OutbreakDr. Stephen Russell on his new book, Command and Control, and the Ebola scare.

Written by Lindsey Lowe

 Photography by Liesa Cole


On a plane ride from London to the United States, Dr. Cooper “Mackie” McKay finds himself caring for an ill passenger, one who seems to have the symptoms of an infectious disease. The passenger is the first domino to fall in a chain that leads to the outbreak of the unknown disease; soon, Mackie is fighting to uncover the origin of a scheme that could have dire implications.

It sounds like a storyline straight from a page-turner, doesn’t it? That’s because it is. The story of Dr. McKay fighting to control the fury of a rapidly spreading disease brought home from another country is told in the pages of Command and Control, by Dr. Stephen Russell, an associate professor of internal medicine and pediatrics at the University of Alabama at Birmingham. But if you’re thinking that this story sounds somewhat similar, albeit more dramatic, to a scenario that we’re all watching unfold day by day, then I—and Russell—would have to agree. “It has been particularly interesting to me that I read and researched information for the book in 2010 and began writing from early 2011 to early 2012. All of these issues seemed a theoretical threat on the horizon at that time. To know that they are now playing out in real time on a world stage is scary and fascinating,” he says.

He’s referring to Ebola, the infectious virus that is ravaging West Africa and, at press time, had claimed one person’s life in the United States. “In his 1994 bestseller The Hot Zone and her 1995 The Coming Plague, Richard Preston and Laurie Garrett (respectively) introduced the world to the deadly hemorrhagic viruses of Ebola, Lassa Fever, and Marburg virus,” Russell says. “I read those books as I was applying for and entering into medical school. Their tales of real-life plagues that offer virtually no cure stuck with me at that time. When the time came for researching Command and Control, I reread them to get a flavor of how bad infections with rogue pathogens can be. Ebola was the poster-boy for deadly viruses and offered a pillar of truth to support my fictional pathogen. Of course, there was no way to know in 2010 that four years later this now-familiar disease would devastate communities in Africa and threaten the security of the American public health system. Command and Control offers a realistic look at the behind-the-scenes workings of the government’s response to a national infectious threat, and it serves as a cautionary tale for the consequences of greed and pride in public office.”

The current Ebola epidemic in West Africa is the worst Ebola outbreak recorded; according to cdc.gov, there have been about a dozen others, in places like the Republic of the Congo, Uganda, and Sudan. There are now more than 9,000 suspected, confirmed, and probable cases of Ebola in West Africa, according to numbers released by the World Health Organization in mid-October (found at who.int). I’m certain that by the time you’re reading this, that number will have increased. The disease has no cure, and on average, it will be fatal for half of the people who contract it.

In late September, when it was confirmed that Ebola had been brought back to the United States, panic set in across the nation. How, people asked, would we contain the disease? The Centers for Disease Control and Prevention (CDC) hold an Ebola update press conference every day, and the general theme seems to remain that an outbreak on American soil is unlikely. “Ebola is a deadly disease and we know that the images from Africa remind us of the severity that Ebola can cause in a community. Everything we’ve seen until now reinforces what we’ve known for the past 40 years. We know how to stop outbreaks of Ebola. In this country, we have health care infection control and public health systems that are tried and true and will stop before there’s any widespread transmission,” said CDC Director Dr. Thomas Frieden at a press conference held on Oct. 4.

Dr. Stephen RussellBut even the prospect of such a thing is terrifying. And because the disease has been brought home, there are a number of parallels to a story like Command and Control that make the Ebola outbreak seem to be straight out of a medical thriller. “In one part of the book, a physician at the CDC says, ‘It’s a global world. A cough in Australia can be a cold in Alabama overnight.’ The fictional pathogen in Command and Control speaks to the very real concerns that patients and public health officials have today that illnesses can spread due to the ease of airplane travel,” Russell says. “Another parallel is the fear that can be generated by just a few cases of incurable illness. Our attention is focused on what is happening in Dallas with the first American case there, and even though public health officials reassure us that contracting Ebola in the U.S. is ‘near zero percent,’ it is hard to be assured of that when so much is still unknown.” Nonetheless, there are a number of gripping details that make Command and Control a page-turner and place that story in a different category than what it happening in the world right now. In the book, McKay discovers that the CDC is fraught with duplicity, a plot Russell fabricated completely. And in Command and Control, an outbreak in the U.S. is imminent. Not the case with Ebola in the U.S., echoes Russell, who explains why.

For one thing, he says, it’s not airborne—Ebola and other hemorrhagic diseases can be only be spread by direct contact with infected body fluids (blood, vomit, sweat, saliva, and so on). In Africa, physical contact is an aspect of the culture in a way that’s not as engrained in Americans. A New York Times article titled “Ebola’s Cultural Casualty: Hugs in Hands-On Liberia,” (written by Helene Cooper) says it this way: “People often held hands while singing hymns at First United Methodist Church on Ashmun Street on Sundays, and after services sometimes took up to an hour to disperse, going systematically from cheek to cheek. At parties in Monrovia, new arrivals went from person to person around a room, taking the hand of each seated guest as they bent down to kiss and chat. Sometimes it could take 15 to 20 minutes to make the rounds at a house party of just 10 people. When it was time to leave, the ritual began again.” There, it’s also spread as people partake in burial traditions.

Moreover, Ebola can only be spread when the infected person has a fever; that is to say, the patient has to have symptoms for the virus to be robust enough to be spread, unlike, say, HIV, which is often spread before the patient even knows he or she is infected. And our health system is able to provide the tools—education, medicine, protective equipment—needed to combat the virus. Our education alone concerning the protocol regarding Ebola puts us in position to staunch it. “In West Africa, where the public health system is not as strong due to the poverty of the country, patients who contracted the disease were not able to be quickly and effectively isolated. Furthermore, the citizens of those countries were not effectively prepared to know how to care for loved ones who showed symptoms of Ebola. Finally, there are not enough hospitals and treatment centers to effectively care for those infected in West Africa,” Russell explains.

Command and Control is Russell’s second book; he is also the author of Blood Money, the novel that introduces Dr. Cooper McKay. He balances being a husband, father, doctor, and novelist by rising early to write; he aims for 25 pages a week, which allows him to complete a rough draft of a novel in three to four months. “My writing tends to be the end result of months of research and reading. Once I have a storyline, I will read as much as I can about the topic (medical topics included) and make notes in a composition book. When I have a general outline in my head, I will create a written pathway for my novel that tends to be no more cleared of literary debris than a backwoods trail at Oak Mountain. All of that takes place in the margins of my day, cutting articles and jotting notes in the early morning hours of my day,” he says. He admits that the demand of publication—edits and rewrites, all on a deadline—can sometimes make the balance more difficult to achieve. But he reiterates an age-old truth for writers: Deadlines always come and go, leaving in their wake a tangible kind of peace.

Moving forward, perhaps the only thing we can do is wait and see (and wash our hands). In the meantime, read the story of Cooper McKay by picking up Command and Control, available now for pre-orders on Amazon.com and on Nov. 14at Books-A-Million and Little Professor in Homewood.

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