Navigating the Aftermath of Epidemics

The symptoms and implications of disease often reach far beyond the individual, carrying consequences for communities, countries, and sometimes the whole world. There are broad social, psychological, economic, and political ramifications when societies are struck by epidemics. Over the past few years, newspaper headlines and Twitter feeds have been filled with stories of Zika, Ebola, and malaria devastating entire communities. We have found ourselves bewildered by the unknown implications of these viruses, confronted with drug resistance, and in need of accessible and affordable diagnostic tools. This year at TEDMED 2017 we will hear from Speakers and Hive Innovators who are facing the challenges of epidemics head-on.

Ebola Survivors Clinic staff

As a rookie physician, Soka Moses helped lead his community through the bleakest days of the Ebola epidemic as Clinical Director of the Ministry of Defense Ebola Treatment Center in Monrovia, Liberia. Soka and his staff treated over 600 patients, risking their own infection and death. After saving hundreds of lives, Soka has now turned his attention to Ebola survivors. According to WHO, Liberia is home to 5,000 survivors, many of whom lost their families to the disease. That is not all that they have lost, as both patients and health care providers who have come in contact with the sick face severe social stigma that isolates them from their communities. Physically, Ebola survivors experience symptoms such as joint pain, dizziness, blurred vision, and the inability to concentrate to such severity that it precludes them from working. The unmet need to care for these patients prompted Soka to take on a new role as Director of the Ebola Survivors Clinic at Redemption Hospital in Monrovia, where he helps survivors reclaim their lives. While there are currently no cases of Ebola infection in Liberia, the effects still linger, and a recent outbreak of Ebola in the Democratic Republic of Congo is a reminder that continued prevention, detection, and response efforts are essential to ensure outbreaks do not turn into epidemics. To that end, Liberia and the United States are partnering to perform clinical research studies at Redemption Hospital and other sites across the country in order to ascertain the long-term ramifications of Ebola virus disease.

Like Soka, retina specialist Camila Ventura is working alongside her patients as they discover the still unknown, long-term consequences of a virus. Camila, who comes from a family of ophthalmologists in Recife, Brazil, works with patients and families affected by Congenital Zika Syndrome. Camila found herself on the front lines of the Zika epidemic after reporting ocular findings in babies with the Zika virus. While the number of cases of Zika infection in Brazil, the Caribbean, and the United States are down this year, US cities near the Mexico border—where infection data is limited and the rainy season has begun—are being cautious. One case of the Zika virus, likely spread from a mosquito, was recently reported in Hidalgo County, Texas.

There’s a new understanding of how infants with Congenital Zika Syndrome can present with a broad spectrum of symptoms, including visual impairments. Camila is actively gathering information on the visual impacts of this virus, closely following her infant patients to uncover the mechanisms behind their unique symptoms and the best treatment options for them. Her team partners with families of babies with Congenital Zika Syndrome to navigate the unknown prognosis and long-term consequences of this virus.

Zika can be a challenge to diagnose because there are so few copies of the virus in a patient’s body, which means that it requires a highly sensitive test. This year at TEDMED, we will hear from Omar Abudayyeh of SHERLOCK, who will take the stage during the Audacious session alongside 19 other innovators who are transforming health and medicine. At SHERLOCK, Omar and his colleagues found a new application for CRISPR technology, using it to detect and diagnose biologic material rather than to edit genomes. The team designed a way to detect viruses, bacteria, and cancer at attomolar levels, allowing for highly accurate diagnosis in incredibly small amounts of sample. The result is a simple and inexpensive diagnostic tool that can be rapidly used—vital when time is of the essence.

The Anopheles mosquito, which transmits malaria

While viruses like Ebola and Zika have presented the global health community with new and unexpected challenges in terms of our ability to offer timely diagnosis and treatment, our world has long been familiar with the suffering caused by malaria. Malaria remains a leading cause of death in developing countries, where young children and pregnant women are at greatest risk of infection. Physician and professor Nick White studies this disease from Mahidol University in Bangkok, Thailand. In 1981, Nick and his colleagues happened upon a Chinese scientific journal describing the antimalarial properties of an herb called qinghao. They performed large-scale studies, treating adults and children infected with malaria with derivatives of qinghao, commonly known as artemisinin. Artemisinin combined with a conventional antimalarial, or artemisinin-based combination therapy (ACT), quickly proved to significantly decrease malaria morbidity and mortality worldwide. Despite the effectiveness of the treatment, Nick and his team faced significant challenges convincing policy makers to adopt it, but found success after another party published an incendiary article in The Lancet. Now, this successful treatment of malaria faces new challenges, as artemisinin resistance has repeatedly emerged in Southeast Asia. In the past few years, Nick and his team have made advances in exploring the options available to eradicate these resistant strains.

