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In A Recent Simulation, A Coronavirus Killed 65 Million People

In October 2019, a group of 15 business people, government officials, and health experts gathered around a table in New York to plan out the global response to a worldwide outbreak of a never-before-seen — and completely fictional — coronavirus.

It was a training exercise with disturbing similarities, in retrospect, to 2019-nCoV — the Chinese virus that has swiftly gone global this month.

Three and a half hours later, the group finished the simulation exercise — and despite their best efforts, they couldn’t prevent the hypothetical coronavirus from killing 65 million people.
The fictional coronavirus at the center of the Event 201 simulation — a collaboration between the Johns Hopkins Center for Health Security, the World Economic Forum, and the Bill and Melinda Gates Foundation — was called CAPS, and it started with pigs in Brazil before spreading to farmers, not unlike how 2019-nCoV reportedly began with animals before spreading to people.

In the simulation, CAPS infected people all across the globe within six months, and by the 18-month mark, it had killed 65 million people and triggered a global financial crisis.

The “players” in the Event 201 simulation included health experts from the United Nations and the Centers for Disease Control and Prevention, as well as several academics and representatives from private companies. In other words, they were the same types of people likely to plan the world’s response to a real-life coronavirus pandemic.

That makes the exercise’s devastating outcome particularly troubling. But according to Event 201’s organizers, the purpose of the simulation wasn’t to stir up fear. Instead, they hoped it would serve as a learning experience, highlighting both the potential impact of a pandemic as well as current gaps in our preparedness for one.

To that end, after the simulation ended, they created a list of seven actions that leaders in both the public and private sectors could take now to prepare for a scenario like Event 201.

The troubling implication remains, though, that if 2019-nCoV reaches the pandemic level, it might already be too late to prevent the millions of deaths predicted by Event 201.



Live Simulation Exercise to Prepare Public and Private Leaders for Pandemic Response


The Johns Hopkins Center for Health Security in partnership with the World Economic Forum and the Bill & Melinda Gates Foundation will host Event 201: a high-level simulation exercise for pandemic preparedness and response, in New York, USA, on Friday 18 October, 08.45 - 12.30 EDT.


The exercise will bring together business, government, security and public health leaders to address a hypothetical global pandemic scenario. It will also feature a live virtual experience from 08.50 – 12.30 EDT to engage stakeholders worldwide and members of the public in a meaningful conversation of difficult high-level policy choices that could arise in the midst of a severe pandemic.

The world has seen a growing number of epidemics in recent years, with about 200 events annually including Ebola, Zika, MERS and SARS. At the same time, collective vulnerability to the social and economic impacts of infectious disease crises appears to be increasing. Experts suggest there is a growing likelihood of one of these events becoming a global threat – or an “event 201” pandemic – that would pose disruptions to health and society and cause average annual economic losses of 0.7% global GDP, similar in scale to climate change.

"We are in a new era of epidemic risk, where essential public-private cooperation remains challenged, despite being necessary to mitigate risk and impact” said Arnaud Bernaert, Head of Shaping the Future of Health and Health Care, World Economic Forum. “Now is the time to scale up cooperation between national governments, key international institutions and critical industries, to enhance global capacity for preparedness and response.”

The International Health Regulations (IHR) that unite 196 countries across the globe in a legal commitment to prevent and respond to acute public health risks, prioritize both minimizing public health risks and avoiding unnecessary interference with international traffic and trade. Minimizing the economic impact of epidemics also represents an opportunity to build core capacities to prevent, detect, and respond to outbreaks generally.

"We live in an increasingly interconnected world, and we must help all UN member states align with the International Health Regulations and be prepared to prevent, detect, and respond to acute outbreaks,” said Chris Elias, President of Global Development at the Gates Foundation. “If we fail to do so, the world will be unprepared for the next pandemic."

"In this new era of extreme pandemic threat, public-private cooperation is essential for an effective response,” said Tom Inglesby, Director of the Johns Hopkins Center for Health Security. “While governments and public health systems are already strained due to the increase in dangerous outbreaks, experts agree that a severe, fast-spreading human-to-human pandemic incident could happen at any time. We believe this well-crafted and thorough realistic tabletop exercise will provide leaders with a deeper understanding of the impact of epidemics on their communities and inspire them to take important steps to advance prevention and response.”



The participants in the live simulation represent a range of backgrounds and industries and include:

    Latoya Abbott, Risk Management/Global Senior Director Occupational Health Services, Marriott International
    Stan Bergman, Chairman and CEO, Henry Schein
    Sofia Borges, Senior Vice President, UN Foundation
    Chris Elias, President, Global Development division, Bill & Melinda Gates Foundation
    Tim Evans, Former Senior Director of Health, World Bank Group
    George Gao, Director-General, Chinese Center for Disease Control
    Avril Haines, Former Deputy Director, Central Intelligence Agency; Former Deputy National Security Advisor
    Jane Halton, Board member, ANZ Bank; Former Secretary of Finance and Former Secretary of Health, Australia
    Matthew Harrington, Global President and Chief Operations Officer, Edelman
    Chikwe Ihekweazu, Director General, Nigeria Centre for Disease Control
    Martin Knuchel, Head of Crisis, Emergency and Business Continuity Management, Lufthansa Group Airlines
    Eduardo Martinez, President, The UPS Foundation
    Stephen Redd, Deputy Director for Public Health Service and Implementation Science, US CDC
    Paul Stoffels, M.D., Vice Chair of the Executive Committee and Chief Scientific Officer, Johnson & Johnson
    Hasti Taghi, Vice President and Executive Advisor, NBCUniversal Media
    Lavan Thiru, Chief Representative, Monetary Authority of Singapore

Similar high-level pandemic exercises designed to address difficult policy issues have included: Dark Winter, examining the challenges of a biological attack on the US; Atlantic Storm, asking NATO leaders to respond collaboratively to a bioterrorist attack: and most recently, Clade X, calling on US government leaders to make difficult national security and public health decisions in the face of a rapidly evolving global crisis.

In addition, Bill Gates co-chaired a simulation at the Forum’s Annual Meeting 2017, resulting in the creation of the Epidemics Readiness Accelerator, a public-private platform to address effective readiness in issues including travel and tourism, supply chain and logistics, legal and regulatory, communications and data innovations.



About the Event 201 exercise

Event 201 was a 3.5-hour pandemic tabletop exercise that simulated a series of dramatic, scenario-based facilitated discussions, confronting difficult, true-to-life dilemmas associated with response to a hypothetical, but scientifically plausible, pandemic. 15 global business, government, and public health leaders were players in the simulation exercise that highlighted unresolved real-world policy and economic issues that could be solved with sufficient political will, financial investment, and attention now and in the future.

