Introduction
In "Crisis in the Red Zone," Richard Preston takes readers on a gripping journey through the 2014 Ebola outbreak in West Africa. This book provides a detailed account of the events that unfolded on the ground during one of the most devastating epidemics in recent history. Preston's narrative is based on hundreds of interviews with survivors and extensive research, offering a comprehensive look at the crisis from its origins to its eventual containment.
The book delves into the scientific aspects of the Ebola virus, explaining its nature and how it spreads. It also highlights the human element of the crisis, showcasing the bravery and sacrifice of those who fought on the front lines. Preston's work sheds light on the challenges faced by healthcare workers, the impact on local communities, and the global response to the outbreak.
"Crisis in the Red Zone" is not just a recounting of events; it's a stark reminder of the potential dangers posed by emerging viruses and the importance of preparedness in the face of such threats. Through vivid storytelling and meticulous research, Preston brings to life the terror and heroism that characterized this modern medical crisis.
The Origins of Ebola
The First Encounter: Zaire, 1976
The story of Ebola begins in 1976 in Zaire, now known as the Democratic Republic of the Congo. On September 9th of that year, a pregnant woman named Sembo Ndobe arrived at the Yambuku Catholic Mission Hospital. She was experiencing troubling symptoms, including fever, inflamed eyes, and bleeding gums. Sister Beata, a nurse at the hospital, believed it to be a case of malaria or blackwater fever.
During the delivery of Ms. Ndobe's stillborn child, Sister Beata used her bare hands, as was common practice. Tragically, Ms. Ndobe died from blood loss and shock. While such deaths during childbirth were not uncommon in Africa, what followed was unprecedented.
Five days later, Sister Beata fell ill with severe symptoms. She experienced fatigue, fever, vomiting, diarrhea, and intense pain. Her condition rapidly deteriorated, with her vomit turning from red to black as her insides began to decompose. On September 19th, Father Sango Germain came to deliver her last rites. In a poignant moment, he wiped away Sister Beata's bloody tears with the same cloth he used for his own. Sister Beata died soon after, and Father Germain followed 13 days later.
The hospital quickly filled with patients showing similar symptoms. Nurses began to flee, fearing this unknown and deadly disease. It was clear that something unprecedented and terrifying was unfolding.
Identifying the Virus
On September 23, 1976, virologist Jean Jacques Muyembe-Tamfun arrived at the Yambuku Catholic Mission Hospital. He found the place in a state of disarray, with empty beds soaked in bodily fluids and basins filled with putrid substances. Muyembe initially suspected typhoid fever but soon realized he was dealing with something far more sinister.
In his quest for answers, Muyembe took samples from a deceased nurse and a critically ill pregnant woman. He did this with his bare hands, unknowingly putting himself at great risk. Upon returning to Kinshasa with his samples, Muyembe realized the disease was not bacterial, ruling out typhoid. As he anxiously awaited his fate, having been exposed to the virus, he sent samples to the Center for Disease Control (CDC) in Atlanta, Georgia.
The CDC researchers initially labeled the disease "X Virus," but by the end of October, it had an official name: Ebola. The 1976 outbreak was eventually contained, but it was clear that a ticking time bomb had been discovered. It would take 37 years for Ebola to reemerge and wreak havoc once again.
The Nature of Ebola
A Microscopic Menace
Ebola is a formidable opponent, despite its microscopic size. An Ebola particle is just 80 nanometers wide and 1,000 nanometers long, composed of only six proteins. However, its simplicity belies its deadly nature. When a single particle enters the human body, it can latch onto a cell and transform it into a factory for producing more Ebola particles. This process continues rapidly, overwhelming the body's defenses.
Unlike many viruses that target specific areas of the body, Ebola is an equal opportunity attacker. It ravages everything except the skeleton and large muscles. The virus causes severe symptoms including diarrhea, projectile vomiting, and blood hemorrhaging. Its extreme contagiousness is evident in the fact that a single drop of infected blood can contain 100 million Ebola particles. Even contact with an infected person's sweat can lead to transmission.
Ebola is classified as an emerging virus, meaning it can jump from animals to humans. This zoonotic nature makes it particularly challenging to predict and control outbreaks.
The 2014 Outbreak Begins
The 2014 Ebola outbreak is believed to have started in mid-December 2013 in the West African village of Meliandou, located in the Makona Triangle where Sierra Leone, Guinea, and Liberia meet. The first victim was likely a two-year-old boy named Emile, who played near a hollow tree inhabited by bats.
