The Hot Zone

by Richard Preston

  She held her breath, fighting the puke factor, and picked up a bag. The monkey kind of slid around inside it. They piled the bags one by one gently in the Toyota’s trunk. Each monkey weighed between five and twelve pounds. The total weight came to around fifty pounds of Biohazard Level 4 liquefying primate. It depressed the rear end of the Toyota. C. J. closed the trunk.

  Nancy was anxious to dissect the monkeys right away. If you left an Ebola monkey inside a plastic bag for a day, you’d end up with a bag of soup.

  “Follow behind me, and watch for drips,” C. J. joked.

  SPACE WALK

  1400 HOURS, WEDNESDAY

  They arrived at the Institute in midafternoon. C. J. Peters parked beside a loading dock on the side of the building and found some soldiers to help him carry the garbage bags to a supply air lock that led to the Ebola suite. Nancy went to the office of a member of her staff, a lieutenant colonel named Ron Trotter, and told him to suit up and go in; she would follow. They would be buddies in the hot zone.

  As she always did before going into Level 4, she took off her engagement ring and her wedding band, and locked them away in her desk. She and Trotter walked down the hall together, and he went first into the small locker room that led to AA-5 while she waited in the corridor. A light went on, telling her that he had gone on to the next level, and she swiped her security card across a sensor, which opened the door into the locker room. She took off all of her clothes, put on a long-sleeved scrub suit, and stood before the door that led inward, blue light falling on her face. Beside the door there was another security sensor. This one was a numerical key pad. You can’t bring your security card with you into the higher levels. A security card would be melted or ruined by chemicals during the decontamination process. Therefore you memorize your security code. She punched a string of numbers on the key pad, and the building’s central computer noticed that Jaax¬ Nancy¬ was attempting entry. Finding that she was cleared to enter AA-5¬ the computer unlocked the door and beeped to let her know that she could proceed inward without setting off alarms. She walked through the shower stall into the bathroom, put on white socks, and continued inward, opening a door that led to the Level 3 staging area.

  There she met Lieutenant Colonel Trotter, a stocky, dark-haired man whom Nancy had worked with for many years. They put on their inner gloves and taped their cuffs. Nancy put a pair of hearing protectors over her ears. She had started wearing them a while back, when people had begun to suspect that the roar of air in your suit might be loud enough to damage your hearing. They hauled on their space suits and sealed the Ziploc zippers. They edged around each other as they fiddled with their suits. People wearing biohazard space suits tend to step around one another like two wrestlers at the beginning of a match, watching the other person’s every move, especially watching the hands to make sure they don’t hold a sharp object. This cringing becomes instinctive.

  They closed up their suits and lumbered across the staging area to a large air-lock door. This was a supply air lock. It did not lead into the hot zone. It led to the outside world. They opened it. On the floor of the air lock sat the seven garbage bags.

  “TAKE AS MANY AS YOU CAN CARRY,” she said to Lieutenant Colonel Trotter.

  He picked up a few bags, and so did she. They shuffled back across the staging area to the airlock door that led to Level 4. She picked up a metal pan containing tools. She was getting warm, and her faceplate fogged up. They opened the airlock door and stepped in together. Nancy took a breath and gathered her thoughts. She imagined that passing through the gray-zone door into Level 4 was like a space walk, except that instead of going into outer space, you went into inner space, which was full of the pressure of life trying to get inside your suit. People went into Level 4 areas all the time at the Institute, particularly the civilian animal caretakers. But going into a containment zone to perform a necropsy on an animal that had died of an amplified unknown hot agent was something a little different. This was high-hazard work.

  Nancy centered herself and brought her breathing under control. She opened the far door and went through to the hot side. Then she reached back inside the air lock and pulled the chain in the chemical shower. That started a decon cycle running in the air lock that would eliminate any hot agents that might have leaked into the air lock as they were going through.

  They put on their boots and headed down the cinder-block hallway, lugging the monkeys. Their air was going stale inside their space suits, and they needed to plug in right away.

