Part 1:The Hot Zone...The Shadow of Mt.Elgon,Something in The Forest...Project Ebola

The Hot Zone

By Richard Preston

This book describes events between 1967 and 1993. The incubation period of the viruses in this book is less than twenty-four days. No one who suffered from any of the viruses or who was in contact with anyone suffering from them can catch or spread the viruses outside of the incubation period. None of the living people referred to in this book suffer from a contagious disease. The viruses cannot survive independently for more than ten days unless the viruses are preserved and frozen with special procedures and laboratory equipment. Thus none of the locations in Reston or the Washington, D.C. area described in this book is infective or dangerous. 

The second angel poured his bowl into the sea, and it became like the blood of a dead man. 

– APOCALYPSE 

PART ONE 

THE SHADOW OF MOUNT ELGON 

SOMETHING IN THE FOREST 

1980 NEW YEAR'S DAY 

CHARLES MONET was a loner. He was a Frenchman who lived by himself in a little wooden bungalow on the private lands of Nzoia Sugar Factory, a plantation in western Kenya what spread along the Nzoia River within sight of Mount Elgon, a huge, solitary extinct volcano that rises to a height of fourteen thousand feet near the edge of the Rift Valley. Monet's history is a little obscure. As with so many expatriates who end up in Africa, it is not clear what brought him there. Perhaps he had been in some kind of trouble in France, or perhaps he had been drawn to Kenya by the beauty of the country. He was an amateur naturalist, fond of birds and animals but not of humanity in general. He was fifty-six years old, of medium height and medium build, with smooth, straight brown hair, a good-looking man. 

It seems that his only close friends were women who lived in towns around the mountain, yet even they could not recall much about him for the doctors who investigated his death. His job was to take care of the sugar factory's water-pumping machinery, which drew water from the Nzoia River and delivered it to many miles of sugar-cane fields. They say that he spent most of his day inside the pump house by the river, as if it pleased him to watch and listen to machines doing their work. 

So often in a case like this, it's hard to pin down the details. The doctors remember the clinical signs, because no one who has seen the effects of a Biosafety Level 4 hot agent on a human being can ever forget them, but the effects pile up, one after the other, until they obliterate the person beneath them. The case of Charles Monet emerges in a cold geometry of clinical fact mixed with flashes of horror so brilliant and disturbing that we draw back and blink, as if we are staring into a discolored alien sun. 

Monet came into the country in the summer of 1979, around the time that human immunodeficiency virus, or HIV, which causes AIDS, made a final breakout from the rain forest of central Africa and began its long burn through the human race. AIDS had already fallen like a shadow over the population, although no one yet knew it existed. It had been spreading quietly along the Kinshasa Highway, a transcontinental road that wanders across Africa from east to west and passes along the shores of Lake Victoria within sight of Mount Elgon. HIV is a highly lethal but not very infective Biosafety Level 2 agent. It does not travel easily from person to person, and it does not travel through the air. You don't need to wear a biological suit while handling blood infected with HIV. 

Monet worked hard in the pump house during the week, and on his weekends and holidays he would visit forested areas near the sugar factory. He would bring food with him, and he would scatter it around and watch while birds and animals ate it. He could sit in perfect stillness while he observed an animal. People who knew him recalled that he was affectionate with wild monkeys, that he had a special way with them. They said that he would sit holding a piece of food while a monkey approached him, and the animal would eat from his hand. 

On the evenings, he kept to himself in his bungalow. He had a housekeeper, a woman named Johnnie, who cleaned up and prepared his meals. 

He was teaching himself how to identify African birds. A colony of weaverbirds lived in a tree near his house, and he spent time watching them build and maintain their baglike nests. They say that one day near Christmas he carried a sick bird into his house, where it died, perhaps in his hands. The bird may have been a weaverbird – no one knows – and it may have died of a Level 4 virus – no one knows. He also had a friendship with a crow. It was a pied crow, a black-and-white bird that people in Africa sometimes make into a pet. This crow was a friendly, intelligent bird that liked to peek on the roof of Monet's bungalow and watch his comings and goings. When the crow was hungry, it would land on the veranda and walk indoors, and Monet would feed it scraps of food from his table. 

He walked to work every morning through the cane fields, a journey of two miles. That Christmas season, the workers had been burning the fields, and 5 so the fields were scorched and black. To the north across the charred landscape, twenty-five miles away, he could see Mount Elgon. 

The mountain displayed a constantly changing face of weather and shadow, rain and sun, a spectacle of African light. At dawn, Mount Elgon appeared as a slumped pile of gray ridges receding into haze, culminating in a summit with two peaks, which are opposed lips of the eroded cone. As the sun came up, the mountain turned silvery green, the color of the Mount Elgon rain forest, and as the day progressed clouds appeared and hid the mountain from view. Late in the afternoon, near sunset, the clouds thickened and boiled up into an anvil thunderhead that flickered with silent lightning. The bottom of the cloud was the color of charcoal, and the top of the cloud feathered out against the upper air and glowed a dull orange, illuminated by the setting sun, and above the cloud the sky was deep blue and gleamed with a few tropical stars. 

He had a number of women friends who lived in the town of Eldoret, to the southeast of the mountain, where the people are poor and live in shacks made of boards and metal. He gave money to his women friends, and they, in return, were happy to love him. When his Christmas vacation arrived, he formed a plan to go camping on Mount Elgon, and he invited one of the women from Eldoret to accompany him. No one seems to remember her name. 

Monet and his friend drove in a Land Rover up the long, straight red-dirt road that leads to Endebess Bluff, a prominent cliff on the eastern side the volcano. The road was volcanic dust, as red as dried blood. They climbed onto the lower skirts of the volcano and went through cornfields and coffee plantations, which gave way to grazing land, and the road passed old, half ruined English colonial farms hidden behind lines of blue-gum trees. The air grew cool as they went higher, and crested eagles flapped out of cedar trees. Not many tourists visit Mount Elgon, so Monet and his friend were probably the only vehicle on the road, although there would have been crowds of people walking on foot, villagers who cultivate small farms on the lower slopes of the mountain. They approached the frayed outer edge of the Mount Elgon rain forest, passing by fingers and islands of trees, and they passed the Mount Elgon Lodge, an English inn built in the earlier part of century, now falling into disrepair, its walls cracked and its paint peeling off in the sun and rain. 

Mount Elgon straddles the border between Uganda and Kenya and is not far from Sudan. The mountain is a biological island of rain forest in the center of Africa, an isolated world rising above dry plains, fifty miles across, blanketed with trees, bamboo, and alpine moor. It is a knob in the backbone of central Africa. The volcano grew up seven to ten million years ago, producing fierce eruptions and explosions of ash, which repeatedly wiped out the forests that grew on its slopes, until it attained a tremendous height. Before Mount Elgon was eroded down, it may have been the highest mountain in Africa, higher than Kilimanjaro is today. 

It is still the widest. When the sun rises, it throws the shadow of Mount Elgon westward and deep into Uganda, and when the sun sets, the shadow reaches eastward across Kenya. Within the shadow of Mount Elgon lie villages and cities inhabited by various tribal groups, including the Elgon Masai, a pastoral people who came from the north and settled around the mountain some centuries ago, and who raise cattle. The lower slopes of the mountain are washed with gentle rains, and the air remains cool and fresh all year, and the volcanic soil produces rich crops of corn. The villages form a ring of human settlement around the volcano, and the ring is steadily closing around the forest on its slopes, a noose that is tangling the wild habitat of the mountain. The forest is being cleared away, the trees are being cut down for firewood or to make room for grazing land, and the elephant are vanishing. 

A small part of Mount Elgon is a national park. Monet and his friend stopped at the park gate to pay their entrance fees. A monkey or perhaps a baboon – no one seems to remember – used to hang out around the gate, looking for handouts, and Monet enticed the animal to sit on his shoulder by offering it a banana. His friend laughed, but they stayed perfectly still while the animal ate. They drove a short way up the mountain and pitched their tent in a clearing of moist green grass that sloped down to a stream. The stream gurgled out of the rain forest, and it was a strange color, milky with volcanic dust. The grass was kept short by Cape buffalo grazing it, and was spotted with their dung. 

The Elgon forest towered around their campsite, a web of gnarled African olive trees hung with moss and creepers and dotted with a black olive that is poisonous to humans. They heard a scuffle of monkeys feeding in the trees, a hum of insects, an occasional low huh-huh call of a monkey. They were colobus monkeys, and sometimes one would come down from a tree and 7 scuttle across the meadow near the tent, watching them with alert, intelligent eyes. Flocks of olive pigeons burst from the trees on swift downward slants, flying at terrific speed, which is their strategy to escape from harrier hawks that can dive on them and rip them apart on the wing. There were camphor trees and teaks and African cedars and red stinkwood trees, and here and there a dark green cloud of leaves mushroomed above the forest canopy. These were the crowns of podocarpus trees, or podos, the largest trees in Africa, nearly as large as California sequoias. Thousands of elephants lived on the mountain then, and they could be heard moving through forest, making cracking sounds as they peeled bark and broke limbs from trees. 

In the afternoon, it would have rained, as it usually does on Mount Elgon, and so Monet and his friend would have stayed in their tent, and perhaps they made love while a thunderstorm hammered the canvas. It grew dark; the rain tapered off. They built a fire and cooked a meal. It was New Year's Eve. Perhaps they celebrated, drinking champagne. The clouds would have cleared off in a few hours, as they usually do, and the volcano would have emerged as a black shadow under the Milky Way. Perhaps Monet stood on the grass at the stroke of midnight and looked at the stars – neck bent backward, unsteady on his feet from the champagne. 

On New Year's morning, sometime after breakfast – a cold morning, air temperature in the forties, the grass wet and cold – they drove up the mountain along a muddy track and parked in a small valley below Kitum Cave. They bushwhacked up the valley, following elephant trails that meandered besides a little stream that ran through stands of olive trees and grassy meadows. They kept an eye out for Cape buffalo, a dangerous animal to encounter in the forest. The cave opened at the head of the valley, and the stream cascaded over its mouth. The elephant trails joined at the entrance and headed inside. Monet and his friend spent the whole of New Year's Day there. It probably rained, and so they would have sat in the entrance for hours while the little stream poured down in a veil. Looking across the valley, they watched for elephants, and they saw rock hyraxes – furry animals the size of groundhogs – running up and down the boulders near the mouth of the cave. 

Herds of elephants go inside Kitum Cave at night to obtain minerals and salts. On the plains, it is easy for elephants to find salt in hardpans and dry water holes, but in the rain forest salt is precious thing. The cave is large 8 enough to hold as many as seventy elephant at a time. They spend the night inside the cave, dozing on their feet or mining the rock with their tusks. They pry and gouge rocks off the walls, and chew them to fragments between their teeth, and swallow the broken bits of rock. Elephant dung around the cave is full of crumbled rock. 

Monet and his friend had a flashlight, and they walked back into the cave to see where it went. The mouth of the cave is huge – fifty-five yards wide – and it opens out even wider beyond the entrance. They crossed a platform covered with powdery dry elephant dung, their feet kicking up puffs of dust as they advanced. The light grew dim, and the floor of the cave rose upward in a series of shelves coated with green slime. The slime was bat guano, digested vegetable matter that had been excreted by a colony of fruit bats on the ceiling. 

