Book Review & Maundering: The Hot Zone by Richard Preston

[roo_ster]

The Hot Zone: The Terrifying True Story of the Origins of the Ebola Virus [Kindle Edition]
http://www.amazon.com/Hot-Zone-Terrifying-Story-Origins-ebook/dp/B007DCU4IQ/ref=sr_1_1?s=books&ie=UTF8&qid=1407939437&sr=1-1&keywords=hot+zone
http://en.wikipedia.org/wiki/The_Hot_Zone

As is usual, I am late to pop culture phenomena.  The cool time to read this book would have been in 1995.  I am sure that was what Newt Gingrich did, reading it alongside the latest Alvin Toffler futurist sack of worthlessness. 

Luckily, THZ ages better than any Toffler book with the words, "future," "shock," "wave," or "shift" in the title.  Something to do with THZ's content focus of fact, history, biology, and the like while not putting on the secular prophet clown costume.

I will quote from Wikipedia for a summary of the content:

The Hot Zone: A Terrifying True Story is a best-selling[1] 1994 non-fiction thriller by Richard Preston about the origins and incidents involving viral hemorrhagic fevers, particularly ebolaviruses and marburgviruses. The basis of the book was Preston's 1992 New Yorker article "Crisis in the Hot Zone".[2]

The filoviruses Ebola virus (EBOV), Sudan virus (SUDV), Marburg virus (MARV), and Ravn virus (RAVV) are Biosafety Level 4 agents. Biosafety Level 4 agents are extremely dangerous to humans because they are very infectious, have a high case-fatality rate, and there are no known prophylactics, treatments, or cures. Along with describing the history of the diseases caused by these two Central African diseases, Ebola virus disease (EVD) and Marburg virus disease (MVD), Preston describes a 1989 incident in which a relative of Ebola virus named Reston virus (RESTV), was discovered at a primate quarantine facility in Reston, Virginia, less than fifteen miles (24 km) away from Washington, DC. The virus found at the facility was a mutated form of the original Ebola virus, and was initially mistaken for Simian Hemorrhagic Fever (SHV).

I had a passing familiarity with Ebola & such, but I figured what with the latest outbreak in W Africa, a concise examination of the history & biology was in order.  THZ is all that.  It is also well-written, even if it goes "reality show manufactured drama" in a few places.  That is forgivable and maybe even laudable if it will draw in the interested layman, as the layman will likely learn quite a bit.  The author manages the hat trick of being entertaining as well as informative.  Kudos to Richard Preston.

Nonetheless, THZ is a sobering read that highlights the gravity of these diseases and our lack of options save palliative & supportive care to the stricken and quarantine to mitigate the spread.  The fatality rates for these diseases run from 25% to 90%.  The fatality rates and likelihood of transmission does not quite capture the horror of the way the infected die or the likely state of "recovery" of those that survive them. 

Thinking back to last week's return of the infected mission doctor to the USA I have to wonder just what those that made the decision were smoking.  It had to have been some really good stuff.  "But he went into a hospital, roo_ster.  What is the problem?"  Well, in every incident of widespread Ebola/Marsburg, the hospitals or care facilities are where it went from futzing along in mostly a series of infections into a massively parallel geometric infection pattern.

This article from The Atlantic does not come close to the reality.  It looks to be a "cool down the (m)asses" propaganda piece.
http://www.theatlantic.com/health/archive/2014/08/what-would-happen-if-someone-got-ebola-in-america/375928/?single_page=true

By the time the paramedics come, you look and feel terrible. You spew vomit as they whisk you to the ambulance...

He wears shoe covers because at this point, you are gushing diarrhea and sweat...

In addition to many other things, the virus has killed the linings of your digestive tract from your lips to your anus.  That vomit & diarrhea is not only laden with coagulating blood, but also the sloughed off tissues from your digestive tract.   EXPLOSIVE vomit and stools.  Meanwhile it is killing your organs and turning them into a dead, pudding-like tissue.  By the time you die from Ebola, many of your internal organs and parts of your brain have died and turned to mush.  If someone wants to autopsy you, they best get cracking before the virus completes its digestion of your tissues and nothing remains but a skin sack of putrescent goo.  And if you do manage to be the "lucky" 10% that survive Ebola Zaire, your body will have to heal back all sorts of damage to include all the mushed/digested bits of organ and you may never regain your former brain function due tot he brain mushing and fever and...

