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Wilmore C. Webley, Ph.D., associate professor, department of microbiology, University of Massachusetts-Amherst. University of Massachusetts Amherst

(JIM GIPE PHOTO)

AMHERST - Wilmore Webley, associate professor of microbiology and an expert in infectious diseases and immunology at the University of Massachusetts-Amherst, said, even without a vaccine, or specific anti-viral treatments for Ebola, the current outbreak of the virus, in West Africa ,could have been less deadly, had there been access to simple basic care.

"Many of the experts there have said they could have easily stemmed the tide of mortality, if provided with resources," Webley said.

Webley will moderate the panel, “The Ebola Epidemic: How We Got Here, Current Preparedness, and Future Outlook” on Tuesday, Oct. 28 at 6 p.m., in the Campus Center Auditorium at the University of Massachusetts-Amherst.

Panelists include: Martha Anker of the UMass Amherst School of Public Health and Health Sciences, a global surveillance and response expert in infectious disease;

George Corey, executive director and medical director, University Health Services;

Donna Gallagher, founding coordinator, UMass Medical School Office of Global Health; and Alpha Kabinet Kaba of the Pioneer Valley Performing Arts Charter Public School, a native of Guinea whose family has been affected by the Ebola outbreak.

The panel is in response to both campus and public interest in Ebola, which Webley said, poses no risk for the general public in the United States, but whose death rate in West Africa could have been cut by three quarters, some 3,657 lives saved of the 4,887 who have died from the virus, had there been the supportive care given the health care workers and photojournalist successfully treated in the United States. Similarly, he said the Texas hospital that initially failed to screen Thomas Duncan, as a possible Ebola patient, "missed an early window to help him."

"Mr. Duncan deteriorated so quickly, it became difficult for him to bounce back, even with getting care," Webley said. "We have the medical know how, the containment facilities, the training for physicians to significantly reduce the mortality of the virus."

He called the epidemic in West Africa, with a few cases treated here, a "wake up call" for using infectious disease protocols in the United States. He also said some of the restrictions and monitoring in U.S. cases, done as an "abundance of caution," may add to the public's confusion about how the disease is spread.

He expanded his views in the following interview.

Was the world slow to respond?

Yes, I think so. The way the world has been slow to respond to any Ebola outbreak every single time. Everyone believed it would be a typical outbreak, small, self-contained, effecting a couple hundred people and then it would be gone.

Some of the factors cited for the spread have been that Ebola was not seen before in Guinea, where it started, in December, and then spread to Sierra Leone and Liberia. What do you think?

We don't know fully yet why this particular outbreak got to the place where it is now. There are certain cultural practices, in Guinea and Liberia, where they don't believe in cremation, that could have contributed to the spread. There is also a lack of trust, among the local native people, for health care workers coming in to help play a role in stopping the transmission. A lack of basic resources, like personal protective equipment, and no quarantine, in the affected areas, contributed to the number of individuals infected.

What is it about the virus that makes it so infectious for healthcare workers, as we have seen both in West Africa, and in the United States.

It is Ebola's ability to build up a high viral load, that is not readily transmitted through casual contact or through respiration. The amount of the virus in the blood, by the time an individual is showing symptoms, is so much greater for Ebola, than for hepatitis, or HIV/AIDs.

Ebola is a viral hemorrhagic infection that destroys cells and tissues; the patient hemorrhages (bleeds) from most of the body's orifices - nose, mouth anus. You have all of that fluid coming out of the patients, with very high numbers of virus. One little move that is not consistent with protocol, and all it takes is one little drop of blood to infect you. Ebola is very unforgiving that way.

Another thing with the transmission of this virus, in a resource limited country, has been that there has not been good support for the patient. Patients are not readily getting IV fluid. There is no standard of treatment for Ebola. We have been figuring it out as we go along. The patient is given fluids. Giving electrolytes helps to keep the body's immune system functioning. The virus really likes kidney cells, so you see early problems there. Returning fluids to the body is useful, but in resource limited areas, giving a bag of IV fluid is not routine.

