without mattresses—the blood-soaked mattresses had been burned in the soccer field—and the floors were clean, spotless, rinsed. The team discovered three surviving nuns and one priest, along with a few devoted African nurses. They had cleaned up the mess after the virus had wiped out everyone else, and now they were busy fogging the rooms with insecticide, in the hope that it might somehow disperse the virus. One room in the hospital had not been cleaned up. No one, not even the nuns, had the courage to enter the obstetric ward. When Joel Breman and the team went in, they found basins of foul water standing among discarded, bloodstained syringes. The room had been abandoned in the middle of childbirths, were dying mothers had aborted fetuses infected with Ebola. The team had discovered the red chamber of virus queen at the end of the earth, where the life form had amplified through mothers and their unborn children.
The rains continued all day and night. Around the hospital and the church stood the beautiful ferocious trees, a complex of camphors and teaks. Their crowns entwined and crisscrossed and whispered with rain, and bowed and shifted as troops of monkeys passed through them like currents of wind, leaping from crown to crown, crying their untranslatable cries. The next day, the doctors set out deeper into the forest in their Land Rovers, and they made contact with infected villages, where they found people dying in huts. Some of the victims had been put into isolation huts on the edge of the village—an old African technique for dealing with smallpox. Some of the huts where people had died had been burned down. Already the virus seemed to be petering out, and most of the people who were going to die were already dead, the virus having echoed so swiftly through Bumba. A wave of emotion roled over Joel Breman as he realized, with the clarity of a doctor who suddenly sees into the heart of things, that the victims had received the infection from the hospital. The virus had taken root with the nuns and had done its work among those who had sought help from them. In one village, he examined a man dying of Ebola. The man sat in a chair, holding his stomach and leaning forward with pain, and blood streamed around his teeth.
They tried to reach Kinshasa by radio, to tell Karl Johnson and the others that the epidemic had already peaked. A week later, they were still trying to make radio contact, but they could not get through. They traveled back to the town of Bumba and waited by the river. One day an airplane droned overhead. It circled the town once and touched down, and they ran for it.
At the Ngaliema hospital in Kinshasa, Nurse Mayinga had been put into a private room, which was accessible through a kind of empty room, a gray zone, where the nurses and staff were supposed to put on bioprotective gear before they entered. Mayinga was cared by a South African doctor named Margaretha Isaacson, who at first wore a military gas mask, but it became increasily uncomfortable in the tropical heat. She thought to herself, I can’t bear it. I’ll be surprised if I come out of this alive anyway. That made her think about her own children. She thought, My children are grown up, they are no great responsibility. And she removed her mask and treated the dying girl face-to-face.
Dr. Isaacson did everything she could to save Mayinga, but she was as helpless before the agent as medieval doctors had been in the face of the black plague. (“This was not like AIDS,” she would later recall. “AIDS is a child’s play compared with this.”) She gave Nurse Mayinga ice cubes to suck on, which helped to ease the pain in her throat, and she gave her Valium to try to stave off her apprehension of what lay ahead.
“I know I am dying,” Mayinga said to her.
“That’s nonsense. You are not going to die.” Dr. Isaacson replied.
When Mayinga’s bleeding began, it came from her mouth and nose. It never came in a rush, but the blood dripped and ran and would not stop and would not clot. It was a hemorrhagic nose bleed, the kind that does not stop until the heart stops beating. Eventually Dr. Isaacson gave her three transfusions of whole blood to replace what she lost in nosebleeds. Mayinga remained conscious and despondent until the end. In the final stage, her heart developed a galloping beat. Ebola had entered her heart.
Mayinga could feel her heart going blubbery inside her chest, and it frightened her unspeakably. That night, she died of a heart attack.
Her room was contaminated with blood, and there was also the question of the two nuns’ rooms, both of which were still locked and bloodstrained. R. Isaacson said to the staff, “I won’t be of much use to you now,” and she got a bucket and mop and wash the rooms.
Medical teams fanned out into Kinshasa and managed to locate thirty-seven people who had face-to-face contact with Mayinga during the time when she had wandered around the city. They set up two biocontainment pavilions at the hospital and shut the people up for a couple of weeks. They wrapped like cadavers of the nuns an Nurse Mayinga in sheets soaked in chemicals, then double-bagged the mummies in plastic and put each one in an airtight coffin which a screw-down lid, and held the funeral services at the hospital, under the watch of doctors.
Karl Johnson, having heard nothing from the team of doctors upriver in Bumba, wondered if they were dead, and assumed that the virus was about to go on a burn through the city. He organized a floating hospital ship and had it moored in the Congo River. It was an isolation ship for doctors. The city would be the hot zone, and the floating ship would be the gray area, the place of refuge for the doctors. Approximately a thousand Americans were living in Zaire at the time. In the United States, the Amy’s Eighty-second Airborne Division went on alert and prepared to evacuate the Americans by air as soon as the first Ebola cases started popping up in the city. But to the strange and wonderful relief of Zaire and the world, the virus never went on a burn through the city. It subsides on the headwaters of the Ebola River and went back to its hiding place in the forest. The Ebola agent seemed not to be contagious in face-to-face contacts. It did not seem to be able to travel through the air. No one caught the virus from Nurse Mayinga, even though she had been in close contact with at least thirty-seven people. She had shared a bottle soda pop with someone, and not even that person became ill. The crisis passed.
CARDINAL
1987 September
As with Ebola, the secret hiding place of the Marburg agent was unknown. After erupting in Charles Monet and Dr. Shem Musoke, Marburg dropped out of sight, and no one could say where it had gone. It seemed to vanish off the face of the earth, but viruses never go away, they only hide, and Marburg continued to cycle in some reservoir of animals or insects in Africa.
On the second of day of September 1987, around suppertime, Eugene Johnson, the civilian biohazard expert attached to USAMRIID, stood in a passenger-arrival area outside the customs gates at Dulles International Airport, near Washington. He was waiting for a KLM flight from Amsterdam, which carried a passenger who had come from Kenya. A man with a duffle bag passed through customs, and he and Johnson nodded to each other. (“I’m going to leave this person’s name out of it. Let’s just say he was someone I knew, someone I trust.” Johnson explained to me). The man laid down the duffle bag at Johnson’s feet, unzipped it, and pulled out a wad of bath towels wrapped around something. Pulling off the towels, he revealed an unmarked cardboard box wound with tape. He handed the box to Johnson. They had little to say to each other. Johnson carried the box out of the terminal building, put it in the trunk of his car, and drove to the Institute. The box held blood serum from a ten-year-old Danish boy who will be called Peter Cardinal. He had died a day or so earlier at Nairobi Hospital with a combination of extreme symptoms that suggested an unidentified Level 4 virus.
As he drove to the Institute, Johnson wondered just what he was going to do with the box. He was inclined to sterilize its contents in an oven and then incinerate it. Just cook it and burn it, and forget it. Most of the samples that came into the Institute—and samples of blood and tissue arrived constantly from all parts of the world— contained nothing unusual, no interesting viruses. In other words, most of the samples were false alarms. Johnson wasn’t sure he wanted to take the time to analyze this boy’s blood serum, if, in all probability, nothing would be found in it. By the time he pulled into the gates of Fork Detrick, he had decided to go ahead. He knew the work would keep him up most of the night, but it had to be done immediately, before the blood serum deriorated.
Johnson put on a surgical scrub suit and rubber gloves, and carried the box into the Level 3 staging area of
