Category: The Hot Zone

The Hote Zone traces the true events surrounding an outbreak of the Ebola virus at a monkey facility in Reston, Virginia in the late 1980s. In order to contextualize the danger posed by this outbreak, Preston provides background about several other viral outbreaks, particularly in Africa in the 1970s and 1980s. The result is a fast-paced scientific thriller that, while lacking the traditional narrative of a fictional work, is all the more terrifying because it describes factual events. While Preston does not overstate the danger of Ebola and other filoviruses, he argues that the greater threat lies in emerging viruses like the AIDS virus, whose effect on the human race cannot yet be measured.

The book begins in Kenya in 1980, where Preston describes the exposure and death of French expatriate Charles Monet due to the Marburg virus. Preston portrays Monet’s symptoms and bloody death in extreme detail, providing the reader with an immediate sense of the virus as a predator with the potential to decimate a large population. The author then provides background about the first outbreak of the Marburg virus in a vaccine factory in Marburg, Germany in 1967.

Over the next several chapters, the book describes outbreaks that occurred four years before Monet’s death. First, Preston highlights an outbreak of the Sudan strain of the Ebola virus, which first strikes a quiet storekeeper named Yu G. before spreading throughout his district. Then, the narrative shifts to an even more horrific outbreak of Ebola Zaire, which simultaneously appears in dozens of villages as the result of the use of dirty needles at a medical clinic. Both outbreaks cause hundreds of deaths, but Preston provides particular details about the death of one woman, a nurse named Mayinga N. who becomes infected with Ebola Zaire at the Ngalemia Hospital and spends two days in the capital city before being quarantined.

Amid the description of specific outbreaks and victims of the filoviruses, Preston also focuses on several American scientists and military personnel who spend their lives wearing space suits and researching hot agents. Despite the dangers surrounding these lethal viruses, the individuals strive to learn as much as possible, all in the hopes of eventually developing a vaccine or cure that will protect the human race. One of these scientists is Nancy Jaax, an army veterinarian and mother of two who specializes in hot agents at Fort Detrick in Maryland. During an experiment on Ebola in 1983, Jaax suffers a near exposure to Ebola after ripping her space suit in the middle of a dissection. Several years later, Jaax is asked to examine tissue samples from monkeys who are dying of an unknown virus at the Reston facility. When Jaax identifies the virus as a new strain of Ebola, the United States Army and the Centers for Disease Control coordinate a secret operation to contain the virus before it can spread to the human population.

While the Reston facility is marked as a “hot zone,” a SWAT team is tasked with entering the building, euthanizing hundreds of monkeys, and collecting blood and tissue samples for further study. The operation is rife with near disasters: one woman’s space suit malfunctions while she is in a contaminated room, an infected monkey escapes from its cage, and a scientist is nearly bitten by a monkey who is not properly sedated. Eventually, the team succeeds in killing all of the monkeys and completely decontaminating the facility. It is revealed the strain of Ebola, known as Ebola Reston, is deadly to monkeys but symptomless in humans.

At the end of the book, the author visits Kitum Cave, a tourist spot in Kenya that was visited by two victims of the Marburg virus before developing symptoms. An earlier scientific expedition to the cave had been unsuccessful in identifying the source of the virus. However, Preston decides to visit, not just to explore possible sources of the disease, but to stand in the spot where the story of The Hot Zone begins.

With the COVID-19 pandemic raging, I found myself looking through my bookshelves for a paperback copy of Richard Preston’s 1994 bestseller, The Hot Zone: A Terrifying True Story. It’s worth noting that one of the bio-disaster movies that everyone seems to want to watch these days is 1995’s Outbreak, with Dustin Hoffman and Renee Russo as government scientists trying to save the world from the fictitious “Motaba” virus. It was adapted from The Hot Zone.

The Hot Zone, though, is about a pair of deadly, and decidedly non-fictitious, “thread viruses” called Marburg and its better known, and even more virulent, sibling, Ebola. The book was not only a bestseller in what Preston described as the “dark biology” genre, but it changed how the world viewed pandemics, ramped up interest in bio-terrorism and led to major changes to public health policies. American Scientist called it one of the books that shaped science in the 20th century, along with Rachel Carson’s Silent Spring and The Autobiography of Charles Darwin.

