The origins of Ebola, then and now
A team of 17 European and African researchers has just identified "Patient Zero" in eastern Guinea.
September 04th, 2014
In her new book, Patient Zero: Solving the Mysteries of Deadly Epidemics (Annick), seek Merilee Peters provides a mesmerizing account of how and exactly where Ebola first arose in Zaire in 1976.
Books don’t always start with authors. When publisher Rick Wilks heard a Radio Lab documentary about the origins of HIV/AIDS, he imagined there ought to be an educational book for young adults about the scientific and social origins of epidemics, sometimes called pandemics. Wilks’ team at Annick Press has since requisitioned Merilee Peters to produce a compendium for readers aged ten and up, PATIENT ZERO: SOLVING THE MYSTERIES OF DEADLY EPIDEMICS (ANNICK $24.95 hc $14.95 sc), in which she traces the origins of epidemics in recent times.
More people have died from epidemics than from wars and natural disasters combined, so scientists in recent centuries have doubled as detectives, often looking for “patient zero”—the first person known to have contracted the disease. For instance, back in the 19th century, physician Dr. John Snow in London traced a cholera epidemic to a six-month-old child whose cholera-laden diarrhea contaminated water at a local pump, leading 10,000 deaths.
This month, after three weeks of study, scientists have announced the source of the largest-ever outbreak of Ebola in Guinea, Liberia, Sierra Leona and Nigeria. After a two-year-old boy contracted the virus from an infected fruit bat in eastern Guinea, the child and his mother died. Ebola was subsequently spread by mourners.
According to a Guardian report: “Scientists have suspected for several years that bats are the wild ‘reservoirs’ of Ebola, but direct transmission to humans is extremely rare, despite communities regularly hunting the bats for food. Nearly all previous epidemics had been linked to the bushmeat trade, with hunters picking up dead infected animals in the forest and selling them on.”
Initially it was suggested a new strain of Ebola has emerged in West Africa but Berlin-based epidemiologist Fabian Leendertz, who led the 2014 research team to Guinea, has concluded the Guinea/Liberia virus is related the a Zaire Ebola virus identified ten years ago in the Democratic Republic of the Congo (formerly called Zaire).
This excerpt, by Merilee Peters, reprinted with permisson from Annick Press, recounts the origins of Ebola——the first time——and the bravery of a young Belgian medical officer, Peter Piot, who discovered its source.
MYSTERY IN THE JUNGLE: EBOLA IN ZAIRE, 1976
The room was stuffy and windowless. Paint was peeling off the walls, leaving damp, scabby patches of discolored plaster. But the floor was clean, and so was the narrow iron cot in the corner. A man lay on the cot, sweating. His eyes were glazed. The only sound was a faint wheeze as he panted for breath. Mabalo Lokela was very sick.
It was September 1976, and Mabalo was in Zaire, a country of steamy, sprawling jungle and congested cities in central Africa. Zaire, in 1976, was not a good place to be sick. There weren’t enough doctors, or enough nurses or hospitals or clinics. Worst of all, there weren’t nearly enough drugs to treat everyone needing medical help. Zaire (now called the Democratic Republic of the Congo) was a tropical country, where diseases spread by insect bites, parasites, or contaminated food and water were common. Since most of the country’s citizens at that time were poor, living in crowded and sometimes unsanitary conditions, illnesses could spread like wildfire. In Zaire, getting sick was a fact of life—but getting well was not so certain.
The village of Yambuku, in Zaire’s remote northern Equateur province, was a particularly unlucky place to fall ill. Yambuku was surrounded on all sides by jungle, hours away by rutted dirt road from the nearest town. The village had no doctors, and no real hospital—just a clinic run by an order of Catholic nuns from Belgium. But unlucky or not, that’s where Mabalo found himself, because Yambuku was his hometown.
Mabalo was the village schoolteacher, and he was just back from one of the only holidays he’d ever taken. He had visited family and friends in surrounding villages, gone on a few hunting trips, done some sightseeing. But instead of returning home with a souvenir or two and some happy memories, he’d gotten a raging fever, a splitting headache, and a body racked with cramps. Malaria, he was pretty sure. Mabalo had been ill with malaria before. Mosquitoes bred in the low wet fields cleared for coffee plantations, and since no villagers could afford screens on their windows, everyone was vulnerable to the “shaking fever.”
