In the summer of 2013, the rivals were at a scientific meeting in Maryland, and Hensley invited them out for drinks at a bistro called the Green Bamboo. Hensley, Zeitlin, Olinger, and Kobinger sat outdoors at a patio and started drinking. Gary Kobinger, in addition to doing space-suit research, specialized in digging graves for Ebola victims during outbreaks, and he regaled the others with stories of nearly getting killed by rioting people who thought he was doing horrible experiments on the bodies. Hensley left early in order to put her son, James, to bed, but the others talked on. They agreed to pool their secret antibodies, and would try to create one best Ebola drug, a drug to rule them all. This superdrug would be a combination of the three most powerful antibodies they could find. Olinger called it a cocktail of antibodies. Hensley later began referring to the meeting as the Green Bamboo Armistice. The three leaders were now fully collaborating, and they made plans to start testing antibodies in guinea pigs rather than in mice. This was a step up a ladder of testing that might someday culminate in a human test of a drug that might or might not cure Ebola.
At the same time, Gary Kobinger in the Canadian lab was working on the experimental vaccine for Ebola called VSV-ZEBOV. It had originally been developed in the early 2000s by an Ebola researcher at USAMRIID named Thomas Geisbert, along with colleagues of his. Geisbert’s team, which included Lisa Hensley, had tested VSV-ZEBOV vaccine on primates, and it seemed to protect them from Ebola infection. However, the team ran out of money. Agencies that provided money for biomedical research had little or no interest in spending money on a vaccine for Ebola. The virus was considered to be easy to control and no danger to the mass population. Gary Kobinger, however, felt that biodefenses against Ebola should be a high priority. He got money from the Public Health Agency of Canada and began testing the VSV-ZEBOV vaccine in his Level 4 lab in Winnipeg.
WINNIPEG
January 14, 2014
Five months after the Green Bamboo Armistice agreement to develop an antibody cocktail drug for Ebola—and just as Ebola was killing the little boy’s family in Meliandou village—Gary Kobinger started testing different Ebola-killing antibodies in guinea pigs in his Winnipeg hot zone. Some of the antibodies had come from Gene Olinger at USAMRIID and some from his own lab. He tested the antibodies in combinations, seeing which combinations were the most potent at stopping Ebola in a guinea pig. Kobinger, Olinger, and Zeitlin decided to name the drug ZMapp. They made plans to test it in monkeys.
Meanwhile Larry Zeitlin, at Mapp Bio, had worked out a deal with a drug-manufacturing facility called Kentucky BioProcessing, in Owensboro, Kentucky, to start making pharmaceutical grade ZMapp—a purified version of the drug. During the spring of 2014, as the Ebola outbreak sharpened, Kentucky BioProcessing began producing very small quantities of ultra-pure ZMapp—for use in animal experiments, not for people.
The manufacturing process was tricky. By June, the Kentucky factory had produced only a small batch of ultra-pure ZMapp. Of this batch, there were six official extra courses of the drug: excess supply, which wasn’t earmarked for lab experiments. Each course of ZMapp consisted of three doses of the drug, in three small plastic bottles or vials of frozen salt water containing dissolved antibodies. These extra courses, numbered one through six, were being stored in a freezer at Kentucky BioProcessing and at a secure facility elsewhere. Courses 1 through 6 had each cost about $100,000 to manufacture.
That wasn’t all. There was yet one more course of ZMapp. An undisclosed, unofficial course. In this book it will be referred to as Course Zero. Course Zero of ZMapp was sitting in a secure freezer at a location somewhere known to the inventors of ZMapp. Course Zero was a hidden, rainy-day supply of the drug.
Officials at Doctors Without Borders had been hearing about ZMapp, and in April they asked Mapp Bio to send some of the drug to Switzerland in case one their international workers came down with Ebola. Mapp Bio then sent one of the seven courses of ZMapp to the World Health Organization in Geneva. This was Course 1 of ZMapp, earmarked for emergency use by personnel from Doctors Without Borders or from any other international medical group. Courses 2 through 6 remained in the freezers in Kentucky and elsewhere.
