Level 4: Virus Hunters of the CDC

by Joseph B. McCormick

These microbes do not lurk in some dark corner waiting to pounce, in ambuscade for human prey. It is we who interfere with their habitat, not the other way around. Left to their own devices, they reside successfully—and often silently—in biological balance with their natural hosts. Only when man invades their environment does he become their prey.

Coronaviruses have even been found in whales.

All of the people who interviewed me seemed more interested in hearing about my adventures than in asking me any complicated medical questions.

serious afflictions, usually birth defects. Dr. Koop

Mostly, though, you have to rely on yourself. You need to have an instinct for finding and absorbing information. Then you have to know how to use it sensibly.

The essence of the training is learning on the job, backed by extensive experienced support and supervision.

a case control study. This is a scientific method used by epidemiologists to discover the most important differences between those people who did become sick and those who did not.

After spending a week in Parker, I was ready to return to Atlanta for the second half of the investigation, which would continue in the lab. In the days before the personal computer, to obtain the statistical results of the questionnaire and other investigation inquiries, I had to enter all my data on punch cards. On the sixth floor of the CDC was an IBM machine known as a card sorter. It operated exclusively on a Yes/No answer system and sorted cards based on where holes had been punched in them. Although the machine was able to process each operation rather rapidly, it required a huge number of operations to arrive at an answer. Holes are punched in cards if the answer was yes, and left alone if the answer was no. The yes cards would then be separated into one pile, and the no cards in another. But if there are several

levels to sort for, then the process of determining an answer grows progressively more difficult.

for example, I wanted to find out whether all of the women who’d eaten potato salad had become ill compared to the men who had eaten it, I would have to sort the cards for all people who ate potato salad, then for all of the females and males. Then I would have to sort those cards for the females who ate potato salad and were ill. Cards would end up strewn all over the place. The whole business was very tedious. Nowadays, we ...

The epidemic further exacerbated the rift between the rich and the poor, in large part because the rich looked upon the disease as the scourge of the lower classes. In their panic, they’d fire their servants rather than keep them in their houses, believing that this step minimized their risk of becoming infected. The impoverished masses of Brazil were thereby made even poorer. Thus, in every way, they bore the brunt of the epidemic.

The poverty I’d seen in Zaire was completely different from what prevailed here. In Africa, there is at least some kind of subsistence economy always at work: barring prolonged droughts, people are usually able to grow enough to feed themselves. But I’d never seen anything like São Paulo. This was poverty on an unimaginable scale, an epidemic in its own right, which had transformed whole parts of Rio and São Paulo into hideous slums, fertile breeding grounds for violence as well as for lethal pathogens. I was told that the population in the slums of Säo Paulo, known asfavelas, which sit on the hills ringing the city, grew at the rate of half a million a year. Most of the slum dwellers came from rural areas, where the economy could no longer sustain them, lured by the prospect of work. With the rapid explosion of the population in Brazil came cutthroat competition for jobs and resources.

was a Pied Piper to public health people, including me. He is a man possessed of the very qualities guaranteed to make certain politicians and bureaucrats view him with mistrust, which is to say that he is dedicated, honest, and straightforward.

so it’s difficult to get a good picture of the situation.” Before signing off, I told him we would contact the Zairian

with. How would we go about trapping animals and insects

In a culture rich with ritual masks, respirators are likely to get you labeled as an evil spirit, with very nasty consequences.

What made ribavirin so interesting, so promising, was that it seemed to interfere with the way the virus makes protein from its own genetic RNA.

There was good safety data on the drug, including human use data, because it had already been used successfully as a treatment for acute viral pneumonia in infants. Best of all, it was easy to make, potentially cheap, and stable at room temperature—maybe not Sierra Leone

So we began. Our first task was to establish a system to determine who would receive oral ribavirin and who would get the plasma according to the criteria laid out in our protocol. Everybody whose liver enzymes were above a certain critical level, which had been determined in our initial studies as indicative of a poor outcome, would receive one or the other treatment.

