The Hot Zone (12 page)

There was a nun at the Yambuku Hospital who is known today as Sister M. E. She became gravely ill with
l’épidémie
, or “the epidemic,” as they had begun to call it. A priest at Yambuku decided to try to take her to the city of Kinshasa, the capital of Zaire, in order to get her better medical treatment. He and another nun, named Sister E. R., drove Sister M. E. in a Land Rover to the town of Bumba, a sprawl of cinder blocks and wooden shacks that huddles beside the Congo River. They went to the airfield at Bumba and hired a small plane to fly them to Kinshasa, and when they reached the city, they took Sister M. E. to Ngaliema Hospital, a private hospital run by Swedish nurses, where she was given a room of her own. There she endured her agonals and committed her soul to Christ.

•   •  •

Ebola Zaire attacks every organ and tissue in the human body except skeletal muscle and bone. It is a perfect parasite because it transforms virtually every part of the body into a digested slime of virus particles. The seven mysterious proteins that, assembled together, make up the Ebola-virus particle, work as a relentless machine, a molecular shark, and they consume the body as the virus makes copies of itself. Small blood clots begin to appear in the bloodstream, and the blood thickens and slows, and the clots begin to stick to the walls of blood vessels. This is known as pavementing, because the clots fit together in a mosaic. The mosaic thickens and throws more clots, and the clots drift through the bloodstream into the small capillaries, where they get stuck. This shuts off the blood supply to various parts of the body, causing dead spots to appear in the brain, liver, kidneys, lungs, intestines, testicles, breast tissue (of men as well as women), and all through the skin. The skin develops red spots, called petechiae, which are hemorrhages under the skin. Ebola attacks connective tissue with particular ferocity; it multiplies in collagen, the chief constituent protein of the tissue that holds the organs together. (The seven Ebola proteins somehow chew up the body’s structural proteins.) In this way, collagen in the body turns to mush, and the underlayers of the skin die and liquefy. The skin bubbles up into a sea of tiny white blisters mixed with red spots known as a maculopapular rash. This rash has been likened to tapioca pudding. Spontaneous rips appear in the
skin, and hemorrhagic blood pours from the rips. The red spots on the skin grow and spread and merge to become huge, spontaneous bruises, and the skin goes soft and pulpy, and can tear off if it is touched with any kind of pressure. Your mouth bleeds, and you bleed around your teeth, and you may have hemorrhages from the salivary glands—literally every opening in the body bleeds, no matter how small. The surface of the tongue turns brilliant red and then sloughs off, and is swallowed or spat out. It is said to be extraordinarily painful to lose the surface of one’s tongue. The tongue’s skin may be torn off during rushes of the black vomit. The back of the throat and the lining of the windpipe may also slough off, and the dead tissue slides down the windpipe into the lungs or is coughed up with sputum. Your heart bleeds into itself; the heart muscle softens and has hemorrhages into its chambers, and blood squeezes out of the heart muscle as the heart beats, and it floods the chest cavity. The brain becomes clogged with dead blood cells, a condition known as sludging of the brain. Ebola attacks the lining of the eyeball, and the eyeballs may fill up with blood: you may go blind. Droplets of blood stand out on the eyelids: you may weep blood. The blood runs from your eyes down your cheeks and refuses to coagulate. You may have a hemispherical stroke, in which one whole side of the body is paralyzed, which is invariably fatal in a case of Ebola. Even while the body’s internal organs are becoming plugged with coagulated blood, the blood that
streams out of the body cannot clot; it resembles whey being squeezed out of curds. The blood has been stripped of its clotting factors. If you put the runny Ebola blood in a test tube and look at it, you see that the blood is destroyed. Its red cells are broken and dead. The blood looks as if it has been buzzed in an electric blender.

Ebola kills a great deal of tissue while the host is still alive. It triggers a creeping, spotty necrosis that spreads through all the internal organs. The liver bulges up and turns yellow, begins to liquefy, and then it cracks apart. The cracks run across the liver and deep inside it, and the liver completely dies and goes putrid. The kidneys become jammed with blood clots and dead cells, and cease functioning. As the kidneys fail, the blood becomes toxic with urine. The spleen turns into a single huge, hard blood clot the size of a baseball. The intestines may fill up completely with blood. The lining of the gut dies and sloughs off into the bowels and is defecated along with large amounts of blood. In men, the testicles bloat up and turn black-and-blue, the semen goes hot with Ebola, and the nipples may bleed. In women, the labia turn blue, livid, and protrusive, and there may be massive vaginal bleeding. The virus is a catastrophe for a pregnant woman: the child is aborted spontaneously and is usually infected with Ebola virus, born with red eyes and a bloody nose.

