Epidemic: Ebola and the Global Scramble to Prevent the Next Killer Outbreak

by Reid Wilson

A global health catastrophe narrowly averted. A world unprepared for the next great threat.

In December 2013, a young boy in a tiny West African village contracted the deadly Ebola virus. The virus spread to his relatives, then to neighboring communities, then across international borders. The world's first urban Ebola outbreak quickly overwhelmed the global health system and threatened to kill millions.

In an increasingly interconnected world in which everyone is one or two flights away from New York or London or Beijing, even a localized epidemic can become a pandemic. Ebola's spread through West Africa to Nigeria, the United Kingdom and the United States sounded global alarms that the next killer outbreak is right around the corner--and that the world is woefully unprepared to combat a new deadly disease.

From the poorest villages of rural West Africa to the Oval Office itself, this book tells the story of a deadly virus that spun wildly out of control--and reveals the truth about how close the world came to a catastrophic global pandemic.

Genres: Nonfiction, Science, Africa, History, Audiobook, Medicine, Politics

Audiobook

First published March 15, 2018

Reviews

[Cav · Rating 3 out of 5]

This was an OK book. Fairly middle-of-the-road...
Epidemic is no-frills telling of the 2014 Ebola outbreak in Western Africa.
The book is written in a fairly chronological fashion, and also mentions the US scare.
I was expecting a bit more from this one. Namely, the book doesn't really dive into the biology and/or virology of the Ebola virus, or spend too much time talking about the related epidemiology.
My biggest criticism of this one was it's overall tone; the writing was pretty dry and tedious. I found my attention wandering many times...
3 stars.

[Liralen · Rating 4 out of 5]

I began reporting this story because the intersection between human society and the nature with which we interact is fascination. Mankind’s spread into the last remaining untouched parts of the natural ecosystem bears a cost—both to humans and to that ecosystem—with which neither side is prepared to deal. Conflict is inevitable; the outbreak of the Ebola virus in three desperately poor West African countries represents a worst-case scenario in microcosm.

What would—will?—happen when the next deadly pathogen with which we have no experience emerges? What would—will?—happen when someone infected with that pathogen boards an international airliner and winds up in the heart of London or New York or Beijing or Jakarta? I kept asking one question of those who had been so intimately involved in the response to the Ebola epidemic: Are we ready for the next one?

The answer, resoundingly, terrifyingly, is no. (283)

As in Richard Preston’s Crisis in the Red Zone, Epidemic dives into the Ebola crisis of 2014—and what a future health crisis with broader global reach might look like. Timely, no? Epidemic came out in 2018, and while Wilson couldn’t have predicted COVID-19, both he and Preston are depressingly accurate about the general global lack of preparedness for such a crisis.

The book is a bit repetitive at times, but it’s still a very nicely in-depth look at some of the main actors in the fight to contain Ebola in 2014 and beyond. I was already very familiar with the overall story (having read quite a lot of news while the crisis was ongoing), so for me, certain parts about context and details proved most interesting. Take this narrative about Thomas Duncan, a Liberian man who ultimately died of Ebola in a Texas hospital:

For years, Thomas Duncan languished, alone, thousands of miles from his family, the woman he loved, and the son he hadn’t seen grow up.

Duncan had been one of the hundreds of thousands of civilians who fled Liberia’s deadly civil war in the 1990s, forced out of his own home and into a squalid refugee camp across the border in the Ivory Coast. He had tried to start over, living with his brother in a tent. The two young men befriended the woman who lived in the tent next door, Louise Troh; Duncan fell in love. Amid the poverty of years in the camp, Troh and Duncan had a son, Karsiah, in 1995.

Everyone in the camp longed for a visa to the United States, a veritable golden ticket that held the promise of a new life on American shores, far away from the violence and poverty of the home they no longer knew. Troh and Karsiah won the lottery in the late 1990s; Duncan, who had never married his partner, was left behind. He spent another decade and a half in the camp, where he learned French, Ivory Coast’s official language.

Finally, in 2013, Duncan, still yearning for a ticket to America, felt it was safe enough to return home to Liberia. He moved into an apartment and got a job as a driver for a FedEx contractor. Louise had moved to the Dallas area, where Karsiah had grown up as a promising student, a high school quarterback who won admission to a college in San Antonia.

Then, Duncan’s luck seemed to change. One day the phone rang at the home of Wilfred Smallwood, the brother who had shared Duncan’s tent in the refugee camp and who now lived in Phoenix: “I got my visa! I got my visa!” Duncan shouted, ecstatic. His life seemed to be moving again; he and Troh would be married when he arrived, his son thrilled with anticipation at the prospect of seeing his father once again. Troh helped him book his plane ticket, from Monrovia through Brussels, then to Washington and on to Dallas. (175)

I remember reading about Duncan at the time, of course; in particular, I remember outrage that a man who had been exposed to Ebola—even if it wasn’t confirmed at the time—would dare to get on a plane, to risk bringing the virus to a country that until then had not been affected. (Not to mention, of course, racism and xenophobia…) I remember thinking, at the time, that it was hard to blame him—if my country was in the middle of an epidemic with a staggeringly high mortality rate and I had a ticket to a country with a much higher standard of medical care and no active epidemic of this sort…what would I do? I don’t remember reading this much of his history, but it paints his decisions in a very different light, doesn’t it? Whether or not he thought he’d been exposed to Ebola becomes almost a moot point. It’s not just about quality of medical care at that point, but rather about spending years hoping for a ticket to a different life, not to mention to loved ones. Of course he wanted to go.

