The Hot Zone: Part I
The Shadow of Mt. Elgon
VOCABULARY
abscess
aerosolized
affectionate
affinity
agonals
ambiguously
amplification
annals
anthrax
antibodies
appalled
archipelago
ARDS
automaton
avert
biocontainmen
biohazard
botulism
bungalow
bushwhacked
cadavers
cascaded
clinical
clotting
coagulate
collagen
conduit
contagious
corrugated
culmination
cupola
dappled
decayed
defecated
dehydrated
delirious
dementia
depersonalization
desolate
deteriorated
dialysis
diatribe
disheveled
drones
epicenter
epidemiology
euthanize
expatriates
expressionless
exquisite
febrile
ferocity
flickery
fulminating
gangway
gaped
gnarled
grackles
granules
grotesque
guano
gurney
hardpans
headwaters
hemispherical
hemophiliac
hemorrhage
hemostats
hostile
icu
immuno
deficiency
imperceptible
implacable
incarnation
incinerate
incision
incubation
index case
industrialized
inexorably
inscrutable
invasive
jaundice
laryngoscope
lesions
lethargy
lucrative
maculopapular
microorganism
monosyllables
mosaic
mummified
mutable
necropsy
necrosis
obligation
obliterate
oupatient
paralytic
parasite
paroxysm
pastoral
pavementing
petechaie
petrified
phenomenon
pinhole
portal
promontory
psychotic
putrid
quarantined
SOMETHING IN THE FOREST
1. Who is Charles Monet? Describe his history and habits.
radiant
radiating
ransacked
recirculates
recollections
regurgitates
replication
reservoir
rigid
riverine
rongeur
sentinel animals
shucked
simultaneous
species
threatening event
spleen
spontaneous
sullen
sullen
superfreezer
tarmac
tarpaulins
theology
third spacing
transformatio
trojan horse
turrets
typhoid fever
ulatrasound
underlying
vector
veranda
warrens
WHO
2. The author uses “as if” regularly in the first page, as if he is trying to
draw comparisons to more familiar settings. Keep track of this literary
device as you keep your journal.
3. What happens to Monet? Describe.
4. (pages 4-6) The author uses a sensory image of hot and cold in
describing the case. Why does he create this disequilibrium?
5. The author makes a distinction between lethal and nonlethal
contagion. What is the difference?
6. Describe the behavior of weaverbirds and what makes them
interesting.
7. Why were workers burning the fields? What impact does this have on
the migration of microbes and the natural biodiversity of an area?
8. What is the importance of the reference to Monet’s “women friends”?
9. Find Mt. Elgon on a map and downloads a picture of this ecological
terrain.
10.
Go to the American Museum of Natural History’s rainforest
exhibit site and find photos of the species listed on page 9.
11.
How big is Kitum Cave? What are the characteristics of Kitum
Cave as a natural habitat?
12.
Why is salt so “precious” in the rainforest?
13.
How does wood petrify?
14.
Why does the author take the time to describe the crystals so
precisely?
15.
as of page 13, list three possible sources of infection from the
cave.
16.
How did the pillar in the cave get scored and marked? How does
this realization contribute to the mood of life in the cave?
17.
Why do you think the author uses a reference about the pull of
the cave” being like gravity”?
18.
List the symptoms, feelings, and progression of the disease as it
struck Monet. Draw a picture of this patient.
19.
List all the contacts Monet had , from symptoms to death. Then
list the next three people each of those contacts might have had. How
many possible infections do you have in this scenario?
20.
Why don’t antibiotics work on viruses?
21.
How does the ease of plane travel make us more susceptible to
infection?
22.
What is the relevance of the East Rift Valley in early human
history? What famous skeleton(s) were found there?
23.
How could you mix up a bag of the black sputum as described on
page 17?
24.
Connective tissue is one of four types of tissue in our bodies.
What are the other three?
25.
Monet vomits even though his stomach is empty. What does this
tell you?
26.
What is the reference to “hot” in this sequence?
27.
Do a lab in serial dilution (using successive 10-fold dilution) to
get a one part per billion solution. What is extreme amplification in this
context? Compare the concentration of virus to the concentration of
blood cells in the same volume.
28.
What does it mean for his bloodstream to “throw clots”?
29.
What is a stroke?
30.
Why is he not feeling pain at this point?
