Ebola

The following sections are included:

• Dedication
• About the Author
• Preface
• Contents

It began with the death of one little boy. His name was Emile, and he lived in a tiny village in forested Guinea called Meliandou…

That was the Q&A testimony provided to the US House Oversight Hearings on Ebola in October by Dr. Thomas Frieden, Director of the CDC…

To understand why it is important to consider the genetic variation that does, in fact, exist, and that may distinguish Ebola guinea from previous strains, it is important to understand the ways in which viral biology can change to increase transmissibility. Much of what is described here is based on observations from past outbreaks. These descriptions should not be taken as a fixed understanding of the biology of Ebola guinea.

Keeping in mind that this strain seems to move faster, may have a distinct symptomology compared to 2012, has a higher R0, and is, in terms of molecular variation, potentially different in numerous ways than past strains, consider the following: Ebola is transmitted via direct, or indirect contact with body fluids from an infected person That sentence may sound very familiar, but it is different in a very important detail from the often stated mantra of the US Centers for Disease Control and Prevention, which reads that Ebola is spread via: Direct contact (through broken skin or mucous membranes in, for example, the eyes, nose, or mouth) with

• blood or body fluids (including but not limited to urine, saliva, sweat, feces, vomit, breast milk, and semen) of a person who is sick with Ebola, and
• objects (like needles and syringes) that have been contaminated with the virus

As the Ebola crisis began to grip the consciousness of the western world, concerns of research on viruses initiating a pandemic of flu much worse than Ebola guinea were mounted by a group of scientists called The Cambridge Working Group in July 2014. In August 2014, Dr. Marc Lipsitch of the Harvard School of Public Health pushed for a meeting on the issue in an Op-ed article in The New York Times (Lipsitch, 2014). In October 2014, the White House suspended government-funded research that could lead to a gain of function in three infectious agents: Influenza, SARS and MERS. Gain-of-function studies are usually animal studies in which the virus' genome is modified specifically to cause the infectious agent to become more pathogenic, or to increase its transmissibility among mammals by respiratory droplets. The risk and value of such studies are being deliberated by the NIH, the National Science Advisory Board for Biosecurity (NSABB) and the National Research Council of the National Academies. Among the concerns cited were statistics on the loss and release of laboratory animals. In his article in The New York Times, Marc wrote: Between 2003 and 2009, there were 395 “potential release events” and 66 “potential loss events” in American labs involving select agents, a category that includes many of the most lethal bacteria and viruses…

The proposed value of such studies is to allow researchers to stay one step ahead of the viruses: To discover ways in which an already dangerous, contagious pathogen may become more pathogenic, or more virulent, and thus be one step closer to developing a vaccine should nature replicate their efforts in the lab…

“We know how to control Ebola, even in this period,” testified CDC Director Thomas Frieden…

You would have to search far and wide to find anyone involved in scientific and biomedical research that would say that a vaccine for Ebola should not be our first priority. At this point in the epidemic in Sierra Leone (early December), the news is not good, and worsening, and while a vaccine is important, at this point, it should not be seen as an exclusive priority. In Sierra Leone, schools and community centers that had been transformed into triage centers have been turned into make-shift full-time containment centers to isolate suspected cases of EVD (NPR, Morning Edition, Dec 5, 2014). The number of new cases per week in the first week of December had reached an all-time high for any country since the outbreak began: 537…

In the months building up to international awareness of the seriousness of the outbreak, information campaigns were launched to inform locals of the terrible truth of EVD. Governments used pamphlets and signs and t-shirts labeled with three words as they sought to reassure people that Ebola is not a curse placed upon, or by a family member; that it is not a disease being given (on purpose) to locals by foreign medical staff; that, in fact, Ebola is Real…

“Treatment” of disease outbreaks involves operations at three levels: The individual and hospital level, the transmission chain, and the region. Each of these levels has its individual set of priorities and needs. As Dr. Michael Osterholm describes efforts as Plans A, B and C, the goal of Plan A is to respond quickly to the isolation and treatment of individuals. This is evidently ineffective for this strain. As Dr. Osterholm pointed out in October 2014: “There is no Plan B. Plan C (meaning a vaccine) is many months away”…

The US population is faced with apparently conflicting signals from government officials on the degree to which they should be concerned over the risks that the West African outbreak of Ebola Virus Disease (EVD) poses to the American public. The CDC's position on Ebola was that they were ready to deal with Ebola making it to the US; that mandatory quarantine is not necessary; that the risk of an outbreak here in the US is very low. They appeared confident that an outbreak will not occur in the US, and that we should not be overly concerned about the few cases that have made it to the US, nor of the few cases due to transmission to health care workers, and potential instances of transmission to loved one. These statements were at odds with the data coming out of Africa, and the information provided by the media. I am scientist; the logical basis of inferences is important to me. Dr. Anthony Fauci, director of the NIAID, and others, have been quoted as saying that we should base policy on science, not on fear. Some of the media and state government's reaction has been dismissed as “hysteria.” However, fear may also exist within our species' genetically encoded hardware upon which the environment, including our parents, writes psychological software. The detect-and-fear repertoire capacity exists for a reason: It has contributed to our survival…

This chapter is a final plea. People across Western Africa are losing loved ones. While initially many villagers feared that outsiders were bringing Ebola to their village, they now seem to understand and are reporting their sick, dying, and dead. People in Uganda have stopped kissing to reduce the rate of spread of Ebolavirus. Liberia has suspended football games. At the request of President Yoweri Museveni, the population is being more aware and limiting physical contact. Health care workers in Western African countries only elbow-bump instead of hand-shaking or high-fiving. People no longer embrace at worship. People are being told to stop touching dead bodies and, against custom, are becoming more accepting of allowing non-family members to handle burials, and the practice of cremation. Deep-seated cultural norms such as washing of the dead by a same-gendered family member are being abandoned. Because they understand now, people are being asked to change, and are changing, their behaviors, habits and ways of thinking…

The following sections are included:

• Appendix 1
• Appendix 2: Ebola Virus Disease (EVD) Clinical Outcomes Data Form
• Epilogue
  • February, 2015
  • March, 2015
  • Treating Vascular Leakage
  • References

The following section is included:

• Index