The Hot Zone

by Richard Preston

  C. J. then gave an overview of the situation, telling the general about the monkeys in Reston, and finishing with these words: “I’d say we have a major pucker factor about the virus in those monkeys.”

  “Well, how certain are you that it’s Ebola?” General Russell asked. “I’m wondering if this could be Marburg.”

  Jahrling explained why he didn’t think it was Marburg. He had done his test twice, he said, and both times the samples were positive to the Mayinga strain of Ebola Zaire. As he spoke to the general, he was very careful to say that that test did not in itself prove that the virus was Ebola Zaire. It showed only that is was closely related to Ebola Zaire. It might be Ebola, or it might be something else—something new and different.

  C. J. said, “We have to be very concerned and very puckered if it is of the same ilk as Ebola.”

  They had to be very puckered, Russell agreed. “We have a national emergency on our hands,” he said. “This is an infectious threat of major consequences.” He remarked that this type of virus had never been seen before in the United States, and it was right outside Washington. “What the hell are we going to do about it?” he said. Then he asked them if there was any evidence that the virus could travel through the air. That was a crucial question.

  There was evidence, horrifying but incomplete, that Ebola could travel through the air. Nancy Jaax described the incident in which her two healthy monkeys had died of presumably airborne Ebola in the weeks after the bloody-glove incident, in 1983. There was more evidence, and she described that, too. In 1986, Gene Johnson had infected monkeys with Ebola and Marburg by letting them breathe it into their lungs, and she had been the pathologist for that experiment. All of the monkeys exposed to airborne virus had died except for one monkey, which managed to survive Marburg. The virus, therefore, could infect the lungs on contact. Furthermore, the lethal airborne dose was fairly small: as small as five hundred infectious virus particles. That many particles of airborne Ebola could easily hatch out of a single cell. A tiny amount of airborne Ebola could nuke a building full of people if it got into the, air-conditioning system. The stuff could be like plutonium. The stuff could be worse than plutonium because it could replicate.

  C. J. said, “We know it’s infectious by air, but we don’t know how infectious.”

  Russell turned to Jaax and asked, “Has this been published? Did you publish it?”

  “No, sir,” she said.

  He glared at her. She could see him thinking, Well, Jaax, why the hell hasn’t it been published?

  There were plenty of reasons, but she didn’t feel like giving them just now. She believed that Gene Johnson, her collaborator, had difficulty writing papers. And, well, they just had not gotten around to publishing it, that was all. It happens. People sometimes just don’t get around to publishing papers.

  Hearing the discussion, Peter Jahrling chose not to mention to the general that he might have sniffed just a little bit of it. Anyway, he hadn’t sniffed it, he had only whiffed it. He had kind of like waved his hand over it, just to bring the scent to his nose. He hadn’t inhaled it. He hadn’t like jammed the flask up into his nostril and snorted it or anything like that. Yet he had a feeling he knew what the general might do if he found out about it—the general would erupt in enough profanity to lift Jahrling off his feet and drop him into the Slammer.

  Then there was the additional frightening possibility that this virus near Washington was not Ebola Zaire. That it was something else. Another hot strain from the rain forest. An unknown emerger. A new filovirus. And who could say how it moved or what it could do to humans? General Russell began to think out loud. “We could be in for a hellacious event,” he said. “Given that we have an agent with a potential to cause severe human disease, and given that it appears to be uncontrolled in the monkey house, what do we do? We need to do the right thing, and we need to do it fast. How big is this sucker? And are people going to die?” He turned to Colonel C. J. Peters and asked, “So what are our options here?”

  C. J. had been thinking about this already. According to standard doctrine, there are basically three ways to stop a virus—vaccines, drugs, and biocontainment. There was no vaccine for Ebola. There was no drug treatment for Ebola. That left only biocontainment.

