OK, I confess to being apparently among the few Americans who never read Richard Prestons mega-seller The Hot Zone, about a virus among monkeys in a Virginia test lab that for a short while researchers worried would jump to humans. I dubbed it The Hype Zone and made a point of ignoring it.
Why? Because for all the tension and build-up the author gave it, not only did nothing happen to the humans at all but really nothing could have happened. The virus in question causes a terrible disease but is terribly difficult to spread.
In Zaire last year, a Red Cross worker covers the body of an Ebola virus victim.
But Level 4, by Dr. Joseph McCormick, former chief of the special pathogens branch at the Centers for Disease Control and Prevention, and his wife, Dr. Susan Fisher-Hoch, is different. Its about real human-killing viruses killing real humans and the doctors who track the bugs and desperately try to save the victims. Like Mr. Prestons book, its a real page turner.
Level 4 refers to the CDCs category of the most dangerous and exotic of viruses and bacteria. The bugs the authors spend most of their time on are Lassa fever and Ebola, both hemorrhagic viruses; that is, they cause severe bleeding from body organs. They do not "turn the organs to mush," as some of the more sensationalist news accounts would have us believe, though the organs are so awash in blood that it may look that way.
Dr. McCormick, an epidemiologist, has spent much of his life tracking these diseases and others in Africa and Asia. "An outbreak investigation is very much like the investigation of a crime," explain the authors. "It consists of detective work, following hunches, and carefully collecting evidence. In epidemiology, however, the criminal is the bug. Find the bug. And then find how it got to its human hosts."
For example, while tracking an unknown pathogen in Nigeria, Dr. McCormick arrived at an abandoned hospital (everyone had died or fled) and had to reconstruct what disease had killed everybody solely on the basis of the drugs they were given, even though it was obvious the drugs had done no good. The use of anticonvulsants and some other drugs confirmed that what was being dealt with was Lassa fever.
American doctors who work in the Third World are a special breed, eschewing the comforts of home for vicious climates, disease-bearing insects, and often corrupt and brutal governments. The authors pull no punches in their condemnation of the various African governments whose cooperation theyve sought. They are to be commended for resisting political correctness and not leaving the slightest doubt that for their long-suffering subjects, things were clearly better in the colonial age.
On the other hand, the authors lapse into full PC mode when it comes to AIDS, blaming the U.S. epidemic on President Reagan. "By steadfastly refusing to acknowledge the true dimensions of the AIDS crisis, the Reagan administration made itself an ally of the virus." But this was back in 1985, when no one fully realized the extent of the AIDS crisis, including the CDC.
And no mention is made of the decision of the CDC and various advocacy groups to ally themselves with the virus by focusing their efforts on preventing AIDS in precisely the group least at risk — white middle-class heterosexuals. No one has worked harder at spreading such disinformation as Dr. Jonathan Mann, a Harvard professor, but the authors treat him like a saint.
Most of the book belongs to Dr. McCormick, which is good because Dr. Fisher-Hochs contribution is far less interesting. She did play a fascinating role in learning about the spread of the bacteria that causes Legionnaires disease. But she spends far too much time bellyaching about how tough it is to be a female doctor. She tells us she quit the special pathogens branch at the CDC because her husbands successor, Dr. C.J. Peters, brought in a crew of all white males. Perhaps the country would be healthier if the CDC chose doctors on the basis of race and various handicaps, though thats doubtful.
Just as the book is a mixture of PC and anti-PC, it also is a mixture of hype and anti-hype. On the subject of Mr. Prestons book about the monkey virus in Reston, Dr. McCormick says, "It was clear to me that the virus had a very low pathogenicity for man. I thought that was very good news. . . . I could see no purpose in unnecessarily perpetuating a climate of fear." But, he says, "my adversaries seemed to crave melodrama and sensation. They were determined to milk the outbreak for all it was worth."
At the same time, the authors declare that Ebola, which Dr. McCormick has spent so much of his time fighting, is "the deadliest virus known to man." Really? HIV, the AIDS virus, appears to have a fatality rate close to 100 percent. Ebola, for the two epidemics for which the authors provide data, had death rates of 53 percent and 88 percent.
The authors also spew the shopworn cliche that any disease afflicting Africa could readily jump to the West and wreak havoc here. "Geography is no protection, and a fat bank account is no guarantee of escape from infection," they write. "If we ignore the afflictions of the underdeveloped countries or pretend they dont hold any importance for us, then they are likely to turn up on our back doorstep some day soon."
Nonsense. Throughout the book the authors make it clear that theres a darned good reason why viruses like Ebola and Lassa fever have been confined to backwater regions of Africa. These diseases are quite difficult to contract, requiring blood contact. Almost all of the victims are hospital workers who had poor or nonexistent barrier protections or family members who handled the bodies and exposed themselves to vast amounts of blood during burial preparation.
Indeed, the authors even tell us about a few Lassa fever cases that have made it to the United States without spreading, precisely because of the quality of our hospitals and our sanitary funeral procedures.
This isnt to argue that Americans should never concern themselves with African health problems. But the impetus must be altruism, and not self-preservation.
Surely the money we do spend on fighting Third World illnesses should be spent in the most efficient manner. The authors bemoan the lack of resources devoted to fighting diseases such as Ebola and Lassa fever, but these illnesses, while horrible to get, are veritable pipsqueaks on Africas fertile continent. The largest Ebola epidemic to date has killed about 300 people. By comparison, diseases for which we have excellent but underfunded treatments, such as tuberculosis and malaria, kill millions of Africans each year.
Even as I write this, an epidemic of bacterial meningitis is sweeping part of Africa, and has claimed more than 15,000 lives. In a better world, there would be plenty of money for diseases that kill a few dozen Africans here, a few hundred there. In the real world, such expenditures cannot be justified even if they do lead to such fascinating tales as the authors have to tell.