Crisis in the Red Zone

by Richard Preston

  She waited an hour and called him again. Still no answer. She began calling all three of his cellphones, in case one of them had run out of charge or something. There was still no answer. She kept calling his phones all day, getting more and more worried. Finally, after dark, she phoned the ambulance driver who drove Khan to the hospital in the mornings. “What is happening with Dr. Khan? I have called him ten times.”

  Doctor had stayed at home today, the man said.

  She realized that he had been seeing her number coming up on his caller I.D. all day, but he hadn’t been answering. Why? Why wouldn’t he answer? A terrible fear gripped her, and her body began shaking. Then her phone rang. It was Khan. “I have a fever,” he said.

  It was a brief call. Afterward, Simbirie Jalloh couldn’t stop shaking. She told her mother that she would return to Kenema immediately. She could not desert Khan after all.

  SCREAMS

  EBOLA WARD

  About 10 a.m., Sunday, July 20

  Next morning, while Simbirie Jalloh was riding in a taxi on her way to Kenema, a blood technician visited Humarr Khan on Sombo Street and drew a sample of his blood and brought it back to the Hot Lab. Just as the Hot Lab people had started testing Khan’s blood, Auntie went into cardiac arrest in the Ebola ward. An Ebola nurse named Alice Kovoma, who was tending her at the time, shouted for help, and she and the WHO doctor David Brett-Major started chest compressions on her and managed to resuscitate her. Auntie continued breathing on her own afterward, but she was in a coma. Alice Kovoma and another Ebola nurse named Nancy Yoko stayed at Auntie’s bedside, doing whatever they could to keep her alive. They couldn’t rouse her to consciousness.

  The news that Auntie Mbalu’s life was hanging on a thread in the Ebola ward raced through the city of Kenema. The city revered her. Within minutes, worried people began coming in through the hospital gates and gathering in front of the Ebola ward, anxious for any news about Auntie’s condition. Many nurses and hospital staff were mixed in with the crowd, wearing civilian clothes—they had stopped working at the hospital. The crowd grew larger, and it began to get agitated.

  People felt that the nurses’ candlelight vigil had failed. Wahab the Visioner’s prophecy had come to pass. More nurses were dying of Ebola, and now Kenema’s Auntie could die. The crowd got bigger, and louder, and shouts came out of the crowd. Auntie could not die. Incompetent fools on the hospital staff had let the virus spread all over the hospital, and now it had gotten into Auntie. If Auntie died, there was going to be payback, they shouted.

  At about one o’clock a rumor went through the crowd that Auntie wasn’t in a coma, but that she had been dead for many hours. The rumor had it that the hospital staff was hiding the truth, afraid to announce the news for fear the hospital would be attacked by the mob.

  There were young men in the crowd, hotheads. They began shouting that if Auntie was dead and the staff was lying they would burn the hospital to the ground. The nurses had brought the virus to Kenema, the men shouted. The hospital staff was responsible for all the deaths in Kenema. And now they had killed Auntie. The young men whipped the crowd into a mutinous rage, and it grew larger and larger as more and more people joined the mob. The crowd had the numbers and the passion to destroy Kenema Government Hospital.

  In the crisis center in the Library, Lina Moses heard the shouting and noise of the crowd around the Ebola ward. Mbalu Fonnie and her late husband Richard Fonnie had a teenage daughter named Martiko. Moses suddenly realized that Martiko was probably near the Ebola ward waiting for news of her mother. Martiko could be in danger, she thought, because the crowd was sounding violent. Lina ran out of the crisis center and up the hill to the Ebola ward, shouting, “Martiko! Martiko! Where are you?”

  She found Auntie’s daughter alone in the crowd, with nobody to protect her, and she was sobbing. People in the mob were shouting that Auntie was dead.

  Lina wrapped her arms around the girl and held her. “Mbalu isn’t dead,” she said to the girl. “If your mother was dead I would know.”

  Just then, a series of piercing shrieks came out of the Ebola ward. Two nurses were screaming.

  Lina knew immediately what it was. She kept her arms wrapped around Auntie’s daughter.

