Cover Image: Crisis in the Red Zone

Crisis in the Red Zone

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Member Reviews

Years ago, when I first read The Hot Zone, I thought it was the scariest thing I'd ever read. The author's newest book on the continuing Ebola crisis earns a spot right next to that one.
Most of us probably don't think about Ebola and other level 4 viruses very often. Why would we, after all? We are safely ensconced in our little cocooned worlds, far removed from these diseases. But we're really not. One sick person undetected on an airline, going into a semi major city, still undetected, and before you know it there's a full blown epidemic right at your door.
Sure, it got kinda scary several years ago when there were a few cases in the US. But they were quickly contained so all is well, right? Not really...
Read it, and be very concerned...

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I read The Hot Zone when it came out and enjoyed it a lot, and so I assumed I'd like this by the same author. Unfortunately, it's slow and pedantic, and reads like it's written for 8-year-olds to understand. The information is fascinating, but the delivery is unsophisticated. It needs a developmental edit for audience, repetition, and flow.

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Thank to Random House and Netgalley for sharing the ARC of Richard Preston’s upcoming Ebola book. I appreciated hearing the details of the 2014 outbreak that were not covered in detail at the time. I didn’t find this book as compelling as The Hot Zone which, at the time, I could not believe wasn’t fiction. So maybe missing that feeling of total shock made me appreciate the book a tiny bit less. Still fascinating and it was good that there seems to be a bit of hope for finding drugs to treat such a terrible and scary illness. I would recommend this to anyone who likes thrillers, non-fiction, or science. However, a warning: if you have a weak stomach when it comes to medical procedures, blood and gore and bodily fluids, you may want to give this a pass.

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Thank you NetGalley and the publisher for the opportunity to read and give an honest review of this book.

Having read Preston’s Hot Zone book many years ago, I was eager to delve into his Crisis in the Red Zone about the Ebola crisis. This book appeared to be a well researched history of the discovery of and progression of the emerging virus, Ebola. It follows the lives of health care works that literally were willing to give their lives caring for victims of this hideous disease. It starts out with the initial emergence of this scary filovirus in the 1970s. It goes through the time when several Americans were infected and brought home for treatment. The use of experimental treatments were discussed. At this point in time, Ebola is still endemic in parts of Africa and there is no readily available cure or vaccine.
After reading this book, I found myself viewing things like food handlers and public washrooms more critically. The book leaves us with the thought that it is not ‘if’ but ‘when’ there will be an emerging virus or bacteria that threatens the entire human race.

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Thank you NetGalley for this advanced reader's copy.
I believe I've read all of Richard Preston's books, and didn't think he could improve on the Hot Zone, but he has!

This is a truly frightening book, and if it were fiction, I would have thought that it came from the mind of Stephen King. It is much scarier because it is true. The monster in this case is the improved (?!) version of Ebola virus, the Makona Ebola. The Hot Zone gave us a "primer" on what Ebola is and does. Now imagine that the virus has mutated in just one letter of its genetic code to allow it to be MORE infectious. How do health care givers deal with something even more virulent? How does a community?

This book, while explaining the how, also looks at the personal impact to people. We see what life is like for the unfortunate people who have been infected, the families of these people and how social customs help the virus to propagate itself. As Preston said, "The virus, a true monster, followed the bonds of fealty and love that joined the hospital's caregivers to one another and ultimately to every other person on earth". We are given the stories of the ambulance driver who was infected, the many nurses who had direct patient care and the doctors who were also infected. Each story is more heartbreaking than the last, with very few happy endings, one or two of which you may remember from the news. As you read this, you’ll realize who the real superheroes are, more than the Avengers or Superman, they are the people who rushed to give aid to people who so easily could kill them just by an accidental transference of bodily fluids. I yelled at the caregivers more than once.

There were issues that I was unaware of at the time, such as the controversy and ramifications of using the untried in humans drug, ZMapp. This part made truly angry. Without spoiling the book I’ll leave that for you to discover and have your own reactions. Days after finishing it, I’m still shocked by this section.
I work in a non-clinical position in a hospital and I remember this unfolding in 2014 and discussions of how our hospital would deal with Ebola if it showed up here. At the time, I found it an intriguing, disturbing thought, but considered it outside of the realm of possibility. Now I know how close a call the whole world had with this outbreak.

