Ebola in the Age of Epidemics – Special Live Episode

November 03, 2014

There’s no doubt that Ebola is an incredibly dangerous and genuinely lethal virus, but it’s also a highly manageable one, though you’d be forgiven for thinking otherwise given the kind of hyperbolic coverage we’ve seen of the epidemic. In order to sort fact from fiction about the real threat posed by Ebola, and to better understand its origins and wider implications, Point of Inquiry presents a special episode, recorded before a live audience in New York.

We begin with a presentation by Dr. Jon Epstein, a veterinarian and epidemiologist who specializes in emerging pandemic threats in the developing world. Then Point of Inquiry host Josh Zepps goes more in depth, in a conversation with Dr. Epstein and Dr. Kevin Olival, a disease ecologist and evolutionary biologist. Both are world-leading experts on Ebola and disease prevention with a great deal of insight as to what governments and aid workers need to do to prevent Ebola from becoming a pandemic.

Recorded live at the Brooklyn Brewery, this event was organized by Eco Health Alliance, an international biodiversity organization.

This is point of inquiry for Monday, November 2nd, 2014. 

I’m Josh Zepps, host of Huff Post Live, and this week, a special edition of Point of Inquiry, a special Ebola edition as the country freaks out about the deadly epidemic. I led a Q&A in front of a live audience of beer sipping hipsters at Brooklyn Brewery with two world experts on the disease. The event was Ebola in the age of pandemics. And we thought that you, as a point of inquiry listener, would enjoy having a little more light and a little less heat shed on the science of the most dangerous epidemic of the century so far. My guests were Dr. Kevin Olival, an ecologist and evolutionary biologist who specializes in emerging infectious diseases. And Dr. Jon Epstein, a veterinarian and epidemiologist who works on emerging pandemic threats in the developing world. Both of those scientists are with Eco Health Alliance. That’s the International Biodiversity Organization, which organized the event. The first thing you’ll hear is a portion of Dr. Epstein’s address, followed by my Q&A. 


It’s not enough to just understand how these are transmitted from person to person. That’s really important in terms of understanding an outbreak. But if you want to be able to prevent diseases from emerging in the first place, prevent diseases like Ebola from happening, you’ve got to understand where they come from. So now we’re going to move to the place where the current Ebola outbreak began, and that’s West Africa. And I got to talk to you about why this outbreak has been absolutely unprecedented in terms of its size, its magnitude, and the speed at which human cases are occurring. And there are a lot of reasons for that. But most of all, they’re human reasons. This is an outbreak that’s been driven by social dynamics and human behavior. Now, this is certainly not the first Ebola outbreak the world has seen. In fact, there have been more than 20 outbreaks throughout history. Ebola was first discovered in 1976 and the second biggest outbreak before this one was the original one that was discovered in Sudan and Congo. There was actually concurrent outbreaks where there were about 600 cases. By comparison, we’re up to about 10000 cases right now at the current one. And what’s terrifying about Ebola, of course, is the fatality rate that exists because this virus is so devastating when it gets into a new host like people. So going from bats into people with a mortality rate of anywhere from 50 percent to 90 percent of people who get infected will die. Now, what really became so important about this outbreak was the geography and the human dimension to this. Now, the bats, as Kevin mentioned, are in West Africa, so it’s no surprise that this could potentially have happened. But this was the first experience that this country that Guinea had ever had with this outbreak, which is part of the reason it got so out of control. By and large, most Ebola outbreaks have occurred in central Africa, in the DRC, formerly Zaire, Republic of Congo and Gabon. They’ve had devastating impacts on wildlife. And that was important as well, because these gorilla die offs that occurred in the early 2000s actually pre were precursors to human outbreaks. 

