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Authors: Laurie Garrett

BOOK: The Coming Plague
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Platt was indeed very confused.
“Why am I in this plastic tent?” he wondered. “Who are these people looking at me? Where am I? Why can't I read? Did I used to be able to read?”
By November 20, nine days into his illness, Platt began to shed his confusion (along with dead skin and hair), and shortly before Christmas the British government was pleased to conclude that nobody else at Porton Down or in the Platt family had become infected.
England, it seemed, was spared.
News of Platt's illness came to Yambuku on November 12, hitting the commission members very hard. Morale plummeted and collective fear rose. Johnson sensed that the anxiety could be impairing the team's efforts. Certainly Max Germain, whose job was collecting wild, possibly infected animals, was on the verge of panic, and Breman had warned Karl that several team members had asked about the reliability of emergency evacuation plans for flying infected scientists to Johannesburg. Johnson tried to reassure the researchers, but he knew every movement the commission had made since the day it formed had been slowed or impaired by logistic problems.
By November 9, Sureau, having personally searched 21 villages, identified 136 fatal Ebola cases, and mapped the complex relationships of all the dead, recovered, and well people in those villages, was ready to leave. Of all the foreigners flown into Zaire during the epidemic, Sureau had been at it the longest. He was burned out, and both he and Johnson felt the epidemic was over. Sureau began his long journey home.
But the mystery of Ebola was far from solved.
On November 16, McCormick cruised into Yambuku, greeting the commission members with startling news.
“Guys,” he said, “what we have here is two totally separate outbreaks. There is no relationship between what's going on here and what's happening in N'zara, except they both happen to be Ebola virus.”
Johnson looked at Joe as if he had just watched his protégé's mind snap. Breman shook his head in disbelief. And young Piot grinned, thinking, “Jeez, this guy's got balls!”
McCormick explained to his disbelieving colleagues that travel between the two areas was so arduous, and the cultural gaps so great, that people simply didn't go back and forth.
“There's no way the Yambuku epidemic could get to N'zara or vice versa unless some infected person traveled those roads. And I can tell you, guys, my Land-Rover was the first vehicle on those so-called roads in months … maybe years.”
Furthermore, he argued, there were no Ebola cases in the villages between N'zara and the Bumba Zone, and the Sudanese epidemic seemed less severe; more people appeared to survive Ebola in N'zara. McCormick's theories were dismissed out of hand by most commission members, and official
WHO
accounts of the 1976 outbreaks implied there was some as yet undiscovered link between the two epidemics.
18
Joe stubbornly insisted, however, that despite what seemed coincidence on an unnaturally profound scale, the two epidemics were entirely separate events. He would not abandon that belief with the passage of time, and years later would provide irrefutable proof that Nature had, indeed, rolled an incredibly bizarre set of snake eyes.
19
While McCormick wrote up his Sudanese findings for the commission, epidemiology investigations continued in the Yambuku area. Piot was left alone full-time in Yambuku, while other commission members combed neighboring areas. A few days after Joe's return, Piot got a radio message from Johnson, telling him a Zairian Air Force helicopter would arrive shortly to bring him back to Bumba for a meeting with “U.S. Embassy officials.” Piot protested: why should he, a Belgian, fly back to brief a group of Americans?
“Look, Peter, they want to see firsthand what's going on. Don't argue with me. Just get your butt on that copter,” Johnson said.
Piot got off the radio grumbling about the “sick tourism” of the U.S. Embassy and CIA interests, but reluctantly prepared to meet the Zairian helicopter.
As he paced about the mission, the skies suddenly darkened and he could tell a storm was coming. Out of the blackened sky came the Puma helicopter. Without shutting off its engines, the pilot opened his cockpit window and called out to Piot. When Piot asked the pilot about the safety of flying such a large cumbersome helicopter in a storm, he smelled the familiar scent of Zairian beer on the pilot's answering breath.
“Pas de problème,”
the pilot insisted.
Piot asked a few more questions, studied the pilots, and concluded the two of them were drunk.
“The hell with it,” Piot said. “I'm not going to that meeting.” As he
waved off the pilots, a Yambuku villager ran up crying, “Doctor, please! I've never been in the air before. If you are not going, may I take your place?”
