Richard Preston’s Hot Zone

The impact of AIDS is ravaging humanity, decimating millions of people across the globe, but most conspicuously in Africa. However, the dangerousness of AIDS, which is only transmitted through sexual contact and blood transfusion, pales in comparison with Ebola, which has been endemic in certain parts of Africa for several decades now but could become a world-wide pandemic any time. The Ebola virus is much more virulent than HIV, it simply eats away at a person’s innards rendering many of his or her vital organs into bloody liquefied mess. It onsets rapidly, and most important of all, is airborne. Hundreds of human beings have died horrendous deaths becoming prey to the Ebola virus so far, but most of these people have been African. If an Ebola outbreak were to occur in a thickly populated metropolitan area of the US sometime in the future, it could wreak chaos and havoc simply on an unprecedented scale.

It gives anyone a spine-tingling chill to think that less than 20 years ago the Ebola virus was killing off monkeys en masse in the vicinity of Washington D.C.  Perhaps there were very few times in the history of humanity, when such a massive disaster was averted so closely. For example, we can imagine what the fate of mankind could have been if the secrets of atom bomb fell into Hitler’s hands during the Second World War, and if he had resources to build many of these weapons of mass destruction. However, the situation could have been much worse if the strain of Ebola virus that was responsible for the deaths of hundreds of monkeys in a monkey house in Reston, Virginia in late 1989, had the capability to jump into humans just like the other three known strains of the Ebola virus. The particular strain of Ebola virus discovered in Reston is almost physically indistinguishable from Ebola Zaire, the most deadly of all the Ebola strains, yet it has miraculously proven harmless to humans.

Richard Preston takes up this story and presents it in a riveting docu-drama that brings out all the personal angles in this shocking, but brief and almost forgotten, episode of twentieth century history. In his description of Charles Monet’s rapidly deteriorating condition at the outset of the novel, Preston vividly brings out the pure horror that Ebola virus really is.  We know the nature of the ending from the very beginning, and are cognizant of the fact that nothing in fact had come out of this whole Ebola Weston episode in terms of loss to human life; yet for readers who are aware of the potential threat these deadly viruses pose to the survival of mankind, the pace of suspense is unrelenting till the very end (that is, the end of part 3 and not part 4), when one is left gasping a sigh of immense relief at the total anticlimax.

This suspense is not about what had happened, but rather about how could have things not happened, or more precisely, how things were not allowed to happen. Most readers would naturally assume from the very beginning that the Ebola virus that broke out in Weston, Virginia, was as deadly as Ebola Zaire that takes the life of a person in such merciless and gruesome manner at the beginning of the novel. The constant question that gnaws at the mind of the reader while following Preston’s narrative is that how could the U.S military or the CDC people so effectively contain the outbreak that most of us have never heard of it even. It is simply impossible in the very nature of things. However, in the end it turns out that the particular Ebola strain that surfaced in the heartland of the United States simply does not infect humans. It is a let-down in a way, but still makes us immensely glad that humanity has so narrowly escaped certain disaster because of pure quirkiness of Mother Nature. This book makes an essential reading for all people, laymen and experts alike, who are concerned about pandemics, about Ebola itself, but also about Bird Flu and threats of bio-terrorism, that are looming ominously in the very near future of mankind.

Book Summary

Part 1

The story opens in Western Kenya, in the year 1980. After returning from an overnight trip to Mount Elgon, in which he visits Kitum Cave, Charles Monet becomes seriously ill. His symptoms rapidly deteriorate. Within a matter of days, even his face becomes expressionless. He is finally admitted to the local hospital, but in view of the emergency of his situation, is transported in a crowded airplane to Nairobi Hospital. During the trip, Monet vomits blood that is marked with black specks. He is becoming a mess of bleeding, as his internal organs and external orifices start to leak blood profusely. Monet somehow manages to reach the hospital, whereupon he collapses and drops into a puddle of his own blood.

Dr. Shem Musoke takes charge of Monet, but is largely clueless as to what is happening. Before the doctor could do anything, though, Monet succumbs to his deadly disease. Within a few days, Dr. Musoke himself begins to show signs of this mysterious illness. He treats himself for malaria and typhoid fever, but to no avail. He is placed in the care of Dr. David Silverstein, who rightly suspects the presence of an unknown or uncommon virus. Silverstein sends blood samples to the Institute of Virology in Sandringham, South Africa, and to the CDC in Atlanta, Georgia.

