‘Long-haul’ covid-19 complications are real. I faced similar problems after surviving Ebola.

Another Recognition. Resources and rehabilitation. Research.

We need to talk about “long-haul” covid.
Many people who’ve had covid-19, the disease caused by the novel coronavirus, continue to experience complications long after their initial illness, and those of us in the medical field don’t know why.
We can draw from similar illnesses and the growing body of research, especially the work being done by some of these patients themselves. It’s no surprise that many who survived an initial bout of covid 19 — even if that illness was mild — continue to experience often-debilitating symptoms weeks and months after they first got sick. We’ve seen this with many other viral illnesses, including covid-19’s close coronavirus cousins, severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS).
In one study of SARS survivors, 24 percent had markedly diminished exercise capacity and health status compared with the general population at 12 months after the onset of the illness. Another study showed that two years after SARS onset, more than 50 percent of SARS survivors had impairment in lung function tests and “their exercise capacity and health status were remarkably lower than that of the general population.”
Dozens of other studies outline how SARS and MERS left many survivors with long-term health conditions. Enduring fatigue, inability to return to work and ongoing mental health challenges were incredibly common, in addition to the cardiac, respiratory and neurologic symptoms.
We know what viruses can do to the immune system long term. And we know that other coronaviruses have left survivors with similar symptoms. So why are covid-19 long-haulers having such a hard time being taken seriously?
As a doctor who treated hundreds of covid-19 patients in New York and sees them frequently in the emergency room, I know how this virus touched nearly every organ system, and how many still haven’t recovered months after their initial illness. But in a sense, I’m also a long-hauler myself.
In 2014, I fell ill with Ebola after taking care of patients in Guinea. I spent 19 days in the hospital, and thankfully ultimately survived. But for months I had joint and muscle pains. It hurt to walk. My hair fell out in chunks. All of that got better.
But some things didn’t.
To this date, nearly six years after my “recovery,” I continue to experience difficulty concentrating. My ability to create new memories is drastically reduced. I forget names and details of people I knew very, very well. And in the past six years, it hasn’t gotten any better.
Honestly, it almost feels as if the virus indiscriminately pulled a razor blade through my brain, severing old memories at random, and on its way out dropped glue in its tracks to make it hard to create new ones.
In discussions I’ve had with many covid long-haulers, both in the ER and online, I’ve heard so many describe symptoms similar to what I experienced in the months after my illness. The fatigue, “brain fog,” and feeling better some days and worse the next.
An article published in the Los Angeles Times this summer by David Lat, founding editor of the Above the Law legal blog who spent 17 days in the hospital including 6 days on a ventilator after he fell ill, said what many other long-covid patients feel:
“Recovering from a severe case of COVID-19 is not like switching a light on or off. It’s more like a dimmer switch, where the light gets brighter, then darker, then brighter again. . . . Before I came down with COVID-19, I could run for miles. After returning from the hospital, I needed a wheelchair to go even half a block.”
So what research do we have for covid-19?
So much of what we know about long-haulers is actually from long-haulers themselves. Groups such as Body Politic (@itsbodypolitic) led the first detailed patient surveys and have set up expansive support groups.
Their findings were further supported in July by a study from the Centers for Disease Control and Prevention showing that 35 percent of covid-19 patients had not returned to their usual state of health when interviewed two to three weeks after testing. Those with chronic conditions were affected the most. But even among young adults ages 18 to 34 with no chronic medical conditions, nearly 1 in 5 reported they had not returned to their usual state of health 14 to 21 days after testing. This is particularly concerning as outbreaks are now emerging at college campuses.
And there are reports that even younger children are having to deal with long-term covid complications. This is beyond the hundreds of cases you may have read about of multisystem inflammatory syndrome in children (MIS-C), often weeks after a covid-19 infection.
Although covid-19 is primarily defined by its respiratory symptoms — low oxygen, pneumonia, acute respiratory distress syndrome (ARDS) — it impacts nearly every organ system in one way or the other. This is true for the acute (early) infection but likely defines the long-term and chronic impacts as well.
What percentage of those with covid-19 are affected with long-term symptoms?
We don’t know for sure, but multiple studies have suggested approximately 10 percent of people experience prolonged illness after covid-19. At even a fraction of that, the toll is huge given that 6.7 million people in the United States so far have gotten the disease (and more than 30 million worldwide).
A study from Rome showed the overwhelming majority of hospitalized patients still struggled with symptoms 60 days out. Fatigue, difficulty breathing, joint pain and chest pain persisted in many. About 87 percent still had at least one symptom, and 55 percent had three or more.
Covid-19 has been associated with many long-term cardiac problems, including inflammation of the heart muscle (myocarditis) or the sac around the heart (pericarditis), as well as abnormal heart rhythms. Some may develop cardiomyopathy, a disease of the heart muscle that prevents the heart from pumping effectively.
A lot of college and professional athletes have been found to have myocarditis, even after a mild bout of covid-19, which has led some leagues and players themselves to call off their season.
A few studies have already outlined the longer term cardiac impact of covid-19. A small one from Wuhan, China, showed a majority of recovered patients (15 out of 26) who were tested with cardiac magnetic resonance imaging had sustained cardiac involvement at a median of 47 days after symptom onset — primarily edema, fibrosis and impaired contractility of the heart.
Another
Unsurprisingly, given that it’s primarily a respiratory virus, emerging data indicate that many patients must deal with lung damage and “experience persistent respiratory symptoms months after their initial illness.”
Like SARS and MERS (where 30 percent had persistent lung abnormalities after their acute illness), breathlessness and cough are commonly reported long after recovery from covid-19. Many also have fibrosis (scarring), bronchiectasis (damage to bronchial tubes) and pulmonary vascular disease.
But we also know that patients who have been on ventilators and who are given pulmonary rehabilitation early on have better and faster resolution of underlying damage and symptoms.
Those of us working on the covid-19 front lines saw how this disease caused kidney injury or failure in so many patients admitted to our hospitals. At the Mount Sinai Health System, in New York, during the peak of the pandemic there, 46 percent of patients admitted with covid-19 had some form of acute kidney injury; of those, 19 percent required urgent dialysis.
“The next epidemic will be chronic kidney disease in the U.S. among those who recovered from the coronavirus,” said Steven Coca, associate professor of nephrology at Mount Sinai and one of the authors on the study, in a published interview last month.
The neurologic system seems to have the most diverse aftereffects of covid infection, such as persistent headaches, anosmia (loss of smell), long-term disability from stroke and some relatively rare conditions — among them encephalitis, cranial neuropathies and even myasthenia gravis (a neuromuscular disorder causing weakness).
There are also many case reports of covid-19 patients with Guillain-Barré syndrome, an autoimmune illness that causes altered sensation and motor function, primarily in the legs and arms. This was something we also saw with infections from the Zika virus a few years ago.
And there have been loads of studies about anosmia related to covid-19. In many, this was reported in 30 to 60 percent of covid cases. Thankfully, most episodes resolved in two to three weeks, but for some, symptoms persist beyond that.
In addition to the neurologic impact, the mental health manifestations of long-covid can be profound. According to a report in STAT, “1 in 3 patients recovering . . . could experience neurological or psychological aftereffects of their infections.”
The mental health toll of this pandemic has been hard on everyone. But for long-haulers, the extra stress of being sick and not knowing if or when you’ll feel better is an added burden. Support groups are helping many, but we need more resources.
So what’s next? What do we need to do to better understand long-haul covid? Here are my suggestions:
Recognition.
Resources and rehabilitation.
Research.
“We must move long-haul covid from anecdote to something that is routinely quantified and monitored, as is currently being done with deaths and positive tests,” Nisreen A. Alwan, associate professor in public health at the University of Southampton in the United Kingdom who has suffered prolonged symptoms herself, wrote in the Lancet. “We must define and measure what ‘recovery’ means, focusing on how long symptoms last, how severe they are, how they impact someone’s quality of life, and the nature of when and how they appear.”
I heartily agree. We urgently need more insight into how health-care providers can best help long-haul covid patients. This includes the “whole-patient approach” to look more broadly at their health problems and assist patients with setting achievable targets for self-management.
While there is much we don’t know about long-haul covid, there is still a lot that we already do know: That it is real, that the toll is huge, that dealing with it is daunting.
If you want to know just how daunting, read bit.ly/Paul_Garner_long-haul by Paul Garner, a professor of infectious diseases at Liverpool School of Tropical Medicine in England, on his struggle to “accommodate” his long-term symptoms after getting covid-19.
Like Garner, many people struggling today might still be recovering after this pandemic eventually recedes. We need action to address this now.


What is the Middle East Respiratory Syndrome (MERS)?

China recently discovered a new coronavirus strain that is similar to MERS.  Tell me about the symptoms of MERS, the incubation period for infection, and the lethality rate.  Information on vaccines and treatments is relevant.  Official sources of information on MERS also is relevant.  Information on the origins of MERS is not relevant nor are the specific locations of previous outbreaks.  Editorials are not relevant. If the document discusses a potential animal origin, please ignore the document.

Find authoritative sources to answer this health-related question.

