We had just landed in
Conakry, the capital of Guinea. In the fields right outside the airport,
a young woman was in tears. She started to wail and shout in Susu, one
of the 40 languages spoken in this tiny country of 12 million people.
The gathered crowd became silent and listened intently.
The young man sitting
next to me quietly translated, although I already had my suspicions. He
told me the woman's husband had died of Ebola, and then quickly ushered us away.
Sanjay Gupta explains Ebola virus
How the Ebola outbreak began
It is probably not
surprising the airplane bringing us into Conakry was nearly empty, as
are all the hotels here. Not many people in the United States have ever
visited Guinea, or could even identify where it sits in West Africa. It
is already one of the world's poorest countries, and the panic around
Ebola is only making that worse.
Some of it is justified.
That's because this time, the outbreak is different. In the past, Ebola
rarely made it out of the remote forested areas of Africa.
Key to that is a grim
version of good news/bad news: because Ebola tends to incapacitate its
victims and kill them quickly, they rarely have a chance to travel and
spread the disease beyond their small villages. Now, however, Ebola is
in Conakry, the capital city, with 2 million residents. Equally
concerning: it's just a short distance from where we touched down, at an
international airport.
It has gone "viral," and now the hope is that it doesn't go global.
When I asked doctors on
the ground about that scenario, they had split opinions. Several told me
the concern is real but unlikely. Most patients with Ebola come from
small villages in the forest and are unlikely to be flying on
international trips, they told me. Furthermore, they don't think Ebola
would spread widely in a western country; our medical expertise and our
culture -- not touching the dead -- would prevent it.
Others aren't so sure.
No one wants to test that theory.
With Ebola, there is an
incubation period of two to 21 days. Remember these numbers. This is the
range of time it takes to develop symptoms after someone has been
exposed.
With an international
airport close by, that means you could be on the other side of the world
before you develop the headache, fever, fatigue and joint pain which
make up the early symptoms of an Ebola infection. The diarrhea, rash and
bleeding come later. Hiccups is a particularly grave sign with Ebola.
It means your diaphragm, which allows you to breathe, is starting to get
irritated.
There is a lot we know about Ebola, and it scares us almost as much as what we don't know.
We do know Ebola, a
simple virus with a small genome, is a swift, effective and bloody
killer. The mortality rate is higher than 50% and in some outbreaks
reaches 90%.
Ebola appears to kill in
a clever way. Early on, it strategically disarms your immune system,
allowing the virus to replicate unchecked until it invades organs all
over your body. It convinces your blood to clot in overdrive, but only
inside your blood vessels. While those blood vessels choke up, the rest
of your body starts to ooze because the clotting mechanisms are all
busy.
You start to hemorrhage
on the outside of your body. Nose bleeds, bruising, even a simple needle
stick will refuse to clot. But, it is the bleeding you don't see -- the
bleeding on the inside -- that causes even more catastrophic problems.
Many patients die of shock, within an average of 10 days.
Ebola outbreak: History of a killer
Photos: Ebola outbreak in West Africa
It sounds like the stuff
of horror movies. But despite the real danger, Ebola is not at all easy
to "catch." If it were, my wife would have refused to let me come in
the midst of an outbreak.
To become infected, you
generally need to spend extended time with someone who is gravely ill,
and come into contact with his or her infected body fluids. That's why
family members and health care workers are the most likely to get sick.
Over the last three weeks, at least 112 people have died, including 14 health care workers.
With some infections,
you can shed and spread the virus long before you get ill. That's not
the case with Ebola. It's only after you are sick and feverish do you
become contagious. However, it only takes a miniscule amount to infect
and kill. A microscopic droplet of blood or saliva on your bare hand
could enter through a break in your skin. And, whether you realize it or
not, we all have breaks in our skin.
Since I was a kid, I
have been fascinated with outbreaks. I learned in medical school that
new pathogens generally make a jump from animals to humans, a process
called zoonosis.
This is happening in
areas where human and animals come into continuous contact. David
Quammen refers to it as "Spillover," in his book of the same name. A
stew of ducks, geese, chickens, pigs and humans in southeast Asia led to
the spillover of avian flu, H5N1. Contact between pigs and humans in
Mexico led to swine flu, H1N1; pigs and fruit bats were the recipe for
Nipah fever in Malaysia.
The best guess is that
fruit bats may be a natural reservoir for the Ebola virus too, but this
has not been confirmed. Quammen makes the point: Ebola didn't enter our
world -- we entered its world.
Pathogens can be
predators, like lions, tigers and bears. A virus may not plan the way a
big cat does, but in a sense it stalks its prey -- waiting for the
moment of opportunity, then attacking with fury. Because it can lie
silent for years, it's also easy to see Ebola as a killing ghost, like
Jack the Ripper.
Presumably outbreaks
begin through some human-animal contact, but since that contact is
ongoing we don't know what it is that leads Ebola to rear its ugly head.
We don't know how to treat the illness or vaccinate against it. We
certainly don't know how to cure it.
I thought about all of
this as I left that woman in the airport, and I have thought about her a
great deal since then. Her grief made an impression on all of us.
It also made this
mysterious, exotic virus the world knows, but doesn't fully understand,
so much more real and frightening. For the next 21 days (the outer range
of the incubation period) the woman we saw will be monitored for a
fever or any early signs she may have contracted Ebola from her husband.
If she exhibits symptoms, she will be isolated and treated with fluids,
oxygen and nutrition.
That is all that can really be offered. Again, there is no cure for Ebola.
For her neighbors, in
Guinea and across its border, another critical number is 42 -- as in 42
days, or two incubation periods. If the health care teams here don't see
any new cases during that time then they officially say the outbreak is
over. We are not there yet, not even close.
The clock is ticking.
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