Bats whirred out of holes and flicked through their flashlight beams, dodging around their heads, making high-pitched cries. Their flashlights disturbed the bats, and more bats woke up. Hundreds of bat eyes, like red jewels, looked down on them from the ceiling of the cave. Waves of bat sound rippled across the ceiling and echoed back and forth, a dry, squeaky sound, like many small doors being opened on dry hinges. Then they saw the most wonderful thing about Kitum Cave. The cave is petrified rain forest. Mineralized logs stuck out of the walls and ceiling. They were trunks of rain-forest trees turned to stone-teaks, podo trees, evergreens. An eruption of Mount Elgon about seven million years ago had buried the rain forest in ash, and the logs had been transformed into opal and chert. The logs were surrounded by crystals, white needles of minerals that had grown out of the rock. The crystals were as sharp as hypodermic syringes, and they glittered in the beams of the flashlights. 

Monet and his friend wandered through the cave, shining their lights on the petrified rain forest. Did he run his hands over the stone trees and prick his finger on a crystal? They found petrified bones of ancient hippos and ancestors of elephants. There were spiders hanging in webs among the logs. The spiders were eating moths and insects. 

They came to a gentle rise, where the main chamber widened to more than a hundred yards across – wider than the length of a football field. 

They found a crevice and shined their lights down to the bottom. There was something strange down there – a mass of gray and brownish material. 

It was the mummified corpses of baby elephants. When elephants walk through the cave at night, they navigate by their sense of touch, probing the floor ahead of them with the tips of their trunks. The babies sometimes fall into the crevice. 

Monet and his friend continued deeper into the cave, descending a slope, until they came to a pillar that seemed to support the roof. The pillar was scored with hatch marks and grooves, the marks of elephant tusks. If the elephants continued to dig away at the base of the pillar, it might eventually collapse, bringing down the roof of Kitum Cave with it. At the back of the cave, they found another pillar. This one was broken. Over it hung a velvety mass of bats, which had fouled the pillar with black guano – a different kind of guano from the green slime near the mouth of the cave. These bats were insect eaters, and the guano was an ooze of digested insects. Did Monet put his hand in the ooze? 

Monet's friend dropped out of sight for several years after that trip to Mount Elgon. Then, unexpectedly, she surfaced in a bar in Mombasa, where she was working as a prostitute. A Kenyan doctor who had investigated the Monet case happened to be drinking a beer in the bar, and he struck up an idle conversation with her and mentioned Monet's name. He was stunned when she said, "I know about that. I come from western Kenya. I was the woman with Charles Monet." 

He didn't believe her, but she told him the story in enough detail that he became convinced she was telling the truth. She vanished after that meeting in the bar, lost in the warrens of Mombasa, and by now she has probably died of AIDS. 

Charles Monet returned to his job at the pump house at the sugar factory. He walked to work each day across the burned cane fields, no doubt admiring the view of Mount Elgon, and when the mountain was buried in clouds, perhaps he could still feel its pull, like the gravity of an invisible planet. Meanwhile, something was making copies of itself inside Monet. A life form had acquired Charles Monet as a host, and it was replicating. 

THE HEADACHE BEGINS, typically, on the seventh day after exposure to the agent. On the seventh day after his New Year's visit to Kitum Cave – January 8, 1980 – Monet felt a throbbing pain behind his eyeballs. 

He decided to stay home from work and went to bed in his bungalow. The headache grew worse. His eyeballs ached, and then his temples began to ache, the pain seeming to circle around inside his head. It would not go away with aspirin, and then he got a severe backache. His housekeeper, Johnnie, was still on her Christmas vacation, and he had recently hired a temporary housekeeper. She tried to take care of him, but she really did not know what to do. Then, on the third day after his headache started, he became nauseated, spiked a fever, and began to vomit. His vomiting grew intense and turned into dry heaves. At the same time, he became strangely passive. His face lost all appearance of life and set itself into an expressionless mask, with the eyeballs fixed, paralytic, and staring. The eyelids were slightly droopy, which gave him a peculiar appearance, as if his eyes were popping out of his head and half-closed at the same time. The eyeballs themselves seemed almost frozen in their sockets, and they turned bright red. The skin of his face turned yellowish, with brilliant star like red speckles. He began to look like a zombie. His appearance frightened the temporary housekeeper. She didn't understand the transformation in this man. His personality changed. He became sullen, resentful, angry, and his memory seemed to be blown away. 

He was not delirious. He could answer questions, although he didn't seem to know exactly where he was. 

When Monet failed to show up for work, his colleagues began to wonder about him, and eventually they went to his bungalow to see if he was all right. The black-and-white crow sat on the roof and watched them as they went inside. They looked at Monet and decided that he needed to get to a hospital. Since he was very unwell and no longer able to drive a car, one of his co-workers drove him to a private hospital in the city of Kisumu, on the shore of Lake Victoria. The doctors at the hospital examined Monet, and could not come up with any explanation for what he might have some kind of bacterial infection, they gave him injections of antibiotics, but the antibiotics had no effect on his illness.

The doctors thought he should go to Nairobi Hospital, which is the best private hospital in East Africa. The telephone system hardly worked, and it did not seem worth the effort to call any doctors to tell them that he was coming. He could still walk, and he had to get to Nairobi. They put him in a taxi to the airport, and he boarded a Kenya Airways flight. 

A hot virus from the rain forest lives within a twenty-four-hour plan flight from every city on earth. All of the earth's cities are connected by a web of airline routes. The web is a network. Once a virus hits the net, it can shoot anywhere in a day – Paris, Tokyo, New York, Los Angeles, wherever planes fly. Charles Monet and the life form inside him had entered the net. 

The plane was a Fokker Friendship with propellers, a commuter aircraft that seats thirty-five people. It started its engines and took off over Lake Victoria, blue and sparkling, dotted with dugout canoes of fishermen. The Friendship turned and banked eastward, climbing over green hills quilted with tea plantations and small farms. The commuter flights that drone across Africa are often jammed with people, and this flight was probably full. The plane climbed over belts of forest and clusters of round huts and villages with tin roofs. The land suddenly dropped away, going down in shelves and ravines, and changed in color from green to brown. The plane was crossing the Eastern Rift Valley. The passengers looked out the windows at the place where the human species was born. 

They saw specks of huts clustered inside circles of thorn bush, with cattle trails radiating from the huts. The propellers moaned, and the Friendship passed through cloud streets, lines of puffy Rift clouds, and began to bounce and sway. Monet became airsick. 

The seats are narrow and jammed together on these commuter airplanes, and you notice everything that is happening inside the cabin. The cabin is tightly closed, and the air recirculates. If there are any smells in the air, you perceive them. You would not have been able to ignore the man who was getting sick. He hunches over in his seat. There is something wrong with him, but you can't tell exactly what is happening. 

He is holding an airsickness bag over his mouth. He coughs a deep cough and regurgitates something into the bag. The bag swells up. 

Perhaps he glances around, and then you see that his lips are smeared with something slippery and red, mixed with black specks, as if he has been chewing coffee grounds. His eyes are the color of rubies, and his face is an expressionless mass of bruises. The red spots, which a few days before had started out as star like speckles, expanded and merged into huge, spontaneous purple shadows; his whole head is turning black-and-blue. The muscles of his face droop. The connective tissue in his face is dissolving, and his face appears to hang from underlying bone, as if the face is detaching itself from the skull. He opens his mouth and gasps into the bag, and the vomiting goes on endlessly. It will not stop, and he keeps bringing up liquid, long after his stomach should have been empty. The airsickness bag fills up to the brim with a substance known as vomit negro, or the black vomit. The black vomit is not really black; it is a speckled liquid of two colors, black and red, a stew of tarry granules mixed with fresh red arterial blood. It is hemorrhage, and it smells like a slaughterhouse. The black vomit is loaded with virus. It is highly infective, lethally hot, a liquid that smell of the vomit negro fills the passenger cabin. The airsickness bag is brimming with black vomit, so Monet closes the bag and rolls up the top. The bag bulging and softening, threatening to leak, and he hands it to a flight attendant. 

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. 

He appears to be holding himself rigid, as if any movement would rupture something inside him. His blood is clotting up – his bloodstream is throwing clots, and the clots are lodging everywhere. His liver, kidneys, lungs, hands, feet, and head are becoming jammed with blood clots. In effect, he is having a stroke through the whole body. Clots are accumulating in his intestinal  muscles, cutting off the blood supply to his intestines. The intestinal muscles are beginning to die, and the intestines are starting to go slack. He doesn't seem to be fully aware of pain any longer because the blood clots lodged in his brain are cutting off blood flow. His personality is being wiped away by brain damage. 

This is called depersonalization, in which the liveliness and details of character seem to vanish. He is becoming an automaton. Tiny spots in his brain are liquefying. The higher functions of consciousness are winking out first, leaving the deeper parts of the brain stem (the primitive rat brain, the lizard brain) still alive and functioning. It could be said that the who of Charles Mont has already died while the what of Charles Monet continues to live. 

The vomiting attack appears to have broken some blood vessels in his nose,he gets a nosebleed. The blood comes from both nostrils, a shining, cloudless, arterial liquid that drips over his teeth and chin. This blood keeps running, because the clotting factors have been used up. A flight attendant gives him some paper towels, which he uses to stop up his nose, but the blood still won't coagulate, and the towels soak through. 

When a man is ill in an airline seat next to you, you may not want to embarrass him by calling attention to the problem. You say to yourself that this man will be all right. Maybe he doesn't travel well in airplanes. He is airsick, the poor man, and people do get nosebleeds in airplanes, the air is so dry and thin ... and you ask him, weakly, if there is anything you can do to help. He does not answer, or he mumbles words you can't understand, so you try to ignore it, but the flight seems to go on forever. Perhaps the flight attendants offer to help him. But victims of this type of hot virus have changes in behavior that can render them incapable of responding to an offer of help. They become hostile, and don't want to be touched. They don't want to speak. They answer questions with grunts or monosyllables. They can't seem to find words. 

They can tell you their name, but they can't tell you the day of the week or explain what has happened to them. 

The Friendship drones through the clouds, following the length of the Rift Valley, and Monet slumps back in the seat, and now he seems to be dozing ... Perhaps some of the passengers wonder if he is dead. No, no, he is not dead. He is moving. His red eyes are open and moving around a little bit. 

It is late afternoon, and the sun is falling down into the hills to the west of the Rift Valley, throwing blades of light in all directions, as if the sun is cracking up on the equator. The Friendship makes a gentle turn and crosses the eastern scarp of the Rift. 

The land rises higher and changes in color from brown to green. The Ngong Hills appear under the right wing, and the plane, now descending, passes over parkland dotted with zebra and giraffes. A minute later, it lands at Jomo Kenyatta International Airport. Monet stirs himself. He is still able to walk. 

He stands up, dripping. He stumbles down the gangway onto the tarmac. 

His shirt is a red mess. He carries no luggage. His only luggage is internal, and it is a load of amplified virus. Monet has been transformed into a human virus bomb. He walks slowly into the airport terminal and through the building and out to a curving road where taxis are always parked. The taxi drivers surround him – "Taxi?" "Taxi?" 

"Nairobi... Hospital," he mumbles. 

One of them helps him into a car. Nairobi taxi drivers like to chat with their fares, and this one probably asks if he is sick. The answer should be obvious. Monet's stomach feels a little better now. It is heavy, dull, and bloated, as if he has eaten a meal, rather than empty and torn and on fire. 

The taxi pulls onto the Uhuru Highway and heads into Nairobi. It goes through grassland studded with honey-acacia trees, and it goes past factories, and then it comes to a rotary and enters the bustling street life of Nairobi. Crowds are milling on the shoulders of the road, women walking on beaten dirt pathways, men loitering, children riding bicycles, a man repairing shoes by the side of the road, a tractor pulling a wagonload of charcoal. The taxi turns left onto the Ngong Road and goes past a city park and up a hill, past lines of tall blue-gum trees, and it turns up a narrow road and goes past a guard gate and enters the grounds of Nairobi Hospital. It parks at a taxi stand beside a flower kiosk. A sign by a glass door says CASUALTY DEPT. Monet hands the driver some money and gets out of the tax and opens the glass door and goes over to the reception window and indicates that he is very ill. He has difficulty speaking. 

