Chapter 31 Chapter 30 Ebola Attacks Virginia

November 30, 1989, Fred.Murphy, now director of the Center for Infectious Diseases at the Centers for Disease Control, came to my office on the fifteenth floor. He said: Joe, I just got a call from General Russell of the U.S. Army Medical Research Institute of Infectious Diseases.Peter.Jalin isolated a virus that was identical to Ebola and found it in privately-raised monkeys in the Reston, Virginia, area. Jalin is one of the leading researchers on hemorrhagic fever in the United States.But will Ebola show up in Virginia?In suburban Washington, then sure?Thanks to the fact that I was sitting on a lean-to at the time.The news was unbelievable for a while, and I needed time to think about it.

How did they even think of isolating the virus?I asked. Apparently, they were looking for the cause of the epidemic of simian hemorrhagic fever (SHFV), so filoviruses were found in tissue culture, and Fred said that Peter himself was more surprised by this discovery than anyone else.We all know Peter very well, he was the one who did the monkey experiment with Reba antiviral a few years ago and proved that it could be successfully used to treat Lassa fever.More recently, he has been working on the investigation of the prevalence of simian hemorrhagic fever in monkey laboratories in the United States.Ape hemorrhagic fever is a serious disease that occurs in monkeys. It should only exist in Africa. It may also appear in India. Once ape hemorrhagic fever starts to spread, it will cause havoc.Scientists knew nothing about simian hemorrhagic fever virus except that it was a large-particle DNA virus.We at the Centers for Disease Control were not involved in these investigations and could not be, because SHFV is an animal disease and it does not cause disease in humans, in fact, it is not even infectious to humans.

Peter is called to Reston to help investigate an epidemic of simian fever that, on the surface, appears to be routine.He took several blood samples from infected and dead monkeys, made tissue cultures, and then examined them, but of course he would not find anything unusual.But his assistant was shocked by what he found under the electron microscope.He asked Peter to come over to see a blood sample he had just taken.The photo shows something that looks like a giant snake.Peter understood right away what had startled his assistant. The snake-like thing looked like a filovirus, and, moreover, it looked like one of the deadliest viruses known to man. It was like Ebola.

As if that wasn't thrilling enough, these monkeys are not from Africa, they were recently imported from the Philippines.Originally there wasn't any simian hemorrhagic fever in Asia, let alone Ebola virus.The U.S. Army Medical Research Institute of Infectious Diseases invites us to discuss this situation and discuss countermeasures.After all, the CDC has more experience with Ebola, both medically and experimentally, than any other agency.And the Centers for Disease Control is also responsible for investigating any disease that threatens human health.At this time, Carl.Johnson is no longer with the U.S. Army Medical Research Institute of Infectious Diseases, where he had been working since leaving the Centers for Disease Control in 1982.After leaving the Institute in 1985, he worked independently in California.That's a pity, his experience with haemorrhagic disease should be invaluable.

On the way to Washington, Fred and I deliberated over several pressing issues.How did the virus get into monkeys in Asia from Africa? Was the monkey transported from Asia to Europe by boat?Has someone smuggled monkeys from Africa to Asia?Have they been exposed to the source of the virus from Africa?The monkeys were brought in in the cargo hold of the airliner.They were shipped in wooden crates on large pallets.The lesser-known traffickers deliver them in miserable conditions.But the monkeys had flown in with KLM, and they were treated in luxury compared to other airlines. Also, we guessed, if the virus didn't come from Africa at all.And what about a new member of the filovirus that actually came from Africa?As far as we know, there are only two members of this filovirus family; Ebola and Marburg.Ebola has two strains of the virus, found only in northern Say and southern Sudan.While Marburg appears to be endemic to the area around Lake Victoria in Uganda and to the Mount Elgon cave region in western Kenya, an unexplained case of Marburg appeared in a South African hospital.The patient had been traveling in Zimbabwe.That's all.That was all we knew about the origin of filoviruses at the time.Despite the remarkable efforts of many researchers, no one knows where the virus originated.

There is another interesting story about Marlborough.Filovirus infection was first identified in 1976 when the first cases appeared in Marburg, West Germany.Investigators determined the virus came from monkeys recently imported from Uganda.Thirty-one laboratory technicians, veterinarians, animal handlers and their close contacts were infected and seven died.It was later learned that even accounting for the exhaustion of the journey, the monkey mortality rate was much higher than estimated.In about three months, one-third of the monkeys died, usually two to three a day. This time we have to be extra careful.Maybe it's a repeat of last time.

