The Coming Plague: Newly Emerging Diseases in a World Out of Balanceby Laurie Garrett
After four decades of assuming that the conquest of all infectous diseases was imminent, people on all continents now find themselves besieged by AIDS, drug-resistant tuberculosis, cholera that defies chlorine water treatment, and exotic viruses that can kill in a matter of hours. Based on extensive interviews with leading experts in virology, molecular biology,
After four decades of assuming that the conquest of all infectous diseases was imminent, people on all continents now find themselves besieged by AIDS, drug-resistant tuberculosis, cholera that defies chlorine water treatment, and exotic viruses that can kill in a matter of hours. Based on extensive interviews with leading experts in virology, molecular biology, disease ecology and medicine, as well as field research in sub-Saharan Africa, Western Euope, Central America and the United States, The Coming Plague takes readers from the savannas of eastern Bolivia to the rain forests of northen Zaire on a harrowing, fifty year journey through our battles with the microbes, and tells us what must be done to prevent the coming plague.
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The Coming Plague
Newly Emerging Diseases in a World Out of Balance
By Laurie Garrett
Farrar, Straus and GirouxCopyright © 1994 Laurie Garrett
All rights reserved.
BOLIVIAN HEMORRHAGIC FEVER
Any attempt to shape the world and modify human personality in order to create a self-chosen pattern of life involves many unknown consequences. Human destiny is bound to remain a gamble, because at some unpredictable time and in some unforeseeable manner nature will strike back.
—Mirage of Health, René Dubos, 1959
* Karl Johnson fervently hoped that if this disease didn't kill him soon somebody would shoot him and put him out of his misery. The word "agony" wasn't strong enough. He was in hell.
Every nerve ending of his skin was on full alert. He couldn't bear even the pressure of a sheet. When the nurses and doctors at Panama's Gorgas Hospital touched him or tried to draw blood samples, Johnson inwardly screamed or cried out.
He was sweating with fever, and he felt the near-paralytic exhaustion and severe pain he imagined afflicted athletes who pushed their training much too far.
When nurses on the Q ward first looked at Johnson lying beside his two colleagues they recoiled from the sight of his crimson blood-filled eyes. All over Johnson's body the tiny capillaries that acted as tributaries flowing to and from the veins' rivers of blood were leaking. Microscopic holes had appeared, out of which flowed water and blood proteins. His throat hurt so much he could barely speak or drink water, thanks to a raw and bleeding esophageal lining. Word around the hospital was that the three were victims of a strange and contagious new plague that felled them in Bolivia.
In brief moments of lucidity Johnson would ask how many days had passed. When a nurse told him it was Day Five, he groaned.
"If my immune system doesn't kick in fast, I'm a dead man," he thought.
He'd seen it happen plenty of times in San Joaquin. Some of the people died in just four days, but most suffered over a week of this torture.
Over and over he reviewed what he had seen in that isolated village on Bolivia's eastern frontier. He hoped to think of something that could help him recover and solve the San Joaquin mystery.
It had all started exactly a year before — in July 1962. Johnson had just arrived at the Middle America Research Unit (MARU) in the Panama Canal Zone, having had his fill of cataloguing respiratory viruses at the U.S. government's National Institutes of Health in Bethesda, Maryland.
Since 1956, then a young physician fresh from his medical training, Johnson had tediously studied viruses that caused common colds, bronchitis, and pneumonia. The work was getting plenty of praise, but Johnson, who was always impatient, was bored. When word got out that the National Institutes of Health was looking for a virologist to staff its MARU laboratory, he jumped at the chance.
Shortly after Johnson arrived in Panama, his newfound MARU colleague, Ron MacKenzie, volunteered to assist a U.S. Department of Defense (DOD) team that was heading into Bolivia to conduct nutritional surveys.
"A nutrition survey?" Johnson asked snidely.
"Well, I could use the experience, and I've never been to Bolivia. So why not?" MacKenzie said.
When MacKenzie and the DOD team met with Bolivia's Minister of Health in La Paz, the official said he had no problem authorizing their research plans, provided they first take care of a more pressing problem hundreds of miles away.
