The Ebola Virus Threatens Human Claims to Evolutionary Superiority

The Ebola virus mimics the lethal cleverness of human war strategy while exposing the inherent irrationality of the generalized human fear-based reaction, as well as the obstacles to effective public health response created by a for-profit health care paradigm.

In 1989, at the height of AIDS epidemic, Susan Sontag reflected on the metaphorical power of AIDS and its ability to elicit horror and fear:

Illness as Metaphor“First, the subjects of deepest dread (corruption, decay, pollution, anomie, weakness) are identified with the disease. The disease itself becomes a metaphor. Then, in the name of the disease (that is, using it as a metaphor), that horror is imposed on other things.”

In Americans’ panicked reactions to Ebola, we are now seeing similar metaphorical processes at work. The shocking images of victims lying abandoned on the streets of Monrovia and Freetown beamed into our homes could not help but provoke primordial fears of the “jungle” and Western anxieties about contamination from “primitive” and dark cultures – a subconscious loathing that was at the heart of the colonial enterprise.

Alexander Garza, former chief medical officer of the Department of Homeland Security, wrote on October 3 that the Ebola virus “is no ordinary communicable disease. It is the ISIS of biological agents. The response should mirror antiterrorism efforts.”

To compare a viral disease, which can be scientifically studied, understood, and counteracted – with traditional public health and medical intervention measures if not with effective drugs and vaccines – with a terrorist army that operates on murderous hatred of even fellow Sunni Muslims who don’t hew to their extremist dogma, is a perfect example of taking fearful metaphor too far (“imposing it on other things”, as Sontag warned), and applying the wrong strategies, particularly when US military response to Islamic insurgency has done nothing but accelerate that “disease”, and the decades-long “War on Drugs” has only made its effects on society more pronounced and more prolonged.

The tiny Ebola virus is NOT a terrorist, although it uses military-like strategies and tactics to invade and reinforce itself inside a host, and it should not elicit the irrational fear that images of beheadings typically do, except that the human mind is more susceptible to terrifying fantasies than our bodies are to what turns out to be a relatively fragile string of RNA that has to work very hard to infect a human host.

 

Introducing a Tiny Adversary

Ebola virus (specifically “EBOV”, and formerly designated Zaire ebolavirus) is one of five known viruses within the genus Ebolavirus. Four of the five cause a severe and often fatal hemorrhagic fever in humans and other mammals, known as Ebola virus disease (EVD). The EBOV strain is the cause of the 2013–2014 Ebola epidemic in West Africa, which has resulted in more than 14,000 suspected cases and almost half that many deaths (the case fatality rate is hovering around 70%).

Ebola In Africa

Ebola In Africa

The Ebola virus that’s causing the devastating outbreak in West Africa, and which has put much of the human world into near-panic, didn’t even have a name 38 years ago when it first surfaced and caused a mysterious illness among villagers in Zaire, now the Democratic Republic of Congo.

According to Dr. Peter Piot, co-discoverer of the Ebola virus, late one night a group of scientists discussed over Kentucky bourbon what the virus they were hunting should be named. The virus had surfaced in a village called Yambuku, so it could be named after the village, but that would run the risk of stigmatizing the village. Karl Johnson, a CDC researcher and the leader of the team, suggested naming the virus after a river. So the scientists looked at a small map pinned up on the wall, and it appeared that the closest river to Yambuku was called Ebola, meaning “Black River” in the local language, which “seemed suitably ominous”.

Ebola virus first infected humans in Zaire in 1976, and it was suspected to be a new strain of the closely related Marburg virus. The natural reservoir of Ebola virus is believed to be fruit bats. Bats drop partially eaten fruits and pulp, and then land mammals such as gorillas, chimpanzees, antelope and porcupine feed on these fallen fruits. Transmission from animals to humans and between humans is through body fluids, possibly from killing and eating or otherwise using the infected secondary animal carriers.

Ebola Vectors

Ebola Vectors

The disease is typically spread between humans only by direct contact with the secretions from someone who is showing significant signs of infection. Because the bodies of those who have died from Ebola are highly infectious, traditional burial practices are one of the primary modes of transfer of the virus. Hundreds of African health care workers have also died as a result of their contact with very sick patients.

The 1976 outbreak infected 318 people and had a case fatality rate of 88%. Ebola reappeared in Zaire in 1977 (1 fatal case), 1995 (315 cases, 81% fatal), 2007 (264 cases, 71% fatal), 2008 (32 cases, 44% fatal), and 2012 (57 cases, 51% fatal). It has also appeared three times in Sudan, four times in Gabon, four times in Congo, five times in Uganda, once in Cote d’Ivoire and once in South Africa, prior to the latest outbreak. Until this year’s epidemic, there had been 2,387 cases of Ebola in Africa, with an average case fatality rate of 67%.

The WHO announced the current epidemic in Guinea on March 23, 2014, but it began in December 2013 with a single patient, a 2-year-old boy in a Guinean village who became violently ill and died. A week later his mother and then his three-year-old sister were also killed by the virus. By March 2014, hospitals and public health officials were reporting clusters of the disease and notified the nonprofit Doctors Without Borders (Médecins Sans Frontières), which has set the global standard for Ebola care.

The two-year-old boy was from Guéckédou, a jungle village which lies on the country’s border with Liberia and Sierra Leone – the other two countries which have been badly affected by the virus.

Guéckédou - Patient Zero

Guéckédou – Patient Zero

The three West African countries at the epicenter of the Ebola epidemic were particularly vulnerable because of their poverty, their lack of public health infrastructure, their traditions of close-knit extended family care for the sick and the dead, and their barely functioning governments.

Liberia, for instance, which has seen the fastest spread of Ebola, is not yet recovered from a 14-year civil war that ended in 2003, has only 170 doctors for 4 million people (with many of them not actively practicing), and has a primary government hospital in its capital of Monrovia that doesn’t always have running water.

While Liberian President Ellen Johnson Sirleaf was pleading with the international community for medical assistance, her own son, Dr. James Adama Sirleaf, was fleeing the country to return to his home in Albany, Georgia, USA.

[For a heart-wrenching account of one Liberian family’s encounter with Ebola, see “For a Liberian Family, Ebola Turns Loving Care Into Deadly Risk“.]

