The Coming Plague

The Coming Plague Page 99

by Laurie Garrett

  15 Very detailed renditions of these events can be found in John Fuller’s Fever and John Frame’s “The Story of Lassa Fever. Part II: Learning More About the Disease.” Both are cited above.

  16 G. M. Edington, and H. A. White, “The Pathology of Lassa Fever,” Transactions of the Royal Society of Tropical Medicine and Hygiene 66 (1972): 381–401.

  17 J. M. Troup et al., “An Outbreak of Lassa Fever on the Jos Plateau, Nigeria, in January-February, 1970,” American Journal of Tropical Medicine and Hygiene 19 (1970): 695–96.

  18 D. E. Carey et al., “Lassa Fever—Epidemiological Aspects of the 1970 Epidemic, Jos, Nigeria,” Transactions of the Royal Society of Tropical Medicine and Hygiene 66 (1972): 402–8.

  19 B. E. Henderson et al., “Lassa Fever: Virological and Serological Studies,” Transactions of the Royal Society of Tropical Medicine and Hygiene 66 (1972): 409–16.

  20 D. Cummins et al., “Acute Sensorineural Deafness in Lassa Fever,” Journal of the American Medical Association 264 (1990): 2093–96; L. P. Ryback, “Deafness Associated with Lassa Fever,” Journal of the American Medical Association 264 (1990): 2119; J. D. Frame, “Clinical Features of Lassa Fever in Liberia,” Review of Infectious Diseases 11, Suppl. 4 (1989): s783–s789; and J. B. McCormick et al., “A Case-Control Study of the Clinical Diagnosis and Course of Lassa Fever,” Journal of Infectious Diseases 155 (1987): 445–55.

  21 J. B. Dibble, Outlaw for God (Hanover, MA: Christopher Publishing House, 1992).

  22 Frame (1992), Part III, op. cit.

  23 It is unfortunate that in historic outbreaks, such as this one, the names of non-Western disease victims and medical staff often go unrecorded in published literature. Whenever possible, the author has endeavored to include such names.

  24 P. E. Mertens et al., “Clinical Presentation of Lassa Fever Cases During the Hospital Epidemic at Zorzor, Liberia, March-April 1972,” American Journal of Tropical Medicine and Hygiene 22 (1973): 780–84.

  25 Ibid.

  26 The team’s predictions proved quite accurate. Lassa is now known to be endemic to many regions of Liberia, and treatment of the disease had, prior to its most recent civil war, become a nearly routine feature of the country’s medicine.

  27 In 1867 English physician Lister revolutionized medicine by publishing and promoting details on sterile hospital practices. Prior to Lister, patients were extremely likely to die of bacterial infections following surgery.

  28 T. P. Monath et al., “Lassa Virus Isolation from Mastomys natalensis Rodents During an Epidemic in Sierra Leone,” Science 185 (1974): 263–65.

  29 D. W. Fraser et al., “Lassa Fever in the Eastern Province of Sierra Leone, 1970–1972. I: Epidemiological Studies,” American Journal of Tropical Medicine and Hygiene 23 (1974): 1131–39; and T. P. Monath et al., “Lassa Fever in the Eastern Province of Sierra Leone, 1970–1972. II: Clinical Observations and Virological Studies on Selected Hospital Cases,” American Journal of Tropical Medicine and Hygiene 23 (1974): 1140–49.

  30 Monath et al. (1974), “Lassa Fever in the Eastern Province.”

  31 Nevertheless, Casals and Pinneo both donated blood countless times over subsequent years, and CDC antisera made from their plasma undoubtedly saved many lives, particularly in Nigeria. Nigerian physicians and nurses who survived Lassa fever also generously donated their blood over the years, providing a steady supply of antiserum specific to the Jos strain.

  32 Upper Volta is now called Burkina Faso.

  33 J. D. Frame, “Surveillance of Lassa Fever in Missionaries Stationed in West Africa,” Bulletin of the World Health Organization 52 (1975): 593–98.

  34 The April 9, 1974, edition of the New Nigerian, published out of Lagos, carried a headline: “How Alien Tried to Spread Killer Disease—Lassa Epidemic Narrowly Avoided.”

  35 Diepahtzer Nachrichter, March 18, 1974: 1.

  36 “This Doctor Risks His Life for a Deadly III Patient,” Bild Zeitung, March 18, 1974.

