Life as an Extreme Sport

An Ebolanoia Anniversary–Or, The Emperor’s [Lack of] Disclosures

October 6, 2015 Kelly Bioethics, BioScary

It’s the Ebolanioa anniversary! Over at Slate, Tara C. Smith takes us through a quick walk down memory lane, and the utterly outsized reactions and political theatre America went through a year ago: quarantines and threats and Daesh-licking doorknob villains, oh my.

Hulk-hits-Thor-after-defeating-alien One thing still sticks in my craw: the utterly ludicrous suggestion from respected epidemiologist Michael T. Osterholm that we were all just afraid to talk about Ebola becoming airborne, but it was a real threat. Even though multiple, well-respected virologists and Ebola experts immediately corrected Osterholm’s panic piece, the panic piece is what took life, with other news outlets repeating him word-for-word–and few people questioning why such a respected epidemiologist would even propose such an outlandish thing, let alone in the pages of a New York Times op-ed rather than in a respected, peer reviewed publication.

While it pains me to point this out, because Osterholm was quite complementary of my anthrax- and NSABB-related posts, someone has to play the fool and point out the emperor has no clothes. Or in this case, the emperor has a pretty glaring conflict of interest, neatly laid out for all to see if they just take a look:
CIDRAPOct62015

Do you see it?
CIDRAPOct62015-Highlighted

3M, a “leading underwriter” of CIDRAP, where Osterholm is (and has been) director, is also a leading manufacturer of N95 masks. The sort of mask used for personal protective equipment if you’re treating a patient with an airborne infectious disease. The sort of mask that is typically advocated by those who have more than a little paranoia when it comes to disease in general.1 The sort of mask all over this National Institute for Occupational Safety and Health website.

Look, I completely understand the need for funding journalism, and as a whole I really enjoy CIDRAP’s reporting.2 Having been in publishing and journalism for over a decade at this point, I understand the need for funding, and just about everyone knows I have no lost love for the University of Minnesotta in general. But when you accept funding from outside sources, you have to start thinking about how that funding influences what you think, support, advocate for and write about. We know that it doesn’t take much to subtly, subconsciously, or consciously influence opinions, and major funding from a source of masks that would block airborne Ebola? That’s a pretty big conflict of interest that should be disclosed in any “but what about mutations” panic discussions in the public sphere.3

Addendum
It’s been brought to my attention that Osterholm et al’s mBio opinion piece, which I didn’t directly refer to here but waved a whole bunch of shade at, was amended in April of this year to “address” perceptions of conflict of interest. Unfortunately for CIDRAP and Osterholm et al, this attempt at damage control is pretty piss-poor. Their objection to being called out on the 3M conflict of interest boils down to what we’ve heard in other situations: the money goes into a giant pot at the university and we don’t know what dollars from them affect us, and besides, it’s unrestricted and they have no say!

Well. Except that if, per CIDRAP’s donation page, only 2% of their funding comes from the University proper, and they know who gives what to such a specific degree that they can list The Benson Foundation as a principle underwriter and 3M as a leading underwriter, then you can’t really say that “it just all goes into a pot and we don’t know which particular dollars 3M touched.” Because what you do know is that if 3M hadn’t touched a significant chunk of the money in that pot, it wouldn’t be there.

You, as an individual, know if you have $30 or $100 in your wallet, and you definitely know if $70 of the $100 came from a particular place. Trying to claim that a business that requires their donated money to function has no operational knowledge of where the money comes from is insulting to basically everyone’s intelligence.

The mBio amendment also attempted to claim that since they don’t talk about respirators in the piece, certainly they can’t be relevant to a piece talking about fears of an airborne mutation. I leave this to the audience: Do you think respirators are relevant, at all, to protection from airborne disease, even if not directly mentioned in an opinion piece? Hmm.

