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Reduced Admissions in Uige Signals Spread of Marburg

Recombinomics Commentary

April 11, 2005

>>  Despite incessant warnings on local radio that families of the sick should neither treat them at home nor touch corpses, Pinto's family cared for her in their house and prepared her body for burial. The virus is spread by bodily fluids, and even stray drops of spittle or beads of sweat can lead to death.

"We heard on the radio that we were not supposed to do it, but out of emotion, we touched the body," said her husband Antonio, 53. "We washed her when she was alive and after she died."

He also knew about the isolation unit set up at Uige's regional hospital, where Pinto had worked for 20 years. But he refused to take her there, he said, because "people believe the isolation unit is making people die."

Cases like this, epidemiologists here say, show how much remains to be done in Uige before the Marburg virus is contained. But Dr. Nestor Ndayimirije, an epidemiologist and leader of the World Health Organization's efforts in Uige, said that he believes the battle is making headway.

"If we compare with previous weeks, when we had 10 to 15 cases a day, now we have four to five cases a day," <<

The above comments related to a nurse who died in Uige on Thursday demonstrate why there has been a recommendation that the main hospital in Uige be closed.  It would seem that cases at the hospital were arriving at the rate of 10-15 per day.  Since there are currently only 12 cases alive in the hospital, 10-15 cases were dying per day.  There are no reports of any survivors, so it does not take very long for people to realize that going into the hospital is a death sentence.

Thus, the family (including six children) of a pediatric nurse at the hospital refused to take her to the hospital for care and isolation.  Instead the entire family was exposed to the Marburg virus in spite of warnings broadcast by radio.  The number of cases coming into the hospital is down, but the drop is due to patients dying at home or moving out of the area.  Several weeks ago there were no reported cases outside of Uige.  Now there are reported official deaths in 6 other provinces.

When Marburg was identified and announced on March 23, the difference between the number of patients diagnosed and number dead was 7 (95 out of 102 had died).  Now the differential has been reported to be as high as 30.  This differential reflects the number of confirmed newly admitted cases. The actual number of cases is much higher.

The drop in the number of admissions at the main hospital in Uige is not an indication that the infections in the country are declining.  It merely reflects the fact that no one entering the hospital in Uige infected with Marburg virus has come out alive, even though over a hundred patients have been admitted over a 1-2 week period.

Thus, the reduced number of admissions, like the increase in number of patients alive, does not represent progress.  The numbers simply represent a lack of confidence in the ability of the treatments in the hospitals to save lives, and an increase in newly diagnosed cases.

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