Arquivo da tag: Ebola

Scientists Were Hunting for the Next Ebola. Now the U.S. Has Cut Off Their Funding (The New York Times)

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By Donald G. McNeil Jr.

Oct. 25, 2019

Original article

Predict, a government research program, sought to identify animal viruses that might infect humans and to head off new pandemics.

Arlette Kavugho, 40, mother of six and an Ebola survivor, carries Kambale Eloge, 16 months old, whose mother died of the disease, in Katwa, near Butembo, Democratic Republic of Congo. USAID’s Predict project helped identify Ebola’s routes of transmission.
Arlette Kavugho, 40, mother of six and an Ebola survivor, carries Kambale Eloge, 16 months old, whose mother died of the disease, in Katwa, near Butembo, Democratic Republic of Congo. USAID’s Predict project helped identify Ebola’s routes of transmission. Credit Zohra Bensemra/Reuters

In a move that worries many public health experts, the federal government is quietly shutting down a surveillance program for dangerous animal viruses that someday may infect humans.

The United Nations Environment Program estimates that a new animal disease that can also infect humans is discovered every four months. Ending the program, experts fear, will leave the world more vulnerable to lethal pathogens like Ebola and MERS that emerge from unexpected places, such as bat-filled trees, gorilla carcasses and camel barns.

The program, known as Predict and run by the United States Agency for International Development, was inspired by the 2005 H5N1 bird flu scare. Launched 10 years ago, the project has cost about $207 million.

The initiative has collected over 140,000 biological samples from animals and found over 1,000 new viruses, including a new strain of Ebola. Predict also trained about 5,000 people in 30 African and Asian countries, and has built or strengthened 60 medical research laboratories, mostly in poor countries.

Dennis Carroll, the former director of USAID’s emerging threats division who helped design Predict, oversaw it for a decade and retired when it was shut down. The surveillance project is closing because of “the ascension of risk-averse bureaucrats,” he said.

Because USAID’s chief mission is economic aid, he added, some federal officials felt uncomfortable funding cutting-edge science like tracking exotic pathogens.

Congress, along with the administrations of George W. Bush and Barack Obama, were “enormously supportive,” said Dr. Carroll, who is now a fellow at Texas A&M’s Bush School of Government and Public Service.

“But things got complicated in the last two years, and by January, Predict was essentially collapsed into hibernation.”

The end of the program “is definitely a loss,” said Peter Daszak, president of the EcoHealth Alliance, a nonprofit global health organization that received funding from the program. “Predict was an approach to heading off pandemics, instead of sitting there waiting for them to emerge and then mobilizing. That’s expensive.”

“The United States spent $5 billion fighting Ebola in West Africa,” he added. “This costs far less.”

A civet cat in a meat market in Guangzhou, China, in 2004. Researchers isolated the lethal SARS virus in civet cats, suggesting that they were infecting humans.
A civet cat in a meat market in Guangzhou, China, in 2004. Researchers isolated the lethal SARS virus in civet cats, suggesting that they were infecting humans.Credit European Pressphoto Agency

The goal of Predict was to speed up and organize the previously haphazard hunt for zoonotic diseases — those that may jump from animals to humans. In recent years, scientists have discovered many lethal viruses lurking in wild and domestic animals.

It has long been known, of course, that AIDS originated in chimpanzees and probably was first contracted by bushmeat hunters. Ebola circulates in bats and apes, while SARS was found in captive civet cats in China.

In South Asia, Nipah virus reaches humans through pigs or date palm sap infected by bats carrying the virus. In Saudi Arabia, MERS also is carried by bats; they infect camels, which then infect humans. The virus can jump from human to human, especially in hospitals.

Novel influenza viruses originate in migratory ducks and geese. The viruses spread first to domestic poultry flocks, then to pigs and humans. Mutations picked up along that viral highway can render the viruses far more dangerous.

These discoveries led to new ways of preventing spillovers of infections into human populations: closing markets where wildlife is butchered for food,; putting bamboo skirts on sap-collection jars to keep bats out; or penning pigs and camels in places where they cannot eat fruit that bats have gnawed.

Predict teams have investigated mysterious disease outbreaks in many countries, including a die-off of 3,000 wild birds in a Mongolian lake. One team proved that endangered otters in a Cambodian zoo were killed by their feed — raw chickens infected with bird flu.

A Predict laboratory helped identify bat-borne viruses that a boys’ soccer team might have been exposed to while trapped for weeks in a cave in Thailand.

Camels for export at the sea port in Mogadishu, Somalia, in 2013. The MERS virus is passed from camels to humans, scientists discovered.
Camels for export at the sea port in Mogadishu, Somalia, in 2013. The MERS virus is passed from camels to humans, scientists discovered. Credit Feisal Omar/Reuters

Allowing Predict to end “is really unfortunate, and the opposite of what we’d like to see happening,” said Dr. Gro Harlem Brundtland, the former prime minister of Norway and former World Health Organization director-general.

She was co-chair of a panel that in September issued a report detailing the world’s failure to prepare for pandemics. “Americans need to understand how much their health security depends on that of other countries, often countries that have no capacity to do this themselves,” Dr. Brundtland said.

Even though USAID is “incredibly proud and happy over the work Predict has done,” the program is closing because it reached the end of a 10-year funding cycle, said Irene Koek, acting assistant administrator of the agency’s global health bureau.

“We typically do programs in five-year cycles, and it had two,” she said. Some similar research will be part of future budget requests, “but it’s still in the design-and-procurement cycle, so exactly what will continue is a bit of a black box.”

In mid-October, the agency said it would spend $85 million over the next five years helping universities in Africa and Asia teach the “one-health” approach that Predict used. (“One health” describes the nexus between animal, human and environmental medicine).

But it will not involve the daring fieldwork that Predict specialized in.