"I need an expert in mysterious diseases to investigate an epidemic in the eastern part of the country."
All eyes turned to MacKenzie, who, as a pediatrician and trained epidemiologist, came closest to fitting the bill. He shifted uncomfortably in his chair, mumbled something about not being able to speak Spanish, and tried to imagine what eastern Bolivia might look like.
The minister went on to explain that the mysterious epidemic was fairly sizable, and two La Paz physicians had tentatively labeled it El Typho Negro — the Black Typhus.
The following morning found the tall, somewhat gawky MacKenzie — dressed in a black suit, starched white shirt, and wing tips — standing on the La Paz tarmac, a briefcase at his feet. He greeted Bolivian physician Hugo Garrón, microbiologist Luis Valverde Chinel, and a local politician, and the quartet boarded an old B-24 bomber bound for the town of Magdalena, in the country's eastern frontier region. MacKenzie looked around for a seat: there were none. The plane had been stripped down for hauling meat, and the only passengers usually on board were sides of beef.
So MacKenzie stood behind the pilot, holding on to the hull for dear life during the long acceleration down the gravel runway. Because La Paz was at an elevation of 13,000 feet, planes had to reach great speeds to gain enough lift for takeoff. After what seemed an extraordinary amount of time, the Bolivian Indian mechanic who was squatting between the pilot and the copilot pulled a lever in the cockpit floor, withdrawing the landing gear, and they took off.
Like a tired old condor, the bomber circled La Paz slowly several times, spiraling upward to 16,000 feet, high enough to fly into a narrow pass between the Andean peaks that towered around La Paz. MacKenzie found himself staring aghast at avalanches of ice cascading off dangerously close cliffs.
When the plane escaped the claustrophobic mountain pass, it was enveloped in a dense fog which forced the pilots to fly by instruments alone: a magnetic compass, stopwatch, map, and notepad.
MacKenzie figured this was already enough adventure. Just three years ago he had been patching broken bones and vaccinating kids in a bucolic town north of San Francisco. This new exploit was a bit more perilous than anything he had gambled on when he left private practice to go into public health.
As the plane descended into the fog, MacKenzie began to feel the heat and humidity increase, sweat built under his stiffly starched shirt, and when the fog cover broke, he watched seemingly endless grassy savannas pass beneath them. These were broken up by outcroppings of low, tree-covered alturas hills, and by long winding rivers lined with thin bandas strips of rain forest.
"It looks just like Florida," MacKenzie thought. "Kind of like the Everglades."
After two more long hours the plane landed in the little town of Magdalena, and MacKenzie couldn't believe his eyes.
"My gosh," he exclaimed, "there must be two hundred people out there, standing around the plane." The women in the throng were dressed entirely in mourning; the men wore black armbands. The bereaved people of Magdalena had gathered to greet "the experts" who had come to end their epidemic.
"Experts?" MacKenzie muttered, casting an uncomfortable glance at Valverde and Garrón. "Well, I'm it."
With the grim entourage around them, the group dodged lumbering oxcarts as it made its way past a scattering of thatch-roofed adobe houses to the town plaza, a large courtyard surrounded by a circular arcade and the homes and stores of Magdalena. A sad, lethargic feeling pervaded everything.
At Magdalena's tiny clinic MacKenzie found a dozen patients writhing in pain.
"My God!" he exclaimed as he watched one after another vomit blood. MacKenzie shuddered, feeling the tremendous onus of his position and cursing the naivete with which he had walked into the situation. It seemed that only yesterday he was doling out antibiotics in a clinic in Sausalito to kids whose frolicking was briefly interrupted by sore throats. What MacKenzie saw on the ward forced him to push aside his pediatrics training and, for the moment, draw upon the lessons in courage and horror he had learned during World War II combat.
He was told that most of the sick were outsiders from Orobayaya. The mere name of that distant village sent shivers through the Magdalenistas, who spoke of it with unconcealed fear.
