The Hot Zone

by Richard Preston

  Jerry didn’t know what to say. Finally he said, “WHICH WAY TO ROOM H?”—shouting to be heard over his blowers.

  The workers led him down the corridor to the infected room. It was at the far end of the hall. Then they retreated to the front of the building and found Dan Dalgard, who had been sitting in an office, waiting for the Army to come in. He showed up at Room H moments later, wearing a respirator, to find out what was going on. Jerry looked at him as if he was insane. It was as if you went to a meeting with someone and the person showed up naked.

  Dalgard was not happy with the space suits. Apparently he had not realized how the Army would be outfitted. He gave them a tour of Room H, feeling exceptionally nervous. “Looks like we have some sick monkeys in here,” he said. Some of the monkeys went berserk when they saw the space suits. They spun in circles in their cages or cowered in the corners. Others stared at the humans with fixed expressions on their faces.

  “You see the clinical signs,” Dalgard said, pointing to a monkey. “I feel pretty confident I can tell when a monkey is getting sick. They get a little bit depressed, they go off their feed, and in a day or two they are dead.”

  Jerry wanted to look at all the monkeys in the monkey house. He and Captain Haines went back out into the corridor and went from room to room through the entire building. They found other monkeys that seemed depressed, with the same glazed expression on their faces. Jaax and Haines, both of whom knew a lot about monkeys, didn’t like the feel of this whole building. Something lived in here other than monkeys and people.

  Nancy Jaax got ready to go inside. She changed into a scrub suit in the van, ran across the lawn, and entered the staging area. The support team helped her suit up. She gathered several boxes of syringes and went in with Captain Steven Denny. They walked down the air-lock corridor and came to the far door. She opened the door and found herself in the long corridor. It was empty. Everyone was down the hall in Room H. Jerry thought his wife looked like the Pillsbury dough boy. Her suit was too large for her, and it billowed around her when she walked.

  Nancy noticed mucus and slime on the noses of some of the monkeys. That scared her, because it seemed so much like the flu or a cold, when it wasn’t. Dan Dalgard, wearing a respirator and a jumpsuit, selected four sick monkeys for sacrifice, the ones he thought looked the sickest. He reached into the cages and gave the monkeys their shots. When they crumpled and fell asleep, he gave them a second round of shots, and that stopped their hearts.

  The room was jammed with people in space suits. They kept coming in in pairs, and they milled around with nothing to do. One of them was Sergeant Curtis Klages. He turned to someone and said, “WELL, THIS IS A BIG CHARLIE FOXTROT.” That’s code for C.F., which means “cluster fuck.” A Charlie Foxtrot is an Army operation that winds up in confusion, with people bumping into one another and demanding to know what’s going on.

  Nancy happened to glance at the sergeant, checking his suit instinctively, and she saw that he had a tear across his hip. She touched the sergeant’s arm and pointed. She reached down to her ankle, where she kept her extra tape, and taped the hole for him.

  She removed the four dead monkeys from their cages, holding them by the backs of the arms, and loaded them into plastic biohazard bags. She carried the bags to the entry door, where someone had left a garden sprayer full of Clorox bleach along with more bags. She double-bagged the monkeys, spraying each bag with bleach, and then she loaded the bags into cardboard biohazard containers—hatboxes—and sprayed them to decon them. Finally she loaded each hatbox into a third plastic bag and sprayed it. She pounded on the door. “IT’S NANCY JAAX. I’M COMING OUT.” The door was opened by a sergeant standing on the other side, a member of the decon team. He was wearing a Racal suit, and he had a pump sprayer filled with bleach. She went into the air lock, pushing the hatboxes ahead of her.

  In the darkness and in the whine of their blowers, he shouted to her, “STAND WITH YOUR ARMS OUT, AND TURN AROUND SLOWLY.” He sprayed her for five minutes, until the air lock stank of bleach. It felt wonderfully cool, but the smell leaked through her filters and made her throat sting. He also sprayed the bags. Then he opened the door to the staging area, and she blinked at the light and came out, pushing the bags ahead of her.

  The support team peeled off her suit. She was drenched with sweat. Her scrubs were soaked. Now it was freezing cold. She ran across the lawn and changed into her civilian clothes in the back of the van.

