#16 – The Ebola Outbreak Nobody Was Ready For

00:00:06: But then again, I don't think we have enough experience with this virus because there's only these two outbreaks historically.

00:00:13: So i think We have to hold off was actually saying This is less or more pathogenic than Ebola Zaire or Ebola Sudan and that brings us To the current outbreak Virological With Florian Kramer.

00:00:51: Hello And welcome to this week episode of ViroLogical!

00:00:57: May, the sixth of twenty-twenty six in Atlanta.

00:01:02: And today we're going to talk about Ebola virus also because it's an immediate lot and I think its worth explaining what kind of virus this is in general?

00:01:13: Also give a little update on current situation.

00:01:16: so Ebola viruses cause disease called Ebola Virus Disease or also call Ebola fever or Ebola hemorrhagic fever and we'll get to the explanation what this hemorrhagic means in this case.

00:01:32: These viruses are single-strand RNA viruses, so they have a singly stranded RNA genome that has negative polarity.

00:01:42: When you look at them there about eighty nanometer in diameter.

00:01:46: So it's not remarkable but their very long.

00:01:49: And thats the remarkable part.

00:01:52: They can be a thousand nanometers long even longer sometimes.

00:01:57: So, they're basically filamentous.

00:01:58: They look like worms and that's why their called filoviruses.

00:02:02: so Ebola viruses belong to the filovirus And then there are other filovires as well.

00:02:08: Marburg virus for example is another type of Filovirus.

00:02:11: We already discussed it.

00:02:13: Then theres also a Quavo virus which is Another type of Filovirus found in European bats.

00:02:19: The Ebola virus itself has different species.

00:02:23: we'll get into that When we look at how the particle is built, We have a genome on the inside.

00:02:29: The genome is protected by a nuclear protein and polymerase associated with the genome.

00:02:36: And then you also have cofactors Polymerase cofactos that are associated.

00:02:41: Then there's a matrix protein and lipid envelope.

00:02:46: In this lipid envelopes they have glycoprotein or GP.

00:02:50: That's the protein that the virus uses to attach to our cells.

00:02:54: The replication cycle is specifically the attachment to the cells and how the virus gets into the cell.

00:03:00: It's pretty interesting in this case, so the virus binds to a cell And then the cell takes up the virus into endosomes.

00:03:08: These are these vesicles that cells use to get stuff inside of cells Inside these endosomes the glycoprotein of the virus.

00:03:19: So spike protein is partially digested by proteins.

00:03:24: So, proteins are enzymes that cut proteins into little pieces and so part of the glycoprotein is destroyed And...that frees up another part of a glycoprotene That then can bind to the real receptor in it Receptor's called Niemann Big One.

00:03:43: It's a protein in the endosome.

00:03:46: Once the virus binds there fusion can occur between the viral membrane and the endosomal membrane.

00:03:54: And then basically, inside of the virus is emptied out into the cell.

00:03:59: so basically a genome is released in to the cells that allows the start-of-virus replication in the cytoplasm I already mentioned.

00:04:09: there are other phylloviruses Other than Ebola viruses Marburg and Joby or Quiva virus.

00:04:17: but even Ebola virus has different species.

00:04:21: The most prominent one is Seir Ebola virus.

00:04:24: That's the species that has caused so far, the most damage.

00:04:29: Then we have Sudan Ebola virus which in a way it was second-most prevalent.

00:04:35: then we have Pondipugio Ebola virus and will talk about this little bit more at end.

00:04:41: We have Typhorist Ebola virus We have Reston Ebola virus And we have Bambali Ebola virus.

00:04:48: They'll go through them one by one.

00:04:52: In general, we know the most about say year Ebola virus.

00:04:56: just because there's a lot of outbreaks with this type of Ebola virus and so it has been better studied.

00:05:03: Typically for these filoviruses when outbreaks happen the assumption is that these are zoonotic events.

00:05:13: We know that Marburg and Lobioquiva virus are carried by bats.

