Sunday, July 05, 2015


The most basic things about Ebola, which we are just reminding ourselves of now, is that it strikes people who are living barely viable lives on the lip of starvation, dehydration, and disease load, so that Ebola is very much a “syndemic” with many interwoven pressures.  Something like climate is linked because that’s one of the strong controls on insect vectors, though bugs are only suspects now -- no proof so far.  The pressure on people of hot weather, the point in crop development between planting and harvest, the current state of governmental corruption and disfunction, and simple things like clean needle syringes (syringes being a significant carrier of all diseases ever since they were invented, even putting aside illegal drugs) all contribute a little bit to the whole.

Some wise people have said all along that medicinal cures are not as effective as the general robustness of individuals and groups.  Unless meds are accompanied by behavior, they are rendered useless, like the current state of overused antibiotics, and the preponderance of diabetics who don’t follow their protocols.  Measles has been controlled since I was a kid suffering through it, but a DEATH from measles just happened in one of the richest, most sophisticated, most carefully governed places on the planet: Seattle.  The victim died because her parents remained susceptible to rumor, unproved claims about immunization, and misplaced sense of entitlement: “we’re too good to die.”


I share thoughts with Aad de Gids, a philosopher, poet, and psychiatric nurse in the Netherlands, and together we ponder what may at last force attention and energy to developing a new world.  The whole planet is hanging on to uninformed superstitions and wrong convictions.  We cherish our sense of privilege based only on money.

Aad and I are cruising websites.  “How Stuff Works” is excellent.  Here’s a quote:

“The Ebola virus is most closely related to the viruses that cause measles and mumps, the paramyxovirus family.

“The genetic information stored in the RNA codes for only seven proteins (the molecules in the cell do most of the work in the organism), as compared to about 20,000 for humans.

“One of these proteins is suspected to be the superpower of the villainous Ebola: glycoprotein. One version of this protein binds to host cells, so the virus can enter and replicate, and the other version is released from infected cells and may play a role in suppressing the immune system.

“The virus is pretty impartial and will infect a wide range of cell types in our bodies, but early on, Ebola typically invades cells associated with our immune systems, namely monocytes, macrophages and dendritic cells. After that early infection, it travels to the lymph nodes, spleen and liver through the blood.
Neil Bodie, DVM

We’re following the #’s on Twitter, including, who’s been researching this stuff for a long time, and Dr. Neil Bodie, veterinarian developer of treatments for zoonoses, the ones that travel between animals and people.  Some common diseases, including measles, got started ten thousand years ago when people began to domesticate animals so that they lived closely with them.  On the other side of the planet, the East is struggling with MERS, a poultry disease, possibly involving pigs.

The most shocking account of Ebola so far has not been so much people dying in the streets, though that was happening, but people dying in what were supposed to be locations of help.  Now that people are beginning to testify, we hear that in the beginning the latrines were overwhelmed so thoroughly that it was impossible to get through the door because of the piles and swamps of feces, all contagious.  Patients were issued buckets, but so many of the nursing staff became infected early -- and there were never enough of them anyway -- that the buckets were soon overflowing for lack of people to empty them.  People died of simple starvation and dehydration because no one was available to bring food and water.

The nations and the world were slow to respond but they did finally, with spacesuits, bleach buckets, and the high-pressure development of vaccines and virus meds, including antibody molecules from those who had survived.  When cases were brought to the USA on purpose and despite filtering, resources for those individuals came quickly, life support on the scale that can pull a person through rabies.

Then everyone complained that they had overbuilt the African clinics because Ebola was “all gone.”  But it wasn’t.  The people were ostriches in denial.  They hid bodies to keep them from being cremated.  Now they resist coming to get their malaria meds for fear of being diagnosed with Ebola and detained.

Everything but patients.

No disease is ONLY a bacteria, a virus, or whatever.  In the first place, they all interact with each other and with everything around them: insects, mammals, plants.  In the second place, probably the most determining forces are the human social groups and behavior and maybe global forces like climate/weather.  Economics have a huge impact in terms of detection, prevention, meds, study, and so on.  And the most devastating consequence can be economic, like the shriveling of tourist industry.

