The Hot Zone: The Terrifying True Story of the Origins of the Ebola Virus

“This is really serious. We don‘t know much about Marburg.”

In this passage, a researcher informs Dr. Silverstein that his patient, Dr. Musoke, is infected with Marburg virus. The phrases haunt him as he ponders the implications of Musoke’s infection with the serious and nearly unknown disease. It emphasizes that Silverstein is practicing medicine—and this book is unveiling information—on the frontiers of science.

“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.”

In this passage, Preston mixes the language of disease containment (“a hot island”) with archaic and poetic language (“an isle of plagues”). The layering of synonyms both ensures reader comprehension and allows for dramatic fancy. The passage also emphasizes the perils of the monkey trade and its role in creating conditions for novel disease jumps between species.

“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. 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.”

In this passage, Preston uses three rhetorical questions to imply connections between the monkey trade and the emergence of novel viruses in the human population. There is insufficient evidence to prove such assertions, but the questions allow him to introduce these ideas nonetheless.

“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.”

Here in “Diagnosis,” following the Charles Monet and Dr. Shem Musoke infections, Preston foreshadows later breaks by Marburg and Ebola into the human species. The qualification, “so to speak,” acknowledges that Ebola is not truly attempting or intending anything. As throughout the book, Preston balances a somewhat mystical sense of these viruses as ancient and powerful beings against a scientific understanding of them as mere molecular machines.

“Today this particular strain of Marburg virus is known as the Musoke strain. Some of it ended up in glass vials in freezers owned by the United States Army, where it was kept immortal in a zoo of hot agents.”

This ominous passage, in which the Army comes to own samples of the virus in Dr. Musoke’s blood, hints at the Murky Ethics of Virus Research. In this case, research interests keep the deadly virus “immortal” rather than eradicating it, hinting at possible applications in bioweapons or bioterrorism, both of which are topics Preston takes up in later works.

“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.”

Here, Preston adopts a close third-person perspective and narrates Nancy Jaax’s thoughts as she ponders the ethical dilemma of the use of laboratory monkeys, bringing to the surface the theme of The Murky Ethics of Virus Research.

“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 the 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.”

Preston describes Nancy Jaax and Tony Johnson at a remove, as “two human primates.” This language works against human exceptionalism, making the point humans are as vulnerable to this disease as monkeys are. The researchers are not special, despite their scientific knowledge and advanced equipment. Preston also uses archaic language to describe both the monkey and the virus, “a dweller in trees” and “a dweller in blood,” adding to the mysterious and ominous atmosphere.

“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.”

In this passage, Preston addresses a fundamental philosophical question: whether viruses can be counted as alive. He compares them to machines like jackhammers and then to “molecular sharks,” a metaphor he uses twice in The Hot Zone. If viruses are all motive and no mind—like sharks in the popular imagination—then the destruction they unleash within human bodies is all the more terrifying.

“The fact that one infected person had wandered around the city for two days when she should have been isolated in a hospital room began to look like a species-threatening event.”

This passage captures the alarm at the World Health Organization headquarters in Geneva, Switzerland, at the news of Nurse Mayinga’s movements through Kinshasa. The passage heightens the suspense over whether a more widespread outbreak will occur and introduces the idea of a “species-threatening event,” a viral plague that could indeed wipe out the human population.

“Then all radio contact with Bumba was lost. No one knew what was happening upriver, who was dying, what the virus was doing. Bumba had dropped off the face of the earth into the silent heart of darkness.”

This cliff-hanger end to a section embodies the imperialist perspective of government and health officials outside of Bumba. The quote alludes to Joseph Conrad’s 1899 anti-imperialist novella, Heart of Darkness. The novel is set along the Congo River in what was then the Belgian Congo, and the titular phrase evokes racist and imperialist tropes of a “mysterious” and “wild” African interior, unpenetrated and unknown by European colonizers or, in this case, the global virology community. The people in Bumba know who is dying and what the virus is doing; thus, this statement is true only from a perspective that discounts local knowledge. When the expedition finally reaches Bumba, World Health Organization scientists will even discover that local people are taking effective steps to counter the spread of the virus.

