemic had waned and there were fewer and fewer patients to enroll in the studies. 

Although there are over 200 ongoing clinical trials around the world for drugs to treat COVID-19 (remdesivir, hydroxychloroquine, etc), few studies are being conducted with enough scientific rigor. Although randomized, well-controlled trials can take months to set up properly, it is still the best way to obtain high-quality data. Studies that do not follow these guidelines often produce low-quality data that cannot be replicated or conflicts with other findings. Only about 20% of current coronavirus drug trials (according to Ann Meeker-O’Connell, VP of Vertex Pharmaceuticals) have enough patients to statistically power the study, have a control group being administered a placebo, and are blinded to both patients and doctors. 

Despite possible problems in study design, some benefits from the numerous drug trials currently being undertaken include increased collaboration between government agencies, non-profits, and big pharma companies. Databases are also being constructed with health records and demographic information of all COVID-19 patients. The challenge in the coming years will be sifting through all the data from the drug trials being performed, both good and bad, to determine if the drugs actually worked.

(Andrew Dunn, Business Insider)

The world wants answers on Gilead’s Covid-19 drug. Experts worry next studies may increase uncertainty

The drug company Gilead has sponsored two trials in the US to test the effectiveness of their antiviral drug remdesivir against COVID-19. In the first trial, a summary of which was released April 29th, the drug alone was given to patients for 5 or 10 days to evaluate safety and efficacy; no difference was observed in the treated groups, although the efficacy of the drug was not measured as there was no control group treated with a placebo. Gilead has suggested that the benefits of remdesivir are expected to only modestly affect patient recovery, rather than a silver bullet cure.

Results from a separate study in China leaked by the WHO last week and published April 29th suggested that remdesivir had no statistically beneficial effect on survival of severely ill patients compared to a control group, though there was potential reduction in time to clinical improvement. However, the study also reported that 12% of patients on remdesivir halted treatment due to adverse effects compared to 5% of patients on the placebo.

The most clarity will come from a NIAID-run trial, data from which is not expected until late May. Preliminary data released April 29th suggests that remdesivir led to a 31% decrease in recovery time (11 days from 15 days) and a 8% mortality rate (survival benefit from the placebo group at 11.6% mortality). Although this data is promising, it is important to note that these results are preliminary, that this treatment is not a replacement for a vaccine, and that Gilead has already mentioned production issues in rationalizing the design of their own studies.

(Matthew Herper and Adam Feuerstein, STAT)

Written by sciencepolicyforall

April 30, 2020 at 4:48 pm

Science Policy Around the Web April 23rd, 2020

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By Tam Vo, PhD

Image by Thomas Hoang from Pixabay

Coronavirus found in Paris sewage points to early warning system

Scientists at Paris’s public water utility – Eau de Paris –  recently published a pre-print study showing an effective and inexpensive way to test for COVID-19. The scientists conducted the study by collecting sewage samples from different regions within Paris. They found that an increase in the concentration of COVID-19 in sewage samples corresponds to the number of known cases in the same region.

Eau de Paris scientists collected sewage samples from five different areas in the city. By using polymerase chain reaction, a technique that allows scientists to identify the presence of the COVID-19 RNA fragment, they noticed a high concentration of viral RNA several days in wastewater samples before Paris saw a spike in known cases and deaths. They consistently detected the increasing viral RNA in advance of a jump in clinical cases. Previously, scientists showed that the RNA of SARS-Cov-2, the virus caused by COVID-19, could be transmitted through fecal matter. Laurent Moulin, a co-author in the study, said that by tracking the presence of viral RNA in sewage, which takes between half a day to three days to transmit from the toilet to the treatment plant, they can predict the current infection rate in the region. 

Monitoring sewers provides many advantages in comparison to human testing. Zhugen Yang, a biomedical engineer at the UK’s Cranfield University’s Water Science Institute, which is developing a $2 test for SARS-CoV-2’s RNA, noted that real-time inexpensive sewage samples, coupled with rapid on-site testing kits, can predict the number of COVID-19 carriers in a certain area. This will enable preventive measurements to contain the local outbreak.

Dr. Paul Bertsch, science director of land and water at the Commonwealth Scientific and Industrial Research Organization (CSIRO) in Australia, pointed out another advantage. He said the wastewater samples can pick up traces of viral RNA in people who are infected with SARS-CoV-2 but do not exhibit symptoms associated with the disease. Further, sewer samples can show variations within a wider community to produce better statistics of the outbreak within a geographic area. 