The man is bleeding, and they will admit him in just a moment. He must wait until a doctor can be called, but the doctor will see him immediately, not to worry. He sits down in the waiting room. 

It is a small room lined with padded benches. The clear, strong ancient light of East Africa pours through a row of window and falls across a table heaped with soiled magazines, and makes rectangles on a pebbled gray floor that has a drain in the center. The room smells vaguely of wood smoke and sweat, and it is jammed with bleary-eyed people, Africans and Europeans sitting shoulder to shoulder. There is always someone in Casualty who has a cut and is waiting for stitches. People wait patiently, holding a washcloth against the scalp, holding a bandage pressed around a finger, and you may see a spot of blood on the cloth. So Charles Monet is sitting on a bench in casualty, and he does not look very much different from someone else in the room, except for his bruised, expressionless face and his red eyes. A sign on the wall warns patients to watch out for purse thieves, and another sign says: 

PLEASE MAINTAIN SILENCE YOUR COOPERATION WILL BE APPRECIATED. NOTE: THIS IS A CASUALTY DEPARTMENT. EMERGENCY CASES WILL BE TAKEN IN PRIORITY. YOU MAY BE REQUIRED TO WAIT FOR SUCH CASES BEFORE RECEIVING ATTENTION 

Monet maintains silence, waiting to receive attention. Suddenly he goes into the last phase. The human virus bomb explodes. Military biohazard specialists have ways of describing this occurrence. They say that the victim has "crashed and bled out". Or more politely they say that the victim has "gone down". 

He becomes dizzy and utterly weak, and his spine goes limp and nerveless and he loses all sense of balance. The room is turning around and around. He is going into shock. He leans over, head on his knees, and brings up an  incredible quantity of blood from his stomach and spills it onto the floor with a gasping groan. He loses consciousness and pitches forward onto the floor. The only sound is a choking in his throat as he continues to vomit while unconscious. Then come a sound like bedside being torn in half, which is the sound of his bowels opening and venting blood from sloughed his gut. The linings of his intestines have come off and are being expelled along with huge amount of blood. Monet has crashed and is bleeding out. 

The other patients in the waiting room stand up and move away from the man on the floor, calling for a doctor. Pools of blood spread out around him, enlarging rapidly. Having destroyed its host, the agent is now coming out of every orifice, and is "trying" to find a new host. 

JUMPER 
1980 JANUARY 15 
NURSES AND AIDES came running, pushing a gurney along with them, and they lifted Charles Monet onto the gurney and wheeled him into the intensive care unit at Nairobi Hospital. A call for a doctor went out over the loudspeakers: a patient was bleeding in the ICU. A young doctor named Shem Musoke ran to the scene. Dr. Musoke was widely considered to be one of the best young physicians at the hospital, an energetic man with a warm sense of humor, who worked long hours and had a good feel for emergencies. 

He found Monet lying on the gurney. He has no idea what was wrong with the man, except that he was obviously having some kind of massive hemorrhage. There was no time to try to figure out what has caused it. 

He was having difficulty breathing – and then his breathing stopped. He had inhaled blood and had a breathing arrest. 

Dr. Musoke felt for a pulse. It was weak and sluggish. A nurse ran and fetched a laryngoscope, a tube that can be used to open a person's airway. Dr. Musoke ripped open Monet's shirt so that he could observe any rise and fall of the chest, and he stood at the head of the gurney and bent over Monet's face until he was looking directly into his eyes, upside down. 

Monet stared redly at Dr. Musoke, but there was no movement in the eyeballs, and the pupils were dilated. Brain damage: nobody home. His nose was bloody and his mouth was bloody. Dr. Musoke tilted the patient's head back to open the airway so that he could insert the laryngoscope. He was not wearing rubber gloves. He ran his finger around the patient's tongue to clear the mouth of debris, sweeping out mucus and blood. His hands became greasy with black curd. The patient smelled of vomit and blood, but this was nothing new to Dr. Musoke, and he concentrated on his work. He leaned down until his face was a few inches away from Monet's face, and he looked into Monet's mouth in order to judge the position of the scope. Then he slid the scope over Monet's tongue and pushed the tongue out of the way so that he could see down the airway past the epiglottis, a dark hole leading inward to the lungs. He pushed the scope into the hole, peering into the instrument. Monet suddenly jerked and thrashed. 

Monet vomited. 

The black vomit blew up around the scope and out of Monet's mouth. Black-and-red fluid spewed into the air, showering down over Dr. Musoke. 

It struck him in the eyes. It splattered over his white coat and down his chest, marking him with strings of red slime dappled with dark flecks. It landed in his mouth. 

He re-positioned his patient's head and swept the blood out of the patient's mouth with his fingers. The blood had covered Dr. Musoke's hands, wrists and forearms. It had gone everywhere – all over the gurney, all over Dr. Musoke, all over the floor. The nurses in the intensive care unit couldn't believe their eyes, and they hovered in the background, not knowing quite what to do. Dr. Musoke peered down into the airway and pushed the scope deeper into the lungs. He saw that the airways were bloody. 

Air rasped into the man's lungs. The patient had began to breathe again. 

The patient was apparently in shock from loss of blood. He had lost so much blood that he was becoming dehydrated. The blood had come out of practically every opening in his body. There wasn't enough blood left to maintain circulation, so his heartbeat was very sluggish, and blood pressure was dropping toward zero. He needed a blood transfusion.  

A nurse brought a bag of whole blood. Dr. Musoke hooked the bag on a stand an inserted the needle into the patient's arm. There was something wrong with the patient's veins; his blood poured out around the needle. 

Dr. Musoke tried again, putting the needle into another place in the patient's arm and probing for the vein. Failure. More blood poured out. 

At every place in the patient's arm where he stuck the needle, the vein broke apart like cooked macaroni and spilled blood, and the blood ran from the punctures down the patient's arm and wouldn't coagulate. Dr. Musoke abandoned his efforts to give his patient a blood transfusion for fear that the patient would bleed to death out of the small hole in his arm. 

The patient continued to bleed from the bowels, and these hemorrhages were now as black as pitch. 

Monet's coma deepened, and he never regained consciousness. He died in the intensive care unit in the early hours of the morning. Dr. Musoke stayed by his bedside the whole time. 

They has no idea what had killed him. It was unexplained death. 

They opened him up for an autopsy and found that his kidneys were destroyed and that his liver was dead. His liver had ceased functioning several days before he died. It was yellow, and parts of it had liquefied – it looked like the liver of a three-day-old cadaver. It was as if Monet had become a corpse before his death. Sloughing of the gut, in which the intestinal ling comes off, is another effect that is ordinarily seen in a corpse that is days old. What, exactly, was the cause of death? 

It was impossible to say because there were too many possible causes. 

Everything had gone wrong inside this man, absolutely everything, any one of which could have been fatal: the clotting, the massive hemorrhages, the liver turned into pudding, the intestines full of blood. Lacking words, categories, or language to describe what had happened, they called it, finally, a case of "fulminating liver failure". His remain were placed in a waterproof bag and, according to one account, buried locally. When I visited Nairobi, years later, no one remembered where the grave was. 

1980 JANUARY 24 
NINE DAYS AFTER the patient vomited into Dr. Shem Musoke's eyes and mouth, Musoke developed an aching sensation in his back. He was not prone to backaches – really, he had never had a serious backache, but he was approaching thirty, and it occurred to him that he was getting into the time of life when some men begin to get bad backs. He had been driving himself hard these past few weeks. He had been up all night with a patient who had heart problems, and then, the following night, he had been up most of the night with that Frenchman with hemorrhages who has come from somewhere upcountry. So he had been going nonstop for days without sleep. 

He hadn't thought much about the vomiting incident, and when the ache began to spread through his body, he still didn't think about it. Then, when he looked in a mirror, he noticed that his eyes were turning red. 

Red eyes – he began to wonder if he had malaria. He had a fever now, so certainly he had some kind of infection. The backache had spread until all the muscles in his body ached badly. He started taking malaria pills, but they didn't do any good, so he asked one of the nurses to give him an injection of an antimalarial drug. 

The nurse gave it to him in the muscle of his arm. The pain of the injection was very, very bad. He had never felt such pain from a shot; it was abnormal and memorable. He wondered why a simple shot would give him this kind of pain. Then he developed abdominal pain, and that made him think that he might have typhoid fever, so he gave himself a course of antibiotic pills, but that had no effect on his illness. Meanwhile, his patients needed him, and he continued to work at the hospital. The pain in his stomach and in his muscles grew unbearable, and he developed jaundice. 

Unable to diagnose himself, in severe pain, and unable to continue with his work, he presented himself to Dr. Antonia Bagshawe, a physician at Nairobi Hospital. She examined him, observed his fever, his red eyes, his jaundice, his abdominal pain, and came up with nothing definite, but wondered if he had gallstones or a liver abscess. A gall-bladder attack or a liver abscess could cause fever and jaundice and abdominal pain – the red eyes she could not explain – and she ordered an ultrasound examination of his liver. She studied the images of his liver and saw that it was enlarged, but, other than  that, she could see nothing unusual. By this time, he was very sick, and they put him in a private room with nurses attending him around the clock. His face set itself into an expressionless mask. 

This possible gallstone attack could be fatal. Dr. Bagshawe recommended that Dr. Musoke have exploratory surgery. He was opened up in the main operating theater at Nairobi Hospital by a team of surgeons headed by Dr. Imre Lofler. They made an incision over his liver and pulled back the abdominal muscles. What they found inside Musoke was eerie and disturbing, and they could not explain it. His liver was swollen and red and did not look healthy, but they could not find any sign of gallstones. Meanwhile, he would not stop bleeding. Any surgical procedure will cut through blood vessels, and the cut vessels will ooze for a while and then clot up, or if the oozing continues, the surgeon will put dabs of gel foam on them to stop the bleeding. Musoke's blood vessels would not stop oozing-his blood would not clot. It was as if he had become a hemophiliac. They dabbed gel foam all over his liver, and the blood came through the foam. He leaked blood like a sponge. They had to suction off a lot of blood, but as they pumped it out, the incision filled up again. It was like digging a hole below the water table; it fills up as fast as you pump it out. One of the surgeons would later tell people that the team had been "up to the elbows in blood". They cut a wedge out of his liver – a liver biopsy – and dropped the wedge into a bottle of pickling fluid and closed up Musoke as quickly as they could. 

He deteriorated rapidly after the surgery, and his kidneys began to fail. He appeared to be dying. At that time, Antonia Bagshawe, his physician, had to travel abroad, and he came under the care of a doctor named David Silverstein. The prospect of kidney failure and dialysis for Dr. Musoke created a climate of emergency at the hospital – he was well liked by his colleagues, and they didn't want to lose him. Silverstein began to suspect that Musoke was suffering from an unusual virus. He collected some blood from his patient and drew off the serum, which is a clear, golden-colored liquid that remains when the red cells are removed from the blood. He sent some tubes of frozen serum to laboratories for testing – to the National Institute of Virology in Sandringham, South Africa, and to the Centers for Disease Control in Atlanta, Georgia, U.S.A. 

Then he waited for results.

DIAGNOSIS 
DAVID SILVERSTEIN LIVES IN Nairobi, but he owns a house near Washington ,D.C. One day in the summer recently, when he was visiting the United States to tend to some business, I met him in a coffee shop in a shopping mall not far from his home. We sat at a small table, and he told me about Monet and Musoke cases. Silverstein is a slender, short man in his late forties, with a mustache and glasses, and he has an alert, quick gaze. 

