August 7, 2024 • 44 mins
Two of the eponymous diseases in this episode are transmitted through incredibly casual exposure. The third requires more prolonged, direct contact with someone who is acutely ill, but can still spread really rapidly in certain conditions.
Research:
- Breman, Joel G et al. “Discovery and Description of Ebola Zaire Virus in 1976 and Relevance to the West African Epidemic During 2013-2016.” The Journal of infectious diseases vol. 214,suppl 3 (2016): S93-S101. doi:10.1093/infdis/jiw207
- Center for Disease Control "Morbidity and mortality weekly report, Vol. 25, no. 32, August 20, 1976" vol. 25, no. 32, 1976
- Centers for Disease Control and Prevention (U.S.) "Morbidity and Mortality Weekly Report, Vol. 25, no. 30, August 6, 1976" vol. 25, no. 30, 1976
- Centers for Disease Control and Prevention (U.S.) "Morbidity and Mortality Weekly Report, Vol. 25, no. 31, August 13, 1976" vol. 25, no. 31, 1976
- Centers for Disease Control and Prevention (U.S.) "Morbidity and Mortality Weekly Report, Vol. 25, no. 34, September 3, 1976" vol. 25, no. 34, 1976
- Centers for Disease Control and Prevention (U.S.) "Morbidity and Mortality Weekly Report, Vol. 26, no. 2, January 18, 1977; special issue : Follow-up on respiratory illness - Philidelphia" vol. 26, no. 2, 1977
- Communicable Disease Center (U.S.) "MMWR Weekly Report, Vol. 17, no. 47, Week ending November 23, 1968" vol. 17, no. 47, 1968
- Dance, Amber. “Norovirus: The perfect pathogen.” Knowable. 9/11/2017. https://knowablemagazine.org/content/article/health-disease/2017/norovirus-perfect-pathogen
- Dolin, Raphael et al. “Transmission of Acute Infectious Nonbacterial Gastroenteritis to Volunteers by Oral Administration of Stool Filtrates.” Journal of Infectious Diseases. Vol. 123, No. 3. March 1971.
- Feldmann, H., Jones, S., Klenk, HD. et al. Ebola virus: from discovery to vaccine. Nat Rev Immunol 3, 677–685 (2003). https://doi.org/10.1038/nri1154
- Lucero Y, Matson DO, Ashkenazi S, George S, O'Ryan M. Norovirus: Facts and Reflections from Past, Present, and Future. Viruses. 2021 Nov 30;13(12):2399. doi: 10.3390/v13122399. PMID: 34960668; PMCID: PMC8707792.
- Markel, Howard. “How a hotel convention became ground zero for this deadly bacteria.” PBS. 7/23/2018. https://www.pbs.org/newshour/health/how-a-hotel-convention-became-ground-zero-for-this-deadly-bacteria
- McDevitt, Dawn. “Case Investigations: Lessons Learned from the 1976 Philadelphia Legionellosis Outbreak.” Indiana Epidemiology Newsletter. Third quarter 2015. https://www.in.gov/health/files/2015_EpiNews_3Q.pdf
- Robilotti E, Deresinski S, Pinsky BA. Norovirus. Clin Microbiol Rev. 2015 Jan;28(1):134-64. doi: 10.1128/CMR.00075-14. PMID: 25567225; PMCID: PMC4284304.
- WHO/International Study Team. “Ebola haemorrhagic fever in Sudan, 1976.” Bulletin of the World Health Organization ,56 (2): 247-270 (1978). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2395561/pdf/bullwho00439-0090.pdf
- Winn, Washington C. “Legionnaires Disease: Historical Perspective.” Clinical Microbiology Reviews. January 1988. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC358030/pdf/cmr00055-0072.pdf
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:01):
Welcome to Stuff You Missed in History Class, a production
of iHeartRadio.
Speaker 2 (00:11):
Hello, and welcome to the podcast. I'm Tracy V.
Speaker 1 (00:14):
Wilson, and I'm Holly Frye.
Speaker 2 (00:16):
I am kind of riffing on Holly's beloved theme of
eponymous foods, but maybe in a less fun direction, which
is diseases that are named after places.
Speaker 1 (00:29):
I like how you said, maybe like there's someone else
going Yeah.
Speaker 2 (00:34):
Somebody is excited about learning where disease names came from.
If you saw the title of today's episode and you
saw the word eponymous and you were expecting food treats
and now you're disappointed, I'm very sorry. The word eponymous
is I think most often used to describe something named
after a person, but it can also describe something named
(00:55):
after a place or a thing. And this episode is
also inspired by an experience I had a few years
ago when I went to visit family and the big,
big local news story. While I was there was an
outbreak of Legionnaire's disease connected to walking past a hot
tub display at affair. I found all of that horrifying
(01:18):
from a number of directions, and it made me, then,
of course, want to do an episode on Legionnaire's disease.
That's a totally normal response to this whole experience. I
was not able to work that into a whole episode,
and it just took me a while to kind of think, hey,
there's a theme here. We are going to really be
focused on the outbreak that led to these diseases being
(01:39):
identified and named, so it won't be like a whole
history of any of these three diseases. Two of the
diseases we're talking about today are ones that people can
contract through incredibly casual exposure, like walking past a hot
tub display. The third requires a lot more pro longed
(02:00):
direct contact with somebody who is acutely ill, but it
can really still spread very rapidly in certain conditions. Although
there will be some experimentation on animals mentioned in this
episode and one of the most disgusting human experiments that
I've ever encountered while working on this show. We're gonna
talk about that just as delicately as possible, but it
(02:23):
is gross. So first up, as Tracy alluded to, Legionnaire's disease,
which is caused by Legionella bacteria. Multiple species of Legionella
bacteria can cause disease, but most outbreaks are connected to
Legionella numophila. Legionella numophila can actually cause two different diseases,
(02:45):
Legionnaire's disease and pontiac fever. Both of these can cause
flu like respiratory symptoms, but pontiac fever is generally milder
and typically resolves on its own. Legionnaire's disease, on the
other hand, can cause pneumonia and lead to hospitalization and death.
It's not fully understood why the same bacteria causes two
(03:07):
clinically different syndromes, or why outbreaks tend to cause one
or the other. Legionnaire's disease is named for the American
Legion convention that was held at the Bellevue Stratford Hotel
in Philadelphia, Pennsylvania, in nineteen seventy six. I guess we
could have a semantic argument about whether a convention is
a place or not. I think it is, at least temporarily.
(03:32):
The American Legion is a veterans organization that was chartered
by Congress in nineteen nineteen, focused on service to veterans
and to their communities. This nineteen seventy six state meeting
in Philadelphia also ran alongside the US bi centennial, so
there were a lot of other celebrations and festivities going
(03:52):
on as well. The American Legion Convention took place from
July twenty first through twenty fourth, and then on July
twenty twenty seven, a retired Air Force captain who had
attended the convention died of an apparent heart attack. Within days,
other convention attendees had also died after reporting symptoms that
included fevers, headaches, chest pain, and chest congestion. On the
(04:17):
afternoon of Friday, July thirtieth, doctor Ernest Campbell of Bloomsburg, Pennsylvania,
tried to alert the Pennsylvania State Public Health Department that
some of his patients had become seriously ill after attending
the convention, but he was told the office had closed
for the day. Another doctor tried to report a similar
(04:39):
pattern of illnesses to the health department on Saturday, which
of course, was also still closed. By the time the
office reopened on Monday, eighteen people had already died.
Speaker 1 (04:51):
In addition to this delay in starting an investigation into
what was going on, there were some specifics that made
it hard to pinpoint where this illness had come come from.
Medical staff who saw multiple patients all around Pennsylvania made
a connection to the convention right away, but there were
also people who got sick who had not gone to
(05:11):
the convention or even been inside the hotel where it
was held. One was a bus driver who had driven
a marching band to Philadelphia for a parade, who had
spent almost all of his time in Philadelphia on the bus.
Another person was local to Philadelphia but had not been
in the hotel for a while, investigators were classifying this
(05:33):
as two different diseases, legionnaire's disease for convention attendees and
broad Street pneumonia for everyone else.
Speaker 2 (05:42):
Health authorities in Pennsylvania, once they had gotten those reports,
contacted the Centers for Disease Control, and the CDC reported
on the illness in its Morbidity and Mortality Weekly Report
on Friday, August sixth, the same week that the illnesses
had first been reported to the Pennsylvania State Public Health Department.
According to this report, one hundred and fifty two people
(06:05):
associated with the convention had become ill between July twenty
second and August third, with most of those illnesses starting
between July twenty fifth and thirty first. Twenty two of
those one hundred and fifty two people had died, but
there didn't seem to be an increase in respiratory diseases
in Philadelphia more generally, and the illnesses didn't seem to
(06:27):
have spread between these patients and their family members or
other close contacts. The CDC included weekly updates in the
Morbidity and Mortality Weekly Report until September third, at which
point the outbreak was over. As of August thirty first,
nineteen seventy six, there had been one hundred seventy nine
cases and twenty eight deaths, including one hundred forty eight
(06:49):
people who had been at the convention and thirty one
who had not, but those had been either in or
near the hotel at some point. The disease had been
particularly lethal in people who had other conditions like heart disease, diabetes,
or cancer, but this report did not include what had
caused the outbreak because at that point they did not know.
