Viruses in Outer Space?

 https://www.nasa.gov/feature/nasa-investigates-how-dormant-viruses-behave-during-spaceflight

https://www.frontiersin.org/articles/10.3389/fmicb.2019.00016/full

This week, I read an article about new discoveries made about viruses in space. In February, a review study came out about the potential risk that viruses might pose to astronauts when they travel to space. The article mentioned how on the Apollo 7 mission one astronaut seemed to have caught a cold and the others soon caught it too. Because there is no gravity in space, the mucus that filled their nose/throats became so uncomfortable that the astronauts refused to wear their helmets when they landed. They were also terrified that the mucus/congestion could be deadly when the pressure changed as they landed. 

While these astronauts came out relatively unscathed, it prompted a new wave of research on viruses in outer space. Recently, the international space station was swabbed for viruses, and it was found that there were lots of viruses such as herpesviruses and papillomaviruses. They also studied a concept called reactivated viruses, whereby viruses that have laid dormant in the body for years can suddenly re-activate, typically due to changes in the environment. When an astronaut goes to space, their external environment changes drastically in terms of temperature, pressure, gravity, etc. Scientists believe that this could cause dormant viruses to begin replicating again. One virus that poses a significant threat is chickenpox, because if someone had chickenpox as a kid and then the chickenpox gets reactivated when they are in space, it can turn into shingles, which is debilitating and very painful. Now, astronauts are required to quarantine several weeks prior to going into space to ensure that they are not sick. 

-Sophia (Week 10)

War in Ukraine, Smallpox/Bioterrorism

 As Russia’s invasion progresses, I was reminded of our conversation in class about the only remaining smallpox vials. We discussed how (to our knowledge) the only remaining vials of the deadly smallpox virus exist in the United States and in Russia. In our homework, we were asked to take a side on the debate as to whether or not these vials should be destroyed. 

It made me think about the possibility of an actual bioterrorist attack. I started listening to the audiobook of Richard Preston’s Demon in the Freezer this past weekend and realized how real and terrifying the anthrax bioterrorism attack of the early 2000s was. I think we take it for granted today that we have not yet had a purposeful, targeted bioterrorist attack in recent years. In some of the other problems from this week’s problem set, there were questions about the ethics of gain-of-function experiments and whether they should be allowed. It made me realize how in science curiosity is often tied with terror. Scientists seek to push the bounds of what we can observe and create something that is stronger or more interesting. They are curious to explore things, especially dangerous things that people don’t know too much about. But with that exploration and experimentation comes a responsibility of ensuring that the knowledge of and access to these dangerous viruses does not get into the wrong hands.

I wonder what the US government’s rationale is for keeping the smallpox vials. Do they really want to do more research on it? Or is it more of a symbol of equal power for destruction against Russia? If Russia does release their smallpox into the population, it’s not like releasing ours will do any good in stopping the bioterrorist attack. So, what is the purpose? Does Russia’s recent invasion of Ukraine change their minds in any way? I have recently started to find biosecurity very interesting and would like to explore this more. 

-Sophia (Week 9)

War in Ukraine, War and Infectious Diseases

 This past week, we learned that Russia had invaded Ukraine. This invasion is an immense tragedy and something that has already cost so many innocent lives in Ukraine. In class this week, we also discussed how war can intersect with pandemics/epidemics and exacerbate the spread of infectious diseases. I remember reading a story about a baby who was born in a bomb shelter in Ukraine because the baby’s family could not get to the hospital. I also remembered this past summer reading about how during violent conflict oftentimes hospitals and health centers become targets for violence, which is a strategy used to further destabilize communities. 

It made me wonder how the conflict in the Ukraine will impact the spread of COVID-19 and other infectious diseases. Particularly as conditions of hygiene may deteriorate during times of war, I wonder if people will become more susceptible to certain diseases, and given the close-quarter living style in bomb shelters, I wonder if diseases will spread more quickly through the population. When people flee into new countries, this also increases the risk of spreading disease across borders. Furthermore, many families are living in bomb shelters, so how will health services reach them, especially if people suffer from medical emergencies or need perscription medications? I wonder if there is anything that the global health community is doing about these concerns. 

-Sophia (Week 8)

Women-Led Teams Vaccinating Families in Pakistan

 This week, I saw an article in NPR Goats and Soda (https://www.npr.org/sections/goatsandsoda/2022/03/05/1084228017/pakistan-has-a-big-idea-send-13-000-teams-led-by-women-to-vaccinate-the-hesitant) about a potential solution for vaccine hesitancy in Pakistan. This article describes how many people are vaccine hesitant simply because they are illiterate and do not know that the vaccine is available or because they have to work all day and it is nearly impossible for them to get the vaccine without skipping work.

The solution that Pakistan has pioneered is to assemble a team of women to go door-to-door in vulnerable communities across the country to offer the vaccine. The team is armed with vaccines from several different countries (the US, China) and explains the importance of the vaccine to each family. 

