An epidemic strikes the United States, plunging the country into chaos. New York Times medical reporter Denise Grady uses this terrifying scenario, taken from the pages of a U.S. government report on the potential outcome of a pandemic, as the starting point for a journey into the gripping world of emerging diseases.
In search of a better understanding of these often deadly diseases, Grady heads to Angola, the site of the 2005 Marburg virus epidemic, a disease closely related to Ebola. On the ground, and sometimes frighteningly close to victims of the disease, Denise explores the realities of health care in the developing world, and its potential effects on our own welfare.
With supplemental sidebars that explain key scientific and social issues and
in-depth chapters on the origins and spread of Marburg, avian flu, HIV, SARS,
West Nile virus, hantavirus, and monkeypox, this is a fascinating look at the health dangers we face in a global society.
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Denise Grady has been a science reporter for The New York
Times since 1998 and has written more than five hundred
articles about medicine and biology. She is the recipient of
numerous awards, including a commendation from the
Newspaper Guild for Choice and Excellence of Crusading
Journalistic Contributions in the Areas of Science and
Medicine. She lives in Westchester, New York.
Monday, April 11, 2005
Standing in a tent outside the Américo Boavida Hospital in Luanda, Angola, I
peeled off my sweaty blouse and jeans and pulled on a green hospital scrub
shirt and pants. It was noon, hot and humid—a typical day in southwestern
Africa—and it felt as if there were no air in the tent. A rooster crowed from a
field of weeds just outside, and as I tied the drawstring on my pants I
thought, I've been writing about medicine for twenty-five years, and I've never
been to a hospital with roosters before. The scrubs, not long off the
clothesline, felt damp, and they reeked of bleach. But it was a reassuring
smell. The tent had been pitched as a changing room for doctors and nurses
just outside a building that housed the "hot zone," a special ward created for
patients infected with the deadly, contagious Marburg virus. Bleach was the
best way to kill the virus on clothing, equipment, and even people's hands.
It was my third day in Luanda, Angola's capital, a teeming city of four million
where SUVs zigzagged around gaping potholes and women strode gracefully
by with enormous baskets of bread or fruit balanced on their heads. About
180 miles (290 kilometers) north of us, the province of Uige (pronounced
Weej) was in the grip of the world's largest epidemic ever of Marburg fever.
There is no cure for Marburg. By the time I arrived in Angola, of 214 people
who had caught it, 194 had died, usually after being sick for only a week. It
was a shockingly high death rate, among the worst for any infectious
disease. Of the first 100 or so victims, many were babies and small children.
The outbreak had taken Angola by surprise, and no one knew exactly how,
where, or when it had started.
Although Marburg had first been identified in blood samples from patients in
Uige in March of 2005, it had probably been killing people for months before
that, maybe since October of 2004. Much of that time, doctors had probably
been mistaking it for something else. There is so much disease in Africa—
malaria, diarrheal infections, and yellow fever are just a few examples—that it
is easy for a new illness to sneak in and gain a foothold. That is precisely
what Marburg did: it blended in and got such a head start on doctors and
health officials that suddenly, before they even knew what was happening,
they had an epidemic on their hands. The disease was still spreading. Virus
experts had flown in from all over the world to try to stop it. Tomorrow, I would
fly to the center of the outbreak, Uige.
From New York, where I work at The New York Times, I had been following
reports from the World Health Organization about the epidemic in Angola,
and urging (some might call it pestering) the paper to cover it. American
newspapers were not writing much about the disease. Finally, when I sent
around an e-mail noting that the outbreak had officially become the largest
known Marburg epidemic ever, one of my editors said, "Do you want to go?"
"Sure," I said—and wondered immediately what I had volunteered for. But, I
must admit, the disease fascinated me. I was a biology major in college, and
the student in me wanted to know more. The reporter in me wanted to tell the
story of the crisis in Angola.
Some people thought going there was a crazy idea. Colleagues, relatives,
and friends asked if I wasn't afraid I would catch the disease myself.
Of course I was afraid. I would be walking into an epidemic of a contagious,
incurable, and usually fatal disease, in an isolated part of a poor, crumbling
nation with a shaky health-care system. At least one doctor and several
nurses in Uige had caught the disease from their patients and died. The
incubation period—the time between when a person is infected and when he
or she becomes sick—is short, between three and ten days. I knew that if I
became infected in Angola, I would probably die there, too.
But at the same time, I thought it should be possible to report on Marburg
without catching it. Infected people aren't contagious until they start having
symptoms, so I wouldn't have to worry around people who weren't sick. Even
then, the virus does not spread through the air. To catch it, you have to
touch body fluids like blood, vomit, and urine from sick patients. Many people
in Angola became infected from taking care of others with the disease.
Corpses, teeming with the virus, are especially dangerous, and some
Angolans got sick and died from washing the body of a dead relative to
prepare it for burial.
It seemed to me that if I didn't get close to sick people or dead bodies, and
took care about where I went and what I touched, I should be able to avoid
the virus. I would be interviewing experts in infectious disease, and I decided
that I would follow their advice and do whatever they did to keep from being
Still, there was a risk. The odds of not coming home were small, but real.
Even without Marburg, Angola wasn't the safest place. It had been torn apart
by civil war from 1975 to 2002, and the countryside was still littered with land
mines, so there were many areas where you simply couldn't walk or ride.
Outside Luanda, you weren't even supposed to drive up on the shoulder of
the road to pass another car, because the shoulders had been planted with
land mines. Medical care was poor, except in Luanda. Law and order were
sketchy. The U.S. State Department Web site warned that bandits might
stop cars along roads outside Luanda, especially at night, and that the police
had been known to rob people. The State Department also said, "Police and
military officials are sometimes undisciplined, and their authority should not
be challenged." Even getting in and out of Angola could be tough, because
there had been incidents in which officials at the airport pulled scams,
detaining travelers or threatening to vaccinate them with unsterilized needles
unless bribes were paid.
I booked flights and a hotel in Luanda, applied for a visa, and saw a doctor
who specialized in travel medicine. He prescribed pills to prevent malaria and
antibiotics to carry in case I got sick from tainted food. He also gave me five
shots: vaccinations against polio, meningitis, hepatitis A, typhoid, and yellow
fever. But there was nothing that could protect me from Marburg fever—
except, perhaps, my own common sense.
I left New York on Thursday night, April 7. My arm was still sore from the
shots. My suitcase was stuffed full of mosquito repellent, germ-killing hand
cleaner, PowerBars, and packages of nuts in case I found myself in places
with no food, or food I was afraid to eat. I was wearing a money belt hidden
under my clothes, with about $4,000 in it. It made me nervous to carry so
much money, but drivers and translators—the official language in Angola is
Portuguese—would be expensive and would have to be paid in cash.
On the first leg of the trip, a flight to London, I sat next to a man who had
traveled quite a bit in Africa.
"Fortunately," he said, "I've always been able to avoid Angola."
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