|Sally Rand, 'Fan Dance' 1942 |
suggests a mystery wrapped around what everyone is sniffing around--that the protagonists in this Affair appear to be beyond the reach, including the reach of the state security services--of key actors at the center of the action. It is quite likely that the usual suspects are not worthy of much attention, and everyone else is beyond reach. So one might be left with the contemplation of a black box, the contours of which can only be discerned by the effects it has when it projects activity outward. We are likely to see that in the future, but connecting the dots may be harder. This is not to pander to conspiracy theories, but rather to acknowledge that that institutionalization of power may not be as transparent or exercised from places that one might expect.
The Trump Administration had promised some sort of explanation, and after several efforts, some connected to the state, others free lance or connected to other actors, the long awaited report prepared for the Department of State has been released. The Report, An Assessment of Illness in U.S. Government Employees and Their Families at Overseas Embassies, was released to the public in the first week of December 2020 and may be downloaded for free from THIS SITE. The Report was edited by by David A. Relman and Julie A. Pavlin for the Standing Committee to Advise the Department of State on Unexplained Health Effects on U.S. Government Employees and Their Families at Overseas Embassies and is styled a Consensus Study Report of the National Academies of Sciences (eg one that documents "the evidence-based consensus on the study’s statement of task by an authoring committee of experts)", Engineering and Medicine. The Standing Committee was charged generally to "provide a forum for discussion of scientific, technical, and social issues relevant to effective health management and protection of staff and family members assigned to overseas locations. (Standing Committee to Advise the Department of State).The popular press response was predictable, both in its conventionally respectable and its tabloid forms, though the tabloid forms are always the more provocative reads. Yet in this case the rports are remarkably similar, and in both cases quite restrained. The Daily Mail (beyond its usual screeching headline) notes only: "The mysterious symptoms American spies and diplomats in Cuba and China have suffered could be due to a directed microwave energy, says a new report by the National Academies of Sciences. The new report, which has been obtained by NBC News, does not explicitly say that the microwaves were deployed intentionally as a weapon, but does not rule that possibility out. Medical and scientific experts from the Academies of Sciences studied 40 State Department employees and noted that no similar symptoms had previously been recorded in medical literature." (Mysterious neurological symptoms suffered by American spies and diplomats in Cuba and China - dubbed 'Havana Syndrome' - could be the result of a microwave energy weapon, says new report). NBC News noted "The report, obtained Friday by NBC News, does not conclude that the directed energy was delivered intentionally, by a weapon, as some U.S. officials have long believed. But it raises that disturbing possibility." (Havana Syndrome' likely caused by pulsed microwave energy, government study finds). See also BBC; the Guardian; . Interestingly the Report from outside the West was more pointed. The India Express noted "By calling it “directed” and “pulsed” energy, the report leaves no room for confusion that the victims’ exposure was targeted and not due to common sources of microwave energy, such as, a mobile phone. The report also mentions that the immediate symptoms that patients reported — including sensations of pain and buzzing sound — apparently emanated from a particular direction, or occurred in a specific spot in a room." (Explained: What is ‘Havana Syndrome’, what does the latest report say about the mysterious illness?). And the New York Times considered the consequences of whatever narrative would be built around the Committee Report in the usual dismissive tones it has adopted since 2016 and will likely abandon after January 2021 ("For the Trump administration, acknowledging that the incidents were the result of a foreign attack could have necessitated evacuating American missions in China, disrupting an important economic relationship. The administration did take a harder approach in Cuba, which aligned with its larger goal of reversing President Barack Obama’s diplomatic opening with Havana.").