I think the strategy of choosing a women-only team is a very powerful and important one. It reminds me a bit of the ASHA worker system of female health workers that has been implemented in India. Several years prior to the pandemic, the Indian government decided to tackle the high levels of maternal and newborn mortality. They trained females from rural regions to handle basic maternal/newborn emergencies and helped them educate communities on best practices. The female-led teams made families feel very safe, and women from the communities were also empowered in the process, which I think is very important. In the case of this vaccination strategy in Pakistan, I do wonder if/how people would respond differently to an all-male team or a mixed gender team. I wonder if these female vaccinators face any barriers or sexism as they are going through communities.

-Sophia (Week 7)

The Death of Paul Farmer

 This week, I was very sad to hear of the death of Dr. Paul Farmer. I had only recently begun to be deeply inspired by Dr. Farmer and had read his book Fevers, Feuds, and Diamonds towards the end of this past summer. 

I first heard of Dr. Farmer from another doctor who inspired me deeply. She is an infectious diseases doctor in Boston who worked on the front lines of the Ebola epidemic in Sierra Leone, Liberia, and the Democratic Republic of Congo. Dr. Farmer was one of her heroes, and she was (and still is!) one of mine, so naturally I started to learn more about the work that Dr. Farmer was doing. 

In my sophomore year at Stanford, I joined Stanford’s Partners in Health Engage chapter. Each week, we read a news article pertaining to important topics like maternal health in Sierra Leone, the rise of diseases like typhus in Los Angeles’ homeless populations, and the implications of war for global health. We wrote letters to newspapers and spoke with congress members to advocate for health bills that Partners in Health was supporting. I even won a free copy of Mountains Beyond Mountains. We watched the movie Bending the Arc, which tells the story of how Farmer and his colleagues founded Partners in Health and the lives that their work saved. I remember being so excited for the Boston infectious diseases doctor who I mentioned above, because she had been invited to a book club where Dr. Farmer was going to discuss Fevers, Feuds, and Diamonds. 

But it wasn’t until I heard Dr. Farmer speak that I truly understood why he was so important to the field of global health. Stanford’s global health center was hosting a Zoom talk with him one night during winter quarter last year. The interviewer praised Dr. Farmer for several minutes and then asked him a single question. The question was bold, perhaps a bit eerie given Dr. Farmer’s passing this year.

“I know you’re still very young. But, when you do die, what would you like to be on your tombstone? How would you like to be remembered, Dr. Farmer?”

Dr. Farmer was silent for a few seconds and then spoke.  

“Useful,” he said. “I hope my tombstone would say that I was useful. That’s how I hope to be remembered.”

It was such a simple, humble response that moved the audience (and the interviewer) deeply. And when I got the chance to read Fevers, Feuds, and Diamonds, I realized Dr. Farmer was being completely truthful. His book is a reflection of his mindset. In his book, the stories of people whose voices are not usually heard are given the power. His voice, careful and compassionate, lifted theirs up to a place where the rest of the world could hear them. 

I think this humility is especially important in the field of global health, especially when it comes to providing aid during epidemics and pandemics. Understanding that every single patient is a human being deserving of dignity and compassion is crucial. Believing that the doctors who come in to provide help are not saviors but rather partners and co-workers to the nurses and doctors who have been living in these communities for their whole lives is also important. I could say a lot more about the profound impact Dr. Farmer has had on me, but I also think that there is a lot I am excited to discover about his work. I hope to read some of his other books and continue to be involved in Stanford’s Partners in Health Chapter. 

-Sophia (Week 6)

Vaccine Hesitancy in Iraq

 This week, I saw an article in NPR Goats and Soda (

https://www.npr.org/sections/goatsandsoda/2022/02/17/1081130414/iraq-has-enough-doses-of-covid-vaccine-for-everyone-but-many-iraqis-dont-trust-i) about vaccine hesitancy in Iraq. The article discussed how despite there being enough vaccine doses for everyone, there is a large amount of hesitancy that is impeding vaccination efforts.

In particular, there appears to be a fear of the Pfizer vaccine because it is from the United States. I think this is a good example of how relations and tensions between countries can indirectly impact public health. It reminded me of the polio outbreak in Nigeria in 2003. At the time, polio had been eliminated from Nigeria. However, given that this was soon after 9/11, there were lots of tensions between Christian and Muslim communities globally. This caused some people in Nigeria to say that the polio vaccine contained ingredients that caused infertility and cancer, and that the Americans wanted to deplete the Muslim population. As a result, there was a ban on the vaccine, which resulted in the re-emergence of polio in the country, which ended up spreading into other nearby countries. 

This parallel shows, in my opinion, how important relationships between countries are. Health should technically not be political, but it inevitably does become tied to governments and religions. As a result, it is crucial to ensure that people feel like they can trust the people who are encouraging them to be vaccinated. I don’t have a good answer for how exactly to ensure this, but I do think that country leaders should keep in mind how much public health can be affected by inter-country tensions. 

