Preston introduces Dr. David Silverstein, a highly successful physician who splits his time between Nairobi and Washington D.C. The author/narrator meets him in a coffee shop to discuss Charles Monet and Dr. Shem Musoke. Dr. Silverstein describes how he believed that Dr. Musoke was close to death, and goes on to explain how the South African lab finally gave him a diagnosis: the little-known Marburg virus. Dr. Silverstein recounts how he lay awake after the phone call until he finally decided to research Marburg in his office.
Preston mentions Dr. David Silverstein’s prestige and adventurousness for a specific reason: to emphasize how terrifying a disease would have to be to keep a man like this up at night. It is also significant that the disease has already passed from Monet to Musoke, and yet this is the first time that the doctors attempting to treat it actually begin to understand what the virus is.
Dr. Silverstein relates the history of Marburg virus, the first known human cases of which occurred in 1967 in the German town of Marburg. A factory there called Behring Works created vaccines using cells from Ugandan monkeys. In a process called “virus amplification,” the virus spread from a few infected monkeys to humans, and eventually spread to the city. The first known victim, Klaus F., worked directly with the monkeys, feeding them and cleaning their cages. The next to fall ill, Heinrich P., was also a monkey-keeper, and the third, Renate L., contaminated herself by breaking a test tube full of “infected material.”
Through Dr. Silverstein, Preston begins to fill the reader in on the history of Marburg virus. Once again, the force of globalization is a powerful player within the narrative. Although the virus is of African origin, its first instance was in a German town, emphasizing the speed and seeming randomness with which such viruses can spread in the modern, technological world.
By the end of the epidemic, thirty-one people had become infected, developing headaches, fevers, and blood clots before hemorrhaging and going into shock. About one in four of the victims died, meaning that Marburg was “an extremely lethal agent.” Preston contrasts this disease with the highly dangerous yellow fever, which only kills one in twenty victims who have been admitted to a hospital.
Although we have learned the symptoms of the virus before, this is the first time that readers learn just how deadly Ebola and Marburg really are. The contrast with yellow fever—another historic and deadly disease—emphasizes the danger that Ebola and Marburg pose to humans.
Marburg virus, we learn, belongs to a family called “filoviruses.” In Latin this word means “thread virus,” because these organisms look like tangled rope (in contrast to most viruses, which are ball shaped). Marburg, specifically, will often form loops that “resemble Cheerios.” When first observed in Germany, the virus had especially terrible effects on the brain, attacking it directly and damaging the central nervous system. For this reason, scientists originally believed that Marburg was related to rabies. Since rabies is shaped like a bullet and Marburg like a ring, it was called “stretched rabies.” After Charles Monet died, researchers defined the family of filoviruses as containing not only Marburg, but also two strains of a virus called Ebola—Ebola Zaire and Ebola Sudan. Marburg is the mildest form of the virus, while Ebola Zaire kills ninety percent of all humans who contract it.
As often happens throughout the book, Preston shifts quickly from a global scale to a microscopic one, describing in detail the physical attributes of the tiny particles that make up Ebola and Marburg. This information will become important later, as scientists attempt to identify Ebola by looking at it through a microscope. By moving so seamlessly from large scale to small, Preston gives the reader the ability to comprehend simultaneously the effects that Ebola has within a single human cell, and also on a national and global scale. The family of “filovirus” has been redefined since The Hot Zone’s publication, so that Marburg and Ebola are now separate subcategories (taxons).
Preston describes the effects of Marburg on the human body, likening it to “nuclear radiation.” It attacks “internal organs, connective tissue, intestines, and skin,” causing everything from hair loss to hemorrhages. Even those who survive lose large pieces of skin, and many men experience inflamed, infected testicles. For months afterward, the virus lingers in testicles and eyeball fluid, and survivors can infect others (especially through sexual intercourse). Marburg also changes behavior, making its victims withdrawn, aggressive, and even psychotic. A patient named Hans O.-V., who seemed to have survived the virus, then suddenly died of a brain hemorrhage.
Preston’s comparison of the virus to “nuclear radiation” offers another comparison between the ancient, “natural” virus and a manmade weapon of mass destruction. Preston goes on to unflinchingly describe the symptoms of the disease, using vivid language to give the reader the clearest picture possible of the terrible effects that Ebola can have on the human body. As usual, he emphasizes the worst-case scenario of symptoms to play up the horror and suspense.
“International health authorities” become concerned about how the monkeys have contracted the Marburg virus in the first place, since it kills them too fast for them to be its natural host. A team from the World Health Organization flies to Uganda to determine the geographical source of the monkeys, but since the monkeys were trapped all over the country, they are unable to do so.
We move once again from microscopic to global as Preston describes the international reaction to the original appearance of Marburg virus. He also gives us a clear picture of the dangers of globalization, and of the ways that human error (or deception) can help to spread a hot virus.
