人類是否會將新冠病毒傳染給動物?
當今年年初中國武漢的一家活體農貿市場中發現了新型冠狀病毒,人們就曾推斷,病毒極有可能是從蝙蝠傳播給人類。從那之后,我們關注的焦點一直是這種可怕疾病的全球人類感染者數量,這是可以理解的。目前全球新冠病毒感染人數已經超過2,800萬人。
但新冠病毒除了在人類之間繼續傳播以外,有沒有可能讓動物界面臨風險?這個問題的答案正在浮出水面,而且瀕危物種和我們的家養寵物都會受到影響。
動物和人類在病毒傳播方面有著漫長的共同的歷史。去年,美國疾病預防與控制中心(Centers for Disease Control and Prevention)的公共衛生服務主任凱西?巴頓?貝拉維什在官網上發表的一份聲明中稱:“每年動物與人之間傳播的疾病導致數以萬計的美國人染病。”美國疾控中心表示,人類傳染病約60%為人畜共患傳染病,這意味著它們是由動物傳播給人類(或者反之)。比如狂犬病、萊姆病、西尼羅河病毒和中東呼吸綜合征等。
但新冠肺炎呢?答案很簡單:新冠病毒從人向動物傳播的病例雖然很少,但確實已經出現。根據人畜傳播最終可能達到的規模,這種情況值得密切關注。
我們掌握的動物發病率數據少之又少。在武漢發布的一篇預印報告中,研究人員發現,他們檢測了100多只家貓和流浪貓,其中約15%新冠肺炎呈陽性,但美國家養的貓、狗等物種感染新冠病毒的病例較為罕見。美國獸醫協會(American Veterinary Medical Association)網站上表示,幾乎沒有證據證明家養動物容易感染新冠病毒,而且美國農業部(Agriculture Department)的數據庫報告稱,到目前為止,國家獸醫服務實驗室(National Veterinary Services Laboratories)確診新冠肺炎呈陽性的動物不足40只。(巴頓?貝拉維什通過電子郵件告訴我說,被感染的動物“不一定出現癥狀……因此,我們無法確定美國有多少動物感染了新冠病毒。”)
中國香港的兩只狗是已知最早感染新冠病毒的犬類。已知第一例人類到貓傳播的病例在3月下旬發生于比利時。貓主人生病后,這只貓出現了腹瀉、嘔吐和呼吸困難等新冠肺炎的典型癥狀。它在9天后完全康復。事實上,巴頓?貝拉維什告訴我,確診感染新冠病毒的多數動物僅出現了“較輕的癥狀,并且已經完全康復。”
除了初期的病例以外,家養貓犬新冠病毒檢測呈陽性的病例極其罕見,而且這些病例似乎主要源于有癥狀或無癥狀的寵物主人將病毒傳染給了他們親愛的貓和狗狗。幸運的是,沒有證據證明寵物會向人傳播新冠病毒。巴頓?貝拉維什說,愛撫或者擁抱毛茸茸的愛寵將病毒從寵物傳播給人的風險很低。
大型貓科動物也可能感染新冠病毒。紐約布朗克斯動物園(Bronx Zoo)發現,5只老虎和3只非洲獅出現了輕度呼吸道癥狀,經檢測新冠病毒均呈陽性,但它們都已經完全康復。此事當時曾經被廣泛報道。美國農業部稱,這幾只動物的傳染源來自一名新冠病毒呈陽性但無癥狀的動物管理員,這位管理員是“一位活躍的病毒傳播者”。巴頓?貝拉維什向我證實,除了南非有一只美洲獅被護理員感染以外,美國動物園內沒有再出現更多感染病例。
西班牙、丹麥、荷蘭和美國的貂養殖場內都爆發了新冠疫情,原因可能是養殖場內患病的工作人員。雖然目前動物向人傳播病毒的情況并不明顯,但荷蘭的病例假設存在從貂向人類傳播的可能。
當然,我們目前還處在摸索階段。例如,《科學》雜志(Science)上發表的一篇研究報告發現,在實驗室中,病毒不會在狗、豬、雞、鴨等動物中復制或輕易傳播。但貓比狗更容易在同類之間傳播新冠病毒。有一份未公布的模擬研究顯示,猿和非洲與亞洲的猴子可能“非常容易感染”新冠病毒。(需要特別注意的是,實驗性和模擬性研究并不見得能體現自然環境下的病毒傳播情況。動物在真實世界中可能不容易感染新冠病毒,這或許是相關數據增長緩慢的部分原因。)