-Sophia (Week 5)

2022–2023 Influenza Vaccine Strains Recommended by FDA

The US Food and Drug Administration's (FDA's) Vaccines and Related Biological Products Advisory Committee has chosen the influenza vaccine strains for the 2022–2023 season in the northern hemisphere, which beginnings in the fall of 2022. The panel voted to include a A/Darwin/9/2021-like strain for the H3N2 component of the vaccine; this is changed from A/Cambodia/e0826360/2020. For the influenza B Victoria lineage component, the committee voted to include a B/Austria/1359417/2021-like virus, a swap from this year's B/Washington/02/2019-like virus. These changes apply to the egg-based, cell-culture, and recombinant vaccines. Both new strains were included in WHO's 2022 influenza vaccine strain recommendations for the southern hemisphere. For the influenza A H1N1 component, the group also agreed to include a A/Victoria/2570/2019 (H1N1) pdm09-like virus for the egg-based vaccine and the A/Wisconsin/588/2019 (H1N1) pdm09-like virus for cell culture or recombinant vaccine. 

--wenqi 

Worst Outbreak of Covid in China for the last 2 years

China is seeing the worst outbreak of Covid than it has in 2 years. In Beijing, there were 3,400 cases in one day, a number doubled from the day before. This has caused China to start shutting down schools and businesses. There were even entire cities shut down due to this sudden outbreak. China has typically been fairly good at maintaining the virus, however the recent spike in asymptomatic cases and the high transmissibility of the Omicron variant has caused maintaining the virus much more difficult. Some people are saying that the response to this outbreak hasn’t been fast enough, however what is more likely is that we do not know enough about Omicron yet to effectively stop it.

One thing we have been talking about in class is the potential of a vaccine that is more specifically targeting the Omicron variant. The vaccine that we are currently using will protect us from the original strain of Covid, however there have been new variants since then that the vaccine does not include (e.g Delta and Omicron). Furthermore, it is likely that there will be more variants as time goes on. This new vaccine that is more geared towards protecting against Omicron could really help decrease these high transmission rates. The only problem is that by the time we do have a vaccine for Omicron, it is likely that it will be too late and there will already be another variant of Covid that is circulating. SO, while it will be good to have a more updated vaccine, we need to find a way to make vaccines faster so that we can work on preventing transmission before it happens rather than stopping transmission rates after it has already gotten really bad. 

China Records Nearly 3,400 Daily Virus Cases In Worst Outbreak In 2 Years

-Lauren Burch

Hidding SARS-CoV-2 in the Body

After studying the herpes virus, I learned that some viruses can hide in a person's lymphocytes or central nervous system and later become expressed as illness in a phenomenon called “latent infection”. This got me wondering if SARS-CoV-2, the virus that causes COVID, also had this quality. I found an article explaining how it can “hide out” in the body, but not in the same way that a herpes virus does. What the SARS-CoV-2 virus does is it “hides” in the body after initial infection, continuing to cause illness while the immune system cannot find the virus. There is a theory that this could be the cause of long-COVID. With the virus hiding in the body, it makes it difficult to get rid of the virus, and therefore more likely that the person will spread COVID to other people. 

Another thing that this article explores is the spike proteins on the outside of every variant of SARS-CoV-2. There is a common spike protein that has been found on every variant of this virus that has most likely given it an advantage inside the body, allowing it to replicate very fast. It is this spike protein that changes shape after coming in contact with the fatty acids in the host’s cell, making the virus nearly undetectable to the immune system. This ability to hide in the body for a long time might make eradication of this virus very difficult.

-Lauren Burch

Variants of COVID Virus May 'Hide Out' in Body: Study - Consumer Health News | HealthDay

Japanese Encephalitis in Australia

 Japanese encephalitis has been making a trek south from Japan recently. It has gotten all the way to Australia, leaving the question of how it got this far south. One theory is that it has traveled so far south because of changing weather conditions. These weather conditions bring water to flood plains, wetlands, and other habitats that are favorable to both mosquitoes and waterbirds that carry the virus and can spread it to humans. Another theory is that mosquitoes and birds are migrating south at the time. While there are many theories, it's still not known for sure why it is traveling so far south.

So, how do people in Australia protect themselves from this virus that is relatively new to them? There is a vaccine available for Japanese encephalitis that is recommended for those who are high risk for Japanese encephalitis, however it is not very widespread and only a few Australians are vaccinated against it. The best way to prevent the spread of this virus is through insecticides and personal protection against mosquito bites. If Australians can prevent getting bitten by infected mosquitoes in the summertime, which is mosquito season, then they should be able to keep the cases of Japanese encephalitis down.

-Lauren Burch

Japanese encephalitis virus has been detected in Australian pigs. Can mozzies now spread it to humans? 

Annual Flu Vaccine in Children Builds Strong Immune Response

A study stated that children who received annual flu vaccines developed robust neutralizing antibody responses that are not strain specific, thus providing strong protection against flu. The benefit of broadly neutralizing antibodies is that they are not strain specific and can therefore provide protection against diverse strains or subtypes of influenza virus. 

