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1-Page Summary of The Hot Zone
The Hot Zone is a non-fiction book written by Richard Preston about the Ebola virus. The story begins with Charles Monet, a Frenchman living in Kenya who visits Kitum Cave on Mount Elgon. He becomes ill and soon after dies from Marburg virus, which was first discovered in 1967 when factory workers were exposed to infected monkeys. His doctor also contracts the virus and all of his internal organs begin to fail as well as his blood refusing to clot. Dr. David Silverstein sends samples of his blood for testing and receives a diagnosis: Marburg virus.
Richard Preston, the author, tells us that Marburg kills one in four of its victims. It is part of a family called filoviruses. Ebola Sudan and Ebola Zaire are also filoviruses. These viruses attack every organ in the body and cause both massive bleeding and deadly blood clots. Like AIDS, Marburg is passed to humans by monkeys; it generally only passes through “direct contact with blood and bodily fluids”
Dr. Shem Musoke miraculously recovers from the Ebola virus, which inspires hope for future victims of the disease. His blood is sent to different laboratories around the world so that scientists can study it and develop a cure or vaccine for this deadly disease. One of these places is USAMRIID called The Institute, where people are working on a cure against Ebola.
Preston takes us back to 1983 and introduces us to Nancy Jaax, a Major in the US Army. She’s also a veterinarian who works at the United States Army Medical Research Institute of Infectious Diseases (USAMRIID) where she handles diseases that have no cure or vaccine with the protection of a spacesuit.
At the Institute, Eugene Johnson (Gene) is researching Ebola. He injects monkeys with it and then tries to find a cure for them. Nancy’s job is to dissect the dead monkeys, while Tony supervises her work from outside of the hot zone. After putting on spacesuits, Nancy and Tony enter the hot zone and begin their dissection process. However, they notice that there are tears in one of Nancy’s gloves—so she immediately leaves without touching anything else or exposing herself at all. Gene and Nancy discover that Ebola can mutate into an airborne virus after this incident ends soon afterward; however, Gene continues his research on other viruses as well
The author describes how Ebola spread in Sudan in 1976 and was worsened by the use of unclean needles to inject patients. He also talks about Ebola Zaire, which killed Mayinga, the nurse who cared for a Belgian missionary with Ebola. The author then recounts how a team of American doctors identified the Ebola virus and traveled to Africa to try to treat it.
In 1987, Gene Johnson receives blood samples from a dead Danish boy named Peter Cardinal. He finds that the boy had Marburg virus within his blood; like Charles Monet, he explored Kitum Cave. Clearly, the virus lurks somewhere in the cave. Gene Johnson attempts to locate its source in an experiment but is unsuccessful.
Meanwhile, Nancy and Jerry both get promotions, becoming lieutenant colonels. Nancy becomes the chief of pathology at USAMRIID (United States Army Medical Research Institute of Infectious Diseases), while Jerry becomes the head of its veterinary division.
A veterinarian named Dan Dalgard notices that monkeys are dying in Reston, VA. He sends samples to a scientist named Peter Jahrling who sends them to Thomas Geisbert for analysis under an electron microscope. They discover the virus is probably simian hemorrhagic fever, which is lethal to monkeys but harmless to humans.
When the cells are ready to be examined under a microscope, Geisbert makes an alarming discovery: whatever is infecting the monkeys is a filovirus, and both he and Jahrling may have been exposed. They immediately inform Gene Johnson about their potential exposure, but they keep it secret from Colonel Clarence James Peters (C. J.). The doctors continue to study the virus until another disturbing find by Jahrling: it’s either Ebola Zaire or one of its close relatives.
The news of the outbreak reaches the higher-ups in charge of USAMRIID, a research institute that studies infectious diseases. They contact their superiors at the Pentagon and C.D.C., who decide to inform local authorities as well as other agencies about this new development. Meanwhile, Dan Dalgard remains calm until he learns that one of his employees has had a heart attack, which he fears may have been caused by Ebola virus infection from monkeys brought into his facility earlier in the day. A team is sent out by USAMRIID to pick up samples and corpses from Jaax’s lab for further analysis back at its headquarters in Maryland. Nancy begins her own investigation while Gene Johnson talks with officials from the C.D.C., who are skeptical about how they should handle this situation because Ebola is such an unknown disease with no known cure or vaccine yet developed for it (McCormick). However, after some tension between them and General Russell over whether it should be handled more locally or nationally/internationally—the group decides on what needs to be done: euthanizing infected monkeys so they don’t spread any further infections among other animals nor humans.
C, Jerry and Gene meet with the military to discuss how they would be able to fight a deadly strain of monkey virus. Nancy helps Dan by doing an autopsy on a dead monkey but soon after ends up rushing into an ambulance due to toxic shock. Dan realizes that he must give permission for all of the monkeys in his house to be killed due to any one of them having been contaminated from the lethal bacteria or otherwise.
Jerry organizes a group of soldiers to enter the building and euthanize the monkeys. They collect samples as they go, but it’s draining and dangerous work. It takes them two days to complete their task, but eventually Jerry is able to catch one monkey. Peter Jahrling runs tests on Milton Frantig’s blood as well as Tom Geisbert’s and his own, but none of them have Ebola.
The team enters the building and decontaminates it. They are trying to figure out why no one has gotten sick from Ebola Zaire, even though the virus was present in that building.
Months go by and the Army decides to let Ebola die out. However, it is found that Jarvis Purdy, Milton Frantig, and two other employees have contracted Ebola Reston. It’s nearly identical to Zaire but can travel through the air and doesn’t affect humans. A change in its genetic code could make it truly deadly for humans.
Preston is a journalist who decided to travel to Kitum Cave in order to see for himself the effects of globalization on Africa. He describes how building the Kinshasa Highway enabled the spread of HIV, and AIDS is just one symptom of globalization. Preston travels with some friends and a guide along the highway, which he describes as being built by Chinese workers. He puts on a spacesuit in order to protect himself from Marburg virus that may be living inside Kitum Cave. After exploring it, he’s awed by its beauty but also sees potential for infection everywhere.
