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BCMC ResearchThis systems engineering analysis is constantly being updated. This web page is the most current. March 03, 2021 Initial Release. Last Modified: 06/15/2021 The initial research was started in March 2020 and is documented in the following links:
A book was produced that includes the 2020 COVID-19 research published on this website and additional systems engineering content: COVID-19 A Systems Perspective. The original research eventually resulted in system architecture solutions to mitigate and eliminate the virus. It was found that the problem is massive within small enclosed spaces, problematic in large spaces, and extremely rare in outdoor spaces. It was also found that the technology exists, is relatively low cost, and is part of the system solution in elite settings. The problem is a social problem where the technology and system solutions must find their way into all facilities especially schools, airports, airplanes, bars, restaurants, etc. where large numbers of people congregate and where the facilities are not properly maintained and use the available technologies to mitigate and eliminate contagions from the air. Like in the original research, it is unclear where this research may lead. The systems perspective will continue to be the approach used to develop this research. One of the key challenges in systems engineering is to determine the key needs, key analysis, key requirements, and key system architecture approaches that will solve the problem. This is very difficult because there is the important consideration to filter out the irrelevant while not losing what may be the answer. So as this research unfolds topics will surface and they either will be abandoned, delayed, or taken to a logical conclusion. The following is offered as a definition of Systems Engineering from Systems Engineering Design: Discipline that concentrates on the design and application of the whole (system) as distinct from the parts. It involves looking at a problem in its entirety, taking into account all the facets and all the variables and relating the social to the technical aspect. -- Simon Ramo. For the specialists that are working their respective areas, in a systems effort they are represented and sit at the systems engineering table. As they present their analysis findings their work informs other specialists in completely different analysis areas. It is this cross fertilization that allows all specialists to broaden their perspectives and enables them to detect new patterns in their own body of work, especially if they are stuck. Systems engineering is the mechanism that allows specialists to quickly and effectively communicate their analysis to completely different areas and significantly shift the overall results in a positive direction. This systems engineering analysis is offered in that spirit of an effective systems engineering activity. One of the important elements that the systems perspective provides is that it includes the human condition in the system. The system solution must include the reality that people are part of the system and that they do not behave rationally. So the system must account for irrational human behavior otherwise it will fail or have very poor performance characteristics. Without the systems perspective this is always lost. The purpose of all the analysis is to enable the development of potential architecture and design solutions. Eventually the architecture(s) and design(s) must be selected. It is important to review and try to understand the research findings from 2020 as part of reviewing this research in 2021. This is a long hard read. Use the table of contents to navigate. It is constantly being updated and follows the natural flow of all systems engineering efforts; some analysis is a dead end and is abandoned, some analysis converges, some analysis diverges, and some analysis stays at a steady state level until new information surfaces, typically from a specialist on the team. More information on the systems perspective for this problem is available as part of this systems engineering analysis at: Systems Perspective.
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Where Did COVID-19 Come FromThis is a very difficult topic to address because it must consider both the mainstream and non-mainstream findings. This should have been part of the research in 2020 but there was a conscious decision to exclude this analysis because it would distract from the key system driver of understanding how the virus spreads and how it can be mitigated or eliminated. This analysis is important because it may help stimulate the Social Will to accept that all our facilities must be upgraded to mitigate and even eliminate the virus using systems that exist within elite facilities. It does not matter where the COVID-19 virus came from, what matters is how we deal with it now that it is part of our civilization. Regardless these are the possible virus source scenarios:
After Chinese scientists posted a draft genome of the novel coronavirus SARS-CoV-2, a team at Flinders University in Australia began running computer modeling studies of the viral sequence as part of a first step for designing a vaccine. This generated an unsuspected result - the spike proteins studding the SARS-CoV-2 virus bound more tightly to human cell receptors, a protein called ACE2, than target receptors on any other species evaluated. The COVID-19 virus was well adapted to infect only humans. This is unusual for a newly emerging pathogen. "Holy shit, thats really weird," Professor Petrovsky the team lead recalled. [1] As Professor Petrovsky considered whether COVID-19 might have emerged in lab cultures with human cells or cells engineered to express the human ACE2 protein, a letter penned by 27 scientists appeared suddenly on February 19, 2020 in the medical journal, The Lancet. The authors insisted that SARS-CoV-2 had a natural origin, and they condemned any alternate hypotheses as conspiracy theories that create only fear, rumors, and prejudice. Petrovksy says he found the letter infuriating. Conspiracy theorists is the last thing we were, he says, and it looked to be pointing at people like us. [1] This is a topic that requires a systems perspective. All perspectives must be considered and there is no room for stakeholders to game the situation to protect hidden self interests. The difficulty as always is to find a team that is fully driven by the systems perspective and cannot be compromised in any way including protecting careers. [2] [3] As of March 2021 there are two mainstream scenarios for the source of COVID-19: (1) a lab leak or (2) a spill over from nature. There are additional scenarios that need to be considered if the systems perspective is to be applied: (3) genetically engineered as part of a research effort and (4) genetically engineered as part of a bioweapon. The following analysis will address these scenarios and offer some observations. References: [1] Did the coronavirus leak from a lab? These scientists say we shouldnt rule it out. For many scientists, challenging the idea that SARS-CoV-2 has natural origins is seen as career suicide. But a vocal few say it shouldn't be disregarded or lumped in with conspiracy theories. MIT Technology Review, March 18, 2021. webpage https://www.technologyreview.com/2021/03/18/1021030/coronavirus-leak-wuhan-lab-scientists-conspiracy, March 2021. Did the coronavirus leak from a lab? These scientists say we shouldnt rule it out. [2] COVID-19 A Systems Perspective, Walter Sobkiw, 2021, ISBN 9780983253044, hardback. [3] COVID-19 Return To Life, webpage http://www.cassbeth.com/covid-19/return-to-life/index.html, March 2021. COVID-19 Return To Life. |
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The attempt to find the source of the virus was politicized and all allegations are irrelevant. What matters is how to mitigate and eliminate the virus since it was not contained. We have a vaccine but we know it will take years to vaccinate the world and relying on just the vaccine will take decades to eradicate COVID-19. We have technologies that are almost 100 years old that can be applied to significantly reduce long term illness and death from COVID-19 but just like with the vaccine there is no Social Will to ensure that these technologies are applied everywhere and not just limited to elite facilities and populations. [1] [2]
In the last 20 years there have been multiple pandemic and epidemic outbreaks, including SARS, chikungunya, H1N1, Middle East Respiratory Syndrome, several Ebola outbreaks, three outbreaks of norovirus, Zika, and now SARS-CoV-2. Lab release dangers are growing because of the benefits possible from genetic research and development. The risk increases with the number of labs handling bioweapons and potential pandemic pathogens. As of 2010 there were more than 1,500 labs on the planet. Many like the Wuhan lab are located in urban areas close to international airports. The largest expansion has been in China during the last four years. This is similar to an arms-race-style reaction for biodefense expansion and includes the US, Europe, and Japan. China has two new BSL-4 facilities, in Wuhan and in Harbin, and has announced plans to establish a network of hundreds of new BSL-3 and BSL-4 labs. [3]
When the atom was split in the middle of the last century many things happened including making sure the technology was not out of control. This was done by a people and a culture deeply entrenched in the systems perspective and higher ideals after dealing with the ravages of multiple World Wars and systemic economic collapse that was the Depression. This is not happening today with the new technologies in the 21st century as self interest is viewed as the best approach for all settings.
Some think that gene manipulation technology is more dangerous than the nuclear technologies in terms of potential massive irrecoverable damage. Nuclear technology is very capital intensive. All anyone can do is just steal its byproducts. So security became part of the early nuclear systems solutions. Genetic engineering technology is not capital intensive. Anyone can do it. Right now China is trying to get the genetic sequences for everyone everywhere so that they can lead the world in offering genetically engineered designer drugs tuned to each person [4]. They have formally announced plans to open hundreds of labs like in Wuhan to support the design and manufacturing of these types of drugs. It is a new industry in the 21st century.
This is happening everywhere in the world but China has set this as the number one priority for the foreseeable future. This is related to the potential source of the COVID-19. Is it natural or is it the result of a bio accident from one of these labs from someplace in the world? This excludes the possibility that it was deliberately released by some fanatics.
We may never know where COVID-19 came from but it should be sounding alarm bells everywhere about this new technology. If it is natural, we will be getting more COVID-19 like events in the future because it is in the biosphere. If it is the result of human action, that is probably a better scenario because we might be able to put it under some type of control to prevent accidents. If it the result of fanatics, it is a serious problem.
References
[1] COVID-19 A Systems Perspective, Walter Sobkiw, 2021, ISBN 9780983253044, hardback.
[2] COVID-19 Return To Life, webpage http://www.cassbeth.com/covid-19/return-to-life/index.html, March 2021. COVID-19 Return To Life
[3] Did the coronavirus leak from a lab? These scientists say we shouldnt rule it out. For many scientists, challenging the idea that SARS-CoV-2 has natural origins is seen as career suicide. But a vocal few say it shouldn't be disregarded or lumped in with conspiracy theories. MIT Technology Review, March 18, 2021. webpage https://www.technologyreview.com/2021/03/18/1021030/coronavirus-leak-wuhan-lab-scientists-conspiracy, March 2021. Did the coronavirus leak from a lab? These scientists say we shouldnt rule it out.
[4] China's push to control Americans' health care future, CBS News 60 Minutes, January 31, 2021. webpage https://www.cbsnews.com/news/biodata-dna-china-collection-60-minutes-2021-01-31, March 2021. China's push to control Americans' health care future.
We know that the virus was first identified in China and it quickly found its way into Italy. On January 31, 2020 after the detection in Rome of two COVID-19 positive Chinese tourists travelling from Wuhan, the Italian Cabinet declared a 6-month national emergency. On January 13, 2020 the first recorded case of COVID-19 outside of China was confirmed in Thailand. Travelers from China would tend to fly to the West Coast of the USA and most likely arrive in San Francisco or Los Angeles. Why Italy is a key question. That is where the outbreaks should have occurred before Italy. We know that the R0 associated with air travel is very high, up to 22, and that one passenger will infect large numbers of other passengers [1] [2].
In September 2020 the following was offered about 1918 pandemic virus and COVID-19 [3]. These are key extracts from this content:
In 1918, a novel strand of influenza killed more people than the 14th centurys Black Plague. But the strand of the flu didnt just disappear. The influenza virus continuously mutated, passing through humans, pigs and other mammals. The pandemic-level virus morphed into just another seasonal flu. Descendants of the 1918 H1N1 virus make up the influenza viruses were fighting today.The 1918 flu is still with us, in that sense, said Ann Reid, the executive director of the National Center for Science Education who successfully sequenced the genetic makeup of the 1918 influenza virus in the 1990s. It never went away.
By 1920, the influenza virus was still a threat, but fewer people were dying from the disease. Some scientists at the time started to move on to other research. Barry wrote that William Henry Welch, a famous pathologist from Johns Hopkins who was studying the virus, found it humiliating that the outbreak was passing away without experts truly understanding the underlying cause of the disease.
What Welch didnt predict was that the virus never truly went away. In 2009, David Morens and Jeffery Taubenberger --- two influenza experts at the National Institutes of Health --- co-authored an article with Anthony S. Fauci explaining how the descendants of the 1918 influenza virus have contributed to a pandemic era that has lasted the past hundred years. At the time the article was published, the H1N1 influenza virus in public circulation was a fourth-generation descendant of the novel virus from 1918.
All those pandemics that have happened since --- 1957, 1968, 2009 --- all those pandemics are derivatives of the 1918 flu, Taubenberger told The Post. The flu viruses that people get this year, or last year, are all still directly related to the 1918 ancestor.
Because of this, the 1918 influenza outbreak doesnt come with a neat bookend. Society moved on, but the virus continued in some form or fashion.
We are living in a pandemic era that began around 1918, Taubenberger wrote with Fauci and Morens back in 2009 for the New England Journal of Medicine. Ever since 1918, this tenacious virus has drawn on a bag of evolutionary tricks to survive.
We continue to turn back to the 1918 outbreak as a point of comparison, said Jeremy Greene, a historian of medicine at Johns Hopkins. Some of the public health measures a hundred years ago are still put in place today. To flatten the curve, cities and towns have more or less shut down. That said, Greene cautions against drawing the parallels too closely.
There are similarities to draw between todays pandemic and the influenza outbreak a hundred years ago. Both come from winged animals --- one from birds and the other from bats. Both are respiratory viruses. Both led people to wear masks in public. Both forced cities and schools to shut down for periods of time. And, finally, in both cases, the countrys leaders exacerbated problems by ignoring the early warning signs.
Despite all that, influenza viruses and coronaviruses are not the same. Theres very little someone can draw from influenza to then provide treatment for the infectious disease named COVID-19, said Paul Offit, the director of the Vaccine Education Center at Childrens Hospital of Philadelphia.
Theyre really different viruses, Offit added.
Influenza is consistent and relatively quick when compared with the novel coronavirus. If you get exposed to the flu, youll start showing symptoms in one to four days after the infection. According to the Centers for Disease Control and Prevention, it tends to take five days for those infected with SARS-CoV-2 to start showing symptoms of covid-19, but the timing can fluctuate from two days to two weeks.
The novel coronavirus is not moving on the same time frame as the 1918 influenza, Greene told The Post. Everything is longer with the novel coronavirus --- the symptoms, the sickness and even the long-term complications. Doctors are concerned covid-19 can lead to lasting cardiovascular complications.
Then there are asymptomatic carriers of the disease. That one detail makes it harder to mitigate the spread of the virus by simply taking temperatures. Symptoms are not a be-all-end-all solution to tracking the disease. With that in mind, the novel coronavirus is acting more like polio, where those with mild cases dont know theyre sick, Greene said.
It immediately raises a different set of problems for managing a disease, Greene said. One needs to relearn the way to think about who is dangerous, and that becomes, basically, everybody.
Recognizing both the similarities and differences to past pandemics can provide a meaningful mirror for the present, Greene added. The million-dollar question is: What can the 1918 influenza outbreak tell us about how our current pandemic may end?
The sad answer is not very much, Markel said. The operative word in this particular pandemic is novel coronavirus. Were learning as we go along, but we dont really know that much.
The case for a Natural Source of the virus is as follows:
To accept the natural source scenario requires a confirmed contact between a naturally infected host species, such as bats that are known to be carriers of coronaviruses, and a human or humans. The details would require a confirmed time and place of the infection encounter, ahead of any other known human cases, and then show how the infection passed to other humans. Basically perfect contact tracing that would lead to patient zero.
References
[1] COVID-19 A Systems Perspective, Walter Sobkiw, 2021, ISBN 9780983253044, hardback.
[2] COVID-19 Return To Life, webpage http://www.cassbeth.com/covid-19/return-to-life/index.html, March 2021. COVID-19 Return To Life.
[3] The 1918 flu is still with us: The deadliest pandemic ever is still causing problems today, The Washington Post, September 3, 2020. webpage https://www.washingtonpost.com/history/2020/09/01/1918-flu-pandemic-end, October 2020. The 1918 flu is still with us: The deadliest pandemic ever is still causing problems today.
[4] Did the coronavirus leak from a lab? These scientists say we shouldnt rule it out. For many scientists, challenging the idea that SARS-CoV-2 has natural origins is seen as career suicide. But a vocal few say it shouldn't be disregarded or lumped in with conspiracy theories. MIT Technology Review, March 18, 2021. webpage https://www.technologyreview.com/2021/03/18/1021030/coronavirus-leak-wuhan-lab-scientists-conspiracy, March 2021. Did the coronavirus leak from a lab? These scientists say we shouldnt rule it out.
The decision to reconstruct the deadliest pandemic flu virus of the 20th century was made in 2005. Senior US government officials decided the reconstruction location would be at the CDC headquarters in Atlanta. Work to reconstruct the complete 1918 virus began in the summer of 2005. Using reverse genetics, plasmids for eight gene segments of the 1918 virus were inserted into human kidney cells. The plasmids then instructed the cells to reconstruct the RNA of the complete 1918 virus. For multiple weeks in July 2005 cell cultures were checked to determine if the virus appeared. By July 2005 the 1918 virus was available and laboratory studies on the reconstructed 1918 virus began in August 2005 [1].
The findings from this analysis are provided below. Placing it at the end of the this analysis may cause some readers to miss these findings.
Key Findings From This Systems Analysis
The work performed at the CDC falls into the category of big complex systems, science, and engineering. The stakes are huge and the goal of minimizing unintended consequences is paramount. Understanding the nature of the 1918 virus is critical if it is something that exists in nature because, it is not a matter of - if - but - when -, the next variant might surface. The intent is not to justify the actions taken by the USA CDC. Rather it is to suggest that if the means and methods are available to understand an aspect of nature, especially if the the nature is extremely dangerous, then should we not use all the tools available in the civilization to find that understanding. These are big issues not for the faint of heart. It is unclear if the work done by the CDC let the genie out of the bottle and provided the unofficial go ahead for humanity to venture down this path.
Key Events | Date | Comment |
1918 Pandemic | 1918 February | Pandemic not contained |
1918 Pandemic Virus victim excavated | 1997 | Gene studies started |
1918 Pandemic Virus is reconstructed | 2005 August | Gene studies completed |
SARS-CoV-1 | 2002 November | Epidemic contained |
MERS-CoV | 2012 November | Epidemic contained |
SARS-CoV-2 or COVID-19 | 2019 December | Pandemic not contained |
On December 17, 2019 the CDC published on their website an article associated with finding and recreating the 1918 pandemic virus. This is such a monumental moment in genetic engineering that the document on the CDC website reflecting this work is provided here in full text but without the associated pictures. This part of the systems analysis on finding the virus source is based on the CDC quest to reconstruct the 1918 Pandemic virus described below.
The Deadliest Flu: The Complete Story of the Discovery and Reconstruction of the 1918 Pandemic Virus [1]
December 17, 2019Background
The 100-year anniversary of the 1918 pandemic and the 10-year anniversary of the 2009 H1N1 pandemic are milestones that provide an opportunity to reflect on the groundbreaking work that led to the discovery, sequencing and reconstruction of the 1918 pandemic flu virus. This collaborative effort advanced understanding of the deadliest flu pandemic in modern history and has helped the global public health community prepare for contemporary pandemics, such as 2009 H1N1, as well as future pandemic threats.
The 1918 H1N1 flu pandemic, sometimes referred to as the Spanish flu, killed an estimated 50 million people worldwide, including an estimated 675,000 people in the United States. An unusual characteristic of this virus was the high death rate it caused among healthy adults 15 to 34 years of age. The pandemic lowered the average life expectancy in the United States by more than 12 years. A comparable death rate has not been observed during any of the known flu seasons or pandemics that have occurred either prior to or following the 1918 pandemic.
The virus unique severity puzzled researchers for decades, and prompted several questions, such as Why was the 1918 virus so deadly?, Where did the virus originate from?, and What can the public health community learn from the 1918 virus to better prepare for and defend against future pandemics? These questions drove an expert group of researchers and virus hunters to search for the lost 1918 virus, sequence its genome, recreate the virus in a highly safe and regulated laboratory setting at CDC, and ultimately study its secrets to better prepare for future pandemics. The following is a historical recounting of these efforts, complete with references and descriptions of the contributions made by all of the remarkable men and women involved.
Discovering a lost killer
For decades, the 1918 virus was lost to history, a relic of a time when the understanding of infectious pathogens and the tools to study them were still in their infancy. Following the 1918 pandemic, generations of scientists and public health experts were left with only the epidemiological evidence of the 1918 pandemic virus lethality and the deleterious impact it had on global populations. A small ocean-side village in Alaska called Brevig Mission would become both testament to this deadly legacy as well as crucial to the 1918 virus eventual discovery.
Today, fewer than 400 people live in Brevig Mission, but in the fall of 1918, around 80 adults lived there, mostly Inuit Natives. While different narratives exist as to how the 1918 virus came to reach the small village --- whether by traders from a nearby city who traveled via dog-pulled sleds or even by a local mail delivery person --- its impact on the villages population is well documented. During the five-day period from November 15-20, 1918, the 1918 pandemic claimed the lives of 72 of the villages 80 adult inhabitants.
Later, at the order of the local government, a mass grave site marked only by small white crosses was created on a hill beside the village --- a grim monument to a community all but erased from existence. The grave was frozen in permafrost and left untouched until 1951. That year, Johan Hultin, a 25-year-old Swedish microbiologist and Ph.D. student at the University of Iowa, set out on an expedition to Brevig Mission in the hopes of finding the 1918 virus and in the process unearth new insights and answers. Hultin believed that within that preserved burial ground he might still find traces of the 1918 virus itself, frozen in time within the tissues of the villagers whose lives it had claimed.
In 1951, Hultin successfully obtained permission from the village elders to excavate the Brevig Mission burial site. With the help of several of his university colleagues, Hultin set up a dig site over the grave. The excavation took days, as Hultin had to create campfires to thaw the earth enough to allow for digging. Two days in, Hultin came across the body of a little girl --- her body was still preserved wearing a blue dress, and her hair was adorned with red ribbons. Ultimately, Hultin successfully obtained lung tissue from four additional bodies buried at the site, but logistical and technological limitations of the time period would prove formidable.
In a conversation Hultin had decades later with CDC microbiologist Dr. Terrence Tumpey [internal reference], Hultin would explain how during the return trip from Alaska to the University of Iowa, he flew on a DC-3 propeller-driven airplane that was forced to make multiple stops along the trip to refuel. During each stop, Hultin --- ever resourceful --- would deboard the plane and attempt to re-freeze the lung samples using carbon dioxide from a fire extinguisher.
The noise generated from this activity apparently drew puzzled glances from fellow passengers and onlookers. Once back in Iowa, Hultin attempted to inject the lung tissue into chicken eggs to get the virus to grow. It did not. In the end, perhaps unsurprisingly, Hultin was unable to retrieve the 1918 virus from this initial attempt.
It wouldnt be until 46 years later, in 1997, that Hultin would have another opportunity to pursue the 1918 virus. That year, Hultin came across an article in the journal Science authored by Jeffery Taubenberger et al. entitled, Initial Genetic Characterization of the 1918 Spanish Influenza Virus. At the time, Dr. Taubenberger was a young molecular pathologist working for the Armed Forces Institute of Pathology in Washington, D.C.
In the article, Taubenberger and his team described their initial work to sequence part of the genome of the 1918 virus. The genome is the complete list of genetic instructions that make up an organism, similar to a blueprint used for construction. Many people are familiar with the concept of DNA, which is dual-stranded and determines the fundamental genetic characteristics of nearly all living things. However, the genome of an influenza virus consists of single-stranded RNA instead. Taubenbergers team successfully extracted RNA of the 1918 virus from lung tissue obtained from a 21-year-old male U.S. service member stationed in Fort Jackson, South Carolina. The serviceman had been admitted to the camps hospital on September 20, 1918, with a diagnosis of influenza infection and pneumonia. He died six days later on September 26, 1918, and a sample of his lung tissue was collected and preserved for later study.
From this tissue, Taubenbergers group was able to sequence nine fragments of viral RNA from four of the virus eight gene segments. This work did not represent a complete sequence of the entire 1918 virus genome, but it provided a clearer picture of the pandemic virus than ever before. Based on the 1918 virus sequence data Taubenberger assembled in 1997, he and his fellow researchers initially claimed that the 1918 virus was a novel influenza A (H1N1) virus that belonged to a subgroup of viruses that came from humans and pigs, as opposed to birds. However, there was still much to learn about the virus.
After reading Taubenbergers article, Hultin once again became inspired to attempt to recover the 1918 virus. Hultin wrote a letter to Taubenberger, asking if Taubenberger would be interested if he could return to Brevig Mission and obtain lung tissues from victims of the 1918 virus buried in the Alaskan permafrost. During a return phone call, Taubenberger responded, yes. A week later, Hultin departed for Brevig Mission once again with meager tools for the task. He famously borrowed his wifes garden shears to assist in the excavation.
Forty-six years had passed since Hultins first trip to the gravesite, and he was now 72 years old. He once again sought permission to excavate the gravesite from the village council --- which he obtained --- and he also hired locals to assist in the work. Hultin paid for the trip himself at a personal cost of about $3,200. The excavation took about five days, but this time Hultin made a remarkable find.
Buried and preserved by the permafrost about 7 feet deep was the body of an Inuit woman that Hultin named Lucy. Lucy, Hultin would learn, was an obese woman who likely died in her mid-20s due to complications from the 1918 virus. Her lungs were perfectly frozen and preserved in the Alaskan permafrost. Hultin removed them, placed them in preserving fluid, and later shipped them separately to Taubenberger and his fellow researchers, including Dr. Ann Reid, at the Armed Forces Institute of Pathology. Ten days later, Hultin received a call from the scientists to confirm --- to perhaps everyones collective astonishment --- that positive 1918 virus genetic material had indeed been obtained from Lucys lung tissue.
Building the Blueprint
The initial impact of this discovery would first be described in a February 1999 paper in the Proceedings of the National Academy of Science (PNAS) journal entitled Origin and evolution of the 1918 Spanish influenza virus hemagglutinin gene, by Ann Reid et al. Hultin was acknowledged as a co-author. In the paper, the authors described their effort to sequence (i.e., characterize) the 1918 viruss hemagglutinin HA gene.
The HA gene of an influenza virus determines the properties of the viruss HA surface proteins. These HA surface proteins allow an influenza virus to enter and infect a healthy respiratory tract cell. HA is also targeted by antibodies produced by the immune system to fight infection. Modern flu vaccines work by targeting an influenza virus unique HA (a fact that virologist Dr. Peter Palese, featured later in this article, helped pioneer).
In the 1999 study, the authors succeeded in sequencing the full length HA gene sequence of the 1918 virus. To accomplish this, the authors used RNA fragments of the virus obtained from the bodies of the formerly described 21-year-old Fort Jackson service member, Lucy from Brevik Mission, and a third person, a 30-year-old male service member stationed at Camp Upton, New York. This man was admitted to the camp hospital with influenza on September 23, 1918, had a rapid clinical course of illness, and died from acute respiratory failure on September 26, 1918.
Sequencing results suggested that the ancestor of the 1918 virus infected humans sometime between 1900 and 1915. Drs. Reid and Taubenberger noted that the 1918 HA gene had a number of mammalian as opposed to avian adaptations, and was more human-like or swine-like depending on the method of analysis. Phylogenetic analysis, which is used to group influenza viruses in accordance with their evolutionary development and diversity, placed the 1918 virus HA within and around the root of the mammalian clade. This means that it likely was an ancestor or closely related to the earliest influenza viruses known to infect mammals. However, the authors believed the virus likely obtained its HA from avian viruses, but were unsure how long the virus may have been adapting in a mammalian host before emerging in pandemic form.
According to the authors, the existing strain to which the 1918 virus sequences were most closely related was A/sw/Iowa/30, the oldest classical swine influenza strain. The authors noted that contemporary avian influenza virus strains are very different from the 1918 pandemic virus, and unfortunately older avian strains from around the time of the 1918 pandemic were not available for study. The authors also noted that the 1918 virus HA1 had only four glycosylation sites, which is different from modern human HAs which have accumulated up to five additional glycosylation sites through the process of antigenic drift. Antigenic drift refers to small changes in the genes of influenza viruses that happen continually over times as the virus copies itself. Antigenic drift is one reason why there is a flu season every year and also a reason for why people can get the flu multiple times in their lifetime.
Glycosylation sites are believed to be necessary for the function of influenza viruses, and the inclusion of additional glycosylation sites is believed to be an adaptation of the virus to human hosts. Also of note, the authors did not see any genetic changes in the 1918 virus HA that would explain its exceptional virulence.
Unlike modern virulent avian influenza strains, such as avian influenza A (H5) and (H7) viruses, the 1918 virus HA did not possess a cleavage site mutation, which is a recognized genetic marker for virulence, i.e., the severity or harmfulness of a disease. The insertion of amino acids in the HA cleavage site can allow an influenza virus to grow in tissues outside of its normal host cells. In the absence of such obvious markers, Dr. Reid and her fellow researchers concluded that there were likely multiple genetic factors responsible for the 1918 virus severity.
A follow-up paper published in June 2000, entitled Characterization of the 1918 Spanish Influenza Virus Neuraminidase Gene, described sequencing of the 1918 virus neuraminidase (NA) gene. In an influenza virus, the neuraminidase gene is responsible for coding the virus NA surface proteins [internal image reference]. An influenza virus NA surface proteins allow an influenza virus to escape an infected cell and infect other cells. Therefore, it plays an important role in spreading influenza infection. The author noted that NA is also targeted by the immune system, and that antibodies against NA do not prevent infection, but they do significantly limit the ability of the virus to spread.
Of note, the authors were able to sequence the entire code of the 1918 virus NA from the virus sample obtained from Lucys body. So here again, Hultins work proved invaluable. The authors found that the NA gene of the 1918 virus shared many sequence and structural characteristics with both mammalian and avian influenza virus strains. Phylogenetic analysis suggested the NA gene of the 1918 virus was intermediately located between mammals and birds, suggesting that it likely was introduced into mammals shortly before the 1918 pandemic. Furthermore, the 1918 virus NA obtained from Lucy suggested that it is very similar to the ancestor of all subsequent swine and human isolates.
Overall, the phylogenetic analysis seemed to indicate that the ultimate source of the 1918 virus NA was avian in nature, but the authors couldnt determine the pathway from its avian source to the virus final pandemic form. Regarding genetic features of the NA that could explain the 1918 virus severity, the researchers were once again unable to find any single feature of the 1918 NA that contributed to the virus virulence. For example, in some modern influenza viruses, the loss of a glycosylation site in NA at amino acid 146 (in WSN/33) contributes to virulence and also results in the virus attacking the nervous system in mice. However, this change was not found in the NA of the 1918 virus.
Following this study, a series of additional studies were published, each detailing the findings from each of the 1918 virus remaining genes (flu viruses have 8 genes in total). In 2001, a paper by Christopher Basler et al. published in the Proceedings of the National Academic of Science (PNAS) described the sequencing of the 1918 virus nonstructural (NS) gene. A 2002 study in the Journal of Virology by Ann Reid et al. described sequencing of the virus matrix gene. Two years later, a 2004 Journal of Virology study described the sequencing of the 1918 virus nucleoprotein (NP) gene. In 2005, the virus polymerase genes were sequenced by Taubenberger et al and described in a Nature article. This final study bookended the nearly decade long process of sequencing the entire genome of the 1918 virus.
With the entire genome of the 1918 virus now sequenced, the necessary information was in place to reconstruct a live version of the 1918 virus. However, one more intermediate step was needed to start the reverse genetics process, which was to create plasmids for each of the 1918 virus eight gene segments.
This task was undertaken by renowned microbiologist, Dr. Peter Palese and Dr. Adolfo Garcia-Sastre at Mount Sinai School of Medicine in New York City. A plasmid is a small circular DNA strand that can be amplified (or replicated) in the laboratory. Years earlier, Dr. Palese helped pioneer the use of plasmids in reverse genetics to produce viable influenza viruses. The techniques he developed allowed the relationships between the structure and function of viral genes to be studied, and these efforts paved the way for the techniques used to reconstruct the 1918 virus. Once Dr. Palese and his colleagues at Mount Sinai completed creation of the plasmids, they were shipped to CDC so the official process of reconstruction could begin.
The Reconstruction
The decision to reconstruct the deadliest pandemic flu virus of the 20th century was made with considerable care and attention to safety. Senior government officials decided on CDC headquarters in Atlanta as the location of the reconstruction. CDC conducted two tiers of approvals: first by CDCs Institutional Biosafety Committee and the second by CDCs Institutional Animal Care and Use Committee, before work in the laboratory began. The work would be performed using stringent biosafety and biosecurity precautions and facilities, including whats known as Biosecurity Level 3 (BSL-3) practices and facilities with enhancements.
For reference, there are four biosafety levels that correspond to the degree of risk posed by research, with 1 posing the least risk and 4 posing the greatest risk. Each biosecurity level also corresponds with specific laboratory practices and techniques, personnel training requirements, laboratory equipment, and laboratory facilities that are appropriate for the operations being performed. The stringency of these considerations --- again ranging from 1 as the lowest to 4 as the highest --- is designed to protect the personnel performing the work, the environment and the community.
Each biosecurity level includes considerations for what is known as primary and secondary barriers. Examples of primary barriers include safety cabinets, isolation chambers, gloves and gowns, whereas secondary barriers include considerations such as the construction of the facility and HEPA filtration of air in the laboratory. The specific criteria for each biosafety level are detailed in the CDC/NIH publication Biosafety in Microbiological and Biomedical Laboratories.
A BSL3 laboratory with enhancements includes a number of primary and secondary barriers and other considerations. For example, all personnel must wear a powered air purifying respirator (PAPR), double gloves, scrubs, shoe covers and a surgical gown. They also must shower before exiting the laboratory. In addition, all work with the virus or animals must be conducted within a certified Class II biosafety cabinet (BSC), and airflow within the laboratory is directionally controlled and filtered so that it cannot accidentally exit the laboratory.
For the reconstruction of the 1918 virus, additional rules were created to govern the experiments to be conducted. For example, to prevent mix-ups and cross-contamination, work on the 1918 virus could not take place alongside work on other influenza viruses.
As part of security and safety considerations, CDCs Office of the Director determined that only one person would be granted permission, laboratory access, and the tremendous responsibility of reconstructing the 1918 virus. That person was trained microbiologist Dr. Terrence Tumpey, who was approved for the project by then CDC director, Dr. Julie Gerberding. Reconstruction of the 1918 virus also was approved by the National Institute of Allergy and Infectious Disease (NIAID) within the National Institutes of Health (NIH), which partially funded the project.
Dr. Tumpey was formerly a U.S. Department of Agriculture microbiologist at the Southeast Poultry Research Laboratory in Athens, Georgia. Earlier in his career, he had applied for an American Society of Microbiology (ASM) postdoctoral fellowship with CDC microbiologist and flu expert Dr. Jacqueline Katz, who recently retired as Deputy Director of CDCs Influenza Division. This two-year fellowship in CDCs Influenza Division would mark the beginning of Dr. Tumpeys career at CDC. He officially transferred employment to CDC for the purpose of studying human health implications of influenza viruses, including the 1918 pandemic virus.
Dr. Tumpeys work to reconstruct the complete 1918 virus began in the summer of 2005. To reduce risk to colleagues and the public, he was required to work on the virus alone and only after hours when fellow colleagues had exited the laboratories for the day and gone home. A biometric fingerprint scan was required for access into the BSL-3E laboratory, and the virus storage freezers were only accessible via an iris scan of his eyes. Dr. Tumpey was required to take a prescribed prophylactic (preventative) daily dose of the influenza antiviral drug, oseltamivir, as an additional safety precaution to prevent him from becoming infected. Should he become infected, he was informed that he would be placed in quarantine and denied contact with the outside world. He understood and accepted this responsibility and its consequences.
Using reverse genetics, Dr. Tumpey took the plasmids created by Dr. Palese for each of the 1918 virus eight gene segments and inserted them into human kidney cells. The plasmids then instructed the cells to reconstruct the RNA of the complete 1918 virus. For multiple weeks in July 2005, colleagues and collaborators asked Dr. Tumpey if he had the 1918 virus and if it had appeared in cell-culture yet.
On the day the 1918 virus appeared in his cell-culture, Dr. Tumpey knew history had been made, and in fact, a historic virus had been brought back from extinction. He sent a playful, Neil Armstrong-inspired email later that day to colleagues and collaborators, which simply said Thats one small step for man, one giant leap for mankind. Everyone then knew what had been accomplished. Dr. Tumpey had become the first man to reconstruct the complete 1918 virus. The next step was to study it and unlock its deadly secrets.
Laboratory studies on the reconstructed 1918 virus began in August 2005. A report of this work, Characterization of the Reconstructed 1918 Spanish Influenza Pandemic Virus, was published in the October 7, 2005, issue of Science. To evaluate the 1918 virus pathogenicity (i.e., the ability of the virus to cause disease and harm a host), animal studies involving mice were conducted. The mice were infected with the 1918 virus, and measures of morbidity (i.e., weight loss, virus replication, and 50% lethal dose titers) were collected and documented. For comparison, other mice were infected with different influenza viruses that were designed via reverse genetics to have varying combinations of genes from the 1918 virus and contemporary human seasonal influenza A(H1N1) viruses. These viruses are called recombinant viruses.
The fully reconstructed 1918 virus was striking in terms of its ability to quickly replicate, i.e., make copies of itself and spread infection in the lungs of infected mice. For example, four days after infection, the amount of 1918 virus found in the lung tissue of infected mice was 39,000 times higher than that produced by one of the comparison recombinant flu viruses.
Furthermore, the 1918 virus was highly lethal in the mice. Some mice died within three days of infection with the 1918 virus, and the mice lost up to 13% of their body weight within two days of infection with the 1918 virus. The 1918 virus was at least 100 times more lethal than one of the other recombinant viruses tested. Experiments indicated that 1918 virus HA gene played a large role in its severity. When the HA gene of the 1918 virus was swapped with that of a contemporary human seasonal influenza A (H1N1) flu virus known as A/Texas/36/91 or Tx/91 for short, and combined with the remaining seven genes of the 1918 virus, the resulting recombinant virus notably did not kill infected mice and did not result in significant weight loss.
Other experiments were conducted to determine if infection with the 1918 virus could spread to other vital organs of mice --- such as the brain, heart, liver and spleen. Laboratory testing did not detect virus in these organs, suggesting that the 1918 virus did not cause systemic infection in its victims.
However, one well-documented effect of the 1918 virus was rapid and severe lung damage. In 1918, victims of the pandemic virus experienced fluid-filled lungs, as well as severe pneumonia and lung tissue inflammation. Within four days post infection, mice infected with the 1918 virus experienced similar lung complications, suggesting that this was a unique aspect of the 1918 virus severity.
The impact of the 1918 virus on lung tissue was also studied using a human lung cell line (known as Calu-3 cells). The amount of 1918 flu virus was measured in the cells at 12, 16 and 24 hours post infection and these results were compared to those produced by recombinant viruses with a combination of genes from the 1918 virus mixed with genes from contemporary human seasonal flu viruses. Similar to the experiments involving mice, the 1918 virus quickly multiplied and spread within the human lung cells. So much so, that the 1918 virus produced as much as 50 times the amount of virus in human lung cells as one of the comparison viruses. These experiments suggested that in addition to the HA, the polymerase genes of the 1918 virus played a significant role in the virus infectivity and virulence in human lung tissue.
Another set of experiments was conducted to better understand the possible avian origins of the 1918 virus. The earlier sequencing efforts led by Dr. Taubenberger and Reid had suggested that the 1918 virus gene segments were more closely related to avian influenza A(H1N1) viruses than H1N1 viruses found in other mammals. Researchers were interested to know whether the 1918 virus would be lethal to fertilized chicken eggs, i.e., chicken eggs containing an embryo, similar to modern highly pathogenic avian influenza viruses.
To find an answer, 10-day old fertilized chicken eggs were inoculated with the 1918 virus. The 1918 virus proved lethal for the chicken egg embryos, similar to the effects caused by contemporary H1N1 bird flu viruses. Notably, comparison experiments using human seasonal influenza A(H1N1) viruses did not have this destructive effect on chicken embryos. Furthermore, the recombinant flu viruses that Dr. Tumpey created containing two, five or seven genes of the 1918 virus also did not hurt chicken embryos. Similar to the results of the studies conducted in mice and human lung cell, these fertilized chicken egg experiments indicated that the HA and polymerase genes of the 1918 virus both likely played roles in its virulence.
The work conducted by Dr. Tumpey and his CDC colleagues provided new information about the properties that contributed to the virulence of the 1918 virus. Dr. Tumpey determined that the HA and PB1 virus genes of the virus played particularly important roles in its infectiousness and severity. However, as his experiments involving recombinant flu viruses with some but not all of the 1918 viruss genes showed, it was not any single component of the 1918 virus but instead the unique combination of all of its genes together that made it so particularly dangerous.
Tumpey and colleagues wrote the constellation of all eight genes together make an exceptionally virulent virus. No other human influenza viruses tested were as exceptionally virulent. In that way, the 1918 virus was special --- a uniquely deadly product of nature, evolution and the intermingling of people and animals. It would serve as a portent of natures ability to produce future pandemics of varying public health concern and origin.
Learning from the Past
Since 1918, the world has experienced three additional pandemics, in 1957, 1968, and most recently in 2009. These subsequent pandemics were less severe and caused considerably lower mortality rates than the 1918 pandemic. The 1957 H2N2 pandemic and the 1968 H3N2 pandemic each resulted in an estimated 1 million global deaths, while the 2009 H1N1 pandemic resulted in fewer than 0.3 million deaths in its first year. This perhaps begs the question of whether a high severity pandemic on the scale of 1918 could occur in modern times.
Many experts think so. One virus in particular has garnered international attention and concern: the avian influenza A(H7N9) virus from China. The H7N9 virus has so far caused 1,568 human infections in China with a case-fatality proportion of about 39% since 2013. However, it has not gained the capability to spread quickly and efficiently between people. If it did, experts believe it could result in a pandemic with severity comparable to the 1918 pandemic. So far, it has shown only limited ability to spread between people. Most human infections with this virus have result from exposure to birds.
When considering the potential for a modern era high severity pandemic, it is important; however, to reflect on the considerable medical, scientific and societal advancements that have occurred since 1918, while recognizing that there are a number of ways that global preparations for the next pandemic still warrant improvement.
Besides the properties of the virus itself, many additional factors contributed to the virulence of the 1918 pandemic. In 1918, the world was still engaged in World War I. Movement and mobilization of troops placed large numbers of people in close contact and living spaces were overcrowded. Health services were limited, and up to 30% of U.S. physicians were deployed to military service.
In addition, medical technology and countermeasures at the time were limited or non-existent. No diagnostic tests existed at the time that could test for influenza infection. In fact, doctors didnt know influenza viruses existed. Many health experts at the time thought the 1918 pandemic was caused by a bacterium called Pfeiffers bacillus, which is now known as Haemophilus influenzae.
Influenza vaccines did not exist at the time, and even antibiotics had not been developed yet. For example, penicillin was not discovered until 1928. Likewise, no flu antiviral drugs were available. Critical care measures, such as intensive care support and mechanical ventilation also were not available in 1918. Without these medical countermeasures and treatment capabilities, doctors were left with few treatment options other than supportive care.
In terms of national, state and local pandemic planning, no coordinated pandemic plans existed in 1918. Some cities managed to implement community mitigation measures, such as closing schools, banning public gatherings, and issuing isolation or quarantine orders, but the federal government had no centralized role in helping to plan or initiate these interventions during the 1918 pandemic.
Today, considerable advancements have been made in the areas of health technology, disease surveillance, medical care, medicines and drugs, vaccines and pandemic planning. Flu vaccines are now produced and updated yearly, and yearly vaccination is recommended for everyone 6 months of age and older. Antiviral drugs now exist that treat flu illness, and in the event of virus exposure, can be used for prophylaxis (prevention), as well. Importantly, many different antibiotics are now available that can be used to treat secondary bacterial infections.
