It’s been 25 years since an Ebola outbreak last threatened the United States.
But Jerry and Nancy Jaax remember it well.
“It certainly looked like we had a serious public health emergency on our hands and all of the people involved in it, from senior administration down to the operational level felt it was a very dangerous situation,” said Jerry Jaax. “It turned out not to necessarily be that. ... Ultimately it was nice it wasn’t something that killed anybody.”
The number of people who study Ebola is a “pretty small club” – a club the two former Army veterinarians belonged to for years.
The Jaaxes were part of a military team that led the response in Reston, Va., when a primate facility that shipped animals to laboratories across the United States for research found its macaques were dying in large numbers. The animals, which had been imported from the Philippines, tested positive for Ebola.
As a result, the Jaaxes and other scientists in hazmat “space suits” blocked off the facility, just a short drive from Washington, D.C., and euthanized hundreds of the animals to prevent the disease from spreading to humans. Their experience was the basis for “The Hot Zone,” a nonfiction thriller published in 1994.
At the time, scientists thought the strain of the virus in Reston was Ebola Zaire – the mostly deadly known form of Ebola – which has infected thousands in the most recent outbreak in West Africa.
Later, they discovered it was a new strain of the virus that doesn’t spread to humans.
Despite the missteps at the Texas Presbyterian Hospital Dallas, where Liberian Thomas Eric Duncan was wrongly discharged in September before returning with full-blown Ebola symptoms, the Jaaxes think the United States is largely prepared to handle the virus, particularly because of the nation’s health care system.
“We won’t have an epidemic or even a serious outbreak,” said Jerry Jaax. “The thing about it is we’ve got a zero risk tolerance bar that we set that says we can’t afford to have one person get infected or it’s a disaster. You can’t ever say never in biology and there are a lot of wild cards thrown in there, but I think basically the United States is ready.
“Somebody had to be first. Unfortunately for the whole public health system, these guys were unprepared,” he said. “Certainly there’s a lot of concern they may not have all the equipment they need and when you train people they turn over, but I think you’d have to be living under a rock if you’re a hospital administrator or an ER doc or an infectious disease specialist at a hospital not to go ‘Wow, I’m glad that wasn’t us. Let’s make sure that doesn’t happen here.’ If nothing else, the fiasco in Dallas sort of was the shot across the bow for everybody else to get ready.”
In the late 1990s, the Kansas natives returned. Jerry Jaax took a position at Kansas State University as associate vice president for research compliance, and both of them worked to bring the Biosecurity Research Institute to Kansas State, which examines threats to plants, animals and humans.
The situation in West Africa is a “perfect storm” for an Ebola outbreak – among the cultural practices of handling infected people or their bodies, the general distrust of doctors and medical staff and the movement of the disease from isolated, rural areas to large cities, said Jerry Jaax.
“It really changed the dynamic of the outbreak when it got into these big cities where you have lots of mobility,” he said. “That really changed what had been a very isolated sort of disease. It would pop up mysteriously, it would get bad and then it would disappear.”
So far, the U.S. has spent more than any other country on the global Ebola response, and the U.S. Army has deployed soldiers to help build temporary medical facilities in West Africa.
Last week, President Barack Obama asked Congress for more than $6 billion in disaster aid to fight the disease overseas.
“I don’t see any other country ponying up like we are,” said Jerry Jaax.
There is still a lot to be learned about Ebola and how it works.
“Ebola is still a bit of a mystery virus. ... It takes a very long time to get real answers. These are tough bugs,” said Nancy Jaax.
She was part of a team of researchers that found Ebola is most likely introduced into the human population through food, particularly in bush meat like fruit bats and other non-primate animals.
Of the many dangerous diseases identified by the Department of Homeland Security and the Department of Defense as potential bio-terror weapons, about 80 percent are zoonotic diseases, or those that people can get from animals, said Jerry Jaax.
The initial source of the virus, where it doesn’t cause the animals who have it to get sick, is called a reservoir.
“In order to be the reservoir, the bat has to be able to maintain the virus and shed the virus and survive. Probably the classic bat-borne disease is rabies, which is distantly related to Ebola virus,” said Nancy Jaax.
It’s likely the reservoir is close to where the first human case in this most recent outbreak occurred earlier this year in Guinea.
“Everything past that is likely human to human, droplet transmission,” she said, or direct contact with bodily fluids.
Droplet transmission occurs when a person sneezes or sweats or some kind of bodily fluid lands on another person’s skin and they touch it and then touch their eyes or mucous membranes, Nancy Jaax said.
“Droplets are heavier than air. They don’t float through the air like the classic virus aerosol would do,” she said. “They drop to a surface and then very rapidly this virus responds to disinfectant, whether that’s Clorox, ultraviolet light, that type of thing. The aerosol risk is what everybody was worried about. It’s not a classic aerosol virus. While the virus may be mutating, I think the biggest worry there is whether it is going to mutate to the point where treatments don’t work. I don’t see it mutating to become airborne.”
When someone is infected with Ebola, the virus infects the body’s macrophages, cells that send signals to other cells in the body to respond to an infection.
“It hones in on those cells, takes over their machinery and multiplies like crazy. Then what it does is those cells no longer signal to lymphocytes ‘Hey, we’ve got an infection here,’ so essentially it’s like cutting the telegraph line,” she said.
Although there is no cure for the virus, there are some promising countermeasures in the pipeline that are not particularly sophisticated, said Nancy Jaax.
Physician Kent Brantly, who in August was the first person to be treated for Ebola in the U.S. after doing mission work in Liberia, has donated his plasma to other Americans who contracted the disease. In September, the World Health Organization endorsed the therapy as an experimental treatment for Ebola patients.
The process takes the cells out of his plasma that have antibodies that are specific for Ebola, giving the blood back to the donor. It appears that it works best for people in early stages of Ebola, and it’s standard procedure for people to be screened for other diseases before they donate the plasma so they don’t infect the recipient with something else.
“In areas where this is ongoing, there are a number of significant diseases that would make it riskier to use blood transfusions,” said Jerry Jaax, including HIV and tropical diseases that are prominent in Africa.
As the outbreak continues in West Africa, it’s important for people to understand that the disease requires a consistent commitment of funding and investment here – something it hasn’t had over the years, said Nancy Jaax.
“If you look at Ebola, that’s one of the things that didn’t happen. We spent a little bit of money and everyone said ‘Well, it’s not really a big disease, so there’s no funding for it this year,’ and ‘It’s not a threat to the U.S.’ ‘Small outbreak.’ Well, as we’ve seen, that paradigm can change dramatically.”
“You have to do the research,” she said. “If you keep turning that faucet on and off, you’re going to lose educated people, the people that have knowledge that’s pretty essential. You have to fund these programs at a base science level because you have to know how these things work before you can come up with a reasonable countermeasure. You need multiple countermeasures because there’s a different one for every situation.”
Six months ago, no one in the U.S. worried about Ebola, but now it dominates public discussion.
“It’s a little bit like the army,” said Jerry Jaax. “Armies are very inconvenient to have until you need one. Then all of a sudden it better be one that’s a good one. That’s the way it is in public health, a lot of this stuff doesn’t look like it makes a lot of sense to dump a lot of money into until it goes bad. And then you need it.”