When two American diplomats stationed at the U.S. Embassy in Havana reported a strange sound in May, Cuban investigators rushed to the diplomatic residence to investigate.
So did FBI investigators, the Cuban government said. It was an opportunity because visits by the FBI, which has made six trips to Cuba since mysterious incidents that the U.S. State Department calls health attacks first were reported, generally haven’t coincided with the actual events.
Sometimes called acoustic attacks, the events are often accompanied by a sound variously described as high-pitched, low-pitched, piercing squeals, grinding metal and incapacitating before the onset of symptoms such as ringing in one ear, vertigo, nausea, recurrent headaches, fatigue, cognitive issues, problems sleeping and even hearing loss in a few cases.
Cubans investigating this latest incident say they concluded that the unpleasant, piercing sound was a water pump starting up in a nearby home. They said the FBI, which declined to comment, drew a similar conclusion.
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Yet in June, the United States said the two incidents were medically confirmed and added them to a list of American diplomats and family members who had been posted in Havana and suffered from strange medical problems. That brought the total cases to 26. Asked about the May incident, a State Department spokesperson said: “We would refer you to the government of Cuba for questions about its report.”
Inconsistencies, secrecy and shifting hypotheses that sometimes seem straight out of science fiction have marked the U.S. government’s effort to get to the bottom of what happened in Havana since the first Cuba cases were reported in late 2016, a time when U.S.-Cuba relations were on the cusp of change with President Donald Trump soon to take office.
The United States also confirmed in May that a U.S. government worker in China suffered from similar symptoms following an acoustic event, bringing the total number of cases to 27.
Sonic weapons, microwaves, a possible directed energy weapon, maybe even a combination of ultrasound and electromagnetic pulses — a technology commonly used to keep pests outside homes — toxins, heavy metals including lead and mercury, drugs, a virus and a mass psychogenic illness (a nervous system disorder brought on by collective stress that causes physical symptoms) have all been advanced as possible causes for the diplomats’ medical problems.
Cuban researchers have even suggested that the shrill sound heard by some of the diplomats could have been the chirping of cicadas, insects that are common on Cuba’s north coast.
But a year after a significant staff reduction at the U.S. Embassy ordered in the wake of the alleged attacks, there are still no definitive answers on who or what made the diplomats sick. There are also widely divergent views among the two groups of doctors who have actually examined the diplomats, as well as among other researchers who have weighed in, on what the underlying medical cause that produced the symptoms is.
Are the Russians or some other player intent on disrupting U.S.-Cuba relations, a rogue element within the Cuban government or maybe no one responsible?
“This episode has gotten way out of hand with wild speculation and competing theories from specialists,” said Robert Bartholomew, a New Zealand scientist who believes mass psychogenic illness played a role in the diplomats’ symptoms. “It can only be understood by sticking to the science, not the science fiction. This is such a convoluted saga that it may take years to sort out and agree on a diagnosis.”
Despite months of investigation by the FBI, Cuban criminal investigators and scientists, and U.S. researchers and doctors, no weapon or acoustic device has been identified.
But with the State Department calling the incidents attacks, it seems to favor the weapon hypothesis. “Information suggests our personnel were deliberately targeted,” said a State Department spokesperson without being more specific. “Based on investigative and medical findings, we do not believe this trauma was caused by naturally occurring phenomena.”
But its position remains that what happened in Havana is still under investigation. “We continue to work to identify the source and cause of the attacks,” said the spokesperson.
Adding credence to the possibility of attacks is that the first incidents targeted diplomats with intelligence assignments and some of the diplomats described directional beams of sound, or energy, that seemed to follow them from room to room, which would seem to indicate a purposeful action.
Citing unnamed government sources, NBC reported that Russia is the most likely suspect because intelligence intercepts, or signals, collected during the investigation point in that direction. But such evidence, according to NBC’s sources, hasn’t been conclusive enough to formally accuse Moscow.
Some researchers contacted by the Miami Herald say there needs to be consensus first on what happened medically in Havana before any fingers should be pointed.
“There is no smoking gun. At this point it’s best to stay very open-minded,” said James Giordano, a professor of neurology at Georgetown University and an expert in neurological weapons. He was asked by the State Department to come up with an explanation of what would have been capable of causing the inner ear problems that doctors and researchers at the University of Miami School of Medicine and the University of Pittsburgh say the affected diplomats share.
It’s called abductive forensics and it’s a bit like police finding a wounded victim and then determining what type of weapon could be used to inflict such a wound.
