What if a pandemic far worse than Covid hit?
This is a question that has haunted me since the early days of 2020, when it was not clear how deadly Covid-19 was. What is now known as SARS-CoV-1 ultimately killed nearly 10 percent of people with confirmed infections. MERS, another coronavirus, had a fatality rate of more than 30 percent in confirmed cases. But none of these viruses were highly contagious. SARS-CoV-2, better known as Covid, however, was from the start a highly contagious virus, and if it had been killed off at nearly the rate of these earlier pathogens, the result would have been horrific.
In general, there are trade-offs between how infectious a virus is and how deadly it is, but it’s not an iron rule: smallpox was more contagious than Covid and as deadly as MERS. There is also the question of which age groups are affected. the 1918 flu disproportionately killed healthy young adults, unlike the seasonal flu, and many viruses are especially dangerous to babies. (I had a newborn in the early days of Covid, and one of the things we were most thankful for was the sheer luck that this virus didn’t seem to be fatal to infants, as it easily could have been.)
I am not reciting this litany to be as depressing as possible. We should be realistic about how devastating a pandemic could really become, but we’re also not that far from a world where the answer to “What if a pandemic far worse than Covid hit?” it’s “we just wipe it dead”.
That’s the message of a new Geneva Center for Security Policy report by MIT biochemist and Future Perfect 50 inductee Kevin Esvelt on what to do to prepare for the next pandemic. The package key? We are not helpless, either against nature or against the evil actions of men. We need to invest in being truly prepared, but if we are, we could face even the worst-case scenario: a deliberate release of a man-made virus designed to be both deadly and highly contagious.
Three stages of pandemic preparedness
Esvelt, who is deeply involved in biosecurity, calls the first preparedness step delay. If someone unleashed a deadly engineered flu tomorrow, we’d be in trouble. Covid made it clear how big the holes are in our pandemic response plan. We do not yet have sufficient stocks of high-quality PPE to protect all essential workers in the event of another virus outbreak. We do not have the ability to detect a virus early and respond before it spreads widely. And we know from the rapid spread of the micron variant that once a sufficiently contagious virus spreads, even countries willing to resort to extreme measures will have great difficulty containing it.
As bad as Covid is, a virus designed to be deadly and contagious could be much worse, so it will be important to ensure that in the near future, we prevent access to dangerous viruses that could be deliberately released and that no one is accidentally released. Esvelt suggests we achieve this by devising programs that look for viruses that would be incredibly contagious and deadly to work to prevent spread, revising research funding to ensure that research to develop more deadly viruses is not funded, and controlling DNA synthesis machines to make it harder to print your own deadly virus at home.
These aren’t meant to be perfect solutions—even if they make it harder to release a dangerous virus, they wouldn’t completely block a decisive factor—but they could buy us time to develop the technology that will fully protect us from future pandemics.
Esvelt’s next stage is detection: developing better tools to detect when a new virus is spreading. In the earliest stages of an epidemic — say, when Covid first started spreading in China in late 2019 — a virus can be stopped with targeted measures. Once it’s released worldwide, things get more difficult.
And even if it’s too late for timely containment, early detection of a virus starts the clock more quickly on developing effective countermeasures. Esvelt argues that a single strategy can make it possible to detect any biological threat. “Any system capable of detecting exponentially increasing patterns of nucleic acid fragments should be capable of reliably detecting any and all catastrophic biothreats,” he writes.
The key is to take advantage of our growing ability to sequence genetic material quickly and cheaply. Regardless of the form of a biothreat, whether it uses DNA or RNA, if you see exponential growth in a new type of nucleic acid, it’s a tip that something grows exponentially. So you can monitor sewage in key places – for example, airports and city centers – for anything new and fast-growing. Then you can take a closer look to understand what it is and how worried we should be.
This won’t be cheap – except for the cost in lives and money of a pandemic, so it seems very cheap indeed. “Building such an observatory appears to be extremely affordable relative to traditional defense budgets,” says Esvelt. “In the United States, a system that performs untargeted metagenomic sequencing of wastewater from all 328 ports of entry could likely operate for less than a billion dollars a year in cost. systems in smaller nations would be less expensive.”
What to do when you detect a virus
Let’s say we’re building this sewage control system and we detect a new virus that’s spreading rapidly. And then what? Here Esvelt argues that we need to go back to basics: mRNA vaccines are an amazing life-saving technology, but they simply cannot be produced at scale faster than a virus can spread. So you need PPE, you need ventilation, and you need good technology to sterilize spaces where people need to work.
The problem with PPE, as we all know by now since the Covid pandemic, is that there aren’t enough of them and what we have isn’t great. Obtaining good masks at the beginning of the pandemic was almost impossible, but high-quality masks are also very unpleasant to wear for long periods of time. Cloth masks are more comfortable, but not really adequate for a highly contagious virus.
But even more than two years after the Covid pandemic, we haven’t really tried that hard to develop good, usable PPE. Imagine if we put a fraction of the effort into developing better-powered air-purifying breathing machines—the safest option for defense against a virus—that we put into developing new phones.
We need innovation in PPE, but it is less scientific innovation than consumer product innovation. This means that the best PPE options are portable, sturdy for regular use rather than requiring perfect fit, and widely available. With this tool in hand, we could face something more contagious and deadlier than Covid with much more protection, even before the first vaccine rolls off the assembly line.
“Combining a reliable early warning system with adequately protective and reliable P4E in the hands of key workers can make nations virtually immune to pandemic-class agents,” Esvelt writes.
Where there is a will there is a way
All these plans, of course, will likely face additional complications as they develop. Esvelt has created a good plan, but implementation is never simple for a huge project like this. But what his ideas make clear is that pandemics are a choice – a choice we choose to make as a society when we don’t bother to invest in preparing for them.
For better or for worse, we haven’t always been so slow to react in the wake of a major disaster. After 9/11 that killed nearly 3,000 Americans, we implemented costly, tedious screening procedures at every airport in the US, as well as every international airport that sends flights to the US, all to make sure no one can ever hijack a plane. plane again. After Covid-19 killed more than a million Americans, we’ve done next to nothing to make sure it couldn’t happen again with a new virus next week.
This is a horrible mistake. But it’s a horrible mistake that we have the power to choose to stop making.
A version of this story was originally published in the Future Perfect newsletter. Sign up here to sign up!