We flash back to July 6, 1976 in Sudan, where a man known as Mr. Yu G. dies of a strain of Ebola. He is a storekeeper in a town called Nzara, a product of the “human population explosion” of the twentieth century. Preston calls attention to the beauty and diversity of the landscape, which changes from savanna to rainforest. Preston notes that many bats roosted in the ceiling near Mr. Yu. G.’s desk, but adds that no one knows whether they were the source of the infection. When Mr. Yu. G. died, his family gave him a traditional burial, and the virus began to spread. One of the victims, a man called P.G., was extremely popular and promiscuous, and he spread the virus to many of his acquaintances.
The theme of globalization returns in this passage, as Preston transitions into Sudan, making the landscape seem vivid and clear with various descriptive details. He recounts yet another outbreak of Ebola (this time the strain Ebola Sudan), illustrating the variety of ways that humans can spread the virus to each other—from funeral rites to sexual contact.
Preston explains that while being fatal to its host is not in the best interest of the virus, if it is extremely contagious, it can jump from one host to another before killing them. The Ebola strain reaches a hospital in a town called Maridi, where the medical staff has not been sterilizing its needles. There, patients, doctors, and family members all begin to die. Many of the victims experience brain damage, and exhibit psychotic behavior.
The mention of unsterilized needles brings back the idea of human error and hubris, since basic medical hygiene may well have prevented this entire destructive outbreak.
The Sudan strain, Preston explains, is more than twice as lethal as Marburg, meaning it kills about 50% of those infected. He says that if the virus had made it to the metropolitan center of Khartoum, it then could have moved to Cairo, from which it would have traveled to every large city in the world. Instead, the virus “ravaged” the hospital and then largely died out. It is possible that this occurred because the virus killed people too quickly (meaning they did not have time to infect others), and because it was not airborne. After this outbreak, the virus has not been seen since, but Preston speculates that it is still out there, living in “some unknown host” until it can mutate once again and infect humans.
Globalization returns once again as Preston traces the path that Ebola Sudan could have taken to become a worldwide pandemic. He admits, however, that Ebola may in fact be too deadly to spread easily, since it kills its hosts so quickly. This realization does not give him much comfort, however, as he speculates that the virus may one day mutate into a more effective and infectious form.
Two months after Ebola struck Sudan, in September 1976, an even more lethal strain struck Zaire, near the Ebola River. This virus was twice as lethal as Ebola Sudan. Although no one knows who the first human case was, Preston asserts that it was likely someone who ate meat from an animal infected by the virus, or who was exposed to an insect host of some sort. It next moved to a hospital in a town called Yambuku, which was staffed by Belgian nuns, and had a small school attached to it.
By immediately moving on to another epidemic—this time of Ebola Zaire—Preston illustrates how constant and endless the struggle to contain Ebola really is. These viruses have survived for millions of years for a reason.
Ebola traveled to this hospital by a way of a teacher from the school, who had recently been on a vacation in the wilds of Zaire. He visited the Ebola River and ate both antelope and monkey meat while there. The next morning he felt sick, and so stopped by the hospital to get an injection of medicine. The conditions in this clinic, however, were highly unsafe, with the nuns using only five hypodermic needles to give injections to hundreds of patients throughout the day, and rinsing them occasionally in bloody warm water. The schoolteacher became desperately ill a few days later, although it is unclear whether he contracted the virus while on his vacation, or from a dirty needle at the hospital.
Once again, a large part of the problem stems from unsterilized needles, emphasizing how much human error and hubris contributes to these epidemics, and how a groundbreaking scientific discovery (injections and innoculations) can, under the wrong circumstances, become deadly vehicles of disease.
Because of the use of these needles, the virus spread almost instantaneously to fifty-five villages close to the hospital. It killed those who had received injections, family members of the victims, and the hospital’s staff, one of whom had aided a woman dying of the virus as she miscarried (her fetus, too, had contracted Ebola and had hemorrhaged inside her uterus). A nun named Sister M.E. became ill as well, and a priest, plus a nun named Sister E.R., decided to take her to the capital city of Kinshasa. Once there they took her to Ngaliema Hospital.
