A Navy Microbiologist on the Ebola Front, Pt. II

By Cmdr. Guillermo Pimentel, MSC, Naval Medical Research Center

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On October 2nd my first lab became operational followed by my second lab on the 3rd.

Editor’s Note.   On September 28,  2014, Navy Microbiologist Cmdr. Guillermo Pimentel, MSC, and advanced laboratory technician HMC Jerrold Diederich traveled to the front lines of the Ebola outbreak  in Liberia where they established two mobile laboratories for detecting the virus.  The importance of these labs in Montserrado and Bong Counties can’t be understated. For many hundreds of men, women and children they have been the difference between life and death.  Within four hours, lab personnel can determine if blood samples contains Ebola, ultimately ensuring that patients receive immediate medical attention. The following narrative is part II of an excerpt.

On October 2nd my first lab[1] became operational followed by my second lab[2] on the 3rd. The impact was tremendous. Before our arrival specimens were taking up to six days to get results back. Ebola is a disease that is highly contagious. The signs and symptoms are very similar to Malaria, Influenza, food-borne poisoning, basic diarrhea, and Lassa Fever.

At the mobile laboratories our mission is strictly detection the virus on clinical samples.

At the mobile laboratories our mission is strictly detection the virus on clinical samples. Because the signs and symptoms mimic a lot of other infectious diseases, if a person has a fever, diarrhea or vomiting they are immediately admitted to the Ebola Treatment Unit (ETU) for medical attention. That’s because the healthcare system has completely collapsed and hospitals are shut down. Clinicians weren’t seeing patients because they don’t know how to handle all of the highly contagious patients.

People with malaria or food poisoning go to ETU’s and wait alongside people suspected of having Ebola. Suspected cases wait in a room waiting their laboratory results. Unfortunately those with malaria or food poisoning must wait six days around people with wet cases of Ebola, and it’s most likely they too will contract the virus, a double-whammy.

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Once our guys became operational, we started providing results within four hours.

We set up our first laboratory in Montserrado County at the Island Clinic.  WHO and CDC chose the location because a brand new ETU had been built, and managed by WHO, with Ugandan physicians. . The day we became operational they had more than 200 cases of Ebola, with a capacity for 150. It was a mess, but once our guys became operational, we started providing results within four hours. What it meant was if an individual came to the ETU with signs and symptoms of Ebola the laboratory could process the blood sample the same day and tell them within four hours whether they were positive or negative.

If negative, they can go home. Since the day we opened until November 12th) the ETU had 63 patients. Within a week of setting up it went from a little more than 200 cases in the confirmed ward to less than 150. After that it went below 100 and the lab has not gone over 100 cases since.

Detection is a straightforward process, but very intense because you know that the one milliliter of blood in front of you can kill you if you are not on top of your game.

Detection is a straightforward process, but very intense because you know that the one milliliter of blood in front of you can kill you if you are not on top of your game. The most intense moment is handling the blood sample to kill the virus (inactivation). You have to know what you are doing. Because we are working in portable glove boxes with “heavy” personal protective equipment it gets tedious and uncomfortable.

Detection Ebola starts when the patient has active signs and symptoms, fever, vomiting, and diarrhea. It’s when the virus becomes active and reproduces in the human body. Hence, we can detect it through PCR.[3]  The day a person is exposed to Ebola to the time they start showing active symptoms can take two -21 days. However, if you were “heavily” exposed to vomit and diarrhea etc., it’s very likely   of seeing symptoms within three days, within 72 hours detection through PCR via molecular diagnostics. You take a blood sample, inactive the virus and continue extracting the RNA[4], set up your PCR reaction and analyze the data.

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It’s very important to understand that we don’t go to the ETUs, we don’t draw blood, and don’t interact with most of the population.

It’s very important to understand that we don’t go to the ETUs, we don’t draw blood, and don’t interact with most of the population. The life of the microbiologist/biochemist and technician on the Ebola front is: going from the hotel to the laboratory and from the laboratory to the hotel and that’s it. That’s how it is over there—saving lives, and saving families. These individuals get the specimens and develop a close relationship with ETU staff.

Each laboratory is equipped with the same equipment. They have three PCR instruments; with one for back-up. We are highly mobile. Our equipment can fit in six-seven Pelican cases.[5]  .For this mission we went extremely heavy with supplies for 90 days of continuous operations.  When both labs deployed each weighed almost 7,500 pounds.

I will never forget the day we got our first samples.. A PhD with a post-doc from Harvard, extremely bright guy, was the first to present the samples. We received 16 patients, four of them were little kids, and one was only 11 months old. The PCR result showed an extremely hot sample (aprx tenth to the ninth particles of Ebola per millimeter of blood).

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We are highly mobile. Our equipment can fit in six-seven Pelican cases.

My laboratory personnel know the job that they are doing and they all want to stay. Frankly, I’m having a hard time bringing these kids back. My guys don’t want to come back because they see the need being there. Let me put it this way, Iraq and Afghanistan was the war for trauma surgeons. This outbreak is the time for microbiologists and advanced laboratory technicians to shine.

Right now we are in a hotspot; we have media coverage and everybody knows about NMRC’s mobile labs. I bet you two years from now nobody will care. Sadly, we are going to go back to our daily lives doing our daily research and I can’t help but think all of our work saving lives will eventually be forgotten.

[1] Island Clinic (Western Liberia)
[2] Cuttington University, Bong County (Eastern Liberia).
[3]PCR (polyemerase chain reaction) is a technique for amplifying DNA sequences.
[4]RNA: ribonucleic acid
[5] High performance, watertight, and almost indestructible cases manufactured by the Pelican Company.
[5] Lofa County is located in Northern Liberia.
[6]HMC Jerrold Diederich, Command Chief, NMRC, Silver Spring, MD
[7 In the last twenty five years Liberia has undergone two civil wars (1989-1997 and 1999-2003).
[8] Ambassador Deborah R. Malac has served in Liberia since been 2012.
[9] General David M. Rodriguez, USA serves as the Commander, United States Africa Command (AFRICOM).
[10] Major General Darryl Williams, USA, commander U.S. Army in Africa.
[11] Island Clinic (Western Liberia).
[12] Cuttington University, Bong County (Eastern Liberia).
[13]PCR (polyemerase chain reaction) is a technique for amplifying DNA sequences.
[14RNA: ribonucleic acid
[15] High performance, watertight, and almost indestructible cases manufactured by the Pelican Company.