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public health – Page 2 – Life as an Extreme Sport
Life as an Extreme Sport

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

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-alienOne 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.


Know Your Variants: Kikwit vs Gueckedou

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); Taï 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:

The current epidemic started with, it is presumed, a Guinea variant Guéckédou,The NEJM article discussing contact tracing back to a December case in Guéckédou. 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 Guéckédou.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
    F.catus-ct/USA/2003/Cougar-ToledoYes, 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.

Know Your Species: SUDV vs. EBOV

Last night, it was confirmed that at least some of the hemorrhagic deaths in a remote area of the Democratic Republic of Congo are from an ebolavirus—but it looks like it’s species Sudan ebolavirus (SUDV), rather than the one ravaging Sierra Leone, Guinea, Liberia, and trying to get a foothold in Nigeria: species Zaire ebolavirus (EBOV). Technically, EBOV is the only member virus within the species Zaire ebolavirus, but let’s keep it simple. …simpler.

In other words, while the two outbreaks involve members of the same family (Filoviridae) and the same genus (Ebolavirus), they are not the same species.

It might help to think about cats.Ian Mackay uses cars, and goes into much more detail. But frankly, it’s the internet. Cats are the obvious go-to. Like these guys:
Bv48v2KIQAAFYEE

While these cats are both members of the same family (Felidae) and the same genus (Felis), their species are different. In fact, black-footed cats and the common domestic house cat look similar enough that it’s often hard to tell them apart without either being an expert or getting a genetic test.

Which is pretty much how it works with SUDV and EBOV, too.

So keep that in mind when people start sky-is-falling about Africa: there are currently two species of the genus Ebolavirus in (probable) outbreak, and there is no known link between the two. And, for what it’s worth, this isn’t the first time both SUDV and EBOV have occurred at the same time. As a matter of fact, the very first known outbreak of both overlapped.More than one person, myself included, has wondered if we might be seeing some sort of weather- or animal migration-related pattern emerging.