The Hot Zone Part 2

THE STRAIN OF Ebola virus that had erupted near Was.h.i.+ngton went into hiding somewhere in the rain forest. The cycling went on. The cycling must always go on if the virus is to maintain its existance. The Army, having certified that the monkey house had been nuked, returned to the possession of Hazleton Resrach Products. Hazleton began buying more monkeys from the Philippines, from the same monkey house near Manila, and restocked the building with crab-eating monkeys that had been trapped in the rain forests of Mindanao. Less than a month later, in the middle of January, some of the monkeys in Room C began dying with b.l.o.o.d.y noses. Dan Dalgard called Peter Jahrling. "Looks like we're affected again," he said. The virus was Ebola. It had come from the Philippines. This time, since there had been no human casualties during the first outbreak, the Army, the C.D.C., and Hazleton jointly decided to isolate the monkeys-leave them alone and let the virus burn. Dan Dalgard hoped to save at least some of the monkeys, and his company did not want the Army to come back with s.p.a.ce suits. What haapened in that building was a kind of experiment. Now they would see what Ebola could do naturally in a population of monkeys living in a confined air s.p.a.ce, in a kind of city, as it were. The Ebola Reston virus jumped quickly from room to room, and as it blossomed in the monkeys, it seemed to mutate spontaneously into something that looked quite a lot like the common cold. But it was an Ebola cold. The monkeys died with great quant.i.ties of clear mucus and green mucus running from their nose, mixed with blood that would not clot. Their lungs were destroyed, rotten and swimming with Ebloa virus. They had pneumonia. When a single animal with a nosebleed showed up in a room, generally 80 percent of the animals died in that room shortly afterward. The virus was extraordinarily infective in monkeys. The Inst.i.tute scientists suspected that they were seeing a mutant strain of Ebola, something new and a little different from what they had seen just a month before, in December, when the Army had nuked the monkey house. It was frightening-it was as if Ebola could change its character fast. As if a different strain could appear in a month's time. The clinical symptoms of the disease served as a reminder of the fact that Ebola is related to certain kind of colds seen in human children. It seemed that the virus could adapt quickly to new host, and that it could change its character rapidly as it entered a new population. bola apparently drifted through the building's air-handling ducts. By January 24, it had entered Room B, and monkeys in that room started going into shock and dying with runny noses, red eyes, and masklike expressions on their faces. In the following weeks, the infection entered Room I,F,E, and D, and the animals in these rooms virtually all died. Then, in mid-February, a Hazleton animal caretaker who will be called John Coleus was performing a necropsy on a dead monkey when he cut his thumb with a scalpel. He had been slicing apart the liver, one of the favorite nesting sites of Ebola. The scalpel blade, smeared with liver cells and blood, went deep into this thumb. He had had a major exposure to Ebola. The liver that he had been cuting was rushed to USAMRIID for a.n.a.lysis. Tom Geisbert looked at a piece of it under his microscope and, to his dismay, found that it was "incredibly hot-I mean, wall to wall with virus." Everyone at the Inst.i.tute thought John Coleus was going to die. "Around her," Peter Jahrling told me, "we were frankly fearful that this guy had bought the farm." The C.D.C. decided not to put him into isolation. So Coleus visited bars and drank beer with his friends. "Here at the Inst.i.tute," Peter Jahrling said, "we were absolutely appalled when that guy went out to bars, drinking. Clearly the C.D.C. should not have let that happen. This was a serious virus and a serious situation. We don't know a whole lot about the virus. It could be like the common cold-it could have a latency period when you are shedding virus before you develop symptoms-and by the time you know you are sick, you might have infected sixteen people. There's an awful lot we don't know about this virus. We don't know where it came from, and we don't know what form it will take when it appears next time." John Coleus had a minor medical condition that required surgery. Doctors performed the operation while he was in the incubation period after his exposure to Ebola. There is no record indicating that he bled excessively during the surgery. He came through fine, and he is alive today, with no ill effects from his exposure.

