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Laurie Chen and Richard Preston on Writing About the Spread of Disease

In this episode, South China Morning Post reporter Laurie Chen and bestselling science writer Richard Preston talk about the global panic over coronavirus, China’s response, and how societies defend themselves against viral outbreaks like Ebola. Chen talks to Fiction/Non/Fiction podcast co-hosts V.V. Ganeshananthan and Whitney Terrell about how misinformation about coronaviruses spreads on social media; Preston discusses his nonfiction books The Hot Zone and Crisis in the Red Zone.

To hear the full episode, subscribe to the Fiction/Non/Fiction podcast through iTunes, Google Play, Stitcher, Spotify, or your favorite podcast app (include the forward slashes when searching). You can also listen by streaming from the player below.

Selected readings for the episode:

Laurie Chen Outbreak has stoked a rise in xenophobia, Chinese living abroad say · Will China’s city lockdowns stop the spread of the coronavirus? · Wuhan doctors beaten up, overworked, under supplied · Left at home disabled boy dies after carer isolated for virus checks · China’s ‘demon’ virus leaves experts at odds on when infection rate will slow · China coronavirus: YouTube and Twitter show realities of life in lockdown · Live from Wuhan: millions tune in to watch China build hospitals · China sends in military doctors to help fight coronavirus outbreak · Wuhan coronavirus confirmed in 29 of China’s 31 provinces · China coronavirus: rush is on in Wuhan to build treatment centre for up to 1,000 patients · Scientists debate whether China coronavirus came from bats or snakes · Debunking the myths around China’s deadly coronavirus outbreak · How Taiwan Strait tensions could hamper efforts to fight Wuhan virus

Part One: Laurie Chen

Whitney Terrell: Is it transmitted by people coughing so that there are particles in the air? Can you pick it up off of a surface? Because I read a story about some British nationals who apparently got coronavirus after being in a ski resort that had been stayed in by someone from Singapore. Do we know how this transmission from human to human is happening?

Laurie Chen: So at the moment most experts agree that transmission mostly occurs via droplets. So if a droplet of someone’s coughing or sneezing lands on you and you touch your eyes, ears or nose or any of those mucous membranes and transfer it via that means then yes, you can get infected. And it can also transfer via surfaces as well. I was talking with an expert today who said that actually on smooth surfaces the virus can linger for a few days.

WT: Oh, fantastic. That’s great.

V.V. Ganeshananthan: I have a propensity for colds and respiratory infections, and I’m supposed to wear a face mask on planes. And I’ve always wondered, how effective is my face mask? And does it do anything? And sometimes I don’t wear it. And from what you’re saying, actually, it would be helpful for someone in China to be wearing a face mask on the street. And there are all these stock photos running with—or maybe not stock photos—running with coronavirus coverage, of people wearing face masks. You go out on the street, is that something you see?

LC: Yeah, very, very often in Hong Kong. Actually, people look at you weirdly if you don’t wear a face mask, and I think all this is a residue from SARS, where the habit of wearing face masks became really widespread, not just to protect others but to protect yourself as well. Most experts agree that if you’re confirmed to be infected with the coronavirus, then it is best just to wear a mask at all times. But if you’re not infected, then actually washing your hands can be just as effective. But it’s probably best to wear a mask, than not wear a mask. And also to wear one properly as well, as that it covers your nose, and not to touch your face, or break the seal.

VG: So in this situation, you’re not only a writer, but you’re also of course vulnerable yourself in a variety of ways, as you’re talking to people. How do you protect yourself or behave differently as a reporter as you’re working on this story?

LC: I’ve been in Hong Kong this time and we’re only a stone’s throw away from the mainland. And yeah, there is a very widespread panic mindset. Earlier this week and last week, people were panic-buying toilet paper and cleaning supplies and queuing around the block for pharmacies to open so they can get their masks. There’s a real scarcity mindset that comes with daily news reports and widely circulating misinformation about the coronavirus. These panic-buying sprees are triggered by online rumors that factories in the mainland weren’t able to manufacture enough toilet paper. It’s very irrational. But this is the sort of mindset that takes hold during these times, when people feel very threatened by the mainland, by the fact that our border is still not closed completely.

VG: If this had been a different kind of story, would you have gone to the mainland?

LC: Yes. My colleagues have actually been there. We have sent people to Wuhan, because I have some colleagues who are already based on the mainland, and some of them needed to be quarantined afterwards. But yeah, most of my colleagues got out before the lockdown happened. So what they were able to gather and receive was very limited. Obviously, they’re putting themselves at very great risk in traveling there in the first place, as well.

WT: As you wrote, coronavirus has now been confirmed in most Chinese provinces. That makes it a very big story, covering a huge geographic area. We’re talking about geography right now in this discussion—how do you or your colleagues at the South China Morning Post cover a story of this scope? How are you coordinating? What’s been the practical journalistic approach?

