by The Pandemic Century- One Hundred Years of Panic, Hysteria
148 “hemorrhagic pneumonia”: Thomas and Morgan-Witts, Trauma, 103; Robert Sharrar, “Talk—Legionnaires’ disease,” Legionnaires’ disease files and manuscripts, Smithsonian, Box 5.
150 at which it remains today: American Thoracic Society, “Top 20 Pneumonia Facts—2015,” accessed May 1, 2017, https://www.thoracic.org/patients/patient-resources/fact-sheets-az.php.
150 and modern lifestyles: Charles-Edward Amory Winslow, The Conquest of Epidemic Disease: A Chapter in the History of ldeas (Madison: University of Wisconsin Press, 1971).
150 never been written up: David W. Fraser, “The Challenges Were Legion,” The Lancet, Infectious Diseases 5, no. 4 (April 2005): 237–41.
151 “febrile respiratory disease”: Statement of David J. Sencer, “House hearings on Legionnaires’ Disease,” 95.
152 “throw them in again”: Elizabeth W. Etheridge, Sentinel for Health: A History of the Centers for Disease Control (Berkeley: University of California Press, 1992), 47–48.
155 collect on city streets: In Gaudiosi’s defense, Fort Detrick, in Maryland, the site of the US germ warfare program, was just across the state border, and there had been reports that the CIA had been experimenting with hallucinogenic fungi at Toughkenamon, just an hour’s drive from Philadelphia. Moreover, the year before, the public had been treated to revelations about MKULTRA, the CIA’s clandestine experiments with LSD and other psychotropic drugs in the 1950s that had grown out of the program to counter Soviet efforts to create a “Man- churian candidate.” For further discussion, see Thomas and Morgan-Witts, Trauma, 179–80; John Marks, The Search for the Manchurian Candidate (New York: Norton, 1991), 81.
157 “bounds of direct observation”: Thomas M. Daniel, Wade Hampton Frost, Pioneer Epidemiologist, 1880–1938: Up to the Mountain (Rochester, NY: University of Rochester Press, 2004), xii.
158 access to the hospitality suites: Sharrar, “Talk—Legionnaires’ disease.”
159 no symptoms of illness: “Progress Report Legionnaires Disease Investigation, August 12, 1976,” Legionnaires’ disease files and manuscripts, Smithsonian, Box 2.
159 “hung around the hotel lobby”: “Progress Report Legionnaires Disease Investigation, August 12, 1976.”
162 circulated throughout the hotel: David Fraser, EPI-2 report on Legionnaires’ disease, March 21, 1976, in “Legionnaires’ disease: Hearing before the Senate Subcommittee on Health and Scientific Research,” November 9, 1977, 85–129.
163 not Legionnaires’ disease: Sharrar, “Talk—Legionnaires’ disease,” 20.
164 chlamydia bacterium: Julius Schachter and Chandler R. Dawson, Human Chlamydial Infections (Littleton: PSG Publishing, 1978), 29–32; Karl F. Meyer, “The Ecology of Psittacosis and Ornithosis,” Medicine 21, no. 2 (May 1941): 175–206.
164 erythromycin and rifampicin: Thomas and Morgan-Witts, Trauma, 224–25.
164 epidemiology at UCSF: Schachter had recently traced an outbreak of psittacosis at UCSF to pigeons roosting on office window sills, a discovery that prompted the university to install antiroost spikes.
165 “human chlamydial epidemics”: Gary Lattimer to Theodore Tsai, December 20, 1976, Legionnaires’ disease files and manuscripts, Smithsonian, Box 5.
165 they concluded: Fraser, EPI-2 report, 125.
166 pathogenic for guinea pigs: Fraser, EPI-2 report, 35.
166 classed as a type of rickettsia: The organism is named for Macfarlane Burnet, who did much to elaborate the etiology of Q fever following a series of outbreaks in Australia in the 1930s.