The injections that the nuns deliver allow Ebola to break out in fifty-five villages at once—a far wider range than the virus would have been able to reach without modern technology and globalization. The decision to take Sister M.E. to Kinshasa, meanwhile, is an altruistic but ultimately dangerous one, because it only furthers the potential spread of the virus.
Preston describes the effects of Ebola Zaire, which “attacks every organ and tissue in the human body except skeletal muscle and bone,” transforming everything else into a kind of “digested slime of virus particles.” It contains “seven mysterious proteins,” which first create blood clots that, as they grow, cut off blood flow to other parts of the body, causing internal organs to begin to die. It especially focuses on connective tissue, essentially turning the body into “mush.” Skin begins to blister, rip, and bruise, and soon every opening in the body begins to bleed. The heart starts to bleed and soften, the brain becomes blocked by dead blood cells, and the eyeballs fill up with blood. Often victims of the virus experience a stroke. Even though blood within the body is clotting, blood outside of the body is unable to coagulate, as the red blood cells themselves have been destroyed. While the host is still alive, internal organs such as the liver, kidneys, and spleen cease to function. Genitals, too, become swollen and may often hemorrhage.
Of all the variations of Ebola (Marburg, Sudan, and Zaire), Zaire is the most terrifying and deadly. It is essentially a hyperefficient tool to destroy the human body. Though by now we have grown accustomed to Preston listing various horrific symptoms, the effects of Ebola Zaire take that horror to a new level. The virus’s deadliness springs from how fast it is able to multiply, literally filling up the body’s cells with virus particles. This need to multiply, it is important to remember, is the fundamental urge that drives the spread of a virus.
Brain damage from the virus can sometimes lead to epileptic seizures, causing a patient to splatter blood all around them (an excellent way for a virus to jump to a new host). The virus multiples so fast that the body’s cells become filled with viral structures called bricks, which break through the cell wall and then disintegrate into the bloodstream. Eventually one drop of blood can contain a hundred million particles of the virus. Once the hosts die, their bodies disintegrate and begin to leak a fluid that was once their internal organs.
Of all the strains and diseases that we have heard about up to this point, Ebola Zaire is the most efficient and destructive—at multiplying, but not at moving from host to host (at least not yet). Preston’s list of symptoms also emphasizes the fragility of the human body, making clear how little we can actually defend ourselves against this kind of deadly disease.
After her death, “Sister M.E.’s hospital room was stained with blood.” Hospital employees refused to clean the room, so it was simply left locked. They did not know what had killed her, but doctors suspected that it might be a relative to Marburg. Next Sister E.R. fell ill and died, after being cared for by Nurse Mayinga. Soon after this, Mayinga developed a terrible headache, but remained in denial because she had just received a scholarship to study in Europe.
Moving Sister M. E. to an urban hospital has exposed dozens more people to the virus, and the person who pays the price is Nurse Mayinga. Preston makes sure to humanize her, but also explains the devastating effects that her choice not to immediately quarantine herself could have had on her city and the world.
Rather than seeking treatment, Mayinga left her job and traveled into the city to obtain travel permits before she grew too obviously ill. When she became too ill to function, she took a taxi to Kinshasa’s largest medical facility, the Mama Yemo Hospital—it is unclear why she didn’t return to Ngaliema Hospital, but Preston speculates that it was “a case of psychological denial.” It was a crowded building, packed with the city’s poor, and the doctors there gave her a shot for malaria. Still ill, she took another taxi to a facility called University Hospital, where doctors were unable to find a diagnosis. Only then did she return to Ngaliema, where she was placed in a private room, and her sickness worsened.
This kind of human error is completely understandable (and, in Mayinga’s case, tragic), but could still be catastrophic in terms of spreading an illness like Ebola. Thus this passage is meant to make readers understand how difficult it is to avoid such errors—and also how, on a person-to-person level, human psychology can have monumental repercussions for an epidemic.
People began to hear a rumor about a virus upriver, and about a sick nurse in Kinshasa. Word spread to government employees, and eventually reached the World Health Organization in Geneva. The place went on high alert, as its employees waited to see whether Mayinga had infected the population of Kinshasa. Countries began to consider blocking all flights from the city, and President Mobutu Sese Seko of Zaire sent in his army to quarantine Ngaliema Hospital. He also sealed off the infected zone upriver with roadblocks. Eventually this area, called the Bumba Zone, lost all contact with the outside world.
