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When did the virus break out?

These were the words of Diana Atwine, Secretary of State for the Ugandan Ministry of Health, on September 20.

Since then, 60 cases have been confirmed. 24 of them ended up fatally. 20 more deaths occurred before the outbreak was announced, bringing the estimated total number of deaths to 44. However, the number of unreported cases is likely to be higher.

How did the outbreak start? That’s not entirely clear. The first confirmed case of Ebola is a 24-year-old man from Mubende district in central Uganda. He died on September 19 from the effects of a high fever, diarrhoea, abdominal pain and vomiting blood.

However, it can be assumed that the 24-year-old is not a “patient zero.” This means that he was not the first carrier of the virus. The reason for this assumption is the fact that six of the young man’s relatives had died three weeks earlier. Three adults and three children.

Because of her contact with the 24-year-old, Ebola is considered the suspected cause of death. This finding is staggering because it means the virus has been around for at least three weeks.

Matshidiso Moeti, WHO Regional Director for Africa, was initially optimistic:

The largest outbreak to date in Uganda in 2000 infected a total of 425 people, 224 of whom died. Later there were smaller eruptions. The largest global Ebola outbreak occurred in West Africa. The virus claimed more than 11,000 lives there between 2013 and 2016.

How fast is the virus spreading in Uganda?

By the time the Ebola outbreak was announced, eight people suspected of having Ebola were being treated. It soon became clear that keeping the virus in check would not be so easy. The Ugandan Ministry of Health’s Ebola chief, Kyobe Henry Bbosa, warned of a rapidly developing situation and suspected the number of cases would rise.

Of particular concern is the fact that the epicenter of the outbreak is in Mubende. The district capital of the same name is located in a region that attracts many people because of its gold mines. In addition, Mubende is located on an important road, so easy to reach. In one direction it leads to Kampala, the country’s capital, 130 kilometers away, and in the other direction to neighboring Congo.

Five days after the outbreak was announced, there were already 16 confirmed and 18 probable cases. Four of these were discovered outside Mubende.

Finally, on October 11, exactly three weeks after the outbreak was announced, the first Ebola death was reported in the capital Kampala. The man was already known to the authorities in Mubende because he may have come into contact with the virus.

But instead of receiving treatment, he fled and visited a healer in another region. He eventually died at the Kiruddu National Referral Hospital in Kampala. The hospital staff were already aware of the danger and protected themselves accordingly. Before that, however, the man probably had contact with about 42 people, who were then placed under surveillance.

How does an infection develop?

Like the coronavirus, the Ebola virus is a zoonotic pathogen. That is, the natural host of the virus is an animal. In the case of the Ebola virus, this is a fruit-eating bat that is mainly found in Africa. Infection occurs by eating contaminated fruit or by touching bats or their droppings.

The virus is also transmitted between people through direct physical contact. In particular, body fluids such as blood, saliva, sweat, urine, stool or vomit are highly contagious. The virus can even be transmitted through semen – even long after the patient has recovered:

However, infected people are not contagious until they have symptoms. The following applies: the stronger the symptoms, the greater the chance of infection. Unlike the coronavirus, Ebola is not transmitted via aerosols. With this argument, Ugandan President Yoweri Museveni initially refrained from taking strict measures: Ebola does not spread through the air like the coronavirus and therefore does not require the same measures.

What measures is the government taking?

However, a few days later, Museveni returned and announced a lockdown in two Ugandan districts on October 15. Bars, nightclubs, places of worship and entertainment will remain closed for three weeks in Mubende and neighboring Kassanda. There should also be a curfew.

The focus of the authorities is now mainly on tracing contacts. All people who have been in contact with patients should be located – this includes those who have already died from the virus. The virus often spreads at funerals.

A facility for Ebola patients has already been set up in Mubende and a second one is still under construction. In addition, President Museveni has sent two mobile labs to the district capital. This is to prevent people from having to travel to test centers. The WHO is also training health workers to prevent the spread of the virus.

The other measures are probably well known to the Ugandan population: frequent hand washing, no shaking and hugging when greeting, cleaning surfaces. The main thing is to avoid contact with infected people.

Is there a vaccine?

No not yet. The US Food and Drug Administration approved an Ebola vaccine in 2019, but it is only effective against the Zaire strain of the Ebola virus. According to a 2016 study, the effectiveness should be 70 to 100 percent. However, the current outbreak is the rarer Sudan strain, for which there is no vaccine.

However, experiments are underway. For example, the US sent an experimental Ebola antibody drug to Uganda last week. This is primarily intended to protect healthcare workers.

Without an approved vaccine, rehydration is the only way to improve survival for Ebola patients right now. The rest of the treatment is just symptomatic relief.

How does the disease progress?

Two to 21 days elapse between infection and the onset of the disease. The first symptoms are usually very unspecific, such as headache and body aches, fever and malaise, making early diagnosis difficult. After this, abdominal pain, vomiting and diarrhea may occur.

After the onset of the disease, severe internal and external bleeding occurs. In addition, vital organs such as the liver and kidneys can fail. The death rate depends on the type of virus, but Ebola is fatal in about 30-90 percent of all cases. In the case of the now active Sudan tribe, the WHO estimates a death rate of between 41 and 100 percent.