Friday, February 14, 2020

Harvard Expert Warns, Coronavirus Likely Just Now "Gathering Steam"

The number of confirmed cases of the Wuhan coronavirus have continued to surge inside China, sickening tens of thousands, with a death toll of more than 1,000. But outside the Asian giant the numbers remain a fraction of that, a trend Harvard’s Marc Lipsitch views with suspicion.
Lipsitch thinks it is just a matter of time before the virus spreads widely internationally, which means nations so far only lightly hit should prepare for its eventual arrival in force and what may seem like the worst flu season in modern times.
Lipsitch, professor of epidemiology at the Harvard T.H. Chan School of Public Health and head of the School’s Center for Communicable Disease Dynamics, talked to the Gazette about recent developments in the outbreak and provided a look ahead.

Q&A with Marc Lipsitch

GAZETTE: We spoke about the Wuhan coronavirus outbreak about a week and a half ago. What do we know now that we didn’t know then?
LIPSITCH: We know that the spread is even greater than it was then. It was likely then that it would spread more widely, but there was still hope for containment. I think now that it’s in more countries — even Singapore, which is really good at tracing cases, has found some cases that aren’t linked to previous known cases — it’s clear that there are probably many cases in countries where we haven’t yet found them. This is really a global problem that’s not going to go away in a week or two.
GAZETTE: You indicated that the rapid increase in cases was largely due to existing cases that hadn’t been diagnosed rather than new infections. Is that still your sense, or is some of the daily increase in cases due to new transmission?
LIPSITCH: It’s clearly partly due to new transmission — and it was partly due to new transmission then. Separating out reporting delays from new transmission is hard, but over the last few days, it appears that the rate of increase in new cases in China has slowed relative to the exponential growth we saw before. Some people are cautiously hopeful that that’s due to the success of control measures rather than the inability to count many cases. I think that’s possible, since the control measures have been rather extreme in some places. So, now the question is whether these control measures are working or whether we’re mostly seeing a saturation in their ability to test thousands of cases.
GAZETTE: When we talk about control measures, I think the one that’s most obvious to people who are following this are the quarantines. Are there other things going on that are also important?
LIPSITCH: For the cutting off of Wuhan, cordon sanitaire is probably a better word for it because the movement restrictions apply to everybody, not just the exposed people. They’re not exactly quarantined. Then there’s the quarantine of people who are sick and may or may not have the coronavirus, along with the isolation of people who have the coronavirus. All of that may be helping. We’ve had some concerns based on news reports that the way they’re doing the bulk quarantine and isolation of cases could be harmful in China, but it’s very hard to get a clear answer on what exactly is being done. The early reports said that they were taking people who were confirmed corona cases and putting them together in mass quarters with people who were not confirmed as corona but might have a fever or respiratory symptoms. If that was true, that could spread the virus further. Since then, I’ve heard a number of times that that’s not actually true. So I don’t know what to think of that. It doesn’t seem like the sort of thing a responsible public health agency would do.
GAZETTE: Has it become apparent that the virus is either easier to transmit or more deadly than previously thought? Or are these increasing case and fatality numbers in line with what our thinking was a week ago?
LIPSITCH: The ease of transmission is still being confirmed. In terms of the so-called “R-nought,” or how many secondary cases a single case infects, experts’ assessment is getting tighter around a level of transmissibility that’s perhaps lower than SARS, which was about 3 and higher than pandemic flu, which can be up to about 2. But what makes this one perhaps harder to control than SARS is that it may be possible to transmit before you are sick, or before you are very sick — so it’s hard to block transmission by just isolating confirmed cases.
GAZETTE: Is that the most concerning new information, that it might be transmissible before symptoms are apparent? That would seem to make this a lot trickier.
LIPSITCH: Yes. I think that’s the most concerning piece, but the evidence for that so far in the public domain is pretty limited. I’ve seen hints that aren’t published yet, but the evidence for that that’s been peer reviewed is quite limited. On severity, estimates are that it’s worse than seasonal flu, where about one in 1,000 infected cases die, and it’s not as bad as SARS, where 8 or 9 percent of infected cases died. I’ve been working with some colleagues on estimates. They’re preliminary still but bounded by those two. That’s a large range, however, so the important question is where the final figure ends up, because 3 or 4 percent of cases dying would be much more worrisome than 0.4 percent.
