Essay: Ebola

1.) My name is xxx and I attend xxx, class of 2016. After high school I hope to go to medical school and graduate with a MD-PhD and pursue my career goals as a physician. I am a rising senior in high school who is aspiring to be a medical professional that helps people of all walks to be treated to a healthier and better lifestyle. I am a charismatic, hard working, committed, organized, thorough, and efficient person who knows that through hard work anything can be accomplished, no matter the level of difficulty involved. I chose the Ebola virus for my project because it’s one of the most deadly diseases known to man that still has an impact on our civilization now. In addition, the amount of damage this microscopic organism can cause in a short amount of time is truly fascinating.
2.) The genus Ebolavirus is a devastating virulent strain of the family, Filoviridae. Its adverse effects tear through its host’s body leaving a path of destruction in the form of necrosis and liquefaction of organs and tissue. Imagine an ordinary man going to work every day and living a normal life getting in contact with a person with Ebola. In a matter of days scorching fevers have stricken the man, along with vomiting and aches all over the body. Now a few more days have passed and at this point the victim is hunched over vomiting not just food, but also massive amounts of blood, and pieces of organs that have sloughed off from the virus. The patient now looks like a zombie walking hunched over in pain and face sloughing off making him look like a skeleton with very little fat and muscle left, along with blood trickling from almost every orifice on his body. Before you know it, the man has died from Ebola.
Ebola is composed of five different virulent strains, each just as deadly as the other. Ebola has affected mass amounts of people and is still not curable, but prognosis and close study has revealed how it’s transmitted, its signs and symptoms, and possible cures that are still in research and development.
3.) The Ebola virus is one genus among two others, which include Marburgvirus and Cuevavirus. The genus Ebolavirus is comprised of five distinct species: Bundibugyo virus (BDBV), Ebola virus (EBOV), Reston virus (RESTV), Sudan virus (SUDV), and Ta?? Forest virus (TAFV) (WHO, Ebola Virus Disease). Transmitted through infected animals, eating milk or raw meat, or direct contact with infected bodily fluids (i.e. sweat, blood, spit, etc.), this virus wreaks havoc on the human body in ways that make it seem almost like science fiction (WHO, Ebola Virus Disease). To put this into perspective, think of a wildfire. How did that fire start? Well it started from a small ember that spread uncontrollably and consumed everything in its sight until finally it was an uncontrollable wild fire with nothing to stop its path of destruction.
4.) This very fast acting disease starts as a fever, and then turns in to severe aching in all of the muscles, making it feel as if they have just ran ten iron man triathlons. This bodily ache is accompanied by constant vomiting of a black substance that is made up of all the things being destroyed in the body from the virus such as organs, tissue, and blood. Gossip and rumors are also another way to visualize the rapid rate at which it spreads. Everyone knows that there is no cure for gossip or rumors because once it’s out, it’s out there forever. Just like Ebola it spreads rapidly from person to person, and it ruins people’s lives.
5.) Ebola has been contained mostly to the regions in Africa, more specifically: Sudan, Zaire, Gabon, Uganda, Sierra Leone, Guinea, and Liberia. In parts of Liberia and Sierra Leone, hugging is a part of certain religious worship (BBC, Why Ebola is so dangerous). Across the region, the ritual preparation of bodies for burial involves lots of physical contact such as washing, touching, and kissing. During preparation of the body, women braid the hair, or shave the head depending on the gender of the diseased individual (BBC, Why Ebola is so dangerous). Due to the cultural traditions, countries in African are the most prone to being impacted by this virus because of the amount of physical contact involved. In addition, very poor living conditions, health care, and hygiene only add tinder to the flame that is the Ebola virus. The first outbreak of Ebola, named after the Ebola Zaire River in Zaire, infected over 248 people, with a mortality rate of 53%. The mortality rate only grew with each outbreak, the highest being 88% with 318 infected people (Unreasonable, The History and Facts of Ebola).The approximate number of cases in one year is around 11-12 thousand cases (CDC).
The first symptoms that result due to the Ebola virus are the sudden onset of fever fatigue, muscle pain, headache and sore throat. This is followed by vomiting, diarrhea, rash, symptoms of impaired kidney and liver function, and in some cases, both internal and external bleeding such as oozing from the gums and/or blood in the stools (WHO, Ebola Virus Disease). These symptoms alone are enough to determine that a person is severely infected with Ebola, however, if these symptoms have not presented yet or the disease is still in its early symptom stages, diagnosis can be difficult. Diagnosis of the disease is found by these methods: antibody-capture enzyme-linked immunosorbent assay (ELISA), antigen-capture detection tests, serum neutralization test, reverse transcriptase polymerase chain reaction (RT-PCR) assay, electron microscopy, or virus isolation by cell culture (WHO, Ebola Virus Disease). There are no specific ICD-9 codes for the Ebola virus, but the code for other specific viral infections is 079.89.
