Infection: The Global Threat

The Coming Plague: Newly Emerging Diseases in a World Out of Balance

by Laurie Garrett
Farrar, Straus and Giroux, 750 pp., $25.00

The Hot Zone

by Richard Preston
Random House, 300 pp., $23.00

“If disease is an expression of individual life under unfavorable conditions, then epidemics must be indicators of mass disturbances in mass life.”

—Rudolph Virchow


Begin with a thought experiment: What might it take to produce a virus with the potential to eliminate Homo sapiens? For a start, it should be one that we are unfamiliar with; our physical naiveté insures only perfunctory resistance to virulent infection. To preserve the element of surprise, the virus must cross to humans from another species. Airborne transmission would encourage such a leap: a cough or simply sharing a breath, especially if only a tiny amount of virus were needed to establish a human foothold. Once inside us, the virus must multiply with extraordinary rapidity, producing catastrophic and irreversible damage to all major organs: liver, heart, lungs, brain, kidneys, and gut. During this phase of fertile proliferation, subtle but significant changes to its structure (mutation) would enable the virus to evade any rear-guard attempt by our immune system to reestablish control. To give the virus the ultimate upper hand, we should possess neither drug nor vaccine to challenge the infection. Finally, we should be denied the means to restrain viral spread, an easy condition to fulfill if one is ignorant of where it normally (and peacefully) resides.1

If this wish list of virulence sounds improbable, Richard Preston will quickly extinguish your skepticism. With almost unseemly relish, he describes the dramatic emergence from Africa of two viruses—Marburg and Ebola—that fit our “perfect” virus rather too well. For instance,

Ebola…triggers a creeping, spotty necrosis that spreads through all the internal organs. The liver bulges up and turns yellow, begins to liquefy, and then it cracks apart…. The kidneys become jammed with blood clots and dead cells, and cease functioning. As the kidneys fail, the blood becomes toxic with urine. The spleen turns into a single huge, hard blood clot the size of a baseball. The intestines may fill up completely with blood. The lining of the gut dies and sloughs off into the bowels and is defecated along with large amounts of blood.

The strain of Ebola found in Sudan, and first discovered in 1976, is twice as lethal as Marburg, killing half of those it infects. The Zaire strain of Ebola is nearly twice as lethal as its Sudanese counterpart. In The Coming Plague Laurie Garrett recounts the details of these discoveries. In the Yambuku Mission Hospital in northern Zaire, Belgian nuns gave out injections of antimalarial drugs with unsterilized needles. Thirteen days after Mabola Lokela, a schoolteacher recently returned from vacation, received such an injection, he became the first known fatality from Ebola Zaire. Eighteen members of his family and friends perished soon after. The virus proceeded to spread through the hospital and surrounding villages. Thirtyeight of the Yambuku staff died, including all of the missionary nurses. A single needle at Yambuku had magnified this chance tragedy into a devastating epidemic.

The first Western physician to be…

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