Drugs and ultrasonic, microwave and electromagnetic stimulation or a combination of those factors are all capable of producing such damage, he told State Department officials at a briefing.
For a variety of reasons, he said, some of those options aren’t very probable.
Microwaves wouldn’t be able to produce severe symptoms without vaporizing a person’s head, said Mitchell Valdés Sosa, the head of Cuba’s Neurological Center and one of nine Cuban scientists who recently came to the United States to confer with the State Department, the National Academy of Sciences and members of Congress.
“The general feeling is that this is not microwaves and I agree,” said Giordano.
At this point in the investigation, he said, some sort of directed energy device is the most likely with electromagnetic pulse stimulation as the leading candidate.
“Could it be a vermin-killing device improperly installed? No one’s saying it’s not,” he said to emphasize that there are a wide range of possibilities still open. Such devices are plugged into a home’s wiring to produce electromagnetic pulses.
It’s also possible that multiple devices inside or outside the diplomatic homes were at work, using various types of directed energy, Giordano said. He also doesn’t rule out that there could be some type of psychological ripple effect with some diplomats truly affected and others open to suggestion.
Cuba rejects the attacks/weapon theory. “Before explaining how donkeys fly, you have to first see a flying donkey,” said Valdés Sosa. The United States, he said, has settled on weapons, “the most bizarre and less likely explanation,” when other simpler and perhaps sounder explanations haven’t been vetted.
“This was politicized too early and it needs to go back on the track of science,” he said.
The Cuban investigative team, Valdés Sosa said, is preparing its own report on all the theories advanced and hopes to publish it soon.
The Cubans don’t believe all the reported cases should be lumped together. “This is not a homogeneous group. The symptoms are not the same,” said Valdés Sosa. “The waters have been muddied in this case by conflating all the symptoms.”
But Dr. Michael Hoffer, the University of Miami specialist in diseases of the ear, nose and throat who examined diplomats in Havana and in Miami, said there is a common ailment that tied all the affected diplomats together.
All 25 patients examined in Miami who were truly symptomatic had a “physical injury in or around the inner ear,” he said. The most common symptoms in that affected group were dizziness (92 percent), cognitive problems (56 percent), and hearing loss and ringing in the ears (both 32 percent), Hoffer said during a recent telephone call-in on the Havana incidents for Pentagon personnel.
When there are abnormalities in the body’s inner ear gravity organs, Hoffer said, it can not only cause dizziness, but “you dedicate a lot of mental energy and attention to staying upright and that results in less energy for cognitive tasks and increasing fatigue.”
The current Cuban working theory is that the affected diplomats had underlying medical conditions, but “we can’t exclude psychological factors as also operating,” Valdés Sosa said.
Not helping either side investigate is that the alleged crime scene is in one country and the diplomats and the evidence held in their bodies is in the United States.
The State Department hasn’t directly blamed Cuba for causing the health incidents, but some in the Trump administration think the Havana government knows more than it is letting on. The Cubans say their investigation has been thwarted by lack of cooperation from U.S. authorities. The Cuban scientific delegation complained that without access to the U.S. patients or their medical records. it’s difficult to draw conclusions.
While in Washington, the Cuban scientists urged cooperation between scientific communities in both countries, but they said the only data shared with them by the State Department was a University of Pennsylvania report that appeared in The Journal of the American Medical Association early this year. They’d already been through it with a fine-tooth comb.
The work by University of Miami doctors and researchers in cooperation with the University of Pittsburgh, which is expected to be published soon in a peer-reviewed publication, wasn’t shared with them. Among these researchers’ hypotheses is that directed energy can result in cavitation bubbles formed by dissolved nitrogen and oxygen in body fluids that can burst and cause damage.
After reading media reports about the cavitation theory, Valdés Sosa said he instructed his Cuban research team to review all the scientific papers they could find on cavitation bubbles.
Meanwhile, researchers at the University of of Pennsylvania who treated and examined 21 of the initial 24 U.S. diplomats suffering from the mysterious ailment have published the most comprehensive report to date in JAMA. Their preliminary conclusion was that the patients — 10 men and 11 women — were suffering from concussion-like brain injuries that weren’t associated with head trauma as might be expected. That raised concerns about a new, unknown mechanism for causing traumatic brain injury.
The Penn researchers said some of the diplomatic personnel reported the onset of additional symptoms days or weeks after exposure at their homes or in three rooms at Havana’s Nacional and Capri hotels. The State Department said the majority of diplomats have now returned to work.
