North Korea's Regime Is Strong (But Kim Jong-un's Death Could Still Destabilize It) What is Pyongyang's contingency plan? by Minseon Ku

Rumors about North Korean leaders’ deaths are not new. Those surrounding Kim Jong-il’s death were rife in South Korea before his “sudden” death was confirmed a month later on December 19, 2011. In hindsight, it is plausible that Kim Jong-il’s health did take a turn for the worse in November, sparking rumors. While current speculations surrounding Kim Jong-un’s health should not be taken seriously in the absence of credible sources, the current situation may be a timely opportunity to probe the “what if” questions in the event of his sudden death. This possibility should be analyzed for its likely impact on North Korea and the region, given the current state of global uncertainty.   

The most critical question to ask related to Kim’s mortality is, who would be his successor? We do not know if Kim has one in mind; even if he does, he has not made his decision public. Kim Jong-un himself became publicly known as Kim Jong-il’s successor in early 2010 after months of internal grooming. This publicity sparked speculations about his involvement in the Cheonan naval ship attack, failed currency reform in North Korea, and the shelling of two northwestern South Korean islands in November that year, all of which were aimed at building his domestic legitimacy.  

But even if Kim Jong-un is dead and has no named successor, history tells us that North Korea has been much more resilient than expected, even during abrupt events. Speculations surrounding regime instability and the possibility of North Korea collapsing following Kim Il-sung’s and Kim Jong-il’s deaths, in 1994 and 2011 respectively, were proven wrong subsequently. On the contrary, Kim Jong-il and Kim Jong-un managed to make North Korea a nuclear state even with years of U.S.-led international pressure and isolation. It is therefore not unthinkable that North Korea, like any other state government, would already have mapped out a post-Kim Jong-un contingency plan that will ensure minimal disruption to internal political stability. 

The second critical question is, what happens to the Korean Peninsula and the region in the event that Kim dies suddenly? Military-wise, South Korea and the United States have joint contingency plans such as OPLAN 5029 to act on in the case of any unexpected instability within North Korea. Past skirmishes between the Koreas that were allegedly initiated by North Korea to promote domestic stability also did not escalate into prolonged, higher-intensity aggressions. 

Given this trajectory of seemingly resilient North Korea, there is, nevertheless, room for greater uncertainty when it comes to a possible “2020 North Korean Leadership Crisis.” Domestically, Kim Jong-un’s young age and short reign pose greater political uncertainty in a country that reportedly possesses 30 nuclear warheads. Regionally, inter-Korea relations have made little progress since the last summit in September 2018. South Korea-Japan diplomatic spats could also create problems for regional security coordination. U.S.-China relations are at their worst since the beginning of the Trump administration following trade war and misinformation war over COVID-19. Internationally, the absence of multilaterally-coordinated response to COVID-19 pandemic has not only questioned U.S. willingness to act multilaterally, but it also suggests how American domestic politics could unintentionally lead to short-sighted security and foreign policy decisions made at the expense of international security and stability. 

Amid this uncertainty within uncertainty, it is still probably best to remain cautiously open to all possibilities while dismissing groundless claims. Because who knows? Kim Jong-un could be the only leader who is able to afford the luxury of taking social distancing to the extreme by canceling his official schedule while enjoying a stay-cation in Wonsan.

Will the Trump White House Make China Great Again in a Post-Pandemic Era? Donald Trump’s range of deflections, failures, misgivings, and utter incompetence in the face of the coronavirus presents a victory for Beijing by default. by Patrick Mendis and Dominique Reichenbach

China is utilizing the novel coronavirus as strategic leverage to vie for global leadership in a post-pandemic era. Meanwhile, due to a lack of visionary leadership, the United States continues to falter and maim its international reputation, which could lead to a significant shift in the world order 

Even with its series of initial mistakes in handling the epidemic, China has effectively used a scientific and health-driven approach to combat the coronavirus. President Donald Trump’s economic-fueled approach has undermined scientists and health professionals and rejected his own intelligence and military briefers.  

China’s sweeping geopolitical strategy provides opportunities from Europe to Africa; whereas, Trump White House’s provincial approach uses Taiwan and Sri Lanka as pawns. With his lack of diplomatic acumen and strategic vision for the United States, President Trump’s range of deflections, failures, misgivings, and utter incompetence in the face of the coronavirus presents a victory for China by default.

Evolving Coronavirus Response 

To deflect blame, Trump recently announced a halt in World Health Organization (WHO) funding while a review is conducted to evaluate its role in “mismanaging” pandemic response. Continuing the pattern of diversion, his own White House trade adviser Peter Navarro was recently humiliated for misrepresenting historical facts to conceal mistakes. Yet, to remind Americans he is a “cheerleader” for the United States, Trump also ensured that his name is printed on stimulus checks, an unprecedented form of retail politics with an inferiority complex. 

