Thought Leadership - NYAS

A recent outbreak of an undiagnosed illness in the Democratic Republic of the Congo is on the radar of public health professionals. Preparedness is key to mitigating the issue.

Published December 10, 2024

By Syra Madad, D.H.Sc., M.Sc., MCP, CHEP
Public Health Editor-at-Large

Testing for malnourishment in Democratic Republic of the Congo. Image courtesy of DFID – UK Department for International Development, CC BY-SA 2.0, via Wikimedia Commons.

A recent outbreak of an undiagnosed illness in the Panzi health zone of the Democratic Republic of the Congo (DRC) has captured global attention, spotlighting the challenges of outbreak investigations in resource-limited settings. Since late October, over 400 cases have been reported, predominantly among children under five years old. Symptoms such as fever, cough, and body aches have resulted in 31 deaths, with severe malnutrition compounding the crisis.

This outbreak highlights the critical need for strong global public health systems to detect and respond to emerging health threats. Although the cause remains uncertain, investigators are exploring various possibilities, including endemic diseases like malaria and respiratory infections such as acute pneumonia, influenza, COVID-19, and measles. Malnutrition is thought to play a significant role in worsening disease severity. Laboratory testing is ongoing, and health officials are evaluating whether multiple diseases may be contributing to the cases and fatalities reported.

Is This “Disease X”?

The term “Disease X” refers to a hypothetical, unknown pathogen with the potential to cause a global epidemic or pandemic. Coined by the World Health Organization (WHO) in 2018, Disease X represents the growing need to prepare for unforeseen infectious threats. In the 21st century, humanity has faced several emerging and re-emerging viral diseases, including SARS-CoV-1, MERS, and Zika, as well as the most recent Disease X, SARS-CoV-2, the virus responsible for COVID-19. These outbreaks underscore the importance of readiness, as novel pathogens like mpox have also spread beyond their endemic regions, creating widespread public health challenges.

While mysterious outbreaks like the one in the DRC often raise alarms, they are more frequently caused by endemic diseases in under-resourced areas than by new pathogens. Known diseases such as measles or influenza, exacerbated by malnutrition or poor vaccination coverage, are often the culprits. My husband often reminds me of the medical adage, “When you hear hoofbeats, think horses, not zebras,” which emphasizes prioritizing the most likely diagnosis. Yet, as someone who works in high-consequence infectious diseases, my mind often first goes to those zebras.

How Outbreak Investigations Work

Outbreak investigations follow a systematic approach to identify and control the source of illness:

1. Epidemiological Analysis: Investigators collect and analyze data to identify trends, clusters, and possible modes of transmission.

2. Clinical and Laboratory Testing: Samples from patients are tested to rule out suspected pathogens such as malaria, pneumonia, or influenza. In this case, samples have been sent to laboratories in Kinshasa for further testing.

3. Community Engagement: Teams work with local communities to identify additional cases, strengthen infection prevention, and provide treatment for the sick.

In the DRC, the investigation faces significant challenges, including remote locations, poor infrastructure, and a healthcare system strained by supply shortages. Despite these obstacles, international and national health teams are collaborating to identify the cause and strengthen the local response according to the latest WHO situation report.

Preparing for Future Threats

The DRC outbreak underscores the importance of global preparedness for both known and unknown diseases. Research shows that the risk of a pandemic with similar impact to COVID-19 is about 1 in 50 in any given year, with a lifetime probability of around 38%. This risk is amplified by environmental changes, which increase the likelihood of pathogens jumping from animals to humans.

To prepare for the next Disease X, scientists are studying the roughly 25 viral families most likely to harbor a novel pandemic threat. Efforts like CEPI’s 100 Days Mission aim to develop vaccines within three months of identifying a new pathogen, offering a proactive defense against future pandemics.

Lessons for the Present and Future

While it is unknown that the current outbreak in the DRC represents a new Disease X, it serves as a reminder of the need to strengthen health systems worldwide. Early investments in surveillance, laboratory capacity, and community engagement are critical to identifying and controlling outbreaks before they spread.

The ongoing investigation in the DRC is a testament to the dedication of public health professionals working in some of the world’s most challenging conditions. It also highlights the importance of global solidarity in addressing outbreaks, whether they stem from endemic diseases or novel pathogens.

Preparedness is our best defense against the unknown. By investing in science, supporting resource-limited health systems, and fostering international collaboration, we can mitigate the impact of today’s outbreaks and prevent the pandemics of tomorrow.

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A Vital Imperative in Rwanda’s Marburg Virus Outbreak

Healthcare workers in Rwanda are disproportionately affected by the ongoing outbreak of Marburg virus disease, which is highly virulent despite its relatively low case fatality rate. How can these medical professionals best protect themselves?

Published October 30, 2024

By Syra Madad, D.H.Sc., M.Sc., MCP, CHEP and Nahid Bhadelia, MD, MALD
Academy Public Health Contributors

A shot of downtown Kigali, the capital city of Rwanda.
Image courtesy of F.C.G. – stock.adobe.com.

As Rwanda faces its first outbreak of Marburg virus disease (MVD), it stands at a pivotal moment. The country has confirmed 65 cases of Marburg as of October 28, 2024, with 47 recoveries and 15 deaths, a relatively low case fatality rate (CFR) of 23%. This is a testament to the strength of Rwanda’s healthcare system, which has earned a reputation as one of the most resilient and high-quality systems in Africa. Although this may be Rwanda’s first MVD outbreak, the country is not a stranger to the threat posed by viral hemorrhagic fevers (VHFs). It has had to maintain vigilance during recent Ebola Virus Disease outbreaks in neighboring Democratic Republic of Congo.

Yet, despite these strengths, the current outbreak has highlighted an urgent vulnerability: the safety of healthcare workers. Over 80% of confirmed cases are among healthcare workers, a statistic that underscores the pressing need to enhance protections for those on the front lines of this and future outbreaks.

