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Authors: Laurie Garrett

BOOK: The Coming Plague
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But the CDC disagreed; director David Sencer commissioned a rival study that concluded that
A. aegypti
eradication within the United States and Puerto Rico and the Virgin Islands alone would cost more than $200 million and speculated that an Americas-wide eradication would exceed $1 billion.
35
The inflated cost was primarily due to private citizens' refusal to allow spraying on their properties and widespread threats of lawsuits. Though poorer nations to the south spent enormous sums, successfully eliminating
A. aegypti
from much of the Americas, the wealthiest country in the hemisphere refused to get rid of its own mosquitoes.
The effort died.
Frustrated and disappointed, Monath packed his Ibadan laboratory into crates and bade his Nigerian colleagues farewell. But he wouldn't be leaving Africa, not just yet. Something even deadlier than yellow fever awaited him.
Into the Woods
LASSA FEVER
I'm not afraid where we have to bring a risky, hazardous virus into the lab. I just hope and pray, and I don't think about it.
—Dr. Akinyele Fabiyi. Lagos. 1993
 
 
Uwe Brinkmann's head suddenly jerked up, he looked out the car window desperately searching for a familiar landmark along the back roads of northern Germany, and panic fell over him, the true deep panic that comes only when something taps into one's innermost fears.
“Now they've got me,” Brinkmann cried out in his mind. “Now I'm going to be gassed. They're taking me to the concentration camp.”
The sides of the van seemed to be closing in and Brinkmann had no idea where he was being taken. As he looked out the window in the summer of 1974, the city and suburbs of Hamburg gave way to countryside and then, he noted with fear, the woods.
Sealed off from the anonymous driver and the entire outside world, Brinkmann and his companions stared ahead in shared terror. Brinkmann's patient, German surgeon Bernhard Mandrella, lay in subdued delirium on a stretcher between them. To his side sat British physician Adam Cargill, who had treated Mandrella in Nigeria. With the men were three Nigerian women; a nurse/nun and two nurse assistants.
“Nobody wanted us here to begin with,” physician-scientist Brinkmann thought. “So now they are going to get rid of us. All of us.”
As claustrophobia overwhelmed him in their tightly sealed mobile unit, Brinkmann later said he was thinking, “How odd. I have spent the last seven days exposed to a lethal microbe, feeling no fear. Now it is people —my people—that terrify me.”
But Brinkmann had never felt completely at home among his fellow Germans. His part-English family had carefully hidden the Jewish identity of Brinkmann's grandmother throughout the years of the Third Reich, and young Uwe had made a career during the counterculture days of the 1960s out of crafty troublemaking. Similarly, his patient was the son of one of the military officers who tried to assassinate Adolf Hitler on July 20, 1944. Mandrella's father was executed, and his mother was billed by the Third Reich for the cost of the hanging.
“But this time it's really too much, even for me,” Brinkmann thought. Taking stock, he could visualize how this group looked to German officials: three African women whose own government had sent them into isolation, an English physician who was suffering a suspicious case of diarrhea, a man apparently dying of a lethal contagious disease, and himself—a hippie troublemaker. He considered his black shoulder-length hair, thick unkempt mustache, tie-dyed T-shirt, and bell-bottoms. And he recalled headlines in German publications just weeks ago that denounced his famine-relief efforts in Ethiopia; Brinkmann was, the German press declared, creating communist communes in the deserts of the Horn of Africa. Though Ethiopian Emperor Haile Selassie had awarded Brinkmann his nation's highest commendations and requested that the young hippie doctor remain indefinitely in the country, the German government recalled Uwe. It seemed that Brinkmann's solution to Ethiopia's ongoing food crisis—establishing village-based communal farms and produce-marketing apparatuses—was a little too left-wing for the conservative West Germans.
“Yes,” he thought in those seconds of panic, “it makes sense. They will simply eliminate us and tell the world we died of the disease. That will take care of everything.”
There was little to comfort Brinkmann when the caravan reached its destination. Just outside the village of Ebstorf, in the woods some fifty miles south of Hamburg, was an abandoned medieval monastery, recently converted to a high-security facility for smallpox containment. A series of three automatic air-lock doors opened for the anxious group, quickly shutting behind to seal them off from the rest of humanity.
Inside were several sleeping rooms, an autopsy laboratory, and research facilities. Sophisticated research devices rested atop aseptic surfaces.
Though there was an autopsy facility, there was no place for patient treatment.
The group settled in as best they could, but tensions were thigh. The Nigerian women had never set foot outside of the Jos region in which they were born before Mandrella came down with the dreaded disease. Then, having tended to the physician in their Jos hospital, the nurses accompanied the patient to the University of Ibadan Hospital, one of Nigeria's premier medical facilities.
Mandrella's problems began two weeks earlier when his colleague, Dr. Egon Sauerwald, was treating a patient from the old colonial city of Enugu in their St. Charles Mission Hospital, miles away in Borromeo. The patient had high fevers, chills, muscle aches, and a sore throat. Despite Sauerwald's efforts, the Enugu man died. Days later, the twenty-nine-year-old doctor developed the same symptoms, quickly descending into acute disease.
Mandrella did everything possible to save his colleague from the mysterious ailment, but Sauerwald continued to deteriorate. He sent Sauerwald's blood samples to Ibadan, from where they made their way to CDC
laboratories in Atlanta. Word eventually got back that Sauerwald was infected with the recently discovered Lassa virus, a microbe that the U.S. Centers for Disease Control said was “thought to have a unique proclivity for killing doctors and nurses.”
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2
The news was too late for Mandrella. By the time word got back that Sauerwald was infected with an exotic lethal virus, the thirty-three-year-old Mandrella had already performed a last-ditch bloody procedure to save his friend. The virus had so devastated Sauerwald's throat that the doctor couldn't breathe, so Mandrella made an incision into his friend's trachea, creating an air hole in his neck. Mandrella was unprepared for the sudden gust of mucus that flew from his friend's throat. He was instantly spattered with Sauerwald's blood. Though he pulled away quickly, Mandrella's face had been very close to Sauerwald's neck as he made the incision, and the surgeon inhaled microscopic bits of blood and mucus.
Mandrella was infected, and in a couple of days he too was shivering with Lassa fever. Still unaware of the CDC laboratory findings, Mandrella saw Dr. Hal White, an American physician who ran the missionary hospital in Jos. White examined Mandrella and warned the young doctor that the symptoms looked suspiciously like those of Lassa fever. As a precaution, White injected Mandrella with a unit of sera donated years earlier by nurse Lily (“Penny”) Pinneo. At White's advice, Mandrella immediately drove to the metropolis of Ibadan, where he came under the care of British physician Adam Cargill of the University Hospital.
Nigerian health officials reacted with considerable alarm. They had already had their fill of this terrible disease, which was named after the village of Lassa, located southeast of Jos, in the Yedseram River valley that runs along Nigeria's eastern border with Cameroon. In 1969 an outbreak of the disease in Lassa had brought it sharply to Western attention for the first time when American nurses fell ill in the town's Church of the Brethren Mission Hospital.
It was a long chain of events, stretching back five years, that brought Mandrella, Brinkmann, and their colleagues to this moment of panic in Germany.
On January 12, 1969, a sixty-nine-year-old mission nurse began complaining of a sharp backache. Laura Wine told her colleagues the pain was increasing as days went by, but assumed she'd done something to wrench her spine. Perhaps the daily rounds of bed changing and turning patients were the cause, she thought.
3
After a week, however, the nurse also had a throat so sore she couldn't swallow, and her colleagues saw ulcers lining her pharynx. Assuming she was suffering from some bacterial infection, such as streptococcus, the hospital staff gave Wine penicillin.
But the antibiotics did no good. Wine's state escalated; fevers of 101°F, acute dehydration, unusual blood-clotting activity, a complete lack of proteins in her urine—these and other symptoms signaled that the woman was
suffering from something wholly unlike the multitude of tropical diseases tolerated by residents of the grassland Yedseram River valley.
 
