A still bigger picture: Médecins Sans Frontières’ (MSF), Samaritan’s Purse, ZMapp and the 2014 Ebola Crisis

One of the first things I knew I wanted to write about almost four years ago when soundingsjohnbarker started was something about Samaritan’s Purse and the 2014 Ebola crisis, particularly in Liberia in West Africa. “A bigger picture” https://soundingsjohnbarker.wordpress.com/2014/09/03/a-bigger-picture/ became my third blog post here on Sept. 3, 2014.

It interested me because Samaritan’s Purse, a Christian international relief ministry run by Franklin Graham, son of the late North Carolina evangelist Billy Graham, and based in nearby Boone, North Carolina, was best known in recent years by many in North America for its Operation Christmas Child, which was started in 1990, and by 1993 it had grown to the point it was adopted by Samaritan’s Purse.

Samaritan’s Purse was founded by Dr. Bob Pierce in 1970 as a nondenominational evangelical Christian organization to provide spiritual and physical aid to hurting people around the world. Samaritan’s Purse Canada was established in 1973.

As of 2014, Operation Christmas Child had collected and distributed over 100 million shoebox gifts in more than 130 countries worldwide.  Each shoebox is filled with hygiene items, school supplies, toys, and candy. Operation Christmas Child then works with local churches to put on age-appropriate presentations of the gospel at the events where the shoeboxes are distributed. Here in Thompson, hundreds of shoeboxes are collected each Christmas season for Operation Christmas Child through efforts co-ordinated in recent years mainly by the First Baptist Church, and previously the Thompson Pentecostal Assembly, which have co-ordinated efforts on behalf of a number of local churches, including St. Lawrence Roman Catholic Church, and other places including University College of the North (UCN), Thompson Public Library, and individual donors.

Rev. Leslie-Elizabeth King, who pastored the Lutheran-United Church of Thompson, and was in active ministerial service here for 19 years, until she retired in June 2014, touched a nerve in her “Spiritual Thoughts” column in the Nickel Belt News Oct. 26, 2012 when she mentioned using the Canada Revenue Agency website to look at how the Billy Graham Evangelistic Association of Canada’s Calgary-based Samaritan’s Purse Canada operates.

In a nutshell, while King had no problem with the charity’s six per cent management and administration budget expense, while 90 per cent went directly to the charity, which, she said, was “very good,” she didn’t much like the concept of sending shoeboxes stuffed with a pillowcase, toothbrush and a few pencils to a poor child on the other side of the world. “Wouldn’t it be better, if we truly want to be of use to others, to send our money to a church, agency or Non-Governmental Organization (NGO) in the destination country so local people could decide what is needed and where? That way, it would be more likely that our gift would build the economy in a community that needs it?” she asked.

Frank King, no relation, communications manager for the Billy Graham Evangelistic Association of Canada’s Samaritan’s Purse Canada, pointed out “our work in developing nations, including distributing Operation Christmas Child shoe box gifts, is always done through local partners. This is a priority for us because we want to build up local churches and we want to rely on local expertise to do (or financially support) the work that best benefits those communities.”

The Ebola story and Samaritan’s Purse was to me the international back story to the local Operation Christmas Child story. “Wouldn’t it be better, if we truly want to be of use to others, to send our money to a church, agency or Non-Governmental Organization (NGO) in the destination country so local people could decide what is needed and where?” Leslie King asked in 2012. Well, speaking of NGOs, in 2014 it would be Médecins Sans Frontières, also known in English as Doctors Without Borders, the highly respected international humanitarian medical non-governmental organization, founded in Paris in 1971, but stretched beyond their limits in Guinea and Sierra Leone in the midst of the deadliest Ebola viral hemorrhagic fever outbreak recorded in West Africa since the disease was discovered in 1976, that would ask Samaritan’s Purse on July 8, 2014 to take over the management of ELWA (Eternal Love Winning Africa) Hospital — the main facility, founded in 1965 by the medical mission group Serving in Mission (SIM) USA, caring for all Ebola patients in Monrovia, Liberia. The West African Ebola crisis — the world’s first urban outbreak as opposed to primarily rural previous ones — began in December 2013 in Meliandou, a small, isolated village in Guinea with only 31 households. It wasn’t until March 21, 2014, that the disease was identified as Ebola. The outbreak peaked in October 2014 and ended in June 2016.

Writing back in September 2014, what I knew then was that Dr. Kent Brantly, 33, medical director at Samaritan’s Purse Ebola Consolidated Case Management Center in Monrovia, contracted Ebola and was the first patient ever medically evacuated to the United States with a confirmed case of Ebola, to be treated at Emory University Hospital in Atlanta. Brantly originally moved to Liberia with his wife and children in October 2013 to be a general practitioner.  Immediately after Samaritan’s Purse took over Ebola treatment operations in Liberia, he traded his hospital scrubs for a full-body hazmat suit.

