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For Future Viral Threats, Health Officials Look to Sewage
When the virologist Kirsten St. George learned last summer that a paralyzed patient in New York’s Rockland County had tested positive for polio, she turned her attention to the state’s sewers.
Polio is particularly stealthy because most infected people never develop symptoms but can still spread the virus. A wastewater-surveillance network established during the Covid-19 pandemic helped officials at the New York State Department of Health’s Wadsworth Center track polio’s spread in several counties.
New York is now expanding wastewater monitoring and starting to look for flu, RSV, hepatitis A, norovirus and antibiotic-resistant genes in parts of the state, as health officials across the U.S. consider wastewater as a more permanent public-health tool for watching a variety of threats.
“Are we on the brink of another outbreak, if it’s rising? Is it just sort of holding steady?” asked Dr. St. George, Wadsworth’s director of virology. “These are all important public health questions.”
Dr. Kirsten St. George of the Wadsworth Center, which is starting to track the spread of pathogens including the hepatitis A virus.
For decades, researchers around the world used wastewater primarily to track poliovirus, which spreads through contact with an infected person’s feces. At the onset of the pandemic, scientists found that the Covid-19 virus’s genetic material could be detected in sewage. That meant sewage might help track other respiratory viruses, too.
Researchers built surveillance networks around the country to track Covid-19 and monitor for variants.
Now they are starting to leverage that system to search for other pathogens they had wanted to track through the sewers for years including norovirus and antibiotic-resistant microbes, said Amy Kirby, program lead of wastewater surveillance at the Centers for Disease Control and Prevention.
“Once you have this system, it’s much easier to activate it for a new pathogen,” Dr. Kirby said.
Sewage samples from treatment plants are sent to labs, where genetic material that can come from hundreds of thousands of people is isolated. Researchers usually test samples for pathogens with the PCR technology used in a Covid-19 lab test administered at the doctor’s office.
Health officials use the data to track changing concentrations of a virus, which can help them monitor the spread of pathogens including flu and RSV for which many people might not be tested. The technique has yielded early evidence of Covid-19 outbreaks and helped officials tailor public messaging and decide where to open testing sites.
Biobot Analytics Inc., which works with the CDC to monitor Covid-19 and the renamed mpox, started tracking opioids in wastewater before the pandemic. It has collected data on substances including fentanyl in more than 100 counties across 47 states. Officials in Cary, N.C., used that data to encourage people to dispose of drugs properly and to distribute more overdose-reversal drugs, Biobot said.
Not everything can be tracked through sewage, and there isn’t a standard national system for collecting data and comparing readings from site to site. Privacy can be a concern in smaller communities or when tracking illicit substances, researchers said, though wastewater data is processed as an anonymous group sample. And some communities that collect wastewater data aren’t using it to guide public-health policy, researchers said.
The wastewater treatment plant in Schenectady, N.Y., where workers collect samples and ship them for analysis at the Wadsworth Center in Albany, N.Y.
The National Academies of Sciences, Engineering, and Medicine said in a report Thursday that the U.S. should invest more in the CDC’s wastewater-surveillance network and expand its reach. The report recommended that the CDC should have an open process for picking which pathogens to track and establish an ethics committee, among other steps.
“We’re at a critical juncture where it has gone from being a grass-roots effort to a more nationally recognized tool,” said Megan Diamond, head of the Rockefeller Foundation’s wastewater-surveillance program, who wasn’t involved with the report.
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Do you think sewage monitoring will help communities respond more quickly to future health threats? Join the conversation below.
After a polio case was confirmed in New York in July, health officials reviewed stored wastewater samples and found poliovirus in wastewater from several counties, including as far back as spring. Health officials urged people who weren’t vaccinated against polio to get the shots and alerted doctors.
The CDC extended poliovirus wastewater testing to a handful of counties with low vaccination rates or potential connections to New York’s polio case.
“What you might expect a virus to do when it starts circulating is exactly what we saw in the wastewater,” said Dan Lang, deputy director of New York’s Center for Environmental Health and head of the state’s wastewater-monitoring program.
No samples tested positive for poliovirus by the end of November, but it was detected again in Orange County last month. Health officials are planning to analyze past samples from additional counties for traces of the virus before deciding whether to widen poliovirus wastewater monitoring when the weather warms and the virus can spread more readily.
“We’re worried about a big sort of roaring back,” said Dr. Eli Rosenberg, a lead epidemiologist who coordinates New York’s polio response. “We’re using this time now to prepare.”
Poliovirus was found in Orange County, N.Y., last month.
Write to Brianna Abbott at brianna.abbott@wsj.com
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Origins of plague could have emerged centuries before outbreaks, study suggests
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—
In the largest DNA analysis of its kind, scientists have found evidence to suggest that historic plague pandemics, such as the Black Death, were not caused by newly evolved strains of bacteria but ones that could have emerged up to centuries before their outbreaks.
The plague-causing bacterium Yersinia pestis is dated to have first emerged in humans about 5,000 years ago. Through animals and trade routes, Y. pestis spread globally over time on multiple occasions, according to a study published Thursday in the journal Communications Biology.
It caused the first plague pandemic in the sixth to eighth centuries and the second one in the 14th to 19th centuries. The latter pandemic is thought to have started with the medieval Black Death outbreak, which is estimated to have killed more than half of Europe’s population. The bacterium also caused the third plague pandemic between the 19th and 20th centuries.
By amassing 601 Y. pestis genome sequences, including modern and ancient strains, researchers from Canada and Australia were able to calculate the time when the bacterial strains likely emerged as a threat. They divided the different strains of the plague bacterium and analyzed each strain population individually.
The strain responsible for the Black Death, which the study says is thought to have begun in 1346, was newly estimated to have diverged from an ancestral strain between 1214 and 1315 — up to 132 years earlier.
The strain of Y. pestis associated with the first plague pandemic was previously recorded as first appearing during the Plague of Justinian, which began in 541. However, the researchers estimated that the strain was already present between 272 and 465 — up to almost 270 years before the outbreak.
“It shows that each major plague pandemic has likely emerged many decades to centuries earlier than what the historical record suggests,” study coauthor and evolutionary geneticist Hendrik Poinar, director of McMaster University’s Ancient DNA Centre in Canada, told CNN via email Thursday.