The author wonders if the emergence of tropical viruses like Ebola and HIV is nature’s way of fighting back against human destruction of tropical land. He also speculates that maybe one day a more deadly virus will emerge to wipe humans from the face of the planet.
Preston takes one last trip to the abandoned monkey house in Reston. He sees plants and insects, as life returns to a place that once harbored a deadly virus. Ebola has disappeared for now, but it will be back someday.
Full Summary of The Hot Zone
The Hot Zone is a book that tells the true story of an Ebola virus outbreak in Reston, Virginia. Preston describes how other viruses have spread around the world, particularly in Africa where some were more devastating than others. He also explains how AIDS was a virus whose effects on humans are still being measured and explored.
The book begins with the exposure and death of a French expat in Kenya due to Marburg. The author describes his symptoms and bloody death in extreme detail, giving you an immediate sense of what it’s like to be exposed to this virus. Then he provides background information about how the first outbreak occurred at a vaccine factory in Germany.
In the next few chapters, Preston describes two outbreaks of Ebola. The first is a Sudan strain of the disease that strikes a quiet storekeeper named Yu G. and spreads throughout his district. Later on, an even more deadly outbreak occurs when dirty needles are used at a medical clinic in various villages across Zaire (now known as Congo). Both outbreaks cause hundreds of deaths, but Preston provides particular details about Mayinga N., who contracts Ebola while working in Ngalemia Hospital and dies after being quarantined in Kinshasa for two days.
In the book, Preston describes several outbreaks of filoviruses and their effects on different people. He also focuses on a few American scientists who work with these viruses in order to learn more about them. Two of these scientists are Nancy Jaax and her husband, Peter Jahrling. They both work at Fort Detrick in Maryland as Army veterinarians specializing in hot agents (deadly viruses). One day while performing an experiment involving Ebola, Nancy’s space suit rips open and she almost gets exposed to it. Several years later, some monkeys at Reston die from a new strain of Ebola that has never been seen before; this is when Nancy first encounters it again. The United States Army along with the Centers for Disease Control then contain the virus so that it doesn’t spread to humans by moving all infected monkeys into an isolated facility where they can be studied without infecting anyone else.
A team of scientists enters a Reston facility to euthanize hundreds of monkeys. They also collect samples from the monkeys and disinfect the facility. The operation is difficult because it involves people in space suits, sedating monkeys, and dealing with an escaped monkey who bites one scientist. After all this work, they find out that Ebola Reston kills only monkeys but has no symptoms in humans.
The author visited Kitum Cave, a tourist spot in Kenya where two victims of the Marburg virus had been before getting sick. Scientists previously had not been able to find the source of the disease, but Preston wanted to visit and see if he could figure it out.
“In the Shadow of Mount Elgon” (pp. 1-47)
The book begins with several pages of large-type text to give the reader a sense of what it’s like to enter a Biosafety level 4 lab. The author uses this technique so that readers can experience first-hand what it would be like to enter one.
In the first chapter of The Hot Zone, a Frenchman named Charles Monet decides to take a trip to Mount Elgon in Kenya. He invites one of his lovers from the village to go with him on this trip. They explore Kitum Cave, which contains crystals and mummified animals among other things.
Monet develops a headache after visiting Kitum Cave. His back also hurts, and he stays home from work for three days. He has a fever and vomits uncontrollably for two days straight. Monet becomes sullen with his housekeeper, who fears that he’s turning into a zombie because of the yellowish color of his skin and red eyes.
Monet’s colleagues visit him to see if he has gotten better. When they arrive, they notice that Monet is still sick and in a bad state of health. They take him to Kisumu Hospital for treatment, but the doctors there are unable to diagnose his illness and recommend treatment at Nairobi Hospital instead. The flight makes Monet even worse, so he manages to get into the taxi before collapsing on the way to Nairobi hospital.
The first doctor on the scene was Shem Musoke. After checking Monet’s pulse, he began clearing blood and debris from his mouth so that he could insert a tube to help him breathe. Dr. Musoke leaned in close to put the tube in place, but suddenly Monet vomited and spewed blood all over Dr. Musoke’s face and upper body. He then slipped into a coma and died early the next morning without regaining consciousness even though an autopsy was performed to try to determine what had killed him.
Dr. Musoke was suffering from a fever and backache, so he first diagnosed himself with malaria and took the appropriate medication for it. When his skin turned yellow, Dr. Musoke revised his diagnosis to typhoid fever and attempted to treat himself with antibiotics. However, when his symptoms worsened even further, Dr. Musoke went to see another doctor who recommended exploratory surgery on him.
The doctors cannot figure out what is wrong with Dr. Musoke, but they see that he bleeds a lot. They send his blood to the National Institute of Virology in South Africa and the Centers for Disease Control in the United States to be tested.
Dr. Silverstein was soon informed that the blood sample contained Marburg, a virus that originated in Africa and spread to Europe after infecting monkeys from Africa. The infection rate was high, killing one out of four people who were infected with it.
New information reveals that the two doctors who were infected with Marburg died from a different disease. Dr. Silverstein convinces Nairobi health authorities to quarantine the hospital’s medical staff, as they had come into contact with either Dr. Musoke or Monet, both of whom tested positive for Marburg virus. However, none of the staff members develop symptoms after ten days in quarantine and are released without further incident. Samples of blood from Dr. Musoke are sent across the world to be tested for other diseases and illnesses but there is no sign of any other illness except for Ebola Zaire which caused his death before he was exposed to Marburg virus
The book starts with a description of the safety measures one would have to take in order to enter a Biosafety level 4 laboratory. This helps emphasize both how dangerous it is, and how important it is that the lab be kept clean. It also helps the reader put themselves in Nancy Jaax’s shoes by following her footsteps through each airlock.
