The Coming Plague

by Laurie Garrett

  He’d seen it happen plenty of times in San Joaquin. Some of the people died in just four days, but most suffered over a week of this torture.

  Over and over he reviewed what he had seen in that isolated village on Bolivia’s eastern frontier. He hoped to think of something that could help him recover and solve the San Joaquin mystery.

  It had all started exactly a year before—in July 1962. Johnson had just arrived at the Middle America Research Unit (MARU) in the Panama Canal Zone, having had his fill of cataloguing respiratory viruses at the U.S. government’s National Institutes of Health in Bethesda, Maryland.

  Since 1956, then a young physician fresh from his medical training, Johnson had tediously studied viruses that caused common colds, bronchitis, and pneumonia. The work was getting plenty of praise, but Johnson, who was always impatient, was bored. When word got out that the National Institutes of Health was looking for a virologist to staff its MARU laboratory, he jumped at the chance.

  Shortly after Johnson arrived in Panama, his newfound MARU colleague, Ron MacKenzie, volunteered to assist a U.S. Department of Defense (DOD) team that was heading into Bolivia to conduct nutritional surveys.

  “A nutrition survey?” Johnson asked snidely.

  “Well, I could use the experience, and I’ve never been to Bolivia. So why not?” MacKenzie said.

  When MacKenzie and the DOD team met with Bolivia’s Minister of Health in La Paz, the official said he had no problem authorizing their research plans, provided they first take care of a more pressing problem hundreds of miles away.

  “I need an expert in mysterious diseases to investigate an epidemic in the eastern part of the country.”

  All eyes turned to MacKenzie, who, as a pediatrician and trained epidemiologist, came closest to fitting the bill. He shifted uncomfortably in his chair, mumbled something about not being able to speak Spanish, and tried to imagine what eastern Bolivia might look like.

  The minister went on to explain that the mysterious epidemic was fairly sizable, and two La Paz physicians had tentatively labeled it El Typho Negro—the Black Typhus.

  The following morning found the tall, somewhat gawky MacKenzie—dressed in a black suit, starched white shirt, and wing tips—standing on the La Paz tarmac, a briefcase at his feet. He greeted Bolivian physician Hugo Garrón, microbiologist Luis Valverde Chinel, and a local politician, and the quartet boarded an old B-24 bomber bound for the town of Magdalena, in the country’s eastern frontier region. MacKenzie looked around for a seat: there were none. The plane had been stripped down for hauling meat, and the only passengers usually on board were sides of beef.

  So MacKenzie stood behind the pilot, holding on to the hull for dear life during the long acceleration down the gravel runway. Because La Paz was at an elevation of 13,000 feet, planes had to reach great speeds to gain enough lift for takeoff. After what seemed an extraordinary amount of time, the Bolivian Indian mechanic who was squatting between the pilot and the copilot pulled a lever in the cockpit floor, withdrawing the landing gear, and they took off.

  Like a tired old condor, the bomber circled La Paz slowly several times, spiraling upward to 16,000 feet, high enough to fly into a narrow pass between the Andean peaks that towered around La Paz. MacKenzie found himself staring aghast at avalanches of ice cascading off dangerously close cliffs.

  AMAZONIA

  When the plane escaped the claustrophobic mountain pass, it was enveloped in a dense fog which forced the pilots to fly by instruments alone: a magnetic compass, stopwatch, map, and notepad.

  MacKenzie figured this was already enough adventure. Just three years ago he had been patching broken bones and vaccinating kids in a bucolic town north of San Francisco. This new exploit was a bit more perilous than anything he had gambled on when he left private practice to go into public health.

  As the plane descended into the fog, MacKenzie began to feel the heat and humidity increase, sweat built under his stiffly starched shirt, and when the fog cover broke, he watched seemingly endless grassy savannas pass beneath them. These were broken up by outcroppings of low, tree-covered alturas hills, and by long winding rivers lined with thin bandas strips of rain forest.

  “It looks just like Florida,” MacKenzie thought. “Kind of like the Everglades.”

  After two more long hours the plane landed in the little town of Magdalena, and MacKenzie couldn’t believe his eyes.

