The complexities of this issue are vast, as attempts to control Ebola must consider not only the virus, but also a multitude of extreme economic and social forces, a lack of information, and cultural behaviors. Paul Farmer explores this well in his book, “Fevers, Feuds, and Diamonds: Ebola and the Ravages of History.”

Economic factors may result in impacted communities lacking necessary infrastructure like roads, hospitals, treatment centers, and diagnostic laboratories that make disease response more effective. Too, rather than misinformation, perpetuation of the Ebola virus may be attributed to a lack of information about how the disease spreads and the benefits of diagnostic and pharmaceutical resources. Many communities, especially those in rural areas, are uneducated on infection mitigation efforts like quarantine and contact tracing, as well as proactive disease prevention efforts like wearing a mask and isolating yourself from diseased individuals.

There is also something significant to be said about cultural behaviors, specifically in West Africa, and their effect on Ebola response. For example, there is a native superstition that attributes Ebola to witchcraft, tasking healers or religious leaders with explaining disease contraction rather than relying on medical professionals. Too, an overall mistrust in government institutions and dependence on traditional caregiving practices may also isolate people in that region from resources to fight and protect against disease.

MRIGlobal's efforts aim to provide impacted communities with mobile laboratories to support research and diagnostic capabilities, as well as training for healthcare workers to practice and teach proper disease management strategies.

Unfortunately, Ebola never went away. It is endemic in wild animal populations and often spills over into human populations in contact with those animals.

If it continues to be under-diagnosed and insufficiently isolated, there will always be an opportunity for it to spread to other areas of the world. However, at this point, it seems quite unlikely.

There are two approved vaccines for Ebola Zaire, although availability is limited to those who work with it and those areas that are most affected. There is also a deficit in willingness to get vaccinated, as with many new vaccines.

There are several vaccines for Ebola Sudan in pre-clinical phases of development that are being fast-tracked in response to the current outbreaks. These are likely to be approved for emergency or compassionate use in the coming months, although general approval may be years away.

There are many factors that may influence a vaccine's availability, namely in resource-limited areas. Cost is just one of them. Developing effective disease treatment requires funding as well as support through technological and scientific resources that can be limited by your geographic area, infrastructure, and more.

As a part of a global community, we should ask: how can we collectively be more proactive in preventing disease and the spread of disease? How do your daily actions and decisions, from your purchases to your lunch order, impact the larger global population?

First and foremost, funding for national and international disease prevention is critical. We live in a highly connected world and science tells us that, because of modern air travel, a pathogen is only about 36 hours from anywhere in the world right to our homes.

Moreover, the impact of an infection that is out of control may remain in its geographical location, but can impact our logistical needs worldwide. This can include food, clothes, our electronics, and other critical aspects that enable our lifestyles.

Ultimately, this means we need to think globally and act locally. To speak generally, we are underprepared for global health crises and remain reactive instead of proactive. Most people assume this only has to do with funding and monetary resources, but it is equally due flaws in our collective mindset. We must invest in basic research, new technologies, and eventually distribution of that knowledge and capability around the world—the distributive medical model.

Medical interventions range from prevention (examples include: social distancing, wearing a mask, and washing your hands regularly) to treatment (examples include: antibody therapies, pharmaceuticals, and other symptoms management) phases of an infection. In general, treatment options depend on when a person first engages health care providers and their clinical status. If it is late, it can be too late. There are very few "miracle cures" for infections that have gotten out of control.

When a person feels so bad that they go to the hospital, it can often be too late or require exhaustive measures.

If disease symptoms are moderate to severe, the patient may survive, but have long-term clinical issues as a result of the acute infection (this is common with both COVID-19 and Ebola).

The long term impact on a survivor can range from mild to extremely debilitating. This is why vaccination is always preferable to treatment in a public health approach. Prevention is less costly and less risky for the individual than treatment.

Preventing infectious disease is not as complicated as you might think. Regular exercise is one of the most effective methods to staying healthy and reducing the risk of developing comorbidities. Other simple and effective methods include healthy eating and maintaining a regular sleep schedule.

If you're interested, our CEO, Ian Colrain, has done some fascinating research on human sleep physiology throughout his career.

At the forefront of MRIGlobal's disease response efforts is our mobile laboratories. During the 2015 outbreak, we were able to send labs outfitted with testing and diagnostic capabilities to aid in disease detection.

