The Hot Zone: Part II The Monkey House

VOCABULARY adrenal glands amplification animosity anorexia bemused blitzed blood serum broods categorically cringing crystalloids curlicues diamond knife ebola USAMRIID

epistaxis filovirus gauntlet gloves gangrene hellacious heirarchy incinerate inclusion bodies inexorably loam macaque marburg memento microscopist

necropsy nether pathologist plutonium ponder prehensile primate husbandry pseudomonas quarantine unit reconnaissance savannas

simian hemorrhagic fever (SHF) slammer splenomegaly statutory standard doctrine subordinates swat team tantalized terrain thread virus warren

QUESTIONS RESTON 1. Use your DC Metro map and locate Reston. What is the industrial/economic status of Reston? 2. Think about an office park in your area. Do you know what kind of businesses are located there? If there was a monkey storage facility there, who in your local government would know about it? 3. Do a Google search to see if Hazelton Research Products is still in existence. 4. How many monkeys are imported into the United States each year? For what purposes does this happen? 5. Which government agency(ies) are responsible for overseeing these facilities? How long are monkeys quarantined before distribution? 6. Who is Dr. Dan Dalgard and what is his job? What kind of person is he? 7. Is a big suburban area like Reston a good place for a facility like this? List 5 reasons pro and 5 reasons con in terms of business location. 8. Where did the October 4, 1989 shipment come from and how big was it? Describe the places they stopped on the way to Reston and how they were stored. 9. What are the characteristics of the crab-eating macaque species of monkey? Can you find a picture? Why are they described as competitors of humans in their natural environment? 10. Describe their lifestyle and habitat.

11. Describe their social structure. How do you think this should affect the way their human handlers store and treat them? 12. As the monkeys began to die, write a letter from Dalgard to his boss defending the need for autopsies. 13. What happened to Jerry that influenced him greatly? What’s the difference between clinical depression and everyday depression or grief over a loss like this? 14. Write a dialogue of the conversation between Bill Volt and Dan Dalgard. What % of monkeys were dead by this time? What questions would Dan be asking? Where were most of the deaths located? 15. What was the condition of the surviving males that concerned Dalgard? What were his suspicions? 16. Why can’t you do an autopsy of a monkey in front of other monkeys? 17. What did he find out during the autopsy? 18. Where did the next shipment of monkeys go? 19. What did Dalgard find when he went to work on Saturday, November 11? 20. Why do scientists keep diaries of their lab notes? Rewrite the notes on page 171 in plain English. 21. What does the spleen do? 22. What was the condition of the spleens in these specimens compared to a normal monkey spleen? INTO LEVEL 3 23. Why did Dalgard decide to contact USAMRIID? Do you think this poses a risk to his company? 24. Who is Peter Jahrling and what is his specialty? In his normal life, what was his giveaway sign about the kind of work he did? 25. What irritated and concerned Peter about the samples Dan sent him? 26. What characterizes the safety conditions in a Level 3 facility? 27. Think back to the Peter Cardinal case. How do you wrap a dangerous sample for shipping? 28. How did they culture the virus? There were at least four different samples, what were they? 29. What was the location of the mass deaths on November 16? 30. What was Peter’s tentative conclusion on 11/16? What was Dalgard’s response? 31. “A freezer can be hot as hell.” What does the author mean in this case? EXPOSURE

32. Who is Thomas Geisbert and what does he do at USAMRIID? What made his background different from the other scientists and technicians? 33. Is he a loner or is he sociable, and how does this affect his work? Why did Geisbert like doing work with hot viruses alone with his microscope? 34. What’s the difference between an electron microscope and a light microscope? What size particles can each see? 35. How did the cells Tom saw differ from normal cells? 36. Jahrling refers to the cell culture as “off the plastic”. What does he mean by this? 37. What was his suspicion about the culture and how did he test it? 38. What is Pseudomonas and how does it live? What is it’s characteristic smell? 39. Why was it a mistake for Geisbert and Jahrling to smell the flask? 40. Write a task list for the steps Geisbert uses in preparing a sample for the EM. 41. The author switches from prepping for the EM to a description of Tom’s upcoming hunting trip and then to a description of the incubation period for the virus. Why does he employ this technique? THANKSGIVING 42. Why did the Jaax family have a horrid Thanksgiving? 43. Why was Nancy estranged from her father? 44. How did Dan Dalgard spend his Thanksgiving? 45. What was his main worry? 46. List three hypotheses about how the virus had apparently jumped from room F to room H. MEDUSA 47. Describe the diamond knife. Why was the diamond knife necessary for the work that Thomas Geisbert was doing? 48. Describe the six steps of preparing an EM photo. 49. What did he see in the EM images? Why did it upset him? 50. “The incredible thing about living systems is that no matter how small the view, it is just as complicated as ever.” What does the author mean by this? Describe some of the complexity at the cellular or molecular level. 51. How did Thomas Geisbert determine that the cells under his microscope were a form of Ebola? 52. What were some of the possible modes of infection?

