The Coming Plague

by Laurie Garrett

  Havana, with a population of 2 million and fewer than 25,000 hospital beds, was overwhelmed. More than 10,000 health care workers had to be corralled into full-time dengue treatment and control efforts, not only in Havana but eventually nationwide. Nearly 10 percent of the residents of Havana suffered symptomatic dengue-2 infection between May and September 1981.

  When researchers tested the city’s residents for prior exposure to dengue, they discovered that the Halstead-Yamarat theory of serial infections and immune system deception was correct: 44.5 percent of Cuba’s urbanites had antibodies to dengue-1 as a result of a very mild epidemic of the virus that swept imperceptibly over the island in 1977, causing little more than mass natural immunization of the population.

  But that was enough.

  When dengue-2 hit Havana it found the urban population sensitized and ready to succumb to its immune system trickery.60

  The Cuban epidemic sent shock waves through the public health communities of the Americas. A year earlier, two residents of Laredo, Texas, had developed dengue hemorrhagic fever, carried by infected A. aegypti mosquitoes found in that city, proving that the viruses had made their way to North America as well.61

  In October 1982, New Delhi, India, suffered a mass epidemic of dengue hemorrhagic fever that sickened more than 20 percent of its 5.6 million residents. By then the World Health Organization regrettably had to announce that attempts to stifle the spread of dengue-2 since its initial appearance in Manila in 1953 had failed, and the virus was now endemic in and around the major cities of Burma, Thailand, Laos, Vietnam, eastern India, and Sri Lanka.

  During the 1980s, Duane Gubler, of the CDC’s laboratory in San Juan, Puerto Rico, would with considerable apprehension chronicle the steady rise of dengue, of all types, in the cities and towns of Latin America. Each year the number of hospitalizations would increase, infected mosquitoes would expand their territory, and the specter of a hemispheric urban dengue disaster would become more imposing. By 1990 he would be forced to conclude that dengue was endemic to Latin America.62

  A key factor in the expansion of dengue threats to the Americas would be the 1985 arrival on the continent of A. albopictus. Carried aboard a shipment of water-logged used tires sent from Japan for retreading in Houston, Texas, the extremely aggressive mosquitoes—capable of carrying both dengue and yellow fever—would quickly outcompete more timid domestic mosquito species in the United States. Within two years A. albopictus tiger mosquitoes would be seeking human blood in the cities and towns of seventeen U.S. states.63

  “The presence of albopictus dramatically increases the probability that exotic viruses will be brought into the urban human environments of the Americas,” Gubler declared. “The tiger mosquito will feed on anything, a rat for example, and then turn right around and feed on a human.”

  Gubler warned that dengue wasn’t the only virus A. albopictus threatened to spread: the midguts of the females were capable of harboring a broad spectrum of viruses, including types found in other mammals and not yet known in humans. In contrast, the finicky A. aegypti fed almost exclusively on human blood; it could therefore spread only known human diseases.

  “We’re in crisis management on this, that’s all,” Gubler would angrily say. “We just wait for crises to occur and then get around to intervening. We could have seen this coming, we could have been vigilant. But the money was never there; the surveillance was never there.”

  When Tom Monath set out to reconstruct the events that led to the global emergence of urban dengue hemorrhagic fever he concluded that every historical advance of the microbes and their mosquito vectors was a direct result of human activities. Still at the CDC’s laboratory in Fort Collins, Colorado, five years after his discovery that rats carried the Lassa virus in West Africa, Monath scoured historical records and contemporary laboratory evidence for clues concerning dengue.

  He concluded that World War II was responsible for the emergence of A. aegypti-carried dengue in Asia. Massive human migrations, aerial bombing campaigns, densely populated refugee camps, and the wartime disruption of all mosquito control efforts allowed for an unprecedented surge in the A. aegypti population: it may very well have numbered more in 1945 than at any time in the planet’s previous history. The mosquitoes were able to use bomb craters filled with water as breeding sites and to draw blood from millions of human victims of war whose homes were destroyed and no longer provided nighttime protection from the hungry insects.