Key terms of the coronavirus outbreak, explained: From asymptomatic to zoonotic

With health officials trying to prevent and prepare for the spread of the coronavirus in the United States, there is much panic and confusion and many questions. Here are some key terms and facts to know: Coronavirus: Covid-19: Zoonotic: Community transmission: Outbreak: Epidemic: Pandemic: Fatality rate: Asymptomatic transmission: Isolation: Quarantine: Containment: Mitigation: Vaccine: Anti-viral medicines:


The best hope for coronavirus treatment is an experimental drug that fizzled against Ebola

Medical researchers spent much of the past year trying to save Ebola victims in Congo using a clutch of experimental drugs. Of the four medications being tested, researchers said, one demonstrated especially poor ability to save patients from the deadly virus.
The drug, called remdesivir, had blocked the Ebola virus in laboratories and in animal experiments. But it did such a bad job extending survival in humans compared to two of the other treatments that researchers decided in August not to try it on any more patients.
Now the drug, created by pharmaceutical giant Gilead Sciences, is being tested in new clinical trials, and global health authorities deem it the most promising of possible treatments for people who are severely ill with the novel coronavirus, which causes the covid-19 disease. Because it is a “broad spectrum’’ drug that has been effective against multiple viral targets in the lab and in animals, the strategy could work, experts said.
The drug’s journey — from failing to prolong the lives of Ebola patients in sub-Saharan Africa just last year to being rushed into coronavirus clinical trials in China and the United States this year — symbolizes a dire lack of antiviral drugs that can fight emerging infectious threats.
As the outbreak spreads worldwide, a vaccine to prevent infection remains at least a year away. Meanwhile, there is no approved treatment to stop the virus once someone is infected, and the severe and sometimes fatal respiratory distress that afflicts a minority of patients.
The hope is that remdesivir will show better results with the coronavirus than it did with Ebola, which is from a different viral family, officials said. The first trial results could be available in April.
Gilead, the National Institutes of Health and Chinese health authorities are racing to test it on hundreds of people in controlled clinical trials, including a patient who was quarantined in Nebraska after being removed from the Diamond Princess cruise ship. Axios reported this month that Gilead acted so quickly that it did not even wait for required approval by the Food and Drug Administration before it shipped doses to China. Asked to respond, Gilead said it thinks its “limited shipments’’ were made in compliance with U.S. law.
“I just hope remdesivir works, because we really need a therapeutic that can intervene in this crisis,’’ said Richard Whitley, director of an NIH-funded research effort involving the world’s most dangerous viruses.
Gilead did not respond directly about the drug’s failure in the Ebola trial. “Covid-19 is a coronavirus that is unrelated to Ebola virus,’’ the company said. “Covid-19 is associated with different symptoms, pathology, and a different course of disease.’’
Invented by Gilead about a decade ago, remdesivir has been proven to stop certain viruses from replicating in lab experiments and in animals. It has been researched in academic labs in North Carolina and Tennessee with backing from federal taxpayers since 2014, as part of a $37.5 million effort by NIH to find treatments for infectious diseases.
Until Monday, when it fell in a brutal market rout, Gilead’s stock price had defied the overall market decline of recent weeks, rising almost 20 percent from Feb. 21 to March 6, on hopes that the drug could provide the first treatment for covid-19.
The lack of treatment helps explain why. The stock price increased 5 percent on Feb. 24 alone when a top official of the World Health Organization pinned much of the world’s hopes for a treatment on the drug.
“There is only one drug right now that we think may have real efficacy, and that’s remdesivir,” said Bruce Aylward, WHO’s assistant director general. Ten days later, RBC Capital Markets gave it only a 50 percent chance of succeeding as a treatment.
The mixed signals have done little to dampen interest. There have been desperate pleas for supplies to treat patients on a “compassionate use’’ basis.
Although Gilead leads the pack on treatments, large drug companies such as Merck, Johnson & Johnson and Sanofi, as well as lesser-known companies Regeneron and Moderna, are pursuing coronavirus vaccines and medications, and executives estimate that at least 40 small biotech companies are developing drugs to fight it.
Every time there is a new virus, “we get started, but we don’t cross the finish line,’’ Julie Gerberding, a former director of the Centers for Disease Control and Prevention who is now the executive vice president and chief patient officer at Merck, said at a news briefing in Washington last week. This time, she said, industry is committed to pushing a vaccine to cross the line for regulatory approval.
“If we don’t cross it, it will be because it’s scientifically hard,’’ she said, “not because of the will or the investment.’’
But drug companies also have been accused of not pursuing vaccines and antiviral treatments aggressively because the commercial markets for such drugs are weak.
The potential patient pool for clinical trials dries up once a new infectious outbreak subsides, so investment can be frozen in partly completed projects. And the pool of medical customers for a drug can be short-lived, if a seasonal epidemic quickly disappears, offering little chance to recoup an investment of what could be hundreds of millions of dollars.
Vaccine and treatment development tailed off after outbreaks of the earlier coronavirus cousins, severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS). The drug industry’s lobbying arm, the Pharmaceutical Research and Manufacturers of America (PhRMA), said that at least half of its members have mobilized in various ways to fight the new coronavirus in recent weeks.
“We need to encourage as many shots on goal as possible,’’ Stephen J. Ubl, PhRMA’s chief executive officer, told reporters.
Government efforts to spur development have produced sporadic progress. In the nearly 20 years since the SARS outbreak, the National Institutes of Health has spent nearly $700 million on research and development efforts around coronavirus, according to a survey by the advocacy group Public Citizen, which criticized the pharmaceutical industry for a “lack of interest that has left us lagging behind.’’
Every epidemic presents uncertainty for drug companies, said Amesh Adalja, a senior scholar for the Center for Health Security at Johns Hopkins University.
“You never know how long it’s going to last. You never know what the market size is going to be,’’ he said. “Every conversation about price is when you’re in the middle of an emergency.’’
Given the large degree of public financial support, debates are already flaring about how much Gilead should charge for its treatment if it ever makes it to market.
Congress and President Trump authorized up to $3 billion last week for efforts by academic researchers and drug companies to develop vaccines and treatments for coronavirus, part of an $8.3 billion emergency spending bill. The industry successfully opposed efforts by some House Democrats to attach guarantees for affordable prices for vaccines or treatments that result.
Gilead said it is too soon to discuss potential markets, in written responses to The Washington Post.
“We are focused on the potential clinical value that remdesivir may bring to patients and doing our part to respond to the coronavirus outbreak,’’ the company said.
Earlier testing of remdesivir has been performed by a partnership of university academics and the National Institutes of Health called the Antiviral Drug Discovery and Development Center, coordinated by the University of Alabama at Birmingham. It is focused on finding treatments for the family of coronaviruses, as well as Ebola, Zika, dengue and chikungunya.
Gilead said it donates free drug samples for the government-funded research of remdesivir and helps design scientific studies and clinical trials. Whitley, an infectious-disease expert who leads the drug development center in Alabama, credited Gilead for staying focused on fighting viral infections despite the poor market incentives.
“Drug companies don’t have an interest in emerging infectious diseases,’’ he said.
The public should not be excessively discouraged by the negative Ebola results last year, Whitley added. The trial in rural areas of Congo, a conflict zone with rudimentary conditions, was complicated by the fact that remdesivir’s correct dosage was unknown, he said. Also, it required a cumbersome daily IV administration, after being reconstituted from a freeze-dried form used for shipping in the uncontrolled climate conditions.
The drug has not been studied in human trials for SARS or MERS, because there are not enough patients, Gilead said.
“The number of clinical MERS infections was limited, with almost exclusive localization in the Kingdom of Saudi Arabia, and there were no SARS infections,’’ the company said.
In the new coronavirus outbreak, it said, it is reviewing individual requests from physicians to provide the drug on a “compassionate use’’ basis but only to patients who are hospitalized and showing “significant clinical manifestations.’’
christopher.rowland@washpost.com


Inside the extraordinary race to invent a coronavirus vaccine

Read more: The dark side of ventilators: Those hooked up for long periods face difficult recoveries ‘Second-week crash’ is time of peril for some covid-19 patients

