We were back at the Hotel Starlight in Karaguuza after spending the morning hunting for bats. The team had bagged more than 50 of them in two abandoned houses and was now preparing to dissect them in a makeshift screened-in lab beneath a tarp in the rear courtyard of the hotel. There, tucked out of sight so as not to disturb the other guests, the group set up an assembly line. Luke Nyakarahuka, the Ugandan health ministry epidemiologist, placed the bats one by one in a sealed plastic bag along with two tea strainers filled with isoflurane, a powerful anesthetic. The bats beat their wings for a few seconds, then stopped moving. It took about a minute to euthanize them. Then Nyakarahuka passed them on to other members of the team, who drew their blood, measured them, tagged them, plucked out their organs, and stored their carcasses and other material in liquid nitrogen for shipment to the CDC.
For Towner and the others, the hope is not only that they will find the Ebola virus, but also that they will shed light on how the pathogen is transmitted from bat to human. “If the kidneys are blazing hot, then the Ebola might be coming out in urine. If it’s the salivary glands, maybe it’s coming out in saliva,” I was told by the CDC’s Brian Amman. Testing of the Marburg virus carriers hasn’t indicated much, he says. “We’ve found the virus only in the liver and spleen, two body filters where you’d expect to find it.” Amman said that if research conclusively found that Ethiopian epauletted fruit bats carried Ebola, it might catalyze an HIV/AIDs-type awareness campaign aimed at minimizing contacts between bats and humans. It might also lead to the boarding up of the many abandoned and half-built houses in rural Africa that serve as bat roosting places and breeding grounds. “Some people here might say, ‘Let’s kill them all,’” said Amman. “But that would be destroying a valuable ecological resource. Our aim is to mitigate the interaction.”
None of the virus hunters had any expectation that a vaccine against Ebola was imminent. The drug development process takes an average of 15 years and costs billions of dollars. Pharmaceutical companies are reluctant to expend those resources to combat a virus that has killed about 1,080 people in 30 years or so. So far, nearly all Ebola vaccine research has been funded by the U.S. government to combat potential bioterrorist attacks. The Army Medical Research Institute of Infectious Diseases in Fort Detrick, Maryland, recently tested an experimental vaccine made from virus-like particles on guinea pigs and monkeys, and reported promising results. Several biodefense contractors have initiated small-scale safety trials with human volunteers, who are not exposed to the Ebola virus. But most virologists say that an effective vaccine is many years away.
In late August, four weeks after Ebola was confirmed, I visited Kagadi Hospital, a tidy compound of tile- and tin-roofed one-story buildings on a hill overlooking the town. I dipped my shoes into a tub of disinfectant at the front gate. Posters on the walls of the administration building and the general wards listed symptoms of Ebola—“sudden onset of high fever...body rash, blood spots in the eyes, blood in the vomit...bleeding from the nose”—and instructed people to avoid eating monkey meat and to make certain to wrap the corpses of victims in infection-resistant polyethylene bags. Cordoned off by an orange plastic fence in the rear courtyard was the “high-risk” ward, where Ebola patients are kept in isolation and attended by masked, gloved, biohazard-suited health workers. “If you were on the other side of the orange tape, you would have to be wearing an astronaut suit,” a physician from Doctors Without Borders told me.
Inside the tent, two women were fighting for life. One had been a friend of Claire Muhumuza, the nurse; after Muhumuza died on July 20, she had cared for Muhumuza’s baby daughter. Then on August 1, the little girl succumbed. On August 3, the caretaker fell ill. “Three days ago I went in and called her name, and she responded,” Amone said. But today, she had fallen unconscious, and Amone feared that she would not recover.
The next afternoon, when I returned to the hospital, I learned that the caretaker had died. The way Amone described it, she had lost all sensation in her lower limbs. Her ears began to discharge pus, and she fell into a coma before expiring. The bereaved family was demanding compensation from the hospital, and had threatened a nurse who had apparently encouraged her to take care of the infected baby. “It has become a police case,” Amone told me. One last Ebola patient—another health worker—remained in the isolation ward. “But this one is gaining strength now, and she will recover,” Amone said.
Now, after 24 confirmed cases and 17 deaths, the latest flare-up of Ebola appeared to have run its course. Since August 3, when the caretaker had been diagnosed, 21 days had passed without another case, and the CDC was about to declare an official end to the outbreak. (By mid-September, however, Ebola would erupt in Congo, with more than 30 reported deaths, and more than 100 individuals being monitored, as this article went to press.)
After visiting Kagadi Hospital, I joined three nurses from the health ministry, Pauline Namukisa, Aidah Chance and Jose Tusuubira, on a field trip to visit the survivors from the family of Winnie Mbabazi—Patient Zero. The three nurses had spent much of the past three weeks traveling around the district, trying to deal with the societal fallout from the Ebola outbreak. Healthy family members of people who had died of Ebola had lost jobs and been shunned. Those who had come down with fevers were facing even greater stigma—even if they had tested negative for the virus. They were banned from public water pumps, called names such as “Ebola” and told to move elsewhere. “We have to follow up, to sensitize people again and again, until they are satisfied,” Tusuubira told me.
The rolling hills spilled over with acacias, jackfruit, maize, bananas and mango trees. We drove past dusty trading centers, then turned onto a dirt path hemmed in by elephant grass. After a few minutes we arrived in a clearing with three mud-brick houses. Except for a few chickens squawking in the dirt, the place was quiet.
A gaunt woman in her 60s, wearing an orange-and-yellow checkered headscarf and a blue smock, emerged from her hut to greet us. She was the widow of the family patriarch here, who had died in late July. One of four survivors in a family of 13, she had been left alone with her 26-year-old daughter and two small grandchildren. She led us to a clearing in the maize fields, where earthen mounds marked the graves of the nine who had succumbed to Ebola.