  But how to achieve biocontainment? That was tricky. As far as C. J. could see, there were only two options here. The first option was to seal off the monkey colony and watch the monkeys die—and also keep a close watch on the people who had handled the monkeys and possibly put them into quarantine as well. The second option was to go into the building and sterilize the whole place. Kill the monkeys—give them lethal injections—burn their carcasses, and drench the entire building with chemicals and fumes—a major biohazard operation.

  General Russell listened and said, “So option one is to cut the monkeys off from the rest of the world and let the virus run its course in them. And option two is to wipe them out. There aren’t any more options.”

  Everyone agreed that there were no other options.

  Nancy Jaax was thinking, It may be in the monkey house now, but it ain’t going to stay there very damn long. She had never seen a monkey survive Ebola. And Ebola is a species jumper. All of those monkeys were going to die, and they were going to die in a way that was almost unimaginable. Very few people on earth had seen Ebola do its work on a primate, but she knew exactly what it could do. She did not see how the virus could be contained unless the monkey house was set up for quarantine with an independently filtered air supply. She said, “How ethical is it to let these animals go a long time before they die? And how do we assure the safety of people in the meantime? I’ve watched these animals die of Ebola, and it’s not a fun way to go—they’re sick, sick, sick animals.” She said that she wanted to go into the monkey house to look at the monkeys. “The lesions are easy to miss unless you know what you are looking for,” she said, “and then it’s as plain as the nose on your face.”

  She also wanted to go there to look at pieces of tissue under a microscope. She wanted to look for crystalloids, or “inclusion bodies.” Bricks. If she could find them in the monkey meat, that would be another confirmation that the monkeys were hot.

  Meanwhile, there was the larger question of politics. Should the Army become involved? The Army has a mission, which is to defend the country against military threats. Was this virus a military threat? The sense of the meeting ran like this: military threat or no, if we are going to stop this agent, we’ve got to throw everything at it that we’ve got.

  That would create a small political problem. Actually it would create a large political problem. The problem had to do with the Centers for Disease Control in Atlanta, Georgia. The C.D.C. is the federal agency that deals with emerging diseases. It has a mandate from Congress to control human disease. This is the C.D.C.’s lawful job. The Army does not exactly have a mandate to fight viruses on American soil. Yet the Army has the capability and the expertise to do it. Everyone in the room could see that a confrontation might boil up with the C.D.C. if the Army decided to move in on the monkey house. There were people at the C.D.C. who could be jealous of their turf. “The Army doesn’t have the statutory responsibility to take care of this situation,” General Russell pointed out, “but the Army has the capability. The C.D.C. doesn’t have the capability. We have the muscle but not the authority. The C.D.C. has the authority but not the muscle. And there’s going to be a pissing contest.”

  In the opinion of General Russell, this was a job for soldiers operating under a chain of command. There would be a need for people trained in biohazard work. They would have to be young, without families, willing to risk their lives. They would have to know each other and be able to work in teams. They had to be ready to die.

  In fact, the Army had never before organized a major field operation against a hot virus. The whole thing would have to be put together from scratch.

  Obviously there were legal questions here. Lawyers were going to have to be consu
lted. Was this legal? Could the Army simply put together a biohazard SWAT team and move in on the monkey house? General Russell was afraid the Army’s lawyers would tell him that it could not, and should not, be done, so he answered the legal doubts with these words: “A policy of moving out and doing it, and asking forgiveness afterward, is much better than a policy of asking permission and having it denied. You never ask a lawyer for permission to do something. We are going to do the needful, and the lawyers are going to tell us why it’s legal.”

  By this time, the people in the room were shouting and interrupting one another. General Russell, still thinking out loud, boomed, “So the next question is, Who the fuck is going to pay for it?” Before anyone had a chance to speak, he answered the question himself. “I’ll get the money. I’ll beat it out of somebody.”

  More shouting.

  The general’s voice rose above the noise. “This is a big one coming, so let’s not screw it up, fellas,” he said. “Let’s write the right game plan and then execute it.” In the Army, an important job is called a mission, and a mission is always carried out by a team, and every team has a leader. “We have to agree on who is going to be in charge of this operation,” the general continued. “C. J. Peters has got this action here. He’s in charge of the operation. He’s the designated team leader. Okay? Everybody agreed on that?”