Preston immediately presents the Marburg virus as a true antagonist in the story. He describes it in literary terms, such as personification, to make it seem like an active force that has malicious intentions and is trying to kill Monet. Preston also uses this technique to transform nonfiction into a dramatic narrative with clear heroes and villains.
Preston’s vivid description of Monet’s symptoms and eventual death sets the stage for the Reston monkey facility. If readers don’t understand how deadly Ebola is, they won’t be able to appreciate what might happen if it got loose in America. Preston doesn’t sugarcoat anything when he describes Monet vomiting and bleeding. He also switches narrative perspectives when Monet flies to Nairobi by plane; instead of writing about the flight from a third-person point of view, he writes as though another passenger were on that flight who could hear everything going on with Monet during his illness.
When Charles Monet arrives at Nairobi Hospital and is treated by Dr. Shem Musoke, he is introduced to the theme of chance in the spread of filoviruses. Although Dr. Musoke seems like a good person who would do well in this story, he ends up being infected with Ebola virus disease himself and nearly dies from it. Preston makes it clear that these viruses don’t discriminate between people based on their character or actions; they infect whoever they want to infect, regardless of what kind of person they are.
In 1967, the Marburg virus first spread to humans. It happened when a doctor was treating his patient who had contracted it from bats. The doctor treated the patient and got infected as well because he was exposed to the virus while trying to save his patient’s life. That is similar to what happens in this novel where scientists are infected by Ebola because they try to find ways of saving people from that disease.
Preston also points out that the Marburg virus outbreak was not entirely due to chance. The veterinarian who examined the monkeys on their way to Germany did a poor job of inspecting them, and they were shipped off to an island instead of being destroyed.
“In the Shadow of Mount Elgon” (pp. 48-94)
Four years after the death of Charles Monet, a Victorian house in Maryland is shown. A major named Nancy Jaax lives there with her two children and husband. While she’s making dinner for her family, she accidentally cuts herself with a butcher knife while opening a can of green beans.
The next morning, Nancy drives to work at the U.S. Army Medical Research Institute of Infectious Diseases (USAMRIID), where she specializes in Biosafety Level 4 hot agents. Many of her colleagues are skeptical about her ability to succeed at Level 4 because she is a “married female.” They also think that her slender frame and tendency to move her hands quickly could be problematic in working with hot agents. In order to combat this perception, Nancy enrolls in martial arts training so that she can make sure that people don’t see her hand movements as being too quick or nervous when handling dangerous materials. She also persuades Lieutenant Colonel Tony Johnson, who oversees all research on biological weapons for the army, to give her a chance by letting him know about some of the things that she’s done while working with other types of infectious diseases before coming there and how well they went (such as successfully making an antidote for anthrax).
Nancy is currently working on an experiment about Ebola. She’s responsible for determining the cause of death after monkeys infected with it die in a lab. Nancy will spend the day in a biohazard suit because two monkeys bled out during the night and need to be dissected.
After spending the morning doing paperwork, Nancy prepares to enter the Ebola suite with Tony Johnson. She puts on a sterile scrub suit, surgical cap, and clean white socks but leaves her band-aid on. In the staging area she tapes up her scrub suit and puts on rubber gloves before going through an airlock into Level 4.
In the lab, Nancy and Johnson examine monkeys that were injected with Ebola Zaire. The strain is lethal to humans. They are clearly suffering. Nancy feels bad for them but reminds herself of the importance of this research in order to save human lives. She still feels uneasy about it though because she can’t help them out in their pain and discomfort.
Nancy and Johnson transport the first dead monkey to the necropsy room, where they open up the animal. Nancy silently talks herself through this process, reminding herself to move slowly so she doesn’t make mistakes. She also keeps washing off blood from her gloves so that it won’t seep into her space suit. Suddenly, Johnson points out that there’s a rip in Nancy’s right glove. She removes it to reveal a hole in her wrist of her space suit.
The author was given permission by Nancy to leave the hot zone and go into the decontamination shower. After taking a shower, she found out that Ebola blood had gotten on her innermost glove next to an open cut. She feared being sent to quarantine because of this exposure risk. However, after testing with water in her glove, it held water so she wasn’t exposed.
Despite various treatments, all of the monkeys infected with Ebola die. The only exceptions are the control monkeys who were never exposed to it. Two weeks after Nancy and Johnson find out about the virus in their laboratory, they discover that two of their control monkeys have contracted Ebola.
In the narrative, Preston shifts to Nancy Jaax’s perspective. She describes her family life and early courtship with her husband. It also explains how she got into this field of work. In addition, he switches from third person to first person narration in order for readers to connect more deeply with Nancy.
Preston describes Nancy as a woman scientist, and he mentions that sexism is an issue in the sciences. He says that Nancy faces discrimination at the Institute because she’s married, but none of the men face such criticism for being married. This shows how women were expected to stay home with their families instead of working outside of the house.
Nancy’s work in science is clearly at odds with the expectations of society, especially since she has two small children and still chooses to work with hot agents. The other scientists at the Institute are not questioning Nancy’s ability to use her hands; they’re questioning her strength of mind under pressure, particularly when she is holding sharp instruments in the presence of male colleagues.
Tony Johnson eventually agrees to use Nancy Jaax for the Ebola experiment, but he does so only after interviewing her husband. This can be seen as perpetuating gender stereotypes. To his credit, Johnson decides to go ahead with using Nancy even after Jerry voices concerns about it. Still, before they enter the hot zone together, Preston notes that Tony looked into Nancy’s eyes for signs of panic.
In the scene when Nancy discovers the rip in her glove, Preston alludes to chance as a factor that determines who becomes infected with a virus. For example, Nancy should have been exposed because of two reasons: she has a ripped glove and an open cut on her hand. However, she escaped both the Slammer and death due to good luck.
“In the Shadow of Mount Elgon” (pp. 95-153)
A man from Nzara, Sudan dies of the Ebola virus in 1976. He is buried in a traditional Zande funeral. Two of his co-workers get sick and die after him, spreading the disease to many people. The outbreak ends when medical staff abandon their hospital and break the chain of infection.