The second to last vignette in THZ is an outbreak of Reston virus outside DC.  Essentially, it was a virus that so resembled Ebola Zaire under the microscope that it was mistaken for Ebola...with two differences as to how it presented:
1. Humans caught it, but were not adversely effected like the monkeys who died like flies. 
2. It could be transmitted via the air, through air ducts and the like and appeared to meld Ebola and Flu-like symptoms as it killed the monkeys.

So, let this keep you warm at night: Ebola Zaire with the transmissivity of the common flu (in addition to the usual means of explosive vomit, diarrhea, and other fluids).  One mutation away from killing humans instead of monkeys.

To sum up, a very good book.  I learned a lot and it was very entertaining in a "The Thing movie from 1982 was a true-life documentary" sort of way.

[Balog]

Every virus, to include flu and the common cold, is one mutation away from causing a global extinction level event. It's the nature of virii. Dead is dead, even if the symptoms are not as dramatic as the hemorrhagic fevers. Unless it's specifically bio-engineered, weaponized, and introduced into the population in a systemic way that is likely beyond the capability of non-state or small state actors it's unlikely to happen. If Putin ever goes insane and decides to try to end all life on earth the commies might be able to make it happen. But there are much better choices for weaponization than ebola.

One of the .mil guys who was present for the Reston outbreak posts over on arfcom, he's a good and informative source.

So, a mutated ebola could definitely cause a serious pandemic. It's less likely than multi-spectrum resistant TB pandemic  from one of our south of the border friends, or the plague that's endemic to prairie dogs out west mutating and going off the reservation; but it is possible. The Yellowstone caldera could go off, or a Vredefort level asteroid could impact too. Some dangers are always there, and there's not realistically a lot one could do about them.

[zahc]

Every virus, to include flu and the common cold, is one mutation away from causing a global extinction level event. It's the nature of virii.

Which is why bacteriophage therapy is so brilliant....the phages co-evolve with the bacteria, like the common cold does with us.

[Balog]

Which is why bacteriophage therapy is so brilliant....the phages co-evolve with the bacteria, like the common cold does with us.

The cold is a virus. You grok the difference between bacteria and virus right?

[zahc]

The cold is a virus. You grok the difference between bacteria and virus right?

Yes, the difference was key to the point of my post,  which I think you have missed.

[Balog]

Yes, the difference was key to the point of my post,  which I think you have missed.

Could you explain it a bit more then, as I do not understand.

[RocketMan]

Just bought the book in Kindle.  Sounds very interesting.  We'll see how it reads.

[brimic]

Read the book about 20 years ago, a worthwhile read.

[Sindawe]

Read the book about 20 years ago, a worthwhile read.

Same here.

Odd story, a co-worker of the time noted what I was reading during lull period between induction and harvest of the E. coli culture we used.  She then told me about a concurrent outbreak at another primate facility that she worked at that sourced their test animals from the same place as the Reston facility.  One that did NOT make the new.s 

Which is why bacteriophage therapy is so brilliant...

Hmmmm... I dunno.  I'd be concerned about all the pyrogens suddenly dumped into my system as a result of the phage therapy.  I've seen T4 turn a 900 liters of vibrant, happy of E. coli turned to nasty slimy foulness in less than an hour.  I had a small dose of airesolized pyrogens twice,  NOT a fun experience, feels like a bad case of the flu, all from the bodies own reaction.

[Balog]

I have heard and believe, that there are many incredibly nasty bugs in American research facilities, held under pretty loose and sloppy security standards. If AQ or another terrorist org managed to recruit just one micro-biologist... 

[zahc]

Could you explain it a bit more then, as I do not understand.

Chemical antibiotics work only until bacteria populations develop resistance. But bacteriophages in theory will co-evolve with the bacteria they target.

[charby]

Read the book about 20 years ago, a worthwhile read.

ditto

[TommyGunn]

The cold is a virus. You grok the difference between bacteria and virus right?

To be precise it is actually a number of viruses.  Virii ... Virusi...   whatever.
You know what I mean.