Ebola destroys the brain more thoroughly than does Marburg, and Ebola victims often go into epileptic convulsions during the final stage. The convulsions
are generalized grand mal seizures—the whole body twitches and shakes, the arms and legs thrash around, and the eyes, sometimes bloody, roll up into the head. The tremors and convulsions of the patient may smear or splatter blood around. Possibly this epileptic splashing of blood is one of Ebola’s strategies for success—it makes the victim go into a flurry of seizures as he dies, spreading blood all over the place, thus giving the virus a chance to jump to a new host—a kind of transmission through smearing.

Ebola (and Marburg) multiplies so rapidly and powerfully that the body’s infected cells become crystal-like blocks of packed virus particles. These crystals are broods of virus getting ready to hatch from the cell. They are known as bricks. The bricks, or crystals, first appear near the center of the cell and then migrate toward the surface. As a crystal reaches a cell wall, it disintegrates into hundreds of individual virus particles, and the broodlings push through the cell wall like hair and float away in the bloodstream of the host. The hatched Ebola particles cling to cells everywhere in the body, and get inside them, and continue to multiply. It keeps on multiplying until areas of tissue all through the body are filled with crystalloids, which hatch, and more Ebola particles drift into the bloodstream, and the amplification continues inexorably until a droplet of the host’s blood can contain a hundred million individual virus particles.

After death, the cadaver suddenly deteriorates:
the internal organs, having been dead or partially dead for days, have already begun to dissolve, and a sort of shock-related meltdown occurs. The corpse’s connective tissue, skin, and organs, already peppered with dead spots, heated by fever, and damaged by shock, begin to liquefy, and the fluids that leak from the cadaver are saturated with Ebola-virus particles.

When it was all over, the floor, chair, and walls in Sister M. E.’s hospital room were stained with blood. Someone who saw the room told me that after they took her body away for burial (wrapped in many sheets), no one at the hospital could bear to go into the room to clean it up. The nurses and doctors didn’t want to touch the blood on the walls and were frankly fearful of breathing the air in the room, too. So the room was closed and locked, and remained that way for days. The appearance of the nun’s hospital room after her death may have raised in some minds one or two questions about the nature of the Supreme Being, or, for persons not inclined to theology, the blood on the walls may have served as a reminder of the nature of Nature.

No one knew what had killed the nun, but clearly it was a replicating agent, and the signs and symptoms of the disease were not easy to consider with a calm mind. What also did not lead to calm thoughts were rumors coming out of the jungle to the effect that the agent was wiping out whole villages
upriver on the Congo. These rumors were not true. The virus was hitting families selectively, but no one understood this because the flow of news coming from upriver was being choked off. Doctors at the hospital in Kinshasa examined the nun’s case and began to suspect that she might have died of Marburg or a Marburg-like agent.

Then Sister E. R., the nun who had traveled with Sister M. E. during the drive to Bumba and the plane flight to Kinshasa, broke with
l’épidémie
. They put her in a private room at the hospital, where she began to die with the same signs and symptoms that had preceded Sister M. E.’s death.

There was a young nurse at the Ngaliema Hospital named Mayinga N. (Her first name was Mayinga and her last name is given as N.) Nurse Mayinga had been caring for Sister M. E. when the nun had died in the bloodstained room. She may have been splattered with the nun’s blood or with black vomit. At any rate, Nurse Mayinga developed a headache and fatigue. She knew she was becoming sick, but she did not want to admit to herself what it was. She came from a poor but ambitious family, and she had received a scholarship to go to college in Europe. What worried her was the possibility that if she became ill, she would not be allowed to travel abroad. When the headache came upon her, she left her job at the hospital and disappeared. She dropped out of sight for two days. During that time, she went into the city, hoping to get her travel permits arranged before she became visibly sick. On the first day of her
disappearance—the date was October 12, 1976—she spent a day waiting in lines at the offices of the Zairean foreign ministry, trying to get her papers straight.

