TIME Infectious Disease

Bill Gates Thinks This Is the Deadliest Threat to Humankind

Bill Gates, co-founder of Microsoft and co-chair of the Bill and Melinda Gates Foundation, speaks at a breakfast meeting with the theme "Dialogue: Technology Innovation for a Sustainable Future" during the Boao Forum For Asia Annual Conference 2015 in Qionghai city, south Chinas Hainan province, 29 March 2015.
Cui hao—Imaginechina/AP Bill Gates, co-founder of Microsoft and co-chair of the Bill and Melinda Gates Foundation, speaks at a breakfast meeting with the theme "Dialogue: Technology Innovation for a Sustainable Future" during the Boao Forum for Asia Annual Conference 2015 in Qionghai city, China's Hainan province, on March 29, 2015

He says it could kill tens of millions

In the next 20 years, is it likely that nuclear war, gigantic earthquakes or asteroids could kill 20 million people? Bill Gates doesn’t think so.

But he did tell Vox that that such numbers could be felled by a major outbreak of disease — something the 59-year-old billionaire believes has a “well over 50%” chance of happening in his lifetime.

“The Ebola epidemic showed me that we’re not ready for a serious epidemic, an epidemic that would be more infectious and would spread faster than Ebola did. This is the greatest risk of a huge tragedy,” Gates said, claiming that a serious epidemic could kill more than 10 million people a year.

Read more at Vox

TIME ebola

Did Authorities Use the Wrong Approach to Stop Ebola?

A health worker takes the temperature of a travelers at a highway checkpoint in Liberia on on Jan. 29, 2015.
John Moore—Getty Images A health worker takes the temperature of a travelers at a highway checkpoint in Liberia on on Jan. 29, 2015.

A new study suggests there was a better way to respond to the Ebola outbreak

It’s known that the response to the most recent Ebola outbreak, which as of Tuesday had infected more than 27,000 people and killed 11,130, was far too slow. Now, a new study suggests that even once they got started, their approach to curbing the spread wasn’t the most efficient or effective.

One of the staples of infectious disease outbreak responses was contact tracing: finding everyone who comes in direct contact with a sick person. And it makes sense that health authorities would employ that in this outbreak, since it’s proven in the past to be an effective way to contain the spread of a virus. However, experts at the New England Complex Systems Institute released new research Tuesday that argues contact tracing wasn’t the best approach.

Yaneer Bar-Yam, founding president of the Institute, and his colleagues conducted in-depth mathematical simulations that found that a community-wide response that monitors entire groups of people—rather than tracking down individuals who may or may not have been exposed to the virus via an infected person they had contact with—could have been more efficient.

In the simulations, the researchers accounted for a wide variety of factors and ultimately concluded that a response that focused on community-wide monitoring—for instance, going door-to-door to check on people in a given area as well implementing travel restrictions—would have been more effective than tracking down contacts of infected people one by one. The objective of a community response, they write, is to progressively limit the disease to smaller and smaller geographical areas, while simultaneously sending in resources.

“You treat the whole community as if it might have been in contact with someone,” says Bar-Yam. “Trying to figure out who [an infected person] was in contact with doesn’t make as much sense—and it’s not as cost effective as saying, ‘Well, everyone may have been in contact with these people, so we better check all of them.'”

One of the most telling parts of Bar-Yam’s study was when the researchers looked at what happens when people do not comply with the health guidelines that are put in place to curb an outbreak. After all, no matter how many times people are told what to do, it’s hard to persuade them to stay away from public areas, for instance, or to avoid travel to at-risk places. They found that community-wide monitoring is successful at ending the outbreak even if there’s only 40% compliance.

“You will save more lives if you have higher conformity,” says Bar-Yam of community monitoring, adding that, “from the macro picture you’re stopping the epidemic very rapidly.”

NECSI

The Key to Liberia Being Ebola Free?

In mid-September 2014 in Liberia, cases of Ebola started to drop significantly. It’s unclear why, but the authors note that around that time, a community-wide approach to stopping the spread of Ebola was taken in Liberia.

Earlier this month the Centers for Disease Control and Prevention (CDC) published a report on how it controlled the final cluster, and noted that the response included community-based approaches. And in a report on how Liberia got to zero cases, the WHO writes:

One of the first signs that the outbreak might be turned around appeared in September 2014, when cases in Lofa county, Ebola’s initial epicentre, began to decline after a peak of more than 150 cases a week in mid-August. Epidemiologists would later link that decline to a package of interventions, with community engagement playing a critical role.

In Lofa, staff from the WHO country office moved from village to village, challenging chiefs and religious leaders to take charge of the response. Community task forces were formed to create house-to-house awareness, report suspected cases, call health teams for support, and conduct contact tracing.

