Dr. Peter Daszak (born 1965)
Married to - Janet D Cottingham (Married Feb 1997 - see https://search.ancestry.com/cgi-bin/sse.dll?indiv=1&dbid=8753&h=1493317&tid=&pid=&usePUB=true&_phsrc=JbL13&_phstart=successSource ) - Her twitter : https://twitter.com/JanetCottingha1
Parents - Father is Bohdan Daszak (born March 21, 1926)
Siblings - John Daszak
HousatonicITS Research Pages :
Peer at Eco Health Alliance of Kevin James Olival (born 1975)
"Farmer Wei Shangzheng"
Was on same editorial board of "Biosafety and Health Journal " as Xiangguo Qiu (born 1964) (see https://www.journals.elsevier.com/biosafety-and-health/editorial-board ), but did not appear to work on any shared research projects with her.
Dr. Lin-Fa Wang (born 1960) ( ... )
Dr. Walter Ian Lipkin (born 1952) ( ( [HK0050][GDrive] : "Dr. Lipkin is Honorary Director of the Beijing Infectious Disease Center, Chair of the Scientific Advisory Board of the Institut Pasteur de Shanghai and serves on boards of the Australian Biosecurity Cooperative Research Centre for Emerging Infectious Disease, the Guangzhou Institute for Biomedicine and Health, the EcoHealth Alliance [EcoHealth President is Dr. Peter Daszak (born 1965) ] ...." )
Dr. Tara Jeanne O'Toole (born 1951) - [HG00CE][GDrive] ( 2016 - National Academies - Workshop : "Rapid Medical Countermeasure Response to Infectious Diseases : Enabling Sustainable Capabilities Through Ongoing Public- and Private-Sector Partnerships")
Dr. Richard Jones Hatchett IV (born 1968) - [HG00CE][GDrive] ( 2016 - National Academies - Workshop : "Rapid Medical Countermeasure Response to Infectious Diseases : Enabling Sustainable Capabilities Through Ongoing Public- and Private-Sector Partnerships")
Thomas Vincent Inglesby, Jr. (born 1957) - [HG00CE][GDrive] ( 2016 - National Academies - Workshop : "Rapid Medical Countermeasure Response to Infectious Diseases : Enabling Sustainable Capabilities Through Ongoing Public- and Private-Sector Partnerships")wolDr. Nathan Daniel Wolfe (born 1970)
Dr. Nathan Daniel Wolfe (born 1970) ( "Animal markets are next in line. Dr Wolfe is working with [Dr. Peter Daszak (born 1965)], of the Consortium for Conservation Medicine, to study the so-called wet markets of China where SARS began in 2002. They will inspect the animals sold in them, and test the stallholders and customers for signs of dodgy viruses. Dr Daszak is a co-author of a study published in this week's Nature that maps the global “hot spots” of emerging diseases and concludes, as [ Dr. Nathan Daniel Wolfe (born 1970)] has, that the real threat lies in the tropics. That is despite the fact that most new diseases are (as with AIDS) first noticed in rich countries." 2008 : [HP00B8][GDrive] )
co-authors : (see https://scholar.google.com/citations?user=HBjU-38AAAAJ&hl=en )
[Dr. William Bamberger Karesh (born 1955)] / Also at EcoHealth Alliance
Feng Li / 1 Food and Drug Administration; 2 University of Maryland, Baltimore County;
Sasha Greenspan / University of Alabama
Christina A. Cuomo / Broad Institute of MIT and Harvard
Jonathan H. Epstein / EcoHealth Alliance
[Dr. Andrew Alexander Cunningham (born 1964)] / Institute of Zoology, Zoological Society of London [ Note - ( 29 shared research papers between Dr. Daszak and Dr. Cunningham - https://www.zsl.org/science/users/andrew-cunningham ) ]
Peter Daszak is a British zoologist and an expert on disease ecology, in particular on zoonosis. He is currently president of EcoHealth Alliance, a nonprofit non-governmental organization that supports various programs on global health with headquarters in New York City. He is a researcher, consultant and public expert for media inquiries on the subject of virus-caused epidemics. In late April 2020, during the COVID-19 pandemic, the National Institutes of Health (NIH) "abruptly terminated" EcoHealth Alliance's research funding.
Daszak earned a B.Sc. in Zoology in 1987 at University College of North Wales (UCNW), and a Ph.D. in parasitic infectious diseases in 1994 at University of East London. 
Daszak worked at the School of Life Sciences, Kingston University, in Surrey, England in the 1990s. In the late 1990s Daszak moved to the United States and was affiliated with the Institute of Ecology at the University of Georgia and the National Center for Infectious Diseases, Centers for Disease Control and Prevention, in Atlanta, Georgia. Later he became executive director at a collaborative think-tank in New York City, the Consortium for Conservation Medicine. He holds adjunct positions at several universities in the U.S. and the U.K., including the Columbia University Mailman School of Public Health. 
He was one of the early adopters of conservation medicine.  The Society for Conservation Biology symposium in 2000, had focused on the "complex problem of emerging diseases". He said in 2001 that there were "almost no examples of emerging wildlife diseases not driven by human environmental change...[a]nd few human emerging diseases don't include some domestic animal or wildlife component." His research has focused on investigating and predicting the impacts of new diseases on wildlife, livestock, and human populations, and he has been involved in research studies on epidemics such as the Nipah virus infection, the Hendra virus, SARS-1, Avian influenza, and the West Nile virus. 
Daszak has served on committees of the International Union for the Conservation of Nature, World Health Organization (WHO), National Academy of Sciences, and United States Department of the Interior.  He is a member of the National Academy of Medicine and Chair of the National Academies of Sciences, Engineering, and Medicine (NASEM)'s Forum on Microbial Threats and sits on the supervisory board of the One Health Commission Council of Advisors.
Daszak is the president of the New York-headquartered NGO, EcoHealth Alliance, known for its research on global emergent diseases such as Severe Acute Respiratory Syndrome (SARS), Nipah virus, Middle East Respiratory Syndrome (MERS), Rift Valley fever, Ebola virus, and COVID-19.
As of 2020 he has authored or contributed to over 300 scientific papers and been designated a Highly Cited Researcher by the Web of Science. In addition to citations in academic publications, his work has been covered in leading English-language newspapers, television and radio broadcasts, documentary films and podcasts.
During times of large virus outbreaks he has been invited to speak as an expert on epidemics involving diseases moving from animals to humans. At the time of the Ebola outbreak in West Africa in 2014, Daszak said"Our research shows that new approaches to reducing emerging pandemic threats at the source would be more cost-effective than trying to mobilize a global response after a disease has emerged".
In October 2019, when the federal government "quietly" ended the ten-year old program called Predict, operated by United States Agency for International Development (USAID)'s emerging threats division, experts like Daszak, expressed concern that shutting Predict down, could "leave the world more vulnerable to lethal pathogens like Ebola and MERS that emerge from unexpected places, such as bat-filled trees, gorilla carcasses and camel barns." Daszak said that compared to the $5 billion the US spent fighting Ebola in West Africa, Predict—which cost $250 million—was much less expensive. As well, Daszak said, "Predict was an approach to heading off pandemics, instead of sitting there waiting for them to emerge, and then mobilizing."
On February 9, 2020, Newt Gingrich invited Daszak as a special guest along with Anthony Fauci on Newt's World to discuss the coronavirus.
In his February 27, 2020 New York Times article, entitled "We knew Disease X was Coming", Daszak said R&D Blueprint group of experts to which he belonged, had warned the World Health Organization in February 2018 in Geneva, Switzerland, of the "next pandemic, which would be caused by an unknown, novel pathogen that hadn't yet entered the human population". The Blueprint group coined this hypothetical pathogen "Disease X" and was included it on a list of eight diseases which they recommended should be given highest priority in regard to research and development efforts, such as finding better diagnostic methods and developing vaccines. He said, "As the world stands today on the edge of the pandemic precipice, it's worth taking a moment to consider whether Covid-19 is the disease our group was warning about."
On March 20, 2020 Daszak was featured in a PBS Newshour special podcast "Understanding the coronavirus".
In April and May 2020, during the COVID-19 pandemic, Daszak was interviewed by National Public Radio (NPR), CNN,  NBC News, CBS News, and other outlets, refuting the idea that COVID-19 pandemic was caused by a virus resulting from a laboratory accident at the Wuhan Institute of Virology.
In his April 26 interview with CNN's Fareed Zakaria, Daszak said that conspiracy theories had emerged "pointing the finger at China". He said that "politicization" had resulted in "countries" cramp[ing] up" which was unfortunate because "what we need right now is open communication with scientists across the world. China has done a lot to deal with this virus before us. They know a lot about how to control it. We need access to that information and talking in political terms about this outbreak closes down the access."
According to a May 9, 2020 news report by a number of media outlets, National Institutes of Health (NIH) "abruptly terminated" EcoHealth Alliance's "research grant, which was "focused on identifying and warning about coronaviruses dangerous to human health."
Daszak was part a segment of the May 11, 2020 broadcast of 60 Minutes. 
Awards and Honors
In October 2018, Daszak was elected to the National Academy of Medicine (NAM), which the New York Times has been called the "most esteemed and authoritative adviser on issues of health and medicine" whose "reports can transform medical thinking around the world." In 2000 he received the CSIRO medal for work on amphibian disease.
