We need early warning to detect epidemics before they grow into pandemics, public health to lead the response, and protective equipment to reduce baseline transmission. For this last, the American Pandemic Preparedness plan includes $5.2B. 1/18
IV Building Core Capabilities

8. Personal Protective Equipment: $3.1B. Develop better protective gear for the next pandemic and update buildings to block transmission. 2/
+ N95s are imperfect, uncomfortable, and ugly: we need reliable, comfortable, and fashionable
+ Easy to manufacture is key to making enough for everyone
+ Respiratory is the big one, but worth blocking surface transmission too 3/
+ Cheap building upgrades might go far in blocking transmission
+ Example: Far-UVC LEDs in every lightbulb could kill airborne viruses without harming us
+ Example: Ventilation is hugely protective vs respiratory viruses; now add air curtains 4/
- No mention of powered air-purifying respirators as an example goal of near-100% blocking
- No funds to make next-gen PPE once developed, support commercial ventures, etc 5/
Key question: would it help us in a pandemic with a 30% mortality rate? I wouldn’t go out in an N95, but would w/ a powered air-purifying respirator. Want essential workers to keep things running? Give them near-perfect protection. 6/
I’d like to see PPE – readily manufactured, cheap enough for all, and 99+% protective for the average user – that is comfortable enough to be worn all day and fashionable enough for the runway. Involve designers in development! 7/
If everyone had a private, comfortable HEPA-filtered air supply (and couldn’t touch their face while wearing it), we wouldn’t need to fear truly nasty pandemics. When it’s life or death, eat at home. At least there’d be food. 8/
With good built environment tech that optimizes ventilation, uses air curtains to control aerosols, and degrades single-celled microbes and viruses, we’d be considerably safer, perhaps even able to eat safely in public. 9/
I’m particularly excited by far-UVC light, which studies suggest doesn’t harm our eyes or skin while doing a number on anything without an epidermis. We need more tests of that, and LEDs to make it. 10/
These are the kinds of tech we need to be completely safe from pandemics. Unlike vaccines, they’ll always work: if it can’t get to you, it can’t infect you. I’d like to see more than $3.1B devoted to it, but will take what we can get. 11/
9. Robust Internal Supply Chain: $2.1B. Refill our stockpiles of protective gear and make sure we can produce needed equipment in-country. That includes active pharmaceutical ingredients (APIs). 12/
+ Stockpiles of protective gear are a must
+ In-country sourcing
+ APIs, including for antibiotics (1918 flu killed by secondary infections) 13/
- This amount won’t outfit even 50 million essential workers with a powered respirator
- Let’s prioritize R&D first, then stockpile aggressively as the tech improves 14/
APIs = active pharmaceutical ingredients needed to make pharmaceuticals. I’m skeptical about antivirals, but not about antibiotics, which would likely have saved most people who died of secondary infections from 1918 influenza. 15/
As for gear, powered air-purifying respirators run about $1000. If we ordered 50 million it’d cost ~half that or less. So ~$25 billion to outfit essential workers with today’s state of the art. R&D can make it better/cheaper, but only so much. 16/
As for gear, powered air-purifying respirators run about $1000. If we ordered 50 million it’d cost ~half that or less. So ~$25 billion to outfit essential workers with today’s state of the art. R&D can make it better/cheaper. 16/
Again with the goal: ensuring all essential workers have PPE sufficient to do their jobs in the teeth of a 30%+ lethality pandemic. To get there, we need to develop it. But we also need to buy enough. This won't suffice. 17/
That’s it for protective tech that, with early warning, will make pandemics and biological weapons obsolete. Funding this is exactly what we should do, only more so. Tell Congress! Tomorrow: biosafety, biosecurity, and catastrophic risk. 18/18

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More from @kesvelt

16 Sep
Let’s not fool ourselves. Containing an epidemic before it becomes a pandemic is difficult.

But CDC and FDA failed us. Their incentives aren’t suited to emergencies; politics made it worse. Lots of people died. The White House plan includes reforms. 1/20
@kmvnarayan14, Curran, Foege, and many others have suggested solutions, including a politics-resistant Federal Reserve model for pandemic preparedness and an independent advisory board to call out failures in real-time. 2/
I’d go further: in a pandemic emergency, new leaders incentivized to act fast and at scale should take over. You don’t run clinical trials in a 30% lethality pandemic; you get shots into arms as they’re developed and track what happens. 3/
Read 19 tweets
15 Sep
The American Preparedness Plan includes one section and $2.0B on preventing accidental and deliberate pandemics. That’s… not much given the $$$trillion cost of (comparatively mild) SARS-CoV-2 and the $714 billion Pentagon budget. 1/20
First, the elephant in the room: there currently isn’t enough evidence to determine the origin of SARS-CoV-2. It’s widely acknowledged that the pandemic might have arisen from a natural spillover, a virus hunter getting infected, or a lab escape. 2/
If we agree COVID-19 arose from either spillover or lab escape, then lab-caused pandemics must be 1) plausible, and 2) able to kill more Americans than died in combat in all wars combined. Perhaps we should take this seriously. 3/
Read 22 tweets
14 Sep
Interested in preventing future pandemics? SecureDNA, an int’l academic/commercial project, seeks a development manager (+Rust & Python coders soon) to prevent the unauthorized synthesis of pandemic viruses & bioweapons. 1/7
Today, it’s all too easy to make nasty things from synthetic DNA, as only members of the International Gene Synthesis consortium (~80% of all DNA) voluntarily check orders for hazards. It’s expensive and requires human experts. 2/7
If someone were to disclose how to make a new pandemic virus, anyone with the relevant lab skills could follow reverse genetics protocols, order it from synthetic DNA, and assemble it. That’s far too many people. 3/7
Read 7 tweets
13 Sep
Early detection and pandemic monitoring systems will warn us of new threats and track spread, but containment will be up to public health. The American Pandemic Preparedness plan tries to ensure that it’ll be up to the challenge. 1/
If a pandemic is like a forest fire, pharmaceutical treatments are the chemical fire suppressants, while public health measures the prophylactic firebreaks, controlled burns, brush-clearing, etc that keep it from spreading 2/
Unlike a forest fire, medical countermeasures take time to develop (if possible at all), so prophylaxis is doubly important. Tiny brushfires are easily controlled, massive infernos not so much. Speed is crucial. 3/
Read 21 tweets
6 Aug
I'm deeply worried about future pandemics & nastier agents. Nature doesn’t try to kill us; humans will. This e-print details a universal early-warning system: a “Nucleic Acid Observatory” (#NAO).
All catastrophic bio-threats grow exponentially
All bio is made of nucleic acids
To detect all threats, deep sequence wastewater + rivers & look for exponentially growing fragments (k-mers)
Why a Nucleic Acid Observatory? @EricLander46: “to keep future viruses from becoming pandemics… (we need) early-warning systems to spot new biological threats anywhere in the world soon after they emerge” washingtonpost.com/opinions/2021/…
Read 21 tweets
11 May 20
Can tracing alone control COVID?

Our model: it's possible if we >double efficacy by changing how we trace & use digital apps.

Thanks to @willbradbio, @EthanAlley, @jhhhuggins, & epidemiologist @alun_l !


Tl;dr: We need bidirectional tracing to find infectors and undiagnosed carriers, and almost everyone’s smartphones should “chirp”. Combined = we win… in the optimistic scenario. Else add masks or distancing.

Right now, we “forward-trace” to find and isolate people who were exposed so they don’t infect anyone else.
Problem: many cases are undiagnosed, especially if asymptomatic, so we miss branches of the viral family tree.

Read 21 tweets

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