Hot Zone Notebook
 Head each section with the name of the chapter.
 Include the question number.
 Include web address for all information used in RESEARCH QUESTIONS (this includes
pictures and diagrams).
Dr Nancy Jaax &
Dr Jerry Jaax
College of Veterinary Medicine
Kansas State University
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
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
SOMETHING IN THE FOREST
Choose 3 Questions:
1. What happens to Monet? Describe.
2. The author makes a distinction between lethal and nonlethal
contagion. What is the difference?
3. Why were workers burning the fields? What impact does this have on
the migration of microbes and the natural biodiversity of an area?
4. What is the importance of the reference to Monet’s “women friends”?
5. As of page 13, list three possible sources of infection from the
cave.
6 List the symptoms, feelings, and progression of the disease as it
struck Monet.
7. 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?
8. How does the ease of plane travel make us more susceptible to
infection?
9. Monet vomits even though his stomach is empty. What does this
tell you? What does it mean for Monet to have “sloughed his gut”?
Choose 1 Research Question:
1. How big is Kitum Cave? What are the characteristics of Kitum
Cave as a natural habitat?
2. Find Mt. Elgon on a map and download a picture of this ecological
terrain.
3. Why don’t antibiotics work on viruses?
JUMPER
Choose 3 Questions:
1. Describe some of the tools the doctor uses on Monet to find out
what is wrong. What is the flaw in his procedure?
2. What happened to Dr. Shem Musoke, who worked on Charles
Monet? How could this have been prevented?
3. 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?
4. Describe the kidneys and liver during the autopsy.
5. How do the results and findings relate to the symptoms of
connective tissue damage?
6. Compare Dr. Musoke’s symptoms with Monet’s.
7. What did Dr. Musoke do that contributed to the spread of the
disease? What would you have done?
8. Describe the findings of the exploratory surgery performed on
Dr. Musoke.
9. What is the significance of the title of this chapter?
Choose 1 Research Question:
1. Dr. Musoke is concerned that he might have malaria. How do the
symptoms of malaria compare to the ones he is experiencing?
2. What is hemophilia and how would the symptoms compare to
the ones described in this chapter?
3. How does dialysis work and why would it be appropriate here?
4. Why did Dr. David Silverstein purify the serum? What is this?
5. What is the range of normal blood pressure? What do the two
numbers represent?
DIAGNOSIS
Choose 3 Questions:
1. What does it mean to “jump species”? What are some more
common examples of this?
2. What everyday shape is the virus particle of Marburg compared
to in the book? What are some of the other main shapes of viruses?
3. 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?
4. What was being done with the sick monkeys? Why was this
dangerous?
5. What is Shem Musoke’s recollection about his illness? Any
lingering symptoms?
6. Page 39—the author lists four possible intermediate hosts. Make
the case for or against any two of them.
Choose 1 Research Question:
1. Use the links page in this guide and go to the Tulane Big Picture
book of Viruses. Find photos of the virus families described.
2. Graph the fatality rate of the three filoviruses named.
3. What is the science of epidemiology? What is the root word
structure of this field?
4. Find the Sese Islands on a map. How did the company take
advantage of this situation?
5. You are the minister of the interior for the nation of Uganda.
Write a 5-step policy to manage a situation like this.
6. Research the species origins of AIDS. How does this compare to
the description of Ebola in this book?
A WOMAN AND A SOLDIER
Question:
Describe Nancy Jaax, who is she? Describe her job, house,
family, location.
Research Question:
How much education do you need to become a vet? Why does
the Army need vets?
PROJECT EBOLA
Choose 3 Questions:
1. Describe the characteristics of the four levels of BSL.
2. Why does she have to do autopsies very quickly in Ebola cases?
3. Anthrax is quite deadly. Why is it referred to as “safer” than
Ebola?
4. Who is Gene Johnson? Describe his personality and some
surprises about him. What makes an expert like him so afraid of
viruses?
5. Which system is attacked first? Why is this important?
6. How do HIV and Ebola compare in their transmission?
Choose 1 Research Question:
1. How does the facility at Roberts Hall at Kansas State University compare
to the facilities at USAMRIID?