Once again, the only available response to Ebola is to quarantine those who have been exposed. This time, however, the action has the unintended effect of completely cutting off a section of Zaire (now the Democratic Republic of the Congo) from the outside world. Though this action may isolate those infected, it also leaves many people without any access to aid or medical care. This again shows the two sides to the interconnectedness of modern sociery.
Doctors had sampled Sister M.E.’s liver as she was dying, trying to ascertain her illness, and had also drawn some of her blood. They sent this to a lab in Belgium, and one in England, but not to the Centers for Disease Control in Georgia—staffers there began begging for samples as well. The main branch of the C.D.C. involved in this effort is called the Special Pathogens Branch, and in 1976, it was run by Dr. Karl M. Johnson, a virus hunter who had spent many years researching in Central and South America. He had heard only that there was a fever with “generalized symptoms” in Zaire, and finally obtained a small amount of Sister M.E.’s blood from the English lab.
Again at play within this passage is the force of globalization, this time working in favor of knowledge and scientific inquiry. Only by the methods of transportation and communication in the modern world are the researchers at the C.D.C. able to access Sister M. E.’s liver, and it is this access that eventually allows them to officially “discover” Ebola Zaire.
When the blood arrived, the tubes that held it had cracked, and the box was “sticky with blood.” The virologist in charge, Patricia Webb (who was married to Karl Johnson at the time), put on gloves to handle the blood and managed to collect a few droplets. She placed it into flasks with monkey cells, and observed as the virus within the blood began to attack the healthy cells. Meanwhile, another doctor named Frederick Murphy, who had helped to identify the Marburg virus, decided to use an electro-microscope to photograph the virus within the dying cells. Putting a droplet of fluid under the microscope, he became instantly terrified as he saw the string-like virus, believing it to be Marburg. Fearful of Marburg’s infectiousness, he scrubbed his entire lab with Clorox bleach, before calling Patricia Webb, who quickly contacted Karl Johnson. The three looked at the shapes of the virus, noticing the classic Ebola shepherd’s crook, which essentially looks like “a Cheerio with a long tail.” When Patricia Webb ran tests for Marburg, they came back negative. Having isolated and identified the strain, the C.D.C. had won the right to name it, and decided to call it Ebola.
Yet again, ignorance and hubris puts multiple people at risk. Since the scientists at the C.D.C. do not know about the danger of the sample they’ve been sent, they handle it without any of the precautions that will later be required when dealing with Ebola. Although no one falls ill as a result, the episode still illustrates the ways in which medical professionals can be put in harm’s way by lack of knowledge about a disease. This is also Preston emphasizing yet again just how much of our lives are beyond our control, no matter how many precautions people might take. There is also a note of irony within this episode—although the scientists become instantly terrified when they find out that they might be dealing with Marburg, they are in fact handling the far deadlier Ebola Zaire.
Karl Johnson is now a fly-fishing aficionado in Montana, who does a great deal of consulting work on global health issues. Preston tries several times to contact him, and finally receives a response via fax, in which Johnson calls Ebola a “confrontational cobra,” and confesses to being “shit scared” of the disease.
A pattern throughout the book is the simultaneous terror and fascination with which scientists such as Karl Johnson and Gene Johnson view Ebola. These opposing emotions are mirrored in Preston, who finds Ebola horrifying, and yet is obsessed with it.
Two days after discovering Ebola, Karl Johnson headed to Africa with two other C.D.C. doctors in an effort to stop the virus in Zaire and Sudan. They stopped in Geneva, where one of the doctors became too frightened to go any further—a fairly common occurrence, Johnson explains.
Karl Johnson and his colleagues show immense bravery in traveling to Zaire, especially considering how little they know about the disease that they are facing. This spirit of self-sacrifice and courage appears in many characters, like Nancy Jaax.
Preston visits Karl Johnson and the two go fly-fishing together. Johnson discusses his trip to Kinshasa, and the panic and chaos that he found there. He explains how catastrophic it would have been had Ebola been able to spread through the air, but reveals that the idea of a species-threatening virus doesn’t upset him, because the human race may in fact need to be thinned out. He then comments that he finds viruses not only fascinating, but beautiful.