00:05:19: That's the reservoir.

00:05:21: And from bats, Mabuk virus can jump over into humans and cause outbreaks.

00:05:26: For Lovio-Cueva virus we don't know if that can actually cause disease in humans.

00:05:32: for Ebola virus We assume it's also in bats but there is no absolute proof of that except one of the Ebola viruses from Bali virus.

00:05:43: But the assumption is that the virus jumps occasionally form animals might be from bats, or other animals in humans and then causes outbreaks.

00:05:55: So basically we have initially a zoonotic transmission animal to human.

00:06:01: one factor.

00:06:01: there may be bush meat.

00:06:03: so when people catch lot of different species wild animals use them for food from the jungle.

00:06:13: that can drive these outbreak.

00:06:16: And of course when animals are hunted and then butchered people come in contact with blood, with other bodily fluids.

00:06:24: With raw meat that is a way to get infected with Ebola virus.

00:06:31: However as I said the reservoir isn't clear except for Bombali virus.

00:06:35: Assumption is bad But it's not hundred percent clear.

00:06:38: Then once the virus is in humans It can also spread from human to human.

00:06:42: That's not super efficient.

00:06:44: Typically the spread is via bodily fluids, blood saliva tears sweat semen milk vomit for example.

00:06:53: and then the assumption is that it can also spread by large droplets respiratory droplets.

00:07:00: but again It's not really aerosol transmissible in this sense as coronaviruses or influenza viruses are aerosols transmissible which means because you almost need direct contact to another person or to contaminated objects, that the virus is relatively easy to stop.

00:07:22: Containment is relatively easier compared with something transmissible via aerosols for example.

00:07:30: That doesn't mean it's not like an actual outbreak but goes global right away.

00:07:39: The incubation time between two and twenty-one days.

00:07:44: And the first symptoms are relatively unspecific influenza like symptoms, fatigue fever loss of appetite muscle and joint pain headache sore throat.

00:07:56: so typical unspecific symptoms that one gets when you have a virus infection then discontinues with often vomiting diarrhea lot of GI tract issues.

00:08:08: chronic hiccups can be rare a rare symptom and then often also but not always bleeding from gums, from other mucosal surfaces.

00:08:20: From the eyes bleeding under this skin.

00:08:23: And that's what is meant with hemorrhagic fever.

00:08:25: So basically a bleeding right?

00:08:28: That occurs!

00:08:29: Thats why it called hemorrhaegic fever.

00:08:32: But again This Is Not Always The Case.

00:08:35: Then people typically die of multiple.

00:08:40: People typically die of multiple organ failure.

00:08:44: And the case fatality rate, so the mortality rates with Ebola can be pretty high.

00:08:49: for ebolas a year it's up to eighty-to ninety percent.

00:08:53: So that is really very high and highly problematic.

00:08:57: Of course even people who recover have long lasting issues post recovery.

00:09:04: what has been observed as hearing loss problems with vision hair loss, there's even observations that the eye color can change.

00:09:15: That probably has to do with the fact that the virus can persist in their eyes a little bit.

00:09:20: actually Ebola virus is good at persisting on what we call immunoprivileged sites so sites where the immune system isn't very active another important site that is immunoprivilized.

00:09:31: this test is in man, testicles right?

00:09:34: and it has been observed that Ebola survivors actually have Ebola virus in their semen for quite some time.

00:09:44: And there's at least one case where an Ebola survivor after recovery infected a sexual partner with Ebola virus, so of course this doesn't help patients, Ebola survivors are stigmatized already.

00:10:02: And then you also have this issue that they can potentially transmit the virus after recovery.

00:10:07: so it's really problematic.

00:10:10: A little bit about history.

00:10:12: The first outbreak was recorded in Saïr in nineteen seventy six.

00:10:18: Saïre is now the Democratic Republic of Congo at DRC and This outbreak was reported in a small village called Yambuku.

