No Time to Lose: A Life in Pursuit of Deadly Viruses (7 page)

Another new arrival was Joe McCormick, a bespectacled young CDC staffer with a Paul McCartney fringe who had broken off his work on Lassa fever in Sierra Leone and was planning to travel from Isiro in northeastern Zaire to southern Sudan, where the mysterious twin epidemic to our own was still advancing.

We made a full report to the International Commission about our preliminary conclusions and our sketch of a hypothetical epidemiological curve. There was a strong possibility that the epidemic had peaked, but there were still at least a dozen people around Yambuku who were critically ill, with almost no provision for quarantine, so a strong potential for flare-ups or another big wave of infection remained. In addition, even if we were right about the scope of the epidemic in Yambuku, if just a few isolated cases reached Kinshasa or any other major city the epidemic would certainly explode. And the logistics situation at Yambuku was extremely dicey. Everything had to be brought in by plane and helicopter.

Karl was ordering radio and laboratory equipment, and he began working on plans to install a special medical center at a distance from Yambuku and other significant villages, so that patients could be separated from their families. It would have to include a highly secure inpatient ward; a highly secure field lab equipped with a centrifuge and other equipment for hematological analysis; a separate quarantine center to isolate suspected cases; and an outpatient ward where serum donations could be obtained and the sick could be brought for diagnosis. Naturally the very ill would need to be transported from their villages, and that meant a helicopter would have to be available on a daily basis.

I could see that setting up a treatment center like this was going to take weeks at the earliest. Meanwhile, we were spending our lives in meetings, which I detested. (Little did I know that meetings would
become
my life.) At every endless meeting Pierre and I argued for our swift return to Yambuku. We had promised the sisters that we would be back, as well as the people in Bumba, and our only contact with them was the haphazard link provided by the radio operator at the Order of Scheut’s Kinshasa headquarters, which passed on messages via the mission in Lisala. There was no direct communication at all, but every message ended with a plea for us to return.

This went on for several days. All of us were still camping out at the Fométro offices, not the easiest setup for a competitive pack of men. (Only Margaretha Isaacson had her own room.) Late one night we were drinking Karl’s Kentucky bourbon—it was one of those half-gallon bottles with a handle—discussing what our new virus should be named. Pierre argued for Yambuku virus, which had the advantage of simplicity; it was what most of us were already calling the disease. But Joel reminded us that naming killer viruses after specific places can be very stigmatizing; with Lassa virus, discovered in 1969 in a small Nigerian town of that name, it had caused no end of problems to the people from the locality. Karl Johnson liked to call his viruses after rivers: he felt that took some of the sting out of the geographical finger-pointing. It was what he had done when he’d discovered Machupo virus in Bolivia in 1959, and it was clear that night that he had every intention of doing the same in Zaire.

But we couldn’t call our virus after the majestic Congo River: a Congo-Crim virus already existed. Were there any other rivers near Yambuku? We charged en masse to a not-very-large map of Zaire that was pinned up in the Fométro corridor. At that scale, it looked as though the closest river to Yambuku was called Ebola—“Black River,” in Lingala. It seemed suitably ominous.

Actually there’s no connection between the hemorrhagic fever and the Ebola River. Indeed, the Ebola River isn’t even the closest river to the Yambuku mission. But in our entirely fatigued state, that’s what we ended up calling the virus: Ebola.

CHAPTER 5

A Pseudo Outbreak and a Helicopter

T
HERE’S A STRAIGHTFORWARD
formula that’s crucial to the life and death of epidemics. (And thus, of course, also crucial to the life and death of humans.) I would study it later in the classic work of Robert May and Roy Anderson, who 30 years after the epidemic attracted me to Imperial College in London where he was then rector. The components of this equation are
β
, virulence (how contagious the virus is—the probability of transmission in a contact between an infected individual and a susceptible one);
c
, contacts (the number of contacts, on average, per infected person per day); and
D
, duration, the number of days you are infectious. Combine those three factors and you come to a number—the Basic Reproductive Rate,
R°
—that determines how fast the epidemic will spread, and whether it will simply die out of its own accord or develop into a long-term pandemic.

R° =
β
c D

If
R°
is less than 1, the outbreak of disease will peter out. If
R°
equals 1, the disease will become endemic. If
R°
exceeds 1, a full-blown epidemic will break loose. The question was which calculation fit Ebola.

In the first 21 villages we looked at, we found evidence of 148 fatal cases of Ebola, and 12 cases where people showed antibodies—in other words, 12 people were confirmed as survivors. This suggested the astronomical fatality rate of 92.5 percent, though in the absence of a serological survey in the population we could not yet exclude that a lot of people were asymptomatically infected, as is the case for many viral infections. And we suspected that Ebola was highly contagious in at least some households. We didn’t know exactly how or exactly how much. But its incubation period was very short, and it killed people so quickly—within 14 days of initial contact—that they probably weren’t infectious for long.