Two months later, there is another outbreak of Ebola in Zaire. It’s a virus that’s more powerful than the Sudan strain, and kills twice as many people. The first “patient zero” was a person being treated by nuns who reused needles on multiple patients. The virus spread quickly from village to village at the same time it infected nurses and nuns at the hospital treating the original patient.
A nun who was infected with Marburg checked into a hospital in Kinshasa, but she died. The doctors couldn’t figure out why she died, but they thought it might have been caused by another virus that is similar to Marburg. Another nun from the same convent also went to the hospital and got sick and later died while under care of Nurse Mayinga.
A nurse named Mayinga is unable to accept that she has been infected with the virus, even though she is already exhibiting signs of illness. She leaves her job at a hospital and wanders through the city, trying to get papers for travel to Europe. After two days, Nurse Mayinga returns to Ngaliema Hospital where she is admitted as a patient. The government realizes the potential for an outbreak and immediately places the hospital under quarantine and establishes roadblocks around Bumba.
A nurse named Mayinga is cared for by Dr. Margaretha Isaacson, who wears a gas mask to protect herself from the disease that Nurse Mayinga has contracted. She can’t work well under these conditions and eventually takes off the mask so she can treat her patient better. Despite her best efforts, Nurse Mayinga dies of a heart attack caused by the virus. Realizing that she might have been infected during treatment, Dr. Isaacson cleans up all of Nurse Mayinga’s blood-soaked rooms as well as those used by Sister M.E., Sister E.R., and others who may have also been infected with the same disease in order to prevent anyone else from getting sick or dying because they were exposed to it without knowing it was there.
Meanwhile, doctors at Ngaliema Hospital perform an autopsy on Sister M.E., and send samples of her blood to laboratories in Belgium and England in order to identify the virus. Karl Johnson manages to acquire a small sample of the nun’s blood from one of his colleagues at the English laboratory. Patricia Webb and Frederick Murphy both examine the blood, and Murphy immediately notices that it is similar to Marburg virus. When it does not respond to any tests for Marburg, scientists realize they have identified a new organism; they name it “Ebola.”
Two days after discovering the Ebola strain, Johnson travels to Zaire and heads an international WHO team in Kinshasa. Meanwhile, Joel Bremen joins a field exploration team to discover the extent of the outbreak at Yambuku Mission Hospital. While traveling there by plane, they arrive in Bumba and discover that most of the infected people are dying or already dead.
Like the strains of Ebola Sudan and Ebola Zaire, which disappear after the outbreaks in Nzara and Bumba, Marburg virus disappears after initial outbreaks. However, in 1987 it reappears in Peter Cardinal, a ten-year-old Danish boy who dies at Nairobi Hospital under care of Dr. David Silverstein. Eugene Johnson receives blood sample from Peter Cardinal shortly before his death and identifies Marburg virus as cause of death. Johnson contacts Dr. Peter Tukei to learn where he might have contracted Marburg virus since they both had visited Kitum Cave.
Gene Johnson and Dr. Tukei organize a scientific expedition to Kitum Cave in order to find the source of the Marburg virus. The trip is dangerous because they know that the disease can travel through air, so everyone must wear breathing masks while inside the cave. They also bring along some sentinel animals, such as monkeys and guinea pigs, which will be placed at the mouth of the cave as an early warning system for disease. While searching for evidence of Marburg in Kitum Cave crystals, insects, small animals and villagers/cattle; Gene Johnson and Dr. Tukei are unable to find any trace of it or prove their theory about its location on Mount Elgon.
In this section of the book, Preston introduces two strains of Ebola virus that are far more lethal than Marburg. He highlights individual characters in each outbreak to dramatize the scenes beyond a simple nonfiction narrative. This also helps readers put faces to each strain and provides necessary context for the scenes featuring both strains during the Reston operation.
In Sudan and Zaire, Ebola outbreaks occur when the virus is spread by medical staff using dirty needles. In both cases, it’s because they’re not following proper procedures to prevent infection from spreading.
The medical facilities in the Congo are quite different from those of Nairobi. The Ngaliema Hospital, for instance, has many more resources and serves a much wealthier population than other hospitals in the region. However, it’s interesting to note that even though there is inequality between these two locations (and others), Ebola Zaire still spreads quickly through 55 villages because they all share one clinic. This demonstrates how poverty affects health care in rural areas where people can’t afford expensive treatments or flights to better hospitals—which was the case with Charles Monet and Peter Cardinal.
In the scene with Nurse Mayinga and Dr. Isaacson, Preston highlights how people deal with death differently. While Mayinga is unable to accept the truth of her situation, Isaacson immediately recognizes the likelihood of her exposure and elects to spend her time being useful. The difference can be attributed to age and milestones already achieved in life. While Nurse Mayinga is barely in her twenties and dreams of studying in Europe, Dr. Isaacson is past the prime of her life and already has adult children. However, they both die from Ebola even though one was much younger than another one who didn’t get infected at all
Throughout the book, Preston reminds us that we know very little about filoviruses. Although Yu G. is clearly the index case (first recorded patient of an outbreak) of Ebola Sudan, we can’t pinpoint where he was exposed or how he contracted it. We also don’t know where Marburg originated from in Zaire; all we have to go on are some theories and suppositions. As a result, readers are forced to consider just how powerful these viruses are because they’re so mysterious and unknown to science.
“The Monkey House” (pp. 157-198)
The book shifts to the monkey house in Reston, Virginia. The building was owned by Hazelton Research Products (Hazelton) and was used for the quarantine of monkeys that were imported from the Philippines. On October 4, 1989, 100 wild monkeys arrived at the facility and two were dead upon arrival. However, there were 98 live monkeys placed throughout 12 holding rooms in the building.
Within a few weeks of the monkeys arriving, Bill Volt notices that a large number of them are dying. He also notices that the heating and air-handling system in the monkey house is malfunctioning. He contacts Dan Dalgard, who’s an expert on this stuff, to see if he’ll look at the problem.
