Science Writer Says Outbreak Is 'Part of a Pattern' of Emerging, Deadly Diseases
BY ANDREW FREEDMAN
Mashable.com
David Quammen is a science writer who has spent years traveling the globe, researching emerging viruses and the people who study them.
These viruses are officially known as zoonotic viruses, as they live in an animal host and occasionally jump to, or "spill over" into human beings. Quammen's 2012 book on the subject, Spillover, won an award from the National Association of Science Writers, and was shortlisted for three others.
He is the author of the timely forthcoming book: Ebola: The Natural and Human History of a Deadly Virus.
Mashable spoke with him by phone from his home in Bozeman, Montana, to get his thoughts on the ongoing Ebola outbreak. This interview took place before Dallas Ebola patient Thomas Eric Duncan passed away and the second Ebola case was diagnosed in that city.
This interview has been lightly edited and condensed for brevity.
Mashable: You’re someone who has researched this stuff for a very long time — as somebody who has looked at these emerging diseases, Ebola being one of them, seeing this play out right now, what are you feeling as you observe this, how should the public at large be thinking about this?
Quammen: I try and tell people, as I tried to tell them in this Ebola book, that this is not a one-time deal — this is not a one-off situation — this is part of a pattern. These outbreaks, or epidemics, are going to continue. Although it’s extremely important that we get control of this current Ebola epidemic and bring it to an end, that’s not going to be the end of the story. That’s not going to be any final solution because next year, or the year after, there’ll be another viral outbreak that either turns into an epidemic or threatens to. So that’s the first thing, but of course nobody wants to hear that right now, because everyone is so concerned about and obsessed with Ebola — and I understand that, it’s a horrible situation.
Another thing is, people are saying, “How worried should we be?” and they want to know exactly how scared they should be, and what they should be scared about, and I say, “We should be worried that Ebola is going to kill thousands of more West Africans. But the likelihood it will kill thousands of Americans is extremely low. But now there’s this case in Dallas, and the case in Dallas has been badly mishandled, and that has fueled fears even more. Now people are saying, well I want to protect my children, we should close the borders, whatever they’re saying. They’re confused and scared.
The facts are, still, that Ebola doesn’t transmit from human to human very readily. But, the people who made mistakes in Dallas certainly aided the possibility of it affecting more people in Dallas, and there may be more cases and that will scare people even more.
One of the things this brings to mind is what a health official in Uganda told me probably six years ago when I visited Uganda right after their most recent Ebola outbreak. And he was talking to me, his name was Sam Okware, and he described to me how this outbreak began in Western Uganda. A few sick animals, and then it got into people, and then it spread through a village. And then there was the second epidemic: And the second epidemic was fear. And then there was the second epidemic: And the second epidemic was fear. People became really, really fearful. They started to ostracize survivors and family members. They wouldn’t take money from people who had had Ebola in the family, and there was a social breakdown. And a social breakdown is not protective.
When people get really fearful and suspicious of one another, and there is this social breakdown, that doesn’t help anybody. That kind of suspicion and that kind of sudden urge for isolating oneself from the problem is not a solution to the problem. Isolation is very important on the case level, but you can’t effectively isolate neighborhoods and you can’t isolate countries in the world we live in — we’re just so interconnected.
If Ebola isn't the virus we should be worried about, what is?
Of the diseases that you looked at in Spillover, and that are still lurking out there for some future event, what is thought of in the epidemiology community and in your mind as the most likely to be what people fear Ebola is — which is a much more easily spread, pandemic type of deal?
I’ve asked exactly that question to the experts, and I talk about this at the end of Spillover, and the experts that I trust say a few things — they say first of all, it will be a zoonotic virus. It will be a new virus that comes out of an animal host somewhere. It will probably be respiratory—something that passes on a sneeze or a cough and hangs in the air rather than something that requires sexual contact or contact with bodily fluids. It will be probably a single-stranded RNA virus.