53. The author likens the image to the face of Medusa. Find a picture or image of Medusa, describe why the author uses this analogy and how it fits. 54. What are inclusion bodies? 55. What are bricks and why are they so dangerous? 56. In retrospect, what was the “pepper” that Tom had seen under the light microscope THE FIRST ANGEL 57. Compare Gene Johnson’s and Peter Jahrling’s offices. What does this tell you about their personalities? 58. What convinced Geisbert that the substance was Marburg? 59. Compare the evidence to Marburg. Why was Jahrling skeptical? What did they check to make sure? 60. Who is Colonel CJ Peters? How is he described? 61. How do you think someone like him could become a division head? 62. What were some of the exotic foods CJ would eat while in the field? How does this add or subtract from your estimation of him as a scientist? 63. Why were Jahrling, Geisbert, and Peters so secretive about the virus? 64. What is “a certain pucker factor”? What is his concern? What is his first idea that he needs to eliminate? What follow-up tests does CJ have done in order to reconfirm the test results? 65. What is the crisis that CJ is worried about? Do you think he’s moving too fast or too slowly? Describe. 66. How do some patients respond to life in the Slammer? How would you react to being in a solitary confinement with a possible fatal exposure to some pathogen? 67. Neither Peter nor Tom mention the “sniffing incident” to CJ Why not? Would you have mentioned it? Why or why not? 68. The author frequently employs narrative suspense as a literary device. How’s he using it here? 69. How’s the author using foreshadowing here? 70. Peter thinks Marburg is not easy to catch. Dan thinks it could be airborne. What evidence do you have to this point? Make a list. 71. How did Peter and Tom resolve their concerns about having breathed in the vapor? 72. Why would it be strange to “handle your own blood while wearing a space suit?” THE SECOND ANGEL

73. Why does Tom Geisbert go to work so early? 74. What did the evidence from monkey 053’s cells show? 75. How did Tom break the news to Jahrling? 76. Why did Jahrling hesitate to tell Dalgard that he had detected an Ebola strain? 77. What were some precautions Jahrling requested of Dalgard? 78. What were the safety precautions Dalgard had already implemented and then what were the new ones he had to implement? 79. What went through Dalgard’s mind as he waited? Why hadn’t any of the workers filed accident reports? 80. How could Jahrling test to see if the monkey virus reacted in humans? What did it mean if the cells were glowing? 81. Compare and contrast the available samples. 82. Why did it have to be so dark to be able to see the samples? Explain how these dyes work. 83. Explain the results of the culture. What was the reaction? 84. Review the 3 strains from the 3 patients, in a table like this: Patient strain results conclusion 1. 2. 3. CHAIN OF COMMAND 85. Why did Jahrling repeat the test? 86. Describe CJ’s reaction. What does it mean for a scientist to be skeptical and how does it apply to this case? 87. How did Peter hand the results to CJ? Why did he do it this way? 88. Who is CJ’s boss and who is the boss’s boss? 89. At this point, stop and make sure you have a flow chart of all the major players in this drama. Use Inspiration or sticky notes to diagram the chain of command and the relationships among them. 90. What did Col. David Huxsoll decide to do? Who did they get involved as their lead researcher and why? 91. What is Gen. Philip Russell’s reaction? If you were at this meeting, write 5 recommendations you would make to Gen. Russell at this stage. 92. How would you answer Gen. Russell’s questions about evidence for the virus being airborne? Summarize Col. Nancy Jaax’s arguments. Did she miss anything? 93. How do your recommendations change based on whether the virus is airborne or not? 94. What is a thread virus?