Soon the lanky MacKenzie, who towered over the Bolivians, was crouched in a dugout canoe making its way by moonlight upriver toward the plagued village. As they glided along MacKenzie kept spotting enormous "logs" — far larger than their canoe — sliding down the riverbanks toward them. The hair on the back of his neck stood up when he realized the "logs" were alligators.
The next day the group rode forty kilometers on horseback to Orobayaya.
It was deserted. The six hundred residents had fled days earlier in panic, leaving the village to pigs and chickens that scampered madly about in search of food.
MacKenzie returned to Magdalena, collected some blood samples from local patients, and headed back to Panama, where he tried to convince MARU director Henry Beye and the NIH bosses in Bethesda that the Bolivian situation warranted further investigation.
"It's probably just the flu," was the consensus from NIH officials.
"It's something strange and dangerous," MacKenzie insisted.
Both MacKenzie and Johnson thought the Bolivian villagers' symptoms resembled those brought on by a recently discovered Latin American virus, found near the Junin River in 1953 in Argentina. The Argentine virus was a close cousin of Tacaribe, which caused a disease of bats and rodents in Trinidad, also only recently discovered. While there was no evidence that Tacaribe could infect human beings, Junin was clearly lethal in many cases. In sparsely populated agricultural areas of Argentina's vast pampas, Junin appeared as if out of nowhere among men working the corn harvests. It too was a human killer that disrupted capillaries, causing people to bleed to death. Nobody was sure how the Argentines got Junin; there was speculation the virus might be airborne.
No point in taking stupid chances, Johnson thought. Though the NIH had not approved a MARU investigation of the epidemic, he flew to the U.S. Army's Fort Detrick, in Maryland, to see Al Wieden. A pioneer in laboratory safety, Wieden had turned Fort Detrick into the world's premier center of research on deadly microbes. Johnson wanted something unheard of: a portable box of some sort so he could safely study Junin in the field — or whatever was wiping out the people of San Joaquin.
At Fort Detrick there was a lot of research underway on "germ-free mice" — animals that had such weak immune systems that virtually any microbe could prove lethal to the mutant rodents. To keep the mice alive, scientists housed them inside airtight boxes that were constantly under positive pressure, pushing air past special filters to the mice, and then out again, toward the scientists. In this way, the mice breathed only sterile air. Scientists worked with the mice by inserting their hands into airtight rubber gloves that were built into the sides of the pressure box. The "glove boxes," as the steel contraptions were called, were about the size of large coffins and weighed hundreds of pounds.
Johnson's idea was to convert one of these contraptions from positive to negative pressure so that all air would go inward, toward samples of possibly dangerous animals or microbes. That way, he could work relatively safely in a portable laboratory.
Such a portable laboratory had never before been used, and Wieden wasn't sure how to jury-rig the positive-pressure boxes. But, racing against time, Johnson and Wieden found a new, lighter-weight plastic glove box and surrounded it with a vast rib cage of aluminum poles to prevent the container from imploding when the pressure reversed from inside-out to outside-in. To their mutual delight, it worked.
Meanwhile, MacKenzie still faced tough opposition in Bethesda, as well as at the Centers for Disease Control in Atlanta. Though he was a physician and had public health training, some higher-ups frankly doubted whether the thirty-seven-year-old MacKenzie had enough tropical experience to be able to recognize a new epidemic. They insisted it would be a waste of time and resources to deploy a team to investigate what would probably turn out to be some garden-variety bug such as influenza.
In the fall of 1962 MacKenzie appealed to Bill Reeves, his old mentor from public health graduate studies at the University of California in Berkeley. He described Magdalena to Reeves, who insisted that MacKenzie "stand up to the Bethesda bureaucrats."
"Go for it. You got something there. Don't let 'em discourage you," Reeves urged.
On January 9, 1963, a meeting of the top brass in the NIH's infectious diseases division was held in Bethesda, and MacKenzie persuasively pleaded his case. It was decided that he and a MARU ecologist named Merl Kuns should first undertake a scouting mission to assess the extent of the epidemic, collect blood samples, and define the nature of the local ecology.
