Hopkins is no stranger to battling epidemics. From the influenza epidemic of 1918 and 1919 to the AIDS crisis, Hopkins researchers have worked on accurately diagnosing patients, developing treatments and identifying at-risk populations. This is why, to Hopkins President Ronald J. Daniels, it made sense that Hopkins would host a symposium on the current Ebola epidemic. The symposium was held Tuesday, Oct. 14 from 9 a.m. to 1 p.m. at the Bloomberg School of Public Health (JHSPH). It was also available to the public on a livestream.
“As we consider the daunting implications for the global population, we are acutely aware of [the University’s] obligation to marshal our intellectual and moral bounty,” Daniels said in his opening statement before the symposium began. Daniels addressed the crowded auditorium after Michael Klag, dean of the JHSPH. Klag welcomed everyone who came and thanked Andrew Pekosz, an associate professor of molecular microbiology and immunology at the JHSPH, who organized the symposium.
Pekosz, following Daniels, gave a short synopsis of the symposium. Afterwards the official presentations began. The first speaker was David Peters, the chair of International Health at the JHSPH. Peters gave a presentation titled “‘Be happy, stay hopeful:’ A Community-Based Strategy to Fight Ebola.” Peters focused not just on the Ebola epidemic, but also on a way to fight epidemics in Africa in general. He addressed the idea of a self-reinforcing cycle of epidemics; one of the hardest-hit populations in Africa during epidemics is health care workers. There are 100 dead health care workers in Liberia alone due to Ebola. These deaths lead to clinics closing, which then leads to a worsening not just of the epidemic but also of all other diseases, such as malaria and pneumonia. This in turn leads to economic losses as people stop working and lose their income. Economic losses lead to a lack of social capital as distrust of the government and loss of community cohesiveness grows.
Peters believes that leadership is a way to end this cycle. He singled out Tolbert Nyenswah, the assistant minister of health in Liberia, from whom he got the “Be happy, stay hopeful” quote. He also talked about Felix Kabange, the minister of health from the Democratic Republic of the Congo (DRC). Kabange has experience from seven prior epidemics in the DRC and wants to share what he has learned from them with the afflicted countries in West Africa. One of Kabange’s ideas is to modify traditional burial ceremonies, which last a long time and require touching the corpse, which can lead to the transmission of Ebola. Kabange also wants to end the stigmatization of survivors and provide a high quality of care to patients.
Peters calls the concept he has come up with to halt epidemics the “Community Core Concept” (CCC). The CCC would be composed of a tightly knit team employed to act quickly and autonomously that would be deployed to a specific geographic area. The team would be made up of paid workers and volunteers who would ideally have their own labs out of which to work. The team would be composed largely of nurses and would rely on community leaders.
According the Peters, Hopkins is the ideal place to start this concept because of its experience in epidemiology, infectious disease management, infection prevention and health services management. Also, since the CCC is such a new concept with little evidence to support it yet, the name recognition Hopkins commands might be necessary to get people to pay attention to it.
Trish Perl, a professor of medicine at the School of Medicine and a senior epidemiologist at the Johns Hopkins Health System, spoke after Peters. In her presentation “Rethinking Care: Lessons from the Current and Previous Ebola Outbreaks,” she walked the audience through the background and epidemiology of Ebola. Ebola is one of two Filoviridae viruses, the other one being Marburg. The name Ebola comes from the Ebola River in the DRC, which is where Ebola was first discovered in 1976. There are five different types of Ebola, four of which reside in Africa. The type causing today’s epidemic is called Ebola Zaire and is one of the most feared for its deadliness.
Perl’s argument, similar to that of Peters, is that it isn’t enough to just go in with drugs that will help treat Ebola. We need to help African countries overhaul their health care systems in order to prevent transmission in the first place. Transmission is caused from contact with secretions such as saliva, tears and nasal blood from infected or deceased people. The very first infection came from an infected animal, but subsequent transmission has been human-to-human. Perl believes that simple barrier precautions can decrease transmission significantly.
Perl also believes that medical care needs to be improved. Liberia is facing serious challenges since their supplies are being rapidly depleted, they lack sterilization techniques for what supplies they do have and their isolation facilities are rudimentary at best. All of this contributes to the spread of Ebola.
Several departments of the U.S. government are assisting the stricken countries. The U.S. has pledged 4,000 troops, of which about 300 to 400 are currently in Africa. They are helping to coordinate logistics, train health care workers and build units to house patients. The U.S. sent about $750 million in aid in September and have decided to send $1.25 billion in October. The U.S. has provided the most money so far, with other contributions coming from other countries, the World Bank, the African Development Bank and the Gates Foundation. In total, about $818 million has been sent so far.
After the first session, there was an opportunity for audience members to ask questions of the three presenters. There were more question and answer opportunities throughout the symposium, as well as a panel discussion.
The panel and other sessions included a variety of other speakers. The featured speaker was infectious disease expert, Michael Osterholm, the director of the Center for Infectious Disease Research and Policy at the University of Minnesota.
Correction: This article previously misidentified the featured speaker.
