Book Review: The Hot Zone

My copy of the book, which I thought was being cute when it said it was a true story. It looks, and the synopsis reads, like a fiction book! If only it was.

I’ve come to the determination — and it is surely not a bold one, given the last year and a half of the COVID-19 pandemic, which has killed 6.33 million people globally, of which just over a million are from the United States — that the absolute scariest threat to the human species is a fast-moving, “slate wiper” virus. That is, at least, until I get around to reading books about the near-misses with nuclear weapons, and their handling otherwise. I came to this determination about 20 pages into reading Richard Preston’s 1994 nonfiction book, The Hot Zone, about the Ebola virus showing up in the United States for the first time in Reston, Virginia a suburb of Washington D.C., in 1989.

Ebola, as described by Preston, is one of the deadliest diseases known to man, killing between 50 and 90 percent of those who contract it, depending on which strain you contract. A blurb on the back of the book made me grab for this book at a yard sale two weeks ago, and I didn’t need to know anything else. It was by Stephen King. He said, “One of the most terrifying things I’ve ever read. What a remarkable piece of work.” Again, 20 pages into the book, where Preston was going into grave detail about what the Ebola virus does to the body, and I couldn’t agree more with Mr. King. It made me uncomfortable. It made my skin itchy and crawly. It gave me the heebie-jeebies. In one description, Preston remarks that you can emit so much black vomit, that it tears off the skin off of your tongue, which is reportedly, obviously, very painful.

A private company imported monkeys from the Philippines to their monkey house in Reston, where those monkeys would then be sent to laboratories for medical research — one of the most fascinating subtle plots of the book is the juxtaposition between those who are veterinarians, but also in the U.S. Army; thus, on one hand, the duty to save animal lives as veterinarians, and the duty on the other hand to save human lives by using animal lives for testing purposes — , and the monkeys end up being absolutely devastated by Ebola. In the end, hundreds of monkeys are euthanized and/or killed by Ebola. But weirdly, even though numerous people come into contact with the monkeys, including via a cut and the transmission of diseased monkey blood into the cut, and three do test positive for Ebola, none get even severely sick, much less die. That is because it’s some peculiar and practically undetectable differentiation under a microscope of a strain modification from Ebola Zaire. They end up calling it Ebola Reston.

Freakily, Ebola Reston seemed to transmit via the air. So, Preston wants us to imagine an Ebola strain that could both be transmitted through the air and be 50 to 90 percent fatal in human beings. For whatever reason, Ebola Reston wasn’t able to jump to humans and fatally replicate its host to death, but what if it one day can? Keep in mind, that COVID-19, by contrast, while highly transmittable, had a mortality rate magnitudes smaller than Ebola, hovering between 0.09 percent and above 2.0 percent, depending on the country, and look how many it still killed. And luckily, we rapidly developed vaccines that saved at least 20 million people in 2021 alone. Now, imagine something like Ebola, with no known vaccine and no known cures.

Again, that’s why this book is utterly terrifying. Worse than what the virus can, or may one day adapt to do, is that we just aren’t prepared for it. Even with lessons to learn from COVID-19, I fear we are no better prepared for a “slate wiper,” as Preston calls Ebola, much less something even worse.

That’s because, as evidenced in Preston’s telling, human beings are flawed, and human beings inside institutions are perpetuating systemic flaws. The pissing match over the monkey house in Reston, for example, between the Centers for Disease Control and USAMRID, the Army’s Medical Research Institute of Infectious Diseases (as one USAMRID colonel put it, the Army has the muscle, but not the jurisdiction domestically, and the CDC has the jurisdiction but not the muscle), not to say anything of the myriad other government agencies at every level (federal, state, and local), who need to be roped in, and all with the same mind: Downplaying by not telling the public the truth because they think not causing a panic is a worthy trade-off for being opaque (we saw how disastrous that turned out to be with COVID-19). Or that individuals within those systems didn’t report certain facts in the case, whether that was the main guy at the corporation, those within USAMRID, like one who didn’t mention he had “whiffed” Ebola, and so on. Or that those who had previously investigated Ebola in Kitum Cave in Mount Elgon National Park in Kenya, didn’t publish those findings, thus not sharing imperative knowledge.

All of these things, and more, are why an already deadly virus, could be catastrophic for the human race. At the end of the book, Preston wonders if we dodged a bullet in 1989, with Ebola emerging in the U.S. for the first time, and so close to Washington, no less, but with no human fatalities. I think we did dodge a bullet, because it is only by the happenstance of it not being deadly to humans that it wasn’t a worse, more tragic event. Because there was an abundance of human error a human-killing virus could have taken advantage of, but luckily, it wasn’t a human-killing virus … for some reason.

That, that, too, is why this is all so disconcerting. There are so many unknowns when it comes to Ebola in particular, and other viruses generally. We don’t know where Ebola comes from; we don’t know why different strains seem to be airborne and others aren’t; and why some seem to devastate monkeys, who are obviously very closely related to us, but not us.

Preston’s theory he touches on at the end is that the viruses, like Ebola and AIDS (which he spends some time talking about, too), are emergent because of human meddling with the tropical biosphere, like at Kitum Cave, with poaching, cutting down trees, and human population growth. We disrupt those biospheres, and the viruses emerge. Moreover, he argues that perhaps that is the Earth’s way of responding to a biosphere attack by humans: releasing deadlier and deadlier viruses to cull the herd. That we could be our own undoing through carelessness with the environment, unleashing a predator we can’t fight, and who has had perhaps billions of years to prepare to take us down, is startling, to say the least.

On a character level, Preston did a good job throughout the book of making me care about the people who are on the frontlines of infectious disease, and the absolutely batshit people who regularly go into USAMRID’s Level 4 space to handle Ebola. No, thank you. But it’s admirable that they do it to no public fanfare. Two of those characters I cared about were wife and husband, Nancy and Jerry Jaax. Nancy was the one who directly handled Ebola. Being the 1980s, she was at first thought to be unable to do the work as a woman, and a “married female” at that, both because her attention would either be on Ebola or her family, not both, and because her hands were too delicate. Fortunately, a higher up vouched for her, and put her in Level 4, and her career continued to take off, and she was invaluable in the Reston situation. Simmering in the background as this couple fights a deadly disease is their own family strife: Jerry’s brother is brutally murdered (and to my knowledge, it is still a cold case), and Nancy’s father dies amid the Reston issue, so she isn’t there before he does so. She felt it would have been a dereliction of duty to leave.

Something I come away thinking after the book is the dire warning inherent in a quote by Gene Johnson, a civilian “virus hunter” working with USAMRID and who is an Ebola expert, which goes back to the problem of unknowns, who said of Ebola, “We don’t really know what Ebola has done in the past, and we don’t know what it might do in the future.”

Ominous, and hopefully something not prescient.

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