Part two: A virologist’s tale of Africa’s first encounter with Ebola
Peter Piot, currently director of the London School of Hygiene & Tropical Medicine, has become one of the world’s most respected epidemiologists because of his work on the viruses that cause AIDS and Ebola. In the first excerpt from his 2012 memoir No Time to Lose, Piot recalled identifying a new virus behind a deadly outbreak in Zaire in 1976—the debut of Ebola virus. In this second excerpt, he and colleagues go into Zaire’s hot zone and, with the help of nuns who had survived, make a tragic discovery about how the virus had spread among pregnant women.Mission in YambukuI examined her blood, and it was a catastrophe. The platelet count was terrifyingly low. As green and unimaginative as I was, the real lethality of this virus began to sink in, and my hands shook a little as I handled her blood. Who knew how this virus was transmitted—by insects, or body fluids, or dust.I cut short the Paris weekend and quickly returned to Antwerp, where my boss Stefaan Pattyn and my colleague Guido Van Der Groen met me in the lab, together with Dr. Kivits, head of the health section of the Department of Development Aid in Brussels. We spent a few hours hunting down protective gloves and masks and some basic lab equipment. I tried to familiarize myself with the procedures for maximal protection from hazardous viruses, both in the lab and in the field. It basically means protecting your eyes, mouth, nose, and hands, and avoiding needle pricks. Guido gave me some motorbike goggles, which turned out to be extremely useful.Sign up for our daily newsletterGet more great content like this delivered right to you!Country *AfghanistanAland IslandsAlbaniaAlgeriaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBolivia, Plurinational State ofBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCongo, The Democratic Republic of theCook IslandsCosta RicaCote D’IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland Islands (Malvinas)Faroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and Mcdonald IslandsHoly See (Vatican City State)HondurasHong KongHungaryIcelandIndiaIndonesiaIran, Islamic Republic ofIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People’s Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People’s Democratic RepublicLatviaLebanonLesothoLiberiaLibyan Arab JamahiriyaLiechtensteinLithuaniaLuxembourgMacaoMacedonia, The Former Yugoslav Republic ofMadagascarMalawiMalaysiaMaldivesMaliMaltaMartiniqueMauritaniaMauritiusMayotteMexicoMoldova, Republic ofMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorwayOmanPakistanPalestinianPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalQatarReunionRomaniaRussian FederationRWANDASaint Barthélemy Saint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint Martin (French part)Saint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint Maarten (Dutch part)SlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwazilandSwedenSwitzerlandSyrian Arab RepublicTaiwanTajikistanTanzania, United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuela, Bolivarian Republic ofVietnamVirgin Islands, BritishWallis and FutunaWestern SaharaYemenZambiaZimbabweI also wish to receive emails from AAAS/Science and Science advertisers, including information on products, services and special offers which may include but are not limited to news, careers information & upcoming events.Required fields are included by an asterisk(*)I was also quickly trained in hematology lab procedures and blood tests. Because this was a hemorrhagic-fever epidemic—which included, by definition, symptoms of bleeding—I would need to monitor all kinds of blood parameters: the degree of disseminated intravascular coagulation, which causes uncontrollable bleeding; the number of platelets and hematocrits; and so on.But Pattyn was mostly interested in teaching me how to capture bats. For some reason he was convinced that they would prove to be the virus reservoir. To be honest this was the only thing that scared me about the trip. I am poor at catching flying objects at the best of times, even when they don’t have claws and teeth. I nodded while he explained, but I decided on the spot that I wouldn’t catch a single bat (and didn’t).I raced home and packed enough for 10 days. Pattyn insisted I take a suit and tie, as I would “represent the Belgian government” and meet with Zairean government officials. Then I hunted down my passport, no easy feat. It had long since expired. (I didn’t need one to go to Paris, since I was a European Community national.) I had even cut out my passport photograph to use for some urgently required sports-club membership card. And of course this defunct and defaced excuse for a passport didn’t have any kind of visa for Zaire. I had no idea if they would even let me get on the plane. That night I couldn’t sleep for nerves and excitement.At check-in, when the police officer at immigration wordlessly gestured me to one side with a hostile glare, Kivits stepped in and exhibited some kind of official supercard that magically gave me passage through immigration and out of my own country. Kivits