The Lost City of the Monkey God: A True Story(84)

This is the sort of thing that writers of postapocalyptic fiction put themselves to imagining, the stuff of our greatest news-cycle nightmares—but this very real Armageddon lies beyond reach of the darkest Hollywood movie fantasies. It was the greatest catastrophe ever to befall the human species.

Should sixteenth-and seventeenth-century Europeans be blamed? If one can blame the dead at all, they are answerable. The Spanish, English, and others contributed mightily to the death toll through cruelty, slavery, rape, abuse, starvation, war, and genocide. Europeans killed many native people directly without the assistance of disease. In some instances, they intentionally used disease as a biological weapon by, for example, giving Indians smallpox-infected blankets. And millions more Indians died of disease who might have survived, had European brutality not left them weakened and susceptible.

It is tempting to argue that if Europeans hadn’t arrived in the New World, these deadly pandemics would not have happened. But the meeting of the Old World and the New was inevitable. If Europeans hadn’t carried disease to the New World, Asians or Africans would have; or New World mariners would have eventually reached the Old. No matter what, disaster would have ensued. This was a monstrous geographic accident waiting to happen. This was a time bomb that had been ticking for fifteen thousand years—counting down to that fateful moment when a ship with sick passengers finally set sail across the wide ocean.

This is in no way an apologia for genocide. Still, the catastrophe was largely a natural event, a mindless biological imperative, a vast migration of dumb pathogens from one side of the planet to the other.

There is much irony in the story of our own disease. The strain of leishmaniasis that befell us is a rare example of a New World disease attacking (mostly) Old World people. While I obviously don’t believe in curses, there is an inescapable sense of commination in the fact that a New World city destroyed by Old World disease wreaked havoc on its Old World rediscoverers with a New World disease. But this irony misses the modern lesson: This was a Third World disease attacking First World people. The world is now divided into Third and First, not Old and New. Pathogens once confined to the Third World are now making deadly inroads into the First. This is the future trajectory of disease on planet Earth. Pathogens have no boundaries; they are the ultimate travelers; they go wherever there’s human fuel. We First Worlders have become far too complacent in the idea that disease, especially NTDs, can be quarantined to the Third World, and that we can live safely in our communities supposedly gated against pathogens, ignoring the suffering of the poor and sick in faraway lands.

The HIV medical crisis has already pushed leishmaniasis into new areas of the globe, especially southern Europe. HIV vastly increases the destructive power of leish and vice versa. A leishmania/HIV coinfection is a terrible combination, considered to be a “new” disease all of its own, almost impossible to treat and usually fatal. HIV and leishmania become locked in a vicious cycle of mutual reinforcement. If a person with leishmaniasis gets HIV, the leish accelerates the onset of full-blown AIDS while blocking the effectiveness of anti-HIV drugs. The reverse is also true: A person with HIV who lives where there’s leishmaniasis is a hundred to a thousand times more likely than a healthy person to get the disease, due to a weakened immune system. People suffering from a leish/HIV coinfection are so teeming with the parasite that they become super-hosts, potent reservoirs accelerating its spread. And visceral leish, like HIV, has been shown to be transmitted by dirty needles among IV drug users; two studies in the late nineties found leish parasites on some 50 percent of dirty needles discarded by drug users in Madrid at two different locations several years apart. Sixty-eight percent of all visceral leishmaniasis cases in Spain were among IV drug users.

Leishmaniasis is a disease that thrives among the detritus of human misery and neglect: ramshackle housing, rats, overcrowded slums, garbage dumps, open sewers, feral dogs, malnutrition, addiction, lack of health care, poverty, war, and terrorism. Cutaneous leish is now running rampant in the areas of Iraq and Syria controlled by ISIS—so much so that families there are choosing to intentionally inoculate their young girls with leishmaniasis on a covered part of their body so that they will not get it on their faces, where it will leave a scar. (This type of leish is a mild variety that usually goes away on its own, leaving the person immune.)

Since 1993, the leishmania parasite has been spreading, not just because of HIV coinfection but also as people move from rural areas into cities. It is attacking people who venture into the rainforest for projects such as dam and road building, logging, and drug smuggling, as well as adventure tourism, photography, journalism, and archaeology. Strange tales abound. Almost everyone on a Costa Rican jungle yoga adventure was struck down by leish. A survival show contestant lost part of his ear to leish. A team of filmmakers shooting an adventure tourist video were stricken with leish.

Leish is now spreading in the United States. Over the course of the entire twentieth century, only twenty-nine cases of leish were reported in the United States, all of which occurred in Texas close to the Mexican border. But in 2004, a young man from a small town in southeastern Oklahoma, ten miles from the Arkansas border, visited his doctor complaining of a sore on his face that wouldn’t heal. The doctor cut it off and sent it to a pathologist in Oklahoma City, who was stymied by what it might be and stored the frozen tissue. A year later, this same pathologist, by sheer chance, got another tissue sample from another patient living in the same small town. The pathologist immediately called the Oklahoma State Department of Health and reached Dr. Kristy Bradley, the state epidemiologist. She and her staff ordered the two tissue samples sent to the Centers for Disease Control in Atlanta. The diagnosis came back: cutaneous leishmaniasis, of a mild type that can usually be cured by surgically removing the ulcer. (Both patients were, in fact, cured this way.)