  Everybody agreed.

  “C. J., what we need is a meeting,” the general said. “Tomorrow we’re going to have a meeting. We have to call everybody.”

  He looked at the clock on the wall. It was five-thirty, rush hour. People were leaving work, monkeys were dying in Reston, and the virus was on the move. “We’ve got to pull the chain on this whole thing,” the general said. “We’ll have to inform everybody simultaneously, as soon as possible. I want to start with Fred Murphy at the C.D.C. I don’t want him to be sandbagged by this.”

  Frederick A. Murphy was one of the original discoverers of Ebola virus, the wizard with an electron microscope who had first photographed the virus and whose work had hung in art museums. He was an old friend of General Russell’s. He was also an important official at the C.D.C., the director of the National Center for Infectious Diseases.

  Russell put his hand on the telephone on his desk. He stared around the room. “One last time: are you sure you’ve got what you think you’ve got? Because I’m gonna make this phone call. If you don’t have a filovirus, we will look like real assholes.”

  Around the room, one by one, they told him they were convinced it was a thread virus.

  “All right. Then I’m satisfied we’ve got it.”

  He dialed Murphy’s number in Atlanta.

  “Sony—Dr. Murphy has gone home for the day.”

  He pulled out his black book and found Murphy’s home phone number. He reached Murphy in his kitchen, where he was chatting with his wife. “Fred. It’s Phil Russell.… Great, how about yourself?… Fred, we’ve isolated an Ebola-like agent outside Washington.… Yeah. Outside Washington.”

  A grin spread over Russell’s face, and he held the phone away from his ear and looked around the room. Evidently his friend Murphy was having some kind of a noisy reaction. Then General Russell said into the receiver, “No, Fred, we’re not smoking dope. We’ve got an Ebola-like virus. We’ve seen it.… Yeah, we have pictures.” There was a pause, and he put his hand over the mouthpiece and said to the room, “He thinks we’ve got crud in our scope.”

  Murphy wanted to know who took the pictures and who analyzed them.

  “It was a kid who took the pictures. Young guy named—what’s his name?—Geisbert. And we’re looking at them right here.”

  Murphy said he would fly up to Fort Detrick tomorrow morning to look at the pictures and review the evidence. He took it extremely seriously.

  1830 HOURS, TUESDAY

  Dan Dalgard had to be called, and they had to notify Virginia state health authorities. “I’m not even sure who the state authorities are,” Russell said. “And we’ve got to get them on the phone right now.” People were leaving work. “We’ll have to call people at home. It’s going to be a bunch of phone calls.” What county was that monkey house located in? Fairfax County, Virginia. My, oh my, a nice place to live. Fairfax County—beautiful neighborhoods, lakes, golf courses, expensive homes, good schools, and Ebola. “We’ll have to call the county health department,” the general said. They would also have to call the U.S. Department of Agriculture, which has control over imported monkeys. They would have to call the Environmental Protection Agency, which has jurisdiction in cases of environmental contamination by an extreme biohazard. General Russell also decided to call an assistant secretary of defense, just to get the Pentagon notified.

  People left the room and fanned out along the hallways, going into empty offices and making the calls. C. J. Peters, now the team leader, went into another office down the hall and called Dan Dalgard’s office, with Peter Jahrling on an extension line. Dalgard had gone home. They called Dalgard’s home, and Dalgard’s wife told him that Dan hadn’t arrived yet. At about half past six, they called Dalgard’s house again, and this time they got him. “This is Colonel C. J. Peters, up at USAMRIID. I’m the chief of the disease-assessment division.… How do you do?… Anyway, I’m calling to report that the second agent is apparently not Marburg. The second agent is Ebola virus.”

  “What is Ebola?” Dalgard asked. He had never heard of Ebola. The word had no meaning for him.

  In his smoothest Texas voice, C. J. Peters said, “It’s a rather rare viral disease that has been responsible for human fatalities in outbreaks in Zaire and Sudan within the past ten or twelve years.”

