Part Four: "Kitum Cave"

PART FOUR

In the end of the book Preston recalls his visit to Africa. While he’s there he remembered what it was living there as a child. During his visit he went to Kitum Cave in Mount Elgon. He took Kinshasa Highway to get there. This highway is also known as AIDS Highway because most of the towns along the road had AIDS outbreaks. Accompanying Preston was his guide Robin MacDonald, Robin’s family, and 4 other men. He entered Kitum Cave protected by a body suit, a hood, gloves, boots, and a respirator. After leaving he made sure to soak everything in bleach and seal them in plastic bags. Once back in the US he eventually visited the monkey house in Reston, Virginia. Preston suggests that Ebola will return.

Overall Response

This book was simultaneously informative and interesting to read. Parts of the book were actually suspenseful. These parts include when Nancy Jaax was almost infected with Ebola. The parts where the characters realized that a strain of Ebola was in the monkey house and then developed a plan to eradicate the monkeys were also suspenseful.  This book was an eye opener as to how much animal testing actually goes on and was kind of upsetting in that aspect. The book was also easy to read and people without a background in biology would be able to understand it without any issues. The virus itself was very scary and disturbing. Being infected with Ebola is probably the worst way for someone to die.

Part Three: "Smashdown"

Part Three

Reston Virus

It is finally time to come into the hot zone and see what is exactly such a commotion. Is this the strain of Ebola that finally breaks out in the United States and causes an epidemic or is this just a big miscommunication? As the monkeys keep dying left and right it is time to get to the bottom of things. Monkey that are known to have a virus are to be brought back to Fort Detrick for testing to correctly identify if they have Ebola. Not only are monkeys dropping like flies but it now appeared that the humans that were in the building are getting sick as well. The monkey house is turned over to the USAMRIID and its time to figure out what exactly is causing this disturbance. After hours of euthanizing monkeys the entire group is exhausted, but it seems that nobody wants to give up on what they started. After a soldier losses air pressure in her space suit due to a malfunction, there is a panic as to whether or not she will be affected by the virus. It seems however, that she was able to fix her suit and get out of the hot zone in time. Upon further inspection it is discovered that she had a hole in her suit. Just as things seem they cannot get any worse it just so happens that a monkey escaped its cage. After multiple tries of using a net to catch the escaped monkey the animal is left free overnight in the room. While these events were occurring in the hot zone back in the laboratory Peter Jahrling was working on a way to isolate and determine how this virus was spreading. Still worried after sniffing the contaminated flask Jahrling continually tests samples of his blood as well as Geisbert in order to see if they glow under ultraviolet light. Luckily none of their blood samples tested positive under the light, yet. They soon realize that they are reaching the end of the incubation period and would soon know if they are indeed infected or not. While the Nancy Jaax was handling the dilemma of keeping the outbreak secret from the rest of the world she was also facing another moral dilemma. She found out that her dad was very ill and was going to die relatively soon. She now had to decide between continuing her work and helping keep this outbreak contained within the monkey house, or visit with her father for his last days alive. She chooses she rather work on this important case and her father dies while she is at work. The team however, was able to euthanize the remainder of the monkeys in the house. The operation was completed and the decontamination team came in with formaldehyde gas and seemingly killed the last traces of the virus. The few people that came into contact with the virus such as Jahrling, Geisbert, and the solider were found to have no symptoms of the virus, as well as all the other human workers. After about a month later there was another outbreak of the virus in another monkey house. Instead of causing the same panic as last time, this time the USAMRIID isolated the house and checked to see how the virus progressed. The virus spread through the facility and killed the monkeys, but as in the previous case there were no causalities for humans. Even though there were no causalities the USAMRIID saw that four men Jarvis Purdy, who had a heart attack, Miltion Frantig, who had become sick and threw up on the lawn, John Coleus, who had cut his thumb and a unnamed fourth man all tested positive for Ebola Reston virus. The virus multiplied in their cells however, it never made them sick. The virus eventually left their systems and they were part of the few people that had actually survived the Ebola virus. After noticing that three out of the four men affect by the virus had not cut themselves, the USAMRIID realized that Ebola can indeed spread through the air.

