Some ten years ago, a vaccine that produced 100 percent protection against Ebola virus infection in monkeys was produced and patented by the Canadian government. The vaccine was produced by the Canadian Public Health Agency, and between 800 and 1,000 vials were manufactured. It was created by removing a gene from the vesicular stomatitis virus (which infects cattle and rarely, people) and inserting an Ebola surface protein gene. This protein stimulated effective immunity in monkeys. Safety tests of this vaccine have recently begun in humans.
The development of a vaccine may cost only a few million dollars, but bringing a human vaccine to market can cost up to 1.5 billion dollars. Until recently, there was simply no market for this vaccine that could afford to pay for it.
If this vaccine works out as well as expected, it will make it possible to stop Ebola in West Africa.
A vaccine would provide powerful protection to health workers exposed to the virus; so far, more than 400 workers have fallen ill, and 233 have died.
Specialists at Emory University have learned that the virus is present on patient’s skin after symptoms have developed, making contact with sick patients even more dangerous. The virus can survive for several hours on dry surfaces and several days in pools of fluid. It is readily killed with bleach.
Symptoms of Ebola initially match those of flu: headache, fever, aches and pains, prostration. Onset is usually eight to ten days but up to three weeks after exposure. There is some apprehension because not all patients are reported to develop fever, only about 85 percent. Sometimes a rash appears. Then vomiting and diarrhea follow. In about half the cases, after several days of worsening, bleeding begins, in vomitus, urine, or from the eyes and mouth and under the skin. Bleeding (or rather leakage from deep internal vessels) eventually causes collapse of blood pressure and organ failure.
It is currently thought that bats are the natural reservoir for the Ebola virus, and that gorillas and humans are infected by contact with surfaces contaminated by bat droppings. At first, it was thought that gorillas were the source, but with the current outbreak, the first cases came from a village where bat hunting is popular.
The Dallas, Texas hospital that treated the first Ebola victim in the United States had a full page apology printed in the major local newspapers on Sunday for its errors in diagnosis, treatment, and infection control. They apologized for failing to diagnose his Ebola on his first visit to the emergency room. They additionally apologized for “mistakes” made in the patient’s treatment. They are also responsible for the infections of two of their nurses during the patient’s stay, due to errors in infection control protocol that were ultimately the responsibility of the Centers for Disease Control.
The Ebola case has been a public relations disaster for the hospital, and there has been reduced patient traffic as well.
The National Institutes of Health has changed its procedures for protective clothing: “It became clear that we needed to modify that protocol where no part of the body is exposed…” sad Dr. Anthony Fauci, clinical director of the NIH’s National Institute of Allergy and Infectious Disease. Full-body suits, hoods, goggles, protective aprons, and rubber boots are used by the Doctors Without Borders teams, with a chlorine spray during de-gowning.
The reason for such intensive protection is that patients are constantly contaminating themselves with vomitus and diarrhea, and close contact is frequently required. In this outfit, a person can work only two hours before succumbing to heat exhaustion. In conditions of heat and stress, mistakes are frequent; workers are assigned to monitor one another for breaches in protocol.
These are the monstrous conditions under which a patient suffers from Ebola, with a fifty-fifty chance of succumbing to the disease.
A nurse has publicly come forward about the conditions at the emergency room where the first Ebola virus patient was treated. She described the “gown and glove” procedures and said that she had voiced her concerns to her supervisor at the time. She said she was told to just put tape over any exposed skin.
This is an important issue because unlike other, better behaved, infections, Ebola frequently causes copious discharges of vomitus, feces, and blood. Just cleaning up after an Ebola patient will strain the resources of the average American hospital.
It is clear that the two American nurses who are infected with Ebola were victims of poor infection control practices at the hospital where they work. This is especially obvious after observing the videos provided by the New York Times that show the gowning and un-gowning procedures that are recommended by Doctors Without Borders.
This same situation is also going on in Spain, where some of the nurses who treated a priest who returned from West Africa and died in a Spanish isolation ward showed symptoms and caused widespread anxiety.
Meanwhile, Senegal has quarantined itself and been declared Ebola free; Nigeria is nearly so. The three countries worst affected are Liberia, Guinea, and Sierra Leone. So far, the number of cases has doubled every month.
Sierra Leone is suffering from famine as a secondary result of the epidemic, and the World Food Program has been distributing food.
The World Health Organization, which is nominally responsible for coordinating international responses to contagious diseases, has criticized itself in an internal document for failing to respond so far, saying “Nearly everyone involved in the outbreak response failed to see some fairly plain writing on the wall.”
We hope that the chief epidemiologists at WHO get a second wind and respond more aggressively. Otherwise, things will eventually come to resemble a Steven King novel.