Defenses Against the Biggest Risk We Face

Bill Gates says the biggest risk that we reasonably face is a bioterrorism attack or natural pandemics.

Pandemic and Epidemic Risks

Relatively average costs for more serious infectious events are high in terms of deaths and costs. One study found the worldwide spread of a serious infectious disease could result in pandemic-related deaths of 700,000 and annual economic losses of $500 billion.

Major epidemics and pandemics are unlike some other risks that are discussed. Epidemics happen all the time. Major pandemics have happened within the lives of people today. They will strike again and few would argue that the world is adequately prepared.

The 1918 influenza epidemic had worldwide impact. 50 million people died and one-fifth of the world’s population got sick from the 1918 flu. World war 1 killed 16 million people but over three times as many died from the 1918 flu. World population was about 1.9 billion. One person in 38 was killed by the flu.

Between 20 and 60% of all those infected and over 80% of infected children died from smallpox. During the 20th century, it is estimated that smallpox was responsible for 300–500 million deaths. In the early 1950s an estimated 50 million cases of smallpox occurred in the world each year.

But Even Though Our Population is Higher, Our Medicine and Public Health is Better, Therefore …

The World Health Organization had a scientific report that modeled the impact of a 1918 style flu pandemic in 2018. They estimated that there would still be 20 to 33 million deaths. This took into account modern vaccination, drugs and public health procedures.

A typical year sees the flu killing 250,000 to 1 million people globally.

Air Travel Now Increases Vulnerability

Air travel now increases the world vulnerability to Pandemic and Epidemics. There were over 4 billion airline passenger in 2017. Air travel will nearly double by 2036. Increased air travel means that infectious disease can be spread globally very quickly.

Some Defense

As previously mentioned we have drugs, hospitals, sanitation, clean water and public health.

There are now temperature checks at most airports around the world.

There is now work to deploy ultraviolet lights to revolutionize public health by killing airborne disease pathogens.

Continuous low doses of far ultraviolet C (far-UVC) light can kill airborne flu viruses without harming human tissues, according to a new study at the Center for Radiological Research at Columbia University Irving Medical Center (CUIMC). The findings suggest that use of overhead far-UVC light in hospitals, doctors’ offices, schools, airports, airplanes, and other public spaces could provide a powerful check on seasonal influenza epidemics, as well as influenza pandemics.

Scientists have known for decades that broad-spectrum UVC light, which has a wavelength of between 200 to 400 nanometers, or nm), is highly effective at killing bacteria and viruses by destroying the molecular bonds that hold their DNA together. This conventional UV light is routinely used to decontaminate surgical equipment.

Normal UVC light can cause skin cancer and cataracts. However, the new light is safe for humans. The lights cost about $1000 but this price would com down with mass production.

Bacteria can be killed in ten seconds under the lights. Viruses are also killed.

There is also the technology for monitoring the pathogens at specific locations in cities and the environment. A device could be at a street corner and monitoring and testing bacteria and viruses. A device can be placed in the sewer to monitor for bacteria and viruses.

I do not think the concern about too much antibiotics applies to UV light. Overusing antibiotics has the concern that you are forcing rapid evolution toward antibiotic resistance. Antibiotics kill 99.9% of the bacteria colony. The 0.1% that survive are antibiotic resistant. They multiply rapidly and your next attack is from antibiotic-resistant bacteria. UV light is going at the molecular bonds, so it seems evolving a defense of molecular bonds does not seem possible. This could be a consideration and concern. If the resistance development was a concern then some of the UV light defense stations would only be activated when an outbreak actually appears to be emerging. Containment protocols are discussed later.

Location Information Critical to Breaking Cholera Epidemic

How important is that?

There is the analysis and the containment of Cholera outbreaks in the mid-1800s. British doctor John Snow couldn’t convince other doctors and scientists that cholera was spread when people drank contaminated water until a mother washed her baby’s diaper in a town well in 1854 and touched off an epidemic that killed 616 people.

