Panic in Level 4: Cannibals, Killer Viruses, and Other Journeys to the Edge of Science

by Richard Preston

Overview

Bizarre illnesses and plagues that kill people in the most unspeakable ways. Obsessive and inspired efforts by scientists to solve mysteries and save lives. From The Hot Zone to The Demon in the Freezer and beyond, Richard Preston’s bestselling works have mesmerized readers everywhere by showing them strange worlds of nature they never dreamed of.

Panic in Level 4 is a grand tour through the eerie and unforgettable universe of Richard Preston, filled with incredible characters and mysteries that refuse to leave one’s mind. Here are dramatic true stories from this acclaimed and award-winning author, including:

• The phenomenon of “self-cannibals,” who suffer from a rare genetic condition caused by one wrong letter in their DNA that forces them to compulsively chew their own flesh–and why everyone may have a touch of this disease.
• The search for the unknown host of Ebola virus, an organism hidden somewhere in African rain forests, where the disease finds its way into the human species, causing outbreaks of unparalleled horror.
• The brilliant Russian brothers–“one mathematician divided between two bodies”–who built a supercomputer in their apartment from mail-order parts in an attempt to find hidden order in the number pi (π).

In fascinating, intimate, and exhilarating detail, Richard Preston portrays the frightening forces and constructive discoveries that are currently roiling and reordering our world, once again proving himself a master of the nonfiction narrative and, as noted in The Washington Post, “a science writer with an uncommon gift for turning complex biology into riveting page-turners.”

Product Details

ISBN-13:	9780812975604
Publisher:	Random House Publishing Group
Publication date:	06/16/2009
Edition description:	Reprint
Pages:	240
Sales rank:	309,854
Product dimensions:	7.96(w) x 5.26(h) x 0.52(d)

About the Author

Richard Preston is the bestselling author of The Hot Zone, The Demon in the Freezer, The Wild Trees, and the novel The Cobra Event. A writer for The New Yorker since 1985, Preston is the only nondoctor to have received the Centers for Disease Control’s Champion of Prevention Award. He also holds an award from the American Institute of Physics. Preston lives outside of New York City.

Hometown:

Hopewell, New Jersey

Date of Birth:

August 5, 1954

Place of Birth:

Cambridge, Massachusetts

Education:

B.A., Pomona College, 1976; Ph.D. in English, Princeton University, 1983

Website:

http://richardpreston.net/

Read an Excerpt

PANIC IN LEVEL 4 by Richard Preston

INTRODUCTION- Adventures in Nonfiction Writing

Oliver Heaviside, the English mathematician and physicist, once said, “In order to know soup, it is not necessary to climb into a pot and be boiled.” Unfortunately, this statement is not true for journalists. As a writer of what’s called “literary nonfiction” or “creative nonfiction”– narrative that is said to read like a novel but is factually verifiable– it has often been my practice to climb into the soup. Getting boiled with your characters is a good way to get to know them, but it has occasionally led me into frightening situations.

Some years ago, while I was researching The Hot Zone, a book that focuses on the Ebola virus, I may have had a meeting with an unknown strain of Ebola. (A virus is an exceedingly small life-form, an infectious parasite that replicates inside living cells, using the cell’s own machinery to make more copies of itself.)

Ebola has now been classified into seven different known types. Though it has been studied for more than thirty years, Ebola is one of the least-understood viruses in nature. Scientists have been understandably reluctant to study Ebola too closely because it has on occasion killed those who tried to do so. The virus was first was noticed in 1976, when it surfaced in Yambuku, Zaire (now the Democratic Republic of Congo), near the Ebola River, where it sacked a Catholic mission hospital, killing most of the medical staff along with a number of patients and people the patients had came into contact with. Ebola spreads from one person to the next by direct contact with blood or secretions, including sweat. There is no evidence that it can spread among humans through the air, although there is some evidence that it may spread among monkeys this way. As a parasite, Ebola carries on its life cycle in some unidentified type of animal–Ebola’s natural host–that lives in certain unidentified habitats in equatorial Africa. Occasionally Ebola comes into contact with a person, and the virus makes what is known as a trans-species jump from its host into the human species.