Ian Haydon, a healthy 29-year-old, reported to a medical clinic in Seattle for a momentous blood draw last week.
“Oh yeah,” said the nurse taking his blood. “That is liquid gold.”
Haydon is an obscure but important participant in the most consequential race for a vaccine in medical history. In early April, he was among the first people in the United States to receive an experimental vaccine that could help end the coronavirus crisis. He volunteered to be a test subject knowing about the risks and unknowns, but eager to do his part to help end the worst pandemic in a century.
Scientists at the National Institutes of Health in Bethesda, Md., will study blood from Haydon and others for signs that the vaccine triggered an immune response to a pathogen they have never encountered. It would be the first, preliminary signal that the vaccine could provide immunity to covid-19, the disease caused by the novel coronavirus, which has claimed more than 200,000 lives worldwide.
A coronavirus vaccine has become the light at the end of a very long tunnel, the tool that will bring the virus to heel, allowing people to attend sports events, hug friends, celebrate weddings and grieve at funerals. The goal to deliver a vaccine in 12 to 18 months, often repeated by the nation’s top infectious disease scientist, Anthony S. Fauci, has become the one reassuring refrain during briefings on the crisis. The White House put together a task force called Operation Warp Speed to try to move even faster, making hundreds of millions of doses ready by January.
With at least 115 vaccine projects at companies and research labs, the science is hurtling forward so fast and bending so many rules about how the process usually works that even veteran vaccine developers do not know what to expect.
Scientific steps that typically take place sequentially over years — animal testing, toxicology studies, laboratory experiments, massive human trials, plans to ramp up production — are now moving in fast-forward and in parallel. Experts keep using the word “unprecedented.”
It’s a thrilling time in vaccine science, but also an unnerving one.
U.S. regulators are firm in promising they will not sacrifice safety for speed, but some ethicists raise concerns about “pandemic research exceptionalism,” in which the demand to speed a vaccine to market could come at the expense of evidence and fuel the powerful anti-vaccine lobby.
“The 26 years it took us to make the rotavirus vaccine is pretty typical. If it’s 12 to 18 months, you’re skipping steps,” said Paul Offit, who developed a vaccine for rotavirus, which causes deadly diarrhea in infants and children. “Is that a little risky? Yes it is, but so is getting infected with the virus.”
On a weekend in early January, scientists at Inovio Pharmaceuticals, a biotech company outside of Philadelphia, began designing a vaccine for a mysterious pneumonia that didn’t even have a name. They, like other teams around the world, used the genetic blueprint of the novel coronavirus, shared online by Chinese scientists, as their guide.
It took about three hours to design the vaccine, said Joseph Kim, chief executive of Inovio.
Scientists at NIH had been in talks about partnering with a Massachusetts biotechnology company, Moderna, and immediately began designing another vaccine candidate. By the end of the month, it was in production in a factory filled with robots in a suburb south of Boston.
With an array of promising vaccine technologies fueled by early scientific openness, dozens of vaccine efforts kicked off blindingly fast in dozens of countries.
“Then, the tough work began,” Kim said.
Designing a promising vaccine is, in some ways, the easy part. Showing that it is safe and effective and then scaling up production can take years or even decades. Researchers are now trying to compress that timeline in ways they never have before, against a type of virus they have never successfully quelled. In some cases, they are also harnessing technologies that have never been used in approved vaccines. In contrast, scientists develop a new flu vaccine each year, an effort that is more of a “plug and play” situation, where a time-tested basic platform can be redirected to fight new flu strains.
“It’s another reason for better preparedness,” said Barney Graham, deputy director of the Vaccine Research Center at NIH, pointing out that his lab had developed a vaccine for MERS, a related coronavirus, but only got it through mouse studies. “If we’d taken at least two to three vaccine concepts through early-phase clinical trials on MERS, we might have a better idea on what to focus on for this SARS coronavirus — so instead of working with 115 different vaccine ideas, we might be working on five.”
Scientists at Oxford University have announced the most aggressive timeline, with plans to make their vaccine — which depends on a weakened cold virus that typically infects chimpanzees — available in the fall.
Moderna and Inovio are developing vaccines that ferry two types of genetic material into cells to train the immune system to recognize the distinctive “spike” protein on the surface of the coronavirus. A Beijing company is trying an inactivated virus. Giant pharmaceutical companies, flush with government funding, are turning their vaccine platforms toward the coronavirus. Researchers at Texas A&M University are repurposing an existing tuberculosis vaccine to see whether it can prevent deaths or severe illness.
To make things more difficult, as the infection spread across the world, scientific teams had to change how they work, practicing social distancing in their labs so the virus doesn’t take out the effort to combat it. That happened at NIH, when one scientist became infected with the coronavirus and two close colleagues on the effort had to quarantine for 14 days.
Graham’s Vaccine Research Center is working with only about 10 percent of its staff coming in, and his laboratory — which usually houses 20 people — can have only two at any one time.
Meanwhile, the difficult laboratory science, such as animal testing, is in many ways, being leapfrogged or running in tandem with testing in people.
“This is unusual,” Kim said. “It’s really moving at lightning speed with the urgency to match it.”
Many researchers can describe how vaccines are typically developed. But they can’t say precisely how the coronavirus vaccines will come about. So much will depend not just on the science, but on how the outbreak evolves, how flexible regulators decide to be and what we continue to learn about the virus in real time.
Philanthropist Bill Gates argues things can’t really return to normal until the world’s 7 billion people are vaccinated — a daunting scenario that could take years and create a new kind of public strife, as governments and individual people scramble for limited doses. More than one vaccine will probably be needed because the first one may not be as effective as the follow-ups.
The front-runner vaccines in the United States have never been made at an industrial scale, and some vaccines require two doses to be given, further complicating any effort to scale up.
“We really have never made those kinds of vaccines in large, large quantities. How quickly can that be done?” said Kathryn Edwards, a professor of pediatrics at Vanderbilt University School of Medicine. “We’re not going to be able to say in 18 months that we have enough for all the world’s people to be immunized with two doses.”
Typically, human clinical trials occur after extensive animal testing. Then, a small number of human subjects receive the vaccine in a phase 1 trial intended to determine the safety and the right dosage. People are monitored for any side effects, as well as early hints that the vaccine works. After carefully analyzing that data, companies decide to proceed to a larger phase 2 trial in several hundred patients, which looks for signs the vaccine is working. Then, they could proceed to a large phase 3 trial in which people are randomly assigned to receive either the vaccine or a dummy shot — a definitive test of safety and effectiveness, which often takes thousands of patients and several years.
Offit, who is helping advise the U.S. vaccine effort, said the “large” trials being considered that he is aware of range from 1,000 to 6,000 people that would probably take place over months. In contrast, when he developed a vaccine against rotavirus, the pivotal trial included 70,000 healthy infants over four years. The human papilloma virus vaccine was tested in 30,000 people.
“Those are typical trials,” Offit said. “They tell you, pretty comfortably, that the vaccine is effective — and to some extent, that it doesn’t have an uncommon side effect.”
No one is talking about that for the coronavirus.
Moderna, the company that manufactures the vaccine Haydon received, plans to start its next larger trial in 500 to 600 people this spring, according to Stéphane Bancel, the chief executive. He said the company began planning the trial nearly a month ago, even though it was still giving shots to the first human subjects.
“We said, ‘We cannot wait,’” Bancel said.
Instead of holding off until the subjects have signs in their blood that the vaccine works, they are going to proceed to the next trial as soon as it shows safety. Bancel said Moderna hopes to sign a contract soon with a government agency so that they can start manufacturing and stockpiling the vaccine before approval. They could have 100 million doses ready to go on day one, if it is approved in a year.
Regulators insist that even under unprecedented urgency, products will be held to a high safety bar.
“My motto is a woodworking one: Measure twice, cut once. The only change to that motto is: Measure quickly twice, cut quickly once,” said Peter Marks, the director of the Center for Biologics Evaluation and Research at the Food and Drug Administration.
But vaccine experts point out that rare safety problems often can be identified only in very large studies or even through monitoring after a vaccine has been deployed. They are most concerned about the risk that the vaccines could actually make the disease worse in some people, as happened in some animal studies of vaccines for severe acute respiratory syndrome (SARS), through a mechanism called antibody dependent enhancement.
In 1966, for instance, an experimental vaccine for RSV, a common respiratory virus in children, backfired when some children developed a more severe disease. Scientific debate is still raging about a dengue vaccine used in the Philippines in recent years that increased the risk of hospitalization for dengue in children who had not previously been infected.
The public’s health — and the trust in vaccines, considered one of the most successful public health interventions in human history — will be guarded by regulators, experts say, even as the political pressure intensifies to get a vaccine into broad use.
“They’re good at holding the line and aren’t going to do anything that’s reckless because if they did it, could jeopardize the whole U.S. vaccine effort, especially with the anti-vaccine lobby,” said Peter Jay Hotez, the dean of the National School of Tropical Medicine at Baylor College of Medicine.
One way to speed up vaccine development is “human challenge” experiments, in which people are intentionally infected with the virus after being vaccinated. While the idea has gained steam among some scientists, people working on vaccine trials said it is an ethically challenging approach they would be uncomfortable with unless an effective treatment is discovered.
“Right now, I think it’s a little premature. However, it’s not off the table,” said Wilbur Chen, chief of the adult clinical studies section in the University of Maryland School of Medicine’s Center for Vaccine Development and Global Health. “I think it could be something that could be done; it could help us to really evaluate the efficacy of a vaccine much more quickly.”
Volunteers for such a challenge effort have already flooded an online sign-up created by a grass-roots group of researchers. Scientists are hopeful that enthusiasm will fill up all the trials necessary to prove the vaccines work. That will mean people willing to be test subjects for unproven vaccines with thinner-than-usual animal evidence behind them. It will mean people volunteering for trials in which half of them get a placebo. It may mean people weighing a vaccine whose benefits and risks aren’t fully known against the risk of the virus.
Haydon, who is due for his second shot of the vaccine next week, said he had never participated in a research study but was eager to assist.
“I’m incredibly hopeful we’ll arrive at a vaccine,” he said. “But in order to do that, we need clinical trials — and at some point, for each new vaccine and each new drug, that has to go into someone for the first time.”
Read more:
The dark side of ventilators: Those hooked up for long periods face difficult recoveries
Chaotic search for coronavirus treatments undermines efforts, experts say
‘Second-week crash’ is time of peril for some covid-19 patients