Meanwhile, Beijing continues to pursue geopolitical ambitions and has emerged as the perceptive leader in humanitarian response. Its “donation diplomacy” has provided thousands of masks, ventilators, and even doctors as well as millions in relief aid from Europe to Africa. President Trump invoked the Defense Production Act to initially halt the export of 3M facemasks to neighboring Canada and beyond. Ironically, the United States has accepted more Chinese aid than it provided to its own people as the “White House airlifts medical supplies from China in coronavirus fight.” 

Indeed, Chinese aid to the United States and beyond comes after its initial coronavirus cover-up that endangered the world. Some even suggest that China’s generous aid is an attempt to blur this memory. However, the aid indeed represents a strategic opportunity to transform the Belt and Road Initiative (BRI) into a new Health Silk Road, bolstering its global reputation.  

Sino-American Tensions in Taiwan

Beijing and Washington spent weeks casting accusations at one another, involving Taiwan and the WHO; however, surprisingly, they seem to be moving towards cooperation. On March 26, Trump tweeted that he finished a “very good” conversation with President Xi Jinping, stating “we are working closely together. Much respect!”

Ironically, Trump slighted China by signing the Taiwan Allies International Protection and Enhancement Initiative or TAIPEI Act into law on the very same March 26. The legislation, which China has called “evil,” all but recognizes Taiwan’s independence. It encourages other countries to establish relations with Taiwan, promising to increase the U.S. “economic, security, and diplomatic engagement” with nations that do so. It even threatens to punitively “alter” its engagements with nations that undermine Taiwan. Given China’s “one country, two systems” policy and its reunification desires, the TAIPEI Act is considered sabotage against China.  

Ultimately, the Trump administration hopes that this act will bolster democracy abroad and pressure other countries into choosing a partnership with the United States instead of China. The Trump administration believes that the economic and diplomatic benefits in this legislation and the Taiwan Travel Act will serve as a more attractive alternative to China’s BRI.

While this act may enhance U.S.-Taiwan relations, it is nothing more than a lame attempt to curb China’s growing influence. China’s BRI— estimated to incorporate up to $8 trillion in infrastructure development projects and connecting more than one hundred countries—is far more attractive than the futile TAIPEI Act’s subtle threats and vague promises. At this point, there is virtually no benefit for most countries to join U.S. ranks, which suggests that China is successfully shifting the global order. 

Actions Speak Louder Than Words

Sri Lanka, for example, is a country becoming increasingly more important to U.S. and Chinese foreign policy goals. U.S. Ambassador Alice Wells called Sri Lanka an important piece of “real estate” given its strategic location in the Indian Ocean, which would allow the United States to sustain maritime supremacy and contain Chinese expansion. However, the United States is losing its grip over Sri Lanka made evident by its failure to renew its Status of Forces Agreement, even after pledging $480 million in development aid via the Millennium Challenge Compact (MCC). The United States and Sri Lanka spent months debating the strings-attached MCC compact, which the Colombo administration ultimately declined to sign.  

Meanwhile mere days after an urgent request from the Colombo administration, China extended a ten-year $500 million concessionary loan to help Sri Lanka manage the coronavirus. China has the power of the purse and Sri Lanka is shifting alliances accordingly like many other countries. The TAIPEI Act will be unlikely to sway Sri Lanka from a Chinese partnership. Similarly, Taiwan is losing diplomatic relationships to China, now only possessing fifteen.   

Even before the coronavirus crisis, the United States’ reputation was losing to China. For instance, the United States failed to persuade its closest intelligence-sharing alliance of “Five Eyes”—Australia, Canada, New Zealand, and the UK—to choose 5G development partnership with Washington over Beijing’s Huawei.  

China has taken advantage of the coronavirus to pursue economic partnerships that advance its foreign policy goals. Meanwhile, the Trump administration’s shortsighted policies that use Taiwan as a pawn are leading the United States into a natural defeat in geopolitics. If Trump continues to pursue failed policies, distrust allies, and shirk global responsibilities, then China will be well-poised to replace the United States as the global leader in a post-pandemic era—not by design but by default. 

How to Get Coronavirus-Relief Efforts on North Korea Right With nuclear negotiations in any case stalled out, the appropriate policy for the United States is not to promise aid directly, but to continue to waive those sanctions that are needed for any relief effort. by Stephan Haggard

Humanitarian disasters in closed, authoritarian regimes pose particular challenges to the international community. Government actions can exacerbate or even create crises; this was certainly true of the great famine of the early 1990s. Yet the victims of the regime’s choices are innocents, including overstretched but dedicated doctors and health care workers. If the sanctions regime is impeding an outside humanitarian response, it needs to be adjusted–and quickly. There is evidence—outlined below—that sanctions exemptions are being granted to multilateral institutions and NGOS with greater speed. But by sheer proximity, China and South Korea are best positioned to play a role, and should exploit the discretion they are being given to act.