31.
Get a brain diagram and describe the functions controlled by the
brain stem. . .why is this seen as the most primitive part of the brain?
32.
Narrative point of view. The author often switches from one
narrative point of view to another. On page 20 the author switches
from third-person narration to the second-person voice, i.e., “he” and
“they” are switched to “you.” What is the impact of this technique?
Why do you think the author does it?
33.
What if Monet had crashed and "bled out" on the plane? What
might some of the consequences have been? Write a one-page safety
manual for flight attendants or other airline personnel for a scenario
like this.
34.
Monet goes from a plane to a taxi. Continue this chain of
infection to consider how it might spread.
35.
Draw or create an image of the emergency room scene. What is
in the middle of the floor in the waiting room? Why?
36.
What does it mean for Monet to have “sloughed his gut”?
37.
The toxic agent has an active voice as the chapter ends. What is
it doing?
38.
Is the agent that killed Charles Monet a character in The Hot
Zone? If it is a character, what sort of a character is it and what role
does it seem to play?
JUMPER
39.
Describe some of the tools the doctor uses on Monet to find out
what is wrong. What is the flaw in his procedure?
40.
What happened to Dr. Shem Musoke, who worked on Charles
Monet? How could this have been prevented?
41.
What is the range of normal blood pressure? What do the two
numbers represent?
42.
What is the condition and tone of Monet’s tissue and blood
vessels at this point? How does this impact their ability to treat him?
43.
Describe the kidneys and liver during the autopsy.
44.
How do the results and findings relate to the symptoms of
connective tissue damage?
45.
Compare Dr. Musoke’s symptoms with Monet’s.
46.
Dr. Musoke is concerned that he might have malaria. How do the
symptoms of malaria compare to the ones he is experiencing?
47.
What did Dr. Musoke do that contributed to the spread of the
disease? What would you have done?
48.
Describe the findings of the exploratory surgery performed on
Dr. Musoke.
49.
What is hemophilia and how would the symptoms compare to
the ones described in this chapter?
50.
How does dialysis work and why would it be appropriate here?
51.
Why did Dr. David Silverstein purify the serum? What is this?
52.
Where did he send the samples? Why?
53.
What is the significance of the title of this chapter?
DIAGNOSIS
54.
Who is Dr. David Silverstein? What kind of practice does he
have?
55.
Why did he treat Dr. Musoke with “supportive care?” What do
you think this means?
56.
What was the diagnosis for Dr. Musoke? What is the history of
this virus?
57.
In the original home of the virus, what % of the monkeys were
infected?
58.
What does it mean to “jump species”? What are some more
common examples of this?
59.
Who was the first victim of Marburg virus and how many people
did the 1967 outbreak affect? What was the fatality rate?
60.
What everyday shape is the virus particle of Marburg compared
to in the book?
61.
What are some of the other main shapes of viruses?
62.
Is a virus alive or not? How would you define life? What are the
characteristics of a virus that make it seem NOT alive? What
characteristics does a virus have that make it seem alive?
63.
Use the links page in this guide and go to the Tulane Big Picture
book of Viruses. Find photos of the virus families described.
64.
Graph the fatality rate of the three filoviruses named
65.
What are the two types of Ebola?
66.
Describe the recovery period and problems from Marburg. What
are some of the surprising organs attacked?
67.
Page 39—the author lists four possible intermediate hosts. Make
the case for or against any two of them.
68.
What was Mr. Jones’ business? How big was it?
69.
In that business, how were the products inspected and what was
the problem? Recommend three improvements in this system.
70.
Mr. Jones feels guilty about the outcome. Should he accept
blame for what happened? Why or why not?
71.
What was being done with the sick monkeys? Why was this
dangerous?
72.
What is the WHO? What do they do?
73.
What is the science of epidemiology? What is the root word
structure of this field?
74.
Find the Sese Islands on a map. How did the company take
advantage of this situation?
75.
You are the minister of the interior for the nation of Uganda.
Write a 5-step policy to manage a situation like this.
76.
Research the species origins of AIDS. How does this compare to
the description of Ebola in this book?
77.
Find the latest statistics on the incidence of AIDS in Central and
East Africa.
78.
How did the mixture of monkey samples and species contribute
to the hypothesis about HIV being a hybridized, or mixed-origin virus?