(07:13):
The CDC Epidemic Intelligence Service and the Pennsylvania Department of
Health had carried out what was at the time the
largest infectious disease investigation in CDC history. They had more
than one hundred and fifty investigators and medical professionals involved.
They looked for evidence of viruses and bacteria, heavy metals,
(07:34):
environmental toxins, and other potential causes, without any success. They
checked seemingly every surface and potential source of contamination at
the hotel. Because there was this clear connection to an
American Legion convention, there were even concerns that it had
been an intentional poisoning carried out by anti war protesters,
(07:55):
or maybe some kind of biological attack connected to the
Cold War. Meanwhile, this outbreak had gotten a lot of
press coverage. There had been an outbreak of swine flu
at Fort Dix in New Jersey the previous winter, believed
to be very similar to the virus that had caused
the nineteen eighteen flu pandemic. This had led to fears
(08:15):
of an impending pandemic and a huge emergency effort to
vaccinate people. Although a pandemic had not developed, and various
issues with this vaccine rollout had led the press to
call it a fiasco. This had led to heightened anxieties
around the idea of contagious illness. Also, this was an
illness that had disproportionately sickened and killed veterans, a lot
(08:40):
of them retirees during the celebration of the US bicentennial,
so the whole thing had additional layers of emotional impact,
like this is right on the heels of the Vietnam War,
but a lot of the people that were that were
sickened and killed had served in like World War Two
and the Korean War, and people rea guarded them with
(09:00):
like a slightly different nuance than how people were viewing
the Vietnam War at the time. The fact that so
many people died so quickly also made this outbreak particularly terrifying.
On August sixteenth, nineteen seventy six, Time Newsweek and US
News and World Report all had cover stories about the outbreak,
and all three of them used the word killer in
(09:22):
the headline.
Speaker 1 (09:24):
By Christmas of nineteen seventy six, the Bellevue Stratford Hotel
had closed in the aftermath of the outbreak, and the
CDC had faced intense criticism for not figuring out the cause.
This included CDC microbiologist Joseph McDade, who got a lecture
about it at a Christmas party from a random man
that he had never met before. McDade worked in the
(09:46):
lab but was not a decision maker at the CDC,
but over the week between Christmas and New Years, he
started re examining slides from his initial work on the case.
This research had involved exposing guinea pigs to pttential pathogens,
and investigators had figured out that there was something in
patient's lung tissue that could make the guinea pigs sick,
(10:08):
but which then couldn't be transmitted from one guinea pig
to another.
Speaker 2 (10:13):
What they hadn't been able to do was to isolate
and identify this pathogen.
Speaker 1 (10:18):
A few things were working against them here. One is
that the bacteria involved didn't respond to some of the
stains being used to prepare the microscope slides. Another was
how the CDC was focusing its efforts. Microbiologists had been
trying to rule out specific pathogens using preparations developed to
grow those particular pathogens. Some of these preparations used antibiotics
(10:42):
to prevent contamination by other bacteria, but those antibiotics were
also killing the bacteria that caused the outbreak. When McDade
did new cultures without those antibiotics, he immediately saw clusters
of bacteria under his microscope. Some additional steps can confirmed
that this bacterium had caused the outbreak, and it was
(11:03):
ultimately named lee Jionella numophila.
Speaker 2 (11:07):
The CDC put out a special issue of the Morbidity
Immortality Weekly Report on January eighteenth, nineteen seventy seven, to
announce the discovery of this bacterium, and then a peer
reviewed paper was published in the New England Journal of
Medicine in December. McDade was a key part of this,
but he did not do it all alone. He was
(11:27):
one of six authors listed on the paper, along with
the laboratory investigation team. The most likely scenario for how
this bacterium sickened and killed so many people is that
it had been growing in the Bellevue Stratford Hotel's air
conditioning system. When a heat wave moved through Philadelphia in
July of nineteen seventy six, the air conditioning system started
(11:50):
working harder, and bacteria laden missed from the cooling towers
made its way into the hotel and to the street
and sidewalk below, which is why people who had not
been in the hotel had also gotten sick. Identifying this
bacterium also allowed investigators to go back and re examine
other earlier outbreaks, going back to at least nineteen fifty nine.
(12:14):
One of these outbreaks had taken place in Pontiac, Michigan,
in nineteen sixty eight. Ironically, this outbreak took place at
the health department and more than ninety percent of the
employees had gotten sick. This included some of the CDC
investigators who arrived to investigate the outbreak. This was a
much milder illness, though, and everyone recovered, and that's why
(12:36):
pontiac fever is given a separate name from Legionnaire's disease.
These outbreaks led to efforts to better coordinate between the
CDC and local health authorities and more stringent sanitation standards
for things like air conditioning systems, swimming pools, and hot tubs.
But there are still disease outbreaks caused by these bacteria,
(12:58):
including the one in twenty nineteen at the Mountain State
Fair in Fletcher, North Carolina that was the one that
inspired this episode. The final report on that outbreak listed
one hundred and thirty six cases of Legionnaire's disease with
ninety six hospitalizations and four deaths, as well as one
case of pontiac fever. Legionella bacteria occur naturally in soil
(13:20):
and water. So some cases of Legionnaire's disease and pontiac
fever have also been traced to things like potting soil.
Let's take a little sponsor break, and then after that,
we're going to be talking about an illness that's really
not for the squeamish, and that also is going to
include the particularly gross research. Next, we're going to talk
(13:49):
about something that's not as deadly as Legionnaire's disease, but
it can still cause serious illnesses and death, especially in
older people, babies, and people that have other health conditions. However,
it is miserable. It is neurovirus, also called Norwalk virus,
and it's probably responsible for more than half of food
(14:11):
borne illnesses worldwide. Neurovirus causes acute gastroenterritis, which is also
known as stomach flu, although that is a totally different
virus from influenza. Neurovirus is a highly infectious RNA virus
that can live on surfaces for up to two weeks,
and it's not killed by alcohol based hand sanitizer and
(14:35):
is resistant to a lot of disinfectants, and that's how
you wind up with stuff like at least two hundred
and forty two people getting neurovirus after one player was
sick court side on the first night of a basketball
tournament and well meaning attendees did the cleanup without informing
the custodial staff of what had happened. This virus has
(14:56):
probably been around for centuries, but the first clear to
description of the illness was by John Zahorski in nineteen
twenty nine in a paper titled Hyperemesis higamis, or the
Winter Vomiting Disease. So Horski was a doctor who described
a cluster of cases he had seen in Saint Louis.
He differentiated between respiratory diseases that could also cause gastro
(15:18):
intestinal symptoms and a disease in which the gastro intestinal
symptoms were the whole thing. He also noted that this
disease tended to happen in the winter, although norovirus is
more common in the colder months, outbreaks can happen at
any time of the year. Norovirus is named for Norwalk, Ohio,
(15:39):
where an outbreak struck an elementary school in October of
nineteen sixty eight. A few people became ill on the
evening of October twenty ninth, but then a lot more
people got sick on October thirtieth and thirty first, making
for a terrible Halloween for all of them. This outbreak
ultimately sickened half the school that also spread to people's
(16:00):
family members and their close contacts, with a wave of
secondary cases from November first through third, and then additional
illnesses continuing until November seventh. According to the CDC report
on the outbreak, there were ninety nine primary cases and
one hundred secondary cases. Everybody recovered, though, and nobody had
(16:21):
to be hospitalized.
Speaker 1 (16:22):
The CDC investigated this outbreak as well. An obvious possible
source for an outbreak of gastro intestinal illness is food,
but students who had brought their lunch from home got
sick at about the same rate as students who got
their lunch from the school cafeteria. Tests on the food
and milk that were still on hand in the cafeteria
(16:43):
did not show any signs of pathogens.
Speaker 2 (16:46):
Another obvious possibility is water. The school had its own
well rather than being on a municipal water system, and
that well was routinely chlorinated. It was checked for coliform
bacteria that did not reveal anything. A miss but it
also wasn't enough to totally rule it out as a
possible source of illness, so the school just used bottled
(17:08):
water until the well was determined to be safe.
Speaker 1 (17:11):
When the CDC issued a report on this outbreak in
the Morbidity and Mortality Weekly Report on November twenty third,
no specific cause had been identified, but the overall conclusion
was that the primary cases had all come from a
single source, while the secondary cases had spread from person
to person starting with those primary cases, and the suspected
(17:33):
cause was a virus.
Speaker 2 (17:35):
The CDC's write up also reflects some expectations around gender
and parenting. Quote person to person spread was probably responsible
for the secondary cases, and consequently one might expect a
significantly higher attack rate in mothers, who have more intimate
contact with sick children than in fathers, and a higher
(17:56):
attack rate in larger families five or more members than
in small doller families. Although the attack rate in mothers
thirty seven percent was higher than in father's twenty two percent,
this difference was not statistically significant. Furthermore, attack rates in
large and small families were similar. Although researchers could not
(18:17):
identify the pathogen right away, they did want to confirm
whether there was an infectious agent at work that was
shed by sick people and could infect others. This involved
collecting and preparing what we are just going to call
the inoculum, which was then given to volunteer test subjects.