The book is fascinating and hard to put down. It will make you a bit paranoid in public with everyone who coughs or sneezes, or even hiccups!

If I could change anything, I would have a map and photos of the main people in the book. I had to constantly google this information.

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Knowing this is nonfiction made this even more frightening, I enjoyed this book immensely. Mr. Preston has employed the style of literary nonfiction to make this a very readable book. It has you sitting at the edge of your seat with suspense and action. But it's absolutely terrifying also. There isn't any graphic violence in this , but there are graphic descriptions of sickness, disease and death. We should really pay closer attention, because it is happening now in Africa. I know some people don't read or see the news much so I really advise you to read this book and also his other books. You will learn some truly scary facts. After I read it I pulled up the word Ebola on the internet and this was front page news, The second-deadliest Ebola outbreak in history has now spread to Uganda -- claiming the life of a 5-year-old boy Wednesday after the virus killed nearly 1400 in Democratic Republic of Congo. ... June 12, 2019 |

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Have you ever read The Hot Zone, and thought to yourself, “Calm the fork down, Richard Preston!” because I know I have, and yet I went on to read more of his books. Sometimes I joke about my last reread of The Hot Zone, I decided to revisit the book via audiobook. The dramatic narrator truly supported the sensational narrative. There were scenes where Preston (dramatically) describes the effects the Ebola virus has on a person, I found myself yelling “It’s Ebola!” to the scientists of the past while casually commuting to work on the El. At least, it’s Philly. I’m sure I’ll be the least weird thing that happens to people on the El that day.

Anyhow, this is not a post dedicated to The Hot Zone. Instead, this is a book review about Richard Preston’s upcoming book, Crises in the Red Zone: The Story of the Deadliest Ebola Outbreak, and the Outbreaks to Come. It’s due to hit shelves July 23rd, so keep an eye out for a copy and request your library to purchase one if they have not already had the title in mind. My focus is going to be on his upcoming book, but I think it’s necessary to compare and contrast it against The Hot Zone.

General Information About Ebola virus:

Scientists are unsure where Ebola originated. Each outbreak is caused by a spillover event, as urbanization destroys forests, viruses are able to jump from an animal to a human host. The leading theory is the virus originated in bats. The evidence is because there is no massive mortality rate in the bat population when it comes to the Ebola virus. Meanwhile, people can face up to a 90% death rate during an outbreak depending on what strain infects them.The more a virus evolves within a species, it becomes less virulent leading scientists to believe the virus began with a bat population. It can leap into primates, pigs, and humans. (There is no current evidence that Ebola virus can affect dogs or cats.)

There are six known strains of the Ebola virus:
Zaire ebolavirus (Ebola virus)
Sudan ebolavirus
Tai Forest ebolavirus
Bundibugyo ebolavirus
Reston ebolavirus
Bombalis ebolavirus

The Reston virus is spread by respiratory droplets, but does not affect humans, and it is currently unknown if Bombali virus can cause infection in humans, only bats. This leaves the other four virulent in humans.

Ebola is spread by direct contact with bodily fluids from a person who is sick or has died of Ebola. If a person touches infected bodily fluids, the virus particles can get through broken skin or mucous membranes, such as the eyes, nose or mouth. The virus spreads fast in a healthcare setting and is a huge threat to pregnant women and healthcare workers.

It’s a popular misconception that a person with Ebola “explodes with blood.” or that their cause of death is due to bleeding out from all their orifices. A person may have ooze blood due to the virus, they ultimately die from organ failure. When infected by the Ebola virus a person is not infectious until they show symptoms, and remain less infectious at the start. The virus begins to increase and a person becomes more infectious. This is a contrast against say influenza where a person is contagious before showing symptoms and remain in a more contagious state at the start of the infection versus the end.

Thoughts on Crisis in the Red Zone:

Richard Preston opens his new book by discussing the 1976 Zaire ebolavirus outbreak. He introduces Sembo Nbode when she arrives to a maternity ward not feeling too well, she seems distant and unusual. Sister Beata cares for her, but does not wear protective gear when caring for Sembo Nbode. Here tension begins and escalates in the narrative as it depicts a prelude to the 2014 outbreak.

