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Hurricane Milton has started to bring its widespread impacts to Florida, with conditions expected to continue deteriorating over the coming hours from the central Gulf coast to the east coast through Thursday. View the scene from various spots using the live webcams below.
NOTE: The cams displayed were operating as of Wednesday morning, but may go offline as storm conditions worsen.
One of the World Health Organization’s most important jobs is managing viral outbreaks. The rapid spread of mpox, a disease related to smallpox, is a reminder of its shortcomings. Although well-intended, WHO’s overcautious and convoluted regulatory process stalled vaccine delivery for months before an approval was granted last month. Hundreds of lives were lost in the meantime, many of them children.
Mpox, previously called monkeypox, was first discovered in monkeys used for research in 1958. The virus began circulating among humans in western and central Africa more than a decade later. This year, more than 27,000 suspected cases and 800 deaths have been reported in the Democratic Republic of the Congo. (A serious outbreak in 2022, which began in Europe and spread to the U.S., largely subsided last year, though mpox never stopped circulating in Congo.)
A new, deadlier and more virulent version of mpox was discovered in 2023. Like past outbreaks, its symptoms are flu-like and include a rash that can develop into pustules or lesions that cover the body. When these excruciating sores erupt in the mouth and throat, eating can become difficult; some children have died of starvation as a result. Children under 15 make up two-thirds of cases and more than 80% of deaths in Africa.
A perfect storm of factors has accelerated the spread of mpox in Congo. Ongoing political violence has displaced millions of people, who’ve crowded into camps where close contact is difficult to avoid and sex work is common. (Though mpox can spread via sexual contact, it isn’t considered a sexually transmitted disease.) The country is also concurrently battling cholera, malaria and measles.
Public-health resources are understandably stretched. Yet the best means of fighting mpox — a safe and effective vaccine, approved by U.S. and European regulators — has been available for years. Why did the WHO take so long to grant its approval, and was its separate endorsement necessary?
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Low- and middle-income countries like Congo typically depend on Unicef and global vaccine alliance Gavi to buy and distribute vaccines. Before doing so, the groups must have approval from the WHO, which can either “prequalify” the vaccines — by conducting its own data assessments, inspections and testing — or issue a so-called emergency use listing that would speed access to unlicensed products.
For two years, the WHO took neither path. Despite Congolese officials regularly sharing data with the WHO — and reports that Bavarian Nordic AS, the principal manufacturer, had submitted the research used for its European approval — the organization said it didn’t have the data required for prequalification. An emergency use listing, meanwhile, couldn’t be sought until an emergency had been formally declared, which didn’t happen until August. Bavarian Nordic, for its part, was left in the dark about procurement commitments from Gavi, which awaited WHO authorization to begin purchase negotiations. This nest of interdependent approvals would be maddening enough, even if the delays it caused weren’t so tragic.
The WHO’s instinct to review new data is to some extent understandable. Absent randomized clinical trials, it’s hard to assess whether the vaccines approved in Europe and the U.S. are effective against the version of the virus circulating in Congo. Moreover, giving an unauthorized vaccine to an otherwise healthy population, including children, can be risky. Yet as the virus spreads and the death toll mounts, the benefits of vaccination start to outweigh the potential costs — and the prospect of stalling to replicate lengthy regulatory processes becomes increasingly indefensible.
To its credit, the WHO has stepped up its response over the past month. Vaccine donations from rich countries have started to arrive and, with last month’s announcement, so too will purchases from Bavarian Nordic. Yet the belated resolution mustn’t obscure the need for a nimbler, more straightforward emergency approval process that allows for quick adoption of U.S. and European standards without all the hoops. A similar process has been used successfully for years in Pepfar, the U.S. government program to treat HIV, and should be expanded — if only for the next outbreak. More transparency with manufacturers and other stakeholders throughout the prequalification process would help, too.
The WHO has substantial responsibilities, and it shouldn’t waste precious time duplicating efforts. By trusting its global partners, it can focus instead on saving lives.
— Bloomberg Opinion
In a climate where so much time and energy is spent trying to tackle human disease, Monday’s Nobel Prize in the category of physiology or medicine is a welcome reminder of the value of pursuing research that scratches a scientific itch. Sometimes, that work might lead to a new understanding of human biology.
“Curiosity research is very important,” said Olle Kämpe, member of the Nobel Committee for Physiology or Medicine, in announcing the prize to Victor Ambros, a professor at the University of Massachusetts Medical School, and Gary Ruvkun, at Harvard Medical School, for discovering so-called microRNA. MicroRNA is one of a handful of biological systems that carefully orchestrate when, where and how intensely DNA should operate.
“They were looking at two worms that looked a bit funny and decided to understand why. And then they discovered an entirely new mechanism for gene regulation. I think that’s beautiful,” Kämpe said.
I do, too.
