tag:theconversation.com,2011:/uk/topics/ebola-virus-38739/articlesEbola virus – The Conversation2023-03-13T12:26:20Ztag:theconversation.com,2011:article/2004862023-03-13T12:26:20Z2023-03-13T12:26:20ZMarburg virus outbreaks are increasing in frequency and geographic spread – three virologists explain<figure><img src="https://images.theconversation.com/files/514041/original/file-20230307-20-6vacw1.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C2100%2C2190&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Marburg virus spreads through close contact with infected body fluids.</span> <span class="attribution"><a class="source" href="https://flic.kr/p/QPbCNb">NIAID/flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span></figcaption></figure><p>The World Health Organization confirmed an <a href="https://www.who.int/emergencies/disease-outbreak-news/item/2023-DON444">outbreak of the deadly Marburg virus disease</a> in the central African country of Equatorial Guinea on Feb. 13, 2023. To date, there have been <a href="https://www.rfi.fr/en/international-news/20230228-death-toll-in-e-guinea-marburg-outbreak-rises-to-11">11 deaths suspected to be caused by the virus</a>, with one case confirmed. Authorities are currently monitoring 48 contacts, four of whom have developed symptoms and three of whom are hospitalized as of publication. The WHO and the U.S. Centers for Disease Control and Prevention are assisting Equatorial Guinea in its efforts to stop the spread of the outbreak.</p>
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<a href="https://images.theconversation.com/files/514050/original/file-20230307-16-7oenhk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Microscopy image of Marburg virus particles" src="https://images.theconversation.com/files/514050/original/file-20230307-16-7oenhk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/514050/original/file-20230307-16-7oenhk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=838&fit=crop&dpr=1 600w, https://images.theconversation.com/files/514050/original/file-20230307-16-7oenhk.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=838&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/514050/original/file-20230307-16-7oenhk.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=838&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/514050/original/file-20230307-16-7oenhk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1053&fit=crop&dpr=1 754w, https://images.theconversation.com/files/514050/original/file-20230307-16-7oenhk.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1053&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/514050/original/file-20230307-16-7oenhk.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1053&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Marburg virus is structurally similar to the Ebola virus.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/marburg-virus-is-a-hemorrhagic-fever-virus-first-described-news-photo/1035562466">Photo12/Universal Images Group via Getty Images</a></span>
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<p><a href="https://doi.org/10.3390/v4101878">Marburg virus</a> and the <a href="https://doi.org/10.12688/f1000research.17573.1">closely related</a> Ebola virus belong to the <a href="https://doi.org/10.1016/j.jmb.2019.06.029">filovirus family</a> and are <a href="https://doi.org/10.1007/82_2017_16">structurally</a> <a href="https://doi.org/10.3201%2Feid1008.040350">similar</a>. Both viruses cause severe disease and death in people, with fatality rates ranging from 22% to 90% <a href="https://www.cdc.gov/vhf/ebola/index.html">depending on</a> <a href="https://www.cdc.gov/vhf/marburg/index.html">the outbreak</a>. Patients infected by these viruses exhibit a <a href="https://doi.org/10.1016/j.ijid.2020.07.042">wide range of similar symptoms</a>, including fever, body aches, severe gastrointestinal symptoms like diarrhea and vomiting, lethargy and sometimes bleeding.</p>
<p>We are <a href="https://scholar.google.com/citations?user=rUT_g04AAAAJ&hl=en&oi=ao">virologists</a> <a href="https://scholar.google.com/citations?hl=en&user=j9jTdBsAAAAJ">who</a> <a href="https://scholar.google.com/citations?user=PdTPtc8AAAAJ&hl=en&oi=ao">study</a> Marburg, Ebola and related viruses. <a href="https://www.bu.edu/muhlbergerlab/">Our laboratory</a> has a long-standing interest in researching the underlying mechanisms of how these viruses cause disease in people. Learning more about how Marburg virus is transmitted from animals to humans and how it spreads between people is essential to preventing and limiting future outbreaks. </p>
<h2>Marburg virus disease</h2>
<p>Marburg virus spreads between people by close contact only after they show symptoms. It is transmitted through <a href="https://doi.org/10.1016/j.ijid.2020.07.042">infected body fluids</a> such as blood, and is not airborne. Contact tracing is a potent tool to combat outbreaks. The incubation time, or time between infection and the onset of symptoms, ranges from two to 21 days and typically falls between five and 10 days. This means that contacts must be observed for extended periods for potential symptoms. </p>
<p>Marburg virus <a href="https://doi.org/10.1093/infdis/jir299">cannot be detected before patients are symptomatic</a>. One major cause of the spread of Marbug virus disease is <a href="https://doi.org/10.3201/eid0912.030355">postmortem transmission</a> due to traditional burial procedures, where family and friends typically have direct skin-to-skin contact with people who have died from the disease.</p>
<p>There are currently no approved <a href="https://doi.org/10.1016/j.ijid.2020.07.042">treatments</a> or <a href="https://doi.org/10.1016/j.vaccine.2020.11.042">vaccines</a> against Marburg virus disease. The most advanced vaccine candidates in development use strategies that <a href="https://doi.org/10.1016/j.ebiom.2023.104463">have been shown</a> <a href="https://doi.org/10.3390/vaccines10101582">to be effective</a> at <a href="https://doi.org/10.1126/scitranslmed.abq6364">protecting against</a> <a href="https://doi.org/10.1016/S0140-6736(22)02400-X">Ebola virus disease</a>. </p>
<p>Without effective treatments or vaccines, Marburg virus <a href="https://doi.org/10.1086/520548">outbreak control</a> primarily relies on contact tracing, sample testing, patient contact monitoring, quarantines and attempts to limit or modify high-risk activities such as <a href="https://doi.org/10.1086/520544">traditional funeral practices</a>.</p>
<h2>What causes Marburg virus outbreaks?</h2>
<p>Marburg virus outbreaks have an unusual history. </p>
<p>The <a href="https://doi.org/10.1086/520551">first recorded outbreak</a> of Marburg virus disease occurred in Europe. In 1967, laboratory workers in Marburg and Frankfurt in Germany, as well as in Belgrade, Yugoslavia (now Serbia) were <a href="https://doi.org/10.1136/pgmj.49.574.542">infected with a previously unknown pathogen</a> after handling infected monkeys that had been imported from Uganda. This outbreak led to the <a href="https://doi.org/10.1086/520551">discovery of the Marburg virus</a>.</p>
<p>Identifying the virus took only three months, which, at the time, was incredibly fast considering the available research tools. Despite receiving intensive care, <a href="https://doi.org/10.1086/520551">seven of the 32 patients died</a>. This case fatality rate of 22% was relatively low compared to subsequent Marburg virus outbreaks in Africa, which have had a <a href="https://www.cdc.gov/vhf/marburg/outbreaks/chronology.html">cumulative case fatality rate of 86%</a>. It remains unclear if these differences in lethality are due to variability in patient care options or other factors such as distinct viral strains.</p>
<p>Subsequent Marburg virus disease outbreaks occurred in Uganda and Kenya, as well as the Democratic Republic of the Congo and Angola in Central Africa. In addition to the current outbreak in Equatorial Guinea, recent Marburg virus cases in the West African countries of Guinea in 2021 and Ghana in 2022 highlight that the Marburg virus is <a href="https://www.cdc.gov/vhf/marburg/outbreaks/chronology.html">not confined to Central Africa</a>.</p>
<p>Strong evidence shows that the <a href="https://doi.org/10.1371/journal.ppat.1000536">Egyptian fruit bat</a>, a natural animal reservoir of Marburg virus, might play an important role in spreading the virus to people. The location of all Marburg virus outbreaks coincides with the <a href="https://www.iucnredlist.org/species/29730/22043105">natural range of these bats</a>. The large area of Marburg virus outbreaks is unsurprising, given the <a href="https://doi.org/10.3390/v4101878">ecology of the virus</a>. However, the mechanisms of zoonotic, or animal-to-human, spread of Marburg virus still remain poorly understood.</p>
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<a href="https://images.theconversation.com/files/514042/original/file-20230307-16-m3dkhs.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Researchers approaching Bat Cave in Queen Elizabeth National Park" src="https://images.theconversation.com/files/514042/original/file-20230307-16-m3dkhs.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/514042/original/file-20230307-16-m3dkhs.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=403&fit=crop&dpr=1 600w, https://images.theconversation.com/files/514042/original/file-20230307-16-m3dkhs.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=403&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/514042/original/file-20230307-16-m3dkhs.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=403&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/514042/original/file-20230307-16-m3dkhs.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=506&fit=crop&dpr=1 754w, https://images.theconversation.com/files/514042/original/file-20230307-16-m3dkhs.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=506&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/514042/original/file-20230307-16-m3dkhs.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=506&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">A number of Marburg virus outbreaks are linked to human activity in caves where Egyptian fruit bats are known to roost.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/jennifer-mcquiston-jonathan-towner-and-brian-amman-approach-news-photo/1073367830">Bonnie Jo Mount/The Washington Post via Getty Images</a></span>
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<p>The origin of a number of Marburg virus disease outbreaks is closely linked to human activity in caves where Egyptian fruit bats roost. More than half of the cases in a 1998 outbreak in the northeastern Democratic Republic of the Congo were among <a href="https://doi.org/10.1056/NEJMoa051465">gold miners who had worked in Goroumbwa Mine</a>. Intriguingly, the end of the nearly two-year outbreak coincided with the flooding of the cave and the disappearance of the bats in the same month.</p>
<p>Similarly, in 2007, four men who <a href="https://doi.org/10.1093/infdis/jir312">worked in a gold and lead mine</a> in Uganda where thousands of bats were known to roost became infected with Marburg virus. In 2008, two tourists were infected with the virus after visiting <a href="https://www.cdc.gov/cdctv/diseaseandconditions/outbreaks/uganda-python-cave.html">Python Cave</a> in the Maramagambo Forest in Uganda. Both developed severe symptoms after returning to their home countries – the <a href="https://doi.org/10.3201%2Feid1508.090051">woman from the Netherlands died</a> and the <a href="https://www.cdc.gov/mmwr/preview/mmwrhtml/mm5849a2.htm">woman from the United States survived</a>.</p>
<p>The <a href="https://www.iucnredlist.org/species/29730/22043105">geographic range of Egyptian fruit bats</a> extends to large portions of sub-Saharan Africa and the Nile River Delta, as well as portions of the Middle East. There is potential for <a href="https://theconversation.com/what-is-spillover-bird-flu-outbreak-underscores-need-for-early-detection-to-prevent-the-next-big-pandemic-200494">zoonotic spillover events</a>, to occur in any of these regions.</p>
<h2>More frequent outbreaks</h2>
<p>Although Marburg virus disease outbreaks have historically been sporadic, their <a href="https://www.cdc.gov/vhf/marburg/outbreaks/chronology.html">frequency has been increasing</a> in recent years. </p>
<p>The increasing emergence and reemergence of zoonotic viruses, including filoviruses (such as <a href="https://www.cdc.gov/vhf/ebola/index.html">Ebola</a>, <a href="https://www.cdc.gov/mmwr/volumes/71/wr/mm7145a5.htm">Sudan</a> and <a href="https://www.cdc.gov/vhf/marburg/index.html">Marburg</a> viruses), coronaviruses (which cause <a href="https://www.cdc.gov/sars/index.html">SARS</a>, <a href="https://www.cdc.gov/coronavirus/mers/index.html">MERS</a> and <a href="https://www.cdc.gov/coronavirus/2019-ncov/index.html">COVID-19</a>), henipaviruses (such as <a href="https://www.cdc.gov/vhf/nipah/index.html">Nipah</a> and <a href="https://www.cdc.gov/vhf/hendra/index.html">Hendra</a> viruses) and <a href="https://www.cdc.gov/poxvirus/mpox/index.html">Mpox</a> appear to be influenced by both <a href="https://doi.org/10.1038/s41586-022-05506-2">human encroachment</a> on previously undisturbed animal habitats and alterations to wildlife habitat ranges <a href="https://doi.org/10.1038/s41586-022-04788-w">due to climate change</a>. </p>
<p>Most Marburg virus outbreaks have occurred in remote areas, which has helped to contain the spread of the disease. However, the large geographic distribution of Egyptian fruit bats that harbor the virus raises concerns that future Marburg virus disease outbreaks could happen in new locations and spread to more densely populated areas, as seen by the devastating <a href="https://doi.org/10.1007/82_2017_69">Ebola virus outbreak in 2014 in West Africa</a>, where <a href="https://www.cdc.gov/vhf/ebola/history/2014-2016-outbreak/index.html">over 11,300 people died</a>.</p><img src="https://counter.theconversation.com/content/200486/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Elke Mühlberger receives funding from NIH/NIAID, the Bill and Melinda Gates Foundation, the Howard Hughes
Medical Institute (as coinvestigator on Emerging Pathogens Initiative project). </span></em></p><p class="fine-print"><em><span>Adam Hume and Judith Olejnik do not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The Marburg virus, a close cousin of Ebola, currently has no approved treatments or vaccines to protect against it.Adam Hume, Research Assistant Professor of Microbiology, Boston UniversityElke Mühlberger, Professor of Microbiology, Boston UniversityJudith Olejnik, Senior Research Scientist, Boston UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2000822023-02-17T04:00:40Z2023-02-17T04:00:40ZWhat is Marburg virus and should we be worried?<figure><img src="https://images.theconversation.com/files/510752/original/file-20230217-28-im18ez.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C3494%2C2839&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/search/marburg-virus">Shutterstock</a></span></figcaption></figure><p>An epidemic outbreak of Marburg virus in Equatorial Guinea, Central Africa, was <a href="https://www.afro.who.int/countries/equatorial-guinea/news/equatorial-guinea-confirms-first-ever-marburg-virus-disease-outbreak">confirmed this week</a>, the first time the virus has occurred there. At least 16 cases have been detected, and <a href="https://www.abc.net.au/news/2023-02-15/marburg-virus-kills-nine-in-equatorial-guinea/101974932">nine deaths</a>.</p>
<p>There are no approved treatments for Marburg virus, which is closely related to Ebola virus, but <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(22)02400-X/fulltext#%20">vaccines are in development</a>. Following an unprecedented Ebola epidemic in West Africa in 2014 that caused more than <a href="https://www.cdc.gov/vhf/ebola/history/2014-2016-outbreak/index.html">28,000 cases and 11,000 deaths</a>, drugs and vaccines against Ebola were developed.</p>
<p>In fact, some of these were <a href="https://www.sciencedirect.com/science/article/pii/S0006291X20320878?via%3Dihub">repurposed for COVID-19</a> in 2020. That experience may help more rapid vaccine and drug development against Marburg virus. </p>
<h2>What is Marburg virus?</h2>
<p>Marburg is a <a href="https://www.cdc.gov/vhf/virus-families/filoviridae.html">filovirus</a> like its more famous cousin, Ebola. These are part of a broader group of viruses that can cause viral haemorrhagic fever, a syndrome of fever and bleeding. </p>
<p>Filoviruses are the most lethal of all haemorrhagic fevers, compared with more common viral haemorrhagic fevers such as dengue, yellow fever and Lassa fever. The <a href="https://www.cdc.gov/vhf/marburg/index.html">first outbreaks</a> of Marburg occurred in 1967 in lab workers in Germany and Yugoslavia who were working with African green monkeys imported from Uganda. The virus was identified in a lab in Marburg, Germany. </p>
<p>Since then, outbreaks have occurred in a handful of countries in Africa, less frequently than Ebola, with the largest in Angola in 2005 (<a href="https://www.who.int/news-room/fact-sheets/detail/marburg-virus-disease">374 cases and 329 deaths</a>).</p>
<p>Marburg’s natural host is a fruit bat, but it can also infect primates, pigs and other animals. Human outbreaks start after a person has contact with an infected animal.</p>
<p>It’s spread between people mainly through direct contact, especially with bodily fluids, and it causes an illness like Ebola, with fever, headache and malaise, followed by vomiting, diarrhoea, and aches and pains. The bleeding follows about five days later, and it can be <a href="https://www.who.int/news-room/fact-sheets/detail/marburg-virus-disease">fatal in up to 90% of people infected</a>.</p>
<h2>How worried should we be?</h2>
<p>Like Ebola in 2014, the fear is that Marburg could spread and become a much larger epidemic, and spread globally. Travel could see it spread to many other countries. In 2014, Ebola cases spread from Guinea to Liberia and Sierra Leone. The majority of cases occurred in these three countries, but travel-related cases occurred in <a href="https://www.cdc.gov/vhf/ebola/history/2014-2016-outbreak/index.html">seven other countries</a> including the United States and the United Kingdom. </p>
<p>If Marburg case numbers increase in Equatorial Guinea or in <a href="https://www.9news.com.au/world/marburg-virus-suspected-cases-in-cameroon/3a86e700-d313-406b-8210-243d5020641e">Cameroon</a>, where it has already spread, or if it spreads to other countries, all countries should be on alert. </p>
<p>Failure to diagnose viral haemorrhagic fever in countries not familiar with it can be deadly. The diagnosis of Ebola was <a href="https://www.nbcnews.com/storyline/ebola-virus-outbreak/nurse-who-caught-ebola-settles-suit-against-dallas-hospital-n672081">initially missed in a traveller from West Africa</a> in Dallas, Texas at the peak of the epidemic in 2014, and a nurse became infected. In Nigeria, the same thing occurred, but resulted in an <a href="https://www.abc.net.au/news/2014-10-20/who-declares-ebola-defeated-in-nigeria/5828414">outbreak and several deaths</a>.</p>
<p>Less is known about Marburg virus than Ebola, which was well-studied during the large 2014 epidemic. It <a href="https://www.medrxiv.org/content/10.1101/2022.06.17.22276538v2">may be less infectious than Ebola</a>, but there are fewer epidemics to assess this. </p>
<p>However, the high fatality rate, lack of available treatments and vaccines, and lessons from Ebola in 2014 should prompt a highly precautionary approach.</p>
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<h2>How to stop its spread</h2>
<p>While researchers will <a href="https://www.nature.com/articles/d41586-023-00468-5">trial Marburg vaccines</a> currently in development against this epidemic, non-phamaceutical measures are the best hope for controlling the epidemic rapidly. That means excellent surveillance and case detection, finding and isolating sick people, tracing their contacts, and quarantine of contacts to prevent transmission. </p>
<p>The infrastructure and planning for this can be substantial, including physical sites for isolation and quarantine. During the Ebola epidemic in Nigeria, a rapid and effective response included <a href="https://www.bellanaija.com/2014/09/must-read-through-the-valley-of-the-shadow-of-death-dr-ada-igonoh-survived-ebola-this-is-her-story/">use of an abandoned building</a> to isolate and treat patients rather than risk further hospital outbreaks.</p>
<p>The importance of identifying and isolating cases was seen in West Africa in 2014, where lack of hospital beds resulted in people dying in the street and worsening spread. <a href="https://www.cdc.gov/mmwr/preview/mmwrhtml/su6303a1.htm#:%7E:text=Extrapolating%20trends%20to%20January%2020,when%20corrected%20for%20underreporting)%20(Appendix**)">One study</a> found if 70% or more of infected people were isolated in a hospital bed, the epidemic could have been controlled without any drugs or vaccines. However it was very late in the epidemic when field hospitals were erected to overcome hospital bed shortages.</p>
<p>Use of <a href="https://www.sciencedirect.com/science/article/pii/S0020748914003319?via%3Dihub">personal protective equipment</a> is also crucial, especially for health workers who are at <a href="https://academic.oup.com/jid/article/218/suppl_5/S679/5091974">increased risk</a> of filovirus infections. Disinfection and safe disposal of <a href="https://medicalguidelines.msf.org/en/viewport/CG/english/viral-haemorrhagic-fevers-16690024.html">biological waste</a> is also important. Funerals where washing of the body is a cultural practice can also <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4709130/">spread infection</a>.</p>
<p>Health promotion and effective, culturally appropriate communication is needed to ensure compliance with health measures. During the Ebola epidemic in 2014, a team of people trying to raise awareness about Ebola were <a href="https://www.bbc.com/news/world-africa-29256443">killed by locals</a> who were fearful of the epidemic and mistrusting of foreigners. These lessons must be heeded if the Marburg epidemic grows.</p>
<p>Both Marburg and Ebola can <a href="https://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0004475">persist in the body</a> after recovery, in organs and fluids including seminal and vaginal fluid, the eye and other sites. This means <a href="https://www.ijidonline.com/article/S1201-9712(15)00292-1/fulltext">outbreaks originating from human survivors</a>, rather than from animals, are possible. </p>
<p>For low-income countries with weak surveillance systems, rapid <a href="https://www.epiwatch.org/">epidemic intelligence</a> using open-source data can help detect signals early. This is where news reports, social media and other data are used to look for patterns that could signify outbreaks of certain diseases in certain areas. We showed we could detect Ebola in the West African epidemic months earlier by <a href="https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0230322">analysing Twitter posts</a> talking about disease symptoms in the area.</p>
<p>If the current epidemic continues to spread and is poorly controlled, the World Health Organization may declare a “Public Health Emergency of International Concern”, as it did with an <a href="https://theconversation.com/why-the-drc-ebola-outbreak-was-declared-a-global-emergency-and-why-it-matters-121991">Ebola epidemic in 2019</a> in the Democratic Republic of Congo. </p>
<p>For now, we have knowledge and experience of a poorly controlled, catastrophic epidemic of Ebola in 2014 that can inform the response to this epidemic of Marburg virus and hopefully control it quickly.</p>
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<img src="https://counter.theconversation.com/content/200082/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>C Raina MacIntyre receives funding from NHMRC and MRFF and leads EPIWATCH, an AI-driven system for rapid epidemic warning signals.</span></em></p>There has been an epidemic outbreak of Marburg virus in Equatorial Guinea for the first time. Here’s what you need to know about the virus, and how it spreads.C Raina MacIntyre, Professor of Global Biosecurity, NHMRC Principal Research Fellow, Head, Biosecurity Program, Kirby Institute, UNSW SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1777212022-03-15T12:15:32Z2022-03-15T12:15:32ZThe Ebola virus can ‘hide out’ in the brain after treatment and cause recurrent infections<figure><img src="https://images.theconversation.com/files/452000/original/file-20220314-13-5nsas.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C2048%2C1536&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">This image shows Ebola virus particles (red) budding from the surface of kidney cell (blue).</span> <span class="attribution"><a class="source" href="https://flic.kr/p/oq68Cn">National Institute of Allergy and Infectious Diseases/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span></figcaption></figure><p><em>The <a href="https://theconversation.com/us/topics/research-brief-83231">Research Brief</a> is a short take about interesting academic work.</em></p>
<h2>The big idea</h2>
<p>The Ebola virus can hide in the brains of monkeys that have recovered after medical treatment without causing symptoms and lead to recurrent infections, according to a study by a <a href="https://www.researchgate.net/profile/Xiankun-Zeng">team I led</a> that was published in the journal <a href="https://doi.org/10.1126/scitranslmed.abi5229">Science Translational Medicine</a>.</p>
<p><a href="https://www.cdc.gov/vhf/ebola/index.html">Ebola is one of the deadliest</a> infectious disease threats known to humankind, with an <a href="https://www.afro.who.int/health-topics/ebola-virus-disease">average fatality rate of about 50%</a>. Ebola is known for a high level of <a href="https://doi.org/10.1038/nmicrobiol.2017.124">viral persistence</a>, meaning the virus remains lurking in the body even after a patient has recovered. But where this hiding place is remains largely unknown.</p>
<p>In 2021, there were <a href="https://www.cdc.gov/vhf/ebola/outbreaks/index-2018.html">three Ebola outbreaks in Africa</a>, all linked to previously infected survivors. Ebola also reemerged in <a href="https://doi.org/10.1038/s41586-021-03901-9">Guinea</a> that same year, linked to a survivor of the 2013-2016 Ebola outbreak.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/452004/original/file-20220314-131639-4tbiwk.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A laboratory technician in full Personal protective equipment pipettes samples under a lab hood." src="https://images.theconversation.com/files/452004/original/file-20220314-131639-4tbiwk.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/452004/original/file-20220314-131639-4tbiwk.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/452004/original/file-20220314-131639-4tbiwk.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/452004/original/file-20220314-131639-4tbiwk.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/452004/original/file-20220314-131639-4tbiwk.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/452004/original/file-20220314-131639-4tbiwk.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/452004/original/file-20220314-131639-4tbiwk.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">The researchers conducted their study in a Biosafety Level 4 lab, the highest level of biocontainment required to safely study hazardous pathogens like Ebola.</span>
<span class="attribution"><span class="source">John W. Braun, USAMRIID</span>, <a class="license" href="http://creativecommons.org/licenses/by-nc-nd/4.0/">CC BY-NC-ND</a></span>
</figcaption>
</figure>
<p>We wanted to better understand where the Ebola virus “hides” in the body of survivors and what triggers recurrent infections. So we examined 36 rhesus monkeys that had been treated for Ebola with <a href="https://www.uptodate.com/contents/overview-of-therapeutic-monoclonal-antibodies">monoclonal antibody therapy</a>, a type of treatment that helps the immune system mount an attack against an infection. These monkeys were deemed fully recovered with no symptoms of infection or detectable virus in their blood. </p>
<p>When we looked more closely at the tissues of different organs under a microscope, however, we found that about 20% of recovered monkeys still had visible Ebola virus located exclusively in the <a href="https://www.ncbi.nlm.nih.gov/books/NBK11083/">ventricular system</a> of the brain. This brain region produces, circulates and stores <a href="https://medlineplus.gov/lab-tests/cerebrospinal-fluid-csf-analysis/">cerebrospinal fluid</a>, which protects, supplies nutrients to and removes waste products from the brain.</p>
<p>Importantly, despite being asymptomatic at the start of our study, two of the monkeys we observed developed Ebola symptoms before dying at 30 and 39 days after their initial infection, respectively. Our findings suggest that the Ebola virus can hide dormant in the brains of survivors even after treatment, and the virus can reactivate and cause fatal infections later on.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/452005/original/file-20220314-101106-3uxlee.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Ventricular system of rhesus monkey that survived Ebola virus infection, with brown stains indicating viral persistence lining the edges" src="https://images.theconversation.com/files/452005/original/file-20220314-101106-3uxlee.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/452005/original/file-20220314-101106-3uxlee.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=301&fit=crop&dpr=1 600w, https://images.theconversation.com/files/452005/original/file-20220314-101106-3uxlee.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=301&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/452005/original/file-20220314-101106-3uxlee.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=301&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/452005/original/file-20220314-101106-3uxlee.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=379&fit=crop&dpr=1 754w, https://images.theconversation.com/files/452005/original/file-20220314-101106-3uxlee.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=379&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/452005/original/file-20220314-101106-3uxlee.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=379&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">This image shows the brain ventricular system of a rhesus monkey that survived Ebola virus infection, where brown indicates viral persistence.</span>
<span class="attribution"><span class="source">Kevin Zeng</span>, <a class="license" href="http://creativecommons.org/licenses/by-nc-nd/4.0/">CC BY-NC-ND</a></span>
</figcaption>
</figure>
<h2>Why it matters</h2>
<p>Treatment with monoclonal antibodies is the current <a href="https://www.statnews.com/2020/10/15/thank-this-ebola-fighting-african-doctor-muyembe-tamfum-for-monoclonal-antibody-treatments/">standard of care for Ebola</a>. But recurrent infections can occur even after apparently successful treatment, and patients can inadvertently transmit the virus and cause new outbreaks.</p>