但歷史提醒我們要時刻保持警惕,因為之前病毒從人向其他物種傳播,曾經對動物和魚類造成了毀滅性的影響。有證據表明,在2002年至2003年的埃博拉疫情期間,有超過5,000只大猩猩死于這種病毒,盡管該證據曾經引發激烈爭論。2015年,美國西海岸數千萬海星患上了胃腸道消耗性疾病,許多海星死亡,罪魁禍首被認為是一場細小病毒疫情。新冠病毒是一種新型病毒,因此我們必須保證面臨風險的野生動物和海洋生物不會因為我們沒有為它們采取有效的保護措施而大規模死亡甚至滅絕。
目前,全球什么問題最值得擔憂?可能是未經處理的人類排泄物。位于加拿大新斯科細亞省的戴爾豪斯大學(Dalhousie University)的科學家格雷厄姆?德萊爾和同事在一篇尚未發表的預印研究報告中預測,至少15種海洋哺乳動物容易感染新冠病毒,比如鯨、海豚、海豹、水獺和海獅等,有些甚至比人類還要脆弱。他們的研究基于對ACE2受體的分析。ACE2受體是病毒進入細胞的一種關鍵蛋白。(美國獸醫協會指出,病毒復制和傳播還需要其他過程,所以很難明確病毒傳播的能力。)這些動物中包含一些瀕危物種,它們被感染的途徑可能是在動物園或水族館里與人類直接接觸,或者通過被人類污水中的新冠病毒污染的未經處理的廢水。
意大利、澳大利亞和西班牙等國均在未經處理的廢水中發現了新冠病毒,并且科學家證實,新冠病毒在被污染的水中幾天甚至幾周后依舊具有傳染性。當然,問題是水中的病毒是否會導致海洋生物被感染。德萊爾告訴我,雖然目前還沒有發現感染SARS-CoV-2的海洋哺乳動物,“……白鯨和海豚曾經被發現感染了相關的伽馬冠狀病毒。”例如,今年7月,圣迭戈海灣有4只海豚出現了胃腸道疾病的癥狀。
潛在的后果極其嚴重。一頭白鯨曾經感染冠狀病毒,出現了肺病和晚期肝衰竭,2000年有一只太平洋斑海豹在感染冠狀病毒后死于肺炎。德萊爾說:“我們不知道新冠肺炎在這些哺乳動物當中會產生多么嚴重的后果。像人類感染新冠病毒一樣,可能只出現了流鼻涕,也可能造成多器官損害。”如果動物感染這種病毒的數量極少,我們可能也無需擔心。
為了幫助減少新冠病毒的影響和阻止病毒傳播,德萊爾和同事們認為,重要的是妥善處理廢水和未經處理的污水。他們甚至討論了一種現在聽起來有些不可思議的觀點:針對瀕危哺乳動物的疫苗項目,目標是實現群體免疫或者小群體免疫。事實上,用于避孕的疫苗早已成功應用于灰海豹,所以我們知道相關技術已經存在。
如果你感染了新冠肺炎,請記住你的寵物朋友可能會被感染,盡管到目前為止人向動物傳播的病例很少。目前有許多研究正在進行當中,但美國疾控中心建議感染新冠病毒的寵物主人采取預防措施,保持衛生,避免與寵物直接接觸。寵物主人在不具有傳染性之前,盡可能讓其他家庭成員照看寵物。在新冠肺炎疫情時代,與其他事情一樣,想與愛寵擁抱需要等待一些時間。
我們還應該加入到拯救海洋生物的行動當中。海洋公園和水族館可以限制游客接觸面臨風險的哺乳動物,從而減少病毒傳播的風險。我們還能夠與政策制定者、城市和衛生狀況較差的欠發達國家合作,更好地監控水中的病毒,并妥善處理廢水。德萊爾建議,至少應該對廢水進行二級處理,最好進行紫外線或臭氧處理。他說這種處理方式可以消滅高達99%的病原體。
相關技術已經很成熟。例如,現有的無人機能夠收集鯨分泌的粘液,從而有效監測新冠病毒等。我們不缺資源。我們需要進一步研究病毒在自然環境下的傳播情況,加強監控和研究,并確定如何通過最有效的方式,阻止當前人類面臨的這場疫情蔓延到動物王國。(財富中文網)
本文作者卡羅琳?巴伯擔任急診科醫生已有25年。她是無家可歸者工作項目“改變之輪”(Wheels of Change)的聯合創始人,也是新書《暴走的藥品:無知可能致命》(Runaway Medicine: What You Don't Know May Kill You)的作者。
譯者:Biz
編譯:陳怡軒、陳聰聰
當今年年初中國武漢的一家活體農貿市場中發現了新型冠狀病毒,人們就曾推斷,病毒極有可能是從蝙蝠傳播給人類。從那之后,我們關注的焦點一直是這種可怕疾病的全球人類感染者數量,這是可以理解的。目前全球新冠病毒感染人數已經超過2,800萬人。
但新冠病毒除了在人類之間繼續傳播以外,有沒有可能讓動物界面臨風險?這個問題的答案正在浮出水面,而且瀕危物種和我們的家養寵物都會受到影響。
