Confronting Ebola:

F&M alumni work together at the CDC to combat a global health crisis

TOM KNAPP | May 22, 2015 | Franklin & Marshall College

They were in an elevator at the CDC, and Barbara Marston was giving Michael Iademarco a hard time.

It's OK, Marston told co-worker Mark Anderson after Iademarco exited the lift. They were classmates at Franklin & Marshall College.

Anderson was surprised. Turns out he was, too -- just one year behind them, in fact.

Marston chuckles when she tells the story. These days, those three F&M alumni from the early 1980s work together at the Centers for Disease Control in Atlanta, Georgia, to combat the world's ebola problem.

Ebola, of course, is a 21st-century plague that frightens some people the way mention of AIDS did in the 1980s.

"The reaction is very similar," Marston said in a recent interview, "although public fear is a little more warranted with ebola than it was with HIV."

There's a greater risk of contracting ebola than HIV, she explained. But, she quickly added, while a little fear can be a good thing, the tendency still is to overreact.

"If we're afraid of ebola, the best thing we can do to protect people in the United States is to control ebola in West Africa," Marston said. "We can't just say it's their problem. Uncontrolled, it would eventually be a big problem in the United States and all over the world."

That, she said, is "information we have to get out to the public, so people understand."

"People should not be afraid," said Anderson. "Ebola is a difficult disease to transmit; someone has to come in direct contact with a symptomatic person's bodily fluids to get the disease. Even then a person may not become ill. There have been instances of persons sleeping in the same bed as an infected person not becoming ill."

The virus, Iademarco added, "is not spread through casual contact, air, water, or food grown or legally purchased in the United States."

Even so, he likes the comparison to HIV.

"There are some similarities between these disease outbreaks," he explained. "Fear of the unknown, stigmatization of infected people, and lack of a cure hampered early education efforts in both. But, like HIV, we now know quite a bit about how the disease is transmitted, how to reduce or prevent transmission between persons, and how the virus works."

Besides, he said, the CDC, working with the governments of Liberia, Guinea and Sierra Leone, is "making progress" against the disease and, consequently, the media has stopped its blanket coverage of the issue that was creating undue anxiety among people here.

But, while the past year has seen great strides by the CDC, the World Health Organization and others, their efforts "must continue until there are zero new cases," Iademarco said.

"The goal is to 'Get to Zero' as quickly as possible, to break chains of transmission, and provide appropriate and respectful treatment, care and, unfortunately, if needed, burials," he said.

***

The CDC's response to ebola, which began in March 2014, has been the agency's biggest mobilization since its founding in 1946. Iademarco said nearly 2,000 CDC staff have been deployed to West Africa, and nearly 3,000 CDC employees have worked on the problem at the Emergency Operations Center in Atlanta.

According to CDC statistics, there have been nearly 15,000 cases of ebola in West Africa since the outbreak began. As of April 16, 10,699 people have died in the three hardest-hit West African nations.

The virus was first discovered in 1976 in Sudan, according to a Jan. 17 article in Global Atlanta. It appeared in scattered instances throughout Central Africa but spread to West Africa in 2013, appearing first in a small village in Guinea before spreading to neighboring countries.

To date, only two cases of ebola have been carried into the United States, one of which was fatal, and two additional cases were contracted within the U.S., states the CDC website.

Typical symptoms of the virus appear anywhere from 2 to 21 days after exposure and include fever, severe headache, muscle pain, weakness, fatigue, diarrhea, vomiting, abdominal pain and unexplained bleeding or bruising, according to the CDC.

Marston said the best way to protect the United States from ebola is to control the outbreak in West Africa.

Even so, she said, it's a common misconception that the disease is easily transmitted.

Marston cited the panic experienced in New York City last October when Dr. Craig Spencer was diagnosed with the virus nearly a week after returning to the city from Guinea, where he treated ebola patients.

"The fear of people who might have shared the subway with him was completely unfounded, but it was also completely understandable," she said.

"The one good thing about ebola is that the amount of virus in a person in whom it hasn't been detected is very low, so the risk of transmission is very low."

And, when instances do occur in the U.S., Marston quickly added, the circumstances are very different.