<p>Our study underscores the importance of careful long-term medical follow-up of successfully treated Ebola survivors to counter the individual and public health cost of recurrent disease. This follow-up, however, will need to be conducted in a way that does not further <a href="https://longreads.trust.org/item/Ebola-survivors-DRC-combat-stigma-misinformation">stigmatize survivors of the disease</a>.</p>
<h2>What still isn’t known</h2>
<p>We still don’t know why the Ebola virus persists in the brain and causes recurrent infections. It is also unclear whether this persistence might be related to monoclonal antibody treatments, and whether other types of therapies, such as antivirals, might produce a different effect. Researchers are still looking into what triggers relapses and whether there might be other parts of the body that may act as reservoirs.</p>
<h2>What’s next</h2>
<p>Our work highlights the need to more deeply investigate why the Ebola virus persists in the brain. Because the brain is <a href="https://doi.org/10.4161/mabs.3.2.14239">less accessible</a> to monoclonal antibodies, treatments <a href="https://doi.org/10.1016/S1473-3099(20)30282-6">combining both monoclonal antibodies and antiviral drugs</a> may help prevent and clear persistent Ebola infection and related disease in the brain. Analyzing viral persistence at the <a href="https://doi.org/10.1038/s41579-020-0354-7">molecular level</a> may provide more insight.</p>
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<p class="fine-print"><em><span>Kevin Zeng does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Although treatments for Ebola have helped many people overcome this deadly disease, the virus can persist in the brain and cause a lethal relapse.Kevin Zeng, Principal Investigator of Infectious Diseases, U.S. Army Medical Research Institute of Infectious DiseasesLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1673922021-09-12T08:22:02Z2021-09-12T08:22:02ZMarburg in Guinea: the value of lessons from managing other haemorrhagic outbreaks<figure><img src="https://images.theconversation.com/files/419655/original/file-20210906-15-jcxilr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">A photo taken in August 2015 of disinfected gloves and boots at an Ebola treatment centre in Conakry, Guinea. Lessons are being drawn to manage the Marburg virus.</span> <span class="attribution"><span class="source">Cellou Binani/AFP via Getty Images</span></span></figcaption></figure><p>As the COVID-19 pandemic rages on in Africa amid insufficient vaccination rollout, viral haemorrhagic fever has again raised its head. This adds to public health turmoil on the continent where resources to respond to emerging and re-emerging epidemic prone zoonotic diseases remain limited.</p>
<p>In the first week of August 2021, a Marburg <a href="https://www.afro.who.int/news/west-africas-first-ever-case-marburg-virus-disease-confirmed-guinea">virus disease outbreak</a> was declared in south-western Guinea. This was the same area in which the recent outbreak of Ebola virus disease occurred and only weeks after the end of the Ebola outbreak was <a href="https://www.afro.who.int/news/ebola-outbreak-guinea-declared-over">declared</a>.</p>
<p>To date, 14 outbreaks of Marburg virus disease have been reported since 1967. These have been mostly in <a href="https://www.who.int/emergencies/disease-outbreak-news/item/25-october-2017-marburg-uganda-en">sub-Saharan Africa</a>. The most recent case in Guinea is the first <a href="https://www.afro.who.int/news/west-africas-first-ever-case-marburg-virus-disease-confirmed-guinea">reported</a> in West Africa. However, evidence of Marburg virus circulation has been reported from countries where Marburg virus disease cases have not been diagnosed to date. These include <a href="https://pubmed.ncbi.nlm.nih.gov/28710694/">Gabon, Zambia, and Sierra Leone</a>. </p>
<p>The first recognised outbreak of Marburg virus disease in Africa occurred <a href="https://www.jstor.org/stable/20407721">in 1975 in South Africa</a>. It was an imported case from Zimbabwe. Imported cases from Uganda were reported in 2008 in the US and the Netherlands and one laboratory infection was diagnosed in Russia in 2004. To date the largest and deadliest outbreak occurred in Angola in 2004–2005.</p>
<p>Recurrent outbreaks of viral haemorrhagic fevers are a major burden on countries such as Guinea where health care systems are already under threat.</p>
<p>Fortunately, many African countries are experienced in managing outbreaks of viral haemorrhagic fevers. Guinean health authorities have been able to respond rapidly and implement measures <a href="https://reliefweb.int/report/guinea/defeating-ebola-guinea-through-better-experience">learnt during the Ebola</a> outbreak to control the spread of Marburg. This has included rapid deployment of multidisciplinary teams, diagnosis, contact tracing, isolation and treatment of patients. </p>
<p>The existence of treatment centres greatly facilitated rapid treatment of suspected cases and confirmed cases, and medical expertise improved patient care. </p>
<h2>Marburg virus</h2>
<p>Marburg virus belongs to the same family as the Ebola viruses. It causes sporadic, but often fatal disease in humans and non-human primates. Studies implicate the Egyptian rousette bat, <em>Rousettus aegyptiacus (Pteropodidae family)</em>, as the prime reservoir host. Entering the roosting habitats, including caves and mining activities have been associated with Marburg virus transmission to humans.</p>
<p>The virus is transmitted by direct contact with the blood, bodily secretions and/or tissues of infected persons or wild animals, for example monkeys and bats. It can also be transmitted through contact with surfaces and materials like bedding or clothing contaminated with these fluids. </p>
<p>The incubation period varies from 2 to 21 days. Symptoms include fever, malaise, body aches, nausea, vomiting, diarrhoea, and internal haemorrhaging (bleeding). </p>
<p>Marburg virus can be difficult to distinguish from other tropical common febrile illnesses, because of the similarities in the clinical presentation. Based on the laboratory confirmed cases, infection with Marburg virus can result in death in 23% to 90% of patients.</p>
<p>There is no specific antiviral treatment or preventative vaccine. Supportive care includes intravenous fluids, replacement of electrolytes, supplemental oxygen, and replacement of blood and blood products may significantly improve the clinical outcome.</p>
<p>Marburg virus can spread easily between people if appropriate preventive measures are not in place. These include personal protection, barriers nursing, safe management of funerals, case finding, contact tracing, isolation and treatment of patient.</p>
<p>The virus is potentially prone to cause formidable epidemics with serious public health consequences.</p>
<h2>Important steps</h2>
<p>The area in Guinea where the case of Marburg virus disease was detected shares close borders with Sierra Leone and Liberia. The movement of people locally and across borders could lead to the potential spread. That’s why the following steps are key:</p>
<ul>
<li><p>the deployment of well-prepared response teams <a href="https://www.who.int/publications/i/item/ebola-and-marburg-virus-disease-epidemics-preparedness-alert-control-and-evaluation">at national and district level</a>.</p></li>
<li><p>surveillance and coordinated efforts within and between countries. </p></li>
<li><p>surveillance at points of entry.</p></li>
<li><p>contact tracing and active case finding in health facilities and at the community level.</p></li>
<li><p>investigations aiming at identification of the source of the infection.</p></li>
<li><p>laboratory testing without delay.</p></li>
<li><p>community engagement. </p></li>
</ul>
<p>It is also vitally important to educate the public and raise community awareness about the risk factors and the protective measures individuals can take to reduce their exposure. These include:</p>
<ul>
<li><p>avoiding close physical contact with someone who is thought to have contracted the virus.</p></li>
<li><p>the transfer of any suspected case to a health facility for treatment and isolation.</p></li>
<li><p>the immediate and safe burial of people who have died from the virus.</p></li>
<li><p>the use of infection prevention and control precautions by health-care workers caring for patients with suspected or confirmed Marburg virus disease. This is to avoid any exposure to blood and/or bodily fluids, as well as unprotected contact with a possibly contaminated environment.</p></li>
<li><p>wildlife to be handled with gloves and appropriate protective clothing to reduce the risk of spread.</p></li>
<li><p>animal products (blood and meat) to be cooked thoroughly before eating. Raw meat should be avoided.</p></li>
</ul>
<p>Community involvement is essential to respond effectively and control an outbreak. This must be supported by primary health care systems to gain greater participation and commitment.</p>
<h2>What needs to be fixed</h2>
<p>A number of factors get in the way of researching, responding to and controlling zoonotic diseases in Africa. These include:</p>
<ul>
<li><p>insufficient and un-coordinated surveillance and research programmes. </p></li>
<li><p>limited regional capacity to develop new and improved diagnostic assays. </p></li>
<li><p>shortage of maximum containment facilities.</p></li>
<li><p>lack of strategic biobanks for long-term and secure storage of reference clinical materials, strains and pathogen biodiversity.</p></li>
<li><p>lack of regional External Quality Assurance programmes for dangerous endemic viral and bacterial pathogens.</p></li>
</ul>
<p>A timely, streamlined, well-funded and efficient disease reporting and surveillance system is essential to monitor the threat of potential epidemics. To strengthen the efficiency of responding quickly, each nation must improve its own capacity in disease recognition and laboratory competence. </p>
<p>We also need innovative African-driven approaches to make the necessary quantum leap in the development of scientific capacity for surveillance and control of infectious diseases. </p>
<p>Global initiatives aiming at improving health security, emergency preparedness and health systems are also important. However, a great deal of work is needed at the higher level of national governance to strengthen resilience and reduce vulnerability.</p><img src="https://counter.theconversation.com/content/167392/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Michelle Groome receives funding from the South African Medical Research Council and the Bill & Melinda Gates Foundation.</span></em></p><p class="fine-print"><em><span>Prof Janusz T. Paweska received funding from the CDC Global Disease Detection Program for investigating the occurrence of zoonotic pathogens in South African bat populations, from the Poliomyelitis Research Foundation for experimental infections of bats with Ebola and Marburg viruses and for Marburg virus transmission study by bat-associated ectoparasites, and from the South African Medical Research Council for investigating the molecular epidemiology of Ebola virus disease in West Africa and the development of diagnostic capacity.</span></em></p>Many African countries are experienced in managing outbreaks of viral haemorrhagic fevers and many of the lessons learnt from the Ebola can be applied to the Marburg outbreak.Michelle J. Groome, Head of the Division of Public Health Surveillance and Response, National Institute for Communicable DiseasesJanusz Paweska, Head of the Center for Emerging and Zoonotic Diseases, National Institute for Communicable DiseasesLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1666942021-08-30T15:30:30Z2021-08-30T15:30:30ZThe first human case of Marburg virus in West Africa is no surprise: here’s why<figure><img src="https://images.theconversation.com/files/418247/original/file-20210827-23-1ekjv48.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">GPS devices on 20 bats in a Ugandan cave in 2018 as part of a research project to determine flight patterns and how they transmit Marburg virus to humans. </span> <span class="attribution"><span class="source">Bonnie Jo Mount/The Washington Post via Getty Images</span></span></figcaption></figure><p>The first case of fatal Marburg virus disease was identified in Guinea, West Africa on <a href="https://www.afro.who.int/news/west-africas-first-ever-case-marburg-virus-disease-confirmed-guinea">9 August 2021</a>. Marburg is a highly infectious zoonotic haemorrhagic fever transmitted to people from fruit bats, specifically the Egyptian Rousette bat (<em>Rousettus aegyptiacus</em>). It spreads among humans through direct contact with the bodily fluids of infected people, surfaces and materials.</p>
<p>No cases have previously been reported in West Africa. </p>
<p>Marburg virus is part of the same family as the Ebola virus. Guinea’s detection comes less than two months after it <a href="https://africacdc.org/news-item/republic-of-guinea-declared-end-of-second-ebola-virus-disease-outbreak/">declared</a> an end to an Ebola outbreak that erupted earlier this year. It is also the same region where cases of the 2021 Ebola outbreak in Guinea and the 2014–2016 West Africa outbreak were <a href="https://www.cdc.gov/vhf/ebola/history/2014-2016-outbreak/index.html">initially detected</a>. Zoonotic diseases will continue to emerge in areas where the reservoir host species occurs and opportunities for contact between humans and wildlife arise. </p>
<p>Marburg disease was first reported <a href="https://doi.org/10.1111/jzo.12769">in 1967</a> in laboratory workers in Germany and Yugoslavia (now Serbia), transmitted from green monkeys (<em>Chlorocebus sabaeus</em>) imported from Uganda to Europe. </p>
<p>Since then, Marburg virus has been <a href="https://doi.org/10.1111/jzo.12769">reported</a> in various parts of Africa in bats. Human disease has been <a href="https://doi.org/10.1111/jzo.12769">reported</a> from Angola, the Democratic Republic of Congo (DRC), Kenya, Uganda and an imported case in South Africa. </p>
<p>The most significant human outbreaks were in the <a href="https://www.mdpi.com/1999-4915/4/10/1878">DRC in 1998–2000 and Angola in 2004–2005</a> with 128 and 227 human fatalities. Case fatality rates varied from 24% to 88% in past outbreaks, depending on virus strain and case management. </p>
<p>The latest detection in West Africa expands our knowledge of the incidence of spillover and human diseases to a new geographical area.</p>
<h2>What does this mean?</h2>
<p>For more than two decades after the first detection, scientists didn’t know how the green monkeys from Uganda had got the disease. The host species – where the virus lives in nature – and epidemiology – how it spreads – weren’t understood. It was only in 1999 that Marburg virus was detected in bats for the first time, including the Egyptian Rousette bat in the DRC. This indicated that the host of the virus might be bats. The virus was detected and isolated from Egyptian Rousette bats in East Africa and South Africa in the following years, expanding the geographical range. </p>
<p>This bat is cave-dwelling and widespread throughout Africa, including West Africa.</p>
<p>The Egyptian Rousette bat has been confirmed as a reservoir host species of Marburg virus. This was done through surveillance and follow-up experimental infections in a laboratory to investigate disease development in a controlled environment. When these bats are infected they do not show signs of disease but can transmit it to humans and other animals, where it is sometimes fatal. </p>
<p>Specific high-risk infection periods have been identified in bat populations, and birthing periods during the summer are reported to be a driver. These pulses coincided with the timing of human infections <a href="https://doi.org/10.1371/journal.ppat.1002877.">in Uganda</a>. The Egyptian Rousette bat lives in caves or mines, and outbreaks have been <a href="https://doi.org/10.1371/journal.ppat.1002877">linked</a> to gold mining activities and entering caves with potential contact with bat faecal excretions or aerosols.</p>
<p>The geographical range where Marburg virus has been detected in bats is more widespread than recorded <a href="https://doi.org/10.1111/jzo.12769">human outbreaks</a> and they coincide with the presence of the Egyptian Rousette fruit bat. However, surveillance has been sporadic and hasn’t covered all geographical areas in the past. Studies in West Africa have been very limited. Wildlife surveillance is severely lacking on several levels including collection of samples. Diagnostic capacity to test for these types of viruses is also lacking. The same is true for detecting disease in humans especially when only a few cases occur and in very remote areas.</p>
<p>From our knowledge of the epidemiology of the virus, it will be present wherever this bat species occurs. Environmental and man-made changes act as a significant <a href="https://doi.org/10.1038/nrmicro.2017.45">contributor</a> to disease emergence. These include changes in land use, human population growth and increased mobility across landscapes, changes in human socioeconomic behaviour or social structure, increased trade, forest fires, extreme weather events, wars, and breakdown in public health infrastructure, to name a few. These activities also result in increased contact with wildlife such as bats, ultimately leading to a higher risk of spillover. The Egyptian Rousette bat will also use abandoned mines as roosting sites and this may change their distribution. </p>
<p>As additional opportunities arise for spillover, it’s probable that more of the bat-borne viral diversity could spill over in the future. This is also true for Marburg virus. More opportunities for contact between bats and humans will certainly lead to an increase in human infections.</p>
<p>This again highlights the importance of surveillance, quickly detecting these spillover events to prevent further human transmission, and building the in-country capacity to make the diagnosis quickly and efficiently.</p><img src="https://counter.theconversation.com/content/166694/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Wanda Markotter receives funding from the National Research Foundation and Defense Threat Reduction Agency, USA . </span></em></p>The Marburg virus will be present wherever the Egyptian Rousette bat occurs.Wanda Markotter, Professor/Director Centre for Viral Zoonoses/ DST-NRF South African Research Chair, University of PretoriaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1638962021-07-14T14:28:22Z2021-07-14T14:28:22ZNigerian academics weigh in on the faults and frustrations of managing COVID-19<figure><img src="https://images.theconversation.com/files/411010/original/file-20210713-13-cjwede.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Nigeria's President Muhammadu Buhari shows his COVID-19 certificate after receiving his first dose of the Oxford/AstraZeneca vaccine in March 2021.</span> <span class="attribution"><span class="source">Photo by Kola Sulaimon / AFP via Getty Images</span></span></figcaption></figure><p><em>The Conversation Africa recently held its first policy dialogue session where seasoned academics in Nigeria and the country’s Minister of State, Health, Dr Adeleke Mamora, discussed the country’s handling of COVID-19 so far as well as its preparedness for the next pandemic. In this interview, Doyin Odubanjo, Folasade Ogunsola, Christian Happi and Oyewale Tomori provide their assessment and verdict on Nigeria’s chances of successfully handling another pandemic.</em></p>
<h2>What has been the most frustrating aspect of managing COVID-19?</h2>
<p><strong>Doyin Odubanjo:</strong> It’s communication. I think we underestimated what is required. And by no means am I trying to undermine the need for vaccines, or laboratory testing, and all of that. But what you need more than anything else is behavioural change management. </p>
<p>You can have the testing capacity, but the people will not go to the labs; you have masks as a controlling measure, but the people will not put them on.</p>
<p>We were dependent more on using law enforcement, instead of understanding that we needed to communicate effectively to get people to change their behaviour and follow the directives that we gave for their benefit. </p>
<p><strong>Folasade Ogunsola:</strong> The greatest problem we have is that our systems around health and education are broken. If you’re going to do research in health, it requires knowledge. It requires that you have strong educational systems. It requires that you have strong healthcare systems. </p>
<p>What we have seen across Africa generally is that we have a reactive approach to health rather than a proactive approach. </p>
<p><strong>Oyewale Tomori:</strong> There are two things that contribute to our problems. First of all, we learn lessons and forget them as fast as we learn them. We boast about the 2014 Ebola outbreak. But what followed in 2015, what followed in 2016? We had Lassa fever. It got worse in 2016. It got worse in 2017. Lassa fever in 2018 was even worse than in previous years, that is, until 2019 came and we said we never had it as bad. This year – 2021 – it’s reducing, because every effort is on COVID-19, and reporting of other diseases is neglected. </p>
<h2>Comparing this pandemic with others, what have been the gaps and the gains?</h2>
<p><strong>Oyewale Tomori:</strong> One way to measure gains is by the differences in your response between the epidemics. Your response depends on how well you prepare. And the longer the space between those epidemics, the more we (Nigeria) forget what happened during the previous outbreaks. And at the sight of each new outbreak, we prepare our ammunition at the war front, piling icing on a rotten cake.</p>
<p>The Minister of Health says Nigeria started to build up laboratories in response to COVID-19. We shouldn’t be building laboratories now, 60 years after independence. What we count as success is actually repairing the damage caused by past neglect. We should be ashamed instead of self back-patting. </p>
<p><strong>Christian Happi:</strong> Nigeria was privileged to have some kind of skeletal infrastructure in place to respond to COVID-19. Maybe a bit better than some other African countries that had nothing. But the question is, could it have done more? Could it have been be better prepared? The answer is yes. </p>
<p>Were we better prepared? The answer is no.</p>
<p>Are we testing enough to represent what is going on in the country? I don’t believe that we’re testing enough, which means we could do more. </p>
<p>At the peak of the pandemic, or some time last year, we had a lot of treatment centres that were active. But after a while, when the number of cases was going down, many of them got deactivated. Now that Africa is experiencing a resurgence, can those new centres be reactivated and do we have what it takes to handle a surge like the one that is happening in India and some other African countries? The answer to that is no. </p>
<h2>How can Nigeria catch up with the rest of the world?</h2>
<p><strong>Doyin Odubanjo:</strong> I think policymakers and decision makers have to engage better and more with researchers. We need to build that synergy and close that science to policy gap. We need to note that economic plans are a waste of time without the input of science. </p>
<p>So we have, for instance, a national economic committee in Nigeria, but we don’t have scientists on board. We don’t even have the Minister of Science and Technology there. The president of the Nigerian Academy of Science is also absent. Yet we’ll give speeches that say we know that science, technology and innovation is what drives the economy in this day and age. </p>
<p>We need the private sector very badly to get things running, because apart from the money, there are some efficient systems that the private sector can bring on board to help us manage our public health system. </p>
<p><strong>Christian Happi:</strong> It is crucial that Nigeria invest a lot in health security. And more importantly, it is critical for Nigeria and Africa to invest in vaccine facilities. It is dangerous for a country of 230 million not to have a single facility that can help provide vaccine in case of emergency. It is dangerous for a continent of 1.3 billion people not to have production facilities that can help the continent to respond to an epidemic or pandemic. </p>
<p><strong>Folasade Ogunsola:</strong> We talk about research, but we don’t fund it. There is a gap between doing the research, having the product or the prototype, and commercialisation. When we’ve done the research, you have a product. Taking it the next step requires government, requires the private sector and requires a policy framework that helps to drive that process. That’s missing in Nigeria. </p>
<h2>How prepared is Nigeria for the next pandemic?</h2>
<p><strong>Doyin Odubanjo:</strong> It’s a simple phrase, “we’re not prepared”. So that’s the real takeaway. If we do all the things that have been said, and we address them, maybe we’ll be prepared, but we’re not prepared. No.</p>
<p><strong>Folasade Ogunsola:</strong> Fundamentally, preparedness builds on a system that’s working – and that system is broken. So if we’re really going to prepare for the next pandemic, or we’re going to get the trust, we have to build the systems and make sure that they’re strong. We need good health systems, we need good educational systems.</p>
<p><strong>Christian Happi:</strong> Nigeria would need to rally all its forces - in public health, the private sector and in academia - coming out with a framework that can prepare the country better. </p>
<p>There are many programmes and projects already being piloted in Nigeria like early warning systems for pandemic preemption and response. Nigeria needs to leverage such initiatives in order to strengthen the health system and prepare the country better for pandemic response.</p><img src="https://counter.theconversation.com/content/163896/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Christian Happi receives funding from the US NIH-H3Africa, the Wellcome Trust, the UK BBSRC, ELMA Foundation. </span></em></p><p class="fine-print"><em><span>Doyin Odubanjo, Folasade Ogunsola, and Oyewale Tomori do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Experts assess Nigeria’s response to COVID-19 so far and express worry that the country does not appear to have learnt much; it isn’t prepared for the next pandemic.Doyin Odubanjo, Executive Secretary, Nigerian Academy of ScienceChristian Happi, Professor of Molecular Biology and Genomics, Redeemer's UniversityFolasade Ogunsola, Professor of Clinical Microbiology, University of LagosOyewale Tomori, Fellow, Nigerian Academy of ScienceLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1460662020-10-14T12:30:06Z2020-10-14T12:30:06ZHow do pandemics end? History suggests diseases fade but are almost never truly gone<figure><img src="https://images.theconversation.com/files/363208/original/file-20201013-21-59qpfn.jpg?ixlib=rb-1.1.0&rect=560%2C288%2C4627%2C3147&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The COVID-19 new normal might be here for quite some time.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/reflecting-on-her-day-royalty-free-image/1263884394">SolStock/E+ via Getty Images</a></span></figcaption></figure><p>When will the pandemic end? After all this time, you may be wondering, with increasing exasperation, how long this will continue.</p>
<p>Since the beginning of the pandemic, epidemiologists and public health specialists have <a href="https://doi.org/10.1038/s41591-020-0883-7">been using</a> <a href="https://doi.org/10.1001/jama.2020.6585">mathematical</a> <a href="https://doi.org/10.1073/pnas.2006520117">models</a> to forecast the future in an effort to curb the coronvirus’s spread. But infectious disease modeling is tricky. Epidemiologists warn that “<a href="https://doi.org/10.1038/d41586-020-01003-6">[m]odels are not crystal balls</a>,” and even sophisticated versions, like those that <a href="https://doi.org/10.1101/2020.08.19.20177493">combine forecasts</a> or <a href="https://covid19-projections.com/">use machine learning</a>, can’t necessarily reveal when the pandemic will end or <a href="https://covid19.healthdata.org/united-states-of-america?view=total-deaths&tab=trend">how many people will die</a>.</p>
<p>As a <a href="https://sc.edu/study/colleges_schools/artsandsciences/history/our_people/directory/nukhet.php">historian who studies disease and public health</a>, I suggest that instead of looking forward for clues, you can look back to see what brought past outbreaks to a close – or didn’t. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/363210/original/file-20201013-17-1d058b0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="people in line outside a COVID-19 testing site" src="https://images.theconversation.com/files/363210/original/file-20201013-17-1d058b0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/363210/original/file-20201013-17-1d058b0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/363210/original/file-20201013-17-1d058b0.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/363210/original/file-20201013-17-1d058b0.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/363210/original/file-20201013-17-1d058b0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/363210/original/file-20201013-17-1d058b0.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/363210/original/file-20201013-17-1d058b0.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Tens of thousands of new cases of COVID-19 are diagnosed in the U.S. every day.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/florida-miami-beach-covid-19-mobile-testing-facility-fdem-news-photo/1262330941">Jeff Greenberg/Universal Images Group via Getty Images</a></span>
</figcaption>
</figure>
<h2>Where we are now in the course of the pandemic</h2>
<p>In the early days of the pandemic, many people hoped the coronavirus would simply fade away. Some argued that it would <a href="https://www.npr.org/2020/04/21/837348551/timeline-what-trump-has-said-and-done-about-the-coronavirus">disappear on its own</a> <a href="https://theconversation.com/coronavirus-may-wane-this-summer-but-dont-count-on-any-seasonal-variation-to-end-the-pandemic-136218">with the summer heat</a>. Others claimed that <a href="https://www.theatlantic.com/health/archive/2020/03/coronavirus-pandemic-herd-immunity-uk-boris-johnson/608065/">herd immunity</a> would kick in once enough people had been infected. But none of that has happened.</p>
<p>A combination of public health efforts to contain and mitigate the pandemic – from rigorous testing and contact tracing to social distancing and wearing masks – <a href="https://www.endcoronavirus.org/countries">have been proven to help</a>. Given that the virus has <a href="https://www.aljazeera.com/news/2020/09/14/which-countries-have-not-reported-any-coronavirus-cases/">spread almost everywhere in the world</a>, though, such measures alone can’t bring the pandemic to an end. The hope now is vaccines, which were developed at unprecedented speed.</p>
