Before Ebola had a name

One tube was intact. The other was broken; its contents mingled with melted ice to form a red soup. A bloodstained note said the nun was among 200 people, including doctors and nurses, dying in an outbreak that had raged for three weeks in remote Yambuku, not far from the Ebola River.

The prime suspect was yellow fever, a mosquito-borne infection that Piot’s laboratory at the Institute of Tropical Medicine was equipped to detect. But unknown to anyone then, the nun’s blood harboured the virus that was soon to be named Ebola.

In those days, microbiologists were cavalier about protection. As Piot and his colleagues emptied the container, they wore only thin latex gloves — none of the high-security masks and moonsuits that are now standard.

They removed small amounts of blood from the intact tube to carry out routine tests for known microbes and special tests for yellow fever, along with haemorrhagic-fever viruses like Lassa, Marburg and dengue. They also injected the nun’s blood into cells grown in the laboratory and the brains of mice.

The tests excluded all known infectious agents, but Piot assumed that whichever one had caused the nun’s illness must have been destroyed during the airplane trip from Zaire. Still, he and his colleagues checked the mice each day.

After a week, all the mice were dead, strongly hinting that the infectious agent had not been destroyed after all. An autopsy showed that the nun’s liver had microscopic lesions that Piot’s boss, Dr Stefaan Pattyn, knew to occur in Lassa fever. But because Lassa had already been ruled out, Pattyn steered the research toward identifying a new one.

At the time, only three laboratories outside the Soviet Union were equipped to handle deadly viruses safely: Porton Down, near London; Fort Detrick, a military base in Maryland; and what is now known as the Centers for Disease Control and Prevention, in Atlanta. The World Health Organization instructed the Belgians to immediately send the samples in tightly sealed containers to Porton Down which, in turn, forwarded them to the CDC because it was the world’s reference laboratory for haemorrhagic viruses.

The Antwerp scientists kept part of the material and looked at it through an electron microscope. It showed that the nun’s virus was a new one — wormlike, and huge as viruses go — that resembled Marburg. CDC scientists then confirmed the Antwerp team’s discovery and named the virus Ebola.

Piot’s wife was three months pregnant with their first child. Yet scientific curiosity fuelled his desire to go to Zaire to undertake the epidemiologic investigations to determine how this new virus spread.

In Zaire, he joined an international team of scientists who flew to Yambuku and mapped Ebola’s spread, determining that the principal route was through unsterilised needles and syringes, contact with infected patients and touching bodies at funerals. They also collected blood from patients for later testing and prepared for the arrival of a larger and better-equipped team to control the outbreak.

In four months of field operations, other scientists also discovered a second outbreak of Ebola in Sudan. Why the virus struck simultaneously in two distant areas with virtually no contact between them was a mystery — just as are the current independent outbreaks of Ebola in West Africa and Congo.

Piot, who has told much of this story in previous interviews and in his 2012 memoir, No Time to Lose: A Life in Pursuit of Deadly Viruses, expanded on it in a recent interview in light of the current epidemic in West Africa, the deadliest Ebola outbreak in history.

He said he expected discovery of more viruses like Ebola. And despite today’s much safer laboratory procedures, he added, such virulent pathogens could prove just as dangerous.

“We were lucky not to get infected, not only in the laboratory but later on when I was drawing blood from patients and touching them,” Piot said from England, where he is now the director of the London School of Hygiene and Tropical Medicine.

Despite the near-misses, “what dominated was the absolute excitement of discovery”, he said. “I didn’t realise that we were making history in those days”, and “I never imagined that Ebola would become a real public-health problem because until now, the outbreaks, as dramatic as they may have been, have been fairly limited.”

Piot played a key role in another epidemic. He went to Zaire to investigate cases soon after AIDS was first recognised in the US in 1981. Later, he directed the United Nations AIDS programme for 10 years.

This July, the normally cautious Piot sounded one of the first alarms that the Ebola epidemic in West Africa was out of control. He publicly called it “a mega-crisis” that required military-like logistics and control measures like isolation and quarantine of infected individuals and their contacts.

He worried that his message about the world’s tardy response to control Ebola might be hyperbolic, he said, but that he “would rather be accused of overreacting than responding too late or not doing enough”. Now he believes he was “on target”.