Posted on 08/10/2014 12:46:23 AM PDT by Smokin' Joe
I have spent a little time compiling links to threads about the Ebola outbreak in the interest of having all the links in one thread for future reference.
Please add links to new threads and articles of interest as the situation develops.
Thank You all for you participation.
This —
“...We believe that at present no suitable outgroup sequences to root the EBOV phylogeny exist and that a temporal rooting gives the most consistent results.
This approach indicates that the outbreak in Guinea is likely caused...”
Means they don't know jack. They are guessing and pretending otherwise.
This genetic analysis is like early WW2 traffic analysis in the Pacific _before_ the Japanese-American translators gave our code breakers the coded traffic unit addresses. AKA outgroup sequences = the unit addresses.
http://www.ncbi.nlm.nih.gov/pubmed/24860690
Conclusion
The phylogenetic analysis of the five ebolavirus species here does not substantially improve on that presented by Baize et al.1 in that even when partitioning the alignment into coding and non-coding regions we get inconsistent rooting positions for the EBOV clade. We believe that at present no suitable outgroup sequences to root the EBOV phylogeny exist and that a temporal rooting gives the most consistent results.
This approach indicates that the outbreak in Guinea is likely caused by a Zaire ebolavirus lineage that has spread from Central Africa into Guinea and West Africa in recent decades, and does not represent the emergence of a divergent and endemic virus.
As the GP sequences show, without more diverse sequences, especially those from the animal reservoir, it is difficult to narrow down the estimates of when and through what means the Central African EBOV lineage has been introduced into West Africa.
A scenario from a terror thread.... Ebola patients kidnapped from that Ebola ward....what if a few of those kidnappers were muslims intent on terror and took samples....that would be easy to get over the Southern boarder.
Don't like the kidnapper scenario how about islamic aid workers doing the same? Why do they even need to get it over out boarder? Why not just release it in South America or Mexico and let it get here on its own?
You want ideas on how Ebola could get here with a good chance of working just read a couple of terror threads here on Freerepublic.
Oorang said: Search any travel website (kayak, expedia) and you will see flights for this week and over the next few weeks from Lagos, Nigeria to the US. United airlines: Lagos direct to Houston. Delta airlines: Lagos direct to Atlanta.
As of Sept. 20, the last person under surveillance in Nigeria has been found to be free of Ebola. That means that the chain of transmission has been broken and the only cases would be those who are still in the hospital. Once Nigeria has gone 2 full incubation periods (total 42 days) without a new case, it will be officially Ebola-free.
Nigeria is not within walking distance of Sierra Leone, Guinea, or Liberia.
The average person in those countries lives on about $3 per day. I don't think they will do much palm-greasing. I do not think the ones who can afford a flight out are going to try sneaking in the back door.
From there, infection would be likely along natural pathways through human contact, and the outbreak would build from there.
Unless, of course the sick jihadi picked a crowded venue to blow themselves up in.
Then you'd have aerosols, direct fluid contact, piece to person contact, and fomites all in one mess, and with the addition of shrapnel, plenty of open wounds among the initial survivors, and contamination of medical personnel and first responders, among others.
That precedent exists, at least in attempt, sans pathogen. (http://www.freerepublic.com/focus/f-news/1497194/posts)
As I have said before, I will not speculate on what terrorists can or will do with Ebola. All of the information that I have posted is strictly limited to natural infections and routes of transmission.
There is a reason Ebola is considered a Level A biothreat agent. And that is all I will say about that.
Oops, I should have included you in my response #2324 to Smokin’ Joe.
I do not care to speculate on the potential use of Ebola by terrorists. There is a reason Ebola is a category A agent, and I will leave it at that.
I post information about natural infections and chains of transmission only.
As I have said before, I will not speculate on what terrorists can or will do with Ebola. All of the information that I have posted is strictly limited to natural infections and routes of transmission.
I read your posts, and decided to fill that gap.
You keep saying what isn't possible, and I only want to point out that I think you have not considered all aspects. By not considering terrorist activity, you confirm my statement.