Look, it’s a common misunderstanding that noting a conflict of interest is akin to admitting guilt or bribery or corruption. It doesn’t have to be like this, and this perception exists in large part because so many people try to pass off their COI as no big deal. But the literature has shown, time and again, that it is a big deal, and that no one is immune from the influence that things as little as pens or as big as unrestricted checks can have on perceptions. If you-the-scientist want us-the-reader to give weight to your opinion paper that, say, Ebola might mutate to become airborne and ZOMG, then perhaps you-the-scientist should give weight to the multiple peer-reviewed papers that say your center funding presents a conflict of interest that requires a necessary disclosure.

Aid Organizations Working in Ebola Regions (v2.0)

November 12, 2014 Kelly ...and everything else

This is an update of an earlier post.

We’re heading in to mid-November, and while the very disturbing logistics/supply chain chart showing that some personal protective equipment stock in countries battling Ebola are at “zero”—and had been for a while—have improved, the Ebola outbreak is still racing through Liberia, Sierra Leone, and Guinea. Sadly, the outbreak also appears to be gaining a small foothold in Mali.

Donation box. Note: Cats are not needed at this time.

Because, contrary to popular opinion, humans don’t always suck, people want to help. However, the best thing to do right now is use established supply lines.For more information on why this is the case, read Harvard professor Calestous Juma’s excellent Al Jazeera op-ed on how the lack of infrastructure in the affected region and how this affects all public health.

In support of both people’s inclination to give, and to have that giving filter through established supply lines, here is a list of trustworthy organizationsTrustworthy as defined by me, based on research, name recognition, and Charity Navigator if possible. Vague, I know, but I wanted to get an international-as-possible list up as quickly as I could. that, as of Tuesday, November 12, are still operating in areas of West Africa affected by Ebola. I’ll update this list as I come across more information, or as people enter/leave the affected region(s). Feel free to add your suggestions in comments.

Please check to see if your workplace does matching donations for charity.

The CDC Foundation
The CDC Foundation is an independent, nonprofit organization that connects individuals and the private sector with CDC’s expertise and distribution channels. The Fund’s Global Disaster Relief Response Fund is only activated during extreme emergencies, and has been activated for the Ebola crisis. They are providing personal protective equipment, communications equipment, emergency operations equipment, and funds for public health campaigns. The CDC Foundation received a rating of 96.07 from Charity Navigator. Donations are accepted worldwide.

The International Federation of Red Cross and Red Crescent Societies
IFRC is the world’s largest humanitarian network. Their donation page currently has a Syria crisis appeal, but if you select “donate,” the second option is for their Ebola campaign. You can also make a donation to your specific Red Cross or Red Cresent; here is the link to the American Red Cross website; that donation is tax-deductible. (I would recommend donating directly to the IFRC website, as that is guaranteed for Ebola efforts.) The American Red Cross receives an 85.25 rating from Charity Navigator.

Here’s the link to the Australian Red Cross donation page. They’re helping with awareness, contact tracing, medical treatment, and burial.

Direct Relief
Direct Relief is coordinating with doctors on the ground in Sierra Leone and Liberia to provide personal protective equipment and other supplies, which are being sourced directly from manufacturers. You can direct your donation to their Ebola efforts; they accept international donations. Charity Navigator gives Direct Funds a pretty amazing 99.71 rating.

AmeriCares
AmeriCares is organizing air shipments to hospitals in Liberia that have no necessary personal protective equipment, including gloves, gowns, and masks. They are accepting contributions for future shipments. AmeriCares receives a rating of 92.89 from Charity Navigator. Donations are tax-deductible.

Medecins Sans Frontieres/Doctors Without Borders
MSF has been pushed to its limits in the outbreak region, and vocal about it. What they need right now, however, is not more supplies, but more people. Their current fundraising campaign for Ebola is listed as fulfilled, and they are requesting that donations be made to their general fund for a more flexible response. MSF anticipates being in the West African region for at least six more months, so it’s entirely likely that they will re-open fundraising for that region. That said, given the extended timeline, it’s plausible general funds will be used. However, they are working in multiple regions of the world, so there is no guarantee that donations to the general fund will be used in West Africa. MSF/Doctors Without Borders receives a 92.03 rating from Charity Navigator. Donations are tax-deductible.