  Meanwhile, people loaded the bags into boxes, and loaded the boxes into the refrigerator truck, and Nancy and a driver headed off for Fort Detrick. She wanted to get those monkeys into Level 4 and opened up as fast as possible.

  Jerry Jaax counted sixty-five animals in the room, after the four that Nancy had removed. Gene Johnson had brought a special injector back from Africa. Jerry used this device to give shots to the monkeys. It was a pole that had a socket on one end. You fitted a syringe into the socket, and you slid the pole into the cage and gave the monkey a shot. You also needed a tool to pin the monkey down, because monkeys don’t like needles coming at them. They used a mop handle with a soft U-shaped pad on the end. Captain Haines held the mop handle against the monkey to immobilize it, and Jerry ran the pole into the cage and hit the monkey’s thigh with a double dose of ketamine, a general anesthetic. They went through, the room from cage to cage, hitting all the monkeys with the drug. Pretty soon the monkeys began to collapse in their cages. Once a monkey was down, Jerry gave it a shot of a sedative called Rompun, which put it into a deep sleep.

  When all the monkeys were down and asleep, they set up a couple of stainless-steel tables, and then, one monkey at a time, they took blood samples from the unconscious monkeys and gave them a third injection, this time of a lethal drug called T-61, which is a euthanasia agent. After a monkey was clinically dead, it was opened up by Captain Steve Denny. He took samples of liver and spleen, using scissors, and dropped the samples into plastic bottles. They bagged the dead monkeys, loaded them into hatboxes, and piled the hatboxes along the corridor. Dan Dalgard, meanwhile, left the room and remained in an office at the front of the building for the rest of the day.

  By late afternoon, all the monkeys in Room H had been put to death. Behind the building, through the trees and down the hill, children ran in circles around their playhouse. Their shouts carried far in the December air. Their mothers and fathers arrived in cars and picked them up. The team exited from the hot zone in pairs, and stood around on the grass in their civilian clothes, looking pale, weak, and thoughtful. In the distance, floodlights began to light up the monuments and buildings of Washington. It was the Friday evening at the end of the week following Thanksgiving, the start of a quiet weekend that precedes the Christmas season. The wind strengthened and blew paper cups and empty cigarette packs in eddies around the parking lots. In a hospital not far from there, Jarvis Purdy, the monkey worker who had had a heart attack, rested comfortably, his condition stable.

  Back at the Institute, Nancy Jaax again stayed up until one o’clock in the morning, dissecting monkeys with her hot-zone buddy, Ron Trotter. When they had suited up and gone in, there had been five monkey carcasses waiting for them in the air lock.

  This time, the signs of Ebola were obvious. Nancy saw what she described as “horrendous gut lesions” in some of the animals, caused by sloughing of the intestinal lining. That sloughing of the gut was a classic sign. The intestine was blitzed, completely full of uncoagulated, runny blood, and at the same time the monkey had had massive blood clotting in the intestinal muscles. The clotting had shut off blood circulation to the gut, and the cells in the gut subsequently died—that is, the intestines had died—and then the gut had filled up with blood. Dead intestine—this was the kind of thing you saw in a decayed carcass. In her words, “It looked like the animals had been dead for three or four days.” Yet they had been dead only for hours. Some of the monkeys were so badly liquefied that she and Trotter didn’t even bother to do a necropsy, they just yanked
samples of liver and spleen from the dead animal. Some of the monkeys that were dying in Room H had become essentially a heap of mush and bones in a skin bag, mixed with huge amounts of amplified virus.

  DECEMBER 4, 0730 HOURS, MONDAY

  Monday arrived cold and raw, with a rising wind that brought a smell of snow from a sky the color of plain carbon steel. In the shopping malls around Washington, Christmas lights had been hung. The parking lots were empty, but later in the day they would fill up with cars, and the malls would fill up with parents and children, and the children would line up to see Santa Clauses. Dan Dalgard drove to the primate building, one more commuter in a sea of morning traffic.