When Dalgard arrives at the facility, he observes two sick monkeys with droopy eyelids and feverish symptoms. Both of them die that night. He dissects them the next day and finds blood in their intestines as well as enlarged spleens. He suspects they may have died from simian hemorrhagic fever (SHF). Over the course of several days, many more monkeys from that room are dying every night.
After examining one of the dead monkeys, Dalgard decides to send samples around. He contacts Jahrling and asks him if he would examine them. The samples are packaged in a tin foil wrapper. Jahrling complains about this, but after looking at the samples, concludes that it is simian hemorrhagic fever.
Dalgard was determined to contain the outbreak. He euthanized the remaining monkeys in Room F, but he wasn’t sure if it was a wise decision because some of them appeared healthy. Therefore, he stored their bodies in the facility freezer until they could be examined further.
Meanwhile, at the Institute for Infectious Diseases, an intern named Tom Geisbert asks to examine a sample from Reston. He enjoys looking at viruses and is eager to tackle this new specimen. When he examines the flask with cells from the Reston monkey, he notices that they seem unrecognizable and sick. He takes it to Peter Jahrling for a second opinion, but Jahrling maintains his original diagnosis of SHF (Simian Hemorrhagic Fever) and calls Dalgard to confirm.
After a weekend hunting trip, Geisbert returns to the laboratory determined to confirm Jahrling’s diagnosis with visual evidence from the electron microscope. He cuts tiny slices of monkey tissue and looks at them under a microscope. When he sees that each cell contains rope-like viruses, his first thought is Marburg virus. He realizes that both he and Peter Jahrling may have inhaled deadly hot agents in their lab.
The Reston facility and the German vaccine factory seem to be similar. Both facilities imported monkeys from other countries, and both of them had dead animals in their shipments. The author implies that there is a connection between these two events, which will be discussed later in the book.
Dan Dalgard is a veterinarian who also worked in the same facility as Nancy Jaax. He euthanized the remaining monkeys when he thought they were infected, but found out later that they were healthy and had been injected with lethal doses of virus to test them. This made him feel like he betrayed his profession by killing healthy animals, so he kept their carcasses in the freezer as a reminder of what happened.
Dalgard knows he’s not an expert on the proper handling of infected samples. However, considering his profession, this lack of knowledge is unexpected and foreshadows some bureaucratic issues that will plague the Reston facility. Fortunately, it turns out that the tin foil-wrapped samples were harmless to humans, but there was a lot of luck involved in preventing a catastrophe.
Significantly, the intern at the Institute identifies the filovirus in a sample from Reston. Geisbert wants to get hard evidence of that through his electron microscope, which speaks to human error as a cause for viral outbreaks. If he hadn’t made that decision, then it might have spread throughout the monkey population and even infected humans like Marburg did.
The author compares the filovirus with a predator. He says that while Tom Geisbert is hunting in Maryland, another predator could be hunting him. The reader doesn’t know if Tom will get attacked by the virus or not when he leaves for his weekend trip because there’s no way to identify it without scientific equipment. However, this comparison foreshadows what Preston will say later on: that humans are also predators and parasites just like viruses are.
“The Monkey House” (pp. 199-282)
Tom Geisbert and Peter Jahrling both agree that a deadly virus is present in the sample they are studying. They compare it to images of Marburg, which can cause fatal hemorrhagic fever. The colonel at the Institute for Disease Control wants proof that this new virus is actually causing disease in monkeys from Reston before he will report his findings to higher-ups.
Colonel Peters asks Geisbert and Jahrling about their exposure to the virus. They’ve been working with it for almost a month, but they haven’t gotten sick yet. The incubation period can last as long as 18 days, so they decide not to tell Colonel Peters about the incident. Instead, they’ll test their blood for the virus and hope that everything is okay.
Geisbert collects some samples of monkey liver and lets them sit overnight. The next day, he uses a diamond knife to cut open the pieces and takes pictures with an electron microscope. These pictures prove that the virus is replicating in the monkey tissue. Geisbert shows these photographs to Peters and Jahrling who are waiting for results from Jahrling’s test.
For the test, Jahrling uses blood serum from three individuals who were infected with a filovirus strain: Shem Musoke for Marburg, Mayinga N. for Ebola Zaire and Boniface, a man who died from Ebola Sudan. Jahrling combines the monkey cells with blood serum from each individual. If any of the samples glow under ultraviolet light then it means that they contain antibodies to fight off those particular strains of virus. So if one sample glows brightly then it could mean that the person was exposed to an infection by one of these viruses before he or she got ill and eventually died. When Jahrling examines the slides he sees that only Mayinga N.’s sample is glowing brightly which means that she had been in contact with an Ebola Zaire strain before her death (it may have been present in her body but not causing disease). He performs this test again but gets the same result so he immediately calls Colonel Peters, who decides to call Colonel Huxsoll at USAMRIID (United States Army Medical Research Institute for Infectious Diseases) headquarters about his findings because they are important enough to warrant immediate attention.
Huxsoll is worried about the possible outbreak of a virus at the Reston facility. He calls a meeting with Jahrling, Peters, Nancy Jaax, and General Russell. During that meeting, Jahrling confirms that his tests confirm that the virus at Reston is Ebola Zaire; however, it may be even more dangerous than Ebola Zaire in some ways because Nancy Jaax believes it can travel through air as well. They decide to use biocontainment procedures to contain this potential biohazard disaster.
The group needs to decide between two options: let the virus run its course or euthanize all of the monkeys. Either way, they need to do a major operation with SWAT (Special Weapons and Tactics) personnel trained in biohazard work. Colonel Peters agrees to lead the team as Major General Russell calls Frederick Murphy at C.D.C., and everyone else contacts other official channels.
Dan Dalgard is hesitant to give Colonel Peters full access to the facility until he can meet him in person. He also learns that one of the animal caretakers has had a heart attack, and wonders if he was infected with Ebola. He suspends all operations except for feeding, cleaning and observation, as well as contacts Purdy’s doctor about strange symptoms.
