Dusk descends on a sweltering New Orleans. A naked man lays in a fetal position, sweating and moaning in an apartment a few blocks from Canal Street. His jaundiced body is mottled with bruises where vessels have hemorrhaged. The pillow and bedside are caked with what looks like coffee grounds but are drying gobs of blackened, coagulated blood that he has vomited. The man's breathing is raspy and labored as he slowly drowns in his own fluids.
The filthy window of the room is shut tightly, letting in no breath of air—and letting out none of the tens of thousands of insects that cover the walls and the man's body. The mosquitoes are Aedes aegypti, not the most common species along the Gulf Coast, but easy to collect in huge numbers if one knows where to look. Anyone with a course in medical entomology could build a simple trap and conscript a bloodthirsty army.
Across the hall, another man cracks his door and peers out. Seeing nobody in the hallway, he draws back into his room. A moment later he emerges with his head covered in netting and wearing beekeepers' garb, then slips into the sickroom. Brushing the whining mosquitoes away from the veil, he watches his suffering compatriot. As a convulsion wracks the martyr's body, the feeding insects rise in a ravenous cloud, droning their annoyance at having their meal disturbed.
Taking advantage of the moment, the garbed man crosses the room and opens the window. Sensing the air currents and drawn toward the light, a cloud of mosquitoes pours through the third-floor window, carrying a payload of yellow fever into the sultry streets. The city's tropical heat, stagnant waters, crumbling infrastructure, decrepit health-care system, and haggard people—nearly a quarter million resolute souls after Katrina—will provide an ideal setting for an epidemic. The man pulls a cellphone from his pocket and reads the coded text messages from his associates in Houston and Miami. He smiles, brushes a mosquito from the key pad, and dials the news desk at CNN.
In 1981, William H. Rose, of the U.S. Army Test and Evaluation Command at Dugway Proving Ground, wrote a report entitled An Evaluation of Entomological Warfare as a Potential Danger to the United States and European NATO Nations.1 The document provided a chillingly prescient view of the changing role of insects from weapons of war to tools of terrorism. The Aedes aegyptilyeWow fever "attack system" was seen as an ideal covert weapon for use against urban populations.
Twenty years later, the Biological Weapons Convention conference issued a report accusing rogue states of operating clandestine biological warfare programs. The villains included Iran, Iraq, Libya, Syria, and North Korea.2 And the North Koreans, according to the Monterey Institute of International Studies, have been conducting research on entomological weapon systems, with yellow fever being the favored insect-borne disease.3
All of this might be taken as political paranoia, except that a recent authoritative analysis of biological threats to the United States put yellow fever at the top of list. Jack Woodall has the credentials to be taken very seriously in the field of bioterrorism. He is a virologist and epidemiologist currently serving as the director of the Nucleus for the Investigation of Emerging Infections Diseases in the Department of Medical Biochemistry at the Federal University of Rio de Janeiro. Woodall was previously the director of the New York State Department of Health's Arbovirus (short for arthropod-borne virus) Laboratory and has worked for the World Health Organization, the U.S. Centers for Disease Control and Prevention, and the East African Virus Research Institute in Uganda. With respect to biological warfare, Woodall cofounded the Swiss Disaster Relief Unit to respond to collateral damage to civilians in case biological, chemical, or nuclear weapons were used in the first Gulf War; he ran the World Health Organization's Iraq desk after that war; and he debriefed the leaders of the first chemical and biological inspection teams of UNSCOM.
In a 2006 article published in the Scientist, Woodall notes that, despite the near eradication of the yellow fever vector from the Americas, Aedes aegypti has reappeared in Florida, Louisiana, and Texas.4 The six-legged home invader is stymied to some degree by the closed windows of air-conditioned buildings, but this line of defense is imperfect. Houston considers itself the most air-conditioned city in the world, but 6 percent of homes still lack this amenity, leaving nearly 120,000 people as prime targets.
There is a yellow fever vaccine, but travelers to endemic areas often don't bother to protect themselves—and they sometimes wish they had. In 2002, a 47-year-old man returned from an Amazonian fishing trip with a raging fever that progressed to the classic hemorrhaging of yellow fever. This fellow lived—and died—in Texas, which is now the home of A. aegypti.
Woodall warns that years of complacency and disease darlings of the media (bird flu being the current infatuation) have set up the American health-care system to miss cases of yellow fever, one of which will eventually seed an outbreak: "After all, what U.S. clinician is going to suspect yellow fever rather than malaria in a traveler returning home from the tropics with fever and vomiting? So how many times will the United States dodge the bullet?" And what if the bullet is not an accident?
To those who would dismiss this scenario as entomophobic hyperbole, consider West Nile virus and our impotent efforts to contain an insect-borne pathogen that arose from a single location to afflict people in 47 states. Consider the 654 dead and the 6,997 people suffering from debilitating neurological damage. Consider whether our ability to medicate humans and control insects makes entomological warfare and terrorism impossible in today's world.
Consider yourself lucky. So far.
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