There have been 4 significant diagnosed cases of Ebola that have appeared in the United States. Three of the 4 cases have resulted in the patient recovering and being discharged from the hospital they were treated in. However, the first case of Ebola in the United States was a man, Thomas Eric Duncan, who had traveled to Dallas, Texas from Liberia (CDC). In the early stages of the disease, no symptoms were presented and Duncan was not aware that he had Ebola. However, after he arrived in Texas, Duncan grew extremely ill very quickly and went to a hospital that isolated him. Once they identified that he showed signs of Ebola, local public health officials identified and contacted everyone with whom Duncan came into contact and monitored them for 3 weeks after exposure (CDC). Unfortunately, the patient passed away on Wednesday, October 8, 2014, at 7:51 a.m. (CDC).
6.) As with any virus, the mechanisms for infection are the same. The virus fuses with target cells, the genetic contents are released into the cell, then the viral genetic material takes over the cell machinery to replicate itself, and finally new copies of the virus are produced and released back into the body, while simultaneously lysing the cell. Much is not known about the specific mechanisms of Ebola, but the mechanisms in which the Ebola virus causes hemorrhagic fever is clearly defined as follows:
-Once inside the body, the virus attacks macrophages and monocytes, relying upon host antibodies and complement component 1 for efficient infection (MicrobeWiki, Infection Mechanism of genus Ebolavirus). These leukocytes respond by releasing large amounts of proinflammatory cytokines that increase permeability of the vascular endothelium, causing easier entry into the virus’s secondary targets, endothelial cells (MicrobeWiki, Infection Mechanism of genus Ebolavirus).
– After GP-mediated receptor binding, Ebola virions have invaded endothelial cells through macropinocytosis (MicrobeWiki, Infection Mechanism of genus Ebolavirus). The invaded cell then loses contact with its basement membrane and detaches from its neighbors (MicrobeWiki, Infection Mechanism of genus Ebolavirus). The new virion particles then leave the cell through lipid rafts as they leave in their wake, a destabilized vascular system, which is responsible for the massive hemorrhaging that manifests from several orifices (MicrobeWiki, Infection Mechanism of genus Ebolavirus).
– As the virus destroys its target cells and causes the symptoms evidenced in patients with Ebola, the immune system is in cataclysmic failure (MicrobeWiki, Infection Mechanism of genus Ebolavirus). Interferons (proteins made by host cells in order to terminate foreign contaminants) are not being made because VP35 (a protein within the Ebola virus that inhibits interferon regulatory factor 3, IRF-3) interferes with nearly every step in the process of producing interferons (MicrobeWiki, Infection Mechanism of genus Ebolavirus). The white blood cells are releasing a mix of proinflammatory cytokines that destroy the vascular endothelium, which activates the coagulation cascade (MicrobeWiki, Infection Mechanism of genus Ebolavirus). This event now triggers the patient’s body into a conflicting state, where the body can either die of hypovolemic shock from the massive bleeding everywhere in the body, or from catastrophic thrombosis, as the victim’s body forms large amounts of blood clots in the body (MicrobeWiki, Infection Mechanism of genus Ebolavirus).
There are seven proteins that are encoded by the single-stranded RNA of the Ebola virus genome. The most important one of the seven proteins is called the nucleoprotein (NP). Although little is known about the structure-function relationship of this protein within the virus, it is known that the protein plays a key role in replication of the virus. There are many symptoms that result from the Ebola virus, but the most important ones are listed below:
‘ Fever, severe headache, muscle pain, sore throat (prodromic symptoms)
‘ The virus enters the body through mucus membranes and it infects many different cell types, as it causes necrosis and releases numerous amounts of new virions (UpToDate).
‘ Diarrhea, vomiting, and extensive fluid loss, liver and other organ necrosis and failure
‘ This extensive fluid loss can result in hypertension and shock, as the virus wreaks havoc and infects the G.I. tract (UpToDate).
‘ Also causes systemic inflammatory response by inducing the release of cytokines, chemokines, and other proinflammatory mediators (UpToDate). This causes the G.I. dysfunction and multiorgan failure (UpToDate).
‘ Unexplained hemorrhaging from all orifices
‘ Once the virus has infected, virus-infected macrophages synthesize cell-surface tissue factor (TF), triggering the extrinsic coagulation pathway, along with proinflammatory cytokines also inducing macrophages to produce TF (UpToDate). Due to these two simultaneous pathways, the Ebola virus causes severe coagulopathy (UpToDate).
