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THE COMING PLAGUE by Laurie Garrett

Friday, October 24, 2014 @ 06:10 AM
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A review of THE COMING PLAGUE: NEWLY EMERGING DISEASES IN A WORLD OUT OF BALANCE by Laurie Garrett, published in 1994. Chapter 5: Yambuku – EBOLA

WHO enlisted high-security laboratories all over the world
WHO enlisted high-security laboratories all over the world. Throughout October and November 1976 blood and tissue samples from disease victims in Yambuku, Kinshasa, and Sudan were sent to laboratories in the United States (Centers for Disease Control, Atlanta), the U.K. (the Microbiological Research Establishment, Porton Down, Salisbury), Belgium (The University of Anvers and the Prince Leopold Institute of Tropical Medicine), West Germany (Bernard Nocht Institute for Naval and Tropical Diseases), and France (Special pathogens branch of the Pasteur Institute).

Sureau opened the box at his lab bench
On October 11 the Pasteur Institute’s director of overseas research, Claude Hannon, told Pierre Sureau to go to Roissy Airport to retrieve a package containing blood samples from Kinshasa, adding that he should “consider the packet’s contents dangerous.” The perilous shipment was misrouted, passing through many hands before Sureau was able to track it down. He opened the box at his lab bench, finding a note from Dr. G. Raffier of the French Embassy in Kinshasa, dated October 10, 1976.

Sureau was in Kinshasa within thirty-six hours
Sureau knew Lassa could be terribly dangerous but he had no reason to believe the suspected virus could be airborne. He placed the nine tubes in a rack atop a sterile lab table, opened the first, and dabbed a sample on filter paper. The implications of such casual behavior would be obvious a few weeks later. One of the tubes contained Sister Edmonda’s blood. Paul Brès called from Geneva saying that “the samples were highly infectious and must be studied in a maximum-security laboratory. They must be sent on immediately to the CDC in Atlanta. Don’t open them!” “Too late, Paul, I already did.” Brès instructed Sureau to repackage the tubes immediately and ship them by overnight plane to Atlanta. Then Brès asked Sureau whether he would serve as the official WHO consultant for the mysterious epidemic. He would be in Kinshasa within thirty-six hours.

An intact test tube, and another one, broken into pieces
Peter Piot was completing his virology postdoctoral research at Anvers when the first mysterious blood samples had arrived from Zaire, having heard of ‘something weird in Zaire, involving Belgian missionaries.’ An accompanying note from WHO authorities in Brazzaville indicated that yellow fever was suspected. He blithely pulled on a pair of latex gloves and without further precautions, opened the thermos to find a soup of melted ice, an illegible, water-soaked note, an intact test tube, and another one, broken into pieces, its contents mixed into the watery soup. Years later he explained that he had been “young, foolish, and fearless.”

Their folly would prove striking in retrospect
The laboratory in which this work was done had no special security or containment facilities. Their folly would prove striking in retrospect, and all concerned would later express astonishment that they suffered no ill consequences from such frivolous disregard of the potential hazards of the microbes. Indeed, three days into their research, the much older Pattyn removed a rack full of incubating infected Vero cells for examination. He tilted the rack to get a clearer look, and a tube slid out, crashing to the laboratory floor.

They were instructed to pass the samples on to higher-security laboratories
Shortly after the Belgian group’s Vero cell studies confirmed the dangers of the mysterious Zairian microbes, their government began questioning the wisdom of continuing the Antwerp research effort. They were instructed to pass the samples on to higher-security laboratories outside Belgium. Van der Gröen convinced Pattyn to save one small sample, reasoning that it should be used as a backup, in case the primary samples were damaged or lost in shipment to Porton Down.

THE COMING PLAGUE by Laurie Garrett

Thursday, October 23, 2014 @ 06:10 AM
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A review of THE COMING PLAGUE: NEWLY EMERGING DISEASES IN A WORLD OUT OF BALANCE by Laurie Garrett, published in 1994. Chapter 5: Yambuku – EBOLA

Dr. William Close immediately contacted the Centers for Disease Control in Atlanta
Dr. William Close, in Wyoming at the time, had lived sixteen years in Kinshasa, serving as personal physician to President Mobutu Sese Seko and directing a nongovernmental medical development group called Coopération Médicale Belge. Dr. Ngwété, Zaire’s Minister of Health, called to ask Close to notify American authorities, requesting assistance. Close immediately contacted the Centers for Disease Control in Atlanta, appraising the agency of the situation and formally requesting laboratory support to determine the cause of the Yambuku outbreak.

