Tiffany '04 finds her mission in tracking Ebola

Amanda Tiffany '04 was profiled in the Winter 2015 issue of Augustana College magazine about her work fighting the deadliest Ebola outbreak in human history.

This summer she has returned to Africa to continue her work. During the past six weeks, she has traveled between Sierra Leone, Guinea and Liberia with the International Federation of Red Cross and Red Crescent Societies to evaluate the impact of safe and dignified burial on controlling the Ebola epidemic.

Currently in Monrovia, Liberia, she continues to work on a survivor follow-up program, advocating for health services for Ebola Virus Disease (EVD) survivors, particularly for the highly prevalent vision/ocular problems, which can be cured with treatment.

In early August, she returns to Freetown in Sierra Leone for a meeting to discuss care for EVD survivors with representatives from local and international agencies.

The beginning of the story

Last March, Tiffany was just settling into her office in Geneva, Switzerland. It was her first day back after a much-needed vacation. She had spent the better part of three years in West Africa, trying to limit the spread of malaria as an epidemiologist for Epicentre, the research arm of Médecins Sans Frontières (MSF), better known in the United States as Doctors Without Borders.

She was compiling the results of the malaria project when a colleague stopped her in the hallway.

There were rumors of a rare viral hemorrhagic fever in Guinea, the same country in West Africa where Tiffany had studied malaria. The fever was setting off alarms at MSF because it looked like the underlying virus could be Ebola, one of the most deadly pathogens on Earth. If an Ebola outbreak was confirmed, the mortality rate would be high, as much as 90 percent. If it wasn’t contained, the consequences could be horrific.

As a global first responder, MSF already was assembling a team that would be the first on the ground in Guinea. They would need an epidemiologist on the front line.

“I immediately volunteered to go,” Tiffany said. For her, it was more than an emergency mission. It was what she had always wanted.

Unlocking Ebola’s mysteries

A stuffed toy microbe in the shape of an Ebola virus sits in her apartment in Geneva. It’s the same one that sat on her desk at Augustana College a decade ago, a symbol of her fascination with the virus, and her dream to unlock its mysteries. It’s also identical to another stuffed Ebola microbe kept by her Augustana biology professor, Dr. Dara Wegman-Geedey. Hers is displayed amid a menagerie of stuffed microbes in her office, and it was in her lab that she saw how Ebola stirred Tiffany’s interest in research, and a career in public health and epidemiology.

“As long as I can remember,” Tiffany said, “Ebola has always been the one disease I really wanted to work on. It’s something that has such a high mortality rate, and yet we had such a tiny bit of information on it. And it was such a rare disease that, up to this point, there had never been an outbreak big enough to really study it.”

The Ebola virus hides in animals, and rarely jumps to humans. Tiffany had wondered if she would ever have a chance to track it down. As she packed her bags in Geneva, all she felt was excitement. She boarded a plane to West Africa the next day. Tiffany landed in Conaky, the capital of Guinea, and began her arduous journey by plane and then overland to Guéckédou, a small city in the rural forest region.

“It was in exactly the same area in Guinea where we’d been doing the malaria research,” she said. “On that level it made a lot of sense for me to go. I speak French and a bit of the local language. I knew the population. I knew the area. I knew the team that was already there, so we were really able to hit the ground running.”

She had no way of knowing she would be the first epidemiologist in a hot zone that would become the biggest Ebola outbreak in human history, one that would kill more than 9,000 people. She and the team of seven specialists would lay the groundwork for the massive undertaking to come, one in which her work would be magnified beyond anything she had done before. It would be two weeks before another epidemiologist arrived to help.

A race against time

In Guéckédou, 55 people already had died. It was now a race against time. She began working 16-hour days with meetings that lasted well past midnight. “It was difficult to comprehend the scale of the outbreak,” she said. “No previous reporting had been done. It was only us responding.”

They received laboratory confirmation of Ebola on the fifth day. A few days later, it was identified as the Zaire strain — the most lethal. In anticipation, a treatment center was already open, erected by the team in a few days with wood frames and plastic sheeting.

“Rumors were flying of sick people and dead bodies,” Tiffany said. “We needed to centralize all the information and add a filter to it, so we could separate fact and fiction. Initially I was that filter.

“Of course, sick people, if they were actually Ebola, had to get picked up and brought to the treatment center. After that, we had to go back out and pick up the bodies and make sure they were buried in a dignified manner that was also safe, so that the virus wasn’t transmitted through burial practices.”

She pitched in wherever she could, but as the epidemiologist her job was to launch the outbreak investigation. That meant contact tracing — identifying the Ebola patients to see where the virus was coming from, and identifying the people with whom they had physical contact to find out where the virus was going. The goal was to follow the chains of transmission, and break them — all of them — by detecting and isolating every case of infection.

But Tiffany could see this Ebola outbreak was bigger than any other. There were more chains than she could follow.

“The way that people were getting infected, you never knew what was going to happen from one day to the next,” she said. “And you were always thinking, oh, it can’t get worse...it has to get better, and unfortunately, it didn’t.”