Sembo Nbode dies. Her healthcare providers believe she died of hemorrhaging during childbirth, a major cause of death in young women throughout African countries. Only five days later, Sister Beata becomes ill. The outbreak begins as Preston describes one after another person who is infected by the Ebola virus only to die soon after.

37 years later.

“A viral lightning bolt had come out of the forest and struck a little boy. The child had been killed, and he had started a chain of infections in a few more people” (Preston)

Crises in the Red Zone focuses on the worst Ebola epidemic to date. According to the Center for Disease Control, 28,610 cases were reported throughout Guinea, Liberia, and Sierra Leone. 11,308 people died in those reported cases. The epidemic technically started in 2013 and continued into 2015. Prior to this outbreak, the worst outbreak had 450 reported cases. This was also the first time the Ebola virus reached West Africa.

Preston describes the first case in 2013 in a Kissi village, Meliandou, located in Guinea. He illustrates a scene of children playing around a tree when a boy named Emile who was possibly bitten by a bat, nobody knows how the infection started. What is known is soon after, Emile passes away. The virus jumped from him to his sister, Philomene, and the rest of his family became infected. The sickness spread taking all their lives including a midwife who cared for them and beyond the village.

Readers soon meet Humarr Kahn, chief physician of Lassa Fever Research program at the Kenema Government Hospital in Sierra Leone. Kahn becomes a main character in the narrative of Crisis in the Red Zone with a few other dedicated scientists. He is a virologist who works with Lassa Hemorrhagic fever, which his similar to Ebola and devastating, the virus invades the brain causing hemorrhagic bleeding.

Kahn spent the rest of his life dedicated to treating patients during the 2014 epidemic. There was no cure for his patients, he could only offer fluids and electrolytes through infusion of vein, oxygen therapy, and medication to reduce vomiting, diarrhea and manage fever and pain. This was the overall treatment for patients throughout quarantine camps that popped up around each country.

Fear and anger builds as the virus continues to spread taking the lives of many. Scientists from foreign countries arrive in spacesuits forcing people from their homes, only for them to die in camps. Preston does his best to stress the growing distrust of the scientists and the lack of communication to support why quarantine is important. West Africa has been heavily colonized in the past by foreign powers, there is a distrust between the public and the scientists who come from abroad. To make matters worse, health care physicians prevented people from performing their burial traditions.

Burial traditions involved washing and touching of the body, which in situations of an Ebola outbreak, continues the cycle of the virus. Therefore, without putting much thought to the impact of preventing tradition, the Western powers in charge ended them. They faced a lot of backlash in a time of crisis. People feared bringing loved ones to camps because those who entered rarely left. Violence occurs as people feel the need to break their loved ones free. All health officials were capable of was preventing the spread of Ebola virus.

Thoughts on The Hot Zone

Preston’s earlier book, The Hot Zone, was published in 1995. The book’s entire title is sensational as well, The Hot Zone: The Terrifying True Story of the Origins of the Ebola Virus. Throughout the 1990s popular nonfiction and fiction was published focused on this public imagination of a biotech thriller authors from Tom Clancy to Terry Gilliam’s Twelve Monkeys stressed the dangers of an approaching apocalyptic virus. Popular history books borrowed from such narratives. The Hot Zone is only one example, another is Laurie Garrett’s The Coming Plague.

Terror consumed the minds of the general public. The Hot Zone and films like Outbreak, presented Africa as an alien landscape that is potentially dangerous, especially for white people. Africa became the setting of the ultimate hot zone, it was an “elsewhere” in the mind of Western popular culture. Nonfiction narratives did not help with this image.

A “docu-fiction” style is utilized for The Hot Zone, it starts with a European man, Charles Monet, who enters Kitum Cave in Kenya. After he visits the cave, Monet becomes ill. Nobody knows what is happening to him, and nobody seems to care. He comes down with the iconic symptoms of what may be Ebola. The “iconic” symptoms being exaggerated by Preston. Killer viruses in fiction and nonfiction are represented as an entity violating the body, it causes a human to disnetigrate and destroys their face.

Readers witness Money’s body disintegrate before it is later revealed he has Marburg virus, it is related to Ebola, and a story for another post. The focus of an individual disintegrating in the narrative is “depersonalization,” they become something not human with death to follow. This expresses a bodily anxiety of people who may be reading or watching a story about a killer virus.