One of the interesting new ideas about Ebola is that it may be “vectored” through several different entities and bats may be only one of the pass-alongs, and maybe only certain species of bats.  The virus may be sitting passively in many places: even in people who have recovered or who had such a strong immune response that they didn’t realize they’d ever been infected.  Maybe the virus lurks in graves or undiscovered bodies in the jungle being parted out by burrowing insects (or maybe their larvae like maggots), passed to rats who eat the bugs, and so on.  Monkeys can catch aerosol "coughing" particles but people cannot.  At least so far.

Related to this is the realization that human bodies have small pockets, refugia, where viruses, antibodies, and so on can hide: where a virus can exist without showing any signs.  Aad’s quick list of examples is:  “immunoprivileged "loges", like the molar pulpa, testes, intracerebral space near the hypothalamus and hypophysis, such a jagged space unseen, the eyeballs....”  I learned from watching CSI TV shows that the interior of the eyeball, the vitreous fluid, is commonly analyzed to get information about drugs or infection in a really thorough autopsy.

Recent studies found 25% of village dogs, not pets but scavenging pariahs, have antibodies but no full viruses in their blood.  The most recent cases were three men who dug up a dead dog and ate it.  One died, the other two became ill, but it turned out not to be Ebola.  I made a grim joke that the best medicine might be cases of peanut butter, enough to prevent eating dogs. 

In the past, few have done autopsies on animals or insects, which are simply part of the scenery, except for the necropsies on bats, primates and duikers, a cute little antelope.  Those revealed that Ebola mutates like flu and each location has a different variation.  Some vary in contagiousness and virulence, which suggests that the milder ones might be a good source of vaccine, the way cowpox was for smallpox.  One strain that turned up as an isolate in monkeys in the Philippines, doesn’t make people sick.

Local indigenous Africans have no knowledge of what blood does, much less viruses.  There is no folk wisdom about Ebola.  In fact, the custom at death is likely to be contact, which is highly contagious even after death.  The most effective -- if almost unbearable -- strategy has simply been to isolate sick people in a remote hut and leave them until they die -- then burn down the hut.  Maybe we’re still doing that on some level.  Like shutting out the communities and villages of Africa.

Pygmies have antibodies for a lot of viruses but seem resistant to most.  They are immune to Ebola and other things.  Suddenly we’re VERY interested in them.  Small, but packed.

There turns out to be a lot of variations among Ebola on a genome level.  They mutate easily, like HIV or flu, and each is specific to a place, which usually gives the variety its name.  But they go on mutating.  They are processes, not objects.  Genome analysis provides much tracking info for a “map.”  The edge of jungle is webbed with paths and trails, not to mention waterways big enough to travel on, like Quammen’s imagined HIV first vector-man.  (“The Chimp and the River”.)  

Much of the interest in Ebola comes from what we’re learning that might lead to an HIV/AIDS cure. Typhoid, malaria, and so on are everywhere:  they might be precursors, intensifiers, or vectors in some way.  They confuse diagnoses and treatment.  The "Big Three" world diseases are malaria, TB and HIV/AIDS.  We don't have malaria in Montana, but TB has afflicted indigenous people for a long time.

A bit of good news is that Ebola works so quickly that it’s a self-snuffer but the infection lingers after death.  This is very different from HIV that was worldwide before it was detected and can be sub-fatal for decades.  The beloved Dr. Bob Frascino from had to answer again and again that once someone is dead, they are no longer contagious for HIV.  However, they taught us at Multnomah County Animal Control that parasite vectors (fleas, lice, et al) are most "contagious" when a just-dead body is cooling and the parasites know they need to seek a new home.  If they carry Ebola, they are dangerous.  They do carry rickettsia and other "interesting" afflictions.

Finding a cure has been too slow coming.  But we know what the main vector is:  poverty.  One group addressing this is called “Blue Marble Health.”

"In its place, “blue marble health” [a focus of analysis] suggests that all economies are rising but that each one leaves behind a bottom segment of society that lives on less than one or two dollars per day, or at some other level of extreme poverty. Moreover, both poverty and disease are not evenly distributed among the G20. Instead they are concentrated in specific areas such as in northern Argentina, northeastern Brazil, southwestern China, Eastern Europe, and even the southern United States."

"A major finding from the blue marble health paradigm is that more than one-half of the world's NTDs occur in G20 countries and Nigeria, and yet in most cases these countries have the financial capacity for controlling or eliminating their own indigenous disease burden. Doing so could eliminate the single major source of global poverty and disease related to NTDs."

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