Comparison of Outbreaks

 

Bio Hazard Level 4

Because of its high mortality rate, EBOV is listed by the World Health Organization (WHO) as a Risk Group 4 Pathogen (the highest risk level, requiring Biosafety Level 4 containment), as a US National Institutes of Health/National Institute of Allergy and Infectious Diseases Category A Priority Pathogen, a US Centers for Disease Control and Prevention Category A Bioterrorism Agent, and as a Biological Agent for Export Control by the Australia Group.

Ebola Drill

Ebola Drill with BSL 4 Isolation Equipment

This puts Ebola virus in a small and frightening group of microbes that are frequently fatal and without treatment or vaccines, including Marburg (from African green monkeys), Hantavirus (from rodents), Lassa Fever (from West African rats), and other hemorrhagic fevers.

 

The History of Civilization is the History of Pandemic Disease

While these are among the most terrifying animal-borne viral diseases, most human epidemic illnesses were originally transmitted from animals to people as an unintended consequence of the domestication of animals for human use. These include tuberculosis, diphtheria, leprosy, influenza and AIDS. Humans now share 65 diseases with dogs, 50 with cattle, 46 with sheep and goats, 42 with pigs, 35 with horses and 26 with poultry.

Ecology of Influenza

Ecology of Influenza

To put the current Ebola epidemic in perspective, here is a timeline of global plagues:

430 BCE:  The Plague of Athens killed a third of the city’s population (of perhaps 100,000).

540 CE: The Plague of Justinian, borne by rats in Egypt, claimed 5,000 lives a day and killed nearly half of Constantinople’s population. Half a century after it began, between 25 million and 100 million in Europe and Asia had died.

1347–1351: Black Death (probably bubonic plague) spread rapidly through much of Europe and parts of Asia among rats nestling in the bowels of grain ships. During that four-year spell, it wiped out as much as two-thirds of Europe’s population. Over the next 200 years, it is believed to have killed roughly 100 million people worldwide.

1492: Christopher Columbus and the European conquistadors who followed him to the New World, brought European diseases which decimated as much as 90% of indigenous American populations, with perhaps as many as 16 million deaths.

1817: The first of seven cholera pandemics that have spread throughout the globe, was carried by travelers along trade routes from India, and spread to what is now Myanmar (Burma) and Sri Lanka, and thne on to the Philippines and Iraq, where 18,000 people died during one three-week period in 1821.

1850s: The Plague wreaked havoc on Chinese citizens, killing tens of thousands, and by the late 19th century it had made its way to Hong Kong and Guangzhou, both major shipping hubs, from which it spread throughout the world – to Bombay, Cape Town, Ecuador, San Francisco and Florida, finally killing some 12 million people.

1878: Refugees fleeing Cuba carried yellow fever to New Orleans, which spread 200 miles north to Memphis, Tennessee where 5,000 people died. In total, the Mississippi Valley counted 20,000 deaths.

1918-19: The great influenza epidemic killed perhaps 20 million people, more than the number who perished in all of World War I. The Spanish flu, as it was known, infected an estimated one-third of the global population, sweeping over the planet in waves.

1916: The US polio epidemic infected 9,000 people in New York City alone, and killed some 6,000 nationwide. It was only in the 1950s that Dr. Jonas Salk developed a vaccine.

1960 onward: AIDS first surfaced in the Congo Basin of Africa, and has killed more than 30 million worldwide.

1970s: Smallpox raged through India, with more than 100,000 reported cases and at least 20,000 deaths.

2003: Severe acute respiratory syndrome (SARS), first reported in Asia, spread to more than two dozen countries in North America, South America, Europe and Asia before being contained. More than 8,000 people were sickened and 774 died. As with Ebola, there is no cure for SARS.

 

Small but Wickedly Intelligent

The EBOV genome is a single-stranded RNA approximately 19,000 nucleotides long (the human genome contains 3.2 billion nucleotides), which encode just seven genes (human DNA contains 20-25,000 genes), and yet is an exquisitely effective killer of humans and other primates once it enters a body. Under an electron microscope, the Ebola virus resembles noosed ropes – a fitting metaphor for such an “intelligent” killer.

Ebola Virus

Ebola Virus

Classified as a filovirus, Ebola shares that family name with the Marburg virus, named after the German city where it was first seen in researchers who caught it from imported African primates. The four deadly species of Ebola are: Zaire (70%–90% fatal), Sudan (50% fatal), Bundibugyo (25% fatal), and Ivory Coast (the one patient survived).

Ebola virus disease (EVD) was previously known as a viral hemorrhagic fever, a description that is falling from use because of the erroneous implication that it kills by exsanguination or bleeding out. In fact, most patients do not hemorrhage or ooze blood, at least not externally.

Few autopsies have been performed on people who have died from EVD because of the high risk of the procedure. But what’s known about the attack strategy of the virus would be worth studying by the world’s military command officers.

 

Turning the Enemy and Employing Decoys

Early in the infection, ebolavirus “hijacks” or “recruits” the front-line defenders of the host – called monocytes, macrophages and dendritic cells – to speed the spread of the virus to the lymph nodes, liver, spleen and elsewhere. In the liver, the presence of the virus appears to trigger a sharp decline of lymphocytes, the “reinforcement troops” or white blood cells that help fight infection, and which typically increase in number during an infection.

Meanwhile, Ebola employs a decoy tactic. It releases large amounts of secreted glycoprotein (sGP) into the bloodstreams of its victims, which looks like the glycoprotein (GP) on the exterior of the virus, which should be the immune system’s chief target. By tricking the immune system into seeing sGP rather than GP as the invader, it leads the host system’s defensive strategies astray while simultaneously weakening its defensive arsenal.

Symptoms_of_ebola

As the amount of virus in a person’s system starts to rise, symptoms begin to appear. They start with low-grade fever, which can come and go, and is sometimes missed. Severe headache and abdominal pain are then followed by vomiting and diarrhea, which lead to profound loss of fluids and finally volumetric shock, organ failure and death.

It has been known for some time that keeping Ebola patients hydrated is the most important supportive care, along with electrolyte rebalancing.

The accumulating damage to the liver leads to disseminated intravascular coagulation (DIC), in which blood over-coagulates in some locations and cannot thicken in others, causing blood vessels to become leaky. That is what results in the bleeding – mostly internal – for which Ebola is known.

