Ebola, Poverty, and Absence of Decent Healthcare in West Africa

Interview with Science Writer David Quammen Michael Slate: Over the last couple of months, people have been... for a while they were riveted to television, to newspapers, to stories coming out about the epidemic of the Ebola virus in West Africa, West and Central Africa. And through the course of this, there was a lot of trash that was put out and a lot of things that laid the basis for and actually did stoke up some very bad things—xenophobia, the kind of, you know, pogromish atmosphere. There were kids coming back from visiting their families in Africa and getting beat up and all this stuff. And so I wanted to try and present a scientific view of Ebola. And I was looking around for someone who had done that in a very thorough sense and somebody who could actually talk about the disease in a scientific way. And I found that person. His name is David Quammen. David is the author of the book, Ebola: The Natural and Human History of a Deadly Virus and he's a contributor for National Geographic magazine. And I'm very happy to welcome him to the show today. David, welcome. David Quammen: It's good to be with you, Michael. Michael Slate: I want to talk about this. We're now in the midst of what you've called and others have called the worst outbreak of the Ebola virus ever, although it now seems that this has receded from the news in this country. And it's something that we can talk about a little bit, I hope. You know, what do you see as the big question... where did this come from? When people look at this, where did it come from? And on this scale in particular, but also generally? David Quammen: Yes, well, the first answer is Ebola virus comes from the African forest. It has to live in some other creature, because viruses can only replicate in living cells. It has spilled over into humans more than 20 times in the last 40 years, first noticed in 1976. So there have been these outbreaks, more than 20 of them. And none of them previously had killed more than about 300 people. The total was about 1,600 fatalities in all these previous outbreaks. And now we're over, what, we're somewhere, I think, over 5,000 fatalities in this one. So this one is no longer an outbreak. As you say, it's an epidemic now in West Africa. But it all began with the spillover of the virus from one animal into one human being, probably in the southeastern corner of Guinea last December. The first known case was a little two-year-old boy. He got sick and died. Then his mother got sick and died, his sister, his grandmother. They all died in this one little village. We still don't know which animal Ebola virus hides in, but whatever it was, it got from that animal into these people in this little village in southeastern Guinea and then started passing from person to person. Michael Slate: Let me ask you this, David, you wrote your book in the style of... in a certain sense, there's like a little bit of a detective story in there. It's related to what you've just been saying about one of the critical aspects—one of the points that you focus on a lot in your book is exactly that point of the search for a host or a reservoir for the virus. And then the actual mechanism for how it gets transmitted from the reservoir to humans. David Quammen: Right. Michael Slate: Why is this the critical point and where are we at on that? David Quammen: Well, we still don't know, as I said, what the reservoir host is. You hear people say, well, it's fruit bats. There is suspicion that it is fruit bats. There has been some circumstantial evidence. But there has been no rock solid evidence that fruit bats of any species are the reservoir host. They're still trying to solve that. And as you say, my book is written sort of as a mystery story and with each of these diseases, the first mystery is where does it come from and why? And then these disease detectives go out and try and solve that mystery. But the reason it spilled over into humans from this animal, whatever it is, presumably has to do with the way people interact with wild animals in the countryside and in the forests of Central and West Africa, in other words, bush meat. People are starved for protein. They eat the animals. They eat wildlife, including bats. And in doing that, they expose themselves to the viruses that these creatures carry. That's what's happened with Ebola. Why is it important to know which animal? Well, it can't help us—it probably can't help us stop the current epidemic to know what the reservoir host is, but it can help a lot in preventing future super viruses and future epidemics. Michael Slate: There was something—and I think I read it either in your book or in an article you had written recently related to this. I mean it was very interesting because it was a point about how if it was fruit bats, say, that was the animal, then the solution would not necessarily be to go and eradicate all fruit bats from the face of the Earth. That would actually cause even more problems if that was done. David Quammen: Right. Absolutely. These different species of bat and all these other animals, they have their ecological roles within the diverse ecosystems where they live and so if