© Amrai Coen

How the virus came into this world

Distraught nurses, superstitious rice farmers and a village in the African rainforest where the plague claimed its first victim. ZEIT reporters followed the trail of the Ebola epidemic. The reconstruction of a global catastrophe. By Amrai Coen and Malte Henk

1 — Arriving at Freetown, Sierra Leone

Sweating and swearing under her breath on the steep hill, past scrubby undergrowth and plastic waste, Kadiatu Lansana is on the tail of a pandemic that cannot be stopped. The noonday sun bears down on the shantytown and the young woman making her way through it. From up here you can see Freetown, the capital of Sierra Leone, which has been under siege for three months. But by whom, or by what? An enemy? The elements? An invisible, elusive menace?

Three uniformed men guarding the entrance to a narrow road pull a tree trunk to the side, and Kadiatu Lansana steps into the quarantine zone – a few huts topped with corrugated iron. The pestilence has gerrymandered the city, separating neighbor from neighbor and safe streets from risk-ridden areas. Kadiatu Lansana and other helpers have become detectives of sorts in the midst of this chaos. If anyone falls prey to or dies of Ebola in this megacity, their job is to monitor everyone who came into contact with that person. In the language of the epidemic, which everyone in Freetown has long learned, they are "contact tracers."

Kadiatu Lansana stops at the first hut. A man is pacing back and forth outside the door like a prisoner in his cell. His name is Shernor Barrie. He is 27 years old. "How are you doing today, Shernor?" Kadiatu Lansana calls out from a safe distance, several yards away. "Physically okay," Shernor Barrie answers.

A patient being watched by a guard in Freetown © Amrai Coen

His father died two weeks ago. Men in protective suits came to pick up the corpse; the next day soldiers sealed off the quarter. Now no one is allowed to leave their homes for three weeks. The virus is holding two dozen people hostage. Shernor Barrie wonders if this thing is lurking in his body too, this thing whose name he does not care to utter. In the evening before he goes to sleep, he thinks about how it would be to wake up critically ill. His chances of survival, in statistical terms, would be just under 30 percent. Barrie knows that no medicine can cure Ebola. He counts the days, the hours, until he can take control of his life again – or until the symptoms overwhelm him, the ones Kadiatu Lansana asks him about every day.

"Headaches?"
"No."
"Fever?"
"No."
"Diarrhea or vomiting?"
"No."

In Freetown alone, tens of thousands of people are under quarantine now – people like Shernor Barrie; many hundreds more are trying to keep a handle on things – people like Kadiatu Lansana. She quit her job as a nurse to combat Ebola. She believes that the battle will be decided out there, in the streets and courtyards. And she knows things are not looking good. There should be many more people under quarantine; there should be many more contact tracers on patrol.

Nowhere in the country is Ebola spreading faster than in the densely populated quarters of the capital. More people are dying by the day; every four weeks the number of infections doubles, and on average each person passes on the virus to two more.

For Shernor Barrie’s father, it was more than two. The house was inhabited by Shernor’s mother, his two sisters and his younger brother Ibrahim. The family shared two rooms. One week after his father’s death, his sisters and mother began feeling fatigued. Kadiatu Lansana called an ambulance – and the last Shernor Barrie heard was the news that they had tested positive. Shernor Barrie stayed behind with eight-year-old Ibrahim.

Then Ibrahim complained that he hurt inside. He cradled his body in his arms. When Kadiatu Lansana came to visit that day, she checked the "joint pain" box on her diagnosis sheet. Shernor Barrie called the Ebola emergency number 117, but no ambulance came. The next day Kadiatu Lansana checked "fever." Ibrahim wanted a cola, and Shernor Barrie gave it to him. No one answered at 117. Shernor pulled plastic bags over his hands and washed his brother’s face.

Day three: "vomiting and fever." Kadiatu Lansana could do nothing but fill out her form. The 117 operator said they would send an ambulance. While Shernor Barrie battled the bureaucracy spawned by the epidemic, Ibrahim lay alone in a room. Shernor tried to care for him through a hatch, but Ibrahim stopped eating and talking.

At her next visit, Kadiatu Lansana wrote "dead" on her form. She drew three lines through the rest of the boxes, slashes that bespeak anger and sadness. A hearse huffed up the hill instead of an ambulance. That was three days ago.  Shernor Barrie is alone now. He asks himself where his father and brother are buried, and he doesn’t know if his two sisters and mother are still alive. If he ever makes it out of the house alive, he wants to search for his family – in the hospitals across the country, in the cemeteries of his home town.

Freetown is not only an enormous reservoir for the Ebola virus, but also a wellspring of nourishment. The city is a gateway to the world, just like Monrovia and Conakry, the capitals of neighboring Liberia and Guinea. Chinese container vessels anchor at the docks; planes lift off the runways and land a few hours later in Europe. An epidemic that takes root here will not be confined to the African continent. The week before, a patient from Liberia died in Leipzig. Nurses have tested positive in the United States and Spain, and the Mayor of London has said he expects the virus to descend upon his city as well. Ten months after the outbreak, some 4,500 people have died and 9,000 been infected. Battalions of soldiers and doctors alike have been set in motion, hailing from Germany, Cuba and the United States. The United Nations has proclaimed that world peace is in peril. The American health authority CDC has warned that the number of infections in West Africa could reach 1.4 million by January 2015.

