The Coming Plague (4 page)
Authors: Laurie Garrett
Meanwhile, MacKenzie still faced tough opposition in Bethesda, as well as at the Centers for Disease Control in Atlanta. Though he was a physician and had public health training, some higher-ups frankly doubted whether the thirty-seven-year-old MacKenzie had enough tropical experience to be able to recognize a new epidemic. They insisted it would be a waste of time and resources to deploy a team to investigate what would probably turn out to be some garden-variety bug such as influenza.
In the fall of 1962 MacKenzie appealed to Bill Reeves, his old mentor from public health graduate studies at the University of California in Berkeley. He described Magdalena to Reeves, who insisted that MacKenzie “stand up to the Bethesda bureaucrats.”
“Go for it. You got something there. Don't let 'em discourage you,” Reeves urged.
On January 9, 1963, a meeting of the top brass in the NIH's infectious diseases division was held in Bethesda, and MacKenzie persuasively pleaded his case. It was decided that he and a MARU ecologist named Merl Kuns should first undertake a scouting mission to assess the extent of the epidemic, collect blood samples, and define the nature of the local ecology.
The pair made their journey in March, and returned a week later even more firmly convinced that a serious epidemic was underway. Kuns, a University of Wisconsin-trained ecologist, was stunned by the thousands of bats that lived in the thatched roofs of towns like Magdalena, swooping out at night to forage for food. They were small bats, about the size of monarch butterflies, but they clustered in huge flocks that could suddenly fill the village sky. For his part, epidemiologist MacKenzie was convinced that nobody was actually getting infected in Magdalena, and the real epidemic was some fifty miles away in a town called San Joaquin. The pair returned to Panama with more than adequate evidence to gain approval for further investigation.
With his new laboratory contraption in crates, Johnson headed to Bolivia in May 1963, along with MacKenzie and Kuns. After arriving in the capital, the team chartered an old USAF B-17 bomber and flew to the eastern edge
of the Andes, then down the eastern Andean foothills to the Itenez River, and from there to the river's Machupo tributary, eventually landing on a field outside San Joaquin. They then hauled their 10,000 pounds of equipment into the tiny town on mules.
of the Andes, then down the eastern Andean foothills to the Itenez River, and from there to the river's Machupo tributary, eventually landing on a field outside San Joaquin. They then hauled their 10,000 pounds of equipment into the tiny town on mules.
Nestled atop a sloping hill just above the Machupo's flood line, San Joaquin was, the flabbergasted Johnson thought, “the last frontier of the New World.” Nothing in his scientific career had prepared him for conditions so primitive: no roads, no real health facilities, no fences, no electricity, no telephones, no running water. Cows outnumbered humans roughly two to one and roamed freely about the town. The people of San Joaquin were an evenly divided mix of pure Spanish, pure Indians, and mestizos whose ancestors had built the town in the seventeenth century. The wealthier citizens resided in tile-roofed, whitewashed adobe homes; the rest of the population lived in mud-stick houses with thatch roofs. Six thin strips of marsh formed the “roads” of San Joaquin, which converged in a modest central plaza.
The Spanish people of San Joaquin were descended from cowboys who for a few generations had tended the large herds of a wealthy Brazilian family in control of an Amazon River fleet of refrigerated steamships. The ships took the beef out of San Joaquin, up the river system some 1,400 miles to the northwest, where the Amazon met the sea. From there the beef was shipped to Europe or North America, reaping excellent profits for the Brazilians.
In tiny San Joaquin, however, the cowboys, their families, and the local Indians were entirely dependent on the “benevolence” of the Brazilian ranch owners and on the food and supplies that returning steamships brought to their remote town.
In 1952 a revolution had brought the Movimiento Nacionalista Revolucionario to power. The land reform party stripped old Bolivian and Brazilian oligarchies of vast tracts of land, and the people of San Joaquin suddenly found themselves property owners. Unwilling to buy back from the local people the cattle they once owned, the Brazilians and their steamships left, never to return; and the villagers found themselves isolated, impoverished, and facing severe malnutrition unless they could grow crops to supplement the all too abundant supply of beef.
When Johnson, MacKenzie, and Kuns arrived in San Joaquin they found a modest town of some 2,000 people managing to survive on beef, the yields of home vegetable gardens, and small rice and corn fields scattered throughout the savannas.
A steady stream of travelers passed through the town on their way from even more remote areas in the savannas to larger Bolivian towns via the steamships that moored occasionally at the San Joaquin dock.
