The Coming Plague (23 page)
Authors: Laurie Garrett
On arrival at Kinshasa's airport, van der Gröen was greeted by Belgian diplomats who ushered his supplies through customs and whisked the bewildered scientist off into the night. Van der Gröen's initiation into the Zairian investigation began with a harrowing midnight drive on the highway to Kinshasa, which, as was typical, was marked by several near-collisions with cars and trucks that careened at high speeds without using their headlights. The Zairois believed that they saved fuel by shunning headlight use. As Ruppol briefed van der Gröen on the Yambuku epidemic, the terrified Belgian stared agape out the windshield as one oncoming vehicle after another suddenly loomed out of the darkness, coming within inches of their car, which was driven by a Zairois who deftly dodged all the nearly invisible cars and trucks.
At that moment nobody could have convinced van der Gröen that within a few days such sights would seem blase.
After a night of restless sleep, van der Gröen arose early to meet his new boss, Karl Johnson. Watching Johnson shout commands, always laced with florid language, van der Gröen thought the American “a very peculiar man.” But during his first of the daily morning epidemic meetings, van der Gröen witnessed Johnson's uncanny ability to coordinate a multilingual, multicultural team of individual egos, creating a single, well-oiled anti-microbe machine. As had all those who arrived before, van der Gröen instantly admired Johnson and accepted his leadership without question. Johnson ordered the young Belgian to go to Ngaliema Hospital and create a modern laboratoryâimmediately.
Late that night Johnson came by, holding up some blood samples that Sureau and Piot had sent down from Yambuku. The men uncrated Johnson's glove box, placed it atop the wooden table, and set to work. Van der Gröen had never worked with his hands inserted inside heavy stationary gloves, and he found the process terribly cumbersome and frustrating. Johnson taught the Belgian tricks that he had learned nearly two decades earlier in Bolivia, and the pair were soon toiling smoothly as a team.
Sweat poured off van der Gröen, and every step of the procedure performed in the glove box seemed to take ten times longer than it would atop his Antwerp lab bench. But by two in the morning, he had completed each step of the immunofluorescence process. All that remained was the ultraviolet light microscope examination to see whether or not the serum from Yambuku was infected with the mystery microbe. For that, the pair needed a completely dark room.
Van der Gröen hauled a small table into the bathroom, used the toilet as his seat, and turned off the electric lights.
He switched on his ultraviolet microscope, and with Johnson holding his breath in anticipation, van der Gröen put his eye to the lens.
“Comme les étoiles!”
he exclaimed. “Like twinkling stars ⦠in a dark night, surrounded by red cells. Look, Karl, the cells containing the virus are bright, glowing, fluorescent masses.”
he exclaimed. “Like twinkling stars ⦠in a dark night, surrounded by red cells. Look, Karl, the cells containing the virus are bright, glowing, fluorescent masses.”
Johnson took the toilet seat and peered down the lens. It was three-thirty in the morning, but the men were too excited to sleep. The serum they were looking at came from Sophie in Yambuku, who had survived the disease. Finally they had a way to test who was infected, and to find people who had been infected but successfully fought off the microbe without developing detectable disease. They also now had a way to test whether a particular person's blood contained potentially lifesaving antibodies.
That morning Pierre Sureau awoke in Bumba feeling feverish, unsettled. He and Piot spent the day arguing with the Zairian Armed Forces for transport of equipment from Kinshasa.
As he sat on a veranda overlooking the Bumba Mission, Sureau contemplated what he had learned so far: The disease was clearly deadly, and most victims died within a week. It had taken a huge toll at Yambuku Hospital, and left the surviving nuns and priests nearly incapacitated with grief.
Sipping a cocktail, Sureau contemplated the most awkward finding: the condition of Yambuku Mission Hospital. The previous day he, Breman, and Piot had examined the now empty facility, its medical records, and equipment. When they entered the compound, Sureau had been appalled. The sterilization facilities were abominable, the surgical equipment positively antique, and the linenâthough washedâwas often covered with old blood stains.