GAZETTE: Is it significant that there are so few cases internationally compared with the number in China? Is that an indication that control measures are working or is it just gathering steam internationally?
LIPSITCH: Unfortunately, I think it’s more likely to be that it’s gathering steam. We’ve released a preprint that we’ve been discussing publicly — and trying to get peer reviewed in the meantime — that looks at the numbers internationally, based on how many cases you would expect from normal travel volumes. And a couple of things are striking. One is that there are countries that really should be finding cases and haven’t yet, like Indonesia and maybe Cambodia. They are outside the range of uncertainty you would expect even given variability between countries. So our best guess is that there are undetected cases in those countries. Indonesia said a couple of days ago that it had done 50 tests, but it has a lot of air travel with Wuhan, let alone the rest of China. So 50 tests is not enough to be confident you’re catching all the cases. That’s one bit of evidence that to me was really striking. Second, I was reading The Wall Street Journal that Singapore had three cases so far that were not traced to any other case. Singapore is the opposite of Indonesia, in that they have more cases than you would expect based on their travel volume, probably because they’re better at detection. And even they are finding cases that they don’t have a source for. That makes me think that many other places do as well. Of course, we’re making guesses from limited information, but I think they’re pretty likely to be correct guesses, given the totality of information.
GAZETTE: People have said a vaccine is probably at least a year away. Do you have a sense that this is going to need a vaccine to finally bring it under control?
LIPSITCH: That seems like the scenario which is most plausible to me right now. Vaccine efforts are very much needed, but I think we should be clear that they won’t necessarily succeed. There’s a lot of effort being put into them, but not every disease has a vaccine. [Tedros Adhanom Ghebreyesus, director-general of the World Health Organization, said Tuesday that a vaccine could be ready in 18 months, according to CNN.]
GAZETTE: But what is most important for the public to know about this?
LIPSITCH: There’s likely to be a period of widespread transmission in the U.S., and I hope we will avert the kind of chaos that some other places are seeing. That’s likely if we continue to be prepared, but I think it’s going to be a new virus that we have to deal with. That won’t be because the United States government has failed to contain it, it will mean that this is an uncontainable virus. If we’re dealing with it, it’s because everybody’s going to be dealing with it. I think that’s a likely scenario.
GAZETTE: From a treatment standpoint, it seems there are a lot of mild cases and then fewer serious cases that need respiratory support. Should hospitals and the medical establishment start thinking about capacity-building now?
LIPSITCH: To the extent that’s possible, yes, but I don’t know how flexible that capacity is. I think we should be prepared for the equivalent of a very, very bad flu season, or maybe the worst-ever flu season in modern times, since we’ve had ventilators and been able to provide intensive respiratory support. And it might not be real flu “season” because the annual flu season is already passing. One question I’ve gotten a lot is whether it will go away in warmer weather, like SARS did. I’m not at all convinced that SARS went away because of the warmer weather. I think it went away because people got it under control in May and June. But there is some evidence — and we’re working on quantifying it — that coronaviruses do transmit less efficiently in the warmer weather. So it’s possible that we will get some help from that, but I don’t think that will solve the problem, as evidenced by the fact that there’s transmission in Singapore, on the equator.
GAZETTE: Once people get this and recover, do we know whether they will have immunity?
LIPSITCH: That is a very important question, but we don’t know the answer yet because it’s been too short a time. The evidence from other coronaviruses is that there is some immunity but it doesn’t last for long. Immunity to the seasonal coronaviruses lasts for maybe a couple of years, and then you can get reinfected. There’s a further question of whether that’s because the virus is changing or because your immunity is not very durable. Given that it’s a new virus, we can’t say anything with certainty, but it would be reasonable to expect immunity to be somewhat short-lived, meaning a couple of years, rather than lifelong.
GAZETTE: So without a vaccine, you may have a respite for a year or two but then you may get it again?
LIPSITCH: Yes, and that is a bit like the flu, although typically people get the flu every five or six years.

