The Heavy Breath of Death Chilled Summer in the City

William Carrasco chose a spot between two oak trees and started digging. Near his feet lay two dead crows, their eyes sunk into their heads.

Crows were dying all over Ft. Totten, the Civil War fort where Carrasco works as a security guard. He was finding them at the front gate, behind the old officers’ club, by the murky pond behind the buildings.

The dying started in late June when the weather turned hot. From his post at the gate, Carrasco watched birds stumble drunkenly around the grounds. Some had growths on their heads.

Within weeks, it was the same all over the New York City area--in Brooklyn’s Prospect Park, by Long Island roadsides, on golf courses in Westchester County. Dead crows were everywhere, and sick birds, listless and disoriented, shuffled about aimlessly.

On Long Island, a man saw one fall right out of a tree.

In nature, death is normally a private affair. Dying wild creatures hide away in brush or holes in the ground, and people seldom see a dead one unless it has been hit by a car. All these birds dying in plain sight made New Yorkers uneasy.

Something had gone wrong with the natural order of things.

The sick birds couldn’t fly. People scooped them up as if they were helpless kittens. One woman showed up at John Charos’ veterinary office with a sick crow perched on her shoulder like a parrot.

People often bring Charos birds that have been hit by cars or poisoned. That is why the first few didn’t seem unusual. Charos squirted nutrient down their throats and gave them antibiotics. Most died anyway.

As the summer wore on, sick birds kept coming. Charos started to wonder:

What was doing all this killing?

He packed some dead crows in dry ice and sent them to the New York State Wildlife Pathology Unit 140 miles up the Hudson River in Delmar.

By Aug. 20, a half-dozen dead crows had arrived in Ward Stone’s basement laboratory there. Soon he had boxes of them from veterinarians all over the metropolitan area. More came from New York City park rangers, a Long Island road crew, worried housewives in Westchester.

They all expected him to tell them what was going on.

Stone cut into a crow’s chest, pushed the breastbone aside and peered at the bird’s organs in the harsh fluorescent light. The liver was bigger than usual, the spleen swollen to twice its normal size. The heart bore faint white blotches, a sign of viral infection.

Stone cut into the crow’s skull to reveal the soft, pink brain. It was swollen. Blood vessels had burst.

He plopped the liver, spleen, heart and brain into a jar of preservative, opened a box and pulled out another dead crow.

Maybe this next one would give him more to go on.

Piecing Together the Puzzle

That same August day, in the New York City neighborhood of Flushing, Dr. Deborah Asnis also had a mystery on her hands. Four elderly patients, all in intensive care, all very sick.

But with what?

Asnis has been the infectious disease specialist for 12 years at Flushing Hospital Medical Center, located, she says, “in a very interesting part of Queens.”

It’s home to people from around the world--Pakistan, Ecuador, Mexico, China, West Africa. And sometimes immigrants bring diseases--tuberculosis, malaria, even dengue fever.

Asnis thought she’d seen them all. But she’d never seen anything like this.

The first patient had arrived Aug. 12, feverish and delirious. After three days in intensive care, he couldn’t lift his arms off the bed.

At first Asnis suspected Guillain-Barre syndrome, a rare autoimmune disease that reduces muscles to jelly. She started treating the patient for that.

The treatment didn’t work.

On Aug. 15, a second patient arrived with the same symptoms.

Maybe botulism, she thought. Then again, it looked more like a virus. Was this the start of some infectious disease outbreak in Queens?

Asnis put her patients on acyclovir, an antiviral drug, and called the New York City Health Department.

Epidemiologist Marcelle Layton listened to Asnis’ description. It sounded like a virus, Layton thought, except that there aren’t many viruses that can virtually paralyze a person. Layton asked Asnis to send blood and spinal fluid samples to a New York State Department of Health laboratory in Albany.

Later that week, a third patient arrived at the Flushing Hospital.

Two days later, there was a fourth.

On Friday, Aug. 27, Layton called Asnis to ask how the patients were doing. Not well, she replied. A visiting doctor, overhearing Asnis’ end of the conversation, jumped in to say he had a patient with the same symptoms in another New York hospital.

To Layton, that sounded like real trouble.

Next morning, she and Dr. Annie Fine, another city epidemiologist, headed for Flushing Hospital. On the drive over, they reviewed what they knew:

Five elderly patients, all from the same part of Queens.

All of them had shown up in emergency rooms complaining of fever, fatigue, aching muscles.

All were getting worse.

At the hospital, Layton and Fine found three of the patients so weak that they needed respirators to breathe. Relatives milled around waiting for news--anything to explain why the people they loved were suddenly fighting for their lives.

Layton and Fine approached them with questions instead of answers.

Where did the patients live?

Where did they work?