The next morning, Nancy Jaax goes to the Hazelton offices with Colonel Peters and Gene Johnson. She examines a sample of monkey liver cells and finds that there is extreme virus amplification in them. The head of the company, Dan Dalgard, still won’t let her into the monkey house but provides seven dead monkeys for her to dissect at home. When she gets back to work, she does an autopsy on those monkeys in a Level 4 laboratory but can only conclude that they are suffering from either SHF or Ebola or both.
Meanwhile, the military calls a meeting with scientists from USAMRIID (U.S. Army Medical Research Institute of Infectious Diseases), C.D.C., and officials from the Virginia Board of Health to discuss how they’re going to deal with this outbreak in Reston, Virginia. The group decides that the C.D.C will handle human issues while the military will manage all animal matters, including euthanizing monkeys and taking tissue samples back to their lab at USAMRIID for study on what’s causing this outbreak in monkeys across America’s research facilities since no one knows exactly what it is yet or why it’s spreading so rapidly among monkey populations nationwide.
The following day, Jerry Jaax (a colonel who works at USAMRIID) calls a meeting with his team consisting of people such as Peter Jahrling, Dan Dalgard, Gene Johnson, Joe McCormick, and others involved in managing this crisis involving an unknown virus infecting monkeys throughout American research centers. He outlines a plan for entering into monkey rooms where infected animals are being housed at Reston Primate Quarantine Unit (RQSU) and euthanizing them before collecting tissue samples for further analysis by researchers working there.
In this section, Preston details the testing and initial planning phase of the USAMRIID and C.D.C. in addressing the outbreak at the Reston facility. In 1976, when Ebola Zaire was first discovered in Zaire, they immediately took steps to quarantine hospitals and isolated villages that were infected with it; however, at USAMRIID there were many more meetings before Jaax’s team went out to Reston to test for Ebola virus in monkeys because there are many bureaucratic obstacles including funding issues as well as different agencies who need to be informed about what is going on.
Preston also highlights the argument over which organization will coordinate which part of the operation. The USAMRIID and CDC have different opinions on how to handle this issue, but they’re not concerned about containing the virus. Instead, it’s more about their own personal rivalry and dislike for each other. In fact, they both want to be in charge of coordinating everything because neither wants to work with the other person. Eventually, a decision is made that splits up responsibilities between them so there won’t be any conflict between them anymore. However, it seems like these decisions are being made based on who likes/dislikes whom rather than what would actually be best for containing Ebola Zaire or something similar (which has a high human kill rate).
The Reston operation and Ebola Zaire have a lot in common. Both of them are caused by filoviruses, which can be airborne. The virus is also fatal if not treated immediately. In both cases, the people who were exposed to it refused to admit that they could have been infected with it or that they might spread it to others. For example, Preston draws parallels between Jahrling and Geisbert’s exposure and Nurse Mayinga’s potential exposure because both of them ignored their exposures for selfish reasons. Although neither one was as likely to develop symptoms as Nurse Mayinga was, their decisions still had potentially disastrous consequences for themselves and those around them.
Even after Peters informs Dalgard of the possibility of an Ebola outbreak, he is still somewhat casual in his reaction. When Purdy has a heart attack, however, Dalgard decides to cease all nonessential operations at the facility. He also tells people not to enter the monkey rooms anymore because they could get sick and spread the virus even further. However, it’s possible that he just wants as many monkeys alive so they can be tested for Ebola before they die from starvation or something else. Another explanation is that Hazelton Research Products might punish him if all their monkeys die since they would lose out on a lot of money.
In this section, Nancy Jaax is introduced as a main character. She has overcome discrimination to become one of the Institute’s best scientists. After Colonel Peters calls her in about the Reston sample, she begins to investigate it with his help. However, even though she’s an expert on Ebola and knows what it looks like under a microscope, she can’t be sure that it isn’t just simian fever until they test the monkeys for antibodies against Ebola virus (which takes another week). This shows how difficult it is to identify Ebola virus without any evidence from its symptoms or effects on humans and animals.
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“Smashdown” (pp. 285-326)
The next day, Jerry Jaax and Gene Johnson went to USAMRIID to gather their equipment for the monkey house. The front page story in that morning’s Washington Post read: “Deadly Ebola Virus Found in VA Monkey House.” Colonel Peters was quoted extensively in the article, but he asserted that there is nothing out of the ordinary going on at Reston. To keep up this image, no one put on space suits until they entered the monkey house itself.
Veterinarian Jerry Jaax and Captain Mark Haines are the first two people to enter a building. They’re both wearing biological hazard suits, which are designed for scuba diving. The two men move into an area called a staging zone that’s between the hot zone (where they’ll be working) and the outside world.
Jerry and Captain Haines enter the hot zone, which is where they’re supposed to be. However, Jerry realizes that not all entrances were sealed off as previously thought. The workers direct them to Room H, so they go there. They find out from Dan Dalgard that he was surprised to see them in space suits but proceeded with giving a tour of the room anyway.
Shortly after Jerry enters the building, Nancy Jaax arrives at the site. She instructs the soldiers to look out for any rips in their suits and also tells them to be wary of aggressive monkeys who might bite. After suiting up, Nancy goes into Room H with a group of four soldiers where she selects four monkeys to euthanize and take back with her base for testing. When she opens up those dead bodies, it is clear that they contracted Ebola from another animal like an ape or another monkey species. In this room alone there are 65 more apes caught up in quarantine that need to be humanely killed by hitting them on the head.
The next morning, Dan Dalgard arrives at the Reston facility and sees one of the monkey caretakers wearing a protective suit outside the building. He orders him to take it off immediately. The man obeys but begins vomiting uncontrollably. Dalgard realizes that two of his employees are sick, so he drives back to Hazelton Labs in Maryland where he suggests evacuation of all personnel from Reston as soon as possible. An ambulance is called for Milton Frantig who arrives with a television news van just as they’re leaving.
