Crisis in the Red Zone:The Story of the Deadliest Ebola Outbreak in History, and of the Outbreaks to Come

By Richard Preston

Random House. 375 pp. $28

Chances are you haven’t noticed, but Africa is once again experiencing a serious Ebola outbreak. This one is in Congo, where about 1,700 people have died over the past year and 2,500 have been infected with the deadly virus, which inflicts days of agony, hemorrhaging, diarrhea and vomiting.

This time, health authorities are grappling with more than the difficulty of quarantining and treating people in small villages far from modern medicine, or resistance from frightened people suspicious of outsiders in moon suits. This crisis also happens to be taking place in a conflict zone, where violence between rival groups sometimes makes it too dangerous for medical aid personnel to get in and save lives.

But Ebola is not on the radar here in the West. Unlike in 2014, when fear of an Ebola epidemic in the United States reached something approaching hysteria, few are aware. We have been protected — so far — by geography. Until recently, the virus had not reached an area with a major airport, and there still is relatively little chance that someone with the highly contagious disease will board a plane and bring it into our midst.

Ebola? So 2014.

Which is one lesson from Richard Preston’s harrowing, horrifying new book, “Crisis in the Red Zone,” an almost day-by-day account of how Ebola smoldered largely unnoticed in small villages along the Guinea-Sierra Leone border before it exploded and overran a city hospital in Kenema, Sierra Leone, five years ago.

The line between a confined local emergency and a widespread, even international crisis remains perilously thin, Preston shows. Despite the efforts of the best and brightest health experts, we are still hostage to the virus’ location, the vigilance of those keeping watch and the effectiveness of the response.

“Ebola’s only mission [is] to never stop replicating, and to never stop moving from person to person,” Preston writes, “and thereby to make itself immortal in the human species.”

The new book is a sequel to Preston’s 1994 best-seller, “The Hot Zone,” which focused on the 1976 Ebola outbreak and the discovery that the virus was accidentally transported to a government lab in Reston, Va., in a shipment of infected monkeys.

In this work, Preston meticulously traces the 2014 outbreak from a tree in Guinea, where a toddler was probably infected when he came in contact with a bat that carried the virus; to the death of a village healer, whose funeral exposed hundreds of people who touched her body; to Kenema Government Hospital in Sierra Leone, which, ultimately, is consumed by the virus.

People from aid groups like Doctors Without Borders and the small circle of Western experts in these dangerous pathogens rush in to help, sometimes exposing themselves to life-threatening situations, as waves of Ebola victims descend on the hospital. Local doctors and nurses, clad in stifling moon suits to protect against the virus, work under unimaginable conditions. The heat is unbearable. Wards designed for a small few hold dozens of victims. It is impossible to keep up with the human excrement, blood, urine, vomit and sweat, which are everywhere, as dying victims lay helpless on cots or drag themselves about the small facility.

Which means that the virus also is on every floor, wall and square inch of victims’ skin. A single, microscopic particle of Ebola that finds its way to an eye, a mouth or a break in the skin usually means death for the medical staff.

Ultimately, small mistakes are made by exhausted caregivers, and the heroes of Preston’s book fall, one by one. First some of the nurses who stayed to care for patients when others fled. Then the revered chief nurse, “Auntie” Mbalu S. Fonnie. And finally Humarr Khan, the physician in charge, who tried but failed to keep his finger in the dike.

In the book’s most excruciating sequence, Khan lies dying in a Doctors Without Borders treatment unit while an experimental medication that could save him sits in a freezer 100 feet away. With only six doses available worldwide, doctors, aid group officials and Khan’s friends across the globe clash over whether it is ethical to give him the medicine — which had never been tested in humans — while local patients have no access to it.

In the end, Khan dies never knowing of the potential cure within his reach. Later, another dose is used to help save the lives of two American health-care workers in Liberia.

Knowing, as we do, that the 2014 Ebola outbreak did reach the United States and infected health-care workers here, and nearly spread to Lagos, Nigeria, a city of 20 million, before it was snuffed out, does nothing to diminish the power of “Crisis in the Red Zone.” A major flaw of the work, in fact, is that Preston barely mentions the world beyond Kenema, save for a few words about the more than 11,000 people who died, almost all of them in Liberia, Sierra Leone and Guinea.

Nor do we see the delayed response by the World Health Organization and parts of the U.S. government. It is important to remember, as Preston takes pains to point out, that Africans stemmed the outbreak themselves, ultimately organizing to quarantine the sick and halt the spread of the virus. Could they have done it without the international aid groups’ treatment centers and the labs set up by the U.S. Centers for Disease Control and Prevention? As a reporter who covered the epidemic in two trips to Liberia during the outbreak, my guess is probably not. But in large part, it is the citizens of these three countries who deserve the credit.

There is also no mention of the man who would lead the U.S. response should the current outbreak threaten this country: President Trump, who forcefully advocated barring the two American missionaries infected with Ebola from treatment in the United States.

“Ebola patient will be brought to the U.S. in a few days — now I know for sure that our leaders are incompetent. KEEP THEM OUT OF HERE!” Trump tweeted in July 2014. Would he feel the same way now? Fortunately, President Barack Obama and public health leaders ignored Trump and others. Kent Brantly, Nancy Writebol and a few other Americans, including a freelance journalist, were treated in this country without endangering the public.

The book ends on a hopeful note, citing the research that, at the time, was leading to the development of cures and vaccines. Now those advances are being put to work: More than 100,000 people have been given an experimental vaccine to protect them from the virus in the Congo outbreak.

Is it enough? No one knows. Ebola mutates quickly and ably, adapting to survive. “The warriors who stand watch at the gates of the virosphere understand that they face a long struggle against formidable enemies,” Preston concludes. “Many of their weapons will fail, but some will begin to work. ... If viruses can change, we can change too.”


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