Maryn McKenna

Journalist and Author

Get Your Shots, Wash Your Hands, Thanks, and Goodbye

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icenine-exit

IceNine (CC), on Flickr

A little less than 5 years ago, editor Betsy Mason of WIRED Science called to ask whether I’d be interested in joining a new thing. WIRED was thinking about starting a science blog platform; she wondered whether I’d want to be one of the bloggers.

I did very much want: WIRED is both a great magazine, with inspiring storytelling and innovative design, and a brand with international reach. I was a bit perplexed why they would want me — scary diseases didn’t seem like a core interest for WIRED readers — but Betsy (now one of the authors of WIRED’s Map Lab blog) was confident the audience was there.

She was right. Superbug debuted Sept. 14, 2010 with a report on the “Indian superbug,” the antibiotic resistance factor NDM that was then just starting to move across the world. My second post explored “livestock MRSA,” the bacterium that originates in antibiotic overuse in agriculture, and the third looked at the shivery subject of a rare and deadly parasite transmitted by organ transplants. Those three posts pretty much defined Superbug’s turf: public health, global health, and food policy, with a sprinkle of dread. Readers responded with fascination and good will, then and to the more than 300 posts afterward.

Of which, as you’ve probably guessed, this is the last. Superbug has had a fantastic run, but there was only one other place I wanted to work, and I’m headed there. Next week, I’ll be joining National Geographic’s Phenomena under a new blog name.

(Worth saying: This move is coincident with Wired.com’s redesign, but is not at all related. Phenomena happened to have a rare opening.)

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"We Are Not Ready": Ebola Analysis from Front-Line Workers (And Bill Gates)

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A volunteer gets sprayed a bleach mixture while training for a mission to support the German Red Cross in Liberia, Oct. 23, 2014.

A volunteer gets sprayed a bleach mixture while training for a mission to support the German Red Cross in Liberia, Oct. 23, 2014. Markus Schreiber/AP

Bill Gates speaks at TED 2015 in Vancouver. (Image courtesy TED on Flickr (CC).)

Bill Gates speaks at TED 2015 in Vancouver. (Image courtesy TED on Flickr (CC).)

We’ve just passed a difficult and little-noticed anniversary: Last week, the Ebola epidemic in West Africa achieved its first birthday. Though the viral outbreak has been contained, it is still not under control: According to the World Health Organization, cases continue in Sierra Leone and are rising again in Guinea. Liberia was about to record an entire incubation period without a new case — a signal that the chain of person-to-person transmission might have been broken — but on Friday, it announced that it had found a single new case. How that woman became infected is unclear; it is possible that she represents, not a new outbreak, but a brief interruption in an otherwise promising trend.

It has been decades since there was an epidemic of this persistence and magnitude. No other Ebola outbreak matches it; nor does the 2003 epidemic of SARS. You would have to go back to the early days of HIV in the 1980s, or to the flu pandemics in 1968, 1957 or even 1918, to find an outbreak that sickened so many people, challenged international response capacity so much, and instilled such fear in other countries.

The anniversary has triggered reflections. Some criticize the response to Ebola for being inadequate and slow. Others — such as two talks at last week’s TED conference, one by Bill Gates — extract lessons that should inform responses to future epidemics.

Because there will be future epidemics. That’s for sure.

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Ebola Could Cause Thousands More Deaths — By Ushering In Measles

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Women gather in the Guinean village of Meliandou, believed to be Ebola's ground zero.

Women gather in the Guinean village of Meliandou, believed to be Ebola’s ground zero. Jerome Delay/AP

Awareness of Ebola is picking up again in the United States: An American volunteer who was working in Sierra Leone has contracted Ebola and been medevac’d to the National Institutes of Health Clinical Center for Ebola treatment, and 10 more volunteers have been brought back to NIH, Omaha and Atlanta, to be examined at three of the four institutions in the US that have safe units to house them.

It’s a reminder that Ebola still persists in West Africa: In the last period the World Health Organization reported on (the 7 days ending March 8), there were 116 new cases. One bit of good news: None of them were in Liberia, for the second week in a row. But Guinea and Sierra Leone, where this volunteer was infected, continue to struggle.

