Journals of the Plague

CRISIS IN THE RED ZONE: THE STORY OF THE DEADLIEST EBOLA OUTBREAK IN HISTORY, AND OF THE OUTBREAKS TO COME BY RICHARD PRESTON. NEW YORK: RANDOM HOUSE. 400 PAGES. $28.
EBOLA: THE NATURAL AND HUMAN HISTORY OF A DEADLY VIRUS BY DAVID QUAMMEN. NEW YORK: NORTON. 128 PAGES. $14.

Ebola “begins as a mystery story,” as the science writer David Quammen puts it in his excellent 2014 primer Ebola: The Natural and Human History of a Deadly Virus, which expands on a chapter from Spillover, his enchanting study of zoonotic diseases. Every new infectious disease is a mystery, of course, but the dramatic efficiency with which Ebola kills—it is highly lethal and infective, causes hemorrhagic fever, and has a brief incubation window—lends it an apocalyptic aura. Indeed, science writer and New Yorker contributor Richard Preston introduced The Hot Zone—his best-selling 1994 account of “The Terrifying True Story of the Origins of the Ebola Virus,” as the breathless subtitle has it—with an epigraph from the Book of Revelation: “The second angel poured his bowl into the sea, and it became like the blood of a dead man.” To ensure no one missed the point, Preston attributed the line to “Apocalypse,” another title for Revelation (the Greek apokalypsis simply means “unveiling” or “revelation”).

Bowls of blood! According to The Hot Zone, Ebola virus disease liquefies the organs of the infected: “People were dissolving in their beds.” The virus “transforms virtually every part of the body into a digested slime of virus particles.” One imagines patients’ garments floating in puddles of goo, as in the third season of Stranger Things. Oh, and “you may weep blood”—it’s “where medical reporting,” Quammen quips, “meets Edgar Allan Poe.”

Ebola is gruesome enough without this hyperbole. The corpses of those whom Ebola kills do not dissolve; they are carried to their graves by grieving relatives or space-suited medical workers, as Preston himself documents in his more responsible account of the 2014 Ebola epidemic in West Africa, Crisis in the Red Zone: The Story of the Deadliest Ebola Outbreak in History, and of the Outbreaks to Come (his penchant for overheated subtitles remains strong, now with a superfluous comma as a bonus).

Ebola treatment unit run by Doctors Without Borders, Monrovia, Liberia, December 2014. UNMEER/Simon Ruf/flickr

I read The Hot Zone when it came out in mass-market paperback, and it noped the bejesus out of me. I’m the kind of person who frets for days if he shakes hands with someone who has a cold. I am never without a small bottle of hand sanitizer. Still, I’d rather sit in a small room with an Ebola patient than with someone suffering from flu or (if I weren’t immunized) measles. The last two are airborne and highly contagious. Ebola is very infective, but it’s transmitted through bodily fluids—chiefly blood, feces, vomit, and sweat. Unsurprisingly, the virus causes its victims to bleed, shit, vomit, and sweat profusely, but if you don’t get infected fluids on or in you, you won’t catch it. The West African outbreak ended the way “all outbreaks end,” an official with Doctors Without Borders told Preston: People began to change their behavior. They inspected everyone coming into villages for signs of infection, avoided touching the infected or dead, and stayed away from sites known to harbor the disease. This entailed a certain hardening of the heart, but it checked the virus’s spread.

Ebola also kills speedily—often within a few days—with an average fatality rate of 50 percent. (In some outbreaks the disease has killed as many as nine out of ten patients, but contextual factors like poverty and available medical care probably contribute to such extreme annihilation.) Because it is so ruthless, and because its transmission can be disrupted relatively simply, it was long assumed that, though dreadful, Ebola posed no real threat of a sustained epidemic. “Never more than 280 people had died in any Ebola outbreak,” Preston writes. “In thirty-seven years of outbreaks, the six different Ebola [species] had killed, in all, only 1,539 people.” These numbers are tragic but, weighed on the scale of global disease, quite modest. Malaria kills over a million people each year. The conventional wisdom held that Ebola was like a flash fire: devastating but soon exhausted from lack of fuel. As one scientist told Quammen, “It pops up and kills a bunch of people, and before you can get there and figure anything out, it’s gone.”

In 2014, however, Ebola became a mega-fire. Mid-December 2013, in a small Guinean village near the borders of Liberia and Sierra Leone, a toddler contracted Ebola, probably from a bat (Ebola’s reservoir host is unknown, but the smart money’s on bats, a common reservoir for zoonotic viruses—“What is the deal with bats?” Quammen asks). From the boy, the virus moved into his sister, his mother, and his grandmother. All were dead by mid-January. Then the village midwife, who had tended the mother and grandmother, got sick. Her relatives took her to a hospital in a nearby city, where she died. A medical worker who had tended the midwife became ill and sought treatment at a hospital in a neighboring town, where she too died. This chain of infection and death spread to Conakry, Guinea’s capital. By July there were cases in the capitals of Liberia and Sierra Leone. From there, the virus eventually reached Italy, Mali, Nigeria, Senegal, Spain, the United Kingdom, and the United States. More than eleven thousand people died. The disease killed 7 percent of Sierra Leone’s doctors.

