Crisis in the Red Zone

by Richard Preston

  The kids backed away. They had no idea why Dad didn’t want them to touch him. He stepped off the motorbike and took off his shoes and socks. The children watched him curiously. He had been walking around contaminated areas for two days, and his shoes could be hot. He nudged his feet into a pair of plastic slippers that he’d left outdoors intentionally. There could be Ebola particles on his feet, too. The slippers would keep his feet from making contact with any surface that the children might touch. Walking in the plastic slippers, he warned the kids to stay away from him, and told them to go indoors: “Now go back na house.”

  He stashed his shoes and zipper bag in a place where no one was allowed to touch them. Then he went to the well outside his house and drew up a bucket of water, and carried the bucket to a small structure made of concrete blocks which stood near his house. It was a wash house. He went inside, carrying the water.

  BEDTIME

  May 27

  Michael Gbakie’s wash house contained a decon room, a decontamination chamber that served as a makeshift gray zone, a barrier between the virus and his family. The room contained a plastic wash tub, now full of water, along with a scrub brush, towels, and packets of alcohol swabs. Right now, nobody was allowed in the decon room except himself.

  He kicked off the plastic slippers and removed his wristwatch and set it on a dry surface. He then measured out a quantity of bleach and poured it into the water. Then he stripped off all his clothing and dropped it into the tub of bleach solution. He scrubbed his clothing with the brush, churning the clothes thoroughly. He would let them soak in the bleach water for thirty minutes. This was a validated kill time for Ebola particles. Next he slowly poured the bucket of water over himself, soaping his entire body carefully, rinsing himself, and he dried himself with a clean towel. He wiped his wristwatch with an alcohol swab to sterilize it, and put it on his wrist.

  Naked except for his wristwatch, and now presumably free of Ebola particles, Michael Gbakie wrapped a towel around himself, got his feet into the plastic sandals, and walked across the yard and went inside the house. In the bedroom, he put on clean clothes. Then he went into the parlor, and at last embraced his wife and the children.

  Zaiinab had made a dinner of cassava leaves and smoked fish over rice, with okra. Everybody had eaten except for him, so he filled a bowl and sat down. They all wanted to hear about everything that had happened on his mission into the Ebola area. He told them how the villagers had attacked the team and chased them, and how their vehicles had almost gotten torched, and how they’d discovered and lost nine Ebola patients, and how people didn’t believe that Ebola was real.

  The children were spellbound. Zaiinab got really frightened, especially when he told her that he and the team would be returning to the Ebola area tomorrow, to search for more Ebola cases. As he went to bed, Michael had a strong feeling that the situation had already gone beyond anybody’s control.

  NEW ORLEANS

  Simultaneously

  While Michael Gbakie was telling his family about his trip into the red area, Lina Moses was standing in a hallway on the second floor of the Tulane Health Sciences Center in downtown New Orleans, looking at $60,000 worth of biohazard gear and medical supplies. The stuff was sitting in many, many cardboard boxes that were piled along nearly the entire length of the hallway. She was returning to Kenema immediately. She had been home for two days.

  The American advisor to the Kenema Lassa program, a Tulane professor of microbiology named Robert F. Garry, had already flown to Kenema with a load of emergency supplies. He had authorized a large cash draw for Lina Moses and asked her to buy up every item of biohazard gear she could find on short notice, and then she was to bring the equipment to Kenema as quickly as possible. Humarr Khan and Auntie Mbalu Fonnie were going to need it, fast.

  Lina felt a mixture of fear and exhilaration as she looked at the vast amount of gear she had collected. Stacks and stacks of disposable nonpressurized whole-body hazmat suits. HEPA breathing masks. Goggles. Tall rubber boots. Nitrile surgical gloves, the kind that are resistant to tearing. Rolls and rolls of tape. You need lots of tape for biohazard work, to seal cracks and to keep a hazmat suit tight. Many, many blood draw kits, for drawing blood from patients, blood to be tested in the Hot Lab for Ebola. Infusion lines, infusion needles, and infusion bags, for administering saline solution to Ebola patients, to help keep them from getting dehydrated. Pump sprayers, for spraying bleach disinfectant. Biohazard body bags, made of white Tyvek—there were going to be Ebola deaths.

