CONTENTS

Cover

About the Book

Title Page

Dedication

Epigraph

Note

To the Reader

Map of Central Africa

Part One: The Shadow of Mount Elgon

Something in the Forest

Jumper

Diagnosis

A Woman and a Soldier

Project Ebola

Total Immersion

Ebola River

Cardinal

Going Deep

Part Two: The Monkey House

Reston

Into Level 3

Exposure

Thanksgiving

Medusa

The First Angel

The Second Angel

Chain of Command

Garbage Bags

Space Walk

Shoot-out

The Mission

Reconnaissance

Part Three: Smashdown

Insertion

A Man Down

91-Tangos

Inside

A Bad Day

Decon

Part Four: Kitum Cave

The Most Dangerous Strain

Highway

Camp

Main Characters

Glossary

Acknowledgements

Index

About the Author

Copyright

About the Author

Richard Preston was born in 1954 in Cambridge, Massachusetts. He received a Ph.D from Princeton University. He is a regular contributor to The New Yorker. His two previous books are American Steel and First Light.

About the Book

Imagine a killer with the infectiousness of the common cold and power of the Black Death. Imagine something so deadly that it wipes out 90% of those it touches. Imagine an organism against which there is no defence. But you don’t need to imagine. Such a killer exists: it is a virus and its name is Ebola.

The Hot Zone tells what happens when the unthinkable becomes reality: when a deadly virus, from the rain forests of Africa, crosses continents and infects a monkey house ten miles from the White House.

Ebola is that reality. It has the power to decimate the world’s population. Try not to panic. It will be back. There is nothing you can do . . .

ACKNOWLEDGEMENTS

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, UK, for her valuable editorial ideas. Thanks for Ian Jackman’s help, and also many thanks to Harold Evans.

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 the 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 and chaired by Morse, which happened, strangely, in May 1989, just months before the Reston outbreak. At that conference, Morse 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, 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, and Anthony Sanchez. With other institutions: David Huxsoll, Dr Joseph B. McCormick, 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 MacDonald as well as 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.

MAIN CHARACTERS

In order of appearance. Military rank given as of the time of the Reston event.

‘Charles Monet’. A French expatriate living in western Kenya. In January 1980, he explodes with Marburg virus while travelling on an aeroplane.

Lieutenant Colonel Nancy Jaax. Veterinary pathologist at USAMRIID. Begins working with Ebola virus in 1983, when she gets a hole in her space-suit glove. Becomes chief of pathology at USAMRIID in 1989 and that year becomes a player in the Reston biohazard operation.

Colonel Gerald (‘Jerry’) Jaax. Chief of the veterinary division at USAMRIID. Married to Nancy Jaax. Has never worn a biological space suit but becomes the mission leader of the space-suited SWAT team during the Reston biohazard operation.

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. Veterinary surgeon at the Reston Primate Quarantine Unit (the Reston monkey house).

Peter Jahrling. Civilian Army virologist. Co-discoverer of the strain of virus that burns through the Reston monkey house.

Thomas W. Geisbert. Technician at USAMRIID. In the autumn of 1989, is responsible for the operation of USAMRIID’s electron microscope. Co-discoverer 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. Head of the US Army Medical R & D Command. Gives the orders to send biohazard troops to Reston.

Dr Joseph B. McCormick. Chief of the Special Pathogens Branch of the CDC. Treated human Ebola patients in a hut in Sudan, where he stuck himself with a bloody needle.

Robin MacDonald. Guide and professional hunter in East Africa. In the summer of 1993, takes the author to Kitum Cave.

TO FREDERIC DELANO GRANT JR,

admired by all who know him

 

 

 

The author gratefully acknowledges a research grant from the Alfred P. Sloan Foundation.

The Hot Zone

Richard Preston

TO THE READER

This book is non-fiction. The story is true, and the people are real. I have occasionally changed the names of characters, including the names of ‘Charles Monet’ and ‘Peter Cardinal’. When I have changed a name, I state so in the text.

The dialogue is reconstructed from the recollections of the participants. At certain moments in the story, I describe the stream of a person’s thoughts. In such instances, I am basing my narrative on interviews with the subjects in which they have recalled their thoughts, often repeatedly, followed by fact-checking sessions in which the subjects confirmed their recollections. If you ask a person, ‘What were you thinking?’ you may get an answer that is richer and more revealing of the human condition than any stream of thoughts a novelist could invent. I try to see through people’s faces into their minds and listen through their words into their lives, and what I find there is beyond imagining.

RICHARD PRESTON

This book describes events between 1967 and 1993. The incubation period of the viruses in this book is less than twenty-four days. No-one who suffered from any of the viruses or who was in contact with anyone suffering from them can catch or spread the viruses outside of the incubation period. None of the living people referred to in this book, whether under their actual names or under fictional names, suffer from a contagious disease. The viruses cannot survive independently for more than ten days unless they are preserved and frozen with special procedures and laboratory equipment. Thus none of the locations in Reston and in the Washington DC area described in this book are infective or dangerous.