Building on lessons learned, our team of engineers evolved our mobile lab technology. Our Athena Mobile Lab goes beyond traditional mobile laboratory designs. Instead of using an ISO container as the basis of the design, our engineers have created a fully customizable structure that greatly increases the capability of a mobile lab. As a result, we developed a lab that improves work ergonomics, while still allowing for easy transport via trucks, boats, railcars, and airplanes.

We designed the Athena Mobile Lab to fill the need for a gold standard mobile model that allowed diagnostic assays to be closer to a collection event. Their goal is to collect the chemical, biological, biometric, and other evidence necessary to reach a diagnosis and decrease the time between collection and test results.

I spoke in a video a few years back on our mobile lab capabilities: https://www.youtube.com/watch?v=D7W3Bd4T2cY

My colleague, Chris Hollars, has also spoken about our Athena Mobile Lab in more detail in this video: https://www.youtube.com/watch?v=IGrVqn-mETc

For more insight into our current Ebola response efforts, listen to my recent podcast with our COO, Dean Gray and Program Manager, Peter Anderson: https://www.mriglobal.org/gray-matter-podcast-conversation-with-peter-anderson-and-jay-mansheim-engineering-an-ebola-response/

During the 2015 outbreak in West Africa, there were limited local diagnostic resources and test results needed to be sent to laboratories in the capital. Because of the travel time, it could take up to 3 days to get a clinical diagnosis back. In this time, their condition could worsen and they could be infecting those around them.

During this time, a team of MRIGlobal researchers joined the scientific community of about 15 other countries to deploy mobile laboratories adjacent to existing treatment centers to expand the geographic reach of testing capabilities, effectively shortening the diagnostic process to just hours. The team also encouraged containment practices like isolation, contact tracing, and limiting travel.

Local government programs provided additional resources like food, water, and other supplies in response to these containment protocols.

Unfortunately, outbreaks happen nearly every day, even small groups of people impacted by a foodborne illness, influenza, or other viral disease.

The health care system, as well as a dedicated public health system with ample resources, is always working to protect us! These are caring and well-meaning people that have individual and community interests in mind.

It's difficult to estimate given that there are no current cases of Ebola Sudan in the US.

In general, the higher the concentration of people in a given area, the more likely it is that transmission occurs and becomes harder to control. The midwest is also a less frequent international travel destination. Just like we saw with COVID-19, the coasts typically experience earlier outbreaks relative to the midwest.

We are working in many parts of the world with government, NGO, and commercial organizations to distribute diagnostic assays to these areas and equip them with trained staff to identify cases early on.

We are also working on Global Health and One Health efforts to better understand threats in different parts of the world to both humans and animals.

A key aspect of infectious disease response is biosurveillance, with the goal of developing effective surveillance, prevention, and operational capabilities to detect and counter infectious disease threats.

Following the Ebola epidemic in 2014-2016, we collaborated with local human and animal health professionals to offer a series of trainings with the goal of enhancing biosurveillance and biosafety and biosecurity (BS&S) in West Africa. These trainings provided them the ideas, policies, and techniques to effectively implement BS&S efforts in the region, improving future response efforts.

In fact, the molecular diagnostics laboratory that we established in Guinea remains in operation, serving as a local public health resource and first line of effective surveillance for the community.

Everyone plays a role in viral outbreak response, whether it's a local outbreak or an international pandemic. First and foremost, your question imparts that you have an open mind and interest in understanding and helping; the core mission of the "professionals".

Caring is key! Yes, there are always ways to contribute. First is to apply basic public health principles—what I refer to as "what my mom and grandmother told me to do"—like washing your hands, staying home if you feel ill, eating well, sleeping well, and avoiding other sick individuals. Here are some strategies for a healthy fall from the CDC.

Outbreaks and pandemics encompass needs other than medical treatments, including food, water, and other resources for patients, their families, and caregivers. Donating or reallocating resources to those in need is a great way to help.

Working with politicians to make informed decisions, which can be unpopular and costly, can also make a massive impact. Staying in the know with international and local policy can make you better equipped to understand and positively contribute to relief and response efforts.

The order of operations is to detect the disease in people (or animals for some diseases) as early as possible, using:

• Contact tracing—monitoring who was in contact with the patient, then monitoring the patients for fever and illness.

If things get worse, countries may:

• Ask for assistance—when the resources are not available or limited, as in remote locations or in the case of new diseases, usually through the Africa Union, WHO, and other trusted partners

The response to these requests for assistance may include:

• Deploying Mobile Laboratories for advanced diagnostic and research capabilities
• Deploying Mobile Treatment Centers to bring patient care closer to the point of outbreak
• Building Isolation Hospitals to mitigate the outbreak and prevent further spread

The on-going responses in Africa are well-coordinated within each country and have the strong backing of Africa Union CDC.

