News highlights on health security threats and countermeasures curated by Global Biodefense
This week’s selections include work towards a Marburg vaccine; the pandemic potential of poxviruses; Crimean-Congo haemorrhagic fever in Macedonia; and a review of novichok nerve agents.
POLICY + GOVERNMENT
As DoD Steps Up Response to Bioweapon Threat, China Plays Complicated Role in Biosecurity
Biological defense isn’t as clear or straightforward as the type of security that’s bought with aircraft carriers and missiles. Government officials announcing the new Biodefense Council Wednesday at a CSIS event said the world—especially the United States—has to try to work with China on emerging biological threats, even as the Pentagon focuses on deterring the nation from conflict. Unlike in many other domains, the United States can’t simply isolate China when it comes to biological security. Defense One
Experts Encourage US States to Create Legislation Aimed at Improving Indoor Air Quality in Public Spaces
Experts are calling on states across the US to improve indoor air quality mitigate the spread of airborne infectious diseases and help reduce chronic conditions like asthma, lower the risk of certain cancers, and prevent cognitive impairment. To assist in that process, the Johns Hopkins Center for Health Security, working closely with a team of legal experts and a national expert advisory committee, developed a Model State Indoor Air Quality Act as a legal framework for states and localities to implement legislation to allow for IAQ inspections and publicly posted monitoring results, actions that will lead to improved IAQ in public buildings. Johns Hopkins Center for Health Security
We Need a Universally Endorsed Definition of a Pandemic for the Pandemic Accord to be Effective
Member states of the Intergovernmental Negotiation Body (INB)1 have roughly nine months left before they need to present a draft outcome to the World Health Assembly in May 2024. While their negotiations to date have understandably focused on provisions related to access and benefit-sharing, and distribution of countermeasures, the implementation of these as well as all other provisions will ultimately depend on whether an outbreak meets member states’ negotiated definition of “pandemic.” The BMJ
FDA Drug Approvals: Let Us See All the Evidence
According to FDA written standards, effectiveness must be demonstrated by substantial evidence. Until relatively recently, “substantial” was defined as at least two well-controlled clinical investigations. However, in 2017 the implementation of the 21st Century Cures Act relaxed the standards to make it easier to gain FDA approval on the basis of a single trial. Many completed studies fail to report results. In 2017, 41% of products were approved on the basis of a single trial. When probed further, it was apparent that other studies had often been initiated before the approval. In many cases these studies had finished data collection many years before. Among studies completed prior to approval, only about one in four had made their results public. For 72% of medicines approved in 2017, new information was made public shortly after approval. MedPage Today
Deaths Averted Due to Vaccination Against 14 Pathogens in 194 Countries From 2021 to 2030
The Immunization Agenda 2030 (IA2030) aims to reduce the number of future deaths averted through immunization in the next decade. This analytical framework estimated the number of deaths averted due to an ambitious vaccination coverage scenario from 2021 to 2030 in 194 countries is 51.5 million. The results from this global analysis demonstrate the substantial potential mortality reductions achievable if the IA2030 targets are met by 2030. Vaccine
MEDICAL COUNTERMEASURES
NIAID Study Shows Low-Dose Marburg Vaccine Effective in Macaques
In a new study published in Emerging Microbes and Infections, scientists from NIAID’s Laboratory of Virology determined in cynomolgus macaques that a low dose of VSV-MARV given two weeks before virus exposure provided robust protection; vaccination one week prior to virus exposure provided limited protection. Global Biodefense
Contrasting Effects of Filamin A and B Proteins in Modulating Filovirus Entry
Ebola (EBOV) and Marburg viruses (MARV) cause severe hemorrhagic fever associated with high mortality rates in humans. This study is the first to identify the filamin family of proteins as regulators of EBOV and MARV entry into host cells. These findings may provide insight into the development of new countermeasures to prevent EBOV and MARV infections. PLOS Pathogens
ARPA-H Announces Project to Strengthen the Immune System
