The Coming Plague (26 page)

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Authors: Laurie Garrett

BOOK: The Coming Plague
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Joel Breman did not return to his Michigan Swine Flu work. Instead, he devoted two more years to African research on behalf of the CDC and WHO. He joined efforts to search for cases of monkeypox, a type of virus similar to smallpox that produced illness, but rarely death, in human beings.
WHO
wanted to be sure that it was safe to cease smallpox immunization efforts; it was essential that Breman find out whether wild monkeys carried forms of pox viruses deadly to humans.
20
Throughout the late 1970s and early 1980s human monkeypox case reports would increase steadily, from zero prior to 1970 to 35 in 1983, most occurring in the rain forest regions of Zaire.
21
In 1984 some 214 cases would be found in Zaire alone.
22
It would turn out that most monkeypox cases occurred in—yes—the Bumba Zone of Zaire in the villages surrounding Yambuku.
23
All sorts of animals living in the Bumba-area jungles would be shown to carry monkeypox: tree squirrels, forest monkeys, chimpanzees, and antelopes. But in the end scientists would conclude that the rain forest virus was not genetically close enough to the smallpox virus to pose a threat to human populations, and the monkeypox virus spread so inefficiently from person to person that
Homo sapiens
epidemics never occurred.
24
Breman insisted that the animals and people studied in equatorial Africa during the monkeypox surveys—particularly those surveyed in the Bumba Zone—also be tested for both Ebola and Marburg virus infections. After nearly ten years of testing, no infected animals would be found, although a handful of bats captured in faraway Cameroon would test antibody-positive for prior exposure to Ebola.
The mystery of where Ebola came from would haunt most of those who had been involved in the Yambuku and N'zara investigations for years to come. Guido van der Gröen would spend years working patiently in the highest-security laboratories in the United States, the Soviet Union, and Europe, searching for clues to the origin of Ebola in the virus itself. He was determined to crack the mystery of the organism that he and Karl Johnson had dubbed the Andromeda Strain.
He would participate in two expeditions back to the Yambuku area in 1979, piggybacking on Bremen's monkeypox searches, and would test countless animals in search of the natural reservoir of the deadly virus.
In 1980, David Heymann, who was also fixated on the Ebola mystery, would discover that pygmies living in the dense rain forests of Cameroon had antibodies to Ebola, indicating that they had once been infected with the virus. He would corral support from Pat Webb and Guido van der Gröen, and the trio would spend two months living among the Cameroonian pygmies.
The tall white foreigners would find their African counterparts remarkably receptive to the pursuit, willing to use their awesome hunting skills to capture all sorts of creatures for the scientists to test. Van der Gröen would run immunofluorescence tests on over 3,000 animals of 100 different species, ranging from one-meter-long poisonous snakes to chimpanzees.
Webb and Heymann would eventually discover that 15 percent of the pygmies had antibodies to Ebola, proving that whatever animal served as the reservoir of the deadly virus lurked in the dense rain forests of that
region. But none of van der Gröen's meticulously preserved animal samples would be infected.
Still further into the future, Joe McCormick would continue his search, testing animals in the western Ghanaian rain forests. Because it turned out that the natural reservoir of monkeypox was flying tree squirrels, McCormick would capture and test squirrels. And he would find one tree squirrel that had antibodies to Ebola. But it would not be carrying the virus.
The source of both horribly lethal viruses—Marburg and Ebola—remains a complete mystery.
“There is a strong suspicion that the disease is a zoonosis. Monkeys did not seem to play a role in these epidemics and rodents, or bats, may perhaps be the animal reservoir,” stated one of the International Commission's reports.
25
A later
WHO
official report would bemoan that “since the natural reservoirs of Marburg and Ebola viruses are unknown, no control activities can be carried out in Africa.”
26
Perhaps the bluntest statement appeared in the commission's second report: “As in the case of Marburg virus, the source of Ebola virus is completely unknown beyond the simple fact that it is African in origin.”
27
But even the assumption that all cases would originate in Africa would prove naive in years to come.