Researchers evaluated immune responses in serum samples from participants of a cluster-randomized control trial. The original trial compared the community-level protection mediated by either inactivated virus (IIV) or live attenuated virus (LAIV) vaccination in children. To examine serologic broadly neutralizing antibodies induction, researchers compared prevaccination microneutralization (MNT) titers to titers after three influenza seasons. They found higher titers in vaccinated participants compared to controls. Specifically, 43% of vaccinees had at least a fourfold increase of MNT, compared with 13% of controls. 

Therefore, annual flu vaccine is encourage especially in children. 

--wenqi

Study identifies how Epstein-Barr virus triggers multiple sclerosis

A new study from Stanford Medicine found that part of the Epstein-Barr virus mimics an adhesion protein made in the brain and spinal cord, leading the immune system to mistakenly attack the body’s nerve cells. 

The adhesion protein is GlialCAM, found in the insulating sheath on nerves.  Epstein-Barr virus, a common type of herpes virus, triggers multiple sclerosis by priming the immune system to attack our own neuron system. The study found that approximately 20% to 25% of patients with multiple sclerosis have antibodies in their blood that bind tightly to both a protein from the Epstein-Barr virus, called EBNA1, and the adhesion protein made in the brain and spinal cord GlialCAM. To search for this elusive mechanistic link, the researchers started by examining the antibodies produced by immune cells in the blood and spinal fluid of nine MS patients. Unlike in healthy individuals, the immune cells of MS patients traffic to the brain and spinal cord -- highly neurotrophic, where they produce large amounts of a few types of antibodies. Patterns of these antibody proteins, called oligoclonal bands, are found during analysis of the spinal fluid and are part of the diagnostic criteria for MS. No one knows exactly what those antibodies bind to or where they’re from previously. 

This finding is really important and interesting in that it illustrates how autoimmune disease ever generated, not only by what mechanism but also where it came from. 

---Wenqi Song

Malawi Declares Polio Potential Outbreak

Health authorities in Malawi have declared an outbreak of wild poliovirus type 1 after a case was confirmed in a 3-year-old girl in the capital, Lilongwe. The 3-year-old girl experienced paralysis in November, and stool specimens were collected. Virus DNA has been identifies in the stool sample and the strain identified  is linked to one circulating in Sindh Province in Pakistan. Polio remains endemic only in Afghanistan and Pakistan. Whether the girl had traveled to Pakistan or was infected in Malawi is very significant detail that would indicate whether or not transmission was actively occurring in Malawi.

As long as wild polio exists still, anywhere in the world all countries remain at risk of importation of the virus. Increasing immunization rate would largely help with preventing the outbreak. 

--Wenqi

Vitamin D Deficiency Linked to Severe COVID

A newly published paper "Pre-infection 25-hydroxyvitamin D3 levels and association with severity of COVID-19 illness" on PLOS ONE suggests the correlation between low vitamin D status and both an increased risk of infection with SARS-CoV-2 and poorer clinical outcomes. The study searched patients with positive polymerase chain reaction (PCR) tests for SARS-CoV-2 (COVID-19) for historical 25(OH)D levels measured 14 to 730 days prior to the positive PCR test. Results show that a lower vitamin D status was more common in patients with the severe or critical disease than in individuals with mild or moderate disease. Patients with vitamin D deficiency (<20 ng/mL) were 14 times more likely to have severe or critical disease than patients with 25(OH)D ≥40 ng/mL. 

The differences still applied after researchers controlled for the patients' age, gender, and history of chronic diseases.

Knowing this correlation, health officials in several countries have recommended vitamin D supplements during the pandemic. 

--Wenqi

Childhood Trauma May Influence Vaccine Hesitancy

 COVID-19 vaccine hesitancy may be associated with traumatic events in childhood that undermine trust, including domestic violence, abuse in the home, or neglect. Findings by Prof. Mark A. Bellis, College of Human Sciences, Bangor University, United Kingdom, and colleagues, were published online in BMJ Open. Studies found that hesitancy or refusal to get the vaccine increased with the number of traumas reported.

Researchers used responses to a nationally representative telephone survey of adults in Wales taken between December 2020 and March 2021, when COVID restrictions were in force. The survey asked about nine types of adverse childhood experiences (ACEs) before the age of 18, including: parental separation; physical, verbal, and sexual abuse; exposure to domestic violence; and living with a household member who has mental illness, misuses alcohol and/or drugs, or who was incarcerated. About half of the respondents said they hadn't experienced any childhood trauma. Of those who did, one in five said they had experienced one type, 17% reported two to three types, and 10% reported four or more. Survey results showed that people with more ACEs were more likely to have low trust in National Health Service COVID-19 information.