[Balog]

Chemical antibiotics work only until bacteria populations develop resistance. But bacteriophages in theory will co-evolve with the bacteria they target.

But given that Ebola (and the common cold) are virii I don't see how that's relevant.

[erictank]

The Hot Zone: The Terrifying True Story of the Origins of the Ebola Virus [Kindle Edition]
http://www.amazon.com/Hot-Zone-Terrifying-Story-Origins-ebook/dp/B007DCU4IQ/ref=sr_1_1?s=books&ie=UTF8&qid=1407939437&sr=1-1&keywords=hot+zone
http://en.wikipedia.org/wiki/The_Hot_Zone

As is usual, I am late to pop culture phenomena.  The cool time to read this book would have been in 1995.  I am sure that was what Newt Gingrich did, reading it alongside the latest Alvin Toffler futurist sack of worthlessness. 

Luckily, THZ ages better than any Toffler book with the words, "future," "shock," "wave," or "shift" in the title.  Something to do with THZ's content focus of fact, history, biology, and the like while not putting on the secular prophet clown costume.

I will quote from Wikipedia for a summary of the content:
I had a passing familiarity with Ebola & such, but I figured what with the latest outbreak in W Africa, a concise examination of the history & biology was in order.  THZ is all that.  It is also well-written, even if it goes "reality show manufactured drama" in a few places.  That is forgivable and maybe even laudable if it will draw in the interested layman, as the layman will likely learn quite a bit.  The author manages the hat trick of being entertaining as well as informative.  Kudos to Richard Preston.

Nonetheless, THZ is a sobering read that highlights the gravity of these diseases and our lack of options save palliative & supportive care to the stricken and quarantine to mitigate the spread.  The fatality rates for these diseases run from 25% to 90%.  The fatality rates and likelihood of transmission does not quite capture the horror of the way the infected die or the likely state of "recovery" of those that survive them. 

Thinking back to last week's return of the infected mission doctor to the USA I have to wonder just what those that made the decision were smoking.  It had to have been some really good stuff.  "But he went into a hospital, roo_ster.  What is the problem?"  Well, in every incident of widespread Ebola/Marsburg, the hospitals or care facilities are where it went from futzing along in mostly a series of infections into a massively parallel geometric infection pattern.

This article from The Atlantic does not come close to the reality.  It looks to be a "cool down the (m)asses" propaganda piece.
http://www.theatlantic.com/health/archive/2014/08/what-would-happen-if-someone-got-ebola-in-america/375928/?single_page=trueIn addition to many other things, the virus has killed the linings of your digestive tract from your lips to your anus.  That vomit & diarrhea is not only laden with coagulating blood, but also the sloughed off tissues from your digestive tract.   EXPLOSIVE vomit and stools.  Meanwhile it is killing your organs and turning them into a dead, pudding-like tissue.  By the time you die from Ebola, many of your internal organs and parts of your brain have died and turned to mush.  If someone wants to autopsy you, they best get cracking before the virus completes its digestion of your tissues and nothing remains but a skin sack of putrescent goo.  And if you do manage to be the "lucky" 10% that survive Ebola Zaire, your body will have to heal back all sorts of damage to include all the mushed/digested bits of organ and you may never regain your former brain function due tot he brain mushing and fever and...

The second to last vignette in THZ is an outbreak of Reston virus outside DC.  Essentially, it was a virus that so resembled Ebola Zaire under the microscope that it was mistaken for Ebola...with two differences as to how it presented:
1. Humans caught it, but were not adversely effected like the monkeys who died like flies. 
2. It could be transmitted via the air, through air ducts and the like and appeared to meld Ebola and Flu-like symptoms as it killed the monkeys.

So, let this keep you warm at night: Ebola Zaire with the transmissivity of the common flu (in addition to the usual means of explosive vomit, diarrhea, and other fluids).  One mutation away from killing humans instead of monkeys.

To sum up, a very good book.  I learned a lot and it was very entertaining in a "The Thing movie from 1982 was a true-life documentary" sort of way.

I first read that in the late 90s, IIRC - sometime after the movie Outbreak, I'm pretty sure. It scared the hell out of me.

[mtnbkr]

I read that book while in college, then moved to Reston after graduating.  Not so bright am I. :D

Chris

[zahc]

But given that Ebola (and the common cold) are virii I don't see how that's relevant.