Piot shrugged, helped the young man into the helicopter, and waved the aircraft on its way.
Two days later a somber Johnson radioed Piot with bad news, telling him that the drunken pilots had crashed the helicopter. Everybody on board died, and a hunter found the wreckage in the jungle southwest of Yambuku.
Piot listened in disbelief as Johnson went on to explain that the Zairian Air Force was holding Piot personally responsible for the deaths.
“They're saying you sabotaged the helicopter because you're some kind of Belgian colonialist,” Johnson continued. “And they're insisting you have to go out there, get those bodies and perform autopsies. There's no ifs, ands, or buts on this one, Peter. You have to do it. The entire research effort could be shut down in an instant if the Zairian military tells Mobutu we're a bunch of CIA agents or something.”
Shaken and angry, Piot jumped in his Land-Rover and drove as fast as roads would allow to Bumba. There, he was assigned a detail of prisoners from the local jail, who worked all night under Piot's direction, making three coffins. The next morning Piot and the prisoners were flown by bitterly angry Zairian Air Force pilots to a plantation on the edge of the jungle area in which the hunter had spotted the wreckage. With the prisoners in a line behind him hauling the coffins and supplies, Piot cut a path through the rain forest. Whatever image the sight of Piot, the coffins, and the prisoners conjured for local villagers, it was obviously one of great interest. As the grim group cut its way deeper into the jungle, it was joined by clusters of the curious. Eventually, over a hundred people trailed the coffin bearers.
The wind first told them when they had reached their destination, for it carried the stench of three human bodies that had literally cooked for four sweltering days in the equatorial jungle. Piot, standing a foot taller than most of his companions, peered ahead, trying to catch a glimpse of the helicopter. The jungle canopy was so dense that little sunlight penetrated it. Still unable to see the copter, Piot paused and pulled a respirator out of his knapsack.
At the ghastly sight of the wreckage, all the prisoners screamed in horror and ran away. When he turned to look straight at the wreckage, Piot had to struggle hard to hold back a wave of nausea. The bodies had bloated in the humid heat, their eyes bulged, insects crawled over their taut skin, and the stench was overpowering. Fighting back his disgust, Piot forced himself to walk up to the first body, formaldehyde sprayer in hand, to ready it for the coffin.
It was the young villager. Piot swayed, feeling suddenly dizzy. “This should have been me,” he thought. “I should have been in that seat, instead of this poor fellow.”
He looked at the villagers, at the bodies, and called out, “The shoes! The shoes! Whoever helps me gets their shoes!”
A cluster of boys ran forward, helped Piot stuff the bodies into their tight coffins, removed the shoes, and then carried the horrendous burdens—unlidded to compensate for the swelling—out of the jungle.
When they reached the plantation Piot found the military pilots busily pursuing the business of alcohol consumption. They had refused to assist in the removal of the bodies, and looked on Piot with undisguised contempt.
“Here are your colleagues,” Piot said, pointing at the gruesome coffins.
The pilots gulped down more beer and
arak
, ordered Piot to put the bodies in the aircraft, and made it clear that they were in no mood to argue with a white man from Belgium. For half an hour Piot sat white-knuckled, barely able to breathe, clutching the armrests of his helicopter seat as the belligerent, inebriated pilots maneuvered their copter and its macabre cargo to Bumba. When they landed, Piot was beside himself with rage and fear; he called the bluff of Bumba military officers, refused to perform the autopsies they had demanded, and declared, “You have your bodies, I've done my part, the hell with you!”
Peter Piot staggered off into Bumba, feeling more emotionally wretched than he had previously imagined was possible. For the first time in his life, Piot set off, with determination, to get drunk.
After a couple of beers, he felt tears pressing against his eyelids, and thought again of the poor villager who had perished in his place. He bought drinks for anybody in the bar who would hear his story, and soon the modest establishment was packed with thirsty ears.
After a couple of rounds, he heard someone greet him in Flemish, looked up, and saw a white man covered in road dust. Simon van Nieuwenhove introduced himself, explained that he had just returned from a four-week tour of the wilds in search of Ebola cases, and asked if he might join in the revelry.
The two men shared sagas, beers, and emotions, and developed an instant friendship that would bond them like brothers for the rest of their lives.