So people were noticing gorilla die offs and then people were starting to get sick with Ebola in the same area. And there’s a very real reason for that. And that is because bushmeat hunting is very prevalent in this area. So people would go into the forest and they hunt gorilla and they hunt chimpanzees. And if they happened to have hunted an animal that’s been infected with Ebola from a bat reservoir or from another animal and they have contact with that animal. They kill it. They butcher it. And they have contact with its bodily fluids. That’s how people get infected. And many of the past outbreaks have been associated with handling an infected animal, specifically great apes. And so that’s been the story here. And we have every reason to believe that it’s a very similar story in West Africa that the original person who got infected in Guinea was probably exposed to an animal that was infected. Whether that’s through butchering or coming in contact. Now, what’s really interesting is in the current outbreak, epidemiologists have actually been able to trace the line of infections all the way back to a single person, a two year old, who they believe was the index case in Guinea. Now, it’s not clear exactly how this two year old became infected. A little boy who may have had contact with blood or or fluids from an animal that perhaps his parents were butchering or handling. This is unclear. But if you look at the genetics of the strain of Ebola that’s circulating right now, it tells you that this whole outbreak happened from a single spillover event. This one person got infected and infected other people, his family members. And from there, more and more people became infected. The genetics are so similar. Of all the viruses that are being isolated from different human cases that it’s clear that this was a single spillover event. And that’s all that it takes. And from there, the human dimension takes over. This is a study published by West Allow Ski recently that looks at population density and communication connectivity in different parts of Africa. The reason that historically Ebola outbreaks have been relatively small. 30 people, 50 people, maybe a couple hundred is that they’ve happened in remote villages. They’ve happened in areas that are isolated from other parts of the country. So Ebola will spill over into a village. It will run its course. This is the equivalent of throwing a match on a small pile of wood. You get a flare up, a big burn, and then the fire goes out. So gradually people will either die or they’ll recover from the virus and have some immunity to it. And because there’s no further contact with other people who might be susceptible to this virus, the outbreak stays contained. And that has been the mantra if you’ve been paying attention to news at all. As to the key for containing Ebola outbreaks is isolation, restriction of patients, supportive care, but making sure they don’t come into contact with other people. 

So that’s been the story now because Central African governments in Congo and Gabon and Republic of Congo have had multiple experiences with Ebola outbreaks. Their public health system has adapted and has become quite responsive. They have diagnostic laboratories. They have infrastructure enough to respond even in some of these remote areas and contain the outbreak. 

West Africa was a different story because they had never experienced Ebola. And so this outbreak of disease was a mystery and it was actually circulating for months. I mean, the Western world, we just first heard about this outbreak in March 2014. But in fact, when you trace back the cases to the original case, that infection occurred in December of 2013. So for four months, Ebola had a chance to spread from person to person in a highly populous area. OK, here’s get Kodo, which was connected to Conakry, the capital city in Guinea, for the first time in history. Ebola made its way to an urban center with millions of people. 

So this is now the equivalent of taking a burning stick from that small little pile of wood and throwing it into a dry forest with unlimited fuel. And this Ebola outbreak has been able to burn on top of that. The original outbreak started right on the border of Sierra Leone and Liberia. And people were actually moving by foot. They would get infected and they would move across borders. There’s no boundary there. There’s no real border patrol. So people would walk into these other countries because maybe they had family there or they were seeking medical care. And suddenly that engaged three different political systems trying to contain an outbreak where they had no infrastructure and no experience doing so. So it made for an incredibly complex and troublesome situation. On top of all that, remember, people there had never seen Ebola before. 

This is. Incredibly scary, it’s scary enough for us who know about Ebola, right? But this is a society that was experiencing for the first time. So there was an incredible mixture of fear, misinformation, lack of understanding and mistrust in the government. People living in remote parts of Guinea had no concept of infectious disease or germ theory. This was a plague attributed to black magic. People were getting sick and dying. 

And as was the custom, family members would take care of sick family members or village members with close, intimate contact, which would, of course, spread the disease. People would die. And the funeral ritual would include washing the body, having close contact with the corpse. And Ebola remains infectious on a dead body for a period of time after death. So that would also promote the spread of this disease. By the time the West, the rest of the world became aware of this when the WHL announced that this outbreak was going on in Médecins Sans Frontières, said, hey, we’ve got an emergency here. It was already March. And so there were hundreds and hundreds of cases and people didn’t know it was going on. But all of a sudden, foreigners swooping in in these white suits and spray bottles were coming in and shutting down villages. Well, to them, to these villagers, they thought we were spreading the virus, that we were bringing it from village to village because everywhere there was Ebola, there were these men in white suits. The logical conclusion. So an incredible amount of fear in the government putting out communications had a lot of mixed messaging, didn’t quite know how to explain what the risks were or do it effectively. There was just no infrastructure for it. There was no support. And there was a lot of mistrust for the government because on top of everything else, this is a part of Africa that has been war torn for decades. And so we have corrupt governments, an already embedded lack of trust in the government, and it just made for a complete disaster. And that’s why this has become so incredibly widespread. And it’s gotten to the point where health care workers have actually been assaulted and killed trying to help contain this outbreak in villages. 

So it’s a devastatingly difficult situation on the ground for people want to do the right thing and it becomes a matter of education. So at the at the base of all this, it’s really important to remember that communication and education and understanding how Ebola operates is going to be critical to stopping its spread. So I figured we in part a little bit of the science now and talk to you hearing a lot of stuff on the news about how Ebola works. You probably heard about how it spread. But this is a disease that really we should work to understand. We have a good understanding of it already. But really try to filter out some of the noise in terms of the fear and the hysteria, particularly now that we’ve had a case in the United States or a few cases. 