79.
What was Silverstein’s response to finding out about the Marburg
diagnosis?
80.
Why does the author compare Charles Monet to “an Exocet
missle struck below the water line”?
81.
What is Shem Musoke’s recollection about his illness? Any
lingering symptoms?
A WOMAN AND A SOLDIER
82.
Describe Nancy Jaax, who is she? Describe her job, house,
family, location.
83.
The author sometimes changes the narrative point of view as
he’s telling the story. How is the narrative point of view different
between the description of Charles Monet and the description of Nancy
Jaax?
84.
How much education do you need to become a vet? Why does
the Army need vets?
85.
What was Nancy’s hobby/activity and how did this help her
confidence?
86.
Nancy is a meticulous cleaner and Jerry is impulsive. How does
this set up the story about finding disease agents?
87.
Nancy cuts herself in the kitchen. How does this foreshadow the
events to come, and what kind of reaction and emotion does it signify
on her part?
88.
The author frequently uses the literary device of foreshadowing.
How is he using it here?
PROJECT EBOLA
89.
Why do you think Nancy got up so early?
90.
What was Nancy’s specialty in the lab?
91.
Why does the author describe the location and ventilation
system at USAMRIID?
92.
What do the initials USAMRIID stand for? What other nicknames
does the place have?
93.
How did the USAMRIID mission change in 1969?
94.
Would you locate this facility here? Why or why not?
95.
What are two examples of the lethal microorganisms being
worked on at USAMRIID? What are the fears of these agents?
96.
Describe the characteristics of the four levels of BSL.
97.
What was Nancy’s job in Gene Johnson’s lab?
98.
Why does she have to do autopsies very quickly in Ebola cases?
99.
What were some of the other agents Nancy had worked on and
had vaccinations for? Pick three and get pictures and describe their
ecology (living conditions and symptoms).
100.
Why was Nancy so determined to get to level 4?
101.
Anthrax is quite deadly. Why is it referred to as “safer” than
Ebola?
102.
Who is Gene Johnson? Describe his personality and some
surprises about him. What makes an expert like him so afraid of
viruses?
103.
Page 64—draw a food web of Central Africa as described here,
showing the relationships among the organisms listed in this passage.
104.
Why does Gene Johnson have nightmares about airborne Ebola?
What are the other vectors, or transmission paths, of infections
(airborne is one method)?
105.
Describe the viral family tree, and some of the cousins to Ebola.
106.
Research and describe the protein sequence of Ebola—since the
book was written it has been completely sequenced and dissected as a
particle.
107.
Which system is attacked first? Why is this important?
108.
How do HIV and Ebola compare in their transmission?
109.
What is the relevance of the practice if cleaning up dead bodies
for burial?
110.
Exchange letters between Jerry and Nancy about the perils and
opportunities of working in level 4.
111.
Why did Nancy take off her rings before entering the lab?
112.
How does UV light act as a sterilizing agent?
113.
Diagram the steps of containment as Gene and Nancy progress
through the different levels.
114.
What is the value of the pressurized suit?
115.
Why are gloves portrayed as the most important part of the
defense against Ebola?
116.
What are some people’s superstitions in dealing with level 4?
117.
What is the decon shower for?
TOTAL IMMERSION
118.
How did the monkeys react when they saw Jaax and Johnson?
119.
Compare the behavior of healthy and sick monkeys in this
setting.
120.
How are the blood samples stored? How do these facilities work?
Why is this method of storage important?
121.
Compare the symptoms of the dead monkeys with the symptoms
in the human victims portrayed so far. Make a list
122.
Why is handling a monkey in level 4 “tricky”?
123.
What were the safety considerations in getting the monkey out
of the cage and into the autopsy room?
124.
What were the three life forms in the room at that time?
125.
Why number the tools?
126.
How and why does the author describe the sound of the air
blowing in the pressure suit?
127.
“Viruses are ambiguously alive”. Defend the truth or lack of truth
in this statement.
128.
What is a parasite and why does the author describe a virus as a
parasite?
129.
Is Ebola a DNA or RNA virus? Why is this a meaningful way to
distinguish viruses?
130.
Why do scientists think that RNA may have appeared on the
earth before DNA?
131.