He added that the bacterium emerged, created small epidemics and then “for reasons we don’t quite understand,” such as famine or war, “it takes off.”
The study authors estimated that individually assessed bacterial strains from the third plague pandemic diverged from an ancestral strain between 1806 and 1901, with highly localized plague cases beginning to appear in southern China between 1772 and 1880 and later diverging into various strains that spread globally out of Hong Kong between 1894 and 1901.
The study also found evidence to support recent academic research suggesting that the third and second plague pandemics were not mutually exclusive events, but that the third was partly the continuation or tail end of the second. Despite the pandemics having their own diverse genetic lineages that evolved differently, the third descended directly from the 14th century strain that caused the second.
Poinar called this finding significant because “it takes into account that most of the history of this bacterium has been a Eurocentric view, so while plague supposedly disappeared from Europe in the 18th (century), it continued to rage in the Ottoman Empire and throughout the Middle East and likely North Africa.”
However, even with so many sequences of the plague bacterium, researchers were not able to determine the path of the global spread of the plague.
A lot of the genetic samples come from Europe. For example, the emergence of the bacterium in Africa has led to 90% of all modern plague cases occurring on the continent, yet there are no ancient sequences from the region, which is represented by just 1.5% of all genome samples — making it difficult to date the appearance of Y. pestis in Africa.
There is also far less surviving historical evidence from the second plague pandemic to help estimate its geographic origins compared with the third, with the earliest textual evidence of the pandemic in Europe coming from the Black Death in 1346, the study authors said. The researchers estimated that the second pandemic originated in Russia.
A study published in the journal Nature in June used DNA analysis to find the plague bacterium in three individuals who are dated to have died in 1338 in what’s now Kyrgyzstan in Central Asia. It provided evidence that the Black Death came from a strain originating in the area near Lake Issyk-Kul in Kyrgyzstan in the early 14th century.
The latest study concluded that more ancient DNA will be needed to refine current estimates on the early events of the second pandemic.
Via email, Poinar described the strain from Kyrgyzstan as “really fascinating” but said that it “still doesn’t sit at the root. So I would guess we’re still looking for something a good 20-50 years earlier.”
He and the other authors noted that the only way to estimate the evolution of the plague bacterium strains precisely “is with well dated sequences, such as those from skeletal remains at Lake Issyk-Kul.”
Exercise Helps Blunt the Effects of Covid-19, Study Suggests
People who exercise regularly had lower rates of hospitalization and death from Covid-19 in a study published recently in the American Journal of Preventive Medicine.
Regular exercise improves overall health and healthier people generally have fewer serious complications with Covid-19 infections. Earlier research has shown an association between exercise and better Covid-19 outcomes. This latest study goes a step further and suggests that even people whose age or health conditions make them higher-risk have better outcomes if they are regular exercisers.
Higher amounts of physical activity were associated with lower rates of death and hospitalizations from Covid across nearly all demographics, says Jim Sallis, a public health professor at the University of California San Diego and co-author of the study. A very active 70-year-old still had a higher risk of Covid-related complications than did a similarly active 40-year-old, but the exercisers in both groups had hospitalization rates lower than those who didn’t work out.
The study used data from nearly 200,000 adult Covid-19 patients across the Kaiser Permanente network in Southern California. It asked patients to self-report the number of minutes of moderate exercise they did per week and analyzed the records of how many people in the study cohort were hospitalized, experienced deterioration, such as admission into an intensive-care unit, or died within 90 days of a Covid diagnosis.
“You don’t have to run, you don’t have to sweat, you don’t have to do anything except get up and go out for a walk,” Dr. Sallis says. “That’s what most people do, and we see how much protection they’re getting from that.”
The findings add to a growing body of evidence that physical activity provides several types of protection from severe illness.
Exercise improves the body’s immune response by mobilizing and redistributing immune cells that can recognize and kill infected cells, says Richard Simpson, a professor at the University of Arizona whose research focuses on exercise immunology and who wasn’t involved with the Kaiser Permanente study. Without exercise, viruses have more time to replicate inside our bodies, which can result in more severe symptoms, he says.
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How does exercise fit into your overall health regime? Join the conversation below.
Physical activity can also help reduce inflammation, the body’s natural immune response to damage or pathogens. Chronic inflammation has been linked to more severe Covid-19 outcomes, especially in the lungs. Cytokines, small messenger proteins that help regulate inflammation, are released during exercise.
The study data were collected from the beginning of the pandemic to May 2021, when vaccines were just starting to become more available and before more recent waves of Covid. However, the researchers believe the results of the study are still broadly applicable.
“Exercise is as effective as many of the drugs that we use and has no side effects,” says Jordan Metzl, a sports medicine physician in New York City who wasn’t involved with the study. “We want to get people taking it every day.”
Write to Alex Janin at alex.janin@wsj.com
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China retaliates against South Korea’s COVID curbs, says outbreaks past peaks
BEIJING, Jan 10 (Reuters) – Beijing retaliated on Tuesday against South Korea’s COVID-19 curbs on travellers from China, while state media further downplayed the severity of the outbreak in the last major economy to reopen its borders after three years of isolation.
China ditched mandatory quarantines for arrivals and allowed travel to resume across its border with Hong Kong on Sunday, removing the last major restrictions under the “zero-COVID” regime which it abruptly began dismantling in early December after historic protests against the curbs.
But the virus is spreading unchecked among its 1.4 billion people and worries over the scale and impact of its outbreak have prompted South Korea, the United States and other countries to require negative COVID tests from travellers from China.
Although China imposes similar testing requirements for all arrivals, foreign ministry spokesperson Wang Wenbin told reporters on Tuesday the entry curbs for Chinese travellers were “discriminatory.”
“We will take reciprocal measures,” Wang said, without elaborating.
The Chinese embassy in South Korea has suspended issuing short-term visas for South Korean visitors, it said on Tuesday, the first retaliatory move against nations imposing COVID-19 curbs on travellers from China.
The embassy will adjust the policy subject to the lifting of South Korea’s “discriminatory entry restrictions” against China, it said on its official WeChat account.
