Dr. Sanjay Gupta: Or, How I Learned to Stop Worrying and Love Ebola

Ebolavirus is deceptively simple. A mere seven proteins surround and comprise a filamentous capsid, which houses its archaic genetic material: a single strand of non-segmented RNA. Yet, treatment — much less a cure — for the hemorrhagic fever Ebola engenders in humans and primates continues to elude us. Of those unfortunate enough to contract the virus, 50% to 90% will die, and there’s literally nothing we can do to help them.

If the raw numbers don’t frighten you, the symptoms sure as shit will. Ebola — like all Filoviridae — is extremely virulent; a few particles are enough to spark a full-blown infection. Injecting itself into a host cell and hijacking its reproductive proteins and organelles, the virus begins cranking out copies of itself at an exponential rate. When the host cell can no longer contain the replicated virus particles, it bursts. The released particles infect other cells, and the process continues. The mass destruction of tissues causes severe hemorrhaging. In infected persons, the lining of the stomach and intestines are sloughed off, and the victim to begins to vomit and defecate blood boiling hot with Ebola particles. The connective tissues beneath the muscles are eaten away, and without such moorings, the muscle and skin of the face droop cartoonishly from the skull. Weakened veins and capillaries break apart with the slightest pressure, making the administration of intravenous drugs or nourishment, or blood transfusions, a dubious proposition. The surface of the tongue peels off. The whites of the eyes, ravaged by the virus, turn blood red. The body bleeds at such an incredible rate its clotting agents are unable to keep up with demand. Most infected persons die of hypovolemic shock within 10 days of becoming symptomatic. It is a horrible, painful, and humiliating way to go. The only silver lining — and it is admittedly a stretch to call it that — is that the virus attacks the brain and body in equal measure. By the time an infected person crashes and bleeds out, he or she is essentially brain dead.

In a recent piece written for CNN, the affable Dr. Sanjay Gupta ponders the implications of a such a vicious disease. To his credit, the assessment is fairly free of fear-mongering, and more or less in line with scientific consensus.

Key to that is a grim version of good news/bad news: because Ebola tends to incapacitate its victims and kill them quickly, they rarely have a chance to travel and spread the disease beyond their small villages. Now, however, Ebola is in Conakry, the capital city, with two million residents. Equally concerning: it’s just a short distance from where we touched down, at an international airport.

It has gone “viral,” and now the hope is that it doesn’t go global.

When I asked doctors on the ground about that scenario, they had split opinions. Several told me the concern is real but unlikely. Most patients with Ebola come from small villages in the forest and are unlikely to be flying on international trips, they told me. Furthermore, they don’t think Ebola would spread widely in a western country; our medical expertise and our culture — not touching the dead — would prevent it.

Lethal as it is, Ebola doesn’t have potential as a pandemic “slate-wiper”. As noted, it isn’t easy to catch. Whenever Ebola breaks, it tends to burn quickly, wiping out villages before it has a chance to spread. While it can be transmitted as an aerosol, Ebola is most commonly — and most reliably — transmitted through bodily fluids. This means, ipso facto, transmission of the disease can be stymied by strict adherence to relatively simple aseptic techniques.

If pandemic is what concerns us, a mutant strain of influenza or coronavirus would be the most troublesome. These beasties may not kill as efficiently, but, being airborne, they have the potential to infect exponentially more people. In the past thirty years, Ebola has been responsible for less than two thousand reported deaths. An aberrant strain of influenza, however, managed to wipe out 3-5% of the world’s population between breaking in 1918 and fizzling out in 1920. That’s 50-100 million dead in just two years.

Still, Gupta’s coverage of Ebola is painfully predictable, and decidedly counterproductive. Like most journalists covering the current Ebola outbreaks in West Africa, Gupta concerns himself solely with the possibility of pandemic (or in this case, lack thereof). It is as if he is saying, “Ebola won’t travel here. You’re safe. Forget about it.”

But while no one will die of Ebola “over here”, more than a hundred have already died “over there”. Ebola isn’t a problem for “us”, but it is certainly a problem for Africans. Taking solace in the fact Ebola is unlikely to travel the distance from Guinea to Washington D.C. is fine, but completely forgetting the disease as a consequence is not. Instead of pandering to the interests of those not-affected, maybe we should instead concern ourselves with the interests of those who are.

And while Gupta does a decent job of describing Ebola to the layman, but he isn’t saying anything particularly new. Anyone who’s interested can get an amateur’s description of the disease and its history into the 1990s by picking up a copy of Richard Preston’s The Hot Zone (and I strongly suggest that you do). There’s still quite a lot about the virus we don’t know, but Gupta is content to simply call the virus “mysterious” and leave it at that. A more purposeful and poignant article would have detailed what we don’t know, why we don’t know it, and, most importantly, why it is imperative we figure these things out.

But that would actually take some effort. It would require taking a critical look at the failures of various African nations, the failure of the industrialized world to assist the struggling continent in any meaningful way, and, by extension, the European colonialism that precipitated the volatile socio-political conditions that in part prevent us from making significant headway in eradicating this disease. It would also require taking a long, hard look at the state of scientific funding here in the United States, particularly that of the National Institutes of Health. You certainly couldn’t sit back and paraphrase Richard Preston and wax morosely of the horrible shit you saw in Guinea.

 

 

 

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