How could this happen? How can a tiny thread-like particle that is only visible under an electron microscope bring three countries in West Africa to a standstill and strike terror into hearts across the globe?

Based on research conducted by scientists and talks conducted with doctors, patients, witnesses and epidemiologists, it is surprisingly easy to reconstruct exactly how the virus spread. A team of ZEIT reporters traveled to the starting point of the epidemic and followed the trail that Ebola blazed through Freetown. This is only one of the paths it took; others lead to Monrovia, to Conakry. They are similar to the route traced here.

A series of unlikely coincidences has served to strengthen the virus. Other factors in the equation include the way farmers live in the rain forest, human contact with animals, old superstitions, and new suspicions vis-à-vis the national governments; paralyzed hospitals and modern highways. What ultimately paved the way for the virus was a toxic cocktail of pre-modern traditions and 21st century advances. This story ends with the world in a panic. It begins in a small village in Africa.

2 — Meliandou, December 2013 – The Cross-infection

Just an everyday incident, so fleeting and insignificant that there are no witnesses. A boy, barely two years old, touches something he should not touch – just like millions of toddlers the world over. Maybe it’s a wild animal from the bush that his mother is cooking for dinner. Maybe then the boy sticks his fingers in his mouth.

In these few seconds, it comes to pass: the virus. It passes into the body of the little boy, who becomes cross-infected. Now referred to by doctors and researchers as patient zero, his name was Emile Ouamouno. His home, ground zero in a global catastrophe that began during the closing days of 2013, is called Meliandou.

The village lies nestled between gently rolling hills in the Guinean hinterland, a handful of narrow mud-brick houses clustered around a stony marketplace. There are fire pits covered with palm leaves, a tumbledown church, a river where the children swim. The house of the rice farmer Etienne Ouamouno is one of the larger dwellings. On a mid-October day, Emile’s father stands in his yard, surrounded by squawking chickens: 32 years old, wearing a blue T-shirt, his head shaven bald, trapped in his grief and his shame. Haltingly, he weighs his words as he recounts what happened to his son and his village nine months before. Gathered around him are friends and neighbors, listening to a narrative they have long known by heart. 

The village of Meliandou © Amrai Coen

A few days after his brief encounter with Nature, Emile can no longer keep food down. He is vomiting. His feces are black as coal, his body is feverish. He does not react to the malaria medicine given to him by the doctor in Meliandou’s tiny health station. Emile dies on December 28, 2013. The virus has found its first victim. No one gives Ebola a thought.

It might have stopped there. Deadly viruses often cross-infect humans without dropping roots. A mysterious illness flames up briefly in a remote village in the back of beyond, a clueless physician pens "cholera" or "malaria" on the death certificate, and the fire dies out – that would have been the more probable conclusion to this story.

None of what happens next was inevitable. Unlike earthquakes and avalanches, epidemics are not governed by the laws of nature. People can aid a virus and hinder it. Every epidemic can be seen as a sequence of unwitting human errors.

The first human error that gives this virus an edge could hardly be more inconsequential. It’s a family argument.

Etienne Ouamouno, little Emile’s father, has been despised by his mother-in-law for years. Ouamouno does not understand why. After all, he is a good man. He doesn’t drink and he goes out to work on his rice field every morning. Yet his mother-in-law hates him. She has convinced his wife to leave him. Ouamouno’s wife took her son and moved in with her mother. Ouamouno stayed home with their daughter.

Emile thus falls ill not in his father’s house, but in that of his father’s mother-in-law. He is not brought home until shortly before he dies. The virus contaminates two houses at once, effectively doubling its chances from the start. It can infect more people.

The year 2014 had just begun when, one after the other, they fall ill and die: Etienne Ouamouno‘s daughter Philomène, four years old; his wife Sia, 25; his mother-in-law Welle, 46; then two people who had been staying with the mother-in-law and who spread the infection to the neighboring villages Dawa and Dandou Pombo before they, too, die.

Etienne Ouamouno broods over his survival to this day. Why him? He held the dying child in his arms, too – Emile, his only son. "We all thought it was a curse," says Ouamouno. "Everyone who touched my child was doomed to die." His gaze is riveted to the ground. Months pass before the inhabitants of Meliandou learn more about the catastrophe that befell their village like a divine punishment. Strangers will come visiting: some are foreigners, many doctors and biologists and epidemiologists. They ask questions for days on end. It is from these people that Ouamouno first hears the word "Ebola." But to this day, Ouamouno and the others will not have quite grasped that they themselves paved the way for this misfortune a long time ago.

In recent years thousands of people have migrated to the area around Meliandou, among them many refugees from the civil wars in Sierra Leone and Liberia. The villages grew, the distance between the houses shrank and the rainforest, which once seemed impenetrable, yielded to fields, farms and mines. The humans forced Nature to obey their laws. They left only a perimeter of trees around Meliandou, trees that bear mangos and papayas.

