The journey proved painful for Casals, as did several hours of waiting in hospital hallways for X-rays and other tests. While physicians worried about how best to limit contagion to others when using cumbersome medical equipment on Casals, the glass-booth isolation unit was prepared.
For the remainder of June and much of July, Casals lived in a glass room specially ventilated with negative pressure and air-lock doors. Only essential medical personnel, adorned in protective gowns, gloves, goggles, and masks, were allowed inside Casals’s little world.
Casals was acutely ill. His temperature was 104°F, his blood pressure high, pulse weak, skin flushed, and red and white blood cells were draining at an alarming rate out of his cardiovascular system and into his urine.
The virus was attacking his heart, throat, and veins.
Though Casals continued to mumble that he was probably okay, it was just a little cold, the hospital staff knew he was fighting for his life, in the grip of Lassa fever.8
It was a long shot, but Leifer solicited the help of the recovered Penny Pinneo.
“We need your blood,†the doctor said, explaining that he hoped Pinneo’s blood contained antibodies that could destroy the Lassa viruses then attacking Casals. Pinneo readily agreed. Meanwhile, Casals’s boss, Wilbur Downs, called Karl Johnson to ask what had been the Bolivian experience with trying sera from a Machupo survivor as treatment for a victim of the disease.
“Works,†Johnson said in his usually abrupt way. “But you better hurry. The longer a patient is sick, the less helpful the immune sera gets to be.â€9
On the fourth day of his hospitalization, having deteriorated quite dangerously, Casals was injected with 500 milliliters of Pinneo’s plasma.
“It’s miraculous,†Casals said the following day as his fever dropped to 101°F and his mind began to clear. With each passing day thereafter Casals gained strength, attained a sense of will while shedding his prior apathy, and felt the muscle pains diminish. Within a week his temperature and cardiovascular signs were normal.
After thirty days of hospitalization, a sadder but wiser Casals went home.
The sadness stemmed from Casals’s inability to explain how he had become infected. Certainly he had taken every possible precaution in the Yale laboratory—precautions that had proven quite adequate for the hundreds of other bizarre viruses he studied. It was clear the Lassa agent was especially dangerous.
Over and over again Casals scanned his lab notes trying to pinpoint an error, a moment when he carelessly allowed the occurrence of contact between himself and the virus. Only two possibilities were open. Because Casals insisted that only he have contact with infected mice, the scientist thought it possible that the animals had urinated viruses on the sawdust and wood chips that lined their cages, and somehow these wood particles had been kicked up into Casals’s breathing space by the agitated rodents. But he always wore a mask: for such a scenario to work, the mask that had protected him against over a hundred other viruses would have failed with Lassa.
An alternative explanation lay in the dried cracked skin of Casals’s hands, full of microscopic holes that might have served as portals of entry for the tough virus. But Casals always wore thick latex gloves and could not remember noticing any leakages. Could the virus get through rubber? Had he unknowingly worn a faulty product one day that was full of microscopic leaks?
The frustrating puzzle remained unsolved, even twenty-five years later, much to the consternation of Yale officials who were less than enthusiastic about having research on mysterious lethal viruses conducted on campus.
Casals reminded inquiring university and Rockefeller Foundation officials that he had, without prior incident, conducted years of successful and safe research in the Yale facility and, earlier, at Rockefeller laboratories in New York City. Ever since the young Catalonian doctor had been stranded in the United States by the Spanish Civil War in the 1930s, Casals had devoted most of his waking hours to studying a succession of deadly viruses: polio, Japanese encephalitis, rabies, St. Louis encephalitis, Junin, Machupo, LCM (lymphocytic choriomeningitis in mice), dozens of hemorrhagic viruses found in people and monkeys, and a host of mosquito-carried South American agents he had discovered.10
Indeed, ever since he and Karl Johnson had traveled all over the Soviet Union investigating strange hemorrhagic diseases, the pair had discovered that the real danger was not the viruses, but politics. In the spring of 1965 for example, they joined Soviet colleagues and a handful of other top American researchers for a monthlong investigation of four different types of viral bleeding syndromes, at least three of which were found exclusively within the borders of the Soviet nation: Omsk hemorrhagic fever, Crimeantype fever, and Central Asian hemorrhagic fever. The trip proved immensely useful for all the scientists involved, and several more exchanges followed over the years.11
But every time Casals and Johnson returned from the Soviet Union, they were hounded by CIA agents who expected the scientists to reveal all that they had seen and discussed in the communist nation. Casals always obliged, but by 1969, as he argued with Yale officials about the continuance of his Lassa work, he was growing impatient with all the inquiry.
