WHO’S TO BLAME

Did One Liberian Prostitute Give Ebola to Eight Soldiers?

On Monday, a Liberian newspaper reported on a ‘concubine’—most likely a commercial sex worker—who somehow infected eight soldiers with the virus; the soldiers later died.

The never-ending story of the 2014 Ebola outbreak took several new turns Monday.

A nurse in Spain contracted Ebola after caring for a known case; the U.S. patient, Thomas Eric Duncan, received an antiviral medication previously untested for human Ebola; Texas’ intensely anti-big government governor, Rick Perry, declared the federal government should be doing more to assist Texas in handling their one case; and, in the Liberian newspaper Daily Observer, a story was published describing the Ebola death of eight barracked soldiers—possibly related to the appearance of a mysterious “concubine” who was herself turned out to be infected.

I don’t know much about the Daily Observer. A look at its front page suggests it is a responsible newspaper doing the best it can in trying circumstances. Granted, it has run one recent letter from Dr. Cyril Broderick, a plant pathologist, suggesting that Ebola and HIV were genetically engineered infections created by Big Pharma and the U.S. Department of Defense. But a letter is a letter.

Nor do I know exactly what a “concubine” is, exactly, in this context, though the article mentioned she slept in the barracks with one of the men. Perhaps a girlfriend, but most likely a commercial sex worker. Nor am I certain whether the sex-and-death innuendo from the story—a woman brought in a disease to eight soldiers that eventually killed them—is standard fare for the Daily Observer and its readership (no other articles were particularly lurid).

But I can comment on a few aspects of the plausibility of the story. The notion that Ebola might be a sexually transmitted disease remains plausible if unproven. The biologic plausibility is based on presence of the virus in semen and vaginal secretions; the implausibility is whether people who are sick with the disease actually are interested in having sex. At the core of this last concept is the observation that still holds up, 8,000 cases later, that people are not contagious unless they have symptoms.

More to the point, I have read the world’s published medical literature on Ebola virus in various body fluids; it is not that difficult—there is only one such article in the easily accessible National Library of Medicine-based index.

Here is what this group of intrepid scientists from the Centers for Disease Control and Prevention (CDC), Uganda, and Tulane University did. During a 2000 outbreak in Gulu, Uganda, caused by the same Ebola species now affecting West Africa, they collected samples from patients who gave their permission for the research to be performed. Examined bodily fluids included saliva, vomit, urine, sputum (lower airway mucus), stool, breast milk, semen, and tears. In all, 38 samples were collected from 23 acutely infected patients. In addition, another set of samples was collected in patients who were convalescing from the often-fatal disease. The investigators, led by Daniel Bausch, also tracked just how many days into the illness the specimens were collected, knowing that those at the height of illness were likeliest to have large amounts of the virus. Overall, the average duration of illness at sampling was nine days.

The researchers found that only about one-third (37 percent) of the body fluid specimens from acute cases were positive when tested by very sensitive molecular detection (PCR) techniques. Though only a few samples per body fluid were collected, saliva, stool, tears, semen, and breast milk all showed clear evidence of detectable virus whereas no virus at all could be detected from urine, sputum, and vomit. Of course the hallmark of Ebola—an overwhelming propensity to hemorrhage—might result in blood leaking into these latter-three fluids (urine, sputum, and vomit), but no virus could be detected in this group of non-hemorrhagic samples.

It is possible that more samples on more patients, particularly those with far-advanced disease, would have yielded higher rates of positivity above the 37 percent observed. Furthermore, a larger sampling might have found virus in vomit or urine or sputum—but the data remains important and useful in formulating approaches to control.

First and foremost, blood is bad. Each of the patients had detectable virus in blood but far fewer had virus found in other body fluids. This is the basis of the stringent admonition to avoid contact with blood made by CDC, World Health Organization (WHO), and others, including donning the elaborate Hazmat-like suits, gloves, and goggles worn by those in direct contact with patients.

Second, the presence of virus in semen (and in vaginal secretions, though this was not tested in the 2007 article) makes it possible that Ebola indeed entered the Liberian barracks with the concubine, though it does not explain, really, exactly how it spread from the one man she was visiting to the others. Without more details, it is impossible to sort out the sequence of events.

Third, the virus could not be found in sputum, further supporting the clear observation that airborne spread does not occur. The greatest disagreement between the public health experts and those who are suspicious of the same people’s confident pronouncements is around this assurance. Somehow there is a sense that the experts secretly know that airborne spread has and will occur and are cavalierly ignoring the facts. But the facts are not confusing. Ebola does not have the molecular equipment to spread through the air and will not develop it despite its zillion mutations per minute habit.

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Finally, this sort of plain laying out of the facts in full sight apparently is nearly useless to quell panic and anger over the Texas case. Scientific observation, rather than being a place of respite from fear, itself has become something else to rail against. As with so many other health topics where passions lead and facts in turn are accepted or rejected according to their ability to conform to that closely held belief. In other words, science is yet another victim of the historic 2014 Ebola virus outbreak.