The "Laptop of Doom" & the Threat of Bioterrorism

Commenting on the ongoing Ebola outbreak, I often note that all the novel medications and vaccines being put in trials are the result of a recognition, post-anthrax, that Ebola could be a potential bioweapon. Almost 13 years have passed since Amerithrax and many have forgotten about the sense of alarm and calamity that gripped the nation in October of 2001. 

The specter of bioterrorism is in the headlines again with the revelation that a laptop found in Syria contained information about using plague as bioweapon. 

Unlike anthrax, plague--caused by the bacterium Yersinia pestis--can be transmissible from person-to-person.

Plague, like anthrax and Ebola, is also classified in the highest priority category (A) and has a long history of use as a bioweapon that stretches back to the times of The Black Death, when a Tartar commander catapulted plague-stricken corpses into the city of Caffa.

In the modern era, the bioweapons programs of the Soviets (and the US) also sought to weaponize plague. One fact that would delimit plague's effectiveness, however, is the fact that it is easily treatable with antibiotics and, upon exposure, prompt administration of antibiotics can abort infection. 

The lesson I draw from the discovery of this laptop is that, despite an absence from the headlines, the threat of bioterrorism is itself not absent. 

Are Pubic Lice Endangered?

The only human disease to be eradicated from the planet is smallpox and it is widely believed that the next will be dracunculiasis, caused by the guinea worm. But, a piece I recently read makes me think that pubic lice (Pthirus pubis) has a squirming chance at becoming #2. 

A summary of a recent journal article appeared in Clinical Infectious Disease reporting on a study in which an STD clinic reported a 26-fold drop in pubic lice between 2003 and 2013. The reason for the near eradication wasn't some magic new lice treatment, but possibly pubic hair shaving. 

I guess making pubic lice homeless really exposes them to inhospitable conditions and they perish--not a bad thing for someone who dreams up extinction events for pathogens. 

I wonder if the pubic lice think of Brazilian waxing the way the dinosaurs viewed that comet? 

To Be or Not To Be...Quarantined for TB

With all the talk of quarantine being used with the Ebola outbreak in West Africa--and now a separate Ebola outbreak in the DRC--an actual quarantine order was issued in Santa Barbara. It wasn't for Ebola though and it wasn't for an entire region--decisions that are really not evidence-based nor effective.

This order was issued for an individual with drug-resistant tuberculosis who is apparently communicable (i.e. smear positive) who represents a contagion risk to others. According to news reports, he has refused treatment and cannot be located. 

Quarantines and isolation orders are difficult topics with many legal nuances however, in my view, they should be used exclusively when solid criteria for contagion with a non-trivial pathogen--not the common cold--are met for individuals (vs. geographic locales) who possess  an actual risk of spreading disease. Smear-positive cases of tuberculosis, in which an individual's cough has been shown to harbor the bacteria, can represent such a contagion risk. 

Diseases spread through the airborne route, like tuberculosis, necessitate a higher degree of intervention than diseases spread  through blood and bodily fluids which are much harder to contract. 

These facts should be kept in mind when using government force with respect to contagious infectious diseases. 

Is Nano Silver Ebola's Snake Oil?

George Washington's last days in which he was bled (maybe to death?) 

Every time an outbreak of a new lethal disease occurs, there is a search for effective medications. In some cases, drugs in development are available for early use, their potential effectiveness extrapolated from animal use. In other cases, existing drugs are repurposed based on pharmacology coupled to projected efficacy based on the characteristics of the pathogen (e.g. same viral family, etc).

However, history abounds with false cures more likely to cure than harm. Strychnine, mercury, and blood-letting are historical examples. In fact, blood letting is thought to have played a role in the death of George Washington who was suffering from a throat infection.

Unfortunately, the modern era is not free from such ill-fated efforts. Like the false cure forsythia hawked by Jude Law's tech-savvy blogger character in the movie Contagion, snake oil salesman come in all forms. In the 2000s, South African President Mbeki and his health minister "Dr. Beetroot"--in the midst of their nation's large HIV burden--repudiated scientifically validated and life-saving antiretrovirals in favor of lemon juice, beetroot, and garlic. You don't have to just imagine the consequences of this and the horrific "Virgin Cleansing Myth".

So when news reports emanating from the West African Ebola outbreak describe dubious therapies, it comes as no surprise. High dosages of salt and "Nano Silver" (on which I was interviewed in this article) are just the newest incarnations of a very old phenomenon.

While I laud efforts to find countermeasures against disease, basic biological plausiblity and following the rules of logic are a precondition to any true advance. 

Is North Carolina's Ebola Quarantine Justified?

I'm puzzled by the announcement that asymptomatic individuals returning to the Charlotte area from Liberia are being quarantined for a period of 21 days because of concern they may be incubating Ebola.

Several important questions that I think need to be answered include:

• Is this a "voluntary" quarantine or is it mandated? What is the penalty for breaking it?
• Who is the governing authority? Mecklenberg County or the state of North Carolina?
• Where will these individuals be confined to? Their homes? A facility? 
• Since Ebola is not casually transmitted what is the evidence that such a quarantine would be effective?
• If this is to be taken as a precedent are all CDC officers deployed to West Africa to be quarantined upon return as well? 
• It's OK to fly, but not to freely move about Mecklenberg County?
• Why was this action never undertaken with travelers to prior Ebola outbreaks, Lassa Fever outbreaks, or to the Middle East (where the more contagious MERS circulates)?

Authorities say this quarantine order is being issued "out of an abundance of caution" but it does not excuse taking actions without an actual risk-based justification. To me, this quarantine delivers a mixed message to a public desperate for clarity on the actual transmission risk of Ebola.