I also knew that Brantly was the first Ebola patient ever treated with ZMapp, a highly experimental three-mouse monoclonal antibody drug serum treatment produced by U.S.-based Mapp Biopharmaceutical, based in San Diego. ZMapp was produced for Mapp Biopharmaceutical in the Reynolds American tobacco plant Kentucky Bioprocessing facility in Owensboro, Kentucky inside the leaves of tobacco plants. Two of the drug’s three components were originally developed at the Public Health Agency of Canada’s containment level 4 National Microbiology Laboratory (NML) in Winnipeg.

But what I didn’t know until I recently saw Samaritan Purse’s compelling 2017 documentary Facing Darkness on Netflix was that at the time Brantly was given ZMapp there were only four courses of ZMapp treatment in existence anywhere in the world. A specially-equipped isolation chamber Phoenix Air modified Gulfstream III air ambulance, the only one of its kind at the time in the world, chartered by Samaritan’s Purse to medically evacuate and repatriate Brantly, and en route from the United States to Liberia, had turned back half way across the Atlantic Ocean with a mechanical problem. Phoenix Air is headquartered in Cartersville, Georgia.

And then, a miracle by many measures. One of Brantly’s colleagues, and one of the physicians treating  the critically-ill doctor, Dr. Lance Plyler, medical director of the Disaster Response Unit at Samaritan’s Purse, located one of those four courses of ZMapp in neighbouring Sierra Leone. A Styrofoam box containing three frozen vials of straw-colored fluid was flown to the border, canoed across a river and put on a plane to Monrovia, the Liberian capital. But there was enough to treat only one person, and meanwhile, Nancy Writebol, 59, with Serving in Mission, (SIM), had also contacted Ebola.

The day the ZMapp arrived in Monrovia, Brantly was actually having one of his better days since contracting the virus, and insisted that Writebol, who appeared sicker, be given the available ZMapp. But as the frozen vials were literally warming up under her arm, Brantly took a sudden and dramatic turn for the worse, and started to seize. Plyler made what must have required the Wisdom of Solomon-like Hippocratic Oath decision to retrieve the ZMapp vials from under Writebol’s arm, and administered the drug to Brantly instead. Brantly started to feel better almost immediately.

Both Brantly and Writebol would both wind up being treated with ZMapp and be medically evacuated by Phoenix Air within days, Brantly first, to Emory.  Both made full recoveries.

Facing Darkness also provides insights into the character of Franklin Graham, as head of Samaritan’s Purse, that I had never seen before. While it may not be charitable to say so, in truth I have wondered more than once if Franklin Graham is up to being his father’s son. He’s a bit too of-this-world political and too cozy with President Donald Trump and his band of cronies for my taste. But recalling how he learned about Brantly contracting Ebola while he was in Alaska, Graham was almost ashen-face still as he recalled the moment. Speaking in the same measured tones Billy Graham often did, doesn’t take away from Franklin Graham’s sense of being overwhelmed by shock and grief. Initially, “I didn’t even know how to pray,” he says. But Graham would soon enough pray. And Samaritan’s Purse with Franklin Graham at the helm, would, in the best tradition of the United States Army Rangers nemo resideo, and “leave no one behind,” move heaven and earth to medically evacuate Brantly and Writebol from Liberia back to the United States.

A true-life page-tuner worthy of the best of the late Michael Crichton’s medical thrillers.

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Potential for aerosal airbone transmission of Ebola hemorrhagic fever has been studied by U.S. Army Medical Research Institute of Infectious Diseases (USAMRIID) at Fort Detrick, Maryland and in Canada at Special Pathogens Program Biosafety Level-Four (BSL-4) National Microbiology Laboratory in Winnipeg, Manitoba

In an op-ed article, “What We’re Afraid to Say About Ebola,” published in the New York Times Sept. 11, Dr. Michael T. Osterholm, the McKnight Presidential Endowed Chair in Public Health and director of the Center for Infectious Disease Research and Policy at the University of Minnesota, wrote the Ebola scenario “virologists are loath to discuss openly but are definitely considering in private: that an Ebola virus could mutate to become transmissible through the air. You can now get Ebola only through direct contact with bodily fluids. But viruses like Ebola are notoriously sloppy in replicating, meaning the virus entering one person may be genetically different from the virus entering the next. The current Ebola virus’s hyper-evolution is unprecedented; there has been more human-to-human transmission in the past four months than most likely occurred in the last 500 to 1,000 years. Each new infection represents trillions of throws of the genetic dice.

“If certain mutations occurred, it would mean that just breathing would put one at risk of contracting Ebola. Infections could spread quickly to every part of the globe, as the H1N1 influenza virus did in 2009, after its birth in Mexico.”

In fact, there has already been some antigenic drift  in the current novel Ebola-Zaire (EBO-Z) subclade from viral samples sequenced in Sierra Leone in June and sequences from Guinea in March three months earlier.

Osterholm is also an international expert on American preparedness for an influenza pandemic, and from 2001 to 2005, served as a special advisor to then–U.S. Health and Human Services Secretary Tommy G. Thompson on issues related to bio-terrorism and public health preparedness.