Earlier outbreaks relied on US, EU, or other countries to participate with resources including staff. Now, Africa uses its own scientists, health care resources, and experts at the regional and continent members to rapidly detect, respond, and recover from any outbreak.

These have been a strong part of the US and WHO. Global resources have been invested in developing this expertise, including work from MRIGlobal, making Africa a partner in Global Health and One Health.

Our team recently covered this topic on our blog.

In his book “Fevers, Feuds, and Diamonds: Ebola and the Ravages of History,” author Paul Farmer reports on the myriad of complex cultural, political, and economic factors that contribute to the conditions that allow Ebola to exist in West Africa. Though too numerous to list here, they include a lack of education, especially in poor and rural communities; Lack of infrastructure, including roads, hospitals, and clinics; Years of civil war and strife, driving professional outmigration; A lasting control-over-care legacy of colonial rule that officials use to quarantine and isolate the affected, rather than developing a medical and educational infrastructure that emphasizes a proactive approach to care; Caregiving practices, especially for the deceased, that are often the responsibility of the family – this results in the deceased spreading the virus to members of their family; The virus is difficult to study due to fear of infection, so even basic therapies aren’t fully understood.In the wake of these many harrowing, ongoing, and compounding factors, the virus itself is sometimes seen as the final blow.

Recent COVID-19 outbreaks, as well as the 2014-15 Ebola outbreaks, have provided us with invaluable experience and knowledge in disease response. Following the 2015 outbreak, we have developed our Athena mobile laboratories, which can be deployed all throughout the world.

The COVID-19 pandemic has changed the face of available diagnostic tools. It has enabled the rapid introduction of at-home testing with relatively easy "rapid" assays that can help determine if you have COVID-19. It has also enabled telemedicine in a way that was slow to emerge until COVID-19.

Getting tests in the hands of patients, and then enabling contact with a healthcare professional that can help manage your case, will improve healthcare worldwide, even in emerging countries with limited infrastructure.

We are currently working on at-home diagnostic assays that can test for a variety of viruses, including COVID. This may have a profound impact on health management for people with other comorbidities like diabetes and other autoimmune disorders.

There are so many more examples, like vaccines and therapeutics and the public response to them across the world.

Ebola may cause hemorrhagic fever in patients, which can look like bleeding in the late stages of disease, but not always. Not every person responds the same to the Ebola virus; this is a rare symptom. Because this symptom is so dramatic, it is more often associated with the disease than it is likely to occur. Like many viruses, there are a wide variety of outcomes that may occur, including being asymptomatic.

Clinical signs of Ebola virus may be similar to cold and flu early on. This makes diagnostics essential in responding to and treating these cases. More developed areas of the world have better access to diagnostic tools that are unfortunately unavailable in other places. This is why assay development and distribution is a focal point of our efforts.

Early detection and contact tracing are key. Patient and contact management are also essential in guiding mitigation efforts.

Further down the line, countermeasures like vaccines and therapeutics and being able to effectively distribute them is important to disease management. Currently, we don't have any approved countermeasures available for Ebola Sudan (the current outbreak).

Monkeypox is a similar example where we initially helped develop assays that were not developed further due to lack of funding and support.

We are fortunate to be a part of the teams developing these crucial assays when resources and funding are available, like in the case of COVID-19.

In the past, before the 2014-15 outbreak, poverty was associated with higher transmission. Since that has occurred, there have been a number of studies done on the correlation and have since found that there is an equal risk of infection between poor and wealthy populations. There could be other factors at play outside of socioeconomic status, such as level of isolation of a community.

In today's cases, local anthropologists are looking further into these questions. What is exciting is local communities are doing these studies within their own culture; this is a big change from the past. A western researcher may not understand the nuances involved in a response or know what questions to ask.

An important consideration is that this point of view is relative to our own socioeconomic status and mitigation efforts depend on everybody's ability to understand their own risk factors among their lifestyle and community.

Our scientists are currently on standby to assist with the incidents taking place, like in the case of Uganda. We must wait to receive request from the efforts in the affected countries before entering the situation.

In the event that we are asked to respond, we have mobile containment laboratories ready to deploy. This assistance is always available to countries in need.

In the past, in addition to providing mobile laboratories and point-of-care diagnostic assays, we have also deployed our own teams to support the local efforts.