2. Research and describe the protein sequence of Ebola—since the
book was written it has been completely sequenced and dissected as a
particle.
3. How does UV light act as a sterilizing agent?
TOTAL IMMERSION
Choose 3 Questions:
1. Compare the behavior of healthy and sick monkeys in this
setting.
2. How are the blood samples stored? How do these facilities work?
Why is this method of storage important?
3. Compare the symptoms of the dead monkeys with the symptoms
in the human victims portrayed so far. Make a list
4. Why number the tools?
5. Why can’t you use a bone saw in level 4?
6. What is the Slammer? The Submarine?
7. 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?
Choose 1 Research Question:
1. “Viruses are ambiguously alive”. Defend the truth or lack of truth
in this statement.
2. What is a parasite and why does the author describe a virus as a
parasite?
3. Is Ebola a DNA or RNA virus? Why is this a meaningful way to
distinguish viruses?
4. Why do scientists think that RNA may have appeared on the
earth before DNA?
EBOLA RIVER
Choose 3 Questions:
1. Where is the virus’ original spreading point? Who was the “index
case”?
2. 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.
3. Compare the hospital conditions in Maridi to the conditions that
are local. Compare the cleanliness of the hospitals in America to the
Yambuku Hospital.
4. The Sudan virus subsides, then vanishes. Can you explain why
this might be happening? What are two possible reasons the outbreak
burned itself out?
5. What is so important about Nurse Mayinga’s story? Why doesn’t
she go into quarantine for her condition?
6. In the end, did the first Zaire outbreak show symptoms of
airborne transmission?
7. Define hot as it is used in this book.
8. Johnson says “I’m glad nature is not benign”. What do you think
he means? Do you agree or disagree and why?
Choose 1 Research Question:
1. What did the nuns at the Yambuku Hospital do to sterilize used
syringes? What recommendations would you make to improve this
practice?
2. Get a road 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?
3. “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.
CARDINAL
Choose 3 Questions:
1. 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?
2. How was the sample stored for safety handling? How many
levels of physical and biological protection were there?
3. What happened to Peter Cardinal?
4. What is “third spacing” and why were his symptoms concerning
about an airborne infection?
5. What is the distinction between parasites and predators?
6. How did Gene Johnson culture the sample of Peter Cardinal’s
blood serum? Describe the three steps of this experimental protocol.
7. What does the relative lethality rate in animal species tell us
about the original host or reservoir species?
8. What did Lt. Johnson discover about Peter Cardinal and where he
had been?
9. What did Lt. Johnson's team discover in Kitum Cave?
GOING DEEP
Questions:
1. What are sentinel animals? Give two examples.
2. How did they set up the containment facility as they approached
the cave? Draw this out on a schematic map.
Choose 1 Research Question:
1. Describe the experiment in 1988 that confirmed that Ebola could
travel through the air.
2. What is an antibody and how does this test confirm the presence
or absence of a virus?
3. What does Pasteur’s quote “chance favors the prepared mind”
mean? What were Pasteur’s contributions to our knowledge of bacteria
and fungi?
4. What are Nancy and Jerry Jaax doing now?
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
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
USAMRIID
RESTON
Choose 3 Questions:
1. 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.
2. 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.
3. What was the condition of the surviving males that concerned
Dalgard? What were his suspicions?
4. Why can’t you do an autopsy of a monkey in front of other
monkeys?
5. What did he find out during the autopsy?
Choose 1 Research Question:
1. Use your DC Metro map and locate Reston. What is the
industrial/economic status of Reston?
2. How many monkeys are imported into the United States each year?
For what purposes does this happen?Which government agency(ies) are
responsible for overseeing these
facilities? How long are monkeys quarantined before distribution?
3. Find a picture of the crab-eating macaque species of
Monkey. What are their characteristics? Why are they described as
competitors of humans in their natural environment?
4. What was the condition of the spleens in these specimens
compared to a normal monkey spleen? What does the spleen do?