WINNIPEG
June 2
A week after the first Ebola patient was admitted to the Kenema Ebola ward, Gary Kobinger began a test of ZMapp in monkeys. He and a colleague named Xangguo Qiu climbed into their space suits and went through the airlocks into a hot zone at the Canadian National Microbiology Laboratory. In the hot zone, twenty-one rhesus monkeys were being housed in cages. Kobinger and his colleague injected each animal with a massive dose of Ebola, enough of the virus to guarantee the animal’s death. Then, in the following days, as the animals got sick, the scientists started giving them doses of ZMapp, to see if the drug would prolong the monkeys’ lives.
Right after Gary Kobinger began the monkey experiment with ZMapp, he flew to West Africa with a group of Canadians on a volunteer mission to work with Doctors Without Borders. Just then the Doctors were building an Ebola treatment center—an encampment of white tents—in a town in Sierra Leone called Kailahun, which is in the Makona Triangle, about seventy miles from Kenema. Kobinger planned to set up a portable blood testing lab at the Doctors’ camp, and after that he planned to work as a gravedigger at the camp.
Kobinger decided to bring some ZMapp with him in case he caught Ebola from a corpse. If this happened, he figured he would make himself the first human experiment with ZMapp. The drug had never been inside a person, and there was no way to tell whether it was safe. In fact, as Kobinger knew, there was a decent chance the drug would throw him into allergic shock and kill him in five minutes. At least it was better than dying of Ebola. On June 18, Kobinger packed the three bottles of frozen, ultra-pure ZMapp into a white foam cooler. This was Course No. 2 of the drug, intended for emergency use by him or any member of his Canadian team.
A few days later, Kobinger and his colleagues arrived at the Ebola Treatment Center of Doctors Without Borders in Kailahun, Sierra Leone. Kobinger placed the foam cooler containing Course No. 2 inside a freezer in a laboratory tent at the camp. After setting up the blood-testing equipment, Kobinger went to work digging graves. By early July he had buried many dead bodies.
The virus was beginning to spread more widely. By July 2, there had been 413 cases reported in Guinea with 303 deaths. In Sierra Leone, there were 239 cases with 99 reported deaths. The virus was now starting to hit hard in Liberia, too, where there had been 107 reported cases with 65 deaths. Ebola had been working its way through Conakry, the capital of Guinea, for a while. And now the virus was beginning to appear in Monrovia, the capital of Liberia.
FREDERICK, MARYLAND
July 1
Lisa Hensley, at the Integrated Research Facility at Fort Detrick, had been watching the growth of Ebola cases with apprehension. By the middle of June it was clear to her that the virus was going to blow up in Liberia. She began to make plans for a second tour of duty with the Department of Defense, to go back to the blood lab at the former chimp station. She had been in constant contact with the Liberian technicians there; they were running out of basic supplies, and they needed more equipment. They were testing more blood every day, and finding more Ebola.
James’s school was ending and summer vacation was about to start. She signed him up for various summer camp programs at the local YMCA, and engaged her mother and father, Mike and Karen Hensley, to come to Frederick and stay with James while she was deployed overseas. As she talked with her son about her plans for West Africa, she thought he didn’t seem worried about her this time. In fact, he was annoyed. He asked her how long she was going to be gone this time. She made a deal with him: After she got back from Africa, they would take that trip to South Carolina and have a summer vacation on the beach.
Hensley’s friend Rafe didn’t like the idea of her going back into the outbreak just as it was exploding. He asked her to reconsider her pl
ans to deploy. He was afraid she would take risks and would expose herself to the virus. Rafe had children of his own. He said to her that James should come first for her, and that she shouldn’t risk her life trying to save other people when she had James to think about.
But Hensley thought that it was important for a parent to set an example. People needed help, and she was an expert in Ebola. She had seventeen years of experience in space suits handling dangerous pathogens, including smallpox. She would never put herself at risk, never. If she chose not to help and turned her back on people who were dying, what lesson would James take from that? Children miss nothing.
Hensley started collecting space suits and gear. She packed everything in footlockers, and the Department of Defense made flight arrangements for her.