He lay in one of the Yambuku mission’s few examining rooms. He hoped that the nuns might have some drugs left over from their last shipment of supplies from Europe. If luck was with him, he’d get a shot, go home, and hope that the fever receded enough so that in a week or two he could work again.
The nun who bustled in to treat Mabalo agreed that, yes, it seemed he’d got malaria again. Sister Beata wasn’t a nurse—none of the missionaries had any formal medical training—but she’d seen many, many cases of malaria in her years in Africa. She rummaged in the almost bare cupboards, filled a glass syringe with the antimalarial drug chloroquine (pronounced klor-uh-kween), and gave Mabalo the injection he’d been waiting for. Soon he was making his slow way home, leaning heavily on his wife M’buzu’s shoulders.
At first, it seemed as though Sister Beata’s injection was working, as it has many times before. But after a day or two, Mabalo’s fever returned with a vengeance. Soon, he was too weak to get up, and his body was ravaged by terrible bouts of diarrhea and uncontrollable vomiting. His wife and two oldest daughters struggled to care for him. Relatives and neighbors took in the six younger children as the crisis in the Lokela hut deepened. Finally, in desperation, M’buzu begged the nuns to visit her husband, hoping they might be able to cure him.
When the sisters entered the family’s small hut, they found Mabalo lying on a low bed covered with raffia matting, bathed in sweat and gasping for breath. Buzzing flies were gathering on patches of dark blood spreading from his ears and pooling beneath his nose and eyes. As they stared, terrified by the change that had come over him, Mabalo convulsed and vomited a stream of blackish blood.
M’buzu turned to the frightened nun beside her. “Sister, can you help? Do you have any medicine that will cure him?”
Slowly, Sister Beata shook her head. “This is new,” she said quietly. “This is definitely new.”
No one realized it, but the virus that had infected Mabalo was causing his internal organs to disintegrate into a soupy mess, which was seeping from his orifices and through his skin. With every retch, Mabalo released millions of infectious microbes into his surroundings. Every blood- and vomit-soaked rag his daughters washed was a time bomb of lethal micro-organisms. Sister Beata was right: this disease was new, and it was incredibly dangerous.
For seven long days and nights, the nuns and M’buzu fought to keep Mabalo alive. But at last he was claimed by the nightmarish illness.
Surrounded by her children, and helped by her family members and neighbors, M’buzu began preparing her husband’s body for the funeral. Together, the group carefully washed the body, sponging away the thick-crusted blood. They would sit with the body all day and all night before carrying Mabola to the prepared grave just outside the family’s hut.
As the wails of mourners reverberated through the hot, still air, the nuns, gathered in prayer in the mission’s tiny church, felt a sense of relief. Mabalo’s illness, as terrifying as it had been, was now over. Life could return to normal in the village and the mission.
But a few days later, everyone began getting sick.
Mabalo’s wife, his eldest daughter, his mother, his sister, and his mother-in-law were among the first to come to the mission clinic suffering from fever, headache, vomiting, and diarrhea. More followed. Within days, twenty-one people who had attended Mabalo’s funeral were showing symptoms of the same violent illness. Others in the village, and throughout the surrounding area, were falling ill as well.
The nuns, with their limited knowledge of medical procedures and scanty supplies, struggled to comfort the dying. Then they too began dying. Sister Beata was among the first.
In the mission office, Sister Marcella, the Mother Superior, hunched over the shortwave radio sending out message after message to the outside world, pleading for help. The fever was spreading fast, and it killed almost every person it touched, young or old, healthy or frail.
For the nuns, for the grieving families, for the villagers numb with fear, there were so many questions. What was causing this terrible disease? Why had it chosen to strike their village? How was it being it spread, and how could the living protect themselves from this killer?
A MICROSCOPIC QUESTION MARK
As the first of October dawned in Yambuku, the epidemic was in its third week. Already well over 100 people were dead. Alerted by Sister Marcella’s calls for help, doctors from Zaire’s capital city, Kinshasa, arrived by helicopter, collected blood samples, then fled back to safety outside the epidemic zone.
Sister Marcella ordered the mission’s gates chained shut, and the remaining patients sent home. There were no longer enough living staff to care for the sick and dying. The remaining nuns gathered together in the mission chapel, praying and waiting for death.
With no clinic to care for the sick, fever patients were taken to neighboring villages to be cared for by family members—spreading the infection throughout the region. Village elders warned people to stay home as much as possible. Schools and shops closed, social gatherings were discouraged, and trees were felled to block the roads. Almost overnight, the epidemic zone became a network of ghost towns.