It really does not matter whether the disease gets off the State Department shuttle, comes over the southern border as part of an ISIS/ISIL operation, or flies in from Lagos after a 30 day hitch on an oil rig, it can get here.
This genetic analysis is like early WW2 traffic analysis in the Pacific _before_ the Japanese-American translators gave our code breakers the coded traffic unit addresses. AKA outgroup sequences = the unit addresses.
No. It means that they are using the language that any good scientist uses, indicating that they have given their best interpretation of the data, but acknowledging that some other interpretation may be better, or that further data might offer better resolution to the phylogenetic trees.
The recent paper in Science gives another analysis of the phylogeny of this outbreak, which is not very different from this analysis that you linked.
My family knows someone who does the 30/30 out of Port Harcourt. Flies into MMA and then to Houston, then a puddle jumper to Jackson or NO. His wife is begging him to go to your neck of the woods instead LOL.
I think that all knowledgeable people are fully aware that droplet transmission is possible. I have never said otherwise. What I say, and what all of the published data supports is that Ebola is not airborne. As any PhD trained microbiologist will tell you, there are very important differences between droplet and airborne transmission, (or between droplets and droplet nuclei). And the infection control measures are different for each kind of transmission.
I questioned your claim regarding epithelial infection because the ZMAPP drug began as an effort to transport modified alleles to treat cystic fibrosis. The researcher used Ebola glycoproteins due to the virus' efficient transduction of lung tissue. Your claim doesn't jibe with the ZMAPP work.
Hmm, it looks like you have ZMapp confused with some kind of gene therapy. ZMapp is a cocktail of monoclonal antibodies, and those antibodies are specific for Ebola virus proteins. Those antibodies cannot attach to epithelial cells, or any other cells. They are injected into the blood, where they look for and attach to Ebola viruses. They then act as a signal to the immune system to get to work to destroy the viruses. There is no Ebola protein in the ZMapp.
I notice that you didn't bother putting any kind of reference to your claim that Ebola glycoprotein was investigated for treatment of cystic fibrosis. Despite your garbled description of this work, it did not take long for me to find some references in PubMed. The first thing I notice is that there are few references to this work, none of them recent. The second thing I notice is that this work involved a modified Ebola glycoprotein inserted into an FIV-type virus. By modifying it, they changed its behavior. This means that whatever biological properties either Ebola virus or FIV virus have in their native forms are not applicable. The fact that a modified Ebola glycoprotein can bind with some affinity to epithelial cells says nothing about the binding affinities of the native protein. (Perhaps your failure to include a reference was not an oversight?)
Intracellular Events and Cell Fate in Filovirus Infection Viruses 2011 (PDF pg 4)
Indeed, MARV or ZEBOV can be isolated from any organ or tissue. Besides the typical target cells for ZEBOV and MARV infection in non-human primates, additional target cells were occasionally found in individual animals. These cells included alveolar epithelial cells, bronchial epithelial cells and the cells of endocardial layer.
In other words, finding virus in these non-target cells was a sporadic event--it did not happen in every animal observed, and was rare even when it was observed. That review only had one reference for these observations of virus in non-target cells, meaning that there is little corroboration for this observation. I will also point out that during the course of Ebola infection, the viremia can be extremely high, 10 million virions/milliliter of blood. All cell types undergo a process called "endocytosis", where they engulf molecules from outside of the cell and bring them inside the cell in a tiny vacuole. Although viruses use cell-surface receptor mediated endocytosis to gain entry into the cell, when the viremia is that high, it is quite possible for the cell to randomly endocytose a viral particle or two when it undergoes non-specific endocytosis. So, it is not surprising that an occasional non-target cell might contain some virus. That does not mean, however, that the non-target tissue is teeming with virus, or that the virus can replicate in or bud from the non-target cell.
I should also point out that monkeys are not people; the virus can and does have different tropisms in different animal species.
Ebola haemorrhagic fever Lancet March 2011
You mislabeled this link; it was not a Lancet article, but was the International Journal of Experimental Pathology.