had several such tricks up his sleeve. He told me, “Find a passenger called Paul Lelievre-Damit in first class. When you get to Kinshasa, just follow his instructions. Do exactly what he says and you’ll be fine.”Lelievre-Damit was chief of the Belgian Development Cooperation in Zaire, and one of the most powerful foreigners in Kinshasa. When he figured out who I was, he interrupted my halting story about an epidemic outbreak and started swearing. “Goddamn! It’s always the same with these bloody bureaucrats in Brussels! We’re facing a terrible epidemic, and all they could find is you? How old are you? Twenty-seven? You’re a totally green trainee, barely even a doctor. You’ve never seen Africa in your life …”I winced at his robust and graphic outburst of Flemish epithets. It was undeniable. I had no expertise; few skills; I could no more save the African heartland from a mystery virus than a comic-strip boy could have done. But after a couple of glasses of ouzo it emerged that Lelievre-Damit had played cards with my dad when they were both penniless students in Leuven, and that helped a lot. “When we arrive in Kinshasa, just stick to me,” he said. “Don’t look left or right or turn around. The airport is pandemonium, the police are worse than the criminals, and you’re as clueless as a puppy—you’ll be eaten alive.”The next morning the pilot smoothly navigated our DC-10 into Ndjili airport in Kinshasa, where we parked near several wreckages of less fortunate airplanes. I pushed to the front of the plane to find Lelievre-Damit, and glued myself to him when descending the DC-10 stairs, as tightly as a baby monkey clings to his mother. To be honest, I wasn’t just bewildered and hungover: I was slightly afraid. With practiced, fluid movements Lelievre-Damit and Pattyn glided me into the VIP room, where a very respectful official smiled. There was no mention of anything so vulgar as an identity document.The roads of Kinshasa were unbelievable, with people and animals wandering randomly across them, not to mention the vehicles, which hurtled from every direction. We drove straight to a meeting at the headquarters of the Fométro, the Fonds Médical Tropical, a nongovernmental organization that operated much of Belgium’s vast program for medical aid in Central Africa. American Karl Johnson—head of Special Pathogens at the Center for Disease Control (CDC) in the U.S. rapped us to attention—it was clearly his meeting—and summarized the situation in a few words. We were dealing with a virus that was completely new to science. Its potential for transmission—particularly to medical teams and caregivers—appeared to be extraordinarily dangerous. Reports claimed that more than 80 percent of people infected were dying. We had only one possible treatment option in the form of serum from convalescents who had very high levels of antibodies, but we needed to track down such individuals, test their blood to be sure it didn’t contain live virus, and then treat it to be able to inject antibodies into people currently sick.He went on: the worst scenario we faced was the specter of a full-blown epidemic in Kinshasa, an unruly megacity with poor infrastructure, an unreliable administration, and 3 million citizens accustomed to defying arbitrary government controls. Barely a fortnight before, three people from the Belgian mission in Yambuku—two nuns and a priest—had been brought to the capital for treatment. All were now dead, and they had infected at least one nurse, Mayinga N’Seka, now hospitalized in critical condition. Efforts were being made to track down all her contacts in the city to quarantine them. They included—here Johnson paused for a second—personnel of the US Embassy, where the nurse had recently finalized arrangements for a student visa to the United States.Was this the beginning of an outbreak in Kinshasa? Once a virus this lethal is introduced into an environment this chaotic, it is almost impossible to control it. It is also an explosive political situation for the government, and it was clear from the health minister’s agitation that news about the epidemic was out and panic was already setting in. At that time we had no real indication of how contagious the disease was, only that it seemed highly lethal.The top priority, then, was Kinshasa, and it was decided that most of the team would remain there temporarily, while a small contingent would travel to Equateur province for a three- or four-day scouting trip to do the logistical groundwork and sketch out a plan for a full-blown investigation. Karl asked for volunteers. I was the first to raise my hand. With an airy wave of his hand, Pattyn then also volunteered me to visit the infected Kinshasa nurse.We were driven to the Clinique Ngaliema a hospital for the wealthy. It was near the Congo River, in Gombe, one of the nicer parts of town, which in colonial times had been a neighborhood reserved for whites. There was a very fearful atmosphere in the corridors of the clinic. Dr. Courteille, the director of Internal Medicine, who received us, briefed us first about safety precautions. After the deaths of the two Belgian nuns—and their infection