When Ebola gets inside a human host, it causes the person’s immune system to vanish, and the person dies with hemorrhages coming from the body’s orifices. The most lethal strains of Ebola have been known to kill up to 95 percent of people who become infected with it. Ebola causes people to vomit masses of black blood with a distinctive  “coffee grounds” appearance. Victims can have a bright red nosebleed, or epistaxis; it won’t stop. A spotty, bumpy rash spreads over the body, while small, starlike hemorrhages appear beneath the skin. An Ebola patient can have blood standing in droplets on the eyelids and running from the tear ducts down the face. Blood can flow from the nose, mouth, vagina, rectum. The testicles can become infected with Ebola and can swell up or be destroyed. Victims display signs of psychosis. They can develop endless hiccups. Rarely, in particularly severe cases of Ebola, the linings of the intestines and rectum may come off. Those membranes may be expelled through the anus in raglike pieces called casts, or the intestinal lining can emerge in the form of a sleeve, like a sock. When an Ebola patient expels a sleeve, it is known as throwing a tubular cast.

Some of the action in The Hot Zone takes place at Fort Detrick, an Army base in the rolling country along the eastern flank of the Appalachian Mountains in Maryland, an hour’s drive northwest of Washington, D.C. The Army’s Level 4 virus laboratories at Fort Detrick are clustered inside a large, nearly windowless building that sits near the eastern perimeter of the base. This building is the headquarters of the United States Army Medical Research Institute of Infectious Diseases,  or USAMRIID–a facility that Army people often simply refer to as “the Institute.” While I was visiting USAMRIID, or the Institute, to interview various experts in Ebola, I began asking officials at the base for per- mission to put on a biohazard space suit and enter one of the Army’s Biosafety Level 4 virus laboratories. I wanted to get a firsthand look at researchers handling Ebola. More than that, I wanted to know what it feels like to wear a biohazard space suit and be face-to-face with a real Level 4 virus, so that I could get a sense of my characters’ feelings and experiences, and could describe them with convincing precision. (Many nonfiction writers refer to their characters as “subjects,” but I prefer to think of them as dramatis personae in a true story.)

Biosafety Level 4, also called BL-4 or Level 4, is the highest and tightest level of biosecurity in a laboratory. Laboratories rated at Biosafety Level 4 are the repositories of viruses called hot agents– lethal viruses for which there is no vaccine or effective cure. Level 4 labs are sealed off from the outside world. People who go inside a Level 4 lab are required to wear a biohazard space suit, a pressurized whole-body suit, like an astronaut’s, made of soft, flexible plastic, typically blue. Army researchers sometimes refer to the space suit as a “blue suit” because of its color. A soft, flexible helmet that completely surrounds the head is joined to the suit, and the helmet has a clear, flexible plastic faceplate in it; the suit also has an independent air supply. The air supply prevents you from breathing the air inside the lab, which could be contaminated with a hot agent. Ebola virus is classified as a Level 4 hot agent, one of the most dangerous known, and it has the potential to be used as a biological weapon. The scientists at USAMRIID (it’s pronounced “you-SAM-rid”) conduct research into vaccines and drugs that could be used to protect the population of the United States against a terrorist or military attack with a biological weapon, including Ebola virus. This is medical research, peaceful in nature.

The Level 4 labs inside the Institute consist of groups of interconnected rooms. Each group of rooms is known as a hot suite or a hot zone. Each suite is sealed off from the outside world and is accessible only through an air lock. The air lock has heavy, stainless steel doors. Inside the air lock there is a chemical decontamination shower, also known as a “decon” shower. The purpose of the decon shower is to sterilize the outer surface of the space suits of researchers who are leaving a hot zone, to prevent a hot agent from getting a ride to the outside world.  Chest freezers inside the Army’s hot zones are filled with collections of microvials (tiny plastic test tubes the size of a pencil stub) that contain frozen or freeze-dried samples of many different strains of lethal viruses.