ARPA-H this week announced up to $24 million for the Curing the Uncurable via RNA-Encoded Immunogene Tuning (CUREIT), a project that aims to train the immune system to better fight cancer and other diseases with the goal of developing generalizable mRNA platforms to treat diverse diseases and save lives. CUREIT will be led by a team at Emory University in Atlanta, Georgia. The proposed CUREIT toolbox of mRNA – a molecule that tells the body what proteins to make – and related technologies could be used to “turn on” helpful immune responses, like prompting immune cells to target and attack tumors. Other applications could extend to autoimmune disorders, transplants, and infectious diseases. ARPA-H
BIOSECURITY + BIOPREPAREDNESS
We Are Neglecting Serious Health Threats
When we discuss biopreparedness and readiness in health care, it is not just about a novel pathogen or high-containment disease like the Ebola virus, but also the response to challenging pathogens that stress our capacity and capabilities. Although things may appear simpler now that the world is past the acute stage of the COVID-19 pandemic, this is the most challenging and pivotal time for public health. Contagion Live
Strengthening Public Health Infrastructure in Indian Country
The CDC developed the Tribal Epidemiology Center Public Health Infrastructure (TECPHI) program, a 5-year investment (2017-2022) to address gaps in data and build public health capacity in American Indian and Alaska Native communities. The COVID-19 pandemic came along and disproportionally hit these communities, underscoring long-standing inequities and the remaining gaps in infrastructure. This article details the challenges and priorities for building off the TECPHI efforts. Public Health Reports
Global Pandemics are Extinction-Level Events and Should Not Be Coordinated Solely Through National or Jurisdictional Emergency Management
While pandemics are certainly biological incidents – and smaller pandemics are included as part of Emergency Management’s CBRNE plans and protocols – the aspects of a global pandemic extend beyond the capabilities of both the field of Emergency Management and its practice as a whole. Government’s command decisions to act during a global pandemic, may start out aligned with the standard Emergency Management/ Disaster Phase Cycle mission actions of Preparedness/Protection/Prevention, Response, Recovery, and Mitigation, but as the pandemic progresses, those command decisions quickly become reprioritized away from the doctrinal standards and practices of emergency management. Homeland Security Affairs
Sex and Gender Considerations in Biowarfare and Disarmament
While gender may be a relatively unintuitive consideration within biological weapons protocols, historically, there has been an incongruent influence on more vulnerable sexes (usually referring to biological females), and this vulnerability is increasing with emerging technologies. The underrepresentation of diverse genders in medicine and biological agent countermeasure development (e.g. anthrax vaccine profile differences in men vs. women) already makes oppressed and minority genders more vulnerable to biological weapons than their male counterparts. Additionally, Gender concerns in the context of CRISPR include the potential implications of using this tool to impact genetic disorders that directly relate to reproductive health and fertility. Observer Research Foundation
SELECT AGENTS + PRIORITY PATHOGENS
Cases of Crimean-Congo Haemorrhagic Fever in North Macedonia, July – August 2023
Crimean-Congo haemorrhagic fever (CCHF) is a severe tick-borne disease caused by the CCHF virus from the Bunyaviridae family and included in the WHO list of important emerging infectious diseases with pandemic potential. Previously, the last report of CCHF in North Macedonia was more than 50 years ago. The distribution of the CCHFV is closely linked to the presence of Hyalomma tick species, which act as the main vectors for this pathogen. This paper describes a fatal case of autochthonous CCHF in North Macedonia as well as a nosocomial infection in a healthcare worker who cared for the patient and preliminary results from contact tracing. Eurosurveillance
Pandemic Potential of Poxviruses: From an Ancient Killer Causing Smallpox to the Surge of Monkeypox
However, the more we understand about the origin and development of past pandemics, the better are we prepared to anticipate and respond to future epidemics. Smallpox caused by the variola virus (VARV) was one of the greatest infectious killers of mankind. The historical records noted marked variability in VARV virulence which scientists tentatively associated with gene losses occurring when broad-host poxviruses narrow their host range to a single host. VARV split from camel and gerbil poxviruses and had no animal reservoir, a prerequisite for its eradication led by WHO. The search for residual pockets of VARV led to the discovery of the monkeypox virus (MPXV). Applied Microbiology International
