Richard Preston is the author of our Ebola nightmares. In 1994, he published the bestselling non-fiction thriller The Hot Zone, based on an earlier New Yorker article. The book inspired the hit film Outbreak, which came out a year later. At a time when the health community — and the popular imagination — was fixated on the threat of an HIV/AIDS pandemic, Preston managed to infect the American psyche with fears about a new virus.
Back then, Ebola was an extremely rare and remote scourge. The virus had affected fewer than 400 people since its discovery in 1976. It had surfaced only in Africa, most commonly in what was then Zaire (today’s the Democratic Republic of the Congo) and South Sudan.
Public-health officials didn’t really worry about Ebola going global. The virus was so violent and deadly, they believed people got too sick and died too quickly for it to have a chance to spread very far. And they knew how to contain it. Every outbreak had been snuffed out by interrupting the human chain of transmission with "contact tracing": isolating those related to the sick before they had a chance to infect anyone else.
"Ebola is a parasite that thrives on the love that exists among human beings"
But, according to Preston, the Ebola experts he talked to were "white-knuckle scared" of the virus. Preston warned that this deadly pathogen with no cure could spread across the globe, endangering mankind's very existence. Even Stephen King was frightened, calling Preston’s Ebola story "one of the most horrifying things I've read in my whole life." Preston was charged with fear-mongering and exaggerating the Ebola threat.
Today, Preston’s nightmare scenario seems less far-fetched. We’re in the midst of the largest and deadliest Ebola outbreak in history. The virus has gone global, first surfacing in December in Guinea, a country that had never seen Ebola, and then spreading to throughout West Africa and recently close to home, with three cases in Dallas, Texas. In total, there have been more than 8,000 cases this year and more than 4,000 deaths. That’s almost three times the sum total of every previous outbreak since the virus was discovered.
Preston has been watching the epidemic unfold from his home in New Jersey, and recently wrote about the latest Ebola science in the New Yorker. I spoke to him about how our understanding of the virus has changed in the last 20 years, why The Hot Zone is such a bloody book, and what most scares him about Ebola today.
Julia Belluz: In your book, you often refer to the virus as "beautiful." You have such reverence for Ebola. Of all the viruses, what fascinated you about this one?
Richard Preston: Two things. The virus is exceptionally lethal in people. There is only one virus that I know of that’s even more lethal, and that’s rabies. The death rate is 100 percent in humans. If you come down with rabies, you will die. But rabies doesn’t spread. Ebola spreads from one person to the next. It’s really a gruesome, invisible monster.
The other thing that attracted me to Ebola: the scientists themselves. They were extremely respectful of the virus. They kept telling me, "There’s a potential here for a really bad outbreak." I took them seriously back then. They needed to be taken more seriously than they were.
One of the really horrifying things about Ebola is that it’s a life form. It doesn't have a consciousness, it doesn't have anything like morality. Its main purpose is to survive and to perpetuate itself. It’s a parasite that thrives on the love that exists among human beings. If you have a member of your family who is sick with Ebola, and there’s no doctor to treat them, that person is going to die in your arms. Loved ones are dying in one another’s arms, so the virus is passed on from the dead to the living.
Julia Belluz: As someone who has followed Ebola so closely for so long, what is going through your mind as you watch the epidemic today?
Richard Preston: I was hearing all about this from Ebola experts 25 years ago. They were right. They treated Ebola with fear and respect. And the people I describe in The Hot Zone knew what would happen if Ebola popped up near Washington, DC. They could see the public fear. They knew it would be bad. That panic would be part of the equation. They also knew this virus has a real propensity to spread in highly mobile urban populations. Here in the US we have that. I’m not saying Ebola is going to spread in the US. We have a robust healthcare system and the doctors — despite mistakes — are well equipped to stop it and they will prevent chains of infection.
Julia Belluz: Viewing Ebola now, and having just researched the latest science for the New Yorker, have your fears about Ebola changed?