“Having centuries of experience with the smallpox virus, the village elders had instituted their own methods for controlling the virus, according to their received wisdom, which was to cut their villages off from the world, to protect their people from a raging plague. It was a reverse quarantine, an ancient practice in Africa, where a village bars itself from strangers during a time of disease, and drives away outsiders who appear.”

The World Health Organization expedition to the Bumba region of northern then-Zaire here meets with local disease control efforts. These American and European scientists must confront the ironic and horrifying fact that a mission hospital was the source of most of the infections, while traditional practices of reverse quarantine and isolating victims are mitigating the impacts of unsafe hospital practices.

“The Marburg virus was a traveler: it could jump species; it could break through the lines that separate one species from another, and when it jumped into another species, it had a potential to devastate the species. It did not know boundaries. It did not know what humans are; or perhaps you could say that it knew only to well what humans are: it knew that humans are meat.”

This passage emphasizes human’s vulnerability in the face of viruses. When Preston asserts that Marburg “did not know what humans are,” he reminds us that the virus does not care about humans, hold them sacred, or even yearn to infect them. By asserting that “humans are meat,” Preston again denies any exceptionalism to humans and lumps them in with other animal hosts and connotes both death and all the gruesome activities of Marburg upon the systems of the human body.

“After you’ve fed and watered monkeys for thirty days, they become your friends. I fed ’em bananas. That was terrible. It sucked.”

Here, Eugene Johnson describes his feelings upon sacrificing the healthy monkeys on the Kitum Cave expedition. This passage uses pathos to highlight the cruelty inherent in the use of laboratory animals, even for a greater good.

“What annoyed him was the fact that the bits of meat were wrapped in aluminum foil, like pieces of leftover hot dog.”

Preston uses a commonplace simile, comparing Dan Dalgard’s casual packaging of the sample of monkey spleen to the way one would wrap up leftover meat, to capture the alarm and annoyance that virologist Peter Jahrling experienced on receiving the package. As the reader has by now surmised that this monkey is likely infected with a filovirus, the passage generates dramatic irony as well as a sense of suspense and foreboding due to the danger of infection that the sample presents to Dalgard, Jahrling, and other bystanders.

“He had been planning to drive his Ford Bronco, but it had broken down, so one of his hunting buddies met him in a pickup truck and they loaded Geisbert’s duffel bag and gun case into it and set off on his hunting trip. When a filovirus begins to amplify itself in a human being, the incubation period is from three to eighteen days, while the number of virus particles climbs steadily in the bloodstream. Then comes the headache.”

In this passage, Preston closes “Exposure” with a cliff-hanger. Moments before, USAMRIID intern Tom Geisbert sniffed the flask containing the unknown virus culture from the Reston monkey house. By juxtaposing his weekend plans with facts about the incubation period of a filovirus, Preston implies that Geisbert may be infected, and encourages the reader to contemplate the potentially deadly consequences for him, his hunting buddy, and the broader human community.

“Jahrling then put on a space suit and carried his own blood into his Level 4 hot lab […] It was very strange, handling your own blood while wearing a space suit. It seemed, however, quite risky to let his blood lie around where someone might be accidentally exposed to it. His blood had to be biocontained in a hot zone.”

This ironic passage, in which Jahrling wears the maximum level of protective equipment to handle his own blood, emphasizes the uncertainty of viral infection and incubation. Jahrling believes he is likely not infected, and is choosing to avoid quarantine after incautious lab practices, but he is simultaneously exercising Level 4 care with his biomaterials, as it is not impossible that he is infected. This highlights the complex risk calculus involved with the ethical obligation a potentially infected person has for protecting others.