  Ever since she had been in college, Lina Moses had wanted to go up against Ebola in an outbreak. This had been her dream for years. Now it was really going to happen. It was a battle of a kind, a public health battle, and the aim was to save lives. This was Zaire Ebola, and nobody who went near it could consider themselves safe. Of course she could catch it, anybody could catch it, but Moses felt a sense of confidence in her training and experience. She was a seasoned epidemiologist, she had worked with Lassa virus for years, and Lassa was a Level 4 pathogen like Ebola. She spent the afternoon pulling things out of boxes and repacking the stuff tightly into twenty-seven plastic footlockers she’d bought at Walmart.

  She got home late. Aron had picked up the girls at school and daycare, and he’d fixed them some supper. That evening, Lina and Aron cuddled in bed with their five-year-old, Audrey, and read a book to her. Their older daughter went off to her room to read one of her dystopian sci-fi novels. There was absolutely no mention of Ebola that night in Lina Moses’s house. No mention about the fact that she was about to rush back to Africa to deal with Ebola. No use of the word Ebola. No talk about viruses at all.

  As she lay in bed next to her husband, Lina Moses felt very protective of him, and of her daughters. She really didn’t want the girls to know about Ebola. They were too young to be told much about the virus, and Aron wasn’t much interested in viruses. He had a highly visual imagination. He had painted her portrait, and he understood her eyes the way no one else did, their mix of greens and browns, the flashes of emotion that would make her eyes fill with tears embarrassingly at the wrong moment. She did not want her husband to see in his mind’s eye an image of her body and face displaying the symptoms of Ebola disease. Aron would stay at home and look after the girls and do his painting while she went to the front line.

  FREDERICK, MARYLAND

  Same night

  Lisa Hensley carried James upstairs to his bedroom and kissed him good-night, and he climbed up the ladder into his platform bed, bringing his laptop with him. Ebola was blowing up in West Africa, and a number of new cases had suddenly appeared in Liberia. She would be going back on a second deployment to the lab at the former chimp station in Monrovia. She had been paying close attention to James, wondering if he was worried about her going back to the Ebola area. This time, he didn’t seem worried at all. More like annoyed. To help cheer James up, she promised him that as soon as she got back they’d take a vacation trip to the beach in South Carolina, where they’d swim in the ocean and have a really great time together.

  * * *

  —

  The next morning, Michael Gbakie left home early on his motorbike, bringing his zipper bag with him. He would be gone for several days. Cellphone service was spotty in the Makona Triangle, so he’d told Zaiinab that she wouldn’t hear from him until he was on his way home and near Kenema, and then he’d call her from the road.

  As she watched her husband’s motorbike go down the road and turn toward the airstrip, Zaiinab Gbakie prayed for him. She was fearful that she and the children wouldn’t see him again. He was a medical officer working in the national service, and his duty was taking him into a dangerous place where he could easily lose his life.

  AMBUSH

  MAKONA TRIANGLE

  May 28–June 1

  During the next three days, Michael and the surveillance team prowled eastern Sierra Leone in several Land Cru
isers, bumping along bad roads, stopping in villages, asking questions. Quickly they found twelve women who showed signs of Ebola; some of them had been patients in the clinic and had been spirited away on motorbikes while the team was taking shelter in the police station. All of the women had been at Menindor’s funeral. The team transported all twelve women back to the Kenema hospital. Their blood was tested in the Hot Lab and came up positive for Ebola, and they were placed in beds in the ward, and were tended by Auntie and her team.

  Michael Gbakie often traveled with his fellow surveillance officer Lansana Kanneh. At times they went with the Kissi-speaking ambulance driver Sahr Nyokor. A Kissi speaker was worth his weight in gold out in the villages. But driver Nyokor was also a bit of a problem. He came from Daru, a large town on the edge of the Triangle about an hour’s drive from Kenema, and he had many friends and relatives in Daru. Quickly the team discovered several Ebola cases in Daru—the virus had already moved closer to Kenema. On May 29, Nyokor was driving an ambulance to pick up a suspected Ebola patient in Daru. The drivers weren’t required to wear PPE. They were supposed to remain inside the ambulance. The Ebola patient would be handled by team members who were suited up in full PPE. During the Daru pickup, however, Sahr Nyokor got out of his ambulance and went inside somebody’s house for a visit with friends or relatives. He evidently didn’t want to frighten his friends, so he didn’t wear PPE. Later it came out that someone in that house had Ebola.

