The Hot Zone: Part 1, Chapter 7 Summary & Analysis

We flash back to July 6, 1976 in Sudan, where a man known as Mr. Yu G. dies of a strain of Ebola. He is a storekeeper in a town called Nzara, a product of the “human population explosion” of the twentieth century. Preston calls attention to the beauty and diversity of the landscape, which changes from savanna to rainforest. Preston notes that many bats roosted in the ceiling near Mr. Yu. G.’s desk, but adds that no one knows whether they were the source of the infection. When Mr. Yu. G. died, his family gave him a traditional burial, and the virus began to spread. One of the victims, a man called P.G., was extremely popular and promiscuous, and he spread the virus to many of his acquaintances.

Preston explains that while being fatal to its host is not in the best interest of the virus, if it is extremely contagious, it can jump from one host to another before killing them. The Ebola strain reaches a hospital in a town called Maridi, where the medical staff has not been sterilizing its needles. There, patients, doctors, and family members all begin to die. Many of the victims experience brain damage, and exhibit psychotic behavior.

The Sudan strain, Preston explains, is more than twice as lethal as Marburg, meaning it kills about 50% of those infected. He says that if the virus had made it to the metropolitan center of Khartoum, it then could have moved to Cairo, from which it would have traveled to every large city in the world. Instead, the virus “ravaged” the hospital and then largely died out. It is possible that this occurred because the virus killed people too quickly (meaning they did not have time to infect others), and because it was not airborne. After this outbreak, the virus has not been seen since, but Preston speculates that it is still out there, living in “some unknown host” until it can mutate once again and infect humans.

Two months after Ebola struck Sudan, in September 1976, an even more lethal strain struck Zaire, near the Ebola River. This virus was twice as lethal as Ebola Sudan. Although no one knows who the first human case was, Preston asserts that it was likely someone who ate meat from an animal infected by the virus, or who was exposed to an insect host of some sort. It next moved to a hospital in a town called Yambuku, which was staffed by Belgian nuns, and had a small school attached to it.

Ebola traveled to this hospital by a way of a teacher from the school, who had recently been on a vacation in the wilds of Zaire. He visited the Ebola River and ate both antelope and monkey meat while there. The next morning he felt sick, and so stopped by the hospital to get an injection of medicine. The conditions in this clinic, however, were highly unsafe, with the nuns using only five hypodermic needles to give injections to hundreds of patients throughout the day, and rinsing them occasionally in bloody warm water. The schoolteacher became desperately ill a few days later, although it is unclear whether he contracted the virus while on his vacation, or from a dirty needle at the hospital.

Because of the use of these needles, the virus spread almost instantaneously to fifty-five villages close to the hospital. It killed those who had received injections, family members of the victims, and the hospital’s staff, one of whom had aided a woman dying of the virus as she miscarried (her fetus, too, had contracted Ebola and had hemorrhaged inside her uterus). A nun named Sister M.E. became ill as well, and a priest, plus a nun named Sister E.R., decided to take her to the capital city of Kinshasa. Once there they took her to Ngaliema Hospital.

Preston describes the effects of Ebola Zaire, which “attacks every organ and tissue in the human body except skeletal muscle and bone,” transforming everything else into a kind of “digested slime of virus particles.” It contains “seven mysterious proteins,” which first create blood clots that, as they grow, cut off blood flow to other parts of the body, causing internal organs to begin to die. It especially focuses on connective tissue, essentially turning the body into “mush.” Skin begins to blister, rip, and bruise, and soon every opening in the body begins to bleed. The heart starts to bleed and soften, the brain becomes blocked by dead blood cells, and the eyeballs fill up with blood. Often victims of the virus experience a stroke. Even though blood within the body is clotting, blood outside of the body is unable to coagulate, as the red blood cells themselves have been destroyed. While the host is still alive, internal organs such as the liver, kidneys, and spleen cease to function. Genitals, too, become swollen and may often hemorrhage.

Brain damage from the virus can sometimes lead to epileptic seizures, causing a patient to splatter blood all around them (an excellent way for a virus to jump to a new host). The virus multiples so fast that the body’s cells become filled with viral structures called bricks, which break through the cell wall and then disintegrate into the bloodstream. Eventually one drop of blood can contain a hundred million particles of the virus. Once the hosts die, their bodies disintegrate and begin to leak a fluid that was once their internal organs.

After her death, “Sister M.E.’s hospital room was stained with blood.” Hospital employees refused to clean the room, so it was simply left locked. They did not know what had killed her, but doctors suspected that it might be a relative to Marburg. Next Sister E.R. fell ill and died, after being cared for by Nurse Mayinga. Soon after this, Mayinga developed a terrible headache, but remained in denial because she had just received a scholarship to study in Europe.

Rather than seeking treatment, Mayinga left her job and traveled into the city to obtain travel permits before she grew too obviously ill. When she became too ill to function, she took a taxi to Kinshasa’s largest medical facility, the Mama Yemo Hospital—it is unclear why she didn’t return to Ngaliema Hospital, but Preston speculates that it was “a case of psychological denial.” It was a crowded building, packed with the city’s poor, and the doctors there gave her a shot for malaria. Still ill, she took another taxi to a facility called University Hospital, where doctors were unable to find a diagnosis. Only then did she return to Ngaliema, where she was placed in a private room, and her sickness worsened.

