An EIS officer in plain clothes called out, “Capacity building.”
“Very good. We are here to identify, treat, and contain this disease, but we’re also here to help the Kenyans develop their own capacity to stop outbreaks. The CDC has poured millions of dollars into Kenya with the hope of developing a disease detection and surveillance system as well as native capability to respond to outbreaks.
“In the battle against pandemics,” Peyton continued, “we have only one hope, and that’s to stop outbreaks where they start. To do that, we need to enable the Kenyans. For those of us in the field, it means training the Kenyan field epidemiologists. In Nairobi, that means giving the staff in the Ministry of Health and their EOC the support and training they need.
“Okay.” Peyton turned back to the board and circled the word Identification. “How do we identify?”
“Lab tests,” a black-haired girl called out.
“Yes. We have a field test for Ebola: the ReEBOV Antigen Rapid Test Kit. ReEBOV will give us a result in about fifteen minutes. Accuracy is 92% for those infected and about 85% for those negative. What else?”
“Symptoms. Disease progression,” a black man in the front row said.
“Correct. If we can establish a consistent pattern of symptoms, we can make a pretty good guess about what we’re dealing with. We’ll be taking patient histories from multiple locations. In Nairobi, your job will be to take all those data points and establish a clear pattern. We’re looking for trends and commonalities. Now—assuming this is Ebola, what are the symptoms?”
Voices across the group called out:
“High fever.”
“Severe headache.”
“Diarrhea.”
“Vomiting.”
“Stomach pain.”
“Fatigue and weakness.”
“Bleeding.”
“Bruising.”
Peyton wrote quickly. “Good. The patients at Mandera presented with most of these symptoms. The physician there also reported seeing a rash. So we may or may not be dealing with Ebola. It may be a completely new filovirus or arenavirus. We know the disease we’re facing is deadly and that it has sickened people in what we believe are two different locations. It takes a human anywhere from two to twenty days to develop Ebola symptoms. On average, infected individuals develop symptoms eight to ten days after contact with the virus. All right. Again, if this is Ebola, how do we treat it?”
“We don’t,” said a white physician in the third row.
“ZMapp,” a redheaded girl said.
“You’re actually both right. There is no FDA-approved treatment for Ebola. There is no vaccine. If a patient breaks with the disease, we simply give them fluids, electrolytes, and treat any secondary infections. In short, the patient is on their own. The hope is that their immune system fights and defeats the virus. About half do; the average Ebola case fatality rate is fifty percent.
“It’s also important to note that there are five known strains of Ebola: Zaire, Ivory Coast, Sudan, Bundibugyo, and Reston. Reston ebolavirus is the only strain that’s airborne. It’s named Reston because it was discovered in Reston, Virginia, only miles from the White House. It is quite possibly the greatest piece of luck in human history that the Reston strain only causes disease in non-human primates. In fact, during the Reston outbreak—which occurred at a primate facility—several researchers were infected. Luckily, all remained asymptomatic. If Ebola Reston had been deadly for humans, there would be a whole lot fewer of us around today. The other four strains of Ebola are among the most deadly pathogens on the planet. Zaire ebolavirus is the worst, killing up to ninety percent of those it infects.
“ZMapp is the only therapy that has proven effective in treating Ebola. It did very well in primate trials. During the West African Ebola outbreak in 2014, we treated seven Americans with ZMapp and an RNA interference drug called TKM-Ebola. Unfortunately, two of those patients died, but five survivors out of seven is still beating the usual odds. We have some ZMapp with us in the cargo hold, but it’s a very small quantity, and I want to stress again that it is not FDA-approved and has had mixed results in humans.
“Can anybody tell me what type of therapy ZMapp is?”
A voice called out, “A monoclonal antibody.”
“Correct. ZMapp is a monoclonal antibody or mab. In fact, it has three mabs. They’re grown in tobacco plants, strangely enough, and they bind the Ebola protein as if they were antibodies made by the patient’s own immune system. So, how might that impact future treatments? Anybody?”
Peyton paused and looked around the group. When no one answered, she continued. “Survivors. Studying the antibodies that survivors produce could offer clues about new therapies and ways to fight the virus. So it’s incredibly important that we document those survivors. In fact, there’s research in progress right now that’s doing just that: studying the immune systems of people who survived a Marburg outbreak years ago. In a worst-case scenario, we could also try using convalescent blood or plasma from survivors to treat critical personnel in Kenya.
“Survivors could also offer clues that would help in the development of a vaccine. In fact, Merck already has trials underway for an Ebola vaccine. Thus far, it appears to be incredibly effective, but we don’t think it offers lifetime immunity. It hasn’t received regulatory approval yet, and it doesn’t protect against every strain of Ebola, so identification will be key here. Nevertheless, if this is Ebola, the Merck vaccine could get fast-track approval and end up saving a lot of lives in uninfected populations.
“Bonus question: can anyone name the other type of therapy in trials to treat Marburg and Ebola?”
Peyton scanned the group. When, once again, no response came, she said, “Small interfering RNA. Shows great promise, but it’s a long way from the market.
“All right, let’s discuss containment. What’s the key?”