Download Outbreak Culture: The Ebola Crisis and the Next Epidemic

Download Outbreak Culture: The Ebola Crisis and the Next Epidemic

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Outbreak Culture: The Ebola Crisis and the Next Epidemic

Download Outbreak Culture: The Ebola Crisis and the Next Epidemic

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Review

“A forceful and instructive account, as passionate and heartfelt as it is learned, Outbreak Culture reveals the experience most Ebola responders had but could not name. Through laboratory data and survey responses from hundreds of individuals directly involved in the world’s largest public health endeavor, Sabeti and Salahi uncover competition, sabotage, fear, blame, and disorganization bordering on chaos, features that are seen in just about any lethal epidemic.”―Paul Farmer, cofounder of Partners in Health“During epidemics and crises we see the best and worst of humanity. Outbreak Culture provides a thought-provoking account of the behaviors and ensuing politics that transpired throughout the Ebola outbreak of 2014–2016. This book offers important lessons, critically needed, to ensure that we are better prepared for the next epidemic.”―Peter Piot, Director, London School of Hygiene and Tropical Medicine“A heroic saga of human nature at its very best and worst. Sabeti and Salahi shed light on the fragmented and uncoordinated global response to the Ebola epidemic. All of us who respond to outbreaks now have a mandatory moral and cultural guide.”―Joseph B. McCormick, coauthor of The Virus Hunters: Dispatches from the Frontline“This book, written eloquently by a journalist and a scientist, highlights many lessons learned from the Ebola epidemic. The need for transparency, collaboration, and coordination among individual actors and agencies is more important than ever.”―Sylvia Blyden, former Sierra Leone Minister of Social Welfare, Gender and Children’s Affairs“The authors deftly weave surveys, interviews, and retrospectives on previous outbreaks into a concise depiction of the Ebola epidemic, with particular focus on human behaviors that exacerbated the course of the outbreak.”―William E. Pewen, Science“Puts a human face on the challenges by telling the stories of researchers, clinicians and patients…The power of Outbreak Culture is its universality. It describes dynamics common at varying levels in every humanitarian emergency…A much-needed call for greater justice next time.”―Nahid Bhadelia, Nature

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About the Author

Pardis Sabeti is Associate Professor of Organismic and Evolutionary Biology and of Immunology and Infectious Diseases at Harvard University. A member of the Broad Institute and a Howard Hughes Medical Institute Investigator, Sabeti was named a World Economic Forum Young Global Leader, a National Geographic Society Emerging Explorer, and one of Time magazine’s 100 Most Influential People of 2015. She is also the recipient of an NIH New Innovator Award and a Richard Lounsbery Award from the National Academy of Sciences. Lara Salahi is an award-winning journalist and television producer for multiple outlets, including ABC News. She was part of the team at the Boston Globe awarded a 2014 Pulitzer Prize for its exhaustive and empathetic coverage of the Boston Marathon bombings. Salahi is Assistant Professor of Broadcast and Digital Journalism at Endicott College.

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Product details

Hardcover: 288 pages

Publisher: Harvard University Press; 1 edition (November 26, 2018)

Language: English

ISBN-10: 0674976118

ISBN-13: 978-0674976115

Product Dimensions:

5.7 x 1 x 8.3 inches

Shipping Weight: 1 pounds (View shipping rates and policies)

Average Customer Review:

5.0 out of 5 stars

2 customer reviews

Amazon Best Sellers Rank:

#363,397 in Books (See Top 100 in Books)

