Webinar Siri's My name is John Reject, and I'm the senior director of alumni networks for the Alumni Association.

Thank you to all alumni and friends who have made time to join us live today.

Today's Webinar, a Citizen's Guide to Ebola, is presented by one of the world's most sought after experts on infectious disease threats in international health.

Dr Michael Foster, home of the University of Minnesota, who will give an overview of key aspects of the Ebola epidemic and what the public really needs to know.

This webinar is part of a new free Siri's being offered by the University of Minnesota Alumni Association, where we're having conversations with experts about career life in learning topics.

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It's now my pleasure to welcome to the Webinar Dr Michael Foster home.

Dr.

Auster Home is the McKnight presidential endowed chair in public health at the University of Minnesota and director of the Center for Infectious Disease Research and Policy.

He's also a professor in the division of Environmental Health Sciences at the School.

Public Health.

A professor in the Technological Leadership Institute in the College of Science and Engineering in an adjunct professor in the medical school here at the University of Minnesota.

He is also a member of the Institute of Medicine off the National Academy of Sciences in the Council of Foreign Relations.

Dr.

Auster Home is the author of more than 315 papers and abstracts, including 21 book chapters, and is a frequently invited guest lecturer on the topic of epidemiology of infectious diseases.

He has received numerous honors for his work and has been the recipient of six major research awards from the N.

I.

H and the CDC.

We're very honored that he's taken time out of his busy schedule to join us today.

Welcome to the weapon, our Dr Foster home.

Thank you very much and thank you for having me today over the next 45 to 50 minutes, I will share with you an overview of what one might call a citizen's guide to the Ebola epidemic.

And in doing that, I hope that I will be able to provide some constructive comments about where we're at and where we're going.

First of all, let me just say I have no financial relationships to disclose here, and I also do not, uh, will not discuss sending off label or investigations from my presentation.

And I know less about Ebola today than I did six months ago.

So please take that information provided here with that acknowledgement to start out, let me just come into and two quotes, I think, really set the overall stage room talk about today.

One is from Daniel Bornstein, former librarian to Congress, once said, the greatest obstacle is discovering the shape of the Earth, the continents and the oceans was not ignorance with the illusion of knowledge.

I think you'll see today that we can safely say that we're learning a lot about Ebola is a virus as an infectious disease and as a interface with global public health practice in medical care, and we have a lot more to learn second ball.

Richard Feinman, the former Nobel Prize laureate, one said, For a successful technology, reality must take precedence over public relations, for nature cannot be full.

I think we can also add here that for a successful public health intervention, reality must take presidents, and we're learning a great deal in that regard.

Now the next slide is really a context slide that shares with you a sense of how and why we might be concerned about Ebola in a different way today than we have in the past.

As you see here, you can see how world population has increased from 18 50 to 2000 today at about 7.5 billion people wanted.

Every eight people who's lived is on the face of the earth right now.

In addition, of course, global trade and travel.

While the time hasn't gotten any faster to get around the world since 19 fifties, the amount of people goods items of the things that go around the world hat these two factors of really combined to make for a potential for Ebola today, too, do things that from a public health perspective that we had not really once considered for example, one of the areas of the fastest growing growth in human population is actually in the equatorial belt of Africa with the new mega cities there, and this is clearly an important aspect of what's happened in terms of the recent months in West Africa.

Now to give a basic background on the Ebola virus in human infection was named after the Ebola River and what was then Zaire now the Democratic Republic of the Congo was first discovered in 1976 in a very remote rural village area.

Since that time, there have been 24 outbreaks are isolated case occurrences documented, of which 20 of these were community white outbreaks.

So in a sense, very limited, likely before 1976 such outbreaks also occurred.

But because of the very sparse human population in Equatorial Africa, it's unlikely that any of these would have been large outbreaks where I'm going and sustaining when you look at the total number of people that were known to be.

Cases in these 20 outbreaks numbered about 2400.

Most of the transmission was extremely limited for the Ebola Sudan outbreak.

There was probably 15 different generations on that was it a generation being from person 12 person to his one generation person to person three.

But for the virus that we're dealing with today, Bhola, Zaire the most number of transmission generations was five.

And in this regard, uh, you can summarize, really by saying Ebola is hardly paying the human species before the current West Africa outbreak and really is an important context point again to understand what do we know and not know about this infection now, in terms of how Ebola virus is transmitted, this is an area that we know a lot about.

But if you could imagine our knowledge base for this is like a normal curve or 98% of the curve eyes fairly well known to us and something that we can describe with some and Chrissy clearly details, the 1% on either side of the curve is yet really unclear to us on.

We have things to learn about it so, but what we do know is that with direct contact from an effective person or animal body fluids including blood, vomit, feces and possibly perspiration is a the primary mechanism for transmission.

The current outbreaks highlighted questions about transmission, for example, Early on, we placed a great deal of emphasis on the presence or absence.

The fever will talk about that.

We'll talk briefly about the issue of what has been labeled airborne transmission on and also just the issue about worker safety.

Despite the recent interest in and concern about health care, worker transmission and safety here in the United States or you, we must understand that while these air important cases we must not take our eye off the ball, which is really about Africa.

And today this presentation will continue to highlight all the aspects of evil in Africa.

Now, I mentioned earlier, just as an example of the questions about what we know and don't know.

Here is a very nice review by the World Health Organization Bullet Response Team, published in the New England Journal of Medicine in mid October, summarizing the 1st 9 months of the epidemic with some kind of some comments on future projections.

One of the things to note here, despite this case definition requiring fever or else to be tested for Ebola virus and found positive, which would favor in fact, finding patients with fever on Lee, 87.1% of cases reported a fever throughout the course of their illness.