we discovered, for instance, that fruit bat Species X was the reservoir host of Ebola, there will be a lot of pressure from people saying oh, we should eradicate that species. But that would cause problems. That would cause cascading effects of one sort or another in the forests. What we have to realize is that there are essentially three options to dealing with this kind of a situation once you identify the reservoir. You can decide you're going to eradicate the reservoir species. Bad idea for ecological reasons. You can try and cure the reservoir species, eradicate the virus from the reservoir species. That's very hard to do. Think about trying to cure an entire population of rodents or bats or monkeys or whatever in the African forests. It's just impracticable. And the third possible approach is just identify the reservoir and then keep people separate from it, educate people, give people opportunities—give people options for other things to eat so that they can leave that reservoir host alone and not give it the opportunity to spill its virus into humans. And the third of those is the one that really needs to be pursued once we identify the reservoir. Michael Slate: Now, David, a related question to all this is that you talk about one of the difficulties in your book is in investigating the virus in humans, is that it's the transitory nature of the outbreaks of the disease. David Quammen: Yes. Michael Slate: That it hits and then it recedes into dormancy for years, who knows how long, who knows where it's going to appear again? And this is a huge problem. How do you deal with that? How does that affect both the course of these epidemics and these outbreaks and also the fight to actually figure out how to eradicate the disease? David Quammen: Well, it is difficult, because scientists can only—they can only study this when there is an outbreak. I mean they can take samples of Ebola and grow it in the laboratory. But in terms of understanding the disease dynamics, the spill-over mechanism, they have to be there when that's happening and Ebola spills over into humans and it causes this outbreak situation and then it's an emergency. People are sick. People are dying. So scientists go in there, public health people, health care workers go in there and they try and deal with the human tragedy that's happening. And it's difficult to do the scientific research at the same time. It's almost a luxury that they don't have. And then, when the outbreak is brought to a halt, the virus disappears. Where is it? Well, it's in its reservoir host. What species is that? We don't know. And so it's difficult to study in between outbreaks. But there are some brilliant and dedicated and courageous scientists who have been working in the forests of Central and West Africa for years and decades now in between outbreaks, sampling animals, taking blood samples from animals of all different sorts and looking for the Ebola virus. That work has been going on. Not many people, but some of them I know. I've spent time in the forest with them. That's the real detective work that's happening behind the scenes. And the fact that they have not yet found the reservoir host of Ebola, they have not yet isolated live Ebola virus from any species of animal in the Central African forests is part of what compounds the mystery of this particular virus, this particular disease. It's really been a tough nut to crack. Michael Slate: And the approach that you're taking with this book of actually doing science reporting from that standpoint. And what you bring out about the scientists themselves and about the various medical professionals and all the people who work with infectious diseases and all this, and the fact that you brought out in this book, I thought it was really important, that there's the element of really applying the science. But then you talked about people who also went in and listened to the people who were affected by this and actually listened to the things that were wrong, the things that were superstitions but also what they could glean from them in terms of how the disease progressed, maybe get a hint of where it was picked up from and who got it, who died, who didn't, all this other stuff. And I thought that was very important. David Quammen: I agree, it is important. And for instance, there's a fellow I met at an Ebola conference in Africa named Barry Hewlett. He's a medical anthropologist. I didn't even know that the profession of medical anthropologist existed. But he goes into these communities where Ebola is killing people or where it has struck and he talks to people. He talks to people about their traditional beliefs. He talks to people about the community dynamics, who's angry at whom. And he's written a book about this, about Ebola in particular, sort of the traditional belief practices and the cultural anthropology of this terrible disease. Different ethnic groups in Central and West Africa have different ways of viewing this, but there's a certain amount of overlap. They tend to attribute these outbreaks to sorcery, to some sort of malign spirits. In some cases, it's almost as though someone were believed to have put a curse on someone else and the result is these chains