  “My gosh,” he exclaimed, “there must be two hundred people out there, standing around the plane.” The women in the throng were dressed entirely in mourning; the men wore black armbands. The bereaved people of Magdalena had gathered to greet “the experts” who had come to end their epidemic.

  “Experts?” MacKenzie muttered, casting an uncomfortable glance at Valverde and Garrón. “Well, I’m it.”

  With the grim entourage around them, the group dodged lumbering oxcarts as it made its way past a scattering of thatch-roofed adobe houses to the town plaza, a large courtyard surrounded by a circular arcade and the homes and stores of Magdalena. A sad, lethargic feeling pervaded everything.

  At Magdalena’s tiny clinic MacKenzie found a dozen patients writhing in pain.

  “My God!” he exclaimed as he watched one after another vomit blood. MacKenzie shuddered, feeling the tremendous onus of his position and cursing the naivete with which he had walked into the situation. It seemed that only yesterday he was doling out antibiotics in a clinic in Sausalito to kids whose frolicking was briefly interrupted by sore throats. What MacKenzie saw on the ward forced him to push aside his pediatrics training and, for the moment, draw upon the lessons in courage and horror he had learned during World War II combat.

  He was told that most of the sick were outsiders from Orobayaya. The mere name of that distant village sent shivers through the Magdalenistas, who spoke of it with unconcealed fear.

  Soon the lanky MacKenzie, who towered over the Bolivians, was crouched in a dugout canoe making its way by moonlight upriver toward the plagued village. As they glided along MacKenzie kept spotting enormous “logs”—far larger than their canoe—sliding down the riverbanks toward them. The hair on the back of his neck stood up when he realized the “logs” were alligators.

  The next day the group rode forty kilometers on horseback to Orobayaya.

  It was deserted. The six hundred residents had fled days earlier in panic, leaving the village to pigs and chickens that scampered madly about in search of food.

  MacKenzie returned to Magdalena, collected some blood samples from local patients, and headed back to Panama, where he tried to convince MARU director Henry Beye and the NIH bosses in Bethesda that the Bolivian situation warranted further investigation.

  “It’s probably just the flu,” was the consensus from NIH officials.

  “It’s something strange and dangerous,” MacKenzie insisted.

  Both MacKenzie and Johnson thought the Bolivian villagers’ symptoms resembled those brought on by a recently discovered Latin American virus, found near the Junin River in 1953 in Argentina. The Argentine virus was a close cousin of Tacaribe, which caused a disease of bats and rodents in Trinidad, also only recently discovered. While there was no evidence that Tacaribe could infect human beings, Junin was clearly lethal in many cases. In sparsely populated agricultural areas of Argentina’s vast pampas, Junin appeared as if out of nowhere among men working the corn harvests. It too was a human killer that disrupted capillaries, causing people to bleed to death. Nobody was sure how the Argentines got Junin; there was speculation the virus might be airborne.

  No point in taking stupid chances, Johnson thought. Though the NIH had not approved a MARU investigation of the epidemic, he flew to the U.S. Army’s Fort Detrick, in Maryland, to see Al Wieden. A pioneer in laboratory safety, Wieden had turned Fort Detric
k into the world’s premier center of research on deadly microbes. Johnson wanted something unheard of: a portable box of some sort so he could safely study Junin in the field—or whatever was wiping out the people of San Joaquin.

  At Fort Detrick there was a lot of research underway on “germ-free mice”—animals that had such weak immune systems that virtually any microbe could prove lethal to the mutant rodents. To keep the mice alive, scientists housed them inside airtight boxes that were constantly under positive pressure, pushing air past special filters to the mice, and then out again, toward the scientists. In this way, the mice breathed only sterile air. Scientists worked with the mice by inserting their hands into airtight rubber gloves that were built into the sides of the pressure box. The “glove boxes,” as the steel contraptions were called, were about the size of large coffins and weighed hundreds of pounds.

  Johnson’s idea was to convert one of these contraptions from positive to negative pressure so that all air would go inward, toward samples of possibly dangerous animals or microbes. That way, he could work relatively safely in a portable laboratory.