Page 85: the author compares the scale of viruses using
analogies to cities and buildings. Create another set of analogies using
drops of water in a bathtub. How many polio viruses can fit on the
period at the end of a sentence?
132.
What is a “rongeur”?
133.
Why can’t you use a bone saw in level 4? PAGE 87:STOP!
134.
What happened to Nancy Jaax while she was dissecting the
monkeys with Lt. Johnson? What do you think is going to happen to
Nancy? Write a short story.
135. Why do you think Nancy didn't contract the virus?
136.
ACTIVITY: Draw and label a diagram of the laboratory and
staging levels at Fort Detrick. Use descriptions and clues from the
book.
137.
What is the Slammer? The Submarine?
138.
ACTIVITY: Act out the scene where Nancy’s suit is breached.
Take this scene from the discovery to the outer room.
139.
After the shower, what does Nancy notice? What is her first
reaction?
140.
How many particles does it take to cause an Ebola infection?
Compare this to some of your answers in #126.
141.
What is the end product of the test on Nancy’s glove?
142.
The author sometimes uses the narrative technique known as
“interior monologue” or “stream of consciousness,” in which he
describes the thoughts of some of the people in the story. Identify
some passages of “interior monologue” in The Hot Zone in which the
author describes the thoughts of a character.
143.
The Hot Zone is a work of nonfiction journalism. How does
Richard Preston know what the characters are thinking?
144.
Conduct an interview with another student (or family member)
in which you ask the person exactly what he or she was thinking
during a moment of crisis in that person’s life. Write it up as a
journalist might.
145.
What did the two sick monkeys make scientists think about
Ebola? What made them special? How were they used as a control in
this experiment? What was the concern about this within the
experimental procedure? What was Nancy’s conclusion about this?
EBOLA RIVER
146.
Where is the virus’ original spreading point? Who was the “index
case”?
147.
Graph the population growth in the equatorial regions of the
word over the last 30 years.
148.
Draw or download a picture of this ecosystem.
149.
How did the spread from P.G. compare to that of Mr. Yu?
150.
This is a good time to do the class activity “dread red disease” if
you have not already done so.
151.
How did the practices of the hospital in Maridi contribute to the
spread of the disease? How can the medical community intensify an
outbreak of infectious disease?
152.
What is the fatality rate in Ebola Sudan strain (subtype) and how
does it compare to the Marburg strain and to the bubonic plague in
medieval Europe?
153.
What are some of the possible vectors for Ebola Zaire?
154.
Take stock! What would happen if Ebola was let loose in a
hospital? You would be safe, you’re in a hospital. Is this theory
correct? Give five reasons why you feel safe or unsafe and one piece of
evidence to support your position.
155.
Compare the hospital conditions in Maridi to the conditions that
are local. Compare the cleanliness of the hospitals in America to the
Yambuku Hospital.
156.
What did the nuns at the Yambuku Hospital do to sterilize used
syringes? What recommendations would you make to improve this
practice?
157.
The Sudan virus subsides, then vanishes. Can you explain why
this might be happening? What are two possible reasons the outbreak
burned itself out?
158.
Define hot as it is used in this book.
159.
How did the trip to the market contribute to the outbreak of the
disease?
160.
After the first recorded patient, how many villages were
infected? What does this tell you about the possible location of the
infection? What are the levels of spread of the disease?
161.
What is “pavementing” in biological terms? What are “bricks”?
162.
What is Ebola’s favorite protein food?
163.
Pages 105-107. Make sure you read this passage out loud to
someone else before going to bed tonight. Especially if Halloween is
coming!
164.
What is Ebola’s “strategy for success”?
165.
What is so important about Nurse Mayinga’s story? Why doesn’t
she go into quarantine for her condition?
166.
Why does the author shift to the present tense while telling this
story?
167.
What were some of the options of the government upon finding
out this story?
168.
What did the President do?
169.
Get a map of your region and make a quarantine plan. What
roads, transportation routes, other measures do you have to close and
why? Do you close going in, out, or both?
170.
What happened to sister M.E.’s blood? Where did it go?
171.
Who is Dr. Karl Johnson and what office does he head up?
172.
What is the condition of the sample when it arrives at the CDC?
What precautions does Patricia Webb take in handling it?
173.
Who is Fred Murphy and what is his specialty?
174.
What about the picture scares Murphy? What did he do next?
175.
