Characters
Glossary
Themes
Essay Questions
Miscellaneous
100
Frenchman, lived by himself near Nzoia Sugar Factory in Kenya and next to Mt. Elgon; he dies of a strange, unknown disease after exploring Kitum Cave
Who is Charles Monet?
100
an area of inflamed or swollen tissue in the body that is filled with pus
What is abscess?
100
The majority of the main characters in the book are highly-trained scientists and medical personnel with significant experience with hot agents. Yet, as Preston reveals, their knowledge of filoviruses is woefully incomplete, especially when it comes to their ability to create a preventative vaccine or cure. Preston notes that only three of the seven proteins in filovirus strains have yet to be identified, while even the mystery of Kitum Cave and the source of the Marburg virus is still far from being solved. Ultimately, until science and knowledge can catch up with the filoviruses, there is no option but for individuals like Nancy Jaax and Gene Johnson to continue their research. In the meantime, the role played by both chance and human error will be even more significant in determining the path of a potential outbreak.
What is Limitations of Human Knowledge?
100
Describe the symptoms of the Marburg virus as it affects Charles Monet.
What are Seven days after his visit to Kitum Cave, Monet develops a headache, shortly followed by a severe backache, fever, and nausea. His face becomes mask-like, and his eyeballs turn bright red, while his personality becomes increasingly sullen and angry. As the virus amplifies in his body, Monet expels "vomito negro" or black vomit, caused by liquefying flesh mixed with virus. His body becomes filled with blood clots, which cut off the blood flow to his brain and cause extensive brain damage, or depersonalization. In the last phase of the virus, Monet collapses and hemorrhages blood from every orifice?
100
an infective agent that typically consists of a nucleic acid molecule in a protein coat, is too small to be seen by light microscopy, and is able to multiply only within the living cells of a host
What is a virus?
200
A veterinarian and scientist in the United States Army, Jaax works on Gene Johnson's Ebola experiment in 1983 and suffers a near exposure to the Ebola virus through a rip in her space suit glove. In 1989, Jaax is appointed chief of pathology for USAMRIID and works extensively on the outbreak operation in Reston, Virginia. Married to Jerry Jaax. Mother of Jaime and Jason.
Who is Lieutenant Colonel Nancy Jaax?
200
a hypothetical infectious pathogen with the ability to mutate unpredictably and resist destruction
What is Andromeda strain?
200
The power of nature is a recurring theme in Preston's descriptions of the various outbreaks of Marburg and Ebola. While human beings may consider themselves to be "master of the earth", Preston argues that nature has the ultimate power, even to the point of determining the course of human evolution. While scientists such as Nancy Jaax and Gene Johnson can strive to understand filoviruses, all humans are ultimately at the mercy of the natural order.
What is Power of Nature?
200
Over the course of the book, the author frequently changes narrative point of view. List some examples of this and explain why Preston may use these techniques in his writing
What are Preston shifts between several narrative styles in the book, including third person, second person, and internal monologue. Because the book is a non-fiction work based on extensive research, Preston's default perspective is the third person, which provides an opportunity for description and clinical observation (such as when he describes Charles Monet's symptoms). Yet, in some scenes, such as when Nancy Jaax is working in the hot zone with Tony Johnson, Preston shifts to internal monologue. Not only does this provide the reader with more insight into Nancy's character, it also heightens the drama of the scene?
200
Good outbreak control relies on applying a package of interventions, namely case management, surveillance and contact tracing, a good laboratory service, safe burials and social mobilisation. Community engagement is key to successfully controlling outbreaks. Raising awareness of risk factors for Ebola infection and protective measures that individuals can take is an effective way to reduce human transmission. Risk reduction messaging should focus on several factors:
What is Prevention and control?
300
A veterinarian and scientist in the United States Army. Jaax is appointed chief of the veterinary division at USAMRIID and serves as the mission leader of the SWAT team during the Reston operation. Married to Nancy Jaax.
Who is Colonel Gerald "Jerry" Jaax?
300
the decay of tissue caused by a lack of blood supply
What is gangrene?
300
Chance plays a significant role in determining how a virus spreads and which characters fall victim to it. In every case, the virus strikes indiscriminately, regardless of age, occupation, or personality. This is particularly clear in the scene with Nurse Mayinga and Dr. Isaacson: while both characters treat a patient dying with Ebola Zaire, only Mayinga succumbs to the disease. Preston also takes care to highlight scenarios in which chance seems to be the only thing that prevents an individual from being exposed. When Nancy Jaax is working on Gene Johnson's Ebola experiment, the circumstances are perfectly arranged for her to be infected: the knife cut, the rip in her glove, and the breach in the wrist of her space suit. Yet, Nancy is saved by chance in the form of a thin layer of latex.
What is change?