It is on these trees that fruit bats now land. Also called "flying foxes," they are European bats’ big brothers with wings as powerful as an eagle’s.

They seemed to be good-natured creatures, these refugees from the rainforest. They did not attack people or eat meat; as frugivores, they hunted only the fruit on the trees. Often the village children would gather and crane their necks to watch the megabats flutter overhead. They invented a game: Who can find a partially eaten mango that was dropped by a flying fox?

When the people of Meliandou set up nets, it was easy to catch the fruit bats. Or they simply used shotguns. The meat, they say, has a pleasantly sweet taste, "much better than chicken." Here flying fox with rice is regarded as a fast and cheap meal.

Everyone in Meliandou has eaten fruit bat meat at one time or another. And no one suspected what researchers have now known for several years: hypsignathus monstrosus, also called the hammer-headed bat due to its physiognomy, is regarded as the primary natural host of a virus called Ebola. 

All living things have viruses. Algae, bacteria, plants, insects, mammals, humans. A virus is nothing other than a minute strand of genetic material, a prestage of life that is programmed to replicate itself and proliferate. A virus needs to penetrate an organism – but without doing too much damage. A dead host can no longer play host. 

Viruses are like gamblers. They do not want to lose to their opponents, but they don’t want to destroy them either. They want to keep playing, forever.

The game the Ebola virus has played with its megabat host has lasted for millions of years. During this time, both parties have refined their reciprocal relationship: the virus has fine-tuned its offensive strategy and the flying fox its defense system. The megabats live in gigantic colonies, often perching in flocks of thousands. This is why Ebola is transmitted by bodily fluids – blood and feces and urine. That suffices for the virus to circulate from bat to bat, from colony to colony, from one jungle to the next and throughout Africa. The flying foxes can easily cope with the symptoms, just as billions of humans weather cold viruses with intercontinental reach in the winter. One might say that Ebola is the common cold of the megabat.

A biological head-on collision took place in Meliandou. Two distinct systems of life crashed into one another: the Ebola virus and the human being, Nature and Civilization. At first glance the human might appear to be the innocent victim, the virus the aggressor. Yet the human destroyed the habitat of the fruit bat, forced it to accept its kind as neighbors. The human hunted the megabat down, dissected it, digested it. The virus did not invade the habitat of humans. Quite the contrary: humans invaded the habitat of the virus.

People have always been afflicted by germs that are transferred from animals. Eons ago a mosquito bit an ape and shortly thereafter a human being. Malaria was born. In 1908 a man came into contact with a chimpanzee in southeastern Cameroun and become the first HIV-positive human. Many researchers believe the Plague was sparked in the Middle Ages by a relative of the Ebola virus. Between 1918 and 1920, more people died of the Spanish flu than in the First World War. The virus was harbored by aquatic birds.

If pathogens are confined to hosting in humans, they can be eradicated. This was the case with smallpox; it no longer exists. But Ebola, HIV, rabies and all the other viruses cannot be destroyed. It would be impossible to kill every last animal that might offer it a safe haven, somewhere in the shadows of a rainforest.

Ebola has been transmitted to human beings 30 times since 1976. Its incidence has increased in recent years. Whether it be in Uganda, in Sudan or in the Congo, its prelude has always been the disappearance of a jungle – the natural barrier between human beings and fruit bats. And deadly infectious diseases are not limited to Africa: witness SARS in southern China in 2003, swine flu in Mexico in 2009. As in the case of Meliandou in 2013, the when and where are pure coincidence. Not so the global cause behind it: never before have so many people lived in such close proximity to animals. And never before have so many people traveled the world.

That’s why this story is also a lesson on something that sounds long ago and far away. A parable about plagues. Humankind will be forced to endure many more in the 21st century.

Slowly, and so subtly as to escape suspicion, the virus begins radiating out from Meliandou in the first weeks of 2014. Fever, diarrhea, vomiting – Ebola disguises its deadliness with symptoms that are commonplace in this part of Africa. Later doctors and experts will struggle to explain why they had failed to register what was happening. Some will argue that, this time around, there was less blood – less hemorrhaging from the eyes, ears, nose, mouth and rectum, a typical sign of Ebola that presented itself in few West African patients in 2014.

Explaining Ebola on public posters © Amrai Coen

The hospital in Guéckédou, some seven miles from Meliandou, has become the infection’s center of gravity. There is some kind of virus at play, the doctors think. They test nine patients for cholera and get seven positive results. The methods used are old and unreliable, and these are false positives. Another human error, another bonus for the virus. Ebola, now dismissed as cholera, is free to spread for weeks before its identity is revealed. Meanwhile the doctors prescribe saline solutions to combat the misdiagnosed cholera; the patients die. It is not until March 10, 2014 – the outbreak has already claimed almost 30 lives – that baffled bureaucrats at the health authorities in the two prefectures of Guéckédou and Macenta draw up a medical report. A few days later it reaches the Geneva headquarters of Doctors Without Borders and the World Health Organization (WHO). These two bodies routinely concern themselves with more or less obscure diseases in every corner of the globe; they receive the accident reports from humankind’s calamities.

