The Institute of Medicine and the National Research Council convened a workshop earlier this week in Washington, DC, to set research priorities for domestic Ebola disease, but the outbreak in West Africa—and the answers it could provide—permeated the proceedings.
“There’s no way to not bring this back to West Africa,” said Daniel Bausch, MD, MPH, a Tulane specialist in tropical medicine and infectious diseases, who recently returned from Guinea and Sierra Leone where, as a World Health Organization (WHO) consultant, he cared for Ebola patients.
Bausch and many of the other speakers expressed frustration about how little is known about the virus behind the current Ebola outbreak, the largest in history.
One example: Bausch chaired the committee that a few days ago updated the WHO guidelines about personal protective equipment (PPE), based mainly on interviews with health care workers returning from West Africa, not on scientific evidence. “It was all opinion,” he said.
Although the conventional wisdom is that people are no longer infectious once they’ve recovered from Ebola, “we haven’t talked much at all about the possibility of transmission after recovery,” said James LeDuc, PhD, director of the Galveston National Laboratory, a biocontainment facility at the University of Texas Medical Branch (UTMB) in Galveston. “I think that deserves a little more discussion.”
There’s also been a lot of talk about whether the Ebola virus can be transmitted through the air, said Vincent Munster, PhD, chief of the Virus Ecology Unit at the National Institute of Allergy and Infectious Diseases.
Should health care workers be concerned about catching Ebola if a patient coughs on them in close quarters? Probably not, given the epidemiological data, Munster said.
Contact with body fluids remains the most likely transmission route, he said, but research into Ebola virus in the respiratory tract and the stability of the virus in droplets and on surfaces is needed. If the virus is found to be carried in droplets of vomit, then you protect against that, Munster said. “It’s not really rocket science.”
However, workshop chair Lynn Goldman, MD, MPH, dean of the Milken Institute School of Public Health, said it would be “extraordinarily complex” to measure Ebola virus in airborne droplets.
Research is also needed into which disinfectants work best on different types of surfaces and how long they need to be applied to inactivate Ebola, said John Howard, MD, MPH, JD, director of the National Institute for Occupational Safety and Health.
What Bausch called “an experiment that desperately needs to be done” in West Africa could help answer some questions. Instead of taking samples of body fluids from patients “on the fly,” he said, take daily samples of every body fluid possible from the first day of symptoms to assess excretion of the virus.
“Technically, that’s not particularly difficult,” Bausch said. But try writing while wearing cumbersome PPE gloves, he said, citing the need for high-tech methods of collecting and transferring data.
Plus, who’s going to collect those samples, considering the low ratio of health care workers to patients in West Africa? asked Thomas Ksiazek, DVM, PhD, director of high containment laboratory operations at the Galveston National Laboratory and a codiscoverer of the virus associated with severe acute respiratory syndrome. “It seems like we have to create some infrastructure that will allow us to ask some of these questions,” Ksiazek said.
“CDC has 325 employees over there,” said C.J. Peters, MD, director for biodefense at the Center for Biodefense and Emerging Infectious Diseases at University of Texas Medical Branch. “Surely they could spare a dozen.”
Despite all the unknowns, US hospitals are aggressively preparing to care for Ebola patients, even though it’s unrealistic to have a treatment unit at every single one, Bausch said.
Those efforts have far-reaching consequences, said Donna Gallagher, PhD, MSN, founding coordinator of the Office of Global Health at the University of Massachusetts. Because US hospitals have stocked up on PPE, it is in short supply in West Africa, Gallagher said.
“If you have every hospital in the United States prepared to take care of Ebola patients,” Howard said, “the supply chain is going to dry up for when you actually need it.”