  He turned into the parking lot. As he got closer to the building, he saw that a man was standing by the front door near the sweet-gum tree, wearing a white Tyvek jumpsuit. It was one of the monkey caretakers. Dalgard was furious. He had instructed them not to come out of the building wearing a mask or a protective suit. He jumped out of his car, slammed the door, and hurried across the parking lot. As he got closer, he recognized the man as someone who will be called Milton Frantig. Frantig was standing bent over with his hands on his knees. He didn’t seem to notice Dalgard—he was staring at the grass. Suddenly Frantig’s body convulsed, and liquid spewed out of his mouth. He vomited again and again, and the sound of his retching carried across the parking lot.

  A MAN DOWN

  As Dan Dalgard watched the man spill his stomach out onto the lawn, he felt, in his words, “scared shitless.” Now, perhaps for the first time, the absolute horror of the crisis at the primate building washed over him. Milton Frantig was doubled over, gasping and choking. When his vomiting subsided, Dalgard helped him to his feet, took him indoors, and made him lie down on a couch. Two employees were now sick—Jarvis Purdy was still in the hospital, recovering from a heart attack. Milton Frantig was fifty years old. He had a chronic, hacking cough, although he didn’t smoke. He had been working with monkeys and with Dalgard at Hazleton for more than twenty-five years. Dalgard knew the man well and liked him. Dalgard felt shaken, sick with fear and guilt. Maybe I should have evacuated the building last week. Did I put the interests of the monkeys ahead of the interests of the human beings?

  Milton Frantig was pale and shaky, and felt faint. He developed the dry heaves. Dalgard found a plastic bucket for him. Between heaves, interrupted by coughing spells, Frantig apologized for leaving the building while wearing a jump suit. He said he had just been putting on his respirator to go inside a monkey room when he began to feel sick to his stomach. Perhaps the bad smell in the building had nauseated him, because the monkey rooms weren’t being cleaned as regularly as usual. He could feel he was about to vomit, and he couldn’t find a bucket or anything to throw up into, and it was coming on so fast that he couldn’t get to the rest room, so he had run outdoors.

  Dalgard wanted to take Frantig’s temperature, but nobody could find a thermometer that hadn’t been used rectally on monkeys. He sent Bill Volt to a drugstore to buy one. When he returned, they discovered that Frantig had a fever of a hundred and one. Bill Volt hovered in the room, almost shaking with fear. Volt was not doing well—“almost spastic in his terror,” Dalgard would later recall, but it wasn’t any different from the way Dalgard felt.

  Milton Frantig remained the calmest person in the room. Unlike Dalgard and Volt, he did not seem afraid. He was a devout Christian, comfortable with telling people that he had been saved. If the Lord saw fit to take him home with a monkey disease, he was ready. He prayed a little, remembering his favorite passages in the Bible, and his dry heaves subsided. Soon he was resting quietly on the couch and said he felt a little better.

  “I want you to stay where you are,” Dalgard said to him. “Don’t leave the building.” He got into his car and drove as fast as he could to the Hazleton Washington offices on Leesburg Pike. The drive didn’t take long, and by the time he got there, he had made up his mind: the monkey facility had to be evacuated. Immediately.

  There had been four workers employed in the building, and two of them were now going to be in the hospital. One man had heart problems, and now the other had a fever with vomiting. From what Dalgard knew about Ebola virus, either of these illnesses could be signs of infection. They had shopped at malls and visited friends and eaten in restaurants. Dalgard thought they were probably having sexual intercourse with their wives. He didn’t even want to think about the consequences.

  When he arrived at Hazleton Washington, he went directly to the office of the general manager. He intended to brief him about the situation and get his approval to evacuate the monkey house. “We’ve got two guys who are sick,” Dalgard said to him. He began to describe what had happened, and he started crying. He couldn’t control it. He broke down and wept. Trying to pull himself together, he said, “I recommend that—the entire operation—be shut down—as soon as possible. My recommendation is—we close it down and turn it over to the Army. We’ve had this god-damned disease since October, we haven’t gotten injured, and all of a sudden we’ve got two guys sick, one in the hospital, one who’s going there. I kept on thinking that if there was a real human risk, we would have seen something by now. We’ve played with fire for too long.”