Yet when he examined the medical records, he found no telltale link between people who had undergone surgery in the antiquated facility and those who got the disease. He wiped fever sweat off his brow, and couldn't shake the uneasy feeling that the starting point for the epidemic wasâsomehowâthat well-intended but fatally primitive hospital.
With the contemplative Sureau now in Bumba, awaiting an armed forces plane to Kinshasa, were Piot, other team members, Sophie, and Sukato. As the surviving wife of Yambuku's first victimâthe index case, in epidemiology parlanceâAntoine, Sophie had antibodies of incalculable value. Yambuku nurse Sukato was the only member of the mission's medical staff who had survived infection and illness. These two in coming days would donate many units of blood, from which would be derived a tiny vial of antiserum of inestimable value.
By October 24 Sureau's secret fever disappeared. He told no one about his illness: Johnson had insisted from the beginning that team members take their temperature twice a day and immediately report fevers to Kinshasa
headquarters. Sureau chose to disobey, convinced that whatever he had was not the Yambuku disease.
headquarters. Sureau chose to disobey, convinced that whatever he had was not the Yambuku disease.
Fortunately, he was correct.
Sureau was still feeling hot under the collar, however, because the long-awaited plane from Kinshasa hadn't arrived. Johnson sent word that President Mobutu was out of the country, in Switzerland, and in his absence the government was nearly paralyzed. No one else dared order the armed forces to fly into the Bumba Zone.
Sureau and Piot were worried that their samples would go bad in the tropical heat if these delays continued. They made more dry ice for their storage thermos and kept their fingers crossed.
At last on October 27 the Zairian Air Force arrived in the form of a C-130 transport, loaded with lumber and supplies for the construction of a villa for Captain General Bumba, a powerful commandant. The pilots refused to turn off their engines and ordered the group to board immediately.
The pilots grew positively enraged when they spotted the unexpected passengers, Sophie and Sukato.
Ruppol explained the two were very important people: survivors of the epidemic. The appalled pilots swore that nobody infected with the disease could board their aircraft, nor would they allow samples of contaminated blood and tissue on the plane.
A truce was reached: the group could board the plane, but none of them could enter the cabin for any reason. Squeezed in among the commandant's building materials, the passengers did their best to get comfortable during the two-hour flight to Kinshasa. For Sophie and Sukato, both novice air passengers, it was a terrifying experience.
The following morning, October 28, Piot nervously strolled the Kinshasa streets. Like Sureau before him, Piot was running a high fever. Worse yet, he had uncontrollable diarrhea and felt distinctly nauseated. Fearing Johnson would order him airlifted out of the country, Piot hid his ailment from the others, deliberately shunned team members, and searched on his own for dysentery treatments.
Meanwhile, both Sureau and Breman told Johnson that they privately believed the source of most of the fatal cases in Yambuku's epidemic was the hospital. Breman described in detail his eerie stroll through the hospital, and showed Karl two syringes he had delicately removed from a pan of water in the outpatient clinic.
“I'll bet these are infected,” Breman said, noting that the clinic issued only five syringes to its nurses each morning. They were used and reused on the 300 to 600 patients who required medical attention each day.
When Johnson suggested it might be a bit dicey to point an accusatory finger at four now deceased Catholic missionaries, Breman said, “The villagers clearly understood the hospital was the source. Long before it was closed, the people voted with their feet. They ran away. That place was almost empty when it closed.”
Johnson decided to put Breman in charge of a second survey team, responsible for designing a way to test Joel's hypothesis. The plan was to conduct a major epidemiological investigation with nearly all the International Commission directly involved. The first step would require returning a small team to Yambuku to recruit and train a staff of local Zairois, particularly those who had survived the disease and were presumably immune. Johnson warned Breman, however, that one of the locally recruited Machupo investigators in San Joaquin had mistakenly thought a past ailment was Bolivian hemorrhagic fever. It was not, and Einar Dorado had paid for the error with his life.
“Be damned careful,” Johnson said.
On October 27 the commission released its first official account of events in Yambuku to foreign embassies in Kinshasa; the following day embassy officials passed the information on to the international press corps. It was a bland statement, conservatively designed to cast a sense of routine around a crisis that had rendered some team members patently terrified.