00:10:28: That's actually in the area of the Ebola River, but not really that close.

00:10:34: But the virus is named after the Ebola river and this outbreak was associated with a mission hospital that was run by Belgian nuns And this outbreak resulted in about three hundred and this out break resulted in three hundred eighteen cases and two hundred eighty deaths.

00:10:53: So it's like case fidelity rate of eighty eight percent.

00:10:57: The assumption is that this outbreak was actually fueled by the hospital.

00:11:02: Back then, pregnant women often got injections with vitamins and it seems that the nuns sterilized their needles overnight but not between patients And they might have fuelled the outbreak.

00:11:18: What was observed back then?

00:11:20: Was already that often health care personnel are also affected.

00:11:25: eleven out of the seventeen healthcare workers at that hospital died as well.

00:11:30: And there's actually a really interesting book about it written by Belgian virologist Peter Biot, It is called No Time to Lose.

00:11:39: He went here to investigate.

00:11:42: so The first start in that outbreak was this yellow fever and samples were sent to Belgium.

00:11:49: In Belgium they tried to culture these virus.

00:11:52: back then in laboratories, tissue culture containers were still made out of gas.

00:11:59: Nowadays this is plastic but the story that he describes in a book was one of these containers broke and you know typical lab worker runs around with open shoes and Birkenstock shoes.

00:12:14: so supposedly one of those containers broke.

00:12:18: The lab worker had this Ebola culture everywhere on his socks.

00:12:23: Nothing happened in the end, but shortly thereafter they got a call from U.S.

00:12:28: CDC who had also gotten sample from Yambuku and said it's not yellow fever and Belgium should destroy their samples right away.

00:12:41: And so instead of you know being afraid this new virus Peter Bjort actually went there to Yambukku and helped with that outbreak investigation.

00:12:53: After that there were a number of Ebola's year outbreaks every now and then, typically numbering between ten to three hundred cases.

00:13:03: Most of them focused on Central African countries often in rural areas which makes sense potentially for bushmeat consumption being close sources for bush meat.

00:13:17: One really big outbreak and that is a remarkable outbreak happened in West Africa So not in the region.

00:13:24: That was known for Ebola outbreaks And there was bit of problem, this outbreak happened between two thousand thirteen and two thousand sixteen and This region where it happens wasn't associated with Ebola.

00:13:39: so The start of these outbreak was missed a little bit.

00:13:43: You know There were late starts trying to contain it.

00:13:47: The first case was recorded in Guinea, December of the year.

00:13:53: In a two-year old child and then infection started to spread in Guinea And from there it made into Liberia and Sierra Leone.

00:14:03: Initially this was also fueled by traditional burial practices where people touched that body of person who just died as a last right and that of course when the person died of Ebola is not a good idea.

00:14:23: The problem here was, that the virus infections were not limited to rural areas which was the case before.

00:14:32: The virus actually made it into urban areas – to Conakry in Guinea , to Monrovia & Liberia and to Freedown in Sierra Leone And this makes it much harder to contain.

00:14:44: You can imagine crowded cities and this virus, even though it's not super transmissible... ...can spread relatively easily in a crowded situation.

00:14:58: In areas with high densities of people.

00:15:00: Nevertheless the outbreak was contained.

00:15:03: It took quite some time but mostly this was done by information campaigns, isolation and quarantine measures And it was stopped in two thousand sixteen.

00:15:13: In the end of this outbreak, there were more than twenty-eight thousand reported cases and more then eleven thousand people had died.

00:15:21: So that's a huge number of cases for an Ebola outbreak And so far it has been the biggest Ebola outbreak in history.

00:15:29: The worst didn't stop at in these countries in Guinea Liberia and Sierra Leone.

00:15:34: There were also exported cases in Nigeria, in Mali and Senegal.

00:15:39: And then there are also cases in Italy Great Britain Spain and other countries those where mostly medical personnel that was flown out from these zones... ...and then treated in Western Countries.

