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

by Richard Preston

Black vomit has a characteristic “wet coffee grounds” appearance, in which the granules are mixed with a dark, watery fluid that resembles weak black coffee. She may have come down with hiccups. The hiccups started for no apparent reason and wouldn’t stop. Unable to move from her bed, she became incontinent. At first the issuances of stool were whitened with mucus and streaked with blood. As she got sicker, her stool changed into a black liquid. The liquid, known as melena, is hemorrhage coming from the linings of the intestines. The membranes that form the linings of the intestines had died and were now undergoing bacterial decomposition.

One way to understand viruses is to think about them as biological machines. A virus is a wet nanomachine, a tiny, complicated, slightly fuzzy mechanism, which is rubbery, flexible, wobbly, and often a little bit imprecise in its operation—a microscopic nugget of squishy parts.

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. Or they may have arisen after life started, during the time when single-celled bacteria had already come into existence—nobody knows.

He turned the blade in a small circle, cutting a plug out of the liver. As he worked, blood continued to pour out of the hole in the skin, and it ran down the handle of his knife and began dribbling over his fingers. It had a brownish color and a slippery consistency.

Dude...

Most viruses use the cells of specific tissues to copy themselves. For example, many cold viruses replicate in the sinuses and the throat. Ebola replicates in all tissues of the body except for the skeleton and the large muscles of the skeleton, and it has a special affinity for the linings of blood vessels.

The man realized he was dying, and he asked his family to carry him into a patch of sacred forest. They placed him on the ground under the trees, where he died surrounded by his loved ones. Afterward, following local tradition, the man’s friends and family members took turns lying next to his body in the forest. They embraced the body, wept over it, and ate meals next to it during which they served foods that the man had liked. This was a way of remembering the man and cherishing their love for him. The disease attacked some of the mourners afterward.

There was no cure. No vaccine, either. No drug, no treatment, no nothing. Every time Ebola broke out it thrust doctors back into the Middle Ages. 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.

When Lisa Hensley was a junior in college, studying public health at Johns Hopkins University, she began thinking about the human immunodeficiency virus, HIV. The most recent evidence suggests that the most common type of HIV made a cross-species jump out of one chimpanzee into one person around 1910 in southeastern Cameroon, along a tributary of the Congo River. From that first human host, HIV began spreading from person to person, amplifying itself in the human species until it reached every community on earth. As of this writing, some seventy million people have been infected with HIV and thirty-five million have died of AIDS.

“The whole secret of the transmission of Ebola,” Kallon said, “is that you wash the body with water, and then the water is collected and used again.” The wash water from the corpse was carefully stored in a container. Then family members would use the water in a ceremony of grief and remembrance. “If you are the son of the dead person, you wash yourself with this same water, the water that washed the body,” Kallon explained. “After that, the daughter washes herself with the same water that the son used.”

Nightmare.

During the water ceremony, family members sometimes drank the wash water, Kallon said. It was a way of bringing the essence of the deceased person into themselves.

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.

The staff of the maternity ward examined her. When they gave her an injection and set up an intravenous drip of saline for her, she had hemorrhages around the needle punctures in her skin—her blood had lost its ability to clot, and it ran steadily out of the needle holes.

Lucy May continued to care for Mr. Nyokor. She was thirty years old, a married woman with a delicate appearance, a devout Catholic who styled her hair in a modest bob.

Past tense isn't a good sign.

“I always think that the absence of bad luck is the most important thing in life,” Piot said.

Human blood is thick with antibodies. A person’s blood is about 2 percent antibodies by volume, and they really do thicken the blood. A droplet of blood large enough to cover a person’s little fingernail contains about 50,000,000,000,000,000,000 (fifty quintillion) individual antibody proteins.

As a person talks, extremely fine, invisible drops of saliva are sent into the air around the person’s mouth, and the drops can drift up to six feet. Had an unseen fleck of the virus landed in her eyes, in her mouth, on her skin?

If she was now infected, she would be in the incubation period, the time during which the virus is replicating, but there would be no symptoms. The typical incubation period of Ebola is about eight days, but the virus can incubate in a person for up to twenty-one days before symptoms appear.

Fun.

Kent Brantly woke up in darkness, an hour before dawn. He stumbled into the bathroom and sat on the toilet and had three heavy bursts of diarrhea. When he had finished, he stood up and looked. The toilet was full of blood—black hemorrhage. He had just lost between a pint and a quart of blood.

He walked through two rows of medical staff giving him applause, and he went home to Fort Worth. Kent Brantly and Nancy Writebol credit their survival to outstanding care by their doctors, to ZMapp, and to the power of God.

Yes, god made the cure. Sigb

“This is how all outbreaks end,” Armand Sprecher, the Doctors’ official in Brussels, said. “It’s always a change in behavior. Ebola outbreaks end when people decide they’re going to end.”

Jonathan K. Ball, at the University of Nottingham, in England, and colleagues of his, discovered something equally disturbing about the Makona strain. It didn’t infect bat cells as well, while it infected human cells much better. In other words, the Makona strain is a humanized Ebola. The Makona strain understands people better than does any other kind of Ebola.

“Why should we be waiting for something that’s truly bananas to break out before we start planning for it?” she asked. “There’s not a lot of value in preparing for a war, because what happens in a war is unpredictable. But there is a lot of value in preparing for an outbreak, because what happens in an outbreak is predictable. Let’s be prepared, not scared.”

As far as anyone knows, Ebola doesn’t travel through the air from person to person. Ebola is a wet virus, and it spreads through contact with liquids or in invisible liquid droplets that can drift a few feet through the air.

If you live in a city teeming with humans, you are nothing more than a host.