The Hot Zone

by Richard Preston

  Ebola is a rather simple virus—as simple as a firestorm. It kills humans with swift efficiency and with a devastating range of effects. Ebola is distantly related to measles, mumps, and rabies. It is also related to certain pneumonia viruses: to the parainfluenza virus, which causes colds in children, and to the respiratory syncytial virus, which can cause fatal pneumonia in a person who has AIDS. In its own evolution through unknown hosts and hidden pathways in the rain forest, Ebola seems to have developed the worst elements of all the above viruses. Like measles, it triggers a rash all over the body. Some of its effects resemble rabies—psychosis, madness. Other of its effects look eerily like a bad cold.

  The Ebola virus particle contains only seven different proteins—seven distinct types of large molecules arranged in a long braided structure that is the stringy Ebola particle. Three of these proteins are vaguely understood, and four of the proteins are completely unknown—their structure and their function is a mystery. Whatever these Ebola proteins do, they seem to target the immune system for special attack. In this they are like HIV, which also destroys the immune system, but unlike the creeping onset of HIV, the attack by Ebola is explosive. As Ebola sweeps through you, your immune system fails, and you seem to lose your ability to respond to viral attack. Your body becomes a city under seige, with its gates thrown open and hostile armies pouring in, making camp in the public squares and setting everything on fire; and from the moment Ebola enters your bloodstream, the war is already lost; you are almost certainly doomed. You can’t fight off Ebola the way you fight off a cold. Ebola does in ten days what it takes AIDS ten years to accomplish.

  It is not really known how Ebola is transmitted from person to person. Army researchers believed that Ebola virus traveled through direct contact with blood and bodily fluids (in the same way the AIDS virus travels). Ebola seemed to have other routes of travel as well. Many of the people in Africa who came down with Ebola had handled Ebola-infected cadavers. It seems that one of Ebola’s paths goes from the dead to the living, winding in trickles of uncoagulated blood and slimes that come out of the dead body. In Zaire during the 1976 outbreak, grieving relatives kissed and embraced the dead or prepared the body for burial, and then, three to fourteen days later, they broke with Ebola.

  Gene Johnson’s Ebola experiment was simple. He would infect a few monkeys with the virus, and then he would treat them with drugs in the hope that they would get better. That way, he might discover a drug that would fight Ebola virus or possibly cure it.

  Monkeys are nearly identical to human beings in a biological sense, which is why they are used in medical experiments. Humans and monkeys are both primates, and Ebola feeds on primates in the same way that a predator consumes certain kinds of flesh. Ebola can’t tell the difference between a human being and a monkey. The virus jumps easily back and forth between them.

  Nancy Jaax volunteered to work as the pathologist on Johnson’s Ebola project. It was Level 4 work, which she was qualified to do, because she didn’t need to be vaccinated. She was eager to prove herself and eager to continue working with lethal viruses. However, some people around the Institute were skeptical of her ability to work in a space suit in Level 4. She was a “married female”—and therefore, they claimed, she might panic. They claimed that her hands looked nervous or clumsy, not good for work with Level 4 hot agents. People felt that she might cut herself or stick herself with a contaminated needle—or stick someone else. Her hands became a safety issue. But the real issue was that she was a woman.

  Her immediate superior was Lieutenant Colonel Anthony Johnson (he is not related to Gene Johnson, the civilian who was the head of the Ebola project). Tony Johnson is a soft-spoken man and a cool customer. Now he had to decide whether to allow her to go into Biosafety Level 4. Wanting to be sure he understood the situation, he sent word around the Institute: Who knows Nancy Jaax? Who can comment on her strengths and weaknesses? Major Jerry Jaax, Nancy’s husband, showed up in Lieutenant Colonel Johnson’s office. Jerry was against the idea of his wife putting on a space suit. He argued strongly against it. He said that there had been “family discussions” about Nancy working with Ebola virus. “Family discussions.” Jerry had said to Nancy, “You’re the only wife I’ve got” … He did not wear a biological space suit himself at work, and he did not want his wife to wear one either. His biggest concern was that she would be handling Ebola. He could not stand the idea that his wife, the woman he loved, the mother of their children, would hold in her hands a monstrous life form that is lethal and incurable.

