Ebola Appears Even Stronger Than in 1976

Sister Dinarosa Belleri, an Italian nursing nun who devoted nearly three decades to serving the poor and sick here, had an unusual funeral Sunday in the sad and dusty graveyard behind the city’s cathedral.

The coffin came on a hospital gurney. The five pallbearers wore full-length green gowns, heavy plastic goggles, surgical face masks, white helmets, thick gloves and knee-high rubber boots. They nearly dropped the casket before nervously lowering it into the freshly dug grave.

Belleri, who died only hours earlier, was one of 10 who lost their lives Sunday to the feared virus that has turned this once-sleepy city into a “hot zone” of incurable disease and agonizing death. Kikwit is the epicenter of the still-spreading Ebola.

Doctors now say the virus appears even stronger than during its first outbreak in another Zairian village in 1976, when nearly 300 people died. The incubation period has dropped to only four days from at least seven then. And there is still no vaccine or cure.

“Most of the symptoms are the same as before,” said Dr. Jean Jacques Muyembe, a professor of microbiology at the University of Kinshasa who led the team that first identified the deadly virus nearly two decades ago. “But the severity of the disease is worse here. People are dying faster.”

Muyembe said Ebola already has claimed 55 lives in Kikwit and 11 in four other villages. But seven of the most recent victims were discovered dead in their homes in Kikwit, rather than in the hospital where an emergency team of 22 doctors has struggled to stop the killer virus before it spreads.

Citing rumors and reports reaching the doctors, Muyembe estimated that at least 30 more people infected or dead from Ebola lie in the mud-walled huts and tin-roofed shacks that line the dusty streets of Kikwit and climb the lush surrounding hills along the Kwilu River.

More worrying yet, Muyembe and local residents say the highly publicized quarantine on Kikwit has been so poorly enforced that people have not only fled the area on buses, bicycles and boats, but three of the early Ebola patients even escaped the hospital. Only two have been found, one already dead.

“The quarantine was not working in the hospital,” Muyembe admitted, “because the conditions were very bad.” So far, the disease has not spread to Kinshasa, the sprawling capital 370 miles to the west, or other major cities in this vast nation of 42 million. But it may be only a matter of time.

“Many people have gone away,” said Rufin Mukoso, a high school biology teacher in Kikwit. “Many of them go to Kinshasa. The older ones go to their villages.”

Even within Kikwit, controlling the disease won’t be easy, warned Sister Sophie Pepper, a nun from a British order. “People are afraid to go to the hospital now,” she said.

Photographers who entered the low-slung cluster of blue hospital buildings Sunday saw health workers dressed like the pallbearers, with protective masks, gowns and gloves. Most of the tin-roofed wards were deserted.

Gray plastic sheeting covered the windows of the Ebola isolation ward in Pavilion 3, but the doors were wide open. More than 20 patients lay on beds inside, and workers mopped blood from the floor. A front-end loader dug a trench outside for burial of the highly infectious medical waste.

Four uniformed Zairian soldiers wearing plastic gloves and carrying assault rifles soon arrived to guard the hospital gates and prevent others from entering.

Muyembe said a single doctor originally had volunteered to stay in the isolation ward to prevent others from being exposed. “After two days he got emotionally sick and came out,” he said. “Watching the people, he could not stand it.”

The Ebola virus literally eats away at internal organs, causing a horrible death by massive bleeding out the eyes, ears and other openings. Like the virus that causes acquired immune deficiency syndrome, or AIDS, Ebola is believed to be transmitted via bodily fluids and secretions, not casual contact. But little else is known.

Indeed, Muyembe said the high-powered medical specialists and sleuths now here have had no more success finding the primary carrier of the lethal disease than he did in 1976.

Back then, he said, scientists killed 100 monkeys, rats, bats and other animals captured in the jungle in hopes of isolating the vector. All tested negative. The search will be different here since no monkeys live in the grasslands around Kikwit.

“The vector of the virus we don’t know exactly,” he said. “The best candidate we don’t know. . . . Maybe it is man.”

The doctors similarly have failed to find a way to treat or prevent Ebola. Muyembe said they tried using plasma preserved from one of the few survivors of the first Ebola outbreak, hoping that the antibodies might lend immunity. Again, there was no success.

For now the 11 visiting specialists from the World Health Organization in Geneva, the Centers for Disease Control and Prevention in Atlanta, the Pasteur Institute in Paris and Doctors Without Borders in Belgium have set up a special task force with 11 local doctors to combat the disease.

A security unit, commanded by a Zairian army colonel, has helped evacuate nearby neighborhoods when Ebola victims are found and put the patients’ families in quarantine.

But Constant Manzumbo, a 40-year-old local school inspector, complained that the doctors and the government have not given nearly enough information on how people can protect themselves, other than warnings not to touch anyone who might be infected.

“It’s difficult to know who is infected and who is not,” he said. “It’s very difficult for us at the moment.”

Although aid shipments of body bags, masks, plasma and other supplies have begun to arrive from abroad, residents here have few options. A search at seven pharmacies and a clinic in Kikwit found none with simple disinfectant.

Although Ebola has hit hospital staff and health workers hardest, it “began in the city,” Muyembe said. “From the city, it spread to the hospital.”

The first known Ebola victim here, the so-called Patient Zero, was a laboratory worker identified as Kimfumu, who died April 14. He apparently contracted the disease while taking blood samples at the Kikwit hospital. But whose blood passed the virus--and whether blood was indeed the carrier--is unknown.

Kimfumu transmitted the virus to at least 12 others, including the doctors and nurses who twice operated on him. An Italian nun who treated him, Sister Floralba Rondi, later passed the lethal disease to four nuns who subsequently treated her. All have now died.

The first three--Italian nuns Daniela Sorti and Clarangela Ghilardi from the Sisters of the Poor order of Bergamo, and Eugenie Kabila, a Zairian nun from Sisters of St. Joseph order of Turin--are buried in the fast-filling graveyard. Crude wooden crosses marked with their names are stuck in the dry red dirt.

Belleri, the Italian nun who died Sunday, ran the ancient generator and the administration at the dilapidated hospital.

“I don’t know how the hospital is going to function now,” said Jacques Demestre, a Jesuit brother attending the funeral. “She was irreplaceable.”

Her death leaves only one Italian nun from her order here. Dressed in a white habit, she stared silently into Belleri’s grave Sunday as Bishop Edouard Mununu sadly intoned a prayer. Two sweating, bare-chested men shoveled dirt atop the coffin moments later in the thick tropical air.