Osterholm: Ebola focus should be on West Africa, not Dallas

MPR's Phil Picardi spoke with Michael Osterholm about Ebola in the U.S. and in West Africa. Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota, is part of a group that's trying to push forward an Ebola vaccine.

You were on MPR News talking about Ebola in July, at that time it seemed unlikely there'd be an Ebola outbreak in the U.S. Do you still feel that way?

First of all, we have to really define what we talk about as outbreak. I want to be really clear here that what's happened in Dallas is really tragic and unfortunate, but what we're really talking about is the health care setting as the problem.

Mr. Duncan came from West Africa with Ebola virus infection. We've not seen any cases in the community, we could still see cases potentially in his direct contacts in the community, but what we focused on is the health care workers. This is what we said all along would be the problem. This would not spread widely in the community as it has in West Africa. So, there is no outbreak there.

The concern we have for healthcare workers is very real. This is a situation that shouldn't have happened, it didn't have to happen, but it did and hopefully the rest of the country has learned that providing health care safely to Ebola patients is something you have to really be expert at doing. Hopefully that message is loud and clear.

President Obama has said that he's ordering a faster Centers for Disease Control response to Ebola cases in the U.S., he called it SWAT team kind of response. Is that what is needed?

Unfortunately, even that is is going to be inadequate...Each and every hospital in the United States, and there are 5,000 of them, do not need to be prepared to care for an Ebola patient. This takes lots of practice, it takes a specific kind of equipment that you want to have protect your health care workers.

We believe every hospital, every emergency room, every urgent care, needs to be prepared to see a possible patient with Ebola because we don't know where they'll show up. But once you have triaged that, and you prioritize and know that these people are potential cases of Ebola, they have to be safely transported to one of what i would consider a series of regional centers that are well prepared for this

It doesn't have to be one of the four hospitals that have already been named as major treatment centers. We could have one or two here, for example, in the Twin Cities. That's what we need right now.

Then those institutions can immediately begin to provide safe and effective care. And the CDC team would arrive a day or two later. If we don't have these teams prepared now, the first 48 hours could be the critical time period when exposures occurred, and they very well may be when the exposures in Dallas occurred.

The CDC model is helpful, but it's not going to be there that first minute that patient presents to medical care, and that's the most critical minutes.

In the meantime, the Ebola epidemic is raging in West Africa. How do we keep it there and how do we make progress in ending it there?

That I think is really the zillion dollar question, and really the important point, do not take your eye off the real ball here: it is West Africa. It is still a travesty that we have responded so inadequately to that outbreak.

When we talked about this way back in July, we talked about the opportunity here to intervene in an aggressive way to try to stop this from spreading, and we have not done that. We still have not constructed one single hospital bed in West Africa, we being the United States, even though we promised weeks and weeks ago, we would do so. Everything is moving in bureaucratic or program time while the outbreak is moving in virus time.

The WHO (World Health Organization) predicted that the next month we'd have 10,000 new cases in just those three affected countries. I think that's a good estimate.

We had the Liberian health care workers, people from Liberia, go on strike because 80 percent of them did not have gloves, gowns or masks to provide care. We can move iPhones from Asia in days but we can't move gloves, gowns and masks to West Africa in months?

It's a travesty. And I think that's where the whole world has to understand. For the World Health Administration, Ebola will be their 9/11. For the world, West Africa is our global Katrina.

I think that's the message we have to get across, and every time we divert to Dallas or places like that, we're missing the point: why has the global response been so absolutely inadequate? That's where the real issue is.

So how do we marshal that response?

First of all, we have to understand that we really do have an urgent need to get there, not just from a humanitarian standpoint, but from a self-interest standpoint.

It's only going to be a matter of days before this virus starts to march eastward. When you look at the 20 million people who live in those three affected countries and you realize that's a very important issue, particularly to the capital cities and the slums there.

If this virus moves east into Nigeria, into Nairobi, into Kinshasa to cities like that, you're going to see an absolute explosion of cases. There are more people living in the slums of Kinshasa than live in all the slums combined of the three countries that are now impacted. We can't fight adequately in one front, how are we going to do it in multiple fronts?

To me we have to absolutely just swarm West Africa with resources and medical personnel to try to stop this.

Ultimately, we need a vaccine, that's going to be the ultimate answer. We've got a fast-track vaccine, research and development, approval, manufacturing and distribution. That's one of the things our group is working on right now, trying to develop that plan, basically a Manhattan Project on Ebola vaccine.

You're working with a U.K. based group. How far along are you?

We're just starting what we call this Team B process right now, bringing together a group of world experts to challenge all the notions, all the timelines, all the resource needs that are really critical to making this happen.

In the end that's going to be the fire hose that will put out that infectious disease forest fire there, which in turn is throwing out these sparks, these embers, that are going around the world that are causing the Dallas-like situations. If we want to make sure that we don't have more Dallas-like situations, we want to make sure that we put the forest fire out in Africa right now. That's critical.

A month ago in a New York Times editorial, What We're Afraid to Say About Ebola, you mentioned a dire scenario: the possible mutation of the disease. What's the concern about that and is it a real possibility?

Take a step back again and realize that when you think about what we know about Ebola, just remember that this was discovered 40 years ago, [although it] likely happened before that time in the dense jungles of Africa, very few people were affected.

During these past 40 years, we've had 24 outbreaks, or case occurrences, 19 of them which were community outbreaks -- only about 2,400 cases.

The most generations of virus transmission we ever saw was in one outbreak, and that was five.This virus has hardly pinged the human species. A lot of whaat we think we may know about Ebola is really based on a very limited experience.

One thing we do know is this virus has been transmitted from subhuman primates, or monkeys, to each other by the respiratory tract.

All we have proposed is that we at least need to consider that because of this, we start to see respiratory transmission like we have seen in monkeys. It's not as much a forecast that it will happen, but it means that we don't want to keep getting caught by surprise like we did in Dallas.

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This transcript was edited for clarity and length by MPR News reporter Jon Collins.