Tue, Jun

Ebola: Hysteria or Legitimate Panic? And, Jonas Salk's 100th Birthday


GELFAND’S WORLD-The only thing getting more attention in the media than Ebola, is criticism of the way Ebola is getting attention in the media. One critical thought that may have some validity is a counterargument argued most coherently by Michael Fumento. 

His position is that the current outbreak will plateau and then decline fairly soon, or may already be in decline, and without the death toll going through the roof. It is summarized in a short piece published in the New York Post, titled "Why Ebola's nothing to worry about," and in longer form in Inference.  

On the other side of the fence, we have the worried public, thinking that we're probably OK for the moment, but also imagining that things could go rapidly out of control. Call it the CNN/24 hour news cycle approach, or if you prefer, call it fashionable hysteria. It seems to be common among radio stations, Donald Trump, and certain east coast governors. 

Then we have journalistic attempts at explaining things, such as the one by Deborah Netburn in the L.A. Times, and the October 27 account by Richard Preston published in the New Yorker.  Preston's piece is the most literary of the lot and well worth reading, but avoids predictions about the future course of the death toll. 

I'm not going to play junior epidemiologist here, but let's consider the way journalists and online blogs have been handling the science side of the story, and along the way, think a little about the way this whole thing has turned over a couple of rocks and allowed a few slimy things to slither out. 

The first thing that you notice about journalistic accounts is that they assume that the readership is almost entirely ignorant about science. This might be a fair assumption, and presumably plays to the standards set by publishers, but it tells you something about literary practice. Put it this way -- if I am reading something in New Republic or Salon, I'm supposed to be educated in the humanities, to the level that I recognize the name Foucault. I'm even expected to know something about postmodernism and terms like "deconstruct." Heaven protect me if I should fail to appreciate the nuances of semiotics. 

But high class journalists writing for the L.A. Times and the New Yorker understand that if they are going to talk about mutations, then they have to illustrate the idea first, and usually by talking down to the reader. Preston actually does a beautiful job of substituting metaphor for straightforward science: 

Within the inner sleeve of an Ebola particle, invisible even to a powerful microscope, is a strand of RNA, the molecule that contains the virus’s genetic code, or genome. The code is contained in nucleotide bases, or letters, of the RNA. These letters, ordered in their proper sequence, make up the complete set of instructions that enables the virus to make copies of itself. A sample of the Ebola now raging in West Africa has, by recent count, 18,959 letters of code in its genome; this is a small genome, by the measure of living things. Viruses like Ebola, which use RNA for their genetic code, are prone to making errors in the code as they multiply; these are called mutations. Right now, the virus’s code is changing. As Ebola enters a deepening relationship with the human species, the question of how it is mutating has significance for every person on earth. 

Notice that final sentence, implying that the Ebola virus is a major threat. It's an argument, however implicit, that is diametrically opposed to Fumento's. 

Ignoring that final sentence for the moment, it's possible for the scientifically literate person to recognize one fairly universal characteristic of this kind of writing. The journalist takes a fairly elementary scientific truth, namely that certain kinds of viruses use RNA as a genetic element rather than DNA, but they won't go any deeper. In this case, we have the fact, mentioned in passing (and taken up later in the New Yorker piece), that RNA viruses are prone to developing genetic mutations when they replicate, much more so than our own cells would do in replicating our own DNA. 

Now why would this be so? It's actually an interesting question, with a multifaceted answer that has lots of public policy correlates. If you are interested, see the Addendum at the bottom of this page. 

In fact, as journalists and bloggers like to point out, having a high rate of mutation is what gives pathogens like the flu virus an edge. As they mutate, our immune systems have to catch up, and this takes time and sometimes an extended bout of illness. It's a bit of a bother to get that yearly flu shot to protect you against the new strains (due to those mutations), but that's why you should do it. (It has another advantage for you this year, in that you will be less likely to go to an emergency room with a fever and an upset stomach, so you won't have to answer those tedious questions about where you have traveled recently.) 

The simple facts about mutation rates and low infectivity lead to the big question that Fumento and the public health establishment are arguing over. Where is it all going to go from here? I think that Michael Fumento makes what you might call a not unreasonable case. Epidemics, even of fairly infectious pathogens, tend to cycle. In the days before effective vaccines, polio cycled up and down, as did smallpox in its day. Since Ebola virus is not as transmissible as measles, and since it kills people fairly quickly (thereby lessening the amount of time a disease carrier is likely to spend in the company of people who are well), it is actually less likely to spread than common diseases did in the pre-vaccine days. The current version of Ebola does not seem to spread by any airborn route, which is another saving grace. 