The leakiness of blood vessels compromises blood supply to key organs like the liver and the kidneys. At the same time, bacteria from the gastrointestinal tract can enter the bloodstream, causing sepsis, or systemic (and often fatal) infection of the bloodstream. In the worst cases, blood pressure plummets, vital organs begin to fail, the patient goes into shock and dies.

Pathology of Ebola

Ebola Pathogenesis (click to enlarge)

The amount (or dose) of virus and the route by which the virus makes its way into the body can mean the difference between death and recovery. In the world of Ebola, less is better but even a very little is bad. It’s not known just how much of the virus is necessary to begin an infection, but it’s believed to be quite small.

But a low-dose exposure may prove less lethal if it allows the immune system to get into gear before the virus has a chance to disable too many of the body’s first responders.

How you get infected also plays a role in how sick you become. An exposure that delivers the virus directly into the blood stream – for example a needlestick injury – is more damaging than when viruses are introduced via the mucus membranes surrounding the eyes and nose and in the mouth. Onset of symptoms can be as little as two days with direct-to-blood exposures, while the incubation period can range up to 21 days for mucosal or broken-skin entry. Most infections become apparent within 8 to 10 days of exposure.

In the first 1976 Ebola epidemic, 85 people were known to have been infected through the reuse of contaminated syringes and all 85 died, along with nearly 200 others.

Age and genetic predisposition also affect the outcome. A recently published study which tracked case outcomes in Sierra Leone during the current West African outbreak showed a higher survival rate for patients under the age of 21 compared to those over the age of 45. Another recently published paper on the spectrum of Ebola disease in mice also suggests genetics play a role in survival.

 

Detection and Treatment

The US Centers for Disease Control and Prevention (CDC) was given a patent in 2010 for the Ebola Bundibugyo virus (EboBun), which is different from, and less deadly than, the EBOV strain that is currently spreading in West Africa. The CDC patents viruses and other pathogenic microbes to make sure the pathogens remain available for research purposes in the public domain. These patents are not, contrary to some conspiracy theories, to allow the creation of bio-weapons.

The blood tests which can identify the virus, include:

  1. antigen-capture enzyme-linked immunosorbent assay (ELISA)
  2. reverse transcriptase polymerase chain reaction (RT-PCR)

RT-PCR assay can detect ebolavirus 24 to 48 hours prior to detection by antigen capture, and as soon as a small amount of virus ends up in the blood. It can find as little as one or two virus particles in a drop of blood – a concentration so low that an infected person’s body fluids pose a minuscule risk to others at that stage.

But in the beginning, that’s not where the Ebola virus hides. The initial sites of replication are mostly in tissues like the spleen or liver, but detection in the blood becomes possible at about the same time that clinical signs and symptoms of disease first appear.

Though the CDC at first insisted that any US hospital was equipped and prepared to handle Ebola patients, because the disease had never appeared in America, few actually were. There are four Biohazard Level 4 isolation facilities in the US with a total of nineteen beds, though perhaps only half that number could be properly staffed for Ebola care. Community-based hospitals quickly found that their isolation protocols, training and facilities were inadequate to contain the infection, and those protocols were revised regularly, with the CDC issuing more stringent guidelines after transmission among US health care providers was discovered.

CDC PPE 2Three of the hospitals – the National Institutes of Health (NIH) hospital in Bethesda, Maryland (3 beds); Emory University Hospital in Atlanta, Georgia (3 beds); and the University of Nebraska Medical Center in Omaha (10 beds, and the only one designated for the general public) – have all treated confirmed and suspected cases of Ebola. Only St. Patrick Hospital in Missoula, Montana (3 beds), has yet to see an Ebola patient.

Treatment involves fluid and electrolyte replacement, monitoring of blood balance, and possible kidney dialysis to support basic organ functions.

 

A Vaccine Sitting on a Shelf

Almost a decade ago, scientists from Canada and the US reported that they had created a vaccine that was 100% effective in protecting monkeys against the Ebola virus. The results were published in Nature Medicine in 2005 (“Live attenuated recombinant vaccine protects nonhuman primates against Ebola and Marburg viruses”). The researchers said then that tests in people might start within two years, and a product could potentially be ready for licensing by 2010 or 2011.

It never happened. The vaccine sat on a shelf. Only now is it undergoing the most basic safety tests in humans – with more than 5,000 people dead from Ebola in an epidemic raging out of control in West Africa, and dozens of countries closing their borders to travelers from the region in panicked over-reaction.

Its development stalled in part because Ebola is rare, and until now, outbreaks had infected only a few hundred people at a time. But experts also acknowledge that the absence of follow-up on such a promising candidate reflects a broader failure to produce medicines and vaccines for diseases that afflict poor countries. Most drug companies have resisted spending the enormous sums needed to develop products useful mostly to countries with little ability to pay.

Now, the World Health Organization and the US Food and Drug Administration have fast-tracked human trials of unproven treatments. These include two vaccines – ChAd3 and VSV-EBOV – and six drugs: ZMapp, Brincidofovir, TKM-Ebola, Faviparavir, AVI-7537, and BCX4430. Of those, one vaccine and four drugs are approved for use in the field.

Drugs & Vaccines

Fast-Tracked Ebola Drugs & Vaccines

 

A Failure of Public Health and Capitalism

For similar reasons, the “advanced” world, relying mostly on for-profit health care and pharmaceutical corporations, has been very slow to respond even to this latest and greatest Ebola epidemic – until it began to threaten the populations of those nations, or at least began to infect them with fear and loathing.

Ironically, the nation which was first to respond to West Africa with health care professionals, and still leading the world in that response, is the tiny and long-isolated island of Cuba.

Cuban Doctors Unloading Medical Supplies in Sierra Leone

Cuban Doctors Unloading Medical Supplies in Sierra Leone

The communist country, which WHO Director Margaret Chan said “is world-famous for its ability to train outstanding doctors and nurses”, has offered more than 460 health care professionals to West Africa, with 165 medical workers deployed to Sierra Leone, bringing its total presence in the three affected countries to 256. As many as 15,000 Cuban health professionals had volunteered for the mission, and more than 50,000 health care workers from Cuba are working in 66 countries around the world.