And in a research paper published as that volunteer was being flown back, there’s a reminder that the Ebola outbreak is creating layers of health risks for those countries. In Science , researchers from NIH and four universities warn that Ebola’s interruption of other health services, such as childhood immunizations, threatens to create secondary epidemics of preventable diseases that would dwarf Ebola’s impact. In particular, they warn that there could be 100,000 additional measles cases, and up to 16,000 additional deaths, if health services are not restored.

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Ebola's Not Over For Health Care's Volunteers

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EU Humanitarian Aid and Civil Protection (CC) on Flickr

EU Humanitarian Aid and Civil Protection (CC) on Flickr

You might have missed it, because we’re barely talking about it in the United States, but the African Ebola epidemic has still not died down: the World Health Organization identified 99 new cases in its most recent status report. And as long as the disease persists, the possibility exists that it could spread back out of that confined area to other countries. Which makes it a good time to consider several new reports of what happened to US health care workers involved in responding to Ebola, and how that experience still affects their lives.

Short version: Of two who contracted Ebola and survived, one remains ill and fears she was manipulated, and the other, though well, feels he was misrepresented and stigmatized. Both worry their experience will dissuade others from volunteering in turn. And a major new government report backs them up.

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Still Fighting Ebola: A View from Liberia's Front Line

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Nine-year-old Nowa Paye is taken to an ambulance after showing signs of the Ebola infection in the village of Freeman Reserve, about 30 miles north of Monrovia, Liberia.

Nine-year-old Nowa Paye is taken to an ambulance after showing signs of the Ebola infection in the village of Freeman Reserve, about 30 miles north of Monrovia, Liberia. Jerome Delay/AP

We’ve pretty much signed off on Ebola in the United States — last week, President Obama withdrew the US troops sent to fight the disease — but in Africa, the news on the epidemic has seemed pretty good. The overall number of known cases stands at 22,894, with 9,177 deaths, far below the dire predictions made last fall that the epidemic could sicken millions.

Progress at beating the disease is stalling, though. According to the World Health Organization, the number of new cases has gone back up for two weeks in a row. Sierra Leone, now the outbreak’s epicenter, still has what the WHO calls “widespread transmission,” and on Saturday its government quarantined part of the capital. Guinea has had a spike in cases, and in several areas, mobs have attacked clinics.

The news is best from Liberia, where there were just three new cases last week compared to 65 in Guinea and 76 in Sierra Leone. Liberia was hard-hit, with 8,881 confirmed cases and 3,826 deaths — 300 cases per week at some points. But it also seems to have done the most to curb the disease’s spread: Today, schools that had been closed since last fall are supposed to open again.

Last week, though, I had the opportunity to speak to a front-line Ebola fighter in Liberia, and what he told me underlined how precarious that country’s progress is.

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The Long Tail of Ebola: Depressing African Economic Progress

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EpSos.de (CC), Flickr

EpSos.de (CC), Flickr

It has almost completely vanished from the news in the United States, but Ebola persists in three countries in Africa: Liberia, Guinea, and Sierra Leone. The World Health Organization’s update today puts the case toll at 21,171 in those three countries, with 8,371 deaths. (Eight thousand deaths. Think about that, for a minute.)

But the uncomfortable reality is that the impact of Ebola reaches far beyond those individual cases. In reports issued today and in December — which I missed at the time, so am bumping it back up for reading now — the World Bank predicts that the disease will cripple the economies of these countries into the future.

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2015 Resolution: Accept that Diseases Hop Borders, Don't Dismiss Them, and Don't Panic

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Cogdog (CC), Flickr

Cogdog (CC), Flickr

Happy New Year, constant readers. There’s no question that the big public health story of 2014 was Ebola. The African epidemic has now racked up more than 20,000 cases, according to the World Health Organization, which has put together a useful map and timeline of developments since March. If you’d like to look back on the year, the best sum-up by far is the New York Times’ long and beautifully told “How Ebola Roared Back,” and for a sense of what we learned this year — and what we still don’t know — consider reading Helen Branswell’s account, published at the Winnipeg Free Press.

The international health community still must focus on Ebola; the disease is by no means contained. But my New Year’s wish, for those of us outside that community, is that we begin 2015 by accepting that wherever diseases occur, they are going to travel. We had repeated demonstrations of this with Ebola; and as a global community, we didn’t react well. (If you feel like revisiting the cringe-making details, the Today in Ebolanoia Tumblr is still up.)