I notice that, although you make a big deal of the researchers finding virus near epithelial cells in Rhesis monkeys--which are not humans, and which show a different pathology--you failed to quote the following from the same article: "Epidemiology studies of human disease out-breaks in sub-Saharan Africa did not suggest that aerosol transmission of filoviruses was likely in that setting. Virus did not spread easily from person to person during the Ebola virus epidemics in Africa, and attack rates were highest in individuals who were in direct physical contact with a primary case (Bres 1978). The rates were 3.5 times higher in people who provided nursing care than in those who were in casual contact with a primary case; no cases occurred in children whose only known exposure to the virus was sleeping in the huts occupied by their fatally ill parents. Although coughing was common among the human Ebola haemorrhagic fever cases in Africa, there was no direct evidence for aerogenic spread of Ebola virus in human populations. (Emphasis mine.) So, back in 1995, Ebola researchers noted what Ebola researchers said previously and what they continue to say now: Ebola is not an airborne disease.
Your problem is that you want desperately to believe that it is transmissible by aerosols, and you are looking for straws to support that belief. You have no independent evidence of aerosol transmission, and (unfortunately for you) no Ebola researcher has ever experimentally or epidemiologically established an aerosol route of transmission.
agreed that it's unlikely that Ebola will mutate into the epidemiological definition of an airborne disease. Nor must it undergo such mutation. Fomite, contact, droplet and aerosol are more than sufficient to spread it far and wide, as we're seeing now in West Africa.
Airborne transmission = aerosol transmission (unless you are speaking of artificially created aerosols)
Droplets can be propelled through the air, but are not airborne.
Ebola can be spread by droplets, but not through aerosols.
You seem to think that no one should be the least bit concerned about the spread of Ebola to the western hemisphere. That is your right, of course, but your continued insistence that you know all possible epidemiological factors is odd given that the researchers engaged with this virus will not say the same. Every statement I've heard and read regarding vectors is predicated with a statement that much is unknown regarding transmission and pathogenesis.
When did I ever say that the potential of Ebola disease introduction into the US is not a concern? I don't recall saying that at all. What I have done is point out that it is extremely unlikely for Ebola to cause an outbreak like that in Africa. It is certainly quite appropriate to alert clinicians to the potential of such a disease so that they can recognize it if a case *does* come into their facility. I have certainly implied, if not said, that Ebola won't be a problem as long as we are prepared for it and stay vigilant--that is not at all the same thing as saying that there is nothing to worry about, and we can be complacent. I was pretty much the same way before Y2K--I figured that people were busy remediating the potential problems ahead of time, so that Y2K would not end up being the end of civilization--and I was right. No reason to get all worked up when proper preparations are in place.
Marburg, another filovirus disease that is almost identical to Ebola, *has* entered the US. No one even knew about it; our normal infection control measures were sufficient to prevent any secondary cases.
I have pointed out many times that there is a LOT of unknown surrounding Ebola. I think that you mistake my confidence in the things that I know are true as somehow my being convinced that I know everything. Go back and reread some of my previous posts. You will see that I am actually very clear about where knowledge is limited. I have said that Ebola spreads through direct contact with infected liquids or sick patients--this is well-established. I have also said that Ebola could spread through fomites--this has not been definitely established or ruled out. I have also said that there is no evidence that Ebola spreads through a natural aerosol route--a study to address this matter has not, to my knowledge, been carried out, but there is enough epi evidence and some collateral experimental animal evidence to be able to discount this mode of transmission.
I suspect continued efforts to communicate with you will not prove fruitful.
That's because you haven't really been communicating. You've been trying to make a claim that simply is not true, and I have taken a considerable amount of time to explain to you why it is not true, and to try to get you to understand the nuances of the issue. You do not have to respond to this post, but I will continue to try to educate people on the various aspects of this disease.
Except for the terrorism aspects of it, I will not talk about that.
It's not that I haven't considered it, or think that it's not possible. I just prefer to stick with talking about what I know, which is natural course of disease.
I have worked with Nigerians here (and Russians, Koreans, Gabonese, Brits, Canadians, Kiwis, an Algerian, etc.). The oil patch is truly a global industry. Hopefully, our current contingent is going to maintain its present staffing...(all domestic).