Kyodo news agency, quoting multiple travel industry sources, said China has told travel agencies that it has stopped issuing new visas in Japan. An AFP journalist tweeted that the Chinese embassy in Japan released a statement confirming the curbs on Tuesday but removed it from its website within minutes.
With the virus let loose, China has stopped publishing daily infection tallies. It has been reporting five or fewer deaths a day since the policy U-turn, figures that have been disputed by the World Health Organization and are inconsistent with funeral reporting surging demand.
Some governments have raised concerns about Beijing’s data transparency as international experts predict at least 1 million deaths in China this year. Washington has also raised concerns about future potential mutations of the virus.
China dismisses criticism over its data as politically-motivated attempts to smear its “success” in handling the pandemic and said any future mutations are likely to be more infectious but less harmful.
“Since the outbreak, China has had an open and transparent attitude,” the foreign ministry’s Wang said.
PAST THE PEAK
State media downplayed the severity of the outbreak.
An article in Health Times, a publication managed by People’s Daily, the ruling Communist Party’s official newspaper, quoted several officials as saying infections have been declining in the capital Beijing and several Chinese provinces.
Kan Quan, director of the Office of the Henan Provincial Epidemic Prevention and Control, said nearly 90% of people in the central province of 100 million people had been infected as of Jan. 6.
Beijing acting mayor Yin Yong said the capital was also past its peak. Li Pan, from the Municipal Health Commission in the city of Chongqing, said the peak there was reached on Dec. 20.
In the eastern province of Jiangsu, the peak was reached on Dec. 22, while in neighbouring Zheijiang province “the first wave of infections has passed smoothly,” officials said.
Financial markets looked through the latest border curbs as mere inconvenience, with the yuan hitting a nearly five-month high.
Although daily flights in and out of China are still at a tenth of pre-COVID levels, businesses across Asia, from South Korean and Japanese shop owners to Thai tour bus operators and K-pop groups celebrated the prospect of more Chinese tourists.
Chinese shoppers spent $250 billion a year overseas before COVID.
PFIZER CRITICISM
The border rules were not the only COVID conflict brewing in China.
State media lashed out at Pfizer Inc (PFE.N) over the price for its COVID treatment Paxlovid.
“It is not a secret that U.S. capital forces have already accumulated quite a fortune from the world via selling vaccines and drugs, and the U.S. government has been coordinating all along,” nationalist tabloid Global Times said in an editorial.
Pfizer’s Chief Executive Albert Bourla said on Monday the company was in discussions with Chinese authorities about a price for Paxlovid, but not over licensing a generic version in China.
China’s abrupt change of course in COVID policies has caught many hospitals ill-equipped, while smaller cities were left scrambling to secure basic anti-fever drugs.
Yu Weishi, chairman of Youcare Pharmaceutical Group, told Reuters his firm boosted output of its anti-fever drugs five-fold to one million boxes a day in the past month.
Wang Lili, general manager at another pharmaceutical firm, CR Double Crane (600062.SS), told Reuters that intravenous drips were their most in-demand product.
“We are running 24/7,” Wang said.
Reporting by Beijing and Shanghai bureaus; Writing by Marius Zaharia; Editing by Raju Gopalakrishnan
Our Standards: The Thomson Reuters Trust Principles.
China to Open Borders as Covid-19 Cases Rise
BEIJING—Chinese health authorities plan to lift Covid-19 quarantine requirements on international arrivals early next month, taking one of the country’s biggest steps to ease restrictions since the pandemic began even as case numbers remain high.
China has maintained among the world’s most restrictive coronavirus lockdown measures, slowing its economy significantly and sparking anger. Following waves of protests this fall, authorities abruptly abandoned the country’s stringent zero-Covid-19 strategy early this month.
From Jan. 8, China will scrap all quarantine measures for Covid-19, including requirements for inbound visitors, both foreigners and Chinese nationals, according to the National Health Commission.
The commission late Monday issued a plan to stop treating Covid-19 as a “Class A” infectious disease, which calls for stringent control measures, and downgrade the management of the virus to “Class B,” which requires more basic treatment and prevention. The Wall Street Journal reported last month that China was weighing such a move, which would give it room to further loosen public-health measures.
The change means people traveling to China from abroad will need to have only a negative Covid-19 test within 48 hours to be allowed into the country, the NHC said. International arrivals will no longer be required to be tested on arrival or undergo quarantine—a major step toward opening up for a country that has been largely closed off to the outside world for three years.
The commission in its statement pledged to facilitate foreigners’ visits to China, including those for business, studying and family reunions, and to provide visa assistance.
The shift came as fever clinics and hospital emergency rooms in Beijing continued to overflow with patients on Monday and Chinese leader
Xi Jinping
called on local officials to take pains to save lives.
Before Monday’s loosening of Covid restrictions, Mr. Xi addressed his country’s new pandemic reality for the first time in comments marking the 70th anniversary of the Patriotic Health Movement, a campaign to wipe out flies and mosquitoes launched by
Mao Zedong
during the Korean War to fortify China against the possibility of American germ warfare.
“At present, our country’s Covid prevention and control efforts are facing new circumstances and a new mission,” Mr. Xi said. China should launch “a more targeted Patriotic Health Movement” to “effectively guarantee the lives and health of the people.”
Visits to three major hospitals in Beijing by the Journal on Monday showed the capital’s healthcare system still swamped with an influx of patients following the government’s about-face on Covid-19 controls, which has left many citizens, especially the elderly, scrambling to find treatment.
In the emergency room of eastern Beijing’s Chaoyang Hospital, known for treating respiratory diseases, hallways at the intensive-care unit were packed with dozens of elderly patients lying on portable beds. One nurse said all the ICU beds were full and only patients with the most life-threatening symptoms were being admitted. “Those patients with less severe symptoms can only get a temporary bed and stay in the hallway,” she said.
To cope with the surge in patients, Beijing’s Chaoyang Hospital opened a second fever clinic in a nearby sports stadium for some Covid-19 patients.
