Ebola: Don't kiss the cadaver

opinion April 05, 2014 00:00

By Laurie Garrett
Foreign Policy

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In the forests of West Africa, medics are fighting a desperate battle to prevent a terrifying epidemic from going global

Despite millions of dollars in research on vaccines and treatments, the deadly and frightening Ebola virus is best tackled today the same way it was during its first epidemic in 1976: With soap, clean water, protective gear, and quarantine. 
The outbreak now unfolding in Guinea – the first in West Africa in 20 years – has also spilled over into neighbouring Liberia and possibly Sierra Leone. With 122 cases and 78 deaths reported to date, the epidemic has officially been declared a “regional threat”. The West African region shares a vast tropical rain forest rife with virus-harbouring animals, including rodents, bats, and chimpanzees.
The Ebola haemorrhagic disease is terrifying, as the virus punches microscopic holes in the endothelial lining of blood veins, vessels and capillaries, causing blood to leak from its normal pipelines coursing through the body. Within hours, the victims become feverish – raging in pain and hallucinations – their tears dripping red with blood. The crimson liquid flows from their noses, ears, bowels, bladders, mouths, while old wounds reopen all over their bodies. Death typically comes within five days. And Ebola is spread, via the infected body fluids, to attendant family members, healthcare workers and funeral preparers.
In 1995, when I was reporting on the Ebola epidemic in Kikwit, Zaire (now the Democratic Republic of the Congo), the disease struck terror across the community of some 600,000 people, many of whom would wail through the pitch dark night the names of the virus’ victims. The dread was compounded by the inability of doctors and nurses in the region’s clinics to protect themselves. As medical workers contracted the infection and fled their posts or succumbed to Ebola, the Kikwit community wondered, “What dreaded thing is this, that even the doctors cannot protect themselves?”
Thanks to the bravery and sound scientific work of the international response teams that responded to the original 1976 epidemic in Yambuku, Zaire, and the subsequent outbreak in Kikwit, the governments of Guinea, Liberia and Sierra Leone can today make smart decisions to stop the virus from spreading and save lives. African communities no longer need to live in horror and dread, fearful of the lurking virus. 
Karl Johnson, a trout-fishing epidemiologist from the American Rockies, led a hastily assembled international team of African, European and American scientists to respond to what was then a completely mysterious epidemic unfolding in one of the most remote locations in the world. The brutal Mobutu Sese Seko regime that then ruled Zaire spent nary a franc on the far-flung rural villages of what was once the Belgian Congo, built no roads or airports and ignored health infrastructure. 
As I described in detail in my first book, “The Coming Plague”, Karl Johnson’s team of disease cowboys had no technological tools at their disposal – vaccines, cures, genetic screening, or rapid diagnostics. 
Johnson deployed a Belgian medical duo – one of which was the now-famous Peter Piot – to the Zaire village of Yambuku, thought to be the epicentre of the mysterious outbreak. The Belgians discovered that the entire epidemic was spawned by a Catholic missionary outpost so poorly supplied that it reused the same five hypodermic syringes for vaccinations, unwittingly spreading the Ebola virus with each injection.
In my second book, “Betrayal of Trust”, I detailed my observations of the 1995 Kikwit epidemic. Though nearly 20 years had passed since Karl Johnson’s intrepid team faced Ebola, the tool kit was little improved: There was still no vaccine, treatment, cure, diagnostic or knowledge of where the virus came from.
Once again an international scientific and medical team was assembled, led by the World Health Organisation’s American-born David Heymann. Doctors Without Borders deployed a tiny team to help in Kikwit’s largest hospital; Zimbabwe and South Africa sent animal experts to detect the source of the mysterious virus; and local Zaire scientists and medical students spread out across the town in search of clues to the epidemic’s origin and solution.
Since 1976, some 2,200 cases of Ebola have been confirmed in outbreaks spread across equatorial Africa, from its far west to Gulu, Uganda, in the east. Of those, 1,500 were fatal, with mortality rates as high as 95 per cent during the Yambuku and Kikwit epidemics.
From the Yambuku, Nzara, and Kikwit epidemics, researchers have learned at least seven lessons that can effectively guide responders today in Guinea and its neighbouring countries.
Seven defences
1. The index case – the initial person contaminated with the Ebola virus – is usually a hunter or villager who recently spent time deep in a tropical forest and came into contact with an animal carrying the virus. In Yambuku, the index case was a hunter; in Kikwit he was a charcoal-maker who spent a week burning wood in the forest to sell in town; in a prior West African outbreak, the index case was a family that killed and ate an ailing chimpanzee. Stopping the spread must include cutting off contact between forest animals and human beings, especially tropical fruit bats that harbour the virus without harm to themselves, and the monkeys and apes that eat the bats or the fruit that they chew on, contracting Ebola in the process.
2. Do not eat wildlife. Guinea’s government has wisely issued warnings to its populace: Do not eat bats or monkeys. Moreover, it has banned the trade in wild animal flesh, or so-called bushmeat – measures neighbouring Sierra Leone and Liberia would do well to immediately imitate. Even bats found in a cave in Spain carried Ebola. 
3. Quarantine. Families protest: Who wouldn’t? Taking parents from their children, wives from their husbands, babies from their mothers’ breasts are all acts that evoke rage and sorrow. But leaving the bleeding patient in the home, to spread the virus to family members, guarantees the epidemic will persist.
4. Burials must – despite religious and cultural preferences to the contrary – be carried out without ceremony, with bodies placed in deep-dug graves to avoid spread within funerals. Traditional practices of touching or kissing the cadaver in open-casket ceremonies must be prohibited.
5. Face masks. Though it is rare, the Ebola virus can be spread through the air among people. Every health worker, Red Cross volunteer, gravedigger and outbreak investigator must wear protective face masks when near an infected animal or individual. 
6. Doctors Without Borders. The agency has attended nearly every outbreak. Before Doctors Without Borders, ebola spread like wildfire among doctors, nurses, lab techs and orderlies – none of whom had soap, running water, electricity, latex gloves, masks or protective gowns.
7. Forget about high-tech solutions, “cures”, and vaccines: They do not exist. The battle against Ebola has garnered $5.4 million in research funds without delivering any vaccine or cure
To get to Kikwit in 1998 I had to buy a “seat” on a stolen military transport plane, strapping myself atop a large wooden crate inside the cargo hold.
Over bowls of rice at the hospital, I had a lunch with one of Kikwit’s surviving nurses – a young man who contracted Ebola on the job and was among the lucky 5 per cent who outlived the microbe. He told me that every day was greeted with dread, as soap, water, gloves and masks were no longer available.
As he spoke, he trembled with fear. I reached into my camera bag and pulled out two small bottles of hand sanitiser. The nurse’s eyes popped, he snatched the bottles, and hid them in his pants. Scanning the dining room to see if any colleagues had spied the precious cleanser, the nurse feigned nonchalance and sauntered to his staff locker, hiding the sanitiser inside.
As I prepared to leave the Kikwit hospital, he walked up beside me, smiled, and whispered: “Tonight I will finally sleep.”
Laurie Garrett is senior fellow for global health at the Council on Foreign Relations and a Pulitzer Prize-winning science writer.