Among the institutions that worked on Predict projects are those staffed by wildlife veterinarians and disease-trackers like the University of California, Davis’s One Health Institute; the EcoHealth Alliance; the Wildlife Conservation Society, which runs the Bronx Zoo; the Smithsonian Institution, which manages the National Zoo in Washington; and Columbia University’s Center for Infection and Immunity.

Some Predict projects will be taken over by other government agencies, such as the Pentagon’s Defense Threat Reduction Agency or the National Institutes of Health. But those agencies have different missions, such as basic research or troop protection. They do not share USAID’s goal of training poor countries to do the work themselves.

A man prepares chickens for sale at the a market in Phnom Penh, Cambodia. Poultry may carry influenza viruses that are transmitted to humans.
A man prepares chickens for sale at the a market in Phnom Penh, Cambodia. Poultry may carry influenza viruses that are transmitted to humans. Credit Nicolas Axelrod/Getty Images

As an agency that gives money to countries, USAID often has a friendlier, more cooperative relationship with governments in poor nations than, for example, Pentagon-led efforts might.

“I’ve always been impressed with the way they were able to work with ministries of health,” said Dr. James M. Hughes, a former chief of infectious diseases at the Centers for Disease Control and Prevention who was on Predict’s advisory board. “They have a high level of trust, and they help countries comply with the International Health Regulations.”

(Those regulations, in force since 2007, require countries to report all major disease outbreaks to the World Health Organization and allow the W.H.O. to declare health emergencies.)

USAID still supports some health-related programs like the President’s Malaria Initiative and the President’s Emergency Plan for AIDS Relief. But Dr. Carroll described those as “cookbook portfolios.”

How to fight those diseases is well-known, he explained, so the agency just comes up with a budget for drugs, diagnostic kits, insecticides, mosquito nets, condoms or other long-established interventions.

Predict more often placed medical detectives in the field, training local doctors, veterinarians, wildlife rangers and others to collect samples from wild and domestic animals.

It can be highly specialized work. Getting blood samples from pigs or wild rodents is fairly routine, but catching birds, bats or monkeys alive is not. Gorillas are harder. (Scientists usually content themselves with just collecting gorilla feces.)

Predict also experimented with novel ways to catch and release animals unharmed, to transport samples without refrigeration and to use DNA testing that can scan for whole viral families instead of just known viruses, said Dr. Christine Kreuder Johnson, associate director of the One Health Institute at the University of California, Davis.

Predict sponsored epidemiological modeling to predict where outbreaks are likely to erupt. It also sought ways to curb practices, such as hunting for bushmeat or breeding racing camels, that encourage eruptions.

The Zaire strain was found in a bat that roosts in caves and mines, said Dr. Jonathan Epstein, an EcoHealth Alliance veterinarian, while the Bombali type was in a species that roosts in houses.

Distinctions like that are important for telling people — especially people who eat bats — which species are dangerous.

“We generated an illustrated book on how to keep bats out of houses by putting screens on windows or mesh below the roof thatch,” he said. “That’s the kind of thing Predict paid for.”

Predict served as a proof of concept for a much more ambitious idea that Dr. Carroll proposed several years ago: the Global Virome Project, which envisioned trying to compile a genetic atlas of all the viruses circulating in all animals. By some estimates, there are more than 800,000 such viruses waiting to be discovered.

Many scientists questioned the wisdom of spending as much as would be needed to do that — over $3 billion. But those experts also argued that Predict, which is focused on viruses dangerous to humans, was very much worth the relatively modest amounts of money it cost.

“Predict needed to go on for 20 years, not 10,” Dr. Epstein said. “We were getting to the point of having a trained work force that could gather animal samples and labs that could test for unknown viruses, not just known ones.”

“Once it stops, it’s going to be hard to maintain that level of proficiency.”

What Might Africa Teach the World? Covid-19 and Ebola Virus Disease Compared (African Arguments)

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By Paul Richards March 17, 2020

A medical official outside an emergency tent installed for patients infected by COVID-19 in Poland- Credit Sky News

Covid-19 is a flu-like illness (symptoms include fever, cough, and breathing problems) caused by a corona virus (SARS CoV-2). Like Ebola, the virus causing Covid-19 circulates within populations of bats and crossed over to humans via the bush meat trade. The first human cases were identified in China in December 2019, and the infection has now (March 2020) reached more than 100 countries.

The disease is now recognised by the World Health Organization as a pandemic. Up to 80 percent of the population of some countries might eventually become infected. Most cases will be mild, and recovery spontaneous. About 5 percent of cases will be life-threatening. Death rates appear to be around 1-2 percent. The elderly are most at risk.[1]

Currently, attention is focused on reducing the rate at which Covid-19 spreads. One aim is to delay the peak of infection beyond the winter flu period in the northern hemisphere, when medical help is stretched. Slowing the epidemic also allows more time for preparation of health systems to cope with large numbers, and for work on vaccine development.

Predictably, some politicians have demanded border closures against immigrants and refugees, even though spread is associated with tourism and normal business travel. Africans internationally stigmatised by Ebola might feel aggrieved that cases of Covid-19 have been introduced from Europe and Asia. But in a globally connected and inter-dependent world blaming and stigmatising helps no one. It is better to share ideas about what can be done to protect.

This is where Africa’s experience of Ebola has something to offer. Communities experiencing Ebola in West Africa in 2014-15 rapidly learnt from scratch how to cope with a deadly new infection, and this provides the rest of the world with important information on strategies to address novel disease threats more generally.

Like Ebola, Covid-19 is a family disease, in the sense that many infections occur in the home. Restrictions on travel can slow the spread of the disease, but it also helps if individuals and families understand infection pathways and implement domestic precautions. This is something in which West Africans confronted by Ebola have had much experience.

History of Pandemics – credit Virtual Capitalists

The name for Ebola in Mende, one of the main languages of Sierra Leone, the worst affected country in 2014-15, was bonda wote, literally ‘family turn round’. In other words, it was clearly recognised that this was a disease requiring families to change behaviour in major ways, especially in how they cared for the sick.

