Outbreak: From Awful Rumor to Deadly Truth

The small diplomatic community in this dismally poor capital had gathered to toast the wedding of a German envoy to a British colleague last weekend when John Yates, the top U.S. diplomat, heard “something that sounded strange.”

“It was a person from the Vatican Embassy,” recalled Yates, the charge d’affaires at the U.S. Embassy in Zaire. “. . . He told us that some Italian nuns that he knew had died. He described what happened. And the missionary doctor who was there said, ‘Ebola.’ ”

At first, Yates said he and others “pooh-poohed” the awful suggestion of the untreatable and uncurable virus. Ebola is so lethal that nine out of 10 die, so agonizing as to defy description and so terrifying that it has entered popular lore as a “doomsday disease.”

Yates first suspected something more mundane. More than 100 Zairians have died in recent weeks of shigella, which causes bloody diarrhea, but the delivery of U.S. antibiotics and other medical aid has helped stem that epidemic.

But just to be safe, Yates walked away from the party and reached for his cellular phone.

“We sat out by the tennis court at the British Embassy and called the CDC,” the U.S. Centers for Disease Control and Prevention, he recalled.

By Tuesday, the Atlanta-based CDC had received blood samples from Zaire for testing. And Wednesday it confirmed Ebola.

Health officials have now confirmed 49 dead from Ebola, including the three Italian nursing nuns, and at least 17 other cases. Some reports put the death toll as high as 57. All are in the supposedly quarantined city of Kikwit, about 370 miles east of Kinshasa, and three nearby farming towns and villages.

Reports that buses, trucks, boats and planes are still leaving the Kikwit area, however, suggest that the quarantine is only partly enforced in a chaotic country where government control is largely absent.

About a dozen virologists, epidemiologists and other determined disease detectives have now arrived from the United States, France, Switzerland, Nigeria and South Africa. In addition to space-suit-like protective gear, all brought the desperate hope of discovering where the mysterious disease came from, where it is going and, most important, how to stop it.

A U.S. Air Force plane is due to arrive today carrying body bags, surgical gowns, face masks, latex gloves and blood plasma from warehouses in Pennsylvania. The European Union and other countries are also sending supplies.

“We may do more, I don’t know,” said Yates, who used his authority to order $25,000 in U.S. aid. “We’ll do anything reasonable. . . . It’s not something you can solve by throwing a lot of money at.”

For now, doctors acknowledge that they can do little except isolate the sick and dying and ease their torment with painkillers as the apocalyptic virus literally liquefies their internal organs. Most die within days from massive hemorrhaging, with blood oozing out of eyes, ears and other orifices.

Ebola is believed to be spread through blood, vomit and other body fluids and secretions, not casual contact. But those infected with the virus become sick almost immediately and are usually unlikely or unable to spread it widely.

Partly as a result, doctors are optimistic that the worst may be over, according to Dr. Abdou Moudi, the World Health Organization representative here.

“There is a small increase (in the number of cases), but let us not be very, very pessimistic,” he said. Still, Moudi said, Ebola is so terrible and so baffling that part of the debate here now is what to do with the victims. Burning the dead is a cultural taboo in Zaire, but no one is sure if burying the corpses--even in sealed body bags inside coffins, as is now being done--won’t let the deadly virus spread into the soil and break out again.

Health officials have warned relatives of the dead not to wash or handle the corpses--and especially not to cut them open, a local funeral ritual that caused one of three prior known outbreaks of Ebola. Belgian doctors first identified the virus in 1976 in a Zairian village along the Ebola River.

Moudi said doctors believe they have found and quarantined nearly everyone who might have contracted the disease. Almost all were health workers who were infected in hospitals, presumably from the abysmally poor hygiene that is common here.

The first known patient in the current outbreak was a 36-year-old laboratory technician called Kimfumu. Doctors now believe that Kimfumu was the key carrier, the man who sparked the crisis.

Zaire’s medical director, Dr. Kipasa Manga, has scribbled a flowchart on a torn piece of lined note paper showing how the disease spread to its first 31 victims. On the crude chart, marked “Viral Hemorrhagic Fever--relationship of cases in Kikwit,” a dozen black arrows radiate from the now-dead hospital worker.

According to the chart, Kimfumu began complaining of persistent fevers in early February. He was taken to Kikwit General Hospital on April 9 with severe vomiting. Doctors operated on his abdomen the next day, then again the following day. He died April 14.

But Kimfumu infected his sister, Abimia, and nearly every doctor and nurse who had operated on him, at least 12 people in all. Among them was an operating nurse identified as Kingansi who was hospitalized for fever, severe headaches and finally hemorrhagic bleeding April 14. She died 12 days later.

Another person infected was a Roman Catholic nun from the Poverelle Order based in Bergamo, Italy. Identified as Sister Floralba, she was hospitalized the day Kimfumu died, complaining of fever and headaches. She died 11 days later.

But according to the chart, Sister Floralba was a carrier as well. Arrows point from her to nine others, including the two other nuns who died. One, identified as Clara, developed fever and nausea April 30 and died a week later. The other, identified as Sister Daniella, died Friday.

A fourth Italian nun has been hospitalized with fever and vomiting since May 1.

Another of the victims linked to Kimfumu, a nurse anesthesiologist identified only as Mubiala, died April 26. But she too was a carrier, infecting nine others, according to the chart. Three are already dead, including two doctors.

Ebola is only the latest bout of misery for Zaire’s 42 million people. The vast equatorial country is a hothouse for nightmarish maladies.

AIDS is epidemic here. But simple infectious and parasitic diseases cause half of all deaths in Zaire, compared to 1.5% in the United States. And four out of five of the dead are children under age 5. Pervasive malnutrition exacerbates the dangers.

Malaria is endemic and growing. Sleeping sickness spread by tsetse flies, river blindness and other dangerous diseases are widespread. So are easily preventable and curable diseases such as measles, tetanus, polio and leprosy.

But the public health system has virtually collapsed under the staggeringly corrupt government of President Mobuto Sese Seko, who has terrorized and looted the impoverished country since taking power in 1965.

Diplomats say Mobuto has billions of dollars in overseas bank accounts from diamond smuggling and graft, while a country with enough arable land and hydroelectric potential to feed and power the entire continent has been reduced to one of the world’s poorest nations.

The United Nations estimates that only half of Zaire’s population has any access to health care. Even that care is meager at best. Most hospitals have little or no medicine, clean syringes, bedsheets or other basic supplies. Nurses and doctors commonly demand payment from poor patients or their families before changing a dressing or administering a drug.

The public sector has largely ceased to work. A visit to the Ministry of Information found an 18-story building with empty offices, broken windows and water flooding the lobby.

Soldiers survive by preying on a frightened populace. Money is meaningless; inflation last year hit 8,500%.

Kinshasa, the capital, is defined by decay. With no electricity in most areas, small fires eerily light the potholed streets at night. Trash heaps and the homeless line sewage-filled ditches. And there is no real rule of law in the city of 4 million.

Yates, the U.S. diplomat, says he isn’t surprised at the intense outside interest in Ebola--and the fact that foreign journalists here now seem to outnumber its victims.

“Unknown things are frightening,” he said. “The movie and popular books haven’t helped. People were worried about a pandemic. They were afraid of the unknown.”

Yates said he has no plans to see the new Hollywood thriller “Outbreak,” the story of brave American doctors desperately fighting an outbreak of a killer disease that originated along a river in Zaire.

“Why should I see the film?” he asked with a laugh. “I’ve seen the real thing.”