00:15:54: What has to be said is the case fidelity rate for this infection that the case fidelity rate for Ebola is very high, but it also depends a little bit on treatment and setting of the treatment.

00:16:12: It seems to be case fidelity rates are lower when people are treated in North America or Europe And this might just have to do with intensity health care.

00:16:22: In an ICU you get compared hospital settings.

00:16:28: There's another species of Ebola virus that has caused larger outbreaks and that is Ebola Sudan.

00:16:36: This was also recorded for the first time in nineteen seventy six, like Ebola as a year but in different countries South Sudan In Asara And this first outbreak led to two hundred eighty four cases and one hundred fifty-one deaths have been observed with Zudan Ebola virus every now and then.

00:17:01: The case for Delta D-rate of this species is somewhere between forty and sixty five percent.

00:17:07: There was actually a more recent outbreak in Uganda, which cases also in Kambala.

00:17:13: Kambal is the capital of Uganda.

00:17:16: it has about four and half million populations so that's also relatively big city And back then there were also concerns that these could spread but the outbreak was actually contained.

00:17:29: Then we have another species of Ebola virus that's Type IV is the Ebola virus, which was detected in Cotywaa in nineteen ninety-four.

00:17:41: So Cotyvaa is every coast and there are only one human infection recorded.

00:17:46: so In nineteen ninety four there were deaths in chimpanzees involved chimpanzee and a veterinary was dissecting them performing necropsy on the gym carcasses.

00:17:59: And then got sick, and was flown to Switzerland and survived the infection... ...and the causative agent was new Ebola virus!

00:18:09: The forest where these gyms were found is called typhorests.

00:18:16: that's how this virus name it.

00:18:18: Then there are the curious cases of restnipolar virus.

00:18:22: This is not a virus that showed up in Africa, actually has nothing to do with Africa.

00:18:28: It was first detected in the suburb of Washington

00:18:31: D.C.,

00:18:32: Reston and thats why it's called Reston Virus.

00:18:35: So they had a primate center there And in nineteen eighty nine end of nineteen eighty-nine beginning of ninety ninety They have lot of monkeys A lot non human primates died There.

00:18:49: These were macaques from the Philippines And it turned out that the virus that infected and killed them was another species of Ebola virus.

00:18:57: That was then named Rastny Ebola virus.

00:19:00: At a time there were no symptomatic infections in humans reported, so people who worked with these macaques but some of them developed antibodies.

00:19:10: So seems like they got infected But didn't get sick but develop an immune response.

00:19:18: And this virus was traced back to the Philippines where these macaques came from and it wasn't just Reston or this primate center in Reston, but other primates centers were affected too.

00:19:30: One in Pennsylvania for example one in Texas.

00:19:33: then the virus showed up again in a Texas primate facility.

00:19:38: In two thousand eight I believe It also detected in pigs in Manila.

00:19:45: so its clearly associated with the Philippines, it seems to be only Asian Ebola virus.

00:19:51: that again was first reported in a suburb of Washington DC.

00:19:57: But again... It's not clear if this virus can cause disease in humans and doesn't look like it.

00:20:04: And then we have Bambali Ebola virus.

00:20:07: That is the youngest one.

00:20:08: The youngest species that was discovered Was discovered in two thousand eighteen In Sierra Leone.

00:20:15: The virus itself wasn't isolated, but the genome was identified in samples from two different pet species.

00:20:24: Angola-free-dale pets and little free-dale bats.

00:20:29: As I said, the virus isn't isolated But you can still study the glycoprotein And if it can bind to human cells It can enter human cells.

00:20:37: You could also make pseudoviruses and study that this glycoprotein of Bambali Ebola virus can actually bind to human cells and help the virus get into human cells.

00:20:51: But we don't know if it can cause human disease, so far there's no cases... Human case is reported!

00:20:58: And again these are also the only Ebola viruses where you know for sure that they're circulating in beds.