The exercise consisted of pre-recorded news broadcasts, live “staff” briefings, and moderated discussions on specific topics. These issues were carefully designed in a compelling narrative that educated the participants and the audience.
The Johns Hopkins Center for Health Security, World Economic Forum, and Bill & Melinda Gates Foundation jointly propose these recommendations.

Purpose

In recent years, the world has seen a growing number of epidemic events, amounting to approximately 200 events annually. These events are increasing, and they are disruptive to health, economies, and society. Managing these events already strains global capacity, even absent a pandemic threat. Experts agree that it is only a matter of time before one of these epidemics becomes global—a pandemic with potentially catastrophic consequences. A severe pandemic, which becomes “Event 201,” would require reliable cooperation among several industries, national governments, and key international institutions.

Recent economic studies show that pandemics will be the cause of an average annual economic loss of 0.7% of global GDP—or $570 billion. The players’ responses to the scenario illuminated the need for cooperation among industry, national governments, key international institutions, and civil society, to avoid the catastrophic consequences that could arise from a large-scale pandemic.

Similar to the Center’s 3 previous exercises—Clade X, Dark Winter, and Atlantic Storm—Event 201 aimed to educate senior leaders at the highest level of US and international governments and leaders in global industries.

It is also a tool to inform members of the policy and preparedness communities and the general public. This is distinct from many other forms of simulation exercises that test protocols or technical policies of a specific organization.

Exercises similar to Event 201 are a particularly effective way to help policymakers gain a fuller understanding of the urgent challenges they could face in a dynamic, real-world crisis.

Recommendations

The next severe pandemic will not only cause great illness and loss of life but could also trigger major cascading economic and societal consequences that could contribute greatly to global impact and suffering.

The Event 201 pandemic exercise, conducted on October 18, 2019, vividly demonstrated a number of these important gaps in pandemic preparedness as well as some of the elements of the solutions between the public and private sectors that will be needed to fill them. The Johns Hopkins Center for Health Security, World Economic Forum, and Bill & Melinda Gates Foundation jointly propose these recommendations.

When/where

Friday, October 18, 2019
8:45 a.m. – 12:30 p.m.
The Pierre hotel
New York, NY

Audience

An invitation-only audience of nearly 130 people attended the exercises, and a livestream of the event was available to everyone.

Exercise team

Eric Toner, MD, is the exercise team lead from the Johns Hopkins Center for Health Security. Crystal Watson, DrPH, MPH and Tara Kirk Sell, PhD, MA are co-leads from the Johns Hopkins Center for Health Security. Ryan Morhard, JD, is the exercise lead from the World Economic Forum, and Jeffrey French is the exercise lead for the Bill and Melinda Gates Foundation.

Exercise team members are Tom Inglesby, MD; Anita Cicero, JD; Randy Larsen, USAF (retired); Caitlin Rivers, PhD, MPH; Diane Meyer, RN, MPH; Matthew Shearer, MPH; Matthew Watson; Richard Bruns, PhD; Jackie Fox; Andrea Lapp; Margaret Miller; Carol Miller; and Julia Cizek.

Event 201 was supported by funding from the Open Philanthropy Project.




Statement about nCoV and our pandemic exercise

In October 2019, the Johns Hopkins Center for Health Security hosted a pandemic tabletop exercise called Event 201 with partners, the World Economic Forum and the Bill & Melinda Gates Foundation. Recently, the Center for Health Security has received questions about whether that pandemic exercise predicted the current novel coronavirus outbreak in China. To be clear, the Center for Health Security and partners did not make a prediction during our tabletop exercise. For the scenario, we modeled a fictional coronavirus pandemic, but we explicitly stated that it was not a prediction. Instead, the exercise served to highlight preparedness and response challenges that would likely arise in a very severe pandemic. We are not now predicting that the nCoV-2019 outbreak will kill 65 million people. Although our tabletop exercise included a mock novel coronavirus, the inputs we used for modeling the potential impact of that fictional virus are not similar to nCoV-2019.

28 Devastating Infectious Diseases



Contagious diseases have shaped human history and they remain with us today. As the new coronavirus spreads across mainland China and elsewhere around the globe, such infectious diseases are top of mind for many of us. Here's a look at some of the worst of these infections, from ebola and dengue to the more recent SARS, the new coronavirus and Zika virus.


The new coronavirus


The 2019 novel coronavirus (2019-nCoV) is a new strain of coronavirus that first appeared in Wuhan, China, in December 2019. Though it was only just discovered, 2019-nCoV has already spread rapidly in China and around the world. As of Feb. 10, 2020, the virus has led to more than 40,000 illnesses and 900 deaths in China, as well as more than 400 illnesses and two deaths outside of mainland China. (The vast majority of cases and deaths have occurred in Hubei Province, where Wuhan is located.)

Coronaviruses are a large family of viruses that cause respiratory illnesses. This family includes the viruses that cause SARS (severe acute respiratory syndrome) and MERS (Middle East respiratory syndrome).

Because 2019-nCoV is so new, many unknowns remain about the virus, including exactly how easily it spreads, how deadly it is and whether it will cause a global pandemic. (The World Health Organization has declared the 2019-nCoV outbreak a "public health emergency of international concern," but has not yet declared it a pandemic.)

Studies suggest 2019-nCoV likely originated in bats, but made it's "jump" to people through a yet-to-be-identified animal, which acted as a bridge between bats and humans.


Smallpox


Scientists think that smallpox, which causes skin lesions, emerged about 3,000 years ago in India or Egypt, before sweeping across the globe. The Variola virus, which causes smallpox, killed as many as a third of those it infected and left others scarred and blinded, according to the World Health Organization.

A photo taken in 1975 shows the village cemetery in the Bangladesh countryside where smallpox victims were buried. The disease is believed to have killed 46 percent of its victims at a hospital in the Dacca, Bangladesh, ravaging the country for centuries.

In 1980, the WHO declared the disease officially eradicated, after a decade-long vaccination campaign. The last remaining samples of the virus are being held in facilities in the United States and Russia.


Plague


Unlike smallpox, this ancient killer is still with us. Caused by a bacterium carried by fleas, plague has been blamed for decimating societies including 14th-century Europe during the Black Death, when it wiped out roughly a third of the population, including in Basel, Switzerland, depicted in this painting from 1349. The disease comes in three forms, but the best known is bubonic plague, which is marked by buboes, or painfully swollen lymph nodes. Though antibiotics developed in the 1940s can treat the disease, in those who are left untreated, plague can have a fatality rate of 50% to 60%, the WHO said.