Dalgard asked Peters and USAMRIID to assume legal responsibility for the facility. He wanted them to sign a letter confirming that they owned it. However, he was unwilling to have the Army take full liability. Eventually, they agreed on a simple letter of ownership from Colonel Peters and General Russell. Jerry Jaax then met with civilian staff at USAMRIID in order to ask them if they would volunteer for such an important mission as euthanizing all of the monkeys in the lab.
The next morning, the new recruits were divided into teams and briefed on the situation. Gene Johnson told them that Frantig had been exposed to Ebola and it was likely airborne. Jerry Jaax and Thomas Amen suited up first so they could go inside. They went through each room of the building in order to feed the monkeys, track their movements, and collect blood samples from them before euthanizing them all. He then split everyone else into three groups: one group collected blood samples, another group performed autopsies on dead monkeys, while a third group euthanized more monkeys as needed.
Colonel Peters is appointed the head of the USAMRIID operation, and he realizes that about half his job will be keeping the press from finding out what’s going on. He knows that if people find out about this deadly virus, they’ll panic even more than they already are. So Colonel Peters emphasizes how routine and normal everything is at Reston to keep them from getting suspicious.
Given the sensitive nature of the operation, it’s understandable that Peters would block news coverage. However, his decision to prioritize the operation is questionable in light of the danger to nearby residents. Preston makes it clear that despite their best efforts, they haven’t been able to isolate themselves from outside world and Peters’ actions could place entire community at risk. Not only do Jerry Jaax and Captain Haines discover hazmat suits are not being worn by employees entering hot zone but Dalgard observes a caretaker vomiting outside building. Moreover, in describing location of Reston facility Preston notes childcare center is located near by which could be put at great risk if virus is airborne
In this section, Preston also reiterates the bureaucratic issues that continue to hamper the operation. The US Army wants full control over the monkey house and is not willing to let Hazelton Research Products off the hook for anything that happens. Peters and Russell want to avoid liability in case of an outbreak, which will only delay containment efforts by USAMRIID.
The fact that the hazmat team is wearing space suits when they arrive at Hazelton speaks to a failure in communication between USAMRIID and Hazelton. It’s possible that Hazelton doesn’t take the situation seriously, but it seems more likely that USAMRIID hasn’t communicated enough information about Ebola. Even Dalgard, who first contacts them, is surprised to see biohazard space suits when he’s only wearing a respirator. If the outbreak is severe enough for space suits, USAMRIID should have told Hazelton so they can take appropriate precautions. As it is, they only shut down after Dalgard sees Frantig vomiting outside and insists on evacuation himself.
Jerry Jaax was faced with a moral dilemma when he had to euthanize the monkeys in his care. He wanted to make sure that all of them suffered as little pain as possible, but he also needed to get rid of them quickly. As a result, Jerry walked around and fed each monkey individually before getting started on the actual task at hand. This act could be viewed as an unnecessary delay, but it allowed him time to come up with a plan for ending their lives without causing undue suffering.
“Smashdown” (pp. 327-371)
After hours of euthanizing monkeys, the group is exhausted. However, none of them are willing to leave their post. One soldier develops a problem with her space suit and starts to lose air pressure. After an initial panic in the room, she borrows a spare battery from one of the other soldiers and is able to fix it temporarily. The leader decides that they should send her outside for some fresh air so she can take a break while they continue working on decontamination procedures. While out there, she discovers that she has a hole in her suit and needs help immediately or else she will die within minutes.
Two soldiers are leaving the building when a news van arrives. Gene Johnson orders both women to hide in one of the vans behind the facility. The television men wander around outside but do not see anything interesting and soon leave. When Williams and Godwin exit their van, they discover several used needles on the ground near where they urinated.
On the second day of the operation, Jerry Jaax and Sergeant Amen repeat their routine of feeding monkeys and tracking viruses. They spend several hours in Room C before a monkey escapes its cage while Jerry is away. The sergeants immediately exit the room, bar the door, and try to find it by sight. After failing to catch it with a net, they decide to leave him alone for now.
The other team members continue to euthanize the monkeys after they have grown agitated as a result of the day’s events. Specialist Williams is first assigned to euthanize them, but later she moves over to draw blood samples while Captain Haines injects sedatives into them.
While Peter Jahrling is working long hours in his lab to isolate the strain of Ebola and determine how it’s spreading, he checks in with another scientist who sniffed a contaminated flask. They haven’t developed symptoms yet, but they will know for sure if they’re infected soon.
While Nancy Jaax is working in the hot zone, her brother calls to tell her that their father is close to death. She considers flying home but decides not to leave because she’s too busy with work. Later that day, while she’s still at work, her father dies. Sergeant Klages discovers a freezer full of dead monkeys when he makes one final sweep through the building before it can be decontaminated and destroyed by the decontamination team. Jerry orders him to leave the monkeys—since they’re already dead—in the hallway for them to destroy later on.
After the operation, the decontamination team sprayed formaldehyde gas to kill any remaining traces of the virus. Neither Peter Jahrling nor Tom Geisbert developed symptoms, and Milton Frantig was diagnosed with nothing more than a bad flu. The C.D.C identified a monkey-storage facility in the Philippines as the starting point for Reston’s Ebola outbreak; however, none of its human workers had symptoms either.
Almost a month after the Reston outbreak, another monkey facility has been infected. The virus travels through air ducts and kills all of the monkeys in that facility. It’s determined that four caretakers who worked at the original Reston facility have also tested positive for Ebola Reston but show no symptoms.
When Preston and Williams discover the dirty needles, they are reminded of the Ebola virus outbreak in 1976. The Reston facility is not used for human injection, but it serves as a reminder that human negligence can cause disease outbreaks. If one of the children from nearby steps on an infected needle, there could be a disaster.