And so it’s really become a very hot topic. And you hear about it in the media all the time. So the first one is this Ebola can be contained. Every outbreak prior to this one has been it’s a control lable. 

Disease people are isolated if they’re infected to keep from contacting other people. Educational campaigns help work with people on the ground in a culturally appropriate way to limit contact with dead bodies, to limit contact with sick village members or relatives. And it’s important to support governments that they have enough infrastructure and enough equipment and supplies to effectively contain an outbreak. 

Now, again, past outbreaks have been in very remote, isolated areas. And we’re dealing with something entirely new right now, which is outbreaks that have hit capital cities and of course, now have started to have international travel to spread a little bit. But it still can be contained. It’s just going to take a lot of resources to do so. Ebola is not easily transmitted. This is not a virus like influenza. When we think about the flu. Think about the worry of being on a crowded subway car or in an office or in a building with people coughing and sneezing. And I know we’ve all been there. And you think, oh, my God, here it comes. You know what? I can I’ve just taken the next car, the next subway. And you think about a virus that is easily transmitted through an aerosolized route and airborne route across the room. That’s not Ebola. 

What we do know about Ebola, what the science tells us is that Ebola requires direct contact with bodily fluids from a symptomatic infected patient. So it’s not even enough for them to be infected. They actually have to be showing signs which include vomiting, diarrhea, severe fever. So there’s a progression here as people start to become sick. They develop a fever early on. But at that point, they still haven’t produced in a virus to infect someone else. It’s still safe. It’s only a few days into the progression of disease as it gets worse. But they start to generate enough virus and start to have some of those symptoms that create bodily fluids that one could be exposed to. That’s the risk factor. So health care workers are certainly on the front line when it comes to dealing with patients. But us generally in society, we have nothing to worry about here in the U.S., especially where we’ve just had one or two cases, three cases in Africa. 

It’s people who are having contact with patients or family members or people in villages have to be wary of contact. But this is not generally an easy virus. Catch the third one. There’s no treatment, there’s no vaccine. Right now, the protocol for taking care of an Ebola patient is supportive care. 

That means give them intravenous fluids, perhaps antibiotics to protect against a secondary bacterial infection. The way that Ebola kills you is that as the virus infects your body, it starts to impact your immune system, which causes your blood vessels effectively to leak internally. So you start to get very dehydrated, coupled with vomiting and diarrhea. The dehydration sends you into organ failure and shock, which is ultimately what kills you. Now, some people will get through the infection. And if you continue to have hydration through intravenous fluids, that can actually help a patient get through it, particularly if it’s administered early on in the process. Now, there are treatments and development or experimental therapies that have some promise, and there are a couple of vaccines that have been greenlit for development. And so we will see vaccines and therapies available, but probably not for at least another six months, if not longer. 

So it’s going to take some time and we’ll see what kind of impact they may have on this particular outbreak. They’ll certainly be important for health care workers who are on the frontlines. Number four, the risk to us here in the United States is extremely low. Right now, we have we’ve had two people come back, are infected, health care worker. And we had a person who was exposed in Africa and there have been a few secondary transmissions. But at this point, hospitals are ramping up. There are dedicated medical centers. This is not a virus that’s circulating in in the public. This is not something you have to worry about walking down the street or getting into a subway car, even though this doctor who came back, who had a fever when running down the street went bowling a few blocks from here. I don’t know if he stopped here and had a beer. 

He might have going to get sued for that. 

But regardless, there was really no risk of transmission at that point. And he was doing the right thing by monitoring his temperature and reporting back to public health authorities. 

And when his temperature spiked, they picked him up and they brought him into isolation at Bellevue. That was absolutely the right thing to do. 

And lastly, if there’s anything I want you to take away from Kevin and I have been talking to you tonight, it’s that this is a preventable outbreak. And I don’t just mean the disease is preventable from getting it from another person. That’s true as well. But we can get ahead of the curve and prevent diseases like Ebola from emerging from their animal reservoirs. It’s going to take a massive influx of educational resources, of outreach, of working in the countries that are most vulnerable. But this is something we understand very well in terms of the process of how Ebola emerges. It’s not going to involve getting rid of bats or trying to exterminate wildlife, but just understanding how practices like hunting practices are high risk that put people in contact with animals that could be infected. And we have to try to either all offer alternatives for people if they’re not going to hunt or give them ways to do what they’re doing more safely. Simple things like handwashing can be incredibly effective, effective at preventing infection. So simple strategies can really make a big difference in terms of public health. 

So it’s human activities that drive these outbreaks to happen, whether it’s hunting or deforestation, which gives us more access into parts of the forest that we generally didn’t have access to before. It’s extraction of wildlife out of their natural environment into a live animal market system so that animals have the opportunity to mingle and mix and share their viruses. This is how Saar’s emerged, bringing animals out of the jungle into an urban live animal market. 