Thursday, February 13, 2020

In Shocking Admission, WHO Advisor Says Coronavirus May Infect Over 5 Billion People

From Zero Hedge:

In yet another sign of the World Health Organization's about-face on the coronavirus outbreak, a top epidemiologist and advisor to the organization said Thursday that if the virus isn't contained soon, it could infect 60% of the global population - or more than 5 billion people - echoing projections made by a Hong Kong scientist who was once labeled an alarmist despite his pioneering work in the fight against SARS.
According to Bloomberg, that's what WHO advisor Ira Longini said after finishing a study of the virus's transmissibility. His estimates suggest that the virus could one day infect billions of people, far more than the ~60,000 or so cases as of earlier on Thursday.
If the virus truly has a mortality rate of 2% (around the low end of current estimates), at this rate, it would kill more than 100 million.
Of course, if the virus manages to spread so widely, it will unequivocally prove that China's draconian quarantines weren't effective enough, and that the government effectively set itself up for failure when it hesitated to try and contain the outbreak after it first emerged in Wuhan late last year.
Ira Longini
In recent days, Dr. Tedros, the WHO's director-general, has warned that we might be seeing only "the tip of the iceberg" in terms of cases, and that a new rash of infections in Europe could lead to another widespread outbreak.
Longini based his numbers on an r-sub-zero of between 2 and 3, meaning that the average infected person will spread the virus to two or three other people.
In recent days, growing attention has been paid to the lack of reliable virus tests, not just in China, but in virtually all countries where the virus has spread. The difficulties in diagnosing the virus could mean we see another sudden surge of cases - but this time, it could be even larger than last night's dump from officials in Hubei.
Even if we could find a way to reduce the virus's ability to spread by half, it would could still wind up infecting more than 2 billion people.
"Unless the transmissibility changes, surveillance and containment can only work so well," Longini, co-director of the Center for Statistics and Quantitative Infectious Diseases at the University of Florida, said in an interview at WHO headquarters in Geneva. “Isolating cases and quarantining contacts is not going to stop this virus."
Longini, a researcher and scientist who has spent his entire career focusing on infectious diseases, is hardly the only scientist making dire warnings.
Neil Ferguson, a researcher at Imperial College London, estimated that as many as 50,000 people may be infected each day in China, and more recently warned that we could still be in the "preliminary stages" of the outbreak.
As always, other scientists warned that the situation is in flux, and readers should take these findings with a grain of salt before they panic.
The estimates of spread are part of a spectrum of possibilities that could unfold as the epidemic progresses, said Alessandro Vespignani, a biostatistician at Northeastern University in Boston. The next few weeks may provide more information about how easily the disease spreads outside China, particularly if more measures are put in place to control it, he said.
"People change behaviors" in response to disease, he said. "This is kind of a worst-case scenario. It’s one of the possibilities."
But as Dr. Tedros said earlier this week, it's still early days. And if Beijing doesn't start being a little more honest with the international community, we might not be able to take the necessary steps to combat the spread until it's too late.

US Continues Crackdown On Huawei, Adds Racketeering Conspiracy Charge

From Zero Hedge:

One would think that with the US and China now in a trade war truce, tensions over the key pawn in the global tech war, China's telecom giant Huawei would finally be easing. One would be wrong.
According to Bloomberg, as part of the ongoing crackdown on Huawei, the US has now added a RICO charge, or "racketeering conspiracy", against the Chinese telecom provider - which in the past was reserved largely for criminal mob cases -  tripling the penalties the Chinese company would face if convicted.
Huawei was already facing a series of criminal charges for allegedly violating U.S. sanctions against Iran and North Korea.
The new charge steps up U.S. pressure on Huawei. The government already had banned the company’s technology and accused Huawei of aiding Beijing in espionage. Now the company faces even more significant criminal penalties, which could be up to 3x the sought damages, if prosecutors win a conviction in federal court in Brooklyn, New York.
In return, Huawei has accused the U.S. government of orchestrating a campaign to intimidate its employees and launching cyberattacks to infiltrate its internal network. The accusations have ratcheted up tensions between Huawei and the Trump administration.
Meanwhile, as Bloomberg reminds us, as the criminal case against Huawei moves forward, the prosecution of its chief financial officer, Meng Wanzhou, remains on hold. She is fighting extradition from Vancouver, Canada, after being arrested at the request of the U.S. last year. She was accused by the US of defrauding banks when she made a presentation to one of its major banking partners and lied about by lying Huawei’s business dealings in Iran, in violation of U.S. sanctions.

Soldiers now testing robot snakes, electric combat scooters and thermal-masking blankets

