What we aren't doing to stop another pandemic like the coronavirus

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Good afternoon, Dailies. This is Cliff, back in the driver’s seat for the newsletter for the rest of the week as Sy gets a break.

As of Thursday (Feb. 20), the outbreak of the novel coronavirus known as COVID-19 has infected more than 75,000 people and killed 2,130. While nearly all of the illness and death so far has occurred in China, where the outbreak began late last year, the virus has managed to sneak across nearly 30 national borders. Indeed, one significant development is that, after being largely contained to mainland China, the disease seems to be gaining a foothold (rather than a mere toehold) in several other Asian nations. South Korea now has 104 confirmed cases, according to Johns Hopkins University’s Center for Systems Science and Engineering, which maintains a daily dashboard for COVID-19; Japan has 94; Singapore, 84.

While it’s possible that the outbreak can be brought under control in the coming weeks or months, the concern among many experts is that things will get far worse before they get better. There are three reasons.

Call the first naivete: Humans seem to have no or little existing immunity to this novel strain of coronavirus. Second is pathogenicity: The virus has the ability to replicate efficiently in our bodies and can cause death or at least serious illness in many. And third is transmissibility: The microbe appears to pass easily from human to human. These are the textbook conditions for a pandemic.

With regard to the last, it’s not yet clear precisely how this virus spreads, though there appear to be multiple routes for transmission, including one newly suspected mode, fecal-to-oral spread. As for its pathogenicity, that’s evident as well. Though a large number of cases seem to be limited to relatively mild flu-like symptoms, roughly one in five of those infected get seriously ill. (The numbers requiring more substantial care might actually be much higher than that. According to one JAMA study published earlier this month, 26% of 138 patients in one hospital in Wuhan, China required treatment in the intensive care unit.)

Perhaps no surprise, much of the coverage has focused on these two factors—how and where it’s spreading and how sick people are getting. But the third issue—the strain’s newness to humans—ought to get far more attention than it has. The simple reason is that understanding the emergence of this virus can help us prevent the next pandemic.

Coronaviruses are incredibly plentiful and diverse. Two strains in particular, 229E and OC43, cause a large share of the common cold and other respiratory infections we mortals get each winter. The overwhelming majority of coronavirus strains affect mammals other than humans, however. The danger comes when one or more mutations enable a virus to “jump” from another species to man—a process called zoonosis. Two highly pathogenic strains, SARS and MERS-CoV (Middle Eastern Respiratory Syndrome), which each morphed from a bat-infecting coronavirus, have killed hundreds of people in recent outbreaks.

The sheer scale of these viral vaults is mindboggling. More than half of all human pathogens are believed to have jumped from animal viruses. “The three most devastating pandemics in human history, the Black Death, Spanish influenza, and HIV/AIDS, were caused by zoonoses, as were 60–76% of recent emerging infectious disease events,” wrote UCLA’s James O. Lloyd-Smith and colleagues in a widely cited 2009 Science paper. “We need models to reveal the points of vulnerability where intervention against zoonoses will be most effective, and to highlight the gaps in data collection. We need to know when particular zoonotic phases, i.e., reservoir transmission, spillover from animals to humans, stuttering transmission or incipient outbreaks among humans, can be targeted to optimize epidemiological outcomes while reducing cost.”

The good news is that, a decade later, we’re getting closer to deciphering these mysteries. We now have much better tools to identify zoonotic jumps—and importantly, to predict them—says Seth Berkley, the CEO of GAVI, the Vaccine Alliance, who is also a renowned medical epidemiologist.

Nonetheless, in a classic case of shortsightedness, we are currently starving the field of the investment it needs. Consider the 2021 federal budget that President Trump submitted to Congress earlier this month. The President requested $550 million for the Centers for Disease Control and Prevention’s entire program for researching and fighting emerging and zoonotic infectious diseases—$85 million less than the previous year’s allotment and less than 4% of what the President proposed for his new “space force.” (The total 2021 budget request for the CDC is about $5.6 billion, roughly a third of the space force haul.)

Presidential budgets aren’t just negotiating tools, of course; they’re mission statements. They tell us what the nation values and what we hope to accomplish—or, in this case, what we fear and hope to protect ourselves against. So what may be even more frightening than the actual dollars invested is the message: We’re not going to do much to stop the next pandemic.

As Berkley posed to me over the phone this morning: “Is this the big one or not—Who the hell knows? But if this is not the big one, it’s a very expensive and severe dress rehearsal for the big one. How do we get the world to pay attention to that?”

An urgent question.

Clifton Leaf, Editor in Chief, FORTUNE
clifton.leaf@fortune.com
@CliftonLeaf

DIGITAL HEALTH

Using deep learning to discover antibiotics. More on this soon—but I wanted to highlight a new piece published in the journal Cell about the prospect of using machine learning to discover promising new antibiotic candidates. This "deep learning" model from MIT researchers could, theoretically, spur the development of antibiotics by leveraging a "neural network capable of predicting molecules with antibacterial activity." In simpler terms: An algorithm might be able to identify antibiotic candidates that are different from the ones which exist today—a critical mission given the dearth of new antibiotics over the past few decades and the rise of "superbugs." (Cell)

INDICATIONS

The AbbVie-Allergan critics sound their latest alarm. A compendium of consumer groups and unions have been reprising their efforts to scuttle drug giant AbbVie's mega-deal to buy Allergan. The former firm markets the world's best-selling drug, Humira; the latter hawks Botox, among a number of other blockbuster treatments. For the deal to close, AbbVie and Allergan have agreed to a number of divestitures to address antitrust concerns. That doesn't quite go far enough, according to critics that include 17 consumer organizations and unions. In a letter, the groups maintained that divesting an experimental anti-inflammatory drug to British drug maker AstraZeneca would do little to quell AbbVie's dominance in the space. AbbVie's Humira has brought in nearly $20 billion in annual sales in recent years, and the company had another treatment called Skyrizi approved to treat psoriasis (and inflammatory disorder) last year.

THE BIG PICTURE

Coronavirus cases are falling in China—but vigilance is still critical. The World Health Organization (WHO) states that the number of new coronavirus cases in China is falling—but that's no reason to get lazy. "We are encouraged by this trend but this is no time for complacency," said WHO director general Tedros Adhanom Ghebreyesus on Thursday. As Cliff wrote, the death toll from coronavirus now stands at more than 2,000 people, nearly all of them in China. But the WHO is being extra cautious because of the potential for the pathogen's spread in other nations with weaker health systems. Vigilance remains the top priority. (Reuters)