Malaria


Although it is preventable and curable, malaria has devastated parts of Africa, where the disease accounts for 20 percent of all childhood deaths, according to the World Health Organization. It is present on other continents as well. A parasite carried by blood-sucking mosquitoes causes the disease, which is first characterized by fever, chills and flu-like symptoms before progressing on to more serious complications. By 1951, the disease was eliminated from the U.S. with the help of the pesticide DDT. A subsequent WHO campaign to eradicate malaria was successful only in some places, and the goal was downgraded to reducing transmission of disease, according to the U.S. Centers for Disease Control and Prevention.

The WHO has distributed so-called long-lasting insecticidal nets in order to reduce bites from malaria-carrying mosquitoes, including in Cambodia (shown in image).


Influenza


A seasonal, respiratory infection, flu is responsible for about 3 million to 5 million cases of severe illness, and about 250,000 to 500,000 deaths a year across the globe, according to the World Health Organization.

Periodically, however, the viral infection becomes much more devastating: A pandemic in 1918 killed about 50 million people worldwide. As became apparent from "swine flu" and "bird flu" scares in recent years, some influenza viruses can jump between species.


Tuberculosis


Potentially fatal, tuberculosis or "TB" is caused by the bacterium Mycobacterium tuberculosis, which usually attacks the lungs and causes the signature bloody coughs. In patients suffering from an advanced stage of TB, you can see the effects in a lung X-ray (shown in image). ,

The bacterium does not make everyone it infects sick, and up to one-third of the world's population currently carries the bacterium without showing symptoms. And among people infected with TB (but not HIV), 5% to 10% become sick or infectious at some time during their lifetimes.


HIV/AIDS


At the end of 2018, about 37.9 million people were living with a Human Immunodeficiency Virus (HIV) infection worldwide, with 25.7 million of those individuals in Africa. About 770,000 people worldwide died from HIV/AIDS in 2018; 49,000 of those deaths were in the Americas, according to the WHO.

While many of the worst offenders on this disease list have a long-standing relationship with humans, HIV is a recent arrival. HIV's decimating effect on certain immune system cells was first documented in 1981. By destroying part of the immune system, HIV leaves its victims vulnerable to all sorts of opportunistic diseases. It is believed to have emerged from Simian Immunodeficiency Virus (SIV), which infects apes and monkeys.


Cholera


Cholera causes acute diarrhea that if left untreated can kill within hours. People catch the disease by eating or drinking substances containing the bacterium Vibrio cholerae. The bacteria tend to contaminate food and water through infected feces. Since it can take 12 hours to 5 days to show symptoms, people can unwittingly spread the disease through their feces. Thanks to improved sanitation, cases of cholera have been rare in industrialized nations for the last 100 years, but worldwide it kills between 21,000 and 143,000 individuals every year, the WHO estimates.

During the 19th century, however, cholera spread from its home in India, causing six pandemics that killed millions of people on all continents, according to the World Health Organization. During a cholera epidemic in Peru in 1992, a hospital waiting room (shown in image) was converted to an emergency cholera ward.

More recently, a cholera outbreak in Haiti, which began after that country's devastating 2010 earthquake, had sickened more than 810000 people and killed nearly 9,000, according to a report published in 2018 in The Journal of Infectious Diseases.


Rabies


No longer a significant threat in the United States, rabies is still a deadly problem in other areas of the world. Rabies causes "tens of thousands" of deaths every year in countries in Africa and Asia, according to the WHO. Approximately two people die yearly in the U.S. from the disease, which is transmitted to humans through the saliva of infected animals, particularly dogs.

The initial symptoms of rabies can be hard to detect in humans, as they mimic that of the flu and include general weakness, discomfort and fever. But as the disease progresses, patients may experience delirium, abnormal behavior, hallucinations and insomnia, according to the Centers for Disease Control and Prevention (CDC). To date, fewer than 10 people who have contracted rabies and started to exhibit symptoms have survived.

However, a rabies vaccine does exist and is usually very effective in both preventing infection with the virus and treating infected individuals before they begin to show symptoms.


Pneumonia


Pneumonia might not conjure up the same dread as diseases like rabies or smallpox, but this lung infection can be deadly, especially for those older than 65 or younger than 5.

The disease can be caused by bacteria, a virus or a combination of both, according to Dr. Amesh Adalja, an infectious-disease specialist and a senior associate at the University of Pittsburgh Medical Center's Center for Health Security. A person can also get pneumonia from a fungal infection, parasites or reactions to certain medicines, Adalja told Live Science in September 2016.

In 2017, there were 49,157 deaths from pneumonia in the United States, according to the CDC.


Infectious Diarrhea


Rotavirus, the most common cause of viral gastroenteritis (inflammation of the stomach and intestines), is a diarrheal disease that can be deadly. In 2013, rotavirus killed 215,000 children under the age of 5 globally, according to the WHO. About 22 percent of those deaths occurred in India alone; and overall most of the deaths occur in children living in low-income countries.
The virus causes dehydration, brought upon by severe, watery diarrhea and vomiting. There are four rotavirus vaccines that are considered highly effective at preventing the disease, the WHO says.


Ebola


Though rare, Ebola virus disease (EVD) is an often fatal infection caused by one of the five strains of the Ebola virus. The virus spreads very rapidly, overcoming the body's immune response and causing fever, muscle pain, headaches, weakness, diarrhea, vomiting and abdominal pain. Some who contract Ebola also bleed from the nose and mouth in the late stages of the disease — a condition known as hemorrhagic syndrome.

The Ebola virus is spread from person to person through bodily fluids, and a healthy person can contract the virus by coming into contact with an infected person's blood or secretions or by touching surfaces (like clothing or bedding) containing these fluids.

The largest outbreak of Ebola began in West Africa in 2014. When the outbreak ended in 2016, approximately 11,325 people had died in the outbreak, with 28,652 suspected and confirmed cases of the virus reported, according to the CDC. In August 2018, the Democratic Republic of Congo announced an outbreak of Ebola in its northern province of Kivu. That outbreak, which has infected 3,428 people and killed 2,246 as of February 2020, is still ongoing. A vaccination for close contacts of Ebola patients, called rVSV-ZEBOV, was approved in 2019.


