Hiccups Were The Clue That Led Researchers To Ebola
The Ebola virus had been circulating in Guinea for roughly three months before doctors and international aid organizations finally detected it.
It was hiccups that eventually gave it away, journalist Jeffrey Stern wrote in Vanity Fair this weekend.
To find out why the virus eluded detection for so long, Stern went to Meliandou, a remote Guinean village where Patient Zero is thought to have lived, to investigate.
Ebola, he writes, isn't easy to diagnose in its early phase.
"Most of us think of Ebola as sort of the cinematic portrayal of it — you know, bleeding out of the eyes and ears," Stern tells NPR's Audie Cornish in an interview today on Morning Edition. "That happens, but it doesn't always happen, and it doesn't happen until the later stages of the virus."
In the early stages, he says, symptoms can look a lot like cholera and malaria. And since Guinea had never experienced Ebola, no one knew to look for it — not even people in the medical community.
"We tend to think of Ebola as a generally African scourge, but the last real outbreak had been more than 2,000 miles away," he stresses. "And it might as well have been another world for the people in the forest region of Guinea."
Then Dr. Michel Van Herp, an epidemiologist with Doctors Without Borders, noticed something odd. Half the patients listed on a medical report from Guinea had the hiccups.
"Hiccups is something that's associated — for reasons we're still not entirely sure of — with hemorrhagic fever, but especially with Ebola," Stern says.
Once they pinpointed the culprit, he says, aid organizations like Doctors Without Borders and the World Health Organization had an incredibly fast response — almost too fast. Health care volunteers were immediately sent in to track contacts and set up isolation wards, but public communication couldn't keep up with the efforts.
That led to resistance among the locals, who had never heard of Ebola until health care workers in big yellow Tyvek suits started coming to their villages and taking away their ailing loved ones.
In the most extreme cases, Stern says, "you heard stories of villages throwing stones at health workers." On a less spectacular level, the mistrust kept health workers from identifying possible cases. People were reluctant to tell volunteers if they had been in contact with an infected patient.
"So if we don't know, then it becomes very difficult to do what is actually a very straightforward process, which is isolating infected patients and tracking their contacts," he explains.
It was also difficult to get patients to come to clinics. The public health messages emphasized that 90 percent of Ebola patients died, although Stern notes that in this outbreak, the fatality rate is in fact lower. But the 90 percent figure stuck.
He says that those who had Ebola would think, "If it's 90 percent mortality anyway, I would rather die in the comfort of my own home, with my family around me, than in some place with people who I can't even really see their faces."
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Transcript
AUDIE CORNISH, HOST:
Today President Obama announces new U.S. assistance for West African nations grappling to contain the deadly Ebola outbreak. The new aid will include 50,000 medical kits, training for hundreds of health workers and the deployment of some 3,000 U.S. military personnel to help with containment efforts in the region.
DAVID GREENE, HOST:
Let's remember this outbreak began six months ago. It's believed to have started in a poor, remote village in the forests of Guinea and quite close to the boarders of Liberia and Sierra Leone, two other countries at the center of the pandemic.
CORNISH: In an article in the current issue of Vanity Fair, reporter Jeffrey Stern writes about traveling to the village to try to learn how the outbreak began and why it's been so hard to stop. He began by telling us the story of the person believed to be Patient Zero, a 2-year-old boy who may have been infected by a bat.
JEFFREY STERN: At the small community where the houses are in very close proximity to one another. And in this case, what seemed to have happened is the child was brought to his grandmother's house by his mother after some kind of family dispute...
CORNISH: And she was pregnant.
STERN: She was pregnant. There was another child, and there was a houseguest. And of course there was her own mother. So it was a group of people in even closer proximity than they tend to live. And this is when the child's symptoms really began to present and the infection really began that way.
CORNISH: In part because there was a funeral, correct?
STERN: Well, there were several periods throughout the beginning of the outbreak where funerals were jumping-off points. There was a doctor, later, who became sick and was brought to a city of about 100,000. And this was before, of course, anyone had any idea what it was. And during his funeral - and this is again a part of the world where laying on of the hands and very intimate contact with the deceased is pretty common. And at the later stages of the virus, it can bubble up through your sebaceous glands and be in your sweat and be in your fluids. And the body can remain hot, as they say, for a few days. And so there was a whole branch of the outbreak that started - at - from a funeral.
CORNISH: Now, there were people, including the grandmother of this little boy, who actually went to see a nurse, see a friend - right? - who reached out to the medical community. But you say that the disease can be misdiagnosed for several reasons. What are some of those reasons?
STERN: Well, a lot of the symptoms don't look as spectacular as we tend to tend to think Ebola is. I think most of us think of Ebola as the kind of cinematic portrayals of it - you know, bleeding out of the eyes and ears. That happens, but it doesn't always happen. And it doesn't happen until the later stages of the virus. And the early stages of the virus can look like Cholera. It can look like Malaria.
And it's also important to remember that this is a part of the world with no experience with Ebola. I think we tend to think of, you know, Ebola as kind of a generally African scourge. But the last real outbreak had been more than 2,000 miles away. And it might as well have been another world for the people in the forest region of Guinea.
CORNISH: Once the WHO and epidemiologists determined that it was Ebola, you say something interesting happened, which is that they had a fairly rapid response. You interpret this as being too rapid.
STERN: Yeah, I mean, the response was incredibly fast, and that's necessary. I mean, I don't know, if we could have done it all again, what we would've done differently. You want people on the ground immediately, tracking and containing the outbreak.
But what ended up happening is that public communication didn't quite keep up with the response. And so you ended up with a lot of times in these villages - villages that would go on to become what we would call recalcitrant villages, meaning they were resistant to the efforts of aid workers in the medical community - that had never heard of Ebola until there were people in these big, yellow, Tyvek suits, you know, trundling into their communities in SUVs trying to take away isolated patients.
CORNISH: How did that play out in terms of treatment and containment?
STERN: Well, it played out in a few different ways. In the most extreme ways, you heard stories of villages throwing stones at health workers. In the village that I went to in Meliandou where it began, they were very open to help. But they lived behind three or four other villages by a single track road that were recalcitrant and that actually destroyed a bridge.
But even on a much less spectacular level, in order to track and contain an outbreak like this, it's really important that you know who has had contact with an infected patient. And if you are not totally trusting of this new community that has descended upon your world, then you might be a little bit resistant to saying, well, yeah, I - you know, I hugged so-and-so two weeks ago right when he was infected. So if we don't know, then it becomes very difficult to do what is actually a fairly straightforward process, which is isolating infected patients and tracking their contacts.
CORNISH: Jeffrey Stern, thanks so much for talking to us.
STERN: Thank you. It was good to be here. Transcript provided by NPR, Copyright NPR.
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