The Ebola virus

The Ebola virus

CDC/Dr. Frederick A. Murphy/Wikimedia Commons

U.S. declares war on Ebola epidemic

Mark 16 September 2014 as the day the United States declared an all-out war on the Ebola epidemic raging in West Africa.

As President Barack Obama explained in remarks he made today at the U.S. Centers for Disease Control and Prevention (CDC) in Atlanta, the world is looking to the United States for help. “It’s a responsibility we embrace,” Obama said. “We’re prepared to take leadership on this to provide the kinds of capabilities that only America has, and to mobilize the world in ways that only America can do.  That’s what we’re doing as we speak.”

At the same time Obama was speaking in Atlanta, the U.S. Senate held an Ebola hearing that featured testimony from leading public health officials and perhaps the world’s most famous Ebola survivor, Kent Brantly, who became ill with the disease while treating patients in Liberia in July. “We must take the deadly dangerous threat of the Ebola epidemic as seriously as we take ISIS [Islamic State in Iraq and Syria],” said Senator Lamar Alexander (R–TN).

The centerpiece of  what Obama called “a major increase in our response” indeed is the U.S. military, which in cooperation with the Liberian government will set up a command center in Monrovia led by U.S. Army Maj. Gen. Darryl Williams. As Obama explained, the military will set up a command and control, logistics and engineering to support civilian organizations working in the region. “Our Armed Services are better at that than any organization on Earth,” Obama said.

The U.S. response will focus on providing beds for Ebola patients—which are almost nonexistent in Liberia—isolation spaces to hold people when Ebola Treatment Units have no space, more trained health care workers, an air bridge to move people and materiel into West Africa more quickly, and kits to help families with infected people in the house both care for an ailing person and protect themselves from infection. “We can’t dawdle on this one,” said Obama, who urged the global communities to dramatically step up their response, too. “International organizations just have to move faster than they have up until this point.” (This fact sheet explains the details of the revamped U.S. response.)

At the 3-hour-long Senate hearing—which, in an unusual move, was jointly held by an appropriations subcommittee and the Committee on Health, Education, Labor and Pensions—topics ranged from financing the effort to the need for a greater sense of urgency, public health and scientific issues, and personal experiences. Beth Bell,  who directs CDC’s National Center for Emerging and Zoonotic Infectious Diseases, described the epidemic in Liberia, Sierra Leone, and Guinea as “ferocious and spreading exponentially,” so severely crippling the health care systems in some locales that malaria can’t be treated and infants cannot safely be delivered.

Today’s situation report from the World Health Organization estimates that there have been nearly 5000 cases, nearly half of whom have died, but Bell says CDC believes “actual numbers would be two to three times higher.” She stressed that we have the tools to stop this epidemic but that the window of opportunity is closing. “If we do not act now to stop Ebola we could be dealing with it for years to come affecting larger areas of Africa,” she said.

Senators repeatedly asked Anthony Fauci, head of the U.S. National Institute of Allergy and Infectious Diseases, whether the Ebola virus might mutate into a more dangerous form and even spread through the air. “We’re watching that carefully,” Fauci said. He explained that like all RNA viruses, the one that causes Ebola makes a lot of mistakes when it copies itself, but most of these mutations do nothing. “It is an unusual situation where a mutation will completely change the way that a virus is transmitted,” said Fauci, stressing that it was not impossible but highly unlikely. “What is likely is if we don’t do what we’re doing now, in the sense of a major ramping up of infection control capability, including what we’re hearing about getting the military heavily involved with all of the things they bring to the table … it’s going to get worse and worse,” Fauci said. “A virus that doesn’t replicate can’t mutate.”

The U.S. Department of Defense is hoping to reprogram $500 million to Ebola efforts. The Obama administration has asked Congress to pass a continuing resolution that will give $30 million more dollars to CDC to use through 11 December, and $58 million to the Department of Health and Human Services to support development of experimental vaccines and treatments. The continuing resolution has passed the House of Representatives, and Senator Tom Harkin (D–IA), who chaired the joint committee hearing, said he expects the Senate to pass it “in the next day or two.” But Harkin and others stressed that more money will be need for the fiscal year 2015 budget. “I hate to say this but Ebola will not be conquered in the 10 weeks of the continuing resolution.”

Harkin and other senators expressed surprise at the lack of a clear leader for the overall U.S. effort against Ebola. “I’m kind of startled to find that out,” Harkin said. Senator Barbara Mikulski (D–MD) said this was an issue the Senate needed to take up with Obama. “We need a point person,” Mikulski said. “If we wanted to meet with the person in charge, who would be the person in charge?”

The hearing ended with testimony and questions of Brantly, an American doctor with Samaritan’s Purse who was airlifted from Monrovia to Atlanta for state-of-the-art care and is doing well today. Brantly, who met with Obama in the Oval Office this morning, spoke of the many people he treated who died of Ebola and the urgent need for healthcare workers from other countries to go help in West Africa.

“Many, including one of the senators today, used the analogy of a fire burning out of control to describe this unprecedented Ebola outbreak,” Brantly said. “Indeed it is a fire. It is a fire straight from the pit of hell. We cannot fool ourselves into thinking that the vast moat of the Atlantic Ocean will protect us from the flames of this fire. Instead we must move quickly and immediately to deliver the promises that have been made and to be open to practical, innovative interventions. This is the only way to keep entire nations from being reduced to ashes.”

*The Ebola Files: Given the current Ebola outbreak, unprecedented in terms of number of people killed and rapid geographic spread, Science and Science Translational Medicine have made a collection of research and news articles on the viral disease freely available to researchers and the general public.

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