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Now that those diseases -- the gruesomely deadly Ebola virus and the tick -- borne Crimean Congo Hemorrhagic Fever, for exampleÑhave become the subject of increasing public concern and an expanding popular literature, the two have been persuaded to offer a personal, insiders' account of the struggle to understand and to curb the destructive power of these viruses. The result is a book that is immensely informative, with, as Fisher-Hoch quickly points out, moments of high drama.
"Reading some of the other books on the subject," Fisher-Hoch says, explaining one of the couple's reasons for deciding to write Level 4, "we realized that the real things that happened to the real people investigating these diseases are far more dramatic than what we saw in most of those other accounts."
Then, in one of the seamless elaborations of one another's thoughts that is a pleasing characteristic of the book itself, McCormick adds, "There hasn't been much written on these diseases that is accessible to the general population and that provides the kind of insight into these viruses that our book does."
Which is true. No other book, for example, describes quite so vividly the "nauseating feeling" of pricking oneself with a contaminated needle from a sick patient during an outbreak of Ebola, as happened to McCormick in southern Sudan in 1979. And few move so easily from bedside descriptions of the torments of the victims of these diseases to discussions of the international -- and inter-agency -- cooperation and competition that create the political and economic environment in which the virus hunters operate.
In telling a story that takes the reader from Africa to Atlanta and England, where Fisher-Hoch was born, to Karachi, Pakistan, where they now live, the two have worked hard to put events that must have frequently seemed nearly incomprehensible to researchers and victims within easy grasp of readers. As Fisher-Hoch says, "In real life we would jump from one virus to another. At the CDC [Centers for Disease Control] you would be working on one virus, but if there was a sudden outbreak of another virus, you would drop what you were doing and begin working on the new one."
"Some of these studies went on for years," McCormick continues. "We had to figure out how not to string the reader too far along over time and subject."
That they are largely successful in their efforts is an achievement. But that they accomplish this without the usual hype and hoopla of our media age is more than remarkable. In conversation and in the book, the two are generous with compliments for dozens of fellow-researchers they worked with over the years. And one must press and press again to get them to tout their singular accomplishments. McCormick, for example, joined the CDC in 1974 and became chief of the Special Pathogens Branch in 1982, later creating the Level 4 facility -- the so-called "hot zone" -- for working with extremely hazardous infectious agents at the CDC's Atlanta headquarters. Yet it is Fisher-Hoch who finally explains the significance of McCormick's groundbreaking work in Sierra Leone on the treatment of Lassa Fever.
But this rather appealing modesty should not be mistaken for a lack of passion. Ask Fisher-Hoch, one of the few women working in the field, about indications of sexism portrayed in the book and you get a warm "there is still a lot of macho-ism in the field which proclaims 'Hey, we look good doing this work.' " And now in her work at Aga Khan University (AGU) in Karachi, where she runs the clinical microbiology lab and has set up the only virology lab in the country, she contends with a culture where "women are still very much second-class citizens." McCormick, too, grows passionate when asked to retell the story of his encounter with the willful, politicized ignorance of a Reagan administration official when he was trying to set up early studies of HIV transmission among heterosexuals in Africa.
In fact, one of the essential lessons of Level 4 is that ignorance is the handmaiden of disease. McCormick and Fisher-Hoch make it clear that they have spent much of their careers warring against an ill-informed officialdom that would demand inefficient, inhumane, and occasionally dangerous methods of handling victims of hemorrhagic fevers when, as McCormick puts it "you can safely handle these patients with simple techniques of gowns, gloves, and masks." And one of the shocks of the book is to learn that many of these lethal viruses are transmitted in hospitals through poor medical care. "This," says McCormick, "is part of the face of poverty. These physicians are trying to make a living. But they are poorly trained because these poor countries can't afford good teaching. And when doctors are poorly trained, they practice poorly."
That, of course, is one of the reasons McCormick and Fisher-Hoch have gone to Pakistan -- to set up a public health service for Pakistan and to train young doctors and researchers. To inform the rest of us, they have written this book.
"We don't believe it's useful to have everyone running around in fear of these diseases," says McCormick, who now chairs the community health sciences department at AGU and continues his research on viruses and the countless other health problems that afflict poor countries like Pakistan. "It's better to have people understand that these viruses are not lying in wait for their next victim. It is human activity that invades the space of these viruses that is the driving force in their transmission. There is rationality to these outbreaks. That's the message we'd like to convey."
Alden Mudge is a freelance writer in Oakland, California.
©1996, ProMotion, inc.