The American Plague: The Untold Story of Yellow Fever, The Epidemic That Shaped Our Nation (29 page)

A series of tests were performed, and he was treated for malaria though his blood test proved negative. McCullough developed anemia, his blood would not clot, and his kidneys and liver failed. He went into shock and developed seizures. He bled uncontrollably from the sites of his needle punctures. Tom McCullough died on March 15—leaving a wife and six children still wondering why.

McCullough’s illness and death were reported to the Centers for Disease Control and Prevention (CDC) in Atlanta, which began their own series of tests looking for dengue, St. Louis encephalitis, spotted fever, leptospirosis, Machupo virus and yellow fever—all viruses known to exist in South America. McCullough, it had been reported to the CDC, had just returned from a week-long fishing trip for peacock bass on Brazil’s Rio Negro. The brochure for the trip read,
We do not suggest any inoculations of any kind for this trip . . . But to make sure you are worry free, consult with your personal physician.

It would seem that some vicious new virus had taken hold of Tom McCullough; instead it was an ancient one. One hundred years ago, doctors would have known immediately what killed him, but modern medicine takes longer. Today, there is a wealth of illnesses known to be caused by insect vectors of all types. There are antibiotics and vaccines to fight disease, and still, this fever seemed to defy contemporary medicine. At last, the autopsy showed antibodies to the yellow fever virus—McCullough’s internal struggle against a virus rapidly taking hold of his body. The CDC had reason to be concerned; McCullough was the third death from yellow fever since 1996, all three originating from trips to the Amazon region. Prior to that, there had not been a yellow fever death on American soil in nearly eighty years.

Tom McCullough had told his wife that he could not remember being bitten by a mosquito during the trip. He slept in an air-conditioned boat and had worn DEET. Still, a mosquito had apparently found him, following the scent of carbon dioxide in the tropical air, perhaps hovering unnoticed around his ankles or legs, biting several times as he moved. But it only took one bite, a pinprick he never even noticed, and the lethal virus made its way into his bloodstream. McCullough’s body had never come in contact with this virus before. He had not had a yellow fever vaccine, and his blood came from stock that had not seen this virus in over a century.

Had an
Aedes aegypti
mosquito in Texas bitten McCullough in the days before he checked into the hospital, hundreds more could have been infected. The virus would have been unleashed on a virgin population. In the mild Corpus Christi winter, virulent eggs could survive to the next summer when even more
Aedes aegypti
mosquitoes would carry the virus through another muggy Texas summer.

At first, the virus would move quietly into the population. People would begin showing up at local emergency rooms with high fevers and flu-like symptoms. They would be released when they showed signs of improvement—yellow fever’s convalescent period. But as many as 50 percent of those people, and possibly many more than that, would enter the toxic phase of the disease and die.Their deaths might be blamed on any number of diseases—pneumonia, hepatitis, influenza, West Nile. Though mosquito bites, swollen and pink, might appear on the skin, no one would think to investigate further. After all, these patients live in the United States. They had not traveled to a tropical country; they had just spent a summer evening outdoors, or found a striped mosquito trapped in their car, or missed a few places of skin when they sprayed Off! on their children playing in the backyard.

As the death toll began to mount, doctors in the local hospitals would begin reporting them to the state health department. Perhaps malaria or dengue had made its way from Central Americanorth. Health officials would be concerned. Resistant strains of malaria have been reported in recent years, and the CDC estimates that as many as 3,800 cases of dengue have appeared in the United States since the 1970s. Dengue is spread by the same mosquito that carries yellow fever. At last, the dead arriving from their homes or on gurneys in emergency rooms would begin to yellow, their skin taking on a bronze color, their eyes like sunflowers.

The state health department would contact the CDC, which, under international law, must contact the World Health Organization within twenty-four hours to report any disease with jaundice and bleeding. Since its inception in the 1950s, the WHO’s International Health Regulations have required reporting of only three diseases: plague, cholera and yellow fever. All three diseases are subject to international quarantine.