When an epidemiologist from Doctors Without Borders pages through the report, he suddenly sits up and takes notice. There’s something in there about hiccups. You don’t have hiccups if you’re suffering from cholera. But hiccups are sometimes symptomatic of an Ebola infection. No one knows why.

How ironic. The most innocuous and trivial symptom of all leads to deadly certainty. It is as though a bank robber were caught because he is wont to wear brightly colored socks.

The emergency routine cranks into gear at Doctors Without Borders. A team of experts travels to the outbreak zone to gather blood samples from the fatally ill. On the evening of March 17, the refrigerated samples are transported from Conakry to Paris on Air France flight number 751. The virus has come to Europe for the first time; its destination is a laboratory in Paris. However, the blood from Guinea cannot be processed – "technical errors" will later be cited as the reason. While more and more people in West Africa become infected, no one knows what to do with the blood samples in France. After two long days they end up in a lab in Lyon. At two in the morning a phone call comes in to the coordinator in charge at Doctors Without Borders in Geneva. The test results are beyond dispute: Ebola.

It is not as though the world failed to react the moment it became clear what was at stake. Every single infected person can infect hundreds more, which is why every day counts when the priority is to stop an outbreak. Experts from Doctors Without Borders, the WHO and other organizations travel to Guinea. Medical equipment is brought in, treatment centers are set up, contact tracers climb into their Jeeps.

And the virus is actually forced into the defensive. During the spring the number of infections has dropped. Nearly 200 have died, but in the evenings experts are increasingly reviewing days with no reports of new cases. At the end of May, vanquishing the virus seems only days away. It has been confined to a few villages in a single prefecture in southwestern Guinea.

In the spring of 2014, the Ebola virus needs a human helping hand.

3 — Koindu, May 2014 – The Return

Those who travel through the outbreak zone today, six months on, will encounter a checkpoint every few miles: a wooden barricade blocking the road and a makeshift hut beside it. A soldier stands on duty, armed with an infrared thermometer. He aims it at the temple of anyone wishing to pass. A moment’s pause, then judgment is pronounced: 98.2° F, Or 96.6. If it’s over 100° F, the person is taken into custody. The military wields its power, hunting down the virus like a terrorist on a wanted list.

This increase in military presence evokes images many people believed consigned to the past. Scenes of the civil wars that wreaked havoc in the region during the 1990s resurface. Today, people say here, things are much worse. Back then the enemy was a fantasized child soldier skulking in the jungle; this time it might be lurking inside one’s own body – or in someone else’s. In the Ebola zone, people regard their hands as enemies that need to be held in check. Who knows what or whom they may have touched?

The roads are empty, their condition lamentable. It’s the rainy season in West Africa. Cars sink into the mud up to their chassis and children stand ready to shovel them out. Suddenly shouts ring out. The children scatter like a frightened flock of birds, then an ambulance approaches. It’s essential to keep a safe distance: these are Ebola victims being transported through the quarantine zone. The ambulance lurches onward.

Finally the river, the boundary that separates Guinea from Sierra Leone. On the other side is a provincial town with 13 churches and two mosques: Koindu. The village of Meliandou is one-and-a-half hours away; Liberia is also nearby. A triangulation of nations, inhabited by the Kissi, a tribe with its own language and traditions that tends to view national borders with indifference.

There’s a house on the outskirts of the town. It has a small yard and an awning; the doors are closed. Half the neighborhood congregates when they notice that visitors have arrived, but none of them dares approach the dwelling. People keep their distance as if it were a bonfire. In a faraway, long-ago time, the time before Ebola, a woman in her early sixties lived here. Everyone called her Finda. Her renown extends far beyond the village. She practices ancient healing rituals. Often she disappears into the woods in search of mushrooms only she can identify. People go to Finda when they have stomach aches or are suffering from nightmares, fever or a curse. Finda has a remedy for everything. She administers steaming brews, places leaves on people’s eyes, washes and recites spells over naked bodies. Rare is the person who does not believe in her gift. Rare is the person who has not turned to her for help.

Finda also helps birth babies and chairs an influential women’s group. A healer as local hero – therein lurks a danger for which the villagers have no antennae.

Unknown numbers of Ebola victims from the outbreak zone in neighboring Guinea seek help from this woman – before she herself contracts the disease. Her own methods are tried, but in vain. Finda dies the night of May 19/20.

Early in the morning the first mourners gather outside the house. Soon a crowd has formed, and in the end there are hundreds, from Guinea and Liberia as well, sitting on plastic chairs under the awning, pressing into the dark rooms. Women wash the corpse that is laid out on a bed, and wrap it in white linen. Hours pass before Finda is borne to the cemetery.

At no point are Ebola victims more contagious than when they die. The viruses amass in the body like worms in a compost heap. Were a virus a thinking being, it could choose who to cross-infect next from the dense ranks of the mourners. Its re-export to Guinea is now on the agenda, and to Liberia, where the authorities have registered very few cases to date. At least 365 deaths can be traced back to this memorial service, as researchers later reconstruct.

Epidemiologists have a special term for a contagious person like Finda: superspreader. The irony is that this role fell to a healer. Ebola is now back in full force, in Guinea, in Liberia – where the statisticians’ curves are due to skyrocket in the coming days and weeks. What is more, it has now established a foothold in Sierra Leone.