Diagnostic tests for identifying influenza are now available and they are improving over time. Current rapid tests for flu, also known as RIDTs, provide results within 15 minutes and have sensitivities ranging from 50-70%. Recently, new rapid molecular assays have become available that are timely and much more accurate than RIDTs. Just as important as these advancements in diagnostic tests are the improvements that have been made in laboratory testing capacity both within the United States and globally.
The World Health Organization (WHO)s Global Influenza Surveillance and Response System (GISRS) is a global flu surveillance network that monitors changes in seasonal flu viruses and also monitors the emergence of novel (i.e., new in humans) flu viruses, many of which originate from animal populations. Through animal and human interactions and environmental exposures, these viruses can cause human infections. CDC in Atlanta is one of WHOs six Collaborating Centers for Reference and Research on Influenza (joining others in Australia, China, Japan and the United Kingdom). The WHO collaborating centers collect influenza viruses obtained from respiratory specimens from patients around the world, and they are supported by 143 National Influenza Centers in 114 WHO member countries.
Expanding laboratory testing and flu surveillance capacity around the world has been an important focus of pandemic preparedness efforts. In 2004, CDC began an international surveillance capacity building initiative that entailed a 5-year period of financial support to improve laboratory diagnostic tests and surveillance of influenza like illness (ILI) and severe acute respiratory infection (SARI) in 39 partner countries.
In 2008, CDC established the International Reagent Resource (IRR), which provides reagents to laboratories around the world to identify seasonal influenza A and B viruses, as well as novel influenza A viruses. During the 2009 H1N1 pandemic, the IRR distributed a new CDC developed 2009 H1N1 PCR assay to domestic public health laboratories and laboratories around the world less than 2 weeks after the 2009 H1N1 virus was first identified. This considerably enhanced the ability of the global flu surveillance community to track spread of the virus.
As part of WHOs International Health Regulations (IHR), countries must notify WHO within 24 hours of any case of human infection caused by a novel influenza A virus subtype. This requirement is designed to help quickly identify emerging viruses with pandemic potential.
Since 2010, CDC has used its Influenza Risk Assessment Tool (IRAT) to evaluate and score emerging novel influenza A viruses and other viruses of potential public health concern. The score provided by the IRAT answers two questions: 1) What is the risk that a virus that is novel in humans could result in sustained human to human transmission? and: 2) What is the potential for the virus to substantially impact public health if it does gain the ability to spread efficiently from person to person? Results from the IRAT have helped public health experts target pandemic preparedness resources against the greatest disease threats and to prioritize the selection of candidate vaccine viruses and the development of pre-pandemic vaccines against emergent viruses with the greatest potential to cause a severe pandemic.
When pre-pandemic vaccines are made, they are stored in the Strategic National Stockpile, along with facemasks, antiviral drugs and other materials that can be used in case of a pandemic.
All of these resources, tools, technologies, programs and activities are excellent tools for pandemic planning, and pandemic planning itself has improved significantly since 1918. In the United States, the Department of Health and Human Services (HHS) maintains a national Pandemic Influenza Plan, and this plan was updated in 2017. The World Health Organization (WHO) has published instructions for countries to use in developing their own national pandemic plans, as well as a checklist for pandemic influenza risk and impact management.
Planners have access to other materials as well. For example, in 2014, CDC published a pandemic framework with six intervals that fall within a pandemic curve. Each interval helps with prioritizing data collection, government resources and interventions, and other important activities during the pandemic. In addition, CDC experts have devised a Pandemic Severity Assessment Framework that uses data to assign severity and transmissibility scores to pandemics. The tool is useful for planning purposes and for determining appropriate mitigations based on the severity of a pandemic. In addition, guidelines for non-pharmaceutical interventions, such as closing schools and large social gatherings, have been established and revised, for use during a pandemic.
While all of these plans, resources, products and improvements show that significant progress has been made since 1918, gaps remain, and a severe pandemic could still be devastating to populations globally. In 1918, the world population was 1.8 billion people. One hundred years later, the world population has grown to 7.6 billion people in 2018. As human populations have risen, so have swine and poultry populations as a means to feed them. This expanded number of hosts provides increased opportunities for novel influenza viruses from birds and pigs to spread, evolve and infect people. Global movement of people and goods also has increased, allowing the latest disease threat to be an international plane flight away. Due to the mobility and expansion of human populations, even once exotic pathogens, like Ebola, which previously affected only people living in remote villages of the African jungle, now have managed to find their way into urban areas, causing large outbreaks.
If a severe pandemic, such as occurred in 1918 happened today, it would still likely overwhelm health care infrastructure, both in the United States and across the world. Hospitals and doctors offices would struggle to meet demand from the number of patients requiring care. Such an event would require significant increases in the manufacture, distribution and supply of medications, products and life-saving medical equipment, such as mechanical ventilators. Businesses and schools would struggle to function, and even basic services like trash pickup and waste removal could be impacted.
The best defense against the flu continues to be a flu vaccine, but even today, flu vaccines face a number of challenges. One challenge is that flu vaccines are often moderately effective, even when well matched to circulating viruses. But perhaps the biggest challenge is the time required to manufacture a new vaccine against an emerging pandemic threat. Generally, it has taken about 20 weeks to select and manufacture a new vaccine.
During the 2009 H1N1 pandemic, the first doses of pandemic vaccine did not become available until 26 weeks after the decision to manufacture a monovalent vaccine. As a result, most vaccinations in the United States occurred after the peak of 2009 H1N1 illness. The HHS Pandemic Influenza Plan has a goal of reducing the timeframe to make a pandemic flu vaccine from 20 weeks to 12 weeks, but accomplishing this is challenging.
One possible solution is to create more broadly protective and longer lasting vaccines. Creation of a universal vaccine continues to elude the worlds top scientists, but in the future, it could become a reality. In the meantime, health officials seek to get the most out of new and existing flu vaccine technologies, such as cell based and recombinant vaccines, which are not reliant on a supply of chicken eggs, like traditional vaccines, and have the potential to be produced faster.
One other vaccine issue is the inadequate global capacity for mass producing flu vaccines. Global pandemic flu vaccine capacity was estimated to be 6.4 billion doses in 2015, but this is not enough to cover even half of the worlds population, should two doses of a pandemic vaccine be required for protection.
Other challenges at a global level include surveillance capacity, infrastructure and pandemic planning. The majority of counties that report to the WHO still do not have a national pandemic plan, and critical and clinical care capacity, especially in low income countries, continues to be inadequate to the demands of a severe pandemic. In 2005, milestones were created in the revised International Health Regulations (IHR) for countries to improve their response capacity for public health emergencies, but in 2016, only one-third of countries were in compliance.
All of these issues show that more work needs to be done, both here in the United States and internationally, to prepare for the next pandemic. On May 7, 2018, The Rollins School of Public Health at Emory University in partnership with the U.S. Centers for Disease Control and Prevention, hosted a one-day symposium on the 100-year anniversary of the 1918 influenza pandemic. The event involved experts from government and academia discussing current pandemic threats and the future of pandemic preparedness, influenza prevention and control. U.S. and global influenza experts who attended the meeting agreed that we still face great challenges to prepare for future flu pandemics, but part of the solution is recognizing these challenges and working together with the rest of the world to address them.
The COVID-19 virus is not an Influenza or as commonly called a Flu virus. It is a coronaviruses and they do not behave like Flu viruses. In the late 1990's the Internet was full of stories about the desire to access and sequence the 1918 pandemic virus. The stories ranged from nefarious forces wanting to create bioweapons to legitimate science wanting to avert a future disaster. In most instances the non-mainstream websites were concerned about unintended consequences and a massive disaster that might result from this work. Eventually this permeated the main stream and a movie called Jurasic Park was made. The movie featured the new genetic engineering technologies and the unintended consequences of bringing life back that went extinct millions of years in the past. One of the more famous series of quotes from the movie is [1]:
Dr. Ian Malcolm : Don't you see the danger, John, inherent in what you're doing here? Genetic power is the most awesome force the planet's ever seen, but you wield it like a kid that's found his dad's gun.Donald Gennaro : It's hardly appropriate to start hurling generalizations...
Dr. Ian Malcolm : If I may... Um, I'll tell you the problem with the scientific power that you're using here, it didn't require any discipline to attain it. You read what others had done and you took the next step. You didn't earn the knowledge for yourselves, so you don't take any responsibility for it. You stood on the shoulders of geniuses to accomplish something as fast as you could, and before you even knew what you had, you patented it, and packaged it, and slapped it on a plastic lunchbox, and now [bangs on the table] you're selling it, you wanna sell it. Well...
John Hammond : I don't think you're giving us our due credit. Our scientists have done things which nobody's ever done before...
Dr. Ian Malcolm : Yeah, yeah, but your scientists were so preoccupied with whether or not they could that they didn't stop to think if they should.
References
[1] The Deadliest Flu: The Complete Story of the Discovery and Reconstruction of the 1918 Pandemic Virus, By Douglas Jordan with contributions from Dr. Terrence Tumpey and Barbara Jester, Centers For Disease Control and Prevention CDC, December 17, 2019. webpage https://www.cdc.gov/flu/pandemic-resources/reconstruction-1918-virus.html, March 2021. The Deadliest Flu: The Complete Story of the Discovery and Reconstruction of the 1918 Pandemic Virus.
[2] Jurassic Park, Movie 1993, Writers: Michael Crichton (novel), Michael Crichton (screenplay). webpage https://www.imdb.com/title/tt0107290, March 2021. Jurassic Park.
The Huanan wet market in China where live animals are sold is thought to be the source of the COVID-19 virus. The scenarios offered are that the virus arrived naturally in the wet market or that it leaked from a bio lab in Wuhan. China as part of the official response denies that the virus originated in Huanan wet market. China also rejected the US charge from right wing political operatives that the novel coronavirus was leaked from its bio lab in Wuhan. China asserted that the pandemic was likely caused by separate outbreaks in multiple locations in the world. The Huanan wet market was closed and sealed in early 2020 [1].
Chinese Foreign Minister Wang Yi communicated that [1]:
We raced against time and were the first country to report cases to the world. More research suggests that the pandemic was likely to have been caused by separate outbreaks in multiple places in the world. When hit by an unknown coronavirus, China took immediate actions to carry out epidemiological investigation, identify the pathogen and publicise key information including the genome sequencing of the virus. All this sounded alarm bells across the world. China took the most rigorous control measures to fight the virus.
In a formal media briefing, Ms Hua launched a scathing criticism against the US [1]:
Washington should produce evidence to back its charge that the virus emerged from the Wuhan Institute of Virology (WIV). She in-turn called for a WHO probe into American military run bio labs while replying to a question on latest allegations by the US National Security Adviser Matthew Pottinger that the COVID-19 has been leaked from the WIV."There is a growing body of evidence that the (Wuhan) lab is likely the most credible source of the virus," Mr Pottinger, a staunch critic of Beijing, allegedly made the claim in a recent virtual meeting with UK officials, according to a British media report.
His allegation is nothing new as US President Donald Trump, who termed COVID-19 as "China virus", too had alleged last year that the institute may have been responsible and called for an inquiry.
"Maybe you could ask the senior US officials since they are considering origin tracing such a priority why doesn''t the US invite the WHO experts to investigate the virus in the US considering the links between the Fort Detrick lab (in Maryland) and the major flu last fall and the pandemic," Ms Hua said.
"Why doesn't the US invite journalists there," she asked.
Ms Hua said, "regarding the Wuhan lab making or leaking of the virus almost all the scientists and experts in the world including Dr Anthony Fauci, (director of the National Institute of Allergy and Infectious Diseases) openly denied this".
"Many media including American ones interviewed officials of Wuhan Institute of Virology to see the truth," she said.
"Pottinger is still hyping despicable lies and rumours. Does it reflect his own stand or that of the official stand of the US government? The US should present evidence on this. There are more reports showing evidence that pandemic broke out in multiple locations in 2020," she said.
"We hope that the WHO can lead the scientists in conducting the tracing of the organ of the virus so that we find out the truth at an early date," Ms Hua said.
Chinese Foreign Ministry spokesperson Hua Chunying's remarks came amidst reports that a ten-member team of the World Health Organisation (WHO) scientists would visit China this month to probe the origin of the coronavirus, which emerged in Wuhan in December 2019.
The case for and against an Unintended Consequence from China as the source of the virus is as follows:
To accept the lab leak scenario from China or any other country including the USA it would require confirmed evidence of possession of the virus in a lab setting, ahead of the first cases, and a likely mechanism for escape into humans. Finding the possible immediate parents of SARS-CoV-2 would help to understand the recent history of the virus but not how and where that history occurred if the work was performed in secret. Unless an offending lab is staffed with very special people, as time moves on this becomes less likely.
References
[1] China Denies US' Allegation That Coronavirus Originated From Wuhan Lab, WorldPress Trust of India, www.ndtv.com, January 04, 2021. webpage https://www.ndtv.com/world-news/china-denies-us-allegation-that-coronavirus-originated-from-wuhan-lab-2347646, March 2021. China Denies US' Allegation That Coronavirus Originated From Wuhan Lab.
[2] Unlikely that Covid came from Wuhan lab, WHO says, NBC News, February 9, 2021. website https://www.nbcnews.com/news/world/who-s-covid-mission-china-give-first-report-n1257105, March 2021. Unlikely that Covid came from Wuhan lab, WHO says.
[3] Did the coronavirus leak from a lab? These scientists say we shouldnt rule it out. For many scientists, challenging the idea that SARS-CoV-2 has natural origins is seen as career suicide. But a vocal few say it shouldn't be disregarded or lumped in with conspiracy theories. MIT Technology Review, March 18, 2021. webpage https://www.technologyreview.com/2021/03/18/1021030/coronavirus-leak-wuhan-lab-scientists-conspiracy, March 2021. Did the coronavirus leak from a lab? These scientists say we shouldnt rule it out.
[4] The Deadliest Flu: The Complete Story of the Discovery and Reconstruction of the 1918 Pandemic Virus, By Douglas Jordan with contributions from Dr. Terrence Tumpey and Barbara Jester, Centers For Disease Control and Prevention CDC, December 17, 2019. webpage https://www.cdc.gov/flu/pandemic-resources/reconstruction-1918-virus.html, March 2021. The Deadliest Flu: The Complete Story of the Discovery and Reconstruction of the 1918 Pandemic Virus.
A bioweapon suggests that some bioagent was deliberately developed and then used for some intended outcome. The bioagent might be something that is naturally harvested and packaged, naturally harvested modified and then packaged, or designed and manufactured in a lab and then packaged. The bioagent can be a bacterium, virus, protozoan, parasite, or fungus. Most immediately jump to genetic engineering of a virus to produce some type of outcome. However this suggests that we have the technology to predict the results of certain gene sequences.
The scenarios associated with a bioweapon will not provide insight into the source of a virus unless the attack is confirmed and can be sourced. When trying to determine if COVID-19 is a bioweapon that went out of control, the investigations should follow traditional paths associated with intelligence and police work. These begin with motive. What would be the motive of the attacker to release something like COVID-19. Then there is the list of possible suspects. The motive may not be visible until all the possible suspects are listed and examined. The list includes fanatics from the Middle East, USA, Eastern and Western Europe, Far East, Africa, South America, Australia, etc. In other words the entire planet. It is unlikely that China and Italy would attack their own countries.
The scenario of a genetically engineered bioweapon is taken off the table because no one has claimed responsibility for the act. It is possible that some fanatics released the virus thinking that its spread would be limited and not go beyond the intended target but that is highly unlikely. Still the scenario must be considered so that we ensure that we have extremely effective systems to detect, prevent, and mitigate such attacks. Fortunately the reality is that we are many years away from a complete understanding of viral gene functions and regulation for construction of lethal viruses. [1]
Just because the use of a bioweapon has been taken off the table it does not suggest that there was no attempt to genetically engineer such a bioweapon and that it may have accidentally escaped from a lab. Li-Meng Yan, a Chinese ophthalmologist and virologist, claimed that SARS-CoV-2 was made in a Chinese government laboratory. In April 2020, she fled to the United States and co-authored two papers. The first paper, September 14, 2020, presented theories that SARS-CoV-2 did not emerge naturally in a spillover from animals, but was produced in a laboratory [2]. The second paper, October 8, 2020, went further, claiming that SARS-CoV-2 was a bioweapon developed by laboratories under the control of the Chinese Communist Party [3]. In the papers, just below the list of authors is identification of the Rule of Law Society & Rule of Law Foundation a political organization with close ties to the extreme right in the USA. The mainstream scientific community rejected these theories using very strong and direct language.
In complex systems every analysis always has flaws. However the flaws should never be used to discredit an entire body of work. Instead the flaws must be noted, addressed, and then the analysis either abandoned because it is fatally flawed or matured. This is a process usually referred to as moving from a strawman, to an ironman, to a stoneman condition. A strawman is something that is easy to knock down with little knowledge. An ironman is difficult to knock down and requires experts to knock it down. A stoneman cannot be knocked down even if all the experts have endless amounts of time to find the flaws. It appears that the Yan analysis is somewhere between a strawman and ironman analysis. It may never reach the stoneman level of maturity but without logical, traceable, counter analysis rooted in the systems tradition, this will not happen. The scientists instead start behaving like politicians and managers driven by external forces either knowingly or unknowingly.
Unfortunately the Yan papers began with strong assertions and then provided technical content to support the assertions. The focus should have been on the technical content. In spite of this flaw, unless there is a paragraph by paragraph analysis of the technical content found in the Yan papers from those that rejected the analysis it is difficult to determine where the Yan analysis broke down and why.
In every systems analysis when systems information products are reviewed there is always a paragraph by paragraph detailed analysis. The method is very simple, a line is added after each paragraph labeled as Comment, and then a clear one word assessment is provided using words like Agree or Disagree. More words are provided when there is a disagree assessment so that a reasonable analysis can be performed moving forward. Johns Hopkins did provide such an analysis using content that is easily understood by the non specialist.
Before the review of the Yan analysis is provided the findings from this analysis are provided below. Placing it at the end of the analysis may cause some readers to miss these findings.
Key Findings From This Systems Analysis
Review of the second Yan paper [3] is not provided in this systems analysis. The papers are now part of the historical record. It probably will be decades before we know the source of the COVID-19 virus and how it spread so quickly across the planet. As suggested by this systems analysis, if it is known, the information is probably locked in military and intelligence organizations and classified with no access.
A key claim in the Yan paper is that the RaTG13 sequence is not found in nature but the Johns Hopkins review invalidated the claim by showing that the RaTG13 is found in GenBank. Assuming we can trust GenBank, this moved the analysis into the fatally flawed category. The GenBank results show that the Bat coronavirus RaTG13 complete genome was submitted by the Wuhan Institute of Virology [A]. The expectation is that the results of the Bat coronavirus RaTG13 genome submitted by the Wuhan Institute of Virology was verified. This includes duplicating the results in other independent labs using material from the Wuhan lab. It is also expected that there is a massive search to find the bats in the cave that provided the original bat material that was used for the RaTG13 genome finding. This systems analysis has not verified if this happened.
This systems analysis performed in 2020 suggested that the virus spread was a direct result of airplanes and airports. Although this is a horrible finding for the airline industry and the US Federal Aviation Administration (FAA), it is a comforting conclusion because it suggests it was not a deliberate planned attack where the virus was spread in multiple locations across the planet by maniacs.
The Yan paper [2] and comments from Johns Hopkins [14] are provided below. The comments from Johns Hopkins are marked as JH and the comments from This Analysis are marked as TA and are non italic to show that they originated from this analysis and not a referenced body of work. These are links to the TA comments:
TA1, TA2, TA3, TA4, TA5, TA6, TA7, TA8, TA9, TA10, TA11
TA1: The following are selected portions from the introduction of the JH comments.JH: Several analyses of the potential origin of SARS-CoV-2 have been published in scientific journals that provide peer review prior to publication.2,3,4,5,6,7,8,9 Peer review is central to the scientific process because scrutiny by experts allows for meaningful conclusions to be drawn about available data and reduces inappropriate extrapolation or misinterpretation. It is an imperfect process, often criticized for slowness, but peer review is a necessary part of building reliability in the scientific record. Complex scientific details are best understood and critiqued by others who are also experts in a technical field. When the audience for an article is broadened, even to a technical audience in an adjacent scientific field, data may appear smoother and less conflicting than it is in reality, leading to a blurring or skewing of its real meaning.
TA2: Eventually the scientific analysis must be reviewed by all the system stakeholders. This is a challenge when the content is highly specialized but it is possible. The approach used is to ensure that the analysis is captured in other information products that are written in such a way that anyone can understand it even everyones grandmother. In the past very sophisticated publications departments were used to help translate the content without distorting the content. This also can be performed by extremely mature professionals that have been exposed to this process multiple times in the highly specialized field. It appears that the Johns Hopkins comments are in that tradition.
JH: The report, Unusual Features of the SARS-CoV-2 Genome Suggesting Sophisticated Laboratory Modification Rather Than Natural Evolution and Delineation of Its Probable Synthetic Route,10 presents a theory about the origin of SARS-CoV-2 but offers contradictory and inaccurate information that does not support their argument. As the report has not been submitted to a scientific peer-reviewed publication, which would provide the expert scrutiny expected by the scientific community and the larger public, we aim to provide an objective analysis of details included in the report, as would be customary in a peer-review process.
TA3: It appears that the Johns Hopkins analysis of the Yan report has concluded that there is noting to salvage from the Yan analysis. It is fatally flawed.
TA4: The following is the Yan report and all the JH and TA comments. There is a conclusion at the end of this analysis of the Yan report.
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Abstract
The COVID-19 pandemic caused by the novel coronavirus SARS-CoV-2 has led to over 910,000 deaths worldwide and unprecedented decimation of the global economy. Despite its tremendous impact, the origin of SARS-CoV-2 has remained mysterious and controversial. The natural origin theory, although widely accepted, lacks substantial support. The alternative theory that the virus may have come from a research laboratory is, however, strictly censored on peer-reviewed scientific journals. Nonetheless, SARS-CoV-2 shows biological characteristics that are inconsistent with a naturally occurring, zoonotic virus. In this report, we describe the genomic, structural, medical, and literature evidence, which, when considered together, strongly contradicts the natural origin theory. The evidence shows that SARS-CoV2 should be a laboratory product created by using bat coronaviruses ZC45 and/or ZXC21 as a template and/or backbone. Building upon the evidence, we further postulate a synthetic route for SARS-CoV-2, demonstrating that the laboratory-creation of this coronavirus is convenient and can be accomplished in approximately six months. Our work emphasizes the need for an independent investigation into the relevant research laboratories. It also argues for a critical look into certain recently published data, which, albeit problematic, was used to support and claim a natural origin of SARS-CoV-2. From a public health perspective, these actions are necessary as knowledge of the origin of SARS-CoV-2 and of how the virus entered the human population are of pivotal importance in the fundamental control of the COVID-19 pandemic as well as in preventing similar, future pandemics.
TA5: They should have deleted strictly censored on peer-reviewed scientific journals and stayed with the known facts that they are presenting. It is off topic, that is the comment and reason for removal. This is a classic example of young researchers that get emotionally attached to their work. This is where an institutional publication department adds significant value to information products. Even though our systems analysis crosses this boundary, we don't care because we expect everyone to not engage in gaming a situation towards some hidden stakeholder. We come from the systems perspective and assertions with little backup information are sometimes needed to fully understand a system. This mistake from the Yan researchers can be attributed to idealistic mental models and strong emotions. The paper should have stayed on the topic of the possible source of the virus and not ventured down the censorship path. That is a very different paper, one possibly written by historians and journalists. However, the technical content in this paper should be examined. Historians and journalists should examine the other content. This is the systems perspective.
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Introduction
COVID-19 has caused a world-wide pandemic, the scale and severity of which are unprecedented. Despite the tremendous efforts taken by the global community, management and control of this pandemic remains difficult and challenging.
As a coronavirus, SARS-CoV-2 differs significantly from other respiratory and/or zoonotic viruses: it attacks multiple organs; it is capable of undergoing a long period of asymptomatic infection; it is highly transmissible and significantly lethal in high-risk populations; it is well-adapted to humans since the very start of its emergence1; it is highly efficient in binding the human ACE2 receptor (hACE2), the affinity of which is greater than that associated with the ACE2 of any other potential host2,3.
The origin of SARS-CoV-2 is still the subject of much debate. A widely cited Nature Medicine publication has claimed that SARS-CoV-2 most likely came from nature4. However, the article and its central conclusion are now being challenged by scientists from all over the world5-15. In addition, authors of this Nature Medicine article show signs of conflict of interests16,17, raising further concerns on the credibility of this publication.
The existing scientific publications supporting a natural origin theory rely heavily on a single piece of evidence - a previously discovered bat coronavirus named RaTG13, which shares a 96% nucleotide sequence identity with SARS-CoV-218. However, the existence of RaTG13 in nature and the truthfulness of its reported sequence are being widely questioned6-9,19-21. It is noteworthy that scientific journals have clearly censored any dissenting opinions that suggest a non-natural origin of SARS-CoV-28,22. Because of this censorship, articles questioning either the natural origin of SARS-CoV-2 or the actual existence of RaTG13, although of high quality scientifically, can only exist as preprints5-9,19-21 or other non-peerreviewed articles published on various online platforms10-13,23. Nonetheless, analyses of these reports have repeatedly pointed to severe problems and a probable fraud associated with the reporting of RaTG136,8,9,1921. Therefore, the theory that fabricated scientific data has been published to mislead the world's efforts in tracing the origin of SARS-CoV-2 has become substantially convincing and is interlocked with the notion that SARS-CoV-2 is of a non-natural origin.
JH: 1. On natural existence of a closely related virus. Line 17: RaTG13 is a previously discovered bat coronavirus which has about a 96% sequence identity to SARS-CoV-2,4 indicating that it is a close relative and that bats are likely involved in the evolution of SARS-CoV-2. Yan et al question the existence of RaTG13, which is found in GenBank.11 The authors cite multiple papers in their reference section that have weaknesses or flaws to make their case. In their paper, reference 7's author is not a scientist or researcher according to his ORCID profile; references 10 and 13 cannot be found online and the links provided are not active; reference 11 is an opinion piece on an anti-GMO interest group website; references 5, 6, 8, 9, and 12 appear to be authored by scientists lacking expertise in coronaviruses and/or viral evolution. Only 2 of these publications (14 and 15) were published in scientific journals with peer review, and none of the authors of these 2 articles specialize in coronaviruses or viral genetics.
TA6: This is a key claim in the Yan paper and the JH review has invalidated the claim by showing that the RaTG13 is found in GenBank. Assuming we can trust GenBank, this moved the analysis into the fatally flawed category.
TA7: The GenBank results show that the Bat coronavirus RaTG13 complete genome was submitted by the Wuhan Institute of Virology. https://www.ncbi.nlm.nih.gov/nuccore/MN996532 VRL 24-NOV-2020. https://www.ncbi.nlm.nih.gov/nuccore/MN996532.1, VRL 24-MAR-2020. https://www.ncbi.nlm.nih.gov/nuccore/MN996532.2, VRL 24-NOV-2020. [A]
TA8: The expectation is that the results of the Bat coronavirus RaTG13 complete genome submitted by the Wuhan Institute of Virology was verified. This includes duplicating the results in other independent labs using material from the Wuhan lab. It is also expected that there is a massive search to find the bats in the cave that provided the original bat material that was used for the RaTG13 genome finding. This systems analysis has not verified if this happened.
Consistent with this notion, genomic, structural, and literature evidence also suggest a non-natural origin of SARS-CoV-2. In addition, abundant literature indicates that gain-of-function research has long advanced to the stage where viral genomes can be precisely engineered and manipulated to enable the creation of novel coronaviruses possessing unique properties. In this report, we present such evidence and the associated analyses. Part 1 of the report describes the genomic and structural features of SARS-CoV2, the presence of which could be consistent with the theory that the virus is a product of laboratory modification beyond what could be afforded by simple serial viral passage. Part 2 of the report describes a highly probable pathway for the laboratory creation of SARS-CoV-2, key steps of which are supported by evidence present in the viral genome. Importantly, part 2 should be viewed as a demonstration of how SARS-CoV-2 could be conveniently created in a laboratory in a short period of time using available materials and well-documented techniques. This report is produced by a team of experienced scientists using our combined expertise in virology, molecular biology, structural biology, computational biology, vaccine development, and medicine.
JH: 2. On the capacity to predict function from genotype. Line 28: Yan et al overstate the capabilities of deducing functional changes from genetic manipulation of coronaviruses, referring to an "abundant literature indicat[ing] that gain-of-function research has long advanced to the stage where viral genomes can be precisely engineered and manipulated to enable the creation of novel coronaviruses possessing unique properties."10 Technologies like CRISPR have enabled precise, directed gene editing, and are major advances for the biological sciences. However, the report overstates current capabilities in designing phenotypes and genetic functions of viruses, which are not already elucidated, including coronaviruses, and vastly overstates the capabilities of genetic manipulation of coronaviruses in 2019, before these viruses were the focus of worldwide interrogation by the scientific community. There were 6 coronaviruses known to infect humans prior to 2020, but their prevalence and pathology in different age groups is incompletely understood, which would hamper any potential design of novel coronavirus functions. Prior to 2020, coronaviruses were not as intensely researched as other viruses that cause human disease, such as HIV, and influenza.JH: 3. Lack of current evidence countering natural origin theory. Line 27: Yan et al refer to an extensive scientific literature providing "genomic, structural, and literature evidence"10 to counter the prevailing theory in the scientific community that the origin of SARS-CoV-2 is a natural zoonosis, emerging from animals, but they do not cite any references to support their claim-a crucial basic practice for any researcher.
1. Has SARS-CoV-2 been subjected to in vitro manipulation?
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We present three lines of evidence to support our contention that laboratory manipulation is part of the history of SARS-CoV-2:
i. The genomic sequence of SARS-CoV-2 is suspiciously similar to that of a bat coronavirus discovered by military laboratories in the Third Military Medical University (Chongqing, China) and the Research Institute for Medicine of Nanjing Command (Nanjing, China).
JH: 2. Role of Chinese military lab. Lines 4-6: The United States has a number of high-containment laboratories in which viruses can be studied safely with engineering controls, including negative air pressure. Some of these labs are located at military laboratories, such as the US Army Medical Research Institute of Infectious Diseases in Frederick, Maryland. China, France, Germany, India, Russia, the United Kingdom, and many other countries similarly have laboratories operated by military researchers that are declared to the Biological Weapons Convention in confidencebuilding measures. Scientific investigation in military laboratories is not uncommon; coronavirus research performed in a Chinese military research institute is not in itself suspicious, as asserted by Yan et al.
TA9: The JH comments are out of numerical sequence when placed in the context of the Yan report. This probably reflects the priority of the comments offered in the group. This is the second most important comment in the group.
TA10: Many young researchers or those that are extremely isolated are not aware of the depth and breadth of military funded projects around the world. It is an unfortunate fact of life in high technology. This is why the concept of Dual Use is so important that was adopted in the last century but lost in this new century. This comment seems off topic but it is relevant because it is unclear what various military and intelligence organizations from around the world have concluded relative to the source of COVID-19 because the information may be classified. As the years click by history may reveal if there is additional information on the source of COVID-19.
ii. The receptor-binding motif (RBM) within the Spike protein of SARS-CoV-2, which determines the host specificity of the virus, resembles that of SARS-CoV from the 2003 epidemic in a suspicious manner. Genomic evidence suggests that the RBM has been genetically manipulated. iii. SARS-CoV-2 contains a unique furin-cleavage site in its Spike protein, which is known to greatly enhance viral infectivity and cell tropism. Yet, this cleavage site is completely absent in this particular class of coronaviruses found in nature. In addition, rare codons associated with this additional sequence suggest the strong possibility that this furin-cleavage site is not the product of natural evolution and could have been inserted into the SARS-CoV-2 genome artificially by techniques other than simple serial passage or multi-strain recombination events inside co-infected tissue cultures or animals.
JH: 3. Furin cleavage sites in coronaviruses. Lines 10-16: The authors assert that a furin cleavage site in its Spike protein is absent in coronaviruses found in nature, which is not the case.* This is fairly common in other coronaviruses16; MERS has a furin cleavage site17 within Spike. * The original version of this report included an editing error in this paragraph. It was updated on 10/14/20.
1.1 Genomic sequence analysis reveals that ZC45, or a closely related bat coronavirus, should be the backbone used for the creation of SARS-CoV-2
TA11: This paragraph numbering is typically found in USA government information products. It dates back to the the Data Item Descriptions for document preparation used extensively since the 1970's up until the PC revolution that replaced publication departments in most organizations. The paragraph name reflects a technique used to prepare thematic based information products as first introduced in Sequential Thematic Organization of Publications (STOP) in 1962. Some with extensive high technology government background have adopted this approach for preparing many information products but they do not apply a theme topic at the paragraph level unless it is a STOP proposal. Unfortunately some extreme right wing foundations have adopted this very powerful publication approach to further political agendas like government privatization. Many young systems oriented researchers get caught up in these institutions not realizing their work is being filtered to further an agenda. This looks similar to an Internet Frequently Asked Question (FAQ) but it is not, because it makes a bold standalone assertion that is then discussed in text and graphics that follow the thematic assertion. However, the review focus must remain on the technical content, even if it is flawed and comes from compromised sources, because it informs the technical research. The broader research just might miss something that is disclosed in this research.
The structure of the ~30,000 nucleotides-long SARS-CoV-2 genome is shown in Figure 1. Searching the NCBI sequence database reveals that, among all known coronaviruses, there were two related bat coronaviruses, ZC45 and ZXC21, that share the highest sequence identity with SARS-CoV-2 (each bat coronavirus is ~89% identical to SARS-CoV-2 on the nucleotide level). Similarity between the genome of SARS-CoV-2 and those of representative [B beta] coronaviruses is depicted in Figure 1. ZXC21, which is 97% identical to and shares a very similar profile with ZC45, is not shown. Note that the RaTG13 virus is excluded from this analysis given the strong evidence suggesting that its sequence may have been fabricated and the virus does not exist in nature2,6-9. (A follow-up report, which summarizes the up-to-date evidence proving the spurious nature of RaTG13, will be submitted soon)
JH: 1. On implausibility of the proposed viral genetic backbone. Lines 19-20: Scientific evidence suggests that many coronaviruses12 similar to SARS-CoV-2 have a recent common ancestor or that convergent evolution13 has occurred. Many coronaviruses infect bats and other animals, most of which have not been analyzed, so the evolutionary record has gaps until more samples are collected. Convergent evolution14 refers to the evolution of similar traits in independent organisms. Yan et al do not attempt to refute the prevailing scientific evidence on viral evolution, but assert that ZC45, a coronavirus with over 3,000 punctuated, broadly distributed nucleotide differences from SARS-CoV-2 (a significantly large number of differences), could have been used as a "backbone" or template to produce SARS-CoV-2 synthetically. ZC45 is a beta coronavirus15 isolated from a bat between 2015 and 2017 in Zhoushan city, Zhejiang province, China. ZC45 and ZXC21 were both discovered and characterized in to better understand animal reservoirs of SARS-like coronaviruses. No explanation is given for how the over 3,000 nucleotide differences SARS-CoV-2 and ZC45 could be produced; this process would be highly challenging for deliberate engineering.
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Figure 1. Genomic sequence analysis reveals that bat coronavirus ZC45 is the closest match to SARS-CoV-2. Top: genomic organization of SARS-CoV-2 (2019-nCoV WIV04). Bottom: similarity plot based on the full-length
JH: 4. Dissimilarities between SARS-CoV-2 and ZC45. Figure 1.1: The report features a figure comparing sequences of various coronavirus strains. The figure's data appear accurate and demonstrate a high degree of dissimilarity between ZC45 and SARS-CoV-2, particularly in ORF1a, but the conclusion made by the authors in the text is that the strains are similar. Neither the figure nor the text clarify which genome serves as the reference.
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genome of 2019-nCoV WIV04. Full-length genomes of SARS-CoV BJ01, bat SARSr-CoV WIV1, bat SARSr-CoV HKU3-1, bat coronavirus ZC45 were used as reference sequences.
When SARS-CoV-2 and ZC45/ZXC21 are compared on the amino acid level, a high sequence identity is observed for most of the proteins. The Nucleocapsid protein is 94% identical. The Membrane protein is 98.6% identical. The S2 portion (2nd half) of the Spike protein is 95% identical. Importantly, the Orf8 protein is 94.2% identical and the E protein is 100% identical.
Orf8 is an accessory protein, the function of which is largely unknown in most coronaviruses, although recent data suggests that Orf8 of SARS-CoV-2 mediates the evasion of host adaptive immunity by downregulating MHC-I24. Normally, Orf8 is poorly conserved in coronaviruses25. Sequence blast indicates that, while the Orf8 proteins of ZC45/ZXC21 share a 94.2% identity with SARS-CoV-2 Orf8, no other coronaviruses share more than 58% identity with SARS-CoV-2 on this particular protein. The very high homology here on the normally poorly conserved Orf8 protein is highly unusual.
JH: 2. Also, lines 11-13: ZC45 and ZXC21 seem to have an 94% identity with ORF8, which is greater than with other circulating coronaviruses (59%), but this is still quite low. ORF8 has been identified20 as a protein of interest in aiding in virus assembly/packaging. Yan et al argue that SARS-CoV-2 is suspiciously similar to SARS-CoV-1, yet these 2 viruses contain less than 20% similarity in their ORF8 sequences.
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Figure 2. Sequence alignment of the E proteins from different [B beta] coronaviruses demonstrates the E protein's permissiveness and tendency toward amino acid mutations. A. Mutations have been observed in different strains of SARS-CoV. GenBank accession numbers: SARS_GD01: AY278489.2, SARS_ExoN1: ACB69908.1, SARS_TW_GD1: AY451881.1, SARS_Sino1_11: AY485277.1. B. Alignment of E proteins from related bat coronaviruses indicates its tolerance of mutations at multiple positions. GenBank accession numbers: Bat_AP040581.1: APO40581.1, RsSHC014: KC881005.1, SC2018: MK211374.1, Bat_NP_828854.1: NP_828854.1, BtRs-BetaCoV/HuB2013: AIA62312.1, BM48-31/BGR/2008: YP_003858586.1. C. While the early copies of SARS-CoV-2 share 100% identity on the E protein with ZC45 and ZXC21, sequencing data of SARS-CoV2 from April 2020 indicates that mutation has occurred at multiple positions. Accession numbers of viruses: Feb_11: MN997409, ZC45: MG772933.1, ZXC21: MG772934, Apr_13: MT326139, Apr_15_A: MT263389, Apr_15_B: MT293206, Apr_17: MT350246. Alignments were done using the MultAlin webserver
(http://multalin.toulouse.inra.fr/multalin/).
JH: 1. Similarity of ORF8 between SARS-CoV-2 and ZC45. Lines 9-14. The authors' assertion that the similarity between the ORF8 gene in SARS-CoV-2 and ZC45 is unnatural (relative to sequence conservation among coronaviruses) is not supported by evidence presented. While the sequence of ORF8 varies among coronaviruses, its function is not well characterized.18 In line 10, the authors report that ORF8 may be involved in SARS-CoV-2's ability to evade the host immune response (and thus affect pathogenicity). They then suggest that ORF8 is usually dissimilar among different coronavirus strains, based on a paper by Muth et al19 that studied deletions in ORF8 during the 2003 SARS-CoV-1 epidemic. Muth et al found that a deletion of 29 nucleotides in ORF8 of SARS-CoV-1 attenuated the virus by decreasing the virus's ability to replicate. A recent paper20 identified the role of ORF8 in pathogenesis of SARS-CoV-2 as potentially playing a role in viral maturation and assembly. Importantly, this study on ORF8 was published after the emergence of SARS-CoV-2, whose mode of action is still not fully understood; this timeline does not align with Yan and colleagues' proposed timeline of events. Furthermore, the authors fail to consider the level of similarity in ORF8 between viral variants of the same strain, which could provide better context for the sequence identity between different strains. It is, therefore, inappropriate to suggest that the similarity of SARS-CoV-2 and ZC45 is unusual.
The coronavirus E protein is a structural protein, which is embedded in and lines the interior of the membrane envelope of the virion26. The E protein is tolerant of mutations as evidenced in both SARS (Figure 2A) and related bat coronaviruses (Figure 2B). This tolerance to amino acid mutations of the E
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protein is further evidenced in the current SARS-CoV-2 pandemic. After only a short two-month spread of the virus since its outbreak in humans, the E proteins in SARS-CoV-2 have already undergone mutational changes. Sequence data obtained during the month of April reveals that mutations have occurred at four different locations in different strains (Figure 2C). Consistent with this finding, sequence blast analysis indicates that, with the exception of SARS-CoV-2, no known coronaviruses share 100% amino acid sequence identity on the E protein with ZC45/ZXC21 (suspicious coronaviruses published after the start of the current pandemic are excluded18,27-31). Although 100% identity on the E protein has been observed between SARS-CoV and certain SARS-related bat coronaviruses, none of those pairs simultaneously share over 83% identity on the Orf8 protein32. Therefore, the 94.2% identity on the Orf8 protein, 100% identity on the E protein, and the overall genomic/amino acid-level resemblance between SARS-CoV-2 and ZC45/ZXC21 are highly unusual. Such evidence, when considered together, is consistent with a hypothesis that the SARS-CoV-2 genome has an origin based on the use of ZC45/ZXC21 as a backbone and/or template for genetic gain-of-function modifications.
JH: 1. Mischaracterization of sequence homology data. Lines 9-10, referring to Figure 2: The authors present a variety of homology data that are superfluous, internally inconsistent, or misinterpreted in the text. For example, the authors state that the E protein, which plays a minimal role in pathogenesis, is highly variable; however, the Figure 2 shows a fairly stable amino acid sequence. In lines 4-5, the authors state that SARS-CoV-2's E gene is highly permissible to mutations because in a 2-month period there have been 4 nonsynonymous mutations. They use this to suggest it is suspicious that early SARS-CoV-2 samples had identical identity to the purported "backbone" viruses, when SARS-CoV-2 is able to tolerate nonsynonymous mutations to the E gene and, therefore, it would be unlikely for SARS-CoV-2 to have evolved naturally to have 100% sequence identity. However, this analysis does not consider the selection bias in the samples' sequences and gaps in the existing phylogenetic trees. It is acknowledged in the field that there are gaps in the phylogenetic trees of the coronavirus family, making it difficult to determine accurately the likelihood of similarity between 2 viral variants. Additionally, Figure 2 shows only 1 sequence from an early time point in the pandemic and 4 samples from April. If other samples from February were to be included, then there might not be 100% amino acid sequence identity between SARS-CoV-2 samples and ZC45 and ZXC21. Finally, 2 strains of coronaviruses showing identical sequences in a particular gene could be an example of convergent evolution.21
Importantly, ZC45 and ZXC21 are bat coronaviruses that were discovered (between July 2015 and February 2017), isolated, and characterized by military research laboratories in the Third Military Medical University (Chongqing, China) and the Research Institute for Medicine of Nanjing Command (Nanjing, China). The data and associated work were published in 201833,34. Clearly, this backbone/template, which is essential for the creation of SARS-CoV-2, exists in these and other related research laboratories.
