In Hot Zone, his classic account of an Ebola outbreak in Washington DC, Robert Preston wrote: “In biology, nothing is clear, everything is too complicated, everything is a mess, and just when you think you understand something, you peel off a layer and find deeper complications beneath. Nature is anything but simple.”

These words take on an ominous, vaguely prophetic tone when applied to what’s happening right now in Guinea, where 61 people are dead – and no one is exactly sure what killed them. Not all of them, anyway.

Initially, medical professionals thought the cases they were trying to treat in rural Guinea were an outbreak of the Ebola virus. This makes sense: the symptoms fit, and the virus is known to thrive in West and Central Africa’s tropical rainforests, of which Guinea has plenty.

Ebola is a terrible way to die, and if you contract the virus you are almost certain to. Along with an extreme fever, patients start hemorrhaging, bleeding from everywhere they can – ears, eyes, nose, mouth, rectum. There is no known cure, and up to a 90% fatality rate.

“After an incubation period of two to 21 days, the virus causes a raging fever, headaches, muscle pain, conjunctivitis and general weakness,” explained Dr Esther Sterk, a tropical medicines specialist with Doctors Without Borders (MSF). “The next phase involves vomiting, diarrhea and, sometimes, a rash. The virus spreads in the blood and paralyses the immune system. It is particularly formidable because the body does not detect these viruses right away. When the organism does respond, it is often too late. By then, the viruses have created blood clots, which block vital organs and cause major hemorrhages. Patients may have heavy bleeding, including from the nose or via their urine.”

However dreadful, Ebola is, at least, a known quantity. It is highly infectious, but requires direct contact with infected blood or tissue (this puts family members and health workers most at risk). It is unlikely to be transmitted through casual contact like sitting next to someone on a bus. There are protocols in place to deal with Ebola outbreaks, which Guinea’s government duly followed, warning citizens to stay calm, avoid shaking hands or kissing, and to wash their hands with soap.

Fortunately, Guinea’s creaking health system will have some help in dealing with the threat. MSF is sending an emergency response team and some 33 tonnes of supplies to assist. MSF will also be following standard procedure:

“Once the first case is confirmed by a blood test, every person who cares for an infected patient must wear a hazmat suit, gloves, a mask and protective goggles and exercise extreme caution when administering treatment,” said Dr Sterk. “Decontamination chambers are generally installed between the isolated patients and the external environment. To confine the epidemic, it is critical to trace the entire transmission chain. All individuals who have had contact with patients who may be contaminated are monitored and isolated at the first sign of infection.  The affected communities must also be informed about the illness and the precautions to be taken to limit risks of contamination. Basic hygiene – such as washing one’s hands – can significantly reduce the risk of transmission.”

When the symptoms started spreading – at least two cases in the capital, Conakry, five in neighbouring Liberia, and one as far afield as Canada (blame the wonder of air travel) – Guinean authorities sent off samples to the Pasteur Institute in Senegal to confirm exactly what strain of Ebola they were dealing with (the high fatality rates suggested it might be the Zaire strain, which is the most deadly). Other samples were taken and tested by the United Nations and Doctors Without Borders.

No one was expecting the results that came back. Sure enough, there were at least six confirmed cases of Ebola, mainly from victims in southeastern Guinea. But the three samples from Conakry came back negative – whatever virus is on the loose in the capital, it’s not Ebola, and the Pasteur Institute has been unable to suggest another likely suspect. “So for now, there’s no Ebola in Conakry, but haemorrhagic fever whose nature remains to be determined,” said an official from Guinea’s health ministry.

This is a disturbing development, to say the least. What exactly is afflicting the citizens of Conakry? Has Ebola mutated into something new and possibly even more dangerous? And if it is unknown, will medical staff be able to treat it effectively? As Preston said: “Nature is anything but simple,” and Guinea’s over-strained health facilities are going to struggle to cope with a strange, mystery illness.

Or perhaps there is a more straightforward explanation after all. Armand Sprecher, another doctor with MSF, told the Daily Maverick that it’s not unusual to mis-diagnose Ebola. “Ebola does not have a characteristic clinical appearance, it starts out as a nonspecific flu-like illness, then one often has vomiting and diarrhea. Some patients will develop unusual bleeding, but this is rarely dramatic, and not all patients have this. Further complicating matters is that other diseases cause unusual bleeding, such as gram negative sepsis, severe malaria, and of course, Lassa fever – which is endemic in the region. So, it is not surprising that someone who had a syndrome compatible with Ebola turned out not to have the disease. This happens all the time, even during epidemics.”

Despite the uncertainty, South Africa’s National Institute of Communicable Diseases maintains that Guinea is still a safe destination for travel, warning just that travellers should be aware of the epidemic and take sensible precautions. At the same time, however, it has warned South African ports to be extra alert to any travellers coming to South Africa from Guinea, just in case they bring the virus with them. DM

Read more:

• Canada probes possible Ebola case on CNN
• Virus in Guinea capital Conakry not Ebola on BBC
• SA on alert after Ebola outbreak in Guinea on Business Day

Photo: A doctor displays collected samples of the Ebola virus at the Centre for Disease Control in Entebbe, about 37km (23 miles) southwest of Uganda’s capital Kampala, August 2, 2012. Residents in western Uganda said on Thursday they were too scared to go shopping in local markets, visit churches or mosques or travel freely for fear of catching the Ebola virus which has already killed 16 people. REUTERS/Edward Echwalu