Rwanda’s Health System: A Success Story Under Strain

Rwanda’s healthcare system has made impressive strides since the country’s recovery from the 1994 genocide. Over the past three decades, Rwanda has transformed its health infrastructure to become a leader in healthcare delivery among low-income countries in sub-Saharan Africa. One of the cornerstones of Rwanda’s success is its Mutuelles de Santé, a community-based health insurance scheme that covers over 90% of the population, making healthcare more accessible and affordable for the vast majority of citizens. Through sustained investments in rural healthcare posts and the decentralization of services, Rwanda has significantly improved healthcare accessibility, particularly for those in remote areas.

These advances have contributed to Rwanda’s remarkable achievements in public health. It is one of the few low-income countries to have met the United Nations Millennium Development Goals related to maternal and child health. Rwanda has also seen significant reductions in the burden of diseases such as malaria, tuberculosis, and HIV/AIDS. During the COVID-19 pandemic, the country’s proactive response and efficient vaccine rollout enabled it to vaccinate over 82% of its population, setting a benchmark in the region and surpassing many of its peers in sub-Saharan Africa.

However, the Marburg outbreak has brought a new set of challenges. The virus, which is transmitted through direct contact with the bodily fluids of infected individuals and can also spread through contaminated surfaces and materials, is highly virulent and shares many similarities with Ebola. Despite Rwanda’s impressive healthcare achievements, the high rate of nosocomial transmission, where infections spread within healthcare facilities, reveals gaps that must be addressed to protect healthcare workers.

Nosocomial Transmission: A Threat to Frontline Workers

The current Marburg outbreak in Rwanda highlights the risks healthcare workers face in outbreaks of VHFs like MVD, particularly when it is not at forefront of clinical suspicion. Nosocomial transmission, or the spread of the virus within healthcare settings, is not uncommon during VHF outbreaks, but it is particularly dangerous for healthcare workers. In Rwanda, the virus has spread primarily in two hospitals, resulting in a disproportionately high number of infections among healthcare professionals.

This is not unique to Rwanda. Across the continent, healthcare workers have been at the epicenter of VHF outbreaks, often working under extreme pressure, sometimes with limited resources. However, Rwanda’s healthcare system, bolstered by strong government commitment and partnerships with international organizations, is better equipped than most to respond to such a crisis. Access to personal protective equipment (PPE) doesn’t seem to be a limiting factor in this outbreak and is further supported by partners like the World Health Organization during this current outbreak.

Yet, despite these resources, healthcare workers remain at risk. This points to the fact that while access to PPE is essential, it is not the only solution. Comprehensive infection prevention and control (IPC) measures, proper training, surveillance and monitoring, and a culture of vigilance within healthcare settings are equally crucial to stopping the spread of the virus among those on the front lines.

Recommendations to Protect Healthcare Workers

Rwanda’s situation is neither unique nor a one-off. The threat posed by viral hemorrhagic fevers like Marburg can emerge anywhere. Any country, regardless of its healthcare infrastructure, can face such outbreaks. The risk of nosocomial transmission, the dangers to healthcare workers, and the broader community impact are universal concerns. The recommendations to strengthen healthcare worker protection in Rwanda extend beyond its borders; they are vital for any nation vulnerable to similar infectious disease threats, which in this globally connected community means all of us. The lessons from Rwanda’s experience provide a framework that can be adapted globally to better protect healthcare workers and communities in the face of future outbreaks.

Here are several recommendations to strengthen the protection of healthcare workers, which apply not only to Rwanda but to any country:

Expand Infection Prevention and Control Training

Continuous and widespread training on infection control is critical to ensuring healthcare workers everywhere are equipped to handle outbreaks of high consequence infectious diseases like MVD. Regular refresher courses, as well as simulations of outbreak scenarios, should be a priority to ensure that healthcare workers remain prepared.

Strengthen Surveillance and Early Detection Systems

Robust surveillance systems that allow for rapid identification, isolation, and treatment of cases can mitigate nosocomial transmission, a threat that any healthcare setting faces.

Invest in Healthcare Worker Safety Programs

Providing comprehensive support, including mental health services, hazard pay, and strong safety protocols—ensures that healthcare workers across the globe feel secure and protected. Furthermore, healthcare facilities must establish clear reporting structures for IPC breaches, allowing for immediate action to protect both healthcare workers and patients.

Foster Global Partnerships for Vaccine Research and Therapeutics

Rwanda is one of the first countries to begin administering vaccines for Marburg, with over 1,149 doses already distributed. However, global support is needed to expand vaccine research and ensure that healthcare workers, those most at risk, are prioritized in vaccination campaigns. Supporting vaccine and therapeutic research, while prioritizing healthcare workers for vaccination, is a global imperative that transcends national boundaries. Rwanda has set a commendable record in deployment of the chAD3 MARV vaccine as part of an open label Phase II trial during the current MVD outbreak, administering 1,609 doses as of October 28th.

A Global Responsibility

Despite the challenges posed by the Marburg outbreak, Rwanda’s response has been commendable. The government’s swift action, transparent communication, and coordinated efforts with international partners have likely prevented a far worse scenario. The relatively low CFR of 23%, compared to historical outbreaks where CFRs have reached as high as 90%, is a testament to the effectiveness of supportive care and early intervention. Rwanda’s healthcare system, known for its resilience, has once again demonstrated its capacity to respond to complex health emergencies.

However, the Marburg outbreak in Rwanda is a stark reminder that viral hemorrhagic fevers are not distant or isolated threats, they are recurring global health crises that require sustained attention and investment. The global health community must rally behind Rwanda, not only to control the current outbreak but to build a future where healthcare workers are fully protected from such dangers.

Healthcare workers are the backbone of any outbreak response, and their safety should be a top priority. The lessons learned from this outbreak in Rwanda should serve as a blueprint for future responses worldwide. Protecting those who protect us is not just a moral imperative, it is essential to ensuring that health systems can withstand the shocks of the next inevitable outbreak.

About the Co-Author

Nahid Bhadelia, MD, MALD, is founding Director at the Boston University Center on Emerging Infectious Diseases, and an associate professor in the Boston University Chobanian and Avedisian School of Medicine.

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Advocating a Better Future for Postdocs

Blavatnik Regional Awards Finalist Nicole Lake, PhD, is now a strong advocate for postdoctoral researchers. She offers advice on how postdocs should advocate for one another.

