Marburg virus (the gentle sister) affects humans somewhat like nuclear radiation, damaging virtually all of the tissues in their bodies. It attacks with particular ferocity the internal organs, connective tissue, intestines, and skin. In Germany, all the survivors lost their hair—they went bald or partly bald. Their hair died at the roots and fell out in clumps, as if they had received radiation burns. Hemorrhage occurred from all orifices of the body. I have seen a photograph of one of the men who died of Marburg, taken in the hours before his death. He is lying in bed without any clothing on his upper body. His face is expressionless. His chest, arms, and face are speckled with blotches and bruises, and droplets of blood stand on his nipples.
During the survivors’ recovery period, the skin peeled off their faces, hands, feet, and genitals. Some of the men suffered from blown up, inflamed, semirotten testicles. One of the worst cases of this testicular infection appeared in a morgue attendant who had handled Marburg-infected bodies and who himself came down with Marburg, having caught it from the cadavers. The virus also lingered in the fluid inside the eyeballs of some victims for many months. No one knows why Marburg has a special affinity for the testicles and the eyes. One man infected his wife with Marburg through sexual intercourse.
Doctors noticed that the Marburg agent had a strange effect on the brain. “Most of the patients showed a sullen, slightly aggressive, or negativistic behavior,” according to the book. “Two patients [had] a feeling as if they were lying on crumbs.” One patient became psychotic, apparently as a result of brain damage. The patient called Hans O.-V. showed no signs of mental derangement, and his fever cooled, and he seemed to be stabilizing, but then suddenly, without warning, he had an acute fall in blood pressure—he was crashing—and he died. They performed an autopsy on him, and when they opened his skull, they found a massive, fatal hemorrhage at the center of the brain. He had “bled out” into his brain.
International health authorities were urgently concerned to find the exact source of the monkeys, in order to pin down where in nature the Marburg virus lived. It seemed pretty clear that the Marburg virus did not naturally circulate in monkeys, because it killed them so fast it could not successfully establish itself in them as a useful host. Therefore, Marburg lived in some other kind of host—an insect? a rat? a spider? a reptile? Where, exactly, had the monkeys been trapped? That place would be the hiding place of the virus. Soon after the outbreak in Germany, a team of investigators under the auspices of the World Health Organization flew to Uganda to try to find out where those monkeys had come from. It turned out they had been trapped at locations all over central Uganda. The team couldn’t discover the exact source of the virus.
There the mystery lingered for many years. Then, in 1982, an English veterinarian came forward with new eyewitness information about the Marburg monkeys. I will call this man Mr. Jones (today, he prefers to remain anonymous). During the summer of 1967, when the virus erupted in Germany, Mr. Jones was working at a temporary job inspecting monkeys at the export facility in Entebbe from which the sick Marburg monkeys had been shipped, while the regular veterinary inspector was on leave. This monkey house, which was run by a rich monkey trader (“a sort of lovable rogue,” according to Mr. Jones) was exporting about thirteen thousand monkeys a year to Europe. This was a very large number of monkeys, and it generated big money. The infected shipment was loaded onto an overnight flight to London, and from there it was flown to Germany—where the virus broke out of the monkeys and “attempted” to establish itself in the human population.
After making a number of telephone calls, I finally located Mr. Jones in a town in England, where today he is working as a veterinary consultant. He said to me: “All that the animals got, before they were shipped off, was a visual inspection.”
“By whom?” I asked.
“By me,” he said. “I inspected them to see that they appeared normal. On occasion, with some of these shipments, one or two animals were injured or had skin lesions.” His method was to pick out the sick-looking ones, which were removed from the shipment and presumably killed before the remaining healthy-looking animals were loaded onto the plane. When, a few weeks later, the monkeys started the outbreak in Germany, Mr. Jones felt terrible. “I was appalled, because I had signed the export certificate,” he said to me. “I feel now that I have the deaths of these people on my hands. But that feeling suggests I could have done something about it. There was no way I could have known.” He is right about that: the virus was then unknown to science, and as few as two or three not-visibly-sick animals could have started the outbreak. One concludes that the man should not be blamed for anything.