Anthrax Vaccine Funding Urged Amid West Africa Outbreak
As Ghana and Nigeria grapple with outbreaks of anthrax, scientists say governments must prioritize funds for vaccination to prevent a re-emergence of the disease across West Africa. Anthrax can infect livestock and other animals when they breathe in or ingest spores in contaminated soil, plants, or water. Humans then become infected by handling animals or animal products that contain spores. Prevention is centred around treatment and vaccination of livestock, which has mostly been discontinued in countries now witnessing an outbreak. Global Biodefense
Halting the Spread of Ebola Through Sexual Transmission
The Men’s Health Screening Programme, led by Liberia’s Health Ministry in collaboration with WHO and the CDC, enrolled 857 Ebola survivors. The program, launched in July 2015 after the third and fourth waves of the Ebola outbreak in Liberia were attributed to sexual transmission, aimed to provide semen testing services and safe sex counselling to male Ebola survivors aged 15 years and older. Over the six years of the program, survivors were tested every two weeks. World Health Organization
Investigation and Decontamination of an Urban Monkeypox Occurrence
Before the described monkeypox virus (MPXV) case in this article, limited cases of human MPXV had occurred within the United States. Lessons learned from prior outbreaks contributed to a successful approach to decontamination and containment of an adult case of MPXV in Dallas, Texas. Disaster Medicine and Public Health Preparedness
Anthrax in EU – Annual Epidemiological Report
This analysis is for the year 2021, but just released this month. Anthrax continues to be uncommon in humans in the EU/EEA, with only a few cases reported every year. For 2021, four confirmed anthrax cases were reported by Bulgaria (one case) and Spain (three cases). Three probable cases were reported by France (one case) and Spain (two cases). Among 30 reporting EU/EEA countries, 27 notified zero cases. ECDC
AVIAN INFLUENZA
Investigating the Genetic Diversity of H5 Avian Influenza Viruses in the United Kingdom from 2020–2022
Since 2020, the United Kingdom has experienced two successive outbreaks of H5 HPAIV. While H5N8 HPAIV was predominant during the 2020–2021 outbreak, other H5 subtypes were also detected. The following year, there was a shift in the subtype dominance to H5N1 HPAIV, but multiple H5N1 genotypes were detected. Through the thorough utilization of whole-genome sequencing, it was possible to track and characterize the genetic evolution of these H5 HPAIVs in United Kingdom poultry and wild birds. This enabled researchers to assess the risk posed by these viruses at the poultry-wild bird and the avian-human interfaces and to investigate the potential lateral spread between infected premises, a key factor in understanding the threat to the commercial sector. Microbiology Spectrum
Interspecies Transmission of Swine Influenza A Viruses and Human Seasonal Vaccine-Mediated Protection
Study confirms that vaccine and challenge strains must be antigenically matched to elicit vaccine-mediated protective immunity and that the immune status of the human population might not provide complete immunity to all currently circulating swine influenza A virus H1N1 strains. Continual evaluation and monitoring of influenza A viruses circulating in human and swine populations is required to identify potential pandemic threats; broadly effective vaccines for both human and veterinary use are needed to mitigate these threats. Emerging Infectious Diseases
CHEMICAL + RADIOLOGICAL THREATS
Fukushima’s Radioactive Wastewater is Being Released in the Pacific. Here’s What You Need To Know
The water is being treated by what’s called an Advanced Liquid Processing System, which can reduce the amounts of more than 60 selected radionuclides to government-set releasable levels, except for tritium, which officials say is safe for humans if consumed in small amounts. About 70% of the water held in the tanks still contains cesium, strontium, carbon-14 and other radionuclides exceeding government-set levels. It will be re-treated until the concentrations meet those limits, then diluted by more than 100 times its volume of seawater before it is released. That will bring it way below international safety limits, but its radioactivity won’t be zero. Scientists generally support the IAEA’s evaluation of the plan, while some call for more attention to dozens of low-dose radionuclides that remain in the water, saying data on their long-term effects on the environment and marine life are insufficient. AP
Ten Years on From the Ghouta Chemical Weapons Attack in Syria: What Lessons Have Been Learned?