The commission was, however, able to explain how the apparently extremely rare disease spread quickly throughout the Bumba Zone and Maridi. Knowing why a disease spread could allow local authorities to limit future epidemics to a handful of primary cases, preventing hundreds of deaths. El Tahir put it best: “The hospital must be viewed as an epidemic amplifier.” Both in Maridi and in Yambuku the poorly supplied clinics reused syringes hundreds of times a day, injecting drugs from one person to another without sterilizing the needles. McCormick calculated that during the months of September and October 1976, an individual's odds of getting Ebola virus from a single injection at the Yambuku and Maridi hospitals
exceeded 90 percent
. Seventy-two of the primary cases in Yambuku (out of 103) were caused by unsterile needles used in the mission hospital. Sureau calculated that 43 percent of the Yambuku-area Ebola victims who got the disease from another person survived the ailment, but only 7.5 percent of those who were injected with contaminated syringes survived.
At the Yambuku Mission Hospital, for example, the commission eventually figured out that the majority of the early Ebola cases involved women who came to see the Sisters for pregnancy-related checkups. When women were questioned, it turned out the real draw to the mission was a miraculous injection that made pregnant women feel energetic and content.
It was vitamin B complex.
The commission determined that injected Ebola infections were far more likely to result in terminal disease than were secondary exposures to sick friends and family members.
The Sisters did not appreciate this information. Still grieving the loss of
more than half their staff and colleagues, the missionaries would not countenance accusations that the very individuals who had given their lives in a saintly struggle against an unknown horror should now be labeled agents of epidemic spread.
28
As Christmas approached, Peter Piot prepared to leave the place that had over two and a half months' time come to feel like something of a home. He had long since sold the wedding suit and wing tips he wore to Kinshasa. Gone too was his naïve arrogance. In its place was a new sense of confidence coupled with a healthy respect for the microbial world.
“I have seen things which most Europeans only read about in books or see in adventure movies,” he told Sister Genoveva. “My mother, a typical Flemish woman, always taught me, ‘Speaking is silver, silence is gold.' But I have seen too much to keep my mouth shut.”
As the Belgian packed crates for his departure, another young adventurer was sitting in Kinshasa, eagerly awaiting his opportunity to go to the Bumba Zone. American CDC scientist David Heymann had volunteered without hesitation to be the last foreign scientist in Yambuku, charged with cleanup epidemiology and, perhaps most important, giving the rest of the crew an opportunity to head home for Christmas.
At Bumba's airport Heymann and Piot met for the first time, shook hands, and headed off in opposite directions. Years later the pair would work side by side, trying to control another, far larger, deadly epidemic. Piot recognized the excited look in Heymann's eyes: it was the same look that had filled the now world-weary Belgian's face when he first arrived so long ago.
As Heymann drove Piot's Land-Rover along the road to Yambuku, he spotted boys along the way playing with homemade toys. Throughout Southern Africa, boys made clever sculptures of cars and trucks from cast-off wire, and rolled their toy vehicles along the roadside in imitations of the real ones. But Heymann saw these Bumba-area boys all had made something very unusual: helicopters. Nowhere else in Africa had Heymann seen children playing with helicopters. One boy, seeing Heymann's white face coming down the road, merrily held his helicopter up in the air and then dropped it to the ground, laughing hysterically.
“Wonder what that was about,” Heymann thought.
Back in Bumba, Piot was unknowingly preparing for one more undesired adventure. He glanced angrily at the military pilots who were laughing and guzzling beers with fellow officers while the huge C-130 was loaded. The Bumba quarantine having finally been lifted, hundreds of local traders and still nervous families were clamoring for spots on the huge plane, along with their goats, pigs, monkeys, chickens, and sacks of worldly goods. The
task of organizing their boarding was left to Piot, who felt no joy in anticipating another airborne excursion with drunken pilots.
Piot and a few other passengers loaded dozens of crates into the cargo hold, having no idea where it was best to place heavy versus lightweight objects. The anxious pilots left the engines running and occasionally shouted for Piot's group to hurry. The men placed most of the lighter objects at the front of the plane, heavier crates of laboratory equipment to the rear, leaving the center open for passengers. With the few nets and ropes provided by the pilots the group did their best to secure all the cargo in place.
By the time all the passengers were on board, crammed shoulder to shoulder without benefit of seat belts, or even actual seats, a storm was brewing. The pilots taxied their huge, heavily laden aircraft to the end of Bumba's tiny tarmac, revved the engines, and roared down the runway. The plane lumbered, groaned, and bounced, unable to gain height with such a heavy load.
“Oh my God!” Piot cried out, seeing the tree line directly ahead. The pilots pulled the throttle sharply, attaining just inches of advantage over the tops of the palm trees. The plane climbed steadily for several minutes until, hitting a pocket of storm turbulence, it suddenly dove a few hundred feet.
