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The Next Pandemic Could Be 'as Infectious As This One But Far More Lethal'—and Make COVID Look Like A Cakewalk, Expert Warns

The next pandemic could make COVID look like a cakewalk, one expert warned Tuesday at Fortune's Brainstorm Health conference in Marina del Rey, Calif.

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COVID was a "very bad pandemic," with more than 1.1 million deaths in the U.S. Alone so far, Dr. Robert Wachter, chair of the Department of Medicine at the University of California in San Francisco, noted. Wachter—the author of 300 articles and six books, including a New York Times best-seller—became popular on Twitter during the pandemic.

COVID wasn't the beast it could have been in terms of mortality, he argued. The virus generally killed under 5% of the people it infected, and, depending on which country you resided in, often much less. Fellow coronaviruses SARS and MERS, on the other hand, were much less transmissible but more deadly, with case fatality rates around 10% and 34%, respectively.

When it comes to the next pandemic, Watchter said he is "quite worried," and that it could be worse than COVID.

"There's nothing in the book of life that says you couldn't have a virus that's as infectious as this one but far more lethal," he noted.

COVID as an evolving threat

Wachter isn't the only expert to raise the possibility of an equally transmissible but more lethal pandemic pathogen. COVID's ability to infect more efficiently has sky-rocketed since 2019, soaring from near the bottom of the list of contagious diseases to near the top.

It's possible that ultra-transmissible Omicron evolves to become more deadly, experts warn—though there's no telling just how likely this scenario is, or when the transition might occur, if it ever does.

"What's to say that we're not going to eventually see a COVID that has both?" Dr. Michael Osterholm, director of the University of Minnesota's Center for Infectious Disease Research and Policy (CIDRAP), told Fortune last fall. He was speaking of transmissibility—which Omicron has in spades—and the lethality of SARS, MERS, or worse.

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If COVID evolution were to take a turn for the worst, powers that be would need to decide whether it constituted a new pandemic and warranted a new name entirely—perhaps SARS-CoV-3—or if it was simply an extension of the current pandemic, which is still ongoing, according to the World Health Organization.

Since Omicron burst onto the scene nearly a year and a half ago, evolution, while speedy, hasn't resulted in any major changes in how the virus presents, though each new major variant tends to chip away a little more at immunity and/or become a bit more transmissible, Wachter said. But "a new variant could come out tomorrow. It could laugh at your prior immunity."

The chances of such a scenario are likely less than 20%, Wachter and colleagues estimate. The largely survivable but less-than-harmonious coexistence with the virus we're experiencing now will likely be unchanged three years from now, he added.

Other viral threats are possible

The next pandemic pathogen may not be a coronavirus at all. Experts are eyeing a variety of strains of bird flu, given increasing transmission to and among mammals, and several recent human cases in disparate parts of the world.

There's always the possibility of something entirely new. Among the list of the WHO's "priority pathogens" that have the potential to cause outbreaks and pandemics is "Disease X," which represents an unknown threat.

That list also includes Crimean-Congo hemorrhagic fever; the Ebola and Marburg viruses; Lassa fever; coronaviruses SARS, MERS, and COVID-19; henipaviruses, and Rift Valley fever. The list was last updated in 2019, and a revised list should be released this year, according to the WHO.

This story was originally featured on Fortune.Com

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Britain's Terrifying Isolation Tent For The World's Deadliest Diseases

Dr Jake Dunning, Consultant in Infectious Diseases (centre) Jennifer Abrahamsen (L) Senior Sister in Infectious Diseases Breda Athan (R) High Consequence Infectious Diseases Lead Nurse

© Provided by The Telegraph Dr Jake Dunning, Consultant in Infectious Diseases (centre) Jennifer Abrahamsen (L) Senior Sister in Infectious Diseases Breda Athan (R) High Consequence Infectious Diseases Lead Nurse

On the 11th floor of the Royal Free Hospital in London, a stone's throw from the genteel hubbub of Hampstead Heath, a single bed stands shrouded and empty in an unlit room.

It's an unsettling sight. The bed is forensically sealed inside a large plastic tent and rests solus in the centre of the room. From its frame, high-tech tubes and wires hang coiled. And in the walls of the transparent structure are five corporeal gloves, each large enough to envelope the arms and head of a nurse or doctor.

It's here, in one of only two high-level isolation facilities in the UK, that patients sickened with the world's most dangerous infectious diseases are brought for treatment. Whether it be Ebola or Marburg, Lassa or even Crimean-Congo hemorrhagic fever, care can be provided while the patient and pathogen remain entirely contained to prevent a wider outbreak.

