The Coming Plague

by Laurie Garrett

  After a day and a half of delirium, Campbell was given a pint of Jordi Casals’s blood antiserum. It was midnight and Campbell barely realized he was being transfused.

  Five hours later he opened his eyes to see his friend Tom Monath worriedly hovering over him.

  “What’re you doin’ in London?” Campbell drawled in his gentle Knoxville accent.

  “We’re getting you out of here,” Monath responded abruptly.

  Campbell had no idea how much anxious negotiation had surrounded his case over the previous thirty-six hours. State Department and White House officials had been in discussions with 10 Downing Street and Whitehall; CDC bosses had kept an open line to their counterparts at the London School; the decision was made to get Campbell onto American soil as quickly as possible.

  That night the Campbells were driven to Heathrow Airport, this time wearing respirators to protect others, and transported in a special ambulance driven by volunteers. Awaiting the couple on the tarmac was a USAF C-141 transfer jet, inside of which was an Apollo space capsule that had been flown from a U.S. military warehouse in Frankfurt, Germany. Sealed off from the outside world, the couple rested in seats designed for astronauts orbiting deep in space. Monath and four USAF medical corpsmen monitored the Campbells during their transatlantic flight.

  When the plane landed at New York’s Kennedy Airport, another special ambulance greeted the group on the runway, taking the Campbells off to Columbia-Presbyterian Hospital.

  For four weeks Kent was treated in the same room in which Casals had once languished. Liz was monitored closely, and remained well. After thirty days, Campbell recovered and was ready to return to his job at the CDC, but officials politely asked that the young doctor “take a little time off”: it seemed many employees of the world’s most prestigious disease control agency were afraid Campbell might still harbor contagious infection.

  During his time off, Campbell got a bill from the U.S. Air Force: $17,000, payable immediately, for medevac airlift services. Kent shrugged and passed the bill on to CDC director David Sencer, who gruffly sent it back to the Defense Department.

  In recognition of his recent hardship, CDC officials next gave Campbell a choice assignment in Hawaii, where he and Liz spent several weeks during a rubella outbreak. Upon returning to Atlanta, his obligatory conscientious objector stint at CDC nearly completed, Campbell spotted a help-wanted notice on an agency bulletin board: “Chief Malaria Control Officer: El Salvador.”

  Kent Campbell re-upped with the CDC, and in 1973 he, Liz, and their two small children moved to San Salvador for what was supposed to be a two-year assignment.

  It eventually became a four-year assignment that completely changed Campbell’s life, giving him a newfound concern for malaria control and the health problems of people in developing countries.

  While the Campbells settled into their new lives in El Salvador, Uwe Brinkmann paced like a lab rat inside the Ebstorf smallpox containment facility, and pondered the stories of Casals, Pinneo, Campbell, and Roman. He knew his predicament in Germany stemmed from all those past incidents, and the high death toll the virus had claimed among Americans and Europeans working in Africa. He thought of all the mysteries surrounding Lassa, and wondered if he had become infected while tending to Mandrella.

  It felt as if a lifetime had passed, but it was just days ago that Brinkmann, the controversial “hippie doctor,” had met Casals in Ibadan. The CDC now made it a practice to send the sixty-three-year-old Casals to investigate all reported Lassa outbreaks. In five years he had seen two serious outbreaks, and arrived in Ibadan in 1974 to witness his third.

  For Casals, the Ibadan case was a tiny episode, highly exaggerated by international press attention and government panic on three continents.

  When Casals arrived, Brinkmann stepped out of the group’s Nigerian isolation house to greet the famous scientist, who, characteristically, brushed aside the young German, barged into the building, and went straight to Mandrella’s bedside.

  Casals carefully examined Mandrella, surprised to discover the patient was recovering. Dr. Hal White, who had attended to Jeannette Troup when she succumbed to Lassa four years earlier, had provided Mandrella with a unit of Penny Pinneo’s antiserum. And English physician Adam Cargill was looking after the ailing man. Cargill, then thirty-four, was on the faculty of the University of Ibadan Medical School.