Published September 17, 2024

By Nicole Lake, PhD
Academy Contributor

As postdocs, we are not just passive participants in our journey. We are active shapers of our own experience. We must learn and apply a wide range of skills, from research and teaching to networking and time management.

Another crucial skill we need is self-advocacy – standing up for our needs. Whether negotiating for better resources, obtaining support to attend a conference, securing mentorship, or balancing work-life demands, self-advocacy is vital for our postdoctoral success and well-being. As we move through our postdoc, some of us will also find ourselves stepping into a new role: advocating for others. Whether it’s pushing for better representation, compensation, childcare support, or benefits, advocacy for postdocs by postdocs also plays a central role in shaping the postdoc experience.

During my postdoc, I navigated a journey that saw me grow from advocating for myself to advocating for my peers in the postdoc community. My experience taught me that advocacy goes beyond identifying needs; it also requires the confidence and understanding of how to ask for your needs to be met effectively. Whether advocating for yourself or pushing for change within a department or university, framing an ask around mutual benefits is often key. Before making a request, I consider the other person’s perspective: understanding their viewpoint, finding common ground, and showing how my request will benefit them can often lead to a solution.

Advocating for Fellow Postdocs

My role as a Yale Postdoctoral Association (YPA) Co-Chair had the most significant impact on my advocacy perspective as a postdoc. In this role, I was privileged to advocate for over 1,000 postdocs. The YPA has a proud history of advocating for positive change for the postdocs it serves, and one of the achievements I’m most proud of during my term was securing salary increases to reflect the value of postdocs and their living costs better. I took away two critical lessons from this experience:

1) the power of data-driven advocacy and
2) the importance that the allyship of faculty and staff plays in advocacy success.

In academia, we rely on data to support our hypotheses, and I’ve found this approach equally powerful for advocacy. To better understand, uncover, and address unmet needs in our community, we initiated a university-wide postdoc survey on topics including cost-of-living considerations, and available resources for postdocs, to obtain data, enable data-driven discussions with university leadership, and strengthen our case for change. This survey was a collaborative effort with the postdoctoral office, representing an example of allyship between postdocs and the university, working together to achieve a common goal: improving the postdoc experience.

It’s important to acknowledge that the success of our advocacy didn’t happen in isolation. Within the YPA it was built on the groundwork laid by previous leaders who, for example, established channels for regular dialogue with university leadership—these channels were critical for communicating our requests. Our time as a postdoc is limited, and we may not always see the outcomes of our efforts advocating for better representation, benefits, compensation, and beyond. However, it’s important to remember that our efforts are cumulative and often provide a foundation for future advocates to build upon, contributing to progress long after we’ve moved on.

A Skill Developed Over Time

Finally, I want to share that self-advocacy does not come naturally to me but rather is a skill I’ve had to develop over time. Advocating for others has always come more easily than advocating for myself. Like any other skill, self-advocacy is learned—it requires practice, patience, and persistence. However, it is a skill worth cultivating, given its impact on your career and well-being.

Overall, my journey has shown me the power of advocacy – not only for improving our circumstances but also for improving the experience of others. Whether you’re advocating for yourself or pushing for change to benefit others, advocacy has an essential place in the postdoctoral experience.

You can learn more about her and the Blavatnik Awards at Blavatnikawards.org

This piece published on the National Postdoctoral Association member blog as part of 2024 National Postdoc Appreciation Week. Current Academy Members can receive a 20% discount on a National Postdoctoral Association postdoc individual membership by emailing info@nyas.org and requesting the NPA membership discount code

About the Author

Nicole Lake is a 2024 Blavatnik Regional Awards Finalist in Life Sciences.

Self-Advocacy Played Important Role in My Journey

Blavatnik Regional Awards Laureate Raghavendra Pradyumna Pothukuchi, PhD, had to advocate for himself to find the right work-life balance. He offers advice so fellow postdocs can do the same.

Published September 17, 2024

By Raghavendra Pradyumna Pothukuchi, PhD
Academy Contributor

Raghavendra Pradyumna Pothukuchi, PhD, celebrates his wife’s birthday with their two children.

We all enjoy science and research, but it’s hard to deny that academic life is grueling. This is especially so as a postdoc, which is a great springboard for one’s career but also brings unique challenges.

Making the most of a postdoc inevitably requires significant effort. Couple this with personal needs, goals, and responsibilities, and you have a fragile contraption of sorts, ready to fall in many ways.

My choice of being a postdoc was born out of an abruptly terminated job search during the COVID-19 fallout. When I graduated from the University of Illinois at Urbana-Champaign in 2020, my kids were 1 and 4, and my dear wife, a fellow PhD in computer science, would soon opt out of work due to long COVID.

My postdoc would be on brain-computer interfaces, and classical and quantum frameworks for cognitive models. It’s exciting — but very new and challenging. I had to balance my research with personal commitments including childcare, my wife’s health, providing long-distance support to my parents living in my home country of India, traveling to help my father while he was being treated for cancer, and, of course, managing my own well-being.

Finding Work-Life Balance

One way that has helped me in making the postdoc process work, is self-advocacy. You are (or can be) your best ally and advocate on issues that matter to you, whether they are about yourself or those that you care about. The definition of being a self-advocate means “identifying your needs and communicating them clearly to help others understand how they can support you”.

There are many valuable resources on self-advocacy, including those at the National Postdoctoral Association (NPA). I’d like to share what I learned from my experience. The first step to self-advocacy is to identify what you need, professionally and personally. These could be resources, compensation, special needs, processes, projects you should be on, or even assistance from people, like teammates and mentors. This step is not easy—it requires time and thought.

One could start with high-level tangible goals such as, readiness for academic job searches within two years, allocating hours for childcare, improving wellbeing in a community you care about, etc.; then move to identify the specific needs to accomplish them. It’s helpful to identify and talk to various stakeholders, such as family and mentors, with whom your plans intersect. On the professional side, a good starting point is the postdoc mentoring plan, which makes career goals and means explicit.

