Ebola Epidemic: A Few Modern Heroes

From the NYTimes, Dr. Mosoka Fallah:

… Months into the Ebola outbreak, Liberia remains desperately short on everything needed to halt the rise in deaths and infections — burial teams for the dead, ambulances for the sick, treatment centers for patients, gloves for doctors and nurses. But it is perhaps shortest on something intangible: the trust needed to stop the disease from spreading.

Dr. Fallah, an epidemiologist and immunologist who grew up in Monrovia’s poorest neighborhoods before studying at Harvard, has been crisscrossing the capital in a race to repair that rift. Neighborhood by neighborhood, block by block, shack by shack, he is battling the disease across this crowded capital, seeking the cooperation of residents who are deeply distrustful of the government and its faltering response to the deadliest Ebola epidemic ever recorded.

“If people don’t trust you, they can hide a body, and you’ll never know,” Dr. Fallah said. “And Ebola will keep spreading. They’ve got to trust you, but we don’t have the luxury of time.”

With his experience straddling vastly different worlds, Dr. Fallah acts as a rare bridge: between community leaders and the Health Ministry, where he is an unpaid adviser; between the government and international organizations, which have the money to back his efforts…

When Dr. Fallah was 10 years old, his father lost his job as a driver for an American mining company, so the family moved to Monrovia. The family lived in West Point for two years and then moved to a squatter’s area called Chicken Soup Factory, where his parents eventually built a house. His mother still lives in it.

During Liberia’s civil war, he spent 11 years completing his college studies at the University of Liberia, and worked for Doctors Without Borders. A friend’s support led to graduate studies in the United States, where he earned a doctorate in microbiology and immunology at the University of Kentucky in 2011 and a master’s degree in public health at Harvard in 2012.

On an afternoon of heavy rain, Dr. Fallah drove out to two neighborhoods where local residents had begun organizing Ebola awareness campaigns on their own. In the face of the hysteria gripping the capital, they were joining forces and fighting back…

From the Washington Post, Joseph Fair:

Joseph Fair hunts viruses. That’s his thing. The 37-year-old American loves chasing dangerous pathogens, studying them in secure labs or searching for them in jungles where the microbes lurk.

And one virus has always loomed as the big one — Ebola. The scientists who first chased this dreaded microbe back in the ’80s and ’90s became legends, inspiring a generation of virologists like Fair. He read their books and papers. He studied how they contained the pathogen’s spread. And the scientists always won. The outbreaks ended, Ebola driven away.

So when the call came in March to travel to Sierra Leone, Fair was excited. He loved Mama Salone, as locals know the nation. He’d worked here for years. His new job: to advise Sierra Leone’s government on a tiny Ebola outbreak in neighboring Guinea, at the behest of the U.S. Defense Department. He set up an Ebola emergency operations center. He trained medical staff. He drew up just-in-case plans. By mid-May, the outbreak seemed on its way out. Fair packed his bags and left.

Then Ebola exploded…

“This is the big one no one expected,” Fair says.

It has been a humbling time. Fair has worked seven days a week, hunting for ways to curb the outbreak, at times begging international groups for staff and supplies. He is exhausted. He’s put on 15 pounds. He sent his girlfriend home to California months ago. Too dangerous here, he told her. He’s seen Sierra Leonean doctors and nurses — friends he’s known for years — get infected and die. He sweated out his own Ebola scare.

“As bad as it has been,” observes Connie Schmaljohn, senior research scientist at the Army’s Medical Research Institute of Infectious Diseases, “it could’ve been worse if people like Joseph hadn’t been there.”…

In the Telegraph, Thelma Kane, Dr. J. Soka Moses, and their colleagues:

… “We cannot cope, the demand is huge,” says Dr J Soka Moses, 34, the hospital’s clinical director, who opened the facility a month ago in what used to be a cholera treatment centre. He points through a gauze-covered window to the “high risk” area, where feverish, vomiting patients occupy both the beds and the floor in between. “This place was constructed for 35 beds, but I have 69 patients, so half of them are on the floor,” he says. “There isn’t even adequate space for us to walk between them. But if we turn them back into the community, they will infect other people.”