Thoughts on The Hot Zone vs, Crisis in the Red Zone

Crisis in the Red Zone similar to The Hot Zone. Rather than Monet, it begins with the 1976 Zaire outbreak. Preston continues to present the depersonalization of humans when he first introduces Sembo Nbode dying of Ebola in a maternity ward:

“There was a strange look on Ms. Nobde’s face, a blank, vacant, dazed expression, but she didn’t seem to be fully aware of her surroundings. The whites of her eyes were inflamed and bright red, and the whites glistened with film of blood covering the surface of the eyeball. She was bleeding around her teeth, and she may have been urinating blood.”

The narrative is different compared to The Hot Zone, the narrative is thankfully less dramatic yet continues makes wild exaggerations. It reads more like a movie script than a dense nonfiction book, that goes for the majority of Preston’s published work. If I owned a copy of The Hot Zone, I would present a stronger argument in my comparison, but alas, I’ve only ever borrowed it from the library.

The descriptions of depersonalization continue from start to finish in the book. I felt as if I learned more overall than all the times I read his previous book and the empathy built around the scientist and the people as so many lives were lost and confusion continued is important. Too many scenes in The Hot Zone felt over the top. Scenes of normalcy and humanity occurred only in the United States. Meanwhile, tragedy existed all throughout Crisis in the Red Zone.

Final Thoughts:

Again, the West African Ebola Epidemic is the largest in current history. There were 28,610 reported cases, 11,308 of those reported cases were people who lost their lives to the virus.

Education and communication around what happened is important. I hope to see less sensationalism in the future, but I am glad to see a popular science book on the subject manner.The Hot Zone. It is a strange line to walk because I know for a lot of people Richard Preston’s work was their introduction to epidemiology, that it inspired them to enter the field of public health yet the additional fear such literature creates is dangerous. The misconceptions are not fair.

A lot went wrong during the 2014 epidemic, a lot can be blamed on health officials coming into areas only in times of need rather than creating general health systems in areas that need the resources. In addition, the stories of survivors are important. Ebola survivor organizations exist for people to help one another in times of outbreak and after.

Since this is already a long post, I do not want to say much else. If you have the time, I think you should maybe give Crisis in the Red Zone a chance, a chance with a grain of salt understanding that Richard Preston is a bit of a problematic favorite. Next month you will be able to purchase the book or borrow it from the library on July 23rd.


Resources:

“Ebola (Ebola Virus Disease.” Center for Disease Control, 2019.
https://www.cdc.gov/vhf/ebola/about.html
“Ebola River.” Wikipedia, 2019. https://en.wikipedia.org/wiki/Ebola_River
Dougherty, Stephen. “The Biopolitics of the Killer Virus Novel.” Cultural Critique, 2001.
https://www.jstor.org/stable/1354395
Galbraith, N.S. “The Hot Zone by Richard Preston.” BMJ: British Medical Journal, 1994.
https://www.jstor.org/stable/29725319
Hutchings, Peter. “Satan Bugs in the Hot Zone: Microbial Pathogens as Alien Invaders.” Alien Identities, 1999.
https://www.jstor.org/stable/j.ctt18fscc0
McElroy, Dr. Sydnee and McElroy, Justin. “Ebola.” Sawbones, 2014.
https://www.maximumfun.org/sawbones/sawbones-ebola
Morse, Stephen A. “The Year 2000: Only a Plane Flight Away from Disaster?” Public Health Reports, 1995.
https://www.jstor.org/stable/4597805
Preston, Richard. Crisis in the Red Zone: The Story of the Deadliest Ebola Outbreak in History and of the Outbreaks to Come. Random House, 2019.
https://www.amazon.com/Crisis-Red-Zone-Deadliest-Outbreaks/dp/0812998839
Preston, Richard. The Hot Zone: The Terrifying True Story of the Origins of the Ebola Virus. Anchor, 1995.
https://www.amazon.com/Hot-Zone-Terrifying-Story-Origins/dp/0385479565
Welsh, Erin and Updyke, Erin. “Ebola: The New Kid on the Block.” This Podcast Will Kill You, 2018.
http://thispodcastwillkillyou.com/2018/02/10/episode-11-ebola-the-new-kid-on-the-block/
Wordsworth, Dot. “How Ebola Got Its Name.” The Spectator, 2014. https://www.spectator.co.uk/2014/10/how-ebola-got-its-name/

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I’m exhausted from grimacing as I read this book, but it’s a very important account. Preston has brought to life the dedicated doctors and nurses who were on the front lines of the deadliest Ebola outbreak ever. His book highlights both how much committed people can do in the face of the horrors of a deadly disease and how wholly unprepared our society is for the next outbreak.