The heavy crates to the rear of the aircraft broke loose of their nets, slamming down on the screaming passengers. Blood spattered in all directions, people screamed in pain, and the inebriated pilots responded by jerking the plane up, causing the front-loaded cargo to snap loose. Piot and his bleeding and battered fellow passengers were sandwiched between heavy crates of cargo, some of which carried thousands of samples of lethal Ebola-infected animal and human tissue and blood samples.
Convinced he was going to die, Piot found himself thinking not of his wife or his past life, but of the epidemic.
“Shit,” he muttered, “all that work for nothing. Nobody will ever know the answers.”
Piot's fellow travelers became nauseated; some had suffered contusions and broken bones. For the rest of their relatively uneventful two-hour flight to Kinshasa the only sound heard above the engines' roar was the sobbing of terrified and injured passengers.
When Peter Piot staggered off the last of a series of planes into the Christmas chill of Antwerp, he found Margarethe obviously pregnant. And suddenly the full weight of what he had been through since September, of his many brushes with death—some foolhardy—hit him like a bolt.
Still, he had tasted adventure, and Piot would never again be satisfied for long with the seemingly mundane life of laboratory science.
Both van der Gröen and Piot were deeply affected by their Zaire adventures, so much so that Guido, whose emotional fuse was normally so long that few had ever witnessed an outburst from the Belgian virologist,
discovered rage. Dragging Piot along with him shortly after Christmas, van der Gröen marched into the headquarters of the Sisters of the Holy Heart of Maria.
“Our objective here is education,” the seething van der Gröen told Piot as they entered the office of the order's Mother Superior.
The meeting began calmly enough, with the two scientists applauding the Catholic education of children in the Yambuku area—an assignation that dated back to 1935. The men also noted the well-intentioned origins of the order's medical effort, which stemmed from its relatively recent recognition that some 50 percent of the schoolchildren were chronically absent from classes in Yambuku due to illness. The order sought to improve school attendance by maintaining child health.
In the early 1970s members of the order had attended several days of basic medical training at the Tropical Institute in Antwerp. That was the full extent of their nursing training before venturing into the field.
“They're not nurses!” van der Gröen uncharacteristically shouted, realizing he was criticizing deceased nuns. Still, he pushed on. He applauded the holiness and devotion of the Sisters.
“But no one was thinking that if you start such a medical business, and the people of the region are receiving no support from the government of Zaire, and you give out free health care, then you must be prepared to be deluged. You must be ready to safely give 300 shots a day. If you build something you call a hospital, then you must do the logistic planning, provide the resources, and train your personnel accordingly.”
Van der Gröen's coup de grace was an accusation: “The price for your lack of planning was high”; half the dead got Ebola in the mission hospital.
Piot insisted that the mission hospital should either be closed or be staffed by a certified physician. And both men warned the Mother Superior that the source of Ebola was never found: it could return, and spread again inside the mission if their instructions weren't followed.
Though their advice was heeded for the Yambuku Mission, Piot and van der Groen left the religious order wondering just how many missionary health facilities of all denominations operated in developing countries with a similarly imbalanced mixture of hopeful devotion and tragically poor medical training and logistics. The two men, who would remain lifelong friends forever bound by their shared Zairian experience, stepped out into the icy Antwerp January morning, their minds and conversation filled with concern for the far-off tropical villages, the women in their
kangas
, the babies tied on their backs, and husbands earning hard livings selling wild animals they captured in the steamy rain forest—a jungle that hid Ebola.
The following Christmas, Pierre Sureau received a letter from Sisters Marcella, Genoveva, and Mariette. He sat in his comfortable Paris apartment, trying to recall the sweltering heat and primitive mission of Yambuku as he read the Sisters' greetings:
Dear Doctor, we wish you a good New Year 1978. These days we talk a great deal about the events of the past year and you, who have left us with good memories. We would like to thank you again, sincerely, for coming to our aid when others dared not to come. At the moment life has returned to normal. A Zairian doctor is here: he also works with all his heart. Four Belgian volunteers and a Sister are here to rebuild the hospital. The students are back in the school, making plenty of noise. Are you well? We send you our affection. Sister Marcella, Sister Genoveva, Sister Mariette.
 
Sureau affectionately refolded the letter, put the pages back inside their envelope, and put the missive into a carton marked “Yambuku.” He carefully shut the box and placed it in the back of a closet.
Souvenirs of a plague.

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