Advocating for Yourself

In my case, I needed a mentor who understood my situation, a system with flexible schedules, reasonable compensation and benefits to support my family, and the leeway to explore new fields. These needs weren’t exhaustive or static, since life changes. However, to the extent possible, it pays to be foresighted so that you don’t appear capricious or importunate, and importantly, that you ask for what actually helps you.

The next step is to identify the people that you would communicate your needs with. This is critical. They should be able to provide what you need and be willing to help. In several cases, this could be your mentor, but it doesn’t have to be. For example, while my mentor was the right person to talk to about compensation and work schedules, it wasn’t so for childcare or other benefits that are set by my university.

Sometimes when asking for policy-level changes, it helps to find others who share your cause. This could be your local postdoctoral association, or the NPA. When I was a grad student, I was concerned about the wellbeing of students in my academic community (computer architecture). At a conference, I met with a fellow student who shared the same cause, and our joint effort led to the creation of a new student association with this mission, CASA. This wouldn’t have been possible if I hadn’t met my co-founder.

The last step is to articulate your needs. This means clearly and politely stating your needs, participating in good faith, and being open. If needed, convey the value you bring to the group.

Raghavendra Pradyumna Pothukuchi, PhD, (second from left) with his lab members.

Identify Your Non-Negotiables

It’s useful to identify which of your needs are non-negotiable. However, it’s also possible that some needs can’t be met, at least not fully or immediately. Be open to alternatives. In my case, my starting postdoc salary was good but not great for my family needs. I brought this up with my mentor, who understood my situation and recommended that we apply for a fellowship, the NSF and CRA computing innovation fellowship, which I received. This took time, but it helped immensely, even beyond the finances.

I hope my experience inspires you to self-advocate. My postdoc journey didn’t happen without making hard choices or giving up things I loved. But I’m glad about my progress—personal and professional (the Blavatnik Regional Award for Young Scientists being one!), and the things I was able to hold on to, and pickup. Self-advocacy played an important role in my journey.

Looking forward, I will continue to practice it as I transition to a tenure-track faculty position at the University of North Carolina, Chapel Hill.

You can learn more about him and the Blavatnik Awards at Blavatnikawards.org

This piece published on the National Postdoctoral Association member blog is part of 2024 National Postdoc Appreciation Week. Current Academy Members can receive a 20% discount on a National Postdoctoral Association postdoc individual membership by emailing info@nyas.org and requesting the NPA membership discount code

About the Author

Raghavendra Pradyumna Pothukuchi, is a 2024 Blavatnik Regional Awards Laureate in Physical Sciences & Engineering

A New Approach to Postdoc Work-Life Balance

A woman poses with her significant others, a river and sunset in the background.

Blavatnik Regional Awards Finalist Amy R. Strom, PhD, offers advice on the subtle differences postdocs must consider when finding work-life balance.

Published September 17, 2024

By Amy R. Strom, PhD
Academy Contributor

Is work-life balance truly harder for postdocs than other professions? The short answer is yes, and there’s a reason you’ll find so many “How I Found Balance” articles written by academics. These narratives often focus on the number of hours spent at work versus at home, which is, of course, an essential aspect of balance. However, this narrow focus misses a crucial component: the role of the employer in shaping the work environment.

Achieving balance in the face of obstacles is not just about personal discipline; it often hinges on the resources and support provided by the institution. We should be building structures that empower individuals to create a balanced life.

My own journey in science has required a long-distance relationship during my postdoc, between New Jersey and California. I have had to carefully organize my project timelines and fund cross-country flights in order to spend time with my partner, but even with these personal sacrifices I quickly ran out of leave.

An Individualized Approach

Then I advocated for myself to my mentor and the University to be able to work remotely from out of state without the time away from campus being counted as vacation. As an experimentalist, remote work can be complicated to coordinate, so I am grateful to my partner, to my mentor and to the administrators in my department for their support in identifying a solution that works for my personal situation.

Perhaps establishing this solution and sharing the story will aid postdocs in similar situations in the future (long-distance relationships among academics are not rare), but more practically, it is important for each individual to get the support they need to enact their own personal solutions. I credit my own navigation of my challenges not in small part to coalescing with a group of fellow women grad students and postdocs who face different but equally complex challenges. Together we discuss the difficulties we face and help each other brainstorm potential solutions. Women in Science groups and other shared identity groups provide not only a sense of belonging but also a platform for advocacy.

Postdocs are not a monophyletic clade. We are women, men, nonbinary, single, partnered, married; we are sexually, racially, and culturally diverse. Such diversity means that a one-size-fits-all approach to work-life balance is ineffective at best and harmful at worst. This is where mutual and intersectional advocacy becomes crucial. By recognizing our shared challenges and working together, we can push for changes that benefit us all.

*Amy with a close group of women scientists. From left: Amy Strom, Claire Weaver, Jessica Zhao, Lindsay Becker, Anita Donlic, Yoonji Kim, Sofia Quinodoz, and Hailey Tanner*

Postdocs and Unionization

In the summer of 2024, postdocs at my home institution, Princeton University, voted to become part of the United Auto Workers (UAW) union, an American union that has grown to represent more than just the auto industry. This victory required immense effort from many current postdocs, demonstrating the power of collective action.

Unionization will allow us to gather centralized information about our needs and bargain more effectively with the University for policy changes that will benefit us as a group and as individuals. Now just a few weeks later, a survey is collecting data on the most pressing issues we face, from pay equity to green card applications to family leave policies. I enthusiastically look forward to the additional support and benefits that Princeton will enact based on these data.

So, this National Postdoc Appreciation Week, let’s truly appreciate postdocs. Let’s listen to their unique stories, empathize with their individual challenges, and then make real, tangible, institutional changes to support them. Acknowledging the diversity of experiences among postdocs is the first step towards creating a more equitable academic environment where each individual can achieve their own balance.

You can learn more about her and the Blavatnik Awards at Blavatnikawards.org

About the Author

Amy R. Strom is a 2024 Blavatnik Regional Awards Finalist in Life Sciences

Our Iceland Adventure Turned into a Climate Crisis Wake-Up Call

The Jökulsárlón glacier lagoon provides not only aesthetic beauty but it’s a case study in the detrimental effects of climate change and the need to take mitigative action now.

