The Hot Zone
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The Hot Zone by Richard Preston is a non-fiction thriller, published in 1994, two years after his article “Crisis in the Hot Zone” appeared in The New Yorker. Both the article and the full length book treat similar subjects, focusing on the history and emergence of several Biosafety Level 4 pathogens, including Ebola. A Biosafety level is a set of containment precautions used by a laboratory in order to protect scientists from the diseases they are working with. Biosafety Level 4 agents are the most dangerous, as they are highly infectious, have a high fatality rate, and there are no known prophylactics, treatments or cures. The thriller element of The Hot Zone is provided by the true story of an outbreak of Ebola among primates near to Washington D.C. in the 1980’s, and the fear that it could spread to the surrounding human population given the extreme infectivity of the disease. The book is divided into four sections: “The Shadow of Mount Elgon,” “The Monkey House,” “Smashdown,” and “Kitum Cave,” respectfully.
The first segment of The Hot Zone is the story of a man Preston has given the pseudonym Charles Monet, a French expatriate who begins exhibiting symptoms of Marburg Disease (MARV) just a few days after visiting Kitum Cave on Mount Elgon in Kenya. The effects of the disease are described in vivid detail from the early stages in which Monet begins to complain of headache, backache, “red eye” and vomiting. From there the disease takes on a much more sinister form and is described by Preston as liquefying connective tissue, causing extensive hemorrhaging from “every orifice” and the general corruption of internal organs. After only two weeks Monet is brought to a hospital in Nairobi where he dies in the waiting room after slipping into a coma and bleeding out. A young physician, Dr. Shem Musoke, becomes infected with MARV while attempting to treat Monet, although he survives and samples of his blood are used in testing for the disease.
There are several other personal stories involving Biosafety Level 4 agents in this section including the first known cases of Marburg disease, which appeared in Marburg, Germany in 1967, as well as the story of Yu G. who is the first person to die from Ebola Sudan in 1976, and of Mayinga N., a nurse who becomes infected with Ebola Zaire after treating a patient who dies of the disease. Mayinga is at first in denial about her symptoms and spends two days in the city, before returning to the hospital, putting an unknown number of people at risk of infection. Also featured in “The Shadow of Mount Elgon” is the story of Lieutenant Colonel Nancy Jaax. Jaax is a veterinarian and scientist for the US Army during the 1980’s working on an experiment involving Ebola. While at home preparing dinner she accidentally cuts herself, then later when she is working on an experiment involving an infected dead monkey, the glove protecting her injured hand tears and Jaax is nearly exposed to contaminated blood. Jaax makes it safely through this incident and is eventually promoted to chief of pathology for USAMRIID (US Army Medical Research Institute of Infectious Diseases).
The second and third sections of the book, “The Monkey House,” and “Smashdown” chronicle USAMIIRD’s involvement in the extermination of hundreds of monkeys in Reston, Virginia, in 1989. Located less than 15 miles away from Washington D.C., a monkey house in Reston received a shipment of 100 wild monkeys; within four weeks of delivery 29 of the monkeys had died. The veterinarian for the house, Dan Dalgard, examines the monkeys and sends samples to a virologist, Peter Jahrling at USAMRIID. Ultimately, it is discovered that the monkeys are infected with Ebola Zaire and the decision is made to euthanize all the monkeys in the same room as the infected monkeys. This does not go completely smoothly and there are several occasions of near contamination, once when a monkey not properly sedated wakes up and struggles with one of the scientists and again where one of the Hazmat suits (Preston refers to these as “spacesuits”) worn by scientists malfunctions. Due to small occurrences of accidental exposure, notably when two scientists breathe in the pathogen before identifying it, it becomes clear that it is a strain of Ebola that does not present symptoms in humans and is only deadly to monkeys. It becomes known as Reston disease.
In the late 1980’s an expedition to Kitum Cave is organized by American scientists to search for the host animal believed to be the originator of MARV. While this expedition is fruitless, Preston himself visits Kitum Cave in full hazmat gear in the culmination of the book. While the cave is occupied by many animals that could potentially bear the disease, Preston himself claims he is not looking for the host, but he means to bring his story back to its origins. Preston warns of similarly dangerous diseases, such as the AIDS virus, and the likelihood that other deadlier outbreaks will occur in the future.
The critical reception of The Hot Zone has varied somewhat from its first publication. While it has been praised in some circles for its ability to play upon real circumstances and invoke a genuine sense of fear in readers, the scientific community has taken issue with some of Preston’s sensationalized version of the disease. In a 2015 memoir scientists for the Center of Disease Control, Joseph B. McCormick and Susan Fisher-Hosch explicitly dispute Preston’s claims that Ebola dissolves organs and refute some of the details of the Reston incident.
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