Ebola ça Suffit-Let us Hope

Scanning Electron Micrograph of Ebola Virus (NIAID, NIH)

It was less than a year ago that the world seemed to be on the brink of catastrophe. There were predictions that hundreds of thousands around the globe would die from Ebola which, at the time, was raging in West Africa. Ebola, named after the river in the former Zaire near which the first recognized outbreak occurred in the 1970’s had, and still has no known cure. In an outbreak of the magnitude that was developing in West Africa, experts from all around the world were floundering as to how to stem its menace: Anyone that came into contact with body fluids of an infected individual was at considerable risk of becoming a patient too and became primed, thereby, themselves, to spread the disease in ever expanding ripples of contagion. That kind of infectivity, coupled with the ways in which the disease manifests itself - the fever, the diarrhoea, the vomiting, bleeding and bloodshot eyes, collapse in the streets- induced a state of terror that was almost medieval in scale. 

Things were not helped by how some sectors of the press stoked up fear by publishing irresponsible statements and wild speculation. As the epidemic progressed, it appeared once in America, that sanctum of wellness and purity: If the walls of citadel America had been breached, where else was safe? Civilization was at the brink. It seemed that the world would regress back to the Dark Ages in the short space of a few months. 

          But nothing like that happened, we are relieved to say. Instead, cool scientific heads systematically considered options. The real challenge was in the outbreak’s epicentre, West Africa, where serious obstacles stood in the way of coping with an epidemic of the scope that was this outbreak. Nevertheless, with public health and acute medicine specialists hanging heads, and with generous support from world governments and medical charities, it was hoped that the disease would remain largely confined to the three countries where it raged, even in the absence of specific treatment or preventive measures.

          Options for managing the epidemic that were considered include administering combinations of so-called monoclonal antibodies engineered in plants (ZMAPP), serum from patients convalescing from the infection, or direct anti-viral agents such as Avigan, an experimental anti-influenza virus agent.  These treatments, although conceptually sound, had the handicap of not having been widely tested in humans before, even though studies had shown that they were effective in animals. Another confounding factor was that none of these treatments was available in any quantity at all. Only a few patients, lucky enough to be carrying the right passport had the opportunity to get access. 

It would be idle to consider the ethical issues involved in deciding who got the treatment, where, how and when. The more important consideration was how to make the treatments available for all in need by scaling up production to hundreds of thousands and perhaps even millions of doses. No one wanted to put up the money for such massive emergency production without reasonable expectation that the products would be effective and safe when used on a community scale. But first, it was how to get round an even greater problem namely, the idea of treating sick patients with medicines that have not gone through the usually mandatory phases of pre-clinical efficacy and safety trials. It was argued back and forth about where the ethical balance laid between trialing treatments that had not gone through the preliminary stages of evaluating safety in sick patients and thereby putting them to unknown hazards on the one hand, while on the other, worrying about the ethical soundness of not treating people who were dying just because we were too timid to try 'newly-hatched and un-fledged remedies'.

However, in the confusion, the well-founded principle that viral diseases are better prevented than treated was not forgotten. But here again, it was not such an open and shut case either because, although candidate vaccines were available, they too, had not undergone the rigorous pre-clinical trials to confirm their safety. So, you’re damned if you do and damned if you don’t. 

          As it has turned out, we escaped damnation alright: the ordinary barrier procedures surrounding nursing, and burial of the dead, gradually ensured that disease transmission was interrupted among those caring for the sick and the dead whilst quarantine, an always inconvenient imposition, ensured that community transmission was curbed. Thus, by time of this writing, the incidence of new cases in West Africa has sunk to zero. And at this time too, the CDC reports a total of 27,988 cases worldwide, with11, 299 dead (CDC Ebola Update 3rdWeek August 2015). The figures are horrible enough, but considerably less dire than the holocaust predicted a few short months ago.

          The rapid fall in the numbers of affected individuals and people at risk had meant that testing other therapeutic measures would prove difficult, not to mention the ethical difficulties that I referred to earlier. But researchers from the WHO, United States, South Africa, Switzerland and Mali, crafted a field trial in Guinea of such elegance (dubbed with the slogan Ebola ça Suffit by the investigators) that issues of ethics and falling numbers could not stand in the way of demonstrating a 100% effectiveness of the trial vaccine, rVSV-ZEBOV (Ebola ça suffit).