Covid-19 will require similar changes at the family level, especially in terms of how the elderly are protected. The buzz words for epidemic responders include self-isolation and social distancing, but the details of how to implement these vague concepts have been left to local social imagination.

Answers are required for both the uninfected elderly, and for others who are sick.

Should grandpa be packed off to a shed in the garden away from the family for his own protection? What happens when grandma gets lonely and wants to see the grandchildren? Who does the shopping? How does the daily-paid worker ‘self-isolate’ when there is no sick pay? Who collects the children from school when a single mum is sick?

Much depends on actual family arrangements and housing stock. So African solutions for Ebola will not work directly in other parts of the world. But it is important to know that under the challenge of Ebola local people showed much inventiveness in devising solutions to such problems.

Evidence shows that ways can be found to reduce family risks of infection, even with a disease 30 times more deadly than Covid-19.[2]For Ebola, these ranged from the elbow knock that replaced shaking of hands as a public greeting, to the appointment of a single carer in the household to look after the sick while waiting for help, to the carefully choreographed ‘safe and respectful’ funerals that allowed some element of local ritual back into the burial process, a major source of infection.

Every encouragement should be given to this local adaptive creativity, and the authorities should listen carefully to information from below about what would help to make a difference.

However, Covid-19 is not Ebola, and differences have to be taken into account. Some of the major questions about how the disease spreads are as yet unknown, and citizens and households need to be listening for this information as it becomes available and helped to adapt to its implications in real time.

This implies having very good means of two-way communication. In Sierra Leone a telephone helpline, ‘117’, played an important part in arranging emergency Ebola response, but it was much poorer at harvesting feedback from communities about what could be done better.

It seems that the lesson has not been learnt with Covid-19. In Britain, the National Health Service helpline, ‘111’ has now been ‘stood down’ for Covid-19 enquiries relating to domestic testing, since the epidemic is deemed to have passed into a new phase. How then are the authorities to have a conversation with families about the resources most needed for adaptation at household level?

Case-handling is a second area of difference. Ebola does not spread easily. The virologist Peter Piot put it well when he stated that he would have no problem sitting next to someone with Ebola provided they were not vomiting over him. Infection spreads only through contact with body fluids. Covid-19, however, spreads through the air, as well as via bodily contact, and case numbers will be much higher.

With Ebola in West Africa the number of cases turning up at specialist Ebola care facilities at the height of the epidemic numbered in tens or hundreds per week. With Covid-19 the numbers of cases requiring intensive care at the peak of the epidemic may amount to hundreds of thousands.

Even if stretched out over several months infection on this scale implies a large extra demand for medical care.

Ebola taught that epidemics cause deaths from other diseases through their impact on health systems. In all there were about 12,000 Ebola deaths in Upper West Africa (Guinea, Liberia, Sierra Leone) in 2014-15 but many additional fatalities resulted from, for example, closure of facilities such as maternity clinics.

So contingency planning is required. A key challenge for Covid-19 is how health system care should best be organized, without severely disrupting other forms of health provision.

For Ebola, the first response was to build large field hospitals (Ebola Treatment Centres).[3]These were seen as the safest option. But they were shunned by families, because so few patients came out alive. They were also often in the wrong place (built behind, not ahead, of the epidemic).

Information started to filter through that some communities were taking their own steps to reduce infection and bury the dead. This raised the question whether there was more scope for community care.

Family do-it-yourself responses proved controversial. International responders were adamant that there would be nothing resembling home care; it was too dangerous. Local communities were equally adamant that there would have to be some form of home care; they could not stand by and watch family members die, when an ambulance to take a patient to an ETC might take days to arrive over bad or non-existent roads.

Families saw it as their duty to be involved in care of the sick. So, they repeatedly asked what to do while waiting for help to arrive. Could they not prepare food for the sick? Could they not be trained to safely bury the dead?

No, they were told. Ebola required specialist management.

Communities answered back. They pointed to areas at the outset of the epidemic, where the epidemic was rolled back with only local resources. In Kailahun District, for example, an intense initial outbreak was reduced to a trickle of cases by local responders organizing quarantine and burial with improvised resources. That cases then declined without outside help implied either that the disease burnt out more readily than anticipated, or that local improvisation worked better than expected. There is evidence to support both interpretations.[4]

Experts knew that Ebola control required prompt diagnosis, before the ‘wet’ symptoms of the disease became apparent. Something had to be done to speed up the presentation of cases. The answer was to build much smaller community care centres (CCC) close to where active transmission was taking place.[5]This also changed the relationship between families and Ebola responders from fear to active cooperation.

Staff of CCC were for the most part local volunteers – trained nurses who had not been absorbed on to the payroll of the Ministry of Health, or villagers willing to take on high-risk chores for a decent wage. The fact that staffing was local meant patients saw familiar faces, and this built trust. CCC also normalized Ebola by bringing treatment within a framework of general medical assistance.

As a result, patients were presented more promptly than was the case with the distant ETC. Ebola (indistinguishable from malaria or typhoid in its early phase) was more rapidly identified and isolated. One study estimates that CCC contributed up to one third of the infection control ending the epidemic in Sierra Leone.[6]

This example of responders modifying their approach to infection control better to accommodate family requirements may hold lessons for Covid-19.

Specifically, cases may have to be kept out of main hospitals as much as possible, Thus, there may be a need for field treatment facilities not dissimilar to CCC, as a half-way house between home isolation and intensive care. In effect these facilities would isolate and triage the most vulnerable cases, as was the case with Ebola CCC.

There is also a possibility that any such facilities might be run up by military personnel[7]and staffed by medically trained ‘volunteers’ (retired doctors and nurses), as in Sierra Leone.