INTO LEVEL 3
Choose 3 Questions:
23. Why did Dalgard decide to contact USAMRIID? Do you think
this poses a risk to his company?
25. What irritated and concerned Peter about the samples Dan
sent him?
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?
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
Choose 3 Questions:
1. Who is Thomas Geisbert and what does he do at USAMRIID?
What made his background different from the other scientists and
technicians?
2. How did the cells Tom saw differ from normal cells?
3. Jahrling refers to the cell culture as “off the plastic”. What does he mean
by this? 3
4. What was his suspicion about the culture and how did he test it?
5. What is Pseudomonas and how does it live? What is it’s
characteristic smell?
6. Why was it a mistake for Geisbert and Jahrling to smell the
flask?
Reasearch Question:
1. What’s the difference between an electron microscope and a
light microscope? What size particles can each see?
THANKSGIVING
Question:
1. List three hypotheses about how the virus had apparently
jumped from room F to room H.
MEDUSA
Choose 3 Questions:
1. Describe the diamond knife. Why was the diamond knife
necessary for the work that Thomas Geisbert was doing?
2. What did he see in the EM images? Why did it upset him?
3. How did Thomas Geisbert determine that the cells under his
microscope were a form of Ebola?
4. What are inclusion bodies?
5. What are bricks and why are they so dangerous?
6. In retrospect, what was the “pepper” that Tom had seen
under the light microscope
Choose 1 Research Question:
1. 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.
2. “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.
THE FIRST ANGEL
Choose 3 Questions:
1. Compare Gene Johnson’s and Peter Jahrling’s offices. What
does this tell you about their personalities?
2. What convinced Geisbert that the substance was Marburg?
3. Why were Jahrling, Geisbert, and Peters so secretive about
the virus?
4. 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?
5. Neither Peter nor Tom mention the “sniffing incident” to CJ
Why not? Would you have mentioned it? Why or why not?
6. Why would it be strange to “handle your own blood while
wearing a space suit?”
THE SECOND ANGEL
Choose 3 Questions:
1. Why does Tom Geisbert go to work so early?
2. What did the evidence from monkey 053’s cells show?
3. How could Jahrling test to see if the monkey virus reacted in
humans? What did it mean if the cells were glowing?
4. Why did it have to be so dark to be able to see the samples?
Explain how these dyes work.
5. Explain the results of the culture. What was the reaction?
CHAIN OF COMMAND
Choose 3 Questions:
1. Why did Jahrling repeat the test?
2. Summarize Col. Nancy Jaax’s arguments about the virus being airborne.
Did she miss anything?
3. How did Jahrling rationalize not telling anyone about having
sniffed the solution?
4. 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?
5. Why is it important to know how the viruses spread?
6. What is a species jumper?
7. How is the tension between the CDC and the Army
characterized by General Russell?
8. Why was Dalgard reluctant to let the Army into his facility?
GARBAGE BAGS
Choose 3 Questions:
1. 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?
2. What is “extreme amplification”?
3. “The Army might have to act decisively to put out this fire.”
What does this mean?
4. Why did they have to sterilize the bags with bleach and what
were they used for?
5. 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?
SPACE WALK
Choose 3 Questions:
1. Why couldn’t Nancy bring her standard ID card into the decon
chamber?
2. How did the spacesuits and the confined space affect the way
the two people had to walk and interact with each other?
3. How does the author characterize the states of order and
disorder in life and death terms? Why are viruses an exception to
this rule?
4. What was Nancy Jaax looking for when she operated on the
monkey and why was she disappointed?
5. Why could she not confirm the presence of Ebola in these
specimens? List the evidence from the internal organs.
6. Why are all the beakers and tubes made out of plastic?
SHOOTOUT
Choose 2 Questions:
1. 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.
2. 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?
3. How did the Army and CDC resolve the issue of case
management?
MISSION
Question:
1. 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?
RECONNAISSANCE
Choose 3 Questions:
1. What was the plan for December 1? What time were they
going to start? Why?