<p>Yet experts tell us that even with successful vaccines and effective treatment, <a href="https://www.theatlantic.com/health/archive/2020/08/coronavirus-will-never-go-away/614860/">COVID-19 may never go away</a>. Even if the pandemic is curbed in one part of the world, it will likely continue in other places, causing infections elsewhere. And even if it is no longer an immediate pandemic-level threat, the coronavirus will likely become endemic – meaning slow, sustained transmission will persist. The coronavirus will continue to cause smaller outbreaks, much like seasonal flu.</p>
<p>The history of pandemics is full of such frustrating examples.</p>
<h2>Once they emerge, diseases rarely leave</h2>
<p>Whether bacterial, viral or parasitic, virtually every disease pathogen that has affected people over the last several thousand years is still with us, because it is nearly impossible to fully eradicate them.</p>
<p>The only disease that has been <a href="https://www.cdc.gov/smallpox/history/history.html">eradicated through vaccination is smallpox</a>. <a href="https://theconversation.com/a-massive-public-health-effort-eradicated-smallpox-but-scientists-are-still-studying-the-deadly-virus-139468">Mass vaccination campaigns</a> led by the World Health Organization in the 1960s and 1970s were successful, and in 1980, smallpox was declared the first – and still, the only – human disease to be fully eradicated. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/363213/original/file-20201013-15-e5td11.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Children holding smallpox vaccination certificates" src="https://images.theconversation.com/files/363213/original/file-20201013-15-e5td11.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/363213/original/file-20201013-15-e5td11.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=391&fit=crop&dpr=1 600w, https://images.theconversation.com/files/363213/original/file-20201013-15-e5td11.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=391&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/363213/original/file-20201013-15-e5td11.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=391&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/363213/original/file-20201013-15-e5td11.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=491&fit=crop&dpr=1 754w, https://images.theconversation.com/files/363213/original/file-20201013-15-e5td11.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=491&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/363213/original/file-20201013-15-e5td11.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=491&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Children in Cameroon show off their smallpox vaccination certificates in 1975.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/children-of-cameroon-with-their-vaccination-certificates-news-photo/509399448">Smith Collection/Gado via Getty Images</a></span>
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</figure>
<p>So success stories like smallpox are exceptional. It is rather the rule that diseases come to stay.</p>
<p>Take, for example, pathogens like <a href="https://www.sciencedaily.com/releases/2010/06/100617120718.htm">malaria</a>. Transmitted via parasite, it’s almost as old as humanity and still exacts a heavy disease burden today: There were about <a href="https://www.who.int/news-room/fact-sheets/detail/malaria">228 million malaria cases and 405,000 deaths</a> worldwide in 2018. Since 1955, global programs to eradicate malaria, assisted by the use of DDT and chloroquine, brought some success, but the disease is <a href="https://www.who.int/malaria/media/world-malaria-report-2018/en/">still endemic in many countries of the Global South</a>.</p>
<p>Similarly, diseases such as <a href="https://www.who.int/news-room/fact-sheets/detail/tuberculosis">tuberculosis</a>, <a href="https://doi.org/10.1126/science/1109759">leprosy</a> and <a href="https://doi.org/10.1126/science.368.6497.1324-o">measles</a> have been with us for several millennia. And despite all efforts, <a href="https://ourworldindata.org/eradication-of-diseases">immediate eradication is still not in sight</a>.</p>
<p>Add to this mix relatively younger pathogens, such as <a href="https://www.nature.com/articles/d42859-018-00008-6">HIV</a> and <a href="https://www.who.int/news-room/fact-sheets/detail/ebola-virus-disease">Ebola virus</a>, along with <a href="https://www.who.int/health-topics/influenza-avian-and-other-zoonotic#tab=tab_1">influenza</a> and <a href="https://www.niaid.nih.gov/diseases-conditions/coronaviruses">coronaviruses</a> including <a href="https://www.who.int/ith/diseases/sars/en/">SARS</a>, <a href="https://www.who.int/news-room/q-a-detail/middle-east-respiratory-syndrome-coronavirus-(mers-cov)">MERS</a> and <a href="https://www.who.int/emergencies/diseases/novel-coronavirus-2019/question-and-answers-hub/q-a-detail/q-a-coronaviruses">SARS-CoV-2 that causes COVID-19</a>, and the overall epidemiological picture becomes clear. Research on the <a href="https://doi.org/10.1016/B978-012373944-5.00185-1">global burden of disease</a> finds that annual mortality caused by infectious diseases – most of which occurs in the developing world – is nearly one-third of all deaths globally.</p>
<p>Today, in an age of global air travel, climate change and ecological disturbances, we are constantly exposed to the threat of <a href="https://wwwnc.cdc.gov/eid/about">emerging infectious diseases</a> while continuing to suffer from much older diseases that remain alive and well.</p>
<p>Once added to the repertoire of pathogens that affect human societies, most infectious diseases are here to stay. </p>
<h2>Plague caused past pandemics – and still pops up</h2>
<p>Even infections that now have effective vaccines and treatments continue to take lives. Perhaps no disease can help illustrate this point better than <a href="https://www.visualcapitalist.com/history-of-pandemics-deadliest/">plague, the single most deadly</a> infectious disease in human history. Its name continues to be synonymous with horror even today. </p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/363217/original/file-20201013-13-ge9rvj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="people excavating human skeletons from ground" src="https://images.theconversation.com/files/363217/original/file-20201013-13-ge9rvj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/363217/original/file-20201013-13-ge9rvj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=716&fit=crop&dpr=1 600w, https://images.theconversation.com/files/363217/original/file-20201013-13-ge9rvj.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=716&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/363217/original/file-20201013-13-ge9rvj.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=716&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/363217/original/file-20201013-13-ge9rvj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=900&fit=crop&dpr=1 754w, https://images.theconversation.com/files/363217/original/file-20201013-13-ge9rvj.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=900&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/363217/original/file-20201013-13-ge9rvj.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=900&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Archaeologists learn more about diseases of the past when they excavate mass graves like this one in Italy.</span>
<span class="attribution"><a class="source" href="https://newsroom.ap.org/detail/ItalyUffiziAncientCemetery/2f84d82d32cd4a22bd1a40347be5b61a">AP Photo/Francesco Bellini</a></span>
</figcaption>
</figure>
<p><a href="https://www.who.int/health-topics/plague#tab=tab_1">Plague</a> is caused by the bacterium <em>Yersinia pestis</em>. There have been countless local outbreaks and at least three documented plague pandemics over the last 5,000 years, killing hundreds of millions of people. The most notorious of all pandemics was <a href="https://www.livescience.com/what-was-the-black-death.html">the Black Death</a> of the mid-14th century.</p>
<p>Yet <a href="https://scholarworks.wmich.edu/medieval_globe/1/">the Black Death</a> was far from being an isolated outburst. Plague returned every decade or even more frequently, each time hitting already weakened societies and taking its toll during <a href="https://doi.org/10.1017/npt.2020.27">at least six centuries</a>. Even before the <a href="https://doi.org/10.1136/bmj.39097.611806.DB">sanitary revolution</a> of the 19th century, each outbreak gradually died down over the course of months and sometimes years as a result of changes in temperature, humidity and the availability of hosts, vectors and a sufficient number of susceptible individuals. </p>
<p>Some societies recovered relatively quickly from their losses caused by the Black Death. Others never did. For example, medieval <a href="https://utpress.utexas.edu/books/borbla">Egypt could not fully recover</a> from the lingering effects of the pandemic, which particularly devastated its agricultural sector. The cumulative effects of declining populations became impossible to recoup. It led to the gradual decline of the Mamluk Sultanate and its conquest by the Ottomans within less than two centuries.</p>
<p>[<em>Deep knowledge, daily.</em> <a href="https://theconversation.com/us/newsletters/the-daily-3?utm_source=TCUS&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=deepknowledge">Sign up for The Conversation’s newsletter</a>.]</p>
<p>That very same state-wrecking plague bacterium remains with us <a href="https://www.cnn.com/2020/08/08/us/second-plague-death-new-mexico-man/index.html">even today</a>, a reminder of the very long persistence and resilience of pathogens.</p>
<p>Hopefully COVID-19 will not persist for millennia. But even with successful vaccines, no one is safe. Politics here are crucial: When vaccination programs are weakened, infections can come roaring back. Just look at <a href="https://www.cdc.gov/media/releases/2019/s0424-highest-measles-cases-since-elimination.html">measles</a> and <a href="https://www.nytimes.com/2019/07/15/health/polio-pakistan-afghanistan.html">polio</a>, which resurge as soon as vaccination efforts falter.</p>
<p>Given such historical and contemporary precedents, humanity can only hope that the coronavirus that causes COVID-19 will prove to be a tractable and eradicable pathogen. But the history of pandemics teaches us to expect otherwise.</p><img src="https://counter.theconversation.com/content/146066/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Nükhet Varlik does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>As ready as you are to be done with COVID-19, it’s not going anywhere soon. A historian of disease describes how once a pathogen emerges, it’s usually here to stay.Nükhet Varlik, Associate Professor of History, Rutgers University - NewarkLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1351912020-04-09T02:13:14Z2020-04-09T02:13:14ZMost laws ignore ‘human-wildlife conflict’. This makes us vulnerable to pandemics<figure><img src="https://images.theconversation.com/files/326389/original/file-20200408-193240-1jjymeb.jpg?ixlib=rb-1.1.0&rect=17%2C44%2C5973%2C3323&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>Never before have we seen how the human use of wildlife can yield such catastrophe, as we have with COVID-19. </p>
<p>The current available <a href="https://www.nature.com/articles/s41591-020-0820-9">evidence</a> indicates COVID-19 was first transmitted in a wildlife market in Wuhan. The disease likely originated in pangolins, bats, or a combination of both and was then transmitted to humans. </p>
<p>While various commentators have <a href="https://www.youtube.com/watch?v=VqfNSx8O0wg">blamed</a> pangolins, bats, or even our lack of “<a href="https://twitter.com/RealMarkLatham/status/1242931982385836032">mastery</a>” of wildlife, the real cause of this pandemic goes deeper – into the laws, cultures and institutions of most countries. </p>
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Read more:
<a href="https://theconversation.com/coronavirus-is-a-wake-up-call-our-war-with-the-environment-is-leading-to-pandemics-135023">Coronavirus is a wake-up call: our war with the environment is leading to pandemics</a>
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<p>At the root of the problem is a social phenomenon called “human-wildlife conflict”. This is when the interests of humans and the needs of wildlife overlap in a negative way.</p>
<p>Both the illegal wildlife trade and zoonotic diseases (that is, diseases transmitted from animals to humans) are aspects of human-wildlife conflict.</p>
<p>This ubiquitous phenomenon is poorly addressed in both international and domestic laws. And this grave omission has led to disastrous effects on humanity, as COVID-19 has shown. </p>
<h2>A complex international issue</h2>
<p>Disease outbreaks stemming from human-wildlife conflict are not new or limited to the Chinese wildlife trade. <a href="https://ensia.com/features/covid-19-coronavirus-biodiversity-planetary-health-zoonoses/">Ebola</a>, for example, originated in the Western African country of Gabon. It was likely spread from a chimpanzee that was hunted and eaten by local people. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/326404/original/file-20200408-45013-ko9wef.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/326404/original/file-20200408-45013-ko9wef.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/326404/original/file-20200408-45013-ko9wef.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/326404/original/file-20200408-45013-ko9wef.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/326404/original/file-20200408-45013-ko9wef.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/326404/original/file-20200408-45013-ko9wef.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/326404/original/file-20200408-45013-ko9wef.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/326404/original/file-20200408-45013-ko9wef.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">The Ebola virus could be connected to poverty in Gabon.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<p>Sometimes the disease itself creates the conflict. <a href="https://www.who.int/health-topics/hendra-virus-disease#tab=tab_1">Hendra</a>, a zoonotic disease confined to Australia, was passed from fruit bats to horses and then to humans. The outbreak prompted <a href="https://www.smh.com.au/environment/conservation/bat-culls-must-be-considered-in-hendra-fight-20110711-1ha2k.html">calls for</a> fruit bats to be culled. </p>
<p>Research shows <a href="https://www.nature.com/articles/nature06536">environmental destruction</a> is also leading to an increase in zoonotic diseases. For example, clearing forests and destroying habitats <a href="https://theconversation.com/coronavirus-is-a-wake-up-call-our-war-with-the-environment-is-leading-to-pandemics-135023">can force</a> animals to move closer to urban areas, bringing diseases with them. </p>
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<em>
<strong>
Read more:
<a href="https://theconversation.com/ebola-one-year-on-the-wins-the-setbacks-and-the-way-forward-124292">Ebola one year on: the wins, the setbacks, and the way forward</a>
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<p>COVID-19 and Ebola can also be connected to poverty, as wildlife hunting is often connected to a basic need for food. Culture, politics, health, issues of <a href="https://www.lowyinstitute.org/the-interpreter/covid-19-responses-why-feminist-leadership-matters-crisis">gender equality</a> and economics (to name a few), are all connected to human-wildlife conflicts as well. </p>
<p>The widespread impact of these types of viruses that can spread across international borders means that they should be governed as an international issue. </p>
<p>But there are no consistent international or domestic laws to guide governance of the multiple and interacting causes of pandemics.</p>
<h2>Laws don’t go far enough</h2>
<p>The human-wildlife relationship goes beyond issues of conservation and animal welfare, yet many of the world’s laws designed to tackle these multidimensional problems <a href="https://theconversation.com/academia-can-help-humans-and-large-carnivores-coexist-115467#comment_1957203">do not</a>. </p>
<p>A select few laws have sought to implement a whole-systems approach to legal decision-making. For example, the <a href="https://www.cbd.int/convention/">Convention on Biological Diversity</a>, an international treaty, requires ecosystem managers to consider the impact of environmental decision-making on multiple parts of society, including levels of poverty and economics. </p>
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<em>
<strong>
Read more:
<a href="https://theconversation.com/from-the-bushfires-to-coronavirus-our-old-normal-is-gone-forever-so-whats-next-134994">From the bushfires to coronavirus, our old 'normal' is gone forever. So what's next?</a>
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<p>But this holistic approach isn’t reflected in domestic laws around the world that are supposed to enforce international treaties, such as Australia’s Environmental Protection and Biodiversity Conservation Act, which is currently under review by the federal government. </p>
<p>Collaborations, such as between health law and conservation law, must be put in place. For example, while the World Health Organisation works on zoonose (animal-borne disease) prevention, there is little interaction between it and the <a href="https://www.cites.org/eng/disc/text.php">Convention on the International Trade of Endangered Species</a>.</p>
<h2>No quick fix</h2>
<p>Our legal systems – especially in the West and in international law – <a href="https://heinonline.org/HOL/LandingPage?handle=hein.journals/ajlph43&div=9&id=&page=">encourage separation</a> and domination of the environment. </p>
<p>For example, the laws that designate protected areas explicitly separate people from wildlife, and this can drastically <a href="https://theconversation.com/dingoes-and-humans-were-once-friends-separating-them-could-be-why-they-attack-115917">change the relationship</a> between them. Laws also continue to encourage domination via implicit means, such as through legalised wildlife hunting and trade.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/326421/original/file-20200408-37363-yj0k6u.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/326421/original/file-20200408-37363-yj0k6u.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/326421/original/file-20200408-37363-yj0k6u.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/326421/original/file-20200408-37363-yj0k6u.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/326421/original/file-20200408-37363-yj0k6u.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/326421/original/file-20200408-37363-yj0k6u.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/326421/original/file-20200408-37363-yj0k6u.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/326421/original/file-20200408-37363-yj0k6u.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Don’t blame bats for the spread of Hendra virus.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
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<p>Various changes to law have been <a href="https://www.theguardian.com/world/2020/apr/06/ban-live-animal-markets-pandemics-un-biodiversity-chief-age-of-extinction">proposed</a> in light of COVID-19, including closing all wildlife markets and trade.</p>
<p>But these types of fixes don’t address the many ways our health can be affected by wildlife use. Nor do they consider the poverty that often drives the consumption of wildlife, such as in Gabon and the other multiple causal factors. </p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/a-major-scorecard-gives-the-health-of-australias-environment-less-than-1-out-of-10-133444">A major scorecard gives the health of Australia's environment less than 1 out of 10</a>
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<p>Such blanket legal prohibitions are neither appropriate nor adequate. We need legal changes on a larger scale. Laws must acknowledge how all humans are vulnerable to wildlife and broader environment change. If they haven’t even acknowledged this, then they can’t start to address it.</p>
<h2>What needs to change?</h2>
<p>Changes to the law at both the international and domestic level should focus on two primary areas. </p>
<p>First, increased cooperation is required between systems and areas of law in addressing the source of our vulnerability, instead of waiting for the vulnerability to become catastrophic, such as with COVID-19.</p>
<p>Second, both international and domestic laws must recognise the interdependency between humans and all aspects of the natural environment, in every area of law – from environmental law, to trade law, human rights and corporate law. </p>
<p>Ecuador, for example, integrated this idea into its <a href="http://pdba.georgetown.edu/Constitutions/Ecuador/english08.html">national constitution</a> so the necessity of environmental protection is linked to the continued existence of its people.</p>
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<em>
<strong>
Read more:
<a href="https://theconversation.com/222-scientists-say-cascading-crises-are-the-biggest-threat-to-the-well-being-of-future-generations-131551">222 scientists say cascading crises are the biggest threat to the well-being of future generations</a>
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<p>Another way is to integrate nature into the objectives of each piece of law. This includes all international treaties and domestic pieces of legislation, even those that do not expressly deal with matters of the environment, such as health law, where a <a href="https://www.jstor.org/stable/43292777?seq=1">healthy environment</a> is directly linked to human health. </p>
<p>No, this is not a small undertaking. But as the catastrophe of COVID-19 has demonstrated, the problems we face if we don’t change are far more onerous in all aspects of our lives.</p><img src="https://counter.theconversation.com/content/135191/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Katie Woolaston does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>There aren’t enough international and domestic laws to address how the interests of humans and the needs of wildlife overlap.Katie Woolaston, Lawyer, Queensland University of TechnologyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1346192020-04-01T22:19:54Z2020-04-01T22:19:54ZAntibodies in the blood of COVID-19 survivors know how to beat coronavirus – and researchers are already testing new treatments that harness them<figure><img src="https://images.theconversation.com/files/324727/original/file-20200401-23115-j8iesi.jpg?ixlib=rb-1.1.0&rect=0%2C191%2C3413%2C2461&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">A person who has recovered from COVID-19 donates plasma in Shandong, China.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/person-who-has-recovered-from-the-covid-19-coronavirus-news-photo/1203849008">STR/AFP via Getty Images</a></span></figcaption></figure><p>Amid the chaos of an epidemic, those who survive a disease like COVID-19 carry within their bodies the secrets of an effective immune response. <a href="https://scholar.google.com/citations?user=E_Ww_nUAAAAJ&hl=en&oi=ao">Virologists like me</a> look to survivors for molecular clues that can provide a blueprint for the design of future treatments or even a vaccine.</p>
<p>Researchers are <a href="https://www.fda.gov/vaccines-blood-biologics/investigational-new-drug-ind-or-device-exemption-ide-process-cber/investigational-covid-19-convalescent-plasma-emergency-inds">launching trials now</a> that involve the transfusion of blood components from people who have recovered from COVID-19 to those who are sick or at high risk. Called “<a href="https://www.theatlantic.com/science/archive/2020/03/plasma-blood-covid-19-survivors/609007/">convalescent-plasma therapy</a>,” this technique can work even without doctors knowing exactly what component of the blood may be beneficial.</p>
<p>For the pioneering work of the first treatment using therapeutic serum in 1891 (against diphtheria), <a href="https://www.nobelprize.org/prizes/medicine/1901/behring/lecture/">Emil von Behring</a> later earned the Nobel Prize in medicine. Anecdotal reporting of the therapy dates back <a href="https://doi.org/10.7326/0003-4819-145-8-200610170-00139">as far as the devastating 1918-19 influenza pandemic</a>, although scientists lack definitive evidence of its benefits during that global health crisis.</p>
<p>The extraordinary power of this passive immunization has traditionally been challenging to harness, primarily due to the difficulty of obtaining significant amounts of <a href="https://www.redcrossblood.org/donate-blood/dlp/plasma-information.html">plasma</a> from survivors. Due to scarce quantities, infusions of plasma pooled from volunteers were reserved for those most vulnerable to infection. </p>
<p>Fast forward to the 21st century, and the passive immunization picture changes considerably, thanks to steady advances in molecular medicine and new technologies that allow scientists to quickly characterize and scale up the production of the protective molecules.</p>
<h2>Immune system’s defense workers</h2>
<p>The immune systems of COVID-19 survivors figured out how to combat and defeat the invading SARS-CoV-2 virus.</p>
<p>Neutralizing antibodies are one kind of immunological front-line response. These antibodies are proteins that are secreted by immune cells called B lymphocytes when they encounter an invader, such as a virus.</p>
<p>Antibodies recognize and bind proteins on the surface of virus particles. For each infection, the immune system designs antibodies that are highly specific for the particular invading pathogen.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/324754/original/file-20200401-23090-11gf0s6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/324754/original/file-20200401-23090-11gf0s6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/324754/original/file-20200401-23090-11gf0s6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/324754/original/file-20200401-23090-11gf0s6.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/324754/original/file-20200401-23090-11gf0s6.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/324754/original/file-20200401-23090-11gf0s6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/324754/original/file-20200401-23090-11gf0s6.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/324754/original/file-20200401-23090-11gf0s6.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">An enlarged 3D model of a single spike protein in the foreground; in the rear is a model of a SARS-CoV-2 virus covered with many of these spike proteins.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/nihgov/49644420096/">NIH</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
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<p>For instance, each SARS-CoV-2 virus is covered by <a href="https://doi.org/10.1038/s41586-020-2179-y">distinctive spike proteins</a> that it uses like keys to unlock the doors to the cells it infects. By targeting these spikes – imagine covering the grooves of a key with tape – antibodies can make it nearly impossible for the virus to break in to human cells. Scientists call these kind of antibodies “NAbs” because they neutralize the virus before it can gain entry.</p>
<p>A holy grail for vaccinologists is figuring out how to spark the production of these ingenious antibodies. On first infection, your B lymphocytes train themselves to become expert producers of NAbs; they develop a memory of what a particular invader looks like. If the same invader is ever detected again at any time, your veteran B lymphocytes (known as memory B cells by this stage) spring into action. They rapidly secrete large quantities of the potent NAbs, preventing a second illness.</p>
<p>Vaccines capitalize on this ability, safely provoking an immune response and then relying on the immune system’s memory to be able to fend off the real pathogen if you ever encounter it.</p>
<p>Passive immunization is a process in which neutralizing antibodies from one individual can be used to protect or treat another. A clever example of this process exploited by nature is breastmilk, which passes protective antibodies from the mother to the infant.</p>
<h2>Example of Ebola virus disease</h2>
<p>In addition to their potential preventative role, neutralizing antibodies are starting to prove beneficial in novel treatments for viral disease. Harnessing their protective power has been challenging, though, primarily because isolating enough antibodies to be effective is laborious.</p>
<p>Recent advances in the technology of molecular medicine at last allowed the kind of scale-up that enabled researchers to test the immunological principle. In 2014-15, Ebola virus disease surfaced in West Africa, triggering an epidemic that raged for over a year, <a href="https://www.who.int/csr/disease/ebola/en/">killing more than 11,000 people</a>. About 40% of those infected died. There were no treatments and no vaccine.</p>
<p>In the midst of the devastation came innovation: ZMapp, a mix of three synthetic NAbs showed early promising results in <a href="https://doi.org/10.1126/scitranslmed.3003876">ameliorating disease</a> <a href="https://doi.org/10.1056/NEJMoa1604330">in people</a> <a href="https://doi.org/10.1038/nature13777">infected with EBOV</a>.</p>
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<a href="https://images.theconversation.com/files/324729/original/file-20200401-23105-1vzyrzm.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/324729/original/file-20200401-23105-1vzyrzm.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/324729/original/file-20200401-23105-1vzyrzm.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=391&fit=crop&dpr=1 600w, https://images.theconversation.com/files/324729/original/file-20200401-23105-1vzyrzm.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=391&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/324729/original/file-20200401-23105-1vzyrzm.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=391&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/324729/original/file-20200401-23105-1vzyrzm.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=491&fit=crop&dpr=1 754w, https://images.theconversation.com/files/324729/original/file-20200401-23105-1vzyrzm.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=491&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/324729/original/file-20200401-23105-1vzyrzm.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=491&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Researchers inserted engineered DNA into plant leaves to produce antibodies to fight the Ebola virus.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/technician-holds-vials-containing-engineered-dna-that-will-news-photo/453595346">Sean Gallup/Getty Images News via Getty Images Europe</a></span>
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<p>By the time Ebola again emerged from the rainforest, this time in 2018 in the Democratic Republic of Congo, the science was ready. In November 2018, doctors launched three parallel trials comparing three different antibody cocktails. Nine months later, <a href="https://investor.regeneron.com/news-releases/news-release-details/new-england-journal-medicine-publishes-results-ebola-clinical">spectacular</a> <a href="https://doi.org/10.1056/NEJMoa1910993">results</a> allowed for an immediate end of the experimental trials so the cocktails could be used in the field.</p>