The UK can go years without reporting any such infections, officially known as viral hemorrhagic fevers (VHFs) but this could be starting to change as immigration and travel to Britain become ever more global.

In February last year, three cases of Lassa fever were reported in England. The cases were within the same family and linked to travel to West Africa. One of the patients, a newborn baby, tragically died but both adults survived.

Dr Jake Dunning, Consultant in Infectious Diseases with the isolation tent - Simon Townsley/The Telegraph

A month later, a case of Crimean-Congo haemorrhagic fever was identified, with the patient transported to the Royal Free's isolation facility. Security staff manned the doors to the ward, as ordered by the Home Office, while a total of 158 rostered medics cared for the patient, who spent several weeks confined in the isolation facility.

"We only had about a week or two of downtime between this case and the cluster of Lassa fever cases we'd dealt with before that," says Dr Jake Dunning, the lead consultant for high consequence infectious diseases at the Royal Free. "We just replaced the tent with a new one, and then we had to activate again."

'We're seeing a genuine increase'

These emergencies came hot on the heels of the Covid pandemic, which, depending on estimates, has so far caused between 14 million and nearly 20 million excess deaths globally. Experts fear the frequency of these events is only going to increase in the decades ahead.

"I think we're seeing a genuine increase in some of these diseases," says Dr Dunning, who argues that climate change, globalisation and deforestation is bringing humanity and nature into ever-closer proximity with one another, increasing the risk of zoonotic outbreaks.

"Things like Crimean Congo hemorrhagic fever, which is tick-borne, you can find in Europe", adds Dr Dunning. "I think we will see more cases of that in people who go hiking in Spanish mountains, for example."

Last year, scientists identified ticks positive for the infection across Spain, indicating it is "widespread" in the country.

Then there are the ongoing, and simultaneous, outbreaks of Marburg in Tanzania and Equatorial Guinea. It is the latter which is generating the most fear among scientists, with authorities struggling to track cases of the disease. To date, there have been 38 cases and 34 deaths, suspected and confirmed, giving a case fatality rate of 89 per cent, although many infections are thought to have gone undetected.

"We're concerned," says Dr Dunning. "I'm more concerned about Equatorial Guinea than Tanzania currently, because there's a wider geographic distribution of the cases I've seen across different provinces. We just have to watch it very closely."

Dr Dunning and his team at the Royal Free - Simon Townsley/The Telegraph

Should a case of Marburg make its way to the UK, several steps will be taken before the patient is passed into the care of Dr Dunning and his team at the Royal Free.

The first involves actually diagnosing the infection. This responsibility lies with the rare and imported pathogens laboratory (RIPL) run by the UK Health Security Agency.

The lab receives several calls a day via its 24/7 hotline from concerned clinicians whose patients have recently travelled abroad and are showing symptoms of a VHF, such as a fever and gastrointestinal complications. Most of the time, these calls come to nothing.

"Hardly any of those end up being positive and, in fact, a large number don't need testing and we can stand them down based on the patient's exposure history and clinical factors," says Dr Claire Gordon, the deputy head of RIPL.

Especially at times of a high-profile outbreak, community clinicians can become hyper-vigilant if they're dealing with a sick patient who has returned from overseas. This was seen during the recent spread of Ebola in Uganda, with the laboratory reporting a notable uptick in calls from worried GPs.

"We calmly try to take them through the actual history [of the patient], get the details, and ask what it is about this patient that made them call us and then what the other differentials might be," says Dr Gordon.

Breda Athan (R) High Consequence Infectious Diseases Lead Nurse - Simon Townsley/The Telegraph

Where there is genuine cause for concern, the patient in question will be subject to further investigations and fast-tracked for testing at RIPL, which is based in the government's high-security Porton Down facility in Wiltshire.

Here, Dr Gordon and her colleagues are capable of turning around a full set of tests "in a matter of hours" to determine whether the patient does indeed have a hemorrhagic fever or is actually infected with a less serious tropical disease like malaria, which is more commonly reported.

The testing team can be brought in at any time to conduct testing, including the middle of the night. "There's always a team on standby and a backup team if needed," adds Dr Gordon.

Once a test is confirmed as positive, the NHS springs into action. Depending on the infection – and whether it spreads by air or touch – the patient could be sent to any one of England's dedicated centres for tropical and infectious diseases.