World Food Programme
With quarantine (quite literally cordon sanitaires) enacted in many of the Ebola-affected regions, food supplies are becoming critical, and people have begun breaking through these forced quarantines to find food. The World Food Programme is ramping up efforts to feed people caught in the Ebola quarantines. You can read more about that here, and donate at this link. World Food Programme is 100% funded by donations, and the US arm of the organization receives an 89.11 from Charity Navigator. US residents who would like their donation to be tax deductible can donate here.

UC San Francisco: Support the Emergency Ebola Response
UCSF clinician Dan Kelly has returned to Sierra Leone to operate a nationwide distribution network for emergency medications and supplies from their international partners; support the Ebola isolation and referral center at Kono’s Public Hospital; implement strict screening and control measures at the UCSF facility in Sierra Leone; coordinate emergency referrals to Ebola treatment centers in Kailahun District; collaborate with the District Health Management Team to implement effective contact tracing and sensitive community engagement. International donations are accepted, and US donations are tax-deductible.

UNICEF
UNICEF is working in Nigeria to help quell their Ebola outbreak. Those in the United States can make a tax deductible donation at this link. If you’re an international donor, go here to find your country. The United States Fund for UNICEF is rated 93.69 by Charity Navigator.

Elizabeth R Griffin Research Foundation
The Griffin Foundation is working in Ebola safety and prevention; you can find information here. I don’t know much about the group, but the foundation was formed in memory of a woman who died after contracting macaque-born B virus. The foundation works worldwide to promote safe and responsible practices for handling biological materials. So, you know, seems like they’re pretty useful right now. This foundation has not been rated by Charity Navigator.

Hospitals for Humanity
Hospitals for Humanity provide quality and affordable health care in disaster areas and people in the developing world. In addition to providing care, they also provide medical training and education to the local population. You can help by either volunteering for a medical mission or donating. Hospitals for Humanity has applied for 501(c)(3) status, but not received it yet. They are not rated by Charity Navigator.

Global Giving Ebola Epidemic Relief Fund

Ebola continues to spread across West Africa, with the number of those affected continuing to rise dramatically. The latest report from the World Health Organization counts 3,069 cases of Ebola in the region and 1,552 deaths from the disease so far.

Global Giving’s Ebola Epidemic Relief Fund focuses on getting grant money on the ground fast, so that rapid responses to changing situations can be made. They are in the middle of a 400,000 fundraising appeal. Here is a full list of grants to date:
-Â BRAC (Sierra Leone) — $10,000
– DEVELOP AFRICA (Sierra Leone) – $26,000
-Â DOCTORS WITHOUT BORDERS (Sierra Leone) — $5,000
-Â FOUNDATION FOR RESTORING WOMEN’S HEALTHCARE TO LIBERIA (Liberia) – $18,000
-Â GBOWEE PEACE FOUNDATION (Liberia) — $5,000
-Â GREATEST GOAL MINISTRIES (Sierra Leone) – $20,000
-Â IMANI HOUSE (Liberia) – $30,000
-Â INTERNATIONAL MEDICAL CORPS (Sierra Leone) – $10,000
-Â INTERNEWS (Guinea) — $10,000
-Â LIFELINE ENERGY (Liberia) — $5,000
-Â WEST POINT WOMEN FOR HEALTH AND DEVELOPMENT (Liberia) — $10,000

Global Giving is a charity fundraising web site that receives an impressive 97.94 rating from Charity Navigator. An anonymous donor is matching all new recurring monthly donations to the Ebola Epidemic Relief Fund. Donations are tax deductible for Americans.

Africa Responds
Africa Responds is a collaborative platform through which African organizations and allies pool their resources, networks, and collective voices to respond to the Ebola outbreak. Like Global Giving, they focus on local, already established and embedded local organizations. Their partner organizations have highlighted three critical areas of need: PPE, community mobilization and outreach, and caretaker and family support. Funds from the campaign will support these needs. Africans in the Diaspora, with support from International Development Exchange, will manage and disburse the funds as well as produce follow-up updates and reports. You can donate here.

