Reviews

Crisis in the Red Zone by Richard Preston

books_and_bawoos's review against another edition

5.0

Title: Crisis in the Red Zone
Author: Richard Preston
Rating: 4.5/5

"If we did some basic preparation for a major outbreak...we could actually make it not such a huge, dramatic, crazy thing. [Referring to a Level 4 pandemic] Why should we be waiting for something that is truly bananas to break out before we start planning for it?...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." (Richard, 363)

I'm going to say what I pretty much always say after reading a Richard Preston book...the world is doomed. Not to be a nay-sayer, but if this book isn't timely I don't know what is. It is AMAZING to see the parallels between this book and our current pandemic situation. Now, we don't have Ebola on our hands but we do have Covid-19 which has pretty much decimated the world with little to no trouble at all. Especially in the United States. Once again I am thinking about just how underprepared this country has been in dealing with Covid-19 and I can't even fathom what would happen if Ebola hit the States in the same way Covid has. It would be beyond awful. I truly believe that our country would react in much the same was as the people of the various countries in Africa presented in this book: denial.

But to get back to the book...a winner! Preston wastes no time re-introducing us to the world of Ebola and how it first ravaged Africa in the 1970s. While reminding the reader of the first outbreaks, Preston talks more in depth about the more recent outbreak in 2014. This was the outbreak that brought Ebola to the shores of the United States for the first time. Preston gives us details of how the disease was brought to our doorstep and does so in a way that reminds us just how close we came to facing Ebola on a national pandemic level. While there is heavy scientific jargon in the book, Preston makes the science easy to understand even for the casual reader.

Overall, I believe everyone should read this book. And while you're at it, pick up his other books too. And do it ASAP.

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ckanta's review against another edition

dark informative reflective sad tense fast-paced

4.0

skigirl1689's review

5.0

In some ways it read like a novel, but it was excellent, but I am fascinated by these kinds of topics (Ebola, Spanish Flu, etc.). I began reading this in January and then restarted it at the end of February. Then the coronavirus went global. It was kind of bad timing, and I don't recommend doing this if you're already worried about the current pandemic. However, it puts current events into perspective, and provides many valuable insights as to containment and why finding treatments for viruses is so difficult and slow.

akhan894's review against another edition

dark tense fast-paced

5.0

So gripping... I could not look away. The fact that Ebola is a real virus and not something of fiction is horrifying. I have so much respect for the doctors and nurses who worked with the virus. Crisis in the Red Zone gave me a lot to think about. I wonder how many potential deadly zoonotic diseases will eventually make the jump to our sphere...

cedrics_mom's review against another edition

4.0

Not as good as the Hot Zone, but definitely worth a read. My main complaint is the amount of repetition. Preston thanks the book’s editor by name, so we know the book had one, but what happened? Perhaps the editor had more pressing responsibilities. My other complaint is that it wasn’t necessary for Preston to meander into the area of scare tactics; Ebola is plenty frightening enough without that. Particularly at the end of the book, he starts with the “what if‘s“, a bunch of questions that no one can answer and we have no way of knowing if we will ever have to face anyway. Had I been the editor, I would’ve left that out.

My main question is why were so many of the Ebola deaths women? There were men who contracted the virus and died from it. But in Africa at least, the majority of the sick were female. Why is that?

undertowsoul's review against another edition

dark sad tense fast-paced

4.0

liralen's review against another edition

4.0

What would it be like if a Level 4 virus event occurred and the Ancient Rule arrived in the supercity of New York? It wouldn't take much to produce the Ancient Rule in New York City. A dry virus with high mortality that infects people through the lungs. No vaccine, no medical treatment for the virus. If you take the subway, if you ride in an elevator, you can be infected, too. If the Ancient Rule came to New York City, we can imagine people lying facedown on the street or in Central Park, crowds staring and hanging back. People begging for help, no one willing to help. Police officers wearing full PPE gear. People needing ambulances. No ambulances. Hospitals gone medieval. Medical staff absent, dying, overwhelmed. All hospital beds full. People being turned away on the street from Bellevue Hospital. Medical examiner facilities gone hot as hell and crammed with corpses. Nobody in their right mind would enter a New York City hospital during a time of the Ancient Rule. Transportation frozen. Food supplies dwindling or absent. Schools closed. People avoiding supermarkets for fear of contagion. Prophets and visioners predicting the future and offering cures. People leaving the city, bringing the virus with them. Airports infective, flights canceled. Parents giving care to their sick children in apartments, at home. If someone in a family got sick, there would have to be one designated caregiver, a person willing to sacrifice their life in an attempt to give care to a loved one. Wealthy people spending money like water trying to save themselves; the poor and disadvantaged, as always, bearing the worst of it. If there is a vaccine or drug that can help, there will be corruption. Companies and individuals hoarding vaccine, selling it at sky-high prices. (341)

