Peter Piot staggered off into Bumba, feeling more emotionally wretched than he had previously imagined was possible. For the first time in his life, Piot set off, with determination, to get drunk.
After a couple of beers, he felt tears pressing against his eyelids, and thought again of the poor villager who had perished in his place. He bought drinks for anybody in the bar who would hear his story, and soon the modest establishment was packed with thirsty ears.
After a couple of rounds, he heard someone greet him in Flemish, looked up, and saw a white man covered in road dust. Simon van Nieuwenhove introduced himself, explained that he had just returned from a four-week tour of the wilds in search of Ebola cases, and asked if he might join in the revelry.
The two men shared sagas, beers, and emotions, and developed an instant friendship that would bond them like brothers for the rest of their lives.
In the following days Piot and van Nieuwenhove talked for hours, trying to make sense both of the strange epidemic and of its impact on their lives. Piot’s backgrounds in medicine and virology had served him well, but the twenty-seven-year-old Belgian had enough humility to recognize that he knew nothing about developing countries, and even less about epidemiology. He had developed a strong admiration for the multifaceted skills of the Americans—Breman, Johnson, and McCormick. And he decided to ask Johnson to recommend him for epidemiology studies at the CDC.
Like so many other members of the International Commission, Piot was discovering that the relatively brief Yambuku experience was completely changing his life. It would be some time before he would discover the effect his African encounter was having back home on his wife, Margarethe. And on van der Gröen’s wife, Dina. Unbeknownst to the men, the Belgian government had informed Dina and Margarethe that “there had been a deadly helicopter crash involving Belgian members of the International Commission.†It would be several days before the women would learn that their husbands were alive.
Since the ghastly incident with the Zairian helicopter, Piot was gaining a healthy respect for danger, among other things. But most of the other survey team members had settled into routines, staying in the more comfortable town of Bumba, driving their Land-Rovers out to the villages, and going house to house completing huge questionnaires on detailed information considered vital to understanding the epidemic. With routine comes complacency, a lowering of both guard and fear.
VIII
On November 26, U.S. Peace Corps volunteer Del Conn told team members in the Yambuku area that his head and back were killing him. The pain came on suddenly, and then hung on relentlessly. Conn, who had previously worked in a small hospital outside Kinshasa, had joined the Yambuku survey effort ten days earlier and was assisting Piot in collecting blood samples and village data. He had also helped van der Gröen prepare microscopic samples of Ebola-infected tissues for study in a field lab the Belgian had recently constructed in the mission. A month later researchers would learn that some of Conn’s samples, despite ultraviolet radiation exposure and acetone treatment, still contained live Ebola virus.
Though Conn’s temperature was only slightly above normal, team members were worried. They notified commission headquarters that it might be necessary to activate the complex system of medical evacuation that had been worked out in detail after days of negotiations with the governments of Zaire, South Africa, the United States, and France. Those procedures required that Conn be placed under strict quarantine for thirty-six hours and airlifted out of the region if his condition worsened.
While Conn lay inside a room of the mission facility, tended to by Karl Johnson and Margaretha Isaacson, the team tried to continue their survey work.
“But there’s no question about it,†Breman radioed to Johnson, “this is a major downer for everybody.†Morale plummeted, fear rose.
A Canadian military officer had, coincidentally, arrived a day earlier in Kinshasa with a newly designed portable plastic isolator unit, intended to allow safe transport of contagious individuals.
By November 29, Conn’s condition had worsened. His fever was up slightly, blood chemistry showed classic signs of viral infection, back pains were severe, and he was nauseated. In Yambuku, Johnson, Dr. Dennis Courtois, and Isaacson tried to prepare Ebola antiserum from recovered patients’ blood, but power failures shut down their centrifuge and other equipment necessary to ensure safe plasma preparation.
“You can’t imagine the fear here,†Johnson radioed to Bumba.