GLOSSARY

amplification. Multiplication of a virus through either (1) the body of an individual host or (2) a population of hosts; extreme amplification: multiplication of a virus everywhere in a host, partly transforming the host into virus.

brick (military slang). Pure crystallike block of packed virus particles that grow 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 haemorrhages from the orifices of the body.

crystalloid. Author’s own term. See brick.

decon (military slang). To decontaminate; decontamination.

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

electron microscope. Large and very powerful microscope which 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 the 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.

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

grey area; grey 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 travelled during its breakout from the central African rain forest. The road links Kinshasa, in Zaïre, 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 Zaïre in 1976.

microbreak. Author’s own term. Small, sometimes 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 haemorrhagic 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 afterwards.

stretched rabies. See Marburg virus.

Submarine (military slang). The Biosafety Level 4 morgue at USAMRIID.

third spacing. Massive haemorrhagic 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.

INDEX

The page references in this index correspond to the printed edition from which this ebook was created. To find a specific word or phrase from the index, please use the search feature of your ebook reader.

Introductory note: Alphabetization is letter by letter. Page numbers referring to illustrations are in bold.

The following abbreviations are used in order to save space: RPQU = Reston Primate Quarantine Unit (the ‘monkey house’) USAMRIID = United States Army Medical Research Institute of Infectious Diseases (at Fort Detrick).

AIDS 36; Kansensero 67; method of travel 85, 113, 339–49, 265–6; mutation 349–50; natural process of clearance 367; origin 67–8, 227–8, 349–50, 365–6; prostitution and 344; simian 350

airborne virus see Ebola virus (general)

agonal biopsy 124

Amen, Sgt. Thomas 251, 290, 306, 319

amplification of virus, extreme 47–8 116, 225

Andembe, Herman 347

Andromeda strain (fictional) 129, 322

animal caretakers 289; Coleus, J. 326–8; Gibson, M. 251, 320–1; Purdy, J. 224–5, 249, 276, 328

animal-care technicians, Army 285, 286–301, 320

antibiotics 45

Army involvement, US, Hazelton Washington 280; Peters, Col. C.J. 226–7, 239–41, 246–7; political problem 214–15; resistance from Dan Dalgard 218–19; Reston PQU 284–6; see also biohazard operation

autopsy of Ebola monkeys 99, 102–3, 237–8, 275, 276

 

Bacillus subtilis niger 323–4

Bagshawe, Dr Antonia 56–7

bats, Kitum Cave 41–2, 43, 359–60; Nzara 110

batteries in space suits 297–8

Behring Works 59–60

Berke, Nicole 289–90

biocontainment areas 80, 96, 104, 196

biocontainment of Ebola virus 213

biocontainment pod (bubble stretcher) 266

biohazard 209, 211–16; conference at Fort Detrick 239–45; legal aspect 215, 218, 229; planning operation 247–8, 251

biohazard operation, RPQU 263–313; see also decontamination at RPQU

biological warfare 79–80, 333

biosafety levels see under Level 0, 2, 3, 4

Black Death 328–9

bleeding out (haemorrhage) 50, 51, 96, 116

blood clotting 47, 57, 117–18

blood testing for Ebola virus 200, 204, 311

Boniface test 204

brain, effect on; Ebola 111–12, 118; Marburg 62–3

Breman, Joel 130–3

Buchanan, Jamy 347

Buente, Reed 162

Bumba (Zaïre) 113, 116, 123–4, 131

 

Cape buffalo 39, 41, 342, 351, 353, 356

‘Cardinal, Peter’ 137–47, 177, 188, 361

Cardinal strain of Marburg virus 143, 188, 196

caretakers, animal see animal caretakers

Centers for Disease Control (CDC) 57, 124, 126, 128, 214–15; biohazard conference 239–40, 244–5; Ebola genes experiment 333–6; Ferlite Farms 322; Hazelton Washington 280–1; restrictions on monkey importers 331

Charles River Primates Corporation 331

Chege, Katana 347

Chemturion biological space suit 90, 150, 171

Cherangani Hills 344

Chikungunya 366

chimpanzees 350

clothing, protective 89–92, 98–9, 235–6, 268, 356–7; see also under trade names

Coleus, John 326–7, 328

‘common cold’ appearance of Ebola 326, 329

conference, biohazard 239–45

Congo River 116, 123, 130, 131, 135

cotton factory 110

‘crash and bleed out’ 51, 96, 116, 143

Crimean-Congo virus 366

crocodiles, fly-fishing for 352

crystalloid see inclusion body

 

Dalgard, Dr Dan; biohazard conference 217–19, 239–45; biohazard operation 248–50, 251, 272, 284, 325; examines dead monkeys 164–9, 173–5, 183–4; Frantig, M. 277–81; Jahrling, P. 170–2, 202–3; liaises with Army 223–7; Reston PQU, duties at 158–9, Room H at 253, 255, 272–4; risk from Marburg 197, 199; Volt, Bill 173

decontamination procedure 103–6, 314–24

Delamere, Diana Lady 58

dengue virus 366

Denny, Captain Steven 251, 273, 275, 295

diamond knife, use of 185–6

disinfection procedure 323; see also decontamination

DNA 100

Dunn, Curtis 181, 257, 259, 314–19

Dunn, Mamie 317–18

Duvenhage virus 366

 

