The virus first makes its presence felt when the victim runs a high temperature, followed by vomiting, chest pains and skin rashes. Then hemorrhaging develops - from the eyes and ears, the stomach and the bowels. There is no vaccine that can ward off the disease - and, once someone is infected, death usually follows within days. In the past 19 years, strains of the Ebola virus have emerged three times to ravage African populations. Last week, doctors were working desperately to control a new outbreak in the central African nation of Zaïre. The virus triggered panic: as the death toll rose at the general hospital in the administrative and commercial city of Kikwit, medical staff and patients fled, prompting government officials to quarantine the city of about 500,000 people. In Geneva, officials of the World Health Organization put the death toll by week's end at 48, including three Italian nuns who worked at the hospital. Another 17 patients were infected, and new cases were turning up at the rate of about six a day. "About half of those infected are not going to make it," said WHO spokesman Thomson Prentice. "We're going to see more deaths."
As American, European and South African medical teams arrived in Zaïre to battle the disease, authorities in Canada and other countries took precautions against a frightening, but remote, possibility - that someone infected by Ebola might carry the virus to other population centres. Officials in Ottawa alerted provincial medical authorities of that risk, but said the possibility of the Ebola virus spreading to Canada was small. Foreign Affairs officials said that about 400 Canadians are currently in Zaïre - and two were believed to be in the Kikwit region. But even if an infected traveller reached Canada, Ebola is not highly infectious: most experts believe that it can only be transmitted by contact with blood or other bodily fluids. "This is a devastating disease," says Ron St. John, a senior adviser at Ottawa's Laboratory Centre for Disease Control. "But as far as we know, it is not one that can be casually transmitted."
The latest outbreak surfaced first in Kikwit's 350-bed hospital. Within days, WHO officials arrived in the area and arranged to send blood samples to Atlanta, where scientists at the U.S. Centers for Disease Control and Prevention (CDC) confirmed the presence of Ebola virus. Meanwhile, the spectacle of death unfolding in Kikwit general hospital - where conditions, according to European experts, are primitive - set off an exodus of medical staff and patients. Some of the patients later turned up at another Kikwit hospital and at hospitals in nearby towns. Prentice said who teams in the area were working to "upgrade sterile conditions and improve the provision of care" in the Kikwit region, an agricultural area about 400 km east of the Zaïrese capital of Kinshasa.
Scientists still know relatively little about Ebola, or where it comes from - though some experts say that it may be carried by monkeys in the central African rain forest. Ebola is part of the family of philoviruses that first surfaced in 1967 when seven employees of a firm in Marburg, Germany, died after being infected by monkeys imported from Uganda and Kenya for pharmaceutical purposes. Ebola itself was first identified nine years later when about 800 villagers succumbed to an infection that struck along the Ebola River, about 1,000 km north of the Kikwit region. In 1979, two more outbreaks of similar viruses killed hundreds of people in Zaïre and neighboring Sudan.
The horrific possibility of Ebola spreading death in North America was underscored by author Richard Preston's best-selling nonfiction book The Hot Zone, which described a 1989 outbreak of a similar virus among imported monkeys at a laboratory in Reston, Va. As it turned out, the Reston strain was harmless to humans. But Preston's book served to heighten awareness of Ebola - as did the movie Outbreak earlier this year, in which scientists battle an Ebola-like virus that is killing people in a small California town.
The Kikwit outbreak reignited controversy over a $5-million Ontario government laboratory in the Toronto suburb of Etobicoke designed to study high-risk viruses. The so-called Level 4 containment facility, which was due to open last Christmas, was put on hold after protests by local residents. A provincially appointed committee now is studying the issue. A similar federal laboratory, currently under construction in Winnipeg, is due to open in 1997.
Federal officials say they have no plans to quarantine travellers arriving from Zaïre - but if a suspected case of Ebola turned up at a Canadian hospital, blood samples would be sent to the CDC in Atlanta for analysis. For some experts, the latest Ebola outbreak demonstrated the need for high-security laboratories in Canada, because it may be only a matter of time before a case of Ebola or another dangerous virus turns up in Canada - and laboratory work is needed quickly. "Ebola is sort of a wake-up call," says Dr. Kevin Kain, a tropical disease specialist at The Toronto Hospital. "This kind of thing is not going to go away."
Maclean's May 22, 1995