of nurse Mayinga—their mattresses were burned, and their rooms locked up and fumigated with formaldehyde vapor on four successive days. Disposal of bodies was carried out by wrapping them in cotton sheets impregnated with a phenolic disinfectant, and the fully wrapped bodies were sealed inside two large, heavy-duty plastic bags before being placed in their coffins.Courteille, who was taking care of the nuns and of Mayinga, was careful not to accompany us to the sick nurse’s bedside, and it seemed that all the personnel kept a guarded distance from their former colleague. She was very sick, and completely desperate, and convinced she was going to die.Mayinga had been hospitalized on Friday, October 15, with a high fever and a severe headache. Now, on Monday the 18th, she began bleeding; there were black, sticky stains around her nose, ears, and mouth and blotches under her skin where blood was pooling. She had uncontrollable diarrhea and vomiting. She clung to Pierre Sureau from Institut Pasteur, who soothed her, telling her about the serum that Margaretha Isaacson from South Africa would administer, which contained antibodies against Marburg virus, from a convalescent patient in South Africa, that might strengthen her immune system to fight the virus. Sadly the serum didn’t work and Mayinga died a few days later.We drew blood to perform a number of tests that would guide the decision to prescribe supportive treatment for intravascular coagulation, which we thought might be the cause of death in hemorrhagic fever. But none of the technicians or personnel was willing to handle Mayinga’s samples for some good reasons, as the hospital lab did not have a containment facility.I examined her blood, and it was a catastrophe. The platelet count was terrifyingly low. As green and unimaginative as I was, the real lethality of this virus began to sink in, and my hands shook a little as I handled her blood. Who knew how this virus was transmitted—by insects, or body fluids, or dust.**************In the 4 a.m. darkness, I watched our military pilots striding angrily back and forth on the tarmac. They were clearly bursting with resentment at the prospect of flying to Yambuku, into the epidemic zone. They refused to help us load the aircraft. Finally they agreed to fly us to Bumba as instructed, but they told us they wouldn’t stop there—just drop us off and fly on.A Land Rover was driven on board and secured. We loaded in some gasoline, a few crates of protective gear and medicine, and some supplies for the Belgian mission. We settled into the military-style seats along the walls and braced for a rocky ride.As the sun rose, the pilots loosened up a little. They let us move, one by one, into the cockpit, where we could take in the incredible vision of the tropical rain forest that flowed beneath us like a vast, heaving green sea punctuated now and then with a hamlet of fragile huts. The plane was basically following the Congo River—huge, nine miles wide in places, the other bank often barely visible. Again I heard the story of pilots watching birds fall dead over the forest around Yambuku, struck midair by the mystery virus, but there was a new twist: dead human bodies lining the roads.We landed in Bumba, a riverside town of then perhaps 10,000 people and the administrative and trading capital of the district. For about two weeks the entire zone had been in quarantine and under martial law, cut off from the rest of the country. And this had occurred during the crucial rice and coffee harvest, the area’s main (if not only) source of cash.As soon as the C-130 came to a standstill, I moved to the hatch at the back, impatient to get to work. What I saw through the open loading dock is permanently imprinted in my memory: hundreds of people—the whole town it seemed—were standing on the red-earth airstrip in the burning sun, first staring at us and then yelling, “Oyé! Oyé!”The crowd was yelling because they were expecting supplies of food and basic goods—this was the first plane to land in several weeks. When they realized we were not delivering foodstuffs, the more desperate pushed forward, hoping to board the plane, but the military police beat them back.A determined Flemish man appeared, perhaps 10 years older than I, wearing dark glasses and a local shirt made of African wax material. He introduced himself to us: Father Carlos, from the Order of Scheut, thus a colleague of the Catholic missionary priests who had died of the virus in Yambuku. Father Carlos briefed us about the epidemic. It had all started in Yambuku in the first week of September, when the headmaster of the mission school, who had been traveling through the north on vacation, returned and fell ill.After his death, crowds attended his funeral, and within days the mission hospital began filling with other sufferers, including the headmaster’s wife. They suffered high fever, headache, hallucinations, and usually bled to death. One after another, his caregivers at the Yambuku mission hospital fell ill, along with members of his family, other patients, and dozens of other, apparently unrelated, people.Nobody knew how many people had