00:21:06: For other ones the assumption was that they do as well but proofs were missing.

00:21:12: I left one species out and that is Pondipusia, we'll talk about it in the end.

00:21:18: Of course these are very dangerous viruses.

00:21:22: as soon as they were discovered people started to develop vaccines which was actually successful.

00:21:29: Vaccines were designed then tested for animals mostly non-human primates but worked well But then they weren't further developed.

00:21:41: It gets really expensive if you want to test vaccines in humans and there was basically no need because this sporadic outbreaks, You can use vaccine for ring vaccination.

00:21:53: For example.

00:21:54: but you can't just vaccinate the whole population Because these outbreaks are so sporadic And There also is not commercial interest.

00:22:01: We can imagine that If there's No need globally for these vaccines It also doesn't make sense for a company to make them, right?

00:22:13: And so basically the vaccines worked.

00:22:16: Men tested in animals but they didn't progress into human testing.

00:22:22: But then this West African outbreak came The really big one and now everybody needed vaccine In these outbreaks area To help contain their outbreak.

00:22:33: There was no data on the vaccines.

00:22:35: people started to do quick phase one trials in North America and Europe.

00:22:40: The Phase One Trials are usually done test safety, then testing in West Africa started.

00:22:47: the issue here was not an issue.

00:22:51: it actually a good thing that they outbreak.

00:22:53: at time when the safety trials were The outbreak was almost contained, right?

00:22:59: And then the field studies with the vaccines started in West Africa and only one of these studies actually produced results just because there were not that many cases anymore.

00:23:10: It's also hard.

00:23:11: an outbreak scenario like this is a virus that kills often fifty-sixty-seventy percent of people who are infected.

00:23:20: to design a trial which is ethical You don't want to have a placebo control group And so there are some designs that you can use where people get the vaccine earlier and other in-the area later, which may have been also kind of unethical but at least allows to calculate efficacy.

00:23:42: So one vaccine was successfully tested for an outbreak then used to contain following outbreaks vector that's called vesicular stomatitis virus.

00:23:59: That is a virus typically infects cattle, but it can be modified and has spike protein.

00:24:06: you take the spike protein away instead give it Ebola spike protein.

00:24:11: in this case Ebola is a year spike protein.

00:24:14: then the virus replicates.

00:24:16: doesn't replicate very well in humans so means its attenuated.

00:24:21: thats why it can used as virus.

00:24:25: But then if you vaccinate somebody with this vaccine vector that expresses the Ebola glycoprotein, it grows a little bit in the vaccinated individual and that's enough to trigger good immune response against the Ebola-glycoprotic.

00:24:42: So again these worked well!

00:24:44: This is now a vaccine available specifically for Ebola a year.

00:24:49: A second vaccine which also based on viral vectors actually two different ones box vector, mba and then adenovector at twenty six.

00:24:59: So this is given in sequence.

00:25:01: both of these vectors also express the glycoprotein of Ebola's a year.

00:25:05: so second vaccine has been developed and licensed and so these vaccines can be used but again they're specific for Ebola as a year.

00:25:13: And there are also antibody therapeutics.

00:25:16: now There's cocktail of three antibodies that was developed by Regeneron that can be used for treatment of Ebola's a year, and then there is the single antibody treatment option.

00:25:28: That can also be used to treat Ebola's here.

00:25:31: so far Ebola say you're there as now countermeasures does vaccines?

00:25:35: And there are small acrylonal antibody treatments might not be perfect but they really great counter measures.

00:25:42: But again their specific for Ebola.

00:25:44: said your and thats the issue right.

00:25:47: know going to the current outbreak and do the last species of Ebola virus that we're gonna talk about.

00:25:56: And, that's bundibugio.

00:25:58: Historically this... ...species has caused two outbreaks so far.

00:26:03: The first lasted from November seven to January eight and that occurred in Uganda in the Bundibugia district.

00:26:13: That is why the virus was named like that and there it infected hundred sixteen individuals, and thirty-four of them died.