AS FOR THE MONKEY HOUSE, the entire building died. The Army didn't have to nuke it. It was nuked by the Ebola Reston virus. Once again, there were no human casualties. However, something eerie and perhaps sinister occurred. A total of four men had worked as caretakers in the monkey house: Jarvis Purdy, who had a heart; Milton Frantig, who had thrown up on the lawn; John Coleus, who had cut his thumb; and a fourth man. All four men eventually tested positive for Ebola Reston virus. They had all been infected with the agent. The virus had entered their bloodstreams and multiplied in their cells. Ebola proliferated in their bodies. It cycled in them. It carried on its life inside the monkey workers. But it did not make them sick, even while it multiplied inside them. If they had headaches or felt ill, none of them could recall it. Eventually the virus cleared from their systems naturally, disappeared from the blood, and as of this writing none of the men was affected by it. The are among the very, very few human survivors of Ebola virus. John Coleus certainly caught the virus when he cut himself with a b.l.o.o.d.y scalpel, no question about that. What is more worrisome is that the others had not cut themselves, yet the virus entered their bloodstreams. It got there somehow. Most likely it entered their blood thought contact with the lungs. It infected them through the air. When it became apparent to the Army researchers that three of the four men who became infected had not cut themselves, just about everyone at USAMRIID concluded that Ebola can spread through the air. Dr. Philip Russell-the general who made the decision to send in the Army to stop the virus-recently said to me that although he had been "scared to death" about Ebola at the time, it wasn't until afterward, when he understood that the virus was spreading in the air among the monkeys, that the true potential for disaster sank in for him. "I was more frightened in retrospect," he said. "When I saw the respiratory evidence coming from those monkeys, I said to myself, My G.o.d, with certain kinds of small changes, this virus could become one that travels in rapid respiratory transmission through humans. I'm talking about the Black Death. Imagine a virus with the infectiousness of influenza and the mortality rate of black plague in the Middle Ages-that's what we're talking about." The workers at Reston had symptomless Ebola virus. Why didn't it kill them? To this day, no one knows the answer to that question. Symptomless Ebola-the men had been infected with something like an Ebola cold. A tiny difference in the virus's genetic code, probably resulting in a small structural change in the shape of one of the seven mysterious proteins in the virus particle, had apparently changed its effect tremendously in humans, rendering it mild or harmless even though it had destroyed the monkeys. This strain of Ebola knew the difference between a monkey and a person. And if it should mutate in some other direction...

ONE DAY IN spring, I went to visit Colonel Nancy Jaax, to interview her about her work during the Reston event. We talked in her office. She wore a black military sweater with silver eagles on the shoulder boards-she had recently made full colonel. A baby parrot slept in a box in the corner. The parrot woke up and squeaked. "Are you hungry?" she asked it. "Yeah, yeah, I know." She pulled a turkey baster out of a bag and loaded it with parrot mush. She stuck the baster into the parrot's beak and squeezed the baster bulb, and the parrot closed it eyes with satisfaction. She waved her hand at some filing cabinets. "Want to look at some Ebola? Take your pick." "You show me." She searched through a cabinet and removed a handful of gla.s.s slides, and carried them into another room, where a microscope sat on a table. It had two sets of eyepieces so that two people could look into it at the same time. I sat down and stared in the microscope, into white nothingness. "Okay, here's a good one," she said, and placed a slide under the lens. I saw a field of cells. Here and there, pockets of cells had burst and liquefied. "That's male reproductive tissue," she said. "It's heavily infected. This is Ebola Zaire in a monkey that we exposed through the lungs in 1986, in the study that Gene Johnson and I did." Looking at the slice of monkey t.e.s.t.i.c.l.e, I got an unpleasant sensation. "You mean, it got into the monkey's lungs and moved to its-?" "Yeah. it's pretty yucky," she said. "Now I'm going to make you dizzy. I'm going to show you the lung." The scene s.h.i.+fted, and we were looking at rotted pink Belgian lace. "This is a slice of lung tissue. A monkey that was exposed through the lungs. See how the virus bubbles up in the lung? It's Ebola Zaire." I could see individual cells, and some of them were swollen with dark specks. "We'll go to higher magnification." The cells got bigger. The dark specks became angular, shadowy blobs. The blobs were bursting out of the cells, like something hatching. "Those are big, fat bricks," she said. They were Ebola crystalloids bursting out of the lungs. The lungs were popping Ebola directly into the air. My scalp crawled and I felt suddenly like a civilian who had seen something that maybe civilians should not see. "These lungs are very hot," she said in a matter-of-face voice. "You see those bricks budding directly into the air s.p.a.ces of the lung? When you cough, this stuff comes up your throat in your sputum. That's why you don't want someone who has Ebola coughing in your face." "My G.o.d, it knows all about lungs, doesn't it?" "Maybe not. It might live in an insect, and insects don't have lungs. But you see here how Ebola has adapted to this lung. It's budding out of the lung, right straight into the air." "We're looking at a highly sophisticated organism, aren't we?" "You're absolutely right. This hummer has an established life cycle. You get into what-if? game. What if it got into human lungs? If it mutates, it could be a problem. A big problem."

