The Coming Plague

by Laurie Garrett

  “All right,” Piot was told, “You can go. We will only fund one week. And you’re representing the Belgian government.”

  Carrying the only suit he owned, he may have been prepared to meet officials in Kinshasa and travel around Zaire for a week. But he was woefully ill equipped for what would become a three-month stay in a tropical rain forest during the Zairian summer.

  Dr. Stefan Pattyn, before sending his samples on to England’s maximum-security laboratory in Porton Down, had completed studies in laboratory mice, which showed that the virus was quite lethal to rodents. He had also compared the mystery virus to Lassa, concluding that “it was probably some other arbovirus,” not the West African killer. Now he too departed for Zaire, leaving van der Gröen behind to monitor the health of the accident-exposed members of the Antwerp laboratory.

  On October 14, Patricia Webb and Fred Murphy completed their first round of studies of the mystery virus, working in the CDC’s maximum-security laboratory. In 1976 the lab was designated a P3 facility. A P1 facility was a basic laboratory such as could be found lining the hallways of university science departments; a P2 facility had a slightly higher level of security with entry limited to trained, authorized personnel and actual research work performed under hoods that sucked air away from the experiment, up a ventilator duct, and past scrubbers that disinfected the air with ultraviolet light and microscopically gridded filters; a P3 lab was state of the art in high-security research. For Webb, working in a P3 lab meant passing through a series of guarded locked doors, presenting her security pass for entry. She would then shower with disinfectant soap and don a set of head-to-toe protective clothing, gauze face mask, double latex gloves, and radiation badge to monitor her levels of exposure to isotopes occasionally used in such research. She would then pass through two more air locks lined with microbe-killing ultraviolet lights.

  Once inside the inner core, Webb might enter either the laboratory or the animal room. Both rooms were pressurized; all air was forced in past microscopic filters and sucked back out rapidly through several additional layers of filters, ultraviolet lights, high heat sources, and chemical scrubbers.

  A further layer of protection was provided by glove boxes: more sophisticated versions of the portable box Karl Johnson jury-rigged for his studies of the Machupo virus in Bolivia. All Webb’s samples from Zaire were stored in deep freezers overnight; small amounts were thawed during the day and analyzed inside the boxes. Webb would thrust her already double-gloved hands into a larger set of thick rubber gloves that were permanently installed in the clear-plastic front wall of the hooded box. She would then try, with three cumbersome layers of rubber over her hands, to manipulate test tubes, pipettes, petri dishes, and the like. It was slow-going, arduous work that often proved physically exhausting.

  Harder still was the animal work. To find a mysterious microbe, it was necessary to inject samples into mice, guinea pigs, hamsters, and monkeys, all of which were also kept in large glove boxes. The animals didn’t sit still in the grasp of bulky gloved hands, and injections were often a test of wills between scientist and guinea pig.

  In such a setting the greatest risks to the scientists were accidents, such as cutting oneself with a broken contaminated test tube or receiving an animal bite. Webb had never cut herself, but she had been bitten several times by monkeys that attacked her approaching gloved hands. Fortunately, those monkeys were part of Webb’s Machupo research, and, having already suffered the disease, she was immune.

  These Zairian samples, however, tested negative for Machupo, and Webb was acutely aware of the need to work with slow, cautious deliberation. It was not her style, really. When Patricia Webb graduated in 1950 from Tulane University Medical School in New Orleans, only eight other women were in her class. In those days a handful of women were given the opportunity to matriculate into a field dominated by males. Unlike most of her fellow students, Webb never planned to spend her life in a profitable practice giving middle-class kids antibiotics for strep throat and monitoring the blood pressures of obese patients.

  Since childhood in England Webb had been fascinated with stories of India, Pakistan, and China and saw medicine as a sort of universal passport.

  It hadn’t gotten her to India yet, but through medicine and research virology she had already seen Malaysia, Panama, Bolivia, California, Louisiana, Georgia, and the Washington-Baltimore area. But now she found herself locked inside an artificial environment day after day.

