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THE COMING PLAGUE by Laurie Garrett

Tuesday, October 28, 2014 @ 08:10 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

The disease was claiming residents of at least forty-four villages in a fifty-mile radius around Yambuku
After a three-hour flight the jet landed on Bumba’s tiny airstrip. The terrified Air Force pilots left the engines running while supplies were unloaded and left immediately. The next morning the group looked in on a handful of mystery disease patients at the Bumba hospital and met Dr. Massamba Matondo who told Sureau that the disease was claiming residents of at least forty-four villages in a fifty-mile radius around Yambuku. Sister Marcella, who had been keeping logs of the dead, presented her grim lists to Sureau. In the past month 38 of the 300 residents and employees of Yambuku had died. The visitors realized that they would have to go to every village, conducting a house-to-house investigation. No other approach would do.

Joe McCormick was needed at Ngaliema Hospital
Mayinga lost consciousness and commission members argued about contingency procedures for handling infected team members. Joe McCormick had just started unpacking his hundreds of crates of laboratory supplies for Lassa research when he received a cable from the CDC in Atlanta, instructing him to temporarily abandon the lab outside Kenema, Sierra Leone, and make his way as quickly as possible to Kinshasa, taking the portable glove-box he and Johnson had rigged up in Atlanta just weeks earlier, and other equipment that was needed at Ngaliema Hospital for testing and screening blood samples and preparing antisera against the mysterious disease.

He bluffed, bullied, and bribed his way
Just a few months earlier, having heard of McCormick’s exploits in Brazil, Johnson said to him “I’d like to send you to Sierra Leone to figure out just how widespread Lassa really is.” So in March 1976 he packed and prepared to set up a one-man Lassa research station in Sierra Leone. McCormick knew there was no easy way to get from Freetown, Sierra Leone, to Kinshasa and for three days he bluffed, bullied, and bribed his way into airplanes and through customs in Freetown, Abidjan, and, finally, Kinshasa.

The people had taken remarkably wise measures to stop the epidemic’s spread
“We must limit the numbers of us who are exposed to this virus until we determine how infectious it is,” Sureau told the group, instructing that only he and Piot should draw blood. A working pattern developed that was repeated in ten villages that day. Everywhere the group went they noticed the people had taken remarkably wise measures to stop the epidemic’s spread. Virtually all traffic on the Ebola and Zaire rivers had come to a halt, the ailing villagers and their families were kept under quarantine, bodies were buried some distance away from the houses, and there was little movement of people between communities.

As he released the tourniquet the husband let out a deep groan and died
In one village about ten miles from Yambuku, Piot and Sureau found a husband and wife lying side by side in their hut, both in the final throes of the disease. Pierre took blood from the husband while Peter prepared the wife’s arm. As he released the tourniquet and watched blood slowly fill the tube, the husband let out a deep groan and died. The wife cried out, Sureau quickly withdrew his needle, and she rolled over to embrace her dead husband. They had no idea whether their modest precautions were adequate to protect them from what they now understood first hand was a particularly horrible disease.

Mayinga died late the night of October 20, 1976
When the team members reunited at the mission after their first long and emotionally exhausting day in the villages, they compared notes and agreed that the epidemic had taken a terrible toll – in some cases claiming entire families. It would require the best their collective talents could muster to solve the mysteries of where the strange virus came from, how it was spread, and how best to prevent its resurgence. A day-old radio communication reached them from Kinshasa, via Bumba. “Mayinga died late the night of October 20.” Sureau was devastated, as were the Sisters, who felt profound gratitude for the student nurse’s courage in tending to Sisters Edmonda and Myriam. “ What we are dealing with is a virus like Marburg, but more pathogenic. A super-Marburg. The incubation time is usually eight days. How many more victims will there be in the villages? What can be done to stop this epidemic?” Sureau asked.