Under contingency plans, a military helicopter was supposed to fly immediately to Yambuku, pick up Conn, and bring him to Bumba. Meanwhile, a C-130 was supposed to fly from Kinshasa to Bumba, load Conn into the Canadian isolator unit, and transfer him to Johannesburg, after a refueling stop in Kinshasa.
But the Zairian Air Force’s pilots balked again. Fearing Conn might give them the disease, the pilots refused to fly their helicopter to Yambuku. All other options closed, Johnson, Isaacson, and Courtois loaded Conn into the back of a Land-Rover and drove the bumpy road to Bumba, their passenger groaning in pain all the way. All three scientists wore disposable protective clothing and surgical masks throughout the journey, which lasted four and a half hours because Conn could not tolerate the sudden jarring produced by hitting ruts at speeds greater than ten miles per hour.
When they reached Bumba, continued Air Force fear was obvious: no plane awaited them. And panic among the townspeople was so great that the Land-Rover was not permitted to leave the center of the Bumba landing strip. Unprotected from the tropical sun and forced to wear a tight rubber respirator mask to allay the fears of the populace, Conn was miserable. Johnson and Isaacson sedated the Peace Corps volunteer and gave him analgesics to ease his pain.
As night fell, there was still no word on air transport for the ailing man, so Johnson and Isaacson were forced to make do with available plasma and equipment. Convinced their colleague had Ebola, they hand-administered a unit of Sophie’s antiserum into Conn while the young man lay in the back of their Land-Rover.
At dawn an Air Zaire “Fokker Friendship†airplane landed, the Canadian respirator on board.
The two doctors studied the isolator for a moment. It consisted of a plastic pipe frame that outlined a space some seven feet long, four feet high, and four feet wide. Suspended from the frame was a box tent of thick, clear, pliable plastic. From the sides of the box tent hung attached gloves, into which attending physicians would insert their hands and arms when they needed to “touch†the patient.
The doctors carefully slid Conn into the isolator, attached an intravenous feeding tube to a device installed in the box tent, shut their patient inside, and switched on the pressurized air device. It seemed to work, but the intravenous feeding device was poorly designed and the feed rate fluctuated wildly.
An assortment of drugs and medical supplies were also on board the aircraft, and the doctors decided to administer strong painkillers to Conn before takeoff. Commission members in Kinshasa failed, however, to provide a file with which the vials could be opened, forcing yet another delay while the physicians sought an alternative sterile means to unseal the ampules.
Once the Keystone Kops-like operation was in the air, another failing of the Canadian device was noted: it did not adjust well to altitude-induced air pressure differences. Conn grew anxious as the box tent slowly caved in on him, making his space ever more claustrophobic.
When the plane landed in Kinshasa another snag appeared in the commission’s grandiose emergency evacuation plan: no plane was “available†to take the patient to Johannesburg.
Johnson, now fuming mad, contacted U.S. Embassy officials, who relayed an air support request to the USAF. A C-141 Starlifter was dispatched from Madrid, arriving in Kinshasa six hours later. During the long wait, fear of contagion once again forced the group to stay at the airport, this time inside an abandoned hangar. The afternoon heat was s
o great that the isolator steamed up and was soon creating its own internal rainfall.
Although he received a variety of analgesics, Conn’s pain was acute, he was running a fever of over 102°F, and the hours inside the wet, coffin-sized plastic cocoon were driving him crazy. His anxiety reached a zenith when the doctors noticed blood oozing out of the tiny puncture hole through which his intravenous feeder was inserted.
Uncontrolled bleeding, Conn knew, was hemorrhaging; and hemorrhaging was the key symptom of Ebola. Conn had to be heavily sedated.
That night Conn was transferred into the USAF jet and flown to Johannesburg. Because of a storm front, the flight was diverted on a huge loop out over the Atlantic Ocean. The doctors felt Conn would be unable to tolerate turbulence, but the diversion added several hours to their flight time.
The plane landed in Pretoria and Conn was transferred to a South African Air Force plane for his final leg to Johannesburg.