And that means one of a certain limited number of families of viruses that, because they have their genomes on single stranded RNA, they have higher mutation rates, and therefore have higher rates of adaptation. Therefore, they have the potential to adapt better and quickly to human hosts and to transmission from one human host to another. And lastly, they said it will probably be something that’s related to things that have already caused outbreaks or epidemics in humans.
So if you put those characteristics together, and lay them down on all the possibilities, it brings your focus to a small number of groups or families of viruses that includes the corona viruses — and that’s the family that encompasses the SARS virus, and also the MERS virus that came out of Saudi Arabia last year. And that, parenthetically, is the reason people paid so much attention to MERS. Because they thought, oh this is a corona virus in the same family as SARS and thought, “This could be the one.” And its association with the Arabian peninsula and with camels as the possible host caused people to be really scared about the prospect that it could go tearing through the hajj, where you have millions of people gathered together in close quarters. But it did not tear through the hajj, so they breathed a little easier.
But that’s the reason they were watching it so carefully, because it fit this profile — single-stranded RNA virus from an animal belonging to the coronavirus family. There is also the pair of myxoviruses that includes measles and a couple of things out of Asia and Australia that I write about in the book. Nipah virus from Malaysia and Bangladesh, and Hendra virus from Australia.
Nipah virus is a virus that is of great concern to the experts because, again, single-stranded RNA is a myxovirus, a group that is known to be able to spread epidemically, and there is some transmission from human-to-human apparently by the respiratory route. Although, it hasn’t so far proven really transmissible. And finally, the last big category in that group is the influenzas. And the experts still believe that influenza is more likely to kill millions of people than probably any other virus.
If you’re sitting in Florida or Massachusetts or Montana, you’re probably more likely to die of influenza in the next year than of Ebola you’re probably more likely to die of influenza in the next year than of Ebola. I said this to a microbiologist recently, and he said, "no, [you're] MUCH, MUCH MUCH more likely to die of influenza than to die of Ebola!"
So the point is not to dismiss or belittle people’s fears about Ebola, but to put that in a broader perspective and say yes, we should be very concerned about this whole category of viruses. And yes, we’ve got to control Ebola, but we’ve got to treat this as a warning alarm and a dress rehearsal for the next one, which is going to be even more dangerous.
You know, seeing this come to the United States and the reaction here, I’ve just been struck by how the reaction here at least in the Dallas area has not been that different, at least in terms of the psychological reaction [fear and ostracism of those associated with the victims], than it is in Africa?
I’ve been struck by that too, and I don’t know if I’ve said that in one of these earlier interviews, I think i did. In Africa, there’s a tendency to ostracize people and just think that by slamming the front door you can make the problem go away. But eventually you’re going to have to go back out of your front door and buy food, do something to earn a living, and Ebola will still be there. So, and the people in Dallas now, they’re very scared, and i’m getting angry emails from some of those people who are scared, they’re not necessarily in Dallas but they’re scared because now it’s in America and we never should’ve let it in and we should close our borders.
That brings us back to that starting point. We can’t close our borders — how can we do that? If we close our doors to West Africa that means no more expertise and no more medical volunteers go into West Africa and those american medical experts and volunteers in West Africa can’t come back out of West Africa and that’s just gonna make the whole thing worse.
Are there any other thoughts, you know, in looking at this, anything else that comes to mind that I didn’t ask about? You have a unique view, with having traveled so extensively and done such, just really in depth research on this, but also the other emerging diseases that we see, that you want to get across to people?
First of all, I think that if you think about this problem from a healthy distance or if you think about it in a broad context then you see that there are three problems here. The first is the problem of spillover, the second is the problem of transmission and the third is the problem of evolution. The first problem, spillover, is that this came into humans from some animal host because humans were destroying forests or killing animals or handling bats or whatever.