I’m squeamish about medical stories of any kind, but I read this book in the mid-1990s because it had a reputation for being an inspired work of creative nonfiction. Today, I’m amazed I made it past a description, in the opening pages, of a French naturalist named Charles Monet ,who lived in western Kenya and was thought to be the first human victim of the Ebola virus: When a hot virus multiplies in a host, it can saturate the body with virus particles, from the brain to the skin. The military experts then say that the virus has undergone “extreme amplification.” This is not something like the common cold. By the time an extreme amplification peaks out, an eyedropper of the victim’s blood may contain a hundred million particles of virus. During this process, the body is partly transformed into virus particles. In other words, the host is possessed by a life form that is attempting to convert the host into itself. The transformation is not entirely successful, however, and the end result is a great deal of liquefying flesh mixed with virus, a kind of biological accident. Extreme amplification has occurred in Monet, and the sign of it is the black vomit.

I chose a relatively benign paragraph. The rest of this section is far more graphic. How graphic? When Stephen King was asked to blurb the book, he called the first chapter “one of the most horrifying things I’ve read in my whole life.”

The book was written a decade into the AIDS crisis. When a colony of African monkeys housed in a military facility in suburban Reston, Virginia, began dying, Preston describes a U.S. Army operation to wipe out the entire colony. It was a necessary action to spare the population in the greater Washington, D.C. area from a plague far worse than the Black Death of the Middle Ages.

It was a virus, Preston writes, that “does in ten days what it takes AIDS ten years to accomplish.” He also notes that a hot virus from the rain forest, like Ebola or Marburg, “lives within a 24-hour plane flight of every city on earth.” Based on what we know today of the origins of the coronavirus in China’s Wuhan province and how quickly it spread via international travellers, this proves just how prescient Preston could be.

Having taken a course called the Literature of Fact at Princeton, taught by the legendary creative nonfiction master, John McPhee, it’s not surprising how Preston vividly reconstructs scenes, like Charles Monet’s final days and the Army maneuver in Reston. He develops primary characters and allows readers inside the thoughts going through the minds of medical staff, scientists and soldiers. In a representative scene, a virologist named Tom Geisbert is looking at a slice of a dead monkey’s cell through an electron microscope:

His breath stopped. Wait a minute — there was something wrong with this cell. This cell was a mess. It wasn’t just dead — it had been destroyed. It was blown apart. And it was crawling with worms. The cell was wall-to-wall with worms. Some parts of the cell were so thick with virus they looked like buckets of rope. There was only one kind of virus that looked like rope. A filovirus. He thought, Marburg. Oh, no. This stuff looks like Marburg.

Preston is often guilty of injecting too much testosterone into his writing, as though he knows sensationalism sells. But in his descriptions of people and their thoughts, he’s very effective. Health workers stand at a non-gazetted crossing point in the Mirami village, near the Mpondwe border check point between Uganda and the Democratic Republic of Congo on June 14, 2019.

Presenting what people are thinking is considered controversial in journalism, but in an Author’s Note to The Hot Zone, Preston explains that he based these passages on interviews with his subjects where he asked them what they recalled thinking at that time, followed by fact-checking sessions to ask them to confirm their recollections. “If you ask a person `What were you thinking?’” he wrote, “you may get an answer that is richer and more revealing of the human condition than any stream of thoughts a novelist could invent.”

A novelist like Stephen King could have invented the Ebola virus. The first known outbreak was in Sudan in 1976, killing half of its victims. Two months later, an even deadlier strain hit Zaire, killing nine out of 10 people in several dozen villages. Zaire’s then-president, Mobutu Sese Seko, called out his army to seal off the entire zone of infected villages and ordered soldiers to shoot anyone trying to come out. But it was already loose and spreading, as Preston dramatically illustrated.