Speaker 1 (18:34):
This was not a new idea. The nineteen seventy one
paper detailing this research cited three prior studies from the
nineteen forties and fifties that had similarly showed that it
was possible to transmit non bacterial gastroenteritis this way. Different
versions of the inoculum were made from samples collected during
four outbreaks of gastro intestinal illness at the elementary school
(18:59):
in Norwalco, Ohio, aboard the US Navy ship Shenandoah while
it was in the Caribbean, and in New Britain, Connecticut,
and Bethesda, Maryland. The inoculum was presumed to contain something
non bacterial that was going to cause gastrointestinal illnesses, but
it also went through a bunch of cultures and safety
(19:19):
tests to try to make sure that it did not
contain any other known pathogen that could cause problems or
other illnesses. Two groups of participants were part of this study.
Some were men who were incarcerated at the Maryland House
of Correction in Jessup, Maryland, and others were from the
Clinical center of the National Institutes of Health. The paper
(19:41):
detailing this work described all of these participants as volunteers
who all gave informed consent before participating, but there are
a lot of caveats around the idea of volunteering for
medical research in the context of being incarcerated. The Maryland
House of Correction was also vote notorious for violence and
(20:01):
harsh treatment of the people incarcerated there.
Speaker 2 (20:05):
Participants were given a complete physical exam, including lots of
lab work and chest X rays, to confirm that they
were in good health before being given the inoculum. They
were also treated with gamma globulin injections to protect them
in case there was some kind of hepatitis contamination in
the inoculum that would not have shown up on tests.
(20:27):
Participants at the prison were isolated in the prison's hospital ward,
and participants in the clinical center of the nih were
placed in isolation rooms there.
Speaker 1 (20:36):
The only inoculum that produced illness in this experiment was
the one that had been prepared from samples collected in
Norwalk Ohio. Of the three volunteers who received this inoculum,
two became ill. Then their samples were used to prepare
additional inoculum, which was administered to additional test subjects. Seven
(20:57):
of those nine people also became ill. When another round
of innoculum was prepared from these patients, only one of
the fore men who received it became ill.
Speaker 2 (21:08):
A paper detailing this research has been described as a
landmark article in the study of viral gastroenteritis, and it
created a pretty thorough picture of how this disease could
spread and what symptoms it could cause, but it still
was not clear what the actual pathogen was. The paper
uses the term non bacterial, and some researchers thought the
(21:30):
illness must be caused by a virus, but others thought
a virus was unlikely because so many other acute gastro
intestinal illnesses were caused by known bacteria, including E. Coli
and salmonilla. The only thing that had been mostly ruled
out was toxins, because it seemed unlikely that a toxin
(21:51):
could progressively pass through multiple people's digestive systems to then
sicken other people. Researchers using immuno electronic roscopy finally got
a look at a particle measuring twenty seven nanometers in
samples collected in Norwalk in nineteen seventy two. This made
neurovirus the first viral gastroenteritis to be conclusively identified, and
(22:14):
within a few years it was being connected to a
lot of illnesses. One paper published in nineteen seventy nine
suggested that a third of the acute gastroenteritis outbreaks that
didn't have a known cause had likely been caused by
Norwalk like viruses. Technological developments later in the nineteen seventies
and into the nineteen eighties allowed researchers to study the
(22:36):
virus further and some more easily detect and identify it
in samples during outbreaks, and this also led to efforts
to identify other viruses that could cause similar illnesses, including rotavirus,
enteric dentovirus, and astrovirus. Neurovirus's whole genome was sequenced in
the nineteen nineties, and today it is described as part
(22:58):
of the Calisaveridae family of viruses. Studying neurovirus continues to
be challenging, though it's only been within the last few
years that researchers have found animal species that could potentially
work as a model for human beings in terms of neurovirus,
and it has also only been recently that researchers have
figured out how to cultivate the virus in vitro. These
(23:21):
are also some of the reasons why there's not yet
a vaccine for neurovirus. As we said earlier, it can
be deadly in some people, but for most people it's
just an extremely unpleasant inconvenience that would be really nice
to avoid. According to a paper published in the Journal
of Infectious Diseases in twenty twenty, neurovirus outbreaks in the
(23:43):
United States costs an estimated seven point six million dollars
in direct medical costs annually, and then another one hundred
and sixty five million dollars in loss productivity. Also just
it's real unpleasant thing to have to go through beyond
those economic numbers. In addition to all the difficulties in
studying the virus itself, there are also multiple strains of
(24:06):
it that shift very rapidly, and that makes the effort
to create a vaccine even more complicated.
Speaker 1 (24:12):
So there are going to continue to be neurovirus outbreaks
all around the world for the foreseeable future. They're particularly
common in places like hospitals, schools, and restaurants. Gastro Intestinal illnesses,
including neurovirus, are so common on cruise ships that the
Centers for Disease Control has a whole vessel sanitation program
(24:33):
to try to prevent and track outbreaks on board. Some
outbreaks are almost counterintuitive, like there have been a number
of outbreaks on long distance hiking trails like the Pacific
Crest Trail and the Appalachian Trail, which are exacerbated by
people using common latrines and shelters and often relying on
hand sanitizer rather than soap and water. Let's take a
(24:56):
quick sponsor break and then talk about on illness that's
a lot dead than neurovirus, but also not nearly as
easy to spread.
Speaker 2 (25:13):
The last disease we're going to talk about is one
that is surrounded by a lot of stigma and fear,
which is ebola virus disease. Ebolavirus disease is a hemorrhagic
disease with a high mortality rate. The World Health Organization
estimates the average at fifty percent, although different species of
(25:33):
ebolavirus can have very different mortality rates, some of them
much higher than that. People who survive ebola infection can
also have long term physical and mental health effects afterward.
All of this is genuinely scary, which has really contributed
to that stigma in places that are affected by this disease.
(25:54):
This includes people who have survived ebola who can continue
to face stigma and ostrasis after recovering. Since Ibola is
also found almost entirely in Central and Western Africa, there's
also a lot of stigma and misinformation about it in
other parts of the world, based on people's preconceptions and
biases rather than any actual experience or knowledge about the disease.
Speaker 1 (26:19):
There were two concurrent outbreaks of a Bowla virus disease
in nineteen seventy six, although at the time it was
not known that these were caused by two different species
of the virus, and it seemed like they were probably related.
One started in the Southern Sudan Autonomous Region, which was
then part of Sudan but is South Sudan's today. The
(26:40):
other was in what's now the Democratic Republic of the Congo,
which was then known as Zaire.
Speaker 2 (26:46):
The first cases in the first known outbreak of ebola
were reported in workers at a cotton factory in Nzara,
which is in what's now South Sudan. This is a
town roughly twenty five kilometers nor the east of the
border with the DRC. The cotton factory was part of
a large agricultural cooperative, which was in Zara's primary employer.
(27:09):
About four hundred and fifty people worked at the cotton factory,
with about two thousand people employed at the agricultural collective overall.
The first illnesses were reported in June and July of
nineteen seventy six in men who worked as storekeepers at
the cotton factory. These men were connected only through their
jobs and didn't have any common contacts outside of work.
(27:33):
The first to become ill eventually went to the hospital
and died there on July sixth. His brother had taken
care of him at home and got sick as well,
but he recovered. The second man to get sick also
died in the hospital on July fourteenth. His wife had
taken care of him at the beginning of his illness,
and she died at their home on July nineteenth. The
(27:56):
third reported illness was in a man who worked in
a cloth roam adjacent to the store who got sick
in mid July, and he also had no other contacts
with these other two men outside of work, but he
had a much more active social life than either of
them did. He had lots of friends, and his friends
also had lots of friends, and this illness really quickly
(28:19):
spread among all these friends and acquaintances as people looked
after each other when they were sick and also just
visited and checked in on one another. This included the
virus being introduced into other areas when people traveled, often
before they realized that they were sick.
Speaker 1 (28:38):
Emola spreads through contact with blood and other bodily fluids,
and it also causes things like vomiting and hemorrhaging, so
it can spread easily between patients and the people taking
care of them, especially if those caregivers don't have access
to things like protective equipment and disinfectants. This pattern of
spread also meant that the outbreak in them Tizara eventually
(29:01):
ended as people started avoiding one another out of fear
of the illness, and the remaining patients and their caregivers
either recovered or died. The last reported infection in Nazara
was on October twenty seventh, nineteen seventy six, and there
were sixty seven total cases there. By the end of
this outbreak there thirty seven percent of the workers in
(29:23):
the cloth factory had been infected. It's likely that the
initial source of the infection was bats that were living
in the roof space of the factory, or possibly rats
that had contracted it from the bats. But on August seventh,
abola had also been introduced to the town of Meridi,
about one hundred and fifty kilometers away, when a patient
(29:45):
was admitted to the hospital there. This patient had been
close friends with the third worker from the Nazara cotton
factory who became ill. A second patient from Nazara, who
was a nurse, was also admitted to the Meridi hospital
on Allfae August twenty ninth.
Speaker 2 (30:01):
And as this illness started to spread at the hospital,
conditions there quickly broke down. This was a teaching hospital
and a lot of the people who got sick were
nurses and nursing students. By the end of the outbreak
in Mariti, ninety three of two hundred and thirteen cases
had been contracted at the hospital. With seventy two of
(30:24):
those cases, or about seventy seven percent, being among hospital staff.