And it’s going to take education. So these kinds of outreach, just whether it’s, you know, easily understandable pictograms, people working in a culturally appropriate way in different countries to really make a difference in terms of how people understand the risk of infection. 

So lastly, and I just want to wrap up here, is what are we doing about getting ahead of that curve and not just with Ebola, but is it a way for us to understand where the next pandemic is going to come from and stop it from happening? And that’s really what we’ve been working towards. Eddie Koff alliance is understanding the ecology of these diseases. Now, we understand very well how they happen and now we have a good idea of where they’re likely to happen. The tricky part is understanding when they’re going to happen. And that’s always tough. But what we do know, and this is that hotspots map that you heard about in the opening video is that there are parts of the world that are particularly vulnerable to these zoonotic diseases emerging because there’s a lot of biodiversity. People have a lot of contact with animals through wildlife or directly through livestock. And so there’s opportunities for that first stage, a pre emergence to go on to spillover. So we need to work with local partners. We need to work with governments in these countries to build infrastructure. And the U.S. Agency for International Development over the past five years has put forward almost 200 million dollars to building up capacity in these countries that are particularly vulnerable for emerging zoonoses, countries in Africa, countries in Asia and countries in South America. And we’ve been part of a team that’s been working to help these governments look at. What viruses are circulating in wildlife, and so we go out into the field, we train wildlife officers and public health officials to safely handle animals, wild animals. We don’t hurt the animals at all. We catch them, sample them safely and release them back into the forest. But we take those samples and we look at the diversity of viruses that are circulating. And we do this in a targeted way. And USAID has just renewed this project for another five years, investing heavily not only in understanding what viruses are out there, but in working to work with governments to build capacity and to create behavioral change, to to start getting on the ground and working with people to better understand what those high risk behaviors and interfaces are. So this is where we need to go with this. We need to work locally on the ground, not only to help people in these countries who are going to be vulnerable to emerging diseases, but we’re in such a globalized society right now that this is ultimately in our own interest as well. So I’m going to end there and it’s only just the beginning, because I’m going to turn this over to the very capable mind of Josh Zepps, who’s our moderator for tonight, and hope to have some interesting discussion on some of these issues. And we’ll hope to hear from some of you. Let’s hear it for John. 

Good, I thank you for all coming out right to have you here. 

I’d love to start with what’s parochial and self interested, and then we can get to the cool science stuff later on. 

At what point do we sort of stop this thing? I’ve looked at the data about the amount of about the transmissibility of the disease in West Africa. And every person who has the disease tends to infect another two people. 

The number of beds that we’re building, the number of healthcare professionals that we’re able to send over there is woefully inadequate income. When you’re talking about the disease doubling every time that someone gets it, we’re not going to be building facilities with 100000 beds and a million healthcare professionals. In which case there’s a possibility, a distinct possibility that West Africa could essentially collapse. 

You could have governments blown away. 

You could have millions of people dying before we really managed to get a grasp on it. You say it’s not a problem here. Where is the juncture at which its most efficacious to stop this thing? Do we need to be going there and sending loads of people in there to stop it at the ground? Do we stop it at the border here? Do we figure out what to do with the people who come here, who have it? Because if you end up with a million people in West Africa who have it, then it’s going to be a thing here. 

Yeah. It’s absolutely imperative that we work on stopping this in Africa. If it gets here and we have onward transmission of cases as much as we really are prepared for this and think we can contain it. The truth of the matter is we can’t let it get to that stage. And so we need to jet we, meaning the United States and the rest of the developed world, need to put serious resources into stopping this outbreak in Africa, in West Africa. And that’s going to take thousands of health care professionals. It’s going to take at this point, billions of dollars. This is how expensive these outbreaks become. But that’s what it’s going to take to stop this in its tracks. And if it gets out of the region, which it might, then it’s going to cost even more to do. What do you mean if. Well, we haven’t seen it move to Asia, for example. And there’s a lot of worry that that could happen as well. So it’s really in everyone’s interests that we keep this contained. You know, even within Africa. Right. 

So what’s the let’s just portray the worst case scenario so that we can allay everyone’s fears by kind of highlighting them. The worst case scenario is it ends up going to India, for example. And you have an entire subcontinent of a billion people where it’s rife, where healthcare is just as bad as it is in Africa. And where the kind of connectedness between people is just as intense and local myths are just as as fiery. 