“I don’t know how difficult it would have been to implement it earlier,” says Bar-Yam. “Everyone kept saying, ‘Contact tracing is the tried-and-true right way to do this.'” Indeed, since contact tracing has been shown in numerous outbreaks in the past to be effective means of disease containment, that was the de facto strategy in west Africa during this Ebola outbreak.

This study alone cannot prove that health authorities and volunteers were misguided in their use of contact tracing.

Is It Either/Or?

The CDC declined to comment about the paper specifically, but spoke to TIME about the agency’s use of contact tracing and community monitoring. “When you are able to understand the connections [between people], while imperfect, you understand who is most likely to be infected and you are able to follow them,” says Jonathan Yoder, an epidemiologist with the CDC who responded to the Ebola outbreak in West Africa. “At the end, it was really important that nothing was missed. One contact can start a whole other outbreak. I don’t know that it’s one or the other. I think the approach of engaging communities is really important.”

Bar-Yam says his work shows that there is an alternative approach to contact tracing alone, and that it appears to work—possibly more quickly than contact tracing, if done early enough.

The paper also underlines the importance of being nimble when it comes to dealing with outbreaks of infectious diseases like Ebola. “Everyone thinks in terms of statistics of prior events. Everyone looks at prior history and says ‘What are we going to be able to expect in the future based on what happened in the past?’” says Bar-Yam.

TIME global health

Man Dies of Rare Lassa Fever in New Jersey

He had recently returned from traveling in Liberia

A man died of a rare African virus in New Jersey Monday after recently returning from Liberia, officials confirmed.

The man died of Lassa fever, a virus that causes hemorrhagic symptoms but is very different from Ebola, the Centers for Disease Control and Prevention said. Lassa fever is only fatal for 1% of those who are infected, while Ebola can be fatal for 70% of those infected without treatment. Lassa fever is also much harder to spread from person to person (it’s usually picked up from rodent droppings). About 100,000 to 300,000 Lassa fever cases are reported in West Africa every year, resulting in about 5,000 deaths.

The man with Lassa fever had arrived at JFK airport from Liberia on May 17, and went to a hospital the following day complaining of fever, sore throat and tiredness, officials said. At that time, he did not say he had been traveling in West Africa, and he was sent home the same day. On May 21 his symptoms worsened and he returned to the hospital, at which point he was transferred to a facility equipped to deal with viral hemorrhagic fevers. The patient was in “appropriate isolation” when he died Monday evening. The CDC is working to compile a list of people who may have encountered the patient while he was sick, and they are monitoring close contacts for 21 days to see if they develop the virus.

TIME ebola

WHO Vows Reform After Ebola Outbreak Mistakes

The agency is establishing a $100 million contingency fund

The World Health Organization (WHO) is implementing “fundamental changes”—including a establishing a $100 million contingency fund—after the poor response to the Ebola outbreak in West Africa.

“The world was ill-prepared to respond to an outbreak that was so widespread, so severe, so sustained, and so complex,” said WHO Director-General, Dr. Margaret Chan at the annual World Health Assembly on Monday.”WHO was overwhelmed, as were all other responders. The demands on WHO were more than ten times greater than ever experienced in the almost 70-year history of this Organization.” The assembly is the decision-making body of WHO and the meeting is attended by delegates from the WHO member states.

Chan told those present at the event that the WHO is making changes to ensure it is better equipped for a similar health-related emergency in the future.

First, the WHO says it is developing a new program specifically focusing on health emergencies that will have performance benchmarks for what must happen 24, 48 and 72 hours after the beginning of an outbreak. The WHO is also establishing a global health emergency workforce and will strengthen its trained emergency response staff through a proposed increase in budget. The agency is also streamlining its managerial and logistical procedures. Lastly, Chan said the agency is establishing a $100 million contingency fund that will be financed through voluntary contributions. This, Chan said, is to make sure the WHO has the necessary resources needed.

“I do not ever again want to see this Organization faced with a situation it is not prepared, staffed, funded, or administratively set up to manage,” said Chan. “We will move forward on an urgent footing. I plan to complete these changes by the end of the year.”

TIME ebola

Health Worker Tests Positive For Ebola in Italy

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Getty Images

The patient was a healthcare worker volunteering in Sierra Leone

A healthcare worker in Italy has been diagnosed with Ebola, the first time a person has received an Ebola diagnosis in the country. The patient is currently undergoing treatment for the disease.

The worker was volunteering in an Ebola treatment center in Sierra Leone, and on May 7, the volunteer flew from Freetown, Sierra Leone to Rome, stopping in Casablanca, Morocco. The patient had no symptoms at that time. It wasn’t until May 10, when the patient was already in Italy, that they began to experience symptoms of the virus. The World Health Organization (WHO) reports that the patient isolated themselves in their home before they were transported on the May 11 to the Hospital of Sassari, Sardinia. On May 12th, samples from the patient confirmed that they did indeed have Ebola.