IN MARCH 1990, while the second outbreak at Reston was happening, the C.D.C. slapped a heavy set of restrictions on monkey importers, tightening the testing and quarantine procedures. The C.D.C. also temporarily revoked the license of three companies, Hazleton Research Products, the Charles River Primates Corporation, and Worldwide Primates, charging these companies with violations of quarantine rules. (Their licenses were later reinstated. The C.D.C.'s action effectively stopped the importation of monkeys into the United States for several months. The total loss to Hazleton ran into the millions of dollars. Monkeys are worth money. Despite the C.D.C.'s action against Hazleton, scientists at USAMRIID, and even some at the C.D.C., gave Dalgard and his company high praise for making the decision to hand over the monkey facility to the Army. "It was hard for Hazleton, but they did the right thing," Peter Jahrling said to me, summing up the general opinion of the experts. Hazleton had been renting the monkey house from a commercial landlord. Not surprisingly, relations between the landlord and Hazleton did not flourish happily during the Army operation and the second Ebola outbreak. The company vacated the building afterward, and to this day it stands empty. Peter Jahrling, a whiffer of Ebola who lived to tell about it, is now the princ.i.p.al scientist at USAMRIID. He and Tom Geisbert, following tradition in the naming of new viruses, named the strain they had discovered Reston, after the place where it was first noticed. In conversation, they sometimes refer to it casually as Ebola Reston. One day in his office, Jahrling showed me a photograph of some Ebola-virus particles. They resembled noddles that had been cooked al dente. "Look at this honker. Look at this long sucker here," Jahrling said, his finger tracing a loop. "It's Reston-oh, I was about to say it's Reston, but it isn't-it's Zaire. The point is, you can't easily tell the difference between the two strains by looking. It brings you back to a philosophical question: Why is the Zaire suffer hot for humans? Why isn't Reston hot for humans, when the strains are so close to each other? The Ebola Reston virus is almost certainly transmitted by some airborne route. Those Hazleton workers who had the virus-I'm pretty sure they got it through the air." "Did we dodge a bullet?" "I don't think we did," Jahrling said. "The bullet hit us. We were just lucky that the bullet we took was a rubber bullet from a twenty-two rather than a dumdum bullet from a forty-five. My concern is that people are saying, "Whew, we dodged a bullet.' And the next time they see Ebola in a microscope, they'll say, 'Aw, it's just Reston,' and they'll take it outside a containment facility. And we'll get whacked in the forehead when the stuff turns out not to be Reston but its big sister."

C.J. PETERS EVENTUALLY left the Army to become the chief of the Special Pathogen Branch at the Centers for Disease Control. Looking back on the Reston event, he said to me one day that was pretty sure Ebola had spread through the air, "I think the pattern of spread that we saw, and the fact that it spread to new rooms, suggest that Ebola aerosols were being generated and were present in the building," he said. "If you look at pictures of lungs from a monkey with Ebola Zaire, you see that the lungs are fogged with Ebola. Have you seen those pictures?" "Yes, Nancy Jaax showed them to me." "Then you know. You can see Ebola particles clearly in the air s.p.a.ces of the lung." "Did you ever try to see if you could put Ebola Reston into the air and spread it among monkeys that way?" I asked. "No," he replied firmly. "I just didn't think that was a good idea. If anybody had found out that the Army was doing experiments to see if the Ebola virus had adapted to spreading in the respiratory tract, we would have been accused of doing offensive biological warfare-trying to create a doomsday germ. So we elected not to follow it up." "That means you don't really know if Ebola spreads in the air." "That's right. We don't know. You have to wonder if Ebola virus can do that or not. If it can, that's about the worst thing you can imagine."