Virus takes big toll on China’s health workers

More than 1,700 Chinese medical workers have contracted the covid-19
Amid widespread shortages of protective equipment for health care workers in China’s Hubei province, Friday’s announcement highlighted the challenges Beijing faces as its overwhelmed heath care system tries to contain the epidemic.
At the same time, officials noted the infection rate among health care workers is in line with that of previous respiratory viruses, including the 2003 SARS outbreak. The total appeared to be a count of infections that have occurred over many weeks, rather than a sudden escalation of the crisis.
“This isn’t surprising, if I’m being honest,” said Saskia V. Popescu, senior infection prevention epidemiologist for Honor Health, a hospital system in Phoenix. “It is very, very easy to have failures in infection control.”
Michael Ryan, executive director of the World Health Organization’s Health Emergencies Program, said he believes the cases peaked in the third and fourth week of January and have declined since because of improved training and awareness.
“It’s a lower percentage than has occurred in other coronavirus outbreaks,” Ryan said. “Now that’s not a guarantee that it won’t change.”
A total of 1,716 Chinese medical providers were infected as of Feb. 11, 3.8 percent of the confirmed cases, Chinese health authorities said. Six have died. One health care worker in Singapore also was infected.
The Feb. 7 death of Li Wenliang, an ophthalmologist at Wuhan Central Hospital who had warned fellow medical school graduates in a private chat of an outbreak of the virus, prompted a national outpouring of grief and rage toward authorities. He died after being detained and released by police for speaking out.
By acknowledging the toll on health professionals, Beijing is trying to signal some transparency on a flash point issue, and letting ordinary people know officials share their sense of alarm.
“It might raise a red flag about how serious the situation is,” said Yanzhong Huang, a senior fellow for global health at the Council on Foreign Relations. “And hopefully that leads to a more effective government response.”
But Huang cautioned against seeing the figure as the final word on medical workers. “If it is coming from an official source, we have to take it always with a grain of salt,” he said.
Concerns about how medical personnel are faring in this crisis have been front and center from the start. Photos and video from Wuhan have shown exhausted doctors and nurses working in overflowing hospitals.
At Zhongnan Hospital in Wuhan, 40 health care workers were infected with the virus in January, according to a JAMA study. The majority worked in the general wards, but seven were assigned to the emergency room and two worked in the intensive care unit. In one case, a single patient infected more than 10 health care workers.
Still the toll on front line workers appears to be smaller than it was in other lethal coronavirus outbreaks. When SARS emerged in 2002, health care workers accounted for a fifth of the cases. A study of MERS infections from 2012 to 2018 found that health care workers made up a similar share — 415 of the 2,223 confirmed cases.
“Patients need to be wearing a mask. Physicians taking care of them need to be protected themselves — not only medical doctors or nurses, but people who work in the hospitals: the transporters, the person who is at the front desk. All these individuals are at risk,” said Charles Dela Cruz, a pulmonary and critical care physician at Yale University School of Medicine.
To date, covid-19, the disease caused by the new coronavirus, has caused more than 1,500 deaths, all but two in China, and 66,000 illnesses, with only 600 of those outside China. The United States has seen 15 cases and no fatalities.
Egypt’s Ministry of Health confirmed Friday that it had detected a case of coronavirus, the first known example of the outbreak in Africa. Health officials have worried about the virus reaching the continent because of its weak health care systems.
A spokesperson for the ministry, Khaled Megahed, said in a statement that a foreign national had tested positive for the coronavirus and the WHO had been notified.
Although the person had not shown symptoms, they were tested because of their travel history. The person was subsequently transported to a hospital and they are in stable condition under quarantine.
A number of people who came into contact with the patient have been tested for the virus, Megahad said. All tested negative, but they will be placed under 14-day quarantine as a precaution.
In Japan, meanwhile, the Health Ministry said Friday that 10 people evacuated from the quarantined Diamond Princess cruise ship in the port of Yokohama are in serious condition, with eight confirmed to have the new coronavirus. One of the other two is still awaiting test results.
Amid persistent criticism of its approach, the government said it would begin allowing some people who have tested negative for the virus to leave the ship and finish their quarantines on shore. Priority will be given to passengers over the age of 80 and those with existing medical problems, as well as people in windowless cabins, Health Minister Katsunobu Kato said.
So far, 218 people aboard the ship have tested positive for the virus out of 713 who were assessed. The government says it plans to step up testing in a bid to examine everyone on board before the quarantine ends Feb. 19.
A quarantine officer involved in screening passengers also fell sick. The health ministry said he did not follow proper procedures, wiping away sweat with his gloves and reusing a mask he had worn earlier, Japan’s national television network, NHK, reported.
The U. S. Centers for Disease Control and Prevention, moving forward with its plan to boost disease surveillance, named the five cities where labs will begin testing flu specimens for the coronavirus. They are Chicago, Los Angeles, New York, San Francisco and Seattle.
The public health labs are part of CDC’s existing flu surveillance network, which monitors seasonal influenza and hospitalizations. Specimens that are negative for flu will be tested for coronavirus, the CDC’s Nancy Messonnier said. Testing will be expanded to additional labs in coming weeks.
Lab tests that confirm additional coronavirus cases could allow public health authorities to take actions to forestall outbreaks, such as canceling large gatherings or calling for telemedicine and telework.
At the same time, flu illnesses have risen sharply in recent weeks, Messonnier said, complicating efforts to determine whether an illness is caused by the new coronavirus or the flu virus. So far this season, at least 26 million people in the U.S. have contracted the flu, including 14,000 who died and 250,000 who were hospitalized.
emily.rauhala@washpost.com
lena.sun@washpost.com
leonard.bernstein@washpost.com


U.S. coronavirus fatality rate could be lower than global rate so far

The question everyone is asking: Just how deadly is the novel coronavirus? As it spreads across the planet, researchers are desperate to understand the contagiousness and lethality of covid-19, a respiratory disease that has killed more than 3,400 people.
Evidence is mounting that the disease is most likely to result in serious illness or death among the elderly and people with existing health problems. It has little effect on most children, for reasons unknown.
The World Health Organization on Tuesday stated that the global case fatality rate is 3.4 percent. But that figure can be misleading if not framed correctly, and the official case fatality rate is likely to drop in coming months.
U.S. health officials on Thursday briefed lawmakers in Congress and said they believe the case fatality rate in this country will most likely be in the range of 0.1 to 1.0 percent, meaning somewhere between one of every thousand and one of every hundred people with covid-19 will die.
That would make covid-19 closer in lethality to influenza in severe or pandemic flu seasons, according to an article in the New England Journal of Medicine co-authored by Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases. The article states that the true fatality rate of covid-19 “may be considerably less” than 1 percent, and “may ultimately be more akin to those of a severe seasonal influenza (which has a case fatality rate of approximately 0.1%) or a pandemic influenza (similar to those in 1957 and 1968) rather than a disease similar to SARS or MERS, which have had case fatality rates of 9 to 10% and 36%, respectively.”
The WHO’s fatality percentage, announced Tuesday, is based simply on the number of deaths globally (the numerator) and the number of confirmed cases of covid-19 (the denominator). As of Friday the WHO had counted 3,400 deaths among 100,000 cases.
But the official numbers do not capture the full scope of the contagion. The actual number of deaths from the virus might be somewhat higher, in part because of undercounting or misdiagnosis. There is little doubt that the number of infections — in many cases among people who either did not get sick or thought they had only a mild illness — is larger than the official case count. The infection rate will not be known until researchers do broad surveys to see who has developed antibodies to the virus.
“Many people don’t get sick and don’t get tested,” Brett P. Giroir,  assistant secretary for health at the U.S. Department of Health and Human Services, told reporters Thursday after participating in a closed-door briefing for House members.
“The modeling suggests that we have a denominator problem. If you’re really sick and you have respiratory failure, you go see someone and you get tested. But if you’re not very ill, as most people are not, they do not get tested. They do not get counted in the denominator, especially in a crisis situation like in China,” he said.
As late as Friday afternoon, the United States had 14 deaths among 260 cases, a rate of 5.4 percent. But testing has been slow in the U.S., and as it becomes more widespread the rate will plummet.
“Your denominator is going to explode, which will push the case fatality rate down. But it will also push the number of affected persons and communities up,” said Kathleen Jordan, vice president and chief medical officer of Saint Francis Memorial Hospital in San Francisco.
The enigmatic nature of the new virus and the many unknowns about its trajectory have put people on edge, she said.
“I do think people tend to panic when it’s unknown. Just having information about how it spread, how to protect yourself, it calms people down and makes them act appropriately and effectively,” she said.
A report from 25 researchers from China, the United States and six other countries and published by the WHO suggests the current high fatality rate is skewed by the terrible death toll in the first chaotic weeks of the outbreak in Wuhan, China. People who became sick in the first 10 days of January experienced a 17.3 percent death rate, the report said.
But among people developing symptoms after Feb. 1, the fatality rate has been 0.7 percent, the report said, noting that “the standard of care has evolved over the course of the outbreak.”
The first cases in Wuhan were identified at the end of December. Not until Jan. 23 did the Chinese authorities impose severe travel restrictions designed to contain the spread of the coronavirus, officially known as SARS-CoV-2.
In those early days, doctors struggled to understand what they were dealing with and how best to treat patients, and “were quite overwhelmed,” said Christine Kreuder Johnson, an epidemiologist at the University of California at Davis.
“That can create a high case fatality rate because you can only tackle the most severe cases,” she said. “You’ve got patients that might not get the same care they might get in other circumstances — in peacetime, as we say.”
Another new study from China, based on 1,099 patients in 552 hospitals across the country, put the case fatality rate there at 1.4 percent.
“At this point it’s all speculative. We don’t know the denominator,” said Columbia University epidemiologist Ian Lipkin, who recently visited China.
The China data does not necessarily predict what will happen elsewhere, said Michael Osterholm, an infectious disease expert at the University of Minnesota.
“You can’t just take Chinese data and suddenly lay it over the United States. And say it’s going to be 2 percent or 3,” he said. “It’s going to be totally a reflection of the at-risk population. What are the underlying risk factors? Obesity? Smoking?  Over 60 percent of Americans have an underlying health problem that could contribute to a poor outcome with this event.”
China has a higher case fatality rate than South Korea, where, as of Thursday, 35 people had died among 6,088 cases — a rate of 0.57 percent. Germany has reported 262 cases but zero deaths.
A new study suggests the virus has split into two strains and a less aggressive strain is now more prevalent than a deadlier one. But that is a preliminary report and not confirmed.
The report said reviews of 103 samples of the virus showed two distinct strains, which the authors name the L and the S strains. They hypothesized that the more aggressive L strain sickened people to the point that they sought medical treatment or other interventions. That would have made it less likely to spread. A less aggressive strain, the S type, could have circulated more easily over time among people who continued about their daily lives.
Jeffery Taubenberger, a virologist at the National Institute of Allergy and Infectious Diseases, said he would have to see “a lot more convincing data before I would begin to think that hypothesis was supported.”
He said the study did not contain enough data showing a clear link between the different strains and different medical outcomes. But animal viruses do mutate soon after they enter a new species, such as human beings, he said: “Certain adaptations are necessary. It’s likely that change will occur early on in the pandemic.”
Taubenberger is an expert on influenza pandemics, including the 1918 Spanish Flu, the worst in history. Estimates of the fatality rate of Spanish Flu are impeded by a lack of data on how many people were infected. But Taubenberger said a plausible estimate is a 1.1 percent case fatality rate in the United States and 4.6 percent globally.
In 1957, the influenza pandemic probably had a U.S. fatality rate of about 0.07, he said.
Asked to appraise the current coronavirus epidemic, he said, “Right now, to me, it looks like it’s sort of on par with an influenza pandemic in its impact. Obviously we hope it’s not going to be a 1918-like impact. It’s something we definitely need to take seriously.”
joel.achenbach@washpost.com
erica.werner@washpost.com


