Ebola: We're months from being out of the woods

Even if the present Ebola outbreak is confined to a few cases in Texas, the US is still in danger of a large scale epidemic down the road.

Two prominent former health care officials have penned an op ed in the Wall Street Journal warning that the virus could break out of West Africa and cause a pandemic all over the world. The chances then of a trickle of cases in the US turning into a wave go up exponentially.

Public-health workers will contain the Ebola case—and any secondary spread—diagnosed in Dallas. But the decisive risk to the U.S. will emerge in a few months. If the virus continues to spread in West Africa at its current pace, much larger global outbreaks will become likely.

Should these outbreaks coincide with the cold-weather peak of the flu season—when symptoms of influenza can be confused for the early signs of Ebola—the health-care system’s ability to quarantine all the people with suspected Ebola infections, and test them in the required specially equipped labs, could be overwhelmed.

And if Ebola does decisively break out of West Africa, we may be unable to control the spread of the disease solely by conventional public-health tools of infection controls, tracking and tracing sick contacts, and isolating the ill. If this happens, we may face a global pandemic early next year.

For now, we must pin our hopes on drugs or vaccines that are still in early stages of development.

The good news is that there are a number of promising therapeutics that have already shown activity against Ebola, from an immune-based drug called ZMapp that was given to seven infected patients, to at least two vaccines that appear ready for large-scale testing. ZMapp showed remarkable efficacy in bolstering the immune system to directly attack the virus in monkey experiments and may also have helped several Ebola sufferers recover.

There are also drugs targeting cancer called “kinase inhibitors” that show potency against the Ebola virus. One advantage of drugs working at the host level—on the person not the virus—is that theoretically the drugs can still work even if the virus mutates. This is in contrast to a vaccine that relies on targeting certain markers on the virus surface that can change as Ebola mutates.

Yet too many public-health officials still believe that they can solve the crisis with tried-and-true methods to contain an outbreak that prioritize manpower over technology. Groups like the World Health Organization have been wrong at every turn in responding to the Ebola outbreak earlier this year. We can’t take the chance that they may again be miscalculating.

As much as the White House would like us to believe that "it could never happen here," the truth is, it can. Perhaps not to the degree that the virus is loose in West Africa, but hundreds of Americans dying and thousands sickened needlessly would constitute gross negligence on the part of government. The chances are low of this happening, but when you have a disease with a 50% mortality rate, risk taking and sunny prognostications should be discouraged.

The man who helped identify the Ebola virus in 1976, Peter Piot, spoke out recently about efforts to contain the epidemic:

Have we completely lost control of the epidemic?

I have always been an optimist and I think that we now have no other choice than to try everything, really everything. It's good that the United States and some other countries are finally beginning to help. But Germany or even Belgium, for example, must do a lot more. And it should be clear to all of us: This isn't just an epidemic any more. This is a humanitarian catastrophe. We don't just need care personnel, but also logistics experts, trucks, jeeps and foodstuffs. Such an epidemic can destabilise entire regions. I can only hope that we will be able to get it under control. I really never thought that it could get this bad.

What can really be done in a situation when anyone can become infected on the streets and, like in Monrovia, even the taxis are contaminated?

We urgently need to come up with new strategies. Currently, helpers are no longer able to care for all the patients in treatment centres. So caregivers need to teach family members who are providing care to patients how to protect themselves from infection to the extent possible. This on-site educational work is currently the greatest challenge. Sierra Leone experimented with a three-day curfew in an attempt to at least flatten out the infection curve a bit. At first I thought: "That is totally crazy." But now I wonder, "why not?" At least, as long as these measures aren't imposed with military power.

A three-day curfew sounds a bit desperate.

Yes, it is rather medieval. But what can you do? Even in 2014, we hardly have any way to combat this virus.

So when we go a few weeks or months without another Ebola case in the US, and Obama supporters poke fun at our concern over what the administration is doing about it, remember that this crisis is far from being over and the disease may yet get the last laugh.

