Rhia's Kitchen : January 2020

Friday, January 31, 2020

New story in Health from Time: Inside the Company That’s Hot Wiring Vaccine Research in the Race to Combat the Coronavirus

Three months. That’s as long as Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases at the National Institutes of Health, is willing to wait to get a vaccine candidate against the latest coronavirus that he can start testing in people.

Since the virus was identified for the first time in people who fell ill with pneumonia-like symptoms in Wuhan, China, last December, the World Health Organization has declared this coronavirus outbreak, named 2019n-CoV, a public health emergency of international concern. In just over a month, more 11,000 people have tested positive for the virus in 18 countries, and more than 250 have died.

When it comes to infectious diseases like this one, vaccines are the strongest weapons that health officials have. Getting vaccinated can protect people from getting infected in the first place, and if viruses or bacteria have nowhere to go, they have no way to spread from person to person.

The problem is, vaccines take time to develop. Traditional methods, while extremely effective in controlling highly contagious diseases like measles, require growing large amounts of virus or bacteria, which takes months. Those microbes then become the key element in a vaccine — the so-called antigen that alerts the human immune system that some foreign interlopers have invaded the body and need to be evicted.

However, researchers at Moderna Therapeutics, Cambridge, Mass., have developed a potential shortcut to this laborious process that could shorten the time it takes to develop vaccines against ongoing outbreaks like the current coronavirus. They’re turning the human body into a living lab for churning out the viral red flags that activate the immune system.

Vaccines essentially give the immune system a crash course in recognizing and rallying defenses against disease-causing microbes like bacteria or viruses. They do this by priming the immune cells with a taste of what they’re supposed to recognize — in some cases vaccines contain killed or compromised bacteria or viruses that aren’t able to cause disease, but still set off alarms to the immune cells that they are foreign and unwelcome intruders. Once the body sees these microbes, they can make antibodies that mark them for destruction, and these antibodies remain as sentries for recognizing future invasions by the same microscopic marauders.

Other vaccines educate the immune system by simply exposing immune cells not to the microbes themselves, but only the proteins that the viruses or bacteria make; enough of these foreign proteins can also prime immune cells to recognize them as unwelcome.

Researchers at Moderna hot wired this process by packing their vaccine with mRNA, the genetic material that comes from DNA and makes proteins. Moderna’s idea is to load its coronavirus vaccine with mRNA that codes for the right coronavirus proteins and then inject that into the body. Immune cells in the lymph can process that mRNA and start making the protein in just the right way for other immune cells to recognize and mark them for destruction. Dr. Stephen Hoge, president of Moderna, explains that “mRNA is really like a software molecule in biology.” “So our vaccine is like the software program to the body, which then goes and makes the [viral] proteins that can generate an immune response.”

Because this method doesn’t involve live or dead viruses, it can be scaled up quickly — a necessity as new diseases emerge and work their way quickly through unprotected populations.

And there are health benefits to this strategy as well. “One of the things that we are able to do with an mRNA vaccine is more closely mimic what it means to get a viral infection,” says Hoge. “The way the body processes the viral protein can and often is very different from the way it processes the same protein made in a stainless steel tank. So one of the theoretical advantages of putting mRNA in a vaccine is that the body then makes the viral protein in the exact same way the virus would have instructed the host to do.”

The first step in developing this vaccine, which is being funded by the Coalition for Epidemic Preparedness Innovations, was deciding which proteins made by the 2019-nCoV virus should be included in the vaccine. Chinese scientists publicly posted the genomic sequence of the newly identified coronavirus on Jan. 10, so from that, researchers at the NIH settled on a genetic snippet that coded for proteins they believed were most likely to alert and trigger alarms for the human immune system. When they sent the team at Moderna their picks, scientists at the company began writing the genetic ‘software’ for their vaccine — in the form of the mRNA instructions that the human body’s cells would need to make the coronavirus protein. To be safe, the team picked a leading viral protein to seed a vaccine, and six backup proteins as well.