Together, these Speakers and Innovators demonstrate diligence and ingenuity as they bravely tackle the overwhelming challenges surrounding epidemics. Whether by navigating the unknown effects of disease alongside patients or developing new ways to diagnose and treat pathogens, their work inspires hope. We invite you to join us at TEDMED this November to hear them share their remarkable stories.

Rethinking New Diseases: Q&A with Sonia Shah

Sonia Shah, an investigative science journalist and historian, challenges conventional understandings about the real causes of pandemics. We caught up with her to ask a few more questions.

Why does this talk matter now?

The way we understand the origins of new diseases shapes our response to them—responses that will become increasingly relevant in this age of emerging and re-emerging pathogens, from Ebola to cholera. This talk is based on my forthcoming book—“Pandemic: tracking contagion from cholera to Ebola and beyond.”

Sonia Shah at TEDMED 2014

Sonia Shah at TEDMED 2014

What kind of meaningful or surprising connections did you make at TEDMED?

I met the comedian Tig Notaro, whom I’ve admired for a long time. We shared a table at a book signing—I did not expect that! I’m a science journalist!

How can we learn more about your latest work?

My book comes out in February 2016, and it’s available for pre-order now. I’ve also collaborated with the Pulitzer Center on Crisis Reporting to create an app called “Mapping Cholera,” which provides an interactive visualization and narrative about the 1832 cholera outbreak in New York City, which I spoke about in my talk, and the 2010 cholera outbreak in Port-au-Prince, Haiti. And you can find more updates at soniashah.com, too.

The Promise of Personalized Medicine: Q&A with Gary Conkright

At TEDMED 2014, PhysIQ CEO Gary Conkright shared his perspective of how personalized, quantified health data is vital to preventing disease.  PhysIQ was recently selected to collaborate with USAID in their efforts to use such techniques to potentially control the spread of Ebola.  We reached out to Gary to learn more.

"Today, we’re on the verge of the next transformation in healthcare: Quantitative Medicine 2.0" - Gary Conkright, TEDMED 2014 [Photo by Brett Hartman]

“Today, we’re on the verge of the next transformation in healthcare: Quantitative Medicine 2.0” – Gary Conkright, TEDMED 2014 [Photo: Brett Hartman]

What is the legacy you want your talk to leave?

I hope that my talk inspires just one entrepreneur to think “outside the box” to innovate a new medical device or procedure, or one physician to dare to adopt a “non-traditional” medical approach to deliver the best care and help prevent a preventable illness.  Failure should not be an option.

Speaking of thinking outside the box, can you tell us more about the work you are doing to help combat the Ebola crisis?

In my TEDMED talk, I spoke about how the next transformation in healthcare is quantified, personalized medicine.  This involves the comparison of a person’s physiology to their own unique baseline instead of population-based norms, like 98.6 degrees for “normal” body temperature. It is now possible to build a personalized baseline and to detect subtle but very important changes in one’s physiology, thereby enabling an early clinical intervention.  Seeing the potential of this approach, The Scripps Translational Science Institute recently asked PhysIQ to work with them alongside USAID to help address the Ebola crisis in West Africa.

One of the reasons why Ebola is so difficult to contain is that once someone is infected with the virus, they become contagious well before any symptoms appear.  Currently, the best Ebola risk management protocol requires patients to self-manage by taking their temperature twice a day. However, as with many diseases or exacerbations, the human body’s natural defense and self-management system kicks in to fight this virus almost immediately to protect and sustain the body, and ultimately life. These defense mechanisms manifest themselves in changes of easily measured vital signs like heart rate, respiration rate and blood pressure.

However, these same vital signs normally vary quite dramatically throughout the day as a person goes about their daily living.  For example, when asleep, a heart rate of 40 beats per minute could be considered “normal” as would a heart rate of 120 beats per minute after walking up a few flights of stairs, but someone’s heart rate can be “within the normal range” of 60-100 but still be a sign of physiologic decompensation if inappropriate in the context of other measured parameters.  These normal dynamic fluctuations can mask the subtle changes that are a direct result of the body’s defense response.

When we holistically compare these multiple key physiologic parameters to the person’s unique baseline, the expected or “normal” physiological response can be removed, leaving the abnormal response that is fighting the disease.  We will soon start field testing in West Africa to validate this approach, which – we hope – will work for any progressive disease where early detection can save lives.

What advice would you give to other aspiring innovators and entrepreneurs?

The mystique of entrepreneurship excites the human spirit, but bringing a disruptive innovation to market is very hard work, and not for the faint of heart.  The highs are exhilarating and the lows are harsh, and the cycle time between these two extremes is often very short.  But, for those who are passionate about making a difference, and who have the risk tolerance, emotional fortitude and – perhaps more importantly – the support of family, there is no better career option.