Angola's Marburg Crisis...

Mr.Atos

As Angola's Marburg outbreak worsens, CIDRAP notes a troubling condition impeding containment efforts... fear.

A specially equipped isolation ward at Uige province's 400-bed hospital is empty, even though Marburg cases and deaths are occurring in the area, the WHO reported. "It is apparent that, for the time being, the community does not accept the concept of isolation," the agency said. "Residents are unwilling to report suspected cases and allow these people to be managed under conditions that reduce the risk of further transmission."

Currently, the death toll in Angola's Marburg hemorrhagic fever epidemic reached 215; 65 more deaths since we reported on the outbreak last week, and nearly 100 since the WHO sent in a containment team two weeks ago. The latest figures suggest an acceleration of the infection which was first noted in October of last year. In the sixth months that followed, the virus claimed over 100 lives, making it the deadliest episode of its kind on record. Yet, in little over a month, the death toll has doubled despite the World Health Organizations efforts to contain this the outbreak. CIDRAP reports the mortality rate of this particular strain to be near 93%, meaning that of 100 persons exposed to the virus, only 7 will be expected to survive. Hence the growing atmosphere of fear. While family and friends see victims contained, extremely few ever emerge.

Fear is a particularly dangerous obstacle to containment. The atmosphere of fear, in its current stage, produces in victims a reluctance to make their potential conditions known to aid workers and officials due to the threat of permanent incarceration. The infected remain among their respective enclaves spreading the virus within and abroad. Containment is therefore breached by a passive reactionary resistance to isolation and treatment. Exposure accelerates. As the condition spreads exponentially, more aggressive methods of containment are required, employing police and even military forces. The atmosphere of fear becomes exasserbated by paranoia. Unable to fight against a microbial foe, human nature encourages a flight response. Victims flee into the security of larger population bodies where they become time bombs of mass destruction. Containment efforts in a center like Luanda - a city of four million people - could easily overwhelm current efforts.

The World Health Organization, recognizing the inherent risks of this situation, has launched an aggressive effort aimed at education:

Measures such as patient isolation and infection control that reduce opportunities for further transmission are the principal tools for bringing the outbreak under control. Given the urgency of the situation, WHO may temporarily introduce, as an emergency measure, a harm reduction strategy aimed at making a dangerous situation somewhat better. Family members and other caregivers who refuse to allow patients to be cared for in the isolation facility are being informed of ways to protect themselves from infection and given appropriate supplies. WHO has placed urgent orders for disinfectants, which are currently in short supply in Angola.

It's a bold effort to be sure. Volunteers expose themselves to a horrendous pathogen delivering certain death. Unfortunately, nature is proving to be an equally aggressive foe, as WHO reports:

In a tragic development, four Red Cross volunteers, freshly trained in social mobilization, were killed today by lightening while on their way to work. Support from Red Cross volunteers has been instrumental in controlling large outbreaks of the closely related Ebola haemorrhagic fever. WHO recognizes the importance of this support and deeply regrets the death of these volunteers.

We honor these heroic volunteers who, like soldiers, deploy themsleves on a different frontier of chaos in the protection of humanity. And yet their unfortunate loss further illuminates the danger of this present situation. Manpower being key, if current efforts at education and containment fail, the implulse for flight will eventually extend fingers of fear into the greater population of Angola; as will the fingers of infection. The danger of global outbreak increases with each passing day. A silent killer threatens to infect would-be travellers. Major Western concourses are less than the incubation period away... in all directions.

Stay Tuned.
(Edited 04.15.05:06:49)

UPDATE: 04.15.05:12:32

From AllAfrica.com today,

"Given the urgency of the situation, WHO may temporarily introduce, as an emergency measure, a harm reduction strategy aimed at making a dangerous situation somewhat better.

"Family members and other caregivers who refuse to allow patients to be cared for in the isolation facility are being informed of ways to protect themselves from infection and given appropriate supplies. WHO has placed urgent orders for disinfectants, which are currently in short supply in Angola," it added. Health care workers in hospitals and surveillances teams have been provided with protective clothing covering them from head to foot, including face masks and goggles.

WHO has repeatedly stressed that early diagnosis, isolation and tracing of all contacts are the only way to break the transmission chain of the disease, a relative of the equally deadly but better-known Ebola, which begins with severe
diarrhoea, abdominal pain, nausea, vomiting and chest and lung pains, and progresses to severe haemorrhage in the gastrointestinal tract and lungs.

But the Sydney Morning Herald confirms that escalting fear may compromise timely containment,

The WHO said medical teams are focusing on detecting cases and isolating them, as well as collecting bodies for swift burial.

But panicked locals are hiding sick family members for fear they will be taken away and never seen again, officials said. This is increasing concerns about contagion, and also has resulted in whole families dying from the virus.

The burial tradition which involves bathing the body, is another high-risk practice, so people resent the medical teams who pour bleach on the bodies, place them in transparent body bags and bury them within hours, without ceremony.

Update from the World Health Organization.

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