Interesting to note, the chief medical advisor for England was previously one of the proponents of the introduction of CCC in Sierra Leone, and we may be about to see some lessons directly transferred.[8]

Quarantine for Ebola in Sierra Leone is also an issue from which Covid-19 responders might wish to draw lessons. Much of it was organised and imposed by the state, and was at times heavy-handed. But communities also organised their own quarantine. They understood that self-isolation was in their own interest, and this sometimes worked surprisingly effectively.

Use was made of an approach used during the civil war of 1991-2002 of mobilising community youth to identify infiltrators. Visitors who might have been carrying the virus were turned away. But in other cases the approach was more focused on sequestering those who were well. Rural families sometimes decamped from villages with outbreaks to settle down for a few weeks in their farms, where sleeping quarters were sometimes built for the purpose.

In this respect, Sierra Leonean rural communities showed a clear appreciation of the fact that there were two distinct kinds of quarantine – self-isolation and protective sequestration. Both kinds are being used as part of the response to Covid-19, but at times without adequate discussion of how the two types differ and have different social motivations – self-protection and altruism towards neighbours. It is not wise to talk about self-isolation for the sick and the elderly in the same breath. The different motivations need to be more clearly explained.

In conclusion, it is also important to say something about what Africa can learn from its own experience of Ebola. The point made above should be reiterated – about the differences as well as similarities between Covid-19 and Ebola.

Prompt case finding, contact tracing and quarantine are being applied to Covid-19 as they were for Ebola.[9]Good hygiene practices, such as hand washing, also remain applicable. African countries with experience of Ebola know how to do these things, and this will be helpful in dealing with early cases.

However, African countries also have to be prepared to learn to adapt to the specific features of this new disease as more data emerge. This will pose more of a challenge, since this will require rapid knowledge-based domestic adaptation to new information on how Covid-19 spreads (perhaps most notably, why it affects the old more than the young, and how older people might be best protected from its effects).

The main lesson for both Africa and other parts of the world from Ebola for Covid-19, however, is that shared learning between communities and medical professionals is a key aspect of human adaptive response to emergent diseases. In any disease in which community mobilization is an important aspect families need to think like epidemiologists, but equally epidemiologists need to think like families.

Paul Richards’ Ebola book front cover, part of the African Arguments book series

References:

[1]Xu, J., Zhao, S., Teng T., Abdalla, A.E., Zhu, W., Xie, L., Wang, Y., Guo, X. (2020) ‘Systematic comparison of two animal-to-human transmitted human coronaviruses: SARS-CoV-2 and SARS-CoV’, Viruses 12, 244.

[2]Richards, P. (2016) Ebola: How a People’s Science Helped End an Epidemic, London: Zed Books.

[3]Richards, P., Mokuwa, E., Welmers, P., Maat, H., Beisel, U. (2019) ‘Trust, and distrust, of Ebola Treatment Centers: a case-study from Sierra Leone’, PLoS ONE14(12): e0224511. https://doi.org/10.1371/journal.pone.0224511.

[4]Glynn, Judith R. et al. (2017) ‘Asymptomatic infection and unrecognised Ebola virus disease in Ebola-affected households in Sierra Leone: a cross-sectional study using a new non-invasive assay for antibodies to Ebola virus’,Lancet Infectious Diseases17(6), 645-653. On local case finding, quarantine and burial procedures see Richards (2016) op. cit.

[5]Mokuwa, E.Y., Maat, H. (2020) ‘Rural populations exposed to Ebola Virus Disease respond positively to localised case handling: evidence from Sierra Leone’, PLoS Negl Trop Dis 14(1): e0007666. https://doi.org/10.1371/journal.pntd.0007666.

[6]Pronyk, P., Rogers, B., Lee, S., Bhatnagar, A., Wolman, Y., Monasch, R., Hipgrave, D., Salama, P., Kucharski, A., Chopra, M., and on behalf of the UNICEF Sierra Leone Ebola Response Team, (2016) ‘The effect of community-based prevention and care on Ebola transmission in Sierra Leone’,American Journal of Public Health 106, 727–32, https://doi.org/10.2105/AJPH.2015.303020.

[7]Aaaron Walawalkar and Jamie Grierson, The Guardian,8 March 2020, 14.12 GMT.

[8]Whitty, C.J.M., Farrar, J., Ferguson, N., Edmunds, W.J., Piot, P., Leach, M., Davies, S.C. (2014) ‘Tough choices to reduce Ebola transmission’, Nature515, 13 November, 192–4; see also Ian Sample and Lisa O’Carroll ‘Prof Chris Whitty – the expert we need in the coronavirus crisis’, Guardian,4 March 2020.

[9]Hellewell, J. et al. (2020) ‘Feasibility of controlling Covid-19 outbreaks by isolation of cases and contacts’, Lancet, 28 February 2020, https://doi.org/10.1016/S2214-109X(20)30074-7.

Ebola Is Wiping Out the World’s Gorillas (The Daily Beast)

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Finbarr O’Reilly/Reuters

01.22.15

In just four decades, Ebola has wiped out one third of the world’s chimp and gorilla populations. If it continues, the results will be devastating.

While coverage of the current Ebola epidemic in West Africa remains centered on the human populations in Guinea, Sierra Leone, and Liberia, wildlife experts’ concern is mounting over the virus’ favorite victims: great apes.

Guinea, where the epidemic originated, has the largest population of chimpanzees in all of West Africa. Liberia is close behind. Central Africa is home to western lowland gorillas, the largest and most widespread of all four species. Due to forest density, the number of those infected is unknown. But with hundreds of thousands of ape casualties from Ebola, it’s doubtful they’ve escaped unscathed.

Animal activists are ramping up efforts to find an Ebola vaccine for great apes, but with inadequate international support for human research, their mission could be seen as competing with one to save humans. Experts from the Jane Goodall Institute of Canada insist such apprehension would be misplaced. Two streams of funding—one for humans, one for apes—can coexist in this epidemic, they assert, and must.