Ebola monkeys 80–1, 95–99, 102–3, 107–8, 206, 327

Ebola Reston virus 326, 327–9; discoverers of 331–2; genes of 333–6; origin 336; return, possible 369; virus particles 335

Ebola River 82, 109, 113, 132

Ebola Sudan virus 61, 110, 112–13, 204, 241–3, 366

Ebola virus (general) 61, 80–1, 84–7, 204; airborne 108, 211–12, 244, 289, 328; characteristics 116–20, 218, 228, 285; discovery 125–7; implications of site (Washington) 209, 217, 227, 325; multiplication 119–20, 228; survivors, human 328–9; test for 204–6, 207–8, 244, 303

Ebola Zaïre virus 61–2, 82–3, 113–20; cells shown to author 330; first known case 115; Mayinga strain 95–6, 204–11; test for 204–6; virus particles 334

Eldoret 38

electron microscope 125, 176–7, 180, 187–9, 216

elephants in Kitum Cave 41, 42–3, 355–6, 359, 361

Elgon, Mount 35–40, 339–40, 342–5, 351–65

Endebess Bluff 38

Entebbe 64, 66

EnviroChem 99, 104, 208, 238, 319

Environmental Protection Agency 218

E.R., Sister 121

euthanasia of monkeys 251–6, 293–6, 308–9, 319

 

Fairfax Hospital 281, 282

Ferlite Farms, Manila 159,165, 166, 322, 325

filovirus, behaviour 180; description 61; discovery near Washington 210; see also Ebolas Reston, Sudan and Zaïre, also Marburg

Flying Doctors (Kenya) 139, 344

Fort Detrick see USAMRIID

Frantig, Milton 277–9, 280–2, 303, 321, 328

 

Geisbert, Thomas, Coleus, J. 327; discoverer of Ebola Reston 331; infection risk 207,309–10; Jahrling, P. 192–3, 197; Marburg experiment 360; Monkey 053 201–2; ‘whiffing’ incident 189,322; USAMRIID work 176–80, 185–91

Germany 59–66, 203

Gibson, Merhl 251, 320, 321

Godwin, Charlotte 292–3, 295–6, 298–300

Grant, Frederic 347–8,357–8,363, 365

Greek River 66

Guanarito virus 366

 

Haines, Captain Mark 251, 267–9, 271–2, 292, 295, 308–9

haemorrhage 117–19, 135; see also bleeding out and ‘third spacing’

hantavirus 367

Hazelton Research Products 158–9, 325–6, 331

Hazelton Washington 158, 223; workers 254, 271, 279–80, 315

Hill, Captain Elizabeth 267–8

HIV 36,68,86,345,350, 366

‘hot agent’ 36, 142–3

hunting in East Africa 342

Huxsoll, Colonel David 209

hypodermic needles infection 115, 226, 292, 300–1

 

inclusion bodies 190, 193, 214, 330

injection technique for monkeys 274–5, 293–4

Institute of Chemical Defense 153

Isaäcson, Dr Margaretha 134–5

 

Jaax, Ada 182–3

Jaax, Colonel Gerald (‘Jerry’), Army duties 72, 87, 153–4; biohazard operation 246–7, 251–2, 267–9, 271–2, 288–91, 294–5, 301; brother (John) 162–3; home 74–6, 181–3, 257–9

Jaax, Jaime 72, 78–9, 153, 181–3, 258

Jaax, Jason 72,78–9, 153, 181–3, 258

Jaax, John 162–3, 182

Jaax, Colonel Nancy, Ebola

pathologist 87–107, 211–14, 219–21; Hazelton Washington 254–6; home 71–7, 181–3, 219–21, 258–9, 269–70, 301–2; RPQU 225–7, 231–3, 270–1, 272–4, 329–31; USAMRIID 78–82, 87–107, 211–14, 219–20, 234–8, 274–6

Jahrling, Peter, biohazard conference 239–45; biohazard operation 309–12; career 170–1; Ebola Reston virus 332; Geisbert, Thomas 179–80, 192–3, 197, 199–200, 202–6; Monkey 053 171–3, 183; notifies chain of conunand 192–3, 195–7; Peters, Col. C.J. 207–11; today 331–2; ‘whiffing’ incident 212, 321–2, 331–2

‘Johnnie’ (Charles Monet’s housekeeper) 37, 44

Johns Hopkins University 83

Johnson, Colonel Anthony 87–8, 89–93, 94–5,97–9, 102–5, 153–4

Johnson, Eugene (‘Gene’), airborne Ebola virus 212; biohazard operation 263–4, 286–8, 297–301, 319–20; ‘Cardinal, Peter’ 137–9, 142–4, 145–53; criticism of 212, 241; RPQU 225, 226, 229–31, 247–8, 253–4; work, Ebola and Marburg virus 80–1,83–5,86; Mayinga strain 96, 107–8; thread viruses 204