What strengthens our contention further is the published RaTG13 virus18, the genomic sequence of which is reportedly 96% identical to that of SARS-CoV-2. While suggesting a natural origin of SARSCoV-2, the RaTG13 virus also diverted the attention of both the scientific field and the general public away from ZC45/ZXC214,18. In fact, a Chinese BSL-3 lab (the Shanghai Public Health Clinical Centre), which published a Nature article reporting a conflicting close phylogenetic relationship between SARSCoV-2 and ZC45/ZXC21 rather than with RaTG1335, was quickly shut down for "rectification"36. It is believed that the researchers of that laboratory were being punished for having disclosed the SARS-CoV2-ZC45/ZXC21 connection. On the other hand, substantial evidence has accumulated, pointing to severe problems associated with the reported sequence of RaTG13 as well as questioning the actual existence of this bat virus in nature6,7,19-21. A very recent publication also indicated that the receptor-binding domain (RBD) of the RaTG13's Spike protein could not bind ACE2 of two different types of horseshoe bats (they closely relate to the horseshoe bat R. affinis, RaTG13's alleged natural host)2, implicating the inability of RaTG13 to infect horseshoe bats. This finding further substantiates the suspicion that the reported sequence of RaTG13 could have been fabricated as the Spike protein encoded by this sequence does not seem to carry the claimed function. The fact that a virus has been fabricated to shift the attention away from ZC45/ZXC21 speaks for an actual role of ZC45/ZXC21 in the creation of SARS-CoV-2.
JH: 2. Binding with ACE2. Lines 31-34: In a discussion about whether RaTG13 can bind various ACE2 homologs from different types of horseshoe bats, the authors neglect to point out that the ACE2 homolog of the specific species of horseshoe bat from which RaTG13 was isolated was not included in the cited binding studies. This makes conclusions about whether RaTG13 can bind ACE2 homologues incomplete.
1.2 The receptor-binding motif of SARS-CoV-2 Spike cannot be born from nature and should have been created through genetic engineering
The Spike proteins decorate the exterior of the coronavirus particles. They play an important role in infection as they mediate the interaction with host cell receptors and thereby help determine the host range and tissue tropism of the virus. The Spike protein is split into two halves (Figure 3). The front or Nterminal half is named S1, which is fully responsible for binding the host receptor. In both SARS-CoV and SARS-CoV-2 infections, the host cell receptor is hACE2. Within S1, a segment of around 70 amino acids makes direct contacts with hACE2 and is correspondingly named the receptor-binding motif (RBM) (Figure 3C). In SARS-CoV and SARS-CoV-2, the RBM fully determines the interaction with hACE2. The C-terminal half of the Spike protein is named S2. The main function of S2 includes maintaining trimer formation and,
JH: 3. Binding of Rhinolophus affinis ACE 2. Lines 34-36: Research22 has shown that the receptorbinding domain of SARS-CoV-2 binds human, pangolin, and Rhinolophus macrotis bat ACE2 receptors optimally, and that the receptor-binding domain of Rhinolophus affinis, a type of horseshoe bat, did not bind the ACE2 of orthologous (different) horseshoe bat species' ACE2. R affinis ACE2 has not been well characterized, so it could not be tested. This is interesting work in progress but does not provide substantive conclusions about the provenance of SARS-CoV-2.
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upon successive protease cleavages at the S1/S2 junction and a downstream S2' position, mediating membrane fusion to enable cellular entry of the virus.
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Figure 3. Structure of the SARS Spike protein and how it binds to the hACE2 receptor. Pictures were generated based on PDB ID: 6acj37. A) Three spike proteins, each consisting of a S1 half and a S2 half, form a trimer. B) The S2 halves (shades of blue) are responsible for trimer formation, while the S1 portion (shades of red) is responsible for binding hACE2 (dark gray). C) Details of the binding between S1 and hACE2. The RBM of S1, which is important and sufficient for binding, is colored in orange. Residues within the RBM that are important for either hACE2 interaction or protein folding are shown as sticks (residue numbers follow the SARS Spike sequence).
JH: 1. Missing methods section. The report is missing a methods section, which is typically included in review articles23 and allows for critical review of the process by which the articles reviewed were chosen. Information should be included about how the alignments were created, sequence quality, and adjustments for sampling bias-all factors that affect the results and conclusions.
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Figure 4. Sequence alignment of the spike proteins from relevant coronaviruses. Viruses being compared include SARS-CoV-2 (Wuhan-Hu-1: NC_045512, 2019-nCoV_USA-AZ1: MN997409), bat coronaviruses (Bat_CoV_ZC45: MG772933, Bat_CoV_ZXC21: MG772934), and SARS coronaviruses (SARS_GZ02: AY390556, SARS: NC_004718.3). Region marked by two orange lines is the receptor-binding motif (RBM), which is important for interaction with the hACE2 receptor. Essential residues are additionally highlighted by red sticks on top. Region marked by two green lines is a furin-cleavage site that exists only in SARS-CoV-2 but not in any other lineage B [B beta] coronavirus.
JH: No comments provided. The comments on page 8 are offered.
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Similar to what is observed for other viral proteins, S2 of SARS-CoV-2 shares a high sequence identity (95%) with S2 of ZC45/ZXC21. In stark contrast, between SARS-CoV-2 and ZC45/ZXC21, the S1 protein, which dictates which host (human or bat) the virus can infect, is much less conserved with the amino acid sequence identity being only 69%.
JH: 1. On variability of Spike sequences. Lines 1-13: There are various judgments about the similarity of SARS-CoV-2 sequences to other related viruses (ZC45 and ZXC21), but no inclusion of contrasting evidence. For example, S2 is not highly variable among coronaviruses,24 but S1 is only a 69% match, making the claims that ZC45 was used as a template not credible. Convergent evolution, seen in several other viruses,25,26 including SARS-CoV-1,27 often as a virulence factor, should be considered by the authors.
Figure 4 shows the sequence alignment of the Spike proteins from six [B beta] coronaviruses. Two are viruses isolated from the current pandemic (Wuhan-Hu-1, 2019-nCoV_USA-AZ1); two are the suspected template viruses (Bat_CoV_ZC45, Bat_CoV_ZXC21); two are SARS coronaviruses (SARS_GZ02, SARS). The RBM is highlighted in between two orange lines. Clearly, despite the high sequence identity for the overall genomes, the RBM of SARS-CoV-2 differs significantly from those of ZC45 and ZXC21. Intriguingly, the RBM of SARS-CoV-2 resembles, on a great deal, the RBM of SARS Spike. Although this is not an exact "copy and paste", careful examination of the Spike-hACE2 structures37,38 reveals that all residues essential for either hACE2 binding or protein folding (orange sticks in Figure 3C and what is highlighted by red short lines in Figure 4) are "kept". Most of these essential residues are precisely preserved, including those involved in disulfide bond formation (C467, C474) and electrostatic interactions (R444, E452, R453, D454), which are pivotal for the structural integrity of the RBM (Figure 3C and 4). The few changes within the group of essential residues are almost exclusively hydrophobic "substitutions" (I428'L, L443'F, F460'Y, L472'F, Y484'Q), which should not affect either protein folding or the hACE2-interaction. At the same time, majority of the amino acid residues that are non-essential have "mutated" (Figure 4, RBM residues not labeled with short red lines). Judging from this sequence analysis alone, we were convinced early on that not only would the SARS-CoV-2 Spike protein bind hACE2 but also the binding would resemble, precisely, that between the original SARS Spike protein and hACE223. Recent structural work has confirmed our prediction39.
JH: 2. On substitution mutations within the Spike protein. Lines 16-18: Substitution mutations that are hydrophobic and classified as minor in the report, are structurally significant and not minor; many mutations are lysines to phenylalanines, which alter structure, or phenylalanine to tyrosine which alter the charge of the side group.
As elaborated below, the way that SARS-CoV-2 RBM resembles SARS-CoV RBM and the overall sequence conservation pattern between SARS-CoV-2 and ZC45/ZXC21 are highly unusual. Collectively, this suggests that portions of the SARS-CoV-2 genome have not been derived from natural quasi-species viral particle evolution.
JH: 3. Quasiviruses and evolution of RNA viruses. Lines 23-26: The authors make teleological assumptions in this passage. "As elaborated below, the way that SARS-CoV-2 RBM [receptorbinding motif] resembles SARS-CoV RBM and the overall sequence conservation pattern between SARS-CoV-2 and ZC45/ZXC21 are highly unusual. Collectively, this suggests that portions of the SARS-CoV-2 genome have not been derived from natural quasi-species viral particle evolution."10 Currently, not enough is understood about SARS quasispecies28 to argue definitively that a certain population arose from another or to eliminate the possibility of said evolution. Many of the Yan and colleagues' arguments could be explained by a mixture of convergent evolution, quasispecies, sampling bias, methodology issues, and/or a common ancestor.
If SARS-CoV-2 does indeed come from natural evolution, its RBM could have only been acquired in one of the two possible routes: 1) an ancient recombination event followed by convergent evolution or 2) a natural recombination event that occurred fairly recently.
In the first scenario, the ancestor of SARS-CoV-2, a ZC45/ZXC21-like bat coronavirus would have recombined and "swapped" its RBM with a coronavirus carrying a relatively "complete" RBM (in reference to SARS). This recombination would result in a novel ZC45/ZXC21-like coronavirus with all the gaps in its RBM "filled" (Figure 4). Subsequently, the virus would have to adapt extensively in its new host, where the ACE2 protein is highly homologous to hACE2. Random mutations across the genome would have to have occurred to eventually shape the RBM to its current form - resembling SARS-CoV RBM in a highly intelligent manner. However, this convergent evolution process would also result in the accumulation of a large amount of mutations in other parts of the genome, rendering the overall sequence identity relatively low. The high sequence identity between SARS-CoV-2 and ZC45/ZXC21 on various proteins (94-100% identity) do not support this scenario and, therefore, clearly indicates that SARS-CoV2 carrying such an RBM cannot come from a ZC45/ZXC21-like bat coronavirus through this convergent evolutionary route.
In the second scenario, the ZC45/ZXC21-like coronavirus would have to have recently recombined and swapped its RBM with another coronavirus that had successfully adapted to bind an animal ACE2 highly homologous to hACE2. The likelihood of such an event depends, in part, on the general requirements of
JH: 4. Viral recombination. Lines 30, 31, and 43: The description of viral recombination does not accurately describe how this process occurs in viruses.29,30 Viral recombination is a complex event,31 which is not a "swapping" of entire genes, as the authors suggest, but a common, important part of viral evolution.29 Reassortment can occur, but only in segmented, positivesense RNA viruses. It is likely that ancestors of SARS-CoV-2 underwent viral recombination, though this is not necessarily a complete exchange of entire gene segments.
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natural recombination: 1) that the two different viruses share significant sequence similarity; 2) that they must co-infect and be present in the same cell of the same animal; 3) that the recombinant virus would not be cleared by the host or make the host extinct; 4) that the recombinant virus eventually would have to become stable and transmissible within the host species.
In regard to this recent recombination scenario, the animal reservoir could not be bats because the ACE2 proteins in bats are not homologous enough to hACE2 and therefore the adaption would not be able to yield an RBM sequence as seen in SARS-CoV-2. This animal reservoir also could not be humans as the ZC45/ZXC21-like coronavirus would not be able to infect humans. In addition, there has been no evidence of any SARS-CoV-2 or SARS-CoV-2-like virus circulating in the human population prior to late 2019. Intriguingly, according to a recent bioinformatics study, SARS-CoV-2 was well-adapted for humans since the start of the outbreak1.
JH: 1. The potential for zoonotic emergence of coronaviruses. Line 9: There is not enough information available in the scientific literature to know whether strains related to SARS-CoV-2 may infect humans or if infections are possible but limited. Therefore, statements made by the authors about the infectivity of ZC45 are unsupported.
Only one other possibility of natural evolution remains, which is that the ZC45/ZXC21-like virus and a coronavirus containing a SARS-like RBM could have recombined in an intermediate host where the ACE2 protein is homologous to hACE2. Several laboratories have reported that some of the Sunda pangolins smuggled into China from Malaysia carried coronaviruses, the receptor-binding domain (RBD) of which is almost identical to that of SARS-CoV-227-29,31. They then went on to suggest that pangolins are the likely intermediate host for SARS-CoV-227-29,31. However, recent independent reports have found significant flaws in this data40-42. Furthermore, contrary to these reports27-29,31, no coronaviruses have been detected in Sunda pangolin samples collected for over a decade in Malaysia and Sabah between 2009 and 201943. A recent study also showed that the RBD, which is shared between SARS-CoV-2 and the reported pangolin coronaviruses, binds to hACE2 ten times stronger than to the pangolin ACE22, further dismissing pangolins as the possible intermediate host. Finally, an in silico study, while echoing the notion that pangolins are not likely an intermediate host, also indicated that none of the animal ACE2 proteins examined in their study exhibited more favorable binding potential to the SARS-CoV-2 Spike protein than hACE2 did3. This last study virtually exempted all animals from their suspected roles as an intermediate host3, which is consistent with the observation that SARS-CoV-2 was well-adapted for humans from the start of the outbreak1. This is significant because these findings collectively suggest that no intermediate host seems to exist for SARS-CoV-2, which at the very least diminishes the possibility of a recombinant event occurring in an intermediate host.
JH: 2. On intermediate hosts in viral evolution. Lines 21-23: Viruses can have complicated evolutionary origins, sometimes with intermediate hosts,32 as seen with influenza33; influenza viruses34 are also known to crossover into humans. The human ACE2 (hACE2) receptor may be optimal for SARS-CoV-2, but recent work has found that SARS-CoV-2 can actually use multiple ACE2 receptors,4 but not mice ACE2. More sampling needs to be done, but assertions about whether the hACE2 is the best receptor to bind SARS-CoV-2 cannot be supported at this time.
Even if we ignore the above evidence that no proper host exists for the recombination to take place and instead assume that such a host does exist, it is still highly unlikely that such a recombination event could occur in nature.
As we have described above, if natural recombination event is responsible for the appearance of SARSCoV-2, then the ZC45/ZXC21-like virus and a coronavirus containing a SARS-like RBM would have to recombine in the same cell by swapping the S1/RBM, which is a rare form of recombination. Furthermore, since SARS has occurred only once in human history, it would be at least equally rare for nature to produce a virus that resembles SARS in such an intelligent manner - having an RBM that differs from the SARS RBM only at a few non-essential sites (Figure 4). The possibility that this unique SARS-like coronavirus would reside in the same cell with the ZC45/ZXC21-like ancestor virus and the two viruses would recombine in the "RBM-swapping" fashion is extremely low. Importantly, this, and the other recombination event described below in section 1.3 (even more impossible to occur in nature), would both have to happen to produce a Spike as seen in SARS-CoV-2.
JH: 3. Zoonotic emergence of coronaviruses in history. Lines 36-38: Coronaviruses have caused human disease before, including SARS and MERS, and many have pointed to warning signs that coronaviruses could become a serious problem, which were not heeded prior to SARS-CoV-2. These facts are contradicted by the authors who also describe SARS-CoV-2 as "intelligent," which is teleological and counterfactual.
While the above evidence and analyses together appear to disapprove a natural origin of SARS-CoV2's RBM, abundant literature shows that gain-of-function research, where the Spike protein of a coronavirus
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was specifically engineered, has repeatedly led to the successful generation of humaninfecting coronaviruses from coronaviruses of non-human origin44-47.
JH: 1. Lack of evidence regarding gain of function research in coronaviruses. Line 2: Some gain of function research using coronaviruses has been published, but the author's statement of an "abundant" literature in this area overstates the amount known. The papers referenced do not support the author's claim that such research led to human competent viruses. One paper, Ren et al,35 inserted the Spike protein gene of all SARS-CoV-like viruses (not SARS) into a viral backbone and did not use the entire SARS virus or infect live animals.
Record also shows that research laboratories, for example, the Wuhan Institute of Virology (WIV), have successfully carried out such studies working with US researchers45 and also working alone47. In addition, the WIV has engaged in decades-long coronavirus surveillance studies and therefore owns the world's largest collection of coronaviruses. Evidently, the technical barrier is non-existent for the WIV and other related laboratories to carry out and succeed in such Spike/RBM engineering and gain-offunction research.
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Figure 5. Two restriction sites are present at either end of the RBM of SARS-CoV-2, providing convenience for replacing the RBM within the spike gene. A. Nucleotide sequence of the RBM of SARS-CoV-2 (Wuhan-Hu-1). An EcoRI site is found at the 5'-end of the RBM and a BstEII site at the 3'-end. B. Although these two restriction sites do not exist in the original spike gene of ZC45, they can be conveniently introduced given that the sequence discrepancy is small (2 nucleotides) in either case. C. Amino acid sequence alignment with the RBM region highlighted (color and underscore). The RBM highlighted in orange (top) is what is defined by the EcoRI and BstEII sites in the SARS-CoV-2 (Wuhan-Hu-1) spike. The RBM highlighted in magenta (middle) is the region swapped by Dr. Fang Li and colleagues into a SARS Spike backbone39. The RBM highlighted in blue (bottom) is from the Spike protein (RBM: 424-494) of SARS-BJ01 (AY278488.2), which was swapped by the Shi lab into the Spike proteins of different bat coronaviruses replacing the corresponding segments47.
JH: 2. Lack of restriction sites in the proposed viral backbone ZC45. Figure 5: The authors describe a possible pathway for designing viruses that is out of step with current scientific methods for gene editing, casting doubt on both their analysis and their conclusions. While use of restriction sites as presented are theoretically possible in SARS-CoV-2, based on the authors' own analysis, ZC45 does not have the necessary restriction sites (of EcoRI and BstEII). Therefore, ZC45 would have to be genetically modified beyond the sequence presented for a restriction digestion to be possible. This negates the authors' argument that ZC45 is the obvious backbone of SARS-CoV-2. Restriction digests are not favored for manipulation of RNA viruses due to several obstacles: genome sizes, viral proofreading enzymes that can limit the success of restriction enzymes, and the ability to recover viruses after reverse genetic manipulation.
Strikingly, consistent with the RBM engineering theory, we have identified two unique restriction sites, EcoRI and BstEII, at either end of the RBM of the SARS-CoV-2 genome, respectively (Figure 5A). These two sites, which are popular choices of everyday molecular cloning, do not exist in the rest of this spike
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gene. This particular setting makes it extremely convenient to swap the RBM within spike, providing a quick way to test different RBMs and the corresponding Spike proteins.
Such EcoRI and BstEII sites do not exist in the spike genes of other [B beta] coronaviruses, which strongly indicates that they were unnatural and were specifically introduced into this spike gene of SARS-CoV-2 for the convenience of manipulating the critical RBM. Although ZC45 spike also does not have these two sites (Figure 5B), they can be introduced very easily as described in part 2 of this report.
It is noteworthy that introduction of the EcoRI site here would change the corresponding amino acids from -WNT- to -WNS- (Figure 5AB). As far as we know, all SARS and SARS-like bat coronaviruses exclusively carry a T (threonine) residue at this location. SARS-CoV-2 is the only exception in that this T has mutated to an S (serine), save the suspicious RaTG13 and pangolin coronaviruses published after the outbreak48.
JH: 1. On restriction sites present within the Spike protein. Lines 6-9: Restriction enzyme sites are found in all genomes and naturally occur frequently.36,37 For instance, in a commonly used adenovirus vector, the BstEII restriction enzyme site occurs 10 times. The frequency of restriction site distribution is due to the fact that they comprise stretches of 6 or 8 consecutive nucleotides, which have high-and measurable-probabilities of occurring by chance within a given genome. With contemporary gene-editing methodologies, restriction sites are rarely used. These arguments aside, Yan and colleagues falsely assert the existence of restriction enzyme sites in the SARS-CoV-2 sequence, but not in the Spike gene sequence of other beta coronaviruses, is evidence of genetic manipulation, or that the presence of restriction sites is rare. A New England BioLabs site search for restriction enzyme sites in the 5' end of the SARS-CoV-2 sequence revealed at least 7 other restriction sites in the RBM, in addition to the EcoRI site Yan et al cited as evidence of manipulation.
Once the restriction sites were successfully introduced, the RBM segment could be swapped conveniently using routine restriction enzyme digestion and ligation. Although alternative cloning techniques may leave no trace of genetic manipulation (Gibson assembly as one example), this oldfashioned approach could be chosen because it offers a great level of convenience in swapping this critical RBM.
Given that RBM fully dictates hACE2-binding and that the SARS RBM-hACE2 binding was fully characterized by high-resolution structures (Figure 3)37,38, this RBM-only swap would not be any riskier than the full Spike swap. In fact, the feasibility of this RBM-swap strategy has been proven39,47. In 2008, Dr. Zhengli Shi's group swapped a SARS RBM into the Spike proteins of several SARS-like bat coronaviruses after introducing a restriction site into a codon-optimized spike gene (Figure 5C)47. They then validated the binding of the resulted chimeric Spike proteins with hACE2. Furthermore, in a recent publication, the RBM of SARS-CoV-2 was swapped into the receptor-binding domain (RBD) of SARSCoV, resulting in a chimeric RBD fully functional in binding hACE2 (Figure 5C)39. Strikingly, in both cases, the manipulated RBM segments resemble almost exactly the RBM defined by the positions of the EcoRI and BstEII sites (Figure 5C). Although cloning details are lacking in both publications39,47, it is conceivable that the actual restriction sites may vary depending on the spike gene receiving the RBM insertion as well as the convenience in introducing unique restriction site(s) in regions of interest. It is noteworthy that the corresponding author of this recent publication39, Dr. Fang Li, has been an active collaborator of Dr. Zhengli Shi since 201049-53. Dr. Li was the first person in the world to have structurally elucidated the binding between SARS-CoV RBD and hACE238 and has been the leading expert in the structural understanding of Spike-ACE2 interactions38,39,53-56. The striking finding of EcoRI and BstEII restriction sites at either end of the SARS-CoV-2 RBM, respectively, and the fact that the same RBM region has been swapped both by Dr. Shi and by her long-term collaborator, respectively, using restriction enzyme digestion methods are unlikely a coincidence. Rather, it is the smoking gun proving that the RBM/Spike of SARS-CoV-2 is a product of genetic manipulation.
Although it may be convenient to copy the exact sequence of SARS RBM, it would be too clear a sign of artificial design and manipulation. The more deceiving approach would be to change a few nonessential residues, while preserving the ones critical for binding. This design could be well-guided by the high-resolution structures (Figure 3)37,38. This way, when the overall sequence of the RBM would appear to be more distinct from that of the SARS RBM, the hACE2-binding ability would be well-preserved. We believe that all of the crucial residues (residues labeled with red sticks in Figure 4, which are the same residues shown in sticks in Figure 3C) should have been "kept". As described earlier, while some should be direct preservation, some should have been switched to residues with similar properties, which would
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not disrupt hACE2-binding and may even strengthen the association further. Importantly, changes might have been made intentionally at non-essential sites, making it less like a "copy and paste" of the SARS RBM.
1.3 An unusual furin-cleavage site is present in the Spike protein of SARS-CoV-2 and is associated with the augmented virulence of the virus
Another unique motif in the Spike protein of SARS-CoV-2 is a polybasic furin-cleavage site located at the S1/S2 junction (Figure 4, segment in between two green lines). Such a site can be recognized and cleaved by the furin protease. Within the lineage B of [B beta] coronaviruses and with the exception of SARSCoV-2, no viruses contain a furin-cleavage site at the S1/S2 junction (Figure 6)57. In contrast, furincleavage site at this location has been observed in other groups of coronaviruses57,58. Certain selective pressure seems to be in place that prevents the lineage B of [B beta] coronaviruses from acquiring or maintaining such a site in nature.
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Figure 6. Furin-cleavage site found at the S1/S2 junction of Spike is unique to SARS-CoV-2 and absent in other lineage B [B beta] coronaviruses. Figure reproduced from Hoffmann, et al57.
As previously described, during the cell entry process, the Spike protein is first cleaved at the S1/S2 junction. This step, and a subsequent cleavage downstream that exposes the fusion peptide, are both mediated by host proteases. The presence or absence of these proteases in different cell types greatly affects the cell tropism and presumably the pathogenicity of the viral infection. Unlike other proteases, furin protease is widely expressed in many types of cells and is present at multiple cellular and extracellular
JH: No comments provided.
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locations. Importantly, the introduction of a furin-cleavage site at the S1/S2 junction could significantly enhance the infectivity of a virus as well as greatly expand its cell tropism - a phenomenon well-documented in both influenza viruses and other coronaviruses59-65.
If we leave aside the fact that no furin-cleavage site is found in any lineage B [B beta] coronavirus in nature and instead assume that this site in SARS-CoV-2 is a result of natural evolution, then only one evolutionary pathway is possible, which is that the furin-cleavage site has to be derived from a homologous recombination event. Specifically, an ancestor [B beta] coronavirus containing no furin-cleavage site would have to recombine with a closely related coronavirus that does contain a furin-cleavage site.
However, two facts disfavor this possibility. First, although some coronaviruses from other groups or lineages do contain polybasic furin-cleavage sites, none of them contains the exact polybasic sequence present in SARS-CoV-2 (-PRRAR/SVA-). Second, between SARS-CoV-2 and any coronavirus containing a legitimate furin-cleavage site, the sequence identity on Spike is no more than 40%66. Such a low level of sequence identity rules out the possibility of a successful homologous recombination ever occurring between the ancestors of these viruses. Therefore, the furin-cleavage site within the SARS-CoV-2 Spike protein is unlikely to be of natural origin and instead should be a result of laboratory modification.
JH: 1. The possibility of convergent evolution in beta coronaviruses. Lines 10-12: Yan et al state that there is only 1 evolutionary pathway that could explain the appearance of SARS-CoV-2-a homologous recombination event. However, convergent evolution is another pathway for the development of the furin cleavage site, which would result in SARS-CoV-2 having the cleavage site similar to nonbeta coronaviruses. Convergent evolution is a well-established phenomenon in biology.
JH: 2. The evolution of a furin cleavage site. Lines 14-16: The authors argue that the existence of polybasic furin cleavage sites in other coronaviruses implies that convergent evolution could not have played a role in evolution of the furin cleavage site in SARS-CoV-2. The furin cleavage site refers to a specific position at the S1/S2 junction in SARS-CoV-2. This is a sequence of amino acids where the host (human) enzyme, furin,38 can cleave. This furin cleavage is essential for the proper maturation39 of the Spike glycoprotein and subsequent cell-to-cell membrane fusion in the host. They present the divergent furin cleavage site sequence in SARS-CoV-2 as evidence that homologous recombination between an ancestor beta coronavirus and a furin cleavage sitecontaining coronavirus is impossible. The argument that homologous recombination is not a likely factor in fact supports a hypothesis of convergent evolution.
Consistent with this claim, a close examination of the nucleotide sequence of the furin-cleavage site in SARS-CoV-2 spike has revealed that the two consecutive Arg residues within the inserted sequence (PRRA-) are both coded by the rare codon CGG (least used codon for Arg in SARS-CoV-2) (Figure 7)8. In fact, this CGGCGG arrangement is the only instance found in the SARS-CoV-2 genome where this rare codon is used in tandem. This observation strongly suggests that this furin-cleavage site should be a result of genetic engineering. Adding to the suspicion, a FauI restriction site is formulated by the codon choices here, suggesting the possibility that the restriction fragment length polymorphism, a technique that a WIV lab is proficient at67, could have been involved. There, the fragmentation pattern resulted from FauI digestion could be used to monitor the preservation of the furin-cleavage site in Spike as this furincleavage site is prone to deletions in vitro68,69. Specifically, RT-PCR on the spike gene of the recovered viruses from cell cultures or laboratory animals could be carried out, the product of which would be subjected to FauI digestion. Viruses retaining or losing the furin-cleavage site would then yield distinct patterns, allowing convenient tracking of the virus(es) of interest.
JH: 3. Homologous recombination. Lines 18-19: The report states that the low sequence identity between beta coronavirus and other coronaviruses that contained a furin cleavage site would be too low to allow homologous recombination to occur. If recombination had occurred, it would not have had to have occurred in the immediate area of the sequence coding the furin cleavage site; it could occur in other, more homologous regions.
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Figure 7. Two consecutive Arg residues in the -PRRA- insertion at the S1/S2 junction of SARS-CoV-2 Spike are both coded by a rare codon, CGG. A FauI restriction site, 5'-(N)6GCGGG-3', is embedded in the coding sequence of the "inserted" PRRA segment, which may be used as a marker to monitor the preservation of the introduced furin-cleavage site.
In addition, although no known coronaviruses contain the exact sequence of -PRRAR/SVA- that is present in the SARS-CoV-2 Spike protein, a similar -RRAR/AR- sequence has been observed at the S1/S2 junction of the Spike protein in a rodent coronavirus, AcCoV-JC34, which was published by Dr. Zhengli Shi in 201770. It is evident that the legitimacy of -RRAR- as a functional furin-cleavage site has been known to the WIV experts since 2017.
The evidence collectively suggests that the furin-cleavage site in the SARS-CoV-2 Spike protein may not have come from nature and could be the result of genetic manipulation. The purpose of this manipulation could have been to assess any potential enhancement of the infectivity and pathogenicity of
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the laboratory-made coronavirus59-64. Indeed, recent studies have confirmed that the furin-cleavage site does confer significant pathogenic advantages to SARS-CoV-257,68.
1.4 Summary
Evidence presented in this part reveals that certain aspects of the SARS-CoV-2 genome are extremely difficult to reconcile to being a result of natural evolution. The alternative theory we suggest is that the virus may have been created by using ZC45/ZXC21 bat coronavirus(es) as the backbone and/or template. The Spike protein, especially the RBM within it, should have been artificially manipulated, upon which the virus has acquired the ability to bind hACE2 and infect humans. This is supported by the finding of a unique restriction enzyme digestion site at either end of the RBM. An unusual furin-cleavage site may have been introduced and inserted at the S1/S2 junction of the Spike protein, which contributes to the increased virulence and pathogenicity of the virus. These transformations have then staged the SARSCoV-2 virus to eventually become a highly-transmissible, onset-hidden, lethal, sequelae-unclear, and massively disruptive pathogen.
Evidently, the possibility that SARS-CoV-2 could have been created through gain-of-function manipulations at the WIV is significant and should be investigated thoroughly and independently.
2. Delineation of a synthetic route of SARS-CoV-2
In the second part of this report, we describe a synthetic route of creating SARS-CoV-2 in a laboratory setting. It is postulated based on substantial literature support as well as genetic evidence present in the SARS-CoV-2 genome. Although steps presented herein should not be viewed as exactly those taken, we believe that key processes should not be much different. Importantly, our work here should serve as a demonstration of how SARS-CoV-2 can be designed and created conveniently in research laboratories by following proven concepts and using well-established techniques.
Importantly, research labs, both in Hong Kong and in mainland China, are leading the world in coronavirus research, both in terms of resources and on the research outputs. The latter is evidenced not only by the large number of publications that they have produced over the past two decades but also by their milestone achievements in the field: they were the first to identify civets as the intermediate host for SARS-CoV and isolated the first strain of the virus71; they were the first to uncover that SARS-CoV originated from bats72,73; they revealed for the first time the antibody-dependent enhancement (ADE) of SARS-CoV infections74; they have contributed significantly in understanding MERS in all domains (zoonosis, virology, and clinical studies)75-79; they made several breakthroughs in SARS-CoV-2 research18,35,80. Last but not least, they have the world's largest collection of coronaviruses (genomic sequences and live viruses). The knowledge, expertise, and resources are all readily available within the Hong Kong and mainland research laboratories (they collaborate extensively) to carry out and accomplish the work described below.
JH: 1. On methods of a literature review. Typically, the scientific description of the steps to create a transmissible virus (as per the chart on page 15) would require biosecurity review before publication in a reputable scientific journal, as this is a dual-use concern,40 which has the potential to lower barriers toward biological weapons development. However, it should be noted that the steps described by Yan et al are not individually novel and, in our judgment, do not present a biological weapons risk, particularly as the methods chosen have been supplanted by more accurate genetic engineering tools.
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Figure 8 Diagram of a possible synthetic route of the laboratory creation of SARS-CoV-2
JH: No comment. See page 14 comment.
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2.1 Possible scheme in designing the laboratory-creation of the novel coronavirus
In this sub-section, we outline the possible overall strategy and major considerations that may have been formulated at the designing stage of the project.
To engineer and create a human-targeting coronavirus, they would have to pick a bat coronavirus as the template/backbone. This can be conveniently done because many research labs have been actively collecting bat coronaviruses over the past two decades32,33,70,72,81-85. However, this template virus ideally should not be one from Dr. Zhengli Shi's collections, considering that she is widely known to have been engaged in gain-of-function studies on coronaviruses. Therefore, ZC45 and/or ZXC21, novel bat coronaviruses discovered and owned by military laboratories33, would be suitable as the template/backbone. It is also possible that these military laboratories had discovered other closely related viruses from the same location and kept some unpublished. Therefore, the actual template could be ZC45, or ZXC21, or a close relative of them. The postulated pathway described below would be the same regardless of which one of the three was the actual template.
Once they have chosen a template virus, they would first need to engineer, through molecular cloning, the Spike protein so that it can bind hACE2. The concept and cloning techniques involved in this manipulation have been well-documented in the literature44-46,84,86. With almost no risk of failing, the template bat virus could then be converted to a coronavirus that can bind hACE2 and infect humans44-46.
JH: 1. On troubleshooting molecular cloning. Line 16: The authors' statement that there is "almost no risk of [molecular cloning] failing"10 contradicts experience with the technique, as it can be a finicky method41 requiring keen problem-solving skills.42
Second, they would use molecular cloning to introduce a furin-cleavage site at the S1/S2 junction of Spike. This manipulation, based on known knowledge60,61,65, would likely produce a strain of coronavirus that is a more infectious and pathogenic.
Third, they would produce an ORF1b gene construct. The ORF1b gene encodes the polyprotein Orf1b, which is processed post-translationally to produce individual viral proteins: RNA-dependent RNA polymerase (RdRp), helicase, guanidine-N7 methyltransferase, uridylate-specific endoribonuclease, and 2'-O-methyltransferase. All of these proteins are parts of the replication machinery of the virus. Among them, the RdRp protein is the most crucial one and is highly conserved among coronaviruses. Importantly, Dr. Zhengli Shi's laboratory uses a PCR protocol, which amplifies a particular fragment of the RdRp gene, as their primary method to detect the presence of coronaviruses in raw samples (bat fecal swap, feces, etc). As a result of this practice, the Shi group has documented the sequence information of this short segment of RdRp for all coronaviruses that they have successfully detected and/or collected.
JH: 2. Virology protocol inaccuracies. Lines 25-29: The report inaccurately describes some common laboratory techniques. For example, the report states that sequence information for short segments of coronavirus RNA-dependent RNA polymerase (RdRp) is possible due to the availability of a polymerase chain reaction (PCR) protocol used to identify coronaviruses. However, PCR is not a sequencing method, it only amplifies existent sequences. PCR is a common tool, used to determine if a specific DNA sequence is in a sample and, if so, how many copies of that sequence are in the sample. Using PCR to detect the presence of coronaviruses in a sample is a standard practice in research and clinical laboratories using standard coronavirusspecific primers, as the RdRp is highly conserved between coronaviruses. Approximately 28 current SARS-CoV-2 diagnostics43 with Emergency Use Authorization use this method and this specific gene target.
Here, the genetic manipulation is less demanding or complicated because Orf1b is conserved and likely Orf1b from any [B beta] coronavirus would be competent enough to do the work. However, we believe that they would want to introduce a particular Orf1b into the virus for one of the two possible reasons:
1. Since many phylogenetic analyses categorize coronaviruses based on the sequence similarity of the RdRp gene only18,31,35,83,87, having a different RdRp in the genome therefore could ensure that SARS-CoV-2 and ZC45/ZXC21 are separated into different groups/sub-lineages in phylogenetic studies. Choosing an RdRp gene, however, is convenient because the short RdRp segment sequence has been recorded for all coronaviruses ever collected/detected. Their final choice was the RdRp sequence from bat coronavirus RaBtCoV/4991, which was discovered in 2013. For RaBtCoV/4991, the only information ever published was the sequence of its short RdRp segment83, while neither its full genomic sequence nor virus isolation were ever reported. After amplifying the RdRp segment (or the whole ORF1b gene) of RaBatCoV/4991, they would have then used it for subsequent assembly and creation of the genome of SARS-CoV-2. Small changes in the RdRp sequence could either be introduced at the beginning (through DNA synthesis) or be generated via
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passages later on. On a separate track, when they were engaged in the fabrication of the RaTG13 sequence, they could have started with the short RdRp segment of RaBtCoV/4991 without introducing any changes to its sequence, resulting in a 100% nucleotide sequence identity between the two viruses on this short RdRp segment83. This RaTG13 virus could then be claimed to have been discovered back in 2013.
2. The RdRp protein from RaBatCoV/4991 is unique in that it is superior than RdRp from any other [B beta]coronavirus for developing antiviral drugs. RdRp has no homologs in human cells, which makes this essential viral enzyme a highly desirable target for antiviral development. As an example, Remedesivir, which is currently undergoing clinical trials, targets RdRp. When creating a novel and human-targeting virus, they would be interested in developing the antidote as well. Even though drug discovery like this may not be easily achieved, it is reasonable for them to intentionally incorporate a RdRp that is more amenable for antiviral drug development.
Fourth, they would use reverse genetics to assemble the gene fragments of spike, ORF1b, and the rest of the template ZC45 into a cDNA version of the viral genome. They would then carry out in vitro transcription to obtain the viral RNA genome. Transfection of the RNA genome into cells would allow the recovery of live and infectious viruses with the desired artificial genome.
Fifth, they would carry out characterization and optimization of the virus strain(s) to improve the fitness, infectivity, and overall adaptation using serial passage in vivo. One or several viral strains that meet certain criteria would then be obtained as the final product(s).
JH: 1. Serial passaging and virulence. Lines 19-20: Serial passaging refers to a process wherein a stock viral population is used to infect an animal, then virus from that animal is collected and used to infect another animal for a designated number of "passages." Serial passage of a virus causes the population to adapt to the animal or cell type in which it is being passaged. Passaging would lead to adaptation to another animal (if passaged in vivo) or, if in vitro, to the specific cell type used. Most human cells used in laboratory culture have significant differences compared to the commensurate cells in humans. Serial passage, then, would not necessarily make a virus more pathogenic to live humans. Additionally, passage does not necessarily increase fitness of a viral population. The report mischaracterizes the complexity of these processes and projects outcomes from passaging that are not supported by laboratory techniques.
2.2 A postulated synthetic route for the creation of SARS-CoV-2
In this sub-section, we describe in more details how each step could be carried out in a laboratory setting using available materials and routine molecular, cellular, and virologic techniques. A diagram of this process is shown in Figure 8. We estimate that the whole process could be completed in approximately 6 months.
Step 1: Engineering the RBM of the Spike for hACE2-binding (1.5 months)
The Spike protein of a bat coronavirus is either incapable of or inefficient in binding hACE2 due to the missing of important residues within its RBM. This can be exemplified by the RBM of the template virus ZC45 (Figure 4). The first and most critical step in the creation of SARS-CoV-2 is to engineer the Spike so that it acquires the ability to bind hACE2. As evidenced in the literature, such manipulations have been carried out repeatedly in research laboratories since 200844, which successfully yielded engineered coronaviruses with the ability to infect human cells44-46,88,89. Although there are many possible ways that one can engineer the Spike protein, we believe that what was actually undertaken was that they replaced the original RBM with a designed and possibly optimized RBM using SARS' RBM as a guide. As described in part 1, this theory is supported by our observation that two unique restriction sites, EcoRI and BstEII, exist at either end of the RBM in the SARS-CoV-2 genome (Figure 5A) and by the fact that such RBM-swap has been successfully carried out by Dr. Zhengli Shi and by her long-term collaborator and structure biology expert, Dr. Fang Li39,47.
Although ZC45 spike does not contain these two restriction sites (Figure 5B), they can be introduced very easily. The original spike gene would be either amplified with RT-PCR or obtained through DNA synthesis (some changes could be safely introduced to certain variable regions of the sequence) followed by PCR. The gene would then be cloned into a plasmid using restriction sites other than EcoRI and BstEII.
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Once in the plasmid, the spike gene can be modified easily. First, an EcoRI site can be introduced by converting the highlighted "gaacac" sequence (Figure 5B) to the desired "gaattc" (Figure 5A). The difference between them are two consecutive nucleotides. Using the commercially available QuikChange Site-Directed Mutagenesis kit, such a di-nucleotide mutation can be generated in no more than one week. Subsequently, the BstEII site could be similarly introduced at the other end of the RBM. Specifically, the "gaatacc" sequence (Figure 5B) would be converted to the desired "ggttacc" (Figure 5A), which would similarly require a week of time.
Once these restriction sites, which are unique within the spike gene of SARS-CoV-2, were successfully introduced, different RBM segments could be swapped in conveniently and the resulting Spike protein subsequently evaluated using established assays.
As described in part 1, the design of an RBM segment could be well-guided by the high-resolution structures (Figure 3)37,38, yielding a sequence that resembles the SARS RBM in an intelligent manner. When carrying out the structure-guided design of the RBM, they would have followed the routine and generated a few (for example a dozen) such RBMs with the hope that some specific variant(s) may be superior than others in binding hACE2. Once the design was finished, they could have each of the designed RBM genes commercially synthesized (quick and very affordable) with an EcoRI site at the 5'-end and a BstEII site at the 3'-end. These novel RBM genes could then be cloned into the spike gene, respectively. The gene synthesis and subsequent cloning, which could be done in a batch mode for the small library of designed RBMs, would take approximately one month.
These engineered Spike proteins might then be tested for hACE2-binding using the established pseudotype virus infection assays45,49,50. The engineered Spike with good to exceptional binding affinities would be selected. (Although not necessary, directed evolution could be involved here (error-prone PCR on the RBM gene), coupled with either an in vitro binding assay39,90 or a pseudotype virus infection assay45,49,50, to obtain an RBM that binds hACE2 with exceptional affinity.)
Given the abundance of literature on Spike engineering44-46,84,86 and the available high-resolution structures of the Spike-hACE2 complex37,38, the success of this step would be very much guaranteed. By the end of this step, as desired, a novel spike gene would be obtained, which encodes a novel Spike protein capable of binding hACE2 with high affinity.
JH: 1. Unrealistic timelines. Lines 25-29: The timeline offered for how an entirely novel protein can be engineered in a little studied virus, circa 2019, is not scientifically realistic.