Dr. Peter Daszak is President of EcoHealth Alliance, a US-based organization that conducts research and outreach programs on global health, conservation and international development. Dr. Daszak’s research has been instrumental in identifying and predicting the origins and impact of emerging diseases across the globe. This includes identifying the bat origin of SARS, the drivers of Nipah virus emergence, publishing the first global emerging disease ‘hotspots’ map, discovering SADS coronavirus, designing a strategy to identify the number of unknown viruses in wildlife, launching the Global Virome Project, identifying the first case of a species extinction due to disease, and discovering the disease chytridiomycosis as the cause global amphibian declines. He is one of the founders of the field of Conservation Medicine and has been instrumental in the growth of EcoHealth, One Health, and now Planetary Health.
A fundamental part of the Dr. Daszak’s work on disease ecology is directed by the conviction that disease outbreaks are not just predictable, but preventable. This approach is informed by a perspective on emerging infectious disease research that sees problems of human and animal disease as intimately linked – exacerbated by ecological change. With this in mind, he led the researcher that produced the first ever global emerging disease ‘hotspots’ map to determine where in the world viruses with pandemic potential are most likely to emerge, and developed a strategy to identify just how many of those viruses currently exist.
Dr. Daszak is a member of the National Academy of Medicine and Chair of the NASEM’s Forum on Microbial Threats. He is a member of the NRC Advisory Committee to the US
NIH Grants ? Many !
Daszak, Peter Ecohealth Alliance, Inc., New York, NY, United States
Understanding the Risk of Bat Coronavirus Emergence Novel zoonotic, bat-origin CoVs are a significant threat to global health and food security, as the cause of SARS in China in 2002, the ongoing outbreak of MERS, and of a newly emerged Swine Acute Diarrhea Syndrome in China. In a previous R01 we found that bats in southern China harbor an extraordinary diversity of SARSr-CoVs, some of which can use human ACE2 to enter cells, infect humanized mouse models causing SARS-like illness, and evade available therapies or vaccines. We found that people living close to bat habitats are the primary risk groups for spillover, that at one site diverse SARSr-CoVs exist that contain every genetic element of the SARS-CoV genome, and identified serological evidence of human exposure among people living nearby. These findings have led to 18 published peer-reviewed papers, including two papers in Nature, and a review in Cell. Yet salient questions remain on the origin, diversity, capacity to cause illness, and risk of spillover of these viruses. In this R01 renewal we will address these issues through 3 specific aims:
Aim 1. Characterize the diversity and distribution of high spillover-risk SARSr-CoVs in bats in southern China. We will use phylogeographic and viral discovery curve analyses to target additional bat sample collection and molecular CoV screening to fill in gaps in our previous sampling and fully characterize natural SARSr-CoV diversity in southern China. We will sequence receptor binding domains (spike proteins) to identify viruses with the highest potential for spillover which we will include in our experimental investigations (Aim 3).
Aim 2. Community, and clinic-based syndromic, surveillance to capture SARSr-CoV spillover, routes of exposure and potential public health consequences. We will conduct biological-behavioral surveillance in high-risk populations, with known bat contact, in community and clinical settings to 1) identify risk factors for serological and PCR evidence of bat SARSr-CoVs; & 2) assess possible health effects of SARSr-CoVs infection in people. We will analyze bat-CoV serology against human-wildlife contact and exposure data to quantify risk factors and health impacts of SARSr-CoV spillover.
Aim 3. In vitro and in vivo characterization of SARSr-CoV spillover risk, coupled with spatial and phylogenetic analyses to identify the regions and viruses of public health concern. We will use S protein sequence data, infectious clone technology, in vitro and in vivo infection experiments and analysis of receptor binding to test the hypothesis that % divergence thresholds in S protein sequences predict spillover potential. We will combine these data with bat host distribution, viral diversity and phylogeny, human survey of risk behaviors and illness, and serology to identify SARSr-CoV spillover risk hotspots across southern China. Together these data and analyses will be critical for the future development of public health interventions and enhanced surveillance to prevent the re-emergence of SARS or the emergence of a novel SARSr-CoV.
Public Health Relevance
Daszak, Peter Renewal: Understanding the Risk of Bat Coronavirus Emergence Project Narrative Most emerging human viruses come from wildlife, and these represent a significant threat to public health and biosecurity in the US and globally, as was demonstrated by the SARS coronavirus pandemic of 2002-03. This project seeks to understand what factors allow coronaviruses, including close relatives to SARS, to evolve and jump into the human population by studying viral diversity in their animal reservoirs (bats), surveying people that live in high-risk communities in China for evidence of bat-coronavirus infection, and conducting laboratory experiments to analyze and predict which newly-discovered viruses pose the greatest threat to human health.
2 call outs -
Li, Wendong; Shi, Zhengli; Yu, Meng; Ren, Wuze; Smith, Craig; Epstein, Jonathan H; Wang, Hanzhong; Crameri, Gary; Hu, Zhihong; Zhang, Huajun; Zhang, Jianhong; McEachern, Jennifer; Field, Hume; Daszak, Peter; Eaton, Bryan T; Zhang, Shuyi; Wang, Lin-Fa (28 October 2005). "Bats Are Natural Reservoirs of SARS-Like Coronaviruses". Science. 310 (5748): 676–679. Bibcode:2005Sci...310..676L. doi:10.1126/science.1118391. PMID 16195424.
Drosten, C.; Hu, B.; Zeng, L.-P.; Yang, X.-L.; Ge, Xing-Yi; Zhang, Wei; Li, Bei; Xie, J.-Z.; Shen, X.-R.; Zhang, Yun-Zhi; Wang, N.; Luo, D.-S.; Zheng, X.-S.; Wang, M.-N.; Daszak, P.; Wang, L.-F.; Cui, J.; Shi, Z.-L. (2017). "Discovery of a rich gene pool of bat SARS-related coronaviruses provides new insights into the origin of SARS coronavirus". PLOS Pathogens. 13(11): e1006698. doi:10.1371/journal.ppat.1006698.
Keynote Speaker : Anthony S. Fauci, NIAID, USA
Special Guest Speaker : Richard Preston , Author of the best seller ‘The Hot Zone’
Dan Barouch, Ragon Institute of MGH, MIT and Harvard, USA
Sara Cherry, University of Pennsylvania, USA
[Dr. James Earl Crowe Jr. (born 1961)], Vanderbilt University School of Medicine, USA
Peter Daszak, EcoHealth Alliance, USA
[Dr. Michael S. Diamond (born 1964)]. Washington University School of Medicine at St. Louis, USA
George Fu Gao, Chinese Center for Disease Control and Prevention, China (Co-Organizer)
[Dr. Adolfo Garcia-Sastre (born 1964)], Mount Sinai School of Medicine, USA
Akiko Iwasaki, Yale University, USA (Co-Organizer)
Yoshihiro Kawaoka, University of Wisconsin-Madison, USA
Sheemei Lok, Duke-NUS Medical School, Singapore
Luciano Moreira, Centro de Pesquisas René Rachou, Brazil
Johan Neyts, KU Leuven, Belgium
Erica Ollmann Saphire, The Scripps Research Institute, USA
Gustavo Palacios, USAMRIID Center for Genomic Sciences, USA
[Dr. Zheng-Li Shi (born 1964)], Wuhan Institute of Virology, China
Nancy Sullivan, NIAID, USA
[Dr. Lin-Fa Wang (born 1960)], Duke-NUS Medical School, Singapore
1991 research - "Ultrastructural studies of the effects of the ionophore lasalocid onEimeria tenella in chickens" ( P. Daszak, S. J. Ball, R. M. Pittilo & C. C. Norton )
Parasitology Research volume 77, pages224–229(1991)Cite this article
Abstract : The ultrastructural development ofEimeria tenella was studied in experimentally infected chicks fed 90 ppm lasalocid, an ionophorous anticoccidial antibiotic. Drug treatment was timed to target-specific endogenous stages. At 6 h after infection, many sporozoites within the epithelium showed degradation as a result of drug action. Only a few intact sporozoites were seen. The drug caused outer-membrane blistering, large surface swellings and enlarged mitochondria in both first-and second-generation merozoites. No effect on the gamonts was discerned.
1996 (Dec) - Research paper submission : "Detection and comparative analysis of persistent measles virus infection in Crohn's disease by immunogold electron microscopy."
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC499879/pdf/jclinpath00253-0035.pdf / 1997-ncbi-nim-nih-gov-pmc-articles-downloads-jclinpath00253-0035.pdf
J Clin Pathol. 1997 Apr; 50(4): 299–304.
"Epidemiology. Several studies have provided epidemiological evidence for the involvement of measles virus in the aetiology of IBD, particularly Crohn's disease (Ekbom et al. 1994; Thompson et al. 1995a; Ekbom et al. 1996). Although controversial, the results ugges f these studies that early exposure to measles virus is a significant risk factor for the development of IBD. As discussed above, early exposure to measles virus and molecular mimicry, without virus persistence, may be a risk factor for the development of IBD later in life, accounting for the observed epidemiological associations"
wow - https://files.eric.ed.gov/fulltext/ED466915.pdf ( AUTISM: PRESENT CHALLENGES, FUTURE NEEDS - WHY THE INCREASED RATES?
HEARING BEFORE THE COMMITTEE ON GOVERNMENT REFORM HOUSE OF REPRESENTATIVES
ONE HUNDRED SIXTH CONGRESS, SECOND SESSION
APRIL 6, 2000 )
COMMITTEE ON GOVERNMENT REFORM DAN BURTON, Indiana, Chairman
"Based on the previous material that I have seen, and on the opinions of experts present at the MRC meeting, I have concluded that there is no link between measles, measles vaccine or MMR immunisation, Crohn's Disease, and ASD. Together with others at the meeting, I was not liktonvinced that any of the studies support --suggestions that measles or MMR vaccines are implicated in Crohn's Disease or in autism."