I don’t know about you, but when there’s something new and alarming going on, I usually start by reading about it: articles and websites and, of course, books. But in March, there weren’t any books about COVID-19 to stress-read, so, uh…back to Ebola reading I went! I realise that this is not the most normal stress response ever, but it was pretty effective—and led to some pretty fascinating reading.

Preston leapt onto the book scene with The Hot Zone in 1994. The Hot Zone is one of the reasons that I already had an idea of what Ebola was when the 2014 outbreak hit—although when I tried to read the book as a teenager, I was so horrified by the image of somebody vomiting black blood (it’s been a while and I might be misremembering) that I never managed to make a dent in the book. I’ve been meaning to return to it…but Ebola was, in the early aughts, considered something rare and far away, a freak disease of nature that I’d never see on the front page of major world news sources. Reading a book about it that had already horrified me was not really a priority.

In Crisis in the Red Zone, though, Preston takes it closer to home: to the Ebola outbreak of 2014, when Ebola was on the front page of major world news sources. I followed the news closely enough to be confident in saying that my layperson’s knowledge of Ebola—while of course far from a scientist or medical professional’s understanding—is high. But I knew virtually nothing of mechanics of the 1976 outbreak, which led to the disease’s identification and which Preston uses to provide additional context and information.

There was a widespread view among public health experts, writes Preston of the period before it became clear that the 2014 crisis was just that, that Ebola "burned itself out" when it entered the human species. The virus was too hot, too lethal; it killed people too quickly to be able to establish itself as a permanent disease of humans. This was the widespread opinion, anyway. The simple fact is that Ebola virus just wasn't perceived as a serious threat. (148)

Ebola is so dangerous both because it kills so quickly and because it is so infectious: blood is infectious, other body fluids are infectious, dead bodies are infectious, fetuses in a woman who is sick basically become balls of virus. It differs from something like COVID-19 in some critical ways: COVID-19 has a much lower death rate of those infected (mortality rates for Ebola can be as high as 90%, depending on strain and, presumably, treatment), but it spreads—as far as we can know, a few months into a pandemic—much more easily, because unlike with Ebola, people are infectious before they are symptomatic.

At any rate, people outside West Africa weren’t too concerned when Ebola cropped up again in 2013/2014; historically, it hadn’t made it very far. But nobody was considering how much technology had changed, how much travel had changed, how much farther people go today than they did even thirty or forty years earlier.

Other things have changed, too. Understanding of infection and sanitary practices is improved. Medical treatment has improved. But even as I say that, it’s a qualified statement: I can look at any country in the Global North and say ‘this has improved, this has improved’, but medical advancements are often slow to come to poorer countries. I don’t know what technologies—to say nothing of basic supplies—are still missing from the average hospital in, e.g., Sierra Leone. One of the most valuable parts of the book for me, then, was a recounting of thought processes and steps taken in 1978 to identify what turned out to be Ebola.