Local children often smoked out bats from the tree, and people in the village hunted and ate bats and rats. It's speculated that Emile may have been bitten by a bat or exposed to bat blood through a bat fly, an insect that feeds on bats.
Emile fell ill and died on December 28, 2013. Within a week, his sister, mother, and grandmother also succumbed to the disease. The village midwife, who had cared for the family, traveled to a local hospital in Guinea, where she died along with the medical worker who treated her. This marked the beginning of the virus's spread beyond the village.
The Outbreak Spreads
From Village to Crisis
By March 2014, the Ebola virus had moved beyond Meliandou. A relative of the midwife became infected, as did mourners at her funeral. The virus then traveled to Sierra Leone when a woman named Sia Wanda Koniono returned from a trip to Guinea, where she had sat next to a sick passenger.
Upon falling ill, Ms. Koniono sought help from a respected local healer named Menindor. Despite Menindor's extensive knowledge of medicinal plants, nothing seemed to help. Ms. Koniono died on March 3, and her body was prepared for the funeral by her five sisters, all of whom subsequently fell ill and died.
The Kenema Government Hospital
As the virus spread through the area, the Kenema Government Hospital in Sierra Leone, about 100 miles from the village of Kpondu, became a key facility in the fight against Ebola. The hospital was equipped with a level-4 biocontainment ward, typically used for dealing with the Lassa virus, another hemorrhagic fever common in West Africa.
The Lassa ward had twelve beds, a limited number of biohazard suits, and a functional hot lab for safely testing blood samples. However, as the Ebola crisis intensified, these resources were pushed far beyond their limits.
In March 2014, the hospital's virologist, Dr. Humarr S. Khan, began hearing reports of a hemorrhagic fever outbreak in the Makona Triangle. He alerted his colleagues, and on March 13, Doctors Without Borders sent an investigative team to Guinea. Ten days later, it was confirmed that the blood samples tested positive for Ebola.
Challenges in Controlling the Outbreak
Cultural and Linguistic Barriers
The unique characteristics of the Makona Triangle presented numerous challenges in controlling the Ebola outbreak. The area spans three countries and is home to multiple languages and dialects. When staff from the Kenema Government Hospital visited affected villages, they often encountered language barriers. For instance, in one village where they went to treat an Ebola-positive woman, the locals spoke Kissi, a language none of the medical team knew. Fortunately, their ambulance driver, Sahr Nyokor, could speak Kissi and acted as an interpreter.
Mistrust and Traditional Practices
Many locals were skeptical of the foreign medical teams, particularly those from Doctors Without Borders. The sight of people in biohazard suits taking away their loved ones, never to be seen again, bred fear and mistrust. In some cases, medical teams were chased away with rocks when they tried to access patients.
Traditional funeral practices posed another significant challenge. In many West African cultures, saying goodbye to the dead involves washing and cleaning the body, with mourners touching and hugging the deceased. These practices, while deeply meaningful to the communities, significantly increased the spread of the virus.
A prime example of this was the funeral of Menindor, the respected healer from Kpondu. Around 200 people attended her funeral, and remarkably, 365 cases of Ebola infection were later traced back to this single event. Within days, as attendees fell ill and sought help, the virus spread in all directions from Menindor's funeral.
The Exploitation of Human Compassion
One of the cruel ironies of the Ebola outbreak was how the virus exploited human compassion and the desire to care for loved ones. The very acts of kindness and care that define our humanity – tending to the sick, comforting the dying, honoring the dead – became vectors for the virus's spread.
This aspect of the outbreak created a heartbreaking dilemma for affected communities. They had to choose between following their cultural traditions and protecting themselves from infection. It was a choice that many found difficult to make, even as the death toll continued to rise.
The Crisis Intensifies
Overwhelmed Healthcare Systems
As the outbreak worsened, medical facilities like the Kenema Government Hospital were pushed to their limits and beyond. By June 2014, the Lassa fever ward was exceeding its capacity, with patients doubling up in beds. The shortage of biohazard suits became increasingly dangerous, putting healthcare workers at grave risk.
The relentless influx of patients created a nightmarish scenario for the nurses, who witnessed a constant stream of agony, death, and deteriorating patients. The physical and emotional toll on the medical staff was immense, yet they continued to work tirelessly to save as many lives as possible.
Medical Staff Falling Ill
The virus soon began to claim the lives of healthcare workers. One of the first was Sahr Nyokor, the ambulance driver who had served as an interpreter. During a visit to another village, Nyokor had visited friends without wearing a protective suit, not wanting to alarm them. Unfortunately, the home was contaminated with Ebola particles.