46 villages were affected, with over 350 deaths
Breman had been on the phone with Pat Webb at least twice a day for the three weeks prior to his arrival in Kinshasa. He knew precisely what Webb had discovered, and he carried with him microscope photos of the enemy. That night, Sureau radioed Bumba to tell Kinshasa that first surveys showed 46 villages were affected, with over 350 deaths. It broke Breman’s heart to watch the nuns ‘communicate’ with their ancient ham radio equipment, and listen through horrendous static for the voice of the monsignor in Lisala, ordering supplies and sharing information.

THE COMING PLAGUE by Laurie Garrett

Monday, October 27, 2014 @ 06:10 AM
posted by admin

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

Logistical nightmares aggravated by national panic
The snowball effect began modestly enough on October 13, 1976 with Pierre Sureau’s arrival in Kinshasa, representing WHO with the task of assisting Zairian authorities in any way possible. It would be several days before transport to Yambuku could be arranged. Such delays were to become a major component of this investigation, one that was constantly plagued not only by the mysterious virus but also by logistical nightmares aggravated by national panic. All commercial flights to Bumba had ceased as a result of the regional quarantine. That left only Zairian Air Force transport to the region, but terrified pilots were rebelling against orders to enter the Bumba Zone.

“My God!” Sureau exclaimed. “That virus is fast!”
Having nursed her dear friend Sister Myriam, Sister Edmonda now lay dying in Ngaliema Hospital’s isolation ward. Sureau found her semi-delirious, severely dehydrated from days of diarrhea, feeble, anorexic, feverish, completely drained of energy; yet, surprisingly, unafraid. Sureau took a blood sample and departed. That night Sister Edmonda died. “My God!” Sureau exclaimed. “That virus is fast!”

A new patient had arrived
The following morning, October 14, Sureau returned to discover a new patient had arrived. Student nurse Mayinga N’Seka, who had attended both Sister Myriam and Sister Edmonda, was developing the first symptoms of the mysterious disease. Two days earlier, Mayinga had spent hours in a general administrative office awaiting transit papers for overseas study, where she had contact with numerous strangers and officials. She then took a taxi to Mama Yemo Hospital, where she sat in a crowded room, waiting for someone to treat her fever, headache, and muscle pains. Sureau and Ngaliema doctors quickly determined that Mayinga had the Yambuku disease, and transferred her to Ngaliema’s Pavilion 5 isolation ward. Concern and rumors started to spread through the streets of Kinshasa.

Dr. Margaretha Isaacson flew up from Johannesburg, Marburg antiserum in hand
WHO remained convinced the culprit could still be a strain of Marburg disease so Sureau and Close contacted the South African team that had treated the Australian tourists a year earlier and Dr. Margaretha Isaacson flew up from Johannesburg, Marburg antiserum in hand. The Zairian medical staff, which had been in a state of extreme agitation ever since their colleague fell ill, was thrilled to see the ‘space suits’ brought from South Africa.

Endangering the 2 million residents of the capital
They were far less enthusiastic that the entire Pavilion 5 staff be placed under quarantine to prevent the possible spread of the Yambuku virus from Ngaliema Hospital into the streets of Kinshasa, endangering the 2 million residents of the capital. For nearly a month, a half dozen staff members would be confined to Pavilion 5 and 2, forbidden to leave the confines of the area to see their families.

No further cases of Yambuku disease would develop in Kinshasa
Officials tracked down 37 people with whom Mayinga had shared meals or close contact in the days prior to her illness, placing all the unfortunate men, women and children inside Pavilion 2 for twenty-one days of quarantine. In addition, 274 people who had had recent contact with the Pavilion-bound individuals were found, blood-tested, and kept under close surveillance. Fortunately, no further cases of Yambuku disease would develop in Kinshasa. Sureau never wore a mask, and often spent long periods of time at Mayinga’s bedside, whose condition worsened the next day.

