DEADLY BUT SELF-LIMITING

Horrifying as it is, the outbreak of the Marburg virus in Angola probably won’t explode into a mammoth pandemic like the bubonic plague or black death of the Middle Ages or the worldwide pandemic of the flu in 1918-1919.

This tentative conclusion seems to be reflected in the cautious wording of a “Travelers’ Health” advisory just updated by the United States Centers for Disease Control and Prevention. The CDC so far has recommended no U.S. travel restrictions. It said the likelihood of contracting Marburg fever or related ebola fever was “considered extremely low unless there has been travel to the affected area and direct contact with the blood or body fluids (e.g., saliva, urine) of symptomatic infected persons or animals, or objects that have been contaminated with body fluids.”

Paradoxically, the reason for this relative optimism is the very deadliness of the outbreak in Angola. An Internet Web site that provides up-to-date scientific information, cbwinfo.com, says that the fever’s “rapid onset, poor transmissibility through air, and high lethality make it strongly self-limiting. Affected areas and individuals can be quarantined and contamination controlled by strict application of barrier nursing practices.”

The outbreak quickly spread out of control in the remote provincial capital of Uige because of a delay in diagnosis and a shortage of doctors and other health workers. Many of the early victims were children in a pediatric hospital ward were the first child’s illness was thought to be malaria. And doctors and other health workers have been among the early victims.

Fear and ignorance gave the local epidemic a head start, even after outside medics from the World Health Organization and Doctors Without Borders arrived with the necessary equipment and knowledge of the disease. Terrified Uige residents stoned WHO vehicles and sometimes hid patients at home rather than getting them to the hospital. The disease thus spread through families and neighborhoods and quickly claimed close to 200 fatalities.

Barrier nursing practices are now in place. Medics must wear protective masks, gowns, gloves, goggles and slippers and keep a few feet from a patient to avoid even a droplet of saliva, sweat, blood, urine or vomit. Some try to rotate out after two weeks, for fear of neglecting necessary protective measures.

Although medical authorities don’t yet claim to have the outbreak under control, they are clearly heading in that direction. The virus has not yet spread to the Luanda, the Angolan capital.

While there is no occasion for worldwide panic, the rest of the world must help the African victims and practice precautions to prevent further spread of the disease.