That process is ongoing, as the team works to continuously debug the software, ensuring that the final mRNA product is as biological stable and reliable as possible. Within a few weeks, when a satisfactory mRNA is made, it will become the key component of the vaccine that’s developed to test in people. Then, says Hoge, “we will be more deliberate and careful in all of the manufacturing steps to make sure we’re doing it in a high-quality way because at the end of the day, this is going to go into humans.”

If the vaccine is effective in generating strong immune reactions against this coronavirus, it could serve as a template for other vaccines against as-yet unknown coronaviruses that might emerge in coming decades. That’s because once the scientists know the genetic makeup of a virus, they can pick out the specific proteins it uses to make people sick, and create the mRNA coding for that protein to put into a vaccine. “Fundamentally and conceptually, it would not be a big deal to do that, says Fauci. “We would be ahead of the game.”

New story in Health from Time: Wuhan Coronavirus Could Test the Trump Administration’s Ability to Respond to a Crisis. Experts are Worried

As a new strain of coronavirus moves from the Wuhan province of China to other parts of the world, including the United States, public health leaders are advising government officials to embrace a deliberate, measured response.

But with President Donald Trump at the helm of an often unpredictable administration, infectious disease and epidemic experts tell TIME they’re concerned about which officials will have the President’s ear, and how the Commander-in-Chief will manage his Twitter presence during a potential pandemic.

On Friday, Health and Human Services Secretary Alex Azar announced that, against the advice of the World Health Organization, the U.S. was declaring the coronavirus a public health emergency and denying entry to any foreign national who “poses a risk” of transmitting the virus. The WHO on Thursday had recommended against limiting trade and movement; doing so can potentially exacerbate the problem by encouraging those in impacted areas to move through underground channels and stigmatizing the sick.

Experts say the coronavirus may be coming at a time when the administration is unprepared. Several high-level health officials have left the administration in the last few years and significant vacancies remain.

Trump began his administration with Rear Admiral Timothy Ziemer, a long-time official who had served under President George W. Bush and Barack Obama, leading a global health security team on the White House National Security Council. But Ziemer left in 2018, and has not been replaced. White House homeland security adviser Tom Bossert, who had called for a strong biodefense strategy to deal with pandemics and other attacks, also left in 2018.

Preparatory efforts have also been stymied. Under the Trump administration, funding for the All-Hazards Preparedness and Advancing Innovation Act, which authorizes programs in HHS that develop responses to threats such as pandemics or bioterrorist attacks, was allowed to lapse for nine months. It expired in September 2018 and was not reauthorized until June 2019.

On Wednesday, the White House announced a special coronavirus task force, and experts told TIME they were heartened to see it would include serious-minded leaders including Azar, CDC Director Dr. Robert Redfield and National Institute of Allergy and Infectious Diseases Director Dr. Anthony Fauci, who has led the country’s infectious disease response since 1984.

But other aspects raised red flags. Rebecca Katz, director of Georgetown’s Center for Global Health Science and Security, noted that the task force was “missing some major players in the world of global health security”: there is no one from the Department of Defense, the U.S. Agency for International Development or the Department of Agriculture. Those voices could be crucial if the government must respond to a contagious disease that spread between humans and animals, and is moving around the globe.

Some experts also told TIME they worried that Azar, who is heading the task force, may struggle to make himself heard within an administration known for its personnel fights, rapid turnover, and fiefdoms. While the Secretary is broadly respected among health experts, he has reportedly found himself enmeshed in administration drama in recent weeks.

“Once you have multiple agencies and departments involved, you have to have somebody at the White House who is who is informed, who has had some experience, and understands what all of these departments and agencies are supposed to do and can bring them together, and do the staffing and represent the President,” said Asha George, executive director of the Bipartisan Commission on Biodefense.

Without Ziemer’s team in place at the White House, George noted that the national biodefense strategy the administration was developing in 2018 has not been implemented.

The White House has not yet said whether it will appoint a “czar” to oversee all coronavirus response efforts as President Barack Obama did during the 2014 outbreak when he named Ron Klain as “Ebola czar.”

“The area where people are perhaps concerned is at the White House level,” says Jennifer Nuzzo, a senior scholar at the Johns Hopkins Center for Health Security. “There are good people at the White House that are working hard on these issues. They just don’t have the same seniority as perhaps existed previously. Having seniority is important if and when there’s a need to move money around or direct agencies to do certain things.”

