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<a class="gmail-domain gmail-reader-domain" href="http://nautil.us/issue/83/intelligence/the-man-who-saw-the-pandemic-coming?fbclid=IwAR3JYKyZZN9oJbJ5LWh5gmYTqV8CJb6cACJApHKs-2IA0hGmA8AAeO8mOfc">nautil.us</a>
<h1 class="gmail-reader-title">The Man Who Saw the Pandemic Coming <br></h1>
<div class="gmail-credits gmail-reader-credits">By Kevin Berger
March 12, 2020</div><div class="gmail-credits gmail-reader-credits"><font size="1"><a href="http://nautil.us/issue/83/intelligence/the-man-who-saw-the-pandemic-coming?fbclid=IwAR3JYKyZZN9oJbJ5LWh5gmYTqV8CJb6cACJApHKs-2IA0hGmA8AAeO8mOfc">http://nautil.us/issue/83/intelligence/the-man-who-saw-the-pandemic-coming?fbclid=IwAR3JYKyZZN9oJbJ5LWh5gmYTqV8CJb6cACJApHKs-2IA0hGmA8AAeO8mOfc</a></font></div>
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<p><span>D</span>ennis Carroll doesn’t mean to sound callous when he
says the coronavirus outbreak was predictable. And he doesn’t. He sounds
sympathetic to people frightened by the outbreak. He has been an
eyewitness to people around the world suffering from similar viruses.
Most of all, Carroll sounds authoritative.</p><p>For decades, Carroll
has been a leading voice about the threat of zoonotic spillover, the
transmission of pathogens from nonhuman animals to us. Scientists are
confident the current outbreak, which began in Wuhan, China, stemmed
from a virus inherent in bats. In 2009, after years of studying
infectious diseases at the Centers for Disease Control and Prevention,
and the United States Agency for International Development (USAID),
Carroll formed a USAID program called PREDICT, where he guided
trailblazing research into viruses hiding, and waiting to emerge, in
animals around the world.</p><p>“Dennis is a visionary,” says Christine
K. Johnson, an epidemiologist at the One Health Institute at the
University of California, Davis, where she is a professor in the School
of Veterinary Medicine. “He took the reactive approach to infectious
diseases and turned it on its head. He said, ‘We’re going to work on a
proactive approach to help countries prepare for the emergence of
infectious diseases.’” Johnson, an investigator at PREDICT for 10 years,
says Carroll was a pioneer in looking beyond livestock. “Dennis saw
that emerging infectious diseases, far and wide, have mostly come from
wildlife, and there needed to be investment in research in the wildlife
sector.” For a decade, PREDICT received annual federal funding of $15 to
$20 million. In 2019, its funding wasn’t renewed. Carroll left USAID
and formed a new program, the <a href="https://www.globalviromeproject.org/overview" target="_blank">Global Virome Project</a>, “to build on PREDICT’s scientific insights and experience,” he says.</p><blockquote><p>This is a global event. It is going to hit every community everywhere in the world.</p>
</blockquote><p>In conversation, scientific insights, based on his
experience, emerge from Carroll with a sting, whether he’s talking about
the biology of viruses or the stagnant response to the outbreak from
the White House. I began by asking about the source of the outbreak.<br></p> <img src="http://static.nautil.us/16967_910f5043d869086f1835d993448cd3a4.png" alt="Berger_BREAKER-1" width="733"><span class="gmail-caption"><strong>on site:</strong> While in Vietnam being filmed for the recent Netflix documentary series, <i>Pandemic</i>, Dennis Carroll took a moment to pose with two members of the Vietnamese crew.</span><span>Courtesy of Dennis Carroll</span><p><b>How did the current coronavirus pass from a bat to humans?</b></p><p>We
don’t know specifically, but presumably the virus was being shed by the
animal in the market, and humans were proximal. Or it could have been
that people were directly handling the animal. There may have been a
secondary source. In the 2002 SARS outbreak in China, we didn’t see
people’s direct exposure to bats as the source of infection. There was a
secondary source, a wildlife animal, the civet cat.</p><p><b>Could the transmission have resulted from people eating the wildlife?</b></p><p>Typically
the preparation of the animal is where you have exposure. By the time
it’s cooked and prepared, the virus would have been dead. It’s more
common that transmission is through the animal shedding or people
slaughtering the animal, when they’re exposed to bodily fluids, blood,
and secretions. With the avian influenza from poultry, a lot of the
exposure and infections go back to the preparation of chicken for
cooking. In Egypt, for instance, when you look at who was infected, more
common than not it was a woman, directly responsible for slaughtering
and preparing the animal.</p><blockquote><p>We think of ourselves as special. But viruses are infecting us with the same purpose they infect a bat.</p>
</blockquote><p><b>In 2018, you and colleagues wrote in <i>Science</i>,
“Our ability to mitigate disease emergence is undermined by our poor
understanding of the diversity and ecology of viral threats.” What do we
need to understand about the diversity and ecology of viral threats?</b><br></p><p>The
first thing to understand is that whatever future threats we’re going
to face already exist; they are currently circulating in wildlife. Think
of it as viral dark matter. A large pool of viruses are circulating and
we don’t become familiar with them until we see a spillover event and
people getting ill.</p><p><b>Do bats have a particularly high potential for spillover?</b></p><p>Certainly.
