data. Furthermore, doctors and nurses saw many of those fifteen hundred people die. So the medical profession knows a good bit about the range of symptoms and the pathological effects produced on a human body during death by ebolavirus infection. It’s not quite like you might think.
If you devoured The Hot Zone when it was published, as I did, or if you have been secondarily exposed to its far-reaching influence on public impressions about ebolaviruses, you may carry some wildly gruesome notions. Richard Preston is a vivid writer, a skillful writer, an industrious researcher, and it was his purpose to make a truly horrible disease seem almost preternaturally horrific. You may recall his depiction of a Sudanese hospital in which the virus “jumped from bed to bed, killing patients left and right,” creating dementia and chaos, and not only killing patients but causing them to bleed profusely as they died, liquefying their organs, until “people were dissolving in their beds.” You may have shuddered at Preston’s statement that Ebola virus in particular “transforms virtually every part of the body into a digested slime of virus particles.” You may have paused before turning the page when he told you that, after death, an Ebola-infected cadaver “suddenly deteriorates,” its internal organs deliquescing in “a sort of shock-related meltdown.” You may not have noticed that meltdown was a metaphor, meaning dysfunction, not actual melting. Or maybe it wasn’t. At a later point, bringing another filovirus into the story, Preston mentioned a French expatriate, living in Africa, who “essentially melts down with Marburg virus while traveling on an airplane.” You may remember one phrase in particular, as Preston described victims in a darkened Sudanese hut: comatose, motionless, and “bleeding out.” That seemed to be so different from just “bleeding.” It suggested a human body draining away in a gush. There was also the statement that Ebola causes a victim’s eyeballs to fill up with blood, bringing blindness and more. “Droplets of blood stand out on the eyelids: You may weep blood. The blood runs from your eyes down your cheeks and refuses to coagulate.” The mask of red death—where medical reporting meets Edgar Allan Poe.
It’s my duty to advise that you need not take these descriptions quite literally—at least, not as the typical course of a fatal case of Ebola virus disease. Expert testimony, some published and some spoken, tempers Preston on several of these more lurid points, without minimizing the terribleness of Ebola in terms of real suffering and death. Pierre Rollin, for instance, deputy chief of the Special Pathogens Branch of the CDC, is one of the world’s most experienced ebolavirus hands. He worked at the Pasteur Institute in Paris before moving to Atlanta, and has been a member of response teams to many Ebola and Marburg outbreaks over the past fifteen years, including those at Kikwit and Gulu. When I asked him, during an interview in his office, about the public perception that this disease is extraordinarily bloody, Rollin interrupted me genially to say:
“—which is bullshit.” When I mentioned the descriptions in Preston’s book, Rollin mockingly said, “They melt, splash on the wall,” and gave a frustrated shrug. Mr. Preston could write what he pleased, Rollin added, so long as the product was labeled fiction. “But if you say it’s a true story, you have to speak to the true story, and he didn’t. Because it was much more exciting to have blood everywhere and scaring everywhere.” A few patients do bleed to death, Rollin said, but “they don’t explode, and they don’t melt.” In fact, he said, the often-used term “Ebola hemorrhagic fever” is itself a misnomer for Ebola virus disease, because more than half the patients don’t bleed at all. They die of other causes, such as respiratory distress and shutdown (but not dissolution) of internal organs.
Karl Johnson, one of the pioneers of Ebola outbreak response, whose credentials I’ve already sketched, offered a similar but even more pointed reaction, expressed with his usual candor. We were talking—in my own office, this time—during one of his periodic trips to Montana for fly-fishing. We had become friends and he had coached me a bit, informally, on how to think about zoonotic viruses. Finally I got him to sit for an interview, and The Hot Zone inescapably came up. Waxing serious, Karl said: “Bloody tears is bullshit. Nobody has ever had bloody tears.” Furthermore, Karl noted, “People who die are not formless bags of slime.” Johnson also concurred with Pierre Rollin that