The Coming Plague (22 page)
Authors: Laurie Garrett
With Massamba and Bumba missionary Father Germain Moke, the scientists made their journey to Yambuku later that morning in two Land-Rovers. The fifty-mile drive took all afternoon. Rarely could the frustrated drivers gain enough speed on the bumpy muddy roads to get out of second gear.
More than three hours later, they reached Yambuku.
They turned off the engines and immediately felt the sad silence of the place. Gone were the noise and activity of typical Zairian villages, the long lines of chattering women and children waiting for vaccinations, the vendors selling their wares. Indeed, gone were the people, altogether.
Piot spotted Sister Genoveva's odd white gauze “cordons sanitaires” strung about the mission, and a sign in French that said: “Do not enter; to call the Sisters ring the bell.” As he approached the bell three nuns came running out of one of the buildings, calling, “Don't come near! You're going to die! You will die! Stay away!”
Recognizing their Flemish accents, Piot jumped over the “cordons” and shouted greetings in their shared native tongue. Overwhelmed at hearing Flemish, the nuns broke down, sobbing. Sureau, Ruppol, and Breman quickly joined Piot in his efforts to comfort the women, and the Sisters were pleased that Jean-François had, as promised, returned to their devastated outpost. As tensions and emotions eased, the scientists unloaded their equipment and followed the Sisters to the school. Closed since the fourth week of the epidemic, the barren classrooms became their temporary home.
Over dinner and plenty of wine the Catholic teachers and clerics poured out their stories for hours on end, while the visitors patiently listened, asked gentle questions, and occasionally jotted down notes. Sister Marcella,
who had been keeping logs of the dead, presented her grim lists to Sureau.
who had been keeping logs of the dead, presented her grim lists to Sureau.
Speaking in a deliberate monotone, which seemed to help her keep her emotions in check, Sister Marcella explained that in the past month 38 of the 300 residents and employees of Yambuku had died, including all the missionary nurses, four out of six Zairian nurses, one of the three padres, and one of two hospital laundry workers. Then she gave the scientists a sobering list of villagers afflicted. The visitors realized they would have to go to every single village, conducting a house-to-house investigation. No other approach would do.
Sister Marcella also volunteered that the first unusual medical problems at the hospital may have occurred in August, when three women died in close succession on the obstetrics ward. They had bled to death after giving birth. The Sister had checked hospital records for the same time periods in 1975 and found no such cases, and she was unable to tease out of the general hospital records cases of anything similar to the strange new disease prior to August 1976.
“It is new,” she told them. “It is definitely something new.”
While the exhausted scientists slept on the hard floors of the Yambuku school, Mayinga lost consciousness in Ngaliema's Pavilion 5. And the commission members argued late into the Kinshasa night about contingency procedures for handling infected team members.
Joe McCormick had just started unpacking his hundreds of crates of laboratory supplies for Lassa research when he received a cable from the CDC in Atlanta, instructing him to temporarily abandon the lab outside Kenema, Sierra Leone, and make his way as quickly as possible to Kinshasa. The cable stated that his familiarity with northern Zaire, coupled with his epidemiology skills, made him indispensable. He was instructed to bring with him the portable glove-box lab he and Johnson had rigged up in Atlanta just weeks earlier, and other equipment that was needed at Ngaliema Hospital for testing and screening blood samples and preparing antisera against the mysterious disease.
Just a few months earlier, having heard of McCormick's exploits in Brazil, Johnson had snagged Joe one day in the CDC hallway.
“I'd like to send you to Sierra Leone,” Johnson said, “to figure out just how widespread Lassa really is.”
McCormick hadn't been in West Africa, and the Lassa puzzle sounded “damned interesting,” so in March 1976 he packed and prepared to set up a one-man Lassa research station in Sierra Leone. Just before he left, McCormick and Johnson rigged a glove-box contraption similar to the one Karl had used in Bolivia, and Joe gathered enough equipment to study the virus safely under even the most primitive conditions.
Within a week he had his Lassa research station: a small building 200 miles from the capital, outside the town of Kenema. It contained two chairs and his cases from Atlanta. He'd just uncrated Johnson's portable laboratory when the cable arrived from Kinshasa.
McCormick knew there was no easy way to get from Freetown, Sierra Leone, to Kinshasa: virtually all flights between African countries were both notoriously expensive and unreliable; nearly all went from one African country to another via the formerly colonial European countries.
For three days McCormick bluffed, bullied, and bribed his way onto airplanes and through customs in Freetown, Abidjan, and, finally, Kinshasa. He completed the 2,000-mile journey with all equipment crates, remarkably, intact. At Kinshasa's N'djili Airport he sprinkled a little Kiswahili and Otetela in with his French, and eventually convinced customs and immigration officials to let his crates into the country, unopened, undamaged, and unexamined.
Meanwhile, the scientific team awoke with the Yambuku dawn, relayed an abbreviated version of Sister Marcella's reports by radio to Bumba (from where they were ultimately relayed to Kinshasa), breakfasted, and set out in different directions in four teams to inspect the villages. Piot and Sureau were teamed up, and Sister Marcella, ecstatic to be outside the mission after so many days of quarantine, acted as their guide.