Where do things currently stand with respect to COVID-19 in North Korea? (The best English-language aggregator is NKPro’s, which includes a thorough timeline). There can be little question that the government moved quickly to close the border and initiate quarantine protocols on those entering or returning to the country. These restrictions began on January 21 with tourism (overwhelmingly Chinese and an important source of foreign exchange that did not fall under multilateral sanction) and within a week, the border had been closed almost altogether. The one land port of entry that remained open—across the bridge linking Dandong and Sinuiju—got snarled in the border closure and quarantine protocols on both sides, although trade resumed in April.

By the fourth week of January, state media were openly addressing the issue domestically as well and Rodong Sinmun covered domestic quarantines in several provinces as early as March 1. Yet transparency remains an issue. To date, the regime has still not announced the presence of any cases in the country, even though underground sources were reporting deaths from COVID-like symptoms across a number of provinces in early March.

As elsewhere, COVID-19 has both an economic and medical dimension. As a result of the sanctions regime, North Korea is almost completely dependent on China for external sources of supply. Although sanctions evasion is rampant, the country has almost certainly faced an external shock as a result of the border closure. Close analysis of food prices through the first week of March by Benjamin Silberstein at 38North detected an uptick that could reflect both scarcity and panic buying. Prices remain elevated in more recent data (March 20).

More damaging is the fact that the multilateral sanctions regime—while formally permitting exemptions—has proven highly cumbersome to navigate. Product bans have swept up a variety of products that are crucial both to public health generally and to management of COVID-19 in particular. A major concern is the way financial sanctions have impeded the aid effort. The UN and prominent NGOs have repeatedly complained about the difficulty of funding their North Korean operations because of banks’ skittishness in transferring funds to North Korean entities. They have been forced to resort to cash transactions as a result.

The American response to the potential humanitarian crisis in North Korea has been mixed, but broadly reasonable. In contrast to the famine era, North Korea quietly sent out feelers for aid quite early. In mid-February, the State Department issued a sober statement offering support. On March 19, Secretary Pompeo reiterated that offer—and on the Hannity show on Fox News no less—and the President himself reportedly sent one of his personal missives on the issue. But American officials—including Secretary of State Pompeo—as well as outside commenters, have also insisted that sanctions pressure should not be taken off, and North Korea has predictably bristled that aid could be a Trojan horse.

What is said may be less important than what is being done, however; Keith Luse at the National Committee on North Korea has the most granular coverage. As he notes, there has been a lot of high-level communication on the issue of adjusting sanctions in the COVID era: in the UN Secretary-General’s letter to the G20; in the High Commissioner for Human Rights statement and in a joint letter by seven countries—led by China and Russia–to the UN. The latter is rightly seen as a move in the global propaganda war, as Washington, Beijing and Moscow seek to jockey for position in the COVID-19 blame game.

However, we looked closely at the 11 requests for multilateral sanctions exemption through the so-called 1718 committee since December; the information can be found here. We calculated the number of days it took for the committee to issue exemptions to applicants. For those requests made in December and January, the average time for approval was 22 days. For those made in February and March, the time fell to 7 days. Those applying can request that their appeals not be made public, and the committee may not report rejections. Sources with knowledge of the process have told me that the 1718 committee now operates with the intent of three-day turnaround on COVID-19 exemption requests.

These actions are inferior to a wider sectoral review of whether the dual-use net is being cast too widely. Nonetheless, it is clear that exemptions are being granted more swiftly and that the U.S.—given its effective veto power—is allowing COVID-related aid to get through.

Sanctions have a role in getting North Korea back to the table. But President Trump—despite his letters to Kim Jong-un—signaled even before the COVID crisis that he did not anticipate a major initiative on the nuclear question prior to the election. Kim Jong-un has shown his pique by resuming missile tests in 2019, and even into the COVID era. Yet that should be seen as a sign of weakness not strength, including possible domestic pushback to Kim Jong-un’s policy failures with the United States. The Trump administration has been right to play down the actual risks.

With nuclear negotiations in any case stalled out, the appropriate policy for the United States is not to promise aid directly, but to continue to waive those sanctions that are needed for any relief effort. China, the humanitarian community and particularly South Korea should take the lead. South Korea has now authorized its first, small-scale private aid effort. Giving President Moon Jae-in scope for maneuver on the humanitarian front is superior to opening commercial ventures, like the Kaesong Industrial Complex, that provide cash directly to the regime. It is overly hopeful to see this as an opening that will have wider effects, and as noted the North Koreans are wary. But as Secretary Pompeo himself said in his Fox interview, “it’s the right thing to do in a time of crisis.”