Once more: the affected countries are not exclusively inhabited by "average" people. The majority are indeed dirt poor. There are, however, wealthy people in each affected country.
When things get bad, or if a wealthy person feels he has been exposed, the wealthy WILL use all the money they have in order to get out of there and to the West.
And if the front door is shut to them, then they WILL try the back door.
The average people in those countries *are* the dirt-poor. I most certainly am not comparing them to the average American.
As for a wealthy African developing Ebola and wanting to travel to the West to get treatment--I don't think that's much of an issue. Someone openly seeking treatment in a Western country isn't the issue--they'd be seeking transfer from one health facility to another--someone who might be infected and is not quarantined, thereby exposing caregivers in the community, is the main concern.
There was a Tom Clancy novel where terrorists took Ebola from the blood of infected people, put it in spray cans, smuggled them into the US and spread the Ebola at trade shows (from which people would return to their home towns all over the US).
Sure, it sounds like a far-fetched thriller plot-line. Almost as far-fetched as the Tom Clancy novel where a guy decided to take an airliner and kamikaze it into the US Capitol building....
It is warning all airlines to treat every human body fluid of a suspected Ebola case as infectious with Ebola. See the text and link from the UK Daily Mail below.
The agency stressed that airlines may ‘deny boarding to air travelers with serious contagious diseases that could spread during flight’ on Friday
The rule applies to all U.S. airlines and to foreign airlines flying directly in or out of the country
By AP and JOSH GARDNER FOR MAILONLINE
PUBLISHED: 17:34 EST, 21 September 2014 | UPDATED: 17:34 EST, 21 September 2014
The Center for Disease Control has issued new, strict guidelines for airline crews in an attempt to stop Ebola from spreading outside West Africa.
Released Friday, the new guidance stresses that flight crews should ‘treat any body fluid as though it it is infectious,’ as the out-of-control outbreak claims thousands of lives in Guinea, Liberia, Nigeria and Senegal.
The warning comes as 3000 U.S. troops start to deploy to the developing nations to set up facilities and form training teams to help the Africans treat victims of the gruesome disease.
The CDC stressed in its release that, per U.S. law, American airlines and foreign airlines traveling non-stop to or from the country are permitted airlines ‘to deny boarding to air travelers with serious contagious diseases that could spread during flight.’
In July, a sick Nigeria man managed to board a plane in Liberia and took the deadly virus with him to Lagos.
Officials moved swiftly to tamp out the spread in Africa's most populous city after the man passed Ebola to several healthcare workers.
None of his fellow passengers appear to have contracted the disease in-flight.
Nonetheless, fears remain that a traveler could potentially facilitate that spread of Ebola beyond the confines of West Africa.
Meanwhile, thousands of promised American forces will be moving into Africa over the next 30 days to set up facilities and form training teams to help the Africans treat Ebola victims, the Army's top officer said Friday.
Gen. Ray Odierno, the Army chief of staff, said the disease has accelerated faster than initially thought, so the U.S. needs to get people on the ground and ramp up numbers quickly. President Barack Obama has pledged 3,000 troops, and the U.S. military commander and a small team has arrived in Liberia to do initial assessments.
Before troops are sent in, Odierno says, the Army needs to make sure they are prepared to operate in that environment, which includes health care safety. The military units expected to deploy have not been identified.
Maj. Gen. Darryl Williams, the U.S. Army-Africa commander, arrived in Monrovia on Wednesday with a 12-person assessment team, said Rear Adm. John Kirby, the Pentagon's press secretary. They are conducting site surveys and other planning needed to construct treatment facilities there.
Kirby added that some equipment has already arrived, including a forklift and generator, and two more aircraft are expected this weekend with 45 more military troops.
The Defense Department has requested up to $1 billion for Ebola response efforts.
Kirby said U.S. troops will not be involved in the direct treatment of patients.