SO THE THREE sisters-Marburg, Ebola Sudan, and Ebola Zaire-have been joined by a fourth sister, Reston. A group of researchers at the Special Pathogens Branch of the C.D.C.-princ.i.p.ally Antony Sanchez and Heinz Feldmann-have picked apart the genes of all the filoviruses. They discovered that Zaire and Reston ar so much alike that it's hard to say how they are different. When I met Anthony Sanchez and asked him about it, he said to me, "I call them kissing cousins. But I can't put my finger on why Reston apparently doesn't make us sick. Personally, I wouldn't feel comfortable handling it without a suit and maximum containment procedures." Each virus contains seven proteins, four of which are completely unknown. Something slightly different about one of the Reston proteins is a probably the reason the virus didn't go off in Was.h.i.+ngton like a bonfire. The Army and C.D.C have never downgraded the safety satus of Reston virus. It seems cla.s.sified as a Level 4 hot agent, and if you want to shake hands with it, you had better wearing a s.p.a.ce suit. Safety experts feel that there is not enough evidence, yet, to show that the Reston strain is not an extremely dangerous virus. It may be, in fact, the most dangerous of all the filovirus sisters, because of its seeming ability to travel rather easily through the air, perhaps more easily than the others. A tiny change in its genetic code, and it might turn into a cough and take out the human race. Why is the Reston virus so much like Ebola Zaire, when Reston supposedly comes from Asia? If the strains come from different continents, they should be quite different from each other. One possibility is that the Reston strain originated in Africa and flew to the Philippines on an airplane not long ago. In other words, Ebola has already entered the net and has been traveling lately. The experts do not doubt that a virus can hop around the world in a matters of days. Perhaps Ebola came out of Africa and landed in Asia a few years back. Perhaps-this is only a guess-Ebola traveled to Asia inside wild African animals. There have been rumors that rain forest have been importing African animals illegally, releasing them into the Philippine jungle, and hunting them. If Ebola lives in African game animals-in leopards or lions or in Cape buffalo-it might have traveled to Philippines that way. This is only a guess. Like all the other thread virus, Ebola Reston hides in a secret place. It seems quite likely, however, that the enter Reston outbreak started with a single monkey in the Philippines. One sick monkey. That monkey was the unknown index case. One monkey started the whole thing. That monkey perhaps picked up four or five particles of Ebola that came from...anyone's guess. ??

PART FOUR.

KITUM CAVE.

Highway 1993 August ...

Camp ...

THE EMERGENCE OF AIDS, Ebola, and any number of other rainforest agents appears to be a natural consequence of the ruin of tropical biosphere. The emerging viruses are surfacing from ecologically damaged parts of the earth. Many of them come from tatered edges of tropical rain forest, or they come from tropical savanna that is being settled rapidly by people. The tropical rain forests are the deep reservoirs of life on the planet, containing most of the world's plant and animal species. The rain forests are also its largest reservoirs of viruses, since all living thins carry viruses. When viruses come out of an ecosystem, they tend to spread in wave through the human population, like echoes from the dying biosphere. Here are the names of some emerging viruses: La.s.sa. Rift Valley. Oropouche. Rocio. q. Guanarito. VEE. Monkeypox. Dengue. Chikungunya. The hantaviruses. Machupo. Junin. The rabieslike strains Mokola and Duvenhage. LeDantec. The Kyasnur Forst brain virus. HIV-which is very much an emerging virus, because its penetration of the human species is increasing reapidly, with no end in sight. The Semlike Forst agent. Grimean-Congo. Sinbis. O'nyongnyong. Nameless Sao Paulo. Marbury. Ebola Sudan. Ebola Zaire. Ebola Reston. In a sense, the earth is mounting an immune response against the human species. It is beginning to react to the human parasite, the flooding infection of people, the dead spots of concrete all over the planet, the cancerous rot-outs in Europe, j.a.pan and the United States, thick with replicating primates, the colonies enlarging and spreading and threatening to shock the biosphere with ma.s.s extinctions. Perhaps the biosphere does not 'like' the idea of five billion humans. Or it could also be said that the extreme amplification of human race, which has occurred only in the past hundred years or so, has suddenly produced a very large quant.i.ty of meat, which is sitting everywhere in the biosphere and may not be able to defend itself against a life form that might want to consume it. Nature has interesting ways of balance itself. The rain forest has its own defenses. The earth's immune system, so to speak, has recognized the presence of the human species and is starting to kick in. The earth is attempting to rid itself of an infection by human parasite. Perhaps AIDS is the first step in a natural process of clearance.

