The Coming Plague (95 page)
Authors: Laurie Garrett
“Well, we've got young people dropping dead all over the reservation,” the panicked dentist told her, adding that he was worried that whatever was killing the Navajo Nation's youth might be transmissible during dental procedures.
“I don't know what you're talking about,” Chapman said, wondering whether she was the victim of a crank caller.
“Okay, turn on CNN right now,” the dentist said, just before he hung up.
Chapman didn't have a television in her office, so she didn't see the report that described an outbreak of “Navajo disease.” Instead, she stepped next door and mulled the situation over with a colleague. They decided the responsible thing to do was to send a heads-up notice on the dentist's queries by computer to the agency's viral disease group. A few minutes later Chapman found herself in the middle of the Four Corners puzzle, as computer messages poured in from other CDC staffers and her old friend IHS epidemiologist Cheek.
The next day, Thursday, May 27, Chapman went to her regularly scheduled grand rounds at the local Veterans Administration Hospital, where she saw Dr. Jim Hughes, the director of the CDC's Center for Infectious Diseases. Chapman filled Hughes in on the mysterious outbreak, adding, “I'd like in on this one.” Hughes, an affable leader who always tried to “keep the troops happy,” smiled and acknowledged Chapman's eager interest.
When Hughes returned late Thursday morning to the CDC, his deputy, Dr. Ruth Berkelman, told him that the Indian Health Service and the state
of New Mexico had formally requested CDC assistance in solving the Four Corners mystery. Now the vaguely interesting puzzle which Chapman had expressed a desire to work on just an hour earlier was a matter of official urgency. Still, what little he knew at that point led Hughes to believe that it was a fairly small problem.
of New Mexico had formally requested CDC assistance in solving the Four Corners mystery. Now the vaguely interesting puzzle which Chapman had expressed a desire to work on just an hour earlier was a matter of official urgency. Still, what little he knew at that point led Hughes to believe that it was a fairly small problem.
Berkelman, whose specialty was newly emerging diseases, begged to differ.
“There's something about certain calls,” Berkelman told her boss. “You get a feeling for these things.”
Respecting Berkelman's expert opinion, Hughes told her to put together an emergency meeting. As they spoke, residents of New Mexico were opening their morning paper, the
Albuquerque Journal,
which carried the headline: “Mystery Flu Kills 6 in Tribal Area.”
Albuquerque Journal,
which carried the headline: “Mystery Flu Kills 6 in Tribal Area.”
When Louisa Chapman walked into the infectious disease conference room that Thursday afternoon, she was stunned. Never in her six years at the CDC had she seen so many top officials and scientists crammed into one room for a disease investigation. She felt a familiar thrill as her adrenaline started pumping.
All the people in that room, and the staff they represented, were already stretched thin with a dizzying array of epidemicsâmore than the agency had ever handled over a six-month period in the CDC's history.
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This came at a time when the CDC's 1994 budget reauthorization, though large at $2.2 billion, required the agency for the first time to conduct several ambitious immunization and disease prevention programs. (The agency's name was changed to the Centers for Disease Control and Prevention, underscoring the shift.) As a result, Hughes and his top-level counterparts throughout the agency were in the process of eliminating 518 jobs in nonprevention divisions of the CDCâabout 7 percent of the agency payroll.
C. J. Peters, who had left the U.S. Army's laboratory at Fort Detrick a year earlier due to Department of Defense budget cutbacks, told meeting participants that his CDC Special Pathogens Branch was already so overextended that he was going to have to borrow scientists to process blood and tissue samples as they came in from the Four Corners area. All suspect materials sent to the CDC were first studied in the high-security P3 and P4 laboratories, until proven safe enough for use in standard research facilities.
Inside the P4 component of the CDC's security lab, scientists wore full-body respirator-fed suits when they worked with animals or conducted experiments on bench tops. Most of the cellular work was done in airtight glass-and-steel boxes that scientists accessed by inserting their hands into heavy rubber gloves that were permanently attached to the boxes. All research animals were kept in similarly air-sealed housings and scientists took special precautions to avoid being bitten or scratched by primates or rodents.
It took a special kind of person to work under such restrictive and tense conditions. Some P4 workers likened it to spending a lifetime in outer space because even the tiniest of invisible holes in a hose, glove, or respirator suit could let in a lethal atmosphere.