<p>While ZMapp did not work as well as anticipated, the trials identified <a href="https://www.who.int/news-room/detail/12-08-2019-update-on-ebola-drug-trial-two-strong-performers-identified">two other antibody-based therapies</a> from two different companies that did suppress Ebola symptoms in infected patients. The earlier in their infection that patients received therapy, the better the protection.</p>
<p>Infectious disease experts around the globe <a href="https://doi.org/10.1038/d41586-019-02442-6">heralded the results</a> <a href="https://www.bloomberg.com/news/articles/2019-08-12/ebola-drug-shows-promising-results-in-heart-of-congo-outbreak">as a vital breakthrough</a>.</p>
<p>At that time last fall, it would have been difficult to imagine that within six months there’d be an even greater need for the powerful strategy of passive immunization.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/324730/original/file-20200401-23105-ne52k8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/324730/original/file-20200401-23105-ne52k8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/324730/original/file-20200401-23105-ne52k8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/324730/original/file-20200401-23105-ne52k8.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/324730/original/file-20200401-23105-ne52k8.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/324730/original/file-20200401-23105-ne52k8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/324730/original/file-20200401-23105-ne52k8.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/324730/original/file-20200401-23105-ne52k8.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">A doctor who has recovered from COVID-19 holds up a bag of his own donated plasma in Wuhan, China.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/this-photo-taken-on-february-18-2020-shows-a-doctor-who-has-news-photo/1201953207">STR/AFP via Getty Images</a></span>
</figcaption>
</figure>
<h2>Applying the technique to SARS-CoV-2</h2>
<p>While the SARS-CoV-2 virus is moving quickly, with <a href="https://www.arcgis.com/apps/opsdashboard/index.html#/bda7594740fd40299423467b48e9ecf6">almost 1 million confirmed infections worldwide</a> as of this writing, the science is racing to catch up.</p>
<p>Days ago a report published by scientists working in Shenzhen, China, suggested that plasma – which contains antibodies – from survivors of COVID-19 was <a href="https://doi.org/10.1001/jama.2020.4783">successful in treating five critically ill patients</a>. At the end of March, the <a href="https://www.fda.gov/vaccines-blood-biologics/investigational-new-drug-ind-or-device-exemption-ide-process-cber/investigational-covid-19-convalescent-plasma-emergency-inds">FDA approved the</a> <a href="https://www.washingtonpost.com/health/2020/03/27/coronavirus-serum-plasma-treatment/">use of convalescent plasma</a> in treating severely ill people here in the U.S. In addition, Mt. Sinai in New York has established a collaboration with the FDA and other hospitals to begin <a href="https://www.newyorker.com/news/news-desk/can-survivors-of-the-coronavirus-help-cure-the-disease-and-rescue-the-economy">clinical trials to scientifically determine</a> whether this strategy of passive immunization is viable.</p>
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<p>While the rapid move to evaluate this novel treatment is a moment for celebration, the science must keep moving. Convalescent plasma, which is isolated from recently recovered survivors, is in too short of a supply to be broadly useful. The most potent neutralizing antibodies must be <a href="https://www.reuters.com/article/us-health-coronavirus-china-scientists/chinese-scientists-seeking-potential-covid-19-treatment-find-effective-antibodies-idUSKBN21J4QW">quickly characterized</a> and then produced efficiently in large quantities. <a href="https://www.statnews.com/2020/03/25/vir-biotechnology-reports-early-progress-in-antibody-treatment-for-covid-19/">Several companies</a>, as well as a number of <a href="https://www.rockefeller.edu/coronavirus/research-program-covid-19-sars-cov-2/">powerhouse academic labs</a>, aim to meet the challenge of identifying and generating these life-saving NAbs.</p>
<p><a href="https://doi.org/10.1038/d41587-020-00005-z">At the fore is</a> <a href="https://newsroom.regeneron.com/index.php/news-releases/news-release-details/regeneron-announces-important-advances-novel-covid-19-antibody">Regeneron</a>, the pharmaceutical company that designed the effective Ebola treatment. Although targeting a different virus, their overall strategy remains the same. They’ve isolated and characterized NAbs and plan to engineer a cocktail of the most potent molecules. The viral target of these antibodies is the SARS-CoV-2 spike protein; the NAbs work by preventing the virus from entering cells.</p>
<p>Clinical trials are planned for early summer, essentially three months’ time. It is a breakneck pace for the development of such a sophisticated tool of intervention.</p>
<p>As the U.S. enters the <a href="https://theconversation.com/coronavirus-cases-are-growing-exponentially-heres-what-that-means-135181">exponential phase</a> of COVID-19’s spread, this treatment cannot come soon enough.</p>
<p>[<em>You need to understand the coronavirus pandemic, and we can help.</em> <a href="https://theconversation.com/us/newsletters?utm_source=TCUS&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=upper-coronavirus-help">Read our newsletter</a>.]</p><img src="https://counter.theconversation.com/content/134619/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Previous funding: NIH, The Royal Society, The Medical Foundation</span></em></p>Before a vaccine is available to teach your immune system to ward off the coronavirus, maybe you can directly use molecules that have already fought it in other people.Ann Sheehy, Professor of Biology, College of the Holy CrossLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1343072020-03-25T12:29:42Z2020-03-25T12:29:42ZCalling COVID-19 a ‘Chinese virus’ is wrong and dangerous – the pandemic is global<figure><img src="https://images.theconversation.com/files/322745/original/file-20200324-155631-1vurwux.jpg?ixlib=rb-1.1.0&rect=174%2C0%2C4304%2C3102&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">U.S. officials risk public health by equating COVID-19 with places far from home.</span> <span class="attribution"><a class="source" href="http://www.apimages.com/metadata/Index/Virus-Outbreak-Trump/4c902df8cb0f4b2a9a26ccd83cc633a3/2/0">AP Photo/Patrick Semansky</a></span></figcaption></figure><p>The COVID-19 pandemic has spread to <a href="https://gisanddata.maps.arcgis.com/apps/opsdashboard/index.html#/bda7594740fd40299423467b48e9ecf6">almost every country on Earth</a>. And yet, <a href="https://twitter.com/DrPaulGosar/status/1236821135964004352">several</a> <a href="https://twitter.com/realDonaldTrump/status/1240226752447873027">American officials</a> refer to it as the “<a href="https://www.cnbc.com/2020/03/06/secretary-of-state-mike-pompeo-says-china-not-forthcoming-initially-on-coronavirus-setting-prevention-efforts-back.html">Wuhan virus</a>” or even the “<a href="https://twitter.com/jabinbotsford/status/1240701140141879298">Chinese virus</a>.”</p>
<p>U.S.-Chinese antagonism in this vein is <a href="https://www.politico.com/magazine/story/2019/10/15/donald-trump-china-trade-war-hostility-229851">not new</a>. But, while this deliberate move to associate Wuhan, and more generally China, with the COVID pandemic <a href="https://slate.com/news-and-politics/2020/03/trump-calling-coronavirus-chinese-virus.html">serves a political purpose</a> <a href="https://www.nytimes.com/2020/03/18/us/politics/china-virus.html">for the Trump administration</a>, it also has significant implications for civil society and public health.</p>
<p>As a <a href="https://www.history.pitt.edu/people/mari-webel">historian of public health and modern Africa</a>, I study the politics of infectious diseases and responses to them. In addition to inflaming racism, emphasizing the foreign or external origins of a disease influences how people understand their own risk of disease and whether they change their behavior.</p>
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<h2>WHO guidelines are clear</h2>
<p>While identifying a new disease by its place of origin seems intuitive, history demonstrates that doing so can harm the people who live there.</p>
<p><a href="http://thenationshealth.aphapublications.org/content/45/6/1.1">Consequences can include</a> economic distress, as tourists withdraw, investment cools down and solidarity between people weakens. Linking a specific disease with a specific place can lead to <a href="https://www.questia.com/library/journal/1G1-195680111/the-yellow-peril-revisited-the-impact-of-sars-on">discrimination</a>, <a href="https://doi.org/10.1353/ces.2008.0002">stigmatization</a> and <a href="https://www.discovermagazine.com/health/death-at-the-corners">avoidance of a town or village</a>.</p>
<p>For all these reasons, in 2015, the World Health Organization established <a href="https://apps.who.int/iris/bitstream/handle/10665/163636/WHO_HSE_FOS_15.1_eng.pdf?sequence=1">a new set of best practices</a> for naming diseases. The WHO sought to <a href="https://www.who.int/mediacentre/news/notes/2015/naming-new-diseases/en/">abandon associating places with a disease</a> – as was the case with COVID-19’s cousin, MERS (Middle East respiratory syndrome) in 2012, and many others in the past.</p>
<p>So on Feb. 11, the WHO recommended <a href="https://www.who.int/dg/speeches/detail/who-director-general-s-remarks-at-the-media-briefing-on-2019-ncov-on-11-february-2020">using the name COVID-19</a> when referring to the novel coronavirus that was, at the time, sickening and killing people in central China and elsewhere in eastern Asia. Other experts concurred, but differentiated between the <a href="https://www.nature.com/articles/s41564-020-0695-z">virus that causes the disease</a>, known as SARS-CoV-2, and the disease itself, COVID-19.</p>
<p>The name reflects the pathogen (a coronavirus, COV), the nature of the illness caused (an infectious disease) and its year of origin (2019).</p>
<h2>A long tradition of naming by place</h2>
<p>Tagging a place when identifying a disease has a long history. </p>
<p>In the 19th century, as global trade and mobility allowed cholera to spread worldwide from its origins in the Ganges Delta, the disease quickly became known as “the Asiatic cholera.” <a href="https://www.amazon.com/Cholera-Biography-Biographies-Christopher-Hamlin/dp/019954624X">That label persisted for decades</a>, implicitly blaming an entire continent for a disease that can spread anywhere as a function of poor sanitation.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/315567/original/file-20200215-11000-4knczk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/315567/original/file-20200215-11000-4knczk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/315567/original/file-20200215-11000-4knczk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=475&fit=crop&dpr=1 600w, https://images.theconversation.com/files/315567/original/file-20200215-11000-4knczk.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=475&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/315567/original/file-20200215-11000-4knczk.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=475&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/315567/original/file-20200215-11000-4knczk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=596&fit=crop&dpr=1 754w, https://images.theconversation.com/files/315567/original/file-20200215-11000-4knczk.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=596&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/315567/original/file-20200215-11000-4knczk.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=596&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">During an 1884 cholera epidemic in France, public health workers disinfect baggage at a quarantine station for maritime travelers.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-illustration/cholera-epidemic-france-1884-public-health-242815612">Everett Historical/Shutterstock.com</a></span>
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</figure>
<p>For Europeans and Americans of the time, Asia was an exotic, distant somewhere else. Distinguishing the disastrous illness of cholera as “Asiatic” fit with the racialized, imperial views that denigrated the intelligence and the cultures of non-white populations globally. It also helped justify more stringent <a href="https://doi.org/10.1017/S0018246X06005280">quarantine measures and travel restrictions</a> for people read as “Asian” and not European. <a href="https://doi.org/10.1017/S0020743808080549">Muslim pilgrims en route to Mecca</a> from southern Asia, for instance, were <a href="https://doi.org/10.1017/S0010417515000407">subject to different rules</a> than European troop ships traveling the same routes. </p>
<p><a href="https://www.cambridge.org/us/academic/subjects/history/history-medicine/laboratory-revolution-medicine?format=PB">Ideas about disease changed</a> after the late 19th century, when scientists could use new laboratory techniques to link specific pathogens – bacteria, parasites and, later on, viruses – to specific diseases. Sometimes, this gave a scientific name to an age-old problem, such as “consumption” becoming the medical entity tuberculosis.</p>
<p>But these new techniques also allowed researchers to correlate pathogens with particular locales. Naming an illness after a place quickly became the norm.</p>
<p>So <a href="https://www.cdc.gov/vhf/rvf/index.html">Rift Valley Fever</a>, caused by a virus in the <em>Bunyaviridae</em> family, got its name from an area of colonial Kenya where it was first reported.</p>
<p>The <a href="https://www.cdc.gov/hantavirus/index.html">Hantaviruses</a> are linked to the Hantan River area of South Korea where <a href="https://doi.org/10.1086/424604">Dr. Ho-Wang Lee first identified the virus</a>.</p>
<p><a href="https://www.cdc.gov/vhf/ebola/index.html">Ebola virus disease</a> got its popular name from a river near the village in the modern nation of Democratic Republic of Congo where U.S. and European scientists <a href="https://doi.org/10.1093/infdis/jiw207">identified that pathogen</a>. Scientists <a href="https://www.statnews.com/2016/07/14/history-ebola-peter-piot/">chose that name deliberately</a>, trying to avoid saddling any one village with being the point of origin for the hemorrhagic fever.</p>
<p>Focusing on a specific place creates something particular from something that could have happened anywhere. There’s nothing peculiarly distinctive about Lassa village in Nigeria, compared to any other village five or 50 miles away. Lassa was <a href="https://doi.org/10.4269/ajtmh.2012.12-0466">just the first place</a> where a white missionary’s death drew the attention of authorities. And yet, in the aftermath of that moment, as “<a href="https://www.cdc.gov/vhf/lassa/index.html">Lassa fever</a>” came to identify a fearsome hemorrhagic fever, the town of <a href="https://nigeriahealthwatch.com/how-lassa-went-from-a-small-nigerian-town-to-a-well-known-virus/#.XkbVLhd7kSd">Lassa became a shadow of its former self</a>.</p>
<p>Likewise <a href="https://www.chicagotribune.com/news/ct-xpm-2002-12-17-0212170281-story.html">Norwalk, Ohio, still deals with its association with noroviruses</a>, first identified from a 1968 outbreak in the small Midwestern town. One of the Norwalk-type viruses causes an acute stomach bug that was <a href="https://doi.org/10.1155/2003/702517">historically known as the “winter vomiting disease”</a> and still causes widespread illness today.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/315568/original/file-20200215-10985-5ziaaj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/315568/original/file-20200215-10985-5ziaaj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/315568/original/file-20200215-10985-5ziaaj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=419&fit=crop&dpr=1 600w, https://images.theconversation.com/files/315568/original/file-20200215-10985-5ziaaj.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=419&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/315568/original/file-20200215-10985-5ziaaj.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=419&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/315568/original/file-20200215-10985-5ziaaj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=526&fit=crop&dpr=1 754w, https://images.theconversation.com/files/315568/original/file-20200215-10985-5ziaaj.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=526&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/315568/original/file-20200215-10985-5ziaaj.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=526&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">The Ebola virus disease outbreak was more about public health infrastructure than people’s lifestyles.</span>
<span class="attribution"><a class="source" href="http://www.apimages.com/metadata/Index/Mali-Ebola-/7f37ac37eb804adbaf11efa628eb8ec1/2/0">AP Photo/Baba Ahmed</a></span>
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<h2>Building blame into a name</h2>
<p>Insisting on emphasizing COVID-19’s origins within China, even though the disease is now global, <a href="https://nplusonemag.com/online-only/online-only/chinese-virus-world-market/">plays into racist stereotypes</a>, including about culture and food.</p>
<p>Similar stereotypes arose, for instance, around Ebola virus disease (EVD) in 2014-15, erroneously blaming people in West Africa for the wider epidemic.</p>
<p>Early conversations about EVD, marked as particularly African with its name, focused on eating “bushmeat,” a term from the colonial era to describe meat from hunted animals, rather than from domesticated animals. Talking about “bushmeat” allowed people to characterize those suffering from EVD as <a href="https://www.washingtonpost.com/news/monkey-cage/wp/2014/08/25/othering-ebola-and-the-history-and-politics-of-pointing-at-immigrants-as-potential-disease-vectors/">primitive or exotic</a>. It also implied that West Africans were responsible for bringing EVD into global circulation because of what they ate or how they lived.</p>
<p>In fact, the <a href="https://doi.org/10.1017/asr.2015.11">wider spread of EVD in 2014-15</a> beyond the rural hinterlands of Guinea had everything to do with <a href="https://doi.org/10.1093/afraf/adu080">underfunded health systems in the affected nations</a> and little to do with what people ate.</p>
<p>A similar process unfolded with assertions that a “wet market” in Wuhan was the culprit of zoonotic spillover that resulted in COVID-19. Scientists don’t yet know how relevant Wuhan’s live-animal markets were for this global epidemic, although they do know that <a href="https://doi.org/10.1371/journal.ppat.1006215">viruses jump from animals to humans</a>, and back again, frequently.</p>
<p><a href="https://www.sciencemag.org/news/2020/01/wuhan-seafood-market-may-not-be-source-novel-virus-spreading-globally">Recent research suggests</a> that one of Wuhan’s “wet markets” was relevant for human-to-human transmission, as a place of close contact, rather than a space of human-animal contact. Ultimately, Wuhan’s historic position as a <a href="https://doi.org/10.3390/ijgi7080320">national high-speed rail</a> and commercial hub is likely to be far more important for the wider dissemination of COVID-19 than where and how people shopped and ate. </p>
<h2>Focusing on the wrong things</h2>
<p>Understanding disease ecology and patterns of transmission at a point of origin are important for biologists and epidemiologists. But persistently linking a disease to a specific place - particularly when other consensus terms exist - serves to keep public attention on the outbreak’s first spillover moment.</p>
<p>This focus on how an <a href="https://dx.doi.org/10.3201/eid0204.960402">emerging disease</a> originally reached human populations sends a mixed message about who is at risk of infection or how to prevent the disease in an ongoing epidemic. This is exactly the situation playing out in the United States right now.</p>
<p>Once a disease has started circulating in human populations, its point of origin is far less relevant for a general public looking to stay healthy or public health practitioners trying to control a person-to-person epidemic than, for instance, good hand and respiratory hygiene or access to medical care.</p>
<p>Further, tagging China or Wuhan amid this global pandemic undermines a sense of mutual responsibility and fundamental human connectivity, values that are vital amid this human crisis.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/322748/original/file-20200324-155702-idqz8l.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/322748/original/file-20200324-155702-idqz8l.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/322748/original/file-20200324-155702-idqz8l.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/322748/original/file-20200324-155702-idqz8l.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/322748/original/file-20200324-155702-idqz8l.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/322748/original/file-20200324-155702-idqz8l.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/322748/original/file-20200324-155702-idqz8l.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/322748/original/file-20200324-155702-idqz8l.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">A focus on the ‘foreignness’ of a virus can cause people to underestimate their own risk and ignore public health messages.</span>
<span class="attribution"><a class="source" href="http://www.apimages.com/metadata/Index/Virus-Outbreak-New-York/4c2a826fe7b64f178c6cc0c16f3c3c23/1/0">AP Photo/John Minchillo</a></span>
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<p>By focusing on the novel coronavirus’s emergence in a place exotic to many Americans, U.S. officials are emphasizing the disease’s past origins rather than its present danger. Playing up the “<a href="https://www.nytimes.com/2020/03/11/us/politics/trump-coronavirus-speech.html">foreign</a>” origins of COVID-19 in Wuhan and China allows governments to lay blame. But it also allows people to justify a lack of caution – it’s a problem from “over there,” not one that “we” are making worse – rather than undertake the everyday measures needed to slow down the spread of disease. </p>
<p>Calling COVID-19 the “Wuhan virus” or the “Chinese virus” is absurd when it has spread globally. Intentionally referring to COVID-19 as a “Chinese virus” only <a href="https://www.nytimes.com/2020/03/23/us/chinese-coronavirus-racist-attacks.html?fbclid=IwAR2MVPNwXG0yaZBXTuGPgWY5mNGVr0hgU65SEE665eD3JP7_Pj3QD6wkK28">inflames animosity</a> and hinders the real work of public health and disease prevention.</p>
<p><em>This is an updated version of an <a href="https://theconversation.com/naming-the-new-coronavirus-why-taking-wuhan-out-of-the-picture-matters-131738">article originally published</a> on Feb. 18, 2020.</em></p><img src="https://counter.theconversation.com/content/134307/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Mari Webel does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Emphasizing foreign origins of a disease can have racist connotations and implications for how people understand their own risk of disease.Mari Webel, Assistant Professor of History, University of PittsburghLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1317462020-03-03T21:46:48Z2020-03-03T21:46:48ZCoronavirus: 5 ways to put evidence into action during outbreaks like COVID-19<figure><img src="https://images.theconversation.com/files/317976/original/file-20200302-141516-1c13163.jpg?ixlib=rb-1.1.0&rect=0%2C681%2C4955%2C2627&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Medical workers in health crisis zones need access to research evidence to inform decisions. Above, workers at a temporary hospital for COVID-19 patients in Wuhan, China on Feb. 21, 2020. </span> <span class="attribution"><span class="source">Chinatopix via AP, File</span></span></figcaption></figure><p>Health crises like the current <a href="https://theconversation.com/what-the-coronavirus-emergency-declaration-means-for-canada-130950">COVID-19 outbreak</a> have the potential to affect large numbers of people and disrupt health systems. The urgency and scale of a health crisis often mean that life-saving decisions about treatment and containment must be made quickly. </p>
<p>To ensure the best care for those infected and to limit transmission, it’s crucial that those decisions be based on evidence from research.</p>
<p>The director-general of the World Health Organization, Dr. Tedros Ghebreyesus, championed the need for <a href="https://twitter.com/DrTedros/status/1229137045634899973?s=20">research evidence to inform policy and decision-making</a> in dealing with the coronavirus. </p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1229137045634899973"}"></div></p>
<p>A <a href="https://www.ghsindex.org">Global Health Security Index</a>, the first comprehensive assessment and benchmarking of health security across 195 countries, found that not a single country in the world is fully prepared to handle an epidemic or pandemic, with 77 per cent of countries not demonstrating capability to collect real-time data. </p>
<p>Research evidence can help decision-makers respond in a timely manner in such situations. However, as <a href="https://www.thespec.com/news-story/9661080-mcmaster-doc-says-academic-research-needs-to-be-more-accessible/">my own research</a> confirms, <a href="https://doi.org/10.1001/dmp.2010.32.1026">the most relevant and current evidence may not always be easily accessible</a>. Based on my years of research on supporting evidence use in crisis zones, I outline five <a href="https://rdcu.be/b1VfO"></a><a href="https://doi.org/10.1186/s12961-020-0530-2">actionable strategies</a> that make health research accessible and available to those making policy and clinical decisions.</p>
<p><strong>1. Strengthen up-to-date and accessible research evidence websites.</strong> </p>
<p>Decision-makers face challenges in accessing evidence when dealing with a crisis, highlighting the need for evidence websites, such as <a href="https://www.evidenceaid.org">Evidence Aid</a>, to support timely use of evidence. <a href="https://rdcu.be/b1VfI">My research</a> has shown the importance of having a well-organized online source of relevant information that gives decision-makers fast, easy and efficient access to the best available evidence to make, inform or advocate for a decision. This includes ensuring that linked full-text articles are not behind a paywall that would prevent users from accessing the information. </p>
<p>In my research, I offer <a href="https://twitter.com/Ahmadfiraskhali/status/1214179780238680066?s=20">seven specific suggestions</a> about how to improve evidence websites to better inform decision-making when dealing with a crisis:</p>
<ul>
<li>Provide advanced search features.</li>
<li>Clearly state the site’s purpose and the kind of evidence it provides.</li>
<li>Make evidence applicable in context, such as providing actionable points for crisis zones.</li>
<li>Improve visuals for better readability and site experience, and provide infographics for key findings.</li>
<li>Provide a mobile app or optimize the site for mobile devices.</li>
<li>Increase transparency by ensuring information on funders and contributors is prominent.</li>
<li>Highlight the important role of evidence in humanitarian aid.</li>
</ul>
<p><strong>2. Establish key networks to co-ordinate and share quality and timely evidence.</strong></p>
<p>Decision-makers often <a href="https://doi.org/10.1186/s13031-019-0231-z">rely on key stakeholders to share their knowledge and expertise</a> in times of crisis. This reaffirms the importance of having networks in place to co-ordinate and share evidence. </p>
<p>For example, <a href="https://www.who.int/evidence/en/">EVIPNet</a> is a network established by the <a href="https://www.who.int">World Health Organization</a> to promote the systematic use of data and research evidence in health policy-making. EVIPNet provides important information such as country-specific summaries with the goal of sharing the information among key stakeholders. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/317986/original/file-20200302-18291-1pvvra5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/317986/original/file-20200302-18291-1pvvra5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/317986/original/file-20200302-18291-1pvvra5.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/317986/original/file-20200302-18291-1pvvra5.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/317986/original/file-20200302-18291-1pvvra5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/317986/original/file-20200302-18291-1pvvra5.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/317986/original/file-20200302-18291-1pvvra5.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Medical staff work in the negative-pressure isolation ward in Jinyintan Hospital, designated for critical COVID-19 patients, in Wuhan in central China’s Hubei province Thursday, Feb. 13, 2020.</span>
<span class="attribution"><span class="source">Chinatopix Via AP</span></span>
</figcaption>
</figure>
<p><strong>3. Provide rapid evidence summaries.</strong> </p>
<p>Rapid evidence summaries are useful in a crisis when concise evidence that can be easily understood by non-technical decision-makers is required in a short time frame. <a href="https://doi.org/10.1186/s12961-020-0530-2">A rapid evidence service</a> is needed to answer urgent questions with the best available evidence in a short summary format, either alone or alongside stakeholders’ insights. </p>
<p><strong>4. Turn research evidence into explicit actionable points such as checklists.</strong> </p>
<p><a href="https://doi.org/10.1186/s12961-019-0498-y">Many decision-makers</a> addressing global crises emphasize the need to develop and communicate messages with practical value in widely used languages. These can be developed by research organizations that produce syntheses or <a href="https://doi.org/10.1111/1468-0009.t01-1-00052">systematic reviews</a>, formats that lend themselves well to the development of actionable messages. </p>
<p><a href="http://doi.org/10.1186/s12961-017-0204-x">Knowledge brokers</a> can fill in gaps by acting as intermediaries between the worlds of research and decision-making, helping to turn research findings into actionable points to support their use in crisis zones.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/318117/original/file-20200302-18279-1pq80m8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/318117/original/file-20200302-18279-1pq80m8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/318117/original/file-20200302-18279-1pq80m8.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/318117/original/file-20200302-18279-1pq80m8.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/318117/original/file-20200302-18279-1pq80m8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/318117/original/file-20200302-18279-1pq80m8.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/318117/original/file-20200302-18279-1pq80m8.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Medical workers check on the conditions of patients in Jinyintan Hospital, designated for critical COVID-19 patients, in Wuhan, China on Feb. 13, 2020.</span>