LC: This story is absolutely huge. It spans multiple desks and time zones as well. We have reporters in the US bureaus, covering it from there, covering all the developments that we’ve missed overnight. In China, obviously, I look after the social media aspect, and trying to contact people from Hong Kong, whereas we have some very good reporters covering Asia, and covering the developments from Singapore, and keeping an eye on Japan as well, and Southeast Asia. And we have a really, really good graphics team, that daily updates an infographic tracker of cases for our global readership. So yeah, it’s basically a huge, huge effort coordinating dozens and dozens of people.

VG: So the story of coronavirus also seems to be every kind of story. It’s a medical story and it’s a national story. And it’s an international story. One of your early stories was about the relationship between Taiwan and the mainland. It’s a human interest story, a business story and a story about culture. And your most recent story is about people of Chinese descent abroad experiencing coronavirus-related racism. And I’ve heard this from a lot of my friends who are East Asian. In the US, post-9/11, there’s a discrimination category people have talked about, “perceived to be Muslim,” and people experiencing Islamophobia. And now I’m wondering in relation to coronavirus, is there a category of “people perceived to be Chinese.” The stories that I’m hearing about this are horrific. I’m probably even missing categories of coronavirus story in that list that I just had. In one of your most recent stories you also wrote about—and this story was heartbreaking—a teenager with cerebral palsy, who passed away because his relatives, who were also his carers, were put in quarantine. So what consequence of coronavirus has surprised you the most or been the hardest to cover?

LC: I think for me personally, it’s been basically dealing with the sheer onslaught of misery. Because no matter where you look on the Chinese Internet, you can find stories of people suffering in the most unimaginable circumstances. People who don’t have access to basic medical supplies, people who can’t even get hospital treatment—on social networks like Weibo, which is kind of like Chinese Twitter, there are huge hashtags and trending super topics of people just posting information of their relatives because they’re desperate to find a bed in a hospital. They have their full personal information and CT scans and everything and they’re just begging for help.

And you hear stories of people whose families who’ve been devastated by the coronavirus.

One day it takes their mother; a couple of weeks later, it takes their father, and then they’re infected. So it’s basically these really harrowing stories of personal misery that you’re subjected to on a daily basis that I find the hardest aspect to deal with. But as a reporter, you have to build up a mental resilience towards these things. And obviously, you want to empathize with these people who are suffering from an unimaginable humanitarian crisis that’s been exacerbated by the government’s inefficient response. But also you want to do justice to the story and not let it affect you and your work too much.

VG: Given how the government has controlled information about coronavirus, it’s interesting to see how information about this and fear about this, and also, of course, these real experiences, have made their way through social media. One of the things that I think was most interesting to me, as I was reading about this is that bat soup clip from 2016, which went viral, and is, I don’t know, in American terms, it’s fake news, and seems to have spread a certain racist stereotype.

There’s this notion of disease as a moral consequence. Oh, this set of people behaves in this way, and so they deserve what they get—it just makes me so angry to read about it. The longstanding notions of Asian communities—”What do they eat? How do they behave? They’re so strange.” There’s exoticism and Orientalism coded into the language of how people are talking about this, and this bat-soup clip, which is from 2016, and which you mentioned in your work, I’m curious how did you first spot that? And track its path to experiences like the ones that you wrote about in the story where people are getting spat at on the street?

LC: I first saw that clip being reported on by Hong Kong media, and a lot of people weren’t sure about where it came from, but a lot of Hong Kong media, local Chinese language media, started picking up on that and a lot of Hong Kong-ers and some people in Hong Kong, social media groups, started forwarding that video clip, with disparaging comments about mainland Chinese and their eating habits. But then further on, it emerged that it was from this travel show and it wasn’t even filmed in China. It was filmed in Palau.

So, this travel show attempted to show this very freaky, exotic delicacy, and it was completely misrepresented as everyday eating habits of the Chinese by people on Western or foreign social media platforms. We’ve seen a lot of this, where clips like this, were just duplicated and shared without any context whatsoever. And people will extrapolate or determine from the fact that they’ve seen this clip that this is how ordinary Chinese people eat in their day-to-day lives, which is obviously untrue and Orientalizing. You know, “Look at these people and their backwards, uncivilized eating habits.”

WT: Just to connect the dots for listeners who might not know, the source of this virus is very likely to have been in a bat population.

LC: Some experts think that the original source is probably a bat, but a lot of people believe that it jumped to an intermediary animal host, right before it jumped to humans. So right now, scientists are trying to figure out what the animal was. You can’t really get it from eating cooked meat anyway, unless that meat is contaminated.

