The Hot Zone (8 page)

Ebola virus is named for the Ebola River, which is the headstream of the Mongala River, a tributary of the Congo, or Zaire, River. The Ebola River empties tracts of rain forest, winding past scattered villages. The first known emergence of Ebola Zaire—the hottest type of Ebola virus—occurred in September 1976, when it erupted simultaneously in fifty-five villages near the headwaters of the Ebola River. It seemed to come out of nowhere, and killed nine out of ten people it infected. Ebola Zaire is the most feared agent at the Institute. The general feeling around
USAMRIID
has always been “Those people who work with Ebola are crazy.” To mess around with Ebola is an easy way to die. Better to work with something safer, such as anthrax.

Eugene Johnson, the civilian biohazard expert who was running the Ebola research program at the Institute, had a reputation for being a little bit wild. He is something of a legend to the handful of people in the world who really know about hot agents and how to handle them. He is one of the world’s leading Ebola hunters. Gene Johnson is a large man, not to say massive, with a broad, heavy face and loose-flying disheveled brown hair and a bushy brown beard and a gut that hangs over his
belt, and glaring, deep eyes. If Gene Johnson were to put on a black leather jacket, he could pass for a roadie with the Grateful Dead. He does not look at all like a man who works for the Army. He has a reputation for being a top-notch field epidemiologist (a person who studies viral diseases in the wild), but for some reason he does not often get around to publishing his work. That explains his somewhat mysterious reputation. When people who know Johnson’s work talk about him, you hear things like “Gene Johnson did this, Gene Johnson did that,” and it all sounds clever and imaginative. He is a rather shy man, somewhat suspicious of people, deeply suspicious of viruses. I think I have never met someone who is more afraid of viruses than Gene Johnson, and what makes his fear impressive is the fact that it is a deep intellectual respect, rooted in knowledge. He spent years traveling across central Africa in search of the reservoirs of Ebola and Marburg viruses. He had virtually ransacked Africa looking for these life forms, but despite his searches he had never found them in their natural hiding places. No one knew where any of the filoviruses came from; no one knew where they lived in nature. The trail had petered out in the forests and savannas of central Africa. To find the hidden reservoir of Ebola was one of Johnson’s great ambitions.

No one around the Institute wanted to get involved with his Ebola project. Ebola, the slate wiper, did things to people that you did not want
to think about. The organism was too frightening to handle, even for those who were comfortable and adept in space suits. They did not care to do research on Ebola because they did not want Ebola to do research on them. They didn’t know what kind of host the virus lived in—whether it was a fly or a bat or a tick or a spider or a scorpion or some kind of reptile, or an amphibian, such as a frog or a newt. Or maybe it lived in leopards or elephants. And they didn’t know exactly how the virus spread, how it jumped from host to host.

Gene Johnson had suffered recurrent nightmares about Ebola virus ever since he began to work with it. He would wake up in a cold sweat. His dreams went more or less the same way. He would be wearing his space suit while holding Ebola in his gloved hand, holding some kind of liquid tainted with Ebola. Suddenly the liquid would be running all over his glove, and then he would realize that his glove was full of pinholes, and the liquid was dribbling over his bare hand and running inside his space suit. He would come awake with a start, saying to himself, My God,
there’s been an exposure
. And then he would find himself in his bedroom, with his wife sleeping beside him.

In reality, Ebola had not yet made a decisive, irreversible breakthrough into the human race, but it seemed close to doing that. It had been emerging in microbreaks here and there in Africa. The worry was that a microbreak would develop into an unstoppable tidal wave. If the virus killed
nine out of ten people it infected and there was no vaccine or cure for it, you could see the possibilities. The possibilities were global. Johnson liked to say to people that we don’t really know what Ebola has done in the past, and we don’t know what it might do in the future. Ebola was unpredictable. An airborne strain of Ebola could emerge and circle around the world in about six weeks, like the flu, killing large numbers of people, or it might forever remain a secret feeder at the margins, taking down humans a few at a time.

