PDF Summary:The Hot Zone, by Richard Preston

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Most caves are carved by water, and they would be too damp for viruses to thrive. But scientists believe the elephants who visit the cave in search of salt carved Kitum Cave through thousands of years of incessant scratching at the rocks with their tusks.

Second, myriad animals, big and small—including monkeys, leopards, rats, and shrews—frequent the cave. The inter-species traffic and the enclosed space create prime conditions for a virus to jump species.

Most of the time, Ebola and its related viruses remain in hiding. But when the viruses have emerged, they’ve devastated local villages and, occasionally, distant cities in other countries and continents. In this summary, we’ll talk about what happened during these outbreaks and the potential for future outbreaks.

But first, let’s discuss what the virus is and how it affects humans.

The Filovirus Family

Ebola belongs to a family of viruses named filoviruses, meaning “thread viruses,” because they look like threads or ropes under a microscope.

There are four viruses in the filovirus family:

1. Marburg, the mildest strain, with a kill rate of 1 in 4
2. Ebola Sudan, with a kill rate of about 1 in 2
3. Ebola...

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After the Marburg outbreak, global health officials were eager to find the source of the virus so that they could contain it and avoid future outbreaks. Although the virus arrived in Marburg via monkeys, the virus killed the monkeys too quickly to make them viable hosts—so it had to have been another animal or insect to which the monkeys were exposed.

The World Health Organization sent a team of investigators to Uganda, where the monkeys had been imported from, but they couldn’t identify the source.

1976: First Ebola Sudan Outbreak

The first known case of Ebola was in a man known as Yu. G., in the summer of 1976. Yu. G. lived in a southern Sudan, about 500 miles from Mount Elgon.

Yu. G. never went to the hospital—he died in a cot at home—nor was he well known outside his family and coworkers. Nevertheless, he set off an outbreak of the virus that was later named Ebola Sudan.

No one knows where or how Yu. G. contracted the virus, but it soon spread to a few of his coworkers, from whom it spread to friends, families, and a nearby hospital. From the hospital, the virus took off through the reuse of dirty needles.

Ebola Sudan killed hundreds of people in...

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• Sagging facial muscles, as his face’s connective tissue dissolved
• Blood clots in his head, hands, feet, lungs, liver, intestines, and kidneys
• Brain damage from blood clots in his brain, resulting in an erasure of personality called depersonalization
• Loss of higher brain functions as parts of his brain liquefied, leaving only more primitive parts of his brain intact
• Incessant nosebleed, as his body had used all the clotting factors to create the blood clots
• Black vomit

The black vomit was a sign that Monet was experiencing extreme amplification, meaning the virus had multiplied so extensively that it inhabited every part of the body, from skin to brain. The virus was literally taking over its host. By this point, even a drop of Monet’s blood may have had a hundred million particles of the virus, and the black vomit itself was heavily laden with the virus.

Still able to walk, Monet got off the plane, into a taxi, and headed to Nairobi Hospital. As he sat in the waiting room, he entered the final phase—what military biohazard specialists call “crashing and bleeding out.” This entailed:

• Dizziness and weakness, as his spine lost strength and...

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Any researchers whose suits had been breached and who were exposed to a Level 4 hot agent had to be quarantined in the USAMRIID’s biocontainment hospital, called the Slammer. Those who died were buried in a Level 4 biocontainment morgue, called the Submarine.

No risk could be overlooked when dealing with such deadly and highly infective agents.

Nancy Jaax’s Close Call

One researcher in Johnson’s Ebola experiments was Major Nancy Jaax, an army veterinarian who was training in veterinary pathology. When monkeys died in the experiment, Jaax’s job was to find out what had killed them—essentially confirming that Ebola was the cause of death.

One day, Jaax entered the monkey room to find and inspect two monkeys that had crashed and bled out. While working on one of the dead monkeys, Jaax noticed a hole in her glove. She panicked. Jaax’s glove had been covered in the infected monkey’s blood—and worse, she had a deep cut in the palm of that hand from a kitchen accident the night before.

Jaax rushed to the decontamination shower, then tore off her suit and carefully inspected the first of her three layers of hand protection, the latex glove that directly covered...

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However, all the animals in Johnson’s expedition remained healthy.

Additionally, the team caught and dissected small animals and thousands of bugs from the cave, hoping to find a sign of Marburg. But they found nothing.

Johnson’s expedition neither confirmed nor ruled out Kitum Cave as the source of the virus. The only thing he knew definitively was what he knew before the expedition: that Marburg lived somewhere on or near Mount Elgon.

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When Dalgard got the verdict from USAMRIID, he killed the rest of the monkeys in Room F, in order to stop the disease from spreading to monkeys in other rooms.

