The next day Nancy wakes at 4 AM and dresses in her Army uniform. She considers that she may need to put on a protective spacesuit later that day because of her training in veterinarian pathology. She is specializing in studying “Biosafety Level 4 hot agents,” for which space suits are required. Nancy wakes her children and leaves them with a babysitter before heading to Fort Detrick. The building she works in is huge, and almost windowless—to protect the general public from the “sealed biological laboratories” within. Nancy works at the United States Army Medical Research Institute of Infectious Diseases (USAMRIID), also known as the Institute. USAMRIID focuses on medical defense. Its scientists research methods to protect soldiers against both “biological weapons and natural infectious diseases.” It even researched offensive biological weapons after WWII, but this practice was made illegal in 1969. Since then it has focused on developing vaccines and other protections against deadly diseases.
Preston now introduces another incredibly important element within his narrative: USAMRIID, the center of the US Army’s efforts to combat various diseases. That it takes a military institution to combat Ebola only further illustrates how deadly and menacing the disease really is. Fighting the disease is like fighting a war, requiring a military level of discipline, bravery, and self-sacrifice—qualities that a great many USAMRIID employees possess, as will become clear as the narrative progresses.
Nancy walks into the building and heads for the Level 4 biocontainment area, where she intends to see what has happened to “the Ebola monkeys.” Preston explains the setup of USAMRIID’s biocontainment system, which creates negative air pressure to keep diseases from leaking into the air. A civilian scientist named Eugene Johnson, an expert on Ebola and Marburg, leads the Institute’s research of Ebola. He has been infecting monkeys with the virus and giving them drugs to attempt to halt the infection. Nancy Jaax has joined this project, and her role is “to determine the cause of death in the monkeys.” Upon arriving at Level 4 (called “the Ebola suite”), she finds a note telling her that two of the monkeys have died overnight. This means that she must put on a spacesuit and enter the Ebola suite to dissect the monkeys—and quickly, before Ebola causes their internal organs to liquefy entirely.
Preston’s description of the measures that USAMRIID takes to keep viruses like Ebola in a completely sterile and self-contained environment illustrates the great precautions that one must take while handling the disease. It also makes clear how unprepared and unprotected most hospitals and healthcare professionals are to deal with it. Eugene Johnson’s experiment, meanwhile, is both important and incredibly dangerous, emphasizing the bravery of those who take part in it, but also the risk involved in any kind of research associated with the disease.
When Nancy first asked to be transferred to pathology within USAMRIID, the colonel in charge told her that the work was too much for a married woman. After a display of both her determination and her temper, however, he allowed her to join up. Nancy began working in the lower, less dangerous Levels 2 and 3, but developed a terrible reaction to the various vaccines that this work required. As a result, she was placed in Level 4 work—Level 4 viruses, or “hot viruses,” are defined as deadly diseases “for which there is no vaccine and no cure.”
More backstory on Nancy illustrates her bravery and perseverance. Though Nancy’s decision to work with Level 4 viruses was motivated by necessity, her willingness to do so makes clear that she is ready to put her life on the line in order to protect the general public.
Preston briefly digresses, introducing the Ebola River, where Ebola Zaire first originated in September 1976, erupting in fifty-five villages along the river’s banks. People at the Institute fear Ebola, and many consider its study to be potentially lethal work. Eugene Johnson (Gene), appropriately, has a reputation (both within USAMRIID and without) for being wild, even fearless. He is considered “one of the world’s leading Ebola hunters.” Large and disheveled with a busy brown beard, Gene does not look like an employee of the US Army, nor does he often publish in scientific journals. Despite his bravery, he is mistrustful of other people, and is deeply afraid of viruses. Having spent years in central Africa looking for the source of Ebola and Marburg, he is one of the few scientists in the Institute willing to even work with the virus. Most consider it too dangerous and frightening to handle. Gene has recurring nightmares about his spacesuit becoming contaminated with Ebola.
The fear that many employees of USAMRIID associate with Ebola emphasizes the disease’s uniqueness even among hot viruses, and the bravery of researchers like Gene Johnson and Nancy Jaax who choose to study it. Gene Johnson’s bravery and fearlessness, meanwhile, contrast with the frequent nightmares that he has about Ebola exposure. As with Dr. David Silverstein, Preston emphasizes Johnson’s bravery to suggest the conclusion that any disease that makes this man wake up in a cold sweat is a force to be reckoned with.