  37 This is the same Dr. Lehmann-Gruber described in Chapter 3 as playing a key role in the battle against the Marburg virus.

  38 “Is the Fever Physician Dangerous for Us?” Bild-Hamburg, March 22, 1974.

  39 “U.S. Foreign Minister Kissinger Will Save the Courageous Fever Doctor from Hamburg,” Bild Zeitung, March 19, 1974.

  40 Had Monath’s final conclusions on the Sierra Leone outbreak been published before these events took place, the group’s fears might have eased. Monath and Casals found that the terrifying fatality rates seen in the hospital outbreaks of Jos and Zorzor were atypical. About half of all infected people in those cases died. But surveys of the Sierra Leone villages showed that most people survived the disease: only 5 percent of those who were infected by inhaling the virus from another person or rat feces/urine developed fatal disease. Monath was convinced direct blood-to-blood exposure to the virus was more dangerous, and might account for the far higher death rates in hospital settings.

  41 K. Muller, “Flug in einer Plastikfolie,” Welt, March 22, 1974.

  42 “Ghostly Arrival,” Hamburger Abendblatt, March 22, 1974.

  43 Hamburger Morgenpost, March 19, 1974: 1.

  44 H. Nannen, “One Can See How One May Err,” Stern, March 28, 1974: 3.

  45 New Nigerian (1974), op. cit. Years later the Nigerian government and press positions concerning Lassa would change, as outbreaks of the disease continued. Though there would continue to be regret that the virus had been named after a Nigerian town, the press and government would no longer claim the disease was carried by foreigners. For good examples of later Nigerian press accounts, see A. Adenmosum, “The Lassa-Fever Scourge,” Pharmacy World Journal 6 (1989): 95; and U. Fabian, “Combating Lassa Fever,” Daily Sketch, February 23, 1993: 5.

  5. Yambuku

  1 In addition to interviews, the author drew generally from the following written materials: P. Sureau, Yambuku (1992), unpublished; and S. R. Pattyn, Ebola Virus Haemorrhagic Fever (Amsterdam: Elsevier Press, 1978).

  2 International Commission, “Ebola Haemorrhagic Fever in Zaire, 1976,” Bulletin of the World Health Organization 56 (1978): 271–93.

  3 R. D. Estes, The Behavior Guide to African Mammals (Berkeley: University of California Press, 1991).

  4 The Belgian Catholic missionaries who worked in the Yambuku Mission Hospital were:

  Sister Béata (Jeanne Vertommen, age 42)

  Sister Myriam (Louise Ecran, age 42)

  Sister Edmonda (Jeanne DeRoover, age 56)

  Sister Romana (Angeline Geerts, age 54)

  Father Germain Lootens (age 67)

  In addition to the Belgians employed in hospital work, there were in Yambuku:

  Sister Genoveva (Annie Ghysebrechts)

  Sister Mariette (Mariette Witrouwen)

  Mother Superior Aloydis (Bumba Zone)

  Sister Marcella (Julienne Ronsmans)

  Father Carlos Rommel (district head for Bumba Zone)

  Father Germain Moke (Bumba Zone)

  Brother Adolphe Litepu

  Father Augustin Siegers (superior for Yambuku)

  Father Léon Claes (aka “Père Dubois”)

  The Zairian staff included seven male nurse assistants:

  Amane Ehumba (age 26)

  Anangi Mabelesama (age 25)

  Mgwanga Magbuka (age 30)

  Ambaya Mandu (age 30)

  Sukato Manzomba (age 24)

  Magbo Mazebele (age 35)

  Masangaya Alola (age 40)

  5 It was common for people to bury their dead inside the village, even under the clay floor of their houses. Ngoi feared such practices could spread the disease.

  6 Untreated rabies ranks as number one: it is 100 percent fatal. Many experts bel
ieve HIV/AIDS has a lethality that approaches 100 percent, but, because of the extremely protracted course of HIV disease and the difficulty in knowing how many people are asymptomatic HIV carriers, it is impossible to say with certainty what percentage of HIV cases are fatal.

  7 Dr. Close’s daughter, the movie actress Glenn Close, reportedly hopes to make a Hollywood film based on the Zairian disease story. William Close has written a novelized version of these events, entitled Yambuku: A Novel. It is, as yet, published only in Dutch. The author also drew comments from W. T. Close, “A Medical Perspective from Africa and the Rocky Mountains,” presentation to the University of California Medical School at Davis, 1993.