  The crowd paused in its agitation, and grew momentarily quiet, listening to the screams coming out of the ward. The nurses’ screams went on and on, an aria of unfathomable loss. As the cries fell over the crowd, their meaning began to sink in. Auntie had just died. The nurses’ cries wouldn’t stop, and they seemed to cool the crowd like falling rain. Sounds of weeping started in the crowd, gusts of sobs, until the entire crowd was in tears, and the mob collapsed in upon itself, all of its anger gone. The shrieks of the nurses kept coming out of the ward.

  Lina Moses began to worry that something dreadful was happening inside the building. She told Auntie’s daughter that she’d be right back. And then she ran straight through the doors of the Ebola ward and into the red zone.

  There was no time to put on safety gear, not even rubber gloves. Lina ran down the narrow corridor, past the cubicles, headed for the screams, trying not to notice too much around her, trying to keep herself focused on getting to the nurses. The smell was beyond description. Patients were naked, or were lying in soiled clothing. She saw red eyes, people near death, people dead, filth and liquids on the floor, which was slippery under her hiking boots. Moses had always told herself that she had good instincts for knowing where the virus was and where it wasn’t, and now she knew where it was. The virus was everywhere around her, on every surface, every bed, every person, every wall. The ward was a melted reactor core of virus, and she ran through it toward the screams, trying not to touch anything.

  LAST OFFICES

  EBOLA WARD

  1:30 p.m., July 20

  When Lina Moses reached the nurses they had moved away from the nook where Auntie lay, and they were crying out uncontrollably. Moses knew them well—Alice Kovoma and Nancy Yoko. The two nurses seemed paralyzed with shock and grief. They couldn’t look at the body of Auntie or go anywhere near it.

  Moses took the nurses lightly by the arms, touching the sleeves of their Tyvek suits. She said that their cries were upsetting the crowd, and she persuaded them to move inside a room. Then she closed the door of the room and went back through the ward and out the door. She had been inside the ward for just a few minutes, but she had touched the nurses with her bare hands. Their suits were heavily contaminated, because they had been working on Auntie, trying to save her.

  As soon as she got outdoors, Moses went to a barrel of bleach water that was standing outside the Ebola ward, and she washed her hands in the water. Then she returned to Auntie’s daughter, who was sobbing. Lina Moses didn’t know what to do, she felt useless around death. It occurred to her that maybe the girl would like a soda. There was a man who sold soft drinks, and she thought he might be nearby. “We need a Fanta!” she shouted.

  The soft drink man heard her, and he brought two cold bottles of Fanta and opened them. Moses led Auntie’s daughter down the hill to the unfinished buildings of the new Lassa ward, and they sat down not far from Khan’s smoking chair and drank the sodas.

  Michael Gbakie watched them as they walked, and he saw how they were crying. He felt like crying himself, but he couldn’t. He was Humarr Khan’s deputy. He had been working at the hospital, getting two or three hours of sleep at home, then riding his motorbike to the hospital in the middle of the night, dealing with constant emergencies. Khan was at home getting tested for Ebola and Auntie was dead. When everybody is in tears, he thought, somebody has to see to what is happening. What are the things that need to be done? Someone had to do the last offices for Auntie. Feeling as if he was the last man standing on a battlefield, Michael donned a set of PPE and entered the ward. He found Alice Kovoma and Nancy Yoko standing in the room where Moses had left them, crying and terrified. Now that Auntie was de
ad, nobody was safe. We’re going to die, they said to him.

  He agreed with them: They were all at risk. “You know, it is not easy,” he said to the nurses. “It is not easy.” They would have to prepare the body because they were the ones who were left alive and were able to do it.

  Alice Kovoma finally agreed to go with Michael to the body. When she said she’d help, Nancy Yoko said she’d help, too. The two nurses and Michael went into the nook where Auntie lay on the cot. They sprayed her body with bleach and moved it into a body bag, leaving the bag outside the Ebola ward to be collected later by the morgue team.

  There is something more to be said about the two nurses who tried to save Auntie. Alice Kovoma was a slender, beautiful woman in her forties, with a sparkling personality. She was well-liked and admired, and she had worked in the ward for many years. She had tried to save Dr. Conteh as he died in the ward, and had wept over him. Five days after she tried to save Auntie, she tested positive for Ebola. Two weeks later, on August 5, she died in the Ebola ward among the patients, in the place where she had served.