AIMS: To determine the specificity of persistent measles virus infection in intestinal samples from Crohn's disease patients using quantitative immunogold electron microscopy. To compare the results with samples from ulcerative colitis, a granulomatous inflammatory control (tuberculous lymphadenitis), and a positive control. METHODS: Formalin fixed, paraffin embedded intestinal tissue from patients with Crohn's disease was reprocessed and stained with antimeasles nucleocaspid protein primary antibody followed by 10 nm gold conjugated secondary antibody. Tissue samples were taken from granulomatous and non-granulomatous areas of the intestine. Intestinal samples from patients with ulcerative colitis, tuberculous lymphadenitis, or acute mesenteric ischaemia were similarly processed. Brain tissue from a patient with subacute sclerosing panencephalitis (SSPE) was used as the positive control. Duplicate sections of all tissues were processed without the primary antibody. Stained specimens were examined by electron microscopy. RESULTS: In Crohn's disease patients, 8/9 foci of granulomatous inflammation and 0/4 foci of non-specific inflammation were positive for measles virus. Of controls, 0/5 non-inflamed intestinal tissues, 1/8 tuberculous tissues, 1/5 ulcerative colitis tissues, and 1/1 SSPE tissues were positive. Gold grain counts per nuclear field-of-view in both Crohn's disease granulomas (43.29) and SSPE (36.94) were significantly higher than in tissues from patients with ulcerative colitis (13.52) or tuberculous lymphadenitis (15.875), and nongranulomatous areas of Crohn's disease (4.89) (p < 0.001, p < 0.001, p = 0.0006, respectively), with no significant difference between Crohn's disease and SSPE (p > 0.1). In both SSPE and Crohn's disease staining was confined to a small population of cells exhibiting characteristic cytopathology. CONCLUSION: These data support a role for measles virus in the aetiology of Crohn's disease.
A newly discovered fungus appears to be the cause of an epidemic among amphibians that is killing off frogs and toads of a wide variety of declining species in rain forests in Australia and Central America, according to a new report by an international team of researchers. Scientists say the new study may help solve the mystery of why amphibians are vanishing around the world, often from pristine, isolated habitats.
Nineteen species of frogs, researchers report, are succumbing to a newly discovered fungus called a chytrid, a type of fungus known previously to live only on decaying matter and insects. Researchers say it remains to be seen how and why the fungus is killing frogs in such large numbers over such a wide area, as well as whether the fungus is doing its deadly work in areas other than Central America and Australia.
The research is described in a report to appear in next month's issue of the Proceedings of the National Academy of Sciences. The mystery of the vanishing amphibians has been plaguing scientists for a decade, ever since they began noticing that frogs were disappearing. At various times, researchers have proposed ultraviolet light, pollution and disease as the villains, but scientists lacked direct evidence that any of these factors was causing large, widespread declines.
Searching the tissues of dead frogs, biologists on the new study say, they found fungi as the clear culprit. When researchers scraped fungi off the skin of the dead frogs and infected the water of healthy frogs, within a couple of weeks all the exposed frogs were dead or dying. But while researchers described the new study as convincing, they noted that skin scrapes were not pure samples of fungus. To be sure that the fungus alone is killing the frogs, researchers must await the results of a last crucial test.
Dr. Joyce Longcore, chytrid fungal specialist at the University of Maine at Orono, said that she had grown a pure culture of the fungus and that she and colleagues at the National Zoo were in the process of doing the experiment find out whether the pure fungus can kill frogs.
Researchers say the new fungus is unlikely to be related to the limb deformities in Minnesota frogs.
The report that will appear next month provides a long-awaited answer for scientists, who had been mystified by the increasing reports of large numbers of dead frogs in rain forests in Central and South America and Australia. Quickly eaten by scavengers, wild frog cadavers are a rare sight, with biologists typically seeing no more than two or three in the wild in a lifetime. The numbers were ''just stunning,'' said Dr. David Wake, amphibian biologist at the University of California at Berkeley. ''When you find carcasses in a rain forest, you know you're only finding a tiny fragment of the number really there.''
Researchers still do not know exactly how the fungus kills so many frogs, but say they suspect it is by suffocation. Frogs breathe not only through their lungs, but also by absorbing oxygen through their moist skin. As the fungus grows in the skin of frogs, the skin appears to grow more layers, making it more difficult for the frog to absorb oxygen.
While biologists say they are confident that the newly discovered fungus is the immediate cause of the death of these frogs, it is unclear whether the frogs were already weakened by other factors and so more susceptible. Researchers are now studying air, water and other samples from regions where the frogs died in a search for such factors.
Researchers agree that other factors are certainly at play in the amphibian deaths around the globe. For example, Dr. Wake said it was very likely that chemical contamination was involved in California and that ultraviolet light was a factor in Oregon.
''Nobody thinks there's a single answer to this problem,'' Dr. Wake said.
Researchers do not know why the fungal disease is emerging now. Dr. D. Earl Green, a veterinary pathologist who worked on the project at the Maryland Animal Health Laboratory, said the new fungus had been seen in healthy frogs from Maryland and Illinois, suggesting that the disease may be from more northern climes and made its way to the tropics recently, perhaps on the boot of a tourist or the net of a biologist. Once there, it might easily attack populations that had never been exposed to it before. Alternatively, the disease may have been around for years and is only now able to ravage populations weakened by other factors.
''It's one thing to go and look for frogs and say they're gone, but what we needed were the bodies to work on,'' said Dr. Peter Daszak, parasitologist at Kingston University in England and an author of the report. Now, with all the carcasses at their disposal, he said, ''at last we seem to be getting somewhere.''
1998 (September 22) - Bill Clinton and Al Gore may have known about Peter Daszak ?
Note - Gore and Daszak were both referenced in 2020 article - https://www.newsmax.com/us/al-gore-wildlife-pandemic-virus/2020/04/11/id/962439/
2000 (Aug 11)
2004 (July 01) - Environmental Health Perspectives (journal) - "Unhealthy Landscapes: Policy Recommendations on Land Use Change and Infectious Disease Emergence"
Jonathan A. Patz, [Dr. Peter Daszak (born 1965)], Gary M. Tabor, A. Alonso Aguirre, Mary Pearl, Jon Epstein, [Dr. Nathan Daniel Wolfe (born 1970)], A. Marm Kilpatrick, Johannes Foufopoulos, David Molyneux, David J. Bradley, and Members of the Working Group on Land Use Change Disease Emergence
"Abstract : Anthropogenic land use changes drive a range of infectious disease outbreaks and emergence events and modify the transmission of endemic infections. These drivers include agricultural encroachment, deforestation, road construction, dam building, irrigation, wetland modification, mining, the concentration or expansion of urban environments, coastal zone degradation, and other activities. These changes in turn cause a cascade of factors that exacerbate infectious disease emergence, such as forest fragmentation, disease introduction, pollution, poverty, and human migration. The Working Group on Land Use Change and Disease Emergence grew out of a special colloquium that convened international experts in infectious diseases, ecology, and environmental health to assess the current state of knowledge and to develop recommendations for addressing these environmental health challenges. The group established a systems model approach and priority lists of infectious diseases affected by ecologic degradation. Policy-relevant levels of the model include specific health risk factors, landscape or habitat change, and institutional (economic and behavioral) levels. The group recommended creating Centers of Excellence in Ecology and Health Research and Training, based at regional universities and/or research institutes with close links to the surrounding communities. The centers’ objectives would be 3-fold: a) to provide information to local communities about the links between environmental change and public health; b) to facilitate fully interdisciplinary research from a variety of natural, social, and health sciences and train professionals who can conduct interdisciplinary research; and c) to engage in science-based communication and assessment for policy making toward sustainable health and ecosystems."
DAVIS, Calif. - Bang! Inside an improvised duck blind -- her parked car -- Grace Y. Lee presses a switch, and her gun blasts a square of light volleyball net over the dirt road she is watching.
One of the two magpies she has baited into range with cornbread, cheese-flavored rice snacks and dog food is snagged, flopping furiously around.
"We mostly catch the young ones," Ms. Lee said. "These birds are too smart to be caught again. We get them once, and they don't shop here anymore."
With the country waiting nervously for avian flu to arrive, catching wild birds is no hobby. It has become part of a national early detection effort, and Ms. Lee, a researcher at the University of California here, is a sentry on the country's epidemiological ramparts.
She is one of hundreds of ornithologists, veterinarians, amateur bird-watchers, park rangers and others being recruited by the National Wildlife Health Center to join a surveillance effort along the major American migratory flyways. They will test wild birds caught in nets; birds shot by hunters on public lands, who must check in with game wardens; and corpses from large bird die-offs in public parks or on beaches.
The plan also calls for sampling bodies of water for the influenza virus, which is shed in bird feces. And it is designating some ducks and geese -- like those in backyard flocks or living year-round in park ponds -- as "sentinels" to be captured, tested, released and periodically retested.
Surveillance of poultry is already in place. Long-standing federal and state laws require farmers to report deaths of birds from any flu strain. The surveillance system was worked out this summer by the Agriculture Department, which oversees poultry, and the wildlife health center in Madison, Wis., part of the Interior Department, which oversees wildlife -- including migratory birds, which are thought to be the most likely entry route for the flu virus.
Dr. Christopher J. Brand, the center's research chief, estimated the cost at $10 million. [On Nov. 1, President Bush announced a $7.1 billion plan to guard against a flu pandemic; Dr. Brand said he hoped money for the surveillance system would come from that.] The sampling plan had a small test run this fall in Alaska, which Dr. Brand said was the obvious choice because of the flu's surprise appearance in Siberia in July. Birds from there mingle in the summer Arctic nesting grounds with birds that migrate down the North American coast.
