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Ebola Followup NEW!

Hans Andersson hasse at panix.com
Fri Jan 26 19:14:13 EST 1996


iayork at panix.com (Ian A. York) wrote:

>To be entirely honest, I don't know what Andersson's argument is.  I went back 
>and reread this thread (thanks to alta vista and dejanews) and, frankly, 
>I'm not much further ahead - although I gather Andersson is a 
>professional journalist, I'm quite honestly unclear on what he's trying 
>to say here.

Okay, let me take it point by point and I'll try to be as clear as I can.

1. EBOLA - WORST-CASE SCENARIO

Kikwit '95 was the worst outbreak, so far - but, I don't believe that it's
a worst-case scenario for Ebola. 

A worst-case scenario for an Ebola-like virus was presented at the 1989
annual meeting of the American Society of Tropical Medicine and Hygiene.
It was presented as a "medical war game", staged by the U.S. government
official, Llewellyn Legters, chairman of preventive medicine and
biometrics at the Uniformed Services University of the Health Sciences in
Bethesda, Maryland.

The background for the simulation was as follows:

* A civil war has broken out in a state in Sub-Saharan Africa. 125,000
civilians have been killed, 200,000 refugees have fled to neighboring
countries and are in a state of starvation. Several hundred U.S. Peace
Corps, Christian aid workers and American military personnel are working
with vaccinations and food distribution in the refugee camps. A
multinational peacekeeping force - including 800 U.S. soldiers - is
stationed in the area...  

* An Ebola-like virus breaks out, initially killing hundreds of refugees,
and the CDC suspects it may be airborne transmitted Ebola.

* A team of four individuals from the CDC representing "nearly all the
personnel in the entire Public Health Service with experience in
hemorrhagic fevers" are sent to crisis zone, "leaving no expertise behind
in the U.S." When the CDC team requests a high contamination, portable
research laboratory, they are told that "there is only one in all the U.S.
Public Health Service."  (These numbers are based in reality.)

* An Emergency Interagency Working Group (EIWG) is initiated by the U.S.
Secretary of State, during the second week of the epidemic. It is composed
of representatives from the CDC, NIH, Department of Defense and Department
of State. Representatives from the WHO, UN's Disaster Relief and various
other international organizations are participating in daily crisis
meetings.

**During a two-month period the virus spreads to every continent of the world.  

CDC, USAMRIID, WHO and some 800 tropical disease experts took part in and
witnessed this simulation.  Some details about the scenario are still
top-secret Department of Health & Human Services material. But, you can
read about the "super-Ebola Pandemic" scenario in Stephen Morse's
"Emerging Viruses" (p. 269-281), Laurie Garrett's "The Coming Plague" (p.
593-597) and in a New York Newsday special, Jan. 23, 1990.

Dr. Llewellyn J. Legters, Chair of the EIWG, answered the question if
there were "any overall lessons learned from the experience":

"Well, to put it succinctly, the outbreak has confirmed, in a very
dramatic way, just how ill-prepared we are to detect global epidemic
disease threats in a timely fashion, and, once detected, to respond
appropriately."

2. VIRUSES DON¹T RESPECT INTERNATIONAL BOUNDARIES

"You can be in an African village where people may be dying like flies.
And twenty-four hours later you're in downtown Los Angeles and coming down
with Ebola or Lassa fever, and you don¹t even know you have it."

--Joshua Lederberg,
Nobel laureate, President Emeritus and University Professor, The
Rockefeller University
Discover magazine, Dec.1990

Ebola has between 5 to 14 days of incubation, with no symptoms or very
mild early symptoms that are similar to a cold or flu. That's plenty of
time to board an international flight from Africa - maybe with a stop in
Europe, and then a connecting flight to JFK Airport, New York. 

"If we had a major epidemic in an urban area, which is quite possible - we
wouldn't even have the resources available to the villagers in remote
parts of Zaire, who might clear the land or burn down the huts to contain
the infection. None would advocate burning down apartment buildings in New
York City."

--Stephen Morse, Virologist and Assistant Professor at the Rockefeller
University
TV interview, A&E Investigative Reports, 1995

But, for those of you that are still sure that Ebola will stay in Zaire,
in Africa or at least in the third world. Please, listen to what Anthony
Sanches, one of CDC¹s real top Ebola researchers had to say in an
interview, just a few weeks ago:

"People don't realize until their house is on fire that the town hasn't
bought enough fire trucks. We'll be seeing more Ebola. Population is
increasing in Africa; so are incursions into the virus's habitat. Sooner
or later somebody's going to haul it back out of the jungle." 

