On Day 15 of the Susa Group respiratory outbreak, a cool, rainy morning, I stood in one place for two hours watching three sick gorillas. The longer I stayed, the more I worried about what we'd find the next day. Ururabo, a first-time mother with a 3-month-old baby, coughed and picked her nose. Her baby coughed and sneezed; white fluid ran down from each nostril. He breathed through his mouth's pursed lips.

Ururabo's infant breathes through pursed lips.
On Day 15 of the Susa Group respiratory outbreak, a cool, rainy morning, I stood in one place for two hours watching three sick gorillas. The longer I stayed, the more I worried about what we'd find the next day.
Ururabo, a first-time mother with a 3-month-old baby, coughed and picked her nose. Her baby coughed and sneezed; white fluid ran down from each nostril. He breathed through his mouth's pursed lips. Poppy, the oldest female in the family, sat motionless, huddled with her two older offspring. She'd been sick for almost two weeks.

Rwandarushya holds her infant with one hand
and picks her nose with the other.
Earlier, I'd gotten a good look at the other three females with infants less than a year old. Dufatayne, also a first-time mother, coughed loudly but ate ravenously, while her 3-month-old baby seemed bright and alert.
Rwandarushya walked by me, coughing, and then sat down to groom her 6-month-old, hiding him from view. He's usually very active, but not on this day. His condition became a question mark in my mind. Ruvumu sat quietly, picking her nose and coughing. Her 11-month-old played in a patch of celery.

Ruvumu's infant, a Susa youngster
When Magda monitored the group yesterday, her tally came to 23 sick gorillas out of 39, including Ururabo and the three mothers with young infants. Most of the other adult females had also shown signs of illness, though not their offspring — yet.
I'd found one adult female recovered today. Adding Ururabo's baby to the list of sick gorillas kept the tally at 23. If Rwandarushya's infant turned out to be a new case tomorrow, the count would be higher. We'd reached the need for daily visits.
These results made me nervous. Of the four mothers with infants less than a year old, all were coughing, and one baby was clearly sick. The likelihood that the other babies would soon show signs of illness seemed high. And we hadn't even begun to see illness in the other Susa youngsters, a group that includes seven older, more independent infants and eight juveniles.
Poppy might also be developing pneumonia. She seemed awfully quiet. While a deep, productive cough is the most prominent sign of infection in the lungs, other clinical signs include fever, loss of appetite and dehydration.

Dufatayne and her infant
Concerned about Ururabo's baby, Poppy, and the other four mother/young infant pairs, I decided to return the next day with Elisabeth, Magda and the medical kit, just in case. If this turned out to be the day when one of the animals needed antibiotic treatment, it would help to have the equipment and team together from the start.
Getting to Susa Group in a rush is difficult, as they're usually at fairly high altitude (at least 3,000 meters/9,500 feet.) But we're also in a weather pattern of late-morning rain, and our work is less arduous if we can complete it before the skies open up.

Poppy and her infant
Most patients let us know in one way or another if they need our help. Ururabo's baby would either be better or much worse. Poppy would either have started eating or become weaker. The other infants would show signs of illness or not. Our plan was to intervene only if necessary.
If the patient was Ururabo's baby, we'd have to anesthetize Ururabo as well. If Poppy was the sickest, we might choose to dart her with antibiotics and save an intervention for a later time, depending on how Ururabo's baby looked.

Susa Group gorillas
We weren't a full team when we arrived the next day. Jean Felix had gone home sick with a cough. He'd visited Susa Group to do a check on the outbreak a week earlier, and we all wondered if he had gotten sick from the gorillas. It was certainly possible. We spend five to 10 minutes observing each animal, and a total of two or three hours in the group, watching and listening for a cough or sneeze. With so many adult gorillas coughing in the heavy mist, aerosolized particles could stay in the air long enough to reach our own noses. Distance alone does not protect us, studies have shown.

Ubuntu holds his head.
Even so, the field vets and trackers try to keep a seven-meter distance from the gorillas. Yet there are times when we must move closer — to see inside a nostril or to hear a baby's soft cough, for example. Wearing masks would protect us (and the gorillas), a measure under consideration during recent discussions about tightening visitation rules.
The general feeling, though, is that since the animals aren't accustomed to visitors wearing masks, they're likely to associate them with the threat of an intervention. We'll have to habituate them to this new look slowly. As we climbed the mountain, I wished we'd already started.

Ururabo's infant chews on celery.
But to our great relief, we found all of the sickest gorillas looking a bit better. Poppy rested during periods of sunshine and finally got up to eat. Ruvumu and Rwandarushya coughed repeatedly and forcefully, to the point of nearly retching, but their infants seemed fine. Ururabo's baby slept, nursed and actively played with bits of plant within reach. He had a tiny bit of crusty nasal discharge but no cough that we could hear. His mother also appeared to feel better, despite an even louder cough.
We thought Ururabo's baby had made it through the worst. We were wrong.
[Rwanda, 2008. Pictures: Dr. Lucy Spelman/MGVP]

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