Another death reported in Saudi Arabian SARS-like virus

Saudi Arabia says a man has died from a new respiratory virus related to SARS, bringing to 62 the number of deaths in the kingdom at the center of the outbreak. The Health Ministry says the latest victim died in a Riyadh hospital on Thursday, according to the Associated Press. The ministry also reported that a chronically ill Saudi man who was admitted to a hospital in Riyadh became a new positive case of the virus, bringing to 150 the number of people infected in the kingdom since September 2012. The new virus is related to SARS, or severe acute respiratory syndrome, which killed some 800 people in a global outbreak in 2003. It belongs to a family of viruses that most often causes the common cold.


New global coalition launched to create vaccines, prevent epidemics

An electron micrograph scan shows the Ebola virus emerging from an infected cell. (NIAID/NIH)
A global coalition to create new vaccines for emerging infectious diseases launched Wednesday with the ambitious aim of protecting the world from future epidemics.
Announced at the World Economic Forum in Davos, Switzerland, the initiative has an initial investment of nearly $500 million from the Bill and Melinda Gates Foundation, Britain’s Wellcome Trust and the governments of Japan, Norway and Germany.
The partnership will be called the Coalition for Epidemic Preparedness Innovations, or CEPI. It grew out of the lessons from the world’s woeful lack of preparedness for the 2014 Ebola epidemic in West Africa, which killed more than 11,000 people and caused at least $2.2 billion in economic losses in the three hardest-hit countries.
As a result of that and the current Zika epidemic in the Americas, a global consensus has steadily grown among an array of governments, public health leaders, scientists and vaccine industry executives that a new system is needed to guard against future health threats.
Global health experts welcomed the initiative, saying it would complement efforts already underway by the World Health Organization and the U.S. Biomedical Advanced Research and Development Authority (BARDA), part of the Department of Health and Human Services, which are working on Ebola and Zika vaccines.
The United States is not providing funding for CEPI, but it is offering subject expertise. Officials took part in the planning discussions, and “while we are not a formal partner to CEPI, we foresee synergies between our approaches,” BARDA Director Rick Bright said in a statement. One such area is development of the most efficient technology for biodefense and infectious disease response, he said.
Rebecca Katz, director of Georgetown University’s Center for Global Health Science and Security, expects the new coalition “will just add much needed resources to a hard problem” and not detract from other efforts' funding and resources.

CEPI initially plans to target three viruses that have known potential to cause serious epidemics and can be transmitted from animals to humans: MERS, a deadly respiratory virus first identified in Saudi Arabia in 2012 that can be spread by camels and now is in 27 countries, including the United States; Lassa fever, an acute viral illness mainly found in West Africa and spread by rats; and Nipah, a newly emerging infection initially identified in 1999 in Malaysia and Singapore. During a Nipah outbreak there among pig farmers and people with close contact with pigs, nearly 300 people were infected and more than 100 died.
Each virus is among WHO's priority pathogens. Few or no medical countermeasures exist to combat them.
The current system for vaccine development is in crisis, health experts say, because it’s a costly, complicated and labor-intensive development process that prioritizes therapeutics with the biggest possible market.
CEPI hopes to develop two vaccine candidates against each of the target diseases. Officials said they did not choose Ebola and Zika vaccine work because considerable research is already underway.
“The last thing we would like to do is duplicate efforts,” Trevor Mundel, president of the Gates Foundation’s global health division, told reporters during a briefing.
Officials said they have raised $460 million, almost half of their $1 billion target for the first five years. They’re now seeking proposals from researchers and companies and expect to announce which will be funded by mid-year. They're also calling for other governments and organizations to help complete fundraising by the end of the year.
The Indian government, one of the coalition founders, is finalizing a financial commitment, according to CEPI.

Several major pharmaceutical companies are providing support in the form of vaccine technology, expertise and guidance. Industry representatives are on the coalition’s board and scientific advisory committee.
Bill Gates has said his biggest worry is a pathogen, more infectious than Ebola, for which the world is totally unprepared. In a statement Wednesday, Gates said, “The ability to rapidly develop and deliver vaccines when new ‘unknown’ diseases emerge offers our best hope to outpace outbreaks, save lives and avert disastrous economic consequences.”
Wellcome Director Jeremy Farrar was among those who first proposed a global vaccine development fund in mid-2015. CEPI’s initial $1 billion investment goal, he said, pales in comparison to the tens of billions of dollars in costs from epidemics, starting with the 2003 SARS outbreak.
“Vaccines can protect us, but we’ve done too little to develop them as an insurance policy,” Farrar said.
CEPI's financial contributions so far for its first five years include:
• Japan: $125 million
• Norway: about $120 million
• Germany: about $10.6 million in 2017 with more funding to come
• Wellcome Trust: $100 million
• Bill & Melinda Gates Foundation: $100 million
Read more:
CDC chief's biggest fear is influenza pandemic
Meet some of the volunteers on the front line testing a new Zika vaccine
The United States already has a vaccine safety commission. And it works really well, experts say


MERS fears in South Korea: Nearly 700 isolated as health officials seek to block spread

South Korea’s Ministry of Health and Welfare is scrambling to contain the spread of Middle East Respiratory Syndrome (MERS), which has killed two people.
South Korean health officials isolated nearly 700 people on Monday in an effort to stop the spread of the potentially deadly Middle East Respiratory Syndrome within its borders after 18 people became infected over the past 10 days -- a rate of transmission that appears more aggressive than in other countries.
South Korea has been on high alert since May 20 when a 68-year-old man who had been traveling in Bahrain tested positive for the virus. Since then, the virus has been detected in a number of patients and visitors to the hospital where he was treated -- triggering global concern about whether the virus had mutated or genetic or environmental factors may have been at play.
MERS, a coronavirus, is related to the one that infected thousands during the 2003 outbreak of Severe Acute Respiratory Syndrome and has no cure or vaccine.
"We must find the reason for the high rate of transmission unlike in the cases of other countries," President Park Geun-hye told a meeting on Monday, according to Reuters.
The Associated Press reported
Since being first reported in 2012, MERS has been mostly contained to Saudi Arabia, the United Emirates and Jordan. The World Health Organization says that 1,150 case have been reported and 427 of the patients have died. The WHO detailed the status of the two most recent cases:
The case is a 35-year-old male who developed symptoms of cough, sputum and fever on 6 May and was admitted to hospital on 13 May. The patient has been on tuberculosis medication since his son was diagnosed with the bacterial disease in April. Between 15 and 17, he shared the same ward with the first case during his hospitalization from 15 to 17 May. On 20 May, after his discharge, the patient visited two different hospitals due to fever and was put on antibiotics. As symptoms persisted despite antibiotic therapy, he was admitted to a hospital again on 27 May and confirmed positive for MERS-CoV on 29 May.
The case is a 35 year-old male whose mother shared the same ward with the first case. From 15 to 21 May, the patient visited his mother every day at the hospital. He developed symptoms and visited an emergency room on 24 May. The patient was admitted to hospital between 25 and 27 May and confirmed positive for MERS-CoV on 30 May.
In this Thursday, Oct. 17, 2013, file photo, Egyptian Muslim pilgrims, some wearing masks as a precaution against the Middle East respiratory syndrome, pray after they cast stones at a pillar, symbolizing the stoning of Satan, in a ritual called "Jamarat," the last rite of the annual hajj, in Mina near the Muslim holy city of Mecca, Saudi Arabia.  (AP Photo/Amr Nabil, File)


Media goes overtime on Ebola coverage, but not necessarily overboard

the word about public-health threats. News reporting, they say, typically underplays some risks and overplays others. Mundane behaviors — smoking, overeating — don’t rate sustained media coverage yet are linked to preventable diseases that kill tens of thousands annually. Ordinary viruses, such as the flu, take a huge toll as well but don’t rate screaming headlines. Result: The “high-media frequency” diseases were rated as more serious than the more obscure diseases by both the undergraduates and the medical students. Both groups overestimated the chances they would get one of the better-reported diseases. By contrast, other diseases have lesser “brand” names. Only a few people outside a medical lab had ever heard of enterovirus until a few weeks ago, despite a series of periodic outbreaks for more than 50 years. “The public has always been interested in risks in proportion to how much fear or outrage they arouse, not in proportion to how much hazard they present,” he said via e-mail. “Since media coverage follows people’s interests, reporters inevitably cover scary diseases that aren’t very dangerous more than dangerous diseases that aren’t very scary. That may drive public health professionals crazy, but it’s a fact of life. Journalism is about news, not education.” He added: “Ebola has all the hallmarks of a scary disease. It is novel, dramatic, horrifying, potentially catastrophic. It’s perfect for horror movies; why wouldn’t it be perfect for news stories?” So, the blanket coverage — of the hospital admission mishap in Dallas, of the debates over travel and the repetitive reporting about the whys and wherefores of transmission — is important cautionary information in the event things get worse: “At least for the moment, U.S. investigative Ebola reporting is flourishing, and that’s a blessing,” he says. But ultimately the Ebola story isn’t about Americans and America, Sandman said. The heart of the story is West Africa, where Ebola still rages. As long as the media focus remains on the United States, it will miss the potential “sparks” that could alight from Africa, finding their way into populous and underdeveloped cities around the world. At which point the global contagion scenarios of so many movies could become more than just science fiction: “Spark suppression is going to be the most important Ebola story,” he said. “I think it’s essential to get this story out, because it is a political and ethical story as much as a technical story.”