Photo:
Chen Zhonghao/Zuma Press
On Monday, the Chinese Center for Disease Control and Prevention issued a report showing fewer than 2,700 new infections and no new deaths on Christmas Day. Over the weekend, local officials presented a much grimmer picture.
A senior health official in the coastal province of Zhejiang, home to e-commerce giant
Alibaba Group Holding Ltd.
, said on Sunday that new daily infections had topped one million, with the wave expected to peak at around two million cases around New Year’s Day.
Roughly half a million people were being infected every day in the northeastern city of Qingdao, a local health official said in a since-removed interview with a state-owned broadcaster.
To minimize the impact of the infection surge on China’s already battered economy, some cities said people could return to work even if they had mild symptoms. Authorities in Shanghai said Saturday that the city’s 25 million residents wouldn’t need to be isolated at home for more than seven days, even if they are still testing positive.
Rapid transmission of Covid-19 in China raises the likelihood for fresh outbreaks beyond its borders and the emergence of risky virus variants, said
Michael Osterholm,
director of the Center for Infectious Disease Research and Policy at the University of Minnesota.
“New variants are a huge possibility, and they could have a tremendous impact on the rest of the world,” Dr. Osterholm said.
In his own comments marking the anniversary of the Patriotic Health Campaign, which evolved over the years to target infectious diseases such as malaria, China’s Premier
Li Keqiang
said adjustments to the country’s Covid-19 policies were being implemented in an orderly manner, but urged officials at every level of government to address public demands for medical care and supplies.
China’s health system, thinly resourced even before the pandemic, has struggled to contend with the fast-spreading Omicron variant. The growth in infections has sent people scrambling to buy up home test kits along with ibuprofen and other medications.
At Chaoyang Hospital’s emergency room on Monday, digital screens showed a long wait list for people seeking treatment at the internal-medicine department. In an interview last week with China’s state broadcaster, Mei Xue, deputy director of the hospital’s emergency department, said around 400 patients were coming seeking internal medicine treatment every day—roughly four times the normal number.
“These patients are all elderly people with underlying diseases. After the combination of fever and respiratory infection, they are all very seriously ill,” he said.
A staffer with Beijing’s emergency medical center, which coordinates requests for urgent medical care in the city, said he and his colleagues had been working nonstop to transfer patients to Chaoyang Hospital in recent weeks and he expected the current situation to last for a few more weeks.
To cope with the surge in patients, the hospital has opened a second fever clinic in a nearby sports stadium for Covid-19 patients with mild symptoms.
Peking Union Medical College Hospital and Peking University First Hospital, both located in the center of Beijing, were similarly overwhelmed.
A sign outside the Peking Union emergency room warned patients it could take more than four hours to see a doctor. A nurse at Peking Union’s fever clinic said that for weeks patients had been forced to wait in the hallways for beds to open up. One elderly patient, unable to secure a bed, was lying on a metal bench just inside the entrance of the fever clinic.
A nurse at Peking University First Hospital’s emergency room said beds there were all full and the wait time at the internal medicine department was roughly six hours. The hospital public address system announced that nearly 50 patients were waiting to be seen.
In recent weeks, doctors and nurses from around China have been dispatched to Beijing to support the capital. Shandong province sent a team of medical staff to Beijing, according to state media reports.
In the U.S., the State Department on Friday updated its travel advisory and is asking that people reconsider travel to China due to the surge in Covid-19 cases, arbitrary enforcement of local laws and Covid-19-related restrictions.
—Xiao Xiao and Dominique Mosbergen contributed to this article.
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Mystery of Smell Loss After Covid-19 Might Be Solved
The nose knows why some people still can’t smell long after recovering from Covid-19.
A haywire immune response in the olfactory system was found to explain why some people still can’t smell long after symptoms of the disease have abated, according to a small, peer-reviewed study published Wednesday in the journal Science Translational Medicine. In some cases, the immune or inflammatory response was detected in patients with smell loss up to 16 months after recovery from Covid-19.
Compared with people who can smell normally, patients with long-term smell loss had fewer olfactory sensory neurons, cells in the nose responsible for detecting smells and sending that information to the brain. Patients with lingering loss of smell had an average of 75% fewer of the neurons compared with healthy people, said
Brad Goldstein,
a study co-author and sinus surgeon at Duke University.
“We think the reduction of sensory neurons is almost definitely related to the inflammation,” Dr. Goldstein said.
Loss of smell is a common Covid-19 symptom, though its prevalence varies widely depending on factors including which variant caused the infection, head and neck specialists said.
Most Covid-19 patients who experience smell loss regain the sense within weeks of infection. But the symptom can stick around for a year or longer for up to 7% of patients, a February analysis said.
Dr. Goldstein said he and his colleagues sought to identify what was damaged or altered in people with long-term smell loss. “If we don’t know what’s broken, it’s hard to tell how to fix it,” he said.
SHARE YOUR THOUGHTS
Did you lose your sense of smell from Covid? How long did it last? Join the conversation below.
They took samples from the nose tissue of nine patients who couldn’t smell long after Covid-19 infections and compared them with cells from healthy people. Patients with persistent smell loss had more T-cells, a type of white blood cell that plays a critical part in immune response, in their noses, the study said. The T-cells were making interferon-gamma, a substance linked to inflammation, Dr. Goldstein said, and support cells appeared to be reacting to it.
The support cells protect and nourish olfactory sensory neurons. Without them, the olfactory sensory neurons can’t survive. Research has shown that the virus that causes Covid-19 doesn’t infect olfactory sensory neurons directly, but that it can attack such support cells.
Patients with smell loss also had fewer of a certain type of anti-inflammatory cell and more of a particular inflammatory cell than healthy people, said the study of 24 patients. The healthy group included two people who had recovered from Covid-19 but didn’t have long-term smell loss.
Covid-19 researchers said the study bolstered evidence that inflammation could be a culprit in long-Covid symptoms. An April study in the journal JAMA Neurology found inflammation among deceased Covid-19 patients in the olfactory bulb, the part of the brain responsible for receiving and processing information from olfactory sensory neurons in the nose.
Neuroinflammation could be a contributor to loss of smell and other neurological symptoms related to long-Covid such as brain fog, said
Cheng-Ying Ho,
a co-author of the April study and an associate professor of pathology at Johns Hopkins University School of Medicine.