Although he is an American, his voice carries a hint of Swahili accent. 

On the day that I met him, he was dressed in a denim jacket and blue jeans, and he was nicely tanned, looking fit and relaxed. He is a pilot, and he flies his own plane. He has the largest private medical practice in East Africa, and it has made him a famous figure in Nairobi. He is the personal physician of Daniel arap Moi, the president of Kenya, he travels with President Moi when Moi goes abroad. He treats all the important people in East Africa: the corrupt politicians, the actors and actresses who get sick on safari, the decayed English-African nobility. He traveled at the side of Diana, Lady Delamere, as her personal physician when she was growing old, to monitor her blood pressure and heartbeat (she wanted to carry on with her beloved sport of deep-sea fishing off the Kenya coast, although she had a heart condition), and he was also Beryl Markham's doctor. Markham, the author of West with the Night, a memoir of her years as an aviator in East Africa, used to hang out at the Nairobi Aero Club, where she had a reputation for being a slam-bang, two-fisted drinker. ("She was a well-pickled old lady by the time I came to her.") 

His patient Dr. Musoke has himself become a celebrity, in the annals of disease. "I was treating Dr. Musoke with supportive care" Silverstein said to me. "That was all I could do. I tried to give him nutrition, and I tried to lower his fevers when they were high. I was basically taking care of somebody without a game plan." 

One night, at two o'clock in the morning, Silverstein's telephone rang at his home in Nairobi. It was an American researcher stationed in Kenya calling him to report that the South Africans had found something very queer in Musoke's blood: "He's positive for Marburg virus. This is really serious. We don't know much about Marburg."

Silverstein had never heard of Marburg virus. "After the phone call, I could not get back to sleep," he said to me. "I had kind of waking dream about it, wondering what Marburg was." He lay in bed, thinking about the sufferings of his friend and colleague Dr. Musoke, fearful of what sort of organism had gotten loose among the medical staff at the hospital. He kept hearing the voice saying, "We don't know much about Marburg." Unable to sleep, he finally got dressed and drove to the hospital, arriving at his office before dawn. He found a medical textbook and looked up Marburg virus. 

The entry was brief Marburg is an African organism, but it has a German name. Viruses are named for the place where they are first discovered. Marburg is an old city in central Germany, surrounded by forests and meadows, where factories nestle in green valleys. The virus erupted there in 1967, in a factory called the Behring Works, which produced vaccines using kidney cells from African green monkeys. The Behring Works regularly imported monkeys from Uganda. The virus came to Germany hidden somewhere in a series of air shipment of monkeys totaling five or six hundred animals. As few as two or three of the animals were incubating the virus. They were probably not even visibly sick. At any rate, shortly after they arrived at the Behring Works, the virus began to spread among them, and a few of them crashed and bled out. Soon afterward, the Marburg agent jumped species and suddenly emerged in human population of the city. This is an example of virus amplification. 

The first person known to be infected with Marburg agent was a man called Klaus F., an employee at Behring Works vaccine factory who fed the monkeys and washed their cages. He broke with the virus on August 8, 1967, and died two weeks later. So little is known about the Marburg agent that only one book has been published about it, a collection of papers presented at a symposium on virus, held at the University of Marburg in 1970. In the book, we learn that the monkey-keeper HEINRICH P. came back from his holiday on August 13th 1967 and did his job of killing monkeys from 14th-23rd. The first symptoms appeared on August 21st. The laboratory assistant RENATE L. broke a test-tube that was to be sterilized, which had contained infected material, on August 28th, and fell ill on September 4th 1967. 

And so on. The victims developed headaches at about day seven after their exposure and went downhill from there, with raging fevers, clotting, spurts of blood, and terminal shock. For a few days in Marburg, doctors in the city thought the world was coming to an end. Thirty one people eventually caught the virus; seven died in pools of blood. The kill rate of Marburg turned out to be about one in four, which makes Marburg an extremely lethal agent: even in the best modern hospitals, where the patients are hooked up to life-support machines, Marburg kills a quarter of the patients who are infected with it. By contrast, yellow fever, which is considered a highly lethal virus, kills only about one in twenty patients once they reach hospital. 

Marburg is one of a family of viruses known as the filoviruses. Marburg was the first filovirus to be discovered. The word filovirus is Latin and means "thread virus". The filoviruses look alike, as if they are sisters, and they resemble no other virus on earth. While most viruses are ball shaped particles that look like peppercorns, the thread viruses have been compared to strands of tangled rope, to hair, to worms, to snakes. When they appear in a great flooding mess, as they so often do when they have destroyed a victim, they look like a tub of spaghetti that has been dumped on the floor. Marburg particles sometimes roll up into loops. The loops resemble Cheerios. Marburg is the only ring-shaped virus known. 

In Germany, the effects of Marburg virus on the train were particularly frightening, and resembled the effects of rabies: the virus somehow damaged the central nervous system and could destroy the brain, as does rabies. The Marburg particles also looked rather like rabies particles. The rabies-virus particle is shaped like a bullet. If you stretch out a bullet, it begins to look like a length of rope, and if you coil the rope into a loop, it becomes a ring, like Marburg. Thinking that Marburg might be related to rabies, they called it stretched rabies. 

Later it became clear that Marburg belongs to its own family. 

Not long after Charles Monet died, it was established that the family of filoviruses comprised Marburg along with two types of virus called Ebola. The Ebolas were named Ebola Zaire and Ebola Sudan Marburg was the mildest of the three filovirus sisters. The worst of them was Ebola Zaire. The kill rate in humans infected with Ebola Zaire is nine out of ten. Ninety percent of the people who come down with Ebola Zaire die of it. Ebola Zaire is a slate wiper in humans. 

Marburg virus (the gentle sister) affects humans somewhat like nuclear radiation, damaging virtually all of the tissues in their bodies. 

It attacks with particular ferocity the internal organs, connective tissue, intestines, and skin. In Germany, all the survivors lost their hair – they went bald or partly bald. Their hair died at the roots and fell out in clumps, as if they had received radiation burns. Hemorrhage occurred from all orifices of the body. I have seen a photograph of one of the men who died of Marburg, taken in the hours before his death. He is lying in bed without any clothing on his upper body. His face is expressionless. His chest, arms, and face are speckled with blotches and bruises, and droplets of blood stand on his nipples. 

During the survivors' recovery period, the skin peeled off their faces, hands, feet, and genitals. Some of the men suffered from blown up, semi rotten testicles. One of the worst cases of this appeared in a morgue attendant who had handled Marburg-infected bodies. The virus also lingered in the fluid inside the eyeballs of some victims for many months. 

No one knows why Marburg has a special affinity for the testicles and the eyes. One man infected his wife with Marburg through sexual intercourse. 

Doctors noticed that the Marburg agent had a strange effect on the brain. "Most of the patients showed a sullen, slight aggressive, or negativistic behavior," according to the book. "Two patients (had) a feeling as if they were lying on crumbs." One patient became psychotic, apparently as a result of brain damage. The patient named Hans O.V. showed no signs of mental derangement, and his fever cooled, and he seemed to be stabilizing, but then suddenly, without warning, he had an acute fall in blood pressure – he was crashing – and he died. They performed an autopsy on him, and when they opened his skull, they found a massive, fatal hemorrhage at the center of the brain. He had bled out into his brain. 

International health authorities were urgently concerned to find the exact source of the monkeys, in order to pin down where in nature the Marburg virus lived. It seemed pretty clear that the Marburg virus did not  naturally circulate in monkeys, because it killed them so fast it could not successfully establish itself in them as a useful host. 

Therefore, Marburg lived in some other kind of host – an insect? a rat? a spider? a reptile? Where, exactly, had the monkeys been trapped? That place would be the hiding place of the virus. Soon after the outbreak in Germany, a team of investigators under the auspices of the World Health Organization flew to Uganda. The team couldn't discover the exact source of the virus. 

There the mystery lingered for many years. Then, in 1982, an English veterinarian came forward with new eyewitness information about the Marburg monkeys. I will call this man Mr. Jones (today, he prefers to remain anonymous). During the summer of 1967, when the virus erupted in Germany, Mr. Jones was working at a temporary job inspecting monkeys at the export facility in Entebbe from which the sick Marburg monkeys had been shipped, while regular veterinary inspector was on leave. This monkey house, which was run by a rich monkey trader ("a sort of lovable rogue," according to Mr. Jones) was exporting about thirteen thousand monkeys a year to Europe. This was a very large number of monkeys, and it generated big money. The infected shipment was loaded onto an overnight flight to London, and from there it was flown to Germany – where the virus broke out of the monkeys and "attempted" to establish itself in the human population. 

After making a number of telephone calls, I finally located Mr. Jones in a town in England, where today he is working as a veterinary consultant. He said to me: "All that animals got, before they were shipped off, was a visual inspection." 

"By whom?" I asked. 

"By me," he said. "I inspected them to see that they appeared normal. On occasion, with some of these shipments, one or two animals were injured or had skin lesions." His method was to pick out the sick-looking ones, which were removed from the shipment and presumably killed before the remaining healthy-looking animals were loaded onto the plane. When, a few weeks later, the monkeys started the outbreak in Germany, Mr. Jones felt terrible. "I was appalled, because I had signed the export certificate," he said to me. "I feel now that I have the deaths of these people on my hands. But  that feeling suggests I could have done something about it. There was no way I could have known." He is right about that: the virus was then unknown to science, and as few as two or three not-visibly-sick animals could have started the outbreak. 

One concludes that the man should not be blamed for anything. 

The story becomes more disturbing. He went on: "The sick ones were being killed, or so I thought." But later he learned that they weren't being killed. The boss of the company was having the sick monkeys put in boxes and shipped out to a small island in Lake Victoria, where they were released. With so many sick monkeys running around it, the island could have become a focus for monkey viruses. It could have been a hot island, an isle of plagues. "Then, if this guy was a bit short of monkeys, he went out to the island and caught a few, unknown to me." Mr. Jones thinks it is possible that the Marburg agent had established itself on the hot island, and was circulating among the monkeys there, and that some of the monkeys which ended up in Germany had actually come from that island. 

But when the WHO team came later to investigate, "I was told by my boss to say nothing unless asked." As it turned out, no one asked Mr. Jones any questions – he says he never met the WHO team. The fact that the team apparently never spoke with him, the monkey inspector, "was bad epidemiology but good politics," he remarked to me. If it had been revealed that the monkey trader had shipped off suspect monkeys collected on a suspect island, he could have been put out of business, and Uganda would have lost a source of valuable foreign cash. 

Shortly after the Marburg outbreak, Mr. Jones recalled a fact that began to seem important to him. Between 1962 and 1965 he had been stationed in eastern Uganda, on the slopes of Mount Elgon, inspecting cattle for disease. At some time during that period, local chiefs told him that the people who lived on the north side of the volcano, along the Greek River, were suffering from a disease that caused bleeding, death, and "a particular skin rash" – and that monkeys in the area were dying of a similar disease. Mr. Jones did not pursue the rumors, and was never able to confirm the nature of the disease. But it seems possible that in the years preceding the outbreak of Marburg virus in Germany, a hidden outbreak of the virus occurred on the slopes of Mount Elgon. 

MR. JONES'S PERSONAL VISION of the Marburg outbreak reminds me of a flashlight pointed down a dark hole. It gives a narrow but startling view of the larger phenomenon of the origin and spread of tropical viruses. He told me that some of the Marburg monkeys were trapped in a group of islands in Lake Victoria known as the Senses Islands. The Senses are a low-lying forested archipelago in the northwestern part of Lake Victoria, an easy boat ride from Entebbe. The isle of plagues may have been situated among the Senses or near them. Mr. Jones does not recall the name of the hot island. He says it is close to Entebbe. At any rate, Mr. Jones's then-boss, the Entebbe monkey trader, had arranged a deal with villagers in the Senses Islands to buy monkeys from them. They regarded the monkeys as pests and were happy to get rid of them, especially for money. 

