The Coming Plague (17 page)
Authors: Laurie Garrett
Further evidence of relapses emerged when the team studied hospital records going back five years. In the end, they were convinced many past
cases of unexplained feverish ailments could be considered Lassa; one such former patient was tracked down, tested, and found to have antibodies against Lassa, showing he had, indeed, once been infected with the virus.
cases of unexplained feverish ailments could be considered Lassa; one such former patient was tracked down, tested, and found to have antibodies against Lassa, showing he had, indeed, once been infected with the virus.
Because the scientists couldn't pin down the original source(s) of the Liberian epidemic, Mertens knew he should expect additional cases of the disease in the future.
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Though he could do nothing to prevent village outbreaks, Mertens was determined that the disease would never again be spread within his hospital. The entire staff was trained in proper disease control measures, hygiene, instrument sterilization, and other classic practices that have been used with general success to block the hospital spread of microbes since the days of Baron Joseph Lister.
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Though he could do nothing to prevent village outbreaks, Mertens was determined that the disease would never again be spread within his hospital. The entire staff was trained in proper disease control measures, hygiene, instrument sterilization, and other classic practices that have been used with general success to block the hospital spread of microbes since the days of Baron Joseph Lister.
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Monath had barely caught his breath and was, once again, preparing to return to the United States when Peace Corps physician Michael Gregg, then working in Sierra Leone, contacted the CDC. The volunteer doctor was convinced Lassa had struck. Once again, Monath gathered up Casals and Pinneo. The trio made their way in September 1972 to Freetown, capital of Sierra Leone, and were joined by CDC investigators David Fraser, Paul Goff, and Carlos (“Kent”) Campbell. Together, they solved the Lassa mystery, though their efforts went largely unnoticed back home in the wake of the Watergate break-in and heated U.S. presidential elections.
About two hundred miles east of Freetown, not far from the borders of Guinea and Liberia, Lassa fever struck among villagers and diamond mine workers. At first glance the epidemic seemed a repeat of those in Jos and Zorzor: hospital-based. But it didn't take long for Monath and Casals to recognize that most of the people then suffering Lassa in Panguma Hospital acquired their infections somewhere else. A search through the medical records of six hospitals in the region revealed sixty-three cases of what looked suspiciously like Lassa, occurring between October 1, 1970, and October 1, 1972, with the numbers of sick having increased steadily over the two years.
Once again, Monath donned thick gloves and a respirator to hunt wild animals in the villages and mining camps around Panguma. Casals and Pinneo took blood samples from hospital staff members. The hunt was on. Cats and dogs were grabbed by the villagers, who held the animals still while Campbell, Casals, and Monath drew blood samples. Hundreds of traps for rats and mice were set, bats were netted in the night. Again, the wild animals bared their fangs at their captors, who carefully killed the beasts with gloved hands.
“This is fantastic!” Monath thought, sensing the possibility that here, in these Sierra Leone villages, the animal that carries Lassa viruses would finally be found. So great was the excitement that the team members kept their fears private, never voicing anxieties about getting the dreaded disease. The shorter, older meticulous Monath kept a watchful eye on Kent, however. Towering over everyone, Campbell had the lanky strong build of a basketball player and the impulsive swift movements of an athlete.
Indeed, twenty-six-year-old Campbell got so wrapped up in the quest that he suggested the team do something they would all later agree was “really, really dumb”: take phlegm samples from deep inside the lungs of Lassa patients lying on the wards of Panguma Hospital. Temperatures in Sierra Leone were hitting 110°F and humidity topped 90 percent, so Monath and Campbell often found their protective gear (consisting of latex surgical gloves, facial respirator masks, surgical cotton gowns and foot coverings) intolerable and “fudged a little,” as Campbell put it, creating spots along their masks and gowns that allowed air circulation. Young Campbell, who had just signed on for a two-year hitch with the CDC to avoid the Vietnam War draft, enjoyed working with the older, more experienced Monath. Though Monath was an urbane Bostonian and Campbell hailed from eastern Tennessee, both men had spent formative years at Harvard studying medicine and public health. Campbell planned to return to Harvard when his CDC hitch was over, to complete his pediatric residency.
Monath, Campbell, and the rest of the group collected more than 640 animals: mice, rats, shrews, bats, and house pets. The animals' lungs, hearts, spleens, kidneys, and blood were carefully removed with sharp dissection scalpels wielded cautiously by gloved hands. All were placed in liquid nitrogen, meticulously labeled, and prepared for overseas air shipment to the maximum-security laboratory at the CDC in Atlanta.