Upon arrival, Johnson immediately set up his portable laboratory contraption, and the team set out to assess the extent of the mysterious outbreak. By then the epidemic had already been underway for some fourteen months,
the people mourned every day when the church bell tolled another death, and fresh graves filled the cemetery.
the people mourned every day when the church bell tolled another death, and fresh graves filled the cemetery.
With the townspeople's eager help, the team mapped the area and painted numbers on all the adobe houses. Every family was interviewed extensively, and asked the questions most essential to the team: How many people in this house have had the disease? How many have died and how many have recovered? What were they doing in the days before they got sick? Is there any chance one family member gave the disease to another? Have any animals been sick?
It became obvious immediately that nearly half the people had been infected, and, of those, nearly half had died of the disease. That was a terrifying finding because few microbes kill nearly 50 percent of those they infect. One family lost nine of eleven members in 1963.
“That's almost a Roman decimation,” Johnson told his colleagues, referring to the great epidemics of ancient Rome's republican era when at least a quarter of the population was felled by a disease now thought to have been smallpox.
The first order of business was to figure out what type of microbe was killing the people of San Joaquin: bacterium, virus, or parasite. Circumstances pointed to a virus, possibly spread by insects, so the team set up two small laboratories located seventy-five yards apart. The first, an existing tile-roofed adobe building, housed Johnson's glove-box contraption and a variety of other equipment and research animals used to isolate microscopic organisms from blood and tissue samples. The second laboratory was built to order by the local people out of lashed poles and thatching. It housed wild insects and animals Kuns and his assistants caught in the San Joaquin area. The team planned to study those animals to determine what species might be carrying the deadly microbes.
The facilities were kept separate to avoid cross-contamination, and the buildings were fitted with window screens and tight doors. Finally, the laboratories were heavily doused with DDT and ringed with rodent traps to protect the scientists from whatever creatures might be carrying the disease.
In June, after days of haggling with the San Joaquin community over the propriety of such things, Valverde convinced the local priest to allow MacKenzie to perform an autopsy on one of the recent victims of the epidemic. A few days later, a two-year-old boy died and from his spleen and brain the team was able to isolate a substance that, when injected into hamsters, produced the disease. Days after the boy died the team completed several more tests that proved the mysterious disease was caused by a virus: they ruled out a parasite or bacteria on the basis of both the minuscule size of filters through which the microbe readily passed and its ability to withstand antibiotics. They also showed the microbe could destroy human cells and cause disease in wild mice.
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Midway through the autopsy on the child, Hugo Garrón's scalpel slipped,
flew across the autopsy table, and hit MacKenzie's hand. Looking at the blood that instantly filled his punctured glove, MacKenzie looked up at Garrón and predicted the worst.
flew across the autopsy table, and hit MacKenzie's hand. Looking at the blood that instantly filled his punctured glove, MacKenzie looked up at Garrón and predicted the worst.
An anxious week passed without symptoms, and MacKenzie decided he was, indeed, a very lucky person. With greater care, he and Garrón performed several more autopsies and were struck by the level of devastation the mysterious microbe produced. Most alarming were the disease victims' brains: where clear cerebrospinal fluid should have been there was, instead, crimson blood; all of the meningeal protective layers around the brain were blood-soaked. Eerily, most of the hair fell off victims' heads before they died.
Toward the end of June the town had a party, which the scientists used as an opportunity to celebrate their rapid discoveries. The next logical steps in their research would involve characterizing the virus and figuring out exactly how people got infected. Johnson, Kuns, and MacKenzie felt confident all the answers would soon reveal themselves, and enthusiastically joined the celebration, eating and drinking the local specialties. While all three men were in the mood for a fiesta, it was Johnson who, with characteristic gusto, threw himself into the spirit of the event, drinking, dancing, and joining in the local macho sport of telling tall tales. Though not a classically handsome man, Johnson carried himself with a mix of cowboy swagger and charisma that inspired other men and attracted women. MacKenzie too threw himself into the gaiety of the evening, while the shyer, more serious Kuns quietly observed the goings-on.
On July 3 Johnson and MacKenzie were some twenty miles outside of San Joaquin gathering ticks from the bushes around a
chaco
, or small cattle ranch. They suspected the virus might be carried by insects and were collecting samples to take back to their field lab for analysis.
chaco
, or small cattle ranch. They suspected the virus might be carried by insects and were collecting samples to take back to their field lab for analysis.
