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How we got the story about monkeypox

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Earlier this year, Washington Post photographer Melina Mara and I traveled with scientists from the Centers for Disease Control and Prevention to a village deep inside the Congo rain forest, reachable only by boat. The team was hunting for the origins of monkeypox, a mysterious and fatal disease.

Monkeypox is a cousin to the deadly smallpox virus and is particularly dangerous for children. It kills up to 1 in 10 of its victims, a mortality rate similar to that of pneumonic plague. But unlike plague, which can be treated with antibiotics, there is no cure for monkeypox.

I’ve tried to get permission for years to accompany scientists tracking disease outbreaks. The answer has always been no. This time, the CDC and the Congolese health ministry said yes, with the condition that we report only on the scientists’ investigation. The CDC had already been to the Congo Republic twice earlier in the year to help with monkeypox investigations. CDC officials had developed a good relationship with the government, and when they asked whether we could be part of the team, Congolese officials agreed. Officials felt like there was a good story to tell and that we could safely be included.

The biologists were looking for monkeypox in wild animals to figure out which species harbor the virus. Contact with wild animals is how humans outbreaks start, and then the virus can spread from person to person.  There’s been an increase in reports of suspected human cases across Africa, including in Congo.

Many of those suspected cases trace back to the village of Manfouete. We camped there for several days with the CDC and their Congolese and international partners as they trapped and sampled animals in the surrounding forest.

To get there, we flew from Washington to Brazzaville, the capital of Congo, and then to a small town called Impfondo. From Impfondo, it was a six-hour boat ride to the village, which has no electricity or running water.

Many readers, friends and colleagues saw our initial story and wanted to know more. Here are answers to some of their biggest questions.

When will the CDC scientists know whether any of the animals they tested carry the virus?

It may take up to a year before the results come out. The latest outbreak of suspected monkeypox cases is in Nigeria. The more cases that are reported, the longer it may take. That’s because some of the biologists who are helping with field investigations are also the same people who do the lab analysis.

What did the test results show for the two young men suspected of having monkeypox?

They tested negative for monkeypox but positive for chickenpox. But it’s unclear whether the family has been informed of the diagnosis because the village is so hard to reach.

What were the logistics like to get to the village?

Commercial flights inside Congo aren’t reliable. We flew from Brazzaville to Impfondo on a United Nations plane that operates in crisis regions around the world. There were four CDC scientists and about a dozen Congolese government officials and other U.N. experts who were part of the team.

My seatmate on that flight, Nkaya Tobi, with the government’s agriculture, livestock and fisheries ministry, used the flight to transport vials of animal plague vaccine to Impfondo. He carried them in a child’s insulated thermos decorated with teddy bears.

We spent two days in Impfondo working out the logistics and shopping for supplies. We stayed with Joseph and Rebecca Harvey, medical missionaries who opened a hospital in 2006 that treats patients with many neglected tropical diseases, including monkeypox and leprosy.

The most complicated logistics involved the boats. We were expecting to make the journey in several wooden dugout canoes. But to everyone’s surprise, a big boat was made available by the U.N. refugee agency at the last minute. That boat carried the team members; supplies and food for the 10-day village stay were loaded onto a dugout canoe, which arrived at the village one day after we did.

Our journey on the big boat upriver took six hours.

The return trip on a dugout canoe took nine hours.

Melina and I had to leave earlier than we expected, to accommodate the schedule of one UN official. Only the dugout canoe was available. We were a total of 10 passengers, along with two goats and one owl. (The animals, whose feet were tied, belonged to the other passengers. The goats were intended for food. We weren’t sure about the owl’s fate.)

There weren’t enough chairs in the dugout, so Melina and I and Jennifer McQuiston, deputy director of the CDC’s Division of High-Consequence Pathogens as well as a popular romance novelist, took turns sitting on an empty gasoline jerrycan.

The sun was intense, but the river was calm. The canoe journey turned out to be less uncomfortable than sitting in front of a computer all day.

How did you go to the bathroom during the boat rides?

There were only three women in our group. We weren’t sure whether the boat would make stops. We had been told that it was important to get off the river before dark, when we were most likely to run into hippos, supposedly the most dangerous animals in Africa. (We did not see any hippos.)

But in case we stopped along the river, I had been advised to bring a skirt that could be slipped over pants to provide additional privacy. Luckily, we didn’t need to take a pit stop on the six-hour way there. I tried to maintain a delicate balance between hydration and not having to ask for a bathroom break.

On the nine-hour return trip, the canoe did stop once along the river bank; the men went one way into the forest, and the women headed in the opposite direction.

What were some of the more challenging aspects of the trip?

It wasn’t the heat or sleeping in a tent on a cement floor, or having one daily meal. It was embracing the different pace of life.

For those of us who work in environments where there is an expectation of immediate answers to questions, it was harder to adjust to the waiting and uncertainty. That was true when I worked in China many years ago as The Post’s Beijing bureau chief, and certainly true on this trip.

Much of the trip had been coordinated in advance. But once the CDC team arrived in the country, the scientists still needed approvals from local, regional and international partners. Even then, on the morning of our departure for the village, no one seemed to know exactly what time the boat would leave.

What precautions did you take to protect against monkeypox?

There is no specific vaccine against monkeypox, but the smallpox vaccine is about 85 percent effective. If you’re older than 50, you probably got a smallpox vaccination as a kid, but it’s not clear how protective it would be today. That vaccine isn’t available to the general public now because smallpox was eradicated decades ago. It’s only available to select laboratory and health-care workers in the United States. The CDC provides the vaccine from the federal government’s Strategic National Stockpile.

Monkeypox can spread through prolonged face-to-face contact. It can also spread through contact with body fluids or indirect contact with contaminated clothing.

We wore special masks and had to keep a certain distance from the scientists when they worked in the lab. We also tried to maintain that distance when we spoke with the young men suspected of monkeypox infections, as well as their mother.

She had cared for her 75-year-old father, who had died two weeks earlier, with suspected similar lesions on his face and body that may have been monkeypox. After we talked, I put my hand on her bare arm to express my sympathy.

On the walk back to camp, the CDC’s McQuiston gently reminded me to clean my hands as a precaution and handed me a bottle of antibacterial gel.

What was the village like?

We walked through the village at least twice a day, on our way in and out of the forest. We saw women washing clothes, weaving palm leaves to make thatched roofs, braiding hair. In front of some homes were freshly cut clusters of palm fruit. In the afternoons, men toted transistor radios on their shoulders. Outside the village store, there were often men playing a wooden board game, a version of mancala.

Were you ever afraid?

We worried about getting sick and not being able to do our jobs. Melina came down with gastrointestinal problems the day before we headed to the village. She took medication she brought with her, supplemented by some from me and McQuiston, but she was battling something the entire time we were in the village. She didn’t recover fully until several days after we returned home.

We also took some comfort that we were with CDC scientists, three of whom had received emergency tactical medicine training for people who deploy overseas. That included how to apply a tourniquet and how to treat sucking chest wounds.

Melina and I also got three doses of rabies vaccine before we left in case of contact with wild animals. Luckily, we had no dangerous encounters.

How did you manage without cellphone service or Internet connection?

In case of emergencies, we had a satellite phone and the CDC also had a satellite phone. It was liberating to be offline and focused on this story.

Would you go back?

Absolutely.

Read more:

CDC scientists hunt origins of deadly monkeypox virus in Congo rain forest

World leaders rehearse for a pandemic that will come “sooner than we expect”

Why this deadly bird flu is causing alarm among scientists

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