Now the flu's recent crossing of Europe "has opened up more eyes," Dr. Brand said. It is unlikely that infected birds will cross the Atlantic, because most migrate north-south and the birds detected in Eastern Europe were from species that migrate to Africa. Still, Dr. Brand said, there is now talk of setting up a surveillance network for Greenland, eastern Canada and the East Coast.
The threat of avian flu has also sped a transformation that was begun by the fear of bioterrorism and fueled by the fight against West Nile virus: veterinarians and doctors, as well as the agencies overseeing them, are joining forces.
Previously, said [Dr. William Bamberger Karesh (born 1955)], head of the field veterinary program at the Wildlife Conservation Society, which runs the Bronx Zoo, the two fields almost never worked in tandem.
"Human medicine and veterinary medicine have advanced beautifully in the last 30 years, but they were not linked," Dr. Karesh said. That has always frustrated him, he said, because "diseases don't care which way they flow -- there is a whole world of bacteria, viruses and fungi that move between wild animals, domestic animals and humans."
[Dr. William Bamberger Karesh (born 1955)] described once trying to get a research grant for surveillance of animal diseases that infect humans, known as zoonoses. The National Institutes of Health told him to apply to the Department of Agriculture, he said, and officials there sent him to the Fish and Wildlife Service, which told him it had no mandate to study disease.
"Then we went to Homeland Security, and they understood what we were talking about," Dr. Karesh said. "But they said: 'You're an orphan. No one does this.' And in their rankings, we're lower than people trying to blow up the subway in New York."
Now, instead of sharing information haphazardly and getting into jurisdictional disputes -- problems that cropped up during the 2003 monkeypox outbreak and in surveillance for mad cow disease -- health officials are writing plans that emphasize teamwork.
The United States still does far better at animal surveillance than most other countries because its medical and veterinary systems are each excellent and because outbreaks cannot be hushed up -- as, for example, the SARS outbreak was in China.
But zoonoses fall into a gray area, and the 2003 monkeypox outbreak in the Midwest is a perfect example of what can go wrong, said [Dr. Peter Daszak (born 1965)], director of the Consortium for Conservation Medicine at the Wildlife Trust, a group specializing in human-animal diseases.
The disease, related to smallpox but less deadly, arrived in a shipment of 18 Gambian giant pouched rats imported for a Chicago pet store, where they infected prairie dogs. By summer's end, there were 37 confirmed human cases -- none fatal, but some scary -- mostly among prairie-dog owners.
"Millions of live animals come into the country each year, and very few have really good surveillance," [Dr. Peter Daszak (born 1965)] said. "Fish and Wildlife checks cargoes to see if they have endangered species, but it's the U.S.D.A. that does health checks, and they don't go unless it's an agricultural product, so the pet trade tends to get a pass."
"The C.D.C. does a great job with outbreak investigation, but that's after the fact," he said of the federal Centers for Disease Control and Prevention. "After monkeypox, they put a blanket ban on rodents from some West African countries. But who's looking at rodents from other places? Nobody. And that's a gap."
Surveillance for diseases in wild animals is particularly difficult, since they do not come to hospitals, are not watched by veterinarians and do not like to be caught.
In the case of the magpie in Davis, it took Ms. Lee and her boss, Dr. Walter M. Boyce, director of the university's Wildlife Health Center, more than 30 minutes to disentangle the bird, set up a lab table, zip themselves into disposable coveralls and get a beak swab, a feces swab and a blood sample before releasing the miffed-looking bird, which high-tailed it for the nearest tree.
Dr. Boyce also gets swabs from hunters' ducks, and his colleagues at the state-run agriculture laboratory on campus get them from poultry farms and from dead crows, jays and robins collected by city health departments on the watch for West Nile virus, which arrived in California earlier this year.
During the test run in Alaska, Dr. Jonathan Runstadler, a biology professor at the University of Alaska in Fairbanks, said he had collected nearly 5,000 fecal samples from ducks, geese, gulls and other shorebirds, owls and other raptors, and even songbirds.
With limited money, Dr. Runstadler could not mount his own bird-catching efforts, but university ornithologists and dedicated amateurs who study migratory patterns run what he called "ring and fling" leg-banding operations. "Our technicians and grad students go out with them, pull out a Q-Tip and say, 'Excuse me, can I take a sample here?' " he said.
Another difficulty is deciding which species to pursue. [Dr. William Bamberger Karesh (born 1955)] expressed frustration that no country with birds dead of flu, from China to Romania, had noted which healthy species were nearby, because survivors were the more likely carriers, he said.
Which explains why Ms. Lee was netting birds that live year-round in Davis.
It's "a bit of a maverick approach," Dr. Boyce admitted, but his theory is that scavengers like magpies, crows and cattle egrets are the most likely vectors for moving the virus from the millions of ducks flying down California's Central Valley each fall to domestic chicken farms.
American industrial farms have high levels of biosecurity, penning thousands of birds in hangar-size barns "that no self-respecting duck or goose is looking to get into," Dr. Boyce said, "but there's a lot of free food there for an opportunist."
Since scavengers also bathe in the ponds where ducks stop over and hang around humans' garbage cans, he said, "we're looking for flu in species that can make the link between wildfowl, poultry and people."
2006 (Jan 04)
Consortium for conservaiton of medicijne ...
Other names on this article include : [Dr. William Bamberger Karesh (born1955)],
2006 (April 24)
Bats have been getting a bad rap. Last autumn, a team of scientists tied bats to the deadly SARS outbreaks. Bats in China, they said, are likely where the virus hides between human outbreaks. Then, in December, another group of researchers suggested that bats in Africa serve as a reservoir for the vicious virus for Ebola hemorrhagic fever, which causes its human victims to bleed to death.
Bats have also been definitively tied to two other recently discovered viruses that are lethal to humans: Nipah and Hendra.
But as researchers have worked to uncover the mysterious links between bats and these emerging viruses, they say they have stumbled upon an even wilier culprit working behind the scenes: humans. It now seems that these outbreaks, and likely many others, were set off when people encroached on rain forests, expanded wild animal markets, or made other changes that removed the natural barriers that keep diseases at bay.
"This is not a wildlife problem, it is a human problem," said Jonathan Epstein, an American researcher who spoke by phone from Bangladesh, where he has been investigating the causes of Nipah outbreaks.
The insights that are coming from these outbreaks are feeding an emerging discipline that seeks to redefine the very meaning of health. Epstein and other proponents of this thinking, which they have dubbed "conservation medicine," argue that it is impossible to divorce human health from that of the environment. Emerging viruses like the one that causes SARS are symptoms of the drastic, large-scale changes humans are making in the life of the planet.
At a time of intense concern about avian flu, it is hardly controversial to argue that human health is linked to animal health. But the field challenges traditional academic divisions, especially the cultural divide between doctors and veterinarians. Epstein is a senior research scientist at the New York- based Consortium for Conservation Medicine at Wildlife Trust, which organizes projects that cross the old disciplinary boundaries.
The consortium includes the Cummings School of Veterinary Medicine at Tufts University in Massachusetts, the Johns Hopkins Bloomberg School of Public Health in Maryland, and the United States Geological Survey National Wildlife Health Center in Wisconsin.
As researchers do their detective work around the world, they are finding connections between human society and disease. Global warming could push mosquito-borne diseases like malaria and encephalitis into more northern countries. One new bat-borne disease, the Nipah virus, was tied to the expansion of pig farming in Malaysia. Outbreaks of avian flu have been tied to farms, and the disease's spread has been helped by farmers reluctant to come forward with sick birds.
The researchers hope that by studying these connections, they will discover the means to prevent future epidemics.
After the 2003 outbreaks of SARS, which attacks the respiratory system, scientists initially identified an animal known as a civet as the disease's reservoir, the place where the virus sustains itself between outbreaks in humans. But further testing found that civets were not widely infected. In a paper published online by the journal Science last September, a team that included Epstein and scientists from China and Australia named a new suspect: cave-dwelling horseshoe bats. These bats, they reported, carry a family of viruses very similar to the one that causes SARS.
It is likely, the study found, that one of these "SARS-like" viruses evolved into the SARS virus at an exotic animal marketplace, where it infected civets, which, in turn, infected humans, according to Michael Farzan, a Harvard Medical School assistant professor who was not involved in the research.
But why did this happen when it did? One intriguing possibility is that it is linked to China's economic boom, according to Peter Daszak, a co-author of the SARS paper who is executive director of the Consortium for Conservation Medicine. With the newfound wealth there, he said, animal markets have grown as more people can afford fresh animal meat. As the markets grow, so do the chances that a virus will jump from one species to the next.
In December, a different group of researchers linked fruit bats to the dreaded Ebola virus. Outbreaks of the disease in humans have been associated with dramatic outbreaks among chimpanzees and gorillas. The team, working in Gabon and Congo Republic, captured various animals near the bodies of chimpanzees and gorillas. They then looked for signs of Ebola virus.
From this, the team found three different species of bats with antibodies to the virus, according to a paper in the journal Nature. Bats are now the leading suspect as the Ebola virus reservoir, but the case against them remains controversial, according to Jens Kuhn, an Ebola specialist at Harvard Medical School. It is thought that changes in human activity are behind the Ebola outbreaks - such as new mining operations deep in forests and the eating of primate meat - Kuhn said, but nobody knows the true origin.
The ties between bats and disease have raised fears in the conservation community that the winged creatures, long maligned and misunderstood, will become the targets of calls for elimination. This would be a mistake, researchers said, because bats play important environmental roles, such as eating pests - and killing off bats would be very difficult in any case.
There are about 1,000 species of bats, making up a fifth of all mammal species.
