Six Ebola Experts Walk Into a Virtual Bar

The Bundibugyo ebolavirus outbreak is a disaster unfolding before our eyes, so our expert panel had to discuss over drinks

Today the World Health Organization (WHO) declared the Bundibugyo ebolavirus outbreak a public health emergency of international concern (PHEIC). This is a formal declaration that WHO is treating the outbreak with the greatest level of seriousness, because of the threat it presents to public health.

This outbreak presents a grave threat, not just because it’s a rare species of ebolavirus that has only emerged twice before, but because the outbreak was so large prior to being detected. The reasons for this are extremely complicated and still unfolding.

In situations like these, experts immediately start talking to each other. Because of the complexity, a lot of different types of expertise are needed, which is why you need clinicians, scientists, and public health professionals with different specialized expertise talking to each other and sharing reliable information. People who know about outbreak responses benefit from talking to people who treat Ebola patients who benefit from people with expertise in drugs and vaccines who benefit from people (like me) who understand how ebolaviruses infect people and make them sick.

That’s why I was talking to Dr. Céline Gounder and several of our colleagues with deep experience in Ebola. When I say “deep experience,” I don’t mean writing Substack articles about it. I mean multiple deployments and a scientific publication record showing years of experience studying ebolaviruses and responding to outbreaks. We started exchanging information so we could all get on the same page and answer each other’s questions. It quickly became apparent that, although we each come from our own specialized areas of expertise, we had all come to the same conclusion: although little is known, what we do know is that the situation is very, very, VERY bad.

There are around 250 suspected cases and 80 deaths. That means we lost precious time in identifying cases, which is disastrous when the outbreak happens in a remote, war-torn area bordering other countries with lots of travel. People fleeing violence, fleeing the outbreak, seeking safety, or simply moving around as people do, in an area that is difficult to access and extremely limited in resources is the worst possible scenario for outbreak response. To make things worse, the US withdrawal from global health deprives the international community of decades of expertise in Ebola outbreak response. Defunding USAID has led to increased violence, which was demonstrated last week in a peer-reviewed study in Science. Ituri province is in the eastern DRC on the border of Uganda and South Sudan, where there are large populations of displaced persons and refugees. Some suspected cases are hundreds of kilometers apart. In Uganda, a man from DRC who died in Kampala was confirmed to be positive, with another suspected case. There is at least one suspected case in Ituri’s capital Bunai, another possible case in the DRC capital of Kinshasa, and a confirmed case in Goma. These are large, crowded cities that are separated by hundreds of kilometers. Potential patients have already traveled widely throughout the region, increasing the chances of spread.

The 2014-2016 West African resulted in nearly 30,000 cases and more than 11,000 deaths. This epidemic exploded when it found its way to the cities of Conakry, Guinea, Freetown, Sierra Leone, and Monrovia, Liberia. I’ll never forget the only time I recall crying at a scientific conference. It was at the 2015 Filovirus meeting in Washington, DC, in which a CDC Epidemic Intelligence Service (EIS) member and officer in the Public Health Service Commissioned Corps, in full military dress, presented with a completely, just-the-facts straight face on the serious (and, at the time, ongoing) problem of transmission from unsafe burials. They showed a picture of dead bodies in the streets of Monrovia. Ebola is a horrific disease that causes enough suffering on its own without adding a massive, preventable public health risk on top of it. I also wasn’t the only person at the conference moved to tears by that image. I remember thinking to myself how we as a scientific community could never allow this level of indignity and human suffering could never happen again.

This outbreak has the potential for this to happen again. However, this time could be much worse. The reason that meeting occurred in the US is that historically, the US has been instrumental in responses to Ebola outbreaks. The Centers for Disease Control and Prevention (CDC) were the global leaders in rapid responses to emerging infectious diseases. The National Institutes of Health (NIH) was responsible for developing vaccines and countermeasures and supporting diagnostic testing. USAID provided critical infrastructure and training, especially in resource-poor low and middle income countries. The US and WHO worked closely together to coordinate responses. All of that is gone. The US has done nothing. The US is not capable of doing anything because its resources are too depleted.

Céline suggested we get together to discuss, to share what we as a group of experts know (and what we don’t) with the public, who will be understandably concerned, particularly since all of the actual experts are themselves agree this situation is potentially catastrophic.

So we had a long discussion on Friday night and now it’s available today. I hope you’ll find it as valuable and informative as I did. We are also all friends, so despite the gravity of the topic, we did lighten the heaviness of this situation a bit. My host who invited me to Hong Kong gave me a beautiful cashmere scarf, so I promptly used it for a Deborah Birx impression (the scarf is really gorgeous and it is Shanghai Tang, not Hermès, but I couldn’t resist since I am blonde, disagreeable, old, and good at wagging my finger). Céline’s dog Zizu kept popping in, as did Craig Spencer’s son.

And as far as expertise goes, our group really covers a lot of ground:

Dr. Céline Gounder, MD: infectious diseases physician and on the ground responder in Guinea in 2014, former Biden COVID-19 Scientific Advisory team, CBS News medical correspondent, KFF Health News Editor-at-Large for public health, and NYU professor.

Dr. Nahid Bhadelia, MD: infectious diseases physician and former director of the Special Pathogens Unit at the National Emerging Infectious Diseases Laboratory (NEIDL) at Boston University, deployed multiple times with WHO and other partners to treat patients in Ebola treatment units (ETUs) and train people in Sierra Leone, DRC, and Uganda, founding director of the Center for Emerging Infectious Diseases (CEID) at BU, former White House Senior Policy Advisor for COVID-19, and founding director of the Biothreats Emergence Analysis Communications Network (BEACON) based at CEID.

Dr. Craig Spencer, MD: emergency room physician, responder in Guinea, professor at the Brown School of Public Health, and Ebola survivor.

Dr. Krutika Kuppalli, MD: infectious diseases physician, veteran of multiple deployments to Ebola outbreaks throughout Africa, former WHO, and professor at UT-Southwestern.

Dr. Megan Coffee, MD: infectious diseases physician, machine learning and mathematical modeling expert, responder with the International Rescue Committee, and professor at Columbia University.

Me, Dr. Angela Rasmussen, PhD: virologist, with over a decade studying Ebola infection and pathogenesis in different animal models and using machine learning and computational modeling to study how the host influences the disease caused by the virus. Or, as Craig put it, the “nerd in the lab.” And a mid-tier Deborah Birx impersonator.

I’m working on a longer piece explaining more about the biology of Bundibugyo virus. In the meantime, hopefully you will find this discussion both informative and maybe even a little entertaining.