  Nurse Nancy Yoko continued to work in the Ebola wards. Later in the outbreak, she became the director of Ebola nursing at the Kenema hospital: She replaced Auntie. One day during the crisis, Yoko told a British colleague that she intended to work in the Kenema wards until the virus was extinguished. “I will not go far from Ebola,” she said to her British friend. “I’m here until we get Ebola finished in this country. I have the faith, that is all.” Not long afterward, on September 14, 2014, Nancy Yoko developed symptoms of Ebola disease, and she died a week later in an Ebola ward among her patients, just as Mbalu Fonnie and Alice Kovoma had done.

  * * *

  —

  At about nine o’clock on the morning after Auntie died, a Hot Lab technician phoned Simbirie Jalloh. “Dr. Khan is positive,” he said.

  An explosive anger came over her. She felt that the entire hospital and Dr. Khan had been abandoned by international authorities. Abandoned to die.

  Shortly afterward, Khan phoned the Ministry of Health and informed them that he had Ebola. Half an hour later, one of his phones rang. It was the president of Sierra Leone, Ernest Bai Koroma, wanting to speak with him.

  FREEZER

  SOMBO STREET, KENEMA

  10 a.m., Monday, July 22

  President Koroma told Humarr Khan that he had just spoken with Dr. Margaret Chan, the director-general of the World Health Organization, and that she had supported a direct request for help from the WHO in getting Khan evacuated from Sierra Leone. If Khan could be flown to Europe or the United States, he would receive the best possible medical care. He also might have access to experimental drugs and treatments that weren’t available in Sierra Leone.

  The minister of health, Miatta Kargbo, was on the line. “We will have a plane waiting on the tarmac for you,” she said to Khan.

  Joseph Fair, Khan’s friend, who was working at the Ministry of Health, was also on the line, listening, though he didn’t speak. As the call ended, Fair privately asked the government officials if he could have a word with Dr. Khan. The president and the minister of health signed off. Fair waited for a moment and then identified himself. “Cee-baby, it’s me, Joseph. How are you feeling?”

  “I’m feeling tired. I’m not acutely sick yet.”

  “I need you to stay strong and remember how much we’ve been through together.” Fair knew that Khan had important decisions to make, so he got ready to say goodbye. But Khan wanted to talk about something.

  He told Fair that he’d been reading up on experimental treatments for Ebola. He had been looking for some drug or vaccine that might help his patients. And now he was the patient. He had concluded that there were three plausible options for treatment. There was the experimental vaccine called VSV-ZEBOV (this was the vaccine that Gary Kobinger and his colleagues were developing in Winnipeg). Khan understood that the vaccine might save a person’s life even if the person was already infected with the virus. In addition, there were two drugs that showed some promise, in Khan’s view. One was called TKM-Ebola and the other was called ZMapp. “If it was up to me, I would comfortably take any of these,” Khan said to Fair. He added that he was leaning toward ZMapp. The drug had been able to cure some guinea pigs. He asked Fair what he thought.

  Fair didn’t know what to say. He had heard of ZMapp, but he didn’t know anything about it. He didn’t even know how it was supposed to be administered to a human. “I have no idea what it would do to you,” he said to his friend. “You might go into anaphylactic shock and die in five minutes. And then you would be Experiment Number One.”

  “What would you do, Joseph?”

  Fair silently interrogated himself. What would he do if he had Ebola? “It’s a miserable fucking death,” Fair explained later. “I’ve seen it when it was my friends dying. Humarr had seen his friends die of Ebola, and he knew what was coming. There’s a saying among Ebola experts that if we get Ebola we’ll fall on a needle. Any needle.”

  After some hesitation, Fair gave Khan an answer. “I personally would take ZMapp.”

  Khan wanted to know more about the drug. “Will you send me the scientific papers on ZMapp?”

  Fair promised he’d gather up the scientific papers on ZMapp and send them to Khan in an email. At that moment, what neither Joseph Fair nor Humarr knew about were the eighteen monkeys that ZMapp had cured no matter how sick the animals had been. The Wow experiment had been finished just three weeks earlier and hadn’t yet been published. Only a few experts knew about it. Humarr Khan also didn’t know about Course No. 1 of ZMapp, which had been deposited in a freezer in Geneva.

