Thursday, August 07, 2014

"The Coming Plague," and "Betrayal of Trust," by Laurie Garrett: Ebola and other emerging diseases

The current Ebola epidemic in West Africa, and the tragic death of Dr. Sheik Humarr Khan, serve as reminders of how the real monsters in our world are far too small for the naked eye to see. I enjoy a good horror story, but Pulitzer Prize winning science journalist Laurie Garrett's book, "The Coming Plague; Newly Emerging Diseases in a World Out of Balance," is the scariest book I've ever read. It's also an excellent and gripping read -- don't be discouraged by its doorstop dimensions (my trade paperback version has 750 pages). Each chapter covers topics only an epidemiologist or a glutton for dread could love, including: Marburg virus, Lassa fever, Ebola, Aids, Hantavirus, and (my personal "favorite" because we are creating them by sheer stupidity) multi-drug resistant pathogens.

I recently went back to re-read her chapter on the first identified Ebola outbreak in Yambuku Zaire, during the summer and fall of 1976. The initial cases appeared in August of that year; by mid-October, when the WHO released a warning bulletin, 137 cases with 59 deaths had been documented. Despite the remote location, and very basic facilities, work began quickly to obtain samples and identify the pathogen. The October WHO bulletin was able to clarify that the new deadly "hemorrhagic fever of viral origin" was similar, but not antigenically identically to Marburg. In other words, they knew it was something never seen before and eventually gave it the name Ebola -- after a river near the stricken village of Yambuku.

In her follow-up book from 2000, "Betrayal of Trust; the Collapse of Global Public Health," Garrett addresses a world-wide decline in commitment to public health and the detrimental effect this has on battling emerging diseases. Mobutu's Zaire left doctors and nurses unpaid, and medical facilities stripped of salable supplies. The country was no more ready for a fresh Ebola outbreak in 1995 than it had been in 1976.
Contributing then, as now, to the spread of Ebola:
  • Crowded and under-equipped medical facilities reusing needles, and unable to effectively isolate infectious patients, sterilize equipment, sanitize bedding, or provide protective gear for their own staff members
  • Unprotected family members caring for their sick loved ones, or preparing remains for burial
  • Difficulty in distinguishing initial cases of Ebola from other -- too common -- diseases presenting similar symptoms such as high fever and bloody diarrhea (such as malaria, AIDS, TB, dysentery) 
"Outbreak News Today" recently interviewed Laurie Garrett about the current Ebola outbreak, and when asked about the new experimental serum used to treat two Americans, she replied:
“I would caution everybody to recall that there is no statistical power whatsoever in an N of 1. One person does well on a drug. That equals one person might have done well because they were a healthy individual to begin with, might have been sheer shake of the dice.
As she goes on to point out, even if both Americans recover, it's far from establishing that the serum is a cure.

To learn more about the current Ebola outbreak, check out this article in the open access online journal, "PLOS, Neglected Tropical Diseases": Bausch DG, Schwarz L (2014) Outbreak of Ebola Virus Disease in Guinea: Where Ecology Meets Economy. PLoS Negl Trop Dis 8(7): e3056. doi:10.1371/journal.pntd.0003056


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