  Lieutenant Colonel Tony Johnson listened to what Major Jerry Jaax had to say, and listened to what other people had to say, and then he felt he should speak with Nancy himself, and so he called her into his office. He could see that she was tense. He watched her hands as she talked. They looked fine to him, not clumsy, and not too quick, either. He decided that the rumors he had been hearing about her hands were unfounded. She said to him, “I don’t want any special favors.” Well, she was not going to get any special favors. “I’m going to put you in the Ebola program,” he said. He told her that he would allow her to put on a space suit and go into the Ebola area, and that he would accompany her on the first few trips, to teach her how to do it and to observe her hands at work. He would watch her like a hawk. He believed that she was ready for total immersion in a hot zone.

  As he spoke, she broke down and cried in front of him—“had a few tears,” as he would later recall. They were tears of happiness. At that moment, to hold Ebola virus in her hands was what she wanted more than anything else in the world.

  1300 HOURS

  Nancy spent the morning doing paperwork in her office. After lunch, she removed her diamond engagement ring and her wedding band and locked them in her desk drawer. She dropped by Tony Johnson’s office and asked him if he was ready to go in. They went downstairs and along a corridor to the Ebola suite. There was only one locker room leading into it. Tony Johnson insisted that Nancy Jaax go in first, to get changed. He would follow.

  The room was small and contained a few lockers along one wall, some shelves, and a mirror over a sink. She undressed, removing all of her clothing, including her underwear, and put everything in her locker. She left the Band-Aid stuck to her hand. From a shelf, she took up a sterile surgical scrub suit—green pants and a green shirt, the clothing that a surgeon wears in an operating room—and she dragged on the pants and tied the drawstring at the waist, and snapped the shirt’s snaps. You were not allowed to wear anything under the scrub suit, no underwear. She pulled a cloth surgical cap over her head and tucked her hair up into the cap while looking in the mirror. She did not appear nervous, but she was starting to feel a little bit nervous. This was only her second trip into a hot area.

  Standing in her bare feet, she turned away from the mirror and faced a door leading into Level 2, A deep blue light streamed through a window in the door—ultraviolet light. Viruses fall apart under ultraviolet light, which smashes their genetic material and makes them unable to replicate.

  As she opened the door and entered Level 2, she felt the door stick against her pull, sucked in by a difference of air pressure, and a gentle drag of air whispered around her shoulders and traveled inward, toward the hot zone. This was negative air pressure, designed to keep hot agents from drifting outward. The door closed behind her, and she was in Level 2. The blue light bathed her face. She walked through a water-shower stall that contained an ultraviolet light, a bar of soap, and some ordinary shampoo. The shower stall led into a bathroom, where there was a shelf that held some clean white socks. She put on a pair of socks and pushed through another door, into Level 3.

  This was a room known as the staging area. It contained a desk with a telephone and a sink. A cylindrical waxed cardboard box sat on the floor beside the desk. It was a biohazard container known as a “hatbox,” or “ice-cream container.” A hatbox is blazed with biohazard symbols, which are red, spiky three-petaled flowers, and it is used for storing and transp
orting infectious waste. This hatbox was empty. It was only a makeshift chair.

  She found a box of latex rubber surgical gloves and a plastic shaker full of baby powder. She shook baby powder onto her hands and pulled on the gloves. Then she found a roll of sticky tape, and she tore off several strips of tape and hung them in a row on the edge of the desk. Then she taped herself. Taking up one strip at a time, she taped the cuffs of her gloves to the sleeves of her scrub shirt, running the tape around the cuff to make a seal. She then taped her socks to her trousers. Now she wore one layer of protection between herself and the replicative Other.

  Lieutenant Colonel Johnson came in through Level 2 wearing a surgical scrub suit. He put on rubber gloves and began taping them to his sleeves, and he taped his socks to his pants.