00:26:21: So that's a case fidelity rate at about thirty four percent.

00:26:24: The second outbreak happened from August two thousand twelve to November of two thousand twelfth in East Zero That is the north east of the DRC.

00:26:35: It was about four hundred kilometers from Bundy Bujo.

00:26:39: so not too far away makes sense because they chose up their tour And depending On the case definitions, either fifty-seven or sixty two cases occurred and either twenty nine or thirty four of them died.

00:26:54: So that's roughly a case for deadly rate of fifty one percent.

00:27:00: And so historically based on these two outbreaks I think their idea was this is milder form of Ebola which you know fifty five hundred percent even thirty four percent case for daily rates not really mild but compared to Ebola Zaire, it seems lower.

00:27:20: But then again I don't think we have enough experience with this virus because there is only these two outbreaks historically.

00:27:28: so i think We need hold off on saying that this is less or more pathogenic than Ebola Zair.

00:27:38: and that brings us the current outbreak here.

00:27:41: The current outbreak started in the Ituri province, in the DRC.

00:27:46: So that's three hundred fifty kilometers from Isiro to a little bit south.

00:27:51: and I think first record of person being sick then dying of Ebola-like disease is on April twenty fourth this year.

00:28:05: On May fifth the WHO was alerted.

00:28:09: samples Potential cases were tested and they tested negative, but there we only tested for Ebola's a year because nobody expected Bonifugio Ebola virus in that area.

00:28:25: And so probably false negatives was just the wrong test.

00:28:29: it was used.

00:28:30: on May fourteenth It was confirmed these are Ebola infections.

00:28:36: On may fifteenth this was then announced officially by government of the DRC as the seventeenth Ebola epidemic in the DR.

00:28:47: And then May, sixteenth there were reports of potential cases in Kinshasa that's the capital of the Drc and in Kambala That is the capitol of Uganda.

00:28:58: I think it turned out to be a case was false positive but not really an Ebola infection which problematic because that's in the large city and also suggests, there was at least some spread already.

00:29:19: On May seventeenth cases were reported from north Kivu where you often have Ebola's a year outbreaks including casein in Goma which is a larger settlement, And on May, the WHO also declared a public health emergency of international concern.

00:29:39: I think for them it was already clear that there is lot potential cases and the case numbers were high compared to when the virus outbreak was detected right?

00:29:52: That triggered this in combination with the fact we don't have countermeasures against Bundy Bujio Ebola virus.

00:30:03: On May eighteenth, there were already five hundred sixteen suspected cases and one hundred thirty-one deaths that was expected to be caused by Ebola.

00:30:13: And there are thirty three confirmed cases in four confirmed deaths.

00:30:17: So this is basically a little bit more than the week ago.

00:30:21: so as of today they have reported that there's thousand eighteen suspected N confirmed cases and two hundred thirty three deaths.

00:30:33: And seven cases in Uganda, one death.

00:30:37: Two of these seven cases seem to be healthcare workers where it's not clear were they got infected.

00:30:45: In addition there was news that American physician Peter Stafford tested positive on May eighteenth and was then flown to Germany for treatment.

00:30:58: many countries put emergency measures in place put travel advisories out, Uganda banned handshakes and hacks and unnecessary physical contact.

00:31:13: The US ban travelers from the DRC, Uganda and South Sudan which South Sudan doesn't make any sense because there's no cases so far except for U.S citizens can.

00:31:27: When they come back from these countries, They can still enter the United States.

00:31:31: But they have to fly via Washington and enter through Dallas International Airport And as I said there's a lot of travel advisories out.

00:31:42: There are lots of emergency measures.

00:31:46: There is four issues that make people nervous.

00:31:52: The first one was that this outbreak was recognized relatively late because inappropriate tests were used and so there's already a large outbreak ongoing.

00:32:05: And we're just a few days into the outbreak, So this could grow relatively quickly.