  The day after Nyokor went inside the house in Daru, Lina Moses arrived at the international airport outside Freetown, along with her twenty-seven trunks full of biohazard gear and medical supplies. She got the stuff through customs and out to a Land Cruiser that was waiting for her in a gravel area that is always crowded with men offering to help travelers with their luggage. The men gathered around Moses, but she told them she could do things by herself, and she packed the Land Cruiser with the trunks. When the vehicle was full of trunks, she climbed up on top of the vehicle and started tying more trunks to the roof. A group of baggage handlers stood around watching. She threw a piece of rope around a trunk and cinched down the lashing.

  “Now look at that woman’s arms and shoulders,” one of the men remarked in Krio.

  “Oh, now look how strong she is!” another man exclaimed. They didn’t realize she knew Krio. “Her husband is a lucky man,” another man said. “He has such a strong, hard-working wife.”

  Moses smiled at them. She felt buoyant.

  A few hours later, Moses was in the Library of the Lassa Laboratory, meeting with Robert Garry, the Tulane microbiologist who was the principal American advisor to the Lassa program. Garry had flown in from New Orleans a few days earlier, bringing with him a large amount of biosafety gear. They planned strategy. Moses would immediately set up a crisis operations center in the Library. She would serve as the nexus of epidemiology and operational support for Auntie in the Lassa ward, for Khan, and for the surveillance team. She would keep the Lassa ward supplied with biohazard suits and medical supplies, and she would coordinate communication and operations among the disparate parts of the Lassa program. The Lassa program was the main line of defense for Sierra Leone.

  Robert Garry would pursue the virus in the laboratory. He was working closely with Pardis Sabeti, the genomic scientist at Harvard, and with Humarr Khan. They planned to assemble a collection of small samples of blood taken from Ebola patients and from people suspected of having Ebola. The blood samples would be shipped by air to Sabeti at Harvard, and Sabeti would lead the genome sequencing of the virus at the Broad Institute—to see how the virus was changing as it went from person to person.

  Robert Garry’s task in Kenema would be to collect and preserve the blood samples and get them shipped to Harvard; he would be working inside the Hot Lab. Humarr Khan and top officials at the Sierra Leone Ministry of Health were anxious to have the genome of Ebola sequenced, and so Khan and Sabeti, working with the ministry officials, would use a method of collecting blood that didn’t interfere with patient care: The researchers would scavenge samples of blood serum from tubes left over from clinical care. This material was biohazardous medical waste. “We did everything we could to make no footprint in the way we took samples,” Sabeti later said.

  In addition to working in the Hot Lab gathering blood, Robert Garry would be traveling with Humarr Khan to community health clinics in the Makona Triangle. Their goal was to educate local health workers about Ebola. Khan and Garry also wanted to view the situation on the ground, up close. Moses and Garry worked out their plans in the Library, and Moses went to work delivering hazmat suits and supplies to Auntie at the Ebola ward. By then, the ward had fifteen Ebola patients in it. The ward had only twelve beds, but Auntie had brought in three extra cots. More Ebola patients were coming in all the time. Auntie and her nurses were wearing full PPE and working hard shifts, trying to keep up, while the patients were vomiting and having diarrhea, and dying. Moses found Auntie in the foyer of the Ebola ward. The two women embraced. It was the middle of the afternoon on the thirtieth of May.

  Same time

  Michael Gbakie and Lansana Kanneh, riding in an ambulance driven by Sahr Nyokor, pulled into a village in the Kissi Teng Chiefdom called Kolusu. Kolusu sits on a steep hillside, embedded in a deep patch of forest. They had received information that one of the suspected Ebola cases who had been taken out of the clinic on a motorbike had died in the village. Accompanying them was an epidemiologist with Metabiota, the American biotech firm, with a vehicle and a driver. They parked in the forest near the village. The drivers stayed with the vehicles, ready for a fast getaway in case there was trouble. Michael and his partner advanced cautiously into the village. After some conversation, the villagers led them to a house where the body of a woman was lying on a bed. Michael and his partner remembered her face. She was indeed one of the nine women who’d been carried away from the clinic. She had certainly died of Ebola.