“We must limit the numbers of us who are exposed to this virus until we determine how infectious it is,” Sureau told the group, instructing that only he and Piot should draw blood.
The trio first arrived in Yalikonde, close by Yambuku, where they quickly learned how to gain the trust of the fearful villagers. A working pattern developed that was repeated in ten villages that day. It would begin with an amble about the middle of the village, during which time the leading elder of the community would introduce himself. The group would discuss the weather for a while, until the elder invited them to share some arak.
“This stuff is pure methanol,” Piot whispered.
“Drink!” Sureau commanded.
After the
arak
burn had made its way down their throats and into their stomachs, the Yalikonde elder introduced the white men to Lisangi Mobago, a twenty-five-year-old man who had been struggling with the disease for six days. The visitors examined Lisangi, who was far too weak to protest, and drew a blood sample.
arak
burn had made its way down their throats and into their stomachs, the Yalikonde elder introduced the white men to Lisangi Mobago, a twenty-five-year-old man who had been struggling with the disease for six days. The visitors examined Lisangi, who was far too weak to protest, and drew a blood sample.
Everywhere the group went they noticed the people had taken remarkably wise measures to stop the epidemic's spread. Roadblocks were staffed around the clock near village entries, virtually all traffic on the Ebola and Zaire rivers had come to a halt, the ailing villagers and their families were kept under quarantine, bodies were buried some distance away from the houses, and there was little movement of people between communities.
“These people have really got their act together,” Piot told Sureau, who was also impressed by the steps taken.
In one village about ten miles from Yambuku, Piot and Sureau found a husband and wife lying side by side in their hut, both in the final throes of the disease. Pierre took blood from the husband while Peter prepared the wife's arm.
Sureau shifted his weight to face the wife, found a vein, and inserted his syringe. As he released the tourniquet and watched blood slowly fill the tube, the husband let out a deep groan and died. The wife cried out, Sureau quickly withdrew his needle, and she rolled over to embrace her dead husband.
Shaken, they stepped out into the sweltering sun and whispered anxiously. If the husband had died while Sureau was taking his blood, the villagers might have attacked the men, accusing them of responsibility or, worse, of homicide. As it was, many villagers were taken aback when the tall white menâespecially Breman and Piot, who both stood over six feetâdonned goggles, rubber gloves, and surgical masks before entering the homes of the infected.
For their part, the Europeans and the American had no idea whether these modest precautions were adequate to protect them from what they now understood firsthand was a particularly horrible disease. Breman was a bit anxious that villagers might be offended by his protective gear, but he was also, as the blunt American put it, “scared shitless.”
“I'm no Marlboro Man, and I don't mind admitting I'm really frightened. As, I think, we all should be,” Breman told his colleagues, who vigorously nodded their concurrence with his sentiments.
When the team members reunited at the mission after their first long and emotionally exhausting day in the villages, they compared notes and agreed that the epidemic had taken a terrible tollâin some cases claiming entire familiesâbut the worst of it seemed to have passed. Breman, in particular, was relieved to see that initial accounts saying entire villages had been exterminated by the virus were gross exaggerations. Without knowing its cause or cure, the people had wisely taken many proper measures to slow the virus's spread. The scientists humbly agreed that their scientific expertise had not been necessary to arrest the epidemic.
But it would require the best their collective talents could muster to solve the mysteries of where the strange virus came from, how it was spread, and how best to prevent its resurgence.
That evening as they relaxed with more mission wine, layered atop several rounds of village
arak
, a day-old radio communication reached them from Kinshasa, via Bumba.
arak
, a day-old radio communication reached them from Kinshasa, via Bumba.
“Mayinga died late the night of October 20,” it stated flatly.
Sureau was devastated, as were the Sisters, who felt profound gratitude for the student nurse's courage in tending to Sisters Edmonda and Myriam.
“What we are dealing with is a virus like Marburg, but
more
pathogenic. A super-Marburg. I don't feel alarmed, but I do feel a sense of disagreeable
uncertainty. Who will be the next victim among the caregivers? Sister Donatienne? ⦠Margaretha or me? The incubation time is usually eight days! How many more victims will there be in the villages? What can be done to stop this epidemic?” Sureau asked.
more
pathogenic. A super-Marburg. I don't feel alarmed, but I do feel a sense of disagreeable
uncertainty. Who will be the next victim among the caregivers? Sister Donatienne? ⦠Margaretha or me? The incubation time is usually eight days! How many more victims will there be in the villages? What can be done to stop this epidemic?” Sureau asked.
The others looked at Sureau in sad agreement, for he was voicing thoughts shared by all.
Though Sureau had clung to the increasingly dubious hypothesis that the epidemic was caused by some sort of Marburg virusâprobably in a spirit of hopefulness on Mayinga's behalfâBreman had no such illusions. Breman had been on the phone with Pat Webb at least twice a day for the three weeks prior to his arrival in Kinshasa. He knew precisely what Webb had discovered, and he carried with him eight-by-ten microscope photos of the enemy. As he wandered about the villages, Joel would hold up the “???? virus” pictures of fuzzy, curled, wormlike microbes and explain to the Zairois that this new entity was the cause of their suffering.