When they began the long trek back to San Joaquin, the shorter Johnson kept having to slow down to avoid outpacing his usually athletic, longlegged colleague.
By the time they reached the river and started to canoe downstream to San Joaquin, Johnson noticed he was pulling most of the weight.
“I feel lousy. Really lousy,” MacKenzie said as he staggered off to bed.
The next morning Peace Corps nurse Rose Navarro, who had been sent in to help with translating, took one look at MacKenzie and pronounced his condition serious. She also noticed that Angel Muñoz, a Panamanian lab technician who had recently arrived from MARU to assist Kuns, had similar symptoms.
Johnson and Kuns contacted Panama through a cumbersome radio relay system, and a USAF C-130 flew in that dayâthe Fourth of Julyâto evacuate the two ailing researchers.
As he waved goodbye to MacKenzie, Johnson felt a feverish chill come over his body and thought, “Damn! I should have been on that plane too!”
Over the next four days Johnson slowly hitchhiked his way, plane to
plane, across Bolivia, Peru, and Colombia, finally reaching the Gorgas Hospital in Panama.
plane, across Bolivia, Peru, and Colombia, finally reaching the Gorgas Hospital in Panama.
And now here he was, bleeding to death. To his left lay MacKenzie, on the right Muñoz. Johnson could imagine his brief obituary: “promising young research physician, born in Terre Haute, Indiana, 1929. Dead, age 34. Unmarried.”
He knew there were two ways the virus could kill him. He'd seen it in San Joaquin. He might soon develop neurological symptoms, getting tremors and losing control of his muscles; eventually, he would have a grand mal seizure and die. Or the sheer volume of blood hemorrhaging from his capillaries would become so devastating that his body would go into shock and he'd die of cardiac arrest. Either death could strike in a matter of hours, or days.
In any event, there was no cure, no antitoxin. There was just lying and waiting.
After several more days of agony all three men showed signs of improvement, thanks largely to the efforts of an Army doctor flown in especially for them from Washington, D.C. Though he had never treated this particular ailment, the doctor had handled dozens of cases of another viral hemorrhagic disease called Seoul Hantaan, which first came to the attention of Westerners when 121 trench-bound American soldiers fighting in the Korean War died bleeding deaths that were not unlike the one threatening Johnson. (Nearly 2,500 U.S. soldiers suffered the Hantaan disease from 1951 to 1955.)
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Nobody had yet identified the Hantaan virus and it wasn't clear how the disease was transmitted, but U.S. Army doctors had discovered that patients' chances of recovery were greatly enhanced by careful supervision of their electrolytes and fluids. In all hemorrhaging diseases, as the capillaries leaked out precious fluids and proteins, the delicate chemical balances of vital organs such as kidneys, hearts, livers, and spleens were severely disrupted. Long before the immune system had a chance to mount a counterattack against the Hantaan virus, the organs would cease functioning and the patient would either convulse or go into shock.
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Nobody had yet identified the Hantaan virus and it wasn't clear how the disease was transmitted, but U.S. Army doctors had discovered that patients' chances of recovery were greatly enhanced by careful supervision of their electrolytes and fluids. In all hemorrhaging diseases, as the capillaries leaked out precious fluids and proteins, the delicate chemical balances of vital organs such as kidneys, hearts, livers, and spleens were severely disrupted. Long before the immune system had a chance to mount a counterattack against the Hantaan virus, the organs would cease functioning and the patient would either convulse or go into shock.
Also in from Bethesda was Pat Webb, Johnson's petite fiancée. Born in England and trained in both medicine and virology, Webb was doing research at NIH and had planned to move to Panama soon to join Johnson. Short, thin, and prematurely graying, Webb had an often caustic, opinionated style of speech. But for those who persevered, knowing Webb meant experiencing a woman possessed of a profound sense of humanity that infused her medical and research work.
Now she sat beside her future husband and caressed, kissed, or embraced him whenever he could tolerate the pain of being touched. By deliberately touching Johnson to illustrate there was no danger, she hoped to allay the fears of the frightened hospital staff.
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Webb's fear was not the virus, but that Johnson would die, and a couple of times his condition seemed so grave she was convinced he wasn't going to make it.
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Webb's fear was not the virus, but that Johnson would die, and a couple of times his condition seemed so grave she was convinced he wasn't going to make it.
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