By Rafaela von Bredow
and Veronika Hackenbroch
 |
|
Professor Peter
Piot, the Director of the London School of Hygiene and Tropical Medicine:
‘Around June it became clear to me there was something different about this
outbreak. I began to get really worried’ Photograph: Leon Neal/AFP
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Peter Piot was
a researcher at a lab in Antwerp when a pilot brought him a blood sample from a
Belgian nun who had fallen mysteriously ill in Zaire.
Professor Piot, as a young scientist in
Antwerp, you were part of the team that discovered the Ebola
virus in 1976. How did it happen?
I still remember exactly. One day in
September, a pilot from Sabena Airlines brought us a shiny blue Thermos and a
letter from a doctor in Kinshasa in what was then Zaire. In the Thermos, he
wrote, there was a blood sample from a Belgian nun who had recently fallen ill
from a mysterious sickness in Yambuku, a remote village in the northern part of
the country. He asked us to test the sample for yellow fever.
These days, Ebola may only be
researched in high-security laboratories. How did you protect yourself back
then?
We had no idea how dangerous the virus
was. And there were no high-security labs in Belgium. We just wore our white
lab coats and protective gloves. When we opened the Thermos, the ice inside had
largely melted and one of the vials had broken. Blood and glass shards were
floating in the ice water. We fished the other, intact, test tube out of the
slop and began examining the blood for pathogens, using the methods that were
standard at the time.
But the yellow fever virus apparently
had nothing to do with the nun's illness.
No. And the tests for Lassa fever and
typhoid were also negative. What, then, could it be? Our hopes were dependent
on being able to isolate the virus from the sample. To do so, we injected it
into mice and other lab animals. At first nothing happened for several days. We
thought that perhaps the pathogen had been damaged from insufficient
refrigeration in the Thermos. But then one animal after the next began to die.
We began to realise that the sample contained something quite deadly.
But you continued?
Other samples from the nun, who had
since died, arrived from Kinshasa. When we were just about able to begin
examining the virus under an electron microscope, the World Health Organisation
instructed us to send all of our samples to a high-security lab in England. But
my boss at the time wanted to bring our work to conclusion no matter what. He
grabbed a vial containing virus material to examine it, but his hand was
shaking and he dropped it on a colleague's foot. The vial shattered. My only
thought was: "Oh, shit!" We immediately disinfected everything, and
luckily our colleague was wearing thick leather shoes. Nothing happened to any
of us.
In the end, you were finally able to
create an image of the virus using the electron microscope.
Yes, and our first thought was:
"What the hell is that?" The virus that we had spent so much time
searching for was very big, very long and worm-like. It had no similarities
with yellow fever. Rather, it looked like the extremely dangerous Marburg virus
which, like ebola, causes a haemorrhagic fever. In the 1960s the virus killed
several laboratory workers in Marburg, Germany.
Were you afraid at that point?
I knew almost nothing about the Marburg
virus at the time. When I tell my students about it today, they think I must
come from the stone age. But I actually had to go the library and look it up in
an atlas of virology. It was the American Centres for Disease Control which determined
a short time later that it wasn't the Marburg virus, but a related, unknown
virus. We had also learned in the meantime that hundreds of people had already
succumbed to the virus in Yambuku and the area around it.
A few days later, you became one of the
first scientists to fly to Zaire.
Yes. The nun who had died and her
fellow sisters were all from Belgium. In Yambuku, which had been part of the
Belgian Congo, they operated a small mission hospital. When the Belgian
government decided to send someone, I volunteered immediately. I was 27 and
felt a bit like my childhood hero, Tintin. And, I have to admit, I was
intoxicated by the chance to track down something totally new.
Was there any room for fear, or at
least worry?
Of course it was clear to us that we
were dealing with one of the deadliest infectious diseases the world had ever
seen – and we had no idea that it was transmitted via bodily fluids! It could
also have been mosquitoes. We wore protective suits and latex gloves and I even
borrowed a pair of motorcycle goggles to cover my eyes. But in the jungle heat
it was impossible to use the gas masks that we bought in Kinshasa. Even so, the
Ebola patients I treated were probably just as shocked by my appearance as they
were about their intense suffering. I took blood from around 10 of these
patients. I was most worried about accidentally poking myself with the needle
and infecting myself that way.