Interestingly, we never expected this new discovery to be the result of laboratory contamination.This should not be an unreasonable explanation, but we have too much respect for the quality of Peter's work.So if Peter says he bred Ebola from monkeys, that's taken for granted. Fred and I got off the plane in Dulles, rented a car, and drove to Frederick, Maryland.Once at Fort Detrick, we made a beeline for the headquarters of the U.S. Army Medical Research Institute of Infectious Diseases.An emergency meeting to discuss the situation is about to begin.All the top officials from the U.S. Army Medical Research Institute of Infectious Diseases are here.Including General Russell, Division Director, Peter.Jalin, and CJ.Peters.Someone introduced us to Dan.Dalgard, the veterinarian at Haysardon's lab, was the importer of the monkeys.I'm glad to see representatives from the Virginia Department of Health were also invited to the meeting.

Peter at the meeting.Jalin first introduced his findings, describing how Dalgard collected and presented blood samples from sick monkeys at Reston's Haysarton Laboratory.Apparently, the veterinarian had previously seen cases of simian hemorrhagic fever in his monkeys and thought the same had occurred again.It does look alike, and in fact, he's right.The monkeys were indeed infected with the simian hemorrhagic fever virus.Peter's technician Joan.Roderick demonstrates yet again why observational lab techniques are critical.She noticed that the cells in a petri dish suddenly disappeared, and something killed them.Peter sniffed the open petri dish for the smell of bacterial contamination.He was not very satisfied with the results, so he gave the petri dish to a man named Tom.Gaisberg's man, a young trainee with a passion for his work.Peter asked him to prepare the material and practice his newfound technique with the electron microscope.The results have been reported by journalist Richard.Preston was published in The Hot Zone.It looked like Ebola virus, but suddenly, Peter and Jalin remembered that the petri dish he had sniffed was full of this kind of thing.

Is it too much for Ebola to operate in broad daylight?After lurking for many years, he suddenly appeared in the most advanced laboratory in the world. Could it be that even the capital of the United States cannot escape this disaster? Without a doubt, I think whatever virus this is is something to be concerned about.At this time, the representatives of the military delegation who sat around the table and seldom spoke also started talking. People in the conference room got excited and rushed to express their views.Strangely, none of the people at the meeting had actually seen a patient with Ebola except me.Listening to their discussions, I recalled the scene in Say, when I knelt on the ground of the hut and collected blood samples from Ebola patients by the light of a kerosene lamp.That's the real thing.But here, in Washington, is that true?

Our main task is to develop a coherent plan of action that prioritizes all matters of public health.This matter is no small matter.To make this happen, I will be working closely with the Virginia Department of Health to provide all the help they need.That's what taxpayers are funding the Centers for Disease Control to do. The meeting decided that the U.S. Army Medical Research Institute of Infectious Diseases would continue to study and solve animal problems.It is up to them to figure out how prevalent the virus is in laboratory animals and to devise strategies to prevent the disease from spreading to the outside world.I worked with state health departments to limit their threat to the population while military representatives tackled the whole ape problem.This is our division of responsibilities.I was later surprised to read in "Tricky Spot" that the Centers for Disease Control was about to take over the entire operation.Neither Fred nor I intended to do so, nor have we ever expressed this view, which is not my style.Also, we don't have the capability to solve problems about monkeys anyway, and we welcome the military to deal with them.