Quotes in that vein, with a spoiler tag for length:

Spoiler

She [a nun] did not wear rubber gloves. Possibly she may have liked the sensation of close contact with babies and their mothers. (12, context: woman with undiagnosed Ebola in labour)

Or, he wondered, could this be a fulminating outbreak of typhoid fever? Typhoid fever is a gastrointestinal infection caused by a type of bacteria—not by a virus. Typhoid fever is extremely contagious, but you can catch it only by eating food or drinking liquid that is contaminated with typhoid bacteria. You can't catch typhoid by contact with blood or body fluids of a typhoid-infected person or by breathing the air near the person. (25)

Yellow fever virus attacks the liver. As the liver fails, the eyes turn yellow or brownish. Indeed her eyes were discolored, either reddish brown or purplish. He wanted to inspect the eyes more closely. In his haste to reach the bodies he had forgotten to bring along rubber gloves. It didn't matter, since the yellow fever virus isn't infectious in direct contact with blood or body fluid—you can only catch yellow fever from the bite of a mosquito. (27)

Not only had he neglected to bring rubber gloves with him, he hadn't brought a scalpel, either. But he needed a way to obtain a sample. He was in a hurry, so rather than go back to the hospital and get a scalpel, he fished around in his pocket and brought out his pocket knife. He unfolded the blade; it seemed long enough to reach the liver. (28, context: removing liver sample from dead body)

As he drew blood and tried to stanch the leaking from needle sticks, Muyembé got smears of blood on his hands. He put on rubber gloves for some of the messier blood draws, but he was in a hurry. At times he washed his hands with soap, but at other times he didn't was them at all. (30, context: live patients)

Now, that first quotation is a little frustrating to me, because it implies a choice that it’s not clear the nun in question had: perhaps she didn’t use gloves because she could feel better without them, sure; or perhaps she didn’t use gloves because it wasn’t standard practice for deliveries in Zaire/DRC (or elsewhere, for all I know) at the time; or perhaps she didn’t use gloves because the mission only had a very limited supply to be used for specific reasons. I don’t know. But altogether, the quotations—including that first one—say something to me about how far medicine has come. Can you imagine a well-trained professional these days investigating an unknown virus without even so much as gloves for protection? Aiiii.

While we’re at it, let’s talk about those nuns in 1976 (again, spoiler tag for length):

Spoiler

At Yambuka [Catholic Mission], they found that most of the hospital's nursing staff was now either dead or dying. Ruppol and Raffier toured the Yambuku hospital, and Ruppol headed straight for the dispensary: his usual practice. He suspected there might be a problem in the dispensary. And he was right, he found what he was looking for. It was a metal pan in which several old-fashioned glass injection syringes had been left lying. The syringes had heavy steel needles, a type of needle that can be reused many times. He started asking questions and learned two things. The first was that the nuns didn't know very much about medicine. The second was that they had not been sterilizing the needles of the syringes regularly. The nuns had been giving injections of vitamins and medicines to hundreds of patients each day, and they were using dirty needles. Occasionally the nuns would rinse a syringe in a pan of water to get the blood off. At day's end, they would sometimes boil the syringes, sometimes not.

Furthermore, Ruppol discovered that the nuns were loaning syringes to hospital staffers who would ride around the countryside on motorbikes, using a single needle and syringe to deliver shots of vitamins and medicines to villagers. They had been visiting villages up to fifty miles away. The staffers on motorbikes had been seeding the virus all over Bumba Zone. (192)

Now, I’m just over here being appalled, but I’d also love to know how much of a standard practice this was—for nuns (or others) who didn’t have medical training to be administering medicines—not just in missions in developing countries but also in the nuns’ native Belgium in 1978. I know the 70s were a singular time, but again…I hope there’d be more of an uproar today. (Bearing in mind: I understand that many things have changed since, for example, the spread of HIV/AIDS, and people in general have a much greater understanding of the danger of blood-bourne illnesses. But still.)

Back to COVID-19, though: one of the many ways to measure the impact of the current pandemic is by looking at not only the number of known coronavirus-related deaths in a time period (e.g., April 2019) but also the expected number of deaths in that time period (e.g., average number of deaths in April, 2010–2019) and how many more deaths there are than expected in April 2019—so if the norm is 100 deaths in a population in April, but in 2020 there are those 100 plus 15 coronavirus deaths plus a further 15 deaths for other causes (so 130 instead of the expected 100)…that’s a sign of the virus’s impact.

