Edward Willett

Saturday Special: Lisa Fernando and Canada’s epidemic response team

In view of the announcement this week that Canada will send a mobile laboratory to help stem an outbreak of Ebola in the Democratic Republic of Congo, I offer an account of a similar effort from Canada to help combat an outbreak of Marburg hemmorhagic fever (closely related to Ebola) in Angola a few years ago, condensed from a chapter in my book Disease-Hunting Scientist: Careers Hunting Deadly Diseases (Enslow Publishers).

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“You’ve got to be kidding me!”

It was 2005, and Lisa Fernando had just been told she would be flying to the African nation of Angola within a week to help battle an outbreak of Marburg hemorrhagic fever. (A hemorrhagic fever is a disease whose symptoms typically include high fever and internal bleeding.)

Fernando had only been working at the Canadian Science Centre for Human and Animal Health in Winnipeg, Manitoba, for 2 1/2 years. She’d started there shortly after she received her master’s degree in medical microbiology. (That’s the study of the tiny organisms, such as bacteria and viruses, that cause disease.)

The Canadian Science Centre for Human and Animal Health is a joint facility, home to both the Public Health Agency of Canada’s National Microbiology Laboratory and the Canadian Food Inspection Agency’s National Centre for Foreign Animal Disease. It’s also home to the country’s only “Level 4” laboratories. A Level 4 laboratory is one that can meet the strict safety standards for working with some of the world’s most dangerous disease-causing agents, such as the Marburg virus.

Marburg is closely related to the Ebola virus, the best-known of the disease organisms scientists study in Level 4 labs. But until the outbreak in Angola, confirmed by the World Health Organization in March, 2005, nobody realized that Marburg could be just as deadly as Ebola.

There is no cure for Marburg hemorrhagic fever, just as there is no cure for Ebola. At the time Fernando got the call to go to Angola, the nine out of every 10 people infected during the outbreak had died. A person can easily become infected if they are in contact with bodily fluids (such as blood) from an infected person.

Well-prepared, but still…

Even though the call to go to Angola surprised her, Fernando was no stranger to working with deadly germs. She had been training to do just that for her whole 2 1/2 years at the Winnipeg lab. “Working with these viruses every day, I really had developed a comfort level,” she says. “I felt well-prepared.”

Still, when “the big boss” (Dr. Heinz Feldmann, chief of special pathogens at the Public Health Agency of Canada) told her she was going to Angola, her surprise was tinged with just a bit of fear. It would be her first overseas mission.

She battled the fear with logic. “Of course there’s all these thoughts that go through your mind, so then you logically think, ‘We’re not visiting the people in the field, and for the samples that we’re handling, we’re following all the same safety requirements as we do in Winnipeg.” The only difference, she says, is that in the field they wouldn’t have “the fancy Level 4 lab.”

Fernando says she knew she had been well-trained and she had a tremendous amount of trust in Dr. Feldmann. “He would never bring us into an area where he was worried about our safety or well-being,” she said. “I just had to trust in his experience.”

Feldmann knew exactly what the team would be getting into, because he was already in Angola. He had gone there as part of the first team Canada sent, along with a mobile laboratory containing the equipment needed to diagnose Marburg. After three weeks in Angola, Feldmann found that cases were increasing and the demand for the lab remained high. That was when he called for Fernando and medical officer Dr. Jim Strong to relieve him and his lab assistant, Allen Grolla.

“I didn’t quite totally believe it until I was actually on the plane with Jim,” Fernando says. “There had been a lot of discussion back and forth through the week leading up to us leaving, you know, ‘Oh, are we really going? Do we have visas? Do we have flights booked? Are there more cases?’ With us being so far away it was hard to really know what the situation was.”

Do not lean on the airplane door

The outbreak began in the northern Angolan city of Uige (pronounced Weej). Getting there was not easy.

“You would fly into Luanda, which is the capital of Angola, and then you would have to take an hour flight in this tiny little four-seater plane,” Fernando recalls. “I remember the first flight out, the pilot leaned over, pulled the door shut, and said, ‘Just don’t lean on it.’ And I thought, ‘This is the last flight I will ever take.’ But at least it was adventurous!”

Conditions were primitive in Uige. The city and the surrounding countryside were badly affected by the civil war that had gripped Angola until just a couple of years before the outbreak. “It was war-torn,” Fernando says. “Everywhere you would look, the windows had been blown out, you would see gunshot holes. Dusty streets, very barren.”

She and Dr. Strong were put up in a hotel…of sorts. They had to share one room, called the honeymoon suite because, unlike the other rooms, it had an attached bathroom. However, the bathroom did not have running water.

“The shower was a bucket shower,” Fernando says. “You had a big tub of water which they would cart in every second day at least, and then you would just bucket shower that way.” They used bottled water to brush their teeth. They had an air conditioning unit, but they had no electricity to run it.

“It was very, very humble, but we got by,” Fernando says. She also notes that the food was sometimes “questionable.” Almost everyone the trip had diarrhea at some point.

Humble surroundings, important work

The words “mobile laboratory” might make you imagine a gleaming air-conditioned semi-trailer. The mobile lab Fernando and Strong worked in, however, was nothing of the sort. “No air conditioning, no running water,” Fernando says.

Everything in it was transported to Angola in six to eight rubber bins. The bins were simply put aboard commercial airplanes as checked luggage. Once the lab was delivered on site, it could be up and operating within two hours.

