The Coming Plague

by Laurie Garrett

  It broke Breman’s heart to watch the nuns “communicate” with their ancient ham radio equipment. Every day at a designated time a Sister would put her ear to the decades-old speaker, turn on the radio, and listen through horrendous static for the voice of the monsignor in Lisala. One by one, he would call out the name of each mission in northern Zaire and in this crude manner the network of missionaries would order supplies and share important news.

  Though he had hooked up newer equipment, the overall system was so primitive that the American-made side-band radios made little difference. There remained no way to communicate directly with Kinshasa, and all communications were subject to the problems inherent in the child’s game of Telephone, in which one person passes a sentence on to another, and another, until after a tenfold relay the message bears little resemblance to the original. U.S. Embassy officials told Johnson that setting up a sophisticated communications system connecting Yambuku, Bumba, Kinshasa, and Atlanta “would entail several million dollars and a twenty-four-hour aircraft relay system.” In his usual insouciant fashion, Johnson had words with the officials, but Breman, having had his fill of U.S. State Department types elsewhere in Africa, suggested Karl not waste his energy on the bureaucrats.

  Meanwhile, Karl Johnson was trying his best to outmaneuver other logistic nightmares created by the Zairian Armed Forces (which didn’t want to fly anywhere near Yambuku), the embassies of the United States and France, and a host of international political issues. He needed a top entomologist or ecologist—somebody who could search, as Merl Kuns had in Bolivia, for the insects or animals that carried the disease. After casting its net far and wide, WHO decided to send French Dr. Max Germain, who worked in the agency’s Brazzaville office.

  Finally, Johnson needed to get a team further out, way up to Sudan, to figure out how the epidemics of Yambuku and Maridi were connected. For that job Johnson knew exactly whom he wanted: “This one’s for Joe,” he said, anticipating McCormick’s imminent arrival.

  McCormick landed in Kinshasa on October 23, the same day the CDC’s David Heymann cabled word that a NASA space capsule had successfully been transported from Houston, where it was staffed and ready to receive any WHO team members unlucky enough to catch the virus. Also ready at the Frankfurt Airport in Germany was a USAF C-131 transport jet with an Apollo space capsule aboard—the same space capsule that Henry Kissinger had offered two years earlier for use in airlifting Lassa-infected Mandrella from Nigeria to Hamburg.

  That day Johnson got an update from Geneva on the Sudanese epidemic. A team of investigators had been selected, comprised of ten Sudanese doctors, Irishman David Simpson, France’s Paul Bres, and the CDC’s Don Francis. The investigators were instructed to rendezvous immediately in Khartoum and from there make their way south to Maridi.

  Johnson also wanted a top-flight lab worker in Kinshasa right away—someone who could improvise and create a diagnostic laboratory out of the meager facilities available. Pattyn recommended van der Gröen, who immediately flew to Zaire loaded down with essential supplies. Key among his gear were microscope slides he had carefully coated with infected Vero cells. Though they were fixed with acetone, van der Gröen had no way of knowing whether or not those slides were covered with contagious organisms.

  “It doesn’t matter,” he told himself. “I’ll make sure I’m the only one exposed to these things. But I must have them. There is no other way to diagnose infection.”

  His plan was to diagnose infections by putting patients’ blood samples on the microscope slides, waiting a while, then rinsing the slides. If patients were infected, they would make antibodies against the mysterious microbe that would latch on to the infected Vero cells. He then planned to mix fluorescein—a molecule that glows under ultraviolet light—with monkey antihuman antibodies. When the fluorescent antibodies were coated onto the microscope slides, they would cling to the human antibody-attached Vero cells. And van der Gröen planned to simply flash ultraviolet light at his slides to see which people had infected blood. Though the method had been in use for Lassa since Jordi Casals’s days at the Rockefeller Foundation, van der Gröen had never tried the immunofluorescence technique, and hoped that he would be able to perform professionally in the epidemic pressure cooker.

