Ebola for Just a Moment - My Experience in Sierra Leon 2014

              Sitting in the lobby café of the Radisson Blu Hotel at Lumley Beach in Freetown, Sierra Leone on Friday night I look down at my right leg and was horror struck…is that Ebola?

            My right leg was a quarter covered by what looked like a red rash, an early sign of Ebola virus disease - EVD to those in the know. I panicked for thirty seconds. Oh my God, it couldn’t be. I had been so careful. Sure I had been into an Ebola treatment unit (ETU) six days earlier, and that was within the incubation period, but I was careful not to touch anyone and I had only gone into the administrative area. A senior official from the ministry of health was castigating a doctor for some apparently embarrassing publicity the government had received. I was surprised to see she was wearing open-toed shoes. At least I wasn’t that careless. So how could this have happened? On closer inspection it turned out the red spots were only a minor skin abrasion I hadn’t noticed in the two days since I had seriously skinned my knee and shin of my left leg and both hands when I fell while running down the sidewalk two nights earlier. I had been in too much of a hurry to pick up more of my Ebola scientific hand-outs to distribute at the Ebola forum from the less classy hotel where I was staying just down the hill from the Radisson. The NIH, CDC and WHO had established headquarters in the Radisson and seemed to be having some kind of Ebola mini-conclave. Worse scares have happened in the Ebola zone.

            After a week in Freetown I didn’t quite know where I stood. I had made the rounds at the ministry of health, the drug regulatory agencies, the government HIV project, a couple of Embassies and an Ebola forum. Most doors had been opened to me for brief five or ten minute meetings but no one person stood out as the lead person in a decision making capacity who understood the issue, and was ready to take action and expedite purchasing a large enough amount of selenium to give to the hundreds of Ebola patients in Sierra Leone who desperately needed it.

            On my first trip to Sierra Leone, I had not come with the ambassadorial introductions and instructions from the highest levels that I had when I arrived three months earlier in Monrovia. Yes, I had my Liberian fixer with me for the first two days, but all that got me was an introduction to the Liberian Ambassador in Freetown, not much else. But I’ve never been shy to knock on doors of government ministers when I had significant information and scientific insights to offer. This time I did. I possessed the secret of how they could cut the death rate from Ebola infection by half. But who could possibly be ready to believe that after they have heard a hundred times over…”there is no treatment for Ebola, there is no cure.” Half of that over-repeated axiom was wrong. The clinical trial conducted by the Liberian Ministry of Health showed that when they used only 60% of the selenium dose I recommended against Ebola, the death rate was cut by 44.4%. Certainly if they used the correct dosage mortality would fall by 50% or more, closer to the 60% reduction in death when selenium had been used in other hemorrhagic fever epidemics.  Hundreds, soon thousands of lives could be saved and the spread of this frightening epidemic would be marginally curtailed. My mission was to break down the accepted common knowledge that there is no effective treatment and make government officials understand something actually does work to improve survival rates significantly - the well-known nutritional supplement selenium. 

            Friday afternoon, after four days of making the rounds of Ministry of Health offices and drug agencies I learned that someone would be appointed to liaise with me to maybe conduct a clinical trial. This information was extremely vague and unspecific but at least sounded encouraging. I was also told that Sierra Leone was using “something else” that seemed to be working. That sounded doubly vague and unsubstantiated. The ministry of health official put it in such a way that it sounded like a dodge; as in, “we really don’t need selenium, we’ve got ‘something else’ that is working.” Of course if they did have their own thing and it is working, should not the whole world be told? Should not the information be shared with neighboring countries? Should not it be combined with selenium to have an extremely effective combination therapy against EVD? That vague reference to “something else” surely raised more questions than it answered. It was hard to believe, but then again, there were many unsolved mysteries in the Ebola Zone. As it turned out, the second part of the official’s statement was probably as untrue as the first.