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Still, two scientists, a Zairois and an American, who read the report, requested permission to drop out of the investigation. The American had made it as far as Geneva before turning back.
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Still, two scientists, a Zairois and an American, who read the report, requested permission to drop out of the investigation. The American had made it as far as Geneva before turning back.
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On October 31, Sureau, Germain, McCormick, and recently arrived Belgian researcher Simon van Nieuwenhove gathered on the military strip at N'djili Airport at four-thirty in the morning. Now accustomed to the anxieties of the Zairian Air Force, the group had triple-confirmed the flight plans. Their cargo was impressive: two fully equipped Land-Rovers complete with a three-week supply of diesel fuel, food (C rations), and water. The plan was for the group to fly up to Bumba, where they would leave off Sureau and Germain, then proceed further north, to Isiro.
For McCormick and van Nieuwenhove, Isiro would be just a first stop on long separate journeys. McCormick was destined for Maridi, van Nieuwenhove was assigned to search the remote southernmost expanse between Zaire and Sudan for additional pockets of the epidemic.
Of course, despite all their prior confirmations, the scientists were told the planes weren't quite ready for takeoff, and at five-thirty in the morning the pilots were scrambling to cannibalize parts from other planes. Finally, five hours later, the reluctant pilotsâhaving exhausted all reasonable dodgesâwere forced to concede defeat to the scientists, and the C-130 took off for Bumba.
The pilots landed in Bumba and, as always, kept their engines running while Max and Pierre unloaded the cargo and waved goodbye to their friends. Then they took McCormick and van Nieuwenhove to Isiro some 300 miles further north near the Sudanese frontier. The two men drove
their well-stocked Land-Rovers off the C-130, shook hands, and headed in opposite directions.
their well-stocked Land-Rovers off the C-130, shook hands, and headed in opposite directions.
In Isiro (known in colonial days as Old Stanleyville), McCormick hunted for information and some additional supplies, quickly discovering there was little of either to be had. After years of central government corruption, Zaire's most remote areas were bereft of all but local trade, and such “luxury” items as toilet paper, matches, and batteries had long since disappeared.
Information was equally scarce, and McCormick found that the lack of trade activity had slowed the flow of traffic and communication between Zaire's various northern zones to a mere trickle. Surprisingly few people in the region seemed aware of the Yambuku epidemic, and nobody could recall a case of anything resembling that hemorrhagic disease.
As McCormick headed northeast toward the Sudanese border his language skills began to fail him; the more remote the area, the fewer people spoke French, or Otetela, or any other Bantu tongue of which McCormick had a passing knowledge. Soon he found himself in villages not visited by a motorized vehicle in months, even years. And he, a bearded white man, would use an assortment of hand signals and languages to try to find out if anybody in the community had recently suffered an unusual disease. It was hard going, and all too often Joe found himself trying to make sense of conversations that, for example, began in Azandi, were translated into Lingala, and then conveyed to him in French. Information was, at best, muddled.
The closer he got to the Sudanese frontier, the less obvious were the roads. Several times he bailed his Land-Rover out of a river, or plowed through yards of six-foot-tall elephant grass praying the road would reappear on the other side. He was making his way through an area that experienced torrential rains nine months out of the year, and was perpetually mudladen.
At the border he discovered an Italian Catholic mission so removed from its Roman headquarters that the priests were living on five-year-old flour and the “protein” provided by the insects that infested their meager supplies. Elated at seeing a visitor from so far away, the priests were eager to assist McCormick and insisted he share in their sparse food reserves.
The priests told McCormick there were rumors of an epidemic around the Sudanese village of N'zara, located some sixty miles further northeast. Joe told the priests he had no visa or travel papers.
“That is no problem,” they said. “We will take care of it.”