What is the characteristic shape they notice? Why did they
decide it was a new strain?
176.
Using the magnification of the picture on page 118, what is the
size of the virus?
177.
If you’re Karl Johnson, what do you pack for a trip to Africa to
study and contain a deadly virus?
178.
Johnson says “I’m glad nature is not benign”. What do you think
he means? Do you agree or disagree and why?
179.
What are the implications if Ebola is airborne?
180.
What is a species threatening event?
181.
“A virus can be useful to a species by thinning it out.” Research
the concept of herd immunity and how it ultimately can benefit a
species chance for survival.
182.
What % of Europeans were killed by the plague in the 14th
century? What % of Americans were killed by the flu in 1918?
183.
Who is Joel Breman and what does he do? Why is he so afraid?
How would you feel in his situation?
184.
How did the CDC team ultimately get to Bumba?
185.
How did the native crew react upon landing?
186.
How did the Belgian doctor on the scene handle the situation?
187.
What was the purpose of felling trees on the road between
villages? Describe the process of reverse quarantine.
188.
Why were they burning mattresses?
189.
“The red chamber of the virus queen” is a metaphor to what
other organism?
190.
What were some of the steps that the villagers had taken to
control the spread of the disease on their own?
191.
Define iatrogenesis and explain the emotion of the villagers to
find out that the disease had spread in the hospital, among the nuns
who had come to help them. What are some local examples of this
fear in our own neighborhood?
192.
How did Nurse Mayinga die? How many contacts had she had
before being hospitalized?
193.
How did they store the bodies to prevent spread?
194.
How did Karl Johnson set up an isolated hospital in this setting?
195.
In the end, did the first Zaire outbreak show symptoms of
airborne transmission?
CARDINAL
196.
As the courier passed the sample of Peter Cardinal’s blood to
Gene Johnson at the airport, think about how this would take place
after 9/11. What would have been different?
197.
How was the sample stored for safety handling? How many
levels of physical and biological protection were there?
198.
What happened to Peter Cardinal?
199.
What is “third spacing” and why were his symptoms concerning
about an airborne infection?
200.
Write a short story about what would happen if a student came
back from Africa and brought Ebola to the campus?
201.
What is the distinction between parasites and predators?
202.
Describe the shape of the virus particle called the 'shepherd's
crook."
203.
Take stock! What would you do in Nancy Jaax's situation?
204.
What hospital did Nurse Mayinga work at?
205.
What happened to Peter Cardinal?
206.
Write a story about what might happen and the chaos that would
go on if a student came to school with the Ebola virus.
207.
How did Gene Johnson culture the sample of Peter Cardinal’s
blood serum? Describe the three steps of this experimental protocol.
208.
What does the relative lethality rate in animal species tell us
about the original host or reservoir species?
209.
What did Lt. Johnson discover about Peter Cardinal and where he
had been?
210.
What did Lt. Johnson's team discover in Kitum Cave?
GOING DEEP
211.
In investigating Peter Cardinal’s family’s house, why were they
interested in the animals?
212.
Describe the experiment in 1988 that confirmed that Ebola could
travel through the air.
213.
What did the U.S. Army scientific team members wear in Kitum
Cave to protect themselves? What other kinds of equipment did they
carry to increase their safety?
214.
There were 35 specialists on this trip. What were some of their
fields of expertise?
215.
What are sentinel animals? Give two examples.
216.
How did they set up the containment facility as they approached
the cave? Draw this out on a schematic map.
217.
Who locally would be likely to have a Racal suit and why?
218.
What were the methods used to collect samples? Describe how
light traps and pitfall traps work.
219.
Which other organisms did they test and collect samples from?
220.
What is an antibody and how does this test confirm the presence
or absence of a virus?
221.
What were the results of these tests?
222.
What does Pasteur’s quote “chance favors the prepared mind”
mean? What were Pasteur’s contributions to our knowledge of bacteria
and fungi?
223.
What was Nancy Jaax’s new job? How did she and Jerry get back
to USAMRIID?
224.
Pretend you are a high-ranked officer at Fort Detrick and Ebola
just escaped from your laboratory. Write orders to your people and
letters to the president and other high officials.
225.
Do a character timeline of Karl, Gene, Nancy, Jerry. How are
their perceptions, fears, being made better or worse? How are their
careers being influenced?