Step 2: Engineering a furin-cleavage site at the S1/S2 junction (0.5 month)
The product from Step 1, a plasmid containing the engineered spike, would be further modified to include a furin-cleavage site (segment indicated by green lines in Figure 4) at the S1/S2 junction. This short stretch of gene sequence can be conveniently inserted using several routine cloning techniques, including QuikChange Site-Directed PCR60, overlap PCR followed by restriction enzyme digestion and ligation91, or Gibson assembly. None of these techniques would leave any trace in the sequence. Whichever cloning method was the choice, the inserted gene piece would be included in the primers, which would be designed, synthesized, and used in the cloning. This step, leading to a further modified Spike with the furin-cleavage site added at the S1/S2 junction, could be completed in no more than two weeks.
Step 3: Obtain an ORF1b gene that contains the sequence of the short RdRp segment from RaBtCoV/4991 (1 month, yet can be carried out concurrently with Steps 1 and 2)
Unlike the engineering of Spike, no complicated design is needed here, except that the RdRp gene segment from RaBtCoV/4991 would need to be included. Gibson assembly could have been used here. In this technique, several fragments, each adjacent pair sharing 20-40 bp overlap, are combined together in one simple reaction to assemble a long DNA product. Two or three fragments, each covering a significant
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section of the ORF1b gene, would be selected based on known bat coronavirus sequences. One of these fragments would be the RdRp segment of RaBtCoV/499183. Each fragment would be PCR amplified with proper overlap regions introduced in the primers. Finally, all purified fragments would be pooled in equimolar concentrations and added to the Gibson reaction mixture, which, after a short incubation, would yield the desired ORF1b gene in whole.
Step 4: Produce the designed viral genome using reverse genetics and recover live viruses (0.5 month)
Reverse genetics have been frequently used in assembling whole viral genomes, including coronavirus genomes67,92-96. The most recent example is the reconstruction of the SARS-CoV-2 genome using the transformation-assisted recombination in yeast97. Using this method, the Swiss group assembled the entire viral genome and produced live viruses in just one week97. This efficient technique, which would not leave any trace of artificial manipulation in the created viral genome, has been available since 201798,99. In addition to the engineered spike gene (from steps 1 and 2) and the ORF1b gene (from step 3), other fragments covering the rest of the genome would be obtained either through RT-PCR amplification from the template virus or through DNA synthesis by following a sequence slightly altered from that of the template virus. We believe that the latter approach was more likely as it would allow sequence changes introduced into the variable regions of less conserved proteins, the process of which could be easily guided by multiple sequence alignments. The amino acid sequences of more conserved functions, such as that of the E protein, might have been left unchanged. All DNA fragments would then be pooled together and transformed into yeast, where the cDNA version of the SARS-CoV-2 genome would be assembled via transformation-assisted recombination. Of course, an alternative method of reverse genetics, one of which the WIV has successfully used in the past67, could also be employed67,92-96,100. Although some earlier reverse genetics approaches may leave restriction sites at where different fragments would be joined, these traces would be hard to detect as the exact site of ligation can be anywhere in the ~30kb genome. Either way, a cDNA version of the viral genome would be obtained from the reverse genetics experiment. Subsequently, in vitro transcription using the cDNA as the template would yield the viral RNA genome, which upon transfection into Vero E6 cells would allow the production of live viruses bearing all of the designed properties.
JH: 1. Methods of genetic modification in viruses. Lines 11-12: The authors incorrectly state that reverse genetics systems are commonly used to assemble coronaviruses. Reverse genetics44 can be used in other virus synthesis, such as influenza. The paper the authors cite, from Thao and colleagues,41 did use reverse genetics in a yeast-based system to synthesize full length SARSCoV-2. However, previous research45 had identified that coronaviruses can be particularly difficult to engineer using reverse genetics systems, as the large size of Nidovirus genomes, replicase activity, and requirement for large transcript synthesis create obstacles. Certain methods require insertion of mutations elsewhere in the genome to manage the T7 transcription termination signals or require helper viruses to coinfect cells to aid in cloning. Recent work in dengue viruses46 and MERS47 has shown the promise of Gibson assembly in synthesizing positive-strand viruses.
JH: 2. Reverse genetics tools (and limitations). Lines 22-24: Reverse genetics and synthetic biology provide technological tools to synthesize SARS-CoV-2, as demonstrated by the methods section of the Thao paper.41 The yeast used for this synthesis of SARS-CoV-2 used a specific platform that depended on a mouse hepatitis virus. The description in Yan et al of pooling the DNA fragments together and "transforming" them into yeast will not work,48,49 as it would require a method known as transformation-associated recombination,50 calling into question the Yan analysis.
Step 5: Optimize the virus for fitness and improve its hACE2-binding affinity in vivo (2.5-3 months)
Virus recovered from step 4 needs to be further adapted undergoing the classic experiment - serial passage in laboratory animals101. This final step would validate the virus' fitness and ensure its receptororiented adaptation toward its intended host, which, according to the analyses above, should be human. Importantly, the RBM and the furin-cleavage site, which were introduced into the Spike protein separately, would now be optimized together as one functional unit. Among various available animal models (e.g. mice, hamsters, ferrets, and monkeys) for coronaviruses, hACE2 transgenic mice (hACE2-mice) should be the most proper and convenient choice here. This animal model has been established during the study of SARS-CoV and has been available in the Jackson Laboratory for many years102-104.
JH: 3. On viral passaging and adaptation. Lines 34-35: Adaptation for receptors likely improves infectability of a virus, but it does not necessarily make the virus more transmissible, pathogenic, or virulent. Even if the virus adapts for the receptor, it does not mean that the virus will be able to cause viremia or transmit to other hosts. The report falsely asserts that serial passage would "validate the virus' fitness and ensure its receptor-oriented adaptation toward its intended host"10 and also argue a contradictory theory on page 3 that the virus was not serially passaged. While viral passaging can optimize viral fitness, this is never a guarantee and has to be scientifically demonstrated.
The procedure of serial passage is straightforward. Briefly, the selected viral strain from step 4, a precursor of SARS-CoV-2, would be intranasally inoculated into a group of anaesthetized hACE2-mice. Around 2-3 days post infection, the virus in lungs would usually amplify to a peak titer. The mice would then be sacrificed and the lungs homogenized. Usually, the mouse-lung supernatant, which carries the highest viral load, would be used to extract the candidate virus for the next round of passage. After approximately 10~15 rounds of passage, the hACE2-binding affinity, the infection efficiency, and the lethality of the viral strain would be sufficiently enhanced and the viral genome stabilized101. Finally, after a series of characterization experiments (e.g. viral kinetics assay, antibodies response assay, symptom observation and pathology examination), the final product, SARS-CoV-2, would be obtained, concluding
JH: 4. SARS-CoV-2 animal models. Line 39: Finding an animal model for SARS-CoV-2 has been difficult51 and, before 2020, there was not a good animal model for SARS-CoV, so the idea of "serial passage in laboratory animals"10 would have been challenging.
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the whole creation process. From this point on, this viral pathogen could be amplified (most probably using Vero E6 cells) and produced routinely.
It is noteworthy that, based on the work done on SARS-CoV, the hACE2-mice, although suitable for SARS-CoV-2 adaptation, is not a good model to reflect the virus' transmissibility and associated clinical symptoms in humans. We believe that those scientists might not have used a proper animal model (such as the golden Syrian hamster) for testing the transmissibility of SARS-CoV-2 before the outbreak of COVID-19. If they had done this experiment with a proper animal model, the highly contagious nature of SARS-CoV-2 would be extremely evident and consequently SARS-CoV-2 would not have been described as "not causing human-to-human transmission" at the start of the outbreak.
JH: 1. Serial passaging and virulence. Lines 2-4: The authors incorrectly assert that serial passage of a virus only leads to increased virulence. The report asserts that 10 to 15 rounds of passage would improve the viral Spike protein's binding affinity and the infectivity and lethality of the virus. However, serial passaging does not always lead to genome stabilization, as some viral populations may die off.52 Of the strains that do stabilize, infection efficiency is only enhanced for the model species used for passaging, not for all species. Some of these (millions of) virions may be more lethal or infectious, just as many may be less so. Passaging cannot guarantee an outcome of viral evolution. The life cycle of a virus and infection efficiency depend on more than just receptor binding, and adaptation to 1 organ or 1 type of receptor may come at the expense of reduced ability to spread to other organs, cause viremia, shed from 1 host, or cause pathogenicity.53 Thus, improved receptor binding does not necessarily mean enhanced transmissibility or pathogenicity.54
We also speculate that the extensive laboratory-adaptation, which is oriented toward enhanced transmissibility and lethality, may have driven the virus too far. As a result, SARS-CoV-2 might have lost the capacity to attenuate on both transmissibility and lethality during its current adaptation in the human population. This hypothesis is consistent with the lack of apparent attenuation of SARS-CoV-2 so far despite its great prevalence and with the observation that a recently emerged, predominant variant only shows improved transmissibility105-108.
Serial passage is a quick and intensive process, where the adaptation of the virus is accelerated. Although intended to mimic natural evolution, serial passage is much more limited in both time and scale. As a result, less random mutations would be expected in serial passage than in natural evolution. This is particularly true for conserved viral proteins, such as the E protein. Critical in viral replication, the E protein is a determinant of virulence and engineering of it may render SARS-CoV-2 attenuated109-111 Therefore, at the initial assembly stage, these scientists might have decided to keep the amino acid sequence of the E protein unchanged from that of ZC45/ZXC21. Due to the conserved nature of the E protein and the limitations of serial passage, no amino acid mutation actually occurred, resulting in a 100% sequence identity on the E protein between SARS-CoV-2 and ZC45/ZXC21. The same could have happened to the marks of molecular cloning (restriction sites flanking the RBM). Serial passage, which should have partially naturalized the SARS-CoV-2 genome, might not have removed all signs of artificial manipulation.
JH: 2. On laboratory adaptation leading to increased virulence. Lines 16-21: Viral adaptation can include attenuation. That is one reason why viruses and bacteria are sometimes serially passaged for attenuation to be used in vaccines.55,56 It cannot be stated as Yan and colleagues do that there is a "lack of apparent attenuation"10 so far in this pandemic, because the global incidence of COVID-19 (especially asymptomatic cases) is unknown, or that viral adaptation, in vitro or in vivo, led to increase transmissibility or virulence.
JH: 3. Viral mutation rates. Line 24: The authors state that if serial passage is confined to 1 species, less random mutations occur, but this is incorrect. Mutation rates are a function of the RdRp, as well as the ExoN proofreading enzyme,57 and so repeated passage will not inherently make a virus more or less likely to mutate. However, passage does affect which mutations58 become fixed in the viral population. Coronaviruses form a quasispecies, where each variant within the population can be different from the others and have different fitnesses. Together, the population of variants infect a host, disseminate from the initial infection site, and cause pathogenesis. During a passage, the viral variants best suited for infection and pathogenesis within the model organism are selected for, but the rate of mutations occurring does not change. Because mutations can still occur, there is a possibility the virus can adapt, unless the mutations cause so many deleterious mutations that the population collapses.
3. Final remarks
Many questions remain unanswered about the origin of SARS-CoV-2. Prominent virologists have implicated in a Nature Medicine letter that laboratory escape, while not being entirely ruled out, was unlikely and that no sign of genetic manipulation is present in the SARS-CoV-2 genome4. However, here we show that genetic evidence within the spike gene of SARS-CoV-2 genome (restriction sites flanking the RBM; tandem rare codons used at the inserted furin-cleavage site) does exist and suggests that the SARS-CoV-2 genome should be a product of genetic manipulation. Furthermore, the proven concepts, well-established techniques, and knowledge and expertise are all in place for the convenient creation of this novel coronavirus in a short period of time.
Motives aside, the following facts about SARS-CoV-2 are well-supported:
1. If it was a laboratory product, the most critical element in its creation, the backbone/template virus (ZC45/ZXC21), is owned by military research laboratories.
2. The genome sequence of SARS-CoV-2 has likely undergone genetic engineering, through which the virus has gained the ability to target humans with enhanced virulence and infectivity.
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3. The characteristics and pathogenic effects of SARS-CoV-2 are unprecedented. The virus is highly transmissible, onset-hidden, multi-organ targeting, sequelae-unclear, lethal, and associated with various symptoms and complications.
4. SARS-CoV-2 caused a world-wide pandemic, taking hundreds of thousands of lives and shutting down the global economy. It has a destructive power like no other.
Judging from the evidence that we and others have gathered, we believe that finding the origin of SARS-CoV-2 should involve an independent audit of the WIV P4 laboratories and the laboratories of their close collaborators. Such an investigation should have taken place long ago and should not be delayed any further.
We also note that in the publication of the chimeric virus SHC015-MA15 in 2015, the attribution of funding of Zhengli Shi by the NIAID was initially left out. It was reinstated in the publication in 2016 in a corrigendum, perhaps after the meeting in January 2016 to reinstate NIH funding for gain-of-function research on viruses. This is an unusual scientific behavior, which needs an explanation for.
What is not thoroughly described in this report is the various evidence indicating that several coronaviruses recently published (RaTG1318, RmYN0230, and several pangolin coronaviruses27-29,31) are highly suspicious and likely fraudulent. These fabrications would serve no purpose other than to deceive the scientific community and the general public so that the true identity of SARS-CoV-2 is hidden. Although exclusion of details of such evidence does not alter the conclusion of the current report, we do believe that these details would provide additional support for our contention that SARS-CoV-2 is a laboratory-enhanced virus and a product of gain-of-function research. A follow-up report focusing on such additional evidence is now being prepared and will be submitted shortly.
JH: 1. While the impact of SARS-CoV-2 on global public health is undeniable, the pathogenic effects of SARS-CoV-2 infection at an individual or cellular level are not unprecedented. Many viruses are capable of causing high morbidity and mortality,59,60 infecting several organs, and/ or presymptomatic or asymptomatic transmission.61 Additionally, other viral infections (eg, chikungunya) also induce long-term sequelae.62 Humans have contended with many scourges and it is a certainty that COVID-19 will not be the last.
Acknowledgements
We would like to thank Daoyu Zhang for sharing with us the findings of mutations in the E proteins in different sub-groups of [B beta] coronaviruses. We also thank all the anonymous scientists and other individuals, who have contributed in uncovering various facts associated with the origin of SARS-CoV-2.
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References:
[1] Did the coronavirus leak from a lab? These scientists say we shouldnt rule it out. For many scientists, challenging the idea that SARS-CoV-2 has natural origins is seen as career suicide. But a vocal few say it shouldn't be disregarded or lumped in with conspiracy theories. MIT Technology Review, March 18, 2021. webpage https://www.technologyreview.com/2021/03/18/1021030/coronavirus-leak-wuhan-lab-scientists-conspiracy, March 2021. Did the coronavirus leak from a lab? These scientists say we shouldnt rule it out.
[2] Unusual Features of the SARS-CoV-2 Genome Suggesting Sophisticated Laboratory Modification Rather Than Natural Evolution and Delineation of Its Probable Synthetic Route, Limeng Yan The University of Hong Kong, September 2020.
[3] SARS-CoV-2 Is an Unrestricted Bioweapon: A Truth Revealed through Uncovering a Large-Scale, Organized Scientific Fraud Li-Meng Yan (MD, PhD)1, Shu Kang (PhD)1, Jie Guan (PhD)1, Shanchang Hu (PhD), October 8, 2020, Rule of Law Society & Rule of Law Foundation, New York, NY, USA.
[4] In Response: Yan et al Preprint Examinations of the Origin of SARS-CoV-2, Johns Hopkins Center for Health Security, centerforhealthsecurity.org, This review has been written by Kelsey Lane Warmbrod, MS, MPH; Rachel M. West, PhD; Nancy D. Connell, PhD; and Gigi Kwik Gronvall, PhD; all from the Johns Hopkins Center for Health Security, September 21, 2020. webpage https://www.centerforhealthsecurity.org/our-work/pubs_archive/pubs-pdfs/2020/200921-in-response-yan.pdf, March 2021. In Response: Yan et al Preprint Examinations of the Origin of SARS-CoV-2
[A] GenBank Bat coronavirus RaTG13 complete genome, Wuhan Institute of Virology, National Center for Biotechnology Information, U.S. National Library of Medicine. webpages https://www.ncbi.nlm.nih.gov/nuccore/MN996532 VRL 24-NOV-2020. https://www.ncbi.nlm.nih.gov/nuccore/MN996532.1, VRL 24-MAR-2020. https://www.ncbi.nlm.nih.gov/nuccore/MN996532.2, VRL 24-NOV-2020. Accessed March 2021. GenBank Bat coronavirus RaTG13 complete genome.
The World Health Organization (WHO) formed a team to perform a global study of the origins of the SARS-CoV-2 contagion and released a Joint WHO-China study in March 2021 [1]. As part of the study they visited various locations in China including the Wuhan Institute of Virology (WIV). Before examining the WHO report on the origin of the COVID-19 virus, this analysis will begin by independently examining the Wuhan Institute of Virology and related topics.
An approach to this investigation is to use the basic journalism practice of who, what, where, when, why, and how. Interestingly the journalistic approach follows the systems perspective approach for developing a system design [A]. This is a quick first pass at the analysis and was performed before the WHO study was examined:
Journalism | Systems Perspective | Comments |
Who | Needs Analysis: Who are the system stakeholders. | The stakeholders are all bio labs engaged in coronavirus research around the world. It is also all the people in physical locations where the coronavirus may have jumped from an animal to a human. |
What | System Boundary: What is the system boundary. | The system boundary initially was assumed to be China because it was first isolated in China. However the system boundary must be the entire world. |
Where | System Location: Where was the system that is the coronavirus infection first detected. | The coronavirus infection was first isolated in China so the assumption is that it originated in China. However like with the Spanish Flu that may not be the case. |
When | System Start: When was the system that is the coronavirus infection started. | The coronavirus infection appears to have started in late 2020. However the Spanish Flu of 1918 investigation eventually suggested that the virus was in the population before it was detected and tracked to the earliest cases in Spain. |
Why | System Emergence: Why did the system that is the coronavirus pandemic emerge. | This one is very important because we have had multiple contagions in the past that were contained. Why did we fail to contain the coronavirus infection is a question that will asked for centuries. This analysis suggests that it was a failure of the US Government and finds the root cause to be privatization and deregulation. |
How | System Implementation: How did the system that is the coronavirus pandemic get implemented. | The system analysis suggests that the coronavirus was spread so quickly because of airplanes and airports. The R0 infection rate is very high when traveling by air. |
The following is an independent review of the WIV and was performed before the WHO study was examined.
The Wuhan Institute of Virology (WIV), originally named as the Wuhan Microbiology Laboratory, was founded in 1956 as a research institute on virology administered by the Chinese Academy of Sciences (CAS) land is located in Jiangxia District, Wuhan, Hubei, China.
The WIV was the site of construction for the first biosafety level 4 (BSL4) laboratory in China. It was completed in 2014 in collaboration with the French government's Centre International de Recherche en Infectiologie is an academic and research institute (CIRI) lab based in Lyon, France. Thed laboratory has 3000 square meters of BSL-4 space, two BSL-3 labs, and 20 BSL-2 labs. The BSL-4 facilities were accredited by the China National Accreditation Service for Conformity Assessment (CNAS) in January 2017, with the BSL-4 level lab put into operation in January 2018. Safety precautions taken when building the BSL4 Wuhan were:
Some of the key findings are:
The following analysis was performed after examining the WHO report.
The WHO report on the origins of the COVID-19 virus is inconclusive [1]. Some continue to suggest without evidence that the virus came from the WIV and this is just a massive distraction. This distraction must not take away from what needs to happen, which is massive collaboration and application of our best science, engineering, and systems practices to deal with this disaster and prevent future contagion disasters.
We know that the virus is not a result of war or an act of terrorism because there have been no claims in either of those horrible scenarios. So the question of where the COVID-19 virus may have come from is irrelevant. What matters is the systems we have to protect us from future natural contagions and future lab accidents. It appears that the world has established many different labs to study the sources of horrible contagions. In the USA there was the massive effort to resurrect the 1918 Flu pandemic virus. Around the world various labs are studying the coronavirus. Military organizations are engaged in various related research efforts. This is the current state of our technology and its pattern is the same as the nuclear technology that surfaced in the last century. Collaboration and strong oversight applying massive science, engineering, and the systems perspective are the tools that we can use to control this very powerful technology.
A relevant question to ask is why the virus was not contained once it was identified. It's possible that containment was beyond our capabilities. The problem with that argument is that we know leadership in the USA lied to the public and the world about the true nature of the virus. We also know that the world depended on the USA as the natural leader in these areas to properly assess and communicate the nature of the situation. It did not happen. History, not the WHO, will eventually decide what caused the COVID-19 disaster. The choices will include:
The search for the source of the virus that is the COVID-19 disaster will continue and it eventually may be found. However, the disaster and accountability is not about the existence of the virus. The disaster and accountability is about what we did once we detected and isolated the virus. After WWII a world court was convened and war criminals were charged with crimes against humanity. There will be no world court in this case, but history will convene such a court and make its findings known to future generations. Our grandchildren will stand in judgment of us and our actions.
References
[1] WHO-convened global study of origins of SARS-CoV-2: China Part, Joint WHO-China study: 14 January - 10 February 2021 Joint Report, World Health Organization (WHO), 30 March 2021. webpage https://www.who.int/publications/i/item/who-convened-global-study-of-origins-of-sars-cov-2-china-part, https://www.who.int/docs/default-source/coronaviruse/who-convened-global-study-of-origins-of-sars-cov-2-china-part-joint-report.pdf, April 2021. WHO-convened global study of origins of SARS-CoV-2: China Part, Joint WHO-China study: 14 January - 10 February 2021 Joint Report . PDF . local
[2] WHO-convened global study of origins of SARS-CoV-2: China Part, Joint WHO-China study: 14 January - 10 February 2021 Joint Report -ANNEXES, World Health Organization (WHO), 30 March 2021. webpage https://www.who.int/publications/i/item/who-convened-global-study-of-origins-of-sars-cov-2-china-part, https://www.who.int/docs/default-source/coronaviruse/who-convened-global-study-of-origins-of-sars-cov-2-china-part-annexes.pdf, April 2021. WHO-convened global study of origins of SARS-CoV-2: China Part, Joint WHO-China study: 14 January - 10 February 2021 Joint Report -ANNEXES. PDF . local
[3] Wuhan Institute of Virology, https://en.wikipedia.org/wiki/Wuhan_Institute_of_Virology, April 2021.
[4] Bats Are Natural Reservoirs of SARS-Like Coronaviruses, Zenodo, October 31, 2005. webpage https://zenodo.org/record/3949088#.YG3TtvkpDDc, April 2021. Bats Are Natural Reservoirs of SARS-Like Coronaviruses
[5] Bat cave solves mystery of deadly SARS virus --- and suggests new outbreak could occur, Nature, .December 01, 2017. webpage https://www.nature.com/articles/d41586-017-07766-9, April 2021. Bat cave solves mystery of deadly SARS virus --- and suggests new outbreak could occur
[6] A SARS-like cluster of circulating bat coronaviruses shows potential for human emergence, National Institutes of Health, National Center for Biotechnology Information, U.S. National Library of Medicine, November 9, 2015. webpage https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4797993, April 2021. A SARS-like cluster of circulating bat coronaviruses shows potential for human emergence
[7] Engineered bat virus stirs debate over risky research, Nature, November 12, 2015. webpage https://www.nature.com/news/engineered-bat-virus-stirs-debate-over-risky-research-1.18787, April 2021. Engineered bat virus stirs debate over risky research
[8] Discovery of a rich gene pool of bat SARS-related coronaviruses provides new insights into the origin of SARS coronavirus, National Center for Biotechnology Information, U.S. National Library of Medicine, Nov 30, 2017. webpage https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5708621, April 2021. Discovery of a rich gene pool of bat SARS-related coronaviruses provides new insights into the origin of SARS coronavirus . PDF . local
[9] Serological Evidence of Bat SARS-Related Coronavirus Infection in Humans, China, National Center for Biotechnology Information, U.S. National Library of Medicine, March 2, 2018. webpage https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6178078, April 2021. Serological Evidence of Bat SARS-Related Coronavirus Infection in Humans, China, National Center for Biotechnology Information
[10] Shi Zhengli Q&A Reply to Science Magazine, American Association for the Advancement of Science (AAAS) Science Magazine , July 23, 2020. webpage https://www.sciencemag.org/sites/default/files/Shi%20Zhengli%20Q%26A.pdf, April 2021.
[A] Systems Engineering Design Renaissance, Walter Sobkiw, ISBN: 978-0983253075, 2014. REF 2
This topic is not meant to be disrespectful to all those that suffered, lost their health, and died because of the COVID-19 disaster. This topic is offered to shake people to their core so that they realize how stupid they have become. It is okay to be stupid when everything is fine and someone else is ensuring your comfortable life style. It is not okay to remain stupid in the middle of a massive disaster like COVID-19. This is a wakeup message. The clock is ticking and the virus disaster is here. It will not be going away soon and action must be taken using all our technologies and capabilities to deal with this disaster [11].
Definitions:
Stupid: This is a person that has access to education but decides not to get the the education or they are exposed to an education and they reject the content.Ignorant: This is a person that is denied an education. In the last century the massive social call was to educate everyone everywhere. Little did they know that people would decide to be stupid in the 21st century.
Author Comment: I was made aware of the difference between stupid and ignorant by a retired teacher. The comment was you can't fix stupid. It took me several months to understand this observation. Little did I know that it would define a serious social illness condition in our current society.
The following is a possible list of conspiracy theories associated with the source of the COVID-19 virus:
In the last century people needed to deal with the 1918 pandemic. They did not know what was happening and they did not have the technologies to deal with the event. They went to work and developed technologies to provide for healthy and safe environments. They realized that when they wanted to fly in an airplane they needed life support systems or the passengers would freeze to death and die from lack of oxygen as the plane flew up to 20,000 feet. This led them to develop modern forced air heating ventilation and cooling systems to provide clean air. They developed new technologies associated with electrical engineering that led to UV ceiling level lights to instantly kill dangerous viruses in public spaces. They did not pack people like sardines into airplane passenger compartments or force them to take off their shoes in a massive crowd where one sick person would make hundreds sick and possibly kill them. They did not say I want my kids back in school without first making sure the schools were safe. They did not enter public establishments known to spread sickness and death.
Unlike the previous generations which needed to develop the technologies and expertise to deal with a pandemic, we have the technologies and expertise to deal with COVID-19 but we do not have the Social Will to do what is right and required [7]. We filled our leadership positions with extremely stupid people because we have an extremely stupid population. The future is not good. We have had a year to move away from stupid and it did not happen.
There have been many news reports on TV showing a distraught mother demanding that her children go back to school. She does not express safety concerns but only demands that her children return to school. The report then ends and the news moves to another story. The reporter does not ask the mother about safety concerns, does not visit the local schools to determine what has been done to make the schools safe outside of social distancing and masking that is known to be ineffective in these settings because they are not practiced for the entire day, does not contact UV companies to get their take on making public spaces safe, does not contact HVAC companies to see what can be done, does not contact the local HVAC companies servicing the local schools and hospitals, does not even do an Internet search to see which school districts have installed ceiling level UV systems, what they have done with their HVAC systems and why they went down those paths. [8] [9]
The same applies to reporters visiting local businesses like restaurants. The restaurant owners demand that they must open. They show that they clean their establishments per government guidelines but they do not mention that their trade journals have articles of small businesses installing ceiling level UV systems, upgrading their HVAC systems, and listing companies that provide these systems. The reporters do not ask the owners about these actions taken by other business owners. The news organization does not follow up to see what businesses have done beyond the trivial and expected in even normal conditions cleaning practices. [1] [2] [3] [4]
The reporter and news organization in the above scenario are stupid people and they are very different from the irate mother. The mother may have have been denied an education while the reporter and news organization were provided an education. The mother is redeemable if given the opportunity for an education. The reporter and news organization are not redeemable because they have the education and rejected it. This is not unlike the observation made by Professor Harry G. Frankfurt in his book On Bullshit [10] where people engaged in lying may be redeemable but those engaged in bullshit are not redeemable because they don't care, they are just pushing an agenda at any cost. The stupid just use bullshit to further their own toxic agendas.
There is evidence that the society is starting to bifurcate. The rich have their own planes, are able to charter exclusive planes, and can fly anywhere in the world. They live, play, and work in state-of-the-art facilities with perfect HVAC systems, room level UV systems, and HVAC duct UV systems. The well to do are purchasing travel trailers and ensuring that their schools are being upgraded with room level UV systems, upgraded HVAC systems, and HVAC duct UV systems. They work remotely and have little need to interact with the general population. The retired who do not need to work live outside and enjoy nature. [5] [6]
The society will continue to bifurcate between those that will use technology to have healthy environments and those that will live in virus and other infection source environments as they pursue conspiracy theories.
The health specialists in our civilization offered COVID-19 guidelines, some of which were captured formally by the CDC and WHO. In the USA some of these guidelines should have immediately translated into regulations at the first sign that the guidelines were being ignored. That did not happen and history will clearly show that the blame falls directly on the Republican party in the USA because they adopted the deregulation and privatization policies in the early 1980s and never let go, even though there was clear evidence they were hurting the people at the expense of their narrow stakeholders that benefited from these policies. This social model came crashing down and was totally invalidated by the COVID-1 disaster. This policy has led to massive suffering and death. Ignoring data, facts, and reality is just like ignoring an education and it is clearly a sign that these people are extremely stupid. They even fed conspiracy theories to protect their catastrophically failed policies.
There are two approaches to fix stupid. The first is to wait for the natural system that is the society to correct itself, which may take multiple life times after much suffering and death. The second approach is to use government regulations to fix the bad or failed system in less time.
References
[1] The Blind Horse Becomes First Restaurant In The United States To Install Far-UVC Light Technology For Real-Time Virus Mitigation And Indoor Sanitization, Globe Newswire, October 13, 2020. webpage https://www.globenewswire.com/news-release/2020/10/13/2107717/0/en/THE-BLIND-HORSE-BECOMES-FIRST-RESTAURANT- IN-THE-UNITED-STATES-TO-INSTALL-FAR-UVC-LIGHT-TECHNOLOGY-FOR-REAL-TIME- VIRUS-MITIGATION-AND-INDOOR-SANITIZATION.html, January 2021.
[2] Wisconsin Restaurant Installs COVID-Killing UV Lights, Spectrum News1, October 14, 2020. webpage https://spectrumnews1.com/wi/madison/coronavirus/2020/10/14/wisconsin-restaurant-installs-covid-killing-uv-lights-, January 2021. Wisconsin Restaurant Installs COVID-Killing UV Lights
[3] With winter approaching, some restaurants turn to UV light to make indoors safer, Products that use UV rays to purify the air are popping up in restaurants., September 02, 2020. webpage https://www.restaurantbusinessonline.com/technology/winter-approaching-some-restaurants-turn-uv-light-make-indoors-safer, January 2021. With winter approaching, some restaurants turn to UV light to make indoors safer
[4] Breathe Easier: Seattle-area restaurants invest in fancy air filtration systems, seattlerefined Sinclair Broadcast Group, October 02, 2020, webpage http://seattlerefined.com/eat-drink/breathe-easier-forward-thinking-restaurants-invest-in-air-filtration-systems, January 2021. Breathe Easier: Seattle-area restaurants invest in fancy air filtration systems
[5] Margate condo first in state to install ultraviolet light sanitizing technology, they say, Press Of Atlantic City, September 09, 2020. webpage https://pressofatlanticcity.com/margate-condo-first-in-state-to-install-ultraviolet-light-sanitizing-technology-they-say/article_5c259798-7c35-5ad8-be85-e5b7a5838aa3.html, January 2021. Margate condo first in state to install ultraviolet light sanitizing technology, they say
[6] Technology at the Forefront for Healthier High-Rise Buildings, The COVID-19 pandemic has real estate developers turning to new tech, like UV light treatments and touchless entrances, to create safer environments for residents, Mansion Global June 07, 2020. webpage https://www.mansionglobal.com/articles/technology-at-the-forefront-for-healthier-high-rise-buildings-216579, January 2021. Technology at the Forefront for Healthier High-Rise Buildings
[7] UV lights, ozone cleaners, sanitizers help shelter keep homeless safe, Catholic News Service, June 16, 2020. webpage https://angelusnews.com/news/nation/uv-lights-ozone-cleaners-sanitizers-help-shelter-keep-homeless-safe/, January 2021. UV lights, ozone cleaners, sanitizers help shelter keep homeless safe
[8] High school installs ultraviolet light system to keep students safe, WNNC, May 20, 2020. webpage https://www.wcnc.com/article/news/health/coronavirus/queens-grant-high-school-uv-light-system-coronavirus/275-c3e54672-905f-4fab-8e5f-8c58d5ca49f3, January 2021. High school installs ultraviolet light system to keep students safe
[9] Some SC schools to use ultraviolet light to fight coronavirus. A few things to know. The Herald November 10, 2020. webpage https://www.heraldonline.com/news/coronavirus/article247021112.html, January 2021. Some SC schools to use ultraviolet light to fight coronavirus. A few things to know
[10] On Bullshit Hardcover, Harry G. Frankfurt, Princeton University Press, ISBN: 978-0691122946, January 30, 2005.
[11] See section Infrastructure Bifurcation.
Leading Causes of Death
In 2020 COVID-19 was the third leading cause of death in the USA. Without the shutdown it would have been the number one cause of death. It is unclear where COVID-19 and its mutations will fall in the rank of causes of death in future years. There is data showing that some people experience reinfection. This suggests that the innate immune system was able to rid the body of the contagion without the stimulation and production of antibodies, that the virus mutated and the previous infection antibodies are not able to fully prevent the second infection, or there was a misdiagnosis.
The leading causes of death in the USA are as follows: [spreadsheet flu]
Cause of Death |
Deaths | Data Year | Comment |
Heart disease |
659,041 |
2019 [1] | Early data Jan 1 to Jun 2, 2020: 397,042 [5] |
Cancer |
599,601 |
2019 [1] | Early data 606,520 for 2020. [6] |
COVID-19 | 548,162 |
March 2020 to April 1, 2021 [2] | |
Accidents (unintentional injuries) |
173,040 |
2019 [1] | |
Chronic lower respiratory diseases |
156,979 |
2019 [1] | |
Stroke (cerebrovascular diseases) |
150,005 |
2019 [1] | |
Alzheimers disease |
121,499 |
2019 [1] | |
Diabetes |
87,647 |
2019 [1] | |
Nephritis, nephrotic syndrome, and nephrosis |
51,565 |
2019 [1] | |
Influenza and pneumonia |
49,783 |
2019 [1] | |
Intentional self-harm (suicide) |
47,511 |
2019 [1] |
The following table shows Flu data over the past several years [3]. It then includes the data from the COVID-19 disaster [4]. [spreadsheet flu, death rates]
Flu Season Date |
COVID19 |
2019-2020 |
2018-2019 |
2017-2018 |
2017-2018 |
2015-2016 |
2014-2015 |
2013-2014 |
2012-2013 |
2011-2012 |
2010-2011 |
Symptomatic Illnesses |
28,405,925 |
38,000,000 |
36,000,000 |
45,000,000 |
29,000,000 |
24,000,000 |
30,000,000 |
30,000,000 |
34,000,000 |
9,300,000 |
21,000,000 |
Medical Visits |
- |
18,000,000 |
17,000,000 |
21,000,000 |
14,000,000 |
11,000,000 |
14,000,000 |
13,000,000 |
16,000,000 |
4,300,000 |
10,000,000 |
Hospitalizations |
20,643,016 |
400,000 |
490,000 |
810,000 |
500,000 |
280,000 |
590,000 |
350,000 |
570,000 |
140,000 |
290,000 |
Intensive Care Unit |
4,056,815 |
- |
- |
- |
- |
- |
- |
- |
- |
- |
- |
On Ventilator |
1,383,024 |
- |
- |
- |
- |
- |
- |
- |
- |
- |
- |
Loss of Life |
548,162 |
22,000 |
34,000 |
61,000 |
38,000 |
23,000 |
51,000 |
38,000 |
43,000 |
12,000 |
37,000 |
Note: From The COVID Tracking Project: Only about two-thirds of states and territories report data for Cumulative hospitalized/Ever hospitalized, and even fewer states report data for Cumulative in ICU/Ever in ICU and Cumulative on ventilator/Ever hospitalized. Therefore, adding these state and territory figures together to get a national count (as we do for other COVID-19 metrics with complete reporting such as cases and tests) drastically undercounts the true cumulative national number of COVID-19 patients who have ever been hospitalized, admitted to the the ICU, or placed on a ventilator. This incomplete reporting can lead to a misleading national picture. For example, since more states report the number of people currently in the ICU or on a ventilator than report them cumulatively, the national numbers for individuals currently in the ICU or on a ventilator sometimes exceed the cumulative values [4].
As the vaccination program continues it is expected that the death rate will subside. However, with the vaccine there is a massive desire to return to life prior to the COVID-19 disaster. The key is to vaccinate as many people as quickly as our industrial base can support. We know there are limitations in the industrial base and vaccinations will not be available for everyone including children for a number of months. There is also the issue of people who will refuse to take the vaccine. Based on this qualitative assessment it is reasonable to predict that COVID-19 will still be at a minimum the third leading cause of death in the USA in 2021.
In 2020 some strongly suggested that existing causes of death were being categorized as COVID-19. However examination of the leading causes of death specifically heart disease and cancer show that is not the case. Also the number of COVID-19 Hospitalizations and patients placed on a ventilator are extremely high. The 1918 pandemic patients were known to turn blue suggesting a lack of oxygen. The COVID-19 patients were also suffering from a lack of oxygen because of massive lung damage. A normal oxygen saturation is between 95% to 100% and below 93% suggests potential hypoxia and the start of organ damage [7]. When on a ventilator oxygen saturation is kept between 92-98% [8] [9]. When oxygen saturation drops below 85% patients are usually intubated and placed on mechanical ventilation [10].
References
[1] Leading Causes of Death, Centers for Disease Control and Prevention, March 1, 2021. webpage https://www.cdc.gov/nchs/fastats/leading-causes-of-death.htm, April 2021. Leading Causes of Death . local
[2] CDC Cases, webpage https://www.cdc.gov/coronavirus/2019-ncov/cases-updates/cases-in-us.html, various dates.
[3] Past Seasons Estimated Influenza Disease Burden, Centers for Disease Control and Prevention, October 01, 2020, webpage https://www.cdc.gov/flu/about/burden/past-seasons.html, April 2021. Past Seasons Estimated Influenza Disease Burden, Centers for Disease Control and Prevention.
[4] The COVID Tracking Project, The Atlantic Monthly Group March 7, 2021. webpage Source: https://covidtracking.com/data/national/hospitalization, April, 2021.
[5] More US cardiac deaths, less heart testing globally in COVID, CIDRAP - Center for Infectious Disease Research and Policy, University of Minnesota, January 11, 2021. webpage https://www.cidrap.umn.edu/news-perspective/2021/01/more-us-cardiac-deaths-less-heart-testing-globally-covid, April 2021. More US cardiac deaths, less heart testing globally in COVID.
[6] Cancer Facts & Figures 2020. American Cancer Society. webpage https://www.cancer.org/research/cancer-facts-statistics/all-cancer-facts-figures/cancer-facts-figures-2020.html, https://www.cancer.org/content/dam/cancer-org/research/cancer-facts-and-statistics/annual-cancer-facts-and-figures/2020/cancer-facts-and-figures-2020.pdf, April 2021. PDF
[7] With ventilators running out, doctors say the machines are overused for Covid-19, STAT, April 8, 2020. webpage https://www.statnews.com/2020/04/08/doctors-say-ventilators-overused-for-covid-19, April 2021. With ventilators running out, doctors say the machines are overused for Covid-19.
[8] Mechanical Ventilator, London Health Sciences Centre, London Ontario Canada, October 31, 2018. webpage https://www.lhsc.on.ca/critical-care-trauma-centre/mechanical-ventilator, April 2021. Mechanical Ventilator.
[9] Oxygenation and Ventilation, National Institutes of Health, December 17, 2020. webpage https://www.covid19treatmentguidelines.nih.gov/critical-care/oxygenation-and-ventilation, April 2021. Oxygenation and Ventilation.
[10] Severe COVID-19 Symptoms: How Ventilators Can Help, UC Health, University of Cincinnati College of Medicine, June 8, 2020. webpage https://www.uchealth.com/en/media-room/covid-19/ventilators-and-covid-19, April 2021. Severe COVID-19 Symptoms: How Ventilators Can Help.
Infrastructure Bifurcation
There is evidence that the infrastructure is starting to bifurcate between facilities that will use technology to have healthy environments and facilities that will allow virus and other infection sources to be part of the facility environments [1]. This is all driven by the society and how it decides to deal with this unequal and dangerous system. There are two approaches to fix this bad system. The first is to wait for the natural system that is the society to correct itself, which may take multiple life times after much suffering and death. The second approach is to use government regulations to fix the bad or failed system in less time.
References
[1] See section Conspiracy Theories and Social Bifurcation.
We have had a year for people to do the right thing. They have failed miserably. They only continue to pursue useless conspiracy theories like COVID-19 is not real, even in March of 2021. The only alternative is to begin with serious government regulations that will not only deal with the current COVID-19 pandemic but also future epidemics and pandemics. On April 5, 2021 the CDC released an update that the principal mode by which people are infected with COVID-19 is through exposure to respiratory droplets carrying infectious virus. It is possible for people to be infected through contact with contaminated surfaces or objects (fomites), but the risk is generally considered to be low [6]. These are some of the CDC [1] [6] WHO [2] [3] and other [4] health guidelines that should be converted into government regulations even though we have a vaccine:
The reason for the strict regulation requirement that the COVID-19 world wide pandemic must end before ignoring the regulations that must be implemented for new occupancy certificates is based on evidence that we are very closely coupled and old geographical boundaries from the previous century and other pandemics no longer applies. Unless world travel is shutdown this is a world wide problem. That will not happen.
Notice retail and work spaces were left out of the regulations. They may need to be added if the pandemic still impacts the USA.
People have ignored the guidelines. They will also ignore the regulations unless there are fines and methods of reporting offenses. The fines need to be steep to discourage the pattern of grave behavior that was set over the past year. For example, airlines are fined $100,000 per incident. Airports are fined $100,000 per day per flight. Small businesses are fined $1,000 per day of violation. Schools are charged $100,000 per day of violation. These details are for legislators finalize. This is unfortunate but this is the state of our current society driven exclusively by self interest rather that higher ideals from the previous century.