Johnson, Dr Karl M. 124–5, 126–9, 135–6, 239–40

Jomo Kenyatta International Airport 49

‘Jones, Mr’ (veterinary surgeon) 63–6

Junin virus 366

 

Kansas City Homocide 162, 163

Kansensero 67

Kenya Airways 45, 48

Kenya Medical Research Institute 144, 147

Ketamine (anaesthetic) 275, 293, 309

Kinshasa 116, 121, 123, 129, 134

Kinshasa Highway 36,339,345, 348

Kisumu 45, 139, 145

Kitale 349

Kitum Cave 41–4, 144, 146–52, 229, 241, 248, 287, 352–65

Klages, Sgt. Curtis 251–3, 273, 319–20

Klaus, F. 60

Kyasanur Forest brain virus 366

Kziasek, Thomas 303

 

Lake Victoria 36, 45, 65, 66–7, 68

lassa fever 171, 366

LeDantec virus 366

Level o, biosafety 80

Level 2, biosafety 36, 89

Level 3, biosafety 149, 172

Level 4, biosafety 36,37,78, 189, 248; biocontainment area (AA–5) 80, 87, 90–1,94–5,96–9, 149

Lofler, Dr Imre 56

lung involvement in Ebola virus 330–1, 333

Luo people 340

 

Machupo virus 227, 366

Mama Yemo Hospital, Kinshasa 121

Manila 159, 322

Marburg virus, ‘Cardinal, Peter’ 142–3;

description 59–70; disappearance 137; Johnson, Eugene 80,83; Kitum Cave 149–50,359–60; multiplication 120; RPQU 188–91, 193, 196, 202–4; test for 204, 207–8; transmission by aerosol route 146

Maridi 111

Markham, Beryl 58–9

Masai, Mount Elgon 39, 151, 152, 342–3

Mayinga, N. (nurse) 95–6, 121–3, 125, 134–5, 322

Mayinga strain of Ebola Zaïre virus 95–6, 204, 206, 207, 322

M.E., Sister 116, 120–1, 124

media reporting, Reston PQU 252, 254, 282, 299–300; television 258; Washington Post 264–5, 307

Moi, Daniel arap 58

Mobutu Sese Seko 123

Mokola virus 366

Mombasa 43, 139

‘Monet, Charles’ 35–55, 68–9, 140, 144

monkey house see Reston Primate Quarantine Unit (RPQU)

Monkey 053 169, 172, 200

monkeys: African green 59, 148; AIDS, source of 67, 350; Colobus 40; crab-eating 159–61, 325; Ebolainfected 80–1, 213, 270–1; euthanasia of 251–6, 290–6; Kitum Cave Expedition 147–8, 151–2; Marburginfected 63–6; ‘Monet, Charles’ 36, 39; RPQU 158–69, 196, 213, 235, 283; running loose 304–8,319; soot mangabey 349; trapping of 63

monkeypox 366

Mount Elgon Lodge 148–9

Mulatya, Morris 347, 351

Murphy, Frederick A. 125–6, 216–17, 239, 245

Musoke, Dr Shem 52–7,59, 68–9, 139–40, 204

mutation of AIDS 350

mutation of Ebola virus 328–9, 330–1

McCormick, Dr Joseph B. 239–45, 254–5, 281–2, 367

MacDonald, Carrie 347, 348, 351

MacDonald, Iain 342

MacDonald, Robin 341–4, 351–3, 364–5

 

Nairobi Hospital 45,49–52,68–9, 138

National Institute for Virology (South Africa) 57

necropsy 295, 296

Ngaliema Hospital, Zaïre 121, 123, 124

91-T (91 Tangos) see animal care technicians, Army

Nixon, Richard M. 80

Nzara 109–10, 111

Nzoia River 35

Nzoia Sugar Factory 35

 

Obangui River 114

Okuku, Polycarp 352, 353

O’nyong nyong virus 366

Oropouche virus 366

 

parainfluenza virus 85

Pasteur, Louis (quotation) 152–3, 248

Peters, Colonel C.J., biohazard conference 239–41,246–7; biohazard operation 265, 281–2, 284–6; career and character 193–6; chain of command 208–13, 218–19, 223; Hazelton Washington 254–5; media 264–5, 307; RPQU 194–8, 202, 225–33, 234; today 332–3

P.G. (man in Nzara) 110–11

plague see Black Death

pneumonia virus 85

postmortem see autopsy

Powell, Major Nathanial 251, 295

prostitution and AIDS 344

proteins in Ebola virus particle 85–6, 116–17

public health hazard 202, 217, 285

pseudomonas bacterium 179

Purdy, Jarvis 224, 225, 249, 276, 328

 

quarantine 331

Q virus 366

 