Dr. Musoke’s blood tests positive for Marburg, a little known virus. The virus is named after a small German town where, in 1967, a few people got infected by a virus that is believed to have spread from monkeys transported from Uganda to a local laboratory.  Marburg is a category of filovirus, estimated to have an infection mortality rate of 25%. It was eventually traced to a region in western Africa populated by sick monkeys which were occasionally captured and sold in other countries. This virus can mutate to spread from monkeys to humans and can have potentially disastrous effects. Dr. Musoke eventually recovers completely; no other persons who could have come in contact with Monet during his plane trip or in hospital report illness; a potential outbreak is thus miraculously contained.

The scene now shifts to Major Nancy Jaax who works for the Veterinary Corps of the U.S. Army at Fort Detrick. Her husband Jerry also works at the same place, and both of them live in Thurmont, Maryland. Nancy Jaax’s building at Fort Detrick is the United States Army Medical Research Institute of Infectious Diseases, or USAMRIID, which researches ways to protect soldiers from biological weapons or naturally occurring diseases. After arriving at her office one morning, Jaax checks in on several monkeys that had been recently infected with a deadly virus called Ebola, which is also a filovirus similar to Marburg. Project Ebola at USAMRIID is headed by an army scientist named Eugene Johnson.

Various areas of USAMRIID are categorized by Biosafety levels. This is Jaax’s second day at Level 4, which is the most dangerous Biosafety level, and she goes through necessary ablutions and disinfecting procedures required to put on a “space suit,” and gets ready to autopsy the monkeys that have died recently from the Ebola virus. Major Nancy Jaax and her supervisor, Lieutenant Colonial Anthony Johnson, enter a room with monkey cages. There are two control monkeys that have not been infected and several other monkeys with Ebola derived from a nurse who had treated an Ebola patient in Zaire in 1976. While Jaax is dissecting a monkey that has bled to death in the same way as Monet, Johnson notices a slight tear in the space suit on her right hand. Jaax is terrified and rushes to decontamination process. Fortunately, Jaax has another layer of protection is free from danger. Thereafter, the two control monkeys in the lab start showing symptoms, while all the infected monkeys die. From this observation it is inferred that Ebola can easily spread through air, and not only transmitted through direct exposure as was previously supposed.

At this juncture, the author takes us back to the summer of 1976, describing the progression of the Ebola Sudan and Ebola Zaire strains of the virus. The latter is the one injected 7 years later into the monkeys at USAMRIID. This narrative begins with the death of a storekeeper in a cotton factory in southern Sudan. A few days later two of his coworkers die. Ebola hits the hospital in the town of Maridi, where it goes on a killing spree. A crucial fact about Ebola is that it kills its host too quickly for its own good, and many of its victims may not have a time window to spread it to others. As a consequence of which, the virus is very likely to make sudden exits from the human scene, after it makes one of its sporadic appearances.

Two months later, another outbreak of virus emerges at a mission hospital in Zaire and spreads to 55 villages around the hospital. One nun from the village moves to the city of Kinshasa where she infects another nurse, and travels around the city before returning to the hospital to die. Samples of the nurse’s blood are sent around the world to identify the illness. The virus that causes this illness is found to be related to Marburg. Dr. Karl Johnson of the CDC names it Ebola after a river in the area where it was discovered. Fortunately, this time the epidemic loses steam rapidly and dies off on its own.

Here, the narrative shifts to September 1987, when a container of blood samples from a dead Dutch boy reaches Eugene Johnson. The child died at Nairobi Hospital in Kenya of what Johnson identifies as a new strain of the Marburg virus. Johnson also discovers that the boy had recently visited the Kitum Cave, which is the very same cave that Charles Monet visited. The child’s death was essentially similar to Monet’s though he does not bleed profusely from outside but drowns in his own blood from inside.

Eugene Johnson and his team travel to Kenya to explore Kitum Cave in 1988. Thirty-five members explore every nook and corner of this sinister dark place in search of the possible origin of the virus. The cave becomes a Level 4 hot zone and the team proceeds with extreme caution. The team has brought a number of monkeys and many guinea pigs into the cave to be left at various places with the hope that they might be exposed to the virus. They collect tens of thousands of biting insects and small animals and dissect them. To their utter frustration, they do not find a trace of Marburg or Ebola, although tales of persons dying a horrible bloody death abound in the local areas. 

Part 2

Part 2 opens in Reston, Virginia, in the latter part of 1989. A company maintains the Reston Primate Quarantine Unit, where monkeys spend several weeks after being imported. Veterinarian Dan Dalgard is called in to examine many of the dying macaque monkeys that are brought from the Philippines. He dissects the monkeys and finds very abnormal spleens. Dan Dalgard calls USAMRIID and sends samples of blood and spleen to a virologist named Peter Jahrling. Jahrling takes the monkey meat into a Level 3 laboratory for tests.