References
[1] Ventilation in Buildings, Centers for Disease Control and Prevention, March 23, 2021. webpage https://www.cdc.gov/coronavirus/2019-ncov/community/ventilation.html, April 2021. Ventilation in Buildings
[2] WHO Publication/Guidelines Natural Ventilation for Infection Control in Health-Care Settings, World Health Organization (WHO), 2009. webpage https://www.ncbi.nlm.nih.gov/books/NBK143284/pdf/Bookshelf_NBK143284.pdf, May 2020. Natural Ventilation for Infection Control in Health-Care Settings, WHO, 2009 . local
[3] Coronavirus disease (COVID-19) advice for the public, World Health Organization (WHO) March 26, 2021. webpage https://www.who.int/emergencies/diseases/novel-coronavirus-2019/advice-for-public April 2021. Coronavirus disease (COVID-19) advice for the public
[4] The History of Ultraviolet Germicidal Irradiation for Air Disinfection, Public Health Reports/JanuaryFebruary 2010/Volume 125. webpage https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2789813 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2789813/pdf/phr125000015.pdf, November 2020. The History of Ultraviolet Germicidal Irradiation for Air Disinfection . PDF . local
[5] UV Lights and Lamps: Ultraviolet-C Radiation, Disinfection, and Coronavirus, UV Lights and Lamps: Ultraviolet-C Radiation, Disinfection, and Coronavirus, US Food and Drug Administration - FDA, August 19, 2020. webpage https://www.fda.gov/medical-devices/coronavirus-covid-19-and-medical-devices/uv-lights-and-lamps-ultraviolet-c-radiation-disinfection-and-coronavirus, November 2020. UV Lights and Lamps: Ultraviolet-C Radiation, Disinfection, and Coronavirus . local
[6] Science Brief: SARS-CoV-2 and Surface (Fomite) Transmission for Indoor Community Environments, Centers for Disease Control and Prevention, April 5, 2021. webpage https://www.cdc.gov/coronavirus/2019-ncov/more/science-and-research/surface-transmission.html, April 2021. Science Brief: SARS-CoV-2 and Surface (Fomite) Transmission for Indoor Community Environments . local
In theory, if the vaccines work then the global pandemic will end soon and the above regulations, while in place, would not apply. If the global pandemic does not end, regardless of reasons, then there is a reasonable path forward. The regulations stay on the books for the next pandemic because some suggest COVID-19 will continue to mutate and cause future problems.
The infrastructure upgrade asscociated with the proposed regulations will not only clean the environment of COVID-19 but also other viruses like the Flu, Tuberculosis, cold virus, and other contagions. It will bring the infrastructure to the same level of previous century capabilities. The following cost benefit analysis is offered to provide further insights.
The following are infrastructure upgrade cost estimates. They are based on the UV and HVAC Return To Life Analysis in 2020 (part 1) [1] [2]. [spreadsheet cost benefit]
Infrastructure Cost Details |
Costs |
Comment |
UV Schools | $2,996,470,588 |
UV Infrastructure Cost Estimates |
UV Commercial Office | $7,058,823,529 |
UV Infrastructure Cost Estimates |
UV Retail | $16,764,705,882 |
UV Infrastructure Cost Estimates |
UV Industrial property | $22,941,176,471 |
UV Infrastructure Cost Estimates |
HVAC Upgrades | $100,000,000,000 |
Based on schools analysis |
Total | $149,761,176,470 |
|
Cost Benefit Analysis Costs A | $134,320,000,000 | minus commercial office space + 50% retail to capture problem areas |
Cost Benefit Analysis Costs B | $122,849,411,765 | minus commercial office space + 50% retail + 50% industrial to capture problem areas |
HVAC Retrofit All Schools | $107,129,337,539 |
Worst case schools analysis Proposed Legislation |
Infrastructure Costs (billion) | $150 |
used in architecture tradeoffs in part 1 Virus Mutations & Architecture Solutions |
The annual costs due to lost productivity from just the Flu are estimated to be $17.6 billion in 2019 [3]. The following are hospitalization, loss of life, and lost productivity costs. [spreadsheet flu]
Flu Season Date |
2019-2020 |
2018-2019 |
2017-2018 |
2017-2018 |
2015-2016 |
2014-2015 |
2013-2014 |
2012-2013 |
2011-2012 |
2010-2011 |
Comment |
Symptomatic Illnesses |
38,000,000 |
36,000,000 |
45,000,000 |
29,000,000 |
24,000,000 |
30,000,000 |
30,000,000 |
34,000,000 |
9,300,000 |
21,000,000 |
[4] CDC 2017 to 2020 data may change. |
Medical Visits |
18,000,000 |
17,000,000 |
21,000,000 |
14,000,000 |
11,000,000 |
14,000,000 |
13,000,000 |
16,000,000 |
4,300,000 |
10,000,000 |
[4] CDC 2017 to 2020 data may change. |
Hospitalizations |
400,000 |
490,000 |
810,000 |
500,000 |
280,000 |
590,000 |
350,000 |
570,000 |
140,000 |
290,000 |
[4] CDC 2017 to 2020 data may change. |
Loss of Life |
22,000 |
34,000 |
61,000 |
38,000 |
23,000 |
51,000 |
38,000 |
43,000 |
12,000 |
37,000 |
[4] CDC 2017 to 2020 data may change. |
Employment to Population Ratio |
60.6% |
60.6% |
nv |
nv |
nv |
nv |
nv |
60.6% |
60.6% |
60.6% |
60.60% for 2018-2019 [3] |
Estimated Sickened Workers |
23,028,000 |
20,000,000 |
25,000,000 |
18,100,827 |
11,049,083 |
18,100,827 |
17,166,702 |
20,604,000 |
5,635,800 |
12,726,000 |
2013-2019 [3] & related |
Hospital Costs (billion) |
$6.8 |
$8.3 |
$13.8 |
$8.5 |
$4.8 |
$10 |
$5.9 |
$9.7 |
$2.4 |
$4.9 |
$17,300 male $14,900 female 2015-216 season [5]. Used $17,000 for all years. |
Loss of Life Costs (billion) |
$154 |
$238 |
$427 |
$266 |
$161 |
$357 |
$266 |
$301 |
$84 |
$259 |
$7 million per life |
Illness Costs - 10 years (billion) |
$2,588 |
|
|
|
|
|
|
|
|
|
10 years expected life of infrastructure |
Hourly Wage |
$28.00 |
$27.48 |
$26.74 |
$26.63 |
$26.63 |
$25.26 |
$24.19 |
$24.00 |
$24.00 |
$24.00 |
2013-2019 [3] & related |
Wages Lost (4 Days) |
$896.00 |
$879.36 |
$855.68 |
$852.16 |
$852.16 |
$808.32 |
$774.08 |
$768.00 |
$768.00 |
$768.00 |
2013-2019 [3] & related |
Productivity Costs (billion) |
$20.63 |
$18 |
$21.39 |
$15.4 |
$9.4 |
$14.6 |
$13.3 |
$15.82 |
$4.33 |
$9.77 |
2013-2019 [3] & related |
Productivity Costs - 10 years (billion) |
$143 |
|
|
|
|
|
|
|
|
|
10 years expected life of infrastructure |
Annual Flu Costs (billion) |
$181 |
$264 |
$462 |
$290 |
$175 |
$382 |
$285 |
$329 |
$91 |
$275 |
Health Care + Lives Lost Costs + Wages |
Total Costs - 10 years (billion) |
$2,736 |
|
|
|
|
|
|
|
|
|
Health Care + Lives Lost Costs + Wages 10 years expected life of infrastructure |
Infrastructure Costs (billion) |
$134 |
|
|
|
|
|
|
|
|
|
This is Cost A. Lower estimate is Cost B = $123 |
The above analysis is summarized as follows:
$134 billion Infrastructure Costs
$143 billion 10 year Productivity Costs
$181 billion Annual Flu Costs (hospital + loss of life + productivity)
$2,736 billion 10 year Total Costs (hospital + loss of life + productivity)
This cost benefit analysis shows the investment in reducing non COVID-19 illness will justify the upgrades because these systems will last for decades. The analysis suggests that the payback period conservatively will be less than 2 years. If the COVID-19 pandemic continues, then it allows the US to restart the civilization during the pandemic and the payback period is on the order of months. The challenge is to realize this must happen immediately because time is of the essence.
This challenge is exactly like the sanitation challenge to provide clean water and sewage management in the previous centuries. It took multiple bouts of Cholera and Dysentery before these systems were established in the 1800s. In the 1900s it was the dream of third world countries to establish clean water and sanitation systems. Providing clean air in a public building is the exact same problem. In the last century this happened naturally in the USA with the rise of forced air HVAC systems and the use of ceiling level UV lights. Today in the USA the HVAC systems have been tuned to minimize costs rather than health and the old ceiling level UV lights were thrown away because the population stopped getting contagious diseases. They became very healthy with new longer life expectancy results and the knowledge was forgotten.
No businesses will make this investment unless it is a small owner operated business that deals with the public. Once aware they will make the investment to protect their health. It is unlikely the commercial real estate and development sectors will make the investment except for exclusive projects. The only way to deal with this bad system situation is through updated building codes that trace to new regulations and or laws.
Everyone has now been educated on this subject. It is time to now make a choice. The reality is that it will happen as time moves on and in 20 years the indoor air infrastructure upgrades will just naturally emerge [6]. If it is not adopted as policy and then very effectively implemented, millions will suffer, many will die, the economy will be devastated, but life will continue. The correct answer is to always save lives.
References
[1] COVID-19 A Systems Perspective, Walter Sobkiw, 2021, ISBN 9780983253044, hardback.
[2] COVID-19 Return To Life, webpage http://www.cassbeth.com/covid-19/return-to-life/index.html, April 2021. COVID-19 Return To Life.
[3] Flu Season to Cost Business $17B in Lost Productivity, New Jersey Business & Industry Association NJBIA, January17,2019. webpage https://njbia.org/flu-season-to-cost-business-17b-in-lost-productivity, April 2021, Flu Season to Cost Business $17B in Lost Productivity
[4] Past Seasons Estimated Influenza Disease Burden, Centers for Disease Control and Prevention, October 01, 2020, webpage https://www.cdc.gov/flu/about/burden/past-seasons.html, April 2021. Past Seasons Estimated Influenza Disease Burden, Centers for Disease Control and Prevention
[5] Inpatient Hospital Stays and Emergency Department Visits Involving Influenza, 2006-2016, Agency for Healthcare Research and Quality, October 2019. webpage https://www.hcup-us.ahrq.gov/reports/statbriefs/sb253-Influenza-Hospitalizations-ED-Visits-2006-2016.jsp, April 2021. Inpatient Hospital Stays and Emergency Department Visits Involving Influenza
[6] Technology at the Forefront for Healthier High-Rise Buildings, The COVID-19 pandemic has real estate developers turning to new tech, like UV light treatments and touchless entrances, to create safer environments for residents, Mansion Global June 07, 2020. webpage https://www.mansionglobal.com/articles/technology-at-the-forefront-for-healthier-high-rise-buildings-216579, January 2021. Technology at the Forefront for Healthier High-Rise Buildings
Healthy Buildings Certification Needs
There is evidence that some are heavily focused on the goal of providing healthy buildings in the wake of the COVID-19 disaster and the realization of other existing illnesses and possible future disasters. The problem is that there are no standards traceable to significant science and engineering performed in government labs capable of making those assessments. Industry is left to self regulate and determine what it thinks is best for an indoor building environment. The government only offers vague guidance and the guidance is usually ignored except in rare cases. Regardless, the current situation is leading to a social bifurcation where some will live, play, work, shop, and learn in healthy buildings and most will not have that opportunity [1].
The challenge is also one of the introduction of snake oil that unsuspecting facilities staff may think is a proper solution. This challenge is not unlike the challenges faced in the last century that eventually led to the establishment of the Food and Drug Administration (FDA). The FDA has a charter to protect the public from exposure to radiation including UV radiation. However, they cannot determine if an installed UV system is effective at eliminating contagions under the advertised conditions or address deceptive advertising practices.
Beyond safety, there are no non-military government standards to certify Ceiling Level UV, Far UV-222 Systems, HVAC systems and other possible system solutions that claim to deal with a contagion. Military standards like MIL-STD-1472 provide ventilation requirements but not from the perspective of maximizing health [2]. Updated HVAC ventilation rates and new UV standards that maximize health and prevent the spread of disease in public spaces need to be developed and then converted into local building codes. Without a lead agency or regulations snake oil will be sold into the infrastructure. As of April 2021 we already have snake oil being sold into the infrastructure and they include bad UV systems, inadequate HVAC systems, and other products. They must be removed and replaced with proper certified systems traceable to government standards established in proper government labs.
References
[1] Technology at the Forefront for Healthier High-Rise Buildings, The COVID-19 pandemic has real estate developers turning to new tech, like UV light treatments and touchless entrances, to create safer environments for residents, Mansion Global June 07, 2020. webpage https://www.mansionglobal.com/articles/technology-at-the-forefront-for-healthier-high-rise-buildings-216579, January 2021. Technology at the Forefront for Healthier High-Rise Buildings.
[2] Human Engineering, MIL-STD-1472F, Department of Defense, 23 August 1999, MIL-STD-1472D, 14 March 1989. MIL-STD-1472F . MIL-STD-1472D . local.
Rehashing Old Knowledge
On April 23, 2021 an article stating that the risk of indoor COVID-19 infection is the same at 6 or 60 feet - MIT researchers say time spent indoors increases risk of COVID at 6 feet or 60 feet in new study challenging social distancing policies [1]. The issue is that this is not new news. The CDC disclosed the Wells-Riley equation that was developed in 1978 as part of their study on natural ventilation for infection control in health-care settings [2]. The equation is very simple and does not include distance. It only considers the number of people infected, volume of the physical space, the rate of infection, and the amount of clean air being provided.
P = D/S = 1 - exp ( - (Ipqt/Q) )
P = probability of infection for susceptibles
D = number of disease cases
S = number of susceptibles
I = number of infectors
p = breathing rate per person (m3/s)
q = quantum generation rate by an infected person (quanta/s)
t = total exposure time (s)
Q = outdoor air supply rate (m3/s)
Wells (1955) proposed a hypothetical infectious dose unit: the quantum of infection. A quantum is defined as the number of infectious airborne particles required to infect the person and may consist of one or more airborne particles. These particles are assumed to be randomly distributed throughout the air of confined spaces [4]. Riley et al. (1978) considered the intake dose of airborne pathogens in terms of the number of quanta to evaluate the probability of escaping the infection [5]. This was a modification of the Reed-Frost equation (Abbey, 1952) [6]. Together with the Poisson probability distribution describing the randomly distributed discrete infectious particles in the air the Wells-Riley equation was developed. [3]
The Wells-Riley equation roots go back into the previous century. It was always known that this is a volume versus infection rate 8th grade algebra and geometry problem.
Revisiting old science and engineering to try and change bad policy and management is pointless and a waste of time and resources. This is not about selling to poor policy makers and management. The poor policy makers and management just need to be replaced.
References
[1] MIT researchers say time spent indoors increases risk of Covid at 6 feet or 60 feet in new study challenging social distancing policies, CNBC, April 27, 2021. webpage https://www.cnbc.com/2021/04/23/mit-researchers-say-youre-no-safer-from-covid-indoors-at-6-feet-or-60-feet-in-new-study.html, April 2021. MIT researchers say time spent indoors increases risk of Covid at 6 feet or 60 feet in new study challenging social distancing policies.
[2] WHO Publication/Guidelines Natural Ventilation for Infection Control in Health-Care Settings, World Health Organization (WHO), 2009. webpage https://www.ncbi.nlm.nih.gov/books/NBK143284/pdf/Bookshelf_NBK143284.pdf, May 2020. Natural Ventilation for Infection Control in Health-Care Settings, WHO, 2009 . local.
[3] Review and comparison between the Wells-Riley and dose-response approaches to risk assessment of infectious respiratory diseases, July 31, 2009. webpage https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7202094, April 2021. PDF.
[4] Wells, W.F. (1955) Airborne Contagion and Air Hygiene, Cambridge MA, Cambridge University Press; 117122. [Google Scholar]
[5] Riley, E.C. , Murphy, G. and Riley, R.L. (1978) Airborne spread of measles in a suburban elementary school, Am. J. Epidemiol., 107, 421432. [PubMed] [Google Scholar].
[6] Abbey, H. (1952) An examination of the Reed Frost theory of epidemics, Hum. Biol., 24, 201233. [PubMed] [Google Scholar].[8] COVID-19 Return To Life, webpage http://www.cassbeth.com/covid-19/return-to-life/index.html, April 2021. COVID-19 Return To Life.
School Case History
On April 25, 2021 the Lower Merion School district reported that 8 second grade students and 2 fully vaccinated family members tested positive for the COVID-19 virus [1]. It is unclear why 2 fully vaccinated family members tested positive for the virus. The district staff evaluated the classroom HVAC system and found that a part within the ductwork above the ceiling was mostly closed allowing only about 30% of the maximum amount of fresh air into the room where the 2d grade children were infected [2]. Lower Merion began full in-person learning at the end of March 2021, after public health and education officials gave the approval. The Childrens Hospital of Philadelphia recommended students return to buildings in January [4]. The Lower Merion School district maintains a dashboard [4].
Date |
Students |
Staff |
Infected |
Infected |
Infected |
Comments |
April 30, 2021 | 8,600 |
1,550 |
265 |
150 |
415 |
Lower Merion School district dashboard [4]. School reopened after the event. The school district thinks it solved the problem. |
April 30, 2021 | 22,727 |
512 |
Philadelphia School district dashboard [5]. |
The following is a system analysis of the Lower Merion School district infection event. Unlike the analysis performed in 2020, this analysis is based only on the single parameter of mechanical ventilation of Cubic Feet Per Minute (CFM). It can be easily converted to AUC as was shown in the 2020 system analysis. However, this analysis will stay exclusively in the CFM domain until the analysis reaches its natural point of diminishing returns and then other system factors will be considered.
The design requirement for the school HVAC system is 375 CFM and the measured rate was 120 CFM for the affected classroom.
The World Health Organization (WHO) recommends the following ventilation rates for a room size of 4×2×3 Meters, which is 13x7x10 Feet [6] [7] [8]:
From this data some analysis can be performed to surface some insights. [spreadsheet dilution]
Analysis Items |
Adult |
Adult |
|
Comment |
Human Respiration |
|
|
|
|
Total lung capacity (Liters) |
6 |
4.2 |
|
|
Total lung capacity (cu in) |
366.12 |
256.284 |
|
|
Total lung capacity (cu ft) |
0.211875 |
0.1483125 |
|
|
Respiration cu-ft/min |
12.7125 |
8.89875 |
|
If there are 10 adult males in the room the combined respiration rate is 127 CFM. This means that fresh air must be provided at a minimum of 127 CFM to replace the CO2 levels, otherwise people will get sleepy or worse. Brain function starts to be impacted once the CO2 level starts to build up in a classroom. The respiration rate for children is less and probably related to weight (e.g. adult male 175 lbs vs 2d grade male 50 lbs). Matching the respiration rate to scrub a room of CO2 will not remove an airborne contagion in a room, it must be significantly higher. There are requirements on what the rate should be to mitigate airborne contagions in patient hospital rooms. |
. |
|
|
|
|
Case History |
Value |
cu-ft |
AUC |
Comment |
Mechanical Ventilation Design Req cu-ft/min |
375 |
7,200 |
3 |
The 375 CFM value is slightly above WHO recommendation for Airborne Precautions. Room cu-ft assumption = 30ft x 30ft x 8ft |
Mechanical Ventilation Actual cu-ft/min |
120 |
7,200 |
1 |
At 120 CFM Infection happened. |
Infection cases |
8 |
|
|
|
Devices in affected building |
4200 |
|
|
One unmonitored mechanical device was set to an unacceptable condition. This is a large complex system and it is only the HVAC portion of the system. |
School district ft-2 (million) |
1.5 |
|
|
|
. |
|
|
|
|
WHO Recommendations |
l/s |
cu-ft/sec |
cu-ft/min |
Comment |
Patient Room Airborne Precautions |
160 |
5.650356 |
339.02 |
This is based on 1 patient in a room that has an airborne contagion. Room cu-ft assumption 13x7x10 ft results in AUC = 24. |
General Areas |
6 |
0.211888 |
12.71 |
|
Transit Spaces |
2.5 |
0.088287 |
5.30 |
|
1 litre = 28.3168 |
|
|
|
|
From the above analysis, this empirical data suggests that infection occurs at 120 CFM. The WHO recommendation for patient room airborne precautions is 339 CFM. This is slightly below the 375 CFM design requirement for the affected school buildings. These numbers once applied to a physical space of a 7,200 cu-ft classroom have an AUC of 3 and 1, which are significantly below what was suggested in the 2020 system analysis. The WHO recommendation for a CFM of 339 translates into an AUC of 25 for a patient room with airborne precautions. A patient room is much smaller than a classroom, thus the larger AUC performance result. This suggests that the current design of 339 CFM is insufficient even though in this case there has not yet been an infection event. When the school district corrected its unmonitored mechanical device it concluded that it solved the problem. Time will tell, they are running a live experiment because we know the previous generation engineering performance requirements when dealing with airborne precautions are not the current design performance requirements for the actual buildings that are in use today. The buildings were never designed to deal with the possibility of a deadly airborne contagion. However, the design can be upgraded.
Healthy buildings and how those buildings are Certified from a contagion mitigation perspective is the key issue. There is massive knowledge that must be converted to standards and then there is massive technology that can be used, all of which were developed in the last century. Some buildings will be fine, others will need upgraded HVAC systems, yet others may need ceiling level UV-C lights and or FAR UV-222 lights. In some cases, high touch surfaces may need to be replaced with proper materials. Social distancing and masking are not the answer for the next 20 years while we wait for the COVID-19 virus to disappear. The answer is our massive technology that our parents and grandparents developed when they had to deal will tuberculosis and other deadly contagions.
We know what needs to be done to make buildings healthy.
Toxic management must be removed. All the talking points and damage control are irrelevant. The bad policy makers must be removed or the COVID-19 disaster will just continue to destroy the civilization.
References
[1] 8 Classmates, 2 Fully Vaccinated Family Members, Test Positive for COVID in Lower Merion, NBC 10 Philadelphia, April 25, 2021. webpage https://www.nbcphiladelphia.com/news/coronavirus/8-classmates-2-fully-vaccinated-family-members-test-positive-for-covid-in-lower-merion/2791754, May 2021. 8 Classmates, 2 Fully Vaccinated Family Members, Test Positive for COVID in Lower Merion.
[2] Lower Merion School District says a ventilation flaw could have fueled a COVID-19 outbreak in second-grade classroom, The Philadelphia Inquirer, April 26, 2021. webpage https://www.inquirer.com/education/lower-merion-school-district-penn-valley-covid-outbreak-hvac-20210426.html, May 2021. Lower Merion School District says a ventilation flaw could have fueled a COVID-19 outbreak in second-grade classroom.
[3] Parents divided after COVID-19 outbreak at Lower Merion school, WHYY PBS NPR April 27, 2021. webpage https://whyy.org/articles/parents-divided-after-covid-19-outbreak-at-lower-merion-school, May 2021. Parents divided after COVID-19 outbreak at Lower Merion school.
[4] LMSD COVID-19 Dashboard, https://www.lmsd.org/departments/health/coronavirus-response/dashboard, May 2021.
[5] School District of Philadelphia COVID-19 Dashboard, https://dashboards.philasd.org/extensions/covid-dashboard/index.html, May 2021.
[6] WHO Publication/Guidelines Natural Ventilation for Infection Control in Health-Care Settings, World Health Organization (WHO), 2009. webpage https://www.ncbi.nlm.nih.gov/books/NBK143284/pdf/Bookshelf_NBK143284.pdf, May 2020. Natural Ventilation for Infection Control in Health-Care Settings, WHO, 2009 . local
[7] COVID-19 A Systems Perspective, Walter Sobkiw, 2021, ISBN 9780983253044, hardback.
[8] COVID-19 Return To Life, webpage http://www.cassbeth.com/covid-19/return-to-life/index.html, April 2021. COVID-19 Return To Life.
There are two basic engineering requirements that are used in designing the ventilation in a room. The first is liters per second per person (l/s/person) also stated as cubic feet per second per person (cuft/s/person). The second is air update changes (AUC) or air changes per hour (ACH) in a room. The CFM designation stands for cubic feet per minute. If a rooms CFM is determined, then it can be divided by the maximum number of people in the room to determine the cuft/s/person. The CFM also can be used to determine the room AUC when the room volume is known. There are 2 potential system performance requirements to consider when designing a room to minimize airborne contagion level. The question is how should they be used and what are the numbers that will become the system requirements.
The respiration rate for an adult male is approximately 12.7 CFM (cuft/min) [1] [2]. Most rely on the standard that the ventilation be 15 CFM (cuft/min) per person. So if there are 10 people in a room, the ventilation rate should be 150 cuft/min. This will prevent CO2 from building up in the room and having people suffer from CO2 poisoning. However, it will not prevent them from catching an airborne contagion. The WHO Patient Room Airborne Precautions requirement is 339 CFM (this is for 1 patient in the room) [3]. They also provided the room volume and based on the room volume this requirement is equivalent to 24 AUC. So there is a disconnect between the 2 requirement levels for the CFM per person (15 versus 339). These are system performance requirements and there are two of them to consider. One requirement performance level (15 CFM per person) is just trying to prevent CO2 poisoning and the other (339 CFM per person) is trying to mitigate airborne contagion levels.
If the basic requirement of 15 CFM per person is applied to a typical room size for an analysis like a classroom, the AUC can drop to a level as low a 1 AUC. We know that people including children are infected with 1 AUC [4]. That means that if the virus is being expelled by an infected person it is airborne for a minimum of 1 hour. If the AUC is increased to 4 then the window of virus exposure is 15 minutes. We see that the number of people in the room is irrelevant. What is relevant is the time the virus is in the air before the air is fully exchanged. [5]
So when considering which performance requirement is relevant in mitigating airborne contagions, it is the AUC. It makes sense because there is no way CO2 poisoning will occur with AUC levels that prevent airborne contagions unless existing occupancy standards are severely exceed. Also it is easy to relate to the AUC number because it translates to virus exposure time and the lower the exposure time the less risk of infection.
AUC |
Infection Risk Window Time |
24 |
2.5 min |
10 |
6 min |
4 |
15 min |
1 |
1 hour |
0 |
full time |
When discussing room airborne contagion risk the discussion must focus only on the AUC system requirement and not be distracted with the CFM per person system requirement. The CFM per person requirement is irrelevant to the system need. All the studies related to airborne contagions are based on air changes per hour and they only offer the CFM per person when closely coupled with other related requirements like the room volume, as in the case of of the WHO guidance.
As of May 2021, most are viewing the system need from an occupancy level perspective rather than a room air change per hour perspective. That has been the guidance since it was publicly admitted that the virus is airborne. It is unclear why this confusion was allowed to start and why it continues. It is well known that when dealing with clean rooms and airborne contagions the system requirement is always in terms of air update changes in a given space.
References
[1] COVID-19 A Systems Perspective, Walter Sobkiw, 2021, ISBN 9780983253044, hardback.
[2] COVID-19 Return To Life, webpage http://www.cassbeth.com/covid-19/return-to-life/index.html, April 2021. COVID-19 Return To Life.
[3] WHO Publication/Guidelines Natural Ventilation for Infection Control in Health-Care Settings, World Health Organization (WHO), 2009. webpage https://www.ncbi.nlm.nih.gov/books/NBK143284/pdf/Bookshelf_NBK143284.pdf, May 2020. Natural Ventilation for Infection Control in Health-Care Settings, WHO, 2009 . local
[4] 8 Classmates, 2 Fully Vaccinated Family Members, Test Positive for COVID in Lower Merion, NBC 10 Philadelphia, April 25, 2021. webpage https://www.nbcphiladelphia.com/news/coronavirus/8-classmates-2-fully-vaccinated-family-members-test-positive-for-covid-in-lower-merion/2791754, May 2021. 8 Classmates, 2 Fully Vaccinated Family Members, Test Positive for COVID in Lower Merion.
[5] MIT researchers say time spent indoors increases risk of Covid at 6 feet or 60 feet in new study challenging social distancing policies, CNBC, April 27, 2021. webpage https://www.cnbc.com/2021/04/23/mit-researchers-say-youre-no-safer-from-covid-indoors-at-6-feet-or-60-feet-in-new-study.html, April 2021. MIT researchers say time spent indoors increases risk of Covid at 6 feet or 60 feet in new study challenging social distancing policies.
Contagion Mitigation System Certification of Buildings
The School District of Philadelphia prepared a COVID-19 mitigation guideline to be followed by maintenance staff. Internally it is called a guideline but it reads like a clear actionable and traceable procedure, which is exactly what is required when dealing with a serious system like mitigating the risk of infection from a deadly contagion. It is based on information from the Center for Disease Control (CDC), the Pennsylvania Department of Health (PDH), the Pennsylvania Department of Education (PDE), the Philadelphia Department of Public Health (PDPH) and the Childrens Hospital of Philadelphia (CHOP) Policy Lab [1]. This is an excellent starting point for developing a Contagion Mitigation System Certification of Buildings standard. There are multiple instructions for operating and maintaining the HVAC system. There are also multiple operating instructions for cleaning the building areas and dealing with a COVID-19 event. The following are performance requirements from the document:
The 15 CFM per person ventilation requirement in the above guideline is less than the WHO Patient Room Airborne Precautions requirement of 339 CFM per person for airborne contagion mitigation. Instead it is similar to the WHO General Areas of 12.71 CFM per person requirement. As of May 2021, that is the challenge, they like most others are viewing the system need from an occupancy perspective rather than a room air changes per hour perspective. Should the ventilation be increased to 339 CFM and what approaches are to be used to reach that level of performance are the key system issues. The approaches are:
There are multiple considerations when certifying a building that mitigates airborne contagions. They include:
Certification is performed by an external entity. For complex systems where there is possible loss of life, the government performs the certification. For example, in new construction there is a certification process that includes multiple inspections as the project unfolds and then there is a final inspection with a certificate of occupancy that is issued for the building. In this case a Contagion Mitigation Certificate of Occupancy would be issued.
As part of privatization many mission critical systems like airplanes have been self certified by the manufacturer. In the industry this is called a self-licking ice cream cone and it is a terrible practice. The Boeing 737 MAX is an example of a self certification approach [2]. This should not be used as the approach to issue Contagion Mitigation Certificates of Occupancy. The certificates should be issued by the same organizations that issue new building and resold building Certificates of Occupancy.
What is needed is proper Building Contagion Mitigation standards based on sound engineering requirements, not guidance. Guidance is something that is usually ignored. It is also typically filled with vague statements associated with management damage control. Clear actionable, traceable, and testable engineering requirements are needed.
Once clear engineering requirements are identified, it is recognized that not all buildings can be mitigated from contagions at the same level. This suggests that different levels of Contagion Mitigation Certificates of Occupancy may need to be issued. They then should be publicly displayed. As time moves on and the COVID-19 contagion subsides this can be used as important data for future outbreaks of deadly contagions.
The following engineering requirements and Contagion Mitigation Levels are proposed to assess a building and issue a Contagion Mitigation Certificate.
Level |
State |
AUC |
AUC Range |
Infection Risk |
Airborne Contagion Mitigation System Building Condition |
Likely Technologies |
6 |
Green |
120 |
120+ |
30 sec |
Approaches outside ventilation conditions | Exhaust fans previously used to remove smoke filled public spaces |
5 |
Green |
50-100 |
50-120 |
1.2 min |
Similar to operating room without PPE conditions in all public affected spaces |
Large HVAC system + UV and or other |
4 |
Yellow |
24 |
24-50 |
2.5 min |
Similar to WHO patient room airborne precautions in all public affected spaces |
Small HVAC system + UV and or other |
3 |
Yellow |
10-24 |
10-24 |
6 min |
Similar to WHO patient room airborne precautions in most public spaces but not all |
Small HVAC system + UV and or other or Large HVAC system |
2 |
Orange |
4 |
4-10 |
15 min |
Marginal mitigation |
Medium HVAC system (usually heater + cooling) |
1 |
Red |
1 |
1-4 |
1 hr |
No mitigation, School data suggests infection happens [6] |
Small HVAC system (usually heater only) |
0 |
Red |
0 |
0-1 |
full time |
No ventilation | No windows, no mechanical, no UV, no other |
The following justification is offered for the Certificate State colors.
The 2020 system analysis suggested that an infected person will exhale an infection load in a very small amount of time. A cough or sneeze is orders of magnitude worse. [3] [4] The lower the infection risk window time, the lower the risk of infection, and the greater the mitigation level. A Level-6 certificate is the most effective indication of contagion mitigation.
The 2020 system analysis suggested that when trying to understand contagions, the problem is best viewed from the perspective of how long a contagion might remain in the affected space. The CFM performance metric is useful for understanding the buildup of CO2 in a space, but not for contagion mitigation. The CFM must be coupled with the associated physical space and the AUC determined.
As part of the certification, all the ventilation CFM and physical volume data needs to be gathered to determine the AUC in each space and clearly documented. This information then needs to be examined and the appropriate certification level applied to the Contagion Mitigation Certificate of Occupancy. Individual certificates need to be placed in each room and then an overall building certificate in the main lobby needs to be placed in clear public view without any special access. A building may have several Level-6 rooms but the building itself may be a Level-1 building based on a worst case finding in a portion of the building where the public may gather. The building operators can either accept the Level-1 certificate, close off the area, or upgrade that area of the building.
This is not a popular analysis finding and suggestion for a path forward. However we have been in COVID-19 disaster mode for over a year.
Welcome to the 21st century of deadly airborne contagions.
References
[1] Cleaning and Ventilation Protocols, Addendum to 2017 General Cleaning Guidelines - COVID-19, Department of Operations - October 2020. webpage https://docs.google.com/document/d/1ujhxHbJH-_73ewQne0m40nXrVu2ejOe6P896-HJYoBE/edit, https://www.philasd.org/coronavirus/schoolstart2020/#1613754853066-88c619db-678c, May 2021. local PDF
[2] Privatization A Systems Perspective, Walter Sobkiw, 2019, ISBN 9780983253068. Privatization A Systems Perspective
[3] COVID-19 A Systems Perspective, Walter Sobkiw, 2021, ISBN 9780983253044, hardback.
[4] COVID-19 Return To Life, webpage http://www.cassbeth.com/covid-19/return-to-life/index.html, April 2021. COVID-19 Return To Life.
[5] Philadelphia School District Air Balance Reports by school. webpage https://www.philasd.org/coronavirus/schoolstart2020/#1613757068528-a10a5ddf-592d, https://drive.google.com/drive/folders/1XULamBiR3v1sB_u15rcyXOxQlq1ygsGT, May 2021. local excel cert analysis
[6] See section School Case History.
Once the certification process starts the findings will identify possible areas for improvement. The improvements may be associated with building procedures or with building systems. The following identifies technologies with the implied products and systems that can be used to boost building certification levels.
In the 2020 system analysis, various technologies were identified to mitigate contagions [1] [2]. The analysis identified Photocatalytic Oxidation air cleaning (PCO) but focused on the HVAC systems, Fans, Natural Ventilation, Ceiling Level UV-C lights, and Far UV-222 lights.
In 2021 PCO technology is being considered by many facilities. A product called Active Pure continuously creates oxidizing molecules that has been claimed to reduce up to 99.99% of pathogens including SARS-CoV-2, Avian influenza, E.Coli, MRSA, Norovirus, Staph bacteria, Candida, Swine Flu, Hepatitis, and Legionella [3] in 3 minutes [4]. A PCO system bathes the entire space in molecules that destroy pathogens. It is assumed that it takes several minutes for the space to be filled with the molecules but once initiated the kill rate is assumed to be continuous as long as the device is in operation. If the kill rate is at 3 minutes then the equvalent AUC or eAUC = 20. No studies were located to add more information and provide a better understanding of these systems from an eAUC perspective. If the eAUC is 20 the this is similar to a ceiling level UV-C system which can have an eAUC = 24 according to various studies and claims from CDC related documentation. There are details such as the production rate of the molecules. For example, one product has an air processing rate of 300 CFM maximum, but if the molecules stay airborne then once initialized the coverage may be for the entire physical space for 100% of the time. As always there are engineering details associated with system sizing and resulting performance.
The available technologies to boost certification levels are:
Technology | Possible AUC | Source | Comments |
Typical HAVC system | 4 |
Current standards [2] | Only when on |
Special HAVC system | 60 |
Current standards [2] | Only when on |
Fans | 100 |
Analysis [2] | Only when on |
Open Windows | 37 |
WHO [2] | Only when open |
Ceiling Level UV-C | 24 |
CDC [2] | Continuous airborne eAUC |
Far UV-222 | 4+ |
Columbia University [2] | Continuous airborne and surface, eAUC is much higher but needs to be validated with more analysis |
PCO | 20 |
Active Pure | Continuous airborne and surface eAUC |
Outside space | 3600 |
Analysis [2] | Continuous full space operation |
Each space is unique and some technologies are more appropriate for a particular space than others. The solution needs to be a system integration solution providing the most effective system.
References
[1] COVID-19 A Systems Perspective, Walter Sobkiw, 2021, ISBN 9780983253044, hardback.
[2] COVID-19 Return To Life, webpage http://www.cassbeth.com/covid-19/return-to-life/index.html, April 2021. COVID-19 Return To Life.
[3] Active Pure company. website https://www.activepure.com, May 2021.
[4] ActivePure seeks emergency FDA approval for air purifier to fight Covid-19, CNBC, December 29, 2020. webpage https://www.youtube.com/watch?v=-Z_wQ29cShw, May 2021.
The Philadelphia School District performed a site survey of their schools and published the findings on the school district website. [1] This is an excellent system site survey and the data is captured in a spreadsheet. Each school is captured in a separate tab in the spreadsheet. There are 220 tabs suggesting that there are 220 schools that were surveyed. Each row represents a space in the school with an appropriate name that conveys the space use. The spreadsheet was converted to a single tab spreadsheet so that all the spaces in all the schools could be easily analyzed for AUC and Contagion Mitigation Level (CML). The CML is the number used for the Contagion Mitigation Certification Level (CMCL). [2]
The pre-contagion mitigation results are as follows. [Certification Spreadsheet]
Room Ratings
|
Overall District Rating
|
The overall District Rating is 1 Red before contagion mitigation. The post contagion mitigation results are as follow. This school district moved from Level 1 Red to Level 2 Orange. We also see that a large number of rooms moved from Level 1 Red to higher levels with a significant jump into Level 3 Yellow. The Level 3 category is approaching hospital room airborne contagion mitigation levels.
Room Ratings
|
Overall District Rating
|
There was 1 room that was rated at Level 6 and 25 rooms rated at Level 5. They are as follows:
Space |
AUC |
Certification Level |
Comments |
Classrooms |
64 |
5 |
|
Classrooms |
70 |
5 |
|
Classrooms |
76 |
5 |
|
Autobody |
73 |
5 |
|
Sheet Metal |
50 |
5 |
|
Warehouse Classroom |
114 |
5 |
|
Factory Lab |
69 |
5 |
|
Offices |
327 |
6 |
Thomas Edison High School - Offices is the row label |
Janitor Close and Storage Rooms |
82 |
5 |
|
CAFE |
70 |
5 |
|
Classroom |
57 |
5 |
|
Gym |
57 |
5 |
|
Asist Prince |
117 |
5 |
|
Classroom |
72 |
5 |
|
Office |
73 |
5 |
|
Classroom |
79 |
5 |
|
1st Flr Kitchen |
68 |
5 |
|
Exercise |
105 |
5 |
|
Storage |
105 |
5 |
|
Boiler Rm. |
118 |
5 |
|
Classrooms |
60 |
5 |
|
Nurses |
59 |
5 |
|
Kitchen |
51 |
5 |
|
Kitchen |
53 |
5 |
|
MEDIA LAB B |
71 |
5 |
|
Gym- Weight Room A |
51 |
5 |
The Philadelphia School District purchased 2000+ Active Pure systems. For this analysis it is assumed that the Active Pure systems have an eAUC = 20. This is similar to a ceiling level UV-C system. Again eAUC of 20 for the Active Pure system is based only on some broad assumptions in this analysis and the number may be significantly smaller (see Section Technologies to Boost Certification Levels). However for this analysis the best case is selected. In both instances the costs are approximately the same, $1500 retail price per unit. It is unclear what the negotiated prices might be for a large purchase like the Philadelphia School District.