The epidemic was contained by counting how many people were getting sick and where they lived and worked. The number of people was higher and higher near one of the town wells. The town well where the mother washed the diapers.

Faster effective responses and being able to quarantine the right people and stopping transmission is huge.

At the 2018 Foresight Vision Weekend the idea was proposed that some form of pro-active medical quarantine defense. However, quarantines often need to last up to two weeks.

However, most society has cellphones and wearable monitoring devices and camera monitoring. This means big data and AI could determine people who have self-quarantined by not going out in public for any particular period.

Digital Eye in the Sky Caught Murderers and Those Who Planted IEDs

Something that is not commonly known is that lockdown big brother surveillance works, has been deployed in various places and is very simple and cheap. It is also getting cheaper.

In 2012, there were Cessna’s flown over Dayton, Ohio for months. They had a high resolution camera. The plane flew at 10,000 feet and kept a constant video recording of Dayton. Each pixel was about one square foot. The cameras could cover 25 square miles. If some crime occurred in Dayton. A murdered body is found at some location or an armed robbery is known at some time and location. The eye in the sky recording of Dayton could be rewound like Tivo. They go back to the time and location of the crime and then look at all of the dots that went in and out of the location. Those moving dots were people. The people would go into bigger collection of dots called cars. All of them could be made to glow using software.

The investigator can watch the dots going back to their home. 75 murders were solved in the months that the Cessna’s were flying. These systems were also used in Iraq and Afghanistan to find IED (Improved Explosive Device) bombers.

It would be trivial to use long duration drones of the Amazon delivery class for a widespread system. High resolution cameras and drones get cheaper and cheaper all the time.

Backtracking from where something important happens does not even require AI. Highlighting a dot is trivial. Video gamers are able to follow a glowing dot through video.

In the Pandemic detection case, the triggering events are the detection of the pathogens or sick people by time and location.

This level of privacy loss and tracking obviously is big brother level of scrutiny. It needs to be very carefully managed. For the public health issues, it should only be used in a high-level containment zone. It could be used for analysis for helping determine what happened leading up to a very serious outbreak. Again there would need to be management and balancing of privacy and public health issues throughout the use of this level of information.

Separately there needs to be discussion of the trivially cheap cost of big brother.

Thin Film Norway Has Cheap and Deployed Postage Stamp RFID Electronics For Food

Thin Film Electronics ASA (“Thinfilm”) has 20+ years of experience in the field of non-volatile memories using functional polymers. Thinfilm’s unique all-printed re-writable products are ideal for use in standalone consumer applications, including personalized toys and online-enabled games. They can also be integrated with logic elements, sensors, batteries, and displays for mass market applications such as all-printed RFID tags. The proven high volume roll-to-roll production of Thinfilm printed memories provides the platform for its Memory Everywhere™ vision.

Several years ago they were already making clear plastic tags that could track grocery goods like fruits. They now provide tracking for wine and spirits and perfume and provide more information to market and sell goods. They also provide supply chain tracking.

Lets Put The Devices Together into a Relatively Convenient and Reasonable Cost Defense in Depth System Against Epidemics and Pandemics

We put better monitoring pathogen and sick people detection devices at all airports, hospitals, shopping malls, schools, stadiums, subways, bus stations, hotels, apartments, etc… Sick people detection is currently crude with systems that check for people with fevers. There are more advanced systems. The more effective and higher costs systems would be placed at more high priority locations based upon the importance for medical defense.

The wearable health monitoring watches and devices provide real-time and location health data from a significant fraction of the population on a voluntary basis. This data can be tapped on a public health emergency basis or via anonymized constant monitoring for epidemic and pandemic early warning.

We put the pathogen detection devices into the sewers. Stool and urine analysis would be able to localize outbreaks where those kinds of medical tests are useful.

We can also place monitoring at farms, supermarkets and the food supply chain.

There can also be analysis of garbage if there was useful information to be gained from this effort.

These systems can catch and monitor outbreaks in near real-time.

When important disease detections are made, then intense monitoring is activated along with containment protocols. Mobile or portable UV light systems can be taken to every suburb or residential area. Additional public health drones can be sent.