On busy days, that still happens — just as it does at the handful of other Ebola treatment clinics across Liberia, which has seen 40 per cent of the 2,200 Ebola deaths across West Africa. At the Médecins Sans Frontières clinic, on the other side of the capital, Monrovia, staff were last week turning away 20 to 30 people a day. Doing so seldom goes down well, as Dr Moses has witnessed. Last weekend, relatives of a man who died while waiting for treatment outside JFK hurled rocks at staff when they came out to spray disinfectant on his corpse…

The risk for medical workers, however, is not just from angry mobs. Last Wednesday, a French volunteer working at MSF’s clinic in Monrovia tested positive for Ebola, the first time any international staff member in the agency has caught the virus. It is proof that even stringent precautions cannot eliminate the risk. And it is that scenario that goes through the minds of Dr Moses and his team as they don multiple layers of boiler suits, aprons and overtrousers, with four separate pairs of gloves. Simply robing up takes 20 minutes.

“So far none our staff have been infected, although we have occasionally had patients develop neurological symptoms and become combative, requiring sedation,” says Dr Moses, whose fondness for medical terminology does not convey how frightening such incidents must be. “It is very dangerous, it is scary,” he concedes. “But if I don’t do it, who else will?”

While Dr Moses’s work has a personal cost — as a high risk worker, he is not allowed to cuddle his two children — he is proud of his ward’s record. Its 43 per cent mortality rate sounds grim by normal standards, but it is much better than the 70-90 per cent rates at the start of the outbreak. While treatment consists of keeping patients fed and hydrated in the hope that they fight the virus, survival rates have improved because more people are coming forward earlier.

By the time Dr Moses’s midmorning rounds are over, however, another five patients and their families are waiting in the rain outside the clinic’s gates. Among them is 15-year-old Faje Kan, who lies convulsing on the ground, mucus streaming down her face. Her elder brother, Kiwai, holds her head and shoulders upright, wearing two carrier bags as makeshift plastic gloves. “She was very sick overnight,” he says. “We got here two hours ago but we could not get in because the place was packed.” …






16 replies
  1. 1
    Omnes Omnibus (the first of his name) says:

    Jesus. Something long about Ebola around midnight EST. Expecting to be bigfooted again?

  2. 2
    Tommy says:

    I want to be careful because there is a lot here. I recall after the outbreak was only a few weeks old. Video of them burying people and I thought it was maybe one of the most horrifying things I’d seen in a decade plus. Maybe my life. Not only can’t they treat people they can’t even bury them.

  3. 3
    ruemara says:

    I was watching ill men & a boy on CNN. I wanted to catch a plane out at first light to go help. It’s heartwrenching.

  4. 4
    Elie says:

    As from above:

    The risk for medical workers, however, is not just from angry mobs. Last Wednesday, a French volunteer working at MSF’s clinic in Monrovia tested positive for Ebola, the first time any international staff member in the agency has caught the virus. It is proof that even stringent precautions cannot eliminate the risk. And it is that scenario that goes through the minds of Dr Moses and his team as they don multiple layers of boiler suits, aprons and overtrousers, with four separate pairs of gloves. Simply robing up takes 20 minutes.

    “So far none our staff have been infected, although we have occasionally had patients develop neurological symptoms and become combative, requiring sedation,” says Dr Moses, whose fondness for medical terminology does not convey how frightening such incidents must be. “It is very dangerous, it is scary,” he concedes. “But if I don’t do it, who else will?”

    Blessed are the care givers. They are God’s presence and deserve our prayers and the very highest respect — Heroes….

    We can drown this plague with enough people and caring… we can put out this flame but the call is still weak and uncertain… I think about it every day

  5. 5
    Anne Laurie says:

    @Omnes Omnibus (the first of his name): Nine p.m, Pacific time. People on the East Coast will read it in the morning.

  6. 6
    Elie says:

    @Tommy:

    ..and the people dying in the streets unattended — rolling in misery — dilerious with fever… No room in the hospitals. One young man’s mother sat with her head in her hands… children lying spread out — not in someone’s arms..

