COVER STORY

The Ebola Web

Columbians race to stop an epidemic.

by Paul Hond Published Winter 2014-15
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At JFK Airport, Frame met the ailing Pinneo and drew her blood. An ambulance took Pinneo to Columbia-Presbyterian Hospital. There, she was placed in isolation. Frame sent all the blood samples to the Yale lab, where Casals and his colleagues set to work to identify the pathogen. Pinneo was acutely ill. At one point, her temperature reached 107 degrees. Somehow, she survived. By early May, after nine weeks in the hospital, she was released.

A month later, Casals, who lived on Manhattan’s Upper West Side, began to feel sick. He thought his symptoms were unrelated to the mystery bug at his lab. But his doctor, Edgar Leifer ’42GSAS, ’46PS, a professor at Columbia’s College of Physicians and Surgeons, convinced him to go to Columbia-Presbyterian. Like Pinneo, Casals was placed in isolation under Frame’s care. As Casals’s condition worsened, and increasingly resembled the unknown disease he was studying, Frame called Pinneo, who lived upstate, and asked her to fly to New York to donate her blood, which had antibodies. Pinneo did. Casals received injections of Pinneo’s serum and recovered.

But in November 1969, Juan Roman, a technician at the Yale lab who hadn’t been working on the virus, fell ill with the same symptoms. His sickness, which ended in death, caused great alarm: no one knew how he’d contracted the disease, and even Casals, meticulous in his own laboratory caution, couldn’t be sure how he himself had gotten it. The lab was shut down.

That winter, at the mission hospital in Nigeria, Jeanette Troup saw more patients with symptoms like those of nurses Wine, Shaw, and Pinneo. To verify her hunch that it was the same disease, Troup did an autopsy on one victim. In the process, she cut her finger. Days later, she was sick. In New York, Frame, having heard about Troup’s illness, asked Pinneo and Casals to fly to Nigeria to donate their antiserum. They agreed to go. Pinneo arrived on February 20, 1970, only to learn that Troup had died two days earlier.

By then, the new virus, whose natural host was the multimammate rat, had been isolated. Frame named it Lassa fever, after the Nigerian town where it first appeared.

It wasn’t until 1976, in Central Africa, that another, more deadly hemorrhagic virus emerged.

William T. Close ’51PS was living in Zaire at the time. Close had lived there since 1960, when he and his wife came with an American missionary group. The country was called the Belgian Congo then. Just after Close’s arrival, Belgium granted independence to its resource-rich colony, and the Republic of the Congo was born. Violence promptly erupted, both against the Belgians and between Congolese political factions. The 1,500-bed hospital in the capital, Leopoldville, had one surgeon. Close heard about this shortage and went there to help. The injured poured in, and Close sewed up a lot of people.

One day, Close was summoned to the home of the army chief of staff, Joseph-Desire Mobutu. Colonel Mobutu wanted Close to remove a fishbone from his great-aunt’s gullet. Close obliged. Soon after, the country’s first prime minister, Patrice Lumumba, a strident anti-imperialist, was toppled in a coup led by Mobutu and backed by the US and Belgium, and later executed. Close was made chief physician of the army. He also became Mobutu’s personal doctor.

In 1971, Mobutu, as president, pursued a program of Africanization. He changed the country’s name to Zaire, the capital’s name to Kinshasa, and his own name to Mobutu Sese Seko. By then, Close was growing disillusioned with Mobutu. To his eyes, the president had gone from a charming, compassionate leader to a detached, wealth-amassing tyrant. In the summer of 1976, Close went on leave to Wyoming, where he planned to set up a rural practice. In October, he got a call from the Zairean health minister, who told him of a strange disease that appeared in August in the northern village of Yambuku, six hundred miles from Kinshasa. Victims died quickly and horribly, with external hemorrhaging. Panic had gripped the capital, and the military was avoiding the hot zone up north. Mobutu was rumored to have fled to France with his family.

Close flew back to Zaire. On the flight from Geneva to Kinshasa, he sat near Joel Breman and Karl Johnson, two epidemiologists sent by the CDC to investigate the disease, which had infected some three hundred people, killing 90 percent of them. The investigators faced towering questions. How was the illness transmitted? How had it spread? How could it be stopped?

“As we rush to find trained health workers, it is essential that we keep them safe,” says Strasser.