Members of the media set up outside of Texas Health Presbyterian Hospital in Dallas where Thomas Eric Duncan, who was the first to be diagnosed with Ebola in the United States, is in critical condition, on Oct. 1.  (G.J. Mccarthy/AP)
There’s a potentially deadly disease afoot in America, with no known cure and terrifying consequences for those infected.
Ebola? Well, yes, but another bug has had far more wide-ranging consequences. Since an outbreak began in late summer, the  enterovirus has sent thousands of people, primarily children, to hospitals in 43 states and the District. One strain, enterovirus D68, has apparently caused polio-like symptoms in some patients, leaving them unable to move their limbs. Four people who recently died tested positive for the disease, although the link between the virus and the deaths is unclear, according to the Centers for Disease Control and Prevention.
You might not know all that from the news media’s reporting over the past few weeks. The enterovirus certainly hasn’t been ignored, but it’s a mere footnote compared with the oceanic volumes devoted to Ebola, a disease that has devastated parts of West Africa but has only one confirmed case diagnosed in the United States. CNN has been especially relentless, chasing down every conceivable Ebola angle and a few inconceivable ones, too. One segment explored the possibility of catching Ebola from a sneeze, a pet or a swimming pool (the expert answers: “really rare,” “no evidence for that” and “highly unlikely,” respectively).
For the most part, the reporting on medical aspects of the disease has been straightforward and responsible, with many stories emphasizing the relatively low risks of infection. A few commentaries, meanwhile, have lapsed into xenophobia about the African sources of the disease. One Fox News pundit, Andrea Tantaros, offered this analysis last week: “In these countries they don’t believe in traditional medical care. So someone could get off a flight and seek treatment from a witch doctor who practices Santeria,” an Afro-Caribbean religion that includes ritual animal sacrifice.
But even when the reporting is accurate, the sheer tonage of it raises a question about proportion and relative risk: Why is Ebola a media superstar when other diseases — say, enterovirus or the common flu — have more far-reaching and even deadlier consequences in this country?
Sally Nuran, manager of the Ivy Apartments where Thomas Eric Duncan stayed after getting sick, responds to questions from reporters during a news conference in Dallas on Oct. 2. (Tony Gutierrez/AP)
The question is a familiar one to people involved in spreading the word about public-health threats. News reporting, they say, typically underplays some risks and overplays others. Mundane behaviors — smoking, overeating — don’t rate sustained media coverage yet are linked to preventable diseases that kill tens of thousands annually. Ordinary viruses, such as the flu, take a huge toll as well but don’t rate screaming headlines.
“If any or all of these issues received the levels of media coverage and public concern that Ebola was receiving, thousands of annual deaths could be prevented,” said  Jay Bernhardt, the founding director of the Center for Health Communication at the University of Texas. The volume of Ebola coverage, he said, “reminds me a lot of the over-the-top coverage of serial killers or celebrity scandals in that they are far out of proportion with the risk or relevance to the general population.”
Social-science research has shown that intensive news reporting on certain diseases can distort public perceptions of their severity and the chances of contracting them. In a 2008 experiment at McMaster University in Ontario that was updated last year, researchers asked undergraduates and medical students their impressions of 10 infectious diseases. Five of the diseases (anthrax, SARS, West Nile virus, Lyme disease and avian flu) had received relatively more news media coverage than a second group of five.
Result: The “high-media frequency” diseases were rated as more serious than the more obscure diseases by both the undergraduates and the medical students. Both groups overestimated the chances they would get one of the better-reported diseases.
But that’s not to say that the media is “over-covering” a particular threat, said Meredith Young, the lead researcher on the studies, who now works at Montreal’s McGill University. “It really only is in hindsight that we can say whether a potential threat was over- or undercovered in the media and what the ‘real’ risk was of that particular infectious disease,” she wrote in an e-mail. That is, “did the threat materialize? Or did the media coverage help to prevent the threat” by warning of a potential contagion and mobilizing preventive action?
Ebola’s preeminence in the news media probably has much to do with the primal fear it inspires and the popular-culture context from which it comes. While Ebola isn’t widespread or common, those who get it are at grave risk; the mortality rate is upward of 70 percent (the far-less covered Middle East respiratory syndrome, or MERS, clocks in with a death rate of about 40 percent). Salon.com columnist Andrew O’Hehir likens Ebola to a great white shark: Your chances of encountering one are abysmally low, but so are your chances of surviving such a meeting.
Like the great white, public perceptions about Ebola have likely been primed by decades of movies, TV shows and books imagining a global contagion and resulting zombie apocalypse. More than a few news stories and TV segments lately have referred to Ebola’s “hot zone,” which was the name of a mega-selling 1994 book about the origins of the virus.
By contrast, other diseases have lesser “brand” names. Only a few people outside a medical lab had ever heard of enterovirus until a few weeks ago, despite a series of periodic outbreaks for more than 50 years.
“It’s not surprising” that Ebola is at the top of the media agenda, says Jeff Levi, executive director of the Trust for America’s Health, a nonprofit health advocacy organization based in Washington. “The novel is more interesting and frightening to people. Part of me gets it. But it’s something we in the public-health community struggle with all the time.”
Despite the low odds of an Ebola pandemic in the United States, Peter Sandman, an expert in risk communication, says the story nevertheless warrants the attention it’s getting.
“The public has always been interested in risks in proportion to how much fear or outrage they arouse, not in proportion to how much hazard they present,” he said via e-mail. “Since media coverage follows people’s interests, reporters inevitably cover scary diseases that aren’t very dangerous more than dangerous diseases that aren’t very scary. That may drive public health professionals crazy, but it’s a fact of life. Journalism is about news, not education.”
He added: “Ebola has all the hallmarks of a scary disease. It is novel, dramatic, horrifying, potentially catastrophic. It’s perfect for horror movies; why wouldn’t it be perfect for news stories?”
So, the blanket coverage — of the hospital admission mishap in Dallas, of the debates over travel and the repetitive reporting about the whys and wherefores of transmission — is important cautionary information in the event things get worse: “At least for the moment, U.S. investigative Ebola reporting is flourishing, and that’s a blessing,” he says.
But ultimately the Ebola story isn’t about Americans and America, Sandman said. The heart of the story is West Africa, where Ebola still rages. As long as the media focus remains on the United States, it will miss the potential “sparks” that could alight from Africa, finding their way into populous and underdeveloped cities around the world.
At which point the global contagion scenarios of so many movies could become more than just science fiction: “Spark suppression is going to be the most important Ebola story,” he said. “I think it’s essential to get this story out, because it is a political and ethical story as much as a technical story.”


Scientists announce important Zika milestone: First vaccine ready for human trials

Stella Guerra performs physical therapy on an infant born with microcephaly at Altino Ventura Foundation in Recife, Brazil. (Mario Tama/Getty Images)
Since the World Health Organization declared Zika a public health emergency in February, teams of scientists from all over the world have been attacking the virus from many different angles. They have made advances in understanding the structure of the virus, the historical path of the mosquitoes that carry it and the risk to babies still in the womb — important knowledge, but of little immediate practical use.
Now, the discoveries have finally led to something that might be able to stop the pathogen: a vaccine.
Pennsylvania vaccine maker Inovio Pharmaceuticals and South Korea’s GeneOne Life Sciences said Monday that they had received approval from U.S. regulators to start testing a DNA vaccine, known as GLS-5700, on humans. The early-stage study will include 40 healthy subjects. It is primarily designed to assess the safety of the vaccine but will also measure the immune response generated by the injection. Zika, part of the flavivirus family of viruses that includes West Nile, dengue and yellow fever, is believed to be responsible for causing thousands of babies to be born with shrunken heads in Brazil and elsewhere. The Centers for Disease Control and Prevention recently detailed the cases of six babies born with the condition in the United States.
Inovio
“We are proud to have attained the approval to initiate the first Zika vaccine study in human volunteers,” Kim said in a statement. “As of May 2016, 58 countries and territories reported continuing mosquito-borne transmission of the Zika virus; the incidences of viral infection and medical conditions caused by the virus are expanding, not contracting.”
Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, has said he believes the world’s best hope against Zika is a vaccine and that, because of previous research on West Nile and dengue, a Zika vaccine should take less time to develop than vaccines for many other infectious diseases. The challenge is that Zika is unique among its related viruses because the others don’t invade the nervous system or developing fetuses because of blood-brain and placental barriers.
Researches who examined the virus’s structure with an electron microscope recently explained to The Washington Post what it is about its structure that might make it so dangerous:
It shares a basic structure with all flaviviruses: Genetic info in the form of RNA is surrounded by a fatty membrane, then encased in a protein shell with a 20-sided face. The protein shells are made of 180 copies of two different proteins, each composed of chains of different amino acids. Once inside a target cell, the virus breaks apart and forces the host to do its bidding, replacing the instructions coded into the cell’s DNA with those programmed by viral RNA.
Zika differs most from other flaviviruses at a spot thought to be crucial to the cellular break-in. At this site, a carbohydrate molecule — made of different sugars — sits on the virus’s protein shell. This spot where Zika differs, called a glycosylation site, actually protrudes from the shell of the virus. In other viruses, similar protrusions act like strangers offering candy, tricking the human cell into binding with the invader. Like other flaviviruses, Zika seems to have a unique smattering of amino acids around that area.
The Food and Drug Administration has also been aggressive about trying to green-light other things that may be useful to the Zika fight. In May, it granted approval for emergency use of a Zika test from Altona Diagnostics. Another company, Hologic, said its product — a diagnostic test used to identify snippets of the Zika virus in human blood — had received similar approval to be used in emergency cases in all 50 U.S. states, plus Puerto Rico and territories.
Read more:
CDC: 6 pregnancies in Zika-infected women resulted in birth defects
U.S. to send rapid response teams when Zika hits here
Zika can cause microcephaly even if moms have no symptoms


