Ecology and the Deadly Ebola Epidemic
Health workers in Guinea suit up. (Photo: European Commission Humanitarian Aid and Civil Protection Department)
West Africa is the middle of the worst Ebola outbreak in recent history. The outbreak has spread into major cities and is out of control, with thousands of cases and hundreds of deaths. Dr. Anthony Fauci, head of the National Institute for Allergy and Infectious Diseases joins host Steve Curwood to discuss the lethal epidemic, the prospects of a vaccine, and environmental causes that help diseases to jump from animals to humans.
CURWOOD: From the Jennifer and Ted Stanley Studios in Boston and PRI, this is Living on Earth. I’m Steve Curwood. West Africa is caught in the grip of the largest outbreak of the deadly Ebola virus that the world has ever seen and the death rate is rising. As we record this, over 3,000 cases have been reported across Guinea, Liberia, Sierra Leone, and Nigeria, and so far more than 1,500 people have died. And recently, an outbreak of a different strain of Ebola emerged in the Democratic Republic of Congo, which got us wondering whether environmental factors might be playing a role in the spread of this scary disease. We called up Dr. Anthony Fauci, head of the National Institute of Allergy and Infectious Diseases. Welcome back to Living on Earth, Dr. Fauci.
FAUCI: Good to be with you.
CURWOOD: So first, give us a little history on this disease. What is Ebola and where did it come from?
FAUCI: Ebola is a viral disease that actually is fundamentally a disease of animals. It pops up and jumps species from animal to human intermittently. We don't know exactly how it occurs, but fruit bats, which people do eat for protein nourishment in the areas of Central Sub-Saharan Africa and even in West Africa, but also nonhuman primates and some animals get infected and people either through butchering them and eating them can get infected. It was first recognized in 1976 in the former Zaïre, currently to Democratic Republic of the Congo as well as in Sudan. Since 1976, there have been about two dozen outbreaks that range in size from just a few people to a few hundred people. As you know, right now the outbreak that's going on in West Africa is much much larger and by far the worst we've ever experienced. Generally, what we see is an outbreak that occurs and usually gets under control because of isolation and infection control practices in geographically restricted areas, because the outbreaks are usually in villages. The current outbreak now is different because it's not in a geographically restricted area, it is in three or four countries that have porous borders, that have high populations and it has gotten into the city. And that's one of the reasons why it is very much not in control. It is actually quite out-of-control.
CURWOOD: What do you make of recent reports of yet a different stain of Ebola developing in the Congo compared to what's going on in West Africa?
FAUCI: That's not surprising to me because, as I said, there have been about two dozen outbreaks since 1976, and what we see now is unfortunately simultaneous ongoing epidemic and outbreak predominantly in Guinea, Sierra Leone, and Liberia. That's an ongoing epidemic with a particular strain of Ebola. What we've seen now simultaneously in the Congo is an outbreak of Ebola that’s a different strain. So they're not connected. It isn't as if there was transmission from the West African countries that we mentioned to the Democratic Republic of the Congo. It's a different outbreak.
CURWOOD: Now, in the past we've seen these outbreaks. A few years go by, there's an outbreak and then more time goes by. Now we're having, what, this big outbreak and yet there's another different strain just a few weeks later. What could be going on here?
FAUCI: Well, you know, it's difficult to determine that. These are random outbreaks. If you look at the two dozen outbreaks that have occurred since 1976, there is no rhythm or pattern to it. They come up in an unpredictable way. So I don't think you can make much out of the fact that at the time we're in the middle of a very serious outbreak in the West African countries that we also have what looks like the beginnings of a mini outbreak in the Democratic Republic of the Congo, hopefully that second outbreak will be able to be contained more efficiently than the one that's currently going on in West Africa.
CURWOOD: To what extent do you think environmental factors are playing a role here?
FAUCI: Well, I'm sure there are some since this is what we call a zoonotic infection, by zoonotic we meant this is predominantly an animal infection that intermittently jumps species to the humans. For example, we know that fruit bats carry this virus, and when people encroach upon this environment into some of forest, into the rainforest, into the woods, into the jungles, into those areas they come into more frequent contact with animals that are actually infected, and that kind of encroachment on the environment could possibly theoretically play a role in what appears to be perhaps a more frequent outbreak.
CURWOOD: So Ebola's a zoonotic disease...we have the bird flu, HIV, SARS. It seems like we've been a lot of these lately. What do you think is going on? Why so many diseases coming from animals in recent years?
