Ari Ciment
Subject: Curing the New Ebola Virus
Bio: Pulmonologist and Former President of Medical Staff at Mount Sinai Medical Center in Miami Beach
Transcript:
Larry Bernstein:
Welcome to What Happens Next. My name is Larry Bernstein. What Happens Next is a podcast that covers economics, politics, and history. Today’s episode is Curing the New Ebola Virus.
Our speaker is Ari Ciment. Ari ran the Covid Ward at the Mount Sinai Hospital in Miami Beach and is the former president of the hospital’s medical staff. He is probably best known for being my doctor.
Let’s begin.
Ebola has reared its ugly head again in the Democratic Republic of Congo. Is this a mutation of the previous Ebola virus or is this something new that has come directly from a bat?
Ari Ciment:
This is a mutation of Ebola virus, but it does have a natural reservoir which is the bat.
Larry Bernstein:
Do the bats get sick and die or are they merely transmitting the virus?
Ari Ciment:
Bats pick up the Ebola virus. The Ebola virus is a filovirus, which is an RNA virus that are responsible for all the previous pandemics because an RNA virus mutates 10,000 times faster than DNA viruses. What does that mean when they mutate? They change their surface proteins. The Ebola Zaire virus from 2014 had specific surface proteins. This one is different than that virus, although it’s in the Ebola virus family. So. the same vaccines that were used for Ebola Zaire or the same monoclonal antibodies are not going to be effective with the current Ebola virus.
So as per your question about what happens with the bats, the bats are protected. The bats pick up this Ebola virus. Then comes along a hunter making bush meat, he’s killing rodents, he’s killing bats. They start eating the meat and they become infected with the Ebola, whereas the bats won’t suffer any symptoms.
Larry Bernstein:
A major difference between Ebola and COVID is that COVID is an airborne virus. I remember at the beginning of COVID that we were like, “Don’t touch this.” It turned out that was a bunch of nonsense and we knew it early on but we still kept using our cleaning fluids and not touching the box.
But over time we recognized that for an airborne virus, it was more important to keep our distance, have the windows open so we wouldn’t catch a substantial viral load.
Ebola is not an airborne virus. So how do you catch it?
Ari Ciment:
So this is purely by contact. I don’t know if you saw the show 24. At the end of the season, if you remember, she shook the hand of the man who had Ebola virus and the implication was that the Ebola virus went through the skin into the person. It doesn’t necessarily go through the skin, but it’s very catchy in the sense that if you have an open wound, if you touch your mucus membranes, that’s what is meant by contact precautions. So that’s why you see all the HAZMAT gear
COVID is airborne. It’s easier to get. However, the mortality is much less than the Ebola virus that is going to be 30 to 50%, whereas COVID was more like 1%.
Larry Bernstein:
Going back to transmission, fluid is the key thing. So, your excrement, blood, vomit, spit, semen, carries the virus and any of those liquids gets into your body, that is how it transmits. What’s interesting is that this illness in the human host results in diarrhea, vomiting, complete and utter bodily destruction. And in that destructive process, you are just disseminating this liquid virus every which way. And you’ve got a loved one in trouble, you go over to check on them to clean up the mess. And in that process, you catch it. You touch an open wound, you touch your mouth, you touch your eye, you touch your nose, and then lo and behold, you’ve got it. This is going to most likely result in transmission in the home.
Ari Ciment:
One bodily function you didn’t mention was sweat.
Larry Bernstein:
I didn’t realize that.
Ari Ciment:
60% of the cases are women and it points to household transmission, which is key here because women are usually the caregivers. They’re taking care of the sick person.
What’s also very interesting, Ebola virus replicates really fast in the cytoplasm as opposed to COVID. The Ebola virus ends up very fast with more dramatic symptoms. The key finding classically is hemorrhaging. Young kids that have bloody noses and just nonstop blood. That will become a cycle of constant transmission and infection. And when they end up dying, the people taking care of the dead bodies are also contracting the illness.