The disease that really makes this case, though, is the antibiotic resistance factor NDM. Since its original discovery in one person in Sweden in 2008, this snippet of DNA — which makes common infections essentially untreatable — has been carried by patients to at least 40 countries, and spread within those countries to create local hospital outbreaks.

That’s a lot of border-crossing.

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Ebola Here and There: Knowing When It Is And Isn't Over

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It may have skipped your notice, but the United States is now Ebola-free. Dr. Craig Spencer was released from treatment in New York City Tuesday; that day also marked the end of the watch period for Kaci Hickox, the nurse force-quarantined in New Jersey and then allowed to go home to a remote town on the Maine border. The two nurses who treated deceased patient Thomas Duncan, Amber Vinson and Nina Pham, were both released from treatment two weeks ago. The health care workers who were sickened in Africa and came home for treatment have all gone home.

There are some things to note in these events. The first is that the Ebolanoia over the possibility of the disease spreading in the United States  is now clearly shown to have been an over-reaction. No one got sick because Spencer went around New York City in the days before he developed symptoms. No one got sick, either, from contact with Kaci Hickox — and, an important point, she never developed symptoms herself. Her quarantine was self-evidently unnecessary. The only people to have contracted Ebola in the United States are the two nurses who were in close face-to-face contact with Duncan when he was floridly ill, and while the hospital that treated him, and the Centers for Disease Control and Prevention, were working out the best protective protocols.

So we really could calm down now. (Have you noticed how the chatter has died down? Especially since the election?) But we also shouldn’t forget that Ebola continues in West Africa, and could return to the US at any time.

Here’s an example of the continuing challenges: the West African country of Mali.

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African Scientist: African Corruption Made Ebola Worse

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Daliborlev (CC), FLickr

Daliborlev (CC), Flickr

Since last week, there has been some good news on the Ebola front: a suggestion that the epidemic in Liberia is beginning to slow down, with fewer new cases reported. At the same time, there is a new outbreak in Sierra Leone, in a part of the country that thought it had beaten the disease and then self-quarantined to keep it at bay. So it is probably too soon to hope that the entire international outbreak is on its way to being extinguished.

At the same time, two major international medical meetings happening this week have allowed researchers to discuss the newest reports from  the field — but not with equal success. The annual meeting of the American Society of Tropical Medicine and Hygiene, the largest medical society devoted to diseases such as Ebola, lost a significant number of attendees when the conference’s host state, Louisiana, threatened to forcibly quarantine anyone traveling from a country experiencing Ebola, whether or not that person had been exposed. Meanwhile, Vienna, Austria had no such qualms, and so the International Meeting on Emerging Diseases and Surveillance proceeded without any difficulties, allowing physicians and epidemiologists fresh from the Ebola zone to share reports.

It’s from that second meeting that this week’s news comes. Oyewale Tomori, president of the Nigerian Academy of Science and a leader of the World Health Organization’s Ebola response in 1995, used the IMED podium to deliver a stinging critique of the behavior of African governments during the current crisis, charging that internal corruption has crippled the continent’s ability to fight its own disease battles.

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The Grim Future if Ebola Goes Global

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Healthcare workers load a man suspected of suffering from the Ebola virus onto an ambulance in Kenema, Sierra Leone, on Sept. 25, 2014.

Healthcare workers load a man suspected of suffering from the Ebola virus onto an ambulance in Kenema, Sierra Leone, on Sept. 25, 2014. Tanya Bindra/AP

If you listened hard over the weekend to the chatter around the political theater of detaining a nurse returning from the Ebola zone in a tent with no heat or running water, you might have heard a larger concern expressed. It was this: What happens if this kind of punitive detention — which went far beyond what medical authorities recommend — deters aid workers from going to West Africa to help?

As a reminder, the African Ebola epidemic is still roaring in three countries; two others have contained the disease, but it has now leaked to a sixth, Mali. The case count is 10,141, with 4,922 deaths. Last month, the Centers for Disease Control and Prevention estimated that if the epidemic continued on its current course, cases would hit 1.4 million by next January. Last week, Yale researchers said in the journal Lancet Infectious Diseases that even current promises of international aid will not contain the epidemic — so the volunteering of medical personnel such as that nurse becomes even more important.

But what if, because of this weekend’s events, volunteers are discouraged from going to West Africa, for fear of how they will be received on return? Or what if they do go, and their efforts are still not enough?