This is a point to make that we have to be very careful about absolutes.

And there have been, I think, a effort by many to do a better job of that early on in the public concern about Ebola, we did, as a public health community, make very absolute statements out of, I think, a obvious need to our desire to assure the public about various aspects of transmission.

Today.

We'll talk more about that as we realize that not everything is going to be in clear black, a wife if we look at the disease itself.

In this slide here, you can see the predominant symptoms of fever, fatigue, loss of appetite, vomiting and diarrhea.

You can also look at this more carefully for those who died and those who recovered.

But the point to make is the traditional viewed picture of Ebola, which was really put forward, and books like the hot zone, copious amounts of bleeding, bleeding out of the eyes and so forth is really not the case.

What we see here, if you look down blood and stool gums.

But he knows Buddy Cough it really is.

Just a few percent of those individuals is high.

It's 18% among the general number of cases.

What unexplained bleeding.

But generally it was very small.

What you're really doing with the disease presents primarily as a constellation of fatigue, loss of appetite, vomiting and diarrhea.

And these air the again, the symptoms today that along with fever, we would urge people to be a mindful of it.

Someone has developed an illness and have recent travel to West Africa, the affected countries or contact with someone who was there.

What do we know about Ebola virus?

Ecology?

Well, this is one that we still have lots of questions about.

One outbreak clearly was able to demonstrate that fruit that's where the source on.

And but beyond that, it's unclear exactly what the natural reservoir is for.

The Ebola virus is.

Goal is a year.

If you look at this very nice cartoon from the CDC, you can see this reservoir being portrayed as being bass and variable possible that that is the primary and on Lee Reservoir within transmission into other animal species called salve attic cycle And there you can see transmission, whether it be, uh, some human primates, bats and other animals, then getting to humans for contact with these animal species, most often usually around a food source exposure where someone who finds a dead animal or a sick animal on and then basically prepares that for a meal with contact occurring with the body fluids of that animal, we still have much to learn about this whole somatic cycle, where the virus resides in between the times when we don't have heaven had outbreaks.

We look at the belt here of where we're talking about countries with index reported cases in countries at risk without reported cases, you get a sense of looking at the rainforest and where we're looking at the potential for these cases.

West Africa, as we know the three primary effected countries today, shouldn't have been a surprise yet.

In a sense, they were because we had not seen in our sporting some your history Ebola virus transmission There.

We begin following this situation in March at our Center for Infectious Disease Research and Policy, recognizing that initially this seemed to be just another Ebola outbreak in this case, in a slightly different location in the equatorial belt.

But it became very clear.

Tow us at least early on that this was a different situation and a number of NGOs, particularly the Doctors Without Borders or MSF.

I made it very clear that they believe that this was different, that it wasn't being brought under control, using the same kind of public health intervention methods of identifying cases, quickly isolating them and medical care and following up context.

Now some of this clearly had to do with a lack of adequate response to due to the lack of public caliph in medical care infrastructure in the affected countries.

Also, it seemed as if something else was happening.

We look at this particular pictorial here, this cartoon in the right hand bottom, you can see the conjoining areas of Guinea, Sierra Leone and Liberia, where the outbreak first begin, and from there, then spread throughout the other three of the three countries throughout their entire area.

I wrote a piece actually in The Washington Post in late July, in which, uh, this was before the cases had occurred in were brought to the public's attention around American physicians brought home which would seem to be a a very important event in terms of highlighting the issue.

One of the things that you'll note in the second paragraph I started enforcement.

Today's outbreak is very different and trying to explain that this really did seem to be very, very different and what I hypothesize in this piece was it wasn't because the virus had changed because Africa changed and I'm not so sure that's the case today.

I think as we gain more information, we may see that this virus is slightly different in terms of its ability to cause disease on and such things as virus load or tighter and so forth.

But the bottom line is it did fall into a geographic area where the health and public health infrastructure were generally virtually nil to absent, and the fact that there was intense personal crowding in for a lack of a better term, the slums of the major cities in the rural area.

We also had some successes early on, and this is one of the things that has made this situation a bit more complicated in terms understanding.

If you look here again, the three of impacted cases but I want to highlight this slide because of their one case occurring in Senegal early on, as well as a case that was introduced into Nigeria.

Let me spend more time in the Nigerian situation where in fact an individual who is infected in Liberia flew to Lagos, Nigeria.

It occurred at a time when the public health care system was actually or the public health system was on strike.

And this individual is hospitalized actually in a private hospital which have provided and you sense a high level of care.

This was a good thing because of the fact that it really limited his contact and potential in a lack of adequate healthcare setting to be cared for.

The problem was, is that there still was transmission occurred in this setting.

And I think one of the really remarkable achievements so far to date was the combined effort of the Nigerian Health and Public Health Systems, along with the CDC toe actually limit and stop this I'm going chain of transmission.

It occurred again primarily in health care workers.

This outbreak required over 1000 people be followed up and I only show this because this slide has often been used in the story in Nigeria is an example of how we can still stop this in Africa.

I would suggest you do the same patient entered Nigeria but spent time in the slums of Lagos and was not detected early.

And there have been several generations the transmission, the outcome could have been very different.

We are seeing that today is we now actually have eight cases in Mali.

Hold the last two weeks of which we now are concerned about a new focus of transmission.

There s O that we recognize also the lack of preparedness.

Even though this is right on the border with getting this individual was able to move freely from Guinea, tamale actually was infected, then started this new chain of transmission Very similar effort that was, as was conducted with the individual uh, flew into Nigeria is being done here.

The question is, will it be able to be stopped here?

But it points out the vulnerability of the rest of Africa to what I call the infectious disease forest fire of the three affected countries, sending sparks throughout other areas of Africa in the world.