The peaceful scene of fly-fishing contrasts with the horrific scenario that Johnson is describing. Johnson takes an unpopular and disquieting view of a species-threatening virus, believing that it might ultimately be a positive event for the earth as a whole. This question will come up repeatedly throughout the book, as Preston often places humanity within the bigger picture of all life on earth.
A C.D.C. doctor named Joel Breman, who had come with Karl Johnson to Zaire, was tasked with travelling to the Bumba Zone, along with a team from WHO (the World Health Organization). Breman became increasingly scared as the plane neared its destination, remembering his wife and children in Michigan. He had only surgical masks, gowns, and gloves in his bag, and knew that this would not be enough to handle an infectious virus. The crew who brought them refused to even get off the plane. Once there, the team bribed the local governor, who loaned them two Land Rovers to travel to the Ebola River. The smallpox virus had attacked this area for centuries, and so each village had created a rudimentary quarantine roadblock out of foreign trees.
Considering how much we as readers know about the infectiousness of Ebola and the precautionary measures that scientists and doctors now take in handling with it, Joel Breman is clearly and woefully unprepared to deal with the disease that he will soon be facing. The mention of smallpox calls back to another famously deadly and disease, drawing a parallel between that widespread virus and Ebola’s potential for an epidemic.
Villagers were suspicious of the WHO team, letting them in only after finding that they were doctors. At last the team reached the Yambuku Mission Hospital, which was nearly deserted, except for a few surviving nuns and nurses, and a priest. They had attempted to sterilize every room except for the maternity ward, which was filled with bloody syringes, and the corpses of infected women and fetuses. Preston takes a moment to describe the beauty of the surrounding landscape before recounting the team’s journey deeper into the forest, where they encountered infected villages who had attempted to quarantine the sick and dying in huts, before burning the buildings altogether. Joel Breman realized that the epidemic had already peaked, and that it had begun at the hospital. He tried to contact Karl Johnson, but was unable to. Eventually they traveled back to the edge of the Bumba Zone, where an airplane picked them up.
The scene in the maternity ward is the horrific climax of this passage. Although we have been told of the effects of Ebola before, what the doctors find within this room represents the ultimate horror that the virus can inflict. Preston’s decision to describe the natural landscape directly afterwards then lends a melodramatic sense of perspective—no matter what Ebola does to the human race, the natural world continues on. Joel Breman, meanwhile, experiences yet another near miss, one of many within the book. This shows how much is up to chance when it comes to contracting a hot virus.
Meanwhile, back in Ngaliema Hospital, Mayinga was being completely quarantined. Her main physician, a South African doctor named Margaretha Isaäcson, at first wore a gas mask whenever treating Mayinga, but eventually took it off, deciding that it offered little protection. She tried to care for Mayinga, but was helpless against the infection. Blood gushed from Mayinga’s nose and mouth and her heart began to give out, though she remained conscious the entire time. She eventually died of a heart attack. Dr. Isaäcson, convinced that she herself was infected, washed out Mayinga’s room and the nuns’ rooms.
Like many of the physicians in the book, Margaretha Isaäcson displays immense bravery in dealing with a patient suffering from an incurable and infectious disease. That she survives despite her exposure is a matter of luck and chance rather than skill.
Medical teams had located thirty-seven people who had encountered Mayinga while she was infected, and quarantined all of them. Karl Johnson, meanwhile, had heard nothing from the doctors in Bumba, and assumed that they were dead and that the virus was highly contagious. He organized a ship that could serve as a place of refuge for doctors, should the city fall prey to an epidemic. A division of the US Army, meanwhile, prepared to evacuate all Americans out of Zaire. Miraculously, however, no one else became ill, not even a person who had shared a bottle of soda with Mayinga. The virus could not spread through casual contact.
The one element that keeps Ebola Zaire from being a truly species-altering pandemic is the fact that it can spread only through bodily fluids rather than through casual contact. It is for this reason—a fluke of genetics—rather than any protective measures, that the virus doesn’t infect all those exposed to it. For all Preston’s suspense-building, this is yet another “close call” that leads nowhere.