Ebola, Marburg and HIV-AIDS

Review: The Hot Zone by Richard Preston

A classic NCIS episode¹ I watched again this week focused on an anthrax attack that took down two of the agents. Marburg deaths have been slowly increasing in Angola over the past decade and AIDS statistics on the continent continue to amplify. Whether news or fiction, virulent infections capture our attention.

The fear of plague is deeply rooted in us. The thought of a disease that wipes out one in five, one in three, or nine of ten panics us, even when the infection is happening in a remote part of the world and is nominally under control. 

How much more terrifying is the realization that there is no part of the world remote enough to contain contagion? That these agents enter our borders daily, taking up residence in our population centers, smoldering unrecognized?

The chilling tale in Preston's book is a true story, lightly fictionalized in its details, and vastly amplified in the disturbing coincidences it presents. It opens with the description of a death in western Kenya, a horrifying account of how the Marburg virus kills. We meet Charles Monet, who dies in a gruesome fashion in a hospital in Nairobi. We meet the physicians and nurses who contract the disease from him. 

More horrifying, we learn that Marburg is the least lethal filovirus of three related agents. Ebola Sudan, which surfaced in the war zone of southern Sudan, kills half of those infected. Ebola Zaire kills eight to nine of ten infected. In this context, Marburg is relatively safe, killing "only" an average of one in two infected. (Unfortunately, one current strain in Angola is much more virulent; in May 2005², for example, the WHO reported that 276 of 316 reported Marburg cases were fatal. That's 87%, beginning to rival Ebola Zaire!)

I first read Hot Zone in 1999, when bioterror was a collegium topic rather than a keyword in current events. The tale of the discovery of a fourth filovirus—Ebola Reston—in a monkey house on the outskirts of Washington, D.C. was an eye-opener for all. Preston's dry, matter-of-fact style gives the already-chilling tale a liquid-helium twist. See, he says on more than one page, we dodged the bullet this time. Next time, we might not be so lucky. The tale of the discovery, containment and disinfection of the building is interspersed with equally factual tales of the devastation wrought by Ebola and Marburg in Africa.

We are already seeing the slow spread of a much more lethal agent, HIV-AIDS³, through the human race. AIDS is more successful than Marburg or Ebola, Preston argues, because it doesn't kill so swiftly and nastily. The virus has much more time to transmit itself. As horrifying as death from AIDS can be, the early stages of the disease may actually make the victim more capable of infecting others, especially in cultures where a slender physique is considered attractive.

Even so, the plague Preston details in this book is terrifying enough, an Ebola-like infection that travels through the air like the common cold, killing 100% of the non-human primates who are exposed to it. This particular game of Russian Roulette turned out to land on an unloaded chamber for the human race.

Do we really want to keep playing?

Liner Notes

1. It was NCIS Season 2, Episode 22, "SWAK." Tony got the anthrax-laden letter.
2. The most recent Ebola outbreak was brought under nominal control in June of 2016.
3. In July 2016, WHO warned of growing HIV-AIDS drug resistance.