The Hot Zone

by Richard Preston

  Ebola kills a great deal of tissue while the host is still alive. It triggers a creeping, spotty necrosis that spreads through all the internal organs. The liver bulges up and turns yellow, begins to liquefy, and then it cracks apart. The cracks run across the liver and deep inside it, and the liver completely dies and goes putrid. The kidneys become jammed with blood clots and dead cells, and cease functioning. As the kidneys fail, the blood becomes toxic with urine. The spleen turns into a single huge, hard blood clot the size of a baseball. The intestines may fill up completely with blood. The lining of the gut dies and sloughs off into the bowels and is defecated along with large amounts of blood. In men, the testicles bloat up and turn black-and-blue, the semen goes hot with Ebola, and the nipples may bleed. In women, the labia turn blue, livid, and protrusive, and there may be massive vaginal bleeding. The virus is a catastrophe for a pregnant woman: the child is aborted spontaneously and is usually infected with Ebola virus, born with red eyes and a bloody nose.

  Ebola destroys the brain more thoroughly than does Marburg, and Ebola victims often go into epileptic convulsions during the final stage. The convulsions are generalized grand mal seizures—the whole body twitches and shakes, the arms and legs thrash around, and the eyes, sometimes bloody, roll up into the head. The tremors and convulsions of the patient may smear or splatter blood around. Possibly this epileptic splashing of blood is one of Ebola’s strategies for success—it makes the victim go into a flurry of seizures as he dies, spreading blood all over the place, thus giving the virus a chance to jump to a new host—a kind of transmission through smearing.

  Ebola (and Marburg) multiplies so rapidly and powerfully that the body’s infected cells become crystal-like blocks of packed virus particles. These crystals are broods of virus getting ready to hatch from the cell. They are known as bricks. The bricks, or crystals, first appear near the center of the cell and then migrate toward the surface. As a crystal reaches a cell wall, it disintegrates into hundreds of individual virus particles, and the broodlings push through the cell wall like hair and float away in the bloodstream of the host. The hatched Ebola particles cling to cells everywhere in the body, and get inside them, and continue to multiply. It keeps on multiplying until areas of tissue all through the body are filled with crystalloids, which hatch, and more Ebola particles drift into the bloodstream, and the amplification continues inexorably until a droplet of the host’s blood can contain a hundred million individual virus particles.

  After death, the cadaver suddenly deteriorates: the internal organs, having been dead or partially dead for days, have already begun to dissolve, and a sort of shock-related meltdown occurs. The corpse’s connective tissue, skin, and organs, already peppered with dead spots, heated by fever, and damaged by shock, begin to liquefy, and the fluids that leak from the cadaver are saturated with Ebola-virus particles.

  When it was all over, the floor, chair, and walls in Sister M. E.’s hospital room were stained with blood. Someone who saw the room told me that after they took her body away for burial (wrapped in many sheets), no one at the hospital could bear to go into the room to clean it up. The nurses and doctors didn’t want to touch the blood on the walls and were frankly fearful of breathing the air in the room, too. So the room was closed and locked, and remained that way for days. The appearance of the nun’s hospital room after her death may have raised in some minds one or two questions about the nature of the Supreme Being, or, for persons not inclined to theology, the blood on the walls may have served as a reminder of the nature of Nature.

  No one knew what had killed the nun, but clearly it was a replicating agent, and the signs and symptoms of the disease were not easy to consider with a calm mind. What also did not lead to calm thoughts were rumors coming out of the jungle to the effect that the agent was wiping out whole villages upriver on the Congo. These rumors were not true. The virus was hitting families selectively, but no one understood this because the flow of news coming from upriver was being choked off. Doctors at the hospital in Kinshasa examined the nun’s case and began to suspect that she might have died of Marburg or a Marburg-like agent.

  Then Sister E. R., the nun who had traveled with Sister M. E. during the drive to Bumba and the plane flight to Kinshasa, broke with l’épidémie. They put her in a private room at the hospital, where she began to die with the same signs and symptoms that had preceded Sister M. E.’s death.

