Cabinda, that isolated one in the north, and all of the provinces between Carmona and Luanda are the affected ones.
Posted on 04/12/2005 4:04:57 AM PDT by Mother Abigail
In Angola's Teeming Capital, a Suspected Virus Carrier Dies Alone
By DENISE GRADY
UANDA, Angola, April 11 - Bonifácio Soloca, 61, was alone when he died here Monday evening at Américo Boavida Hospital, in an isolation unit for patients suspected of being infected with the Marburg virus. He was admitted on Saturday, the unit's first patient, and never saw his family again. While doctors and nurses disinfected his lifeless body, his wife stood outside a fence on the grounds, waiting patiently for someone to come and get the dinner she had brought him.
The prospect of the Marburg virus spreading through this teeming capital city, with four million inhabitants and an international airport, inspires dread among health officials. Though the virus does not spread through the air like influenza - Marburg requires contact with infected bodily fluids - health officials believed Luanda had to be prepared for the worst.
So Doctors Without Borders created the isolation unit here, with room for 30 to 40 patients, by clearing out a building that had formerly been an H.I.V. clinic.
The few patients who have turned up in Luanda contracted the disease about 180 miles away in Uíge, the province at the center of the outbreak, and are not thought to have passed it one to anyone else. It is not known whether Mr. Soloca had the Marburg virus - one blood test was negative, but a second must still be done. He was admitted because he had some Marburg-like symptoms - fever, and blood in his urine and vomit - and he might have been exposed to the virus while being treated for malaria at another Luanda hospital where a Marburg patient had died. Because of that, his doctors said, they had to treat him as if he did have the virus.
Once in the isolation unit, Mr. Soloca probably received less medical attention than he would have gotten had he been on a normal ward where doctors and nurses could easily look in on him on the spur of the moment, without having to put on layer upon layer of protective gear first.
Relatives were discouraged from visiting because the precautions needed to enter are so arduous. Anyone who goes in must spend a half-hour or more suiting up in surgical scrubs, overalls, rubber boots, a hood, goggles, and double masks and gloves.
Keeping the family away poses a hardship for patients. Hospitals do not provide meals or much nursing, so patients depend on their families to bring food and take care of them. Mr. Soloca's family brought his meals to the hospital, but he spent much of his time alone.
Doctors and nurses generally suited up and visited him as a group three times a day, once during each of three daily shifts, and stayed in the room for an hour or two each time - as long as they could stand to wear the stifling suits. The rest of the time, he was by himself. There were no monitors. He had lost control of his bodily functions and often lay in his own wastes between their visits.
Dr. Benjamin Ip, a Doctors Without Borders volunteer from Las Vegas who had spent hours tending to Mr. Soloca the day before, emerged from the unit looking troubled after the man's death on Monday. Earlier in the day, he said, he had considered starting an intravenous line but did not, because it would increase the nurses' risk of being exposed to Mr. Soloca's blood or stuck by a contaminated needle. "I don't know whether it would have made a difference," he said. "It's a fine line to balance care for the patient and risk to yourself."
A psychiatrist walked Mrs. Soloca to a tent used for counseling, to tell her that her husband had died, and to explain that the family would not be allowed to claim his body. Rather, it would be buried in a special cemetery designated by the Ministry of Health for Marburg victims.
But the doctors said one important custom would be respected. When someone dies in Angola, tradition says it is essential that the family see the person's face, to know for sure that their loved one is dead. So, in the dark, Dr. Ip and an assistant, in full protective gear once again, carried Mr. Soloca, zipped into two body bags, to a patch of bare dirt outside the isolation unit and set him down on the ground.
The bags were open just enough to reveal his face, and the doctor shone a flashlight on it. Mr. Soloca's wife and sons and his priest looked at him from the other side of a fence, said a prayer and left. In a few days, they will learn whether he had the Marburg virus.
That's but one of many nightmare scenarios.
Another 361 have been found who look like they have it, and they won't get the tests back until they're probably dead, anyway.
So, we're well on our way to over 500 fatalites, and the question is, how many people have it who are not under observation?
The extremely high bar set for confirmation of suspect deaths as Marburg deaths is giving a false sense of security. If we even take the lowest numbers as accurate, this outbreak is alarming in its implications for Africa.
If, as seems clear, WHO has grossly underestimated the number of deaths, then worldwide outbreaks are inevitable.
Whether they can be contained when they appear is questionable.
This could easily spread to a country like Cuba.
Cabinda, that isolated one in the north, and all of the provinces between Carmona and Luanda are the affected ones.
In this case, it isn't the media who are giving false numbers, although you have to wonder why the people who write these articles show so little curiosity or common sense.
It's the WHO, and Angolan authorities, imho, who are suppressing the numbers to "confirmed" cases--that would be cases where samples are collected under less than ideal conditions, degraded by long transport times to the US CDC, and showing many false negatives.
I suspect WHO is doing this for a reason, what, I do not know. To prevent worldwide panic? To make themselves seem important? To get money from the US while they pretend the money can be used for something other than isolation containment?
What's the deal, here? Is there no Angolan authority, to address this? What is the strategy? If it's "education" and pamphlets, as someone posted, then good bleeping luck.
Note the major road swinging south from Uige to Luanda. Also not the lack of major roads to the isolated province of Cabinda (NE) leading one to wonder how the virus was transported there. Cabinda also has coffee plantation in the north as Uige does. Traffic between the two areas may account for the cabinda incident. If that occurred via coastal freighters picking coffee we may see a problem elsewhere within a few weeks. Another thing, Uige has been mentioned as the point of origin (maybe not ground zero but close enough). What we don't know is if the outbreak was in Uige city or elsewhere in the province with news being posted from Uige.
Which by the way is pronounced Whee-zh. 
see my 32 for large political map
Thanks for a very informative post.
"By the end of December, at least 95 children were dead, local health workers say. How many deaths were Marburg-related is unknown, but the numbers were alarming."
Is there any reason why this initially would have struck down kids in such large numbers? Or was it just a coincidence that it started in a pediatric ward and now has spread out into the population at large?
As many have already pointed out, we have very sketchy data from which to infer the growth of this bug.
However, considering the nominal growth rate of 9 days per e-fold, we would expect about 400 confirmed cases (cumulative, but not deaths) by this Friday or so. It seems it is about on track.
Fortunately, this effect seems to be a basic constant. Therefore, although we cannot know exactly the absolute number of Marburg cases, this error will not affect the growth rate of the epidemic. That is, the 9 day efolding time calculation would not be affected (to lowest order).
As much as I have been able to glean these are the med groups involved:
WHO (are these actually Drs or just pols?)
Medicins sans frontieres
CDC team
and a reported South Africa specialist on the way
Thanks for putting all these stories in one place. Sounds like it's not going to be 'under control' any time soon. How sad. The pale horse is riding...
They said 361 people across the country were under observation for the virus
That's a very broad statement which can't be reassuring to the local population hoping that the virus is isolated around Uige.
Africa is probably the very worse place this could happen.
There is somewhat of a culture of death in Africa, I imagine ninety percent of the people there have seen dead bodies, it is not something unusual.
And the extreme poverty, the wars, the near total absence of sterile procedures, the culture that passes food and drink from hand to hand to hand.
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