VT Medicine: Concerns Regarding Ebola

Concerns Regarding The Ebola Virus

“We saw a gigantic worm like-structure — gigantic by viral standards. It’s a very unusual shape for a virus.To some it might be considered wormlike, to others serpentine.” … Peter Piot

… by Dr. Lawrence Broxmeyer, M.D.

Referenced by Jeff Smith, Science Editor, Veterans Today

The CDC recently declared:

“Diagnosing Ebola in a person who has been infected for only a few days is difficult, because the early symptoms, such as fever, are nonspecific to Ebola infection and are seen often in patients with more commonly occurring diseases, such as malaria and typhoid fever.”

Only a sin of omission then would explain why anyone or any group would not want to specifically mention the most commonly occurring cause of infectious death in Africa — tuberculosis — whose sky-high rates in West Africa make Ebola look like a dropper-full of water squeezed into the Mississippi.

If by October, 2014, Ebola had laid claim to what some say is 3,000-plus deaths since its February outbreak, certainly this ought to be weighed in the light of the approximately 600,000 Africans killed by TB in the same time-frame.

Furthermore, although TB incidence is decreasing globally, incidence rates are increasing in most of West Africa1 — ground zero for the current Ebola outburst. Just as curiously, almost half of all TB cases in the West African Ebola zone are caused by an unusual, yet just as deadly member of tubercular family,Mycobacterium africanum — a strain of tuberculosis exclusive to West Africa, which is fast becoming a microbe of great public — and now possibly global concern.

Surely the CDC is aware that there is not a sign or symptom of Ebola, including its hemorrhagic tendencies that cannot be found in acute disseminated miliary (blood-bourne) tuberculosis, once called “galloping consumption” — the single most feared form of the disease ever. And most likely it is also aware that such tuberculosis has its own viral-like forms, some of which can simulate the Ebola. Such viral TB is generally acknowledged to be TB’s preferred form — as a survival strategy to storm any inclement conditions the microbe might find itself in.2

Then why did the CDC not mention TB, by name, in their short-list of possibilities that could cause Ebola-like symptoms? If such oversight stopped there it would be unremarkable, but it seems to have been carried over in the very design of the most recent diagnostic tests issued to detect Ebola.

Mycobacterium Africanum Cases in California

Photo: National Institute of Health

In September of 1978, about 40 years ago, a team — including a 27-year-old medical graduate, training as a clinical microbiologist at the Institute of Tropical Medicine in Antwerp, Belgium, received a blue thermos from Zaire. It was filled with the two 5ml. clotted blood specimens of an African-based Flemish nun.

The Belgium doctor who sent it, Jacques Courteille, practicing in Kinshasa, included a note saying that he was at a complete loss for the nun’s mysterious, yet deadly illness. Also, could the samples be tested for Yellow Fever? This thermos had traveled from Zaire’s capital city of Kinshasa, on a Sabena commercial flight to Belgium — inside its deliverer’s hand luggage.

When the samples were received, Peter Piot, the 27-year-old medical graduate and his colleagues, among other things, placed the blood samples under an electron microscope. Piot: “We saw a gigantic worm like structure — gigantic by viral standards. It’s a very unusual shape for a virus, only one other virus looked like that and that was the Marburg virus.”

But the new “virus” needed a name. Piot relates the interesting tale of how Ebola came to be named as Ebola:

“On that day our team sat together late into the night we had also had a couple of drinks discussing the question. We definitely didn’t want to name the new pathogen “Yambuku virus”, because that would have stigmatized the place forever. There was a map hanging on the wall and our American team leader suggested looking for the nearest river and giving the virus its name. It was the Ebola River. So by around three or four in the morning we had found a name. But the map was small and inexact. We only learned later that the nearest river was actually a different one. But Ebola is a nice name, isn’t it?”3

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Pere Piot has been in this fight from the beginning

It depends upon how you look at it. Piot’s specimens proved negative for Yellow Fever and he mentions that the tests for Lassa fever and typhoid were also negative. What, then, could it be?

Piot: “To isolate any virus material” small amounts of the blood samples were injected into VERO cells and into mice. Several of these mice subsequently and abruptly died — “a sign that a pathogenic virus was probably present in the blood samples that we had used to inoculate them.”

