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.