So although β, virulence, was playing against us,
D
, the quick kill rate, was, paradoxically, an advantage from an epidemiological point of view. People simply didn’t stay infectious for very long, because they died so rapidly. While we would, of course, seek to improve patient survival, we also needed to cut down on c, the number of infective contacts per sick person.

In that respect, we were extremely lucky that Ebola still had not flared up in the sprawling, intensely interconnected megacity of Kinshasa, where contact patterns were almost uncontrollable. Because Ebola was still isolated in the remote Yambuku region, and because the village elders had of their own accord set up a measure of quarantine, we could just about hope that it would die down on its own.

Meanwhile, I was stuck in Kinshasa, at Karl’s orders. I liked the city. It was huge—far larger than Brussels—and it flashed with a terrific energy, generosity, and joy. When there weren’t any evening activities at work (on most days), Guido and I went out in the evening and ate grilled “Capitaine,” a white river-fish, and huge
cossa-cossa
shrimp with some of the hottest
pili pili
spices in Africa. Then we took a taxi to some bar in Matonge and submerged ourselves in the rich atmosphere of this crazed metropolis and the intricate cadences of Congolese
suka suka
. We drank locally brewed
Primus
and
Skoll
beer while discussing local and international politics with Zaireans and foreigners, and I learned to dance with my hips in the huge mirrors that were often a feature of the dance halls, from a series of grinning women who took pity on a poor foreigner with jerky sticks for limbs.

But I wasn’t in Zaire to learn to dance.

I spent a lot of time in Kinshasa’s three main hospitals: Mama Yemo Hospital, named after Mobutu’s mother (I noted later how much dictators seem to revere their mothers); Clinique Ngaliema; and the University Hospital, up the hill. In spite of its name, the latter was the worst off in terms of infrastructure and equipment, but it had very competent physicians. In the past week I had seen more cases of hemorrhagic fever than anybody else in Kinshasa except for Pierre Sureau, and was thus what might pass in the dark for a world “expert” on the subject! It was also an opportunity to soak up more knowledge about medicine in Central Africa, and to learn from my resourceful Zairean colleagues, many of whom were intellectually brilliant but had to hold down several jobs and run side businesses to feed their extended families and put their children through decent schools.

I became friends with the head of the clinical lab at Ngaliema, a young Flemish lab technician named Frieda Behets who had trained in our lab in Antwerp. She was one of the most practical and energetic people I met during my work in Africa and helped me out numerous times with both logistics and political advice. (She later played a major role in AIDS research in Africa and elsewhere and is now a professor at the University of North Carolina.) Her then husband was a veterinarian who introduced me to two important places: the Bralima (Heineken) brewery and the presidential farm in Nsele. The brewery was not only a welcome source of cold beer but more importantly a generous source of CO
2
to produce dry ice, necessary for transporting virus samples. And the farm was a source of an even more precious commodity: liquid nitrogen, used to preserve semen for artificial insemination of cows, and the best medium to store viruses at –170°C. I also helped him later with some microbiological research on diseases of Mobutu’s chickens and pigs.

Meanwhile, at the Fométro office Margaretha Isaacson was driving me nuts. She was constantly at us to report our body temperature three times a day, to detect early signs of viral infection. Although she was right, I was still enough of an adolescent that this annoyed me to an unreasonable degree.

There were also discussions and tensions between Karl and Pierre Sureau. Pierre and I wanted to return to Yambuku immediately, while Karl argued that it was far more important to secure Kinshasa and to wait for the crates of equipment that were on their way from the United States. I was bursting with frustration.

It was around this time that I came down with diarrhea and fever. I felt dizzy, and my head began to ache as though it was circled by a metal vise. As one of the few members of the team to have actually seen an Ebola victim, I was perhaps hyperaware that these were invariably the first symptoms of the disease. In any case, we were all under the strictest instructions to report any kind of incipient infection. But I knew that if I did I would be put in a plastic-wrapped isolation bed under the care of Margaretha Isaacson, and that as soon as my condition stabilized I would be sent to South Africa for weeks of quarantine.

So, unforgivably, I decided not to tell anyone. I tried to isolate myself as much as possible. I was so frightened that I could barely admit to myself what I was risking, and the kind of risk to which I was exposing my colleagues. When the fever dissipated after less than 48 hours—it had probably been some random intestinal bug—I was a little less arrogant; I recognized the kind of fear that the sisters and the other inhabitants of Yambuku endured, night after night, fever after fever, death after death, for over two months.

Then a report came in that the hemorrhagic fever had hit a prison in the town of Kikwit, about 250 miles away from Kinshasa. Three people were dead and another three were said to be sick. I volunteered to accompany Jean-François Ruppol, the seasoned Zaire hand. And I will never forget traveling there in a little Fokker aircraft from Air Zaire. We were the only two passengers and the pilot told us to sit on either side of the plane to maintain the aircraft’s balance. Suddenly, as I was looking out at the rain forest, the Fokker swung sideways and as I watched, one of the engines literally broke off in front of my eyes and fell off the plane. I thought this was the end but, unbelievably, the pilot landed us safely.