Either dead or too sick to continue tending patients
Back at the mission, more of the hospital staff contracted the disease. Now ten of the seventeen employees were either dead or too sick to continue tending patients. Following Muyembe’s parting recommendations, Sister Genoveva closed the hospital to all but the remaining dying victims of the mysterious disease. Sister Romana and Father Lootens died on October 2 1976 and the surviving Belgian missionaries were in such despair and terror that a visiting team of Kinshasa scientists found the group virtually paralyzed by anxiety.

Transport of goods and people in and out of the area came to a full stop
At Minister Ngwété’s request, a team of three medical experts had been assembled and flown to Bumba by the Zairian Air Force. From there they drove to Yambuku. Close explained the crisis to President Mobutu, who expressed concern about containing the epidemic, and put his personal Hercules C-130 transport jet at the disposal of the medical effort. He also ordered the entire Bumba Zone placed under strict isolation. All roadways, waterways, and airfields in the region were placed under martial law, and the transport of goods and people in and out of the area came to a full stop within a week. Close helped gather medical supplies, rudimentary lab equipment, and other hospital essentials from warehouses and hospitals around Kinshasa, and these were loaded aboard Mobutu’s jet and flown to Bumba.

The Sudanese accounts bore a remarkable resemblance to those from Yambuku
At about the same time, Paul Brès received word that another strange epidemic was unfolding in a town called Maridi in the grasslands of southern Sudan. Brès and other experts in the virus branch of WHO thought – from their Geneva vantage point – that the Sudanese accounts bore a remarkable resemblance to those from Yambuku. He urged Khartoum to immediately send blood and tissue samples from Maridi patients.

It was no simple matter for a doctor
It was no simple matter for a doctor in Khartoum to make his way to Sudan’s southernmost provinces, to gather blood samples, store the precious fluids in containers that would protect their contents from the intense desert heat, and make his way back to Khartoum. The people in the three most southerly provinces lived and believed as they had since before the Nubians were enslaved by Egypt’s Pharaohs. Speaking a variety of ancient Bantu languages, the southerners lived in small, temporary villages, were often nomadic, had a high rate of illiteracy, and could not be expected to be found in any particular locale at any specific time. In addition to the usual – and monumental – logistic obstacles to such a trek, whoever went faced the even more towering blockade of politics. In 1969 Sudan had a military coup d’état.

Their greatest fear was that the epidemics of Yambuku and Maridi were one and the same
Brès and other Geneva officials insisted on pushing past the political obstacles to discover what was going on in Maridi. Their greatest fear was that the epidemics of Yambuku and Maridi were one and the same, representing a vast super-lethal disaster spanning an area of about 1,000 square miles in at least two nations. Blood samples, collected in Maridi and shipped over several days’ time to Khartoum, finally reached Geneva. They were in poor condition, but WHO immediately sent them on for analysis in laboratories in the United States and the U.K.

THECOMING PLAGUE by Laurie Garrett

Wednesday, October 22, 2014 @ 06:10 AM
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A review of THE COMING PLAGUE: NEWLY EMERGING DISEASES IN A WORLD OUT OF BALANCE by Laurie Garrett, published in 1994. Chapter 5: Yambuku – EBOLA

Yombe Ngongo was fighting for her life at home
Yombe Ngongo had checked out on August 30, 1976 and was now fighting for her life at home, in the village of Yamisakolo, tended by her anxious nine-year-old sister, Euza, feeling her own first symptoms of headache and fever.

They could only guess what might be causing such horrendous things to happen
Though Sebo Dombe was recovering nicely from his hernia operation and the pair had returned home, Sebo was semi-delirious, hemorrhaging blood. As was Lizenge Embale, who had returned to her home in Yaekenga in the beginning of September but was now struggling to stay alive. At her side, vomiting blood and bleeding from his eyes, was her husband, Ekombe Mongwa. The Sisters knew only of Antoine’s case, and they did everything they could to save their friend, although they could only guess what might be causing such horrendous things to happen to a human body.

They died
Nothing worked. On September 8, Mabalo (Antoine) Lokela died. Unbeknownst to the Sisters, Yombe Ngongo died the day before in her village home. On September 9, her little sister, Euza, succumbed. That week Lizenge Embale and her husband, Ekombe, died in the hut in Yaekenga – again the Sisters didn’t know.

His body was readied for burial by evacuating all food and excreta
Antoine’s funeral was well attended and, as was customary, his body was readied for burial by evacuating all food and excreta, a procedure that was generally performed by bare-handed women. In a matter of days Antoine’s mother, Gizi and Sophie were suffering the same ghastly disease. Sophie and Gizi survived, but Antoine’s mother died on September 20, as did his mother-in-law, Ngbua, who had assisted in the funeral preparations. Though Sophie survived those hellish September days, her baby was stillborn – another hemorrhagic victim. In all, twenty-one of Antoine’s friends and family members got the disease; eighteen died.