95. Why hadn’t they published the pictures? Why did the General want it published? How does publishing advance science? 96. How did Jahrling rationalize not telling anyone about having sniffed the solution? 97. Jahrling is a civilian but his bosses are military officers. Do you think he violated any military rules or regulations by not disclosing his exposure to Ebola? 98. If you were one of the military officers above Jahrling in the chain of command and you learned he had been exposed to Ebola, what would you do? 99. Why is it important to know how the viruses spread? 100. What are three ways to eliminate a virus? Which are or are not applicable at this point? 101. What are the options for biocontainment? 102. What is a species jumper? 103. What was Nancy’s recommendation of what to do next? 104. What are the pros and cons of considering Army involvement? What would some of the different considerations and agencies be after 9/11? 105. How is the tension between the CDC and the Army characterized by General Russell? 106. Agree or disagree with the explanation of the legal impacts as described by Russell. How did he resolve the issue of leadership of the operation? 107. What series of calls did he make next and why? 108. The author leaves some mystery in describing Murphy’s reaction. How would you have reacted to this? 109. Who were the next people to be notified? Identify your local, county, and state authorities in a situation like this? 110. First Dalgard is relieved, then very concerned, to hear the comparisons to Marburg. Explain. 111. “CJ agreed to wait before pulling the trigger.” Would you have waited? Why? 112. Why was Dalgard reluctant to let the Army into his facility? 113. How did Nancy and Jerry spend that night? What is the relevance of the quote from The Killer Angels? GARBAGE BAGS 114. Why was Dalgard so afraid of Peters and of letting outsiders into the monkey house? 115. What did Volt tell Dan? How did that affect his next set of decisions? 116. They are all worried about the news media getting hold of the information. What do you do here? Keep it a secret, try to get out

in front of the story, or let it all out at once? Have a class debate or write a series of pros and cons for the decisions here. Write a potential press release to cover this situation. 117. Stage a press conference held by the leading players in the Reston outbreak. Some students can play the roles of Peters, Dalgard, etc. while other students can be news media asking questions. One or more students can play the role of “spokesperson for the Army” and “spokesperson for the CDC” and can try to handle the hard questions. 118. What did Nancy notice on the cells from the sample the Hazelton doctors had prepared? 119. What is “extreme amplification”? 120. They examine the dirty needle hypothesis. Name two other infectious diseases spread through dirty needles? 121. CJ notices the goings on in the gas station. What would those people think and do if they knew what had invaded their town? 122. “The Army might have to act decisively to put out this fire.” What does this mean? 123. The comparison to AIDS is made here. Compare the deaths so far with the 100 million predicted in this 1993 book. “And all it did was suppress the immune system.” How does the HIV virus do this? 124. What option is CJ and Gene Johnson talking themselves into at this point? 125. CJ and Gene don’t like each other very much. What is the background of this tension? 126. Why did they have to sterilize the bags with bleach and what were they used for? 127. If you drove by the switch with the van, what would you be thinking? Compared to some of the other packaging descriptions, are these specimens safely packaged? 128. How did Nancy get out of transporting the bags herself? 129. Why did they have to move fast with these specimens? Why couldn’t they wait? SPACE WALK 130. Why couldn’t Nancy bring her standard ID card into the decon chamber? 131. How did the spacesuits and the confined space affect the way the two people had to walk and interact with each other? 132. How did life in level 4 compare to a spacewalk? 133. Write a lab report outline of the steps involved in the autopsy. 134. Describe the steps to take prior to going into a Level 4 zone.

135. How does the author characterize the states of order and disorder in life and death terms? Why are viruses an exception to this rule? 136. What was Nancy Jaax looking for when she operated on the monkey and why was she disappointed? 137. Why could she not confirm the presence of Ebola in these specimens? List the evidence from the internal organs. 138. Why are all the beakers and tubes made out of plastic? SHOOTOUT 139. Why didn’t Russell want the CDC to take over the operation? Contrast the Army’s and the CDC’s perspective on the outcome of the meeting. 140. Looking back on it, how could the Army and CDC have handled the meeting differently? 141. Who was out the meeting? Who else would you have invited? 142. Why can’t Dr. Joe McCormick and C.J Peters stand each other? 143. Describe the history of conflict from McCormick’s perspective. What are the differences in their approach to how science is done? 144. Pretend you are Dr. Joe McCormick. From your point of view, the Army is trying to take over an investigation that should be handled by you and to the CDC. How would you conduct yourself at the meeting, what would you say and do in order to prevail? 145. ACTIVITY: Government during a public health crisis. Divide into teams representing the Army and the CDC and have the meeting, with some students playing the roles of McCormick, Peters, Murphy, Dalgard. Add roles, add teams. Pretend there are members of the White House National Security Council attending the meeting. Add staffers from the Maryland governor’s office. Add the mayor of Reston. Add local law enforcement officers. Add FBI. Add local and state public health officials. Now let the meeting rock, and see what happens. 146. What had McCormick done to deserve recognition? 147. Describe the scene inside the hut in the Zande village. 148. What would have happened if the old lady that McCormick was treating did have Ebola and had infected him with it? What in fact had happened? 149. What were McCormick’s choices and do you agree with his decision to stay? 150. How did this episode affect McCormick’s perspective on the danger of Ebola? 151. What didn’t CJ tell anyone else at the meeting? Why?