  Dalgard was starting to feel relieved—good thing it isn’t Marburg. “What is the nature of Ebola virus?” he asked.

  C. J. described the virus in vague terms. “It is related to Marburg. It is transmitted the same way, through contact with infected tissue and blood, and the signs and symptoms are much the same.”

  “How bad is it?”

  “The case-fatality rate is fifty to ninety percent.”

  Dalgard understood exactly what that meant. The virus was much worse than Marburg.

  C. J. continued, “With the information we have, we are going to notify state and national public health officials.”

  Dalgard spoke carefully. “Would you, ahem, would you please wait until seven p.m., to allow me to apprise my corporate headquarters of recent developments?”

  C. J. agreed to wait before pulling the trigger, though in fact General Russell had already called the C.D.C. Now C. J. had a favor to ask of Dalgard. Would it be all right if he sent someone down to Reston tomorrow to have a look at some samples of dead monkeys?

  Dalgard resisted. He had sent a little bit of blood and tissue to the Army for diagnosis—and look what was happening. This thing could go way out of control. He sensed that Colonel Peters was not telling him all there was to know about this virus called Ebola. Dalgard feared he could lose control of the situation in a hurry if he let the Army get its foot in the door. “Why don’t we meet by phone early tomorrow morning and discuss this approach?” Dalgard replied.

  After the phone call, C. J. Peters found Nancy Jaax and asked her if she would come with him to meet Dalgard the next day and look at some monkey tissue. He assumed Dalgard would give permission. She agreed to go with him.

  Nancy Jaax walked across the parade ground back to the Institute and found Jerry in his office. He looked up at her with a pained expression on his face. He had been staring out the window and thinking about his murdered brother. It was dark; there was nothing to see out there except a blank wall.

  She closed the door. “I’ve got something for you. This is close hold. This is hush-hush. You are not going to believe this. There’s Ebola virus in a monkey colony in Virginia.”

  They drove home, talking about it, traveling north on the road that led to Thurmont along the foot of Catoctin Mountain.

  “This is killing me—I’ll never get a
way from this bug,” she said to him.

  It seemed clear that they both were going to be involved in the Army action. It wasn’t clear what kind of an action it would be, but certainly something big was going to go down. She told Jerry that tomorrow she would probably visit the monkey house with C. J. and that she would be looking at monkey tissues for signs of Ebola.

  Jerry was profoundly surprised: so this was what Nancy’s work with Ebola had come to. He was impressed with his wife and bemused by the situation. If he was worried about her, he didn’t show it.

  They turned up a gentle swing of road that ran along the side of the mountain, and passed through apple orchards, and turned into their driveway. It was eight o’clock, and Jason was home. Jaime had gone off to her gymnastics practice. The kids were latchkey children now.

  Jason was doing his homework. He had made himself a microwave dinner of God knows what. Their son was a self-starter, a little bit of a loner, and very self-sufficient. All he needed was food and money, and he ran by himself.

  The two colonels changed out of their uniforms into sweat clothes, and Nancy put a frozen chunk of her homemade stew into the microwave and thawed it. When the stew was warm, she poured it into a Thermos jar. She put the dog and the Thermos into the car, and she drove out to get Jaime at her gymnastics practice. The gym was a half hour’s drive from Thurmont. Nancy picked up Jaime and gave her the stew to eat in the car. Jaime was an athletic girl, short, dark haired, sometimes inclined to worry about things—and she was exhausted from her workout. She ate the stew and fell asleep on the back seat while Nancy drove her home.

  The Colonel Jaaxes had a water bed, where they spent a lot of time. Jaime got into her pajamas and curled up on the water bed next to Nancy and fell asleep again.

  Nancy and Jerry read books in bed for a while. The bedroom had red wallpaper and a balcony that overlooked the town. They talked about the monkey house, and then Nancy picked up Jaime and carried her into her own bedroom and tucked her into her bed. Around midnight, Nancy fell asleep.