The need for even basic medical supplies was acute. In some more remote areas, gloves, life-saving essentials for any medical professional, began selling for the equivalent of fifty cents a pair, in an area where most residents lived on less than a dollar a day. (47)

There’s so much we still don’t know about Ebola and best practices for treatment, partly because it’s never been treated on more than a case-by-case basis in countries with the most advanced medical care. During the crisis a few years ago, a tiny number of patients were infected in those high-medical-quality countries, and they had treatment from the beginning—but so many patients in rural, impoverished areas went without so much as an IV to help with hydration when the body was expelling fluid at an alarming rate. I remember reading at the time that there was an argument to be made for treating Ebola more like one treats cholera: a critical thing with cholera is hydration, and the problem is often that in places where cholera is common, it can be harder to find clean water, and dirty water can lead to further diarrhea, et cetera. When someone is vomiting and has diarrhea, IV fluids can be lifesaving…but of course, with Ebola, there’s also the risk of the patient bleeding through the needle site and infecting others, and anyway the vast majority of Ebola patients have been treated in places where IVs are a precious commodity. Like gloves.

The remoteness of rural West Africa is difficult to comprehend. Communities can be an hour’s walk from the nearest passable road. The Liberian burial teams carried supplies on their heads, through thick jungle along barely visible trails. Some burial teams took canoes through murky rivers, which meant they needed life preservers. After retrieving a body, oarsmen would paddle canoes back downstream, still clad in full protective gear. (246)

An Ebola epidemic in the US would probably look very different from an epidemic in West Africa—starting with that powerful countries would be quicker to take notice and take action, but still. The landscape is simply different, and the resources. (But then, an Ebola epidemic in the US with the current government would look very different than an Ebola epidemic in the US with a competent government, so.)

In August when Nolen deployed for the second time, this time to Sierra Leone, she found a situation very different from the one she had left in April. In Freetown, the Ministry of Health was scrambling to respond. Few NGOs were operating at a high level. There were just two working ambulances in the entire country, and the beginning of the rainy season meant that many of the already-difficult roads became impassible. The system, Nolan recalled later, was “completely overwhelmed.”

Nolen and her team of six other CDC workers soon grew to fifteen. They spent their days tracking down trucks that could be used as ambulances, dispatching body management teams and identifying new clusters of Ebola. Some of the decisions the team was asked to make were moral dilemmas with no clear answer: One day, a colleague called Nolen looking for an ambulance to take an infant showing symptoms to an Ebola treatment unit. They couldn’t find a car seat for the child, and putting the baby in someone’s arms for the six-hour drive to the hospital would mean putting that person at risk. Eventually, they decided to strap the baby into a basket and hope for the best. The infant made it to the hospital, but it did not survive the disease. (144)

But of course the US is not in an Ebola epidemic right now (though there have been outbreaks, albeit smaller ones, in parts of Africa since this particular crisis): the US is in a coronavirus crisis.

Though Ebola is among the most deadly pathogens in the world, its relative lack of transmissibility hinders its ability to easily cause a global pandemic. (289)

The expansion of human civilization, an interconnected world, and a changing climate all conspire to pave the way for the spread of the fire of the next deadly pathogen. (291)

What we know about the novel coronavirus, then, is that it wasn’t really a surprise—the exact details (origin, timing, effects, death rate) could not have been predicted, but a pandemic occurring at all was, for scientists and medical workers who think about this sort of thing, a given. Only a matter of time. Ebola is a biosafety level 4 virus (highest possible level of protection when handling patients, specimens, etc.), and I’ve seen COVID-19 listed, variously, as biosafety level 2 and biosafety level 3, and yet here we are with the world turned on its head and governments and individuals scrambling to adapt. The biggest difference, perhaps, is that wealthy countries are affected just as badly as poorer countries—sometimes much worse—and so it will likely (touch wood) not take forty years to develop effective treatments or vaccines.

[Amy · Rating 4 out of 5]

I found this book enlightening, though i wish I hadn't read it in the middle of the global pandemic. It did provoke some anxiety.

[Emily Lucht burdette · Rating 4 out of 5]

Very informative and well-written. As a graduate of University of Arizona School of Public Health, I found the information about how health workers broke down cultural barriers to help in ending the Ebola epidemic and I loved reading the process of how different organizations from around the world came together to overcome Ebola. Reading the ending now during the current Coronavirus pandemic is spooky. The last sentence says something to the effect of the world is not ready for the next pandemic. Boy, were we not ready.