<span class="attribution"><span class="source">Chinatopix Via AP</span></span>
</figcaption>
</figure>
<p><strong>5. Increase the value of using evidence to inform interventions.</strong> </p>
<p>There is a need to increase awareness among decision-makers about the existence of available research evidence and its value in decision-making. </p>
<p><a href="https://www.evidenceaid.org/wp-content/uploads/2018/10/Evidence_Aid_Practice_Guide_52pp_DIGITAL-FINAL-VERSION-2018-10-22.pdf">Professional judgement</a> is known to play a key role in informing decisions. My research recognizes that decisions are not determined by evidence alone, but rather alongside professional opinion and other decision-making inputs. One way to increase the value of using evidence alongside professional judgement is to conduct a <a href="https://doi.org/10.1016/j.socscimed.2012.06.016">stakeholder dialogue</a> that puts the research evidence alongside the tacit knowledge, real world views and experiences of decision-makers.</p>
<p>In responding to a health crisis, decision-makers draw on different types of information. Research evidence can help clarify problems, help frame options to respond appropriately and help address implementation considerations for interventions in specific contexts. </p>
<p>These five actionable strategies to support evidence use in decision-making can help ensure that the public is well-informed and decision-makers are basing their interventions to save lives on the best available research evidence.</p><img src="https://counter.theconversation.com/content/131746/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Ahmad Firas Khalid does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>In a health crisis, decisions about treatment and containment must be made quickly. It’s crucial those decisions be based on research evidence, but fast and easy access is not always available.Ahmad Firas Khalid, Medical doctor, Health Policy Researcher and Advisor, Educator, McMaster UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1317382020-02-18T13:55:15Z2020-02-18T13:55:15ZNaming the new coronavirus – why taking Wuhan out of the picture matters<figure><img src="https://images.theconversation.com/files/315517/original/file-20200214-11040-1vlxzi1.jpg?ixlib=rb-1.1.0&rect=91%2C22%2C2425%2C1747&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The virus that causes COVID-19 seems able to spread to anyone, anywhere.</span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/niaid/49530315733/in/album-72157712914621487/">NIAID/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span></figcaption></figure><p><em>Editor’s Note: An updated version of this article was published on March 25, 2020. <a href="https://theconversation.com/calling-covid-19-a-chinese-virus-is-wrong-and-dangerous-the-pandemic-is-global-134307">Read it here</a>.</em></p>
<p>Stop calling the novel coronavirus outbreak the “Wuhan coronavirus,” and start getting comfortable with “COVID-19.” That’s the World Health Organization’s <a href="https://www.who.int/dg/speeches/detail/who-director-general-s-remarks-at-the-media-briefing-on-2019-ncov-on-11-february-2020">recommended name for the disease</a>.</p>
<p>While identifying a new disease by its place of origin seems intuitive, history demonstrates that doing so can harm the people who live there. <a href="http://thenationshealth.aphapublications.org/content/45/6/1.1">Consequences can include</a> economic distress, as tourists withdraw, investment cools down and solidarities between people weaken. Linking a specific disease with a specific place can lead to <a href="https://www.questia.com/library/journal/1G1-195680111/the-yellow-peril-revisited-the-impact-of-sars-on">discrimination</a> <a href="https://doi.org/10.1353/ces.2008.0002">and stigmatization</a> and <a href="https://www.discovermagazine.com/health/death-at-the-corners">avoidance of a town or village</a>.</p>
<p>As a <a href="https://www.history.pitt.edu/people/mari-webel">historian of public health and modern Africa</a>, I study the politics of infectious diseases and the importance of understanding the cultural contexts of epidemics and responses to them. Past epidemics underscore the social and public health consequences of how people talk about a disease’s origins.</p>
<h2>A long tradition of naming by place</h2>
<p>Tagging a place when identifying a disease has a long history.</p>
<p>In the 19th century, as global trade and mobility allowed cholera to spread worldwide from its origins in the Ganges Delta, the disease quickly became known as “the Asiatic cholera.” <a href="https://www.amazon.com/Cholera-Biography-Biographies-Christopher-Hamlin/dp/019954624X">That label persisted for decades</a>, implicitly blaming an entire continent for a disease that can spread anywhere as a function of poor sanitation.</p>
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<a href="https://images.theconversation.com/files/315567/original/file-20200215-11000-4knczk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/315567/original/file-20200215-11000-4knczk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/315567/original/file-20200215-11000-4knczk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=475&fit=crop&dpr=1 600w, https://images.theconversation.com/files/315567/original/file-20200215-11000-4knczk.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=475&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/315567/original/file-20200215-11000-4knczk.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=475&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/315567/original/file-20200215-11000-4knczk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=596&fit=crop&dpr=1 754w, https://images.theconversation.com/files/315567/original/file-20200215-11000-4knczk.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=596&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/315567/original/file-20200215-11000-4knczk.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=596&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">During an 1884 cholera epidemic in France, public health workers disinfect baggage at a quarantine station for maritime travelers.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-illustration/cholera-epidemic-france-1884-public-health-242815612">Everett Historical/Shutterstock.com</a></span>
</figcaption>
</figure>
<p>For Europeans and Americans of the time, Asia was an exotic, distant somewhere else. Distinguishing the disastrous illness of cholera as “Asiatic” fit with the racialized, imperial views that denigrated the intelligence and the cultures of non-white populations globally and justified colonial overrule. It also helped justify more stringent <a href="https://doi.org/10.1017/S0018246X06005280">quarantine measures and travel restrictions</a> for people read as “Asian” and not European. <a href="https://doi.org/10.1017/S0020743808080549">Muslim pilgrims en route to Mecca</a> from southern Asia, for instance, were <a href="https://doi.org/10.1017/S0010417515000407">subject to different rules</a> than European troop ships traveling the same routes.</p>
<p><a href="https://www.cambridge.org/us/academic/subjects/history/history-medicine/laboratory-revolution-medicine?format=PB">Ideas about disease changed</a> after the late 19th century, when scientists could use new laboratory techniques to link specific pathogens – bacteria, parasites, and later on, viruses – to specific diseases. Sometimes, this gave a scientific name to an age-old problem, such as “consumption” becoming the medical entity tuberculosis.</p>
<p>But these new techniques also allowed researchers to correlate pathogens with particular locales. Naming an illness after a place quickly became the norm.</p>
<p>So <a href="https://www.cdc.gov/vhf/rvf/index.html">Rift Valley Fever</a>, caused by a virus in the Bunyaviridae family, got its name from an area of colonial Kenya where it was first reported.</p>
<p>The <a href="https://www.cdc.gov/hantavirus/index.html">Hantaviruses</a> are linked to the Hantan River area of South Korea where <a href="https://doi.org/10.1086/424604">Dr. Ho-Wang Lee first identified the virus</a>.</p>
<p><a href="https://www.cdc.gov/vhf/ebola/index.html">Ebola virus disease</a> (EVD) got its popular name from a river near the village in the modern nation of Democratic Republic of Congo (formerly Zaïre) where U.S. and European scientists <a href="https://doi.org/10.1093/infdis/jiw207">identified that pathogen</a>.</p>
<p>Focusing on a specific place creates something particular from something that could have happened anywhere. There’s nothing peculiarly distinctive about Lassa village in Nigeria, compared to any other village five or 50 miles away. Lassa was <a href="https://doi.org/10.4269/ajtmh.2012.12-0466">just the first place</a> where a white missionary’s death drew the attention of authorities. And yet, in the aftermath of that moment, as “<a href="https://www.cdc.gov/vhf/lassa/index.html">Lassa fever</a>” came to identify a fearsome hemorrhagic fever, the town of <a href="https://nigeriahealthwatch.com/how-lassa-went-from-a-small-nigerian-town-to-a-well-known-virus/#.XkbVLhd7kSd">Lassa became a shadow of its former self</a>.</p>
<h2>Focusing on the wrong things</h2>
<p>In the short term, close associations between places and diseases can stigmatize the sick, as well as influence perceptions of risk for people both nearby and distant.</p>
<p>An outbreak of a serious and deadly respiratory and hemorrhagic disease <a href="https://www.discovermagazine.com/health/death-at-the-corners">reported in the U.S.’ Four Corners region in 1993</a> was tagged by the press as a “Navajo flu.” People in the area assumed incorrectly that the disease was directly contagious and highly localized to the Navajo Nation.</p>
<p>Associating this alarming new disease specifically with the Navajo Nation had a chilling effect on reporting illness to medical authorities because of fear of stigma. In the end, officials named the new hantavirus that caused that particular outbreak Sin Nombre, which means “without a name” in Spanish.</p>
<p>Understanding disease ecology and patterns of transmission at a point of origin are important for biologists and epidemiologists. But permanently naming a disease for a specific place serves to keep public attention on the moment of origin – the “spillover” case or known outbreak of an epidemic. </p>
<p>Focusing on how an <a href="https://dx.doi.org/10.3201/eid0204.960402">“emerging” disease</a> originally reached human populations can come at the expense of clear messaging about who is at risk of infection or how to prevent the disease in an ongoing epidemic. What’s more, that outbreak moment is often less relevant for a general public looking to stay healthy or public health practitioners trying to control a person-to-person epidemic.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/315568/original/file-20200215-10985-5ziaaj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/315568/original/file-20200215-10985-5ziaaj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/315568/original/file-20200215-10985-5ziaaj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=419&fit=crop&dpr=1 600w, https://images.theconversation.com/files/315568/original/file-20200215-10985-5ziaaj.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=419&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/315568/original/file-20200215-10985-5ziaaj.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=419&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/315568/original/file-20200215-10985-5ziaaj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=526&fit=crop&dpr=1 754w, https://images.theconversation.com/files/315568/original/file-20200215-10985-5ziaaj.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=526&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/315568/original/file-20200215-10985-5ziaaj.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=526&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">The Ebola outbreak was more about public health infrastructure than people’s lifestyles.</span>
<span class="attribution"><a class="source" href="http://www.apimages.com/metadata/Index/Mali-Ebola-/7f37ac37eb804adbaf11efa628eb8ec1/2/0">AP Photo/Baba Ahmed</a></span>
</figcaption>
</figure>
<h2>Building blame into a name</h2>
<p>Affixing place to disease also puts a spotlight on specific people, which matters for how a wider public associates a population’s perceived culture, foodways or activities with a disease. </p>
<p>These kinds of stereotypes arose, for instance, around Ebola virus disease in 2014-15, erroneously blaming some people for a wider problem.</p>
<p>Early conversations about EVD, marked as particularly African with its name, focused on eating “bushmeat,” a term from the colonial era to describe meat that people hunt, rather than buy in a market. Talking about “bushmeat” allowed people to characterize those suffering from EVD as <a href="https://www.washingtonpost.com/news/monkey-cage/wp/2014/08/25/othering-ebola-and-the-history-and-politics-of-pointing-at-immigrants-as-potential-disease-vectors/">primitive or exotic</a>. It also implied that people were responsible for bringing this disease into circulation because of what they ate or how they lived.</p>
<p>In fact, the <a href="https://doi.org/10.1017/asr.2015.11">wider spread of EVD in 2014-15</a> had everything to do with <a href="https://doi.org/10.1093/afraf/adu080">underfunded health systems in the affected nations</a> and nothing to do with what people ate.</p>
<p>A similar process is unfolding now, with rumors that Wuhan’s “wet markets” are the culprits of zoonotic spillover, where viruses jump from animals to humans. Scientists don’t yet know how relevant Wuhan’s live-animal markets truly were for this global epidemic, although they do know that <a href="https://doi.org/10.1371/journal.ppat.1006215">viruses jump from animals to humans</a> (and back again) frequently. Wuhan’s historic position as a <a href="https://doi.org/10.3390/ijgi7080320">national high-speed rail</a> and commercial hub is likely to be far more important for the wider dissemination of COVID-19 than where and how people shopped and ate.</p>
<p><iframe id="PAiyo" class="tc-infographic-datawrapper" src="https://datawrapper.dwcdn.net/PAiyo/2/" height="400px" width="100%" style="border: none" frameborder="0"></iframe></p>
<h2>Get used to COVID-19</h2>
<p>Public health officials and scientists have come to understand the potentially harmful repercussions of associating place and disease names – for both the immediate public health response and the long-term economic and social future of a given place. In 2015 WHO announced its <a href="https://apps.who.int/iris/bitstream/handle/10665/163636/WHO_HSE_FOS_15.1_eng.pdf;jsessionid=5573CA8D94F69633BF56C3265377A5B2?sequence=1">official guidelines</a> to avoid the practice.</p>
<p>In the past weeks, as the novel coronavirus has dominated the news and <a href="https://gisanddata.maps.arcgis.com/apps/opsdashboard/index.html#/bda7594740fd40299423467b48e9ecf6">spread around the world</a>, there’s been vigorous debate about what to call it. It’s important for both a popular understanding of risk and prevention, as well as for global solidarity with the heavily affected population of Wuhan, to get used to saying “COVID-19” and to insist that others do the same.</p>
<p>After all, <a href="https://doi.org/10.1086/590567">Spain had nothing specific to do</a> with the so-called “Spanish influenza,” as the devastating H1N1 influenza pandemic of 1918-19 was popularly known for decades. They just reported it first.</p>
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<p class="fine-print"><em><span>Mari Webel does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>While identifying a new disease by its place of origin seems intuitive, history shows that doing so can have serious consequences for the people that live there.Mari Webel, Assistant Professor of History, University of PittsburghLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1242922019-09-29T09:32:39Z2019-09-29T09:32:39ZEbola one year on: the wins, the setbacks, and the way forward<figure><img src="https://images.theconversation.com/files/294343/original/file-20190926-51457-4epgpx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Hugh Kinsella Cunningham/EPA-EFE</span></span></figcaption></figure><p>The last five years have witnessed the two biggest outbreaks of Ebola, first in <a href="https://www.cdc.gov/vhf/ebola/history/2014-2016-outbreak/index.html">West Africa</a> and currently in the <a href="https://www.who.int/emergencies/diseases/ebola/drc-2019">Democratic Republic of Congo (DRC)</a>. The DRC is no stranger to Ebola and has battled the virus on nine previous occasions since 1976. </p>
<p>The current outbreak however, for a multitude of socio-political reasons, refuses to give in to efforts by an international team of health care workers, armed with vaccines and treatment regimes, which did not even exist during previous episodes. As the outbreak surpasses its one year mark, the virus has <a href="http://who.maps.arcgis.com/apps/opsdashboard/index.html#/e70c3804f6044652bc37cce7d8fcef6c">infected over 3000 people</a> and claimed more than 2000 lives. </p>
<p>In July, the World Health Organisation <a href="https://theconversation.com/why-declaring-ebola-a-public-health-emergency-isnt-a-silver-bullet-120685">declared</a> the outbreak a public health emergency but recent weeks still saw an average of 80 new cases. Every new case is followed up with contact-tracing and <a href="https://theconversation.com/why-ebola-vaccine-on-trial-in-the-drc-is-raising-hopes-111126">ring-vaccination</a>. To date, more than 200 000 people have been administered the Merck rVSV-ZEBOV vaccine in the country. </p>
<p>In addition to the vaccine, <a href="https://www.nature.com/articles/d41586-019-02442-6">two treatments</a> are also under trial and have shown promise to prevent deaths from Ebola, if administered early enough after infection. These drugs are based on “neutralizing” antibodies from Ebola survivors which bind to proteins on the virus and prevent it from infecting cells.</p>
<p>The exponential rise of infections in this epidemic was curbed by a rapid health response and the early use of an effective vaccine to immunise those at highest risk of exposure. On the other hand, 14 months on, the epidemic has not yet ended. </p>
<p>At this stage of the outbreak it’s useful to take a step back and reflect on why the disease gets so much attention – and if it’s justified. Second, to consider what the blockages have been. And finally, what the way forward might be. </p>
<h2>Why so much attention?</h2>
<p>The medical response to an Ebola infection is markedly more challenging than many other diseases. It is one of the most deadly viruses with a 60% - 90% mortality rate compared to <a href="https://qz.com/africa/1711485/measles-is-killing-more-people-in-dr-congo-than-ebola/">2% for measles</a>. </p>
<p>The Ebola virus is extremely infectious and highly communicable. Treating the disease is resource intensive. Patients must be kept in isolation in specialised, well-designed treatment centres. Health care workers are at high risk of exposure and must take extreme precautions to examine patients. Breakdown in personal protection and infrastructure can be fatal. </p>
<p>In fact, approximately 6% of the victims have been involved in looking after patients. These issues bring logistical limitations to the management of this disease, especially in a densely populated region shouldering an extremely high share of the <a href="https://ourworldindata.org/burden-of-disease">global infectious disease burden</a>. </p>
<p>While the Ebola epidemic powers through, the DRC is also battling serious outbreaks of <a href="https://www.msf.org/deadly-measles-outbreak-spreading-wildfire-democratic-republic-congo">measles</a> and <a href="https://reliefweb.int/report/democratic-republic-congo/democratic-republic-congo-drc-cholera-outbreak-un-drc-authorities">cholera</a>. In fact, more lives have been lost to measles since January this year than to Ebola in the last one year. Both measles and cholera are vaccine preventable diseases, but the majority of the population must be immunised for this to be effective. </p>
<p>Given that containing the Ebola outbreak would allow resources to be channelled towards tackling other infectious diseases too explains why it’s getting so much attention.</p>
<p>Of course, there is always more that could be done.</p>
<h2>Blockages</h2>
<p>This outbreak of Ebola has been a lesson in how infrastructure and the prevailing socio-political climate can hamper the best of efforts by medical practitioners and scientists. </p>
<p>The region has been the centre of acute violence for two decades. It’s a potent mix. The violence has affected the lives of the people so much, that the implications of the disease are lost in their <a href="https://www.npr.org/sections/goatsandsoda/2019/09/10/759343232/in-congo-ebola-is-just-one-more-thing-to-worry-about">day-to-day struggles</a>. This has added to the difficulty of getting people to cooperate with medical teams and report cases in time. </p>
<p>For example, people are often afraid of the response teams and flee, as demonstrated by a <a href="http://www.cidrap.umn.edu/news-perspective/2019/07/ebola-case-identified-near-south-sudan-border">recent case</a> from Ariwara, very close to the South Sudan and Uganda border. </p>
<p>There have also been attacks on infrastructure, as was seen in the case of <a href="http://www.cidrap.umn.edu/news-perspective/2019/07/more-violence-drc-officials-report-51-ebola-cases-recent-days">two treatment centres</a> being burnt down at the Uganda border.</p>
<p>In situations such as these, part of the solution lies in spreading awareness about the disease and gaining their trust in the system. </p>
<p>In addition, the efficiency of the response has been hampered by the difficulties in administering the vaccine to as many people as is needed, sub-optimal reporting rates at clinics, new hot spots of disease and <a href="https://www.statnews.com/2018/11/17/ebola-response-setback-attack-who/">periodic waves of violence</a>, some directly targeted on health care units. </p>
<h2>Next steps</h2>
<p>Leaders and international health teams have talked about the possible need for a change in strategy. </p>
<p>The DRC has finally agreed to the trial of the <a href="https://www.who.int/blueprint/priority-diseases/key-action/ebola-vaccine-candidates/en/">prime-boost vaccine</a> Ad26.ZEBOV/MVA-BN from Johnson & Johnson. This is in addition to a vaccine from Merck that’s been rolled out. This strategy promises to provide an alternative, if supplies from Merck deteriorate or if the vaccination net has to be cast wider in the community. </p>
<p>But, as with all vaccination drives, building trust is key. This will require hands-on cooperation between medical and humanitarian workers in the region.</p>
<p>In addition to immunisation campaigns, decentralisation and enabling local clinics to diagnose and manage patients early is a much needed investment to uplift the health care system. </p>
<p>Over-riding everything, however, is that a significant effort is required to increase the trust between communities, response teams and the government, so people come forward early if they have symptoms. Only this can ensure that the virus is stopped before it transmits. </p>
<p>There’s quite a long road ahead. Only 14 out of 47 affected health zones have been reported <a href="http://www.cidrap.umn.edu/news-perspective/2019/09/violence-15-new-ebola-cases-reported-drc-outbreak">free from Ebola</a> over the last 21 days. That number needs to rise quickly.</p><img src="https://counter.theconversation.com/content/124292/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Shirin Ashraf receives funding from the Wellcome Trust and the Medical Research Council.</span></em></p><p class="fine-print"><em><span>Emma Thomson receives funding from the Wellcome Trust and the Medical Research Council.</span></em></p>The current outbreak refuses to give in to efforts by an international team of health care workers, armed with vaccines and treatment that did not even exist during previous episodes.Shirin Ashraf, Postdoctoral Researcher, MRC-Centre for Virus Research, University of GlasgowEmma Thomson, Professor in Infectious Diseases, MRC-Centre for Virus Research, University of GlasgowLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1240152019-09-26T13:35:27Z2019-09-26T13:35:27ZEbola survivors can pass on the virus: we’re trying to understand what role sex plays<figure><img src="https://images.theconversation.com/files/293613/original/file-20190923-54749-n3j9qf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">A health worker spreading disinfectant at a health checkpoint in Goma, DRC.</span> <span class="attribution"><span class="source">Patricia Martinez/EPA-EFE</span></span></figcaption></figure><p>The <a href="https://www.who.int/emergencies/diseases/ebola/drc-2019">current Ebola disease outbreak</a> in the Democratic Republic of the Congo (DRC) is the second largest in history. It has been raging for over a year with no indication that it is nearing an end. Many of the issues that prevent effective containment of Ebola disease outbreaks <a href="https://theconversation.com/how-to-manage-in-a-crisis-lessons-from-the-west-africa-ebola-outbreak-121590">have been discussed</a>. These include <a href="https://theconversation.com/why-its-hard-to-stop-ebola-spreading-between-people-and-across-borders-118851">porous borders</a>, <a href="https://theconversation.com/the-drcs-ebola-outbreak-has-all-the-makings-of-a-humanitarian-crisis-114636">community mistrust</a> of health workers, and the spread of <a href="https://www.sciencemag.org/news/2019/01/fighting-ebola-hard-congo-fake-news-makes-it-harder">misinformation</a>. </p>
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Read more:
<a href="https://theconversation.com/why-its-hard-to-stop-ebola-spreading-between-people-and-across-borders-118851">Why it's hard to stop Ebola spreading -- between people and across borders</a>
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<p>But one area that requires further study is Ebola virus’ persistence in the reproductive systems of otherwise healthy survivors. Understanding how Ebola disease outbreaks are exacerbated by sexual transmission is important to stop new chains of transmission and to prevent the disease from spreading to new geographic regions. </p>
<p>Multiple reports strongly suggest that <a href="https://www.ncbi.nlm.nih.gov/pubmed/27585800">re-emergence</a> of Ebola disease is linked to <a href="https://www.ncbi.nlm.nih.gov/pubmed/25950255">persistent infections</a> and <a href="https://www.ncbi.nlm.nih.gov/pubmed/26465384">sexual transmission</a> from survivors. What this means is that people who have survived infection by Ebola virus – and who no longer show any symptoms of the disease – can continue to carry the virus and pass on the infection months after they have recovered.</p>
<p>Our research group recently <a href="https://www.ncbi.nlm.nih.gov/pubmed/30513823">reviewed</a> the current understanding of rates and mechanisms of Ebola virus persistence in male disease survivors. We are using this information to fill in gaps about how persistence relates to sexual transmission of the virus. </p>
<p>In addition, we are combining molecular investigations with insights from survivors to better equip future outbreak response efforts. We also hope the work will help address long-term health issues faced by Ebola disease survivors. </p>
<h2>The role of the reproductive system</h2>
<p>Nearly everything known about Ebola virus persistence in the reproductive system has resulted from testing semen of West African Ebola disease survivors. </p>
<p>It has been established that the Ebola virus can be detected in semen long after it is cleared from other organs and tissues. For example, a <a href="https://www.nejm.org/doi/10.1056/NEJMoa1805435">recent study</a> showed that the virus could be detected in <a href="https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(16)30243-1/fulltext">50% of male survivors 115 days</a> after recovery and may linger for up to three years. </p>
<p>The virus has also been detected in semen at concentrations greatly exceeding that found in the blood at peak infection. The <a href="https://www.ncbi.nlm.nih.gov/pubmed/28582513">data</a> suggests that this occurs in the absence of any symptoms of disease. In addition, <a href="https://www.ncbi.nlm.nih.gov/pubmed/27585800">sexual transmission</a> of Ebola virus from <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4584553/">male survivors</a> has been reported up to 18 months following their recovery.</p>
<p>These observations are important to public health. Firstly, long-term persistence of Ebola virus could lead to the initiation of new chains of disease transmission long after outbreaks have ended. Secondly, the presence of high concentrations of virus in the semen in the absence of disease symptoms means that male survivors could carry and transmit the virus without knowing they’re still infected.</p>
<p>But the fact that only semen is being used in these studies presents a problem. This means that the perseverance of the virus is only being traced in males. This means that little is known about persistence of the virus in women. This urgently needs attention because Ebola virus has been detected in <a href="https://bmjopen.bmj.com/content/6/1/e008859">female survivors</a> up to 15 months <a href="https://www.ncbi.nlm.nih.gov/pubmed/26465384">following recovery</a>, and there are <a href="https://www.ncbi.nlm.nih.gov/pubmed/30049622">recorded cases of female to male</a> transmission. </p>
<h2>Unanswered questions</h2>
<p>There is a strong need for greater understanding of Ebola virus infections, including:</p>
<ul>
<li><p>When Ebola virus is transmitted to reproductive tissues during illness.</p></li>
<li><p>How Ebola virus persists over extended periods in reproductive tissues.</p></li>
<li><p>How long persistent virus remains infectious.</p></li>
<li><p>How often sexual transmission occurs.</p></li>
</ul>
<p>In a bid to answer some of these questions – particularly the molecular intricacies of Ebola virus persistence within the reproductive system – we used laboratory models of male and female reproductive systems. This allowed us to:</p>
<ul>
<li><p>Study the dynamics of Ebola virus transmission to the reproductive system. </p></li>
<li><p>Identify the particular types of cells that are infected by Ebola virus in the reproductive system. </p></li>
<li><p>Determine how local immune responses in the infected cells help facilitate Ebola virus persistence. </p></li>
<li><p>Characterise damage to the reproductive system, including altered sperm health. </p></li>
