A Special Ebola Update: 
A Briefing by Dr. Tony Fauci set up by The White House

[Updated October 23, 2014 9:00PM]

Dear Families,

At Advanced Pediatrics we have worked hard to try to keep up to date with the rapidly changing picture that the Ebola virus and its infection has been presenting to the world.  Lately, we have focused on the nature of this infection in the US.

The Briefing
Tonight, I am very honored to share with you the very latest information available in the United States on Ebola.  As a state director for Ohio in the organization, Doctors for America, I was invited this evening to be part of a special, invitation only, briefing by Dr. Anthony Fauci put together by The White House, on the state of Ebola.  No press were invited, so this information is not part of the usual news cycle.

The White House selected a small group of doctors from across the United States to help get as accurate a picture of what is happening with Ebola right now.  This posting is the first communication I have made to anyone on what I learned from Dr. Fauci.

Dr. Tony Fauci
Leading the briefing is one of the world’s great minds in the area of new, deadly, viral infections.  Dr. Fauci currently serves as director of the National Institute of Allergy and Infectious Diseases (NIAID), the National Institute of Health charged with research and care of such diseases.  He is known across the world as one of two scientists who led the work that revealed the cause of AIDS and its nature, namely HIV.  As such, he is uniquely positioned to know in depth the details of the virus Ebola.

The briefing was moderated by Ms. Andrea Purse, The White House Director of Broadcast Media.  

I was joined by roughly 15-20 doctors, each from a state across the US, from NY to Utah.

What We were Told, What We Learned about Ebola Tonight
Here are the key points communicated to us tonight:

• Ebola is not changing its nature much despite many mutations.  Dr. Fauci did note that the Ebola virus is a type of virus in which the genes change rapidly as it transmits across a population, but the vast, vast majority of these changes in its genes, have no impact on it actual nature or function.   These sorts of virus change their genes frequently, but do not really change their behavior much over time.
• How it spreads remains very stable and unchanging.  An enduring feature of the Ebola virus spreading is that all strains studied need direct contact.  None of them have developed the ability to survive being dried out and spreading across the air for any large distance.  The virus must remain in a wet state, hence the repeated references to bodily fluids.  It is most concentrated in sweat and blood.  Sneezing and coughing can produce wet particles that can travel several feet and create direct contact.  So for example, if someone with Ebola coughed, in particular if they had bloody sputum, wet droplets landing on an uninfected person who then wiped their eyes while the droplets were wet, could catch Ebola.  But if that person coughed and the droplets in their cough dried out before landing on someone else, which is what typically happens with sneezes and coughs, then it will not spread.   Dr. Fauci noted that across the whole history of viruses, none that required direct wet contact have ever mutated into one that could be spread by dried out airborne transmission.
• There is no American outbreak now, nor is there likely to be one.  A total of two people to date have caught Ebola in the United States and not one of their contacts so far have caught it from them.  Therefore, the only instance of Ebola spreading, in the United States, is in the very unusual setting of being a health care worker exposed during care of a sick patient in protocols that are no longer current.
• A note on how the two nurses in Dallas got Ebola.  Dr. Fauci is also the doctor caring for the nurse from Dallas now in an NIH hospital in Washington.  He shared his impressions after having had the chance to talk with her about her exposure.  It turns out that when she was caring for the patient with Ebola in Dallas, the protocols in place were developed in Africa, for exposures limited to care such as IV placement in a relatively informal quonset hut like setting.  These protocols contained over 20 Ebola outbreaks in Africa in such settings.   But in the ICU setting in the US, so much more can be done, including intubation, deep central IV lines, etc.  This leads to a far more intense level of exposure to far more bodily fluids, and the old protocols did not protect against that.  These protocols are now updated which will protect health care workers much better.  But the main point here is that the Ebola case caught in the US, are limited to only 2 cases, to situations that no longer exist:  health care workers intensely exposed in an ICU setting without the new protocols for ICU exposures in place.
• The status of the Ebola vaccine.  There are two vaccine trials in place.  Each use a harmless virus as a transport virus to deliver the not infectious Ebola fragment to the immune system- thereby creating safe immunity to Ebola virus infection.  Both have worked in monkeys.  One is being tested in humans now and as of Sept. 22, has not shown any harm to people.  By sometime in November, results should be known of how well it protects people.  The plan, if the results look good, is to have a many thousand person trial in West Africa launched by the end of November.  If that goes well and no bad reactions are found, a vaccine for Ebola that can stop this illness may be in hand.
• Our current US Strategies.  The key challenges are threefold:
• Identify all those infected
• Transport without spread to qualified facilities
• Care for those with Ebola infection