This included the doctor in charge and about forty percent
of the nursing staff, about half of whom died. Understandably,
patients and staff alike started to be afraid to go
to the hospital, and that meant the disease continued to
spread out in the community as people were cared for
(30:47):
by friends or relatives instead, as they became more and
more ill, and people with other illnesses and conditions weren't
able to get the care that they needed because of
what was happening at the hospital. This disease he also
spread in the community as people prepared their loved ones
bodies for their funerals.
Speaker 1 (31:06):
As the disease was starting to spread in the hospital
at Meridi, another outbreak began in the Yambuku Mission Hospital
in what's now the Democratic Republic of the Congo. The
headmaster of the Yumbuku Mission School was admitted to the
hospital on August twenty sixth with what was believed to
be a relapse of malaria. He had just returned from
(31:27):
a two week trip to the area near the border
with Sudan. He was treated with anti malarial medications by injection,
and he was discharged on September first, but he returned
on September fifth after developing a hemorrhagic illness, and he
died the following day. Another man, whose identity is not known,
(31:48):
had also been admitted to the hospital on August twenty eighth.
He was experiencing nosebleeds, dysentery, and fever. He left the
hospital two days later, even though he was serious ill
and what happened to him after that is not known.
Some sources conclude that the headmaster was the index patient
in this outbreak, while others conclude that it was that
(32:11):
unknown other patient. It is possible that the headmaster contracted
abola during his treatment for malaria through a needle or
a syringe that had been used on the other patient.
Speaker 2 (32:22):
Injections using contaminated needles and syringes became a major source
of the spread of illness in this outbreak. At the time,
it was a common practice at the hospital to administer
a lot of medicines and supplements by injection, including things
like prenatal vitamins. Some of this was cultural. People generally
(32:42):
believed that medicines delivered by injection were more powerful and
worked better than ones that were taken orally, so nurses
administered more injections than they would have in other contexts.
This was an impoverished area without a lot of resources,
including a limited supply of needles and syringes. These were
(33:04):
rinsed with sterile water between patients, and they were boiled
at the end of the day, but neither of those
steps was enough to effectively sterilize them. Roughly a quarter
of the ebola patients at this hospital had no risk
factors for the disease other than the injections that they
received there. As had happened in Mariti, the disease also
(33:25):
spread from patients to their direct caregivers at the hospital. Ultimately,
thirteen of the seventeen staff at Yambuku Mission Hospital became ill,
and eleven of them died. People in Yambuku also contracted
the illness while preparing people's bodies for their funerals. This
included the headmaster's mother, wife, mother in law, sister in law,
(33:48):
and other loved ones. The disease also spread from Yambuku
to the capital city of Kinshasa. In September of nineteen
seventy six, doctor Gooi Mishola, who was the district's chief
medical officer, visited Yambuku and wrote the first clinical description
of this disease that with description was sent to health
(34:09):
officials in Kinshase. On September twenty eighth, Belgian physician Jacques
Corteat took a blood sample from a nun at a
hospital in Kinshase. He sent this sample to the Institute
of Tropical Medicine and Antwerp, Belgium, where it was analyzed
in the microbiology department electron Micross because Vin Jakub spotted
(34:30):
a Marburg like virus in this sample, and then the
institute notified the World Health Organization. Marburg virus is named
for Marburg, Germany, which was the site of an outbreak
of another hemorrhagic fever in nineteen sixty seven. That nineteen
sixty seven outbreak also involved Frankfurt, Germany in Belgrade, Serbia,
(34:51):
and it was connected to contact with monkeys that were
used in laboratory research.
Speaker 1 (34:56):
Officials from the World Health Organization arrived in Zayu on
October nineteenth and in Sudan on October twenty ninth, and
in both places went through similar efforts to work with
local health officials and medical and nursing staff to investigate
and contain these outbreaks. This included distributing personal protective equipment
like gowns, masks, and gloves, and teaching staff how to
(35:20):
use them Safely. Donning and doffing this kind of protective
equipment without contaminating anything is a whole process. They also
taught nursing staff how to thoroughly sterilize needles and other instruments,
and worked with local leaders and chieftains to identify cases and,
whenever possible, bring patients to isolation units at a hospital.
(35:41):
An isolation bard had been built in Mariti just before
the World Health Organization arrived. Since there was no known
treatment for this illness, the World Health Organization also collected
plasma from people who had recovered to see if it
could be used for therapeutic purposes. This process took time, though,
since they also needed to develop tests to confirm that
(36:05):
this plasma didn't contain any active virus. Direct patient care
was handled by healthcare workers from the local area, while
the World Health Organization managed things like disease surveillance, tracking,
education and support. Samples were also sent to facilities that
had the ability to contain such a dangerous pathogen, including
(36:26):
the Centers for Disease Control in Atlanta and Porting Down
in the UK. The virus was eventually determined to be
in the same family as Marbourg virus. The species of
a bolovirus that were involved in these two outbreaks are
now known as Sudan a bolavirus and Zayre a bolavirus.
Speaker 2 (36:44):
By the end of these outbreaks, three hundred eighty one
people had contracted the disease in what's now the Democratic
Republic of the Congo, and two hundred and eighty of
them had died. In Sudan, there were two hundred and
eighty four cases and one hundred and fifty one deaths.
There was also one smaller outbreak in this same part
of South Sudan in nineteen seventy nine, but then after
(37:07):
that there was really no known ebola activity until nineteen
ninety four. The nineteen ninety four outbreak kind of revived
scientific and medical interest in studying the disease. The largest
ebola epidemic in history took place between twenty fourteen and
twenty sixteen, when the disease was introduced into more densely
populated areas in western Africa that had no prior experience
(37:30):
with it.
Speaker 1 (37:32):
There were more than twenty eight thousand suspected and probable
cases and more than eleven thousand deaths during this outbreak.
It was confirmed that a Bola virus can be transmitted
sexually as well as through direct contact with blood and
other bodily fluids.
Speaker 2 (37:48):
It's suspected that bats are the natural carrier of this virus,
although other animals can carry it as well, and in
addition to the types of transmission that we've talked about
in this episode, it can also be transmitted when people
have contact with animals, including when hunting and when butchering
animals for their meat. Today, a bolavirus disease is treated
(38:11):
with monoclonal antibodies and supportive care, and there are two
licensed vaccines for zayre ebolavirus. Carl Johnson, who was part
of the international commission that formed to investigate and worked
to control this outbreak, suggested the name of Bolah for
a river in the Northern Democratic Republic of the Congo. Locally,
(38:32):
this river is more commonly known by its Bondi name
of Lake Bala. This name was accepted in nineteen seventy
seven Johnson reportedly suggested this name because he wanted to
avoid bringing additional stigma to any of the villages, towns,
or cities where this outbreak had taken place, and this
(38:53):
is part of the thought process for how diseases are
named today. In twenty fifteen, the World Health Organization released
updated best practices for naming diseases and they specifically discouraged
the use of geographic locations as well as people's names, industries, foods,
and animals. And this is because these kinds of names
(39:14):
for diseases can contribute to a lot of stigma and
other unnecessary negative effects, including misinformation like monkey pox, which
has been renamed empos doesn't have anything to do with
monkeys other than that it had been identified in work
that involved lab monkeys. The word monkey is connected to
(39:35):
racist stigma, and then people were sort of folding that
into their discussions of the disease. And we also all
just lived through something like this at the start of
the COVID nineteen pandemic, when people, mostly outside of the
medical field, used the fact that it was first reported
in China to stoke a lot of anti Asian racism.
(39:57):
So there are a lot of these names that are
still in use, but the best practice now is to
just name things descriptions of what the illness is, rather
than connecting it to like a place or a person,
or an industry or anything like that.
Speaker 1 (40:13):
I have thoughts on this. We'll discuss that.
Speaker 2 (40:15):
Sure, Sure we may have another one of these episodes
at some point in the future, because I found it interesting.
Speaker 1 (40:23):
Do you have listener mail for us?
Speaker 2 (40:24):
Yes?
Speaker 1 (40:25):
I have email.
Speaker 2 (40:25):
This email is from Carolyn, who wrote about Icelandic volcanoes
and Norwegian corvids. Carolyn wrote, Hello, Tracy and Holly. Huge
fan and second time emailer. I finished John Ben and
the Lucky Fisher episodes yesterday on my commute and had
to write in again. No pronunciation corrections this time. Carolyn
(40:47):
is one of the folks who wrote in about how
to say decalb.
Speaker 1 (40:52):
It's so hard to see it.
Speaker 2 (40:53):
I can't. Yeah, I have a hard time for me too. First,
I also love and have already visited this year, so
I won't be joining you. I do have a suggestion
for another country for a future stuff you miss in
history class road trip, But more of that in a minute.
If you haven't already been to the Snifelessness Peninsula in Iceland.
(41:15):
You may want to go there. I've attached two of
my favorite seal pictures from our trip there earlier this year.
I was so excited to hear you talk about the
Locky Fissure because that was my very first introduction to
Iceland before my husband and I went for the first
time just before shut down in March twenty twenty. I
read Island on Fire by Alexandra Vitz to do some
(41:37):
quote light geology reading, history reading before arriving. I don't
know if you use this book in your research for
the episode, but I highly recommend it. I was fortunate
to see the chapel dedicated to Jan Steinerson on another trip.
It's small but cool, but it wasn't open when we stopped.