Even if the present Ebola outbreak is confined to a few cases in Texas, the US is still in danger of a large scale epidemic down the road.

Two prominent former health care officials have penned an op ed in the Wall Street Journal warning that the virus could break out of West Africa and cause a pandemic all over the world. The chances then of a trickle of cases in the US turning into a wave go up exponentially.

Public-health workers will contain the Ebola case—and any secondary spread—diagnosed in Dallas. But the decisive risk to the U.S. will emerge in a few months. If the virus continues to spread in West Africa at its current pace, much larger global outbreaks will become likely.

Should these outbreaks coincide with the cold-weather peak of the flu season—when symptoms of influenza can be confused for the early signs of Ebola—the health-care system’s ability to quarantine all the people with suspected Ebola infections, and test them in the required specially equipped labs, could be overwhelmed.

And if Ebola does decisively break out of West Africa, we may be unable to control the spread of the disease solely by conventional public-health tools of infection controls, tracking and tracing sick contacts, and isolating the ill. If this happens, we may face a global pandemic early next year.

For now, we must pin our hopes on drugs or vaccines that are still in early stages of development.

The good news is that there are a number of promising therapeutics that have already shown activity against Ebola, from an immune-based drug called ZMapp that was given to seven infected patients, to at least two vaccines that appear ready for large-scale testing. ZMapp showed remarkable efficacy in bolstering the immune system to directly attack the virus in monkey experiments and may also have helped several Ebola sufferers recover.

There are also drugs targeting cancer called “kinase inhibitors” that show potency against the Ebola virus. One advantage of drugs working at the host level—on the person not the virus—is that theoretically the drugs can still work even if the virus mutates. This is in contrast to a vaccine that relies on targeting certain markers on the virus surface that can change as Ebola mutates.

Yet too many public-health officials still believe that they can solve the crisis with tried-and-true methods to contain an outbreak that prioritize manpower over technology. Groups like the World Health Organization have been wrong at every turn in responding to the Ebola outbreak earlier this year. We can’t take the chance that they may again be miscalculating.

As much as the White House would like us to believe that "it could never happen here," the truth is, it can. Perhaps not to the degree that the virus is loose in West Africa, but hundreds of Americans dying and thousands sickened needlessly would constitute gross negligence on the part of government. The chances are low of this happening, but when you have a disease with a 50% mortality rate, risk taking and sunny prognostications should be discouraged.

The man who helped identify the Ebola virus in 1976, Peter Piot, spoke out recently about efforts to contain the epidemic:

Have we completely lost control of the epidemic?

I have always been an optimist and I think that we now have no other choice than to try everything, really everything. It's good that the United States and some other countries are finally beginning to help. But Germany or even Belgium, for example, must do a lot more. And it should be clear to all of us: This isn't just an epidemic any more. This is a humanitarian catastrophe. We don't just need care personnel, but also logistics experts, trucks, jeeps and foodstuffs. Such an epidemic can destabilise entire regions. I can only hope that we will be able to get it under control. I really never thought that it could get this bad.

What can really be done in a situation when anyone can become infected on the streets and, like in Monrovia, even the taxis are contaminated?

We urgently need to come up with new strategies. Currently, helpers are no longer able to care for all the patients in treatment centres. So caregivers need to teach family members who are providing care to patients how to protect themselves from infection to the extent possible. This on-site educational work is currently the greatest challenge. Sierra Leone experimented with a three-day curfew in an attempt to at least flatten out the infection curve a bit. At first I thought: "That is totally crazy." But now I wonder, "why not?" At least, as long as these measures aren't imposed with military power.

A three-day curfew sounds a bit desperate.

Yes, it is rather medieval. But what can you do? Even in 2014, we hardly have any way to combat this virus.

So when we go a few weeks or months without another Ebola case in the US, and Obama supporters poke fun at our concern over what the administration is doing about it, remember that this crisis is far from being over and the disease may yet get the last laugh.