2008 (Oct 11) references .. The Human/Animal Interface: Emergence and Resurgence of Zoonotic Infectious Diseases
Michael Greger ( see https://en.wikipedia.org/wiki/Michael_Greger )
To link to this article: https://doi.org/10.1080/10408410701647594
Published online: 11 Oct 2008.
2010 - Video : Peter Daszak at TEDMED 2010
video posted : Jan 13, 2011 / TEDMED
Peter Daszak talks about how pathogens from animals around the world are creating disease epidemics, and how we should stop them before they affect the human population.
Kenneth H. Thomas / Photo Researchers, Inc. American bullfrogs are resistant to the lethal amphibian disease known as chytrid, and since they are commonly traded overseas, they are becoming the Typhoid Marys of the amphibian world.
A recent study in the Proceedings of the National Academy of Science reported that global trade in amphibians is one of the big culprits in spreading a fungal disease known as chytrid, responsible for the stunning die-off of amphibians across the world.
Half of all amphibians are in decline, while a third are threatened with extinction, because of the pathogen, which carries the formal name Batrachochytrium dendrobatidis. It infects the amphibians’ skin cells — through which most amphibians take in water and salts, including those of sodium and potassium — and thickens the skin, reducing its ability to absorb water and salts.
The recent study indicates that not only has the trade spread the disease, it may have created it.
Rhys Farrer of the Imperial College London and his team foundthat different strains of the chytrid fungus were identified in different parts of the globe. Through sequencing of the fungal genome, they found that the extremely lethal form of the fungus was created when two distinct strains came together to create a potent killer.
A likely explanation is that the global trade during the last century brought two strains together, experts say. “Chytrid is one of the most devastating wildlife diseases with the largest host range of any, and responsible for dozens of species’ extinctions and many more extirpations of local populations,” Dr. Farrer said.
The finding highlights the dangers of the worldwide movement of wildlife, including the huge global trade in pets. According toEcoHealth Alliance, a New York nonprofit that researches and works to prevent disease caused by wildlife, 120 million animals – fish, birds and reptiles – are shipped around the globe annually, legally and illegally.
American bullfrogs, which are carriers of the chytrid pathogen but resistant to it, are also widely available for sale; another study, done in 2009, looked at records from the ports of San Francisco, Los Angeles and New York from 2000 through 2005 and found “Importation of live amphibians into these ports totaled almost 28 million individuals over this six-year period.”
The illegal wildlife trade, valued at as much as $20 billion a year, is second only to the drug trade in terms of its worth, according to EcoHealth. Some 13 million animals are taken illegally from ecosystems for the pet trade. Many of those species come from “hot spots” in tropical regions where the risk of diseases’ emergence from the wild are high.
Even legal wildlife importation poses a disease risk, not only to other wildlife but to people as well. Diseases in other mammals pose the biggest threat to humans of all wildlife ailments, said Dr. Peter Daszak, president of EcoHealth. “Phylogenetically they are closer to us, which means we are more likely to share viruses we carry.” he said. “That means if we get infected there’s a higher change of that virus being transmitted human to human.”
One species that he is particularly worried might pass a disease into the human sphere is the sugar glider from Indonesia.
Associated Press A baby sugar glider in a Minnesota home
“They are extremely cute, really good looking little animals, very cheap and very trendy,” Dr. Daszak said. The trouble is, he said, they are coming in straight from the forest, in an emerging disease hotspot.
Plucking animals out of the wild can also cause declines in populations and lead to extinctions.
Earlier this year the EcoHealth Alliance started a program calledPetWatch that seeks to educate consumers to the dangers of exotic diseases on imported pets, from parrots to turtles to monkeys. They also include factors like invasive threats, the sustainability of wild populations and animal welfare issues.
The best bet for a disease-free animal is one that is bred in captivity and so is unlikely to harbor a disease from the wild. Among the best choices, according to Pet Watch, are the bearded dragon and cockatiels, while the worst include the African grey parrot and the squirrel monkey.
2012 (July 21)
2012 (Dec 01) - "Zoonoses 3 - Prediction and prevention of the next pandemic zoonosis : Stephen S Morse, Jonna A K Mazet, Mark Woolhouse, Colin R Parrish, Dennis Carroll, William B Karesh, Carlos Zambrana-Torrelio, W Ian Lipkin, Peter Daszak"
Authors : , [Dr. William Bamberger Karesh (born1955)] ,
In past years, this might have been occasion for panic. Yet chicken and pork sales have not plummeted, as they did during flus linked to swine and birds. Travel to Shanghai or Mecca has not been curtailed, nor have there been alarmist calls to close national borders.
Is this relatively calm response in order? Or does the simultaneous emergence of two new diseases suggest something more dire?
Actually, experts say, the answer to both questions may well be yes.
“We’ve done a great job globally in the last 10 years,” said [Dr. William Bamberger Karesh (born1955)], a wildlife veterinarian and chief of health policy for the EcoHealth Alliance, which tracks animal-human outbreaks. “Compared to H5N1 and SARS, we’re getting on top of these diseases much, much faster.”
But he added that “people have become desensitized over time — it’s ‘Oh, O.K., another one.’ ”
And scientists say the world cannot afford to relax. The threat is real. New diseases are emerging faster than ever.
Peter Daszak, a parasitologist and president of the EcoHealth Alliance, has even put a number on it: 5.3 new ones each year, based on a study using data from 1940 to 2004. He and his co-authors blamed population growth, deforestation, antibiotic overuse, factory farming, live animal markets, bush meat hunting, jet travel and other factors.
Some aspects of the new viruses are scary. The Arabian coronavirus — now officially named MERS, for Middle East respiratory syndrome — has killed about half of those it infects, while SARS killed less than a quarter; in the lab, it replicates faster than SARS, penetrates lung cells more readily and inhibits the formation of proteins that warn the body that it is under attack.
In her closing remarks on Monday at the annual meeting of the world’s health ministers, Dr. Margaret Chan, director-general of the World Health Organization, said the virus was now her “greatest concern.”
Until experts figure out where it hides and how it infects humans, “we are empty-handed when it comes to prevention,” she said. “These are alarm bells, and we must respond.”
The H7N9 flu has been fatal in a quarter of known cases — the 1918 Spanish flu killed only 2 percent of its victims — and already has one dangerous mutation that helps it replicate at human body temperatures.
Still, better surveillance means that such threats are being caught sooner, giving time to develop countermeasures like vaccines and making it far less likely that a virus like the 1918 flu will ever again kill millions.
It also means that outbreaks that once might have faded away unnoticed now set off alarms, for better and for worse. Fifty years ago, even the dreaded H5N1 bird flu, which emerged in 2003 and kills about half its victims, might have been missed. It makes the jump to humans so rarely that even now it is basically a poultry problem: It has killed millions of chickens and occasional flocks of wild birds, but in a whole decade has claimed only 364 human lives, and that is known only because it can be distinguished from other flus by genetic typing.
The world’s ability to detect new diseases has sped up for reasons both technical and political.
First, rapid gene sequencing is now done in many laboratories.
Second, accurate symptom descriptions are instantly available. Web-based news services like ProMED, with scientist-members all over the world, issue several daily reports of outbreaks of everything from banana wilt to sheep bluetongue to human Ebola. Also, genetic sequences of new viruses are often posted on public databases, so their travels can be tracked. Scientists learned, for example, that a 2008 convention of Roman Catholic youth in Sydney, Australia, drew in influenza strains that then seeded new outbreaks all over the Northern Hemisphere.
An image of a coronavirus, part of a family that causes the common cold and SARS. A new strain, called MERS, for Middle East respiratory syndrome, has been particularly lethal, killing half those infected.
Uncredited/Health Protection Agency, via Associated Press
Third, and very important, countries that used to hide their outbreaks now admit them. It would be virtually impossible now, for example, to repeat what happened in Africa in the 1980s, when presidents insisted for years that no one in their countries had AIDS.
The paragon of the new transparency cited most often is China. In 2003, it was excoriated for covering up its SARS outbreak. It later dismissed many of the officials involved. Now, with H7N9, “they’re being forthright and they’re also right at the forefront of research,” said Dr. W. Ian Lipkin, a microbe hunter at the Mailman School of Public Health at Columbia University, who just opened a partner laboratory at China’s Centers for Disease Control.
Saudi Arabia suffered a similar embarrassment in 2005, when it reacted slowly to polio spreading toward Mecca with pilgrims from northern Nigeria. Cases of paralysis ultimately reached the hills outside Mecca and from there spread briefly as far as Indonesia. Saudi Arabia now gives polio vaccines to millions of pilgrims on arrival.
Covering up an outbreak is now a violation of World Health Organization regulations adopted in the wake of SARS. The rules require members to disclose any public health event that could spread beyond their borders.
Both H7N9 and MERS fit that description. Neither is easily transmissible, though both have almost undoubtedly infected family members, nurses or hospital roommates after long exposure. Most deaths from both have been in older patients with other health problems.
More worrisome is that no one knows how these viruses first infect victims.
H7N9 is avian, a mix of genes from domestic chickens and wild waterfowl. But many Chinese H7N9 patients have had no known bird contact, and the disease has been found only rarely in birds. Unlike H5N1, it does not wipe out flocks, so it is hard to hunt. Its spread pattern is roughly circular around Shanghai, suggesting it is mostly in poultry, not migratory birds. That could change if it starts traveling in wild ducks. (Rice farmers have duck farmers drive flocks into paddies to eat the snails that eat rice shoots, and wild ducks mix with them there.)
A decade ago, H5N1 also started in China but spread west in a zigzag pattern as wild waterfowl shared Mongolian lakes in summer with species that went southwest to Eastern Europe, Egypt and Africa and were caught in storms that blew them as far as Britain.