  There was a young nurse at the Ngaliema Hospital named Mayinga N. (Her first name was Mayinga and her last name is given as N.) Nurse Mayinga had been caring for Sister M. E. when the nun had died in the bloodstained room. She may have been splattered with the nun’s blood or with black vomit. At any rate, Nurse Mayinga developed a headache and fatigue. She knew she was becoming sick, but she did not want to admit to herself what it was. She came from a poor but ambitious family, and she had received a scholarship to go to college in Europe. What worried her was the possibility that if she became ill, she would not be allowed to travel abroad. When the headache came upon her, she left her job at the hospital and disappeared. She dropped out of sight for two days. During that time, she went into the city, hoping to get her travel permits arranged before she became visibly sick. On the first day of her disappearance—the date was October 12, 1976—she spent a day waiting in lines at the offices of the Zairean foreign ministry, trying to get her papers straight.

  The next day, October 13, she felt worse, but instead of reporting to work, again she went into the city. This time, she took a taxi to the largest hospital in Kinshasa, the Mama Yemo Hospital. By now, as her headache became blinding and her stomach pain increased, she must have been terribly frightened. Why didn’t she go to the Ngaliema Hospital to seek treatment where she worked and where the doctors would have taken care of her? It must have been a case of psychological denial. She did not want to admit, even to herself, that she had been infected. Perhaps she had a touch of malaria, she hoped. So she went to Mama Yemo Hospital, the hospital of last resort for the city’s poor, and spent hours waiting in a casualty ward jammed with ragged people and children.

  I can see her in my mind’s eye—Nurse Mayinga, the source of the virus in the United States Army’s freezers. She was a pleasant, quiet, beautiful young African woman, about twenty years old, in the prime of her life, with a future and dreams, hoping somehow that what was happening to her could not be happening. They say that her parents loved her dearly, that she was the apple of their eye. Now she is sitting in the casualty ward at Mama Yemo among the cases of malaria, among the large-bellied children in rags, and no one is paying any attention to her because all she has is a headache and red eyes. Perhaps she has been crying, perhaps that is why her eyes are red. A doctor gives her a shot for malaria and tells her that she should be in quarantine for her illness. But there is no room in the quarantine ward at Mama Yemo Hospital; so she leaves the hospital and hails another taxi. She tells the driver to take her to another hospital, to University Hospital, where perhaps the doctors can treat her. But when she arrives at University Hospital, the doctors can’t seem to find anything wrong with her, except for possibly some signs of malaria. Her headache is getting worse. She is sitting in the waiting room of this hospital, and as I try to imagine her there, I am almost certain she is crying. Finally she does the only thing left for her to do. She returns to Ngaliema Hospital and asks to be admitted as a patient. They put her in a private room, and there she falls into lethargy, and her face freezes into a mask.

  News of the virus and what it did to people had been trickling out of the forest, and now a rumor that a sick nurse had wandered around Kinshasa for two days, having face-to-face contact with many people in crowded rooms and public places, caused a panic in the city. The news spread first along the mission grapevine and through government employees and among the diplomats at cocktail parties, and finally the rumors began to reach Europe. When the story reached the offices of the World Health Organization in Geneva, the place went into a full-scale alert. People who w
ere there at the time said that you could feel fear in the hallways, and the director looked like a visibly shaken man. Nurse Mayinga seemed to be a vector for an explosive chain of lethal transmission in a crowded third-world city with a population of two million people. Officials at the WHO began to fear that Nurse Mayinga would become the vector for a world-wide plague. European governments contemplated blocking flights from Kinshasa. The fact that one infected person had wandered around the city for two days when she should have been isolated in a hospital room began to look like a species-threatening event.

  President Mobutu Sese Seko, the maximum leader of Zaire, sent his army into action. He stationed soldiers around Ngaliema Hospital with orders to let no one enter or leave except doctors. Much of the medical staff was now under quarantine inside the hospital, but the soldiers made sure that the quarantine was enforced. President Mobutu also ordered army units to seal off Bumba Zone with roadblocks and to shoot anyone trying to come out. Bumba’s main link with the outside world was the Congo River. Captains of riverboats had heard about the virus by this time, and they refused to stop their boats anywhere along the length of the river in Bumba, even though people beseeched them from the banks. Then all radio contact with Bumba was lost. No one knew what was happening upriver, who was dying, what the virus was doing. Bumba had dropped off the face of the earth into the silent heart of darkness.

