A review of THE COMING PLAGUE: NEWLY EMERGING DISEASES IN A WORLD OUT OF BALANCE by Laurie Garrett, published in 1994. CHAPTER 7: N’ZARA: LASSA, EBOLA, AND THE DEVELOPING WORLD’S ECONOMIC AND SOCIAL POLICIES
The first penalty that capitalistic society had to pay for the ruthless exploitation of labor
The Alma-Ata Declaration called for “the attainment by all peoples of the world by the year 2000 of a level of health that will permit them to a socially and economically productive life.” In his 1976 Plagues and Peoples, University of Chicago historian William H. McNeil created a sensation in academic circles because it argued with the force of centuries of historical evidence that human beings had always had a dramatic reciprocal relationship with microbes. Waterborne parasitic diseases dominated the human ecology when people invented irrigation farming. Global trade routes facilitated the spread of bacterial diseases, such as plague. The creation of cities led to an enormous increase in human-to-human contact, allowing for the spread of sexually transmitted diseases and respiratory viruses. After centuries of doing battle with one another, humans and most parasites had settled into a coexistence that was rarely a cause of mass destruction. In René Dubos’ view, most contagious diseases grew out of conditions of social despair inflicted by one class of human beings upon another. Tuberculosis arose from the social conditions of the poor during Europe’s Industrial Revolution: urban crowding, undernutrition, long work hours, child labor, and lack of fresh air and sunshine. “Tuberculosis was, in effect, the social disease of the 19th century, perhaps the first penalty that capitalistic society had to pay for the ruthless exploitation of labor,” Dubos argued.
By 1979 McCormick had reached a conclusion
Joe McCormick had heard it all, but all the hand-wringing and theorizing wasn’t going to provide the resources needed to get rid of Lassa. By 1979 McCormick had reached the conclusion that Lassa was an entrenched endemic disease, causing thousands of cases of illness of varying degrees of severity each year. The only way to rid Sierra Leone of human Lassa cases would be to eliminate contact between the rats and humans – an option he considered doable if millions of dollars were spent improving the country’s rural housing and hospitals. The alternative was mass education about rat avoidance and ribavirin therapy for those who suffered Lassa fever. That prospect was also orders of magnitude too expensive for the impoverished state.
A suspect epidemic in Sudan
In late June 1979, McCormick returned to CDC headquarters to take over Karl Johnson’s job as chief of the Special Pathogens Branch leaving Web in charge of the Sierra Leone laboratory. The World Health Organization called to formally request McCormick’s assistance in investigating a suspect epidemic in Sudan. It was believed that Ebola was the culprit. McCormick hastily gathered supplies and the first assistant he could get his hands on – a new EIS officer, Dr. Roy Baron. McCormick showed Baron the only available maps of the region, made in 1955. He described the difficulty of finding villages, which were deliberately hidden in the ten-foot-tall Sudan grass and swamps. He gave a quick sketch of the political and social situation. Since McCormick’s last visit to the region during the 1976 Ebola outbreak, the relationship between Sudan’s north and south had grown more strained; the country was on the brink of civil war.
A vision from hell
The translator led McCormick through the hamlet of mud-and-wattle structures to a round hut on the periphery, to see what he would later describe as a vision from hell. Twenty men and women lay upon grass mats, crammed one against another in a small dark atmosphere of overpowering heat and stench. Most were in agonizing pain, horribly ill, groaning aloud or crying out in demented visions. Some, their skin in excruciating pain, had torn off their clothing and lay in naked terror. All night long McCormick, wearing only latex gloves and constantly steamed-up respirator for protection, knelt beside the Ebola victims, giving them thorough physical examinations, painstakingly noting all information on a pad, and taking blood samples. The instant the needle hit her vein, the woman thrashed wildly, the syringe popped out and landed in McCormick’s thumb. Shoving aside all thoughts of being struck by the needle, McCormick completed his rounds, prepared all samples for shipment, putting them inside a small tank of liquid nitrogen and placing that in a case of dry ice. He injected himself with Ebola antiserum collected from Yambuku three years earlier.
It was clear that Ebola had struck again
It was clear that Ebola had struck again and that he had been exposed to the virus that would take from five to seven days before he got sick, leaving him time to get to the bottom of this epidemic. One afternoon, he spotted an old woman from the death hut strolling through N’zara, a jug of water on her head, clearly full of energy. McCormick was ecstatic. CDC blood tests results cables from Atlanta shortly thereafter indicated that she alone among those in the death hut was uninfected. Whatever her ailment, it wasn’t Ebola. And Joe McCormick had never been infected with the deadly virus.
Poorly run hospitals were the amplifiers of microbial invasions
When the team reconstructed the events of the summer of 1979, they discovered many parallels with the 1976 outbreak, but were still unable to say where the virus came from. Once again, the first case involved a man who worked in the run-down colonial-era cotton factory that was filled with huge swarms of bats and a vast array of insects. He fell ill on August 2, 1979 and died of the disease in N’zara Hospital three days later. All infections could be tied to some direct blood or fluid contact between an ailing Ebola victim and another individual. The team was able to find fifty-six Ebola cases, many hidden in the tall grasses. 65% of those who got infected died. Their inability to pinpoint the reservoir for Ebola would bother McCormick for years. As was the case with Lassa, poorly run hospitals operating under conditions of extreme deprivation were the amplifiers of microbial invasions. Once again, elimination of a disease threat seemed inextricably bound to economics and development. McCormick felt certain that Ebola and other dangerous diseases would continue to haunt the most impoverished communities on earth, constantly threatening to explode into epidemics, some of which might one day lap at the shores of the planet’s richest nations. Out of such poverty, from the African Serengeti to the burned-out tenements of the Bronx, would soon come microbial invasions that would bear out McCormick’s prophecy.