But only the Royal Free, in London, and Newcastle's Royal Victoria Infirmary have the isolation facilities capable of treating a case as serious as Marburg, Ebola or Crimean Congo hemorrhagic fever.

Sealed in a plastic tent

The technology behind these units, known as a Trexler isolator, was first developed in the 1970s as means for creating a positive pressure environment, free of bugs and germs, in which pure lines of animals could be bred. Over time, it has been evolved to keep medics safe when treating patients with deadly infections.

Patients are effectively sealed into the plastic tent, unable to leave until they're given the green light by doctors, who make a decision based on whether the pathogen, whatever it may be, is still detectable in blood, stool and urine samples.

The psychological and physical demands of this confinement are considerable, but "we do everything we can to make it more comfortable for them with TV and iPads and all those things," says Dr Dunning.

The tent at the Royal Free even has a small exercise space where a patient can stand and stretch out.

For children, the team does not use the isolator tent, which can "be very distressing for all involved". Instead the medics dress in full protective suits.

But the benefit of the Trexler isolator is that "I can train anyone in 10 minutes how to use that system," says Dr Dunning. "We had 158 different members of staff over a three-to-four week period who had direct hands-on contact with the [Lassa fever] patient, including external specialists like a radiologist who came in to do a scan."

Infectious Diseases Isolation Unit at the Royal Free Hospital, Hampstead - Simon Townsley/The Telegraph

The Royal Free has two of the tents, each based in a separate room. Nurses and doctors looking after an isolated patient must follow a strict one-way system: they enter through two sets of air-locked doors and, after delivering their care, leave via a walk-through shower.

"Even though we don't wear PPE because the system is safe, we shower," says Dr Dunning. "That's also partly to provide reassurance to the staff working on the unit because there's a psychological element of going home to your family dirty."

All waste produced by patients kept in the Trexler unit is carefully removed in bags, mixed with granules that solidify it, and then sterilised – or "autoclaved" – in a room next door. At every stage of the patient journey, every precaution possible is taken to minimise the risk of an outbreak.

This commitment to protocol was put to the test in responding to last spring's cases of Lassa fever and Crimean Congo hemorrhagic fever, which came after Covid-19 and a long spell without any patients with viral fevers. The last person to receive care in the isolation unit before then was Pauline Cafferkey, a Scottish nurse who was infected with Ebola in 2015 while working in West Africa.

"There was that element of 'are we a bit rusty now?'," says Dr Dunning. "We had also toned down a lot of our training because it was impossible to do our usual level during the pandemic."

"But in reality, staff were amazing," he adds. "It was slightly refreshing, in a sense, to deliver another type of expert care [different to Covid]."

When it comes to deadly diseases like Ebola and Lassa fever, it used to be assumed that luck would play as big a chance in a patient's survival prospects as the care they received.

But the team at Royal Free have shown there is a way to dramatically improve the odds.

"In the old days, we'd say it's too difficult to deliver intensive care to such patients," says Dr Dunning. "Now, we've proved that we can do it."

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Urgent Warning Amid Fears Outbreak Of Deadly 'bleeding Disease' Has Spread

A SUSPECTED case of Marburg virus has been detected in the south eastern African country of Malawi, raising further concerns of international spread.

Marburg virus is one of the most deadly infectious diseases in the world - and has a 90 per cent fatality rate and epidemic potential, according to the World Health Organisation (WHO).

A suspected case of Marburg has been detected in a southeastern African country raising concerns of further spreadCredit: Getty

Map of confirmed Marburg deaths in Africa since February 2023

The central African countries, Equatorial Guinea and Tanzania are facing their first known outbreaks of the bug, for which no vaccine or treatment exists.

At least 35 cases and up to 32 deaths (when including probable fatalities) have now been detected since the outbreak was declared in mid-February, official health data suggests.

Yesterday (April 13), Malawi health authorities confirmed one suspected case of the bug.

According to Ministry of Health spokesperson, samples taken from the individual have been sent to South Africa to determine the disease.

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It comes as cases of Marburg have spread from rural districts in Equatorial Guinea to the main port of the African nation, Bata, increasing the risk of international transmission.

Previously, the WHO said the "the risk of international spread [of Marburg] cannot be ruled out".

At least four cases have now been detected in the city, which has a population of around 200,000 people, an international airport and links to several neighbouring countries.

Last week, a mysterious 'nosebleed' disease claimed the lives of three people in Burundi, west Africa.