This is a very insightful and thought provoking book regarding the 2013-2016 Ebola epidemic in Western Africa, the book reads like a mix between a historical account, a doctoral thesis and a primary source of information.One of the authors is a Harvard scientist who worked with Dr. Sheik Umar Khan, a famous physician virologist in Sierra Leone, and expert in viral hemorrhagic fevers such as Ebola, who worked in extremely difficult conditions to save Ebola patients in Sierra Leone and whom himself died from Ebola possibly due to examining a patient, later proven to have Ebola, without protective clothing. Surveys were sent to various health workers after the outbreak to determine what went wrong, and the authors coined the term “outbreak culture”, which describes a somewhat dystopian view of competing governmental organizations (such as the WHO) and NGOs such as MSF (Doctors Without Borders) and how they failed to work together and how some parties even engaged in unethical conduct in a gold rush to obtain and sequester scientific data and failure to support local experts such as Dr. Kahn.In the final chapter, the authors apparently decline to make any firm recommendations regarding how to improve the global response to the next Ebola outbreak (adding others have already made concrete recommendations), though they do make many useful general comments. The authors appear conflicted on several issues such as “no-bid” contracts used in times of war and during infectious disease outbreaks to speed the response, and creating a global authority to oversee the response to such outbreaks versus the benefits of independent grassroots organizations, among other complex issues.I think that the response to the Ebola outbreak is similar to the military concept of the “fog of war”, and the authors even make the obvious analogy of the Ebola outbreak to a war, if so their proposed solution of a global organizational body overseeing the deployment to an Ebola epidemic and a war room to coordinate the response makes a lot of sense as tracking of friendly forces and increased situational awareness helps reduce the fog of war.I had to read several of Dr. Sabeti’s research papers to understand her comments regarding the Ebola virus becoming more infectious during the 2013-16 West African outbreak by looking at research regarding tracking mutational changes in the Ebola virus during the epidemic. Epidemiologists studying simply the number of infected and transmission patterns concluded that the virus didn’t become more infectious despite a jump in cases, though these same epidemiologists agree that the biological data on the mutations of the Ebola virus during the epidemic appear to increase Ebola’s ability to infect human cells and evolved in such a fashion to quite possibly make Ebola more infectious. I wish that this scientific information was described in the book to greater detail.I think that the takeaway lessons from this book regarding the current and ongoing 2018-19 Kivu DRC Ebola epidemic are:1. Quite possibly “outbreak culture” or the “fog of war” has lead the WHO (World Health Organization) and national governments to NOT have situational awareness with regards to the ongoing 2018 Kivu Ebola outbreak. The WHO has said that although the CDC (which is actually larger than the WHO and very experienced with Ebola outbreaks), that they can “cover” the outbreak without CDC help on the ground given that the CDC and USAID are banned from working on the Kivu DRC Ebola outbreak by the US government ostensibly due to regional fighting.2. It might be that the WHO and other organizations are ignoring the advice of MSF (Doctors Without Borders) which is very concerned about spread of Ebola to many countries surrounding the eastern flank of DRC such as Uganda, Rwanda and South Sudan and the possibility of a prolonged outbreak in the Kivu region due to the ongoing conflict and other factors. The WHO has not yet classified this Ebola outbreak as an Public Health Emergency of International Concern and is uncertain how such a designation would even help this epidemic. MSF, given their field work and large volume of direct work with patients, seem to be poised to give an early indication when an Ebola epidemic is spiraling out of control. Though the UN apparently provides some security in the Kivu region for health workers, ongoing conflict has hampered the response effort greatly.3. Real time sequencing of mutational changes in the Ebola virus might be important in this current Ebola outbreak and future ones, especially if the CDC is correct in predicting that this Ebola epidemic may become endemic in this region of the DRC if not controlled, which presumably would mean a more infectious, but perhaps less lethal virus circulating indefinitely in a human population, which is a terrifying prospect.4. Sabeti concludes that the bottle-neck in terms of failing to control the West African Ebola epidemic was the roll out of a global health response once an Ebola epidemic is recognized, NOT a delay in recognition of an Ebola outbreak in the first place. If so, the current lack of a more robust response to the Kivu outbreak could mean having to deal with an exponentially larger outbreak in the coming 6 months. However, a multi-regional Ebola outbreak, such as in the case of 2 or 3 simultaneous Ebola outbreaks occurring in different susceptible countries in Africa at the same time might well tax the ability of the WHO and NGOs to respond to multiple Ebola outbreaks simultaneously as apparently aid workers currently fighting the Kivu DRC Ebola outbreak are often working exhausting hours. A preventive global health monitoring system might be able to catch a small epidemic before it requires a massive response to contain it.5. Testing of multiple Ebola vaccines in the field during an outbreak might well save precious time in terms of finding an effective vaccine. It seemed that current Ebola vaccine was tested at the tail-end of the last Ebola epidemic (when the number of new Ebola cases fell off dramatically) and possibly the finding of 100% efficacy was premature based on preliminary results during this current Kivu DRC outbreak.6. The authors spend some time on the case of Kaci Hickox, a nurse who worked with Ebola patients through MSF (Doctors Without Borders). Hickox was quarantined for 80 hours in New Jersey (a connection on her way home to Maine) after showing signs of a fever. The authors note that currently the scientific evidence (as outlined by the WHO) is that a person becomes infected with Ebola first shows non-specific signs and symptoms such as the sudden onset of fever, fatigue, muscle pains, headache and sore throat. However, when the patient progresses to vomiting, diarrhea, and in some cases internal and external bleeding, then the patient with Ebola is infectious.Hickox was first singled out upon returning to the US from West Africa after she registered a “slight fever” with a forehead thermometer which is much less accurate than a traditional oral thermometer. However, she did not have a fever when checked again in quarantined in New Jersey and an initial test for Ebola came back negative. Apparently, she did not have any other symptoms of a recently acquired Ebola infection such as the fatigue, muscle pains, headache and sore throat, so she probably should have been released to monitor her symptoms at home.Kaci Hickox was involved in drafting a quarantined patient’s “Bill of Rights” to require the quarantining of possible Ebola carriers for only medical and public health reasons. The authors note that the poor conditions during the quarantine of Hickox, which included the lack of a shower for the 80 hours, as well as possibly psychological trauma make returning healthcare workers from hot zones less likely to agree to quarantine.The authors also discuss Thomas Eric Duncan who died of Ebola in the US and his family who was quarantined within their apartment and may have been contaminated with dirtied clothes and bed linens from Duncan when he was sick.Both of these examples in the book might lead one to conclude that the US has a very limited ability in terms of having a quarantine facility which is both humane, comfortable and even safe, in the event of needing to quarantine healthcare workers and travelers from a hot zone and their contacts in the US if deemed medically and epidemiologically necessary.

A well researched and authoritative work that accurately depicts the challenges with international epidemic response and provides a way forward to improve global efforts.

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