So the trader was obtaining wild monkeys from Senses Islands, and if the animals proved to be sick, he was releasing them on another island somewhere near Entebbe. And some monkeys from the isle of plagues seemed to be ending up in Europe. 

In papyrus reeds and desolate flatlands on the western shore of Lake Victoria facing the Senses Islands, there is a fishing village called Kasensero. You can see the Senses Islands from the village. Kasensero was one of the first places in the world where AIDS appeared. Epidemiologists have since discovered that the northwestern shore of Lake Victoria was one of the initial epicenters of AIDS. It is generally believed that AIDS came originally from African primates, from monkeys and apes, and that it somehow jumped out of these animals into the human race. It is thought that the virus went through a series of very rapid mutations at the time of its jump from primates to humans, which enabled it to establish itself successfully in people. In the years since AIDS virus emerged, the village of Kasensero has been devastated. The virus has killed a large portion of the inhabitants. It is said that other villages along the shores of Lake Victoria have been essentially wiped off the map. 

The villagers of Kasensero are fishermen who were, and are, famous as smugglers. In their wooden boats and motorized canoes they ferried illegal goods back and forth across the lake, using the Senses Islands as hiding places. One can guess that if a monkey trader were moving monkeys around Lake Victoria, he might call on the Kasensero smugglers or on their neighbors. 

One general theory for the origin of AIDS goes that, during the late nineteen-sixties, a new and lucrative business grew up in Africa, the export of primates to industrialized countries for use in medical research. Uganda was one of the biggest sources of these animals. As the monkey trade was established throughout central Africa, the native workers in the system, the monkey trappers and handlers, were exposed to large numbers of wild monkeys, some of which were carrying unusual viruses. 

These animals, in turn, were being jammed together in cages, exposed to one another, passing viruses back and forth. furthermore, different species of monkeys were mixed together. It was a perfect setup for an outbreak of a virus that could jump species. It was also a natural laboratory for rapid virus evolution, and possibly it led to the creation of HIV. Did HIV crash into the human race as a result of the monkey trade? Did AIDS come from an island in Lake Victoria? A hot island? Who knows. When you begin probing into the origins of AIDS and Marburg, the light fails and things go dark, but you sense hidden connections. Both viruses seem part of a pattern. 

WHEN HE LEARNED what Marburg virus does to human beings, Dr. David Silverstein persuaded the Kenyan health authorities to shut down Nairobi Hospital. For a week, patients who arrived at the doors were turned away, while sixty seven people were quarantined inside the hospital, most medical staff. They included the doctor who had done autopsy on Monet, nurses who had attended Monet or Dr. Musoke, the surgeons who had operated on Musoke, and aides and technicians who had handled any secretions from either Monet or Musoke. It turned out that a large part of the hospital's staff had direct contact with either Monet or Musoke or with blood samples and fluids that came from the two patients. The surgeons who had operated on Musoke, remembering only too well that they had been "up to the elbows in blood", sweated in quarantine for two weeks while they wondered if they were going to break with Marburg. A single human virus bomb had walked into the Casualty waiting room and exploded there, and the event had put the hospital out of business. Charles Monet had been an Exocet missile that stuck the hospital below the water line.

Dr. Shem Musoke survived his encounter with a hot agent. Ten days after he fell sick, the doctors noticed a change for the better. Instead of merely lying in bed in a passive state, he became disoriented and angry and refused to take medicine. One day, a nurse was trying to turn him over in bed, and he waved his fist at her and cried, "I have a stick, and I will beat you." It was around that time that he began to get better, and after many days his fever subsided and his eyes cleared; his mind and personality came back, and he recovered slowly but completely. Today he is one of the leading physicians at Nairobi Hospital, where he practices as a member of David Silverstein's group. One day I interviewed him, and he said to me that he has almost no memory of the weeks he was infected in Marburg. "I only remember bits and pieces," he said. "I remember having major confusion. I remember, before my surgery, that I walked out of my room with my IV drip hanging out of me. I don't remember much of the pain. The only pain I can talk about is the muscle ache and the lower-back ache. And I remember him throwing up on me." Nobody else at the hospital developed a proven case of Marburg-virus disease. 

When a virus is trying, so to speak, to crash into the human species, the warning sign may be a spattering of breaks at different times and places. These are microbreaks. What had happened at Nairobi Hospital was an isolated emergence, a microbreak of a rain-forest virus with unknown potential to start an explosive chain of lethal transmission in the human race. 

Tubes of Dr. Musoke's blood went to laboratories around the world so that they could have samples of living Marburg for their collections of life forms. The Marburg in his blood had come from Charles Monet's black vomit and perhaps originally from Kitum Cave. Today this particular strain of Marburg virus is known as Musoke strain. Some of it ended in glass vials in freezers owned by the United States Army, where it was kept immortal in a zoo of hot agents.  

A WOMAN AND A SOLDIER 
1983 SEPTEMBER 25, 1800 HOURS 
THURMONT,MARYLAND, nearly four years after the death of Charles Monet. 

Evening, A typical American town. On Catoctin Mountain, a ridge of the Appalachians that runs north to south through the western part of the state, the trees were brightening into soft yellows and golds. Teenagers drove their pickup trucks slowly along the streets of the town, looking for something to happen, wishing that the summer had not ended. Faint smells of autumn touched the air, the scent of ripening apples, a soreness of dead leaves, cornstalks drying in the fields. In the apple groves at the edge of town, flocks of grackles settled into the branches for the night, squawking. Headlights streamed north on the Gettysburg road. 

In the kitchen of a Victorian house near the center of town, Major Nancy Jaax, a veterinarian in the United States Army, stood at a counter making dinner for her children. She slid a plate into the microwave oven and pushed a button. Time to nuke up some chicken for the kids. Nancy Jaax wore sweatpants and a T-shirt, and she was barefoot. Her feet had calluses on them, the result of martial-arts training. She had wavy auburn hair, which was cut above the shoulders, and greenish eyes. Her eyes were actually two colors, green with an inner rim around the iris was amber. 

She was a former homecoming queen from Kansas – Miss Agriculture, Kansas State. She had a slender, athletic build, and she displayed quick motions, flickery gestures, with her arms and hands. Her children were restless and tired, and she worked as fast as she could to fix the dinner. 

Jaime, who was five, hung on Nancy's leg. She grabbed the leg of Nancy's sweatpants and pulled, and Nancy lurched sideways, and then Jaime pulled the other way, and Nancy lurched to the other side. Jaime was short for her age had greenish eyes, like her mother. Nancy's son, Jason, who was seven, was watching television in the living room. He was rail thin and quiet, and when he grew up he would probably be tall, like his father. 

Nancy's husband, Major Gerald Jaax, whom everyone called Jerry, was also a veterinarian. He was in Texas at a training class, and Nancy was alone with the children. Jerry had telephoned to say that it was hot as hell in Texas, and he missed her badly and wished he was home. She missed him, too. They had not been apart for more than a few days at a time ever since they had first started dating, in college.  

Nancy and Jerry Jaax – the name is pronounced JACKS – were both members of the Army Veterinary Corps, a tiny corps of "doggy doctors". 

They take care of Army's guard dogs, as well as Army horses, Army cow, Army sheeps, Army pigs, Army mules, Army rabbits, Army mice, and Army monkeys. They also inspect the Army's food. 

Nancy and Jerry had bought the Victorian house not long after they had been assigned to Fort Detrick, which was nearby, within easy commuting distance. The kitchen was small, and at the moment you could see plumbing and wires hanging out of the walls. Not far from the kitchen, the living room had a bay window with a collection of tropical plants and ferns in it, and there was a cage among the plants that held an Amazon parrot named Herky. The parrot burst into a song: 

Heigh-ho, heigh-ho, it's home from work we go! 

"Mom! Mom!" he cried excitedly. His voice sounded like Jason's. 

"What?"Nancy said. Then she realized it was the parrot. "Nerd brain," she muttered. 

The parrot wanted to sit on Nancy's shoulder. "Mom! Mom! Jerry! Jaime! Jason!" the parrot shouted, calling everyone in the family. When he didn't get any response, he whistled the "Colonel Bogey March" from The Bridge on the River Kwai. And then: "What? What? Mom! Mom!". 

Nancy did not want to take Herky out of his cage. She worked quickly, putting plates and silverware out on the counter. Some of the officers at Fort Detrick had noticed a certain abrupt quality in her hand motions and had accused her of having hands that were "too quick" to handle delicate work in dangerous situations. Nancy had begun martial-arts training partly because she hoped to make her gestures cool and smooth and powerful, and also because he had felt the frustrations of a woman officer trying to advance her career in the Army. She was five feet four inches tall. She liked to spar with six-foot male solders, big guys. She enjoyed knocking them around a little bit; it gave her a certain satisfaction to be able to kick higher than the guy's head. She used her feet more than her hands when she sparred with an opponent, because her hands were delicate. She could break four boards with a spinning back kick. She had reached the point where she could kill a man with her bare feet, an idea that did not in itself give her much satisfaction. On occasion, she had come home from her class with a broken toe, a bloody nose, or a black eye. Jerry would just shake his head: 

Nancy with another shiner. 

Major Nancy Jaax did all the housework. She could not stand housework. Scrubbing grape jelly out of rugs didn't give her a feeling of reward, and in any case she did not have time for it. Occasionally she would go into a paroxysm of cleaning, and she would race around the house for an hour, throwing things into closets. She also did all the cooking for her family. Jerry was useless in the kitchen. Another point of contention was his tendency to buy things impulsively – a motorcycle, a sailboat. Jerry had bought a sailboat when they were stationed at Fort Riley in Kansas. And then there was that god-awful diesel Cadillac with a red leather interior. She and Jerry had commuted to work together in it, but the car had started to lay smoke all over the road even before the payments were finished. One day, she had finally said to Jerry, "You can sit in the driveway in those red leather seats all you want, but I'm not getting in there with you." So they sold the Cadillac and bought a Honda Accord. 

The Jaaxes' house was the largest Victorian house in town, a pile of turreted brick with a slate roof and tall windows and a cupola and wooden paneling made of golden American chestnut. It stood on a street corner near the ambulance station. The sirens woke them up at night. 

They had bought the house cheap. It had sat on the market a long time, and a story had been going around town that the previous owner had hanged himself in the basement. After the Jaaxes bought it, the dead man's widow showed up at the door one day. She was a wizened old lady, come to have a look around her old place, and she fixed a blue eye on Nancy and said, 

"Little girl, you are going to hate this house. I did." 

There were other animals in the house besides the parrot. In a wire cage in the living room lived a python named Sampson. He would occasionally escape from his cage, wander around the house, and eventually climb up inside the hollow center post of the dining room table and go to sleep. There he would stay for a few days. It gave Nancy a creepy feeling to think that there was a python asleep inside the dining table. 

You wondered whether the snake was going to wake up while you were eating dinner. Nancy had a study in the cupola at the top of the house. The snake had once escaped from his cage and disappeared for a few days. They pounded and knocked on the dining room table to try to flush him out, but he wasn't there. Late one night when Nancy was in her study, the snake oozed out of the rafters and hung in front of her face, staring at her with lidless eyes, and she screamed. The family also had an Irish setter and an Airedale terrier. Whenever the Jaax's were assigned to a different Army post, the animals moved with them in boxes and cages, a portable ecosystem of the Jaax family. 