There were two sentences in the report worth noting, which follows without comment: "The committee is left with a number of concerns. First, even though it was not in a position to assess or comment on how these DOS cases arose, such as a possible source of directed, pulsed RF energy and the exact circumstances of the putative exposures, the mere consideration of such a scenario raises grave concerns about a world with disinhibited malevolent actors and new tools for causing harm to others, as if the U.S. government does not have its hands full already with naturally occurring threats." (An Assessment of Illness in U.S. Government Employees and Their Families at Overseas Embassies, p. xi).
|Faith Bacon, 'Dance of Shame' 1942|
leverages sophisticated technology to manipulate space and time. . . Just understand that in 6GW, we are getting inside our enemy’s OODA loop (Observe, Orient, Decide, and Act). Once inside, we can control what they see and hear, what they think, what they decide, and what they do, all to our advantage. . . . Meanwhile, let's consider what Sun Tzu teaches:"Be extremely subtle, even to the point of formlessness. Be extremely mysterious, even to the point of soundlessness. Thereby you can be the director of the opponent’s fate."(Sixth generation warfare: manipulating space and time)
The Report reface and Summary follow.
An individual assigned to the U.S. Embassy in Cuba was awakened one night at home in Havana in 2016 by severe pain and a sensation of intense pressure in the face, a loud piercing sound in one ear with directional features, and acute disequilibrium and nausea. Symptoms of vestibular and cognitive dysfunction ensued. A handful of other cases involving colleagues with similar features began that year, and others in the next. Few people were aware of these cases until spring 2017. In addition, the mechanisms and origins were mysterious, and for these and other reasons, there was a delay in recognizing an important cluster of unexplained illnesses, and an early failure to investigate them in a concerted, coordinated, rigorous, and interdisciplinary manner.
In some ways, the problem presented here is an age-old one; that is, how to detect and recognize important anomalies or signals, in a complicated, “noisy” background. Public health systems have grappled with this problem for centuries. In the 1990s, the Centers for Disease Control and Prevention (CDC) conducted population-based surveillance for “unexplained death and critical illness” in persons less than 50 years of age, with features suggestive of infectious cause, at four sites in the United States, and found a surprisingly high incidence of 0.5 cases per 100,000 per year (Hajjeh et al., 2002). The most common clinical presentation was neurologic; a known infectious cause was discovered for only a minority of them; and no obvious relationships among cases were uncovered (Nikkari et al., 2002). But the landscape that countries face today in which the cases in question arise, is an even more complicated one. Not only must governments consider a wide variety of evolving natural causes in a rapidly changing world, but also an increasing threat of disease of deliberate human origin, both accidental and purposeful.
The cases of the Department of State (DOS) employees in Cuba and China have attracted much attention. Among the reasons and ramifications, the clinical features were unusual; the circumstances have led to rampant speculation about the cause(s); and numerous studies, along with the charged political setting, have had consequences for international relations.
The committee was asked by DOS to review the cases, their clinical features and management, epidemiologic investigations, and scientific evidence in support of possible causes, and advise on approaches for the investigation of potential future cases. The committee faced a variety of challenges in responding to these requests (see Section 2). In particular, much of the detail and many of the investigations performed by others were not available to it, either because they are classified for reasons of national security or restricted for other reasons (e.g., internal department deliberations, protected health information, etc.). Thus, the committee had only limited amounts and kinds of information. Despite these challenges, the committee arrived at a number of observations and recommendations, after carefully reviewing the information that was available.
First, the committee found a constellation of acute clinical signs and symptoms with directional and location-specific features that was distinctive; to its knowledge, this constellation of clinical features is unlike any disorder in the neurological or general medical literature. From a neurologic standpoint, this combination of distinctive, acute, audio-vestibular symptoms and signs suggests localization of a disturbance to the labyrinth or the vestibulocochlear nerve or its brainstem connections. Yet, not all DOS cases shared these distinctive and acute signs and symptoms. In fact, the cases are highly heterogeneous. Some patients described only a set of nonspecific, chronic signs and symptoms indicative of disruption of vestibular processing and/or cognition and diffuse involvement of forebrain structures and function, raising the possibility of multiple causes or mechanisms among different patients, as well as for the same patient.