Dr. Ho, who wasn’t involved in the new study, said inflammation that starts in the nasal cavity could extend to the brain. She said that the new study was compelling but that its small sample size necessitated further work in more patients. Because the vaccination status of participants wasn’t collected, she said it wasn’t clear whether getting the shots played a role in the olfactory system’s inflammatory response.
In a survey published last year of more than 400 patients with smell loss, more than 40% reported depressive symptoms and almost 90% reported enjoying food less.
“People might think smell loss is not really an important Covid symptom compared with severe symptoms such as pneumonia, but it can really bother some patients,” Dr. Ho said.
Researchers said regions of the brain linked to the sense of smell are closely associated with brain regions that control memory and emotion.
Sandeep Robert Datta,
a co-author of the new study and a professor of neurobiology at Harvard Medical School, said he and others are conducting more research into the reasons for smell loss following Covid-19 infection smell loss. The research could lead to potential targets for treatment. There are no effective treatments for long-term smell loss, Dr. Datta said.
“Smell gives you a sense of place. It can be very disorienting without it,” Dr. Datta said.
Write to Dominique Mosbergen at dominique.mosbergen@wsj.com
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Surge in Overlapping Viral Outbreaks Threatens ‘Tripledemic’ Crisis
COVID cases are on the rise again in many countries. And this time, the SARS-CoV-2 virus has company. In the United States, Europe and Asia, the flu virus and a third dangerous pathogen—the respiratory syncytial virus—are surging at the same time as the novel-coronavirus.
It’s a “tripledemic,” to use an admittedly non-scientific term. And it’s a harbinger of our pathogenic future. As we chop down more forests, releasing more and more animal viruses into the human population—and as disinformation floods social media, driving vaccine-skepticism to startling highs—overlapping viral outbreaks could become the norm.
Add another monkeypox or bird flu outbreak, and we might even experience a “quadrupledemic.” Besides potentially overwhelming health systems, the simultaneous outbreaks come with another troubling risk. Research indicates they might actually make each other worse.
Epidemiologists expect viral infections to spike in the winter months. People are traveling for various holidays, dragging their viruses along with them and exposing everyone else along the way. Cold weather drives people indoors, where they share air, spittle and any pathogens riding on the air and spittle.
Hence the seasonal flu outbreaks we usually see in the winter. COVID has also developed a seasonal pattern for the same reasons. So it came as no surprise that COVID cases began ticking upward in the U.S., Europe and Japan in recent weeks. There’s an alarming surge in novel-coronavirus infections in China, too—but there are unique reasons for that.
COVID and flu were about to begin their usual winter rampage when the respiratory syncytial virus showed up in a big way, too. At the peak of the RSV outbreak in the U.S. in mid-November, the Centers for Disease Control and Prevention logged a case-rate five times as high as last year.
The European division of the World Health Organization summed up the crisis in a Dec. 1 statement. “The region is currently experiencing increasing circulation of influenza and RSV. Together with COVID-19, these viruses are expected to have a high impact on our health services and populations this winter.”
RSV usually causes mild, cold-like symptoms—and most people recover quickly. In infants and seniors, however, RSV can be deadly. It’s the leading cause of pneumonia in newborns. Besides the cumulative strain that RSV and other viruses can place on hospitals when they surge simultaneously, there are signs that the flu and COVID are making RSV more dangerous—and vice versa.
James Lawler, an infectious disease expert at the University of Nebraska Medical Center, pieced together the clues. “We had relatively normal levels of flu and RSV activity last year, but with relatively normal … hospitalization [or] death consequences,” he told The Daily Beast. “This year, we have somewhat higher than normal flu and RSV activity—at least earlier for flu—and much higher rates of hospitalization in young people.”
Last year’s winter surge in COVID, driven by the Omicron variant, may have weakened millions of people who wouldn’t normally be at high risk for flu and RSV. “COVID results in long-lasting disruption in immune function and health effects in people well after acute infection,” Lawler explained.
It’s okay to be skeptical of possible interplay between the three viruses. “It’s difficult to say we have hard evidence,” Lawler stressed. But he noted a compelling bit of circumstantial evidence. “Countries that have done better controlling COVID—South Korea, Japan, Taiwan—are not experiencing increased levels of hospitalization from flu or RSV this year.” Sure, the rate of flu and RSV is high in Japan, but the severity is normal—and most people are recovering at home.
Research could eventually prove, or disprove, that the immune effects of one viral infection make a separate and different infection more likely or worse. While we wait for the science to catch up, we’re walking on epidemiological thin ice. Humanity seems determined to expose itself to more and more viruses. At same time, it’s equally determined not to protect itself from the effects of these pathogens.
Many of the worst human viruses didn’t start in humans. They’re animal viruses that made the leap to homo sapiens after prolonged exposure. Monkeypox was endemic in monkey and rodent populations in West and Central Africa and only became a human problem with the accelerating destruction of the African rainforest in the 1970s. COVID appears to have jumped from pangolins (a kind of scaly anteater) or bats to people, possibly at a wildlife market in Wuhan, China. Bird flu, which occasionally rages through human populations, is—as its name implies—a bird virus.
The more forests we chop down, the more wild animals we trade as pets or for food and the more chickens we cram into industrial farms, the more viruses we come into contact with—and the greater the risk of animal-to-people transmission. A process scientists call “zoonosis.”
Barring a profound shift in the way people build and eat, zoonosis is only going to get worse. “Larger human population overall—increases the number of human-animal contact events,” Tony Moody, a professor of immunology at the Duke Human Vaccine Institute, told The Daily Beast. There’s also a “need for increased food production because of the increased population, so increasing domestic animal contacts.”
We could protect ourselves from the worst outcomes with vaccines. But the trends on that front are equally discouraging. As trust in science wanes and more people get their “news” from conspiracy theorists on social media, vaccine uptake is beginning to suffer.
A quarter of Americans still refuse to get any COVID vaccines. Uptake of the latest booster is catastrophically low in the U.S. More people didn’t bother getting their flu jabs this year, as well. Vulnerable communities eagerly embraced the monkeypox vaccine, thank goodness, but rejection of the tried-and-true polio vaccine in a handful of New York counties led to a rare—and frankly terrifying—surge in polio cases this summer. Polio, once widespread, can cause paralysis in a small number of cases.
