The Hot Zone (14 page)

They pushed north toward the Ebola River.

It was the rainy season, and the “road” was a string of mudholes cut by running streams. Engines howling, wheels spinning, they proceeded through the forest at the pace of a walk, in continual rain and oppressive heat. Occasionally they came to villages, and at each village they encountered a roadblock of fallen trees. Having had centuries
of experience with the smallpox virus, the village elders had instituted their own methods for controlling the virus, according to their received wisdom, which was to cut their villages off from the world, to protect their people from a raging plague. It was reverse quarantine, an ancient practice in Africa, where a village bars itself from strangers during a time of disease, and drives away outsiders who appear.

“Who are you? What are you doing?” they shouted to the Land Rovers from behind a barrier of trees.

“We are doctors! We are coming to help!”

Eventually the people would clear away the trees, and the team would proceed deeper into the forest. In a long and desperate day of travel, they penetrated fifty miles away from the Congo River, and finally, toward evening, they came to a row of round, thatched African houses. Beyond the houses stood a white church in the middle of the forest. Around the church, there were two soccer fields, and in the middle of one field they noticed a heap of burned mattresses. Two hundred yards farther on, they came to the Yambuku Mission Hospital, a complex of low, whitewashed buildings made of concrete, with corrugated tin roofs.

The place was as silent as a tomb and appeared to be deserted. The beds were iron or wooden frames without mattresses—the blood-soaked mattresses had been burned in the soccer field—and the floors were clean, spotless, rinsed. The team discovered three surviving nuns and one
priest, along with a few devoted African nurses. They had cleaned up the mess after the virus had wiped out everyone else, and now they were busy fogging the rooms with insecticide, in the hope that it might somehow disperse the virus. One room in the hospital had not been cleaned up. No one, not even the nuns, had had the courage to enter the obstetric ward. When Joel Breman and the team went in, they found basins of foul water standing among discarded, bloodstained syringes. The room had been abandoned in the middle of childbirths, where dying mothers had aborted fetuses infected with Ebola. The team had discovered the red chamber of the virus queen at the end of the earth, where the life form had amplified through mothers and their unborn children.

The rains continued all day and night. Around the hospital and the church stood the beautiful ferocious trees, a complex of camphors and teaks. Their crowns entwined and crisscrossed and whispered with rain, and bowed and shifted as troops of monkeys passed through them like currents of wind, leaping from crown to crown, crying their untranslatable cries. The next day, the doctors set out deeper into the forest in their Land Rovers, and they made contact with infected villages, where they found people dying in huts. Some of the victims had been put into isolation huts on the edge of the village—an old African technique for dealing with smallpox. Some of the huts where people had died had been burned down. Already the virus seemed to be petering out, and most of
the people who were going to die were already dead, the virus having echoed so swiftly through Bumba. A wave of emotion rolled over Joel Breman as he realized, with the clarity of a doctor who suddenly sees into the heart of things, that the victims had received the infection from the hospital. The virus had taken root with the nuns and had done its work among those who had sought help from them. In one village, he examined a man dying of Ebola. The man sat in a chair, holding his stomach and leaning forward with pain, and blood streamed around his teeth.

They tried to reach Kinshasa by radio, to tell Karl Johnson and the others that the epidemic had already peaked. A week later, they were still trying to make radio contact, but they could not get through. They traveled back to the town of Bumba and waited by the river. One, day an airplane droned overhead. It circled the town once and touched down, and they ran for it.

At the Ngaliema Hospital in Kinshasa, Nurse Mayinga had been put into a private room, which was accessible through a kind of entry room, a gray zone, where the nurses and staff were supposed to put on bioprotective gear before they entered. Mayinga was cared for by a South African doctor named Margaretha Isaäcson, who at first wore a military gas mask, but it became increasingly uncomfortable in the tropical heat. She thought to herself, I can’t bear it, I’ll be surprised
if I come out of this alive anyway. That made her think about her own children. She thought, My children are grown up, they are no great responsibility. And she removed her mask and treated the dying girl face-to-face.

Dr. Isaäcson did everything she could to save Mayinga, but she was as helpless before the agent as medieval doctors had been in the face of the black plague. (“This was not like
AIDS
,” she later recalled to me. “A
IDS
is child’s play compared with this.”) She gave Nurse Mayinga ice cubes to suck on, which helped to ease the pain in her throat, and she gave her Valium to try to stave off her apprehension of what lay ahead.

