‘Hot Zone’ Author Richard Preston on What We Can Learn From Ebola - Rolling Stone

If the story of the COVID-19 outbreak seems familiar — a rare disease strikes a small area, only to become a deadly global pandemic — it's because we have indeed seen it all before. Not just in the real-life cases of other diseases including SARS and bird flu, but in movies like Contagion and 28 Days Later.

These can largely be traced back to the original virus-leaps-from-a-monkey-to-almost-destroy-humanity story: 1995's Outbreak, in which Dustin Hoffman and Renee Russo play stoic government scientists racing against time to save humanity from a faceless, relentless enemy every bit as scary as Michael Meyers: the fictional Motaba virus.

The film was based on The Hot Zone, a 1994 nonfiction book by journalist Richard Preston about the very real Ebola virus, which he'd been reporting on in West Africa for several years. The book was a massive bestseller that completely changed how the world looked at pandemics, spurring action and discussion around bioterrorism and public health as never before in modern times; in 1999, American Scientist named it one of the 100 or so books that shaped a century of science, alongside classics like Silent Spring and The Autobiography of Charles Darwin.

Though this coronavirus, COVID-19, is a very different contagion than Ebola — including different methods of transmission and fatality rates — Rolling Stone caught up with Preston about the spread of coronavirus, how the bumbled response by officials mirrors what he saw around Ebola, and what the path forward might be.

Outbreak is a product of the Nineties in one major way: It has a basic faith that the government is full of competent people working hard and doing their best to protect people. Today, the public doesn't have that faith.
Well I think there's some validity to that view. I think the average person should be very alarmed by the ineffectiveness of the federal government to get on top of this situation more quickly. I am extremely glad that [National Institute of Allergy and Infectious Diseases Director] Anthony Fauci is speaking for the public health community in a position of authority. He's saying social distancing can really help, and that's borne out by what I saw in West Africa. It makes a huge difference in the explosiveness of an epidemic.

In Africa, at first, people believed Ebola wasn't real, that it was a plot by the Deep State, that it was fake news, and that it wasn't much to worry about and would go away. In other words, President Trump has lately been acting like an Africa villager, and that's not to denigrate African villagers. They were just being human, they were in denial. But once they figured out what Ebola was, they began doing ferocious social distancing, and they also quarantined villages. And Ebola died out in a matter of weeks in the villages where it was born. It just simply was extinguished. Social distancing is what killed Ebola.

What do you make of the way the coronavirus has been spreading? Has it been progressing the way you would expect, or not?
I think it is playing out more or less the way I and any number of public health experts thought would happen. Let's step back a little bit and look at the big picture.

The COVID-19 virus is just an aspect of a much larger phenomenon, which is the fact that viruses we've never encountered before as humans are leaking out of the earth's ecosystems. And the epidemics and outbreaks are getting bigger, they're getting more frequent, and they're ballooning faster now.

How can we protect ourselves as a species? There are good answers. One is to do exactly what is being done: to use social isolation and self-quarantine to protect ourselves. This is the ancient way of dealing with plagues.

During the Black Death in Europe, if you were rich enough you went to the country.
Exactly, and the cities are left to the poor who can't get out, so the poor always suffer the most. I'm especially worried about large cities in the developing world. It could be really bad.

There are other things we can do, looking forward to the future. The United States needs to invest national resources in the development of vaccines. And also, very importantly, the development of antiviral drugs, [which] can be developed very quickly. The choke point is surge manufacturing. What the United States needs is a surge manufacturing capacity to bring antiviral drugs online very quickly, and then manufacture them in large enough quantities that people can be protected en masse, and healthcare workers can be protected.

What is the balance between panic and reasonable precaution?  Americans don't panic. We tend to ignore problems as long as we can, and then when we finally wake up to the fact that we have a real problem, we're amazing at solving it.

Americans do buckle down and get the job done in the end. It's always a clusterfuck at the beginning. What we're seeing right now is an American clusterfuck; it's classic. I'm hoping that, over time, the public and our leadership wake up to this and start doing the right thing.

We're way behind the curve on testing. Eventually I hope we'll catch up.

Preston Portrait: Carlos Beltran

This interview has been edited and condensed for clarity. Richard Preston's latest book is Crisis in the Red Zone