The origins of MERS are even more baffling. Scientists assume it is from bats, because it is genetically closer to coronaviruses found in them than to SARS or to the four known human coronaviruses, which cause common colds. But while bats in Mexico, Europe and Africa have similar viruses, none have yet been found in Arabian bats or in camels, goats or other animals that might transfer it to humans.
Dr. Daszak cited Nipah virus as an example of how humans get bat diseases. It was the inspiration for the 2011 movie “Contagion,” in which Gwyneth Paltrow had vivid death and autopsy scenes. Bat feces landed on fruit eaten by pigs, and Ms. Paltrow’s character was infected when she shook the unwashed hand of a casino chef who had just cleaned out a dead pig’s mouth. (In the first real-life Nipah outbreak, in Malaysia in 1999, most victims were pig farmers and butchers.)
But another study, done in Bangladesh by a colleague of Dr. Daszak, showed that humans get Nipah directly from bats by drinking fresh date palm sap. Sap-drinking bats crawled into the collecting jugs hung in trees, drooling and urinating in them.
Small numbers of sap drinkers may have died of Nipah for decades without it being noticed, Dr. Daszak said.
Right now, doctors are relying on isolating patients and antiviral treatment with oseltamivir and zanamivir for H7N9, and ribavirin and interferon for MERS.
If either virus goes epidemic, the next step would be vaccine.
The Centers for Disease Control and Prevention began making one against H7N9 in early April. The first of several candidates may be ready for manufacturers by the end of May, a spokeswoman said. How long it then would take to make and package millions of doses is unpredictable, she said, but should take at least six additional months.
Any vaccine for MERS will take much longer, said Mark A. Pallansch, director of the C.D.C.’s viral disease division. While flu vaccines have been produced around the world for 60 years, the passion for a coronavirus vaccine has faded since the SARS epidemic. Until recently, the most interested parties were poultry farmers, since one coronavirus kills turkeys.
Coronaviruses are unusually complex, so finding potential vaccine targets has been hard, and the extensive safety testing is expensive. Also, an animal model for testing was only recently found — macaque monkeys, in which the virus causes pneumonia.
2013 (July 01) - NYTimes : Solving a Viral Mystery"
A field team from EcoHealth Alliance, Columbia, and the Saudi Health Ministry examined a room taken over by bats in an abandoned village. They took samples for testing for the coronavirus causing Middle East respiratory syndrome.
K.J. Olival/EcoHealth Alliance
As the scientists peered into the darkness, their headlamps revealed an eerie sight. Hundreds of eyes glinted back at them from the walls and ceiling. They had discovered, in a crumbling, long-abandoned village half-buried in sand near a remote town in southwestern Saudi Arabia, a roosting spot for bats.
It was an ideal place to set up traps.
The search for bats is part of an investigation into a deadly new viral disease that has drawn scientists from around the world to Saudi Arabia. The virus, first detected there last year, is known to have infected at least 77 people, killing 40 of them, in eight countries. The illness, called MERS, for Middle Eastern respiratory syndrome, is caused by a coronavirus, a relative of the virus that caused SARS (severe acute respiratory syndrome), which originated in China and caused an international outbreak in 2003 that infected at least 8,000 people and killed nearly 800.
As the case count climbs, critical questions about MERS remain unanswered. Scientists do not know where it came from, where the virus exists in nature, why it has appeared now, how people are being exposed to it, or whether it is becoming more contagious and could erupt into a much larger outbreak, as SARS did. The disease almost certainly originated with one or more people contracting the virus from animals — probably bats — but scientists do not know how many times that kind of spillover to humans has occurred, or how likely it is to keep happening.
There is urgency to the hunt for answers. Half the known cases have been fatal, though the real death rate is probably lower, because there almost certainly have been mild cases that have gone undetected. But the virus still worries health experts, because it can cause such severe disease and has shown an alarming ability to spread among patients in a hospital. It causes flulike symptoms that can progress to severe pneumonia.
The disease is a chilling example of what health experts call emerging infections, caused by viruses or other organisms that suddenly find their way into humans. Many of those diseases are “zoonotic,” meaning they are normally harbored by animals but somehow manage to jump species.
“As the population continues to grow, we’re bumping up against wildlife, and they happen to carry some nasty viruses we’ve never seen before,” said Peter Daszak, a disease ecologist and the president of EcoHealth Alliance, a scientific group that studies links between human health, the health of wild and domestic animals, and the environment.
Saudi Arabia has had the most patients so far (62), but cases have also originated in Jordan, Qatar and the United Arab Emirates. Travelers from the Arabian peninsula have taken the disease to Britain, France, Italy and Tunisia, and have infected a few people in those countries. Health experts are also worried about the Hajj, the Muslim pilgrimage that will draw millions of visitors to Saudi Arabia in October.
MERS has not reached the United States, but health officials have told doctors to be on the lookout for patients who get sick soon after visiting the Middle East. So far, more than 40 people in 20 states have been tested, all with negative results, according to Dr. Anne Schuchat, the director of the National Center for Immunizations and Respiratory Diseases at the Centers for Disease Control and Prevention.
The illness can be spread by coughs and sneezes, or contaminated surfaces, and people with chronic diseases seem especially vulnerable. More men than women have fallen ill, possibly because women have been protected by their veils. A cluster of cases that began in a Saudi hospital in April ultimately involved 23 people, including several family members and health workers. One man infected seven people, each of whom spread the disease to at least one other person.
An electron microscope image of a novel coronavirus particle, also known as the MERS virus.
National Institute of Allergy and Infections Diseases - Rocky Mo, via Associated Press
Regardless of where they emerge, new illnesses are just “a plane ride away,” said Dr. Thomas Frieden, the director of the C.D.C.
And while MERS is not highly contagious like the flu, he said, “the likelihood of spread is not small.”
Ailing Patients Most Vulnerable
In May, Saudi health officials asked an international team of doctors to help investigate the hospital cluster. One concern was that a number of cases were in patients at a dialysis clinic, and doctors feared that dialysis machines or solutions might be spreading the disease.
“It was pretty easy to figure out that couldn’t have been the case,” said a member of the team, Dr. Connie S. Price, the chief of infectious diseases at Denver Health Medical Center.
The patients’ records did not point to dialysis as the culprit, she said, and there were clear cases of transmission in other parts of the hospital that had no connection to dialysis.
Why, then, the outbreak among dialysis patients? The answer seems to be that they were older, chronically ill and often diabetic; diabetes can suppress the immune system’s ability to fight off infections. So, when one dialysis patient contracted MERS, others who happened to be in the clinic at the same were easy targets for the virus.
“Introducing it into a dialysis center gives it the perfect environment to spread among vulnerable patients sitting in open bays for many hours,” Dr. Price said.
Some health experts have suggested that MERS, like SARS, may fade away. The SARS outbreak erupted in early 2003, but ended by that summer. Much of the success was attributed to infection control in hospitals and also to eliminating animals like civet cats, which were thought to have caught the virus from bats and to be infecting people in markets where the civets were being sold live to be killed and eaten.
But Dr. Allison McGeer, a microbiologist and infectious disease specialist at Mount Sinai Hospital in Toronto who is also part of the team that studied the Saudi hospital outbreak, said there were no signs that MERS was going away.
“Absolutely not,” she said. “There are ongoing cases of disease acquired in the community. The first we know about is April 2012 in Jordan. There has been a steady and continuing number of cases.”
Researchers with a bat captured in a remote Saudi village. The team searched areas near where cases of Middle East respiratory syndrome had been reported.
J.H. Epstein/EcoHealth Alliance
The fact that the disease has apparently emerged in geographically disparate places, with widely scattered cases in four Middle Eastern countries, also makes Dr. McGeer doubt that it is simply going to fizzle out.
Finding out where in the environment the disease is coming from might make it possible to tell people how to avoid it. Bats are the leading suspect, because they are a reservoir of SARS and carry other coronaviruses with genetic similarities to the MERS virus. Bats could be transmitting the disease directly to people, or they might be spreading it to some other animal that then infects humans. But what kind of bat? There are 1,200 species; 20 to 30 have been identified in Saudi Arabia.
Last October, to test the theory, a team of scientists from the Saudi Ministry of Health, Columbia University and EcoHealth Alliance began scouring Saudi towns near where cases of MERS had been reported, showing people pictures of bats and asking if they had seen any. They struck pay dirt when one man led them to an abandoned village in the southwest, said to be hundreds of years old. It was there, in the inky darkness, that they found a small room that had become the roost of about 500 bats.
The scientists set up nets to catch them when they flew out at dusk to hunt insects, then spent the night testing them for the MERS virus. The bats were let go after the testing.
The animals can weigh as little as four grams (one-seventh of an ounce), and a bat that size may have an eight-inch wingspan.
“They’re mostly wing,” said Kevin J. Olival, a disease ecologist with EcoHealth Alliance. “They’re little flying fur balls.”
It takes about 15 minutes to process a bat — to weigh and measure it, swab it for saliva and feces samples, and collect some blood and a tiny plug of skin from a wing for DNA testing to confirm its species. The specimens were then frozen and sent to the laboratory of Dr. W. Ian Lipkin, a leading expert on viruses at Columbia.
Bats do not much appreciate all this medical attention. They bite, and in addition to potentially carrying MERS, they may harbor rabies and other viruses.
“You’re wearing coveralls that cover everything — hoods, gloves, respirators, booties,” Dr. Lipkin said. “You’re all dressed, so you don’t have any contact with the animals. It’s night, but still very hot.”
Hundreds of bats have been tested, he said, but it is too soon to disclose the results.