In the following days Piot and van Nieuwenhove talked for hours, trying to make sense both of the strange epidemic and of its impact on their lives. Piot's backgrounds in medicine and virology had served him well, but the twenty-seven-year-old Belgian had enough humility to recognize that he knew nothing about developing countries, and even less about epidemiology. He had developed a strong admiration for the multifaceted skills of the Americans—Breman, Johnson, and McCormick. And he decided to ask Johnson to recommend him for epidemiology studies at the CDC.
Like so many other members of the International Commission, Piot was discovering that the relatively brief Yambuku experience was completely changing his life. It would be some time before he would discover the effect his African encounter was having back home on his wife, Margarethe. And on van der Gröen's wife, Dina. Unbeknownst to the men, the Belgian
government had informed Dina and Margarethe that “there had been a deadly helicopter crash involving Belgian members of the International Commission.” It would be several days before the women would learn that their husbands were alive.
Since the ghastly incident with the Zairian helicopter, Piot was gaining a healthy respect for danger, among other things. But most of the other survey team members had settled into routines, staying in the more comfortable town of Bumba, driving their Land-Rovers out to the villages, and going house to house completing huge questionnaires on detailed information considered vital to understanding the epidemic. With routine comes complacency, a lowering of both guard and fear.
On November 26, U.S. Peace Corps volunteer Del Conn told team members in the Yambuku area that his head and back were killing him. The pain came on suddenly, and then hung on relentlessly. Conn, who had previously worked in a small hospital outside Kinshasa, had joined the Yambuku survey effort ten days earlier and was assisting Piot in collecting blood samples and village data. He had also helped van der Gröen prepare microscopic samples of Ebola-infected tissues for study in a field lab the Belgian had recently constructed in the mission. A month later researchers would learn that some of Conn's samples, despite ultraviolet radiation exposure and acetone treatment, still contained live Ebola virus.
Though Conn's temperature was only slightly above normal, team members were worried. They notified commission headquarters that it might be necessary to activate the complex system of medical evacuation that had been worked out in detail after days of negotiations with the governments of Zaire, South Africa, the United States, and France. Those procedures required that Conn be placed under strict quarantine for thirty-six hours and airlifted out of the region if his condition worsened.
While Conn lay inside a room of the mission facility, tended to by Karl Johnson and Margaretha Isaacson, the team tried to continue their survey work.
“But there's no question about it,” Breman radioed to Johnson, “this is a major downer for everybody.” Morale plummeted, fear rose.
A Canadian military officer had, coincidentally, arrived a day earlier in Kinshasa with a newly designed portable plastic isolator unit, intended to allow safe transport of contagious individuals.
By November 29, Conn's condition had worsened. His fever was up slightly, blood chemistry showed classic signs of viral infection, back pains were severe, and he was nauseated. In Yambuku, Johnson, Dr. Dennis Courtois, and Isaacson tried to prepare Ebola antiserum from recovered
patients' blood, but power failures shut down their centrifuge and other equipment necessary to ensure safe plasma preparation.
“You can't imagine the fear here,” Johnson radioed to Bumba.
Under contingency plans, a military helicopter was supposed to fly immediately to Yambuku, pick up Conn, and bring him to Bumba. Meanwhile, a C-130 was supposed to fly from Kinshasa to Bumba, load Conn into the Canadian isolator unit, and transfer him to Johannesburg, after a refueling stop in Kinshasa.
But the Zairian Air Force's pilots balked again. Fearing Conn might give them the disease, the pilots refused to fly their helicopter to Yambuku. All other options closed, Johnson, Isaacson, and Courtois loaded Conn into the back of a Land-Rover and drove the bumpy road to Bumba, their passenger groaning in pain all the way. All three scientists wore disposable protective clothing and surgical masks throughout the journey, which lasted four and a half hours because Conn could not tolerate the sudden jarring produced by hitting ruts at speeds greater than ten miles per hour.
When they reached Bumba, continued Air Force fear was obvious: no plane awaited them. And panic among the townspeople was so great that the Land-Rover was not permitted to leave the center of the Bumba landing strip. Unprotected from the tropical sun and forced to wear a tight rubber respirator mask to allay the fears of the populace, Conn was miserable. Johnson and Isaacson sedated the Peace Corps volunteer and gave him analgesics to ease his pain.