We’ve been able to identify bats as reservoirs for coronaviruses and
documented specific bat populations as reservoirs for Ebola virus. We
want to understand how each of these bats operate within an ecosystem.
Do they have certain behaviors and practices that either keep them
remote from or proximal to human populations? The bat population in
which we isolated the Ebola virus in West Africa was a species of bat
that also tends to co-roost within human housing, so it elevates the
opportunity for spillover.</p><p><b>Have there been disturbances in their environments that have brought bats closer to us?</b></p><p>The disturbances in their environments are us. We’ve penetrated deeper into ecozones we’ve not occupied before.</p><p><b>What’s a telling example of our incursion?</b></p><p>In
Africa, we see a lot of incursion driven by oil or mineral extraction
in areas that typically had few human populations. The problem is not
only moving workers and establishing camps in these domains, but
building roads that allow for even more movement of populations. Roads
also allow for the movement of wildlife animals, which may be part of a
food trade, to make their way into urban settlements. All these dramatic
changes increase the potential spread of infection.</p><p><b>Are spillover events more common now than 50 years ago?</b></p><p>Yes. <a href="https://www.ecohealthalliance.org/" target="_blank">EcoHealth Alliance</a>,
an NGO, and others, looked at all reported outbreaks since 1940. They
came to a fairly solid conclusion that we’re looking at an elevation of
spillover events two to three times more than what we saw 40 years
earlier. That continues to increase, driven by the huge increase in the
human population and our expansion into wildlife areas. The single
biggest predictor of spillover events is land-use change—more land going
to agriculture and more specifically to livestock production.</p><blockquote><p>I’m stunned by the absolute absence of global dialogue for what is a global event.</p>
</blockquote><p><b>Is there something specific about a virus that makes it zoonotic?</b><br></p><p>You
can argue viruses aren’t living organisms. They’re sheets of proteins
encapsulating some DNA or RNA. Beyond that, they have no machinery to be
able to live on their own. They’re looking for an ecosystem that has
all of the other cellular machinery essential for replication. They
can’t live outside another animal population. They need that animal to
replicate. And we’re just one more animal. We think of ourselves as
something special. But viruses are infecting us with exactly the same
purpose they infect a bat or a civet cat.</p><p><b>Viruses live on a delicate balance, don’t they? They have to be able to thrive without killing their host.</b></p><p>Right.
The ones that kill off their host quickly will disappear. With the SARS
virus, it’s no surprise that killing 10 percent of its host, it wasn’t
able to establish itself as a pandemic virus on this planet.</p><p><b>Are there any signs that this coronavirus will kill itself?</b></p><p>This
one has a lower pathogenicity. The lower its virulence, the more likely
it’ll become part of an endemic, part of a seasonal event. That’s one
of the big things that’s going to be a worry. If it does go quiet over
the summer months, then the question’s going to be, “Is it still
infecting people?” We could be walking around in the middle of summer
with influenza viruses, but they’re not active. They’ve just gone quiet.
When the right ecology comes into play, it starts getting cold, and
damp, then it starts replicating like crazy. If it’s able to park
itself, and not kill its host over the summer months, then we’ve got a
virus that has all the telltale signatures of establishing itself as
part of our normative landscape, much to our detriment.</p><p><b>Do you think the current outbreak was inevitable?</b></p><p>Oh,
sure. It was predictable. It’s like if you had no traffic laws and were
constantly finding pedestrians getting whacked by cars as they crossed
the street. Is that surprising? No. All you need to do is to better
manage how we set up crosswalks, how we establish traffic rules and
regulations. We’re not doing that. We’re not establishing the kind of
safe practices that will minimize the opportunity for spillover. If we
better understood where these viruses are circulating and understood
that ecology, we would have the potential to disrupt and minimize the
risk of spillover.</p><p><b>Why aren’t we—governments and policymakers—doing that?</b></p><p>First,
this is an expanding problem driven by unprecedented population change.