  8 World Health Organization, “Viral Haemorrhagic Fever,” Weekly Epidemiological Report 52 (1977): 177–84; and WHO Expert Committee, “Viral Haemorrhagic Fevers,” Technological Report Series (1985), No. 721.

  9 Isolated by Guido van der Gröen and Peter Piot.

  10 Translated from the French by the author.

  11 CDC memo, October 14, 1976, signed by Karl Johnson and issued on that date internally; several days later sent to WHO in Geneva and the U.S. Embassy in Kinshasa.

  12 G. A. Martini and R. Siegert, Marburg Virus Disease (Frankfurt: Springer Verlag, 1971).

  13 Despite deliberate attempts to render press accounts banal, some reports swung hyperbolically in the opposite direction. The October 28 issue of L’Express claimed: “Huit cents morts en un mois au Soudan. Responsable: le virus de Marburg. Un des trois cents ‘arbovirus’ de l’Afrique Centrale contre lesquelle la médecine n’a pas d’armes.” And the highly exaggerated account concluded by asking:

  “Que se passera-t-il le jour ou des voyageurs commenceront à exporter la virus? D’ores et déjà , l’Afrique du Sud a annonce que des mesures sanitaires impitoyables ont été prises aux frontières. Mais l’extension des transports aériens permet-elle de contrôler efficacement l‘état de santé de tous les voyageurs circulant dans les regions infestées par ces maladies méconnues, venues du fond des temps? La civilisation industrielle a commence d’unifier la planète. Les philosophes s’en rejouissent autant que les hommes d’affaires. Les medecins, eux, ne cachent pas qu‘ils y a aussi des raisons de s’inquieter.”

  14 To this day members of the CDC team refuse to name the American individual. As McCormick puts it, “You can’t blame a guy for being scared as hell. And I respect that he had the guts to be honest about it. It would have been a lot worse if he tried to be macho about it and came to Zaire, and then was an impediment to our work because he was so frightened that we couldn’t count on him.”

  15 The species gathered for analysis in the Yambuku area were:

  Bedbugs, Cimex hemipterus 818 samples

  Mosquitoes, Culex cinereus 8

  Culex pipiens 2

  Mansonia africana 5

  Pigs, domestic 10

  Cows, domestic 1

  Bats, species unidentified 7

  Rodents, Mastomys 69

  Rattus rattus 30

  Squirrels 8

  Monkeys, Cercopithecus 6

  Duikers, Cephalophus monticola 2

  None of the samples was infected with the Ebola virus.

  16 That day Sureau summarized his feelings after a month in the eye of the epidemic storm. “There it is, the virus responsible for the Yambuku hemorrhagic fever is baptized: ‘Ebola’! I would have preferred ‘Yambuku’ but Karl prefers to give the names of rivers where the virus is discovered: he called ‘Machupo’ after the name of a nearby river, the virus that caused hemorrhagic fever in Bolivia … . But no matter; we don’t ask genius to be right; we ask it to be provocative,” Sureau wrote in his diary.

  17 A clinical account of Platt’s case appears in: R. T. D. Emond, et al., “A Case of Ebola Virus Infection,” British Medical Journal 2 (1977): 541–44.

  18 “The disease was hitherto unknown to the people of the affected region. Intensive search for cases in the area of northeastern Zaire between the Bumba Zone and the Sudan frontier near N‘zara and Maridi failed to detect definite evidence of a link between an epidemic of the disease in that country and the outbreak near Bumba. Nevertheless, it was established that people can and do make the trip between N’zara and Bumba in not more than four days: thus it was regarded as quite possible that an infected person had travelled from Sudan to Yambuku and transferred the virus to a needle of the hospital while receiving an infection at the outpatient clinic,” stated the official report of an International Commission. See World Health Organization, “Ebola Haemorrhagic Fever in Zaire, 1976” (1978), op. cit.

  19 N. J. Cox, J. B. McCormick, K. M. Johnson, and M. P. Kiley,”Evidence for Two Subtypes of Ebola Virus Based on Oligonucleotide Mapping of RNA,” Journal of Infectious Diseases 147 (1983): 272–75.

