By the Mailman School of Public Health
They were on the ground in Beijing to fight the SARS pandemic in 2003 and more recently in Saudi Arabia to hunt for the origins of MERS. Now the Mailman School of Public Health’s Center for Infection and Immunity (CII) is heading to the heart of the Ebola outbreak to set up a state-of-the-art diagnostic laboratory by early next year.
Currently, only 12 labs serve the countries most affected by Ebola. At best they can perform 100 tests a day, far less that what is needed to handle what the World Health Organization estimates will be 10,000 cases per week by December.
The new facility, staffed and equipped by CII scientists with logistical support from the World Health Organization, will alleviate this shortage with an additional benefit: It will test for more than just Ebola. The multiplex diagnostic system built in collaboration with a leading medical technology company can screen for a range of viruses and parasites, such as malaria, shigellosis, yellow fever, and Lassa fever.
“Ours is the only center, to my knowledge, that will offer this kind of sophisticated testing,” says Ian Lipkin, MD, director of CII and the John Snow Professor of Epidemiology at Mailman and professor of neurology and of pathology & cell biology in Columbia’s College of Physicians & Surgeons. “We’ll be able to give a more coherent and comprehensive picture of why people might be sick.”
Testing for a range of infections is critical in this outbreak, since symptoms like fever and vomiting are shared between Ebola and other deadly diseases. “Right now, patients are kept at the clinic until they test negative three days apart. During the interim they could die of malaria,” says Dr. Lipkin. The goal is a quick diagnosis to get patients the treatment they need and, if they don’t have Ebola, to isolate them from patients with the disease to lower their risk of getting infected at the clinic.
Getting the lab up and running will take considerable resources. Two infectious disease specialists from CII will staff the facility in four-week rotations for a minimum of six months. The added burden of travel and quarantine upon their return to New York will double the costs, says Dr. Lipkin. In all, 24 months of salary is needed along with supplies and equipment. The Mailman School is actively pursuing support for the lab. To date, it has secured $160,000.
CII’s experience in developing diagnostics in outbreaks positions it to build what will be the most advanced diagnostic lab in the region. At the height of the SARS epidemic, Dr. Lipkin and CII Associate Director Thomas Briese hand-delivered 10,000 SARS test kits to Beijing. In 2012 they deployed a mobile field laboratory in Saudi Arabia to identify camels and bats as MERS carriers.
The new lab will be situated adjacent to an Ebola treatment center at a location yet to be determined. Dr. Lipkin thinks it might be Sierra Leone, where the outbreak continues to escalate, but says it could be anywhere in the region. “This outbreak is evolving. It’s capricious; it can pop up somewhere else. We’ll go wherever we can be most helpful.”
The CII team will not be the first from Mailman in West Africa or even the first to partner with WHO. Since October, Population and family health professor Les Roberts, PhD, has served as the organization’s foreign medical team coordinator in Sierra Leone. His principal role is to mobilize hospital beds for patients, a demanding task that involves trying to stay ahead of ballooning outbreak. Dr. Roberts has been blogging about his experiences for his home department with reports, among others, on hand-washing habits, his take on the U.S. quarantines on returning health workers, and how he is inspired by his students. According to Roger Vaughan, vice dean for academic advancement at Mailman, Dr. Roberts will return in December and plans to teach classes via Skype while in quarantine.