AIDS IS ARGUABLY the most environmental disaster of the twentieth century. The AIDS virus may well have jumped into the human race from African primates, from monkeys and anthropoid apes. For example, HIV-2 (one of the two major strains of HIV) may be a mutant virus that jumped into us from an African monkey known as the sooty mangabey, perhaps when monkey hunters or trappers touched b.l.o.o.d.y tissue. HIV-1 (the other strain) may have jumped into us from chimpanzees-perhaps when hunters butchered chimpanzees. A strain of simian AIDS virus was recently isolated from a chimpanzee in Gabon, in West Africa, which is, so far, the closest thing to HIV-1 that anyone has yet found in the animal kingdom. The AIDS virus was first noticed in 1980 in Los Angeles by a doctor who realized that his gay male patients were dying of an infectious agent. If anyone at the time suggested that this unknown disease in gay men in southern California came from wild chimpanzees in Africa, the medical community would have collectively burst out laughing. No one is laughing now. I find it extremely interesting to consider the idea that the chimpanzee is an endangered rain-forest animal and then to contemplate the idea that a virus that moved from chimps is suddenly not endangered at all. You could say that rain-forest viruses are extremely good at looking after their own interests. The AIDS virus is a fast mutator; it changes constantly. It is a hypermutant, a shape s.h.i.+fter, spontaneously altering its character as it moves through populations and through individuals. It mutates even in the course of one injection, and a person who dies of HIV is usually infected with multiple strains, which have all arisen spontaneously in the body. The fact that the virus mutates rapidly means that vaccines for it will be very difficult to develop. In a larger sense, it means that the AIDS virus is a natural survivor of changes in ecosystems. The AIDS virus and other emerging viruses are surviving the wreck of the tropical biosphere because they can mutate faster than any changes taking place in their ecosystems. They must be good at escaping trouble, if some of them have been around for as long as four billion years. I tend to think of rat leaving a s.h.i.+p. I suspect the AIDS might not be Nature's preeminent display of power. Whether the human race can actually maintain a population of five billion or more without a crash with a hot virus remains an open question. Unanswered. The answer lies hidden in the labyrinth of tropical ecosystems. AIDS is the revenge of the rain forest. It is only the first act of the revenge. No problem, I thought. Of course, I'll be all right. We'll be al right. No problem at all. Everything will be all right. Plenty of people have gone inside Kitum Cave without becoming sick. Three to eighteen days. As the amplification begins, you feel nothing. It made me think of Joe McCormick, the C.D.C. official who had clashed with the Army over the management of the Ebola Reston outbreak. I remembered the story of him in Sudan, hunting Ebola virus. At the end of a plane flight into deep bush, he had come face to face with Ebola in a hut full of dying patients, had p.r.i.c.ked his thumb with a b.l.o.o.d.y needle, and got lucky, and had survived the experience. In the end, Joe McCormick had been right about the Ebola Reston virus: it had not proved to be highly infectious in people. Then I thought about another Joe McCormick discovery, one of the few breakthroughs in the treatment of Ebola virus. In Sudan, thinking he was going to die of Ebola, he had discovered that a bottle of Scotch is the only good treatment for exposure to filovirus.

I DROVE TO the abandoned monkey house one day in autumn, to see what had become of it. It was a warm day in Indian summer. A brown haze hung over Was.h.i.+ngton. I turned off the Beltway and approached the building discreetly. The place was deserted and as quiet as a tomb. Out front, a sweet-gum tree dropped an occasional leaf. For LEASE signs sat in front of many of the offices around the parking lot. I sensed the presence not of a virus but of financial illness-clinical signs of the eighties, like your skin peeling off after a bad fever. I walked across the gra.s.sy area behind the building until I reached the insertion point, a gla.s.s door. It was locked. Shreds of silver duct tape dangled from the door's edges. I looked inside and saw a floor mottled with reddish brown stains. A sign on the wall said CLEAN UP YOUR OWN MESS. Next to it, I discerned the air-lock corridor, the gray zone through which the soldiers had pa.s.sed into the hot zone. It had gray cinder-block walls: the ideal gray zone. My feet rustled through shred of plastic in the gra.s.s. I found elderberries ripening around a rusted air-handling machine. I heard a ball bounce, and saw a boy dribbling as basketball on a playground. The ball cast rubbery echoes off the former monkey house. Children's shouts came from the day-care center through the trees. Exploring the back of the building, I came to a window and looked in. Climbing vines had grown up inside the room and had pressed against the gla.s.s of the windows, seeking warmth and light. Where had those vines found water inside the building? The vine was Tartarian honeysuckle, a weed that grows in waste places and on abandoned ground. The flowers of Tartarian honeysuckle have no smell. That is, they smell like a virus; and they flourish in ruined habitats. Tartarian honeysuckle reminded me of Tartarus, the land of the dead in Virgil's Aeneid, the underworld, where the shades of dead whispered in the shadows. I couldn't see through the tangled vines into the former hot zone. It was like looking into a jungle. I walked around to the side of the building and found another gla.s.s door beribboned with tape. I pressed my nose against the gla.s.s and cupped my hands around my eyes to stop reflections, and saw a bucket smeared with a dry brown crust. The crust looked like dried monkey excrement. Whatever it was, I guessed it had been stirred up with Clorox bleach. A spider had strung a web between a wall and the bucket of waste. On the floor under the web, the spider had dropped husks of flies and yellow jackets. The time of being autumn, the spider had left egg cases in its web, preparing for its own cycle of replication. Life had established itself in the monkey house. Ebola had risen in these rooms, flashed its color, fed, and subsided into the forest. It will be back. ??