Considering the burden on the economy as many countries continue with quarantine measurements, sewage data for COVID-19 presents a robust and inexpensive way of testing in the current outbreak. The promising results from Paris’s study, agreed upon by a number of scientists around the globe, show an innovative and effective method to combat the COVID-19 outbreak. 

(Christa Lesté-Lasserre, Science)

Written by sciencepolicyforall

April 23, 2020 at 2:22 pm

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Science Policy Around the Web April 16th, 2020

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By Dorothy Butler, PhD

Source: Pixabay

Pandemic brings mass vaccinations to a halt

GAVI, the Vaccine Alliance, has a mission to improve access to vaccines for children in vulnerable populations like those in developing countries. The World Health Organization (WHO) and other agencies have partnered with GAVI in their mission to eliminate diseases, such as polio and measles, through mass vaccination campaigns. 

However, due to the growing threat of the novel coronavirus, the consistency of many of these vaccination programs is under threat. GAVI estimates that at least 13.5 million people in the least developed countries will not be protected from diseases like measles, polio, and HPV due to a disruption of vaccinations in these countries. Vaccine shortages are already being reported as a result of border closures and disruptions to travel. Not only are shortages of vaccines posing a threat, but the spread of coronavirus from visits to administer vaccinations also is a concern. It is not easy to choose between giving live-saving vaccinations and stopping those same vaccinations to help potentially curb the spread of coronavirus. But that is what organizations like GAVI have been faced with. Ultimately, they have chosen to postpone mass vaccination campaigns for these diseases. 

Other organizations such as the Global Polio Eradication Initiative (GPEI) have also chosen to halt their vaccination campaigns. GPEI has successfully eliminated polio from many countries, including Iraq, Somalia, Yemen, and Syria. However, there is concern that with this pause in the vaccination campaign, polio could see a resurgence in countries who are now termed polio-free. While those involved in the GPEI are hopeful that social distancing practices used to combat the spread of COVID-19 might also help slow the spread of polio, they are continuing to work on plans to continue polio virus surveillance and to amass a stockpile of polio vaccines for when the program can continue again. 

Additionally, organizations like GAVI have redirected some of their funds. Hopefully, the redirection of funds and manpower to support the health systems in developing countries will allow them to better respond to the virus. While the work continues to help stop the spread of coronavirus, they will also prepare for the hard work of restarting the mass vaccination campaigns once they can. 

(Leslie Roberts, Science)

Written by sciencepolicyforall

April 16, 2020 at 9:27 am

How the COVID-19 pandemic response fits into a national security framework

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By Lynda Truong, PhD

Image by fernando zhiminaicela from Pixabay 

What began as mysterious cases of pneumonia in Wuhan, China in late December escalated into a global pandemic in a matter of just a few months. By the end of January, cases had been reported in 18 countries and the disease was declared a Public Health Emergency of International Concern by the World Health Organization (WHO). In March, the WHO officially raised COVID-19 to pandemic status. By this time, there were already more than 118,000 cases and over 4,000 deaths reported worldwide. At the time of writing this article, there have been over 1.4 million confirmed cases of COVID-19. Countries across the world are experiencing unprecedented disruptions in their health, social, and economic systems. Italy has seen its hospitals completely overwhelmed. China and several other countries have implemented strict quarantine protocols. US stock markets have plummeted 20% and over 17 million Americans have filed for unemployment. To date, there have been over 14,000 COVID-19 related deaths across the US, over 6,000 of which were in the state of New York alone. When compared to the 2,977 deaths following the attacks on 9/11, the urgent need for action becomes quickly evident. Given the rapid spread of the virus and its far-reaching negative effects, addressing pandemics as a matter of national security can provide an effective model for preparation, prevention, and mitigation.

In response to the 2001 anthrax attacks, President George W. Bush passed Homeland Security Directive 10: Biodefense for the 21st century in 2004. While the focus of his directive was the prevention of biological weapons attacks, biodefense strategy has since been expanded to include natural outbreaks of disease. The connection between global heath and national security was initially proposed in 2005 to raise awareness for the HIV/AIDS pandemic, and helped provide much needed funding and resources to combat the spread of the disease. The global health / security connection became apparent again during the Ebola epidemic in West Africa in late 2014, when President Barack Obama deployed 2,800 military personnel and allocated over $2.3 billion in aid. At that time, cases had already spread to Dallas and New York City. However, as a result of the administration’s quick action and the international cooperation of several countries, the transmission of the disease was contained in West Africa by January 2015 and transmissions had slowly decreased to zero by the end of the year. 

