No Time to Lose: A Life in Pursuit of Deadly Viruses (3 page)

However, when I walked into the conference room at the Hotel Nikko on that Friday afternoon, my name was on a screen, with a message: I should urgently contact a phone number in Brussels. What the heck?

Before doing anything, I called Pattyn, who was still at the lab. He said the Department for Development Aid and the Ministry for Foreign Affairs had been ringing his phone off the hook: we had to get to Kinshasa. The Americans were going there to take a look at the epidemic, and there was some kind of French delegation already in place; even a South African was on his way. Also, Belgian expatriates in Kinshasa had begun panicking, sending their children to Europe because of the epidemic.

“The Belgian government is under pressure to do something,” he told me. I thought, surely that “something” can’t be just me, a recent graduate from medical school? But I kept my mouth shut.

“This is now a political priority!” Pattyn continued, and I thought: So, that’s how it goes. Unless something is a
political
priority, figuring out how to save lives is not a big issue.

“It’s
our
Congo, you know,” he said, and I had no idea whether he meant it ironically or straight up, no ice.

So I phoned a Dr. Kivits at the Department of Development Aid. There was minimal discussion. He said I should leave the next day on a 10-day mission. I asked if it would be OK if I waited until Sunday, and Dr. Kivits said fine. So I said yes. I didn’t think about it for a second but asked Greta, who was three months’ pregnant and immediately agreed.

In a sense, it would be a voyage of self-discovery as much as discovery. In that classic way of the Grand Tour, I was leaving my home, at the age of twenty-seven, to discover myself. Leaving the plain, hardheaded Flemish world of no bullshit—head down, nose clean, hard work, low profile—and heading to a place of big, apocalyptic emotions: despair and exuberance and tragedy and fear. A place that was really coming apart at the seams; a slow-moving disaster scene that had just once again hit a new catastrophe. It was my dream: I was going to the heart of Africa—Zaire—to explore the outbreak of a new virus.

CHAPTER 2

Adventure at Last

G
RETA AND I
cut short our Paris weekend and quickly returned to Antwerp, where Pattyn and Guido met me in the lab, together with Dr. Kivits, head of the health section of the Department of Development Aid in Brussels. We spent a few hours hunting down protective gloves and masks and some basic lab equipment. I tried to familiarize myself with the procedures for maximal protection from hazardous viruses, both in the lab and in the field. It basically means protecting your eyes, mouth, nose, and hands, and avoiding needle pricks. Guido gave me some motorbike goggles, which turned out to be extremely useful.

I was also quickly trained in hematology lab procedures and blood tests. Because this was a hemorrhagic-fever epidemic—which included, by definition, symptoms of bleeding—I would need to monitor all kinds of blood parameters: the degree of disseminated intravascular coagulation, which causes uncontrollable bleeding; the number of platelets and hematocrits; and so on.

But Pattyn was mostly interested in teaching me how to capture bats. For some reason he was convinced that they would prove to be the virus reservoir (the place or animal where the virus normally hides). To be honest this was the only thing that scared me about the trip. I am poor at catching flying objects at the best of times, even when they don’t have claws and teeth. I nodded while he explained, but I decided on the spot that I wouldn’t catch a single bat (and didn’t).

Meanwhile, WHO had just released the news of an outbreak of a hemorrhagic fever in southern Sudan. Nzara was 450 miles east of Yambuku, where “our” Zairean epidemic seemed focused. And analysis at Porton Down “had revealed a new virus, morphologically similar to Marburg, but antigenically different,” WHO said. This meant that by October 15, three laboratories—ours, the CDC, and Porton Down—had independently identified what seemed like it could be the
same
new virus, which was the probable cause of
two
, simultaneous, deadly epidemics.

The telex from WHO was the first we heard of the Sudan outbreak, and this startled us. There was something very sinister about a virus suddenly unleashing in two such isolated places. Where would it strike next?

I went back to the library. Pattyn had told me that the American team from the CDC included Karl Johnson, the man who had discovered Machupo fever in Bolivia. I tried to photocopy everything he’d written.

I raced home and packed enough for 10 days. Pattyn insisted I take a suit and tie, as I would “represent the Belgian government” and meet with Zairean government officials—something I had absolutely no interest in then, but would have to do hundreds of times two decades later as head of UNAIDS. Luckily I did own a suit; I had bought one for my wedding.

Then I hunted down my passport, no easy feat. It had long since expired. (I didn’t need one to go to Paris, since I was a European Community national.) I had even cut out my passport photograph to use for some urgently required sports-club membership card. And of course this defunct and defaced excuse for a passport didn’t have any kind of visa for Zaire in it. I knew that Pattyn had decided to come with me to Kinshasa, just for the week—but I had no idea if they would even let me get on the plane. That night I couldn’t sleep for nerves and excitement.