China Wants to Crackdown on Hong Kong Beijing wants action soon on two issues that face great local opposition and could spur new protests. by Robert Keatley

Three years ago, when visiting Washington, DC as she neared completion of her term as Hong Kong’s second-ranking official, career civil servant Carrie Lam Cheng Yuet-ngor said she planned to leave government and do something different at yearend—“perhaps social work”.

Would that she had.

Instead, Hong Kong’s then-incumbent chief executive, Leung Chun-ying, ran into such grave political turmoil that he couldn’t win a second term and left under a cloud, the third government head in a row to do so since China regained sovereignty over the former British colony in 1997. That cleared the way for Carrie Lam to become the fourth, which she is managing to excess.

As yet another Beijing-backed local leader required (or quite willing) to enforce unpopular policies on her constituents, Lam has become a political pariah for many of those she is supposed to help enjoy prosperity and stability. Rather than provide strengthened and peaceful self-rule, her term has seen growing mainland interference in Hong Kong affairs and a steady erosion of its promised “high degree of autonomy”—with predictable and growing public opposition. A recent poll found that 68 percent of the public disapproves of her government.

That has made the answer to Hong Kong’s basic question of “Who’s in charge here?” more obvious. Whenever the Chinese Communist Party considers the topic important, Beijing makes the decision and Hong Kong’s administrators must fall in line. Any inconvenient laws or traditions that suggest otherwise can be ignored; true local autonomy is an occasional thing. Most recently, Beijing has decreed that its own officials based in Hong Kong are entitled to guide local affairs even though existing laws state otherwise.

Last week brought an apparent example of such guidance. Hong Kong police arrested fifteen veteran advocates of a more democratic political system for their allegedly illegal roles in mass protests last August and September. They ranged from eighty-one-year-old Martin Lee, a distinguished barrister who helped found the local Democratic Party (no link to the American one) in 1994, to Jimmy Lai, publisher of the Apple Daily, a racy tabloid that thrives on local scandal and anti-communist rhetoric. Others included former members of the city’s Legislative Council (Legco) who are largely retired from active politics. Most are moderate pro-democrats not central to the increasingly violent street protests over the past year led by an angry and frustrated younger generation.

Chief Executive Lam claims—though few believe her—that the arrests had nothing to do with politics and are merely a reasonable exercise of law enforcement, that the accused broke the law by supporting unauthorized demonstrations. But it seems no coincidence that they include people who for years have been on Beijing’s enemies list by agitating for a freer electoral system, something expected if not explicitly promised when China regained sovereignty. They will face court proceedings beginning next month and could be sent to jail, a warning to others like them.

Lam soon acted again. She demoted four cabinet members and named five new ones, a move—local analysts say—intended to tighten control over the civil service (whose members sometimes sympathize with protesters) and to make her administration more pliable whenever Beijing calls. Lam claims she did this only to seek greater efficiency and speedier economic recovery once the covid-19 virus is contained, not to appease the Chinese Communist Party. But many don’t believe her. 

The context for all this extends far beyond Hong Kong’s borders. Ever since he took over as Communist Party General Secretary and the country’s president in 2012, Xi Jinping has been consolidating his power and stifling dissent across China—to a degree not seen since the days of Mao Zedong. Hong Kong hasn’t suffered the harsh repression of Tibet and Xinjiang Province, but it’s clear that its protesters have gone much too far for his taste. The Occupy Central protests of 2014, with their telegenic yellow umbrellas, and the more recent, often violent, demonstrations against local and national policies tarnished Hong Kong’s self-proclaimed goal of being “Asia’s World City,” an attractive center for global finance and commerce. While the city’s economy is no longer crucial to China, it still provides useful financial and other services that Beijing doesn’t want to lose.

The goal of tighter control presumably explains why Xi recently demoted the senior Beijing official in charge of Hong Kong policy and replaced him with a longtime associate with a tough reputation. The new man is Xia Baolong, brought out of semi-retirement after serving as party boss in Zhejiang Province near Shanghai. Unlike his predecessor, he has no personal ties to the city and thus no old friends to favor. Early in his career, he spent years working directly for Xi and most notoriously harried Christian worship, often seen as a rival to Communist ideology. When Xi visited Zhejiang in 2013, he complained about the prominence of religious insignia; party boss Xia soon had more than 1,000 crosses toppled from church roofs and several churches destroyed. In Hong Kong, he’s again expected to be Xi’s enforcer.