Discover magazine, January, 1996

3. LESSONS FROM RESTON

a. The Reston '89 outbreak demonstrated that hundreds of people on at
least three continents were exposed to an airborne Ebola virus strain -
that later proved to be harmless to humans - before CDC, USAMRIID or any
other authority were aware of its existence.

b. The success in containing the filovirus from being disseminated into
the human population had more to do with the biology of the virus than any
intervention on the part of public health agencies." In fact, several
individuals were infected with the Reston Ebola virus but luckily did not
develop disease and did not spread the virus to others. Thus, dodging the
bullet in this case in no way should be regarded as a success in terms of
the measures used to contain such outbreaks."   (Jonathan S. Allan,
Primate Virologist, 
Nature Medicine, Vol. 2., No. 1., Jan.1996)

4. FILOVIRUSES: MUTATION AND TRANMISSABILITY

Anthony Sanches, CDC molecular biologist and Ebola expert, has concluded
that Ebola Zaire and Reston are genetically very close:

"I term them kissing cousins... But, I can't put my finger on why Reston
is apparently apathogenic in human beings and doesn't make us sick."
("Crisis in The Hot Zone", The New Yorker, Oct. 26, 1992)

Ian York wrote:

>I do not want to see journalists advocating research on the latest flavour
>on the month.

>Let's look next at his concern about mutation.  He seems to feel that
>because Ebola has been shown to spread by aerosol then it might mutate to
>become as infectious as flu - or something like that.

You don't need to be a journalist to come up with an Ebola strain, either
yet to evolve or lurking undetected, as lethal as Zaire and as easily
spread as Reston. It was actually Peter Jahrling, USAMRIID¹s virologist,
that declared that "Ebola has the potential to go airborne and be spread
like the flu." (CNN 5/14, 1995) And, it was Gene Johnson, another
filovirus researcher from USAMRIID that said to Richard Preston that "an
airborne strain of Ebola could emerge and circle around the world in about
six weeks." ("The Hot Zone", p. 65)

It's the researchers who have direct field and/or laboratory experience of
filoviruses who are concerned about this possibility. They are concerned
because research on filoviruses is still in its infancy and receives very
little funding (Discover magazine, January 1996). Or, as some of the
worlds foremost experts on Ebola write:

"The viral family known as the Filoviridae is unique among animal viruses
families: we understand virtually nothing about the natural history and
maintenance strategies of any member of the family, yet Marburg and Ebola
viruses are highly pathogenic for man and are capable of epidemic
transmission."

--A group of scientists from CDC and USAMRIID - "Filoviruses"
Stephen Morse's "Emerging Viruses", 1993

Ebola researchers have seen several strains of Ebola that are highly
lethal to humans, and one strain that was not - but, it was airborne
instead. And, USAMRIID have in their study "Lethal experimental infection
of rhesus monkeys by aerosolized Ebola virus" concluded that even Ebola
Zaire have an airborne potential. 

"I think that filoviruses in general, are the one group of viruses, that
identified, that I find to be the most disturbing in terms of emerging
infections. They have an alveolar aerosol transmissibility, they have a
high lethality for man, they are highly mutable RNA viruses, and we
understand so little about what there natural reservoir is, and what their
properties are, in nature. That I think we have a very volatile mixture
here, that could be the next emerging virus." 

--C. J. Peters, Chief of CDC's Special Pathogenic Branch 
TV interview, A&E Investigative Reports, 1995

5. NEWLY EMERGING VIRUSES vs. VIRUSES THAT HAVE ALREADY EMERGED

I believe that "the magic bullet" for virus diseases is the gate-keeper -
surveillance, early detection and prevention. 

I've never said that we shouldn¹t care about viral, fungal or bacterial
diseases that have already emerged.  

6. THE LESSON FROM AIDS

>If the only virus you know anything about is Ebola, then it's going to
>look like the biggest threat.  But if you look at some of the established
>killers like TB (and yes, Hans, I know you said "*This* discussion just
>happens to be about Ebola", but you're wrong; this discussion is about
>public health risks, of which Ebola is one), measles, and polio, then it's
>hard to argue that resources should be withdrawn from them in order to
>cover the hypothetical risk of a hypothetical mutation.  And if you do
>want to cover that hypothetical mutation scenario, than you should also
>cover the risk of rabies mutating, polio mutating, TB mutating, measles
>mutating ... 

Okay, let's bring in another virus - let's talk about HIV vs. Ebola.

"Many of these problems may begin in the tropical Third World, but they
are not localized to these areas. Most viruses that today are worldwide
were once localized or 'exotic'... 

If HIV had been discovered in nature before it emerged to spread round the
world as a human disease, it would probably have seemed as 'exotic' to us
as Ebola does now (the same observation is also made by C.J.Peters.) In
fact, from all available data, it may well have had much the same origin
as Ebola...