  The general manager sympathized with Dalgard and agreed with him that the monkey facility ought to be evacuated and shut down. Then, holding back his tears, Dalgard hurried to his own office, where he found a group of officials from the C.D.C. waiting for him. He felt as if the pressure would never let up. The C.D.C. people had arrived at Hazleton to begin surveillance of all employees who had been exposed to the virus. Dalgard told them what had just happened at the monkey house, that a man had gone down with vomiting. He said, “I have recommended that the facility be evacuated. I feel that the building and the monkeys should be turned over to the people from USAMRIID, who have the equipment and personnel to handle it safely.”

  The C.D.C. people listened and did not disagree.

  Then there was the question of what to do with Milton Frantig, who was still lying on the couch at the monkey house under orders from Dalgard not to move. Since the C.D.C. was in charge of the human aspects of the outbreak, the C.D.C. was in charge of Frantig—and the C.D.C. wanted him taken to Fairfax Hospital, inside the Washington Beltway.

  It was now nine-twenty in the morning. Dalgard sat in his office and sweated it out, managing the crisis by telephone. He called C. J. Peters at Fort Detrick and told him that he had a monkey caretaker who was sick. In his dry, calm voice, now without any hint that he had recently been weeping, he said to Peters, “You have permission to consider the facility and all the animals to be the responsibility of USAMRIID.”

  Colonel C. J. Peters was shocked to hear that a man had gone down, but he was a little distrustful of the phrase “the responsibility of USAMRIID.” It implied that if anything went wrong and people died, the Army could be held responsible and could be sued. He wanted to take control of the building and sterilize it, but he didn’t want lawsuits. So he said to Dalgard that the safety of his people and the safety of the general public were the most important things to him but that he would have to clear this with his command. He said he would get back to Dalgard as soon as possible.

  Then they talked about the sick man, and C. J. learned that he was being taken to Fairfax Hospital. That disturbed him greatly. He felt that it should be assumed that the guy was breaking with Ebola—and do you really want to bring a guy like that into a community hospital? Look at what Ebola had done in hospitals in Africa. Ebola could shut down a hospital; it could amplify itself in a hospital. C. J. thought the man belonged in the Slammer at the Institute.

  As soon as he got off the line with Dalgard, C. J. Peters telephoned Joe McCormick, who was in charge of the C.D.C. effort, to try to persuade him to let the Army put the man in the Slammer. He said to McCormick something like, “I know you have this idea that a surgical mask and gown are all you need to handle an Ebola patient, but I think you need to use a higher level o
f containment,” and he offered to pick up the sick man in an Army ambulance—put him in an Army biocontainment pod—and carry the pod to the Army’s facilities at the Institute. Put him in the Slammer.

  C. J. Peters recalls that McCormick said to him something like, “I want the guy at Fairfax Hospital.” C. J. replied, “All right. I believe this, Joe, and you believe that, and we don’t agree. Regardless—what is going to happen to the medical personnel at Fairfax Hospital or to you, Joe, if Ebola virus gets into that hospital?”

  McCormick would not budge on his decision: he had been face-to-face with Ebola in Africa and he hadn’t gotten sick. He had worked for days inside a mud hut that was smeared with Ebola blood, on his knees among people who were crashing and bleeding out. You didn’t need a space suit to handle an Ebola patient. They could be handled by skilled nurses in a good hospital. The guy was going to Fairfax Hospital. C. J. Peters, in spite of his strong dislike for McCormick, found himself admiring him for making strong decisions in a very difficult situation.

  At this moment, a television-news van arrived at the monkey house from Channel 4 in Washington. The workers peered through curtains at the van, and when the reporter came to the door and pushed the buzzer, no one answered. Dalgard had made it clear to them that no one was to talk to the media. Just then, an ambulance from Fairfax Hospital arrived to take Frantig away. Channel 4’s timing could not have been better. The news team turned on their lights and started filming the action. The door of the monkey house swung open and Milton Frantig stumbled out, still wearing his Tyvek suit, looking embarrassed. He walked over to the ambulance, the medical team opened the back doors of the vehicle, and Frantig climbed in by himself and lay down on the gurney. They slammed the doors and took off with Channel 4 following them. A few minutes later, the ambulance and Channel 4 pulled into Fairfax Hospital. Frantig was put in an isolation room, with access restricted to doctors and nurses wearing rubber gloves, gowns, and surgical masks. He said he felt better. He prayed to the Lord and watched a little television.