A panicked populace …

So much soothing music.

Within the week I shall abandon my sheltered work station and make a foray into darkest Africa. If I make it back you will hear all about it in due course. Among the places I will be visiting is the Republic of Congo. You will remember that there are two Congos separated by the Congo River. I’m off to the smaller one to the north. The other one used to be Zaire and is now the Democratic Republic of Congo (DRC). In June 1976 a haemorrhagic fever broke out in Sudan, in August a second outbreak occurred in Zaire. The virus was later isolated and named Ebola after a river close to the site of the Zaire outbreak.

The 1976 event affected 602 people, 151 died in Sudan, 280 died in Zaire, a mortality rate of 72%.

Ebola revisited the DRC in 1995 (254 dead) and in 2003 it appeared in the Republic of Congo killing 128,a death rate of 90%. There were further cases in the DRC in 2012. There have been outbreaks in Uganda. Currently the largest outbreak of all is threatening the people of Guinea, Liberia and Sierra Leone. It has recently been contained in Nigeria.

These last countries are in west Africa, reassuringly for me, the capital of Liberia is  5,000 km by road from Brazzaville in the Republic of Congo (or a seven hour flight).

Viruses are essentially little packets of genetic material. They find their way into living cells, hijack the process of protein manufacture within the cell so that it churns out lots of copies of itself and usually packages them for export. They are obligate intracellular parasites. Therefore if they are not infecting humans full-time they need to be hiding in other organisms. The ebola viruses are a little group of closely related viruses, they contain RNA. They are lethal to primates so the reservoir is not likely to be in Gorillas or monkeys. Fruit bats and dogs are high on the list of suspects. Endothelial cells are their main target especially in the liver. These are the cells that line the inside of blood vessels.

Incubation occurs in 2 to 21 days. The first symptoms are like the flu. Fever is usually greater than 38.3 °C,  often followed by vomiting, diarrhea and abdominal pain. Shortness of breath and chest pain may occur next along with swelling, headache and confusion. In about half of cases the skin may develop a maculopapular rash (a flat red area covered with small bumps). Five or so days into the process vomiting and coughing up of blood as well as voiding blood in the feces may occur. For the majority death will follow within 16 days from the onset of symptoms. Those who survive start to show signs of recovery in the second week of the illness.

As recently as July this year Nature’s Declan Butler could tell us that Ebola does not pose a global threat.

… to become infected in the first place, a person’s mucous membranes, or an area of broken skin, must come into contact with the bodily fluids of an infected person, such as blood, urine, saliva, semen or stools, or materials contaminated with these fluids such as soiled clothing or bed linen. By contrast, respiratory pathogens such as those that cause the common cold or flu are coughed and sneezed into the air and can be contracted just by breathing or touching contaminated surfaces, such as door knobs. A pandemic flu virus can spread around the world in days or weeks and may be unstoppable whereas Ebola only causes sporadic localised outbreaks that can usually be stamped out.

Since then the disease has made it to the US and Spain and transmission has occurred in both places. Reassuring noises from the ill-prepared CDC have not prevented alarm or transmission. Indeed, given the number of affected healthcare workers in Africa and out of Africa, it seems to me that ebola has a greater capacity for spread than so far suspected.

One of the hospitals I work at has begun to prepare itself (for my return?). It issued a memorandum a week ago.The Quality, Risk and Business Manager informed us …

A week later a quick look around the point of entry was not reassuring. There is a crowded waiting area between the front door and the first staff member, there was no personal protection equipment to hand, nor illustrated signage on how to put it on or take it off. No area had been designated for isolation nor is there an area that could be accessed without passing close to waiting patients or other staff.

Visitors to Africa or Texas can take a few precautions …

• Avoid contact with sick people and the recently dead
• Don’t handle bushmeat
• Wash your hands thoroughly and often
• Don’t pat the dogs

… and don’t lose sight of the fact that Malaria will kill more than 600,000 people this year.