RETURN TO THE HOT ZONE

By MICHAEL D. LEMONICK

The outbreak apparently began with a 36-year-old laboratory technician identified only as "Kimfumu." He arrived at a medical clinic in the small agricultural city of Kikwit, Zaire, last month for emergency surgery. But after two operations, surgeons realized they could do nothing for him; his internal organs were hemorrhaging so badly that life was quickly draining from his body. Soon after Kimfumu died, the five medical workers who treated him, including an Italian nun who assisted in the operations, began coming down with their own symptoms: headache and fever, diarrhea, massive bleeding from every body orifice and, within a few days, death.

Horrific tropical fevers are an unfortunate fact of life in Central Africa, but this was no ordinary fever. It was the fourth outbreak ever recorded of the dreaded Ebola virus, which resists all medicines and kills up to 90% of its victims. As the full measure of the danger dawned on them, alarmed government officials called for help from international public-health experts in the U.S. and Europe. They closed schools and health clinics in Kikwit, ordered people to stay off the streets, and imposed a quarantine on the city in a desperate attempt to keep the virus from spreading 250 miles west to the capital city of Kinshasa, with its 4 million people.

The effort may have been too late. When international emergency teams arrived last week at the clinic where the outbreak began, they found only 20 people left in the 350-bed facility, raising fears that patients had fled, taking the virus with them. By week's end, cases were being reported in the outlying villages of Mosango, Bonga-Yasa and Vanga. And thousands of miles away, in Bergamo, Italy, two sisters of Floralba Rondi, the nun who helped operate on Kimfumu, sat in medical quarantine. They were waiting to see if they too had been exposed when they visited Kikwit for their sister's funeral. "It's been a week of prayer," said Rosanna Rondi to an Italian newspaper.

In Kinshasa, residents fretted about their relatives and friends in Kikwit-there are no phone links and now no movement between the two cities-and feared that Ebola might breach the quarantine. Says Cornaille Mbala, a senior nurse at Kinshasa's Mama Yemo Hospital: "When this sickness hits you, you die in one week. Of course we are all afraid." And around the world, but especially in the U.S., people sensitized to Ebola's horrors by a spate of books and movies-Richard Preston's chilling best seller The Hot Zone; the TV movie Robin Cook's 'Virus'; the film Outbreak, starring Dustin Hoffman-wondered nervously whether the disease would spread out of Africa.

By week's end, there were 49 confirmed deaths from Ebola and 50 more suspected-the number was highly uncertain because Kikwit is also dealing with an outbreak of shigellosis, a form of dysentery whose symptoms can easily be confused with Ebola's. While the death toll is certain to rise, since the virus' incubation period lasts up to 21 days, infectious-disease experts doubt that the Ebola will travel much farther than it has already, even within Zaire. Says Dr. Ralph Henderson, an assistant director-general of the World Health Organization: "We are not talking about thousands or tens of thousands. This is not a plague situation."

In fact, the Ebola virus is ill-suited to sustaining an epidemic: it kills victims so quickly that they don't have much chance to infect others. Says Henderson: "People who are ill with Ebola are not walking around. They are on their backs." Moreover, the virus is not all that easy to pass along. Unlike the most highly contagious illnesses-tuberculosis or influenza, for example, Ebola can't be transmitted with a sneeze or cough. It's more like AIDS; direct contact with a victim's blood or other body fluids appears to be the only way to catch the virus. And contact with someone who's bleeding from every body opening is likely to be shunned in any case.

That means that most people, especially those outside Zaire, have little to fear from Ebola. Says Dr. Peter Piot, who investigated the first Ebola outbreak in 1976 and heads the United Nations aids program: "It's theoretically feasible that an infected person from Kikwit could go to Kinshasa, get on a plane to New York, fall ill, and present a transmission risk there. But even if this were to happen, it would likely stop there."

It is health-care workers who will continue to face the greatest danger in the Ebola outbreak. Under ordinary conditions, even an operation wouldn't necessarily put doctors and nurses at undue risk. But in Zaire, sanitary conditions are a luxury. Patients in even the biggest hospitals lie on the floor, or on soiled mattresses; doctors and nurses rarely have a chance to wash their hands, and sterilized instruments are almost unheard of. Says nurse Mbala: "We have no masks, no gowns, nothing, nothing at all. If the virus comes [to Kinshasa], we have no way to protect ourselves." In the three earlier Ebola outbreaks the virus also flourished in hospitals, helped along by such practices as re-using unsterilized needles.

The current crisis should be eased, at least temporarily, by an influx of medical supplies: the U.S., the European Union and the U.N. have donated hundreds of thousands of dollars' worth of gowns, masks, caps, boots and gloves along with medicines and blood plasma-enough, officials hope, to keep the outbreak contained. Emergency health workers are trying to locate people who may have come in contact with a victim and get them back into the hospitals for isolation and observation.

But there is still no answer to the crucial question of how Kimfumu came by the virus in the first place. As a lab technician, he may have been exposed to a contaminated blood sample, but the ultimate origin of Ebola remains a mystery. Scientists suspect that it has probably circulated in wild animals such as rodents for years, and only makes the jump into humans when the two populations come into contact. Observes Yale epidemiologist Dr. Robert Ryder: "These viruses basically say to man, 'You stick to your territory and I'll stick to mine.' But then man begins to encroach on the habitat of the viruses."

Ebola is just one of several viruses to have emerged from the jungle in the past few decades; others include Lassa and Marburg in Africa, and Sabia, Junin and Machupo in South America. But the most insidious of all, of course, is the AIDS virus, HIV. It probably originated in Africa as well, but unlike Ebola, it was ideally suited to spread around the globe. It kills so slowly and leaves victims without symptoms for so long that they can infect many others before dying.

Are there other viruses as dangerous as HIV-or even more dangerous-lurking on the edge of civilization? That's the question that haunts public-health officials. Dr. Karl Johnson, formerly a virologist with the U.S. Centers for Disease Control and Prevention, wonders: "Suppose we get a virus that is both deadly to man and transmitted in the air?" It needn't even be a new organism, since viruses undergo mutations every so often. Sometimes they change into a more harmless form--but sometimesthey get more virulent. Which means that the next time Ebola virus emerges from the jungle, it might be much harder to control. -- Reported by Bruce Crumley/Paris, Scott Norvell/Atlanta and Andrew Purvis/Kinshasa