WT: It wouldn’t be transferred that way. I’m just saying the reason that the original meme started has to do with that connection, I would guess.

LC: Yeah, probably, and also touching on latent stereotypes of Chinese people as uncivilized and dirty in their eating habits. But also, it’s actually started a really vital debate on Chinese social media about the need to close these wildlife markets. And people are questioning why are they still running, after SARS was found to have originated in one of these wildlife markets in southern China.

Part Two: Richard Preston

V.V. Ganeshananthan: One of the most helpful things about the way that you write about viruses are the metaphors that you choose. I still remember reading The Hot Zone and some of the metaphors from that. You’re talking about the gray zone between life and non-life, right? And viruses seem so abstract because we can’t picture them, and one of the things the language you use does is that it gives us all these pictures—the swarm of fish is really great, because I can imagine that. So when you’re writing about all of this, is there a way that you think about the language to try to make it vivid to people? There is so much misinformation going on about this. How do you think about metaphor and viruses?

Richard Preston: Well, just in terms of technique, and as a writer, I think back to when I was in junior high or high school, and I was reading The Iliad and The Odyssey, and the teacher got up there and they said, “Now, I’m going to describe what a simile is and what a metaphor is, and here is a simile, it’s when you say something and it’s like the other thing that you’re talking about.” And this is the problem of metaphor or simile: it’s finding images for things that are invisible or too small to be seen with the naked eye. The only thing I can say about that as a writer is that I fiddle around a lot with words. I like to see words hanging out with each other, and I like to test them out in combinations. And somehow or other, we come to something.

I think of Ebola virus, or any of the viruses, as non-human antagonists or protagonists. Dark protagonists. And as I write nonfiction, I conduct intensive focus interviews with all the people I’m writing about, and I go back to them again and again in person, and then numerous fact-checking conversations on the telephone where I run scientific information past them. Scientists are tricky to write about because you have to get it right, and that’s not easy. But in the course of all this, I came to think of Ebola virus as a subject to be interviewed. Except that this is a subject whom you can’t see and doesn’t have speech, per se. But at one point, when I was working on The Hot Zone, researching it, I got permission from the army to put on a spacesuit and go into the biosafety level four hot zone laboratory, one of them. It was the Ebola lab at Fort Detrick in Maryland.

Whitney Terrell: That is not something that I would do.

RP: In retrospect, I wouldn’t have done it either because I got into trouble in the lab. In The Hot Zone, there is this scene when Colonel Nancy Jaax gets a pinhole in her glove, and her sleeve fills up with monkey blood, which is hot with Ebola virus, and she has to make an emergency exit from the hot zone, and she’s standing in the chemical shower, and she could feel the monkey blood mushing around inside her suit. So I go into the hot zone to, in effect, do an interview with Ebola virus. I’m in the hot area in the presence of Ebola and also in the presence of another X virus that the army hadn’t even identified yet, but was considered to be a level four hot agent. And I’m in there and it turned out that they had given me a loaner spacesuit.

VG: This can’t be good.

WT: Hey, we found this in a back closet! Give it to the writer!

RP: Yeah, they’re all hanging on a wall, and all the scientists have their names on their suits. And your spacesuit is like your parachute if you’re a jumper, it’s your life. Well, I got this loaner, and I’m peering through a microscope, looking at cells that are infected with this X virus, and all of a sudden, my spacesuit suddenly popped, and it lost pressure. It had actually exploded and burst. And I’m groping around with my hands, I can’t see anything through my visor, and I suddenly realized that with my gloved hands, I was touching my surgical scrubs inside my spacesuit. And I looked down. The whole suit had blown open—there’s a zipper across the chest, and it had just blown open under pressure. And so I stood up, and I turned to one of the scientists and I said, “Do I have a problem?” And the look on his face was indescribable. His eyes went wild, and he rushed at me. And he just sort of patched me together, and he got me all together, and he said, “Now you don’t.”

And I’m thinking okay, now I’ve just had some kind of an exposure, and I’m writing about Nancy Jaax’s exposure, and now what am I going to do? I have options here. One of the options would be to wet myself and start screaming and demand to be taken out. And maybe another one would be, since I’m already exposed, what can I do about it and just carry on with my assignment, which is what I chose to do. But then I’m standing in that shower afterwards in this airlock, and the chemicals are pouring over my suit. And I’m thinking, okay, if there’s something alive in my suit with me, I’m not going to know it until I start throwing up blood. And I had a great insight into Colonel Nancy Jaax and into the interior of her mind as I went through this experience. Now, I never wrote about that in The Hot Zone. I thought it would be inappropriate to use autobiography or to draw attention to myself, because really, the story is about Nancy Jaax, it’s not about me. But it gave me what I guess you could call a real interview with Ebola.