Earlier, Xi had fired the central government’s senior man based in Hong Kong—blamed for failing to warn that mass protests would reach such intensity—and deployed another enforcer. He is Luo Huining, former party boss of Shanxi Province who earned a tough guy reputation by cracking down on Tibetans and corrupt officials considered loyal to Hu Jintao, Xi’s predecessor in China’s top two posts.

So what comes next?

Youthful organizers of recent protests say they’ll be back this summer, perhaps even on May 1, following a lull due partly to the coronavirus. They hold both economic and political grievances and blame many problems on China’s role. For example, many college graduates consider the local economy tilted against them, with the best career jobs—such as in finance—going to young mainlanders who have superior command of official Mandarin (and often English) and may have mainland connections that Hong Kong businesses find helpful. Often relegated to second-tier positions, young people worry about ever affording their own homes in a city with perhaps the world’s highest housing costs and one of the world’s greatest income disparities between rich and poor. And because no Hong Kong autonomy is guaranteed past 2047, young people worry about their long term future if Communist Party restrictions are mandated.

This anxiety feeds localism, the sense that young people above all are Hong Kongers and less so citizens of China proper, where authorities don’t reflect their concerns. And that is poison in Beijing where separatism of any kind isn’t tolerated. As a senior official noted recently, protesters have “colluded in a bid to turn Hong Kong into an independent or semi-independent political entity, and a base for infiltration, sabotage, secession and subversion against China.” Beijing repeatedly blames foreign “black hands”—mainly American and British—for promoting such dissent. In particular, it fears letting Hong Kong truly manage its own affairs will prompt similar desires across the border, where no mainland entity can do so.

If major protests resume and include violence, a tough response is likely. The Hong Kong police, according to reports, are receiving special training from the mainland’s People’s Armed Police—crowd control specialists—who teach China’s harsh “philosophy” of law enforcement which includes greater use of modern technology. Mass arrests could ensue, with perceived ringleaders getting little mercy from baton-wielding officers. The goal would be to bring demonstrations to a forceful end. More than seventy-six hundred were arrested in past demonstrations.

There could also be a cancelation of legislative elections scheduled for September. Last year anti-mainland sentiment let pro-democracy candidates win unprecedented victories in voting for District Councils, neighborhood bodies that deal with basic issues like trash collection and street-cleaning. Pro-democrats hope this feeling will endure and let them score more wins, perhaps a majority, in voting for the seventy-member Legco. That’s unlikely because half are selected by interest groups generally loyal to Beijing for political or commercial reasons, rather than by public ballot. But major gains would be an embarrassing setback for Chinese authorities, so the Lam government may be told to call off elections or at least rig the system to exclude opposition candidates—some of whom have already been banned. 

At present, pro-government forces act as if the elections will occur. Two former chief executives, who left office in disgrace but still faithfully echo the party line, have formed a large coalition of establishment figures who support candidates the mainland favors. They seem to assume the unpopular Lam administration needs a boost if its side is to win. “The patriotic pro-Beijing forces should grasp the chance to unite themselves to hit back at the opposition camp and their foreign allies,” asserts Lau Siu-kai, head of a political group that supports the new coalition.     

If Beijing does interfere more directly in the voting, then there will be little pushback from Lam who admittedly has a near-impossible job. She once told a business group that she must serve two masters—authorities in Beijing and the Hong Kong public—and resolving differences is never easy. But she has reflected China’s interests in ways, and with a governing style, that leaves the impression that local priorities come distinctly second. Even taking a recent 10 percent pay cut to show solidarity with a public battered by a virus-caused economic relapse didn’t help much; that came only a day after being widely criticized for accepting a scheduled 2.36 percent raise that leaves her, at more than $600,000 per year, one of the world’s highest-paid politicians. 

Beijing wants action soon on two issues that face great local opposition and could spur new protests. One is the introduction of “patriotic” education in schools, designed to teach students to “love” the Chinese Communist Party and the teachings of Xi Jinping. The other is passage of a long-delayed law against “sedition” that pro-democrats fear would greatly curtail civil liberties permitted under current law. Past efforts to do so have sent protesters into the streets; in the current political atmosphere, the opposition could be even stronger.  

China could respond with an even heavier hand. Beijing’s local office promises that it won’t interfere “in general” in Hong Kong affairs, but claims the right to “rectify” situations when it considers the national interest to be at stake. Whatever happens, Hong Kong’s prospects for a more democratic system of self-rule is not optimistic.

Genetic Studies Can Help Prevent Blindness in Africa Current research is focusing on glaucoma in African populations. by Susan Williams

Glaucoma is the most common cause of irreversible blindness in the world. It's estimated that by 2040 there will be about 112 million people in the world with glaucoma – mostly in Africa and Asia. The best that medical science can do at present is identify it early and slow or halt its progression 

The disease affects the optic nerve, which normally sends signals from the eye to the brain. With glaucoma, this nerve doesn’t work properly. The first sign is loss of peripheral vision. This gradually progresses to tunnel vision and, ultimately, blindness.