FAUCI: Well, there are probably a lot of reasons that are complex, and then there are some reasons we own even fully appreciate, but some of the ones, for example, if you take influenza, it's the close proximity of chickens, waterfowl, pigs and people. If you look at the places where they generally originate, in the far east, in China, in those areas where we see many of the flus emerge, not all, but many of them. It's that kind of proximity of animals that serve as the host for these viruses and mankind, and again, it all comes under the big umbrella of the encroachment of mankind, again, upon environmental factors, including animal habitations.
CURWOOD: Let's talk about population. Sub-Saharan Africa is having one of the biggest increases on the planet. A lot of those people are in cities. Something like Ebola in the city...that Sounds like the basis of the script for a horror movie.
FAUCI: Well certainly when you get into the city it makes it much more difficult to contain, to isolate, and even to do contact tracing. One of the best tools for getting one's arms around and controlling and ultimately stamping out an outbreak is to do what we call contact tracing. Getting people who've come into contact with a sick person and may themselves be infected, and then putting them under isolation quarantine so that they will not infect others and if they do get infected you can treat them immediately as opposed to having them walk around in society. When you have a big city and you have an outbreak it becomes much more difficult to do contact tracing thaan if you have a mini outbreak in a small village in a remote area.
CURWOOD: So what are the people doing in countries like Sierra Leona and Libera to cope with this disease?
FAUCI: Well, it's very, very difficult. They're trying both the in-country people themselves as well as help from the outside groups like Médecins Sans Frontières, the WHO, the World Bank, and countries that have a special interest in trying to help out. I mean we are now trying to get hospital beds over there. The CDC has sent experienced medical personnel to help to do contact tracing, resources are going there, so it really needs a concerted global solidarity effort to help those West African countries control and hopefully eliminate this outbreak.
CURWOOD: A series of Liberian musicians - F.A., Soul Fresh, Den G, they recently released a song called "Ebola is real". It's sort of a public service announcement about the disease that's one most popular songs right now in the country. Let's take a listen.
[MUSIC: Various Artists “Ebola Song” (Self Produced)]
CURWOOD: Dr. Fauci, how important are songs like this in raising public awareness in countries like Liberia?
FAUCI: Well, I think anything that can effectively away, arise and fortify public awareness is important. Be it a song, be it a public service announcement, be it leadership of the country getting out, popular figures getting out and talking about it because you want to get away from the myths and the stigmas associated with it because when people get sick, they need to go to a proper healthcare facility, they need to be isolated under the proper conditions, and they need to have the protective equipment of the people to take care of them. When people are misinformed about this and they are gripped by the stigma associated with it, they will not seek the appropriate care, get taken care in their own homes, and when that happens, they spread it to their families, the people who take care of the bodies after people die can also get infected. All of that can be helped in the sense of in a positive way if messages, correct messages of what the dangers on what needs to be done. So be it a song, be it a popular rock group, be it a public service announcement. All of that can help.
CURWOOD: Now, a lot is being made about doctors and community workers being treated for Ebola in the United States. Set the record straight for us. How worried should we be about Ebola coming here to the US?
FAUCI: Well, I would not be surprised if someone gets infected in a West African country, gets on a plane feeling well, and then gets here. It could be New York, Washington, Paris, London, or whatever and actually gets sick with Ebola. I don't think that's a big stretch of the imagination. What won't happen here is the kind of out-of-control outbreak that we're seeing in West Africa. You may have a person infected, and that person might infect someone else before one realizes that you're dealing with Ebola, but once you get the proper healthcare facility, the isolation, the quarantine, the contact tracing, that's what will prevent there being a major outbreak.
CURWOOD: Fill us in on the state of the vaccines and treatment for this disease?
FAUCI: Well, first of all, there is no treatment and no vaccine that is been approved to be safe and effective. There's a lot of work going on right now in trying to develop both therapies and vaccines, and in fact, here at the NIH we have a vaccine and it's one of several candidates - it's not the only one - that is shown to be effective in an animal model, a monkey model, to protecting these animals from lethal challenge with Ebola virus. This will soon go into humans in a phase one trial for safety right here at the NIH. It probably will be starting in a couple of weeks so the research is going on in an accelerated rate, but the bottom line is that this particular time we don't have a vaccine, we don't have treatment. The best way to address the Ebola outbreak is by good public health practices, namely isolation, protective equipment for people who are taking care of individuals, good infection control and quarantine where appropriate.
CURWOOD: So, at the end of the day, what do we need to get a handle on the disease. We need the resources to allow the people in the West African countries to do the proper infection control. They are in the situation now where it's a bit out of control, in fact, quite out of control. They need help, they need supplies, they need equipment, and they need personnel, and that's what hopefully the rest of the world will help them get.
CURWOOD: Dr. Anthony Fauci is an immunologist and director of the National Institute of Allergy and Infectious Diseases. Thanks for taking the time today.
FAUCI: Very good to be with you.
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