The Coming Plague (108 page)

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Authors: Laurie Garrett

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Expertise in tropical disease was dwindling in the United States. Of the roughly 1,000 members of the American Society of Tropical Medicine and Hygiene the majority were retired or approaching retirement age. “There is no question that human resources are dwindling,” Dr. Stephanie Sagabiel of the National Academy of Sciences said. “There is a real dearth of shoeleather scientists with actual experience of working in the tropics.”
The CDC's Duane Gubler and Joe McCormick had separately reached the conclusion that America and Europe no longer offered the kinds of training that would leave the world another generation of “disease cowboys.” Everybody was overly specialized, they argued, unable to handle themselves in a crisis that required a broad range of skills.
“Twenty years ago field epidemiologists were the real article,” Gubler explained. “They could do it all: field study on the ground, laboratory work, organism isolation, vector analysis. There's a paucity of that now. And I can't understand it, really. To me what's sexy is to go out in the field—that's where the excitement is. Maybe I'm a romantic, but to me what's hot is going out, kicking around in the field, and seeing a disease in its natural ecology.”
The problem was money, or the lack thereof. Any bright twenty-five-year-old junior scientist could see that there was no financial future in preparing to be a “disease cowboy.” At Harvard University, Dr. John David ran the Department of Tropical Public Health and spent increasing amounts
of his time trying to find words of encouragement for his students and young faculty.
“I tell them, ‘First you have to decide, do you want to do biomedical research, practice medicine, or do research in developing countries, fieldwork,'” David said, noting that it would be almost impossible to have it all in the 1990s. “If you want to do it badly, you'd better realize there will be a lot of sacrifice. A bright young person could be trained very quickly here in epidemiology or health policy for developing countries, but where would he get a job?
“It's a big problem now, and people are leaving the field. It's a very hard time to recruit people to the field. And it's
very
discouraging. I have faculty people here say to me, ‘Look, if I don't get a grant this time I'm going to have to go to industry.' And they have gone, many of them.
“There's no reason to be particularly optimistic about these problems,” David concluded.
Had the Honolulu scenario been reality, had an airborne Ebola virus broken out in a genuine refugee crisis as depicted, less than ten days after its apparent emergence the virus would have been carried by infected relief workers and soldiers from its Basangani epicenter to the following locations: Bangkok, Manila, Frankfurt, Geneva, Fayetteville, Washington, D.C., New York, Honolulu, and Fort Detrick, Maryland. Quarantine and isolation procedures would have to be strictly adhered to in each location where people interacted with the infected travelers. In addition, since most of the civilian travelers from Basangani flew aboard standard commercial airlines, WHO would need to mount an immediate international effort to trace all passengers who had flown on more than ten intercontinental flights. As the experience nearly two decades earlier with the U.S. Peace Corps volunteer infected with Lassa had shown,
2
such passenger tracings, health examinations, and quarantines were both monumentally difficult to perform and extremely expensive. Most participants in the Honolulu exercise were frankly skeptical that such an effort could be mounted before the virus became pandemic in scope.
Two years after the Honolulu war games Russell would be out of a job, as would most of the experienced scientists who had served under his command, victims of DOD cutbacks. The military's preparedness for such medical emergencies would only worsen after the 1989 war games in Honolulu.
U.S. military preparedness was put to the test in the Persian Gulf war. In that case several months of diplomatic saber rattling would precede actual combat, providing the Department of Defense with ample time to construct portable operating theaters, quarantine units, “space suits,” respirators, and other gear to withstand Saddam Hussein's alleged biological weaponry.
But biowarfare would never break out, so the Defense Department would never know whether or not the equipment would have stood up to anthrax,
plague, Ebola, or whatever microbe was hurled at U.S. troops. Physicians working in the facilities would complain, however, of the damage wrought by the Saudi desert sands that would find their way inside all the portable hospitals and operating theaters, into the high-tech equipment, and onto complaining patients. Grains of sand were considerably larger than bacterial and viral microbes.
 
