Re: This Ebola epidemic -

You're right, of course. I know, I'm supposed to be an objective molecular/structural biologist and dispassionate biochemist who's study (at the time they called it a "landmark study" FWIW of bacterial and specifically pathogenic helicases was to be the foundation for and would pave the way for whole new classes of antibiotics (the idea was that bacteria use a different process to turn RNA into proteins - it's fundamentally the same but as they say "the devil's in the details" - than we do, so if we could discover the way that bacteria, trypanosomes (like malaria or sleeping sickness) and viruses unwind RNA prior to sticking it onto the ribosome where it would be turned into protein - which is completely different than what we do , basically they use a stripped down and faster version of those proteins to get the job done - and figure out which atoms bind to what and compare this binding among a whole bunch of the same protein from a bunch of different bacteria, trypanosomes, and viruses then we could figure out which parts of those unwinding proteins, called helicases, are critical for the things to operate and design a drug, e.g. a small molecule, to bind at that site and gum up the works. Since we use a different process then such a molecule wouldn't or shouldn't affect us - theoretically. This was how I wound up working with Ebola - along with polio, HIV, herpes simplex virus, and some other pathogenic viruses like the SARS virus along with yersinia - Bubonic Plague - anthrax, tulerimia, and a bunch of other bacteria, along with trypanosomes such as malaria, or P.falciparum.

Anyhoo, yes, as a dispassionate and removed scientist I'm supposed to say we've got this under control and all will be right with the world. However, knowing what I know about these things - and Ebola in particular - I can't. Like I wrote above, we got extremely lucky with SARS.

However, Ebola is a horse of a different color. First, since this virus was first discovered - at least by western medicine anyway - back in 1976 it has only shown up eight other times, and, with the exception of one really weird case in Reston, Virginia (this was perhaps the strangest filovirus outbreak ever. In 1989, a group of monkeys ,from the Congo Basin was imported to an animal quarantine facility in Reston, Virginia, where, according to standard quarantine protocol, they were kept in isolated styrene cages completely isolated from each other except for food/water and breathing holes. Over the course of a couple months the monkeys became sick with Ebola-like symptoms. The disease began killing them off and then animals in nearby cages became sick and died of hemorrhagic fever. When investigators began searching for the causative agent, USAMRIID technicians were shocked to find "worms" - Ebola Virus as it's colloquially known - within sight of the US Capitol building! Working at night in sweltering conditions - clearly this virus had to have become airborne as there was no other way for the disease to have been passed from one monkey to another other than through the air OR through a contaminated food or water source, BUT if it were the latter ALL of the monkeys would've gotten sick simultaneously rather than what they were seeing which was that the disease was radiating outward from the original sick monkeys to infect nearby monkeys - and therefore they had to shut off the air conditioning unit and all the fans in the building - which, in an animal holding facility in mid-August in the DC area made for a very hot and stinky work environment! However, very carefully and quietly and working at night, the technicians managed to wrangle up, remove, and sacrifice all the animals in the building, sterilize the building thoroughly with bleach, literally take the building apart brick-by-brick, sterilized all of it in an industrial kiln before dumping each piece of the building into a series of 50 gallon drums filled with concrete made by using bleach instead of water and dumped the drums in an old mine shaft they subsequently filled with more of the bleach-concrete mixture and sealed with three feet of rubber and another two feet of steel before dumping another 10 feet of regular concrete over the top and finally closed it off with a foot of top soil and planted a grove of poison oak and poison ivy ground cover. This they figured would keep anything from getting out. At the time they only had four other encounters with Ebola and knew only that it killed up to 90% of it's victims and that this particular strain was airborne and wiped out an entire monkey holding facility within two months - it turned out that every monkey in the place had Ebola and none of them survived. Also, this facility was in the nation's capital so when the Secret Service for Bush 41 heard that this bug could be crawling across the White House Lawn... Also, they completely isolated everybody working at the facility, their families, and anybody they'd chanced to contact plus two technicians who were scratched and bitten by an infected monkey in what's called "the slammer." This is a fully contained BL4 hospital ward where any medical procedure can be completed in by those people with the blue suits and nobody is let out for at least 42 days and 2 blood tests that are negative for Ebola. After all was said and done, here's the really ironic part: this particular strain of Ebola, even though it's 95% identical to Ebola-Zaire - the most deadly strain of Ebola - was asymptomatic in humans. While most of the people they had isolated DID ultimately develop Ebola antibodies - and when I checked last week a buddy of mine at USAMRIID was taking blood samples from the people involved in the '89 outbreak to see if they still had those antibodies for use combatting the current outbreak - none of the humans under observation got so much as a head cold: actually, one person did actually get a cold, if memory serves, but in that case, the guy actually had a cold. So, yes, Ebola-Reston is a strain - the ONLY strain - of filovirus that humans are immune to.) and each time it's shown up has been in some rural backwater in the Congo Basin or in Central Africa. The people living in those places have been living with this disease for thousands of years and know how to quarantine themselves and keep their villages safe from infection - they actually quarantine the infected village, posting guards and cutting the infected village off from the rest of society for a period of two moons, which is actually a very accurate barometer as the incubation rate for Ebola is up to 21 days and the CDC will only certify an area Ebola free and the outbreak over IF there are no new cases over a period of 42 days straight - and the locals figured this out all by themselves by living with it for the last few millennia. Sometimes those witch-doctors actually DO know as much or even MORE when it comes to dealing with a disease like Ebola than the guys in the blue space suit full body condoms over at the Red Cross tent.