We still don’t know the reservoir host of Ebola, we don’t know it’s identity, we don’t know for sure that it’s a bat although we suspect that it’s a bat. So, say that it’s a bat, somebody in southeastern Guinea killed and cooked a bat, perhaps, and that person had contact with this 2-year-old boy who was apparently the first case back in December of 2013, and that began the whole chain of infection. But nobody is interested in that right now, because this whole West African outbreak comes from a single spillover, just one animal to one human transfer, we know that from genetic terms, it all results from a single spillover ...
The second problem is transmission, human to human, we’ve got to stop that chain of transmission, that’s what everybody cares about and there haven’t yet been enough resources brought to bear where the chain of transmission is occurring in order to get control of it, to encircle it, to trace all the contacts, to isolate them, and to keep it from spreading from cases to their loved ones and the people around them ...
The Dallas hospital, despite its fecklessness, should be able to isolate this guy, and with help from the CDC, public health authorities should be able to trace the contacts and isolate people and should be able to stop it in Dallas, it shouldn’t be a problem, unless they screw up again. That’s transmission.
The third problem is evolution, and that comes back to the fact that, the higher the case count goes, the more chances the virus gets to mutate. And mutation of the virus is a legitimate issue. mutation of the virus is a legitimate issue. Whether it’s going to mutate to become airborne is another question because it’s a lot of mutational leaps away from being an airborne virus. Bird flu or MERS were much closer, and evolution in them would be a much greater concern because it could get to be both an airborne virus and one that’s extremely lethal.
Ebola is not one that is close to being airborne but that’s not to say that it’s impossible for it to achieve that kind of evolution. It might also evolve in a different way, it might evolve, for instance, it doesn’t cause headache, it doesn’t cause fever, but it builds up in a body and all of a sudden, it causes a person to vomit. Or it builds up in saliva and then if a person coughs then it is spread even better than it is currently spread, and that sort of evolution could increase its rate of transmission and that would be a big concern.
Part of the nightmare virus scenario is a virus that is infectious before it is symptomatic, so that you have people walking around feeling well enough to go to work, to ride the subway, and yet they are shedding virus. That’s the nightmare scenario, and it’s the nightmare scenario that was presented in the movie Contagion…. it may not be a great movie, but the science was very careful in that.
BY ANDREW FREEDMAN
Mashable.com
David Quammen is a science writer who has spent years traveling the globe, researching emerging viruses and the people who study them.
These viruses are officially known as zoonotic viruses, as they live in an animal host and occasionally jump to, or "spill over" into human beings. Quammen's 2012 book on the subject, Spillover, won an award from the National Association of Science Writers, and was shortlisted for three others.
He is the author of the timely forthcoming book: Ebola: The Natural and Human History of a Deadly Virus.
Mashable spoke with him by phone from his home in Bozeman, Montana, to get his thoughts on the ongoing Ebola outbreak. This interview took place before Dallas Ebola patient Thomas Eric Duncan passed away and the second Ebola case was diagnosed in that city.
This interview has been lightly edited and condensed for brevity.
Mashable: You’re someone who has researched this stuff for a very long time — as somebody who has looked at these emerging diseases, Ebola being one of them, seeing this play out right now, what are you feeling as you observe this, how should the public at large be thinking about this?
Quammen: I try and tell people, as I tried to tell them in this Ebola book, that this is not a one-time deal — this is not a one-off situation — this is part of a pattern. These outbreaks, or epidemics, are going to continue. Although it’s extremely important that we get control of this current Ebola epidemic and bring it to an end, that’s not going to be the end of the story. That’s not going to be any final solution because next year, or the year after, there’ll be another viral outbreak that either turns into an epidemic or threatens to. So that’s the first thing, but of course nobody wants to hear that right now, because everyone is so concerned about and obsessed with Ebola — and I understand that, it’s a horrible situation.
Another thing is, people are saying, “How worried should we be?” and they want to know exactly how scared they should be, and what they should be scared about, and I say, “We should be worried that Ebola is going to kill thousands of more West Africans. But the likelihood it will kill thousands of Americans is extremely low. But now there’s this case in Dallas, and the case in Dallas has been badly mishandled, and that has fueled fears even more. Now people are saying, well I want to protect my children, we should close the borders, whatever they’re saying. They’re confused and scared.