  They told the villagers that the body was dangerous, and should be buried immediately with special safety precautions.

  The villagers were hostile to this idea.

  “They were in serious, serious denial. We talked to them at length, and there were a lot of confrontations as it went on,” Gbakie later said. “They didn’t believe at all in Ebola. It was not an easy conversation.”

  Gbakie and his partner stayed in the village for three hours, trying to persuade the villagers to bury the corpse. Night came, but the epidemiologists made it clear that they weren’t going to leave until the body was buried. Finally two teenage boys stepped forward and said they’d do the burial. Worried about the boys’ safety, Michael and his partner got them dressed in moon suits, and they dressed themselves as well. Then they sprayed the body with bleach and got it inside a biohazard bag. They placed the bagged corpse on top of an old wooden door and carried the door with the bagged body on it to a place in the ring forest where the villagers buried their dead, and they dug a grave, sweating in their gear. By the time they had finished the grave, it was nine o’clock at night. It was completely dark in the forest, and they had no lights. They could barely see what they were doing. Just as they were getting ready to lower the body into the hole, all hell broke loose.

  The burial had been a setup. As they had worked, young men of the village had quietly snuck up and hidden themselves in the underbrush around the grave. At a signal, they began hurling rocks at the epidemiologists. Rocks the size of baseballs whipped past Gbakie and Kanneh. The two men ducked and yelled, and ran blindly into the forest and up the steep hillside, trying to find their vehicles, while the young men chased them, throwing rocks. The attackers knew the forest perfectly, and the white moon suits made good targets. Michael and his partner had no idea where they were going and they couldn’t see anything in the forest. But then the attack stopped. They had shaken off their pursuers.

  Gbakie heard a vehicle’s engine start—and then it roared off down the dirt track tha
t led to the village. It was the Metabiota team, getting away in a hurry. “They left unceremoniously,” Michael later said. He and his partner could hear Sahr Nyokor’s voice, and they ran toward it. He was shouting to them so that they could find him, and he had started his ambulance and turned it around, poised to make a getaway. They reached the ambulance just in time to be ambushed a second time. Rocks again flew out of nowhere, crashing into the doors. Nyokor gunned the engine, and the ambulance lurched forward as a rock punched a hole in the windshield, and more rocks smashed the side mirrors. Moments later they were out of the ring forest and moving fast.

  They had almost been killed. They drove back to Kenema without stopping. Michael Gbakie got home at three o’clock in the morning, deeply shaken. He went into the decon room, sterilized himself, got dressed in clean clothes, and went into the parlor. Zaiinab and one of his older sons had stayed up waiting for him, and they were dreadfully worried. Zaiinab had kept dinner warm for him, but he was too upset to eat anything, though he drank some water and tried to get a few hours of sleep. He and the team, first thing the next morning, would be driving back into the Ebola zone to continue their search for people sick with Ebola.

  He could now see the problem only too clearly: The local people didn’t believe that Ebola was real. The virus was out there, it was spreading, and the local people would become violent if the team tried to find it. It was very clear to him—after nearly being killed in a village—that his nation was heading for a disaster. All he could do, personally, was just keep working and try to keep his family safe.

  * * *

  —

  Robert Garry, the Tulane scientist, was working inside the Hot Lab, collecting blood samples from used tubes of patient blood. The Hot Lab was a small place, with a limited amount of equipment. Augustine Goba and his technicians were running a PCR machine, testing blood for the virus, so that patients who had Ebola could be distinguished from those who didn’t. Nadia Wauquier, the French scientist with Metabiota, was running tests on her PCR machine in parallel with Goba and his machine: This was to ensure that each patient got two tests for Ebola. This practice would cut down on false results, which could be fatal for a patient. If somebody tested positive but actually didn’t have Ebola, the person would be placed in the Ebola ward, where they would certainly catch Ebola. And if somebody tested negative but they actually had Ebola, the person would be sent home or placed in the general wards, where the person would spread the virus. Thus every blood test done by Augustine Goba and Nadia Wauquier was a matter of life or death. Both Goba and Wauquier, and their technicians, were under intense emotional strain, and they were handling raw infected blood. The slightest mistake with the blood and their lives could be over. Nobody working in the Hot Lab was sleeping much.