Part Three Response

Reading this section I felt like Nancy Jaax working with Ebola, I just could not stop until I finished. What made this section interesting was the sense of mystery and suspense throughout. Would Jahrling and Geisbert get Ebola? Would the escaped monkey attack the workers? How would Nancy react to finding out her dad is very ill? All these questions plus many more kept me planted in my seat hoping that everything would be resolved. I felt as if I went through every emotion reading this part ranging from anger to joy and relief. I feel as though the low point of the book came when Nancy said that she rather keep working rather than visit her dying father. I understand where she is coming from wanting to help resolve the issue in the monkey how but family comes first to me. Throughout the book it seemed as though she put work in front of her family, even going against her husband’s wishes to not work with Ebola. While she loved her family dearly she loved her work even more. I respect her for that, though if I were in her shoes I think I would have made a different choice. After figuring out that the virus only affected monkeys and not human helped calm me down. Knowing that Jahrling and Geisbert were not going to die after worrying for weeks if they were infected or not put a smile on my face. That smile quickly disappeared though after it was revealed that Ebola could spread through the air. While we might be safe now we never know when another strain can cause a pandemic and worldwide fear.

Part Two: "The Monkey House"

Part Two

In this chapter we learn that the monkey house is located in Reston Virginia, and was founded in 1989. It is Officially known as the “Reston Primate Quarantine Unit” which is owned by Hazelton research products, which is A company that coordinates the import and sale of laboratory animals. On October 4, the facility receives 100 wild monkeys from the Philippines. Two of the monkeys are dead upon arrival. The remaining animals are places in 12 holding rooms.
            About 4 weeks after the shipment, 29 monkeys are found dead in room F of the facility. Bill Volt the operator/man in charge of the Reston facility contacted Dan Dalgard who is a veterinarian. When Dalgard arrives he identifies two sick monkeys in room F.
He notices 2 Monkeys have droopy eyelids, both have a fever. Those two monkeys end up dying that night, and as a result he ends up performing a dissection on one of the monkeys and finds enlarged spleens, and blood in their intestines. He thinks it might be (SHF) Simian Hemorrhagic Fever, but he is not sure. So Dalgard sends samples the money’s spleen and some throat mucous to USAMirrad a military facility at Fort-Detrick.
Dr. Peter Jahrling a virologist at USAMirrad specializes in monkey viruses. He examines the samples sent by Dalgard, and he ends up thinking that the reason for death was from (SHF), as Dalgard hypothesized. Dalgard euthanizes remaining monkeys in room F to prevent further spread of the disease, but ends up finding out from a dissection from one of the euthanized monkeys that it was completely healthy. As a result based off of his guilt for killing healthy monkeys he then stores their bodies in the freezer of the Reston facility.
            Back at the USAMirrad facility Tom Geisbert an intern there for Dr. Peter Jahrling also examines the samples sent from D. Dalgard, in a flask from the Reston Monkey, Cells and he observes that the cells appear sick. Peter Jahrling believes the flask is contaminated with bacteria. Both Tom Geisbert and Dr. peter Jahrling sniff the contents of the flask. Jahrling still believes (SHF) is the cause for the monkey’s sickness.
Geisbert tries to confirm Jahrling’s diagnosis using an electron microscope and a diamond knife cutter.  He observes a rope like virus crawling within the cells. He now believes the virus could be Marburg, and if his findings are correct he and Dr. Jahrling
 may have sniffed up a potentially hot agent. He takes photographic evidence and compares it to textbook images of Marburg virus with the assistance of Dr. Jahrling.
Jahrling decides to confirm virus by testing Reston Monkey cells with blood samples from humans who were infected with Ebola or Marburg. Geisbert is then sent to the Reston facility to find prove that the virus in still active in the dead monkeys. He collects pieces of a monkey’s liver the same one used for the initial testing’s. He then slices the pieces open with a diamond knife cuter, and takes photographs. The Photographs come back positive for continued growth in the monkey tissue, which is an alarming result. At USAMirrad Dr. Jahrling is useing blood serum from individuals what were infected with a filo-virus;
1) Shem Musoke- Marburg virus
2) Mayinga N. –Ebola Zaire
3) Boniface- Ebola Sudan
            Dr. Jahrling combines the monkey cells with blood serum from each individual. The mixed blood sample of cells will glow under UV light if both identical viruses are present in the sample of cells which is indicative of a positive result for one of the 3 strains. The results of the blood serum test are scary and concerning because, the experimental results show that Ebola Zaire is to blame for the numerous monkey deaths.
            From here high-ranking officials of USAMirrad are called forth, and a meeting is held to discuss the findings. A huge concern about this virus is that it may have the ability to travel through the air, which was discovered by Gene Johnson’s Ebola Experiment.
A Bio-containment is called for, which consists of two different operations; 1) Let virus run it’s course 2) Euthanize all moneys in the Reston facility. Both of which require major field operations with Swat personnel trained in biohazard work. Contact with official channels like the C.D.C is made. Because of the recent discovery all operations at the Reston facility are suspended except for feeding, cleaning, and observation, and operations of how to resolve the situation are being calibrated upon.

