By Cynthia Gorney
Published May 13, 2014
The Index Patient
His name, two years later, is guarded within the privacy of medical files and a family compound of bereaved relatives, his wives, and his children. He was 60 years old. He was a businessman. He lived in Bishah, a small city southeast of the great Saudi port metropolis of Jeddah, and when he became too sick for the Bishah doctors to care for him properly, he was transported to Jeddah, feverish and coughing. There he lay, inside one of the tall white buildings of the Dr. Soliman Fakeeh Hospital, where a diagnostic physician called onto his case happened to be a virology specialist, an Egyptian physician named Ali Mohamed Zaki, who liked to pay close attention to the latest reports of pernicious infectious disease.
His name, two years later, is guarded within the privacy of medical files and a family compound of bereaved relatives, his wives, and his children. He was 60 years old. He was a businessman. He lived in Bishah, a small city southeast of the great Saudi port metropolis of Jeddah, and when he became too sick for the Bishah doctors to care for him properly, he was transported to Jeddah, feverish and coughing. There he lay, inside one of the tall white buildings of the Dr. Soliman Fakeeh Hospital, where a diagnostic physician called onto his case happened to be a virology specialist, an Egyptian physician named Ali Mohamed Zaki, who liked to pay close attention to the latest reports of pernicious infectious disease.
All this was at the very beginning, a single week in the middle of June 2012, long before the sick man was understood to be the "index patient."
In clinical reports you don't see the popularized term "patient zero." Once the international detective hunt was under way, as one researcher after another joined in and the search and the connector clues spread around the globe—to Rotterdam and New York City, to the Spanish Canary Islands and Oman and Qatar, to France, England, Greece, Jordan, Egypt, Nigeria, Hong Kong, Malaysia, Australia, Indiana, and, just announced this past week, Florida—and as the questions and implications continue to spread, the man from Bishah has invariably been referred to as the "index patient" or "the patient in Jeddah."
He died in the hospital, 11 days after he was brought in. Zaki says the work on the Bishah man was routine at first, distressing but routine. The patient developed pneumonia, his kidneys began to fail, and Zaki sent sputum samples to the Saudi Ministry of Health, as required by law in such cases, to check for swine flu.
Negative for swine flu. Zaki wondered about hantavirus, which is carried by rodents and can be deadly in humans; when he studied the patient's samples under a microscope he could see the kinds of changes that told him a virus was at work. But no. Negative for hantavirus. Zaki was perplexed, and growing frustrated. He began to guess that the patient had some form of what are called paramyxoviruses—the family that includes measles and mumps. In the 1990s there were scary, lethal eruptions of new paramyxoviruses: in Australia, where the victims were stabled horses and two humans who cared for them up close, and in Malaysia, where a paramyxovirus named Nipah killed more than a hundred people and brought about the slaughter of more than a million pigs.
It didn't seem to be a paramyxovirus, either; Zaki had the lab capabilities to test for that. By the closing days of June 2012 the man from Bishah was deceased, his mourning relatives had come and and gone, and Zaki was not letting go. Maybe his paramyxovirus testing needed another round? As he told me last week, by phone from his current office at the medical school of Ain Shams University in Cairo, "I wanted to know what this is." Some viral malady had felled that patient, something different from anything Zaki could recognize, and apparently something fatal.
So Zaki put some of the samples he had saved from the Bishah man into sterile plastic tubes. He double tubed them for safety, set them inside a metal biohazard box, and shipped the box by courier to Rotterdam, where an institute called the Erasmus MC employs some of the most celebrated virus detectives in the world.
And that was how it started.
A Bedouin in western Abu Dhabi, United Arab Emirates, caresses his camels, which have been brought from Saudi Arabia for a beauty contest. The discovery that many camels show current or past infection with the MERS virus has sent shock waves throughout the Middle East, where camels are revered as important sources of transport, food, entertainment, and affection.
PHOTOGRAPH BY DAVID YODER, NATIONAL GEOGRAPHIC SOCIETY/CORBIS
And the scary reason why Saudis are still kissing their camels [link].
LWDLIK - Ignorance and lack of precaution, with the Haj season coming up, is quite terrifying.
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