Since 1960, almost immediately following their revolution, Cuba has sent 135,000 health workers overseas for emergency response or to work in under-served communities. In 1998, Cuba founded the Latin American Medical School (ELAM), which offers scholarships to low-income students from around the world with the expectation that they will graduate and return to their home countries as health workers. More than 23,000 physicians from low-income communities in 83 countries (including the US) have graduated from ELAM, and nearly 10,000 are currently enrolled.

When Cuban doctors graduate from medical school, they are given the opportunity to volunteer to be called upon for medical missions, like an Ebola outbreak or a natural catastrophe, for one to two year commitments. To prepare for something like Ebola, health care workers not only undergo aggressive training for the specific disease they are treating, but they also take courses on the region’s culture and history as well, so they do not appear as the “Great White Hope” that the capitalist Western world has so often been accused of. Their mission is emergency intervention and training of local resources to encourage medical self-sufficiency.

 

The True Global Epidemic

Other than the three primary West African countries of Guinea, Sierre Leone and Liberia, Nigeria had an infected air traveler introduce the virus to Lagos, which led to 20 Ebola infections and eight deaths before the nation was declared by WHO to be Ebola-free on October 20, 2014. Unlike the other three African nations, Nigeria has an intact and functioning national health care and public health infrastructure and was able to track and isolate all those who came into contact with Ebola patients. Mali reported its first case of Ebola on 10/23: a 2-year-old girl who came from Guinea with her grandmother, and whose father (and possibly mother) died of Ebola. A second death in Mali, of a nurse who treated a Grand Imam from Guinea at a private clinic in Bamako, who died 15 days earlier and was washed and buried without diagnosis, has triggered a clinic lockdown and quarantine of 90 contacts. Senegal had a single case which was quickly contained.

Ebola Cases Out of Africa

Ebola Cases Out of Africa

Outside of Africa, one nurse in Spain became infected from treating a Spanish priest who was repatriated from Africa with the disease. And one Liberian good Samaritan, who contracted the disease by helping a pregnant 19-year-old woman out of a taxi, brought Ebola to Dallas, Texas in the US and passed the infection to two nurses who treated him without adequate isolation garments. The Liberian, Thomas Duncan, succumbed to the disease, perhaps because of his initial misdiagnosis and late treatment. All other Western health care workers, however, have recovered after intensive hospital treatment, including some experimental drugs and plasma transfusions from recovered patients.

American Ebola Patients (100% Recovery with Early Detection & Treatment)

  1. Patrick Sawyer, 40, a naturalized American consultant to the Liberian Ministry of Finance, infected while caring for his Ebola-stricken sister in Liberia, was the first American to have died of Ebola, but he was treated belatedly in Lagos, Nigeria.
  2. Kent Brantly, 33, physician with Christian relief in Liberia, was treated at Emory University Hospital in Atlanta, including ZMapp, and released on 8/21.
  3. Nancy Writebol, 59, of Christian relief in Liberia, was treated at Emory University Hospital with ZMapp, and released on 8/19.
  4. Rick Sacra, 52, physician with Christian relief in Liberia, was treated at the Nebraska Medical Center, receive plasma from Brantly as well as TKM-Ebola, and released on 9/25, then suffered a respiratory infection on 10/4 and was released on 10/5.
  5. “John Doe”, physician for WHO, was treated at Emory University Hospital on 9/8 and apparently released.
  6. Ashoka Mukpo, 33, an NBC camerman, was admitted on 10/6 to the Nebraska Medical Center in Omaha, treated with brincidofovir antiviral, and cleared on 10/21.
  7. Nina Pham, a 26-year-old nurse at Texas Health Presbyterian Hospital was diagnosed with Ebola on 10/11. She was being treated at Texas Health Presbyterian, moved to a National Institutes of Health isolation unit in Bethesda, Maryland, and released on 10/24.
  8. Amber Joy Vinson, a 29-year-old nurse at Texas Health Presbyterian Hospital, was diagnosed with Ebola on 10/15, isolated and transferred to Emory University Hospital in Atlanta, and released on 10/23.
  9. Craig Spencer, 33, of Doctors Without Borders, returning from Guinea, tested positive for Ebola on 10/23 in NYC, and was released from Bellevue Hospital on 11/11.
  10. Dr. Martin Salia, 44, of the African Academy of Christian Surgeons, was born in Sierra Leone but a permanent US resident, was flown to the University of Nebraska Medical Center from Sierra Leone. He was in kidney and respiratory failure at arrival on 11/15 and died on 11/17.

 

[Lewis Rubinson, an American doctor working in Sierra Leone was admitted to the National Institutes of Health hospital on 9/28 for isolation after a needle-stick injury, and discharged on 10/8 after determination that his Ebola-like symptoms were a result of an experimental Ebola drug rather than the virus. He then finished his 21-day quarantine at home.]

 

American Ebola Patients

Dr. Martin Salia was the chief medical officer and surgeon at United Methodist Church’s Kissy Hospital outside Freetown, Sierra Leone, and worked at three other clinics. He was not treating known Ebola patients, but was somehow infected and was more critically ill than other US patients at the time of admission. He also did not test positive for Ebola until four days after the first symptoms appeared, which were initially attributed to other causes. The delay in diagnosis proved to be determinative of the outcome.

Given that the US public health system has so far successfully treated every American infected with ebolavirus who was diagnosed and treated in a timely manner, and (as in Nigeria) effectively tracked and isolated every person who came into contact with any known Ebola patient, there is no epidemic of Ebola virus disease in America.

However, there IS an epidemic of Ebola fear and fear-mongering in America (and elsewhere around the world).

As soon as the Liberian good Samaritan, Thomas Eric Duncan, was diagnosed with Ebola (after being first misdiagnosed and sent home with antibiotics and Tylenol), Americans began screaming for his head, demanding that he be prosecuted for knowingly entering the US with a deadly disease. Even Liberian President Ellen Johnson Sirleaf, in reaction to the US overreaction to Duncan, promised that he would be prosecuted in his own country if it is found that he lied to airport screeners.

Thomas Duncan

Thomas Duncan

It turned out that he would not be prosecuted, not only because his belated treatment resulted in the only US death by Ebola, but because it was discovered that he did not know the young, pregnant woman he so selflessly assisted in Liberia was infected with Ebola.

The four dozen contacts of Duncan and the 72 other Texans who came into secondary or tertiary contact with him or his caregivers, have all passed the 21-day incubation period with no signs of infection, including his family with whom he was in very close contact, but who now have to start life over again after all their possessions were destroyed by “cleaners”, including his fiancée’s engagement ring.