Researchers suggest the effect of childhood adversity needs to be considered at all levels in health systems

---Wenqi Song 

The Unfortunate Link Between Health Misinformation and Moneymaking

I recently read a blog post on MedPage (https://www.medpagetoday.com/opinion/revolutionandrevelation/96978) that discussed the monetization of health information and misinformation. It was written by a physician named Milton Packard who described a conversation that he had with a colleague during the pandemic. Packard has been a columnist for MedPage since 2018 and states that he does not make any money or have any sponsorships for any of the posts that he writes. They are purely written from his perspective, with his personal opinions based on his experience in the medical field. A colleague had recently asked him how much money he made per MedPage article, and the colleague was surprised to find that Packard was writing the articles for free. “You are kidding me! You are giving your work away for free?” The colleague said. “But you are writing whole essays that are very well written and researched. Your opinions are valued, and thousands of people want to read what you write.” The colleague went on to discuss how other physicians like Eric Topol have curated massive twitter followings during the pandemic and who have also joined Substack as a “writer-in-residence” where they share their opinions for a price. But the colleague also discussed the dark side of substack, saying that some people use Substack to profit off spreading health/COVID/vaccine misinformation. “They are making millions of dollars a year by selling their thoughts to subscribers on Substack,” the colleague said. “Being a physician who spreads disinformation about COVID-19 is very profitable.” 

I found the discussion between Packard and his colleague very interesting and eye-opening. In an era where virtually anyone has a platform to speak their mind, due to social media outlets like twitter, information is not as regulated as it used to be. In this regard, it has been hard to control misinformation because anyone can post and anyone can read what they want. However, I think it's an entirely different battle when money comes into the picture. It makes me feel frustrated that people can make millions of dollars each year by promoting misinformation, and I can unfortunately see exactly how that model would work. Someone whose words are provocative, controversial, and extreme may get more views and be in higher demand than someone who speaks with more facts and caution (and who understands the complexity of science), so the person who is spewing misinformation could get paid more. I think it’s very sad to see that money could potentially drive a scientist or doctor to deliberately spread misinformation, and I wonder what the role of hospitals and universities is in regulating this type of speech from their doctors/scientists. 

-Sophia

Pfizer Vaccine for Children

In class today, we had a guest lecturer named Sally Susman, and she is the Executive Vice President and Chief Corporate Affairs Officer at Pfizer. She was telling us that Pfizer's goal is to reduce suffering worldwide and to get medicine to those who need it or who might not have it available. Sally Susman has a team of 400 people around the globe who work together to interact with people around the world. The COVID pandemic changed quite a lot of the company. Their goal at the beginning of the pandemic was to create a vaccine within a year, when this usually takes over a decade to do. And through very long hours and meetings every single day, they were successful.

Currently, Pfizer is trying to get the vaccine available to as many people as possible. Sally Susman told us that the Pfizer vaccine has just been approved in for children older than 6 months old. This has huge implications for the stop of the spread of COVID-19 because it will get rid of a large portion of the unvaccinated population and increase the safety in elementary schools. A big problem before this got approved was unvaccinated children getting and spreading COVID to their families at home. Furthermore, the children were more at risk for a serious or possibly fatal case of COVID because they were unvaccinated. This will greatly decrease the spread of the virus and hopefully reduce some anxiety parents have about their children going to public schools.

-Lauren Burch

 

Emerging Drug-Resistant Malaria in Africa

Malaria kills more than half a million people per year, most of them small children. A new kind of antimalarial treatment: artemisinin-based combination therapies, or ACTs, that replaced older drugs like chloroquine, has successfully saved millions of lives in Africa. 

Used as a first-line treatment, ACTs have averted a significant number of malaria deaths since their introduction in the early 2000s. ACTs pair a derivative of the drug artemisinin with one of five partner drugs or drug combinations. Delivered together, the fast-acting artemisinin component wipes out most of the parasites within a few days, and the longer-acting partner drug clears out the stragglers.

ACTs quickly became a mainstay in malaria treatment. But in 2009, researchers observed signs of resistance to artemisinin along the Thailand-Cambodia border. With more studies, scientists have confirmed the emergence of artemisinin resistance in Africa. This can cause malaria reemerging and can be really detrimental to the global health. Researchers have remained on the lookout for signs that the malaria parasite is evolving to resist artemisinin or its partner drugs, planning to run therapeutic efficacy study, which involves closely monitoring infected patients as they are treated with antimalarial drugs, to see how well the drugs perform and if there are any signs of resistance.

#reemergingdiseases

--Wenqi 

Presence of Autoantibodies Most Predictive of Long COVID in Study

According to the studies, as many as 69% of COVID-19 patients suffer from long COVID – a range of new, recurrent, or ongoing problems 4 or more weeks following initial SARS-CoV-2 infection. Long COVID has been associated with acute disease severity, and is suspected to be related to autoimmune factors and unresolved viral fragments.

 Studies found that the presence of autoantibodies in peripheral blood at initial diagnosis is one of the chief factors predicting if a patient would experience long COVID, along with having type 2 diabetes, SARS-CoV-2 RNAemia, and Epstein-Barr virus (EBV) viremia. EBV was reported to be reactivated by COVID infection. These autoantibodies can reduce anti–SARS-CoV-2 antibodies during COVID-19 infection.

Studies also identified an association between T2 hyperinflammation and long COVID–anticipating autoantibodies. This association further implies that hyperinflammation-controlling therapies in the acute stage of COVID may influence whether a patient experiences long COVID. 

