[The medical school at Johns Hopkins began a  very helpful symposium on Ebola just as we were completing this post. The symposium, in three parts, was all good, but Part 3 was most interesting [to us]. It featured Dr. Osterholm of the University of Minnesota, who has put out opinion pieces for the New York Times and Politico. He was quite eloquent about what we don’t know about Ebola. Take a look at http://www.c-span.org/video/?322092-3/ebola-epidemic-western-africa-panel-three ]

Uneasy Introduction

The news about Ebola is in from Dallas. The nurse who was infected while treating Mr. Duncan says she followed all the rules. So she shouldn’t be sick? Well, obviously she is, so she must have made a mistake.[1] There can’t be anything wrong with the rules – CDC calls them “protocols” – so the sick person must be at fault. At least, that’s the implication.

On the 14th, CDC announced it will send, within hours, an Ebola Response Team to any hospital in the U.S. that diagnoses a patient with Ebola. The team will be comprised of experts from CDC, and will work with the local physicians, healthcare workers and others concerned with the patient’s treatment. CDC did that in a limited way in Dallas; that’s why it will deploy more robust teams in the future.  Also, CDC has not identified any specific error that led to infection of the Dallas nurse.[2]  Again, if no mistakes were made, were the protocols at fault? After all, the nurse is sick.

Don’t expect an answer to that any time soon. CDC is in the thick of things, attempting to control a fast-moving epidemic with the tools it has. It’s understandable if CDC doesn’t want to spend a lot of time going over past practices. But one thing is for sure: If CDC doesn’t look for defects in its own protocols, it certainly won’t find any.

There are reasons to worry. CDC protocols are based on prior experience with much smaller outbreaks. The virus may be more virulent today, and it may be mutating.  So who’s keeping an independent and scientific eye on these viral shenanigans?  Is CDC supposed to be our guardian in these matters?  “Sed quis custodiet ipsos Custodes?” Then who will watch CDC?[3] Where are the second opinions on these complex matters? Are we missing anything that might help us control this epidemic?

What’s a “Contact”?

There’s a lot of dogma involved in the current battle against Ebola. You can see it in the CDC posters on the subject. One of them tells us that Ebola poses no significant risk to the United States. Really? That’s because we can only get it from: (i) touching the blood or body fluids of a person who is sick with or has died from Ebola; (ii) touching contaminated objects, like needles, or (iii) touching infected animals, their blood or other body fluids or their meat.[4] Another poster says Ebola is not spread through casual contact or “air.[5]

So far, everybody seems to agree that no one should touch the body fluids of Ebola victims, or objects they’ve contaminated, or the meat or body fluids of contaminated animals. Those are definitely effective ways to transmit the Ebola virus. But what does it mean to say the virus will not spread through casual contact? Is it “casual” to shake hands with someone? Does it depend on the setting? Should one shake hands on formal occasions, but not informal ones; or vice versa? What if the other person’s hand is hot and sweaty, because he [or she] is sick with Ebola?

Personally, I will avoid shaking hands with anyone if Ebola is lurking in the environment; but that’s just me. What about this idea that you can’t catch Ebola through air? What does that mean? Suppose somebody takes a towel, soaked in Ebola fluids, and throws it at you. Will the air rise up like a barrier and deflect the towel? Probably not; instead you might get a face full. How about a less extreme example? Suppose somebody with Ebola walks up to you and sneezes in your face? You could get a face full that way as well, or would the air around you blow the Ebola away? Don’t count on it, especially if you’re indoors.

So, what does CDC really mean by this? Well, most likely they’re saying that the Ebola virus can’t be transmitted to humans via extremely fine, i.e., aerosolized particles in the air. We, at Elemental Zoo Two, are not pathologists, or any sort of biological scientists, either; but nevertheless, we think there’s enough evidence on the other side of that question to justify a second look.

Brief Notes on Biological Warfare

This post is not about biological warfare, but it’s worth noting that, back in the bad old days, disease was considered a weapon of war, just like guns and bombs. Disease weapons were temperamental; infect the enemy’s troops with something, and it might well spread to our side as well. So, it’s said, the U.S. generally confined itself to developing armaments that could be countered with antibiotics and vaccines.[6]

The old Soviet Union, however, took the opposite view. The Soviets decided that “the best agents were those for which there was no known cure.”[7] Given that operating assumption, the Soviets [apparently] spent a lot of time attempting to discover new biological agents, or strengthen old ones to defeat the cures and vaccines developed by the medical community.[8] Soviet scientists considered viruses spread by contact to be among the most lethal, and, it’s reported, they weaponized smallpox by suspending it in an aerosol.[9] They also experimented with Marburg, a hemorrhagic fever virus similar to Ebola[10] and numerous other toxins.[11]

This work was not necessarily illegal. Back in 1972 we and the Soviet Union agreed to discontinue work on biological weapons and destroy any existing stockpiles. A number of other nations signed on as well. However, we [and they] retained the right to work on toxins “for prophylactic, protective or other peaceful purposes.”[12]

Of course, this is old news from the Cold War, but there are lessons in it for today. History demonstrates that no weapon is unthinkable to everybody. If the West was fastidious in developing biological weapons, the East was not.  So, for those of you who are concerned about terrorism, probably you should be. There are always people out there willing to think about the unthinkable. What could be more terrifying than a disease that has no cure? Just think of the possibilities.