died, but all those who fell ill died within eight days. The few nuns still alive at the Yambuku mission were convinced they too would die soon. Only one person was known to have recovered from the virus. As for current cases, there were some in Bumba, and several people who had traveled to Bumba from Yambuku and were being kept in quarantine.By the time we left for Yambuku we had heard of well over a hundred fatalities. My natural skepticism began to fall away, replaced by doom. The stories of Father Carlos and Dr. N’goy, the District Medical Officer who had first identified the epidemic, the reports at the Bumba hospital, the evident fear of the pilots and the townspeople of Bumba and their desperate attempts to flee the town … the apparent virulence of this disease, the high mortality—put together with the poverty and poor organization that characterized Zaire and the potential for contagion in Kinshasa—added up to a picture that Joel Breman, a CDC senior epidemiologist, summarized as “potentially the most deadly epidemic of the century.”We left in two Land Rovers—one of them lent to us by Father Carlos—and drove in silence through the overpowering, unstoppable, exuberant force of uncut equatorial jungle, well over 30 feet high. All kinds of green pressed in on us, high walls of leaves and muscular lianas like something out of a Tarzan movie. I had never experienced how powerful and all-invading nature can be, and somehow it compounded my sense that we were making our way to something horrible and uncontrolled.We stopped off at the Unilever plantation in Ebonda. The personnel were frantic. They had incredibly high expectations for our visit, and our brief stay clearly disappointed and further upset them. Women were chanting and shouting in mourning around the small clinic; a number of deaths had recently occurred.I had a photocopy of the image of the virus that we had seen under our electron microscope in Antwerp, and for some reason it occurred to me to pull it out and show it. This had a fascinating placebo effect on the crowd. I suppose it made the virus seem more real—less supernatural, and perhaps less potent.Beyond Ebonda the road became almost impassable, barely more than a sinkhole of mud and water, with entire sections washed away by the torrential equatorial rains. We drove through small villages of not more than 10 to 25 huts, snuggling like nests at the foot of the towering tropical trees. About half of the villages had erected barriers to control people’s movements in this time of quarantine. The elders explained that they had done this without any official instructions, just as their elders had done in the time of smallpox epidemics. We asked if anyone in those villages was currently ill; all shook their heads no.The thick green curtain around the road closed in again, and we advanced with great difficulty until first the coffee plantations and then the church and red roofs of the Yambuku mission appeared, like mirages, in the blinding sunlight. Surrounded by a neatly swept courtyard lined with royal palm trees and immaculate lawns, they seemed surreal. It was difficult to believe that this clean, orderly, even idyllic place was really Yambuku, the heart of the mysterious killer virus.The nuns were staying in the guest house in between the fathers convent on the right, and the nuns convent and school, on the left. As our group walked up, Sister Marcella, the mother superior, shouted, “Don’t come any nearer! Stay outside the barrier or you will die just like us!”Although she was speaking French, I could hear from her accent not only that she was Flemish, but also the region that she was from, near Antwerp. I jumped over the line of gauze bandage that had been strung up to warn away visitors and shook her hand. In Flemish, I said, “Good day, I’m Dr. Peter Piot from the Tropical Institute in Antwerp. We’re here to help you and stop the epidemic. You’ll be all right.”There was a very emotional scene as the three nuns, Sisters Marcella, Genoveva and Mariette, broke down, clinging to my arm, holding each other and crying helplessly as they all began talking at once. Watching their colleagues die one by one had been an appalling experience.Later the sisters told us that they had read that in case of an epidemic, a cordon sanitaire had to be established to contain the spread of the disease. They had interpreted this literally, with an actual cord that they strung around the guesthouse where they had taken refuge. They had also nailed to a nearby palm tree a sign in Lingala, warning “Anybody who passes this fence will die.” It instructed visitors to ring a bell and leave messages at the foot of the tree. It was scary and sad and spoke volumes about the fear that they had endured.As Sister Mariette prepared dinner for us, Sister Marcella showed us the notebooks where she had recorded all the deaths of hemorrhagic fever patients, and any data she felt was relevant to their illness, such as recent travel. Nine out of 17 hospital staff had died, as had 39 other people among the 60 families living at the mission, and four sisters and two fathers. She broke down several times as