While the Cuban scientists said they don’t doubt something has made the diplomats sick, they said they have seen no credible evidence in the Penn study that they actually suffered brain damage as a result of deliberate attacks with some mysterious weapon.
Other scientists and doctors, including those at the University of Miami who were the first to examine the Havana diplomats, aren’t buying the brain damage theory either.
“The [Penn] findings don’t match” criteria established by the military for mild traumatic brain injury injury,” Hoffer said.
In its Aug. 14 issue, JAMA published four letters from groups of doctors and scientists from around the world who said there were flaws in the Penn study and doctors should not have discounted the possibility of a functional neurological disorder, an inner ear disorder or mass psychogenic illness, commonly referred to as mass or collective hysteria.
But even earlier than that scientists were raising concerns about the Penn findings, because many of the reported symptoms are prevalent not only in the general population but also among people with other neurological illnesses.
In a March editorial that appeared in JAMA, Dr. Christopher Muth and Dr. Steven Lewis, both neurologists at Rush University Medical Center in Chicago, urged caution in interpreting the findings. They pointed out that not only was there “some variability between patients in terms of symptoms that each experienced” but there were no baseline evaluations to determine if the patients had preexisting conditions. Some of the symptoms were based on reports by the patients themselves instead of through standardized examinations, and the diplomats were evaluated a mean of 203 days after the onset of their symptoms.
Without a baseline study, they said, it can’t be determined whether the hearing loss experienced by three patients, who were fitted with hearing aids as part of their treatment, resulted from exposure to the sounds they said they heard. Still, they said the similarities among the 21 cases evaluated at that point do “merit consideration of a common medical, environmental, or psychological event as their potential cause.”
“It remains unclear whether individuals who developed symptoms later were aware of the previous reports of others,” Muth and Lewis said. If they were, it could lend credence to the possibility of mass psychogenic illness.
The ailment has nothing to do with hypochondria and is not a made-up illness. Those suffering from stress-induced mass psychogenic illness have real symptoms such as headaches, insomnia, fatigue and dizziness and may require treatment to recover. A famous example is the 1999-2002 Kokomo Hum where nearly 100 residents of the Indiana city reported getting sick after hearing a humming sound. No acoustical source of the hum was ever identified.
Bartholomew, the Auckland, New Zealand, expert on mass psychogenic illness, also had a letter published in JAMA, in which he said that ailment shouldn’t be discounted.
If researchers truly wanted to get to the bottom of the Havana illnesses, he said, they should have conducted a social network analysis that looked at how the patients might be acquainted and whether they had knowledge of others becoming ill. “If patients were unaware that others were falling ill, it rules out mass psychogenic illness,” he said.
Asked about the University of Miami/University of Pittsburgh assertion that testing of the Havana patients showed differences in eye movement patterns in the affected diplomats and family members, Bartholomew said: “These results are not definitive and open to interpretation.”
He said he’s willing to stake his career that the answer is mass psychogenic illness. “Think of it as a collective stress response. It happens to normal, healthy people. We are all susceptible,” Bartholomew said in response to Miami Herald questions.
In another letter to JAMA, two neurologists and a neuropsychiatrist from Scotland and Germany noted that there are “high rates of vestibular (inner ear) abnormalities in patients with anxiety disorders.”
On May 23, the United States established a multi-agency task force to address the situations in Cuba and China, but its mission appears to be primarily on protecting and enhancing the security of U.S. government personnel and their families.
“The task force meets weekly to coordinate efforts and share information and ensure that our posts overseas have the information they need to support our employees in the field,” said a State Department official. The task force doesn’t plan to issue any reports, said a State Department official.
Part of its mandate includes risk mitigation, but the official declined to comment on any security measures that may have been undertaken. The State Department, however, recently reduced the tour of duty for diplomats in Havana from two years to one, a reflection of “the more challenging conditions affecting U.S. diplomats on the ground,” the official said.
The United States pulled two-thirds of its personnel from the U.S. Embassy in Havana last September, leaving only a skeletal staff to carry out essential services. A State Department roster dated Sept. 14 showed only 10 U.S. diplomats posted at the Havana embassy and three of them were on temporary assignment.
The cutbacks have stretched the diplomats thin, severely hampering visa-issuing operations and outreach to Cuban citizens.
But California Republican Rep. Paul Cook, the chairman of the House Western Hemisphere subcommittee, said at a recent congressional hearing that such a staffing level is “essential and prudent until we can determine the cause of these attacks and effectively mitigate it.”
Follow Mimi Whitefield on Twitter: @HeraldMimi