of disease. They tend not to think of it as a virus—they tend to be suspicious of Western medicine—but they have their own ways of explaining these things. Now, in some cases, those beliefs cause them a lot of trouble, cause them misery, because it includes burial practices that expose more and more people to the virus. But Barry Hewlett and the people like him who study these cultures realize that you can't just go in there and tell people that they're wrong, tell people stop doing that, stop cleaning the bodies of your loved ones before you bury them, you have to stop doing it. You can't simply dictate to them. You have to absorb the traditional beliefs with respect and then give people options and guide them away to safer practices that allow them to avoid these kinds of situation. Michael Slate: You know, it's interesting, David, because that's something that I think is actually also well worth thinking about in relation to how things have developed here in this country, where you have, in the wake of this, and attached to the epidemic in Africa, you have this sort of xenophobia and this pogromish atmosphere being whipped up, a lot based on the idea that people think, well, if someone looks at me wrong or they breathe in my direction, I'll get Ebola. David Quammen: Yes. Michael Slate: And on the basis of that, there's terrible things happening, including, you know, the beating of little children who have just returned from a visit to some place in Africa and people being isolated and if you get sick and you're African, you're basically suspect immediately and they want to quarantine you or who knows what's going to happen? And combating that can only happen with this kind of scientific approach that you're advocating. David Quammen: Well, yes. And there's a tremendous amount of fear in this country, in the U.S., about Ebola, partly because it's such a lethal disease. It kills a high percentage of the people that it infects. But partly because of misunderstandings. People have been led by some previous publications to believe that Ebola is this spooky, mysterious disease that causes people to dissolve on the inside. It's incredibly bloody. People bleed bloody tears. In fact, those are myths. That's not true about Ebola. It is a horrible disease. The virus kills a lot of people. It does not cause organs to dissolve. It does not cause most of its victims to bleed inordinately. It kills in other ways. So that misconception has partly led to this high level of fear. And as you said, people tend to be ignorant of Africa. Most people have never been to Africa. They have only the dimmest ideas of Africa. And here's a virus that comes from the African forest. Oooh, the African forest. That makes it more terrifying. I try to get around that in my book. I've spent a lot of time in the African forests, of Central Africa particularly. And they're beautiful places with a lot of diversity, including Ebola virus. But it's just a virus. It's not a preternatural miasma. It's not a spooky thing. It's just a virus that transmits in bodily fluids and can be stopped with proper precautions and equipment. Michael Slate: Now, I want to ask you a couple more questions. One is this point that you've made in a number of places about evolution and the virus and that just as worrisome as the virus's geographic spread is its journey across the evolutionary landscape. Tell me what you're talking about there and then what are the possible repercussions of this? David Quammen: Right. Well, people wonder, is Ebola virus evolving? Is it going to adapt toward being more lethal in humans, maybe toward being a respiratory virus transmissible through the air? We know from good science that's been done since this outbreak began, some of it published in the journal Science in early September, we know that the Ebola virus is mutating. But that's almost a truism. Viruses always mutate. They make mistakes copying themselves. This is a particular kind of virus that has a relatively high rate of mutation. So it has been mutating more during this epidemic because it's infecting more humans. The more people it infects, the more opportunities it has to mutate. But it's important to distinguish that from adapting. Mutation is random change, mistakes in copying its genome. Adaptation is Darwinian natural selection, taking those random mutations and selecting for the ones that cause the survival of the fittest, the survival of the fittest virus. There is no evidence so far that Ebola virus, during this outbreak, has been adapting to be more dangerous in humans. It's possible that it could happen and the higher the case count goes, the greater the possibility. But in terms of the randomness of mutation, the case count is still relatively low and scientists are watching that carefully. So we shouldn't be alarmed that this is going to become an airborne virus through mutation. We should be aware of the fact that the longer the outbreak, the epidemic, goes on, the better the chances of the virus mutating in some way that might make our prototype vaccines ineffective against it or might make it more problematic in other ways. But it's not likely to become an airborne virus. Michael Slate: Just a follow-up here, because