The most important risk factor for developing glaucoma is having high pressure inside the eyeball. Reducing this pressure is currently the only way to treat glaucoma. It’s done with eye drops, laser treatment or surgery.

The most common type of glaucoma is primary open-angle glaucoma, which typically begins in middle to older age. Visual loss is only noticeable at an advanced stage of the disease. It’s more common in populations of African descent than in those with European or Asian ancestry. In African populations it starts at an earlier age and progresses faster. The prevalence of primary open-angle glaucoma in Africans between the ages of 40 and 80 is about 4.2%.

The cause and mechanisms underlying this condition are poorly understood. But it’s known that family members of affected individuals are much more likely to get the disease. We conducted a study to identify genetic risk factors for primary open-angle glaucoma in African populations.

Identifying glaucoma associated genetic factors could make it easier to identify patients at risk before they develop the disease. It could also shed light on the cause and unlock new treatments.

We found a new genetic association that may help us achieve these goals.

Most primary open-angle glaucoma is inherited in a complex manner. In other words there is not just one mutation in a single gene that is sufficient to cause the disease. Rather there are small variations in several genes that contribute to an increase in risk for the disease.

Genetic risk factors have been identified using association studies. In these studies thousands of affected individuals are compared with even larger numbers of unaffected individuals. This identifies associations between certain genes and either glaucoma or characteristics associated with glaucoma (like high pressure inside the eye). Each association provides information about the diseases.

Most of these studies have been performed on European populations. Genetic enquiry in African populations is challenging because there is so much more diversity within African genomes.

The genome is the complete set of genetic material we carry in all the cells of our bodies. Genes are the parts of the genome that contain instructions to make proteins. All humans’ genomes are almost identical but tiny variations occur. It is these “variants” that determine our individuality. The more ancient a population, the more time there has been for “variants” to develop and the more genetic diversity there will be in that population.

This diversity means that African populations are valuable in studies of the links between genes and diseases like glaucoma.

We found new associations

Our group of researchers (the Genetics of Glaucoma in People of African Descent Consortium) recently published an association study of close to 10,000 primary open-angle glaucoma patients of African descent.

We identified a new association, with a gene called APBB2. It occurs in all populations but the variant associated with glaucoma was only found in Africans.

We demonstrated that this genetic variant results in increased amyloid deposition in both the eye and the part of the brain responsible for vision. Amyloid is a protein that is toxic to brain tissue and is associated with Alzheimer-type and related dementias. We can’t yet say for certain that amyloid depositions cause glaucoma, but this seems likely. If further studies can prove this, then drugs that were developed to treat dementias might be useful to treat primary open-angle glaucoma.

There is no evidence that glaucoma occurs more frequently in individuals with dementia or vice versa. But this study found a genetic link that could help explain how the optic nerve is damaged in glaucoma.

We recently confirmed this direct genetic link in a large analysis of data from different studies all over the world. The analysis identified another three genes that are known to cause Alzheimer-type dementias and are also associated with primary open-angle glaucoma.

How this could change management of glaucoma

Discovering the genetic associations of an inherited disease is an important step. It identifies biological pathways that may cause the disease.

In a complex condition like primary open-angle glaucoma, it is likely that there are several different pathways involved which all end up with damage to the optic nerve. Only by studying multiple populations will a true picture of all the genetic associations emerge. There may already be treatments available that target the biological functions of these associated genes which could then be used to treat glaucoma. Alternatively, new treatments targeting these functions could be developed specifically for glaucoma.

Knowing about genetic associations in specific populations will make it possible to focus prevention and treatment on those who will benefit most, sparing expense and side effects from those who will not.

Ultimately genetics could pave the way for precision medicine in glaucoma: tailoring care to the individual patient.

Coronavirus: The Science of Infectious Aerosols From your lungs into the air around you, aerosols carry coronavirus. by Shelly Miller

During the 1970s when I was growing up in Southern California, the air was so polluted that I was regularly sent home from high school to “shelter in place.” There might not seem to be much in common between staying home due to air pollution and staying home to fight the coronavirus pandemic, but fundamentally, both have a lot to do with aerosols.

Aerosols are the tiny floating pieces of pollution that make up Los Angeles’ famous smog, the dust particles you see floating in a ray of sunshine and also the small droplets of liquid that escape your mouth when you talk, cough or breathe. These small pieces of floating liquids can contain pieces of the coronavirus and can be major contributor to its spread.

If you walk outside right now, chances are you will see people wearing masks and practicing social distancing. These actions are in large part meant to prevent people from spreading or inhaling aerosols.