The patient was then transferred from the Hospital of Sassari to he National Institute for Infectious Diseases (INMI) Lazzaro Spallanzani of Rome in a special aircraft.

Since the patient did not start experiencing symptoms until 72 hours after returning to Italy, WHO says it is not necessary to conduct contact tracing of individuals who were on the same plane. Ebola can only be transmitted via the bodily fluids of a symptomatic person.

More than 26,720 cases of Ebola have been reported in Sierra Leone, Liberia and Guinea since the start of the outbreak, and more than 11,000 people have died.

TIME ebola

Watch an Ebola Survivor’s Powerful Speech to Med School Grads

"The most important thing we do is enter into the suffering of others"

Dr. Kent Brantly, one of the Americans who contracted Ebola while treating patients in Liberia, told graduates of the Indiana University School of Medicine on Saturday that failure isn’t the focus of being a physician.

Brantly, among the “Ebola Fighters” honored as TIME’s Person of the Year, recalled his experience treating—and losing—patients as a missionary doctor in Liberia, the Indianapolis Star reports. After he contracted Ebola last summer, he was transferred to the U.S. for care and later declared virus-free.

“Losing so many patients certainly was difficult, but it didn’t make me feel like a failure as a physician,” the Indianapolis native said at the commencement ceremony, “because I had learned that there was so much more to being a physician than curing illness. That’s not the most important thing we do. The most important thing we do is enter into the suffering of others.”

“We were able to hold the hands of people as they died, to offer dignity in the face of humiliating circumstances,” Brantly said. “You are going to share in the most intimate parts of your patients’ lives. You will share in their moments of tragedy. But you will also share in their moments of greatest joy. You will make a difference in people’s lives, and you will make a difference in the world.”

Brantly, a graduate of the same medical school, also proudly shared the news that the World Health Organization, earlier in the day, had declared an end to the Ebola outbreak in Liberia.

[Indianapolis Star]

TIME Innovation

Why It Might Be Time to Rethink Motherhood

The Aspen Institute is an educational and policy studies organization based in Washington, D.C.

These are today's best ideas

1. Motherhood is a cultural invention. It might be time to rethink it.

By Kathleen McCartney in the Boston Globe

2. You should want Facebook to give away your data.

By Tara E. Buck in EdTech

3. Do we have Alzheimer’s completely wrong?

By Turna Ray at Science Friday

4. On the brink of becoming Ebola-free, Liberia should embrace its survivors.

By AllAfrica

5. Can an app improve America’s crumbling infrastructure?

By Ashley Tate in NationSwell

The Aspen Institute is an educational and policy studies organization based in Washington, D.C.

TIME Ideas hosts the world's leading voices, providing commentary and expertise on the most compelling events in news, society, and culture. We welcome outside contributions. To submit a piece, email ideas@time.com.

TIME ebola

Doctors Stumped After Ebola Survivor’s Eye Changed Colors

His blood was declared Ebola-free, but the virus remained in an eye

Ebola may stick around longer in survivors than researchers previously believed, and it may even cause eyes to change color, according to a case study released Thursday.

Dr. Ian Crozier, who contracted the virus while working as a World Health Organization volunteer at a treatment center in Kenema, Sierra Leone, underwent an intensive struggle with the disease after being transferred to Emory University Hospital in Atlanta. Less than two months after he was released in October, the New York Times reports, based on the study in the New England Journal of Medicine, Dr. Crozier was experiencing vision issues and pain in his left eye. Test results would later show that although Crozier’s blood had been declared Ebola-free, his eye was still full of the virus. Not only that, but the iris turned from blue to green.

“It felt almost personal that the virus could be in my eye without me knowing it,” he said, adding that the color change felt “like an assault.” Dr. Crozier’s sight and eye color later returned, mystifying doctors who had been helping treat his eye inflammation called uveitis, but his case shows researchers there is still much to learn about the deadly virus.

Read more at the New York Times.

TIME movies

Olivia Wilde on Celebs and Social Media: ‘The Nature of Society Has Changed’

'Home' Premiere, Tribeca Film Festival 2015
Dennis Van Tine—Geisler-Fotopres/AP Olivia Wilde attends the Shorts Program World Pemiere of 'Body Team 12' during the 2015 Tribeca Film Festival at Regal Battery Park 11 on April 19, 2015 in New York City.

The actress discusses her Ebola documentary, "Body Team 12"

Correction appended, April 23

Olivia Wilde may be best known for her work onscreen in the likes of House and Tron: Legacy. But she’s increasingly getting more involved behind the camera, most recently in producing the documentary short Body Team 12.