she described their symptoms and the agony of their deaths, particularly those of her fellow nuns.Sister Marcella continued reading out from her neatly kept records as I scribbled down more precious pieces of information. She listed the names of villages where deaths had occurred. She wondered whether the illness might be linked to eating fresh monkey meat: the villagers often foraged for food in the forest and the headmaster who was, tentatively, our “Patient Zero” had returned from his travels with several monkey and antelope carcasses. She noted a high number of deaths among newborn children born at the mission clinic, and observed too a sudden spike in stillbirths among their herd of pigs. Three months ago, she said, there was an epidemic among goats in the region of Yandongi.These were all good lines of inquiry. (Later I took blood from the pigs through their tail veins, a new experience for me.) None of them panned out exactly, but another of Sister Marcella’s hypotheses proved to be exactly right. “Something strange must be happening at the funerals,” she told us. “Again and again we’ve seen that the funerals have been followed a week later by a batch of new cases among the mourners.”She was clearly pleading with us for answers, but there was nothing we could say. Our first job was just to ask questions. To break the ice I showed the electron microscope photos of the new virus, as I later did in every village we visited. The sisters too were fascinated by the wormlike structures that had caused so much pain and devastation in their community.As we had no clue how the virus was transmitted, and whether the virus could somehow survive on materials such as mattresses and linen, we decided to sleep on the floor of a classroom in the girls’ boarding school, which we first fumigated with formaldehyde and mopped with bleach. I was exhausted, but once again could not sleep. There were too many impressions and questions racing through my head. We had no idea whether the epidemic was still spreading or how fast, but we clearly were approaching the heart of it: soon it would be staring us in the face. I wondered too what on earth happens at a Zairean funeral, and what could motivate a Flemish woman to spend her life in the middle of a faraway jungle, totally disconnected from her world, without the most basic infrastructure and communication. How could you run a 100-bed hospital without even one physician? How did people survive in these villages? How could I be most useful here?The night was bursting with the caws and cries of animals. I went outside in the blackest of nights, where stars shining uninhibited by city light seemed so close above my head that I might almost reach them, and I listened to the distinct and ominous sound of drumming. Perhaps, in the ancient manner, our arrival was being announced.**************For the next two days we toured villages every morning, taking blood where we could, jotting down every potentially telling detail and piece of data we could muster. We saw patients with blood crusting around their mouths or oozing from their swollen gums. They bled from their ears and nose and from their rectum and vagina; they were intensely lethargic, drained of force.In every village we organized a meeting with the chief and elders. After the ritual passing of a plastic cup of roughly distilled arak— banana alcohol, which Pierre had the courage (or perhaps the common sense) to refuse—we asked them to describe their experience of the new illness, the number of cases and deaths, the dates, whether they had knowledge of any people currently sick. We questioned every villager we came across about day-to-day practices—unusual contact with animals, new areas of forest cleared, food and drink, travel, contact with traders.We heard of entire families who had been wiped out by the swift moving virus. In one case, a woman in Yambuku had died days after giving birth, swiftly followed by her newborn. Her thirteen-year-old daughter, who had traveled to Yambuku to take charge of the child, fell ill once she returned to her home village and died days later; followed by her uncle’s wife, who had cared for her; then her uncle; and then another female relative who had come to care for him. This extremely virulent interhuman transmission was frightening.We were all familiar with our terms of mission: we were here just for three or four days, to act as scouts in preparation for the arrival of a larger team that would try to set up systems to control the epidemic and break ground for further research. Our job was to document what was going on, sketch out some basic epidemiology, take samples from acutely sick patients, and, if possible, find recovering convalescents who might provide plasma to help cure future sufferers.And we were doing that job—harvesting samples, collecting data, and cataloging the basic logistical equipment that the larger team would need to bring. But we knew that from a human point of view this simply wasn’t enough. We needed to stop the virus from infecting and killing people.The mystery fever’s epidemic curve was starting to take shape. The classical epidemiological