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Pandemic virus simulation from Johns Hopkins shows our vulnerability



Clade X Exercise 5 15 18_061
executive committee to advice the President meets to discuss
Clade X.

Johns Hopkins Center for
Health Security

  • The Clade X simulation, created by the Johns Hopkins
    Center for Health Security, shows how vulnerable the world is
    to the spread of a pandemic virus.
  • In that simulation, political experts from the US tried
    to figure out how to respond to the emergence of a new and
    deadly disease.
  • Despite being a “moderately contagious” and “moderately
    lethal” virus, at the end of the day — 20 months in simulated
    time — the virus would have killed 150 million people.
  • According to the scenario’s creator, if efforts to
    create a vaccine continued to fail, a disease like that could
    kill 900 million, or more than 10% of the global

The committee to advise the President first met approximately one
month after the virus first appeared.

There had been more than 400 cases and 50 deaths so far, mostly
split between Frankfurt, Germany, and Caracas, Venezuela.

Patients presented with fever, cough, and confusion. In a
disturbing number of cases, encephalitis — swelling in the brain
— caused patients to fall into a potentially fatal coma.

Researchers had been able to isolate what appeared to be a new
pathogen, a disease-causing agent.

The virus seemed to be a new type of parainfluenza
 from a family of respiratory viruses that normally
cause mild illnesses like the cold. Scientists studying the
disease couldn’t identify where the virus fit in the
parainfluenza family, so they referred to the pathogen as
parainfluenza Clade X.

Health authorities said Clade X, which appeared to spread by
coughing and to take up to a week before patients started showing
severe symptoms, had pandemic potential.

This situation described here is fictional.

It’s part of a scenario created by researchers at the Johns
Hopkins Center for Health Security, designed to see how real
policy experts and government decisionmakers would respond to a
similar situation.

The scenario was designed to be completely realistic, with a
disease that could plausibly exist and a world that has the exact
same resources to respond as we do now.

On May 15th, when the “Clade
X” simulation
was played out real-time, the people acting out
the scenario were the sorts of individuals who’d be responding to
this situation in real life. The
players included
former Senate Majority Leader Tom Daschle,
Indiana Representative Susan Brooks (R), former CDC
Director Julie Gerberding, and others with extensive

Yet by the day’s end, representing 20 months after the start of
the outbreak, there were 150 million dead around the globe, and
15 to 20 million deaths in the US alone. With no vaccine for the
illness yet ready, that death toll would have been expected to

“I think we learned that even very knowledgeable, experienced,
devoted senior public officials who have lived through many
crises still have trouble dealing with something like this,” Dr.
Eric Toner, a senior scholar at the Johns Hopkins Center for
Global Health Security and the designer of the Clade X
simulation, told Business Insider. “And it’s not because they are
not good or smart or dedicated, it’s because we don’t have the
systems we need to enable the kind of response we’d want to see.”

If efforts to develop a vaccine continued to fail, Toner said a
disease like this could kill 900 million people, or more than 10%
of the world’s population.

Clade X Exercise 5 15 18_615
debate solutions to Clade X, a bioengineered

Johns Hopkins Center for Health

We’ve been lucky in the past

A virus capable of wiping out more than 10% of the world might
sound like it would need to be one of the most fatal, contagious
diseases ever — as easy to catch as measles,
which spreads to 90% of the non-vaccinated people near an
infected person, but as fatal as Ebola.

This is not the case, according to Toner, who spent a year
creating the simulation.

The Clade X virus that Toner and colleagues used in the
simulation was only moderately contagious and moderately lethal.
It spread as easily and was about as deadly as SARS, which
infected more than 8,000 between 2002 and 2003,
killing about 10% of those infected

The world was lucky SARS wasn’t worse. That virus wasn’t
particularly contagious until people were already very sick. As a
result, it spread more in healthcare settings, once patients had
landed in clinics and hospitals. That limited the spread of SARS
in broader public spaces.

There’s also evidence it mutated to become less virulent. SARS
was stopped, but there was “a great deal of luck involved,”
according to Toner.

With Clade X, which theoretically would spread relatively fast in
community settings (like SARS did in healthcare facilities), the
world would not be as lucky.

“We think this scenario is quite plausible,” said Toner.