167 CDC hands for direction: Joseph McDade, interview with author, May 26, 2016.
168 look for a virus: Joseph McDade, interview with author, May 26, 2016.
169 “swine flu in Pennsylvania”: Statements of F. William Sunderman and F. William Sunderman Jr., “House hearings on Legionnaires’ disease,” 54.
169 nickel carbonyl poisoning: Statements of Sunderman and Sunderman Jr., “House hearings on Legionnaires’ disease,” 51–61.
169 “yet to be determined”: Statements of Sunderman and Sunderman Jr., “House hearings on Legionnaires’ disease,” 60.
170 “group,” he concluded: “House hearings on Legionnaires’ disease,” 4–6.
170 the Legionnaires’ deaths: Jack Anderson and Les Whitten, “Paranoid Suspect in Legion Deaths,” Washington Post, October 28, 1976, 1.
170 Republican senator from Arizona: Richard Hofstadter, “The Paranoid Style in American Politics,” Harper’s Magazine, November 1964.
170 “upon the American people”: Laurie Garrett, The Coming Plague: Newly Emerging Diseases in a World out of Balance (New York: Farrar, Straus and Giroux, 1994), 176.
171 “finest kind of Americans”: Michael Capuzzo, “Legionnaires Disease,” Philadelphia Inquirer, July 21, 1986.
171 speculation into a song: It would seem Dylan never recorded the song and only played it on one occasion—at a sound check in Detroit on Oct. 13, 1978. By then, of course, the real pathogen had been discovered, so perhaps Dylan lost interest. However, Cross liked the song and recorded it three years later with his Delta Cross Band. Some writers have detected a similarity to the melody of “Hurricane,” the song released by Dylan the year before inspired by the wrongful conviction of the Canadian middleweight boxer Rubin “Hurricane” Carter, for a triple homicide in a bar in New Jersey in 1966, a conviction that was eventually overturned in 1985. “Delta Cross Band Back on the Road Again,” accessed May 1, 2017, https://www.discogs.com/Delta-Cross-Band-Back-On-The-Road-Again-Legionaires-Disease/release/2235787.
171 reservations one by one: “The Philadelphia Killer,” Time, August 16, 1976.
171 to further business: After sale to a local developer and extensive renovations, the Bellevue was acquired by San Francisco’s Fairmont chain, reopening its doors in 1979 as the Fairmont Philadelphia. Since then, the hotel has changed hands and its name several times.
172 he told Fraser: David Fraser, interview with author, February 4, 2015.
173 “also negative so far”: EPI-2, Second Draft, December 15, 1976, Legionnaires’ disease files and manuscripts, Smithsonian, Box 2.
173 “puzzle of the century”: Gwyneth Cravens and John S. Karr, “Tracking Down The Epidemic,” New York Times, December 12, 1976, accessed April 4, 2018, https://www.nytimes.com/1976/12/12/archives/tracking-down-the-epidemic-epidemic.html.
CHAPTER V: LEGIONNAIRES’ REDUX
175 “child in the United States”: Laurie Garrett, The Coming Plague: Newly Emerging Diseases in a World out of Balance (New York: Farrar, Straus and Giroux, 1994), 167.
176 life-saving vaccine: Arthur M. Silverstein, Pure Politics and Impure Science: The Swine Flu Affair (Baltimore: Johns Hopkins University Press, 1981), 100–1.
176 willing to be immunized: Garrett, Coming Plague, 175.
176 a causal connection: George Dehner, Influenza: A Century of Science and Public Health Response (Pittsburgh: University of Pittsburgh, 2012), 183–84.
177 “wait and see” policy: Dehner, Influenza, 148.
177 time and effort: For further discussion, see Dehner, Influenza, 185–88, and Garrett, Coming Plague, 180–83.
178 “swine flu pandemic remained”: Dehner, Influenza, 144.
178 “before we go public”: Garrett, Coming Plague, 185.
178 chicken cholera germs: The chickens survived, prompting Pasteur to repeat the experiment with both old and new cultures and discover the principle of attenuated vaccines.
