Wednesday, August 27, 2014

Fireside Chat with Dr. C.J. Peters: How will the 2014 W. Africa Ebola epidemic play out?

Greetings Friends,

While scientific advancement greatly depends on controlled experimentation, and knowledge and comprehension of the literature, hanging out with an expert and engaging in relaxed but highly stimulating intellectual discourse can be just as valuable. It's often during these informal chats that you become privy to important anecdotal information that can only be gotten through personal experience. While this information might not make it into an article, it is still very valuable and revealing about the subject at hand. Pioneers in the field of emerging infectious disease are often on the front lines during epidemics and have great stories. Just listening is not only educational, it's a whole lot of fun.

This Fireside Chat is my way of sharing one of these conversations with you, of providing what I believe is valuable and relevant information straight from someone who knows because his career is built upon pioneering Ebola research and outbreak response efforts. And as luck would have it, I recently got to sit down with Dr. C.J. Peters and discuss the current Ebola epidemic.

If you don't know C.J. by name, I'm sure you'll recognize his career. He is the original virus hunter and the real man behind Dustin Hoffman's character in "Outbreak". His career is filled with honors and distinction, not the least of which is that the Army created "The C.J. Peters Award" in his honor. The award states: "In the inception and granting of this award, we honor Colonel C.J. Peters, Medical Corps, a brilliant and innovative scientist, scholar and physician...whose work is a lesson not only in science, but in humanity." If you want to read about his amazing career, read his autobiography Virus Hunter. His is truly a remarkable journey. Although to make it even more riveting he should consider updating it with a chapter on being my PhD mentor. That was probably more exciting than he expected. Anyway, I had the pleasure of sitting down with C.J. and discussing this outbreak. This man is brilliant and agreed with everything I said, but he also brought up some things that I hadn't thought of. I am very pretty smart too, so I agreed with everything he said. As you can imagine, it was a lot of fun.

As we discussed the current epidemic, many of the factors contributing to the rampant spread of Ebola in West Africa became a little clearer. I have not been to Africa, so C.J.'s experience here was invaluable. He explained to me how very different hospitals over there are. No surprise there, right? Well, the differences are even greater than you might imagine. Yes, as we've already discussed at length, they lack many basic resources, but they also do things very differently. For example, hospitals don't provide food and laundry services for patients, family members are responsible for those. And they don't have reclining chairs or other places for family members to sleep, so they often sleep in bed with the patient. Since direct contact is the single most important risk factor for Ebola transmission, those things combine into a very effective transmission pipeline.

C.J. also stressed the problem of disposable needles and syringes. It turns out that infected needles/syringes play an even bigger role than you might think in Ebola transmission, both between patients and between patients and HCW. In the U.S. we use disposable syringes one time and toss 'em. You'd think that the switch from stainless steel needles and glass syringes that had to be sterilized, to disposables would help. But the problem is that they don't have enough. They hardly have any. Disposable syringes can't be sterilized by the customary heat methods and disposable needles might survive one or two rounds of sterilization, after which they're unusable. So they do what they have to: use the same needle/syringe in different vials or multi-use vials, and between patients. This is a very effective way to spread a virus.

In addition, glove shortages aren't the only problem with gloves. Here in the U.S., whenever doctors or nurses see a patient in the E.R. they wear gloves. It became standard with the advent of HIV. C.J. explained that that's not the case in these hospitals treating Ebola patients. Gloves are hard to come by, and if they are there, they are saved for only the most overt needs. Ebola patients don't have signs on their foreheads, so they may be cared for without gloves before Ebola is suspected. C.J. made the point that using gloves correctly for every single patient contact would go far in slowing the transmission of this virus, if they were available. You see, Ebola doesn't actually spread that easily.

To illustrate this, let's consider a concept that epidemiologists useR0 (R naught). This is the basic reproduction number of an infection: the average number of cases that a single infectious case will cause in an uninfected population. Basically, it's how many people one person can infect. While this number is based on a mathematical model, with assumptions etc., it's been shown to be very relevant to what we see in epidemics. The higher the R0 the more the virus spreads. For Ebola, even with environmental factors that increase its transmission (lack of sanitation and resources), the R0 is relatively low: 2.7 for both the 1995 Kikwit, and 2000 Uganda outbreaks.

