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| "Dressing up is the easy part," nurse in special protective clothing |
More needs to be done to stop the spread of the deadly Marburg epidemic that's continuing in Angola in southwest Africa, says the medical aid agency Doctors Without Borders (MSF), while the World Health Organisation (WHO) agrees that the outbreak is far from over.
More than 230 people are known to have died since the first cases appeared in the northern province of Uige six months ago, with additional infections emerging in other areas, most recently to the west and southwest of the epicentre.
Marburg Haemorrhagic Fever was officially confirmed only towards the end of March. Since then MSF and other bodies such as WHO have been working to help control the situation. Marco Visser, a water and sanitation advisor to MSF Holland has recently returned to the Netherlands after helping to establish an isolation unit in Angola's capital city Luanda, where a number of people have been infected.
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Isolation units
What Visser and his colleagues want people to do is to take their ill relatives to the isolation units that have been established to prevent the highly infectious Marburg virus from spreading. Personnel at these centres have learned the correct techniques for 'dressing up' in multiple layers of protective clothing before entering the high-risk zone, where confirmed Marburg patients are cared for, and for 'dressing down' - removing the garments safely when exiting into the low-risk zone immediately adjacent.
"Dressing up is the easy part," Visser explains, "then the materials are still clean. But when you're dressing down they're potentially contaminated so you need proper ways."
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Marco Visser
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Medically speaking, there's relatively little that can be done for the patients in the high-risk zone as no specific treatment exists for Marburg Haemorrhagic Fever, "but you can care for them, clean them, give them some food and drink if they require," Marco Visser says.
The problem is that this particular outbreak, which is the largest to date, has an unusually high mortality rate, killing around 95 percent of those infected as compared with only about 25 percent in earlier epidemics. And there's a climate of suspicion surrounding the hospitals and medical staff themselves.
"It becomes very difficult to persuade people to actually come to the unit or to send their relatives, because the chances they will come out alive is very small." Indeed, according to an online MSF article, only two patients have survived longer than 24 hours in any of the isolation units.
Why so deadly?
What may account for this outbreak's unusually high mortality rate? One explanation may be to do with practicalities, such as people waiting longer before seeking help. But Albert Osterhaus, who's Professor of Virology at the Erasmus Medical Centre in Rotterdam and an internationally renowned expert on viral diseases, thinks a particularly virulent strain of the Marburg virus could also be a factor: "I think it could be a combination of the two."
He explains, "the number of cases we have seen could be due largely to the population structure and to changes that have happened locally, but with the case fatality rate, it's very likely that there is a role of the virus itself."
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Cleaning up an MSF isolation unit in Africa
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"Since these viruses have only caused a limited number of outbreaks, relatively limited information about the pathogenesis is available," says Professor Osterhaus. In order to learn more about these viruses, or to work towards vaccines or other specific treatments, experiments would necessarily require Bio-Safety Level 4 (BSL 4) facilities, which exist in only a few locations around the world.
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Professor Albert Osterhaus
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Another hindrance is the fact that relatively small numbers of people have ever been the victims of these diseases, making it hard to justify the "hundreds of millions of dollars" that would be required to produce any kind of vaccine or treatment for use in humans.
"Although it's very serious for the hundreds of people who die, on a worldwide scale the priority for that type of research is not so high," explains Professor Osterhaus. He concedes though that the filoviruses are beginning to receive more attention, particularly from researchers in the USA, because of the perceived threat of biological terrorism - although he personally believes that "there are much better candidates" for biological weapons that are also "much easier to handle" than Ebola or Marburg.
Breaking the cycle
Only last week the National Institute of Allergy and Infectious Diseases (NIAID), a component of the USA's National Institute of Health (NIH) announced that its scientists have discovered how Ebola infects human cells, raising the hope of an eventual antiviral therapy that could combat various haemorrhagic fevers.
For the time being though, given that relatively little is known about which creatures may be the 'reservoir' for these diseases, nor about the genetic background of the microbe itself, Professor Osterhaus believes "it's very important to give the virus as little time as possible to adapt itself more to the human species."
That means breaking the cycle of the disease as rapidly as possible. By informing the Angolan population about the disease and what the isolation units are for, MSF and collaborating agencies aim to alleviate the current feelings of panic and distrust.
Local culture
But Marco Visser adds that the learning process in such situations is not just one-directional; experience of earlier haemorrhagic fever outbreaks, such as that in Brazzaville in the Congo a few years ago, also gives the international aid workers a perspective on local culture that can prove useful in countering suspicion too. High fences around isolation units were lowered to allow families to maintain visual contact with their ill relatives, and transparent body bags were introduced so goodbyes could be said to the deceased. "There's all kinds of issues which you learn along the way," he says.