The resources that are available to control things here, the conditions for treatment, are wildly divergent," she said. "It's completely common in West Africa for hospitals to be operating ... without even having gloves available for the doctors and nurses."

"The U.S. has a well-functioning public health system that can quickly respond and contain an outbreak," Anderson agreed. "Part of the problem in West Africa was that these countries did not have the capacity to respond effectively."

The good news, he said, is that "considerable progress" has been made.

"As of today, Liberia has had only one case in the last 50 days," Anderson said on April 10. "Progress is being made in both Sierra Leone and Guinea as well, where the number of cases being seen each week have fallen dramatically. Still, there is a lot to do before we 'get to zero.' So, it is very important that we do not lose focus or momentum in controlling this outbreak."

"Once you get to zero, you have to stay at zero," said Marston. "You have to stay vigilant. In Liberia right now, the biggest threat would be someone coming in from an adjacent country."

***

The three doctors didn't know each other well at F&M, Marston said, although she and Iademarco shared some classes and professors. It's chance that brought them together at the CDC.

"Our past experiences at F&M don't have anything to do with our work now," she said.

Marston ('82), a medical epidemiologist, is head of the health systems recovery team and coordinates field work. Iademarco ('82) is director of the Center for Surveillance, Epidemiology & Lab Services, overseeing systems for data management related to the epidemic. And Anderson ('83), a physician and epidemiologist on the team, is deputy incident manager and has served as liaison between the CDC and the U.S. Office of Foreign Disaster Assistance.

Even with so many people involved, the F&M grads are part of a close-knit team.

"We work fairly closely," Marston mused. "We were all in a meeting together on Thursday, and there were only about 15 of us in the room. \'85 We come together a lot in different roles."

Marston, whose background is in medicine and infectious diseases, faced similar challenges when she aided the health-care recovery effort following a catastrophic earthquake in Haiti in 2010.

"This is somewhat up my alley," she said. "After something as serious as ebola, with the damage to the country and the healthcare system in particular, we want to try to help them rebuild their system."

That includes building up capacity for public health care in West Africa, developing efficient emergency-response protocols and initiating standards for investigating outbreaks more quickly.

"We want to prevent this from happening again in the future, or at least have a system in place to make it easier to recognize and respond," Marston said.

Officials also need to address issues that have been shelved during the crisis, she said. For instance, many West Africans are afraid to visit health-care centers because of the risk of exposure to ebola; in other words, they're not getting routine immunizations.

"We have to take care of this now," she explained. "If we don't, the next thing will be an outbreak of measles."

Richard A. Fluck, associate director of Foundation and Corporate Relations at F&M, was a professor of biology when Marston attended the college. "She was a terrific student: smart, dedicated, serious," he recalls. "At the CDC, she has been very helpful to F&M students who are interested in public health."

He didn't know Anderson, a psychology major, nor did he meet Iademarco, who majored in chemistry and mathematics, until some 15 years ago.

"I was teaching a first-year seminar about tuberculosis," Fluck said. Iademarco at the time was the CDC's associate director for science in the Division of Tuberculosis Elimination.

"He was very supportive of the work that my students and I were doing at F&M, invited me to the CDC, introduced me to the scientists and staff in the division, and welcomed me into his home," Fluck said. "His intellect, generosity, and commitment to public health, public service, and first-rate science (traits typical of the scientists, physicians, and public health professionals I met at the CDC) are inspiring.

"A consummate mathematician as well, Michael sees the world through a peculiar lens. I always appreciate his sharing the vision that lens affords him."

Iademarco said he started his college career majoring in chemistry but found it "too practical." Then he took calculus, he said, and "I found the abstract topics in mathematics fascinating and fell in love."

F&M, he said, "helped guide me to health as an important and personal career pursuit from a liberal arts-grounded perspective and as importantly shaped and honed my abilities as an analytical thinker."

The team is putting those skills to use as they confront not only ebola but whatever lies in store next.

The world has changed, Marston said: People travel more, for example, and food is shipped globally.

"There's a chance that contagious diseases that occur in one place can show up in another place pretty easily," she warned.

"Even before this outbreak, we had been advocating for resources in various countries for a better response to just this sort of thing. ... We need to get these systems in place everywhere.

"We'll have plenty to do in the foreseeable future."