From Animals to Humans
Dr Jonathan H. Epstein, left, and Dr. Kevin J. Olival in the room where they set a trap for the bats.
V. Kapoor/Columbia University
The team has also tested camels, goats, sheep and cats, which might act as intermediate hosts, picking up the virus from bats and then infecting people. One reason for suspecting camels is that a MERS patient from the United Arab Emirates had been around a sick camel shortly before falling ill. But that animal was not tested.
“If animals are acting as a reservoir, getting people sick, how would this happen?” asked Dr. Jonathan H. Epstein, a veterinary epidemiologist with EcoHealth Alliance.
If animals harbor the virus, does it make them ill? Do they infect people by coughing? Or do they pass the virus in urine or feces, and infect people who clean their stalls? The answers do not come easily.
“Camels are tough, let me tell you,” said Dr. Epstein. “They’re ornery. It takes a certain kind of person to be able to wrangle a camel. They’re strong, they’re fast, they bite really hard.”
The trick, he said, is to get the camel into a position that veterinarians call “ventral recumbency,” or lying on its belly. A very feisty camel may also have its legs tied together so it cannot run away or kick anybody. Then someone steadies its head, maybe with a harness, and holds its jaws open so a vet can reach in and out quickly with a cotton swab.
“They have a pretty big mouth,” Dr. Epstein said. “You try not to get bitten.”
So far, he said, “none of the animals we looked at were overtly sick.”
But Dr. Lipkin noted that the virus tests on livestock samples were not complete. Any specimens from such animals from other countries are considered a threat to agriculture in the United States because they could carry foot-and-mouth disease or other pathogens, and have to be screened first by the Agriculture Department before being released to research labs.
Testing may identify animal species that carry the virus, but that will not immediately explain why it has emerged now.
“The most common reason that wildlife viruses make the jump into people is that we do things that bring us and our livestock into closer contact with wildlife, such as the wildlife trade or agricultural intensification,” Dr. Epstein said.
And, said his colleague Dr. Olival, finding the animals that carry the disease is “not just an academic exercise.”
“It’s a way to inform public health measures,” he said, “to try to stop zoonotic diseases before they emerge into humans.”
See you tonight at the Cosmos Club, our event will begin with a cocktail reception at 6:00 pm on the second floor in the Grand Room.
Dr. Peter Daszak and the scientists of EcoHealth Alliance cordially invite you and a guest to a cocktail reception & presentation
GLOBAL HEALTH SECURITY
with special guest: The Honorable Andrew C. Weber, Assistant Secretary of Defense for Nuclear, Chemical, and Biological Defense Programs, U.S. Department of Defense
Dr. Peter Daszak, President, EcoHealth Alliance
Dr. Nicholas Preston, Director of Data Science and Research Technology, EcoHealth Alliance
Date: Tuesday, November 19, 2013 ; Cocktail Reception: 6:00 pm to 7:00 pm ; Presentations: 7:00 pm to 8:00 pm
Cosmos Club 2121 Massachusetts Avenue, NW - 2nd floor, Washington, DC 20008
About Peter Daszak, PhD
- Dr. Peter Daszak, President of EcoHealth Alliance, is a leader in the field of conservation medicine and a respected disease ecologist. EcoHealth Alliance is a global organization dedicated to innovative conservation science linking ecology and the health of humans and wildlife. EcoHealth Alliance's mission is to provide scientists and educators with support for grassroots conservation efforts in 20 high-biodiversity countries in North America, Asia, Africa, and Latin America.Previous to his current position, Dr. Daszak was the Executive Director of EcoHealth Alliance's Consortium for Conservation Medicine (CCM) - a collaborative think-tank of institutions. Dr. Daszak's research has been instrumental in revealing and predicting the impacts of emerging diseases on wildlife, livestock, and human populations. Dr. Daszak has also consulted for other non-profit organizations and governmental agencies such as the OIE ad hoc working group on amphibian diseases, the National Academy of Sciences, U.S. Department of the Interior, International Union for the Conservation of Nature, National Institutes of Health, Australian Biosecurity CRC, DIVERSITAS, Society for Conservation Biology, and the Millennium Ecosystem Assessment. Dr. Daszak has been called upon time and again to advise governmental, commercial, and non-commercial organizations including, NASA and leading pharmaceutical companies on issues ranging from the environment to national security. With an impressive track record of more than 100 peer-reviewed published papers, Dr. Daszak has also authored book chapters, and his research has been featured in such publications as Nature, Science, The Lancet, Proceedings of the National Academy of Sciences, and Trends in Ecology and Evolution. Dr. Daszak's work has been the focus of extensive media coverage, including articles in The New York Times, The Wall Street Journal, The Economist, The Washington Post, TIME and broadcast appearances on 60 Minutes II, CNN, ABC News, NPR's Talk of the Nation, Morning Edition, and BBC News.
About The Honorable Andrew C. Weber
- The Honorable Andrew C. Weber is the principal advisor to the Secretary of Defense, the Deputy Secretary of Defense, and the Under Secretary of Defense for Acquisition, Technology and Logistics for matters concerning nuclear, chemical, and biological defense programs. As the ASD(NCB), his mission is to prevent, protect against, and respond to these global threats. Mr. Weber is the Staff Director of the Nuclear Weapons Council, which manages the nuclear weapons stockpile, and he oversees the Defense Threat Reduction Agency and the Nunn-Lugar Cooperative Threat Reduction Program. Since taking office, Mr. Weber has overseen an expansion of Nunn-Lugar programs into new regions, including Africa and South Asia. He has also been a key player in reforming the nation's medical countermeasures enterprise. His nuclear duties include executing President Obama's direction that as the U.S. reduces the number of deployed weapons; we are assured that the remaining stockpile is safe, secure, and effective. Prior to his appointment by President Obama, Mr. Weber served for 13 years as an Adviser for Threat Reduction Policy in the Office of the Secretary of Defense. He played a key role in Nunn-Lugar operations to remove weapons grade uranium from Kazakhstan and Georgia, and nuclear capable MiG-29 aircraft from Moldova. Mr. Weber also developed and oversaw the Department of Defense Biological Threat Reduction Program. For his work at the Department of Defense, Mr. Weber has twice been awarded the Exceptional Civilian Service Medal. Most of Mr. Weber's 26 years of public service have been dedicated to reducing the threat of weapons of mass destruction. He served previously as a United States Foreign Service Officer, with diplomatic assignments in Saudi Arabia, Germany, Kazakhstan, and Hong Kong. From 2002 through 2008 Mr. Weber taught a course on Force & Diplomacy at the Edmund A. Walsh Graduate School of Foreign Service at Georgetown University. He has a Master of Science in Foreign Service degree from Georgetown and is a graduate of Cornell University. Mr. Weber speaks Russian and is a member of the Council on Foreign Relations.
About Nicholas Preston, PhD
- Dr. Nicholas 'Nico' Preston is the Director of Data Science and Research Technology (DART) at EcoHealth Alliance (EHA). His research in computational disease ecology (a blend of ecology, computing, and health) combines data mining, web technology, and statistical modeling to assess infectious disease threats to human, animal, and ecosystem health. Through emerging web technologies and cloud computing, Dr. Preston builds complex computer models and biosurveillance platforms to monitor global ecosystems and understand how they respond to human impacts. Dr. Preston is currently exploring global media and field data to identify new diseases, pathogens, or environmental risks. Dr. Preston's doctoral training was in ecosystem ecology at the University of Wisconsin - Madison Center for Limnology (CFL), with a certificate in global health and postdoctoral work in global health informatics at the UW-Madison Global Health Institute (GHI) and Center for Sustainability and the Global Environment (SAGE). His postdoctoral work on HealthScapes, and underlying dotSkapes technology, has continued at EHA through web platforms designed to support and enhance collaborative global environmental health research. Nico founded the DART lab at EHA - a dynamic team of data scientists and software developers that draw upon interdisciplinary backgrounds in ecology, computer science, and health. The lab is developing flagship projects, such as the Sicki web encyclopedia, to pinpoint the origins of infectious diseases by curating and analyzing historic disease media through dynamic web applications. Sicki builds upon EHA's expertise in developing 'hotspot' maps of infectious diseases. This historic perspective from Sicki informs our field programs and virtual biosurveillance laboratories. The next generation of technology being developed combines recommendation engines, adaptive models, and decision support tools to monitor, detect, and diagnose emerging threats in real-time dashboards for analysts. [...]
A new study suggests that camels are the major source of the Middle East Respiratory Syndrome, or MERS, a viral disease that has sickened 182 people and killed 79 of them since it was first detected in Saudi Arabia in 2012.
The animals are most likely to infect people through respiratory secretions — from coughing, sneezing, snorting or spitting — that travel through the air or cling to surfaces.
People with chronic illnesses like diabetes, lung disease or kidney failure, or other conditions that weaken their immunity, seem to be most susceptible, and should avoid close contact with camels, researchers say.
Saudi Arabia has had the most cases, other Middle Eastern countries have had a few and a handful of travelers from that region have taken the disease to Europe. There have been no cases in the United States. Although people have infected one another, the disease is not highly transmissible among humans, so researchers say that unless the virus changes to become more contagious in people, the risk of global spread does not seem high.
The new study provides the first evidence that the virus is widespread in dromedary camels (the kind with one hump) in Saudi Arabia, and has been for at least 20 years.
Younger animals are more likely than older ones to be infected and contagious. The virus invades the camels’ nose and respiratory tract, but does not kill them. It is not known whether it even makes them sick.
“It would be very difficult to know if they were ill, since these are creatures that slobber a great deal,” said Dr. W. Ian Lipkin, the senior author of the study and a virus expert at Columbia University’s Mailman School of Public Health in New York. The results, by researchers from Saudi Arabia and the United States, were published on Tuesday in mBio, an online journal.
