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Ebola hunter relishes trips inside African 'Hot Zone'

Dr. Scott Dowell, left, was among the CDC officials helping contain the Ebola outbreak in Uganda
Dr. Scott Dowell, left, was among the CDC officials helping contain the Ebola outbreak in Uganda  

ATLANTA, Georgia (CNN) -- Most travelers would avoid booking a plane trip to a country where a red alert was issued for an outbreak of severe hemorrhagic fever.

But Dr. Scott Dowell jumped at the opportunity several weeks ago when his bosses at the Centers for Disease Control and Prevention in Atlanta asked him to join up with a CDC team flying into Africa to help contain the latest spread of deadly Ebola virus.

Five years ago, in fact, Dowell had already gone to the Central African country of Zaire where Ebola had emerged and had begun killing hundreds of people. The desire to help control the disease's spread and possibly save lives keeps him from worrying about the risks.

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"I don't know if I'll ever get the chance to go out there again," Dowell said. Two CDC-sponsored trips into Ebola outbreak zones may be the limit. If so, "I'll miss it," he said.

Ugandan health officials confirmed on October 14 that Ebola had infected people in Gulu, 225 miles north of Kampala. The virus, a lethal strain first identified in northern Congo in 1976, attacks almost every tissue and organ in the body and turns them into mush. Victims often see their immune system destroyed, followed by internal hemorrhaging and bleeding out through the body's orifices. Death usually comes within two weeks.

CDC officials and experts from the World Health Organization and other groups converge on Ebola outbreak points knowing there is no cure -- they also know their expertise could keep one country's nightmare from turning into a much larger epidemic.

Dowell, who now serves as the CDC's acting associate director for global health, was glad to put his knowledge of managing disease outbreaks to work "in the field." The 37-year-old father of three had fulfilled his pediatric residency at a children's hospital in Seattle, Washington, before deciding to sign on with the health service's front-line epidemiologists, who investigate the spread and control of disease.

"There's been a half dozen Ebola outbreaks in the world -- ever recorded -- so everything you do is groundbreaking," Dowell said.

And as soon as the six-person team landed at the airport outside the Ugandan capitol of Kampala, there were local ministry of health officials and hospital workers waiting for specific directions, such as how many hospital beds would be needed and what should be done to protect doctors and nurses.

"When we landed, we were faced with an outbreak on the order of 300 cases" and hundreds of patients who may have been infected with Ebola, Dowell said. Specific laboratory tests done on-site in Gulu would help Dowell and his crew to better define those numbers in the coming days. The CDC workers and others protected themselves by staying away from the bodily fluids or blood of patients in the acute stage of infection.

They had to deal with local hospitals, which were filling up with Ebola patients and needed help managing the disease's symptoms and quarantining others.

Dowell was among the CDC and WHO experts who also track nearly every person that comes in contact with a confirmed Ebola patient, including family, friends and residents from any nearby towns.

"Their first job is to insure the proper system is in place in the hospitals to make sure patients are being treated," said WHO spokesman Gregory Hartl. "But the epidemiologists also have to make sure they trace all possible contacts to make sure they don't spread Ebola any further."

There is an "education" component as experts try to educate the Ugandan public about the disease. Ebola-Zaire, the first strain identified, kills 90 percent of people it infects. The strain that hit Uganda is called Ebola-Sudan -- named for a strain that erupted in Sudan in the late 1970s then disappeared until this latest outbreak. It kills roughly half of those infected, Dowell said, but may only spread to 16 percent of the family members staying in the home where an Ebola patient is recovering.

"Luckily, it looks roughly like less people die with Ebola subtype Sudan," Dowell said, pointing out the benefits of his crew's data gathering. "Also, the hospitals there are more sophisticated so the there's a better survival rate."

The fever caused by the Ebola virus is transmitted through body fluids. While there is no cure, patients aggressively treated for dehydration can recover.

Overall though, Ebola's spread is lethal in terms of disease outbreak rankings. It kills hundreds before it disappears into its hiding place somewhere in Africa, experts said, waiting for the next chance to strike. So far, 149 people have died in the Ugandan outbreak -- an additional 367 are known to have the virus, according to official WHO numbers.

The CDC, WHO and others have the tools and skills to fight such severe hemorrhagic diseases worldwide, but that's not enough. When he was young, Dowell traveled with his parents to Haiti, where his father, also a doctor, treated patients. More work needs to be done on how Ebola seems to jump species and mutate into new strains, explained Dowell.

"It's amazing we can have an outbreak in one place, then some five years later, have the virus show up again -- but with virtually the same kind of genetic sequence as the first virus," said Dowell.

After returning to work on Ebola from his office at CDC headquarters in Atlanta, Georgia, a couple of weeks ago, Dowell has kept track of his team's work in Gulu. He and others wait for the final batch of new cases to be registered so workers can follow those patients for a safe number of days before the outbreak can be declared over.

He keeps a map of Uganda on his wall to remind him of the reality of Ebola and tells visitors that outbreak control has little to do with spacesuit-clad biohazard workers like those found in the best-selling novel "The Hot Zone" or testing monkeys for infection.

Tackling Ebola is going to take an international team of experts, Dowell said, who will start with the epidemiological data gathered in Gulu and elsewhere before launching widespread testing or scouring the jungles of Africa on a hunt for the virus.

Misplaced time or money won't stop Ebola, he said, because "there's just a lot we need to understand."



RELATED STORIES:
Uganda's Ebola death toll at 54; 10 new cases identified
October 22, 2000
Ugandan officials try to contain Ebola outbreak
October 16, 2000
Experts see increased threat from new infectious diseases
April 26, 2000

RELATED SITES:
CDC Link to Special Pathogens Branch
CDC Ebola Hemorrhagic Fever Fact Sheet
World Health Organization Site on Disease Surveillance

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