Ebola is a rather simple virus—as simple as a firestorm. It kills humans with swift efficiency and with a devastating range of effects. Ebola is distantly related to measles, mumps, and rabies. It is also related to certain pneumonia viruses: to the parainfluenza virus, which causes colds in children, and to the respiratory syncytial virus, which can cause fatal pneumonia in a person who has
AIDS
. In its own evolution through unknown hosts and hidden pathways in the rain forest, Ebola seems to have developed the worst elements of all the above viruses. Like measles, it triggers a rash all over the body. Some of its effects resemble rabies—psychosis, madness. Other of its effects look eerily like a bad cold.

The Ebola virus particle contains only seven different proteins—seven distinct types of large molecules arranged in a long braided structure that is the stringy Ebola particle. Three of these proteins are vaguely understood, and four of the proteins are completely unknown—their structure
and their function is a mystery. Whatever these Ebola proteins do, they seem to target the immune system for special attack. In this they are like
HIV
, which also destroys the immune system, but unlike the creeping onset of
HIV
, the attack by Ebola is explosive. As Ebola sweeps through you, your immune system fails, and you seem to lose your ability to respond to viral attack. Your body becomes a city under seige, with its gates thrown open and hostile armies pouring in, making camp in the public squares and setting everything on fire; and from the moment Ebola enters your bloodstream, the war is already lost; you are almost certainly doomed. You can’t fight off Ebola the way you fight off a cold. Ebola does in ten days what it takes
AIDS
ten years to accomplish.

It is not really known how Ebola is transmitted from person to person. Army researchers believed that Ebola virus traveled through direct contact with blood and bodily fluids (in the same way the
AIDS
virus travels). Ebola seemed to have other routes of travel as well. Many of the people in Africa who came down with Ebola had handled Ebola-infected cadavers. It seems that one of Ebola’s paths goes from the dead to the living, winding in trickles of uncoagulated blood and slimes that come out of the dead body. In Zaire during the 1976 outbreak, grieving relatives kissed and embraced the dead or prepared the body for burial, and then, three to fourteen days later, they broke with Ebola.

Gene Johnson’s Ebola experiment was simple.
He would infect a few monkeys with the virus, and then he would treat them with drugs in the hope that they would get better. That way, he might discover a drug that would fight Ebola virus or possibly cure it.

Monkeys are nearly identical to human beings in a biological sense, which is why they are used in medical experiments. Humans and monkeys are both primates, and Ebola feeds on primates in the same way that a predator consumes certain kinds of flesh. Ebola can’t tell the difference between a human being and a monkey. The virus jumps easily back and forth between them.

Nancy Jaax volunteered to work as the pathologist on Johnson’s Ebola project. It was Level 4 work, which she was qualified to do, because she didn’t need to be vaccinated. She was eager to prove herself and eager to continue working with lethal viruses. However, some people around the Institute were skeptical of her ability to work in a space suit in Level 4. She was a “married female”—and therefore, they claimed, she might panic. They claimed that her hands looked nervous or clumsy, not good for work with Level 4 hot agents. People felt that she might cut herself or stick herself with a contaminated needle—or stick someone else. Her hands became a safety issue. But the real issue was that she was a woman.

Her immediate superior was Lieutenant Colonel Anthony Johnson (he is not related to Gene
Johnson, the civilian who was the head of the Ebola project). Tony Johnson is a soft-spoken man and a cool customer. Now he had to decide whether to allow her to go into Biosafety Level 4. Wanting to be sure he understood the situation, he sent word around the Institute: Who knows Nancy Jaax? Who can comment on her strengths and weaknesses? Major Jerry Jaax, Nancy’s husband, showed up in Lieutenant Colonel Johnson’s office. Jerry was against the idea of his wife putting on a space suit. He argued strongly against it. He said that there had been “family discussions” about Nancy working with Ebola virus. “Family discussions.” Jerry had said to Nancy, “You’re the only wife I’ve got” … He did not wear a biological space suit himself at work, and he did not want his wife to wear one either. His biggest concern was that she would be handling Ebola. He could not stand the idea that his wife, the woman he loved, the mother of their children, would hold in her hands a monstrous life form that is lethal and incurable.