Nyokor was later treated at the Kenema hospital by a nurse named Lucy May, who was unaware of his exposure. Soon after, Lucy May fell ill. She was also pregnant, which complicated her condition significantly.
A Desperate Measure
When Lucy May's condition deteriorated, four nurses, led by the head nurse Mbalu Fonnie (known as "Auntie"), attempted a risky procedure to save her life. Pregnant women infected with Ebola faced an almost certain death, but ending the pregnancy could increase the mother's chances of survival.
Knowing the extreme risk of exposure, Auntie and the other nurses agreed to perform the procedure. Despite their efforts, Lucy May died an hour after the operation. The screams of anguish from the nurses who had tried to save her echoed through the hospital, a stark reminder of the emotional toll the crisis was taking on healthcare workers.
Key Personnel Fall Ill
The Loss of Leaders
The Ebola crisis dealt a devastating blow to the medical community when key personnel began to fall ill. Shortly after Lucy May's death, Auntie and the three nurses who had assisted in the procedure also became sick. Auntie's death on August 5 was a crushing loss for the entire hospital. Her passing seemed to cast a dark cloud of doom over the facility.
As more staff members abandoned their posts out of fear, the situation became increasingly dire. Then came the unthinkable – Dr. Sheik Humarr Khan, the internationally renowned head of the Lassa and Ebola ward, contracted the virus.
Dr. Khan's Infection
Dr. Khan's infection was a cruel twist of fate. He had reflexively touched the back of the neck of one of his most committed nurses, Alex Moigboi, to check for fever when Moigboi reported feeling unwell. This simple, compassionate gesture led to Khan's own infection.
The news of Khan's illness sent shockwaves through the international healthcare community. As one of the most experienced Ebola experts in the world, his infection underscored the relentless nature of the virus and the extreme risks faced by those on the front lines.
The ZMapp Debate
A Glimmer of Hope
As Dr. Khan's condition worsened, discussions about experimental treatments intensified. One promising candidate was ZMapp, a drug that had shown remarkable success in treating Ebola-infected monkeys during trials. Every one of the 18 infected monkeys in the trial had been cured.
A series of ZMapp doses were kept at a Doctors Without Borders camp in Kailahun, Sierra Leone, where Dr. Khan was being treated. The presence of this experimental drug sparked a heated debate about whether it should be administered to Dr. Khan.
An Agonizing Decision
The decision to use ZMapp on Dr. Khan was not straightforward. After much deliberation, the choice was left to those in charge of the camp where Khan was being treated. They ultimately decided against using the experimental treatment, citing ethical concerns.
Their reasoning was twofold. First, they feared that if the treatment failed and Khan, a well-known figure in Sierra Leone, died, it could further agitate the public who were already distrustful of foreign medical interventions. Second, they believed it would be unethical to provide a treatment that wasn't available to all patients.
This decision was controversial and criticized by some of Khan's colleagues, including Michael Gbakie. However, those in charge of the Doctors Without Borders facility in Kailahun were themselves deeply traumatized by the outbreak and were trying to make the best decisions they could under extraordinarily difficult circumstances.
Survival Against the Odds
Dr. Khan's Fate and ZMapp's Success
Dr. Khan died on July 29, 2014, a national hero and beloved colleague to many. His death was a significant blow to the fight against Ebola, robbing the effort of one of its most experienced leaders.
Ironically, on the very day of Khan's death, ZMapp would prove its effectiveness in treating Ebola victims. At the Eternal Love Winning Africa Hospital (ELWA) in Monrovia, Liberia, run by Samaritan's Purse, two American aid workers, Nancy Writebol and Dr. Kent Brantley, were critically ill with Ebola.
Dr. Lance Plyler, the physician in charge, received a package of ZMapp on the day of Khan's death. Faced with the agonizing decision of which colleague to treat with the limited supply, Plyler ultimately decided to split the dose between Writebol and Brantley.
The results were astonishing. Just one hour after receiving his share of the first dose, Kent Brantley was able to stand up and walk to the bathroom. While Nancy Writebol's response wasn't as dramatic, the treatment helped her survive the night. Both were subsequently transported to Atlanta, Georgia, where they received the full course of ZMapp and fully recovered.
Other Survivors
Despite the extreme lethality of the Makona strain of Ebola that ravaged West Africa in 2014, there were remarkable stories of survival. Two of the nurses who had assisted Auntie in trying to save Lucy May survived their bout with Ebola. Mohamed Yillah, Auntie's brother and an epidemiologist at the Kenema hospital, also survived, as did Alex Moigboi, Dr. Khan's dedicated nurse.