What If Analysis
A What If Analysis [3] can be performed using the Philadelphia School District site survey. The site survey provided data to calculate the AUC, CML, and CMCL. The data shows that the school district purchased 2500 PCO like systems to help with classroom ventilation. This allowed the school district to move from a CMCL of 1 to 2 and it moved 2000+ rooms into CMCL 3. This analysis increases the number of PCO like systems to determine its impact on the overall school district CMCL rating. The analysis is approximate and is based on the total district cubic feet, AUC, and number of rooms. This results in a slightly different AUC number than when the individual room AUCs are calculated. This is an artifact of the site survey data where in some instances cubic feet is provided but no ventilation number is provided. Regardless the results are similar and what is desired is a What If Analysis to determine the effect of adding more mitigation technology units. The results are as follows. [Certification Spreadsheet]
For the analysis the following date was used:
eAUC / PCO |
20 | Assumption based on vendor claims |
Total cu-ft | 92,871,681 | site survey data |
Total HVAC CFM | 4,337,033 | site survey data |
Total HVAC AUC | 38,489 | site survey data |
The analysis results are:
Num PCO Units |
Total eAUC |
Total AUC |
AUC |
CML |
Cost |
PCO / Room |
Comments |
0 |
0 |
38,489 |
3.0 |
1 |
|
|
|
2503 |
50,060 |
88,549 |
6.9 |
2 |
$3,754,500 |
0.19 |
From site survey. |
4503 |
90,060 |
128,549 |
10.0 |
3 |
$6,754,500 |
0.35 |
If the technology complements the HVAC system then the system quickly jumps to CML 3 |
6503 |
130,060 |
168,549 |
13.1 |
3 |
$9,754,500 |
0.51 |
This does not impact the overall rating for the school district but it continue to the number of rooms to the next CML level. |
8503 |
170,060 |
208,549 |
16.2 |
3 |
$12,754,500 |
0.66 |
|
10503 |
210,060 |
248,549 |
19.4 |
3 |
$15,754,500 |
0.82 |
|
12503 |
250,060 |
288,549 |
22.5 |
3 |
$18,754,500 |
0.97 |
|
14503 |
290,060 |
328,549 |
25.6 |
4 |
$21,754,500 |
1.13 |
It is unclear if over dosing the space with the PCO technology is an issue. |
16503 |
330,060 |
368,549 |
28.7 |
4 |
$24,754,500 |
1.29 |
Eventually the HVAC system becomes irrelevant |
18503 |
370,060 |
408,549 |
31.8 |
4 |
$27,754,500 |
1.44 |
Multiple units per room is probably not appropriate for most technologies. What needs to happen is the either other additional technologies are added into the system or the technology performance is increased. For example, instead of HVAC + PCO move to HVAC + PCO + UV but there may be compatibility issues that need to be understood. |
20503 |
410,060 |
448,549 |
34.9 |
4 |
$30,754,500 |
1.60 |
|
22503 |
450,060 |
488,549 |
38.0 |
4 |
$33,754,500 |
1.75 |
|
24503 |
490,060 |
528,549 |
41.2 |
4 |
$36,754,500 |
1.91 |
|
26503 |
530,060 |
568,549 |
44.3 |
4 |
$39,754,500 |
2.06 |
|
28503 |
570,060 |
608,549 |
47.4 |
4 |
$42,754,500 |
2.22 |
|
30503 |
610,060 |
648,549 |
50.5 |
5 |
$45,754,500 |
2.38 |
|
32503 |
650,060 |
688,549 |
53.6 |
5 |
$48,754,500 |
2.53 |
|
34503 |
690,060 |
728,549 |
56.7 |
5 |
$51,754,500 |
2.69 |
|
36503 |
730,060 |
768,549 |
59.8 |
5 |
$54,754,500 |
2.84 |
|
38503 |
770,060 |
808,549 |
63.0 |
5 |
$57,754,500 |
3.00 |
|
40503 |
810,060 |
848,549 |
66.1 |
5 |
$60,754,500 |
3.15 |
|
42503 |
850,060 |
888,549 |
69.2 |
5 |
$63,754,500 |
3.31 |
|
44503 |
890,060 |
928,549 |
72.3 |
5 |
$66,754,500 |
3.47 |
|
46503 |
930,060 |
968,549 |
75.4 |
5 |
$69,754,500 |
3.62 |
|
48503 |
970,060 |
1,008,549 |
78.5 |
5 |
$72,754,500 |
3.78 |
|
50503 |
1,010,060 |
1,048,549 |
81.6 |
5 |
$75,754,500 |
3.93 |
|
52503 |
1,050,060 |
1,088,549 |
84.8 |
5 |
$78,754,500 |
4.09 |
|
54503 |
1,090,060 |
1,128,549 |
87.9 |
5 |
$81,754,500 |
4.24 |
|
56503 |
1,130,060 |
1,168,549 |
91.0 |
5 |
$84,754,500 |
4.40 |
|
58503 |
1,170,060 |
1,208,549 |
94.1 |
5 |
$87,754,500 |
4.56 |
|
60503 |
1,210,060 |
1,248,549 |
97.2 |
5 |
$90,754,500 |
4.71 |
|
62503 |
1,250,060 |
1,288,549 |
100.3 |
5 |
$93,754,500 |
4.87 |
|
64503 |
1,290,060 |
1,328,549 |
103.5 |
5 |
$96,754,500 |
5.02 |
|
66503 |
1,330,060 |
1,368,549 |
106.6 |
5 |
$99,754,500 |
5.18 |
|
68503 |
1,370,060 |
1,408,549 |
109.7 |
5 |
$102,754,500 |
5.33 |
|
70503 |
1,410,060 |
1,448,549 |
112.8 |
5 |
$105,754,500 |
5.49 |
|
72503 |
1,450,060 |
1,488,549 |
115.9 |
5 |
$108,754,500 |
5.65 |
|
74503 |
1,490,060 |
1,528,549 |
119.0 |
5 |
$111,754,500 |
5.80 |
|
76503 |
1,530,060 |
1,568,549 |
122.1 |
6 |
$114,754,500 |
5.96 |
The point of the What If Analysis was to determine what it would take for the system to reach a CML of 6. |
If the technology complements the HVAC system then the system quickly jumps to CML 3. It is unclear if over dosing the space with the PCO technology is an issue. Eventually the HVAC system becomes irrelevant. Multiple units per room is probably not appropriate for most technologies. What needs to happen is the either other additional complementary technologies are added into the system or the individual technology performance is increased. For example, instead of HVAC + PCO move to HVAC + PCO + UV or HVAC + PCO + Fans with filtration (Classroom & Other Designs) [4] [5] or HVAC + PCO + Negative pressure per person systems [4] [5] but there may be compatibility issues that need to be undersold.
Other Buildings Based On Existing Standards
The starting point for Contagion Mitigation Certification Level assessments is to examine the current standards. The standards do not reflect the actual building design and implementation but they are a starting point for what the best case expected results might be after the assessment.
There is a spreadsheet with several hundred Area Types (Rooms) identified with various AUC standard numbers that are expected to be used in the design of a physical space. [spreadsheet ACH CML]
The Certification Levels below are based on the Max AUC standard from the various sources in the spreadsheet. [spreadsheet ACH CML]
Area |
AUC |
AUC |
Source |
Cert Level |
Area |
AUC |
AUC max |
Source |
Cert Level |
Hospital Trauma room | 15 | - | CDC | 3 yellow |
Classroom (Art) | 16 | 20 | EPA | 3 yellow |
Hospital room airborne precautions | 24 | - | WHO | 4 yellow |
Malls | 6 | 10 | EPA | 2 orange |
Hospital operating room | 25 | - | 4 yellow |
Office | 8 | 30 | Greenheck | 4 yellow |
|
Hospital rooms | 6 | 10 | EPA | 2 orange |
Engine Room | 20 | 60 | Greenheck | 5 green |
Restaurants | 8 | 12 | EPA | 2 orange |
Kitchen | 12 | 60 | Greenheck | 5 green |
Restaurants | 8 | 20 | NCI | 3 yellow |
Kitchen | 7 | 8 | NCI | 2 orange |
Restaurants | 15 | 20 | wiki | 3 yellow |
Kitchen | 14 | 18 | NCI | 3 yellow |
Bar | 15 | 30 | Greenheck | 4 yellow |
Kitchens (commercial) | 15 | 30 | EPA | 4 yellow |
Bar | 15 | 20 | NCI | 3 yellow |
Retail | 6 | 10 | NCI, wiki, EPA | 2 orange |
Bar | 15 | 20 | wiki | 3 yellow |
Laboratory | 12 | 30 | Greenheck | 4 yellow |
School Classroom | 4 | 12 | EPA | 3 yellow |
Laboratory | 6 | 12 | wiki | 3 yellow |
Auditorium | 8 | 15 | EPA | 3 yellow |
Club Houses | 20 | 30 | EPA | 4 yellow |
Assembly Hall | 6 | 8 | EPA | 2 orange |
Theatres | 8 | 15 | EPA | 3 yellow |
There are no design standards that would result in a Level 0 or 1 Red condition as long as the lower limits of the standard were not picked for the design. Some of the design standards are Level 5 Green. Just because a design, resulting implementation, and actual test results may yield a rating above Level 0 it does not mean that the building operates at its suggested Level. The systems could be turned off or disabled. This is especially of concern in public buildings like bars and restaurants where there is no large central maintenance organization responsible for the facility. In these buildings the certification level is drastically affected because the CML is zero when the HVAC system is not running. One strategy is to apply a simple set of rules that modify the certification level with a ceiling cap based on the ability to bypass or mismanage the systems. The other strategy is to offer two separate certification levels, one for the equipment CML and one for the controls CML. The in either case the criteria might be:
Max Possible Cert Level |
System Operation | Risk of System Compromise | Comments |
6 |
Fully automated with alarms | Very Low six 9s five |
State of the art office building and schools |
4 |
Fully automated | Very Low three 9s five |
Office building, large schools, large retail stores |
3 |
Manually controlled by onsite dedicated maintenance staff | Low 1% |
Office building and large schools |
0 |
Manually controlled by building users | Very High 50% |
Bars, restaurants, clubhouses, retail stores |
An approach to capture this information in a certificate, that is physically posted in the building, is to provide the building Contagion Mitigation Level when the system is on and the Contagion Mitigation Level when the system is off (because of the high risk of system compromise). This can be accomplished with two separate certification ratings on the same physical certificate document: Contagion Mitigation Level and Contagion Mitigation Controls. The following are examples:
Certificate 1:
Building | Contagion Mitigation Level | Contagion Mitigation Controls |
Bar and Restaurant | Level 5 GREEN |
Level 0 RED |
Certificate 2:
Building | Contagion Mitigation Level | Contagion Mitigation Controls |
Large Retail Store | Level 5 GREEN |
Level 4 Yellow |
Certificate 3:
Building | Contagion Mitigation Level | Contagion Mitigation Controls |
State of the art School | Level 5 GREEN |
Level 6 Green |
Notice that Certificate 3 has a higher rating for the controls than the general Contagion Mitigation Level. This suggest that the school still has the possibility of adding higher levels of system performance to mitigate airborne contagions.
References
[1] Philadelphia School District Air Balance Reports by school. webpage https://www.philasd.org/coronavirus/schoolstart2020/#1613757068528-a10a5ddf-592d, https://drive.google.com/drive/folders/1XULamBiR3v1sB_u15rcyXOxQlq1ygsGT, May 2021. local excel cert analysis
[2] Philadelphia-Schools-Walkthroughs-Total-Summary_Public_final-merged.xls, May 2021. webpage http://www.cassbeth.com/covid-19/lib/Certification/Philadelphia/Certification-Analysis/Philadelphia-Schools-Walkthroughs-Total-Summary_Public_final-merged.xlsx, May 2021. local
[3] Systems Practices As Common Sense, Walter Sobkiw, ISBN: 978-0983253082, first edition 2011, ISBN: 978-0983253051, second edition 2020. REF 1
[4] COVID-19 A Systems Perspective, Walter Sobkiw, 2021, ISBN 9780983253044, hardback.
[5] COVID-19 Return To Life, webpage http://www.cassbeth.com/covid-19/return-to-life/index.html, April 2021. COVID-19 Return To Life.
What has just been described is a maturity model targeted towards contagion mitigation. Maturity models are not new and their roots trace back to the previous century. Examples include using maturity curves for employee evaluations and capability maturity model assessments of organizations engaged in software intensive systems.
In the late 1960's Hughes Aircraft was the first company to develop a large software intensive air defense system using scientific and engineering principles. It became the foundation for all future software intensive systems development at Hughes [1]. Prior to that time software was viewed as an artistic process. Embedded in this setting surfaced the concept of maturity level for developing software based on science and engineering. By the 1980s Hughes Aircraft was deeply engaged in maturity models across the organization. They were used for employee evaluations, company evaluations to assess ability to provide subsystems for Hughes system solutions, technology assessments, and other areas including software development. In the 1980s the Howard Hughes Medical Institute was forced to divest itself of Hughes Aircraft and General Motors took over Hughes Aircraft. The software maturity documentation eventually moved to Carnegie Mellon University and the Software Engineering Institute (SEI) was established with the Capability Maturity Model. The concept of a maturity model grew and SEI maintains multiple Maturity Models [2].
Today many in the high technology industries tend to associate the concept of a capability maturity model with software. However the roots of a capability maturity model concept go back many years and can be found in the way employees were and still are compensated and the way companies were evaluated when selected as part of a proposal evaluation process for a major project or program. The idea of maturity is not new and connecting maturity to some expectation was and still is a reasonable process if all the players follow the rules of civilized enlightened behavior. That last phrase is the fly in the ointment because many will find ways to reject or game a model to avoid or achieve an invalid high rating.
The early systems and software capability maturity models were more about teaching. They had content that organizations could use to try to determine what to do when engaged in a large systems and software intensive program. This was an artifact left over from Hughes Aircraft. These models are based on an ideal world; however, the ideal world does not exist. Just as in economics we know that people do not behave rationally, people do not behave rationally in organizations that do not naturally evolve into a capability maturity model mind set. The initial reaction when these models were released was don't tell me what to do. So the models moved away from teaching into more of a regulatory mode. However, again in an irrational world the organizations find ways around the models and cause havoc.
The models themselves tried to capture what was considered good from the companies and organizations that gave us our modern world. Just like the government standards and data item descriptions they are incomplete. Not because the people were lazy or driven by hidden agendas but because it was hard to capture that magic sauce that these great organizations offered to the world.
Organizational Capabilities
An organization's process capability can be examined and assessed. However that is not a complete view of the organization. This becomes very apparent when an organization is subjected to a proposal or vendor selection process. Typically the selection process includes the technical approach, company assessment, and cost. The company assessment includes items such as:
Further there are generic company capabilities that can be used to measure its capability. The following are ordered lists of company capabilities from the most capable to the least capable:
Employee Capability Maturity Curves
Capability maturity curves were used extensively in the 1970's and early 1980's to determine an employee's compensation in many premier high technology companies. Although not stated explicitly the US Government also used capability maturity to determine the compensation of a employee. This was accomplished by defining the expectations associated with each level of maturity. Then there was a factor added to the starting salary of each maturity curve as the employee gained more years of experience on a particular maturity curve. If the employee would demonstrate proficiency at the next level of maturity then the employee would be moved to the next level maturity curve, which would have a higher final salary. Each maturity curve would plateau in salary. So the expectation was that employees would jump to the next level of maturity prior to reaching the plateau on a particular salary band (maturity curve).
The following is an example of criteria that could be used to determine maturity curves in a technical organization. This concept goes back several hundred years and is based on the apprentice, journeyman, and master model. This model acknowledges that something worthy of mastering requires skilled labor rather than unskilled labor.
The US government salary scale is based on this concept where each GS level has 10 steps and movement within a GS level follows a scenario of: 1 year at steps 1-3, 2 years at steps 4-6, and 3 years at steps 7-9. Movement into a different GS scale represents movement into a different maturity level. The following words associated with each maturity level are only offered as an example and do not represent any organization.
Levels were used at Hughes Aircraft. All technical people entered at Level 7 regardless of experience, including former executives (vice presidents). They then progressed through the Hughes Aircraft maturity curves. This progression was based on observed behavior and was regardless of years of experience. The advantage of this compensation system was that young high technology staff with demonstrated maturity could command the high salaries of senior executives in other organizations .
Author Comment: This system was abandoned when leveraged buyouts surfaced in the early 1980's. There was enormous wealth built up in all of the large successful companies that could be extracted by outsiders using various financial schemes. This required relaxation of regulations and non-enforcement of laws such as racketeering and antitrust legislation. As these organizations were pillaged in much the same way a medieval village was pillaged in the middle ages, the need for these systems disappeared. Employees were just happy to have jobs and human resources was converted to a liability limiting organization to ensure that employee lawsuits would be minimized as both written and implied contracts were scrapped in a war like setting. Nobody cared about capability anymore. In this disastrous setting organizations were no longer able to deliver reasonable designs, especially software. Meanwhile there was a need for thousands of companies to start producing high quality software, not just a few, as the computer became available to everyone. Computer costs had dropped so that everyone was now able to purchase a computer. This discussion is important because it describes why multiple future capability models surfaced. It also describes the need for a contagion mitigation model in this century to deal with the COVID-19 disaster.
Stages of Growth Model
The Stages of Growth Model (SGM) is a model for the growth of computer automation in an organization. Today we refer to computer automation as information technology (IT) but the computer automation term is more accurate because it represents what was happening with the introduction of the computer. Many manual tasks performed by people were being replaced with the computer. SGM offers a structured framework for what happens when the computer is introduced into an organization. It is based on the concept that an organization evolves slowly into the new technology, in this case computer automation. There are six stages in SGM.
The challenges faced with the introduction of computer automation in the last century are the same challenges that will be faced with introducing contagion mitigation systems in this century. This description is offered to understand that the challenge is not new and there are frameworks that can be used to address this challenge. Just replace IT and software with contagion mitigation system in the following description.
Stage I - Initiation Stage
In this stage, computer automation is introduced into the organization. There are two primary reasons for this introduction. In the first case the company reaches a size where the administrative processes cannot be accomplished without computers. Also, the success of the business justifies a large investment in specialized equipment. The second case deals with computational needs where the critical size of the company is the primary reason for computer acquisition.
At this stage the personnel are unfamiliar with the technology. So they take a hands off approach to new technology. The focus is on the functional applications to reduce costs. The initial software is simple to use and cheap to implement. This offers substantial monetary savings to the company in some cost benefit analysis. The new IT department receives little attention from management and work in a carefree atmosphere.
Stage II - Contagion Stage
At Stage II, even though the benefits of computers are recognized by many in Stage I, computing still alienates many. So management explains the potential of computers to the alienated users. This eventually leads to adoption of computers in new areas and a proliferation of applications in exiting areas.
At this stage project and budgetary controls are not developed. This leads to a saturation of existing computer capacity and more sophisticated computer systems being obtained. The new system sophistication requires hiring new specialized professionals. Due to the shortage of qualified individuals, employee salaries are high. The budget for the computer organization the significantly increases and causes management concern. The price of Stage II is high, the benefits are visible, but planning and control of computer systems needs to be introduced.
Stage III - Control Stage
During Stage III centralized controls are established and a shift occurs from management of computers to management of data resources. This stage is a reaction against excessive and uncontrolled expenditures of time and money spent on computer systems. Management has recognized the need to take control of the computer operating costs. Project management and management report systems are organized. This leads to the development of programming, documentation, and operation standards. A shift occurs from management of computers to management of data resources. This shift is an outcome of analysis of how to increase management control and planning data processing operations. The shift provides flexibility in data processing that is needed for management's new controls. There is a reconstruction of data processing operation.
Stage IV - Integration Stage
During Stage IV there is adoption of new technology to integrate separate systems. This results in additional data processing cost growth similar to that of Stage II. In the last half of Stage IV, there is also dependence on computer controls, which leads to inefficiencies. These inefficiencies that are really associated with rapid growth result in another wave of problems. In the original SGM this was the last stage.
Stage V - Management Stage
In 1979 SGM was updated with this stage. Stage V has a new emphasis on managing corporate data rather than IT. The concept of Information Services (IS) surfaces and replaces data processing. It includes the development and maturity of the new concept of data administration.
Stage VI - Maturity Stage
In Stage VI, the applications mirror the organization and information flows in the company. There is emphasis on manufacturing, marketing and financial control. Manufacturing control includes forecasting, looking down the road for future needs. Marketing control deals with research. Financial control forecasts future cash requirements. When effective, this stage allows the organization to function at high levels of efficiency and effectiveness.
The SGM is very similar to the technology push pull discussions [3]. SGM can be easily adopted and used for the introduction of any new technology, process, or technique, not just computer automation. It describes a natural maturity progression from the initial neophyte stages to final sophisticated highly mature stages that exist in all settings.
Natural Human Maturity
The concept of maturity is a very general concept and is seen in nature. This is why many have surfaced it to explain unique aspects of their domains. Like many theories, these models are just extensions of what is observed in the natural world. The following is a description of the Its all Relative Model (IRM).
IRM is an explanation of human maturity and is based on the concept of measuring maturity based on years of exposure to a topic as one matures from birth to old age. It is offered as an analogue to explain and sensitized everyone to the concept of experience base. The IRM is described as follows:
Maturity Scale |
|||||
Age | Phase | Baby | Child | Kid | Teen |
1 | baby | 33 | 100 | 100 | 100 |
2 | baby | 66 | 100 | 100 | 100 |
3 | Baby stage mastered | 100 | 100 | 100 | 100 |
4 | child | 0 | 50 | 100 | 100 |
5 | Child stage mastered | 0 | 100 | 100 | 100 |
6 | kid | 0 | 0 | 14 | 100 |
7 | kid | 0 | 0 | 28 | 100 |
8 | kid | 0 | 0 | 42 | 100 |
9 | kid | 0 | 0 | 56 | 100 |
10 | kid | 0 | 0 | 70 | 100 |
11 | kid | 0 | 0 | 84 | 100 |
12 | Kid stage mastered | 0 | 0 | 100 | 100 |
13 | teen | 0 | 0 | 0 | 17 |
14 | teen | 0 | 0 | 0 | 34 |
15 | teen | 0 | 0 | 0 | 51 |
16 | teen | 0 | 0 | 0 | 68 |
17 | teen | 0 | 0 | 0 | 85 |
18 | Teen stage mastered | 0 | 0 | 0 | 100 |
So just when you master becoming a baby you are pushed into the child frame of reference. Just when you master being a child you are pushed into the kid frame of reference. Babies know nothing about being a child. A child knows nothing about being a kid, and so on through each phase, its maturity curve and transition to the next phase. This model surfaced when attempting to properly raise my own children. It was a simple way to communicate that they are engaging in areas well outside their area of understanding. This same relationship holds true in every aspect of System Engineering and Management.
Where Did This Really Originate
The 1980s were dominated by massive hardware miniaturization. This allowed the cost of computers to significantly drop. A computer was no longer a significant capital investment. Instead it approached the cost of a typewriter in any setting. All these new computers and users gave rise to millions of new needs that required software. The few companies that were proficient in developing software could not fulfill the need. So new companies formed, many with management from other industries including the failing rust belt industries. The new software industry participants had members with failed business models and little or no knowledge of high technology or software. Meanwhile existing highly capable companies ran into trouble. A new trend of vulture capitalism surfaced where various financial schemes were used to extract wealth from many very successful high technology companies that were also software proficient. This resulted in chaos within previously stable effective companies and they were no longer able to develop effective software in a reasonable cost schedule project vehicle.
This turn of complex events significantly affected the US Government, which needed to maintain existing systems and develop new systems. The result was the Software Engineering Institute (SEI) at Carnegie Mellon University. This led to the Capability Maturity Model (CMM) and it became the foundation for the new SEI. Shortly after the introduction of the CMM, the US Government also changed their procurement strategy to include a working prototype as part of proposal submissions for software intensive projects.
Author Comment: RCA is a classic example of these events, where GE devastated the company. Only employees know how much capability, knowledge, technologies, and opportunities were lost as GE extracted wealth from RCA. Also in this same time frame Hughes was sold (as part of a political movement to eliminate non-profits) General Motors, not exactly an example of high technology or great management at that time. The thought was that Hughes would transform GM into a modern high technology company. Instead GM sold off the massive Hughes real estate assets (e.g. Fullerton Campus) and then dumped the high technology business to defense companies that refused to transition from defense to industrial and or commercial work after the fall of the Berlin Wall. This was in an atmosphere of privatized government where it became accepted to have a business derive 100% of its earnings from government funds and also make significant profits. This is contrary to RCA, where David Sarnoff publicly stated it was his patriotic duty to maintain defense divisions that did not need to make money. Instead the industrial and consumer divisions were the business and made money for RCA. Meanwhile GM eventually declared bankrupcy, probably because they sold off the last remaining real estate assets owned by Hughes Aircraft.
The Big Picture of Maturity Models
They capability maturity models were started in a stable time and used as part of normal system development. They were taken for granted and just naturally existed in organizations like Hughes Aircraft. In times of crisis the maturity models and associated assessments became critical tools as a way to try and continue to move forward. The model proposed for contagion mitigation in this century is in the same category and can be used to deal with the massive COVID-19 disaster.
The contagion mitigation model when used to assess a building provides a view of the level of maturity of the buildings ability to mitigate airborne contagions. Its value is not in the rating but in understand where the building falls in airborne contagion mitigation maturity. With that understanding various strategies can be developed to increase the level of contagion mitigation maturity until the building reaches what can be considered the highest level of contagion mitigation.
References
[1] Hughes Aircraft's Widespread Deployment of a Continuously Improving Software Process, R.R. Willis, R.M. Rova, M.D. Scott, M.I. Johnson, J.F. Ryskowski, J.A. Moon, K.C. Shumate, T.O. Winfield, Technical Report CMU/SEI-98-TR-006, ESC-TR-98-006, May 1998.
[2] Software Engineering Institute, webpage https://www.sei.cmu.edu, May 2021.
[3] Systems Practices As Common Sense, Walter Sobkiw, ISBN: 978-0983253082, first edition 2011, ISBN: 978-0983253051, second edition 2020. REF 1
The purpose of this Product Certification Testing Strategy is to test and evaluate various products and systems for airborne contagion mitigation. The goal is to provide a common engineering metric that can be used in the design of effective airborne contagion mitigation systems. Most of the studies in the past 50 years are associated with Air Update Rates (AUC) or Air Changes Per Hour (ACH). There is a difference between the two where one represents the introduction of fresh air. For this test and evaluation platform there will be no introduction of fresh air. This will allow solutions other than HVAC systems and Fans to be evaluated like UV systems, PCO systems, and others systems that do not use air exchange as part of the mitigation mechanism.
The test approach is to use a controlled Known Test Bed (KTB) or gold standard and then a Target Test Bed (TTB) containing the product and or system under test. The approach is to use 2 separate clean rooms and feed them from a single airborne contagion source using a Y-pipe. The purpose of the Y-pipe is to ensure that each test bed receives the same amount of airborne contagion. Petri dishes are to be uniformly distributed in the same locations after the clean rooms are initiated to an ISO-3 level condition. The recommended locations are on the walls and in the spaces 3 feet apart at the 3, 6, and 8 foot levels. The size of each test bed is recommended to be a real world setting of 30 x 30 x 10 feet or 9,000 cubic feet. Each test bed is to use identical construction, materials, and configurations. The test beds are to be a minimum of ISO-3 or FED-STD-209E Class 1 rooms [1] [2].
ISO-14644-1 | ISO-ACH | FED-STD-209E | FED-ACH |
ISO-1 | |||
ISO-2 | |||
ISO-3 | 360-540 | Class-1 | |
ISO-4 | 300-540 | Class-10 | |
ISO-5 | 240-480 | Class-1,000 | |
ISO-6 | 150-240 | Class-10,000 | |
ISO-7 | 60-90 | Class-100,000 | |
ISO-8 | 5-48 | Class-1,000,000 | |
ISO-9 | Room Air |
The following are the broad test steps to certify products and subsystems for contagion mitigation.
It is expected that eventually high levels of ACH for an integrated solution that uses an HVAC system will make most products or systems under test ineffective. For example high levels of ACH will prevent a ceiling level UV system from acting on contaminated air. That is why both test conditions must be performed: (1) the first is just the product and system under test and (2) the second is the product or system under test with an operating HAVC system in the same room.
The contagion must be as close to the contagion that is the current threat. In the case of a virus this requires live subjects like test mice. However, various bacteria in a Petri dish may be a good indicator of what to expect for a viral contagion. For a bacteria / viral calibration testing, mice in small cages can be used in place of the Petri dishes during early test and evaluation efforts.
The above proposed Product Certification Testing Strategies is a path forward that industry can handle and it will allow people to make proper engineering based choices when performing the system analysis and integration of contagion mitigation systems. In 2020 this systems analysis expected this testing to have been performed by US government labs immediately once it was known that the contagion was not contained. That date was in March 2020 when the US was shutdown. It is May 2021 and still there is no public data on any testing of this type.
In 2020 this systems analysis proposed a US Government Ventilation Test and Evaluation program using National Labs and the Industrial base from around the world. At the time the analysis stated that this would be the largest and most important test and evaluation program in history. The government would then certify the findings so that we know that the best science and engineering had been used to address this challenge. This certification would have cleared the issues associated with legal liability. Once the specifications would have been known then they could have been rolled out to the community, building checks could have been performed, and if needed certificates issued. That did not happen. So people were left on their own to determine what to do to make their buildings safe. However, people still needed common performance requirements so that the they can compare different products and make reasonable system integration decisions [3] [4]. This Product Certification Testing Strategies approach can provide the common performance requirements.
The US developed standard FED-STD-209E and it is in the public domain because it was paid for by the taxpayers. The US FED-STD-209E standard was abandoned and it moved to an ISO standard. All ISO standards are sold for a fee. The public no longer has access to this critical information that significantly impacts their lives. Also, the taxpayer was never compensated for this transition of their asset to another entity. Just like FED-STD-209E was developed using national labs, a new FED-STD-COVID-19-Mitigation standard should have been developed in 2020. However, the government walked away from its responsibilities to the people all in the broad policy approach of deregulation and privatization [5].
Once again history will not paint a nice picture of the performance of this generation [6].
References
[1] ISO 14644-1, Classification of air cleanliness by particle concentration, ANSI Standard 2015, webpage https://www.iest.org/Standards-RPs/ISO-Standards/ISO-14644-Series, May 2021.
[2] FED-STD-209 E Airborne Particulate Cleanliness Classes in Cleanrooms and Cleanzones, US Government, September 11, 1992. PDF local E . PDF local D
[3] COVID-19 A Systems Perspective, Walter Sobkiw, 2021, ISBN 9780983253044, hardback.
[4] COVID-19 Return To Life, webpage http://www.cassbeth.com/covid-19/return-to-life/index.html, April 2021. COVID-19 Return To Life.
[5] Privatization A Systems Perspective, Walter Sobkiw, 2019, ISBN 9780983253068. Privatization A Systems Perspective.
[6] See section Toxic Generational Choices.
The wells-Riley equation is used to predict the probability of infection in a space with a certain volume and infection load. The volume of a space is easily determined but the infection load is a challenge. Even if the infection load is approximate, Wells-Riley provides a good metric to compare spaces of different volumes. For example this research compared the probability of infection between small, large, and outside spaces. From this research it was found that the problem is massive within small enclosed spaces, problematic in large spaces, and extremely rare in outdoor spaces [1] [2].
Wells-Riley equation:
P = D/S = 1 - exp ( - (Ipqt/Q) )
P = probability of infection for susceptibles
D = number of disease cases
S = number of susceptibles
I = number of infectors
p = breathing rate per person (m3/s)
q = quantum generation rate by an infected person (quanta/s)
t = total exposure time (s)
Q = outdoor air supply rate (m3/s)Q = Space Cubic Feet * AUC
quanta = virus
Using Wells-Riley to determine the actual probability of infection has 2 major challenges. The first is determining the infection load. The second is the use of an exponential in the equation.
For the first challenge of finding the actual infection load, no one has the resources to determine the infection load except for the US government. This research disclosed estimates on the infection load under different scenarios from others attempting to measure the infection load [1] [2]. This requires massive multi billion dollar resources to bring the needed technology to perform the correct test and evaluations, so the numbers are approximate and may be incorrect. Unfortunately since the big push to privatize and deregulate the government beginning in 1980, those types of activities are not being performed, and if they are they are locked up as proprietary data in privatized companies doing the work, even though they are using taxpayer funds. So we are primarily left with pre-1980 numbers for diseases from that era and some estimates on the COVID-19 virus load from researchers doing their best with their limited resources. The following table shows virus load estimates from researchers in 2020 [1] [2].
Bio Event |
Droplets |
Virus Load |
Comment |
Single Breath |
50 - 5000 |
none |
Source [5]. This analysis uses this baseline to estimate sneeze and cough virus load. |
Infected Single Breath |
- |
20 |
A person infected with influenza releases about 3 - 20 virus RNA copies per minute of breathing. [6] COVID-19 patients exhale 1,000 to 100,000 virus particles per minute, with the highest rate seen during the early stages of COVID-19. [8] [9] |
Speaking |
- |
200 |
Increases the release of respiratory droplets about 10 times over breathing. [7] |
Sneeze |
30,000 |
6X single breath |
Source [3] [4]. |
Infected Cough or Sneeze |
200,000,000 |
40,000X single breath |
Source [3] [4]. |
In 2021 we now have evidence of when infection happens in a room with a given size and the rate of air update changes. This allows the Well-Riley equation to be tuned to match the empirical data and it makes the virus load hunt less critical. The value can be back calculated.
The second challenge of the exponent in the equation is used to approximate the effects of dilution in large spaces. There is a way to determine the effects of dilution between two spaces and that is to just calculate the volume ratio. The problem surfaces with spaces that have very high ceilings. A simple mental model suggests that dilution tends to happen around the height of the infectors and a reasonable assumption is that the maximum ceiling height to consider is 12 feet. This suggests that using the ratio of square footage is a more reasonable approach to determine the effects of dilution.
The following table shows the dilution as a function of room volume in cubic feet or room size in square feet.
cu-ft |
Ceiling ft |
Dilution (cu-ft ratio) |
. |
Ceiling ft |
L or W ft |
sq-ft |
Dilution (sq-ft ratio) |
10,000 |
12 |
1 |
|
12 |
30 |
900 |
1 |
20,000 |
12 |
2 |
12 |
41 |
1667 |
2 |
|
50,000 |
22 |
5 |
|
12 |
48 |
2273 |
3 |
100,000 |
22 |
10 |
|
12 |
67 |
4545 |
5 |
200,000 |
40 |
20 |
|
12 |
71 |
5000 |
6 |
300,000 |
4 |
30 |
|
12 |
87 |
7500 |
9 |
400,000 |
40 |
40 |
|
12 |
100 |
10000 |
12 |
The dilution analysis based on room volume and room size shows that the dilution number for a large room of 400,000 cu-ft with a ceiling height of 40 feet is 40. However, if we assume the dilution tends to happen around the height of the infectors and limit that height to 12 feet the large room dilution factor drops to 12. This analysis is important once the Wells-Riley equation is revisited because it will take into account the effects of dilution based on room size. However that dilution is based on the exponent in the equation.
Given all these limitations of the well-Riley equation in real world settings, it can be tuned to match observations of infection and direct ratios of volume or square footage.
We know from empirical data that infection ours at 1 AUC in a classroom. Taking the inverse of an actual room AUC with similar size will lead to an Infection Risk metric. This is not probability of infection, it is an infection risk metric. However if the wells-Riley probability of infection is equated to the Infection Rick metric, then the wells-Riley equation can be tuned to match a simple but very effective model of infection risk.
Infection Risk = 1/AUC
Level |
State |
AUC |
Infection |
Exposure Time |
Airborne Contagion Mitigation System Building Condition |
6 |
Green |
120 |
<1 |
30 sec |
Approaches outside ventilation conditions |
5 |
Green |
50 |
2 |
1.2 min |
Similar to operating room without PPE |
4 |
Yellow |
24 |
4 |
2.5 min |
Similar to WHO patient room airborne precautions |
3 |
Yellow |
10 |
10 |
6 min |
Similar to patient room airborne precautions |
2 |
Orange |
4 |
25 |
15 min |
Marginal mitigation |
1 |
Red |
1 |
100 |
1 hr |
School data suggests infection happens [6] |
0 |
Red |
0 |
100 |
full time |
No ventilation infection happens |
The infection risk model needs to consider more that just 1/AUC because it is associated with a particular room volume. Somehow the 1/AUC reading must be augmented with another parameter to account for larger spaces. This is the Large Space Factor.
There are 3 approaches to determine the large space factor and they are to use room volume, room square footage, or return back to the Wells-Riley equation to determine the large space factor. In this case the Wells-Riley equation was used to determine the large space factor for discrete volume measurements.
Space cu-ft |
Volume Ratios |
Square Footage Ratios |
Wells Riley LS Factors |
400,000 |
40 |
12 |
7.75 |
300,000 |
30 |
9 |
5.94 |
200,000 |
20 |
6 |
4.14 |
100,000 |
10 |
5 |
2.35 |
50,000 |
5 |
3 |
1.49 |
20,000 |
2 |
2 |
1.06 |
<10,000 |
1 |
1 |
1 |
The following table shows how Wells-Riley calculation assumption of infection load was used to match the Infection Risk. It was tuned to match the Infection Risk and empirical data.
I |
p cu-ft/sec |
q/sec |
lpq sec |
lpq hr |
t sec |
hour |
lpqt |
cu-ft |
AUC |
Q hr |
POI |
Infection Risk |
Color |
1 |
0.21 |
17 |
3.57 |
12852 |
3600 |
1 |
12852 |
10,800 |
1 |
10800 |
0.695778736 |
1 |
Red |
1 |
0.21 |
17 |
3.57 |
12852 |
3600 |
1 |
12852 |
10,800 |
4 |
43200 |
0.257327417 |
0.250000 |
Orange |
1 |
0.21 |
17 |
3.57 |
12852 |
3600 |
1 |
12852 |
10,800 |
10 |
108000 |
0.112192199 |
0.100000 |
Yellow |
1 |
0.21 |
17 |
3.57 |
12852 |
3600 |
1 |
12852 |
10,800 |
24 |
259200 |
0.048374147 |
0.041667 |
Yellow |
1 |
0.21 |
17 |
3.57 |
12852 |
3600 |
1 |
12852 |
10,800 |
50 |
540000 |
0.023519014 |
0.020000 |
Green |
1 |
0.21 |
17 |
3.57 |
12852 |
3600 |
1 |
12852 |
10,800 |
120 |
1296000 |
0.009867659 |
0.008333 |
Green |
Since the Wells-Riley equation was tuned using the Infection Risk model it can be used as an alternative to determine Infection Risk. When this calculation is performed we see more movement into the upper and lower levels. This is the effects of the exponent in the equation.
References:
[1] COVID-19 A Systems Perspective, Walter Sobkiw, 2021, ISBN 9780983253044, hardback.
[2] COVID-19 Return To Life, webpage http://www.cassbeth.com/covid-19/return-to-life/index.html, April 2021. COVID-19 Return To Life.
[3] Natural Ventilation for Infection Control in Health-Care Settings, World Health Organization 2009. webpage https://www.ncbi.nlm.nih.gov/books/NBK143281, March 2020. NIH. webpage https://www.ncbi.nlm.nih.gov/books/NBK143284/pdf/Bookshelf_NBK143284.pdf, March 2020. Natural Ventilation for Infection Control in Health-Care Settings PDF . local
[4] The Gross Science of a Cough and a Sneeze, Live Science www.livescience.com, May 12, 2009. webpage https://www.livescience.com/3686-gross-science-cough-sneeze.html, May 2020. The Gross Science of a Cough and a Sneeze
[5] Factors involved in the aerosol transmission of infection and control of ventilation in healthcare premises, Journal Of Hospital Infection www.journalofhospitalinfection.com, October 01, 2006. webpage https://www.journalofhospitalinfection.com/article/S0195-6701(06)00286-6/fulltext, May 2020. Factors involved in the aerosol transmission of infection and control of ventilation in healthcare premises
[6] Influenza Virus in Human Exhaled Breath: An Observational Study, .PloS ONE www.plosone.org, July 16, 2008. webpage https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2442192 March 2020. Influenza Virus in Human Exhaled Breath: An Observational Study . PDF
[7] Aerosol emission and superemission during human speech increase with voice loudness, Nature www.nature.com, February 19, 2019. webpage https://pubmed.ncbi.nlm.nih.gov/30787335, March 2020. Aerosol emission and superemission during human speech increase with voice loudness . PDF
[8] Aerodynamic analysis of SARS-CoV-2 in two Wuhan hospitals, Nature www.nature.com, April 27, 2020. webpage https://www.nature.com/articles/s41586-020-2271-3, Marh 2020. Aerodynamic analysis of SARS-CoV-2 in two Wuhan hospitals
[9] COVID-19 patients exhale millions of viral particles per hour, News Medical www.news-medical.net, June 3, 2020. webpage https://www.news-medical.net/news/20200603/COVID-19-patients-exhale-millions-of-viral-particles-per-hour.aspx June 2020, COVID-19 patients exhale millions of viral particles per hour
Vaccinations Impact
Most view the vaccine from the perspective of building herd immunity so that life can return to normal. Others view the vaccine as a life safer and focus on the number of lives saved. There is yet another system stakeholder view and that is from the perspective of those that will develop short, middle, long term, and life long negative health consequences [4] [5] [6]. This area of understanding is still very fuzzy. The reference terms are not even established as of March 2021 and there are only various vague references. The term as of March 2021 is Long Haulers and the estimates range from 10% [4] [6] to 33% [7]. Yet another study suggests cardiac involvement in 78% and myocardial inflammation in 60% independent of pre-existing conditions, severity and overall course of the acute illness, and the time from the original diagnosis [8] [9]. For this analysis the most conservative figure of 10% was selected to capture the effects of the vaccine in preventing chronic health issues.
The analysis shows that as of April 2021 the vaccine has saved over a million lives and prevented chronic health conditions from developing in millions of people. [spreadsheet]
Date |
Total Cases |
Daily Cases |
Total Deaths |
Case fatality rates (%) |
Daily Deaths |
Vaccinated |
Lives Saved Because of Vaccine |
Chronic Health Issues % |
Chronic Health Issues Prevented Because of Vaccine |
Remaining Possible Deaths if Herd Immunity is |
% into pandemic |
Comments | ||
- |
[1] |
- |
[2] |
- |
- |
[3] |
- |
[4] |
- |
50% |
60% |
75% |
Cases + Vaccinated |
- |
Feb 01, 2021 |
25,921,703 |
201,862 |
438,035 |
3.3 |
3124 |
5,930,000 |
193,160 |
10% |
593,000 |
4,754,605 |
5,823,012 |
7,425,624 |
9.71% |
Actual |
Mar 01, 2021 |
28,405,925 |
88,722 |
511,839 |
2.6 |
2636 |
25,470,000 |
662,966 |
10% |
2,547,000 |
3,395,106 |
4,248,866 |
5,529,507 |
16.43% |
Actual |
Apr 01, 2021 |
30,213,759 |
58,317 |
548,162 |
2.1 |
1172 |
54,610,000 | 1,151,234 |
10% |
5,461,000 |
2,439,142 |
3,132,758 |
4,173,183 |
25.86% |
Actual |
May 01, 2021 |
32,145,557 |
64,393 |
573,012 |
2.0 |
828 |
103,420,000 |
2,086,216 |
10% |
10,342,000 |
1,775,605 |
2,437,255 |
3,429,731 |
41.33% |
Actual |
. | ||||||||||||||
Jun 01, 2021 | 34,077,355 |
597,862 |
2.0 |
133,420,000 | 2,640,080 |
10% |
13,342,000 |
1,414,573 |
2,063,611 |
3,037,168 |
51.07% |
Prediction | ||
Jul 01, 2021 | 36,009,153 |
622,712 |
1.9 |
163,420,000 | 3,165,713 |
10% |
16,342,000 |
1,080,149 |
1,715,538 |
2,668,623 |
60.80% |
Prediction | ||
Aug 01, 2021 | 37,940,951 |
647,562 |
1.9 |
193,420,000 | 3,675,504 |
10% |
19,342,000 |
769,303 |
1,392,591 |
2,327,525 |
70.54% |
Prediction | ||
Sep 01, 2021 | 39,872,749 |
672,412 |
1.9 |
223,420,000 | 4,172,003 |
10% |
22,342,000 |
477,817 |
1,090,303 |
2,009,033 |
80.27% |
Prediction No more vaccinations |
||
Oct 01, 2021 | 41,804,547 |
697,262 |
1.8 |
223,420,000 | 4,105,914 |
10% |
22,342,000 |
491,901 |
1,094,685 |
1,998,861 |
80.86% |
Prediction Deaths will continue at lower rate |
||
Nov 01, 2021 | 43,736,345 |
722,112 |
1.8 |
223,420,000 | 4,046,229 |
10% |
22,342,000 |
502,776 |
1,096,797 |
1,987,830 |
81.45% |
Prediction Deaths will continue at lower rate |
||
Dec 01, 2021 | 45,668,143 |
746,962 |
1.8 |
223,420,000 | 3,992,060 |
10% |
22,342,000 |
511,013 |
1,097,082 |
1,976,185 |
82.04% |
Prediction Deaths will continue at lower rate |
||
Jan 01, 2022 | 47,599,941 |
771,812 |
1.8 |
223,420,000 | 3,942,676 |
10% |
22,342,000 |
517,061 |
1,095,880 |
1,964,109 |
82.63% |
Prediction Deaths will continue at lower rate |
Note: CDC line 1 [1] . Johns Hopkins University & Medicine line 2 [2] . Our World In Data [3]
As of May 2021 various news reports are suggesting that a segment of the USA population is refusing to take the vaccination. Just because a herd immunity level is reached in the USA it does not mean the virus will be eradicated from the planet. It also does not mean that people will no longer be infected. It just suggests that the infection rate will drop significantly. How much it drops, time will tell. Because the virus will be present, unvaccinated or uninfected people will still be at risk of death. This is identified as Remaining Possible Deaths.
