The back story has emerged of how personnel working together for US company
company Metabiota and Tulane University at a lab in Kenema hospital, Sierra Leone, falsely diagnosed healthy people as having Ebola (false positives), bungled lab results, neglected protective gear and basic hygiene measures, undermined disease surveillance, and helped spread the disease.
The first false positive case involved a healthy woman who spent five days together with a confirmed Ebola patients in a hospital ward.
An AP investigation has unearthed the staggering story of systematic failures fuelling the Ebola outbreak in Sierra Leone in 2014.
Excerpts from the AP report:
“When Gary Kobinger, head of special pathogens at the Public Health Agency of Canada, double-checked some of the facility’s work in mid-July, he found worrying discrepancies in four of eight tests and identified as many as five people wrongly diagnosed with Ebola, according to emails obtained by AP.
“If you detect two, three, four, five, how many are out there?” Kobinger said in an interview.
The mistakes sparked concern about bigger problems in the lab — worries relayed all the way up to WHO Director-General Dr. Margaret Chan. When U. S. health official Austin Demby inspected the facility, he found a mess.
“The cross contamination potential is huge and quite frankly unacceptable,” he wrote in late July.
Bertherat relayed reports of “total confusion” in the government lab split between Metabiota and Tulane at the Kenema hospital in Sierra Leone, noting there was “no tracking of the samples” and “absolutely no control on what is being done.” He said the flubbed results were particularly dangerous given suspicion among the local population that international workers were spreading Ebola deliberately.”
Excerpts from another report:
San Francisco-based Metabiota Inc. was tapped by the Sierra Leonean government and the World Health Organization to help monitor the spread of the virus and support the response after Ebola was discovered circulating in neighboring Guinea in March 2014. But emails obtained by AP and interviews with aid workers on the ground show that some of the company’s actions made an already chaotic situation worse.
As the death toll mounted in July, scientists from WHO, the United States and Canada were voicing concerns about what Metabiota and its Tulane colleagues were doing at the Kenema lab, according to the emails obtained by AP and interviews with those on the ground at the time.
When Gary Kobinger, head of special pathogens at the Public Health Agency of Canada, double-checked some of the facility’s work in mid-July, he found worrying discrepancies in four of eight tests and identified up to five people wrongly diagnosed with Ebola, among them a worker with the medical charity Doctors Without Borders.
Kobinger told AP in a telephone interview that the misdiagnoses he caught suggested many more had gone unnoticed.
“If you detect two, three, four, five, how many are out there?” he said.
days later, Geneva-based WHO staffer Pat Drury emailed the agency’s chief, Dr. Margaret Chan, with criticism of both Tulane and Metabiota, referring to their shared facility as two labs.
“Both labs do not meet international standards for Biosecurity,” he said, adding that “several patients have been wrongly tested positive.”
Used needles littered the place, according to a worker who spoke on condition of anonymity because the worker was not authorized to speak to the media. Demby said in his email that the lab lacked an ultraviolet light for decontamination and didn’t have enough space to process blood samples safely.
“The cross contamination potential is huge and quite frankly unacceptable,” he wrote.
Tulane pulled the plug on its tests soon thereafter and the lab’s results improved. Kobinger credited Metabiota researcher Nadia Wauquier — “the hero of that whole gang” — with tightening procedures, but eventually the company was relieved of its testing duties and the CDC took over. Both Tulane and Metabiota say they stepped aside voluntarily.
Outside the lab, the training touted by Metabiota unnerved some fellow responders.
Anja Wolz, an emergency coordinator with Doctors Without Borders, told AP in an interview that she saw Metabiota workers enter the homes of suspected Ebola patients without protective gear and without decontaminating themselves before leaving high-risk areas.
“They didn’t even have chlorine with them to wash their hands,” she said, adding that Metabiota project coordinator James Bangura told her they didn’t need the critical disinfectant.
Aid workers also complained that Metabiota employees including Bangura and a Ugandan consultant hijacked the outbreak response in Kenema, which was supposed to be directed by WHO.
Metabiota staffers “are systematically obstructing any attempt to improve the existing surveillance system and there are a lot of improvement(s) needed,” WHO Ebola coordinator Philippe Barboza said in an August 8, 2014, email. The next day, he argued that WHO should pull its outbreak staff from Kenema so they wouldn’t be tarred with Metabiota’s failures, writing he was “very concerned of the potential reputational risk for WHO.”
1. In the first false positive case, a sample from Port Loko came up positive by the Metabiota
qPCR assay and negative by the KGH EBOV assay. The KGH team performed a repeat
test that was also negative. However, the woman was brought to the KGH EVD/LF Ward
and spent five days with her partner (who was a confirmed case of EVD). She was finally
released when her husband survived and a repeat test result by Metabiota showed that she
had been a false positive.
2. In the second false positive case, a man with no known prior contact with EVD patients
from Makeni, which has no prior cases of EVD, was suspected to have EVD after becoming
sick with bloody diarrhea. A sample was sent to KGH for testing and came up as a low
positive on the Metabiota qPCR assay and negative for the KGH EBOV assay. The test
was then repeated with identical results. The case ended up being reported as positive
instead of indeterminate. Finally, the test was repeated a third time, and it came up
negative by both the Metabiota qPCR assay and the KGH EBOV assay. It was then ruled
to be a contamination by the Metabiota staff. This case has become a political issue since
the subject was from an area that had not previously had EVD.