‘TREAT ANY BODY FLUID AS IF IT IS INFECTIOUS’: MAIN POINTS OF CDC'S NEW FLIGHT CREW GUIDELINES AMID EBOLA FEARS
The CDC has released new guidelines concerning the handling of sick passengers as Ebola digs its heels deeper into West Africa:
- A U.S. Department of Transportation rule permits airlines to deny boarding to air travelers with serious contagious diseases that could spread during flight, including travelers with possible Ebola symptoms. This rule applies to all flights of U.S. airlines, and to direct flights (no change of planes) to or from the United States by foreign airlines.
- Cabin crew should follow routine infection control precautions for onboard sick travelers. If in-flight cleaning is needed, cabin crew should follow routine airline procedures using personal protective equipment available in the Universal Precautions Kit. If a traveler is confirmed to have had infectious Ebola on a flight, CDC will conduct an investigation to assess risk and inform passengers and crew of possible exposure.
- Hand hygiene and other routine infection control measures should be followed.
- Treat all body fluids as though they are infectious.
Source: CDC.gov
Graph above reflects stats as of Sept. 13 so the number of cases now must be over 6000 and will probably be about 7000 by the end of this month. Since the cases approximately double every 3 weeks there should be at least 15,000 by end of October.
There are three key take aways from the article and video link below —
1. The rate of transmission has increased hugely. The Head of the WHO stated that 25% of the cases of Ebola have happened in the last two weeks.
2. MSF thinks the current reported WHO numbers represent only 20% — one fifth — the visibility of the total Ebola pandemic in the affected nations. That is, the 5,300 WHO number reported a few days ago represents ~26,500 actual cases.
3. The chain of transmission in densly populated West African urban areas is very, very fast, and there is no epidemic model available that matches what MSF and WHO are now seeing in West Africa. Score one for Smokin’ Joe’s fears about the Ebola fomite threat. They seem to have been realized.
Doctors Without Borders chief: World losing battle with Ebola now
September 22, 2014 08:30
Download video (208.21 MB)
http://rt.com/shows/sophieco/189516-west-africa-ebola-threat/
While the world is preoccupied with Islamic State or political games around Ukraine, there’s another threat emerging from the West Africa - where people are dying by hundreds, reaped by the deadliest Ebola epidemic to be ever known to mankind. Efforts to contain it end in a failure, and the vaccine is nonexistent yet. Are we seeing another pandemic slowly growing up to strike at mankind? What should be done to stop it? What does it mean to be a doctor in a place where death reigns? We try to find out this together with the head of the Médecins Sans Frontières - Doctors Without Borders. Dr. Joanne Liu is on Sophie&Co today.
Sophie Shevardnadze: Dr. Joanne Liu, head of International NGO, Médecins Sans Frontières, also known as “Doctors without Borders” - welcome to the program, it’s really great to have you with us today. Now, you recently arrived back from Liberia, which is ravaged by Ebola - but you also worked in other epidemic-affected areas, like Haiti, for example - how is this one different?
Joanne Liu: I think what is different in terms of Western Africa and what’s’ going on in the three mostly affected countries is the, I would say, the ravage of the illness. Basically, the Ebola epidemics has affected all state infrastructure of the countries, mostly in Liberia. So, we don’t have health care centers that are running properly in the city of Monrovia, people don’t have access to the basic health care - because health care workers became infected and some of them have died. So, that’s how it has somehow affected the whole healthcare system. But, what else is different is the fact that we are dealing with a disease that right now is rapidly spreading. In the past we used to deal with this kind of epidemic in some remote rural areas, and then very quickly it would die out by itself, because a chain of transmission was really short. Now, that it has reached a capital, like Monrovia, with1.3 mn people, the chain of transmission is much quicker, and then, what we have seen recently - it’s a thousand new infected cases that are recorded over the last 2 weeks, meaning that we have about 25% of the cases of Ebola that happened in the last two weeks and we were dealing with this epidemic in the last 6 months.
SS: So, is it fair to say that this Ebola epidemic is the gravest you have encountered as someone who is heading an NGO and is dealing with epidemics all the time?
JL: I think, with respect to hemorrhagic fever, this is the biggest and the most unprecedented Ebola epidemic that we have seen. In terms of magnitude, in terms of spread, in terms of people being infected - and the fact that we are really right now facing the unknown on how to tackle at best this epidemic.