Before the virus lies the path to the coast, 285 miles straight across the country.

Soon the first victims report to the health station in Koindu – a sad little house with three rooms labeled "Birth Room 1," "Birth Room 2" and "Birth Room 3." The clinic director there cares for the eight infected women as best he can: Suleiman Kanneh Saidu, a man in his mid-forties, is the supporting-actor-as-hero type occasionally generated by catastrophes. Many of his patients will die, but he will carry on. He will contract the disease, but he will survive. And then, immune to Ebola, he will continue his work to this day.

His top priority is to instantly sound an alarm. He calls the number of the Kenema Government Hospital, the largest in the eastern part of the country. To date, the healthcare workers here have concentrated on other infectious diseases, but following the outbreak in neighboring Guinea they have equipped their laboratory to detect the Ebola virus in blood. Since March they have been prepared for the emergency. Now, on May 25, Saidu dispatches blood samples to Kenema by motorcycle. Five days after the burial of the healer, the authorities know that the virus has reached Sierra Leone as well.

The next morning an exploratory team leaves the hospital in Kenema: two men in protective gear and a driver in an ambulance. Their job is to bring Saidu’s patients to Kenema as soon as possible in order to isolate them. Their mission: to stop the virus in its tracks. From a medical standpoint, this is a measure taken to combat an infectious disease. From the standpoint of the Kissi people, it is an offensive launched by a hostile power.

Suddenly Suleiman Kanneh Saidu and his colleagues from Kenema find themselves under siege at the clinic. The people outside are calling out to one another, saying that these strangers with their covered bodies and cumbersome masks are trying to kidnap the sick. They want our blood, they shout, they want to use it to distill a potion to exterminate us. Others in the crowd firmly believe that merely uttering the word "Ebola" will bring on the curse of the disease. In reverse logic, this means it is imperative to say nothing. Then nothing will happen.

The author Malte Henk (white shirt) © Amrai Coen

The hysterical mob drives the team out of the village. As head of the clinic, Suleiman Kanneh Saidu points out the medical arguments. But the virus profits not only from the villagers’ penchant for and proximity to magic and superstition, but also from the remoteness of the state, the authorities and bureaucracy. The virus is also aided by the strength of one individual. One of the eight patients in Koindu recovers. Supported by her husband, she exits the clinic and makes her way into the woods. There she hides for 10 days from the strangers in the ambulance. Months later her neighbors will still be staring at her as if she were a walking miracle.

They had been told that Ebola always ended in death, but that wasn’t true. When the families of the others see the patient leave the health station, there is no more restraining them. Seven fatally ill women are borne to their homes on their husbands’ backs. The men all contract the disease, and before they die they will infect others. The deadly virus was supposed to be stopped in Koindu. Instead it gains a new lease on life.

To this day, most of Koindu’s inhabitants are still under Finda’s spell; only a few believe that the healer violated the peace and prosperity of their town. Those who have gathered at her house on this October day are talking about a snake. It was responsible for bringing about all this evil, all this dying that was still going on. The snake had killed the healer and lived in her house ever since. "Has anyone ever seen the snake?" No. Since that fateful May 20, when Ebola came to Sierra Leone, no one has entered the barricaded house.

A few teens step forward from the group, brazen boys sporting soccer shirts. One of them strolls toward the house, followed by another. A bit of rattling, and the door springs open. There are cries of horror and the crowd shrinks back. A glimpse of a wooden table, a bedstead. No sign of a snake. It is as invisible as the virus. Hastily, before more sunlight can invade the dim interior of the healer’s house, the boy closes the door.

4 — Kenema, Summer 2014 – The Explosion

Nobody realizes that something has changed when, on May 26, the exploratory team returns with an empty ambulance to Kenema – less than 100 miles and yet, in terms of the disease, a quantum leap from Koindu. The virus is already in the city.

The day before, a young woman from Koindu had been hospitalized after a miscarriage. She was hemorrhaging heavily and running a high fever. The Kenema Government Hospital is a relatively modern institution that cooperates with universities around the world, but initially no one thinks of Ebola. The woman who has lost her child lands up in the maternity ward. She is given an infusion, but the blood refuses to coagulate at the insertion site on the back of her hand. The next day it is still seeping, and the young woman is tested for Ebola. Positive. It turns out that she had attended the healer’s funeral in Koindu.

A few hours later the next Ebola victim appears at the Kenema Government Hospital asking for help. He is admitted. The protective clothing worn by the physicians is insufficient; the gloves thinner than paper, the face mask a plastic shield that barely covers the eyes. The patient infects a porter and three nurses. Two of the nurses survive, the porter dies. The third nurse, who is pregnant, suffers a miscarriage and then dies. Four midwives assist with the delivery. All four contract the disease and die. In this way the virus claims the lives of almost all the healthcare workers who are exposed to it.

Soon hundreds of Ebola victims are crowded into a ward designed to hold half their number, including many nurses. Almost every day a nurse metamorphoses into a patient, cared for by the remaining few. Changing sides – from life to death, from nursing to dying – is a matter of hours. The healthy nurses feed the patients, washing and cleaning up as best they can on the heels of the virus, but people are lying in their own excretions on the floor of the ward, and they are alone. At one point someone throws up all over Josephine, one of the senior nurses.  