152. How did the Army and CDC resolve the issue of case management? MISSION 153. Who was on the team that CJ put together? 154. What were the three priorities set up by the team? Do you agree with the priorities set up by the team? Why or why not? 155. Why is Kitum Cave so important to the story? How was the monkey house like Kitum Cave? 156. As they set up the staging area outside the monkey house, by this time the press was sure to find out. Take out the press release you wrote in the last chapter and update it to accommodate this scene. 157. Hazelton is a private company. What are their concerns about this case? Liability? Stock value? What about the contractors, leases, and employees involved? 158. What does Nancy know at this point? RECONNAISSANCE 159. What was the plan for December 1? What time were they going to start? Why? 160. Who did Gene Johnson see in the parking lot? 161. How did the media find out? 162. Stage a debate among the city council, local reporter, USAMRIID, the neighborhood association, and Dalgard as to what information and how much to let loose at this point. 163. Why do you think Bill Volt wasn’t concerned about being in the monkey house? Do you think his opinion changed when Gene Johnson and Sergeant Klages were afraid to touch things in his office? 164. Draw the map of the staging and storage areas as described on page 275. 165. Why did they seal off Room H? 166. What did the first radio reports say that scared the workers? 167. if you were Dalgard, how would you have responded to the concerns of the lab workers? 168. Why didn’t Dalgard invite McCormick when he invited CJ in? 169. Why weren’t they wearing respirators or suits in room H? 170. Why did Nancy avert her eyes? 171. What else did she notice about the monkeys that scared her? 172. What would you do if you were involved in the Reston operation and you saw one of the monkeys escape its cage?

173. You’re the lawyer for the company. Who pays the bill for this operation and why? Prepare a legal brief for the CEO explaining your position. 174. What questions would you ask if it were your mom and dad going into that lab the next day? 175. What is the dramatic effect of the lengthy description of the normal family life of the Jaax family? 176. What did Nancy do when she heard about her father? What would you have done? Why? INTERNET LINKS • www.mcn.net/`jimloy/hotzone.html • www.zmag.org/zmag/articles/jan94eckhardt.html • www.best.com/`caitlinb/ebola.html • www.erskine.edu/news/lethalvirus.html • http://desires.com/1.2/words/docs/zone.html • www.bocklaps.wise.edu/eov-ebola.html TAKING STOCK ON CHARACTERS 1. During the chapter “Thanksgiving”, what do you imagine Nancy and Jerry Jaax’s early morning conversation would have been like on their way to the base? Be specific, think about what’s been going on in the book. 2. Conduct an interview (imaginary) with Peter Jahrling and yourself right after “the Fist Angel” chapter. What would your questions be? What would his responses be? 3. Make a list of all of the characters in the book that have been introduced and are involved in part two. Rank them in order of importance in your opinion, give evidence, cite examples, and quotes as to why you think that is the appropriate rank for each person. Consider who is a “problem solver” and who is a “problem causer.” 4. What would your reaction have been if you had woken on the morning of December 1, 1989 and read the story in the Washington Post? 5. Why do you think some scientists are eager to work with hot viruses while others want nothing to do with them? ALTERNATE SOLUTIONS 1. Who would have taken control of the mission if Jerry Jaax declined and how would the mission have been different? 2. What would have happened if Geisbert and Jahrling found out that they had contracted Ebola and had told someone and were forced

to go into the slammer? Would the mission have been affected? For better or for worse? 3. After Geisbert discovered the disease in the Reston monkey house, what would some consequences be if he ran to the press? How would Virginia and the “mission” have been altered? ROLE PLAYS 1. Stand in the middle of a classroom or field and have all your classmates stand in a circle about 15 ft. around you and two at a time throw a tennis ball at you. If you catch the tennis ball, that means that you have successfully prevented yourself from contracting Ebola. If it hits you, you have contracted Ebola. This should symbolize how easy it is to get Ebola and the dangers of epidemic. 2. Go to a theme park and play “crocodile bonkers”, the game where you hit the crocodiles on the top of the head before they disappear. As the game goes on, more and more come at a time. This could represent how hard it is to destroy the monkeys and the Ebola virus. 3. Play a mock game of telephone. Have the class get in a line, which represents the chain of command in the Hot Zone. Have the lowest person in command start a rumor that creates tension/fear. Note how everyone reacts and how people react to others reactions. How has it changes from the beginning to the end of the line? Imagine that every person is vital to the mission and if one person panics then the mission is heavily compromised. Use this activity to show the significance of cooperation and teamwork.