members of his family—who might otherwise have been able to recall details of his activities during the days when he became infected—were dead, too. Ebola kills the witnesses to its appearance. There were hints that some type of bat might be the natural host of Ebola. In laboratory tests, Ebola virus has been able to infect certain kinds of bats without making them sick. The bat’s immune system is resistant to Ebola, which suggests bats may be carriers of the virus. Even so, no wild bats have ever been found with Ebola in them.
Bats have very unusual wingless parasitic flies that live on them, sucking their blood. These bloodsucking bat flies, called strebelid flies, crawl from bat to bat while the bats are hanging in roosts. The flies might transmit Ebola among the bats. Does Ebola live in wingless flies crawling on bats? Nobody knows.
This is a story with no end. Recently, I called Dr. William Close, to see how he was doing. He lives in Big Piney, Wyoming.
“That Belgian doctor,” I said. “The one who got the Ebola-infected blood all over his face? How long did he survive?”
Close began chuckling. “More than thirty years, so far. I just talked with him yesterday. Jean-Francois Ruppol. He’s a great friend of mine. He lives in Belgium now.”
I could hardly believe it. How could anyone survive an Ebola exposure like that?
Not long afterward, I received a series of pleasant e-mails from Dr. Jean-Francois Ruppol. He had written down, in French, some of his recollections of the first Ebola outbreak, in Yambuku, near the Ebola River, Congo, in 1976. Ruppol went to Yambuku three times during the outbreak, seeking to understand the virus and get it under control. (At the time, Ebola virus did not yet have a name.) Here, in Ruppol’s words, is what happened:
At this point, I asked a nun if they could put a kitchen table on the building’s porch. We put the pregnant woman on the table, after we had donned protective gear (gown, cap, mask, gloves, etc.). I wanted to take all the necessary precautions, the same ones I had ordered others to use during this epidemic.
In the course of my examination, I came to the following conclusions:
• The woman was at the end of her rope.
• The fetus was presenting in a dangerous way. If I remember correctly, the fetus was stuck sideways, making birth impossible.
• The fetus was in extremis.
We had to act quickly. But a caesarean was impossible because of the dangers in the operating room, the blood and foul sponges, and because of the absence of qualified personnel. Therefore I decided to utilize a technique that I had occasionally practiced in Kimpangu, the symphysisiotomy [the Zarate procedure]. It consisted of cutting the cartilage at the pubic symphysis, and then spreading the legs to open the pelvis and favor the passage of the fetus.
Getting the help of two people to hold the mother’s knees and legs, I performed the Zarate procedure under a local anesthetic, and I reached in and turned the fetus around inside her, in order to deliver it bottom-first.
Illuminated by flashlights and an electric light from a generator, the maneuver went well, but once the baby was delivered and the umbilical cord cut, the baby would not breathe despite various attempts to wake it up. Then, pushed by habit (or instinct, perhaps?), I took down my mask and practiced gentle mouth-to-mouth resuscitation. At that very moment I got a terrible shock: I realized that if the woman was infected with the virus, then I had just condemned myself to death. This was because we knew the virus was transmitted in all the secretions and fluids of the body. Even so, the child was revived and the mother seemed to be doing all right. It’s hardly necessary to add that I spent the next forty-eight hours keeping a very close watch on the health of the mother and baby. Oof! They weren’t contaminated, and I was alive. This was the only time in my medical career when I was not just afraid, but felt and lived real terror….
Ruppol had lost his sense of self-protection during the emergency, but had gotten lucky. The mother hadn’t had Ebola.
Close thought it was just typical of the way doctors can forget themselves when a patient is in trouble. It didn’t give him any confidence, though, that the doctors had the situation with emerging viruses and microbes under control. “In the battle between the doctors and the bugs,” he remarked, “in the long run, I’d put my money on the bugs.”
The Human Kabbalah
“CRAIG VENTER IS AN ASS. He’s an idiot. He is a thorn in people’s sides and an egomaniac,” a senior scientist in the Human Genome Project said to me one day. The Human Genome Project was an ongoing nonprofit international research consortium that had been working to decipher the complete sequence of nucleotides, or letters, in human DNA. The human genome is the total amount of DNA that is spooled into a set of twenty-three chromosomes in the nucleus of every typical human cell. (There are two sets of chromosomes, for a total of forty- six chromosomes in each human cell.) This entire package of DNA in every cell is sometimes referred to as the book of human life. Most scientists agreed that deciphering it would be one of the great achievements of our time. The stakes, in money and glory, to say nothing of the future of medicine, were huge and incalculable.
In the United States, most of the money to pay for the Human Genome Project had been coming from the National Institutes of Health, the NIH. The project was often referred to, in a kind of shorthand, as the “public project,” to distinguish it from for-profit enterprises like the Celera Genomics Group, of which Craig Venter was the president and chief scientific officer. “In my perception,” said the scientist who was giving me the dour view of Venter, “Craig has a personal vendetta against the National Institutes of Health. I look at Craig as being an extremely shallow person who is only interested in Craig Venter and in making money. Only God knows what those people at Celera are doing.”
What Venter and his colleagues were doing was preparing to announce that they had placed in the proper order something like 95 percent of the readable letters in the human genetic code. They were referring to this milestone as the first assembly. They had already started selling information about the human genome to subscribers. The Human Genome Project, largely in response to Craig Venter and the corporate effort to read the human book of life, was also on the verge of announcing a milestone. Its scientists were calling their milestone a “working draft” of the genome. They were claiming it was more than 90 percent complete, and they were making the information available to anyone, free of charge, on a database called GenBank. Both images of the human genome—Celera’s and the public project’s—were becoming clearer and clearer. The book of life and death was opening, and we held it in our hands.
A HUMAN DNA MOLECULE is about a meter long. It is about a twenty-millionth of a meter wide—the width of twenty hydrogen atoms. It is shaped like a twisted ladder. Each rung of the ladder is made of one of four nucleotides—adenine, thymine, cytosine, and guanine. The DNA code is expressed in combinations of the letters A, T, C, and G, the first letters of the names of the nucleotides. The human genome contains at least 3.2 billion letters of genetic code. This is about the number of letters in three thousand copies of
Perhaps three percent of the human code consists of genes. Genes hold the recipes for making proteins. Human genes are stretches of between a thousand and fifteen hundred letters of code, often broken into pieces and separated by long passages of DNA that don’t code for proteins. It is believed that there are about twenty-five thousand genes in the human genome. Much of the rest of the genome consists of blocks of seemingly meaningless letters, gobbledygook. These sections are referred to as junk DNA, although it may be that we just don’t understand the function of the apparent junk.
