Crisis in the Red Zone

by Richard Preston

  When Ruppol and Raffier arrived at the Bumba hospital, they discovered that there were only two patients in the hospital with the disease. They were a husband and wife, and they had been isolated in a room. The man was the headmaster of the Yambuku boarding school, and the wife was a teacher and administrator at the school. They had caught the virus from their six-month-old baby, which had died.

  Ruppol and Raffier paused outside the door of the couple’s hospital room. Clearly there was something infective in the room. They hadn’t brought any bioprotective safety supplies with them except for rubber gloves. They put on the gloves and entered the room cautiously.

  The woman was lying curled up in bed, on a plastic mattress pooled with urine, begging for help. Her husband was sitting on a lounge chair facing her. One of his legs was bent, with the foot planted on the floor, while the other leg was extended straight out. One arm was bent at a right angle and propped on the arm rest, and the hand of that arm was clenched into a loose fist. He was perfectly motionless. The chair and floor were splashed with liquids of various colors. The man’s face was a blank mask, and his eyes were carnelian stones, fixed on his wife.

  Ruppol and Raffier inspected the patients but didn’t touch them, and they were very mindful of the liquids that were splashed around, since the agent would certainly be in the liquids. The patients were in dreadful trouble, but Ruppol nevertheless felt encouraged by what he saw in the room. This confirmed the reports: The agent caused large amounts of liquids to flow and be expelled from the body. This suggested that the agent was transmitted through contact with blood and body fluids. This relieved Ruppol.

  The real worry would be if the agent traveled through the air. If it was airborne, you could catch it by breathing the air near somebody who had it. In which case this hospital room would be very dangerous to anyone who walked into it and inhaled its fetid air. The air of the hospital room would also be dangerous to the human population of the region, because the virus in the room could spread easily to people, who could spread it easily to others who breathed the air near the infected ones.

  The patients seemed beyond medical help. Ruppol and Raffier were doctors. It would be extremely unethical to examine a patient and then just walk out of the patient’s room with no intention of coming back. They went out of the room and got water and food, and brought it back to the couple. They posted a police guard by the door with orders to let nobody enter the room. This was to prevent anyone else from having contact with the infectious agent inside. Ruppol had no idea what was in the room. What was important was that he and Raffier had guessed how the agent moved. It was present in liquids that poured out of the body. To stop it you had to stop people from touching the liquids.

  It was getting on toward noon, and they needed to be at the marketplace for the big meeting. When Ruppol, Raffier, and Buassa got to the market, hundreds of people had already gathered, waiting for the doctors to tell them what was going on. The crowd was agitated and confused, gripped by fear. Ruppol borrowed a table from a vegetable seller and stood on top of it so that everybody could see him. He waited a few moments for the crowd to fall quiet, and then he began to speak. He used Lingala, a regional language. “Today,” he said, “we will talk about a disease.”

  THE ANCIENT RULE

  MARKET, BUMBA VILLE

  Noon, October 5, 1976

  “It is a serious, transmissible disease,” Ruppol continued, speaking in Lingala, as he stood on the table in the Bumba marketplace. “How does it spread? It spreads through contact with sweat, saliva, and the other liquid humors of the body.” He had seen these liquid humors in the hospital room, and the humors had come out of every opening in the patients’ bodies. “The disease will be very difficult to stop,” he went on. “What can YOU do to stop it? First, you must pay attention to a sick person.” Then he listed the symptoms of the disease, exactly as he had just observed them in the hospital room. “You must avoid close contact with a person who has this,” he said.

  “Now, the second thing you must do,” he went on, “is pay attention to the dead. You must not use the traditional method of preparing a dead body for burial. You can gaze on the body of a dead person, no problem there, but you must not embrace the dead. You must not touch a dead body except with rubber gloves, and you should bury the body as soon as possible.”

  Then he went on to recommend a traditional method called the Ancient Rule that people could follow to protect themselves from the unknown disease. As Ruppol wrote in his journal:

  By chance, I knew that for many centuries the population of that region had had a customary experience with another disease, smallpox, which was both fatal and highly contagious, and has now been eradicated. Whenever there was an epidemic of smallpox, people who were suspected of having the disease, and their young children, were placed in a hut that was constructed outside the village. The hut was stocked with a supply of water and food, while any physical contact with the victims was forbidden. After a certain amount of time, if anybody in the hut had survived, they were allowed to come back to the village. When there were no more signs of life in the hut, it was burned, with the corpses in it.

  “You must apply the Ancient Rule for this new disease,” Ruppol told the crowd. He didn’t need to explain the Rule to the people of Bumba. They already knew the Rule, just as many of the older people of Bumba knew smallpox. The virus had been eradicated in the central Congo region during the 1960s, though pockets of the virus remained into the 1970s.

  Smallpox virus is transmitted from person to person through the air. The particles are embedded in microscopic, invisible drops of moisture that come out of an infected person’s mouth when the person is talking or simply breathing. Smallpox is also easily transmitted through contact with pus and scabs.