Then, on the first of July, Hensley got an email from her friend and colleague Gary Kobinger, who was working as a gravedigger at the Doctors’ camp. The news was stunning.
WOW
DOCTORS WITHOUT BORDERS EBOLA TREATMENT CENTER, KAILAHUN, SIERRA LEONE
July 1, 2014
It was evening in West Africa, and Gary Kobinger was sitting with his laptop computer in a plastic tent, just outside the red zone of the camp, and he opened an email from Xangguo Qiu, his colleague in Winnipeg who had been testing ZMapp in monkeys. She had incredible news. She had just finished the monkey experiment. Eighteen dying monkeys had been given superlethal doses of Ebola. And ZMapp had cured all eighteen, rescuing some of them when they had been only hours from death. In some of the dying animals, ZMapp reversed the symptoms of Ebola in ninety minutes.
A ninety-minute cure for Ebola? A hundred percent efficacy rate, even when the animals were hours from death? Results like this simply don’t happen in pharmaceutical research. It seemed impossible. Kobinger started emailing people who had contributed to the development of the drug, telling them about the results. They quickly began referring to the monkey experiment as the Wow experiment, because everybody was typing Wow in their emails. But the Wow experiment was unpublished. Nobody knew about it except the people who were in the email chains. And the inventors of ZMapp understood that humans aren’t monkeys. Just because ZMapp cured monkeys didn’t mean the drug would do the same thing in a human. It might do very little. It might kill a human. It might kill Ebola. Nobody knew what ZMapp would do inside the human body.
KENEMA GOVERNMENT HOSPITAL
First week of July
In the days after Wahab the Visioner predicted that many nurses and an important doctor would die at the Kenema hospital, the hospital went into total crisis. Nurses working in the Ebola ward started skipping work. They still hadn’t received their $3.50 a day in hazard pay from the government of Sierra Leone. By this time there were three Ebola red zone wards at Kenema Government Hospital; collectively they were known as the Ebola Treatment Center. The three wards held, in total, somewhere between seventy and ninety people infected with Ebola, a number that was steadily climbing, even as many patients died and their bodies were removed. Ebola patients were coming from all over eastern Sierra Leone, riding in taxis or clinging to the backs of family members driving motorbikes. Some of the Ebola victims being carried on the motorbikes were already dead. The bike rider would dump the body at the hospital gates and speed off.
Of the three red zone wards in the Ebola Treatment Center, the first was the original Ebola ward, formerly the Lassa ward, with a normal capacity of twelve beds. This ward now contained about thirty Ebola patients.
The second ward was the Annexe ward, where Lucy May had worked. It was situated near the Ebola ward, and had been converted into a ward for holding patients who were suspected of having Ebola but hadn’t yet gotten results from blood tests.
The third ward was a large tentlike structure, with white plastic walls and a metal roof, which had been constructed in late June in a field on the hillside below the Ebola ward. It was called the Tent. By early July the Tent held around thirty Ebola patients lying in cots. The three wards were being tended by just a handful of nurses, who were running out of disposable hazmat suits and equipment. In fact, a severe shortage of hazmat suits had developed at the hospital.
The beds in the Tent were of a certain type that is common in African hospitals, known as a cholera bed. A patient with cholera suffers from uncontrollable watery diarrhea. A cholera bed has a plastic-covered mattress with a hole in the center. A bucket is placed on the floor under the hole and the patient defecates through it into the bucket. This system didn’t work well in the Tent. There was a lot of splashing when a patient defecated into a bucket, and patients fell out of bed, got deranged, and wandered, knocking over the buckets. A small number of Ebola nurses were working inside the Tent, emptying the buckets, but it became impossible to keep things clean.
There was a plastic window in the Tent so that people could see and talk to their loved ones inside. Family members of Ebola patients stood behind a protective fence and looked into the window. There were shouts of joy and surprise when a patient came to the window and family members could see the person was alive, and there were cries of sorrow when news came that someone had died in the Tent. Some in the crowd were silent, baffled by the moon suits worn by the nurses and doctors.
Humarr Khan was doing rounds through all three wards.
