Dress Rehearsal? The name of the virus that causes COVID-19 — SARS-CoV-2 — offers a vital clue about future, more deadly, pandemics

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The severe pneumonia condition we call coronavirus disease 2019 (COVID-19) is caused by a virus scientists have named severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). And it’s the ‘2’ that tells us something we overlook at our peril: there was a previous SARS virus – and, crucially, more are on the way. Evolution demands it and we’re already watching a preview in real time – the emerging ‘variants of concern.’ When they vary enough we’ll have a new species with new properties, the first of which we’ll call SARS-CoV-3.

It’s those new properties that concern scientists like Bruce Walker, founding Director of the Ragon Institute of Massachusetts General Hospital, MIT and Harvard. In a public lecture series put on by the MIT Department of Biology last fall called “COVID-19, SARS-CoV-2 and the Pandemic,” Dr. Walker explained that this is not the first pathogenic human coronavirus we’ve seen – and it won’t be the last.

SARS-CoV-1 in 2003, he said, caused a total of 8000 cases with a case fatality rate (CFR) of 11% but, thankfully, low transmissibility.

Then MERS (Middle East Respiratory Syndrome, also a coronavirus) came along in 2011 and still persists. There’ve been 2500 some cases with a much higher CFR of 34% but, again, thankfully, low transmissibility.

But compare that to SARS-CoV-2. We now have over 155 million cases, globally, as of this morning. The estimated CFR is ½ – 1%. Which varies widely depending on the age group and the geography and it’s very transmissible as it begins before the onset of symptoms.

Now here’s Walker’s money shot:

I think the important thing for everybody to recognize … is that we can expect to have additional coronaviruses in our future. And the big fear, and I think what’s an existential threat to society, is the possibility of a coronavirus  with the transmission of SARS-CoV-2 and the case fatality rate of MERS.

So it really does behoove us to monitor for these emerging pathogens.

How we do that monitoring was recently profiled in Science magazine (above photo) in a piece called “Scientists scour the Amazon for pathogens that could spark the next pandemic.” The thought is that although new diseases can emerge anywhere – COVID originated in China, MERS in Saudi Arabia – tropical rainforests, with their staggering biodiversity, are the most likely cradle of a “bewildering range” of dangerous new pathogens.

But that comes with a huge asterisk because as the article points out, we’re the ones causing the danger:

When human populations encroach on rainforests, the risk of spillover skyrockets. Manaus, Brazil, a city of 2.2 million people in the Amazon rainforest, is just such a place. … Urban growth, highway expansion, hydroelectric dam construction, mining for gold, and deforestation for cattle ranches and small farms erode the jungle and bring humans and wildlife into ever closer contact … [with] monkeys, bats, and rodents, the mammals thought most likely to transmit disease to people. … In Brazil, the pro-business policies of President Jair Bolsonaro have only boosted that risk.

However, just as personnel & policy and can increase risk, they can also reduce it.

When super-scientist Eric Lander appeared before a Senate committee last week to be confirmed as President Biden’s choice to be his science advisor (elevated to a Cabinet positon, for the first time), he was asked how to prevent future pandemics. Dr. Lander began his answer by saying that because there’ll always be emerging infectious disease we have to make sure that when the next one shows up it doesn’t rule the world the way COVID has. To do that, he says, we have to set bold goals; namely, we have to arrest the new threat within 100 days of seeing it:

We have to set very bold goals. It was great that we could produce a vaccine in one year and then get it distributed. But we have to do much better. I think the the sort of goals we need and I think what’s possible with science today is to say within 100 days from the detection of a potential pandemic we should be able to have enough doses of an approved vaccine, clinically tested, for the whole country.

[To do that] we’ll need to  have capacities in place – hot capacities that can be turned on a dime – because we’ve learned what it means to have an exponential increase in something.

Those are capacities for diagnostics – the ability in a week to reprogram existing diagnostics being used in public health to take on a new pathogen. To do it so cheaply that we don’t agonize how to pay for it.

The ability to produce vaccines against any of the classes of viruses that infect humans.

The ability to make therapeutics very rapidly. We did not succeed in making new therapeutics in this pandemic rapidly enough to respond, yet there are approaches to do it.

I think we need a top to bottom look at the components. The good news is there are scientific approaches for all of these things and we need to pull together – across agencies and countries – because we all have to prevent this from happening again.

If all we’ve endured till now hasn’t been enough to convince us of that, take a look at something else the Science piece warns us about: An important dynamic in human-animal viral transmission called spillback, the idea that viruses can be passed from humans to wildlife and back again – returning with even more variance:

In Europe and the United States, scientists worry about COVID-19 outbreaks on mink farms, for example, because such events give the virus more opportunities to evolve and jump back into people. 

Given enough time to evolve in both human and animal populations we could see, as Dr. Walker tells us, not just CoV-3, CoV-4, and so on, but a CoV-x, with the CFR of MERS – 1 in 3 – and, with that, absent Lander’s bold vision coming true, unprecedented carnage vastly superior to that associated with war; human vs. human war, that is.

As of this morning GISAID reports 579, 410 deaths in the US due to SARS-CoV-2 – nearly twice the number of US combat deaths in all of WW2 – by a virus with case fatality rate of a ‘mere’ 1%.

GISAID also tells us there’s been 32,566,849 cases of infection in the US so far.

And with a case fatality rate of 1 in 3, where would that leave us?

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