The first death from COVID-19 in the U.S.

Today, the CDC announced the first death from COVID-19 in the United States, a 50-year-old man in Washington state, and the source of the infection is unknown, with no known contact with an infected person. According to Robert Redfield, Director of the CDC, in today's White House press conference said there was  "no evidence of link of travel" to how the man contracted coronavirus.

While anthrax is not communicable, it sounds similar to a case during the Anthrax attacks in the U.S. in 2001, where a death occurred with no contact with anthrax-containing envelopes. Ollie Lundgren in Connecticut, was an elderly lady who only went out to have her hair done once a week. After extensive investigation involving a wide net, it was finally determined that she had a habit of ripping her junk mail before throwing it in the trash, thereby aerating the anthrax spores and exposing Ollie to a spray of anthrax spores. It happened that her mail had been exposed in mail sorting machines, and unfortunately, she became a victim.

Should we be looking for a similar pathway of infection? What if this individual had a habit of popping the air bubble/pillow packing material from China, where lots of our products are made and packed? The incredible viability of this virus to survive passing through vent systems in buildings might just allow it to survive in sealed plastic packing pillows, thereby releasing air contamined while in China.

The CDC has a corps of epidemiologists the EIS, Epidemiological Investigative Service, experienced and professional on-the-ground experts who search for the cause of infected humans and animals. I expect they are asking the same questions, right now.

COVID-19, WHO and US legal authorities and actions, disaster planning

Here is what has happened so far regarding legal authorities. WHO declared a Public Health Emergency of International Concern (PHEIC) on January 30. The U.S. issued a National Public Health Emergency declaration on Jan. 31, 2020: https://www.phe.gov/emergency/news/healthactions/phe/Pages/2019-nCoV.aspx .  This allows the use of non-programmed funds, allows certain waivers, etc.. States may issue emergency declarations, usually from the Office of the Governor, but they probably would not declare an emergency until there is a community transmission. That is, where it is spread from person to person, not a traveler returning with the infection. 

The American Bar Association issued disaster planning guidance today, and so I am going to address the framework for disaster planning for law schools that I would recommend as a starting point. There are typically a few levels that are triggered by certain events in a biological disaster. For example, we are at the equivalent of Level 1 preparation, taking precautions for COVID-19 which are the same precautions you would take to avoid influenza, including hand sanitizer stations. Level 2, might include cautioning students and faculty to stay home if they feel sick, postpone or cancel events that involve large numbers of people, and cancel travel to areas that have travel warnings. Preparation for teaching online should be fully in development. Level 2 might be triggered by person to person transmission in the state.  Level 3 would be full closure and teaching online. That is just an example of how a plan might unfold. Level 3 might be triggered by person to person transmission in the state, coupled with an emergency order by the Governor. 

While I served as Chief Counsel at US DOT, we spent a year planning for Bird Flu, back in 2005-2007. I am optimistic that we will not get to my Level 2, given that MERS, SARS (all in the coronovirus family) and Bird Flu and Swine Flu (the influenza family) did not reach the worst case planning scenarios. That said, given the epidemiological predictions, we have not reached the peak, and if we do reach a community transmission state, we will have our own peaks in the U.S. with the epidemiological curve. If the pandemic does move toward the worst end of the scenario, a vaccine may be ready as IND status in a few months, which means it is still not fully approved, but in investigational new drug status, and you can use it, but with your informed consent of that status. (Using an IND status vaccine is one of the waivers by the President available in a national emergency declaration.) 

Finally, if you are wondering whether you should call it a "pandemic", the global definition for the term includes person to person transmission, has consequences including death, and has spread worldwide. COVID-19 meets this standard definition for a pandemic, if spread to 38 countries constitutes a "worldwide" spread. Yet, WHO (through their committee of experts) has not yet declared COVID-19 a pandemic. In my opinion, the reason it has not yet been declared a pandemic, is mostly for diplomatic and political reasons. They may be hoping that with the shrinking number of new cases in China indicates we are past the peak and on the downside of the epidemiological curve, headed toward fewer and fewer cases. They may be right. Epi-curves often have a second peak, usually smaller than the first, with new cases generated from the first peak. But we can hope we have seen the peak and that is what we should all be hoping for.

What will we be saying about vaccination 100 years from today?

It is always jolting to read news of a smallpox infection. The Idaho, Bonnie Daily Bee newspaper reported a story from 100 years ago today, of a smallpox infection in a school. It is surreal to think how calmly this report must have been received, since smallpox was still part of the human existence. What I also found interesting, is the encouragement to the readership to get the vaccination for smallpox because "there is no danger of infection or sore arms." One hundred years later, we are still encouraging people to get childhood vaccinations for their children, but with different objections, not founded in science. One has to wonder what will be published in the news format of the day, one hundred years from today. In one hundred years, will the readership wince in horror at the thought of a cold outbreak like we do for a smallpox outbreak? But the most important question is will we still be encouraging resisters to vaccinate their children, after another unnecessary outbreak of a disease?