  They came to a refrigerator room, and put all the bags in the refrigerator except for one. This bag they carried into the necropsy room. Stepping around each other cautiously, they plugged in their air hoses, and dry air cleared their faceplates. The air thundered distantly beyond Nancy’s hearing protectors. They gloved up, pulling surgical gloves over their space-suit gloves. She laid her tools and specimen containers at the head of the table, counting them off one by one.

  Trotter untwisted some ties on the garbage bag and opened it, and the hot zone inside the bag merged with the hot zone of the room. He and Nancy together lifted the monkey out and laid it on the dissection table. She switched on a surgical lamp.

  Unclouded brown eyes stared at her. The eyes looked normal. They were not red. The whites were white, and the pupils were clear and black, dark as night. She could see a reflection of the lamp in the pupils. Inside the eyes, behind the eyes, there was nothing. No mind, no existence. The cells had stopped working.

  Once the cells in a biological machine stop working, it can never be started again. It goes into a cascade of decay, falling toward disorder and randomness. Except in the case of viruses. They can turn off and go dead. Then, if they come in contact with a living system, they switch on and multiply. The only thing that “lived” inside this monkey was the unknown agent, and it was dead, for the time being. It was not multiplying or doing anything, since the monkey’s cells were dead. But if the agent touched living cells, Nancy’s cells, it would come alive and begin to amplify itself. In theory, it could amplify itself around the world in the human species.

  She took up a scalpel and slit the monkey’s abdomen, making a slow and gentle cut, keeping the blade well away from her gloved fingers. The spleen was puffed up and tough, leathery, like a globe of smoked salami. She did not see any bloody lesions inside this monkey. She had expected that the monkey’s interior would be a lake of blood, but no, this monkey looked all right, it had not bled into itself. If the animal had died of Ebola, this was not a clear case. She opened up the intestine. There was no blood inside it. The gut looked okay. Then she examined the stomach. There she found a ring of bleeding spots at the junction between the stomach and the small intestine. This could be a sign of Ebola, but it was not a clear sign. It could also be a sign of simian fever, not Ebola. Therefore, she could not confirm the presence of Ebola virus in this animal based on a visual inspection of the internal organs during necropsy.

  Using a pair of blunt scissors, she clipped wedges out of the liver and pressed them on glass slides. Slides and blood tubes were the only glass objects allowed in a hot zone, because of the danger of glass splinters if something broke. All laboratory beakers in the room were made of plastic.

  She worked slowly, keeping her hands out of the body cavity, away from blood as much as possible, rinsing her gloves again and again in a pan of EnviroChem. She changed her gloves frequently.

  Trotter glanced at her once in a while. He held the body open for her and clamped blood vessels, handing her tools when she asked for them. They could read each other’s lips.

  “FORCEPS,” she mouthed silently, pointing to it. He nodded and handed her a forceps. They did not talk. She was alone with the sound of her air.

  She was beginning to think that this monkey did not have Ebola virus. In biology, nothing is clear, everything is too complicated, everything is a mess, and just when you think you understand something, you peel off a layer and find deeper complications beneath. Nature i
s anything but simple. This emerging virus was like a bat crossing the sky at evening. Just when you thought you saw it flicker through your field of view, it was gone.

  SHOOT-OUT

  1400 HOURS, WEDNESDAY

  While Nancy Jaax was working on the monkeys, C. J. Peters was in the conference room at Fort Detrick’s headquarters building. Careers were at stake in this room. Almost all of the people in the world who understood the meaning of Ebola virus were sitting around a long table. General Russell sat at the head of the table, a tall, tough-looking figure in uniform; he chaired the meeting. He did not want the meeting to turn into a power struggle between the Centers for Disease Control and the Army. He also did not want to let the C.D.C. take over this thing.

  Dan Dalgard was there, wearing a dark suit, seeming reserved and cool; in fact, he churned with nervousness. Gene Johnson glowered over the table, bearded and silent. There were officials from the Virginia Department of Health and from Fairfax County. Fred Murphy—the codiscoverer of Ebola virus, the C.D.C. official whom General Russell had called—sat at the table beside another official from the C.D.C., Dr. Joseph B. McCormick.