The story becomes more disturbing. He went on: “The sick ones were being killed, or so I thought.” But later he learned that they weren’t being killed. The boss of the company was having the sick monkeys put in boxes and shipped out to a small island in Lake Victoria, where they were being released. With so many sick monkeys running around it, the island could have become a focus for monkey viruses. It could have been a hot island, an isle of plagues. “Then, if this guy was a bit short of monkeys, he went out to the island and caught a few, unknown to me, and those infected or recently infected monkeys were then shipped off to Europe.” Mr. Jones thinks it is possible that the Marburg agent had established itself on the hot island, and was circulating among the monkeys there, and that some of the monkeys which ended up in Germany had actually come from that island. But when the WHO team came later to investigate, “I was told by my boss to say nothing unless asked.” As it turned out, no one asked Mr. Jones any questions—he says he never met the WHO team. The fact that the team apparently never spoke with him, the monkey inspector, “was bad epidemiology but good politics,” he remarked to me. If it had been revealed that the monkey trader was shipping off suspect monkeys collected on a suspect island, he could, have been put out of business, and Uganda would have lost a source of valuable foreign cash.
Shortly after the Marburg outbreak in Germany, Mr. Jones recalled a fact that began to seem important to him. It seems that the Marburg virus may have been burning through rural areas in Uganda not far from Kitum Cave. Between 1962 and 1965 he had been stationed in eastern Uganda, on the slopes of Mount Elgon, inspecting cattle for diseases. At some time during that period, local chiefs told him that the people who lived on the north side of the volcano, along the Greek River, were suffering from a disease that caused bleeding, death, and “a peculiar skin rash” —and that monkeys in the area were dying of a similar disease. Mr. Jones did not pursue the rumors, and was never able to confirm the nature of the disease. But it seems possible that in the years preceding the outbreak of Marburg virus in Germany, a hidden outbreak of the virus occurred on the slopes of Mount Elgon.
Mr. Jones’s personal vision of the Marburg outbreak reminds me of a flashlight pointed down a dark hole. It gives a narrow but disturbing view of the larger phenomenon of the origin and spread of tropical viruses. He told me that some of the Marburg monkeys were trapped in a group of islands in Lake Victoria known as the Sese Islands. The Seses are a low-lying forested archipelago in the northwestern part of Lake Victoria, an easy boat ride from Entebbe. The isle of plagues may have been situated among the Seses or near them. Mr. Jones does not recall the name of the hot island. He says it is “close” to Entebbe. At any rate, Mr. Jones’s then-boss, the Entebbe monkey trader, had arranged a deal with villagers in the Sese Islands to buy monkeys from them. They regarded the monkeys as pests and were happy to get rid of them, especially for money. So the trader was obtaining wild monkeys from the Sese Islands, and if the animals proved to be sick, he was releasing them again on another island somewhere near Entebbe. And some monkeys from the isle of plagues seemed to be ending up in Europe.
In papyrus reeds and desolate flatlands on the western shore of Lake Victoria facing the Sese Islands, there is a fishing village called Kasensero. You can see the Sese Islands from the village. Kasensero was one of the first places in the w
orld where AIDS appeared. Epidemiologists have since discovered that the northwestern shore of Lake Victoria was one of the initial epicenters of AIDS. It is generally believed that AIDS came originally from African primates, from monkeys and apes, and that it somehow jumped out of these animals into the human race. It is thought that the virus went through a series of very rapid mutations at the time of its jump from primates to humans, which enabled it to establish itself successfully in people. In the years since the AIDS virus emerged, the village of Kasensero has been devastated. The virus has killed a large portion of the inhabitants. It is said that other villages along the shores of Lake Victoria have been essentially wiped off the map by AIDS.
The villagers of Kasensero are fishermen who were, and are, famous as smugglers. In their wooden boats and motorized canoes they ferried illegal goods back and forth across the lake, using the Sese Islands as hiding places. One can guess that if a monkey trader were moving monkeys around Lake Victoria, he might call on the Kasensero smugglers or on their neighbors.