As night fell, there was still no word on air transport for the ailing man, so Johnson and Isaacson were forced to make do with available plasma and equipment. Convinced their colleague had Ebola, they hand-administered a unit of Sophie's antiserum into Conn while the young man lay in the back of their Land-Rover.
At dawn an Air Zaire “Fokker Friendship” airplane landed, the Canadian respirator on board.
The two doctors studied the isolator for a moment. It consisted of a plastic pipe frame that outlined a space some seven feet long, four feet high, and four feet wide. Suspended from the frame was a box tent of thick, clear, pliable plastic. From the sides of the box tent hung attached gloves, into which attending physicians would insert their hands and arms when they needed to “touch” the patient.
The doctors carefully slid Conn into the isolator, attached an intravenous feeding tube to a device installed in the box tent, shut their patient inside, and switched on the pressurized air device. It seemed to work, but the intravenous feeding device was poorly designed and the feed rate fluctuated wildly.
An assortment of drugs and medical supplies were also on board the aircraft, and the doctors decided to administer strong painkillers to Conn before takeoff. Commission members in Kinshasa failed, however, to provide a file with which the vials could be opened, forcing yet another delay
while the physicians sought an alternative sterile means to unseal the ampules.
Once the Keystone Kops-like operation was in the air, another failing of the Canadian device was noted: it did not adjust well to altitude-induced air pressure differences. Conn grew anxious as the box tent slowly caved in on him, making his space ever more claustrophobic.
When the plane landed in Kinshasa another snag appeared in the commission's grandiose emergency evacuation plan: no plane was “available” to take the patient to Johannesburg.
Johnson, now fuming mad, contacted U.S. Embassy officials, who relayed an air support request to the USAF. A C-141 Starlifter was dispatched from Madrid, arriving in Kinshasa six hours later. During the long wait, fear of contagion once again forced the group to stay at the airport, this time inside an abandoned hangar. The afternoon heat was so great that the isolator steamed up and was soon creating its own internal rainfall.
Although he received a variety of analgesics, Conn's pain was acute, he was running a fever of over 102°F, and the hours inside the wet, coffin-sized plastic cocoon were driving him crazy. His anxiety reached a zenith when the doctors noticed blood oozing out of the tiny puncture hole through which his intravenous feeder was inserted.
Uncontrolled bleeding, Conn knew, was hemorrhaging; and hemorrhaging was the key symptom of Ebola. Conn had to be heavily sedated.
That night Conn was transferred into the USAF jet and flown to Johannesburg. Because of a storm front, the flight was diverted on a huge loop out over the Atlantic Ocean. The doctors felt Conn would be unable to tolerate turbulence, but the diversion added several hours to their flight time.
The plane landed in Pretoria and Conn was transferred to a South African Air Force plane for his final leg to Johannesburg.
When he was finally removed from his nightmarish cocoon, Conn's entire body was covered with a florid measleslike rash that was not usually seen with Ebola but had been noted in some Machupo and Marburg cases. He had been severely ill for six days before reaching a hospital.
Clearly, the commission's contingency plans had failed completely when put to the test. Johnson was enraged, and scientists still deployed in the field were extremely distressed.
Behind the scenes still more misadventures occurred. The CDC sent a massive hospital containment bed isolator by air from Atlanta, but when the contraption arrived in Johannesburg two crucial components were missing: instructions for assembly and an electrical converter that would allow the American-made device (designed for 110 volt, 60 Hz electricity) to function in South Africa (which uses 220 volt, 50 Hz electricity).
Furthermore, early difficulties in transporting Conn prompted CDC officials to prepare an Apollo space capsule for use in South Africa. That forced a major South African Army mobilization of ground transport capable
of maneuvering the eighty-ton capsule. At the last minute space capsule airlift plans were scrubbed.
All in all, the planned thirty-four-hour evacuation actually took over seventy-two hours, at an inestimable cost to the governments of Zaire, the United States, and South Africa.
And when Conn's blood was submitted to repeated examinations, no Ebola viruses could be found. Nor could the South African team find evidence of any other known human pathogen.
Twenty years later, the cause of Conn's bona fide illness would remain a complete mystery.
Conn, it seemed, had “discovered” another new virus.

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