Dr. Andy Anderson: The Science of Ebola

Writer / Janelle Morrison . Photographer / JJ Kaplan Endocrinologist, Diabetologist, and retired Lt. Col. in the U.S. Army Medical Corps are only a few titles that James “Andy” H. Anderson Jr., MD, FFPM, FACE, a Carmel resident, husband and father of three has listed in his resume. Dr. Anderson is also the Medical Director for PTS Diagnostics, Inc., a U.S.-based manufacturer of point-of-care diagnostic products that is based in Indianapolis. Anderson recently weighed in on the topic of the infamous Ebola virus and on his experience with infectious diseases. Anderson was one of the last of the drafted physicians in 1971. It wasn’t a popular practice for physicians to volunteer for the military so the draft had a program where physicians were deferred to do part or all of their postgraduate medical training. Anderson was deferred for his internal medicine and endocrinology medical training. The military benefited from having doctors who were not just day-one graduates from medical school but fully trained physicians. “At that time, I was very attached to research and academic medicine and had the opportunity to go to Fort Detrick, in Frederick, Maryland,” Anderson said. “Several other endocrinologists had been there because USAMRIID (United States Army Medical Research Institute of Infectious Diseases) was doing similar work to what I had conducted research on during my fellowship at LSU and the Medical College of Virginia in terms of the affect of infection and toxic shock on carbohydrate metabolism and insulin secretion. “About the same time that I went up to Detrick, they got a new commander who asked me if I would take the medical division on a temporary basis and I declined. I told them that if he wanted to give me the medical division then I’ll do that but I don’t want to be a ‘temporary’ anything, so I wound up being the head of medicine. While infectious disease isn’t closely related to diabetes, it was a marvelous opportunity for me to learn a lot of new things.” He served at Fort Detricke from 1976 to 1980. According to Anderson, the medical personnel at Fort Detrick worked with a number of vaccines and drugs that had been developed and that were all kept at the Investigational New Drug (IND) stage rather than the New Drug Application (NDA) stage. The reason being that the people that they were intended for were so limited, primarily laboratory personnel at Detrick who required immunization because they were working with these diseases to develop methods for prevention, detection and treatment. The treaties that President Nixon signed in 1969 and 1971 clearly stated that the U.S. would never engage in a first strike with biological weapons so the work performed by the physicians at Fort Detrick was strictly for defensive preparedness. Historically, Fort Detrick was the center of the U.S. biological weapons program from 1943 to 1969. Since the discontinuation of that program, it has hosted many elements of the program. The fort is home to the USAMRIID and their bio-defense agency. It had the Department of Agriculture’s plant diseases facility on site, as well as the Army’s East Coast Telecommunications Center. “During the years that I was at Detrick, the world had dangerous hemorrhagic fevers such as; Bolivian Hemorrhagic fever, Lassa, Marburg as well as other various diseases like Malaria, Dengue, Rift Valley Fever, etc., that could in fact be potential biologic weapons," he said. "I participated in a lot of work in developing various vaccines and drugs and was, at the same time, responsible for our medical facilities. “Had Ebola taken place pre-1980, the patients probably would have come to Detrick and we might have been able to limit the exposure to others. One of the issues with the patients going into modern area hospitals, is that while the staff there may have had training that includes a few hours of watching films, and instructions on bio-protective clothing, etc., it’s not something that they have practiced on a daily basis for years. Where as my group at Fort Detrick, this is what we did day and day out, for several years as a career.” Fort Detrick had a medical facility that was basically two hospital rooms inside a completely contained unit inside of the building and the rooms were at negative air pressure to the hallway and the outside so movement of air was always going in to prevent the escape of any infectious materials. The air exhaust from the rooms went thru an incinerator and any liquid or water from the room went thru a concrete pipe that was 12 inches thick all the way around to another incinerator. “Anything that was solid only made it out of the rooms by going thru an autoclave,” Anderson explained. “I had a suit that was similar to the suits that they wear now but I had a hood with an air hose so I was positive pressure to the patients. Upon exiting the patient’s room, I went thru a shower that was basically bleach and acid to decontaminate the outside of the suit. After that, I went thru a regular shower and everything that I had been wearing went out thru the autoclave. This level of bio-containment is what is needed to be comfortable with what you’re doing and a typical community hospital usually doesn’t have that kind of facility or training.” Anderson described in great detail the protocol that he and his staff created and performed when dealing with infectious viruses and bacteria. “Having only those two rooms to use for patients had the potential of not being enough and so I talked to the people at the Vickers Corporation in the U.K. who had developed these plastic bubbles that went around a bed, a smaller one that could be put in an airplane and an even smaller one that could be around a stretcher in an ambulance. “There was absolute, or what was termed P4 containment. Once the individual was in there, they are sealed in there and there is no way of anything getting out. There is a HEPA like filter for air passage in, sealed glove ports for handling and ports for giving the patient food etc without breaking the seal and when taking the waste out, it would go through the port in a sealed bag so that there is no chance of anything getting external exposure. The book Hot Zone by Richard Preston came out and was followed by the movie ‘Outbreak’ that featured Dustin Hoffman, who basically played my role at Fort Detrick. It was a fictional story that was inspired by the procedures and processes that we were implementing at Detrick. However, when my staff and I went to see the movie, we noted several dozen actions that they did wrong but it did represent a