A Daunting Search: Tracking a Deadly Virus in Angola
By SHARON LAFRANIERE and DENISE GRADY
UÍGE, Angola, April 11 - The staff in the pediatric ward of Uíge’s regional hospital suspected something was terribly wrong as early as October, when children who had been admitted with seemingly treatable illnesses began, suddenly and wrenchingly, to die.
But were those early deaths caused by the Marburg virus? If they were, and had they been diagnosed at the time, might the current epidemic have been averted?
The international health experts who have descended on Angola say they cannot pinpoint exactly when the largest outbreak of the deadly virus began.
“Nobody really has a sense of where or when it started,” said Dr. Thomas Grein, a medical officer in the World Health Organization. “The widespread belief that it began in October is speculation.”
But local officials in Uíge, the center of the outbreak, believe it began around that time, and then spread from the pediatric ward of the regional hospital, which has now been effectively closed except for emergency operations.
If they are correct and there was a delay in explaining the deaths, the reason may be that in Africa, sometimes the extraordinary is buried in the ordinary.
Children die at such an astonishing pace here and for any range of horrible reasons unknown to other parts of the world that it takes much more time for health workers to piece together if something as deadly as Marburg is at work.
In a country like Angola, where one in four children dies before the age of five, mostly from infectious diseases, crises like the one in the pediatric ward can easily be overlooked.
An outbreak of Marburg can look like a host of other illnesses to doctors and nurses who have never before encountered the disease.
“This is Africa,” said Dave Daigle, the spokesman here for the World Health Organization. To be a health official here, he said, “is like being a fireman in a village with the whole village on fire.”
Experts say at least 214 people have caught the virus and 194 have died. Marburg is spread by contact with bodily fluids, from blood to sweat, and kills with gruesome efficiency. Victims suffer from vomiting, diarrhea, high fever and bleeding from body orifices. Nine in 10 are dead within a week. There is no effective treatment.
When strange deaths first began to appear in October, mystified local health officials shipped samples of tissue and blood from four children to the United States.
In November, the Centers for Disease Control and Prevention tested them for at least three different types of hemorrhagic fever, including Marburg.
The results, which nearly all agree were accurate, came back negative. But in the tumult of deadly diseases and other health issues that plague this continent, it remains possible that Marburg was present in Uíge even then.
By the end of December, at least 95 children were dead, local health workers say.
How many deaths were Marburg-related is unknown, but even by the grim standards of the continent, it was an alarming number of deaths.
“In October, November, December, we were seeing so many children dying - just children,” said Dr. Gakoula Kissantou, 31, the hospital’s acting administrator. “It was becoming scarier.”
He recalled the doctor in charge of the pediatric ward at the time, Dr. Maria Bonino of Italy, called a meeting with the staff and asked, “What is going wrong here in the hospital?” She herself died in March, a victim of the virus.
It was not until early March that the provincial health officials alerted a W.H.O. representative that they had found 39 suspected cases of Marburg. W.H.O. officials identified 60 possible cases. Angolan authorities then shipped more samples to the C.D.C. in Atlanta. On March 18, 9 of 12 came back positive for Marburg, which by then was claiming more victims by the day.
Since those new lab tests positively confirmed the virus, a growing number of epidemiologists, anthropologists, public health experts and emergency medical workers have descended on Uíge in a race to cut off the disease.
One thing is certain, scientists say: the epidemic began with just one infected person, and was then transmitted from one person to another.
That conclusion, based on finding only one strain of virus in all the samples tested, means the outbreak can be stopped if infected people are isolated.
Given the degree to which it has been contaminated, the regional hospital, which serves 500,000 people, has now been limited to emergency operations and an isolation ward where Doctors Without Borders, the international health charity, treats Marburg victims.
Eight pediatric nurses and the doctor in charge of the ward are dead, along with six other nurses and one other doctor, all Marburg victims. Every mattress, bed sheet and hospital uniform must be thrown out. Everything left must be disinfected.
On Monday, teams of soldiers and hospital personnel clad in bright yellow prowled the grounds, spraying grass, benches and dirt paths with a solution of diluted bleach. Afterward, they burned their uniforms.
At some point, said Dr. Kissantou, the hospital’s acting administrator, normal operations will resume. He refused to hazard a guess as to when.
“I am upset that we are not serving patients,” he said, plopping down on a wooden chair outside his office as two aides stood by. Barred from the hospital, he said, some of the sick are diagnosing their own illnesses and trying to treat themselves with medicine they buy at the local market, with disastrous results.
“Some people are dying because the medicine doesn’t fit the illness,” he said. “That’s why we are asking for help, so people can come here to get treatment.”
But to treat patients safely again, hospital officials need to address a range of problems. They must find ways to systematically isolate high-risk patients before they mix with other patients; to equip the medical staff with masks, gloves and other protective equipment; and to enforce sanitation measures, like proper hand-washing, even when there is no running water.
Dr. Kissantou, one of only two Angolan doctors at the hospital, says all that could be done, with enough money. The provincial governor has promised $1 million, he said, but more support is needed.
Yet the biggest challenge of all may be regaining the trust of the community after so many deaths. It is one reason why Dr. Kissantou, who took over the hospital after his predecessor was fired, still comes to work every day.
“I am a doctor,” he said. “I will not flee, because I prefer to give my life to another.”