Crisis in the Red Zone

Crisis in the Red Zone: The Story of the Deadliest Ebola Outbreak in History, and of the Outbreaks To Come (2019), a non-fiction thriller by American author Richard Preston, narrates the 2013 outbreak of the deadly Ebola virus in West Africa, focusing on the efforts of doctors and scientists to minimize fatalities and find a cure. Kirkus Reviews described the book as “an exhaustive and terrifying story of viral mayhem that will rivet readers.” Some reviewers, however, found Preston’s handling of his West African setting “problematic in parts” (New York Times).

Preston begins his narrative in Meliandou, a village in the Guéckédou region of Guinea. A toddler called Emile Ouamouno wanders away from his mother to make his own entertainment in the shade of a decaying tree. There, “he might have played with a groggy bat, or he might have gotten some bat blood or bat urine in his eyes or in a cut in his skin.”

Emile is the index case; the first victim of a virus that has been dormant for decades and for which there is no cure. Within weeks, Emile, his mother, his sister, and his grandmother would all be dead. In total, more than 11,000 people will die, most of them in Emile’s native Guinea and in the neighboring countries of Sierra Leone and Liberia.



Ebola is highly contagious, and it is a brave team of scientists and medics who scramble to try to contain the virus. They establish a “red zone,” where confirmed and suspected cases are quarantined: “Patients die in the red zone. They are not permitted to die anywhere else.”

Ebola’s contagiousness means that it can spread through the burial ceremonies for its victims. Early in the outbreak, scientists trace more than 365 cases to a single funeral. “The Ebola virus,” Preston observes, “moves from one person to the next by following the deepest and most personal ties of love, care, and duty that join people to one another and most clearly define us as human.”

Preston provides a history of the virus, from its first recorded appearance in 1976. Its first symptoms are flu-like, but these quickly give way to fever, paralysis, diarrhea, and bleeding. Strange though it seems, the virus also causes hiccups. On average, 50 percent of those infected die. Fluid loss is the usual cause of death. The virus interferes with the body’s natural immune response, weakening patients’ immune systems. There is no known cure, and at the time of the 2013 outbreak, there was no vaccine and no drug treatments available.



However, the focus of Preston’s account is the human stories, particularly heroic figures like Lisa Hensley, an American researcher who voluntarily traveled to West Africa to offer her help, and Humarr Khan, a physician from Sierra Leone who had already turned down a lucrative position in America to stay in his homeland to help fight another viral outbreak (of Lassa Fever).

Khan contracted the Ebola virus in the course of trying to manage the outbreak. At the time, Western researchers were excited about an experimental drug called ZMapp: doctors nicknamed it “Wow,” because “everybody was typing Wow in their emails.” ZMapp had been found to work in monkeys, but it had never been tested on humans.

Was it ethically appropriate to test it now? When Khan fell ill, Western medics debated whether to administer the treatment to the medical man. Khan himself wanted to try it. The decision was agonizing: he might die without it; but equally, he might survive the virus without it, while the treatment could kill him.



There was another factor at play. Local people had become deeply distrustful of foreign medics. Preston explains that from their point of view, the doctors were “white foreigners” who showed up in “spacesuits” to take away people who in most cases never returned. Even their bodies were never seen again, as they remained infectious and had to be disposed of. “Many didn’t believe in this thing called Ebola.”

Doctors Without Borders reasoned that Khan might die from the ZMapp treatment or be “miraculously” cured by it, and either result might become fuel for further rumors. These rumors were already impacting NGOs’ ability to do their work. At least one community hid people infected with the virus and attacked doctors who tried to take them away. When epidemiologists tried to disrupt the burial of a victim, they were attacked with rocks and nearly killed.

Doctors Without Borders ultimately decided to deny Khan treatment. He died. Later, ZMapp would be administered to two Americans, both of whom survived.



Preston closes his account of the epidemic with an analysis of the likelihood of future outbreaks. He warns that Ebola has emerged in recent decades in part because of human penetration into previously wild places, where diseases carried by other species (in this case fruit bats) can infect people. He points out that this pattern is present not just in Africa but also in Asia and, in fact, the U.S., where tick-borne diseases are on the rise.