  When smallpox erupts in a person’s body, the body becomes covered with tense, pus-filled blisters, called pustules, and a sweet, sickly odor comes off the body. The pain of the pustules is said to be extreme. If the pustules merge into a confluent mass across the person’s skin, especially on the face, the person typically dies. If there are no blisters and the skin remains flat but darkens and develops a corrugated or charred appearance, and there is hemorrhaging into the eyeballs or from the orifices of the body, the patient has a 100 percent chance of death. Smallpox is highly contagious. If somebody with smallpox is in one room in a house, people who are in other rooms in the same house can catch smallpox without ever having seen the face of the person with smallpox. If an unvaccinated person catches smallpox, their chance of death is roughly 33 percent, or one chance in three. There is a vaccine for smallpox. The worldwide eradication of smallpox, led by a small team of doctors at the World Health Organization, and accomplished by tens of thousands of vaccinators, is the greatest achievement in the history of medicine.

  In 1976, older people still remembered smallpox, and they knew the Ancient Rule. Ruppol assumed that they would teach the younger people about it if the younger people didn’t already know. After Ruppol gave his speech in Lingala, he repeated it in French. Then some nurses from the hospital repeated Ruppol’s speech in the local language, Budza. Don’t touch anybody who has the disease, don’t embrace the dead, bury them right away, and follow the Ancient Rule.

  * * *

  —

  The next morning Dr. Buassa began going around Bumba Ville educating townspeople about the disease and searching for possible cases. Ruppol and Raffier returned to the hospital to check on the married couple. They also wanted to collect samples of their blood. When they arrived, they found that the guards stationed by the door had left. They looked in the room. Nothing had changed, it was all the same. The wife was still lying on the bed in a fetal position, and her husband was sitting in the lounge chair facing her in exactly the same position as they’d left him the day before, with one foot planted on the floor, his left arm still bent at a right angle, and his fingers curled in a loose fist. They were
both dead.

  Ruppol and Raffier didn’t want to move the corpses far, since they were obviously dangerous. But they had to be buried. The doctors looked around the hospital for somebody who’d help them dig the grave. Nobody wanted to help, so the doctors found a shovel and started digging a sort of trench. But it was a hot day, and they didn’t progress far.

  The commissioner of Bumba Zone was a man named Citizen Olongo. He worked out of an office in the center of town. Dr. Buassa went to Citizen Olongo’s office to see if the commissioner could find them a proper gravedigger. The commissioner sent word into the town that there was an urgent need for a gravedigger at the hospital.

  There was no response. The town’s gravediggers all seemed to be busy just then.

  At that point the commissioner sent word to the town jail: He would liberate any prisoner who was willing to dig the grave at the hospital. To the last man, the prisoners refused. They would rather rot in a Congolese jail than get near a corpse with the deadly illness.

  Ruppol and Raffier were at a loss, but then a young man named Mando Lingbanda, who was a janitor at the hospital, came forward and said he’d help with the grave. Mr. Lingbanda got to work, and he dug a deep trench, but as the hole got deeper the doctors began to feel awkward. The janitor, somebody told them, was a person locally described as the “town simpleton.” The doctors got concerned and began to wonder if Mr. Lingbanda really understood what he was doing near this virus. I think we should give Mando Lingbanda full credit for what he did. Of course he knew what he was doing, he was digging a grave for some people who had died horribly. Mando Lingbanda goes down in the history of the Ebola wars as the one man in Bumba who had the courage and kindness to give two Ebola victims, a married couple, educators, who had loved and cared for each other and their child to the bitter end, the simple honor of a grave.

  After the trench was finished, Ruppol and Raffier stripped off their clothes and put on complete surgical outfits, including disposable paper scrubs, a head covering, rubber gloves, surgical masks, and shoe covers. Then they went into the hospital room to collect the corpses. By this time, the cadaver sitting in the chair had gone rigid with rigor mortis. Given the man’s pose, it was obvious that there would be a problem fitting him into the trench. Ruppol tried to straighten out the man’s bent arm, but that proved to be impossible. And there was no way he could straighten out the bent leg that had its foot planted on the floor. Finally, very carefully, the two doctors lifted the body off the chair in its frozen position, carried it to the trench, and dropped it in. The body ended up sitting in the grave, with the half-closed fist raised in the air. They placed the woman in the trench, still curled up like a baby. Then Mando Lingbanda shoveled a light covering of earth over the bodies, and the doctors poured gasoline into the grave and tossed in a match, and the grave erupted in fire. The doctors’ last sight of the married couple was the man’s hand reaching out of the flames as if he were asking for help. The sight haunted Ruppol.

  Dr. Buassa remained in the town while Ruppol and Raffier flew in a military helicopter to Yambuku Catholic Mission to check on the situation there. At Yambuku, 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 it. 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.