            A month earlier Sierra Leone had gone into a three-day lockdown to conduct a door-to-door survey to find people suffering from Ebola and try to clean-up the problem at its roots. Many NGOs warned the idea would not work. It did not – at least as well as it intended. The house-to-house approach had been taken because many infected people seemed to be hiding. Not surprising when there were not enough Ebola treatment unit (ETU) beds available and to go to an ETU seemed as good as digging your own grave. Many people still did not believe Ebola existed at all or that the men in white protective plastic suits were actually giving people Ebola instead of trying to save lives. Many thought Ebola was caused by evil spirits or else must be some kind of government scheme to make money. This viral epidemic was new, confusing, frightening and almost supernatural. A new sort of evil in a part of the world that still believes in witches, evil spells and black magic. Ebola was ruining the country, destroying lives, families, communities, jobs…everything. Schools, clubs, bars and theaters were closed, and even worse, football games cancelled. People were told not to touch, kiss or shake hands. Every time you entered an office, bank, restaurant or hotel you had to wash your hands with chlorinated water and have a temperature gun held to your head to check to see if you have a fever. Ten times a day! It was a catastrophe. In just more than the week I was in Sierra Leone, two Sierra Leonean doctors died and a Cuban doctor had to be flown to Geneva, Switzerland for treatment. When not fully protected by an Ebola suit, he foolishly tried to catch a man who was physically collapsing. On my last day there an infected Italian doctor was airlifted back to Italy for treatment. Doctors and health care workers were dying at an alarming rate and nobody in an official capacity had more than five minutes to meet with me to learn how they could cut the dying in half. In Liberia they had listened with concern and they acted quickly. In Sierra Leone maybe I just didn’t have the right introductions or maybe the situation had not become desperate enough. I could tell more trouble lay ahead. It would get worse before it would get better. Within three weeks the number of cases in Sierra Leone would exceed the total number of cases in Liberia.              

            When I met with one top health official he mostly ignored what I was saying and stared into his computer. As I handed him document after scientific document detailing information about selenium and Ebola and selenium and HIV, he placed them one after another in a neat pile to his left. Halfway through my brief presentation a man in the office shouted out that he could not sit idly by while I gave such false information to the good doctor. The pompous shouter professed himself “a professor of immunology from Stanford University, Palo Alto”. After his second interruption I finally stood up from my seat, turned to him and retorted, “Maybe I know more about Ebola than you do.” After all I had brought the first treatment to prove effective against the disease in Liberia. What had he brought? I walked over to where he was sitting and put my selenium-Ebola science on the coffee table in front of him. “Read this and maybe you will learn something.” After all, I was in regular contact with the top Ebola expert in the world, the scientist who first sequenced the genetic code of the Ebola virus.  I called the professor a “know-it-all” and challenged him to a debate on the subject “anytime, anywhere in the world”. Then I returned to the doctor’s desk to finish giving him my material. Not wanting to extend my brief, most basic of presentations longer than necessary, as we walked out of his large office I apologized to my host, the Chief Medical Officer of Sierra Leone's Ministry of Health. “I’m sorry for the fireworks, especially since it isn’t Sierra Leone’s national day.”       

            Often in such crisis situations logic gets lost in the frantic crosscurrent of information and misinformation, judgements and misjudgments that inevitably occur. Completely closing down a nation’s economy for three days costs approximately .75% of annual GNP - tens of millions of dollars. Buying enough selenium to treat every person in the country who is infected with Ebola, cut the mortality rate in half, and encourage people to seek attention for their disease because an effective treatment for Ebola disease actually exists and is available costs less than $14,000. That is about the same as one used ambulance.  

            As international health “experts” in short sleeve shirts mindlessly knocked elbows, skin to skin in the bar of the Radisson Blu, instead of shaking hands - because that might transmit Ebola - I asked myself how clueless most of them really are. Yes, they want to fight Ebola. But sometimes in meetings they seem to be fighting selenium just as hard. I think back to the title of the first real book I ever read in summer school between first and second grade. Yes, this is still A Topsy Turvy World.