International Rescue Committee
The International Rescue Committee staff and community health workers in Liberia and Sierra Leone are working to educate people on how to stop the spread of the virus. They are also bolstering local health systems with medical staff, protective gear and logistical support. They are also in the process of opening a treatment center in Liberia. Importantly, IRC is offering medical care to those with treatable diseases who would otherwise die as people are too afraid to visit health centers. (This is seriously so important. We’re at the point where it’s believed more people are now dying of treatable diseases than Ebola.) IRC has a very high 95.35 rating from Charity Navigator. You can donate to IRC here.

Partners in Health
Partners In Health was founded in 1987 to deliver health care to the residents of Haiti’s mountainous Central Plateau region. In the 25 years since then, PIH has expanded in Haiti’s Artibonite and Central Plateau regions, and launched additional projects around the world. PIH is working with two grassroots organizations: Last Mile Health in Liberia and Wellbody Alliance in Sierra Leone. These longtime PIH partners are already working to train health workers, identify sick patients, and deliver quality care.

PIH is actively recruiting clinicians, logisticians, and other health system professionals to support the work of Last Mile Health and Wellbody Alliance. They are seeking a large number of short-term volunteers and longer-term positions to help support the community-based effort needed to contain the Ebola outbreak. Experienced clinical and non-clinical health sector workers interested in staffing the ETUs and supporting existing community-based work should apply here. You can also donate here. Donations are tax deductible. PIH receives a 90.60 rating from Charity Navigator.

Heart to Heart International
Heart to Heart International works to broaden access to healthcare services and connect global partners with local communities. Because of the desperate need in West Africa—and to do their part to keep the virus from spreading further—Heart to Heart International will open and operate an Ebola Treatment Unit in Liberia. The facility is already under construction and is expected to open in November. They are also recruiting doctors and medical personnel to help, as well recruiting Liberian health workers to operate the facility. In addition to operating an ETU, HHI will continue to ship supplies like protective suits and gloves to help health workers on the ground. HHI receives an impressive 99.90 from Charity Navigator, and donations are tax deductible. You can donate here.

Google
This might seem strange, but right now, for every $1 you donate through Google, they will match and double. So if you donate a dollar, they’ll donate two. The goal is for another 7.5 million, and they’re almost there, but hey, every little bit. Give away Google’s money here.

There are more organizations listed at Charity Navigator.

OutbreakChat: A Livetweet of a Movie That Gives People Nightmares,…

November 12, 2014 Kelly ...and everything else, Bioethics, Pop Culture

…and probably not for the reason you think. Outbreak is one of those movies people seem to either love or hate (or possibly love to hate); almost everyone I know who has anything to do with public health, infectious diseases, or virology tends to swear up a blue storm when the movie comes up.

So naturally, a group of us are going to watch it in real-time tonight, drinking and live-tweeting our thoughts on Twitter. This will include fact-checks, snark, and almost certainly questions and answers from the crowd-at-large. Who is doing this? Well, you might remember David Shiffman (@whysharksmatter) from my Virtually Speaking Science interview a few months ago; while he might seem like an odd choice to organize this, remember he has significant experience with pop culture/movie portrayals of sharks, mermaids, and other scientifically incorrect portrayals of the ocean.

Tara Haelle (@tarahaelle) is a freelance journalist probably best known for her excellent article that debunks flu myths. She’s written extensively on science and the need for accuracy in media imagery and discussion.

Nicholas Evans (@neva9257) is a post-doctoral bioethicist at the University of Pennsylvania’s Department of Medical Ethics and Health Policy, based in the Perelman School of Medicine. He specializes in biosecurity, bioterrorism, and the ethics of pandemic preparedness, and recently wrote a piece for Slate explaining why Ebola is not a bioweapon, despite media myths. (He’s also my husband.)