The freezers are kept at 95 degrees below zero Fahrenheit. They are said to be hot. They are hot in a biological sense: they contain frozen samples of lethal viruses that are held in suspended animation in the extreme cold. The virus collections stored in USAMRIID’ s hot freezers are said to include strains of Bolivian hemorrhagic fever virus, Guanarito virus, Junín virus, dengue hemorrhagic fever, Venezuelan equine encephalitis (VEE), Japanese encephalitis virus (JEV), Hendra virus, Nipah virus, Lassa virus, and the seven known types of Ebola. (These viruses’ effects on humans vary. Guanarito, Junín, and Lassa, for example, cause hemorrhaging from the body’s orifices, like Ebola. VEE and JEV infect the brain and spinal cord, causing coma or death. Nipah is a brain virus from Malaysia that can trigger a literal meltdown of the brain. The brain of a Nipah victim can be semiliquefied as the virus consumes it, and can pour out of the skull during an autopsy.) The hot freezers also may contain (although the Army doesn’t say much about this) an assortment of Level 4 Unknown viruses, or X viruses. The Unknown X viruses appear to be lethal in humans, but little is known about them. They’ve never been fully studied or classified. They may include something known as the Linköping Samples, which may or may not harbor an unidentified type of Ebola. The X viruses are presumed to be potentially lethal, so they are kept in Level 4 for safety.

We know that Ebola virus was one of the more powerful bioweapons in the arsenal of the old Soviet Union. In the years before the Soviet Union broke up, in 1991, bioweaponeers had reportedly been experimenting with aerosol Ebola–powdered, weaponized Ebola that could be dispersed through the air, over a city, for example. The Soviet weaponized Ebola was apparently stable enough that it could drift for distances in the air and still infect people through the lungs when they breathed a few particles of it. This is why the U.S. Army was studying it: the Army researchers were trying to come up with a vaccine or a drug treatment for Ebola, in case of a terrorist or military attack on the United States with Ebola.

As a natural disease, Ebola virus does not seem to be able to pass from person to person through the air, though. In each of the natural Ebola outbreaks, the disease seems to burn itself out, and Ebola fades away and is lost in the backdrop of nature, until, once again, by chance, it finds its way into a human host.



 

Table of Contents

List of Illustrations     xi
Introduction: Adventures in Nonfiction Writing     xiii
The Mountains of Pi     3
A Death in the Forest     48
The Search for Ebola     71
The Human Kabbalah     89
The Lost Unicorn     132
The Self-Cannibals     150
Glossary     181
Acknowledgments     187

Introduction

Oliver Heaviside, the English mathematician and physicist, once
said, “In order to know soup, it is not necessary to climb into a pot and
be boiled.” Unfortunately, this statement is not true for journalists. As
a writer of what’s called “literary nonfiction” or “creative nonfiction”–
narrative that is said to read like a novel but is factually verifiable–
it has often been my practice to climb into the soup. Getting
boiled with your characters is a good way to get to know them, but it
has occasionally led me into frightening situations.

Some years ago, while I was researching The Hot Zone, a book that
focuses on the Ebola virus, I may have had a meeting with an unknown
strain of Ebola. (A virus is an exceedingly small life-form, an infectious
parasite that replicates inside living cells, using the cell’s own machinery
to make more copies of itself.)

Ebola has now been classified into seven different known types.
Though it has been studied for more than thirty years, Ebola is one of
the least-understood viruses in nature. Scientists have been understandably
reluctant to study Ebola too closely because it has on occasion
killed those who tried to do so. The virus was first was noticed in
1976, when it surfaced in Yambuku, Zaire (now the Democratic Republic
of Congo), near the Ebola River, where it sacked a Catholic
mission hospital, killing most of the medical staff along with a number
of patients and people the patients had came into contact with. Ebola
spreads from one person to the next by direct contact with blood or secretions,
including sweat. There is no evidence that it can spread
among humans through the air, although there is some evidence that
it may spread among monkeys this way. As a parasite, Ebola carries on
its life cycle in some unidentified type of animal–Ebola’s natural
host–that lives in certain unidentified habitats in equatorial Africa.
Occasionally Ebola comes into contact with a person, and the virus
makes what is known as a trans-species jump from its host into the
human species.

