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You’re reading The Checkup With Dr. Wen, a newsletter on how to navigate covid-19 and other public health challenges. Click here to get it in your inbox.
My column this week focused on the need to shift from single-mindedly pursuing covid-19’s origins to preventing the next pandemic, whether it is caused by laboratory accidents or animal-to-human spillover. I believe our energy is better spent shoring up future defenses than finger-pointing over the past.
Not everyone agrees. House Foreign Affairs Committee Chair Michael McCaul (R-Tex.) told CNN on Monday that “some people need to be held accountable, whether that be in a civil context or criminal liability context.” He mentioned the possibility of sanctions against China as well as reparations “for killing millions of people across the world.”
These comments suggest an intentionality behind the spread of covid-19 that neither scientists nor intelligence experts have found any evidence for. To the contrary, as much as U.S. intelligence agencies disagree about the coronavirus’s origins, they agree on one aspect: This was not intentional. It was not an act of bioterrorism. No one intended to weaponize a virus to cause a global pandemic.
This fact bears repeating, and I hope McCaul and others who have been calling for “accountability” will be clear with Americans to distinguish between an intentional act and their preferred theory of a laboratory accident.
And they should be reminded that such a mishap could have happened in the United States, too.
In 2014, when the Food and Drug Administration conducted an office cleanup to move to a new location, it found hundreds of vials of virus samples in an unsecured storage room. Six of them turned out to be vials of the deadly smallpox virus. Astonishingly, no one knew they were there. It’s possible the vials had been there since the 1950s but were forgotten in subsequent inventories.
Also in 2014, some 75 staff members at the Centers for Disease Control and Prevention were exposed to anthrax after scientists failed to inactivate the anthrax bacterium before sending it to three labs that weren’t prepared to handle it. In a separate incident, the CDC inadvertently sent what it thought were harmless strains of flu but actually was the H5N1 avian flu.
More recently, in November 2022, poliovirus was found in the wastewater of a lab in the Netherlands that conducted research on polio. One lab employee was infected as a result of this mishap, which was described in the Eurosurveillance journal as an “unnoticed breach of containment at the facility.”
None of these incidents resulted in mass outbreaks. But they could have. If they did, what would accountability have looked like?
Certainly, mistakes should be identified and systems put into place to prevent them, as was done in the occurrences above. But if an outbreak spread beyond our shores as a result of human error, should other countries impose sanctions or require reparations? Should they go so far as to demand civil and criminal penalties for lab workers?
And what about diseases that don’t originate in the lab but could be attributed to farming practices, deforestation, climate change and other activities that bring animals — and animal pathogens — closer to humans? Should the Democratic Republic of Congo and South Sudan, where the first two outbreaks of Ebola occurred, be on the hook for costs borne to other countries from Ebola? Should the United States, where Lyme disease was first identified, be held responsible to the world for its effects?
Such blame games are not conducive to the goal of preventing pandemics. They could deter researchers from engaging in scientific investigations crucial to the development of vaccines and treatments. They could also give fodder to conspiracy theories and fuel violence against people of certain ethnic origins, as we have already seen in the rise in anti-Asian attacks. And if countries are worried about liability and retribution, it could further disincentivize global health cooperation.
None of this absolves the Chinese government, whose obstruction of international investigations has made it such that we might never find the true cause of covid. Chinese officials also made many tragic errors in failing to contain the coronavirus early on.
But it’s not going to make the world safer to threaten punishment. Political leaders should consider that the shoe could have easily been on the other foot. Instead of further inflaming tensions, we should reiterate that while the cause of the coronavirus remains unknown, what is known is that its spread was not intentional. And we must emphasize that preventing the next pandemic requires international cooperation, including on the critical issue of laboratory safety.
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“If I were to contract covid, why is it not possible to go out wearing a mask immediately until I test negative? The isolation period seems redundant.” — Deborah from Massachusetts
This is a good question. At the moment, CDC isolation guidelines are still restrictive in the sense that we are treating covid differently from other diseases. For example, people who have the flu or RSV are not told that they have to stay at home for five days and then only go out while wearing masks for the next five days.
I suspect the CDC guidance factors in human behavior — that a lot of people won’t follow mask guidance. That is, if the CDC says infected people can immediately go out with a mask, a lot of people would take that to mean that they can be in public but without a mask.
In any case, I think many people are already not following CDC guidance. Anecdotally, I hear that the isolation guidance dissuades some from using covid tests because they don’t want to have to stay home from work or keep their kids home from school.
At some point, covid will need to be treated like other diseases. Instead of a blanket isolation period for everyone, perhaps the recommendation could change to testing before visiting vulnerable individuals. The CDC should also provide guidance for how people who live at home with vulnerable people can best protect them.
“People are using the Enovid nasal spray for covid prevention. Is this effective, or are they getting a false sense of security from it?” — Doug from Massachusetts
Enovid is a nitric oxide nasal spray that is available in certain countries, including Israel, Indonesia and Bahrain. There is some evidence this medication is effective at clearing coronavirus particles if it’s sprayed in the nose as prevention. In addition, a Phase III trial published in the Lancet Regional Health found that the spray can reduce the viral concentration in people with mild symptomatic covid.
Enovid is available for purchase in some other countries, but the Food and Drug Administration has not authorized it. People who are given Enovid should be careful to verify that the medication came from a reputable source. They should also be aware that it is not approved in the United States for treatment or prevention of covid.
“What is the trivalent vaccine? I have received the original Moderna vaccines plus boosters. Do I need a trivalent booster now? I am 75 and have several medical issues.” — Jack from Arizona
There are two vaccine formulations: the original vaccine first authorized in December 2020, and the updated bivalent vaccine authorized in September 2022. To my knowledge, there is no trivalent vaccine. The bivalent is a combination of the original vaccine plus a component that targets two omicron subvariants. This is the one that vulnerable individuals should receive if they have not already.
The Post has also compiled Q&As from my previous newsletters. You can read them here.
Researchers at Harvard University found a strong association between a healthy lifestyle and reduced risk of persistent symptoms following covid infection. In their study of nearly 2,000 women, published in JAMA Internal Medicine, the authors said that participants who maintained a healthy weight, exercised regularly, didn’t smoke or abuse alcohol, and ate and slept well were about half as likely to develop long covid as those who didn’t follow these practices. This is not to suggest that all long covid is caused by the lack of good lifestyle habits, but rather that there are steps people can take to improve their health and reduce their chance of developing persistent symptoms.
Wastewater has been used as an early-detection tool for the spread of covid and poliovirus. Now, new research in the New England Journal of Medicine shows it can also be used for mpox (formerly known as monkeypox). This adds to the body of evidence in favor of wastewater as a surveillance mechanism that can alert health officials and guide them on where to focus limited resources.
Here’s more evidence in favor of Paxlovid: An Annals of Internal Medicine study of more than 44,500 patients who are part of the Mass General Brigham health system found that the covid antiviral treatment reduced the risk of hospitalization by 40 percent and death by 71 percent. Notably, this was a highly vaccinated population, and the observed reduction in risk was similar across age groups and those with underlying medical conditions.