Zoonosis and vaccine-hesitancy are the twin forces of the overlapping viral outbreaks that could define our epidemiological future as a species. It’s hard to imagine any point in the foreseeable future when humanity won’t be grappling with at least one major viral outbreak, because it’s hard to imagine humanity swiftly ending deforestation and quickly reversing the flow of disinformation on the internet.
Preventable outbreaks are here to stay. From probably more than one major virus at a time.
China’s Covid Protests Began With an Apartment Fire in a Remote Region
As smoke crept through the 21-story apartment building in far western China, panicked messages filled the residents’ chat group. “On the 16th floor, we don’t have enough oxygen,” a woman gasped in an audio message. “Soon our children won’t be OK.”
Another person added a plea about the people in apartment 1901: “They wouldn’t be able to open the door. Can you break into it and take a look? There are many children inside.”
Many who heard the reports were shocked, not by a tragedy in the remote city of Urumqi, but because it had taken firefighters three hours to control the fire. People across the country believed the delays happened in part because of the pandemic restrictions that have been a running source of discontent throughout the country. The impact has reached into the heart of Chinese politics.
Excerpts of residents’ panicked conversation began to circulate on social media, along with videos of the emergency response. They showed fire crews struggling to get around barriers to approach the building. Videos showed fire crews’ water streams falling short of the fire as its flames slithered toward the top of the apartment tower.
Pandemic controls imposed by Chinese authorities around, and possibly inside, the apartment building had delayed the fire response, neighbors and family members of those killed have said. That would mean that the death toll, which many believed was much higher than the official tally of 10, was ultimately in part a product of China’s strict, already widely detested zero-tolerance Covid policy. The government denies all that.
Outrage spilled onto the streets of Urumqi, the capital of the heavily Muslim Chinese region of Xinjiang, where residents had been locked down for more than 100 days. Footage of the fire and the protest in Urumqi spread on Chinese social media and on the popular do-everything app
WeChat.
Firefighters sprayed water on a residential-building fire in the city of Urumqi that killed 10 and triggered protests against Covid-19 lockdowns.
Photo:
Associated Press
To large numbers of Chinese people who have had the experience of being locked inside their own apartments because of Covid controls, the words and images flowing out of Xinjiang conjured a scenario that seemed terrifyingly plausible.
“The 100-plus day lockdown is real. The many deaths from Covid controls are real. Discontent has accumulated and is destined to erupt,” said a user on the Twitter-like
platform in one widely endorsed comment about the fire.
Within days, the protest would spread throughout China, growing into the largest show of public defiance the Communist Party has faced since the 1989 pro-democracy protests at Tiananmen Square. The demonstrations have posed a rare challenge to the recently extended rule of Chinese leader
Xi Jinping,
compounding the government’s challenges over how to ease its Covid restrictions.
China has experienced public outrage over its strict Covid-19 restrictions before, most of which the authorities had managed to contain online. Going back nearly three years, the death from the coronavirus of Li Wenliang, a doctor who was punished for warning others about the initial outbreak in Wuhan, unleashed a flood of grief and anger.
This September, a bus crash in Guizhou province that killed 27 people who were being sent to quarantine in the middle of the night raised an outcry about steps taken to control the coronavirus.
Mourners in Hong Kong paid their respects in February 2020 to Chinese physician Li Wenliang. Dr. Li raised early alarms about the coronavirus outbreak in Wuhan but was silenced by police, only to die of the disease himself.
Photo:
jerome favre/EPA/Shutterstock
More recently, after an announcement that Covid restrictions would be eased led to little actual change, public frustration spilled out onto the streets. Workers at
Foxconn Technology Group’s
main plant in the city of Zhengzhou, the world’s largest iPhone factory, clashed with police while protesting a contract dispute with roots in pandemic lockdowns. In some Beijing neighborhoods, people argued with officials over the legality of controls.
In maintaining the lockdowns in Xinjiang, local authorities have been able to rely on the country’s most advanced and suffocating security apparatus, originally built to carry out a campaign of ethnic re-engineering against the region’s 14 million Uyghurs and other Turkic Muslims.
Most if not all of the fire’s victims belonged to these groups, according to relatives and overseas Uyghur activists. Discrimination by China’s Han majority against Turkic minorities has long fueled ethnic tensions in the region, which exploded into deadly race riots in Urumqi in 2009.
Yet in the past week, the sides found common cause, at least temporarily, in anger over the fire.
According to an official account published in the state-run Xinjiang Daily newspaper, the blaze began on the 15th floor, in the apartment of a Uyghur woman who was having a bath in a home spa when a circuit breaker flipped. She flipped it back, then was alerted by her daughter to the smell of smoke. When she re-emerged from the bathroom, flames had risen to the wooden ceiling from the bed.
A community worker arrived just as they were fleeing the flames, according to Xinjiang Daily. He called the fire service at 7:49 p.m. last Thursday, then helped rush the pair and their neighbors downstairs.
A still taken from a social media video shows a fire truck shooting water at the burning residential building in Urumqi. The fire and delays in fighting it proved a catalyst for nationwide protests against Covid-19 lockdowns.
Photo:
REUTERS
At the ground level, burning debris had begun falling over the doorway. Those who couldn’t leave through the front gate in time had to climb out of a window from an apartment, the newspaper reported.
Firefighters didn’t reach some of the apartments until around 90 minutes after they were called, according to posts on the chat group.
Video footage showed that traffic-control structures had to be removed as a line of fire trucks waited, causing delays. The government denied the structures had been installed for pandemic-control reasons.
At a press briefing convened late Friday night as protests unfolded, officials said that three fire trucks from a nearby station arrived at the scene five minutes after the fire was reported, but they were blocked by cars that had to be moved.
On social media, residents said those cars had been parked there for months during the fall Covid lockdown, and the engines couldn’t start.
Li Wensheng, Urumqi’s fire chief, said at the press briefing that some residents’ “self-rescue abilities were weak,” a comment that added to the simmering anger.