Nancy loved Jerry. He was tall and fine looking, a handsome man with prematurely gray hair. She thought of his hair as silver, to go along with his silver tongue, which he used trying to talk her into buy diesel Cadillacs with red-leather interiors. He had sharp brown eyes and a shape nose, like a hawk's, and he understood her better than anyone else on earth. Nancy and Jerry Jaax had very little social life outside of their marriage. 

They had grown up on farms in Kansas, twenty miles apart as the crow flies, but had not known each other as children. They met in veterinary school at Kansas State University had gotten engaged a few weeks later, and they were married when Nancy was twenty. By the time they graduated, they were broke and in debt, with no money to set up a practice as veterinarians, and so they had enlisted in the Army together. 

Since Nancy didn't have time to cook during the week, she would spend her Saturdays cooking. She would make up a beef stew in a Crock-Pot, or she would broil several chickens. Then she would freeze the food in bags. On weekday nights, she would take a bag out of the freezer and heat it in the microwave. Tonight, while she thawed chicken, she considered the question of vegetables. How about canned green beans? The children liked that. Nancy opened a cabinet and pulled down a can of Libby's green beans. 

She searched through one or two drawers, looking for a can opener. Couldn't find it. She turned to the main junk drawer, which held all the utensils, the stirring spoons and vegetable peelers. It was a jam-packed nightmare. 

The hell with the can opener. She pulled a butcher knife out of the drawer. Her father had always warned her not to use a knife to open a can, but Nancy Jaax had never made a point of listening to her father's advice. She jabbed the butcher knife into the can, and the point stuck in the metal. She hit the handle with the heel of the right hand. All of a sudden her hand slipped down the handle, struck the tang of the blade, and slid down the blade. She felt the edge bit deep. 

The butcher knife clattered to the floor, an big drops of blood fell on the counter. "Son of a bitch!" she said. The knife had sliced through the middle of her right hand, on the palm. It was a deep cut. 

She put pressure on the cut to stanch the bleeding and went over to the sink, turned on the faucet, and thrust her hand under the stream of water. The sink turned red. She wiggled her fingers. They worked; so she had not sliced a tendon. This was not such a bad cut. Holding her hand over her head, she went into the bathroom and found a Band-Aid. She waited for the blood to coagulate, and then she pressed the Band-aid over the cut, drawing the sides of the cut together to seal the wound. She hated the sight of blood, even if it was her own blood. She had a thing about blood. She knew what some blood could contain. 

Nancy skipped the children's baths because of the cut on her hand and gave them their usual snuggle in bed. That night, Jaime slept in bed with her. Nancy didn't mind, especially because Jerry was out of town, and it made her feel close to her children. Jaime seemed to need the reassurance. Jaime was always a little edgy when Jerry was out of town.

PROJECT EBOLA 
1983 SEPTEMBER 26 
THE NEXT MORNING, Nancy Jaax woke up at four o'clock. She got out of bed quietly so as not to wake Jaime and showered and put on her uniform. 35 She wore green Army slacks with a black stripe down the leg, a green Army shirt, an in the cold before sunrise she put on a black military sweater. 

The sweater displayed the shoulder bars of a major, with gold oak leaves. 

She drank a Diet Coke to wake herself up, and walked upstairs to her study in the cupola of the house. 

Today she might put on a biohazard space suit. She was in training for veterinary pathology, the study of disease in animals. Her specialty was turning out to be the effects Biosafety Level 4 hot agents, and in the presence of those kinds of agents you need to wear a space unit. She was also studying for her pathology-board exams, which were coming up in a week. As the sun rose that morning over the apple orchards and fields to the east of town, she opened her books and hunched over them. Grackles began croaking in the trees, and trucks began to move along the streets of Thurmont, below her window. The palm of her right hand still throbbed. 

At seven o'clock, she went down to the master bedroom and woke Jaime, who was curled up in the bed. She went into Jason's room. Jason was harder to wake, and Nancy had to shake him several times. Then the babysitter arrived, an older woman named Mrs. Trapane, who got Jaime and Jason dressed and gave them their breakfasts while Nancy climbed back up to the cupola and returned to her books. Mrs. Trapane would see Jason off to the school bus and would watch Jaime at home until Nancy came back from work that evening. 

At seven-thirty, Nancy closed her books and kissed her children goodbye. She thought to herself, Have to remember to stop at the bank and get some money to pay Mrs. Trapane. She drove the Honda alone to work, heading south on the Gettysburg road, along the foot of Catoctin Mountain. 

As she approached Fort Detrick, in the city of Frederick, the traffic thickened and slowed. She turned off the highway and arrived at the main gate of the base. A guard waved her through. She turned right, drove past the parade grounds with its flagpole, and parked her car near a massive, almost windowless building made of concrete and yellow bricks that covered almost ten acres of ground. Tall vent pipes on the roof discharged filtered exhaust air that was being pumped out of sealed biological laboratories  inside the building. This was the United States Army Medical Research Institute of Infectious Diseases, or USAMRIID. 

Military people often call USAMRIID the Institute. When they call the place USAMRIID, they drawl the word in a military way, making it sound like "you Sam rid," which gives it some hang time in the air. The mission of USAMRIID is medical defense. The Institute conducts research into ways to protect soldiers against biological weapons and natural infectious diseases. It specializes in drugs, vaccines, and biocontainment. At the Institute, there are always a number of programs going on simultaneously – research into vaccines for various kind of bacteria, such as anthrax and botulism, research into the characteristics of viruses that might infect American troops, either naturally or in the form of a battlefield weapon. 

Beginning with the Second World War, Army labs at Fort Detrick performed research into offensive biological weapons – the Army was developing strains of lethal bacteria and viruses that could be loaded into bombs and dropped on an enemy. In 1969, President Richard M. Nixon signed an executive order that outlawed the development of offensive biological weapons in the United States. From then on, the Army labs were converted to peaceful uses, and USAMRIID was founded. It devoted itself to developing protective vaccines, and it concentrated on basic research into ways to control lethal micro-organisms. The Institute knows ways to stop a monster virus before it ignites an explosive chain of lethal transmission in the human race. 

Major Nancy Jaax entered the building through the back entrance an showed her security badge to a guard behind a desk, who nodded and smiled at her. She headed into the main block of containment zones, traveling through a maze of corridors. There were soldiers everywhere, dressed in fatigues, and there were civilian scientists and technicians wearing ID badges. People seemed very busy, and rarely did anyone stop to chat with someone else in the corridors. 

Nancy wanted to see what had happened to the Ebola monkeys during the night. She walked along a Biosafety Level 0 corridor, heading for a Level 4 biocontainment area known as AA-5, or the Ebola suite. The levels are numbered 0, 2, 3 and finally 4, the highest. (For some reason, there is no Level 1.) All the containment levels at the Institute, from Level 2 to Level 4, are kept under negative air pressure, so that if a leak develops, air will flow into the zones rather than outward to the normal world. The suite known as AA-5 was a group of negative-pressure biocontainment rooms that had been set up as a research lab for Ebola virus by a civilian Army scientist named Eugene Johnson. He was an expert in Ebola and its sister, Marburg. He had infected several monkeys with Ebola virus, and he had been giving them various drugs to see if they would stop the Ebola infection. In recent days, the monkeys had begun to die. Nancy had joined Johnson's Ebola project as the pathologist. It was her job to determine the cause of death in the monkeys. 

She came to a window in a wall. The window was made of heavy glass, like that in an aquarium, and it looked directly into the Ebola suite, directly into Level 4. You could not see the monkeys through this window. Every morning, a civilian animal caretaker put on a space unit and went inside to feed the monkeys and clean their cages and check on their physical condition. This morning there was a piece of paper taped to the inside of the glass, with handwritten lettering on it. It had been left there by a caretaker. The note said that during the night two of the animals had "gone down". This is, they had crashed and bled out. 

When she saw the note, she knew that she would be putting on a space suit and going in to dissect the monkeys. Ebola virus destroyed an animal's internal organs, and the carcass deteriorated abruptly after death. It softened, and the tissue turned into jelly, even if you put it in a refrigerator to keep it cold. You wanted to dissect the animals quickly, before the spontaneous liquefaction began, because you can't dissect gumbo. 

WHEN NANCY Jaax first applied to join the pathology group at the Institute, the colonel in charge it didn't want to accept her. Nancy thought it was because she was a woman. He said to her, "This work is not for a married female. You can either going to neglect your work or neglect your family." One day, she brought her resume into his office, hoping to persuade him to accept her. He said, "I can have anybody I want in my group" – implying that he didn't want her because she wasn't good enough – and he mentioned the great Thoroughbred stallion Secretariat. "If I want to have Secretariat in my group," he said, "I can get Secretariat." 

"Well, sir, I am no plow horse!" she roared at him, and slammed her resume on his desk. He reconsidered the matter and allowed her to join the group. When you begin working with biological agents, the Army starts you in Biosafety Level 2, and then you move up to Level 3. You don't go into Level 4 until you have a lot of experience, and the Army may never allow you to work there. In order to work in the lower levels, you must have a number of vaccinations. Nancy had vaccinations for yellow fever, Q fever, Rift Valley fever, the VEE, EEE, and WEE complex (brain viruses that live in horses), and tularemia, anthrax and botulism. And, of course, she had a serious of shots for rabies, since she was a veterinarian. Her immune system reacted badly to all the shots; they made her sick. The Army therefore yanked her out of the vaccination program. At this point, Nancy Jaax was essentially washed up. She couldn't proceed with any kind of work with Level 3 agents, because she couldn't tolerate the vaccinations. 

There was only one way she could continue working with dangerous infectious agents. She had to get her assigned to work in a space suit in Level 4 areas. There aren't any vaccines for Level 4 hot agents. A Level 4 hot agent is a lethal virus for which there is no vaccine and no cure. 

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 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's 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 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 jacker, he could pass for a roadie with 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 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 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 unit 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 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 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 which 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 large molecules. 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 onset of HIV, the attack of Ebola is explosive. As Ebola sweeps through you, you immune system fails, and you seem to lose your ability to respond to viral attack. Your body becomes a city under seize, 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 blood stream, 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 flight 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 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" – 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.  

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 weakness? 

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 discussion" 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. 

1300 HOURS 
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 bio-hazard 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 Chemturion biological space suit, and it was marked in letters across the chest: JAAX. A Chemturion is also known as a blue suit that meets government specifications for work with airborne hot agents. 

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. These were the space suit's main gloves, and they were made of heavy rubber. They were the most important barrier between her and Ebola. 

The hands were the weak point, the most vulnerable part of the suit, because of what they handled. They handled needles, knives, and sharp pieces of bone. You are responsible for maintaining you space unit in the same way that a paratrooper is responsible for packing and maintaining his own parachute. Perhaps Nancy was in a bit of a hurry and did not inspect her space suit as closely as she should have. 

Lieutenant Colonel Johnson gave her a short briefing on procedures and then helped her lower the helmet over her head. The helmet was made of soft, flexible plastic. Johnson looked at her face, visible through the clear faceplate, to see how she was doing. 

She closed an oiled Ziploc zipper across the suit's chest. The zipper made a popping sound as it snapped shut, pop, pop, pop. The moment the space suit was closed, her faceplate fogged up. She reached over to a wall and pulled down a coiled yellow air hose and plugged it into her suit. Then came a roar of flowing air, and her suit bloated up, fat and hard, and a whiff of dry air clear away some tiny beads of sweat that had collected inside her faceplate. 

Around the Institute, they say that you can't predict who will panic inside a biological space unit. It happens now and then, mainly to inexperienced people. The moment the helmet does over their faces, their eyes begin to glitter with fear, they sweat, turn purple, claw at the suit, try to tear it open to get some fresh air, lose their balance and fall down on the floor, and they can start screaming or moaning inside the suit, which makes them sound as if they are suffocating in a closet. 