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Thank you NetGalley and Random House for the advanced digital copy of Crisis in the Red Zone by Richard Preston. This book tells about the 2014 Ebola Crisis and how our society is not prepared for an outbreak such as this one, should it occur. The book was very interesting but difficult to read. It was heartbreaking to read how many people died and how desperately the nurses, doctors, and scientists tried to put an end to the outbreak while endangering their own lives. We would like to think this could never happen to us; but it can.

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Crisis in the Red Zone is Richard Preston's thorough documentation of the 2014 Ebola crisis. It reads as the best long form journalism, and is told in four parts alternating between Yambuku Mission (1976, the first Ebola outbreak) and West Africa (2014, the latest). Preston intersperses the human story of Ebola outbreaks with his thorough research regarding the history of the disease. He focuses on the interaction between humans and Ebola and, in the final part of the book, looks forward to what may need to be done to prevent and treat Ebola and any other diseases that find humans a perfect host. It is, ultimately, a book about human perseverance, resilience, and hope.

I read this book in one sitting, from start to finish. Preston makes a compelling case that the global community needs to work together to prepare now for the next Ebola, whatever it may be and wherever it may occur.

I received an ARC of this title via NetGalley for an honest review.

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Thanks to Netgalley and Random House Publishing Group for the ARC in exchange of an honest review.
I think this book is very informative on something that has happened and most definitely will happen again but at times, all throughout the book,there are sentences that seemed like they were written by a first grader. For example, Lucy is sick. Lucy died. Alex cared for Lucy. Alex died. Maybe just me, but I really noticed it.
The book is still very interesting and we as a nation are woefully unprepared for a disease like Ebola to hit us. Maybe even as a whole not just a nation. But I definitely think one will hit us one-day.

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Crisis in the Red Zone by Richard Preston grabbed my interest from the beginning, and it was very hard to put the book down. It reads like a fast paced medical thriller but is the factual account of the deadliest Ebola outbreak in history. Terrifying that it could happen again.

Thank you to the publisher, author, and NetGalley for the opportunity to preview the book.

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What would you do if a loved one came down with Ebola? Do you remember when if you went to a doctor's office they asked if you had traveled outside the U.S. within a certain time period and where?

That is what Richard Preston's forthcoming book, Crisis in the Red Zone is about. It is the account of the 2014 Ebola outbreak in Guinea, Sierra Leone, Liberia, and other countries in West Africa that started with one boy and then traveling through the Makong Triangle and spreading outwards until it reached Dallas, Texas and New York. Ebola killed thousands as it spread like wildfire until finally villagers began taking the fight to Ebola through implementing the Ancient Rule -- understanding that Ebola is not a white man's myth but a deadly wet virus that is spread through contact with bodily fluids, recognizing the symptoms of Ebola, isolating of and removal from contact with those infected with Ebola, and destruction through fire or protected burial of the deceased and everything that the deceased may have come in contact with. It is the story of giving (or protecting) life through temporarily changing practices, habits, and deeply ingrained customs and a way of life so that those who are not already infected with Ebola do not break with it and succumb. 

Crisis in the Red Zone is also the story of the intersection of modern medicine and ways with ancient tribal medicine, folk healing, and culture and the clash between the two as seen in the struggle of Doctors of Without Borders in their "moon suits" to locate and then isolate and treat those infected with Ebola. To be clear, there were other similar conflicts elsewhere that rose to the level of near war between villagers and those who fought Ebola. 

Preston's account also delves into the conflict that developed between the World Health Organization, Doctors with Borders, and governmental agencies, in Africa and outward including the U.S. and how this clash led to the death of the doctor of the of the Kenema Government Hospital's Ebola ward, Humarr Khan. It is the story of how adherence to inflexible practices and procedures can kill through ignorance of and the overriding local traditions that in turn creates conflict with local populations who have had limited contact with outsiders. This conflict and misunderstanding then creates myths and superstition in the minds of the villagers that eventually leads into war between the villagers and outsiders.