In the summer of 1969 a recovering Casals pursued his Lassa research vigorously, aware that university authorities were debating whether to shut it down. In short order he verified that the disease that had nearly killed both him and Pinneo was caused by an apparently new virus.12 He further showed that the virus’s genetic material was in the form of RNA, rather than the DNA present in human cells. Using techniques similar to those Johnson and Webb had followed for purifying Machupo viruses, he was able to isolate Lassa microbes from all the Nigerian samples, as well as his own taken during hospitalization, including throat swabs, blood, and urine. His lab ruled out the possibility that Lassa was carried by a common African mosquito because they were unable to experimentally infect such insects. On the other hand, they pointed an accusatory finger at the rodent world when they showed that experimental mice could be infected with Lassa and none became ill; rather, the rodents served as lethal carriers of the disease.
The strange virus failed to cross-react with any of the hundreds of agents in Casals’s viral library, which ranged from the nonpathogenic Tacaribe to 100 percent lethal strains of rabies viruses, and when he tested his own blood against all those viruses he found that his anti-Lassa antibodies reacted only against the new virus. In other words, Casals was immune to Lassa, but the immunity did not overlap to protect him against any other virus. That was clear evidence that Lassa was, indeed, unique.13
Most disturbing, Casals concluded that the virus could be spread in four ways: by inhaling viral particles from an infected human or animal, by contact with contaminated urine, by direct blood-to-blood contact with an infected person, or by some less clear method involving laboratory mice.
In the fall of 1969 Casals was forced to accede to the Yale authorities’ concern about the safety of Lassa research, and all samples of the virus were shipped to the Atlanta headquarters of the Centers for Disease Control, where they were studied and maintained in a uniquely designed high-security facility.14 What prompted Casals to agree that it was wise to cease Lassa studies was the tragedy of Juan Roman, a fifty-five-year-old technician in the Yale laboratory. Roman had decided to spend the Thanksgiving holiday that year with cousins in York, Pennsylvania. The Puerto Ricoborn assistant had never been involved in Casals’s Lassa research and was strictly forbidden (as were all people at the Yale facility, save Buckley and Casals) to touch anything labeled “Lassa.â€
On Wednesday evening, Roman left New Haven, apparently feeling fine, and made the drive to York. By Friday he was severely ill, suffering all the classic Lassa symptoms: fevers, shivering, muscle pains, severe fatigue, and lethargy. He was admitted to a local hospital, where he was treated without special contagion precautions for a week before his s
tymied physician called the Yale arbovirus laboratory to ask whether Roman had handled any strange viruses.
Casals made a worried visit to York that Saturday and found his technician desperately ill. After warning the hospital staff about the need for high-security contagion precautions, he returned immediately to Yale and began preparing samples of his own blood to use as antiserum for the dying laboratory technician. By the time he had arranged to have Roman transferred to Columbia-Presbyterian Hospital in New York, it was too late.
Roman died Monday morning, after just ten days of illness. He never had a chance to try Casals’s antiserum.
Though Casals and Yale authorities went over Roman’s notes and activities for hours, searched every inch of the laboratory for an improperly labeled tube or dish, and hunted for leaks in the ventilation systems, they were never able to explain how the technician got Lassa. Concerned that panic would spread through New Haven, particularly amid the Vietnam War protests and student suspicions that biological warfare research was being conducted at all the nation’s high-security laboratories, Yale and Casals agreed it was time to get rid of the Lassa samples.
