Crisis in the Red Zone: The Story of the Deadliest Ebola Outbreak in History, and of the Emergencies
By Richard Preston
Random House. 375 pp. $ 28
You may not have noticed, but Africa is experiencing a serious Ebola outbreak again. 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 causes days of agony, hemorrhage, diarrhea and vomiting.
This time around, health authorities are complicating more than the difficulty of quarantining and treating people in small villages far from modern medicine, or resisting scared people suspicious of outsiders in moon suits. This crisis also occurs in a conflict zone, where violence between rival groups sometimes becomes too dangerous for medical aid personnel to enter and save lives.
But Ebola is not on the radar here in the West. Unlike in 2014, when fear of the Ebola epidemic in the United States reached something close to hysteria, few are aware. We have been protected – until now – by geography. Until recently, the virus did not reach an area with a major airport, and there is relatively little chance that someone with the highly contagious disease will board a plane and bring it into our midst.
Ebola? So 2014.
This is one lesson from Richard Preston's hideous, groundbreaking new book, "Crisis in the Red Zone," an almost daily day about how Ebola burned mostly unexpectedly in small towns along the Guinea-Sierra Leone border before it exploded and overflowed. city hospital in Kenema, Sierra Leone, five years ago.
Preston shows the line between a limited local emergency and a widespread, even international, crisis. Despite the efforts of the best and brightest health experts, we are still hostages to the location of the virus, the vigor of those guarding and the effectiveness of the response.
"Ebola's only mission [is] "To never stop replicating, and never to stop moving from person to person," Preston writes, "and to do so is immortal in the human species."
The new book is a sequel to Preston's best-seller in 1994, "The Hot Belt," which focused on the 1976 Ebola outbreak and the discovery that the virus had been accidentally transported to a government lab in Reston, Va., In shipping. of the infected. monkeys.
In this work, Preston scrupulously tracks the 2014 outbreak of a tree in Guinea, where a child was likely infected when he came in contact with a bat that carried the virus; to the death of a village healer, whose mourning exposed hundreds of people who touched her body; to Kenema Government Hospital in Sierra Leone, which is ultimately consumed by the virus.
People from relief groups like Doctors Without Borders and the small round of Western experts on these dangerous pathogens rush to help, sometimes exposing themselves to life-threatening situations as waves of Ebola victims descend into the hospital. Local doctors and nurses, dressed in sturdy moon suits to protect against the virus, work in unimaginable conditions. The heat is unbearable. Wardens designed for the few can hold dozens of victims. It is impossible to maintain the human excrement, blood, urine, vomiting, and sweat that are everywhere, as dying victims lie helpless on beds or crawl around the small facility.
Which means that the virus is also on every floor, wall and square inch of the victims' skin. A single, microscopic component of Ebola that finds its way to an eye, mouth or break in the skin usually means death for medical personnel.
Eventually small mistakes make exhausted caregivers, and the heroes of Preston's book fall, one after the other. First some of the nurses who stayed to look after patients when others fled. Then the respected head nurse, "Aunt" Mbalu S. Fonnie. And finally Humarr Khan, the doctor who tried but failed to keep his finger in the dam.
In the book's most heartwarming sequence, Khan lies dying in a medical unit Doctors Without Borders during an experimental drug that could save him sitting in a freezer 100 feet away. With only six doses available worldwide, doctors, support group officials and friends from Khan all over the world are conflicted over whether it is ethical to give him the medicine – which has never been tried in humans – while local patients have no access to it.
In the end, Khan dies never knowing of the possible cure at his disposal. Then another dose is used to save the lives of two US doctors in Liberia.
Knowing, like us, that the 2014 Ebola outbreak hit the United States and infected health care workers there, and nearly spread to Lagos, Nigeria, a city of 20 million, before it was taken out, it does nothing to diminish power. about "Crisis in the Red Zone." A major flaw of the work is that Preston barely mentions the world beyond Kenema, with just a few words about the more than 11,000 people dead, almost all in Liberia, Sierra Leone and Guinea.
Nor do we see the late response of the World Health Organization and parts of the US government. It is important to remember, as Preston is straining to point out that Africans caused the outbreak itself, eventually organizing to quarantine the sick and stop the spread of the virus. Could they do it without the medical centers of international aid groups and the laboratories set up by the US Centers for Disease Control and Prevention? As a reporter who covered the epidemic on two trips to Liberia during the outbreak, I guess probably not. But for the most part, the citizens of these three countries deserve the credit.
Nor is there any mention of the man who would lead the U.S. response should the current outbreak threaten this country: President Trump, who strongly recommended to prevent the two U.S. missionaries infected with Ebola from treatment in the United States.
"An Ebola patient will be taken to the United States in a few days – now I know for sure that our leaders are incompetent. TAKE THIS HERE!" Trump tweeted in July 2014. Would he feel the same way now? Fortunately, President Barack Obama and heads of public health have ignored Trump and others. Kent Brantly, Nancy Writebol and a few other Americans, including a freelance journalist, have been treated in this country without endangering the public.
The book concludes with a promising note, citing the research that at the time led to the development of medicines and vaccines. Now these advances are working: More than 100,000 people have received an experimental vaccine to protect them against the virus in the congenital outbreak.
Is that enough? Nobody knows. Ebola mutates quickly and skillfully, adapting to survive. "The military, who stand guard at the gates of the virgin sphere, understand that they are facing a long struggle against formidable enemies," Preston concludes. “Many of their weapons will fail, but some will start to work. … If viruses can change, so can we. "