  The further Webb got into her research, however, the more obvious it became that the CDC needed to deploy a team immediately for fieldwork on the ground in Yambuku. With the approval of her CDC seniors, Webb began amassing further information and planning her fieldwork.

  She asked the CDC’s personnel office to find a staff scientist with three key qualifications: fluency in French, strong African experience, and training in epidemiology. The name Joel Breman popped up.

  Breman had spent six years in Africa since completing his medical studies—two years in Guinea and four in Burkina Faso. He had been part of D. A. Henderson’s successful campaign to eradicate smallpox, and he was fluent in African-dialect French. But Webb was a little anxious when she noted he was technically an EIS (the CDC’s Epidemic Intelligence Service) trainee.

  In late September, when the CDC’s Lyle Conrad contacted Breman in Michigan, the epidemiologist was knee-deep in another investigation—of Swine Flu. Conrad asked if the EIS trainee would like “one hell of an assignment. It’s in Africa, it’s a little frightening. Something has killed just about every villager in the area. You’d be gone about a week.”

  Having spent six years in tropical Africa, Breman knew nothing got done in one week. And he didn’t like the sound of this particular mystery. Nevertheless, over the next three weeks the tall, bearded scientist talked almost daily over the phone with Webb, getting a sense of the excitement and fear surrounding the Zaire outbreak. For her part, Webb soon grew used to Breman’s long-winded, often cliché-packed ramblings. Beneath his occasionally incoherent conversational style lay a sharp intellect that Webb recognized and planned to push to its limits in Yambuku.

  On October 10, Webb and her co-worker, Fred Murphy, officially informed WHO that “the illness is caused by a virus that resembles Marburg (Marburg-like), that the epidemics are probably caused in Zaire and Sudan by an etiological agent that is similar but represents a new immunotype that is in the family of Marburg.”11

  Webb’s Marburg speculation prompted an international escalation in scientific security. Thereafter the CDC and Porton Down—the world’s most secure labs in 1976—received virtually all samples of the mystery agent.

  At Porton Down it was Geoffrey Platt who handled most of the mystery virus research. His lab wasn’t exactly an American-standard P3 facility; rather it was a uniquely English mix of P3 and P2 elements. Because the British antivivisection movement was quite militant in its opposition to the use of laboratory animals, security in the form of controlling access to Porton Down was very high. Indeed, most British citizens had no idea where the lab was located or what it did.

  Since 1964 Platt had worked at Porton Down with dangerous viruses, particularly Lassa, taking precautions to protect himself, though the microbes were not kept safely inside glove boxes, as was done at the CDC. The rooms were, indeed, pressurized, and the air was decontaminated before being released into the English countryside, but Platt’s personal protection was limited to a cloth surgical gown, a double layer of latex gloves, and an old World War II-era gas mask. Though the respirator had been thoroughly tested for its effectiveness in protecting British soldiers from combat gases, it had never been proven that the mask filtered out viruses. Nevertheless, the handful of Porton Down scientists and technicians who worked with super-lethal microbes were limited to using the cumbersome, often hot masks that always see
med to cloud up in the midst of delicate procedures, usually leaving researchers with headaches by the end of the day.

  Every night after work, Platt would scrub his mask with Lysol and spray it with formalin disinfectant.

  Though mindful of the risks, and very careful in his work, Platt knew there were dangers, especially when working with an unknown, Marburg-like killer.

  “Care is absolutely essential,” Platt told his colleagues, warning that nobody should enter his lab or animal care area unless absolutely necessary—at least, not until Platt knew what lurked in those test tubes. “You’ve got to realize you’re working in some danger and be able to accept that. It’s not good if you’re going to go home at night and not be able to sleep.”

  Platt had no way of knowing that in just three weeks he himself would lose a great deal of sleep worrying about his own chances of survival.