Larry Bernstein:
Let me ask an ethics question as it relates to funeral rights. People die every day and the state does not limit anything to do with what happens next. But I could see from a health consideration that the state could say, “This dead body we are going to burn it because the dead body can spread Ebola. Have your funeral without the body. Okay. That’s over. Now that violates Jewish traditions for sure. Tell us about the ethics of state actions to take the dead body for fear of Ebola spread.
Ari Ciment:
If you watch the videos, there was a video on CNN I saw it. It’s an actual coffin that’s being handled by a healthcare worker in HAZMAT and the family want to get to the coffin and he is protecting it. He is making sure nobody gets close to the coffin. But you could see the skepticism, which is so critical to this epidemic to be going out of control.
Larry Bernstein:
Americans and other doctors who work for Doctors without Borders are going to the Democratic Republic of the Congo (DRC) and the locals are very suspicious of their behavior because their loved ones are dying from their care given the 30-50% mortality rates from the Bundibugyo Ebola virus.
Ari Ciment:
In some cases, they burn down their housing because they don’t know why they can’t see their loved ones. First of all, they don’t understand.
Larry Bernstein:
It doesn’t help that there is ongoing violence in the area between the Hutu and the Tutsi people in the DRC. You may remember that there was a genocide in Rwanda and there is ongoing fighting now between these peoples in the very place where the Ebola is running wild. Is there a relationship between civil wars and epidemics.
Ari Ciment:
Because of the ongoing friction between the M23, the Hutu and the Tutsi that is rampaging from the DRC and Rwanda, that friction is causing a lot of skepticism.
Larry Bernstein:
The medical professionals in the DRC are taking the individual patients and separating them from their families, and the families are outraged. They want to see their sick kid, they want to see their father. The families get angry and then they burn down the medical facility.
Ari Ciment:
They’re burning down in frustration; they want to see their family members.
Larry Bernstein:
Pandemics success needs a host to propagate, and then the virus will jump to the next patient and so on. The last thing you want to do as a virus is to kill the host before it jumps to the next patient. Ironically, Ebola is very successful at killing its host and that usually burns out the disease.
Ari Ciment:
Yeah. It’s great in killing its host, but the key difference is there is no asymptomatic transmission as far as we know. So the people that are spreading Ebola are the people actively infected. A super spreader like the early COVID is spread because people are walking around, they’re totally fine, they’re laughing and they’re breathing in your face, you’re getting the infection, you don’t know it. And then one week later you’re sick and then you’re spreading it the same way. Ebola virus, there is also an incubation period. The incubation period is roughly 2 maximum 21 days, but it’s probably more like seven days. That’s incubating while you’re not symptomatic, you’re not transmitting the disease. This is the real hope. The truth is the Ebola virus will not spread crazily like COVID did because you know who is the person spreading the disease. So, if you get really good at cordoning them off, blocking that transmission, then you should be okay.
The other important part to this story is the rate of infection called R0 (R-Naught) that we used to talk about a lot with COVID. If you’re infected with a virus, how many people will that one sick person infect? The R0 for COVID was about two to three. The R0 for measles is 12 which is enormous because it’s such an easily propagated virus through the air, very catchy. R0 for Ebola is something like 1.5.
It’s high but it’s not as high as the airborne viruses.
Larry Bernstein:
Years ago, with the Zaire Ebola virus an infected person traveled on a 12-hour bus trip in West Africa and nobody else got infected from him. If that had been Covid, everyone would have gotten sick because it is an airborne infection in a closed bus. But Ebola can only spread through liquids so that is a big advantage for us all.
Next topic is antibodies. What is an antibody?
Ari Ciment:
An antibody is your immune response to the illness. You develop your B-cells create a response to the proteins in the virus and then you could combat it the next time you see it.
