General Russell’s office occupied a corner of a low-slung Second World War barracks that had been recently plastered with stucco into a hopeless effort to make it look new. It had a view of the legs of Fort Detrick’s water tower. Consequently, the general never opened his curtains. The visitors sat on a couch and hairs, and the general settled behind his desk. He was a medical doctor who had hunted viruses in Southeast Asia. He was in his late fifties, a tall man with hair thinning on top and gray at the temples, lined cheeks, a long jaw, pale blue eyes that gave him a look of intensity, and a booming, deep voice.
C.J. Peters handed the general a folder containing the photographs of the life form in the monkey house.
General Russell stared, “Holy shit,” he said. He drew a breath. “Man. That’s filovirus. Who the hell took this picture?” He flipped to the next one.
“These were done by my microscopist, Tom Geisbert,” Jahrling said. “It could be Ebola. The tests are showing positive for Ebola Zair.”
C.J. then gave an overview of the situation, telling the general about the monkeys in Reston, and finishing with these words: “I’d say we have a major pucker factor about the virus in those monkeys.”
“Well, how certain are you that it’s Ebola?” General Russell asked. “I’m wondering if this could be Marburg.”
Jahrling explained why he didn’t think it was Marburg. He had done his test twice, he said, and both times the samples were positive to the Mayinga strain of Ebola Zaire. As he spoke to the general, he was very careful to say that test did not in itself prove that the virus was Ebola Zaire. It showed only that is was closely related to Ebola Zaire. It might be Ebola, or it might be something else—something new and different.
C.J. said, “We have to be very concerned and very puckered if it is of the same ilk as Ebola.”
They had to be very puckered, Russell agreed. “We have a natural emergency on our hands,” he said. “This is an infectious threat of major consequences.” He remarked that this type of virus had never been seen before in the United States, and it was right outside Washington. “What the hell are we going to do about it?” he said. Then he asked them if there was any evidence that the virus could travel through air. That was a crucial question.
There was evidence, horrifying but incomplete, that Ebola could travel through the air. Nancy Jaax described the incident in which her two healthy monkeys had died of presumably airborne Ebola in the weeks after the bloody-glove incident, in 1983. There was more evidence, and she described that, too. In 1986, Gene Johnson had infected monkeys with Ebola and Marburg by letting them breathe it into their lungs, and she had been the pathologist for that experiment. All of the monkeys exposed to airborne virus had died except for one monkey, which managed to survive Marburg. The virus, therefore, could infect the lungs on contact. Furthermore, the lethal dose was fairly small: as small as five hundred infectious virus particles. That many particles of airborne Ebola could easily hatch out of a single cell. A tiny amount of airborne Ebola could nuke a building full of people if it got into the airconditioning system. The stuff could be like plutonium. The stuff could be worse than plutonium because it could replicate.
C.J. said, “We know it’s infectious by air, but we don’t know how infectious.”
Russell turned to Jaax and asked, “Has this been published? Did you publish it?”
“No, sir,” she said.
He glared at her. She could see him thinking, Well, Jaax, why the hell hasn’t it been published?
There were plenty of reasons, but she didn’t feel like giving them just now. She believed that Gene Johnson, her collaborator, had difficulty writing papers. And, well, they just had not gotten around to publishing it, that was all. It happens. People sometimes just don’t get around to publishing papers.
Hearing the discussion, Peter Jahrling chose not to mention to the general that he might have sniffed just a little bit of it. Anyway, he hadn’t sniffed it, he had only whiffed it. He had kind of like waved his hand over it, just to bring the scent to his nose. He hadn’t inhaled it. He hadn’t like jammed the flask up in his nostril and snorted it or anything like that. Yet he had a feeling he knew what the general might do if he found out about it—the general would erupt in enough profanity to lift Jahrling off his feet and drop him into the Slammer.