300
Preston describes the Ebola virus as being neither dead nor alive. Provide evidence to support both sides of the argument
What is From one perspective, a virus is no more alive than a machine. It has no mind and no motivation beyond a simple directive to replicate itself. From another perspective, a virus such as Ebola is an incredibly ancient life form that has survived for thousands of years. Despite not having a consciousness, the virus displays a strategic cunning when it comes to its existence, particularly when it comes to infecting and replicating in a new host?
300
The incubation period, that is, the time interval from infection with the virus to onset of symptoms is 2 to 21 days. Humans are not infectious until they develop symptoms. First symptoms are the sudden onset of fever fatigue, muscle pain, headache and sore throat. This is followed by vomiting, diarrhoea, rash, symptoms of impaired kidney and liver function, and in some cases, both internal and external bleeding (e.g. oozing from the gums, blood in the stools). Laboratory findings include low white blood cell and platelet counts and elevated liver enzymes.
What are Symptoms of Ebola virus disease?
400
A civilian biohazard expert who runs the Ebola research program at USAMRIID in 1983. In 1987, Johnson identifies the Marburg virus in a blood serum sample taken from Peter Cardinal. He also proves that Marburg and Ebola have the ability to travel through the air. In 1988, he organizes an expedition to Kitum Cave with Dr. Peter Tukei but is unable to identify the origin of the virus. In 1989, Johnson works with Jerry Jaax on the Reston operation.
Who is Eugene "Gene" Johnson?
400
a medical instrument used to examine the larynx
What is a laryngoscope?
400
Particularly in "The Monkey House" and "Smashdown," Preston highlights the various obstacles caused by bureaucratic considerations in dealing with the outbreak at the Reston facility. Preston describes the arguments between various organizations over control and ownership of the problem, as well as highlighting Colonel Peters' job to limit publicity about the operation. In general, these discussions do little to help contain the outbreak at the Reston facility and, in some cases, even increase the potential risk to the general population. The issues with bureaucracy faced by USAMRIID and the C.D.C. are presented in sharp contrast to the steps taken by the government of Zaire in 1976, where bureaucratic discussion is replaced with immediate action to quarantine the hospital and infected villages.
What is Bureaucracy?
400
What is the ethical dilemma faced by Nancy Jaax in her work with hot agents?
What is Nancy Jaax works with Level 4 agents in an effort to save human lives through medicine. However, in order to progress in her research, Jaax must inject laboratory animals with deadly viruses and observe their suffering and eventual deaths. This is in direct opposition to her oath as a veterinarian. While her actions are made for the sake of protecting and promoting life, Jaax must still deal with knowledge that she is promoting one species of life over another?
400
formerly known as Ebola haemorrhagic fever, is a severe, often fatal illness in humans.
What is Ebola virus disease (EVD)?
500
A physician at Nairobi Hospital who suspects that Dr. Musoke has been infected by a rare virus and sends samples of Musoke's blood serum to the CDC in 1980. After learning of the mysterious virus' similarities to the Marburg virus, Dr. Silverstein persuades Kenyan authorities to shut down Nairobi Hospital and quarantine the staff members who had interacted with Dr. Musoke and Charles Monet. Seven years later, Dr. Silverstein treats Peter Cardinal at Nairobi Hospital.
Who is Dr. David Silverstein?
500
a purplish spot on the skin caused by a small hemorrhage
What is petechiae?
500
From the use of dirty needles at the Yambuku Mission Hospital and the hospital at Maridi, to the negligence of Hazelton Research Products in knowingly purchasing infected monkeys from the Philippines, human error can be directly connected to the majority of the outbreaks described in the book. Preston also highlights several instances in which negligence could easily have led to an outbreak under different circumstance, such as when dirty needles are left outside the Reston facility or when Dan Dalgard wraps contaminated monkey samples in mere tin foil before sending them to USAMRIID. In every case, Preston makes it clear that the potential for a devastating outbreak can be determined by a single member of the human population.
What is Human Error?
500
During the outbreak at the Reston facility, the virus seems to jump from Room F to Room H. Describe three possible ways the virus might have spread.
What is The rooms in the Reston facility have a linked air supply, so it is possible that the virus could have traveled through the air from Room F to Room H. Alternately, the virus could have spread through the dirty injection needles used for monkeys in both rooms. As a third option, one of the animal caretakers could have tracked the virus into the other room by carrying feces on his or her shoes. The unknown element of transmission makes Ebola Reston incredibly dangerous.
500
include prompt and safe burial of the dead, identifying people who may have been in contact with someone infected with Ebola, monitoring the health of contacts for 21 days, the importance of separating the healthy from the sick to prevent further spread, the importance of good hygiene and maintaining a clean environment.
What is Outbreak containment measures?
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