  On arrival at Kinshasa’s airport, van der Gröen was greeted by Belgian diplomats who ushered his supplies through customs and whisked the bewildered scientist off into the night. Van der Gröen’s initiation into the Zairian investigation began with a harrowing midnight drive on the highway to Kinshasa, which, as was typical, was marked by several near-collisions with cars and trucks that careened at high speeds without using their headlights. The Zairois believed that they saved fuel by shunning headlight use. As Ruppol briefed van der Gröen on the Yambuku epidemic, the terrified Belgian stared agape out the windshield as one oncoming vehicle after another suddenly loomed out of the darkness, coming within inches of their car, which was driven by a Zairois who deftly dodged all the nearly invisible cars and trucks.

  At that moment nobody could have convinced van der Gröen that within a few days such sights would seem blase.

  After a night of restless sleep, van der Gröen arose early to meet his new boss, Karl Johnson. Watching Johnson shout commands, always laced with florid language, van der Gröen thought the American “a very peculiar man.” But during his first of the daily morning epidemic meetings, van der Gröen witnessed Johnson’s uncanny ability to coordinate a multilingual, multicultural team of individual egos, creating a single, well-oiled anti-microbe machine. As had all those who arrived before, van der Gröen instantly admired Johnson and accepted his leadership without question. Johnson ordered the young Belgian to go to Ngaliema Hospital and create a modern laboratory—immediately.

  Late that night Johnson came by, holding up some blood samples that Sureau and Piot had sent down from Yambuku. The men uncrated Johnson’s glove box, placed it atop the wooden table, and set to work. Van der Gröen had never worked with his hands inserted inside heavy stationary gloves, and he found the process terribly cumbersome and frustrating. Johnson taught the Belgian tricks that he had learned nearly two decades earlier in Bolivia, and the pair were soon toiling smoothly as a team.

  Sweat poured off van der Gröen, and every step of the procedure performed in the glove box seemed to take ten times longer than it would atop his Antwerp lab bench. But by two in the morning, he had completed each step of the immunofluorescence process. All that remained was the ultraviolet light microscope examination to see whether or not the serum from Yambuku was infected with the mystery microbe. For that, the pair needed a completely dark room.

  Van der Gröen hauled a small table into the bathroom, used the toilet as his seat, and turned off the electric lights.

  He switched on his ultraviolet microscope, and with Johnson holding his breath in anticipation, van der Gröen put his eye to the lens.

  “Comme les étoiles!” he exclaimed. “Like twinkling stars … in a dark night, surrounded by red cells. Look, Karl, the cells containing the virus are bright, glowing, fluorescent masses.”

  Johnson took the toilet seat and peered down the lens. It was three-thirty in the morning, but the men were too excited to sleep. The serum they were looking at came from Sophie in Yambuku, who had survived the disease. Finally they had a way to test who was infected, and to find people who had been infected but successfully fought off the microbe without developing detectable disease. They also now had a way to test whether a particular person’s blood contained potentially lifesaving antibodies.

  That morning Pierre Sureau awoke in Bumba feeling feverish, unsettled. He and Piot spent the day arguing with the Zairian Armed Forces for transport of equipment from Kinshasa.

  As he sat on a veranda overlooking the Bumba Missio
n, Sureau contemplated what he had learned so far: The disease was clearly deadly, and most victims died within a week. It had taken a huge toll at Yambuku Hospital, and left the surviving nuns and priests nearly incapacitated with grief.

  Sipping a cocktail, Sureau contemplated the most awkward finding: the condition of Yambuku Mission Hospital. The previous day he, Breman, and Piot had examined the now empty facility, its medical records, and equipment. When they entered the compound, Sureau had been appalled. The sterilization facilities were abominable, the surgical equipment positively antique, and the linen—though washed—was often covered with old blood stains.

  Yet when he examined the medical records, he found no telltale link between people who had undergone surgery in the antiquated facility and those who got the disease. He wiped fever sweat off his brow, and couldn’t shake the uneasy feeling that the starting point for the epidemic was—somehow—that well-intended but fatally primitive hospital.