So it's clearly not magically infectious. They just need PPE and the training to use it. C.J. was clear that they need trained people with the basics, including gloves, gowns, masks and goggles, to go from town to town and hand them to the nurses, doctors and family members caring for Ebola patients, and explain to them when and how to use them. These people must be able to not only train locals in proper use of PPE, but also communicate effectively while respecting cultural differences. Even if you have such people, and we don't have enough of them, this isn't always easy in communities rife with fear and mistrust.

And there are other factors making the logistics of supplying hospitals even more difficult. Turns out, supplies don't always make it to their intended destinations. Delivery trucks can be raided or willingly detoured for the sake of profit for a small few. C.J. described this as a very real problem during the Kikwit Ebola outbreak in 1995, and in 2014 we've seen the armed invasion of medical facilities to steal supplies and "liberate" patients. These additional challenges are incredibly complex, and packed on top of minimal health care infrastructures that are already overtaxed. It's a heartbreaking and nearly foolproof formula for tragedy.

So what does it all mean? Well, C.J. made it clear that it means that Africa is in real trouble. This virus is likely to keep spreading within Africa before this is over and those countries already affected are in it for the long haul. They face the very real possibility of rapid depletion of resources and the death toll will keep rising. But it also means that, as I said in my first post, this virus won't cause real problems outside of Africa, and it certainly won't cause a pandemic. Those suffering with Ebola infection generally don't have the resources for international travel. Those that do are unlikely to get on a plane while symptomatic; the symptoms of Ebola are debilitating. Even if a few people travel internationally and then come down with symptoms, most other countries will be able to contain it. Especially since it's now on our radar.

Of everything we discussed, the one thing that C.J. said that stuck with me the most, was how the Rof Ebola compares to that for measles. Measles has an Rof 12-18. That means that someone infected with measles could infect, on average, up to six times more people than someone with Ebola. Six times. And the incidence of measles, a serious and potentially life-threatening illness, is rising in the U.S. because people are choosing to not vaccinate their children. Did you know that between Jan 1st and August 15th of this year (2014) there have been 593 diagnosed cases of measles in the U.S. and 18 outbreaks? It hasn't been that high since...I don't know when and most of those cases were in the unvaccinated. This boggles my mind. The measles vaccine became available in 1963 and before that, when it wasn't an option, each year ~500,000 people were infected in the US with 48,000 hospitalizations and 500 deaths. Now adjust that for the current population density and it becomes even more frightening. That is the power of a vaccine. And yet today, we face people choosing to not vaccinate, usually with only enough information to be dangerous. Clearly.

So guess what happens if an unvaccinated person gets measles? They go to the doctor. Guess who they transmit it to while in the waiting room? Almost everyone (90%). Guess who will get really sick? Those in that waiting room who aren't vaccinated will be in trouble and sometimes that means an infant who has not yet been vaccinated, only because he/she is too young. Read about just such an infant here.

My point is this: We live in a country with resources and access to things like vaccines against life-threatening illnesses, and yet we have people who are making the uneducated, arrogant and selfish choice to not vaccinate, and in so doing put their entire family and community at risk. Looking at images from this epidemic, I imagine these same people would be first in line for an Ebola vaccine, and yet they risk their children's lives every day by leaving them susceptible to diseases that are a far bigger problem. But until it hits home they won't realize the flaws in their logic.

Unfortunately, when it does hit home, it will hit hard.

C.J. agrees.



Thank you for the chat C.J.! 


Legrand,J., Grais,R. F.,  Boelle, P. Y., Valleron, A. J. and Flahault,A. Understanding the dynamics of Ebola epidemics. Epidemiol Infect. May 2007;135(4): 610–621


  1. I remember the first lab meeting I attended when Doug and I started doing SARS work. His comparison of a nude mouse to a certain anatomic feature was......interesting, if not funny. The way he'd go off on a tangent of a tangent of a tangent is legendary.