Published September 11, 2024

By Syra Madad, D.H.Sc., M.Sc., MCP, CHEP
Public Health Editor-at-Large

On a recent trip to Iceland with my children, we visited the Jökulsárlón glacier lagoon, a place known for its serene beauty, where fractured icebergs from the Breiðamerkurjökull glacier drift across the water. Their ethereal shades of blue and black felt timeless, but in reality, they represent the fragility of an ecosystem being reshaped by climate change.

While sailing through the lagoon, we witnessed massive icebergs drifting across the water, their glistening surfaces reflecting the light in stunning shades of blue. During the excursion, we watched as one of the staff members aboard the boat scooped up a piece of ice from the lagoon—once part of a melted glacier—and took a bite.

For most of the group, this was a fun and quirky highlight of the trip. But as an infectious disease epidemiologist, my thoughts immediately turned to the potential microbes preserved in that ancient ice—microbes that could have been dormant for millennia. Research shows that as glaciers and permafrost thaw due to climate change, long-dormant microorganisms, including potential pathogens, can be released.

Glacial ice can harbor viable infectious pathogens, as evidenced by a recent study which found that over 50% of bacterial cells on glacier surfaces are capable of resuming activity within 24 hours after thawing, highlighting their ability to remain dormant and potentially pathogenic in frozen environments, only to become active under the right conditions.

Public Health and Melting Ice Caps

This experience left me thinking not just about climate change in the abstract, but also about the potential public health consequences of melting ice caps. The possibility of ancient microbes resurfacing is a stark reminder that climate change affects more than just the physical environment—it also has implications for causing future outbreaks.

Jökulsárlón, which didn’t exist before the 20th century, is a direct result of rising global temperatures. This glacial lagoon only began to form around 1935, driven by the rapid retreat of the Breiðamerkurjökull glacier, a process that has accelerated with every passing decade. The lagoon’s surface area has doubled since the 1970s, and it now stands as Iceland’s deepest lake, growing as the ice that once shielded this region melts into history.

The expansion of Jökulsárlón is a living testament to the impact of a warming planet, visible and visceral. This lagoon’s growth is not a triumph of nature’s beauty but a stark reminder of the irreversible transformations happening in our environment.

Every meter of receding glacier signifies the loss of critical ice reserves that have sustained ecosystems for centuries. Iceland’s glaciers are losing significant ice mass each year. For example, a study on Iceland’s glaciers revealed a loss of approximately 9.6 gigatons of ice annually as observed from 1995 to 2019, with half of the total mass loss occurring during this period, reflecting an accelerated rate due to climate change.

The Urgency of Action

As I stood at the lagoon’s edge with my children, I couldn’t help but wonder what kind of world they will inherit. Will these glaciers become distant memories? As a mother, the climate crisis is deeply personal. The wildfires, floods, and extreme heat waves we see across the world are not exceptions but increasingly the new normal, driven by a warming planet.

In Jökulsárlón, the visible melting glaciers underline the urgency of action. Climate change is no longer an abstract concept; it is unfolding right before our eyes. As we approach Climate Week NYC, it is a reminder that the time for action is now. The retreating glaciers of Iceland tell us a story of loss, but they also challenge us to decide what kind of future we will create for the generations to come.

Will we act, or let this pivotal moment pass, forever changing the world our children will inherit?

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Have We Passed the Turing Test, and Should We Really be Trying?

The 70th anniversary of Turing’s death invites us to ponder: can we imagine AI models that will do well on the Turing test?

Published August 22, 2024

By Nitin Verma, PhD
AI & Society Fellow

Alan Turing (1912-1954) in 1936 at Princeton University.
Image courtesy of Wikimedia Commons.

Alan Turing is perhaps best remembered by many as the cryptography genius who led the British effort to break the German Enigma codes during WWII. His efforts provided crucial information about German troop movements and helped bring the war to an end.

2024 has been a noteworthy year in the story of Turing’s life as June 7th marked 70 years since his tragic death in 1954. But four years before that—in 1950—he kickstarted a revolution in digital computing by posing the question “can machines think?” and proposing an “imitation game” to answer it.

While this quest has been the holy grail for theoretical computer scientists since the publication of Turing’s 1950 paper, the public launch of ChatGPT in November 2022 has brought the question to the center stage of global conversation.

In his landmark 1950 paper, Turing predicted that: “[by about the year 2000] it will be possible to programme computers… [that] play the imitation game so well that an average interrogator will not have more than 70 per cent. chance of making the right identification after five minutes of questioning.” (p. 442). By “right identification”, Turing meant accurately distinguishing between human-generated and computer-generated text responses.

This “imitation game” eventually came to be known as the Turing test of machine intelligence. It is designed to determine whether a computer can successfully imitate a human to the point that a human interacting with it would be unable to tell the difference.

We’re much past the year 2000: Are we there yet?

In 2022, Google let go of Blake Lemoine, a software engineer who had publicly claimed that the company’s LaMDA (Language Model for Dialogue Applications) program had attained sentience. Since then, the closest we’ve come to seeing Turing’s prediction come true is, perhaps, GPT-4, deepfakes, and OpenAI’s “Sora” text-to-video model that can churn out highly realistic video clips from mere text prompts.

Some researchers argue that LLMs (Large Language Models) such as GPT-4 do not yet pass the Turing test. Yet some others have flipped the script and argued that LLMs offer a way to assess human intelligence by positing a reverse Turing Test—i.e., what do our conversational interactions with LLMs reveal about our own intelligence?

Turing himself made a noteworthy remark about the imitation game in the same 1950 paper: “… we are not asking whether all digital computers would do well in the game nor whether the computers at present available would do well, but whether there are imaginable computers which would do well.” (Emphasis mine; p. 436).

Would Turing have imagined the current crop of generative AI models such as GPT-4 as ‘machines’ capable of “doing well” on the Turing test? I believe so, but we’re not quite there, yet. As an information scientist, I believe that in 2024 AI has come closer than ever to passing the Turing test.

If we’re not there yet, then should we strive to get there?