動物和人類在病毒傳播方面有著漫長的共同的歷史。去年,美國疾病預防與控制中心(Centers for Disease Control and Prevention)的公共衛生服務主任凱西?巴頓?貝拉維什在官網上發表的一份聲明中稱:“每年動物與人之間傳播的疾病導致數以萬計的美國人染病。”美國疾控中心表示,人類傳染病約60%為人畜共患傳染病,這意味著它們是由動物傳播給人類(或者反之)。比如狂犬病、萊姆病、西尼羅河病毒和中東呼吸綜合征等。
但新冠肺炎呢?答案很簡單:新冠病毒從人向動物傳播的病例雖然很少,但確實已經出現。根據人畜傳播最終可能達到的規模,這種情況值得密切關注。
我們掌握的動物發病率數據少之又少。在武漢發布的一篇預印報告中,研究人員發現,他們檢測了100多只家貓和流浪貓,其中約15%新冠肺炎呈陽性,但美國家養的貓、狗等物種感染新冠病毒的病例較為罕見。美國獸醫協會(American Veterinary Medical Association)網站上表示,幾乎沒有證據證明家養動物容易感染新冠病毒,而且美國農業部(Agriculture Department)的數據庫報告稱,到目前為止,國家獸醫服務實驗室(National Veterinary Services Laboratories)確診新冠肺炎呈陽性的動物不足40只。(巴頓?貝拉維什通過電子郵件告訴我說,被感染的動物“不一定出現癥狀……因此,我們無法確定美國有多少動物感染了新冠病毒。”)
中國香港的兩只狗是已知最早感染新冠病毒的犬類。已知第一例人類到貓傳播的病例在3月下旬發生于比利時。貓主人生病后,這只貓出現了腹瀉、嘔吐和呼吸困難等新冠肺炎的典型癥狀。它在9天后完全康復。事實上,巴頓?貝拉維什告訴我,確診感染新冠病毒的多數動物僅出現了“較輕的癥狀,并且已經完全康復。”
除了初期的病例以外,家養貓犬新冠病毒檢測呈陽性的病例極其罕見,而且這些病例似乎主要源于有癥狀或無癥狀的寵物主人將病毒傳染給了他們親愛的貓和狗狗。幸運的是,沒有證據證明寵物會向人傳播新冠病毒。巴頓?貝拉維什說,愛撫或者擁抱毛茸茸的愛寵將病毒從寵物傳播給人的風險很低。
大型貓科動物也可能感染新冠病毒。紐約布朗克斯動物園(Bronx Zoo)發現,5只老虎和3只非洲獅出現了輕度呼吸道癥狀,經檢測新冠病毒均呈陽性,但它們都已經完全康復。此事當時曾經被廣泛報道。美國農業部稱,這幾只動物的傳染源來自一名新冠病毒呈陽性但無癥狀的動物管理員,這位管理員是“一位活躍的病毒傳播者”。巴頓?貝拉維什向我證實,除了南非有一只美洲獅被護理員感染以外,美國動物園內沒有再出現更多感染病例。
西班牙、丹麥、荷蘭和美國的貂養殖場內都爆發了新冠疫情,原因可能是養殖場內患病的工作人員。雖然目前動物向人傳播病毒的情況并不明顯,但荷蘭的病例假設存在從貂向人類傳播的可能。
當然,我們目前還處在摸索階段。例如,《科學》雜志(Science)上發表的一篇研究報告發現,在實驗室中,病毒不會在狗、豬、雞、鴨等動物中復制或輕易傳播。但貓比狗更容易在同類之間傳播新冠病毒。有一份未公布的模擬研究顯示,猿和非洲與亞洲的猴子可能“非常容易感染”新冠病毒。(需要特別注意的是,實驗性和模擬性研究并不見得能體現自然環境下的病毒傳播情況。動物在真實世界中可能不容易感染新冠病毒,這或許是相關數據增長緩慢的部分原因。)
但歷史提醒我們要時刻保持警惕,因為之前病毒從人向其他物種傳播,曾經對動物和魚類造成了毀滅性的影響。有證據表明,在2002年至2003年的埃博拉疫情期間,有超過5,000只大猩猩死于這種病毒,盡管該證據曾經引發激烈爭論。2015年,美國西海岸數千萬海星患上了胃腸道消耗性疾病,許多海星死亡,罪魁禍首被認為是一場細小病毒疫情。新冠病毒是一種新型病毒,因此我們必須保證面臨風險的野生動物和海洋生物不會因為我們沒有為它們采取有效的保護措施而大規模死亡甚至滅絕。