But help was on the way for the residents of Yambuku and their neighbors. The blood and tissue samples the Kinshasa doctors had collected were winging their way around the globe. In labs across Europe and North America scientists were peering into microscopes and realizing with a jolt of fear and excitement they were looking at a virus that had never been seen before.
In Belgium, 27-year-old Dr. Peter Piot, a researcher in the microbiology lab at the Prince Leopold Institute of Tropical Medicine, was one of the first to look down the barrel of a microscope at the virus. He learned quickly that the mysterious microbes were lethal: laboratory mice injected with just tiny amounts died within days. Doctors in Zaire had suspected the disease might be related to yellow fever, but all the antibody tests were coming up negative. With its curved, whiplike tail, Piot thought the virus looked like a question mark—a question mark taunting him and his colleagues.
When the director of the institute told Piot that the World Health Organization (WHO) was sending an international team of scientists to Zaire, Piot didn’t ask to go—he demanded to be sent as Belgium’s representative. This deadly virus was a question to which he was determined to find the answers.
ON THE HUNT
Days later, sitting on a flight to Kinshasa, Dr. Piot started to wonder what he’d gotten himself into. His seatmate, a powerful Belgian diplomat to Zaire, was incensed to learn why the young doctor was on his way to Africa: “Intolerable! We’re facing a terrible epidemic, and all they could find is you? How old are you? Twenty-seven? You’re totally green, you’re barely even a doctor. You’ve never seen Africa in your life!”
The taxi ride through Kinshasa didn’t help to calm his growing nervousness. Everywhere he looked there were throngs of people, and the sticky heat and humidity had him panting. Chaotic traffic jammed the litter-choked streets. He’d hardly been out of Belgium before, and never anywhere as unfamiliar as this city. Had he been foolish to sign up for this mission?
The hastily assembled group of scientists knew only one thing for sure: they didn’t have enough information. They needed to have a scouting team head for Yambuku, the centre of the epidemic, and report back on the scale of the disaster, the conditions in the affected region, and, if possible, the source of the infection and how it was spread. The team would have just four days to collect enough information for a full-scale epidemiological investigation to move in. Who was willing to volunteer?
Before the question was even finished, Piot had his hand up.
Piot gasped and choked, his throat searing with pain. Around him, a circle of men laughed uproariously. As soon as his eyes stopped watering, Piot joined in the laughter.
It was his first taste of arak, a powerful homemade alcohol popular among Zairean villagers. As Piot was discovering, sharing a drink of the fiery liquor with the community leaders was an important part of gathering information about the epidemic.
He had arrived early that morning in Yalikonde, the nearest village to Yambuku. As he stepped from the jeep, he was struck by the brooding silence. No children played in the central square, no adults lingered to gossip outside the huts, no shops were open. Only slowly did people emerge from their homes to talk to the foreign doctor.
Later, as the cup of arak was passed from man to man, the village elders revealed how many in the village had died and when. They brought Piot into the huts of the sick, where for the first time he saw the suffering the disease inflicted on its victims. As frightened as he was, Piot felt useful in a way he never had while working in the lab in Belgium. He took blood samples and interviewed family members, noting down everything—the names of the dead, when they had died, their relationships with other fever victims.
The scene in the village square in Yalikonde would be repeated in 10 more villages that day, and in more than 40 others in the days to come. By visiting every village within driving distance of Yambuku, the scouting team determined that over 200 fever deaths had occurred so far, and there were still infected victims.
FROM SOCCER TO FUNERALS
Each night when the WHO team members returned to their headquarters at the Yambuku mission, they shared the data they had collected and the notes they had taken. Soon the scientists had enough information to plot graphs of the disease, showing the number of cases by location, age, and gender, and the dates of known deaths. To everyone’s relief, the graphs indicated that the worst of the epidemic was probably already over.
The scouting team was doing its job: collecting enough information so that a full-scale investigation could be set up in the region. But Peter Piot was frustrated. He wanted to find answers to the questions that were tormenting him. How was the disease being transmitted? Why had it spread so quickly from Mabalo Lokela to the rest of the village? And where had the virus come from?