Ebola tent at the hospital in Kenema © Amrai Coen

Josephine Sellu, nicknamed "Mama," heads the Ebola ward at the Kenema Government Hospital, a sturdy woman with the aura and warm voice of a gospel singer. As June comes to a close, she is fighting to keep the ward open. More and more nurses are not coming to work; others conceal from their families what they are doing during the day. This will remain the lasting damage done this summer in Kenema: nurses, once respected and appreciated, turn into objects of hatred. People move away from them in church, on the streets they are hailed with cries of "Ebola!"

The virus takes two months – June and July – to devastate one of Sierra Leone’s best hospitals. Every day the inhabitants of Kenema gather outside the main gate. First hundreds, then thousands. They hurl stones and threaten to set the buildings on fire, and they yell, "It’s your fault that we’re all going to die of Ebola!" In her darkest hours, Nurse Josephine is tormented by the thought that they might be right. After the healer from Koindu, it is now again a health service site that is importing and spreading the virus, this time in a city with a population of 180,000.

During all these long weeks, Nurse Josephine is on her own. The government of Sierra Leone persists in its state of denial: it is not until the end of July, after 729 have died in West Africa and 233 in his country, that the president speaks publicly about Ebola for the first time. And it is not until August 8 that the WHO announces an international emergency, following pressure behind the scenes from Doctors Without Borders. The epidemic took the WHO by surprise. Since the global financial crisis, it has lost a fifth of its funding. Whole departments devoted to combating epidemics were dissolved. Doctors Without Borders is infuriated by this global organization that does not send vehicles to the crisis region – or fuel, or mobile medical centers, or protective clothing. According to staff at Doctors Without Borders, the WHO is simply an obstacle in Africa.

Then in mid-August, after 36 doctors and nurses die at the hospital in Kenema, help finally arrives from the outside world. The Red Cross sets up a treatment center beyond the city limits, where fresh cases are admitted.

Two months later Nurse Josephine is standing in the courtyard of her hospital, surrounded by white tents that recall a military field hospital. This is the Ebola ward. "Damn, where are your rubber boots?" she hisses at a nurse who is walking around in sneakers. A scrutinizing glance into the patient zone, partitioned off by a waist-high tarp. This is where symptoms are evaluated. A woman in a colorful summer dress reels in; her arms and legs look like they belong to a marionette. She collapses and lies motionless, the life in her all but extinguished. A man in a protective suit hurries over. "Make an effort, pick her up!" Josephine yells at him. "Come on, get her on her feet." The masked man hoists the woman into an ambulance that will take her to the Red Cross.

Healthcare workers at the Kenema Government Hospital © Amrai Coen

These days Nurse Josephine sometimes simply bursts into tears, tormented by survivor guilt. "Every day you ask yourself: Why didn’t I get it?" she says. When she talks about the summer now, it sounds like a wartime report. The day the first victim arrived: "D-Day." The virus: "our enemy." The dead: "the fallen." She herself: a widow left to pick up the pieces in the ruins of a deplorable health system. Before Ebola, there were fewer than a dozen ambulances for an entire country of six million, and only one doctor per 50,000 inhabitants. Today the Kenema Government Hospital stands empty. Hardly a single patient ventures onto the grounds. In the mornings the sick drag themselves to the gate and demand medical assistance, calling out through the chain-link fence.

Not all those who contract the virus die of Ebola. Some die because no one treats their malaria or cholera. In Kenema the doctors have stopped operating on tumors and they no longer vaccinate children. Only one person remained behind on Nurse Josephine’s ward: a woman suffering from mental illness. At night she tries to escape, and Josephine’s staff wave sticks at her. She’s crazy. Josephine laughs. The suffering of everyone struck down by Ebola includes a fleeting bout of madness, she says. All their strength returns, the patient jumps out of bed and bellows at death in a final attempt to keep it at bay.

There are viruses like HIV that take their time. Like sleepers, they wait patiently for years until the infected person has probably passed it on to many others. At some point the initial victims will have served their purpose and are no longer needed.

With Ebola, the extreme opposite is the case. Its potency lies in numbers and speed. It takes only a few Ebola virus particles that have entered the bloodstream by way of the mucus membranes to overwhelm the human immune system. Initially Ebola attacks the body’s defense cells and shuts them down. Then it deploys them for its own ends. The virus hitches a ride throughout the body on them, infecting the other cells.

No virus can replicate in a vacuum; it needs to reprogram the cells of the organism it has attacked to produce more viruses. Ebola is capable of doing this at a pace that has astounded researchers. Within the space of just days, a few virus particles can produce billions of copies of themselves per milliliter of blood. Ebola commandeers growing numbers of cells that then multiply at an accelerating rate. In the end the cells are so full of the virus that they burst. Ebola not only spreads exponentially in a country such as Sierra Leone. It does so in every single human being that it attacks.