It’s only in the last 100 years that we’ve begun adding people at a
rate that’s causing this incredible disruption of the larger ecosystem.
If you and I were having this discussion 100 years ago, there were 6
billion fewer people on this planet. It took us the better part of our
total existence of the species, 300,000 years, before we hit the 1
billion mark. But in 100 years we’ve added 6 billion people and we’ll
add another 4 to 5 billion before the end of this century.</p><p>Second,
governments and society by and large are governed by inertia. We don’t
change and adapt and evolve very quickly. And we’re barely cognizant as a
global society that the world we’re living in today is fundamentally
different than the world our species has ever lived in. You know that
old saw that if you drop a frog in a pot of boiling water, it will leap
out. But if you take that same frog and put it in a pot of ambient water
and slowly crank up the temperature, it will stay in that water and
boil to death. It loses perspective on the changing environment around
it. We’re that frog in the ambient water. We’re oblivious to the
conditions that have enabled zoonotic viruses to become integrated into
us.</p><blockquote><p>There are things about this outbreak that are not being talked about. Those are the things that worry me the most.</p>
</blockquote><p><b>What first really opened your eyes to the scale of the spillover problem?</b><br></p><p>You mean my Saul on the road to Damascus moment?</p><p><b>Exactly.</b></p><p>It
was avian influenza in the 2000s. What you saw with avian influenza was
a direct consequence of how much poultry was being produced to feed
people. If you look at China today, it produces something on the order
of 15 to 20 billion poultry per year. But if you went back and you
looked at the data from the 1960s, you see that, at best, only a few
hundred million poultry were under production. When you look in
Bangladesh, Vietnam, and elsewhere in Asia and Indonesia, you see that
the amount of poultry that was being produced 50 years ago was orders of
magnitude less than poultry being produced today. That’s a consequence
of more people and more purchasing power. One of the things we know
about household purchasing power is that when you have disposable income
in your hands, you’re going to move from a root- or grain-based diet
and try to get animal protein. And that’s what happened.</p><p><b>One statistic that jumps out of what you wrote in <i>Science</i> is
there are 1.67 million viruses on Earth and an estimated 631,000 to
827,000 have the capacity to infect people. That’s pretty frightening,
no?</b></p><p>On one level it is pretty frightening. But on another
level the potential to infect doesn’t necessarily correlate with illness
and death. Some viruses may not have any consequence at all. And some
may be involved in enhancing our own biology. They could become part of
our microbiome. It’s nothing new in the course of evolution. We have to
be open to the idea that viruses aren’t simply our enemies, that they
may have an important and positive role to play for us. We found that
out about bacteria. At the same time, we have to keep our eyes open and
be cautious about the pharmaceuticals we take. If we’re taking
broad-spectrum antivirals, they could be opening up other complications.</p><p><b>How would you describe the general attitude of the United States government toward the threat of zoonotic diseases?</b></p><p>It’s
not just the U.S. government but governments at large and the private
sector—we don’t invest in risk. Talking about zoonotic diseases is
different than talking about tuberculosis or malaria. Those are
tangible. They are clear and present problems. Zoonotic diseases are an
emerging problem. But we as a society don’t invest in things that are
not kicking our door down.</p><p><b>The coronavirus is kicking our door down now, don’t you think?</b></p><p>Yes,
it’s got everyone’s attention. But this coronavirus will fall off the
headlines and when it does, you will see a contraction in the kind of
investments that are made in it. We have war budgets and then no monies
during peacetime. So part of the challenge—it’s a social engineering
exercise—is getting lawmakers and investors to invest in risk. That’s
really difficult.</p><p><b>The fact that your PREDICT program was not refunded has
become a political rallying point against President Trump, who has shown
an ignorance of science. Do you think there’s a connection between the
end of PREDICT and what has happened with the coronavirus?</b></p><p>No,
I don’t think so. PREDICT was a beautiful project. It was
scientifically well executed. It was forward-leaning. But its scale was
small. It discovered slightly more than 2,000 viruses. If you’re going
to have a public health impact, finding 2,000 viruses out of a pool of
600,000, over 10 years, isn’t going to transform your ability to
minimize public health risk. And PREDICT didn’t really navigate the
second step in a critical equation—turning science into policy. We
didn’t design it for that purpose. Also, even an annual budget of $20
million is not sufficient. You’d need about $100 million a year to carry
out the kind of global program that would give us evidence to transform
how we think about viral risk and how we should prepare for it. That’s
