Taking technology to the Ebola fight
Today, even the world's best hospitals rely upon a thermometer (a 400-year-old technology) to decide who to quarantine for Ebola.
The ambiguity in our current approaches to diagnosing Ebola has resulted in over 1400 Ebola suspects in the U.S. today who still have not received a definitive diagnosis.
Recently, Congress and the Senate approved $5.48 billion to fight Ebola both at home and abroad. I truly believe that the U.S. can win this global war on Ebola and other pandemics, but we must invest our resources wisely to significantly upgrade our diagnostic technologies and capabilities, bolstering the heroic efforts of those fighting this viral enemy on the frontlines, whether in African villages or in American hospitals.
Solutions exist today (beyond the thermometer) that can revolutionize how we stop the spread of Ebola and provide a quantum leap in our current capabilities for responding to such global pandemic threats. I have made this case directly to top officials in recent weeks at the Departments of Defense, State, Health and Human Services, and CDC, as well as CEOs and CMOs of our nation's leading hospitals.
The Thermometer Problem in Triaging Ebola Cases
It typically takes 10-21 days after a person has been infected with Ebola, for fever to occur. Meanwhile, the Ebola virus continues to replicate in the blood during this "incubation period" so that by the time the fever manifests, the patient has between 50,000 and 100,000 copies of Ebola virus infecting every milliliter of his/her blood. The thermometer thus has low sensitivity for detecting Ebola, resulting in a high rate of false negatives. An unfortunate case in point: Thomas Eric Duncan – the first domestic Ebola case, showed no feverish symptoms when he entered the country from Liberia.
With the current Ebola protocol, individuals can wait in limbo for as long as three weeks without a definitive diagnosis. During this time individuals are neither quarantined nor treated. Recent findings in monkeys and humans have shown that providing even supportive therapy to an Ebola infected individual early in the incubation period significantly increases the likelihood of survival.
Further, without a quick and accurate way to rule out the virus, any new Ebola cases coupled with flu season could cause panic and overwhelm our healthcare systems. For worried patients experiencing Ebola-like symptoms, a thermometer will have low specificity (high false positive rates) and cannot distinguish between Ebola and the flu.
The costs of false positives and negatives are too high to bear. Dr. Craig Spencer's case alone reportedly cost New York taxpayers $20 million. A flare-up of a critical number of suspect Ebola cases could exhaust our already fragile American healthcare system.
Disrupting the Centralized Paradigm in Healthcare
In a perfect world, pandemic response would use the gold standard for medical diagnoses. Based on 20-year old Nobel Prize-winning polymerase chain reaction (PCR) technology, this method measures the Ebola virus's ribonucleic acid (RNA) in the blood. But, this method requires centralized labs with expensive overhead infrastructure, trained personnel, large machines, running water, electricity and complex sample transport logistics.
This centralized lab paradigm does not work in West Africa due to the lack of basic infrastructure. Even in the U.S., this model broke down when the leading centralized lab testing companies refused to accept blood suspected of Ebola.
The Holy Grail is point-of-care (POC) testing. Unfortunately, the current generation of such PC tests suffer from a high rate of false positives and false negatives and therefore, require gold standard PCR confirmatory testing in centralized labs.
Nanobiophysics can provide next generation tools and infrastructure to decentralize, mobilize and personalize healthcare delivery. These tools can today rapidly detect and quantify deadly pathogens like Ebola, as well as and other diseases like HIV and the Flu, at the point of care with gold standard accuracy.
Quantifying the viral loads of viruses before symptoms appear will radically change how we stop the spread of diseases and prevent future pandemics. This will lead to early quarantine; stop the spread to others; and enable early onset of supportive and experimental therapies.
Our healthcare industry still operates on a paradigm of centralized infrastructure that was developed in the Industrial Revolution of the 1700's. The result is that today billions of people worldwide lack access to adequate healthcare infrastructure and we have a multi-trillion dollar healthcare dilemma here in the U.S.
The urgent Ebola crisis we face today might just be the catalyst needed to disrupt this old centralized paradigm and open the door for the next generation of global healthcare infrastructure.
Dr. Anita Goel, MD, PhD, is the Chairman and CEO of the Nanobiosym Research Institute and Nanobiosym Diagnostics in Cambridge, Massachusetts. A Harvard-MIT–trained physicist and physician- scientist, she was awarded the 2013 XPRIZE in recognition of her pioneering contributions to the new field of nanobiophysics and the Gene-RADAR® technology.
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