Thread by @kesvelt

Imagine a future in which thousands can start new pandemics at will. It’s likely coming.

It’s also solvable.

To safeguard civilization, we need to delay misuse, reliably detect threats, and build defenses to prevent infection. A biodefense roadmap:

1/25
dam.gcsp.ch/files/doc/gcsp…

Leo Szilārd wrote: "science, which has created the bomb and confronted the world with a problem, has no solution to offer to this problem."
I'm certainly no Szilárd, but I do have experience inventing exponential biotech, and there are ways to obviate catastrophic bioterrorism.

Surprisingly, few of the solutions involve biomedicine. Omicron infected 26% Americans within 100 days of ID in Africa. The 100 Days Mission is epic and should be funded, but won’t be fast enough to combat multiple pandemics released in travel hubs.
100days.cepi.net

So what are the answers? We don’t have them ready yet, so we’d best delay.

To start, let's refrain from characterizing high-risk viruses in the lab to learn which ones are likely pandemic-capable, i.e. share blueprints for an arsenal of plagues.

https://twitter.com/kesvelt/status/1445887108179243008

Again, write to @USAID and ask them to reform DEEP VZN to remove the laboratory characterization steps. Redirect funds to ensure vulnerable communities in hotspots can identify epidemics and sequence the responsible agent within 1 day (via nanopore).

samharris.org/podcasts/makin…

We could go further and sign a pandemic test-ban treaty that would ban the narrow set of laboratory experiments required to substantially raise our confidence that a given virus would cause a pandemic (and aren't useful for anything else)

jfklibrary.org/learn/about-jf…

Perhaps best: catastrophic liability and insurance. Pass a trigger law: anyone causally linked to an event causing >1m American deaths, no matter how indirectly, can be held liable, and general liability insurance must cover this (up to a cap given the astronomical cost).

To conduct research with a nontrivial chance of such a catastrophe, like pandemic virus identification (but almost nothing else), institutions would have to pay to cover the downside risk as determined by expert insurance risk assessors.

If @USAID wanted to identify natural pandemic viruses or @NIH wanted to fund virus enhancement work because they viewed the benefits as greater, they could do so, but only if they covered the cost of the downside risks that are currently offloaded onto taxpayers.

Finally, we can ensure that all DNA synthesis providers and next-gen benchtop devices screen orders, with immediate updates to cover newly identified pandemic genomes. In short, fully automated screening with cryptography to protect trade secrets.

secureDNA.org

Detect

Suppose a new pandemic respiratory virus has effects similar to HIV: no acute symptoms, long incubation period, but lethal years later. It would infect most of the world before we knew it was there. The end.

Solution: a Nucleic Acid Observatory.

arxiv.org/abs/2108.02678

Once we spot an emerging threat, targeted wastewater monitoring (@BiobotAnalytics) and rapid diagnostics - such as Cas12/Cas13-based methods - can determine which communities have been affected, and within those communities, who has been infected.

sherlock.bio/sherlock-biosc…

Defend

Imagine you work in food production in close contact with others. A new pandemic, 50% lethal, is as transmissible as omicron. Do you keep going in with only a mask offering 95% protection?

If many decline to risk their lives for inadequate pay, societies will collapse.

That’s why we need pandemic-proof PPE (P4E). It needs to be ~100% protective without requiring fit-testing, so we can send it to all essential workers within days of a new pandemic. The Atlantic’s @jdkstern13 wrote about this in depth:

theatlantic.com/science/archiv…

A list of all essential workers (w/supply chain analysis), a stockpile of enough P4E units, and reliable delivery within a week would completely defuse the threat of a highly transmissible + lethal pandemic.

Cost? Less than a new aircraft carrier.

cnet.com/pictures/meet-…

But we don’t want to wear PPE all the time. To handle the early and late stages, when we’re stamping out brushfires, we want people to take precautions only when needed. The solution: personalized early warning based on social connections.

The idea, first pioneered by @PoShenLoh, is to tell you how many 1-degree (your contact), 2- (friends’ contacts), 3-, 4-, and 5-degree contacts have been infected, so you know how at-risk you are before you get exposed… and can take precautions.

arxiv.org/abs/2010.03806

What I hope to see: a project uniting cryptographers and @EFF to develop a decentralized privacy-preserving early warning system, engineers to fine-tune proximity sensing, and @Google and @Apple agreeing to roll it out as OS updates when the next pandemic comes.

But the best pandemic defense would block transmission without people having to do anything at all. Ventilation is great, but expensive. Upper-room germicidal needs high ceilings and fans. We need to cleanse the air passing between two people in conversation. And we can.

Go low enough in wavelength, and light starts to be absorbed by proteins, meaning it can no longer penetrate our skin and eyes. But it’s still germicidal to tiny viruses and bacteria. That means our light fixtures might save us from the next pandemic.

The @ACGIH recently raised its safe exposure limit for 222nm light to a level that can eliminate 90% of viruses per minute. That’s nearly 10x better than the best aircraft or hospital ventilation system… and they stack.

tandfonline.com/doi/full/10.10…

Better still, preliminary experiments suggest that much higher levels of low-wave light are safe.

If we could inactivate most viruses in the air or on surfaces within a second or two, that would be the end of pandemics. And the flu, and common cold, and most infectious disease!

One thing I hope to arrange: comprehensive safety studies of much higher levels of low-wave light. Skin, eyes, wounds, ozone, VOCs, everything.

Let’s invite the world to share suggestions/concerns, listen, design experiments together, & run pre-registered studies in replicate.

To those weary of pandemics, this may seem excessive.
Consider that the detection and defensive investments will also work for natural and accidental pandemics.
Nature isn’t trying to kill us, but it could still crash civilization if we're unlucky.

Let's not take the chance.

How likely is pandemic terrorism?

We know of one mass murderer - Seiichi Endo - who, if he lived today and pandemic blueprints were available, would have both the skills and the intent.

That’s a 2% risk per year since the dawn of biotech.

Best we prepare our defenses.

Thanks to G. Epstein, R. Casagrande, G. Lewis for reviews, @willbradbio, @anjali_gopal + more in my lab, and @DavidRelman, @AndyWeberNCB, @JaimeYassif, @RickABright, @T_Inglesby, @gregkoblentz, @FilippaLentzos, @JonasSandbrink @JacobSwett, and others for highlighting the threat

@willbradbio @anjali_gopal @DavidRelman @AndyWeberNCB @JaimeYassif @RickABright @T_Inglesby @gregkoblentz @FilippaLentzos @JonasSandbrink @JacobSwett Anyone who prefers a more condensed scientific style manuscript over the policy version, you can find it here:

drive.google.com/file/d/1YF0F7D…