The Xinjiang and Urumqi governments didn’t respond to requests for comment.
Han residents of Urumqi led the protests that unfolded in the freezing night air the day following the fire. Uyghur residents have faced the strictest lockdowns and largely stayed home out of fear they would bear the brunt of any reprisals, overseas activists said.
Demonstrations were fueled by the group chat conversations and footage of obstructed fire trucks, as well as by videos circulating online that appeared to capture the screams of people from the smoldering building. “Open the gate!” one woman could be heard shouting in horror in one video.
On Saturday night, several female students stood for hours on the campus of Communication University of China in Nanjing, holding blank sheets of paper in silence, widely taken to be a reference to Chinese censorship. A male student from Xinjiang offered a tribute to the victims in Urumqi and to “all other victims nationwide,” saying he had been a coward for too long.
A man was arrested on a Shanghai street when protests erupted following a deadly apartment-building fire in China’s Xinjiang region.
Photo:
hector retamal/AFP/Getty Images
That same night, dozens of people in Shanghai gathered for a vigil with flowers and candles near a street named after Urumqi. Passersby joined in, and the crowd grew into the hundreds. Just past midnight, some demonstrators began chanting for Mr. Xi to step down.
Similar protests emerged in half a dozen Chinese cities and more than a dozen university campuses in the following days. In several instances, demonstrators chanted “We are all Xinjiang people.” Others called for democracy and free speech.
Chinese authorities have devoted enormous resources to building domestic security and surveillance systems specifically designed to prevent such wide and unified outbreaks of dissent. While protests aren’t uncommon, scholars who study China say they are almost always local events with little capacity to spread.
The Cyberspace Administration of China issued guidance to companies on Tuesday, including Tencent Holdings Ltd. and ByteDance Ltd., the Chinese owner of short video apps TikTok and Douyin, asking them to add more staff to internet censorship teams, according to people familiar with the matter. The companies were also asked to pay more attention to content related to the protests, particularly any information being shared about demonstrations at Chinese universities and the fire.
In imposing its stringent Covid controls, human-rights activists and other observers say, the Communist Party created an issue that China’s citizens only have to look out their front door to understand. Some Uyghurs affected by the fire said the fear and frustration stemming from pandemic controls crossed deep-seated ethnic divides.
Marhaba Muhammad, now a resident of Turkey, said she read news of the fire with a sense of horror. She recognized the building as the home of her aunt, whom she last visited in 2016, shortly before leaving China. The family lived in apartment 1901, the subject of one of the desperate messages left in the residents’ chat group.
Ms. Muhammad said she and her family abroad learned that the aunt, Qemernisahan Abdurahman, 48, had died in the apartment, along with four children age 5 to 13.
Ms. Abdurahman’s husband wasn’t there. He and an elder son were detained as part of the crackdown in Xinjiang in 2017 and now are imprisoned, said Ms. Muhammad and her brother, Abdulhafiz Maiamaitimin, who lives in Switzerland.
“This news is so painful. No one imagined,” she said.
Qemernisahan Abdurahman, 48, with 3 of her four children who died in the fire in Urumqi.
Photo:
Marhaba Muhammad
In apartment 1801, directly below where Ms. Muhammad’s aunt and children died, a woman also died along with her children, according to Abduweli Ayup, a Uyghur activist in Norway who spoke with relatives and neighbors of the fire victims.
Han Chinese don’t have to fear the level of oppression faced by Uyghurs, Ms. Muhammad said, referring to the Chinese government’s detention of upwards of a million Uyghurs and other Turkic Muslims in internment camps and prisons—a practice the United Nations has said may constitute a crime against humanity.
Yet “after the fire, they realized that Uyghurs today would be the Chinese tomorrow,” she said.
Police have targeted protest participants by using some of the surveillance techniques honed in Xinjiang to target Uyghurs. In chat rooms used to organize demonstrations, protesters have reported police scanning the smartphones of pedestrians for overseas apps such as Twitter and Telegram, a common experience on the streets of Urumqi.
A lawyer representing more than a dozen protesters taken by police said she believes many of her clients were tracked through mobile-phone data, another echo of the Uyghur experience in Xinjiang.
On Tuesday, Chinese-Australian activist and cartoonist Badiucao, who goes by one name, reposted a widely shared video of police on the Shanghai subway checking the phones of passengers on Twitter. He appended a single phrase: “Xinjiang-ization.”
Protesters in Beijing lighted candles during a protest against China’s strict zero-Covid measures.
Photo:
Kevin Frayer/Getty Images
Write to Austin Ramzy at austin.ramzy@wsj.com and to Wenxin Fan at Wenxin.Fan@wsj.com
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Chinese Protests Put Xi Jinping in a Bind
President
Xi Jinping
faces a difficult choice between loosening China’s zero-tolerance Covid-19 policy or doubling down on restrictions that have locked down neighborhoods and stifled the country’s economy over the past three years.
Neither option is a good one for a regime focused on stability. Stock markets around the globe declined Monday as protests in China fueled worries among investors about the outlook for the world’s second-largest economy.
“Xi’s leadership is in a bind,” said
Yuen Yuen Ang,
a political scientist focused on China at the University of Michigan. “If they compromise and relax zero-Covid, they fear it will encourage mass protests. If they repress more, it will create wider and deeper grievances.”
Protesters across China have directly challenged the authority of the Chinese leader and the Communist Party in scenes unthinkable just a month ago, when Mr. Xi secured a third term in power.
In Shanghai over the weekend, protesters used call-and-response chanting to demand political change. In Beijing, crowds shouted “Freedom.” In other large cities, demonstrators marched holding blank sheets of paper—a swipe at government censorship.
China experts say the protests are unlikely to translate into a leadership change, in the near term at least. But Beijing’s dilemma is a tough one. It could lift restrictions and risk a large and potentially deadly wave of Covid infections that could undermine its credibility. Or it could crack down on the demonstrators and stick with a strict pandemic strategy that large parts of the population are clearly fed up with.
All three benchmark U.S. stock indexes closed more than 1% lower on Monday as investors worried that the protests would lead to more market volatility.