The fact that the mice died did not mean that it was at the hands of a “pathogenic virus”. Piot’s boss, Stefaan Pattyn, who Piot admitted “could be a bit of a bully”, supposedly specialized in the study of mycobacteria — tuberculosis and leprosy, yet seemed unaware of the hemorrhagic consequences of acute TB, nor had he taken the time to use special stains and cultures to detect its viral cell-wall-deficient forms.

Instead Pattyn followed his current passion. He had recently worked in Zaire for six or seven years and exotic viral illnesses were now “right up his alley”. So Pattyn’s team likewise never really considered a strain of acute milliary TB or its viral cell-wall-deficient forms in his rule-outs for an acute hemorrhagic or epidemic fever — among them

Mycobacterium tuberculosis and Mycobacterium africanum.

The Ebola of its day on steroids, “galloping” acute consumptive tuberculosis could kill in days — the mere memory of which, just a few generations ago, brought terror to the faces of those who had witnessed and were describing it. Dubos made clear that “galloping consumption” was not an isolated, but a frequent diagnosis in the 19th and early 20th centuries.4

And despite persistent myths to the contrary, in the early phase of any new TB epidemic from a new and virulent strain, tuberculosis manifests itself as an acute disease and only much later as the chronic pulmonary tuberculosis that we know in today’s western world.

An example of this can be found in the high mortality during the 1918 influenza pandemic, when African-Americans were brought to fight in France during World War I — large numbers of them dying from a fast-tracked tubercular “galloping consumption.”

Many often underestimate the speed, contagiousness and ferocity of a TB epidemic. Khomenko’s 1993 study5should have cemented the notion that the explosive contagiousness of just such Ebola and influenza-like viral forms of tuberculosis are exactly the stuff that previous epidemics and pandemics could have been made of. But it didn’t.

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I know, seeing is believing; but this is the first time an official announcement is made in regard to this and why not?, we can maybe allow ourselves to be hopeful however thin hopes are.

This graphic novelist tells the true story of climate change

If Philippe Squarzoni knows one thing, it’s that a book can’t change the world. When the French graphic novelist — whose work tackles such hard-hitting topics as the Zapatista movement in Mexico and homicide rates in Baltimore — decided to put together a 500-page tome on climate change, he did so, he says, not out of any kind of activist agenda, but because “je ne pouvais pas ne pas le faire” — “I couldn’t not do it.”

He never thought it would alter the trajectory of things, change anyone’s mind, or make people care. Nope: He claims it was simply because the problem was so vast and so all-encompassing. The more he learned about it, the bigger and scarier it got, and he just couldn’t to put it down.

“It’s climate change that chose me,” he says. “I didn’t choose anything.”

Climate Changed: A Personal Journey Through the Science was published this spring in the U.S. The original French title translates as “Brown Season,” which refers to that lifeless, muddy interval between winter and spring, and, as Squarzoni told OnEarth Magazine, “I feel like humankind is in a similar state of transition.”

The hefty illustrated primer is a sort of memoir, tracing Squarzoni’s own process as he learns about climate science and politics. Along the way, he weaves in personal moments with his life partner, his dog, his travels, and his favorite movies. He explains and depicts everything from atmospheric science to the Intergovernmental Panel on Climate Change, from climate disasters to renewable energies, adding in his own reflections and ruminations about it all. Squarzoni is interested in political discourse, but he’s not taking sides. He’s not an environmentalist or a scientist or a policy advocate.

“I present myself very modestly to my readers,” he says. “These questions are new to me, but they’re not new questions — the environmental movement has been asking them for 40 or 50 years. I think that if this book works for the reader, though, it’s precisely because I’m in this position: I myself am discovering things.”

The book is thoughtful and ponderous, dense and poetic, and approaches climate change from the perspective of someone who cares, and is afraid and angry, but who, like all of us, can’t possibly care and be afraid and be angry every single minute of his life. It won l’Academie Francaise’s 2012 Leon de Rosen prize, an environmental award given to a book or essay; this is Squarzoni’s first book to be translated and published in the United States.

I chatted with Squarzoni about his motivation for the project, his current views on climate change and political will, and his very, very faint glimmer of hope for our future. Below is a translated and edited version of what he had to say:

So, why climate change?