I was also so grateful to meet you both in
(41:58):
person at the recent live episode of and Indie, and
Holly's mention of crow love reminded me that I hadn't
yet sent the pictures of Norwegian hooded crows. I think
they look like they're wearing fluffy vests. My husband is
Norwegian and I have a lot of topic suggestions for you,
and wonder if you've considered doing a trip there. It's
really beautiful and full of history that definitely has not
(42:18):
made it into many American history books. Carolyn then follows
with some topic suggestions and says, since I sent pictures
of my dog Penny, she loves kisses Holly and my
granddog and kitties last time, my pet taxes some pictures
of the beautiful hooded crows and icelandic seals, I hope
you enjoy best. Carolyn, thank you so much for this email.
Speaker 1 (42:39):
Carolyn.
Speaker 2 (42:39):
I did not use that book as part of the
research for the Locky Fissier eruption episode, but I did
have a paper by that author that was part of it.
There were just too many possible resources to use to
be able to go through all of them. And man,
these birds are definitely beautiful, and you're right they look
(43:02):
like they have little white vests on this is I
don't think this is a place that we visited when
we were in Iceland last time, and I have not
looked at a map to see if it is in
the vicinity of where we will be in November. We
have mentioned the trip we're taking to Iceland in November
a couple of times recently. At last check that was
sold out, but there is a waiting list, and if
(43:24):
you're curious and maybe you want to see if you
can get on that waiting list, it is at Defined
Destinations dot com. So thank you again for sending these
great pictures in this email, Carolyn. If you would like
to write to us about this or any other podcast,
or at History Podcast at iHeartRadio dot com, and you
(43:44):
can subscribe to the show on the iHeartRadio app or
wherever else you would like to get your podcasts. Stuff
you Missed in History Class is a production of iHeartRadio.
For more podcasts from iHeartRadio, visit the iHeartRadio app, Apple Podcasts,
or wherever you listen to your favorite shows.
Welcome to Stuff You Missed in History Class, a production
of iHeartRadio.
Speaker 2 (00:11):
Hello, and welcome to the podcast. I'm Tracy V.
Speaker 1 (00:14):
Wilson, and I'm Holly Frye.
Speaker 2 (00:16):
I am kind of riffing on Holly's beloved theme of
eponymous foods, but maybe in a less fun direction, which
is diseases that are named after places.
Speaker 1 (00:29):
I like how you said, maybe like there's someone else
going Yeah.
Speaker 2 (00:34):
Somebody is excited about learning where disease names came from.
If you saw the title of today's episode and you
saw the word eponymous and you were expecting food treats
and now you're disappointed, I'm very sorry. The word eponymous
is I think most often used to describe something named
after a person, but it can also describe something named
(00:55):
after a place or a thing. And this episode is
also inspired by an experience I had a few years
ago when I went to visit family and the big,
big local news story. While I was there was an
outbreak of Legionnaire's disease connected to walking past a hot
tub display at affair. I found all of that horrifying
(01:18):
from a number of directions, and it made me, then,
of course, want to do an episode on Legionnaire's disease.
That's a totally normal response to this whole experience. I
was not able to work that into a whole episode,
and it just took me a while to kind of think, hey,
there's a theme here. We are going to really be
focused on the outbreak that led to these diseases being
(01:39):
identified and named, so it won't be like a whole
history of any of these three diseases. Two of the
diseases we're talking about today are ones that people can
contract through incredibly casual exposure, like walking past a hot
tub display. The third requires a lot more pro longed
(02:00):
direct contact with somebody who is acutely ill, but it
can really still spread very rapidly in certain conditions. Although
there will be some experimentation on animals mentioned in this
episode and one of the most disgusting human experiments that
I've ever encountered while working on this show. We're gonna
talk about that just as delicately as possible, but it
(02:23):
is gross. So first up, as Tracy alluded to, Legionnaire's disease,
which is caused by Legionella bacteria. Multiple species of Legionella
bacteria can cause disease, but most outbreaks are connected to
Legionella numophila. Legionella numophila can actually cause two different diseases,
(02:45):
Legionnaire's disease and pontiac fever. Both of these can cause
flu like respiratory symptoms, but pontiac fever is generally milder
and typically resolves on its own. Legionnaire's disease, on the
other hand, can cause pneumonia and lead to hospitalization and death.
It's not fully understood why the same bacteria causes two
(03:07):
clinically different syndromes, or why outbreaks tend to cause one
or the other. Legionnaire's disease is named for the American
Legion convention that was held at the Bellevue Stratford Hotel
in Philadelphia, Pennsylvania, in nineteen seventy six. I guess we
could have a semantic argument about whether a convention is
a place or not. I think it is, at least temporarily.
(03:32):
The American Legion is a veterans organization that was chartered
by Congress in nineteen nineteen, focused on service to veterans
and to their communities. This nineteen seventy six state meeting
in Philadelphia also ran alongside the US bi centennial, so
there were a lot of other celebrations and festivities going
(03:52):
on as well. The American Legion Convention took place from
July twenty first through twenty fourth, and then on July
twenty twenty seven, a retired Air Force captain who had
attended the convention died of an apparent heart attack. Within days,
other convention attendees had also died after reporting symptoms that
included fevers, headaches, chest pain, and chest congestion. On the
(04:17):
afternoon of Friday, July thirtieth, doctor Ernest Campbell of Bloomsburg, Pennsylvania,
tried to alert the Pennsylvania State Public Health Department that
some of his patients had become seriously ill after attending
the convention, but he was told the office had closed
for the day. Another doctor tried to report a similar
(04:39):
pattern of illnesses to the health department on Saturday, which
of course, was also still closed. By the time the
office reopened on Monday, eighteen people had already died.
Speaker 1 (04:51):
In addition to this delay in starting an investigation into
what was going on, there were some specifics that made
it hard to pinpoint where this illness had come come from.
Medical staff who saw multiple patients all around Pennsylvania made
a connection to the convention right away, but there were
also people who got sick who had not gone to
(05:11):
the convention or even been inside the hotel where it
was held. One was a bus driver who had driven
a marching band to Philadelphia for a parade, who had
spent almost all of his time in Philadelphia on the bus.
Another person was local to Philadelphia but had not been
in the hotel for a while, investigators were classifying this
(05:33):
as two different diseases, legionnaire's disease for convention attendees and
broad Street pneumonia for everyone else.
Speaker 2 (05:42):
Health authorities in Pennsylvania, once they had gotten those reports,
contacted the Centers for Disease Control, and the CDC reported
on the illness in its Morbidity and Mortality Weekly Report
on Friday, August sixth, the same week that the illnesses
had first been reported to the Pennsylvania State Public Health Department.
According to this report, one hundred and fifty two people
(06:05):
associated with the convention had become ill between July twenty
second and August third, with most of those illnesses starting
between July twenty fifth and thirty first. Twenty two of
those one hundred and fifty two people had died, but
there didn't seem to be an increase in respiratory diseases
in Philadelphia more generally, and the illnesses didn't seem to
(06:27):
have spread between these patients and their family members or
other close contacts. The CDC included weekly updates in the
Morbidity and Mortality Weekly Report until September third, at which
point the outbreak was over. As of August thirty first,
nineteen seventy six, there had been one hundred seventy nine
cases and twenty eight deaths, including one hundred forty eight
(06:49):
people who had been at the convention and thirty one
who had not, but those had been either in or
near the hotel at some point. The disease had been
particularly lethal in people who had other conditions like heart disease, diabetes,
or cancer, but this report did not include what had
caused the outbreak because at that point they did not know.
(07:13):
The CDC Epidemic Intelligence Service and the Pennsylvania Department of
Health had carried out what was at the time the
largest infectious disease investigation in CDC history. They had more
than one hundred and fifty investigators and medical professionals involved.
They looked for evidence of viruses and bacteria, heavy metals,
(07:34):
environmental toxins, and other potential causes, without any success. They
checked seemingly every surface and potential source of contamination at
the hotel. Because there was this clear connection to an
American Legion convention, there were even concerns that it had
been an intentional poisoning carried out by anti war protesters,
(07:55):
or maybe some kind of biological attack connected to the
Cold War. Meanwhile, this outbreak had gotten a lot of
press coverage. There had been an outbreak of swine flu
at Fort Dix in New Jersey the previous winter, believed
to be very similar to the virus that had caused
the nineteen eighteen flu pandemic. This had led to fears
(08:15):
of an impending pandemic and a huge emergency effort to
vaccinate people. Although a pandemic had not developed, and various
issues with this vaccine rollout had led the press to
call it a fiasco. This had led to heightened anxieties
around the idea of contagious illness. Also, this was an
illness that had disproportionately sickened and killed veterans, a lot
(08:40):
of them retirees during the celebration of the US bicentennial,
so the whole thing had additional layers of emotional impact,
like this is right on the heels of the Vietnam War,
but a lot of the people that were that were
sickened and killed had served in like World War Two
and the Korean War, and people rea guarded them with
(09:00):
like a slightly different nuance than how people were viewing
the Vietnam War at the time. The fact that so
many people died so quickly also made this outbreak particularly terrifying.
On August sixteenth, nineteen seventy six, Time Newsweek and US
News and World Report all had cover stories about the outbreak,
and all three of them used the word killer in
(09:22):
the headline.
