At this moment in the COVID-19 odyssey, President Trump and his administration are lost on a wine-dark sea. They have been infected but we do not know what to do or what the course of their disease will be — only that they are spreading it. The Centers for Disease Control and Prevention has apparently not been consulted. They have taken a battering, but what will happen the next time we face a pandemic?
Nothing is more valuable in the world of infectious disease than the human ability to watch for calamity coming over the horizon. That is what the CDC, the World Health Organization and the plant disease specialists in the Department of Agriculture do. No organization or country is big enough to watch all impending diseases.
The scientists and physicians who will confront a new pandemic in 2040, say, are now in high schools around the world. Investment in people is what we did after World War II and after Sputnik, and that surely worked. We need to engage students in science and medicine, and there is nothing better than a good story to do that. I was pushed toward science by a series of elegant medical detective stories by Berton Roueché that appeared in the New Yorker beginning in the 1940s.
The first Roueché story I read was “Eleven Blue Men.” It begins: “At about eight o’clock on Monday morning, September 25, 1944, a ragged aimless old man of eighty-two collapsed on the sidewalk on Dey Street, near the Hudson Terminal.” A little further on we learn that: “The old man’s nose, lips, ears, and fingers were sky-blue.” Really? Sky-blue? Not just a little blue, as in cold, but sky-blue? I needed to know what happened to this guy and 10 men like him.
Soon we meet Dr. Morris Greenberg and Dr. Ottavio Pellitteri of the New York Department of Public Health — the first was the chief epidemiologist and the second a field epidemiologist. Dr. Pellitteri traced the blue men to bleak Bowery hotels and then to a restaurant where they all ate. It was not easy to do. All of these unfortunate old men had eaten oatmeal with sodium nitrite (used to cure meat) rather than sodium chloride (table salt). Ten of them recovered and the blue color gradually disappeared. Berton Roueché wrote stories that influenced many a nascent scientist and physician.
Decades later I taught medical and graduate students at Columbia University Irving Medical Center, and a physician from the New York City Department of Public Health called me. She needed a job reference on a young researcher from my lab. We talked for a while (he got the job) and then I asked if it was true that the health department conference room was named for Berton Roueché. She seemed delighted to be asked. “It is! He is my hero. He changed my life,” she said. It’s good to have kindred spirits.
Mr. Roueché died in 1983, but CDC continues to solve cases and save lives. For example: In April 1993, a Navaho woman on her way to a friend’s wedding in Gallup, New Mexico, developed trouble breathing. Doctors at the Gallup Indian Medical Center tried to help, but she died of a devastating pneumonia. A week later so did her fiancé. Twenty-six people, Native American, Hispanic and white, most young and healthy, became ill, and 13 died. The New Mexico Department of Public Health called the CDC.
The lungs of these patients were white with liquid that blocked X-rays. There was one clue: The X-ray looked like one from a hantavirus patient seen years before in Korea. The CDC scientists knew that hantavirus infected mice.
No hantavirus infection had been found in North America up to that time. But if the pneumonia was caused by hantavirus, the mice around the victims’ house should carry it. They did, and CDC scientists cultured the virus from them. The previous year had been wet, resulting in abundant food for mice. The ground around the victim’s house was loaded with their urine and feces, both with virus. When the ground dried, the wind whipped these leavings into an aerosol that people inhaled. CDC issues guidelines for diagnosis and provides training for physicians practicing in the Four Corners Region of the Southwest. Navaho elders had made the association between mice and pneumonia long before.
The novel hantavirus was named Sin Nombre (no name). The Sin Nombre virus is a nasty piece of work, one of our most worrisome, for which there is still no vaccine or treatment. Unlike COVID-19, Sin Nombre is not transmitted person to person. Imagine if it had been.
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CDC urges caution when cleaning out spaces that have not been used in some time. These include garages, storage facilities and any place mice have been living.
