Marburg Outbreak Breeds Fear in Angola Hospitals

What a killer looks like...

When this bad boy shows up in your electron microscope, you WILL know fear!

Mar 30, 2005 — By Zoe Eisenstein

LUANDA (Reuters) - Amid fears the deadly Marburg virus may reach Angola's capital, staff at state hospitals in tatters after a ruinous civil war said on Wednesday the government must do more to protect them.

"Of course we're all panicking. Everyone's scared, there's no cure for Marburg," said a male nurse at one government hospital in Luanda who requested anonymity.

The viral hemorrhagic fever — characterized by headaches, nausea, vomiting and diarrhea accompanied by blood — is spread through bodily fluids including saliva and perspiration.

Medical workers who may have direct contact with potentially infected patients are advised to exercise the most caution, but staff said not enough was being done to ensure staff safety.

"The government should be doing a lot more to protect us. In some hospitals, medical workers aren't even wearing protective clothing," said the nurse.

"In private institutions the preventative measures are much more rigorous. In state hospitals I'm not sure they've got the means to protect us," added a female colleague.

The latest figures available show the disease had killed 117 out of 124 people known to be infected by Tuesday. The Centers for Disease Control and Prevention in Atlanta says the usual death rate is 23 percent to 25 percent, but few infected patients are reported to have recovered this outbreak. There is no known cure.

While all the known cases have originated from Angola's northern Uige province, medical workers in Luanda said they could not be sure Marburg had not already spread to the capital, only 150 km (100 miles) southwest of Uige province.

"Luanda's the province where it's most likely to spread to. Maybe it already has, but hasn't been registered yet," the male nurse said. "Many sick people are refusing to go to hospital because they think if they do, they'll catch the disease."

Angola has told people who have visited Uige to stay in Angola for at least 21 days — the virus's incubation period Nearby countries have scrambled to stop Marburg spreading.

The Democratic Republic of Congo, Republic of Congo, Zambia and Namibia took steps to prevent infected people crossing borders.

Further afield, Kenyan health authorities are on alert for Marburg, and may consider screening air passengers from Angola.

SHATTERED HEALTH SYSTEM

The outbreak has highlighted the deep cracks in Angola's health system three years after the end of a 27-year civil war.

"The medical sector is already very bad, and now we have got a real emergency on our hands. This epidemic is going to weaken it even more," said the female nurse.

Luanda's oil-driven expatriate community is worried and even though most companies say it is business as usual, sources say some executives have provisionally booked plane seats out.

"There is certainly, among some communities here, a movement of panic that is not justified by the situation. But there exists a certain risk and precautions need to be taken," said Pierre-Francois Pirlot, resident representative of the United Nations Development Program (UNDP).

The U.N. told staff this week to defer non-essential travel to Uige and urged those already there to be careful and avoid physical contact especially with people in health facilities.

But an official at one of the U.N. agencies said even personnel working in the capital had been told to step up personal hygiene, avoid kissing or shaking hands.

(Additional reporting by Katie Nguyen in Nairobi)

Urbane Analysis: This is deadly serious, and underscores the shaky nature of work on issues in Africa. The point is that this is not an Africa issue: it is a greed, corruption and hatred issue. This is not something that Nongovernmental Organizations (NGOs), even the most effective and efficient among them, can prevent from happening - simply because outsiders cannot create an entire health care system for regimes which care not to bother. This illness does not happen where the most basic levels of health care are delivered, where people are allowed to go about the normal processes of agriculture and mercantile relationships - in other words, this does not happen where bad people are prevented from gaining control over society. You can forget the usual liberal conspiracies: feel-good, hand-me-down, liberal cast-off grant-and-aid mentality does no good here. In fact, they perpetuate the problem. Those people who care - need to break the cycle of co-dependence with dictatorial regimes. Bill Clinton's apologies are good for jack squat when it comes to solving these issues. Jimmy Carter never did a damn thing to make this situation improve one iota. Feeling bad about the situation never did anything to help it - just look at Rwanda in 1994.

But George W. Bush makes these bad guy dictators squirm - and jet off to see their Paris doctors to get more COX-2 Specific NSAIDs. Capiche?

Urbane R update: One week later, and things are looking a whole lot worse off.