目前,全球什么問題最值得擔憂?可能是未經處理的人類排泄物。位于加拿大新斯科細亞省的戴爾豪斯大學(Dalhousie University)的科學家格雷厄姆?德萊爾和同事在一篇尚未發表的預印研究報告中預測,至少15種海洋哺乳動物容易感染新冠病毒,比如鯨、海豚、海豹、水獺和海獅等,有些甚至比人類還要脆弱。他們的研究基于對ACE2受體的分析。ACE2受體是病毒進入細胞的一種關鍵蛋白。(美國獸醫協會指出,病毒復制和傳播還需要其他過程,所以很難明確病毒傳播的能力。)這些動物中包含一些瀕危物種,它們被感染的途徑可能是在動物園或水族館里與人類直接接觸,或者通過被人類污水中的新冠病毒污染的未經處理的廢水。
意大利、澳大利亞和西班牙等國均在未經處理的廢水中發現了新冠病毒,并且科學家證實,新冠病毒在被污染的水中幾天甚至幾周后依舊具有傳染性。當然,問題是水中的病毒是否會導致海洋生物被感染。德萊爾告訴我,雖然目前還沒有發現感染SARS-CoV-2的海洋哺乳動物,“……白鯨和海豚曾經被發現感染了相關的伽馬冠狀病毒。”例如,今年7月,圣迭戈海灣有4只海豚出現了胃腸道疾病的癥狀。
潛在的后果極其嚴重。一頭白鯨曾經感染冠狀病毒,出現了肺病和晚期肝衰竭,2000年有一只太平洋斑海豹在感染冠狀病毒后死于肺炎。德萊爾說:“我們不知道新冠肺炎在這些哺乳動物當中會產生多么嚴重的后果。像人類感染新冠病毒一樣,可能只出現了流鼻涕,也可能造成多器官損害。”如果動物感染這種病毒的數量極少,我們可能也無需擔心。
為了幫助減少新冠病毒的影響和阻止病毒傳播,德萊爾和同事們認為,重要的是妥善處理廢水和未經處理的污水。他們甚至討論了一種現在聽起來有些不可思議的觀點:針對瀕危哺乳動物的疫苗項目,目標是實現群體免疫或者小群體免疫。事實上,用于避孕的疫苗早已成功應用于灰海豹,所以我們知道相關技術已經存在。
如果你感染了新冠肺炎,請記住你的寵物朋友可能會被感染,盡管到目前為止人向動物傳播的病例很少。目前有許多研究正在進行當中,但美國疾控中心建議感染新冠病毒的寵物主人采取預防措施,保持衛生,避免與寵物直接接觸。寵物主人在不具有傳染性之前,盡可能讓其他家庭成員照看寵物。在新冠肺炎疫情時代,與其他事情一樣,想與愛寵擁抱需要等待一些時間。
我們還應該加入到拯救海洋生物的行動當中。海洋公園和水族館可以限制游客接觸面臨風險的哺乳動物,從而減少病毒傳播的風險。我們還能夠與政策制定者、城市和衛生狀況較差的欠發達國家合作,更好地監控水中的病毒,并妥善處理廢水。德萊爾建議,至少應該對廢水進行二級處理,最好進行紫外線或臭氧處理。他說這種處理方式可以消滅高達99%的病原體。
相關技術已經很成熟。例如,現有的無人機能夠收集鯨分泌的粘液,從而有效監測新冠病毒等。我們不缺資源。我們需要進一步研究病毒在自然環境下的傳播情況,加強監控和研究,并確定如何通過最有效的方式,阻止當前人類面臨的這場疫情蔓延到動物王國。(財富中文網)
本文作者卡羅琳?巴伯擔任急診科醫生已有25年。她是無家可歸者工作項目“改變之輪”(Wheels of Change)的聯合創始人,也是新書《暴走的藥品:無知可能致命》(Runaway Medicine: What You Don't Know May Kill You)的作者。
譯者:Biz
編譯:陳怡軒、陳聰聰
We think we know about the initial transmission of the coronavirus; it occurred at a live animal market in Wuhan, China, most likely from a bat to a person. In the time since, our attention has been understandably focused on the global human toll of this brutal disease, which already has reached a total of more than 28 million cases.