  • • •

  As the first nun at Ngaliema Hospital, Sister M. E., lay dying, her doctors had decided to give her a so-called agonal biopsy. This is a rapid sampling of tissue, done close to the moment of death instead of a full autopsy. She was a member of a religious order that prohibited autopsies, but the doctors very much wanted to know what was replicating inside her. As the terminal shock and convulsions came over her, they inserted a needle into her upper abdomen and sucked out a quantity of liver. Her liver had begun to liquefy, and the needle was large. A fair amount of the nun’s liver traveled up the needle and filled a biopsy syringe. Possibly it was during this agonal biopsy that her blood squirted on the walls. The doctors also took some samples of blood from her arm and put it in glass tubes. The nun’s blood was precious beyond measure, since it contained the unknown hot agent.

  The blood was flown to a national laboratory in Belgium and to the English national laboratory, the Microbiological Research Establishment at Porton Down, in Wiltshire. Scientists at both labs began racing to identify the agent. Meanwhile, at the Centers for Disease Control in Atlanta, Georgia—the C.D.C.—scientists were feeling left out, and were still scrambling to get their hands on a little bit of the nun’s blood, making telephone calls to Africa and Europe, pleading for samples.

  There is a branch of the C.D.C. that deals with unknown emerging viruses. It’s called the Special Pathogens Branch. In 1976, at the time of the Zaire outbreak, the branch was being run by a doctor named Karl M. Johnson, a virus hunter whose home terrain had been the rain forests of Central and South America. (He is not related to Gene Johnson, the civilian virus hunter, or to Lieutenant Colonel Tony Johnson, the pathologist.) Karl Johnson and his C.D.C. colleagues had heard almost nothing about the occurrences upriver in Zaire—all they knew was that people in Zaire were dying of a “fever” that had “generalized symptoms”—no details had come in from the bush or from the hospital where the nun had just died. Yet it sounded like a bad one. Johnson telephoned a friend of his at the English lab, in Porton Down, and reportedly said to him, “If you’ve got any little dregs to spare of that nun’s blood, we’d like to have a look at it.” The Englishman agreed to send it to him, and what he received was literally dregs.

  The nun’s blood arrived at the C.D.C. in glass tubes in a box lined with dry ice. The tubes had cracked and broken during shipment, and raw, rotten blood had run around inside the box. A C.D.C. virologist named Patricia Webb—who was then married to Johnson—opened the box. She found that the package was sticky with blood. The blood looked like tar. It was black and gooey, like Turkish coffee. She put on rubber gloves, but other than that, she did not take any special precautions in handling the blood. Using some cotton balls, she managed to dab up some of the black stuff, and then by squeezing the cotton between her gloved fingertips, she collected a few droplets of it, just enough to begin testing it for viruses.

  Patricia Webb put some of the black blood droplets into flasks of monkey cells, and pretty soon the cells got sick and began to die—they burst. The unknown agent could infect monkey cells and pop them.

  Another C.D.C. doctor who worked on the unknown virus was Frederick A. Murphy, a virologist who had helped to identify Marburg virus. He was and is one of the world’s leading electron-microscope photographers of viruses. (His photographs of viruses have been exhibited in art museums.) Murphy wanted to take a close look at those dying cells to see if he could photograph a virus in them. On October 13—the same day Nurse Mayinga was sitting in the waiting rooms of hospitals in Kinshasa—he placed a droplet of fluid from the cells on a small screen and let it dry, and he put it in his electron microscope to see what he could see.

  He couldn’t believe his eyes. The sample was jammed with virus particles. The dried fluid was shot through with something that looked like string. His breath stopped in his throat. He thought, Marburg. He believed he was looking at Marburg virus.