Remembering those hospital workers who died this summer © Amrai Coen

First the liver, then the kidneys, the intestines, the brain – nowhere in the human body is safe from the virus. Tissue breaks down, the blood loses its ability to coagulate and leaks into the abdominal cavity, into muscle fiber, under the skin. The immune system reacts much too slowly, finally gearing into action in hyperactive mode. This explains the sudden onset of fever, headaches, diarrhea and all the other symptoms.

No one knows exactly how Ebola kills its victims in the end. Multiple organ failure, the medical experts say.

A virus needs to pass to its next organism. But viruses also suffer from a handicap: they cannot walk, fly or swim. This is why they control the behavior of the creature they infect. Some viruses make us sneeze or cough so that we hurl them in the direction of our fellow beings. The rabies virus settles into a dog’s brain, where it triggers insanity. The virus is in its saliva, too, and passes to any organism the mad dog bites.

The Ebola virus benefits from the fact that an infected person will bleed and sweat, along with suffering from diarrhea and vomiting. All of the fluids discharged by the body serve as transport routes. The suffering of one victim always paves the way to the next – passing the baton in a nihilistic biological relay race.  

5 — Freetown, October 2014 – Chaos

The final leg of Ebola’s journey from Kenema to the coast cannot be reconstructed with certainty. At the end of July, isolated cases surface in Freetown. A 32-year-old hairdresser, abducted by her family from a treatment facility in the city center, keeps the inhabitants in suspense: allegedly she was from the east. Later the spokesman for the health department will focus on a male nurse. He had tested positive in Kenema and then travelled to Freetown via several major towns. Despite knowing his diagnosis, he had infected people all along the way. "A criminal!" the spokesman bellows. Others in the department claim that some foreigner brought the virus in from Kenema. An Egyptian perhaps. Or someone from Lebanon.  

It seems people need to identify a specific culprit, to attach a face to the deadly phantom. The enemy stereotype is malleable. Caregivers can be replaced by foreigners.

By the end of July, 2014, 850 people have died in West Africa. The rumors and allegations grow in tandem with the deaths. And although no one really knows exactly how the virus came to Freetown, one thing seems clear: it has covered the distance of less than 100 miles within a few hours. In a car, on a bus, coasting along a well-maintained highway – a modern motorway comparable to a standard European state road.

Gravedigger Mr. Parker in Freetown © Amrai Coen

The European Union helped fund the highway improvements. Good roads support a country’s economy; they increase the mobility of goods and people. And diseases. Two different groups of people were hit especially hard by AIDS: prostitutes and long-distance truck drivers. An epidemic’s chances of success can always be best predicted by studying maps, timetables and traffic-flow statistics. If colonial rulers had not introduced steamships and railways to Africa a century ago, HIV would never have made it out of the jungle to Kinshasa, the city that exported the virus to the rest of the world.

Back then it took decades. Today we live in an accelerated age. Scientists analyze air traffic in the United States when predicting the next flu outbreak. Viruses are just as much a part of globalization as hotel chains and the Internet. From the perspective of a virus, humankind melds and melts into a single, gigantic organism. It forms a cluster. One might say it adopts a way of life that fruit bats have been practicing for millennia. 

Kenema. Bo. Moyamba Junction. Port Loko. Makeni. The places where Ebola has taken root are all junctions at which trade routes intersect. These are the roads shown on the Google Maps route planner and it is along these that, over the summer, the crisis migrates westward from the lesser developed eastern reaches of the country. And, in the end, engulfs the entire nation.

Freetown in the autumn of 2014 is a capital in which chaos has superseded reality as the status quo. At the meetings of the Emergency Operations Center, a type of improvised interim government, international organizations and local authorities are at cross purposes. They speak different languages. Aid money seeps through the cracks of a corrupt political machine. Nurses and contact tracers are constantly on strike because the department of health has stopped paying their wages. Politicians ask foreign reporters to please, please file more positive reports about their country. Corpses lie rotting in the streets. Buses have discontinued their services. Schools and universities are closed until further notice, as are movie theaters, bars and the soccer stadium. It is as though Freetown had metamorphosed into the city of Oran from Albert Camus’ The Plague

As a society, Sierra Leone is still in the incubation phase, says the emergency effort coordinator from Doctors Without Borders. The actual epidemic is yet to break out. He predicts civil unrest, the collapse of the political and social systems.

Freetown, with the rest of the world, is still hoping for vaccinations. By Christmas, at the earliest, the first batches should be available. At this point no one knows how effective they will be. Or whether they would reach the narrow roads and steep hills of Freetown faster than the virus has. Only one thing is certain: before this comes to pass, many people will die.

Back up the hill, past the piles of plastic waste and the red, sunburned soil. The contact tracer Kadiatu Lansana trod this path every day for three weeks to visit the Barrie family. She was there when the mother and daughter were driven off in the ambulance, their fate unknown; she saw how young Ibrahim died. She had hoped that Ibrahim’s brother Shernor at least would make it. Now the time has come to close this file.

