Publications

A major challenge of pandemic preparedness is how to anticipate and prepare for future pandemic threats among the wide range of viral threats that can infect humans. Fortunately, only a subset of the 25 viral families that can infect humans have both the capability of widespread respiratory transmission in humans or animals, a prerequisite for pandemic-causing capability, as well a lack of medical countermeasures (MCMs) to prevent and treat the key viral species within them.

The purpose of this article is to examine the potential role of immunomodulators as a means of protecting against a wide range of future biological threats—whether they are deliberately caused by bioweapons or naturally occurring epidemics or pandemics—and to provide policy recommendations for implementing this approach.

The Pneumoviridae viral family, formerly a subfamily of Paramyxoviridae, consists of 2 genera: Orthopneumovirus, the members of which infect mammals, and Metapneumovirus, which are specific for either mammals or birds.

The Adenoviridae viral family is divided into 6 genera, with only members of the genus Mastadenovirus known to infect mammals, including humans.

This is the first of a 2-part special feature that focuses on threat agnostic approaches for the early detection of naturally occurring or humanmade biological threats, which are critical for a robust biodefense and public health response.

Paramyxoviridae is a large viral family that contains many once common and well-known human pathogens, such as measles and mumps, as well as other pathogens that pose concerns for their potential to cause epidemic or pandemic disease.¹

Among the approximately 2 dozen families of viruses that have the capacity to infect humans, roughly 25% of these families have pandemic potential (Figure 1). Specifically, this capacity is conferred by their ability to be transmitted via the respiratory route.¹ Devising response plans for each of these 6 viral families — Adenoviridae, Coronaviridae, Paramyxoviridae, Picornaviridae, Pneumoviridae, and Orthomyxoviridae — is essential for pandemic preparedness.

The COVID-19 pandemic, while unfortunately notable for immense strain and death throughout the world, has also shown great promise in the development of medical countermeasures. As the global scientific community shifted almost entirely towards vaccines, diagnostics and therapeutics, new trial designs most significantly adaptive platform trials, began to be used with greater speed and broader reach. These designs allowed for deploying and investigating new therapeutics, repurposing currently existing therapeutics and flexibly removing or adding additional medications as data appeared in real-time. Moreover, public–private sector partnering occurred at a level not seen before, contributing greatly to the rapid development and deployment of vaccines.

The COVID-19 pandemic has caused approximately 20 million deaths worldwide (0.25% of the world's population) and brought health systems in many places to the brink of collapse. As tragic and consequential as this has been, future pandemics could be worse.

On July 23, 2022, the Director General of the World Health Organization declared a multicountry outbreak of mpox disease a Public Health Emergency of International Concern. Since this declaration, there have been thousands of cases detected in the United States. Although the outbreak has now waned, the virus is likely to continue transmitting at low levels across the United States among high-risk populations. Thus, it is critical for radiology nurses to be able to recognize mpox disease within the inpatient and outpatient settings, so that proper infection prevention and control precautions can be adhered to and so that patients can be referred for treatment.

In this article, we summarize findings from research conducted by the Johns Hopkins Center for Health Security and the Infectious Diseases Society of America to understand infectious disease (ID) workforce contributions to the coronavirus disease 2019 (COVID-19) response and their impacts. ID experts were found to have made diverse and unique contributions that went well beyond their usual responsibilities, with many spending several hours a week on these activities without additional compensation. These efforts were thought to not only build community resilience but also augment the ongoing public health response. Respondents also reported several hospital and clinical leadership roles taken on during the pandemic, such as developing protocols and leading clinical trials. We also make several policy recommendations, such as medical student debt relief and improved compensation, that will be needed to help fortify the ID workforce for future pandemics.

There are scant data on the impact of coronavirus disease 2019 (COVID-19) on hospital antibiotic consumption, and no data from outside epicenters. At our nonepicenter hospital, antibiotic days of therapy (DOT) and bed days of care (BDOC) were reduced by 151.5/month and 285/month, respectively, for March to June 2020 compared to 2018–2019 (P = 0.001 and P < 0.001). DOT per 1,000 BDOC was increased (8.1/month; P = 0.001). COVID-19 will impact antibiotic consumption, stewardship, and resistance in ways that will likely differ temporally and by region.

A hallmark of the coronavirus disease 2019 (COVID-19) pandemic in its current stage is the ubiquity of home diagnostic testing for severe acute respiratory coronavirus virus 2 (SARS-CoV-2). These tests have been touted for their varied uses to facilitate navigating a world in which SARS-CoV-2 is an ever-present consideration. Apart from HIV at-home testing, COVID-19 is one of the only conditions that can be tested for at home with an almost immediate result. At-home infectious diseases testing has gained significant momentum during the COVID-19 pandemic given the myriad cascading positive benefits the technology offers. Currently, plans for home influenza and RSV tests are underway, as well as tests for sexually transmitted infections (STIs). These efforts began before the pandemic and have only accelerated as COVID-19 home tests have demonstrated their value. Here, I discuss how at-home infectious disease tests can be harnessed to optimize individual treatment outcomes and positively influence public health efforts. I have explored many of these themes in a prepandemic report,¹ and the ensuing years have concretized many of the theoretic benefits.

