The Hot Zone

by Richard Preston

  COLONEL GERALD (“JERRY”) JAAX. Chief of the veterinary division at USAMRIID. Married to Nancy Jaax. Had never worn a biological space suit, but becomes the mission leader of the space-suited SWAT team during the Reston biohazard operation.

  EBOLA. (Pronounced ee-BOH-la.) Extremely lethal virus from the tropics, its exact origins unknown. It has three known subtypes: Ebola Zaire, Ebola Sudan, and Ebola Reston. It is closely related to Marburg virus. All of them constitute the filovirus family.

  EUGENE (“GENE”) JOHNSON. Civilian virus hunter working for the Army. Specialist in Ebola. In the spring of 1988, following the death of “Peter Cardinal,” leads an Army expedition to Kitum Cave in Mount Elgon. Chief of logistics and safety for the Reston biohazard operation.

  “PETER CARDINAL.” Danish boy visiting his parents in Kenya in the summer of 1987, when he dies of Marburg virus. The Army keeps a strain of Marburg named after him in its freezers.

  DAN DALGARD. Veterinarian at the Reston Primate Quarantine Unit (the Reston monkey house).

  PETER JAHRLING. Civilian Army virologist. Codiscoverer of the strain of virus that burns through the Reston monkey house.

  TOM GEISBERT. Intern at USAMRIID. In the fall of 1989, is responsible for the operation of USAMRIID’S electron microscope. Codiscoverer of the virus.

  COLONEL CLARENCE JAMES (“C. J.”) PETERS, MD. Chief of the disease-assessment division at USAMRIID. Overall leader of the Reston biohazard operation.

  MAJOR GENERAL PHILIP K. RUSSELL. MD. The general who gave the command to dispatch the military teams to Reston.

  DR. JOSEPH B. MCCORMICK. Chief of the Special Pathogens Branch of the C.D.C. Treated human Ebola patients in a hut in Sudan, where he stuck himself with a bloody needle.

  GLOSSARY

  AMPLIFICATION. Multiplication of a virus through either (1) the body of an individual host or (2) a population of hosts. See also extreme amplification.

  BRICK. (Military slang.) Pure crystal-like block of packed virus particles that grows inside a cell. Also known as an inclusion body. In this book, often called a crystalloid (author’s own term).

  BUBBLE STRETCHER. Portable biocontainment pod used for transportation of a hot patient.

  BURN; BURNING. See explosive chain of lethal transmission.

  CHEMTURION SPACE SUIT. Pressurized, heavy-duty biological space suit used in Biosafety Level 4 containment areas. Also known as a blue suit because it is bright blue.

  CRASH AND BLEED OUT. (Military slang.) To die of shock, with profuse hemorrhages from the orifices of the body.

  CRYSTALLOID. See brick.

  DECON. (Military slang.) To decontaminate; decontamination.

  ELECTRON MICROSCOPE. Large and very powerful microscope that uses a beam of electrons to enlarge the image of a very small object, such as a virus, and replicate it on a screen.

  EMERGING VIRUSES. “Viruses that have recently increased their incidence and appear likely to continue increasing.” Term and definition coined by Stephen S. Morse, a virologist at Rockefeller University.

  ENVIROCHEM. Green liquid disinfectant used in air-lock chemical showers. An effective virus killer.

  EXPLOSIVE CHAIN OF LETHAL TRANSMISSION. Sort of biological meltdown wherein a lethal infectious agent spreads explosively through a population, killing a large percentage of the population. Also known as burning.

  EXTREME AMPLIFICATION. Multiplication of a virus everywhere in a host, partly transforming the host into virus.

  FILOVIRUS. A family of viruses that comprises only Ebola and Marburg. In this book, also called thread viruses.

  GRAY AREA; GRAY ZONE. Intermediate area or room between a hot zone and the normal world. A place where the two worlds meet.

  HATBOX. (Military slang.) Cylindrical biohazard container made of waxed cardboard. Also known as an ice-cream container.

  HIV. Human immunodeficiency virus, the cause of AIDS. It is an emerging Level 2 agent from the rain forests of Africa. Exact origin unknown. Now amplifying globally, its ultimate level of penetration into the human species is completely unknown. See also amplification.

  HOST. Organism that serves as a home to, and often as a food supply for, a parasite, such as a virus.

  HOT. (Military slang.) Lethally infective in a biological sense.

  HOT AGENT. Extremely lethal virus. Potentially airborne.

  HOT SUITE. A group of Biosafety Level 4 laboratory rooms.

  HOT ZONE; HOT AREA; HOT SIDE. Area that contains lethal, infectious organisms.

  ICE-CREAM CONTAINER. See hatbox.

  INDEX CASE. First known case in an outbreak of infectious disease. Sometimes spreads the disease widely.

  KINSHASA HIGHWAY. AIDS highway. The main route by which HIV traveled during its breakout from the central African rain forest. The road links Kinshasa, in Zaire, with East Africa.

  MARBURG VIRUS. Closely related to Ebola. Was initially called stretched rabies.

  MAYINGA STRAIN. Hottest known strain of Ebola virus. Comes from a nurse known as Mayinga N., who died in Zaire in 1976.

  MICROBREAK. (Author’s own term.) Small, sometimes almost invisible outbreak of an emerging virus.

  NUKE. (Military slang.) In biology, an attempt to render a place sterile. See also sterilization.

  RACAL SUIT. Portable, positive-pressure space suit with a battery-powered air supply. For use in fieldwork with extreme biohazards that are believed to be airborne. Also known as an orange suit because it is bright orange.

  REPLICATION. Self-directed copying. See also amplification.

