Sentinel minutes for week #36/2024
Status: Greenish. Mpox continues to spread, H5 case with no know contact with animal arises.
Clade Ib mpox continues to spread in the Democratic Republic of the Congo (DRC). The first mpox vaccine doses arrived in the DRC, which will be used to try to slow the outbreak. In the US, a case of H5 influenza was detected in a hospitalized patient with no known contact with infected animals; while concerning, this case likely does not represent substantial community spread of H5N1 bird flu—but we will be watching closely for any new human cases.
Biological Risks
Mpox
Clade Ib mpox continues to spread in Africa, but no new cases were reported outside the continent. Dr. Jean Kaseya, Director-General of the African CDC, reported on September 6 on cases the previous week and running totals.
In the DRC, this week we say 2.6K reported cases of mpox (any clade), and 25 deaths. And so far, the DRC has seen more than 20K cases and 600 deaths.
And for all of Africa, the continent reported 5,466 mpox cases this past week. This total is substantially higher than the nearly 4,000 that were reported two weeks ago. Dr. Kaseya noted that 58% of all mpox cases in the DRC this year had been in children younger than 15.
Clade Ib mpox has also been detected in Kinshasa, DRC’s capital, which has a population of more than 17 million people. Mpox continues to be detected in other African countries, including Guinea and Liberia, but the genetic groupings of these cases are not yet known.
200,000 mpox vaccine doses are on their way to the DRC. The US FDA has granted approval for Emergent Bio's smallpox vaccine, allowing the vaccine to be used for the prevention of mpox in high-risk individuals. This vaccine is the second vaccine to receive FDA approval for use against mpox; the first vaccine that was approved was Bavarian Nordic’s Jynneos vaccine, which was also developed for smallpox.
H5N1 bird flu
The US CDC announced that a hospital patient in Missouri was found via routine influenza surveillance to have had H5 influenza—most likely H5N1 bird flu—but had had no contact with any animals that were known to be infected with H5N1. The patient has recovered. Such cases are worrying because they can indicate that the virus could be spreading in the community. As Helen Branswell noted in Stat:
Missouri has not reported any H5N1 outbreaks in dairy cattle. Fourteen states, including three that neighbor Missouri, have reported a total of 197 infected herds since the virus was first detected in cows in late March. The state has reported some infections in poultry. The CDC’s statement said there is no unusual flu activity being detected in Missouri. And wastewater surveillance has not picked up evidence of H5 virus there."
H5N1 was last detected in a poultry flock in Missouri on February 23, 2024; any H5N1 present in birds in the state is most likely in wild birds and animals, such as cats, that interact with them. It is very encouraging that no healthcare worker or other contact has been reported to have contracted an H5 infection from this patient.
Our forecasting team thinks that this case likely represents an isolated incident—such as transmission from raw milk or directly or indirectly from an infected wild bird or dairy cow—or, potentially, limited human-to-human transmission. If no further human cases are seen in Missouri or other states, then this case is likely zoonotic or part of at most a short chain of human-to-human transmission. However, if we do start to see more human cases with no known links to infected animals, then we would suspect that at least limited community transmission is occurring.
Our forecasters think that this case likely does not reflect a large pandemic risk. Our team estimates the chance that H5 will be detected in the next two weeks in another community transmission case to be ~5% (range 2%-15%). If such a case is found, then it would likely herald the start of another pandemic; this is how the 2009 flu pandemic started and is almost certainly how the next one will as well.
In other news, the H5N1 avian influenza virus has been found in multiple bird species in Antarctica and has been found in birds in the Falkland Islands as well.
Other biological risks
A total of 125 virus species with zoonotic potential, including seven coronaviruses, have been found in China's fur farms.
A collapse in North America's bat population led to a surge in pesticide use by farmers that has caused over 1,000 infant deaths, claims a study. The loss of millions of bats shocked the ecosystem, leading to a 31 percent increase in pesticide use where bat populations had declined, resulting in nearly 1,334 additional infant deaths due to contaminated water and air.