“I know I am dying,” Mayinga said to her.

“That’s nonsense. You are not going to die,” Dr. Isaäcson replied.

When Mayinga’s bleeding began, it came from her mouth and nose. It never came in a rush, but the blood dripped and ran and would not stop and would not clot. It was a hemorrhagic nosebleed, the kind that does not stop until the heart stops beating. Eventually Dr. Isaäcson gave her three transfusions of whole blood to replace what she lost in nosebleeds. Mayinga remained conscious and despondent until the end. In the final stage, her heart developed a galloping beat. Ebola had entered her heart. Mayinga could feel her heart going blubbery inside her chest as Ebola worked its way through her heart, and it frightened her unspeakably. That night, she died of a heart attack.

Her room was contaminated with blood, and there was also the question of the two nuns’ rooms, both of which were still locked and bloodstained. Dr. Isaäcson said to the staff, “I won’t be of much use to you now,” and she got a bucket and mop and washed the rooms.

Medical teams fanned out into Kinshasa and managed to locate thirty-seven people who had had face-to-face contact with Mayinga during the time when she had wandered around the city. They set up two biocontainment pavilions at the hospital and shut the people up for a couple of weeks. They wrapped the cadavers of the nuns and Nurse Mayinga in sheets soaked in chemicals, then double-bagged the mummies in plastic and put each one in an airtight coffin with a screw-down lid, and held the funeral services at the hospital, under the watch of doctors.

Karl Johnson, having heard nothing from the team of doctors upriver in Bumba, wondered if they were dead, and assumed that the virus was about to go on a burn through the city. He organized a floating hospital ship and had it moored in the Congo River. It was an isolation ship for doctors. The city would be the hot zone, and the floating ship would be the gray area, the place of refuge for the doctors. Approximately a thousand Americans were living in Zaire at the time. In the United States, the Army’s Eighty-second Airborne Division went on alert and prepared to evacuate the Americans by air as soon as the first Ebola cases started popping up in the city. But to the
strange and wonderful relief of Zaire and the world, the virus never went on a burn through the city. It subsided on the headwaters of the Ebola River and went back to its hiding place in the forest. The Ebola agent seemed not to be contagious in face-to-face contacts. It did not seem to be able to travel through the air. No one caught the virus from Nurse Mayinga, even though she had been in close contact with at least thirty-seven people. She had shared a bottle of soda pop with someone, and not even that person became ill. The crisis passed.

As with Ebola, the secret hiding place of the Marburg agent was unknown. After erupting in Charles Monet and Dr. Shem Musoke, Marburg dropped out of sight, and no one could say where it had gone. It seemed to vanish off the face of the earth, but viruses never go away, they only hide, and Marburg continued to cycle in some reservoir of animals or insects in Africa.

On the second day of September 1987, around suppertime, Eugene Johnson, the civilian biohazard expert attached to
USAMRIID
, stood in a passenger-arrival area outside the customs gates at Dulles International Airport, near Washington. He was waiting for a
KLM
flight from Amsterdam, which carried a passenger who had come from Kenya. A man with a duffle bag passed through customs, and he and Johnson nodded to each other. (“I’m going to leave this person’s name out of it. Let’s just say he was someone I knew, someone I trust,” Johnson explained to me.) The man laid down the duffle bag at Johnson’s feet, unzipped it,
and pulled out a wad of bath towels wrapped around something. Pulling off the towels, he revealed an unmarked cardboard box wound with tape. He handed the box to Johnson. They had little to say to each other. Johnson carried the box out of the terminal building, put it in the trunk of his car, and drove to the Institute. The box held blood serum from a ten-year-old Danish boy who will be called Peter Cardinal. He had died a day or so earlier at Nairobi Hospital with a combination of extreme symptoms that suggested an unidentified Level 4 virus.