The Middle East respiratory syndrome (MERS) coronavirus is seen in an undated transmission electron micrograph from the National Institute for Allergy and Infectious Diseases (NIAID).  REUTERS/National Institute for Allergy and Infectious Diseases/Handout via Reuters
like SARS and MERS, shown here, have pandemic


‘We don’t want to provide a recipe for how to do this’

Shortly after the committee to advise the President met to
discuss how to respond to Clade X, the first case appeared in the
US, at a university in Massachusetts.

New information about the pathogen emerged. Despite being a
parainfluenza virus, Clade X also had genetic elements of the

Nipah virus, a rare but extremely lethal virus
that the World
Health Organization considers an urgent research priority because
of its potential to cause a pandemic.

In the simulation, the virus was bioengineered and released by a
group known as A Brighter Dawn, with the intention of reducing
the world’s population back to pre-industrial levels. The group
was largely modeled after the cult Aum Shinrikyo, which
released the chemical weapon sarin on the Tokyo subway in 1995.

Before the sarin attack, Aum Shinrikyo reportedly tried to

develop biological weapons
. Advances in the field of
synthetic biology make the production of deadly biological
weapons a far simpler procedure today than when Aum Shinrikyo
carried out attacks, to the point that many
experts believe weaponized disease
may be the biggest threat
humanity now faces.

Toner said researchers are convinced a virus like the one
released by A Brighter Dawn could be created and released. But he
said the simulation designers will not reveal exactly how they
determined this disease would be designed.

“We don’t want to provide a recipe for how to do this,” he said.

biosafety virus work lab biological weapon
Creating a deadly virus
using synthetic biology is less complicated than it used to


Dark Winter, Atlantic Storm, and the lessons learned

The Center for Health Security has run two other major
simulations before Clade X.

In June of 2001, a similar group of policy experts played the

Dark Winter
scenario, in which a terrorist group released
smallpox at shopping malls in the US  — still a scary enough
potential scenario that the
FDA for the first time this month approved a drug
to treat
smallpox in case of an attack. An analysis of that exercise
suggested that if the outbreak couldn’t be stopped using
vaccines within two months, the devastating illness could
have infected 3 million and killed one million.

“People were just beginning to think of bioterrorism as a threat”
at the time, said Toner. Not long after, the 9/11 attacks and

anthrax letters
 would convince the world that the threat
of terrorism was of far greater concern.

In 2005, in the
Atlantic Storm
 exercise, political leaders played
through another smallpox release scenario. By then, governments
around the world had stockpiled smallpox vaccines. But as the
health experts
behind the scenario
explained after, a smallpox outbreak in a
world with vaccines is not a worst-case scenario — other
pandemics, naturally occurring or created, could be even more
dangerous. Clade X reflects that.

Though Clade X involved a bioengineered virus, Toner said the
response required wasn’t necessarily different from what we’d
need to deal with a naturally-emergent pathogen. A virus like
Clade X could just as easily emerge naturally — if SARS had been
just slightly different, it might even have been that virus.

pandemic disease ebola
also helped show how unprepared the world is for dealing with
rapidly spreading diseases.


We aren’t ready for what’s coming

A deadly disease with the potential to cause widespread loss of
life around the world is coming. Whether it’s manufactured or
jumps to humans after spreading in animal species, that’s
considered a fact by infectious disease and bioterror

George Poste, an ex officio member of the Blue Ribbon Study Panel
on Biodefense, a group created to assess the state of biodefense
in the US, previously told Business Insider it was
inevitable that a disease as deadly as the 1918 flu pandemic

that killed 50 million people would emerge again. 

At a recent talk,
Bill Gates warned
that we’re not prepared.

“In the case of biological threats, that sense of urgency is
lacking,” he said. “The world needs to prepare for pandemics in
the same serious way it prepares for war.”

Toner said the Clade X scenario highlighted many of the
shortcomings in our global healthcare system.

“We don’t have the ability to produce vaccines to a novel
pathogen within months rather than decades and we don’t have the
global public health capabilities that would allow us to rapidly
identify and control an outbreak before it becomes a pandemic,”
he said.

He also said that the health systems in the US and around the
world aren’t ready for the rapid surge in cases they’d see in the
case of pandemic disease spread.

A pandemic could cause hospital systems to collapse under the
pressure. Most people don’t know how close we came to having that
happen in the US in 2009, he said, due to a not particularly
virulent flu strain.

We also don’t have systems in place to deal with the overlap
between healthcare, foreign policy, and national security.

“It will happen, but I don’t know when,” Toner said. Whenever it
does, we have to hope that we’ll be more prepared than we are

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