  SENTINEL ANIMAL. Susceptible animal used as an alarm for the presence of a hot agent, since no instrument can detect a hot agent. Used as a canary is in a coal mine.

  SHF. Simian hemorrhagic fever. A monkey virus that is harmless to humans.

  SLAMMER. (Military slang.) The Biosafety Level 4 containment hospital at USAMRIID.

  STERILIZATION. Unequivocal, total destruction of all living organisms. Extremely difficult to achieve in practice, and almost impossible to verify afterward.

  STRETCHED RABIES. See Marburg virus.

  SUBMARINE. (Military slang.) The Biosafety Level 4 morgue at USAMRIID.

  THIRD SPACING. Massive hemorrhagic bleeding under the skin.

  USAMRIID. United States Army Medical Research Institute of Infectious Diseases, at Fort Detrick, in Frederick, Maryland. Also called the Institute.

  VIRUS. Disease-causing agent smaller than a bacterium, consisting of a shell made of proteins and membranes and a core containing DNA or RNA. A virus depends on living cells in order to replicate.

  CREDITS

  I owe first thanks to the civilian and military staff of USAMRIID as a whole. The people who took part in the Reston operation risked their lives anonymously, with no expectation that their work would ever come to public attention.

  I am deeply grateful to my editor at Random House, Sharon DeLano. At one point, I said to her, “God is in the details,” and she replied, “No, God is in the structure.” I am also indebted to Sally Gaminara, of Doubleday, U.K., for her valuable editorial ideas. Thanks for Ian Jackman’s help, and also many thanks to Harold Evans. And to Charlie Conrad of Anchor Books.

  For helping to keep my family solvent, much gratitude to Lynn Nesbit. Also: Robert Bookman, Lynda Obst, Cynthia Cannell, Eric Simonoff, and Chuck Hurewitz. Thanks to Jim Hart for his extremely perceptive conversations, and to Ridley Scott.

  This book began as a New Yorker piece. I am grateful to Robert Gottlieb, who commissioned the article, and to Tina Brown, who published it and gave it wings. I am indebted to John Bennet, the editor for the piece, and to Caroline Fraser, the checker. Also many thanks to Pat Crow, Jill Frisch, Elizabeth Macklin, and Chip McGrath.

  I received philosophical guidance from Stephen S. Morse and Joshua Lederberg, both of whom are virologists at Rockefeller University in New York City. Some of the concerns (or fears) expressed in this book were brought to world attention in an important conference on emerging viruses organized an
d chaired by Morse, which happened, strangely, in May 1989, just months before the Reston outbreak. At that conference, Morse apparently coined the term “emerging virus.” I have also been influenced by decades of thinking and commentary by Lederberg. Any scientific follies committed in this book are mine alone.

  At USAMRIID, my special thanks go to Dr. Ernest Takafuji, commander of USAMRIID, and to David Franz, deputy commander. I also wish to acknowledge the detailed help of Peter Jahrling, Nancy and Jerry Jaax, Thomas Geisbert, and Eugene Johnson with passages that deal with their thoughts and feelings during the Reston crisis. Curtis Klages, Nicole Berke Klages, Rhonda Williams, and Charlotte Godwin Whitford also gave much time and help. Also thanks to: Cheryl Parrott, Carol Linden, Joan Geisbert, and Ed Wise, as well as to the other 91-Tangos and civilian animal caretakers who described their experiences at Reston to me. And many thanks to Ada Jaax.

  At the Centers for Disease Control, for their generous time and for sharing their recollections: I thank Dr. C. J. Peters and Susan Peters, Dr. Joel Breman, Heinz Feldmann, Thomas G. Ksiazek, Dr. Joseph B. McCormick, and Anthony Sanchez. With other institutions: David Huxsoll, Dr. Frederick A. Murphy, and Dr. Philip K. Russell. In Kenya: Dr. Shem Musoke, Dr. David Silverstein, and Colonel Anthony Johnson. In South Africa: Dr. Margaretha Isaäcson and Dr. G. B. “Bennie” Miller. On the Bighorn River: Dr. Karl M. Johnson. At Hazleton Washington: I am grateful to Dan Dalgard for the assistance he gave me on portions of the manuscript that deal with his thoughts, as well as for letting me quote from his “Chronology of Events.”

  At the Alfred P. Sloan Foundation, I am most grateful to Arthur L. Singer Jr., for his sustained interest and support. At Princeton University, thanks to Carol Rigolot, of the Council of the Humanities.

  At Conservation International, thanks to Peter A. Seligmann and Russell Mittermeier. For the record, it was Mittermeier who seems to have originated the interesting comparison between the human species and a pile of meat waiting to be consumed.

  Concerning the trip to Kitum Cave, I owe special thanks to Graham Boynton as well as to Christine Leonard, not to mention Robin and Carrie Mac-Donald, and Katana Chege, Morris Mulatya, Herman Andembe, and Jamy Buchanan. Ian Redmond gave me valuable information about the cave. Also, I cannot fail to mention the help of David and Gregory Chudnovsky.

  Thanks to many friends: Peter Benchley, Freeman Dyson, Stona and Ann Fitch, Sallie Gouverneur, William L. Howarth, John McPhee, Dr. David G. Nathan, Richard O’Brien, Michael Robertson, Ann Waldron, Jonathan Weiner, and Robert H. White. Thanks to my grandfather, Jerome Preston, Sr., and my parents, Jerome Preston, Jr., and Dorothy Preston, for their support, and special thanks to my brother, Dr. David G. Preston, for his enthusiasm for the story, and to my other brother, the author Douglas Preston.

  Final and greatest thanks go to my wife, Michelle Parham Preston, for her extraordinary support and love.