Richard Preston: The assumption we made was that Ebola doesn’t mutate very much. But in the New Yorker article — I’m talking to scientists at Harvard and MIT, who are studying how the genetic code of the virus is changing as it moves from person to person. Ebola is mutating rapidly. Ebola does not do a very good job of copying itself. Ebola is like a medieval monk hand copying a manuscript and as the manuscripts are copied, the monk makes mistakes and a letter is changed here or there, a word is changed here or there.
Steadily, Ebola is evolving. And it’s now spreading widely through the human population. So Ebola is learning more and more about people, so to speak. It’s encountering a new environment in humans and adapting to us. The worry and danger is that the longer this outbreak goes on and the more and more people get infected, the more chances Ebola has of coming up with a mutation that would be really dangerous for us. Bad for humans and good for Ebola.
Julia Belluz: What kind of mutation are we talking about?
Richard Preston: I don’t mean that Ebola is going to mutate so that it can spread through the air. It’s not going to do that. In order to mutate so that it becomes airborne, the virus would have to survive being dried out on to little dust particles that float in the air and get into somebody’s lungs. But Ebola is a wet virus. It doesn’t survive being dried out. In order to do that, it would have to have lots and lots of changes in its genetic code.
So the question isn’t whether could Ebola could go in the air. What scientists are seeing is blood samples that are explosively loaded with Ebola particles, super-charged Ebola. This would cause Ebola to spread more easily. But some samples are not. What they don’t know is whether this happened in previous outbreaks. They don’t have the data. Maybe in previous outbreaks, some people had supercharged blood, or maybe not. But they are finding these people who just have ten times more Ebola in their blood.
Julia Belluz: You’ve been charged with being hyperbolic about the effects of the disease. There’s a lot of hemorrhaging in your book, and yet we know only about half of Ebola patients bleed. What would you change in the book if you take a second crack at it?
Richard Preston: Yes, the one thing I would love to modify a little bit would be the descriptions of huge effusions of blood coming out of the human body. It’s certainly true there are some people who bleed to death. In particular, it’s women in childbirth who can lose all the blood in their body. The child is always lost during the process. So that’s really horrifying. There are certainly a fraction of the patients — some significant fraction of the patients — who lose enough blood that they need transfusions. They can really basically hemorrhage to death.
But the hemorrhages aren’t visually like I describe them in the book. I had a nurse weeping tears of blood. Ebola does something even more grisly: it causes leakage and hemorrhaging of blood in the capillaries in the eyes so the eyes turn brilliant red and the capillaries rupture and leak along the lining of the eyelid. If you look at a person you can see these droplets of blood on the eyelid but not tears of blood.
Julia Belluz: Why did you make bleeding seem so common?
Richard Preston: A lot of what we knew about Ebola then was what scientists were telling me they saw in monkeys. The basic scientific understanding of Ebola came from watching it in a monkey. They had not seen very many human Ebola cases. It was a very rare virus back then. Now instead of seeing one or two or three Ebola cases in a monkey, we’re seeing hundreds in human beings. What we’re seeing a lot of is occult hemorrhaging, in vomit or diarrhea. It’s just as grisly as anything in The Hot Zone.
I would love to take a crack at [updating the book]. We know a lot more about Ebola than we did 20 years ago. I would love to get some of that knowledge reflected in that text. On the other hand, The Hot Zone is a work of time and place. It reflects what the experts knew back then. So that part of the book is really the story of the book.
Julia Belluz: Another thing that changed since you published the book: most public health experts thought Ebola could never be a widespread, multinational epidemic, yet here we are.
Richard Preston: That was the belief. Scientists are human and just like the rest of us they often function on a belief system that is not well tested. They thought because Ebola hasn’t erupted into a major epidemic in the past it won’t do it in the future. And they made an assumption which turned out to be wrong that Ebola is so infective and so lethal that it can’t really establish itself in the human population because it burns itself out. People die too quickly. They don’t stay alive long enough to spread the virus effectively. The miscalculation was that none of us ever imagined what would happen if Ebola virus got into a crowded city in the developing world where people live close to each other and don’t have access to medical care so they die in one another’s arms.