The fundamental discoveries underpinning this week’s award were conducted in a lowly roundworm. C elegans is a millimeter-long organism made up of a manageable 1,000 cells (Humans have somewhere between 28 trillion and 36 trillion) yet also boasts a surprising sophistication that has made it a workhorse in research labs. In fact, this is the third set of scientists that can thank the organism for their Nobel nod.
Studying the roundworm allowed Ambros and Ruvkun to add needed nuance to biology’s central dogma that DNA is copied to RNA, which then is translated into proteins inside cells. But that simple, linear story can’t address a fundamental question: If each of our trillions of cells carry the exact same genetic blueprint, how can a neuron look and behave so differently from, say, heart tissue or a different muscle cell? As the researchers helped explain, it’s all about when various proteins are turned on and off — a process that these small stretches of RNA play a vital role in regulating.
Understanding this deeper layer of gene regulation took decades. After Ambros described the first microRNA in 1993, it was seven more years before Ruvkun unveiled the second one. Soon it became clear that humans, too, shared these molecules and the field exploded as researchers identified the snippets of code in various organisms.
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While microRNA’s central role in regulating gene expression hasn’t yet directly led to approved treatments or a groundbreaking vaccine, that doesn’t mean that microRNA won’t one day have an impact on our health. The discovery has already been vital to our knowledge of human disease.
MicroRNAs can tamp down expression of genes that allow healthy cells to go through their normal process of dying and cause the kind of uncontrolled cell growth that is a hallmark of cancer, explains Matthew Disney, a chemistry professor at The Herbert Wertheim UF Scripps Institute for Biomedical Innovation & Technology. Already there is compelling evidence that microRNAs are misbehaving in cancers such as so-called triple-negative breast cancer and brain cancer.
And while turning microRNA into a diagnostic or targeting it with a medicine is tricky, academic scientists and biotech companies are hard at work on it. Disney is the founder of one of several biotech companies devoted to tapping into the therapeutic potential of harnessing microRNA. Given that microRNA levels are out of whack in so many diseases, others are working on ways to use the tiny molecules as a diagnostic tool.
The discovery of microRNA also emphasizes the importance of all the dark matter in our genome. Of the several billion base pairs that make up a human genome, only a small portion make up the recipes for proteins. So what is the rest of that so-called “non-coding” material for? Over the past few decades, scientists have started to understand that it’s far from junk — rather, buried within is the code for vital molecules, like microRNA.
We can’t lose sight of the value of these kinds of astonishing, foundational discoveries. “Our government has gone more and more toward funding the type of research that is only connected to a disease,” says chemist Thomas Cech, who won the Nobel Prize in chemistry in 1989 for a discovery that helped illuminate RNA’s essential role in life. And yet these foundational breakthroughs in biology are what lay the groundwork for better understanding human health.
This prize underscores the need to strike the right balance between basic research and direct applications to medicine. As Ambrose and Ruvkun’s work makes clear, no matter how much we think we know about our inner workings, biology has a way of reminding us how much left there is to discover.
Lisa Jarvis is a Bloomberg Opinion columnist covering biotech, health care and the pharmaceutical industry. Previously, she was executive editor of Chemical & Engineering News.
Millions of Floridians in the near-certain path of Category 4 Hurricane Milton have just hours remaining to prepare for — or evacuate from — the monstrous storm, which is forecast to strike a devastating blow to the central Gulf coast, then carve a path of destruction to the opposite side of the state.
Milton is expected to come ashore within 40 miles north or south of Sarasota with the potential to be “one of the most destructive hurricanes on record” for Florida. The potential landfall zone includes Tampa Bay, home to more than 3.3 million people, which has not endured a direct hit from a hurricane in more than 100 years.
The weather on Florida’s west coast had already started to deteriorate ahead of the monstrous storm, which was packing wind speeds of 155 mph as of 8 a.m. Wednesday, when the storm was just 250 miles from Tampa. The wind speeds had slowed slightly after being at Category 5 strength — 160 mph — earlier in the morning.
The National Hurricane Center predicted Milton would likely continue to weaken in the hours before landfall, but it will be too late to spare the state from the storm’s catastrophic impacts. Forecasts call for Milton to be at least a Category 3 hurricane at landfall, and remain a hurricane during its entire path across the state.
Here’s the forecast track of Hurricane Milton as of 8 a.m. Wednesday. (National Hurricane Center)
Gov. Ron DeSantis said at a media briefing late Tuesday that the storm’s track could put several million Floridians at risk, compared to Hurricane Helene, which made landfall in the sparsely populated Big Bend region. “You start talking about the greater Tampa Bay area, that’s millions of people, and then if the storm rides I-4, out to the Atlantic, that’s many millions more.”
Even as Milton weakens, its wind field will grow considerably, hurricane center forecasters said, bringing a large area of tropical-storm force and hurricane-force winds, especially on the storm’s northwest side.
Making matters worse, tides on the Gulf coast will be incoming around the time of Milton’s landfall, exacerbating the storm surge, which could reach 12-15 feet in some spots. High tide peaks between 4 a.m. and 6 a.m. Thursday in the area around Sarasota and Tampa Bay.