In 1982, an English veterinarian whom Preston calls Mr. Jones reveals that at the time of the Marburg outbreak, he was inspecting monkeys in Entebbe that were to be exported to Europe. This house sent out 13,000 monkeys a year, and the infected shipment in question was flown from this facility to London, and then to Germany. Mr. Jones’s job was to visually inspect each monkey before sending it out to Europe, and to remove those that looked ill. Although he could not have known that seemingly healthy monkeys were harboring Marburg virus, he goes on to assert something more “disturbing”—the sick monkeys he picked out were not killed, as he thought, but were instead shipped out to an island in Lake Victoria. Despite the fact that the entire island was a hotbed of disease, the owner of the exporting business would sometimes use these sick monkeys as replacements when he was running low and a shipment was due, meaning that he easily could have sent Marburg to Europe. When the WHO team came to investigate, however, they never looked closely enough at the business. Mr. Jones further recalls that he observed a Marburg-like virus that infected both humans and monkeys near Kitum Cave between 1962 and 1965.
The story of Mr. Jones is a chilling one, because it means that humans may have essentially created a hotbed for disease—one that could eventually explode into a global pandemic. This is a theme that Preston comes back to frequently: that humans have essentially made it easier than ever for hot viruses to infect us. From the laziness and greed of Mr. Jones’s employer to the WHO investigators’ lack of diligence, every human action within this chain of events makes clear that they are entirely ignorant to the terrible risks that they are taking. Kitum Cave, too, pops up yet again, a reminder of the mysterious source of the now-globalized virus.
Preston compares Mr. Jones’s experience of Marburg to “a flashlight pointed down a dark hole,” giving a “narrow but disturbing view” about how tropical viruses originate and spread. Mr. Jones had claimed that the Marburg monkeys were trapped in a group of islands in Lake Victoria called the Sese Islands, and said that the infected isle was close by, meaning that the Marburg monkeys may have been infected by the very animals that Mr. Jones’s company set free.
Preston goes on to mention a nearby fishing village called Kasensero, one of the origin points of AIDS. He describes AIDS’s transition from monkeys and apes to humans, following a series of “rapid mutations” that enabled HIV to jump from one species to another. Although Kasensero is now almost completely wiped out by AIDS, the villagers of Kasensero were once famous smugglers, and it’s possible that they smuggled the infected monkeys that Mr. Jones mentioned. Preston expands on a theory about the origin of AIDS, which links it closely to the business of monkey trading that sprang up in the 1960s, in which African monkeys were shipped to industrialized countries for medical research. As native workers came into close contact with wild monkeys, different species of which were also infecting each other as they were shipped all over the world, HIV may have mdade the transition to the human race. He goes on to compare AIDS to Marburg, saying that both viruses are part of a pattern, but that their origins are ultimately unknowable.
Preston once again uses HIV/AIDS—an African virus that has successfully expanded into a global pandemic—in order to illustrate the ways in which such viruses grow and spread. Although no one knows the exact origin point of AIDS, Preston speculates that smugglers may be responsible for its introduction into the human race—yet another example of human greed and ignorance leading to the destruction of millions of lives. He goes on to refer to a “pattern,” by which he means the pattern of tropical viruses infecting humans. According to Preston, as globalization continues and the human population swells, this pattern is only going to become more obvious and prevalent.
Dr. David Silverstein, meanwhile, faced with a Marburg diagnosis and a desperately ill Dr. Shem Musoke, gets the Kenyan government to quarantine Nairobi hospital, as many employees there had come into contact with or handled samples from Charles Monet and Musoke. Miraculously, Dr. Musoke survives, although he is at first confused and aggressive. Slowly he recovers, and at the time of the book’s writing, he is one of the foremost doctors at Nairobi Hospital. In an interview with Preston, he relates that he remembers only shreds of his time while infected with Marburg. No one else in the hospital, meanwhile, becomes ill.
Although Monet’s trip through Nairobi and Musoke’s stay in the hospital have already exposed many people to Marburg, quarantining the hospital is the only way the health authorities know to stem the spread of the disease. The ultimate positive outcome is, it’s implied, essentially just good luck, and has nothing to do with any measures that the authorities have taken.
Preston, however, does not draw an optimistic conclusion from this outcome. He explains that when a virus is about to emerge in the human race, “the warning signs may be a spattering of breaks at different times and places” called “microbreaks.” The incident at Nairobi Hospital, he asserts, was just such a microbreak. Meanwhile, tubes of blood from Dr. Musoke are sent to international laboratories so that they can begin to study Marburg. Some of this Marburg virus (which Preston traces from Musoke to Monet to possibly Kitum Cave) is currently in a collection of samples kept by the US Army.
Preston returns to the “pattern” that he has previously warned readers about, explaining that these kinds of isolated episodes actually point to the possibility of a much larger epidemic in the future. Yet at the same time, globalization also proves useful in the fight against the virus, as vials of Musoke’s blood travel all over the world to be studied and analyzed.