Where, and how, did they spend their time?

Had they had recent contact with children?

They were looking for something, anything, that tied the cases together. By the end of the day, they had found one thing. The patients were walkers, gardeners, sunbathers.

They all spent a lot of time outdoors.

The next day, Layton and Fine called the federal Centers for Disease Control for advice and were referred to John Roehrig, a specialist in insect-borne pathogens.

Roehrig, based in Fort Collins, Colo., is a researcher whose work usually takes months, even years, to produce results. In 20 years on the job, he had never gotten an emergency call at home. Until now.

He turned off the Denver Broncos preseason game and listened with growing amazement as Layton and Fine described the situation: elderly dying; scores of patients complaining of fever and muscle weakness. And all over the region, birds keeling over dead. Could that be related?

It sounded a bit like St. Louis encephalitis, a tropical disease spread by insects, Roehrig thought. But there had never been a case in New York, and it was awfully late in the summer for an insect-borne disease outbreak.

Roehrig asked for blood samples from patients as well as the general population. There were some tests he could do to see if it was St. Louis encephalitis.

He hung up and settled back on his sofa to watch the football game, but he couldn’t stop thinking about Queens.

Two days later, on Aug. 31, time ran out for one of the patients at Flushing Hospital. The 80-year-old man was the first to succumb to the mysterious illness.

The next day, an investigator was poking through his yard in College Point, a Queens neighborhood of tidy houses with small, well-kept lawns. Varuni Kulasekera was looking for clues to identify a killer. But she isn’t a cop; she’s an entomologist, an expert on insects.

In the garden out back she found something suspicious: open barrels and buckets of water.

As she walked around the neighborhood, Kulasekera saw kiddie pools, barbecue grills, birdbaths and old plastic coolers, each cupping a little standing water.

By the College Point Yacht Club she found a vacant lot. There were “No Dumping” signs all around, but that hadn’t stopped the accumulation of beer cans and cardboard boxes. And tires, dozens of them, each holding a puddle of water.

As Kulasekera took a water sample from each one, the air hummed with mosquitoes. This place was a breeding ground.

The next day, Thursday, Sept. 2, another patient died.

Clues Point to the Wrong Answer

Technicians at the state laboratory in Albany and the Centers for Disease Control laboratory in Fort Collins knew they were in a race against the spreading disease, but their tests were producing uncertain results.

Finally, in Albany, one blood sample tested positive for St. Louis encephalitis. The next day, CDC technicians in Fort Collins got a similar result.

Later that day, Friday, Sept. 3, New York City Mayor Rudolph Giuliani stood before TV cameras to announce that the city was facing its first-ever outbreak of a mosquito-spread disease called St. Louis encephalitis.

Three weeks would pass before scientists realized they were wrong.

Within hours of Giuliani’s announcement, John Sondgeroth was buzzing over College Point, a fine mist of malathion insecticide spreading beneath his helicopter. Soon he was joined by four more helicopters, an airplane and a fleet of trucks spraying much of New York City and Westchester County.

At daily news conferences, the mayor insisted that everything was under control; but news reports about killer mosquitoes and pesticide spraying led many New Yorkers to stay indoors with windows shut tight.

Stone, the wildlife pathologist, watched and wondered. Could the disease that was killing people be the same one killing the crows?

Right after Labor Day weekend, he sent a few dead birds to a pair of federal laboratories--the National Wildlife Health Center in Madison, Wis., and the U.S. Department of Agriculture virology laboratory in Ames, Iowa.

There, virologists ran a slew of tests for North American bird viruses--Newcastle disease, equine encephalitis, Venezuelan encephalitis, all 15 types of avian influenza.

And St. Louis encephalitis.

Everything came up negative. Whatever had killed these crows wasn’t St. Louis encephalitis.

And it wasn’t any other virus that has ever infected a bird in North America.

Roger Nasci, an expert on insect-borne diseases, got the call as he was collecting mosquitoes in the swamps of Louisiana, where a few horses were infected with eastern equine encephalitis. His employer, the CDC, wanted him in New York on the double.

Nasci rushed to New York the second week of September and, before he knew much about what was going on, was hustled into a meeting with health officials and Giuliani.

The mayor, whose friends call him imposing and whose enemies call him tyrannical, turned to Nasci and demanded answers.

“Should we close the public schools?”

“Should we postpone the U.S. Open?”

“What about the Mets game?”

“Should we close Central Park?”

The enormity of the mayor’s questions--whether to close landmarks and events that define New York--left Nasci shaken.

“No,” Nasci responded. Not yet, anyway. There wasn’t enough information to justify it.

Giuliani dismissed Nasci with a clipped “OK, I got it,” and strode outside into a thicket of cameras and microphones.

