Ebola Comes To U.S. Shores; Will Panic Follow?

Earlier today the first case of Ebola diagnosed in the United States was reported.  Discovered in Dallas, the affected patient had been traveling in West Africa and was not exhibiting symptoms on return to the United States earlier this month.  The patient is presently in what the hospital describes as “strict isolation.”

As the National Institutes of Health and Centers for Disease Control have treated people in the United States who had been infected in Africa, this case is not the first connected to this outbreak that U.S. facilities have dealt with.  The key factor for containing the spread of the disease is not only isolation of the patient, but tracking and monitoring of those who have interacted with that patient since entering the country.

That said, I am concerned about panic.  The threat of Ebola was used in recent political squabbling over immigration, and others advocated for not transferring infected assistance workers to the United States.  I’d be really surprised if this diagnosis was not the source of some overreaction in some quarters.

The United States is in a much better position than the African nations currently suffering from the outbreak and the associated strains on its limited medical infrastructure.  The relevant federal agencies have been preparing to deal with Ebola, and can transfer methods used in Africa to a United States context with a very, very small fraction of the thousands of cases currently in Africa.

It won’t be easy, but the U.S. has the tools, the people, and the infrastructure to contain Ebola.

Latest PCAST Report Tied To Executive Actions

Earlier this month the President’s Council of Advisers on Science and Technology (PCAST) released a report on antibiotic resistance.  President Obama asked for the report in 2013 to make practical recommendations for combating the rise of antibiotic resistance which has been keenly felt over the last decade.  The report offers three major recommendations for addressing the threat:

  • Increasing the surveillance of antibiotic-resistant bacteria. 
  • Improving the longevity of current antibiotics.
  • Increasing the rate at which new antibiotics and other treatments are developed and implemented

The second and third recommendations are as much about using antibiotics as they are about addressing concerns over resistance.  You can refine existing antibiotics to increase their shelf life and effectiveness, but it’s as meaningful to be more judicious with the use of these drugs.  They are very effective tools, but they lose this effectiveness with overuse.  By increasing the use of other treatments and otherwise trying not to hit every bug with large doses of antibiotics, we can hopefully stave off the rise of resistant bacteria.

Like with many things the United States developed over the course of the 20th century, antibiotic use and infrastructure could benefit from new investments and research.  It’s hard to see this getting much positive attention in the current climate.  After all, Congress has been less than speedy in opening the purse for fighting Ebola.

The report was released in conjunction with other Executive Branch actions.

Continue reading

New Ebola Projections Should Give You Pause

The World Health Organization (WHO) and the Centers for Disease Control (CDC) have each released new studies of the current Ebola outbreak in Africa (H/T ScienceInsider).  The current totals related to the outbreak are over 5800 infected, with more than 2800 dead.  The current outbreak has affected more people than all of the previous reported outbreaks combined.

The new reports suggest things could well get a lot worse, making me think there’s a non-trivial chance this outbreak may not go away.  Of course, I am not a virologist.  But given how little attention the outbreak is getting outside of Africa, I’m not optimistic.

The WHO projections were published in the New England Journal of Medicine.  I encourage you to read them in detail, but this language in the summary should stop you cold.

“These data indicate that without drastic improvements in control measures, the numbers of cases of and deaths from [Ebola virus disease] are expected to continue increasing from hundreds to thousands per week in the coming months.”

Control measures, including procedures for tracing the infected, controlling their contact with uninfected populations, and sufficient medical infrastructure, are not currently sufficient to handle the need, certainly while production in therapeutic medicines and vaccines is ramping up to address the outbreak.  The American response to the outbreak is good, but if not backed up by sufficient resources, it may not be enough. Continue reading

Follow-up Saturday – NIH Cleared On Ethics Case, May Proceed On Common Rule

Earlier this year I wrote about a case where the National Institutes of Health (NIH) was alleged to have acted improperly in a case involving a research study.  Public Citizen lodged a complaint with the Department of Health and Human Service’s (HHS) Office of Inspector General claiming that senior officials from the NIH and HHS interfered with the decision process of the Office for Human Subjects Research Protection (OHRP).  The specific case involved a research study on premature infants and optimal oxygen levels.

Earlier this month the Office of Inspector General issued its report on the allegations (H/T ScienceInsider).  The main conclusions were that senior NIH and HHS officials did not interfere in the initial decision of the OHRP, and that the subsequent communications between those officials and the OHRP was permissible under the law.  The OIG issued a separate report on how OHRP conducted its evaluation of the research study.  Public Citizen is not happy with the decision, characterizing the investigation as a ‘whitewash.’

While the OIG report indicated that OHRP is not an independent organization, part of the Public Citizen complaint indicated (page 2) that moving OHRP out of the NIH was done in part to insulate the office from interference by NIH officials.  It seems worth revisiting whether or not OHRP and related ethics organizations within HHS and NIH should be independent from those entities.