Second, after considering the information available to it and a set of possible mechanisms, the committee felt that many of the distinctive and acute signs, symptoms, and observations reported by DOS employees are consistent with the effects of directed, pulsed radio frequency (RF) energy. Studies published in the open literature more than a half century ago and over the subsequent decades by Western and Soviet sources provide circumstantial support for this possible mechanism. Other mechanisms may play reinforcing or additive effects, producing some of the nonspecific, chronic signs and symptoms, such as persistent postural-perceptual dizziness, a functional vestibular disorder, and psychological conditions.
The committee is left with a number of concerns. First, even though it was not in a position to assess or comment on how these DOS cases arose, such as a possible source of directed, pulsed RF energy and the exact circumstances of the putative exposures, the mere consideration of such a scenario raises grave concerns about a world with disinhibited malevolent actors and new tools for causing harm to others, as if the U.S. government does not have its hands full already with naturally occurring threats. Because the committee was not able to assess specific scenarios involving malevolent actors, one strong suggestion is that follow-up studies on this topic be undertaken by subject-matter experts with proper clearance, including those who work outside the U.S. government, with full access to all relevant information. Second, the committee was concerned about the possibility of future new cases among DOS or other U.S. government employees working overseas, either similar or dissimilar to these, and the ability of the U.S. government to recognize and respond to these cases in a coordinated and effective manner. The next event may be even more dispersed in time and place, and even more difficult to recognize quickly. Toward this end, the committee offers a number of observations, best practices, and recommendations for clinical management, surveillance, and a systematic response in anticipation of future health events. These observations and recommendations should be reviewed and acted on now. It is imperative that the United States recognize and quickly respond to future cases with a well-coordinated, multi-disciplinary, science-based investigation and effective interventions. Finally, the committee is concerned about how best to manage the continuing care of those already affected, and how to strengthen the nation’s commitment to the health and well-being of those who serve the country overseas. Both of these priorities need and deserve additional attention and resources.
On a personal note, it was an honor and privilege to work with a wonderful committee and staff at the National Academies of Sciences, Engineering, and Medicine. Every person contributed unique and important insights and ideas. Finally, it was humbling to learn of the commitment and sacrifices made by those who work for DOS and the rest of the U.S. government in difficult and challenging circumstances overseas. It would behoove us all to consider how we can provide greater support.
David A. Relman, Chair Standing Committee to Advise the Department of State on Unexplained Health Effects on U.S. Government Employees and Their Families at Overseas Embassies
Hajjeh, R. A., D. Relman, P. R. Cieslak, A. N. Sofair, D. Passaro, J. Flood, J. Johnson, J. K. Hacker, W-J Shieh, R. M. Hendry, S. Nikkari, S. Ladd-Wilson, J. Hadler, J. Rainbow, J. W. Tappero, C. W. Woods, L. Conn, S. Reagan, S. Zaki, and B. A. Perkins. 2002. Surveillance for unexplained deaths and critical illnesses due to possibly infectious causes, United States, 1995-1998. Emerging Infectious Diseases 8(2):145-153.
Nikkari, S., F. A. Lopez, P. W. Lepp, P. R. Cieslak, S. Ladd-Wilson, D. Passaro, R. Danila, and D. A. Relman. 2002. Broad-range bacterial detection and the analysis of unexplained death and critical illness. Emerging Infectious Diseases 8(2):188-194.
In late 2016, U.S. Embassy personnel in Havana, Cuba, began to report the development of an unusual set of symptoms and clinical signs. For some of these patients, their case began with the sudden onset of a loud noise, perceived to have directional features, and accompanied by pain in one or both ears or across a broad region of the head, and in some cases, a sensation of head pressure or vibration, dizziness, followed in some cases by tinnitus, visual problems, vertigo, and cognitive difficulties. Other personnel attached to the U.S. Consulate in Guangzhou, China, reported similar symptoms and signs to varying degrees, beginning in the following year. As of June 2020, many of these personnel continue to suffer from these and/or other health problems. Multiple hypotheses and mechanisms have been proposed to explain these clinical cases, but evidence has been lacking, no hypothesis has been proven, and the circumstances remain unclear. The Department of State (DOS), as part of its effort to inform government employees more effectively about health risks at posts abroad, ascertain potential causes of the illnesses, and determine best medical practices for screening, prevention, and treatment for both short and long-term health problems, asked the National Academies of Sciences, Engineering, and Medicine (the National Academies) to provide independent, expert guidance.