I wanted to be sure I wasn’t over-imagining what might happen next with Ebola, if it is not contained at its source now. For a fact-check, I turned to Jody Lanard and Peter Sandman, two risk-communication experts who have been involved in most of the big epidemic threats of the past decades. (I met them, I think, in the first run-up of concern over H5N1 avian flu in 2003.)

I hoped they would tell me not to be too worried about Ebola becoming a permanent threat in West Africa. Instead, they told me to be very worried indeed.

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Ebolanoia: The Only Thing We Have to Fear is Ebola Fear Itself

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panic

Star5112 / Flickr

It is almost a month now since Thomas Eric Duncan appeared at the emergency room of Texas Health Presbyterian Hospital, was sent home after evaluation, and returned two days later with symptoms of Ebola. On Monday, his family and the health workers who treated him at the hospital were released from quarantine, with none having fallen ill.

But if you’ve been paying any attention to the Ebola news, you’ll know that the story is far from over, with one nurse who took care of him in Dallas now hospitalized at NIH (and upgraded to good condition Tuesday) and the other at Emory University, where the aid workers who fell ill in Africa also received treatment and recovered. Duncan remains the only person who came to the US with Ebola but not already identified and under medical care.

Given our nationwide reaction, though, you might think we have had as many cases as West Africa.

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What Would Keep Ebola from Spreading in the US? Investing in Simple Research Years Ago.

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Daliborlev (CC), FLickr

Daliborlev (CC), Flickr

There’s a thing you learn, when you’ve been writing about infectious diseases for a while: People love drama. They’re not so much with detail.

Drama is H5N1 avian flu killing half the people who contract it, and the enormous surge in whooping cough, and the sinister movement of almost-untreatable NDM-1 resistance from South Asia to the West.

Detail is the question of whether health care workers treating pandemic-flu patients should expect viral spread for 3 feet or 6 feet; and why immunity conferred by the current pertussis vaccine fades a few years earlier than expected; and how hospitals can encourage their janitors to clean rooms more thoroughly, when they’ve always treated them as a disposable part of the staff.

All of those details are crucial to controlling those diseases. All of them are also research questions. None of them, guaranteed, have gotten the attention or funding that would answer the questions in a way that equips us to counter the dramatic problems.
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US Will Screen Air Passengers for Signs of Ebola. Will It Work?

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Masked customs officers look on in a screening area for international passengers from United flight 998 from Brussels at Newark airport in Newark, N.J., Saturday, Oct. 4, 2014. New Jersey health officials say Ebola has been ruled out as the cause of illness for a man who became sick on a flight from Brussels to the United States.

Masked customs officers look on in a screening area for international passengers from United flight 998 from Brussels at Newark airport in Newark, N.J., Saturday, Oct. 4, 2014. New Jersey health officials say Ebola has been ruled out as the cause of illness for a man who became sick on a flight from Brussels to the United States. Viorel Florescu / AP Photo / Northjersey.com

If you’ve been following the Ebola story, you may have noticed that the Centers for Disease Control and Prevention announced a move yesterday to try to keep the disease off US soil. At the five US airports that receive most passengers from the three countries where Ebola is circulating, passengers will be singled out on the basis of their travel records; interviewed by means of a questionnaire; and have their temperature taken, to see if they have a fever.

It’s the first attempt to control Ebola at the US border, announced, probably coincidentally, on the same day as the death of the only Ebola patient to make it into the US thus far. Political pressure for the CDC to do something was growing, and some visible step was necessary. But in the public health world, I am hearing some doubt whether it will work. Here are some reasons why.
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Keys to Controlling Ebola in the US: Travel Records and Infection Control

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Daliborlev (CC), FLickr

Daliborlev (CC), Flickr

If you’re at all interested in infectious diseases, you’ve probably heard by now that a person traveled to the United States while infected with Ebola, was diagnosed and is now in a hospital in Texas. (I was on a flight without Wi-Fi yesterday from before the press conference was announced to after it concluded. Turning my phone on after arrival was… interesting.)

The Centers for Disease Control and Prevention held a press conference yesterday afternoon (transcript is here), and WIRED’s Greg Miller covered it.

