World

Mysterious Killer

Stefan Lovgren November 13 2000
World

Mysterious Killer

Stefan Lovgren November 13 2000

At first, there are few signs of tragedy in this impoverished town in northern Uganda. Along Gulu's sleepy main street, shopkeepers languish in the doorways of their businesses, waiting for the first customers of the day. A few streets over, a group of soldiers in fatigues doing its morning exercises runs past a farmer cultivating a small plot of land. But this quiet place is the “hot zone,” the epicenter of the latest outbreak of Ebola—one of the deadliest viruses known to man, whose victims suffer an agonizing death when they begin bleeding through every orifice in their body. Since Sept. 17, 83 people have died in the plague that last week appeared to be spreading to other regions of the country. “We don’t understand Ebola,” said Ponsian Okwera, after his daughter, Akot, was moved into the isolation ward in Gulu's hospital. “But I understand that my daughter is dying.”

As soon as the epidemic was confirmed, top Ebola experts from around the world, known as virus hunters, packed their equipment and rushed to Gulu, 300 km north of the Ugandan capital, Kampala. In a temporary laboratory inside the villages main hospital, known as the “Hot Room,” scientists from the Atlanta-based Centers for Disease Control and Prevention (CDC), dressed head-to-toe in protective gear, immediately began examining patients for any signs of Ebola. In addition to the 83 deaths, they confirmed another 183 cases, including one last week in the town of Mbarara, in southwestern Uganda. The population has reason to be afraid. In one graveyard in the village of Rwot Abilo near Gulu, mounds of earth cover nine fresh graves—all belonging to a single family. “There is no one living here now,” said Odora Santina, a local woman, pointing to a house. “They all died from this Ebola. All of them.”

In the courtyard of St. Mary’s Lacor Hospital in Gulu, relatives wait patiently to find out if their loved ones will also die. To enter the isolation ward, visitors must wear a face mask, rubber boots and gloves, and be sprayed with disinfectant. Inside, a nurse calls out the names of the patients, but no one is strong enough to answer back.

There is no cure for the highly contagious virus, which is transmitted through contact with infected body fluids. It first struck simultaneously in 1976 in Zaïre, now Congo, and Sudan, killing 397 people. And in 1995, 245 people were also killed by Ebola in the thick jungles of Kikwit, Congo. But this is the first time the virus has struck Uganda. Scientists have identified a strain called Ebola-Sudan, the same strain that first appeared in Sudan—raising speculation that the virus may have been carried to Uganda by rebels known as the Lord’s Resistance Army. The guerrillas, who stage cross-border raids from bases in nearby Sudan, are fighting to carve a Christian state from Ugandan territory.

Even if the virus is similar to the one that hit Sudan in 1976, scientists still have a greater mystery to solve. “Where has the virus been hiding?” asks Scott Dowell of the CDC. Dowell and other experts speculate that it could have remained alive in other animal species, insects or even plants before emerging to attack humans. “It’s in there in the forest,” says Dr. Mike Ryan, a member of the emergency response team from the World Health Organization. “We don’t know where it is, we don’t know its natural site.”

In previous outbreaks, Ryan’s team found that some victims had come in contact with sick chimpanzees while hunting them for food. “We go back and we find one person,” says Ryan, “who was working in the forest and who comes out ill and infects his own family.” But chimpanzees also die from the virus, he notes, so they must have caught it from another animal.

The mystery surrounding the killer virus has contributed to a morbid fascination with it. The book The Hot Zone, a 1994 best-seller by Richard Preston, recounted how Ebola turned up in research monkeys in a laboratory in Reston, Va. Ebola was also the subject of Outbreak, a 1995 movie starring Dustin Hoffman in which his character leads a group of American scientists to Africa in an attempt to stop the spread of the disease. “Uncertainty,” says Ryan, “and a lack of knowledge about what may come around the corner create a strong fear of the disease.”

How did the virus travel to Gulu? Scientists are now mapping the current epidemic to discover its origin. So far, the index case, or first confirmed case, was Esther Awete, a 36-year-old woman who was found dead on Sept. 17 in her tiny mud hut in Kabede Opong, a village near Gulu. In accordance with local tradition, her body was kept in the hut for two days to allow friends and family to view it. Then, her family ritually bathed the body and washed their hands in a communal basin as an act of family unity. Soon, one of Esther’s daughters died. Another child followed a few days later, then her grandmother, her husband and three other family members. A farmer who came to the funeral, Albino Ciero, spent 10 days in the hospital before he, too, died.

Experts are also focusing on the mysterious death of a local doctor more than a month before Awete passed away. The physician, who was in his late 20s, appeared to be in good health, but he suddenly fell ill with a fever. He died two days later, on Aug. 8, at St. Mary’s Lacor Hospital where he had practiced. Scientists believe that if the young doctor in fact died from Ebola, he could have been infected while treating a patient and, in turn, passed on the disease to others. Experts are searching hospital records for evidence of who that initial patient might have been.

The greatest fear is that someone who is a carrier of the virus will leave the infected area and start a new epidemic. This happened during an outbreak in Gabon in 1996 that killed 45 people. A man who had been in the country traveled to South Africa, where he fell ill and checked into a hospital with flu-like symptoms. The doctors did not know they were dealing with Ebola, and while the man survived, the nurse who treated him did not.

There is no ban on travel to Uganda, but neighborliness countries like Kenya and Tanzania are screening for Ebola at their borders by checking for physical symptoms. “We’re looking,” said Dr. Guenael Rodier, the World Health Organization team leader in Gulu, “for the one that may get away.” Health workers continue to fan out to remote villages and towns in search of new cases. But despite the horrific nature of the disease, Red Cross volunteers find that many villagers remain skeptical. “Some people don’t believe it is Ebola,” says Francis Obuto, the Red Cross volunteer leader. “They say it is witchcraft.”

Staff with the Toronto-based Canadian Physicians for Aid and Relief have also been working in the crowded refugee camps near Gulu, which contain nearly 400,000 people fleeing the invading Lord’s Resistance Army. Such camps can be a breeding ground for disease and Gizaw Shibru, program manager in Gulu for the group, said they are trying to educate people about the dangers of Ebola. “It was really important,” said Shibru, “to get people to wear protective clothing, especially when preparing the dead for burial.”

Even as the death toll mounts, there is some reason for optimism. Recent research has raised hopes for a vaccine. Scientists have uncovered a protein produced by the Ebola virus that disrupts the cells that line blood vessel walls. They believe this protein could be responsible for the severe bleeding in those infected with the disease. Blocking the action of the protein might be one way to treat Ebola infection, by giving the body time to fight off the virus before the patient bleeds to death.

The Ugandan outbreak may also offer the best opportunity yet to unravel the mysteries surrounding the virus. The country has a good healthcare system, and with the help of Ugandan health officials, scientists have created a database to track the origin of the epidemic. “This is our chance to learn more about the disease,” said Dowell. “We only see this virus every four years. So it’s incumbent upon us to try to learn more about the disease now.” That just may help solve the riddle of Ebola—and ease the terror in Gulu.



A VILE SCOURGE

Since it was first isolated in northern Zaïre, now Congo, Ebola has become one of the deadliest viral diseases. Ebola has its origins in the jungles of Africa and Asia and kills up to 90 per cent of its victims within two weeks of their contracting it. The disease is transmitted by direct contact with the blood, bodily secretions or semen from infected persons. Initial symptoms include fever, muscle pain, headache and sore throat, followed by violent vomiting, bloody diarrhea, blindness and finally bleeding from all orifices. The virus attacks almost everything in the body except bone, destroying the immune system and causing internal organs to liquefy.