The pair made their journey in March, and returned a week later even more firmly convinced that a serious epidemic was underway. Kuns, a University of Wisconsin-trained ecologist, was stunned by the thousands of bats that lived in the thatched roofs of towns like Magdalena, swooping out at night to forage for food. They were small bats, about the size of monarch butterflies, but they clustered in huge flocks that could suddenly fill the village sky. For his part, epidemiologist MacKenzie was convinced that nobody was actually getting infected in Magdalena, and the real epidemic was some fifty miles away in a town called San Joaquin. The pair returned to Panama with more than adequate evidence to gain approval for further investigation.
With his new laboratory contraption in crates, Johnson headed to Bolivia in May 1963, along with MacKenzie and Kuns. After arriving in the capital, the team chartered an old USAF B-17 bomber and flew to the eastern edge of the Andes, then down the eastern Andean foothills to the Itenez River, and from there to the river's Machupo tributary, eventually landing on a field outside San Joaquin. They then hauled their 10,000 pounds of equipment into the tiny town on mules.
Nestled atop a sloping hill just above the Machupo's flood line, San Joaquin was, the flabbergasted Johnson thought, "the last frontier of the New World." Nothing in his scientific career had prepared him for conditions so primitive: no roads, no real health facilities, no fences, no electricity, no telephones, no running water. Cows outnumbered humans roughly two to one and roamed freely about the town. The people of San Joaquin were an evenly divided mix of pure Spanish, pure Indians, and mestizos whose ancestors had built the town in the seventeenth century. The wealthier citizens resided in tile-roofed, whitewashed adobe homes; the rest of the population lived in mud-stick houses with thatch roofs. Six thin strips of marsh formed the "roads" of San Joaquin, which converged in a modest central plaza.
The Spanish people of San Joaquin were descended from cowboys who for a few generations had tended the large herds of a wealthy Brazilian family in control of an Amazon River fleet of refrigerated steamships. The ships took the beef out of San Joaquin, up the river system some 1,400 miles to the northwest, where the Amazon met the sea. From there the beef was shipped to Europe or North America, reaping excellent profits for the Brazilians.
In tiny San Joaquin, however, the cowboys, their families, and the local Indians were entirely dependent on the "benevolence" of the Brazilian ranch owners and on the food and supplies that returning steamships brought to their remote town.
In 1952 a revolution had brought the Movimiento Nacionalista Revolucionario to power. The land reform party stripped old Bolivian and Brazilian oligarchies of vast tracts of land, and the people of San Joaquin suddenly found themselves property owners. Unwilling to buy back from the local people the cattle they once owned, the Brazilians and their steamships left, never to return; and the villagers found themselves isolated, impoverished, and facing severe malnutrition unless they could grow crops to supplement the all too abundant supply of beef.
When Johnson, MacKenzie, and Kuns arrived in San Joaquin they found a modest town of some 2,000 people managing to survive on beef, the yields of home vegetable gardens, and small rice and corn fields scattered throughout the savannas.
A steady stream of travelers passed through the town on their way from even more remote areas in the savannas to larger Bolivian towns via the steamships that moored occasionally at the San Joaquin dock.
Upon arrival, Johnson immediately set up his portable laboratory contraption, and the team set out to assess the extent of the mysterious outbreak. By then the epidemic had already been underway for some fourteen months, the people mourned every day when the church bell tolled another death, and fresh graves filled the cemetery.
With the townspeople's eager help, the team mapped the area and painted numbers on all the adobe houses. Every family was interviewed extensively, and asked the questions most essential to the team: How many people in this house have had the disease? How many have died and how many have recovered? What were they doing in the days before they got sick? Is there any chance one family member gave the disease to another? Have any animals been sick?
It became obvious immediately that nearly half the people had been infected, and, of those, nearly half had died of the disease. That was a terrifying finding because few microbes kill nearly 50 percent of those they infect. One family lost nine of eleven members in 1963.
Excerpted from The Coming Plague by Laurie Garrett. Copyright © 1994 Laurie Garrett. Excerpted by permission of Farrar, Straus and Giroux.
