Stemming viral outbreak will require Angolans' trust

Marburg virus has killed more than 200 people


UIGE, Angola - For nearly four weeks, teams of health experts have been trying to set up a rescue operation in this town of windowless, crumbling buildings with no running water, intermittent electricity, poor sanitation and a perennially jammed telephone network.

They are trying to contain the world's worst outbreak of one of the world's most frightening viruses, known as Marburg. But with the death toll rising every day, no one is predicting success soon.

A cousin of Ebola, the Marburg virus has erupted periodically in Africa in sudden, gruesome epidemics, only to disappear just as mysteriously. This time it has struck with a vengeance, killing nine out of 10 people infected. The toll stands now at 210 - including some of the doctors and nurses caring for the sick. The virus is highly contagious, making any outbreak a cause for widespread fear and fascination in a world shrunk by international travel and trade.

Marburg spreads through blood, vomit, semen and other bodily fluids. Even a cough can prove fatal if a few drops of spittle hit someone else. Corpses, teeming with the virus, are especially dangerous. A contaminated surface can be deadly - the virus can find its way into someone's eyes, nose or mouth, or enter the bloodstream through a cut.

Inside the body, it moves with terrifying speed, invading white blood cells essential to fighting off infection. On Day 3 of the infection, there are fewer than 200 viruses in a drop of blood. By Day 8, there are 5 million.

"That's why dead bodies are kind of like bombs," said Dr. Heinz Feldmann, a virologist from Winnipeg, Canada, who is here working with the teams of specialists dispatched by the World Health Organization, the Centers for Disease Control and Prevention, and Doctors Without Borders.

Their efforts to curtail the outbreak turn on whether distrustful local people in this desperately poor and isolated town of 50,000 notify health workers of suspicious cases. So far, persuading them has not been easy. Victims who are taken to the isolation ward are never seen again; their bodies, rapidly buried for safety, cannot be honored in the traditional funerals so important in this country.

Despite the best efforts of some dedicated doctors, the virus has a long head start, spreading for what may have been months from a deadly brew of poverty, ignorance and government inaction.

For the people of Uige, rampant death is now joined by health workers encased in masks, goggles, zip-up jump suits, rubberized aprons and rubber boots as they collect corpses in the stifling heat.

Teams of epidemiologists and provincial health workers have fanned out, checking out reports of potential new cases and tracking down people who had contact with the dead or dying.

Most reports from the community deal with the dead, not the sick. If that continues, the teams could be reduced to a high-tech, specialized burial service, helping prevent the transmission of the virus from the dead but not from the living.

At the cemetery on the edge of town, a section created for Marburg victims is filling up with graves marked by simple wooden crosses bearing names written in black.

But the 30-bed isolation ward for Marburg victims set up at the hospital here two weeks ago rarely has more than a patient or two. "The population is hiding sick relatives," said Col. Pascoal Folo, a military doctor dispatched by the Angolan government to help coordinate the effort here.

Every morning between 9 and 10 at the World Health Organization quarters in Uige, medical teams pile into jeeps and vans and head out into the neighborhoods that surround the town. Their job is to check out reports of possible cases or deaths, and look in on people who had close contact with someone who died of Marburg.

Each person who may have been exposed to the disease has to be followed for 21 days and hospitalized if symptoms develop. Symptoms usually appear within five to 10 days of infection.

The disease interferes with blood clotting.

Victims die from shock as fluid leaks out of the blood vessels, causing blood pressure to drop. There is no specific treatment, but more patients would probably survive if they could get the kind of intensive care available in developed countries.

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