  Platt’s work on the Sudan samples prompted WHO to release, on October 15, the following urgent bulletin:

  Haemorrhagic Fever of Viral Origin. Between July and September 1976, it was observed in the region spanning N’zara to Maridi, in southern Sudan, sporadic cases of fever with haemorrhagic manifestations. It is thought that the first cases occurred among agricultural families. During the last week of September, the situation worsened considerably, 30 of 42 cases occurred in Maridi hospital among members of the staff; it is thought the disease was spread directly from one person to another. By October 9, 137 cases, 59 deaths, were reported for the region comprising N’zara, Maridi and Lirangu. The epidemic has caused panic on the local level … .

  The report closed with these words: “Samples from Sudan and Zaire have revealed the presence of a new virus, morphologically similar to Marburg, but antigenically different.”

  Well before WHO officially released that report, the agency had confirmed from three labs (CDC, Anvers, Porton Down) that a deadly new virus had been discovered, and had initiated an international effort to try to stop the epidemics in Zaire and Sudan, identify the virus, and determine how and why it had appeared. In a matter of days, what began as a problem in a missionary hospital would involve investigators and military personnel from eight countries, several international organizations, the foreign ministries of at least ten nations and the entire health apparatus of Zaire. Almost overnight, events would snowball into an effort necessitating over 500 skilled investigators, and mobilizing the resources of numerous European and American institutions, all at an indirect cost of over $10 million.

  Direct costs for the Yambuku investigation alone would exceed $1 million.

  IV

  The snowball effect began modestly enough on October 13, with Pierre Sureau’s arrival in Kinshasa. The Pasteur Institute virologist represented WHO for the duration of the epidemic, and had the task of assisting Zairian authorities in any way possible. Sureau’s first meeting was with Minister Ngwété Kikhela, who informed the French scientist that it would be several days before transport to Yambuku could be arranged. Such delays were to become a major component of this investigation, one that was constantly plagued not only by the mysterious virus but also by logistical nightmares aggravated by national panic. All commercial flights to Bumba had ceased as a result of the regional quarantine. That left only Zairian Air Force transport to the region, but terrified pilots were rebelling against orders to enter the Bumba Zone.

  Though his hopes of getting an immediate look at the Yambuku epidemic were thwarted, the spry, middle-aged French doctor was able to see a case of the disease on his first day in Zaire. Having nursed her dear friend Sister Myriam, Sister Edmonda now lay dying in Ngaliema Hospital’s Pavilion 5 isolation ward. Sureau found her semi-delirious, severely dehydrated from days of diarrhea, feeble, anorexic, feverish, completely drained of energy; yet, surprisingly, unafraid.

  “She knows what is coming. She has seen it before with Sister Myriam and all the cases in Yambuku. Yet she is calm,” Sureau noted, with considerable amazement.

  Sister Edmonda thanked the doctor for his attention and “the good conversation,” and clutched the hand of an elderly Kinshasa nun, Sister Donatienne. Sureau took a blood sample and departed.

  That night Sister Edmonda died.

  “My God!” Sureau exclaimed. “That virus is fast!”

  The following morning, October 14, Sureau returned to Ngaliema and discovered that a new patient had arrived. Student nurse Mayinga N’Seka, who had tended to both Sister Myriam and Sister Edmonda, was developing the first symptoms of the mysterious disease at about the time Sister Edmonda died. Two days earlier, Mayinga had spent hours in a general administrative office awaiting transit papers for overseas study, where she had contact with numerous strangers and officials. She then took a taxi to Mama Yemo Hospital, where she sat in a crowded waiting room, waiting for someone to treat her fever, headache, and muscle pains.

  Sureau and Ngaliema doctors quickly determined that Mayinga had the Yambuku disease, and transferred her to Ngaliema’s Pavilion 5 isolation ward. Concern and rumors started to spread through the streets of Kinshasa.