The film, which screened at the Tribeca Film Festival and has a planned release in the fall, is directed by aid worker David Darg. It depicts the work a Liberian woman named Garmai Sumo, whose work hauling the bodies of the dead during the Ebola crisis is both arduous and emotionally taxing. In the time since, Sumo has moved from burying the dead to feeding the living and is involved in aiding the orphans of Monrovia through her Ebola Orphan Project. “It’s a wonderful tale of redemption for Garmai,” Darg says.

The film upsets and overwhelms with scenes of Sumo facing angry families even as she places herself at grave risk, but the film provides viewers uplift in the form of a fairly direct way to support Sumo’s work today. It emerged from Darg’s aid work in Liberia; he embedded with a body team along with journalists from the Washington Post and China’s CCTV. Wilde came in at a later stage of production; Darg and producer Bryn Mooser “approached me about coming on as an executive producer, and I wanted to help in any way I could to facilitate the process and help people see it.”

That’s a role with which Wilde has grown more and more comfortable. The actress joined Twitter in an attempt to raise money after the 2010 earthquake in Haiti. “That’s ancient history now,” she said, “and I’ve embraced it for both valuable causes and complete bulls—.”

Wilde, who in recent bookings on TV has brought Darg and Mooser along to speak authoritatively about Ebola, is on the forefront of celebrities who’ve embraced the power of celebrity to draw attention to causes, even if it erodes mystique.

“I think a lot of celebrities are coming around to the idea that Twitter and the Internet in all ways is not necessarily as representative of defeat as it was once seen,” she says. “When Twitter started, I think a lot of celebrities thought, ‘This is the ultimate betrayal of privacy, blah blah blah’—that it would ruin all sense of separation between people and celebrities.”

Instead, though, stars who use social media to promote causes are widely lauded, a change that Wilde pegs to broader societal indulgence of a life online. “It used to be very separated, and there was this sense of maintaining the illusion, and that an actor had to be anonymous so people would believe you in character. But I think the nature of society has changed and it’s happened for everyone, not just celebrities. People share more, and people expect to be shared with. There’s just a sense of acceptance of a more complex and dynamic life, a more varied personality.”

The one risk, perhaps, is Wilde’s believability as an actress given how out-front she is as a public persona. She’s unbothered: “Maybe there’s someone who won’t buy me because they’ve seen me speaking about Ebola on the Today show. Who knows? But that would seem very rigid to me.”

Correction: The original version of this story incorrectly described David Darg, who directed Body Team 12. He is an aid worker.

TIME Infectious Disease

An Experimental Ebola Drug Shows More Promise

TKM Ebola, which at least a few US and European health care workers may have received to treat their Ebola infection, is upgraded and proves effective in animal studies

When the Ebola outbreak hit last spring, there were a handful of potential treatments at the experimental stage in labs around the world. Some of them—like the drug TKM Ebola—that had shown promise in primates were given to U.S. and European health care workers who had been infected. Assessing how effective these drugs were in humans, however, posed some unique challenges.

That’s because many of the patients who got experimental treatments were also given a number of other therapies—making it impossible to know what was responsible for their recovery. But in a new paper published Wednesday, several of the scientists responsible for developing TKM Ebola, led by Thomas Geisbert of the University of Texas Medical Branch, report that the drug worked on all the monkeys it used it on, even after the monkeys were given a lethal dose of Ebola.

The animals exposed to Ebola that didn’t get the drugs all died at day eight or nine.

The study used an updated version of the drug that is made up of snippets of the Ebola virus’ genome encapsulated in fatty particles. The fragments bind to their matching counterparts on the circulating virus and become a genetic monkey wrench that prevents Ebola from copying itself and infecting more cells.

MORE: WHO Outlines Timeline for Experimental Ebola Drugs

It turns out that the virus responsible for the current outbreak in west Africa differs from the 1976 strain at three points in the Ebola genome, so Geisbert and his team adjusted the drug accordingly. That’s one of advantages of the TKM Ebola approach, he says, compared to therapies such as vaccines or other drugs that rely on antibodies to the virus. These regimens are designed to attack the broadest range of virus strains possible, but in doing so, they may give up some of their virus-fighting potency. With gene sequencing technology becoming more refined and accessible, however, having drugs that are specifically targeted against a particular strain of a virus is actually a realistic goal. “It’s especially important when you look at how big this outbreak is, and it’s continuing for over a year,” says Geisbert of such matched therapies. “With this technology, we could theoretically turn around a new treatment in something like weeks. This outbreak taught us a lot about how to prepare for the future.”

MORE: The Ebola Fighters

These results will still have to be repeated in human patients, to ensure TKM Ebola is both safe and effective, but they strongly hint that the drug could be a critical part of future anti-Ebola strategies. The company that is developing TKM, Tekmira Pharmaceuticals, is now testing this latest form of the drug in Ebola patients in Sierra Leone, west Africa.

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