When Ebola gets inside a human host, it causes the person’s immune
system to vanish, and the person dies with hemorrhages coming
from the body’s orifices. The most lethal strains of Ebola have been
known to kill up to 95 percent of people who become infected with it.
Ebola causes people to vomit masses of black blood with a distinctive
“coffee grounds” appearance. Victims can have a bright red nosebleed,
or epistaxis; it won’t stop. A spotty, bumpy rash spreads over the body,
while small, starlike hemorrhages appear beneath the skin. An Ebola
patient can have blood standing in droplets on the eyelids and running
from the tear ducts down the face. Blood can flow from the nose,
mouth, vagina, rectum. The testicles can become infected with Ebola
and can swell up or be destroyed. Victims display signs of psychosis.
They can develop endless hiccups. Rarely, in particularly severe cases of
Ebola, the linings of the intestines and rectum may come off. Those
membranes may be expelled through the anus in raglike pieces called
casts, or the intestinal lining can emerge in the form of a sleeve, like a
sock. When an Ebola patient expels a sleeve, it is known as throwing a
tubular cast.

Some of the action in The Hot Zone takes place at Fort Detrick, an
Army base in the rolling country along the eastern flank of the Appalachian
Mountains in Maryland, an hour’s drive northwest of Washington,
D.C. The Army’s Level 4 virus laboratories at Fort Detrick are
clustered inside a large, nearly windowless building that sits near the
eastern perimeter of the base. This building is the headquarters of the
United States Army Medical Research Institute of Infectious Diseases,
or USAMRIID–a facility that Army people often simply refer to as “the
Institute.” While I was visiting USAMRIID, or the Institute, to interview
various experts in Ebola, I began asking officials at the base for per-
mission to put on a biohazard space suit and enter one of the Army’s
Biosafety Level 4 virus laboratories. I wanted to get a firsthand look at
researchers handling Ebola. More than that, I wanted to know what it
feels like to wear a biohazard space suit and be face-to-face with a real
Level 4 virus, so that I could get a sense of my characters’ feelings and
experiences, and could describe them with convincing precision.
(Many nonfiction writers refer to their characters as “subjects,” but I
prefer to think of them as dramatis personae in a true story.)

Biosafety Level 4, also called BL-4 or Level 4, is the highest and
tightest level of biosecurity in a laboratory. Laboratories rated at
Biosafety Level 4 are the repositories of viruses called hot agents–
lethal viruses for which there is no vaccine or effective cure. Level 4
labs are sealed off from the outside world. People who go inside a
Level 4 lab are required to wear a biohazard space suit, a pressurized
whole-body suit, like an astronaut’s, made of soft, flexible plastic, typically
blue. Army researchers sometimes refer to the space suit as a
“blue suit” because of its color. A soft, flexible helmet that completely
surrounds the head is joined to the suit, and the helmet has a clear,
flexible plastic faceplate in it; the suit also has an independent air supply.
The air supply prevents you from breathing the air inside the lab,
which could be contaminated with a hot agent. Ebola virus is classified
as a Level 4 hot agent, one of the most dangerous known, and it has
the potential to be used as a biological weapon. The scientists at
USAMRIID (it’s pronounced “you-SAM-rid”) conduct research into
vaccines and drugs that could be used to protect the population of the
United States against a terrorist or military attack with a biological
weapon, including Ebola virus. This is medical research, peaceful in nature.

The Level 4 labs inside the Institute consist of groups of interconnected
rooms. Each group of rooms is known as a hot suite or a hot
zone. Each suite is sealed off from the outside world and is accessible
only through an air lock. The air lock has heavy, stainless steel doors.
Inside the air lock there is a chemical decontamination shower, also
known as a “decon” shower. The purpose of the decon shower is to
sterilize the outer surface of the space suits of researchers who are leaving
a hot zone, to prevent a hot agent from getting a ride to the out side world.
Chest freezers inside the Army’s hot zones are filled with
collections of microvials (tiny plastic test tubes the size of a pencil stub)
that contain frozen or freeze-dried samples of many different strains of
lethal viruses.