Before he was President, Trump’s response to the Ebola outbreak was less than measured. He fired off all-caps alarmist tweets, called for airports to unilaterally close and questioned the information being put out by the Centers for Disease Control and Prevention.

“It’s all these little things that can just scare people unnecessarily,” says Tara C. Smith, an epidemiologist at Kent State University who studies infections that are transferred between animals and humans, like the Wuhan coronavirus. Panicking prematurely can also lead to stigmatizing groups that people think are associated with a virus, Smith said. In this case, Chinese people have already reported being targets of racist scrutiny as disinformation and fear about the virus has spread.

So far, Trump’s response has been more measured, but not entirely informed. Hours after the World Health Organization (WHO) declared the coronavirus a global emergency on Thursday, Trump tweeted: “Working closely with China and others on Coronavirus outbreak. Only 5 people in U.S., all in good recovery.”

Working closely with China and others on Coronavirus outbreak. Only 5 people in U.S., all in good recovery.

— Donald J. Trump (@realDonaldTrump) January 30, 2020

But at that point, a sixth case of the virus had already been confirmed, and public health experts said it was not yet clear that those infected were “all in good recovery.”

It can be problematic under any circumstances when elected officials make statements that contradict or cast doubt on public institutions, but the stakes are even higher during an outbreak, experts warned. “It undermines trust not only during these kinds of crisis situations where there is a potential epidemic looming, but also in the day to day,” Smith says. “We see a lot of people that don’t trust the CDC with their vaccine information or local public health with their information.”

All of the experts who spoke to TIME stressed that they are confident in the leadership at the CDC, National Institutes of Health and other health agencies. The concern is whether information from those agencies is efficiently and calmly relayed to the American people.

Trump is still facing his impeachment trial, and has recently clashed with Iran, North Korea and has had a fraught relationship with China. The administration’s response has not caused problems yet, experts say, but as new information about the coronavirus keeps coming, more of the mechanisms in place will be put to the test.

New story in Health from Time: U.S. Declares Public Health Emergency Over Coronavirus and Will Deny Entry to Foreign Nationals Who Have Been in China

The Trump Administration on Friday declared an outbreak of novel coronavirus a public health emergency in the U.S. and announced that it will temporarily deny entry to any foreign national who “poses a risk” of transmitting the virus.

Specifically, the Administration will temporarily deny entry to any foreign national who has been in China, members of the Trump Administration’s Coronavirus Task Force announced Friday. The policy’s only exceptions are for immediate family of American citizens and permanent U.S. residents.

Additional new temporary measures will take effect beginning Sunday at 5 p.m., U.S. Department of Health and Human Services Secretary Alex Azar announced Friday. Americans returning to the U.S. who were in Hubei province — the epicenter of the outbreak — 14 days prior to returning to the country will be subject to up to 14 days of a mandatory quarantine, “to ensure they’re provided proper medical care and health screening,” Azar told reporters at a White House press briefing.

Additionally, any citizens who were in mainland China 14 days prior to returning to the U.S. will be placed in a “self-imposed” quarantine for 14 days. They will also under a health screening at selected ports of entry upon arrival.

Despite these drastic measures, Azar emphasized that risk to the American public remains low, and said these efforts are a way to keep risk low. Nearly 10,000 people have been infected by the virus worldwide and 213 have died, mostly in mainland China.

The decision stands in contrast to remarks made just yesterday by the World Health Organization (WHO), which declared the outbreak a public health emergency of international concern (PHEIC) but emphasized that “there is no reason for measures that unnecessarily interfere with international travel and trade.” The agency reiterated that it “doesn’t recommend limiting trade and movement.”

“The actions we have taken and continue to take complement the work of China and the World Health Organization to contain the outbreak within China,” Azar said.

The WHO traditionally opposes limiting travel, since it can stigmatize those who are sick, force people in affected areas to move through underground channels and discourage nations from aiding public-health response efforts. The agency made similar warnings last year, when it declared the Ebola outbreak in the Democratic Republic of the Congo a PHEIC.