And what am I (@rocza) doing involved in this? Well, aside from spending much of the last couple of months educating Twitter about Ebola, blogging extensively about Ebola, and doing Justice Putnam’s “The Morning After” radio show to talk about the ethics of science journalism and Ebola coverage, I once upon a time was pursuing a PhD in bioethics and philosophy, looking at how popular media portrayals of medical issues affects our medical-decision-making (a continuation of my undergraduate thesis on autonomy and medical ethics). I’ve taught courses through pop culture (Stargate and Applied Ethics), and one of my most popular and invited lectures was on why we watch reality TV. I also have a weird affinity for Ebola; I once intended to become a virus hunter, and I’ve been studying Ebola, outbreaks, and the research for going on 20 years.

We are, of course, hoping more people will join in the viewing party-both experts and lay people alike. So pop up some popcorn, grab your favourite beverage of choice, and join us at 8pm ET tonight (#OutbreakChat) to see firsthand what set the foundations for the Ebolanoia that has raced through the world these past few months.

Edited to add: Bingo cards are available on Twitter.

Know Your Variants: Kikwit vs Gueckedou

November 11, 2014 Kelly ...and everything else

This is an update of an earlier post, Know Your Species: SUDV vs EBOV.

When last we discussed the Democratic Republic of Congo outbreak of Ebola, it was presumed that it was actually an outbreak of the genus Ebolavirus, species Sudan ebolavirus (SUDV), largely because that’s what initial reports indicated. It hasn’t yet been clarified why there were reports of a positive test for SUDV and a positive test for a SUDV/EBOV mix (although I’ve heard speculations about earlier outbreak exposure), but what we do know is that on 2 September, the World Health Organization released the results from their virological analysis, showing that while the Ebola outbreak in the DRC was actually EBOV (Zaire ebolavirus),See Maganga G, Kapetshi J, Berthet N, Ilunga B, et al. Ebola Virus Disease in the Democratic Republic of Congo. NEJM 2014;DOI: 10.1056/NEJMoa1411099. it also was not linked to the on-going epidemic in West Africa.I say “was” because there is currently no known active transmission occurring, and the country is in the cool-down period, waiting for 42 days to pass in order to be declared virus-free.

This brings us back to my last post illustrating Ebola with kittehs.The language of the internet. For a quick refresher, all ebolaviruses are the family Filoviridae and the genus Ebolavirus. There are five different species within that genus: Reston ebolavirus (RESTV); TaÃ¯ Forest ebolavirus (TAFV); Bundibugyo ebolavirus (BDBV); Sudan ebolavirus (SUDV); Zaire ebolavirus (EBOV).

And then we have a obligatory illustrative cute cat picture, because this is just likeWell, with significantly less cuddles. how cats are members of the same family (Felidae) and the same genus (Felis), but have a variety of different species.

Bv48v2KIQAAFYEE

But what does it mean when we learn that, in fact, it’s the same species of ebolavirus, but different variant? Simply put, it just means being even more specific: variant fits inside species fits inside genus fits inside family.Are you having flashbacks to biology class yet? (Inside order. Viruses stop at that point; for the curious, the family Filoviridae is part of the order Mononegavirales.)

Variants are written out in a specific way that tells you the virus name, the isolation host-suffix, country of sampling, year of sampling, variant designation, and isolate designation. It looks like this:

For more information on all of this, see: Kuhn J, Bao Y, Bavari S, Becker S, et al. Arch Virol. Jan 2013; 158(1): 301—311.

The current epidemic started with, it is presumed, a Guinea variant GuÃ©ckÃ©dou,The NEJM article discussing contact tracing back to a December case in GuÃ©ckÃ©dou. which would be written like this:

Ebola virus H.sapiens-wt/GIN/2014/Gueckedou-XXXXX

This tells us that it’s an ebolavirus infecting homo sapiens (that’s us humans), wild type (it hasn’t been cultured), that it was sampled in Guinea in 2014, and that the variant is GuÃ©ckÃ©dou.There is a brief post on Virology Down Under about this, too. (Don’t worry about the isolate. That’s basically an individual code that’s given per sample, hence the name.)