In related news, the ScienceInsider article (and the behind a paywall, Chronicle of Higher Education reporting it references) suggests that OHRP may soon be ready to issue new proposed rules on human subjects research.  This would seem to be forward progress on the Common Rule, which was the subject of a public comment period back in 2011.  As it hasn’t be revised in decades, it’s long overdue.

Ebola Roadmap And U.S. Response Should Remind Us That It’s A Big Deal

By the best estimates of people at the World Health Organization (WHO), we are at least six months, and probably nine, away from successfully containing the current outbreak of Ebola (the largest outbreak ever recorded).

At least that’s the goal.

The agency released a roadmap in late August to outline the necessary response to the disease.  There have already been over 3,500 reported cases, and the death toll is approaching 2,000 (or has surpassed it, depending on your source), making this outbreak larger than any previous recorded outbreak combined).  The estimates within the roadmap are sobering, with the possibility of over 20,000 people suffering from the virus.  By the end of September the WHO will do all it can to establish full coverage of Ebola response activities in the affected countries.

The United States will contribute to the effort.  More than 100 experts, and $100 million, have been committed to the region, with more money and personnel expected.  The U.S. military will be involved, according to an interview with President Obama broadcast over the weekend.  This re-emphasizes the severity of the problem, in part because Doctors Without Borders typically eschews military involvement in outbreak responses.  But the organization is stretched too thin to turn down such help.  With much of the outbreak area emerging from civil war, infrastructure and institutions are either broken or strained close to breaking.  Perhaps this lack of capacity has contributed to the spread of the outbreak.  If this is true (and we simply don’t know), addition resources applied to the region in a systematic fashion should help contain and better understand this outbreak before the virus has an opportunity to mutate.

While I’m certain that the U.S. public health infrastructure is in better shape than it’s West African counterparts, this crisis has made me mindful that maintaining such infrastructure involves constant investment and participation.  Without the facilities, regular training, and meaningful information provided by patients using those facilities, it becomes much harder to track diseases and be in a better position to contain or anticipate outbreaks.  In other words, for the grace of preparation go us.

DARPA Wants To Fight A Bug

The Defense Advanced Research Projects Agency (DARPA) often uses challenges to stimulate research in challenging areas.  At least some of the current work in self-driving cars can be traced back to several of DARPA’s Grand Challenges in autonomous ground vehicles.

The latest challenge appears to be the first that DARPA has issued outside of engineering and/or information technology.  Last week it announced the CHIKV Challenge for teams to develop methods to track and predict the emergence of a virus (H/T ScienceInsider).  The competition is interested in the Chikungunya virus, which has appeared in the Western Hemisphere for the first time in decades.  It’s mosquito borne, and any challenge solutions proven successful could be used for other viruses, especially those carried by mosquitoes.

The competition starts on September 1, and run through February 1 of next year.  The contest involves predictions of disease spread over the Western Hemisphere.  Entrants must submit the methodology, along with an indication of data sources and related models, by September 1.  Over the next several months, teams will submit accuracy reports indicating how well (or badly) their predictions match the spread of the virus, and describing their prediction for the balance of the competition period.

The top six teams will receive cash prizes (unless they are part of a federally funded research and development center).  DARPA hopes to follow in the footsteps of the Centers for Disease Control, which held a comparable competition on predicting the timing, peak and intensity of influenza during the 2013-2014 season.

‘Secret’ Ebola Treatment And Other Stories

The outbreak of Ebola virus disease (formerly known as Ebola hermorrhagic fever) in western Africa is no laughing matter.  The way it’s been inserted into fights over immigration reinforces the need to fight misinformation.  (That one of the politicians concerned that Ebola will come into the U.S. via Central American immigrants is a retired doctor reinforces my belief that not all doctors are scientists.)

Here’s what the Centers for Disease Control (CDC) has to say (effective August 6).

“The World Health Organization, in partnership with the Ministries of Health in Guinea, Sierra Leone, Liberia, and Nigeria announced a cumulative total of 1711 suspect and confirmed cases of Ebola virus disease (EVD) and 932 deaths, as of August 4, 2014. Of the 1711 clinical cases, 1070 cases have been laboratory confirmed for Ebola virus infection.”

Contrary to the concerns of several elected officials and media outlets, there is no significant risk of Ebola in the United States.  Two researchers with the disease were evacuated to the United States for treatment at Emory University in Atlanta.  As long as a hospital follows CDC infection control recommendations and can isolate the patient, it can contain the disease.

There is word of a ‘secret serum’ that the U.S. has, but is not currently going to send over to Africa.  This likely refers to the experimental treatment ZMapp, which has not undergone testing on humans.  While it was used in connection with one of the U.S. cases, neither the National Institutes of Health nor the CDC were involved in procuring the experimental treatment or getting it to the infected person in Africa. Continue reading