People began to hear a rumor about a virus upriver, and about a sick nurse in Kinshasa. Word spread to government employees, and eventually reached the World Health Organization in Geneva. The place went on high alert, as its employees waited to see whether Mayinga had infected the population of Kinshasa. Countries began to consider blocking all flights from the city, and President Mobutu Sese Seko of Zaire sent in his army to quarantine Ngaliema Hospital. He also sealed off the infected zone upriver with roadblocks. Eventually this area, called the Bumba Zone, lost all contact with the outside world.

Doctors had sampled Sister M.E.’s liver as she was dying, trying to ascertain her illness, and had also drawn some of her blood. They sent this to a lab in Belgium, and one in England, but not to the Centers for Disease Control in Georgia—staffers there began begging for samples as well. The main branch of the C.D.C. involved in this effort is called the Special Pathogens Branch, and in 1976, it was run by Dr. Karl M. Johnson, a virus hunter who had spent many years researching in Central and South America. He had heard only that there was a fever with “generalized symptoms” in Zaire, and finally obtained a small amount of Sister M.E.’s blood from the English lab.

When the blood arrived, the tubes that held it had cracked, and the box was “sticky with blood.” The virologist in charge, Patricia Webb (who was married to Karl Johnson at the time), put on gloves to handle the blood and managed to collect a few droplets. She placed it into flasks with monkey cells, and observed as the virus within the blood began to attack the healthy cells. Meanwhile, another doctor named Frederick Murphy, who had helped to identify the Marburg virus, decided to use an electro-microscope to photograph the virus within the dying cells. Putting a droplet of fluid under the microscope, he became instantly terrified as he saw the string-like virus, believing it to be Marburg. Fearful of Marburg’s infectiousness, he scrubbed his entire lab with Clorox bleach, before calling Patricia Webb, who quickly contacted Karl Johnson. The three looked at the shapes of the virus, noticing the classic Ebola shepherd’s crook, which essentially looks like “a Cheerio with a long tail.” When Patricia Webb ran tests for Marburg, they came back negative. Having isolated and identified the strain, the C.D.C. had won the right to name it, and decided to call it Ebola.

Karl Johnson is now a fly-fishing aficionado in Montana, who does a great deal of consulting work on global health issues. Preston tries several times to contact him, and finally receives a response via fax, in which Johnson calls Ebola a “confrontational cobra,” and confesses to being “shit scared” of the disease.

Two days after discovering Ebola, Karl Johnson headed to Africa with two other C.D.C. doctors in an effort to stop the virus in Zaire and Sudan. They stopped in Geneva, where one of the doctors became too frightened to go any further—a fairly common occurrence, Johnson explains.

Preston visits Karl Johnson and the two go fly-fishing together. Johnson discusses his trip to Kinshasa, and the panic and chaos that he found there. He explains how catastrophic it would have been had Ebola been able to spread through the air, but reveals that the idea of a species-threatening virus doesn’t upset him, because the human race may in fact need to be thinned out. He then comments that he finds viruses not only fascinating, but beautiful.

A C.D.C. doctor named Joel Breman, who had come with Karl Johnson to Zaire, was tasked with travelling to the Bumba Zone, along with a team from WHO (the World Health Organization). Breman became increasingly scared as the plane neared its destination, remembering his wife and children in Michigan. He had only surgical masks, gowns, and gloves in his bag, and knew that this would not be enough to handle an infectious virus. The crew who brought them refused to even get off the plane. Once there, the team bribed the local governor, who loaned them two Land Rovers to travel to the Ebola River. The smallpox virus had attacked this area for centuries, and so each village had created a rudimentary quarantine roadblock out of foreign trees.

Villagers were suspicious of the WHO team, letting them in only after finding that they were doctors. At last the team reached the Yambuku Mission Hospital, which was nearly deserted, except for a few surviving nuns and nurses, and a priest. They had attempted to sterilize every room except for the maternity ward, which was filled with bloody syringes, and the corpses of infected women and fetuses. Preston takes a moment to describe the beauty of the surrounding landscape before recounting the team’s journey deeper into the forest, where they encountered infected villages who had attempted to quarantine the sick and dying in huts, before burning the buildings altogether. Joel Breman realized that the epidemic had already peaked, and that it had begun at the hospital. He tried to contact Karl Johnson, but was unable to. Eventually they traveled back to the edge of the Bumba Zone, where an airplane picked them up.

Meanwhile, back in Ngaliema Hospital, Mayinga was being completely quarantined. Her main physician, a South African doctor named Margaretha Isaäcson, at first wore a gas mask whenever treating Mayinga, but eventually took it off, deciding that it offered little protection. She tried to care for Mayinga, but was helpless against the infection. Blood gushed from Mayinga’s nose and mouth and her heart began to give out, though she remained conscious the entire time. She eventually died of a heart attack. Dr. Isaäcson, convinced that she herself was infected, washed out Mayinga’s room and the nuns’ rooms.

Medical teams had located thirty-seven people who had encountered Mayinga while she was infected, and quarantined all of them. Karl Johnson, meanwhile, had heard nothing from the doctors in Bumba, and assumed that they were dead and that the virus was highly contagious. He organized a ship that could serve as a place of refuge for doctors, should the city fall prey to an epidemic. A division of the US Army, meanwhile, prepared to evacuate all Americans out of Zaire. Miraculously, however, no one else became ill, not even a person who had shared a bottle of soda with Mayinga. The virus could not spread through casual contact.