This is the gripping and frequently excruciating story Preston tells in Crisis in the Red Zone, alongside a narrative of the Zaire outbreak of 1976, which led to the identification of the Ebola virus. Whereas Quammen’s book proffers only a broad overview of the 2014 crisis, Preston travels to West Africa and talks to several of the principal actors. He provides vivid portraits of the brave medical personnel without whom the disease’s human cost would have been even higher. Dr. Humarr Khan, Mbalu Fonnie, and Lucy May worked tirelessly in the makeshift Ebola ward at Kenema Government Hospital in Sierra Leone before succumbing to the virus themselves; the American scientist Lina Moses, also in Kenema, splashed through infected effluvia in flip-flops to deliver blood samples because every second counted and protective boots would have slowed her down. Aid workers were attacked by panicked villagers (as Preston notes, we should not assume that we would behave differently if “federal officers wearing moon suits” announced they were taking our loved ones to a government facility). Sierra Leone’s government promised Ebola nurses $3.50 a day in hazard pay that never materialized.

Preston’s after the detail that snaps a person into focus, and he often finds it. Trying to get to Yambuku in ’76, three doctors commandeered a helicopter bound for President Mobutu’s palace, persuading the pilot to jettison some of his posh cargo to make room for their gas cylinders. “As the Hercules took off,” one doctor “experienced a sharp pang of regret as he thought about all that beautiful cheese from Normandy sitting on the tarmac and spoiling in the tropical sun.” Preston also writes, for the most part, at the level of an airport thriller, which is fine when he’s writing airport thrillers (cf. The Cobra Event, Preston’s novel about a bioterrorist attack, which spooked Bill Clinton in the late ’90s). It’s irksome in his nonfiction. “The rains had begun,” Crisis in the Red Zone opens. “The nights were clamorous with downpours, and malaria troubled the villages.” (Cue Toto’s “Africa.”) There are passages that seem drawn from a melodramatic press release: “The warriors who stand watch at the gates of the virosphere understand that they face a long struggle against formidable enemies.” Preston’s pedestrian style is particularly striking if you come to Crisis in the Red Zone after reading Quammen, who writes with pizzazz (human population “came to the 7-billion mark and flashed past like it was a ‘Welcome to Kansas’ sign on the highway”).

As Preston implies in passing, Ebola is, among many other things, yet another cautionary tale about human interference in the global ecosystem. The related phenomena of climate change, urbanization, deforestation, commercial transportation, and refugee migration make it inevitable that devastating new viruses will continue to emerge. Quammen, in Spillover, pulls no punches:

Make no mistake, they are connected, these disease outbreaks coming one after another. And they are not simply happening to us; they represent the unintended results of things we are doing. . . . Mankind’s activities are causing the disintegration (a word chosen carefully) of natural ecosystems at a cataclysmic rate.

The outbreak of 2014 happened in part because extreme deforestation by mining and lumber operations made human interaction with the virus’s host more likely (also gorilla interaction—Quammen writes forebodingly of the toll the disease exacts from our ape cousins). “Emerging diseases are linked to environmental alterations caused by humans. Humans are in much more contact with animals when you open up a forest,” John E. Fa, a senior research associate with the Center for International Forestry Research, told the New Internationalist. “You have a balance of animals, viruses and bacteria and you alter that when you open up a forest.” Ebola defied prognostication and reached New York City and London because the world is small and getting smaller.

As I write this, another Ebola epidemic is underway in the Democratic Republic of Congo and has expanded into Uganda. The New York Times reports the virus has reached Goma, a city of two million about half a mile from Rwanda. More than 1,600 people have died so far, making it the second-worst outbreak in history. The World Health Organization has (finally) declared the outbreak a Public Health Emergency of International Concern, only the fifth time it has sounded this highest alarm. Promising new vaccines were developed during the 2014 emergency, and it remains unlikely that Ebola will spark a global pandemic. But it is almost certain that something else will, and there is every danger that it will exacerbate prevailing social tensions. “There were many Instances of immovable Affection, Pity, and Duty,” Daniel Defoe recorded in A Journal of the Plague Year. So there were, Preston’s narrative reveals, in West Africa. Closer to home, affection and pity seem in short supply.

Michael Robbins is the author of the poetry collections Alien vs. Predator (2012) and Walkman (forthcoming, both Penguin) and the essay collection Equipment for Living: On Poetry and Pop Music(Simon & Schuster, 2017). He is an assistant professor of English at Montclair State University.