</ul>
<p>We have also performed Ebola virus infections in mice to better understand how our molecular data reflects the complex pathophysiology of Ebola virus disease and persistence in humans. Mouse models have been used in <a href="https://www.ncbi.nlm.nih.gov/pubmed/23170168">numerous investigations of Ebola virus</a> infection. </p>
<p>By infecting mice with Ebola virus, we can determine whether the male reproductive system is damaged by persistent infection. We can also determine if there is an effect on fertility, and how often persistent infections result in sexual transmission. In addition, infections of female mice help us determine the severity of disease caused by sexually transmitted Ebola virus, the effects on female fertility, and consequences for gestational development.</p>
<p>In addition to our laboratory research, we are surveying Ebola disease survivors in Sierra Leone in an effort to identify and understand the long-term health consequences, with a focus on reproductive health. Our goal is to determine if survivors have encountered post-recovery reproductive complications such as reduced fertility or problems during pregnancy. </p>
<p>We are also investigating whether Ebola disease survivors face greater burdens of subsequent infections by other pathogens.</p>
<h2>Future outbreaks</h2>
<p>The recent success of vaccination and therapeutic treatments in the current DRC Ebola disease outbreak provides hope. But a great deal about the virus remains unknown. A greater understanding of the mechanisms of how persistent infections occur will help us guide future outbreak response efforts, with the goal of reducing additional Ebola virus transmission events and providing increased care, support and safety for survivors and their communities.</p><img src="https://counter.theconversation.com/content/124015/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Brayden G. Schindell receives funding from Canadian Institutes of Health Research. </span></em></p><p class="fine-print"><em><span>Jason Kindrachuk receives funding from the Canada Research Chairs program and from the Manitoba Medical Services Foundation.</span></em></p><p class="fine-print"><em><span>Andrew L. Webb and Jia B. Kangbai do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Nearly everything known about Ebola virus persistence in the reproductive system has resulted from testing semen of West African Ebola virus disease survivors.Andrew L. Webb, PhD Candidate, University of ManitobaBrayden G. Schindell, PhD Candidate, University of ManitobaJason Kindrachuk, Assistant Professor/Canada Research Chair in emerging viruses, University of ManitobaJia B. Kangbai, PhD candidate, Ludwig Maximilian University of MunichLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1188512019-06-17T07:59:36Z2019-06-17T07:59:36ZWhy it’s hard to stop Ebola spreading – between people and across borders<figure><img src="https://images.theconversation.com/files/279568/original/file-20190614-158931-zrejph.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">An Ebola treatment centre in North Kivu where the outbreak's epicentre is.</span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/monusco/42684940960/in/photolist-282VtPW-2aHpmqd-29pkUdP-24K7D7a-2aMJ2LM-29GipwS-29pkTQe-SVBgw1-29Gix2w-2f4Lixp-29pqFT8-M2QK5c-29prfMK-2aHpsb1-2aHpnXb-282VA4Q-2773MDU-282RxdC-29Gn6cY-2dXSCMm-2aHpZtG-282Wr3b-NEb5Sh-2cKuxBc-2aHjHNd-29GjwKY-29GiFRA-2cKroaT-2eZ9hgd-29GjxR5-RUfF9B-2fcwL1W-LjGafR-2dEVKdK-24sjuxp-24sjune-2dEVLs8-2aHjMrL-UGMjQS-2cF45xC-2cKuu4F-2cEZQTE-29preQK-2bDrD3W-2cF3KT3-2bmNEwZ-2cF43ju-2bmKLx2-2aHjNCy-QBJ3xq">Flickr/MONUSCO Photos</a></span></figcaption></figure><p><em>Ebola has claimed around 1400 lives in the Democratic Republic of Congo while there are <a href="https://www.bbc.com/news/world-africa-48622635">reports</a> that two people have lost their lives in western Uganda. The Conversation Africa’s Ozayr Patel asked Janusz Paweska about how the disease has spread and what can be done.</em> </p>
<p><strong>How is Ebola spread between human beings?</strong></p>
<p>The source of primary human infection with Ebola virus are wild animals. The exposure takes place during unprotected hunting and processing of infected wild animals for meat consumption. This includes close contact with their infected blood, secretion and organs. In central equatorial Africa, bush meat is viewed as a major prize. This includes monkeys, chimpanzees, gorillas, bush pigs, forest antelopes (duikers), chevrotains, pangolins, civets and bats. Some particular species of fruit bats are considered the possible natural hosts for Ebola virus.</p>
<p>Once the Ebola virus is introduced into a human body, it replicates at very high concentrations in almost all organs and tissues. After an incubation period ranging from 2 to 21 days, it spreads by human-to-human transmission. This happens through direct contact – such as unprotected broken skin or mucous membranes – with blood, secretions or other bodily fluids (faeces, vomit). </p>
<p>Burial ceremonies where family members and other mourners have direct contact with the body of the deceased person can play a role in transmission. Direct contact with contaminated beds, bedding, and cloths can also be a source of infection. Another risk is sexual transmission. To reduce the risk, male survivors of Ebola should practice safe sex and hygiene for 12 months from the onset of symptoms or until their semen has tested negative twice for Ebola virus.</p>
<p>Healthcare workers can become infected while taking care and treating Ebola patients through close contact without the use of adequate infection control precautions and adequate nursing procedures. For example, when not wearing gloves, masks or goggles and gowns.</p>
<p><strong>What steps can Uganda take to ensure that the disease is controlled and doesn’t spread?</strong></p>
<p>The spread of Ebola across international borders is of a great concern. But it’s not surprising that the epicentre of the Ebola outbreak is in the highly unstable northeastern part of the DRC (North Kivu and Ituri provinces). The area <a href="https://www.worldbank.org/en/news/immersive-story/2019/03/04/drc-a-trip-to-the-front-lines-of-the-fight-against-ebola">is deeply troubled with high levels</a> of social disruption caused by war and internal civil conflict resulting in widespread violence. This has included attacks on healthcare workers make implementing outbreak control measures, in addition, people move around in the region a lot and borders are porous between North Kivu province of the DRC and neighbouring countries. This has always meant that the potential for Ebola to cross the border has been high.</p>
<p>Uganda has had incidents of Ebola before. Previous outbreaks occurred in <a href="https://www.who.int/csr/don/2000_10_16/en/">2000</a> (425 cases with 224 deaths), <a href="https://www.cdc.gov/vhf/ebola/history/distribution-map.html">2007</a> (149 cases with 37 deaths), and <a href="https://www.cdc.gov/vhf/ebola/history/distribution-map.html">2011-2012</a> (25 with 21 cases). All these led to Uganda developing local diagnostic capacity which is now being used for rapid diagnosis of imported cases from DRC.</p>
<p>Measures and strategies to control the Ebola outbreaks are in place in the country. These include social mobilisation, health education and psychosocial support, case management and funerals (safe burials, patient screening, barriers and nursing). Other measures include surveillance and laboratory testing as well as contact tracing, sample collection and transport, reporting and analysing results, logistics and security. Mobile response teams have also been mobilised. These measures need high levels of coordination and community engagement.</p>
<p>The Ugandan Ministry of Health and the World Health Organisation are taking all the necessary measures to contain the outbreak and prevent further spread. This includes vaccination and deployment of more resources. Mass gatherings, market days and prayers in areas at risk have been cancelled. And a mobile response team has been deployed to the affected border area of Uganda.</p>
<p><strong>What can neighbouring countries to do keep themselves safe?</strong></p>
<p>Rwanda, South Sudan, and Uganda have been on high alert since the ongoing outbreak of Ebola was <a href="https://ecdc.europa.eu/en/ebola-virus-disease-outbreak-democratic-republic-congo-ongoing">officially declared</a> on 01 August 2018 in the DRC. Health border control measures – like screening body temperature – have been put in place as well as outbreak control and response measures.</p>
<p><strong>Should people avoid travelling to the DRC and Uganda for the moment? What precautions should be taken?</strong></p>
<p>So far, there are no travel restrictions to either country. But travellers should take general precautions by avoiding:</p>
<ul>
<li><p>contact with sick or dead people;</p></li>
<li><p>contact with wild animals, including dead animals, and particularly monkeys, chimpanzees, gorillas, duikers, chevrotains, pangolins, and bats;</p></li>
<li><p>consumption of bushmeat and make sure that animal products (blood and meat) are thoroughly cooked before consumption;</p></li>
<li><p>unprotected sex; and</p></li>
<li><p>visiting any caves.</p></li>
</ul>
<p>Symptoms of infection will emerge 21 days after a person has been in contact with the virus. Symptoms could include fever, headache, weakness, muscle pain, diarrhoea, abdominal pain, vomiting and bleeding. All contact with others should be avoided, and medical help sought immediately.</p><img src="https://counter.theconversation.com/content/118851/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Janusz Paweska received funding from the SA Medical Research Funding to study the molecular epidemiology of Ebola virus disease outbreak in Sierra Leone and to improve Ebola diagnostic capacity. </span></em></p>Borders are porous between North Kivu province of the DRC and neighbouring countries, so the potential for spread is highly likely.Janusz Paweska, Head of the Center for Emerging and Zoonotic Diseases, National Institute for Communicable DiseasesLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1187192019-06-15T08:12:29Z2019-06-15T08:12:29ZHow Africa’s porous borders make it difficult to contain Ebola<figure><img src="https://images.theconversation.com/files/279507/original/file-20190614-158953-19s9dco.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Health workers from Bwera hospital prepare to transport the body of a fifty-year-old woman who died of Ebola to the burial site in Bwera, Uganda. </span> <span class="attribution"><span class="source">MELANIE ATUREEBE/EPA</span></span></figcaption></figure><p><em>More than <a href="https://www.who.int/ebola/situation-reports/drc-2018/en/">2000 cases of Ebola</a> have been recorded in the Democratic Republic of the Congo (DRC) since last August. Now, despite authorities’ efforts – such as <a href="https://apps.who.int/iris/bitstream/handle/10665/311641/SITREP_EVD_DRC_20190331-eng.pdf?ua=1">screening millions of travellers</a> moving between the DRC and its neighbours – the disease has spread. The World Health Organisation <a href="https://www.bbc.com/news/world-africa-48603273">announced</a> on 12 June that a five-year-old boy had died in Uganda after testing positive for Ebola. A day later, his grandmother died. It’s believed he contracted Ebola when they attended the funeral of his grandfather (who died of Ebola) in the DRC. The Conversation Africa’s Natasha Joseph asked Professor Mosoka Fallah to explain the implications.</em></p>
<p><strong>There have now been two Ebola deaths in Uganda. Do we know anything more about these cases?</strong></p>
<p>We now know that a family of 14 travelled from the DRC to Uganda. Most of them crossed at the formal border, but five evaded the main port of entry. Instead they crossed over informally. Those five arrived with symptoms that included diarrhoea and bleeding. This implies a period of illness in the DRC and that they were most likely symptomatic while travelling.</p>
<p>It appears they knowingly evaded the official check point that would have monitored their temperature and physical signs to pick them up as possible Ebola cases.</p>
<p>In some ways this is a replica of the cross-border import and export of Ebola cases between Guinea, Liberia and Sierra Leone that were hit by the <a href="https://www.cdc.gov/vhf/ebola/history/2014-2016-outbreak/index.html">2014 outbreak</a>. Many borders between countries in the region are porous: people are in fact much more likely to cross into a neighbouring country without even going through a formal border crossing. </p>
<p>People cross for all sorts of reasons. One of them is funeral rites. The spread of the cases from Guinea to Liberia and eventually to Sierra Leone centred around funeral rites.</p>
<p><strong>Authorities have worked hard to keep Ebola from spreading beyond the DRC. Does the spread mean they need to do more, or do things differently?</strong></p>
<p>The response teams from both the DRC and Uganda must be commended for preventing the mass cross-border export of Ebola cases given the complex nature of the current outbreak.</p>
<p>There are a lot more informal crossings than the formal ones. The surveillance system for scanning people who are crossing into Uganda are at these formal crossings. This isn’t always foolproof. When I was working in Liberia during the West African epidemic between 2014 and 2016, we found that some people would take antipyretic medications to avoid being detected at the formal border crossings. These drugs bring fevers down so that scanners don’t detect a high temperature.</p>
<p>You may wonder why people would do this. The reality is that people across geographical boundaries don’t have any physical boundaries in their minds. When they are in the DRC and fall ill, they will do what anyone would: seek support from their relatives and friends, some of whom are in border towns.</p>
<p>All of this means that health authorities’ interventions must be strategic. They cannot physically monitor all of the informal porous borders between these countries.</p>
<p>What they need to do now is to mobilise all of the towns and villages that share border points with the regions of DRC that are at high risk for the export of Ebola. These villages and towns can physically monitor their individual crossing points. The local leaders and chiefs can keep a visitor log and identify a common building to keep new visitors from the DRC for observation. These logs should be reported to the regional response team daily.</p>
<p>The visitors can then be tracked back to their village of origin to investigate any linkage to a cluster of cases. Coordinating visitors’ movements across the multiple borders will be the greatest strategic intervention. If possible, mobile application can be deployed to local youths to enter these data for real time reporting and coordination. </p>
<p>This strategy was employed in Liberia during the latter part of the Ebola crisis in the region and was critical in preventing the cross-border import of cases. Even within Liberia some counties – sub-regional division – did this to prevent the import of cases from Monrovia or neighbouring counties. When Lofa county went to zero in November of 2014, it was able to maintain that status by using these methods.</p>
<p><strong>What is being done now to try and ensure the cases in Uganda do not lead to more Ebola infections?</strong></p>
<p>Health workers are tracking the cases, finding out who the five people came in contact with and then taking them to a treatment centre immediately. From the recent situation report from Uganda, they have tracked down 98 contacts which is very impressive. As the average number of contacts per case is 10-12. But they have gone beyond that average.</p>
<p>These are very critical response steps in any epidemic. The surveillance team has to enter the mind of a typical villager from the DRC who knows they’re infected and is trying to escape to relatives in Uganda. They will have to figure out whether the infected people visited traditional healers or local medicine stores. How long were they in Uganda before they were picked up? In this way they’ll be able to identify all the contacts and monitor them.</p>
<p>Ebola is a very difficult disease to contain because of human social and behavioural factors. But it can be easily contained if 100% of the infected people’s contacts are identified and monitored and if cases are quickly removed into treatment units. The sooner you are treated, the higher your chances of surviving Ebola. And the more survivors there are, the more the community will trust response workers.</p><img src="https://counter.theconversation.com/content/118719/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Mosoka Fallah consults for MERCK/MSD as an expert from Africa on the process of the Ebola vaccine licensing.</span></em></p>Ebola is difficult to contain because of human social and behavioural factors. But it can be if 100% of the infected people’s contacts are identified and monitored.Mosoka Fallah, Part-time lecturer at the Global Health & Social Medicine, Harvard University, and Lecturer at the School of Public Health, College of Health Sciences, University of LiberiaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1156602019-05-09T09:58:36Z2019-05-09T09:58:36ZHow humans interact with the changing environment is affecting the spread of infectious disease<figure><img src="https://images.theconversation.com/files/273339/original/file-20190508-183112-2nv35x.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/tourist-feeds-monkey-hungry-1071610928?src=J0StBu5DRNr3E313PewXOA-1-38">Roma Likhvan/Shutterstock</a></span></figcaption></figure><p>Some of the world’s most notorious infections – including <a href="https://www.nhs.uk/conditions/lyme-disease/">Lyme disease</a>, <a href="https://www.nhs.uk/conditions/rabies/">rabies</a>, and <a href="https://www.nhs.uk/conditions/ebola/">Ebola</a> come from zoonotic diseases. These illnesses are caused by pathogens (bacteria, viruses, or other parasitic organisms) which can be passed from animals to humans. But, even though they can lead to <a href="https://www.gov.uk/government/collections/zoonotic-diseases-zoonoses-guidance-data-and-analysis">serious health problems</a>, there is a gap in our knowledge when it comes to these diseases. We don’t yet fully understand how pathogens “shift” between different host species and cause epidemics – and research is starting to show that the changing environment could be a factor.</p>
<p>The number of animal species that a pathogen infects is an indicator of its capability to shift to other host species and infect them, too. Pathogens that infect more animal species should be more likely to jump to a new host. Rabies viruses, for example, are seemingly capable of infecting virtually any mammalian species they encounter, putting <a href="https://travelhealthpro.org.uk/news/359/worldwide-rabies-risk--reminder-for-travellers">humans worldwide at risk of spillover</a>. </p>
<p>Research has also found that how infected animals <a href="https://www.nature.com/articles/nature22975">are related to one another</a> is important. If a pathogen infects monkey and ape species, for example, it will probably have a better chance of infecting humans than one that primarily infects birds or fish. </p>
<p><a href="https://www.sciencedirect.com/science/article/pii/S1471492219300637?via%3Dihub">Our new study</a> highlights that there is a growing body of evidence showing that <a href="https://www.nature.com/scitable/knowledge/library/ecology-of-multi-host-pathogens-of-animals-105288915">host shifting is inexorably linked to the environment</a>, too. Studies have found that the environments around us – including different habitats as well as climate conditions – provide new opportunities for humans to pick up different pathogens from wildlife. </p>
<h2>Wildlife and disease spread</h2>
<p>The world’s <a href="https://www.youtube.com/watch?v=PUwmA3Q0_OE">growing human population</a> and the way we utilise and modify our planet means that we are living closer to wildlife than ever before. Hardly any wildlife lives alone in a pristine environment. In addition, <a href="https://www.nature.com/articles/ncomms14435">invasive species are also rising unprecedently</a>, with animals such as rats spreading their parasites <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/ddi.12297">across former biogeographical borders</a>. Now, previously isolated wildlife and their pathogens have become embedded in a global and ever-changing network, spreading diseases further than seen previously.</p>
<p>This new line of thinking – that pathogens could infect more hosts if they had access to them – is important for how we address emerging diseases in times of global change. The spread of multi-host pathogens has already become a worldwide phenomenon, with wild animals often playing a big role in zoonotic events. Even seemingly benign holiday wildlife encounters can cause problems. For example, since 2012, tourists from Europe and elsewhere have been contracting <a href="https://www.who.int/news-room/fact-sheets/detail/middle-east-respiratory-syndrome-coronavirus-(mers-cov)">Middle East respiratory syndrome (MERS)</a> from camels in Saudi Arabia.</p>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/269785/original/file-20190417-139107-1v1sqr0.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/269785/original/file-20190417-139107-1v1sqr0.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=399&fit=crop&dpr=1 600w, https://images.theconversation.com/files/269785/original/file-20190417-139107-1v1sqr0.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=399&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/269785/original/file-20190417-139107-1v1sqr0.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=399&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/269785/original/file-20190417-139107-1v1sqr0.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=501&fit=crop&dpr=1 754w, https://images.theconversation.com/files/269785/original/file-20190417-139107-1v1sqr0.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=501&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/269785/original/file-20190417-139107-1v1sqr0.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=501&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Humans and dogs share a long history of companionship and pathogens alike.</span>
<span class="attribution"><span class="source">Konstans Wells/Swansea University</span>, <span class="license">Author provided</span></span>
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<p>But the threat is not just about wildlife pathogens infecting humans. Many pathogens have been introduced by us and our pets to new areas. Of the nearly 400 parasitic worm species recorded in people, almost 50% have been found <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/gcb.14064">in a diverse range of animals</a>, including dogs, cattle, and wildlife such as primates, rodents and deer. Research has found that this shifting of parasites has likely been <a href="https://www.cell.com/trends/ecology-evolution/fulltext/S0169-5347(16)30173-2">intensified by globalisation</a> as humans and their companion animals move around the world.</p>
<h2>Joining forces</h2>
<p>So what’s the next step in understanding how these diseases shift? And what can we do to stop their spread? Environmental measures are certainly needed but we also need to work out how pathogens may move between species, and how to minimise the risks when that happens.</p>
<p>Predicting the next emerging infectious events has much in common with daily weather forecasts. First, we must build our knowledge of the diseases using basic research, and then use sophisticated algorithms to generate predictions. Computational tools to tackle this kind of challenge are available, but they are generally used in other ways. </p>
<p>Many disciplines – including physics and social sciences – deal with “contagious processes” to <a href="https://theconversation.com/modelling-social-networks-reveals-how-information-spreads-18776">understand the spread of objects</a>. And researchers commonly use algorithms to study sensor networks, process images, and track information spread in social media. Similar models have a long history in health research, but they could now be used to account for changing environmental conditions in order to predict when and where pathogens will be exposed to new host species.</p>
<p>This is not just about new infectious diseases. Implementing a system like this could help track the reemergence of diseases that are under control in humans and domestic animals, but still present in wildlife. It could also increase awareness of the large diversity of poorly studied pathogens which have unpredictable zoonotic capacity.</p>
<p>There is still much to be learned about how diseases are shared among humans and animals, but by preempting global disease spread we can start to understand their origins and hopefully predict their movements.</p><img src="https://counter.theconversation.com/content/115660/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The way humans share the world with wildlife has rapidly changed – and this is having a serious impact on the spread of pathogens.Konstans Wells, Research Lecturer in Ecology and Global Change Biology, Swansea UniversityNicholas J Clark, Postdoctoral Fellow in Disease Ecology, The University of QueenslandLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1146362019-04-05T11:38:08Z2019-04-05T11:38:08ZThe DRC’s Ebola outbreak has all the makings of a humanitarian crisis<figure><img src="https://images.theconversation.com/files/267767/original/file-20190405-180017-1mz9mcr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">West Africa experienced the worst Ebola outbreak between 2013 and 2016. </span> <span class="attribution"><span class="source">Ahmed Jallanzo/EPA</span></span></figcaption></figure><p><em>It’s been eight months since the start of the current Ebola <a href="https://theconversation.com/search/result?sg=d0cacbf2-ff5c-4505-b41a-51af12639b07&sp=1&sr=2&url=%2Febola-returns-to-the-drc-for-the-10th-time-heres-what-we-know-101048">outbreak</a> in the Democratic Republic of Congo (DRC). By the beginning of April, almost <a href="https://www.who.int/ebola/situation-reports/drc-2018/en/">700 people</a> have succumbed to the disease, making this the second worst Ebola outbreak ever recorded. It’s second only to the West Africa <a href="https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(19)30055-6/fulltext">outbreak</a> of 2013 to 2016 that claimed more than 11 000 lives. And it seems that the end is not yet in sight. The Conversation Africa’s Ina Skosana asked Jacqueline Weyer about this deepening public health crisis.</em></p>
<p><strong>Why can’t this outbreak be brought under control?</strong></p>
<p>The outbreak is reported from the eastern DRC, and specifically in the Ituri and North Kivu provinces. This region has been <a href="https://www.cfr.org/interactives/eastern-congo#!/?cid=soc-at-interactive-the_eastern_congo_infoguide-121015">ravaged by political instability and conflict</a> for more than two decades; much of the violence has its roots in the Rwandan genocide of 1994. </p>
<p>Against this unstable backdrop, the delivery of health care services and other public health interventions that are required to interrupt the outbreak has become very problematic and dangerous business. </p>
<p>In recent months, there have been <a href="https://www.who.int/news-room/detail/09-03-2019-who-director-general-reiterates-commitment-to-ebola-response-despite-another-attack">reports</a> of health care facilities and health care workers being targeted by violent groups. In some <a href="https://www.msf.org/daily-struggle-survival-democratic-republic-congo">instances</a>, there have been large scale interruptions of health services and containment efforts. </p>
<p><a href="https://apps.who.int/iris/bitstream/handle/10665/311641/SITREP_EVD_DRC_20190331-eng.pdf?ua=1">This has had dire consequences</a>: the outbreak has spread to 21 health zones in the two affected provinces. In some of those zones, the outbreak can be controlled. But others, such as Butembo, have proven more challenging. </p>
<p>The outbreak is devastating vulnerable communities that are already affected by displacement and violence. UNICEF has identified <a href="https://www.unicef.org/press-releases/six-months-ebola-outbreak-eastern-democratic-republic-congo-now-second-largest">nearly 700 children who’ve been orphaned as a result of this outbreak</a>. This outbreak has all the makings of a humanitarian crisis. </p>
<p><strong>Could the outbreak spread even further?</strong></p>
<p>The outbreak is occurring where the DRC’s eastern borders meet Uganda, Rwanda and South Sudan and the fear is that it may spread across the borders to these countries. The effort to prevent this has been extensive, and the <a href="https://apps.who.int/iris/bitstream/handle/10665/311641/SITREP_EVD_DRC_20190331-eng.pdf?ua=1">World Health Organisation (WHO) reports</a> that more than 46 million travellers crossing borders in these areas in the past few months have been screened to prevent the disease spreading to other countries. To date, no case of Ebola has been exported beyond the borders of the DRC. </p>
<p><strong>What needs to be done to bring the DRC closer to ending this outbreak?</strong></p>
<p>A major obstacle has been community resistance for health interventions and mistrust of the health care workforce. It’s crucial that measures are introduced to enhance community engagement and participation in the public health activities related to the outbreak. In its latest <a href="https://apps.who.int/iris/bitstream/handle/10665/311641/SITREP_EVD_DRC_20190331-eng.pdf?ua=1">external situation report</a>, the WHO says that some painstaking strides are being made in winning communities’ confidence.</p>
<p>Secondly, it’s important to manage the growing risk of fatigue among health care workers, public health professionals and other stakeholders as the outbreak continues to evolve with no end in sight. These workers are being pushed to the edge, working long hours, days, weeks, and months under very trying circumstances. </p>
<p>Reactive and vigorous responses are required until the outbreak is declared over: taking care of the health care and public health workforce is critical. This is easier said than done and in addition, the safety and security of the outbreak workforce has been an issue in past months. Given the complex political situation of the region, an end to the violence may not be expected. </p>
<p>The WHO reports that steps have been taken to improve the safety and security situation for health care workers. More guards have been deployed at treatment centres and the accommodation used by health care workers. </p>
<p>It’s also crucial to ensure that adequate resources are available to keep up the fight against this outbreak. This includes sufficient, uninterrupted supplies of the Ebola vaccine to see the DRC through this outbreak and beyond. The <a href="https://apps.who.int/iris/bitstream/handle/10665/311641/SITREP_EVD_DRC_20190331-eng.pdf?ua=1">WHO says</a> that there’s been no interruption of vaccine supply to date. But as the outbreak continues to grow concerns are being raised as to whether this situation will remain the same.</p>
