A controversy that has been brewing for several years in the world of influenza research may ignite again with the publication last week of a new paper that’s worth a read. I haven’t to date written about the controversy, which centers on what’s called “gain of function” research. In the case of flu, what is being gained (via lab manipulation) is the ability for flu to transmit easily from one lab animal to another. The strains being manipulated are already virulent, that is, causing severe illness; and novel — that is, humans have never experienced them before, and so have no immunity to them. Adding transmissible to virulent and novel brings flu into the territory of becoming a potential pandemic strain. That’s where the controversy is, and what this new paper addresses.
Cast your mind back to about this time a year ago. A novel strain of flu, influenza A (H7N9), had emerged in China, in the provinces around Shanghai. International health authorities were deeply concerned, because any new strain of flu bears careful watching — and also because, on the 10th anniversary of the SARS epidemic, no one knew how candid China would be about its cases.
By the time peak season for flu ended in China, there had been 132 cases and 37 deaths from that newest flu strain. But, confounding expectations, the Chinese government was notably open about the new disease’s occurrence, and scientists worldwide were able to ramp up to study it. Still, no one could say whether that flu would be the one to make the always-feared leap to a pandemic strain that might sweep the globe. As with other, earlier, worrisome strains of flu, science could only wait and see whether it might return.
And now it has.
Last week’s New England Journal of Medicine included a thoughtful meditation on the possibility that the new bird flu out of China, H7N9, could become a globe-spanning pandemic — and on how much knowledge is needed before we’ll be able to predict whether it will or not. The authors, all from the US National Institutes of Health, know a fair amount about pandemics: Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases; Dr. David Morens, Fauci’s senior advisor and a medical historian; and Dr. Jeffery Taubenberger, a physician and microbiologist who brought back to the world the viral cause of the worst pandemic: the influenza of 1918, which killed 100 million people.
In various combinations over the past 10 or so years, the three have written a number of papers looking back at the record fro 1918, interrogating its impact, and particularly examining the causes of its extraordinary death toll. So they are probably the perfect authors to write about gaps in knowledge about H7N9.
But aside from its useful examination of the virology, what struck me as most interesting about their paper is how soon it is to be able to write something like this. After all, H7N9 only emerged to public knowledge in late February, and so far has caused 132 cases and 37 deaths, all in eastern China. That these authors could write this paper now is yet another marker, I think, of how different this outbreak is from SARS 10 years ago, as well as how rapidly international public health science can move, if everyone cooperates.
In my last post 36 hours ago, I raised questions about Saudi Arabia’s apparent delay in reporting new cases of the novel coronavirus that has been causing low-level unease since last summer. (For the full history of that, check these posts.) So it’s only fair to say that, within 24 hours, the Saudi government behaved very differently with a new report.
The bad news is, the new report is about yet more cases of the novel virus. But the good news is, the report of the new cases was quickly shared internationally, by the government’s Deputy Minister for Public Health, via the international disease-alert mailing news ProMED.
I’m still catching up on all the news that happened during the weeks I was away, and I had a food-policy post just about set to go today. And then this happened.
I opened my morning mail to find a note from a private list I subscribe to, published by a company that monitors hazards for businesses with expatriate employees. The note flagged new news from Saudi Arabia:
Saudi Arabia: Seven more case of novel coronavirus reported
Seven people in Al-Ahsa governate in the Eastern province have been confirmed infected with the novel coronavirus. Five have died and the other two are critically ill in intensive care. It is unclear whether there are any links between these cases or whether they are “sporadic” infections. Overall the risk to travellers remains low.
This was odd. You’ll remember the new coronavirus, distantly related to SARS, which surfaced last year in a slow and not well-disclosed manner (for the back story, see these posts from last September, October, November and December). Since the initial reveal last year, there has been very little information released about the virus and whatever illness it might be causing. The World Health Organization has been monitoring the gradual accumulation of cases, but there has been almost nothing published since last fall. In fact, though teams from Columbia University and the Centers for Disease Control and Prevention have been to the Kingdom of Saudi Arabia to help investigate the new illness, neither entity has published anything since those trips were made. And at the point at which I opened my inbox this morning, the WHO’s last update on the new virus had been published on March 26.*
Meanwhile, of course, the infectious disease world has been riveted by the rapid emergence in China of a different virus, the new avian flu H7N9, and many questions have been aimed at whether the Chinese government, which attempted to conceal the emergence of SARS 10 years ago, has learned the lesson of transparency. (I talked about that history, and how the world found out about SARS, in this segment from On the Media a few weeks ago.)
Almost since H7N9 emerged in March, though, the WHO and other bodies have been averring that China is actually doing a good job this time around. And with this overnight news from Saudi, it seems that the questions about disease-outbreak transparency may have been directed at the wrong country.
By now you’ve no doubt heard that international health authorities are deeply concerned about a new flu strain that has surfaced in China: H7N9, which so far has sickened at least 16 people and killed six of them. The outbreak has a number of features that are troubling. It emerged rapidly; the first cases were announced five days ago, and the first death apparently occurred on Feb. 27. It is widely distributed: Confirmed cases have been found in three adjoining provinces that wrap around Shanghai, and also in Shanghai municipality itself. And it is novel: H7N9 has never been recorded in humans before.
For infectious-disease geeks, it’s that last aspect that raises a particular nervous thrill. Most of the time, most people take flu for granted, to the point of not bothering to be vaccinated against it because they assume it will not make them very sick. But every once in a while, flu defies expectations, and roars up into a pandemic: worldwide spread, high numbers of cases, high rates of death. When a pandemic occurs, almost definitionally, it is because of a new strain to which humans have no prior immunity. In human terms, H7N9 is a new strain.