Ebola control suffers from lack of fast detection tool

Early in August, when doctors worried that a patient at Mount Sinai Hospital in New York had Ebola, it took nearly three days to confirm that he didn't. And that was in one of the richest, most medically advanced cities in the world.

In Sierra Leone and neighboring Liberia, local hospitals have closed because no one can tell the difference between early Ebola and other common ailments. This means no one is getting care for other illnesses like malaria and the even deadlier Lassa fever, multiplying the misery there.

Detection will become particularly crucial when drugs are available to treat the virus, which has killed more than 1,000 people in four West African nations since late last year. No one will want to waste scarce medications on someone unless they are convinced the person has Ebola, said John Connor, a microbiologist at Boston University. and the drugs are more effective the earlier they are given.

"The faster you can diagnose, the better chance you have of giving therapy effectively," Connor said.

But diagnosing diseases in sub-Saharan Africa remains a challenge, despite years of research.

Current systems of detection involve large, expensive machines that depend on water and electricity, and require skilled technicians to operate and maintain. It took so long to diagnose the man at Mount Sinai, because his blood sample had to be shipped to the Centers for Disease Control and Prevention in Atlanta, which has one of the few labs in America that can diagnose Ebola.

Such a process is totally impractical in low-income countries like Sierra Leone and Liberia, which lack basic infrastructure. Liberia, a nation of 3.5 million, reportedly has just 50 doctors.

What's needed is something as easy to use as a pregnancy test, said Bill Rodriguez, CEO of Daktari Diagnostics, which has been developing a diagnostic device for HIV/AIDS.

But getting to that point from where we are now "would be like (leaping) from the early days of stereo systems 100 years ago to the world's smallest iPod overnight," said Rodriguez, who left Harvard Medical School where he was an infectious disease doctor to start the company. "No one's done it yet for anything, let alone Ebola."

Ebola is particularly challenging, he said, because it is so dangerous to study.

A number of American academics and small companies have been working on detection methods for Ebola, and others like Daktari are now thinking about how to adapt their technologies to help fight an outbreak that has already killed more than 1,000 people in West Africa. None of the approaches has yet received regulatory approval to be used on patients, though several are in or getting close to human testing.

Daktari, based in Cambridge, Mass., uses a device that looks like an old tape recorder: Slide in a cassette with a sample of blood and the device determines within three or four minutes whether the sample contains HIV. Rodriguez said he has been discussing the possibility of retooling the device to screen for Ebola.

Connor at Boston University is using LED lights to illuminate and identify viruses in what will be a portable device. Developed to detect Ebola, he and his colleagues have tested the device on similar diseases and are now getting ready to test it with the deadly pathogen, said Connor, an investigator at a Boston University lab, which is awaiting federal approval to begin working with Ebola.

A third approach pioneered by a company called Nanobiosym, also in Cambridge, reads the genetic fingerprint of a virus. Company CEO and founder Anita Goel said her Gene-RADAR device can accurately detect a wide range of pathogens within an hour for a few dollars a test. Goel said her company is in discussions with potential clients now about the possibility of adapting the device to detect Ebola.

Any rapid detection method will also benefit patients and health-care providers in the United States, according to Belinda Ostrowsky, an infectious disease specialist at Albert Einstein College of Medicine and Montefiore Medical Center in New York City.

Otherwise, someone has to take a sample from a sick patient, transport the sample to a lab, and examine the sample — putting themselves at risk for accidental exposure. Quickly ruling out Ebola or other diseases will allow those lab workers and the patient to breathe easier.

"We want to protect our workers and really take care of that patient," Ostrowsky said.

Getting funding to develop such devices remains a major challenge, Rodriguez said. "People are much more aware of the need for drugs than diagnostics," he said. "There's no economic incentive for a company to develop an Ebola diagnostic test."

Until they do, Rodriguez said, the most common method of Ebola detection is simply waiting out the disease.

"It's pretty easy to diagnose Ebola four weeks later," he said, based on their symptoms and survival. But that doesn't help the patient or contain the outbreak.