The Hot Zone traces the true events surrounding an outbreak of the Ebola virus at a monkey facility in Reston, Virginia in the late 1980s. In order to contextualize the danger posed by this outbreak, Preston provides background about several other viral outbreaks, particularly in Africa in the 1970s and 1980s. The result is a fast-paced scientific thriller that, while lacking the traditional narrative of a fictional work, is all the more terrifying because it describes factual events. While Preston does not overstate the danger of Ebola and other filoviruses, he argues that the greater threat lies in emerging viruses like the AIDS virus, whose effect on the human race cannot yet be measured.
The book begins in Kenya in 1980, where Preston describes the exposure and death of French expatriate Charles Monet due to the Marburg virus. Preston portrays Monet’s symptoms and bloody death in extreme detail, providing the reader with an immediate sense of the virus as a predator with the potential to decimate a large population. The author then provides background about the first outbreak of the Marburg virus in a vaccine factory in Marburg, Germany in 1967.
Over the next several chapters, the book describes outbreaks that occurred four years before Monet’s death. First, Preston highlights an outbreak of the Sudan strain of the Ebola virus, which first strikes a quiet storekeeper named Yu G. before spreading throughout his district. Then, the narrative shifts to an even more horrific outbreak of Ebola Zaire, which simultaneously appears in dozens of villages as the result of the use of dirty needles at a medical clinic. Both outbreaks cause hundreds of deaths, but Preston provides particular details about the death of one woman, a nurse named Mayinga N. who becomes infected with Ebola Zaire at the Ngalemia Hospital and spends two days in the capital city before being quarantined.
Amid the description of specific outbreaks and victims of the filoviruses, Preston also focuses on several American scientists and military personnel who spend their lives wearing space suits and researching hot agents. Despite the dangers surrounding these lethal viruses, the individuals strive to learn as much as possible, all in the hopes of eventually developing a vaccine or cure that will protect the human race. One of these scientists is Nancy Jaax, an army veterinarian and mother of two who specializes in hot agents at Fort Detrick in Maryland. During an experiment on Ebola in 1983, Jaax suffers a near exposure to Ebola after ripping her space suit in the middle of a dissection. Several years later, Jaax is asked to examine tissue samples from monkeys who are dying of an unknown virus at the Reston facility. When Jaax identifies the virus as a new strain of Ebola, the United States Army and the Centers for Disease Control coordinate a secret operation to contain the virus before it can spread to the human population.
While the Reston facility is marked as a “hot zone,” a SWAT team is tasked with entering the building, euthanizing hundreds of monkeys, and collecting blood and tissue samples for further study. The operation is rife with near disasters: one woman’s space suit malfunctions while she is in a contaminated room, an infected monkey escapes from its cage, and a scientist is nearly bitten by a monkey who is not properly sedated. Eventually, the team succeeds in killing all of the monkeys and completely decontaminating the facility. It is revealed the strain of Ebola, known as Ebola Reston, is deadly to monkeys but symptomless in humans.
At the end of the book, the author visits Kitum Cave, a tourist spot in Kenya that was visited by two victims of the Marburg virus before developing symptoms. An earlier scientific expedition to the cave had been unsuccessful in identifying the source of the virus. However, Preston decides to visit, not just to explore possible sources of the disease, but to stand in the spot where the story of The Hot Zone begins.