Part Two Response

           
            This book was super fascinating and thrilling to read. The book is all the more interesting when you’re taking a microbiology class and you know how viruses work, what laboratorial techniques were performed, you understand the terminology be used. You also have these “ohh crap” moments when reading because, you know something bad is going to happen and yet you continue to want to know more. The part of the book I enjoyed the most was the Monkey house section. I enjoyed this section the most because this is where the initial investigation and uncovering for the unknown deaths of the Reston monkeys occurs. I also like this section the most because as the reader you could really feel the nervousness, and anticipation that the investigators were going through. Overall it was just one of those chapters that was continuously drawing you in, because you felt as though you were a part of the investigation.

Part One: In the Shadow of Mount Elgon

PART ONE

Charles Monet – Marburg Virus

The book begins by discussing a man by the name of Charles Monet who lived in western Kenya.  He was known for spending a lot of time with animals, specifically wild monkeys and birds.  He and a female friend, whose name is unknown, went on a trip to Mount Elgon on New Year Eve. The exposure they had to animals was discussed in detail.  Monet fed a wild monkey while it sat on his shoulder. They then set up their tent in an area with buffalo feces on the grass. Trees containing olives poisonous to humans also surrounded the area and monkeys feeding on the olives were living in these trees. The next morning, Monet and his friend visited Kitum Cave. There the platform in which they walked on contained elephant feces as well as bat guano (digested feces).  The cave was described as a petrified rain forest containing needle-like crystals everywhere. After the trip, Monet went back to work as usual. However, one week later he began to have a headache. As time passed, he began to show other symptoms including a backache, fever, nausea, and vomiting.  His personality began to change and his eyes turned red and droopy, his skin turned yellow and began to bruise, and he no longer seemed to understand where he was. His coworkers took him to the hospital where the doctors could not diagnose him. He was sent to another hospital via commercial airplane and his condition worsened on the flight. He began to vomit black and red vomit and eventually got a nosebleed.  Once the plane landed, he went straight to the hospital via taxi and was told to wait to be attended in the Casualty Department along with other patients. There he collapsed on the floor, lost consciousness, and yet continued to vomit and began to bleed out from his anus.

Dr. Musoke – Marburg Virus

Dr. Shem Musoke and several nurses got Monet onto a gurney and took him to the ICU. There Dr. Musoke tried to treat him while wearing no gloves. Blood ended up getting all over Dr. Musoke including in his mouth and eyes. That night Monet died and Dr. Musoke stayed by his side all night. Nine days after the blood and vomit got into Dr. Musoke’s eyes and mouth he began to get a backache and then his eyes turned red.  He got an injection for an antimalarial drug and it caused him more pain than an injection should cause. Other symptoms began to develop including jaundice, abdominal pain, and images revealed that his liver was enlarged. Dr. David Silverstein performed surgery on Dr. Musoke and ended up having trouble stopping Dr. Musoke’s bleeding. His blood was losing its ability to clot. After the surgery Dr. Silverstein sent some of Dr. Musoke’s blood samples to the CDC. Dr. Musoke was diagnosed with Marburg virus. Dr. Silverstein treated him with supportive care and Dr. Musoke was able to survive the virus.

Peter Cardinal – Marburg Virus

A 10-year-old named Peter Cardinal became sick after visiting Kitum Cave with his family. His eyes turned red and doctors though he had malaria. He was having trouble breathing and x-rays demonstrated watery mucus developing in his lungs. His skin had red spots and his fingertips turned blue. His skin then began to spontaneously bruise and his pupils dilated indicating brain death. His skin then began to fill with blood, to the point where it was almost separated from his flesh. Cardinal then died.

Ebola Sudan Victims

The first known case of Ebola Sudan was Mr. Yu. G. in southern Sudan.  No one knows how he was infected but he infected two of his workers. After Mr. Yu G.’s death his coworkers bled, went into shock, and died of massive hemorrhages.  The virus spread and ended up in a hospital in Maridi. The virus jumped from patient to patient quickly because the medical staff had been using dirty needles for injections. Eventually the remaining staff fled and the virus subsided because there were no more dirty needles being used and other people had not come in contact with the blood of the infected patients.

