Every so often I get an email from NatGeo asking if I’d like to review one of their shows and interview the production team. It’s always a treat and of course the shows are great. It’s also a good break from my life at the moment. I’m currently living in a place that’s being given desperately needed renovations. Being asked “would you like to sit down and binge watch six hours of TV and forget that you had to remove a family of possums from your attic this week” is hardly something you have to twist my arm to do. This time, I got an email asking if I wanted to preview The Hot Zone and interview Dr. Michael Smit, an infectious disease doctor who worked on the series.
I wasn’t happy. I was ecstatic.
I’ve been seeing ads for The Hot Zone mini-series on Nat-Geo for a few months and I was already looking for ways to watch it without cable (punchline: Hulu with live TV, and there are a few other options, you’re welcome). Based on the Richard Preston novel, the series is a dramatization of the 1989 incident of Ebola landing on US soil for the first time. As it’s a historical event that happened when I was six (oh God I need eye cream), I think it’s safe to drop some spoilers without too much yelling.
This is not the organs-leaking-out-of-your-eyes-Ebola. Which shouldn’t be a surprise, given that you bring up “that Ebola outbreak in Maryland the 80s,” and you get some funny looks. Especially when you bring it up while eating ribs that are falling off the bone. In my interview with Dr. Smit, I learned a lot more about this particular strain of Ebola. I was a little surprised in one of the earliest scenes of the series when Dr. Nancy Jaax, portrayed by Julianna Margulies, was wearing minimal personal protective equipment (PPE). Gloves, a lab coat, some hair in her face, no mask. This was not the PPE I remembered from that classic 90s documentary, Outbreak. Ahem.
“They really didn’t know what they were dealing with when they got the initial sample, so the initial concern in real life was that it was Simian Hemorrhagic Fever, which is not contagious to humans, so they wouldn’t have used Ebola PPE initially,” Dr. Smit explained. He went on to tell me that a lot of the science portrayed in the series is accurate but condensed. “The whole process that you go through for processing samples is time consuming and boring. Taking a piece of tissue, fix it, staining it, rinse it, it can take days to prepare a sample so they had to condense that. We also combined events and locations. Like the freezer (with the Biosafety Level 4 pathogens)- that’s really in a remote location but in order for the flow of the story to not be confusing and boring, we kept them in the same location.” Take note, children, science in real life is going to bore you to tears for hours before something exciting… maybe eventually happens. If you’re lucky. Or you light something on fire (please don’t do that). If you want to see some fact checking on the events and science in the series, click here.
We learn early in the series that Ebola is one of few known filoviruses, a nasty little group of viruses all classified as Biosafety Level 4 (translation: there’s no cure, prevention, and may the odds be ever in your favor). The first documented outbreak occurred in 1976 in Zaire involving two pathogenic strains of the disease, Zaire Ebolavirus and Sudan Ebolavirus. It’s believed that the virus existed in nature before then, but larger outbreaks became inevitable due to human migration into the native environments of host animals. This virus was named Reston Ebolavirus, much like the other strains, after the location at which the first outbreak occurred. The series takes us through visceral moments that make you grip at your arms, cover your mouth, and occasionally hold your breath for a little too long. Even going into the story knowing that this wasn’t a deadly strain of Ebola, every encounter with a monkey is petrifying. It made me wonder if any of the dangers were dramatized for the series.
“No, I don’t think that they played up any tension,” Dr Smit told me. “In 1989, Ebola was really an unknown disease. Even in Fort Dietrich, only a handful of people had worked with Ebola or knew what it was. Back then there weren’t all these types of Ebola that we recognize of today, so they were really concerned that it was Ebola Zaire which was 90% fatal at that point. So even after they’d euthanized all the monkeys and contained the outbreak it took a little time to sort out that it was this new type of Ebola and not Ebola zaire. So there was a lot of concern that this was the real deal.”
At the time, we didn’t know of any strains of Ebola that didn’t infect humans. A new strain was discovered as recently as last year, provisionally called the Bombali virus, which has not been shown to infect humans yet. In terms of how a disease can be so similar to a highly deadly one and be non-pathogenic, or affect monkeys and not humans in some cases, Dr. Smit explained, “It’s kinda like a lock and key situation. We have different locks on our cells than they have on their cells.”
The story hits a few genuinely scary points. Scientists are scratched by monkeys that are almost certainly infected. People who have been exposed come down with some symptoms. And, after exposure, four people test positive for antibodies to this strain of Ebola. Beekeeper suits and quarantine for all!
‘But wait Scibabe,’ I psychically interpret you thinking, ‘didn’t you write that humans can’t get this strain of Ebola?’ Indeed I did, which is why I asked Dr. Smit about this.
“So as far as people who tested positive, there are cases of people who tested positive to Ebola Reston, but when they say “positive,” there are different ways of testing positive- they had positive antibodies. You can have the antibodies but not have the clinical illness. Their immune system recognized it but it was unable to make them sick.”
This made me wonder if, since they had the antibodies to this, if they somehow had any immunity to Ebola Zaire. As the concept of vaccination came as a result of people developing some immunity to smallpox after first being infected with cowpox, it wasn’t a stretch. But it’s something that I’ll continue to wonder, as Dr. Smit had no answer.