Larry Bernstein:
Doctors have been aware of antibodies for generations. With the Spanish flu in 1918, doctors knew that the surviving patients had produced antibodies that were successful in beating back the Spanish influenza. And physicians got samples from the now healthy survivors of the flu and they injected these antibodies into sick patients who just came down with or have been exposed to the Spanish flu and it works to a degree. Tell us about the history of this. Tell us about how we’ve improved upon it in the last century, whether we can make antibodies artificially. Tell us about antibodies as a response to viral attacks.
Ari Ciment:
The antibodies live in the plasma. The very first records of convalescent plasma are WW1 soldiers who survived and they took their blood and injected it into people that were currently infected. I enabled our hospital to use convalescent plasma for the treatment for COVID here in Miami Beach, but that is not as effective as the monoclonal antibodies, which were being developed by companies like Regeneron or in this specific Ebola crisis. It’s a company called Biopharmaceutical MAP. They’re the ones that made the monoclonal antibody against Ebola virus in the previous Zaire Ebola virus. Those companies make a more modified directed antibody versus the protein that’s on that virus.
Larry Bernstein:
So, one approach is to take surviving patients antibodies and give it to an infected patient. Another approach is to look at the actual virus and build and mass produce antibodies to kill it.
Ari Ciment:
I would say the biggest one on the market right now probably is this one called MBP134, which is by that company I mentioned MAP Biopharmaceuticals. It’s basically a pan Ebola virus. It should work against all the Ebola viruses.
Larry Bernstein:
The antibodies are like magic.
Ari Ciment:
For sure. That was the most miraculous medicine I ever witnessed. That was the Regeneron and the Eli Lilly. Those monoclonal antibodies, they stopped the virus in its tracks. It would hit it and boom, your disease process stopped. But if somebody already has hemorrhagic symptoms, they’re bleeding out, they have organ failure, those things are going to correct over time if the patient could survive, but they’re going to be significant organ dysfunction if they’re not caught in time. It’s going to be everything is about timely administration. With COVID, if you got the monoclonal antibodies within the first one to three days, you were golden, but if you got it five days late, it’s not so clear it was going to be beneficial.
Larry Bernstein:
I want to expand on Ari’s point. This MBP134 monoclonal antibody therapy is a cocktail to two antibodies designed to treat multiple strains of Ebola virus and it worked on both the Zaire Ebola virus from 2014 and it is working also with the Bundibugyo Ebola that is running wild right now in the Democratic Republic of the Congo. So far in the DRC it reportedly decreased mortality by 30% but from a very high number. I suspect that if you got the monoclonal antibodies in a place like a top US hospital at the right time, you are going to survive.
Tell us about the previous Ebola Zaire virus.
Ari Ciment:
It’s named after the Zaire River, because that’s where it originated from. It caused 11,000 deaths in the Western part of Africa. It was Sierra Leone. It wasn’t in the DRC.
Larry Bernstein:
The Sierra Leone is far away from the DRC. It is 1800 miles apart which is like the distance from Denver to NYC.
Ari Ciment:
Most of the deaths from Ebola Zaire happened in the Western part of Africa. Whereas this Bundibugyo is in the Eastern DRC, which is near Uganda.
In 1994, the Hutus massacred 800,000 Tutsis, a real genocide over 100 days. The genocidal Hutus escaped to the Eastern DRC, the place right now, which is the epicenter of the Bundibugyo Ebola. And that was the Hutus’ stronghold till now. The M23 is a Tutsi group that is at war currently. They fight with the Hutus’ remnant in the Eastern DRC. That’s where they have gold mining. They have tons of metals, tungsten, and it’s a mineral haven.
Bernstein:
I want to give my audience some background information about the Democratic Republic of the Congo. It is in the South and Central part of Africa. It is a geographically a large country that borders several African countries including Angola, Sudan, Uganda, Rwanda, and Tanzania. The population is growing very quickly. In 1960, the DRC population was 15 million and today it is 115 million. It is expected to be 220 million in 2050 and 320 million in 2075.
