Fighting Future COVID-19s

The Spanish Flu of 1918 was an unusually deadly influenza pandemic, infecting 27% of the then world population and killing 40 – 50 million people. It’s been common knowledge in the global health community that another pandemic ‘Disease X’ whose speed and severity could match that of the Spanish Flu is a matter not of if but of when.

Welcome to 2020, the year of Covid-19. Its efficient transmission between humans and case fatality rate of around 1% (higher in elderly) has made the world come to a standstill. As I write this, there are 93000+ confirmed cases and 3100+ deaths in 60+ countries amidst a massive global effort to contain the spread of this potentially pandemic zoonotic coronavirus.

Learn how to protect yourself against Covid-19 here. Live track Covid-19 spread here.

While you are reading this at home (hopefully trying to avoid travel & public spaces), let’s take a step back and look at the bigger picture of pandemics and the global efforts to deal with it.

What are Pandemics?

The WHO defines pandemic as the worldwide spread of a new disease. Our growing population, encroachment into wildlife habitats and globalization fuelled trade & travel has led to an era when the threats posed by global pandemics and epidemics are accelerating exponentially.

The Middle East Respiratory Syndrome (MERS) coronavirus originated from the camels of Saudi Arabia in 2012 and spread halfway across the world to South Korea in 2015. Severe Acute Respiratory Syndrome (SARS) emerged in China and went on to infect people in over 30 countries in 2003. Add the Ebola and Zika stories to this, and you know how ill prepared we are to predict when, where, or from what species the next emerging virus will break out. Yet our knowledge of viruses is limited to only 260 out of the estimated 700,000 viruses which can possibly infect humans.

Novel viruses usually jump from mammals/birds to humans in regions where dense human populations and biodiversity intersect. Limited laboratory facilities, surveillance and healthcare infrastructure at such places delay early detection and subsequent control efforts. This jumping of a pathogen from a reservoir species to a new species is called Zoonotic Spillover. For example, Ebola virus jumped from bats to humans. It is a poorly understood phenomenon specifically because there are just too many factors influencing it. The idea of building models to predict a zoonotic spillover would give nightmares to even Shri O.P. Tandon, an Organic Chemistry author, whose books have given nightmares to millions of unsuspecting entrance exam aspirants.

Lets breakdown a Zoonotic Spillover event:

First, the amount of pathogen available to the human host at a given point in space and time, known as the pathogen pressure, is determined by interactions among reservoir host distribution, pathogen prevalence and pathogen release from the reservoir host, followed by pathogen survival, development and dissemination outside of the reservoir hosts.

Pathogen Pressure

Second, human and vector behavior determine pathogen exposure; specifically, the likelihood, route and dose of exposure.

Identifying key bottlenecks between barriers will help predict and intervene during a Zoonotic Spillover event.

Third, genetic, physiological and immunological attributes of the recipient human host, together with the dose and route of exposure, affect the probability and severity of infection.

A Zoonotic Spillover is a rare event.

Although we are continually exposed to many potentially infectious pathogens that are derived from other species, barriers at each phase make infection and subsequent disease a rare event. Understanding how these barriers are functionally and quantitatively linked, and how they interact in space and time, will substantially improve our ability to predict or prevent spillover events.

The Global Virome Project

In 2016, our approach to pandemics changed from reacting to outbreaks to proactively preparing for them with the Bellagio Initiative on the Global Virome Project (GVP). Based on USAID’s PREDICT program, which has discovered hundreds of known and unknown viruses in over 30 countries, the Global Virome Project (GVP) is a groundbreaking  global partnership to develop a comprehensive ecologic and genetic database of virtually all naturally-occurring viruses in 10 years. It aims to be the beginning of the end of the Pandemic Era.

If you know the enemy and know yourself, you need not fear the result of a hundred battles.

Sun Tzu

How will this ‘VIRAL BIG DATA’ help us deal with the next pandemic?

The availability and access to human genetic data has revolutionized how we see and treat cancer today. It has pushed cancer from the era of chemotherapy to that of personalized medicine. The Global Virome Project is based on the same principle, and hopes to use this data to predict things like the Top 10 emerging viruses, Zoonotic Spillover hotbeds, Virus migration patterns, Risk mitigation interventions and Drugs/Vaccines discovery strategies. The project will use artificial intelligence across the largest viral data set ever assembled, similar to machine learning techniques that are used in genomics to identify gene function, expression and disease biomarkers. It will also build capacity to further strengthen the global surveillance network.

Influenza pandemics are estimated to cause an average of US$ 570 billion in economic damages per year to the global economy and these costs will rise as our economies expand and become more interconnected. The Global Virome Project will cost US$ 1.2 billion, which is less than 0.2% of this estimated loss. In the late 1980s, the Human Genome Project catalyzed the development of new technologies and ushered in the era of personalized genomics. It is estimated that every U.S. federal dollar put into the Human Genome Project resulted in a $178 return on investment. The Global Virome Project is also expected to go beyond the immediate goal of tackling novel viruses to yield a treasure of publicly accessible unbiased data for advancements in science and global health.

Pandemics are like terrorist attacks: We know roughly where they originate and what’s responsible for them, but we don’t know exactly when the next one will happen. They need to be handled the same way — by identifying all possible sources and dismantling those before the next pandemic strikes.

We Knew Disease X Was Coming. It’s Here Now by Peter Daszak

Was this blog too technical? Watch this Netflix episode on Pandemics instead.