  20 J. G. Breman et al.,”Human Monkeypox Update 1970–79,” Bulletin of the World Health Organization 58 (1980): 849–68.

  21 I. Arita et al.,”Human Monkeypox: A Newly Emerged Orthopoxvirus Zoonosis in the Tropical Rain Forests of Africa,” American Journal of Tropical Medicine 34 (1985): 781–89.

  22 Z. Jezek et al.,”Human Monkeypox: A Study of 2,510 Contacts of 214 Patients,” Journal of Infectious Diseases 154 (1986): 551–55.

  23 L. Khodakevich, Z. Jezek, and D. Messinger,”Monkeypox Virus: Ecology and Public Health Significance,” Bulletin of the World Health Organization 66 (1988): 747–52.

  24 P. E. M. Fine et al.,”The Transmission Potential of Monkeypox Virus in Human Populations,” International Journal of Epidemiology 17 (1988): 643–50.

  25 World Health Organization, Weekly Epidemiologic Record (1977), op. cit.

  26 WHO Expert Committee, “Viral Haemorrhagic Fevers,” WHO Technical Report Series 721 (1985).

  27 International Commission (1978), op. cit.

  28 The brief official CDC summaries of Yambuku and Maridi events appeared in the agency’s Morbidity and Mortality Weekly Report: October 15, 1976 (p. 324); October 26, 1976 (p. 339); November 5, 1976 (p. 342); December 3, 1976 (pp. 378–79); and July 1, 1977 (pp. 209–10).

  6. The American Bicentennial

  1 A great deal has been written about the Swine Flu crisis of 1976, and though interpretations of events differ markedly, the basic facts are fairly consistent. Key sources of such information include: P. M. Boffey, “Anatomy of a Decision: How the Nation Declared War on Swine Flu,” Science 192 (1976): 636–41; P. M. Boffey, “Swine Flu Vaccination Campaign: The Scientific Controversy Mounts,” Science 193 (1976): 559–63; P. M. Boffey, “Swine Flu Vaccine: A Component Is Missing,” Science 193 (1976): 1224–25; P. M. Boffey, “Guillain–Barré: Rare Disease Paralyzes Swine Flu Campaign,” Science 195 (1976): 155–59; W. Dowdle and J. LaPatra, Informed Consent: Influenza Facts and Myths (Chicago: Nelson–Hall, 1983); General Accounting Office, The Swine Flu Program: An Unprecedented Venture in Preventive Medicine, report to the U.S. Congress, Washington, D.C., 1977; R. M. Henig, “Flu Pandemic, a Once and Future Menace,” The New York Times Magazine, November 29, 1992: 28–31, 55–67; R. M. Henig, “The Emergence of a New Flu,” Chapter 7 in R. M. Henig, A Dancing Matrix (New York: Alfred A. Knopf, 1993); R. E. Neustadt and H. V. Fineberg, The Swine Flu Affair: Decision-Making on a Slippery Slope (Washington, D.C.: U.S. Department of Health, Education, and Welfare, 1978); R. E. Neustadt and H. V. Fineberg, The Epidemic That Never Was: Policy-Making and the Swine Flu Affair (New York: Random House, 1982); J. E. Osborn, ed., “Influenza in America 1918–1976 (New York: Prodist, 1977); A. M. Silverstein, Pure Politics and Impure Science: The Swine Flu Affair (Baltimore: Johns Hopkins University Press, 1981); and
Swine Flu Supplement, Journal of Infectious Diseases 136 (December 1977).

  2 According to base officials, windchills at Fort Dix during January 1976 ranged from 0°F to - 45°F, and snowfall was heavy and frequent.

  3 Centers for Disease Control,”Current Trends: Influenza—United States,” Morbidity and Mortality Weekly Report 25 (1976): 47–48.

  4 W. I. B. Beveridge,”The Chronicle of Influenza Epidemics,” History and Philosophy of Life Sciences 13 (1991): 223–35.

  Influenza is an ancient microbe that has appeared in millions of different forms over the millennia, periodically producing devastating epidemics. Some outbreaks caused debilitating illnesses in well over half the populations of vast areas, such as all of continental Europe. Only a few epidemics are thought to have also produced mass mortality, claiming the lives of over 5 percent of those infected with the influenza virus. A rough estimate of historic pandemics follows:

 

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