Mr. Jones’s personal vision of the Marburg outbreak reminds me of a flashlight pointed down a dark hole. It gives a narrow but startling view of the larger phenomenon of the origin and spread of tropical viruses. He told me that some of the Marburg monkeys were trapped in a group of islands in Lake Victoria known as the Sese Islands. The Senses are a lowlying forested archipelago in the northwestern part of Lake Victoria, an easy boat ride from Entebbe. The isle of plagues may have been situated among the Senses or near them. Mr. Jones does not recall the name of the hot island. He says it is close to Entebbe. At any rate, Mr. Jones’s then-boss, the Entebbe monkey trader, had arranged a deal with villagers in the Sese Islands to buy monkeys from them. They regarded the monkeys as pests and were happy to get rid of them, especially for money. So the trader was obtaining wild monkeys from Sese Islands, and if the animals proved to be sick, he was releasing them on another island somewhere near Entebbe. And some monkeys from the isle of plagues seemed to be ending up in Europe.
In papyrus reeds and desolate flatlands on the western shore of Lake Victoria facing the Sese Islands, there is a fishing village called Kasensero. You can see the Sese Islands from the village. Kasensero was one of the first places in the world where AIDS appeared. Epidemiologists have since discovered that the northwestern shore of Lake Victoria was one of the initial epicenters of AIDS. It is generally believed that AIDS came originally from African primates, from monkeys and apes, and that it somehow jumped out of these animals into the human race. It is thought that the virus went through a series of very rapid mutations at the time of its jump from primates to humans, which enabled it to establish itself successfully in people. In the years since AIDS virus emerged, the village of Kasensero has been devastated. The virus has killed a large portion of the inhabitants. It is said that other villages along the shores of Lake Victoria have been essentially wiped off the map.
The villagers of Kasensero are fishmen who were, and are, famous as smugglers. In their wooden boats and motorized canoes they ferried illegal goods back and forth across the lake, using the Sese Islands as hiding places. One can guess that if a monkey trader were moving monkeys around Lake Victoria, he might call on the Kasensero smugglers or on their neighbors.
One general theory for the origin of AIDS goes that, during the late nineteen-sixties, a new and lucrative business grew up in Africa, the export of primates to industrialized countries for use in medical research. Uganda was one of the biggest sources of these animals. As the monkey trade was established throughout central Africa, the native workers in the system, the monkey trappers and handlers, were exposed to large numbers of wide monkeys, some of which were carrying unusual viruses. These animals, in turn, were being jammed together in cages, exposed to one another, passing viruses back and forth. furthermore, different species of monkeys were mixed together. It was a perfect setup for an outbreak of a virus that could jump species. It was also a natural laboratory for rapid virus evolution, and possibly it led to the creation of HIV. Did HIV crash into the human race as a result of the monkey trade? Did AIDS come from an island in Lake Victoria? A hot island? Who knows. When you begin probing into the origins of AIDS and Marburg, the light fails and things go dark, but you sense hidden connections. Both viruses seem part of a pattern.
When he learned what Marburg virus does to human being, Dr. David Silverstein persuaded the Kenyan health authorities to shut down Nairobi Hospital. For a week, patients who arrived at the doors were turned away, while sixty seven people were quarantined inside the hospital, most medical staff. They included the doctor who had done autopsy on Monet, nurses who had attended Monet or Dr. Musoke, the surgeons who had operated on Musoke, and aides and technicians who had handled any secretions from either Monet or Musoke. It turned out that a large part of the hospital’s staff had direct contact with either Monet or Musoke or with blood samples and fluids that came from the two patients. The surgeons who had operated on Musoke, remembering only too well that they had been “up to the elbows in blood”, sweated in quarantine for two weeks while they wondered if they were going to break with Marburg. A single human virus bomb had walked into the Casualty waiting room and exploded there, and the event had put the hospital out of business. Charles Monet had been an Exocet missile that stuck the hospital below the water line.