Racal space suits 150, 151, 268, 270, 290

radio reporting see media reporting rain forest 38–41, 353–5; petrified 42, 361

rapid Elisa test 303

rash, skin 117

Redmond, Ian 358–9

respiratory syncytial virus 85

Reston Primate Quarantine Unit (RPQU), author’s visit 368–9; electron microscopy results 188–97, 216–17; euthanasia of monkeys 251–6,293–6,307–9, 319;

importation of monkeys 158–62, 325;

monkey deaths 162–4, 167, 168–9, 173; autopsies 164–9, 174–5, 225–6; sterilization by Army 284–6; vacated 331; see also biohazard operation and decontamination

Reston strain see Ebola Reston

Reston, Virginia 157–8, 196

Rhoderick, Joan 172–3, 178

Rift Valley, Kenya 35, 46, 49, 339, 344, 345

Rift Valley virus 366

RNA 100, 101, 127

Rocio virus 366

Rompun (sedative) 275

Russell, Major General Philip K. 209–17,239,284, 328

 

salt, animal need for 355–6

São Paulo virus 366

Semliki Forest virus 366

Sese Islands (Lake Victoria) 67

Silverstein, Dr David 57–9, 68–9, 140, 142, 145

simian haemorrhagic fever (SHF) 166, 170, 174, 177–8, 183, 202, 250

Sindibis virus 366

‘Slammer’ (biocontainment hospital) 104, 198–9

speleogenesis 359

sterilization of RPQU 284–6

‘Submarine’ (biocontainment morgue) 104

Sudan 109–13

sugar-cane and factory 35–7, 43–4

Sunbeam electric frying pans 323–4

survivors of Ebola virus, human 328–9

SWAT (biohazard team) 215, 229

 

T–61 (euthanasia agent) 275, 295

television reporting see media reporting

‘third spacing’ 140–1

thread virus see filovirus

Trapane, Mrs 79, 105

tribal warfare 342–3, 351

Trotter, Colonel R. 234–8, 276

Tukei, Dr Peter 144, 145, 147

Tyvek fabric (protective clothing) 277, 356, 364

 

Uganda 65, 66, 67–8

University Hospital, Kinshasa 122

United States Army Medical Research Institute of Infectious Diseases (USAMRIID) 79–80, 83; biohazard conference 239–45; chain of command 209–19; Monkey 053 172–3; problem announced 170; see also Army involvement

 

vaccines, protective 79–80

VEE virus 366

virus see under individual names

virus structure 100–1, 237, 366–8

Volt, Bill 164–6, 173, 203, 224, 231–3, 252–3, 279

 

Washington Post 264–5

Weaver, John 163

Webb, Patricia 125–6

Williams, Rhonda 297–300, 305, 308–9, 312–13

World Health Organization (WHO) 63, 65, 123, 128, 130

Worldwide Primates 331

 

Yambuku Mission Hospital (Zaïre) 114–16, 132–6

Yu. G.,Mr 109–11

 

Zaïre 86; Bumba Zone 113, 116, 123–4, 130–6; Yambuku Mission Hospital 115–16, 132–6

Zande tribe 109–10

PART ONE

The Shadow of Mount Elgon

PART TWO

The Monkey House

PART THREE

Smashdown

PART FOUR

Kitum Cave

Some people think I’m being hysterical, but there are catastrophes ahead.

—JOSHUA LEDERBERG

SOMETHING IN THE FOREST

New Year’s Day 1980

CHARLES MONET WAS a loner. He was a Frenchman who lived by himself in a little wooden bungalow on the private lands of the Nzoia Sugar Factory, a plantation in western Kenya that spread along the Nzoia River within sight of Mount Elgon, a huge, solitary, extinct volcano that rises to a height of 14,000 feet near the edge of the Rift Valley. It is not clear what brought Monet to Africa. As with many expatriates who end up there, his history seems a little obscure. Perhaps he had been in some kind of trouble in France, or perhaps he had been drawn to Kenya by the beauty of the country. He was an amateur naturalist, fond of birds and animals but not of humanity in general. He was fifty-six years old, of medium height and medium build, with smooth, straight, brown hair; a good-looking man. It seems that his only close friends were women who lived in towns around the mountain, yet even they could not recall much about him for the doctors who investigated his death. His job was to take care of the sugar factory’s water-pumping machinery, which drew water from the Nzoia River and delivered it to many miles of sugar-cane fields. They say that he spent most of his day inside the pump house by the river, as if it pleased him to watch and listen to machines doing their work.

So often in a case like this, it’s hard to pin down the details. The doctors remember the clinical signs, because no-one who has seen the effects of a Biosafety Level 4 hot agent on a human being can ever forget them, but the effects pile up, one after the other, until they obliterate the person beneath them. The case of Charles Monet emerges in a cold geometry of clinical fact mixed with flashes of horror so brilliant and disturbing that we draw back and blink, as if we are staring into a discoloured alien sun.

Monet came into the country in the summer of 1979, around the time that the human immuno-deficiency virus, or HIV, which causes AIDS, made its final break-out from the rain forests of central Africa and began its long burn through the human race. AIDS had already fallen like a shadow over the population of central Africa, although no-one yet knew it existed. It had been spreading quietly along the Kinshasa Highway, a transcontinental road that crosses Africa from east to west and passes along the shores of Lake Victoria within sight of Mount Elgon. HIV is a highly lethal but not very infective Biosafety Level 2 agent. It does not travel easily from person to person, and it does not travel through the air. You don’t need to wear a biological space suit while handling blood infected with HIV.