    1. Oh yes. His story skills are amazing. :)

    THERE IS NO CURE FOR IT,BUT THANKS BEEN TO THIS GREAT MAN CALLED DR GADAGODO WHOM I READ A TESTIMONY ABOUT ON HOW HE CURED HIV/AIDS WITH HIS HERBAL MEDICINE,I NEVER BELIEVE THIS BUT I DECIDED TO CONTACT HIM THROUGH THE STATED EMAIL, and he send to me a herbal medicine and ask me to drink and bath with the herbal medicine for one month but to my greatest surprises, i went for a medical test after two weeks and my status was negetive till today i cant keep sharing this testimony please brothers and sisters there is a cure to hiv/aids, contact this man for what ever you are going through, what ever sickness you are suffering from, hiv/aids,perkinsons disease, ALS,CANCERS,HERPES. contact him with his email via, or phone,+2347034629991 or whatsapp him on +2347034629991

  3. Good day every one,I am Albert Richard from Vancouver Canada. I have been in pains ever since my wife left me,so on this faithful day when i was online i eventually came across some various testimonies about this spell caster Dr.prince,on how he has helped so many people to get their lovers and broken homes back,i got convinced of all the testimonies and immediately i contacted him through his email address at (DR.PRINCEARATAABRAHAM@GMAIL.COM) because I was absolutely desperate to get my wife back. Life without my wife was a real mess for me and my children. i wanted a dramatic change and I thought magic could be the solution. After discussing the resolution with Dr prince, he told me that he was going to restore my marriage back. I felt confident that he will actually make my wife to return home and he did! It’s fantastic what this great spell caster have done for me, his help is priceless! I don’t know what I would have done without Dr.prince he does his job so well he is organized and highly functional, i believe he is the best spell caster i can count on when it comes to all kinds of spell, I was floored that his spells worked. He fix the following problems to all across the globe on(1) Getting your lover or husband back (2) Sickness and disease spell (3) Visa spell (4) Money spell (5) Long life spell (6) Prosperity spell (7) Protection spell (8) Job spell (9) Becoming a manager spell (10) Werewolfe spell (11) Getting your scam money back (12) Child spell (13) Pregnancy spell (14) Freedom spell (15) Love spell (16) vanishing spell (17) Loan spell (18) Success or pass spell (19) Marriage spell (20) Lottery/lotto winning. You can contact Dr.prince true his email at (DR.PRINCEARATAABRAHAM@GMAIL.COM) you can also call or whatsapp him true his phone number at (+2348163241499) thank you very much doctor prince.

  4. Hello everyone, this is serious. My Brother of 39 years who has suffered of HERPES for 1 and half years has been cured by a Herbal doctor called Dr. KEN who uses herbal and traditional medicine to cure people. I have spent so much on my Brother's health paying hospital bills for years but no improvement. A friend told me about this herbal man who cure people with herbal medicine. He cures all sickness, diseases, viruses, and infections with his different herbal curing medicine.
    The result that declares my Brother Roland healed was from a hospital here in New York, And the results of the test says my brother was okay. Dr KEN directed that my Brother would be okay in 21 days if he uses the medicine as directed. And 21 days later, we went to confirm it from the central hospital and several test that was done says my brother is fully healed. So he was cured by this herbal doctor in 21 days. This amaze me though. I would advice everyone to meet this Dr KEN who made my Brother healthy again.
    Meet Dr KEN and set yourself and your love ones free.
    Doctor KEN's email again is call or whats app +2347034971061

  5. Good day everyone my name is blunt james from USA, I have this great opportunity to share this testimony about how I get cure for my HIV, two years ago I was HIV positive so I was suffering from it I was doing one thing or the order to get a cure there was know way for it so I was on my way search on the internet I see a testimony of a young man,speaking about how Dr Aziba help him get a cured for HIV with his herbal medicine I was surprise and I do not believe, I said okay let me try him I contacted him on his email address and he gave me intrusion and I followed it he told me what to do and I do it after 5 days he send me the medicine through DHL and i received it, he told me how to use it and I do it after two weeks he told me that I should go for test I do it and I was afraid then later on the test came out i was so surprise that am HIV negative I was so very happy i could not believe it will work and i we be HIV Negative, now am happy with my family with my two kids. I want to use this opportunity to say this if you have this kind of disease called HIV I want you to contact him on is email ( OR WHATSAPP HIM ON +2349076651593 ) and he can also help you get a cure for HPV disease or any disease with his herbal medicine. all you have to do is to believe him. this is one of the promise i made that i will purblish him to the world. thank you my Dr may God bless you.