Since then, there have been other attacks on our vulnerable immune systems. H5N1, the Avian (or Bird) flu, mainly killed poultry, birds and waterfowl until 1997, when it suddenly infected 18 people in Hong Kong, killing six. It has flared up several times since then and scientists consider it a significant pandemic threat. From 2002-2004, SARS, a viral respiratory disease traced to horseshoe bats in China’s Yunnan province, and a coronavirus like Covid-19, infected more than 8,000 people from 29 countries and killed approximately 775. (Canada had 251 cases and 43 deaths.) In 2012, MERS (Middle East respiratory syndrome), another coronavirus, appeared. Although, it mainly affected countries in the Middle East with some travel-related cases recorded in Europe and the UK. It has been responsible for around 1,000 infections and 350 deaths. These numbers are part of what makes the magnitude of COVID-19 so staggering. As of this writing, there are nearly 1.4-million known infections in the world and 75,000 deaths, calculated since January 22.

To save ourselves we’ve retreated into our caves, an uncomfortable parallel to where the bats that spread COVID-19 live. It’s unsettling, especially when environments become too crowded for too long, or, if one lives alone, so solitary that it disturbs our mental health.

Just when you thought it was safe to ease out of your movie-theater seat and head home from a close encounter of the viral kind in Outbreak — wait. It turns out that Dustin Hoffman and Morgan Freeman haven’t even begun to tell the real story. For that you’ll have to go to Richard Preston’s riveting The Hot Zone, the book that started it all. Lurking beyond the bounds of Preston’s brilliant reportage are sobering, and compelling, questions about the nature of viruses and the research that is beginning to elucidate their mysteries.

When the U.S. Army, in a morning rush-hour maneuver, moved from Fort Detrick, Maryland, to a small suburban mall in Reston, Virginia, to wipe out a colony of sick African monkeys housed there, people in the greater Washington, D.C. area had no idea they were being saved from the threat of a plague far worse than the Black Death of the Middle Ages. The monkeys, imported for research, arrived infected with a mysterious rain-forest virus thought to be the deadliest ever known — a virus, Richard Preston writes, that ‘does in ten days what it takes AIDS ten years to accomplish.’ The Army’s secret assault on the virus in December 1989, and the history of several earlier outbreaks of such viruses in Africa and Germany, are narrated with chilling, graphic detail in The Hot Zone, a book not meant for readers with faint hearts or weak stomachs. There are paragraphs here that could of themselves produce cold sweats and shortness of breath.

Once you are infected with these viruses, Preston reports, vital organs such as your liver ‘begin to liquify,’ your skin ‘bubbles up’ into a rash ‘likened to tapioca pudding,’ and ‘you may weep blood.’ I will leave aside other details. His description of one emerging virus, however, will illustrate Preston’s way with words. Noting its ability to jump from one primate species to another, he writes, ‘It did not know boundaries. It did not know what humans are; or perhaps you could say that it knew only too well what humans are: it knew that humans are meat.’

The viruses Preston writes about belong to a small family of ‘thread viruses’ named Marburg and Ebola, seemingly primitive particles of RNA (genetic copying instructions) and proteins. Of Ebola’s seven proteins, three are vaguely understood and four are ‘completely unknown — their structure and their function is a mystery.’

Marburg first showed up in 1967 in a vaccine factory in Marburg, Germany, and was traced to cells from African green monkeys. Seven people died, a quarter of those infected. The first known Ebola outbreak was in Sudan in 1976. The virus spread rapidly from village to village, killing half of its victims. Two months later, an even deadlier strain of Ebola hit Zaire, erupting simultaneously in some 50 villages, killing nine out of ten people it infected. Zaire’s president, Mobutu Sese Seko, called out his army to seal off the Kinshasa hospital and the entire zone of infected villages, with orders to shoot anyone trying to come out.

Preston’s account makes these events unforgettable, tracing them back to individuals with names and faces and stories, not only the victims but the doctors and scientists willing to risk their own lives to treat and investigate these mysterious outbreaks. The book then focuses on the 1989 emergence of Ebola in the Reston, Virginia, monkey colony, and the Army’s attempts to identify and fight this most feared of ‘hot agents.’

Preston takes us inside the Army’s Medical Research Institute of Infectious Diseases at Fort Detrick, the labs that once developed biological warfare weapons and now search for new vaccines and seek to unravel the mysteries of lethal viruses like Ebola. To work with anything like Ebola, researchers must wear bulky biological space suits and go through elaborate safety and security precautions.