As with any other technology ever invented, as much as Turing may have only been thinking of the public good, there is always the potential for unforeseen consequences.

Technologies such as deepfake apps and conversational agents such as ChatGPT still need human creativity to be useful and usable. But still, the advanced AI that powers these technologies carries the potential of passing the Turing test. That potential portends a range of consequences for society that deserve our serious attention.

Leading scholars have already warned about the consequences of the ability of “fake” information to fuel distrust in public institutions including the judicial system and national security. The upheaval in the public imagination caused by ChatGPT even prompted US President Biden to issue an Executive Order on the Safe, Secure, and Trustworthy Development and Use of AI in the fall of 2023.

We’ll never know what Turing would have made of the spurt of AI advances in light of his own foundational work in theoretical computer science and artificial intelligence. His untimely death at the young age of 41 deprived the world of one of the greatest minds of the 20^th century and the still more extraordinary achievements he could have made.

But it’s clear that the advances and use of AI technology have brought society to a turning point that he anticipated in his seminal works.

It remains difficult to say when—or whether—machines will truly surpass human-level intelligence. But more than 70 years after Turing’s death we are at a point where we can imagine AI agents that will do well on the Turing test. And if we can imagine it, we can someday build it too.

Passing a challenging test can be seen as a marker of progress. But would we truly rejoice in having our AI pass the Turing test, or some other benchmark of human–machine indistinguishability?

The Rising Threat of Mosquito & Tick-Borne Illnesses

A closeup of a mosquito sucking blood from a human.

Mosquitos and ticks thrive during the summer months, which is when they also present their greatest threat to public health. Dr. Syra Madad, Chief Biopreparedness Officer with NYC Health + Hospitals, offers advice on how to protect yourself, your family, and your pets from these disease-carrying insects.

Published August 8, 2024

By Syra Madad, D.H.Sc., M.Sc., MCP, CHEP
Public Health Editor-at-Large

The mosquito (*Culex pipiens*) drinks blood on human skin. Image courtesy of ihorhvozdetskiy – stock.adobe.com.

The rise in mosquito-borne and tick-borne illnesses is a pressing public health concern. In recent years, there has been a significant increase in these illnesses globally, including in the United States. Both mosquito and tick-borne diseases thrive in the summer months due to warmer temperatures and increased humidity, which create ideal breeding conditions for mosquitoes and enhanced tick activity.

The increase in diseases such as dengue, West Nile virus, and Lyme disease underscores the urgent need for effective prevention and public awareness. By adopting the ABCDE approach and taking practical preventive measures, we can combat the spread of these diseases and protect our health.

The Growing Burden of Mosquito-Borne Diseases

Dengue is a mosquito-borne viral infection that has reached unprecedented levels in the Americas, with over 9.7 million cases reported in the first half of 2024 alone, a significant rise from previous years. Symptoms of dengue include high fever, severe headache, pain behind the eyes, joint and muscle pain, rash, and mild bleeding. The CDC has issued a health advisory highlighting the increased risk of dengue in the United States, particularly in Puerto Rico and among travelers returning from endemic areas. Majority of dengue virus cases are asymptomatic, with about one in four people infected with dengue getting sick.

West Nile virus, another mosquito-borne disease, has also been detected early and extensively. For example, in New York City, there were 325 positive mosquito pools reported as of mid-2024. There’s been 103 human diseases cases including 68 neuroinvasive disease cases of West Nile virus across 26 states in 2024 so far. An estimated 70-80% of human West Nile virus infections are subclinical or asymptomatic.

Symptoms of West Nile virus infection can range from mild, flu-like symptoms to severe neurological illness. Less than 1% of infected individuals develop West Nile Neuroinvasive Disease (WNND), which typically presents as meningitis, encephalitis, or acute flaccid paralysis. People over 60 years of age, or those with certain medical conditions or undergoing treatments that cause immunosuppression—such as diabetes, hypertension, cancer, or organ transplantation—are at greater risk of developing WNND.

A blacklegged/deer tick (*Ixodes scapularis*).
Image by Centers for Disease Control and Prevention via Fairfax County/Flickr. Licensed via CC BY-ND 2.0. No changes were made to the original work.

Tick-Borne Diseases on the Rise

Ticks are responsible for transmitting various diseases, with Lyme disease being the most prevalent in the United States. The blacklegged tick, which carries Lyme disease, anaplasmosis, and babesiosis, has expanded its range due to climate change, leading to increased cases even in urban areas like Staten Island and the Bronx. Symptoms of Lyme disease include fever, headache, fatigue, and a characteristic skin rash called erythema migrans. If left untreated, the infection can spread to the joints, heart, and nervous system. The warming climate has extended the tick season, allowing these vectors to remain active for longer periods and spread more widely.

ABCDE Approach to Mosquito and Tick-borne Disease Prevention:

To protect yourself against mosquito and tick-borne diseases, utilize the ABCDE approach:

Ticks are often found in tall grasses. Image courtesy of Yuriy T – stock.adobe.com.

Avoid: Avoid areas with high mosquito and tick activity, especially during peak seasons. This includes wooded, brushy, and grassy areas where ticks are common, and areas with stagnant water where mosquitoes breed. Mosquitoes that carry West Nile virus usually bite around dusk and dawn.

Block: Use Environmental Protection Agency-approved insect repellents on exposed skin and clothing. DEET, picaridin, and oil of lemon eucalyptus are effective options.

Control: Use air conditioning and window screens to prevent mosquito entry. Regularly empty containers that collect water to reduce mosquito breeding sites.

Dress: When outdoors, especially in wooded or grassy areas, wear long sleeves, long pants, and socks. Light-colored clothing makes it easier to spot ticks.

Examine: After spending time outdoors, perform thorough tick checks on yourself, children, and pets. Promptly remove any attached ticks with fine-tipped tweezers.

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Scientists Can Help Prepare for Record Heatwaves

With average global temperatures rising, here’s some expert guidance so you can keep yourself, and those around you, safe during extreme heat waves.