Christmas 1969 found Pinneo and Casals happy to be alive, sharing the company of their families. It was possible to look at the glittering lights strung along Manhattan’s avenues, feel the crisp night air filled with the promise of winter snowfall, and completely forget the tropical menace that so nearly claimed their lives. Casals blessed his hearty constitution, and Pinneo mused often during that season’s church services about her great luck. Her ears still rang all the time due to some damage left by the virus, but she was alive and her energy was slowly returning.
The season’s sense of joy quickly dissipated after the New Year when patients started pouring into Pinneo’s former hospital in Jos, now renamed Evangel Hospital. In three weeks’ time, Dr. Jeannette Troup treated seventeen cases of what looked like Lassa fever.15 Panic quickly spread among the Evangel staff, and at the weekly prayer meeting of January 21 the reading was from Psalm 91:
Thou shall not be afraid for the terror by night;
nor for the arrow that flieth by day;
nor for the pestilence that walketh in darkness.
Though she suspected Lassa was the culprit, Dr. Jeannette decided to perform one autopsy to confirm the diagnosis. On January 25, 1970, the petite Troup, who sported a Lady Bird Johnson hairdo, glasses, and the conservative cotton dresses suitable for the tropics, stepped up to the autopsy table. Acutely aware of the risks, she took a deep breath and made her first incision.
Minutes later, she cut herself, drawing blood through her protective gloves. Though she insisted to others at the time that it was “just a nick,†Troup was terrified.
For good reason, as it turns out. Ten days later Dr. Jeannette told colleagues she had the flu. On February 10 she was admitted to the hospital with a fever of 103.8°F.
As Troup’s condition worsened, fear spread in the Jos medical community and her colleagues notified Frame at Columbia University. He, in turn, set into motion plans to fly Pinneo and Casals to Jos. Though both were still suffering Lassa virus-related symptoms, Frame was confident they were now immune to the disease. That made them ideal Lassa investigators.
Unfortunately, civil war once again raged in Biafra, and the Nigerian government—which had never been pleased about Frame’s decision to name the deadly disease after one of its towns—delayed granting visas to Casals and Pinneo. As days dragged by, filled with cables describing Troup’s deterioration, the two Lassa survivors became increasingly anxious.
In a frantic effort, Frame shipped Pinneo’s antiserum via U.S. diplomatic channels, but it was mistakenly routed to Ibadan, miles from Troup’s Jos deathbed. The antiserum reached Ibadan on February 15, and was carried from there to Jos by Pinneo. She reached Jos on February 20.
Jeannette Troup, however, died on February 18.16
On March 3 Casals arrived, and a team of five researchers—including Troup’s assistant Dr. Harold (Hal) White and Pinneo—was assembled. Pinneo’s fluency in Hausa, as well as the great respect she had garnered over the years from the people of Jos, proved invaluable.
After weeks of investigation the team was unable to say from where, exactly, the virus had come, but it could explain the dramatic spread of Lassa inside Evangel Hospital and nearby Vom Christian Hospital.17
Tracing back the cases, the team decided that it began with a woman who traveled from Lagos, Nigeria’s huge metropolis, to her home village of Bassa during September 1969. There, she gave birth.
Forty days later, on Christmas Day, the woman developed symptoms of acute viremia and was put in a general ward of Evangel Hospital. Throughout her hospitalization the woman’s newborn and three-and-a-half-year-old child stayed beside her, and she was closely tended to by her mother and brother-in-law.
By mid-January the woman was well enough to return to Bassa, but shortly after the family reached their home the older child died and the woman’s mother fell ill.18 Altogether, twenty-eight people suffered Lassa fever in the two hospitals between Christmas 1969 and February 26; thirteen died. With the exception of Jeannette Troup, all were Nigerian.
