There Before Ebola Had a Name
Larry Altman describes the work of renown virologist Peter Piot after conducting several interviews. "He said he expected discovery of more viruses like Ebola. And despite today’s much safer laboratory procedures, he added, such virulent pathogens could prove just as dangerous," writes Lawrence K. Altman on Dr. Peter Piot's expertise in working with Ebola.
Dr. Peter Piot was just 27, a budding virologist with a thirst for adventure, when he was dispatched to the heart of Africa to track down a terrifying virus that he had helped discover.
It was 1976, and the virus had arrived at his laboratory in Antwerp, Belgium, in a blue plastic cooler holding two glass tubes of blood. They had been sent from Zaire (now the Democratic Republic of Congo) by a doctor caring for a Flemish nun who was dying of fever and loss of blood.
One tube was intact. The other was broken; its contents mingled with melted ice to form a red soup. A bloodstained note said the nun was among 200 people, including doctors and nurses, dying in an outbreak that had raged for three weeks in remote Yambuku, not far from the Ebola River.
The prime suspect was yellow fever, a mosquito-borne infection that Dr. Piot’s laboratory at the Institute of Tropical Medicine was equipped to detect. But unknown to anyone then, the nun’s blood harbored the virus that was soon to be named Ebola.
In those days, microbiologists were cavalier about protection. As Dr. Piot and his colleagues emptied the thermos, they wore only thin latex gloves — none of the high-security masks and moonsuits that are now standard.
They removed small amounts of blood from the intact tube to carry out routine tests for known microbes and special tests for yellow fever, along with hemorrhagic-fever viruses like Lassa, Marburg and dengue. They also injected the nun’s blood into cells grown in the laboratory and the brains of mice.
The tests excluded all known infectious agents, but Dr. Piot assumed that whichever one had caused the nun’s illness must have been destroyed during the airplane trip from Zaire. Still, he and his colleagues checked the mice each day.
After a week, all the mice were dead, strongly hinting that the infectious agent had not been destroyed after all. An autopsy showed that the nun’s liver had microscopic lesions that Dr. Piot’s boss, Dr. Stefaan Pattyn, knew to occur in Lassa fever. But because Lassa had already been ruled out, Dr. Pattyn steered the research toward identifying a new one.
At the time, only three laboratories outside the Soviet Union were equipped to handle deadly viruses safely: Porton Down, near London; Fort Detrick, a military base in Maryland; and what is now known as the Centers for Disease Control and Prevention, in Atlanta. The World Health Organization instructed the Belgians to immediately send the samples in tightly sealed containers to Porton Down, which, in turn, forwarded them to the C.D.C. because it was the world’s reference laboratory for hemorrhagic viruses.
The Antwerp scientists kept part of the material and looked at it through an electron microscope. It showed that the nun’s virus was a new one — wormlike, and huge as viruses go — that resembled Marburg. C.D.C. scientists then confirmed the Antwerp team’s discovery and named the virus Ebola.
Dr. Piot’s wife was three months pregnant with their first child. Yet scientific curiosity fueled his desire to go to Zaire to undertake the epidemiologic investigations to determine how this new virus spread.
The Belgian government said it lacked funds for such travel — until politics and scientific competition intervened. As American, French and South African scientists who knew about the findings headed to Zaire, the Belgian government realized it would be shutting out its own scientists, and it rushed Dr. Piot to its former colony to study the virus.
Two Belgian nuns with Ebola had been evacuated from Yambuku to Kinshasa, Zaire’s capital, and the specter loomed of an imminent, uncontrolled epidemic of Ebola among the millions living there and beyond. In the few hours he had before his plane left, Dr. Piot raced to amass as much protective gear as he could take along.
In Zaire, he joined an international team of scientists who flew to Yambuku and mapped Ebola’s spread, determining that the principal route was through unsterilized needles and syringes, contact with infected patients and touching bodies at funerals. They also collected blood from patients for later testing and prepared for the arrival of a larger and better-equipped team to control the outbreak.
In four months of field operations, other scientists also discovered a second outbreak of Ebola, in Sudan. Why the virus struck simultaneously in two distant areas with virtually no contact between them was a mystery — just as are the current independent outbreaks of Ebola in West Africa and Congo.
Dr. Piot, who has told much of this story in previous interviews with me and in his 2012 memoir, “No Time to Lose: A Life in Pursuit of Deadly Viruses,” expanded on it in a recent interview in light of the current epidemic in West Africa, the deadliest Ebola outbreak in history.
He said he expected discovery of more viruses like Ebola. And despite today’s much safer laboratory procedures, he added, such virulent pathogens could prove just as dangerous.
“We were lucky not to get infected, not only in the laboratory but later on when I was drawing blood from patients and touching them,” Dr. Piot said from England, where he is now the director of the London School of Hygiene and Tropical Medicine.
He was lucky in another way. In 1976, ordered to fly in a waiting helicopter to meet with visiting Belgian officials in Kinshasa, he smelled alcohol on the pilots’ breaths and refused to go.
Soon after it took off, the helicopter crashed. A few days later, Dr. Piot led a team to retrieve the decomposing bodies from the jungle.
Despite the near-misses, “what dominated was the absolute excitement of discovery,” he said, adding: “I didn’t realize that we were making history in those days,” and “I never imagined that Ebola would become a real public-health problem because until now, the outbreaks, as dramatic as they may have been, have been fairly limited.”
Dr. Piot played a key role in another epidemic. He went to Zaire to investigate cases soon after AIDS was first recognized in the United States in 1981. Later, he directed the United Nations AIDS program for 10 years.
This July, the normally cautious Dr. Piot sounded one of the first alarms that the Ebola epidemic in West Africa was out of control. He publicly called it “a mega-crisis” that required militarylike logistics and control measures like isolation and quarantine of infected individuals and their contacts.
He worried that his message about the world’s tardy response to control Ebola might be hyperbolic, he said, but that he “would rather be accused of overreacting than responding too late or not doing enough.” Now he believes he was “on target.”
But when asked about health organizations’ widely varying projections of the extent of the current Ebola epidemic — one worst-case estimate said it could reach 1.4 million — he said he “would definitely take them with a big grain of salt” because they are “not based on accurate current data, so there are too many unknowns.”
Dr. Piot returned to Yambuku to celebrate his 65th birthday in February, a month before Ebola was first identified in Guinea. Since then, he has not gone to the affected areas in West Africa because of his duties at the tropical medicine school. But there, driven by moral and practical issues, Dr. Piot has set up one of the rare programs to ensure that faculty and staff members who go to West Africa to work on Ebola will continue to be paid, and 163 have expressed interest in volunteering, he said.
“The mortality to medical staff and nurses has been enormous and devastating,” he told me. “Our colleagues are the most affected of all professions, paying a high price for their work, and also infecting others.”
The opinions expressed here are solely those of the author.