After a night's rest, McCormick was introduced to the chief of a Zairian village adjacent to the border. At the priests' request, the chief signed a letter that formally asked his counterpart on the Sudanese side of the border to admit McCormick into the country. Arriving at the much-anticipated border, Joe found two posts, atop which rested a long stick. Between the border posts lay the road, now narrowed to a mud footpath and bearing no
signs of recent vehicular traffic. A handful of obviously hungry soldiers sat on their haunches around the site; they greeted McCormick's arrival as a source of grand gossip and entertainment, breaking up an otherwise miserably monotonous day.
signs of recent vehicular traffic. A handful of obviously hungry soldiers sat on their haunches around the site; they greeted McCormick's arrival as a source of grand gossip and entertainment, breaking up an otherwise miserably monotonous day.
When Joe finally reached N'zara he sent a relayed radio signal to Karl Johnson to assure his friend in Kinshasa that he had arrived safely and could confirm there was an epidemic afoot. To accomplish such a seemingly simple task: McCormick first sent a ham radio signal to the Italian missionaries back at the Zaire border. They relayed the message to a pilot flying a missionary twin-engine plane. He ascended to sufficient altitude to be able to send an unblocked signal down the length of Zaire, where it came out of the speaker of Johnson's single side-band radio. With such a complex system it was obvious that the message had to be short and sweet: the details would have to await Joe's return to Bumba.
For three weeks McCormick slept in the Land-Rover by night and interviewed epidemic victims and survivors by day. It became obvious that few people traveled between the N'zara area and Yambuku, a distance of over 400 miles.
By the time Joe arrived the worst of the Nâzara outbreak was past, and there were no more active cases in the clinic. For several days he questioned residents of N'zara and the outlying villages, and collected blood samples. Satisfied that the epidemic was under control, his supplies dangerously low, McCormick prepared to return to Zaire. But first, with a hint of mischief, Joe wrote a note to his CDC colleague Don Francis. McCormick knew Francis was heading up an official WHO team that was trying to make its way to N'zara from Khartoum.
Before he left, McCormick put the note in a box and left it with a town leader instructed to “give the container to the white man who will come soon from Khartoum.”
McCormick had no idea that Francis and his team were trapped in Khartoum, hostage to terrified pilots who were refusing to fly and government bureaucrats uncertain about providing open access to the Europeans and Americans. It would be several days before the WHO team would reach the area. In the meantime, McCormick's container, pregnant with information, waited in the hot N'zara sun.
In American holiday terms, McCormick left Isiro on Halloween and returned to the Bumba Zone the day before Thanksgiving, having been virtually incommunicado the entire time.
Much had happened in his absence. A full-scale epidemiological survey of all the villages surrounding the Yambuku Mission had been conducted, involving most of the International Commission members. For nearly two weeks, the team, augmented by dozens of trained local volunteers, surveyed over 550 villages, interviewed 34,000 families, and took blood samples from 442 people in the hardest-hit communities. In addition, team members gathered a sampling of local insects and animals to test for viral infection.
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And on November 6, Zaire's Minister of Health, Ngwété, issued an international report summarizing findings to date: 358 cases of the viral disease had occurred, 325 were fatal. That was an astonishing lethality rate of 90.7 percent.
Ngwété said all tests in labs throughout the world proved that “this agent is a new virus.”
“The name âEbola,' after a little river in the region where the disease first appeared, is proposed for this virus,” Ngwété concluded.
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Somehow, having a name for the culprit had brought new energy and focus to the Yambuku investigation, and the fears of the scientists receded with repetition of the word “Ebola.” After a while, “Ebola” sounded almost routine, like “measles” or “polio.”
That sense of relative calm evaporated when, several days later, the International Commission learned that Geoffrey Platt had contracted Ebola disease in England.
For nearly a month Platt had toiled with caution and deliberation in his laboratory at Porton Down, trying to learn quickly as much as possible about the Sudan strain of the Ebola virus. On the morning of November 5 he was working in the Toxic Animals Wing of Porton Down, passing Ebola samples from one guinea pig to another to see if the virulence of the virus was diminished as it went through successive generations of animals. As always, he was wearing a respirator, protective lab clothes, and three layers of latex gloves.
His hand slipped.
The syringe containing Ebola-infected guinea pig blood jammed into the tip of his thumb, just above the nail.
Horrified, Platt was seized by panic, and for some timeâhe had no idea whether it was seconds or minutesâhe stared at the thumb and saw his mortality.