The U.S. has been unusually aggressive in its travel policies during the coronavirus outbreak. Earlier Friday, the U.S. Centers for Disease Control and Prevention (CDC) announced that it would quarantine 195 people who were evacuated to California from the outbreak’s epicenter in Wuhan for a period of 14 days. The U.S. has not enacted a quarantine for at least 50 years, CDC officials said on a call with reporters Friday, calling the agency’s decision an “unprecedented” response to an “unprecedented public-health threat.”

Twenty major U.S. airports are also set up to screen travelers for signs of coronavirus.

Food over football: Americans are more excited about the grub than the game, study suggests

Food over football: Americans are more excited about the grub than the game, study suggests

A new study suggests that half the attendees could care less if you were screening “The Lion King,” just as long as there are wings.

Wine pairings for big game's most popular snack foods

Wine pairings for big game's most popular snack foods

In case you didn’t know, the Super Bowl is coming.

New story in Health from Time: Want to Protect Yourself from Coronavirus? Do the Same Things You Do Every Winter

Many Americans likely grew a little nervous after the U.S. Centers for Disease Control and Prevention (CDC) announced Thursday that a novel coronavirus has spread for the first time within the U.S. But agency officials and other doctors have a simple message for Americans: keep doing what you’re doing to stay healthy.

“The best things that you can do are the things that we generally recommend at this time of year to prevent the spread of infectious diseases,” Dr. Nancy Messonnier, director of the National Center for Immunization and Respiratory Diseases, said during a Jan. 30 call with reporters. “Wash your hands, cover your cough, take care of yourself and keep alert to the information that we’re providing, because we’ll provide new information as it becomes available.”

In Asia, the novel coronavirus known as 2019-nCoV is spreading rapidly, and has reached far enough to warrant being designated a public health emergency of international concern by the World Health Organization. As of noon Friday, it has infected nearly 10,000 people, most of them in mainland China, and killed 213. But public health officials have emphasized that risk to the American public remains low, and spreading within the U.S. has so far been limited to one wife-to-husband transmission.

While 2019-nCoV has never been seen before, it’s part of a family of viruses that are well-known both to doctors and the public; the common cold, for example, can be caused by certain coronaviruses. And while influenza is not a coronavirus, it isn’t so different from 2019-nCoV, either. Both result in symptoms including cough and fever, and—from what scientists can tell so far—both seem to be spread mainly via respiratory droplets and close person-to-person contact.

For those reasons, experts are recommending prevention measures in keeping with those deployed during a normal flu season. The CDC has not recommended that Americans wear protective masks or take dramatic measures against coronavirus. Messonnier did emphasize during Thursday’s call that people who have been in Wuhan, China—where the outbreak originated—or spent time around people who have traveled from the area should monitor themselves for symptoms of coronavirus, such as cough, fever and respiratory distress. These people should call their health care provider and stay home from work or school if any symptoms develop.

Aside from that, though, there’s not much Americans can or should do at this point, beyond the usual measures.

“Good hand-washing helps. Staying healthy and eating healthy will also help,” says Dr. Sharon Nachman, a pediatric infectious disease specialist at New York’s Stony Brook Children’s Hospital. “The things we take for granted actually do work. It doesn’t matter what the virus is. The routine things work.”

And while the flu shot won’t protect against coronavirus—and there’s no vaccine for the new virus yet—experts are still recommending that people get vaccinated against influenza if they haven’t yet, since the likelihood of getting the flu in the U.S. is far higher than contracting coronavirus. (For context, the CDC estimates that around 19 million Americans have gotten the flu so far this season, compared to only a handful who have developed coronavirus domestically.) As long as flu virus is still circulating, it’s not too late to get a flu shot.

New story in Health from Time: Can Face Masks Prevent Coronavirus? Experts Say That Depends

A new coronavirus outbreak, which originated in the Chinese city of Wuhan and has spread throughout Asia and globally, has prompted people around the world to buy medical face masks in hopes of preventing infection.

Retailers in the U.S. and across the Internet are running out of antiviral face masks as the number of confirmed cases of the coronavirus (2019-nCoV) now exceeds 9,700 globally. More than 200 people have died from the virus in China, where the majority of the 2019-nCoV cases have been detected. The World Health Organization declared a global health emergency on Thursday as the outbreak continues to spread. As of Friday morning, the United Kingdom and Russia had both confirmed their first cases of the viral infection.

