Crisis in the Red Zone

by Richard Preston

  Finally he got a spurt of blood flowing into the tube. The tube filled quickly. He removed the needle from her arm, capped it, and put the tube into a Ziploc bag and sealed it. He exited the house and handed the bag to Nadia. She sprayed it with bleach, to disinfect the outside of the bag.

  Wauquier wrapped her hand around the blood tube inside the plastic bag. The tube felt really warm, almost hot. That was a high fever. No doctors had arrived from the World Health Organization. She and Lina were isolated in Kenema, and were a long way from help. There was no need to worry, she told herself. Stay calm. Do the test.

  FONNIE

  LASSA WARD

  Same time, June 22

  Grim and unsmiling, Auntie Mbalu Fonnie stood in the foyer of the Ebola ward, next to the chart table where she often met with Humarr Khan. She wore a white nurse’s outfit with a small white nurse’s cap on her head. In a whispery British voice, she issued orders to her nurses and spoke with people milling around the entrance to the ward, attempting to calm panicky families who were trying to get news of a patient inside. A strong odor drifted out of the ward. Fonnie’s nurses were getting overwhelmed. Some of them were staying at home, but most of them continued to work. Hospital staff members came and went, delivering messages to Auntie from elsewhere, taking messages from her to other parts of the hospital. A crowd of people seethed around the entrance of the Ebola ward, a mix of sick people and family members. In front of the ward was an enclosure made of chicken wire. People who were obviously sick with Ebola-like symptoms were supposed to stay in this area, to keep them out of contact with everybody else. Fonnie sometimes left her post and went on errands around the hospital, looking for supplies, finding Khan. Khan and she were making rounds in the general wards, looking at patients in the beds, looking for signs of Ebola infection in the patients. Auntie and Khan knew there were undiagnosed Ebola patients in the general wards, and they wanted to find them and get them out. In the general wards were still many patients lying in beds, and staff doctors were still on duty, tending a large number of patients with all sorts of illnesses. One of them was a doctor named Sahr Rogers, who would not survive the situation. Auntie had begun working fifteen-hour days at the hospital, from before sunrise to late at night.

  She showed little emotion as she worked, only a seemingly desperate focus on the immediate tasks in front of her. She neither cried, nor laughed, nor smiled. She expected more from her nurses than they could give, more from herself than she could give. “It is in God’s hands,” she said over and over. “God holds in God.”

  Fonnie had recently lost her husband, Richard, and she was still grieving for him. A tall, handsome man with a wild sense of humor, Richard Fonnie had been the only person who could make Auntie laugh, or so it was said. He had built a house for their extended family, a large structure made of cement blocks, with a wall around it, on the lower slopes of the Kambui Hills. Richard died suddenly, before he could quite finish the house. Auntie had had Richard buried, as is the custom, right next to the house’s foundation. This left her in charge of a large family compound. Auntie’s brother, an epidemiologist named Mohamed Yillah, was living at the compound with his family, along with Mbalu and Mohamed’s mother, Kadie.

  Yillah, a tall, thin, quiet man, was devoted to his older sister, Auntie. He drove her to and from the hospital on his motorbike, before dawn and late at night. As they went down Hangha Road, they were an unmistakable pair—an extremely tall man with a small woman dressed in white sitting behind him, her arms wrapped around his middle. Yillah was never far from Auntie when she worked in the Ebola ward. He brought her food to eat, he ran errands and took messages around the hospital for her, and he watched over her to make sure she wasn’t getting too tired.

  At the Ebola ward there was a private room for the nurses, where the nurses took rest breaks. There was a table in the room that was usually piled with purses—the nurses put their purses there before they went on duty. When Auntie needed a break, a nurse would move the purses off the table, and she would get on top of the table and stretch out on it and rest for a little while. Often her brother sat in the room, watching over her as she rested on the table. She never seemed to fall asleep, though. After fifteen minutes or so she would get down from the table and go back to managing the Ebola ward.