  Meanwhile, WHO remained convinced the culprit could still be a strain of Marburg disease, so Sureau and Close contacted the South African team that had treated the Australian tourists a year earlier, asking for antiserum. The politics of such a request were dicey, and necessarily involved notifying the Mobutu government, South Africa’s apartheid leaders, and the embassies of France and the United States. Though it violated Zaire’s ban on relations with South Africa, all government representatives eventually agreed, for the sake of young Mayinga and the people of Yambuku, to allow Dr. Margaretha Isaacson to fly up from Johannesburg, Marburg antiserum in hand.

  “It’s our only hope,” Sureau told Zairian officials.

  Talking incessantly, Isaacson hit the ground running and approached medicine like a field commander, ordering the Ngaliema medical troops about and bringing instant order to a scene that had been dangerously close to chaos. She and Sureau gave Mayinga the Marburg antiserum, and then the South African sat down with Zairian doctors to plan the transformation of Pavilion 5 into a bona fide isolation ward. The Zairian medical staff, which had been in a state of extreme agitation ever since their colleague fell ill, was thrilled to see the “space suits” Isaacson brought from South Africa. Soon the entire staff of Pavilion 5 worked in head-to-toe white suits that had clear-plastic face coverings and respirators. The suits proved horrendously uncomfortable in the steamy Kinshasa heat, but the Ngaliema staff was enthusiastic about the protection.

  They were far less enthusiastic about Isaacson’s recommendation, supported by the Zairian Health Ministry, that the entire Pavilion 5 staff be placed under quarantine. Health Minister Ngwété made it clear his greatest concern was the possible spread of the Yambuku virus from Ngaliema Hospital into the streets of Kinshasa, endangering the 2 million residents of the capital. For nearly a month, a half dozen staff members would be confined to Pavilions 5 and 2 of Ngaliema Hospital, forbidden to leave the confines of the area to see their families.

  Officials tracked down 37 people with whom Mayinga had shared meals or close contact in the days prior to her illness, placing all the unfortunate men, women, and children inside Pavilion 2 for twenty-one days of quarantine. One quarantined woman would give birth during her stay, and all the staff and isolated civilians would fight day-to-day personal battles against boredom, fear, and fatigue. In addition, 274 people who had had recent contact with the Pavilion-bound individuals were found, blood-tested, and kept under close surveillance.

  Fortunately, no further cases of the Yambuku disease would develop in Kinshasa.

  Years later, reflecting on the extreme precautions taken at Ngaliema Hospital, Isaacson would say that “perhaps we were overdoing things a little bit,” but “we could not afford doing less than the maximum precautions that were
available. We could not do it ethically, we could not do it scientifically.”

  Constantly abandoning all precautions—much to Isaacson’s consternation—Sureau never wore a mask, and often spent long periods of time at Mayinga’s bedside, chain-smoking cigarettes and dispensing calming conversation. Despite huge cultural and generational gaps, the student nurse and the physician became close, and Sureau often voiced his increasingly urgent hope that the Marburg antiserum would save his new friend. Mayinga herself was far from optimistic. Having seen the agony the Sisters had endured, she was frankly terrified.

  “Dr. Isaacson is here,” Sureau told Mayinga gently. “She is one of the greatest experts in the world on Marburg. You are in very good hands. Have faith.”

  Later, as he carefully prepared samples of Mayinga’s blood for shipment to Pat Webb’s CDC laboratory, Sureau could barely contain his excitement about the coming trip to Yambuku.

  “For the community of arbovirologists, this is one of the greatest events in contemporary epidemiology,” he noted in his diary. “No one of us would pass up such an opportunity for passionate study. Personally, I am delighted to be in this place, and to participate in such an adventure.”

  Sureau’s enthusiasm was tempered the following day, however, when Mayinga’s condition deteriorated. Isaacson decided to try a second dose of the precious antiserum, and Sureau again comforted Mayinga by telling her that Isaacson was an expert. But by then the French and South African physicians knew the truth: whatever was infecting Mayinga was not the Marburg virus.