While President Donald Trump has received much criticism for restructuring the Global Health and Security Biodefense team, global health and pandemic preparedness has remained a recognized issue within the National Security Council (NSC) under the current administration. In 2018, the NSC established the National Biodefense Strategy, which outlines several objectives for preparing and responding to naturally occurring or deliberate biological threats. These include, but are not limited to: promoting domestic and international biosurveillance to aid in the prevention and rapid detection of new threats, strengthening global health security to prevent local incidents from becoming epidemics, and ensuring a strong public health infrastructure. While the document clearly addresses the need for pandemic preparedness, it does not delineate specific responsibilities amongst various federal agencies and the plan for implementation was still under development when the COVID-19 outbreak began. 

Due to growing trends in globalization, an epidemic in a distant area of the world can have severe consequences within the US if left unchecked. The spread of infectious disease domestically has a direct impact on the health and well-being of citizens and can overburden existing healthcare systems. A growing population of sick or panicked citizens can result in disruptions in local and national supply chains for essential medical supplies, food, or other basic necessities. As the pandemic escalates, these effects will impact businesses, leading to unemployment and pushing the economy toward a recession. The recent spread of COVID-19 exemplifies many of these consequences, and the rapid development of events provides little room for error or hesitation when implementing counteractive policies. 

The current administration has enacted policies intended to aid or accelerate the development of medical and pharmaceutical supplies. While these are direct and effective solutions, they require time. Although several companies are racing to develop a vaccine for COVID-19, the creation of a safe and effective vaccine for public use is likely at least a year away, even with the support of federal agencies to expedite clinical trials. Until a vaccine is available, public/private partnerships can focus on the development and manufacture of diagnostic tests, medical devices, and personal protective equipment (PPE). Singapore, Hong Kong, and other east Asian countries have managed to control the spread of COVID-19 by implementing early diagnostic testing, while a reliable test is still not widely available in the US. The Strategic National Stockpile, the country’s largest reserve of medical supplies for use in public health emergencies, is nearly depleted less than three months after the US reported its first case of COVID-19. President Trump has already invoked the Defense Production Act, directing several companies to manufacture ventilators and N95 medical masks to address current shortages. Until medical and pharmaceutical solutions are more readily accessible, there are also a number of mitigation strategies available. Border screening and quarantine are effective methods for delaying the spread of the coronavirus to prevent inundating the healthcare infrastructure. Countries, such as China, have slowed the spread of new cases by implementing a mandatory national lockdown. Throughout the US, many states have been closing all nonessential businesses and strongly encouraging, if not mandating, social distancing. 

As with any national crisis, it is essential to have clear and strong leadership during a pandemic. The past few weeks have seen a disjointed and inconsistent adoption of policies throughout the US. While all states have now declared a state of emergency, the implementation of policies such as nonessential business closures and mandated quarantine have varied widely by state. A centralized effort between federal and state governments would mitigate viral spread more thoroughly than disunited policies and avoids unnecessary confusion during a turbulent period. Effective communication and transparency are also paramount to establishing public trust and facilitating compliance with local and federal guidance. President Trump is now warning of the severity of the spread of COVID-19, but still tempers that message with the desire to reopen businesses soon. Such mixed signaling risks inciting more confusion in an already turbulent time. In the modern age of social media, the accidental or deliberate spread of misinformation can endanger public health, and the dissemination of scientific, evidence-based facts by government and medical authorities is especially critical. 

Despite the national security implications of pandemics, framing global health as a matter of defense and security should be approached with caution. Pandemics will always be an issue of public health, and as such require expertise from epidemiologists and infectious disease experts as much as it requires input from defense strategists. Additionally, drastic measures such as mandatory lockdown and border control may prove necessary in extreme circumstances, but institutionalizing such methods risk infringing on civil liberties. In response to COVID-19, Hungary’s parliament has introduced a set of measures that allow prime minister Viktor Orbán to rule by decree for an indefinite period. In the Philippines, President Rodrigo Duterte has been granted an extension of emergency powers and has ordered military officials to shoot violators of the national lockdown. In contrast, many countries such as Singapore, South Korea, and Taiwan have successfully implemented aggressive and targeted quarantine measures, in combination with a number of other policies, without overreaching government authority or threatening human rights. In the face of crisis, the necessity of public health can and must be appropriately balanced with a commitment to human rights. 