what my new Global Virome Project aims to do.</p><p><b>What worries you about this coronavirus?</b></p><p>There’s
the obvious stuff that’s worrying everyone. But there are things not
being talked about. Those are the things that worry me the most. This is
a global event. It is going to hit every community everywhere in the
world. And the impact will not be equally distributed because there are
parts of the world that have health care systems that are far more
fragile than ours or China’s or Europe’s. We know that when fragile
healthcare systems have extraordinary new demands put on them, there’s
an enormous risk those health systems will collapse. Specifically in the
Africa region and regions where there’s civil disorder or war.</p><p>In
2014, when the Ebola virus swept across the three countries of West
Africa, we saw that one of the immediate consequences of the virus was
to essentially shut down health-service delivery. Health workers became
exposed, sickened, and fearful. For five months, you did not have health
services that were tending to people’s normative healthcare. Pregnant
women didn’t have access to trained birth attendants. Kids didn’t have
access to anti-malarials. Immunizations didn’t go on. You had an
undocumented population of people whose lives were compromised because
they couldn’t get routine health services. My fear is this will likely
play itself out again. If the coronavirus continues to be as significant
as it appears to be, we’re going to see health systems get overloaded
and not be capable of responding to both the virus and normative health
issues. No one in government seems to be talking about this.</p><p>In
2005, during the avian influenza, George W. Bush was on the phone
routinely with leaders around the world about how to coordinate a global
response. Barack Obama did the same in 2009 for the second H1N1
pandemic and in 2014 for the Ebola epidemic. You saw presidential
leadership step up and act as a catalyst for forging a global way
forward for a global problem. It has been absolute silence in this White
House. I think the only reason the White House is even paying any lip
service to this is because the stock market has gone into a free fall.
So they’re trying to figure out what are the words they need to say to
placate the stock market.</p><p><b>Why do you think there’s been silence in this White House?</b></p><p>Because
the Trump administration is only interested in America first. Populism
here and across Europe and elsewhere has fragmented the global networks,
which had been so instrumental in being able to bring together a global
approach to problems like this. I’ve not seen any reports coming out of
the White House that showed that as China was struggling to bring the
virus under control, our president reached out to President Xi to talk
about how to coordinate action. I’m stunned by the absolute absence of
global dialogue for what is a global event. In Europe right now, you
would never believe that there was a European Union. From where I sit,
it looks like every country is making this up as they go along. Italy
isn’t coordinating with Brussels. Brussels isn’t coordinating with
Germany. There’s no coherent regional approach to this problem in
Europe, even though they have a platform for doing it.</p><p><b>So what will it take to make people aware of the global threat of zoonotic diseases?</b></p><p>There’s
nothing like a serial assault to heighten your awareness, and that’s
what we’re looking at. We’re on a cycle of about every three years of
getting something like this. And each time that happens, there’s more
awareness that these investments need to be made and sustained. The
problem is getting these monies as part of the annual regular
non-emergency funding.</p><p><b>There’s been exemplary sharing of data among scientists and geneticists, don’t you think?</b></p><p>Yes.
But think of the syllogism from Socrates: right thinking leads to right
action. We know that’s not the case. Your thoughts can be absolutely
right on, but your practices can be completely divergent. What science
allows us to do is understand, with greater granularity, what’s at risk.
Science will give us insight. But we have to translate that insight
into a sustained valuation of risk and move that forward.</p><p><b>How, ideally, should we move forward?</b></p><p>These
viruses inherently have the ability to mutate. What we’re looking at
today isn’t necessarily what we’ll be looking at in a few months. It
could become more deadly or it could attenuate and disappear, like the
common cold. The big issue is, Are we tracking that? Do we have enough
data and transparency and the availability of samples? What’s showing up
in Iran? What’s showing up in Israel? What’s showing up in Italy?
What’s showing up in the United States? Is there enough open
transparency in real time that allows us to keep our finger on the
pulse? I’m an internationalist. Figure out how to care for our people.
Pay attention to communities around the world that need assistance.
We’re all part of the same ecosystem. This is a global issue. We either
prepare for it and respond to it in the context of a global lens, or we
don’t. If our preparations and responses are country-centric, we’re in
for some serious trouble.</p><p><i>Kevin Berger is the editor of</i> Nautilus.</p>
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