To Stop Deadly Virus in Angola, Group Seeks Hospital's Closing (Much bad news here)

NYT ^ | 4-9-05 | `

[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.

[KoRn]

I'm by no means an authority on this, and I didn't stay at a Holiday Inn Express last night, but what jumps out at me is this disease has a longer incubation period than the Ebola Virus.

The Ebola virus, and others like it kill so fast it doesn't spread very far geographically. Since this disease, being more lethal, and having potential to spread outside of a limited geographic area; we could have a huge problem getting ready to go down.

Who cares though. The Micheal Jackson case is underway, and we shouldn't be paying attention to anything else!

[NY Attitude]

A response to your question may be that they have pourous borders and that people have travelled beyond the town. Just that alone may spread a wide area concern.

[Judith Anne]

Some logical dissonance here. If death is the almost- certain outcome, what the heck do you need a hospital for?

For isolation, primarily. And to know how many patients there are. But medical facilites are inadequate, at this point, and the question is likely moot in Angola.

[Judith Anne]

Please excuse me for jumping in.

Not a retrovirus.

[Gabz]

Closing the hospital in Uige may create similar new outbreaks elsewhere.

That was exactly my reaction when I read this. I can see isolating the hospitals for only Marburg victims - but to totally shut them down sounds to me like the wrong move.

[armymarinemom]

ack! My husband bought me that book to read while I was suffering from Legionaries disease.

[SE Mom]

Horrible..if this begins to spread further.

[muawiyah]

I'm envisioning this International Medical Team in the capital city telling some government bureaucrats "You go close that hospital".

Right!

[KoRn]

That was nice of him. =)

[muawiyah]

This probably isn't making big time news because the reporters are all keeping a healthy distance between themselves and the outbreak.

No doubt everyone could use a volunteer to go in there and see what's happening.

You are free to do so.

[Mears]

Beats me! I just E-mailed the article to my daughter.She reads the NYT anyway and may see it but I want to spread the word.

If it can be transferred by sweat think about the seats of planes,busses etc. The way I interpret the article the disease can be spread any old way.

Why aren't they just isolating everyone in the country
until they can beat this thing down?

I come from a generation where we were quarantined for many of the childhood diseases---quarantine of the entire area is the answer,I hope.

[Judith Anne]

From another forum:

NPR interview included comments by Christa Kitz, who is coordinating the work of Medecins Sans Frontieres. She indicated that cases in and around Luanda have been identified who have not been to Uige and have no contacts in Uige, indicating the urban transmission of Marburg has begun.

http://www.curevents.com/vb/showthread.php?threadid=12832

[armymarinemom]

LOL, we just thought I had simple pneumonia at the time. It was still spooky especially when contacted by the CDC. I never want to deal with them again.

The whole matter did cause an interest in infection control.

[Boundless]

>> If death is the almost- certain outcome, what the
>> heck do you need a hospital for?

For isolation, primarily.

Except, as you allude, that isolation is not only not
working in this case, the hospitals are aggravating
transmission.

And the CDC, re this outbreak, has not updated its
travel recommendation since the 5th, which stands
unchanged as:
"No U.S. travel restrictions are recommended at this time."

Wouldn't it be nice if we had networks reporting
news, instead of providing wall-to-wall coverage of
philandering princes re-marrying.

[NY Attitude]

Consider the last flu Asian Flu season when all of a sudden it was everywhere. The sad fact is: no country wants to admit that a disease has traveled into their area.

[Judith Anne]

Borders are very porous.

Truthfully, EVERY border is porous. Everywhere.

[Jim Noble]

This will almost certainly result in some leaving Luanda, increasing the likelihood of Marburg being seeded internationally.

The airport should be closed.

[lainie]

I was just reading this article, which says Marburg, ebola, dengue, yellow fever, etc. are filoviruses/hemorrhagic fevers.

[KoRn]

"The airport should be closed."

Damn right it should be! If this thing got into a populated area of this country we should be in big trouble!

[Diogenesis]

01.025.0.01.001. Marburg virus [Location of isolation: Marburg; Germany]
CHARACTERISTICS: Filoviridae; 800-100 nm elongated filamentous virion, single stranded, negative sense RNA

Virus is assigned to the genus 01.025.0.01. "Marburg–like viruses"; family 01.025. Filoviridae; order 01. Mononegavirales.

EPIDEMIOLOGY: 1967 - outbreak in Germany and Yugoslavia following exposure to African green monkeys imported from East Africa (31 cases with 7 deaths); 1975 and 1982-4 cases reported in South Africa (originated in Zimbabwe); 1980 - two cases in Kenya

Virions have a complex construction and consist of an envelope, a nucleocapsid, a polymerase complex, and a matrix. Virions are enveloped. Virions are filamentous, or pleomorphic with extensive branching, or U-shaped, 6-shaped, or circular forms occur (particularly after purification) flexible; about 80 nm in diameter; 790 nm long (after purification). The surface projections are distinctive knob-shaped peplomers evenly covering the surface. They are spaced widely apart; evenly dispersed and embedded in a lipid bilayer. The surface projections comprise surface glycoproteins (GP) and are composed of one type of protein. Surface projections are 10 nm long; spaced 10 nm apart. The nucleocapsid exhibits helical symmetry. The nucleocapsid is helical; is cross-striated; 50 nm in diameter. Axial canal is distinct; in 20 nm in diameter; basic helix is obvious; pitch of helix is 5 nm. Morphologically aberrant forms are observe (after centrifugation).

The incubation period for hemorrhagic fever Marburg virus is 2 to 21 days.

Intrahepatic Marburg