If you compare the population of the DRC to Russia for example. Russia had 8x more people in 1960 but that gap shrank so now Russia is only 20% more populous today. By 2050 Russia will have half as many people as the DRC and by 2075 only a third of DRC’s population. This shows the power of exponential growth in the DRC as compared to zero growth in Russia.
Another metric is that the DRC will have the same population as the US in 2090.
Ari Ciment:
You also have to factor in that they lost six million people during the second Congo War, which was 1997 to 2003. So even with that their population is growing.
Larry Bernstein:
The DRC is an impoverished country that lacks suitable drinking water and a poor healthcare system. The infant mortality rate is 6% as compared to ½ of 1% in the USA. Each year 300,000 babies die in the DRC. We have been discussing the Ebola virus which as killed around 200 people this year in the DRC. But in comparison 1000 babies are dying every day in the DRC. I know Ebola is scary because it could jump the ocean and end up in our backyard. But isn’t the relevant health risk for the DRC its infant mortality?
Ari Ciment:
I think that’s a great point. 1300 Ebola cases so far, there’s 240 deaths and the fear is it going to rise above even the Zaire Ebola virus, which was 11,000 deaths.
Larry Bernstein:
What is definition of a pandemic?
Ari Ciment:
A pandemic is it’s not only crossing local boundaries; it’s crossing all over. Pandemic is all over the world, pan. Epidemic is a local out of control. You could think of it like a fire with the embers going from one room to the next, whereas the pandemic is a fire with smoke going all over all the rooms.
People who want to know about the epidemiology of the virus, it’s a filovirus, which is unique to the Ebola viruses. That’s the thread-like RNA virus that replicates really fast in the cytoplasm, causes hemorrhagic symptoms as opposed to the flavivirus, that’s Dengue fever and Zika that is spread by mosquitoes.
Larry Bernstein:
Can a mosquito transmit the Ebola virus from one human host to another?
Ari Ciment:
I don’t think so.
Larry Bernstein:
Would you take a Pfizer vaccine that’s been approved by the DRC, even though it’s not FDA approved.
Ari Ciment:
Yes. If the mortality was that high, for sure. I would.
Larry Bernstein:
I end my podcast on a note of optimism. What are you optimistic about as it relates to this new Ebola mutation?
Ari Ciment:
I think it’s a fascinating scary story. What makes it unique is this geopolitical situation and the fact that the DRC is in the World Cup for the first time after 52 years. Hopefully this Ebola will die down. I think this will be a stimulus for the DRC and for Rwanda to finally make amends.
Larry Bernstein:
Thanks to Ari for joining us.
If you missed our previous podcast, it was How AI will Change Law Schools, Law Firms, and Users of Legal Services.
Our speaker was Polk Wagner who is the Deputy Dean of Penn Law School who has been charged with figuring out how to adapt the law school curriculum to the AI revolution. Polk discussed how law schools will adapt as their graduates’ jobs will no longer focus on document creation but will instead require complex legal analysis.
We also talked about how AI will change the structure of law firms since the by-the-hour billing practice will end and what will replace it.
In addition, we chatted about how consumers of legal services will use AI to negotiate contracts, to comprehend complex legal agreements, and to help draft documents that previously would have been delegated to their attorneys.
Upcoming on What Happens Next is Encouraging Competing Viewpoints Among College Students.
Our speaker will be Daniel Diermeier who is the Chancelor of Vanderbilt. I want to hear from Daniel about how the administration can achieve political neutrality on campus. I want to learn about how to create a university culture that encourages free speech and allows for debate without shaming the opposing perspective.
You can find our previous episodes and transcripts on our website. Please follow us on Apple Podcasts or Spotify.
I am Larry Bernstein with the podcast What Happens Next.
Check out our previous episode, How AI Will Change Law Schools, Law Firms, and Users of Legal Services, here.