Pandemics also present a number of national security risks on an international stage. Disease can have direct impacts on the health of diplomats, foreign officers, and military personnel, potentially jeopardizing any standing plans or activities abroad. If not contained, widespread disease and fatalities can also lead to international unrest and instability in vulnerable nation states. If the US is unable to manage the spread of the disease domestically, it will not have the resources to aid allies or other nations, which can negatively affect US influence abroad. During the Ebola epidemic, the US actively provided expertise, supplies, and leadership in a time of crisis. In contrast, China was at the front of the COVID-19 pandemic and has seemingly now been able to contain the spread of the disease. It has sent supplies and experts abroad to 120 countries, as many other countries continue to grapple with increasing cases of COVID-19. Furthermore, US influence is already experiencing resistance as the administration is coming under increasing pressure to lift sanctions against Iran in the wake of COVID-19. In fact, a number of EU countries have already taken steps to bypass these sanctions in order to deliver critical medical supplies to Iran

In order to adequately address the national security risks posed by pandemics, international frameworks and collaborations must be established. Biosurveillance is a key approach in preventing the spread of infectious disease. Data sharing is imperative, and misleading information can cause governments to develop inadequate, or even harmful, public health strategies. China’s early suppression of information surrounding COVID-19 cost valuable time. If countries battling epidemics are reluctant to solicit aid or provide data, diplomatic international pressure may suffice to elicit a response. Failing this, intelligence communities could offer valuable information, and it may be prudent to provide technical training or expert input to help intelligence officers accurately interpret medical data. Still, the best resolution of an epidemic is to contain it at the source, and this requires international cooperation. The costs of a global pandemic far outweigh the cost of international aid if the epidemic can be contained. The US is estimated to have spent approximately $2.3 billion in fighting the Ebola epidemic in West Africa, which is three orders of magnitude less expensive than the critical $2.2 trillion stimulus package recently passed in Congress.

Modern trends in globalization, urbanization, and population growth make epidemics more difficult to contain and a pressing threat to national and global security. Recent events surrounding the international spread of COVID-19 provide a glimpse of the severe impact a pandemic can have and a useful case study for how a national security framework can be used to help prevent or mitigate future pandemics. Within the US, pandemic preparedness has remained a keystone of the national biodefense strategy. Some priorities, such as the focus on developing and delivering pharmaceutical solutions are well recognized. However, the spread of COVID-19 highlights a need for a more centralized and cohesive response within the US and a more collaborative and faster response abroad. A detailed implementation plan addressing these gaps would serve to better inform future decisions and leadership and help protect national security.

Written by sciencepolicyforall

April 10, 2020 at 3:18 pm

Evolution of FDA Diagnostic Testing Policies in the Changing Landscape of the COVID-19 Pandemic

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By Emily Phung, PhD

Image by Gerd Altmann from Pixabay

In the United States, the Food and Drug Administration (FDA) regulates the development and marketing of commercial tests. In vitro diagnostics (IVD) inform healthcare workers how to help cure, treat, or prevent diseases. These devices go through an extensive submission process which can take several months for approval. During this timeframe, the tests are evaluated for their safety, effectiveness and risk level based on their intended use.

If there are no available alternatives, unapproved medical products (including diagnostic kits and personal protective equipment) can be rapidly approved by the FDA through an Emergency Use Authorization (EUA) to diagnose, treat or prevent life-threatening conditions in times of chemical, biological or nuclear threats. However, an EUA is not a pathway to permanent marketing. Companies that wish to sell their device or diagnostic must file a premarket submission in order to legally market their product after termination of the EUA. For example, in response to the Zika virus in 2016, the FDA authorized 15 diagnostic tests for Zika. After termination of the EUA, three of those tests underwent premarket submission and gained full FDA clearance.

When posed with an emerging health threat, the Centers for Disease Control and Prevention (CDC) is the first to develop a diagnostic test in the United States. COVID-19 is an infectious disease that infects the respiratory tract. Therefore, diagnostic kits use the reverse transcription polymerase chain reaction (RT-PCR) technique to detect the presence of the SARS-CoV-2 virus (the infectious agent the causes COVID-19) in upper and lower respiratory specimens (such as nasopharyngeal swabs, bronchoalveolar lavage and lower respiratory or nasal aspirates) collected from the patient. With the high transmission rate of SARS-CoV-2, it is crucial to make diagnostic kits widely available to contain the spread of the virus. 