  There were now about thirty-five patients in the Ebola ward—it had been designed to hold twelve patients. The nine cubicles were jammed with cots and beds. Each cot and bed had at least two people lying on it; some beds had three people in them. Children were lying next to adults. People died in the beds next to living people. Ebola made people disoriented, and disoriented patients got out of their beds and wandered along the corridor, and fell on the floor, and couldn’t get up. The Ebola nurses continued giving IV fluids to everyone who seemed dehydrated. Their biohazard suits were getting splashed with body fluids. The floors were filthy. People were dying during the night, and their bodies weren’t removed the next morning. Corpses lay on beds or on the floor. When there was time, the nurses would put a body in a body bag and leave it inside a small structure next to the ward—a morgue. Ambulance crews wearing PPE would take the bodies to the Kenema cemetery, a stretch of brushy ground outside the city, which, as the city’s potter’s field, is full of unmarked graves. The Ebola dead could only be buried there.

  TULANE GUEST HOUSE

  4:30 p.m., June 22

  Nadia Wauquier, standing at the back door of Lina Moses’s house and holding the plastic bag containing the tube of Lina’s blood, discussed the situation with Lina, who was lying in bed in her room. They decided that Lina would not leave her room for any reason, except to visit the bathroom. Nadia promised to call Lina on her cellphone whe she had gotten solid results.

  Then Nadia and the blood technician drove back to the hospital, and Nadia went into the Laboratory building, holding the bagged blood tube. She stood in the anteroom of the Hot Lab and dressed herself in full PPE, and then she pushed through the glass door of the Hot Lab.

  A logbook rested on a window ledge under a row of windows running along one side of the room. The logbook was the registry for all blood samples that came into the lab. Wauquier didn’t want to write Lina Moses in the logbook—the lab staff would see her name and would be very alarmed. Instead, she wrote Lucia Musa. Musa is Krio for Moses. Then she removed the tube’s red rubber top, inserted a pipette into the tube, and sucked up a droplet of her friend’s blood, and put the drop in a very small tube, and spun the tube in a centrifuge. This made the red cells settle to the bottom of the tube, while the blood serum floated on top of the red cells. From that point she purified the serum, extracting broken RNA from the serum—the molecule that contains Ebola’s genetic code. Meanwhile it grew dark.

  HOT LAB

  7:30 p.m.

  An hour after sunset, Nadia Wauquier was in her suit and standing by the exit door of the Hot Lab, just inside. There, she stepped into a plastic tub that held bleach water, to disinfect her rubber boots, and she sprayed herself all over with bleach spray and washed her gloved hands in the liquid with special care. She sprayed the inside and outside of a box that held a number of thin glass tubes, each of which contained a purified sample of blood taken from a person suspected of having Ebola. One of the glass tubes held the sample taken from “Lucia Musa.”

  After having sterilized everything, Nadia took off her mask and threw it in a large plastic barrel, a biohazard barrel. She very carefully unzipped her suit and stepped out of it, peeled her gloves off her hands, and put the suit and gloves into the biohazard barrel. Now in her street clothes, and standing in the exit doorway, Nadia turned around so that her back was facing the exit and she was looking into the Hot Lab. Then she walked backward out of the Hot Lab. She was following protocol: You push the door open with your rear end and step backward through it. You end up in a small, closet-like room. The reason for facing backward as you exit the Hot Lab is so that you can watc
h to make sure you aren’t accidentally dragging any contaminated material or object out of the lab, anything that might have somehow gotten stuck to your body.

  Once she was out of the Hot Lab, Nadia carried the box out of the Laboratory and went around a corner into the alley where her cargo container lab was situated. She went into the lab and placed the glass tubes in the tray of her PCR machine, and started the machine running.

  Two minutes passed while the PCR machine went through a cycle. Then some dots appeared on a screen. The machine went through another cycle, and more dots appeared. Every two minutes more dots came up. A pattern was beginning to form in the dots. There were several lines of dots running horizontally across the screen, and each line was getting longer as dots appeared. Each line of dots belonged to one sample of blood. If a person’s blood contained Ebola virus, then a horizontal line of dots indicating that sample would begin to turn upward and start climbing. If a line of dots turned upward, this was a signal of Ebola in the person’s blood.