The 5 things you need to know about MERS (and global health)

The hunt for the MERS virus in South Korea continues. (Reuters) Even before the Ebola outbreak in West Africa has ended, there’s a new infectious disease to fear: Middle East respiratory syndrome, or MERS. Will it become an epidemic? Can it be contained? 1. There’s a lot we don’t know about MERS yet, but it doesn’t act like a disease that will become a widespread epidemic. 2. The South Korean government is trying to avoid China’s mistakes with SARS. The Korean government’s strategic shift shows that it understands the importance of sharing information to combat a disease outbreak — and the importance of responding to public unrest. But we have not yet seen whether this newfound openness will restore the public’s faith in the government’s ability to deal with public health, or whether the initial delay in responding will have long-term consequences. 3. Diseases like MERS move with people, but that does not mean that people should not move. But these reactions, while understandable, are ineffective and may cause bigger problems. The better strategies are contact tracing and monitoring those who have recently been in affected regions, strategies far more focused on key individuals than immobilizing the whole population. 4. MERS in South Korea should not distract us from what is happening in Saudi Arabia. Unfortunately, the Saudi government has not shown much inclination to share information or to cooperate with the international community. If we have learned anything from the history of successful interventions by global health institutions, it’s that cooperation between national governments and international public health institutions is vital. 5. So far, WHO is doing its job. With Ebola, WHO largely failed to perform these tasks. In the case of MERS, though, it appears to be fulfilling its obligations. Part of the difference may also be that, unlike Ebola, MERS has not strained the organization’s resources. So far, WHO has not asked the international community for financial contributions for MERS, suggesting that its current resources are enough to handle the outbreak. If things become more serious, WHO may need a serious infusion of money and personnel. Furthermore, if MERS spreads to more countries, it could strain the ability of disease surveillance systems to monitor and trace new cases. The lack of funds to support and strengthen disease surveillance systems is a serious shortcoming in the international community’s efforts to stop the spread of infectious diseases. Jeremy Youde

The hunt for the MERS virus in South Korea continues. (Reuters)
Even before the Ebola outbreak in West Africa has ended, there’s a new infectious disease to fear: Middle East respiratory syndrome, or MERS.
MERS appeared three years ago in Saudi Arabia, probably after jumping from camels to their human handlers, and had mostly stayed there — until last month, when it struck in South Korea. Within that month, MERS has caused more than 100 illnesses and at least 9 deaths in that country.
Will it become an epidemic? Can it be contained?
Those questions are on many minds for several reasons. Scientists know relatively little about MERS. We don’t yet know how to treat it. It’s related to other deadly respiratory ailments like SARS. Many wonder whether global institutions like the World Health Organization can keep people safe — especially after WHO’s failures in responding to Ebola.
But the situation does not appear quite as dire with MERS. Thanks to the lessons learned from previous outbreaks of respiratory diseases and relatively pro-active responses, the global health governance system’s response has reassured a number of experts that a full-blown MERS epidemic is unlikely. At the same time, MERS shows that there are still important shortcomings in global health governance.
1. There’s a lot we don’t know about MERS yet, but it doesn’t act like a disease that will become a widespread epidemic.
MERS appears unlikely to become widespread, in part because of its unique qualities. MERS is a relatively new disease. It was first identified in 2012 in Saudi Arabia, after a 60-year-old man entered a hospital in Jeddah complaining of shortness of breath, a week-long cough, and kidney failure. Between its discovery in 2012 and this past March, MERS had infected slightly more than 1,000 people and caused nearly 400 deaths.
Two facts about how MERS spreads make a widespread outbreak less likely. First, MERS doesn’t spread very easily. The average MERS patient causes only 0.7 additional illnesses. By contrast, the average SARS patient infected 5 other people. Many of the Saudi cases still occur in people who are in close contact with camels. Since the typical MERS patient does not infect another person, the disease can be contained.
Second, human-to-human MERS transmission is happening mainly within health-care facilities and among people with weakened immune systems. As a result, relatively simple changes in hospital procedures may stop MERS’ spread.
2. The South Korean government is trying to avoid China’s mistakes with SARS.
When SARS appeared in 2002, the Chinese government’s initial response was abysmal. It denied the reports of a new disease. It recommended ineffective prevention strategies, like using vinegar to disinfect the air. It imposed a news blackout to prevent reporting about “atypical pneumonia.” It prevented WHO officials from having access to hospitals and clinics.
These responses exacerbated the problem, giving the disease time to infect more people and causing people to question the government’s trustworthiness. The secrecy and failure to share information with international partners impeded a timely response, and China was widely condemned.
At first, the Korean government underestimated the disease’s extent and provided little information about how widely it had spread. This caused many to openly question the government’s ability to handle the crisis. By last Sunday, though, Seoul had thoroughly changed its tactics. The government is sharing the names of all the hospitals treating MERS patients, providing public information about how people can protect themselves, and actively countering rumors. President Park Geun-hye even postponed her planned trip to Washington this week so that she could help coordinate her government’s response.
The Korean government’s strategic shift shows that it understands the importance of sharing information to combat a disease outbreak — and the importance of responding to public unrest. But we have not yet seen whether this newfound openness will restore the public’s faith in the government’s ability to deal with public health, or whether the initial delay in responding will have long-term consequences.
3. Diseases like MERS move with people, but that does not mean that people should not move.
Travel spreads infectious diseases. In 1918 and 1919, a global influenza pandemic killed at least 30 million people worldwide, in no small part because World War I troop movements  spread influenza around the globe. Nearly a century later, a never-before seen disease called severe acute respiratory syndrome (SARS) emerged in southern China.
Over nine months, SARS spread to 34 countries, caused nearly 8100 illnesses, and killed 774 people. After the outbreak ended, epidemiologists identified globalization and rapid travel as key to SARS’ rapid spread. Indeed, they traced roughly 4000 cases and 550 deaths to a single doctor who checked into a Hong Kong hotel in February 2003.
The current MERS outbreak in South Korea has been traced back to a 68-year-old man who had spent time in Saudi Arabia and United Arab Emirates.
When these sorts of outbreaks occur, there is often an impulse to close borders, restrict travel, and close down public gathering spots like schools and theaters. Indeed, nearly 2500 South Korean schools have been closed so far. Arrivals at South Korean airports, movie ticket sales, and amusement park admissions are down substantially.
But these reactions, while understandable, are ineffective and may cause bigger problems.
WHO is not recommending any travel restrictions, and a WHO-Korean government task force is urging schools to reopen. Why? Since MERS does not spread easily from one person to another, travel restrictions and school closings will do little to stop its spread. Rather, they may generate panic, which can have larger social, economic, and political consequences. They may also discourage people from seeking treatment.
The better strategies are contact tracing and monitoring those who have recently been in affected regions, strategies far more focused on key individuals than immobilizing the whole population.
4. MERS in South Korea should not distract us from what is happening in Saudi Arabia.
While the MERS cases in South Korea have received much attention in recent weeks, the disease remains largely centered in Saudi Arabia. MERS first emerged there, and more than 85 percent of human cases of the disease have happened in the country. Because there is so much we still do not know about MERS and because Saudi Arabia figures so prominently in its origin and transmission, this is where global health institutions need to devote a great deal of time and attention.
Unfortunately, the Saudi government has not shown much inclination to share information or to cooperate with the international community.
In 2013, WHO Director-General Margaret Chan lambasted the Saudi government for failing to share virus samples with WHO-affiliated labs, delaying the ability of scientists to research the virus and attempt to discover treatments. International officials have said that the Saudi government has repeatedly denied offers of help and assistance since 2012.
More recently, the Saudi deputy minister of health deflected attention away from MERS and suggested that the only reason for the high number of cases in his country was that it was looking for them. “The more you look, the more you find,” he told science journalist Helen Branswell.
If we have learned anything from the history of successful interventions by global health institutions, it’s that cooperation between national governments and international public health institutions is vital.
5. So far, WHO is doing its job.
Under the International Health Regulations, human cases of new diseases that have a high likelihood of spreading internationally should be reported to WHO. In response, WHO works to keep countries informed about risks, builds capacity to detect new cases, and coordinates an international response.
With Ebola, WHO largely failed to perform these tasks. In the case of MERS, though, it appears to be fulfilling its obligations.
WHO set up an emergency committee to work on MERS in 2013, and it publicly makes available both the minutes of its meetings and the names of its members. It has provided governments with guidance about proper procedures and policies for dealing with MERS, and it provides regular updates on the numbers of cases and epidemiological information.
What explains the difference? Part of it may be that WHO has experience working with this sort of virus. WHO’s response to SARS was widely praised, and MERS and SARS are in the same virological family. It may be that the organization has been monitoring MERS for a number of years, giving it time to develop its expertise and appropriate strategies.
Part of the difference may also be that, unlike Ebola, MERS has not strained the organization’s resources. So far, WHO has not asked the international community for financial contributions for MERS, suggesting that its current resources are enough to handle the outbreak. If things become more serious, WHO may need a serious infusion of money and personnel.
Furthermore, if MERS spreads to more countries, it could strain the ability of disease surveillance systems to monitor and trace new cases. The lack of funds to support and strengthen disease surveillance systems is a serious shortcoming in the international community’s efforts to stop the spread of infectious diseases.
Jeremy Youde is an associate professor of political science and department head at the University of Minnesota Duluth. His most recent books are


What is the Middle East Respiratory Syndrome (MERS)?