Following protocol

The surrounding villages were full of potential contacts. Tiffany was venturing out, sometimes into known hot zones. The full-body protective suits were always available, but she never wore one. Instead, she found safety by following a proven protocol.

“It was about taking simple precautions,” she said. “You keep a distance of at least one meter from anyone that you’re talking to. You don’t touch anyone — no shaking hands. You don’t sit down, and you don’t lean against anything. You operate in your own space, and when you get back to the car, you spray your hands with disinfectant and you also spray your shoes — the only points of contact with your environment.”

Her ability to focus on cause and effect not only kept her safe, it was part of her scientific perspective. “Amanda was always driven by her desire to understand why,” said Dr. Wegman-Geedey. “When a lab experiment collapsed, Amanda would never panic. Instead, she would follow a protocol, turning her attention to what went wrong, and why.”

That determination to find answers paid off. She was part of the elite team that tracked the transmission chain all the way back to “Patient Zero” — the person believed to be the source of the outbreak. The research was published in the New England Journal of Medicine and reported in media outlets around the world. The evidence showed the virus had “jumped” from an animal to a 2-year-old boy in Guinea who played in a hollow tree inhabited by bats, which are known carriers of Ebola in Africa. The bats infected the boy, who infected his family, and the transmission chain had begun.

Having found Patient Zero on her first Ebola mission, Tiffany returned six more times.

Augustana's effect

The push and pull of an international spotlight is a long way from Lake Summerset, an idyllic lakefront community north of Rockford, Ill., where Tiffany grew up. There were few signs in her childhood that she would choose the life she now leads. She believed she would become a doctor when she enrolled at Augustana for biology/pre-medicine. But she became disillusioned with traditional medical practice. It was too limiting, she thought, and often unable to reach the people who needed it most.

“It was really at Augustana, where you’re encouraged to explore all avenues and all your different interests in those four years, that I began to see things differently,” she said.

Her explorations led to public health and epidemiology. Tiffany cites Dr. Wegman-Geedey as an essential part of her journey.

“Dara was always encouraging me to do things,” she said. “Research internships and fellowships and foreign study.” “Helping students see their options is absolutely my favorite part of the job,” Dr. Wegman-Geedey said.

“Some students who major in biology often think they’ll become a doctor or a nurse, and then we have them in class and give them experiences that show them a wider view, and introduce them to careers like microbiologist or epidemiologist that they might not have considered.”

Today, the two scientists are good friends, which has created some interesting experiences for Augustana students. Two years ago, Tiffany flew from Switzerland to Nicaragua to meet Dr. Wegman-Geedey and accompany her class on a trip for JETS (Joining Education Through Service). The students often are pre-med majors, ready to work as volunteers at local medical clinics. This time, they found themselves in the middle of a dengue fever outbreak.

Tiffany helped show the students how to mount a classic public health initiative. The group set out to limit the spread of dengue fever by telling villagers how to get rid of the mosquitoes that carry the virus. For example, they helped residents find and drain sources of standing water where mosquitoes breed.

Dr. Wegman-Geedey is sure their efforts made a significant difference. “It was great for our students to have a chance to make an impact like that with Amanda’s help,” she said.

Tiffany says she is really living her dream. Her career in epidemiology and public heath has taken her to Botswana, Zambia, Angola and the Democratic Republic of the Congo to work on AIDS prevention and to West Africa to help fight the spread of malaria. And then, in an incredibly fateful and defining moment, she was able to work on Ebola, launch the outbreak investigation, find Patient Zero, and advance the frontiers of knowledge about the disease. She’s become an international expert on the epidemiology of Ebola at the age of 32.

Now what?

“That’s my current dilemma,” she said. “I’m asking myself what I’m going to do after I complete my Ph.D. in epidemiology. “It’s likely that after the Ebola missions are over and my Ph.D. is finished, I’ll return to the field, perhaps in Africa or Asia to live and work for awhile, doing something interesting with epidemiology — malaria, viral hemorrhagic fevers, who knows?”

In the meantime, she expects fate will intervene as it always does. It’s why she’s was back in West Africa on her seventh Ebola mission. She had just returned to her home office in Geneva from Liberia, her sixth mission, when someone stopped her in the hall. They needed someone in Sierra Leone. Could she go?

Tiffany landed in Freetown, the capital of Sierra Leone, where MSF had opened another Ebola treatment center. She has helped launch a project to improve follow-up care for the growing number of survivors, many of whom report a curious mix of symptoms after their recovery, from joint pain to vision problems. No one knows exactly why, and Tiffany is once again deep into her work, advancing the frontiers of understanding.

In past Ebola outbreaks, there were fewer survivors and limited opportunities to follow their recovery. Improvements in epidemiology and medical care have brought survival rates for this epidemic to about 50 percent, a vast improvement over prior outbreaks.

“The fact that we can even think about survivor projects is a good sign that things are calming down,” she said. “It’s part of this mission that I find satisfying. Nevertheless, despite the progress we have made, I believe it will be a long, hard fight to zero cases.”