“The media was really focusing on human beings,” Sophie Muset, project manager for JGI, says. “But it has been traumatic to [the great ape] population for many years.”

Over the course of just four decades, Ebola has wiped out one third of the world’s population of chimpanzees and gorillas, which now stand at less than 300,000 and 95,000 respectively.

The first large-scale “die-offs” due to Ebola began in the late 1990s, and haven’t stopped. Over the course of just four decades, Ebola has wiped out one third of the world’s population of chimpanzees and gorillas, which now stand at less than 300,000 and 95,000 respectively. Both species are now classified as endangered by the International Union for Conservation of Nature; western gorillas are “critically” so.

One of earliest Ebola “die-offs” of great apes came in 1994, when an Ebola outbreak in Minkébé decimated the region’s entire population—once the second largest in the world. In 2002, an outbreak in the Democratic Republic of Congo wiped out 95 percent of the region’s gorilla population. And an equally brutal attack broke out in 2006, when Ebola Zaire in Gabon (the same strain as the current outbreak) left an estimated 5,000 gorillas dead.

The dwindling population of both species, combined with outside poaching threats, means Ebola poses a very real threat to their existence. To evaluate the damage thus far, the Wild Chimpanzee Foundation is conducting population assessments in West Africa, with the goal of getting a rough estimate of how many have died. Given the combined damage that Ebola has inflicted on this population, the results are likely to be troubling.

In a way, great apes are Ebola’s perfect victims. Acutely tactile mammals, their dynamic social environments revolve around intimacy with each other. Touching hands, scratching backs, hugging, kissing, and tickling, they are near constantly intertwined—giving Ebola a free ride.

In a May 2007 study from The American Naturalist, researchers studying the interactions between chimpanzees and gorillas found evidence the Ebola can even spread between the social groups. At three different sites in northern Republic of Congo, they found bacteria from gorillas and chimps on the same fruit trees. For a virus that spreads through bodily fluids, this is an ideal scenario.

“They live in groups [and] they are very close,” says Muset, who has worked with chimps on the ground in Uganda and the DRC. “Since Ebola transmission happens through body fluids, it spreads very fast.”

For gorillas in particular, this culture proves deadly, making their mortality rate for this virus closer to  95 percent. But like humans, the corpses of chimpanzees and gorillas remain contagious with Ebola for days. While the chimps and gorillas infected with Ebola will likely die in a matter of days, the virus can live on in their corpse for days—in turn, spreading to humans who eat or touch their meat.

It is one such interaction that could result in the spread from apes to humans. But in this particular outbreak, experts have zeroed in on the fruit bat (believed to be the original carrier) as the source. The index patient, a 2-year-old in Guinea, was reportedly playing on a tree with a fruit bat colony.

Whether or not a great ape was involved in the transmission of the virus to humans during this outbreak is unknown. Such an interaction is possible. Interestingly, however, it’s not the risk that great apes with Ebola pose to humans that wildlife experts find most concerning. It’s the risk that their absence poses to the wild.

Owing to a diet consisting mostly of fruit, honey, and leaves, gorillas and chimpanzees are crucial to forest life. Inadvertently distributing seeds and pollen throughout the forest, they stimulate biodiversity within it. Without them, the biodiversity of the vegetation may plummet, endangering all of the species that relied on it—and, in turn, the people that relied on them.

“They are not the only ones who act as seed dispersers,” says Muset. “But they are the big players in that field. So when [a die-off] happens, it can decimate an entire forest.”

Wildlife experts worldwide are working to raise both awareness and funds for a vaccination process. It’s a battle that she says was gaining speed last January, when a researcher announced that he had found a vaccine that could work in chimps But as the epidemic in West Africa grew, the focus shifted.

But Muset says its time to return to the project. “There is a vaccine, but it has never been tested on chimpanzees,” she says.  “Progress has been made, and preliminary testing done, but testing in the field need to happen to make it real.”

As to the question of whether it’s ethical to be searching for a vaccine for wild animals when humans are still suffering as well, Muset is honest. “For sure there is a direct competition here. But wildlife and humans have a lot of diseases in common that they can transmit from one to the other,” she says. “And I think you can think of it as two streams of funding, one to wildlife and the other to human beings.”

While it’s great apes that wildlife experts are seeking to save, human nature as a whole, Muset argues, is at stake. “If you want a healthy ecosystem, the more you have to invest in health for wildlife and humans,” she says. “Then, the better place it will be.  Because really, it all works together.”

Some Fear Ebola Outbreak Could Make Nation Turn to Science (The New Yorker)

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Borowitz Report
OCTOBER 16, 2014
BY ANDY BOROWITZ

Borowitz-Ebola-Scientists-690CREDIT PHOTOGRAPH BY WILLIAM THOMAS CAIN/GETTY

NEW YORK (The Borowitz Report)—There is a deep-seated fear among some Americans that an Ebola outbreak could make the country turn to science.

In interviews conducted across the nation, leading anti-science activists expressed their concern that the American people, wracked with anxiety over the possible spread of the virus, might desperately look to science to save the day.

“It’s a very human reaction,” said Harland Dorrinson, a prominent anti-science activist from Springfield, Missouri. “If you put them under enough stress, perfectly rational people will panic and start believing in science.”

Additionally, he worries about a “slippery slope” situation, “in which a belief in science leads to a belief in math, which in turn fosters a dangerous dependence on facts.”

At the end of the day, though, Dorrinson hopes that such a doomsday scenario will not come to pass. “Time and time again through history, Americans have been exposed to science and refused to accept it,” he said. “I pray that this time will be no different.”

Without swift influx of substantial aid, Ebola epidemic in Africa poised to explode (Science Daily)

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Date: October 23, 2014

Source: Yale University

Summary: The Ebola virus disease epidemic already devastating swaths of West Africa will likely get far worse in the coming weeks and months unless international commitments are significantly and immediately increased, new research predicts.