Crisis in the Red Zone also relates the superhuman efforts of Doctors Without Borders, World Health Organization doctors, outside experts and local medical personnel to struggle beyond the point of collapse and utter chaos to combat Ebola in situations that were war-like inside the treating areas.     

Preston also details the evolution of Ebola vaccines and treatments, the Level 4 containment and care that is required to stop an outbreak through in essence creating a fire break in the path of the disease and the history of Ebola including the 1976 outbreak in the Democratic Republic of the Congo and the lessons learned there which became known as the Ancient Rule and was ultimately implemented by the villagers and medical personnel in the 2014 outbreak.

This reader learned a lot through Preston's cogent and in-depth writing and analysis that was easy to understand. At times, in the early part through mid-way, the writing had the annoying quality of like talking to a child. It was not enough to distract this reader. Also, at some point, Preston begins to write part of the time in the first person as he starts to relate to readers his investigation and research for the book. The first time a section appears this reader thought it was an error. It is not as later in the narrative, it becomes clear what the author is doing. Other than that, Preston's account is a fascinating, if chilling, account of how linked this world and how societies and worlds can be destroyed by a microscopic invader.

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A great story about unsung heroes but the writing falls short in places

I enjoyed this book. I like science books that read like thrillers and this one certainly did. There was just enough science to explain the story and it was all well-explained. The book was hard to put down, but it had one big weakness and that was too much minutiae about the book’s characters. It reached a point where I started skipping text. The same thing happened with “What the Eyes Don't See” by Mona Hanna-Attisha, and it affected my enjoyment of the book. I also found the writing simplistic and at times repetitive. Nonetheless, this is an important book and I recommend it for anyone interested in science or medicine.
Disclosure: I received a complimentary copy of this book via Netgalley for review purposes.

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Preston had a winner with a previous book, The Hot Zone, and he hits it out of the park with his new entry, Crisis in the Red Zone. He has a talent for personalizing and making complex content comprehensible to readers who are not in the medical or health sciences. Once again, this is edge of the seat reading, much more exciting and engaging than most fiction thrillers. Preston’s warnings about what might present future threats to humanity are not to be taken lightly. Highly recommended.

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Wow! This book reads like a good thriller but is in reality, scarily true! Crisis in the Red Zone is an extremely well written account of the deadliest Ebola outbreak in history. I couldn’t put this book down.

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Crisis in the Red Zone is a engrossing true story of the Ebola breakout in 2013. The writing is incredible and this book will give you a true understanding of how ready and scary this disease is. A must read.

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Crisis in the Red Zone: The Story of the Deadliest Ebola Outbreak in History by Richard Preston is an incredible read about one of the deadliest viruses in history. I started reading this book on my commute and I cannot put this book down. I have read a couple of books on Ebola in the past but this book is by far the most detailed account as you can tell the author really committed himself to capturing every detail. From the beginning of the book when Sister Beata first encounters a pregnant Ms Dbobe to her ordeal, the book captivates the reader, and never let's you go! Highly, highly, HIGHLY recommended!

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Richard Preston is a truly gifted writer, and his immense talent is on fully display in this book that I believe represents the zenith of his craft. The story of the 2013-14 ebola epidemic is terrifying and fraught with details that one finds horrifying and heart-rending. Yet, Preston's gifts as a writer make this story something the reader is unable to put down, even in spite of the horror of the story. I was amazed that Preston is able to distill the true horror and evil of ebola by writing in what I can only describe as a lyrical manner. Not only is Preston able to describe all the details of ebola and the efforts to find a cure in a way that anyone can understand, he makes a point of also translating the details of the book's main setting in Africa (not just geographically far from most readers but even farther in terms of lifestyle and traditions) into a comparison to everyday American life so the reader can better understand. One of the best books I've read this year and also one of the books I will most recommend.

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I couldn’t stop reading this book. Richard Preston has an amazing skill for writing a nonfiction narrative that draws you into the story. It’s like a really good thriller novel, but is scary because it’s real. I remembered some of the players involved in this Ebola epidemic from media coverage at the time, but this book really helped me understand the relationships between all of the different organizations and individuals who were on the front lines of the fight. It is also a warning of how unprepared we are for a global pandemic of a disease like Ebola.

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