Variant Creutzfeldt-Jakob disease


Its name is not the only complicated thing about variant Creutzfeldt-Jakob disease, or vCJD. This rare and fatal disease is, as its name implies, a variant of Creutzfeldt-Jakob disease (CJD). It's classified as a Transmissible Spongiform Encephalopathy (TSE) — transmissible because it can be spread from cattle to humans and spongiform because it causes a characteristic "spongy" degeneration of brain tissue.

Humans can get vCJD when they eat beef from cows with Bovine Spongiform Encephalopathy (BSE), a disease similar to vCJD that occurs in cattle. Between 1996 and March 2011, approximately 225 cases of vCJD were reported in the United Kingdom and several other countries. Before 1996, scientists didn't know that people could acquire CJD from eating meat contaminated with BSE. Most people who had the disease prior to then acquired it sporadically or because of a particular gene mutation linked to the disease. And about 5 percent of all reported cases resulted from accidental transmission of the disease via contaminated surgical equipment or certain eye and brain tissue transplants.

Individuals infected with vCJD tend to be younger than those infected with CJD. The median age of people with vCJD is 28, whereas that for CJD patients is 68, according to the WHO. Those with the variant version of the disease tend to exhibit psychiatric symptoms, including depression, apathy or anxiety.


Marburg


Marburg virus belongs to the Filovirus family of viruses, whose defining characteristic are the filamentous shapes of the viral particles. The disease it causes, Marburg virus disease (MVD), is spread from person to person through bodily fluids, much like Ebola. Marburg virus has other things in common with Ebola, as well. It's transferred to humans by fruit bats belonging to the Pteropodidae family, and it can cause viral hemorrhagic fever in some patients.

Marburg virus was first identified in Germany in 1967 after lab workers who had handled infected monkeys imported from Uganda became sick with the virus, according to the WHO. Monkeys, like humans, can be infected with Marburg virus. Fruit bats, however, aren’t sickened by the Marburg virus (or the Ebola virus); they are simply reservoirs or hosts of the virus.


Middle East respiratory syndrome (MERS)


As if bat-borne diseases like Ebola and Marburg weren't enough, it turns out the flying mammals are also host to another deadly disease:  Middle East respiratory syndrome, or MERS, a viral respiratory disease that was first identified in 2012 in Saudi Arabia. However, though MERs originated in bats, its major reservoir in the Middle East is likely dromedary camels, according to the WHO.

The MERS coronavirus (MERS-CoV) is closely related to SARS and the 2019-ncOv coronavirus currently spreading in China. People who contract MERS develop severe respiratory illness, including fever, cough and shortness of breath. As of 2020, 2,494 cases of the illness had been reported, mostly in Saudi Arabia. About 34% of those who contracted the illness died, according to the WHO.


Dengue


Mosquito-borne viruses — of which dengue is one of many — kill an estimated 50,000 people worldwide every year, according to the WHO and the CDC. (Malaria isn't included in that estimate because it's caused by a parasite, not a virus.)

Dengue (pronounced den' gee) is a disease that can be caused by one of four related viruses: DENV 1, DENV 2, DENV 3 and DENV 4. Mosquitos — usually the species Aedes aegypti (shown here), but sometimes A. albopictus — spread the disease from one person to the next. It's not possible for people to catch dengue from one another. People with the disease typically experience flu-like symptoms. Sometimes the virus leads to a potentially lethal complication known as "severe dengue" or dengue hemorrhagic fever, with symptoms that include fever, abdominal pain, vomiting, bleeding and trouble breathing, according to the WHO.


Yellow Fever


Like dengue, yellow fever is a member of the Flavivirus family, and it spreads from one person to the next by mosquitos. The disease gets its name from a symptom experienced by a small percentage of infected patients: jaundice, or yellowing of the skin and eyes.

However, most people who contract the virus never develop jaundice or any other severe symptoms. The small percentage of patients who do develop such symptoms are those who enter a second, more toxic, phase of the disease that affects their body systems, including the liver and kidneys. Half of the patients who enter the toxic phase of yellow fever die within 7 to 10 days, according to the WHO.

Luckily for those living and traveling in one of the 47 countries in Central America, South America and Africa where yellow fever is endemic, there is a highly effective vaccine against the disease. That was not the case in the 17th century, when yellow fever was first transported to North America and Europe, where it caused huge outbreaks and, in some cases, decimated populations, according to the WHO.


Hantaviruses


Hantaviruses are spread to humans by rodents, particularly mice and rats. People can become infected with a hantavirus if they come into direct contact with the bodily secretions of these animals or if they breathe in virus-carrying particles from those secretions that have become aerosolized.

The Sin Nombre hantavirus was first identified in the U.S. in 1993 after a mysterious disease killed several young people in the Four Corners region of the Southwest. Half of the 24 patients initially infected with the Sin Nombre virus died from the disease — a severe respiratory infection known as hantavirus pulmonary syndrome, or HPS.

Outside of the U.S. — in Asia, Europe and some parts of Central and South America — hantaviruses can cause another severe illness, known as hemorrhagic fever with renal syndrome, or HFRS. The initial symptoms of this disease are similar to those of HPS and include fever, vomiting and dizziness; but HFRS can also cause hemorrhaging and kidney failure.


Anthrax


You might be familiar with anthrax from the anthrax attacks in September 2001 in the U.S., which killed five people and sickened 17, and which collectively are considered the worst biological attack in U.S. history.

You might be familiar with anthrax from the anthrax attacks in September 2001 in the U.S., which killed five people and sickened 17, and which collectively are considered the worst biological attack in U.S. history.

Anthrax is an infectious disease caused by the bacterium Bacillus anthracis, which lives in soil and usually infects wild and domestic animals, such as goats, cattle and sheep. Humans usually get the disease when they handle infected livestock or animal products. Though you can get anthrax when bacteria spores enter your skin, those who work with animal hides or wool that may be infected with anthrax are also susceptible to inhaling B. anthracis. This pulmonary method of infection with the disease is more lethal, with 92 percent of reported cases resulting in death.


MRSA "Superbug"


Short for methicillin-resistant Staphylococcus aureus, MRSA is a type of "staph" bacterium that is capable of causing life-threatening skin and bloodstream infections and is resistant to most antibiotics used to treat such infections.

MRSA's resistance to antibiotics began in the 1940s, when doctors started treating staph infections with penicillin. The overuse (and misuse) of the drug helped microbes evolve resistance to penicillin within a decade, according to a feature in Harvard Magazine, causing doctors to start treating staph infections with the drug methicillin. But MRSA developed resistance to methicillin, as well. In fact, the superbug is now resistant to many penicillin-like antibiotics, including amoxicillin, oxacillin, dicloxacillin and all others in the beta-lactam class of antibiotics.