Artist’s conception (stock illustration). Credit: © Jim Vallee / Fotolia

The Ebola virus disease epidemic already devastating swaths of West Africa will likely get far worse in the coming weeks and months unless international commitments are significantly and immediately increased, new research led by Yale researchers predicts.

The findings are published in the Oct. 24 issue of The Lancet Infectious Diseases.

A team of seven scientists from Yale’s Schools of Public Health and Medicine and the Ministry of Health and Social Welfare in Liberia developed a mathematical transmission model of the viral disease and applied it to Liberia’s most populous county, Montserrado, an area already hard hit. The researchers determined that tens of thousands of new Ebola cases — and deaths — are likely by Dec. 15 if the epidemic continues on its present course.

“Our predictions highlight the rapidly closing window of opportunity for controlling the outbreak and averting a catastrophic toll of new Ebola cases and deaths in the coming months,” said Alison Galvani, professor of epidemiology at the School of Public Health and the paper’s senior author. “Although we might still be within the midst of what will ultimately be viewed as the early phase of the current outbreak, the possibility of averting calamitous repercussions from an initially delayed and insufficient response is quickly eroding.”

The model developed by Galvani and colleagues projects as many as 170,996 total reported and unreported cases of the disease, representing 12% of the overall population of some 1.38 million people, and 90,122 deaths in Montserrado alone by Dec. 15. Of these, the authors estimate 42,669 cases and 27,175 deaths will have been reported by that time.

Much of this suffering — some 97,940 cases of the disease — could be averted if the international community steps up control measures immediately, starting Oct. 31, the model predicts. This would require additional Ebola treatment center beds, a fivefold increase in the speed with which cases are detected, and allocation of protective kits to households of patients awaiting treatment center admission. The study predicts that, at best, just over half as many cases (53,957) can be averted if the interventions are delayed to Nov. 15. Had all of these measures been in place by Oct. 15, the model calculates that 137,432 cases in Montserrado could have been avoided.

There have been approximately 9,000 reported cases and 4,500 deaths from the disease in Liberia, Sierra Leone, and Guinea since the latest outbreak began with a case in a toddler in rural Guinea in December 2013. For the first time cases have been confirmed among health-care workers treating patients in the United States and parts of Europe.

“The current global health strategy is woefully inadequate to stop the current volatile Ebola epidemic,” co-author Dr. Frederick Altice, professor of internal medicine and public health added. “At a minimum, capable logisticians are needed to construct a sufficient number of Ebola treatment units in order to avoid the unnecessary deaths of tens, if not hundreds, of thousands of people.”

Other authors include lead author Joseph Lewnard, Martial L. Ndeffo Mbah, Jorge A. Alfaro-Murillo, Luke Bawo, and Tolbert G. Nyenswah.

The National Institutes of Health funded the study.

Journal Reference:

  1. Joseph A Lewnard, Martial L Ndeffo Mbah, Jorge A Alfaro-Murillo, Frederick L Altice, Luke Bawo, Tolbert G Nyenswah, Alison P Galvani. Dynamics and control of Ebola virus transmission in Montserrado, Liberia: a mathematical modelling analysis. Lancet Infectious Diseases, October 24, 2014 DOI:10.1016/S1473-3099(14)70995-8

Cruz Vermelha prevê ao menos quatro meses para controlar ebola (Agência Brasil)

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A epidemia já causou mais de 4,5 mil mortes na África Ocidental

A epidemia de ebola vai demorar pelo menos quatro meses para ser contida se todas as medidas necessárias forem tomadas, disse hoje (22) o responsável geral da Cruz Vermelha, Elhadj As Sy, alertando para “o preço da inação”. A epidemia já causou mais de 4,5 mil mortes na África Ocidental e os especialistas alertam que a taxa de infecção poderá chegar a 10 mil por semana no início de dezembro.

Ainda não há vacina aprovada para o ebola, que também atingiu profissionais da saúde na Espanha e nos Estados Unidos.

Elhadj As Sy listou uma série de medidas que poderiam ajudar a colocar o ebola sob controle, incluindo “um bom isolamento, bom tratamento dos casos confirmados, e bom, seguro e digno enterro às pessoas falecidas”. “Será possível, como era possível no passado, conter esta epidemia dentro de quatro a seis meses” se a resposta for adequada, acrescentou.

“Eu acho que esta é a nossa melhor perspectiva e nós estamos fazendo todo o possível para mobilizar nossos recursos e nossas capacidades para travar o surto”, destacou. As Sy, que falava em uma conferência da Cruz Vermelha da Ásia-Pacífico, acrescentou que “há sempre um preço pela inação”.

Novas medidas serão adotadas hoje nos Estados Unidos, entre as quais os voos dos países mais afetados – Libéria, Serra Leoa e Guiné-Conacri – serão encaminhados para cinco aeroportos e os passageiros passarão por exames mais completos de saúde.

Entretanto, especialistas que escrevem para a revista The Lancet, disseram, na terça-feira (21), que a triagem dos passageiros nos aeroportos de saída seria uma opção melhor do que monitorá-los no destino da viagem.

(Agência Lusa / Agência Brasil)

http://agenciabrasil.ebc.com.br/internacional/noticia/2014-10/cruz-vermelha-serao-necessarios-pelo-menos-quatro-meses-para-controlar

Liberia: Dead Ebola Patients Resurrect? (The New Dawn)

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24 SEPTEMBER 2014

Photo: Boakai Fofana/allAfrica. A burial team carries the body of a suspected Ebola victim under the watchful eyes of police officers.

By Franklin Doloquee

Two Ebola patients, who died of the virus in separate communities in Nimba County have reportedly resurrected in the county. The victims, both females, believed to be in their 60s and 40s respectively, died of the Ebola virus recently in Hope Village Community and the Catholic Community in Ganta, Nimba.