AIDS was once an emerging viral disease. Like the other diseases discussed
here, it too could have been stopped at the precrisis stage."

--Stephen Morse in "Emerging Viruses",1993

This is what Dr Joe McCormick, a former head of CDC's Special Pathogenic
Branch and Ebola field virologist, concluded from the "Super-Ebola
Pandemic" scenario, 1989:

"We can't wait until our own people are dying. Look at the AIDS situation.
If we had spotted that disease when the first cases appeared in Africa,
imagine how different the situation could be today."  (New York Newsday,
Jan. 23, 1990)

Ian wrote:

>I do not want to see money being thrown at Ebola, because that 
>money will come from somewhere else - and it will probably come from
>somewhere in the health care/research system, and people will die because
>they didn't get the measles vaccine that money was originally going to cover. 

A group of experts on filoviruses from CDC and USAMRIID answered that a
couple of years ago, when they wrote:

"Any 'realistic' administrative review in 1989 could have established that
filoviruses were of little significance for human health and that scarce
research funds should not be allocated to expensive BL4 laboratories and
oversease field programs to study them. I imagine similar opinions would
have been proffered if a lentivirus had been isolated from a handful of
immunosuppressed people in Zaire in the mid-1970's."

--C.J.Peters, E.D. Johnson, P.B. Jahrling a.o.
 "Emerging Viruses", edited by Stephen Morse, 1993.

So HIV was once an emerging virus which was incubating in the jungle while
nobody was paying much attention.  And now we are dealing with the
full-blown disaster of HIV/AIDS, as we will continue to have to do in the
future.

"By the time WHO realized there was an AIDS epidemic it already existed on
four continents."

--D.A. Henderson, M.D., M.P.H. responsible for WHO's smallpox eradiction
program.
Associate Director for Life Sciences Office of Science and Technology
Policy, Executive Office of the President, Washington D.C

Yes, and by the time the "Medical War Game" scenario was over, airborne
Ebola existed on all continents.

7. DRUG RESISTANCE AND MULTI-DRUG RESISTANT TB

And by the way - as far as I can see, there's a similar lesson to be
learned from our current problem with multi-drug resistant TB, and a
growing number of other diseases. 

Now, "we're running out of bullets for dealing with a number of these
infections," said Joshua Lederberg. "Patients are dying because we no
longer in many cases have antibiotics that work." ("The Coming Plague", p.
431) 

Mitchell Cohen, director of the National Center for Infectious Diseases
(NCID) division of fungal and bacterial infections, has predicted that "We
are going back to a pre-antibiotic era." (US News & World Report, March
27, 1995, p. 52)

I agree with Lederberg, that the race against the microbes is still
winnable. But, we are in deep water - because we're now facing a drug
resistance problem that is already in full swing. Why? I believe that
it's because we didn't listen to early-warnings and take action when it
was still a newly emerging problem. We didn't listen or act on Mark
Lappe's book "Germs That Won¹t Die", 1981 - or other early warnings.

8. ARE WE PREPARED TODAY FOR A VIRAL EPIDEMIC EMERGENCY?

This is what Joshua Lederberg said at a press conference where experts
from 17 U.S. government agencies called for intensified international
surveillance of disease outbreaks, and a quick-strike system that would
respond rapidly to outbreaks:

"Efforts to monitor outbreaks and to detect new diseases early are now
stripped and inadequate because of cuts in the federal budget for general
diseases." (AIDS Weekly News Report, August 7, 1995)

Dr. Michael Osterholm, Minnesota state epidemiologist, at the same press
conference:

"Congress allocates millions for disease surveillance, but except for 15
percent, it is all directed towards AIDS, TB and sexually transmitted
diseases. As a result, a major outbreak of some other type of disease,
such as Hanta or Ebola, could go undetected until it became a major
epidemic."

"Disease surveillance is at a really modern all-time low, except for
AIDS", said Osterholm.
(AIDS Weekly News Report, August 7, 1995)

So, to answer the question in the headline:

"We are poorly prepared for viral emergence... and in the absence of
effective action, tragedies like the AIDS epidemic will be repeated."

--Stephen Morse in "Emerging Viruses", 1993  

9. AFTERWORD

I'm sorry that this posting became so long. But, don't worry guys - I
won't have time to write these on a weekly basis!

I've deliberately used many statements from different professionals in the
medical field. That's because I don't consider myself a real expert - only
a rather well-informed messenger. It's also because some people in this
group seem to have a problem with the fact that I'm a journalist.

Best regards,

--Hans Andersson, NYC
hasse at panix.com



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