Panic in Level 4: Cannibals, Killer Viruses, and Other Journeys to the Edge of Science (18 page)

4. Ebola Kiss

W
HILE
E
BOLA
was breaking out in Kikwit, I spoke with a doctor named William T. Close, who had lived in Congo (then Zaire) for sixteen years. When he was in Zaire, Bill Close rebuilt and ran the Mama Yemo General Hospital, a two-thousand-bed facility in the capital. When Ebola broke out for the first time, in 1976, Close went to Zaire and helped coordinate the medical effort to deal with the virus, and advised the Zairian government. Years later, during the Ebola Kikwit outbreak, he acted as a liaison between Congolese government officials and doctors from the CDC in Atlanta.

“In 1976, when Ebola broke out in Yambuku that first time, there was a nun, Sister Beata, who died of Ebola,” Close recalled. “There was a priest, Father Germain Lootens, who gave her the last rites as she died. She had a terrible fever, sweat was pouring down her face, and bloodstained tears were running down her face. Father Lootens took out his handkerchief and wiped the sweat from her forehead and the bloody tears from her face. Then, unthinkingly, he took the tearstained handkerchief and wiped the tears from his own face with it—he had been crying, too. A week later, he came down with Ebola, and a week after that he was dead.”

Now, Close had been hearing reports that some members of the medical staff of Kikwit General Hospital—Dr. Bwaka and his nurses—had continued to care for Ebola patients despite the grave risks to themselves. “Those hospital staff people have gone into that hospital to work knowing that they may die,” Close said. And the doctors and nurses in Kikwit were working without basic medical supplies. “The greatest need in Kikwit right now is for rubber aprons to protect the doctors and nurses, because the blood and vomit is soaking through their operating gowns,” he said. “This is a huge, lethal African hemorrhagic virus. We all sort of feel that Ebola comes out of its hiding place when something occasionally alters the very delicate balance of the ecosystems, in a tropical region where things grow as they would in a petri dish. But if there are lessons to be learned here, they are human lessons. This is about people doing their duty. It’s about doctors doing what has to be done, right now, without a whole lot of heroics. Have you ever been petrified with fear? Real fear? Possessed by naked fear, where you have no hope of control over your fate? If you’re a medical worker, when the die is cast, the fear goes away, and you do what you have to do—you get to work. That’s what’s happening with the medical people in that hospital right now. There are things happening in Kikwit…” He paused. “Magnificent human things…. How can I explain this? There was another incident in 1976, also in Yambuku. One of the doctors—he was a Belgian named Jean-François Ruppol—delivered a baby in the middle of it all.” Ebola has a profound effect on pregnant women: they hemorrhage profusely and abort the fetus, which itself is infected with Ebola. “There were people dying of Ebola all around in that room in the hospital, and there was a woman in childbirth. She was Dr. Ruppol’s patient, and her baby was his patient, too. The baby was stuck—too big for the birth canal.” The woman had a high fever, she was terribly ill, but her baby had to be delivered, even if it was infected with Ebola. “So he performed the Zarate procedure on her,” Close said.

“What’s that?” I asked.

“The Zarate procedure? It’s a simple and rather crude but very effective way of enlarging the outlet to remove the baby. With a knife, you split the pubic symphysis.”

Sister Beata waving good-bye on the Ebola River. In 1976 she would die of Ebola while a priest, Father Lootens, wiped bloody tears from her face with his handkerchief and then unthinkingly wiped the tears from his own face, a mistake that sealed his doom.
Courtesy of William T. Close

“The what?”

“The front of the pelvis. The pelvic bones,” he said. It’s a hard, bony spot, and you can feel it, just above the pubic area, he said. “You split the bones there. You press a scalpel through cartilage. The bones go
pop
and the pelvis springs open, and you pull the baby out. The hospital had run out of anesthetics. So he did the Zarate procedure on the woman without giving her an anesthetic.”

“My God.”

