By Michael Howell
Dr. Marshall Bloom, Associate Director of Rocky Mountain Laboratory (RML), gave a community based talk about the Ebola virus last week at the Darby Public Library. He told the audience that he doesn’t work directly on the virus and thus does not consider himself an “expert,” but he does know a lot about the subject due to his position at the lab and has become somewhat of an “authority” on the subject. RML, located in Hamilton, is part of the National Institute of Allergies and Infectious Diseases (NIAID) headquartered in Bethesda, Maryland. It employs three or four of the top experts in the world on the Ebola virus.
According to Bloom, a vaccine against the Ebola virus is going into the first phase of human trials and the initial results have been very successful. So it is likely, he said, that the testing and use of the vaccine will be expanded and given initially to health care workers engaged in the West Africa outbreak that has caught the world’s attention. This vaccine is not the same one developed by doctors that are now working at the lab in Hamilton lab. That vaccine, which has proven to be successful on non-human primates, is also moving forward in the testing process.
Bloom started out by putting the situation in the United States into perspective. He noted that 300,000 die every year in the United States from obesity. Every year in the U.S. up to 80,000 people die from alcohol abuse and close to 500,000 die from tobacco use. So far in the U.S., only two people have died from Ebola and they had both recently been to West Africa. Two health care workers got infected tending to the first patient in Dallas, Texas. Aside from the two cases that resulted in death, another dozen or so cases have been flown into the country for treatment and another 40 to 50 have been monitored and then declared free of the disease.
He said it is worth comparing this to other communicable diseases in the U.S. The first case of influenza of the current season has already shown up in eastern Montana on October 12, and from 10,000 to 40,000 people die annually from the disease in this country.
“So when people ask me about Ebola virus and what’s the best the thing to do, I tell them to get a flu shot,” said Bloom. He said first of all, a person is way more likely to die from the flu than from Ebola virus and secondly, the presenting symptoms of Ebola are similar to influenza and a lot of other diseases, so by getting a flu shot, which is 60% to 70% effective, it not only helps prevent the flu but, if hospitalized, it will prevent you from presenting symptoms similar to Ebola and causing a ruckus at the hospital.
Bloom noted that there are a considerable number of potentially deadly communicable diseases occurring around the world. Here in the U.S. we still have occurrences of vaccine-preventable diseases such as measles, mumps and pertussis (whooping cough).
So why worry about diseases on the other side of the world? In answer, he showed an animated slide showing the number of international airline flights taking place worldwide in a twenty-four hour period and called it astonishing.
“This points out in graphic fashion,” he said, “how impossible it would be to screen air flight passengers coming into the U.S.” He said it was tried in Canada in response to the SARS epidemic and officials eventually concluded it was a total waste of time.
Bloom said there is a lot of outrageously inaccurate information and unwarranted fear being generated by movies and media hype. He said the best place to get accurate information about the disease is on the Centers for Disease Control and Prevention (CDC) website. He said with the proper equipment and protocols almost any hospital in the United States could handle a case of Ebola. He said they take care of very serious infectious diseases like bubonic plague, tularemia, hanta virus, Lyme disease, relapsing fever and salmonella somewhere in the country every day.
“We could get in a car and in two hours find any of these diseases right here in Montana,” said Bloom. He said the current Ebola hysteria is elevating awareness of hospitals across the country to infectious diseases of all kinds and leading them to step up preparedness for them. He said Marcus Daly Memorial Hospital in Hamilton has done a terrific job in this regard.
A person is not infectious until the first symptoms present themselves, usually within two to 21 days after being infected. The earliest symptoms include the abrupt onset of fever, muscle pain, fatigue and headache. One problem is that these symptoms resemble those of many other diseases including influenza.
“Is there anybody in this room that hasn’t had these symptoms in the past year?” Bloom asked. He said that in West Africa they have 30 to 40 infectious diseases that present the same way and they had never had a case of Ebola virus in that part of West Africa before, so it wasn’t the first thing on their minds, when it arrived. As a result it was not identified quickly enough to contain it and got into highly populated urban areas where containment is very difficult.
“They are going to get it under control,” he said, “but it’s going to take a while.” He said there is some indication that the number of new cases in Liberia is diminishing.
As the disease progresses other symptoms appear, the two major ones being vomiting and diarrhea, usually containing blood. The Ebola virus is not really an airborne disease like influenza. It is transmitted only by bodily fluids and extremely close contact. But it can be carried though the air in droplets of vomit that may reach a few yards away.
The severe vomiting and diarrhea lead to dehydration which bring on other complications. It is believed that keeping patients hydrated and refurbishing their electrolytes may account for the reduced mortality rate from the 90% seen in many past outbreaks to the 50% to 60% mortality rate in the current epidemic. The Ebola virus is also a hemorrhagic fever which affects the liver, inhibiting the production of the blood’s clotting factor, which increases the chances of transmission.
It is believed that the Ebola virus circulates primarily in fruit eating bats, which do not get sick but which carry the disease. The bats urinate and defecate on the fruit and this can lead to other animals becoming infected. People then may become infected by eating the bats or some other animal, like a monkey, that has the virus. Bloom recommended a book called “Spillover” by Montana author David Quammen as a very good and easy to read book on the subject of how diseases that are carried in an animal reservoir can then spill over into a human population.
Bloom said that funeral practices in West Africa, where family members wash and may even kiss the deceased, have played a major role in spreading the disease in West Africa.
“These kinds of practices make it difficult to disrupt the spread of the disease,” he said. “It is not a scientific issue so much as an anthropological and sociological issue. It’s very, very difficult to change people’s behavior in this regard.”
So far the majority of cases in West Africa have occurred in Liberia, Sierra Leone, and Guinea and, as of the end of November, 16,899 people have been infected and 5,987 people have died, leaving an estimated 4,000 orphans. Young children have a better chance of survival than older people and people over 50 years of age have the greatest chances of dying.
What exacerbates the epidemic, he said, is that these countries are among the poorest countries in the world. There is only one doctor for every 70,000 to 100,000 people.
“That’s like having only one doctor to serve all of Missoula County,” said Bloom.
The team at RML is involved in the current outbreak in a number of ways. They are working on basic virology, trying to determine how the disease grows, what cellular proteins it uses, looking for a chink in its armor in the hopes of discovering how to disrupt its life cycle. Dr. Feldman and others at the lab are working on another type of vaccine that is showing promise. They are testing anti-viral medications as a treatment. Volunteers from the lab are also working in makeshift labs in West Africa checking blood samples.
They have education and outreach programs in place as well and helped students at Hamilton High School put an educational slide show together to show other students. These students have taken the program to other schools in Victor and Corvallis.
Bloom said he was very impressed with the success of the program.
“It’s kids educating kids,” he said.
Bloom said when he first looked at the slides he was intrigued by one slide that simply showed Kevin Kardashian. He had to ask why that was included.
The student answered, “Because, you know, you have a greater chance of marrying Kevin Kardashian than dying from Ebola.”