“We don’t know that. There is going to be some cross reactivity. But we don’t have a lot of data on that yet and it’s not recommended to voluntarily infect somebody to see if they’re resistant. They don’t have a clear understanding on if there’s cross-reactive protection or, if there is, how long that lasts.” Well, um, glad that they’re not infecting people with Ebola just to see if they’re immune.
But there is something they’re doing now to give people immunity: an actual vaccine that’s 97.5% effective against Ebola. There is another Ebola outbreak currently in the DRC, and though there have been problems in deploying the vaccine, it’s been highly effective in curbing the spread of the virus. “They’ve given over 100,000 doses of vaccine in the DRC in the current outbreak where they’ve had over 1,000 people with confirmed Ebola die so far. My sense is that they’re going to find it’s very effective. A lot of places where they need it, they’re not going to be able to get to because of the violence and unrest with militant groups in that area.”
So how does a virus like this end? Does the WHO launch worldwide eradication effort like with smallpox or polio, or do they attempt to vaccinate solely in areas likely to be affected? As it was explained to me, the divining calculus is more complicated than just how scary the disease is.
“A lot of this is going to come down to economics and politics. In that part of the world, Ebola periodically resurfaces. However, there are thousands of people every year who die of malaria, measles, and diarrhea. There is serious economic competition, they’re trying to get coverage with the measles vaccine. Probably because it’s so sensationalistic it will get more traction, but it’s yet to be determined if we’ll do widespread vaccination for Ebola.”
But, there’s a solid reason he pointed out for why an eventual push may occur for more widespread Ebola vaccination: security. “I think one of the reasons it will get more traction in pushing for vaccines is it’s such a sensationalistic issue and it’s security issue. Having Ebola cases pop up outside of the DRC can cause mass chaos, disruption of travel, disruption of economic performance, so it would probably that would be an added advantage of the vaccine being more widely distributed.”
However, the most surprising thing that I learned from Dr. Smit: Ebola is far less scary than it looks in the seriess if you were to get it in America. “You have to really understand that it’s a disease of poverty. If you look at the epidemics from 1976 to the 1989 Reston event, some of the Ebola Zaire outbreaks, the fatality rates are up to 90%. Fast forward now to the 2014 West Africa outbreak, in the patients who were evacuated from Africa and treated in Europe and the United States, the survival rate was about 90%. So if you’re able to get IV fluids, electrolyte replacements, the survival rate is drastically different. The sickest person who survived- at one point was intubated was losing ten liters of fluid a day on diarrhea. If you can imagine that in the field environment in West Africa? You’re not going to be able to support that, but in the ICU in the US that’s something you can survive. To boil it down to a single sentence- the way it’s treated now in Africa, two out of three people die. In the US, one out of ten people die.”
Things I didn’t see coming: that.
So what’s the chance of Ebola ever becoming a global pandemic? Is Ebola the threat we have to worry about or is, say, the flu more of a problem? “The way Ebola is transmitted is through contact. You have to touch your face or your mouth or a cut to be infected. We calculate the R0, which represents how many patients your primary infected patient will they infect before they either die or get better. For Ebola, that number is two. One person out in the community, on average, is going to infect two other people. Even though it’s deadly, it’s not that easy to get. The thing you have to worry about is something like Avian influenza when it gets easy to get like measles. For something like measles the R0 is 15. So one person with measles can infect fifteen people. When something like a bird flu mutates, that’s of grave concern.”
The last occurrence of a global pandemic was when H1N1 hit in 1918, a strain of the avian flu dubbed the Spanish Flu. It infected approximately half a billion people and killed 50 million. Even though this was a particularly virulent strain, keep in mind that deaths from the flu aren’t uncommon. Deaths from Ebola are.
“Things like Ebola get a lot of media attention because if you look at the 2014 Ebola epidemic in West Africa, they had over 11,000 die from the infection. In the US, we have over 40,000 deaths from the regular old flu some years. We have this disease that kills tens of thousands of people every year and some people saying ‘I don’t think I need a vaccine.’ If you’re talking about the most bang for your buck if you’re worried about something you’ll get sick with in the US, the flu shot is a no-brainer.”
The infectious disease doctor who consults on Ebola said to get your fucking flu shot (slight paraphrase).
As for the acting and writing? Remember the movie Outbreak? It’s like that only a mini-series and the monkeys are creepy af. There are a few clunky bits in the last episode of the series, but that may have been how I interpreted it after a day of binging the series to write this. It was a bit heavy handed to drive home the seriousness of how much work the medical system had to do to prepare for if- and when- a pathogenic strain of Ebola arrived in the US. From the incident The Hot Zone, the CDC went on to make major advances in how prepared they were for another Ebola incident. The disease has gone from an automatic death sentence to something that we have a vaccine for. You probably won’t ever have to worry about needing that Ebola vaccine, but you should get that flu shot and watch The Hot Zone.
The Hot Zone is appearing as a three night special on National Geographic from May 27th-May 29th and can be viewed on Hulu Live TV.