Monet worked hard in the pump house during the week, and during weekends and holidays he would visit forested areas near the sugar factory. He would take food with him, and he would scatter it around and watch while birds and animals ate it. He could sit in perfect stillness while he observed an animal. People who knew him recalled that he was affectionate with wild monkeys, that he had a special way with them. They said that he would sit holding a piece of food while a monkey approached him, and the animal would eat from his hand.

In the evenings, he kept to himself in his bungalow. He had a housekeeper, a woman named Johnnie, who cleaned up and prepared his meals. He was teaching himself how to identify African birds. A colony of weaver-birds lived in a tree near his house, and he spent time watching them build and maintain their baglike nests. They say that one day near Christmas he carried a sick bird into his house, where it died, perhaps in his hands. The bird may have been a weaverbird – no-one knows – and it may have died of a Level 4 virus – no-one knows. He also had a friendship with a crow. It was a pied crow, a black-and-white bird that people in Africa sometimes have as pets. This crow was a friendly, intelligent bird which liked to perch on the roof of Monet’s bungalow and watch his comings and goings. When the crow was hungry, it would land on the veranda and walk indoors, and Monet would feed it scraps of food from his table.

He walked to work every morning through the cane fields, a journey of two miles. That Christmas season, the sugar workers had been burning the fields, and so the fields were scorched and black. To the north across the charred landscape, twenty-five miles away, he could see the twin peaks of Mount Elgon. The mountain displayed a constantly changing face of weather and shadow, rain and sun, a spectacle of African light. At dawn, Mount Elgon appeared as a slumped pile of grey ridges receding into haze, culminating in a summit with two peaks, which are the opposed lips of the eroded cone. As the sun came up, the mountain turned silvery green, the colour of the Mount Elgon rain forest, and as the day progressed, clouds appeared and hid the mountain from view. Late in the afternoon, near sunset, the clouds thickened and boiled up into an anvil thunderhead that flickered with silent lightning. The bottom of the cloud was the colour of charcoal, and the top of the cloud feathered out against the upper air and glowed a dull orange, illuminated by the setting sun, and above the cloud the sky was deep blue and sparkled with a few tropical stars.

He had a number of women friends who lived in the town of Eldoret, to the south-east of the mountain, where the people are poor and live in shacks made of boards and metal. He gave money to his women friends, and they, in return, were happy to love him. When his Christmas vacation arrived, he formed a plan to go camping on Mount Elgon, and he invited one of the women from Eldoret to accompany him. No-one seems to remember her name.

Monet and his friend drove in a Land Rover up the long, straight red-dirt road that leads to Endebess Bluff, a prominent cliff on the eastern side of the volcano. The road was volcanic dust, as red as dried blood. They climbed onto the lower skirts of the volcano and went through cornfields and coffee plantations, which gave way to grazing land, and the road passed old, half-ruined English colonial farms hidden behind lines of blue-gum trees. The air grew cool as they went higher, and crested eagles flapped out of cedar trees. Not many tourists visit Mount Elgon, so Monet and his friend were probably driving the only vehicle on the road, although there would have been crowds of people walking on foot, villagers who cultivate small farms on the lower slopes of the mountain. They approached the frayed outer edge of the Mount Elgon rain forest, passing by fingers and islands of trees, and they passed the Mount Elgon Lodge, an English inn built in the earlier part of the century, now falling into disrepair, its walls cracked and its paint peeling off in the sun and rain.

Mount Elgon straddles the border between Uganda and Kenya and is not far from Sudan. The mountain is a biological island of rain forest in the centre of Africa, an isolated world rising above dry plains, fifty miles across, blanketed with trees, bamboo, and alpine moor. It is a knob in the backbone of central Africa. The volcano grew up seven to ten million years ago, producing fierce eruptions and explosions of ash, which repeatedly wiped out the forests that grew on its slopes, until it attained a tremendous height. Before Mount Elgon was eroded down, it may have been the highest mountain in Africa, higher than Kilimanjaro is today. It is still the widest. When the sun rises, it throws the shadow of Mount Elgon westward and deep into Uganda, and when the sun sets, the shadow reaches eastwards across Kenya. Within the shadow of Mount Elgon lie villages and cities inhabited by the Elgon Masai, a pastoral people who came from the north and settled around the mountain some centuries ago, and who breed cattle. The lower slopes of the mountain are washed with gentle rains, and the air remains cool and fresh, and the volcanic soil produces rich crops of corn. The villages form a ring of human settlement around the volcano, and the ring is steadily closing around the forest on its slopes, a noose that is strangling the ecosystem of the mountain. The forest is being cleared away, the trees are being cut down for firewood or to make room for grazing land, and the elephants are vanishing.