Perhaps one of the most extraordinary survival stories is that of Jean Jacques Muyembe-Tamfun, the virologist who first encountered Ebola in 1976 in Zaire. Despite having his bare hands covered in the blood of an Ebola victim, Muyembe-Tamfun did not contract the virus. He went on to become one of the most respected medical teachers in the Democratic Republic of the Congo.
Lessons from History
The Ancient Rule
The 2014 Ebola outbreak wasn't the first time the world had faced such a crisis. In 1976, when Ebola first emerged in Zaire, it was ultimately contained through the implementation of what was known as the Ancient Rule.
Dr. Jean Francois Ruppol, a medical director working for the Belgian government, invoked this rule on September 28, 1976. The Ancient Rule, dating back to the days of smallpox, stipulated that if a family member became sick with a contagious disease, they were to be placed in a hut outside the village with some food and water. If they survived, they were welcomed back; if they died, the hut and the person in it were burned to ashes.
The people of Zaire were familiar with this practice and accepted it as a necessary measure to protect the community. This acceptance played a crucial role in containing the 1976 outbreak.
Changing Behaviors
In 2014, it took much longer for the inhabitants of West Africa to accept similar measures. The Ancient Rule went against everything they had known and practiced up to that point. It required them to change deeply ingrained behaviors, abandon traditional funeral rituals, and refrain from caring for their loved ones in the ways they always had.
However, as the crisis deepened and the death toll mounted, West Africans did begin to change their behavior. This shift was crucial in turning the tide of the outbreak. By the end of October 2014, no new cases were reported from the Makona Triangle, signaling that the worst of the crisis had passed.
The Aftermath
The Toll of the Outbreak
The 2014 Ebola outbreak was one of the most severe in history. At the beginning of October 2014, there had been 9,200 cases and 4,500 deaths reported. By the time the outbreak was finally contained, these numbers had grown to a staggering 30,000 cases and over 11,000 deaths.
The crisis brought Guinea, Liberia, and Sierra Leone to the brink of collapse. It devastated communities, overwhelmed healthcare systems, and left deep scars on the psyche of the affected nations.
Scientific Advancements
Despite the tragedy, the outbreak provided valuable scientific insights. Thanks to the tireless efforts of medical teams on the ground, samples were taken throughout the crisis. This allowed researchers to track the virus's progression and observe how it mutated to more efficiently attack human cells.
As a result, more is now known about the genetic code and behavior of Ebola than ever before. This knowledge is crucial for developing better treatments and prevention strategies for future outbreaks.
Lessons Learned
The 2014 Ebola outbreak taught the world several important lessons:
- The importance of early detection and rapid response to emerging infectious diseases.
- The need for robust healthcare systems capable of handling sudden surges in critically ill patients.
- The crucial role of clear communication and community engagement in controlling outbreaks.
- The value of international cooperation in facing global health threats.
- The necessity of continued research and development of treatments for emerging diseases.
Perhaps most importantly, the crisis demonstrated the remarkable capacity of human beings to change and adapt in the face of extreme adversity. It showed that even deeply ingrained cultural practices can be modified when survival is at stake.
Conclusion
"Crisis in the Red Zone" provides a gripping account of one of the most severe Ebola outbreaks in history. Richard Preston's narrative brings to life the terror, heroism, and human drama that unfolded in West Africa in 2014.
The book serves as a stark reminder of the ever-present threat of emerging infectious diseases. It highlights the delicate balance between human behavior and viral spread, showing how our most compassionate instincts can sometimes work against us in the face of a highly contagious disease.
At the same time, the story is one of incredible resilience and sacrifice. Healthcare workers risked – and often lost – their lives in the fight against Ebola. Communities came together to change long-held traditions for the greater good. And scientists and researchers worked tirelessly to understand and combat the virus.
The 2014 Ebola outbreak was a wake-up call for the global health community. It exposed weaknesses in international response systems and highlighted the need for continued vigilance and preparedness. But it also showed the power of human determination and the importance of global cooperation in the face of shared threats.
As we move forward, the lessons learned from this crisis will be invaluable in preparing for and responding to future outbreaks. The story of the 2014 Ebola outbreak, as told in "Crisis in the Red Zone," serves as both a warning and a guide for handling the inevitable health crises of the future.
In the end, it's a story of hope – hope that with knowledge, preparation, and unity, we can face even the most formidable of adversaries. It's a testament to human resilience and our capacity to overcome even the most daunting of challenges when we work together.