A Collective Realization—We May All Die Horribly

Well, the obvious place to start was that little paper where scientists used CRISPR technology to show that Homo naledi buried their dead next to coursing rivers on Mars. Despite that slam-dunk of a choice, my vote for the most interesting/important piece of science news comes in two parts, spanning the last twenty-five months.

Part I: The plot setup

Back to December 2013, a one-year-old boy in a Guinean village died an agonizing death and, as a result, large numbers of people in the West learned the names of some West African countries for the first time. By now, everyone is familiar with the broad features of the West African Ebola virus epidemic. The disease, which previously had barely been on the public’s radar, had been flaring up intermittently in Central Africa and then quickly burning out. Its disease was devastatingly lethal, rapidly killing the majority of people infected; the virus requires contact with bodily fluid for transmission, and it has evolved brilliantly to facilitate that, as sufferers die in an explosion of bodily fluids—projectile vomiting, continuous diarrhea, and external hemorrhaging with some viral strains. If Joseph Conrad had known about Ebola, he would have written it into the story line in Heart of Darkness.

And then the virus made the nightmare jump from sporadic cases in the darkness of low density rain forest populations to its debut in the light of high density urban settings, bursting out almost simultaneously in the cities and towns of Sierra Leone, Liberia, and Guinea. It was inevitable, given modern mobility.

The countries were utterly unprepared—big surprise—as if anyone would be. Poor, with large shantytown populations, still recovering from years of war, minimal medical infrastructure. Liberia had all of around fifty doctors at the time.

It was a disaster on a breathtaking scale. Nearly 30,000 cases, over 11,000 deaths—numbers that are probably underestimates. By most analyses, an even larger number of people sickened and died in the secondary death toll due to hospitals being overwhelmed solely handling Ebola patients. At its peak, there were thousands of new cases each week.

The impact was staggering. Entire extended families were wiped out, as people cared for relatives, or washed their corpses, as per custom. Villages and towns were emptied, the capitals became ghost towns as governments urged people to stay in their homes, to not touch other people. What semblance there was of healthy economies in the countries was demolished. Hysteria flared in various predictable ways. One extreme was to deny the existence of the disease, insist it was a hoax—some quarantine centers were ransacked by crowds intent on “liberating” their relatives, burial teams were attacked when they came for bodies. Other forms took shunning, ostracizing, even brutally driving out virus-free survivors. And naturally, suspicion and fear of the disease prompted various shoot-the-messenger scenarios; in a machete-the-messenger variant, eight aid workers were hacked to death in a village in Guinea.

Naturally, suspicion and fear also played out on a larger level of conspiracy theories. No less a combination of a leading newspaper in Liberia, a Liberian professor in the US, Pravda’s English edition and Louis Farrakhan all declared that Ebola was invented by the West. As a bioweapon that escaped from a lab. As a bioweapon intentionally being field tested on Africans. As a strategy to decrease the number of Africans. Or, in a capitalist critique from Pravda showing a seeming nostalgia for Soviet-era thinking, as a bioweapon to be released, allowing the West to then hold the world hostage by charging exorbitant prices for the already patented cure—i.e., a military-pharmacology complex. And of course, various West African clergy weighed in with their discovery that God was using Ebola to punish West African countries for the supposed laxity with which they persecuted homosexuals.

Unless you were one of these conspiracy theorists, the story had no villains (amid the World Health Organization getting a lot of criticism for not being prepared and being slow off the mark; how in hell are you supposed to be prepared for something like that? they retorted). But there were heroes of enormous magnitude. Doctors Without Borders deservedly achieved cult status, both for its presence and effectiveness, but also for its honesty and lack of institutional BS. Medical missionaries were extraordinary (something I was initially loath to admit; having worked regularly in Africa for thirty years, I spout a secular leftist’s obligatory condemnation of missionaries). And most of all, there were the heroics of the West African health care workers—the doctors, nurses, ambulance drivers, burial teams—short of every resource that would make them effective or keep them safe. Ten percent of the deaths in the epidemic were of health care workers; in August 2014, Science published an Ebola paper where five of its West African authors were already dead.

We watched it all from afar, with the option to turn the page to the next story. And then it came home.

First were the handful of expatriate health care workers who became infected and were brought, amid extraordinary care and containment methods, back to the West for almost always successful treatment.

Then came Thomas Eric Duncan, a Liberian man visiting relatives in Dallas, whose Ebola was the first case diagnosed in the US. He was a good Samaritan who drove a sick, pregnant neighbor to the hospital, unaware that she had Ebola and thinking that her illness was pregnancy-related. Thus, he failed to note his exposure on health forms and was allowed to fly; he went to an ER in Dallas with the starts of the disease and someone (the finger pointing continues) failed to ask him if he had come from another country, let alone from the West African hot zone. He was sent home with an antibiotic prescription and returned to the hospital a few days later, dying. My god, for a few days, America learned the name of some African guy and worried about his health.

Then came the Ebola cases in two of the nurses that cared for him. The second, aware of the first having been diagnosed, nevertheless chose to fly to Akron to buy a wedding dress, resulting in the shop of thirty years tenure going out of business soon after because of people’s fears (in a move that defines chutzpah, the nurse joined the array of other customers of the wedding shop in requesting a refund on her ostensibly tainted purchase).

Then came the doctor, back from treating Ebola in West Africa, on the loose in New York City, going to a bowling alley in Brooklyn the evening before he developed symptoms. And the returning nurse who either did or didn’t represent a health risk, and who refused to be quarantined, biking around her Maine town for photographers, asymptomatic and virus free, wearing her bike helmet.

By then, we were all collectively wetting our pants with terror, and the obligatory question that would appear at the end of old articles about that obscure Central African hemorrhagic virus, “Could it happen here?” had become, “it’s happening here, isn’t it?”

And that produced what I consider to be the most important, significant moment concerning science in 2014. It hadn’t happened for Legionnaire’s disease, toxic shock syndrome, the anthrax scare, or even AIDS. It sure hasn’t happened for global warming. For the first time in my lifetime, America had a collective realization—we may all die horribly unless some scientists figure out a way to save us.

Part II: The (starts of a) resolution

As the most scientifically significant moment of 2015, a twenty-eight-author team publishes in Lancet about the results of a Phase II clinical trial of an Ebola vaccine. Nearly 8,000 Guinean subjects, careful experimental design, 100 percent effectiveness at preventing disease occurrence when administered immediately after exposure to someone with Ebola. Yes, this isn’t the end of the disease, and the research started long before the West African epidemic. But this is a rough approximation of scientists, with lightning speed, saving us. It would be nice if the general public thought the same.