Tests on 203 dromedaries from different parts of Saudi Arabia found evidence of past infection in about 75 percent overall, with higher rates in some regions. About 35 percent of young animals and 15 percent of adults had current infections, with significant variations by region. In addition, measurements of stored blood samples from camels indicate that MERS or a virus closely related to it has been present in the animals since at least 1992.
Genetically, the virus found in camels matches samples from infected humans.
The disease was not detected in people until 2012. It is not known whether the cases in humans are a new phenomenon, or whether they have been occurring but were not recognized. Some people develop mild respiratory infections, but in others the disease turns deadly, with worsening fever, cough and shortness of breath.
In some cases, patients were known to have been around camels, but until recently it was not clear whether the animals might be the source. Other cases have been complete mysteries, with no known exposure to animals or ill humans. Sick people have infected family members, health workers and nearby patients in the hospital, but the virus is not considered highly contagious among humans.
Researchers do not know how camels become infected, but they suspect that the virus may have originally come from bats. MERS belongs to the coronavirus family, like SARS, the deadly and more contagious respiratory infection that began in China and caused a global outbreak in 2003. Bats are a host for SARS and other coronaviruses, and studies have found evidence linking MERS to bats.
But at this point the evidence linking people and camels is stronger.
“This is an issue for Saudi Arabia,” said Peter Daszak, an author of the study and the president of EcoHealth Alliance, a group that studies the links between human and animal health. “Camels are highly valuable livestock, traded internationally. Unfortunately, they have an endemic virus that can cause death in people.”
Camels are sold for meat and milk in the Middle East. There are also racing camels, and prized “beauty camels” that compete in pageants and have fetched prices of $1 million or more.
Dr. Lipkin and Dr. Daszak said it was not immediately obvious how to protect people who come into contact with camels, like farmers, breeders and slaughterhouse workers. But they said animals can be quickly and cheaply tested for the virus, and those with current infections could be quarantined and not sold or transported.
Dr. Lipkin said MERS in camels may be analogous to the many respiratory infections that children catch early in life and then become immune to. In camels, once tests no longer find the active infection, the risk of transmitting the disease is probably greatly reduced or even gone, Dr. Lipkin said.
He also said it may be possible to develop a vaccine to prevent the disease in camels. But he said creating a vaccine for people would not make sense, given that so far, MERS is rare.
Saudi Arabia imports many camels, from other countries in the Middle East, sub-Saharan Africa and Australia. Dr. Lipkin said studies should be done in those countries, or in animals being imported, to try to find out where MERS is coming from, in hopes of eliminating it.
2014 (June 29) - NYTimes : "Flawed Saudi Response Is Cited in Outbreak of the Middle East Virus MERS"
A camel market in Al-Thamama, Saudi Arabia. MERS infects camels and can spread to humans, possibly in raw camel milk.
JIDDA, Saudi Arabia — As the virus tore through the city’s largest hospital, jumping from bed to bed and afflicting scores of people, terror filled the wards.
Some doctors and nurses refused to treat the sick or stopped coming to work altogether. Patients panicked. One surgeon recalled a man with a broken limb trying to flee the emergency room so he would not catch it, too.
“Everyone was afraid,” the surgeon, Dr. Mohammed Ahmed, said of the spike in cases this spring.
It was the darkest hour since the new illness, known as Middle East respiratory syndrome, or MERS, first appeared in Saudi Arabia late in 2012. In all, more than 700 cases have been documented in 20 countries, nearly all of them linked to Saudi Arabia. More than 250 people have died.
The sudden spread of a mysterious and fatal new virus is reminiscent of the early days of SARS, or severe acute respiratory syndrome, a related disease that appeared in dozens of countries and killed more than 770 people, principally in Asia in 2003.
MERS circulates most heavily in a region that is the nexus for Islam. This port city, Jidda, is the arrival point for most of the two million to three million pilgrims who make the hajj to Mecca each year. Riyadh, the Saudi capital, has had the second-largest outbreak after Jidda, and cases have also appeared in Mecca. The hajj will not take place until October, but many Muslims travel to Mecca during the holy month of Ramadan, which most Muslims began observing on Sunday. And off-season pilgrims have already spread the disease to Iran, Jordan and Algeria.
Saudi officials know how urgently they need to beat the disease, and they say they now have the latest outbreak under control. But the fact that the number of cases and deaths has more than tripled since the end of 2013 has led health experts to cite grave flaws in the way this ultraconservative and staunchly private monarchy has handled the crisis.
King Abdullah fired the country’s health minister and his deputy in April, leaving experts wondering whether the shake-up would bring greater transparency and international cooperation. “In the U.S., when you have a crisis like the Veterans Administration scandal, the new head is in front of the TV cameras explaining what the new plan is,” said Dr. Peter Daszak, president of EcoHealth Alliance, a veterinary organization that tracked the disease in animals. “There is no tradition of openness in Saudi Arabia.”
A World Health Organization panel said this month that the surge in cases that began in April had fallen off, but that “the situation remains serious” and that hospital outbreaks should be investigated for breaches in safety protocols.
“I am not saying we’re not worried, but this is something that can be controlled,” said Hanan Balkhy, executive director for infection prevention and control at Saudi Arabia’s National Guard hospitals. “If this were Ebola, I would go the king myself and tell him, ‘We need to isolate the kingdom.' ”
Both SARS and MERS are coronaviruses, named for their shapes. Both are thought to have originated in bats and then spread through other animals to people. But while SARS circulated in obscure forest animals like palm civets that are eaten in southern China, MERS infects camels, which are common in the Middle East. MERS seems to jump more easily to humans, possibly in raw camel milk, but it spreads less readily between people than SARS did.
One theory gaining popularity is that MERS cases peak in the spring because camel calves are born at that time. So until a human or veterinary vaccine is developed, people in contact with camels must be careful, especially in the spring.
Yet the outbreak this year suggested that lapses in the kingdom’s health system played a bigger role in spreading the virus than camels did. Most of the hundreds of new infections were linked to hospitals, dialysis clinics or other health facilities, and many were among staff members. Two health workers from Saudi clinics were hospitalized in Indiana and Florida.
The greatest number of new cases was at King Fahd Hospital in Jidda. Doctors said a mix of bad management, crowding and lax hygiene helped spread the virus there.
The outbreak came during the busiest time of year, when many Saudis were on vacation, leading to more car accidents, sports injuries and other mishaps, doctors said. New emergency patients were registered in a crowded area, and hospital rooms meant for four people often held 12.
Suspected MERS cases were not always identified and isolated, and patients unwittingly spread the virus around the hospital — one in the cardiac ward, and another among dialysis patients, according to Dr. Ahmed Ragab, chief of the hospital’s intensive-care unit.
“If one patient came in with the virus, all the others would get it, because they were all next to each other,” Dr. Ragab said.
Some medical staff members were lax with sanitary measures, not wearing masks or infrequently sanitizing their hands. Many fell ill.
When the king fired the health minister, Abdullah al-Rabeeah, in April, he gave the job to the labor minister, Adel Fakieh, who is known for bypassing the kingdom’s bloated and inefficient bureaucracy. Mr. Fakieh enlisted McKinsey & Company, the corporate consulting firm, and opened a command center in Jidda to track cases.
The changes at the top soon filtered down to King Fahd Hospital, where Dr. Imad al-Jahdali became director in May.
A man with a surgical mask in Jidda, a focal point for MERS.
“The scene at the time was panic, from the public and from the media,” Dr. Jahdali recalled. “King Fahd Hospital was the spotlight for everything.”
He divided the hospital in two, with one half exclusively for MERS patients. Anyone with a fever and breathing problems is quickly isolated for testing.
The disease has been surrounded by controversy since it came to light, when an Egyptian microbiologist, Ali Mohammed Zaki, sent a sample from a Jidda hospital to Rotterdam, in the Netherlands. Dutch researchers patented the new virus and named it after their center, enraging Saudi officials, who considered the action intellectual property theft. They fired Dr. Zaki and petitioned the W.H.O. for a new name for the virus.
Scientists from 18 universities or health agencies in eight countries were recruited to work on the virus. Egos began clashing, especially as teams raced to publish results. Two rivals published the genomes of viruses from the same patient and his camel in separate academic journals.
Some researchers accused the Saudi deputy minister of health, Ziad Memish, of duplicity and bad management, saying he hampered progress, while others said he was made a fall guy for an outbreak beyond his control.
Dr. Memish, described recently in The Lancet, the British medical journal, as “the father of mass gatherings medicine” for his work on protecting pilgrims, denied accusations that he took credit for the work of others or kept sloppy records. But he acknowledged occasionally switching cooperation from one team to another, bruising feelings.
“Some collaborations began and prospered; some did not,” Dr. Memish said by email. “That’s the way science and life progresses, sometimes.”
One recent afternoon, a family brought an old woman with a nasty cough to King Fahd Hospital. She was immediately wheeled into an isolation room. Dr. Jahdali watched proudly as health workers blocked her relatives from following, so they would not get sick. Confirmed cases go to a special wing where rooms with tight sliding glass doors hold one patient each and nurses wear gloves and snug-fitting masks.
Whether Saudi Arabia can get the virus under control will depend, experts said, on how effectively such measures can be applied nationally — not an easy task in a country of long distances and weak government oversight of some health centers.
The number of new cases reported nationally appears to be falling, with about 200 in May and only 27 since then, the Health Ministry said.
“The most direct cause of this improvement — after, of course, the blessing of Allah — is the stringent implementation of infection control in hospitals,” said Tariq Madani, who heads the Health Ministry’s MERS task force.