The next pandemic is already happening – targeted disease surveillance can help prevent it

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  1. Buffaloed webmaster

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    The next pandemic is already happening – targeted disease surveillance can help prevent it


    [​IMG]

    Sustained surveillance for disease outbreaks at global hot spots may be the key to preventing the next pandemic.
    MR.Cole_Photographer/Getty Images

    Maureen Miller, Columbia University

    As more and more people around the world are getting vaccinated, one can almost hear the collective sigh of relief. But the next pandemic threat is likely already making its way through the population right now.

    My research as an infectious disease epidemiologist has found that there is a simple strategy to mitigate emerging outbreaks: proactive, real-time surveillance in settings where animal-to-human disease spillover is most likely to occur.

    In other words, don’t wait for sick people to show up at a hospital. Instead, monitor populations where disease spillover actually happens.


    The current pandemic prevention strategy
    Global health professionals have long known that pandemics fueled by zoonotic disease spillover, or animal-to-human disease transmission, were a problem. In 1947, the World Health Organization established a global network of hospitals to detect pandemic threats through a process called syndromic surveillance. The process relies on standardized symptom checklists to look for signals of emerging or reemerging diseases of pandemic potential among patient populations with symptoms that can’t be easily diagnosed.

    This clinical strategy relies both on infected individuals coming to sentinel hospitals and medical authorities who are influential and persistent enough to raise the alarm.

    Sentinel surveillance recruits select health institutions and groups to monitor potential disease outbreaks.

    There’s only one hitch: By the time someone sick shows up at a hospital, an outbreak has already occurred. In the case of SARS-CoV-2, the virus that causes COVID-19, it was likely widespread long before it was detected. This time, the clinical strategy alone failed us.

    Zoonotic disease spillover is not one and done
    A more proactive approach is currently gaining prominence in the world of pandemic prevention: viral evolutionary theory. This theory suggests that animal viruses become dangerous human viruses incrementally over time through frequent zoonotic spillover.

    It’s not a one-time deal: An “intermediary” animal such as a civet cat, pangolin or pig may be required to mutate the virus so it can make initial jumps to people. But the final host that allows a variant to become fully adapted to humans may be humans themselves.

    Viral evolutionary theory is playing out in real time with the rapid development of COVID-19 variants. In fact, an international team of scientists have proposed that undetected human-to-human transmission after an animal-to-human jump is the likely origin of SARS-CoV-2.


    Viruses jump species through a process of random mutations that allow them to successfully infect their hosts.

    When novel zoonotic viral disease outbreaks like Ebola first came to the world’s attention in the 1970s, research on the extent of disease transmission relied on antibody assays, blood tests to identify people who have already been infected. Antibody surveillance, also called serosurveys, test blood samples from target populations to identify how many people have been infected. Serosurveys help determine whether diseases like Ebola are circulating undetected.

    Turns out they were: Ebola antibodies were found in more than 5% of people tested in Liberia in 1982, decades before the West African epidemic in 2014. These results support viral evolutionary theory: It takes time – sometimes a lot of time – to make an animal virus dangerous and transmissible between humans.

    What this also means is that scientists have a chance to intervene.


    Measuring zoonotic disease spillover
    One way to take advantage of the lead time for animal viruses to fully adapt to humans is long-term, repeated surveillance. Setting up a pandemic threats warning system with this strategy in mind could help detect pre-pandemic viruses before they become harmful to humans. And the best place to start is directly at the source.

    My team worked with virologist Shi Zhengli of the Wuhan Institute of Virology to develop a human antibody assay to test for a very distant cousin of SARS-CoV-2 found in bats. We established proof of zoonotic spillover in a small 2015 serosurvey in Yunnan, China: 3% of study participants living near bats carrying this SARS-like coronavirus tested antibody positive. But there was one unexpected result: None of the previously infected study participants reported any harmful health effects. Earlier spillovers of SARS coronaviruses – like the first SARS epidemic in 2003 and Middle Eastern Respiratory Syndrome (MERS) in 2012 – had caused high levels of illness and death. This one did no such thing.