We have an opportunity right now to prevent that from happening. And also, Sunny, it’s it’s a horrible scenario to think about. It’s not the first time in history we’ve had a global pandemic. You know, Spanish flu in 1918 wiped out 40 million people. This is, you know, at the cusp of World War One. And, of course, health care systems were different back then. But, you know, outbreaks like this are devastating. But we have an opportunity right now to prevent it from spreading. And we know how to do it. We have to create, you know, get enough boots on the ground to build hospital beds, to treat patients were really to prevent onward spread. Get that educational campaign going. And there’s another element to this scenario that we should mention, too, is that we’re all consumed with this outbreak. And I mentioned that this outbreak stemmed from a single spillover event. The conditions that existed that allowed that virus to spill over still exist. There are still places throughout Africa where people are hunting bats and other wildlife. The virus is still circulating. And in fact, we saw a second outbreak happen this year. 

It got a little bit less attention. But in DRC, there was a second spillover event that was totally unrelated to this outbreak that ended up impacting about 80 people. But it was a second spillover event of the same virus. Now, if we start having multiple spillovers, it’s going to be exponentially harder to control. So that’s where the education becomes so important to prevent this from happening elsewhere where we haven’t seen it happen yet. 

How do you do that without being culturally insensitive? 

You know, a lot of this is about I read an article where there was a Liberian woman who was saying they just came and they took my mother away like she was an old abandoned fridge, like she was a broken piece of equipment. Part of their culture is that they wash the bodies and they kiss the bodies and they touch the bodies. 

We have to come in and say, actually, we know the truth. We know germ theory of disease. We know how this shit works. That’s a difficult message to send without feeling like a colonialist. 

That’s why to give that message, because it is a difficult message. You work with anthropologists, people from the local culture who can be effective communicators, who will have the ability to have rapport with people that they’re giving this very hard news to. It can’t be people from America tromping in and saying, you have to stop hunting, you have to stop burying your dead. I mean, in an emergency situation, that’s often happen, but it creates a lot of angst. So coupling that with local partners, members of the community, village leaders, is really going to be the key to that so that people will take this information on board. And I think. Seen people modify funeral practices, they know that they can no longer cleanse and touch a body the way they used to because of Ebola. And people get they will get that as you start to get those messages and they have. 

So let’s talk about this. This virus. This little critter isn’t alive. 

Oh, tough question. Getting philosophical. I mean, the end of the villus philosophy of science here. Our virus is alive. Well, it needs a host to live. So if you let Ebola sit out in the environment for hours, it’s going to start to die off. All right. So it doesn’t stop. It’s not going be as you know, 24 hours later, you come into the bar and you’re going to get infected. Maybe I don’t quote me on the timeframe, but within a few days. Right. The virus is not going to be able to live outside of a host. It replicates. It’s driven by evolution, not by reason. So viruses like human beings, viruses are smart, but they are smart because of trial and error. There’s so many billions and billions and billions of them. Something sticks. And then those succeed. Right. 

Natural selection, evolution survive a bit better at a higher temperature. And that virus becomes more successful. It’s going to billions of copies within hours and days. Right. So they’re very smart because they’re tricky and they can outsmart us. But it’s on an evolutionary strategy. 

So at the moment, the concern is moderate here. 

But not off the charts because we’re aware that this is a difficult disease to catch. Difficult disease to transmit. Is there a concern, a legitimate concern that the disease could mutate and become airborne and become easier to catch? But equally deadly? Or should we be focusing on other viruses that are more likely to be airborne and more likely to mutate into being something equally deadly as Ebola? 

Yeah, great question. So we are concerned about things that are able to go airborne that we know about. 

So remember, Saar’s coronavirus Saar’s was the first pandemic of the 21st century. And then another virus came along, Meurs Corona virus, which looks really similar to Saar’s. It also can be airborne, right? Airborne transmission. And so we got involved with Meurs early on. 

Well, it turns out Meurs wasn’t the big pandemic people thought it might be when it was sarin, a bubble up to the surface. 

Philo, viruses seem sort of, by their nature, are generally transmitted through direct transmission, meaning you have to touch some saliva or feces or vomit or write some nasty fluids. You never really want to come into contact with, but especially not if they’re infected with Ebola. So. 

There is sort of an intrinsic nature to viruses where they are sort of they’re better at being transmitted in different ways. 

And there’s also this kind of evolutionary tradeoff between transmissibility and virulence sometimes. 

Right. So sometimes those things that are highly transmissible might be like a little less lethal and they might not kill you as easily. And so that’s a kind of standard evolutionary trade off balance. But things like influenza virus that John mentioned in 1918 kind of had both. 

Right. That they weren’t as lethal as Philo virus, but they’re a super transmissible. So they killed a lot of people. 

And I’ll just add to that, too. And we have a virologist in the room, Simon Anthony. So you can correct me if I’m wrong, but I don’t think there are any examples from any viral family of a virus that has mutated to the point where it’s changed its route of transmission. 

