DOCTOR ON TRAIL OF ANOTHER DEADLY VIRUS
10 Apr 2003
Source: Seattle Post-Intelligencer, April 10, 2003
Doctor on trail of another deadly virus
By TOM PAULSON, SEATTLE POST-INTELLIGENCER REPORTER
Young people were dropping dead from a disease that, at first, looked like just another flu or garden-variety respiratory illness.
As the death toll mounted, it became clear this was something new. Panic grew as local doctors and public health officials struggled, but failed, to explain the illness or prevent the deaths. One ethnic group got hit particularly hard by this mysterious disease -- simply because the bug decided to make its debut in their community.
This sounds like SARS, severe acute respiratory syndrome, the disease now plaguing parts of Asia and frightening the world. But it's also a description of an outbreak that took place almost exactly one decade ago in the Southwestern United States.
Dr. Jeff Duchin, chief of communicable diseases for Public Health -- Seattle & King County, was one of the lead investigators on the 1993 hantavirus outbreak for the U.S. Centers for Disease Control and Prevention. Today, Duchin, is Seattle and King County's top infectious disease doctor leading the preventive response to SARS.
Both outbreaks began with common flulike, respiratory symptoms that rapidly progress to life-threatening respiratory distress. The most severely afflicted die after choking to death as their lungs fill with fluid. Both began with an unknown cause and an unknown mode of transmission.
"Just like with SARS, nobody at the beginning knew what was causing it or how it would spread," Duchin said of hantavirus. "Almost everybody we dealt with who got sick ended up dying. ... It was pretty scary."
The disease detectives who are sent in to investigate such mysterious outbreaks want answers to the same basic questions: What's causing this new disease? How is it spread? Can it be treated?
The investigations are unlike most biomedical puzzles. They are life-and-death questions in which speed is critical. And it isn't always a stranger's life or death at stake.
The physician who first identified SARS, Dr. Carlo Urbani of the World Health Organization, died of it on March 29. He was 46 and the father of three children.
In May 1993, when reports of a mysterious killer disease in the Four Corners region of New Mexico and Arizona came to the CDC, Duchin and two colleagues in the agency's Epidemic Intelligence Service were tapped. It was a Friday afternoon. The three young epidemiologists were handed gas masks and airplane tickets.
"We were both excited and frightened," Duchin said. "Unlike SARS, this outbreak had a much higher fatality rate, something like 75 percent. And we didn't know what it was."
The Epidemic Intelligence Service is sort of a Special Forces branch of the CDC designed for rapid deployment into unknown territory. The military analogy is apt since the EIS began with a military purpose.
It was created in 1951, during the Korean War, when the United States was worried about biological warfare, said Dr. Bill Foege, director of the CDC from 1977 to 1983.
"The idea," he said, "was to train a small cadre of people who could react quickly to outbreaks and determine if it was bioterrorism."
Given the global problem of emerging and expanding infectious diseases, Foege said the EIS has had plenty of work dealing with natural threats.
But as with the SARS outbreak, the 1993 outbreak in the Southwest prompted initial speculation about chemical or biological weapons.
"Some suspected a toxin had been released from a military depot," Duchin said. The media didn't help much at the time, he added. The outbreak happened to have started among the Navajo, so journalists at first dubbed it "Navajo flu."
"It became sort of a feeding frenzy," Duchin said. "Native Americans were stigmatized. Kids were discriminated against at schools."
But Duchin and his colleagues didn't have any answers. It's hard to combat ignorance and its harmful social side effects if you don't have answers.
"We had to figure out what was going on," he said.
After a week of intense investigation (which revealed that the disease was unlikely to be spreading person-to-person), they got a call from the CDC lab. The lab in Atlanta had been running tests on the blood of the victims.
"They called us and said, 'You're not going to believe this,' " Duchin recalled. "It's a hemorrhagic fever virus."
It was a new strain of hantavirus (named, appropriately enough, for the Hantaan river in Korea, where it was first identified). Ebola is another hemorrhagic fever virus that, for a while, got plenty of media attention. An estimated 120 people recently died of it in the most current outbreak in the Congo Republic.
Dying from a hemorrhagic fever virus is a hot, bloody mess. Duchin and his colleagues were in a "hot zone."
"This was the first time anyone had ever seen a hemorrhagic fever virus in North America," he said.
The CDC sent in reinforcements.
Despite the fear of having an Ebolalike virus on American soil, a greatly expanded CDC team worked with local experts to exploit the knowledge of other hantaviruses to identify how it was spread. In a relatively short period of time, they tracked it down to a specific rodent, the deer mouse.
People still die from hantavirus.
Aggressive early care has reduced the fatality rate to less than half of those infected. Yet once the public learned the true nature of hantavirus, once it ceased to be a mystery, it -- like Ebola -- has receded into the background noise.
"SARS is different in that it's been shown it can be passed person-to-person and can travel around the globe in hours," Duchin said. Though experts at the World Health Organization say the SARS outbreak appears to be under control, he said it's still too early to say what will happen.
SARS appears to be more easily spread but much less dangerous, Duchin emphasized, and should be viewed in context with influenza, which kills 20,000 to 40,000 Americans every year.
"The main message here," he said, "is we are going to continue to be challenged by new disease agents."