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Meet the Author
Laurie Garrett wrote her first bestselling book, THE COMING PLAGUE: Newly Emerging Diseases in a World Out of Balance, while splitting her time between the Harvard School of Public Health and the New York newspaper, Newsday. In the 1992-93 academic years Garrett was a Fellow at Harvard, where she worked closely with the emerging diseases group, a collection of faculty concerned about the surge in epidemics of previously unknown or rare viruses and bacteria. The book was published in hardcopy by Farrar, Straus, and Giroux in 1994.
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The news comes out every year, people are expecting to be living longer. Williard Scott announces the birthdates of those who reach a hundred years old almost every day. If that is all you hear everyday, you may mistakenly believe that all of our serious health problems have either been cured or at least controlled. Smallpox is a distant memory, few are alive who remember the Influenza epidemic of 1917-1918, and most of us are young enough to have received at least 10 different vaccines for ancient worries, measles, mumps, rubella, polio, etc. All is calm, right? This book will jolt you out of your state of nirvana. Diseases are lurking, parasites are biding their time, viruses are mutating, bacterium are slowly winding their way through the jungle, new quasi-organisms(prions)are making themselves known in ever increasing terroristic fashion. We fear dictators, terrorists and their bombs, but in reality, our true fear should be of the unknown, unseen, and the unthought of consequences of modern life and it's many conveniences. Ventilation systems=Legionnaires disease. Beautiful and rare tropical wooden furniture=strange and exotic bacterial infections. Superabsorbent tampons=death. Supersonic air travel=fast moving influenza. We see that modernity brings it's own double edged sword to the conversation. This book should be mandatory reading for all citizens of the world. It should make us take pause and give homage to the maxim 'to every action their is an equal and opposite reaction.' We humans pay the price of creating, destroying and altering our known world. The unseen worlds maximize their opportunities to florish in the wake. The author, Laurie Garrett does a superb job of telling the story of each of the latest discovered menaces, tracing each to the earliest known siting, and following the trail of the hunters, World Health Organization (WHO) or the Center for Disease Control (CDC) as they do their best to combat these microscopic terrorists. She pulls no punches in this 622 page tome, and includes some additional 100 pages of notes and references. This book could be an excellent resource for any science student or medical professional.
the message Ms. Garrett relayed about disease in our modern world is still relevent and compelling. The genius of the book is the way in which Ms. Garrett presents the subject, researched thoroughly but engagingly written to allow people without advanced degrees in biology understand the topic it is imminently readable.
Ms. Garrett's book was my first induction into the world of microorganisms and their history. Even with the 600 + page book, I found it to be a frightening and exhilarating book to read. Even though it read like a horror story I derived knowledge from this amazing book and so I consider it one of my wisest choices.
I plan to use this book in my high school biology classes as a teaching tool. Not only does it give a chillingly accurate description of the infectious diseases facing us in the near future, but it also gives plenty of the history behind the research efforts on this disease. The non-scientific public tends to see science as almost destined knowledge; Ms. Garrett has done a wonderful job revealing the twists and turns that accompany any research effort and the many, many, many questions that still remain about so many diseases. A long book, but well worth it!
Laurie Garret skillfully captures the history of the last 50 years of bacterial and viral research and encounters. The Comming Plauge is a true and factual account of the widespread problem with globalization. With the comming of faster ground transportation and global air travel, the world is no longer isolated from the threats that were once held in check simply by the distance that a person could travel while infected. This text should be a wake up call for all those who believe that these diseases will never reach our closely guarded shores.
I bought this book in the train station in Frakfurt Germany in 1995 and i can honestly say it by far the best book of its kind, it scared me so much it gave me nightmares.
Even though published almost 20 years ago, it is still a must read. Well researched and documented, this book explains how viruses and bacteria are winning the battle in the spread of new and old diseases.
Not an encouraging book to buy your husband while he is in the hospital with pneumonia and 104+ temperature. Not that I'd do that or anything. ;)
My room. Bed is two feet long. Red dresses are in the wardrobe.