One general theory for the origin of AIDS goes that, during the late nineteen-sixties, a new and lucrative business grew up in Africa, the export of primates to industrialized countries for use in medical research. Uganda was one of the biggest sources of these animals. As the monkey trade was established throughout central Africa, the native workers in the system, the monkey trappers and handlers, were exposed to large numbers of wild monkeys, some of which were carrying unusual viruses. These animals, in turn, were being jammed together in cages, exposed to one another, passing viruses back and forth. Furthermore, different species of monkeys were mixed together. It was a perfect setup for an outbreak of a virus that could jump species. It was also a natural laboratory for rapid virus evolution, and possibly it led to the creation of HIV. Did HIV crash into the human race as a result of the monkey trade? Did AIDS come from an island in Lake Victoria? A hot island? Who knows. When you begin probing into the origins of AIDS and Marburg, the light fails and things go dark, but you sense hidden connections. Both viruses seem part of a pattern.
When he learned what Marburg virus does to human beings, Dr. David Silverstein persuaded the Kenyan health authorities to shut down Nairobi Hospital. For a week, patients who arrived at the doors were turned away, while sixty-seven people were quarantined inside the hospital, mostly medical staff. They included the doctor who had done the autopsy on Monet, nurses who had attended Monet or Dr. Musoke, the surgeons who had operated on Musoke, and aides and technicians who had handled any secretions from either Monet or Musoke. It turned out that a large part of the hospital’s staff had had direct contact with either Monet or Musoke or with blood samples and fluids that came from the two patients. The surgeons who had operated on Musoke, remembering only too well that they had been “up to the elbows in blood,” sweated in quarantine for two weeks while they wondered if they were going to break with Marburg. A single human virus bomb had walked into the hospital’s waiting room and exploded there, and the event had put the hospital out of business. Charles Monet had been an Exocet missile that struck the hospital below the water line.
Dr. Shem Musoke survived his encounter with a hot agent. Ten days after he fell sick, the doctors noticed a change for the better. Instead of merely lying in bed in a passive state, he became disoriented and angry and refused to take medicine. One day, a nurse was trying to turn him over in bed, and he waved his fist at her and cried, “I have a stick, and I will beat you.” It was around that time that he began to get better, and after many days his fever subsided and his eyes cleared; his mind and personality came back, and he recovered slowly but completely. Today he is one of the leading physicians at Nairobi Hospital, where he practices as a member of David Silverstein’s group. One day I interviewed him, and he said to me that he has almost no memory of the weeks he was infected with Marburg. “I only remember bits and pieces,” he said. “I remember having major confusion. I remember, before my surgery, that I walked out of my room with my IV drip hanging out of me. I remember the nurses just turning me and turning me in bed. I don’t remember much of the pain. The only pain I can talk about is the muscle ache and the lower-back ache. And I remember him throwing up on me.” Nobody else at the hospital developed a proven case of Marburg-virus disease.
When a virus is trying, so to speak, to crash into the human species, the warning sign may be a spattering of breaks at different times and places. These are microbreaks. What had happened at Nairobi Hospital was an isolated emergence, a microbreak of a rain-forest virus with unknown potential to start an explosive chain of lethal transmission in the human race.
Tubes of Dr. Musoke’s blood went to laboratories around the world so that they could have samples of living Marburg for their collections of life forms. The Marburg in his blood had come from Charles Monet’s black vomit and perhaps originally from Kitum Cave. Today this particular strain of Marburg virus is known as the Musoke strain. Some of it ended up in glass vials in freezers owned by the United States Army, where it was kept immortal in a zoo of hot agents.
A WOMAN
AND A SOLDIER
1983 SEPTEMBER 25, 1800 HOURS
Thurmont, Maryland, nearly four years after the death of Charles Monet. Evening. A typical American town. On Catoctin Mountain, a ridge of the Appalachians that runs north to south through the western part of the state, the trees were brightening into soft yellows and golds. Teenagers drove their pickup trucks slowly along the streets of the town, looking for something to happen, wishing that the summer had not ended. Faint smells of autumn touched the air, the scent of ripening apples, a sourness of dead leaves, cornstalks drying in the fields. In the apple groves at the edge of town, flocks of grackles settled into the branches for the night, squawking. Headlights streamed north on the Gettysburg road.