Julia Belluz: More than 30 years have passed since this virus was discovered. We still don’t know where Ebola lives when it’s not in humans. Why?
Richard Preston: It’s just a weird conundrum. The scientists are all scratching their heads. It’s an interesting problem. The guy who wrote the textbook on Ebola explained it to me: there is a gold standard proof that the Marburg virus (an Ebola cousin) lives in a particular species of bat. They’ve proved that. But that’s Ebola, not Marburg. They are both members of the filovirus family. With Ebola, there’s a lot of speculation that it could be living in fruit bats. The fruit bat carries Marburg. Could Ebola be in fruit bats? Living Ebola has never been found in a fruit bat. So maybe it could it be tiny little tick or insect that lives on the body of a bat, and then it’s infecting the bat and the bat infects a human. Those fruit bats are incredibly common in Africa. People eat them. They are supposed to be delicious. So there’s all this contact between bats and humans. Shouldn’t there be more Ebola? But there isn’t.
Ebola could easily live in an arthropod. But go into a rainforest environment — ecologists haven’t even given names to a lot of the insects there, and when it comes to mites and ticks, forget it. Even experts have real trouble distinguishing one species of insect from another. All of a sudden, you have to test thousands of creatures for Ebola and you still might not have found Ebola because it might be in that insect you didn’t test. There’s something here we’re not seeing.
Julia Belluz: Here in the US, despite Ebola being a very remote risk, people are very afraid. Has the response so far been what you imagined it would be?
Richard Preston: I’m not surprised about the alarm and panic. Somebody throws up on a bus, and we shut the bus down and send in guys in space suits. It’s kind of ridiculous. But people are human beings and they get easily frightened. I’m not at all surprised by the panic. All I can say to the public is I’m not scared. And I know perfectly well that the health authorities and hospitals can and will handle Ebola. They are on a steep learning curve. They made some idiotic mistakes at the beginning. Our health system, despite our gleaming hospitals and vast expense of medical care in the US, made fundamental mistakes that no well-trained African health worker would make. Anybody working in a hospital in Africa knows you need to cover every inch of the body.
Julia Belluz: Yet, even the Centers for Disease Control and Prevention didn’t get that message through to health workers. They are just in the process of changing their guidelines so that health workers are now required to cover all their exposed skin while caring for Ebola patients. How do you explain that screw up?
Richard Preston: I think it has to do with the CDC’s good bedside manner with the American public. "Don’t worry, it’s not that scary. Despite what certain popularizers are saying, Ebola is not this dangerous." Well, it turned out they made mistakes that Doctors Without Borders learned long ago.
Another problem is that all of the people who really know about Ebola are all over in Africa fighting it there. And the CDC sent more than 50 Ebola experts and disease detectives over to Africa. Every expert was over there, and the people left didn’t have that much experience with Ebola.
Julia Belluz: What lesson do you think American health policymakers need to learn from this Ebola epidemic?
Richard Preston: In the US, we need the equivalent of a fire engine company for novel, unusual, emerging viruses. We don't have that. What we have are research groups that specialize in one thing. They specialize in Ebola or HIV. They specialize in anthrax. But we don't have any installed capacity to bring a team in to deal with an emerging outbreak of some new disease. We don't have a fire engine company, and we need one.
I honestly wish I didn’t have to be talking about Ebola today. It’s a really terrible thing for so many people in West Africa and could potentially cause a great deal more suffering around the world. I was surprised by the ferocity of this outbreak. It’s no longer an outbreak, it’s an epidemic. It’s a great illustration of the fact that nature is always pulling surprises on us.
This interview has been edited and condensed for clarity and length.
Developer: Yuri Victor
Lead image: Still from the movie Outbreak (Warner Brothers)