Panic spread
Soon the hospital was full of people suffering with the new symptoms. Panic spread as village elders spoke of an illness, unlike anything ever seen before, that made people bleed to death. In Yambuku the Sisters were already close to the breaking point, not knowing the why, what, or how of the new disease. The horror was magnified by the behavior of the many patients whose minds seemed to snap. Word, and the disease, spread quickly to villages throughout the Bumba Zone. In some, the huts of the infected were burned by hysterical neighbors.

A horror that shook the provincial physician to his very soul
On September 12, 1976 Sister Béata developed the sudden fever, muscle aches, nausea, diarrhea, and bleeding gums that she and her fellow nurses now recognized only too well. Sisters Myriam and Edmonda prayed for a miracle and radioed urgent pleas for assistance. Bumba Zone medical director Dr. Ngoi Musshola scoured the city of Bumba for petrol, finally arranging transport across the roughly fifty miles to Yambuku on September 15. What greeted Ngoi upon arrival was a horror that shook the provincial physician to his very soul. With great care he gathered as much clinical information as possible, and on September 17 rushed back to Bumba in order to cable his report to authorities in Kinshasa.

Ngoi’s report
Ngoi’s report described the first case, that of Mabalo Lokela, and then listed twenty-six cases of the strange illness, giving the names of the patients, noting that fourteen had died, ten were still sick, and four had fled the hospital in terror, their whereabouts now unknown. Eerily, Ngoi corrected his report just before sending it to Kinshasa to note that two individuals on his ‘ailing’ list had died by the time he reached Bumba. He listed the treatments tried without success and noted that the hospital had used all its antibiotic supplies. Warning that “there is already panic” in all the villages, Ngoi requested assistance from Kinshasa authorities.

The first historic description of a new disease
He left Yambuku having recommended that the Sisters take three measures immediately: Hospitalize the cases; Use public cemeteries; Boil potable water. What Ngoi had written, though he did not know it at the time, was the first historic description of a new disease. In clear, succinct, and, as time would show, largely accurate terms, Ngoi had described what would prove to be the second most lethal disease of the 20th century.

A hasty retreat from Yambuku after just twenty-four hours
On September 19 Sister Béata died. The same day reports came into the mission of illnesses and deaths from the bizarre bleeding disease in over forty villages. By now, there was real danger of a mass exodus of hysterical villagers fleeing to nearby zones – and taking the disease with them. Through the missionary radio relay system, the Sisters sent more urgent pleas for assistance. Federal authorities dispatched two professors from the National University of Zaire to Yambuku. They reached the mission on September 23, intending to conduct a six-day study of the problem, but cut their visit short and beat a hasty retreat from Yambuku after just twenty-four hours.

When they performed autopsies, they were aghast at the extensive damage inflicted by the disease
The professors first focused on a small child who was writhing in agony in a hospital crib. While they discussed what might be done, the child died before their eyes. The academics were shaken from their intellectualizing, and immediately set to work collecting blood and tissue samples from patients and cadavers, interviewing ailing patients and reviewing their medical charts. As the professors commenced their research, Sister Myriam, who had nursed Sister Béata, was suddenly overcome by piercing headaches and fever. The fear among mission staff was contagious. Unfortunately, the academics hadn’t taken Ngoi’s field report seriously, and brought no protective gloves, masks, or gowns for their use during procedures that put them in contact with infected blood. When they performed autopsies, they were aghast at the extensive damage inflicted by the disease, and removed liver samples to send to sophisticated laboratories for further analysis. On September 30, Sister Myriam died in the Kinshasa hospital.

THE COMING PLAGUE by Laurie Garrett

Friday, October 17, 2014 @ 07:10 AM
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A review of THE COMING PLAGUE: NEWLY EMERGING DISEASES IN A WORLD OUT OF BALANCE by Laurie Garrett, published in 1994. Chapter 5: Yambuku – EBOLA

Sure, he had a fever, but it was undoubtedly just the malaria again
Mabalo Lokela (whom friends called Antoine) was in great mood. Sure, he had a fever, but it was undoubtedly just the malaria again. The important thing was that he was back from a great vacation – one of the few he’d had in his forty-four years. While he waited for one of the Sisters to give him malaria medicine, Mabalo shared with his colleagues at the Yambuku mission stories of his recent travels. When he got back to Yambuku he bought some fresh antelope meat in the market and his wife, Mbuzu Sophie, who was eight months pregnant, made a stew for a family celebration.