  “What a ridiculous international brouhaha!” Casals thought. In Lagos, Nigerian government officials had informed him, “There is no Lassa fever in this country. Period. So the German must have brought it here.”34

  Angrily Casals thought, “So nice. They eliminated the disease by saying it didn’t exist.”

  Meanwhile, the Catholic Church, which ran St. Charles Mission Hospital outside Enugu and had employed both Sauerwald and Mandrella, alerted the German Foreign Ministry and the Tropical Disease Institute (Tropeninstitut) in Hamburg, raising concern in Germany. On March 15, 1974, Ibadan’s Catholic bishop, Richard Finn, officially requested, on behalf of Mandrella, help from the German government.

  The Nigerians insisted that the German must take “his disease” back to Germany, along with all the Nigerians and others he may have touched. Panic escalated, and no nation between Nigeria and Germany would grant permission for a suitably small aircraft to land en route for refueling.

  “Ideally, the patient should remain exactly where he is, tended to by the apparently able nurses and these Brinkmann and Cargill fellows,” Casals thought, knowing that the stress of traveling could aggravate a condition that otherwise appeared to be improving.

  The Lassa expert then focused on Brinkmann, briefly conveying his view that the patient’s condition was no longer acute and it would be best for all if he remained exactly where he was. After all, Casals said, transport would only aggravate the patient’s pain and increase the number of people worldwide who could be exposed to Mandrella’s breath and bodily fluids.

  Brinkmann agreed wholeheartedly, and waved goodbye to Casals, hoping the highly respected scientist would succeed in convincing Nigerian and German authorities of the folly of their transport plans.

  Unbeknownst to Brinkmann, Casals flew immediately to WHO headquarters in Geneva, where he tried, in vain, to argue for calm. He knew his was a lost cause when he scanned the German and French newspapers on sale at the kiosk located in the organization’s lobby.

  For days the German press and, to a lesser degree, British and French media were spellbound by the saga of Lassa and the German doctor.

  “Who Will Save This Physician?” screamed a Diepahtzer Nachrichter headline, adding, “A scandal!”35

  The Bild Zeitung ran huge portraits of Brinkmann, depicted as a heroic figure who was braving death to rescue a colleague. Alongside the frontpage story was a sidebar describing practice sessions held by the Hamburg fire brigade and police department, in preparation for Mandrella’s top security arrival and transport to hospital facilities.36

  Such flattering articles were common, and of no help to Brinkmann, whose colleagues considered his journey to Nigeria distasteful. Germany in 1974 was, like the United States, experiencing an enormous generation gap that affected every aspect of society, including science. Brinkmann, with his tie-dyed T-shirts, long hair, and Indian sandals, became a lightning rod for the resentments of older, more traditional tropical disease experts. When the German Foreign Ministry contacted the Tropeninstitut in Hamburg on March 16 asking for information about Lassa, Brinkmann eagerly offered his services. But some older scientists, notably virologists Godske Nielsen at the Tropeninstitut and Fritz Lehmann-Gruber, acting director of the Virology Institute of Hamburg University Hospital, felt it was foolhardy to bring Mandrella back to Germany. They argued that such an effort was overly dangerous for everybody, including Mandrella.

  Lehmann-Gruber went
further, telling the German press that bringing Mandrella into the country could lead to a Teutonic Lassa epidemic.37

  “We don’t know whether the virus may not find an ideal vector,” Lehmann-Gruber told Bild-Hamburg.38

  “Are you talking about an insect?” the reporter asked.

  “Yes, a fly. A mosquito. All is possible,” Lehmann-Gruber responded, adding, “The danger [of bringing Mandrella to Germany] is still incalculable.”

  For Brinkmann such talk seemed utterly absurd. Having spent years in Ethiopia with his scientist-wife, Agnes, Uwe knew Europeans tended to exaggerate the dangers of African diseases. And in a manner typical among peers of his generation, Brinkmann favored immediate action. Brinkmann told the institute director he’d gladly take vacation leave immediately and fly at his own expense, if necessary, to aid Mandrella. Brinkmann’s offer was made in a room full of Tropeninstitut staff in response to the director’s request for a volunteer.

