Viruses are the undead of the living world, the zombies of deep time. Nobody knows the origin of viruses–how they came into existence or when they appeared in the history of life on earth. Viruses may be examples or relics of life forms that operated at the dawn of life. Viruses may have come into existence with the first stirrings of life on the planet, roughly four billion years ago.
Richard Preston, author of several bestselling narrative nonfiction titles about infectious diseases, returns to the territory he’s best known for. In 1994, he published The Hot Zone, a page-turning, nail-biting account of the Ebola virus told through the Marburg strain’s appearance in patient zero, alongside the story of a strain reaching the US. It’s gotten an intense, important sequel two decades after its initial publication.
Crisis in the Red Zone puts faces to the staggering numbers of the West African Ebola epidemic that began raging in 2014, of victims and the doctors and health workers who risked – and sometimes lost – their lives trying to care for patients and curb the epidemic. The deadliest outbreak to date, the Makona strain responsible left 7% of the doctors in Sierra Leone dead. Providing background, Preston depicts events from the 1976 outbreak in Zaire, believed to be the first jump of the virus into humans.
The red zone is the section of tents with strict biocontainment measures, cloistered in the center of a typical Ebola treatment unit within Doctors Without Borders and sectioned off behind fences. Red zones are for known infection cases: “Patients die in the red zone; they are not permitted to die anywhere else.”
On the ground in Sierra Leone, employing his trademark rich detail and smooth story structure, Preston creates portraits of several African doctors and healthcare workers as well as some sent from various international aid and research agencies. Primary among these are Dr. Sheik Umar Khan and epidemiologists Lina Moses and Lisa Hensley from the NIH working in diagnostic and research capacities. As he did in The Hot Zone, Preston shapes their experience into highly readable and telling story arcs, letting events play out in harrowing real time, allowing readers to follow developments as they progress.
This includes the fear and the learning that characterized their work, as they watched the epidemic explode despite their best efforts, grappled with superstition and misunderstanding, and endured the pain of having to diagnose colleagues or be diagnosed themselves.
The African medical professionals gave their lives trying to rescue one another, and, at the same time, they served as a thin, dissolving line of sacrifice in which they stood between the virus and you and me.
It’s laden with the psychological burden staff were saddled with — if they treated patients who were bleeding out, they risked infecting themselves. One distressing scene depicts nurses assisting in a procedure on an infected, pregnant colleague. After delivering her baby, they realize the gravity of the situation, covered as they are in fluid and thus, Ebola particles. Preston emphasizes that the virus has been able to thrive thanks to exactly this human capacity for care, including the cultural rituals in the affected West African countries of washing and mourning the dead.
The Ebola parasite got into a human network of affection and care, the ties of humanity that join each person ultimately to every other person on earth.
It didn’t help that science is still learning about the virus, and people in affected communities know much less. It’s hard to help them understand the magnitude of what it’s capable of, and what it is in its makeup, when what they see is loved ones going to medical centers where they’re supposed to heal and instead come out dead, attended by spacesuit-wearing, faceless personnel.
And what are viruses, actually? With his remarkable skill for breaking down complex scientific subjects, making them almost poetic, Preston tackles that, capturing something of their strange existence: “Viruses carry on their existence in a misty borderland that lies between life and death, a gray zone where the things we encounter are neither provably alive nor certainly dead.”
He has an incredible gift for scientific and biological writing, not only making it engrossing but accessible to readers like me with limited background and understanding of fields like epidemiology and virology. Yet it never feels like he’s talking down to better-versed readers.
He seems more cautious thanks to some of the criticisms of broad generalizations made in The Hot Zone. Although he traces the genesis of the Makona strain in a story about a boy and a bat, he’s careful in identifying what’s guesswork and speculation.
History turns on unnoticed things. Small, hidden events can have ripple effects, and the ripples can grow. A child touches a bat…a woman riding on a bus bumps against someone who isn’t feeling well…an email gets buried…a patient isn’t found…and suddenly the future arrives.
I’d hoped it would go more in-depth on where this is headed in future — so, if a Level 4 virus does cross the virosphere into humans, but I guess the apocalyptic-sounding picture he describes of a woefully unprepared, economically imbalanced US says all it needs to. Ethical issues play a big role in this narrative, with serious future implications. When the heroic Dr. Khan contracts the virus himself, the thorny debate arises of whether he should be given an experimental treatment drug not available to all patients. These stories are gut-wrenching, morally complex, sensitively told and exquisitely written, leaving the reader with deeper understanding and appreciation of the complications. 4.5/5
Though this story focuses on a few people at certain moments in time, I hope it can be thought of as a window that looks at the future of everyone.
Crisis in the Red Zone:
The Story of the Deadliest Ebola Outbreak in History and the Outbreaks to Come
by Richard Preston
published July 23, 2019 by Random House
I received an advance copy courtesy of the publisher for unbiased review.