Arbovirologist, professor, and GWU lab director Dr. Chris Mores has just returned from Africa, supporting local and international field teams in the fight against Ebola in the DRC. Though COVID-19 has taken center stage over the last year, it’s important to remember other deadly viruses haven’t taken a day off. They have been, and continue to be, active around the world. Dr. Mores works every day to prevent regional and global outbreaks of arthropod-transmitted and other emergent viruses, like Eastern Equine Encephalitis, West Nile, Dengue, Chikungunya, Zika, and Ebola.
The recent WHO-led consortium on the Development of Methods for Mask and N95 Decontamination (DeMaND) Study, in which Dr. Mores participated, sought to find affordable, accessible, and successful methods for PPE (mask) decontamination for lower and middle-income countries. Here we talk to Dr. Mores about his recent trip to the Congo and how the DeMaND Study findings could be helpful in fighting pathogens worldwide.
Q. First of all, welcome home. Tell us about your recent trip to the Congo.
A. Yes, I just returned from the DRC a few weeks ago. We went out as a part of the ongoing WHO and CDC emergency response to the Ebola outbreak in Équateur Province. Though thankfully the outbreak was winding down, we wanted to assist with the closure of the acute phase of the outbreak and start a 90-day surveillance phase. This particular outbreak was much different from the past 10 Ebola outbreaks in Africa. We have an ongoing mission there, along with the CDC and the DRC government, to understand the differences and enhance their ability to enhance surveillance for Ebola and other pathogens. Our teams of researchers try to understand, predict, and prevent the spread of these deadly viruses.
Q. Talk about the situation healthcare workers face in the DRC.
A. Ebola, unfortunately, takes advantage of the most underserved and chronically impoverished areas. With every Ebola outbreak, we have losses in community members, of course, but it hits healthcare workers the hardest. They don’t have a lot of support to protect themselves. In many villages around the DRC, losing a healthcare worker to infection could mean losing healthcare for many in the village. It can decimate their ranks. So, we place a lot of importance on protecting healthcare workers so that they can protect their communities. Ebola is a contact-driven disease. If a healthcare worker has unprotected direct contact with an infected patient, there is an extremely high risk for infection. The protections needed from Ebola are even quite a bit more substantial than that needed for coronavirus.
Q. This was your second trip related to an Ebola outbreak in Africa. What are conditions typically like for you in-country?
A. We are often in pretty rough conditions, sleeping in sleeping bags in tents. Our labs are bolted together with whatever we can get, often without reliable data and power access. We set-up the best we can, the safest we can. We do our best to protect ourselves from exposure to virus through the separation of spaces and isolation of materials, like using glove boxes to process samples. Without access to space suit labs (as you would normally use for Ebola), PPE becomes even more important. Unfortunately, though, it’s hard to bring enough of it and even more difficult to get resupplied while there. Also, adding more and more PPE layers doesn’t necessarily make us safer in these areas because of the heat. Some of our team members in the past have faced heat exhaustion while trying to administer care. We have to guard against this almost as much as accidental needle sticks of Ebola.
Q. Did you have to reuse gear?
A. In these limiting environments, re-processing gear is needed. Though we didn’t reuse gloves, we did reuse face shields and lab coats. There isn’t enough of either to go around. We can use chlorine, alcohol, and other chemicals in the states, but these chemicals can be hazardous, difficult to move, and hard to import in more remote areas. We need to reduce our reliance on them. And, we need to enhance PPE so it’s better suited for reuse. Certainly, these are the reasons we explored new decontamination and inactivation methods in the DeMaND Study.
Q. Do local healthcare workers face the same types of PPE challenges?
A. The facilities I’ve seen are quite rudimentary. Lack of PPE is a major challenge. There is also a lack of understanding of how to use the PPE. Too often, these healthcare workers get used to not using PPE in everyday procedures, so it’s hard to transition to such when an outbreak occurs. These behaviors need to be trained. You can’t expect healthcare workers in austere environments who don’t typically have access to or make use of PPE to suddenly know how to use it correctly when critical times come.
Q. How was your travel impacted by the coronavirus pandemic?
A. It certainly was a lot more difficult to travel. All the team members had to receive multiple negative tests before traveling. Even with the pre-testing, daily testing, and with very strict mask adherence by all team members, COVID-19 still popped up in our team. In fact, about half of our 12-person team ended up contracting COVID-19 while in-country to help with the Ebola outbreak. SARS-CoV-2 is surprisingly contagious, and we still haven’t determined how the transmission even occurred. It was very disappointing, as well as anxiety inducing, to stop our Ebola efforts while isolating for two weeks in the DRC due to COVID-19.
Q. What made you want to study virology? You have said before you like to hunt the very things that hunt us. Tell us more about that.
A. Outbreaks of viruses, like Ebola or the coronavirus, come out of the darkness. That’s what drew me into studying them. The unknown. Plus, I’ve had a long-held desire to give people a better, healthier life, and hope they do some good with it. I am doing my part. Studying these crazy viruses, looking for answers, trying to make people safer … that’s what gets me out of bed each morning. Though I typically study viruses that come from mosquitos, the critical nature of the coronavirus pandemic compelled me to devote most of my attention and research there.
Q. Earlier this year, you participated in the WHO-led consortium studying emerging pathogen decontamination methods. Talk to us about the DeMaND Study and what excited you about the findings.
A. I was honored to contribute to the DeMaND Study. Essential to the DeMaND study was the mission of finding ways to better protect frontline workers from deadly pathogens. We tested two methods for mask and PPE decontamination. Honestly, I wasn’t investing much thought into the light-activated dye method because I believed that dry heat would be good enough. I quickly saw, however, the tremendous effects of Methylene Blue, which my colleagues all confirmed. This totally changed my mind regarding what could be done to combat pathogens. This work transcends COVID-19. Though it’s desperately needed right now, the ways we can improve safety moving forward are terribly exciting, as well. Without the pandemic, we may have never realized the potential of light-activated dyes for fighting pathogens. In the LMICs with which I am most familiar, I hope to find ways to use these methods to minimize reliance on chlorine and alcohol. I am hopeful we will find ways to improve PPE to better serve the frontline workers in vulnerable populations.
The Infection Control & Hospital Epidemiology medical journal has published the peer-reviewed DeMaND study. Singletto’s Dr. Tom Lendvay served as Lead Author.
Mike Butler spent over two decades in leadership at Providence Health, growing such from a $2 billion organization to $25 billion. Upon recently retiring, Mike knew he wanted to find ways to continue impacting the lives and health of others. Now at Singletto, Mike is on a mission to bring the novel Singletto technology to market – in healthcare and beyond. But, it’s not just a passion project … upon learning about the technology, Mike felt a moral obligation to get it in as many hands as possible. More with recently retired Providence Health President Mike Butler…
Dr. Belinda Heyne was recently featured in a CBC piece covering the DeMaND study’s findings and the life-giving potential of dye and light.
The World Health Organization (WHO) just added Methylene Blue and Light as a supported Personal Protective Equipment (PPE) decontamination method in the “Rational use of personal protective equipment for COVID-19 and considerations during severe shortages” interim guidelines.