  “No, Uwe, you can’t do it,” the director said. “You have two little children.”

  Brinkmann shuddered for an instant, thinking of his sons, Patrick, age two, and four-year-old John Vincent. But no other hands were raised.

  The director took Brinkmann up on the offer, handing the young scientist cash—drawn from his own wallet—for the airfare.

  After Brinkmann arrived in Lagos, the German press started making trouble, fueling the debate between Uwe and his opponents, by building him up as a hero. On March 18, a day after Uwe left Germany, a national television correspondent visited Brinkmann’s mother.

  “How does a mother feel whose son is flying off to death?” the reporter asked.

  Unaware of Uwe’s departure, Mrs. Brinkmann invited the TV crew to take tea in her living room, and answered their question with one of her own: “Who is so crazy to ask him to do something like that?”

  Meanwhile, the German government, now convinced Lassa was akin to the Andromeda Strain, was frantically trying to find some form of airtight container in which to transport Mandrella. On March 19 the answer seemed at hand when headlines declared, “Danke! Kissinger Will Save the Fever Physician.”39 U.S. Secretary of State Henry Kissinger offered the use of an American military transport plane to fly an Apollo space capsule to Nigeria. Mandrella and Brinkmann would then board the airtight capsule, as had Kent Campbell eighteen months earlier, breathe filtered air, and remain so encapsulated for several hours’ flight time from Ibadan to Hamburg. It was a precaution considered brilliant by the German press and political hierarchy, but paranoid by experts like Casals.

  While the German, American, and Nigerian governments debated the relative merits of using the Apollo spacecraft, Mandrella and his caregivers grew increasingly anxious in Ibadan. Mandrella had been sick for nearly a month (his symptoms began February 22); and the three men, the nun, and the two nurse assistants had been under virtual house arrest for days. For the three chaste Nigerian women, being co-housed with men was particularly disgraceful, and they greatly feared their reputations would be damaged.

  Dr. Cargill was especially agitated. He feared the Nigerian government would mount a campaign of blame against him, primarily because he—the Lassa victim’s physician—was a citizen of Nigeria’s former colonial power. He paced the small house anxiously, thinking of his wife, Alice, and their two small children—all safely tucked away in Sussex, England.

  When he developed serious diarrhea and a mild fever, Cargill was convinced that he too had Lassa. Fear within the group escalated. Brinkmann tried to calm everyone down, saying, “I know in my gut we’re all going to survive.”40

  Finally, on March 21, a specially outfitted Lufthansa Condor jet landed at the Ibadan airstrip. The three foreigners and the three Nigerian women were driven to the tarmac, and Mandrella, languid on a stretcher, was placed on a forklift and loaded in the cargo entry of the jet. The others climbed stairs to the plane, finding no comfort inside. To protect the flight crew, German engineers had gutted the passenger section of the aircraft, placing a huge airtight barrier between the plane’s tail section and the forward crew compartment. In addition, special air circulators were installed, providing the two halves of the craft with separate oxygen supplies. No flight attendants greeted the group; just a forbidding, barren compartment. 41

  Brinkmann, the last to board, took his seat before realizing there was no crew in their section.

  “Close the door immediately!” the captain shouted over the plane’s public-address system. Brinkmann jumped out of his seat and stared at the pressurized door, upon which were printed two pages of instructions on proper methods of closure and opening.

  “We are leaving immediately. Close the door now!” the pilot said.

  “Well, here goes nothing,” Brinkmann thought, as he grabbed the door, pulled and twisted the handles, and hoped he had safely sealed them in their strange cabin to Deutschland.

  When the plane landed hours later at the Hamburg airport the door was opened by a man dressed in a white head-to-toe outfit reminiscent of astronaut’s gear over which he wore a huge clear plastic bubble that enclosed his legs from the knees up and all of his torso and head. From the bizarre inflated bubble protruded his arms, which flopped about almost helplessly. A long plastic hose connected to the back of the bubble provided the man with a germ-free atmosphere.