But in America, these diseases are so rare that doctors would doubtfully even recognize the symptoms in twenty-four hours. Americans traveling to the coastal areas of Texas for vacation would pick up the virus and fly home to cities like Houston, Dallas, Memphis and New Orleans, where entire colonies of
Aedes aegypti
live.

In 2005, the CDC published a detailed response to an epidemic of yellow fever in Africa and the Americas. Field investigators, border officials and vector control would arrive. They would contact the Global Alliance for Vaccines and Immunization to report an epidemic and request that mass vaccines be delivered within the week. Those who already have the virus would have little chance for survival—they would be part of the nonimmune population, the kindling that the virus relies upon to spread. Vaccines would be given to hospital personnel and military first, but postexposure, it would do little good. In the time it would take the vaccine to prompt the production of antibodies, the virus would have run its course, leaving its host either immune or dead.

A live vaccine, yellow fever can also have adverse effects. Infants, patients with depressed immune systems or anyone over the age of seventy-five cannot receive the vaccine. Though pregnant women are usually denied the attenuated vaccine for the safety of the fetus, the CDC would make an exception in the case of an epidemic. In the hospitals where yellow fever patients arrive, rooms would have to be screened and strictly quarantined. Lab technicians handling blood samples would have to follow strict procedure with gloves, masks and air purifiers.

A general panic would settle into the city and surrounding ones as educational warnings on television and radio recommended that people cover their beds in netting. Informational pamphlets would instruct people to empty any outdoor water containers around their homes. In spite of the summer heat, people would wear pants, long sleeves and socks with shoes. Store shelves would be cleared of Off! and any other DEET products. Windows would be screened. Water and food stockpiling might occur as people prepared to board themselves up in their homes, keeping their children indoors. Public pools and parks might close. Chemicals would be pungent in the air as people sprayed insecticides on their lawns and in their homes. Vector control units would send out patrols of trucks and crop dusters to mass spray.

The panic would worsen.

Vaccines from the Global Alliance for Vaccines and Immunization would arrive, but not enough in the event of a full-scale outbreak. The GAVI only recently began stockpiling the yellow fever vaccine. Six million doses are reserved each year for an epidemic, and they could take a few million more from their reserves for routine vaccine usage. The CDC would assess which portions of the population are most in need of the vaccine, reserving several for the personnel, military and hospital staff. Even if all six million vaccines arrived in a town like Corpus Christi, there would not be enough to inoculate cities the size of Houston and Dallas, much less other southern cities where the mosquitoes or infected people may have made their way.

Cases would continue to appear well into December, spiking every time another warm front moves through the country. At long last the epidemic would subside, though it would live on in the news and on the covers of magazines for months. Major vaccine production programs would begin, grown in chicken eggs over the next six months. And, hopefully, there would be enough vaccines ready for the approach of warm weather the following spring when yellow fever season arrived once again. That is not always the case—especially in underdeveloped countries. After an outbreak of yellow fever that killed thousands in Nigeria during the 1990s, it took ten years to clear the population of the virus. In order to prevent an epidemic, at least 80 percent of a country must have immunity to yellow fever.

According to the World Health Organization, even a single case of yellow fever must be treated as epidemic.

A Return to Africa

Dr. Adrian Stokes bound a monkey onto a cushioned board with gauze, keeping his head firmly strapped. For an hour, Stokes allowed
Aedes aegypti
mosquitoes to bite the monkey on his face, lips, ears. Then, he returned the monkey to its cage. It seemed a little cruel, but it was too dangerous for the doctors to hold the monkeys while loaded mosquitoes fed. Even with leather gloves on, the insects could bite through the stitching. Across the lab from the monkeys, in a cage with roughly six screens dividing it, mosquitoes hummed in their wire prison.

A forty-year-old doctor who worked in pathology at Guy’s Hospital Medical School in London, Stokes was a part of the Yellow Fever Commission sent to West Africa in 1920—the one William C. Gorgas was to be a part of when he died in London. Stokes was a graying Englishman—charming, a tennis player, loved by all those who worked with him. Stokes rarely wore gloves when he worked and took poor care of his hands and fingernails. One doctor had even noticed an open sore on Stokes’s finger from a monkey bite.