Of course, all of this is being done in the shadows of the most sensitive propaganda tool in the world.Up until this point, we had not received major funding from Washington for a research program on viral hemorrhagic fevers.We'll just have to sit back and watch as huge sums of money are poured into harmless diseases like chronic fatigue disorder. Sometimes we joke that we most need a few Lassa rats running around the capital, and that will get some attention.Congress will understand that these viruses do exist. Suddenly the joke came true, we knew that the press would leave us breathless once the news got out, and we knew it was likely that the reporters would bring small cameras and tiny tape recorders to the venue, adding to the tension. The attention of the news media can only mean one thing: the most important thing is to keep a low profile and engage calmly to avoid chaos.I worked on the Lassa case in Chicago and the suspected case of Ebola in New Jersey a few years ago.My secret to working effectively is to stay calm, to assess possible dangers, and to develop a plan to limit them.Explain to people what happened and get them to calm down.When dealing with the news media, I always tell them what I know and never comment on what I don't know.So even when I'm anxious, I appear calm and at ease. The first thing that happened after the meeting was a press conference, which was jointly convened by the U.S. Army Medical Research Institute of Infectious Diseases and the Centers for Disease Control, to briefly explain what happened at the Reston Regional Laboratory in Virginia. An Ebola-like virus has been found in a group of monkeys.Our action plan calls for us to identify human exposures in Hessatton; assess and contain the monkeys to find out if monkeys elsewhere will become infected.For that, we need to investigate other imported animals, and maybe that will figure out where monkeys in the Reston area came from to be infected with the virus.This work is undertaken by the Quarantine Division of the Centers for Disease Control. For some time, the Ministry of Quarantine has been concerned about environmental and conditional issues in the monkey trade, so their actions have been positive and effective.Our workload was intense from the start, and the operation quickly grew into a formidable collaborative force. The people sent by the Virginia Department of Health to work were all smart and capable. They were not only professionally competent, but also kept their heads clear, which was not easy under the circumstances at the time. I explained to them that Ebola can be transmitted, and that it has not been transmitted, etc., which was much easier than expected.They might be tempted to lump anyone who comes close to infected tissue or monkeys into the high-risk category.In reality, this is unnecessary and would cause unnecessary anxiety for those people.Still, that's quite convenient for state health officials, who have adopted a strategy of locking down if suspected.Officials in the state are reluctant to cause panic. Unfortunately, some journalists want to use this opportunity to make a big splash by creating an atmosphere of crisis.In this way, some of the messages we would like to express our experience in the medical field and in the laboratory tell us that it is necessary to preserve these viral infections are distorted.But Brent.Blackledge is an exception.As a reporter for The Journal, a Fairfax County area newspaper, he not only wrote good stories, but also provided accurate information to the community, eliminating the small hidden dangers that caused panic. I set out to study the possibility of the outbreak spreading to the human population with my colleagues at the Centers for Disease Control, including Sue.Sue is the only person with actual experience of monkeys being infected with Ebola virus.Me and Steve.Osteroff, epidemiologists at the Centers for Disease Control and the Virginia Department of Health worked together to create a list of people who had been exposed to monkeys and devised questionnaires to assess their exposure Degree.We had to investigate everyone who had contact with animals or their tissues. Things didn't go smoothly.When I rushed to the Haysardon laboratory, I found that, except for the people in the animal laboratory we dealt with separately, all employees who may have had contact with animal cells and tissues had been called for a meeting.I did not schedule such a meeting.This is what the company claims.The meeting was chaired by a veterinary pathologist from the Army.Her job is to work with lab apes.She has no idea who I am.I also don't know what Ebola is.The meeting was well organized and I thought it best not to interfere.In fact, until I was invited to speak, I remained silent. That doesn't mean I don't want to get up and argue, it's just that I have to be patient and listen to her rambling description of the disease.Contradicting her in public won't help.It can make people think that none of us know what we're doing and give the impression that things are out of control, which of course creates concern for no reason.When I finally got a chance to speak, I told everyone that their chances of getting Ebola were low.In fact, it is impossible for the virus to escape from the animal room in the laboratory to the secretary in the coffee shop.Even if you were in the same room as a piece of infected monkey tissue, you would definitely not get Ebola.The only people at risk are those who have had close contact with sick animals.I assured the participants that we would identify these individuals and observe them closely.Naturally, people wonder what will happen if they become ill.I told them that in case anyone ever got this disease, they would get the best treatment at Fairfax County Hospital.I emphasized that the medical staff in the hospital were prepared to deal with such a situation, saying that after all we have established that in Africa even among those who have been in close contact with the disease and dying Ebola patients, the infection rate is only about ten percent.Among those who provided long-term care for the seriously ill, the risk rose, but remained fairly low.The greatest danger comes from a wound or an instrument's needle stick that is infected with blood.Those employees who work with the virus wear gloves and have a good laboratory environment.And none of the reported cases were related to wounds, scratches, or needle sticks.Also, I have seen the rows of dying patients in Sudan, and seen the terrible consequences of the spread of the disease in Say, so I don't want to be overwhelmed by the disease, I use my knowledge and experience to accept Challenge and reverse the crisis. Dr. Dalgard, the monkey veterinarian, was the most sensible person I met while working at Haysarton, and I sympathized with his plight.He is under pressure from three sides.He worries about the animals, and at the same time, he has to consider the possibility