But you apparently managed to avoid
becoming infected.
Well, at some point I did actually
develop a high fever, a headache and diarrhoea …
... similar to Ebola symptoms?
Exactly. I immediately thought:
"Damn, this is it!" But then I tried to keep my cool. I knew the
symptoms I had could be from something completely different and harmless. And
it really would have been stupid to spend two weeks in the horrible isolation
tent that had been set up for us scientists for the worst case. So I just stayed
alone in my room and waited. Of course, I didn't get a wink of sleep, but
luckily I began feeling better by the next day. It was just a gastrointestinal
infection. Actually, that is the best thing that can happen in your life: you
look death in the eye but survive. It changed my whole approach, my whole
outlook on life at the time.
You were also the one who gave the
virus its name. Why Ebola?
On that day our team sat together late
into the night – we had also had a couple of drinks – discussing the question.
We definitely didn't want to name the new pathogen "Yambuku virus",
because that would have stigmatised the place forever. There was a map hanging
on the wall and our American team leader suggested looking for the nearest
river and giving the virus its name. It was the Ebola river. So by around three
or four in the morning we had found a name. But the map was small and inexact.
We only learned later that the nearest river was actually a different one. But
Ebola is a nice name, isn't it?
In the end, you discovered that the
Belgian nuns had unwittingly spread the virus. How did that happen?
In their hospital they regularly gave
pregnant women vitamin injections using unsterilised needles. By doing so, they
infected many young women in Yambuku with the virus. We told the nuns about the
terrible mistake they had made, but looking back I would say that we were much
too careful in our choice of words. Clinics that failed to observe this and
other rules of hygiene functioned as catalysts in all additional Ebola outbreaks.
They drastically sped up the spread of the virus or made the spread possible in
the first place. Even in the current Ebola outbreak in west Africa,
hospitals unfortunately played this ignominious role in the beginning.
After Yambuku, you spent the next 30
years of your professional life devoted to combating Aids. But now Ebola has
caught up to you again. American scientists fear that hundreds of thousands of
people could ultimately become infected. Was such an epidemic to be expected?
No, not at all. On the contrary, I
always thought that Ebola, in comparison to Aids or malaria, didn't present
much of a problem because the outbreaks were always brief and local. Around
June it became clear to me that there was something fundamentally different
about this outbreak. At about the same time, the aid organisation Médecins Sans
Frontières sounded the alarm. We Flemish tend to be rather unemotional, but it
was at that point that I began to get really worried.
Why did WHO react so late?
On the one hand, it was because their
African regional office isn't staffed with the most capable people but with
political appointees. And the headquarters in Geneva suffered large budget cuts
that had been agreed to by member states. The department for haemorrhagic fever
and the one responsible for the management of epidemic emergencies were hit
hard. But since August WHO has regained a leadership role.
There is actually a well-established
procedure for curtailing Ebola outbreaks: isolating those infected and closely
monitoring those who had contact with them. How could a catastrophe such as the
one we are now seeing even happen?
I think it is what people call a
perfect storm: when every individual circumstance is a bit worse than normal
and they then combine to create a disaster. And with this epidemic there were
many factors that were disadvantageous from the very beginning. Some of the
countries involved were just emerging from terrible civil wars, many of their
doctors had fled and their healthcare systems had collapsed. In all of Liberia,
for example, there were only 51 doctors in 2010, and many of them have since
died of Ebola.
The fact that the outbreak began in the
densely populated border region between Guinea, Sierra Leone and Liberia ...
… also contributed to the catastrophe.
Because the people there are extremely mobile, it was much more difficult than
usual to track down those who had had contact with the infected people. Because
the dead in this region are traditionally buried in the towns and villages they
were born in, there were highly contagious Ebola corpses travelling back and
forth across the borders in pickups and taxis. The result was that the epidemic
kept flaring up in different places.
For the first time in its history, the
virus also reached metropolises such as Monrovia and Freetown. Is that the
worst thing that can happen?
In large cities – particularly in chaotic
slums – it is virtually impossible to find those who had contact with patients,
no matter how great the effort. That is why I am so worried about Nigeria
as well. The country is home to mega-cities like Lagos and Port Harcourt, and
if the Ebola virus lodges there and begins to spread, it would be an
unimaginable catastrophe.