There’s no evidence today’s Ebola epidemic is the product of terrorists. But what about the next epidemic? The virus is not hidden away in secret laboratories; it’s rampant in West Africa. Any terrorist brave enough to go there can get some and, if he [or she] survives, experiment with it.

Ebola through the Air

All right, where does this leave us with regard to Ebola and aerosols? Well, there’s evidence that the Soviets experimented with Ebola and may have been close to developing an Ebola weapon. [13] Apparently we thought they had.[14] Using aerosols? Probably, but who’s to say at this late date?

More to the point, there was the unfortunate incident in Reston, VA, back in 1989 – 1990.[15]  Research monkeys arrived at the Hazelton Primate Center on October 24, and not long thereafter began to die of a hemorrhagic fever. The monkeys were quarantined, and found to be infected with a simian hemorrhagic fever and a variety of Ebola.[16] Eventually 50 monkeys died and 300 were euthanized to control the epidemic. Luckily, that particular strain of Ebola was not dangerous to humans.

So, if the monkeys were all in separate cages, how did they infect one another? Well, possibly by physical contact or possibly by breathing the same air.[17] Also, humans along the supply chain who transported the monkeys tested positive for Ebola antibodies. And in 1995 U.S. scientists proved that, in the laboratory, the Ebola virus could be aerosolized, and when monkeys breathed that air, they died.[18]

Back in 2009 CDC was a bit less dogmatic than today about how Ebola could be transmitted.[19] It admitted, for example, that “[A]ll Ebola virus species have displayed the ability to be spread through airborne particles (aerosols) under research conditions[;] this type of spread has not been documented among humans in a real-world setting, such as a hospital or household.”[20] Today, of course, it says categorically that people can’t get Ebola through the air. No qualifications, no explanations. No further research needed.

Strictly speaking, none of this history proves that the Ebola now killing humans in West Africa also transmits by aerosols.[21] But it doesn’t disprove that, either. In fact, some commentators say if the virus transmits that way, perhaps humans are immune to it in that form.[22] Others are concerned, fearing that there is no such immunity[23], or if there is, it may disappear as the virus mutates and/or evolves.[24] All in all, none of these are very nice prospects.[25]

We’re not professional scientists here at Elemental Zoo Two, but we do know something about the scientific method. Scientists are supposed to let reality speak for itself, not attempt to cram it into pre-existing dogma.[26] As Karl Popper said, “On the pre-scientific level we hate the very idea that we may be mistaken. So we cling dogmatically to our conjectures, as long as possible. On the scientific level, we systematically search for our mistakes….”[27] So, our modest proposal here at Elemental Zoo Two, is that our Government should re-explore the whole issue of how, and under what circumstances, Ebola might travel through the air or by other, unexpected means.

CDC has plenty to do with the epidemic we have, so probably this assignment – call it pure science, if you will – should go to a different agency. Perhaps to DoD, which has some experience in this area, or perhaps to DHS? The purpose, of course, is to get an independent view of the science in play, not simply a reaffirmation of old beliefs.

Anyway, that’s our suggestion.

[1] See Slate, Politi, Dallas Hospital Worker Contracts Ebola Despite Wearing Full Protective Gear (October 12, 2014), http://www.slate.com/blogs/the_slatest/2014/10/12/dallas_hospital_worker_contracts_ebola_despite_wearing_full_protective_gear.html?wpsrc=slatest_newsletter&sid=5388f4dddd52b8e411012c54

[2] If  you want to see the video of the announcement, you can get it at http://www.c-span.org/video/?322111-1/cdc-briefing-ebola-us-west-africa

[3] The Latin is from Juvenal, a Roman satirist of the 1st and 2nd Century. The translation is loosely adapted from one in the Oxford Dictionary of Quotations (6th Edition) (Oxford, 2004) (Henceforth, ODQ at __) at Juvenal, p. 439, n. 22, & p. 440.