If recent history hadn't offered ample evidence, a startling reminder of the difficulties inherent in trying to limit the spread of emerging microbes in the era of jet travel came from the Reston Ebola outbreak among research monkeys. The incident showed that in a week's time hundreds of people on four continents could be exposed to an apparently new microbe, well before authorities were aware of its existence. Though the particular strain of virus involved in the outbreak at Hazelton Research Products, Inc., in Reston, Virginia, later proved harmless to human beings, public health experts were stunned, and a little bit frightened. What if it
had
been a human pathogen?
Jim Meegan, who in 1989 filled the emergency response slot at WHO that would later be Jim LeDuc's posting, had been responsible for tracing the international aspects of the Reston monkey Ebola outbreak. The Reston incident bared all the public health system's weaknesses, and the naked truth was deeply disturbing to the scientific community.
The chain of events began on October 21, 1989, at the Ferlite Company in the Philippines, an animal distribution center. One hundred cynomolgus monkeys were shipped from Manila in the cargo hold of a KLM commercial airliner; their ultimate destination was New York City.
On October 24 the monkeys arrived at the Hazelton Primate Center in Reston, Virginia, and within two weeks the caretakers noticed an unusually high die-off rate among the group, according to General Philip Russell. “By November 10 we began to suspect some sort of hemorrhagic fever was killing these animals off,” and they took steps to quarantine the infected animals.
By December over 50 monkeys had died of the disease and 300 had been euthanized to control the epidemic. Blood tests showed that the monkeys carried two viruses: the simian hemorrhagic fever virus, which was not infectious to humans, and Ebola, which usually was.
3
Inside the Hazelton facility and nearby Fort Detrick, where Army scientists were trying to figure out what was causing the monkey die-off, panic reigned. Every sniffle, headache, or fever that struck the personnel was taken as a sign of a possible spread from the monkeys to humans. And it was the flu season, so many researchers had some symptoms of illness.
Urgent detective work began, headed by Meegan and Joe McCormick, then head of the CDC's Special Pathogens lab. Where possible, every human being and animal that might have come in contact with the monkeys was examined for infection. Unfortunately, testing in the Philippines was
delayed because a rebel uprising made it impossible for CDC investigators to reach the Ferlite Company, located well outside Manila in an area under guerrilla siege.
When Meegan tried to guess how many
Homo sapiens
had been exposed to the cynomolgus monkeys before they reached Reston, he came up with sobering numbers. He warned his colleagues at the Honolulu gathering to pay close attention to the message hidden behind the numbers: namely, that epizootic events could instantly lead to global pandemics if the microbes possessed the ability to infect human beings. As he described the chain of events, General Russell tried to keep a mental tally of how many human beings could have been exposed to the monkey virus and might—had it been a microbe that was dangerous to humans—have fallen ill and/or spread it to others.
The human exposure trail began at the Ferlite Company, where more than a dozen employees handled the animals, and proceeded to the Manila Airport. There, the boxed animals rested in a hangar prior to enplaning, and were fed and watered by a small staff of caretakers. The animals were loaded onto the airplane mechanically, but their plywood boxes were positioned by two cargo men prior to takeoff. It did not appear that additional personnel were exposed to the monkeys during flight stopovers in Bangkok and Dubai.
But in Amsterdam the animals were off-loaded manually by a team of cargo handlers who, without wearing gloves or protection of any kind, carried the monkeys in their boxes to automated delivery conveyer belts. The animals were then housed inside one of the world's largest animal hostels, located in the Amsterdam airport and operated by KLM. More than 23,000 monkeys per year were housed for a day or longer in the KLM facility, species of all types, coming from all over the world.
Stacked near the Philippine monkeys were two monkeys from Ghana that were destined for delivery in Mexico, and another group of African animals bound for Moscow. During their stay in the hostel the Philippine animals shared a common water source, and caretakers fed and monitored the animals, moving around the monkey area without wearing masks or changing gloves.
After their Amsterdam stay was completed, the animals were hand-carried aboard another KLM aircraft, potentially exposing an additional crew of cargo loaders. Hours later the plane landed at JFK International Airport in New York City, where yet another crew of cargo handlers was potentially exposed to the animal viruses. The monkeys were stored in the massive JFK animal holding center, through which more than 50,000 animals were processed every month. They were tended to by animal caretakers who, as had been the case with their KLM counterparts in Amsterdam, took few special precautions to protect themselves from potential primate microbes. Outside the animal center was the huge airport, which typically handled close to 28 million human passengers a year,
coming from or bound for nearly every other international airport in the world.
Even as CDC investigators began screening employees at Hazelton Research Products in Reston and at JFK, word came down that an unusual die-off of cynomolgus monkeys was occurring in another research colony, in Philadelphia. Those animals also came from the Philippines, via JFK, arriving in Philadelphia on November 28, 1989.
4
And three other shipments of Philippine monkeys that arrived in the United States between November 1989 and March 1990 were found to contain animals that were infected with the Reston virus. At least 173 people working in the various monkey centers were potentially exposed.
5
The CDC found that five animal handlers working in the primate centers and one employee of the animal center at JFK had developed antibodies to the Reston virus, indicating that they had probably been infected.
6
U.S. Army researchers maintained a fairly high level of concern about the Reston virus well past the New Year, but Joe McCormick and his CDC crew at the Special Pathogens Branch had long since decided that the microbe was harmless to human beings. And they had good reasons to be dismissive: McCormick was one of fewer than ten scientists on earth who had ever witnessed an Ebola epidemic and studied patients who were afflicted by the virus. Working with McCormick was British physician Susan Fisher-Hoch, who had studied Ebola extensively, first at England's Porton Down Laboratory and later at the CDC. And McCormick's group had just completed genetic sequencing of key portions of the dangerous human Ebola virus.
7
“This is not a dangerous pathogen,” McCormick and Fisher-Hoch repeatedly said, despite continued panic at Fort Detrick. They were thoroughly convinced that the Reston virus posed no threat to human beings.
But that wasn't satisfactory for the New York State Department of Health. The agency was appalled to learn of the apparent infection of an airport employee, particularly given that 80 percent of all research primates legally imported into the United States passed through JFK. There was also grave concern that the Ebola-like virus might not be limited to monkeys from the Philippines. CDC tests showed that 10 percent of all African and Asian monkeys had antibodies to filoviruses, the class of viruses that included Ebola and Marburg.
Accordingly, the New York Commissioner of Health, David Axelrod, decreed that effective at 12:01 a.m., March 23, 1990, no more monkeys could come through facilities located in the state of New York without documented evidence of sixty prior days of quarantine outside the United States and the understanding that an additional sixty days of quarantine would be required before commercial sale or research use of the animals would be permitted.
8
The state's action forced the CDC's hand, and a flurry of edicts and national meetings followed. The public health community was reminded of
the 1967 Marburg disaster, of a 1989 outbreak of simian hemorrhagic fever virus in New Mexico State University's primate center, and of the 1989 death of a laboratory worker at the International Research and Development Corporation in Mattawan, Michigan, who caught the simian herpes B virus from a Chinese monkey. There were loud calls for a full ban on the importing of wild monkeys.
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