Ebola-Bundibugyo, Thursday Night Numbers

First, Scott posted pictures of the burials today (first link called “Ebola Burial Pictures” on the sidebar to the right) which probably do more than the proverbial thousand words to explain why this situation is so intimidating. There is also a picture of Jonah’s mother and wife, and his three oldest daughters Masika (15), Biira (12), and Magga (10). The other two, Karen (5) and Sara (2 1/2), stayed back home with their aunt. I missed the briefing due to the burial, but here is what I can glean:

• Cummulative Cases: 101
• Deaths: 22
• New admissions: 1 in Kikyo and 0 in Bundibugyo

Hmm . . . How can new cases increase more than admissions? Well, there were five patients evaluated today by triage who were told to go into the isolation ward but somehow disappeared. Not encouraging for control of the spread . . . But consider this dilemma. Someone comes to triage. She has a low grade fever and mild diarrhea. 10 days ago she stood in a known patient’s presence and prayed for them. She claims to have not touched the patient. Is she a contact? Is she a suspect case? If she is lying and she really did touch the patient she’d be a definite contact, and a contact with a fever and symptoms should be admitted. But she says she didn’t touch, so then she’s not a contact, just a person with diarrhea who happened to be in the room of an Ebola patient once. Yet if you are making the decisions and you take this lady’s denial of contact at face value ( in a culture where truth is very fluid and relative) then you might be condemning others to die as she gets sicker and spreads the virus. On the other hand, if she really didn’t touch the patient and she has some mild crud that is not in any way related to Ebola, yet you admit her to the isolation ward, she’ll probably get Ebola from the patients already there, and she might die. That is very very tough. And the above case scenario was actually presented to Scott today, who turfed the decision to those with more experience. No easy answers.

• Inpatients seen by Scott W in Nyahuka: 1
• Maternity cases Scott M was on call for in Bundibugyo: 1

Another Hmmmm. . . . Where are all the sick people? Hiding at home. Lastly, the CDC epidemiologists are searching now for the earliest cases. Fascinatingly, the in-charge from Kikyo, Julius (the man who has cared for the most patients of all!) told Scott that in the first family to be affected, four brothers all died. There must have been someone who survived, because the story later came out that they had eaten a monkey together. It is not clear whether they found a dead monkey or shot one (men do hunt up in the forests that border the Rwenzori National Park, I see them sometimes on the road or an obscure bike path, suddenly emerging from the bush with their mangy little brown dogs and their bows and arrows). It is also not clear if the “monkey” was a primate, since we do have chimps in the district and we know that Ebola can infect chimps and gorillas. I hope the CDC team or one of the other epidemiology groups can shed light on how the virus suddenly appears.