“She was conscious. By the time he got the baby out, the baby had stopped breathing. The baby was in breathing arrest and drenched with the woman’s blood. He put the baby’s mouth to his mouth and gave the baby mouth-to-mouth resuscitation. The baby started to breathe. He pulled away, and his mouth and face were smeared with blood. There was a nurse standing by. When she saw his face she said, ‘Doctor,
do you realize what you’ve done?
’

“‘I do now,’ he said.”

5. Seeking the Ghost

W
HEN THE
WHO
TEAM ARRIVED
in Kikwit, they found Dr. Mpia Bwaka working alone in Pavilion Three with only two nurses—the third nurse had died of Ebola a few days earlier. Dr. Bwaka seemed to be all right. The WHO team had brought medical supplies, including jugs of bleach. They washed the ward with the bleach, rinsing the blood and feces off the floor. The team members put on double rubber gloves, waterproof gowns, masks, and goggles, and distributed the same equipment to Dr. Bwaka and his nursing staff. They wrapped the mattresses (which were blood-soaked) in plastic covers. Afterward, Ebola patients were placed directly on the plastic, without sheets. A Belgian team from Doctors Without Borders arrived a few days later, and put up white Tyvek sheets around Pavilion Three, as a sort of crude barrier to keep the virus inside the pavilion; the Belgian team also brought water for the hospital. Dr. Bwaka continued to work in the Ebola ward. It was so hot that the goggles fogged up, so the medical workers often didn’t wear them. One day, a nurse forgot himself momentarily and wiped his eyelid with his gloved fingertip, which was contaminated with Ebola blood. He died of Ebola.

But by the time the teams arrived in Kikwit, the outbreak was fading away. What really ended it was the fact that the virus had killed a third of the doctors in the city. Once the medical system collapsed, people didn’t go to the hospitals where the virus had spread. The outbreak burned itself out. Dr. Mpia Bwaka survived.

I
N THE FOLLOWING MONTHS
, a team of epidemiologists and zoologists led by Herwig Leirs, an ecologist at the Danish Pest Infestation Laboratory in Lyngby, Denmark, fanned out into the countryside around Kikwit and began trapping animals and birds and testing their blood. They were trying to find a species of animal that was either infected with Ebola or had antibodies to Ebola in its bloodstream, which would suggest that the animal was a natural carrier of the virus. They set out traplines and mist nets all through the forest of Mbwambala, and in other places in the countryside around the city. In the end, they collected slightly more than three thousand specimens. Most of them were mammals. About ten percent of the specimens were birds, and a few of them were reptiles and amphibians. Most of the mammals were rodents, and there were a number of bats. But they also collected wild African cats, as well as wild red pigs, pangolins, and elephant shrews. Not one of the specimens turned up positive for Ebola virus. Not one.

The Danish team didn’t look at any insects. Insect biodiversity in tropical Africa is enormous and unfathomed—many species of insects in Congo have never been identified or given names. A collecting team led by Paul Reiter of the CDC went around Kikwit and the countryside and collected thirty-five thousand arthopods—insects, ticks, sand flies, fleas, lice. They collected many bedbugs from around the city. For some reason, they didn’t catch any spiders or scorpions. They also didn’t report collecting any mites. (Mites are very small arthropods that are very difficult to see and collect.) Mites can live in hair follicles or on the skin of an animal or person, as well as in soil. The CDC arthropod team didn’t find any trace of Ebola in any of the thirty-five thousand specimens. No Ebola in a single bug.

It left the mystery unsolved. In what creature does Ebola make its everyday home? One interesting question about Ebola is this: Why aren’t humans infected more often with Ebola? Why are the outbreaks actually quite rare? If Ebola lives in some common animal or insect, then people should become infected more frequently. Possibly Ebola lives in primeval rain-forest canopies, in some creature that exists high above the ground in the remains of an ancient forest ecosystem. When a forest is disturbed—when trees are chopped down—people come in contact with the canopy and all that lives there. Perhaps the first man with Ebola in Kikwit, G.M., cut a tree down, then touched or ate a bat, bird, or insect that lived only in the tops of trees. Or perhaps he got Ebola from something that had lived underground, something he found in the small hole he dug that day in Mbwambala. He was dead, and many members of his family—who might otherwise have been able to recall details of his activities during the days when he became infected—were dead, too. Ebola kills the witnesses to its appearance. There were hints that some type of bat might be the natural host of Ebola. In laboratory tests, Ebola virus has been able to infect certain kinds of bats without making them sick. The bat’s immune system is resistant to Ebola, which suggests bats may be carriers of the virus. Even so, no wild bats have ever been found with Ebola in them.