  Nancy turned to the right, into an antechamber, and found her space suit hanging on a rack. It was a Chemturion biological space suit, and it was marked in letters across the chest: JAAX. The Chemturion type is also known as a blue suit, because it is bright blue. It is a pressurized, heavy-duty plastic space suit that meets government specifications for work with airborne hot agents.

  She opened up the space suit and laid it down on the concrete floor and stepped into it, feet first. She pulled it up to her armpits and slid her arms into the sleeves until her fingers entered the gloves. The suit had brown rubber gloves that were attached by gaskets at the cuffs. These were the space suit’s main gloves, and they were made of heavy rubber. They were the most important barrier between her and Ebola. The hands were the weak point, the most vulnerable part of the suit, because of what they handled. They handled needles, knives, and sharp pieces of bone. You are responsible for maintaining your space suit in the same way that a paratrooper is responsible for packing and maintaining his own parachute. Perhaps Nancy was in a bit of a hurry and did not inspect her space suit as closely as she should have.

  Lieutenant Colonel Johnson gave her a short briefing on procedures and then helped her lower the helmet over her head. The helmet was made of soft, flexible plastic. Johnson looked at her face, visible through the clear faceplate, to see how she was doing.

  She closed an oiled Ziploc zipper across the suit’s chest. The zipper made a popping sound as it snapped shut, pop, pop, pop. The moment the space suit was closed, her faceplate fogged up. She reached over to a wall and pulled down a coiled yellow air hose and plugged it into her suit. Then came a roar of flowing air, and her suit bloated up, fat and hard, and a whiff of dry air cleared away some tiny beads of sweat that had collected inside her faceplate.

  Around the Institute, they say that you can’t predict who will panic inside a biological space suit. It happens now and then, mainly to inexperienced people. The moment the helmet closes over their faces, their eyes begin to glitter with fear, they sweat, turn purple, claw at the suit, try to tear it open to get some fresh air, lose their balance and fall down on the floor, and they can start screaming or moaning inside the suit, which makes them sound as if they are suffocating in a closet. There was one case in which a man in Level 4 suddenly began screaming, “Get me out of here!”—and he tore off his space suit’s helmet, taking great gasps of air from Level 4. (They dragged him into a chemical shower and kept him there for a while.)

  After he had helped Nancy Jaax put on her space suit, and had looked into her eyes for signs of panic, Tony Johnson put on his own suit, and when he was closed up and ready, he handed her a pack of dissection tools. He seemed calm and collected. They turned and faced the stainless-steel door together. The door led into an air lock and Level 4. The door was plastered with a biohazard symbol and warnings:

  CAUTION

  BIOHAZARD

  DO NOT ENTER

  WITHOUT WEARING VENTILATED SUIT

  The international symbol for biohazard, which is pasted on doors at USAMRIID whenever they open through a major transition of zones, is a red trefoil that reminds me of a red trillium, or toadshade.

  The Level 4 air lock is a gray area, a place where two worlds meet, where the hot zone touches the normal world. The gray area is neither hot nor cold: A place that is neither provably sterile nor known to be infective. At USAMRIID, toad-shades bloom in the gray zones. Nancy took a breath and gathered her thoughts into stillness, using her martial-arts training to get her breathing under control. People performed all kinds of small rituals before they walked through that steel door. Some people crossed themselves. Others carried amulets or charms inside their space suits, even though it was technically against the rules to bring anything inside the suit except your body and the surgical scrubs. They hoped the amulets might help ward off the hot agent if there was a major break in their suit.

  She unplugged her air hose and unlatched the steel door and entered an air lock, and Tony Johnson followed her. The air lock was made entirely of stainless steel, and it was lined with nozzles for spraying water and chemicals. This was the decon shower. Decon means “decontamination.” The door closed behind them. Nancy opened the far door of the air lock, and they crossed over to the hot side.