  Joe McCormick was the chief of the Special Pathogens Branch of the C.D.C., the branch that had been run by Karl Johnson, another codiscoverer of Ebola virus. Joe McCormick was the successor to Karl Johnson—he had been appointed to the job when Johnson retired. He had lived and worked in Africa. He was a handsome, sophisticated medical doctor with curly dark hair and round Fiorucci spectacles, a brilliant, ambitious man, charming and persuasive, with a quick, flaring temper, who had done extraordinary things in his career. He had published major research articles on Ebola. Unlike anyone else in the room, he had seen and treated human cases of Ebola virus.

  It happened that Joe McCormick and C. J. Peters couldn’t stand each other. There was bad blood between these two doctors that went back many years. They had both rifled the darkest corners of Africa searching for Ebola, and neither of them had found its natural hiding place. Like Peters, Joe McCormick evidently felt that now, finally, he was closing in on the virus and getting ready to make a spectacular kill.

  The meeting began with Peter Jahrling, the codiscoverer of the strain that burned in the monkeys. Jahrling stood up and spoke, using charts and photographs. Then he sat down.

  Now it was Dalgard’s turn to speak. He was exceedingly nervous. He described the clinical signs of disease that he had seen at the monkey house, and by the end he felt that no one had noticed his nervousness.

  Immediately afterward, Joe McCormick got up and spoke. What he said remains a matter of controversy. There is an Army version and there is another version. According to Army people, he turned to Peter Jahrling and said words to this effect: Thanks very much, Peter. Thanks for alerting us. The big boys are here now. You can just turn this thing over to us before you hurt yourselves. We’ve got excellent containment facilities in Atlanta. We’ll just take all your materials and your samples of virus. We’ll take care of it from here.

  In other words, the Army people, thought McCormick tried to present himself as the only real expert on Ebola. They thought he tried to take over the management of the outbreak and grab the Army’s samples of virus.

  C. J. Peters fumed, listening to McCormick. He heard the speech with a growing sense of outrage, and thought it was “very arrogant and insulting.”

  McCormick remembers something different. “I’m sure I offered some help or assistance with the animal situation at Reston,” he recalled, when I telephoned him. “I don’t know that there was any conflict. If there was any animosity, it came from their side, not ours, for reasons they know better than I. Our attitude was, Hey guys, good work.”

  But McCormick and the Army had not been getting along well, and there was a history of conflict. In the past, McCormick had publicly criticized Gene Johnson, the Army’s Ebola expert, for spending a lot of money to explore Kitum Cave and then not publishing his findings. McCormick expressed his opinion of the Army to me this way: “They want to tell you about their experiments, but the way to tell people about them is to publish them. That’s not an unreasonable criticism. They’re spending taxpayers’ money.” And besides, “None of them had spent as much time in the field as I had. I was one of those who had dealt with human cases of Ebola. No one else there had done that.”

  What McCormick had done was this. In 1979, reports reached the C.D.C. that Ebola had come out of hiding and was burning once again in southern Sudan, in the same places where it had first appeared, in 1976. The situation was dangerous, not only because of the virus but because a civil war was going on in Sudan—the area where Ebola raged also happened to be a war zone. McCormick nevertheless volunteered to go there to try to collect some human blood and bring the strain back alive to Atlanta. He traveled to Sudan in the company of another C.D.C. doctor named Roy Baron. McCormick and Baron arrived in southern Sudan in a light plane flown by two terrified bush pilots. Around sunset, they landed at an airstrip near a Zande village. The pilots were too scared to get out of the plane. It was getting dark, and the pilots decided to spend the night in the cockpit, sitting on the airstrip. They warned McCormick and Baron that they would leave the next morning at sunrise. The doctors had until dawn to find the virus.

  They shouldered their backpacks and walked into the village, looking for Ebola. They arrived at a mud hut. Villagers stood around the hut, but wouldn’t go inside. They heard sounds of human agony. A dark doorway led inside. They couldn’t see into the hut, but they knew that Ebola was in there. McCormick rummaged in his backpack and found his flashlight, but it was dead, and he realized that he had forgotten to bring batteries. He asked the crowd if anyone had a light, someone brought him a lantern, and they entered the hut.