The facts are, still, that Ebola doesn’t transmit from human to human very readily. But, the people who made mistakes in Dallas certainly aided the possibility of it affecting more people in Dallas, and there may be more cases and that will scare people even more.
One of the things this brings to mind is what a health official in Uganda told me probably six years ago when I visited Uganda right after their most recent Ebola outbreak. And he was talking to me, his name was Sam Okware, and he described to me how this outbreak began in Western Uganda. A few sick animals, and then it got into people, and then it spread through a village. And then there was the second epidemic: And the second epidemic was fear. And then there was the second epidemic: And the second epidemic was fear. People became really, really fearful. They started to ostracize survivors and family members. They wouldn’t take money from people who had had Ebola in the family, and there was a social breakdown. And a social breakdown is not protective.
When people get really fearful and suspicious of one another, and there is this social breakdown, that doesn’t help anybody. That kind of suspicion and that kind of sudden urge for isolating oneself from the problem is not a solution to the problem. Isolation is very important on the case level, but you can’t effectively isolate neighborhoods and you can’t isolate countries in the world we live in — we’re just so interconnected.
If Ebola isn't the virus we should be worried about, what is?
Of the diseases that you looked at in Spillover, and that are still lurking out there for some future event, what is thought of in the epidemiology community and in your mind as the most likely to be what people fear Ebola is — which is a much more easily spread, pandemic type of deal?
I’ve asked exactly that question to the experts, and I talk about this at the end of Spillover, and the experts that I trust say a few things — they say first of all, it will be a zoonotic virus. It will be a new virus that comes out of an animal host somewhere. It will probably be respiratory—something that passes on a sneeze or a cough and hangs in the air rather than something that requires sexual contact or contact with bodily fluids. It will be probably a single-stranded RNA virus.
And that means one of a certain limited number of families of viruses that, because they have their genomes on single stranded RNA, they have higher mutation rates, and therefore have higher rates of adaptation. Therefore, they have the potential to adapt better and quickly to human hosts and to transmission from one human host to another. And lastly, they said it will probably be something that’s related to things that have already caused outbreaks or epidemics in humans.
So if you put those characteristics together, and lay them down on all the possibilities, it brings your focus to a small number of groups or families of viruses that includes the corona viruses — and that’s the family that encompasses the SARS virus, and also the MERS virus that came out of Saudi Arabia last year. And that, parenthetically, is the reason people paid so much attention to MERS. Because they thought, oh this is a corona virus in the same family as SARS and thought, “This could be the one.” And its association with the Arabian peninsula and with camels as the possible host caused people to be really scared about the prospect that it could go tearing through the hajj, where you have millions of people gathered together in close quarters. But it did not tear through the hajj, so they breathed a little easier.
But that’s the reason they were watching it so carefully, because it fit this profile — single-stranded RNA virus from an animal belonging to the coronavirus family. There is also the pair of myxoviruses that includes measles and a couple of things out of Asia and Australia that I write about in the book. Nipah virus from Malaysia and Bangladesh, and Hendra virus from Australia.
Nipah virus is a virus that is of great concern to the experts because, again, single-stranded RNA is a myxovirus, a group that is known to be able to spread epidemically, and there is some transmission from human-to-human apparently by the respiratory route. Although, it hasn’t so far proven really transmissible. And finally, the last big category in that group is the influenzas. And the experts still believe that influenza is more likely to kill millions of people than probably any other virus.
If you’re sitting in Florida or Massachusetts or Montana, you’re probably more likely to die of influenza in the next year than of Ebola you’re probably more likely to die of influenza in the next year than of Ebola. I said this to a microbiologist recently, and he said, "no, [you're] MUCH, MUCH MUCH more likely to die of influenza than to die of Ebola!"