However, second, this particular outbreak didn't occur in the Congo Basin or in Central Africa where the locals have been living with and have adapted their lives to these kinds of diseases. This outbreak, by contrast, occurred in one of the only other parts of Africa safe enough for communal activities - like irrigation. This means that unlike those Congolese Witchdoctors who've been dealing with these kinds of diseases since humans first moved into the Congo basin, which was roughly just after humans became human - around 70,000 years ago - the people in West Africa lived close enough and were communal enough to have been capable of irrigation and domestication (at least some domestication of local flora like cassava, sorghum, yams, and soy beans if memory serves). This means that unlike the Congo Basin, the peoples of West Africa don't have any aspects of their culture that would enable them to effectively isolate infected groups to save the rest of the population - like exists in the Congo Basin.

Third, if you're still with me, is that because it doesn't happen very often and because when it does, it, until now, has only happened to very poor people who've learned through the millennia how to deal with it, there just aren't that many people - and no real biotech interest - in researching this bug. That ZMapp stuff is just a fortuitous happenstance. There were looking for a new way to potentially make a vaccine for, ultimately, herpes or HIV - or at least find a way to shut those diseases off like a faucet. It was just blind luck that they were using Ebola coat proteins - actually there's only one but there are another three on the bug's surface, which is probably why it was chosen to work with.

Mapp biotech is, I believe, making a synthetic version of what they already use. The current treatment is to take a liter of blood from an infected person who survived, spin out the blood cells, and inject the plasma - which contains a whole lot of anti-Ebola antibodies - and hope that the patient's immune system isn't too far gone to respond (one of the first things Ebola does is shutdown the body's own immune system through some not-very-well understood method - there are only a couple dozen people working on Ebola full time, so the knowledge we have isn't very good nor is there a lot of it.). ZMapp is the same as above except they purify the antibodies and are injecting just those antibodies into people - largely to avoid the obvious problems associated with injecting people with straight plasma in a part of the world where up to 1/4 of the people have the HIV virus circulating through their system (or malaria or whatever). The plasma they gave to Nancy Writbol came from a 14-year old kid - that's about as close as they could come to an HIV test under the circumstances.

Finally, Ebola is an RNA virus. This is good AND bad. On the positive side, it's a very fragile thing which can't survive outside the host very long. On the minus side, so was polio - and that did plenty of damage (polio is ALSO an RNA virus - a very, very small one, but it's an RNA virus. Also, like polio and every other RNA virus, it sucks at reproducing itself. The enzyme responsible for reproducing the RNA is very mutation prone - like polio or HIV. However, unlike polio, which we created a vaccine for by clipping out a couple of key parts and having it reproduce in the cells lining the intestines - so that while those cells are wracked by polio infection, they also naturally slough off before the virus is able to infect more cells - infecting a person with an attenuated Ebola virus will kill them, so that's off the table. However, given a couple decades we could design a drug to gum up the reproductive enzyme of Ebola.


Long story short, if anybody gave a damn over the intervening 40 years, we could've developed a slew of drugs to counter this epidemic. As is, we don't really have anything!

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