Ebola virus causes severe viral hemorrhagic fever with a high fatality rate estimated at about 70 per cent on average. Five Ebola virus species within the genus Ebolavirus are known, including four that cause Ebola virus disease (EVD) in humans:  Zaire, Bundibugyo, Sudan and Taï Forest, while Reston.  the fifth species, has only caused disease in non-human primates.  The current outbreak in West Africa, plus a handful of travel-related additional cases in Madrid in Spain and in the United States in Dallas and New York City, is Ebola Zaire, the deadliest form of the disease in previous outbreaks with case fatality rates of 90 per cent reported.

With more than 10,000 reported cases and more than 5,000 people dead (for what is widely believed to be a vastly under-reported case fatality rate of about 50 per cent), the 2013-14 outbreak  in Guinea, Liberia, Sierra Leone,  Mali, Nigeria and Senegal in West Africa, caused by Ebola virus (Zaire ebolavirus species), is the 20th, largest and most complex outbreak of EVD in its 38-year history, with more cases and deaths in this outbreak than all others combined, since the disease was first discovered in 1976 during two simultaneous outbreaks, one in Nzara in Sudan, and the other in Yambuku in the Democratic Republic of Congo, which was then called Zaire, where a Belgian Roman Catholic nun at a small mission hospital was infected. The latter occurred in a village near the Ebola River in what was then northern Zaire, from which the disease and species both takes their  names. When those first cases were reported in the mid-1970s they were from remote villages in Central Africa, near tropical rainforests. The World Health Organization (WHO) said earlier this month the Ebola outbreak is now over in both Nigeria and Senegal, although the disease is threatening  the Ivory Coast,  which shares a 716-kilometre international border with Liberia in the southwest; a 610-kilometre border with Guinea to the northwest; and a 532-kilometre border with Mali to the north and northwest.

It began last December with an index case in Meliandou, in southeastern Guinea, not far from the borders with both Liberia and Sierra Leone.

Two decades ago, scientists at the  U.S. Army Medical Research Institute of Infectious Diseases (USAMRIID), based  at Fort Detrick, Maryland, exposed  monkeys to airborne Ebola, which “caused a rapidly fatal disease” in four to five days, they  concluded in their 10-page August 1995 article,  “Lethal Experimental Infections of Rhesus Monkeys by Aerosolized Ebola Virus,” published in the International Journal of Experimental Pathology.

The  researchers hypothesized Ebola can spread through air but likely hasn’t in Africa because the equatorial region is generally too warm, with temperatures rarely dropping below 18.3°C or 65°F.

In 2012, Canadian researchers here in Manitoba, led by Gary Kobinger, head of Special Pathogens and Vector Design and Immunotherapy at the Special Pathogens Program of the  Biosafety Level-Four (BSL-4) National Microbiology Laboratory of the Public Health Agency of Canada on Arlington Street in Winnipeg, along with researchers from the National Centre for Foreign Animal Disease in Winnipeg and the University of Manitoba in Winnipeg, observed transmission of Ebola from pigs, which can remain largely healthy and carry Ebola with only minor ill effects, including heavier breathing and mild fever, to monkeys where the disease was fatal, indicating the Ebola virus may spread between species through the air, although the researchers could not  say for certain that is how the transmission actually occurred. Their research was published in  Scientific Reports 2 on Nov. 15, 2012.

The Biosafety Level-Four (BSL-4) National Microbiology Laboratory in Winnipeg is where some of the world’s deadliest pathogens  – such as Ebola, Marburg, Lassa and Crimean-Congo hemorrhagic fever viruses and Nipah Virus Encephalitis  – are studied.

In December 1989,  not far away from USAMRIID, in a strip mall in Isaac Newton Square in suburban Reston, Virginia, army scientists  from nearby Fort Detrick, Maryland were called in when monkeys from the Philippines,  kept by Hazelton Research Products for shipment to other U.S. laboratories,  began to die in their cages, one by one, after contracting what is now known as Reston ebolavirus species, the only known form of Ebola that causes disease only in in non-human primates. While the Reston Ebola species can infect humans no one got sick in Virginia 25 years ago and no serious illness or death in humans have been reported to date as a result of human exposure to the the Reston Ebola species. The Reston episode would become a key part of author Richard Preston’s electrifying 1994 non-fiction thriller, The Hot Zone: A Terrifying True Story, an earlier version of which had appeared in The New Yorker magazine on Oct. 26, 1992 as “Crisis in the Hot Zone.”

The Atlanta-based Centers for Disease Control and Prevention (CDC) says in its “Review of Human-to-Human Transmission of Ebola Virus” summary of published information on the current science that “airborne transmission of Ebola virus has been hypothesized but not demonstrated in humans. While Ebola virus can be spread through airborne particles under experimental conditions in animals, this type of spread has not been documented during human EVD outbreaks in settings such as hospitals or households.”

Referring to the USAMRIID experiment that provided the data for the 10-page August 1995 article,  “Lethal Experimental Infections of Rhesus Monkeys by Aerosolized Ebola Virus,” published in the International Journal of Experimental Pathology, CDC says, “In the laboratory setting, non-human primates with their heads placed in closed hoods have been exposed to and infected by nebulized aerosols of Ebola virus.”

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