The WHO polio vaccination campaign in Gaza is going well. “Dr Rik Peeperkorn, the UN agency's representative in the Palestinian territories, said 161,030 children under the age of 10 were vaccinated on Sunday and Monday—above the projection of 156,500.”
Geopolitical Risks
US researchers have located a probable launch site for Russia's new nuclear-powered, nuclear-armed missiles. We reported on Russia's pursuit of nuclear-powered, nuclear-armed missiles a few months ago. These weapons are unlikely to change the nuclear calculus but could result in radiation being released along its flight path and could contaminate the surrounding region if an accident were to occur.
The directors of the US CIA and UK MI6 have warned that Russia is conducting a “reckless campaign of sabotage across Europe.”
The US has detected increased Russian military activity around key undersea cables and believes that Russia may be more likely to sabotage these cables than it was before.
In northern Sweden, a drilling site for rare earth metals saw two security incidents: four drilling machinery units were vandalized one night, and several nights later, an armed man entered the mining area. The site is the location of Europe's largest deposit of rare earth metals; the discovery of this deposit was announced in early 2023.
In Norway, a cargo ship with 20,000 tons of ammonium nitrate from Russia, which could be used to make explosives, sought and was initially granted port of refuge in a port in Norway. After several days and a visit by a Norwegian navy frigate, it asked to leave for a different port for repairs. This event underscores that risks of shipping accidents—and naval military actions—are not zero.
Exports to Kyrgyzstan and other former Soviet republics from at least some European countries, especially Italy and Germany, ramped up after Russia invaded Ukraine and sanctions were imposed against Russia. Austrian and Czech exports are also notable. According to Robin Brooks at the Brookings Institution,
None of this stuff actually goes to Kyrgyzstan. If you look at Kyrgyz data on imports from Italy (blue), they're flat. Kyrgyzstan is just what gets written on the invoice. This stuff is going to Moscow...
Europe bought oil from India at record rates, and a lot of that oil most likely originated in Russia.
The EU’s imports of refined oil imports from India grew to record levels in 2023 at the same time as New Delhi’s imports of Russian crude oil more than doubled year on year. It means consumers in Europe likely received unprecedented volumes of petrol, diesel, kerosene and other oil products that originate from Russia via India last year, in spite of the sanctions imposed after Vladimir Putin’s invasion of Ukraine.
The FT also reported that Russia has been developing secret trade links with India. "Russia has been secretly acquiring sensitive goods in India and explored building facilities in the country to secure components for its war effort, according to Russian state correspondence seen by the Financial Times."
In the US, Donald Trump's sentencing for his felony convictions related to hush-money payments has been postponed until after the presidential election. Because Trump’s sentence could have started before the November presidential election, this decision could have a substantial impact on the outcome of the election.
“The General Staff of the Armed Forces of the Islamic Republic of Iran has released its findings regarding the dimensions and causes of the crash of Ibrahim Raisi’s plane, the former president of the country, indicating that “complex weather and climatic conditions” led to the plane crash.” According to the report, “no violations or ‘indications of sabotage were found in the components and systems of Ibrahim Raisi’s plane, which ultimately crashed.’” The wreckage of the plane was discovered the day after the crash, confirming the deaths of Ibrahim Raisi, along with several other members of his government.
Tensions are increasing in the Horn of Africa, between Egypt and Somalia on the one hand, and Ethiopia on the other. "Ethiopia is increasingly concerned over a recent defense deal between Egypt and Somalia, two countries that Addis Ababa is embroiled in disputes with.... Under the agreement, Egyptian troops would be deployed to Somalia after Dec. 31, when an African Union's peacekeeping mission to Somalia ends.
There are two key disputes involving the three African countries. The first dispute, between Ethiopia and Egypt, is over Ethiopia’s construction of a $4 billion dam on the Blue Nile, a key tributary to the Nile River. Egypt fears it will have a devastating effect on its water and irrigation supply downstream unless Ethiopia takes its needs into account. Ethiopia is using the dam to generate badly needed electricity. The second dispute, between Ethiopia and Somalia, is over Somalia's breakaway region of Somaliland.