  With the contemplative Sureau now in Bumba, awaiting an armed forces plane to Kinshasa, were Piot, other team members, Sophie, and Sukato. As the surviving wife of Yambuku’s first victim—the index case, in epidemiology parlance—Antoine, Sophie had antibodies of incalculable value. Yambuku nurse Sukato was the only member of the mission’s medical staff who had survived infection and illness. These two in coming days would donate many units of blood, from which would be derived a tiny vial of antiserum of inestimable value.

  By October 24 Sureau’s secret fever disappeared. He told no one about his illness: Johnson had insisted from the beginning that team members take their temperature twice a day and immediately report fevers to Kinshasa headquarters. Sureau chose to disobey, convinced that whatever he had was not the Yambuku disease.

  Fortunately, he was correct.

  Sureau was still feeling hot under the collar, however, because the long-awaited plane from Kinshasa hadn’t arrived. Johnson sent word that President Mobutu was out of the country, in Switzerland, and in his absence the government was nearly paralyzed. No one else dared order the armed forces to fly into the Bumba Zone.

  Sureau and Piot were worried that their samples would go bad in the tropical heat if these delays continued. They made more dry ice for their storage thermos and kept their fingers crossed.

  At last on October 27 the Zairian Air Force arrived in the form of a C-130 transport, loaded with lumber and supplies for the construction of a villa for Captain General Bumba, a powerful commandant. The pilots refused to turn off their engines and ordered the group to board immediately.

  The pilots grew positively enraged when they spotted the unexpected passengers, Sophie and Sukato.

  Ruppol explained the two were very important people: survivors of the epidemic. The appalled pilots swore that nobody infected with the disease could board their aircraft, nor would they allow samples of contaminated blood and tissue on the plane.

  A truce was reached: the group could board the plane, but none of them could enter the cabin for any reason. Squeezed in among the commandant’s building materials, the passengers did their best to get comfortable during the two-hour flight to Kinshasa. For Sophie and Sukato, both novice air passengers, it was a terrifying experience.

  The following morning, October 28, Piot nervously strolled the Kinshasa streets. Like Sureau before him, Piot was running a high fever. Worse yet, he had uncontrollable diarrhea and felt distinctly nauseated. Fearing Johnson would order him airlifted out of the country, Piot hid his ailment from the others, deliberately shunned team members, and searched on his own for dysentery treatments.

  Meanwhile, both Sureau and Breman told Johnson that they privately believed the source of most of the fatal cases in Yambuku’s epidemic was the hospital. Breman described in detail his eerie stroll through the hospital, and showed Karl two syringes he had delicately removed from a pan of water in the outpatient clinic.

  “I’ll bet these are infected,” Breman said, noting that the clinic issued only five syringes to its nurses each morning. They were used and reused on the 300 to 600 patients who required medical attention each day.

  When Johnson suggested it might be a bit dicey to point an accusatory finger at four now deceased Catholic missionaries, Breman said, “The villagers clearly understood the hospital was the source. Long before it was closed, the people voted with their feet. They ran away. That place was almost empty when it closed.”

  Johnson decided to put Breman in charge of a second survey team, responsible for designing a way to test Joel’s hypothesis. The plan was to conduct a major epidemiological investigation with nearly all the International Commission directly involved. The first step would require returning a small team to Yambuku to recruit and train a staff of local Zairois, particularly those who had survived the disease and were presumably immune. Johnson warned Breman, however, that one of the locally recruited Machupo investigators in San Joaquin had mistakenly thought a past ailment was Bolivian hemorrhagic fever. It was not, and Einar Dorado had paid for the error with his life.

  “Be damned careful,” Johnson said.