Peters knew it was going to be hard to find additional personnel capable of working in his P3/P4 facilities.
The meeting resolved to send epidemiologist Dr. Jay Butler, along with two EIS officers, out to Four Corners immediately. A shy, blue-eyed marathon runner, Butler first learned of the mysterious Four Corners deaths on Friday morning, and was in Albuquerque that afternoon. In the few hours between the staff meeting and his flight to New Mexico, Butler hastily prepared for the unknown.
The next day, May 29, he pored over X rays and medical records in Albuquerque. Together with colleagues from the New Mexico Department of Health, the University of New Mexico medical staff, and the IHS, Butler and his two CDC assistants made up a list of twenty-five possible explanations for the deaths and posted it on a large board. Then, drawing from their collective experience and knowledge of strange diseases, they eliminated most of the options.
By five o'clock the forty experts in the room had a short list of hypothetical causes that included some unknown chemical toxin, a new virulent flu strain, a new coxiella (sheep) bacterium, anthrax, Crimean-Congo hemorrhagic fever virus, Hantaan virus, or “something completely new.” Though the researchers had no evidence as yet that any of these microbes or chemicals were rampaging through Four Corners, all fit the disease patterns that had been observed.
That pattern typically started with flu-like symptoms: fever, muscle aches, headaches. After a period of a few hours to two days, those symptoms escalated to include coughing and irritation in the lungs. These were caused by leaks in the capillary network feeding the lungs, through which poured fluids. Within a matter of hours patients would become highly hypoxic, unable to absorb oxygen that they hungrily inhaled. Starving for oxygen, the heart would slow down and death could soon follow, caused by either cardiac failure or pulmonary edema.
Butler noticed that those doctors in the meeting who had personally handled such cases were clearly emotionally affected by the drama of patients' deaths and the futility of their medical efforts.
While the New Mexico meeting was getting underway, a similar gathering of experts was winding down in Hughes's office at the CDC. Breimen and other physicians in the room were going over the latest medical reports faxed from Cheek's Albuquerque office.
After an hour of discussion, the CDC list of hypothetical causes of the outbreak was almost identical to the one then being compiled in Albuquerque. And Hughes could see no way to narrow the scope. It troubled him that two completely different categories of agentsâtoxic chemicals
and infectious microbesâwere on the list. He remembered that the 1976 Legionnaires' Disease outbreak, which claimed fifty-nine lives in Philadelphia among those attending a summer convention, was bogged down for months with a similarly broad range of causes under consideration.
and infectious microbesâwere on the list. He remembered that the 1976 Legionnaires' Disease outbreak, which claimed fifty-nine lives in Philadelphia among those attending a summer convention, was bogged down for months with a similarly broad range of causes under consideration.
Hughes grabbed the phone and called the man who solved the Legionnaires' Disease puzzle in 1977, discovering a new bacterium, dubbed
Legionella
, in the hotel air conditioning system. Thirty minutes later, Joe McDade strolled into the meeting. After they gave him a brief status report, McDade quietly narrowed the options.
Legionella
, in the hotel air conditioning system. Thirty minutes later, Joe McDade strolled into the meeting. After they gave him a brief status report, McDade quietly narrowed the options.
“It's unlikely to be a toxic chemical because few chemicals cause fevers,” McDade said, suggesting that the effort focus on the microbes.
“You've got to develop an algorithm of the disease,” McDade said, using terms most of those in the room had heard from him before. “You start by ruling out what is known. And then you get to work on isolating the virus. My guess is it's a virus.”
He suggested that C. J. Peters's group test the patient samples they'd received from Four Corners against antibodies for every virus they had in stock.
“Throw out a big net and see what comes in,” McDade urged.
Peters agreed, but reiterated his urgent plea for additional personnel. Over the next few days, “loaners” would join the fifteen staff scientists in the P3/P4 lab, some coming from state agencies as well as other sectors of the CDC.
While the Special Pathogens staff toiled in maximum security over petri dishes full of patients' blood and some twenty different types of viral reagents, Cheek, Butler, and the state epidemiologists in the Four Corners area were having a hard time getting useful information from the friends and relatives of the deceased. The local press, having gotten wind of the story several days earlier, was crawling all over the Navajo Nation asking questions many residents found offensive. Furthermore, they were publishing information that the privacy-minded Navajo considered distasteful.