  TOTAL IMMERSION

  1983 SEPTEMBER 26, 1330 HOURS

  They were standing in a narrow cinder-block corridor. Various rooms opened on either side. The hot zone was a maze. From the walls dangled yellow air hoses. There was an alarm strobe light on the ceiling that would be triggered if the air system failed. The walls were painted with thick, gobby epoxy paint, and all the electrical outlets were plugged around the edges with a gooey material. This was to seal any cracks and holes, so that a hot agent could not escape by drifting through hollow electrical conduits. Nancy reached for an air hose and plugged it into her suit. She could not hear anything except the roar of air in her helmet. The air rumbled so loudly in their suits that they did not try to speak to each other.

  She opened a metal cabinet. Blue light streamed out of it, and she removed a pair of yellow rubber boots. They reminded her of barn boots. She slid the soft feet of her space suit into the boots and glanced at Johnson and caught his eye. Ready for action, boss.

  They unplugged their air hoses and proceeded down the hallway and entered the monkey room. It contained two banks of cages, positioned facing each other along opposite walls of the room. Jaax and Johnson replugged their hoses and peered into the cages. One bank of cages contained two isolated monkeys. They were the so-called control monkeys. They had not been injected with Ebola virus, and they were healthy.

  As soon as the two Army officers appeared in space suits, the healthy monkeys went nuts. They rattled their cages and leaped around. Humans in space suits make monkeys nervous. They hooted and grunted—“Ooo! Ooo! Haw, wah, haw!” And they uttered a high-pitched squeal: “Eek!” The monkeys moved to the front of their cages and shook the doors or leaped back and forth, whump, whump, whump, watching Jaax and Johnson the whole time, following them with their eyes, alert to everything. The cages had elaborate bolts on the doors to prevent fiddling by primate fingers. These monkeys were creative little boogers, she thought, and they were bored.

  The other bank of cages was mostly quiet. This was the bank of Ebola cages. All the monkeys in these cages were infected with Ebola virus, and most of them were silent, passive, and withdrawn, although one or two of them seemed queerly deranged. Their immune systems had failed or gone haywire. Most of the animals did not look very sick yet, but they did not display the alertness, the usual monkey energy, the leaping and the cage rattling that you see in healthy monkeys, and most of them had not eaten their morning biscuits. They sat almost motionless in their cages, watching the two officers with expressionless faces.

  They had been injected with the hottest strain of Ebola known to the world. It was the Mayinga strain of Ebola Zaire. This strain had come from a young woman named Mayinga N., who died of the virus on October 19, 1976. She was a nurse at a hospital in Zaire, and she had taken care of a Roman Catholic nun who died of Ebola. The nun had bled to death all over Nurse Mayinga, and then, a few days later, Nurse Mayinga had broken with Eb
ola and died. Some of Nurse Mayinga’s blood had ended up in the United States, and the strain of virus that had once lived in Nurse Mayinga’s blood now lived in small glass vials kept in superfreezers at the Institute, which were maintained at minus one hundred and sixty degrees Fahrenheit. The freezers were fitted with padlocks and alarms and were plastered with biohazard flowers and sealed with bands of sticky tape. The first line of defense against a hot agent is sticky tape, because it seals cracks. It could be said that without sticky tape there would be no such thing as biocontainment.

  Gene Johnson, the civilian scientist, had thawed a little bit of Nurse Mayinga’s frozen blood and had injected it into the monkeys. Then, as the monkeys became sick, he had treated them with a drug in the hope that it would help them fight off the virus. The drug did not seem to be working.

  Nancy Jaax and Tony Johnson inspected the monkeys, moving from cage to cage, until they found the two monkeys that had crashed and bled out. Those animals were hunched up, each in its own cage. They had bloody noses, and their eyes were half-open, glassy, and brilliant red, with dilated pupils. The monkeys showed no facial expression, not even pain or agony. The connective tissue under the skin had been destroyed by the virus, causing a subtle distortion of the face. Another reason for the strange faces was that the parts of the brain that control facial expression had also been destroyed. The masklike face, the red eyes, and the bloody nose were classic signs of Ebola that appear in all primates infected with the virus, both monkeys and humans. It hinted at a vicious combination of brain damage and soft-tissue destruction under the skin. The classic Ebola face made the monkeys look as if they had seen something beyond comprehension. It was not a vision of heaven.