“This is an unusual and extremely concerning forecast track for a hurricane approaching the west-central Florida coast and the Tampa Bay area,” warned AccuWeather Chief Meteorologist Jonathan Porter, “For many, Milton may be a once-in-a-lifetime hurricane in terms of severity.”
Thousands of fleeing cars clogged Florida’s highways ahead of the storm, but time for evacuations was running out Wednesday. Tampa Mayor Jane Castor noted that up to 15 feet of storm surge forecast for her city would be deep enough to swallow an entire house.
“So if you’re in it, basically that’s the coffin that you’re in,” Castor said.
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Authorities have issued mandatory evacuation orders across 11 Florida counties with a combined population of about 5.9 million people, according to U.S. Census Bureau estimates.
Officials have warned that anyone staying behind must fend for themselves, as first responders are not expected to risk their lives attempting rescues at the height of the storm.
After weakening early Tuesday during an eyewall replacement in the Gulf of Mexico — something which typically happens in large hurricanes — Milton’s winds increased to 165 mph later in the day and were at 155 mph as of early Wednesday. On Monday, Milton had intensified at an astonishing rate with barometric pressure plunging below 900 millibars, making it one of the top five most intense Atlantic hurricanes on record.
A hurricane hunter aircraft reported early Tuesday evening the pressure in the eye of Milton was plunging yet again, indicating another explosive intensification. Colorado State University meteorologist Philip Klotzbach said in a post on X that the only other hurricane on record in the Atlantic with a lower pressure this late in the year was Hurricane Wilma in 2005.
As of 8 a.m. Wednesday, Hurricane Milton was located about 250 miles southwest of Tampa, moving northeast at 16 mph. Hurricane-force winds extended outward up to 30 miles from the center, and tropical-storm-force winds extended outward up to 125 miles from the center, the National Hurricane Center said in its latest advisory.
The hurricane center issued a multitude of watches and warnings ahead of the storm. South Florida is under a tropical storm warning with high winds from 58-73 mph and heavy rain possible, despite being far from Milton’s forecast path.
State and local governments scrambled ahead of the storm to remove piles of debris left in Helene’s wake, fearing that the oncoming hurricane would turn loose wreckage into flying missiles. Gov. Ron DeSantis said the state deployed over 300 dump trucks that had removed 1,300 loads of debris.
Bands of heavy rain already moving ashore on Wednesday morning will likely hamper preparations.
In Riverview, south of Tampa, several drivers waiting in a long line for fuel Tuesday said they had no plans to evacuate.
“I think we’ll just hang, you know — tough it out,” said Martin Oakes, of nearby Apollo Beach. “We got shutters up. The house is all ready. So this is sort of the last piece of the puzzle.”
Others weren’t taking any chances after Helene.
On Anna Marie Island along the southern edge of Tampa Bay, Evan Purcell packed up his father’s ashes and was trying to catch his 9-year-old cat, McKenzie, as he prepared to leave Tuesday. Helene left him with thousands of dollars in damage when his home flooded. He feared Milton might take the rest.
“I’m still in shock over the first one and here comes round two,” Purcell said. “I just have a pit in my stomach about this one.”
At a briefing late Tuesday, Gov. Ron DeSantis urged residents to follow the instructions of local officials. “I know some of our residents that just experienced hurricane damage from Hurricane Helene are fatigued,” DeSantis Said. “Just hang in there and do the right thing. Let’s get through this. We can do it together.”
Milton presents a worst-case scenario that hurricane experts have worried about for years.
A 2015 report from the Boston-based catastrophe modeling firm Karen Clark and Co. concluded that Tampa Bay is the most vulnerable place in the U.S. to storm surge flooding from a hurricane and stands to sustain $175 billion in damage.
The city is particularly vulnerable because of the Gulf of Mexico’s underwater topography. The Gulf’s gentle slope allows storms to push water long distances and far inland.
The state has prepared emergency fuel sources and electric vehicle charging stations along evacuation routes, and “identified every possible location that can possibly house someone along those routes,” the state’s director of emergency management, Kevin Guthrie said Tuesday. People who live in homes built after Florida strengthened its codes in 2004, who don’t depend on constant electricity and who aren’t in evacuation zones, should probably avoid the roads, he said.
DeSantis said crews were readying to mobilize for power restoration, and that Milton may cause outages greater than those brought by Hurricane Helene.
There is a “massive amount of resources being marshalled,” he added.
As many as 5,000 National Guard troops are helping state crews to remove the tons of debris left behind by Helene, DeSantis said, and he directed that Florida crews dispatched to North Carolina in Helene’s aftermath return to the state to prepare for Milton.
Milton is expected to bring rainfall totals of 6 to 12 inches, with localized areas seeing potentially up to 18 inches, across portions of central to northern Florida through Thursday. That will come on top of moisture ahead of the hurricane that is already saturating the state.
Information from the Associated Press was used in this report.