of them infecting humans.He can't ignore the possible financial impact of the incident on the lab he depends on.Employees remained calm during any incident, at least not panicking, going home and quitting, or making irresponsible remarks to the press and lawmakers.Working with us, they organize themselves into risk groups according to their degree of contact with any animal or animal tissue. Throughout the process, there was a lot of discussion about whether Ebola was airborne.Whenever Ebola is visible, this gray hairy monster will show up.All of the epidemiological evidence for human disease, including the first epidemics in 1976, 1979 and Marburg, has sparked discussion of this issue.Although many patients were treated in poorly ventilated huts, the only people who contracted the disease from others were those who had direct contact with sick people, especially with their blood, urine, vomit or diarrhea people.If Ebola is spread by smoke, Roy.Barron and I would have caught it in Say.A recent Ebola epidemic among some villagers in Gabon resulted from exposure to a gorilla that died of the virus and was brought home by some young people.Likewise, exposure to infected animals and the preparation and consumption of their fresh meat are prevalent causes.Indeed, it was the knowledge of this mode of transmission that made Alan.George and the people from the Longs International Medical Research Center were able to control the spread of the epidemic in time. The problem is that there is no way to prove that Ebola is not airborne.You can prove something happened, but you can't prove it never happened.We have stark examples of airborne transmission like chicken pox, flu, measles, but these diseases are distinct from Ebola.First of all, their hosts are humans, and humans are the largest source of infection, and the respiratory system is the main target.In order to spread to humans through the air, these diseases are basically linked.This is the main strategy for disease transmission.Second, because diseases like measles spread so easily and quickly, they strike people at a much higher rate than Ebola.Most African patients are cared for in airless rooms, where other airborne viruses, even germs like tuberculosis, can easily spread.Many of these cases were contagious, but Ebola was different. Indeed, experiments by the U.S. Army Medical Research Institute of Infectious Diseases have shown that airborne transmission of several hemorrhagic fever viruses is possible, but this requires placing masks on the faces of guinea pigs and monkeys, where the masks can deliver large quantities of virus under pressure.In this experiment, all animals were infected.Clearly, this is not natural transmission.The only lesson of this experiment is that if you press on the mask you can get pneumonia and all the germs you want, including non-pathogenic bacteria on the surface of the skin like staphylococcal epidermis.It is worth noting that this experiment did not use any non-pathogenic bacterial organisms as controls for the purpose of the experiment. Even with the proof, I believe that while airborne transmission is not impossible, it is very individual.That's not really my biggest concern, we used to sort through a comprehensive list of everyone who might have been exposed to the virus.According to the degree of their contact, divide them into three categories of high risk, medium risk and low risk, and then observe each category.We make sure to have daily contact with the people on the list to monitor their overall health and check for fever. In addition, I also ensure that appropriate medicines and wards are in place to provide medical care for patients who may arise.Our approach to work is the same as in Chicago, patients will be admitted to regular hospitals and receive the medical attention they deserve, possibly including isolation nursing techniques.This is done for several reasons. First, patients with hemorrhagic fevers require the highest quality of medical care, which cannot be achieved unless the patient is relatively easy to obtain, especially monitoring.Second, it is difficult for patients to be admitted to the fourth-level high-control ward.Valuable time will be lost in finding a hospital for the patient, and more people will be infected during the transport of the patient.Patients with hemorrhagic fever can hardly bear the bumps during transport, because their cardiovascular system is very fragile, there is a risk of shock and bleeding, and handling can cause death.Third, medical staff assigned to high-containment wards may not be able to maintain high standards of tertiary care unless they practice daily.If the hospitals in big cities don't have these equipments, some things will be very difficult to do. I have evidence to support my view, suffice it to say that a few years ago some Lassa patients were admitted to the general wards of some London hospitals with no clear cause.Some patients are not even diagnosed after they recover.Without isolation care, not a single medical staff member was infected.Azquiwe had higher levels of Lassa virus in his blood than any other patient, but none of the people who came into contact with him at a tertiary hospital in Chicago became infected. I spoke with Alan Alan, an epidemiologist and infectious disease specialist at Fairfax General Hospital.Dr. Morrison and the medical staff of the monitoring team spent a lot of time together.They listened carefully to my estimates of the dangers they faced and as I explained the precautions they should take.In order to cope with the unexpected, Kuka.Perez procured a mobile laboratory equipped to detect level 4 viral pathogens.so.We have the ability to test blood and serum for any case wherever Ebola infection is suspected and make a timely diagnosis.Kuka is responsible for conducting experiments when necessary. We didn't have to wait long. On December 4, an animal keeper in Reston went to work in the morning with a fever and began to vomit.In a high-tension monkey lab, that's enough to make people sound the alarm.The patient was rushed to the hospital and admitted to the intensive care unit.Medical staff receive patients as usual.Our recommended protective measures were used and the patient was thoroughly examined and histories taken.I knew right away what if he had Ebola.I doubt it might not be the traditional form of Ebola infected in Africa, one of the notable symptoms of Ebola is sudden fever, muscle aches, joint pains, headaches, you feel sick immediately, and this patient didn't have any of those Class symptoms. But maybe he was infected with another form of Ebola that we don't know about.So we have to be prepared for different manifestations of the disease.In two.Within an hour, a series of negative test results from Kuka confirmed my impression.Not Ebola.By this time the patient had a fever.My guess is that the man's illness was caused by anxiety.Consider the environment of Reston.I don't blame him.