  The PCR machine would run for about an hour before it showed any reliable signals. Nadia used the time to game out her future moves: If Lina’s test results signaled Ebola, she would need to be evacuated fast: Every hour counts. Lina was an American. There were no emergency evacuation plans lined up for Americans. Nobody was aware of what was happening in Kenema. Nadia herself would handle Lina’s evacuation. Nadia had a boyfriend in Kenema, Hadi, who was a businessman and Lebanese. Hadi had contacts and some money. Nadia would stay with Lina no matter what. The best chance might be to get her to Switzerland.

  But it might not be possible to get Lina to Switzerland. If she tested positive she would never be allowed to get on board a commercial airliner. Therefore it would be necessary to hire a private jet to get her to Switzerland. With a crew trained in biohazard. If such an aircraft couldn’t be found and paid for within twenty-four hours, then Nadia planned to put her friend into an ambulance and take her to Freetown and get her admitted to a hospital there. But Ebola was starting to arrive in the Freetown hospitals. They were becoming unsafe. The medical system in Freetown could be breaking down. Nadia really wasn’t worried. She watched her machine.

  A PROPHET AND A VISION

  NADIA WAUQUIER’S CARGO CONTAINER

  10:30 p.m., June 22

  Three hours later, after two tests, Nadia hadn’t seen an Ebola signal in Moses’s blood. She felt very calm. The virus could be in Lina’s blood but at least there wasn’t enough of it to trigger a signal. Nadia called Lina and told her the results. Lina was somewhat relieved. For most people, trying to imagine oneself with all the symptoms wasn’t something that was easy to confront mentally.

  The next morning, though, Lina was worse, sicker than the day before. She was running a high fever and was extremely weak, with vomiting and diarrhea, and with severe abdominal pain. She refused any more blood testing and went back to work in the crisis center. Her husband and daughters had absolutely no idea of her situation. After forty-eight hours, when her symptoms didn’t progress, Moses concluded that she probably didn’t have Ebola. But she was still very sick.

  A few days later, a doctor from the World Health Organization finally arrived to bring help to Humarr Khan. He was a U.S. Navy physician named David Brett-Major. He examined Lina and gave her an antibiotic, and her symptoms abated. Afterward, Brett-Major set to work in the Ebola ward, doing what he could. He was distressed by the situation, and disturbed by what he felt were serious lapses of biosafety. The nurses were supposed to spray their hazmat suits with bleach before they took them off, but often the bleach sprayer was out of bleach, or the nurses didn’t bother to spray themselves.

  * * *

  —

  Then a man who worked as a nursing aide in the maternity ward tested positive for Ebola and later died in the Ebola ward. This was the second member of the Kenema medical staff to die of Ebola—the first victim had been the ambulance driver Sahr Nyokor. The maternity aide’s death terrified the nurses who were still working. If somebody working in the maternity ward could catch the virus, anybody on the staff could catch it anywhere in the hospital.

  As news of the aide’s death spread, a teenage boy suddenly walked through the hospital gates and began shouting. He was a wiry stick of a kid, about eighteen, and his name was Wahab. Wahab was known around Kenema. He was an herbalist who treated sick people with preparations made from plants, and he was considered to be a visioner who could see into the future. There were people in town who thought that Wahab was a little crazy, while others believed that Satan had gotten into his mind and made him confused. Still others believed that Wahab really could see the future, and that his visions were significant and powerful. Wahab paid house calls. If you wanted to know your future, he would show up at your door, if he chose to. He didn’t charge money for his visions, he gave them for free, and only if visions came to him.

  According to Wahab the Visioner, fate was real but it wasn’t absolute: One’s fate could sometimes be changed. If you were fated to have something happen to you, Wahab could see your fate hanging in the future, but he also sometimes saw a way you could change your fate.

  Now, he began walking around on the paths outside the hospital buildings, and he lingered at the maternity ward. “Oh!” he shouted in a piercing voice that carried into the maternity ward. “Oh! A nurse has died here!” (He was speaking in Krio—his words are an English translation provided by a member of the hospital staff who heard Wahab speak.)

  “Three nurses will die!” Wahab shouted. “One nurse has already died! Two more will die! Three nurses will die! This cannot be changed!”