  Such a portable laboratory had never before been used, and Wieden wasn’t sure how to jury-rig the positive-pressure boxes. But, racing against time, Johnson and Wieden found a new, lighter-weight plastic glove box and surrounded it with a vast rib cage of aluminum poles to prevent the container from imploding when the pressure reversed from inside-out to outside-in. To their mutual delight, it worked.

  Meanwhile, MacKenzie still faced tough opposition in Bethesda, as well as at the Centers for Disease Control in Atlanta. Though he was a physician and had public health training, some higher-ups frankly doubted whether the thirty-seven-year-old MacKenzie had enough tropical experience to be able to recognize a new epidemic. They insisted it would be a waste of time and resources to deploy a team to investigate what would probably turn out to be some garden-variety bug such as influenza.

  In the fall of 1962 MacKenzie appealed to Bill Reeves, his old mentor from public health graduate studies at the University of California in Berkeley. He described Magdalena to Reeves, who insisted that MacKenzie “stand up to the Bethesda bureaucrats.”

  “Go for it. You got something there. Don’t let ’em discourage you,” Reeves urged.

  On January 9, 1963, a meeting of the top brass in the NIH’s infectious diseases division was held in Bethesda, and MacKenzie persuasively pleaded his case. It was decided that he and a MARU ecologist named Merl Kuns should first undertake a scouting mission to assess the extent of the epidemic, collect blood samples, and define the nature of the local ecology.

  The pair made their journey in March, and returned a week later even more firmly convinced that a serious epidemic was underway. Kuns, a University of Wisconsin-trained ecologist, was stunned by the thousands of bats that lived in the thatched roofs of towns like Magdalena, swooping out at night to forage for food. They were small bats, about the size of monarch butterflies, but they clustered in huge flocks that could suddenly fill the village sky. For his part, epidemiologist MacKenzie was convinced that nobody was actually getting infected in Magdalena, and the real epidemic was some fifty miles away in a town called San Joaquin. The pair returned to Panama with more than adequate evidence to gain approval for further investigation.

  With his new laboratory contraption in crates, Johnson headed to Bolivia in May 1963, along with MacKenzie and Kuns. After arriving in the capital, the team chartered an old USAF B-17 bomber and flew to the eastern edge of the Andes, then down the eastern Andean foothills to the Itenez River, and from there to the river’s Machupo tributary, eventually landing on a field outside San Joaquin. They then hauled their 10,000 pounds of equipment into the tiny town on mules.

  Nestled atop a sloping hill just above the Machupo’s flood line, San Joaquin was, the flabbergasted Johnson thought, “the last frontier of the New World.” Nothing in his scientific career had prepared him for conditions so primitive: no roads, no real health facilities, no fences, no electricity, no telephones, no running water. Cows outnumbered humans roughly two to one and roamed freely about the town. The people of San Joaquin were an evenly divided mix of pure Spanish, pure Indians, and mestizos whose ancestors had built the town in the seventeenth century. The wealthier citizens resided in tile-roofed, whitewashed adobe homes; the rest of the population lived in mud-stick houses with thatch roofs. Six thin strips of marsh formed the “roads” of San Joaquin, which converged in a modest central plaza.

  The Spanish people of San Joaquin were descended from cowboys who for a few generations had tended the large herds of a wealthy Brazilian family in control of an Amazon River fleet of refrigerated steamships. The ships took the beef out of San Joaquin, up the river system some 1,400 miles to the northwest, where the Amazon met the sea. From there the beef was shipped to Europe or North America, reaping excellent profits for the Brazilians.

  In tiny San Joaquin, however, the cowboys, their families, and the local Indians were entirely dependent on the “benevolence” of the Brazilian ranch owners and on the food and supplies that returning steamships brought to their remote town.

  In 1952 a revolution had brought the Movimiento Nacionalista Revolucionario to power. The land reform party stripped old Bolivian and Brazilian oligarchies of vast tracts of land, and the people of San Joaquin suddenly found themselves property owners. Unwilling to buy back from the local people the cattle they once owned, the Brazilians and their steamships left, never to return; and the villagers found themselves isolated, impoverished, and facing severe malnutrition unless they could grow crops to supplement the all too abundant supply of beef.