--Wenqi Song 

Robots, UV Lights and Virus-Killing Seat Covers

With the rapid spread of COVID-19, companies have been forced to do what they should have been doing for a very long time: be clean. This is especially prominent in airplanes, where before COVID, would clean the trash from the rows between flights and only do a true cleaning once a month. People were uncomfortable returning to airplanes after the rise in COVID-19 cases, so airplane companies increased their cleanliness to entice people to come back to flying. 

One way some companies have proposed to clean their planes between flights is the use of a robot that would clean up to 99% of germs on the plane within 5 minutes. This sanitizing robot looks like a beverage cart and pushes itself through the cabin and, using cameras and a laser sensor, cleans surfaces within 5 feet.

Another way is by pushing a high-intensity UV light through the cabin to kill all the germs on the plane. This technology has already been used in hospitals, so it is proven to kill all viruses on surfaces and even viruses in respiratory droplets in the air. This is actually already being used in nine airlines, including Qatar Airways and Brazil's Azul.

And finally, some plane companies are developing a spray to put on the seat covers that would kill any viruses that land on it. A virus won't spread as easy if it can't land on the seat, so this could also be a very effective way to keep airplanes clean.

https://www.bloomberg.com/news/newsletters/2022-01-25/of-robots-uv-lights-and-virus-killing-seat-covers 

-Lauren Burch

Vaccines Are Being Shipped to Low-Income Countries, But Are They Actually Reaching People?

This week, I read an article in the Washington Post (https://www.washingtonpost.com/world/2022/01/24/vaccine-distribution-logistics-inequality-access/) that discusses vaccine inequity in low and middle income countries. It discusses how millions of doses of the COVID-19 vaccines have been shipped to low-resource countries through the Covax program, but that there is a lot of uncertainty around whether or not these doses are actually reaching people. 

The author of the article critiques the global COVID vaccine strategy, arguing that it is not enough to just ship vaccines to poorer countries. Those vaccines will be of no use unless there are adequate supply chains and health infrastructure programs that can help to distribute and administer the shots. One statistic that shocked me was that 32 low income countries have used less than half of the vaccines that have been delivered to them. For instance, Burkina Faso has used just 27%, Somalia has used just 26%, and Burundi has used less than 1%. This could be explained by the spending of the World Bank, which allocated less than 15% of its vaccine assistance program towards distribution. 

I really appreciated this article because it reminded me of something I learned in my global child health class last quarter. Our teacher told us about an invention called the “Soccket”, which was a soccer ball that generated energy when it was kicked. The goal was that children in poor communities could play with the Soccket during the day, and then families could use the energy to power the electricity in their homes. The inventors dropped off a bunch of Soccket balls in these communities and left. When they returned years later, they were surprised to find that the balls had never been used. The purpose of this story is to show that simply dropping off resources is not enough to solve the problem of equity.

Another point that the author brought up was the argument that the low uptake of vaccines in poor countries is caused by vaccine hesitancy. The author describes how, actually, poor countries have around the same rates of vaccine hesitancy as high-income countries like the United States. In my opinion, reducing the problem to “vaccine hesitancy” puts blame on individuals in these communities, framing them as lazy rather than understanding that the supply chains may not be reaching them or their local clinics may not have the resources to provide vaccines. There probably are high levels of vaccine hesitancy in these communities, but that hesitancy may also result from complex relationships between people and their government, which are problems that definitely exist in the United States as well.

Ensuring that vaccines actually reach people in these countries will not be an easy feat. Now that vaccines have been delivered, I think organizations like the World Bank, GAVI, and WHO should focus on distribution and supporting overburdened healthcare workers/systems. As we have learned with the Delta and Omicron variants, reaching high levels of vaccination globally will be crucial to ending the pandemic, but it will require better coordination and attention at both global and local levels. 

-Sophia (Week 3)

Rapid Test Hacking: Swabbing the Throat?

 Recently, there has been a twitter craze associated with using at-home rapid tests in a new way. While the tests are supposed to be used as nasal swabs, some people have become convinced that swabbing the throat is a better and more effective way to see if someone is positive for COVID. 

This article from NPR Goats & Soda (https://www.npr.org/sections/goatsandsoda/2022/01/12/1071362475/coronavirus-faq-why-are-some-folks-hacking-home-covid-tests-by-swabbing-their-th) discusses this phenomenon and whether it has any scientific merit. The authors discuss how in other countries, such as the UK and Canada, rapid tests are designed to swab the throat. Interestingly, this idea of throat swabbing is linked to the omicron variant specifically. 

This is because some researchers believe that unlike previous variants omicron replicates in the throat prior to replicating in the nose. This means, in theory, that someone could swab their nose and test negative but then swab their throat and test positive. This phenomenon appears to be backed by a study conducted in South Africa. For people with any other COVID variant, the throat swabs were only 71% effective at recognizing it while the nasal swabs recognized it every time. However, for the omicron variant, nasal swabs were 86% effective while throat swabs were 100% effective. 

