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OCT 27, 2014, VOL. 20, NO. 07 BY JONATHAN V. LASTSix Reasons to Panic

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CDC DIRECTOR THOMAS FRIEDEN AND COLLEAGUES

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As a rule, one should not panic at whatever crisis has momentarily fixed the attention of cable newsproducers. But the Ebola outbreak in West Africa, which has migrated to both Europe and America,may be the exception that proves the rule. There are at least six reasons that a controlled, informedpanic might be in order.

(1) Start with what we know, and dont know, about thevirus. Officials from the Centers for Disease Control(CDC) and other government agencies claim thatcontracting Ebola is relatively difficult because the virusis only transmittable by direct contact with bodily fluidsfrom an infected person who has become symptomatic.Which means that, in theory, you cant get Ebola byriding in the elevator with someone who is carrying thevirus, because Ebola is not airborne.

This sounds reassuring. Except that it might not be true.There are four strains of the Ebola virus that havecaused outbreaks in human populations. According tothe New England Journal of Medicine, the currentoutbreak (known as Guinean EBOV, because it

originated in Meliandou, Guinea, in late November 2013) is a separate clade in a sister relationshipwith other known EBOV strains. Meaning that this Ebola is related to, but genetically distinct from,previous known strains, and thus may have distinct mechanisms of transmission.

Not everyone is convinced that this Ebola isnt airborne. Last month, the University of MinnesotasCenter for Infectious Disease Research and Policy published an article arguing that the current Ebolahas unclear modes of transmission and that there is scientific and epidemiologic evidence that Ebolavirus has the potential to be transmitted via infectious aerosol particles both near and at a distancefrom infected patients, which means that healthcare workers should be wearing respirators, notfacemasks.

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And even if this Ebola isnt airborne right now, it might become so in the future. Viruses mutate andevolve in the wild, and the population of infected Ebola carriers is now bigger than it has been at anypoint in historymeaning that the pool for potential mutations is larger than it has ever been. As Dr.Philip K. Russell, a virologist who oversaw Ebola research while heading the U.S. Armys MedicalResearch and Development Command, explained to the Los Angeles Times last week,

I see the reasons to dampen down public fears. But scientifically, were in the middle of the firstexperiment of multiple, serial passages of Ebola virus in man. ... God knows what this virus isgoing to look like. I dont.

In August, Science magazine published a survey conducted by 58 medical professionals working inAfrican epidemiology. They traced the origin and spread of the virus with remarkable precisionforinstance, they discovered that it crossed the border from Guinea into Sierra Leone at the funeral of atraditional healer who had treated Ebola victims. In just the first six months of tracking the virus, theteam identified more than 100 mutated forms of it.

Yet whats really scary is how robust the already-established transmission mechanisms are. Have youever wondered why Ebola protocols call for washing down infected surfaces with chlorine? Because thevirus can survive for up to three weeks on a dry surface.

How robust is transmission? Look at the health care workers who have contracted it. When Nina Pham,the Dallas nurse who was part of the team caring for Liberian national Thomas Duncan, contractedEbola, the CDC quickly blamed her for breaching protocol. But to the extent that we have effectiveprotocols for shielding people from Ebola, theyre so complex that even trained professionals, who arekeenly aware that their lives are on the line, can make mistakes.

By the by, that Science article written by 58 medical professionals tracing the emergence of Ebola5of them died from Ebola before it was published.

(2) General infection rates are terrifying, too. In epidemiology, you measure the R0, or reproductionnumber of a virus; that is, how many new infections each infected person causes. When R0 is greaterthan 1, the virus is spreading through a population. When its below 1, the contamination is receding. InSeptember the World Health Organizations Ebola Response Team estimated the R0 to be at 1.71 inGuinea and 2.02 in Sierra Leone. Since then, it seems to have risen so that the average in West Africais about 2.0. In September the WHO estimated that by October 20, there would be 3,000 total cases inGuinea, Liberia, and Sierra Leone. As of October 7, the count was 8,376.

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