Ebola Zaire Victims

The Ebola Zaire strain was twice as lethal as Ebola Sudan. It appeared in a district by the name of Bumba Zone in northern Zaire. The first human case remains unknown however the disease surfaced in a clinic run by nuns called the Yambuku Mission Hospital. A schoolteacher had taken a trip to northern Zaire where he and his friends bought antelope and monkey meat. Upon returning from the trip his wife cooked it and they ate it. He began to feel sick and got an injection at the clinic. The nuns used the same five syringes on hundreds of patients all day and did not clean the regularly. It is unknown whether the man got infected during the trip, from the meat, or from the injection with the dirty needle. The virus erupted simultaneously in 55 villages surrounding the clinic. Many nuns were infected and died. Sister M. E. was infected and taken to Ngaliema Hospital in Kinshasa, Zaire where she died. Sister E. R. accompanied her and ended up getting infected and dying as well. Nurse Mayinga N. was infected with the virus. She was in denial and travel around town for 2 days. Eventually she returned to the hospital and died. Nobody that she came in contacted with during her days in town was infected.

Marburg Virus

Marburg virus is a ring shaped filovirus. A filovirus is a virus that is shaped like a thread. Marburg virus affects the central nervous system as well as the brain. Signs and symptoms include headaches, red eyes, backaches, fever, nausea, vomiting, depersonalization, and spontaneous bruising. Other symptoms include jaundice, abdominal pain, and the blood looses its ability to clot. Before dying the victim can undergo different types of spacing. First space is when you bleed out into your lungs. Second space is when you bleed into your stomach and intestines. Third space is when you bleed into the space between the skin and the flesh and they eventually become separated.

Ebola Sudan

It is twice as lethal as the Marburg virus. Ebola Sudan causes bleeding and shock. Signs and symptoms include mental derangement, psychosis, and depersonalization. Massive hemorrhages from all openings of the body occur and then the victim dies. The mortality rate for Ebola Sudan is 50%.

Ebola Zaire

Ebola Zaire is almost twice as lethal as Ebola Sudan. This strain attacks every organ and tissue in the body except skeletal muscle and bone. Clots appear in the bloodstream and block blood supply to different parts of the body. The skin develops petechiae (red spots that signify hemorrhages under the skin). The connective tissue in the body is liquefied and the skin develops a maculopapular rash. This rash consists of tiny white blister mixed with red spots. Rips appear in the skin from which blood comes out of and the skin begins to bruise. Every opening in the body begins to bleed and the surface of the tongue sloughs off. The heart muscle softens and bleeds into itself, the brain becomes clogged with dead blood cells, and the eyeballs are filled with blood which and leads to blindness. Even though the body is filed with blood clots, the bleeding that occurs outside of the body cannot clot. He liver, kidneys, and intestines are also destroyed and the spleen turns into one big blood clot. Ebola patients have epileptic convulsions during the final stage and after dying their bodies begin to dissolve.

Gerald and Nancy Jaax

Majors Gerald and Nancy Jaax where then introduced to the story. They are a married couple and are both veterinarians that work for the US Army. Major Nancy Jaax began to work with Ebola in the biosafety level four labs. She entered the lab without realizing that there was a hole in the glove of her space suit.  Blood from the monkey she was working on got into the glove but upon further inspection it turned out that the blood did not get passed the first layer of gloves she was wearing under the space suit. She later finds out that the two healthy monkeys in the lab somehow got infected with Ebola. She realized Ebola is airborne.

Part One Reaction

As I was reading this part I found myself forgetting that the victims where not aware of the disease or their exposure to it. Because of my previous knowledge about viruses I was able to recognize the actions that lead to their infections. For instance, when Monet was in the cave the detailed description of the animal feces everywhere and then the sharp crystals were a clear indication that he would begin showing symptoms of the virus soon after the trip. I was in utter shock when the doctors sent him to another hospital via commercial airplane and then again when Dr. Musoke was attending to him with no gloves on. The book became suspenseful when Nancy Jaax was working with Ebola in the lab. I too felt fear for her as she was removing the layers of gloves to see of the money blood had gotten to the cut on her hand and then relief when it was revealed that it had not. After it was known that Peter Cardinal had visited Kitum Cave I too felt Eugene Johnson’s excitement for the expedition to the cave. It was disappointing that when there they could not find the source of the virus and even more disappointing that they had to euthanize the monkeys even though they were not infected.