  Murphy stood up abruptly, feeling strange. That lab where he had prepared these samples—that lab was hot. That lab was as hot as hell. He went out of the microscope room, closing the door behind him, and hurried down a hallway to the laboratory where he had worked with the material. He got a bottle of Clorox bleach and scrubbed the room from top to bottom, washing countertops and sinks, everything, with bleach. He really scoured the place. After he had finished, he found Patricia Webb and told her what he had seen in his microscope. She telephoned her husband and said to him, “Karl, you’d better come quick to the lab. Fred has looked at a specimen, and he’s got worms.”

  Staring at the worms, they tried to classify the shapes. They saw snakes, pigtails, branchy, forked things that looked like the letter Y, and they noticed squiggles like a small g, and bends like the letter U, and loopy 6s. They also noticed a classic shape, which they began calling the shepherd’s crook. Other Ebola experts have taken to calling this loop the eyebolt, after a bolt of the same name that can be found in a hardware store. It could also be described as a Cheerio with a long tail.

  A single Ebola-virus particle with a pronounced “shepherd’s crook”—in this case, a tangled double crook. This is one of the first photographs ever made of Ebola. It was taken on October 13, 1976, by Frederick A. Murphy, then of the Centers for Disease Control—on the same day that Nurse Mayinga wandered around Kinshasa. The lumpy ropelike braided features in the particle are the mysterious structural proteins. They surround a single strand of RNA, which is the virus’s genetic code. Magnification: 112,000 times.

  The next day, Patricia Webb ran some tests on the virus and found that it did not react to any of the tests for Marburg or any other known virus. Therefore, it was an unknown agent, a new virus. She and her colleagues had isolated the strain and shown that it was something new. They had earned the right to name the organism. Karl Johnson named it Ebola.

  Karl Johnson has since left the C.D.C., and he now spends a great deal of his time fly-fishing for trout in Montana. He does consulting work on various matters, including the design of pressurized hot zones. I learned that he could be reached at a fax number in Big Sky, Montana, so I sent him a fax. In it, I said that I was fascinated by Ebola virus. My fax was received, but there was no reply. So I waited a day and then sent him another fax. It fell away into silence. The man must have been too busy fishing to bother to answer. After I had given up hope, my fax machine suddenly emitted this reply:

  Mr. Preston:

  Unless you include the feeling generated by gazing into the eyes of a waving confrontational cobra, “fascination” is not what I feel about Ebola. How about shit scared?

  Two days after
he and his colleagues isolated Ebola virus for the first time, Karl Johnson headed for Africa in the company of two other C.D.C. doctors, along with seventeen boxes of gear, to try to organize an effort to stop the virus in Zaire and Sudan (the outbreak in Sudan was still going on). They flew first to Geneva, to make contact with the World Health Organization, where they found that the WHO knew very little about the outbreaks. So the C.D.C. doctors organized their equipment and packed more boxes, getting ready to go to the Geneva airport, from where they would fly to Africa. But then, at the last possible moment, one of C.D.C. doctors panicked. It is said he was the doctor assigned to go to Sudan, and it is said he was afraid to proceed any farther. It was not an unusual situation. As Karl Johnson explained to me, “I’ve seen young physicians run from these hemorrhagic viruses, literally. They’re unable to work in the middle of an outbreak. They refuse to get off the plane.”

  Johnson, one of the discoverers of Ebola virus, preferred to talk about these events while fly-fishing. (“We’ve got to keep our priorities straight,” he explained to me.) So I flew to Montana and spent a couple of days with him fishing for brown trout on the Bighorn River. It was October, the weather had turned clear and warm, and the cottonwood trees along the banks were yellow and rattled in a south wind. Standing waist-deep in a mutable slick of the river, wearing sunglasses, with a cigarette hanging from the corner of his mouth and a fly rod in his hand, Johnson ripped his line off the water and laid a cast upstream. He was a lean, bearded man, with a soft voice that one had to listen for in the wind. He is a great figure in the history of virus hunting, having discovered and named some of the most dangerous life forms on the planet. “I’m so glad nature is not benign,” he remarked. He studied the water, took a step downstream, and placed another cast. “But on a day like today, we can pretend nature is benign. All monsters and beasts have their benign moments.”