Sierra Leone – When Fatmata Kabia walked into the Ebola isolation centre, her chances of survival were almost zero.
Not because her symptoms were particularly bad – though they were. Not because the disease had already killed most of her family – though it had. Kabia, 21, appeared doomed for another reason: She was pregnant.
Few diseases are less understood than the Ebola virus, which has claimed over 7 900 lives across West Africa.
But one thing is clear: pregnant Ebola patients rarely survive. And their babies never do.
Even as doctors watched a succession of Ebola-stricken pregnant women die or lose their babies in recent months, they weren’t entirely sure why it was happening.
Perhaps the mothers’ immune systems were weakened, making them more susceptible to the incapacitating fever that accompanies the disease, or maybe the virus pooled in fetal fluid. Some of the babies died early in pregnancy, others closer to term.
“There have been no neonatal survivors,” that’s how flatly Denise Jamieson, an obstetrician with the Division of Reproductive Health at the Centers for Disease Control and Prevention, put it.
Kabia didn’t know that. She knew only that some time after the disease crossed the border from Guinea to Sierra Leone, it had arrived in her town, called Lunsar.
Then it snaked into her home, where her mother, father and brother tested positive. And then she tested positive.
A few weeks later, when she walked out of the Port Loko Ebola isolation centre – her test results negative, her baby growing in her belly – the epidemiologists had already started talking about her.
Childbirth fears
She had become pregnant in August just as the disease started spreading rapidly across Sierra Leone. Kabia had already miscarried once, years before. She was so worried when she became pregnant this time that she didn’t tell her husband. One day, he pointed to her belly and asked: was she? Kabia told him, and they celebrated.
He died from Ebola a few weeks later.
When she came down with the disease, already one month and three weeks pregnant, everything was working against her. Maternity wards had started closing amid fears that pregnant women with the virus would infect anyone who attempted to assist their deliveries. Ebola is transmitted through bodily fluids, which gush during childbirth.
An ambulance took her to a hospital overflowing with suspected patients and filled with dirty mattresses. It wasn’t even an Ebola treatment facility – just a place to keep suspected patients while centres were built.
Often, dead bodies lay on the floor for days.
“Based on what I learned about the disease, I was expecting her to die,” said Matilda N’glanda, the head nurse.
Then, remarkably, Kabia’s health started to improve. “It was the drugs and God,” Kabia said.
She was released in mid-October, with a certificate declaring her a survivor.
Some doctors and nurses have begun testing the fetuses of the miscarried infants of Ebola victims. The research isn’t formal, and it’s still in an early stage, but the results have been startling.
Grazia Caleo, an epidemiologist for Doctors Without Borders, remembers the first fetus she tested last year. “It was the highest viral load we’ve ever seen. Just off the charts,” she said.
For scientists, this Ebola outbreak is more than just a horrible tragedy. It’s a once-in-a-lifetime research opportunity that could help prevent, or contain, the next epidemic.
The last study on pregnant Ebola patients was conducted in 1995, during an outbreak in Kikwit, Zaire, where a total of 315 people came down with the disease, just a handful of them expectant mothers.
This outbreak has infected more than 20 000 people.
If the right cases are documented and researched, it could change the foundations of common knowledge about the disease.
If Kabia and her baby survive, it could prompt a reevaluation of what is known about the intersection of Ebola and obstetrics.
“It would give a lot of people a lot of hope,” said Denise Jamieson.
Washington Post-Bloomberg