  This was the unchangeable future he saw, that three nurses were fated to die. One nurse was already dead, and two more nurses, the fated ones, were doomed, though Wahab didn’t say who they were. Wahab began walking up and down the walkways that joined the wards together, circling the wards and speaking his vision in a wild voice, saying that two more nurses were going to die. His voice carried into the wards and was heard by nurses and patients.

  Then Wahab offered the hospital his vision of how to change fate. “All the living nurses at the hospital must do sacrifice or prayer!” he cried. “You must do a ceremony!” If the nurses failed to do a ceremony as he recommended, then many more nurses were going to die, many more nurses than just three would die. But no matter what the Kenema nurses did in a ceremony, three of them were fated to die. “Even if you can make that ceremony or you don’t do it, three nurses are going to die,” he shouted. “But if you don’t do that, if you don’t make the ceremony, many nurses will die! You must do a sacrifice and prayer!” Then, as suddenly as he had appeared, the boy slipped out through the hospital gates and disappeared into the city.

  Wahab’s vision frightened the nurses who heard him speaking—those who were still working at the hospital. His word of prophecy went around the hospital quickly, and it went around the nurses’ families in the city. Wahab had been vague about certain details, however. He hadn’t explained what he meant by a “ceremony” or a “sacrifice.” It wasn’t clear exactly what kind of a ceremony Wahab wanted the nurses to perform in order to prevent many more nurses from dying. And he hadn’t identified the two nurses who were doomed no matter what, the ones who couldn’t escape their fates. The nurses wondered who among them were the two who couldn’t escape death.

  The next morning—a Friday—a crowd of nurses gathered in a dusty, open area near the maternity ward, where the dead maternity aide had worked. They offered Christian and Muslim prayers, and sang hymns, and they offered penance to God, asking God to forgive them for their sins and to spare them and the hospital from more deaths.

  Lucy May, the pregnant nurse who had taken care of the ambulance driver as he died, may have been in the crowd that morning. She may have sung hymns with the nurses, since she had a fine voice and sang in the cathedral choir. Eight days earlier, she had wiped blood from Sahr Nyokor’s
head just before he died of Ebola. Since she was a night nurse at the Annexe ward, Lucy May would have just gotten off her shift on the morning of the “sacrifice.” But she was close to the end of her pregnancy, and since she was expecting a baby soon, she may have skipped the ceremony and gone home right after her shift ended, and she may not have been feeling very well.

  At eight o’clock that evening, Lucy May didn’t report to work in the Annexe ward for the night shift, which was her regular shift. Her colleagues assumed that her pregnancy was bothering her. The next day, Saturday, she stayed at home in bed all day, and by then she wasn’t well at all. On Sunday morning she didn’t attend mass or sing in the choir at St. Paul’s Cathedral. By Sunday night Lucy May was desperately ill. Somebody in her family called the hospital for an ambulance, and she was admitted to the Annexe ward, her place of work.

  She was put in a semi-private room, and Dr. Humarr Khan examined her. Because she was a member of the hospital staff, Khan became her attending physician and paid close attention to her. By now it was clear to Khan that she might have symptoms of Ebola, and he ordered a blood draw so that she might be tested. Even if it was suspected she had Ebola, she had to remain in the semi-private room in the Annexe ward. It would have been unethical to put a pregnant woman in the Ebola ward without a blood test proving she had Ebola. If she wasn’t infected but they put her in the Ebola ward, she and her baby would certainly catch the virus.

  Ebola virus is known to be nearly one hundred percent fatal for pregnant women and their unborn babies. The virus typically kills the baby inside the womb, and triggers flooding hemorrhages from the birth canal as the baby is being born. The baby, itself infected with Ebola, is either stillborn or dies shortly after birth. This aspect of Ebola disease has been known to doctors since 1976, when Sister Beata, the midwife of Yambuku, delivered at least two babies during hemorrhagic childbirths. It has also been known since the death of Sister Beata following those deliveries that Ebola virus is extremely dangerous for medical caregivers who come into contact with blood or body fluids of an Ebola-infected pregnant woman during childbirth.