    Researchers conducted a larger study in Southern China between 2015 and 2017. It’s a region home to bats known to carry SARS-like coronaviruses, including the one that caused the original 2003 SARS pandemic and the one most closely related to SARS-CoV-2.

    Fewer than 1% of participants in this study tested antibody positive, meaning they had been previously infected with the SARS-like coronavirus. Again, none of them reported negative health effects. But syndromic surveillance – the same strategy used by sentinel hospitals – revealed something even more unexpected: An additional 5% of community participants reported symptoms consistent with SARS in the past year.

    This study did more than just provide the biological evidence needed to establish proof of concept to measure zoonotic spillover. The pandemic threats warning system also picked up a signal for a SARS-like infection that couldn’t yet be detected through blood tests. It may even have detected early variants of SARS-CoV-2.

    Had surveillance protocols been in place, these results would have triggered a search for community members who may have been part of an undetected outbreak. But without an established plan, the signal was missed.

    From prediction to surveillance to genetic sequencing
    The lion’s share of pandemic prevention funding and effort over the past two decades has focused on discovering wildlife pathogens, and predicting pandemics before animal viruses can infect humans. But this approach has not predicted any major zoonotic disease outbreaks – including H1N1 influenza in 2009, MERS in 2012, the West African Ebola epidemic in 2014 or the current COVID-19 pandemic.

    Gregory Gray and his team at Duke University recently discovered a novel canine coronavirus at a global “hot spot” through surveillance and genetic sequencing.

    Predictive modeling has, however, provided robust heat maps of the global “hot spots” where zoonotic spillover is most likely to occur.

    Long-term, regular surveillance at these “hot spots” could detect spillover signals, as well as any changes that occur over time. These could include an uptick in antibody-positive individuals, increased levels of illness and demographic changes among infected people. As with any proactive disease surveillance, if a signal is detected, an outbreak investigation would follow. People identified with symptoms that can’t be easily diagnosed can then be screened using genetic sequencing to characterize and identify new viruses.

    This is exactly what Greg Gray and his team from Duke University did in their search for undiscovered coronaviruses in rural Sarawak, Malaysia, a known “hot spot” for zoonotic spillover. Eight of 301 specimens collected from pneumonia patients hospitalized in 2017-2018 were found to have a canine coronavirus never before seen in humans. Complete viral genome sequencing not only suggested that it had recently jumped from an animal host – it also harbored the same mutation that made both SARS and SARS-CoV-2 so deadly.

    [The Conversation’s most important coronavirus headlines, weekly in a science newsletter]

    Let’s not miss the next pandemic warning signal
    The good news is that surveillance infrastructure in global “hot spots” already exists. The Connecting Organisations for Regional Disease Surveillance program links six regional disease surveillance networks in 28 countries. They pioneered “participant surveillance,” partnering with communities at high risk for both initial zoonotic spillover and the gravest health outcomes to contribute to prevention efforts.

    For example, Cambodia, a country at risk of pandemic avian influenza spillover, established a free national hotline for community members to report animal illnesses directly to the Ministry of Health in real time. Boots-on-the-ground approaches like these are key to a timely and coordinated public health response to stop outbreaks before they become pandemics.

    It is easy to miss warning signals when global and local priorities are tentative. The same mistake need not happen again.[​IMG]

    Maureen Miller, Adjunct Associate Professor of Epidemiology, Columbia University



    This article is republished from The Conversation under a Creative Commons license. Read the original article.
     
  2. LEAFANFORLIFE23 Registered User

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    We aren't even through this one yet and you are already trying to spread fear over the next one.

    Absolutely disgusting
     
  3. JMCx4 Gateway to Hockey

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    Fear is in the eye of the beholder.
     
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  4. TaLoN Red 5 standing by

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    Nothing fear mongering about the information in that article.

    Unless you're saying you only read the click bait title. I thought we were getting through to people that you need to read the article, not just the title.
     
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  5. mouser Business of Hockey

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    The title is really bad, and factually unsupported by the article. I can’t blame people for having a negative reaction.
     
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  6. JMCx4 Gateway to Hockey

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    At some point, the consumer of media content must share the blame. Negative reactions feed the beast.
     