Speaker 1 (09:24):
By Christmas of nineteen seventy six, the Bellevue Stratford Hotel
had closed in the aftermath of the outbreak, and the
CDC had faced intense criticism for not figuring out the cause.
This included CDC microbiologist Joseph McDade, who got a lecture
about it at a Christmas party from a random man
that he had never met before. McDade worked in the
(09:46):
lab but was not a decision maker at the CDC,
but over the week between Christmas and New Years, he
started re examining slides from his initial work on the case.
This research had involved exposing guinea pigs to pttential pathogens,
and investigators had figured out that there was something in
patient's lung tissue that could make the guinea pigs sick,
(10:08):
but which then couldn't be transmitted from one guinea pig
to another.
Speaker 2 (10:13):
What they hadn't been able to do was to isolate
and identify this pathogen.
Speaker 1 (10:18):
A few things were working against them here. One is
that the bacteria involved didn't respond to some of the
stains being used to prepare the microscope slides. Another was
how the CDC was focusing its efforts. Microbiologists had been
trying to rule out specific pathogens using preparations developed to
grow those particular pathogens. Some of these preparations used antibiotics
(10:42):
to prevent contamination by other bacteria, but those antibiotics were
also killing the bacteria that caused the outbreak. When McDade
did new cultures without those antibiotics, he immediately saw clusters
of bacteria under his microscope. Some additional steps can confirmed
that this bacterium had caused the outbreak, and it was
(11:03):
ultimately named lee Jionella numophila.
Speaker 2 (11:07):
The CDC put out a special issue of the Morbidity
Immortality Weekly Report on January eighteenth, nineteen seventy seven, to
announce the discovery of this bacterium, and then a peer
reviewed paper was published in the New England Journal of
Medicine in December. McDade was a key part of this,
but he did not do it all alone. He was
(11:27):
one of six authors listed on the paper, along with
the laboratory investigation team. The most likely scenario for how
this bacterium sickened and killed so many people is that
it had been growing in the Bellevue Stratford Hotel's air
conditioning system. When a heat wave moved through Philadelphia in
July of nineteen seventy six, the air conditioning system started
(11:50):
working harder, and bacteria laden missed from the cooling towers
made its way into the hotel and to the street
and sidewalk below, which is why people who had not
been in the hotel had also gotten sick. Identifying this
bacterium also allowed investigators to go back and re examine
other earlier outbreaks, going back to at least nineteen fifty nine.
(12:14):
One of these outbreaks had taken place in Pontiac, Michigan,
in nineteen sixty eight. Ironically, this outbreak took place at
the health department and more than ninety percent of the
employees had gotten sick. This included some of the CDC
investigators who arrived to investigate the outbreak. This was a
much milder illness, though, and everyone recovered, and that's why
(12:36):
pontiac fever is given a separate name from Legionnaire's disease.
These outbreaks led to efforts to better coordinate between the
CDC and local health authorities and more stringent sanitation standards
for things like air conditioning systems, swimming pools, and hot tubs.
But there are still disease outbreaks caused by these bacteria,
(12:58):
including the one in twenty nineteen at the Mountain State
Fair in Fletcher, North Carolina that was the one that
inspired this episode. The final report on that outbreak listed
one hundred and thirty six cases of Legionnaire's disease with
ninety six hospitalizations and four deaths, as well as one
case of pontiac fever. Legionella bacteria occur naturally in soil
(13:20):
and water. So some cases of Legionnaire's disease and pontiac
fever have also been traced to things like potting soil.
Let's take a little sponsor break, and then after that,
we're going to be talking about an illness that's really
not for the squeamish, and that also is going to
include the particularly gross research. Next, we're going to talk
(13:49):
about something that's not as deadly as Legionnaire's disease, but
it can still cause serious illnesses and death, especially in
older people, babies, and people that have other health conditions. However,
it is miserable. It is neurovirus, also called Norwalk virus,
and it's probably responsible for more than half of food
(14:11):
borne illnesses worldwide. Neurovirus causes acute gastroenterritis, which is also
known as stomach flu, although that is a totally different
virus from influenza. Neurovirus is a highly infectious RNA virus
that can live on surfaces for up to two weeks,
and it's not killed by alcohol based hand sanitizer and
(14:35):
is resistant to a lot of disinfectants, and that's how
you wind up with stuff like at least two hundred
and forty two people getting neurovirus after one player was
sick court side on the first night of a basketball
tournament and well meaning attendees did the cleanup without informing
the custodial staff of what had happened. This virus has
(14:56):
probably been around for centuries, but the first clear to
description of the illness was by John Zahorski in nineteen
twenty nine in a paper titled Hyperemesis higamis, or the
Winter Vomiting Disease. So Horski was a doctor who described
a cluster of cases he had seen in Saint Louis.
He differentiated between respiratory diseases that could also cause gastro
(15:18):
intestinal symptoms and a disease in which the gastro intestinal
symptoms were the whole thing. He also noted that this
disease tended to happen in the winter, although norovirus is
more common in the colder months, outbreaks can happen at
any time of the year. Norovirus is named for Norwalk, Ohio,
(15:39):
where an outbreak struck an elementary school in October of
nineteen sixty eight. A few people became ill on the
evening of October twenty ninth, but then a lot more
people got sick on October thirtieth and thirty first, making
for a terrible Halloween for all of them. This outbreak
ultimately sickened half the school that also spread to people's
(16:00):
family members and their close contacts, with a wave of
secondary cases from November first through third, and then additional
illnesses continuing until November seventh. According to the CDC report
on the outbreak, there were ninety nine primary cases and
one hundred secondary cases. Everybody recovered, though, and nobody had
(16:21):
to be hospitalized.
Speaker 1 (16:22):
The CDC investigated this outbreak as well. An obvious possible
source for an outbreak of gastro intestinal illness is food,
but students who had brought their lunch from home got
sick at about the same rate as students who got
their lunch from the school cafeteria. Tests on the food
and milk that were still on hand in the cafeteria
(16:43):
did not show any signs of pathogens.
Speaker 2 (16:46):
Another obvious possibility is water. The school had its own
well rather than being on a municipal water system, and
that well was routinely chlorinated. It was checked for coliform
bacteria that did not reveal anything. A miss but it
also wasn't enough to totally rule it out as a
possible source of illness, so the school just used bottled
(17:08):
water until the well was determined to be safe.
Speaker 1 (17:11):
When the CDC issued a report on this outbreak in
the Morbidity and Mortality Weekly Report on November twenty third,
no specific cause had been identified, but the overall conclusion
was that the primary cases had all come from a
single source, while the secondary cases had spread from person
to person starting with those primary cases, and the suspected
(17:33):
cause was a virus.
Speaker 2 (17:35):
The CDC's write up also reflects some expectations around gender
and parenting. Quote person to person spread was probably responsible
for the secondary cases, and consequently one might expect a
significantly higher attack rate in mothers, who have more intimate
contact with sick children than in fathers, and a higher
(17:56):
attack rate in larger families five or more members than
in small doller families. Although the attack rate in mothers
thirty seven percent was higher than in father's twenty two percent,
this difference was not statistically significant. Furthermore, attack rates in
large and small families were similar. Although researchers could not
(18:17):
identify the pathogen right away, they did want to confirm
whether there was an infectious agent at work that was
shed by sick people and could infect others. This involved
collecting and preparing what we are just going to call
the inoculum, which was then given to volunteer test subjects.
Speaker 1 (18:34):
This was not a new idea. The nineteen seventy one
paper detailing this research cited three prior studies from the
nineteen forties and fifties that had similarly showed that it
was possible to transmit non bacterial gastroenteritis this way. Different
versions of the inoculum were made from samples collected during
four outbreaks of gastro intestinal illness at the elementary school
(18:59):
in Norwalco, Ohio, aboard the US Navy ship Shenandoah while
it was in the Caribbean, and in New Britain, Connecticut,
and Bethesda, Maryland. The inoculum was presumed to contain something
non bacterial that was going to cause gastrointestinal illnesses, but
it also went through a bunch of cultures and safety
(19:19):
tests to try to make sure that it did not
contain any other known pathogen that could cause problems or
other illnesses. Two groups of participants were part of this study.
Some were men who were incarcerated at the Maryland House
of Correction in Jessup, Maryland, and others were from the
Clinical center of the National Institutes of Health. The paper
(19:41):
detailing this work described all of these participants as volunteers
who all gave informed consent before participating, but there are
a lot of caveats around the idea of volunteering for
medical research in the context of being incarcerated. The Maryland
House of Correction was also vote notorious for violence and
(20:01):
harsh treatment of the people incarcerated there.
Speaker 2 (20:05):
Participants were given a complete physical exam, including lots of
lab work and chest X rays, to confirm that they
were in good health before being given the inoculum. They
were also treated with gamma globulin injections to protect them
in case there was some kind of hepatitis contamination in
the inoculum that would not have shown up on tests.
(20:27):
Participants at the prison were isolated in the prison's hospital ward,
and participants in the clinical center of the nih were
placed in isolation rooms there.
Speaker 1 (20:36):
The only inoculum that produced illness in this experiment was
the one that had been prepared from samples collected in
Norwalk Ohio. Of the three volunteers who received this inoculum,
two became ill. Then their samples were used to prepare
additional inoculum, which was administered to additional test subjects. Seven
(20:57):
of those nine people also became ill. When another round
of innoculum was prepared from these patients, only one of
the fore men who received it became ill.
