Fortunately, that’s been tested. Kobinger’s group followed up their pig study by specifically looking at whether Ebola virus could be transmitted between primates by an airborne route. That, after all, is what we’re interested in. Most Americans aren’t concerned about coming across an infected pig, but they may be worried about sharing breathing air with a person infected with Ebola virus. They set up this study so monkeys would share the same air but be unable to throw feces or other debris between cages, which could easily confound the results. When they did this, none of the control monkeys were infected, despite the experimentally infected monkeys getting sick and dying.
What it boils down to is not only is there no evidence that Ebola virus spreads between primates by an airborne route, there’s actually evidence it does not. If Ebola virus-infected pigs are found in an outbreak zone, which has never happened, they can easily be culled. Hatfill knows about the subsequent study, and that we have never seen airborne transmission in an outbreak; he mentions both. But he still circles back, relying on the pig study, to say that it’s irresponsible to say Ebola virus isn’t airborne. It’s a careful balance of not ignoring the inconvenient data, but emphasizing that which frightens but is far less relevant. It’s misleading without lying, and it leaves the reader, at best, unsure of what to believe.
In reality, there’s nothing equivocal about the data. No biologist would stand before you and absolutely discount the possibility of nearly anything, but based on the excellent experimental data we actually have, we can conclude that Ebola virus simply isn’t transmitted through the air between primates.
The breakdowns in infection control in Dallas have also been in the news, with a focus on the inadequacy of the CDC’s original guidelines on the use of Personal Protective Equipment when treating Ebola patients. Hatfill offered the opinion that the problem here is that “We've taken a BSL-4 disease, and we're treating it in BSL-3 conditions.” BSL-4 though, means positive pressure suits, like those seen in the movies Outbreak and Contagion. In reality, the gold standard for clinical Ebola PPE, recommended by Doctors Without Borders and now the CDC, is something less than that. This entails full skin coverage with an impermeable gown or suit, use of a respirator to protect the worker during procedures like intubation, double gloves, and show covers. This all sounds a lot like what we wear to work with SARS or MERS, two viruses that require BSL-3 containment and procedures.
The specialized facilities we have to treat diseases like Ebola do reflect this. None of the hospitals that have safely treated Ebola patients, Emory, University of Nebraska, the NIH, or Bellevue have BSL-4 medical suites. What they have are contained-isolation rooms and the rigorous and careful use of BSL-3-like PPE by highly trained staff. The BSL-4 medical suite at USAMRIID wasn’t closed for budgetary reasons, it was closed because the NIH isolation facility used to treat Nina Pham is fully sufficient for treating any USAMRIID researchers exposed to Ebola or other dangerous viruses during lab accidents. Ebola is a scary virus, but making it ten feet tall won’t help us save lives. To safely and successfully treat patients we need excellent training and effective PPE that enables nurses and doctors to do their jobs. Not only is medical treatment in a restrictive BSL-4 suit that much more difficult and cumbersome, the recent experience in non-BSL-4 medical facilities shows us that it’s unnecessary for the safe clinical management of infected people.