On 11/12/2014, an attorney for Duncan’s family announced that the Texas hospital that treated him will create a foundation in his name, to assist other Ebola victims in West Africa. The attorney said the foundation is part of a larger settlement that will “take care” of Duncan’s four children and his parents (though not his fiancée).

Cleaners at Duncan's Apartment

Cleaners at Duncan’s Apartment

It turns out that Ebola, as deadly as it can be without sophisticated intervention, is actually rather difficult to transmit until the patient is losing vast amounts of body fluids, and the virus itself is not very robust and succumbs quickly to environmental factors outside a host body. Soap and water or alcohol are sufficient to remove the virus from the hands.

 

The Right Wing Goes Nuts

“The arrival of the virus in America has crystallised a range of Conservative anxieties: immigration, race, terrorism, science, big government, Barack Obama – you name it. For the right, Ebola is not just a disease, it is a metaphor for some of the things they don’t understand and many of the things they loathe.” – Gary Younge, award-winning British journalist

Real estate mogul Donald Trump and retired neurosurgeon Dr. Ben Carson were both critical of bringing the infected missionaries back to the US. Columnist Ann Coulter went further, questioning why the missionaries were working in the “disease-ridden cesspools” of Africa.

This is reminiscent of the Victorian colonial-era Anglo-American disdain for dark-skinned peoples, cultures and regions, which were considered “filthy” and in need of Western assistance in becoming “clean” and fully human.

White Man Burden is to teach cleanliness described in a Pears Soap advertisement 1890sWhite Man Burden is to teach cleanliness described in a Pears Soap advertisement 1890s

“If Dr. Brantly had practiced at Cedars-Sinai hospital in Los Angeles and turned one single Hollywood power-broker to Christ, he would have done more good for the entire world than anything he could accomplish in a century spent in Liberia,” Coulter wrote in a column.

Carson, who is flirting with a White House run after taking on President Obama at the 2013 National Prayer Breakfast, said it was a mistake to bring the missionaries back for treatment and doctors could have flown overseas to treat them.

After it was first announced that the Ebola-infected American health care professionals would be flown back to the US from Africa, Donald Trump tweeted:

Ebola patient will be brought to the U.S. in a few days – now I know for sure that our leaders are incompetent. KEEP THEM OUT OF HERE! — @realDonaldTrump, August 1, 2014

Stop the EBOLA patients from entering the U.S. Treat them, at the highest level, over there. THE UNITED STATES HAS ENOUGH PROBLEMS! — @realDonaldTrump, August 1, 2014

The U.S. cannot allow EBOLA infected people back. People that go to far away places to help out are great-but must suffer the consequences! — @realDonaldTrump, August 2, 2014

The U.S. must immediately stop all flights from EBOLA infected countries or the plague will start and spread inside our “borders.” Act fast! — @realDonaldTrump, August 2, 2014

The fact that we are taking the Ebola patients, while others from the area are fleeing to the United States, is absolutely CRAZY-Stupid pols — @realDonaldTrump, August 2, 2014

Dr. Jane Orient, the president of the American Association of Physicians and Surgeons (a politically conservative non-profit association founded in 1943 to “fight socialized medicine and to fight the government takeover of medicine”), is claiming that “100,000 West Africans are in Central America, have been taught to speak Spanish and are coming across our Southern border” carrying Ebola.

Conservative mouthpiece Phyllis Schlafly believes Obama is allowing it into the country deliberately. “Obama doesn’t want America to believe that we’re exceptional,” she said. “He wants us to be just like everybody else, and if Africa is suffering from Ebola, we ought to join the group and be suffering from it, too.” Rightwing radio host Rush Limbaugh claims liberals won’t impose a travel ban from infected areas because Ebola is “payback” for slavery.

 

Political Over-Reactions

But, in spite of the science and medical knowledge about Ebola, New York, New Jersey, Illinois and Florida imposed 21-day mandatory quarantines for anyone arriving with a risk of having contracted Ebola in Sierra Leone, Liberia and Guinea.

GOP lawmakers and some Democrats urged a blanket travel ban on anyone from the three West African countries at the center of the Ebola outbreak. Thirty countries have instituted travel bans, though most are African nations, small countries with poor public health systems or totalitarian states such as North Korea – with the obvious exceptions being Canada and Australia, two countries which should be leading the effort to fight the epidemic in Africa rather than leading the infection of fear.

ebolatrafficconnections4

Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, rejected travel bans, noting a ban would likely induce travelers from the heart of the outbreak to go underground. “Right now, we know who’s coming in,” he said. “If we try to eliminate travel, the possibility that some will travel over land, will come from other places, and we don’t know that they’re coming in, will mean that … when they arrive, we wouldn’t be able to impose quarantine as we now can if they have high-risk contact.”

Schools in both Ohio (where nurse Amber Vinson traveled before becoming symptomatic) and in Texas were closed because of secondary contacts with the infected nurses, and Frontier Airlines (on which Vinson flew) placed six crew members on leave and tore out the carpet and seat covers of their airplane.

A nurse, Kaci Hickox, returning from volunteering with Doctors Without Borders in West Africa, was detained and interrogated for hours at a New Jersey airport, where an infra-red scanner finally read 101° after her face became flushed with anger, then was isolated in a hospital tent (where she showed no fever and tested negative twice for Ebola) until she threatened legal action against the state of New Jersey. The governor then relented and allowed her to return to her home state of Maine, where that governor also threatened to enforce a quarantine and had state police guard her boyfriend’s house, where she was staying. A judge, however, sided with Hickox and medical science and ordered only self-monitoring and reporting of travel plans to the state health department. She and her boyfriend, who had to quit the nursing program at the University of Maine at Fort Kent, have since move out of Maine because of their treatment.

Kaci Hickox in Siera Leone

Kaci Hickox in Siera Leone

Nurse Hickox Speaks to her Lawyer from a Hospital Quarantine Tent in Newark

Nurse Hickox Speaks to her Lawyer from a Hospital Quarantine Tent in Newark

In Louisiana, the governor came under criticism after telling participants of an international conference on infectious tropical diseases in New Orleans not to attend if they had recently been in Liberia, Sierra Leone or Guinea, or had had contact with someone infected with the Ebola virus. The American Society of Tropical Medicine president, Dr. Alan Magill, said this restriction would harm the conference’s Ebola sessions, where scientists, doctors and administrators who had been in the region were going to teach others.