Speaker 2 (21:08):
A paper detailing this research has been described as a
landmark article in the study of viral gastroenteritis, and it
created a pretty thorough picture of how this disease could
spread and what symptoms it could cause, but it still
was not clear what the actual pathogen was. The paper
uses the term non bacterial, and some researchers thought the
(21:30):
illness must be caused by a virus, but others thought
a virus was unlikely because so many other acute gastro
intestinal illnesses were caused by known bacteria, including E. Coli
and salmonilla. The only thing that had been mostly ruled
out was toxins, because it seemed unlikely that a toxin
(21:51):
could progressively pass through multiple people's digestive systems to then
sicken other people. Researchers using immuno electronic roscopy finally got
a look at a particle measuring twenty seven nanometers in
samples collected in Norwalk in nineteen seventy two. This made
neurovirus the first viral gastroenteritis to be conclusively identified, and
(22:14):
within a few years it was being connected to a
lot of illnesses. One paper published in nineteen seventy nine
suggested that a third of the acute gastroenteritis outbreaks that
didn't have a known cause had likely been caused by
Norwalk like viruses. Technological developments later in the nineteen seventies
and into the nineteen eighties allowed researchers to study the
(22:36):
virus further and some more easily detect and identify it
in samples during outbreaks, and this also led to efforts
to identify other viruses that could cause similar illnesses, including rotavirus,
enteric dentovirus, and astrovirus. Neurovirus's whole genome was sequenced in
the nineteen nineties, and today it is described as part
(22:58):
of the Calisaveridae family of viruses. Studying neurovirus continues to
be challenging, though it's only been within the last few
years that researchers have found animal species that could potentially
work as a model for human beings in terms of neurovirus,
and it has also only been recently that researchers have
figured out how to cultivate the virus in vitro. These
(23:21):
are also some of the reasons why there's not yet
a vaccine for neurovirus. As we said earlier, it can
be deadly in some people, but for most people it's
just an extremely unpleasant inconvenience that would be really nice
to avoid. According to a paper published in the Journal
of Infectious Diseases in twenty twenty, neurovirus outbreaks in the
(23:43):
United States costs an estimated seven point six million dollars
in direct medical costs annually, and then another one hundred
and sixty five million dollars in loss productivity. Also just
it's real unpleasant thing to have to go through beyond
those economic numbers. In addition to all the difficulties in
studying the virus itself, there are also multiple strains of
(24:06):
it that shift very rapidly, and that makes the effort
to create a vaccine even more complicated.
Speaker 1 (24:12):
So there are going to continue to be neurovirus outbreaks
all around the world for the foreseeable future. They're particularly
common in places like hospitals, schools, and restaurants. Gastro Intestinal illnesses,
including neurovirus, are so common on cruise ships that the
Centers for Disease Control has a whole vessel sanitation program
(24:33):
to try to prevent and track outbreaks on board. Some
outbreaks are almost counterintuitive, like there have been a number
of outbreaks on long distance hiking trails like the Pacific
Crest Trail and the Appalachian Trail, which are exacerbated by
people using common latrines and shelters and often relying on
hand sanitizer rather than soap and water. Let's take a
(24:56):
quick sponsor break and then talk about on illness that's
a lot dead than neurovirus, but also not nearly as
easy to spread.
Speaker 2 (25:13):
The last disease we're going to talk about is one
that is surrounded by a lot of stigma and fear,
which is ebola virus disease. Ebolavirus disease is a hemorrhagic
disease with a high mortality rate. The World Health Organization
estimates the average at fifty percent, although different species of
(25:33):
ebolavirus can have very different mortality rates, some of them
much higher than that. People who survive ebola infection can
also have long term physical and mental health effects afterward.
All of this is genuinely scary, which has really contributed
to that stigma in places that are affected by this disease.
(25:54):
This includes people who have survived ebola who can continue
to face stigma and ostrasis after recovering. Since Ibola is
also found almost entirely in Central and Western Africa, there's
also a lot of stigma and misinformation about it in
other parts of the world, based on people's preconceptions and
biases rather than any actual experience or knowledge about the disease.
Speaker 1 (26:19):
There were two concurrent outbreaks of a Bowla virus disease
in nineteen seventy six, although at the time it was
not known that these were caused by two different species
of the virus, and it seemed like they were probably related.
One started in the Southern Sudan Autonomous Region, which was
then part of Sudan but is South Sudan's today. The
(26:40):
other was in what's now the Democratic Republic of the Congo,
which was then known as Zaire.
Speaker 2 (26:46):
The first cases in the first known outbreak of ebola
were reported in workers at a cotton factory in Nzara,
which is in what's now South Sudan. This is a
town roughly twenty five kilometers nor the east of the
border with the DRC. The cotton factory was part of
a large agricultural cooperative, which was in Zara's primary employer.
(27:09):
About four hundred and fifty people worked at the cotton factory,
with about two thousand people employed at the agricultural collective overall.
The first illnesses were reported in June and July of
nineteen seventy six in men who worked as storekeepers at
the cotton factory. These men were connected only through their
jobs and didn't have any common contacts outside of work.
(27:33):
The first to become ill eventually went to the hospital
and died there on July sixth. His brother had taken
care of him at home and got sick as well,
but he recovered. The second man to get sick also
died in the hospital on July fourteenth. His wife had
taken care of him at the beginning of his illness,
and she died at their home on July nineteenth. The
(27:56):
third reported illness was in a man who worked in
a cloth roam adjacent to the store who got sick
in mid July, and he also had no other contacts
with these other two men outside of work, but he
had a much more active social life than either of
them did. He had lots of friends, and his friends
also had lots of friends, and this illness really quickly
(28:19):
spread among all these friends and acquaintances as people looked
after each other when they were sick and also just
visited and checked in on one another. This included the
virus being introduced into other areas when people traveled, often
before they realized that they were sick.
Speaker 1 (28:38):
Emola spreads through contact with blood and other bodily fluids,
and it also causes things like vomiting and hemorrhaging, so
it can spread easily between patients and the people taking
care of them, especially if those caregivers don't have access
to things like protective equipment and disinfectants. This pattern of
spread also meant that the outbreak in them Tizara eventually
(29:01):
ended as people started avoiding one another out of fear
of the illness, and the remaining patients and their caregivers
either recovered or died. The last reported infection in Nazara
was on October twenty seventh, nineteen seventy six, and there
were sixty seven total cases there. By the end of
this outbreak there thirty seven percent of the workers in
(29:23):
the cloth factory had been infected. It's likely that the
initial source of the infection was bats that were living
in the roof space of the factory, or possibly rats
that had contracted it from the bats. But on August seventh,
abola had also been introduced to the town of Meridi,
about one hundred and fifty kilometers away, when a patient
(29:45):
was admitted to the hospital there. This patient had been
close friends with the third worker from the Nazara cotton
factory who became ill. A second patient from Nazara, who
was a nurse, was also admitted to the Meridi hospital
on Allfae August twenty ninth.
Speaker 2 (30:01):
And as this illness started to spread at the hospital,
conditions there quickly broke down. This was a teaching hospital
and a lot of the people who got sick were
nurses and nursing students. By the end of the outbreak
in Mariti, ninety three of two hundred and thirteen cases
had been contracted at the hospital. With seventy two of
(30:24):
those cases, or about seventy seven percent, being among hospital staff.
This included the doctor in charge and about forty percent
of the nursing staff, about half of whom died. Understandably,
patients and staff alike started to be afraid to go
to the hospital, and that meant the disease continued to
spread out in the community as people were cared for
(30:47):
by friends or relatives instead, as they became more and
more ill, and people with other illnesses and conditions weren't
able to get the care that they needed because of
what was happening at the hospital. This disease he also
spread in the community as people prepared their loved ones
bodies for their funerals.
Speaker 1 (31:06):
As the disease was starting to spread in the hospital
at Meridi, another outbreak began in the Yambuku Mission Hospital
in what's now the Democratic Republic of the Congo. The
headmaster of the Yumbuku Mission School was admitted to the
hospital on August twenty sixth with what was believed to
be a relapse of malaria. He had just returned from
(31:27):
a two week trip to the area near the border
with Sudan. He was treated with anti malarial medications by injection,
and he was discharged on September first, but he returned
on September fifth after developing a hemorrhagic illness, and he
died the following day. Another man, whose identity is not known,
(31:48):
had also been admitted to the hospital on August twenty eighth.
He was experiencing nosebleeds, dysentery, and fever. He left the
hospital two days later, even though he was serious ill
and what happened to him after that is not known.
Some sources conclude that the headmaster was the index patient
in this outbreak, while others conclude that it was that
(32:11):
unknown other patient. It is possible that the headmaster contracted
abola during his treatment for malaria through a needle or
a syringe that had been used on the other patient.
Speaker 2 (32:22):
Injections using contaminated needles and syringes became a major source
of the spread of illness in this outbreak. At the time,
it was a common practice at the hospital to administer
a lot of medicines and supplements by injection, including things
like prenatal vitamins. Some of this was cultural. People generally
(32:42):
believed that medicines delivered by injection were more powerful and
worked better than ones that were taken orally, so nurses
administered more injections than they would have in other contexts.
