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Experience from the trenches in the first Ebola outbreak

512px-Ebola_virus_emNoted infectious disease expert Donald Francis, MD, PhD, was "a quiet doctoral student" at Harvard when he was called in to fly into the remote bush of southern Sudan in 1976 to help with one of the world's first documented outbreaks of Ebola. The federal Centers for Disease Control and Prevention dispatched him for a two-week assignment that stretched into two months, as he saw villages demolished by the virus and helped bury some 274 bodies, he told a group of 70 science writers earlier this week in San Francisco.

Like today's epidemic in West Africa, most people who contracted the disease were caregivers, either at home or at the make-shift tent hospital, or people assisting at funerals, where bodies were literally dripping with blood, he said. A single drop contains many thousands of viral particles, so all it took was a simple scratch of the nose with a contaminated finger to become infected.

Remarkably, none of his team members became infected, though they took risks, including storing viral samples in unsafe vials, and flying in and out of the treatment area when they were supposed to be in quarantine, he said.

Unlike today's epidemic, the outbreak burned itself out because it took place in the remotest of areas.

"This was a very good place to control an outbreak - very rural, very isolated," said Francis, co-founder and executive director of Global Solutions for Infectious Diseases.

Francis is the former director of the CDC’s AIDS Laboratory Activities and was among the first to suggest that AIDS was caused by an infectious agent. He has worked in epidemics around the world and helped eradicate smallpox from Sudan, India and Bangladesh before he became involved in the AIDS epidemic.

But his early work was in Ebola. During that first outbreak in Sudan, his five-member team worked with local nurses, some of whom were sickened by the virus but recovered. "I had patients who were so sick that the whole skin of their feet would slough off," he said. And though the survivors were in a weakened state, losing as much as 20 percent of their body weight, they were determined to continue caring for their fellow villagers, he said.

He said today’s epidemic in West Africa presents a number of “worrisome challenges,” as it is occurring in a part of the world beset by political and social chaos.

"You have social chaos, socio-economic lack of resources, and hospitals that are just set up for transmission of the virus," he said.

He said Ebola "can be controlled, but once it becomes so broad (as is currently the case), you lose that capability." He expressed little hope that the current epidemic could be contained anytime soon: "I expect it will play out very badly for at least a year.”

Previously: Ebola: A look at what happened and what can be done,  Dr. Paul Farmer: We should be saving Ebola patients, Ebola panel says 1.4 million cases possible, building trust key to containmentShould we worry? Stanford’s global health chief weighs in on Ebola and Biosecurity experts discuss Ebola and related public health concerns and policy implications
Photo by CDC/ Dr. Frederick A. Murphy

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