Panama City – Panama launched a criminal investigation Thursday after health officials announced that the mysterious deaths of 21 people were likely caused by the intentional contamination of government-made cough syrup with a coolant used in brake fluids.
The deaths had set off a panic as doctors struggled for weeks to decipher why a disturbing number of men in their 60s were showing up at clinics suffering from severe disorientation and kidney failure.
In addition to those who died, at least 38 people fell ill with the same symptoms.
Panama’s health minister, Camilo Alleyne, initially suspected a high-blood-pressure medicine called lisinopril and recalled 2 million tablets of the drug, which is made in Spain.
But later, with the help of investigators from the U.S. Centers for Disease Control and Prevention in Atlanta and the Pan American Health Organization, researchers determined that sugar-free cough syrups made by Panama’s social-security system were laced with diethylene glycol.
The chemical is most commonly used as a coolant for brake fluids and hydraulic systems.
“It has been a very unfortunate and troublesome and sad episode,” Samuel Lewis Navarro, Panama’s first vice president and foreign minister, said in an interview at his waterfront office. “It’s an issue that now goes on to the Justice Department.”
The CDC twice sent planes to Panama to collect blood, urine, tissue and other samples from patients. Technicians at CDC laboratories and analysts at the U.S. Food and Drug Administration searched for clues.
“It was a mystery for a while,” said one of the investigators, Ali Khan, acting deputy director of the National Center for Zoonotic, Vector-Borne and Enteric Diseases at the CDC. The real breakthrough, Khan said, came from old-fashioned “shoe-leather epidemiology.”
Researchers who were sent into the field to conduct interviews began “with a wide net,” said Carol Rubin, another CDC official involved in the investigation. Meanwhile, Panamanians grew more agitated and rumors ricocheted across the capital.
“These are situations that create panic, especially when they’re based on speculation,” said Lewis Navarro.
Eventually, investigators began to notice a pattern: All the victims were taking sugar-free cough syrup, a remedy that doctors here often prescribe for patients with diabetes. The cough syrup has since been recalled.
The deaths called to mind a similar outbreak in late 1995 and early 1996 in Haiti, where 31 children died after taking acetaminophen syrup that was contaminated with diethylene glycol while being shipped from China through Europe.
At least 98 people died in the early 1990s in separate outbreaks in Nigeria and Bangladesh because of diethylene glycol-contaminated acetaminophen, according to a CDC report. And one of the largest outbreaks of diethylene-glycol poisoning took place in the U.S., where 105 people died in 1937 after drinking a poisonous elixir.