A few days later, Dalgard returned to the Reston facility to find that five monkeys had died in a room two doors down from Room F. This was alarming: Not only was the disease spreading, but it could skip rooms, suggesting it could be airborne.

Unusual Cell Cultures from the Reston Monkey Sample

Thomas Geisbert, an intern at USAMRIID, grew curious about the cultures that Jahrling was growing from the Reston monkey sample. Despite being just an intern, Geisbert specialized in taking high-powered electron-microscope photos and identifying the viruses he saw. He had studied the distinct shapes of various viruses and committed many to memory.

Under a standard light microscope, the Reston cultures looked like they’d been contaminated by outside bacteria. When bacteria destroy cultures, they create a smell—and when Geisbert and Jahrling opened the flask and took a few whiffs, they didn’t smell anything. However, they decided to put it under the electron microscope for a closer look anyway. It was the Friday...

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The group considered the options. There are three ways to stop a virus:

1. Vaccines, but none existed for Ebola
2. Drug treatments, but none existed for Ebola
3. Biocontainment, which would be their only option

One way to achieve biocontainment would be to cut off the Reston facility from the world, allow the virus to spread and kill the monkeys, and potentially quarantine all the employees who’d been exposed. But Option 1 would mean allowing the monkeys to suffer as they died off, and it wouldn’t give the researchers an opportunity to collect samples to study.

Option 2 was to enter the facility—a Level 4 hot zone. They would kill, collect samples from, and incinerate the monkeys, and then sterilize the entire building with chemicals.

The Army Informs Dalgard

Peters called Hazleton veterinarian Dalgard to let him know what they were dealing with. Dalgard was relieved to find out the virus wasn’t Marburg, which is well known and feared among professionals who work with monkeys. Dalgard had never heard of Ebola, but when Peters told him Ebola’s kill rate, he understood he was dealing with something even worse than Marburg.

Dalgard needed to loop in...

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With two of the facility’s four employees sick, Dalgard grew more worried about the seriousness of the situation. He immediately drove to his company’s headquarters to make the case for evacuating and shutting down the Reston facility, and then turning the building over to officials at USAMRIID. The general manager agreed.

Dalgard told Peters and Russell that Hazleton would let the Army take over the monkey house for full sterilization. They drew up an agreement, and the Reston facility was officially under the Army’s charge.

Biohazard SWAT Team Moves In

Jerry Jaax and his team would need to go back into the monkey house to deal with the hundreds of animals that were still in the remaining rooms. He made sure that everyone on his team was willing to participate in the mission, and he instructed team members to say nothing to anyone about the operation. Taking on the entire facility would be the first major biohazard mission in the world.

Johnson and Jaax planned the logistics of the operation. The biohazard SWAT team would systematically work through one monkey room at a time, dealing with each monkey in five steps:

1. **Making the monkey unconscious...

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1. Unlike the other filoviruses, it didn’t appear to affect people.

Researchers and officials at USAMRIID and CDC were stuck on several critical questions:

• If Ebola Zaire and Ebola Reston were so similar, why wasn’t Reston harmful to humans?
• Ebola Reston traced back to the Philippines, but how could it be so similar to Ebola Zaire if it originated on a different continent?

With still so much unknown about Ebola Reston, it remained classified as a Level 4 hot agent, despite the fact that it had yet to make any humans sick.

1990: Another Outbreak Hits Reston

After the Army was confident that the Reston facility was sterilized, it returned the monkey house to Hazleton’s custody. Hazleton resumed importing monkeys from the same supplier in the Philippines, and, within a month, the Reston facility had another outbreak.

As a result, the CDC imposed serious restrictions on companies that imported monkeys to mandate stricter testing and quarantine practices. The CDC also temporarily revoked Hazleton’s license for quarantine violations—though officials still praised Hazleton for making the responsible decision to turn over the Reston facility to the...

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The origin of AIDS was just as murky as the origin of Ebola, but most experts agreed the viruses probably jumped to humans from primates in the same region around Mount Elgon.

When Ebola emerged, infections erupted like wildfire, quickly spreading and rapidly killing its victims. By contrast, HIV’s outbreak was a slow burn, because it incubated for years before its victims finally died.

Scientists have struggled to develop a vaccine for AIDS because the virus mutated so quickly. In fact, an infected person could die with multiple strains present in her body—all of which mutated from the single strain that originally infected her. The virus’s rapid adaptability also made it extremely resilient in the face of changes.

Could AIDS and Ebola Be the Earth’s Defenses?

Preston mused that viruses like Ebola and AIDS could be the planet’s natural method of defending against the boom of human population and development. These and other emerging viruses originated in ecosystems under duress, and the strain was often due to human encroachment.

Rainforests—like the one on Mount Elgon—were fertile grounds for viruses because viruses lived in insects and animals, and the...