Dr. Kivits reassured me that he would get me on the airplane, even with my shredded and useless identity document. Indeed, when Pattyn’s wife Renée drove us to Brussels airport on Sunday evening—while her husband ranted nonstop about various bat species, the viruses that nestled in their organs, and the need to keep our guard up with those confounded Americans and French—Kivits was there in the departure lounge, a mild smile on his face.

At check-in, when the police officer at immigration wordlessly gestured me to one side with a hostile glare, Kivits stepped in and exhibited some kind of official supercard that magically gave me passage through immigration and out of my own country. So far so good, but without a passport, how would I manage to get into Zaire?

It appeared that Dr. Kivits had several such tricks up his sleeve. He told me, “Find a passenger called Paul Lelievre-Damit in first class. He knows you’re on the plane. When you get to Kinshasa, just follow his instructions. Do exactly what he says and you’ll be fine.”

I felt like Tintin, the boy hero, in some sort of comic-strip thriller. I wanted to laugh out loud. It was absolutely nothing like real life.

On board the aircraft, I still couldn’t sleep. When our DC-10 stopped off in Athens at about 4
A.M
. to refuel, only four people left the plane to stretch their legs. All of us were men and all of us headed to the airport bar, where we introduced ourselves. One was Paul Lelievre-Damit, the very man I was supposed to meet.

Lelievre-Damit was chief of the Belgian Development Cooperation in Zaire, and one of the most powerful foreigners in Kinshasa. He was probably mightier than the Belgian ambassador, since Lelievre-Damit sat on the money sack. When he figured out who
I
was, he interrupted my halting story about an epidemic outbreak and started swearing.

“Goddamn! It’s always the same with these bloody bureaucrats in Brussels! We’re facing a terrible epidemic, and all they could find is you? How old are you?
Twenty-seven
? You’re a totally green trainee, barely even a doctor. You’ve never seen Africa in your life . . .”

I winced at his robust and graphic outburst of Flemish epithets. It was undeniable. I had no expertise; few skills; I could no more save the African heartland from a mystery virus than a comic-strip boy could have done. But after a couple of glasses of ouzo it emerged that Lelievre-Damit had played cards with my dad when they were both penniless students in Leuven, and that helped a lot.

“When we arrive in Kinshasa, just stick to me,” he said. “Don’t look left or right or turn around. The airport is pandemonium, the police are worse than the criminals, and you’re as clueless as a puppy—you’ll be eaten alive. When we land, follow me as close as possible. Don’t look left or right, don’t reply to any question, and above all, don’t hand your piece-of-shit passport to anybody but me. We’ll go straight to the VIP room, and I’ll make sure you’ll get into the country. OK?”

I nodded, speechless.

The next morning the pilot smoothly navigated our DC-10 into Ndjili airport in Kinshasa, where we parked near several wreckages of less fortunate airplanes. Out of the windows I could see hundreds of people on the terrace of the airport building, waiting for family or hoping for business, and when the doors of the plane opened, a steaming sauna of air rushed into my face. I pushed to the front of the plane to find Lelievre-Damit, and as instructed, I glued myself to him when descending the DC-10 stairs, as tightly as a baby monkey clings to his mother.

To be honest, I wasn’t just bewildered and hungover: I was slightly afraid. The light was very bright—it must have been 10
A.M.
—and the tarmac was full of women swathed in cloth and men in
abakos
(an acronym for
à bas le costume
, “down with the suit,” a Mao-style jacket that Zaire’s longtime dictator, Mobutu Sésé Seko, had made compulsory after a visit to China). They cried out and waved and grabbed at the passengers.

With practiced, fluid movements Lelievre-Damit and Pattyn glided me into the VIP room, where a very respectful official smiled and accompanied us to Lelievre-Damit’s diplomatic car. There was no mention of anything so vulgar as an identity document.

THE ROADS OF
Kinshasa were unbelievable, with people and animals wandering randomly across them, not to mention the vehicles, which hurtled from every direction. It looked to me like the most unbridled chaos. We drove straight to the headquarters of the Fométro, the
Fonds Médical Tropical
, a nongovernmental organization that operated much of Belgium’s vast program for medical aid in Central Africa. We were told that an important meeting of the
Commission Internationale pour le Contrôle de la Fièvre Hemorragique au Zaire
, chaired by the minister of health, was already underway.

We found a large number of men, and one woman, seated around a table in an intense fog of cigar and cigarette smoke. When we entered the room all of them had just stopped speaking, and as their heads swiveled almost all seemed to be glaring at us. Pattyn’s reputation had clearly preceded him, and hackles were rising in anticipation of a turf battle.