general overview of what was going on at Detrick.” Throughout his tenure at Fort Detrick, Anderson worked on the containment procedures and the academic study of anything that could have been considered a bio-agent such as anthrax, botulism, etc. He studied what the bacteria or virus did, how it replicated and how it could be transferred. Then he began his research on developing a treatment or vaccine. Anderson explained that Ebola was first recognized in 1976 when two outbreaks of the disease occurred simultaneously, one in Sudan and one in the Democratic Republic of Congo in a village near the Ebola River from which the virus derived its name. “The Ebola virus is a member of the Filoviridae virus family,” he said. “There are five species of Ebolavirus, also named after the location where they were first identified: Zaire ebolavirus, Bundibugyo ebolavirus, Sudan ebolavirus, Tai Forest ebolavirus, and Reston ebolavirus. Only the first three have been associated with human outbreaks causing deaths in Africa. Tai Forest Ebolavirus has infected one person who survived the disease. The virus associated with the current, multi-country outbreak in Africa is the Zaire species. “The viral host of Ebola virus is thought to be fruit bats of the Pteropodidae family. The introduction of the Ebola virus into human populations is from close contact with the blood, secretions, organs or other bodily fluids of infected animals such as chimpanzees, gorillas, monkeys, fruit bats or forest antelope in the rainforest areas. Prior outbreaks have been in more remote villages in Africa. The current outbreak (with the most cases and more deaths than all previous outbreaks combined) has affected more urban areas, and starting in Guinea has spread to Sierra Leone and Liberia. There have been a few infected, but asymptomatic travelers who have become ill after arrival in other African countries (Senegal and Nigeria) as well as Europe and the U.S. Human-to-human transmission of Ebola is by direct contact through broken skin or mucus membranes (eyes, mouth) with the blood, secretions, organs, or bodily fluids of infected people or their clothing or bedding contaminated with these fluids. Ebola is not transmitted by causal contact or airborne sources like the flu, and infected people are not contagious until they have symptoms. The incubation period, the time from infection to onset of symptoms, is two to 21 days with most people becoming symptomatic in the first seven to 10 days. First symptoms are sudden onset of fever, fatigue, muscle pain, headache and sore throat. These symptoms are later followed by vomiting and diarrhea, and later by kidney and liver failure with internal and external bleeding.” There are not yet any proven effective vaccines or specific treatments for Ebola virus, but multiple companies and institutions around the world are working intensively on gaining understanding of the disease, developing drugs that can be effective in destroying the virus or reducing its effect, and in developing both human and animal vaccines. Three potential human vaccines will begin human testing in the next few months. Several anti-viral drugs have been used experimentally with mixed results. Early and intensive supportive care with rehydration significantly improves survival. Several patients who have done well have been treated with transfusions of plasma containing anti-Ebola antibodies from patients who have recovered from Ebola virus disease. “Quarantine of exposed individuals, isolation and supportive care of infected people, strict avoidance of direct contact with infectious materials and fluids, and effective education to eliminate human contact with dead or dying animals potentially infected with Ebola will be the most effective solution to eliminating the current outbreak," said Anderson. About that fifth species of Ebola virus identified in the U.S, while investigating an outbreak of Simian hemorrhagic fever in crab-eating Macaque monkeys imported from Indonesia via a holding facility in the Philippines to Hazelton Laboratories in Reston, Virginia, an electron microscopist from USAMRIID discovered filoviruses in the tissue samples. Dr. Peter Jarhling isolated the filovirus, which was identified as a member of the Ebola family and named Reston Ebola virus (RESTV). Despite close human exposure, the Reston Ebola virus has not caused illness in humans, although it is lethal in monkeys.” In summary, Dr. Anderson stated, “The better the health that you’re in and the earlier that you get treatment, the more likely you are to survive a disease like Ebola. As concerned citizens, health care providers, etc., supporting the efforts of the organizations and groups that are working directly with the epidemic in Africa is the best thing we can do to prevent the spread of the problems associated with the epidemic, rather than only placing the focus on preventing the epidemic from coming here. Africa has at least 2,000 orphans whose parents have died from Ebola and the children are now stigmatized and abandoned. For the few people who have been exposed in the U.S. and are in quarantine, they should remain in quarantine for the 21 days and when flying, in addition to screening and taking temperatures, we are all relying on the integrity of travelers to be truthful.” While Indiana is not a native home to fruit bats, gorillas, chimpanzees or forest antelope or Ebola virus, residents can eliminate their risk of exposure to other diseases by avoiding contact with ill or dead animals. Unless you or someone close to you is a humanitarian aid worker working in Sierra Leone, Guinea, and Liberia or along side a patient who has been recently named in the news media, you’re not at risk of contracting the Ebola virus is significantly minimalized. People should be proactive in remaining informed. Education is the best weapon to eliminating fear, developing solutions and saving lives. Credentials for James H. Anderson Jr., MD, FFPM, FACE • M.D. from the LSU School of Medicine • Fellow of the Faculty of Pharmaceutical Medicine, Royal Colleges of Physicians, U.K. • Former Eli Lilly Senior Medical Director • Actively involved with the American Diabetes Association • Founding Board Member of American Academy of Pharmaceutical Physicians • Independent Director of Generex Biotechnology Corp. • President and CEO at Sycompeia Co. • Responsible for 6 U.S. NDAs • Previous clinical responsibility for two families of diabetes care products, Humulin and Humalog • Clinical Associate Professor of Medicine for the Division of Endocrinology and Metabolism at the Indiana University School of Medicine