178 “stuck in my mind”: Joe McDade, interview with author, May 26, 2015.
180 “found the etiologic agent”: Joseph McDade, interview with author, May 26, 2015. Later, CDC researchers would also demonstrate that the organism was present in lung tissue from patients who had died of Legionnaires’ disease. Previous attempts to detect the organism had failed, but when researchers used a little- known stain called Dieterle’s, the bacteria showed up clearly. Subsequently, researchers also succeeded in growing the bacteria on special agar media and deve
loping a specific reagent to aid diagnosis. “Statement of William H. Foege,” in “Follow-up examination of Legionnaires’ Disease,” US Senate Subcommittee on Health and Scientific Research, November 9, 1977, 42–43.
181 “rickettsia-like”: Joseph McDade, interview with author, May 26, 2015.
182 dating from 1947: W. C. Winn, “Legionnaires Disease: Historical Perspective,” Clinical Microbiology Reviews 1, no. 1 (January 1988): 60–81.
182 exposure eluded them: C. V. Broome et al., “The Vermont Epidemic of Legionnaires’ Disease,” Annals of Internal Medicine 90, no. 4 (April 1979): 573–77.
182 antibodies to Legionella: John T. MacFarlane and Michael Worboys, “Showers, Sweating and Suing: Legionnaires’ Disease and ‘New’ infections in Britain, 1977–90,” Medical History 56, no. 1 (January 2012): 72–93.
182 five years earlier: J. F. Boyd et al., “Pathology of Five Scottish Deaths from Pneumonic Illnesses Acquired in Spain due to Legionnaires’ Disease Agent,” Journal of Clinical Pathology 31, no. 9 (September 1978): 809–16.
182 act of industrial espionage: MacFarlane and Worboys, “Showers, Sweating and Suing: Legionnaires’ Disease and ‘New’ Infections in Britain, 1977–90.”
183 cooling tower was to blame: Ronald Sullivan, “A Macy’s Tower Held Bacteria That Cause Legionnaires’ Disease,” New York Times, January 12, 1979, accessed May 1, 2017, http://www.nytimes.com/1979/01/12/archives/a-macys-tower-held-bacteria-that-cause-legionnaires-disease.html.
183 widespread in the environment: G. K. Morris et al., “Isolation of the Legionnaires’ Disease Bacterium from Environmental Samples,” Annals of Internal Medicine 90, no. 4 (April 1979): 664–66.
183 sixty-one serogroups: accessed May 1, 2017, http://www.bacterio.net/legionella.html.
184 “Trojan horse” bacteria: R. F. Breiman, “Impact of Technology on the Emergence of Infectious Diseases,” Epidemiologic Reviews 18, no. 1 (1996): 4–9.
184 contaminated with the organisms: Breiman, “Impact of Technology,” 6.
184 vents and air shafts: Alfred S. Evans and Philip S. Brachman, eds., Bacterial Infections of Humans: Epidemiology and Control (Springer, 2013), 365.
185 due to Legionnaires’ disease: Evans and Brachman, Bacterial Infections of Humans, 361–63.
186 were in fact L. pneumophila: “Statement of William H. Foege,” 43.
186 “side of the building”: David Fraser, interview with author, February 4, 2015.
188 had never been identified: H. M. Foy et al., “Pneumococcal Isolations from Patients with Pneumonia and Control Subjects in a Prepaid Medical Care Group,” The American Review of Respiratory Disease 111, no. 5 (May 1975): 595–603.
189 without air conditioning: Willis Haviland Carrier, “The Invention That Changed the World,” accessed May 1, 2017, http://www.williscarrier.com/1876–1902.php; Steven Johnson, How We Got to Now: Six Innovations That Made the Modern World, reprint edition (New York: Riverhead Books, 2015), 76–83.