I thought I remember reading in your book the point about when they looked at this, that mutations over the last 10 years have been proceeding at a really phenomenal rate. And I was sort of wondering what that would mean. David Quammen: Now, let me distinguish a little bit. Mutations over the course of this year, during the outbreak in West Africa, have been higher than usual. The mutation rate has been up. And they have found that there are five species of Ebola virus. And one of them is known as Zaire Ebola virus from Central Africa. And this virus in West Africa is part of that species. But it has diverged from that species by about 10 years worth of mutations. So what that seems to suggest is that the virus is moving, that this strain of the virus in West Africa has diverged from the Central African Ebola virus over the last 10 years and moved into a new area, either perhaps because the reservoir host has been migrating. If it's bats, maybe the bats have been migrating, or because the virus has been moving through a population of reservoir hosts and the virus itself has been expanding its range. In either case, that's a little bit disturbing over the longer-term. Again, it's not knowledge that helps us stop this outbreak, but it's something that we need to take into account in terms of what comes next, what happens next year and the year after, how to prevent future outbreaks of Ebola virus. We need to be aware that the virus seems to be moving. Michael Slate: All right, David, the argument you make for basically people stepping back, taking a deep breath and looking at things from the standpoint not of oh, how can we escape this horror and all this other stuff, but that actually the whole way that the fight against Ebola has to be carried out has so much to do, and really would hinge on the idea that people here—and people everywhere in the world—have to do as much as they can to fight the disease where it is now in Africa. And not from the standpoint of get it there before it gets us, but from the standpoint of the situation facing humanity in that part of the world. Can you talk about that a little? David Quammen: Yes. When there was a case in the U.S. and then a couple of secondary transmissions, we got very obsessed with the idea of how to protect ourselves in this country. Should there... should we close borders? Should we screen people at airports and have mandatory quarantine? And in the midst of all that debate and kerfuffle and confusion, there's a tendency to forget that no matter what we do in this country, the right thing to do and the necessary thing to do for all concerned is to give all possible aid and support to ending the epidemic in West Africa. We can institute airport protocols in this country, but we will never completely protect ourselves from the possibility of an infected person arriving until the epidemic has ended in West Africa. And equally or more important, we need, on sheer humanitarian grounds, because it's the right thing to do, we need to continue sending help, to send more help, the entire international community. We need to be sending more help, more material, more experts, more brave volunteers, health care experts, to West Africa to stop this epidemic there. Nobody will be completely safe anywhere in the world until this outbreak ends in West Africa. Michael Slate: You know, and quite frankly, even if we were safe, it wouldn't be worth it if it was at the cost of all these people in Africa just continually dying and who knows what happening there in relation to this. David Quammen: Amen to that, Michael. Michael Slate: You know, I was reading the Los Angeles Times last week and they had an article about, well, hallelujah, the people who get Ebola in the U.S. aren't dying. And they talk about the reason is because we have the equipment, we have the facilities, we have this. And then you look at the listing of the equipment that's required to actually save a life and it's not rocket science. David Quammen: Yes. That's right. Michael Slate: You know, it's like yes, there's advanced stuff, but there's like just the right type of tubing and the various machines to deal with the disease as it progresses. And it's concentrated in these metropoles in the U.S. and Western Europe, but the rest of the world has no access to that at all. And it was really stunning to me. David Quammen: That's right. That struck me, too. And the fact that the case fatality rate seems to be going down, that we've had much better than 50 percent case fatality in this country so far is a reminder—and I may have said this in my book, I can't remember—but it's a reminder that what's been happening in West Africa doesn't just tell us about the ugly facts of the Ebola virus, it tells us about the ugly facts of poverty and underserved populations and absence of decent health care in those countries in West Africa. That's what it represents, as much as anything. Michael Slate: All right, David, thank you very much for joining us today. David Quammen: Yes, thanks very much. And, yes, good questions. I'm glad that we got to dig into it a little deeper than usually is possible. A real pleasure to talk with you. Michael Slate: You, too, man. Thanks a lot.