Clearly, at this point, it becomes harder to do a one-to-one correlation between viruses and kitties, because kitties don’t break down into variants and isolates, but work with me a bit here. What cats do break down into is year they were born, litter, and even what they look like. So we do have ways we tell each individual Felis catus apart, even though we recognize them all as belonging to the genus Felis and species catus.

DifferentVariants80Per

In theory, we could roughly write these two cats out like this, utilizing their species, country of origin, year they were born, where they were born, and their name:

F.catus-wt/USA/2005/Philadelphia-Zeus

Yes, Toledo is from a place in Washington called Cougar. Honest.

Just as we can all look at Zeus and Toledo and see that they’re different domestic cats (but still clearly domestic cats, all the same), researchers can look at the virus they isolate from individuals and see that they’re different variants of the same strain. In the case of the outbreak in the DRC, it was a variant most closely related to the 1995 Kikwit Zaire ebolavirus outbreak.

So why does this matter? In an era of ebolanoia, it’s important to understand what it means when there’s an epidemic of Ebola in one area of the world and a new outbreak in another. People are quick to panic and assume that all outbreaks are connected to the epidemic, and equally quick to forget that ebolavirus has been cropping up sporadically for nearly 40 years in other parts of Africa. Knowing how scientists differentiate between strains and variants within viruses is another tool in being an educated and informed media consumer.

Help Stop Ebola with this One Simple Trick!*

August 27, 2014 Kelly ...and everything else, Bioethics

I mean, other than donating to aid organizations that desperately need help, that is.

See, yesterday, it was revealed there was yet another Western person being treated with ZMapp. Yep, that experimental drug that the world supposedly ran out of last week. Except, apparently, when there’s a Briton involved, in which case, someone checked behind the couch cushions, NIH thought to look in an unused cold storage closet, or who knows—because that’s the problem. The world now knows British man Will Pooley received at least one dose of ZMapp and will receive more, and no one has explained how the Royal Free Hospital happened to stumble across these doses that theoretically didn’t exist. In fact, all they’re saying is

[T]he team treating the nurse had sourced the drug through its clinical networks with the help of international colleagues.

Well, that’s not at all suspicious. Clinical contacts? International experts? Sure, that doesn’t sound at all sketchy.

See, the thing is, we’re going back to risk communication, international relations, and the people who are dying en masse in affected countries who’ve been told that there is just no drug left. When you say “nope, sorry, no drugs left, we are all and completely out of ZMapp” and then manage to suddenly find some when a white British guy needs it, you foster a climate of mistrust—something that’s already a huge issue that doesn’t really need further fuel on the fire.

Which is why, at this point, when these random unaccounted for surprise stores of ZMapp are discovered, there needs to be transparency about where it came from, why we didn’t know about it, and why it was suddenly found. Because otherwise, it sure looks like the double standard of treatment for Westerners vs. native Western Africans is continuing to happen.

(*How does this help to actually stop Ebola? Right now, one of the bigger issues being seen in countries like Liberia and Sierra Leone is a complete lack of trust in Westerner health care workers who are trying to help. Reinforcing the idea that there is a cure for Westerners when people in Liberia, Sierra Leone, and Guinea have been repeatedly told there isn’t a cure for them is going to continue to emphasize this lack of reason to trust, and that trust is an extremely crucial step to all of the very basic things that need to be done to stop this outbreak from spreading any further. At this point, I’m leaning pretty hard on it being unethical for doctors or journalists to report on ZMapp use without also identifying the source of the drug.)

Tag: ebola

An Ebolanoia Anniversary–Or, The Emperor’s [Lack of] Disclosures

Aid Organizations Working in Ebola Regions (v2.0)

OutbreakChat: A Livetweet of a Movie That Gives People Nightmares,…

Know Your Variants: Kikwit vs Gueckedou

Help Stop Ebola with this One Simple Trick!*

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