VG: Oh my God. Thank you for sharing that story. That is the answer to my question about metaphors. Wow. You speak and talk about this with such clarity—you did mention before the point of view of a virus, and this is always the thing that I love to do on the podcast is to ask, when you’re a specialist in this particular thing, how does it change how you think about the language of that? For what it’s worth, the metaphor that I remember from The Hot Zone, which I read when I was 16, and I remember, there was a specific pasta metaphor. And everyone in my class, we would run into each other in the halls at our high school and be like, “God, the pasta.” The clarity that that brought to my imagining of the disease, which was so abstract before that! The visceral experience of having your body invaded by something, it can be so diffuse. And that language is just incredible. Thank you for telling us that story. I wonder if you could talk a little bit about the 2013/2014 Ebola epidemic for listeners who might not be familiar with it and read to us a little bit from Crisis in the Red Zone.

RP: Sure, well, the Ebola epidemic in West Africa in ’14 and ’15 started with a one-and-a-half year old child, a little kid named Émile. He lived in a village near the Makona River in Guinea, and he was apparently playing with a sick bat that came from a bat colony that lived in a hollow tree near his village. We don’t really know what he did or how he actually got the virus, but it looks like it came from a bat to him. He died with black diarrhea in his mother’s arms. She died, his four-year-old sister died, their grandmother died, the village midwife who took care of the grandmother and the children died, the mother died. And then the virus went from there to a local hospital to another hospital. And over time, it just blew up into a frightening epidemic that got into three major cities in West Africa. Ultimately, about 30,000 people were infected, 11,000 or more died, and there were eleven Ebola cases in the United States. All but one of them survived, but the survivors in the US were treated in very special hot zone, high biocontainment hospital units, and to save one person from Ebola virus cost millions of dollars.

So that was the Ebola outbreak of ’14 and ’15. And one of the focuses of my book is to try to get to this very interesting question. Well, actually, how did the virus die out? How was it defeated? And the answer is that it wasn’t defeated by modern medicine. It wasn’t really defeated by the isolation camps that were put up by Doctors Without Borders and other organizations. It was actually the people themselves who eradicated the virus from their midst. And they did this with the most traditional ancient method that we have as humans, which is to not touch or go near anybody who seems to be infected. The villages around the Makona River where it first broke out began practicing reverse quarantine. That is, they shut themselves off from the outside world so that nobody who was infected could come into the village.

And when people died on the streets, as they did in these cities, nobody would go near the corpse. Nobody would help anybody who was sick. The hospitals were filled with people who were getting little or no care. And over time, the virus just didn’t have enough new hosts. So, when somebody died of Ebola, nobody would touch them. The virus particles that were in that person’s body never had a chance to make that jump to the next human being.

RP: [reading from Crisis in the Red Zone] The Ebola war wasn’t won with modern medicine. It was a medieval war, and it went down as a brutal engagement between ordinary people and a life form that was trying to use the human body as a means of survival through deep time. In order to win this war against an inhuman enemy, people had to make themselves inhuman. They had to suppress their deepest feelings and instincts, tear down the bonds of love and feeling, isolate themselves from or isolate those they loved the most. Human beings had to become like monsters in order to save their human selves.

In a town in Liberia, a young woman named Fatu Kekula, who was a nursing student, ended up caring for four of her family members at home when there was no room for them in a hospital—her parents, her sister, and a cousin. She didn’t have any protective gear, so she created a bio-hazmat suit out of plastic garbage bags. She tied garbage bags over her feet and legs, put on rubber boots over the bags, and then put more bags over her boots. She put on a raincoat, a surgical mask, and multiple rubber gloves, and she covered her head with pantyhose and a garbage bag.

Dressed this way, Fatu Kekula set up IV lines for her family members, giving them saline solution to keep them from becoming dehydrated. Her parents and sister survived, her cousin died, and she herself remained uninfected. Local medical workers called Fatu Kekula’s measures the Trash Bag Method. All you needed were garbage bags, a raincoat, and no small amount of love and courage. Medical workers taught the trash bag method, or variants of it, to people who couldn’t get to hospitals.

Slowly at first, then more surely, the number of new Ebola cases began to drop. As the number of new cases dropped, the total number of Ebola particles in the swarm dropped at the same time. The particles weren’t able to jump to fresh hosts, and the swarm began to shrink rather than grow. Trapped in the host they had killed, unable to reach a new host, vast numbers of particles died along with the ruined host. By the end of 2014, Ebola was fading away. In the Makona Triangle, it was virtually gone.


Transcribed by Condensed and edited by V.V. Ganeshananthan, Harmony Lassen, Hunter Moseley, and Abbey Outain. Photo of Laurie Chen courtesy of The South China Morning Post. Photo of Richard Preston by Michael J. Butts.

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