Everybody introduced themselves. The Zairean health minister, Professor Nguete, was a sharp-minded, obese man, about sixty years old, with a half-chewed cigar screwed tightly into his mouth: I rarely saw him without it. The American Karl Johnson—head of Special Pathogens at the CDC—had a thin beard and small, sharp eyes; he smoked a pipe. His right arm, Joel Breman, was taller, burlier, with an amiable smile and was speaking French with a funny accent; I liked him immediately. Pattyn curtly shook their outstretched hands and then stiffened when the lone Frenchman, Pierre Sureau, introduced himself as the representative of the World Health Organization and the French Institut Pasteur. A lean man with silver, curly hair, Sureau was a true
Pasteurien
, a veteran of exotic epidemics from Vietnam to Madagascar, and he was to become something of a mentor to me.

Margaretha Isaacson was the only woman among us; her eyes glinted behind metal-rimmed glasses and her dark brown hair remained helmetlike as she acknowledged our presence. Born in Holland, she escaped the Holocaust and emigrated to Israel, where in her youth she was a fighter pilot. Now she was a South African national, thus a most improbable presence in Zaire, a country that, at least theoretically, observed the ban on travel for citizens of the apartheid regime. But in 1974 in a hospital in Johannesburg, Isaacson had treated a couple of Australian backpackers who had come down with Marburg and infected one of their nurses. The male Australian died, but the two women survived. Thus Isaacson brought with her, from forbidden Johannesburg, the world’s entire, tiny supply of serum from Marburg convalescents.

Although we knew our mystery virus wasn’t Marburg, we all hoped that it would prove to be a close enough relative that we could use the Marburg antiserum from South Africa to treat patients from this epidemic. Even if not proven clinically, the hypothesis was that high levels of serum antibodies would inactivate the virus in the patient’s blood.

There were others present, too: Jean-Jacques Muyembe, a sleek and brilliant young Zairean professor of microbiology for whom I later came to develop profound respect: Gérard Raffier, head of the French Medical Mission in Zaire, and his equivalents at the Belgian Fométro, Jean-François Ruppol and Jean Burke; and André Koth, a slim, bespectacled young doctor from the Kinshasa Medical Service who looked extremely intimidated. Except for Koth, I was by far the youngest of the lot.

Karl Johnson rapped us to attention—it was clearly his meeting—and summarized the situation in a few words. We were dealing with a virus that was completely new to science. Its potential for transmission—particularly to medical teams and caregivers—appeared to be extraordinarily dangerous. Reports claimed that more than 80 percent of people infected were dying. We had only one possible treatment option in the form of serum from convalescents who had very high levels of antibodies, but we needed to track down such individuals, test their blood to be sure it didn’t contain live virus, and then treat it to be able to inject antibodies into people currently sick. These tests required very specialized material and highly qualified researchers working in extremely safe environments. In the meantime—here he nodded at Margaretha—we would attempt to use the Marburg serum. Furthermore, since the immediate cause of death was severe hemorrhage, and given the probable role of coagulation in the development of uncontrollable hemorrhaging, we would endeavor to treat patients with heparin, an anticoagulant medication.

He went on: the worst scenario we faced was the specter of a full-blown epidemic in Kinshasa, an unruly megacity with poor infrastructure, an unreliable administration, and 3 million citizens accustomed to defying arbitrary government controls. Barely a fortnight before, three people from the Belgian mission in Yambuku—two nuns and a priest—had been brought to the capital for treatment. All were now dead, and they had infected at least one nurse, Mayinga N’Seka, now hospitalized in critical condition. Efforts were being made to track down all her contacts in the city to quarantine them. They included—here Johnson paused for a second—personnel of the US Embassy, where the nurse had recently finalized arrangements for a student visa to the United States.

Was this the beginning of an outbreak in Kinshasa? Once a virus this lethal is introduced into an environment this chaotic, it is almost impossible to control it. It is also an explosive political situation for the government, and it was clear from the health minister’s agitation that news about the epidemic was out and panic was already setting in. At that time we had no real indication of how contagious the disease was, only that it seemed highly lethal.

Karl spoke no French, though by necessity that was the language of our meeting, so Pierre Sureau and I translated for him, back and forth. This is a role I’ve often picked up and it’s useful, because translators have a lot of power and connections. It also keeps your mind from wandering, which is crucial, because when I heard the phrase “
probably the most serious risk to public health in the past 25 years
,” something inside me went oddly quiet.

The top priority, then, was Kinshasa, and it was decided that most of the international team would remain there temporarily, while a small contingent would travel to Equateur province for a three- or four-day scouting trip to do the logistical groundwork and sketch out a plan for a full-blown investigation.

Karl asked for volunteers. I was the first to raise my hand. The others were Pierre Sureau, the Frenchman; Ruppol, a jovial man with a leathery tan; and Joel Breman, the younger American. André Koth was later deputized to join us, to represent Zaire.