We need to be ingenious to fight Ebola: Siddhartha Mukherjee

Describing Ebola as an ingenious virus, Pulitzer Prize winning Indian-American author and cancer physician Siddhartha Mukherjee has said "we need to be just as ingenious" to fight the disease by detecting viruses in the pre-symptomatic phase of an infection.
In an op-ed in the New York Times on Sunday, Mukherjee said in the wake of the case of Thomas Duncan, the Dallas man who contracted the virus and died, three strategies to contain the entry and spread of the virus in the US have been proposed.
The first suggests drastic restrictions on travel from Ebola-affected nations, the second involves screening travellers from Ebola-affected areas while the third proposal is of isolation of all suspected patients and monitoring or quarantining of everyone who came into contact with them.

"Ebola is an ingenious virus," Mukherjee wrote in the op-ed, adding, "To fight it, we need to be just as ingenious."
Mukherjee, who won the Pulitzer in 2011 for his book 'The Emperor of All Maladies: A Biography of Cancer', suggested a fourth strategy involving use of novel methods to detect viruses in the pre-symptomatic phase of an infection.
"One of these involves the polymerase chain reaction, or PCR, a chemical reaction that amplifies pieces of a virus's genes floating in blood by more than a millionfold, which is what makes early, pre-symptomatic infections identifiable," Mukherjee said.

He said as an oncologist working with blood cancers, he has been using variants of the technique to detect sub-clinical infections in patients for nearly a decade.

He cited a 2000 study in leading medical journal The Lancet, according to which 24 "asymptomatic" individuals exposed to Ebola were tested using PCR.
The test now requires only a teaspoon of blood and the sample is transported, on ice, to a centralised lab with results back in a few hours.
"Technologies like this allow us to imagine a new form of quarantine. Rather than relying on primitive instruments, indiscriminate profiling or questionnaires, we should consider running a pilot program to test asymptomatic travellers using sensitive PCR-based techniques," Mukherjee said.
The assistant professor of medicine at Columbia University said huge logistical questions would need to be solved, including where would such a screening test be administered, what infection precautions would need to be in place for such testing and who exactly would be tested.

"Despite these questions, we should develop a pilot program, perhaps targeting the worst-hit regions of the epidemic. It certainly does not solve the civil liberties questions of quarantining, but it makes them vastly more palatable," he said.