The freezers are kept at 95 degrees below zero Fahrenheit. They
are said to be hot. They are hot in a biological sense: they contain
frozen samples of lethal viruses that are held in suspended animation in
the extreme cold. The virus collections stored in USAMRIID’s hot freezers
are said to include strains of Bolivian hemorrhagic fever virus, Guanarito
virus, Junín virus, dengue hemorrhagic fever, Venezuelan equine
encephalitis (VEE), Japanese encephalitis virus (JEV), Hendra virus,
Nipah virus, Lassa virus, and the seven known types of Ebola. (These
viruses’ effects on humans vary. Guanarito, Junín, and Lassa, for example,
cause hemorrhaging from the body’s orifices, like Ebola. VEE and
JEV infect the brain and spinal cord, causing coma or death. Nipah is a
brain virus from Malaysia that can trigger a literal meltdown of the
brain. The brain of a Nipah victim can be semiliquefied as the virus consumes
it, and can pour out of the skull during an autopsy.) The hot
freezers also may contain (although the Army doesn’t say much about
this) an assortment of Level 4 Unknown viruses, or X viruses. The Unknown
X viruses appear to be lethal in humans, but little is known
about them. They’ve never been fully studied or classified. They may include
something known as the Linköping Samples, which may or may
not harbor an unidentified type of Ebola. The X viruses are presumed
to be potentially lethal, so they are kept in Level 4 for safety.

We know that Ebola virus was one of the more powerful
bioweapons in the arsenal of the old Soviet Union. In the years before
the Soviet Union broke up, in 1991, bioweaponeers had reportedly
been experimenting with aerosol Ebola–powdered, weaponized
Ebola that could be dispersed through the air, over a city, for example.
The Soviet weaponized Ebola was apparently stable enough that it
could drift for distances in the air and still infect people through the
lungs when they breathed a few particles of it. This is why the U.S.
Army was studying it: the Army researchers were trying to come up
with a vaccine or a drug treatment for Ebola, in case of a terrorist or
military attack on the United States with Ebola.

As a natural disease, Ebola virus does not seem to be able to pass
from person to person through the air, though. In each of the natural
Ebola outbreaks, the disease seems to burn itself out, and Ebola fades
away and is lost in the backdrop of nature, until, once again, by chance,
it finds its way into a human host.

One day I was interviewing the commander of Fort Detrick. We
were getting toward the end of the interview, and I decided to ask one
last question. “I’d like to try to convey to readers what it really feels like
to be face-to-face with Ebola virus.” I said. “Could I go into Level 4?”

“That should be no problem,” the commander answered
promptly. “We’ll get you outfitted in a blue suit,” he said, “and walk
you through Suite AA-4”–one of the Ebola hot zones. “It’s down
and cold,” he added.

“What do you mean by ‘down and cold’?” I asked.

He explained that the hot zone had been completely sterilized
with gas and opened up for routine maintenance. The rooms weren’t
dangerous. Anyone could go into the lab without wearing a space suit.
The hot freezers, too, had been moved out of the lab. Therefore, the
lab was completely cold and safe.

“That’s not really what I had in mind,” I said.

“What did you have in mind?” he asked.

“I would like to experience the real thing, so that I can describe it.
I’d like to go into a hot BL-4 lab and see how the scientists work with
real Ebola.”

“That’s not possible,” he answered immediately.

Excerpted from Panic in Level 4 by Richard Preston Copyright © 2008 by Richard Preston. Excerpted by permission of Random House, a division of Random House, Inc. All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.

Editorial Reviews

Compelling . . . stories of high scientific adventure.”—Seattle Times

“[Preston’s] stories sparkle with images of stark beauty and darkness; mature reflections about the complex worlds we all occupy.”—Denver Post

“With his 1994 sensation The Hot Zone, science writer Richard Preston terrified millions. . . . In his new book, Panic in Level 4, he continues to probe nature’s stranger side.”—USA Today

From the Publisher

Richard Preston has made a career of making us nervous. And make no mistake; he's done it quite successfully. The author of The Hot Zone and The Demon in the Freezer specializes in devilishly calibrated true stories about tropical contagions and medical anomalies. Panic in Level 4 packs a powerful barrage of real-life tales of peril, all of which have been updated since they first appeared in The New Yorker. Among the discombobulating topics: the West Nile virus; a genetic disease that causes compulsive self-cannibalism; and the hunt for the key to Ebola. Popular science writing of high quality.