The commission’s lab was located in Yaba, not far from Lagos, Nigeria. Africa at the start of the twentieth century was still very much the “Dark Continent”—dark primarily because of colonial Europe’s inability to understand it. For centuries Europeans and Americans had landed on the coast of Africa to enslave Africans; now, they landed on the same shores to enlighten them. The white man, it seemed, would not stay out of Africa; but Africa would not have him. In The Coming Plague, Laurie Garrett wrote of the song African children sing championing yellow fever: “Only mosquito can save Nigeria, Only mosquito can save South Africa, Only mosquito can save Zimbabwe, Only Mosquito can save Africa, Only malaria can save Africa, Only yellow fever can save Africa.”

By the 1920s, after Reed’s proof of the mosquito vector and the vigorous campaign by Gorgas to eliminate yellow fever in urban environments, yellow fever, it seemed, would soon be conquered. Paul De Kruif, in his popular book,
Microbe Hunters,
wrote: “Because, in 1926, there is hardly enough of the poison of yellow fever left in the world to put on the points of six pins; in a few years there may not be a single speck of that virus left on earth.” Hubris. Arrogance. The lessons of the previous century diminished in the distance as the wheels of the Progressive Era rolled forward.

The same year that De Kruif wrote that statement, 1,000 people in an African village of only 5,000 became infected with yellow fever. Although the fever routinely hit nonimmune populations like British and French colonials, the colonial doctors had never seen an epidemic among native Africans before. It was as though an ember had been left smoldering in the jungle, and now fires were beginning to erupt.

America had entered the Progressive Era. Gone were Victorian ideals, heavy-laden tradition, elaborate ceremony and sentimentality. This was the age to move forward. Everything from home life to education to medicine took on a rational precision. For the first time in American history, more people lived in urban environments than on farms. Ideas, people and governments were compartmentalized—there were experts to lead the masses. Medicine had finally become a profession, and science was at the center of progressive thought. Greer Williams wrote that the old bacteriologist was not dead; he had merely “shaved his beard, put on horn-rimmed glasses, changed hats, and reappeared in a new branch of microbiology as a virologist.”

The Rockefeller Institute embodied all the ideas of the Progressive Era. Johns Hopkins had been the premier place for the study of medicine since the 1870s, and it had made monumental discoveries, much like the European institutions before it. They lifted the veil and unraveled the mystery around disease, adding name after name to the list of famous scientists. The Rockefeller Institute, which opened its first lab in 1904, would take a more aggressive tack. It would not model itself after European research and individual scientists, but instead make a departure from it, moving beyond the study of disease to the eradication of it. Like the Progressive Era itself, the institute would take the offensive, its mission “to promote the well-being of mankind throughout the world,” its vision “to cure evils at their source.” Over thirty years, the Rockefeller Foundation would spend fourteen million dollars in an effort to eradicate yellow fever. It would seek out the fever and control the natural world. And there was no place where the natural world was still so unconquered as in Africa, no place where the well-being of mankind was more at stake.

A large cast of American and British doctors was sent to Nigeria by various organizations, including the Rockefeller Foundation, to eradicate yellow fever. The Rockefeller team needed a good pathologist, and in 1927, Adrian Stokes was assigned to work with them. They were the plague hunters, and their aim was not only to see that yellow fever disappeared from North America but to destroy it entirely.

In spite of bubonic plague, malaria and yellow fever, the scientists from both countries made the most of their time in the tropics. They played croquet on the lawn and dined together. They kept gardens with orange bursts of marigold and salmon-colored hibiscus and sun-streaked zinnias. They visited nearby villages in the touring Dodge. But there were a few cultural differences. The Englishmen usually stopped working after 4:00 in the afternoon to enjoy cocktails or play golf or tennis. The British, in turn, found the Americans and their penchant for sunshine strange. The Americans were forever bareheaded in the sun or screening their bungalows and blocking the breeze.