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While the team anxiously awaited results, they studied the villages carefully, trying to see what was unique about those that had Lassa cases. In all the eastern Sierra Leone villages around Panguma and nearby Tongo, people lived in large extended families that resided in houses made of mud coated with cement. Their roofs were of iron sheets or thatching, the floors packed mud. Harvested grains were stored in sacks and baskets inside the homes.
The villages were clusters of homes encircling a clearing. Outside the village lay some croplands and rain forest; at times it was hard to tell where one stopped and the other began. Because it was the rainy season, peopleâand animalsâtended to spend their time in shelters.
When the team captured animals they noticed three types of mice and rats scurrying about the villages, and one typeâthe
Mastomys natalensis
ratâwas present in greater numbers in villages stricken with Lassa.
Mastomys natalensis
ratâwas present in greater numbers in villages stricken with Lassa.
To the joy of all the research team members, CDC laboratory analysis confirmed their hunch. Of 350 animal species initially tested, only
Mastomys natalensis
turned up positive for Lassa virus infection. Better yet, the infected rats came from the same villages where humans had the disease.
Mastomys natalensis
turned up positive for Lassa virus infection. Better yet, the infected rats came from the same villages where humans had the disease.
Though the major puzzle was finally solved,
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two questions remained: why had the
Mastomys
suddenly become a problem in key villages; and how did the rats pass Lassa virus on to the people?
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two questions remained: why had the
Mastomys
suddenly become a problem in key villages; and how did the rats pass Lassa virus on to the people?
Monath's group noticed that
Mastomys
had tough turf competition in the form of the larger, more aggressive black rat,
Rattus rattus.
In some villages, the people had driven out or eaten the big black rats, leaving smaller brown
Mastomys
virtually unopposed on the playing field.
Mastomys
often came out of neighboring fields and took shelter from the rains inside homes.
Mastomys
had tough turf competition in the form of the larger, more aggressive black rat,
Rattus rattus.
In some villages, the people had driven out or eaten the big black rats, leaving smaller brown
Mastomys
virtually unopposed on the playing field.
Mastomys
often came out of neighboring fields and took shelter from the rains inside homes.
Less clear was how the rats gave people Lassa. Few of the humans who were infected could recall being bitten, and the team was unable to prove one way or another that
Mastomys
could pass the virus in its urine, as had already been seen with Junin and Machupo.
Mastomys
could pass the virus in its urine, as had already been seen with Junin and Machupo.
Back at the hospitals in Tongo and Panguma, Pinneo's lifesaving antibodies once again were used in hopes they would help in the recovery of two Lassa patients. But the team discovered in laboratory studies that antibodies from the original Nigerian strain of Lassa virus (now dubbed Pinneo) reacted poorly with the Sierra Leone virus. Weaker still was the reaction to Monath's Liberian strain. This meant there were at least two widely divergent strains of Lassa viruses in West Africa, and Pinneo's antiserum could not be counted on to save patientsâand scientistsâwho got Lassa outside of the Jos region of Nigeria.
It was possible, the group concluded, that Pinneo's antiserum had no real effect on the two Sierra Leone patients to whom it had been given, as there were indications that both women were already recovering.
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Any comfort Pinneo's units of blood carefully stored at the CDC might have provided to doctors, nurses, and researchers working in West Africa in the 1970s clearly had to be muted.
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Because
Mastomys
was a common African rat, found in fields and villages from Sudan to South Africa, it seemed possible dozens of additional strains of Lassa lurked on the continentâstrains Pinneo's antiserum might not be able to combat.
Mastomys
was a common African rat, found in fields and villages from Sudan to South Africa, it seemed possible dozens of additional strains of Lassa lurked on the continentâstrains Pinneo's antiserum might not be able to combat.
Back at Columbia University, John Frame was convinced Lassa fever could be found throughout West Africa if a scientific search was carried out. With a paltry budget of only $5,000, Frame and Casals screened the blood of missionary workers from countries all over West Africa. They found evidence of Lassa infection in people stationed in Mali, Upper Volta,
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Ivory Coast, Zaire, and possibly the Central African Republic. That meant Lassa existed in at least eight countries.
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Ivory Coast, Zaire, and possibly the Central African Republic. That meant Lassa existed in at least eight countries.