SS: I saw videos of you wearing a protective gear and all - how worried were you about actually being infected, were you scared?
JL: It’s a fair question, and I think that everyone who goes in any Ebola environment has to overcome their own fear - but I think it’s the same thing when we go to any other context, where are risking your life. I would say, the main difference that I see is when you are in a country like South Sudan, or a Central African Republic, you can see some “firing” and at one point, there’s a pause in terms of ‘firing’. What happened in country with Ebola is that there’s no downtime - you were always exposed, and that can be really straining on the mental.
SS: But is there any way a doctors who are there to save people can protect themselves, to insure that they’re not affect?
JL: There are some basic rules in terms of protection. When you are in Ebola-management centers, we have very strict rules in terms of how the personnel needs to protect themselves, and this is why we call this “Protective Personal Ebola Gear” - so, there’s a full routine on how to put on this equipment, there’s a full routine on how to remove it in many steps. The way we’re working in MSF is that we have basically a dresser-coach, who gives you order to make sure that you don’t miss one step and you don’t infect yourself while you’re undressing. So, if you’re following that, you’re fine. I think, the other challenge is when you are in the community and you would do some care on the community. It’s how much you should protect yourself - but the reality is: A. someone is not infected until he has symptoms, and B. it’s contagious via body fluids, meaning that you’re not in contact with anybody’s fluids, you will not get the illness. So, when we talk about the body fluids, we talk about if someone has some ejection from the body, vomit, diarrhea or sweat….
SS: Here’s another question which from my understanding is another huge problem with tackling the disease. Did you feel like the people there trusted you? How desperate did you feel they were for your help?
JL: I think that Ebola is always a challenge, wherever it comes. This one is more challenging because it spreads so quickly. There is three ways of intervening with Ebola, these are what I call “The Three Pillars of Intervention”. The first one is the community mobilization and education, telling them what is a symptom, when to do consultation, and in what to use as universal precaution and of washing regularly. The second pillar is in terms of surveillance - getting the data to find out about the magnitude and as well working on breaking the chain of transmission, which means doing the contact briefing with people who have been in contact with someone infected, making sure that we have save burials to avoid more contamination. And the third pillar is in terms of caring for patient with Ebola in isolation center. And so, that’s how we need to respond to it. What is going on right now is that out of those three pillars we haven’t done enough, and the community mobilization needs to be done hand-in-hand - and it’s with the community mobilization and education we will get acceptance, and so we had our times of challenges in some areas.
SS: I guess, what I’m asking is do you still see situations in countries like Liberia, where shamans, for examples, and the likes of shamans, are more respected than educated doctors, the conventional doctors?
JL: Right. This is not something I saw first-hand, I’ve heard some stories about that, never been able to verify, but I think that this is something somehow that we need to respect - but I think that right, there is a good understanding of what’s going on to a certain extent, there’s still a lot of fear, and I would say that now our challenge is translate this fear into vigilance and not panic. Community acceptance is key, talking to the elders, the leaders of the community or prefecture is key, and this is what we have done, and in some places, where initially we were rejected, today people don’t want us to leave.
SS: Now, here’s some measures that some countries are introducing: for example, Sierra-Leone is introducing prison sentences for people who hide their sick relatives. Is that likely to help, in your opinion?
JL: I think that those kind of measures are really tough decision and it’s really difficult to predict how it will unfold and whether it will create more panic. We have a lot of reservation in those kind of measures, we have shared our concerns, but we respect the government’s decision.
SS: But also, why do you think some are still reluctant to send their sick ones to the hospital? Why are they prone to hide them more than make them get some help?
JL: I think if people realize this is the last moment of the loved-one, they want to accompany this person, doing that by themselves; in the places where you have only people in spacesuits around - it may be something difficult. And this is why we are really trying in our isolation center to make it more human and give some sort of an access to the family members. But it’s our hypothesis.
SS: Now, you’ve also spoken of the total collapse of infrastructure and health systems in affected states. How is that possible to get that under control?