[4] See CDC, Facts About Ebola in the U.S. Infographic (October 12, 2014), available at http://www.cdc.gov/vhf/ebola/pdf/infographic.pdf

[5] See CDC, Facts about Ebola (October 12, 2014) available at http://www.cdc.gov/vhf/ebola/pdf/facts-about-ebola.pdf

[6] See Alibek, Biohazard, The Chilling True Story of the Largest Covert Biological Weapons Program in the World – Told from Inside by the Man Who Ran It (Random House, 1999) at 18:”At the height of the U.S. offensive biological weapons program, American scientists restricted themselves to developing armaments that could be countered by antibiotics or vaccines …” (Henceforth this book will be cited as Biohazard at __) This book is a first person account of events in the Soviet Union.  It’s not clear to what extent Dr. Alibek’s statements have been corroborated by the U.S. intelligence.  However, he was a KGB Colonel, in charge of a good part of the Soviet Union’s biological warfare program, and defected to the U.S. in 1992.  You can find him in Wikipedia at http://en.wikipedia.org/wiki/Ken_Alibek

[7] Id.

[8] See Biohazard at 18: “Every time a new treatment or vaccine came to light somewhere, we were back in our labs, trying to figure out how to overcome its effects.”

[9] See Biohazard at Chapter 9, Smallpox, especially p. 114 – 115.

[10] See Biohazard at Chapter 10, Vector.

[11] See Biohazard at p. 202 -203, describing a visit by Western dignitaries and what they did not see: In the upper levels were floors dedicated to work on smallpox, Ebola, Machupo, Marburg, Junin, and other hemorrhagic fevers, as well as VEE, Russian spring and summer encephalitis…” etc.

[12] See Convention on the Prohibition of the Development, Production and Stockpiling of Bacteriological

(Biological) and Toxin Weapons and on Their Destruction (signed, 1972, effective 1975), available at http://www.opbw.org/convention/conv.html  Article I says: “Each State Party to this Convention undertakes never in any circumstances to develop, produce, stockpile or otherwise acquire or retain:  (1) Microbial or other biological agents, or toxins whatever their origin or method of production, of types and in quantities that have no justification for prophylactic, protective or other peaceful purposes;   (2) Weapons, equipment or means of delivery designed to use such agents or toxins for hostile purposes or in armed conflict.”

[13] See Biohazard at p.133: “…by the end of 1990, the long-term problem of cultivation had been solved and we were close to developing a new Ebola weapon.”

[14] War Games held in Honolulu tested U.S. defenses against a hypothetical attack using weaponized Ebola. See Garrett, The Coming Plague (Farrar, Strauss, 1994) at Ch. 17, Searching for Solutions. Apparently we weren’t ready. Henceforth, this book will be cited as The Coming Plague at __.

[15] You can find a good discussion of this in The Coming Plague at p. 598 – 601.

[16] See The Coming Plague at 598: “Inside [the facilities] panic reigned. Every sniffle, headache or fever that struck the personnel was taken as a sign of a possible spread from the monkeys to humans.”

[17] Garrett doesn’t say, specifically.

[18] See International Journal of Experimental Pathology, Johnson et al., Lethal experimental infections of rhesus monkeys by aerosolized Ebola virus (1995), available at http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1997182/pdf/ijexpath00004-0007.pdf

[19] See HHS, CDC, National Center for Emerging Zoonotic Infectious Diseases, Ebola Hemorrhagic Fever Information Packet (2009). The document is available as a pdf download from HHS. You can find it at http://www.cdc.gov/vhf/ebola/pdf/fact-sheet.pdf . (Henceforth we’ll cite it as Information Packet at __.) There are, of course, later versions.

[20] See Information Packet at p. 2 of 12.

[21] See, e.g., Public Health Agency of Canada, EBOLAVIRUS: PATHOGEN SAFETY DATA SHEET – INFECTIOUS SUBSTANCES, available at http://www.phac-aspc.gc.ca/lab-bio/res/psds-ftss/ebola-eng.php

[22] See Virology Blog, Racaniello, Transmission of Ebola virus (September 24, 2014), available at http://www.virology.ws/2014/09/27/transmission-of-ebola-virus/

[23] See Los Angeles Times, Willman, Some Ebola experts worry virus may spread more easily than assumed (October 7, 2014), available at http://www.latimes.com/nation/la-na-ebola-questions-20141007-story.html#page=1

[24] See the guardian/ The Observer, von Bredow, et al., ‘In 1976 I discovered Ebola – now I fear an unimaginable tragedy’ (October 4, 2014), available at  http://www.theguardian.com/world/2014/oct/04/ebola-zaire-peter-piot-outbreak

[25] See also The New York Times, Op-Ed, Osterholm, What We’re Afraid to Say About Ebola (September 11, 2014) available at http://www.nytimes.com/2014/09/12/opinion/what-were-afraid-to-say-about-ebola.html?_r=0

[26] It says so in Wikipedia. Go to the Wikipedia website and search “Scientific Method,” or simply click here: http://en.wikipedia.org/wiki/Scientific_method

[27] See ODQ at Karl Popper, p. 607, n. 6.