In Navajo culture it was taboo to speak of the dead or utter their names for several days after their demise, yet reporters were doing their jobs, knocking immediately on relatives' doors to ask for details about the lives and deaths of Merrill Bahe and the eighteen other known ARDS victims. Matters worsened when an Arizona newspaper published details about one patient, drawing extensively from the deceased's medical chart.
“The obvious conclusion people drew was that [the paper] got it from us,” IHS physician Tempest said. “Here we were trying desperately to protect patient confidentiality, and the public trust was eroding. We were getting it from both sides, being accused of giving the press confidential information on the one hand, and charged with some conspiratorial cover up on the other. There was so little trust that some people called for an independent investigation.”
The situation reached a boiling point when some officials and media
referred to the mysterious ailment as “Navajo flu” or “Navajo disease,” ignoring the fact that non-Navajos were also falling ill, and marking the American Indians with what the Navajos considered a grossly unfair stigma.
referred to the mysterious ailment as “Navajo flu” or “Navajo disease,” ignoring the fact that non-Navajos were also falling ill, and marking the American Indians with what the Navajos considered a grossly unfair stigma.
By the first week of June the situation was out of control, as anti-Indian racism mixed with fears of disease. Non-Navajos stayed away from Indian-owned businesses, schoolchildren from the Navajo Nation were denied a field trip to California that had long since been planned, waitresses reportedly wore rubber gloves when serving Navajo customers, and there were rumors of tourists driving across the Navajo mesas wearing surgical masks.
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Shortly after Memorial Day there were reports of health investigators and journalists being run off the Navajo Nation at gunpoint by angry residents, and Cheek feared that the entire disease investigation might collapse. Cheek, a Cherokee Indian, sympathized with the Navajos and worked with the IHS area director, Dr. John Hubbard, to relieve tensions in the Four Corners area. Hubbard, a Navajo physician, took Cheek with him to a meeting of the Tribal Council, where they made their case. Tribal president Peterson Zah promised full cooperation, and Hubbard vowed there would be no further violations of tribal sensitivities. Zah also issued an unusual plea to the press, asking that they stay off reservation land until the investigation was completed.
“We decided to have Navajo people involved in every step of the investigation. I insisted on it,” Cheek said. “Because I could sense this feeling of betrayal, that we [the Indian Health Service] had betrayed them. We were seen as conduits to the media, even though it wasn't true.”
What followed was an investigation unprecedented in its integration of community members into every aspect of the inquiry. Tribal medicine men and elders were respectfully consulted, and they provided the investigators with two vital clues: the piñon nut harvest was unusually large that spring, as was the mouse population. Not since the great epidemics of 1918 and 1936, the elders said, had piñon, mouse, and disease conditions all been so high. The elders' insights steered Cheek, Butler, and other investigators toward searching for a link between the ailments and mice.
By fortuitous coincidence, the University of New Mexico's Robert Parmenter was heading up the massive Sevilleta Long Term Ecological Research survey of the region's flora and fauna, and his team of forty scientists had recently focused on the local rodent population. They had been startled to note a sudden population explosion among the deer miceâa tenfold increase that began in May 1992 and was peaking as the CDC's disease investigation began.
On June 2, with the death toll up to twelve and suspected cases numbering twenty-one, U.S. Health and Human Services Secretary Donna Shalala turned to her staff in a morning meeting in Washington, D.C., and asked, “Are we on top of it? Do you need more resources?”
Assured that the CDC was mobilized, Shalala requested regular briefings. And she expressed concern that Navajos were being improperly labeled as
the source of the disease. Recalling the early, incorrect assumptions that AIDS was a “gay disease,” she warned her staff to shun the use of terms that linked Navajos to the ailment and asked that special steps be taken at the highest levels to demonstrate sensitivity to American Indian concerns.
the source of the disease. Recalling the early, incorrect assumptions that AIDS was a “gay disease,” she warned her staff to shun the use of terms that linked Navajos to the ailment and asked that special steps be taken at the highest levels to demonstrate sensitivity to American Indian concerns.
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