Then there was the additional frightening possibility that this virus near Washington was not Ebola Zaire. That it was something else. Another hot strain from the rain forest. An unknown emerger. And who could say how it moved or what it could do to humans? General Russell began to think out loud. “We could be in for a hellacious event,” he said. “Given that we have an agent with a potential to cause severe human disease, and given that it appears to be uncontrolled in the monkey house, what do we do? We need to do the right thing, and we need to do it fast. How big is this sucker? And are people going to die?” He turned to Colonel C.J. Peters and asked, “So what are our option here?”
C.J. had been thinking about this already. There are three ways to stop a virus—vaccines, drugs and biocontainment. For Ebola, there was only one way to stop it. There was no vaccine for Ebola. There was no drug treatment for Ebola. That left only biocontainment.
But how to achieve biocontainment? That was tricky. As far as C.J. could see, there were only two options. The first option was to seal off the monkey colony and watch the monkey die—and also keep a close watch on the people who had handled the monkeys and possibly put them into quarantine as well. The second option was to go into the building and sterilize the whole place. Kill the monkeys—give them lethal injections—burn their carcasses, and drench the entire building with chemicals and fumes—a major biohazard operation.
General Russell listened and sad, “So option one is to cut the monkeys off from the rest of the world and let the virus run its course in them. And option two is to wipe them out. There aren’t any more options.”
Everyone agreed that there were no other options.
Nancy Jaax was thinking. It may be in the monkey house now, but it ain’t going to stay there very damn long. She had never seen a monkey survive Ebola. And Ebola is a species jumper. All of those monkeys were going to die, and they were going to die in a way that was almost unimaginable. Very few people on earth had seen Ebola do its work on a primate, but she knew exactly what it could do. She did not see how the virus could be contained unless the monkey house was set up for quarantine with an independently filtered air supply. She said, “How ethical is it to let these animals go a long time before they die? And how do we assure the safety of people in the meantime? I’ve watched these guys die of Ebola, and it’s not a fun way to go—they’re sick, sick, sick animals.” She said that she wanted to go into the monkey house to look at the monkeys. “The lesions are easy to miss unless you know what you are looking for,” she said, “and then it’s as plain as the nose on you face.”
She also wanted to go there to look at pieces of tissue under a microscope. She wanted to look for crystalloids, or “inclusion bodies” Bricks. If she could find them in the monkey meat, that would be another confirmation that the monkeys were hot.
Meanwhile, there was the larger question of politics. Should the Army become involved? The Army has a mission, which is to defend the country against military threats. Was this virus a military threat? The sense of the meeting ran like this: military threat or not, if we are going to stop this agent, we’ve got to throw everything at it that we’ve got.
That would create a small political problem. Actually it would create a large political problem. The problem had to do with the Centers for Disease Control in Atlanta, Georgia. The C.D.C. is the federal agency that deals with emerging diseases. It has a mandate from Congress to control human disease. This is the C.D.C.‘s lawful job. The Army does not exactly have a mandate to flight viruses on American soil. Yet the Army has the capability and the expertise to do it. Everyone in the room could see that a confrontation might boil up with the C.D.C. if the Army decided to move in on the monkey house. There were people at C.D.C. who could be jealous of their turf. “The Army doesn’t have the statutory responsibility to take care of this situation,” General Russell pointed out, “but the Army has the capability. The C.D.C. doesn’t have the capability. We have the muscle but not the authority. The C.D.C. has the authority but not the muscle. And there’s going to be a pissing contest.”
In the opinion of General Russell, this was a job for soldiers operating under a chain of command. There would be a need for people trained in biohazard work. They would have to be young, without families, willing to risk their lives. They would have to know each other and be able to work in teams. They had to be ready to die.
In fact, the Army had never before organized a major field operation against a hot virus. The whole thing would have to be put together from scratch.
Obviously there were legal questions here. Lawyers were going to have to be consulted. Was this legal? Could the Army simply put together a biohazard SWAT team and move in on the monkey house? General Russell was afraid the Army’s lawyers would tell him that it could not, and should not, be done, so he answered the legal doubts with these words: “A policy of moving out and doing it, an asking forgiveness afterward, is much better than