Staph infections on the skin typically start off as small red bumps but can turn into large abscesses that need to be surgically drained, according to the Mayo Clinic. More serious infections with the bacteria can occur throughout the body, including the blood, heart and bones. Such infections can be deadly.


Pertussis


Also known as whooping cough, pertussis is a bacterial infection of the respiratory tract caused by the bacterium Bordetella pertussis. As its name suggests, the telltale symptom of whooping cough is severe coughing.

Pertussis is particularly dangerous for babies, who can experience apnea, or pauses in breathing, as a result of the prolonged coughing fits brought about by the disease, according to the CDC. About 50 percent of infants who become sick with whooping cough need to be hospitalized, and 25 percent of those who are hospitalized develop lung infections, according to the CDC. Most people who died from whooping cough (87 percent) between 2000 and 2012 were babies less than 3 months old. The best way to prevent pertussis is to get vaccinated, according to the CDC. There are two vaccines for whooping cough, one for children younger than 7, called DTap, and one for older children, teens and adults, called Tdap.


Tetanus


The same vaccine that defends against pertussis (Tdap) can also protect you from tetanus, an infection caused by the bacteria Clostridium tetani. Once in the body, C. tetani produces a toxin that causes painful muscle contractions, according to the CDC. The neck and jaw are usually the first parts of the body affected by the disease, leading to tetanus' other name, "lockjaw."

The bacteria that cause tetanus enter through the skin but live in dirt or soil (as well as stuff lying around in the dirt, like rusty nails) and on the intestines of animals and people.


Meningitis


Meningitis refers to inflammation of the meninges, or the membranes that cover the brain and spinal cord. This infectious disease can be caused by a number of things, including fungi, viruses and bacteria. [Related: 5 Meningitis Facts You Need to Know]

Bacterial and viral meningitis are the most common types and can be spread from person to person. Whereas bacterial meningitis is often spread through kissing, viral meningitis is typically spread when someone comes into contact with the feces of an infected person (i.e. when changing a diaper or when a person doesn't wash his or her hands properly after using the toilet), according to the CDC.PLAY SOUND

Some people get meningitis after suffering a head injury, having brain surgery or having certain kinds of cancer. This type of meningitis is not contagious, nor is fungal meningitis, which was responsible for a meningitis outbreak in the U.S. in 2012.

Some people with meningitis develop meningococcal disease, which is caused by the bacteria Neisseria meningitides. The disease causes flu-like symptoms, as well as nausea, vomiting, increased sensitivity to light and an abnormal or confused mental state, according to the CDC.


Syphilis


Syphilis is a sexually transmitted disease that is easily treated but can lead to serious complications if neglected. In the first stage of the disease, sores may appear on a person's genitals or anus. Usually these sores are small and painless, and they heal on their own, leading many people to simply overlook them or confuse them with ingrown hairs or blemishes.

The second stage of the disease is more noticeable and usually begins with a rash on one or more parts of the body. Sometimes these rashes can be very faint, and since they don't itch, people infected with the disease might not know they have it. Others may develop more severe symptoms such as fever, swollen lymph glands and muscle aches.

If syphilis is left untreated throughout the first and second stages of the illness, it can cause much more severe problems later on, according to the CDC. Some people don't develop symptoms of the late stage of syphilis until 10 to 30 years after they contract the disease. Late-stage symptoms include difficulty coordinating muscle movements, paralysis, numbness, blindness and dementia. The disease can also damage internal organs, which may result in death.


Sars


Severe acute respiratory syndrome, or SARS, is the virus behind the 2002 and 2003 pandemic that killed more than 750 people worldwide. SARS is spread to people by bats, much like Ebola viruses, Marburg virus and MERS. The SARS virus likely originated in horseshoe bats in China, according to the National Institutes of Health.

SARS is characterized by high fever, dry cough, shortness of breath and pneumonia, according to the WHO.


Leprosy


A contagious, chronic disease, leprosy is caused by a bacterium known as Mycobacterium leprae. Also called Hansen's disease, after the Norwegian doctor who found the responsible bacterium, leprosy affects the skin, peripheral nerves, upper respiratory tract and eyes. If left untreated, it can cause muscle weakness, disfigurement and permanent nerve damage, according to the WHO. [Related: 6 Strange Facts About Leprosy]

People with leprosy used to be quarantined to prevent the spread of the disease, but as doctors now know, the condition is not highly contagious. The disease is transmitted through droplets expelled when an infected person coughs or sneezes. Simply touching a person with leprosy will usually not cause infection, and a healthy person's immune system can typically ward of infection with the bacteria that cause the disease, according to the U.S. National Library of Medicine. However, children are at greater risk of contracting leprosy than adults.


Measles


One of the most contagious of all infectious diseases, measles (also called rubeola) causes a characteristic red rash on the skin. Other symptoms of this viral disease are similar to that of the common cold.

Measles is so contagious that 90 percent of the people who simply stand near someone with the virus will become infected, according to the CDC.

"Near means within 50 feet or entering a room where the measles person had been in — even two hours after the infected person left the room," Aileen M. Marty, professor of infectious diseases at the Herbert Wertheim College of Medicine and member of the WHO Advisory Group on Mass Gatherings, told Live Science.

Luckily, there's an easy way to defend yourself against the measles virus: Get vaccinated. Out of every 1,000 people vaccinated against measles, 997 will never get the disease.


Zika



First identified in Africa in 1947,  Zika virus is a flavivirus spread by mosquitoes in the Aedes genus. While the disease caused by Zika virus isn't particularly dangerous for most people, it can cause serious complications for fetuses and newborns.

Only one in five people infected with the virus becomes ill, according to the CDC. Those who do become ill may have a fever, rash, joint pain and conjunctivitis (pink eye), but these symptoms are typically mild and last only a few days. However, serious birth defects, particularly microcephaly, have been linked to the Zika virus, and the virus can also cause miscarriage in pregnant women, according to the Pan American Health Organization.

NSA Creating Spy System To Monitor Domestic Infrastructure

The National Security Agency has begun work on an "expansive" spy system that will monitor critical infrastructure inside the United States for cyber-attacks, in a move that detractors say could end up violating privacy rights and expanding the NSA's domestic spying abilities.

The Wall Street Journal cites unnamed sources as saying that the NSA has issued a $100-million contract to defense contractor Raytheon to build a system dubbed "Perfect Citizen," which will involve placing "sensors" at critical points in the computer networks of private and public organizations that run infrastructure, organizations such as nuclear power plants and electric grid operators.