The trained epidemiologist of the group, Breman laid out a symptomatic definition of the Yambuku disease that the four teams should use as they scoured villages for cases.
That night, Sureau radioed Bumba to tell Kinshasa that first surveys showed 46 villages were affected, with over 350 deaths.
For the next few days the scientists worked in Yambuku, Bumba, and the villages in between, having no way to communicate either with Karl Johnson in Kinshasa or with one another once they split off daily to investigate separate villages. Sureau and Breman occasionally received garbled messages about helicopters due to arrive with more experts and better equipment. When the copters failed to arrive, they simply assumed the messages were mixed up.
It broke Breman's heart to watch the nuns “communicate” with their ancient ham radio equipment. Every day at a designated time a Sister would put her ear to the decades-old speaker, turn on the radio, and listen through horrendous static for the voice of the monsignor in Lisala. One by one, he would call out the name of each mission in northern Zaire and in this crude manner the network of missionaries would order supplies and share important news.
Though he had hooked up newer equipment, the overall system was so primitive that the American-made side-band radios made little difference. There remained no way to communicate directly with Kinshasa, and all communications were subject to the problems inherent in the child's game of Telephone, in which one person passes a sentence on to another, and another, until after a tenfold relay the message bears little resemblance to the original. U.S. Embassy officials told Johnson that setting up a sophisticated communications system connecting Yambuku, Bumba, Kinshasa, and Atlanta “would entail several million dollars and a twenty-four-hour aircraft relay system.” In his usual insouciant fashion, Johnson had words
with the officials, but Breman, having had his fill of U.S. State Department types elsewhere in Africa, suggested Karl not waste his energy on the bureaucrats.
with the officials, but Breman, having had his fill of U.S. State Department types elsewhere in Africa, suggested Karl not waste his energy on the bureaucrats.
Meanwhile, Karl Johnson was trying his best to outmaneuver other logistic nightmares created by the Zairian Armed Forces (which didn't want to fly anywhere near Yambuku), the embassies of the United States and France, and a host of international political issues. He needed a top entomologist or ecologistâsomebody who could search, as Merl Kuns had in Bolivia, for the insects or animals that carried the disease. After casting its net far and wide, WHO decided to send French Dr. Max Germain, who worked in the agency's Brazzaville office.
Finally, Johnson needed to get a team further out, way up to Sudan, to figure out how the epidemics of Yambuku and Maridi were connected. For that job Johnson knew exactly whom he wanted: “This one's for Joe,” he said, anticipating McCormick's imminent arrival.
McCormick landed in Kinshasa on October 23, the same day the CDC's David Heymann cabled word that a NASA space capsule had successfully been transported from Houston, where it was staffed and ready to receive any WHO team members unlucky enough to catch the virus. Also ready at the Frankfurt Airport in Germany was a USAF C-131 transport jet with an Apollo space capsule aboardâthe same space capsule that Henry Kissinger had offered two years earlier for use in airlifting Lassa-infected Mandrella from Nigeria to Hamburg.
That day Johnson got an update from Geneva on the Sudanese epidemic. A team of investigators had been selected, comprised of ten Sudanese doctors, Irishman David Simpson, France's Paul Bres, and the CDC's Don Francis. The investigators were instructed to rendezvous immediately in Khartoum and from there make their way south to Maridi.
Johnson also wanted a top-flight lab worker in Kinshasa right awayâsomeone who could improvise and create a diagnostic laboratory out of the meager facilities available. Pattyn recommended van der Gröen, who immediately flew to Zaire loaded down with essential supplies. Key among his gear were microscope slides he had carefully coated with infected Vero cells. Though they were fixed with acetone, van der Gröen had no way of knowing whether or not those slides were covered with contagious organisms.
“It doesn't matter,” he told himself. “I'll make sure I'm the only one exposed to these things. But I must have them. There is no other way to diagnose infection.”
His plan was to diagnose infections by putting patients' blood samples on the microscope slides, waiting a while, then rinsing the slides. If patients were infected, they would make antibodies against the mysterious microbe that would latch on to the infected Vero cells. He then planned to mix fluoresceinâa molecule that glows under ultraviolet lightâwith monkey antihuman antibodies. When the fluorescent antibodies were coated onto
the microscope slides, they would cling to the human antibody-attached Vero cells. And van der Gröen planned to simply flash ultraviolet light at his slides to see which people had infected blood. Though the method had been in use for Lassa since Jordi Casals's days at the Rockefeller Foundation, van der Gröen had never tried the immunofluorescence technique, and hoped that he would be able to perform professionally in the epidemic pressure cooker.
the microscope slides, they would cling to the human antibody-attached Vero cells. And van der Gröen planned to simply flash ultraviolet light at his slides to see which people had infected blood. Though the method had been in use for Lassa since Jordi Casals's days at the Rockefeller Foundation, van der Gröen had never tried the immunofluorescence technique, and hoped that he would be able to perform professionally in the epidemic pressure cooker.
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