The August 21, 2013 attack forced thousands of people to hospitals with symptoms such as convulsions, suffocation, coughing up blood, and foaming at the mouth. The U.S. government estimated that 1,429 Syrians–including 426 children–were killed. Since the attack on Ghouta, there have been scores of alleged chemical weapons attacks in Syria. The prohibition of the use of chemical weapons contained in the Chemical Weapons Convention is absolute and applies in all circumstances. This has not made one iota of difference in Syria, where the government’s conduct has repeatedly proved unrestrained by international law and norms. Just Security
A-agents, Misleadingly Known as ‘Novichoks’: A Narrative Review
The environmental stability of A-series agents, the lack of environmentally safe decontamination, their high toxicity, and the scarcity of information on post-contamination treatment pose a challenge for managing possible incidents.This review critically assesses the information published to date on this class of compounds. The scope of this work is to summarize all the available and relevant information, including the physicochemical properties, chemical synthesis, mechanism of action, toxicity, pharmacokinetics, and medical countermeasures used to date. Archives of Toxicology
Chlorinated Organic Compounds in Concrete as Forensic Markers for Chlorine Gas Exposure
The formation of chlorinated organic compounds in concrete debris exposed to reactive chlorine was studied to search for markers specific to chlorine gas exposure. The chlorinated chemicals and specific markers for chlorine gas discovered in this research may assist other laboratories in forensic investigations of chlorine gas attacks. Journal of Hazardous Materials
A Manual for the Recovery of CBRNE-Contaminated Human Remains
Due to the complications of recovery, contaminated human remains are often left unrecovered and unidentified. This thesis works to create a framework for the recovery of contaminated human remains for organizations with a focus on creating safe and sustainable working environments for those conducting the recovery. It includes a three-phrase implementation of remains recovery which includes contaminant surveys and PPE recommendations, and a theoretical case study for the recovery of the victims of the 1988 Halabja Massacre. University of Nebraska – Lincoln
On-Site Detection and Laboratory Verification of the Presence of Nerve Agent Biomarkers Using Dried Blood Spots
The analysis of biomedical samples is important for the investigation of the alleged exposure to chemical warfare agents. The present study aims to use dried blood spots for portable detection and laboratory verification of organophosphate poisoning. Forensic Chemistry
SURVEILLANCE + DETECTION
Laboratory Diagnosis of Mpox, Central African Republic, 2016–2022
During 2016–2022, PCR testing confirmed 100 mpox cases among 302 suspected cases in the Central African Republic. The highest detection rates were from active lesions (40%) and scabs (36%); cycle thresholds were lower (≈18) than those for blood samples (≈33). Results were consistent for generic primer– and clade I primer–specific PCR tests. Approximately one third of suspected mpox cases in CAR are confirmed MPXV infections; an additional 2/5 are varicella zoster virus (VZV) infections, leaving ≈3/5 cases of papulovesicular cutaneous eruptions undiagnosed. Emerging Infectious Diseases
Highly Multiplexed Targeted Sequencing Strategy for Infectious Disease Surveillance
Shotgun and metagenome-based next generation sequencing (NGS) approaches are limited by low concentrations of microbial DNA in clinical samples, requirements for tailored sample and library preparations plus extensive bioinformatics analysis. Here researchers adapted molecular inversion probes (MIPs) as a cost-effective target enrichment approach to characterize microbial infections from blood samples using short-read sequencing. They designed a probe panel targeting 2 bacterial genera, 21 bacterial and 6 fungi species and 7 antimicrobial resistance markers (AMRs). BMC Biotechnology
Considerations for Developing a National Genomic Surveillance Strategy for Pathogens with Pandemic and Epidemic Potential
This step by step guide outlines key considerations and a proposed approach for countries to develop a national genomic surveillance strategy or action plan for pathogens with pandemic and epidemic potential. This technical document is intended for use by all stakeholders at the national and subnational levels relevant to the development and implementation of the strategy, including health authorities, One Health partners, donors, public health officers, academia, the private sector and laboratory specialists. World Health Organization
INFECTIOUS DISEASES
Complexity of Restarting Oral Poliovirus Vaccine (OPV) in National Immunization Programs After OPV Cessation