So although viruses do evolve and they do mutate and they may have different virulence and they may change how lethal they are or subtle things. One virus doesn’t suddenly become airborne. That wasn’t before. We don’t have an instance of that so far. So that gives you a lot of confidence. 

All right. That’s fine. With no go, go home. Good night, everybody. That’s fantastic. 

We’re done everything to worry about, wouldn’t it, if it just became more potent to be able to be transmitted in a an invisible droplet of spittle as you sneeze rather than requiring you to drink a cup of someone’s saliva? 

Different bodily fluids have different concentration of viral particles, depending on, of course, the person stage of infection. Blood and vomit, diarrhea have huge amounts of viral particles are highly infectious. Spittle, sweat, tears much lower. Now, you’re right. If you were standing real close to someone who was sick with raging Ebola and they coughed and you had, you know, globules of saliva in your mouth. Yes. You’ll be exposed that way. But when we talk about a virus being airborne, it’s the concept that the virus can suspend itself on particles in the air and float for some period of disperse over some distance and still be infectious. And that’s a property bill that does not have projectile vomiting is bad. 

So let’s keep that in mind that we are one of the concerns among virologists is the appetite for meat that’s growing in the developing world, especially in China for the first time in history. You’ve got hundreds of millions of people who are wealthy enough to consume meat where previously they ate rice and vegetables. And that’s leading to the concentration of vast numbers of poultry, especially, but also pigs. And we don’t quite know what the consequences of intense farming on that scale are going to be. If you think of the genetic shuffling of cards, that happens as viruses mutate. You’re just shuffling a lot more packs of cards a lot more times. 

Should we be concerned about that? 

This is one of the drivers that Kevin mentioned before is agricultural expansion and intensification. So the increasing demand for protein is going to drive farms to be bigger, more expansive. People are going to require more. They’re going to be able to afford more. And so that is a risk because the more opportunity there is for viruses to jump from one species to another, say from Awilo species onto a farm that’s been built next to a forest. It’s a lottery. So that does increase the chances that something will emerge on a on a farm. And if that farm’s big enough, it might support an outbreak of something new. So knowing that as we expand our agriculture, we have to think about biosecurity. So the way to defend against that is to make sure that your livestock is segregated from wild animals, having them somehow enclosed and it doesn’t have to be, you know, completely indoors. But having a mesh net or some kind of fencing so that wildlife doesn’t have contact. 

Tell us about the work that scientists are doing to be able to head off the possible viruses that are coming down the pike. I’m just taking a slight detail from Ebola because I think if if if what we’re concerned about is there being a massive global pandemic that’s going to kill us all, we’re probably unwise to focus on Ebola and more wise to focus on the potential viruses that could be evolving in those kinds of neighborhoods. How can we get ahead of the curve and make sure that we’re actually attacking it at the source rather than waiting until it turns into a pandemic and then trying to put the genie back in the bottle? 

Well, the first step is to recognize the behaviors that people do that put us at risk for a pandemic virus being unleashed. And that’s what we’re really gaining a real good appreciation for. That there’s a lot of science for is understanding things like agriculture, deforestation, hunting, wildlife, trade, global travel. These are activities they’re not likely to stop anytime soon. But we have to be smarter about how we do them. We have to realize that there’s a risk inherent in those activities. So that’s step one. Step two is we’re largely ignorant of what viruses are out there in nature. And so if we’re going to identify what might be the next pandemic, we have to start with just basically understanding what’s out there in that galaxy of viruses or bacteria that may put us at risk. 

And is that is bizarre. Just to clarify, is that the case that we actually have? Scientists who are going into poultry farms in China, who are taking what it what do they do, a swab of the chicken’s cheek. The chickens have cheeks. 

Whatever you do to help the cloaca, you’re about to get the virus from in there. And then it’s on the other end from the right. And it goes the other side of the animal. Enough said. Enough said, please. Let’s. Let’s end this conversation right now. But. 

But you basically take a viral swab, right. Figure out what’s going on and then extrapolate from that about what might happen to that virus that would cause it to become. 

Yeah. A balloon or autocross the species. That is reckless. That’s the tricky part. That’s the the viral blackbox. So as John mentioned in the under the predict project that we’ve been working on and talk to Simon Anthony about this as he’s found a lot of these viruses, we found hundreds and hundreds of new viruses in wildlife around the world. So what do they mean? What are the ones that we need to be afraid of? What are the big scary ones? And so we’re working on a system now to really try and build a predictive approach to taking a little piece of genetic sequence from a new virus. And what what do we know about the hosts and the ecology? As John said, that’s one part of the model. What do we know about the viral traits? Are there certain traits? There’s some viruses that are just more intrinsically nasty than others. 

Well, are there and are there other towns that one looks for in a virus that goes, oh, well, actually makes it a pretty good candidate to cross to jump across to human beings. We better keep an eye on that one. 