The virus was hitting Monrovia hard. All of the city's hospitals were filling up with Ebola patients, and the medical system in the city had become almost nonexistent. A blood sample came into the lab that had been taken from a pregnant woman who was in a distressed childbirth. She was lying on the sidewalk outside the main city hospital of Monrovia, bleeding from her birth canal. The doctors wouldn't admit her because she appeared to have Ebola, and a pregnant woman with Ebola who is hemorrhaging is an extreme danger to medical staff. Hensley knew that the woman and her baby needed immediate medical attention. She tested the woman's blood sample immediately—but the process took two hours. The result came up: The woman didn't have Ebola. She could be admitted; she and her baby could be saved. But by the time she got the results back to the hospital, the woman and her baby had died on the sidewalk. (243)

It will be months or years before we understand the full impact that the coronavirus is having, but we’ve seen this already: procedures big and small cancelled, a drop in hospital admissions, cancelled appointments. In the US, at least, medical workers doing work unrelated to COVID-19 were laid off because there wasn’t work for them—but that doesn’t mean that medical concerns have disappeared. And of course that happened during the Ebola crisis as well: patients simply couldn’t be seen because hospitals were overwhelmed, and anyway who wants to go to hospital when there’s a highly contagious, very deadly disease around?

There’s so much more to say, about book and about virus, but this review is already (thank you, quotations) four single-spaced pages in Word, and that seems a little excessive, no? So I’ll just leave these (again, tags for length) for your consideration:

Spoiler

If a group of powerful foreigners who spoke no English, or spoke it badly with a heavy accent, were to set up a camp of tents in suburban Wellesley, Massachusetts, and they were wearing biohazard moon suits and were telling townspeople that an extreme virus had gotten loose in Wellesley and that anybody who had symptoms must go into the camp and stay there until they died, there might be some opposition from the Wellesleyites. And if most people who went into the camp were never seen again, dead or alive, and if the foreigners were burying white body bags next to the camp, and if quite a few of the bags obviously held dead children, and if social media hit up with rumors of hideous experiments, it's a pretty sure bet that the Wellesleyites would be reaching for their guns and doing anything they could to get the hell out of Wellesley. (78)

A doctor has a duty to inform a patient of the treatment options that are available to the patient. If nobody at the camp would agree to administer ZMapp to Khan [a Sierra Leone doctor treating patients for Ebola], then the drug wasn't available as a treatment for him, and so the camp doctors had no ethical duty to tell him about it.
When international medical personnel went to work for Doctors Without Borders, they were informed that if any of them came down with Ebola, the person would be flown to Geneva, placed in a world-class hospital, and offered experimental drug treatment. The treatment, specifically, was human-grade Course No. 1 of ZMapp. (265)

As the tide of the Makona strain receded, it left its dead scattered across eight countries, including Spain and the United States. Thirty thousand people had been infected. More than eleven thousand people had died of the virus, and untold thousands more had died because they couldn't get medical care during the epidemic, since hospitals were devastated. Seven percent of all the doctors in Sierra Leone were dead. The medical infrastructure of Guinea, Liberia, and Sierra Leone had been wrecked. The three nations' economies had functionally collapsed. At Kenema Government Hospital, at least thirty-seven nurses were dead. Two Kenema hospital doctors were also dead—Humarr Khan and Sahr Rogers. In the end, the Ancient Rule prevailed, and the emerging virus temporarily went back to its hiding place in the vi

silodear's review against another edition

4.0

I just love a nonfiction thriller about infectious disease. What can I say?

poetpenelopee's review against another edition

dark tense slow-paced

3.0

books_plan_create's review against another edition

5.0

Well. This was a straight up horror story. Like, I knew a lot of the people were going to die, and I am sitting here just on edge because even though it is non-fiction, and about Ebola, I became invested in these people and their lives.

And then there is the realization that I remember this outbreak. I remember being at the doctor's office and them asking if you had been to West Africa. I remember when the Americans came back to America. I remember people in America dying of Ebola.

And scarier...I live south of Atlanta...of the CDC, of Emory where one of the patients was located. It is scary to think that if something went wrong, Ebola could have infected Georgia, and since GA is home to one of the largest International Airports, it is not beyond the realm of possibility. It is a sobering thought.

Anyway, wonderful book that reads so smoothly and fluidly.