          There has been much jubilation, rightly, at this breakthrough, achieved so quickly and against such odds. But perhaps there should be a note of caution. This is because there have been reports of a “post-Ebola” syndrome, consisting of arthritis, hearing loss and visual problems. And we should note that preliminary studies to determine the rVSV-ZEBOV best dose for the Ebola ça Suffit trial showed that at a certain level, some recipients developed arthritis, requiring scaling down of the dose.

The question that arises then is, if rVSV-ZEBOV is approved for general use, could there be a risk, in the long term, of similar complications developing in those receiving the vaccine? 

   

Tell Fren Tru

Moaning in Toronto

You know the silly season is here when the death of a racoon on a city street makes the obituary columns. I would probably not have taken much notice of the reports myself except that the creature apparently died just round the corner from where we live.

In the nature of things, racoons everywhere die all the time, whether they enjoy an urban life or reside in their country habitat. Also, few would normally shed a tear when a racoon passes on, least of all for city-dwelling racoons. These are animals that do not normally endear themselves to city humans, principally because of their habit of upsetting our garbage bins during the night and leaving the mess for us to clear up.

But July is the month when public sources of entertainment dry up. Politics, especially, is at an ebb, with Parliament in recess and politicians find themselves at a loose end, with fewer opportunities to keep their mouths shut except at the traditional constituency barbecue. True, there could be music entertainments of all kinds, jazz, pop, classical, etc. Besides, every weekend sees some street party or the other in celebration of the city’s cultural diversity.  And of course, there are the staple shootings, stabbings, road rage and other fracas that keep the police busy. All predictable, but apparently not quite enough to satisfy our desire for something out of the ordinary. Even something as big as the Pan-American Games coming to town was, initially, not enough to get residents animated, leading to no less than the New York Times harrumphing that, “most Torontonians seem to be greeting the event with a shrug” (NYTPanAMGames) And, not until the country’s athletes started winning shedloads of medals did the city wake up to the possibility that something special might be going on on their doorstep.

But it seems that when it comes to dead racoons, we get pumped up enough to send messages around the world through the internet.  How else can one explain the sensational spread of an inconsequential story of a racoon dying at a street corner in mid-town? (DeadRacoon) Of course the term “viral” has acquired a whole new meaning in the last few years, perhaps without a full appreciation of the word’s provenance or of how the original can be a potential killer not to be trifled with.

Tell Fren Tru

We hold these truths to be self-evident...

 

What is it about America and race? Why does that country obsess so much about it? And, if you ask Americans, I doubt whether they themselves can give a coherent explanation why it looms as large as it does in their nation’s psyche.

In less than one year, there have been at least half a dozen occasions when race in America became the focus of not only national but international attention as well. Here is a sample of some of the more notorious ones:

·        July 17, 2014, Eric Garner died in New York City, after a police officer locked him in a chokehold. 

·        August 9, 2014, an 18-year-old man, Michael Brown, is fatally shot by Darren Wilson, a Ferguson MO cop. 

·        April 4, 2015, Patrolman Michael Slager fatally shoots Walter Scott in the back following a traffic stop for a non-functioning brake light in North Charleston, South Carolina.

·        April 12, 2015 Freddie Gray suffers a fatal spinal injury while being transported in a Baltimore MD police van that made several rough stops, starts and turns. Gray did not have a seat belt on. His only restraint apparently was handcuffs, a latter-day version of the Middle Passage.

·        June 5, 2015 Officer Eric Casebolt, a McKinney TX cop is filmed pulling his gun on a bunch of teenagers at a pool party. He wrestles a 14 year-old girl to the ground for good measure. 

·        June 10, 2015 Rachel Dolezal, the Spokane WA NAACP president is outed by her parents. She had been “passing” as black for many years.

·        June 17, 2015 Dylann Roof, a 21 year old joins a Bible Study group in Charleston SC’s Emanuel AME Church and sits in quietly for an hour. Then, declaiming hatred, he pulls out a gun and opens fire on the group of churchgoers he was ostensibly studying with. He kills nine of them.

The thing about these incidents is that, in nearly all, the victims are black. The exception is Rachel Dolezal's, whose journey to victimhood may have been partially self-mediated although eventually sparked by intra-family dysfunction. 