When he was finally removed from his nightmarish cocoon, Conn’s entire body was covered with a florid measleslike rash that was not usually seen with Ebola but had been noted in some Machupo and Marburg cases. He had been severely ill for six days before reaching a hospital.
Clearly, the commission’s contingency plans had failed completely when put to the test. Johnson was enraged, and scientists still deployed in the field were extremely distressed.
Behind the scenes still more misadventures occurred. The CDC sent a massive hospital containment bed isolator by air from Atlanta, but when the contraption arrived in Johannesburg two crucial components were missing: instructions for assembly and an electrical converter that would allow the American-made device (designed for 110 volt, 60 Hz electricity) to function in South Africa (which uses 220 volt, 50 Hz electricity).
Furthermore, early difficulties in transporting Conn prompted CDC officials to prepare an Apollo space capsule for use in South Africa. That forced a major South African Army mobilization of ground transport capable of maneuvering the eighty-ton capsule. At the last minute space capsule airlift plans were scrubbed.
All in all, the planned thirty-four-hour evacuation actually took over seventy-two hours, at an inestimable cost to the governments of Zaire, the United States, and South Africa.
And when Conn’s blood was submitted to repeated examinations, no Ebola viruses could be found. Nor could the South African team find evidence of any other known human pathogen.
Twenty years later, the cause of Conn’s bona fide illness would remain a complete mystery.
Conn, it seemed, had “discovered†another new virus.
IX
Don Francis was burned out before he ever got involved in the Sudan episode. Hell, he was burned out before he even got to Harvard.
After two years of chasing down smallpox cases all over Sudan, India, and Bangladesh he was ready for a break. September 1975 found Francis at Harvard University, working on a Ph.D. in virology. With the CDC’s permission, Francis was studying in Max Essex’s laboratory when the Ebola mystery started unfolding some ten thousand miles away.
When CDC officers called him in October 1976, Francis was a bit flattered at first.
Francis got off the phone and searched out his mentor, Max Essex. He found the Rhode Island-born Yankee, as usual, poring over data, and requested a two-week leave from doctoral studies.
Essex agreed to let Francis take two weeks off; indeed, he later had to talk Don into going when the younger scientist’s ego was bruised by learning that, far from being indispensable, he was the CDC’s last resort. Every other person on the agency’s list had turned down the assignment out of fear.
Word from Zaire had, by early November, been exaggerated in the gossip mills of international virology and finding eager volunteers for the Sudan investigation proved exceedingly difficult. Eventually WHO’s Paul Brès gave up his search, bought a Geneva—Nairobi ticket, and assigned himself to the investigation. The WHO team in Maridi would be composed of David Smith (of the Kenyan Ministry of Health), Don Francis, Bres, Irishman David Simpson (of the London School of Hygiene and Tropical Medicine), animal expert Barney Highton (also of the Kenyan Ministry of Health), and Sudanese medical experts Babiker El Tahir, Isaiah Mayom Deng, and Pacifico Lolik. Most would join Francis and Simpson in the south, having made their own way to Maridi via Nairobi or Juba … after several days’ delay.
Because of the ancient rift between Khartoum and the southern Sudanese provinces, the federal government decided to stop the epidemic by completely cutting the south off from the rest of the country. It was sort of a damage control approach: many might die in the remote south, but the disease would not reach the more densely populated Muslim north. Absolutely no airplanes, trucks, or other vehicles were allowed in or out of the southern section of the country.
For four days Francis and Simpson begged, cajoled, and bribed their way around Khartoum, searching for a way to get themselves—with a couple of tons of supplies—past the quarantine lines, all the way south to Maridi and N’zara. Simpson, El Tahir, and Francis visited all the Western embassies, pleading for assistance. Much was promised, little materialized. Chartering a private airplane was ruled out: Khartoum and Kenyan officials insisted the entire aircraft would be burned, as a protection against contagion, upon return from the quarantine area.