Usually, clinical trials required a “control group”—patients who would be given a placebo (a solution that looks like the drug, but is actually nothing more than sugar water)—in order to “blind” the researchers, so that there is no way for their enthusiasm or prejudice

influence the patient or affect the results.

The control group provides a neutral index against which to measure the effects of the actual drug. The trouble is that half the patients go untreated in a controlled trial. With Lassa fever, we knew that many untreated patients would die. Because the laboratory data looked promising, our committee had determined that we should not use an untreated group in our study. We determine...

Besides, costume—whatever the style or motivation—held an important place in the culture. Best of all, it meant that they could continue their traditional practices.

Apparently this material contained a modest amount of interferon, a naturally occurring human substance known to inhibit virus growth under some circumstances.

longitudinal study. Such a study would allow us to compare rates of infection in rural Africa over a significant period of time.

was in his seventies and practiced in Belgravia,

meaning that her tests might be relatively normal. The most important thing about viral infections is to start treatment as early as possible, before the virus has done any irreversible damage.

she was needlessly exposed to Lassa in Panguma Hospital because no one had bothered to institute protective measures for the staff. And then there was the matter of the treatment itself. “In the future,” he said, “we should learn from this. We must never delay

giving any sick hospital staff exposed to Lassa patients ribavirin.

insistent. “If we are going to teach them something useful about Lassa fever,” he said, “then we have to show them Lassa fever.”

we divided them into three groups and set them to work. One group made the rounds of the wards to see Lassa fever patients; another went into the field to see village housing conditions and to catch rats; and the third stayed in the lab to learn the techniques for diagnosing Lassa.

In the evenings, we reconvened on the hill above Kenema to eat meals cooked for us over an open fire and conduct a postmortem on the days activities. During these sessions, the delegates developed the

These were simple, cheap, and sensible, and were based on the techniques we knew had worked in Sierra Leone. As workshops go, it was certainly a very unusual one, and extremely productive ...

So the next logical step was to acquire the capacity to grow the virus in sufficient quantities to work with it and identify it. Only then could we develop a routine diagnostic test that was simpler than the more cumbersome one then in use.

teaching method was simple and to the point: he first gave me ten minutes of verbal instructions and then he threw me in the water. He said that it was the same way he’d learned.

sputum. She could no longer even get him to drink water, because

In Africa, you cannot go into a government office and simply ask questions. Elaborate greetings are essential and certain formalities must be adhered to. Great ceremony was attached to these encounters, especially since we

The records were inadequate and staff fear too great to

The investigation was simplified to some degree because Kate and Steve were dealing with Asian Ebola virus in this instance and not a mixture of Ebola and simian hemorrhagic fever as in Reston. Most facilities, including the Texas one, administered a tuberculin skin test to monkeys as soon as they arrived. TB is a major problem in caged monkeys, particularly newly arrived animals. The test calls for a reagent to be injected in a tiny dose under the skin in the soft folds around the eye. If the animal is actively infected by TB, the injection produces a large bump. The reagent comes in vials containing several doses, while rhe narrow syringe itself can, in theory, accommodate eight doses; however, because of the “dead space” in the needle shaft, you can only draw up enough at one time for seven injections. A trivial detail, this turned out to be the key to solving the riddle of how this particular group of monkeys became infected.

Kate carefully examined the layout of the cages, paying special attention to the monkeys that

infected. Then she reviewed the procedures with Steve and his staff. Yes, they said, they always examined the monkeys in the same order. She asked them to show her how they went about their routine. Indeed, the handlers would proceed from one cage to the next in a specific order. The cages were arranged in two layers: a top row and a bottom row. Then Kate numbered the monkeys according to the order in which they were injected with the TB reagent. Once she had that information, she went back to the data compiled on the monkey deaths. She counted carefully. Every eighth monkey remained well, with no signs of illness. In fact...