But to the amazement of residents and onlookers on Monday, the deceased reportedly regained life in total disbelief. The New Dawn Nimba County correspondent said the late Dorris Quoi of Hope Village Community and the second victim only identified as Ma Kebeh, said to be in her late 60s, were about to be taken for burial when they resurrected.

Ma Kebeh had reportedly been in door for two nights without food and medication before her alleged death. Nimba County has had bizarre news of Ebola cases with a native doctor from the county, who claimed that he could cure infected victims, dying of the virus himself last week.

News of the resurrection of the two victims has reportedly created panic in residents of Hope Village Community and Ganta at large, with some citizens describing Dorris Quoi as a ghost, who shouldn’t live among them. Since the Ebola outbreak in Nimba County, this is the first incident of dead victims resurrecting.

The Most Terrifying Thing About Ebola (Slate)

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The disease threatens humanity by preying on humanity.

By

SEPT. 19 2014 12:13 PM

Photo by John Moore/Getty ImagesSuspected Ebola patient Finda “Zanabo” prays over her sick family members before being admitted to the Doctors Without Borders Ebola treatment center on Aug. 21, 2014, near Monrovia, Liberia. Photo by John Moore/Getty Images

As the Ebola epidemic in West Africa has spiraled out of control, affecting thousands of Liberians, Sierra Leonians, and Guineans, and threatening thousands more, the world’s reaction has been glacially, lethally slow. Only in the past few weeks have heads of state begun to take serious notice. To date, the virus has killed more than 2,600 people. This is a comparatively small number when measured against much more established diseases such as malaria,HIV/AIDS, influenza, and so on, but several factors about this outbreak have some of the world’s top health professionals gravely concerned:

  • Its kill rate: In this particular outbreak, a running tabulation suggests that 54 percent of the infected die, though adjusted numbers suggest that the rate is much higher.
  • Its exponential growth: At this point, the number of people infected is doubling approximately every three weeks, leading some epidemiologists to projectbetween 77,000 and 277,000 cases by the end of 2014.
  • The gruesomeness with which it kills: by hijacking cells and migrating throughout the body to affect all organs, causing victims to bleed profusely.
  • The ease with which it is transmitted: through contact with bodily fluids, including sweat, tears, saliva, blood, urine, semen, etc., including objects that have come in contact with bodily fluids (such as bed sheets, clothing, and needles) and corpses.
  • The threat of mutation: Prominent figures have expressed serious concerns that this disease will go airborne, and there are many other mechanisms through which mutation might make it much more transmissible.

Terrifying as these factors are, it is not clear to me that any of them capture what is truly, horribly tragic about this disease.

The most striking thing about the virus is the way in which it propagates. True, through bodily fluids, but to suggest as much is to ignore the conditions under which bodily contact occurs. Instead, the mechanism Ebola exploits is far more insidious. This virus preys on care and love, piggybacking on the deepest, most distinctively human virtues. Affected parties are almost all medical professionals and family members, snared by Ebola while in the business of caring for their fellow humans. More strikingly, 75 percent of Ebola victims are women, people who do much of the care work throughout Africa and the rest of the world. In short, Ebola parasitizes our humanity.

More than most other pandemic diseases (malaria, cholera, plague, etc.) and more than airborne diseases (influenza, swine flu, H5N1, etc.) that are transmitted indiscriminately through the air, this disease is passed through very minute amounts of bodily fluid. Just a slip of contact with the infected party and the caregiver herself can be stricken.

The images coming from Africa are chilling. Little boys, left alone in the street without parents, shivering and sick, untouchable by the throngs of people around them. Grown men, writhing at the door to a hospital, hoping for care as their parents stand helplessly, wondering how to help. Mothers and fathers, fighting weakness and exhaustion to move to the edge of a tent in order to catch a distant, final glimpse of a get-well video that their children have made for them.

If Ebola is not stopped, this disease can destroy whole families within a month, relatives of those families shortly thereafter, friends of those relatives after that, and on and on. As it takes hold (and it is taking hold fast), it cuts out the heart of family and civilization. More than the profuse bleeding and high kill rate, this is why the disease is terrifying. Ebola sunders the bonds that make us human.

Aid providers are now working fastidiously to sever these ties themselves, fighting hopelessly against the natural inclinations that people have to love and care for the ill. They have launched aggressive public information campaigns, distributedupdates widely, called for more equipment and gear, summoned the military, tried to rein in the hysteria, and so on. Yet no sheet of plastic or latex can disrupt these human inclinations.

Such heroic efforts are the appropriate medical response to a virulent public health catastrophe. The public health community is doing an incredible job, facing unbelievable risks, relying on extremely limited resources. Yet these efforts can only do half of the work. Infected parties—not all, to be sure, but some (enough)—cannot abide by the rules of disease isolation. Some will act without donning protective clothing. Some will assist without taking proper measures. And still others will refuse to enter isolation units because doing so means leaving their families and their loved ones behind, abandoning their humanity, and subjecting themselves to the terror of dying a sterile, lonely death.

It is tempting, at these times, to focus on the absurd and senseless actions of a few. One of the primary vectors in Sierra Leone is believed to have been a traditional healer who had been telling people that she could cure Ebola. In Monrovia a few weeks back, angry citizens stormed a clinic and removed patients from their care. “There is no Ebola!” they are reported to have been shouting. More recently, the largest newspaper in Liberia published an article suggesting that Ebola is a conspiracy of the United States, aimed to undermine Africa. And, perhaps even more sadly, a team of health workers and journalists was just brutally murdered in Guinea. It is easy, in other words, to blame the spread on stupidity, or illiteracy, or ritualism, or conspiracy theories, or any number of other irrational factors.

Photo by John Moore/Getty ImagesA man checks on a very sick Saah Exco, 10, in a back alley of the West Point slum on Aug. 19, 2014, in Monrovia, Liberia. Photo by John Moore/Getty Images

But imagine: You are a parent whose child has suddenly come ill with a fever. Do you cast your child away and refuse to touch him? Do you cover your face and your arms? Stay back! Unclean! Or do you comfort your child when he asks for you, arms outstretched, to make the pain go away?