When you stand back, the dynamic in the majority of these encounters favours those with the power. Yet, those wielding power, influence and authority never seem satisfied unless the disadvantaged are rendered even more disadvantaged and, still better, dead. True, no one in his right senses would describe Mr Roof, the alleged assassin in the Bible Study murders as powerful and privileged (America, that bastion of the classless society has a term for individuals like this) but such is the overwhelming grip of racism in America that it pops up in the most improbable of circumstances.

There are two reasons why I am writing this post. One is that, what happens in America and what America does have resonance for the entire world; American Law is virtually World Law and all of us are expected to tow its line. Just ask FIFA. Besides, America would not have come about except for their expressed conviction thal all men are created equal. They say that upfront in their Declaration of Independence document.

The other reason is that American racism is just another iteration of tribalism. And while we in Africa now generally experience little racism, tribalism is alive and well throughout the continent. It is an ism that is every bit as corrosive as America’s principal moral failing. Perhaps even worse.

Tell Fren Tru

Finding Ourselves

I know. I have been quiet over the last few weeks.

Hope you missed me.

          The thing is, I got caught up in the spring migration back to Canada from West Africa. Now, back in the condo jungle that is Toronto, spring has been rather slow in coming. Not altogether ideal conditions for working, contrary to what some might think. Ordinarily, at this time of the year, one would expect the weather to be such that it gets the creative juices flowing, in tandem with sap rising. But enough of weather-related excuses. Spring has now fully sprung with temperatures in the mid-twenties, albeit under a blanket of cloud.

          A more germane reason for not getting down to actually writing is “research”, an activity that covers a range of sins from sitting in the park observing people go by, to watching lots of TV or surfing the net or sticking your nose in a book, activities that require more or less undivided attention, depending on the seriousness with which the task is undertaken or on how interesting the subject is. This time, I have been much captivated (pun not intended) by the problem of how to trace the origins of  Africans that were forcibly taken to the Americas during the Atlantic Slave Trade. 

          It had always been a challenge to determine who the people were that had been dragged from their homeland and taken across the Atlantic to live in slavery. And, as to where they came from, there was no dependable information either, although it was clear that the field of this execrable harvest was along the entire west coast of Africa bounded by the northern and southern tropical latitudes. And by the time the trade ended, recorded information of the 20 million slave identities was scarce, if available at all and, for the majority of these individuals memory, handed down the generations was also vanishingly scanty. Nor was there any remembrance of where exactly on the continent they had been taken from. 

When African slaves were landed on American soil there was no reception committee inquiring about who they were and where they had come from. They were just sold. Like so much chattel. In due course, individual identities became submerged under the weight of slavery’s institutions, losing their own names for that of their “owners”. Two hundred years after the end of slavery, the search for these individuals’ names, faces and personalities remains much as that for the holy grail. Now, as researchers sift through the detritus of history they are beginning to discover sources that might indicate not only geographic origins but, as well, suggestions of slaves’ original names and identities. I came upon some of these when I was, myself, researching my own antecedents as a descendent of “Liberated Africans”. Liberated Africans, or “recaptives”, were individuals freed from captivity aboard slave ships by the Royal Navy after Britain passed a law in 1808 declaring the Atlantic Slave Trade unlawful. 

From then, on to about mid-19^th century, the navy intercepted and captured hundreds of slave-carrying ships, freeing over 90,000 Africans and landing them at Freetown, Sierra Leone. The power of these sources is that the identity of each liberated slave is written down in a ledger kept by clerks of Britain’s colonial administration in Freetown, giving details of name, age, sex, physical characteristics and, importantly, the port on the African coast from which they had been taken. The records were in duplicate, one set remaining in Sierra Leone and the other sent to Britain. These records can be seen in the National Archives of Sierra Leone or at the Britain's National Archives. Besides, the records have been digitised and are available at http://slavevoyages.org/tast/resources/slaves.faces  

The main limitations of the records is that the names were, presumably, phonetically recorded (the clash of accents among clerks from different regions of Britain is best not imagined) and are not easily referenced to currently recognizable African names although, with a bit of imagination, useful guesses can be made. 

Besides being useful for identifying where Liberated Africans came from in the post-abolition era, the records are a potential proxy for where others might have come from during the active phase of the Slave Trade itself. But I won’t go there for the moment. It is enough to say that whenever men do evil they leave a trail that ultimately leads to their indictment. A warning to those thugs who violate the continent today. 

 

Tell Fren Tru