The polio eradication endgame continues to increase in complexity. With polio cases caused by wild poliovirus type 1 and circulating vaccine-derived polioviruses of all three types (1, 2 and 3) reported in 2022, the number, formulation, and use of poliovirus vaccines poses challenges for national immunization programs and vaccine suppliers. While OPV restart represented a hypothetical situation for risk management and contingency planning to support the 2013-2018 Global Polio Eradication Initiative (GPEI) Strategic Plan, the actual epidemiological experience since OPV2 cessation raises questions about what, if any, trigger(s) could lead to restarting the use of OPV2 in routine immunization. We anticipate many challenges for forecasting prospective vaccine supply needs during the polio endgame due to increasing potential combinations of poliovirus vaccine choices. Gates Open Research
I’m A Doctor Who Specializes In Treating Leprosy. Here’s What I Want You To Know
The exact mechanism for the transmission of leprosy is unknown. It is thought to spread through respiratory droplets after prolonged periods of exposure, such as a household contact. It is important to note that spread does not occur by incidental contact. The other unique feature about this disease is that over 95% of the world’s population is immune to infection. Therefore, most people will never go on to develop disease even if they do come in contact with the bacteria. Finally, there is potential transmission of leprosy through zoonotic, or animal exposure, sources. This has been established specifically with the 9-banded armadillo, which has been confirmed to be a source. STAT
Where are the Mosquitoes That Spread Malaria in the U.S.? Officials Aren’t Sure
A ninth case of malaria diagnosed in a person who had not traveled out of the U.S. has experts on alert — and calling for more surveillance of the mosquitoes that spread the illness. It’s been decades since U.S. health authorities have had malaria on their radar. Insecticides and elimination of standing water where mosquitoes like to breed wiped out the mosquito-borne illness from the U.S. in the early 1950s. Since then, the vast majority of cases in the country — more than 2,000 each year — have been among people returning from travel abroad. NBC News
Infants Admitted to US Intensive Care Units for RSV Infection During the 2022 Seasonal Peak
This cross-sectional surveillance study of 600 infants across 39 hospitals requiring intensive care in winter 2022 for RSV infection found that most were delivered full-term and previously healthy. Infants aged less than 3 months and those born prematurely were at higher risk for intubation. In this study, only 2 of 17 infants eligible for palivizumab because of gestational age less than 29 weeks had documentation of receipt, highlighting potential barriers to administration and emphasizing the need to ensure that all eligible patients receive it in a timely manner. JAMA Network Open
Children in DR Congo Facing Worst Cholera Outbreak in Six Years
A spike in conflict and displacement in the eastern Democratic Republic of the Congo is pushing children into the worst cholera crisis since 2017, warns UNICEF. More than 8,000 children under 5 years infected in North Kivu during first seven months of this year, over six times as many cases as in all of 2022. UNICEF
CDC Sets New Standards for Hospitals to Combat Sepsis
The CDC on Thursday released new guidelines to help hospitals quickly detect and treat cases of sepsis. The road map of the “core elements” of a hospital sepsis program is meant to help administrators bring together experts from various medical disciplines to detect and treat sepsis faster. A new survey of over 5,000 hospitals found that about 73 percent had sepsis teams, but only 55 percent had a leader with time allocated to manage the program. Only about half of hospitals integrate their sepsis programs with antibiotic stewardship initiatives, despite the fact that these drugs are the key to recovery. New York Times
ANTIMICROBIAL RESISTANCE CRISIS
Candida auris‒Associated Hospitalizations, United States, 2017–2022
Candida auris is a highly transmissible and frequently drug-resistant emerging fungal pathogen capable of causing severe infections. In the United States, reported clinical cases increased by 95% during the first year of the COVID-19 pandemic. Using a large US hospital database, we describe 192 Candida auris‒associated hospitalizations during 2017–2022, including 38 (20%) C. auris bloodstream infections. Hospitalizations involved extensive concurrent conditions and healthcare use; estimated crude mortality rate was 34%. These findings underscore the continued need for public health surveillance and C. auris containment efforts. Emerging Infectious Diseases
COVID-19 PANDEMIC
U.S. Health Officials Lay Out Plans to Cope with Respiratory Virus Season
Pending the expected sign-offs by the FDA, ACIP and CDC Director in September, the Covid vaccines released this fall will once again be monovalent, targeting a single strain of the SARS-CoV-2 virus. They will be the first not to include the original version of the SARS-2 virus that emerged in late 2019. This year, as last, older adults and people who have immunocompromising health conditions will be able to get a second dose of vaccine. STAT
COVID-19 Epidemiology During Delta Variant Dominance Period in 45 High-Income Countries
