US hospitals working to prevent coronavirus spread to doctors and nurses
Identifying the disease in patients has become the biggest challenge for health care providers; correspondent Laura Ingle reports from Oceanside, N.Y.
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It is time for a Viral Manhattan Project to combat COVID-19. In order to minimize the current health and economic disaster, we must begin immediately.
During World War II, the United States sponsored a massive project of unprecedented scope. The purpose of the Manhattan Project was to develop weapons to put an end to a world conflict.
Once again, we are in an all-out war. This time, the war does not involve a world divided. Rather, it is a time when all of humanity must come together to face a common threat.
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This time the enemy is a microscopic virus, but the devastation it is causing is colossal.
Pandemic coronavirus is one of the most serious invaders we have faced in our lifetimes, an invader that threatens our health, our economic security, and the very fabric of life in America.
It has infiltrated our ranks and is attacking from within.
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By learning from the experience in Asia, the U.S. could have begun an early scale–up in terms of its response. This did not happen.
Recently, the government has begun what appears to be a three-pronged approach.
- Proposed financial measures will help lessen the economic impact of the epidemic, but they will do little to stem the flow of infections.
- Public health responses will limit the spread of the virus, but they may not be enough. We cannot wait to assess their impact, because it will be too late if they fall short.
- Economic research incentives have begun to produce tools to directly combat the virus.
While they appear impressive, the government’s multibillion-dollar proposals are woefully inadequate in response to the pandemic.
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The original Manhattan Project sought to develop a single solution. The current project needs to be multifaceted in its approach.
The cost of such a project will be large, but the economic benefits and the lives saved will more than offset this cost.
The following is a 10-point plan for creating the Viral Manhattan Project.
1. A dramatic scale-up in the production capacity of several types of testing capability. This would include tests that focus on diagnosis, screening, prognosis (predicting outcome), immune status indicating cured individuals, and research.
This capacity needs to be scaled up to more than a thousand-fold over current availability.
Testing should shift its emphasis from confirming the diagnosis in sick patients to detecting and isolating infected individuals in the general population.
2. Wartime scale-up in the production capacity of personal protective equipment to be used by clinicians, hospital personnel and first responders. These individuals not only provide critical services, but they are also the group at the greatest risk of infection.
3. Wartime scale-up in the production of critical care facilities. While the Chinese were building 1,000-bed hospitals for surge capacity, why weren’t we? The National Guard and the military need to be employed.
There has been a significant focus on strategies for “flattening the epidemic curve” by increasing “social distance” and curtailing aggregations of people. Despite the critical importance of these measures, they will not be adequate for the task at hand.
4. Scale-up of research capacities related to our basic scientific understanding of coronavirus. Although a tremendous amount is known about the molecular nature of the viral genome and the viral proteins, this is just the tip of the iceberg.
We need to know the function of each of the viral proteins and how they may be inhibited, the specific ways in which the virus subverts the functions of cells, the full range of cells that can be infected, the possibility of viral reservoirs and protected sites within the body, the host genetic and environment cofactors that contribute to pathology, and the ways in which the immune response inhibits or fails to inhibit the spread of the virus.
The more we know, the quicker we will be able to produce novel antiviral agents, diagnostic tests and vaccines.
If we succeed, it may look as if we overreacted. If we fail, the reasons will be all too obvious.
5. Economic incentives and financial safeguards need to be provided for public and private organizations that are already on the front line in their research efforts. A lucrative prize for the successful licensure of new drugs should be instituted.
6. A tremendous scale-up in our ability to physically quarantine infected individuals and their contacts. These facilities need to be humanely run and they need to be separate from family members – contrary to the “quarantine at home” recommendations.
7. A multifaceted approach needs to be employed that includes many types of expertise. This should include laboratory scientists, social workers, epidemiologists, educators, information technologists who can make house calls to ensure that students all have access to online learning modalities, providers of meals and services for those in need, custodians, journalists, medical anthropologists, and construction workers.
Properly carried out, this project will provide gainful employment for large numbers of individuals at all levels of expertise whose financial well-being might otherwise be jeopardized.
8. Allocation of resources for this Viral Manhattan Project needs to be in the hands of disease experts at the Centers for Disease Control and Prevention and the National Institute of Allergy and Infectious Diseases. Resources must not subject to the whims of politicians.
The typical granting process is far too slow to respond to the current crisis. A highly accelerated track must be created.
9. Rapid mobilization of technology will require significant modification of the current testing and licensing protocols needed to allow a much faster turnaround of candidate therapies and diagnostic tests.
A vaccine has been promised in 18 months, but there is no historical precedent for a vaccine to be developed and made available at this pace. Many vaccine strategies need to be tested for their safety and efficacy, and the production of candidate vaccines needs to be developed and scaled up.
Even at this highly accelerated schedule, we cannot depend on the near-term availability of a vaccine to combat the threat that we are facing.
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10. This Viral Manhattan Project must be flexible. It must be able to rapidly pivot as new information becomes available.
If we succeed, it may look as if we overreacted. If we fail, the reasons will be all too obvious.
There is no time to waste.