In an email obtained by the Journal, an unnamed Raytheon employee describes the system as "Big Brother."

"The overall purpose of the [program] is our Government...feel[s] that they need to insure the Public Sector is doing all they can to secure Infrastructure critical to our National Security," the email states. "Perfect Citizen is Big Brother."

"Raytheon declined to comment on this email," the Journal reports.

Some officials familiar with Perfect Citizen see it "as an intrusion by the NSA into domestic affairs, while others say it is an important program to combat an emerging security threat that only the NSA is equipped to provide," the Journal states.

The program is reportedly being funded under the Comprehensive National Cybersecurity Initiative, a program launched by the Bush administration in January, 2008, and continued under the Obama administration. The initiative is budgeted to cost $40 billion over several years.

ANOTHER WAR WITHOUT DEFINITION?

News of the spy system comes in the wake of months of news reports and government statements on the the threat of cyber-attacks. Last year, the US pointed the finger of blame at North Korea for a "widespread" attack on US and South Korean government computers. Earlier this year, a coordinated attack on Google servers was identified as originating from China.

But many observers say the threat of cyberwar is exaggerated, and they suggest that profit may be a motive behind efforts to build cyber-defense systems.

"It's about who is in charge of cyber security, and how much control the government will exert over civilian networks," writes security technology expert Bruce Schneier at the CNN Web site. "And by beating the drums of war, the military is coming out on top."

Schneier sees danger in the media "mislabeling" activities like computer hacking and "cyber-activism" as "cyberwar."

"One problem is that there's no clear definition of 'cyberwar.' What does it look like? How does it start? When is it over? Even cybersecurity experts don't know the answers to these questions, and it's dangerous to broadly apply the term 'war' unless we know a war is going on."

MONEY TO BE MADE

In a report published last month, Cecilia Kang at the Washington Post described cyber-security as "Washington's growth industry of choice," and companies in the business are "in line for a multibillion-dollar injection of federal research dollars."

Kang reported: Delivering the keynote address at a recent cybersecurity summit sponsored by Defense Daily, Dawn Meyerriecks, deputy director of national intelligence for acquisition and technology, said that along with the White House Office of Science and Technology, her office is going to sponsor major research "where the government's about to spend multiple billions of dollars."





Also:

Is the NSA's 'Perfect Citizen' the Ultimate Spying Tool?

Could the NSA's new "Perfect Citizen" actually be used for spying on every citizen in the U.S.?

The name sounds like an action movie -- the heroic vigilante chases down the bad guys to aid his country and prevent a nuclear armageddon. It also sounds like the worst possible name for a government program intended to protect citizens, not spy on them.

The NSA's new cyber-security program Perfect Citizen will monitor nuclear power plants, train stations, and the electric power grid to safeguard against cyber-assaults.

And as the Wall Street Journal reported, the new program is intended to monitor cyber-terrorist threats and "would rely on a set of sensors deployed in computer networks for critical infrastructure that would be triggered by unusual activity suggesting an impending cyber attack."

According to that report, Raytheon was awarded a $100M contract to develop Perfect Citizen. (Raytheon declined to comment to FoxNews.com, as did the NSA other than describing Perfect Citizen in an official statement as a "research and risk-assessment" project that does not use sensors.)

How would such a system work? Why do experts fear it could be turned against us? And should the government really be in the business of installing sensors on the private power grid and at nuclear plants owned by private companies?

Fighting cyber-attacks

Your local power plant was built long before Google became a household name. Yet just about every nuclear power plant, train station, subway system and local power company now connects to the outside Internet, either for employees to access their e-mail or just to check the weather.

And many utility companies provide remote access for workers to monitor these utility systems; some plants are even interconnected over the Internet to share data.

Perfect Citizen will analyze these attack vectors and plug any security holes. Yet experts claim the new program is just a stop-gap measure -- a band-aid on an old wound.

"Cybersecurity wasn't even a concept when these infrastructure systems were built, and yet they have now all been connected and interconnected online -- making them high profile targets for a cyber-attack," says Hemanshu Nigam, a security consultant who advises Congress on cyber-security.

"Finding anomalous activity will do very little to prevent real cyber-attacks, especially since Perfect Citizen will not be 24/7 and will not be all encompassing [to every point of entry into these systems]."

Nigam says Perfect Citizen is a very broad security program. It will monitor nuclear plants and the electric grid for denial-of-service attacks, which is when hackers -- many of them from China and Russia -- send repeated requests to a computer to cause an overload and failure. Nigam says cyber-terrorists already know the NSA fights denial-of-service threats and will attack through other means.

Interestingly, a more likely attack vector at power plants is the Web browser on an employee's workstation, says Bradley Anstis, a vice president at M86 Security. A terrorist might use malware that tricks an employee into installing a virus, which then infects higher-level systems -- such as a command and control server -- on the same network.

Krish Shetty, the CEO at Wiznucleus, a company that specializes in protecting nuclear power plants and power companies from cyber-assaults, says protecting the aging utility infrastructure in the U.S. requires a risk-assessment for every plant and at every endpoint -- and that Perfect Citizen is a step in the right direction. Yet the challenge is in correlating why a cyber-attack occurred at one power plant and learning from that new attack.

Nigam suggests a similar ground-level approach to protecting power plants. He advocates grants and incentives to companies to build their own private security layer.

Mike Lloyd, the chief scientist at the security company RedSeal Systems, says our current utility cyber-defenses are weak compared to what they should be. He says a terrorist only has to find one weak spot, but a security defense needs to protect against every conceivable attack.

The main issue with protecting utilities is that they are incredibly complex -- not just one company at an office, but multiple buildings and networks, a complex infrastructure with antiquated systems.

The next step: no more privacy?

If Perfect Citizen really is a series of sensors that monitor cyber-attacks, it's easy to envision how this same network could be used for monitoring everyday citizens.

With any NSA program, communication is a one-way street, noted Nigam. There won't be any new official information about the Perfect Citizen program, so it's left to the experts to hypothesize about what it really is -- and the true nature of the program, he says.

They have. And they're worried about what the NSA is planning.

For starters, there's a Wired.com report that claims the NSA has teamed with Homeland Security to get around any legal entanglements, hinting at a justification for spying on U.S. citizens. And a story in The Economist declares a new cyberwar that involves secret cyber-weapons and cyber-armies from Iran, North Korea, and Russia attacking utility companies and the grid.

In the Wall Street Journal, an unnamed military official said Perfect Citizen is long overdue and that "any intrusion into privacy is no greater than what the public already endures from traffic cameras."