  Ruppol, Raffier, and Buassa visited houses of sick people in Yambuku and collected many samples of blood from the patients. They also collected blood from a few people who had survived the illness. It was known as survivor blood. The survivor blood could be used to identify the X virus that was killing people in Bumba Zone. When a person is sick with a virus, their immune system produces antibodies to the virus, which are proteins that stick to the virus particles and kill them. The antibodies in the survivor blood would react to the X virus. This was very important for identifying the X virus.

  Ruppol and Raffier ended up crisscrossing Bumba Zone by helicopter, traveling with Dr. Buassa. The doctors visited seventeen towns and villages, and they gave speeches and provided information about the virus in every place they landed, speaking in local languages. Know what it looks like. Don’t touch a person who has this. Don’t embrace the dead. Bury the dead quickly. Follow the Ancient Rule.

  They returned to Kinshasa by helicopter, bringing with them a number of vacuum flasks full of glass tubes of blood they’d collected. The doctors transferred some of the blood into new tubes, packed those tubes in dry ice, and shipped them by air to the Pasteur Institute in Paris. The Pasteur Institute quickly sent the blood along to the Centers for Disease Contol in Atlanta, Georgia.

  X VIRUS

  CDC HEADQUARTERS, ATLANTA

  October 13, 1976

  In midmorning on October 13, Ruppol’s blood samples were delivered to the Special Pathogens Branch of the CDC. This is the unit that deals with the eeriest things from the virosphere, the Level 4 demons. In 1976, the head of Special Pathogens was a doctor named Karl Johnson, a tall, bearded man with a soft voice, who had begun his career studying the common cold. Karl Johnson, however, was not a man to be content with mucus. Soon he switched to hunting for unknown jungle viruses that make people bleed. After beating around Central American rain forests, he went to Bolivia, where he discovered a virus that he named Machupo. While Johnson was in Bolivia investigating Machupo, Machupo investigated him, and he ended up in a hospital in Panama where he nearly bled to death.

  Johnson had been following the deaths in Zaire with deep interest. He soon managed to get a sample of Sister Myriam’s blood. The nun’s blood was badly spoiled, just a smear of black ooze. Nevertheless, a scientist in Johnson’s team named Patricia Webb put some of this ooze into some flasks of monkey cells, and an X virus grew in the flasks—an unidentified virus. (Patricia Webb was married to Karl Johnson at the time.) In the early afternoon, October 13, an expert in electron microscopes named Fred Murphy photographed particles of the X virus in a tiny droplet of liquid taken from one of the flasks. The particles looked like snakes.

  Meanwhile, Ruppol’s blood was sitting in a refrigerator at Special Pathogens. It had just arrived that morning. This blood was fresh and red, not black slime. It was perfect for testing—and it included some blood taken from survivors of the disease. This survivor blood had antibodies to the X virus in it. This meant the blood would react to the X virus. But it wouldn’t react to other viruses. That afternoon, Patricia Webb, working with a colleague named Jim Lange, discovered that the survivor blood didn’t react to any known viruses. Therefore the blood had been infected with an unknown virus. And therefore the virus was new to science. Two weeks later the virus would be named Ebola. Patricia A. Webb is credited as the principal discoverer of Ebola virus, along with Karl M. Johnson, Frederick A. Murphy, and James V. Lange.

  The CDC team had actually discovered a ticking time bomb. It ticked for thirty-seven years, making very few experts nervous, until
it detonated in 2014 and gave the experts a heart attack. Doctors Jean-François Ruppol, Gilbert Raffier, and Buassa played a part by collecting the blood that was the key to the discovery, and by managing to keep it cold using tanks of carbon dioxide gas. The price was the regrettable loss of two crates of French Camembert cheese rotting on the runway at Kinshasa.

  Within hours of the discovery, the CDC was preparing to rush an international virus SWAT team to Kinshasa to try to stamp out the virus before it turned into a nightmare for the human species. The director of the CDC appointed Patricia Webb to be the leader of the international team. Soon afterward, though, the director started having doubts about Webb. “This is too big for Patricia,” he stated, and he appointed Karl Johnson to lead the team instead. Patricia Webb stayed home in the lab while the men flew off to Zaire. They left Atlanta so quickly that they didn’t have time to pack any biohazard safety gear.

  A HOLE IN THE NIGHT

  KINSHASA

  October 18, 1976

  A few days later, at the whitewashed house on Avenue Mfumu Lutunu in Kinshasa, Jean-François Ruppol began packing for a second expedition to Bumba Zone, this time with the international team. Karl Johnson, the overall leader of the team, had asked for volunteers and formed them into an away team, called an epidemiology team, or epi team. Their mission would be to travel to ground zero of the disease in Bumba, trace the movement of the virus, and try to break the spreading chains of infection. Ruppol was the epi team’s fixer. He knew the country and spoke local languages, and he had already visited Yambuku and seen the disease.