Crisis in the Red Zone: The Story of the Deadliest Ebola Outbreak in History, and of the Outbreaks to Come

by Richard Preston

Many virologists feel that viruses are not truly living things. At the same time, viruses are obviously not dead.

Like all kinds of life, viruses possess a relentless drive to reproduce themselves so that they can persist through time.

When a virus starts copying itself strongly and rapidly in a host, the process is called virus amplification. As a virus amplifies itself in its host, the host, a living organism, can be destroyed. Viruses are the undead of the living world, the zombies of deep time.

Ebola multiplies to extreme concentrations in the bloodstream. When a person dies of Ebola, a drop of their blood the size of the “o” in this text can easily contain a hundred million particles of Ebola. Ebola can destroy a person’s immune system in seven to ten days. HIV requires years to wipe out a person’s immune system.

Viruses such as Ebola, which use RNA for their genetic code, are prone to making errors in the code as they multiply. These errors are called mutations.

Yambuku, in 1976, a few particles of Ebola slipped out of an animal that lives in the central African rain forest and got into the bloodstream of one person. The first human victim of Ebola at Yambuku has never been identified.

Sophie Lisoke was the first known survivor of Ebola disease.

Ebola’s only mission was to never stop replicating, and to never stop moving from person to person, and thereby to make itself immortal in the human species.

far as anyone knows, viruses replicate in the cells of all species of living things, all of them, from bacteria to blue whales.

Viruses can sometimes infect other viruses. A giant virus named the Mamavirus, which was discovered infecting amoebae that live in a water-cooling tower in Paris, gets infected by a small virus called the Sputnik. A Mamavirus particle with Sputnik disease is one sick virus—deformed and unable to replicate very well.

Almost all viruses in any ecosystem are unknown to science.

Nobody actually knows how Émile got infected. All we know is that a few particles of a virus, maybe only one particle of a virus, emerged from the virosphere and entered the little boy.

The child had been killed, and he had started a chain of infections in a few more people. The virus started amplifying itself in two places in Guinea, and then it jumped to more places, and soon a viral fire was smouldering in the Makona Triangle.

But exactly what kind of creature had the virus come from? Where in the ecosystem did the virus hide?

That is, the virus could be a rare disease of the bats, a disease that most of the bats never catch. Bats have their own rare diseases, of course, just as humans do.

Humarr Khan was then the chief physician of the Lassa Fever Research Program at Kenema Government Hospital. He was a virologist who specialized in Lassa hemorrhagic fever, which is a devastating and frequently fatal disease caused by Lassa virus, a Biosafety Level 4 virus that invades the brain and causes hemorrhagic bleeding.

BSL-4 viruses, or Level 4 viruses, are sometimes referred to as hot agents. They are lethal, highly infective viruses for which, in almost all cases, there is no vaccine, no cure, and no effective treatment.

When Humarr Khan heard about a hemorrhagic disease breaking out in Guinea, he immediately suspected it was Lassa hemorrhagic fever.

The virus exists naturally in a certain kind of wild rat that lives in parts of West Africa. People come into contact with the rats, and the virus then jumps from a rat into a person. Once it gets into a person, Lassa virus can travel directly from person to person through contact with blood and body fluids.

In Brussels, Belgium, in a brick building on the Rue Dupré, managers at Médecins Sans Frontières, or Doctors Without Borders, a large international medical relief organization, were also receiving worrisome reports that a viral hemorrhagic fever had broken out in Guinea.

On March 13, a combined team of epidemiologists from Doctors Without Borders and the government of Guinea set out from Conakry, the capital of Guinea, in four-wheel-drive vehicles, to see what was going on in the Triangle. By this time, two and a half months had passed since the death of the little boy in Meliandou.

There, a virologist named Delphine Pannetier, along with colleagues who included a virologist at the Pasteur Institute in Paris named Sylvain Baize, began working to identify the infectious agent in the blood samples from Guinea.

By the early hours of the morning on March 21, the French scientists were sure that the agent in the blood was a filovirus. The filoviruses are a family of viruses that all look alike, and most of them are extremely lethal.

The French investigators had learned that some of the patients had had hiccups. This detail really caught their attention. Hiccups are a classic sign of Ebola virus disease.

The only way to cut off an Ebola outbreak was to put people in quarantine camps, where they died like flies, as if they were in a fourteenth-century plague house. About the best doctors could do for Ebola patients was to give them water and hope for the best.

