A review of THE COMING PLAGUE: NEWLY EMERGING DISEASES IN A WORLD OUT OF BALANCE by Laurie Garrett, published in 1994. Chapter 5: Yambuku – EBOLA
Absolutely no airplanes, trucks, or other vehicles were allowed
Don Francis was burned out before he ever got involved in the Sudan episode. When CDC officers called him in October 1976, he was a bit flattered at first. Later he learned that far from being indispensable, he was the CDC’s last resort. Every other person on the agency’s list had turned down the assignment out of fear. Because of the ancient rift between Khartoum and the southern Sudanese provinces, the federal government decided to stop the epidemic by completely cutting the south off from the rest of the country. Many might die in the remote south, but the disease would not reach the more densely populated Muslim north. Absolutely no airplanes, trucks, or other vehicles were allowed in or out of the southern section of the country. Francis visited all the Western embassies and two large British trucks were found, loaded up, and filled with extra tanks of gas. It was two in the morning when the exhausted group pulled into the town of Maridi, population 2,000
Near-famine conditions in the region
The national quarantine of the south was bringing on near-famine conditions in the region. The rolling elephant grass savanna was insect-infested. Tsetse flies swarmed about infecting livestock and people with trypanosomes that cause sleeping sickness. The problem was so severe that most people had years earlier ceased raising animals, and the entire region was dependent upon shipments of meat and protein from the north. Francis, Simpson and El Tahir found the distances between villages untraversable in four-wheel-drive vehicles. Some of the nomadic villages were virtually invisible, hidden in tall stands of elephant grass, reachable only by nearly imperceptible footpaths.
Constant war against a host of tropical diseases
The district’s headquarters, Maridi, was a sparsely supplied government town whose sole significant employer was a UNICEF-funded teaching hospital, staffed by two poorly paid public health doctors and 120 nurses, most of whom were trainees. Their shared skills and supplies pretty much limited the Maridi staff to tender loving care in their constant war against sleeping sickness, malaria, bacterial meningitis, septicemic plague, relapsing fever, and a host of other tropical diseases. When Francis, Simpson, and El Tahir arrived, the two Maridi doctors were in the process of closing their hospital, most of the nursing staff having either died of the new hemorrhagic fever or run away in fear, carrying the virus and panic with them back to the villages.
The virus was so toxic that it caused their hair, fingernails, and skin to fall off
Wearing respirators, protective gowns, and gloves, Simpson and Francis inspected the hospital and were horrified by their first sight of Ebola. Neither Francis nor the more experienced Irish physician, Simpson, had ever seen anything even approaching its devastation. Weak, emaciated men and women lay about the mud-and-stick chamber, staring out of ghost eyes at the white men. The virus was so toxic that it caused their hair, fingernails, and skin to fall off. Those who healed grew new skin.
The major sources of the continuing spread of the virus was funerals
They soon discovered that the major sources of the continuing spread of the virus was funerals; more specifically, the procedures – not unlike those practiced in Yambuku – used to cleanse the bodies before burial. Francis called a halt to all the funerals of Ebola victims, promising that his team would cleanse the bodies according to tribal customs. The people were outraged, and their collective anger nearly destroyed the entire WHO effort. One of Maridi’s public health doctors was the son of a powerful local chief, and with the leader’s support the people were coaxed into bringing their dead to Maridi. Francis, Simpson, El Tahir, and Brès would take the bodies a discreet distance away from public view, put on their protective clothing, gloves and respirators, and remove all undigested food and excreta from the cadavers, as prescribed by tribal custom, which entailed hand removal and manipulation of wastes without evisceration. They would also carefully remove tissue and organ samples for laboratory analysis.
At least thirty-five had died
Stopping the funeral cleansings and closing the hospital brought the Maridi epidemic to a halt, so Francis and El Tahir made their way to the even more remote town of N’zara where they found Joe McCormick’s boxed note, guiding them through the sequence of original Ebola cases. On June 27, 1976 well before the apparent onset of the Yambuku epidemic, a man who worked in the N’zara cotton mill fell ill and died on July 6 of hemorrhaging. His death was soon followed by those of two co-workers whose jobs were in the factory’s cloth room, the same site where the first man worked. By July about two factory workers each week contracted the virus. By September several workers and their friends and family members had contracted Ebola, and at least thirty-five had died.
Most of N’zara’s epidemic evolved from those liasons
Two-thirds of the subsequent Ebola cases in N’zara involved a man named Ugawa, who was comparatively wealthy because he ran a jazz club. The factory workers would spend much of their earnings in Ugawa’s club, eating, drinking, and buying the sexual favors of the barmaids. Most of N’zara’s epidemic evolved from those liaisons. And it was Ugawa who had enough money to travel to the Maridi hospital when he came down with the disease. Once his virus got into the Maridi hospital, it spread like wildfire. From the staff, the epidemic spread into the community through several generations of transmission. Later investigations would reveal that the N’zara virus was highly contagious, spreading more than eight generations from the index case. The Yambuku strain, in contrast, never spread more than four generations. On the other hand, the Yambuku virus was far more likely to kill those it infected.
By December, Webb would give the WHO team disturbing news
By November 20, 1976 it seemed the epidemic was over, the spread having halted as a result of the hospital closures and changes in funeral practices. Francis totaled up his case list: 284 Ebola cases, 151 deaths, all but four cases occurring in either N’zara or Maridi. While upward of 90% of those infected in the Yambuku outbreak died, 53% of the Sudanese cases were fatal. In N’zara the virus seemed to come from the cotton factory where nearly a thousand men worked at any given time. Blood tests showed the highest infection and death rates were among the twenty-four men employed in the cloth room. They found the cloth room heavily infested with bats, rats, cotton boll weevils, spiders, and numerous other insects. By December, Webb would give the WHO team disturbing news: none of the animal samples contained Ebola virus. Thus the origin of N’zara’s epidemic remained a mystery. The mystery of where Ebola came from would haunt most of those who had been involved in the Yambuku and N’zara investigations for years to come. The source of both horrible lethal viruses – Marburg and Ebola – remains a complete mystery.