190 around 50,000 cases: A. D. Cliff and Matthew Smallman-Raynor, Infectious Diseases: Emergence and Re-Emergence: A Geographical Analysis (Oxford and New York: Oxford University Press, 2009), 296.
190 was 9 percent: Laurel E. Garrison et al., “Vital Signs: Deficiencies in Environmental Control Identified in Outbreaks of Legionnaires’ Disease—North America, 2000–2014,” MMWR. Morbidity and Mortality Weekly Report 65, no. 22 (June 10, 2016): 576–84.
CHAPTER VI: AIDS IN AMERICA, AIDS IN AFRICA
193 “like an immune deficiency”: Ronald Bayer and Gerald M. Oppenheimer, AIDS Doctors: Voices from the Epidemic (Oxford and New York: Oxford University Press, 2000), 18.
193 very few T cells: T cells, so-called because they are produced in the thymus, are a type of lymphocyte, or white blood cell. They can be distinguished from other lymphocytes by the presence of a T-cell receptor on their surface.
194 recipients of organ transplants: Michael S. Gottlieb, “Discovering AIDS,” Epidemiology 9, no. 4 (July 1998): 365–67. PCP used to be considered a protozoan infection, but in 1988 it was reclassified as a fungus and renamed Pneumocystis jirovecii. However, to avoid confusion, the abbreviation “PCP” was retained. “Pneumocystis pneumonia” CDC, accessed September 21, 2017, https://www.cdc.gov/fungal/diseases/pneumocystis-pneumonia/index.html#5.
194 “that we were aware of”: Nelson Vergel, “There When AIDS Began: An Interview With Michael Gottlieb, M.D,” The Body, June 2, 2011, accessed October 10, 2016, http://www.thebody.com/content/62330/there-when-aids-began-an-interview-with-michael-go.html.
195 quiescent in healthy adults: CMV can be transmitted in saliva, semen, vaginal fluids, urine, blood, even breast milk. Newborns can also contract CMV infections via the placenta or during delivery if their mother’s genital tract is infected. Most people contract CMV in childhood and are unaware they carry the virus, but if their immune systems are compromised the infection can be reactivated. Prior to AIDS, CMV was most commonly seen in transplant patients who had received immunosuppressant medication to prevent the rejection of donor organs.
195 found in his lungs: Elizabeth Fee and Theodore M. Brown, “Michael S. Gottlieb and the Identification of AIDS,” American Journal of Public Health 96, no. 6 (June 2006): 982–83.
196 “cover them up anymore”: Bayer and Oppenheimer, AIDS Doctors, 12–14.
196 “bigger story than Legionnaires’ Disease”: Fee and Brown, “Michael S. Gottlieb and the Identification of AIDS.”
196 ampules make when broken: Amyl nitrate reduces blood pressure while increasing heart rate, producing a dizzying “rush” to the head. Poppers were popular at parties, where they were commonly used to break the ice and heighten the pleasure of sex.
197 first five months of 1981: Garrett, Coming Plague, 285.
198 “pneumocystis and candidiasis”: CDC, “Pneumocystis Pneumonia—Los Angeles, 1981,” Morbidity and Mortality Weekly Report 45, no. 34 (August 1996): 729–33.
198 “completely unknown”: “The Age of AIDS,” Frontline, accessed October 13, 2016, http://www.pbs.org/wgbh/frontline/film/aids/.
199 mortality of the Spanish flu: “A Timeline of HIV/AIDS,” accessed October 13, 2016, https://www.aids.gov/hiv-aids-basics/hiv-aids-101/aids-timeline/; “WHO | HIV/AIDS,” WHO, accessed October 13, 2016, http://www.who.int/gho/hiv/en/.
200 told an interviewer in 1994: Office of NIH History, “In Their Own Words: NIH Researchers Recall the Early Years of AIDS,” interview with Dr. Robert Gallo, August 25, 1994, 33, accessed October 21, 2016, https://history.nih.gov/nihinownwords/docs/gallOI_OI.html.