We’re we’re learning. Right. And as we’re moving into this age of genomics, where we’re getting full genome sequencing for all these viruses, we’re going to know a lot more. We’re going to know more about the receptors that they bind to and which receptors, different animals or humans carry that can or cannot allow them to be infected. 

I feel like such an ignorant nerd saying this, but like in the future, man, we’re going to have like a computer that can run an algorithm where you will just feed in a virus and it’ll it’ll crunch the numbers and it’ll go is an 83 percent chance that this within the next 24 months is going to be able to cross the species barrier. Given the fact that I know that it’s in the all of these different locations in China and that the pigs have got it in Saudi Arabia, therefore it’s probably going to happen. So focused on this one being red light. Go for it. It’s going to be an iPhone app. 

It’ll be on Android, too. Don’t worry, guys. Five months later. But is that is that right? Is that crazy talk? 

You know, it it’s very complex. And I’d love to sit here and say absolutely will have that. But I don’t know if that’s we’re ever going to get that precise. 

There’s a lot of randomness out there in nature in terms of how viruses change and mutate and what those mutations actually mean in terms of how a virus behaves. 

Now, there’s a lot we’ve we can learn and we’ll get a better understanding of that. But to be able to absolutely look at the genetics of a virus and say this is the one. It’s uncertain at this point. We saw a long way to go with that science. 

And I’ll say there are a lot of naysayers out there. A lot of virologists that say there’s no way you can go from a sequence to understanding its pandemic potential or its spillover potential. But we’re trying to kind of tap into that and see if if we can at least get some, you know, some headway on it now. 

I want to remind people, too. We’re staring down the sort of genetic route. But this is why it’s so important to understand the process by which diseases emerge. Because the truth of the matter is, if we can be safer about how we farm and how we interact with wildlife, it actually doesn’t matter what virus is out there lurking in wildlife. If we’re effectively protecting ourselves from anything that might come along, we don’t have to be that precise. So we need to focus on making our behavior safer in order to reduce the risk of spillover from happening. 

Right. But we can’t change the behavior of people who are who are hunting bushmeat in Africa or people who are farming poultry in in remote western China. 

I believe we can’t. I mean, one thing that’s happening naturally in China is there are more people are becoming wealthy and a younger generation is coming along. They don’t want to eat wildlife as much anymore like their grandparents did. They want to have KFC or McDonald’s or more Western, you know, globalized food. 

It’s true. Lord, help us. Yeah. You know, that that brings a whole host of other health issues. 

But in terms of infectious disease, you know, tastes are changing now. We can’t necessarily wait for that to happen organically. But there is a change in perception attitude. I do believe we can modify people’s behavior if we leverage health. 

And at the very least, presumably, even if we can’t necessarily modify a huge amount of behavior at the source of the interface between humans and animals, we can at least modify behavior between humans. Right. I mean, that seems to be an easy way because it’s not like there’s a financial incentive for people to wash each other’s bodies off of them died. You know, there’s a financial incentive to go kill a baboon, but there’s not a financial incentive to uphold cultural habits that might spread diseases. Maybe that’s one way that we can effect change. We’re going to have to find a way to to leverage that and make people feel comfortable. So let’s get back to Ebola here in the States. Is there a possibility that Ebola is going to become a an endemic disease in the United States? 

I mean, if if worst case scenario is. 

Africa pan out. And we end up having a number of cases here in the States. 

Is there a chance that it could become like measles used to be, where it’s just something that people occasionally get and they die and that’s that? 

Yeah. So it’s a really, really pathogenic measles, right, where 50 percent. Well, in Africa, 50 percent of people are dying. But that is a very intriguing question. If you think about all the what we think of as human diseases. Right. Exclusively human diseases like measles, smallpox, other viruses that we we know of and we’re trying to eradicate measles started as a virus of cows called rinderpest. 


So somewhere maybe around 10000 years ago, rinderpest, which is found in cows, evolved into measles and jumped into the human population. And so we think of measles as like this only human virus. But the truth is, it had a history as a zoonotic spill or spillover event as well. So did HIV. So did HIV. Right. Which is HIV came from chimpanzees and in Africa. So when there’s precedent for this and it’s going to happen again, we’ll be ignorant to think it won’t happen again, that some of these new emerging viruses will become endemic. So it’s possible this will be a pretty nasty one if it was. And the other side issues that will become endemic in the U.S. as well. Once people start getting regularly infect in the U.S., there’ll be a lot of pressure to really push a vaccine and treatment. 

Well, this is going to be my next question. I mean, if it were an endemic background, part of life where, you know. Oh, I. Yes, Sally got Ebola and she died. If that were the case, then wouldn’t we have a vaccine? I mean, wouldn’t we immediately if if five or ten thousand Americans had died is the reason why we don’t have a vaccine and an adequate treatment because they are black and poor? 