This report from the New York Times indicates that the health mega-NGO Medicins sans Frontieres/Doctors Without Borders (MSF/DWB) has called for hospitals to be shut down in a last-ditch effort to contain the spread of Marburg. Monica de Castellarnau of MSF/DWB says her organization is calling for the curtailment of health care for thousands - by closing down hospitals across wide areas - in order to do what? The answer is clear, save tens of thousands (and maybe more) potential victims of this incredibly deadly virus:

"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..

This is an incredibly important news story. And the media is barely reporting on it. It proves that the media learned absolutely nothing after Rwanda in 1994.

But the media is not entirely to blame - where is the World Health Organization (WHO) in all of this? What about asking for help from the Centers for Disease Control and Prevention? Pardon the cynicism, but it must be asked of the WHO, are you absolutely powerless without outside agencies mandating your involvement?

This weekend, a Reuters report indicates that WHO has halted operations in Angola - due to security concerns. Isn't there something in your budget that provides any kind of line item to act, say under "Pandemic, Virulent"? WHO: when are you going to do something, anything - when the airlines start bringing Marburg cases into Paris, Amsterdam, Frankfurt, London and Lisbon? Wouldn't that be just a little inadvisable?

This report and commentary from Professor Henry L. Niman of Recombinomics Corporation indicates that this strain of Marburg has now spread across international boundaries to Zaire - with six deaths reported there so far. That is an enormous negative development. But Niman, a world expert in infectious disease, is particularly concerned as the outbreaks spread southward toward Angola's capital city, Luanda:

"These two cases highlight the difficulties in treating these patients and monitoring contacts. Controlling the spread of the virus in the slums near Luanda will be particularly challenging because of a high population density, and an increase in the number of people who want to leave the area. Thus, as the virus radiates out from Uige, controlling spread via contact tracing and quarantine will be increasingly difficult."

What about when the virus crosses over into Congo, and health care workers can effectvely do absolutely nothing to contain it? Contact tracing and quarantine in the Congo? How many mirror-lensed Colonels (with AK-47 toting "professionals" in tow) will have to be paid off in order to accomplish that in one small town, much less across a wide area? What will the WHO do when the disease spans from one crowded city teeming with slums filled with desperately poor people (Luanda) across an international border comprising two enormous cities - full of even more desperately poor people ( Kinshasa/Brazzaville) - watch it spread upriver throughout the entire Congo basin? And what about the panic that will spread throughout every country that borders Congo? That's a whole lot of panic. Trust me, you don't want to see that.

This report from the New York Times outlines that fear and panic have overtaken reason in Angola - even as the number of cases has grown from thirty to over two hundred (at last report this weekend, some twenty five more in twenty four hours).

"It's becoming a huge problem," said Dick Thompson, a spokesman for the World Health Organization, which has dispatched surveillance teams to the country's northern provinces. "We clearly don't know the dimensions of the outbreak." Health officials said some Angolans are hiding sick relatives out of fear that they will die if taken to the hospitals, thereby increasing the chance the disease will spread.

A state of panic has descended in some areas - to the point that those who come to help are instead viewed as purveyors of the illness' deadly affect:

As field workers tried to trace suspected cases in two Uige neighborhoods Thursday, townspeople threw stones at them, accusing them of killing people who had been taken away sick and who were returned to them dead. The violence forced the health workers to suspend their checks, according to officials from the World Health Organization and Doctors Without Borders. The government has dispatched soldiers to the province but so far made only a limited effort to educate an increasingly terrified public.

Until they decide to become truly effective on this outbreak, the WHO might want to file this under another heading: "Disaster, Prescription for"

Thanks a lot, Lads.

So, to sum it all up: United Nations administration of Angola has rendered the worst health conditions on the planet - and an outbreak of the virulent Marburg virus - that is breaking out in wide areas, even across international borders.

This is a disasterous situation. I shudder to think that the U.S. is going to get handed this one after the UN botched it all so horribly. The U.S. military is equipped to handle this kind of situation - but we shouldn't have to risk another Mogadishu in order to clean up the UN's mess. The American people won't risk that, and won't stand for it. But we should be LOUD in the clarification of what led to this situation. Given the cost to American taxpayers in funding, and the poor of the world in suffering, can this planet tolerate much more of what the UN is doing to it?