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Read more:
<a href="https://theconversation.com/ebola-vaccine-is-key-in-ongoing-efforts-to-contain-the-drc-outbreak-110924">Ebola vaccine is key in ongoing efforts to contain the DRC outbreak</a>
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<img src="https://counter.theconversation.com/content/114636/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Jacqueline Weyer does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The current Ebola outbreak in the DRC is devastating vulnerable communities already affected by displacement and violence.Jacqueline Weyer, Senior Medical Scientist, National Institute for Communicable DiseasesLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1125372019-03-07T13:36:51Z2019-03-07T13:36:51ZEbola in the DRC: the race is on between research and the virus<figure><img src="https://images.theconversation.com/files/261040/original/file-20190226-150712-13gemj7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Health workers in Liberia at the height of the 2014-2016 Ebola outbreak.</span> <span class="attribution"><span class="source">Ahmed Jallanzo/EPA</span></span></figcaption></figure><p>Since August last year the Democratic Republic of Congo (DRC) has been facing its 10th Ebola virus disease outbreak. As of early March this year, 907 cases and 569 deaths have been <a href="https://www.who.int/ebola/situation-reports/drc-2018/en/">reported</a>. </p>
<p>The virus seems to be gaining ground in this <a href="https://www.msf.org/new-ebola-outbreak-declared-north-kivu">current outbreak</a> in North Kivu. This despite extensive control measures being put in place. These were sufficient to end the 9th outbreak region of Equateur, 2500km from North Kivu. </p>
<p>Part of the response has been to try out new drug regimes. As such, research is playing a critical role as efforts are made to establish their efficacy. But testing new vaccines is an arduous and time consuming process. It’s also hard in the case of Ebola because there are a few different strains of the virus.</p>
<p>In the race between research and Ebola, a <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(16)32621-6/fulltext">vaccine candidate</a> made by Merck is being tested. It’s part of new strategies implemented to limit the number of deaths.</p>
<p>The vaccine was inherited from the West African Ebola outbreak between 2014 and 2016 when there were <a href="https://www.cdc.gov/vhf/ebola/history/2014-2016-outbreak/index.html">28,600 cases and 11,325 deaths</a>. The severity of the outbreak led the international community to vow that it would never happen again. </p>
<p>The question is: why, despite the vaccine trials, as well as a range of other interventions, does the outbreak remain <a href="https://www.statnews.com/2019/01/22/some-needed-good-news-on-ebola-vaccine-supplies-are-expected-to-last/?utm_source=STAT+Newsletters&utm_campaign=1349fbec8c-MR_COPY_12&utm_medium=email&utm_term=0_8cab1d7961-1349fbec8c-150521553">out of control</a> in North Kivu?</p>
<p>Factors contributing to this include violence in the region during the recent <a href="https://www.theguardian.com/world/2018/dec/27/congolese-soldiers-fire-air-quell-protests-against-election-delay">presidential election</a>. Unrest in North Kivu led to the destruction of an <a href="https://www.bbc.com/news/world-africa-46692506">Ebola Transit Center</a> earlier this month in Katwa. Then at the end of February two more centres <a href="https://www.theguardian.com/global-development/2019/feb/28/arsonists-attack-ebola-clinics-in-drc-as-climate-of-distrust-grows">were burnt to the ground</a> in Katwa and Butembo. On top of this, armed rebel groups in the area are limiting people’s access and hampering the response. </p>
<p>These challenges highlight the impact the community has on the success or failure of the Ebola response. </p>
<h2>Breaking new ground</h2>
<p>The Merck vaccine that’s being used in the DRC has gone through several research studies. But it’s still not licensed and can’t be used in the same way as any other vaccines. </p>
<p>The vaccine is being used on a compassionate basis to protect those most at risk of infection. This use of the vaccine requires that patients give informed consent, that data on safety including severe side effects be collected after every vaccine. This is not the case for licensed vaccines used in mass campaign vaccination.</p>
<p>Since May 2018 more than 40,000 people have received Merck’s rVSV vaccine in Equateur and North Kivu. The rollout has been a <a href="https://www.sciencemag.org/news/2018/12/ebola-vaccine-having-major-impact-outbreak-may-still-explode-west-africa">joint effort</a> run by, among others, the Ministry of Health, Institut National de Recherche Biomédicale, World Health Organisation (WHO) and Medécins Sans Frontieres. </p>
<p>Early data suggests that the vaccine is <a href="https://www.sciencemag.org/news/2018/12/ebola-vaccine-having-major-impact-outbreak-may-still-explode-west-africa">contributing</a> to limiting the spread of the outbreak.<br>
Other treatment options are also being tested alongside the vaccine. People who manage to get to an Ebola treatment centre and who test positive for the disease now have the opportunity to receive four new treatments being tried out. This is part of a clinical trial – the first of its kind – assessing the efficacy of these treatments. One of them was developed from the blood of a survivor of the 1995 Ebola outbreak in Kikwit, <a href="https://www.nytimes.com/2018/10/31/health/ebola-congo-treatments.html">DRC</a>. </p>
<p>The efficacy of the new drugs will be assessed by comparing the number of deaths in each of the four treatments groups after 28 days. </p>
<p>In all Ebola treatments centres, confirmed Ebola patients are asked if they want to participate. One of the drugs is then randomly selected and given to the patient who is followed for 58 days. Since 27th November 2018, 62 patients have participated in the trial. However the study is currently on hold due to the recent attacks. </p>
<p>As the virus is moving faster than the response, another vaccine will soon be <a href="https://www.hivresearch.org/news/new-multi-site-phase-2-ebola-vaccine-study-begins-africa">evaluated</a> in Uganda by a consortium including the London School of Hygiene and Tropical Medicine, Uganda Virus Research Institute, and Epicentre.</p>
<p>Developed by Janssen Pharmaceutical, this works differently to the Merck vaccine. Results so far show that <a href="https://www.nejm.org/doi/full/10.1056/NEJMoa1411627">it can provide</a> protection for one year and could be used in areas not yet affected by Ebola (preventively). For its part, rVSV could be used reactively – that is in response to contacts of confirmed cases. </p>
<p>The Janssen vaccine targets Ebola Zaire, and when used with a booster 56 days after the first dose, it also targets Ebola Sudan, Ebola Bundibugyo and Marburg virus which have caused outbreaks in neighbouring Uganda and Sudan. The design of this new study is not yet finalised. But we believe that the 2 million courses of the vaccine that are available could play their part in the race between research and the Ebola virus.</p>
<p>In Uganda 800 health care and frontline workers will receive the first dose of the vaccine followed by a second dose 56 days later. They will be followed for two years. </p>
<p>It will take many years for the successful vaccines and drugs to be licensed. But, if they prove effective, they will improve responses to any new Ebola outbreaks. </p>
<h2>The end game</h2>
<p>The hope is that, by the end of the current outbreak, the world will be better equipped to prevent, treat and stop Ebola virus disease. But science will win the race against Ebola virus only if communities are fully part of the response. Getting a deeper understanding of how people respond to crises such as Ebola will require others, such as anthropologists, to get involved too.</p><img src="https://counter.theconversation.com/content/112537/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Yap Boum is the regional representative for Epicenter Africa, the research arm of Médecins sans Frontières. He is involved in the Ebola outbreak and the use of the Ebola vaccine for MSF/Epicenter. </span></em></p><p class="fine-print"><em><span>Jean-Jacques Muyembe is the Director General of the DRC National Institute for Biomedical Research. He is involved in the clinical trial assessing the efficacy of 4 new Ebola treatments, and is working on the investigations of Ebola vaccine candidates in DRC. </span></em></p><p class="fine-print"><em><span>Sabue Mulangu is a Senior Researcher at the DRC National Institute for Biomedical Research and is involved in the clinical trial assessing the efficacy of 4 new Ebola treatments.</span></em></p><p class="fine-print"><em><span>Steve Mundeke Ahuka is a Senior Researcher, National Institute for Biomedical Research.</span></em></p>Four new Ebola treatments are being tried out in the DRC.Yap Boum, Professor in the faculty of Medicine, Mbarara University of Science and TechnologyJean-Jacques Muyembe, Professor of Microbiology, Faculty of Medicine, University of Kinshasa Sabue Mulangu, Senior Lecturer, Faculty of Medicine, University of Kinshasa Steve Mundeke Ahuka, Professor of Microbiology, Faculty of Medicine, University of Kinshasa Licensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1109242019-02-11T13:28:09Z2019-02-11T13:28:09ZEbola vaccine is key in ongoing efforts to contain the DRC outbreak<figure><img src="https://images.theconversation.com/files/259249/original/file-20190215-56229-18dbn6i.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">A health worker prepares to administer the experimental Ebola vaccine in north-western DRC. </span> <span class="attribution"><span class="source">EPA-EFE/STR</span></span></figcaption></figure><p>Vaccines are recognised as one of the most powerful tools in controlling and preventing <a href="https://www.who.int/bulletin/volumes/86/2/07-040089/en/">infectious diseases</a>. This despite strong <a href="https://www.health24.com/Medical/Childhood-diseases/Measles/as-us-measles-outbreaks-spread-why-does-anti-vax-movement-persist-20190207">anti-vaccination</a> movements around the globe. </p>
<p>It was with vaccine in hand that one of the most dreaded diseases of the last two centuries, <a href="https://www.who.int/biologicals/vaccines/smallpox/en/">smallpox</a>, was eradicated. Likewise, the eradication of vaccine preventable diseases such as <a href="http://polioeradication.org/who-we-are/strategy/">poliomyelitis</a> and <a href="https://www.who.int/news-room/fact-sheets/detail/measles">measles</a> remain global goals. And vaccines have lessened the burden of many other diseases around the world.</p>
<p>Ebola outbreaks have been <a href="https://www.who.int/news-room/fact-sheets/detail/ebola-virus-disease">sporadically reported</a> since 1976. Before 2014, these outbreaks occurred mostly in countries located in the equatorial belt of Africa. Often outbreaks occurred in remote locations, affecting very isolated communities. They could be controlled by identifying sick people and isolating them, tracing contacts of the sick, monitoring them and in turn isolating them if they developed illness. This essentially allowed for the chain of transmission of the virus to be interrupted and, eventually, the containment of the outbreak. </p>
<p>This approach was more effective in earlier Ebola outbreaks because they happened in areas that were fairly isolated geographically. </p>
<p>But this changed dramatically during the course of the <a href="https://www.cdc.gov/vhf/ebola/history/2014-2016-outbreak/index.html">West Africa Ebola outbreak</a> from 2014 to 2016. Communities were more mobile. They crossed borders more easily, spreading the disease across three countries – Guinea, Liberia and Sierra Leone – in a matter of months. This rendered the conventional containment approach <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5394636/">problematic</a>, and led to the outbreak spreading rapidly and widely. This resulted in the largest Ebola outbreak recorded to date.</p>
<p>It took a massive multinational effort to bring the outbreak under control. The scale of response efforts were historic. </p>
<p>The fear of Ebola spreading across a region have once again surfaced during the current <a href="https://www.who.int/ebola/situation-reports/drc-2018/en/">outbreak in the Democratic Republic of Congo (DRC)</a>. Extensive efforts are again being undertaken to prevent this from happening. </p>
<h2>Controlling the outbreak</h2>
<p>The outbreak in the DRC has been raging on for six months. A total of <a href="https://mailchi.mp/sante.gouv.cd/ebola_kivu_31jan19">759 people</a> had been infected and 468 deaths reported by the end of January 2019. This makes it the second worst outbreak in recorded history, after the outbreak in West Africa. </p>
<p>But the World Health Organisation recently announced that an experimental vaccine that has been rolled out in the affected area of the DRC that has been <a href="https://www.afro.who.int/news/south-sudan-vaccinates-health-workers-against-ebola?country=876&name=South%20Sudan">highly effective</a>. Although the vaccine, known as rVSV-ZEBOV, is yet to be licensed, <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(16)32621-6/fulltext">evidence to date indicates</a> that it protects against the strain of the Ebola virus behind the current outbreak. </p>
<p>The vaccine underwent limited testing during the West Africa outbreak and the outbreak in the DRC between May and July 2018. More than 60,000 doses of the vaccine have been used in the current outbreak. It was primarily provided to front-line health workers and other at-risk contacts. Health workers in Uganda, South Sudan and Rwanda have also been vaccinated to help prevent the disease from spreading across borders. </p>
<p>The ability to vaccinate and protect proactively may largely remove the proverbial sting from Ebola. </p>
<p>Ebola is a feared disease, not only for the communities directly affected by an outbreak, but for countries around the world nervous that it can spread closer to home. The direct and indirect effects of the West Africa outbreak are well appreciated and demonstrated how these fears play into economies, travel and trade <a href="https://www.reuters.com/article/us-health-ebola-cost/west-africas-ebola-outbreak-cost-53-billion-study-idUSKCN1MY2F8">beyond the affected countries</a>. </p>
<p>Much of this was driven by a disease that seemed to be an unstoppable killer. This may no longer be the case. </p>
<p>The Ebola vaccine – like others – should have the obvious advantage of protecting the outbreak-affected communities. But there are other advantages to having a vaccine in use in the ongoing outbreak. These include:</p>
<ul>
<li><p>Vaccinating and protecting health care and other front-line workers during an outbreak supports improved care for patients, and containment efforts due to a lower or removed risk of infection for workers who come into contact with sick individuals;</p></li>
<li><p>Vaccinating and protecting contacts and possible contacts of people known to be infected with the virus allows health workers to create a barrier of immunity (called “herd immunity”) that prevents the virus from proliferating and spreading. This aids with the interruption of an outbreak;</p></li>
<li><p>The psychological impact of having prophylaxis – a tangible tool to address the problem, allowing fears to be allayed and approached in a way that was not possible before. </p></li>
</ul>
<p>It’s with great anticipation that the world awaits the final outcome of the efficacy testing of this vaccine. This would allow for licensing and pave the way for its availability in the future. </p>
<p>Time will also tell how the unprecedented approach to accelerating the testing and rollout of an Ebola vaccine will affect the development of vaccines for other infectious diseases. </p>
<p>It also remains to be seen if a successful Ebola vaccine could aid in restoring public faith and interest in vaccinations, and support longstanding efforts to eradicate disease such as polio and measles.</p><img src="https://counter.theconversation.com/content/110924/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Jacqueline Weyer does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The new Ebola vaccine is yet to be licensed but evidence shows that it protects against the strain of the virus.Jacqueline Weyer, Senior Medical Scientist, National Institute for Communicable DiseasesLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1111262019-02-10T07:39:13Z2019-02-10T07:39:13ZWhy Ebola vaccine on trial in the DRC is raising hopes<figure><img src="https://images.theconversation.com/files/257044/original/file-20190204-193209-10jaeyn.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Mali was one of the West African countries affected by the biggest Ebola outbreak ever recorded from 2014 to 2016.</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>The World Health Organisation (WHO) has emphasised that an <a href="https://www.who.int/ebola/drc-2018/faq-vaccine/en/">experimental vaccine</a> is playing a major role in controlling the spread of Ebola in the <a href="https://www.who.int/csr/don/archive/disease/ebola/en/">ongoing outbreak</a> in the Democratic Republic of Congo (DRC). Without the vaccine, the outbreak has the potential to spiral out of control, considering the country’s social and political landscape as well as the sheer ability of the virus to spread. </p>
<p>It’s clear that having a vaccine in use early in an epidemic is a significant breakthrough in the fight against this deadly disease. And yet, six months after the first case was diagnosed, the outbreak is still <a href="https://www.who.int/ebola/situation-reports/drc-2018/en/">not contained</a> and cases are being reported almost daily and occasionally spreading outwards. </p>
<p><a href="https://mailchi.mp/sante.gouv.cd/ebola_kivu_31jan19">By the end of January</a>, a total of 759 people had been infected with the death toll rising to <a href="http://www.cidrap.umn.edu/infectious-disease-topics/ebola">468</a>. This makes it the second worst outbreak in recorded history.</p>
<p>Normally the DRC is <a href="https://theconversation.com/ebola-outbreak-in-drc-are-we-better-prepared-this-time-96368">well prepared</a> and has substantive experience in dealing with Ebola. But a <a href="http://theconversation.com/why-ebola-is-proving-hard-to-beat-in-the-drc-109017">number of factors</a> have hampered the current situation and made it hard to contain the outbreak – even for experienced frontier medical teams. </p>
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<a href="https://theconversation.com/why-ebola-is-proving-hard-to-beat-in-the-drc-109017">Why Ebola is proving hard to beat in the DRC</a>
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<p>The epicentre of the outbreak was in North Kivu province. This lies in an active conflict zone and has very little infrastructure making it very difficult to administer enough of the vaccine to ensure immunity. In addition, health workers have been confronted with widespread violent unrest due to political instability <a href="https://edition.cnn.com/2018/11/18/health/dr-congo-ebola-cases-deaths-rise/index.html">in the country</a>. A number of units had to be pulled out following attacks. Response rates were also slowed down following <a href="https://www.bbc.com/news/world-africa-46692506">protests at the time of elections in December</a>. </p>
<h2>The vaccine rollout</h2>
<p>The <a href="https://www.who.int/ebola/drc-2018/faq-vaccine/en/">rVSV-ZEBOV vaccine</a> is being tested in the DRC. It was first rolled out towards the end of the West Africa epidemic in Guinea in 2015. This was part of a phase III trial to evaluate the efficacy of the vaccine to prevent Ebola spreading among people. </p>
<p>Initial investigative data came from comparing a group of at-risk people who were vaccinated immediately after diagnosis of an Ebola virus case in their surrounding with a similar group of people who received the vaccine after a delay of 21 days. </p>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/257953/original/file-20190208-174894-3pav4h.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/257953/original/file-20190208-174894-3pav4h.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=800&fit=crop&dpr=1 600w, https://images.theconversation.com/files/257953/original/file-20190208-174894-3pav4h.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=800&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/257953/original/file-20190208-174894-3pav4h.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=800&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/257953/original/file-20190208-174894-3pav4h.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1005&fit=crop&dpr=1 754w, https://images.theconversation.com/files/257953/original/file-20190208-174894-3pav4h.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1005&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/257953/original/file-20190208-174894-3pav4h.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1005&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">An Ebola information pamphlet.</span>
<span class="attribution"><span class="source">Author supplied</span></span>
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<p>The “immediate” group didn’t contract Ebola while some individuals in the delayed group contracted the disease. This <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(16)32621-6/fulltext">evidence</a> gave the WHO hope that the vaccine could be <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(16)32621-6/fulltext">100% effective</a>. </p>
<p>But that point hasn’t yet been reached. More <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)30560-9/fulltext">data and investigation</a> are required before the vaccine is licensed for general use. </p>
<p>The rollout of rVSV-ZEBOV in the DRC has been done using a conventional strategy common in other vaccine trials. Called <a href="https://wwwnc.cdc.gov/eid/article/22/1/15-1410_article">“ring vaccination”</a>, it involves vaccinating the first and second degree contacts of an infected individual. The aim is to form an immunised “ring” around every infection and prevent it from being transmitted further. </p>
<p>Since August 2018 nearly <a href="https://www.precisionvaccinations.com/v920-ebola-vaccine-now-deployed-drc-uganda-and-south-sudan">66,000 doses</a> of this experimental rVSV-ZEBOV vaccine have been administered in the DRC.</p>
<p>The WHO’s confidence in the vaccine has been boosted by the fact that the cases of Ebola haven’t increased at the same rates as was the case in <a href="https://www.who.int/csr/disease/ebola/ebola-6-months/west-africa/en/">2014 in West Africa</a> before the vaccine was introduced. </p>
<p>But vaccine effectiveness isn’t always straightforward to gauge. Detailed data from the current outbreak will help make a more confident assessment and predict the future of its licensing and application. </p>
<h2>The vaccine landscape</h2>
<p>Currently, the WHO and the international community are in favour of the <a href="https://www.pharmaceutical-technology.com/comment/deployment-mercks-rvsv-zebov-combat-ebola-marks-crossroads-vaccine-rd/">Merck rVSV-ZEBOV vaccine</a>, as it has already been used and a number of studies prove that it’s a promising candidate for licensing in the near future. In the current scenario, it’s a ray of hope in addressing the current outbreak and preparing for future ones. Merck has recently promised to <a href="https://www.krmg.com/news/world/the-latest-merck-ship-120-000-more-ebola-vaccine-doses/zuhM2KMIxDlfWV8vi8ZD4I/">roll out another 120,000</a> doses of the vaccine to the DRC. </p>
<p>Further academic research on this vaccine have shown a sustained antibody response across two years, with little or no adverse effects to health in a large <a href="https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(17)30313-4/fulltext">multicentre study</a>. </p>
<p>In addition to rVSV-ZEBOV, <a href="https://ecdc.europa.eu/en/ebola-and-marburg-fevers/prevention-and-control/treatment-vaccines">other potential vaccines</a> are also being investigated. Two of them are being developed by Johnson & Johnson and GlaxoSmithKline. The former has tested a prime-boost vaccine, which is administered in two stages at different times; while the latter has introduced a single dose variant, administered as a one-time injection. </p>
<p>Two other candidates come from China and Russia. The one from <a href="https://www.fiercepharma.com/vaccines/china-approves-self-developed-ebola-vaccine-from-2014-outbreak-virus-type">China</a> was licensed by the country without a trial or human efficacy data, and the one from <a href="http://www.mid.ru/en_GB/foreign_policy/news/-/asset_publisher/cKNonkJE02Bw/content/id/2838077">Russia</a> is also pending clinical trials. Hence, little is known about their safety and efficacy yet, and have not been employed during these outbreaks. </p>
<p>Vaccine development for challenging diseases like Ebola and <a href="https://theconversation.com/marburg-cases-in-uganda-the-lowdown-about-ebolas-sister-virus-86077">Marburg</a> viruses remains a very difficult task. The pace at which the rVSV-ZEBOV vaccine has been developed and implemented, in addition to the effectiveness of the ring vaccination strategy, has paved a way for dealing with future outbreaks. </p>
<p>The challenge, however, is to reach adequate numbers of vaccinated people in unfavourable sociopolitical and underdeveloped infrastructure situations, such as those in many of the countries that are hot spots of viral outbreaks. </p>
<p>The viral disease burden in Africa is largely underestimated and the rVSV-ZEBOV vaccine is hopefully the first of many to be fast-tracked and invested in, to address what is fast becoming a global health challenge. It’s certainly a much needed vaccine in the fight against Ebola.</p><img src="https://counter.theconversation.com/content/111126/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Without the current experimental vaccine the Ebola outbreak in the DRC has the potential to spiral out of control.Shirin Ashraf, Postdoctoral Researcher, MRC-Centre for Virus Research, University of GlasgowArthur Wickenhagen, PhD candidate, MRC Centre for virus research, University of GlasgowLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1090172018-12-19T11:38:12Z2018-12-19T11:38:12ZWhy Ebola is proving hard to beat in the DRC<figure><img src="https://images.theconversation.com/files/251466/original/file-20181219-27755-d217z7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Ebola is a dreadful disease and is one of the deadliest infections known to medical science.</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>Nearly this time exactly two years ago I wrote about <a href="https://theconversation.com/the-new-100-effective-ebola-vaccine-owes-a-debt-to-the-scientists-who-beat-smallpox-70762">the latest positive results</a> showing – for the first time – that a vaccine against one of the world’s scariest viruses, Ebola, could work. I was writing after the epidemic that hit Guinea, Liberia and Sierra Leone from 2013 until 2016. Since then, there have been three more outbreaks of the disease: all in the Democratic Republic of Congo (DRC). </p>
<p>The <a href="https://www.cdc.gov/vhf/ebola/history/chronology.html">first two outbreaks</a> (in 2017 and 2018) were extinguished quickly as the DRC is experienced in stopping Ebola. When a new outbreak happened earlier this year, I also said that <a href="https://theconversation.com/ebola-outbreak-in-drc-are-we-better-prepared-this-time-96368">it would be quickly brought under control</a> especially with use of the vaccine. But that is not the case: the <a href="https://www.who.int/csr/don/13-December-2018-ebola-drc/en/">latest outbreak</a> has been going on for months, infecting 505 people and killing 296 by the middle of December 2018.</p>
<p>Why is Ebola proving so recalcitrant to our best efforts at stopping it? The answer lies partly with the inherently deadly properties of the Ebola virus; the DRC’s instability is another element of the problem.</p>
<h2>Ebola: one of the worst viruses</h2>
<p>Ebola is a dreadful disease. It causes fever, vomiting and diarrhoea and bleeding, and is one of the deadliest infections known to medical science. <a href="https://www.who.int/news-room/fact-sheets/detail/ebola-virus-disease">At least half of the people who get the disease will die</a> – even with the best medical care. </p>
<p>The spread of the virus is closely linked to human behaviour. It’s transmitted via contact with the bodily secretions from someone who is already sick with Ebola. This means that those who are caring for the sick and dying, such as close family members or healthcare workers, are more likely to get infected. </p>
<p>These close ties to basic human social biology can result in a dramatic disruption to family community and regional life. This is only compounded by the trade and travel restrictions that are often applied by surrounding nations. </p>
<h2>No cure</h2>
<p>There is now a safe and effective Ebola vaccine, <a href="https://theconversation.com/the-new-100-effective-ebola-vaccine-owes-a-debt-to-the-scientists-who-beat-smallpox-70762">rVSV-ZEBOV</a>. But one of the reasons that Ebola is so deadly and frightening is that there is no cure. There are medical treatments for some of the symptoms, such as fluid loss, pain and fever – but nothing that can eradicate the disease entirely.</p>
<p>This lack of a cure shouldn’t suggest that researchers and doctors aren’t trying. Since Ebola was <a href="https://www.nature.com/scitable/blog/viruses101/the_scientist_who_discovered_ebola">discovered in the late 1970s</a>, scientists across the world have been studying the virus and have identified a number of ways of preventing infection and disease. But testing new potential drugs for a virus that’s as unpredictable as Ebola in humans is nearly impossible.</p>
<p>That being said, some experimental drugs are being used under <a href="https://www.statnews.com/2018/12/04/conducting-ebola-clinical-trial-war-zone/">compassionate usage</a> rules, giving an unapproved medicine to someone who is very near to death. And there are plans in place to conduct a number of rigorous trials in the DRC, during the current outbreak. </p>
<p>Finding a safe and effective cure for the disease will go a long way in stemming future outbreaks.</p>
<h2>Controlling the virus</h2>
<p>For now, the best way to control the Ebola outbreak is to ensure that an infected person does not pass the infection on to more than one other person.</p>
<p>A “straightforward” way to do this would be to find, treat and isolate every infected person then track down all the people they could have spread the virus to and make sure they don’t get sick and then isolate them, and so on. This is aided in Ebola as it has a relatively long incubation period of at most three weeks and it is typically pretty obvious that you are sick allowing you to find sick people and their exposed contacts before it’s too late. </p>
