What We’re Afraid to Say About Ebola

[Warren DeMontague]

82. Let me start by saying that this ebola outbreak is something I've been worried about since April.

When there were little or no indications that it was going to be any different, substantially, than previous outbreaks, which have all been fairly quickly contained.

I claim no special insight; rather, like a character in a star wars flick, I've just had a bad feeling about this.

And, by even the most conservative estimations, it is set to be a catastrophe- hitting precisely the poorest, most ill equipped countries and health systems it possibly could.

Simply by spreading how it normally does, this outbreak is likely to take a simply horrific toll on the populations of Guinea, Sierra leone, and particularly Liberia. And make no mistake, it could spread elsewhere- it has, and it likely will again. Much will depend on how well those further outbreaks are contained, and how quickly.

There has been talk, like the osterholm piece, of the potential of ebola to mutate into an airborne mode of transmission- and likewise other prominent voices have come forth to calm the alarm by suggesting it is not terribly likely. I am not a virologoist so I don't really know, but I have done some reading and try to stay well-informed about the science. I'll say a couple things- one, ebola scares the fuck out of me, as it should any human, since the zaire strain at least has traditionally had up to a 90% lethality rate- although in this epidemic it has been running around 50-55%. Which indicates, perhaps, that it already HAS mutated, mutated in such a way to lessen the "burn-out" of previous outbreaks, perhaps by not killing as quickly, or effectively. Word on the ground is that the ebola currently infecting west Africans does not produce, at least as often, the gruesome "bleed-out" hemorrhagic end stage that is so horribly described in books like The Hot Zone.

Edited to add- as for evolving in a way that would require less viral load for infection- according to some accounts of the virus, it already is incredibly infectious, at least in terms of viral load. It would be hard for me to imagine how it could get any moreso, since as it is I dont believe it takes much virus exposure to produce infection anyway.

So a few things-

One, if it does have the potential to become airborne, it does not seem to have done so yet. If it had, i believe we would know. And fairly quickly.

Two, as others have noted in response to the Osterholm piece- ebola mutating to an entirely different mode of transport would be fairly unprecedented in the viral world. Early in the AIDS crisis there was fear of that virus doing the same. As we can see, that never happened. The ebola virus is big, in virus terms- and it is a strange, if particularly lethal, fucker. Basically a strand of RNA in a protein tube, that steals the lipid cell lining of its host for its own outer coat- which explains why the hosts cells burst so spectacularly, and nastily, in large numbers when the virus really takes hold. But what this means is that, design wise, it is fundamentally unlike a spherical flu virus wrapped in an ever-changing protein ball. Evolving to be able to survive in the air as a flu virus does, would likely require more than just a series of random mutations. At least, I hope.

Three, yes, as was extensively detailed in the Hot Zone, there has been evidence of the Reston strain of ebola being transmitted by air, by animals, in closed situations. This may be relevant to the human experience with ebola, it may not.


The bottom line is that at best this is a massive humanitarian crisis for west africa and it is the responsibility of the rest of the species and planet to come to their immediate aid, and when and if this is all over, not leave them with the shamefully inadequate health systems they went into this with. Because as we see, it is all our problem.