We learned that some people panic and others do not. We learned that physicians, nurses, hospitals, the CDC and the NIH make mistakes, but we have perhaps forgotten that one of their strengths is in how they correct errors. We learned that in the later phases of the illness, extraordinary numbers of virus particles are released. We learned, or relearned, that in the absence of symptoms, people do not transmit the virus.
The responses of every sector of society are worth scrutinizing because there are still thousands of cases in Africa, but also because there will be another epidemic — SARS, Hanta, Lassa, Influenza or Chikungunya viruses — to name other worries.
As with every infectious disease, the best defense lies with public health measures — avoiding contact with animals that harbor a virus will limit future Ebola outbreaks. Tracing and isolating potentially infected individuals prevents the spread of the virus. Burying victims safely limits the epidemic, realizing that it is hard for people to give up traditional customs of respect for their dead. There have been many smaller Ebola outbreaks since the virus was discovered in 1979, but no one predicted an outbreak this devastating.
Previous columns described Ebola viruses and the drugs and vaccines that are being developed to treat them. There are several forms of antibody treatment — starting with the antibodies of people who have survived or the more sophisticated and safer monoclonal antibodies. These seem to help by binding and inactivating the virus in the bloodstream and giving the body a chance to mount its normal defenses. Then, there are drugs that inhibit the ability of Ebola to replicate in various cells of the body. These, too, have passed tests in non-human primates (some also inhibit other viruses) and will enter human trials soon. Finally, there are several vaccines that are a collaborative effort of the NIH, GlaxoSmithKline and other agencies. One vaccine takes a gene from the Ebola virus and inserts it into a harmless adenovirus. A score of volunteers from the NIH were injected with this candidate vaccine several months ago and the results have just been published in the New England Journal of Medicine: They all made antibodies and some made cytotoxic T cells, which go antibodies one better by killing the cells that are infected with Ebola — destroying the factories that make the virus. Accelerated Phase II trials will begin in Sierra Leone, Liberia and Guinea in January, 2015. President Obama dropped in to the NIH to congratulate the people who helped develop this vaccine.
What of the press and newscasters? Dr. Sanjay Gupta at CNN, Dr. Nancy Snyderman at NBC and others did dangerous and accurate reporting. The news anchors and commentators often panicked. When a man who had been in Africa showed up at Mt. Sinai with a fever, he was immediately isolated but many TV crews converged on the hospital and back in the studio the anchors and pundits got very excited. There are too many examples to quote, but Politifact, a fact-checking service of the Miami Herald and the Tampa Bay Times, called the Ebola story the biggest lie of 2014. You can find the list of inane claims on Politifact’s website. I would not call the story a lie precisely, but it was an example of how ignorance, fear, and hyperbole lead to absurd ideas. Note how the story has collapsed.
Many politicians did poorly. New Jersey Gov. Chris Christie ordered a nurse with no symptoms into an isolation tent and then tried to give her medical lessons. The nurse, Kaci Hickox, back from treating Ebola patients in Africa, was not about to put up with bullying governors in New Jersey or Maine. Good for her. She did not have Ebola and the precautions of staying out of crowds and taking her temperature were sufficient.
Congress, especially the House Committee that called Dr. Thomas Frieden of the CDC and Dr. Anthony Fauci of the NIH, excoriated them about various errors. It’s true, they and their agencies made some errors and they have learned from them. There are now more hospitals equipped and trained to handle the next emergency. Congress just appropriated $6 billion for Ebola costs in the United States and Africa. Large teams have arrived in West Africa. Hectoring experienced public servants who helped fight AIDS, TB and other diseases to a draw does not accomplish anything.
I have some suggestions: I suspect very few congressional offices have adequate scientific expertise. There are many recent Ph.D. or MD graduates interested in public policy. A scientifically experienced person in every congressional office would elevate the discourse. Or am I being too optimistic?
My second suggestion takes us back to the vaccine that NIH staff members volunteered to test. Wouldn’t it have been great if the chairman of the Subcommittee on Oversight and Investigations of the Committee on Energy and Commerce, Rep. Tim Murphy (R-Pa.), had said:
“Great news about that vaccine, Dr. Fauci!”
“We are very pleased, yes. I’ll send you the New England Journal of Medicine article.”
“Say, do you need a larger number of volunteers for the Phase II trials?”
“Actually, Mr. Chairman, we do.”
“Well, you just count me in, Tony, my friend. Count me in!”
Or, again, am I being too optimistic?
Richard Kessin, Ph.D., is a professor of pathology and cell biology at Columbia University and lives in Norfolk. The author’s recent novel, “The Famine of Men,” describes how a very different and, so far, hypothetical virus was discovered. His course, called From Microbes to Molecular Biology and why it matters, will begin at The Taconic Learning Center in January.
