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LEVEL 4: VIRUS HUNTERS OF THE CDC, by Joseph B. McCormick M.D. and Susan Fisher-Hoch M.D. with Leslie Alan Horvitz

by Caitlin Burke

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Ebola. The Hot Zone. Level 4 Virus. In 1989, a monkey house in Reston, Virginia, catapulted "novel" viruses into the consciousness of Americans, unleashing a flood of articles and books (and ultimately a movie), whose tone became all the more hysterical after another outbreak in Zaire in 1994. Ebola has captured the imaginations of many people whose lives are lived, for the most part, out of sight of anything like the kind of suffering a hemorrhagic fever can cause. And the Reston outbreak again publicized some of the names and the work of the people who actually have seen that suffering. Two of those people are Joseph B. McCormick and Susan Fisher-Hoch.

In The Hot Zone, Richard Preston remarks that McCormick "had been face-to-face with Ebola in Africa and he hadn't gotten sick. He had worked for days inside a mud hut that was smeared with Ebola blood, on his knees among people who were crashing and bleeding out. You didn't need a space suit to handle an Ebola patient." And indeed you don't, which is a good thing, because there aren't a heck of a lot of space suits to be had in rural Africa. But Level 4: Virus Hunters of the CDC doesn't just tell the story of Ebola (although it does tell it, twice). It spends more time on Lassa fever, offering both war stories and a history of the program and treatment options McCormick and Fisher-Hoch worked to develop. It also serves as something of an autobiography for McCormick and Fisher-Hoch.

Imperfect copyediting leaves the impression that Level 4: Virus Hunters of the CDC was hurriedly prepared, but it doesn't obscure the book's strong political component. McCormick and Fisher-Hoch want to tell their stories their way, and several statements in the book are simple rebuttals of Richard Preston's description of the Reston incident -- "I was later suprised to read in The Hot Zone a suggestion that CDC was preparing to take over the entire operation. Neither Fred [Murphy] nor I had any such idea, nor did we ever express such a view." (Preston's "suggestion" is "Immediately afterward, Joe McCormick got up and spoke. What he said remains a matter of controversy.... According to the Army people, he turned to Peter Jahrling and said words to this effect: Thanks very much, Peter. Thanks for alerting us. The big boys are here now. You can just turn this thing over to us before you hurt yourselves.... We'll take care of it from here.")

McCormick and Fisher-Hoch also take issue with the way Ebola itself has been reported. They aren't exactly reassuring about the gory details, but they want to clarify what Ebola is and what it isn't. Fisher-Hoch remarks, "Contrary to a common misconception -- spread by certain movies and best-selling books -- the vital organs do not liquefy or to turn to gumbo, as one author described it." Preston had described Nancy Jaax, a veterinary pathologist with the military, as wanting to do her autopsies immediately after an animal's death, "before liquefaction sets in," because "you can't dissect gumbo." In Level 4: Virus Hunters of the CDC, McCormick does not name Jaax but describes her as giving "a description of [Ebola] that only vaguely resembled reality." This is an interesting recurrent theme; McCormick seems to want Ebola to be both the most formidable of adversaries and a veritable pussycat in the hands of ... someone like Joe McCormick. When McCormick says "The room was full of excitement and ego," you have to believe him.

Level 4: Virus Hunters of the CDC has a kind of exuberance to it, especially the autobiographical component. McCormick left the Centers for Disease Control under a cloud, and Laurie Garrett, author of The Coming Plague, quotes a CDC secretary in 1993 who had "asked around -- nobody around here has ever heard of him. You're the first reporter I know of who's ever asked for him. Are you sure he works at CDC?" -- a fairly astonishing comment (or gutsy party line) about a high-profile CDC official who had joined up some 20 years before. But the reader of Level 4: Virus Hunters of the CDC won't get a whiff of that scandal, even though McCormick was quoted later in 1993 as saying a few choice words about the CDC, too -- right before he left for his next (and current) job, at Aga Khan University in Pakistan. Fisher-Hoch joined him shortly thereafter, and they make it clear in this book that they are thrilled with their new life.

Is Level 4: Virus Hunters of the CDC a good book? It's certainly an interesting book. McCormick and Fisher-Hoch are very smart, very energetic people with appealing voices and a clear and deep commitment to their work. The book paints a picture of a pair of very memorable people, even cowboys, whose highest compliments are "character" and "maverick." It also has some terrific anecdotes about epidemiology in the field, obviously the first and lasting love of the authors. It is, however, uneven in the quality of its writing, and its greatest value seems to arise from its place in the continuing saga of the politics, personalities and events surrounding the emergence of the Ebola virus.

Ebola: Books and Links contains very short reviews of books that treat themes and topics that appear in Level 4: Virus Hunters of the CDC.

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