  “This is like a scene from a bad science fiction movie,” Brinkmann told his fellow travelers.

  The fantastic bubble creature waved his arms clumsily, beckoning the group out of the plane. Three other bubble men ushered them into a waiting van and carried Mandrella’s stretcher.

  In the process, one bubble man fainted for lack of oxygen, and shouts of “The virus! The virus!” went up among the security entourage. For a few moments the operation was seized with panic.42

  When they were on their way into the woods, and Brinkmann was struggling to suppress his concentration camp fantasies, he shared an anxious glance with Mandrella. Only later, during their long days of captivity in Ebstorf, would Mandrella tell Uwe that he too had momentarily thought of the Third Reich, remembering his father’s execution and the almost unbelievably cruel “bill for hanging” his mother had received.

  Until their release from Ebstorf on April 20, the sextet had only occasional telephone contact with the outside world. All papers, food, garbage, clothing, and medicines were sterilized or destroyed when passed out of the facility through specially designed airlocks.43

  Every day Agnes would bring Patrick and John Vincent to Ebstorf to wave at their father from behind a chain-link fence some twenty yards from the containment facility. Groups of nuns and Catholic parishioners would also gather at the fence to pray for the three Nigerian women and their missionary doctor. Pictures of the chain-fence gatherings graced the pages of German newspapers for over three weeks.

  Inside, Brinkmann tried to keep the sorry spirits of the group buoyed with jokes. His sense of humor tending to sarcasm, Uwe told the group, “We could go out right now and become millionaires. It’s true! We could walk right out of here, rob the biggest bank in Germany, hijack an airplane, and spend the rest of our lives in luxury on some tropical island. No one would dare stop us, they’re all so afraid of the virus.”

  On March 28, Der Stern, one of Germany’s two most popular news magazines, published a lengthy article praising Brinkmann. Describing his hippie attire and disheveled appearance, the magazine declared Brinkmann a far greater physician than, for example, Dr. Ernest Fromm, then head of the German Physicians’ Association. Fromm was under investigation for allegedly embezzling funds.44

  The day the article was released a public relations manager for the federal Health Ministry called Brinkmann in the Ebstorf facility, accusing the young doctor of planting the article as a deliber
ate smear against Fromm.

  “You better never come back to Hamburg!” the PR man said. At that moment Brinkmann knew his efforts on Mandrella’s behalf were going to demand a high career price.

  Cargill feared he too would pay for his actions. A slim, nervous man, Cargill anticipated the worst, and carefully monitored news from Nigeria. Indeed, he was fired in absentia from his hospital job, and the Lagos press accused him of being responsible for the mini-epidemic.

  “An expatriate doctor … almost caused an epidemic of the disease in Ibadan by arbitrarily getting in contact with a patient of the killer disease,” said Lagos press accounts.45

  When CDC laboratory tests finally confirmed that all six people in the Ebstorf containment facility were free of the Lassa virus, Mandrella having recovered and the others never having been infected in the first place, the group was released. A department store gave the Nigerian women an allday free shopping spree as compensation for their long captivity. Mandrella quietly retreated to the company of German friends for several more months of recuperation, Cargill joined his family in Sussex, and Brinkmann—despite the warnings of some—returned to the Tropeninstitut.

  He found an atmosphere deeply polarized by the Lassa virus events. On one extreme, the federal government offered Brinkmann one of the country’s highest medals, which he discreetly declined. On the other, many old-guard scientists bitterly denounced Brinkmann’s actions and demanded his resignation. At the director’s insistence, Brinkmann took his family on a vacation to allow time for things to cool down in Hamburg.

  Two weeks into their vacation, John Vincent went to play in a friend’s flat. While adult eyes were briefly turned away, the energetic four-year-old jumped and leapt about, misjudged his footing, and fell out of the apartment window.