JL: Right now, it’s a huge task, because when you face an Ebola epidemic, the people who are at the beginning, who are at the forefront, are really the health personnel, and we often see health personnel being infected, some of them will die, and some of them will infect other people and their patients in centers. And so this is why we had a collapse of the healthcare structure. Today we need to reopen healthcare centers with good infection controls, train the health personnel to protect themselves, and this is a huge task because right now, for example, in Monrovia, we don’t have any of the big hospitals open and running, and we seen some very dramatic stories, like the one of, I think, a dozen, pregnant women that were walking around Monrovia, the capital of Liberia, looking for safe place to deliver, and couldn’t find any places and ended up coming to our Ebola-management center at the end of the day. By the time they reached us, their babies were dead. This is really dramatic situation and we need to restore basic health care access.
SS: I’m just going to show our viewers a map, so they have a clear idea of what I’m talking about. The virus has spread from rural areas to some of Africa’s biggest cities. There were Ebola epidemics in 1995, in 2002, 2003, 2007 - why has this one become worse?
JL: This Ebola epidemics has become worse because, we think - and this is our hypothesis - in fact it was concentrated in rural area, in remote villages, where the chain of transmission would die off very quickly, because people were not mobile, it was small village, so the chain of transmission stops. Now, that it has reached big city, where there’s a lot of people, dense population, and living conditions as well difficult in terms of weather and sanitation - then the chain of transmission is much faster and actually, we don’t have a model of forecast figures right now.
SS: As you’ve said, the chain of transmission is very fast, and if we look at the map of Ebola outbreak, some countries are seriously affected, and then we have the others that are clear of the disease - how’s that work, why is that?
JL: The thing is, right now it’s affecting three major countries: Liberia, Sierra-Leone and Guinea, we have to appreciate that epidemics at different stages in that different countries. In Guinea, we are at the third peak of cases since March, in Sierra-Leone we’re still seeing growing numbers of cases, and in reality we don’t have full visibility on the number of cases. We know there’s a lot of death in the communities. In Liberia we have a little bit more of visibility, but again, what we know, is that there’s an acceleration in the chain of transmission: we had a lot of cases over the last few weeks. About the other countries around, there may be some rumors, we don’t know - we ask people to be vigilant, to really scale up in terms of education of their health care workers, and to be prepared if it ever happens. So, the reality is that it reminds me a little bit of what happened in Haiti with cholera - if you have a country that has a health care structure that was weak for different reasons, when the epidemic of that high level of contagiousness comes, it somehow, I would say, moves really fast and so this is most likely what is happening in West Africa.
SS: The bigger question is, of course, I’ve heard your address the UN, where you’ve said that the world has lost the fight against Ebola. Why do you believe that?
JL: Why I did that? I said the world is losing the battle against Ebola - it’s the fact that we’ve been working in the West Africa for the last 6 months, we’ve been opening Ebola-management centers, we have 5 of them, we have 2000 staff on the ground, and every day, for the last many weeks, we have to turn back home the patients that have Ebola, because we don’t have enough isolation beds in our centers. Everyday we are picking up dead bodies at our doorsteps, because the families are coming and leaving their loved ones at our doorsteps, because they want us to care safely about their bodies. This is why we say we’re losing the battle. This should not happen. People should be able to consult and have access to isolation bed when they are infected, and if they have to do the last journey, they should be able to do it with dignity, and this is not happening.
SS: Now, if you turn on any news station around the world, the headlines are running Ukraine and ISIS as their first stories. Do you believe Ebola is a greater international threat?
JL: I don’t like to compare different contexts, but I really think that today the Ebola epidemic is an international concern, as it has been called by the WHO on 8th of August. I think it’s everyone’s business. If we don’t contain the Ebola epidemic in the more the most concerned countries, or regionally, it would have a major impact in terms of economy, in terms of human life loss, and we’re going to pay the cost of that for years to come. So, I really urge all the members of the world to consider to come up and bring help in the field. I really do think as well that it’s really strange that today the know-how how to tackle an Ebola epidemic is in the hands of the international private organisation. I think every nation should develop a know-how how to deal with highly contagious disease.