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  7. TaLoN Red 5 standing by

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    I wholeheartedly agree, but that doesn't change my point. I realize the title is click bait, that's why I called it as such. We the consumers know these titles are click bait though and we need to get past that click bait to the actual substance.

    By feeding the shock and awe and ignoring the substance, we actually encourage more shock and awe.

    It's up to US to recognize this.
     
  8. Montag DP Sabres fan in...

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    That's true, but when the click-bait title does not accurately portray the content, I put most blame on the people who wrote it. That's just bad journalism, and intentionally misleading to boot. After all, it's the writers' job to come up with an appropriate title. You can't have a title that says one thing and then say "but you should have read the whole article" when someone takes it at face value. The title is the one-line summary.

    Another point is that when you draw people in with click-bait, you can't blame them for not reading the whole thing once they realize the article is not really about what the title said. That's the whole reason they clicked it, after all. If you hosted an event called "hot chicks in bikinis," but it was really about raising baby chickens, do you think most of the people who showed up would stay?

    It's a shame, because this is a good article but spoiled by someone who decided clicks were more important to them than sharing actual information.
     
    Last edited: Jun 1, 2021
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  9. TaLoN Red 5 standing by

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    I don't disagree, but we as consumers STILL know this is happening more often than not, don't we?
    If we as consumers can't get past this, how can we as consumers ever expect to drive it to change?

    It's the nature of the internet. Clicks drive the money and thus click bait drives the titles.
     
  10. mouser Business of Hockey

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    I am highly skeptical a negative feedback loop exists where media sites will reduce click bait titles if more people read the articles.

    I suspect increased readers would turn into a positive feedback encouraging even more click bait titles.
     
  11. Montag DP Sabres fan in...

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    See my edit. By making incorrect click bait titles, they are actively drawing in people who won't want to read it once they click. It's not the readers' fault. They were expecting something else, so why should they keep reading?
     
  12. TaLoN Red 5 standing by

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    So you suspect there is no way out of the loop at all... if that is the case, then it's even more vital than ever for the consumer to recognize this so they can filter and take in the relevant information in a perpetual format that is always going to be going for shock and awe.

    It still lies on us to recognize where the substance lies.

    So they can understand what is truly being said? What the actual facts are?

    If the system is being setup to get the most amount of people the least amount of information by title alone, shouldn't we as consumers go against that and actually try to make ourselves more aware of the situation in the first place?

    It's stuff like this that spreads like wildfire on facebook, where people share an article and everyone doing the sharing is only reading the titles that feeds into this whole world of misinformation at every level.

    Here I feel bad for @Buffaloed - sharing a great article, ruined by a horrible title.
     
  13. mouser Business of Hockey

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    The advertisers and websites get their revenue once you click. They don’t know whether you stay to read the article or not afterward. Though many sites will break up articles into multiple click pages to confirm continued reading (and extra ad revenue).

    The only real way for us to provide negative feedback—discouraging click bait titles—are to never click on them and read the article in the first place. Regardless of the quality of the article itself.
     
  14. TaLoN Red 5 standing by

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    Never click on the articles, yet everyone still reads the title and assumes they know. That's back to our original problem.

    The more sparse the clicks, the more outlandish they feel they need to make the titles to get the clicks in the first place.

    It's a broken system. You get no accurate information from the titles, yet it creates a lot of misinformation if you don't read it.
     
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  15. jd22 Registered User

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    I don't see anything clickbaity about the title, other than the misuse of 'pandemic'. Epidemic may be a more accurate term.

    Like the article says, there is not the first coronavirus found in humans. It is just the most widespread one.
     
  16. MikeyMike01 U.S.S. Wang

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    Reddit is worse than Facebook in this department
     
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  17. Big Phil Registered User

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    Welcome to the world in the last year and a half. It is like a sober person at a party where mostly everyone is drunk. The drunk people are paranoid over things that you already know is just hysteria.

    They already know the behaviour of people and just how much fear they can inject in you. If they can make a person wear a mask while biking on the sidewalk, or walking on the sidewalk, then that's a bad thing.
     

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