WEST AFRICA
Over the next four days Wine began to swell, her skin showed signs of hemorrhaging, her heartbeats became irregular, she grew disoriented and was unable to speak properly.
On January 25 volunteer pilots flew Wine to Jos, rising from the hot grasslands at sea level up to the 4,000-foot-high town of Jos. As they made their journey the air cooled, the humidity dropped, and the tin mines around Jos came into view.
Jos itself was inhabited by some 12,000 people, a large percentage of whom were European expatriates seeking refuge from the heat and malarial mosquitoes of Nigeria's lowlands. Members of all three of Nigeria's leading tribes—Hausa, Ibo, and Yoruba—lived in Jos, and the community had come through the tragic Biafran war fairly unscathed. Though tens of thousands of Nigerians died in the civil warfare of 1967–68 and thousands more were uprooted from their homes, Jos suffered only twenty-four hours of rioting and killing during that period.
Dr. Jeanette Troup and nurse Lily Pinneo greeted Wine at the Jos landing field. Because radioed descriptions of Wine's illness seemed to indicate cardiac problems, the pair immediately strapped an oxygen mask on the ailing nurse and rushed her to their Bingham Memorial Hospital emergency ward. There, Troup and her staff did everything possible to save Wine's life.
They failed. A day after arriving in Jos, Wine went into horrible convulsions and died.
Three days later, a Jos hospital nurse who had tended to Wine felt chills, a headache, and dull pains in her back and legs. Forty-five-year-old Charlotte Shaw had gently dabbed Wine's bleeding mouth with a gauze pad. When she too fell ill, Shaw remembered she had a tiny rose thorn cut on her finger—the very finger she had used to push the gauze along Wine's mouth.
Soon Shaw was experiencing the same symptoms that had claimed her patient: fevers, rashes, hemorrhaging, pains, swellings, heart irregularities. After eleven days of illness, she died.
That night Dr. Jeanette, as she was called, performed an autopsy, assisted by her head nurse, fifty-two-year-old Pinneo.
Pinneo, a Presbyterian missionary, had followed Shaw's progress carefully, monitoring her lab results every day. Shaw and Pinneo had been close friends. As she donned her gown, gloves, and mask to assist in the autopsy, Pinneo thought, “How can I do this? How can I possibly face opening her up?”
Troup and Pinneo gasped when they saw the devastation; every organ of Shaw's body was seriously damaged. The heart was stopped up, with loads of blood cells and platelets piled well into the arteries and veins. Fluids and blood filled the lungs. Dead cells and fat droplets clogged the
liver and spleen. The kidneys were so congested with dead cells and proteins that they had failed to function. When the team cut open Shaw's lymph nodes they discovered with some shock that absolutely no lymphocytes—disease-fighting white blood cells—were inside. The nodes had been completely emptied.
A week after assisting in the autopsy, nurse Pinneo also fell ill. This time the medical staff took the case seriously, admitting their colleague to the hospital with the first signs of fever.

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