200 struggled to comprehend HIV: Robert C. Gallo, “HIV—the Cause of AIDS: An Overview on Its Biology, Mechanisms of Disease Induction, and Our Attempts to Control It,” Journal of Acquired Immune Deficiency Syndromes I, no. 6 (1988): 52I-35·
201 homosexuals’ “perverted” lifestyles: Garrett, Coming Plague, 330.
201 Pentagon and Big Pharma: Douglas Selvage, “Memetic Engineering: Conspiracies, Viruses and Historical Agency,” Open Democracy, October 21, 2015, accessed November 8, 2016, https://www.opendemocracy.net/conspiracy/suspect-science/douglas-selvage/memetic-engineering-conspiracies-viruses-and-historical-agency.
201 presence for several years: In this stage of the infection, virus levels fall and it becomes harder to pass on HIV via sexual intercourse.
202 coping with the virus: The CD4 count of a healthy, uninfected adult generally ranges from 500–1600 cells/mm3. By contrast, a very low CD4 count (less than 200 cells/mm3) indicates a compromised immune system.
202 result of an immune deficiency: The significance of Mabs to immunology must not be understated. As the historian of medicine Lara Marks puts it, “Before the arrival of Mabs, scientists had as much knowledge of the surface of immune cells as they had of the surface of the moon.” Lara V. Marks, The Lock and Key of Medicine: Monoclonal Antibodies and the Transformation of Healthcare (New Haven and London: Yale University Press, 2015), 68.
203 close cousin of herpes: Oncoviruses
do not always cause tumors. For instance, Epstein-Barr is ubiquitous in infancy, and infections in adolescence usually result in mononucleosis, the so-called “kissing disease.” Similarly, while infection with hepatitis B can lead to cirrhosis and liver failure, only a small percentage of people go on to develop hepatocellular carcinomas.
204 passed on to daughter cells: Surindar Paracer and Vernon Ahmadjian, Symbiosis: An Introduction to Biological Associations, 2nd edition (Oxford and New York: Oxford University Press, 2000), 21. When the human genome was sequenced it revealed some 96,000 retrovirus-like elements. These elements occupied around 8 percent of the genome, suggesting they might be the remains of ancient virus infections.
205 perpetuating cell lines indefinitely: Mirko D. Grmek, History of AIDS: Emergence and Origin of a Modern Pandemic (Princeton, NJ: Princeton University Press, 1990), 56.
205 designated HTLV-II by Gallo: John M. Coffin, “The Discovery of HTLV-I, the First Pathogenic Human Retrovirus,” Proceedings of the National Academy of Sciences of the United States of America 112, no. 51 (December 22, 2015): 15525–29.
205 tested positive for HTLV-I: Robert C. Gallo, Virus Hunting: AIDS, Cancer, and the Human Retrovirus: A story of Scientific Discovery (New York: Basic Books, 1991), 135–36.
206 isolate HIV before the French: The Yugoslavian historian of science Mirko Grmek, who made a detailed study of the history of AIDS and the intellectual and technological developments that led to the discovery of HIV, claims that in early 1983 Gallo had dissuaded a researcher at the CDC from pursuing the hypothesis that AIDS was due to a cell-killing virus, insisting “it had to be oncogenic.” Grmek, History of AIDS, 58.
206 the pathogen of AIDS: R. C. Gallo et al., “Isolation of Human T-Cell Leukemia Virus in Acquired Immune Deficiency Syndrome (AIDS),” Science 220, no. 4599 (May 20, 1983): 865–67; M. Essex et al., “Antibodies to Cell Membrane Antigens Associated with Human T-Cell Leukemia Virus in Patients with AIDS,” Science 220, no. 4599 (May 20, 1983): 859–62.
206 theirs was a different virus: F. Barré-Sinoussi et al., “Isolation of a T-lymphotropic Retrovirus from a Patient at Risk for Acquired Immune Deficiency Syndrome (AIDS),” Science 220, no. 4559 (May 20, 1983): 868–71.