           The US plan is to have every hospital in the country able to identify anyone who comes to their facility who has an Ebola infection.

There are currently 3 hospitals in the US, per Dr. Fauci, that are fully ready to care for anyone with an Ebola infection:  one in Nebraska, the NIH hospital in Washington, DC, and the Emory Hospital with the CDC in Atlanta.

Plans are to focus actual care of those infected in these three hospitals, but to develop a small network of hospitals with various levels of expertise in a tiered system providing care across a range of regions.

• The current Ebola strains seem to affect children less than adults.
• What about travel bans?  Many people wonder, why not simply keep everyone from the most concentrated areas of infection, Sierra Leone, Liberia, and Guinea out of the US.  It turns out a complete travel ban may have a paradoxical effect.   Right now, the US has a policy that travelers from these 3 countries can only enter the US via two airports in NYC, and one at Dulles, Atlanta, and Chicago.  Anyone from these 3 countries must go through an intensive Ebola screening process before they enter the US.  About 96% of travelers from these three countries entered the US via one of these five countries before the policy was in place that all had to. Now 100% do and they all undergo the Ebola screen.  If a ban were imposed, we would not know where they are coming from, their travel will then go undetected, perhaps via another country and go anywhere into the US.  Further, the only real hope of eliminating the chance of a US outbreak is to eliminate the outbreak in W Africa.  A travel ban would not only be cruel and deliver a signal that the US shuns them, but such a signal could lead to a collapse in efforts to contain and conquer this outbreak in W Africa, leading to an explosive spread across their borders.
• What are the key misunderstandings?  The #1 key misunderstanding is that impression that some mis-steps constitute an actual outbreak.  There is no Ebola outbreak in the United States at this time.  Dr. Fauci anticipates a small number of people with Ebola will continue to get through even the best policy to limit US exposure [one man in NYC may be such a case, he came in from Liberia], but seriously doubts that number will rise beyond a handful of people, particularly if efforts to reverse the outbreak in W Africa succeed.   But he does recognize that having some cases come into the US, a hospital missing the diagnosis, 2 nurses getting Ebola, all erode trust, and raise worry.  But that worry must be put to good use, to learn about how Ebola really acts, to support good science and its principles in winning the fight against Ebola.  Dr. Fauci sees no benefit in reacting purely out of fear.  Diverting planes, closing businesses when there is little reason to believe anyone could catch Ebola on these planes or in these businesses only raises fear, and does not reduce the spread of the virus.

Bottom Line

• Ebola is a dangerous virus that will require great human ingenuity to contain and, ultimately eradicate.
• At this moment, there is no Ebola virus epidemic in the United States.  The total number of people who we know have been infected with Ebola in the US is 2. 
• A key feature of the Ebola virus spreading is that all strains studied need direct contact.  None of them have developed the ability to survive being dried out and spreading across the air for any large distance.  The virus must remain in a wet state, hence the repeated references to bodily fluids. 
• There is good hope for an effective vaccine. This along with a worldwide effort in West Africa establishes a good reason to believe that human ingenuity will indeed defeat this virus.
• It is critical that efforts to eradicate Ebola infection in West Africa prevail, that careful care of the small number of infections that will appear in the US and other countries is very doable, and is being done.
• Ebola demands our respect and care.  But a very thoughtful response is rapidly coming into place.  We have every reason to not only hope, but expect this infection will not pose danger to us here in the US, and that the world can defeat it in West Africa.

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