For the next two weeks, Nasci worked 20 hours a day to help authorities find the source of the outbreak and contain it.

Workers set scores of mosquito traps in the city’s five boroughs. Soon their bug sweep extended from Cape May, N.J., to West Point on the Hudson River to the eastern tip of Long Island.

In his hotel room at night, Nasci plucked the insects from plastic bags with tweezers. Then the phone would ring, and he would find himself speeding back to city hall, passing Shea Stadium, where Mets fans showed up carrying insect repellent.

“We may not be able to deal with this,” he worried. “It may be out of control.”

By Sept. 20, three people in New York had died. At least 12 people had contracted the disease. Another 89 cases were suspected.

At the CDC laboratory in Fort Collins, researcher Robert Lanciotti was completing genetics tests expected to confirm that the virus attacking people was St. Louis encephalitis. But he wasn’t getting the results he expected.

“It’s not SLE,” he finally told his boss. “I’ve got this feeling in the pit of my stomach over this, and it’s not going away.”

If it wasn’t St. Louis encephalitis, what was it?

The Ames laboratory still had the same question about the bird-killing virus. After two weeks of testing failed to identify it, researchers there packaged some crow blood and brains and forwarded them to the CDC.

A Virus Never Seen in This Country

Finally, on Sept. 23, the CDC solved the mystery.

Human and crow blood samples contained the same virus. An analysis of its genetic makeup identified it as West Nile virus, a strain first discovered in Uganda in 1937. The last major human outbreak was in 1996, when it infected 393 people and killed 40 in Romania.

Giuliani’s office convened yet another news conference. This time, the mayor had something new to say.

New York had been invaded by a disease that had never been seen before in the United States.

Diseases have made intercontinental leaps before. For example, hantavirus, a disease that kills a few people each year in the Southwest, was brought to the United States by troops returning from the Korean War. And AIDS, now a worldwide scourge, originated in Africa.

Modern trade and travel are increasing the risk. A deadly virus can hitch a ride from a remote Congolese rain forest to New York City in a matter of hours.

How West Nile got here, nobody can say. Maybe an infected mosquito stowed away on a transatlantic flight. Perhaps a person with a mild case of the disease spread it to New York.

Experts say it probably came to New York several years ago and gradually spread through the bird population. Maybe a few crows died unnoticed, but most infected birds just passed the virus on without getting sick.

“It would take a little while to kind of smolder,” said Robert G. McLean, director of the National Wildlife Health Center in Madison, Wis.

This summer, as drought stressed the crow population and boosted the reproduction of Culex pipiens, an urban mosquito that prefers dry weather, the disease suddenly devastated the crows and spread to people.

If this had been a movie, identification of the virus might have been a climactic event, allowing doctors to stamp out the disease. Real life isn’t that neat.

By the time the mystery was solved in late September, the spraying, along with a few cold nights, had nearly wiped out the disease-spreading mosquitoes. Seven patients had died, and more than 100 had survived a bout with the illness.

The crisis was over. For now.

No One Can Say if Illness Will Reappear

But what happens in spring, when the mosquitoes return?

The West Nile virus could vanish as suddenly as it appeared. Or it could start killing again almost anywhere on the migratory-bird flight path along the East Coast. McLean and his colleagues already have found the virus in birds as far north as Albany and as far south as Baltimore.

On a mid-October day, birds plunged into a net strung across a Cold Spring Harbor, N.Y., barnyard. Federal biologists, trying to determine how far the virus has spread, retrieved them to draw blood samples. McLean finished with a blue jay, then tossed it skyward. In a flurry of wing beats, it disappeared into the brilliant golden autumn.

Twenty miles away, in the New York City neighborhood where it all began, barbecues and kiddie pools have been put away for the season, and many of the old tires have been carted away.

But here and there, tires missed during the cleanup or discarded since then lay scattered in the grass, ready to become mosquito nurseries with the first spring rain.

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This story is based on interviews with Deborah Asnis of Flushing Hospital Medical Center; Marcelle Layton and Annie Fine of the New York City Department of Health; Stephen Ostroff, Roger Nasci, Robert Lanciotti, John Roehrig and Katherine Volpe of the Centers for Disease Control and Prevention; New York State Wildlife Pathologist Ward Stone; veterinarians John Charos and Basil Tangredi; security guard William Carrasco; Varuni Kulasekera of the American Museum of Natural History; Robert McLean and Paul Slota of the National Wildlife Health Center; Bev Schmitt of the U.S. Department of Agriculture Virology Laboratory; Sally Rupert of Volunteers for Wildlife in Huntington, N.Y.; and John Sondgeroth of North Point Helicopters. It also draws from reports in two medical journals: Emerging Infectious Diseases and the Morbidity and Mortality Weekly Report.