Diatribes of Jay

This is a blog of essays on public policy. It shuns ideology and applies facts, logic and math to economic, social and political problems. It has a subject-matter index, a list of recent posts, and permalinks at the ends of posts. Comments are moderated and may take time to appear. Note: Profile updated 4/7/12

21 October 2014

How Not to Beat Ebola

What a relief! The twenty-one day quarantine period has passed for all of the late Thomas Eric Duncan’s contacts. We Yanks sure dodged a bullet there!

Let’s congratulate ourselves and break out the champagne! We Yanks are so smart and competent we make ourselves sick. No virus needed.

But wait a minute. I know it’s hard for a nation whose people no longer study geography, but look at a map. An epidemic map.

On that map a large part of Africa reads red (infected) or yellow (about to be). Now consider. An out-of-shape Yank can walk fifteen miles a day. A good African can maybe walk thirty. Multiply that daily progress by twenty-one days—the ebola incubation period—and you get 630 miles.

Now extend the bleeding-red incubation map by 630 miles in all directions, except at sea. (Ebola doesn’t swim, yet.) Then you get most of the “bulge” of West Africa infected. If the infected people ride animals, let alone fossil-fuel vehicles, you begin to affect the rest of Africa, the biggest continent on Earth.

Think that large an epidemic might affect us complacent Yanks, if only indirectly through economic and political turmoil, let alone possibly infected refugees?

If so, maybe we ought to start thinking about all the things we’re apparently not doing to get this epidemic under control.

1. What’s the virus’ ex vivo longevity? You would think that, with an epidemic so serious—and for a disease first discovered almost forty years ago!—somebody would have done an experiment or two to see how long the virus remains active and dangerous outside a host. Yet I can’t find that simple number anywhere.

The CDC’s website has that number [search for “5 days”] for hantavirus, a deadly respiratory virus, endemic but rare in the US, vectored by rodents. It’s five days. (I know because I live near hantavirus country and have had occasional encounters with deer mice, the vector of choice.)

Let’s suppose it’s the same for ebola. (No reason it should be, but let’s just suppose.) Then, when somebody gets sick, you could move everyone out of the residence for a week (just to be safe), to a remote quarantine site. Knowing they won’t get infected from viruses still active on inanimate surfaces, you could move them back into the now-safe residence for another two weeks, the remainder of their quarantine period.

There would be no need for strong disinfectants, people in hazmat suits, or letting those people risk infection themselves, unless someone gets sick. We could have done the same thing with Duncan’s residence, avoiding much of the panic and publicity and sparing poorly-trained cleanup crews from risking their health. Think this strategy might reduce the expense, effort and risk of containing the disease in Africa?

2. ZMapp. As I’ve written before, we have more direct evidence—far more—that ZMapp works than we had that atomic weapons would work when we started the Manhattan Project. As you may recall, that Project, to date, is the single most expensive crash high-technology project in our nation’s history. At one time, it commandeered about 10% of our nation’s total electric power just to run the centrifuges to enrich uranium for explosive fission.

Why, oh why, is there no Manhattan Project to crash-produce ZMapp, which has had 100% success in monkey trials, has proved effective at the cellar level (in petri dishes) and has helped cure two out of three of the first people to survive ebola here at home? (The other got antibodies from the blood of survivors.) Why are the Chinese and Canadians leading this effort, and not we Yanks, who invented monoclonal antibodies?

There’s another funny thing. The antibodies grow in genetically modified tobacco plants. Canada is a bit cold for growing tobacco, except in greenhouses. Where is our Yankee tobacco industry, when it could be saving lives instead of selling addiction, suffering and death? It looks like Chinese are stealing another march on us Yanks.

Could it be that our penchant for putting private profit first, even when war and lives are at stake, is putting us last in the race to fight this horrible disease? Doesn’t this quote from International Business Times tell the whole sordid story: “Due to the limited nature of previous Ebola outbreaks, larger pharmaceutical companies were not developing drugs to treat the virus, which has led to small companies trying to meet the demand”?

If we had run the Manhattan Project this way, we would still have been writing a contract to develop the A-bomb after our troops had spent another year or two slogging their way through Honshu and maiming the Japanese Mainland (and our two people’s relationship forever).

3. The vaccine, safety and effectiveness. Believe it or not, we have a vaccine for ebola. It’s already passed safety tests in small-scale human trials.

It hasn’t passed an effectiveness test yet. But there are several reasons. First, we haven’t yet had enough time to make it in bulk.

Second and more important, it makes no sense to test for effectiveness against a disease as deadly as ebola. You want to expose a control group to ebola without the vaccine just to prove it works, when 70% or so of the control group will die?

The third reason not to test a vaccine in the usual way for effectiveness against ebola is ethics. It’s unethical to condemn people to a 70% chance of death, even with their informed consent, unless there’s no other way to save others.

But there is a way to save others. The way to test a verified-safe vaccine in the midst of an epidemic is to let anyone in harm’s way who wants it have it, as long as supply lasts. Then you see if the vaccine lowers the mortality rate among the vaccinated and mostly likely exposed. (You might have to do some clever statistics to calculate who was exposed.)

For example, ebola’s mortality rate in African now is around 70%. If the vaccine is just 30% effective, it would save 30% of the 70% who otherwise would die, or 21%. That would increase the survival rate to 51% and lower the mortality rate to 49%—a drop visible with simple arithmetic.

So where’s the crash program to produce the vaccine in bulk for these wholly ethical tests? In Canada. Glory to the British Commonwealth, and shame on us!

4. Peacetime Generals. Did you ever notice a funny thing about history? Peacetime generals don’t win wars.

The generals who do win them rise from the ranks after it slowly dawns on their political masters that military skill, not political skill, is required. Abe Lincoln ran through a number of generals before he found one—in U.S. Grant—who could almost match wits with confederate General Robert E. Lee. Generals MacArthur and Patton were irascible, abrasive and sometimes insubordinate, but they got the job done in World War II.

It takes a while for any society to understand when war has come to stay and to pick the best people to run it. Apparently we Yanks have been slower than the Canadians, Chinese and French to realize that we—our whole human race—is at war with ebola.

Once that realization strikes, we will need leaders with no-nonsense command skills, who can ask the scientists, doctors and public-health experts the right questions and then put in motion men, women, machines, and (in this case) vast productive enterprises. In other words, we will need someone like General Leslie Groves, who ran the Manhattan Project.

But in this case we will need more than General Groves’ engineering skills, which allowed him to understand how to make an atomic bomb, if not all the details of nuclear physics. We need a no-nonsense leader who can deal with and command scientists as General Groves did, but with enough general knowedge of medicine, monoclonal antibodies and viruses to lead intelligently.

I’m sure Ron Klain is a good vice-presidential aide. Maybe he’s even politically skilled. But if Klain is that person, I’m Napoleon.

Forgive me for being politically incorrect, but no general or leading physician looks as he does. Generals are in fighting trim, and our leading doctors are trim because they have to set an example of good health. The appointment of Klain as ebola “czar” is a portent of business as usual in Washington. Thank goodness Canada, China and France are on the case.



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