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Kent Campbell had a similar idea. Mischievously, he thought he could combine some smart science with a CDC-paid extended trip through Ireland by offering to screen nuns who had in the past worked at Panguma Hospital. Since its opening in the 1950s Panguma had been staffed by the Sisters of the Holy Rosary, an Irish Roman Catholic order. The nuns tended to rotate through the African hospital, returning to Ireland after a year or two, so several dozen women who could have been exposed to Lassa now lived in Ireland. Campbell told the CDC that testing those women might reveal the answer to a key question: had Lassa been around Sierra Leone for decades but gone unnoticed amid the plethora of diseases people suffered, or was the virus new?
He argued persuasively to the Atlanta bosses: “If you weren't paying close attention, you wouldn't be able to distinguish Lassa from malaria.
They look exactly the same until the tail end of Lassa when the hemorrhaging starts.”
They look exactly the same until the tail end of Lassa when the hemorrhaging starts.”
Campbell got the okay, hopped a commercial jet to London, connected with his wife, Liz, and the two of them happily embarked for the Emerald Isle. For four days Kent and Liz traveled all over Ireland, from convent to convent, testing the nuns and sightseeing. For Kent, it was a welcome relief from the hard work in Sierra Leone; for Liz it was a break from pacing about their Atlanta home worrying about her husband's safety.
One afternoon two of the Sisters took the Campbells to Blarney Castle, where they, like thousands of Americans before them, bent to kiss the Blarney stone. When they returned to their car, Kent suddenly reeled, feeling as if he'd been hit hard on the back of the head. Within seconds, sweat poured out of his skin and he became terribly feverish.
By the time the Sisters got the Campbells back to their hotel, Kent was delirious and running a 107°F fever. Liz was hysterical. The Sisters called London authorities, who ordered Kent transferred immediately to the hospital of the London School of Hygiene and Tropical Disease.
Later that day, the Campbells boarded a commercial Aer Lingus jet, and flew without special precautions, amidst hundreds of tourists. No one had instructed Liz to do otherwise, and Kent was in no condition to do more than follow Liz's orders. On arrival in London, again without extraordinary precautions, they grabbed a taxi to the London School. And once inside the hospital, the ailing Kent was placed on an ordinary isolation ward and treated by doctors and nurses who had no idea what should be done.
After a day and a half of delirium, Campbell was given a pint of Jordi Casals's blood antiserum. It was midnight and Campbell barely realized he was being transfused.
Five hours later he opened his eyes to see his friend Tom Monath worriedly hovering over him.
“What're you doin' in London?” Campbell drawled in his gentle Knoxville accent.
“We're getting you out of here,” Monath responded abruptly.
Campbell had no idea how much anxious negotiation had surrounded his case over the previous thirty-six hours. State Department and White House officials had been in discussions with 10 Downing Street and Whitehall; CDC bosses had kept an open line to their counterparts at the London School; the decision was made to get Campbell onto American soil as quickly as possible.
That night the Campbells were driven to Heathrow Airport, this time wearing respirators to protect others, and transported in a special ambulance driven by volunteers. Awaiting the couple on the tarmac was a USAF C-141 transfer jet, inside of which was an Apollo space capsule that had been flown from a U.S. military warehouse in Frankfurt, Germany. Sealed off from the outside world, the couple rested in seats designed for astronauts
orbiting deep in space. Monath and four USAF medical corpsmen monitored the Campbells during their transatlantic flight.
orbiting deep in space. Monath and four USAF medical corpsmen monitored the Campbells during their transatlantic flight.
When the plane landed at New York's Kennedy Airport, another special ambulance greeted the group on the runway, taking the Campbells off to Columbia-Presbyterian Hospital.
For four weeks Kent was treated in the same room in which Casals had once languished. Liz was monitored closely, and remained well. After thirty days, Campbell recovered and was ready to return to his job at the CDC, but officials politely asked that the young doctor “take a little time off”: it seemed many employees of the world's most prestigious disease control agency were afraid Campbell might still harbor contagious infection.
During his time off, Campbell got a bill from the U.S. Air Force: $17,000, payable immediately, for medevac airlift services. Kent shrugged and passed the bill on to CDC director David Sencer, who gruffly sent it back to the Defense Department.
In recognition of his recent hardship, CDC officials next gave Campbell a choice assignment in Hawaii, where he and Liz spent several weeks during a rubella outbreak. Upon returning to Atlanta, his obligatory conscientious objector stint at CDC nearly completed, Campbell spotted a help-wanted notice on an agency bulletin board: “Chief Malaria Control Officer: El Salvador.”
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