In a Bronx NY neighborhood, children were screaming “Ebola” at West African classmates. In Milford CT, a third-grader returning from a wedding in Nigeria – where there are no known cases of Ebola – has been barred from school. The girl’s family is suing the school and town, the latter of which has ordered 21-day segregation of anyone traveling from the entire African continent.

Africa Without Ebola

A London graduate student who carries a Liberian passport but had not traveled to Liberia was detained at Heathrow Airport. Mothers in a Rome suburb petitioned to keep a 3-year-old out of nursery school because she had gone to Uganda, thousands of miles from the Ebola-affected region.

“The Ebola panic is the latest manifestation of a centuries-old tradition of overreacting to infectious diseases,” Catherine Hanssens, executive director and founder of the Center for HIV Law and Policy, said. “We have equivalently irrational laws on the books” – passed in contradiction to known science even at the time – “covering pretty much every infectious disease you can think of, from syphilis to hepatitis to tuberculosis.”

“But panics are faster and hotter – and responses harsher – when the pathogen is associated with a ‘stigmatized identity’: black, gay, drug using, foreign. The screamed-at kids in the Bronx, the Connecticut third-grader, the Londoner and the Italian preschooler are all blacks of African descent. The white health workers who went to Africa are contaminated by association.” wrote Judith Levine in the Vermont weekly, 7 Days.

 

Sanity and Science

An editorial in the prestigious New England Journal of Medicine described the quarantines as unfair, unwise and “more destructive than beneficial”. The editors said the policy could undermine efforts to contain the international outbreak by discouraging American medical professionals from volunteering in West Africa.

“The way we are going to control this epidemic is with source control and that’s going to happen in West Africa, we hope. In order to do that we need people on the ground in West Africa,” said Dr. Jeffrey Drazen, editor-in-chief of the journal.

Federal guidelines from the Centers for Disease Control and Prevention (CDC) call for health care workers to be quarantined only if they have a known direct exposure to the virus as a result of a needle stick or a breach in their protective suits, and break down travelers’ risk level into “high risk”, “some risk”, “low risk” and “no risk”.

Only “high risk” individuals would be required to isolate themselves in their homes for 21 days, and not be allowed to take public transportation or go to places with high numbers of people or “congregate gatherings”. They will undergo active monitoring by public health personnel.

People who fall under the “some risk” category would have their temperatures checked twice a day, and their travel and public activities will be assessed on a case-by-case basis. Those who are “low risk” would self-monitor and report any symptoms.

CDC Director Tom Frieden said “The best way to stop this epidemic is to help the people in West Africa; we do that by sending people over there, not only from the USA but from other places.” Friedan said mandatory 21-day quarantines for people returning from the Ebola “hot zone”, could have the unintended consequence of discouraging healthcare workers from volunteering to fight the disease in Africa. “We will only get to zero risk by stopping it at the source,” he said.

The CDC guidance reflects the positions of the World Health Organization, the Infectious Diseases Society of America, and other healthcare groups. They assert that it is pointless to quarantine individuals while they are asymptomatic and therefore unable to spread the virus.

The CDC recommendations were also endorsed by the American Medical Association, the American Nurses Association, and the American Hospital Association. In a joint statement, the three groups said the CDC guidance “appropriately safeguards public health without unduly burdening those who have heroically cared for Ebola patients.”

A senior Obama administration official said. “We have let the governors of New York, New Jersey, and others states know that we have concerns with the unintended consequences of policies not grounded in science may have on efforts to combat Ebola at its source in West Africa.”

President Obama defended his administration’s recommendation to monitor but not quarantine clinicians returning from Ebola care assignments in West Africa, saying that it is based on science. “We just don’t react based on our fears,” he said on the White House lawn. “We react based on facts and judgment and smart decisions.”

New York City Health Commissioner Dr. Mary Bassett said she was concerned that the quarantine will discourage health workers from volunteering to help these areas.

 

Medical Volunteers Backing Out

Dr. Robert Fuller didn’t hesitate to go to Indonesia to treat survivors of the 2004 tsunami, to Haiti to help after the 2010 earthquake or to the Philippines after a devastating typhoon last year. But he’s given up on going to West Africa to care for Ebola patients this winter. He could make the six-week commitment sought by International Medical Corps, but the possibility of a three-week quarantine afterward adds more time than he can take away from his job heading UConn Health Center’s emergency department.

Dr. Robert Fuller Provides Medical Care to an Earthquake Survivor in Port-au-Prince, Haiti.

Dr. Robert Fuller Provides Medical Care to an Earthquake Survivor in Haiti.

About 30 US-based charities and service organizations are responding to a range of needs in West Africa, including helping to safely bury the victims of Ebola, building badly needed clinics and educating people about ways to halt the virus’ spread.

But the recent debates triggered by the decisions of New Jersey, New York and other states to issue their own quarantine rules for those returning from West Africa have added new challenges to the goal of getting more Americans to help fight an epidemic that has overwhelmed the fragmented health systems in the three impoverished nations.

“We’ve heard from members … that some people who were about to deploy to the region pulled back,” said Julien Schopp, director of humanitarian practice for InterAction, a DC-based umbrella group of international aid organizations.

West African Medical Missions, a small nonprofit that brings in American health professionals to help educate and improve the health system in Sierra Leone, had seven of eight prospective volunteers drop out recently, said co-founder Gabriel Warren.

Those would-be volunteers were turned off by some of the vitriol in the debate over quarantines, and some were threatened with losing their jobs at home if they signed onto one of the group’s weeks-long volunteer stints.

Some potential volunteers are wary of not only being quarantined but being seen as potential disease-carriers, rather than conscientious professionals. “People are afraid what will happen when their kid goes back to school, what their family will think,” said Dr. Joia Mukherjee, chief medical officer of Partners in Health.

“People who go there do it out of a sense of service, and then they fear they will end up stigmatized,” said Schopp, of InterAction. “It’s hard for them psychologically to think that they might be treated as a pariah for that.”

