How would the outbreak of Ebola Zaire in 1976 have been different if the virus were airborne?
After being infected with the Ebola virus, Nurse Mayinga spent two days in the city of Kinshasa where she had face-to-face contact with at least thirty-seven people. If the Ebola virus had been airborne, Mayinga could have become a vector for the spread of the disease throughout the entire city. Once a large percentage of the population was infected through airborne transmission, it would only be a matter of time before the virus spread to other countries through plane travel.
Describe the symptoms of the Marburg virus as it affects Charles Monet.
Seven days after his visit to Kitum Cave, Monet develops a headache, shortly followed by a severe backache, fever, and nausea. His face becomes mask-like, and his eyeballs turn bright red, while his personality becomes increasingly sullen and angry. As the virus amplifies in his body, Monet expels "vomito negro" or black vomit, caused by liquefying flesh mixed with virus. His body becomes filled with blood clots, which cut off the blood flow to his brain and cause extensive brain damage, or depersonalization. In the last phase of the virus, Monet collapses and hemorrhages blood from every orifice.
Over the course of the book, the author frequently changes narrative point of view. List some examples of this and explain why Preston may use these techniques in his writing.
Preston shifts between several narrative styles in the book, including third person, second person, and internal monologue. Because the book is a non-fiction work based on extensive research, Preston's default perspective is the third person, which provides an opportunity for description and clinical observation (such as when he describes Charles Monet's symptoms). Yet, in some scenes, such as when Nancy Jaax is working in the hot zone with Tony Johnson, Preston shifts to internal monologue. Not only does this provide the reader with more insight into Nancy's character, it also heightens the drama of the scene.
Preston describes the Ebola virus as being neither dead nor alive. Provide evidence to support both sides of the argument.
From one perspective, a virus is no more alive than a machine. It has no mind and no motivation beyond a simple directive to replicate itself. From another perspective, a virus such as Ebola is an incredibly ancient life form that has survived for thousands of years. Despite not having a consciousness, the virus displays a strategic cunning when it comes to its existence, particularly when it comes to infecting and replicating in a new host.
What is the ethical dilemma faced by Nancy Jaax in her work with hot agents?
Nancy Jaax works with Level 4 agents in an effort to save human lives through medicine. However, in order to progress in her research, Jaax must inject laboratory animals with deadly viruses and observe their suffering and eventual deaths. This is in direct opposition to her oath as a veterinarian. While her actions are made for the sake of protecting and promoting life, Jaax must still deal with knowledge that she is promoting one species of life over another.
What role does chance play in the events described in the book? Give at least two examples.
Over the course of the book, characters seem to be infected or not infected solely on the basis of chance. Charles Monet and his female friend both visit Kitum Cave in 1980, yet only Monet becomes infected with the Marburg virus. Similarly, when Nurse Mayinga treats a patient with Ebola Zaire, she immediately becomes infected, while Dr. Isaacson remains unaffected. In both of these cases, there is no logic to explain why the virus strikes one individual and not the other. The virus seems to take an arbitrary path, one that cannot be controlled by science or human knowledge.
Describe the characteristics of each of the four "sister" strains of the filovirus family.
Each of the four filovirus strains contains seven proteins, four of which are unknown. The symptoms of all four strains are similar, but they have a varied kill rate. Ebola Zaire is the most deadly strain, with a kill rate of approximately 9 out of 10. Also identified in 1976, Ebola Sudan has a lower kill rate of approximately 7 out of 10. In contrast to both, Ebola Reston is harmless to humans but is deadly to monkeys. Finally, Marburg has a kill rate of approximately 3 out of 10. Of the four, only Reston is able to travel through the air easily.
Compare and contrast the behavior of Nurse Mayinga and Margaretha Isaacson when faced with the virus.
Nurse Mayinga and Margaretha Isaacson are both responsible for caring for a patient who has been infected with Ebola Zaire. However, they both deal with their own possible exposure in very different ways. While treating Mayinga, Isaacson accepts the likelihood of her own exposure and removes her gas mask in order to comfort Mayinga during her final hours. Later, she volunteers to clean the contaminated hospital rooms so that others will not be exposed to infection. In contrast, Nurse Mayinga approaches her exposure with denial and self-absorption. Despite recognizing the symptoms of Ebola in herself, she wanders throughout the city for two days in spite of the risk she poses to dozens of other people.
During the outbreak at the Reston facility, the virus seems to jump from Room F to Room H. Describe three possible ways the virus might have spread.
The rooms in the Reston facility have a linked air supply, so it is possible that the virus could have traveled through the air from Room F to Room H. Alternately, the virus could have spread through the dirty injection needles used for monkeys in both rooms. As a third option, one of the animal caretakers could have tracked the virus into the other room by carrying feces on his or her shoes. The unknown element of transmission makes Ebola Reston incredibly dangerous.
Preston describes AIDS as "the worst environmental disaster of the 20th century." Why is AIDS potentially more dangerous than the Ebola virus?
The AIDS virus has the ability to mutate quickly, even to the point that it can mutate several times during the infection of a single host. As a result, the virus is able to survive extreme environmental changes and is currently resistant to vaccines. In contrast to the Ebola virus, which has killed approximately 3,000 people since 1976, the AIDS virus has caused the deaths of more than 10 million people at Preston's time of writing and is expected to affect millions more.