We had just been discussing viruses and how they mutate and evolve to keep infecting their hosts. If observations about how viruses mutate and evolve to keep infecting their hosts are not relevant, I apologize.   

[Balog]

We had just been discussing viruses and how they mutate and evolve to keep infecting their hosts. If observations about how viruses mutate and evolve to keep infecting their hosts are not relevant, I apologize.   

Sorry, probably a misunderstanding on my end. I was talking about the treatment of virus caused diseases, so the mention of things that treat bacteria caused diseases threw me off. And, honestly, I forgot bacteriophages were virii. 

[KD5NRH]

I have heard and believe, that there are many incredibly nasty bugs in American research facilities, held under pretty loose and sloppy security standards. If AQ or another terrorist org managed to recruit just one micro-biologist... 

Therein lies the problem; since they're self replicating and at variable rates, it's not like you could just weigh all the samples once a week and know whether somebody snuck out a useful amount, nor is there any good way to scan employees leaving the facility like there would be for a nuke site.  Swipe a microgram in a sealed, disguised container and grow them out with readily available stuff in your home glovebox for under $2k until you have as much as your handler wants.

[K Frame]

"Well, in every incident of widespread Ebola/Marsburg, the hospitals or care facilities are where it went from futzing along in mostly a series of infections into a massively parallel geometric infection pattern."

Critical difference...

The hospital the doctor in the US went into is a biohazard 4 containment hospital, one of the few in the United States. One of the few in the world, actually.

Hospitals in third and fourth world nations being consumed by Ebola right now are nowhere near that. Hell, in a lot of cases, they're no where near "the MinitClinic at your local pharmacy" standards.

Current strains of Ebola are only transmitted via contact with bodily fluids. That's not happening in a BH 4 facility. It happens all of the time in a third/fourth world "hospital."

A lot of people I've seen talking about this are worried that there will be a massive Ebola outbreak in the United States that will rip through the population as it is doing in Africa.

My take on it is....

That won't happen because the United States has a functional, functioning, integrated first-world health care system.

Again, Ebola is only spread via contact with body fluids. People with Ebola only become contagious when it's evident that there is something very, VERY VERY wrong, meaning that they're not going to be coming into contact with a lot of people at that point.

A pretty good indication of how functional the US healthcare system is in this regard was the incident a few weeks ago where someone was identified as possibly having an Ebola-type virus. The quarantine cycle that sprang to life was pretty impressive. http://newyork.cbslocal.com/2014/08/10/man-quarantined-in-nyc-ebola-scare-calls-experience-surreal/

This is the telling part:

"It took hospital staff 7 minutes from the time Silverman hit the emergency room doors to when he was in isolation."

Americans are also well versed in the AIDS culture, which naturally makes you steer clear of blood and body fluids, even further lessening the possible transmission of the virus.

"One mutation away from killing humans instead of monkeys."

To put it absolutely and completely bluntly, EVERY virus strain on earth, from the mundane ones to the ones that make you feel like crap, is a single mutation away from becoming a pandemic killer.


To put it succinctly, I'm not at all worried about Ebola in the United States, especially not when illnesses like annual influenza kill upwards 50,000 people in the United States ever year.

If you want to be scared by a virus, be scared by Hepatitis C.

[mtnbkr]

Then there are the cultural issues in Africa to contend with.  Patients don't trust western medicine and go to witch doctors (actually read this in connection to Ebola there), family and friends ostracize survivors discouraging others from seeking care when they get sick, and generally not even trying to take precautions.

We probably wouldn't even know Ebola existed if it came from a 1st world country because it wouldn't get anywhere.  In Africa, their very culture works against any attempts to contain it.

Chris

[K Frame]

Exactly, Chris.

In the areas where Ebola is hitting right now people view hospitals as we view hospice. Once you go in, you go in to die, not get better, so they turn to home care and village healers, which simply ends up spreading the diease even worse than if they were to enter a hospital.

[KD5NRH]

That won't happen because the United States has a functional, functioning, integrated first-world health care system.

Give the Obama administration time.  It's hard to destroy every aspect of an advanced nation in only 6 years and still have time for a daily round of golf.