Published August 5, 2024

By ISR Staff
Academy Contributor

Last year, the world shattered a record we never should have hit: our warmest year ever. In response, UN Secretary General Antonio Guterres remarked that we are in an “era of global boiling,” as he called for swift action on human-induced climate change. So far in 2024, global temperatures have continued to break monthly records as prolonged heatwaves are impacting millions of people worldwide, from India to Mexico.

Researchers from the World Meteorological Organization (WMO) also found that for the average person on Earth, there would be 26 additional days of extreme heat this year, compared to if climate change was not happening. In certain regions of the world, that number reaches as high as an extra 120 days.

Urban residents, who represent more than 55% of the world’s population, are particularly at risk from these warmer temperatures due to urban heat islands (UHIs), which occur when a city’s infrastructure, like roads, parking lots, and rooftops, absorb and remit heat more than natural landscapes like forests. In effect, UHI makes urban environments hotter than rural locations.

The greenhouse gas emissions that humans have already emitted into the atmosphere means that extreme heat is not going away anytime soon, even if we rapidly reach climate targets and zero emissions. That’s why, as a network of scientists and experts concerned about crisis, we can be thinking of new ways to collaborate to inform, prepare, and reduce harm to humans and ecological systems during extreme heat waves.

The Limits of Heat on the Human Body

Climate change is already affecting human health. There are risks to human bodies from extreme heat, particularly for residents in cities, and within communities that are more vulnerable to its adverse impacts. Extreme heat is more dangerous for children, older adults, and outdoor workers – particularly those who do not have labor protections to keep them safe.

Of particular concern to human health is when heat and humidity remain high in combination, especially at night. It becomes difficult for the body to rest, relax, and stabilize – and that can put the body under significant stress.

More and more experts are calling for decisionmakers to gauge upcoming risks to the public by using a wet-bulb globe temperature (WBGT) reading versus temperature alone. WBGT is measured through temperature, humidity, wind speed, sun angle, and cloud cover. Tropical and coastline cities, for example, are already reaching critical “wet bulb” temperatures, where the human body cannot cool down through its normal sweating process because sweat is not able to evaporate in high humidity. Dry heat is cooler for the body, for this reason.

Experts define 95 degrees Fahrenheit (35 degrees Celsius) as the upper limit of WGBT for young and healthy people. During India’s recent heatwave, the WGBT reached at least 100 degrees (37.8 degrees Celsius), making the chances of heat exhaustion, stroke, and even death much higher for vulnerable populations.

Cities in China, Bangladesh, Pakistan, India, the Arabian Peninsula, and the African Sahel are among the highest risk zones for dangerous levels of WGBT. Jacobabad, Pakistan is often called one of the hottest cities on earth and has experienced at least four extreme wet bulb events in recent years. Many cities lack the infrastructure or resources to deal with extreme heat, in some cases because in the past they did not need it.

Understanding the Toll of Extreme Heat

Unlike hurricanes, earthquakes, or tornadoes, heat disasters often go unseen by decisionmakers because the public health impacts often happen inside homes or go undiagnosed by health professionals as heat related.

In the US, the National Weather Service (NWS) cites that heat has been the deadliest form of extreme weather over the last decade. But many researchers believe current counts of heat illnesses death are vastly underestimated. In sub-Saharan Africa, for example, there is little to no accurate tracking of heat deaths. In 2022, a groundbreaking study found that approximately 70,000 people died in Europe due to the summer’s extreme heat. Europe is considered the fastest warming inhabited continent, and many countries lack common cooling mechanisms, such as air conditioning, in older buildings.

Additionally, the burden of heat is not often shared equally. In India after recent heatwaves, schools closed, agricultural supply chains were disrupted, and workers lost significant income. According to a recent report by the UN, the rising temperatures in India will reduce daily working hours by at least 5.8 percent by 2030. Loss of economic opportunity also acutely impacts women and girls.

What Experts Can Do to Respond and Save Lives

Just like with a hurricane or earthquake, the world’s most vulnerable cities need stronger preparation and mitigation measures to prevent and reduce severe health impacts. First and foremost, the rapid phaseout of fossil fuels is the most critical step to take to reduce harm.

Second, if scientists and health experts begin to treat extreme heat like other disasters, the public will be equipped with more tools to take the proper steps to help prepare for it. Early warning systems remain as one of the most effective ways to keep people safe, and countries with “limited early warning systems” are experiencing heat-related deaths at a rate eight times higher than countries that have comprehensive warning services.

In the US, the Centers for Disease Control (CDC) and NWS recently created a new scale that helps the public gauge health risks associated with extreme heat. HeatRisk considers several factors, such as time of year and length of heatwave, and models where elevated risks exist to help leaders better communicate on a clear scale of 1-4.

Scientists and health experts can also help the public better understand what to do once a warning about elevated risk occurs, including educating them on action steps like:

Having a plan to acclimatize your body safely over time by gradually increasing activity outdoors,
Staying in cool environments,
Hydrating quickly and drinking electrolytes, when possible,
Removing restrictive layers and wearing light layers,
Taking a cold shower or bath when overheated,
Avoiding alcohol and caffeine, and
Reducing work in the sun.

Several major cities have also taken to hiring Chief Heat Officers who create Heat Action Plans, or roadmaps to help urban dwellers deal with heat. The World Economic Forum and Adrienne Arsht-Rockefeller Foundation Resilience Center (Arsht-Rock) also created the Heat Action Platform, a free online resource that provides cities with tools to assess, plan, implement, and evaluate their heat plans.

Energy supply is also critical to preparations. Given the pressure on the energy grid in many countries, there has been an increase in rolling or prolonged blackouts due to high demand during heatwaves. Air conditioning therefore cannot be seen as the only stable solution to cool down. In just one month in Mexico, for example, over 32 states including Mexico City experienced blackouts. The loss of power can lead to life-threatening situations for people with disabilities, health conditions, and older adults. In the mid- to long-term, in order to reduce harm in many countries, there needs to be major updates to the power grid that are powered by renewable energy and stabilized through weatherizing of buildings for energy efficiency and planting more trees for shade and cool roofs.

If you want to learn more about how to collaborate with other researchers on scientific issues related to heatwaves, please join the International Science Reserve and RSVP for our upcoming heat webinar at the United Nations General Assembly (UNGA)’s Science Summit this September.