Johnson reminded the group that the virus was extraordinarily dangerous
On October 18, six weeks after the Yambuku epidemic began, the core of what would that day be dubbed the International Commission arrived with enormous crates of sophisticated equipment. Now a middle-aged veteran of dozens of CDC investigations, Johnson inspired confidence in the men around him. In coming weeks this core group would guide nearly all Yambuku-related activities, operating in several languages, crossing often difficult political and cultural boundaries. Johnson reminded the group that the virus was extraordinarily dangerous, ordered everyone to take their temperature twice a day, follow to the letter Isaacson’s recommendations for protection, and always work in teams.

THE COMING PLAGUE by Laurie Garrett

Sunday, October 26, 2014 @ 07:10 PM
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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

The greatest risks to the scientists were accidents
Harder still was the animal work. To find a mysterious microbe, it was necessary to inject samples into mice, guinea pigs, hamsters, and monkeys, all of which were also kept in large glove boxes. The animals didn’t sit still in the grasp of bulky gloved hands, and injections were often a test of wills between scientist and guinea pig. In such a setting the greatest risks to the scientists were accidents, such as cutting oneself with a broken contaminated test tube or receiving an animal bite. Webb had never cut herself, but she had been bitten several times by monkeys that attacked her approaching gloved hands. Fortunately, these monkeys were part of Webb’s Machupo research, and, having already suffered the disease, she was immune.

The excitement and fear surrounding the Zaire outbreak
These Zairian samples, however, tested negative for Machupo, and Webb was acutely aware of the need to work with slow, cautious deliberation. She asked the CDC’s personnel office to find a staff scientist with three key qualifications: fluency in French, strong African experience, and training in epidemiology. The name Joel Breman popped up, but he was knee-deep in another investigation – of Swine Flu. Over the next three weeks he talked almost daily over the phone with Webb, getting a sense of the excitement and fear surrounding the Zaire outbreak.

His lab wasn’t exactly an American-standard P3 facility
Webb’s Marburg speculation prompted an international escalation in scientific security. Thereafter the CDC and Porton Down – the world’s most secure labs in 1976 – received virtually all samples of the mystery agent. At Porton Down it was Geoffrey Platt who handled most of the mystery virus research. His lab wasn’t exactly an American-standard P3 facility; rather it was a uniquely English mix of P3 and P2 elements. Because the British antivivisection movement was quite militant in its opposition to the use of laboratory animals, security in the form of controlling access to Porton Down was very high. Indeed, most British citizens had no idea where the lab was located or what it did.

Platt knew there were dangers
Since 1964 Platt had worked at Porton Down with dangerous viruses, particularly Lassa, taking precautions to protect himself, though the microbes were not kept safely inside glove boxes, as was done at the CDC. His personal protection was limited to a cloth surgical gown, a double layer of latex gloves, and an old World War II-era gas mask that had not been proven to filter out viruses. Every night after work, Platt would scrub his mask with Lysol and spray it with formalin disinfectant. Platt knew there were dangers, especially when working with an unknown, Marburg-like killer.

An effort necessitating over 500 skilled investigators
Platt’s work on the Sudan samples prompted WHO to release, on October 15, a bulletin that closed with these words: “Samples from Sudan and Zaire have revealed the presence of a new virus, morphologically similar to Marburg, but antigenically different.” In a matter of days, what began as a problem in a missionary hospital would involve investigators and military personnel from eight countries, several international organizations, the foreign ministries of at least ten nations and the entire health apparatus of Zaire. Almost overnight, events would snowball into an effort necessitating over 500 skilled investigators, and mobilizing the resources of numerous European and American institutions, all at an indirect cost of over $10 million. Direct costs for the Yambuku investigation alone would exceed $1 million.