  On October 27 the commission released its first official account of events in Yambuku to foreign embassies in Kinshasa; the following day embassy officials passed the information on to the international press corps. It was a bland statement, conservatively designed to cast a sense of routine around a crisis that had rendered some team members patently terrified.13 Still, two scientists, a Zairois and an American, who read the report, requested permission to drop out of the investigation. The American had made it as far as Geneva before turning back.14

  VI

  On October 31, Sureau, Germain, McCormick, and recently arrived Belgian researcher Simon van Nieuwenhove gathered on the military strip at N’djili Airport at four-thirty in the morning. Now accustomed to the anxieties of the Zairian Air Force, the group had triple-confirmed the flight plans. Their cargo was impressive: two fully equipped Land-Rovers complete with a three-week supply of diesel fuel, food (C rations), and water. The plan was for the group to fly up to Bumba, where they would leave off Sureau and Germain, then proceed further north, to Isiro.

  For McCormick and van Nieuwenhove, Isiro would be just a first stop on long separate journeys. McCormick was destined for Maridi, van Nieuwenhove was assigned to search the remote southernmost expanse between Zaire and Sudan for additional pockets of the epidemic.

  Of course, despite all their prior confirmations, the scientists were told the planes weren’t quite ready for takeoff, and at five-thirty in the morning the pilots were scrambling to cannibalize parts from other planes. Finally, five hours later, the reluctant pilots—having exhausted all reasonable dodges—were forced to concede defeat to the scientists, and the C-130 took off for Bumba.

  The pilots landed in Bumba and, as always, kept their engines running while Max and Pierre unloaded the cargo and waved goodbye to their friends. Then they took McCormick and van Nieuwenhove to Isiro some 300 miles further north near the Sudanese frontier. The two men drove their well-stocked Land-Rovers off the C-130, shook hands, and headed in opposite directions.

  In Isiro (known in colonial days as Old Stanleyville), McCormick hunted for information and some additional supplies, quickly discovering there was little of either to be had. After years of central government corruption, Zaire’s most remote areas were bereft of all but local trade, and such “luxury” items as toilet paper, matches, and batteries had long since disappeared.

  Information was equally scarce, and McCormick found that the lack of trade activity had slowed the flow of traffic and communication between Zaire’s various northern zones to a mere trickle. Surprisingly few people in the region seemed aware of the Yambuku epidemic, and nobody could recall a case of anything resembling that hemorrhagic disease.

  As McCormick headed northeast toward the Sudanese border his language skills began to fail him; the more
remote the area, the fewer people spoke French, or Otetela, or any other Bantu tongue of which McCormick had a passing knowledge. Soon he found himself in villages not visited by a motorized vehicle in months, even years. And he, a bearded white man, would use an assortment of hand signals and languages to try to find out if anybody in the community had recently suffered an unusual disease. It was hard going, and all too often Joe found himself trying to make sense of conversations that, for example, began in Azandi, were translated into Lingala, and then conveyed to him in French. Information was, at best, muddled.

  The closer he got to the Sudanese frontier, the less obvious were the roads. Several times he bailed his Land-Rover out of a river, or plowed through yards of six-foot-tall elephant grass praying the road would reappear on the other side. He was making his way through an area that experienced torrential rains nine months out of the year, and was perpetually mudladen.

  At the border he discovered an Italian Catholic mission so removed from its Roman headquarters that the priests were living on five-year-old flour and the “protein” provided by the insects that infested their meager supplies. Elated at seeing a visitor from so far away, the priests were eager to assist McCormick and insisted he share in their sparse food reserves.

  The priests told McCormick there were rumors of an epidemic around the Sudanese village of N’zara, located some sixty miles further northeast. Joe told the priests he had no visa or travel papers.

  “That is no problem,” they said. “We will take care of it.”

  After a night’s rest, McCormick was introduced to the chief of a Zairian village adjacent to the border. At the priests’ request, the chief signed a letter that formally asked his counterpart on the Sudanese side of the border to admit McCormick into the country. Arriving at the much-anticipated border, Joe found two posts, atop which rested a long stick. Between the border posts lay the road, now narrowed to a mud footpath and bearing no signs of recent vehicular traffic. A handful of obviously hungry soldiers sat on their haunches around the site; they greeted McCormick’s arrival as a source of grand gossip and entertainment, breaking up an otherwise miserably monotonous day.