00:32:11: counter measures on these starting now?

00:32:14: There is a few complicating factors as well but one issue that the outbreak is very large it not going for long time yet.

00:32:24: The other issues are that we don't have vaccines or treatments of Ebola virus.

00:32:30: There's some experimental data from animals that the VSV-based vaccine, which has been licensed for Ebola a year could potentially work to certain degree.

00:32:43: But there is basically just one animal study suggested and it wasn't complete protection.

00:32:48: so probably makes sense to use this vaccine, but I don't know how much you can expect from it.

00:32:54: There needs be a risk-benefit analysis done and then decisions need made if they should or shouldn't have been used.

00:33:01: If that helps is not clear But probably better than doing nothing.

00:33:07: there's a number of molecular antibodies in development.

00:33:10: The target only puts either specifically or a BAN Ebola Antibodies.

00:33:17: the problem isn´t ready.

00:33:20: One of the antibody cocktails that's used for treatment of Ebola's a year has one antibody, so it is three antibodies that are mixed together.

00:33:31: It seems to have some activity against bundi budgea but this needs to be confirmed.

00:33:36: But basically all these counter measures developed for Ebola in a year aren't there for Bundi Budgeo.

00:33:42: So that makes the situation also complicated.

00:33:46: The other issue outbreak happens in an area, the DRC where you have civil war and unrest.

00:33:53: There's a lot of different parties that are fighting each other.

00:33:59: You've got this Congo River Alliance which controls part of this area.

00:34:04: M-Twenty Three is another party or armed group associated with this Congo river alliance.

00:34:12: It seems that Burundi and Rwanda has some kind of military in their areas.

00:34:18: There's, of course the army of the DRC that tries to fight these other armed forces.

00:34:26: And then a little bit to the north you have the elite democratic forces from Uganda That is basically an armed force of Islamists and then we have the Ugandan Army.

00:34:37: So there are lots of chaos here.

00:34:42: Of course when all this armed conflict happens there's no way to tackle this in an efficient and safe way for healthcare workers, right?

00:34:53: So that another factor makes it complicated.

00:34:56: And I think the last important point is... There are really a lot of loss-of-support from the US.

00:35:03: The USAID kind of stopped basically.

00:35:07: A lot less effort goes into stopping these from the U.S side.

00:35:12: There was a lot of expertise there, and it had lots of competence.

00:35:16: And that's not missing too.

00:35:21: Those are the four points why this is complicated Large numbers already early in outbreak No counter measures civil unrest in area and loss support through US.

00:35:35: This is really a tragedy for local population.

00:35:38: This outbreak will likely grow.

00:35:40: It might be become the second largest Ebola outbreak, it might even became the largest Ebola outbreak so far.

00:35:48: It's really hard to say again this is a tragedy for the local population.

00:35:54: but we also have to be careful about you know not panicking about these.

00:36:01: This isn't going to be global pandemic.

00:36:04: very unlikely with transmission routes that Ebola virus has that this is going to spread and become a pandemic, right?

00:36:11: This is locally epidemic.

00:36:15: That will be hard-to-control –that's my assumption– but international spreads are much easier to control in these cases specifically because of the transmission through contact, through bodily fluids, through contaminated objects... But not through aerosols!

00:36:34: So basically, because of this different transmission routes the virus is much easier to contain in that area.

00:36:41: But it also teaches us an important lesson we need be prepared for these things.

00:36:46: We had a very similar situation few weeks ago with the Andershanta virus and outbreak came before lot people out-of-the blue.

00:36:56: nothing in terms counter measures was prepared And now we have the same situation with this species of Ebola virus again.

00:37:04: This really shows us how important it is to invest in preparedness, outbreak preparedness epidemic preparedness pandemic preparedness.

00:37:15: That was for today.

00:37:16: Thanks for listening In and as always if you have any comments concerns questions just send an email at Virological.com And if you like the podcast, please support it on Steady.

00:38:06: Thanks!