The mobile lab contained various test kits, a generator, a laptop computer designed to withstand humidity, dust, and heat, and a satellite phone. It also contained personal protection equipment, to insure the scientists did not infect themselves as they worked with samples from patients.

Using the lab, workers could determine who was infected and who was not. That was vital information, because the only way to bring an outbreak under control is to prevent uninfected people from coming into contact with infected people, and thus contracting the diseases.

The most important piece of equipment in the lab was a device called a “real-time polymerase chain reaction (RT PCR) unit.” The RT PCR copied the incredibly tiny bits of genetic material found inside viruses over and over again. Once there wa enough of it, it could be identified.

Fernando and the others would receive samples–typically blood samples or swab samples–for people who might be infected with Marburg. They would examine those samples, with the help of the RT PCR, for the presence of the Marburg virus.

They ran the lab in a room at the Uige Provincial Hospital, where the outbreak was first identified. At the time of the outbreak, that hospital, and its four doctors, were the only health care available for the 1.5 million people in the region. Some of the earliest victims of outbreaks of both Ebola and Marburg are often the medical staff at the hospitals where the first patients are taken. The Angola outbreak was no exception. Among those who died early on were two doctors and sixteen nurses.

Fernando says that by the time they got there, the doctors running the isolation ward (a special, sealed room where people with contagious diseases are place so they don’t infect others in the hospital), wouldn’t even attempt to treat a patient until they had a diagnosis from the lab.

That made the Canadians’ work doubly important. Fernando says that malaria is a huge problem in the region, and many of the children being brought to the hospital with symptoms similar to Marburg actually had malaria. Malaria can be treated, but the doctors wouldn’t even attempt to help the children until they were certain they didn’t have Marburg.

Taking precautions

Fernando and Strong were not working directly with patients, but they still had to take precautions because they were dealing with samples that might contain Marburg virus. The lab tests themselves were run on killed virus–but that meant the first step was killing live virus.

While they were working with potentially live virus, Fernando and Strong wore something similar to the Level 4 “space suit” (described in more detail in the next chapter). The suit had its own battery-operated breathing supply, drawing in air through a HEPA (High Efficiency Particulate Air) filter, a filter so fine even viruses can’t get through it. The suit also had rubber boots, taped at the top, and three pairs of gloves. “It’s like wearing this big snowsuit and it gets very, very hot in there,” Fernando says. “At times we were in that suit for an hour or two.”

(The current edition of the mobile lab, sent to the Democratic Republic of Congo for a 2007 Ebola outbreak, includes a high-tech box called an “isolator.” A scientist can reach inside the isolator and work on viruses without having to wear an uncomfortable full-body suit.)

After three weeks in the field, Fernando returned home for a month. Then she went back to Angola for another three weeks, because the World Health Organization wanted the lab to remain in Angola for three weeks after the last lab-confirmed case.

“We came home, ironically, the day before Canada Day (July 1), and that was the best Canada Day ever. I remember thinking, ‘Flushing toilets! Right on!’ I had never been so grateful for running water and electricity!”

Ready to go again

So far, Fernando has not been called for another outbreak. But she is ready to go if asked. “If there is the need, absolutely. I think that it is a great humanitarian effort and I think that as a scientist, it’s sometimes very easy to forget that this virus actually kills people.

“When you work in a lab you’re working with very artificial systems, with cell lines, cells that we use to grow up the virus. It’s easy to forget that this is an actual disease that kills people and affects families.”

She says that going to Angola really helped her put her research into perspective, because the main project she is working on is focused on developing a vaccine for both Marburg and Ebola. Seeing the effects of the disease in Angola has reinforced for her the importance of her job in Winnipeg.

When she was growing up, though, working with deadly viruses was certainly not what she thought she would end up doing as a career. “I mean, I had no idea what a Level 4 virus was,” she says. Instead, the job just “fell into her lap,” when Heinz Feldmann offered her a job as a biologist with the group shortly after she completed working on her master’s degree with him.

High-school interest pays off

But if working with Level 4 viruses was not something she always thought she wanted to do, working in a research lab certainly was. Fernando says became interested in biology and chemistry in high school and knew early on that she would study science in college.

“My second year I took a micro(biology) course, and I fell in love with bacteria. Then when I finished my degree I knew that I wanted to do research, so doing a master’s was the first step in that direction.”

She says that was the best decision she ever made, because it helped her understand exactly what research involved. It also proved to her that she did not want to go on to obtain her Ph.D. With that more advanced degree, she says, “You kind of get stuck working behind a desk or writing grants or writing papers. I wanted to be more involved in the lab.”

Even though she enjoys it, “Research is hard,” Fernando says. “We often say in the lab it’s 90 percent failure, 10 percent success.”

Fernando says she laughs whenever she watches the 1995 movie Outbreak, the best-known fictional version of the kind of work she does. “I love the way they find a cure in 24 hours, and the scientists fall in love. Really, we don’t lead glamorous lives like that. Research is hard: it’s mostly failure. You get maybe one day of success out of the whole year. You have to be the type of person who can put up with that frustration and be very patient.

A hero? No way!

Fernando says the question she was most often asked by media in Canada at the time of the outbreak was, “Do you consider yourself a hero?”

She found it hard to believe they would even ask her the question.  “Everyone I know in this business, the colleagues of mine that went to Angola, none of us are this for the glory or the money, because there isn’t a lot of money in science,” Fernando says. “We’re not in this for the front-page news, not at all.

“We’re just here to do our job.”

 

 

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