Yeah, well, that’s a pretty political statement. But there is not financial incentive for pharmaceutical companies to really push the vaccine. 

There’s also scientific limits. I will say so. They’ve been working on a vaccine. NIH and other universities and organizations have been working on Ebola vaccine for many, many years. So you could say that same argument. Well, why don’t we have an HIV vaccine? We still have an HIV vaccine because there are scientific limits to it being effective. Right. So we’ve got work. 

We the royal we, the scientific community has been working on an Ebola vaccine, but there maybe hasn’t been the political and economic incentive to really push it ahead. 

That that’s been true for Ebola. It’s been economics. We haven’t even had 5000 people in the world with Ebola, let alone in the United States. So it now we’re at a stage where there is not only a lot of people being infected, but it’s raging out of control. And that, of course, is driven interest in an economic incentive now where there wasn’t before. 

John, last question. What’s your most sober sort of judgment about the way that this plays out? Not wearing rose colored glasses and nor wearing your hat of doom? 

That’s what we’re seeing right now, is a virus that is going through that second stage of emergence where it is on its way to becoming endemic in a human population to the point where it no longer will need an animal reservoir anymore if there is enough susceptible people to become infected. If we don’t contain this, it will become, as you described, endemic circulating at least in Africa and probably in broader parts of the world. I do see us containing this outbreak, though. I think the world will kick it into high gear. This is not just being rosy. I think that there’s really no choice. In eight months or so, vaccines and therapeutics will start to be produced in a large enough supply to perhaps make an impact in controlling some of this. And that may tip the scales. But I do think we’ll we’ll get there and be able to contain this. 

Thank you so much for coming. Do. Do we have a moment to take any questions or are we a couple? But does anyone have any pressing yet? 

Some of the issues that have recently arose and we’ve seen this before, have been that in trying to contain something like this. People feel that their civil and human rights are being violated. What are your perspectives on what the balances in terms of how much someone’s rights can I need to be violated for the greater good? And how do you justify that? 

I just I just start quickly by saying, you know, I think education can go a long way, too. I don’t think it’s ridiculous to say that. I think you can have a sort of iron political fist on this on the problem. 

Or if you have everyone very hyper aware and self reporting, then that is almost ineffective, like virtual quarantine, if you will. Right. Where people are really aware and they know the symptoms, they know the potential transmission. 

And so education, I think, can go a long way as well. That’s not addressing the sort of the highlighted news articles on quarantine in New Jersey. But John can address some of those other issues. 

The issues around quarantine is I don’t think it is necessary to violate civil rights. I think that we need to let science dictate policy. We need to take what we know about this virus, what we know about the epidemiology, and use that to make decisions, not the. You’re in hysteria and not the concern that we have to approach this with machine guns when it requires, you know, more of a pistol approach. And the criticism is that it relies on an honor system. But people, especially health care workers, are some of the most knowledgeable about this disease. The doctor, they came over the United States, did the right thing and reported his fever. And that’s really what we need to do, is to make sure people are reporting and monitoring and then being able to isolate themselves when the time is right. And that will be effective. I think that will be effective. So we don’t need to violate civil rights to do this. 

My first question is, how do you know that these places in Africa have Ebola if they’re quarantined and there’s only been 10, 10 people that died. Second is, we’re all New Yorkers. We ride the subway. We have very high immune systems. And the third is regarding like farming practices, like, you know, America is the worst with having pigs and cows just eating and antibiotics and everything like that. We can’t we can’t stop it if it goes through animals and we eat them. We have to change our whole agricultural business. And that’s a lot of money. 

So I don’t know why I like the faith in New York citizens immune systems. 

I don’t want knowledge. Wash your hands, though. 

As far as our causes, I mean, it’s true. We have a huge agricultural system in the US. But we also have really high biosecurity in the U.S., whereas a lot of other countries have low. And what I mean by biosecurity is when an animal starts getting sick, we really know how to contain that in our agricultural system as as best we can. And how to prevent things from getting into the agricultural system. So I’m with you. I mean, antibiotics. And that’s a whole nother issue to deal with antibiotics and ag. But as far as Ebola getting into that U.S. ag system, that’s not the main concern, is not that it’s really through the human to human transmission. 

We know that lots of animals, lots of mammals are susceptible to Ebola. 

But eating infected animals sort of culture is probably not going to be a big risk there. 

We’re out of time, unfortunately. Thank you so much for coming. We’re all going to be loitering around and mingling and drinking beers. Drink more beer. Feel free to come and ask questions of Kevin or John. 

Have a great night. Thank you so much for coming. Great to see you.