Yet the story Preston tells is full of accidents and misjudgments, and enough scientists and monkeyhandlers were exposed so that, had the virus really been the deadly strain of Ebola, a major plague might very well have been unleashed. In the end, the Reston Ebola proved fatal to monkeys but seemed to infect humans without any harm, although it is so nearly identical to the deadly Zaire virus that scientists still cannot see the difference. By the slenderest thread of some unknown molecular detail, this book reads like a prophecy instead of a postmortem.

Preston casts this story as a scientific thriller, which it is. And he writes in the manner of such popular novelists as Michael Crichton, Robin Cook and Stephen King, who have made the ‘strange virus outbreak’ into a literary convention of high-tech, neo-Gothic horror. As a result, this book is hard to put down, very scary, crammed with the detail that can make fiction seem real — or reality read like fiction: ‘She opened up the space suit and laid it down on the concrete floor and stepped into it, feet first. She pulled it up to her armpits and slid her arms into the sleeves until her fingers entered the gloves. The suit had brown rubber gloves that were attached by gaskets at the cuffs.’

The genre Preston has inherited from the fiction writers draws you in by amassing small, even trivial details, and he is a master at this. But in a science thriller about the realities of AIDS and the threat of future epidemics, one might hope to find the insights of science as well as the ingredients of a thriller. Describing a tense moment when three Army officers arrive at a Virginia gas station to wait for a clandestine hand-off of some dead Reston monkeys for analysis, Preston pauses to tell us, ‘Nancy went into the gas station and bought Diet Cokes for everyone and a pack of cheddar-cheese crackers for herself, and she bought C.J. some peanut butter crackers.’ This junk-food prose would be fine if Preston gave more attention to the larger questions this story raises.

He reports, for instance, the Army’s decision during the crisis to take actions it thought might be illegal. ‘You never ask a lawyer for permission to do something,’ the general in charge tells his staff. ‘We’re going to do the needful, and the lawyers are going to tell us why it’s legal.’ He also notes, as the Army prepared to move on the Reston monkey colony, that ‘half of this biocontainment operation was going to be news containment.’ Disregarding the law and deceiving the press may have seemed necessary at the time, but these decisions deserve some ex post facto scrutiny and serious contemplation. Here they get no more attention than those officers’ snacks.

More important, perhaps, are the questions of science that are never explored. There are clues scattered throughout this story that our relation to viruses is more complex and less understood than our image of them as ‘individuals,’ as deadly predators, might suggest. Despite repeated dire predictions throughout these pages of epidemics similar to that in Crichton’s classic Andromeda Strain, the early outbreaks in Germany, Sudan and Zaire soon mysteriously abated, leaving both the doctors and the scientists puzzled.

Of Sudan, Preston simply says, ‘For reasons that are not clear, the outbreak subsided and the virus vanished.’ And of fears that Ebola Zaire would devastate Kinshasa, ‘But to the strange and wonderful relief of Zaire and the world, the virus never went on a burn . . . and went back to its hiding place in the forest.’ And the Reston virus proved infectious but mysteriously innocuous.

Yet these curious facts are left strangely unexamined. It may be as vital to understand why these viruses retreated as to understand why they attacked, but this question isn’t asked. ‘Viruses,’ Preston writes, ‘are molecular sharks, a motive without a mind. Compact, hard, logical, totally selfish. . . .’ Indulgence in such anthropomorphism and metaphor reinforces a terrifying Darwinian view of ‘Nature, red in tooth and claw,’ but it blinds us to new views from molecular biology.

Current research suggests that viruses may be more like wandering messengers than alien predators, their visitations serving to exchange genetic information among individuals and species in an ecology more intricate and a biochemical balance more delicate than we have yet realized. One promising experimental drug for AIDS is based on this idea: it blocks a receptor site for the virus’ message instead of working through the immune response.

Preston concludes that ‘AIDS is the revenge of the rain forest’ for human incursions and overpopulation of the Earth. ‘It is only the first act of revenge,’ he adds. Marburg and Ebola pose the new threat of a virus ‘trying, so to speak, to crash into the human species.’ These images may owe more to the fictions we know than to the truths we have only begun to recognize. Peering into the edges of the rain forest, Preston shows us a landscape of infectious terror, but he misses a path into the frontiers of science.