The Horror of Ebola

 

A review of Crisis in the Red Zone by Richard Preston, Random House, 2019

Richard Preston the foremost author writing about hemorrhagic fever, especially Ebola, provides a blow-by-blow, day-by-day, chronicle of how the 2013/14 Ebola epidemic arose, grew, and swamped West Africa in disease and death.  He tells of patient zero, a child in Guinea, and tabulates how the virus spread via contaminated bodily fluids, specifically through traditional funeral practices and/or care for those infected.  At first no one in the medical establishment knew what they were dealing with, perhaps malaria, perhaps Lassa fever.  No one knew of Ebola in West Africa. When laboratories in the U.S. and Europe finally identified the virus as Ebola, the epidemic had already killed hundreds. Thousands more were to die.

The bulk of the book details the personal stories of the heroic work of front-line medical personnel in Kenema, Sierra Leone and their efforts to find victims, identify the virus, but mostly to care for the infected.  Preston writes of bloody medical procedures, the difficulty of working in protective gear, and the challenges of providing care in overcrowded unsanitary wards, as well as the need to counter community fears and suspicions engendered by so many deaths.  An additional challenge was the necessity to get the outside world to recognize the scope of the tragedy and to step up.

In order to put the 2014 outbreak in perspective, Preston remembers the first major outbreak in the Congo in 1976. Again, the author effectively employs personal vignettes in order to tell the tale.  In the Congo hundreds died before village communities there invoked the ancient rule, a practice of isolation and quarantine in which those infected were left to live or die. Either way the disease ran its course and did not spread further.

In addition to events in West Africa, Preston also details how individuals in the U.S. and Europe, the small community of folks who tracked dangerous viruses, worked to identify the virus, parse its DNA and begin to create an antidote.   Once one dose (of 7) was in West Africa, medical personnel there were confronted with the ethical issue of who should receive it.  ZMAPP vaccine was not used in Sierra Leone to save a key doctor but was used in Liberia to save an American doctor and a nurse.

By the time more vaccine could be produced, the terrible epidemic had largely run its course.  Two key doctors and thirty-seven nurses from Kenema Hospital numbered among the 10,000 dead in the region.

Preston concludes with a warning: with Ebola we were lucky! The world is not prepared for a lethal virus that could devastate the planet’s huge cities.  

Comment:  The book focuses narrowly on the early spread of the disease coupled with efforts in the U.S. to identify the scourge.  What is missing is an assessment of how governments of the three affected countries (Guinea, Liberia, Sierra Leone) acted, how the international community intervened, with what assistance and when.  I was the interim U.S. ambassador in Freetown in August and September of 2014 at the height of the epidemic. CDC had dozens of experts on the ground, to be followed by disaster team from USAID. Neighboring Liberia had more of the same including a belated U.S. military presence.  It did take some time, but finally the collective effort of many governments and organizations helped stem the tide.  As Preston correctly notes Ebola died out – this time – essentially because the ancient rule of isolation, quarantine, and no contact was implemented by the governments and communities affected.

A separate note: As U.S. Ambassador in the Central African Republic (1992-1995) I once visited the town of Mobaye, located on the Oubangui River across from Zaire.  The Ebola River and the mission of Yambuku where Ebola first surfaced in 1976 were nearby. Zairians often came to Mobaye for market and health care. While touring the local hospital I asked the doctor in charge about procedures for patients who had hemorrhagic fever. He said such people did not come to the hospital, instead they quarantined themselves or the village did, or neighboring villages did, while the disease ran its course. Clearly this was the ancient rule that Preston identified being implemented.