In India, militants in Manipur’s ethnic conflict are now using drones and rocket-propelled grenades. Nine Maoist rebels were killed by government forces in an anti-Maoist operation.
Indonesian police arrested seven people for a terror plot to kill Pope Francis.
China conducted large amphibious landing drills across the strait from Taiwan.
The US and South Korea held joint amphibious landing drills this past week.
Ukraine is using fire-throwing "dragon drones" to deliver thermite streams into Russian trenches.
Japan is seeking a record defense budget.
The Venezuelan opposition leader, Edmundo González, has fled to Spain.
In the Democratic Republic of the Congo, 129 people were killed during a mass prison-break attempt.
AI Risks
Elon Musk says xAI brought their colossus 100k H100 training cluster online, which he says would be the most powerful AI training cluster in the world, and says it will double in size in a few months. One member of our team performed some back-of-the-envelope calculations and estimated that it would likely take this cluster less than a week to train a GPT-4-sized model.
Ilya Sutskever’s new company, Safe Superintelligence Inc., has raised a billion dollars. The aim of the company is to build artificial superintelligence, but safely. In contrast to Anthropic and OpenAI, SSI is explicitly a for-profit company.
Yi Zeng, one of the top experts on AI safety and governance in China, has announced the founding of the Beijing Institute of AI Safety and Governance, of which he will be the director.
The US, UK, EU and other countries have signed the Framework Convention on artificial intelligence and human rights, democracy, and the rule of law, which covers some AI harms such as the spreading of misinformation and the use of biased data to make decisions.
TMSC reported that trials at its new plant in Arizona in the US achieved productivity on a par with what the company sees in its fabs in Taiwan. TMSC plans to start mass production of chips in Arizona in 2025.
Google DeepMind has announced AlphaProteo, which they say generates novel proteins for biology and health research.
OpenAI Japan’s CEO Tadao Nagasaki has said that OpenAI’s next model “GPT NEXT” will perform 100 times better than current models.
Facial recognition company Clearview AI has been fined 30.5M euros for building an illegal database.
Anthropic has rolled out Claude Enterprise.
Climate Risks
This Atlantic hurricane season was predicted to be the most active ever. So far, it's not.
Conversely, storms are unusually active in Africa because a tropical rainfall belt called the Intertropical Convergence Zone (ITCZ) has shifted north; this has resulted in a once-in-several-thousand-years rainfall event in the Sahara Desert.
So, instead of hurricanes in the Atlantic, we're currently seeing extreme rain in the Sahara. We can expect more such unexpected anomalies to happen as our climate continues to change.
Climate change is already having substantial, negative impacts on crops. Food inflation in Europe is projected to be amplified by 30%-50% by 2035 by extra warming. In China, extreme rainfall has already cut rice yields by about 8% from 1999-2012.
High-temperature records continue to be broken globally. The northern 2024 summer was the hottest on record. Record high September temperatures have been reached in Europe, including in Germany, Sweden and Norway. Global temperatures in the Arctic are rising almost four times as fast as temperatures in the rest of the world. Australia just had its warmest August ever. In Phoenix, AZ, in the US, "56 days of high temperatures at or above 110 degrees [F] have been recorded so far this year. This breaks the previous record of 55 days set just last year." Phoenix has also seen 100 days in a row of high temperatures of at least 100 degrees F. Japan saw its hottest summer ever, and parts of China saw record heat in August. Ocean heat content averaged over the Gulf of Mexico is also at an all-time high.
Typhoon Yagi has killed dozens of people, caused flooding and landslides and left millions without power in Vietnam and China.
A new heat wave is expected in South America.
Thousands of fires are burning in South America. “Thousands of wildfires across South America are decimating the planet's largest rainforest, the Amazon, and shrouding the continent in smoke. Authorities in Brazil, Peru and Bolivia are struggling to contain the blazes amid a historic dry season.”
Brazil has been exceptionally drier than usual. The country experienced its driest August in half a century, and by the metric of the standardized precipitation index (SPI), it has been the driest region in the world over the past 12 months.