At least sixteen people got Lassa from the first Bassa woman, though most never had physical contact with the patient. Much to the embarrassment of Evangel physicians, it seemed most infections actually occurred on the A Ward of their hospital. There, the Bassa woman struggled with her fever for two weeks, lying on a corner bed beside an open window. The prevailing breezes carried her exhaled viruses down the ward, past the noses and mouths of four patients, six visitors to the ward, and four hospital employees, all of whom developed Lassa. The infected, in turn, passed the virus on to family members after leaving the hospital, indicating it was possible for Lassa survivors to carry the virus for two or more weeks.
Searches throughout Bassa failed to find the source of the epidemic.
For Frame, who was responsible for the health and safety of SIM missionaries in West Africa, the second Lassa outbreak was particularly worrisome for three reasons: it occurred primarily among Nigerians, indicating there might not be natural immunity in the population; the outbreak clearly spread as a result of hospital procedures; and the source of the disease remained elusive.
In 1970 Frame collected blood samples from 712 current and recent American missionaries working in West Africa and had them tested for evidence of past Lassa virus infection.19 Five tested positive, four of whom recalled having suffered long, unexplained fevers. Only one member of the group, Harry Elyea, had been ill while in Nigeria. In 1952, Elyea spent a month in Rahama, Nigeria, severely ill. As a result, he suffered a lifelong hearing deficit.20 Hearing loss would prove a common side effect of Lassa infection. Twenty-five years after her brush with death from Lassa fever, Pinneo would still have a constant ringing in her ears.
The other four cases were missionaries who fell ill between August 1965 and February 1968 in far-off Telehoro, Guinea. Sixty-one-year-old missionary Carrie Moore was rendered stone-deaf by her illness, having suffered total auditory nerve destruction.
Frame’s group also tested blood samples that had been collected in 1965–66 from villagers in northern Nigeria as part of a parasite survey; 2 percent showed signs of previous Lassa infection. The scientists suspected Lassa was hiding inside some ubiquitous species of African animal and might well be infecting human beings all over West Africa. With so many fever-producing diseases to worry about in the tropics, it was to be expected that the occasional Lassa case would go unnoticed.
They warned that Lassa would undoubtedly strike again.
It was just months before their prediction proved sadly accurate. Not in Nigeria, nor Guinea, but Liberia.
Garbazu, a Liberian peasant, was four months pregnant when she started bleeding profusely. Though she had been nauseated and sick for a week, she tried to treat
herself in her village of Zigida, using traditional antisorcery methods of herbs and incantations. The uterine bleeding, however, scared her enough to prompt a twenty-seven-mile journey to the Curran Lutheran mission hospital in Zorzor.21
On March 3, 1972, Esther Bacon, a missionary nurse-midwife from Colorado, performed an emergency dilation and curettage after Garbazu spontaneously aborted twins. Throughout the procedure, Garbazu bled an inordinate amount, hemorrhaging so severely that Bacon’s nursing gown soaked through, as did her cotton dress beneath, leaving her torso drenched in Garbazu’s blood.
After a few days, Garbazu recovered and went home to Zigida, but two other women with whom she had shared the ob-gyn ward developed similar symptoms: nausea, mouth sores, fevers. By mid-March, Bacon was ailing, as were other members of the hospital staff. At month’s end, five patients (including an ob-gyn patient’s newborn baby) and eight hospital staff members were sick,22 and, as rumors spread of Lassa fever, panic erupted in Zorzor. Travelers zoomed through the town, their car windows shut tight against imagined plague. And residents of neighboring towns became dangerously agitated.
The fear was compounded by a very special concern for Bacon. Since her arrival in Zorzor in 1941, the energetic midwife had personally revolutionized health care in the region, and eventually throughout Liberia, by creating a vast infrastructure of trained midwife assistants and prenatal screenings. Twice she was awarded Liberian presidential medals for her years of walking hundreds of miles to far-flung villages to convince women of the wisdom of delivering their babies in clean hygienic settings, assisted by trained personnel.
Located in the high-country tropical forestland of eastern Liberia, close to the Guinea border, Zorzor was a remote area where sorcerers usually resented the intrusion of all forms of competing providers of medicine, yet Bacon managed to gain respect even in villages located so deep in the rain forest that they could only be reached by horseback or on foot.
The Coming Plague Page 13