The Standing Committee to Advise the Department of States on Unexplained Health Effects on U.S. Government Employees and Their Families at Overseas Embassies faced several challenges in assessing these clinical cases, including lack of access to individual-level health and other information, evolving and changing clinical features over time, and a highly heterogeneous population in terms of the timing and type of clinical symptoms and signs, to include those whose symptoms were only acute, only chronic or both. However, the committee was able to identify distinctive clinical features, consider possible causes, evaluate plausible mechanisms and rehabilitation efforts, and offer recommendations for future planning and responses.
A distinct set of unusual clinical manifestations occurred abruptly in some individuals at the onset of their illness, and the illness became chronic and debilitating for some, but not for all. The most distinctive clinical aspects of the illnesses were the nature of the onset and the initial features: the sudden onset of a perceived loud sound, a sensation of intense pressure or vibration in the head, and pain in the ear or more diffusely in the head. Most individuals reported that the sound or these other sensations seemed to originate from a particular direction and were perceived only when the individual was in a specific physical location. Some also reported sudden onset of tinnitus, hearing loss, dizziness, unsteady gait, and visual disturbances. From a neurologic standpoint, this combination of distinctive, acute, auditory-vestibular symptoms suggests an effect localized to the labyrinth or VIII cranial nerve or its brainstem connections.
Chronic symptoms suffered by many of those affected suggested problems with vestibular processing and cognition, as well as insomnia and headache; these manifestations are more consistent with diffuse involvement of forebrain structures and function, such as cerebral cortex or limbic structures. However, no consistent picture of brain injury emerged from laboratory-based tests of vestibular function. It is possible that these subsequent, more persistent symptoms were caused by sequelae of the same initial insult or that they occurred secondarily as an accommodative response. For those without reports of an acute initial phase, the symptoms
could be from a separate cause or a similar exposure that resulted more exclusively in forebrain dysfunction.
The committee found the unusual presentation of acute, directional or location-specific early phase signs, symptoms and observations reported by DOS employees to be consistent with the effects of directed, pulsed radio frequency (RF) energy. Many of the chronic, nonspecific symptoms are also consistent with known RF effects, such as dizziness, headache, fatigue, nausea, anxiety, cognitive deficits, and memory loss. Patient clinical heterogeneity could be due to variability of exposure dosage conditions, differences in interpretation of non-physiological vestibular stimuli, and anatomical differences that could influence individual exposure and/or response.
The committee also considered chemical exposures, infectious diseases and psychological issues as potential causes or aggravating factors. Although some reports suggested that exposure to organophosphates (OP) and/or pyrethroids from insecticide spraying in Havana could be a cause or contributing factor, the committee concluded that this mechanism was not likely because there was no convincing evidence of acute high-level exposures and the clinical histories of affected U.S. Embassy personnel were not consistent with acute OP poisoning. However, as insecticides can increase the risk or severity of adverse outcomes after exposure to a wide variety of physical or psychosocial stressors, the committee cannot rule out subacute or chronic OP and/or pyrethroid exposures as a possible contributing factor to nonspecific chronic symptoms.
Infectious agents known to be prevalent in Cuba at the time of the U.S. Embassy cases and capable of causing neurological manifestations most prominently include Zika, which was epidemic in Cuba in 2016-2017. However, after reviewing the medical and public health literature, the committee found it highly unlikely that Zika was the cause of the constellation of signs and symptoms reported among DOS personnel.