Michael Gbakie, the epidemiologist and biohazard control officer, was Khan’s deputy, the number two operations manager of the Lassa program. As the situation grew chaotic, Michael stayed close to Khan. Khan carried three cellphones. As Khan prepared to enter the red zone, he would hand his phones to Michael and step inside the cargo container staging room, and would put on his suit and gear. There was a full-length mirror in the container. He would stand in front of the mirror and stare at himself, turning himself around, inspecting his gear for flaws. He called the mirror “the Policeman.” He said to a reporter from Reuters, “I’m afraid for my life, because, I must say, I cherish my life.” After inspecting himself in the mirror, he would round all the Ebola wards.
Khan’s three phones rang constantly while he was rounding the red zones. Michael Gbakie would answer the phones and jot messages on slips of paper. When Khan finally came out of the wards and took off his gear, Michael would hand him a stack of paper slips.
People were calling him from everywhere—government officials, doctors, officials from the World Health Organization, international scientists, officials of nonprofit medical aid organizations, families and patients in Kenema. Khan was also making calls everywhere, seeking help for Kenema. Khan and the district medical officer, Mohamed Vandi, spent hour after hour, day after day, on their phones pleading with the minister of health for the promised $3.50 in hazard pay for the Ebola nurses. They made calls all over the government in Freetown looking for the money, which simply didn’t arrive. The Ebola nurses were earning their regular five dollars a day, but after the horrifying death of Lucy May, many of the Ebola nurses couldn’t bring themselves to go into the wards for that amount.
On July 7, Dan Bausch, Humarr Khan’s friend and mentor, who’d recruited him to lead the Lassa program ten years earlier, arrived at the Kenema hospital as a WHO volunteer. Bausch, Khan, and the U.S. Navy doctor David Brett-Major started making rounds together through the Ebola wards. They tried to make sure that dehydrated patients were getting IV saline and that all the patients had access to drinking water and some food, if possible, but that was about all they could do. Every surface inside the Tent and the Ebola ward was covered with a film of Ebola particles.
Khan was under strain. He became irritable, exasperated, prone to flashes of paranoia. He became angry with Lina Moses for reasons that seemed very obscure. He would disappear for hours at a stretch, and nobody seemed to know where he was. “I’m going off to take a nap,” he would say to colleagues. He was still seeing some patients in his private clinic. Possibly he felt he could help his private patients, when he couldn’t help anybody in the Ebola
wards. Who was Khan taking care of? To some observers, it seemed that Khan was failing his nurses.
In early July, a WHO doctor named Timothy O’Dempsey started working in the Kenema Ebola wards. Later he published a description of what he witnessed.
The ETC [Ebola Treatment Center] was poorly maintained and disorganized, with grossly inadequate attention to infection prevention and control (IPC) procedures; evidence of numerous structural and procedural breaches; and catastrophic standards in hygiene, sanitation, and management and disposal of medical waste and corpses. Essential treatment supplies for patients and personal protective equipment (PPE) for staff were woefully inadequate and only haphazardly available. Staff morale was at an all-time low; the nurses were on strike….As they witnessed increasing numbers of their colleagues fall ill and die, [the nurses felt] a growing sense of inevitability that they would be next.
Humarr Khan was the physician in charge of the Ebola wards. Did he look like an incompetent, cowardly doctor, a man not up to the job? Was he failing his nurses and staff, failing the patients? He was getting blamed for the horror in the wards; maybe he deserved it. He was the doctor in charge.
Alex Moigboi, the senior Ebola nurse, continued working twelve-hour shifts in the Ebola ward and in the Tent, going back and forth between the two wards. A sensitive, gentle person, Alex had devoted himself to caring for Nurse Lucy May when she was in the nook at the back of the Ebola ward. Alex and another night nurse named Edwin Konuwa were tending sixty Ebola patients by themselves, all night. There was no electricity in the Tent, and at night the ward went totally dark. Alex continued working with patients in the dark tent at night, talking with them, trying to comfort them, feeling around with his hands in the dark. He seemed unable to leave the Ebola wards. Then Nurse Edwin Konuwa broke with Ebola and ended up in the Ebola ward as a patient. Alex cared for him, too.
Crisis in the Red Zone Page 24