So the point is not to dismiss or belittle people’s fears about Ebola, but to put that in a broader perspective and say yes, we should be very concerned about this whole category of viruses. And yes, we’ve got to control Ebola, but we’ve got to treat this as a warning alarm and a dress rehearsal for the next one, which is going to be even more dangerous.
You know, seeing this come to the United States and the reaction here, I’ve just been struck by how the reaction here at least in the Dallas area has not been that different, at least in terms of the psychological reaction [fear and ostracism of those associated with the victims], than it is in Africa?
I’ve been struck by that too, and I don’t know if I’ve said that in one of these earlier interviews, I think i did. In Africa, there’s a tendency to ostracize people and just think that by slamming the front door you can make the problem go away. But eventually you’re going to have to go back out of your front door and buy food, do something to earn a living, and Ebola will still be there. So, and the people in Dallas now, they’re very scared, and i’m getting angry emails from some of those people who are scared, they’re not necessarily in Dallas but they’re scared because now it’s in America and we never should’ve let it in and we should close our borders.
That brings us back to that starting point. We can’t close our borders — how can we do that? If we close our doors to West Africa that means no more expertise and no more medical volunteers go into West Africa and those american medical experts and volunteers in West Africa can’t come back out of West Africa and that’s just gonna make the whole thing worse.
Are there any other thoughts, you know, in looking at this, anything else that comes to mind that I didn’t ask about? You have a unique view, with having traveled so extensively and done such, just really in depth research on this, but also the other emerging diseases that we see, that you want to get across to people?
First of all, I think that if you think about this problem from a healthy distance or if you think about it in a broad context then you see that there are three problems here. The first is the problem of spillover, the second is the problem of transmission and the third is the problem of evolution. The first problem, spillover, is that this came into humans from some animal host because humans were destroying forests or killing animals or handling bats or whatever.
We still don’t know the reservoir host of Ebola, we don’t know it’s identity, we don’t know for sure that it’s a bat although we suspect that it’s a bat. So, say that it’s a bat, somebody in southeastern Guinea killed and cooked a bat, perhaps, and that person had contact with this 2-year-old boy who was apparently the first case back in December of 2013, and that began the whole chain of infection. But nobody is interested in that right now, because this whole West African outbreak comes from a single spillover, just one animal to one human transfer, we know that from genetic terms, it all results from a single spillover ...
The second problem is transmission, human to human, we’ve got to stop that chain of transmission, that’s what everybody cares about and there haven’t yet been enough resources brought to bear where the chain of transmission is occurring in order to get control of it, to encircle it, to trace all the contacts, to isolate them, and to keep it from spreading from cases to their loved ones and the people around them ...
The Dallas hospital, despite its fecklessness, should be able to isolate this guy, and with help from the CDC, public health authorities should be able to trace the contacts and isolate people and should be able to stop it in Dallas, it shouldn’t be a problem, unless they screw up again. That’s transmission.
The third problem is evolution, and that comes back to the fact that, the higher the case count goes, the more chances the virus gets to mutate. And mutation of the virus is a legitimate issue. mutation of the virus is a legitimate issue. Whether it’s going to mutate to become airborne is another question because it’s a lot of mutational leaps away from being an airborne virus. Bird flu or MERS were much closer, and evolution in them would be a much greater concern because it could get to be both an airborne virus and one that’s extremely lethal.
Ebola is not one that is close to being airborne but that’s not to say that it’s impossible for it to achieve that kind of evolution. It might also evolve in a different way, it might evolve, for instance, it doesn’t cause headache, it doesn’t cause fever, but it builds up in a body and all of a sudden, it causes a person to vomit. Or it builds up in saliva and then if a person coughs then it is spread even better than it is currently spread, and that sort of evolution could increase its rate of transmission and that would be a big concern.
Part of the nightmare virus scenario is a virus that is infectious before it is symptomatic, so that you have people walking around feeling well enough to go to work, to ride the subway, and yet they are shedding virus. That’s the nightmare scenario, and it’s the nightmare scenario that was presented in the movie Contagion…. it may not be a great movie, but the science was very careful in that.
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