The Download: Novavax has laid the groundwork for MERS vaccine, executives say

Executives at Gaitherburg-based Novavax say the company has laid the groundwork for a vaccine to combat Middle East Respiratory Syndrome, or MERS, should the number of people infected with the virus continue to rise as some public health officials fear. In the April 13 issue of the medical journal Vaccine, researchers from the company and the University of Maryland School of Medicine published data showing they were able to block infection in laboratory tests. The vaccine is still considered highly experimental and would need additional safety and efficacy tests before it could be used in humans. But researchers contend their findings are a promising development for health officials. “We’ve been talking with a lot of different people who are interested in what’s going on here. No decision has been made about going forward,” said Greg Glenn, senior vice president of research and development at Novavax. Matthew Frieman “If it continues to rise as it has been, this type of vaccine, even though it’s experimental, may be fast-tracked all the way,” Frieman said. The Center for Disease Control and Prevention reports the first case of MERS emerged in 2012, and most cases have been contained to countries on the Arabian Peninsula. The first confirmed case in a traveler to the United States was reported last week. Symptoms of the virus include fever, cough and shortness of breath, according to the CDC. About 30 percent of those with the illness die from it. Bits & bytes Bethesda-based WealthEngine, a data analytics company that helps marketers to learn about the wealth and lifestyles of customers, raised $7 million from investors last week. Novak Biddle Venture Partners Making your summer reading list? Aneesh Chopra, the nation’s first chief technology officer, last week released his book, “Innovative State: How New Technologies Can Transform Government.” Chopra, who now works for under-the-radar upstart Hunch Analytics, argues in the 299-page book that modern technology offers the government ways to operate more efficiently and tackle persistent problems in new ways .

The vaccine is still considered highly experimental and would need additional safety and efficacy tests before it could be used in humans. But researchers contend their findings are a promising development for health officials. Matthew Frieman “If it continues to rise as it has been, this type of vaccine, even though it’s experimental, may be fast-tracked all the way,” Frieman said. The Center for Disease Control and Prevention reports the first case of MERS emerged in 2012, and most cases have been contained to countries on the Arabian Peninsula. The first confirmed case in a traveler to the United States was reported last week. Symptoms of the virus include fever, cough and shortness of breath, according to the CDC. About 30 percent of those with the illness die from it. Bits & bytes Novak Biddle Venture Partners


Gaithersburg-based Novavax developing vaccine to prevent spread of Ebola

Gaithersburg-based Novavax, a life sciences company that develops vaccines for infectious diseases, could begin testing a vaccine to stem the spread of Ebola in humans as soon as December, the company’s chief executive said.
Should the vaccine prove to be safe and effective, there still would be more work to do. Executives said it remains unclear how quickly the medicine would be available for health workers and military personnel working in areas stricken with Ebola.
Chief executive Stanley C. Erck said the company would expect to have results from its initial trial in humans during the first three months of 2015 and, based on those results, could plot a path toward selling the vaccine later that year.
To get to that stage, Novavax would require both positive test results and an agreement with the Food and Drug Administration to expedite the approval process.
Novavax has developed technology that uses the genetic code of particular strain of virus to generate a vaccine. It has allowed the company to respond quickly to recent outbreaks of influenza and the Middle East Respiratory Syndrome, known as MERS.
“What our technology allows us to do is quickly make a vaccine that is both safe and stimulates antibody responses to emerging diseases,” Erck said. “Ebola comes up and that is a virus that is a perfect fit for our platform.”
The company began work on an Ebola vaccine as soon as scientists had mapped the genetic sequence of the strain responsible for the ongoing outbreak in West Africa. Novavax has already tested the vaccine in rodents and rabbits, and plans are underway for a trial in baboons.
“Safety in vaccines is really important because when you develop cancer drugs or drugs for severe diseases, you can afford to have drugs that work but have some side effects,” Erck said. “But with vaccines, you’re working with healthy people.”
The FDA and global health agencies are fervently seeking ways to contain and treat the Ebola virus as it continues to spread across West African nations and isolated cases emerge in other countries, including the United States.
“We’ve called [the FDA] up and told them what we’re doing, and we’ve worked very closely with the FDA,” Erck said. “They want to see products emerge that can be effective in this outbreak.”
That sense of urgency has allowed some drugmakers and biotechnology companies to expedite safety trials. Regulators in Switzerland, for example, approved inoculating health workers traveling to Africa with an experimental vaccine developed by GlaxoSmithKline.
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This SARS-like virus has killed 30 of the 50 people who contracted it

The organization has now confirmed 50 cases of what it calls Middle East respiratory syndrome, or MERS. Thirty of those patients have died. We do not know yet how dangerous the virus is, but we can hope health care systems around the world are up to the task of monitoring and preventing infections, in which case we won't have to find out.

The World Health Organization has announced three new deaths from a new virus that has alarmed health officials in the Middle East and Europe since it was first discovered last year.
The organization has now confirmed 50 cases of what it calls Middle East respiratory syndrome, or MERS. Thirty of those patients have died.
Those numbers are cause for concern. The MERS virus is a coronavirus, which is the same type of virus responsible for the common cold as well as SARS, but less than a tenth of the people who fell ill in the SARS epidemic of 2002 and 2003 died. The new avian influenza virus spreading in China, known as H7N9, has resulted in death in a quarter of known cases, while the more well-known bird flu strain, H5N1, kills about half of those who are infected, according to The New York Times. It's still too early to say whether the MERS virus is more dangerous than these other viruses, since many more people could have been infected without developing severe symptoms.
Yet MERS is worrisome for other reasons. A study published online Thursday in The Lancet described how one patient in a French hospital caught the disease from another who had recently traveled to Dubai and did not survive. The two shared a room together for three days, but it wasn't until more than a week afterward that symptoms appeared in the other patient. The authors of the study estimated the incubation period at 9-12 days, a long time in which infected people could spread the disease without realizing that they are ill. It still isn't certain at what stage people carrying the virus are most contagious, the Los Angeles Times reports.
Another concern is that the virus is difficult to identify. An article published in The New England Journal of Medicine this week described how the disease apparently spread through three generations of a family in Riyadh. A boy and his uncle survived the illness, while the boy's father and grandfather did not. Yet doctors could not confirm the presence of the MERS virus in the youngest of the patients, and were not able to confirm it in the two who died until after they passed away.
The World Health Organization is not advising restrictions or special screening for travelers, but it has issued recommendations for surveillance that describe what respiratory illnesses hospital personnel should regard as suspicious. Still, the agency has to rely on doctors to find cases, who in many countries have other problems to worry about, as Foreign Policy reports. For example, the virologist who first identified the MERS pathogen at a Saudi hospital told the Guardian that he was fired for making his discovery public.
We do not know yet how dangerous the virus is, but we can hope health care systems around the world are up to the task of monitoring and preventing infections, in which case we won't have to find out.


Here are the five U.S. cities where most travelers from Saudi Arabia and the UAE arrive

There’s been a lot of attention to the deadly respiratory virus known as Middle East Respirator Syndrome (MERS), now that two confirmed cases have emerged in the United States. Both patients were travelers from Saudi Arabia. Most of the 571 confirmed cases worldwide are in the Middle East, particularly Saudi Arabia and the United Arab Emirates. With infections just a plane trip away, as experts like to say, here are the top five destinations in the United States for travelers arriving from Saudi Arabia and the UAE in the months of May and June, according to the Centers for Disease Control and Prevention. The five accounted for 75 percent of the arrivals from those two countries; based on historical patterns, the CDC estimates that about 100,000 travelers will arrive in these cities in May and June of this year. The CDC is urging travelers to and from the Arabian Peninsula to take extra precautions, such as avoiding contact with sick people and washing hands frequently. Anyone who comes down with fever, cough or shortness of breath within 14 days after traveling to the region should consult a physician. The agency emphasizes, however, that there is no evidence that the disease is transmitted by casual contact. It appears to require close contact, such as patient to caregiver, for the disease to be communicated. 1. New York 30,680 2. Washington ~24,514 3. Los Angeles 15,070 4. Atlanta 14,567 5. Chicago 10,457 And let’s not forget our neighbor to the North. Toronto is also a big destination, with 14,889 travelers.

With infections just a plane trip away, as experts like to say, here are the top five destinations in the United States for travelers arriving from Saudi Arabia and the UAE in the months of May and June, according to the Centers for Disease Control and Prevention. The five accounted for 75 percent of the arrivals from those two countries; based on historical patterns, the CDC estimates that about 100,000 travelers will arrive in these cities in May and June of this year. The CDC is urging travelers to and from the Arabian Peninsula to take extra precautions, such as avoiding contact with sick people and washing hands frequently. Anyone who comes down with fever, cough or shortness of breath within 14 days after traveling to the region should consult a physician. 1. New York 30,680 2. Washington ~24,514 3. Los Angeles 15,070 4. Atlanta 14,567 5. Chicago 10,457 And let’s not forget our neighbor to the North. Toronto is also a big destination, with 14,889 travelers.