Preston focuses on the new characters in this section of the book. He gives them minimal backstory, but he tries to give a different perspective on how scary it is when they’re working at USAMRIID. Rhonda Williams has three exposure scares, including a rip in her space suit and an improperly sedated monkey that almost bites her. She stays committed to her job throughout all of these experiences and only leaves because Jerry Jaax insists she go home for a break. The other recruits also stay committed to their jobs despite being exhausted after hours of work. Even Nancy Jaax chooses not to visit her dying father so she can continue helping out with the operation instead.
When Jahrling and Geisbert talk about their symptoms, Preston contrasts them with the military personnel in the facility. While Williams recognizes that she may be infected by a tear in her suit, Jahrling and Geisbert continue to keep their exposure secret. They both justify it by continuing to test samples of their blood but still focus on themselves rather than the greater good. Williams faces reality as she euthanizes hundreds of monkeys, and she realizes what is at stake if she inadvertently takes the virus outside of the hot zone. On the other hand, Jahrling and Geisbert see viruses only through slides or microscopes; they are unaware or unwilling to accept how serious this situation could become.
The second Ebola Reston outbreak gives the team an opportunity to observe the progression of the virus without any interference. While they had suspected that it was airborne during their first operation, they find definitive proof during this second outbreak as the virus travels from room to room through air ducts. The C.D.C and UAMRIID also realize that while humans are susceptible to infection, they do not develop symptoms after exposure to Ebola Reston. This discovery is positive for John Coleus, Milton Frantig, and other animal caretakers because it means that there’s a good chance of containing the disease before it spreads beyond its current locations in Virginia and Texas. However, Preston notes that since Ebola Reston can be transmitted through air particles, all precautions must be taken until further research determines how effective these measures will be at preventing transmission between humans.
The second outbreak of Ebola Reston is alarming for a few reasons. First, it’s the direct result of a business decision made by Hazelton Research Products. The company continues to purchase animals from the facility that caused the initial outbreak even though they know where it came from. This may be due to financial concerns or convenience, but either way, the company knowingly purchases additional monkeys from that same facility which could cause another human death if Ebola Reston becomes harmful again in future outbreaks.
“Kitum Cave” (pp. 376-411)
In the next chapter, he talks about his trip to Mount Elgon and Kitum Cave. He mentions that the road he took was known as the Kinshasa Highway, or “AIDS highway.” This road used to be a dirt path through Africa until it was paved in the 1970s. Shortly after it became a paved road, AIDS started spreading throughout all of Africa.
Preston hires Robin MacDonald as his guide for the trip to Mount Elgon. He’s a professional hunter and safari guide, who is unconcerned about the Marburg virus that might be in Kitum Cave. If Preston needs it, he will roll him up in a tent and drop him off at Nairobi Hospital. However, he has bleach with him just in case something happens.
In addition to his wife, Robin and their two sons, the expedition to Kitum Cave includes three professional safari men and Preston’s close friends. Unbeknownst to his friends, Preston has prepared a list of instructions in case he breaks with the Marburg virus after visiting the cave. At the end of the first day, they reach Kitale at Mount Elgon where Charles Monet had camped 13 years before.
The next day, the group hikes to Kitum Cave. They are accompanied by an armed guard because of poachers from Uganda and other problems in the area. The trail is covered with animal dung, which could be a host for the Marburg virus. Therefore, he becomes increasingly nervous about his mission.
Before entering the cave, Preston puts on a suit that keeps out bacteria and other organisms. He also wears gloves and boots. As he finishes dressing, one of the safari men asks how many people have died in the cave. Preston admits that two people have died, but both deaths happened several days after they visited the cave. The man remembers hearing about an expedition of American scientists who came to the cave in late 1980s.
Preston begins his journey into the cave. He has a map drawn by an expert who studied Kitum Cave, and he passes through bat roosts to reach a dry, dusty area with remnants of a petrified rainforest. When Preston reaches the back wall of the cave, he turns off his light and stands in the darkness trying to feel if there is any virus present.
Preston removes his space suit and immediately experiences fear. He tries to remind himself of the many people who have entered Kitum Cave without getting sick, but he can’t. Finally, he remembers that Joe McCormick once told him that the only treatment for exposure to a filovirus is a bottle of scotch.
Preston visits the facility where he had previously worked. He sees a few things, such as an airlock corridor and a bucket of bleach used to clean up after the monkey’s death. The building is abandoned now, but Preston knows that there will be new outbreaks in the future.
The author uses the character of Richard Preston to provide his own perspective on Kitum Cave and Ebola. He also explains that he used to visit Africa as a child, which helps explain why he is so fascinated with the filoviruses and their role in nature.
Preston also writes about the Kinshasa Highway. It was paved in the 1970s, which made it easier for AIDS to spread because of increased travel through Africa. Preston has spent most of his book on filoviruses, but he says that AIDS is a bigger threat to humanity. However, since AIDS symptoms are less dramatic than those of Ebola and other viruses, people haven’t taken it as seriously as they should have.
Preston’s decision to enter Kitum Cave is similar to the decisions made by Nancy Jaax, Gene Johnson, and other scientists in The Hot Zone. They all faced a fear of hot agents for the sake of research. Preston’s decision was important because he understood how dangerous it was to enter a hot zone like Kitum Cave. He wasn’t an unknowing victim like Charles Monet or Peter Cardinal; rather, he actively participated in his own risk of life.
Preston’s motivation for entering the cave seems tenuous. He is researching Marburg, but he also has a book to write. Regardless, Preston enters Kitum Cave with the same amount of courage required to work at Level 4. This allows him to share his characters’ experiences and helps readers understand what it is like in a hot zone.
Preston’s experience in the cave is more than just stepping into the mindset of scientists. He wants to understand how Ebola works and what makes it so deadly. While he is walking through the cave, he tries to feel if there are any signs of Ebola, even turning off his flashlight to see if that helps him notice anything. Although Preston doesn’t say whether or not he feels anything, his experience affects him after coming out of the cave because now he has no idea if he will get sick later on from being infected by Ebola. This personal episode about terror ends with a larger message about human folly and threats greater than mankind can handle alone.