Here's the report:

100 Years Ago

Pend d’Oreille Review

Jan. 16, 1920 — SCHOOL CHILDREN EXPOSED

County Health Officer Wendle reported that a little girl in the Washington school building came down yesterday with smallpox. Her sister was home with the disease, the parents ascribing her symptoms to eczema, and not calling a physician.

Today the Washington school children are being vaccinated and two rooms exposed were fumigated. With 16 cases of smallpox reported in the county this week, Dr. Wendle advises general vaccination and states that under modern methods of vaccination there is no danger of infection and sore arms. 

Bioterrorism Victims (and anniversary) Ignored

A subtle reminder of the 2001 anthrax attacks, triggering the most expensive FBI investigation in its history, appeared in a "this day in history" note today, October 5, 2019:

"2001 — Tabloid photo editor Robert Stevens died from inhaled anthrax, the first of a series of anthrax cases in Florida, New York, New Jersey and Washington."

Five victims died in the anthrax attacks of 2001, and about a dozen were infected but survived. The bioterror attack followed the shocking 9/11 attack on the United States. The anthrax attacks clearly meant to mislead the investigators into believing Al Qaida was responsible, with the scrawled letter that came in the envelopes containing anthrax spores intended for inhalation by the victims.

The FBI, led by Robert Mueller, had to quickly get up to speed on understanding biology as a weapon. Not surprisingly, the investigation was frought with missteps and confusion. The investigation dragged on for ten years, and was only ended with the suicide of the most likely suspect, who had not yet been arrested by the FBI. 

The United States through the National Institutes of Health, and its National Institute of Allergies and Infectious Diseases (NIH/NIAID) funded Centers of Excellence throughout the U.S. to pull together our best research on combatting infectious diseases. This program lasted a little more than ten years, and Pres. Obama chose to let the vast scientific research capacity that was built dissolve into history, with no continuing support. Bioterrorism started to fade from memory.

Today, undergraduate students were mostly born after the 9/11 attacks and the anthrax attacks. Recognizing the anniversary date of the first anthrax death of Robert Stevens, is a reminder of that horrendously terrorizing period in our nation's history. It should also serve as a reminder that we are still unprepared and vulnerable to another bioterrorism attack, today with vastly better biotechnology tools to develop bioweapons. 

Biohazards in Australia-- snakes, spiders and platypuses, oh my! But moths, too?

Sure, we know about the poisonous snakes in Australia and even the poisonous Funnel Spider, and the deadly (to dogs) barb of the male platypus, but the soft-sounding white cedar moth? Apparently the region has been overrun with catapillars that begin the metamorphosis to a moth, and their fuzz is known to be poisonous. That poisonous is believed to continue into the moth. Tell that to the small child who popped one of them in her mouth. Luckily, she recovered.

It is time to take plague seriously in Madagascar

The World Health Organization published in its Disease Outbreak News, an update on pneumonic plague in Madagascar. The cases of pneumonic plague are up to 51 cases now. Due to its relative isolation from a major transport area, WHO has not considered it to be a global threat. They have recommended notices to people arriving in the ports about precautions to take.
The patient zero became ill Aug. 23 and it was not until Sept. 11 after 31 people had died, was an epidemic discovered in the region. According to the WHO report, protective measures were not taken with the death of the first victim.
The best use of resources is always in the earliest possible stages, and in Madagascar where plague is endemic, why is education not a primary objective of WHO in this region? The resources needed after an outbreak begins is exponentially greater than those to prevent it or stop it immediately. I recommend that Madagascar be used as a model for WHO to launch a plague education program. It is time to take plague seriously in Madagascar.

ISIS claims to have "secret weapons" in store for Raqqa

ISIS announced (Aug. 6, 2017) that they have "secret weapons" that await coalition forces in Raqqa. Their usual approach is explosives, so one might assume it was just a variation on the explosives strategy. Their commander reportedly said, the Islamic State might unleash “other types of weapons which Allah has bestowed upon the Mujahidin and which we have not yet revealed.” 

Historically, ISIS has bragged about having biological weapons, but these require a good bit of skill and discipline to develop. ISIS seems to have no problem recruiting suicide bombers, but clearly they haven't been recruiting suicide bio-bombers, whether by choice or just failure to recruit. By bio-bomber, I mean a suicidal attacker, infected with a lethal disease, with a purpose of infecting as many people as possible. Fortunately, the U.S. military has been preparing for this eventuality. If this is ISIS's "secret weapon" then it is fortunate that with the foresight of defensive training, planning and resources of the U.S. military, they have little chance of succeeding with it.