[Jennifer · Rating 3 out of 5]

Wilson offers a play-by-play of the 2014 Ebola epidemic in West Africa. I didn't find this book to be of the level of David Quammen's insightful looks at various epidemics, including Ebola. There is a lot of useful information in here, and Wilson hits some themes hard, such as the incompetence of the WHO and the importance of local, culturally sensitive burial teams. Wilson seems extremely impressed by the US response. It's hard for me to gauge if his feeling is warranted. Wilson crows at one point about New York City's public health department and readiness to handle an epidemic. How wrong he was, in retrospect. I also, given what we've subsequently seen from Covid, disagree with is position on quarantining arrivals from West Africa.

One thing that bothered me is that the book seemed unnecessarily political at times. I looked up Wilson, and according to brookings.com, "Reid Wilson is national correspondent at The Hill newspaper in Washington, D.C., where he covers politics, public policy, campaigns and elections. He is a former staff writer at The Washington Post and a former editor in chief of National Journal’s The Hotline." I guess I'm not surprised that he covers politics first and foremost. While politics is undoubtedly an important function in an epidemic, for me, I would have liked more science and detail and a little less politics.

With all this being said, there is enough information here to make it a must-read if you are interested in the Ebola outbreak in 2014. There just aren't that many books out there on this topic.

[Amit · Rating 4 out of 5]

This book is so much more relevant today, with the recent Covid-19 outbreak. From patient 0 to an eventual continent-wide outbreak, it covers nearly all aspects of the process that a multitude of organizations and people on all levels go through to fight an enemy that they cannot see with the naked eye. It is clear to see that mistakes were made and were hard to rectify. But with the recent response, it is clear to see that lessons were not learned.

Reporting from the quarantine that is my bed.

Stay safe people.

[Melissa Eddy · Rating 5 out of 5]

The rating on this book can't help but be influenced by the fact that it shows a presidential administration dealing with a threat to the U. S. populace with facts, science, data, and competence. The story is presented, the players are described, the mistakes are detailed, but in the end, an Ebola outbreak was halted. It took the world to do it, but the world would never have gotten involved if the U. S. hadn't shown leadership. We sent the CDC, we sent the army, we raise money from the tech industry and we didn't shut our borders or halt volunteers from helping. There were compromises made and both Republicans and Democrats worked to make help available. One can't help comparing this response to that of the present COVID-19 response, to a government stripped of resources, people, expertise, and at times even reason. When you hear criticism of prior administration responses to global health emergencies, read this book and compare.

[Sam Lee · Rating 5 out of 5]

An engrossing, clear, and comprehensive overview of the 2013-2015 Ebola epidemic of West Africa. Reid Wilson interviews dozens of the key actors that played major roles during the response to the epidemic. The timeline of the epidemic is clearly laid out and Wilson corroborates what each group does with accounts from other players.

The narrative is riveting, the arc of the epidemic is comprehensive, and language is clearly understood with no unnecessary jargon. The audiobook was narrated by Jonathan Yen, who does an admirable job. I will likely reread the hard copy to go over it more thoroughly.

I highly recommend this book for anyone that is seeking a clear and comprehensive understanding of what happened during the 2013-2015 Ebola epidemic and the global response that it eventually triggered.

[Gabriele Siino · Rating 4 out of 5]

Interesting. A bit too much US-centered, although especially the first few chapters (at least half of the book) are very informative. It tells a tale that is prophetic about the inability of the WHO of dealing with an aggressive pandemic, and at the same time grotesque as perhaps Ebola has been the last great emergency where the US saved others. Now with COVID we see how the US are unable to save themselves. They clearly lost their role of leadership in the world, and it can only be a good thing. This also makes the book a bit of a historical tale about a world that is not any more like that. Interesting.
Definitely interesting to know what Ebola is and how really aggressive viruses like that will be quite different from the mild SARS-CoV-2. If a virus like Ebola had to explode now, it would wipe away jerks like Johnson, Trump an d Bolsonaro, taking millions of lives with them.

[Mercurybard · Rating 3 out of 5]

I apparently have a lot of feelings about the 2014 outbreak that I did not know I had.

The biggest issue I had with the book was the author tended to repeat himself, which might be useful if the reader feels overwhelmed with the number of people and organizations operating in 4 countries, but actually confused me at times.

[Josh Morris · Rating 4 out of 5]

Traces the 2014 outbreak from Patient Zero to its conclusion with a focus on the various agencies and strategies.

[djgalvan Sonia Galvan · Rating 5 out of 5]

That’s what he said. We’re not ready. If only people had listened....

[Vikas Jadon · Rating 3 out of 5]

This book was a good read, specially in the context of COVID Menace we are facing.

[Andrea · Rating 5 out of 5]

Fascinating look at the 2014 Ebola outbreak in West Africa. I have always found these types of books interesting. This was written prior to COVID. I'd be interested in an epilogue or something.

[Emily · Rating 5 out of 5]

It is so rare that I have positive feelings for the way the United States acts in the global world, but under the Obama administration, and with the help of the military and the CDC, the US government really helped to stem the tide and control this outbreak. It was particularly interesting to me as I was reading it at the same time I was reading And The Played On, in which the United States, under the Reagan administration, had a devastatingly poor response which lead to so many deaths.