He was never seen again
Two days later, on August 28, 1976, a thirty-year-old man came to the Yambuku Mission Hospital complaining of terrible diarrhea. Though nobody at the mission recognized the man, he told the Sisters that he came from the nearby village of Yandongi. The case of the man from Yandongi was odd and Sisters Béata, Edmonda, and Myriam weren’t sure of the source of his illness. They put the man in one of the 120 beds and, for two days, debated his diagnosis. After two days the man left the hospital against the Sisters’ wishes, his diarrhea and epistaxis, or severe nosebleed, still unresolved. He was never seen again, though events days after his disappearance would prompt dozens of investigators from all over the world to scour villages throughout the Bumba Zone in search of the elusive patient.

There was no doctor in Yambuku
Since 1935 the major hospital and dispensary for some 60,000 villagers living in the central Bumba Zone was that operated by Belgian Catholic missionaries in the village of Yambuku. A staff of seventeen ‘nurses’ – so designated, though none of the Sisters had attended a certified nursing school – and medical assistants tended to the health needs of the community. There was no doctor in Yambuku.

His temperature soared over 100°F
Antoine spent days on end at the mission so it was natural that he returned to the Sisters on September 1, 1976 when, despite the quinine injection, his temperature soared over 100°F. They checked his vital signs and told Antoine to rest for a few days, where Sophie tended to him.

Yombe Ngongo, Lizenge Embale, Ekombe Mongwa, Angi Dobola and Sebo Dombe
At the same time as Antoine was awaiting his chloroquinine shot, sixteen-year-old Yombe Ngongo lay in Yambuku Hospital undergoing transfusions to counter her severe anemia. Nearby, twenty-five-year-old Lizenge Embale was recuperating from what seemed to be malaria, tended by her husband, Ekombe Mongwa. Angi Dobola was recovering from hernia surgery, watched closely by his wife, Sebo Dombe, who complained to the Sisters of exhaustion.

On September 5 Antoine returned to the mission critically ill
On September 5 Antoine returned to the mission critically ill. He was vomiting and had acute diarrhea, leaving him so dehydrated that he had ‘ghost eyes’. His chest hurt, he had a terrible headache, fevers continued, he was deeply agitated and confused. His nose bled, his gums bled, and there was blood in his diarrhea and vomitus.

THE COMING PLAGUE BY LAURIE GARRETT

Thursday, October 16, 2014 @ 04:10 PM
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The hypocrisies, cruelties, failings, and inadequacies of humanity’s sacred institutions
At the macro level a sense of global interconnectedness was developing over such issues as economic justice and development, environmental preservation, and, in a few instances, regulation. However, it wasn’t until the emergence of the human immunodeficiency virus, that the limits of, and imperatives for, globalization of health became obvious in a context larger than mass vaccination and diarrhea control programs. Through the AIDS prism it was possible for the world’s public health experts to witness what they considered to be the hypocrisies, cruelties, failings, and inadequacies of humanity’s sacred institutions, including its medical establishment, science, organized religion, systems of justice, the United nations, and individual government systems of all political stripes.

HIV, far from representing a public health aberration, may be a sign of things to come
Over the last five years, scientists – particularly in the United States and France – have voiced concern that HIV, far from representing a public health aberration, may be a sign of things to come. They warn that humanity has learned little about preparedness and response to new microbes, despite the blatant tragedy of AIDS. And they call for recognition of the ways in which changes at the micro level of thee environment of any nation can affect life at the global, macro level.

An ever-changing ecology we cannot see, but, nonetheless, by which we are constantly affected
In this book I explore the recent history of disease emergence, examining in roughly chronological order examples that highlight reasons for microbial epidemics and the ways humans respond, as cultures, scientists, physicians, bureaucrats, politicians, and religious leaders. This book also examines the biology of evolution at microbial level, looking closely at ways in which disease agents and their vectors are adapting to counter defensive weapons used to protect human beings. In addition, The Coming Plague looks at means by which humans are actually aiding and abetting the microbes through ill-planned development schemes, misguided medicine, errant public health, and shortsighted political action/inaction. Finally, some solutions are offered. What is required, overall, is a new paradigm in the way people think about disease. As Harvard University’s Dick Levins puts it, “We must embrace complexity, seek ways to describe and comprehend an ever-changing ecology we cannot see, but, nonetheless, by which we are constantly affected.”

Perspectives must be forged that meld many disparate fields
Preparedness demands understanding. To comprehend the interactions between Homo sapiens and the vast and diverse microbial world, perspectives must be forged that meld such disparate fields as medicine, environmentalism, public health, basic ecology, primate biology, human behavior, economic development, cultural anthropology, human rights law, entomology, parasitology, virology, bacteriology, evolutionary biology, and epidemiology.