But how likely is it that, in addition to continually infecting each other, our human viral spread is also putting the animal world at risk? The answers to that question are emerging, and they carry implications both for endangered species and our own household pets.
Animals and humans have a long, common history when it comes to viruses. “Every year, tens of thousands of Americans get sick from diseases spread between animals and people,” said Casey Barton Behravesh, U.S. public health service director at the Centers for Disease Control and Prevention (CDC), in a statement posted to the organization’s website last year. The CDC says roughly 60% of human infectious diseases are zoonotic, meaning they’re transmitted by animals to people (or vice versa). Think of rabies, Lyme disease, West Nile virus, and MERS, among others.
But what about COVID-19? The short answer is that, although the numbers remain very low, human-to-animal transmission of the novel coronavirus has occurred. Depending upon what scale that ultimately achieves, it’s something worth watching closely.
We have very little prevalence data on animals. In a published preprint from Wuhan, researchers found that of more than 100 domestic and stray cats they tested, approximately 15% were positive for the coronavirus, but only rare cases of COVID-19 have been reported in domesticated cats, dogs, and other species in the U.S. The American Veterinary Medical Association website says that there’s little to no evidence that domestic animals are easily infected with the virus, and the Agriculture Department database reports that fewer than 40 animals so far have been confirmed COVID-positive by the National Veterinary Services Laboratories. (Barton Behravesh told me via email that infected animals “might or might not have any symptoms…and for this reason we don’t know for sure how many animals are infected in the U.S.”)
Two dogs in Hong Kong were among the first known cases to appear in canines. The first known human-to-cat transmission, meanwhile, occurred in Belgium in late March, where a sick owner’s cat developed typical coronavirus-like symptoms including diarrhea, vomiting, and breathing difficulties. The cat made a full recovery nine days later. In fact, Barton Behravesh told me, most of the animals diagnosed with COVID experienced only “mild illness and fully recovered.”
Since these initial cases, very rare reports of domesticated dogs and cats testing positive for coronavirus have appeared, and they appear to stem primarily from either symptomatic or asymptomatic pet owners transmitting the infection to their beloved felines and canines. Thankfully, there is little evidence of the reverse. The risk that petting or hugging your furry domestic companion might transmit the virus from the pet back to you, Barton Behravesh said, is considered low.
Big cats can get the coronavirus, too. As was widely publicized in April, New York’s Bronx Zoo found that five tigers and three African lions developed mild respiratory symptoms—and all tested positive for the virus, though each recovered without incident. Transmission was felt to have occurred from an asymptomatic but positive zookeeper “who was actively shedding virus,” according to the Agriculture Department. Barton Behravesh confirmed to me that no further outbreaks of the coronavirus at zoos in the U.S have been reported, though a single puma in South Africa was infected by its caretaker.
We’ve seen COVID-19 outbreaks in other animals, including on mink farms in Spain, Denmark, the Netherlands, and the U.S., where it’s believed that ill farm workers were responsible for the outbreaks. And while animal-to-human transmission is felt to be insignificant at this time, cases in the Netherlands hypothesize possible spread from minks to humans.