SS: But why do you think people aren’t giving, the international community isn’t giving enough to battle this disease if its that grave?
JL: I think the reality is that there are many crises in the world right now. I people are having difficulty to pay attention to all the crises, but it’s difficult to get a reality check about what is the magnitude of the epidemic when we just look at some of the cold figures or think “oh, 4700 people infected, about half of them died - well, compared to other context it is not that bad” - but the reality is that this is only the tip of the iceberg. First of all, we know that the figures underestimate it, we have only 20% visibility of the number of cases, we know the potential of this Ebola epidemic to the rest of African continent and we know as well that a biologic threat like is something that will probably come again and everybody should develop a know-how on how to deal with it.
SS: John Ashton, a senior UK health official, he condemned the pharmaceutical industry for not caring about Ebola since the potential market for a vaccine is not profitable or not profitable enough - is that the case?
JL: There’s always this sort of issue about research and development of new vaccine or new treatment. I think that this is something that we can overcome, we need to put pressure on pharmaceutical companies to make sure what would be developed, and I think that right now the vaccine is key to be developed as soon as possible, it’s needs to be tested to make sure it’s safe and it’s efficient - but the other things is that once we know that it is that good, we have to make sure that it’s going to be available in the production line, and so, the question about intellectual property should not be an obstacle for accessibility to this vaccine to come.
SS: Now, the current outbreak is happening in the volatile region that has seen the rise of terrorists, like Boko Haram - back in 1992, there was a Japanese cult group as well that collected samples of the Ebola virus from Africa allegedly planning to use it in a terror attack. Now, does Ebola pose a potential terror risk? I’m trying to figure out if that’s going to speed up the search for an effective antidote?
JL: Everybody has different scenario, and I would say, conspiracy plot scenario in their mind - I think it’s very difficult for me, as a medical doctor to position myself on it. My take on this is that I think there’s going to be other biological diseases that are highly infectious that probably will spread to other countries in the future, and getting a know-how on how to deal with that is paramount.
SS: I guess what I’m trying to find is how close are we to a vaccine as of right now - I know that back in 2010 the U.S. department of Defence signed $140 mn dollar contract with a company called “Techmira” to develop the Ebola treatment. Are we any closer now?
JL: Right now there’s a huge momentum in terms of research and development of the vaccine. There are different companies that are working on the prototype, so I’m pretty hopeful that something will be tested pretty soon, and, again, I think it’s not the question of finding the vaccine, but it’s to make sure that it is safe and efficient, and after that, that it is accessible.
SS: Just few more questions about the ways of tackling these things. For example, president Obama has indicated he’s prepared to send troops to help combat the outbreak. How soldiers could help in this kind of situation?
JL: In my UN remark, one of the things I’ve said is that we need civilian or military asset with a good chain of command that could deploy rapidly in a big number and have discipline - because that’s what it needs to treat and care for Ebola patients. So, I think that somehow they are responding to one of our appeals. When we see natural disaster we never question when some army comes and deploys - we have disaster response, and often it’s military, and they often do a very good job.
SS: But, if we look at the things the way they are right now - what are the prospects, what’s going to happen? Is it going to get any worse? Is it going to get better?
JL: I wish I could answer you, and as I’ve said in the beginning of my interview, we are in the uncharted waters, we are in the unknown, and it’s difficult. The thing that I know is the fact that if we don’t deploy right now, more assets, more workforce, and more isolation beds for infected patients - we will not be able to control and contain this epidemic. Every day that we wait it’s lost lives, but in addition it complexifies in terms of how we need to deploy in response. We know that every 3 weeks, more or less, the number of cases are doubling, so it’s exponential.
SS: Joanne Liu, thank you so much for this wonderful insight, very interesting, very helpful. I do agree the whole world should reunite to fight and contain this horrific epidemic. Thanks a lot for what you’re doing to help that. We were talking to Dr. Joanne Liu, who’s the head of the international NGO, Médecins Sans Frontières also known as Doctors without Borders - we were talking about Ebola epidemic, the last outbreak, what can be done to contain it, and how, and how the international community should pay more attention to grave issues like Ebola.
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