From China to Panama, a Trail of Poisoned Med...4

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As a precaution, the patients with the mystery illness were segregated and placed in a large empty room awaiting renovation. Health care workers wore masks, heightening fears in the hospital and the community.
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Ángel Franco/The New York Times
A Survivor Poison cough syrup from China hospitalized Ernesto Osorio in Panama last year and partly paralyzed his face.
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“That spread a lot of panic,” said Dr. Jorge Motta, a cardiologist who runs the Gorgas Memorial Institute, a widely respected medical research center in Panama. “That is always a terrifying thought, that you will be the epicenter of a new infectious disease, and especially a new infectious disease that kills with a high rate of death, like this.”
Meanwhile, patients kept coming, and hospital personnel could barely keep up.
“I ended up giving C.P.R.,” Dr. Sosa said. “I haven’t given C.P.R. since I was a resident, but there were so many crises going on.”
Frightened hospital patients had to watch others around them die for reasons no one understood, fearing that they might be next.
As reports of strange Guillain-Barré symptoms started coming in from other parts of the country, doctors realized they were not just dealing with a localized outbreak.
Pascuala Pérez de González, 67, sought treatment for a cold at a clinic in Coclé Province, about a three-hour drive from Panama City. In late September she was treated and sent home. Within days, she could no longer eat; she stopped urinating and went into convulsions.
A decision was made to take her to the public hospital in Panama City, but on the way she stopped breathing and had to be resuscitated. She arrived at the hospital in a deep coma and later died.
Medical records contained clues but also plenty of false leads. Early victims tended to be males older than 60 and diabetic with highblood pressure. About half had been given Lisinopril, a blood pressure medicine distributed by the public health system.
But many who did not receive Lisinopril still got sick. On the chance that those patients might have forgotten that they had taken the drug, doctors pulled Lisinopril from pharmacy shelves — only to return it after tests found nothing wrong.
Investigators would later discover that Lisinopril did play an important, if indirect role in the epidemic, but not in the way they had imagined.
A Major Clue
One patient of particular interest to Dr. Sosa came into the hospital with a heart attack, but no Guillain-Barré-type symptoms. While undergoing treatment, the patient received several drugs, including Lisinopril. After a while, he began to exhibit the same neurological distress that was the hallmark of the mystery illness.
“This patient is a major clue,” Dr. Sosa recalled saying. “This is not something environmental, this is not a folk medicine that’s been taken by the patients at home. This patient developed the disease in the hospital, in front of us.”
Soon after, another patient told Dr. Sosa that he, too, developed symptoms after taking Lisinopril, but because the medicine made him cough, he also took cough syrup — the same syrup, it turned out, that had been given to the heart patient.
“I said this has got to be it,” Dr. Sosa recalled. “We need to investigate this cough syrup.”
The cough medicine had not initially aroused much suspicion because many victims did not remember taking it. “Twenty-five percent of those people affected denied that they had taken cough syrup, because it’s a nonevent in their lives,” Dr. Motta said.
Investigators from the United StatesCenters for Disease Control and Prevention, who were in Panama helping out, quickly put the bottles on a government jet and flew them to the United States for testing. The next day, Oct. 11, as Panamanian health officials were attending a news conference, a Blackberry in the room went off.
The tests, the C.D.C. was reporting, had turned up diethylene glycol in the cough syrup.
The mystery had been solved. The barrels labeled glycerin turned out to contain poison.
Dr. Sosa’s exhilaration at learning the cause did not last long. “It’s our medication that is killing these people,” he said he thought. “It’s not a virus, it’s not something that they got outside, but it was something we actually manufactured.”
A nationwide campaign was quickly begun to stop people from using the cough syrup. Neighborhoods were searched, but thousands of bottles either had been discarded or could not be found.
As the search wound down, two major tasks remained: count the dead and assign blame. Neither has been easy.
A precise accounting is all but impossible because, medical authorities say, victims were buried before the cause was known, and poor patients might not have seen doctors.