Hot Zone by Richard Preston ~ November Bookclub Online Prediscussion

[JoanP]

The Book Club Online is  the oldest  book club on the Internet, begun in 1996, open to everyone.  We offer cordial discussions of one book a month,  24/7 and  enjoy the company of readers from all over the world.  Everyone is welcome.

November Book Club Online  Will you join us?

The Hot Zone: A Terrifying True Story
by Richard Preston

It reads like a detective thriller, but it's a true story--how the Ebola virus was discovered, and what happened when it turned up in a research lab just a few miles from Washington, DC. "When Richard Preston's novel "The Hot Zone" was published in 1995, it was, for many, their first introduction to the deadly Ebola and Marburg viruses.  Nearly two decades later, Ebola has infected hundreds of people in three countries across West Africa, in what is considered the worst outbreak in history. As fear over the deadly virus grows, we need a reminder of what we learned so long ago from Preston." British Broadcasting Corporation BBC

DISCUSSION SCHEDULE:

Nov. 1 - 5~  First three chapters--Something in the Forest, Jumper, Diagnosis (Africa, 1980)

 

RELEVANT LINKS:
Mt. Elgon National Park; Mt. Elgon Hotel and Spa;
BBC Ebola Primer;

  

Discussion Leader: PatH

[JoanP]

Hopefully you will not have trouble getting your hands on a copy of this book!  Since the spread of the Ebola disease out of Africa - and some cases in the United States, the book has become scarcer at libraries across the country.  How can this be happening again?

Have we learned anything from the 1980's and from Richard Preston's book that will help us cope with the disease this time around?  If we return to the book, and then consider the recent cases, maybe we can find assurance that we can cope better this time.  (although we've had a rocky start in Dallas, haven't we?).  The BBC came out with a recent program we'll consider - the 10 Things we've learned from Richard Preston's book. 

Will you check Hold Lists at your local libraries and let us know how difficult it will be to find copies by Nov 1?  Also - the book has since come out in paperback.
We're looking forward to your input!  Let us know in a post below if you will be able to join us.

[Ella Gibbons]

Joan, I'm going to buy a copy; sounds so interesting and we do need to learn all we can about this virus.  I know we have all been attached to the TV as the first man to bring it in to the USA died and now two nurses have been diagnosed with it.  NURSES!  NO DOCTORS??   Were the nurses careless?  Or just spent more time with the patient. 

And I never knew, or thought of, a hospital at the National Institutes of Health; I must google that.

My llibrary's copies were all out.

I also tried to get a copy of KILLING PATTon, try that one!!   My library has 159 copies and is ordering more, so think I'll buy a copy of that also.   My sister said she could not lay the book down.

See you in November, a month I've been dreaading as it is my birthday on the llth and I must renew my drivers' license.  My eye doctor says I should have no problem but when you are 86, you get this look from those in authority; dread it.

[Frybabe]

My library has one three copies. They are all out with seven holds at the moment. I think I saw the book in my sister's home library. Still, I am not sure I want to terrify myself any more what with all the horrific thinks being reported lately.

[PatH]

Ella, can your eye doctor do what they can do in Maryland, give you a filled out form which you can hand over instead of taking the eye exam?  That cuts out one bit of stress.

Indeed, NIH has a hospital.  I worked in it for 35 years.  It opened in 1953, and I went to work there in 1954, took some time off when having children, and retired in 1999.  They've built a new part, latched onto the original building, which doubles its size.  It's used for patients involved in studies.

http://clinicalcenter.nih.gov/

The building has research labs as well as a hospital, and that's where I worked, doing chemical research that was disease-related in one way or another.

[PatH]

Were the nurses careless?  Or just spent more time with the patient.

They were caring for a patient with massive diarrhea and projectile vomiting, the disease is transmitted through bodily fluids, and at first the protective clothing wasn't totally sealed, and it's tricky to get in and out of, especially if you don't have much practice.  It's not surprising that some of them got sick.

[marcie]

I've added my name to the "hold" list for the book at my library. I'm looking forward to learning more about this disease and talking about the book with all of you.

[marjifay]

No thanks, I'll pass.  I'm sick and tired of hearing/reading about Ebola!

Marge

[ginny]

I'm in. Knowledge is power. Those of us who spend a lot of time in airplanes want to know the facts so we'll be less likely to panic when the plane touches down in Dallas and the person in front of us throws up (which has happened to me in Dallas).. It will keep us from turning out to the TA in a space suit. It will give us a basis for understanding when  the news is going excitedly on and on because they are having a slow news day. I have quit watching CNN on the TV for this reason. I prefer it on the IPad where I can pick and choose from the day's stories.