The next day, October 13, she felt worse, but instead of reporting to work, again she went into the city. This time, she took a taxi to the largest hospital in Kinshasa, the Mama Yemo Hospital. By now, as her headache became blinding and her stomach pain increased, she must have been terribly frightened. Why didn’t she go to the Ngaliema Hospital to seek treatment where she worked and where the doctors would have taken care of her? It must have been a case of psychological denial. She did not want to admit, even to herself, that she had been infected. Perhaps she had a touch of malaria, she hoped. So she went to Mama Yemo Hospital, the hospital of last resort for the city’s poor, and spent hours waiting in a casualty ward jammed with ragged people and children.

I can see her in my mind’s eye—Nurse Mayinga, the source of the virus in the United States Army’s freezers. She was a pleasant, quiet, beautiful young African woman, about twenty years old, in the prime of her life, with a future and dreams, hoping somehow that what was happening to her could not be happening. They say that her parents loved her dearly, that she was the apple of their eye. Now she is sitting in the casualty ward at Mama Yemo among the cases of malaria, among the large-bellied children in rags, and no one is paying any attention to her because all she has is a
headache and red eyes. Perhaps she has been crying, perhaps that is why her eyes are red. A doctor gives her a shot for malaria and tells her that she should be in quarantine for her illness. But there is no room in the quarantine ward at Mama Yemo Hospital; so she leaves the hospital and hails another taxi. She tells the driver to take her to another hospital, to University Hospital, where perhaps the doctors can treat her. But when she arrives at University Hospital, the doctors can’t seem to find anything wrong with her, except for possibly some signs of malaria. Her headache is getting worse. She is sitting in the waiting room of this hospital, and as I try to imagine her there, I am almost certain she is crying. Finally she does the only thing left for her to do. She returns to Ngaliema Hospital and asks to be admitted as a patient. They put her in a private room, and there she falls into lethargy, and her face freezes into a mask.

News of the virus and what it did to people had been trickling out of the forest, and now a rumor that a sick nurse had wandered around Kinshasa for two days, having face-to-face contact with many people in crowded rooms and public places, caused a panic in the city. The news spread first along the mission grapevine and through government employees and among the diplomats at cocktail parties, and finally the rumors began to reach Europe. When the story reached the offices of the World Health Organization in Geneva, the place went into a full-scale alert. People who were
there at the time said that you could feel fear in the hallways, and the director looked like a visibly shaken man. Nurse Mayinga seemed to be a vector for an explosive chain of lethal transmission in a crowded third-world city with a population of two million people. Officials at the
WHO
began to fear that Nurse Mayinga would become the vector for a world-wide plague. European governments contemplated blocking flights from Kinshasa. The fact that one infected person had wandered around the city for two days when she should have been isolated in a hospital room began to look like a species-threatening event.

President Mobutu Sese Seko, the maximum leader of Zaire, sent his army into action. He stationed soldiers around Ngaliema Hospital with orders to let no one enter or leave except doctors. Much of the medical staff was now under quarantine inside the hospital, but the soldiers made sure that the quarantine was enforced. President Mobutu also ordered army units to seal off Bumba Zone with roadblocks and to shoot anyone trying to come out. Bumba’s main link with the outside world was the Congo River. Captains of riverboats had heard about the virus by this time, and they refused to stop their boats anywhere along the length of the river in Bumba, even though people beseeched them from the banks. Then all radio contact with Bumba was lost. No one knew what was happening upriver, who was dying, what the virus was doing. Bumba had dropped off the face of the earth into the silent heart of darkness.

•  •  •

As the first nun at Ngaliema Hospital, Sister M. E., lay dying, her doctors had decided to give her a so-called agonal biopsy. This is a rapid sampling of tissue, done close to the moment of death instead of a full autopsy. She was a member of a religious order that prohibited autopsies, but the doctors very much wanted to know what was replicating inside her. As the terminal shock and convulsions came over her, they inserted a needle into her upper abdomen and sucked out a quantity of liver. Her liver had begun to liquefy, and the needle was large. A fair amount of the nun’s liver traveled up the needle and filled a biopsy syringe. Possibly it was during this agonal biopsy that her blood squirted on the walls. The doctors also took some samples of blood from her arm and put it in glass tubes. The nun’s blood was precious beyond measure, since it contained the unknown hot agent.