On the other hand, Fumento could be wrong on a couple of things. Ebola has already sickened several thousand people over the past few months, killing about half of them, and we can't really say for sure that it is going to go away quietly. Were Ebola left to spread on its own, without a concerted public health effort in west Africa, then it would probably continue to infect people. Whether that level of infection would eventually get really out of control and get into Europe, for example, is anybody's guess. 

What's more likely is that the areas with the greatest level of infection will take the measures necessary to halt the epidemic, and the rest of the world will contribute supplies, medicines, and healthcare workers. But we can't be absolutely, one-hundred percent sure. That's because we've only recognized the existence and danger of Ebola and its close relative, Marburg virus, since the 1960s. 

The other uncertainty is that we don't know for sure where Ebola virus stays when it is not infecting humans. We know that apes can get it, that fruit bats may be carriers, but that there may be other places where the virus resides when it's not in us. In other words, it could come back pretty much anytime, and the next time it might be a mutated version that is transmitted more easily. The New Yorker article takes pains to discuss this point, albeit at a fairly superficial scientific level. 

There's one other point to be made, which falls in with the recent celebration, just a few days ago, of the 100th birthday of Jonas Salk, pioneer of the first really effective polio vaccine. 

For the first half of the last century, polio was feared. As the polio cycle ramped up, cities closed their public swimming pools, and children were kept home rather than being allowed to go out to the movies. The Salk vaccine rapidly changed all that. In fact, a large fraction of the American school age population was vaccinated in fairly short order. As paralysis and death largely disappeared, the fear went away. 

Ebola has been creating that kind of fear, at least for some people in the United States, and is obviously creating a more realistic fear in the African countries in which it is still prevalent. That fear, geographically limited or not, is going to push the creation and manufacture of one or more vaccines. That is, of course, assuming that such vaccines are possible. But there is reason to believe that the Ebola virus disease may be susceptible to vaccination and that we can have one fairly soon. 

The idea here is that an Ebola vaccine would be the way to stop a new epidemic in its tracks, the way polio and measles have been abolished, or nearly so, in the United States. Every time an Ebola case appears, the public health authorities would only have to vaccinate the surrounding community in order to prevent the kind of situation that has been occurring in west African countries. 

The obvious case for development of a new vaccine has caused a certain element to go even more crazy than usual. The small subset of the American population who are seriously deranged about the use of vaccines have reacted to the Ebola scare by conjuring up their own paranoid fantasies. To the rest of us, Ebola is a potential threat, and a vaccine against it would be a great public health breakthrough. If the very idea of vaccines is anathema to you, then I guess you have to find some way to believe that Ebola is just a conspiracy or not really there. 

Like I said, rocks have been turned over, and slithery things have been coming out. The blog Respectful Insolence has been covering the fringe backlash against the idea of a hoped for vaccine, and has been reporting on numerous quack nostrums that are being proposed by numerous quacks for the Ebola infection. The author of Respectful Insolence, who uses the nom de plume of Orac, has become something of a leader in the fight against the more insane forms of quackery, which he refers to as "woo," as in woo-woo. 

It's always a little stressful when election season intersects a significant public policy issue, whether it is rising crime or, in this case, an infectious disease. The governors of New Jersey and Maine have been demonstrating their rock solid toughness on crime -- excuse me -- on a runaway nurse, and it took a judge in Maine to point out that you sometimes have to look at the science rather than the polls. 


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Addendum: For one thing, our cells are supplied with complicated systems that seek out DNA damage and either fix it or, if the repair is not working, make sure to kill off the cells which suffer from that damaged DNA. In fact, the failure of this surveillance and repair system is one of the mechanisms that leads to a higher risk of cancer (that's where the public policy issues come in). RNA viruses don't have the same kinds of needs as cellular organisms such as ourselves, and can afford to have mutations at much higher rates. After all, if the evolutionary pressure is to put out millions of virus particles, there is plenty of room for a few deficient copies here and there. 

At the mechanistic level, there are a lot of structural biochemistry issues, including the fact that the viral genome is copied by a protein that does a lot of other things along the way, and is obviously adapted for speed rather than for precision. 

One other point: The popular literature likes to refer to genomes as being made of "letters," which is shorthand for the fact that the chemicals that make up DNA and RNA can be abbreviated by letter designations. Thus the chemical guanosine can be referred to as "G." It is actually guanosine, and a pretty complicated looking molecule at that, but writers like to call it by a letter, since we are interested in the sequence of all those guanosines and adenosines.


(Bob Gelfand writes on culture and politics for City Watch. He can be reached at [email protected])  





Vol 12 Issue 89

Pub: Nov 4, 2014

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