The acute initial, sudden-onset, distinctive, and unusual symptoms and signs are difficult to ascribe to psychological and social factors. However, the significant variability and clinical heterogeneity of the illnesses affecting DOS personnel leave open the possibility of multiple causal factors including psychological and social factors. These factors could exacerbate other causes of illness and cannot be ruled out as contributing to some of the cases, especially some of the chronic symptoms or later in the course of illness in some cases. Finally, the committee concurred with the diagnosis of persistent postural-perceptual dizziness (PPPD), a functional (not psychiatric) vestibular disorder that may be triggered by vestibular, neurologic, other medical and psychological conditions and may explain some chronic signs and symptoms in some patients.
Overall, directed pulsed RF energy, especially in those with the distinct early manifestations, appears to be the most plausible mechanism in explaining these cases among those that the committee considered, along with PPPD as a secondary reinforcing mechanism, as well as the possible additive effects of psychological conditions. The committee cannot rule out other possible mechanisms and considers it likely that a multiplicity of factors explains some cases and the differences between others. In particular, the committee could not be certain that the individuals with only the chronic set of signs and symptoms suffered from the same cause(s) and etiologic mechanisms as those who reported the initial, sudden onset set of signs and symptoms.
The committee recommends early evaluation and treatment, a supportive environment, and an interdisciplinary approach for rehabilitation of chronic neurological conditions. Without information on patient-specific treatment approaches and responses, it was difficult for the committee to develop recommendations on specific neurologic rehabilitation alternatives. For those with chronic vestibular symptoms, a diagnosis of PPPD offers a potential avenue for rehabilitative interventions.
Part of the committee’s task was to provide advice in anticipation of future threats to DOS personnel and their families’ well-being. To that end, the committee proposes a number of recommendations in order to enhance future responses.
Recommendation 1. The Department of State should expand its collection of baseline and longitudinal data and biological specimens from all personnel prior to and during overseas assignments.
The committee believes that there should be routine data collection for all DOS employees on foreign assignments, including collection of whole blood, plasma, and urine, as well as general medical and neurological examinations, and local environmental assessments. The Acquired Brain Injury Tool (ABIT) is a clinical assessment tool currently used pre- and post-deployment to inventory the same neurological, vestibular and auditory symptoms that were identified in DOS personnel in Cuba. However, given that the nature of future events is unknown, it would be wise to revise it and include symptoms beyond those encountered in Cuba and China.
Recommendation 2. The Department of State, with support from the U.S. government, should establish plans and protocols now to enable comprehensive, expeditious public health and research investigations in the future, should a cluster of new cases warrant investigation.
The committee recommends that a response capability be prepared and authorized in advance of the next potential set of cases, so that the necessary collection of information for a proper public health investigation of U.S. embassy employees can be undertaken in a timely fashion and made available immediately.
Recommendation 3. Following the identification of a possible new case cluster, the Department of State should ensure the collection of data critical for an effective investigation.
The committee suggests that DOS utilize an expert panel described in Section 6 to provide advice on the collection of routine medical data. In addition to the collection of data pertaining to individual diplomats, it is critical that additional public health and epidemiological surveillance data be obtained to provide the temporal and geographic context for the health presentation of individuals.
Recommendation 3-A. If research or assessments support the possibility of radio frequency (RF) energy as a cause of illness experienced by some of its employees, the Department of State should train and equip employees with the capability to measure and characterize their exposure to RF energy in real time should the need arise in the future.
Recommendation 3-B. The Department of State should develop a systematic approach for toxicological diagnoses, and a protocol that supports this approach.
Recommendation 4. The Department of State, with support from the U.S. government, should provide for appropriate personnel to identify public health emergencies and activate the necessary response.
DOS should consider a change in policy so that it enables structured medical investigations of affected individuals in a manner that does not preclude, but is separate from private medical care. The National Institutes of Health Disaster Research Response (DR2) Program may serve as a valuable model for a coordinated system-wide research response to public health emergencies. In addition, to facilitate early identification of health threats to Embassy personnel, the committee suggests an expanded role for health attachés.