  Rapid troop movements by air transit, coupled with massive refugee migrations, allowed the various dengue types to get into new ecospheres, carried by humans who were unaware that they were infected. Almost overnight, areas such as the Philippines, which for centuries had only a single dengue strain infecting its human and insect populations, were overrun by all four dengue types. During World War II Japanese, European, and American troops landed on Filipino soil after having been in other dengue-infested parts of Asia, such as Burma, Thailand, Indonesia, islands throughout the Pacific, and China. The soldiers carried various strains of dengue in their blood—strains that were absorbed by local Philippine A. aegypti mosquitoes.

  After a few years of circulation among humans and mosquitoes in Manila, the immune system cycle necessary for the creation of the acute hemorrhagic and shock syndrome of dengue-2 was in place. Such serial infection of one dengue type after another hadn’t been possible before World War II, Monath concluded, because few—if any—areas of Asia had endemic dengue of more than one type.

  The Korean and Vietnam wars only created further opportunities for mosquito breeding and dengue cross-fertilization. By the conclusion of the Vietnam conflict in 1975, dengues of all four types were endemic in urban centers throughout the region. The Cuban epidemic of 1981, interestingly, followed a period of intensive cooperative postwar exchange of personnel between the two countries for professional training and Vietnamese reconstruction efforts.

  By the time dengue hit Latin America in the 1960s, ecologies that were favorable to A. aegypti in Asia were also in place in the Western Hemisphere, the result of enormous tidal waves of migration into the area’s largest cities. Conditions in the favelas and slums of cities like São Paulo, Rio de Janeiro, Caracas, and Santiago were similar, from the mosquitoes’ perspectives, to those in wartime Asia. The surge in commercial air traffic throughout the world during the 1970s, Monath concluded, facilitated the spread of people whose bodies were incubating as yet asymptomatic infections of dengue-1, -2, -3, and -4. Once they arrived in the cities of Latin America and their dengue illnesses set in, these people transmitted the four dengue viruses to local mosquitoes and, eventually, to other human city dwellers.

  When dengue hemorrhagic fever broke out in the streets of Havana the viruses had become so thoroughly entrenched back in Manila that millions of cases of the disease had occurred, and epidemics—particularly among children—had become an annual feature of urban Philippine society. By 1981, as regular as clockwork, dengue arrived each year shortly after the onset of every rainy season in Manila; tens of thousands of children contracted dengue hemorrhagic fever; and 15 percent of those children died.

  It hadn’t been so before World War II. But by 1980 dengue was one of Asia’s most prevalent childhood illnesses. And would remain so.

  All things considered, Uwe Brinkmann estimated in 1981 that some 300 million residents of cities located in developing countries suffered debilitating illnesses at any given time due to chronic parasitic infections, over and above periodic viral epidemics, such as dengue. And though the costs of prevention through large-scale housing, sewage systems, potable water, insect control, and improvement in garbage collection might have seemed daunting to the governments of poor countries, Brinkmann argued that the price of doing nothing was far greater. Treatments for parasitic diseases were either extremely expensive by Third World standards—$240 for tre
atment of leishmaniasis, for example—or nonexistent. Since few such countries could afford to treat their citizens, the true price was an ever-greater trend toward urbanization of previously rural diseases and the tremendous toll they took in human life and productivity.

  Tragically, events during the 1980s would prove far worse than Brinkmann had imagined.

  10

  Distant Thunder

  SEXUALLY TRANSMITTED DISEASES

  AND INJECTING DRUG USERS

  The Snake Pit raid is one more illustration of the ugly games that straights inflict on gays, driving them underground, to be periodically chastised by the city’s conscience, driving them into self-conscious, paranoid postures, driving them finally into an up-front struggle for liberation to establish, once and for all, that gay is neither perversion nor sissy nor sick nor faggot nor silly. Gay is good.

  The Village Voice, 1970

  I

  Around midnight on Friday, June 27, 1969, Deputy Inspector Seymour Pine of the New York Police Department reviewed procedures with the men under his command in the public morals section. Under the pretense of liquor license violations, they were about to shut down a bar at 53 Christopher Street in Greenwich Village.