  Years later, McCormick told me that he would never forget the sight. The first thing he saw was a number of red eyes staring at him. The air inside the hut reeked of blood. People lay on straw mats on the floor. Some were having convulsions—the final phase, as death sets in—their bodies rigid and jerking, their eyes rolled up into the head, blood streaming out of the nose and flooding from the rectum. Others had gone into terminal comas, and were motionless and bleeding out. The hut was a hot zone.

  McCormick opened his backpack and fished out rubber gloves, a paper surgical gown, a paper surgical mask, and paper boots to cover his shoes, to keep them from becoming wet with blood. After he had dressed himself, he laid out his blood tubes and syringes on a mat. Then he began drawing blood from people. He worked all night in the hut on his knees, collecting blood samples and taking care of the patients as best he could. Baron worked at his side.

  Sometime during the night, McCormick was drawing blood from an old woman. Suddenly she jerked and thrashed, having a seizure. Her arm lashed around, and the bloody needle came out of her arm and jabbed into his thumb. Uh-oh, he thought. That would be enough to do it. The agent had entered his bloodstream.

  At dawn, they gathered up their tubes of blood and ran to the airplane and handed the samples to the pilots. The question for McCormick was what to do with himself, now that he had been pricked with a bloody needle. That was a massive exposure. He probably had three to four days before he broke with Ebola. Should he leave Sudan now, get himself to a hospital? He had to make a decision—whether to leave with the pilots or stay with the virus. It seemed obvious that the pilots would not come back later to pick him up. If he planned to leave and get medical help for himself, the time to do it was now. There was an additional factor. He was a physician, and those people in the hut were his patients.

  He returned to the village with Baron, and rested that day in a hut. That evening, he and his colleague had dinner with some local United Nations officials, where McCormick drank at least half a bottle of scotch. He got talkative, then he collapsed. Baron dragged and carried McCormick to a nearby hut, sat him up on a cot, and gave him a large transfusion of blood serum from Africans who had survived Ebola. This might help McCormick fight off the virus. Or it mi
ght not. That night, whirling drunk on scotch, McCormick still could not sleep. He lay awake, thinking about the needle jabbing into his thumb, thinking about Ebola starting its inevitable replication in his bloodstream.

  He worked with Ebola patients for the next four days inside the hut, and still he did not have a headache. Meanwhile, he watched the old lady like a hawk to see what happened to her. On the fourth day, to his surprise, the old lady recovered. She had not had Ebola. She had probably been suffering from malaria. She had not been having an Ebola seizure but, rather, had been shivering from a fever. He had walked away from a firing squad.

  Now, at the meeting at Fort Detrick, Joe McCormick of the C.D.C. was convinced that Ebola virus does not travel easily, especially not through the air. He had not become sick, even though he had breathed the air inside an Ebola-ridden hut for days and nights on end. He felt strongly that Ebola is a disease that is not easy to catch. Therefore, in his view, it was not as dangerous as perhaps the Army people believed.

  Dan Dalgard asked a question of the assembled experts. He said, “How soon after we give you samples can you tell us whether they have virus in them?”

  C. J. Peters replied, “It may take a week. This is all we know.”

  Joe McCormick spoke up. Wait a minute, he said—he had a new, fast probe test for Ebola virus that would work in just twelve hours. He argued that the C.D.C. should have the virus and the samples.

  C. J. Peters turned and stared at McCormick. C. J. was furious. He didn’t believe McCormick had any quick test for Ebola. He thought it was Joe McCormick blowing smoke, trying to get his hands on the virus. He thought it was a poker bluff in a high-stakes game for control of the virus. It was a delicate situation, because how could he say in front of all these state health officials, “Joe, I just don’t believe you”? He raised his voice and said, “An ongoing epidemic is not the time to try to field-test a new technique.” He argued that Fort Detrick was closer to the outbreak than was the C.D.C., in Atlanta, and therefore it was appropriate for the Army to have the samples and try to isolate the virus. What he did not say—no reason to rub it in—was that seven dead monkeys were at that very moment being examined by Nancy Jaax. Even as they argued, she was exploring the monkeys. What’s more, the Army was growing the virus in cultures. Possession is nine tenths of the law, and the Army had the meat and the agent.