A small part of Mount Elgon is a national park. Monet and his friend stopped at the park gate to pay their entrance fees. A monkey or perhaps a baboon – no-one seems to remember – used to hang out around the gate, looking for handouts, and Monet enticed the animal to sit on his shoulder by offering it a banana. His friend laughed, but they stayed perfectly still while the animal ate. They drove a short way up the mountain and pitched their tent in an open clearing of moist green grass that sloped down to a stream. The stream gurgled out of the forest, and it was a strange colour, milky with volcanic dust. The grass was kept short by Cape buffalo grazing it, and was spotted with their dung.

The Elgon rain forest towered around their campsite, a web of gnarled African olive trees hung with moss and creepers and dotted with an olive that is poisonous to humans. They heard a scuffle of monkeys, a hum of insects. Flocks of olive pigeons burst from the trees on swift downward slants, flying at terrific speed, which is their strategy to escape from harrier hawks, which can dive on them and rip them apart on the wing. There were camphor trees and teaks and African cedars and red stinkwood trees, and here and there a dark green cloud of leaves mushroomed above the forest canopy. These were the crowns of podocarpus tress, or podos, the largest trees in Africa, nearly as large as a California sequoia. There were thousands of elephants on the mountain, then, and they could be heard moving through the forest, making cracking sounds as they peeled bark and broke limbs from trees. Colobus monkeys scuttled across the meadow near the tent, watching them with alert, intelligent eyes.

In the afternoon, it would have rained, as it usually does on Mount Elgon, and so they would have stayed in their tent, and perhaps they made love while a thunderstorm hammered the canvas. It grew dark; the rain tapered off. They built a fire and cooked a meal. It was New Year’s Eve. Perhaps they celebrated, drinking champagne. The clouds would have cleared off in a few hours, as they usually do, and the volcano would have emerged as a black shadow under the Milky Way. Perhaps Monet stood on the grass at the stroke of midnight and looked at the stars – neck bent backwards, unsteady on his feet from the champagne.

On New Year’s morning, sometime after breakfast – a cold morning, air temperature in the forties, the grass wet and cold – Monet and his friend drove up the mountain along a muddy track and parked in a small valley below Kitum Cave.

They bushwhacked up the valley toward Kitum Cave, following elephant trails that meandered beside a little stream that ran through stands of olive trees and grassy meadows. They kept an eye out for Cape buffalo, a dangerous animal to encounter in the forest. The cave opened at the head of the valley, and the stream cascaded over its mouth. The elephant trails joined at the entrance and headed inside. Monet and his friend spent the whole of New Year’s Day there. It probably rained, and so they would have sat in the entrance for hours while the little stream poured down in a veil. Looking across the valley, they watched for Cape buffalo and waterbuck, and they saw rock hyraxes – furry animals the size of groundhogs – running up and down the boulders near the mouth of the cave.

They also watched for elephants. Herds of elephants go inside Kitum Cave at night to obtain minerals and salts. On the plains, it is easy for elephants to find salt in hardpans and dry water holes, but in the rain forest salt is a precious thing. The cave is large enough to hold as many as seventy elephants at a time. They spend the night inside the cave, dozing on their feet or mining the rock with their tusks. They pry and gouge rocks off the walls, and chew them to fragments between their teeth, and swallow the broken bits of rock. Elephant dung around the cave is full of crumbled rock.

Monet and his friend had flashlights, and they walked back into the cave to see where it went. The mouth of the cave is huge – fifty-five yards wide – and it opens out even wider beyond the entrance. They crossed a platform covered with powdery dry elephant dung, their feet kicking up puffs of dust as they advanced. The light grew dim, and the floor of the cave rose upwards in a series of shelves coated with green slime. The slime was bat guano, digested vegetable matter that had been excreted by a colony of fruit bats on the ceiling.

Bats whirred out of holes and flicked through their flashlight beams, dodging around their heads, making high-pitched cries. Their flashlights disturbed the bats, and more bats woke up. Hundreds of bat eyes, like red jewels, looked down on them from the ceiling of the cave. Waves of bat sound rippled across the ceiling and echoed back and forth, a dry, squeaky sound, like many small doors being opened on dry hinges. Then they saw the most wonderful thing about Kitum Cave. The cave was a petrified rain forest. Mineralized logs stuck out of the walls and ceiling. They were trunks of rain-forest trees turned to stone – teaks, podo trees, evergreens. An eruption of Mount Elgon about seven million years ago had buried the rain forest in ash, and the logs had been transformed into opal and chert. The logs were surrounded by crystals, white needles of minerals that had grown out of the rock. The crystals were as sharp as hypodermic syringes, and they glittered in the beams of the flashlights.

Monet and his friend wandered through the cave, shining their lights on the petrified rain forest. Did he run his hands over the stone trees and prick his finger on a crystal? They found petrified bones sticking out of the ceiling and walls. Bones of crocodiles, bones of ancient hippos and ancestors of elephants. There were spiders hanging in webs among the logs. The spiders were eating moths and insects.