Local government officials in Wuhan have required that people wear face masks when they go out in public places to prevent the spread of infection. Health experts tell TIME that such a move is probably effective in the city, where a person is more likely to come in contact with someone who is infected than in other parts of the world.

But in the U.S., where just six cases of the coronavirus have so far been detected, wearing face masks will not be that effective, experts say. That’s largely because, according to public health workers, there is no sustained person-to-person transmission of the new coronavirus in the U.S., making face masks not yet necessary.

“People believe wearing masks will protect them against a novel organism they’re scared about,” says Saskia Popescu, a senior infection prevention epidemiologist at a private healthcare system in Phoenix, Ariz. “I understand the fear, but the U.S. is at a very low risk for this right now.”

Here’s what to know about using face masks in connection with the new coronavirus.

What does the CDC say about using face masks?

The Centers for Disease Control and Prevention (CDC) does not currently recommend that people in the U.S. wear face masks in public to prevent infection. Dr. Nancy Messonnier, director of the National Center for Immunization and Respiratory Diseases, told reporters during a press call on Thursday that the best preventative measures include washing hands and covering coughs.

The CDC has issued guidelines on two different kinds of face masks — surgical masks and N95 respirators — which are commonly worn by health care professionals and those who are already sick.

Typical surgical masks usually found at pharmacies (and which were sold out on Amazon and other e-tailers as of Friday) are approved by the U.S. Food and Drug Administration to protect the wearer against large droplets or splashes of bodily and infected fluids from others, according to the CDC.

Wearing surgical masks does not prevent a person from inhaling smaller airborne particles; they are not considered respiratory protection by the CDC. Surgical masks are also loose fitting, and when the wearer inhales, there is potential for particles to leak in or out of the sides.

N95 respirators are recommended for healthcare professionals by the CDC in the event they are treating patients who are infected by the new coronavirus. The N95 masks, which require testing and approval by the CDC, are tight fitting and filter out at least 95% of airborne particles.

Although N95 respirators are sold to the public, health and infectious disease experts caution against non-medical professionals wearing them. N95 masks are supposed to be fit tested to ensure they work correctly, so people who are not trained could put them on the wrong way, negating preventative effects, says Dr. Peter Rabinowitz, a director of the MetaCenter for Pandemic Disease Preparedness and Global Health Security at the University of Washington. He adds that N95 masks are difficult for people to wear effectively for prolonged periods of time.

“They tend to slip and change position. It’s easy for air leaks to develop, even if they’re fitted correctly,” he says.

Can face masks prevent diseases?

Studies on the efficacy of face masks in preventing diseases are inconclusive, largely because they have only been conducted on healthcare professionals in their workplace settings. In general, studies have found that if workers use face masks, the risk of spreading disease as they deal with infected patients is reduced, according to experts.

For members of the public, the effects of using face masks are not well known. But experts say already sick and infected people who can’t avoid going outside — especially those who will be in confined spaces or hospital waiting rooms — should wear masks to avoid spreading germs.

“It’s not foolproof, but it does keep you from coughing out infectious particles with any respiratory virus,” says Dr. Marybeth Sexton, assistant professor in the Division of Infectious Diseases at Emory University School of Medicine.

People who aren’t sick should not rely on masks as a way of preventing respiratory infections, according to Popescu, who notes that surgical masks offer “limited protection” against contracting illness. While face masks can be helpful in stopping the spread of germs in certain situations — like when people are in close quarters on a train or packed into a waiting room — they are unlikely to stem the outbreak of the new coronavirus.

“You’re more likely to contract the coronavirus through continued exposure versus being outside walking about,” Popescu says.

What are more effective preventative measures to avoid coronavirus?

Advice from the CDC and health experts on better preventative measures against viruses like the novel coronavirus or influenza is fairly straightforward and involves basic everyday actions.

To help stop the spread of respiratory infections, it is recommended that people wash their hands often, avoid touching their faces, keep distance from people who are sick and to stay inside if they are sick.