After he had helped Nancy Jaax put on her space suit, and had looked into her eyes for signs of panic, Tony Johnson put on his own suit, and when he was closed up and ready, he handed her a pack of dissection tools. He seemed calm and collected. They turned and faced the stainless-steel door together. The door lead into an air lock and Level 4. The door was plastered with biohazard symbol and warning: 

CAUTION 

BIOHAZARD 

DO NOT ENTER 

WITHOUT WEARING VENTILATED SUIT 

The international symbol for biohazard, which is pasted on doors at USAMRIID whenever they open through a major transition of zones, is a red trefoil that reminds me of a red trillium, or toadshade.

The Level 4 air lock is a gray area, a place where two worlds meet, where the hot zone touches the normal world. The gray area is neither hot nor cold. A place that is neither provably sterile nor known to be infective. At USAMRIID, toadshades bloom in the gray zones. Nancy took a breath and gathered her thoughts into stillness, using her martial-arts training to get her breathing under control. People performed all kinds of little rituals before they walked through that steel door. some people crossed themselves. Others carried amulets or charms inside their space suits, even though it was technically against the rules to bring anything inside the suit except your body and the surgical scrubs. They hoped the amulets might help ward off the hot agent if there was a major break in their suit. 

She unplugged her air hose and unlatched the steel door and entered an air lock, and Tony Johnson followed her. The air lock was made entirely of stainless steel, and it was lined with nozzles for spraying water and chemicals. This was the decon shower. Decon means "decontamination." The door closed behind them. Nancy opened the far door of the air lock, and they crossed over to the hot side. 

TOTAL IMMERSION 
1983 SEPTEMBER 26, 
1330 HOURS 
THEY WERE STANDING in a narrow cinder-block corridor. Various rooms opened on either side. The hot zone was a maze. From the walls dangled yellow ar hoses. There was an alarm strobe light on the ceiling that would be triggered if the air system failed. The walls were painted with thick, goby epoxy paint, and all the electrical outlets were plugged around the edges with a gooey material. This was to seal any cracks and holes, so that a hot agent could not escape by drifting through hollow electrical conduits. Nancy reached for an air hose and plugged it into her suit. She could not hear anything except the roar of air in her helmet. The air rumbled so loudly in their suits that they did not try to speak to each other. 

She opened a metal cabinet. Blue light streamed out of it, and she removed a pair of yellow rubber boots. They reminded her of barn boots. She slid the soft feet of her space suit into the boots and glanced at Johnson and caught his eye. Ready for action, boss. 

They unplugged their air hoses and proceeded down the hallway and entered the monkey room. It contained two banks of cages, positioned facing each other along opposite walls of the room. Jaax and Johnson replugged their hoses and peered into the cages. One bank of cages contained two isolated monkeys. They were the so-called control monkeys. 

They had not been infected with Ebola virus, and they were healthy. 

As soon as the two Army officers appeared in space suits, the healthy monkeys went nuts. They rattled their cages and leaped around. 

Humans in space suits make monkeys nervous. They hooted and grunted – "Ooo! Ooo! Haw, wah, haw!" And they uttered a high-pitched squeal: "Eek!". 

The monkeys moved to the front of their cages and shook the doors or leaped back and forth, whump, whump, whump, watching Jaax and Johnson the whole time, following them with their eyes, alert to everything. The cages had elaborated bolts on the doors to prevent fiddling by primate fingers. These monkeys were creative little boogers, she thought, and they were bored. 

The other bank of cages was mostly quiet. This was the bank of Ebola cages. All the monkeys in these cages were infected with Ebola virus, and most of them were silent, passive and withdrawn, although one or two of them seemed queerly deranged. Their immune systems had failed or gone haywire. Most of the animals did not look very sick yet, but they did not display the alertness, the usual monkeys energy, the leaping and the cage rattling that you see in healthy monkeys, and most of them had not eaten their morning biscuits. They sat almost motionless in their cages, watching the two officers with expressionless faces. 

They had been injected with the hottest strain of Ebola known to the world. It was the Mayinga strain of Ebola Zaire. This strain had come from a young woman named Mayinga N., who died of the virus on October 19, 1976. She was a nurse at a hospital in Zaire, and she had taken care of a Roman Catholic nun who died of Ebola. The nun had bled to death all over Nurse Mayinga, and then, a few days later, Nurse Mayinga had broken with Ebola and died. Some of Nurse Mayinga's blood had ended up in the United States, and the strain of virus that had once lived in Nurse Mayinga's blood now  lived in small glass vials kept in superfreezers at the Institute, which were maintained at minus one hundred and sixty degrees Fahrenheit. The freezers were fitted with padlocks and alarms and were plastered with biohazard flowers and sealed with bands of sticky tape, because it seals cracks. It could be said that without sticky tape there would be no such thing as biocontainment. 

Gene Johnson, the civilian scientist, had thawed a little bit of Nurse Mayinga's frozen blood and had injected it into the monkeys. 

Then, as the monkeys became sick, he had treated them with a drug in hope that it would help them flight off the virus. The drug did not seem to be working. 

Nancy Jaax and Tony Johnson inspected the monkeys, moving from cage to cage, until they found the two monkeys that had crashed and bled out. Those animals were hunched up, each in its own cage. They had bloody noses, and their eyes were half-open, glassy, and brilliant red, with dilated pupils. The monkeys showed no facial expression, not even pain or agony. The connective tissue under the skin had been destroyed by the virus, causing a subtle distortion of the face. Another reason for the strange faces was that the parts of the brain that control facial expression had also been destroyed. The mask like face, the red eyes, and the bloody nose were classic signs of Ebola that appear in all primates infected with the virus, both monkeys and humans. It hinted at a vicious combination of brain damage and soft-tissue destruction under the skin. 

The classic Ebola face made the monkeys look as if they had seen something beyond comprehension. It was not a vision of heaven. 

Nancy Jaax felt a wave of unease. She was distressed by the sight of the dead and suffering monkeys. As a veterinarian, she believed that it was her duty to heal animals and relieve their suffering. As a scientist, she believed that it was her obligation to perform medical research that would help alleviate human suffering. Even though she had grown up on a farm, where her father had raised livestock for food, she had never been able to bear easily the death of an animal. As a girl, she had cried when her father had taken her 4-H Club prize steer to the butcher. She liked animals better than many people. In taking the veterinarian's oath, she had pledged herself to a  code of honor that bound her to the care of animals but also bound her to the saving of human lives through medicine. At times in her work, those two ideals clashed. She told herself that this research was being done to help find a cure for Ebola, that it was medical research that would help save human lives and might possibly avert a tragedy for the human species. That helped reduce her feeling of unease, but not completely, and she kept her emotions off to one side. 

Johnson watched Jaax carefully as she began the removal procedure. 

Handling an unconscious monkey in Level 4 is tricky operation, because monkeys can wake up, and they have teeth and a powerful bit, and they are remarkably strong and agile. The monkeys that are used in laboratories are not organ-grinder monkeys. They are large, wild animals from the rain forest. A bite by an Ebola-infected monkey would almost certainly be fatal. 

First Nancy inspected the monkey, looking through the bars. It was a large male, and he looked as if he was really dead. She saw that he still had his canine fangs, and that made her nervous. Ordinarily the monkey would have had its fangs filed down for safety. For some reason, this one had enormous natural fangs. She stuck her gloved fingers through the bars and pinched the monkey's toe while she watched for an eye movement. The eyes remained fixed and staring. 

"GO AHEAD AND UNLOCK THE CAGE," Lieutenant Colonel Johnson said. 

He had to shout to be heard above the roar of air in their space suits. 

She unlocked the door and slid it up until the cage gaped wide open. She inspected the monkey again. No muscle twitches. The monkey was definitely down. 

"ALL RIGHT, GO AHEAD AND MOVE HIM OUT," Johnson said. 

She reached inside and caught the monkey by the upper arms and rotated him so that he was facing away from her, so that he couldn't bite her if he woke up. She pulled his arms back and held them immobile, and she lifted the monkey out of the cage. 

Johnson took the monkey's feet, and together they carried him over to a hatbox, a biohazard container, and they slid the monkey into it. 

Then they carried the hatbox to necropsy room, shuffling slowly in their suits. They were two human primates carrying another primate. One was the master of the earth, or at least believed himself to be, and the other was a nimble dweller in trees, a cousin of the master of the earth. Both species, the human and the monkey, were in the presence of another life form, which was older and more powerful than either of them, and was a dweller in blood. 

Jaax and Johnson moved slowly out of the room, carrying the monkey, and turned left and then turned left again, and entered the necropsy room, and laid the monkey down on a stainless-steel table. The monkey's skin was rashly and covered with red blotches, visible through his sparse hair. 

"GLOVE UP," Johnson said. 

They put on latex rubber gloves, pulling them over the space suit gloves. They now wore three layers of gloves: the inner-lining glove, the space suit glove, and the outer glove. Johnson said, "WE'LL DO THE CHECK LIST. SCISSORS, HEMOSTATS." He laid the tools in a row at the head of the table. 

Each tool was numbered, so he called the numbers out loud. 

They went to work. Using blunt-ended scissors, Johnson opened the monkey while Jaax assisted with the procedure. They worked slowly and with exquisite care. They did not use any sharp blades, because a blade is a deadly object in a hot zone. A scalpel can nick your gloves and cut your fingers, and before you even feel a sensation of pain, the agent has already entered your blood stream. 

Nancy handed tools to him, and she reached her fingers inside the monkey to tie off blood vessels and mop up excess blood with small sponges. The animal's body cavity was a lake of blood. It was Ebola blood, and it had run everywhere inside the animal: there had been a lot of internal hemorrhaging. The liver was swollen, and she noticed some blood in the intestines. 

She had to tell herself to slow her hands down. Perhaps her hands were moving too quickly. She talked herself through the procedure, keeping herself alert and centered. Keep it clean, keep it clean, she thought. Okay, pick up the hemostat. Clamp that artery 'cause it's leaking blood. Break off and rinse gloves. She could feel the Ebola blood through her gloves; it felt wet and slippery, even through her hands were clean and dry and dusted with baby powder.

She withdrew her hands from the carcass and rinsed them in a pan of disinfectant called EnviroChem, which sat in a sink. The liquid was pale green, the color of Japanese green tea. It destroys viruses. As she rinsed her gloves in it, the liquid turned brown with monkey blood. All she could hear was the noise of the air blowing inside her suit. It filled her suit with a roar like a subway train coming through a tunnel. 

A VIRUS IS a small capsule made of membranes and proteins. The capsule contains one or more strands of DNA or RNA, which are long molecules that contain the software program for making a copy of virus. Some biologists classify viruses as "life forms," because they are not stricky known to be alive. Viruses are ambiguously alive, neither alive nor dead. They carry on their existence in the borderlands between life and nonlife. They are dead. They can even form crystals. Virus particles that lie around in blood or mucus may seem dead, but the particles are waiting for something to come along. They have a sticky surface. If a cell comes along and touches the virus and the stickiness of the virus matches the stickiness of the cell, then the virus clings to the cell. The cell feels the virus sticking to it and enfolds the virus and drags it inside. Once the virus enters the cell, it becomes a Trojan horse. It switches on and begins to replicate. 

A virus is a parasite. It can't live on its own. It can only make copies of itself inside a cell using the cell's materials and machinery to get the job done. All living things carry viruses in their cells. Even fungi and bacteria are inhabited by viruses and are occasionally destroyed by them. That is, disease have their own disease. 