All told, Nigam maintains that Perfect Citizen is a result of new beefed up security measures, partly due to an influx of funding for the Comprehensive National Cybersecurity Initiative.

"The Obama Administration is playing catch-up. And so for that reason alone it needs to invest more than ever," says Nigam. "Such spending is fully warranted only if it is directed to the right areas, and right now the Perfect Citizen program is not a good example of that."

Digital Driver’s License - Your ID In Your Smartphone


The world is evolving rapidly towards mobile and digital formats for many everyday tasks.

Key drivers for this trend are convenience and ease of use for transactions that require some form of identification. And one of the most used documents to confirm identity is looking at going down this route - the driver's license .

The primary goals of the driving license, whether physical or digital, remain to confirm identity and to confer the right to drive a vehicle.During the course of the last two years, studies and pilots have been launched in several states in the US to explore the technical feasibility of a digital driver's license.

There, digital driver's licenses also named mobile driver's licenses are set to retain the key visual aspects of a physical driver's license, displaying the driver's personal information - name, address and date of birth, along with his photo.

Various technologies are considered to address but security and user friendliness will be key drivers.

There's more.

The topic is now receiving even more federal attention.

In August 2016, the U.S. Commerce Department's National Institute of Standards and Technology (NIST) awarded a grant to further support the development of trusted identities based on Digital Driver's License provided by states.

Through a $2M grant awarded to Gemalto, four jurisdictions – Idaho, Colorado, Maryland and Washington D.C. – are implementing a pilot for a secure Digital Driver's License (DDL), which many believe to be the future of trusted identities. ​​​​​In 2017, Wyoming decided to join the pilot. ​

Discover in detail and pictures the July 2017 DDL pilot in Colorado​.

There are striking similarities in challenges and potential benefits with what is called a "national eID scheme" in many other countries where states are including digital identity as a defining feature in a digital space of trust, with good levels of security, interoperability and data protection.

See our January 2016 white paper on national identity schemes to learn more on this topic. ​​
Digital driver licenseConvenience of the mobile format – potential new identification use cases​​

Beyond the important security aspects, issuing authorities have shown particular interest in the universal convenience of this mobile format:​

    Convenience for holders, who can travel lighter with a digital driver's license, instantly updatable, on their phone.
    Convenience for law enforcement or other parties wanting to verify identity and privileges.
    Convenience for issuing authorities who can explore new services needing such a trusted and secure channel for sharing and validating identity.

The driver's license has been a standard for decades, acting not just as proof that you can drive but as an ID to verify age and identity, opening mobile driver's license to many usages such as:

    Police control: roadside stops to identify the driver of a vehicle and his/her privileges.
    Proof of age: where purchase of alcohol, as in many countries, is restricted to people aged 18 or more, verified by the retailer.
    Car rental: to identify the renter, ensure driving privileges and share attributes (address…etc )
    Identity validation or confirmation for hotel check-in, financial institutions, social services...
    Online authentication: from access control to identity verification…

When could you use a DDL?
Digital driver's license - The 2016-2017 US landscape​

Iowa was the first state decide to test digital driver's license in 2014. It started a pilot on an IOS platform with 100 state employees at the end of 2015. The goal was to test the daily usability of the solution. The Department of Transportation hopes to make the app public in 2017.

Several legislatures (legislative body of States in the United States) authorize the study of smartphone driver's license app such as Arizona, Illinois, Utah and Texas to name a few.

Some other states have legislation under consideration. Idaho, Colorado, Maryland and Washington D.C are now on their way to set up a pilot funded by a federal grant.

    In Tennessee, legislation (HB556) enacted in May 20, 2015 authorizes the State DMV to develop a secure "electronic driver license system" and to display electronic images on a cellular phone or any other portable electronic device.
    In Arizona the Senate Bill 1237 bill was passed and signed on May 11, 2016.  The Arizona Department of Transportation (ADOT) has to study and specify what may be done with an electronic driver license.
    In Utah, Bill 227 effective in May 2016 requires the Driver License Division and Department of Technology Services to study and report findings and recommendations regarding electronic driver licenses.
    In Louisiana, Bill 481 was signed by Governor Edwards on June 23, 2016. The law outlines requirements for a digitized driver's license. It allows persons to use the digitized license in lieu of a physical license when stopped by law enforcement.  The proposed law provides that display of the digital driver's license shall not serve as consent to search the mobile device. A fee of up to $6 can be charged for use of the drivers license app.
    Kentucky was considering the topic as well but the feasibly study has not been launched as the measure did not receive ​a hearing.
    In California, the state legislature passed a bill (February – September 2015) to study the feasibility of a digital mobile driver's license app for smart phone. It was however vetoed by Governor of California Jerry Brown in October 2015.
    In New Jersey, the bill introduced in January 2016 has been withdrawn from consideration in February 2016.
    In Illinois, the Legislature approved a resolution in 2015 that created an Electronic Driver's License Task Force to study the feasibility of a digital/mobile DL.  The Task Force reported its finding on April 21, 2016. It recommended that the Secretary of State continue to monitor advancements in mobile driver's license technology.
    In March 2015, North Dakota passed HCR 3036, a bill to study implications of driver's licenses for smart phones. However, the measure has not been considered as of October 2016 by Legislative Management.
    In August 2016, through a $2M grant awarded to Gemalto, Idaho, Colorado, Maryland and Washington D.C. are to set a pilot for a secure Digital Driver's License (DDL). Its goals are to define and create a convenient and secure way for citizens and authenticating parties to exchange and verify government-issued credential information via smartphone.
    In 2017 Wyoming joined this initiative.
    On March 21 2017, in Arkansas, the  Senate Bill 428​ was signed into law  and is allowing the Office of Driver Services to issue a digital copy of an Arkansas driver’s license for a $10 fee.
    In July 2017, Colorado and Maryland started a live pilot. Follow the progress of the DDL pilot​ on our dedicated pages. September 2017 was dedicated to full pilot analysis, conclusion, lessons learned, best practices​. Stay tuned for the December 2017 phase of the pilots.

​The American Association of Motor Vehicle Administrators Working Group is looking at DDL standards and their specifications.


The legal environment is also positively impacted by the famous Riley v. California case of September 2014. The United States Supreme Court ruled that Police may not, without a warrant, search digital information on a mobile phone seized from an individual during an arrest.

This makes it easier for states to implement DDL solutions since the court is clear: police cannot arbitrarily search phones.​
Other initiatives around the world

    In Australia, New South Wales announced in November 2015 the introduction for 2016 of digital driving licenses on smartphones and in February 2016 the press revealed that Victoria is also analyzing technology to produce a digital driver's license app in the next few months. Western Australia State announced a plan to turn driver's licenses into digital IDs in April 2016.