  When Johnson, MacKenzie, and Kuns arrived in San Joaquin they found a modest town of some 2,000 people managing to survive on beef, the yields of home vegetable gardens, and small rice and corn fields scattered throughout the savannas.

  A steady stream of travelers passed through the town on their way from even more remote areas in the savannas to larger Bolivian towns via the steamships that moored occasionally at the San Joaquin dock.

  Upon arrival, Johnson immediately set up his portable laboratory contraption, and the team set out to assess the extent of the mysterious outbreak. By then the epidemic had already been underway for some fourteen months, the people mourned every day when the church bell tolled another death, and fresh graves filled the cemetery.

  With the townspeople’s eager help, the team mapped the area and painted numbers on all the adobe houses. Every family was interviewed extensively, and asked the questions most essential to the team: How many people in this house have had the disease? How many have died and how many have recovered? What were they doing in the days before they got sick? Is there any chance one family member gave the disease to another? Have any animals been sick?

  It became obvious immediately that nearly half the people had been infected, and, of those, nearly half had died of the disease. That was a terrifying finding because few microbes kill nearly 50 percent of those they infect. One family lost nine of eleven members in 1963.

  “That’s almost a Roman decimation,” Johnson told his colleagues, referring to the great epidemics of ancient Rome’s republican era when at least a quarter of the population was felled by a disease now thought to have been smallpox.

  The first order of business was to figure out what type of microbe was killing the people of San Joaquin: bacterium, virus, or parasite. Circumstances pointed to a virus, possibly spread by insects, so the team set up two small laboratories located seventy-five yards apart. The first, an existing tile-roofed adobe building, housed Johnson’s glove-box contraption and a variety of other equipment and research animals used to isolate microscopic organisms from blood and tissue samples. The second laboratory was built to order by the local people out of lashed poles and thatching. It housed wild insects and animals Kuns and his assistants caught in
the San Joaquin area. The team planned to study those animals to determine what species might be carrying the deadly microbes.

  The facilities were kept separate to avoid cross-contamination, and the buildings were fitted with window screens and tight doors. Finally, the laboratories were heavily doused with DDT and ringed with rodent traps to protect the scientists from whatever creatures might be carrying the disease.

  In June, after days of haggling with the San Joaquin community over the propriety of such things, Valverde convinced the local priest to allow MacKenzie to perform an autopsy on one of the recent victims of the epidemic. A few days later, a two-year-old boy died and from his spleen and brain the team was able to isolate a substance that, when injected into hamsters, produced the disease. Days after the boy died the team completed several more tests that proved the mysterious disease was caused by a virus: they ruled out a parasite or bacteria on the basis of both the minuscule size of filters through which the microbe readily passed and its ability to withstand antibiotics. They also showed the microbe could destroy human cells and cause disease in wild mice.1

  Midway through the autopsy on the child, Hugo Garrón’s scalpel slipped, flew across the autopsy table, and hit MacKenzie’s hand. Looking at the blood that instantly filled his punctured glove, MacKenzie looked up at Garrón and predicted the worst.

  An anxious week passed without symptoms, and MacKenzie decided he was, indeed, a very lucky person. With greater care, he and Garrón performed several more autopsies and were struck by the level of devastation the mysterious microbe produced. Most alarming were the disease victims’ brains: where clear cerebrospinal fluid should have been there was, instead, crimson blood; all of the meningeal protective layers around the brain were blood-soaked. Eerily, most of the hair fell off victims’ heads before they died.

  Toward the end of June the town had a party, which the scientists used as an opportunity to celebrate their rapid discoveries. The next logical steps in their research would involve characterizing the virus and figuring out exactly how people got infected. Johnson, Kuns, and MacKenzie felt confident all the answers would soon reveal themselves, and enthusiastically joined the celebration, eating and drinking the local specialties. While all three men were in the mood for a fiesta, it was Johnson who, with characteristic gusto, threw himself into the spirit of the event, drinking, dancing, and joining in the local macho sport of telling tall tales. Though not a classically handsome man, Johnson carried himself with a mix of cowboy swagger and charisma that inspired other men and attracted women. MacKenzie too threw himself into the gaiety of the evening, while the shyer, more serious Kuns quietly observed the goings-on.