One evening Piot drove to a nearby village, Yamotili-Moke. The village elders welcomed him, and soon a lively debate about the strengths and weaknesses of Belgian and African soccer players started. Peter stayed and talked through the evening, and he returned again the following night. Unlike the systematic data-gathering he did during the day, during these conversations Piot took no notes. He just listened, piecing together information about local customs and culture. He wasn’t sure how this would help to fight the epidemic, but he knew that if he wanted to help these people, he needed to understand them better.
Piot’s instinct soon proved right. One evening the conversation turned to the preparations for the latest fever victim’s funeral, and as the men spoke, Piot learned why a pattern of new infections followed each funeral. The custom was for family members of the deceased to wash the body by hand and then to hold a vigil over the body before burial. These practices meant that there were many opportunities to come into contact with infected blood and body fluids. Piot immediately advised the elders to put a stop to their customary funeral rituals for fever victims.
In reviewing the data the team had collected, Piot had noticed something else that worried him. The numbers of young women contracting the disease were abnormally high. Usually in an epidemic more deaths were to be expected among the elderly or the very young—those without reserves of strength to fight the disease. But in this case, it looked as though those most vulnerable were women between 18 and 25. The number of deaths of young women was more than double that of young men. What could be the explanation?
Piot recalled what he’d learned about the activities at the Yambuku mission clinic before the epidemic had forced it to close. Despite a tiny staff and only the most basic equipment and supplies, the mission had served the medical needs of thousands of people throughout the region, including offering prenatal care for pregnant women. Piot was willing to bet that many of those expectant mothers were between the ages of 18 and 25. Could there be a connection between the mission and this terrible epidemic?
Piot knew he needed to get a look at the clinic for himself.
CRACKING THE CASE
As Piot toured the empty rooms with Sister Marcella, he told her about the strangely high number of deaths among young women. Had anything unusual happened at the mission’s prenatal clinic, he asked, around the time that Mabalo Lokela fell ill?
Sister Marcella smiled as she remembered those happier days, when the mission’s courtyards had been filled with the bustle of patients and families. She told Piot proudly about the excellent prenatal care that young mothers received at the clinic, and in particular the popular weekly vitamin shots. All pregnant women visiting the mission clinic were given an injection of vitamin B12.
With a growing sense of dread, Piot asked to see the clinic’s dispensary, where all the drugs and medical equipment were stored. In that small bare room, he opened drawers and cupboards one after another. Finally, he turned to Sister Marcella.
“There are only five syringes here for the entire clinic. How did you manage to give so many injections with such a small stock?”
The sister replied matter-of-factly that each morning the syringes were sterilized. After that, they were used over and over again for all the patients treated that day, with a quick rinse between uses. On their meager budget, she explained, the clinic couldn’t afford to buy more syringes or needles.
Piot realized with horror that the nun who had given Mabalo Lokela his shot of chloroquine had unwittingly spread the infection to every pregnant woman in the village through the unsterilized needle. Here was the link he’d been searching for. The epidemic had been spread by the very clinic to which people had turned for help.
Piot carefully bagged two of the syringes to take back to Kinshasa for testing. “I’d bet anything these are both infected,” he thought sadly to himself.
The conclusions that the scouting team reached were proven correct: the epidemic had spread through unsterilized needles and through contact with infected patients in the mission clinic and at funerals. The last infected patient died on November 5, and there were no further cases reported. The international scientific delegation continued to work in Zaire for several months, collecting as much information as they could about the mysterious disease that they began to call Ebola, after a nearby river.
Researchers eventually identified the Ebola virus as a filovirus—one of only two ever discovered. The filoviruses are a small family of viruses causing extremely lethal diseases in humans. Both filoviruses, Ebola and Marburg, cause severe hemorrhagic (pronounced hem-or-rhag-ik) fever—illnesses in which the victims bleed profusely. In the Yambuku outbreak, 318 people were infected, and 280 died.
CAREFUL! THERE’S NO CURE
More than 30 years after the first outbreak, we still don’t have an effective treatment or vaccine for Ebola. Doctors and nurses run a high risk of contracting and spreading the disease if they accidentally come into contact with a patient’s infected bodily fluids. Poor hygiene practices in rural medical clinics have helped spread many of the Ebola epidemics over the past 30 years.
The World Health Organization recommends that suspected Ebola patients be treated using barrier nursing techniques, which means that patients must be kept in strict isolation, and all medical staff must wear protective gear and take extreme precautions to make sure that no contact with bodily fluids occurs. Patients who die from Ebola must be buried promptly, and there should be no direct contact with the body.