    New South Wales' Premier Mike Baird promised to introduce the digital license within four years. However a lot of co-operation will be needed to set up a working multi-jurisdictional approach in the country.

    In November 2016, NSW's Minister for Finance, Services and Property Dominic Perrottet said  that digital driver licences will be introduced by 2019. A pilot in Dubbo​ started in November 2017.

    In October 2016​, senior officials at the Dutch road transport authority have made it clear that the country is working on a mobile app version​ of the license that would accompany a card.​

    In May 2016,  Britain's Driver and Vehicle Licensing Agency (DVLA)​ revealed it was also working on a digital driving licence for smart phones and showed a "prot​otype" of a feature that would let people store their license in their phone and turn driver's iPhone into an ID. According to the Daily Mail of March 31, 2017, the ​​Agency will test the system this September and plan a roll out for spring 2018.  The existing UK driving licence will still be available.​​ ​​​
    ​​​In July 2017, CONTRAN, the Brazilian National Traffic Board, approved a proposition for a digital driver's license to be launched in 2018.

​In Other countries like India are investigating this option.
DDL standards at early stage

As of today, the market is at an early stage and standards are not fully defined. In 2016, the ISO SC17 WG10 - Task Force 14 "Mobile Driving Licence" started to work on  verification standards for Mobile DL and defined the scope of off-line verification.

2017 will see draft specs of both off-line and on-line verification appear for a new work item.​​
Mobile driver license
4 key requirements

Mobile driver's license needs to address 4 key requirements in order to gain acceptance as a trusted digital identity.

It needs to be :

    accessible in both online and offline modes,
    highly secure to protect the confidentiality and privacy of user data,
    interoperable between different issuing and verifying authorities,
    able to manag​e the integrity of data throughout its life cycle - from enrolment to the in-field verification process.

For the time being, mobile driving licenses will not replace physical driver's licenses but will exist as a secondary form of ID to complement to these physical driver's licenses.

How would you get a DDL on your phone? 
​Technologies and implementation models from Gemalto​

In September 2015, Gemalto conducted an extensive study with a consumer on-line community gathering 200 members from the United Kingdom and United States. The direct feedback from potential users of the digital driver's license solution revealed the benefits, concerns and the diversity of audiences. These results allowed the company to set up relevant implementation models.

Gemalto Mobile DL solutions bring technology and implementation models which take into account user-friendliness, the local DL schemes and practices (drivers, Police, service providers…), and provide the highest level of security in both credential storage, data transmission and verification.

What's the story here?

Not only does a digital credential bring new layers of security, such as PIN or fingerprint verification, but it is also much more difficult to fraudulently duplicate or alter.

Why?

Because it is checked with the issuer backend in real-time, a fraudulent credential can quickly and easily be identified as invalid, to make verifying even out-of-state digital credentials significantly simpler and more secure.

If a user's mobile device is ever lost or stolen, the digital license can be remotely deactivated or wiped almost instantly.

Secure DDL

Unlike a traditional driver's license card, a mobile driver's license never needs to leave the owner's hands. A person verifying the driving license in the field will have access to advanced real-time authentication through another version of the application on an authentication device – either another smart-phone or a reader.

No footprint is left on the verification device and no geo-location tagging or tracking of user information occurs.

With a digital driver's license, an issuer can have much greater control over in-use credentials compared to a traditional physical license - for example alerting holders when their license is about to expire. Citizens could also update their personal information or even renew their license directly through the application instead of visiting a branch office, saving time and resources.

Control and convenience will prove essential elements for issuers and users on the road to  mobile driver's licenses.

This form of digital credential could enable a new, more efficient and more secure way of authenticating a person and their entitlement for a range of personal identification usages.

New 'Sonic' Attack Reported In Cuba, 19 Americans Now Affected


 
 Sonic Weapons


Nineteen Americans are suffering from a range of symptoms, including mild traumatic brain injury and hearing loss, related to mysterious "sonic harassment" attacks in Cuba -- with a new incident reported just last month.

Previously, U.S. officials said the incidents started in December 2016 and ended this past spring. But State Department spokesperson Heather Nauert revealed Friday that a new incident occurred in August and is now part of the ongoing investigation.

"We can’t rule out new cases as medical professionals continue to evaluate members of the embassy community," warned Nauert, who has described the situation as "unprecedented."

The U.S. government, including the FBI, continue to investigate who and what are behind the incidents, but with no firm answers so far.

The American Foreign Service Association said Friday that its representatives met this week in Washington, D.C., with Foreign Service Officers posted at the U.S. embassy in Havana who have faced diagnoses including mild traumatic brain injury and permanent hearing loss, but also loss of balance, severe headaches, cognitive disruption and brain swelling.

Traumatic brain injury is caused by a violent blow or jolt to the head or body that may cause temporary dysfunction of brain cells or more lasting damage, according to the Mayo Clinic. Symptoms can be immediate or appear days or weeks later, ranging from loss of consciousness or confusion to sensory problems, memory loss, or headache and nausea.

AFSA said they only met with 10 affected because the others were not available; the State Department has said that some of those affected have remained at their posts in Havana.

Sources have told ABC News that some U.S. officials were exposed to a sonic device in Havana that caused serious health problems and physical symptoms. Sound waves above and below the range of human hearing could potentially cause permanent damage, medical experts have told ABC News.

No device or piece of equipment has been discovered yet, according to Nauert. Some of the affected Americans are still experiencing symptoms "because the symptoms are experienced at different times, because the symptoms are different in various people," according to a State Department official.

The Cuban government, which denies any involvement, is said to be cooperating with the ongoing U.S. investigation, but the two governments are not working together on the matter.

In May 2017, the State Department asked two Cuban officials working at the embassy in the United States to depart the country. The State Department said that the move was not a form of retaliation or a sign that the U.S. believes Cuba is behind the attack but rather to punish Cuba for its failure to keep American diplomats safe -- something it is obligated to do under an international treaty known as the Vienna Convention.

AFSA is encouraging the State Department and U.S. government to "do everything possible to provide appropriate care for those affected, and to work to ensure that these incidents cease and are not repeated."

"What has happened there is of great concern to the U.S. government," Nauert has said, defending the U.S.'s response. "Let me just reassure you that this is a matter that we take very seriously.... It is a huge priority for us and we're trying to get them all the care that they need."

There have been no reports of other embassies experiencing this, a senior State Department official said.


By: http://abcnews.go.com/