In the hills and woodlands of western Georgia, soldiers in squad to company-sized teams are running mock battles, testing out the latest, greatest and weirdest tactical-level gear that the Army hopes will give them the edge in a rapid, complex, fight of the future.
The Army Expeditionary Warrior Experiments this year focused on six categories: lethality, mission command, mobility, survivability, sustainment, team and soldier performance.
The AEWE began in 2004 to focus modernization effort on the small unit. They run in two phases, the first phase, from October to January, are standalone and live fire events with each system.
The force-on-force experiments begins in February and will run for three weeks. The annual event culminates on March 17 with a an “Insights Day” at Fort Benning, Georgia, that includes briefings on gear tested and how soldiers used it during the experimentation, Maneuver Battle Lab spokeswoman Monica Manganaro told Army Times.
Below is a just small sampling of a few of the 68 items listed for experimentation in six categories.
Cerberus GL UCAV
A 14 pound 3-shot, 40mm grenade-firing bot, this drone puts tactical-level loitering munitions in the hands of the small unit for fires support, basic aerial reconnaissance and battle damage assessments. The platform can fire explosive, flash, smoke, infrared and tear gas rounds and fly for 22 minutes at ranges up to 2 miles. It can also accommodate a laser rangefinder and swap out payloads to use a netgun for opposing drones, 12 gauge rounds and micro munitions. (Skyborne Technologies Pty Ltd.) ARC-Response
This shot-tracking, 1.6 ounce sensor is embedded in rifle or pistol handgrips. The device monitors, timestamps and geolocates all weapon use and weapon discharge in a given area. It uses a rechargeable battery that can run for 96 hours. The autonomous battle coordination system allows commanders to monitor and respond to “ground-level incidents in real time.” (Armaments Research Company, Inc.)
PDX carbine
The 6.75-pound, 18.5-inch suppressed 5.56mm rifle with collapsible stock for soldiers rides with vehicles like the Bradley Infantry Fighting Vehicle or M1 Abrams tank. For day-to-day activities in permissive and semi-permissive environments, key leader engagements and urban settings, the weapon offers more firepower than a pistol but fits within vehicles, allowing for more maneuver room. (Maxim Defense Industries, LLC)
LETS/MACS-B Unmanned System Technology
This air and ground robot system deploys multiple drones from an unmanned ground robot to run rapid 3D-mapping of an area. The system can run autonomously and share data across networked devices. It can also be controlled for more fine-tuned use by a soldier. During force-on-force operations, soldiers can use the system for target acquisition, reconnaissance and mapping, as well as compile data for advanced fires planning. (Army Combat Capabilities Development Command Armament Center)
Guardian S-robot
This snake-like robot gives soldiers the ability to check out subterranean, confined space or unstructured environments. The multipurpose unmanned ground vehicle can transmit visual, audio and data intelligence to the user. It can carry up to a 10 pound payload, including sensors for chemical, biological, radiological and nuclear detection. Its range extends to 1,000 feet and can operate for up to three hours. (Sarcos Corporation)
This tactical level radar kit can be mounted at sites across an area and will remotely monitor enemy movement. The system can detect human movement up to 500 meters and vehicles at up to 1,000 meters away. First displayed at the 2017 AEWE, upgrades include an integrated GPS, ruggedized connectors, MPU5 radios and wireless operation. (ELTA North America)
This scooter-like ATV can ride either with a soldier driving or semi-autonomously. It can carry up to two people and pull a two-wheel, specially designed trailer for casualty or equipment transport. Both two- and four-wheel versions are available. It can fold onto itself for storage and transport. (Mistral Inc.)
Knee and ankle exoskeletons
The novel pneumatic exoskeleton is designed to reduce fatigue and give soldier knees more endurance for carrying loads or changing elevation. It can also help troops maintain peak running and walking speeds for longer when on flat ground. (Roam Robotics Inc.)
Ametrine thermal blanket
Material made using ametrine technology can shelter soldiers from thermal detection. It conceals heat signatures and can be used in forms like blankets, uniforms, or even a vehicle cover. (Federal Resources)
Audio gunshot detector
This body-worn system uses a wireless radio link to detect the source of small-arms fire and present that location on a visual display unit. It provides the direction and distance of the threat, allowing soldiers to collect information for targeting without having to see a shooter. That, coupled with other sensors, can help identify a target. (QinetiQ North America)
Safe Shoot friendly fire prevention
The weapons-mounted mesh networked radio system senses a weapon’s azimuth, angle and communication network backchannel to determine if a friendly entity is in the path of the weapon. It then provides immediate, automatic and autonomous alerts directly to the shooter. (Mistral Inc.)
Single soldier-portable micro generator
The P3 can provide consistent electrical output of 1 to 2 kilowatts and fits in a medium-sized backpack configuration, weighing 20 to 34 pounds. The microgenerator can run on any combustible liquid and is designed for low thermal output and sound attenuation. The microgenerator gives platoons with power requirements an “on-the-go” logistics option. (Enginuity Power Systems)
Bell Autonomous Pod Transport
The APT is a scalable drone that comes in two variants, one can carry up to 20 pounds and the other, 70. The larger version has a 48 kilometer range in under 30 minutes. With vertical takeoff, it does not rely on runways or roads. An all-electric system, it reduces fuel needs. And with swappable pods APT can support various missions from chemical-biological detection, to radio transmission/retransmission, to medical resupply. (Bell)
The system integrates heads-up display goggles and weapons sensors to track weapon orientation, shot counting and downrange gunnery. It connects with existing platforms such as Nett Warrior, adding human performance data. The system can help commanders quantify shooter ability to engage targets accurately and consistently and identify weapon location and orientation. (FN America, LLC)
CRG Total Exposure Health Sensor Pod System
This system is designed to monitor varying air quality exposure. The sensor collects total exposure data for a variety of common volatile compounds and logs that information wirelessly into a system that can be adjusted to specific environments. The pods can be deployed in field environments or industrial settings. (CRG, Inc.)