  It was a homosexual bar, and raids such as this had been a routine part of New York City “morals” enforcement for decades. Though rarely legal, the raids succeeded in driving out of business many establishments catering to gay men and scaring away closeted men and women who feared being identified as sexual deviants on police rap sheets.

  As they had done many times before, Pine’s undercover team got out of their unmarked cars and strolled across Christopher, past the Lion’s Head—an often wild heterosexual bar—to the Stonewall.

  With military precision the men surrounded the gay bar, Pine went inside, the management was presented with papers ordering a shutdown: routine closure of the Stonewall began. One by one the clientele were ushered out to Christopher Street, where they hammed it up playfully for the gathering crowd of Greenwich Village onlookers—hippies, gays, bohemians, the denizens of New York’s most notoriously offbeat neighborhood. The mood was calm, even playful.

  Until the fifteen paddy wagons appeared.

  Within minutes a full-scale riot was underway as the Village’s gay men fought the police, removed colleagues from custody, and declared the immediate neighborhood “Home of the Queens.” Rioting would continue throughout the weekend, often with a joyous giddiness to it.

  By Monday morning everyone involved—both rioters and police—knew something dramatic had happened. Overnight, new gay political organizations appeared, not only in New York City but in other cosmopolitan American centers, notably San Francisco and Los Angeles.1

  “The nights of Friday, June 27, 1969, and Saturday, June 28, 1969, will go down in history as the first time that thousands of homosexual men and women went out into the streets to protest the intolerable situation which has existed in New York City for many years—namely, the Mafia (or Syndicate) control of this city’s gay bars in collusion with certain elements of the Police Department of the city of New York,” declared a leaflet from a group calling itself the Homophile Youth Movement, which urged the city’s gay population to boycott mob-controlled bars and demand an end to police raids.

  Within days printed signs appeared all over the Village, stating bluntly for “gays” and “straights” alike: “Do you think homosexuals are revolting? You bet your sweet ass we are.”

  The gay liberation movement burst like champagne from a highly agitated, just uncorked magnum. The politics of the movement, for many, went no further than open, unabashed displays of their previously closeted gay sexuality. Groups of gays in New York and San Francisco stood up, however, and publicly declared not only their identity but also their right to their sexuality, and the two cities became magnets pulling longsuppressed homosexuals from the small towns of America; indeed, from all over the world.

  The cities, it seemed, had more than just economic opportunity to offer.

  A year after the “Stonewall Riots,” New York’s activist homosexuals staged a commemorative parade in Central Park. It was attended by a crowd The New York Times estimated at 20,000. The same day, 1,000 gay men marched in Los Angeles and about 100 in San Francisco.

  A wiry young Brooklyn activist named Marty Robinson mugged for a TV camera crew that day in Central Park, then changed his mood, stared defiantly into the camera, and said that the parade “serves notice on every politician in the state and nation that homosexuals are not going to hide anymore.

  No one could have imagined on that day in 1970 that a mere eight years later June 27 would be commemorated in cities all over the world as Gay Freedom Day, drawing crowds of well over 375,000 to San Francisco and tens of thousands more to the streets of Washington, D.C., Los Angeles, Miami, New York, and Chicago. There would even be small sympathy gatherings in Paris, London, Amsterdam, and Berlin. By 1978, the U.S. gay rights movement mobilized massive protest demonstrations against a former beauty queen turned spokeswoman for the far right, Anita Bryant. The outspoken, “pro-Christian” Bryant had become a leading advocate of both consumption of Florida orange juice and revocation of the hard-won civil rights recently afforded homosexuals in a few cities, notably San Francisco. The leader of San Francisco’s gay community, Harvey Milk, called upon homosexuals nationwide to come to the city for the June 27, 1978, Gay Freedom Day parade to “send a message” to Bryant and other opponents of gay rights. And they did.

