WHO on How to Handle Ebola
N E W Y O R K, Oct. 23, 2000 -- When Belgium’s Dr. Peter Piot first analyzed Ebola microbes under an electron microscope during the 1976 Sudanese outbreak that brought the virus to the world’s attention, he found they looked like question marks. Nearly a quarter century later, the deadly virus still eludes scientists.
While scientists still don’t know where Ebola originates, experts dealing with the current epidemic in Uganda are better prepared for an outbreak now than they were in 1976. According to World Health Organization virologist Dr. Ray Arthur, Ebola control measures are “pretty straightforward.”
On Oct. 14, experts confirmed that a virus killing people around Gulu in northern Uganda was Ebola hemorrhagic fever, one of the most dangerous viral diseases known to humans. “Ugandan health officials were quick to respond,” says WHO spokesman Valeri Abermov, explaining that they immediately called the WHO and other organizations.
When a Country Calls for Help
When the call for help comes from a country experiencing an outbreak, Arthur explains, a task force is set up consisting of representatives from principal organizations in the outbreak country, such as the Ministry of Health , as well as from groups around the world, including the United Nations, WHO and the U.S. Centers for Disease Control. The task force assigns various duties to the groups, such as charging the military with the transportation of scientists and equipment in and out of the often hard-to-reach outbreak regions.
“We’re invited to assist with on-site aid and technical assistance,” explains Bernadette Burden, a spokeswoman for the Centers for Disease Control in Atlanta, Ga. Six CDC infectious disease specialists from the organization’s “Special Pathogens” branch are currently in Uganda helping to treat patients.
According to Arthur, any health worker with experience treating and containing infectious diseases can treat an Ebola outbreak. “The first step is to establish an isolation ward and implement barrier nursing techniques,” he says. Armed with “lots of chlorine,” rubber boots and gloves, masks and gowns, health officials treat infected patients and keep away visitors who, in Uganda, for example, normally provide meals for hospital patients.
Once a quarantine is established, an active surveillance team starts hunting down the disease around the outbreak area, going door to door to find those who’ve been in contact with the infected. The team monitors contacts during the two-to-three-week incubation period and takes their temperature twice a day. These healthcare workers often discover new cases of Ebola fever, which kills 50 percent to 90 percent of its victims.
Establishing contacts, like treating patients, does not require Ebola experience specifically, says Arthur, and can be done by any epidemiologist, or those scientists who specialize in understanding the cause of disease.
Working in the Field
Arthur himself has never worked at the site of an Ebola outbreak, but had his first epidemic experience with another disease in 1992 in Egypt. What makes the job difficult is adapting to circumstances outside of a lab. But controlling an outbreak in unpredictable and tough field conditions is also ultimately gratifying, he says.
The most important element of outbreak control is containment, according to Arthur, which means there’s little likelihood of the epidemic spreading to the United States. “The average citizen in Gulu is probably not going to be flying to the States,” he says. “And infection control practices [in the U.S.] are good so there wouldn’t be an explosive outbreak.”
The CDC’s Burden doesn’t know how long U.S. health officials will be in Uganda. “Nothing’s automatic,” she says. “It depends on the outbreak and the municipality or country that has contacted us for assistance.”
But even after an outbreak is contained, Arthur explains, international organizations continue to track down the Ebola virus in the hope of locating its reservoir or discerning outbreak patterns. The WHO and National Aeronautics and Space Administration have been collaborating to analyze rainfall data and satellite imagery of areas where Ebola epidemics have taken place. They are finding that outbreaks seem to occur after very dry periods during which little vegetation grows in the surrounding areas.
“There is a pattern that is recognized in the clustering of Ebola,” says Arthur, who considers this a hopeful sign in an otherwise difficult disease to crack. “Ebola remains one of the great mysteries.”
Experts dealing with the current outbreak in Uganda are not available by telephone, according to the WHO and the CDC. The outbreak in Uganda has claimed more than 40 lives so far, based on reports from local news gathering organizations.