Then the soldiers, who open the barrier. In shorts and flip-flops, with a nervous air but steady gaze, Shernor Barrie comes to the door. For 21 days he has feared for his life and mourned the death of his family. Kadiatu Lansana asks a few final questions, then hands him a piece of paper with a stamp on it reading "discharged." The quarantine is over. Barrie has not become infected. Now he is free. But alone. His first destination is the nearby treatment center, a place of pain and suffering: overcrowded, cramped and loud. This is where his mother and sister must have ended up as soon as it was confirmed they had Ebola. But they were no longer here, he was told. Shernor Barrie heads to the cemetery.

King Tom Cemetery is located in the northern part of the city; just a few months ago it was a long-forgotten memorial ground for the victims of two world wars in another century. Now a white Jeep pulls up every few minutes, equipped with flashing blue lights and a siren. The tailgates are opened and plastic sacks are removed; some are large and heavy, some so small that only a child could fit inside. People are standing around in the cemetery, crying, wailing.

"Can I help you?"
The man who addresses Shernor Barrie is wearing rubber gloves and a rubber apron. He seems very calm, very decisive, as if he is in charge here.
"I’m looking for my family," Barrie answers.
The man introduces himself: Mr. Parker, "the head gravedigger at King Tom." He fishes a tattered notebook out of his trouser pocket. Its cover reads "Ebola Funerals."
"Surname?"
"Barrie."

Mr. Parker thumbs through the pages. His fingers scale down a list of hundreds of names, entered along with age, gender and the date of the funeral. Then he stops.
No. 394: Mohammed Barrie, age 52
No. 423: Ibrahim Barrie, age 8
Shernor Barrie says nothing. His mother and two sisters are not on the list. "Number 394 and number 423 are back this way," Mr. Parker intones. A narrow path leads toward a tall tree. Music wafts over from the nearby shantytown; stray pigs and dogs rummage in the refuse that lines the road. Then, under the tree, a field opens up, punctuated by mounds of brown soil. The grounds holding Freetown’s Ebola dead spread out before him like a sea full of bumps. "They’re buried somewhere over there," Mr. Parker says, pointing to two of the many mounds without markers. 

Barrie takes a brief look and glances away. "I’m the only one left," he mutters to himself. And bids a hasty farewell to this friendly helper who seems proud of his work. Maybe his mother and sisters have survived. They could be somewhere in a treatment center, somewhere in a cemetery. Shernor Barrie vows to scour the country for them.

Mr. Parker and his men resume their work. Dig a hole four feet deep, throw in the plastic bags, spray with chlorine, shovel back the earth, enter the dead in their list – a list that contains many more names than the government officially announces. Forty corpses are brought to King Tom Cemetery every day. "I don’t know where to put them anymore," Mr. Parker says. The gravediggers use machetes to hack away the bushes and make room for new graves.

6 — Epilog

Asking what a virus wants is similar to asking about the meaning of life. It is a question that defies answering. A virus does not want to kill people; it does not want to wage war or conquer the world. A virus only wants to exist. That is why, in terms of biological evolution, it is only logical that Ebola resorted to cross-infection at that point when its home base, the flying fox, became endangered.

Perhaps the virus will find a new, permanent home – in humankind. Yet to do so it would need to stay in circulation longer, inside us. It would have to become less dangerous. A virus that kills swiftly is tantamount to a mass murderer who ultimately commits suicide. Someday Ebola could become a disease that stays put, becoming a part of life like herpes, measles, colds and the flu – all viruses that were passed to us by animals at one point. No one knows how long this kind of process takes. The adaptation would be very painful, that much is certain.

Life has grown quiet in the small Guinean village of Meliandou. Many of the houses are empty. A year ago 600 people lived here; just under half are left. Sixteen died of Ebola, the last in early April; many others ran away, never to return. The village doctor was one of the first, followed by the teacher. For a long time friends and relatives from outside have not dared enter the village. Meliandou is still under a quarantine that has become obsolete from a medical standpoint. Meliandou, one might also say, is still under a spell. The place where it all began has not been spared the suspicion and pandemic paranoia that Ebola has triggered around the world.  

Etienne Ouamouno, the father of the child that touched something he should not have, has stopped going out to his rice field of a morning. No one trades with this village anymore. Ouamouno is often at a loss as to how to fill his days. He now shares his empty house with a few orphans abandoned by the dead and those who have fled. He looks after these children now.

Which is why a troupe of them trails after him when he walks through his village, passing the grave of his wife, the grave of his daughter, heading for the woods. He does not know that players refuse to shake hands with his country’s soccer team before matches anymore. He does not know that fearful parents are taking their children out of school in the United States and that the stock prices of some airlines are falling. But he does know one thing, and it drums on his mind like a pounding headache: it was his family that spread suffering and devastation around the world.

Emile too lies interred beneath a tree. It is cool out here, and in the 284 days since Emile Ouamouno’s death, Nature has begun to obscure his gravesite with undergrowth. Almost all of the things that could remind Ouamouno of his son were buried with the body. Including the boy’s favorite toy, a small rattle. All that remains is a photograph of him holding his little son in his arms.

The worst thing about their plight, Etienne Ouamouno and the other villagers say, is not the dead. The worst thing is the hunger. They have long stopped butchering the flying foxes, they say. They’re afraid of them now.

This article was first published in German and then translated into English by Mary Fran Gilbert and Keith Bartlett