They came to a gentle rise, where the main chamber widened to more than a hundred yards across – wider than the length of a football field. They found a crevice, and shone their lights down to the bottom. There was something strange down there – a mass of grey and brownish material. It was the mummified corpses of baby elephants. When elephants walked through the cave at night, they navigated by their sense of touch, probing the floor ahead of them with the tips of their trunks. The babies sometimes fell into the crevice.

Monet and his friend continued deeper into the cave, descending a slope, until they came to a pillar that seemed to support the roof. The pillar was scored with hatch marks and grooves, the marks of elephant tusks – the elephants had been tusking out the rock around the pillar, scraping at it, and chewing the rock to extract the salts. If the elephants continued to dig away at the base of the pillar, it might eventually collapse, bringing down the roof of Kitum Cave with it. At the back of the cave, they found another pillar. This one was broken. Over it hung a velvety mass of bats, which had fouled the pillar with black guano – a different kind of guano from the green slime near the mouth of the cave. These bats were insect eaters, and the guano was an ooze of digested insects. Did Monet put his hand in the ooze? Investigators who studied the case considered the possibility that he and his friend took off their clothes and made love, but the investigators were never able to determine whether this happened. If he removed his clothes inside the cave, he would have exposed a large amount of his skin.

The woman dropped out of sight for several years after that trip to Mount Elgon with Charles Monet. Then, unexpectedly, she surfaced in a bar in Mombasa, where she was working as a prostitute. A Kenyan doctor who had investigated the Monet case happened to be drinking a beer in the bar, and he struck up an idle conversation with her and mentioned Monet’s name. He was stunned when she said, ‘I know about that. I come from western Kenya. I was the woman with Charles Monet.’ He didn’t believe her, but she told him the story in enough detail that he became convinced she was telling the truth. She vanished after that meeting in the bar, lost in the warrens of Mombasa, and by now she has probably died of AIDS.

Charles Monet returned to his job at the pump house at the sugar factory. He walked to work each day across the burned cane fields, no doubt admiring the view of Mount Elgon, and when the mountain was buried in clouds, perhaps he could still feel its pull, like the gravity of an invisible planet. Meanwhile, something was making copies of itself inside Monet. A life form had acquired Charles Monet as a host, and it was replicating.

The headache begins, typically, on the seventh day after exposure to the agent. On the seventh day after his New Year’s visit to Kitum Cave – 8 January 1980 – Monet felt a throbbing pain behind his eyeballs. He decided to stay home from work and went to bed in his bungalow. The headache grew worse. His eyeballs ached, and then his temples began to ache, the pain seeming to circle around inside his head. It would not go away with aspirin, and then he got a severe backache. His housekeeper, Johnnie, was still taking her Christmas holiday, and he had recently hired a temporary housekeeper. She tried to take care of him, but she really didn’t know what to do. Then, on the third day after his headache started, he became nauseous, spiked a fever, and began to vomit. His vomiting grew intense and turned into dry heaves. At the same time, he became strangely passive. His face lost all appearance of life and set itself into an expressionless mask, with the eyeballs fixed, paralytic, and staring. The eyelids were slightly droopy, which gave him a peculiar appearance, as if his eyes were popping out of his head and half-closed at the same time. The eyeballs themselves seemed almost frozen in their sockets, and they turned bright red. The skin of his face turned yellowish and began to resemble Limburger cheese, with brilliant starlike red speckles. He began to look like a zombie. His appearance frightened the temporary housekeeper. She didn’t understand the transformation in this man. His personality changed. He became sullen, resentful, angry, and his memory seemed to be blown away. He was not delirious. He could answer questions, although he didn’t seem to know exactly where he was. He acted as if he had had a mild stroke.

When Monet failed to show up for work, his colleagues began to wonder about him, and eventually they went to his bungalow to see if he was all right. The black-and-white crow sat on the roof and watched them as they went inside. They looked at Monet and decided that he needed to get to a hospital. Since he was very unwell and could no longer drive a car, one of his colleagues drove him to a private hospital in the city of Kisumu, on the shore of Lake Victoria. The doctors at the hospital examined Monet, and could not come up with any explanation for what had happened to his eyes or his face or his mind. Thinking that he might have some kind of bacterial infection, they gave him injections of antibiotics, but the antibiotics had no effect on his illness.

The doctors thought he should go to Nairobi Hospital, which is the best private hospital in East Africa. The telephone system hardly worked, and it did not seem worth the effort to call any doctors to tell them that he was coming. He could still walk, and he seemed able to travel by himself. He had money; he understood he had to get to Nairobi. They put him in a taxi to the airport, and he boarded a Kenya Airways flight.

A hot virus from the rain forest lives within a twenty-four-hour plane flight from every city on earth. All of the earth’s cities are connected by a web of airline routes. The web is a network. Once a virus hits the net, it can shoot anywhere in a day – Paris, Tokyo, New York, Los Angeles, wherever planes fly. Charles Monet and the life form inside him had entered the net.

The plane was a Fokker Friendship with propellers, a commuter aircraft that seats thirty-five people. It started its engines and took off over Lake Victoria, blue