As of now, there is no known vaccine for the Ebola virus or any specific treatment that can alleviate the symptoms. Severely ill patients require intensive supportive care and patients are frequently dehydrated (WHO, Ebola Virus Disease). These dehydrated patients require oral rehydration with solutions containing electrolytes, or intravenous fluids (WHO, Ebola Virus Disease).
7.) Since the recent outbreak from Ebola in 2014 that has devastated Africa, researchers and physicians have pulled together their skills, efforts, and money to find a vaccine. Amongst the myriad of leading researchers, there is one woman who is not only working hard inside the lab, but also outside, right next to the ‘hot zone’ of the disease itself. Dr. Joanne Liu is a physician who leads the Doctors Without Borders International Board and International General Assembly who knows that the most recent outbreak is the most deadliest one of all, as not only was it unprecedented, but has now spread to urban areas as well (The Washington Post, Looking for Leadership in the Ebola Epidemic). As Dr. Liu says ‘you need people who are operational in the field. You don’t just need people sitting in meetings and discussing things. You need to come out with a plan with clear priorities and capacity to implement it. This is not happening yet (The Washington Post, Looking for Leadership in the Ebola Epidemic).’ This direct quote perfectly establishes what Dr. Liu and others should be doing to further benefit the efforts towards curing Ebola and helping those afflicted with the disease.
Although not everyone is out there treating patients face to face, every small thing counts. One of those things is support, especially in the form of money. There are researchers all over the world combining their strengths to find a cure for Ebola by providing support to the health care systems in Sierra Leone, Liberia, and Guinea. They have contributed over 6oo million dollars and plan to keep offering help until a viable vaccine is found. Companies such as WHO, NIH, and NIAID are sponsoring this research. By studying diseased patients and their blood in cultures, researchers analyze the specific proteins involved and determine if there is a way to inhibit them to stop the virus in its path. The progress so far in the efforts is that there are clinical trials for several vaccine candidates which began November 4, 2003. One of the drugs, VRC-EBODNA012-00-VP, was being tested as a vaccine to induce the immune response to the virus. The vaccine is made from small parts of Ebola genetic material, however, the exerpimental drug itself cannot cause the patient to develop Ebola (Clinical Trials). In the trial, participants received one of three vaccine doses or placebo (Clinical Trials). These patients were given three injections, four weeks apart, and were then studied and observed (Clinical Trials). Unfortunately, there is no one specific working at Nationwide Children’s studying this disease, however, the hospital as a whole and hospital representatives from various institutions are working with Columbus Public Health as well as the Ohio Department of Health to further alleviate the effects of this virus with a vaccine (Nationwide Children’s, 5 Ebola Facts We Want You To Know).
8.) The information I researched was through various websites including ones by the CDC, WHO, NIH, and Nationwide Children’s. I found lots of useful information on the different strains of Ebola and its adverse symptoms, along with how each is manifested through the specific molecular pathways. I think this is useful because it will help me further investigate the mechanisms and impact of this disease on the human body. My interest in the disease is that it is very unique in the sense that it devastates the body in a way that no other virus can. Its symptoms of pure catastrophe fascinate me because it makes me curious how such a small organism that needs a microscope to even be observable can wreak so much havoc and pain on the human body.
With these interests, some potential next steps would be to keep looking at every possibility of a cure without any dismissal of a suggestion by organizing groups of the top researchers and doctors in the country to truly dissect the problem down to a valid solution. Something that I could do is potentially collaborate with other researchers by interning at hospitals that are conducting research on Ebola and help learn about the virus’s key protein structures, ways to prevent its replication life cycle, and other key aspects of the virus in order to get a better understanding of the virus and potential vaccines for it.
If there was a potential venture capitalist willing to invest in the research and efforts for a cure for Ebola, I would take hold of that opportunity. To prepare to pitch for a venture capitalist, I would rehearse a speech along with a presentation that would captivate their attention on the impact the virus has had on individuals in West Africa. I would also look to contact researchers art NIH on more information on the status of Ebola research and how the money from a venture capitalist can have a significant impact on the potential cures for this disease. To present, I would bring up interviews from grief stricken families in West Africa and show case pictures of how lethal and deadly this virus can be. I would also try to instill urgency into the speech by emphasizing its potential to spread further than Africa if it is not given more attention. The impact of potential new cures is exponential, as not only would a cure help the thousands of people impacted by Ebola, but it could also lead to new ideas and research for cures for other diseases on a global health level.