“To his horror, the Mayinga glowed brightly. He jerked his head back. Aw, no! He adjusted his helmet and looked again. The Mayinga blood serum was still glowing. The dead woman’s blood was reacting to the virus in the monkey house.”

Thirteen years after her death from Ebola Zaire, Jahrling uses Nurse Mayinga’s blood to test for the virus. The last time we saw her in this narrative, Mayinga was a dying young woman who had dreamed of studying in Europe. The glow of these samples under ultraviolet light is a potent symbol for the illumination of science into the inner workings of the natural and cellular world, while Nurse Mayinga’s name, through the reader’s familiarity with her story and her experience, is a reminder of the human being behind these biomaterials.

“They piled the bags one by one gently in the Toyota’s trunk. Each monkey weighed between five and twelve pounds. The total weight came to around fifty pounds of Biohazard Level 4 liquefying primate. It depressed the rear end of the Toyota.”

In this passage describing Nancy Jaax, CJ Peters, and Eugene Johnson piling deceased monkeys into CJ’s cheap old car, Preston contrasts the language of precise scientific measurement (the weight of the monkeys) with the casual setting and colloquial language. He illustrates the weight of 50 pounds by noting that the springs of the car depress, and when he calls the contents of the bags “liquefying primate,” he creates a description strong in what Preston himself calls “the puke factor,” (217), the natural human tendency to react with disgust and fear to potentially pathogenic objects and situations. The repeated mention of the Toyota by brand name—an unglamorous one at that, nearly synonymous with the ordinary and everyday—also drives home the inappropriateness of using a car’s trunk and some garbage bags to contain something as harmful as a Level 4 pathogen.

“This is the real thing. A biological Level 4 outbreak is not a training session.”

In this scene, Eugene Johnson strives to impress on the young soldiers of the 91-Tangos the seriousness of the monkey house operation. Ironically, the Reston outbreak is not quite “the real thing”—the Reston virus does not sicken humans, although no one involved in the operation had cause to conclude this at the time.

“At the day-care center down the hill, parents had been dropping off their children, and the children were playing on swings.”

In this scene, Preston contrasts the dangers of the monkey house with the daycare center full of unsuspecting children just down the hill. The oblivious children are a symbol of innocence and all that the Army must protect by defeating the threat of Ebola.

“I had not been back to Africa since I was twelve years old, but when you have encountered Africa in childhood, it becomes a section of your mind. […] When I saw Africa again, Africa came back whole, alive, shining with remembered enigma.”

Preston’s childhood memories from his time on a Luo farm near Lake Victoria (likely in Kenya or Tanzania, but never specified) and his adult encounter with Kenya are here described as “exotic” and “mysterious,” “shining with remembered enigma”—a colonialist perspective also seen in the international medical community’s response to Ebola outbreaks.

“I used to go up to that cave when I was a kid […] So there’s a disease up there, eh? Makes AIDS look like a sniffle, eh? You turn into soup, eh? You explode, eh? Pfft! - coming out of every hole, is that the story?”

This banter from Robin MacDonald regarding the Marburg virus shows that he both understands what the virus does and doesn‘t quite believe in the dangers. His personal experience of exploring the cave without illness makes the idea of contracting a gruesome and deadly virus there feel unlikely, and he literally scoffs at it.

“It occurred to me that nettles are, in fact, injection needles. Stinging cells in the nettle inject a poison into the skin. They break the skin. Maybe the virus lives in nettles. Moths and tiny flying insects drifted out of the cave mouth, carried in a steady cool flow of air. The insects floated like snow blown sideways. The snow was alive. It was a snow of hosts.”

This passage emphasizes that lethal viruses engender—because the virus is invisible and its sources in the natural world are unknown, every animal in the forest on Mount Elgon, and here even a plant, presents a potential danger. Preston uses the simile “like snow” and then the metaphor, “a snow of hosts,” comparing the insect life around Kitum Cave to snow, to emphasize the numerous possible hosts for the Marburg virus.