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August 3, 2004

Hard Facts About Fighting Ebola

“It seemed to the victims they were dying for no reason, slapped in the face by the hand of God,” said Erwin Van den Enden, MD, during a July 28 talk on Ebola at the Johns Hopkins Bloomberg School of Public Health.

He was referring to the fact that most people struck down by the Ebola virus had never heard of the disease before.

Van den Enden had come to the School not to talk about the scientific details of the virus but to give students attending the Summer Institute in Tropical Medicine and Public Health a glimpse of what it's like to fight the dread disease in the field, with few modern medical tools.

Van den Enden, who has attended Ebola victims during outbreaks in what was then Zaire (1976) and in the Democratic Republic of Congo (1995), began by describing the harrowing symptoms of the disease: sudden onset of fever, headache, joint and muscle aches, sore throat and weakness; then diarrhea, nausea and vomiting, stomach pain; followed by delirium, both internal and external bleeding, shock and death. Because the Ebola virus is present in all the victim's bodily fluids, the disease is easily spread by touch and most caretakers fall ill. Fatality rates range from 50 percent to 90 percent. No cure or vaccine has yet been developed.

After describing these details of the disease, Van den Enden, from Belgium's Prince Leopold Institute of Tropical Medicine, turned to the real business at hand: informing public health workers about what they can expect when contending with an Ebola outbreak, and imparting the regimen that will save workers' lives.

He said public health workers will know immediately when they've arrived at a village where Ebola has struck: Not a soul will be smiling. Conditions will often be primitive. The hospital will lack electricity and running water and there will be no drugs or supplies. (Cotton swabs, for instance, will have been reused after rinsing out.) Water will have to be hauled to the hospital in order to make the bleach (using hypochloride tablets) that will neutralize any Ebola-laced vomit and diarrhea in the place. All objects that cannot be sterilized will have to be burned.

All health workers must don protective masks, goggles, gloves (double), boots and plastic suits. All this gear makes wielding even a stethoscope difficult. Trying to see will be difficult while looking through fogged-up goggles, with only tiny oil lamps to light the dark wards.

The plastic suit, worn in such fearsome heat and humidity, will cause the body to lose about a kilogram of sweat every hour; workers should drink lots of fluids and leave the ward immediately if they become dizzy.

If workers must go out to collect corpses in a truck, they should never argue with those who refuse to give up the remains of their relatives. Workers have been killed trying to disrupt traditional rituals. If necessary, stake out a graveyard and begin to bury the dead, putting caustic lime both in the graves and on the bodies.

Finally, Van den Enden noted that tensions will begin to build among the health workers themselves; he recommends organizing occasional beer and pancake evenings to siphon off the stress.

Interestingly, Van den Enden noted that scientists have not yet identified Ebola's reservoir, the living organism(s) where the virus hides out between epidemics. His group has tested for the virus in, among other species, monkeys, apes, rats, mice, bats, salamanders, mosquitos and other insects, crocodiles and even plants—without result. “Thirty-thousand specimens tested, 30,000 negatives,” he said. “And so the search goes on.”

The last slide of the lecture read, “To be continued.” He hopes to return to the School next year about this time to report on a successful Ebola vaccine trial. —Rod Graham