The first confirmed case of Ebola has been reported in the United States.
Ebola is a totally different ball game from long-established and controllable diseases that are genetically stable, easily preventable, and already well understood and treatable. Ebola is a lot scarier than malaria, for example, even though malaria currently causes a lot more deaths.
Looking at ebola today is like looking at Amazon.com when it was doing $1 million a year in revenue. Both have had alarmingly good early success, are breathtakingly effective at making money/killing people, nimble and constantly evolving, and just looking to explode in growth.
Looking at malaria today is like looking at Phillip Morris. It’s still a huge company with lots of cash, but already in a saturated market that is likely to decline as people move away from cancer-causing habits, or as campaigns for mosquito nets keep improving.
That is insane.
Why does Ebola have the growth potential of Amazon?
The first thing to know about Ebola is that it is a RNA based virus. To understand what that means and why it’s important, we need to delve briefly into viral and cellular mechanics, via an extended metaphor:
In a cell, DNA is like a printing press. It prints pamphlets with instructions for all sorts of useful things, like building cell membranes or making hormones. It’s located in the publishing house of the cell, the nucleus. RNA is the pamphlet that is printed from DNA, and is sent out of the publishing house to the factory. The RNA pamphlet has the instructions that the factory uses to make cell walls, hormones, etc.
DNA viruses are like extra printing presses that add themselves into the publishing house. The cell starts printing pamphlets to send to the factory from this new viral printing press, not realizing it’s not its own.
RNA viruses insert themselves into the cellular pathway at a later step. They essentially add new pamphlets into the cell, which are directly taken up by the factory to make copies of the virus.
Ebola is much more likely than other pathogens to become highly contagious.
RNA viruses replicate with less fidelity than DNA-based viruses. RNA is the pamphlet, not the printing press. It is less stable and meant to be temporary. That means it mutates faster when being replicated, and has a higher chance of randomly replicating into a new strain that is much more successful than its parent strains.
Ebola is not a stable pathogen. A previous Ebola Reston strain has already shown strong evidence that Ebola can spread without direct contact with bodily fluids. The outbreak of the Reston strain was discovered in laboratory monkeys in Virginia in 1989, where it jumped from room to room with no contact between the monkeys. Researchers found that the strain did not infect humans, but concluded it had a "high likelihood of aerosol transmission outside a controlled laboratory setting."
The strain causing the outbreak today is extremely deadly. Its very close sibling strain has shown capacity to be contagious without direct contact.
Put two and two together. The strain causing the outbreak today is extremely deadly. It already has a viral coefficient of 2.0, which means that every person it infects infects two more people, on average. And its very close sibling strains likely had capacity to be contagious without direct contact. How many replications does this deadlier strain need to find the right mutations and reach a tipping point on its viral coefficient at which it becomes essentially unstoppable? The potential for mutation is what personally scares me the most.
Ebola is really far from being treatable.
If we have a global epidemic, we are unlikely to quickly come up with a cure. Very little drug development has been done on the Ebola and its mechanisms for penetrating cells and avoiding our immune system are not yet well understood. It had been a deadly but extremely rare disease with limited outbreaks in developing countries. As a result, it was difficult to size the market and drug development has depended largely on public funding, which has been very limited.
Ebola is startlingly effective at killing people.
Ebola kills 70% of the people it infects. Couple that with a viral coefficient of 2.0 and a non-zero likelihood that it can go airborne, which would send the viral coefficient through the roof, and you’re sitting on a lot more potential for carnage than if the common cold develops a more effectively contagious strain.
mortality rate = 70%
viral coefficient = 2.0
Ebola is everyone’s problem, not Africa’s problem.
If there is ever a time to use complete and overwhelming force to knock something out, this is it. China did the right thing with SARS, killing millions of chickens and aggressively quarantining to contain the virus.
African countries do not have the resources to handle this on their own, the way China could.
I’m afraid that we’ve already reached a point where the world does not have the resources to handle this. But we at least need to try.
No one seems to be able to agree on who should be in charge of stopping Ebola. Opinions range from the UN Security Council to the United States Department of Defense. I find this incredibly strange, because the answer is obvious to me.
The CDC (Center for Disease Control) should be front and center on this effort in the U.S., and I would argue that they should be the ones to control all the money and all the efforts at containing Ebola internationally. To have a coordinated response, there needs to be a coordinated response team, which means only one organization is in charge of the resources the U.S., Japan, Canada, the Gates Foundation, Doctors without Borders, and others are all contributing.
The CDC is made up of phDs in pathology and epidemiology who dedicate their lives to preventing disasters like the one that is unfolding now. Their annual budget is six times the budget of the World Health Organization (WHO), and the CDC has a much stronger specialization in detecting and controlling dangerous emergent diseases internationally. The United Nation’s WHO tends to focus on global health initiatives like immunization and mosquito nets, and are not in as good a technical position to deal with a dangerous and quickly developing crises, as this Washington Post article details.
The U.S. military also has a small wing of specialists at the USAMRIID that specialize in studying Level 4 Biohazards like Ebola, but they are not as well equipped as the CDC to take a leadership role. Their specialization is laboratory research and drug development, not international boots on the ground containment work. And when it comes to optics, it will politically be more difficult to get things done if the military is in charge versus a less controversial organization like the CDC.
The CDC is predominantly made up of epidemiologists and scientists, and they stand a better shot than anyone of knowing what they’re doing. This is their mission and the reason the organization exists. Give them the reins in determining the strategy and tactics for containing and treating patients of this Level 4 Biohazard.
Putting the CDC in charge is not going to guarantee success. It will only increase our chances of it. The way these emergent, little understood, and highly deadly viruses are supposed to be handled is through highly technical and overwhelming force at the very start of an outbreak, so they are controlled and stopped when the number of cases are still in the double digits. That’s the scenario that the CDC is designed to handle, and even then, it can be a chaotic process that is successful in no small part because of luck.
Realistically, the entire Ebola response today is going to look like an early stage start-up that just raised $20 million and is trying to scale when there’s still a hacker as CEO. No executive CEO exists, because a crises of this magnitude hasn’t happened before. The best hacker we have is the head of the CDC. Having a non-technical professional CEO is out of the question with a disease outbreak like Ebola. We just have to hope that Tom Frieden is Mark Zuckerberg and Drew Houston material, and can rise to the occasion.
We need to pull ourselves together and kill Ebola before it kills us. America needs to take it seriously, and we need to let the CDC lead on this globally.