<p>The existence of rVSV-ZEBOV makes this process much more efficient. It can make treating Ebola safer and less open to disruption. Vaccination can be used to immunise and block infection in contacts of identified sick people. </p>
<p>The vaccination approach appeared to work well at the end of the West African outbreak and this time it may in fact be the reason that this DRC outbreak is not infinitely larger than it could be. However, the vaccination process requires a lot of effort and resources on the ground. Working in larger, more-complex, densely-populated regions – and especially in the case of an extended outbreak – makes this much more challenging. This is what’s happened in the DRC. And why predictions about getting the latest outbreak under control have been so wrong. What I, and others, hoped would not be an insurmountable issue, is that a great deal of the East of the DRC is <a href="https://www.theguardian.com/world/2018/apr/03/millions-flee-bloodshed-as-congos-army-steps-up-fight-with-rebels-in-east">essentially war zones</a>. This has meant that contact tracing and vaccination efforts are easily disrupted.</p>
<h2>Ebola in the future</h2>
<p>As the DRC outbreak shows no sign of ending, and grows in complexity near cities and war zones, the world must not get complacent. Global efforts must be redoubled. If they are not, there’s the risk that we will have to somehow learn to live with an Ebola that never goes away.</p><img src="https://counter.theconversation.com/content/109017/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Connor G G Bamford does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Instability in the DRC and Ebola’s deadly properties is making it hard to contain the virus.Connor G G Bamford, Virologist, University of GlasgowLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1029342018-09-12T10:40:38Z2018-09-12T10:40:38ZGame theory can help prevent disease outbreaks<figure><img src="https://images.theconversation.com/files/235988/original/file-20180912-133895-cbmqav.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-vector/world-map-whit-dashed-trace-line-563621422?src=Nz3yieGZsxLzgCV5XtKOlQ-1-13">Eva Cornejo Coba/Shutterstock</a></span></figcaption></figure><p>When multiple passengers on a flight from Dubai to New York recently were taken ill with flu-like symptoms, the plane was <a href="https://www.cnbc.com/2018/09/06/passengers-quarantined-jet-appear-to-have-the-flu.html">understandably quarantined</a>. It’s not too hard to imagine how international travel could quickly help <a href="https://theconversation.com/flu-plane-are-we-really-ready-for-a-global-pandemic-102789">spread a new disease</a> around the world. But surprisingly, grounding planes in such a situation might not always be the best strategy, and not just because of the economic impact.</p>
<p>When it comes to decisions about health, what’s best for us as individuals might not always be the best thing for the wider population, and vice versa. This can make it difficult for authorities to take decisions to protect the whole population. But there’s a way we can make sense of such a dilemma that’s more typically used in economics: game theory. </p>
<p>Game theory attempts to predict how an individual within a group will choose between different strategies, when the outcome of the situation depends on how everyone else in the group behaves. The difficulty is that you can’t work out an individual’s optimal strategy without knowing what all the others will do.</p>
<p>Take vaccination as an <a href="http://www.pnas.org/content/101/36/13391">example</a>. While vaccines have been repeatedly <a href="https://www.cdc.gov/vaccinesafety/research/iomreports/index.html">proven safe</a>, they can have short-term negative effects (financial cost, pain from injection, a temporary reaction from the immune system). So a family deciding whether to have a flu vaccine has to weigh up these costs against the benefit of getting vaccinated to protect themselves from the disease.</p>
<p>Given that flu can be deadly, it might seem like a no-brainer to accept the costs of vaccination. But if almost everybody else in the population gets vaccinated, the family will still be relatively protected from the disease because they are much less likely to come into contact with it. And so not getting vaccinated might appear to be the better choice. </p>
<p>The problem, of course, is that if every family thinks like this, then no one will be protected and a major outbreak could easily occur. Our example family may or may not be fine but the population as a whole suffers.</p>
<p>We’ve seen the catastrophic results of this problem with the measles, mumps and rubella (MMR) vaccine. After the vaccine was <a href="https://theconversation.com/autism-and-vaccines-more-than-half-of-people-in-britain-france-italy-still-think-there-may-be-a-link-101930">falsely linked</a> to autism, vaccination rates in Europe and the US dropped. This has led <a href="https://www.telegraph.co.uk/news/2018/07/02/national-measles-warning-five-fold-rise-cases-england/">to an increase</a> in the incidence of measles and mumps, <a href="https://www.bmj.com/content/362/bmj.k3596">resulting in deaths</a> and serious permanent injuries. </p>
<p>Game theory explains that, in situations like this, the best strategy for an individual can often be in conflict with the optimal strategy for the well-being of the whole group. What determines the outcome of an outbreak is the interaction between the individuals involved and how risk is perceived to those individuals and to the group as a whole.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/235993/original/file-20180912-133898-9ybxh6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/235993/original/file-20180912-133898-9ybxh6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/235993/original/file-20180912-133898-9ybxh6.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/235993/original/file-20180912-133898-9ybxh6.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/235993/original/file-20180912-133898-9ybxh6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/235993/original/file-20180912-133898-9ybxh6.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/235993/original/file-20180912-133898-9ybxh6.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Vaccination has only tiny risks to the individual but big benefits for everyone.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/female-doctor-makes-vaccination-child-599228528?src=enwg57uFOJPUw6FaAlawpg-1-61">Oksana Kuzmina/Shutterstock</a></span>
</figcaption>
</figure>
<p>We can apply the same thinking to travel restrictions during an outbreak of disease. When the an epidemic of Ebola virus disease emerged in West Africa in 2014, preventing people flying to and from the region might have seemed like a good way of containing the situation and protecting individuals. But researchers <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4415609/">later showed</a> that such measures only delayed the onset of the epidemic in different regions and may have stopped aid workers getting to the most affected areas.</p>
<p>So how can we work out the best strategy in this kind of situation? Typically, the answer is to use the “<a href="https://theconversation.com/john-nash-and-his-contribution-to-game-theory-and-economics-42355">Nash equilibrium</a>”, named after the famous mathematician <a href="https://theconversation.com/john-nash-a-beautiful-mind-and-its-exquisite-mathematics-42333">John Nash</a> portrayed in the movie <a href="https://www.imdb.com/title/tt0268978/">A Beautiful Mind</a>. You reach a Nash equilibrium when changing your own strategy won’t improve your situation, as long as everyone else’s strategy stays the same. Understanding the Nash equilibrium helps us understand the optimal strategies for all individuals in a group. </p>
<p>In some cases, however, the optimal individual and population strategies can actually be the same. This mostly occurs when the population is “open”, meaning it includes people joining and leaving.</p>
<h2>Individual and group interests sometimes match</h2>
<p>An example of this was shown in a recent study, published in the <a href="http://rsif.royalsocietypublishing.org/lookup/doi/10.1098/rsif.2018.0515">Journal of the Royal Society Interface</a>, that looked at a situation where people from one area could choose whether or not to travel to another area affected by disease. If the risk of disease was perceived as high because the outbreak was severe and was publicised with frequent news updates, then individuals would choose not to travel. This would be in line with the authorities’ desire for a travel ban. But if the outbreak wasn’t severe, then the travel ban would be lifted and tourists would be more likely to want to travel.</p>
<p>For most of the parameters the study considered, the optimal individual and group-level strategies coincided in this way. But sometimes there was still a discrepancy, for example when the number of individuals choosing to travel exceeded the optimum. This could lead to those people importing the disease back to their homeland, followed by a large outbreak there. </p>
<p>The difficulty is that, realistically, these discrepancies could emerge suddenly because many factors, such as the climate or virus evolution, could affect how quickly the disease spreads. What’s more, media coverage of the risk and relevant educational programmes could also influence visitors’ perception of the risk, regardless of official guidelines.</p>
<p>What game theory can do is help us make sense of all these factors to find out when individuals are most likely to act in a way that goes against the best interests of the group. Public authorities can then implement appropriate control measures in order to minimise the impact of an outbreak.</p><img src="https://counter.theconversation.com/content/102934/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Istvan Zoltan Kiss receives funding from Leverhulme Trust, EPSRC, LMS, IMA, University of Sussex, DEFRA, SEEDA.</span></em></p><p class="fine-print"><em><span>Nicos Georgiou receives funding from EPSRC. </span></em></p>Banning travel might not always be the best way to respond to a disease outbreak.Istvan Zoltan Kiss, Professor of Applied Mathematics, University of SussexNicos Georgiou, Senior Lecturer in Mathematics, Probability and Statistics, University of SussexLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/981812018-06-14T12:39:52Z2018-06-14T12:39:52ZChallenges of administering an Ebola vaccine in remote areas of the DRC<figure><img src="https://images.theconversation.com/files/222999/original/file-20180613-32334-11budpb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">A nurse prepares the Ebola vaccine in Bikoro in the DRC.</span> <span class="attribution"><span class="source">MSF/Louise Annaud</span></span></figcaption></figure><p>No one said tracking the movements of a patient, suspected to be a carrier of the deadly Ebola virus, through the dense forests of the eastern region of the Democratic Republic of Congo (DRC) was going to be easy. </p>
<p>With no discernible roads, only dense bush, we were forced to travel on three motorbikes to get to our destination, riding through areas where no car could reach.</p>
<p>There were six of us: a research investigator, a medical doctor, an officer monitoring water, sanitation, safety and security and the three motorbike drivers. After almost three hours we finally found our destination: a village in the middle of the forest. This was Bokongo. </p>
<p>It took our epidemiologist several days to find this remote village. He was tracing the travels and contacts of just one patient suspected of having Ebola. Just before the epidemiologist broke his leg, he identified some contacts and first line workers that needed to receive the Ebola vaccine.</p>
<p>After arriving in Bokongo we managed to vaccinate 13 first line workers. But ours was not the only operation. </p>
<p>As health authorities in the Democratic Republic of Congo continue to try and contain the Ebola outbreak in the north eastern region of the country, there are several teams vaccinating targeted populations in Bikoro, Ikoko-Impenge, Itipo, Mbandaka and Iboko. </p>
<p>The country’s health ministry has stepped in to <a href="https://www.news24.com/Africa/News/drc-health-minister-says-ebola-outbreak-under-control-20170602">coordinate the response</a> to the outbreak. And the World Health Organization, Médecins Sans Frontières, Epicentre and others organisations have sent <a href="https://www.doctorswithoutborders.org/article/drc-emergency-team-supports-rapid-response-ebola-cases">teams of specialists to assist</a>. </p>
<p>As a result more than 1500 people have been vaccinated so far. But already 27 people have died since the outbreak was declared on May 8, 2018.
Ours is a race against time – making sure we get to everyone who could possibly be infected before the deadly virus does. </p>
<h2>Part of the team</h2>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/223003/original/file-20180613-32342-l4ata4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/223003/original/file-20180613-32342-l4ata4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/223003/original/file-20180613-32342-l4ata4.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/223003/original/file-20180613-32342-l4ata4.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/223003/original/file-20180613-32342-l4ata4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/223003/original/file-20180613-32342-l4ata4.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/223003/original/file-20180613-32342-l4ata4.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Team members get dressed in full protective gear at the Ebola Treatment Centre.</span>
<span class="attribution"><span class="source">MSF/Louise Annaud</span></span>
</figcaption>
</figure>
<p>It’s not the first time that I have been part of an Ebola response. As the African representative of <a href="http://www.epicentre.msf.org/en">Epicentre</a> – the research arm of Médecins Sans Frontières – I have been involved in Ebola response since 2012 during the <a href="https://reliefweb.int/disaster/ep-2012-000124-uga">Kibaale outbreak in Uganda</a>. </p>
<p>At the time I led Epicentre’s Mbarara Research Centre. Then I coordinated the field and laboratory part of the clinical trial assessing vaccine’s efficacy, safety and performance on first line workers in Guinea during the <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(15)60656-0/fulltext">Ebola outbreak in 2014 to 2015</a>. </p>
<p>The vaccine was also considered during the <a href="https://theconversation.com/speed-and-co-ordination-are-key-to-curbing-the-drcs-ebola-outbreak-77727">2017 outbreak in Likati</a> in the DRC. But the Likati Ebola outbreak ended with a limited number of cases and the vaccine didn’t have to be used.</p>
<p>With the current outbreak in the DRC I came to the capital city, Kinshasa, two days after the outbreak was officially declared to assess the situation and see whether or not the vaccine could be part of the response. </p>
<p>The increasing number of cases and the fact that the outbreak had reached an urban area (Mbandaka) meant it was clear that the vaccine would be an additional tool for the response. </p>
<h2>Testing a new vaccine</h2>
<p>The vaccination is administered using a “ring” approach. This involves identifying newly diagnosed and laboratory confirmed Ebola patients. Epidemiologists first need to locate the people they have been in contact with. And then the patients and their contacts -— often family members, neighbours, colleagues and friends -— constitute the ring who all get vaccinated. First line workers from the health area where an Ebola case has been detected also qualify to receive the vaccine.</p>
<p>This method of investigating contacts is one of the biggest challenges when administering the vaccine. Tracing and following people to the middle of the forest presents a massive logistic challenge – which means that it can take days to find people who need the vaccine most. </p>
<p>The Ebola vaccine is known as a recombinant vaccine. This means that the glycoprotein of the Ebola virus has replaced the glycoprotein of another virus. The glycoprotein is important because it builds antibodies against a virus.
Ebola’s glycoprotein was added to the vesicular stomatitis virus, which is not harmful to humans. People are given the vaccination so that they can immediately build antibodies against the Ebola virus. </p>
<p>The vaccine was discovered by a small Canadian company and later bought by the <a href="https://cen.acs.org/pharmaceuticals/vaccines/Mercks-Ebola-vaccine-offers-lasting/96/i17">big pharmaceutical company Merck</a>. The vaccine is still not licensed but it’s known as VP920.</p>
<p><a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5490784/">Several studies</a> across the US, Switzerland, Gabon and Kenya have assessed the safety of the vaccine which targets the Zaire strain of the Ebola virus. </p>
<p>Its safety, efficacy and immunogenicity was also assessed during the Ebola outbreak in West Africa in 2014; the results have shown great safety efficacy and effectiveness. The vaccine is still in the process of being registered – but this is a really long procedure. </p>
<h2>The logistics</h2>
<p>One of my primary responsibilities has been ensuring that the teams that administer the vaccine have everything we need in this process. I’ve also coordinated our activities with health officials, the WHO and the country’s extended programme for immunisation so that they understand how the vaccine is administered.</p>
<p>To launch the vaccine in this outbreak we’ve had to train the locally recruited staff about Ebola, the study protocol as well as good clinical practices. This includes ensuring everyone who gets the vaccine consents to it, understands the study and possible side effects. </p>
<p>This has been difficult because we only have a limited time to teach people about the dangers of the virus as well as the importance of the protocols when they are out in the field. </p>
<p>While the WHO team started administering the vaccine in Mbandaka, the MSF/Epicentre team went in Bikoro where all the confirmed cases from Itipo – the epicentre of the outbreak – were referred. </p>
<p>Since then vaccination drives have not stopped. Each time we enter a village we’re greeted by one of the most frightening moments knowing that we’re surrounded by people who have been in contact with the deadly virus but may not have been traced. But then we look into the eyes of the people full of hope and we’re reminded about why we do what we do: to make a difference by reaching the unreachable.</p><img src="https://counter.theconversation.com/content/98181/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Yap Boum does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Teams administering the Ebola vaccine in the Democratic Republic of Congo are in a race against time to find and help people exposed.Yap Boum, Professor in the faculty of Medicine, Mbarara University of Science and TechnologyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/945512018-05-28T21:49:46Z2018-05-28T21:49:46ZViruses can cause global pandemics, but where did the first virus come from?<p>Viruses such as <a href="https://www.cdc.gov/vhf/ebola/outbreaks/2014-west-africa/index.html">Ebola</a>, <a href="https://www.cdc.gov/flu/pandemic-resources/basics/past-pandemics.html">influenza</a> and <a href="https://www.theglobeandmail.com/news/world/zika-crisis-brazil/article36142168/">Zika</a> make headlines. They grab our attention with their potential to cause widespread disease and death. </p>
<p>But where did these viruses first come from?</p>
<p>Unlike bacteria, viruses aren’t living organisms — they can’t reproduce on their own. Instead, they hijack cells to multiply, spread and cause disease. </p>
<p>But what if it wasn’t always this way? </p>
<p>Scientists studying a so-called giant virus called a Tupanvirus (named for the South American Guarani God of Thunder) found that it, unlike the viruses we encounter today, had an almost complete machinery to take care of itself. </p>
<p>This recent discovery has refuelled the debate over the origin of viruses. </p>
<h2>Frozen viruses</h2>
<p>There is no physical fossil record of viruses like there is for the dinosaurs. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/220347/original/file-20180524-51095-174r2em.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/220347/original/file-20180524-51095-174r2em.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=586&fit=crop&dpr=1 600w, https://images.theconversation.com/files/220347/original/file-20180524-51095-174r2em.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=586&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/220347/original/file-20180524-51095-174r2em.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=586&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/220347/original/file-20180524-51095-174r2em.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=736&fit=crop&dpr=1 754w, https://images.theconversation.com/files/220347/original/file-20180524-51095-174r2em.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=736&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/220347/original/file-20180524-51095-174r2em.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=736&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Beautiful, but deadly. A colourized scanning electron micrograph magnified 20,000 times of Ebola virus particles (green) from a chronically infected African Green Monkey kidney cell (blue).</span>
<span class="attribution"><a class="source" href="https://commons.wikimedia.org/wiki/File:Ebola_Virus_-_Electron_Micrograph.tiff">(BernbaumJG/Wikimedia Commons)</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<p>One way scientists detect viruses, and study their origins, is to look for their <a href="https://www.nature.com/scitable/definition/virus-308">genetic material</a> — molecules of DNA or RNA — in animal tissues and soil. </p>
<p>Even though the movies might have you believe otherwise, viral genetic material has never been detected in fossilized plant leaves or in insects trapped in amber. </p>
<p>However, some ancient viruses have been <a href="http://www.pnas.org/content/111/11/4274">detected in permafrost</a> in Siberia, and there are hopes of discovering more as <a href="https://www.independent.co.uk/news/science/global-warming-ancient-viruses-expose-dormant-thousands-fortitude-years-scientists-warn-a7719201.html">global warming continues</a> to thaw ground that has been frozen for thousands of years. Until then, we remain limited in our ability to precisely reconstruct the origin of viruses. </p>
<h2>Virus evolution</h2>
<p>Viruses are microscopic organisms that require a <a href="https://theconversation.com/explainer-what-is-a-virus-22902">living cell, often called a host, to multiply</a>. They largely consist of genetic material (either DNA or RNA) <a href="https://www.ncbi.nlm.nih.gov/books/NBK8174/">wrapped in a protein coat</a>. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/220351/original/file-20180524-117628-1pysmqe.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/220351/original/file-20180524-117628-1pysmqe.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=338&fit=crop&dpr=1 600w, https://images.theconversation.com/files/220351/original/file-20180524-117628-1pysmqe.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=338&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/220351/original/file-20180524-117628-1pysmqe.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=338&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/220351/original/file-20180524-117628-1pysmqe.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=424&fit=crop&dpr=1 754w, https://images.theconversation.com/files/220351/original/file-20180524-117628-1pysmqe.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=424&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/220351/original/file-20180524-117628-1pysmqe.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=424&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">An illustration of the hepatitis C virus.</span>
<span class="attribution"><a class="source" href="https://www.cdc.gov/nchhstp/newsroom/2016/hcv-perinatal.html">U.S. Centers for Disease Control and Prevention</a></span>
</figcaption>
</figure>
<p>These DNA and RNA sequences may change over time, accumulating modifications to the genetic code that favour the survival of the virus. Scientists can look at these genetic sequences to estimate how different viruses are related and how they may have evolved. </p>
<p>These studies have shown us that viruses do not have a <a href="https://www.sciencedirect.com/science/article/pii/S0923250809001065">single origin</a>; that is, they did not all arise from one single virus that changed and evolved into all the viruses we know today. Viruses probably have a number of independent origins, almost certainly at different times. </p>
<p>One assumption scientists make when considering the origin of viruses is that <a href="https://www.sciencedirect.com/science/article/pii/S1879625711001374">each co-evolved with its host</a>. For example, the herpes virus that infects humans evolves over time, adapting so that it will continue to retain the ability to infect human cells.</p>
<p>If we consider that all life forms on Earth began <a href="https://www.nature.com/news/how-life-emerged-from-deep-sea-rocks-1.12109">in the ocean</a>, then it’s reasonable to believe that viruses evolved with their hosts in the seas. As these creatures moved onto land and evolved, viruses also evolved and gained the ability to infect terrestrial organisms. </p>
<p><a href="https://www.sciencedaily.com/releases/2018/04/180404133510.htm">Earlier this year, scientists discovered</a> evidence that some viruses may be millions of years old and have been in existence since the first vertebrates existed. But this doesn’t explain the origin of viruses per se.</p>
<h2>Origin stories</h2>
<p><a href="https://genomebiology.biomedcentral.com/articles/10.1186/gb-2006-7-6-110">One theory</a> hypothesizes that viruses arose from circular DNA (also called a plasmid) that can replicate independently and move between cells, transferring genetic information from one organism to another. For example, some <a href="https://www.nytimes.com/2018/04/13/health/drug-resistant-typhoid-epidemic.html">plasmids carry the genes responsible for antibiotic drug resistance</a>. According to this theory, the plasmid escaped from cells and evolved in a way that allowed it to enter another cell to produce viruses.</p>
<p>Another theory suggests that viruses could have evolved from more complex free-living organisms, such as bacteria, or cells. A <a href="https://www.ncbi.nlm.nih.gov/pubmed/29328916#">recent study</a> showed that a protein called ARC that is important for memory in humans can form virus-like particles and transfer RNA between cells. Perhaps similar ancient proteins evolved to move from one organism to another. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/220348/original/file-20180524-51130-4dyg97.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/220348/original/file-20180524-51130-4dyg97.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=399&fit=crop&dpr=1 600w, https://images.theconversation.com/files/220348/original/file-20180524-51130-4dyg97.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=399&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/220348/original/file-20180524-51130-4dyg97.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=399&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/220348/original/file-20180524-51130-4dyg97.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=502&fit=crop&dpr=1 754w, https://images.theconversation.com/files/220348/original/file-20180524-51130-4dyg97.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=502&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/220348/original/file-20180524-51130-4dyg97.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=502&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">The Tupanvirus is a giant virus that can infect protists and amoebas, but are no threat to humans.</span>
</figcaption>
</figure>
<p>And then there was that recent discovery of <a href="https://www.nature.com/articles/s41467-018-03168-1">the giant Tupanvirus in a Brazilian soda lake</a>. Lakes like this are very salty and have a high pH. They may mimic the conditions of aquatic environments on Earth billions of years ago. </p>
<p>Tupanvirus has a more complete set of protein-making machinery than any other known virus. Unlike other viruses, it’s probably not as dependent on the cell it infects to replicate. This discovery has reignited interest in the theory that viruses arose from complex, free-living cells. </p>
<h2>Which came first?</h2>
<p>Both the theories above assume that cells existed before viruses, and that viruses potentially evolved in the presence of cells. </p>
<p>But there is yet another hypothesis that proposes that viruses existed first, even before cells. In a prehistoric world, viruses might have existed as self-sustaining entities, a sort of ancient machine that could probably reproduce its genetic material. Over time, these prehistoric viruses may have formed complex, organized structures that eventually evolved into <a href="https://www.sciencedirect.com/science/article/pii/S016895250500288X?via%3Dihub">cell-like entities</a>. </p>
<p>For the time being, these are only theories. The technology and resources we have today cannot confidently test these theories and identify the most plausible explanation for the origin of viruses.</p>
<p>An alternative — yet seemingly impossible — strategy would be to isolate or identify viruses in their primitive forms on other planets such as Mars. Staying on Earth seems like a more plausible approach. </p>
<p>The ongoing discovery of new viruses, like Tupanvirus or a <a href="http://www.pnas.org/content/111/11/4274">30,000-year-old </a> relative of giant DNA viruses (Pithovirus), may allow us to piece together the puzzle of their origins.</p><img src="https://counter.theconversation.com/content/94551/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Arinjay Banerjee receives funding from Saskatchewan Innovation and Opportunity and the Department of Veterinary Microbiology, University of Saskatchewan. </span></em></p><p class="fine-print"><em><span>Karen Mossman receives funding from the Canadian Institutes for Health Research and the Natural Sciences and Engineering Research Council of Canada. </span></em></p><p class="fine-print"><em><span>Vikram Misra receives funding from the Natural Sciences and Engineering Research Council (NSERC) of Canada through Discovery and CREATE grants. . </span></em></p>Recent discoveries of ancient viruses are helping scientists understand their origins.Arinjay Banerjee, Research Scientist and Principal Investigator, University of SaskatchewanKaren Mossman, Professor of Pathology and Molecular Medicine and Acting Vice President, Research, McMaster UniversityVikram Misra, Professor of Veterinary Microbiology, University of SaskatchewanLicensed as Creative Commons – attribution, no derivatives.