Lieutenant Colonel Tony Johnson listened to what Major Jerry Jaax had to say, and listened to what other people had to say, and then he felt he should speak with Nancy himself, and so he called her into his office. He could see that she was tense. He watched her hands as she talked. They looked fine to him, not clumsy, and not too quick, either. He decided that the rumors he had been hearing about her hands were unfounded. She said to him, “I don’t want any special favors.”
Well, she was not going to get any special favors. “I’m going to put you in the Ebola program,” he said. He told her that he would allow her to put on a space suit and go into the Ebola area, and that he would accompany her on the first few trips, to teach her how to do it and to observe her hands at work. He would watch her like a hawk. He believed that she was ready for total immersion in a hot zone.

As he spoke, she broke down and cried in front of him—“had a few tears,” as he would later recall. They were tears of happiness. At that moment, to hold Ebola virus in her hands was what she wanted more than anything else in the world.

Nancy spent the morning doing paperwork in her office. After lunch, she removed her diamond engagement ring and her wedding band and locked them in her desk drawer. She dropped by Tony Johnson’s office and asked him if he was ready to go in. They went downstairs and along a corridor to the Ebola suite. There was only one locker room leading into it. Tony Johnson insisted that Nancy Jaax go in first, to get changed. He would follow.

The room was small and contained a few lockers along one wall, some shelves, and a mirror over a sink. She undressed, removing all of her clothing, including her underwear, and put everything
in her locker. She left the Band-Aid stuck to her hand. From a shelf, she took up a sterile surgical scrub suit—green pants and a green shirt, the clothing that a surgeon wears in an operating room—and she dragged on the pants and tied the drawstring at the waist, and snapped the shirt’s snaps. You were not allowed to wear anything under the scrub suit, no underwear. She pulled a cloth surgical cap over her head and tucked her hair up into the cap while looking in the mirror. She did not appear nervous, but she was starting to feel a little bit nervous. This was only her second trip into a hot area.

Standing in her bare feet, she turned away from the mirror and faced a door leading into Level 2, A deep blue light streamed through a window in the door—ultraviolet light. Viruses fall apart under ultraviolet light, which smashes their genetic material and makes them unable to replicate.

As she opened the door and entered Level 2, she felt the door stick against her pull, sucked in by a difference of air pressure, and a gentle drag of air whispered around her shoulders and traveled inward, toward the hot zone. This was negative air pressure, designed to keep hot agents from drifting outward. The door closed behind her, and she was in Level 2. The blue light bathed her face. She walked through a water-shower stall that contained an ultraviolet light, a bar of soap, and some ordinary shampoo. The shower stall led into a bathroom, where there was a shelf that held some
clean white socks. She put on a pair of socks and pushed through another door, into Level 3.

This was a room known as the staging area. It contained a desk with a telephone and a sink. A cylindrical waxed cardboard box sat on the floor beside the desk. It was a biohazard container known as a “hatbox,” or “ice-cream container.” A hatbox is blazed with biohazard symbols, which are red, spiky three-petaled flowers, and it is used for storing and transporting infectious waste. This hatbox was empty. It was only a makeshift chair.

She found a box of latex rubber surgical gloves and a plastic shaker full of baby powder. She shook baby powder onto her hands and pulled on the gloves. Then she found a roll of sticky tape, and she tore off several strips of tape and hung them in a row on the edge of the desk. Then she taped herself. Taking up one strip at a time, she taped the cuffs of her gloves to the sleeves of her scrub shirt, running the tape around the cuff to make a seal. She then taped her socks to her trousers. Now she wore one layer of protection between herself and the replicative Other.

Lieutenant Colonel Johnson came in through Level 2 wearing a surgical scrub suit. He put on rubber gloves and began taping them to his sleeves, and he taped his socks to his pants.

Nancy turned to the right, into an antechamber, and found her space suit hanging on a rack. It was a Chemturion biological space suit, and it was marked in letters across the chest:
JAAX
. The Chemturion type is also known as a blue suit, because
it is bright blue. It is a pressurized, heavy-duty plastic space suit that meets government specifications for work with airborne hot agents.