However, there are some holes that I think it’s important to recognize in this research. The sample size of patients in this study was fairly small, with less than 400 people total. Furthermore, the study used PCR tests rather than the rapid antigen tests that people have been using at home in the United States. Finally, the NPR article states that the research has not undergone peer review, so it is difficult to say whether the methods and conclusions are sound. 

However, several individuals in the United States have tried to informally test whether throat swabs are more effective. One advocate for this approach is Micheal Mina, a former epidemiologist and immunologist at Harvard. Other health experts such as infectious diseases expert Jill Weatherhead of Baylor College says that this approach could just be producing a higher rate of false positives rather than a lower rate of false negatives. It is also important to note that the swab sticks are designed for use in the nostrils, so it may be dangerous for people to stick them down their throats (perhaps accidentally injuring their tonsils). As of right now, the FDA has warned against using the testing kits as throat swabs. 

-Sophia (from Week 2)

"Twindemic?"

 One very interesting statistic, that was first noticed in France and surrounding European countries, is that there is a significant increase of flu infections that seems to follow the increase in COVID cases because of the Omicron variant. People are calling this a “Twindemic” because of this similarity between the rise in COVID cases and the rise in flu cases. This year’s version of flu has reached endemic levels in many cities in France and is at a pre-endemic level in many other parts of the country. One thing that the WHO is finding is that flu vaccination coverage for the flu variants this year are not as high as they would have hoped they would be this year, and this is likely the cause of this increase in cases. Furthermore, this strand of flu virus seems to be quite severe, already causing 72 severe cases of the flu with 6 deaths this year in France.

The reason people are concerned about this so called “Twindemic” is because it has been going on for quite a long time and doesn’t seem to be slowing down. Furthermore, it is spreading at a faster rate than was expected of the flu virus this year. The flu virus is very versatile, seeing as it changes and adapts consistently as people become immune to other strands. This makes creating a vaccine for it very difficult, and that is the reason a person has to get a new flu vaccine every single year. So, what I said earlier about how the vaccination coverage is low this year means that the vaccine that is being used, based off a prediction of what the flu virus would be like this year, is not as effective as one would hope. Since December of 2021, this flu strain seems to be very severe and very contagious and rising in cases alongside COVID-19 Omicron cases. Some people are saying this strand of the flu could lead to a very long flu season that leads all the way into the summertime.

-Lauren Burch

https://www.youtube.com/watch?v=k6S9jJKx8Yg

Study Says Previous Common Cold Coronavirus Infection Could Protect Against COVID-19

According to a study published Monday in Nature Communications, people who build up high levels of immune cells from previous coronaviruses that cause the common cold could have some protection against COVID-19. Human Coronavirus has several different types including common human coronaviruses: 229E (alpha coronavirus), NL63 (alpha coronavirus), OC43 (beta coronavirus) and HKU1 (beta coronavirus). Other types include MERS-CoV (the beta coronavirus that causes Middle East Respiratory Syndrome, or MERS), SARS-CoV (the beta coronavirus that causes severe acute respiratory syndrome, or SARS), and SARS-CoV-2 (the novel coronavirus that causes coronavirus disease 2019, or COVID-19), according to CDC: https://www.cdc.gov/coronavirus/types.html 

People around the world commonly get infected with human coronaviruses 229E, NL63, OC43, and HKU1. The researchers were curious about why some people exposed to SARS-CoV-2 don't necessarily get infected, and it turned out that these people have high concentration of T memory cells from previous coronavirus infection. The study found that T cells created from other coronaviruses can recognize SARS-CoV-2 and provide immune protection. This elicits new ways to generate universal vaccines that targets the common proteins shared by the coronaviruses family to protect against future variant infection. 

This also posts other questions: why do some of the coronaviruses non-pathogenic or only generate mild symptoms like a cold while others lead to severe respiratory disease? What are the differences between the different strains? Understanding the key determinant of the pathogenic coronavirus strains can also help with universal vaccine production. 

-- Wenqi Song 

 

Are At-home Testing Kits Actually Reliable?

Coming back from winter break, everyone was required to immediately do an at-home antigen testing kit. It took 15 minutes and as soon as everyone got a negative result, we socialized mask-less like everything was normal. And this was great and all, but it got me wondering. How reliable are these at-home testing kits? Should we all be more cautious rather than immediately trust that everyone did the test correctly? Do we even know that this test can detect the new Omicron virus?

I recently found a post about this, on the Washington Post, saying at-home testing kits are very useful, however results are not always as accurate as you think. The kits are very useful in detecting a protein in the virus that causes COVID. Furthermore, it can detect the Omicron virus as well as other versions of COVID. However, because Omicron is a virus that primarily affects the upper respiratory tract, it would be more useful to use saliva to detect the virus rather than the typical nasal swab. Even with this, the FDA still recommend following the nasal swab instructions to have the most accuracy with the at-home testing. A PCR test using saliva, however, would still be the most accurate form of testing.

While at-home testing does have its perks, it also has its flaws. The at-home testing kit does not detect if you are still contagious on the last few days of infection. It also does not detect Omicron on the first few days of infection. So, while someone may get a negative test, they should treat it with caution if they have symptoms or came into contact with someone who tested positive. This means that the blind trust that my friends and I had with our at-home testing kits may have been a bit too fast to trust them, but we are all still negative, so perhaps there is some truth to them after all.

