Once again the World Health Organization is seriously under-funded as it strives to fight against the worst outbreak of Ebola Virus Disease in the history of the planet, one which threatens to develop into a nightmare scenario in West Africa before Christmas, and one which could become a global catastrophe. Time to pull together.
Once again in a world which spends one point seven trillion USD on weapons to murder people, we see the World Health Organization (WHO) seriously under-funded as it struggles to control the worst Ebola Virus Disease (EVD) in history. However this is not the time for political in-fighting: it is a serious global threat which could easily turn into a catastrophe, especially if the virus attains sustained infection rates outside West Africa - imagine this disease in South-East Asia, or crowded cities in Latin America. Or anywhere else.
Worst outbreak in history
This outbreak of EVD has a mortality rate of around 50 per cent. 4,447 people (including 236 healthcare workers) out of the 8,914 infected, have died and the WHO predicts the number will rise to over 9,000 by the end of the week, and potentially could reach 10,000 new infections weekly by the end of the year, the infection rate being 1.7, meaning each infected person infects 1.7 others. Beginning in the Republic of Guinea, West Africa, in February, the outbreak has since spread to neighboring countries Liberia, Sierra Leone and Senegal, and also to Nigeria, there have been human-to-human transmission cases in Spain (1) and the USA (2) and other cases treated in Germany (5 successfully, one death), France (1), Norway (1) and the UK (1 case). There is now a suspected case in Poland, in the city of Lodz. There are currently 6 cases in quarantine in Spain, awaiting confirmation and one in France.
The potential to spread is massive, especially because of the lackadaisical attitude of Institutions across the globe and even healthcare facilities in some cases, for instance the Texas Health Presbyterian Hospital, where Patient Zero, Thomas Eric Duncan, had reported ill after travelling from Liberia, and was sent home with a prescription for antibiotics, being diagnosed with a "low-grade common viral disease". Two of the nurses who treated him after he was finally re-admitted, Nina Pham and Amber Vinson, contracted the disease -Union officials allegedly claimed they were dealing with the patient in a terminal phase either with inadequate equipment or were not clearly informed about which protective gear to use.
It has been reported that nurses treating the patient were given the option to use the N95 masks, but some were told full protective gear was not necessary.
In Vinson's case, the hospital isolated her within two hours of reporting the virus. However, before this she had informed the Center for Disease Control about having a temperature and that she had treated a patient with EVD before taking her Frontier Airlines flight to Ohio, and was not prevented from doing so. The fact that she already showed symptoms means she was infectious and some of the 132 passengers on board that aircraft are at risk of infection.
One would expect higher control procedures at such a time, especially from healthcare professionals. Yet the situation is no different elsewhere: how many public Institutions (education ministries, health ministries, hospitals, clinics) have issued protocol procedures beyond a hastily-written flyer copying and pasting data from the WHO website?
Need for clear and concise information
It is this void in clear and concise information that gives rise to scare stories and panic attacks, apparently responsible for the lion's share of the expenses in such outbreaks. In just a week we have witnessed the Turkish Airlines' emergency landing in Rome because of two Bangladeshi passengers with temperatures, the five patients with flu-like symptoms evacuated from an Emirates aircraft at Boston Airport, the Nigerian passenger pulled off the aircraft in Madrid, the scare with the 132 passengers on the Frontier Airlines. This, the same week in which a more serious story came from the Middle East with the hospitalization of a patient in the United Arab Emirates and the news that EVD is spreading to new areas in the Republic of Guinea, Liberia and Sierra Leone.
While as yet there are claims that effective treatment does not exist, there is the experimental drug Brincidofovir, administered to Thomas Eric Duncan unsuccessfully, there is the plasma treatment in which a patient receives a transfusion from an EVD survivor with the same blood type (as was the case of Nina Pham receiving plasma from Dr. Kent Brantly, one of the first two American citizens infected), and there is Z-Mapp, which was successfully administered to these two patients, Dr. Brantly and aid worker Nancy Writebol.
What is ZMapp?
ZMapp is a treatment composed of the use of cultures of cells which make monoclonal antibodies, mAbs. The experimentation began with MB-003, a cocktail of three human/human-mouse mAbs, namely c13C6, h13F6 and c6D8, which showed promising results when administered to rhesus monkeys infected with EVD. The process evolved to the creation of ZMab, a cocktail of three mouse mAbs, namely m1H3, m2G4 and m4G7. These also proved very promising in trials on Ebola-infected macaque monkeys. ZMapp humanized the three ZMab antibodies and tested these with combinations of MB-003 first in guinea pigs and then in monkeys. The best and most successful therapeutic combinations were the c13C6 from MB-003 and the humanized mAbs c2G4 and c4G7, from ZMab, and the result is what is known today as ZMapp.
Contagion and symptoms
EVD is not yet an airborne virus like the Influenza viruses, although it is transmitted by contact with bodily fluids, such as blood, faeces and vomit, milk, urine and semen, possibly also saliva and tears, more especially in the later stages of the illness, and from sweat, studies are inconclusive, according to the WHO. However, the information is unclear because the same source, the WHO, states that EVD can be caught from touching contaminated surfaces. Some say that the virus then needs to be passed to mucous membrane through touching the mouth, nose or eyes, others say it can be transmitted through lesions in the skin, while others state that it can be absorbed directly through the skin, in which case it is enough to touch an infected and contagious person.
Contagion occurs when a patient is infectious, in other words displaying the first symptoms, which is a sudden high fever, extreme fatigue, headache, sore throat, body pain and lack of appetite. This develops into nausea, then diarrhea and vomiting. As the virus takes hold and destroys the blood vessels, the central nervous system takes control from the digestive system and tells the body to expel as much fluid as it can through violent and sustained, copious projectile vomiting and diarrhea, which in the terminal stage can include blood. The patient becomes a human volcano of bodily fluids and torrents of blood.
It is for this reason that the healthcare workers need to use full protective gear at all times, while treating the patient and when cleaning a room after a patient has been accommodated in it, and to follow the protocols for removal of the gear strictly, not touching the face with infected gloves.
The Russian Federation has been present fighting this pandemic at all levels. President Vladimir Putin has met the WHO Director-General Margaret Chan and has pledged full support. A medical team of Russian virologists, epidemiologists and bacteriologists is in the field in the Republic of Guinea, to date 19 million USD has been provided, alongside humanitarian aid. Russia is ready to send large numbers of doses of the anti-viral drug Triazavirin, which is effective in 70 to 90% of cases of infections with 15 strains of Influenza, including A H1N1 (Swine Flu) and H5N1 (Avian flu), at any stage of the infection.
Russia is also working on a vaccine and is ready to begin trials on primates. After this the human trials will begin and it may be ready for massive operations by Summer 2015.
A collective lesson: Pulling together
The history of the last week, which has seen success stories in Nigeria and Senegal (where EVD contagion appears to have been halted), but which has also seen social and political and economic disruption appearing in the areas where the infection is concentrated, is a history of heroic efforts by healthcare volunteers from around the globe fighting desperately, but together, against a common foe.
While there is no room for complacency, by pulling together and fighting side by side, the international community can beat this serious threat. Perhaps Ebola Virus Disease has taught us all a lesson.