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- [00:00]
Dr. Craig Spencer
Hey, everybody.
- [00:01]
Jonathan Cohn
Welcome back to Bulwark Takes. I am Jonathan Cohn. We are here to talk about this Ebola outbreak. What's going on, why so many people are worried about it, what the US Is doing in response or not doing in response. Our guest today is Craig Spencer. He is an emergency medicine physician. He is also a professor of public health at Brown University. If he looks familiar, if his name sounds familiar, that's because he was in the headlines in 2014. He was part of a Doctors Without Borders mission to go treatment people in guinea during that year's 2014 Big Historic West African Ebola outbreak. He came back to the United States, contracted the disease. Thankfully for all of us, he's here, he survived. He's here to kind of walk us through everything from Ebola 101, what is this disease, to looking at what the United States is doing is not doing, and so on. Dr. Spencer, really, thanks. I know everyone wants a piece of you. I'm so glad you are here with us today.
- [00:57]
Dr. Craig Spencer
Yeah. Thanks for making time. I'm looking forward to chatting.
- [01:00]
Jonathan Cohn
Yeah. Yeah. So let's start high level here for people just tuning into this Ebola. What is it? Where does it come from? How does it spread?
- [01:06]
Dr. Craig Spencer
It's a great question because last night I was Talking to my 5 year old in bed and he had heard me on NPR yesterday morning and he was like, dad, there's this disease. I don't know what it is. Where does it come from? So I had to explain to him, you know, Ebola, bad disease, high mortality, there are multiple different strains of it. So people might be hearing that there's this thing called Bundebugio. Hard to spell. Hard to. Yeah.
- [01:33]
Jonathan Cohn
How do you say it one more time? How do you say it?
- [01:35]
Dr. Craig Spencer
Bundabudjo. Bundabudjo. Yeah, exactly. Keep going. So there are multiple different strains. The strain that we're dealing with now kind of looks the same clinically. If you're a provider or you're a patient, it's going to look the same or feel the same. But it's different than the strain that caused the 2014 outbreak and different from the strains that primarily caused most outbreaks. It's only the third time that we've seen a bull outbreak from Bundibugya Str. It is a virus that is transmitted. I've been calling it a disease of compassion because it's primarily transmitted between people taking care of other people when they're really sick. So think of a mom taking care of their kid or a family member burying one of their loved ones who recently died, or a healthcare worker that might be taking care of someone and the maximum part of their kind of contagiousness. We think that the reservoir for this virus is a fruit bat, meaning that the fruit bats can carry this virus, doesn't get them sick, but maybe if they chew on a piece of fruit that you later eat, or if you come in contact with their droppings, you can be affected. My son told me yesterday that if that's the case, that I probably shouldn't eat any fruit after a bat has eaten it. And I told him that's probably a good set of life advice, whether you're in Congo or in Colombia. And so, you know, we've known about ebola outbreaks for 50 years. There have been dozens of them. In reality, there have probably been many, many, many, many more that we just haven't detected because the majority of the time, they end up fizzling out pretty quickly.
- [03:20]
Jonathan Cohn
So this one's getting. I mean, we've had a number of outbreaks that did make the news since 2014. This one, I'm definitely detecting more concern, as much as I've heard about any of the others. I mean, the others have also generated concern. But what is it about this particular outbreak that has a lot alarmed who, declaring it a. WHO declaring it a crisis of international attention? What's going on?
- [03:41]
Dr. Craig Spencer
I was concerned as soon as I saw the announcement on Friday that this was going to be remarkably bad. And I know that as someone that's followed these outbreaks for the past decade, the thing that concerned me the most was that the case numbers when this was first reported was much bigger than most outbreaks when they end. And so even within the first day of this Ebola outbreak, it had already become one of the top 10 largest ever. Within the first 24 to 48 hours, it had joined the top five. And right now, I think it's probably the third largest Ebola outbreak ever. And again, we didn't know about this last Thursday. That's exactly why within a day, we saw the World Health Organization come out and declare a public health emergency of international concern, which is essentially a global call to arms to say, hey, this is bad. There's potential for regional and international spread. We need resources to manage this now, because otherwise this is definitely going to get much worse. We also saw on that first day cases not just in the Congo, but cases hundreds of kilometers away in Kampala, the capital of Uganda. This is concerning for so many reasons. Why one, we saw cases that were unrelated so think about two cases of a disease in a place that don't appear to be connected to each other. That's worrisome because that means they're coming from some source somewhere, maybe multiple different sources. You don't know where that source is. Could it be back in the Congo? Could it be somewhere else? Could it be somewhere in Kampala itself? And so we're now five, six days in. We don't have that much more clarity on exactly how bad this is. But what I can say with confidence is that case numbers are undoubtedly a lot higher than what is being reported. And this is almost certainly been going on a lot longer than what was initially thought, which was a case, you know, sometime towards the end of April on a health care worker.