Imagine: You live in a home with five other family members. Your sister falls ill, ostensibly from Ebola, but possibly from malaria, typhoid, yellow fever, or the flu. You are aware of the danger to yourself and your other family members, but you have no simple means to move her, and she is too weak to move herself. What do you do?

Imagine: You are a child of 5 years old. Your mother is sick. She implores you to back away. But you are scared. What you need, more than anything, is a hug and a cry.

Who can blame a person for this? It is a terrible, awful predicament. A moral predicament. To stay, comfort, and give love and care to those who are in desperate need, or to shuttle them off into an isolation ward, perhaps never to see them again? What an inhumane decision this is.

What makes the Ebola virus so terrifying is not its kill rate, its exponential growth, the gruesome way in which it kills, the ease of transmission, or the threat of mutation, but rather that people who care can do almost nothing but sit on the sidelines and watch.

* * *

Many have asked whether Ebola could come here, come West. (The implication, in its way, is crass—as if to suggest that we need not be concerned about a tragedy unless it poses a threat to us.) We have been reassured that it will never spread widely here, because our public health networks are too strong, our hospitals too well-stocked. The naysayers may be right about this. But they are not right that it does not pose a threat to us.

For starters, despite the pretense, the West is not immune from absurd, unscientific thinking. We have our fair share of scientific illiteracy, skepticism, ritualism, and foolishness. But beyond this, it is our similarities, not our differences, that make us vulnerable to this plague. We are human. Every mechanism we have for caring—touching, holding, feeding, playing, warming, comforting, caressing—every mechanism that we use to bind us to our families and our neighbors, is preyed upon by Ebola. We cannot seal each other into hyperbaric chambers and expect that once we emerge, the carnage will be over. We are humans, and we will care about our children and our families even if it means that we may die in doing so.

The lesson here is a vital one: People do not give up on humanity so very easily. Even if we persuade all of the population to forgo rituals like washing the dead, we will not easily persuade parents to keep from holding their sick children, children from clinging to their ailing parents, or children from playing and wrestling and slobbering all over one another. We tried to alter such behaviors with HIV/AIDS. A seemingly simple edict—“just lay off the sex with infected parties”—would seem all that is required to halt that disease. But we have learned over the decades that people do not give up sex so readily.

If you think curtailing sex is hard, love and compassion will be that much harder. Humans will never give this up—we cannot give this up, for it is fundamental to who we are. The more that medical personnel require this of people without also giving them methods to manifest care, the more care and compassion will manifest in pockets outside of quarantine. And the more humanity that manifests unchecked, the more space this virus has to grow. Unchecked humanity will seep through the cracks and barriers that we build to keep our families safe, and if left to find its own way, will carry a lethal payload.

The problem is double-edged. Ebola threatens humanity by preying on humanity. The seemingly simple solution is to destroy humanity ourselves—to seal everything off and let the disease burn out on its own. But doing so means destroying ourselves in order to save ourselves, which is no solution at all.

Photo by John Moore/Getty ImagesA medical worker in a protective suit works near Ebola patients in a Doctors Without Borders hospital on Sept. 7, 2014, in Monrovia, Liberia. Photo by Dominique Faget/AFP/Getty Images

We must find a method of caring without touching, of contacting without making contact. The physiological barriers are, for the time being, necessary. But we cannot stop people from caring about one another, so we must create, for the time being, mechanisms for caring. Since we will never be able to beat back humanity, we must coordinate humanity, at the family level, the local level, and the global level.

The only one way to battle a disease that affixes itself parasitically to our humanity is to overwhelm it with greater, stronger humanity. To immunize Africa and the rest of the world with a blast of humanity so powerful that the disease can no longer take root. What it will take to beat this virus is to turn its most powerful vehicle, our most powerful weapon, against it.

Here are some things we can do:

Donate to the great organizations that are working tirelessly to bring this disease under control. They need volunteers, medical supplies, facilities, transportation, food, etc. Share information about Ebola, so people will learn about it, know about it, and know how to address it when it comes. And inform and help others. It is natural at a time of crisis to call for sealing the borders, to build fences and walls that separate us further from outside threats. But a disease that infects humanity cannot easily be walled off in this way. Walling off just creates unprotected pockets of humanity, divisions between us and them: my family, your family; that village, this village; inside, outside.

* * *

One final thing.

When Prince Prospero, ill-fated protagonist of Edgar Allan Poe’s story “The Masque of the Red Death,” locked himself in his castle to avoid a contagion that was sweeping his country—a disease that caused “profuse bleeding at the pores”—he assumed mistakenly that the only reasonable solution to his problem was to remove himself from the scene. For months he lived lavishly, surrounded by courtiers, improvisatori, buffoons, musicians, and wine, removed from danger while the pestilence wrought havoc outside.

As with much of Poe’s writing, Prospero’s tale does not end well. For six months, all was calm. He and his courtiers enjoyed their lives, secure and isolated from the plague laying waste to the countryside. Then, one night during a masquerade ball, the Red Death snuck into the castle, hidden behind a mask and a cloak, to afflict Prospero and his revelers, dropping them one by one in the “blood-bedewed halls.” Prospero’s security was a façade, leaving darkness and decay to hold “illimitable dominion over all.” The eventual intrusion that would be his undoing foretells of a danger in believing that we can keep the world’s ills at bay by keeping our distance.

If we seek safety by shutting out the rest of the world, we are in for a brutally ugly awakening. Nature is a cruel mistress, but Ebola is her cruelest, most devious trick yet.

Benjamin Hale is associate professor of philosophy and environmental studies at the University of Colorado–Boulder. He is vice president of the International Society of Environmental Ethics and co-editor of the journal Ethics, Policy & Environment.