2. Who did Gene Johnson see in the parking lot?
3. How did the media find out?
4. Why did they seal off Room H?
5. Why weren’t they wearing respirators or suits in room H?
6. Why did Nancy avert her eyes?
7. What else did she notice about the monkeys that scared her?
8. What did Nancy do when she heard about her father? What
would you have done? Why?
The Hot Zone: Part III
Smashdown
VOCABULARY
cacophony
claustrophobia
cryptic
sharps container
heart stick
unequivocal
INSERTION
Choose 3 Questions:
1. Why did the teams wear civilian clothes?
2. What might happen if the teams wore military biohazard suites?
3. Why didn’t the army officials just let the virus kill off all the
monkeys?
4. What is the purpose of the gray area?
5. What advice did Nancy give her crew before going in?
6. Why did she carry extra tape on her uniform?
7. How much time could they have in the suits?
8. Why did the monkeys react the way they did to the people in the
suits?
9. What did Nancy notice on the monkeys?
10.
How did they euthanize the monkeys?
11.
How did Nancy package the carcasses?
Choose 1 Research Question:
1. How does bleach kill microbes?
2. What is a blood clot and how does it cause organ damage?
A MAN DOWN
Questions:
1. Describe all the human contacts you have had since you got up
this morning. In case of a dangerous exposure, how would you begin
the process of contacting them and maybe quarantining them?
2. Why is the Slammer a safer place to keep an Ebola patient than
a community hospital?
3. If it’s hot inside and cold outside, what happens if you open a
window? What are the dangerous consequences associated with this
possibility?
91 TANGOS
Choose 3 Questions:
1. Why is the buddy system useful, why did they use it in the
monkey house?
2. What is the new danger Gene sees, and what is the evidence for
this?
3. How many monkeys do they have to kill?
4. What was the condition of the monkey house?
5. What human setting could you compare this to?
65. What had the monkeys done to the walls? How does the author
describe this?
6. What were 4 symptoms Jerry saw as he moved around?
7. Why does the coughing and sneezing worry Jerry? What
comparison does the author make in this case and why?
8. Why is it not safe to hand an opened syringe to another person?
9. Why is bleach poured down the drain after blood?
INSIDE
Question:
1. During the cleanup what did they find lying around? What do you
think was the source of these items?
didn’t
A BAD DAY
Choose 3 Questions:
1. What were Frantig’s results on the Ebola test? What would have
happened if it had come up with the opposite result?
2. What is T-61?
3. What happened in Room C? Describe the room.
4. Why did Jerry veto the idea of shooting the monkey?
Research Question:
1. What is the rapid Elisa test? (do the HHMI Virtual Immunology
lab which is available on the Howard Hughes Medical Institute site,
http://www.hhmi.org )
DECON
Choose 3 Questions:
117. Why is it better to dispose of the monkeys the way they did
instead of just burying them? What improvements would you
suggest?
119. How did Jerry finally catch the escaped monkey?
125. How did the CDC trace the origin of this collection of monkeys?
What are their remaining unknowns?
Choose 1 Research Question:
127. List the further procedures in cleaning out the facility. Go to
www.cnn.com to compare this to the procedures used in isolating
suspected centers of anthrax in 2002.
128. What was the sentinel species used to see if the place was really
clean? Research this species to find out why it is so hard to kill off.
What are some other hard-to-kill microbes?
THE MOST DANGEROUS STRAIN
Choose 3 Questions:
1. How and where does a virus hide?
2. Although this new strain turned out not to be lethal to humans,
what was scary about it?
3. What scared General Russell the most in retrospect?
4. “Imagine a virus with the infectiousness of the flu and the
mortality rate of the black plague.” What could we do to protect
ourselves against this?
5. What is the likely index case for Reston? What are some other
possibilities for the link between the African and Asian strains? Why
can we rule out convergence in this case
Choose 1 Research Question:
1. How are viruses able to evolve so rapidly?
2. Go to www.erapg.org/everyone/9587/18624/18615/18674
and match the sequences of Ebola Reston and Ebola Zaire.