curve is pretty simple; it plots the number of new cases of an infection against time. In the simplest type of outbreak the number of people infected rises gradually, then picks up pace, reaching a peak at the midpoint of the graph. Once the virus has exhausted its stock of easy victims (the weak or easily accessible), the rate of new infections begins to wane until the epidemic fades to a whisper.All of us were aware of the many exceptions to this in real life— the unexpected outliers, the blips and lags, the complications of propagated epidemics with secondary and tertiary infections. But night by night, as we jotted down data and sketched out a picture from our interviews and notes, it appeared that although people were still dying (and dying horribly), the peak number of new infections around the Yambuku mission might be, at least provisionally, behind us.This was a huge relief. But another conclusion also began to take shape, and it was a great deal more uncomfortable to deal with. Two elements linked almost every victim of the mystery epidemic. One factor was funerals: many of the dead had been present at the funeral of a sick person or had close contact with someone who had. The other factor was presence at the Yambuku Mission Hospital. Just about every early victim of the virus had attended the outpatient clinic a few days before falling ill.We developed near-certitude about the mode of transmission one evening, when Joel and I were drawing curves showing the number of cases by location, age, and gender. (Working with Joel was a real education, like a terrific crash course in epidemiology.) It seemed likely by this point that aerosol contact was not enough to transmit the disease. But particularly in the eighteen- to twenty-five-year age group, at least twice as many women had died as men. We knew that there was something fishy about the hospital, and about funerals, but this was the real clue. What’s different in men and women at that age?Being a bunch of men, it took us a little time to figure out the answer. Women get pregnant. And indeed, almost all of the women who had died had been pregnant, particularly in that age-group, and they had attended the antenatal clinic at the Yambuku mission.Masamba and Ruppol were the first to figure out the picture. Vitamin shots. They were usually completely pointless, but many African villagers considered them vital: to them the act of injection with a syringe was emblematic of Western medicine. Thus there were two words for Western medicine in the region. Anything you ingested orally was aspirin, and it was hopelessly weak. An injection was dawa, proper medicine—something strong and effective.We needed to take another tour of the Yambuku hospital. Knowing what we now did, the empty rooms and bare metal bed frames of the mission hospital seemed more disturbing—grim killers of the joyful young mothers who had come there to be cared for but left with a lethal disease. When we reached the stockroom, we hunted through the large multidose jars of antibiotics and other medications.Their rubber bungs had been perforated multiple times by syringes. In some cases the bung had been removed and was stuck down with a simple bandage. Nearby were a few large glass syringes, five or six.We politely interviewed the nuns. Sister Genoveva told us quite freely that the few glass syringes were reused for every patient; every morning, she told us, they were quickly (and far too summarily) boiled, like the obstetric instruments employed in the maternity room. Then all day long they were employed and re-employed; they were simply rinsed out with sterile water.She confirmed that the nuns dosed all the pregnant women in their care with injections of vitamin B and calcium gluconate. Calcium gluconate is a salt of calcium and gluconic acid; it has basically no medical value in pregnancy, but it delivers a shot of energy, and this temporary “high” made it very popular among patients.In other words, the nurses were systematically injecting a useless product to every woman in antenatal care, as well as to many of the other patients who came to them for help. To do so, they used unsterilized syringes that freely passed on infection. Thus, almost certainly, they had unwittingly killed large numbers of people. It looked as though the only obstacle to the epidemic had been the natural intelligence of the villagers, who saw that many of the sick came from the hospital, and thus fled it; who knew to set up at least some barriers to travel, thus creating a semblance of quarantine.The nuns were totally committed women. They were brave. They faced an incredibly difficult environment and they dealt with it as best they could. They meant well. We had shared their table and their lives for what seemed like far longer than four days, and every evening, as they sipped their little tots of vermouth, they had told us about the villages of their childhoods. Every evening the discussion had ended up circling around and around the same subject—the epidemic. Who had fallen ill first, when it had happened and how. The dread of infection, the horrible deaths of their patients and colleagues. They had been trying to map out the frightening terrain until, I suppose, it would seem more manageable, less horrific. It was a narrative in which they had felt like heroes of a sort, and certainly martyrs.Now it appeared that they were in some sense villains as well. It was very hard to formulate the words that would inform the sisters that the virus had in all likelihood been amplified and spread by their own practices and lack of proper training. In the end I think we were far too polite about it: I’m not certain at all that it really sank in when we told them our preliminary conclusions.