Explaining the theory of microbreaks, Preston introduces the worry that Ebola will one day become an epidemic. Gene Johnson calls Ebola “unpredictable,” since we have no way of knowing whether it will one day become an airborne, worldwide pandemic, or whether it will remain forever rare and mysterious. The virus, Preston asserts, is a simple one, killing humans “with swift efficiency and with a devastating range of effects.” Taking the “worst elements” of many more commonplace viruses, from measles to rabies to influenza, the Ebola virus particle contains seven proteins, four of which are completely mysterious in terms of form and function. These proteins combine to attack the body’s immune system above all (like HIV), acting terrifyingly quickly once Ebola enters the human bloodstream. Scientists do not know exactly how Ebola is passed between people. Originally they believed that it came through “direct contact with blood and bodily fluids,” but touching the bodies of the dead also seems to cause infection.
As he often does, Preston moves quickly from the human to the scientific, introducing questions and anxiety about the ways that Ebola spreads. This issue will become a vital one as the narrative progresses, and as scientists struggle to understand how exactly the deadly virus is transferred. The mystery deepens as Preston explains that scientists do not fully understand the fundamental workings of the proteins that make up the virus. This sense of uncertainty is one of the most terrifying aspects of Ebola. Humans know so little about the deadly virus that we cannot even grasp what it’s made of, let alone how exactly it spreads.
We learn about Gene Johnson’s Ebola experiment, in which he attempts to cure monkeys infected with the disease. Since monkeys and humans are so closely related, Ebola can move between them easily, and its effects on a monkey closely mirror the effects that it has on humans.
The parallel between humans and monkeys is one that Preston often highlights—we think of ourselves as something wholly separate from other animals, but to a virus humans are just another creature, something to prey on.
Nancy Jaax, meanwhile, has volunteered to work on Gene Johnson’s Ebola experiment in order to prove herself capable and brave. Various sexist critics within the Institute, however, believe that her status as a married woman and the supposed clumsiness of her hands combine to make her unfit for this kind of duty. Her “immediate superior” on the project is Colonel Anthony Johnson (Tony), a quiet and calm man. When Nancy applied for the program, he asked around about her, even talking to Jerry Jaax, who didn’t want his wife handling Ebola or wearing a spacesuit. When Tony talked to Nancy, however, he found her capable, and didn’t think her hands were a problem at all. He told her that he would help train her for the work ahead. After the meeting, she cried of happiness.
Nancy Jaax’s attitude towards Ebola is quite different from that which we’ve seen before. She thinks of researching it as a kind of test of bravery, and a chance to prove herself to those who believe she’s too weak and feminine. In her mind, working with a deadly disease is actually a positive thing, because she can help others and pursue her passion while also asserting her own value and skill to her detractors.
After a morning of paperwork, Nancy stops by Tony Johnson’s office and the two decide to enter the Ebola suite. Alone in a locker room, Nancy strips naked (except for the Band-Aid on her hand) and dresses in a surgeon’s scrubs. This is, we learn, “only her second trip into a hot area.” She then enters Level 2, which is protected by UV light that destroys viruses and by the Institute’s system of negative air pressure. Nancy then passes through to Level 3. This room contains sterile furniture and a “hatbox,” a container covered in biohazard symbols that is meant to store and transport infectious waste. In this room, the hatbox is a chair. Nancy puts baby powder on her hands underneath a pair of latex gloves, sealing these around her hands with tape, and doing the same with her socks.
Preston now gives a detailed description of the methodical preparations USAMRIID researchers like Nancy must undergo before dealing with a virus like Ebola. The many levels of safety and sterilization illustrate the great danger of Ebola, but also show the many opportunities for a small, relatable human error to lead to disaster—a mistake during any of these steps could lead to potential contamination. Once again, this description also implies how unprepared most of the rest of the world is to ever deal with these kinds of viruses.
As Tony Johnson enters, Nancy puts on her Chemturion biological spacesuit, taking special care with its heavy rubber gloves, the “most important barrier between her and Ebola.” Although she is supposed to inspect her spacesuit, Nancy rushes through this step, allowing Johnson to lower a helmet over her head, zipping up the suit, and plugging in her supply of oxygen. Although some experience terrible panic when inside a biological spacesuit, Nancy remains calm. Nancy and Tony prepare to enter Level 4, which is covered in a giant biohazard warning. Preston calls the Level 4 air lock a “gray area…where the hot zone touches the normal world.” Nancy forces herself to remain calm, crosses the air lock (which functions as a decontamination shower), and with Tony Johnson, enters “the hot side.”
This passage introduces gloves and spacesuits, two crucial symbols for the lengths to which humans must go in order to keep viruses such as Ebola at bay. The spacesuit, in particular, emblemizes complete protection and isolation from the outside world (and the viruses that live there). Yet as we will see later in the narrative, even these extreme protective measures sometimes fail—a testament to the danger these viruses pose, and to the vulnerability of the human body.