Mpox outbreak forecasts
How big will the clade Ib mpox outbreak get? How long will it last? How far will it spread?
To attempt to answer these questions, it’s helpful to look back at past outbreaks that are similar in some respects. The most relevant comparison is to an Ebola outbreak that was identified in the summer of 2018 in the North Kivu area of the Democratic Republic of Congo (DRC) - the same region in which clade Ib mpox cases are currently growing. That outbreak took a little less than two years to contain; there were 3,470 cases, of which 2,287 died.
The world’s largest Ebola outbreak to date, with just under 29,000 cases reported in West Africa in 2014-2016, also took just under two years to contain.
In comparison, just under 3,400 laboratory-confirmed mpox cases of any clade and over 20,000 confirmed and suspected cases have been reported in the DRC in 2024 through September 1 alone - and case numbers are growing rapidly there and in Burundi as well. So, clearly, containing clade Ib mpox in the DRC and surrounding areas is going to require a larger effort than was needed to control Ebola there in 2018-2020, at a minimum. It could also be somewhat more complicated to control clade Ib mpox than it was to control Ebola because it can be hard to distinguish clade Ib mpox disease from somewhat common diseases caused by other viruses. In particular, several genetic groups of mpox virus commonly infect humans in Central and Western Africa, but only one of these genetic groups, clade Ib, poses a substantial pandemic risk. A lot of testing will be required to identify clade Ib cases and distinguish them from ongoing clade II and zoonotic clade Ia cases. In addition, mpox and chickenpox cases can be confused; chickenpox is caused by an unrelated herpes virus.
The incubation periods for Ebola and mpox are of similar length, so we can expect similar time scales for outbreak control, if all else were equal. The secondary attack rates (the percentages of close contacts who become infected) for Ebola and mpox may be similar as well. While a greater percentage of people infected with Ebola virus may be asymptomatic than of people infected with mpox virus, it is also possible that roughly comparable percentages of people infected with Ebola and mpox viruses largely evade detection because they have minimal or no symptoms or never seek care.
Given the similarities between Ebola and mpox disease transmission and previous experience with controlling Ebola in the region, is thus reasonable to guess that it will take at least just under two years to control clade Ib mpox in the DRC and surrounding countries, if the world takes mpox as seriously as it did the two largest Ebola outbreaks to date. It could also take much longer to control clade Ib mpox virus, or control could fail in the region.
Contact tracing and ring vaccination could eventually give way to mass population vaccination campaigns in areas in which clade Ib mpox virus spreads, in an effort to keep any outbreaks that occur small, brief and local. If eradication isn’t possible, it is possible that cases could eventually be controlled in this way, with ongoing efforts.
A total of 10,000 mpox vaccines arrived in Nigeria in the last week of August. More importantly, 99,000 doses arrived in the DRC on September 5, and another 101,000 doses were to be delivered to the DRC over the weekend.
New mpox vaccines are being developed, as well. An mRNA vaccine developed by Moderna is in Phase 1/2 clinical trials.
If the recent Ebola outbreaks are any guide, then based on how many cases we have seen so far, we think we could expect to see the mpox outbreak in the DRC and surrounding countries reach somewhere in the ballpark of 20K to 100K confirmed cases of all clades over the next two years, with containment efforts. We expect that most of these cases would be clade Ib mpox cases, the strain which is better able to spread among humans.
Those numbers could translate into totals of approximately 120K to 600K confirmed and suspected cases over the next two years. And because many, or perhaps even most, cases will not be detected, the actual number of cases could be roughly double those estimates.
It’s also possible that the mpox virus will jump to another region of the world with poor surveillance and establish itself in that location. If that starts to happen, then a control effort will be needed in that region as well. Contacts of every known case in every region in which clade Ib mpox cases appear will need to be monitored to prevent spread from getting out of control. Otherwise, our forecasting team believes that the virus will continue to spread to new locations around the world, and we would run the risk that it will become established in the human population much as smallpox once was.