Progress beyond wait-and-see.
HEALTH Two friends of mine visited Zimbabwe, South Africa in August. Though they were far from Guinea, Sierra Leone, Liberia or Nigeria in West Africa, their family was quite concerned they might contract the Ebola virus. People are worried about a global spread of the disease that claims the lives of 90 percent of its victims. Perhaps you are as well.
Imagine that everyone on your residential block is suddenly without food. They seek your help. Overwhelmed, you phone a neighbor in the block to the left, only to discover he too is similarly caring for those in his area. The same is true of your neighbor in the block to the right. Across the street, is another block where everyone needs food and medical supplies. And it continues for as far as your eyes can see on each block into the horizon. Overlay the erroneous rumor that the food you are provided is poisoned. This gives you an idea of the insurmountable task facing healthcare workers battling the Ebola virus.
Hundreds of villages with numerous dialects are infected. Telecommunication is poor. There are not enough workers, beds or medications to deal with the outbreak that has so far claimed the lives of more than 1,400, with thousands that have been diagnosed. “You have 60, 70, 80, 90 patients" and you’re one of two or three doctors, says Dr. Rob Fowler. In hazmat gear, valiant doctors, nurses and indigenous volunteers attempt to disinfect homes, diagnose, and quarantine patients, then perform the grim task of burying bodies without contamination but currently workers are outnumbered by the geographical scope of the operation.
The cry for help in proportion to the task is largely falling on deaf ears. Lindis Hurum of Doctors Without Borders says she thinks experts don’t step forward because they fear they would be putting themselves in immediate danger, which is not necessarily true. Though brave people are needed, “There [are] a lot of things you can do in this response that [are] not high-risk," she says. "You do not have to put on that astronaut equipment that you see in all the pictures to respond to this crisis."
What is Ebola?
There are five strains of the Ebola virus, named after the Ebola River in the Democratic Republic of Congo (formerly Zaire), where one of the first outbreaks occurred in 1976. Spread by contact with body fluids of anyone infected, an Ebola virus causes viral hemorrhagic fever, which according to the U.S. Centers for Disease Control and Prevention (CDC), refers to a group of viruses that affect multiple organ systems in the body and are often accompanied by bleeding. Most patients die of uncontrolled hemorrhaging and organ failure.
Early symptoms include sudden onset of fever, weakness, muscle pain, headaches and a sore throat. These symptoms can appear two to 21 days after infection. Some patients may also develop a rash, red eyes, hiccups, chest pains and difficulty breathing and swallowing. Ebola can only be definitively confirmed by five different laboratory tests.
What technology is available to curb global Ebola virus spread? High fever is one of the early symptoms. Airports, particularly in high-risk areas, are implementing thermal imaging and non-invasive thermometers to isolate individuals who may be carriers. Geolocation and surveillance cameras can be used to track individuals suspected of carrying the virus. So if you have a fever from another illness, you may wish to avoid commercial travel in order to prevent extra screening, blood test, and/or quarantine.
Touting such technologies makes impressive sound bites. However, thermal scanners alone will not prevent the spread of the virus. As many as 20 days can pass before symptoms show up. That means that an individual could be carrying the virus for two weeks or longer and not even know it, much less have it show up via thermal scan.
Is is possible that Ebola can enter other continents? Yes, it already has. Two infected missionary workers were flown from West Africa to Atlanta, Georgia, USA, where they received an experimental drug called ZMapp. One British Ebola patient was repatriated yesterday. So any of the Ebola virus strains have the potential for international travel. The key is containment wherever it springs up in order to prevent a pandemic.
Will use of experimental drugs be expanded? ZMapp has not undergone extensive clinical trials. It was not even supposed to be tested on humans until 2015. Of the six human patients who received the drug, the two Americas that received it are responding well. A Liberian doctor was unsuccessfully treated with ZMapp and died. This and the growing epidemic in West Africa is accelerating studies of the drug. However, Mapp Biopharmaceutical, Inc. has indicated that its supply has been exhausted, and more is not expected for several months.
Meanwhile, Japan’s health ministry has said that it is ready to authorize the use of an anti-influenza drug called Favipiravir (brand name Avigan) as a possible treatment for the Ebola virus upon request of the WHO. It has not been proven to be effective against Ebola but the pharmaceutical subsidiary of Fujifilm said it has enough stock for 20,000 patients. Avigan inhibits viral gene replication within infected cells to prevent propagation. WHO said earlier this month that it is ethical to use untested drugs on Ebola patients given the magnitude of the outbreak.
These and several other drugs under development are offering hope beyond quarantine and palliative care. Even if a vaccine is approved, however, one challenge would be figuring out who to vaccinate. Commenting before the news of Avigan, “It’s not going to be all of Africa,” says Stephen Calderwood, chief of the Division of Infectious Disease at Massachusetts General Hospital. “It’s going to be in response to a specific outbreak and within a specific population that is at high risk, for example health-care workers.”
- Ebola virus: Nine things to know about the killer disease. Susannah Cullinane and Madison Park, CNN
- Treating Ebola in Sierra Leone: 'We are two steps behind.' Brent Swails and David McKenzie, CNN
- Aid Workers In Short Supply As Ebola Grips Liberia. npr.org
- How the experimental serum works. CNN, video
- Challenges Remain for Technologies to Fight Ebola. technologyreview.com
- Ebola outbreak: Japan offers anti-influenza drug for treatment. cbc.ca
- Cropped lab photo by Dr. Randal J. Schoepp. Flickr. A technician sets up an assay for Ebola within a containment laboratory. Samples are handled in negative-pressure biological safety cabinets to provide an additional layer of protection.