Close overheard the discussion and introduced himself. The three men talked through the night. When they landed in Zaire, the charismatic, French-fluent Close began forging order from chaos: as the director of the country’s biggest hospital, he secured medical equipment and supplies; and as the president’s doctor, he convinced a wary Zairean air force to provide a C-130 cargo plane to take a Land Rover and materiel up to the jungle-bound village of Yambuku. He obtained helicopters, too, so that the investigators could visit the hundreds of neighboring villages in their quest to halt the disease. One of Close’s children, the actress Glenn Close, wrote of her father, who died in 2009, “His was the kind of vitality that immediately changed the chemistry of whatever space he entered — a true life force.”

The response team reached Yambuku. There, the investigators found that a high rate of infections occurred in young women. Hospital records showed that many of the women had been pregnant. It turned out that the Flemish nuns who ran the local clinic had given the women vitamin injections with reused, unsterilized needles. The case was cracked: Ebola, named for a river near Yambuku, was spread through bodily fluids. Now, under Close’s logistical command, the team made its way to villages to find and quarantine the sick, using the medical equipment and protective gear that Close had marshaled. Years later, Peter Piot, the Belgian microbiologist who isolated the virus and who was part of the team in Zaire, referred to Close’s role in stopping the world’s first recorded Ebola outbreak as “indispensable.”

 

By December 2014, reported cases in the current outbreak approached twenty thousand, with around seven thousand deaths. The death toll of all twenty-four previous Ebola outbreaks combined was 1,590, according to the World Health Organization (WHO). Unlike those outbreaks, this one crossed borders and got into big cities like Monrovia, Freetown, and Conakry — the capitals of nations still recovering from wars, where public-health infrastructures are almost nonexistent, and where doctor-patient ratios are woefully low. Liberia, for example, a country of 4.3 million, has about fifty doctors.

In some ways, the health infrastructure in parts of Africa hasn’t changed much since the 1960s, when Bill Close was one of three doctors at the main hospital in Kinshasa, performing cranial surgery with a carpenter’s drill.


LIBERIA - Ashoka Mukpo left Providence and flew back to Liberia in September. On his first day in Monrovia, he saw bodies lying in front of a treatment center. One of them was a child.

He listened to parents talk about how they’d spent days driving around in vain to find a facility that would take their son. They were forced to watch the boy die in the car.

People couldn’t get treatment. There weren’t enough ambulances. Bodies were decaying in homes. “The depth of human suffering was much more than anything I’d ever seen,” Mukpo says. “Life in Liberia was already very difficult, and nobody needed this.”

In Monrovia, he encountered a city steeped in anxiety. While you could still go to the beach and have a great afternoon and not even discuss Ebola, just tell jokes and drink beer, the underlying energy was concern for the future and an awareness that nobody knew how bad things were going to get.

Mukpo had come this time as a journalist. A friend was working on a documentary about Liberia, and had offered to pay Mukpo’s way if he would help her shoot. Mukpo, who had some experience with a video camera, agreed.

“The depth of human suffering was much more than anything I’d ever seen.”

The case count swelled. Each day, dozens of sick people were turned away from treatment centers. They could either go to a government holding center and wait in a cot or on the floor with other patients, or they could go home, where they risked infecting family members and neighbors.

On Tuesday, September 30, Mukpo was hired by NBC News to be the second cameraman for Dr. Nancy Snyderman, the network’s chief medical correspondent. The next day, he began to feel tired and achy. He took his temperature and saw that he was running a fever of 101.3. Frightened, he quarantined himself, and on Thursday morning he visited a Doctors Without Borders treatment center to get tested. The results came back that night. Mukpo had Ebola.

By Sunday he was on a plane back to the US, to the biocontainment unit at Nebraska Medical Center in Omaha. Like CUMC assistant professor Craig Spencer ’13PH, a Doctors Without Borders volunteer who contracted Ebola in Guinea and was treated at New York’s Bellevue Hospital, Mukpo benefited from excellent care. His treatment included serum from an Ebola survivor, the missionary doctor Kent Brantly, who happened to be driving through the Midwest while Mukpo was hospitalized — and whose blood type matched Mukpo’s. Mukpo left the hospital on October 22.

Back home in Providence, Mukpo opened up to the press about his experience. He thinks he got Ebola while interviewing patients outside a treatment center. But Mukpo, like Spencer, asks that we focus our attention on West Africa.

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