Containment of Pandemic has not really been tried other than for Ebola.

For Pandemic FLu

* Mathematical modeling indicates “window of opportunity” to act is very short.

* May have ~ 3 weeks to start antivirals and non-pharmaceutical measures after Index Cluster is detected

* Detection, investigation and reporting of first cases must happen quickly followed by timely assessment and decision-making

* Clinical severity not important consideration
– Early cases could be “mild”
– Later cases could be “severe”

1. Is there compelling evidence to suggest that a novel influenza virus has gained the ability to spread easily from person to person and initiate and sustain outbreaks in the community?
2. If so, are there compelling reasons why a containment operation should not go forward?

Pharmaceutical Interventions in the Containment Zone

* All well persons given 20 days of antiviral prophylaxis
* Why 20 days?
– Increase the time most persons on prophylaxis or treatment at the same time
– Uncertainty about the emerging virus; e.g. possibility of longer incubation period than seasonal influenza
– Packaging considerations – blister pack of 10 tablets
* WHO global stockpile of oseltamivir can be used; countries must be ready to receive and distribute
* Possible role for vaccine if available

Perimeter Controls in the Containment Zone

Discourage all non-essential movement of persons as this is where persons are most likely to be infected or exposed
– Post signs and other reminders
– Establish clear entry and exit points
– Perform exit screening (e.g. question travellers, measure temperature, issue certificate)
*Ideally, close major air, land and sea transit points in CZ
* Allow entry of essential goods and services; provide antiviral prophylaxis for persons who must enter

Non-pharmaceutical Interventions in the Containment Zone

Necessary to reduce the possibility that a non-infected person will come into contact with someone who has influenza and is infectious
* Community-wide practice of hand and respiratory hygiene (Note: technology could help ensure compliance and make it easier to comply and make it easier to monitor)
* Use of multiple measures
– Isolation of ill persons
– Voluntary quarantine of exposed persons
– Social distancing measures (e.g. close schools, cancel mass gatherings)
– Other ways to minimize person density (e.g. staggered work and market hours)
– Support needed to reduce impacts (e.g. social, economic)

Surveillance in the Containment Zone

This is where the drone-camera public health big brother can be used more.
* Objectives
– Identify and laboratory confirm suspect cases
– Monitor the evolution of the outbreak
– Evaluate effectiveness of containment operation
– Guide decisions to modify, continue or end operation
* Strategy
– If large number of suspect cases, do active and passive surveillance and lab confirm only a sample of cases
– After antiviral prophylaxis completed, do active and complete surveillance and lab confirm all cases

The XPrize has awarded prizes for devices that are trying to move toward the Star Trek Medical tricorder. These kinds of new technology would be helpful for improved public health in general and for improved Pandemic response.

Some Background on This

The integration of the existing technology into the outlines of a system for the purpose of countering disease outbreak was by Brian Wang. The technologies are from past coverage at Nextbigfuture. The listing of information on the risks of epidemics and pandemics is a known problem. The World Health Organization had a presentation on managing a flu breakout. This has the drug and non-drug use in the containment zone and provided the example of flu containment zone management.

Different known and categories of unknown diseases would need to have pre-made containment zone strategies and plans.

Determinations would need to be made about how to balance privacy with disease outbreak control.

12 thoughts on “Defenses Against the Biggest Risk We Face”

  1. Flu starts every year because people are living in the same huts with their pigs and chickens/ducks. That is what needs changed. Separate these species and no more flu.

    We need to raise the standard of living of these people. Build them chicken coups, and pigsties…or bring them to the cities and make large modern farms.

  2. I highly doubt this is the limit of the potential losses. The Spanish flu came in three waves. The second one was extremely deadly. Of those who got that one, one hundred years ago in the fall of 1918, a significant fraction died. Often, if a disease is too deadly, it has trouble spreading because the people don’t stay alive long enough to spread it very far. However, with high population density, that is no longer true, especially if you have a lot of public transportation. Even the most deadly bug could spread very rapidly and engulf a major city or conglomeration of cities. And when they spread fast, you don’t have time to generate countermeasures. Losses could be astronomical.