Have we completely lost control of the
epidemic?
I have always been an optimist and I
think that we now have no other choice than to try everything, really
everything. It's good that the United States and some other countries are
finally beginning to help. But Germany or even Belgium, for example, must do a
lot more. And it should be clear to all of us: This isn't just an epidemic any
more. This is a humanitarian catastrophe. We don't just need care personnel,
but also logistics experts, trucks, jeeps and foodstuffs. Such an epidemic can
destabilise entire regions. I can only hope that we will be able to get it
under control. I really never thought that it could get this bad.
What can really be done in a situation
when anyone can become infected on the streets and, like in Monrovia, even the
taxis are contaminated?
We urgently need to come up with new
strategies. Currently, helpers are no longer able to care for all the patients
in treatment centres. So caregivers need to teach family members who are
providing care to patients how to protect themselves from infection to the
extent possible. This on-site educational work is currently the greatest
challenge. Sierra Leone experimented with a three-day curfew in an attempt to
at least flatten out the infection curve a bit. At first I thought: "That
is totally crazy." But now I wonder, "why not?" At least, as
long as these measures aren't imposed with military power.
A three-day curfew sounds a bit
desperate.
Yes, it is rather medieval. But what
can you do? Even in 2014, we hardly have any way to combat this virus.
Do you think we might be facing the
beginnings of a pandemic?
There will certainly be Ebola patients
from Africa who come to us in the hopes of receiving treatment. And they might
even infect a few people here who may then die. But an outbreak in Europe or
North America would quickly be brought under control. I am more worried about
the many people from India who work in trade or industry in west Africa. It
would only take one of them to become infected, travel to India to visit
relatives during the virus's incubation period, and then, once he becomes sick,
go to a public hospital there. Doctors and nurses in India, too, often don't
wear protective gloves. They would immediately become infected and spread the
virus.
The virus is continually changing its
genetic makeup. The more people who become infected, the greater the chance
becomes that it will mutate ...
... which might speed its spread. Yes,
that really is the apocalyptic scenario. Humans are actually just an accidental
host for the virus, and not a good one. From the perspective of a virus, it
isn't desirable for its host, within which the pathogen hopes to multiply, to
die so quickly. It would be much better for the virus to allow us to stay alive
longer.
Could the virus suddenly change itself
such that it could be spread through the air?
Like measles, you mean? Luckily that is
extremely unlikely. But a mutation that would allow Ebola patients to live a
couple of weeks longer is certainly possible and would be advantageous for the
virus. But that would allow Ebola patients to infect many, many more people
than is currently the case.
But that is just speculation, isn't it?
Certainly. But it is just one of many
possible ways the virus could change to spread itself more easily. And it is
clear that the virus is mutating.
You and two colleagues wrote a piece
for the Wall Street Journal supporting the testing of experimental
drugs. Do you think that could be the solution?
Patients could probably be treated most
quickly with blood serum from Ebola survivors, even if that would likely be
extremely difficult given the chaotic local conditions. We need to find out now
if these methods, or if experimental drugs like ZMapp, really help. But we
should definitely not rely entirely on new treatments. For most people, they
will come too late in this epidemic. But if they help, they should be made
available for the next outbreak.
Testing of two vaccines is also
beginning. It will take a while, of course, but could it be that only a vaccine
can stop the epidemic?
I hope that's not the case. But who
knows? Maybe.
In Zaire during that first outbreak, a
hospital with poor hygiene was responsible for spreading the illness. Today
almost the same thing is happening. Was Louis Pasteur right when he said:
"It is the microbes who will have the last word"?
Of course, we are a long way away from
declaring victory over bacteria and viruses. HIV is still here; in London
alone, five gay men become infected daily. An increasing number of bacteria are
becoming resistant to antibiotics. And I can still see the Ebola patients in
Yambuku, how they died in their shacks and we couldn't do anything except let
them die. In principle, it's still the same today. That is very depressing. But
it also provides me with a strong motivation to do something. I love life. That
is why I am doing everything I can to convince the powerful in this world to
finally send sufficient help to west Africa. Now!
Der Spiegel
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