Zaire is the most lethal of the six Ebolas; it is the homicidal elder sister. In the 1976 outbreak, Zaire Ebola killed 88 percent of its victims, though in subsequent outbreaks it killed roughly 60 to 70 percent. Zaire Ebola is not only the most deadly of the five Ebolas, it is also the most deadly of all the known filoviruses, the family of viruses that includes the Ebolas. Zaire Ebola is the lord of the strains.

Ravn virus was first isolated from the blood of a ten-year-old Danish boy known as Peter Cardinal, who died of Ravn disease after possibly getting infected inside Kitum Cave, a bat cave on the slopes of Mount Elgon in Kenya. The Ravn virus has been found exactly nowhere except in the blood of the Danish boy—he is the only individual who is known to have been infected with Ravn.

Nipah is a bat virus that causes personality changes and liquefaction of the brain. Nipah is only moderately infectious, but it gets into the lungs, and there is a certain alarm among experts that the code of the virus could change and turn the virus into a sort of brain-destructive neurological cough that travels in the air. There is no vaccine or treatment for Nipah disease.

On March 23, the World Health Organization announced that it was, indeed, Ebola: “A rapidly evolving outbreak of Ebola virus disease (EVD) in forested areas of southeastern Guinea. As of 22 March, 2014, a total of 49 cases including 29 deaths (case fatality ratio: 59%) had been reported.”

Thirty-seven years later, Zaire Ebola had come out of nowhere in West Africa and was sacking humans along the Makona River. It was the lord of the strains, back from the dead.

Ebola had to be put down quickly before it spread far and claimed many lives.

The red zones were artificial walls placed around hot spots of Ebola in order to break the growing chains of infection in the human species.

On March 31, an official at Doctors Without Borders sent out a news release that vibrated with alarm: “We are facing an epidemic of a magnitude never before seen in terms of the distribution of cases in the country.”

The mourners wept over her body, caressed her face, embraced her. As people touched the body, Ebola particles on the body’s skin were transferred to the mourners’ skin and clothing, especially to their hands.

Eventually, somewhere in the person’s body, the particle sticks to a cell. The core of the particle gets pulled inside the cell. Now one Ebola particle is sitting inside one cell in the person’s body. At this point, the person may be doomed.

Those who loved them gave them care, and the virus moved to the caregivers, traveling along chains of duty and affection.

The network of human connection, going hot with a virus, extended into the cities of West Africa.

When epidemiologists finally learned about Menindor’s funeral and followed the chains of infection that emerged from the funeral, they found that at least 365 cases of Ebola could be traced back to the funeral.

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.

Ebola is not a thing but a swarm.

By the time Menindor caught the virus around March 26, the virus that had originally infected the little boy had mutated into several different kinds of Zaire Ebola.

The virus had been chaining through people, crushing their immune systems, exploring the body’s defenses, and it had begun to adapt to the human species. Sometime in early March, a new kind of Ebola arose in the Makona Triangle. This mutant Zaire Ebola was four times better at infecting human cells.

The change in Zaire Ebola happened in just one letter of its genetic code. The virus that was spread at Menindor’s funeral, the mutant, the changed Ebola, is officially named the A82V Makona Variant of Zaire Ebola.

The funeral produced an unseen biological flash of a new virus, and the virus began explosive amplification in the human species.

While much remains unknown about the hot Makona, there is no doubt that by the first day of April it had become the new lord of the strains.

In other words, the first kind of Ebola to enter Liberia was wild Ebola, fresh from the ecosystem. The A82V Makona Variant, the Makona strain, the mutant, which had first appeared in Guinea just a few weeks earlier, was still jumping around the Triangle, and hadn’t made a breakout for the cities. And nobody knew the Makona strain existed.

As she looked at the results, Nadia could see that the test had gone wrong. Of the eight blood samples, three of them were positive for Ebola.

This was not a false result, it really was Ebola. And it was in the hospital. There were two patients in the Kenema hospital with Ebola disease. Kenema Government Hospital was already going hot.

The coming Ebola wave was likely to overwhelm Humarr Khan and his people. The virus was no longer under anybody’s control. It had gone beyond human control and had become a force of nature.

Ebola is an entity of a kind, though it is not a conscious thing. It was not even a thing, it is uncounted numbers of things, each one striving, in a biological sense, to survive and replicate.