Well, I would have loved not to have done this book, I would love for this problem not to exist. I discovered it while working on my previous book, which was a retrospective on what [former French president] Jacques Chirac had done during his time in office. In the process of trying to assess his administration’s environmental action — or rather, lack of action — I realized that when it came to climate change, I had a very superficial understanding. I knew next to nothing. And I started to do a little research, and when I started to realize the nature of the problem and its gravity, I realized that I couldn’t do it justice in a few pages; it was an enormous problem that touched every aspect of our lives. And that gave birth to the book. Almost in spite of me, really.

Climate change is an enormous problem; it supplants all the others. Everyone has heard about it, but we really don’t know what it means. And there are all different kinds of solutions that all mean something different politically. Certain solutions are dead ends, certain solutions drive a vision for society that I don’t really agree with, and certain solutions drive a vision for society that I do agree with, but that still causes climate change. That’s what I wanted to explore.

It’s a tough topic. You spent six years working on it. Was it hard to keep going?

There were difficult moments. There were moments when I was so saturated with negative information. And I’m like everyone: There are moments when you’re working and you don’t have your mind on your work. You’ve got to do all these pages on global warming but you don’t have your mind on global warming. You have other personal problems, other worries. There are days when global warming keeps me from sleeping. And there are days when I want nothing to do with it.

It’s what I tried to say in the book: The problem with global warming is that you simply can’t be afraid all your life.

I put myself in the shoes of the climate scientists who work every day on this stuff, and I say to myself, “Those people have to learn about all this bad news, and after dozens of years to see that nothing has changed… I wonder how they do it!” Every day they learn that emissions are increasing, that the situation is getting more and more complicated, and worse than we thought, because the projections about the consequences of global warming are getting more precise, to the point where there isn’t any more doubt, but… what is going to change?

But at least for you… ? Did this process change anything in your own life?

Everyone wants to know that, because everyone wants to know what they can do about this — what they can change in their daily lives. And there really isn’t anything I do differently except that I almost never take airplanes anymore. There’s not a lot that one can do. In my life, anyway, there isn’t much to change. I don’t have a driver’s license, I don’t have a car, I work at home. The are certain dilemmas I can avoid. But if I had to drive to work, I’m sure after writing this book I would have started taking public transportation.

What changed for me really is that I realized to what extent this theme is absent from political discourse. When I think about big political questions, I know that I have to add in questions about the climate, but it’s enormously absent in France right now. It’s a topic that has totally disappeared because of the subprime mortgage crisis, because of the public debt crisis, because of the European financial crisis, et cetera. People only talk about boosting economic growth. And then the old-school drivers of the economy are the ones polluting and creating global warming! Converting our energy systems, reducing energy consumption… Those are words you never hear, never, never.

When Al Gore’s film came out, when the 4th report of the Intergovernmental Panel on Climate Change came out, people were talking a lot about the climate; now, it’s a topic that’s pretty much disappeared from public discussion. And I’m terrified.

Publishing a book is talking about it, at least a little bit, right? You don’t think that makes any difference in the global conversation?

I’ve never seen that happen! The arts are a reflection of the culture of an era and if we are discussing global warming, then the artists are going to investigate that, too. And there will be films, and there will be books, and there will be comic books. But I don’t think that a film on its own, a book on its own, is going to change things. Al Gore’s film is unfortunately proof of that. People were talking so much about him! A lot of people saw it. In France it was screened at the National Assembly, in front of deputies, who the next day told the press, “I didn’t know things were so bad.” And then, three days later, everything went back to its place, and the [economic] machine started turning the wrong direction all over again. So, no, I don’t think that a book or a film on its own can change things. But it’s not to change things that I did this book.

OK, OK. But isn’t there any kind of hope here? Please tell me that all this research gave you a little something to hold on to.

One surprise for me is that although the wall we’ve got to climb is very, very high, we can still climb this wall. The caricature of the environmental movement is like, “Oh, you want to go back to candles, you want to stop using cars,” et cetera. But we’re wasting so much energy that we could basically be at our same standards of living, we could reduce our energy consumption without it having a huge impact on us. (Well, in the U.S., you’d probably have to change a lot of things because the energy consumption is really incredible there…) But in France, we can, without reverting to the Middle Ages, just by using more efficient systems, by paying attention, we can in fact reduce our levels of energy consumption to levels that would work for the climate. The bad news is that we’d need to bring in so many more liberal politicians that it’s very unlikely that we’d put them in place in the time we’ve got left… before things start becoming very complicated.

That doesn’t sound much like hope.