The quick details:

  • The infected person flew from Liberia to the US on Sept. 19-20 to visit family members who live in Texas.*
  • He began to develop symptoms on Sept. 24 (important because victims are infectious only after symptoms develop).
  • He went to an ER in Dallas on Sept. 26 and was given antibiotics and sent home.
  • Two days later, Sept. 28, he was taken by ambulance to Texas Presbyterian Hospital in Dallas and was admitted on suspicion of Ebola and put in isolation.
  • The test results confirming the diagnosis came down yesterday, the same day as the announcement.

 

(*A quick Google will demonstrate that the patient and his family have been named by the Associated Press, with the New York Times using the name and attributing it to AP. Given the unnecessary panic around Ebola at this point, I have conflicting thoughts about whether and how the name should be used, so am passing on using it for now.)

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The Mathematics of Ebola Trigger Stark Warnings: Act Now or Regret It

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Daliborlev (CC), FLickr

Daliborlev (CC), Flickr

The Ebola epidemic in Africa has continued to expand since I last wrote about it, and as of a week ago, has accounted for more than 4,200 cases and 2,200 deaths in five countries: Guinea, Liberia, Nigeria, Senegal and Sierra Leone. That is extraordinary: Since the virus was discovered, no Ebola outbreak’s toll has risen above several hundred cases. This now truly is a type of epidemic that the world has never seen before. In light of that, several articles were published recently that are very worth reading.

The most arresting is a piece published last week in the journal Eurosurveillance, which is the peer-reviewed publication of the European Centre for Disease Prevention and Control (the EU’s Stockholm-based version of the US CDC). The piece is an attempt to assess mathematically how the epidemic is growing, by using case reports to determine the “reproductive number.” (Note for non-epidemiology geeks: The basic reproductive number — usually shorted to R0 or “R-nought” — expresses how many cases of disease are likely to be caused by any one infected person. An R0 of less than 1 means an outbreak will die out; an R0 of more than 1 means an outbreak can be expected to increase. If you saw the movie Contagion, this is what Kate Winslet stood up and wrote on a whiteboard early in the film.)

The Eurosurveillance paper, by two researchers from the University of Tokyo and Arizona State University, attempts to derive what the reproductive rate has been in Guinea, Liberia and Sierra Leone. (Note for actual epidemiology geeks: The calculation is for the effective reproductive number, pegged to a point in time, hence actually Rt.) They come up with an R of at least 1, and in some cases 2; that is, at certain points, sick persons have caused disease in two others.

You can see how that could quickly get out of hand, and in fact, that is what the researchers predict. Here is their stop-you-in-your-tracks assessment:

In a worst-case hypothetical scenario, should the outbreak continue with recent trends, the case burden could gain an additional 77,181 to 277,124 cases by the end of 2014.

That is a jaw-dropping number.
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CDC Director on Ebola: 'The Window of Opportunity Really Is Closing'

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Daliborlev (CC), FLickr

Daliborlev (CC), Flickr

I said last month that I was going to try to stay out of Ebola news because so much is being written about it elsewhere. Since then, the African outbreak — now really an epidemic, since it is in multiple countries —  has ballooned to 3,000 cases, and the World Health Organization has predicted it may take 6 months or more to bring it under control.

Something caught my attention today though that felt worth highlighting. Dr. Tom Frieden, director of the US Centers for Disease Control and Prevention, gave a lengthy press conference immediately after returning to the US from a visit to the Ebola zone. Frieden has shown in the past that he knows how to be outspoken in a very strategic way; yet even so, the urgency of his language, and his call for an immediate, comprehensive global response, was striking.

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Ebola in Africa and the U.S.: A Curation

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Daliborlev (CC), FLickr

Daliborlev (CC), Flickr

I’ve stayed out of the Ebola news so far, for a couple of reasons. First, as longtime readers know, I’m writing a book; I’m in the last 6 months of it and the work is intense and involves a lot of travel. I’m not always available at the exact moment news breaks. Second, I try to explore things here that readers may not have heard about elsewhere. The Ebola outbreak has been building in West Africa for a while, but when it was revealed at the end of last week that two American aid workers had caught the disease — and that they were being transported back to the US for treatment — the news and the reaction to it instantly filled every channel. Over the weekend, so much misinformation and outrage got pumped out that it feels as though there’s no way to cut through the noise.

