Winter 2014 Vol. 14 Number 2
PREPARING FOR EBOLA
Workshop Explores Research That Could Aid U.S. Efforts
In the fall, as parts of west Africa struggled with the worst outbreak of Ebola in history and the disease made its first appearance in the United States, hospitals and public health officials in the U.S. grappled with how best to respond and prepare for any future cases that emerge. At the request of three agencies in the U.S. Department of Health and Human Services, the Institute of Medicine and the National Research Council hosted a workshop in early November to discuss priorities for research that would give U.S. public health officials, health care providers, and the public the most up-to-date information about transmission and steps that should be taken to prevent the disease from spreading.
"The emergence of Ebola is a wake-up call for the importance of having a robust preparedness, public health, and hospital system," said IOM President Victor Dzau in welcoming over 250 participants who attended in person, along with over 500 who listened to the webcast. "In addition, it is important to ensure that guidance and actions are based on up-to-date scientific evidence. Only then can we rest assured that we are doing our best for our patients, for the providers, and for society. There are still many unknowns regarding Ebola virus, and we must put enormous effort into research that addresses them."
An overview of Ebola in the U.S. context was offered by James LeDuc, director of the Galveston National Laboratory in Texas. Available data confirm that patients start to "shed" virus in bodily fluids at the time they start to show symptoms, and that the concentration of virus gets greater as the disease progresses, peaking upon a patient's death, he said. LeDuc also explained some lessons learned from the Ebola cases in Dallas, such as the importance of safe donning and doffing of personal protective equipment. Additional presentations covered the existing research landscape on Ebola and observations from Africa's battle with the virus that could inform future research.
In four breakout sessions, workshop participants took a more focused look at several areas. During one session, individual participants identified questions about the virus's transmission that merit more research -- including whether transmission can happen in the absence of symptoms, how much virus is present in bodily fluids during different phases of the disease, whether Ebola could be spread through particles or droplets in the air, and how to safely handle the bodies of those who die from the disease.
Another breakout group discussed the need for research on how long the virus survives and is infectious outside of the body. Participants pointed to questions such as whether the virus can be spread through household surfaces and other materials, how it can be rendered noninfectious, and what the virus's definitive incubation period is. During an earlier session, C.J. Peters of University of Texas Medical Branch had observed that it's possible a small number of people could surpass the 21-day incubation period before showing symptoms. Additional breakout sessions identified research questions related to personal protective equipment and waste management.
In one of the closing sessions, Dzau and workshop chair Lynn Goldman, dean of George Washington University's School of Public Health, asked participants to identify important aspects of Ebola response that were not addressed by the workshop. Many participants said that communicating with the public is an important area for research. One participant pointed to a need for research on the effectiveness of different quarantine options, while another suggested research on how best to care for patients who show up at hospitals with "undifferentiated symptoms" -- symptoms that might be either Ebola or something else.
-- Sara Frueh