In light of the COVID-19 pandemic, the FDA has justified the emergency use of IVDs for the detection and diagnosis of COVID-19 through an EUA. The FDA issued several new policies for COVID-19 diagnostic tests in order to rapidly expand to availability of testing kits in the United States. The first policy was issued on February 4th, 2020 and expanded the use of the CDC’s RT-PCR test to CDC-qualified labs. This policy was the first step to expedite the availability of diagnostic kits to labs outside of the CDC. On February 29th, 2020, the FDA issued a second policy, which granted more flexibility around the development of diagnostic tests. Specifically, this allows facilities certified under the Clinical Laboratory Improvement Amendments (such as most hospital labs) to develop and use their own COVID-19 tests based on FDA guidelines. However, labs that wish to develop their own diagnostic are still required to fill out an EUA and must validate their tests by sending five positive and five negative samples to a qualified lab for confirmation.

On March 16th, the FDA began allowing state laboratories to set up their own systems of authorizing diagnostic tests. Because state laboratories will be engaging directly with state authorities instead of the FDA, they do not need to submit an EUA. Furthermore, an extension of the February 29th policy allows manufacturers that have internally validated their COVID-19 diagnostic tests to immediately start distributing their tests to other laboratories, as long as they provide clear instructions for use and share data of the test’s performance characteristics on their website. The manufacturers are still required to submit an EUA within 15 days of validating their diagnostic test. 

Finally, the latest update provided guidelines on the development of serological tests for COVID-19. Serological tests can measure the level of antibodies, which are proteins in the blood produced in response to an infection. Because it takes about two weeks for the immune system to start producing antibodies after a first exposure to a pathogen, serological tests cannot distinguish between a recent or past infection and are not meant to diagnose or inform COVID-19 infection status. However, serological tests can differentiate whether or not individuals have had a history of exposure to SARS-CoV-2 and determine how long immunity will last. These results are essential to inform long-term decisions about lifting stay-at-home orders and reopening schools and businesses.

As of March 31st, 2020, the FDA issued 22 in vitro diagnostic EUAs for SARS-CoV-2 testing. These FDA policies will expand testing capabilities in laboratories across the United States and increase surveillance. The guidance for serological tests offers a solution to determine how society can return to normalcy after the pandemic is over. Together, these efforts can bolster the public health response and help inform the development of upcoming policies regarding SARS-CoV-2 in the United States.

Written by sciencepolicyforall

April 3, 2020 at 3:01 pm

Posted in Essays

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Science Policy Around the Web April 2nd, 2020

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By Somayeh Hooshmand, PhD

Image by Gerd Altmann from Pixabay 

Social distancing comes with psychological fallout

An effective way to stop the spread of coronavirus is social distancing (although The WHO is now promoting the phrase “physical distancing” instead). Many states have imposed new rules for closings schools, restaurant and bars, parks, playgrounds and barring families from visiting relatives at nursing homes. However, social distancing comes at psychological and economic costs that could have short term and long-term impacts on individuals. These psychological impacts include stress, confusion, anger, anxiety, insomnia, emotional exhaustion and substance abuse. 

A recent study that was published in The Lancet reviewed the psychological impact of quarantine using three electronic databases. Most studies included in this review revealed that individuals that were separated and quarantined suffered from post-traumatic stress symptoms, frustration, boredom, inadequate supplies, inadequate information, financial loss, and stigma. 

This is particularly hard on the elderly since they are not as comfortable as younger generations with the use of technology and social networking. They also have a hard time getting the health services they might need. On the other hand, technology can not substitute for human touch such as holding hands, hugging or massage, which studies suggest can affect health, including possibly lowering blood pressure and reducing the severity of symptoms from the common cold.

During this unprecedented time caused by coronavirus government officials should be concerned about individual’s mental health, which is one of the biggest challenges of quarantine or self-isolation, and ensure sufficient supplies are provided. The must provide financial support for individuals who lost their jobs to reduce the level of anxiety and frustration. Also individuals need to find ways to protect their mental health in a time of social distancing by reading, exercising at home, maintaining a sense of community and sticking to a healthy diet, while also avoiding unhealthy behaviors such as drinking excessive amounts of alcohol and smoking,

Written by sciencepolicyforall

April 2, 2020 at 9:04 am