    We are looking at the end of humanity in a way that war and massacres can’t capture…

  7. 7
    Omnes Omnibus (the first of his name) says:

    @Anne Laurie: Aw, crap…. You know quite well that your midnight-ish posts are the last things many people will see.

    Let’s not all play dumb.

  8. 8
    Mnemosyne says:

    As I said in the thread below, I think there probably are quite a few people who would be willing to go and volunteer, but there doesn’t seem to be any agency willing to coordinate that. The CDC probably has teams standing by, but nobody knows who’s supposed to be in charge of securing the situation on the ground. AFAIK, the UN doesn’t have any power to declare a state of emergency — the governments involved would have to ask for outside assistance and many of them are reluctant to do so.

  9. 9
    Mnemosyne says:

    @ruemara:

    Also, take a look below — there is a link to a specific job that caught my eye when I was looking at the site earlier today.

  10. 10
    JordanRules says:

    Whoa. Those stories gave me a serious double shot of despair and hope.

    Respect to the care givers. Wow.

  11. 11
    RaflW says:

    I made a substantial donation to Doctors Without Borders and will continue to do so monthly as long as they keep working this crisis. They have been some of the strongest providers of care, hope and sanity in this outbreak. I cannot fathom their courage, but I honor it all the more.

  12. 12
    Felanius Kootea says:

    Thanks for the posts on Ebola, Anne Laurie. I’m reposting this from a previous thread:

    I found a Journal of Infectious Diseases paper from 1999 through PubMed titled “Treatment of Ebola Hemorrhagic Fever with Blood Transfusions from Convalescent Patients.” The outbreak was in the DRC in the 1990s and relatively small compared to this one, but the use of transfused blood with Ebola antibodies but no active Ebola showed promise.

  13. 13
    Felanius Kootea says:

    And there’s also this Science tribute to heroes now deceased from your earlier Slate link:
    Ebola’s heavy toll on study authors. Sierra Leone lost its foremost experts on Lassa hemorrhagic fever to Ebola (they ran the country’s main Lassa isolation ward) and it’s not like Lassa fever isn’t going to pop up again.

  14. 14
    Julia Grey says:

    @Felanius Kootea:

    the use of transfused blood with Ebola antibodies but no active Ebola showed promise.

    There are many problems associated with that treatment modality, especially, I’m sorry to say, in Africa. The HIV virus, which is rampant in some areas of the continent, may be able to hide even in plasma (which ordinarily comes from multiple donors), and the whole blood of cured people is even more dangerous in that things like malaria and other tropical diseases can be transmitted that way.

    It is true that the antibodies these people develop will probably be useful in developing a vaccine, but in terms of treating active illness, it is very difficult to assemble ENOUGH antibodies to be useful without multiple donors, and it is then very difficult to ensure that all the donors are clear of all the other potential threats.

  15. 15
    Felanius Kootea says:

    @Julia Grey: Here’s the paper’s abstract:

    Between 6 and 22 June 1995, 8 patients in Kikwit, Democratic Republic of the Congo, who met the case definition used in Kikwit for Ebola (EBO) hemorrhagic fever, were transfused with blood donated by 5 convalescent patients. The donated blood contained IgG EBO antibodies but no EBO antigen. EBO antigens were detected in all the transfusion recipients just before transfusion. The 8 transfused patients had clinical symptoms similar to those of other EBO patients seen during the epidemic. All were seriously ill with severe asthenia, 4 presented with hemorrhagic manifestations, and 2 became comatose as their disease progressed. Only 1 transfused patient (12.5%) died; this number is significantly lower than the overall case fatality rate (80%) for the EBO epidemic in Kikwit and than the rates for other EBO epidemics. The reason for this low fatality rate remains to be explained. The transfused patients did receive better care than those in the initial phase of the epidemic. Plans should be made to prepare for a more thorough evaluation of passive immune therapy during a new EBO outbreak.

    They screened the blood for HIV and hepatitis B but don’t mention malaria, Hep C, etc. I think it might be a tempting approach for countries that can’t afford to wait for western donors to come up with a solution.

  16. 16

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