-Lauren Burch

Board, Editorial. “Opinion | Those Rapid at-Home Virus Tests Are Useful. but Look at Results with Caution.” The Washington Post, WP Company, 8 Jan. 2022, https://www.washingtonpost.com/opinions/2022/01/08/those-rapid-at-home-virus-tests-are-useful-look-results-with-caution/.

CORBEVAX Subunit Vaccine Pioneered for COVID-19 in Low Income Countries

     This article in NPR Goats & Soda (https://www.npr.org/sections/goatsandsoda/2022/01/05/1070046189/a-texas-team-comes-up-with-a-covid-vaccine-that-could-be-a-global-game-changer) discusses a new COVID-19 vaccine called CORBEVAX that is currently being manufactured for distribution in low and middle income countries such as India. CORBEVAX is not an mRNA vaccine, which makes it different from the Pfizer and Moderna COVID-19 vaccines that are very common in the United States.

    CORBEVAX is a subunit vaccine, which means that it uses proteins from the SARS-CoV-2 virus in order to mount an immune response. Other highly successful vaccines that make use of this technology are the Hepatitis B vaccine and the Human Papillomavirus (HPV) vaccine. 

    Interestingly, researchers Peter Hotez and Maria Elena Bottazzi from the Baylor College of Medicine began developing this vaccine during the first pandemic of SARS in the early 2000s. As we discussed in class, the global response to SARS was mounted very effectively, causing the outbreak to decline quickly. As a result, their vaccine was never tested. I thought this was really interesting, and I wonder how common it is that vaccines are created and then never tested/used because the spread of the virus decreases to such a large extent within the population. For instance, were U.S. scientists developing vaccines for the recent outbreaks of Zika/Ebola in case they ever spread rapidly through our country? Or do we tend to be more reactive than proactive, waiting to make vaccines until it’s almost too late?

    When the COVID-19 pandemic began, the scientists decided to see if they could use the same technology for SARS-CoV-2. Interestingly, though, the scientists said that no one wanted to fund or support their work because subunit vaccines were not as “innovative” as the mRNA vaccines that companies like Pfizer and Moderna were making. This statement confused me because I don’t understand why a vaccine technology would need to be “innovative” in order for people to want to support it. I would think that people would be more wary of novel vaccine technologies. As we learned in class, subunit vaccines for HPV and Hepatitis B are highly effective in preventing disease, so why would funders hesitate to support a technology that they know has worked well in the past? 

    Eventually, the researchers were able to test the vaccine. The vaccine has high efficacy (90%) against the original strain and almost as high efficacy for the delta variant (80%). Trials are currently underway to see whether it maintains this efficacy against omicron. One thing I learned from this article was that subunit vaccines are harder to modify than mRNA vaccines, which means that it is more difficult to adapt the vaccine technology when new strains of the virus become more common in the population. I think this lack of adaptability may pose a problem for combatting SARS-CoV-2, especially given how quickly new variants seem to be arriving. 

    One of the most important benefits of this vaccine, in my opinion, is its low cost. Each dose costs only about $1.50, which is much more accessible than the $15-20 per dose that the United States is currently paying for the Pfizer/Moderna vaccines. Furthermore, Hotez and Bottazzi have decided to allow any manufacturer to view the “recipe” for the vaccine, meaning that it can easily be manufactured worldwide. According to the NPR article, Pfizer and Moderna have not been transparent in this regard. I think the concept of intellectual property and patents when it comes to vaccines is really interesting, especially when thinking about who stands to benefit from the production and gatekeeping of these vaccines.

-Sophia Nesamoney

Codon Deoptimization As a Novel Way to Develop Live-attenuated Vaccines

I was listening to the podcast This Week in Virology and a very interesting episode caught my interest. The episode talks about a paper published by Dr. LuisMartínez-Sobrido's lab recently that focuses on developing a live-attenuated arenavirus vaccines using codon deoptimization method. Codon deoptimization is something that I've never heard of before but is really effective and meaningful in the field of vaccine development. Their work focuses on one of the arenaviruses - Lassa virus, the cause of Lassa fever, which currently doesn't have FDA approved vaccines. As we all know, many amino acids are coded by more than one codons. However, these codons don't have the same frequencies of being translated because all animals have a codon usage bias. Codon deoptimization is when all the preferred codons are replaced by non preferred codons, thus dramatically reducing the amount of proteins being made. By using codon deoptimization method, they made mutations in one of the nucleoproteins that plays an important part of virus life cycle and largely decreased the viral nucleoprotein translation, ultimately resulting in virus attenuation. 

I found this method really impressive and I think it is a promising way to generate more live-attenuated vaccines for other viruses. One concern mentioned by the paper is that codon deoptimization requires computer algorithms to design viral genomes with proper less preferred codons and the use of these new codons might result in different degrees of attenuation. Further improvement can be done in terms of generating consistent degrees of attenuation. 

Wenqi Song