- [05:39]
Jonathan Cohn
Yeah. So let's talk for a second about possible impact in Africa and then we're going to broaden the lens. What are we looking at here? Without an adequate response, what does this look like in the continent?
- [05:49]
Dr. Craig Spencer
There was an outbreak of Ebola in 2018-20 in exactly the same area, same region. There were thousands of cases. It was the second largest Ebola outbreak. It was super complicated, particularly because this is a tough place to work. I've worked in eastern Congo. Road infrastructure is really, really bad. It can take a whole day to go 50km. Health infrastructure is incredibly limited. You also have conflict. So M23 other groups.
- [06:21]
Jonathan Cohn
That's like a Rwanda backed militia rebel.
- [06:23]
Dr. Craig Spencer
Yeah, and there's. Exactly. So there's. There's multip. Different groups. We don't need to go back to 1994 and the genocide and the aftermath. But there have been for decades, there's been instability and conflict along the border with Uganda, with Rwanda. And this has created instability in the region for healthcare, but also just on a daily basis for folks that are living there, there are refugee camps. What we have with Ebola is an acute humanitarian crisis on top of a chronic humanitarian crisis. All of that layered on top of the fact that within the past year the US and other countries have pulled out a lot of their humanitarian support, including support for places like eastern Congo. Yeah. Yeah.
- [07:06]
Jonathan Cohn
Well, we're going to get to that in a second. Just before we get to that, for Americans watching this, they want to know, do I need to like start hiding in my house or whatever? I mean, I've heard most people I've talked to have said they are not at the moment certainly concerned of this becoming a worldwide pandemic. As things stand, what's an appropriate way to think about the level of concern? What should People be thinking in their personal lives.
- [07:29]
Dr. Craig Spencer
I think it's important for us all to be concerned. This is definitely going to get much worse. I don't have a whole host of optimism for how this unfurls in the next couple of weeks and in months. Quite frankly, do I think this is going to become the next global pandemic? No, Ebola is not an efficient transmitter. Like I said, it's a disease of compassion in that it's the people who care for others that get infected. But what you actually need to prevent and stop transmission is not all that complicated. Washing your hands, gloves. Ideally, when you're taking care of people, you're in full protective equipment. But even just using gloves, washing your hands, basic sanitation can slash the likelihood of transmission pretty high. This is not airborne. This is not a respiratory virus. This requires direction, direct contact. And so I'm not concerned about this spreading far afield and causing hundreds or thousands of cases outside of Congo. That being said, I would absolutely not be surprised if we end up hearing about cases not only a lot more in the region, but also cases in other countries around the continent, in Europe, maybe in the US and in other places. That would not be surprising to me at all.
- [08:44]
Jonathan Cohn
I do want to get to the US response, but just before we do that, you are one of the relatively unique experience of having both had Ebola and treated Ebola just for people to understand what it's like to go through this. I mean, what does this disease do to people and for health care workers, what's it like to try to treat it?
- [09:01]
Dr. Craig Spencer
I mean, what the disease does, unfortunately, is it kills, you know, half, if not more of the people that it infects. For the Zaire strain, the one that I was infected with, the one that's caused the majority of outbreaks, we have treatments and we have vaccines. Those created in the aftermath of the 2014 outbreak, those don't appear to work well for this strain, the Bendibugio strain. And we don't have vaccines or treatments. So that means we're gonna rely on good clinical care, good public health, end of contact tracing. The disease is pretty horrific in that it goes from kind of a non specific viral thing, you know, fever, headache, malaise, et cetera, to diarrhea, vomiting, some hemorrhage, so you could have bleeding from your gums. One of the things that we saw that was really, really kind of concerning every time we saw it was hiccups. So people that had hiccups seemed to be a, you know, pretty high predictor of mortality. And you just, you know, you see folks that maybe in the morning look okay, and you come back in the afternoon and they're dead. It is tough for providers who, you know, you're putting yourself in that position, which is really dangerous and really scary. But on top of that, you know, you're doing everything you can, and still, you know, 40 to 50% of the people you're taking care of end up dying, particularly people that are older kids.