During the Delta-dominant period, most high-income countries reported higher peak case rates (57%) and lower peak case-fatality rates (98%). Vaccination coverage was vital to preventing infection and death from COVID-19 during the Delta wave. Each quartile increase in vaccination coverage resulted in a 5% reduction in peak case rates and a 4% reduction in peak death rates. Countries with a larger percentage of persons >65 years of age had lower death rates and CFRs during the Delta dominance period, likely because of focused early vaccination activities in this age group and case management protocols prioritizing older populations for close observation and hospital admission. Emerging Infectious Diseases
WHO COVID-19 Epidemiological Update
In the last 28-day period (17 July to 13 August 2023), over 1.4 million new COVID-19 cases and over 2300 deaths were reported from WHO’s six regions, an increase of 63% and a decrease of 56%, respectively, compared to the previous 28 days. As of 13 August 2023, over 769 million confirmed cases and over 6.9 million deaths have been reported globally. While four WHO regions have reported decreases in the number of both cases and deaths, the Western Pacific Region has reported an increase in cases and a decrease in deaths. In the context of high variability in the timeliness of COVID-19 reports produced by Member States in the Americas, as of August 2023 PAHO/WHO has paused its specific COVID-19 Epidemiological Update. Subsequent COVID-19 surveillance will continue through the Influenza ad Other Respiratory Viruses bulletin and dashboards. World Health Organization
Engaging Community-Based Organizations to Address Barriers in Public Health Programs
Recognizing the unique challenges faced by rural communities, coupled with higher rates of vaccine hesitancy, the CDC Foundation awarded grants to 21 community-based organizations serving rural communities in 7 Midwest states to support the equitable uptake and distribution of COVID-19 vaccines. In this case study, 2 grantees provide case studies that document their experiences, challenges, and strategies to overcoming barriers during the implementation of COVID-19 vaccine acceptance projects in diverse rural communities. Health Security
COVID Omicron Carries 4 Times the Risk of Death as Flu, New Data Show
The risk of death from SARS-CoV-2 Omicron infection was four times higher than that from influenza in late 2022 and early 2023 in France, a Harvard Medical School researcher reports today in Epidemiology & Infection. CIDRAP
Persistent Symptoms After COVID-19 Not Associated with Differential SARS-CoV-2 Antibody or T Cell Immunity
Among the unknowns in decoding the pathogenesis of SARS-CoV-2 persistent symptoms in Long Covid is whether there is a contributory role of abnormal immunity during acute infection. In this study, researchers did not find evidence for aberrant anti-viral immunity as a predictor of persistent symptoms and the data also were not strongly supportive either of differential immune waning or of ongoing immune stimulation from a persistent immune reservoir of virus. Nature Communications
Lockdowns and Face Masks ‘Unequivocally’ Cut Spread of Covid, Report Finds
A new report from The Royal Society found non-pharmaceutical interventions taken during the Covid pandemic “unequivocally” reduced the spread of infections. These measures included distancing and lockdowns, test, trace and isolate, travel restrictions and controls across international borders, environmental controls, and communications. Evidence showed NPIs were most effective when the intensity of transmission was low, supporting their use early in a pandemic and at first sign of resurgence. The Guardian
SPECIAL INTEREST
CSIS Event: DoD’s Newly Released Biodefense Posture Review
“A certain urgency surrounds strengthening biodefense at DOD and elsewhere in our government, but it did take 21 months to complete the BPR. And these delays, I think, are a reflection of the complexity of the threats and the science, the array of DOD institutions involved, the desire to achieve consensus across these institutions, the inevitable turf conflicts and bureaucratic politics. But we’re at this point now where it’s out and the – and the moment has arrived to accelerate implementation.” CSIS
A New One Health Platform for Emerging Infectious Diseases
There’s never been a stronger need to advance scientific knowledge related to the connections between humans, animals, plants and their shared environment. To this end, ISID recently launched The International Journal of Infectious Diseases One Health (IJID One Health). Global Biodefense
ALSO READING
Molecular Characterization of Circulating Yellow Fever Viruses from Outbreak in Ghana. Emerging Infectious Diseases
New standard on cutting risk of infectious aerosol spread sets high bar for building ventilation but is work in progress. CIDRAP
Inside the New Bureau of Global Health Security and Diplomacy. Think Global Health
Phylogeographic Aspects of Bat Lyssaviruses in Europe: A Review. Pathogens
Prevalence of Asymptomatic Mpox among Men Who Have Sex with Men. Emerging Infectious Diseases
Predicting sepsis using deep learning across international sites. eClinicalMedicine
Two Commercially Available Blood-Stabilization Reagents Serve as Potent Inactivators of Coronaviruses. Pathogens