Certainly, we’re learning as we go. For example, research reported in Science magazine found that in the laboratory, the virus either did not replicate or did not spread easily in dogs, pigs, chickens, or ducks. Cats, meanwhile, appeared able to pass along the coronavirus much easier to one another than were dogs. And there’s an unpublished modeling study that shows apes and African and Asian monkeys are likely to be “highly susceptible” to COVID-19. (It is important to remember that experimental and modeling studies do not necessarily reflect how infection will occur under natural conditions. Animals may not be as easily infected in the real world—perhaps that’s part of the reason the numbers are so low.)
Still, history suggests we need to have our guard up, as the spread of viruses to other species previously has had devastating effects on animal and fish populations. Though once hotly debated, the evidence shows that during the Ebola outbreak of 2002–03, more than 5,000 gorillas died of the virus. In 2015, an outbreak of parvovirus was thought to be responsible for a gastrointestinal wasting illness that affected hundreds of millions of starfish off America’s West Coast, many of which succumbed. Given that the coronavirus is a novel virus, we need to ensure that our at-risk wild animal and sea life populations do not experience massive die-offs or suffer extinctions because we failed to act to protect them.
What’s our concern globally right now? Above all else, it may well be untreated human waste. At Dalhousie University in Nova Scotia, scientist Graham Dellaire and his cohorts predicted in an unpublished preprint study that at least 15 species of marine mammals, including whales, dolphins, seals, otters, and sea lions, are susceptible—or potentially more susceptible than humans—to coronavirus infection. This is based on their analysis of ACE2 receptors, the key protein for virus entry. (The American Veterinary Medical Association notes that other processes are necessary for a virus to replicate and spread, so it is difficult to make definitive statements regarding the ability of the virus to transmit.) Some of these species are endangered, and their infection would likely occur either through direct contact with humans at zoos or aquariums or via untreated wastewater that is contaminated with the coronavirus from human sewage.
Several countries, including Italy, Australia and Spain, have detected the coronavirus in untreated wastewater, and scientists have shown that previous coronaviruses remained infectious in the contaminated water for days to weeks. The question, of course, is whether virus present in the water will lead to actual infections in sea life. Dellaire told me that while no marine mammals have been found yet infected with SARS-CoV-2, “…beluga whales and dolphins have been found to be infected by related gammacoronaviruses.” That includes four dolphins in San Diego Bay who were symptomatic with a gastrointestinal illness this past July.
The potential consequences are grave. Coronavirus infections were linked to a beluga whale that experienced lung disease and terminal liver failure, and Pacific harbor seals that died from pneumonia in 2000. Said Dellaire, “We do not know how bad the disease could be in these mammals. It could be a sniffle or multi-organ damage, just like COVID-19 in humans.” It also could be nothing, if transmission is negligible.
To help mitigate the impact and prevent coronavirus transmission, Dellaire and his colleagues believe proper treatment of wastewater and raw sewage is essential. They even discuss what right now may sound inconceivable: a potential vaccination program for endangered mammal populations in which the goal is to achieve herd immunity, or perhaps pod immunity. In fact, vaccines have already been used successfully in gray seals for contraceptive purposes, so we know the technology is there.
If you get COVID, know that your furry friends and oceangoing pals may be susceptible, though we have seen only rare spread so far. While many studies are underway, the CDC recommends that pet owners infected with the coronavirus maintain hygiene precautions and restrain from having direct contact with their animals. If possible, another member of the family should care for the pets until the individual is no longer infectious. Like so much else in the age of COVID, snuggle time will have to wait.
But let’s help save the Shamus of the world, too. Let’s limit visitor contact with at-risk mammals at marine parks and aquariums to reduce viral exposure. Let’s work also with policymakers, cities, and underdeveloped countries with poor sanitation to better monitor live virus in our waters and treat wastewater appropriately. Dellaire recommends at least secondary treatment of wastewater or—even better—UV or ozone treatment, which he says destroys up to 99% of pathogens.
The technology is ready. A drone already exists, for example, that can collect mucus from a whale and feasibly detect viruses like the coronavirus. We have the resources. We need to investigate further how much transmission is occurring under natural conditions, conduct more surveillance and studies, and then determine how we might best prevent our now-human pandemic from becoming a problem for the animal kingdom as well.
Carolyn Barber has been an emergency department physician for 25 years. She is cofounder of the homeless work program Wheels of Change and author of a new book, Runaway Medicine: What You Don’t Know May Kill You.