I am a professor of mechanical engineering and study aerosols and air pollution. The more people understand how aerosols work, the better people can avoid getting or spreading the coronavirus.

Airborne and everywhere

An aerosol is a clump of small liquid or solid particles floating in the air. They are everywhere in the environment and can be made of anything small enough to float, like smoke, water or coronavirus-carrying saliva.

When a person coughs, talks or breathes, they throw anywhere between 900 to 300,000 liquid particles from their mouth. These particles range in size from microscopic – a thousandth the width of a hair – up to the size of a grain of fine beach sand. A cough can send them traveling at speeds up to 60 mph.

Size of the particle and air currents affect how long they will stay in the air. In a still room, tiny particles like smoke can stay airborne for up to eight hours. Larger particles fall out of the air more quickly and land on surfaces after a few minutes.

By simply being near other people, you are coming into constant contact with aerosols from their mouth. During a pandemic this a little more concerning than normal. But the important question is not do exhaled aerosols exist, rather, how infectious are they?

Aerosols as virus delivery systems

The new coronavirus, SARS-CoV-2, is tiny, about 0.1 microns - roughly 4 millionths of an inch - in diameter. Aerosols produced by people when they breathe, talk and cough are generally between about 0.7 microns to around 10 microns – completely invisible to the naked eye and easily able to float in air. These particles are mostly biological fluids from people’s mouths and lungs and can contain bits of virus genetic material.

Researchers don’t yet know how many individual pieces of SARS-CoV-2 an aerosol produced by an infected person’s cough might hold. But in one preprint study, meaning it is currently under peer review, researchers used a model to estimate that a person standing and speaking in a room could release up to 114 infectious doses per hour. The researchers predict that these aerosolized bits of saliva would easily infect other people if this happened in public indoor spaces like a bank, restaurant or pharmacy.

Another thing to consider is how easy these particles are to inhale. In a recent computer model study, researchers found that people would most likely inhale aerosols from another person that is talking and coughing while sitting less than 6 feet away.

While this seems bad, the actual process from exposure to infection is a complicated numbers game. Often, viral particles found in aerosols are damaged. A study looking at the flu virus found that only 0.1% of viruses exhaled by a person are actually infectious. The coronavirus also starts to die off once it has left the body, remaining viable in the air for up to three hours. And of course, not every aerosol coming from an infected person will contain the coronavirus. There is a lot of chance involved.

Public health officials still don’t know whether direct contact, indirect contact through surfaces, or aerosols are the main pathway of transmission for the coronavirus. But everything experts like myself know about aerosols suggests that they could be a major pathway of transmission.

Evidence of aerosol transmission

It is almost impossible to study viral transmission in real time, so researchers have turned to environmental sampling and contact tracing to try to study the spread of the coronavirus in aerosols. This research is happening extremely fast and most of it is still under peer review, but these studies offer extremely interesting, if preliminary, information.

To test the environment, researchers simply sample the air. In Nebraska, scientists found airborne SARS-CoV-2 in a hospital. In China, scientists also found the virus in the air of a number of hospitals as well as a department store.

But environmental sampling alone cannot prove aerosol transmission. That requires contact tracing.

One restaurant in Guangzhou, China, was the site of a small outbreak on Jan. 23 and offers direct evidence of aerosol transmission. Researchers believe that there was one infected but asymptomatic person sitting at a table in the restaurant. Because of the air currents circulating in the room due to air conditioning, people sitting at two other tables became infected, likely because of aerosols.

Overall, the evidence suggests that it is much more risky to be inside than outside. The reason is the lack of airflow. It takes between 15 minutes and three hours for an aerosol to be sucked outside by a ventilation system or float out an open window.

Another preprint study of outbreaks in Japan suggests that the chances of direct transmission are almost 20 times higher indoors compared to outdoors. In Singapore, researchers traced the first three outbreaks directly to a few shops, a banquet dinner and a church.

Once outside, these potentially infectious aerosols disappear in the expanse of the atmosphere and are much less of a worry. It is of course possible to catch the virus outside if you are in close contact with a sick person, but this seems very rare. Researchers in China found that only one of 314 outbreaks they examined could be traced back to outdoor contact.

There has been recent concern over aerosol transmission during running and biking. While the science is still developing on this, it is probably wise to give other bikers or runners a little more room than normal.

How to reduce aerosol transmission

With all of this knowledge of how aerosols are produced, how they move and the role they play in this pandemic, an obvious question arises: what about masks?

The Centers for Disease Control and Prevention recommends wearing a face mask in any public setting where social distancing is hard to do. This is because homemade masks probably do a reasonable job of blocking aerosols from leaving your mouth. The evidence generally supports their use and more research is coming to show that masks can be very effective at reducing SARS-CoV-2 in air. Masks aren’t perfect and more studies are currently underway to learn how effective they really are, but taking this small precaution could help slow the pandemic.

