Experimental, Untested Ebola Cure -- "ZMapp" -- Appears to Work, Sometimes

But not always.

The first two doses of an experimental serum created to treat Ebola went to American missionaries.

Then the drug was sent to treat a Spanish priest.

The two Americans, Dr. Kent Brantly and Nancy Writebol, appear to be recovering. The priest, Miguel Pajares, died Tuesday morning.

That's the problem with experimental drugs that have never been tested in humans: No one knows if they'll work -- and if they do, in whom.

And, as you probably already know -- they don't have any of the drug left for sending to Africa.

Mapp Biopharmaceutical said Monday its supply has been exhausted after fulfilling the request of a West African country. (It did not name the country). Kentucky BioProcessing, which manufacturers a version of the drug, is working to increase production of ZMapp, but the process will take several months, company spokesman David Howard told CNN last week.

There's an ethical question here about permitting the use of an untested drug on people -- but I think an easily answered one, given that there is no known cure for Ebola and it has a kill-rate of, what, at least 75% in this latest outbreak?

WHO has approved the use of this untested serum on people (to the extent we have any of it on hand).

Ebola raises another ethical concern -- that about the police power of any state to detain you, even lock you up, without trial, without jury, without wrongdoing.

Just because they suspect you may be sick-- and could potentially infect dozens if not quarantined.

[G]iven the deadly nature of the Ebola virus, and the popular worry it’s likely to engender, one can expect the CDC and health authorities to pull out all the stops. The response could include invocation of the CDC's evolving quarantine authorities.

These federal powers comprise a set of rules that gives CDC sweeping authority to hold and isolate Americans in a public health emergency. These authorities haven't been fully updated in decades. They've only been amended in piecemeal fashion to deal with modern threats like SARS and MERS. In advance of what may be a very public test of these powers, the collected scheme deserves closer scrutiny.

...

The set of regulations also included a new "provisional quarantine" rule that would have allowed CDC to detain people involuntarily for up to three days, with no mechanism for appeal. CDC had to believe a person was infected with certain pathogens. Among the diseases included were pandemic flu, infectious tuberculosis, plague, cholera, SARS, diphtheria, and viral hemorrhagic fevers such as Ebola.

The regulations also defined "ill person" to include anyone with the signs or symptoms commonly associated with the diseases in question. This gave CDC more flexibility in deciding whom to quarantine by capturing a broader and earlier range of symptoms as the basis for holding an individual. It allowed for greater exercise of discretion public health officials and those staffing quarantine stations.

The regulations were an attempt to provide clarity to how quarantine would be implemented. But in spelling out its proposed procedures, the rule raised concerns that the feds were assuming too much jurisdiction to detain people involuntarily. In short, CDC got itself into political trouble by merely clarifying how it proposed to implement federal authorities that the agency long held, and still maintains.

Looking at the situation in Liberia -- where people are covertly disposing of relatives killed by Ebola, rather than inform the government they may have been infected -- it occurs to me that people wind up being willing vectors of infection, essentially in league with an epidemic, in symbiosis with it, evangelists for disease, even, just because no one wants to be quarantined, especially with other people who may be sick.

Nevermind terrorists who may see this as a weapon.

"For the safety of the community" is the bedrock justification for the state's large police power -- and it is a little scary, even if absolutely necessary.

posted by Ace at 07:24 PM

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