5/22/2015 Tom Knapp

Confronting Ebola

This magazine article is part of Spring 2015 / Issue 81

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

They were in an elevator at the U.S. Centers for Disease Control in Atlanta, and Barbara Marston, M.D., ’82 was giving Michael Iademarco, M.D., ’82 a hard time.

It’s OK, Marston told co-worker Mark Anderson, M.D., ’83 after Iademarco exited the lift. They were classmates at Franklin & Marshall College. Anderson was surprised. It turns out that he was an F&M graduate, too—just one year behind them, in fact. Marston laughs when she tells the story.

The three F&M alumni from the early 1980s recently found themselves working together on the CDC’s response to the deadly Ebola outbreak in West Africa. Ebola, of course, is a 21st-century plague that frightens some people the way mention of AIDS did three decades ago.

“The reaction is very similar,” Marston says, “although public fear is a little more warranted with Ebola than it was with HIV.” But while a little fear can be a good thing, she says the tendency still is to overreact.

Marston, a medical epidemiologist, was supporting health systems in Haiti prior to the Ebola outbreak. She currently coordinates the CDC’s field teams responding to the Ebola epidemic overseas. Iademarco is director of the Center for Surveillance, Epidemiology and Laboratory Services, overseeing systems for data management related to the epidemic. And Anderson, also a physician and epidemiologist, is deputy incident manager and has served as liaison between the CDC and the U.S. Office of Foreign Disaster Assistance. They are key cogs in the agency’s response to a disease that reached American soil for the first time in 2014.

“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 says. “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,” Anderson says. “Ebola is not highly contagious; most commonly, the disease is transmitted only to people who come in direct contact with a symptomatic person’s bodily fluids. Even those with direct contact may not be infected—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 purchased in the United States.” Even so, he likes the historical comparison to HIV.

“With both diseases there is the fear of the unknown, stigmatization of infected people, and the lack of a cure hampered early education efforts,” he says. “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.”

Working with the governments of Liberia, Guinea and Sierra Leone, the CDC is “making progress” against the disease, Iademarco says. Consequently, the media has stopped its blanket coverage of the issue that was creating undue anxiety among people in the U.S. But while the past year has seen great strides by the ministries, CDC, World Health Organization and others, their efforts “must continue until there are zero new cases.”

“The goal is to ‘get to zero’ as quickly as possible, to break chains of transmission, and to provide effective and respectful treatment, care and, unfortunately, if needed, burials,” he says.

 
  • 18707 lores Image Credit: U.S. Centers for Disease Control
  • img 2181 Image Credit: U.S. Centers for Disease Control
  • 18793 lores Image Credit: U.S. Centers for Disease Control

 

‘Get to Zero, Stay at Zero’

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 members have been deployed to West Africa, and nearly 3,000 CDC employees have worked on the problem at the Emergency Operations Center (EOC) in Atlanta, a large command center that looks a bit like NASA mission control.

Inside this sprawling room with massive television screens and state-of-the-art technology, Marston leads the International Task Force for the Ebola response. She’s in charge of identifying and deploying the agency’s teams going to West Africa and coordinating the activities of those teams in the field. She also stays on top of what’s happening in the affected countries so she can share information with leaders at the CDC, informing their decisions about appropriate response measures and funding.

“On a day-to-day basis, that's not very exotic, but it helps translate to effective CDC field teams,” Marston says. “The field work is very challenging, but is closer to the action and can be very rewarding. I’ve spent some brief time in West Africa, and I wish I could be there more. But without the EOC team, there wouldn’t be field teams. So we play an important role.”

According to the World Health Organization, there have been more than 25,000 cases of Ebola in West Africa since the outbreak began. As of mid-April, more than 10,000 people had died in the three hardest-hit West African nations of Liberia, Guinea and Sierra Leone. To date, only two cases of Ebola acquired in West Africa have been diagnosed in the United States, one of which was fatal, and two additional cases were contracted within the U.S.

When instances do occur in the U.S., Marston says, the circumstances are very different than in West Africa. “The resources that are available to control things here, and the options for treatment, are markedly better. It’s common in West Africa for hospitals to be providing services without even having gloves available for the doctors and nurses.”

Anderson, who is the CDC’s acting branch chief for the Emergency Response and Recovery Branch, helps to coordinate the agency’s response to humanitarian emergencies overseas. As part of the Ebola response, he is responsible for facilitating the agency’s collaboration with the U.S. Office of Foreign Disaster Assistance, a critical element of the U.S. government’s work in West Africa.

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

“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.’”

“Once you get to zero, you have to stay at zero,” Marston says. “You have to remain vigilant.”

Building Capacity for Public Health

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

Even with so many people involved in the CDC’s response to Ebola, 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—and three of us were F&M grads.”

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

That experience is relevant in West Africa, she said. “After something as serious as Ebola, with the damage to the country and the health-care system in particular, we want to try to help affected countries rebuild their health systems.”

The efforts toward rebuilding public health capacity in West Africa include 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 says.

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; as a consequence, children are not getting routine immunizations. “We have to work on this now,” she explained. “If we don’t, the next thing will be an outbreak of measles.”

Analytical Approach to a Changed World

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. Fluck was teaching a seminar about tuberculosis, and Iademarco 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.”

F&M, Iademarco 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 ahead.

The world has changed, Marston says: 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 warns.

“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.”

From left, Barbara Marston ’82, Michael Iademarco ’82 and Mark Anderson ’83 are key cogs in the CDC's response to the Ebola outbreak in West Africa. Iademarco and Anderson are wearing uniforms as officers of the U.S. Public Health Service.

“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.”

  • Barbara Marston ’82

Photos: U.S. Centers for Disease Control

  • From left, Barbara Marston ’82, Michael Iademarco ’82 and Mark Anderson ’83 are key cogs in the CDC's response to the Ebola outbreak in West Africa. Iademarco and Anderson are wearing uniforms as officers of the U.S. Public Health Service. From left, Barbara Marston ’82, Michael Iademarco ’82 and Mark Anderson ’83 are key cogs in the CDC's response to the Ebola outbreak in West Africa. Iademarco and Anderson are wearing uniforms as officers of the U.S. Public Health Service. Image Credit: U.S. Centers for Disease Control
“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.”
From left, Barbara Marston ’82, Michael Iademarco ’82 and Mark Anderson ’83 are key cogs in the CDC's response to the Ebola outbreak in West Africa. Iademarco and Anderson are wearing uniforms as officers of the U.S. Public Health Service.
Barbara Marston ’82
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