As he drove to the Institute, Johnson wondered just what he was going to do with the box. He was inclined to sterilize its contents in an oven and then incinerate it. Just cook it and burn it, and forget it. Most of the samples that came into the Institute—and samples of blood and tissue arrived constantly from all parts of the world—contained nothing unusual, no interesting viruses. In other words, most of the samples were false alarms. Johnson wasn’t sure he wanted to take the time to analyze this boy’s blood serum, if, in all probability, nothing would be found in it. By the time he pulled into the gates of Fort Detrick, he had decided to go ahead. He knew the work would keep him up most of the night, but it had to be done immediately, before the blood serum deteriorated.

Johnson put on a surgical scrub suit and rubber gloves, and carried the box into the Level 3 staging area of the Ebola suite, where he opened the box, revealing a mass of foam peanuts. Out of
the peanuts he fished a metal cylinder sealed with tape and marked with a biohazard symbol. Along the wall of the staging area was a row of stainless-steel cabinets with rubber gloves protruding into them. They were Biosafety Level 4 cabinets. They could be sealed off from the outside world while you handled a hot agent inside them with the rubber gloves. These cabinets were similar in design to the safety cabinets that are used for handling nuclear-bomb parts. Here the cabinets were designed to keep human beings from coming into direct contact with Nature. Johnson unscrewed some wingnuts and opened a door in the cabinets, and placed the metal cylinder inside. He closed and tightened the door.

Next, he put his hands into the gloves, picked up the cylinder and, looking through a window to see what he was doing, peeled the tape off the cylinder. The tape stuck to his rubber gloves, and he couldn’t get it off. Damn! he swore to himself. It was now eight o’clock at night, and he would never get home. Finally he got the cylinder open. Inside it was a wad of paper towels soaked in bleach. He pulled apart the wad and found a Ziploc bag. It contained a couple of plastic tubes with screw tops. He unscrewed them and shook out two very small plastic vials containing golden liquid: Peter Cardinal’s blood serum.

The boy’s mother and father worked for a Danish relief organization in Kenya, and lived in a house in the town of Kisumu, on Lake Victoria. Peter had been a student at a boarding school in
Denmark. That August, a few weeks before he died, he had gone to Africa to visit his parents and his older sister. She was a student at a private school in Nairobi. She and Peter were very close, and while Peter was visiting his family in Kenya, the two young people spent most of their time together—brother and sister, best friends.

The Cardinal family went on vacation after Peter’s arrival, and traveled by car through Kenya—his mother and father wanted to show him the beauty and sweetness of Africa. They were visiting Mombasa, staying in a hotel by the sea, when Peter developed red eyes. His parents took him to the hospital, where the doctors examined him and concluded that he had come down with malaria. His mother did not believe it was malaria. She began to perceive that her son was dying, and she became frantic. She insisted that he be taken to Nairobi for treatment. The Flying Doctors, an air-ambulance service, picked him up, and he was flown to Nairobi and rushed to Nairobi Hospital, where he came under the care of Dr. David Silverstein, who had also taken care of Dr. Musoke after Charles Monet had spewed the black vomit into Musoke’s eyes.

“Peter Cardinal was a blond-haired, blue-eyed guy, a tall, thin guy, a fit-looking ten-year-old,” Dr. Silverstein recalled as we drank coffee and tea at a table in the shopping mall near his house outside Washington. A small girl sitting nearby burst
into wails, and her mother hushed her. Crowds of shoppers passed by our table. I kept my eyes on Dr. Silverstein’s face—steel-rimmed glasses, mustache, eyes that gazed into space—as he recalled the unusual death he had seen, which he spoke of in a matter-of-fact way. “When Peter came to me, he was febrile, but he was very with it, very alert and communicative. We gave him an X ray. His lungs were fluffy.” A kind of watery mucus had begun to collect in the boy’s lungs, which caused him difficulty in breathing. “It was a typical
ARDS
picture—acute respiratory distress syndrome—like early pneumonia,” Dr. Silverstein said. “Shortly afterward, he started turning bluish on me. He had blue in his fingertips. Also, he had little red spots. I had everybody glove up before they handled him. We suspected he had Marburg, but we didn’t have the paranoia we had had with Dr. Musoke. We just took precautions. In twenty-four hours, he was on a respirator. We noted that he bled easily from puncture sites, and he had deranged liver functions. The small red spots became large, spontaneous bruises. He turned black-and-blue. Then his pupils dilated up on us. That was a sign of brain death. He was bleeding around the brain.”