  10:45 a. m., July 22

  After the phone call with the president, Khan made a decision to be transported to the Ebola Treatment Center of Doctors Without Borders in Kailahun, Sierra Leone, a town in the Makona Triangle. He didn’t want to be placed in a ward in Kenema where conditions were horrific and where he would be cared for by his own nurses, who would be demoralized to see him sick. The Doctors’ camp was equipped with elements of basic care. It also had European and American managers and doctors, who were working alongside paid local staff, who were mainly Sierra Leonians. Khan figured he could spend a short time in the Doctors’ camp until he could be airlifted to a hospital in Europe or the United States.

  His three phones were ringing constantly. He was losing energy, getting sicker. He didn’t want to talk on the phone. He gave some money to his houseman Peter Kaima and told him to go to the shops and buy him a cheap cellphone. It would have a new number, a secret number. He would share the number only with a handful of people. He especially didn’t want his parents to find out that he had Ebola. His mom and dad were in good health, still living in their small house on the edge of Freetown Bay. His dad was ninety-nine, though, and Khan feared the news could kill him.

  He could hear a crowd gathering in the courtyard. He stayed indoors. An ambulance arrived, and the crew, wearing PPE and carrying a stretcher, entered the house. They found Khan lying on his bed, fully dressed. They helped him put a bio-hazmat suit over his clothing, and a mask and gloves, so that he wouldn’t spread the virus to others. Then they carried him out of the house on the stretcher. When the stretcher men emerged from the house carrying Khan dressed in a hazmat suit, the crowd erupted with cries and sobs.

  Khan asked the ambulance men to stop, and he got off the stretcher and stood up. “Gentlemen, don’t worry. I’m going to come back,” he said to the crowd. Then he walked to the ambulance and climbed into the back and lay down on the gurney. Khan’s houseman got into the ambulance with the driver. It pulled out of the courtyard and went north along Hangha Road. An hour later, driving on pavement, the ambulance crossed the Makona River on a bridge. The pavement ended after the bridge. The ambulance slowed down and began creeping along a dirt road that wandered into the Makona Triangle.

  MONROVIA, LIBERIA


  11:35 a.m., July 22

  While Khan’s ambulance was leaving Kenema, Lisa Hensley was traveling through Monrovia in a four-wheel-drive vehicle owned by the U.S. Embassy, with an Embassy driver. She was on her way to the Eternal Love Winning Africa Hospital, situated along a beach on the Atlantic Ocean just south of the city. Hensley and her Liberian colleagues had been testing blood samples that were being sent to them by doctors at ELWA Hospital, and Hensley wanted to visit the operation. An Ebola ward, being run by the Christian medical relief organization Samaritan’s Purse, had been set up in the hospital’s chapel.

  The Embassy vehicle stopped near the chapel, and Hensley got out. The chapel, a small, whitewashed building with a cross on it and a wide-spreading roof, was surrounded by white plastic barriers, and it was full of Ebola patients. Hensley met the head of the Ebola ward, a physician with Samaritan’s Purse named Kent Brantly—a thin, tall American in his thirties, with sandy hair and a neatly trimmed beard. Samaritan’s Purse medical staff, Liberians and Americans dressed in PPE, were going in and out of the chapel through designated entry and exit points. At the ward’s exit point, the medical workers were having their suits decontaminated with bleach spray by decontamination staff.

  Kent Brantly was very busy. He needed to go inside a supply storeroom to work for a while. Hensley offered to help. They went into the room together and moved boxes of medical supplies from place to place as they talked. Afterward, they went out into the sunshine, and Hensley took a picture of Kent Brantly with her phone. That evening, at her hotel in Monrovia, she took out her phone and looked at the pictures she’d taken that day. Kent Brantly had seemed fine in the storeroom, but as she looked at the photo she’d taken of him, she noticed that he had dark circles under his eyes, and he looked terrible. It had been dark in the storeroom when they were talking and working together, and she hadn’t noticed how tired he looked.