Dr. Stephen Ssesanga thought he was doing just another routine check on a newly admitted patient at the hospital in Bundabigyo, in western Uganda. The man was unable to hold food down, had a very high fever and was having problems breathing and talking. "It seemed to me to be a textbook case of Ebola," says Ssesanga, the hospital's chief medical superintendent, "but I couldn't tell for sure." The man died a few days later, on Nov. 27. Last Friday health officials confirmed the reason for Ssesanga's doubt: a new strain of the deadly Ebola virus is spreading through Uganda. Ssesanga's patient, it seems, had contracted the disease, and the symptoms didn't exactly correspond to known forms of Ebola that caused trouble in the past. By then Ssesabga had a bigger problem: he had contracted the new Ebola virus.
Ssesanga, who's been battling the disease for the past week, has almost regained his strength and appetite. Of eight other medical staff members in his hospital who have become infected with the virus, three have died. "They were all buried today," Ssesanga said, though he was unable to leave his quarantine to pay his respects. Funerals, Ssesanga says, are too dangerous in western Uganda right now.
In the last week an outbreak of a new strain of the Ebola virus has ravaged villages across the rural districts of western Uganda. As it has spread, the outbreak has plunged Uganda into a health crisis and put the entire Great Lakes region, from Rwanda to Kenya, on high alert. Ebola II is the fifth strain of the virus since its discovery near the Ebola River in the Democratic Republic Congo, in 1976. Some scientists think the new strain of Ebola may be a milder form than earlier strains, which is not necessarily good news—the high mortality rate has previously helped keep transmission levels low, as infected people got sick and died before they could infect too many others. A mild version of Ebola could, in theory, spread more effectively through populations—though health officials are quick to say that there's no solid evidence that this strain is spreading more quickly than past outbreaks.
The current outbreak was first reported in western Uganda in late August, but because of a variety of logistical and clinical difficulties, not the least being that many locals consult herbalists and traditional healers rather than medical practitioners, confirmation was slow in coming. As of now, with 33 reported dead out of a total of nearly 71 infections in the epicenter Bundabigyo district, the virus appears to have a considerably higher survival rate than the four prior strains. Officials from the U.S. Centers for Disease Control emphasize that the data are not conclusive. To confirm the mortality rate, doctors must make further study of patients in the field. Only when that work is done, weeks from now, will they be able to characterize the new strain.
Ugandan officials have refused to comment on how the current outbreak got started, and epidemiologists from the CDC and World Health Organization are actively working to pin down the source. According to a number of other Ugandan and foreign doctors with clinical knowledge of the outbreak, the present consensus is that this strain originated in a monkey killed and eaten by a Ugandan man and his family in the highland village of Kyiko, near the Congolese border. The hunter and four of his 14 family members, battling high fevers and extreme nausea, sought care at a government-run hospital, where medical workers, puzzled by their symptoms, treated them for food poisoning.
The eating of monkey and "bushmeat" is an accepted tradition throughout the eastern Congo—monkeys, dead and alive, are sold in markets for consumption. But because the practice is prohibited in Uganda, people tend to deny it. The hunter's claim that he had become sick from consuming infected goat meat, which is considered to be an unlikely carrier for Ebola, certainly didn't help health workers identify the disease.
Like other cases, this Ebola II strain has an incubation period of up to 21 days before an infected person experiences symptoms. Earlier Ugandan health ministry inquiries into a so-called "mystery" virus in western Uganda spawned speculative diagnoses of the Marburg virus, a feared hemorrhagic fever similar to Ebola that was successfully contained after an outbreak among Ugandan mine workers last July. Ebola is not airborne, but rather passes through contact with bodily fluids or skin. Studies have shown that in the past it has spread to humans from contact with wild chimpanzees, antelope and gorillas, according to analyses of cases in the Congo, Gabon, and Sierra Leone. And with 13 different primate species, the Bundabigyo region of Uganda has the most variation of primates on earth.
Allegations that the government intentionally concealed the outbreak have swirled through newly beautified Kampala since the announcement of the new Ebola strain last week. Today the state-run New Vision newspaper lashed out against the ministry of health for mishandling the situation, blaming the deaths and new infections of medical staff on the lack of readily available protective gear and underfunded hospitals in the outbreak region.
Dr. Jakson Amone, a senior health ministry official in Bundadisgyo, is concerned about the possibility of the new strain of Ebola spreading across the rest of Uganda and into its relatively populous capital, Kampala. "It's hard to treat something you've never seen before," he says. A task force of local doctors and specialists from the CDC, the World Heath Organization and Doctors Without Borders as well as local and international NGOs are working around the clock to contain the outbreak. "We have plenty of manpower on the ground now. We are going village to village looking to find and isolate new cases," says Amone. A dramatic rise in the number of reported infections in the coming days, he suggests, could be the result of better surveillance and monitoring.
For Dr. Ssesanga, who's anxious to get back to his hospital when he's fully recovered from his bout with the disease, fear and panic are the greatest enemies to containing the outbreak. With more cases confirmed each day, doctors and civilians are staying away from the hospital. As of this morning the usually crowded maternity ward at Bundadigybo was empty. Dr. Scott Mehyre, an American missionary doctor who runs a health clinic in a neighboring village, is down to only three doctors working in shifts clad in isolation suits. "This virus is spreading by the foot of the hills," Ssesanga says, referring to the many people who may be affected but are trying to flee the region. "Running away is the worst thing people can do now."