A virus makes copies of itself inside a cell until eventually the cell gets pigged with virus and pops, and the viruses spill out of the broken cell. Or viruses can bud through a cell wall, like drips coming out of a faucet – drip, drip, drip, drip, copy, copy, copy, copy – that's the way the AIDS virus works. The faucet runs and runs until the cell is exhausted, consumed, and destroyed. If enough cells are destroyed, the host dies. A virus does not "want" to kill its host. That is not in the best interest of virus, because then the virus may also die, unless it can jump fast enough out of the dying host into a new host. 

The genetic code inside Ebola is a single strand of RNA. This type of molecule is thought to be the oldest and most "primite" coding mechanism for life. The earth's primordial ocean, which came into existence not long after the earth was formed, about four and a half billion years ago, may well have contained microscopic life forms based on RNA. This suggested that Ebola is an ancient kind of life, perhaps nearly as old as the earth itself. Another hint that Ebola is extremely ancient is the way in which it can seem neither quite alive nor quite unalive. 

Viruses may seem alive when they multiply, but in another sense they are obviously dead, are only machines, subtle ones to be sure, but strictly mechanical, no more alive than a jackhammer. Viruses are molecular sharks, a motive without a mind. Compact, hard, logical, totally selfish, the virus is dedicated to making copies of itself – which it can do on occasion with radiant speed. The prime directive is to replicate. 

Viruses are too small to be seen. Here is a way to imagine the size of a virus. Consider the island of Manhattan shrunk to this size: /. 

This Manhattan could easily hold nine million viruses. If you could magnify this Manhattan and if it were fully of viruses, you would see little figures clustered like the lunch crowd on Fifth Avenue. A hundred million crystallized polio viruses could cover the period at the end of this sentence. There could be two hundred and fifty Woodstock Festivals of viruses sitting on that period – the combined populations of Great Britain and France – and you would never know it. 

KEEP IT CLEAN, Nancy thought. No blood. No blood. I don't like blood. Every time I see a drop of blood, I see a billion viruses. Break off and rinse. Break off and rinse. Slow yourself. Look at Tony's suit. Check him. 

You watched your partner's suit for any sign of a hole or a break. 

It was kind of like being a mother and watching your kid – a constant background check to see if everything is okay. 

Meanwhile, Johnson was checking her. He observed her for any kind of mistake, any jerkiness with the tools. He wondered if he would see her drop something. 

"RONGEUR," he said. 

"WHAT?" she asked. He pointed at her air hose to suggest that she crimp it so that she could hear him better. She grabbed the hose and folded it. The air stopped flowing, her suit deflated around her, and the noise died away. 

He put his helmet close to hers and spoke the work rongeur again, and she released her hose. She handed him a pair of pliers called the rongeur. 

The word is French and means "gnawer." It is used for opening skulls. 

Getting into a skull is always a bitch in Level 4. A primate skull is hard and tough, and the bone plates are knitted together. 

Ordinarily you would whip through a skull with an electric bone saw, but you can't use a bone saw in Level 4. It would throw a mist of bone particles and blood droplets into the air, and you do not want to create any kind of infective mist in a hot area, even if you are wearing a space suit; it is just too dangerous. 

They popped the skull with the pliers. It made a loud cracking sound. They removed the brain, eyes, and spinal cord and dropped them into a jar of preservative. 

Johnson was handing her a tube containing a sample when he stopped and looked at her gloved hands. He pointed to her right glove. 

She glanced down. Her glove. It was drenched in blood, but now she saw the hole. It was rip across the palm of the outer glove on her right hand. 

Nancy tore off the glove. Now her main suit glove was covered with blood. It spidered down the outer sleeve of her space suit. Great, just great – Ebola blood all over my suit. She rinsed her glove and arm in the disinfectant, and  they came up clean and shiny wet. Then she noticed that her hand, inside the two remaining gloves, felt cold and clammy. 

There was something wet inside her space suit glove. She wondered if that glove was a leaker, too. She wondered if she had sustained a breach in her right main glove. She inspected that glove carefully. Then she saw it. It was a crack in the wrist. She had a breach in her space suit. 

Her hand felt wet. She wondered if there might be Ebola blood inside her space suit, somewhere close to that cut on the palm of her hand. She pointed to her glove and said, "HOLE." Johnson bent over and inspected her glove. He saw the crack in the wrist. She saw his face erupt in surprise, and then he looked into her eyes. She saw he was afraid. 

That terrified her. She jerked her thumb toward the exit. "I'M OUTTA HERE, MAN. CAN YOU FINISH?" 

He replied, "I WANT YOU TO LEAVE IMMEDIATELY. I'LL SECURE THE AREA AND FOLLOW YOU OUT." 

Using only her left hand, her good hand, she unplugged her suit from the air hose. She practically ran down the corridor to the air lock, her right arm hanging rigidly at her side. She did not want to move that hand because every time she moved it she felt something squishing around in there, inside the glove. Fear threatened to overwhelm her. How was she going to remove her boots without using her bad hand? She kicked them off. They went flying down the corridor. She threw open the air-lock door and stepped inside and slammed the door behind her. 

She pulled a chain that hung the ceiling of air lock. That started the decon shower. The decon shower takes seven minutes, and you are not permitted to leave during that period, because the shower needs time to work on viruses. First came a blast of water jets, which washed traces of blood from her space suit. The water jets stopped. Then came a spray of EnviroChem, coming out of nozzles all up and down the sides of the air lock, which deconned her space suit. Of course, if something lived inside her glove, the chemical shower would not reach it. 

There were no lights in the air lock; it was dim, almost dark. The place was literally a gray zone. She wished it had a clock. Then you would know how long you would have to wait. Five minutes to go? four minutes? Chemical mist drizzled down her faceplate. It was like driving a car in the rain when the windshield wipers are broken; you can't see a thing. Shit, shit, shit, she thought. 

At the Institute, there is a Level 4 biocontainment hospital called the Slammer, where a patient can be treated by doctors and nurses wearing space suits. If you are exposed to a hot agent and you go into the Slammer and fail to come out alive, then you body is taken to a nearby Level 4 biocontainment morgue, known as the Submarine. The soldiers around the Institute call the morgue the Submarine because its main door is made of heavy steel and looks like a pressure door in a submarine. 

Son of bitch! she thought. Aw, fuck! They'll put me into the Slammer. And Tony will be filling out accident reports while I'm breaking with Ebola. And a week later, I'll be in the Submarine. Shit! Jerry's in Texas. And I didn't go to the bank today. There's no money in the house. The kids are home with Mrs. Trapane, and she needs to be paid. I didn't go to the market today. There's no food in the house. How are the kids going to eat if I'm in the Slammer? Who's going to stay with them tonight? Shit, shit, shit! 

The shower stopped. She opened the door and flung herself into the staging area. She came out of the space suit fast. She shucked it. 

She leaped out of it. The space suit slapped to the concrete floor, wet, dripping with water. 

As her right arm came out of the suit, she saw that the sleeve of her scrub suit was dark wet and her inner glove was red. 

That space suit glove had been a leaker. Ebola blood had run over her innermost glove. It had smeared down on the latex, right against her skin, right against the Band-Aid. Her last glove was thin and translucent, and she could see the Band-Aid through it, directly under the Ebola blood. Her heart pounded, and she almost threw up – her stomach contracted and turned over, and she felt a gag reflex in her throat. The puke factor. It is a sudden urge to throw up when you find yourself unprotected in the presence of a Biosafety Level 4 organism. Her mind raced: Oh, shit. What now? I've got an undeconned glove – Ebola blood in here. Oh, Jesus. What's the procedure here? What do I have to do now? 

Tony Johnson's blue figure moved in the air lock, and she heard the nozzles begin to hiss. He had begun the decon cycle. It would be seven minutes before he could answer any questions. 

The main question was whether any blood had penetrated the last glove to the cut. Five or ten Ebola-virus particles suspended in a droplet of blood could easily slip through a pinhole in a surgical glove, and that might be enough to start an explosive infection. This stuff could amplify itself. A pinhole in a glove might not be visible to the eye. She went over to the sink and put her hand under the faucet to rinse off the blood and held there for a while. The water carried the blood down the drain, where the waste water would be cooked in heated tanks. 

Then she pulled off the last glove, holding it delicately by the cuff. Her right hand came out caked with baby powder, her fingernails short, no nail polish, no ring, knuckles scarred by a bite form a goat that had nipped her when she was child, and a Band-Aid on the palm. 

She saw blood mixed with the baby powder. 

Please, please, make it my blood. 

Yes – it was her own blood. She had bled around the edges of the Band-Aid. She did not see any monkey on her hand. 

She put the last glove under the faucet. The water was running and it filled up the glove. The glove swelled up like a water balloon. 

She dreaded the sudden appearance of a thread of water squirting from the glove, the telltale of a leak, a sign that her life was over. The glove fattened and held. No leaks. 

Suddenly her legs collapsed. She fell against the cinder-block wall and slid down it, feeling as if she had been punched in the stomach. 

She came to rest on the hatbox, the biohazard box that someone had been using as a chair. Her legs kicked out, and she went limp and leaned back against the wall. That was how Tony Johnson found her when he emerged from the air lock. 

THE ACCIDENT REPORT concluded that Major N. Jaax had not been exposed to Ebola virus. Her last glove had remained intact, and since everyone believed that the agent was transmitted through direct contact with blood and bodily fluids, there did not seem to be any way for it to have entered her bloodstream, even though it had breached her space suit. She drove home that night having escaped the Slammer by the skin of her last glove. 

She had almost caught Ebola from a dead monkey, who had caught it from a young woman named Mayinga, who had caught it from a nun who had crashed and bled out in the jungles of Zaire in years gone by. 

She called Jerry that night in Texas. "Guess what? I had this little problem today. I had a near-Ebola experience." She told him what had happened. 

He was appalled. "God-damn it, Nancy ! I told you not to get involved with that Ebola virus! That fucking Ebola!" And he went into a ten-minute diatribe about the dangers of doing hot work in a space suit, especially with Ebola. 

She remained calm and did not argue with him. She realized he wasn't angry with her, just scared. She let Jerry run on, and when he had gotten it all out of his system and was starting to taper off, she told him that she felt confident that everything was going to be all right. 

Meanwhile, he was surprised at how calm his wife seemed. He would have flown home that night if he had perceived any inkling of distress in her. 

THE EBOLA EXPERIMENTS were not a success in the sense that the drugs had no effect on the virus. All of Gene Johnson's infected monkeys died no matter what drugs they were given. They all died. The virus absolutely nuked the monkeys. It was a complete slate wiper. The only survivors of the experiment were the two control monkeys – the healthy, uninfected monkeys that lived in cages across the room from the sick monkeys. The control monkeys had not been infected with Ebola, and so, as expected, they had not become sick.

Then, two weeks after the incident with the bloody glove, something frightening happened in the Ebola rooms. The two healthy monkeys developed red eyes and blood noses, and they crashed and bled out. 

They had never been deliberately infected with Ebola virus, and they had not come near the sick monkeys. They were separated from the sick monkeys by open floor. 

If a healthy person were placed on the other side of a room from a person who was sick with AIDS, the AIDS virus would not be able to drift across the room through the air and infect the healthy person. But Ebola had drifted across a room. It had moved quickly, decisively, and by an unknown route. Most likely the control monkeys inhaled it into their lungs. "It got there somehow," Nancy Jaax would say to me as she told me the story some years later. "Monkeys spit and throw stuff. And when the caretakers wash the cages down with water hoses, that can create an aerosol of droplets. It probably traveled through the air in aerosolized secretion. That was when I knew that Ebola can travel through the air." 

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EBOLA RIVER 1976 SUMMER - AUTUMN 

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