Other than wearing a mask, follow common sense and the guidance of public health officials. Avoid crowded indoor spaces as much as possible. Practice social distancing both inside and outdoors. Wash your hands frequently. All of these things work to prevent the spread of the coronavirus and can help keep you from getting it. There is a significant amount of evidence that COVID-19 is transmitted by the inhalation of airborne particles, but by carefully following the advice of experts, individuals can minimize the risk they pose.

Coronavirus: Why Price Controls Are Good for Masks (Not in Other Cases) The coronavirus pandemic is an outlier. by Amihai Glazer

The Centers for Disease Control and Prevention recommends that people wear a cloth face covering for their nose and mouth to protect others from the spread of the coronavirus. Research shows masks lead to a more than threefold reduction in how much flu virus people spray into the air.

Yet there have been reports for weeks that there are shortages of face masks, both the N95 respirators needed by health workers and the simpler ones worn by the public. While companies have promised to ramp up supplies, those will likely be overwhelmed by demand as lockdowns ease and more people need masks as they return to public life.

Countries such as South Korea and Taiwan have responded to shortages by imposing price controls and rationing.

As an economist who wrote a textbook on price theory and teaches it to undergraduates, I’m generally skeptical about price controls. But not in this case.

Why price controls are normally bad

In economics, the price of a given product generally tends to find its “equilibrium,” where demand and supply are equal.

A shortage of a good typically results from a sudden drop in supply – for example, a factory gets hit by a hurricane – or because its price falls below this equilibrium. At this point, more people will want to buy the product than companies are willing to sell at that price. Normally, the reduced supply would cause the price to rise. But when there are price controls, the shortage remains.

For most goods, it is unwise to impose price controls because it causes companies to produce or provide less of the good, which forces some form of rationing, whether imposed by companies – for example, limiting the number of rolls of toilet paper a customer can buy – or government.

In either case, people who value or may most need a good don’t get it, while others with less need – or simply more money – can get a lot more and even hoard it.

There is a long history of governments implementing price controls and rationing.

Medieval governments fixed the maximum price of bread. During World War II, the U.S. government allowed no driver to own more than five automobile tires and let people buy only half a pound of sugar per week.

During the early 1970s, the government set price controls on gasoline leading up to the oil embargo of 1973 and ended up rationing who was able to fill up their tanks amid severe shortages. These price controls caused havoc and violence. Up to 20% of American gasoline stations sometimes had no fuel.

Why masks are different

But masks, hand sanitizers and vaccinations are different from most goods because they may benefit more than just the person using them.

A face mask, for example, may help reduce the chances that he or she will infect others nearby. Economists call this a “positive externality,” and it is the main reason the CDC began recommending people wear masks in public.

Since the people who may be infected from an uncovered sneeze or cough will often be total strangers, an individual may not fully take their health into account when deciding whether to buy and wear a mask. So when a product becomes scarce, pushing up prices, the problem is that a person willing to pay the higher price may not be someone whose use of a mask would most benefit others.

So let’s imagine two men. The first one can do his well-paid professional job from home and doesn’t go out because he fears getting the coronavirus. The other is an essential worker who must continue to do his low-income job everyday and interact with others in close proximity. When the price of masks shoots up, the first man can easily afford to order a supply for himself via Amazon, but the other is unable to do so.

Since the first man interacts with few others, there’s little benefit to his wearing a mask. But the essential worker interacts with dozens of people daily, which means he’s protecting many others by wearing a mask.

In other words, allowing the market to ration a scarce good through higher prices means the wrong people are likely to get it. Moreover, some people may end up hoarding masks, whether for personal use or to sell at even higher prices.

Markets sometimes need a little help

Two of the countries touted as coronavirus success stories have been rationing masks.

South Korea limits the price to US$1.20 a mask, far below the previous market price of $2.00. And it imposes a weekly ration of two face masks per person. Taiwan’s government rationed masks to prevent panic buying and prioritize allocations to health personnel. At the same time, production was ramped up so that individuals are allowed 10 masks every two weeks.

The U.S. could do something similar. For example, the government could buy a large share of the available masks and distribute them at a low price to families in places with high infection rates – in effect a price control. Or, if Americans prefer to avoid direct governmental distribution, the federal government could set the price and require that no more than two masks be sold per person.

This doesn’t mean that all medical supplies should be under price control or rationed. But price controls on goods like masks, hand sanitizer or vaccines, once they become available, can be useful if doing so helps limit the spread of the coronavirus.

The market generally works. But sometimes it needs an assist.