Whenever a virus breaks out anywhere in the world, Eric van Gorp is there. And sometimes there is no time to wait for money or approval. “In November, I thought that this would be a quiet year. But then the first Zika case came in.”
With all the news about Ebola – and recently Zika – it is easy to forget that less than a decade ago bird flu had the world in its grip. Mayhem! Especially after it appeared that the aggressive virus had mutated and had now passed on to humans. While scores of chicken farms in the Netherlands were undergoing preventive culling, virologist Eric van Gorp was en route to Indonesia. “I arrived in Jakarta, where chickens are transported to market on the back of mopeds and are quite at home scratching around inside the house. Then it dawns on you that we in the West can come up with all kinds of advice and regulations, but this is something that won’t be solved overnight.”
Eric van Gorp is professor of Clinical Virology. He works in clinics from Barbados to South Africa and from Indonesia to Suriname. In addition to his work for Erasmus MC, he is dedicated to socially oriented projects, such as Viruskenner on behalf of the Cirion Foundation. As a young doctor in the early 1990s, he treated one of the first Dutch patients with ‘bleeding fever’, which earned him the nickname of Dr Dengue. This summer he will be the point of contact for Olympic athletes returning from Brazil.
Cowboys in science
In this series of articles, Geert Maarse interviews researchers who take things just a tiny bit farther than their colleagues. Read all about academic adventures and the absolute necessity for this type of field research.
He just wants to say that change will be difficult. In contrast to most virologists (the majority of which are microbiologists or veterinarians), Eric van Gorp is hardly ever in the lab. He is a doctor and specialises in internal medicine and infectious diseases. This means that he is no stranger to dirty work. He visits the hospital beds in countries such as Barbados, Indonesia and Suriname. He works with local doctors to look for the causes and solutions to numerous infectious diseases. He feels that science consists of small steps and patience. And this is why his research group has been working with hospitals around the world for many years. It has the advantage of travelling to a place without delay when all hell breaks loose.
Do you pack your bags as soon as you get the first reports?
“When the first reports of the Zika virus came in from Brazil, we didn’t know what the virus was going to do. We immediately contacted our colleagues in Barbados, Trinidad, Jamaica and Suriname and discussed what we could do. Everyone was afraid of microcephaly as a result of Zika. It appeared to be better than expected in Suriname, but we did see a marked increase in Guillain-Barré syndrome, which is accompanied by symptoms of paralysis and often requires patients being put on a ventilator. However, there are only a limited number of ventilator beds available in Suriname and on the Caribbean islands, which are quickly filled when there is an explosive increase in patients. We then decided to tackle the problem, together with our colleagues from intensive care in Erasmus MC and the Academic Hospital in Paramaribo. Within one-and-a-half months, we had prepared everything: a team of doctors and virologists and the research and treatment protocols. At the same time, we looked at how we could provide breathing equipment. We were busy day and night for weeks. And then in early February we were on the plane.”
What do you find when you arrive in such a crisis area?
“You’re struck by the full extent of what is going on. I can still remember when I first went abroad for my doctoral research. It was 1992. I’d just started my specialist training and I landed in Semarang, the capital of Central Java. The research was on dengue. We knew the big picture: many millions of people get this disease every year, with a portion of them becoming moderately ill and a portion dying from it. But then you suddenly find yourself on a crowded paediatric intensive care ward, where you know that one in three of the children won’t survive this. Moreover, the political and economic situation in a country has a huge impact on the quality of the health care. Once, when Suharto was still President in Indonesia, we arrived in Singapore and actually had to turn back, simply because it was too dangerous and airports were closed.”
Is this just a form of development aid in disguise?
“When it comes to viruses, we tend only to think in terms of the likelihood of it ending up here. But you never know when a problem in South America will become a problem in Europe. As researchers, we’ve also been working for years with partners in these countries. This creates a responsibility in the event of a crisis. Although that is not to say that it’s easy to get things done at such a time. You need people who are prepared to stick their necks out, both inside Erasmus MC and beyond. People who are willing to step outside their comfort zone. This means that personal contacts are very important, whether it’s with colleagues from intensive care, the legal department or logistics. If you have to wait for all the red tape to be sorted, it will be a few months later. And then there will be no point in going.”
We are permanently available in the countries where we have ties and collaborations. And that’s not going to change. Even after the cameras have left.
In her book De Crisiskaravaan, journalist Linda Polman sketches a very gloomy picture of this kind of acute aid. It appears to be an industry in itself, which is completely driven by money. Does this sound familiar?
“When an outbreak occurs, you sometimes see the entire world fly in. This is partly well-intentioned, by people who are fully committed to the cause. But there are also parties that have never been in the area before and that arrive there simply because there is business to do. Money can really have an adverse effect, particularly because we can often achieve a great deal without money. Part of the problem is the quest for organisations to make a name for themselves. That’s why I don’t want to create the image of boarding a plane with yellow jackets and search and rescue dogs, and that we have cured everyone a few months later. Because that’s not how it is. We are permanently available in the countries where we have ties and collaborations. And that’s not going to change. Even after the cameras have left.”
How often have you been sick?
“It’s quite possible that I’ve had one or other subclinical disease, without it being known. But in any case I have had the Zika virus, with all the classic symptoms: fever, pain in the joints, spots on the skin and inflamed eyes. I knew straight away what it was, also as a patient.”
You are the point of contact for Olympic athletes returning from Brazil. Should they be worried?
“It’s now the dry season there. Although the seasons are a little mixed up – just as it’s raining here more than usual now – this means that there are fewer mosquitoes and therefore less chance of Zika. If an athlete takes the normal precautions to prevent mosquito bites, we expect that the risk of infection will remain low. But if an athlete does actually become infected, on average eighty per cent of people don’t notice anything. Twenty per cent do develop symptoms, but they recover quickly. There is a particular risk for pregnant women and for people who want to have children. The virus can also be transmitted through sexual intercourse, so both men and women can have themselves tested on their return to the Netherlands. These kinds of topical questions and specific groups form a pleasant side to this work. But nobody gets to hear about any of this, unless athletes decide to go public themselves when they come along here after Rio.”
As a doctor, you would like to eliminate a virus, whereas as a researcher you might relish the discovery of a new aggressive variant that suddenly rears its head. Do you find that strange?
“Eliminating all viruses is an illusion and will never succeed. There was a time, however, that this was thought possible. In the early eighties of the last century, we thought that virology could be dispensed with. It seemed as if everything could be vaccinated or treated. And then came HIV. The picture we had about infectious diseases quickly changed. HIV patients developed AIDS and died because of a lack of available treatment. And in the subsequent decades, all kinds of new infectious diseases have surfaced, as well as old ones in a new form. That is why it is absolutely necessary to continue to study these diseases, even when they have fallen out of the limelight or are attracting less attention. These include the important group of neglected diseases. The majority of funding is injected into combating the ‘big three’: malaria, tuberculosis and HIV. But infectious diseases such as Ebola, dengue, yellow fever and leptospirosis are also a potential risk to public health. And there are currently insufficient funds available to carry out proper research into them.”
