There’s a way to prevent the virus from spreading, but the answer isn’t travel bans.
- By Laurie GarrettLaurie Garrett is senior fellow for global health at the Council on Foreign Relations and a Pulitzer Prize winning science writer.
Since Thomas Eric Duncan entered the United States from Liberia on Sept. 20 and was diagnosed with Ebola on Sept. 30, Americans have been wracked with fear and concern that any traveler coming from West Africa might bring invisible viruses to their communities. There have been calls on Capitol Hill for various forms of special treatment for those traveling from West Africa, ranging from fever checks at airports to such extreme measures as denying visa applications and forbidding the return of soldiers and volunteers now working in Liberia, Sierra Leone, and Guinea.
In the age of globalization, there is no simple way to bar viral entry across national borders. Flights route through multiple countries; jet-age travel allows incubating viral colonies to thrive inside an asymptomatic human, only emerging days after the person has arrived at his or her destination. Duncan is a case in point: Airport fever tests were administered, but the Liberian citizen had no fever while traveling, nor did he exhibit symptoms for days after arriving in Dallas.
Here is my proposed solution.
First, a rapid point-of-care diagnostic that can find Ebola virus in a single droplet of blood must be developed. A point-of-care test avoids the need to ship samples to a laboratory and then wait for days to learn the results. In the early days of the HIV epidemic, firm diagnosis could mean a terrified week for worried patients — today there are home test kits sold in drugstores across America that can reveal HIV results in an hour. And, of course, today women can learn whether they are pregnant almost instantly with kits that they can purchase from neighborhood shops. Such Ebola-specific tests are in development now, modeled on diagnostics already used to rapidly find everything from abnormal cholesterol levels to blood glucose levels that are dangerous for diabetics to common infections. Some major donors have already provided funding to accelerate the development and testing of such devices, and it is well within the realm of realistic possibilities that reliable exams will be ready for commercial development and approval by the U.S. Food and Drug Administration in less than one month’s time.
Given the danger of coming into contact with Ebola-contaminated blood, the test should avoid needles, syringes, and other devices that might accidentally poke health workers. I suggest the use of self-administered implements commonly used by diabetics to make a finger prick and squeeze out a droplet of blood. That droplet would go into a tiny plastic well — an object about an inch in size that is internally coated with either DNA or antibodies that recognize specific genes or proteins found exclusively in the Ebola virus. If those viral markers are present, the device would glow with bioluminescence or change color — the result would be observable with the naked eye.
Some such quick tests have been developed for clinical settings, intended to provide results after a day of lab work on a battery of blood hormones and infection. In contrast, the Ebola test must be very rapid — results should be present within an hour.
At airports in West African countries, passengers in this scenario would still go through all customary airline, immigration, and customs checks, and would then be isolated in a secure waiting area in which they would receive their test kit and instructions for use. Local health officials would observe the passengers, who would not be allowed to leave the secure area to board their aircraft until test results were reviewed. Those who tested negative for Ebola would receive an internationally recognized certificate of non-infection, noting the time, date, airlines, and destination of the traveler. The U.N. Mission for Ebola Emergency Response (UNMEER), the umbrella organization overseeing all aspects of Ebola control, should create the certificate and stamping device, maintaining its secure administration and recognition at airports worldwide.
Upon arrival for connecting flights — typically at major European airports — the individual’s certificate would then be examined by health authorities as passengers exited the aircraft, authenticity of the certificate would be verified, and it would be so stamped. From that point onward, the traveler would have freedom of movement without concern that he or she was a potential Ebola-spreader.
This type of approach could revolutionize the sorts of procedures now underway in Dallas to prevent the spread of the virus from Duncan and his contacts. Currently, public health workers are limited to two key tools — thermometers and quarantines — both of which must be administered for 21 days. The prolonged surveillance time creates high anxiety and social disruption, not only for those placed under observation but for their entire communities. And as was seen in the Nigerian Ebola-control effort, it is extremely difficult to prevent scofflaws from fleeing their confines, potentially taking the virus to another city or town.
In the African epidemic, there is currently no way to tell who the Ebola carriers and spreaders are, as nobody is diagnosed until they are visibly sick, by which time they have often infected two or three others. A point-of-care test could easily discriminate the infected from the non-infected. Moreover, it could assure feverish individuals that Ebola is not the cause of their 100 degree Fahrenheit reading — perhaps as determined by a process of elimination, they have malaria, HIV, Lassa fever, or a long list of microbial ailments that commonly lurk in West Africa.
While a great push is now underway for development of Ebola vaccines and treatments, nothing could immediately be a greater game-changer than a quick, reliable Ebola screening test. Such an assay would help quell the rising panic in the United States, prevent passage of laws that could be viewed as discriminatory against people of color and/or Africans, and provide nearly instantaneous hospital diagnosis. Rather than rattling the nerves of hundreds of Dallas parents afraid to return their children to classrooms visited by Duncan’s youngest contacts, public health officials could simply test the Duncan clan and assure the public that none are carrying Ebola.
Several tests are now in development, but the wheels of discovery, clinical testing, and federal approval require greasing. A point-of-care assay must be at the absolute top of the Ebola-control innovation agenda. Although compassion might dictate that the search for a treatment is of greater importance, the fact is that no tool — short of a 100 percent effective vaccine — can slow the spread of Ebola quite so dramatically. And though a vaccine may eventually emerge from the R&D process sometime in 2015, a rapid diagnostic could be in commercial production before Thanksgiving (with proper greasing of financial and regulatory wheels). Finger-prick tests for Ebola are in development now at Senova, a company in Weimar, Germany; at a small Colorado company called Corgenix; and at California-based Theranos.
One of these screening tests should soon meet the criteria of speed, accuracy, and ease of use necessary to prevent travelers’ spread of Ebola; facilitate contact tracing; and, in the midst of the epidemic, tell who has the virus and who does not.
And that could put an end to prolonged quarantines of uninfected populations, airport fears, and talk of banning entire nations from traveling. Better still, the worried, panicked parents and flummoxed politicians could inhale deeply and focus on the real problem: Ending the West African Ebola epidemic.