Peter Piot

The Discovery of Ebola (1976)

• Initial Encounter and Context:

  • Doctor Peter Piot, currently the Director of the London School of Hygiene & Tropical Medicine (LSHTM), was in training for infectious diseases and clinical microbiology in $1976$.
  • This period was exactly $2$ years after he had completed medical school.
  • In September $1976$, a sample arrived at the Institute of Tropical Medicine in Antwerp, Belgium, where Piot was working.

• The Physical Sample (The Blue Thermos):

  • The sample was delivered in a shiny, blue thermos.
  • It was brought by a pilot from a commercial flight originating in Kinshasa, the capital of modern-day Democratic Republic of Congo (then known as Zaire).
  • The thermos contained two glass vials swimming in water and melting ice cubes; one of the vials was broken upon arrival.
  • The accompanying information for the sample listed a suspected diagnosis of "Yellow Fever?"
  • The sample consisted of blood from a Catholic missionary nun who had died of a suspected yellow fever infection.

• Laboratory Analysis and Virological Methods:

  • Because yellow fever is an arbovirus, the team followed standard protocols for that family of viruses.
  • Diagnostic technology in $1976$ did not include rapid diagnostic tests, DNA detection, or RNA detection.
  • Isolation methods involved inoculating the sample into:
    • Mice.
    • Guinea pigs.
    • Baby mice.
    • Specific cell lines.
  • After several days, the team observed a "cytopathic effect," meaning the cell layer was being disrupted. This indicated the presence of a toxic element or a living virus.
  • Following the cell disruption, the inoculated mice began to die.

• Morphological Identification:

  • Since viruses cannot be seen under a normal microscope, the team used an electron microscope.
  • The shape observed was unconventional and baffling: instead of the standard sphere, cube, or rectangular shapes, the virus appeared as very long filaments resembling worms.
  • Lacking internet or Google, the researchers consulted a physical atlas of viruses.
  • They identified only one other virus with similar morphology: the Marburg virus.
  • Marburg Virus Context: This virus had previously caused an epidemic among vaccine workers in Marburg, Germany, and was known to be highly lethal.

• Safety and External Confirmation:

  • The initial work was performed under regular laboratory precautions (e.g., latex gloves, flow hoods), which would be considered illegal or insufficient by modern biosafety standards for such a pathogen.
  • Upon hearing reports of a major hemorrhagic fever epidemic in the Zaire rainforest, the World Health Organization (WHO) ordered the laboratory to stop work immediately.
  • The sample was shipped to the Centers for Disease Control (CDC) in Atlanta, Georgia.
  • The team at the CDC, led by Karl Johnson, eventually proved that the virus was not Marburg, but a brand-new virus.

Field Investigation and the Naming of Ebola

• The Expedition to Central Africa:

  • Approximately one week after the virus was isolated, Peter Piot (then age $27$) traveled to Central Africa.
  • He joined an international team comprising:
    • Congolese public health physicians.
    • American doctors from the CDC.
    • Representatives from the Institut Pasteur (France).
    • Specialists from South Africa.
  • Piot volunteered to go to the epicenter of the epidemic, driven by the scientific excitement of discovering the transmission vector of a new pathogen.

• Transmission Vectors Identified:

  • The team used basic epidemiology over the course of a few days to identify two primary modes of transmission:
    1. Close Contact: Direct contact with someone who was sick or through funeral rites (handling the deceased).
    2. Contaminated Injections: The use of unsterilized needles.

• The Naming Process:

  • The team avoided naming the virus after the discoverers, as it was considered to be in "bad taste."
  • The team avoided naming it after the epicenter village, Yambuku, to prevent stigmatizing the local population.
  • They decided to follow the convention of naming viruses after rivers.
  • Using a small-scale map of the region, they identified the closest river to Yambuku: the Ebola River.
  • The name was chosen for its "beautiful" sound and to avoid regional stigma.

Comparison of Historical Outbreaks vs. the 2014 West African Crisis

• Historical Pattern ($1976$ to $2014$):

  • There were approximately $25$ known Ebola outbreaks in this timeframe.
  • Geography: Almost all were in Central Africa (Congo, South Sudan, Uganda, Gabon).
  • Scale: Typically limited to $50$ to $100$ deaths per outbreak.
  • Characteristics: Limited in time, place, and person; usually occurred in rural areas.
  • Exceptions: The $1995$ outbreak was larger, but cumulative deaths remained low.
  • Cumulative statistics prior to $2014$: Approximately $1600$ known deaths in total, averaging fewer than $40$ deaths per year.

• The 2014 Outbreak (The "Perfect Storm"):

  • Statistics: Over $11,000$ deaths and $27,000$ total cases.
  • Virus Biology: Genomic analysis confirmed the virus was not significantly different, more virulent, or more lethal than previous strains. The difference was found in society and governance, not the pathogen.
  • Societal Fragility: The outbreak affected Liberia, Sierra Leone, and Guinea—countries with some of the worst indicators for health, gender, development, and education.
  • Historical Trauma: Liberia and Sierra Leone were recovering from decades of civil war; Guinea had a history of corrupt dictatorship.
  • Healthcare Infrastructure Collapse:
    • There was a massive exodus of medical professionals.
    • In $2010$, Liberia had only $51$ registered physicians for a population of $5,000,000$.
  • Lack of Trust: Civil war and political history created a total lack of trust between the population and the government.

Governance and Response Failures in 2014

• Delayed Recognition: It took three months to identify the virus as Ebola because healthcare workers only "find what they are looking for," and Ebola was not expected in West Africa.
• Economic Denial: Governments were initially in denial because the region was experiencing significant economic growth ($GDP$ growth rates exceeding $10\%$). There were fears that an Ebola declaration would damage trade and business.
• Response Gaps:
  • The response was severely delayed.
  • Until June or July of that year, Médecins Sans Frontières (MSF) was essentially the only organization actively managing the crisis.
  • The World Health Organization (WHO) provided only occasional visits early on.
  • Piot describes the situation as a "massive failure of governance" combined with infrastructure deficits, a lack of societal trust, and traditional beliefs.