This report — a joint collaborative effort between the Infectious Diseases Society of America and the Johns Hopkins Center for Health Security — captures just how valuable infectious diseases professionals are to America’s health care system and society and sheds light on critical policies needed to ensure they are well positioned to help America for decades to come. We invite you to learn more.

The response by the biotech and pharmaceutical sectors to the COVID-19 pandemic has been historically unprecedented. Vaccines based in cutting-edge technologies, such as the mRNA platform, were invented, tested, and distributed to patients in less than a year. Yet politicians and activists argue that patents and other intellectual property (IP) have impeded the development and distribution of these vaccines. In explaining why this is profoundly mistaken, this essay first describes the medical and economic uncertainties inherent in the production of vaccines, especially those made in response to an emerging infectious disease like COVID-19. This makes clear the unprecedented achievement in the mass production and distribution of COVID-19 vaccines in less than 1 year after the start of the COVID-19 pandemic. It then describes the current manufacturing and licensing landscape, which was created on the basis of a market infrastructure built by reliable and effective patent rights. There is now a glut in the global supply of vaccine doses—and billions more doses are still being produced. The essay concludes by identifying the non-IP causes impeding global vaccine distribution, such as lack of infrastructure in the developing world, as well as regulatory restrictions and trade barriers. Those concerned with global vaccine equity should focus on policies to resolve these real-world problems.

Few clinicians practicing in the United States have ever seen a case of monkeypox infection. However, a new, unusual, multinational outbreak of monkeypox that is unfolding rapidly makes it important to know what a case might look like. This is critical not only to permitting rapid and proper medical and public health interventions but also to helping to understand the extent and spread of the outbreak. The current outbreak—which includes confirmed or suspected cases in the United States, the United Kingdom, Spain, Portugal, Italy, Belgium, Sweden, France, Canada, Australia, Germany, and the Netherlands—appears to have a pattern of spread that does not mirror past outbreaks outside of Africa, almost all of which have been related to importation via flights from Africa or exposure to infected exotic pets (1). This unusual monkeypox outbreak should prompt all clinicians to be attuned to the possibility of this infectious disease. Clinicians who suspect they may have a patient with monkeypox should contact their state or local health department immediately.

As of September 2021, mortality in the United States due to the SARS-CoV-2 virus had exceeded the death toll from the 1918 influenza pandemic. COVID-19 was the ultimate test of healthcare and public health capacity and capability across the United States. From its acute onset and throughout its extended duration, the COVID-19 pandemic has overwhelmed hospitals, disrupted businesses, and caused lasting economic harm. It has also illuminated and exploited major vulnerabilities within the US healthcare and public health systems. The impact of the pandemic on hospitals, and to a lesser extent on public health departments, has been explored elsewhere, but relatively little has been written about the impact on primary care services. Operating largely in silos and chronically underfunded disciplines, primary care providers and public health practitioners in the United States have struggled to respond to the numerous waves of the pandemic, which have caused high levels of morbidity and mortality and jeopardized health systems in communities across the country, especially those that are most vulnerable. It is crucial that the lessons learned from the COVID-19 pandemic must be shared.

The COVID-19 pandemic has revealed that a true, end-to-end research and development (R&D) and response ecosystem—meaning, one that develops, produces, and delivers needed vaccines to global populations in a rapid and equitable fashion—remains an elusive goal. Most low- and middle-income countries (LMICs) have been unable to acquire and administer a sufficient supply of COVID-19 vaccines, and the dearth of vaccines and limited capacity to deliver them are prolonging the pandemic and contributing to destabilizing economies and societies around the world. Multilateral initiatives, bilateral aid, and vaccine donations, though useful, have been slow to arrive and insufficient to provide adequate vaccine coverage for LMIC populations. The consequences of this deeply inequitable global response extend beyond the COVID-19 pandemic. Global initiatives to prepare for and respond to future pandemic threats cannot succeed if LMIC governments believe they will be the last to benefit from vaccines produced as a result of improvements in global disease surveillance, increased sample sharing, or expedited vaccine R&D.

Masks and respirators have played an essential role in the response to the COVID-19 pandemic for both healthcare workers and the public. However, the masks and respirators that both healthcare workers and the public have needed to rely upon leave much to be desired. Despite drawbacks in terms of comfort and fit, the ubiquitous disposable masks and disposable N95 respirators used by the vast majority of healthcare workers have not appreciably improved since the mid-1990s. During the COVID-19 pandemic, the public has been advised to wear masks as well. Masks have long been known to be effective means of “source control” (ie, reducing transmission of respiratory droplets from the wearer to others). More recently evidence has accumulated that properly constructed and worn masks as well as respirators afford a limited but not inconsequential degree of protection to the wearer as well. Existing masks and respirators run the gamut in terms of effectiveness and wearability. In a future large-scale outbreak or pandemic, it is possible to increase the protection of healthcare workers and the public from infection through more efficient, well-fitting, and comfortable masks. The design and manufacture of better masks and respirators are possible by harnessing emerging technologies, the innovative research and development spirit evidenced since the early days of the COVID-19 pandemic, and the availability of resources to support technological innovation.