In the kitchen of a Victorian house near the center of town, Major Nancy Jaax, a veterinarian in the United States Army, stood at a counter making dinner for her children. She slid a plate into the microwave oven and pushed a button. Time to nuke up some chicken for the kids. Nancy Jaax wore sweatpants and a T-shirt, and she was barefoot. Her feet had calluses on them, the result of martial-arts training. She had wavy auburn hair, which was cut above the shoulders, and greenish eyes. Her eyes were actually two colors, green with an inner rim around the iris that was amber. She was a former homecoming queen from Kansas—Miss Agriculture, Kansas State. She had a slender, athletic build, and she displayed quick motions, flickery gestures, with her arms and hands. Her children were restless and tired, and she worked as fast as she could to fix the dinner.
Jaime, who was five, hung on Nancy’s leg. She grabbed the leg of Nancy’s sweatpants and pulled, and Nancy lurched sideways, and then Jaime pulled the other way, and Nancy lurched to the other side. Jaime was short for her age and had greenish eyes, like her mother. Nancy’s son, Jason, who was seven, was watching television in the living room. He was rail thin and quiet, and when he grew up he would probably be tall, like his father.
Nancy’s husband, Major Gerald Jaax, whom everyone called Jerry, was also a veterinarian. He was in Texas at a training class, and Nancy was alone with the children. Jerry had telephoned to say that it was hot as hell in Texas, and he missed her badly and wished he was home. She missed him, too. They had not been apart for more than a few days at a time ever since they had first started dating, in college.
Nancy and Jerry Jaax—the name is pronounced JACKS—were both members of the Army Veterinary Corps, a tiny corps of “doggy doctors.” They take care of the Army’s guard dogs, as well as Army horses, Army cows, Army sheep, Army pigs, Army mules, Army rabbits, Army mice, and Army monkeys. They also inspect the Army’s food.
Nancy and Jerry had bought the Victorian house not long after they had been assigned to Fort Detrick, which was nearby, within easy commuting distance. The kitchen was very small, and at the moment you could see plumbing and wires hanging out of the walls. Not far from the kitchen, the living room had a bay window with a collec
tion of tropical plants and ferns in it, and there was a cage among the plants that held an Amazon parrot named Herky. The parrot burst into a song:
Heigh-ho, heigh-ho,
it’s home from work we go!
“Mom! Mom!” he cried excitedly. His voice sounded like Jason’s.
“What?” Nancy said. Then she realized it was the parrot. “Nerd brain,” she muttered.
The parrot wanted to sit on Nancy’s shoulder. “Mom! Mom! Jerry! Jaime! Jason!” the parrot shouted, calling everyone in the family. When he didn’t get any response, he whistled the “Colonel Bogey March” from The Bridge on the River Kwai. And then: “Whaat? Whaat? Mom! Mom!”
Nancy did not want to take Herky out of his cage. She worked quickly, putting plates and silverware out on the counter. Some of the officers at Fort Detrick had noticed a certain abrupt quality in her hand motions and had accused her of having hands that were “too quick” to handle delicate work in dangerous situations. Nancy had begun martial-arts training partly because she hoped to make her gestures cool and smooth and powerful, and also because she had felt the frustrations of a woman officer trying to advance her career in the Army. She was five feet four inches tall. She liked to spar with six-foot male soldiers, big guys. She enjoyed knocking them around a little bit; it gave her a certain satisfaction to be able to kick higher than the guy’s head. She used her feet more than her hands when she sparred with an opponent, because, her hands were delicate. She could break four boards with a spinning back kick. She had reached the point where she could kill a man with her bare feet, an idea that did not in itself give her much satisfaction. On occasion, she had come home from her class with a broken toe, a bloody nose, or a black eye. Jerry would just shake his head: Nancy with another shiner.
The Hot Zone Page 4