Bats have very unusual wingless parasitic flies that live on them, sucking their blood. These bloodsucking bat flies, called strebelid flies, crawl from bat to bat while the bats are hanging in roosts. The flies might transmit Ebola among the bats. Does Ebola live in wingless flies crawling on bats? Nobody knows.

This is a story with no end. Recently, I called Dr. William Close, to see how he was doing. He lives in Big Piney, Wyoming.

“That Belgian doctor,” I said. “The one who got the Ebola-infected blood all over his face? How long did he survive?”

Close began chuckling. “More than thirty years, so far. I just talked with him yesterday. Jean-François Ruppol. He’s a great friend of mine. He lives in Belgium now.”

I could hardly believe it. How could anyone survive an Ebola exposure like that?

Not long afterward, I received a series of pleasant e-mails from Dr. Jean-François Ruppol. He had written down, in French, some of his recollections of the first Ebola outbreak, in Yambuku, near the Ebola River, Congo, in 1976. Ruppol went to Yambuku three times during the outbreak, seeking to understand the virus and get it under control. (At the time, Ebola virus did not yet have a name.) Here, in Ruppol’s words, is what happened:

Ma première nuit à Yambuku fut calme….
My first night in Yambuku was calm, but around five o’clock in the morning, a nursing sister woke me, banging on the door of the room I was occupying. A woman had just been brought in who had been in labor for a full day, and her situation didn’t look good. I have to admit that I was a little nervous. For one thing, I didn’t want to go into the hospital or the maternity ward, where there had been numerous sick patients and where the virus might still be present in patches of blood and soiled sponges that were scattered all about. For another thing, practically all of the male and female nurses had died, and the survivors had fled. Was the woman they had just brought in contaminated?

At this point, I asked a nun if they could put a kitchen table on the building’s porch. We put the pregnant woman on the table, after we had donned protective gear (gown, cap, mask, gloves, etc.). I wanted to take all the necessary precautions, the same ones I had ordered others to use during this epidemic.

In the course of my examination, I came to the following conclusions:

• The woman was at the end of her rope.

• The fetus was presenting in a dangerous way. If I remember correctly, the fetus was stuck sideways, making birth impossible.

• The fetus was in extremis.

We had to act quickly. But a caesarean was impossible because of the dangers in the operating room, the blood and foul sponges, and because of the absence of qualified personnel. Therefore I decided to utilize a technique that I had occasionally practiced in Kimpangu, the symphysisiotomy [the Zarate procedure]. It consisted of cutting the cartilage at the pubic symphysis, and then spreading the legs to open the pelvis and favor the passage of the fetus.

Getting the help of two people to hold the mother’s knees and legs, I performed the Zarate procedure under a local anesthetic, and I reached in and turned the fetus around inside her, in order to deliver it bottom-first.

Illuminated by flashlights and an electric light from a generator, the maneuver went well, but once the baby was delivered and the umbilical cord cut, the baby would not breathe despite various attempts to wake it up. Then, pushed by habit (or instinct, perhaps?), I took down my mask and practiced gentle mouth-to-mouth resuscitation. At that very moment I got a terrible shock: I realized that if the woman was infected with the virus, then I had just condemned myself to death. This was because we knew the virus was transmitted in all the secretions and fluids of the body. Even so, the child was revived and the mother seemed to be doing all right. It’s hardly necessary to add that I spent the next forty-eight hours keeping a very close watch on the health of the mother and baby. Oof! They weren’t contaminated, and I was alive. This was the only time in my medical career when I was not just afraid, but felt and lived real terror….