“Hurry, get a grip on yourself,” he said, ripping off the three sets of gloves and squeezing hard at his punctured thumb tip.
“Bleed, damnit! Bleed,” he muttered, but no blood appeared. He dashed out to the next chamber and shoved his hand into a disinfectant tank. For two minutes he held his digit submerged, praying against all biological probability that no virus had actually passed into his thumb; or the disinfectant was getting drawn up into the microns-wide pore created by the needle, killing the virus; or the accident hadn't actually happened at all. He could feel his heart pounding hard against his chest, and feared the adrenaline-propelled organ was all too efficiently pumping Ebola virus throughout his body.
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He slowly withdrew his hand from the vat, daubed it with a towel, and used a magnifying lens to search for the needle puncture site. He saw no sign of it.
Carefully following lab exiting procedures, Platt left the Toxic Animals Wing and reported to the Laboratory Safety Office, where he was examined
briefly, given a thermometer, and sent home with instructions to report any sudden rise in his temperature.
briefly, given a thermometer, and sent home with instructions to report any sudden rise in his temperature.
For six days Platt paced the floors of his lab and house, losing sleep for the first time in his many years of working with lethal viruses. His wife, Eileen, did her best to shield their two preadolescent children from the growing anxiety shared by their parents.
At midnight on November 11, Platt's temperature suddenly jumped, and he felt the chills of a fever. The following morning he reported to the Porton Down safety office. By then his fever was over 100°F, and the staff was very worried, not only on Platt's behalf but also for everyone at the laboratory with whom he'd had contact. They immediately took a blood sample from Platt, examining a droplet under an electron microscope.
The dreaded “???? virus” was there.
Platt donned a respirator to protect others from his virus, and a special ambulance staffed by volunteer drivers and guided by a police escort took the English scientist to North London's Coppetts Wood Hospital. While Platt was placed inside a new Trexler negative-pressure plastic isolator, the 160 other patients then in the hospital were hastily packed off to alternative medical facilities.
For forty-nine days Platt languished inside his plastic environment, which was, in turn, inside an otherwise empty hospital. The large medical staff that tended to him, led by Dr. Ronald Emond, was placed under quarantine. And throughout the first week of Platt's life-struggle, he was entirely cut off from family and friends.
Meanwhile, Eileen and the kids were under house quarantine, forced to constantly check their own temperatures, and terrified that Geoffrey would die.
The British government's reaction to Platt's illness was rapid and severe. Porton Down was immediately shut down, all its employees sent home and placed under surveillance. Several friends of the Platt family were also put under home quarantine. Over a month's time some £200,000 was spent by the U.K. government to compensate employees for lost work time, relocate Coppetts Wood hospital patients, and monitor over 300 people for possible Ebola infection.
Meanwhile, Platt suffered most of the symptoms seen among Ebola victims in Zaire and Sudan. His care, however, bore no resemblance to that available to the people of Yambuku.
As Platt's fever climbed to over 104°F, his hair fell out and he passed blood in his stools and vomitus. Dr. Emond's team attacked the virus with every weapon available. Recently isolated human interferonâa crucial chemical of the immune systemâwas injected into Platt twice a day in large doses (3 million units). The ailing scientist was placed on intravenous feedings, carefully selected to balance his diarrhea-disrupted electrolytes. When
Candida
fungal infections appeared in his throat, Platt got amphotericin
B lozenges. Every fluctuation in his vital signs and blood and urine chemistry were monitored closely.
Candida
fungal infections appeared in his throat, Platt got amphotericin
B lozenges. Every fluctuation in his vital signs and blood and urine chemistry were monitored closely.
And forty-seven hours after his fever began, Platt was infused with Sophie's plasma, flown in from Kinshasa.
Following the Ebola plasma treatment Platt's condition worsened; his fever spiked again, he was extremely nauseated, his bowel was incontinent, his joints all ached, and he was very weak. Most alarming to Emond was Platt's mental state. The bright scientist was losing his memory, couldn't concentrate long enough to finish reading a sentence and seemed disoriented.
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