Learn more about the ISR and about The New York Academy of Sciences.

HPAI A(H5N1) Transmission Among Cattle in the U.S.

While the risk to the public remains low, the highly pathogenic avian influenza (HPAI) A(H5N1) is on the radar of those in sectors like livestock breeding, animal sciences and food production.

Published May 28, 2024

By Syra Madad, DHSc; Jason Kindrachuk, PhD; and Rick A. Bright, PhD
Academy Public Health Contributors

Image courtesy of Nazzu via stock.adobe.com.

Recent observations on highly pathogenic avian influenza (HPAI) A(H5N1) have highlighted the virus’s transmission among dairy cattle in the United States. Key findings include ongoing detection and transmission of H5N1 among cattle, a second human case of H5N1 infection in a farmworker; mixed virus receptor distribution in mammary gland tissue of cattle, genetic evolution of H5N1 with onward transmission, evaluation of pasteurization effectiveness for virus inactivation, and a clinical description of HPAI H5N1 influenza A virus infection in a U.S. dairy farm worker.

Genomic and Epidemiologic Insights

In May 2024, investigators at the U.S. Department of Agriculture (USDA) reported genomic and epidemiologic data showing HPAI A(H5N1) spillover to, and transmission among, cattle. While prior data on Influenza A virus in cattle is scarce, the current geographic expansion of HPAI H5N1 among herds across multiple U.S. states demonstrates clade 2.3.4.4b’s affinity for cattle.

Reduced food intake, milk production, and shifting milk quality was first noted in January 2024, followed by detection of influenza A virus, specifically H5N1 clade 2.3.4.4b genotype B3.13, by the National Animal Health Laboratory Network and National Veterinary Services Laboratories. Subsequent analysis suggested movement of genotype B3.13 between dairy cattle farms and domestic poultry.

The study’s authors suggested a single spillover event from wild birds with limited cattle-to-cattle transmission around December 2023. Additional spillovers were identified from infected cattle to poultry and other nearby mammals, with the virus potentially shedding from infected cattle for 14-21 days. Genome sequencing indicated ongoing evolution, possibly linked to mammalian adaptation.

Viral Receptor Distribution

Sialic acid receptors utilized by influenza A viruses for cellular attachment, are found in multiple cattle tissues, including the respiratory tract, mammary glands, and brain. Though all type of sialic acid receptors could be found in each of these areas, the types and concentration of sialic acid receptors varied by tissue; those used by human and duck viruses were more prominent in the mammary gland and to a lesser degree in the respiratory tract, while those used by chicken viruses were more prominent in the respiratory tract and to a lesser degree in the mammary glands.

These findings provide insights into HPAI A(H5N1)’s tissue tropism in cattle and its transmission patterns. The presence of multiple types of species-specific receptors for influenza A viruses located throughout the dairy cattle also permits hypotheses on potential for them to serve as a mixing vessel for accelerated reassortment of influenza viruses, increasing a potential for the evolution of an influenza A virus with human pandemic potential.

Pasteurization and Food Safety

On May 1, 2024, the U.S. Food and Drug Administration confirmed that pasteurization inactivates H5N1 virus in a variety of milk products. No infectious H5N1 virus was found in nearly 300 retail dairy samples that were positive for viral nucleic acid by quantitative PCR. Additionally, neither viral nucleic acid nor infectious virus was found in retail powdered infant formula and powdered milk. This supports pasteurization’s effectiveness in inactivating concentrations of H5N1 virus found in the milk supply among samples collected in April. Advisories against consuming raw/unpasteurized milk or milk products remain in place.

Clinical Case in a Dairy Farm Worker

A recent study reported on the first reported human case of H5N1 infection in a U.S. dairy farm worker who experienced ocular discomfort without respiratory symptoms or fever. The worker had close contact with symptomatic dairy cows from farms with confirmed H5N1 infections. Personal protective equipment included gloves but no ocular protection. Swab specimens from the conjunctiva and nasopharynx confirmed H5N1 through RT-PCR and viral genome sequencing. Home isolation and oral oseltamivir were recommended, leading to resolution of conjunctivitis.

No secondary infections were reported among household contacts. Importantly, viral sequences showed no mutations suggesting changes in receptor binding or antiviral susceptibility. However, a mutation in the internal PB2 gene showed a change that is more commonly associated with human adaptation and warrants close monitoring.

Implications and Recommendations

These reports underscore the need for comprehensive HPAI A(H5N1) surveillance in agricultural settings. While cattle infections have been reported by the USDA to be generally transient with mild symptoms, the potential impact on milk production and food security is significant. The risk of ongoing viral evolution and broad transmission among cattle could lead to further mammalian adaptation. Although human infections from cattle seem to be rare at this time, the burden of infection necessitates detailed assessments of human spillovers, especially in areas with current or prior outbreaks. This includes serology to establish spillover rates to humans and monitor for changes in spillover frequency.

While the general public’s risk remains low, those at higher risk include individuals with routine or frequent contact with potentially infected birds, livestock, other animals or contaminated animal products and environments (e.g., farmers, livestock workers, animal handlers, employees of milk and meat processing facilities, milk or carcass transport drivers, and veterinarians).

Human infections with H5N1 can occur when the virus enters the eyes, nose, or mouth, or is inhaled. This can happen through airborne droplets, small aerosol particles, or dust that settles on mucous membranes. Infection can also occur if a person touches a contaminated surface and then touches their mouth, eyes, or nose. Exposed individuals should monitor for symptoms within 10 days, including fever (100°F [37.8°C] or higher), chills, cough, sore throat, difficulty breathing/shortness of breath, eye tearing, redness, or irritation, headaches, runny or stuffy nose, muscle aches, and diarrhea.

About the Co-Authors

Jason Kindrachuk, PhD is an Associate Professor, Canada Research Chair, Department of Medical Microbiology & Infectious Diseases, University of Manitoba, Winnipeg, MB, Canada.

Rick A. Bright, PhD is CEO, Bright Global Health and Former Deputy Assistant Secretary for Preparedness and Response, U.S. Department of Health and Human Services.

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