Disease outbreaks need hurricane-style warning systems

By F D Flam

It’s hurricane season once again, and once again Floridians were warned to evacuate as a deadly storm bore down on the state. Not everyone follows such warnings, but many do. That saves lives. Now, thanks to advances in biotechnology, we can do even better with disease outbreaks — alerting people when and where a threat is growing long before it can become a pandemic.

“Just like we made our buildings more resistant to hurricanes and earthquakes and fires, we have to do that kind of stuff in our society for infectious diseases,” says epidemiologist Jennifer Nuzzo, head of the Pandemic Center at Brown University. “They’re just going to keep coming.”

Hurricane forecasting has gotten better by leaps and bounds, even as climate change is making such storms tougher to predict. Pathogens are also increasing, yet scientists have invented a system for predicting outbreaks of infectious disease: a new way of testing wastewater for emergent signs of known viruses.

That’s possible thanks to several scientific and technological advances, including biologists’ ability to quickly synthesize or “print” thousands upon thousands of fragments of DNA. These can be used as probes to pick up any virus that can get into the sewage system.

This “pan virome” detector was developed at the University of Texas Heath, Houston and the Baylor College of Medicine. Researchers deployed it earlier this year to show exactly when the H5N1 bird flu started showing up this year in 10 different cities. That virus has grown more worrisome in recent months, since it has started spreading in multiple mammal species, including dairy cows, and has jumped multiple times into people.

Early warning could, in principle, prevent pandemics altogether. If caught early enough, a local outbreak could be curtailed through testing and contact tracing. In that way, pandemic prediction could save even more lives and prevent more suffering and disruption than hurricane forecasting — since we don’t have the technology to turn a Category 5 storm into a safer Category 1.

Nuzzo said it’s vitally important to get ahead of the H5N1 virus. It’s not clear how many people might carry mild infections. Other diseases, such as mpox and parovirus BV19, should be tracked whether or not they’re ever officially declared pandemics.

One of the developers of the system used in Texas, virologist Michael Tisza of the Baylor College of Medicine, explains that it works because single strands of DNA and RNA both stick to strands with complementary sequences of coding bases — A sticks to T, and C to G, which is why DNA in our cells sticks together in a double helix.

And now they can quickly “print” millions of small pieces of single-stranded DNA to use as probes. When placed on a surface and exposed to wastewater, the probes will pick up whatever viral fragments are floating around. The researchers can use the fragments to figure out which viruses are present and even find the specific genetic variations that could determine if, say, a new cluster of H5N1 had mutated from the version infecting cows.

The system still can’t automatically distinguish whether a virus such as H5N1 is coming from humans or animals, but a positive wastewater signal should prompt voluntary testing in people seeking medical care for respiratory or flu-like symptoms.

If such technology had been employed during early 2020, we could have seen ahead of time where Covid was about to surge and focus mitigations where and when they were most needed. People in New York, for example, might have been notified weeks earlier that an infectious storm was building, preventing the kind of acute crisis that engulfed the city in March.

Americans are still hopelessly polarized over Covid. But people on both sides of our political divide like a good, smart technological advance. If scientists came up with a better way of accurately predicting the paths and strengths of hurricanes, I like to think we’d adopt it. We should do the same for this novel way of predicting infectious disease.