Posted on 04/09/2005 5:42:01 PM PDT by Mother Abigail
To Stop Deadly Virus in Angola, Group Seeks Hospital's Closing
By SHARON LAFRANIERE
UIGE, Angola, April 9 - An international medical charity battling a hemorrhagic fever that so far has killed 181 Angolans has urged the government to close the regional hospital here, at the center of the outbreak, saying the medical center itself is a source of the deadly infection.
Doctors Without Borders, the global relief organization that runs an isolation ward at the hospital for victims of the deadly fever, Marburg virus, told Angolan officials on Friday that the hospital should be closed if the rapidly spreading epidemic was to be contained.
Two other hospitals within 60 miles of Uige may also have to be shut down, said Monica de Castellarnau, the organization's emergency coordinator in Uige, the provincial capital, where the outbreak was first reported.
That possibility raises the prospect of a second health care crisis, one in which hundreds of thousands of people already facing a disease that is almost always fatal may suddenly have no access to hospital care. But in an interview in the streets of Uige, where an intensive effort is under way to find and isolate new cases of the virus, Ms. Castellarnau said there might be no alternative.
"The hospital has been the main source of infection," she said. "We have to break that chain somehow. It is a massive public health decision, and it must be taken by the government."
Angola's outbreak of Marburg virus, a close and equally deadly relative of the better-known Ebola, is the largest ever recorded, and continues to spread. The disease, which causes a high fever, diarrhea, vomiting and bleeding from bodily orifices, has no effective treatment. Nine out of every 10 victims here have died, usually within a week of falling ill. Uige, a town of roughly 200,000 set in the idyllic green hills of northern Angola, has become a surreal backdrop to a public-health disaster as medical workers swathed head-to-toe in spacesuit-style garb roam neighborhoods in trucks, trying to round up the sick.
Because Marburg virus is so dangerous and so contagious, spread by contact with almost any bodily fluid, from blood to sweat, the workers are encapsulated in air-filled white suits, white aprons, green gloves, face masks and face guards. On their backs they wear battery packs to keep the suits inflated. Some carry canisters of bleach or chlorine on their backs and hose sprays so they can disinfect the homes of the sick. A few have sprayed so much bleach that the buckles on their shoes are rusting.
Medical workers warn visitors not to shake hands with anyone and not to stand directly in front of residents when talking to them, for fear that a cough could release an infectious spray of spittle. Silo Margarita is one of the few nurses still working at the 500-bed regional hospital here, a sprawling collection of well-kept, one-story concrete buildings that appeared almost deserted on Saturday afternoon. Wearing a surgical mask and plastic wrapped on her boots, she continued to care for 12 patients despite the fact, she said, that as many as 15 of the hospital's nurses and two doctors have died from the Marburg virus. Two nurses died only last Thursday, she said.
"Of course I am afraid," she said. Asked why she still comes to the hospital when many co-workers have stopped, she replied, "It's an order." Medical workers here are scrambling to persuade a terrified public to alert them to sick relatives so patients can be isolated in a ward before still more people become infected. Suspected cases have already been identified in seven of Angola's provinces. In the capital, Luanda, two cases have been confirmed and one is suspected.
On Saturday, medical workers seeking to build cooperation in one neighborhood here faced angry residents, even though they were accompanied by government officials and police officers. Officials have ruled out surveillance efforts in that neighborhood, saying it has become too dangerous. Often in epidemics of such lethal diseases, medical workers become the focus of the public's fear, frustration and anger, according to officials of the World Health Organization, which is organizing the emergency response to the outbreak.
Dr. Heinz Feldmann, a Canadian with the World Health Organization who has set up a laboratory at the hospital to test for the virus, said he could check as many as a 100 samples a day. But because the medical teams were forced Thursday to suspend their community searches for new cases, he said, he was now getting only four samples a day.
Wow. BTW, been following your posts on this subject, and appreciate your ability to communicate complex viral analysis in layman's terms.
The closing of three hospitals in Uige would truly be remarkable, and may force more to flee the area, spreading the Marburg virus even further. Although said to be transmitted by bodily fluids, there are now 15 dead nurses and 2 dead physicians, suggesting viral spread is quite efficient. The deaths of the 17 health care workers have all been within the last month.
The situation in Angola is clearly deteriorating. Closing the hospital in Uige may create similar new outbreaks elsewhere. The closing of three hospitals in Uige that are 60 miles apart demonstrates the rapid spread of the virus, and will almost certainly ring alarm bells in Luanda, where transmission has been reported.
This will almost certainly result in some leaving Luanda, increasing the likelihood of Marburg being seeded internationally.
I read elsewhere that the medical workers were stoned.
Have you heard anything about the status of the 9 under quarantine in Italy?
Many of us are asking the same question, and there is no information - on any channel that
I can find.
Sorry
MA
As I understand it, Uige has a population of 500,000.
Additionally, many of the back roads of Angola are mined, making contact tracing, if the populace were not hostile, extremely dangerous.
So no one knows how many cases there are, actually. Some estimates I have read are double the known cases, but I think it is far higher than that. No one is telling people to flee--they are doing it on their own.
"Although said to be transmitted by bodily fluids, there are now 15 dead nurses and 2 dead physicians, suggesting viral spread is quite efficient. The deaths of the 17 health care workers have all been within the last month."
oooooooooooooooooooooooooooooooooooooooooooooooooooooooooooo
This is one scary bug and obviously we'll be hearing lots more about it.
One person on one jet and we could have a pandemic that would make the influenza epidemic of 1918 look like the common cold.
The almost-always fatal disease can't be treated with hospital care. What a horrible situation.
This is sounding a lot like trying to pick up mercury by mashing it.
True, and I am astonished that Doctors without Borders advised that the hospital be closed.
Shades of the movie "Outbreak" that had Dustin Hoffman and Morgan Freeman in it.
No one knows how many cases there are...
Mobile surveillance operations in Uige have ceased because of damage to vehicles and threats of violence. It is unclear if health care workers have been killed because of the unrest, but clearly contact tracing has been limited in the Uige, which is the epicenter of the outbreak.
Therefore management by contact tracing and quarantine will be difficult. The lack of survivors has also led to relatives hiding sick patients because no one has come out of the hospital alive. However, care by untrained and unprotected relatives leads to further transmission. This transmission has now reached Luanda, Angola's capital.
The 3 million residents of Luanda will get increasingly concerned as the virus spreads in Luanda and the number dead increase. The lack of any survivors creates more suspicion about the motives of health care workers and those trying to monitor and quarantine contacts of infected patients.
I've continued to keep up with these threads and am utterly baffled why this isn't making international news. This could turn into a world-wide nightmare. Why isn't this all over the news?
> That possibility raises the prospect of a second health
> care crisis, one in which hundreds of thousands of people
> already facing a disease that is almost always fatal may
> suddenly have no access to hospital care.
Some logical dissonance here. If death is the almost-
certain outcome, what the heck do you need a hospital for?
Is health care a contributory factor with 10% who survive?
Obviously, people with OTHER problems will be affected by
the closings. But given the state of healthcare there, it
might also be a blessing, as they are now at reduced risk
of catching HIV from re-used hypodermic needles.
Do you know, is this a retrovirus? There have seem to have been a few instances when symptoms developed quite a while after exposure.
The media is run by the money interests.
They stand to lose alot if international travel and commerce is curtailed.
Move along, nothing to see here...
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