Even when patients recover from Ebola, those around them need to continue taking precautions to make sure they don’t become infected. Tests have shown that the virus can linger in the bodily fluids of recovered patients for up to six weeks.
In addition, for the first time people realized that modern transportation had the potential to spread viruses around the globe with incredible speed and efficiency. The time it takes to fly between Kinshasa and any major city in North America or Europe is much less than the incubation period for Ebola. Medical care in the Democratic Republic of the Congo is still very basic for most people, because years of civil war in that country have left the population very poor, and roads, hospitals, and medical clinics are in bad repair or have been destroyed. That makes the possible re-emergence of Ebola in that country an ongoing concern, and one that international health organizations take very seriously.
hc 978-1-55451-671-1 / sc 978-1-55451-670-4
HERE IS ADDITIONAL INFORMATION CULLED FROM PATIENT ZERO: SOLVING THE MYSTERIES OF DEADLY EPIDEMICS (ANNICK $24.95 hc $14.95 sc).
MORE TO COME
Since the epidemic in Yambuku, there have been a number of other Ebola outbreaks in Africa and around the world. Between 1977 and 2012, 29 outbreaks occurred, and three of them were in the United States. The Ebola outbreaks in the U.S. happened in research facilities in Virginia and Texas, and the disease was spread from monkeys that had recently been imported from the Philippines. Four workers were accidentally bitten by the monkeys, and tests afterward showed that they had Ebola antibodies in their blood—proteins produced by their immune systems in response to the Ebola virus. But the workers never developed symptoms, although the monkeys became sick with Ebola and most died. This particular strain of Ebola, which is not dangerous to humans, was named Ebola-Reston, after the city in Virginia where it was first identified.
The impact of Ebola on the public imagination has been enormous. At the time Ebola emerged in 1976, medical science had seemed to be winning the war against disease, with powerful weapons like vaccines and antibiotics in their medical arsenal. But Ebola reminded everyone of the vast number and diversity of disease-causing viruses and bacteria, and of how much scientists and doctors still had to learn about fighting disease.
Over the past 20 years, there’s been a steady stream of movies and books about epidemics, including 2011’s Contagion; 2007’s I Am Legend, starring Will Smith as the last man in New York; and Twelve Monkeys, a 1995 tale of a zoonotic plague (a disease spread from animals to humans) that destroys life on earth. Some people even argue that the current fascination with zombies can be traced back to Ebola. While zombies (or at least the idea of them) have been around in folklore for hundreds of years, their popularity on movie screens today may be partially the result of our fear of becoming infected by mysterious diseases that can spread around the world like lightning—like a zombie apocalypse.
WHERE DOES EBOLA COME FROM?
Peter Piot’s team never learned exactly how Mabalo Lokela contracted Ebola, but we now know that it is a disease transmitted to humans through contact with infected animals. The Ebola virus has been identified in gorillas and chimpanzees in Africa, and scientists think that in at least some outbreaks, the index case—Patient Zero—was either a local hunter or a customer who bought infected meat from hunters.
Scientists also know now that gorillas aren’t the reservoir species for the virus (where the virus lives in between the human outbreaks) because Ebola kills gorillas almost as fast as it kills humans. Although it has yet to be proven conclusively, evidence currently points to African fruit bats as the reservoir species. Fruit bats may infect humans directly or transmit the virus to them indirectly, through other animals.
[NOTE: The bat pictured on the home page was photographed in Uganda–Ed.]
A key part of preventing future outbreaks of Ebola is reducing the risk of animal-to-human transmission, particularly through the consumption of wild meat. That may sound simple, but it isn’t. Several factors play a part in explaining why Ebola outbreaks happen in Africa, and very likely will for the foreseeable future. As forests in Africa are destroyed through agriculture and logging, human populations are forced into closer contact with animals. Civil wars create large numbers of refugees, and widespread poverty makes wild meat a key food source. Climate change is affecting the animal populations and their movement patterns, again bringing them into more contact with human settlements. And poverty and inequality contribute to inadequate health systems and overcrowded hospitals. This is the case in many regions of Africa.
Microbiology laboratories around the world use a numbering system to identify their level of biosafety. There are four levels. In Level 1 labs, scientists work only with organisms that do not cause disease. In Level 2 labs, mild disease-causing microbes can be handled. Level 3 labs work with serious diseases for which treatments or vaccines exist. Only in Level 4 labs are the most lethal, highly infectious, and untreatable diseases allowed.