At long last two large British trucks were found, loaded up, and filled with extra tanks of gas. Unbeknownst to the hapless WHO crew, McCormick had already left N’zara by the time Francis finally got behind the wheel of a truck bound for Maridi. It was the rainy season, and what passed for roads had become muddy rivulets. For twelve hours the WHO team kept their trucks in four-wheel drive and their accelerators floored and endured a battering, crashing ride. It was two in the morning when the exhausted group pulled into the town of Maridi, population 2,000.
They were greeted by the Maridi hospital’s night watchman, who awoke the town’s two public health doctors and installed the tired team in an old British missionary complex.
The following day further impediments to their investigation mounted, and Francis, Simpson, and El Tahir were frankly stunned by the scale of their problems. The national quarantine of the south was bringing on near-famine conditions in the region. Because the rolling elephant grass savanna was often wet and marshy, it was insect-infested. Tsetse flies, in particular, swarmed about, infecting livestock and people with the trypanosomes that cause sleeping sickness. The problem was so severe that most people had years earlier ceased raising animals, and the entire region was dependent upon shipments of meat and protein from the north. No shipments had come through since September 30, when the quarantine was imposed. El Tahir, who had made the first official visit to the epidemic area on September 26, could clearly see the enormous difficulties imposed on the people by six weeks of quarantine.
The three men also found the distances between villages in the region lengthy and untraversable in four-wheel-drive vehicles. Some of the nomadic villages were virtually invisible, hidden in tall stands of elephant grass, reachable only by nearly imperceptible footpaths.
The district’s headquarters, Maridi, was a sparsely supplied government town whose sole significant employer was a UNICEF-funded teaching hospital. Constructed of wattle, the hospital was staffed by two poorly paid public health doctors and 120 nurses, most of whom were trainees. Their shared skills and supplies pretty much limited the Maridi staff to tender loving care in their constant war against sleeping sickness, malaria, bacterial meningitis, septicemic plague, relapsing fever, and a host of other tropical diseases. Long cut off from the rest of the world, Maridi had no telephones, so a ham radio was used to relay signals to Juba, where a French scientist remained throughout the Sudan investigation, serving as a communications officer, relaying messages to and from Khartoum. There was no communication with International Commission members in Zaire.
When Francis, Simps
on, and El Tahir arrived, the two Maridi doctors were already in the process of closing their hospital, most of the nursing staff having either died of the new hemorrhagic fever or run away in fear, carrying the virus and panic with them back to the villages. The handful of nurses who remained were in the process of closing down the regular hospital facilities and tending to Ebola cases in a specially constructed wattle quarantine building.
Wearing respirators, protective gowns, and gloves, Simpson and Francis inspected the hospital and were horrified by their first sight of Ebola. Neither Francis nor the more experienced Irish physician, Simpson, had ever seen anything even approaching its devastation. Weak, emaciated men and women lay about the mud-and-stick chamber, staring out of ghost eyes at the white men. The virus was so toxic that it caused their hair, fingernails, and skin to fall off. Those who healed grew new skin.
Over the following days Francis, the epidemiologist of the group, questioned hundreds of people in the Maridi area, using local schoolteachers as translators. He drew many blood samples and mapped how the epidemic had spread. Barney Highton led efforts to capture animals and insects, hoping to discover the natural reservoir of the Ebola virus, and El Tahir set up a laboratory inside the abandoned Maridi hospital.
They soon discovered that the major sources of the continuing spread of the virus were the funerals; more specifically, the procedures—not unlike those practiced in Yambuku—used to cleanse the bodies before burial. Francis ordered a halt to all the funerals of Ebola victims, promising that his team would cleanse the bodies according to tribal customs.
The people were outraged, and their collective anger nearly destroyed the entire WHO effort.
“I think they’re going to kill us,†Francis told his colleagues. “I mean it. Watch your backs.â€
The Coming Plague Page 22