The title of New Yorkercontributor Preston's new collection refers to the subject of his bestselling The Hot Zone: a series of rooms in a government biohazard laboratory where scientists work with virulent pathogens like the Ebola viruses that would be devastating in the hands of terrorists. The essays (all from the New Yorker) cover such scientific matters as a profile of controversial über-genome mapper Craig Venter; a gene that leads people to cannibalize themselves; and two Russian-Jewish émigré scientists who built a monster computer in their cramped apartment to puzzle out patterns in the value of pi. Preston's essay on the destruction of large swaths of eastern U.S. forests by insect parasites accidentally brought into the country from abroad is the shortest but most compelling. Preston might have done more to update his pieces; for example, the Marburg virus was found in bats last year, supporting his hypothesis that they are the reservoir for Ebola. But Preston's fans will enjoy his showing how few degrees of separation there are between far-flung areas of scientific endeavors. Illus. (June)

Copyright © Reed Business Information, a division of Reed Elsevier Inc. All rights reserved.

Publishers Weekly

Adult/High School

Preston gets to the heart of these nonfiction essays by placing himself in the center of the story. The "panic" of the book's title refers to his own when his biohazard suit was breached and he feared he may have been exposed to one of the deadliest known viruses. Two of the pieces involve the brothers Chudnovsky, mathematicians so closely dependent on one another that they refer to themselves as The Mathematician. The author was able to disappear as an interviewer to the extent that he became part of the brothers' portrait. At one point, one Chudnovsky says to the other: "The interviewer answers our questions.... The interviewer becomes a person in the story." Preston used this skill of blending into his accounts to his advantage. Whether he was strapping on gear to climb mammoth hemlocks with arborists trying to understand the diseases killing the great trees of the world or acting as an off-road driver for a couple of men with the disease of self-cannibalization, Preston fit in like a good supporting actor who also happened to be the cameraman, writer, and director. Teens will find these stories compelling. The author has the eyes and language of a fine novelist, but he has the mind of a scientist who is trying to understand some of the most fascinating mysteries of our age.-Will Marston, Berkeley Public Library, CA

School Library Journal

A collection of science essays first published in the New Yorker, here brought up to date and lightly threaded together. Preston (The Wild Trees: A Story of Passion and Daring, 2007, etc.) opens with an introduction, "Adventures in Nonfiction Writing," that returns to the frightening world of viruses explored in The Hot Zone (1994), to demonstrate how he researches and shapes his work, sometimes under extraordinary circumstances. At one point, he shares his feelings of horror when the zipper on his biohazard suit breaks while he is inside Biosafety Level 4 at the U.S. Army Medical Research Institute of Infectious Diseases. He offers a bloody, stomach-churning account of what a virus can do to the human body in "The Search for Ebola," centered on Kikwit General Hospital in the Congo. Mortality is again the focus in "A Death in the Forest," but this time the agent is a tiny brown parasitic insect, and its victim is the eastern hemlock, once found in abundance in temperate rain forests in the southern Appalachians. This story takes Preston valiantly bushwhacking through the Cataloochee Valley and climbing 160-foot trees with an arborist to witness and record the devastation. "The Human Kabbalah," which focuses on Craig Venter and the business and technology behind the deciphering of the human genome, is loosely linked to "The Self-Cannibals," which tackles a genetic disorder that causes those who have it to attack themselves brutally. While the tone of the former is at times acerbic, the latter piece includes a moving portrait of two sufferers the author befriended. "The Mountains of Pi" sympathetically profiles two eccentric mathematicians who designed and built a supercomputer frommail-order parts in a Manhattan apartment to calculate pi to a world-record-setting number of digits: 2,260,321,336. They return in "The Lost Unicorn," which recounts how their expertise enabled them to capture digital images of large medieval tapestries for The Cloisters museum. Well researched, well paced and accessible.

Kirkus Reviews