But I have a few thoughts. Start with this: No, I don’t think the two aid workers who are being returned to the US pose any risk at all to the average American, or even the average Atlanta resident. Here’s my marker on that: I’m an Atlanta resident. I live less than 2 miles from the CDC and Emory University (the aid workers are being treated in a special unit housed at Emory on behalf of the CDC; the two institutions are next door to each other). My entire neighborhood and a good part of my various friendship circles are CDC employees, Emory healthcare workers, or both.

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A Patient in Minnesota Has Lassa Hemorrhagic Fever. (Don't Panic.)

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Daliborlev (CC), FLickr

Daliborlev (CC), FLickr

News from the Minnesota Department of Public Health and the Centers for Disease Control and Prevention: A Minnesota traveler returning from Africa has been hospitalized with what the CDC confirms to be Lassa fever, a viral hemorrhagic fever that is often lumped together with Ebola hemorrhagic fever, though they are caused by different organisms.

Given the news from West Africa of the growing Ebola outbreak there — 127 cases including 83 deaths, according to the World Health Organization’s last posted update — I suspect there’s going to be some attention to this case, possibly even some alarm. So, switching from Scary Disease Girl to Scary Disease Killjoy (which is sort of like Phoenix becoming Dark Phoenix, only without any planets blowing up): The Minnesota department says there’s no sign the disease has spread. The CDC says it’s not even likely to have infected passengers on the same airplane.

And if you’re thinking, well, surely this has never happened before, a viral hemorrhagic fever coming to the US via airline: Actually, it’s happened seven times before. And no one caught Lassa from the infected travelers in any of those times — not from sitting next to them, not from living in the same house with them, not from having sex with them. It is a very bad disease. But it is not the threat we like to imagine.

(Sorry to spoil the fun.)

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A New Tick-Borne Illness, and a Plea to Consider the Insects

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A tick’s mouth parts under 40x magnification.

In the summer of 2009, two men from northwest Missouri showed up at Heartland Regional Medical Center in St. Joseph, tucked up against the Kansas border 50 miles north of Kansas City. The men were seriously sick. They had high fevers, fatigue, aches, diarrhea and disordered blood counts: lower than normal amounts of white blood cells, which fight infection, and also lower than normal platelets, cells that control bleeding by helping blood to clot. But they had none of the diseases that were high on the differential diagnosis, the list of possible causes that doctors work their way down as they try to figure out what has gone wrong: no flu, no typhus, no Clostridium difficile, and none of the serious foodborne illnesses — no Salmonella, no Shigella, and no Campylobacter.

The two men had one thing in common, though: About a week before being hospitalized, each remembered, he had been bitten by a tick.

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Lassa fever: Coming to an airport near you

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Out of all the scary diseases, none seem to make people horripillate quite as much as the viral hemorrhagic fevers: Ebola, Lassa, Marburg and the rest. That might be due to their still-murky origins, crossing over from the edges of the world of animals into the infringing habitats of men. It might be their uncomfortable classification in biosafety level 4, reserved for life-threatening infections that spread by fine exhaled aerosols and for which there is no vaccine and no treatment. (Four is the highest level. There is no 5.) Probably it is due in part to the enduring impact of the 15-year-old book The Hot Zone by Richard Preston, which in its early pages conducts a master class in describing truly revolting symptoms:

He is holding an airsickness bag over his mouth. He coughs a deep cough and regurgitates something into the bag. The bag swells up. Perhaps he glances around, and then you see that his lips are smeared with something slippery and red, mixed with black specks, as if he has been chewing coffee grounds. His eyes are the color of rubies, and his face is an expressionless mass of bruises. The red spots, which a few days before had started out as starlike speckles, have expanded and merged into huge, spontaneous purple shadows: his whole head is turning black-and-blue.

The cultural response to the viral hemorrhagic fevers has always struck me as interesting. They’re terrifying, and yet we love to hear about them, in a Scary Stories to Tell in the Dark kind of way. When I’ve asked people why the fascination (because I, myself, am much more frightened of parasites, thanks to Carl Zimmer. And brain amoebas), they usually say back to me that it feels like a don’t-leave-the-campfire fright, a safe fright — because, you know, Ebola is over there somewhere. It’s not like it’s coming here.

The problem with that is that VHFs do come here. Actively infectious VHF has been diagnosed in the United States at least six times — most recently in January, in Philadelphia.

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