It has been estimated that, with supportive treatment, replacing the fluids lost, with electrolytes, that 70 percent of the patients could have been saved. We could have literally cut that 70 percent mortality rate by three quarters by having fluid replacement. Many of the experts there have said they could have easily stemmed the tied of mortality, if the healthcare workers there were provided with resources. This is particularly true for the younger, and the healthier in terms of individual supportive care, and not for those who already have chronic conditions, with lowered immunity.

The truth is that, giving access to this type of health care, gives those with Ebola a fighting chance, and this has been known for awhile.

Has anything new been learned from the outbrea, in terms of the use of serum, made from the blood of those who recovered from Ebola? This had been done in an earlier outbreak.

This is a therapeutic, and not preventative measure, of course. Known individuals who have survived have a high antibody titer against the virus. If you have a donor with the same blood type as the patient, this convalescent serum could be useful.

Probably the good thing to come out of this epidemic is the focus on vaccines that have been in development for a decade. They will work them out in clinical trials, so when there is another outbreak in another area of the world, we will be better prepared for it.

Ebola is a Filo virus, a family of viruses that has been around for a long time. Most of these viruses don't survive long outside the body. They require cells to replicate, and fluid to stay alive and ticking. They don't want to kill their host. In general, they want to make more of themselves. This is their mission. What happens in a natural reservoir (the fruit bat is thought to be a natural host for the Ebola virus), there is a lease agreement so to speak. The virus takes over the cell mechanism to replicate protein, and the host lets the virus replicate to a certain level (without killing the host). The host may block the amount of receptors the virus can bind to. It takes the virus awhile (anywhere between three to 21 days) to overpower our immune system,but it is not understood why our genetic makeup does not have a better immune response.

Is it likely there will be a widespread Ebola outbreak in the United States?

What people need to realize is that getting Ebola is not as easy as getting the flu. If someone is truly contagious with Ebola, they are not going to be walking in the street. They will be too sick. You only get infected when you are in close proximity with an individual who is very sick. We have not had any cases of a bystander Ebola transmission. Individuals who display symptoms of the disease go into the hospital to be monitored. This is what is important. In Guinea, Sierra Leona and Liberia, patients did not have the opportunity to go to hospital. They were taken care of at home, by family members not wearing protective clothing.

Some of the confusion in the public focuses on the abundance of caution (in tracing movements of someone prior to their symptoms).The movements of the Texas nurse (who was infected) on the plane, and in the bridal shop, all those contacts came back not infected. The family of Mr. Duncan (the Liberian man who died, in Texas, of the disease he contracted in West Africa) had close contact, but he was in hospital by the time of his increased infectious load. What this says, over and over again, is that the virus is not easily caught; it has to be through bodily fluids where the virus is. It is not airborne, unless there are large air droplets, that land on a scratch or cut, and that is a remote possibility, as the infected person would be too sick to be walking around.

For individuals exposed to the virus, we can do a blood test very early when symptoms are barely showing.

We also have treatment facilities to make sure patients are in quarantine to mitigate (an outbreak), as well as systems in place to do contact tracing.

Will this focus on Ebola change how infectious diseases are treated in the United States?

The truth is there are universal precautions we all follow, that say treat every sample as if it is the most deadly antigen. HIV brought those protocols into play but, again, Ebola is very unforgiving. It is that much different from HIV, because of its viral load in the blood. We have to re-educate health care professions about the nature of infectious disease, and what sort of protocols are needed in the various health care settings. I think if you look at statistics a year or two from now, you will see hospital acquired infectious diseases drop, because of protocols in places. This goes to the very heart of how we do health care, and to do it consistently carefully and mindfully. It is not just about putting on protective personal equipment and taking it off, but putting on a glove and taking the time to take it off carefully.

You don't need every nurse trained to this level, but you need a cohort of people trained very well. Doctors are not trained in this country to deal with Ebola. We learned the hard way by what happened in Texas. You can't just jump into dealing with a suspected case. You have to simulate in a meaningful way, putting on and taking off personal protective equipment, and even using the respiratory protection. The equipment doesn't fit everyone the same way.

This is not everyday wear that you see a patient in, but hospitals are going to have to have supplies available, and identify where they have the capability to hold a patient in isolation.