This was an impoverished area without a lot of resources,
including a limited supply of needles and syringes. These were
(33:04):
rinsed with sterile water between patients, and they were boiled
at the end of the day, but neither of those
steps was enough to effectively sterilize them. Roughly a quarter
of the ebola patients at this hospital had no risk
factors for the disease other than the injections that they
received there. As had happened in Mariti, the disease also
(33:25):
spread from patients to their direct caregivers at the hospital. Ultimately,
thirteen of the seventeen staff at Yambuku Mission Hospital became ill,
and eleven of them died. People in Yambuku also contracted
the illness while preparing people's bodies for their funerals. This
included the headmaster's mother, wife, mother in law, sister in law,
(33:48):
and other loved ones. The disease also spread from Yambuku
to the capital city of Kinshasa. In September of nineteen
seventy six, doctor Gooi Mishola, who was the district's chief
medical officer, visited Yambuku and wrote the first clinical description
of this disease that with description was sent to health
(34:09):
officials in Kinshase. On September twenty eighth, Belgian physician Jacques
Corteat took a blood sample from a nun at a
hospital in Kinshase. He sent this sample to the Institute
of Tropical Medicine and Antwerp, Belgium, where it was analyzed
in the microbiology department electron Micross because Vin Jakub spotted
(34:30):
a Marburg like virus in this sample, and then the
institute notified the World Health Organization. Marburg virus is named
for Marburg, Germany, which was the site of an outbreak
of another hemorrhagic fever in nineteen sixty seven. That nineteen
sixty seven outbreak also involved Frankfurt, Germany in Belgrade, Serbia,
(34:51):
and it was connected to contact with monkeys that were
used in laboratory research.
Speaker 1 (34:56):
Officials from the World Health Organization arrived in Zayu on
October nineteenth and in Sudan on October twenty ninth, and
in both places went through similar efforts to work with
local health officials and medical and nursing staff to investigate
and contain these outbreaks. This included distributing personal protective equipment
like gowns, masks, and gloves, and teaching staff how to
(35:20):
use them Safely. Donning and doffing this kind of protective
equipment without contaminating anything is a whole process. They also
taught nursing staff how to thoroughly sterilize needles and other instruments,
and worked with local leaders and chieftains to identify cases and,
whenever possible, bring patients to isolation units at a hospital.
(35:41):
An isolation bard had been built in Mariti just before
the World Health Organization arrived. Since there was no known
treatment for this illness, the World Health Organization also collected
plasma from people who had recovered to see if it
could be used for therapeutic purposes. This process took time, though,
since they also needed to develop tests to confirm that
(36:05):
this plasma didn't contain any active virus. Direct patient care
was handled by healthcare workers from the local area, while
the World Health Organization managed things like disease surveillance, tracking,
education and support. Samples were also sent to facilities that
had the ability to contain such a dangerous pathogen, including
(36:26):
the Centers for Disease Control in Atlanta and Porting Down
in the UK. The virus was eventually determined to be
in the same family as Marbourg virus. The species of
a bolovirus that were involved in these two outbreaks are
now known as Sudan a bolavirus and Zayre a bolavirus.
Speaker 2 (36:44):
By the end of these outbreaks, three hundred eighty one
people had contracted the disease in what's now the Democratic
Republic of the Congo, and two hundred and eighty of
them had died. In Sudan, there were two hundred and
eighty four cases and one hundred and fifty one deaths.
There was also one smaller outbreak in this same part
of South Sudan in nineteen seventy nine, but then after
(37:07):
that there was really no known ebola activity until nineteen
ninety four. The nineteen ninety four outbreak kind of revived
scientific and medical interest in studying the disease. The largest
ebola epidemic in history took place between twenty fourteen and
twenty sixteen, when the disease was introduced into more densely
populated areas in western Africa that had no prior experience
(37:30):
with it.
Speaker 1 (37:32):
There were more than twenty eight thousand suspected and probable
cases and more than eleven thousand deaths during this outbreak.
It was confirmed that a Bola virus can be transmitted
sexually as well as through direct contact with blood and
other bodily fluids.
Speaker 2 (37:48):
It's suspected that bats are the natural carrier of this virus,
although other animals can carry it as well, and in
addition to the types of transmission that we've talked about
in this episode, it can also be transmitted when people
have contact with animals, including when hunting and when butchering
animals for their meat. Today, a bolavirus disease is treated
(38:11):
with monoclonal antibodies and supportive care, and there are two
licensed vaccines for zayre ebolavirus. Carl Johnson, who was part
of the international commission that formed to investigate and worked
to control this outbreak, suggested the name of Bolah for
a river in the Northern Democratic Republic of the Congo. Locally,
(38:32):
this river is more commonly known by its Bondi name
of Lake Bala. This name was accepted in nineteen seventy
seven Johnson reportedly suggested this name because he wanted to
avoid bringing additional stigma to any of the villages, towns,
or cities where this outbreak had taken place, and this
(38:53):
is part of the thought process for how diseases are
named today. In twenty fifteen, the World Health Organization released
updated best practices for naming diseases and they specifically discouraged
the use of geographic locations as well as people's names, industries, foods,
and animals. And this is because these kinds of names
(39:14):
for diseases can contribute to a lot of stigma and
other unnecessary negative effects, including misinformation like monkey pox, which
has been renamed empos doesn't have anything to do with
monkeys other than that it had been identified in work
that involved lab monkeys. The word monkey is connected to
(39:35):
racist stigma, and then people were sort of folding that
into their discussions of the disease. And we also all
just lived through something like this at the start of
the COVID nineteen pandemic, when people, mostly outside of the
medical field, used the fact that it was first reported
in China to stoke a lot of anti Asian racism.
(39:57):
So there are a lot of these names that are
still in use, but the best practice now is to
just name things descriptions of what the illness is, rather
than connecting it to like a place or a person,
or an industry or anything like that.
Speaker 1 (40:13):
I have thoughts on this. We'll discuss that.
Speaker 2 (40:15):
Sure, Sure we may have another one of these episodes
at some point in the future, because I found it interesting.
Speaker 1 (40:23):
Do you have listener mail for us?
Speaker 2 (40:24):
Yes?
Speaker 1 (40:25):
I have email.
Speaker 2 (40:25):
This email is from Carolyn, who wrote about Icelandic volcanoes
and Norwegian corvids. Carolyn wrote, Hello, Tracy and Holly. Huge
fan and second time emailer. I finished John Ben and
the Lucky Fisher episodes yesterday on my commute and had
to write in again. No pronunciation corrections this time. Carolyn
(40:47):
is one of the folks who wrote in about how
to say decalb.
Speaker 1 (40:52):
It's so hard to see it.
Speaker 2 (40:53):
I can't. Yeah, I have a hard time for me too. First,
I also love and have already visited this year, so
I won't be joining you. I do have a suggestion
for another country for a future stuff you miss in
history class road trip, But more of that in a minute.
If you haven't already been to the Snifelessness Peninsula in Iceland.
(41:15):
You may want to go there. I've attached two of
my favorite seal pictures from our trip there earlier this year.
I was so excited to hear you talk about the
Locky Fissure because that was my very first introduction to
Iceland before my husband and I went for the first
time just before shut down in March twenty twenty. I
read Island on Fire by Alexandra Vitz to do some
(41:37):
quote light geology reading, history reading before arriving. I don't
know if you use this book in your research for
the episode, but I highly recommend it. I was fortunate
to see the chapel dedicated to Jan Steinerson on another trip.
It's small but cool, but it wasn't open when we stopped.
I was also so grateful to meet you both in
(41:58):
person at the recent live episode of and Indie, and
Holly's mention of crow love reminded me that I hadn't
yet sent the pictures of Norwegian hooded crows. I think
they look like they're wearing fluffy vests. My husband is
Norwegian and I have a lot of topic suggestions for you,
and wonder if you've considered doing a trip there. It's
really beautiful and full of history that definitely has not
(42:18):
made it into many American history books. Carolyn then follows
with some topic suggestions and says, since I sent pictures
of my dog Penny, she loves kisses Holly and my
granddog and kitties last time, my pet taxes some pictures
of the beautiful hooded crows and icelandic seals, I hope
you enjoy best. Carolyn, thank you so much for this email.
Speaker 1 (42:39):
Carolyn.
Speaker 2 (42:39):
I did not use that book as part of the
research for the Locky Fissier eruption episode, but I did
have a paper by that author that was part of it.
There were just too many possible resources to use to
be able to go through all of them. And man,
these birds are definitely beautiful, and you're right they look
(43:02):
like they have little white vests on this is I
don't think this is a place that we visited when
we were in Iceland last time, and I have not
looked at a map to see if it is in
the vicinity of where we will be in November. We
have mentioned the trip we're taking to Iceland in November
a couple of times recently. At last check that was
sold out, but there is a waiting list, and if
(43:24):
you're curious and maybe you want to see if you
can get on that waiting list, it is at Defined
Destinations dot com. So thank you again for sending these
great pictures in this email, Carolyn. If you would like
to write to us about this or any other podcast,
or at History Podcast at iHeartRadio dot com, and you
(43:44):
can subscribe to the show on the iHeartRadio app or
wherever else you would like to get your podcasts. Stuff
you Missed in History Class is a production of iHeartRadio.
For more podcasts from iHeartRadio, visit the iHeartRadio app, Apple Podcasts,
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Tracy V. Wilson
Holly Frey
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