    Did they even consider how much of the Word’s population is urban now?

    Then there is the large increase in global trade. Your next package of capacitors or lithium ion batteries from China could have the little stowaways. Fedex or UPS may be the largest vector in the next epidemic. People would think, “Oh, I don’t want to go to the store; someone may sneeze on me. I will just order stuff on line”. And there you go.

    I have three great aunts that served as nurses in the tents during the Spanish flu epidermic. They all made it through, but that could have easily turned out differently…and they knew it. None are alive now, obviously. That was 100 years ago after all.

  3. Actual statistics indicate that the biggest threat we face is actually heart disease, stroke and cancer.
    But we don’t have cool technosolutions to those. So meh…

  4. Having a default “free all expenses paid extended holiday” as the response to any plague alarm SEEMS like it introduces a moral hazard…
    But the fact that the kids of today seem to live in a world where

    1. A cartoon of a gun stuck on a school wall results in a school lockdown.
    2. Schools are somehow not locked down on a daily basis

    Indicates that actually, the average troublemaker has less imagination than a goldfish.

  5. See ‘The Transparent Society’ by David Brin
    He argues that the technology of cheap cameras makes secrecy impractical for the little guy & that the important thing is to make it impractical for the rich and powerful to keep secrets from the rest. We need ‘souseveillance’ to fight surveillance.

  6. To those who believe the Federal government has no role to play in healthcare please remember that flu pandemics are a reality. And that it can quickly overwhelm us while private enterprise is figuring how to profitable respond to it.

  7. The pandemic will start someplace in the world and has it grows exponentially there will be a debate in Congress over spending the money to stop it. Those who don’t want to spend the tax payers money to save the life of people in some foreign country will win the debate. And as a result tens of millions of Americans will die.

  8. I am well aware there are massive privacy issues. What I was working on was combining technologies that exist today for what I believe would actually achieve detection of epidemic and pandemics inside of an actionable window of a few days. I have not seen such an integrated system proposed using a few pieces of existing technology.

    Also, there has been any serious discussion of how trivially easy it is for people with a few thousand dollars per year for for drones and cameras and cloud storage for beyond big brother movement monitoring.

    The privacy is already massively lost or has gone away to Facebook and other companies.
    The Self-driving car companies could activate this kind of monitoring. All Tesla’s have some real-time data feeds back to central systems. China’s self driving cars would probably have the monitoring and integration of data feeds.

    What we will end up with is all of the big brother without big doctor-public health.

    If the goal is pandemic-epidemic defense, a good public health system could try to apply some form of HIPAA to put some privacy back while have the monitoring and activation of an appropriate level of outbreak management. Stepping up levels zone management with identification of an actionable cluster.

    Useful benevalence is possible in theory.

  9. I’d just like to point out that the simplest approach, which doesn’t require Orwell’s telescreens, is to encourage people to keep several months of non-perishable supplies at home, (Food, water, toilet paper, that sort of thing.) so that if a pandemic starts up, they can just hole up for a few weeks.

    Nothing stops disease transmission in its tracks more effectively than stopping face to face encounters for a period longer than the incubation period of the disease.

    Add that his is useful for all sorts of civil emergencies, not just dealing with pandemics.

  10. The lights seem like a great idea but I concur with Dr Pat, WHY DOES IT ALWAYS COME DOWN TO FULL, 24/7 SURVEILLANCE??? I like being anonymous thanks. I cant believe that even saying that these days makes you sound like a pariah!! The average American commits unwittingly 3-5 felonies a day!! You really want the gov watching you every moment of the day??

  11. Mmm… people didn’t accept omnipresent surveilance for fear of heretics. Or communists. Or fascists. And it doesn’t look like they are accepting it for racists, or fascists-attempt-2, or terrorists.
    What to do? How to get them to give up all privacy?
    I know! Plague!

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