**************Our thermoses were full of blood samples that we needed to deliver to a lab for detailed analysis. After great persuasion, the two survivors, Sophie and Sukato, agreed to come with us to Kinshasa for further testing and, assuming that their blood did indeed have antibodies to the virus, plasmapheresis. It was time to head back to Bumba for our rendezvous with the pilots who had agreed to return us to Kinshasa.When the plane finally came to pick us up after four days of waiting, the pilots refused to load our two convalescents or our samples of virus. They had arrived with a load of construction material for a villa that General Bumba was building in a nearby hamlet, and they planned to take off with a load of local produce, breaking the quarantine embargo. Thankfully it seemed there was no logistical problem that Jean-François Ruppol could not solve. The aircraft finally took off, in pouring rain with all of us on board as it lurched and hiccupped perilously across the tree line.We made a full report to the International Commission about our preliminary conclusions and our sketch of a hypothetical epidemiological curve (Ebola Haemorrhagic Fever in Zaire. Report of an International Commission. Bull World Health Org 1978;56:271-293). There was a strong possibility that the epidemic had peaked, but there were still at least a dozen people around Yambuku who were critically ill, with almost no provision for quarantine, so a strong potential for flare-ups or another big wave of infection remained. In addition, even if we were right about the scope of the epidemic in Yambuku, if just a few isolated cases reached Kinshasa or any other major city the epidemic would certainly explode. And the logistics situation at Yambuku was extremely dicey. Everything had to be brought in by plane and helicopter.Karl was ordering radio and laboratory equipment, and he began working on plans to install a special medical center at a distance from Yambuku and other significant villages, so that patients could be separated from their families. It would have to include a highly secure inpatient ward; a highly secure field lab equipped with a centrifuge and other equipment for hematological analysis; a separate quarantine center to isolate suspected cases; and an outpatient ward where serum samples could be obtained and the sick could be brought for diagnosis. Naturally the very ill would need to be transported from their villages, and that meant a helicopter would have to be available on a daily basis. I could see that setting up a treatment center like this was going to take weeks at the earliest.Late one night we were drinking Karl’s Kentucky bourbon—it was one of those halfgallon bottles with a handle—discussing what our new virus should be named. Pierre argued for Yambuku virus, which had the advantage of simplicity; it was what most of us were already calling the disease.But Joel reminded us that naming killer viruses after specific places can be very stigmatizing; with Lassa virus, discovered in 1969 in a small Nigerian town of that name, it had caused no end of problems to the people from the locality. Karl Johnson liked to call his viruses after rivers: he felt that took some of the sting out of the geographical finger-pointing. It was what he had done when he’d discovered Machupo virus in Bolivia in 1959, and it was clear that night that he had every intention of doing the same in Zaire.But we couldn’t call our virus after the majestic Congo River: a Congo-Crim virus already existed. Were there any other rivers near Yambuku? We charged en masse to a not-very-large map of Zaire that was pinned up in the Fométro corridor. At that scale, it looked as though the closest river to Yambuku was called Ebola—“Black River,” in Lingala. It seemed suitably ominous.Actually there’s no connection between the hemorrhagic fever and the Ebola River. Indeed, the Ebola River isn’t even the closest river to the Yambuku mission. But in our entirely fatigued state, that’s what we ended up calling the virus: Ebola.Adapted from No Time to Lose: A Life in Pursuit of Deadly Viruses by Peter Piot. Copyright © 2012 by Peter Piot. With permission of the publisher, W. W. Norton & Company Inc. All rights reserved.*The Ebola Files: Given the current Ebola outbreak, unprecedented in terms of number of people killed and rapid geographic spread, Science and Science Translational Medicine have made a collection of research and news articles on the viral disease freely available to researchers and the general public.