References:
[1] CDC Cases, webpage https://www.cdc.gov/coronavirus/2019-ncov/cases-updates/cases-in-us.html, various dates.
[2] Johns Hopkins University & Medicine Cases, webpage https://coronavirus.jhu.edu/map.html, various dates.
[3] Coronavirus (COVID-19) Vaccinations, Our World In Data, https://ourworldindata.org/covid-vaccinations, various dates
[4] Management of post-acute covid-19 in primary care, Practice Pointer, August 11, 2020. webpage https://www.bmj.com/content/370/bmj.m3026, https://www.bmj.com/content/bmj/370/bmj.m3026.full.pdf, March 2021. Management of post-acute covid-19 in primary care
[5] As Their Numbers Grow, COVID-19 Long Haulers Stump Experts, JAMA Network, September 23, 2020. webpage https://jamanetwork.com/journals/jama/fullarticle/2771111, March, 2021. As Their Numbers Grow, COVID-19 Long Haulers Stump Experts
[6] Long haulers: Why some people experience long-term coronavirus symptoms, UC Davis Health, February 08, 2021, webpage https://health.ucdavis.edu/coronavirus/covid-19-information/covid-19-long-haulers.html, March 2021. Long haulers: Why some people experience long-term coronavirus symptoms
[7] Studies show long-haul COVID-19 afflicts 1 in 4 COVID-19 patients, regardless of severity, UC Davis Health, March 30, 2021. webpage https://health.ucdavis.edu/health-news/coronavirus/studies-show-long-haul-covid-19-afflicts-1-in-4-covid-19-patients-regardless-of-severity/2021/03, March 2021. Studies show long-haul COVID-19 afflicts 1 in 4 COVID-19 patients
[8] Can COVID-19 Cause a Heart Attack?, Hackensack Meridian Health, February 15, 2021, webpage https://www.hackensackmeridianhealth.org/HealthU/2021/02/15/can-covid-19-cause-a-heart-attack/#:~:text=In%20one%20German%20study%2C,recovered%20from%20the%20virus, March 2021, Can COVID-19 Cause a Heart Attack?
[9] Outcomes of Cardiovascular Magnetic Resonance Imaging in Patients Recently Recovered From Coronavirus Disease 2019 (COVID-19), JAMA Nwetwork, July 27, 2020. webpage https://jamanetwork.com/journals/jamacardiology/fullarticle/2768916, Outcomes of Cardiovascular Magnetic Resonance Imaging in Patients Recently Recovered From Coronavirus Disease 2019 (COVID-19)
In 2020 this systems analysis investigated various living scenarios and applied the Wells-Riley equation to determine the probability of infection. The probability of infection was then used to predict various system outcomes where the system boundary was the entire USA. Different system technologies where then applied to determine the level of mitigation of the COVID-19 virus. The technologies included vaccines, HVAC systems, ceiling level UV systems, and FAR UV-222 systems [1] [2].
This analysis revisits the various living scenarios and treats each living scenario as a standalone system. A new system boundary is then introduced associated with each unique individual. The system performance is then determined using the probability of infection to calculate a new set of system performance numbers. The new performance numbers are:
Infection Visits: This is how many visits to this System (scenario) before there is 100% probability of infection. A good way to view this number is in terms of weeks, months, and years.Health Availability: This is a measure of the effectiveness of the system in mitigating the chance of infection. It comes from the system reliability area where system availability and unavailability are calculated. In this case this is a measure of the system to mitigate the virus. Its meaning becomes relevant when it is compared with mission critical system availability numbers. These are systems where loss of life is possible if they fail. These mission critical systems are designed to have what is called six nines five (six 9s five) availability; this number is represented as .999 999 5. This is a very difficult number to achieve but it does exist in the infrastructure. In some cases of a disaster, an emergency system mode of operation has an availability of five 9s five which is .999 995.
COVID-19 Death Chance: Just because there is the chance of COVID-19 infection, it does not mean that it will result in death. With the vaccine(s), the chance of death is significantly lower.
There is data associated with the ability of the vaccines to protect people. As of April 26, 2021, more than 95 million people in the United States had been fully vaccinated against COVID-19. During the same time, CDC received reports of vaccine breakthrough infections from 46 U.S. states and territories. [3]
[spreadsheet Vac BTI]
CDC Vaccine Breakthrough Infections Data |
April 26, 2021 |
Fully vaccinated | 95,000,000 |
Total number of vaccine breakthrough infections reported to CDC |
9,245 |
Females |
5,827 (63%) |
People aged =60 years |
4,245 (45%) |
Asymptomatic infections |
2,525 (27%) |
Hospitalizations |
835 (9%) note 1 |
Deaths |
132 (1%) note 2 |
Personal COVID-19 Death Chance with Vaccine | 0.0000014 |
Personal System Health Availability with Vaccine | 0.9999986 |
Notes:
1. Of the 835 hospitalizations, 241 (29%) were reported as asymptomatic or
not related to COVID-19.
2. Of the 132 fatal cases, 20 (15%) were reported as asymptomatic or not
related to COVID-19.
The odds of death from the vaccine are very small compared to other odds of death statistics. There is a greater chance of death from a lightening strike than from the current Vaccine Breakthrough deaths. The lifetime odds of death for selected causes in the United States are as follows [4]. [spreadsheet Vac BTI]
Cause of Death |
Odds of Dying |
Heart disease |
1 in 6 |
Cancer |
1 in 7 |
All preventable causes of death |
1 in 24 |
Chronic lower respiratory disease |
1 in 27 |
Suicide |
1 in 88 |
Opioid overdose |
1 in 92 |
Fall |
1 in 106 |
Motor-vehicle crash |
1 in 107 |
Gun assault |
1 in 289 |
Pedestrian incident |
1 in 543 |
Motorcyclist |
1 in 899 |
Drowning |
1 in 1,128 |
Fire or smoke |
1 in 1,547 |
Choking on food |
1 in 2,535 |
Bicyclist |
1 in 3,825 |
Sunstroke |
1 in 8,248 |
Accidental gun discharge |
1 in 8,571 |
Electrocution, radiation, extreme temperatures, and pressure |
1 in 13,394 |
Sharp objects |
1 in 29,334 |
Cataclysmic storm |
1 in 58,669 |
Hornet, wasp, and bee stings |
1 in 59,507 |
Hot surfaces and substances |
1 in 63,113 |
Dog attack |
1 in 86,781 |
Lightning |
1 in 138,849 |
Vaccine Breakthrough Deaths (see above April 26, 2021) |
1 in 719,697 |
It is reasonable to assume that the breakthrough infections were associated with small indoor spaces, but no data was provided to confirm that assumption.
[spreadsheet Probability]
System (scenario treated as standalone system) |
COVID -19 People |
Time hour |
Masks |
Probability of Infection Wells-Riley Equation |
Space cu-ft |
AUC |
Infection Visits |
Infection Visits |
Infection Visits |
System Health Availability 1-P |
System Health Availability Vaccine @90% |
System Health Availability with UV @90% |
Personal COVID-19 Death Chance with Vaccine |
Personal System Health Availability with Vaccine |
Small indoor space |
2 |
1 |
Yes |
6% |
10,800 |
1 |
16 |
160 |
1,600 |
0.9375024 |
0.9937502 |
0.9993750 |
0.0000014 |
0.9999986 |
Small indoor space |
1 |
1 |
Yes |
6% |
10,800 |
1 |
16 |
161 |
1,610 |
0.9378875 |
0.9937887 |
0.9993789 |
see row 1 |
see row 1 |
Small indoor space Small Restaurant Not sure how to eat with a mask |
1 |
1 |
Yes |
4% |
10,800 |
4 |
22 |
222 |
2,224 |
0.9550374 |
0.9955037 |
0.9995504 |
see row 1 |
see row 1 |
Small indoor space Small Restaurant Reality no mask while eating |
1 |
1 |
No |
72% |
10,800 |
4 |
1 |
14 |
139 |
0.2805977 |
0.9280598 |
0.9928060 |
see row 1 |
see row 1 |
Small indoor space |
1 |
1 |
Yes |
2% |
10,800 |
10 |
40 |
402 |
4,015 |
0.9750936 |
0.9975094 |
0.9997509 |
see row 1 |
see row 1 |
Small indoor space |
1 |
1 |
Yes |
1% |
10,800 |
40 |
134 |
1,341 |
13,407 |
0.9925413 |
0.9992541 |
0.9999254 |
see row 1 |
see row 1 |
. | ||||||||||||||
Large indoor space |
2 |
1 |
Yes |
2% |
400,000 |
1 |
67 |
667 |
6,665 |
0.9849970 |
0.9984997 |
0.9998500 |
0.0000000 |
1.0000000 |
Large indoor space |
1 |
1 |
Yes |
1% |
400,000 |
1 |
125 |
1,248 |
12,476 |
0.9919845 |
0.9991985 |
0.9999198 |
0.0000000 |
1.0000000 |
Large indoor space |
1 |
1 |
Yes |
0% |
400,000 |
4 |
474 |
4,743 |
47,435 |
0.9978918 |
0.9997892 |
0.9999789 |
0.0000000 |
1.0000000 |
Large indoor space |
1 |
1 |
Yes |
0% |
400,000 |
10 |
1,174 |
11,738 |
117,377 |
0.9991480 |
0.9999148 |
0.9999915 |
0.0000000 |
1.0000000 |
Large indoor space |
1 |
1 |
Yes |
0% |
400,000 |
40 |
4,671 |
46,710 |
467,103 |
0.9997859 |
0.9999786 |
0.9999979 |
0.0000000 |
1.0000000 |
. | ||||||||||||||
Small indoor space |
1 |
1 |
Yes |
6% |
10,800 |
1 |
16 |
161 |
1,610 |
0.9378875 |
0.9937887 |
0.9993789 |
see row 1 |
see row 1 |
Small indoor space |
1 |
1 |
Yes |
4% |
10,800 |
4 |
22 |
222 |
2,224 |
0.9550374 |
0.9955037 |
0.9995504 |
see row 1 |
see row 1 |
Small indoor space Best case school & work Setting |
1 |
8 |
Yes |
6% |
10,800 |
4 |
16 |
160 |
1,600 |
0.9375024 |
0.9937502 |
0.9993750 |
see row 1 |
see row 1 |
. | ||||||||||||||
Large indoor space |
1 |
1 |
Yes |
1% |
400,000 |
1 |
125 |
1,248 |
12,476 |
0.9919845 |
0.9991985 |
0.9999198 |
0.0000000 |
1.0000000 |
Large indoor space Shopping |
1 |
1 |
Yes |
0% |
400,000 |
4 |
474 |
4,743 |
47,435 |
0.9978918 |
0.9997892 |
0.9999789 |
0.0000000 |
1.0000000 |
Large indoor space Retail Work |
1 |
8 |
Yes |
2% |
400,000 |
4 |
67 |
667 |
6,665 |
0.9849970 |
0.9984997 |
0.9998500 |
0.0000000 |
1.0000000 |
. | ||||||||||||||
Small indoor space School Setting Small Restaurant |
1 |
1 |
Yes but 1 hour mask off |
99% |
10,800 |
1 |
1 |
10 |
101 |
0.0061992 |
0.9006199 |
0.9900620 |
see row 1 |
see row 1 |
Small indoor space School Setting |
1 |
1 |
Yes but 1 hour mask off |
72% |
10,800 |
4 |
1 |
14 |
139 |
0.2805977 |
0.9280598 |
0.9928060 |
see row 1 |
see row 1 |
Small indoor space School Setting |
1 |
1 |
Yes but 1 hour mask off |
12% |
10,800 |
40 |
8 |
84 |
838 |
0.8806603 |
0.9880660 |
0.9988066 |
see row 1 |
see row 1 |
Small indoor space |
1 |
8 |
No |
100% |
10,800 |
4 |
1 |
10 |
100 |
0.0000384 |
0.9000038 |
0.9900004 |
see row 1 |
see row 1 |
Small indoor space |
1 |
8 |
No |
64% |
10,800 |
40 |
2 |
16 |
157 |
0.3617989 |
0.9361799 |
0.9936180 |
see row 1 |
see row 1 |
. | ||||||||||||||
Large indoor space |
1 |
1 |
No |
13% |
400,000 |
1 |
8 |
78 |
780 |
0.8717523 |
0.9871752 |
0.9987175 |
0.0000000 |
1.0000000 |
Large indoor space |
1 |
1 |
No |
3% |
400,000 |
4 |
30 |
296 |
2,965 |
0.9662695 |
0.9966269 |
0.9996627 |
0.0000000 |
1.0000000 |
Large indoor space |
1 |
1 |
No |
0.34% |
400,000 |
40 |
292 |
2,919 |
29,194 |
0.9965746 |
0.9996575 |
0.9999657 |
0.0000000 |
1.0000000 |
Large indoor space |
1 |
8 |
No |
24% |
400,000 |
4 |
4 |
42 |
417 |
0.7599520 |
0.9759952 |
0.9975995 |
0.0000000 |
1.0000000 |
Large indoor space |
1 |
8 |
No |
3% |
400,000 |
40 |
37 |
369 |
3,693 |
0.9729233 |
0.9972923 |
0.9997292 |
0.0000000 |
1.0000000 |
. | ||||||||||||||
Outside small enclosed back yard |
1 |
4 |
No |
1% |
10,800 |
3600 |
178 |
1,775 |
NA |
0.9943678 |
0.9994368 |
NA |
0.0000000 |
1.0000000 |
Outside small enclosed back yard |
1 |
4 |
No |
0.11% |
10,800 |
18000 |
886 |
8,857 |
NA |
0.9988710 |
0.9998871 |
NA |
0.0000000 |
1.0000000 |
Outside beach park |
1 |
4 |
No |
0.02% |
400,000 |
3600 |
6,558 |
65,579 |
NA |
0.9998475 |
0.9999848 |
NA |
0.0000000 |
1.0000000 |
Outside beach park |
1 |
4 |
No |
0.00% |
400,000 |
18000 |
32,787 |
327,874 |
NA |
0.9999695 |
0.9999970 |
NA |
0.0000000 |
1.0000000 |
Outside beach park |
1 |
4 |
No |
0.00% |
4,000,000 |
3600 |
65,574 |
655,743 |
NA |
0.9999848 |
0.9999985 |
NA |
0.0000000 |
1.0000000 |
Outside beach park |
1 |
4 |
No |
0.00% |
4,000,000 |
18000 |
327,869 |
3,278,694 |
NA |
0.9999970 |
0.9999997 |
NA |
0.0000000 |
1.0000000 |
There are multiple ways to view this analysis. The first is from the perspective of each scenario being a standalone system with its own system performance. In this case we see that the system where people live outside results in the expected Health Availability approaching the design goal of mission critical systems of six 9s five availability and in some cases exceeding five 9s five availability. That is excellent. The other systems do not have that level of performance, however, examining the Infection Visits offers reasonable numbers for some living scenarios. The effect of the vaccine and the use of UV systems each multiply these numbers by 10 or for a total of 100. So what would have been a problem in 1 week suddenly becomes a problem after 2 years.
The most important perspective is to change the system boundary from the various living scenarios to the individual that is vaccinated. Within that system boundary of the individual there may be a chance of infection but as of April 2021 there is no chance of COVID-19 death and the Personal System Health availability becomes 1.0. This a perfect system performance level. Eventually some vaccinated people may die from COVID-19 but the chance will be 1 in tens or hundreds of millions. Although sad for the people impacted, the system performance is outstanding and represents a massive triumph on the part of our technologies and systems.
As with all systems the human element must be considered. The reality is not everyone will get vaccinated. There is also a time lag associated with when everyone that wants the vaccine will actually receive the vaccine. Then there is the chance of COVID-19 mutating or other contagions surfacing. All these system observations translate into the need to make the infrastructure safer from a contagion perspective. The need to upgrade, maintain, and properly use HVAC systems, add more ceiling level UV-C lights, add more FAR UV-222 lights, and replace some high touch surfaces is not gone and it must be addressed. There is still the fundamental question of why COVID-19 spread when we have been able to prevent the spread of other contagions for decades. The reality is that the answer might be in changes in our infrastructure as suggested in the 2020 system analysis [1] [2].
The system boundaries that were addressed in the 2020 system analysis and this new analysis in 2021 are as follows.
System Boundary | System Name | Also known as | Comment |
Planet | Planet COVID-19 Mitigation System | Return to life | |
USA | USA Work COVID-19 Mitigation System | Return to work | System boundary was too small and thus irrelevant |
Small Indoor Spaces | Small Indoor Spaces COVID-19 Mitigation System | Return to life | |
Large Indoor Spaces | Large Indoor Spaces COVID-19 Mitigation System | Return to life | |
Outdoors | Outdoors COVID-19 Mitigation System | Return to life | |
Personal | Personal COVID-19 Mitigation System | Return to life |
References
[1] COVID-19 A Systems Perspective, Walter Sobkiw, 2021, ISBN 9780983253044, hardback.
[2] COVID-19 Return To Life, webpage http://www.cassbeth.com/covid-19/return-to-life/index.html, April 2021. COVID-19 Return To Life.
[3] COVID-19 Breakthrough Case Investigations and Reporting, Centers For Disease Control and Prevention, April 26, 2021, April 30, 2021. webpage https://www.cdc.gov/vaccines/covid-19/health-departments/breakthrough-cases.html, May 2021. COVID-19 Breakthrough Case Investigations and Reporting.
[4] Odds of Dying, National Safety Council, 2019. webpage https://injuryfacts.nsc.org/all-injuries/preventable-death-overview/odds-of-dying, May 2021. Odds of Dying
Post Vaccine World
Many view the post vaccine world as a place where people can return to work. We know that the return to work system boundary is too small and that the actual system boundary is Return to Life. This analysis will address remote work, healthy infrastructure challenges, how we may have arrived at this point in history and how we might be able to prevent this from happening again.
Healthy Infrastructure
The Philadelphia Water Works was the first water treatment facility in the United States. It was a model for all future water works to follow in the New World. People would flock from around the planet to see this facility which combined engineering and art to solve a massive problem of safe water for the inhabitants of Philadelphia. It was born of necessity as the people decided they would not tolerate yet another yellow fever outbreak. The Museum sits on top of the original water reservoir that provided the city with water. As Philadelphia grew the reservoir and Water Works could no longer meet the needs of the city and new projects eventually replaced this once great technological and artistic achievement. It stopped operations in 1909. When I took the picture I knew nothing of the Water Works or its history. Like many things in our world it was invisible to me, until now. I only knew of its beauty in a very urban landscape setting [A].
The Philadelphia Art Museum and Water Works
Picture was taken in 1979 |
A post vaccine world implies that everyone has received a vaccine against the COVID-19 virus. However, we know that will not happen. In the USA some will refuse the vaccine [1]. In many countries the poor will not have access to the vaccine. The idea of a post vaccine world also suggests that we can return to the pre-COVID world. However, we know that is not the case. The contagion and its variants will be in the environment for decades. This is not unlike the situation that existed in the early part of the last century where there were deadly contagions that were part of normal life. It was not until multiple technologies were introduced in multiple systems that there was a decline in many deadly contagions in the USA and other parts of the world. These technologies and systems were embedded in [2] [3] [B]:
All the systems analysis performed to date has led to system requirements for a Post Vaccine World [2] [3] [B]. The key system requirements are:
There is a reason why airports and buildings were designed the way they were in the last century. It was not completely about form and function. There was also a reason why airplanes were never stuffed to system capacity limits in the last century. All these systems were established by people who lived through Polio, Tuberculosis, the 1918 Flu Pandemic, Cholera, Small Pox, and other terrible contagions. Not everything was written down, it just came naturally and it was also under the umbrella of doing the right thing after the massive devastation of WW I, the Depression, and WW II. It was ingrained in the culture. This was a massive mega trend. Unfortunately an unhealthy mega trend surfaced after this period and it erased the previous common sense healthy mega trend that transformed the civilization. The system has now been severely shaken.
We know that there have been changes and our buildings and airplanes have become sources of infection. There are many studies showing the problems and people know from personal experience that is the case. People would get sick but recover because the deadly contagions were eliminated by the previous generation. Now the situation has changed radically and we have a deadly contagion in our environment that has immediate detectable effects [4] [5]. There is no choice but to upgrade our infrastructure until this deadly contagion is reduced to either a level where it has no effect or it is eliminated.
Ensuring a safe infrastructure is within the boundaries of government and there are massive existing regulations that set the precedent. It is one of the reasons why we have clean water systems, buildings and bridges that do not collapse, safe HVAC systems that do not leak toxic gasses into occupied spaces, etc. Addressing safety to reduce exposure to the new deadly COVID contagion is the combined government and social challenge in the post vaccine world.
A picture is worth a thousand words. The following pictures are offered [6] [7].
Possible Infrastructure Upgrade - Airport 2020
|
The products and companies that install the Far UV-222 systems exist and are being installed and used in various airports and public buildings including Planned Real Estate Developments like condominiums [8] [9].
Possible Infrastructure Upgrade - School 2020 - Small Space
Photo: Upper-Room-Disinfection |
The products and companies that install the ceiling level UV-C systems exist and are being installed and used in various schools around the country [10] [11].
Possible Infrastructure Upgrade - Large Crowded Space
Photo: Upper-Room-Disinfection |
The products and companies that install the ceiling level UV-C systems exist and are being installed and used in large crowded spaces around the country [12] to [16].
St. Vincents Hospital and Harvard School of Public Health conducted a TB/UV Shelter Study (TUSS). The study was a double-blind placebo-controlled field trial in 6 USA cities, with 14 shelters. Nearly 1200 UVGI luminaries were installed covering 200,000 sq. ft in a diverse set of buildings [7]. The studies confirmed the results from the all other studies since 1936 beginning with the first study by University of Pennsylvania in Philadelphia, PA [17]. What matters in this new study is that the technology was rediscovered and that there were 1200 UVGI luminaries easily acquired, installed, and managed. The products, systems, and companies exist. The technology is proven and it works. There is nothing special about COVID-19 that would protect it or other future contagions from these systems.
References
[1] See section Conspiracy Theories and Social Bifurcation.
[2] COVID-19 Return To Life, sections HVAC Systems, Air Flow Rates And Natural Ventilation, Ultraviolet Germicidal Irradiation (UVGI) - Open Air, Decontamination Background and Solutions, March 2021. webpage http://www.cassbeth.com/covid-19/return-to-life/index.html, April 2021.
[3] COVID-19 Return To Life, section Design Solutions, March 2021. webpage http://www.cassbeth.com/covid-19/return-to-life/index.html, April 2021.
[4] The Sick Building Syndrome, Indian Journal of Occupational and Environmental Medicine, August 12, 2008. webpage https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2796751, August, 2020. The sick building syndrome
[5] COVID-19 Return To Life, section Airplanes and Airports, March 2021. webpage http://www.cassbeth.com/covid-19/return-to-life/index.html, April 2021.
[6] Could a New Ultraviolet Technology Fight the Spread of Coronavirus, Columbia University, June 30, 2020. webpage https://news.columbia.edu/ultraviolet-technology-virus-covid-19-UV-light, November 2020. Could a New Ultraviolet Technology Fight the Spread of Coronavirus
[7] Upper-Room-Disinfection, National Academies of Sciences, Engineering, and Medicine, September 17, 2020. webpage https://www.nationalacademies.org/event/09-16-2020/docs/D00062573057472031C5B95374B5C068AE9324D53EC4, November 2020. Upper-Room-Disinfection . local
[8] Margate condo first in state to install ultraviolet light sanitizing technology, they say, Press Of Atlantic City, September 09, 2020. webpage https://pressofatlanticcity.com/margate-condo-first-in-state-to-install-ultraviolet-light-sanitizing-technology-they-say/article_5c259798-7c35-5ad8-be85-e5b7a5838aa3.html, January 2021. Margate condo first in state to install ultraviolet light sanitizing technology, they say
[9] Technology at the Forefront for Healthier High-Rise Buildings, The COVID-19 pandemic has real estate developers turning to new tech, like UV light treatments and touchless entrances, to create safer environments for residents, Mansion Global June 07, 2020. webpage https://www.mansionglobal.com/articles/technology-at-the-forefront-for-healthier-high-rise-buildings-216579, January 2021. Technology at the Forefront for Healthier High-Rise Buildings
[10] High school installs ultraviolet light system to keep students safe, WNNC, May 20, 2020. webpage https://www.wcnc.com/article/news/health/coronavirus/queens-grant-high-school-uv-light-system-coronavirus/275-c3e54672-905f-4fab-8e5f-8c58d5ca49f3, January 2021. High school installs ultraviolet light system to keep students safe
[11] Some SC schools to use ultraviolet light to fight coronavirus. A few things to know. The Herald November 10, 2020. webpage https://www.heraldonline.com/news/coronavirus/article247021112.html, January 2021. Some SC schools to use ultraviolet light to fight coronavirus. A few things to know
[12] UV lights, ozone cleaners, sanitizers help shelter keep homeless safe, Catholic News Service, June 16, 2020. webpage https://angelusnews.com/news/nation/uv-lights-ozone-cleaners-sanitizers-help-shelter-keep-homeless-safe/, January 2021. UV lights, ozone cleaners, sanitizers help shelter keep homeless safe
[13] The Blind Horse Becomes First Restaurant In The United States To Install Far-UVC Light Technology For Real-Time Virus Mitigation And Indoor Sanitization, Globe Newswire, October 13, 2020. webpage https://www.globenewswire.com/news-release/2020/10/13/2107717/0/en/THE-BLIND-HORSE-BECOMES-FIRST-RESTAURANT- IN-THE-UNITED-STATES-TO-INSTALL-FAR-UVC-LIGHT-TECHNOLOGY-FOR-REAL-TIME- VIRUS-MITIGATION-AND-INDOOR-SANITIZATION.html, January 2021.
[14] Wisconsin Restaurant Installs COVID-Killing UV Lights, Spectrum News1, October 14, 2020. webpage https://spectrumnews1.com/wi/madison/coronavirus/2020/10/14/wisconsin-restaurant-installs-covid-killing-uv-lights-, January 2021. Wisconsin Restaurant Installs COVID-Killing UV Lights
[15] With winter approaching, some restaurants turn to UV light to make indoors safer, Products that use UV rays to purify the air are popping up in restaurants., September 02, 2020. webpage https://www.restaurantbusinessonline.com/technology/winter-approaching-some-restaurants-turn-uv-light-make-indoors-safer, January 2021. With winter approaching, some restaurants turn to UV light to make indoors safer
[16] Breathe Easier: Seattle-area restaurants invest in fancy air filtration systems, seattlerefined Sinclair Broadcast Group, October 02, 2020, webpage http://seattlerefined.com/eat-drink/breathe-easier-forward-thinking-restaurants-invest-in-air-filtration-systems, January 2021. Breathe Easier: Seattle-area restaurants invest in fancy air filtration systems.
[17] Air Disinfection in Day Schools, W.F. Wells Associate Professor in Research in Air-borne Infection, Laboratories for the Study of Air-borne Infection, the Department of Preventive Medicine and Public Health, University of Pennsylvania School of Medicine, Philadelphia, Pa. 1943. webpage https://ajph.aphapublications.org/doi/pdf/10.2105/AJPH.33.12.1436, November 2020. Air Disinfection in Day Schools . local
[A] Sustainable development Possible with Creative Systems Engineering, Walter Sobkiw, 2008. ISBN 9780615216300.
[B] COVID-19 A Systems Perspective, Walter Sobkiw, 2021, ISBN 9780983253044, hardback.
Remote Work
Remote work, telecommuting, telework, telepresence, working from home, mobile work, remote job, work from anywhere, and flexible workplace, is a work system where employees and operator owners, do not commute or travel to a central work location, such as an office building, warehouse, or store.
Because of the pandemic, some suggest that work will change because we have learned that we can telework. However, we have been able to telework for decades because of the personal computer revolution. There were many requests in the last century to telework but it was rare when people were able to telework. A simple system stakeholder analysis shows that there are massive divergent stakeholder needs. They are as follows:
Stakeholder | Telework Impact |
Needs |
Management | Negative |
Reject telework because they think their role is to physically watch the workers. Telework is a threat to their jobs, their role in many cases disappears. |
Commercial Real Estate Companies | Negative |
They need to have rents and new sales. Massive vacancies will need to repurpose the properties or cause the properties to be abandoned with massive financial loss. |
Commercial Real Estate Investors | Negative |
With the lower demand for commercial space these investors will see the investment value drop unless these spaces are repurposed |
Workers | Positive |
They have found that they can successfully do their work. It is very convenient with the new family life where everyone works. Quality of life significantly increases. |
Children | Positive |
They have access to their parents when needed. Parents are home when they come home from school. Quality of life significantly increases. |
Customers | Neutral |
Customers don't care as long as the quality is high and the costs are low. |
All Other Companies | Positive |
Companies always want to increase profits. As long as the business does not falter the new cost savings are embraced. |
All Other Investors | Positive |
Investors always want to increase profits. As long as the business does not falter the new cost savings are embraced. |
Planet | Positive |
Reduced energy consumption because there are less cars on the road commuting to work. This has a huge positive impact on future sustainability. |
The stakeholder analysis shows that most of the benefits come from telework, as was suggested in the last century with the personal computer revolution. However, because there is less need for management in a telework setting, typically management acting out of self interest just rejects telework requests. There is also the commercial real estate industry and its investors that stand to significantly lose in the wake of telework. There is enormous pressure to fill office space even if it is not needed. Nothing has changed with COVID-19, these two stakeholders control the post emergency telework decision. This is during a time in our culture when everyone knows we are able to telework and that it works in many settings.
This is a very difficult situation since government regulation is not the answer even though there can be massive benefits. This is a social challenge, to deal with very powerful stakeholders that stand to lose if the system changes. In normal times government can't force a company into a telework mode. Once the COVID-19 disaster subsides the government emergency will be gone. It will require some serious systems thinking to change the status quo and shift to a future telework society.
Once the virus is declared to be under control there will be massive movement for everyone to go back into the offices and sit there even if there is no work to do. This is what the Trump administration was doing throughout the COVID-19 disaster [1] [A]. They were unable to hide the large death count because of the physical evidence in the hospitals and so the virus decided that people should continue to telework. Eventually the virus will subside, the hospitals will have few COVID patients, and so there will be massive pressure to end telework.
Some progressive organizations with effective management that can embrace change will realize that they can significantly reduce costs by maintaining their proven telework approaches developed during the pandemic. Bad organizations with their poor management unable to embrace the changes in the same and adjacent industries will go back to the old approach of maintaining large physical office spaces and become unable to compete in the marketplace. This transformation will be slow but it will happen unless there are attempts to manipulate the markets. It is also unclear if the return to the offices will lead to new worker movements that may help increase the telework system.
If telework is allowed to continue in areas where it makes sense, there will be a massive release of leisure time that is lost when sitting in offices and commuting to and from work. This leisure time may lead to new personal activities with possible positive unintended consequences:
These unintended consequences are interesting because new stakeholders that may benefit have been added to the system as follows:
The new leisure time is a form of productivity, but the gains are not made by the employers. Instead the gains are made by the society where a new more productive and perhaps more happy society emerges.
For centuries the concept of working from home was common. Most of the people lived on farms when the society was primarily agrarian. Merchants and craftsmen lived in their shops. Conceptually both work and home life were within the same circle. With the rise of the industrial revolution people needed to report to a physical location where capital intensive equipment and production lines were located, the factory. This resulted in a split between home and work life. Conceptually this is represented as 2 separate and distinct circles with little overlap - work life and home life. This condition tended to reflect the culture in the USA for most in the last century.
System A
USA Life 1945 to 2021 |
Systems B
USA Pre-Industrial Revolution |
In other parts of the world the 2 separate circles do not exist and the culture is based on the 1 circle. This is a way of life that is very different. Those that own small operator owner businesses in the USA experience this way of life. Examples include the small shop on the first floor of a building and living quarters above the business. Other examples include maintaining an office and storage in a home for a business that may provide a service like painting, plumbing, consulting, etc. In the last century, up until approximately 1980, it was not uncommon for doctors and dentists to have their business locations in their homes.
Mixing home and work life is a cultural shift with new challenges that surface in this system of work. Some of the challenges are:
The above challenges suggest a pattern that may surface in the future where those that are unable to telework may find themselves in physical work settings. This suggests that two different management approaches may emerge where one is associated with the telework setting and one is associated with the physical work location.
In the last century the time clock was introduced to ensure that people actually reported to work. The time clock was associated with production like settings rather than professional settings. It was common knowledge that many professionals worked throughout the waking day because their work is associated with thought not a physical action. An engineer conceiving the architecture of a system cannot shutdown based on a clock. That is the price that is paid by professionals. They are sitting down at a dinner table with their families but their thoughts drift into the challenges of their work as they engage in problem solving. So in theory their pay, if tied to a time clock based on hours, should be based on a 24 hour working day. Thus the concept of salary versus hourly pay. Many in the last century consciously stayed away from being promoted into professional positions because they wanted to be paid overtime for their work. Professionals based on a salary rarely made overtime. There were rare exceptions like RCA (Radio Corporation of America), which paid their engineers overtime if they were in the physical work location.
System C
Compensated work plus
Uncompensated work
Many professionals like Engineers |
System D
Compensated work
Professionals like Engineers |
The idea of tracking the time of professionals did not surface until the 1960's and did not take root until the 1970's where time cards were signed by employees coincident with the end of a pay period. As late as the 1960's some staff in highly professional and creative settings rebelled against the concept of being forced to report to the office if there was no work to be performed. Three hour lunches with colleagues was not uncommon. This is a system that allowed the USA to eventually break out of the massive poverty of the early 1900's and send people to the moon. So this system was not without merit.
Existing management and investors are actually irrelevant as stakeholders in the telework question. It is the masses of people that will decide the new businesses that they will develop and invest in as the new century unfolds. As this generation considers the possibilities of telework, they should realize that the concepts are not new. There is massive history and experience to access to enable this new system of telework to surface. A fundamental question to always ask as a society is: Do we live to work or do we work to live?
There are studies suggesting that much of the existing work is irrelevant and just a waste of time [B]. The issue is what happens when massive automation causes less work for people to perform because compensation is tied to work hours. As early as the 1960's many proposed that the work week should be reduced to 30 hours to deal with the massive automation at the time. Unfortunately the opposite happened and not only did the work hours increase but also the percentage of the population in the workforce increased as the time clock was established for everyone and connected via computers to compensation. This is an extreme failure of management. Management established a highly inefficient system that just harmed people in the last 20 years of the last century. Nothing changed in the next 20 years of the new century until the COVID-19 disaster.
The approach used in the past was to increase jobs even if they were useless and reduce compensation to increase profits. If work hours, jobs, or compensation are reduced the velocity of money is reduced. When the velocity of money drops below a certain rate there is either a recession or depression. The system challenge is how to transition to a system that either has jobs that add value as opposed to useless work and or how to increase compensation as hours are reduced because machines have taken over the tasks performed by humans. This is all under the umbrella of a telework future which may lead to the elimination of useless jobs as all work is examined for transition to telework.
The slowing of the velocity of money is tightly associated with the concentration of wealth in the hands of a few. This is not new and is well documented and understood after the 1930s depression. With massive wealth concentrated in the hands of the few and the massive loss of jobs that may happen with the new emerging telework system it is unclear what will happen with the health of the economy. Negative growth is a strong possibility unless there are system mechanisms established to prevent the negative spiral. In the past the US Government was the mechanism that was used to flood the economy with money, which would then increase the velocity of money and get the economy out of a downward spiral in anticipation of future jobs that would then naturally surface. However what happens if the jobs do not surface? How will compensation and worker time be adjusted to prepare for a new system that is extremely efficient at producing goods and services and requires little worker time?
This is a huge systems challenge.
Individual [2] |
Wealth |
Comment |
Jeff Bezos | $196 |
Founder Amazon dot com. See note 1. |
Elon Musk | $175 |
Founder of PayPal. See note 1. |
Bill Gates | $132 |
Co-founder Microsoft Corporation. See note 2. |
Mark Zuckerberg | $110 |
Co-founder Facebook. See note 1. |
Larry Page | $99 |
Co-founder Google. See note 1. |
MacKenzie Scott | $60 |
Married to Jeff Bezos. See note 1. |
Jack Ma | $49 |
Co-founder Alibaba Group. See note 1. |
Note 1: Company concept and software that makes the company is based on open source community that developed the massive Internet Infrastructure using Apache web server, UNIX, web browser, PERL applications like search engines, shopping carts, social media, secure transaction processing, etc.
Note 2: Microsoft software is based on work performed in the open source community in the 1980s associated with the UNIX workstation and the new low cost Personal Computer (PC). The concept was to recode existing capabilities found in the existing infrastructure and then make the software code proprietary with license fees on the low cost PC.
One billion dollars employs 10,000 people for a year. More importantly is that 10,000 people engaged in the economy are 10,000 sources of new creative ideas that translate into progress. Removing this creative energy eventually leads to stagnation.
References
[1] COVID-19 Return To Life, section US Insurrection 2021, March 2021. webpage http://www.cassbeth.com/covid-19/return-to-life/index.html, April 2021.
[2] [individual name]/People also search for, webpage https://www.google.com/search, April 2021.
[A] COVID-19 A Systems Perspective, Walter Sobkiw, 2021, ISBN 9780983253044, hardback.
[B] Bullshit Jobs: A Theory, David Graeber, 2018. ISBN: 9781501143311.
Recent Mega Trends
How we arrived at this point in history and how we might prevent this from happening again is a huge systems analysis challenge. This will be studied for hundreds of years. This analysis is offered from the perspective of examining recent mega trends in the USA.
The mega trend that existed after World War II and the mega trend that surfaced approximately in 1980 can be associated with different philosophies. The predominant philosophies practiced in the culture suggests a cultural mega trend. The following summarizes various philosophies and suggests that certain philosophies were predominant in the culture between 1945 and 1980. After 1980 there was a shift and a new cultural mega trend surfaced. For this analysis they are named as System A and System B. The allocations and limited comments are subjective but not without merit. In the areas where there is massive divergence in philosophies it is probably reasonable.
Philosophy |
Description |
System A |
System B |
System C |
Logical Positivism |
Also called Logical Empiricism is a philosophy that scientific knowledge is the only kind of factual knowledge and that all traditional metaphysical doctrines are to be rejected as meaningless. The best way to philosophize is through science. Science is truth. An individual with this philosophical core is a Logical Positivist. | X |
rejected |
X |
Greek Cynicism |
A philosophy where the purpose of life was to live in virtue in agreement with nature. As reasoning creatures, people can gain happiness by rigorous training and by living in a way which is natural for themselves, rejecting all conventional desires for wealth, power, and fame. Instead, they are to lead a simple life free from all possessions. | partial within reason |
rejected |
partial within reason |
Cynicism |
This was originally Greek Cynicism but it changed by the 19th century. The emphasis on the negative aspects of Cynic philosophy led to the modern understanding of Cynicism to mean disbelief in the sincerity or goodness of human motives and actions. It has also moved into a philosophy where the rules of society should be ignored. | frowned upon |
X |
negative |
Humanism |
A philosophy placing importance on human rather than divine or supernatural matters. It stresses the potential value and goodness of human beings, emphasizes common human needs, and seeks solely rational ways of solving human problems. In modern times it is aligned with secularism and may refer to a nontheistic life stance centered on human agency and looking to science rather than revelation from a supernatural source to understand the world. Renaissance Humanism is a philosophy where meaning is found in the human form through art. | X |
rejected |
X |
Altruism |
A philosophy that we should live by only bringing happiness to others. It is the principle and moral practice of concern for the happiness of other human beings or other animals,resulting in a high quality of life both material and spiritual. In an extreme case, altruism may become a synonym of selflessness, which is the opposite of selfishness. | X |
rejected |
X |
Transcendentalism |
A philosophy that our deepest connection is with nature. Philosophical and social movement which developed in New England around 1836 in reaction to rationalism. Divinity pervades all nature and humanity. There is inherent goodness in people and nature. Society and its institutions corrupt the purity of the individual. People are at their best when truly self-reliant and independent. There is divine experience inherent in the every day, rather than believing in a distant heaven. Physical and spiritual phenomena are part of dynamic processes rather than discrete entities. | partial |
partial |
harmless |
Traditionalism |
All moral and religious truth comes from divine revelation passed on by tradition and human reason is incapable of attaining it. Belief in the existence of a perennial wisdom or perennial philosophy, primordial and universal truths which form the source for, and are shared by, all the major world religions. There are primordial and universal religious truths which are at the foundations of all major world religions. A philosophy that the best way of life is a return to the past. | within reason |
X |
harmless |
Egoism |
A philosophy that we should live by only bringing happiness to ourselves. Treats self-interest as the foundation of morality. Ethical egoism does not require moral agents to harm the interests and well-being of others when making moral deliberation. What is in an agent's self-interest may be incidentally detrimental, beneficial, or neutral in its effect on others. However, when practiced by individuals this is usually extreme self interest at the cost of all other interests. Winner take all is the tendency even if it is possible to have win win situations. | rejected |
X |
reject extremely toxic |
Nihilism |
A philosophy where there is no point to anything because it all ends in nothingness because we are all going to die. It is the rejection of all religious and moral principles in the belief that life is meaningless. It is negation towards life or towards fundamental concepts such as knowledge, existence, and the meaning of life. Human values are baseless, that life is meaningless, that knowledge is impossible, or that some set of entities do not exist. Modern Nihilism comes from the Nietzschean crisis of nihilism with two central concepts: the destruction of higher values and the opposition to the affirmation of life. Earlier forms of nihilism were more selective in negating specific social, moral, political and aesthetic thought. In popular use it refers to forms of existential nihilism where life is without intrinsic value, meaning, or purpose. Other prominent positions within nihilism include the rejection of all normal and ethical views, the rejection of all social and political institutions, the stance that no knowledge can or does exist, and a number of metaphysical positions, which assert that non-abstract objects do not exist, that composite objects do not exist, or even that life itself does not exist. | rejected |
partially embraced |
reject extremely toxic |
Utilitarianism | A philosophy that balances Altruism with Egoism. Actions that maximize happiness and well-being for all affected individuals. Actions that tend to produce benefit, advantage, pleasure, good, or happiness and to prevent mischief, pain, evil, or unhappiness to the party whose interest is considered. Treat one's self with no higher regard than one has for others. One is not obligated to sacrifice one's own interests to help others' interests, so long as one's own interests are substantially equivalent to the others' interests and well-being, but the choice to do so is permitted. | X |
rejected |
X |
Vannevar Bush was a key scientific adviser in the USA and he and others in the Franklin D. Roosevelt administration were working on stopping what they thought was the start of a new dark age. President Roosevelt asked his advisors what was happening and the response was that we were entering a new dark age. President Roosevelts response was to ask how long it would last in terms of 2, 3, or 5 years. The response was, no you don't understand, we are entering a dark age that might last 500, 700, 900 years. As the war was ending and the outcome was clear, president Roosevelt asked Vannevar Bush to identify what should happen after the war. The brain trust produced a document called Science The Endless Frontier [1]. This is the start of System A. This document established the policies of the USA after WW II up until approximately 1980 when the USA started to reject the New Deal.