Kikwit was another sad and shabby town, with a few decaying old colonial buildings and shacks no cleaner or more orderly than those of Bumba. As in Bumba, there was no electricity and little sanitation: the infrastructure had collapsed since Independence.

The hospital surprisingly was one of the cleanest and best managed I saw in all my decades in Zaire. It was run by Paul Janseghers and his colleagues from the Belgian development agency, and had reasonable supplies and competent, active staff. (Sadly, Belgium later withdrew support from the hospital as part of policy changes in development aid stressing that local institutions should not be managed by Belgians, and Mobutu’s concept of authority did not include investment in local services for his citizens. One dramatic result of the predictable breakdown in basic infrastructure and management were hospital-based epidemics, such as the Ebola outbreak that Kikwit did indeed witness in 1995, which killed over 200 people.)

Within an hour we established that there was no outbreak of Ebola in the dilapidated prison. In reality, the prisoners had acute hepatitis, with massive liver necrosis, and this, combined with rumors of a mystery killer disease afoot in the country, set off panic. The local medical authorities had already done liver biopsies but the results (and the samples) hadn’t gotten to Kinshasa, because of the haphazard nature of transport links. (In those days it was said that there were only 600 miles of paved road in Zaire, a country half the size of the entire United States. There are probably even fewer now.)

We drove back to Kinshasa in a car lent to us by Kikwit hospital, and stayed there for another day or two; finally Karl gave Pierre and me the go-ahead to return to Yambuku. We left in the first week of November, with a heavy load of food supplies—cans and C-rations that had arrived from the US Army, to counteract the damaging effects of the quarantine. (You’re obviously not going to solve a systemic problem of hunger by handing out a few cans of corned beef, and, in any case, there was no famine whatsoever in either Bumba or Yambuku. But these food supplies had arrived in Kinshasa, so we took them with us.)

In retrospect, it was all very amateurish. I have since, for my sins, become a professional of humanitarian assistance, and this sort of individual charity solution violates all the rules. In fact, the money I had with me, to hire people and set up teams was far more useful to the region than the cans of meat.

I was in charge of logistics, again in preparation for the arrival of a far larger international team, with a lab. Inwardly I quavered, because although I did have some claim to a little knowledge of viruses, I really could have no pretense of any ability to organize a long-term expedition to the jungle beyond 10 years of Boy Scout training and my high school summer jobs working for a professional travel outfit in Turkey and Morocco.

Before we left Kinshasa I made one phone call to Greta. This was a very complex production. Even the powerful Fométro office had no international phone line, and the local lines had been out of operation for years. But the Fométro administrators knew a man at the telephone company, where you went to book a long-distance call. If you asked the proper person (and if all other factors in the telephonic constellations were correctly aligned at the time), the Fométro phone miraculously came to life at the appointed hour. You were patched through by the operator and after an unpredictable few minutes the line went dead; subsequently, the special phone guy to whom you owed this extraordinary service came to the office for his
matabiche
, his tip.

Greta was worried. Ebola was making some minor news in Belgium, and all travelers from Zaire had to submit to medical exams. She was alarmed to learn that I was about to go back to Yambuku and that I would be staying in Zaire for considerably more than 10 days. I felt strangely disembodied. I was sorry that she was anxious, and I was relieved that her pregnancy was advancing without problems, but my life in Belgium now seemed very far away.

Again we took the president’s C-130 airplane to Bumba, and again the pilots kept the engines running as we unloaded. As soon as we disembarked, they took off. As we watched the plane take off from the red dirt airstrip I wondered when, how, and even whether we would see it again. We had set no date for them to return, and there was no other way to get out of quarantined Bumba. I had an empty feeling as we headed over to Father Carlos’s mission.

With the help of Dr. N’goy Mushola, I hired and trained a few men to create a surveillance network around the town. These men sought out cases of Ebola and brought symptomatic patients to the hospital in Bumba or the clinic at the Unilever plantation in Ebonda. We drew blood to test later for Ebola antibodies. (Patricia Web’s lab at the CDC in Atlanta was frantically developing the antibody test that Guido later deployed in Kinshasa and Yambuku.)

We also needed medical staff. N’goy told us that none of the local nurses or medics had received their pay for months. These were government employees, so the money for their salaries had to come from Kinshasa. The doctors and nurses in Bumba were at the bottom of a huge pyramid, and as the money percolated down, at every level—regional, local—a portion of their wages was sliced off by corruption, and the slices had become so vast and shameless that there was often nothing left.

N’goy suggested that we simply agree to pay their normal, full salaries for a while. For us it was hardly any money at all, but for them it was a gift: to be actually paid, in predictable fashion, a fair, agreed-on wage for your work.

All the people we hired for the mobile surveillance networks were men. In those days it didn’t occur to me that there was a specific need to hire women. I knew, but at the time didn’t
perceive
, the fact that whenever we went to villages we saw only men, partly because women traditionally worked the fields and did all the heavy work. If we asked to talk to women—or to a specific woman—a man would say, “Why? I can tell you what you need to know.”