  By 1978 San Francisco’s gays were a potent political force. According to the city’s noted gay chronicler Randy Shilts,2 gay immigration to San Francisco between 1969 and 1978 outstripped California’s gold rush, adding 30,000 gay men to the population. After 1979, San Francisco would attract an additional 5,000 gay migrants yearly until 1988.

  In November 1978, the U.S. gay rights movement attained that dubious notoriety offered to all grass-roots efforts whose leaders are assassinated because of their beliefs. Harvey Milk, by then the city’s first openly gay elected official—a member of the Board of Supervisors—was shot dead in his office, along with the mayor, George Moscone. The assassin was another supervisor and former police officer, Dan White, who would later get a light sentence based on his creative plea of temporary insanity, caused by the overconsumption of sweets (Hostess Twinkies). The jury’s acceptance of the so-called Twinkie defense would be interpreted by the gay community as an obscene display of homophobia.

  Milk’s murder placed the political fate of the gay rights movement in the United States solidly in the ranks of other civil rights movements. If African-Americans resented analogies between their civil rights struggles and those of homosexuals—and there were strong protests over comparisons drawn between Martin Luther King, Jr., and Harvey Milk, or between the Stonewall riot and Rosa Parks’s refusal to sit at the back of segregated buses—the sentiment had little impact on the youthful exuberance of gay activists.

  A party atmosphere pervaded the gay communities of San Francisco, New York, and, to a lesser degree, Montreal, Los Angeles, Washington, D.C., Paris, London, Berlin, and Amsterdam in the late 1970s. Night after night the gay neighborhoods filled with young men determined to make up for lost time, dancing through trysts with such haste that niceties, like partners’ names, might be overlooked.

  “I was an ecstatic slut,” Bobbi Campbell would say later of his days—and nights. A member of the Sisters of Perpetual Indulgence, a group of humorous drag queens who dressed in nun’s habits for all major San Francisco public events, Campbell, and thousands of others like him, found plenty of time to indulge in the mass revelry.

  Worldwide, the 1970s were a time of sexual liberation and experimentation for young adults—straight as well as gay—who poured into trendy metrop
olises from Nairobi to Amsterdam in search of the excitement and anonymity of urban nightlife. The birth control pill gave young women freedom from concern about unwanted pregnancy, and, for the first time in history, heterosexual exploration seemed safe. In Europe and North America it was gay men who took greatest advantage of the new climate; in developing countries, particularly in Africa, it was young heterosexuals. From London’s posh West End to downtown Abidjan the nexus of all this activity was a new sexual milieu: the disco. In bars all over the world, young adults drank or danced to electronic music, their eyes peeled for potential partners. In the often harsh, alienating atmosphere of big, unfriendly cities, discos provided instantaneous intimacy. If there was potential danger in leaving the disco with a stranger, it might only enhance the sexual allure of the adventure. And for millions of women, particularly in developing countries, this new atmosphere provided what was often the only potential source of independent income: prostitution.

  Finally, throughout the developing world new patterns of male employment appeared during the late 1970s and the 1980s. Young men, tied by marriage and family to their villages or small towns, commuted to large cities for work. They made their mass exodus every Monday morning, converging on cities like Nairobi, Harare, Bombay, Lima, and Abidjan from the countryside, stayed in flophouses or workers’ barracks until Friday night, and returned to their villages for the weekend. For many, a disco cycle set in: on city nights they might pick up a young lady—prostitute or not—but they returned on the weekends to their wives.3

  Such things had happened in cities before. During the days of Aristotle and Plato, Athens was so replete with (homo and hetero) sexual activities that even the gods had orgies. But the scale of multiple-partnering during the late twentieth century was unprecedented. With over five billion people on the planet, an ever-increasing percentage of whom were urban residents; with air travel and mass transit available to allow people from all over the world to go to the cities of their choice; with mass youth movements at their zenith, advocating, among other things, sexual freedom; with a feminist spirit alive in much of the industrialized world, promoting female sexual freedom; and with the entire planet bottom-heavy with people under twenty-five—there could be no doubt that the size and drama of this worldwide urban sexual energy was unparalleled.