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.
The solution should be not to admit Marburg patients, not to deny treatment to all other residents for every other problem. My best guess is that Doctors Without Borders is simply getting weak-kneed about this. They're French-based, of course.
Without any treatment options, the only solution is quarantine. Whether that can be achieved is certainly questionable.
Good. I haven't turned on the television since very early this morning, so I'm not in any position to judge TV coverage today. It was all Prince Charles when I had the tube on.
(what the heck was she wearing on her head?)
I, like Judith Anne, would sure like the know what is happening with the 9 under quarantine in Italy. My feeling is the longer it goes without sounding an all clear to Marburg the better the chance it is and they don't want to say..........
"And then some."
I thought all brides wore sheaves of wheat in their hair. She looked like a regular harvest.
Thanks. I am definitely concerned about the Italians in isolation.
The demographics began to change several weeks ago when the first health care workers were infected. The number of workers who have died is at least 12. In the past 1-2 weeks deaths have been reported for the first time in the four provinces surrounding Uige.
The latest reports do not have as much detail on the age of patients or the breakdown of locations. They also do not update the status of the passenger in Portugal being tested (a report on the third passenger was scheduled for release last Thursday), or the suspect cases in the Democratic Republic of Congo. There have also been media rumors of additional cases in Cabinda.
The number dead has surpassed the record of 126 for Marburg and now appears likely to surpass the record number of 280 Ebola deaths. Although contact tracing efforts are increasing, the 20 newly diagnosed patients who have not died indicate that the number of contacts should be at least 2-4X the 100 being monitored or traced by WHO. Media reports indicate that 16 are under hospital quarantine in Cabinda and 9 are under quarantine in Italy. These 25 under quarantine are linked to just two of the 155 deaths.
The case fatality rate of 100% and rapid spread of the virus in five provinces is markedly different than prior Marburg outbreaks.
Paradoxically IIRC the first outbreaks of Ebola were partly contained because the suspicious villagers blockaded the roads and paths and turned away all travelers, thus assisting the virus burn itself out. Sometimes the farm fold remember effective strategies.
Again, thank you for your informative posts.
"The initial symptoms are a severe frontal & temporal headache, generalised aches & pains, malaise, by the second day the victim will have a fever. Later symptoms include watery diarrhoea, abdominal pain, nausea, vomiting, a dry sore throat, & anorexia. By day seven of the symptoms, the patient will have a maculopapular (small slightly raised spots) rash. At the same time the person will develop thrombocytopenia & haemorrhagic manifestations, particularly in the gastrointestinal tract, & the lungs, but it can occur from any orifice, mucous membrane or skin site. By day twelve the skin starts to peel away from the rash. Ebola causes lesions in almost every organ, although the liver & spleen are the most noticeably affected. Both are darkened & enlarged with signs of necrosis. The cause of death is normally shock, associated with fluid & blood loss into the tissues.
The haemorrhagic & connective tissue complications of the disease are not really understood, but may be related to the fact that the VP40 protein is antigenically related to human cell matrix proteins (abdominal aortic aneurism protein & MFAP-4), leading to autoimmune attack.
>> Allarangar Yokouidé, an epidemiologist with the World Health Organization, told reporters that more than 80 percent of those who contracted the virus in Angola had died, a mortality rate that surpassed previous Ebola epidemics in the region. "Marburg is a very bad virus, even worse than Ebola," he said. <<
The case fatality rate for Marburg in Angola is above 99.4%. There is at most 1 survivor out of 181 outcomes. Thus, hospitalization offers little hope for survival, which has led to mistrust by local residents.
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.
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Doesn't sound good.
I did see elsewhere that a 21 day quarantine is supposedly in effect for anyone leaving the Uige province. How and whether that can be enforced seems entirely debateable.
Gack!!! As if living in the southeast I would know the difference.
Here's another nightmare scenario: 38% of the population is Roman Catholic. It's an extremely poor country so I very much doubt the likelihood, but picture a planeload of people flying to Rome for the Pope's funeral, with one or of them infected by Marburg...
Of course they are very different.
What is NOT different is that, as soon as the Hong Kong epidemic was identified, travel from China should have been stopped. If this had been done, the Toronto epidemic would have been prevented.
It is criminally negligent to allow transport category aircraft to take off from Luanda. Do you disagree?
Yes, but IIRC the symptoms that present in the first 4 to 7 days could also be any number of other diseases in central Africa, or over here for that matter. That's what punches the primal fear button in observers here.
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