Dr. Shem Musoke survived his encounter with a hot agent. Ten days after he fell sick, the doctors noticed a change for the better. Instead of merely lying in bed in a passive state, he became disoriented and angry and refused to take medicine. One day, a nurse was trying to turn him over in bed, and he waved his fist at her and cried, “I have a stick, and I will beat you.” It was around that time that he began to get better, and after many days his fever subsided and his eyes cleared; his mind and personality came back, and he recovered slowly but completely. Today he is one of the leading physicians at Nairobi Hospital, where he practices as a member of David Silverstein’s group. One day I interviewed him, and he said to me that he has almost no memory of the weeks he was infected in Marburg. “I only remember bits and pieces,” he said. “I remember having major confusion. I remember, before my surgery, that I walked out of my room with my IV drip hanging out of me. I don’t remember much of the pain. The only pain I can talk about is the muscle ache and the lower-back ache. And I remember him throwing up on me.” Nobody else at the hospital developed a proven case of Marburg-virus disease.
When a virus is trying, so to speak, to crash into the human species, the warning sign may be a spattering of breaks at different times and places. These are microbreaks. What had happened at Nairobi Hospital was an isolated emergence, a microbreak of a rainforest virus with unknown potential to start an explosive chain of lethal transmission in the human race.
Tubes of Dr. Musoke’s blood went to laboratories around the world so that they could have samples of living Marburg for their collections of life forms. The Marburg in his blood had come from Charles Monet’s black vomit and perhaps originally from Kitum Cave. Today this particular strain of Marburg virus is known as Musoke strain. Some of it ended in glass vials in freezers owned by the United States Army, where it was kept immortal in a zoo of hot agents.
A WOMAN AND A SOLDIER
1983 September 25, 1800 Hours
Thurmont, Maryland, nearly four years after the death of Charles Monet. Evening, A typical American town. On Catoctin Mountain, a ridge of the Appalachians that runs north to south through the western part of the state, the trees were brightening into soft yellows and golds. Teenagers drove their pickup trucks slowly along the streets of the town, looking for something to happen, wishing that the summer had not ended. Faint smells of autumn touched the air, the scent of ripening apples, a soreness of dead leaves, cornstalks drying in the fields. In the apple groves at the edge of town, flocks of grackles settled into the branches for the night, squawking. Headlights streamed north on the Gettysburg road.
In the kitchen of a Victorian house near the center of town, Major Nancy Jaax, a veterinarian in the United States Army, stood at a counter making dinner for her children. She slid a plate into the microwave oven and pushed a button. Time to nuke up some chicken for the kids. Nancy Jaax wore sweatpants and a T-shirt, and she was barefoot. Her feet had calluses on them, the result of martial-arts training. She had way auburn hair, which was cut above the shoulders, and greenish eyes. Her eyes were actually two colors, green with an inner rim around the iris was amber. She was a former homecoming queen from Kansas—Miss Agriculture, Kansas State. She had a slender, athletic build, and she displayed quick motions, flickery gestures, with her arms and hands. Her children were restless and tired, and she worked as fast as she could to fix the dinner.
Jaime, who was five, hung on Nancy’s leg. She grabbed the leg of Nancy’s sweatpants and pulled, and Nancy lurched sideways, and then Jaime pulled the other way, and Nancy lurched to the other side. Jaime was short for her age had greenish eyes, like her mother. Nancy’s son, Jason, who was seven, was watching television in the living room. He was rail thin and quiet, and when he grew up he would probably be tall, like his father.
Nancy’s husband, Major Gerald Jaax, whom everyone called Jerry, was also a veterinarian. He was a Texas at a training class, and Nancy was alone with the children. Jerry had telephoned to say that it was hot as hell in Texas, and he missed her badly and wished he was home. She missed him, too. They had not been apart for more than a few days at a time ever since they had first started dating, in college.
Nancy and Jerry Jaax—the name is pronounced Jacks—were both members of the Army Veterinary Corps, a