 

The Baselessness of Fear and Loathing

Published by NPR, 10-23-2014

Published by NPR, 10-23-2014

A November 6-9 poll of Americans put Ebola at third place (17%) as the “most urgent health problem”, right behind health care costs (19%) and access (18%), while the far more pernicious killers of diabetes, heart disease, drug and alcohol abuse, flu, mental illness and AIDS were mentioned by only 1% to 2%.

Influenza, for instance, was listed by only 1%, while it kills between 3,300 and 49,000 Americans every year, according to the CDC.

This fear and loathing of Ebola among Americans is a result of political and media misrepresentation, sensationalism and exploitation – not science or reason. The Ebola scare has even knocked “government interference” in health care – another politically-generated meme – almost off the chart.

Gallup Pol - Health Concerns

In announcing new and more stringent isolation guidelines, CDC director Tom Frieden cited a 1995 study conducted in what is now the Democratic Republic of the Congo that looked at the Ebola infection risk of people living within a household of someone with Ebola. The study showed that only 28 (16%) of the 173 contacts of 27 Ebola patients developed Ebola, and those who did had direct contact with a known patient. None of the 78 family members who did not have direct contact later became infected.

Similarly, not one of the 120 people who had primary or secondary contact with Thomas Duncan, the Liberian who died of Ebola in Dallas, contracted the disease – including the close family members who were with him after he became symptomatic, including the fiancée who shared a bed with him.

Another example of how difficult it is to transmit the Ebola virus in normal public settings is the story of Maili’s single initial Ebola fatality.

Unlike most West African countries, Mali has not closed its border with its neighbor, Guinea, even though it is at the heart of the Ebola epidemic. Closing the border would violate the time-honored Malian principle of diatiguiya  (pronounced JAH-tih-GEE), the belief that hospitality to friends and even strangers is obligatory.

In a selfless act, Aminata Gueye Tamboura, 45, of Mali went deep into Guinea to rescue her two young granddaughters. Her daughter had married a Guinean and moved to southern Guinea, where the outbreak began. Her husband’s family did not believe the virus existed and rejected medical help, even as relatives began to die, including the grandchildren’s father. Their mother remained in Guinea with a 3-month-old baby because she had to observe 40 days of mourning for her husband. So the grandmother retrieved the two other children and took them on a 700-mile ride aboard buses and taxis, back to her home in Kayes, a small city in northwest Mali.

Trip to Mali

 

Along the way, the littlest – 2-year-old Fanta Condé – developed a 104° fever and an unstoppable nosebleed and later died of Ebola.

The 21-day quarantine period since Fanta’s death on October 24 is almost over, and the 108 Malians in quarantine are being released, since none are showing symptoms. No one who touched Fanta in Mali is yet sick, including her grandmother, her 5-year-old sister or her uncle, who each spent three days traveling with her from Beyla, Guinea. Not Dr. Abdouramane Koungoulba, the pediatrician who first examined her on Oct. 21, nor two traditional healers who saw her earlier, nor any of a dozen other doctors or nurses who gave her a transfusion and intravenous hydration and cleaned up her vomit and diarrhea in the 48 hours before she died.

In Kayes, Ms. Tamboura took Fanta to two different traditional healers, known as marabouts, and then to a neighbor, a former doctor, who urged her to go to the hospital, which she did on Oct. 21. Initially, the doctor there was told that Fanta was a local child, so he did not suspect Ebola. He wore gloves, but no other protection.

In spite of this extensive contact, no one else was infected.

 

Ebola Shows More Signs of Intelligent Life than Does Homo Sapiens

The tiny noose-rope-shaped seven-gene virus has developed the ability to be carried without infection by fruit bats, whose droppings are eaten by other mammals and primates, which then carry the pathogen to human beings, whose civilizations have encroached on wild animal territory.

The simple microbe has developed attack, infiltration and subversion skills that would put Sun Tzu and every military strategist in the last 2,000 years to shame.

The Ebola Virus

And, even more dangerous perhaps than the hemorrhagic fever that it produces, the Ebola virus has been able to generate a pandemic of irrational fear among the allegedly most evolved and most intelligent of all species on planet Earth.

For all the belated rush to create drug treatments and vaccines for Ebola, what “cures” most patients is their own innate immune system, while the most that modern medical science can do is simply support the patients’ natural biological homeostasis and give Mother Nature time to recover from the viral invasion and the “shock & awe” assault.

It’s a shame that modern humans have not learned the same lesson about backing away from our technological interventions into Nature’s near-perfect 3.5 billion-year homeostasis on planet Earth, reducing our unsustainable population numbers, simplifying out technologies, and giving Mother Nature the space and time to regenerate and restore the evolutionary and ecological balance that She has maintained so precariously for so long.

The simple truth that we may never learn is that humanity is not nearly as smart or as clever as we have so long believed, and our place at the top of the evolutionary pyramid is NOT the most important but the most problematic and expendable.

It is often said that crisis brings out both the best and the worst of humanity, and the little Ebola virus seems to have done just that, making a mockery of our hubristic claim to superiority as a species.

 

Winning the Battle While Losing the War

Will we win this skirmish with the Ebola virus? There is little doubt of that, even though our response was too little too late, and most of the casualties will be among the world’s poorest and most powerless. But we are losing the war on the Earth that we began to think we could wage on our own terms since the first tilling stick was used to force the soil to produce more food for us than it naturally provided and the first spear was tossed into a mastodon to initiate megafauna extinctions and dramatically alter our natural environment.

evolutionofman

We humans are the preeminent tool-makers and tool-users and master script writers and choreographers of unnatural cultural paradigms, but every tool has come with significant unintended consequences, and every human-in-control paradigm has experienced blowback of immense proportions, with global climate catastrophe and the Sixth Great Extinction but the latest of 10,000 years of such Gaian responses to our all-too-human shortsightedness, arrogance and greed.

 

Only in America

With the holidays right around the corner, parents can buy their children an untraditional yet socially relevant gift: The “Case-E Ebola Nurse Action Figure”.

Case-E Ebola Action Figure & the Real Kaci Hickox

Case-E Ebola Action Figure & the Real Kaci Hickox

Herobuilders made the toy of an Ebola-free nurse with curly hair and a red “x” sewed over her eye, who bears a strong resemblance to Kaci Hickox, the nurse who made headlines for fighting New Jersey and Maine over their controversial quarantine policy for those returning from Ebola affected countries.