Widespread and public outpourings of political grievance have been extremely rare in a country where people have long consented to obey party authorities—as long as they deliver prosperity and allow citizens relative freedom in their personal lives.
People sang slogans and chanted for political change on a street in Shanghai on Sunday.
Photo:
hector retamal/Agence France-Presse/Getty Images
Police cars were parked on a Shanghai street on Monday, a day after rare demonstrations were held.
Photo:
hector retamal/Agence France-Presse/Getty Images
The protests put in stark relief the fraying of that social contract, showing that the climbing economic and social costs of China’s zero-Covid policies—coupled with an increasingly authoritarian regime’s zero-tolerance for dissent—have driven many to a kind of breaking point.
Demonstrations aren’t unusual in China, but they are largely over local grievances such as unpaid wages, land disputes or pollution. Since the Tiananmen Square protests in 1989, the party has made it a priority to prevent nationwide protests of a political nature.
The current wave of unrest started last week in the remote northwestern region of Xinjiang after 10 people died in a fire. Residents contended that Covid restrictions were partly to blame for delaying rescuers and contributing to the death toll. Officials said some barriers had to be moved but attributed the delay to parked cars in the way.
In the days since, the anger has spread across China. On Monday, authorities moved broadly to prevent any new protests, including dozens of uniformed and undercover police swarming the area around a highway bridge in Beijing where a lone protester hung a banner denouncing Mr. Xi in October. On Sunday, protesters had chanted lines from the banners.
The unrest also underlined how anger about the Covid restrictions has united people from a range of social backgrounds—from migrant workers assembling iPhones in central China and residents of the remote region of Xinjiang to college students and middle-class urbanites in the nation’s biggest cities.
“The mass protests represent the biggest political crisis for Xi,” said
Minxin Pei,
editor of quarterly academic journal China Leadership Monitor. “It’s the first time in recent decades that protesters from a broad coalition of social groups have mounted a direct challenge to both the top leader himself and the party.”
Students staged a small protest Sunday at Tsinghua University in Beijing.
Photo:
Associated Press
Sudden reopening could lead to millions of intensive-care admissions in a country with fewer than four ICU beds per 100,000 people, and where many elderly still haven’t been fully vaccinated, according to public-health experts and official data. In addition, such a compromise would send a signal to the general public that mass protests are an effective means to win change, not something the government would want to encourage.
On the other hand, sticking to the zero-Covid policy could stir up even greater public resentment toward the leadership, with hard-to-gauge consequences.
The University of Michigan’s Ms. Ang and others say that the protests are unlikely to lead to any radical policy shift. Rather, one likely outcome is a mixture of selective relaxation of controls and harsh retaliation against select protesters.
Protesters and police stood on a street in Beijing on Monday.
Photo:
Kevin Frayer/Getty Images
“The danger is that if the leadership responds with repression, that could take China down a vicious cycle of control, leading to more grievances, to more control,” Ms. Ang said.
China’s Covid struggle underscores the limits of a political system where a lack of public debate has made it hard to adjust policies as other countries have done.
Many public-health experts say Beijing has missed the window to put in place a gradual exit plan out of zero-Covid. For the past three years, the government has spent significant resources on building ever more quarantine facilities and expanding mass-testing capabilities, while China’s progress on developing more effective vaccines has been slow.
Partly thanks to Beijing’s early successes at stemming infections, the Chinese population has developed little natural immunity. It only has access to homegrown vaccines that are less effective than some of the global alternatives.
A neighborhood in Beijing where access is restricted because of Covid regulations.
Photo:
Ng Han Guan/Associated Press
Notably, negotiations between China and the European Union over mRNA vaccine imports from the bloc fell through nearly two years ago, according to people familiar with the matter, after Beijing insisted that Europe recognize Chinese vaccines.
Beijing has also resisted approving any large-scale adoption of the mRNA vaccine co-developed by
Pfizer Inc.
and
BioNTech SE,
a decision healthcare and foreign-policy experts attribute partly to China’s strained relations with the U.S.
Mr. Xi and the party have faced public anger before, most notably during the early days of the pandemic when emotions swelled with the death from the virus of
Li Wenliang,
a young doctor in the city of Wuhan who was punished for trying to raise an early alarm. Ultimately, much of the nation’s anger then was directed at local authorities.
In the years since, Mr. Xi has identified himself closely with the zero-Covid strategy. That is now turning him into the natural target of protesters’ fury and has also made it nearly impossible to shift course without diminishing his standing. Notably, a People’s Daily article on Sunday continued to stress the importance of unwaveringly sticking to the existing Covid-control policy.
A Covid testing station in Shanghai on Monday. The government has built quarantine facilities and expanded mass-testing capabilities, while its development of more-effective Covid vaccines has been slow.
Photo:
Bloomberg News
As repeated lockdowns kept businesses closed and pushed up unemployment, some hoped there would be a shift away from the zero-Covid strategy once an October party conclave that handed Mr. Xi another five-year term was over.
As long as the top leader felt politically secure enough, those people argued, he would want to adjust the policy to help the economy—which still matters to the leadership despite its increased emphasis on ideology and party control.
Businesses and investors alike cheered when Beijing earlier this month unveiled plans to “optimize and adjust” the Covid policy, including shortened quarantine restrictions. Many market analysts viewed the step as the beginning of a gradual exit from zero-Covid.
However, as Covid cases surged again along with the colder season, local officials across the country reimposed strict restrictions for fear of putting their jobs in jeopardy. Keeping Covid under control has remained the overarching political priority for localities that are also struggling to reboot economic activity.
The contrast of China’s continued Covid lockdowns as the rest of the world has moved on became more obvious over the past week as many Chinese soccer fans have seen TV images of thousands of maskless spectators cheering in stadiums during the World Cup in Qatar.
Then came the deadly fire in Urumqi, the capital of Xinjiang, where residents had struggled with lockdowns of more than 100 days, prompting protesters across the country to defy the risks of expressing dissent to seek change.
People lighted candles on Sunday in Beijing for victims of a deadly fire in the northwestern city of Urumqi, the capital of Xinjiang.
Photo:
Bloomberg News
Write to Lingling Wei at Lingling.Wei@wsj.com
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