On January 20, 1961, John F. Kennedy, the youngest US president ever elected, gave an inaugural address and stated: Ask not what your country can do for you - ask what you can do for your country. This challenged every American to contribute in some way to the public good. It inspired children and adults to see the importance of civic action and public service This is System [A] that started in 1945.
The USA transitioned from System A to System B. The transition started in the 1980. There are many references that document the transition from newspapers, magazines, movies, and other media. In an interview on the BBC documentary, The Trap What Happened to Our Dream of Freedom, conservative economist James M. Buchanan criticized the concept of public interest, asking what it is and suggested that it consists purely of self-interest of the governing bureaucrats. Buchanan also proposed that organizations should employ managers who are motivated only by money. He described those who are motivated by other factors, such as job satisfaction or a sense of public duty as zealots [2]. The implication being that they are to be removed from power and authority in all institutions.
We know that System A was not bad compared to System B. There was war and famon in System A but Nuclear War was avoided and in general the entire civilization was uplifted and enjoyed health and prosperity. We know that System B was starting to cause massive economic problems and that there was a general decline in the quality of life in the civilization. We now know that System B catastrophically failed with the spread of the COVID-19 virus that has now become the COVID-19 disaster. The key reasons why System B failed are:
The big question is what should System C be in terms of philosophical approaches. The suggested approach is to reject the elements that led to the collapse of the civilization. They are marked as - reject extremely toxic. In addition, there are certain philosophies that were rejected in System B that need to be reestablished in System C. They are marked with an X in System C.
It is not easy designing a system that is a civilization. This is probably the most important systems analysis that this generation must perform and they have to get it right and do it quickly. The price is enormous and can be as high as the civilization entering into a dark age that can last for hundreds of years. This challenge is not unlike the challenge faced by President Roosevelt and the people in the last century.
References
[1] Science The Endless Frontier, US Government Office of Scientific Research and Development, United States Government Printing Office, Washington: 1945. webpage https://www.nsf.gov/od/lpa/nsf50/vbush1945.htm, November 2020. Science The Endless Frontier . local
[2] The Trap What Happened to Our Dream of Freedom, BBC Documentary, Adam Curtis, March 2007.
Toxic Legislation
In 2021 legislation has been submitted at the state level to remove COVID-19 legal liability in planned real estate developments. Management companies in these communities have contacted residents urging them to support this legislation otherwise facilities will continue to be closed and legal liability will be on the volunteers suggesting that the management companies have no liability concerns.
Before this analysis is offered it is clear that COVID-19 is not a legal problem. It is not a social problem. It is not a political problem. COVID-19 is a deadly contagion that has shut down our civilization and the only way to deal with it is by using our best technologies. COVID-19 is a technology problem and legislation should be coming from the perspective of using all our technologies to mitigate and removed the COVID-19 and other future deadly contagions.
This is an example of a typical message sent by home owners associations management companies [1] [2]:
Please support New Legislation
We have important news about legislation introduced by Assemblymen. You all are quite aware of the liability issues that contributed to preventing the vast majority of all community association pools, gyms, and other amenities in New Jersey from opening last year. As a means of helping avoid that difficult situation again this year, this new legislation will render it easier for executive boards to make the important decision whether to open community association pools and other amenities.
Assemblymen from Atlantic County introduced A4979. A senator from Mercer and Middlesex Counties, introduced the identical bill in the Senate, S3584, which is modeled after language which your CAI Legislative Action Committee (LAC-NJ) recommended.
Bills A4979 and S3584 provide that any illness, injury or death from or related to an exposure to or transmission of COVID19 on the premises of a planned real estate development shall not give rise to any cause of action. This immunity would not apply to acts or omissions constituting a crime, actual fraud, actual malice, gross negligence, recklessness, or willful misconduct.
We need your help to encourage your local legislators to support A4979 and S3584. Please send an email to your local legislators in support of the bill which benefits every member of a community association.
Contact info: Senator, Assemblyman
Sample Language:
I am writing to request your support of S3584 and A4979 which would protect common interest community associations and their volunteer board members from causes of action for damages arising from a COVID-19 exposure or transmission on the premises of their planned real estate development. This immunity would not apply to acts or omissions constituting a crime, actual fraud, actual malice, gross negligence, recklessness, or willful misconduct.
Please consider and support this legislation for the following reasons:
1. This legislation is vital because our associations are non-profit and our volunteer board members may be sued personally for COVID-19 claims.
2. It will give volunteer board members an important tool to provide comfort when considering how and when to safely re-open their amenities.
3. Last year the vast majority of community associations across our state did not open their recreational amenities due largely for fear of uninsured COVID-19 claims resulting in residents of community associations being denied access to their recreational amenities.
4. It is unique from other pending immunity bills because it is narrowly focused to protect planned real estate developments and their volunteer board members and will allow for the safe reopening of their amenities.
5. It is industry specific and serves all common interest communities.
Thank you for your anticipated support for this important legislation that would benefit the nearly 1.5 million people who live and work in common interest communities in New Jersey.
This is the A4979 legislation text [3].
ASSEMBLY, No. 4979
STATE OF NEW JERSEY
219th LEGISLATURE
INTRODUCED NOVEMBER 12, 2020Sponsored by:
Assemblyman VINCENT MAZZEO
District 2 (Atlantic)
Assemblyman JOHN ARMATO
District 2 (Atlantic)SYNOPSIS
Establishes immunity relating to COVID-19 spread in planned real estate developments.
CURRENT VERSION OF TEXT
As introduced.
An Act establishing immunity relating to COVID-19 spread in planned real estate developments and supplementing Title 2A of the New Jersey Statutes.
Be It Enacted by the Senate and General Assembly of the State of New Jersey:
1. a. Any illness, injury, death, or other damages arising from, or related to, an exposure to, or transmission of, COVID-19 on the premises of a planned real estate development shall not give rise to any cause of action.
b. The immunity provided pursuant to subsection a. of this section shall not apply to acts or omissions constituting a crime, actual fraud, actual malice, gross negligence, recklessness, or willful misconduct.
c. As used in this section:
COVID-19 means the coronavirus disease 2019, as announced by the World Health Organization on February 11, 2020, and first identified in Wuhan, China.
Planned real estate development means the same as that term is defined in section 3 of P.L.1977, c.419 (C.45:22A-23).
2. This act shall take effect immediately.
STATEMENT
This bill would prohibit any causes of action for damages arising from a COVID-19 exposure or transmission on the premises of a planned real estate development. This immunity would not apply to acts or omissions constituting a crime, actual fraud, actual malice, gross negligence, recklessness, or willful misconduct.
This the the S3584 text [4].
SENATE, No. 3584
STATE OF NEW JERSEY
219th LEGISLATURE
INTRODUCED MARCH 25, 2021Sponsored by:
Senator LINDA R. GREENSTEIN
District 14 (Mercer and Middlesex)SYNOPSIS
Establishes immunity relating to COVID-19 spread in planned real estate developments.
CURRENT VERSION OF TEXT
As introduced.
An Act establishing immunity relating to COVID-19 spread in planned real estate developments and supplementing Title 2A of the New Jersey Statutes.
Be It Enacted by the Senate and General Assembly of the State of New Jersey:
1. a. Any illness, injury, death, or other damages arising from, or related to, an exposure to, or transmission of, COVID-19 on the premises of a planned real estate development shall not give rise to any cause of action.
b. The immunity provided pursuant to subsection a. of this section shall not apply to acts or omissions constituting a crime, actual fraud, actual malice, gross negligence, recklessness, or willful misconduct.
c. As used in this section:
COVID-19 means the coronavirus disease 2019, as announced by the World Health Organization on February 11, 2020, and first identified in Wuhan, China.
Planned real estate development means the same as that term is defined in section 3 of P.L.1977, c.419 (C.45:22A-23).
2. This act shall take effect immediately.
STATEMENT
This bill would prohibit any causes of action for damages arising from a COVID-19 exposure or transmission on the premises of a planned real estate development. This immunity would not apply to acts or omissions constituting a crime, actual fraud, actual malice, gross negligence, recklessness, or willful misconduct.
In response to the proposed legislation in A4979 / S 3584, the following was provided to the sponsors of the bills.
Subject: COVID Legislation Planned Real Estate Developments
We have recently been made aware of proposed legislation A4979 / S3584 to remove legal liability from COVID-19 spread in planned real estate developments. We urge you to drop this toxic deadly legislation immediately.
There is a massive split that is occurring between elite communities and other communities. The elite communities have invested in upgraded HVAC systems, ceiling level UV-C systems, and Far UV-222 systems in their planned real estate developments and schools. Because of money, they have access to proper engineering firms and their desire to provide the safest conditions that industry can provide are not squashed by external influences. The non elite communities are either not aware of what is possible or when they are made aware are quickly challenged by the lack of funds. They then reject the topic because there is no government regulations for them to upgrade their systems to match the elite communities.
Instead of this legislation, which will make people sick and cause death, we need legislation that will prevent people from getting sick and dying. The legislation needs to be in the form of new regulations now that we have a deadly virus in our environment. Future legislation can be developed for funds in the form of grants and tax incentives so that the COVID-19 infrastructure can be upgraded by all other communities.
SYNOPSIS
Establishes regulations to maximize the safety of planned real estate development facilities from the grave harm caused by COVID-19.
CURRENT VERSION OF TEXT
Not introduced yet.
This is proposed legislation instead of A4979 and S3584, which will cause illness and death
An Act establishing regulations to use proper building HVAC, ceiling level UV-C, and Far UV-222 systems to minimized the spread COVID-19 in planned real estate developments and supplementing Title 2A of the New Jersey Statutes.
Be It Enacted by the Senate and General Assembly of the State of New Jersey:
1. No planned real estate development public club houses can open until the COVID-19 world pandemic is over unless they install ceiling level UV-C lights or Far UV-222 lights in all public areas and HVAC systems are upgraded to support a minimum of 6 AUC or more in all areas.
2. All installed ceiling level UV-C and Far UV-222 systems must be inspected and approved according to approved standards by local authorities before a COVID-19 certificate of occupancy can be issued.
3. All HVAC systems must be inspected and approved according to approved standards by local authorities before a COVID-19 certificate of occupancy can be issued.
4. Definitions:
"AUC" air update changes per hour.
"ceiling level" also called upper-room or upper-air.
"ceiling level UV-C" is a form of Ultraviolet germicidal irradiation (UVGI) to kill or inactivate microorganisms. Developed in 1936. Products are available in the commercial market.
"COVID-19" means the coronavirus disease 2019, as announced by the World Health Organization on February 11, 2020, and first identified in Wuhan, China.
"Far UV-222" is a form of Ultraviolet germicidal irradiation (UVGI) to kill or inactivate microorganisms. Developed by University of Columbia. Products are available in the commercial market.
"HVAC" means Heating Ventilation and Cooling.
"Planned real estate development" means the same as that term is defined in section 3 of P.L.1977, c.419 (C.45:22A-23).
"UV" means Ultraviolet.
5. This act shall take effect immediately.
STATEMENT
This bill will save lives and improve the quality of life for millions of people. This bill will reduce the number of COVID-19 infections, COVID-19 long terms health losses, and COVID-19 deaths. There are 1.5 million people who live and work in common interest communities in New Jersey that are at risk of grave harm.
Please do not act on the grave legislation that is A4979 and S3584. Instead consider the above legislation that will save lives and improve the quality of life of thousands of people.
*** End ***
COVID-19 is not a legal problem. It is a Technology and Access Problem. Legislation should never remove the rights of citizens who are harmed. All legislation should encourage health and life not sickness and death.
This is an example of the Social Bifurcation that is happening around the COVID-19 disaster [5]. With the A4979 and S3584 legislation the elite settings have the most healthy facilities and everyone else will be unable to take legal action when they get sick and die in their unhealthy facilities. History will record this as yet another toxic action taken during the COVID-19 disaster.
References
[1] NJ LAC (Legal Action Committe) Needs Your Help, April 2, 2021, Community Associations Institute Keystone Chapter. webpage https://www.cai-padelval.org/nj-lac-needs-your-help, April 2021.
[2] NJ-LAC ALERT: WE NEED YOUR HELP! To Get Immunity Legislation for Planned Real Estate Developments Passed into Law in New Jersey, Community Associations Institute New Jersey Legislative Action Committee. webpage https://cainj.org/cai-nj-legislative, April 2021.
[3] A4979, STATE OF NEW JERSEY, 219th LEGISLATURE, INTRODUCED NOVEMBER 12, 2020. webpage https://www.njleg.state.nj.us/bills/BillView.asp?BillNumber=A4979, https://www.njleg.state.nj.us/2020/Bills/A5000/4979_I1.HTM, April 2021.
[4] S3584, STATE OF NEW JERSEY, 219th LEGISLATURE, INTRODUCED MARCH 25, 2021. https://www.njleg.state.nj.us/bills/BillView.asp?BillNumber=A4979, https://www.njleg.state.nj.us/2020/Bills/A5000/4979_I1.HTM, April 2021.
[5] See section Conspiracy Theories and Social Bifurcation.
Toxic Management
In 2020 this research addressed the topic of massive management failure and the practices extremely bad and dangerous management engage in organizations, like a criminal enterprise or a nation state that has lost its soul [1] [2]. This topic is different and examines what some may consider legitimate management practices but are actually toxic. These practices will be noted in history as one of the primary reasons for the COVID-19 disaster.
Toxic Management:
Proper Management:
A classic example of toxic management attempting to control the message is the introduction of the word falsehood during the Trump Administration to deflect from the correct words of lie and inaccurate. Never has this author heard the use of the word falsehood to replace the words lie or inaccurate over the last 6 decades. In 2021 the word is still being used in place of the words lie and inaccurate. It is an imprecise word and because of its rare use it does not evoke the same reaction of outrage and anger that the words lie or inaccurate invoke. That is why it was selected and that is why this is an indication of extremely toxic management. The emotions of outrage and anger are important because they result in the system need to make immediate massive corrective actions to solve the problem. It is a critical feedback loop and if it is disabled it prevents the system from self correcting.
References
[1] COVID-19 Return To Life, section Management Failure, March 2021. webpage http://www.cassbeth.com/covid-19/return-to-life/index.html, April 2021.
[2] COVID-19 A Systems Perspective, Walter Sobkiw, 2021, ISBN 9780983253044, hardback.
Toxic Generational Choices
Previously there were many outbreaks of disease, some of which became local epidemics, but since the end of World War II there were always intervention and containment results. So why did COVID-19 turn into a pandemic that shut down the civilization? A possible explanation is a tipping point may have been reached where the number of bad participants in the society has exceeded a threshold. We always had toxic government and management but there were always people to push back and hold the toxic elements in authority accountable. In some cases people lost their jobs, careers, wealth, health, families, and life. Usually there would be a lost job and in some instances a lost career. When toxic government was being challenged the stakes elevated to a loss of life level.
The possible causes might be:
A key new element in the social system is the rise of social media. This is different than the rise of the Internet. The Internet was available during other times of disease outbreaks and yet there was containment. However, the previous generation that developed the Internet was still active and alive in the civilization and they were following the values that surfaced after World War II. Those values were embodied in: Ask not what your country can do for you - ask what you can do for your country, which easily translates to Ask not what someone can do for you - ask what you can do for someone. In other words a people that look outward, instead of a people that only look inward with massive self interest.
It is interesting to see how the Republican party is targeting its fellow party members and attempting to remove them from power. This is exactly the same scenario and tactics that were used once corporate downsizing was started in the 1980's. People were targeted and systematically removed for no apparent reason. In hindsight this was part of a strategy to remove powerful people in the corporate setting at all levels who were driven by the philosophies embedded in the simple phrase of Ask not what your country can do for you ask what you can do for your country. They were replaced by people who follow orders based on self interest. By the year 2000 the transformation in corporate culture was complete. This transformation probably happened across the entire society.
Meanwhile damage control is being performed and history is being modified. On May 7, 2021 an opinion piece appeared trying to explain why it took so long to accept the facts about COVID-19 [1]. The problem is the facts were known by the US Government and others including newspaper reporters but they did not disclose it to the people [2]. They lied, pure and simple. The end results were the massive spread of COVID-19 and massive death. In taped interviews with journalist Bob Woodward on Feb. 7, 2020, President Trump said that the virus was more dangerous than the flu, even as he told the country otherwise [2]. It is clear that it was known from the beginning that the virus is spread through the air. President Trump stated the following in the audio interview.
It is obvious that the US Government and media knew that the virus was airborne but they did not inform the public or take action to mitigate the virus spread from the airborne element. This information was made public on September 09, 2020.
The following is an excerpt from a May 7, 2021 opinion piece in the New York Times [1]. Comments to this excerpt from This Analysis are marked as TA and numbered.
A few sentences have shaken a century of science.
A week ago, more than a year after the World Health Organization declared that we face a pandemic, a page on its website titled Coronavirus Disease (Covid-19): How Is It Transmitted? got a seemingly small update.
The agencys response to that question had been that current evidence suggests that the main way the virus spreads is by respiratory droplets - which are expelled from the mouth and quickly fall to the ground - among people who are in close contact with each other.
The revised response still emphasizes transmission in close contact but now says it may be via aerosols - smaller respiratory particles that can float - as well as droplets. It also adds a reason the virus can also be transmitted in poorly ventilated and/or crowded indoor settings, saying this is because aerosols remain suspended in the air or travel farther than 1 meter.
The change didnt get a lot of attention. There was no news conference, no big announcement.
Then, on Friday, the Centers for Disease Control and Prevention also updated its guidance on Covid-19, clearly saying that inhalation of these smaller particles is a key way the virus is transmitted, even at close range, and put it on top of its list of how the disease spreads.
There was no news conference by the C.D.C. either.
TA1: The public has officially known since mid 2020 that COVID-19 is airborne and spread primarily via aerosols not droplets. The websites are only just now being updated in May 2021.
But these latest shifts challenge key infection control assumptions that go back a century, putting a lot of what went wrong last year in context. They may also signal one of the most important advancements in public health during this pandemic.
TA2: This is inaccurate. It is not an advancement in public health. It has been known for decades.
If the importance of aerosol transmission had been accepted early, we would have been told from the beginning that it was much safer outdoors, where these small particles disperse more easily, as long as you avoid close, prolonged contact with others. We would have tried to make sure indoor spaces were well ventilated, with air filtered as necessary. Instead of blanket rules on gatherings, we would have targeted conditions that can produce superspreading events: people in poorly ventilated indoor spaces, especially if engaged over time in activities that increase aerosol production, like shouting and singing. We would have started using masks more quickly, and we would have paid more attention to their fit, too. And we would have been less obsessed with cleaning surfaces.
TA3: This is clear evidence that the above claim of an advancement is not accurate.
Dig deeper into the moment.
Our mitigations would have been much more effective, sparing us a great deal of suffering and anxiety.
Since the pandemic is far from over, with countries like India facing devastating surges, we need to understand both why this took so long to come about and what it will mean.
Initially, SARS-CoV-2 was seen as a disease spread by respiratory droplets, except in rare cases of aerosol transmission during medical procedures like intubation. Countertops, boxes and other possible fomites - contaminated surfaces - were seen as a threat because if we touched them after droplets fell on them, it was believed the virus could make its way to our hands, then our noses, eyes or mouths.
TA4: The only ones that saw this as a disease spread by respriatory droplets are the general public because they were denied access to the information and they were lied to by the President of the United States and US Government offcials. [2]
The implications of this were illustrated when I visited New York City in late April - my first trip there in more than a year.
A giant digital billboard greeted me at Times Square, with the message Protecting yourself and others from Covid-19. Guidance from the World Health Organization.
First, Hygiene flashed, urging me to wash my hands, practice respiratory hygiene, avoid touching my face and wear a mask when necessary. Next, Social distancing told me to avoid close contact with people (illustrated by people separated by one meter), avoid shaking hands and stay home if unwell. Then Medical help advised me to follow local medical protocols.
I was stunned that the final instruction was Stay informed.
That billboard neglected the clearest epidemiological pattern of this pandemic: The vast majority of transmission has been indoors, sometimes beyond a range of three or even six feet. The superspreading events that play a major role in driving the pandemic occur overwhelmingly, if not exclusively, indoors.
The billboard had not a word about ventilation, nothing about opening windows or moving activities outdoors, where transmission has been rare and usually only during prolonged and close contact. (Ireland recently reported 0.1 percent of Covid-19 cases were traced to outdoor transmission.)
The omission is not surprising. Throughout the pandemic, the W.H.O. was slow to accept the key role that infectious particles small enough to float could be playing.
TA5: The WHO is irrelevant. What matters is how the President of the United States behaved because he disclosed that he knew the COVID-19 virus was airborne and deadly in February 2020. This suggests that the United States Government with its massive resources knew long before February 2020. This includes the CDC, DOD, and other government agencies all of which are staffed with people [2]. For those who are not aware, it is illegal to stamp illegal activities as classified. Hiding information about a deadly disease that could kill millions of US citizens falls into the category of a possible criminal act that should be handled by the courts.
Mary-Louise McLaws, an epidemiologist at the University of New South Wales in Sydney, Australia, and a member of the W.H.O. committees that craft infection prevention and control guidance, wanted all this examined but knew the stakes made it harder to overcome the resistance. She told The Times last year, If we started revisiting airflow, we would have to be prepared to change a lot of what we do. She said it was a very good idea, but she added, It will cause an enormous shudder through the infection control society.
This assumption that these larger droplets that can travel only a few feet are the main way the disease spreads is one of the key reasons the W.H.O. and the C.D.C. didnt recommend masks at first. Why bother if one can simply stay out of their range? After the C.D.C. recommended masks in April 2020, the W.H.O. shifted last June, but it first suggested ordinary people generally wear masks if physical distancing could not be maintained, and still said health care workers performing screenings in the community did not need to wear masks if they could stay that single meter away from patients. The W.H.O. last updated its mask guidance in December but continued to insist that mask use indoors was not necessary if people could remain separated by that mere meter - this time conceding that if ventilation might not be adequate, masks should be worn indoors, regardless of distancing.
TA6: This is just more evidence that it was known that COVID-19 is airborne and that a massive disinformation campaign had been initiated.
In contrast, if the aerosols had been considered a major form of transmission, in addition to distancing and masks, advice would have centered on ventilation and airflow, as well as time spent indoors. Small particles can accumulate in enclosed spaces, since they can remain suspended in the air and travel along air currents. This means that indoors, three or even six feet, while helpful, is not completely protective, especially over time.
TA7: This analysis performed in 2020 disclosed these findings. These are all well known findings. All this analysis did was provide the numbers in one place that no one could deny.
To see this misunderstanding in action, look at whats still happening throughout the world. In India, where hospitals have run out of supplemental oxygen and people are dying in the streets, money is being spent on fleets of drones to spray anti-coronavirus disinfectant in outdoor spaces. Parks, beaches and outdoor areas keep getting closed around the world. This year and last, organizers canceled outdoor events for the National Cherry Blossom Festival in Washington, D.C. Cambodian customs officials advised spraying disinfectant outside vehicles imported from India. The examples are many.
TA8: This is not a misunderstanding. This is a direct result of a disinformation campaign that has led to millions of people getting sick and dying. That damage control word must never be forgotten by future generations when they try to determine what happened and how they were hurt by the current policy makers and people in positions of authority.
Meanwhile, many countries allowed their indoor workplaces to open but with inadequate aerosol protections. There was no attention to ventilation, installing air filters as necessary or even opening windows when possible, more to having people just distancing three or six feet, sometimes not requiring masks beyond that distance, or spending money on hard plastic barriers, which may be useless at best. (Just this week, President Biden visited a school where students were sitting behind plastic shields.)
This occurred throughout the world in the past year. The United States has been a bit better, but the C.D.C. did not really accept aerosol transmission until October, though still relegating it to a secondary role until its change on Friday, which put the risk infection from inhaling these tiny particles first on its list of means of transmission.
TA9: Future generations will perform the equivalent of running courts in their history books where various players will be charged with crimes against humanity. There is no escape from this legacy.
The scientific wrangling, resistance and controversy that prevented a change in guidance stem from a century of mistaken assumptions whose roots go back to the origins of germ theory of disease in the 19th century.
TA10: More disinformation. A great deal was learned in the previous century. It was the engineers who studied particle flows that pushed the understanding to new levels and that is why we have force air heating cooling and ventilation (HAVC) systems. It is also why we had ceiling level UV lights in many public buildings in the last century. To claim that our knowledge was stuck at the level of when germ theory surfaced is just wrong.
Until germ theory became established in the 19th century, many people believed that deadly diseases like cholera were caused by miasma stinking fumes from organic or rotting material. It wasnt easy to persuade people that creatures so small that they could not be seen in a seemingly innocent glass of water could be claiming so many lives.
This was a high-stakes fight: Getting the transmission mechanisms of a disease wrong can lead to mitigations that not only are ineffective but also make things worse. During the 19th century, fearing miasma, Londoners worked hard to direct their stinky sewers into the nearby Thames River, essentially spreading cholera even more.
But clear evidence doesnt easily overturn tradition or overcome entrenched feelings and egos. John Snow, often credited as the first scientific epidemiologist, showed that a contaminated well was responsible for a 1854 London cholera epidemic by removing the suspected pumps handle and documenting how the cases plummeted afterward. Many other scientists and officials wouldnt believe him for 12 years, when the link to a water source showed up again and became harder to deny. (He died years earlier.)
Similarly, when the Hungarian physician Ignaz Semmelweis realized the importance of washing hands to protect patients, he lost his job and was widely condemned by disbelieving colleagues. He wasnt always the most tactful communicator, and his colleagues resented his brash implication that they were harming their patients (even though they were). These doctors continued to kill their patients through cross-contamination for decades, despite clear evidence showing how death rates had plummeted in the few wards where midwives and Dr. Semmelweis had succeeded in introducing routine hand hygiene. He ultimately died of an infected wound.
Disentangling causation is difficult, too, because of confusing correlations and conflations. Terrible smells frequently overlap with unsanitary conditions that can contribute to ill health, and in mid-19th-century London, death rates from cholera were higher in parts of the city with poor living conditions.
Along the way to modern public health shaped largely by the fight over germs, a theory of transmission promoted by the influential public health figure Charles Chapin took hold.
Dr. Chapin asserted in the early 1900s that respiratory diseases were most likely spread at close range by people touching bodily fluids or ejecting respiratory droplets, and did not allow for the possibility that such close-range infection could occur by inhaling small floating particles others emitted. He was also concerned that belief in airborne transmission, which he associated with miasma theories, would make people feel helpless and drop their guard against contact transmission. This was a mistake that would haunt infection control for the next century and more.
In modern medical parlance, respiratory transmission routes are divided between the larger droplets, associated with diseases that spread at close distance, and the smaller aerosols (sometimes also called droplet nuclei), associated with diseases like measles that we know can spread at long distance and are usually highly contagious. Indeed, studies showing that respiratory diseases spread more easily in proximity to infected people seemingly confirmed the role of droplets.
It was in this context in early 2020 that the W.H.O. and the C.D.C. asserted that SARS-CoV-2 was transmitted primarily via these heavier, short-range droplets, and provided guidance accordingly.
TA11: More disinformation. A great deal was learned in the previous century. It was the engineers who studied particle flows that pushed the understanding to new levels and that is why we have forced air heating cooling and ventilation (HAVC) systems. It is also why we had ceiling level UV lights in many public buildings in the last century. By the end of the last century our machines and test equipment were able to track tiny particles and their behavior under various air flow conditions. The science and engineering behind this is massive and applies across the spectrum of systems from rockets and jet aircraft to simple HVAC systems. It is obvious that a virus is very small and will be suspended in the air for a very long time. It is also obvious that a virus will be viable for a long time while floating in the air. Simple animal studies would have shown this with the COVID-19 virus. Why was the public not shown the animal studies on a daily basis is a key question that will be asked for hundreds of years. To claim this is just wrong.
But from the beginning, the way the disease was spreading around the world did not fit this theory well. In February 2020, after an infected person was found to have boarded the cruise ship Diamond Princess, hundreds of people trapped on board for weeks were infected, including 567 of the 2,666 passengers, who were largely confined to their rooms and delivered food by masked personnel hard to explain solely with droplet-driven transmission. (Hitoshi Oshitani, a Japanese virologist who played an important role in his countrys response to the epidemic, said it was this ship outbreak that helped convince him this was airborne and its why Japan planned around airborne transmission assumptions from as early as February 2020.)
Then there were the many superspreader events around the world that defied droplet explanations. In March 2020 in Mount Vernon, Wash., 61 pandemic-aware people showed up to a choir practice and sang with some distance between them in a large space, were provided hand sanitizer and left the doors open, reducing the need for people to touch the handles. But 53 of them were confirmed or strongly suspected to have contracted Covid-19 anyway, and two died. Long-distance transmission was being documented as well: One study from China in April 2020, clearly documenting transmission from beyond one meter, had video evidence showing the initially infected person had not come very close to those he infected, and there were no common surfaces touched.
Epidemiological studies and examples kept pouring in, too, all of them showing that Covid-19 was spreading primarily indoors and clusters were concentrated in poorly ventilated spaces. And when outdoor transmission did occur, it was often when people were in prolonged close contact, talking or yelling, as with construction workers on the same site.
TA12: It was known as early as 2003 that SARS-1 was airborne when the New England Journal of Medicine published a paper on the transmission of a SARS outbreak that occurred on a flight from Hong Kong to Beijing on March 15, 2003 [3]. These other studies just confirmed what was already known.
The disease was also greatly overdispersed, sometimes being not very contagious and other times dramatically so. Large-scale studies showed that more than 70 percent of infected people did not transmit to any other person, while as few as 5 percent may be responsible for 80 percent of transmissions through superspreading events. Despite databases documenting thousands of indoor superspreader incidents, Im not aware of a single confirmed outdoor-only case of superspreading.
None of this could be explained easily if the disease were primarily transmitted between people through respiratory droplets and contact routes, as the W.H.O. had said, since those larger, heavier particles would behave the same indoors as outdoors, would be largely indifferent to ventilation and would not be conducive to so much superspreading.
Finally, it was clear from early on that people who werent yet sick or coughing or sneezing which produce a lot more droplets were transmitting and that things correlated with aerosol emissions like talking, yelling and singing were associated with many of the outbreaks.
Amid the growing evidence, in July, hundreds of scientists signed an open letter urging the public health agencies, especially the W.H.O., to address airborne transmission of the coronavirus.
TA13: They were being ignored along with all the other studies and empirical data.
That month, after the open letter, the W.H.O. updated its guidance to say that short-range aerosol transmission from infected people in poorly ventilated spaces over time cannot be ruled out but went on to say that the detailed investigations of these clusters suggest that droplet and fomite transmission could also explain human-to-human transmission within these clusters and that close contact could still be the reason, especially if hand hygiene was not performed and masks were not used when physical distancing was not maintained.
TA14: It was not until this systems analysis from 2020 was provided to the media that it was finally admitted that the virus is airborne. That is because this systems analysis provided easily understood numbers that no one could refute. Other engineers and scientists were signing petitions but not providing the easily understood numbers that anyone could access and understand. Within one day of transmitting this analysis to the media, the media started to finally report that the virus is airborne. The gig was up as they say.
Evidence kept accumulating. Transmission was documented in adjacent rooms in a quarantine hotel where people never interacted. Several hospital workers were proved to have been infected despite strict contact and droplet precautions. Viable virus was found in air samples from hospital rooms of Covid-19 patients who hadnt had aerosol-generating procedures and in an air sample from an infected persons car. The virus was found in exhaust vents in hospitals, and ferrets in cages connected only via shared air infected each other. And so on.
There were quibbles with each study: Was the sampled virus infective enough? (It is hard to catch the viruses from the air without destroying them.) Could some fomite connection have been missed? Still, it kept getting harder to deny the role of aerosols as a major factor.
TA15: All irrelevant. The systems slang is called beating a dead horse.
Last October, the C.D.C. published updated guidance acknowledging airborne transmission, but as a secondary route under some circumstances, until it acknowledged airborne transmission as crucial on Friday. And the W.H.O. kept inching forward in its public statements, most recently a week ago.
Linsey Marr, a professor of engineering at Virginia Tech who made important contributions to our understanding of airborne virus transmission before the pandemic, pointed to two key scientific errors - rooted in a lot of history - that explain the resistance, and also opened a fascinating sociological window into how science can get it wrong and why.
First, Dr. Marr said, the upper limit for particles to be able to float is actually 100 microns, not five microns, as generally thought. The incorrect five-micron claim may have come about because earlier scientists conflated the size at which respiratory particles could reach the lower respiratory tract (important for studying tuberculosis) with the size at which they remain suspended in the air.
TA16: Still trying to explain away toxic choices from policy makers. The systems slang is called grasping for straws. Just stop already. You are beating a dead horse.
Dr. Marr said that if you inhale a particle from the air, its an aerosol. She agreed that droplet transmission by a larger respiratory particle is possible, if it lands on the eye, for example, but biomechanically, she said, nasal transmission faces obstacles, since nostrils point downward and the physics of particles that large makes it difficult for them to move up the nose. And in lab measurements, people emit far more of the easier-to-inhale aerosols than the droplets, she said, and even the smallest particles can be virus laden, sometimes more so than the larger ones, seemingly because of how and where they are produced in the respiratory tract.
Second, she said, proximity is conducive to transmission of aerosols as well because aerosols are more concentrated near the person emitting them. In a twist of history, modern scientists have been acting like those who equated stinky air with disease, by equating close contact, a measure of distance, only with the larger droplets, a mechanism of transmission, without examination.
Since aerosols also infect at close range, measures to prevent droplet transmission masks and distancing can help dampen transmission for airborne diseases as well. However, this oversight led medical people to circularly assume that if such measures worked at all, droplets must have played a big role in their transmission.
Other incorrect assumptions thrived. For example, in July, right after the letter by the hundreds of scientists challenging the droplet paradigm, Reuters reported that Dr. John Conly, who chairs a key W.H.O. infection prevention working group, said that there would be many more cases if the virus was airborne and asked, Would we not be seeing, like, literally billions of cases globally? He made similar claims last month. And he is not the only member of that group to assert this, a common assumption in the world of infection control well into 2021.
However, Dr. Marr pointed out, there are airborne diseases, like measles, that are highly contagious and others, like tuberculosis, that are not. Moreover, while SARS-CoV-2 is certainly not as infectious as measles on average, it can be highly infectious in the superspreading events driving the pandemic.
Many respiratory viruses carried by aerosols survive better in colder environments and lower relative humidity, Dr. Marr said, again fitting the pattern of outbreaks around the world, for example, in many meatpacking plants. Plus, some activities produce more aerosols talking, yelling, singing, exercising also fitting the pattern of outbreaks globally.
Why did it take so long to understand all this?
TA17: It is all matter of system boundary. Are we talking about the general public or the United States Government and the President of the United States. The President of the United States disclosed their knowledge to journalist Bob Woodward on Feb. 7, 2020. No one told the public until September 09, 2020.
One reason is that our institutions werent necessarily set up to deal with what we faced. For example, the W.H.O.s Infection Prevention and Control (I.P.C.) global unit primarily concentrates on health care facilities. Many of the experts they enlisted to form the Covid-19 I.P.C. Guidance Development Group were hospital-focused, and some of them specialized in antibiotic-resistant bacterial infections that can spread wildly in health care facilities when medical personnel fail to regularly wash their hands. So this focus made sense in a prepandemic world. Hospitals employ trained health care workers and are fairly controlled, well-defined settings, with different considerations from those of a pandemic across many environments in the real world. Further, in some countries like the United States, they tend to have extensive engineering controls to dampen infections, involving aggressive air-exchange standards, almost like being outdoors. This is the opposite of modern office and even residential buildings, which tend to be more sealed for energy efficiency. In such a medical environment, hand hygiene is a more important consideration, since ventilation is taken care of.
Another dynamic weve seen is something that is not unheard-of in the history of science: setting a higher standard of proof for theories that challenge conventional wisdom than for those that support it.
As part of its assessment of the viruss spread, the W.H.O. asked a group of scientists last fall to review the evidence on transmission of the coronavirus. When reviewing airborne transmission, the group focused mostly on studies of air samples, especially if live virus was captured from the air, which, as mentioned above, is extremely hard. By that criterion, airborne transmission of the measles virus, which is undisputed, would not be accepted because no one has cultivated that pathogen from room air. Thats also true of tuberculosis. And while scientists, despite the difficulties, had managed to capture viable SARS-CoV-2 in three studies that Im aware of, the review noted that the virus was detected only intermittently in general, disputed whether the captured live virus was infective enough and ultimately said it could not reach firm conclusions over airborne transmission. The lead author and another senior member of the research group previously said they believed transmission was driven by droplets.
The skepticism about airborne transmission is at odds with the acceptance of droplet transmission. Dr. Marr and Joseph Allen, the director of the Healthy Buildings program and an associate professor at Harvards T.H. Chan School of Public Health, told me that droplet transmission has never been directly demonstrated. Since Dr. Chapin, close-distance transmission has been seen as proof of droplets unless disproved through much effort, as was finally done for tuberculosis.
Another key problem is that, understandably, we find it harder to walk things back. It is easier to keep adding exceptions and justifications to a belief than to admit that a challenger has a better explanation.
The ancients believed that all celestial objects revolved around the earth in circular orbits. When it became clear that the observed behavior of the celestial objects did not fit this assumption, those astronomers produced ever-more-complex charts by adding epicycles intersecting arcs and circles to fit the heavens to their beliefs.
In a contemporary example of this attitude, the initial public health report on the Mount Vernon choir case said that it may have been caused by people sitting close to one another, sharing snacks and stacking chairs at the end of the practice, even though almost 90 percent of the people there developed symptoms of Covid-19. Shelly Miller, an aerosol expert at the University of Colorado Boulder, was so struck by the incident that she initiated a study with a team of scientists, documenting that the space was less full than usual, allowing for increased distance, that nobody reported touching anyone else, that hand sanitizer was used and that only three people who had arrived early arranged the chairs. There was no spatial pattern to the transmission, implicating airflows, and there was nobody within nine feet in front of the first known case, who had mild symptoms.
Galileo is said to have murmured, And yet it moves, after he was forced to recant his theory that the earth moved around the sun. Scientists who studied bioaerosols could only say, And yet it floats.
So much of what we have done throughout the pandemic the excessive hygiene theater and the failure to integrate ventilation and filters into our basic advice has greatly hampered our response. Some of it, like the way we underused or even shut down outdoor space, isnt that different from the 19th-century Londoners who flushed the source of their foul air into the Thames and made the cholera epidemic worse.
Righting this ship cannot be a quiet process updating a web page here, saying the right thing there. The proclamations that we now know are wrong were so persistent and so loud for so long.
Its true that as the evidence piled on, there was genuine progress and improvement, especially as of late. Even before the change in language last week, for example, the W.H.O. published helpful guides on ventilation, first in July and updating it in March. Recently, though the organizations documents have lagged, more of its officials have started giving advice compatible with aerosol transmission, emphasizing things like close mask fit which matters little for droplet transmission and ventilation which matters even less. All this is good, but nowhere near enough to change the regulations and policy bundles that had already been put in place around the world.
And the progress weve made might lead to an overhaul in our understanding of many other transmissible respiratory diseases that take a terrible toll around the world each year and could easily cause other pandemics.
So big proclamations require probably even bigger proclamations to correct, or the information void, unnecessary fears and misinformation will persist, damaging the W.H.O. now and in the future.
Scientists have responded. In just the past few weeks, there has been a flood of articles published about airborne transmission in leading medical journals. Dr. Marr and other scientists told me the situation was very difficult until recently, as the droplet dogma reigned. I co-wrote one of those papers, published in The Lancet last month, arguing that aerosols may be the predominant mode of transmission for SARS-CoV-2, a step farther.
Ive seen our paper used in India to try to reason through aerosol transmission and the necessary mitigations. Ive heard of people in India closing their windows after hearing that the virus is airborne, likely because they were not being told how to respond. Plus, there are important questions for what this means for higher-risk settings, like medical facilities.
The W.H.O. needs to address these fears and concerns, treating it as a matter of profound change, so other public health agencies and governments, as well as ordinary people, can better adjust.
The past year has revealed how crucial the agency is, despite being hampered by chronic underfunding, lack of independence and attempts to turn it into a political football by big powers. Like other public health organizations, many of its dedicated staff members work tirelessly under difficult conditions to safeguard health around the world. Maintaining its credibility is essential not just for the rest of this terrible pandemic but in the future.
It needs to begin a campaign proportional to the importance of all this, announcing, Weve learned more, and heres whats changed, and heres how we can make sure everyone understands how important this is. Thats what credible leadership looks like. Otherwise, if a web page is updated in the forest without the requisite fanfare, how will it matter?
TA18: The rest is irrelevant. There is no excuse.
TA19: It is sad that the New York Times published this opinion piece without a follow up comparison of the history of events and its own findings. There was only 1 reference that was needed and that was the documented evidence of what the President of the United States disclosed in a phone call to a journalist and published in the New York Times [2]. In systems we look for consistency. In large complex systems sometimes it is difficult to get external consistency but loss of internal consistency is viewed as a very bad or broken system.
The analysis provided in the opinion piece above is an example of a narrow specialty providing critical data and information but it is not a systems analysis that considers all the data and information. That is why the above analysis is wrong and dangerous because it is being used by some stakeholders to game the situation in a particular direction; in this case to deflect blame and stop accountability. This is a classic example of why systems thinking, practices, and engineering must be reintroduced into the society.
This generation will not come out of the COVID-19 disaster until they begin to build a world based on something other than exclusive self interest. They still have all the history and technologies to get them out of this disaster. However, the clock is ticking and they immediately need to roll up their sleeves and get to work because it will take years to implement everything in the infrastructure that needs to happen. If they do it right they can make a better world for their kids and grand kids. If they do it wrong it will be a massive tragedy that will result in a new dark age lasting several hundred years. You don't allow a civilization to spread disease, sickness, and death without paying a severe price.
This will be a topic of study for hundreds of years.
References
[1] Why Did It Take So Long to Accept the Facts About Covid, The New York Time, May 07,2021. webpage https://www.nytimes.com/2021/05/07/opinion/coronavirus-airborne-transmission.html, May 2021. Why Did It Take So Long to Accept the Facts About Covid
[2] Trump Admits Downplaying the Virus Knowing It Was Deadly Stuff, New York Times, September 09, 2020. webpage https://www.nytimes.com/2020/09/09/us/politics/woodward-trump-book-virus.html, September 10, 2020. Trump Admits Downplaying the Virus Knowing It Was Deadly Stuff
[3] Transmission of the severe acute respiratory syndrome on aircraft. The New England Journal of Medicine, December 18, 2003. webpage https://www.nejm.org/doi/pdf/10.1056/NEJMoa031349, March 2020. Transmission of the severe acute respiratory syndrome on aircraft.
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