THE COMING PLAGUE by Laurie Garrett

Saturday, October 25, 2014 @ 08:10 PM
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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

The viruses simply answered back: “????”
Piot eagerly prepared the sample for analysis under an electron microscope. He gasped as he stared at the strange viruses; they were shaped like question marks. “This is a new virus! It’s something we have never seen before,” he exclaimed, feeling the thrill of discovery. The virus was a long wormlike tube that coiled at one end and left the other extended. Piot imagined that when he asked, “What is this?” the viruses simply answered back: “????”

Piot packed the last sample and wrote up his findings
Thoroughly committed to solving the mystery of the “????” viruses,” Piot was disappointed when WHO telexed on October 7 1976 that the group should cease all research immediately. Piot packed the last sample, wrote up his findings, and, as per WHO instructions, shipped the lot off to Karl Johnson at CDC. He was intrigued by the diagnosis, wanted to go to the scene of the epidemic to see for himself, and marched over to the Belgian Ministry of Development Cooperation to argue his case.

You can go. We will only fund one week
He didn’t need to underscore Belgium’s unique relationship with Zaire. In 1876 the European power had begun to colonize and brutalize the Congo, as it was called. Now, almost a hundred years since King Leopold II declared the Congo a part of the Belgian Empire, authorities in Brussels were at pains to rid their country of its guilty legacy. On the other hand, the Belgian government was also acutely aware of the risks inherent in offending Mobutu or his government. It was an extremely delicate situation to place in the hands of a twenty-seven-year-old, politically naïve post-doctoral student. “You can go. We will only fund one week. And you’re representing the Belgian government.” He was woefully ill equipped for what would become a three-month stay in a tropical rain forest during the Zairian summer.

The virus was quite lethal to rodents
Dr. Stefan Pattyn, before sending his samples on to England’s maximum-security laboratory in Porton Down, had completed studies in laboratory mice, which showed that the virus was quite lethal to rodents. He had also compared the mystery virus to Lassa, concluding that “it was probably some other arbovirus,” not the West African killer. Now he too departed for Zaire, leaving van der Gröen to monitor the health of the accident-exposed members of the Antwerp laboratory.

In 1976 the lab was designated a P3 facility
On October 14, Patricia Webb and Fred Murphy completed their first round of studies of the mystery virus, working in the CDC’s maximum-security laboratory. In 1976 the lab was designated a P3 facility. A P1 facility was a basic laboratory such as could be found lining hallways of university science departments; a P2 facility had a slightly higher level of security with entry limited to trained, authorized personnel and actual research work performed under hoods that sucked air away from the experiment, up a ventilator duct, and past scrubbers that disinfected the air with ultraviolet light and microscopically gridded filters; a P3 lab was state of the art in high-security research. For Webb, working in a P3 lab meant passing through a series of guarded locked doors, presenting her security pass for entry. She would then shower with disinfectant soap and don a set of head-to-toe protective clothing, gauze face mask, double latex gloves, and radiation badge to monitor her levels of exposure to isotopes occasionally used in such research. She would then pass through two more air locks lined with microbe-killing ultraviolet lights.

All air was forced in past microscopic filters
Once inside the inner core, Webb might enter either the laboratory or the animal room. Both rooms were pressurized; all air was forced in past microscopic filters and sucked back out rapidly through several additional layers of filters, ultraviolet lights, high heat sources, and chemical scrubbers. A further layer of protection was provided by glove boxes: more sophisticated versions of the portable box Karl Johnson jury-rigged for studies of the Machupo virus in Bolivia. All Webb’s samples from Zaire were stored in deep freezers overnight; small amounts were thawed during the day and analyzed inside the boxes. Webb would thrust her already double-gloved hands into a larger set of thick rubber gloves that were permanently installed in the clear-plastic front wall of the hooded box. She would then try, with three cumbersome layers of rubber over her hands, to manipulate test tubes, pipettes, petri dishes, and the like. It was slow-going, arduous work that often proved physically exhausting.

THE COMING PLAGUE by Laurie Garrett

Friday, October 24, 2014 @ 06:10 AM
posted by admin

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.