More monkeys die in Reston. Dalgard thinks that the animals have simian hemorrhagic fever, which is fatal to monkeys and harmless to humans.

Back at USAMRIID, an intern named Thomas Geisbert notices that the cells in the test tubes are dying, appearing puffy and full of black specks. He and Jahrling suspect there is a bacterial contamination.

Dan Dalgard has been anxious to get the test results from Jahrling, who says he believes the monkeys have simian hemorrhagic fever, but that he cannot be certain just yet. This is bad news for Dalgard because it has such a high fatality rate in monkeys.

Tom Geisbert returns to work after a small vacation, and prepares the specimen to be examined under an electron microscope. Presently he realizes that the cells under his scrutiny look just like those drawn from the Dutch boy who had died from Marburg.

Tom Geisbert takes the pictures of the Marburg virus to Peter Jahrling, who proceeds to intimate his superior officer, Colonel Peters. Jahrling and Geisbert of them are now scared for their life, for having come in so close contact with this deadly virus, and decide to continually check their blood for infection. Peter Jahrling calls Dan Dalgard to let him know there is a danger, but he does not reveal how big of a potential danger it really is. All necropsies in the monkey house are suspended to lower the humans’ exposure to infected blood. After further tests, Jahrling determines that the filovirus is not in fact Marburg, but the even more fatal Ebola Zaire. And this deadly organism is now on the U.S. soil, right in the backyard of Washington D.C.

Jahrling’s superiors gather a team of military experts to deal with the impending crisis. Nancy and Jerry Jaax also get involved. The group decides to use biocontainment at the monkey house. Colonel C.J. Peters holds a meeting that includes nearly every person in the world who understands the meaning of the Ebola virus. The group decides that the Army will handle the monkeys and the monkey house, while the CDC would handle any human outbreaks of Ebola.

The monkey house has already been quarantined and would be treated as a Level 4 hot zone.

Part 3

Jerry Jaax and Gene Johnson drive to Reston carrying all the necessary equipment. Washington Post breaks story about the Ebola outbreak in the monkey house. Colonel C.J. Peters manages to downplay the severity of the situation in a desperate attempt to avoid a panic.

The Army takes over the charge of monkey house. Jerry Jaax and his team inject the monkeys to knock them out and then retrieve blood from the animals before giving them another injection to kill them. Then a necropsy is done, and samples of each animal are taken. Here there ensue some intense scenes as one of the infected monkeys escapes and runs amuck, and also when some of the volunteers who are actively engaged in euthanizing the monkey find their protection breached. Also a news crew arrives, but unable to detect any action from the outside, loses interest and leaves, without ever discovering the enormity of the situation that could have really made for such sensational news.

A very good news emerges that, in spite of some very real initial scares and concerns, none of the monkey house workers are diagnosed with Ebola. Everyone wonders how the virus managed not to kill any human beings.

In January 1990, the virus is named Ebola Reston, and it has killed hundreds of monkeys in the monkey house, spreading through air. Four of the animal caretakers eventually test positive for Ebola Reston, but even when it infects humans, the virus merely incubates for a period and then automatically slips from the system with no significant ill effects. The author visits Nancy Jaax and gets a chance to personally look at Ebola under a sufficiently powerful microscope. Thus ends the story of the dramatic discovery of a new strain of Ebola. Ebola Reston has become of one of the group that contains Marburg, Ebola Zaire, and Ebola Sudan. The question remains: how come Ebola Reston does not seem to make humans sick when it resembles Ebola Zaire so much as to be almost indistinguishable? 

Part 4

Part 4 is not part of the story but an epilogue, and narrates the author’s travels to Africa, sometime before the publication of the novel. The author Richard Preston, accompanied by a guide and few others, moves deeper into the interior of Africa.  He heads to Mt. Elgon and Kitum Cave. The author recounts his exhilaration and fright in visiting this dreaded cave first hand. For example, at one point, the author hits his head and worries that the virus could have gotten in through tiny cracks in his skin. He also relates many reflections that the darkness inside this enigmatic and elusively dangerous cave evokes in him, including those thoughts about Charles Monet and the Dutch boy who visited this cave long ago.

Subsequent to his daring African expedition, Preston visits the now-abandoned monkey house in Reston, where a potential human catastrophe of unimaginable proportion lies silently buried.

Reference:

Preston, Richard. 1995. The Hot Zone: A Terrifying True Story. New York : Anchor