“I don’t know who you’re talking about, I don’t know who Kaci Hickox is,” Hero Builders president Emil Vicale said, laughing. “This nurse’s name is Case-E. She bears no resemblance.”

The toy, which comes complete with an Ebola-free certificate, went on sale for $29.99 the morning of November 10.

Herobuilders also sells dolls of the World’s Sexiest Criminal, (Toronto Mayor) Rob Ford with beer bottle accessories, and the Miley Bubble-Butt Twerking doll.

A more troubling product now on the market is The Ebola Handbook – written by the Ob/Gyn Dr. Joseph Alton, creator of the survivalist website doomandbloom.net, and the author of The Survival Medicine Handbook – which purports to teach readers how to survive an Ebola apocalypse. In the two days since the book was released, it landed the No. 4 spot on the health section of The New York Times bestseller list and received a four-star rating on Amazon.

The Ebola Handbook

Interspersed with some useful information on Ebola, Dr. Alton’s handbook also contributes to the fear-mongering with incorrect or misleading assertions about airborne transmission, ease and likelihood of infection, and long-term side effects after recovery.

This is the epitome of what capitalism and “free enterprise” has to offer to a troubled world.

**********************************************************************************

In addition to Dr. Alton’s Ebola Survival Handbook, Amazon currently lists 33 other similar titles:

  1. Ebola Survival Handbook: A Collection of Tips, Strategies, and Supply Lists From Some of the World’s Best Preparedness, Sep 22, 2014 by Lost Arts Publishing
  2. Ebola Pandemic Survival Guide: The Quick-and-Dirty Guide to Prepare and Survive, Oct 6, 2014 by Laissez Faire Contributors
  3. Ebola: The Preppers Guide to Surviving Ebola. Oct 7, 2014 by Max White
  4. Ebola : The Ultimate Guide to Ebola Protection, History, Symptoms, Treatment, Nov 2, 2014 by Akshat Agrawal and Shubham Agarwal
  5. Ebola survival guide: What If…: “A 2015 prepper’s handbook for surviving the coming Ebola outbreak”, Oct 26, 2014 by William Durden and Raven koussala
  6. The Ultimate Guide to the Ebola Crisis: How to Protect Yourself from the Ebola Virus – Strategies You Must Know, Oct 19, 2014 by Richard Pressman
  7. Ebola: Should We Be AFRAID? What You Need to Know To Survive The Deadly Ebola Outbreak, Oct 12, 2014 by Jones Walton
  8. Ebola Survival Guide 2015: The 21 Things you Must Know to Survive the Coming Ebola Outbreak, Nov 4, 2014 by Joy Lincoln
  9. Ebola: 50 Critical Facts about Ebola That You Need to Know, Aug 26, 2014 by David C. Lugo
  10. Ebola: The Ultimate Guide to Prepare For and Prevent Ebola, Oct 13, 2014 by Matthew Mahone
  11. Ebola Survival Guide: 12 Things You Must Know to Survive Ebola Outbreakm Oct 31, 2014 by Max Kessler
  12. Ebola:2015. A prepper’s survival guide: 7 day guide handbook to being the most prepared for the Ebola Outbreak, Oct 13, 2014 by David Lattimer and Jennifer Osbourne
  13. Ebola Survival Guide: The Ultimate Prepper’s Guide to Preparing for a Global Ebola Pandemic, Oct 22, 2014 by James Clark
  14. Ebola: What You Are Not Being Told, Oct 30, 2014 by John Raymond
  15. Ebola – Ebook Pandemic, Oct 16, 2014 By Seth Vandelay
  16. EBOLA: HOPE FOR THE CURE: Ebola Situation in USA, Ebola Vaccine and ZMAPP, Oct 20, 2014 by David C. Lugo
  17. Ebola Explained: Know, Prepare, Protect Are You Ready for the Outbreak?, Ebola Survival, Oct 21, 2014 by David Cage
  18. Ebola Survival Guide, Aug 13, 2014 by Paul D. Chan MD PhD
  19. Screw Ebola!: How to Protect Yourself (and Your Family) from a Pandemic, Oct 23, 2014 by Wilton M. Evans
  20. Ebola: What You Need To Know Now!, Oct 3, 2014 by Sam Jonstone
  21. Ebola Outbreak Guide: Discover the Truth About Ebola – and Be Prepared for the Coming Civil Collapse, Oct 23, 2014 by Aaron Stockton
  22. Ebola Survival Handbook: The Ultimate Guide to Preparing for and Surviving an Ebola Outbreak, Nov 10, 2014 by Jennifer Thay
  23. How to Avoid Ebola: 53 Simple Ways to Avoid Ebola – And Save Your Life, Oct 20, 2014 by John Brennan
  24. EBOLA VIRUS: The Simple Ebola Survival Guide, Aug 9, 2014 by Dr. K.L. Summers
  25. Ebola-Virus: Understand What Ebola Is, Symptoms, Prevention, And Possible Treatments (Escape Ebola Virus Hot Zone), Nov 18, 2014 by John Korsh and Ebola And Ebola Virus
  26. Ebola Pandemic Survial Guide :The Ebola Virus, The Facts, The Myths And How To Prepare & Survive The Coming Ebola, Oct 29, 2014 by Elise Greenwald
  27. Ebola Survival Guide: Experts Tell You Exactly What You Must Know to Protect Yourself and Your Family, Oct 20, 2014 by Christopher Seagal
  28. Ebola: The Ultimate Ebola Survival Guide to Preparing and Surviving the Ebola Outbreak, Nov 14, 2014 by Jerry Cline
  29. Ebola Survival Guide: Based on The Prepper’s Handbook, Oct 30, 2014 by Bryan Foster and Nicole Foster
  30. Ebola: The Definitive Guide to Prepare For and Survive the Ebola Outbreak, Nov 18, 2014 by Stephen R. Price
  31. The Fast Guide to Ebola Prevention & Survival, Oct 20, 2014 by Tom Talbot
  32. Ebola: A Quick Guide to Understanding, Preparing and Protecting Yourself from The Ebola Epidemic, Nov 10, 2014 by Jake Anderson

 

 

 by Robert Riversong: may be reproduced only with attribution for non-commercial purposes

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One Response to “Ebola as Metaphor”

  1. s.k. said

    A very thought-provoking and fact-filled read. Thanks for writing it!

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