Joshua Amupadhi traces how the virus was identified by a Johannesburg doctor before it could spread too far
`Angel,” the Gabonese doctor who unwittingly brought the Ebola virus to South Africa, flew home on Wednesday.
Back in Libreville he is popularly known as the “Angel” because of the lives he saves so regularly at the resuscitation unit in the city’s central hospital. He has asked that his actual name not be disclosed.
While he has fully recovered, the woman he accidentally infected lies, heavily sedated, fighting for her life in Johannesburg Hospital’s intensive care unit.
The Mail & Guardian has pieced together an extraordinary story of how the Ebola virus brought by Angel to South Africa was identified by a combination of skill and intuition.
Dr Reeve Jobson, a gastro-enterologist, was called in to care for theatre nurse Marilyn Lahana at the Sandton Clinic, north of Johannesburg.
She had been admitted there on November 6: weak, with a severe headache, diarrhoea, loss of appetite, and with a high temperature fluctuating around 40 degrees C.
And like Angel, she was mystified by her illness. She had been tested for everything — malaria, meningitis, typhoid, and a range of others. Nothing showed up.
But Jobson’s sub-conscious medical brain was working overtime. Congo fever had been in the headlines in the past few weeks. It is a viral haemorrhagic fever (VHF), a less virulent virus in the VHF family.
In addition, Jobson was nudged by memories of work in the casualty section of a London hospital. There, any West African patient with unexplained fever which was not malaria was treated as a VHF candidate until tests proved otherwise.
So after consultation with Clive Solden, a pathologist, on Saturday, November 9, he sent off 10ml of Lahana’s blood to South Africa’s National Institute for Virology (NIV). And he asked for tests for viral haemorrhagic fever. Among those fevers are the cousins, Marburg, various Ebola strains and Congo.
The first results were through quickly. There were no VHF antibodies in Lahana’s blood.
And so the possibility of Ebola or any of the other VHFs faded from the diagnostic stage.
But unbeknown to Jobson, the NIV had not finished with Lahana’s blood. It not only tested for antibodies, but simultaneously began to grow a viral culture which would take a week to mature.
As the week wore on, Lahana, now in the eye of the disease’s storm, was getting weaker and weaker. Her stomach had swollen and Jobson discovered her liver was inflamed. He wondered whether Lahana, as a theatre sister, was suffering from an allergy to an anaesthetic or had picked up an unusual infection from one of her patients.
But by this time both he and his rapidly deteriorating patient were frantically worried about the lack of diagnosis. He decided to operate on Lahana’s increasingly painful abdomen, not ruling out the possibility of appendicitis.
Lahana was wheeled into theatre in a poor state of health on the morning of Friday, November 15.
A surgeon performed a “laparotomy” — an abdominal incision — and found the remains of two huge bleeds, a usual sign of a severe viral haemorrhagic fever. Meanwhile, Jobson performed a gastroscopy which showed diffused internal bleeding. There was still uncertainty about the diagnosis, but “we thought she could have typhoid”.
And as Lahana was transferred to post- operative care, the culture was coming to maturity. By early afternoon on November 15, the National Institute began to see the alarming results of the viral culture it had grown, and told Sandton and Morningside clinics there was a 50% chance Lahana had one of the Ebolas. By midnight the evidence increased the chances to 80%.
The next morning, Saturday, at 8.55am, NIV confirmed she had contracted a viral haemorrhagic fever, Ebola, the deadliest of them all.
Meanwhile, Ben Rust, the manager of Morningside Clinic, where Lahana works, had asked for a list of all people treated at the clinic between October 19 and November 15, to trace the source.
Rust said the list produced three names of people from “north of the Limpopo, who were considered to be of high risk” — two Zaireans and Angel.
Angel was the only one tested, according to Professor Bob Swanepoel, head of the NIV, because medical information on the Internet had shown a remote part of Gabon was experiencing an outbreak of Ebola. The reports said some people in that area reportedly moved to Libreville, where one of them might have passed the illness to the Angel.
Tracking down the source was also made easy by the fact that before she fell ill Lahana had told her family how sorry she felt for a “man from Africa” who was suffering from a mysterious illness. She also expressed her fear he might not survive.
The Gabonese doctor arrived on a commercial flight on October 27, having contacted the International Health Care Bureau, which specialises in putting foreign medical practitioners and patients in contact with South African specialist doctors and nursing homes.
Angel was suffering from what he believed was chronic gastritis, and knew he needed specialised treatment not available at home. He arrived complaining of severe abdominal pains — he was initially diagnosed with hepatitis B, then for inflammation of muscles.
A colonoscopy was performed under anaesthetic, when doctors put a fibre optic tube into his colon. It was Marilyn Lahana who assisted in the insertion of the main drip. And it was at this moment that she may have been infected.
The scope showed up nothing. Angel remained ill. As the doctors trawled anxiously for a diagnosis, an auto-immune disease was considered and Angel was put on to steroids. He responded brilliantly and recovered.
Ebola was never suspected either by Angel himself or the South African doctors treating him. He recovered fully and was discharged on November 11.
Meanwhile, Lahana’s countdown to Ebola was already well on its way. Nearly two weeks later, when it was discovered she had contracted Ebola, she was transferred to the Johannesburg Hospital for treatment.
Her condition remains “critical but stable”, and she is on life-supporting machines. She is now receiving treatment for infections caused by damage to her immune system inflicted by the Ebola virus, which is now no longer active in her body.
Professor Guy Richards, a chest and intensive-care specialist, says Lahana could spend “a long period” connected to life- support machines as she battles against the infections.