To get clearance to study life-threatening microbes, Level 4 labs must create hot zones: isolation chambers located either in a separate building or in a highly controlled area within the main lab. Before entering a hot zone, researchers dress in special coveralls, over which they pull a bright blue, heavy-duty pressurized hazmat (hazardous materials) suit equipped with a breathing apparatus called a Chemturion. Before entering and after leaving the hot zone, the researcher must also pass through a series of decontamination showers, a vacuum room, and an ultraviolet light room, in order to eliminate all potential traces of disease.
There are 50 of these Level 4 labs across the globe—15 of them are in the U.S., and there is 1 in Canada: the National Microbiology Lab in Winnipeg, Manitoba. It was there, in the summer of 2012, that scientists developed the first potential treatment for Ebola: a drug cocktail that is effective in treating the disease in monkeys.
MEET THE MICROBE
A virus is a type of microbe, or single-celled organism. Microbes are the oldest and most numerous life form on earth, and they are essential to human life.
There are several types of microbes, including bacteria, fungi, viruses, and the lesser known archaea and protista. Without microbes we couldn’t digest our food, breathe, break down wastes, or do a range of other tasks vital to our survival. But despite being useful in so many ways, microbes have a bad reputation. That’s because, amidst the vast diversity of microbes, there are some that cause disease—and in the case of viruses like Ebola, potentially lethal disease.
Viruses are the tiniest, and in many ways the strangest, of all the types of microbe. Scientists can’t even agree whether viruses are alive, strictly speaking. Until a virus comes into contact with a host cell, it is nothing more than a lifeless bundle of DNA. But once it makes contact with cells in your body, the virus springs to life, hijacking the cells and using them to reproduce itself and spread. Illnesses from the common cold to AIDS and Ebola are all caused by viruses. And many of the symptoms of viral illnesses—such as coughing, vomiting, diarrhea—help to spread the virus to new hosts.
TOOL OF THE TRADE: QUALITATIVE RESEARCH
When Peter Piot arrived in Zaire, he had no formal training as an epidemiologist. Very few people at that time did. Aside from a few internationally recognized organizations, such as the U.S. Center for Disease Control in Atlanta, Georgia, there were hardly any research laboratories in 1976 that specialized in epidemiology. That meant scientists learned epidemiology on the job.
The investigative team sent to Zaire took blood samples, drew detailed maps of epidemic-stricken areas, asked the same questions of people over and over again, and noted down everything. But Piot realized that in addition to the “how many” approach of quantitative research (for example, finding out how many people had come into contact with each patient, and how many of those people got sick), the researchers needed to add the element of “why.” They needed to uncover why some people were getting infected while others weren’t. And that meant spending time with villagers to learn the details of their everyday lives.
That kind of approach is called qualitative research. As Peter Piot wrote years later, “It’s like detective work. You take blood samples also but the essence is… talking, talking, talking… and understanding.”
ABOUT MARILEE PETERS
Raised in Ottawa, Marilee Peters of Vancouver has a Master’s degree in English literature, having specialized in Victorian novels. She entered the Library Studies program at UBC and graduated as a librarian in 2006 with a MLIS. She soon became Communications Director at the BC Council for Families, later serving as its Acting Executive Director. In addition to working as Communications Officer for the Real Estate Council of BC, she is editor of the BC Organic Grower. As someone who thrives on research, she was pleased to be asked to write Patient Zero: Solving the Mysteries of Deadly Epidemics and discover, in particular, Dr. John Snow’s determination to prove that cholera was spread through contaminated drinking water. She later met with epidemiologist Dr. Jennifer Gardy and toured the BC Centre for Disease Control.
Marilee Peters has been living and working in Vancouver since the late 1990s. She has also worked for the Arts Club Theatre, the Canadian Parks and Wilderness Society and the BC Council for Families–and as a lifeguard, chambermaid and tree planter in northern B.C. Patient Zero, her first book, helped her to answer a number of nagging questions, including why, when as a child she forgot to cover her mouth while coughing, her mother always told her “don’t be a Typhoid Mary!” With two children of her own, she sees first-hand how thirsty for information kids can be — and how wide-ranging in their interests. Her kids and their friends develop fascinations with the most arcane topics — everything from the history of the Salem witch trials to the Beatles’ discography. She hopes the stories of medical sleuthing she shares in Patient Zero inspire kids to learn more about the science of epidemiology.