 I read this book years ago, only remember that it was good, nothing more... I don't recall being "scared," or anything else. Now I'd like to see for myself. I've already learned something from Pat H's post in this discussion and she, having been a scientist herself, will add no end of interesting bits to the discussion.

How lucky we are to have the members on this website that we do, with their incredible backgrounds and experiences, and how reassured we'll all be that we're not going to "get it" by going to the grocery.  Nigeria is Ebola free already, and probably by the time we get thru this, the latest scare will be over.  I think it's something we owe it to ourselves to be informed about. I've ordered the paperback from Amazon, it's dirt cheap, and they just wrote it's on the way.

[pedln]

Ginny, you make many good points.  Knowledge IS power.  I  think the  trail from The Hot Zone to now will be fascinating.  The Kindle version is $5.00.  I downloaded it the other night, but have just barely begun reading.  It seems to start out like a detective story.  Count me in for this discussion.

PatH, my son's MIL worked at NIH -- at the library, with the indexers for Index Medicus.

[JoanP]

Can't think of a better leader than  PatH for this discussion!  
I think I heard that NIH only has 2 beds dedicated to the treatment of Ebola.  Let's hope that more are NEVER needed.

Minutes ago, I heard on the radio that the magic date is Nov. 7 - if no new cases emerge among those 120 who were exposed in Dallas by then, we might be free here in the US.  Did I hear that correctly?  Heartened to hear of those who are recovering.  It seems we are on the way to effective treatment.

My youngest son is living in Africa for the next two years...not West Africa, but South in Zambia.  He plans to come home for Christmas, flying first to London and then to DC.  I'm praying that there are no developments between now and then - the kind that will ban travelers from Africa.
Of course I pray for everyone who is in danger of becoming affected by this  horrible disease.

[PatH]

That's worrisome for you, JoanP.  I like to think that by Christmas things will have quieted down.

[Ella Gibbons]

No, PATH, I don't think that would fly for a renewed drivers license in Ohio; however, I think it would be great if it would.

Yes, I knew how the Ebola virus is spread, but do you know specifically  how the two nurses contacted it?  Through the discard of their hazmat suits or contact with the patient?  I'm sure all was as careful as     possible and I know it must be difficult.  But I would think it would be very helpful for future caretakers of Ebola patients (hopefully none in the USA) to know specifically what happened.

[Ella Gibbons]

We read about numerous hospitals in the country preparing for ebola patients and the expense is staggering.  Could we make a prediction of our own how many new cases turn up in the USA in the next two years?

My prediction would be at the most 5-6 new cases?  And they are treated promptly and live.

[PatH]

That sounds like a good guess, though I doubt we'll be able to save all of them.

As far as I know, they haven't pinned down how the nurses were infected.  It seems most likely through some failure in protocol or training, both of which have been tightened up and enhanced since then.

[JoanP]

I think I read something about the importance of skin protection, Pat.  The new guidelines are specifying every inch of the caregiver be covered.  Don't know if this is a brand new requirement.

I'm heartened to hear of recovering infected patients.  Does that mean there is a cure, then?
Wouldn't it be wonderful to be able to share this treatment with the Ebola patients confined  in the countries of West Africa?

Gee, Ella, I don't want to even think of that many!  I read there are only 11 treatment rooms in the entire country...right now.  I'll go lower.  Three.

[PatH]

I think I read something about the importance of skin protection, Pat.  The new guidelines are specifying every inch of the caregiver be covered.  Don't know if this is a brand new requirement.

I'm heartened to hear of recovering infected patients.  Does that mean there is a cure, then?

Skin protection over every inch: It's not new that you should do this for this kind of infection, but the hospital was not prepared to deal with this kind of infection.

Unfortunately, the recovering patients don't mean there is a cure, it means that they got a light enough dose of the infection that first-class medical treatment could support them while they pulled through.

[hysteria2]

I'm in. I now have the book on my Kindle. This hits home for me. I retired after 30 years of nursing, many of which were spent at the bedside in intensive care units. I remember "what a pain" it was to dress in isolation gear 10 - 12 times a shift. I also remember the contamination that occurred when the patient in isolation crashed. Adrenalin kicks in and you tend to forget about your protection. Your focus becomes the patient, and you worry about yourself later. None of these patients had ebola of course, so I was fortunate.

I am looking forward to this discussion!

[PatH]

I thought of a way to appreciate the contamination/decontamination precautions.  Think of putting on a pair of close-fitting rubber gloves.  Then imagine the outsides of the gloves coated with wet paint.  How are you going to take them off without getting paint on yourself?  If you pull the first one off by pulling with the other hand, then what?

Now imagine you are encased in a bodysuit coated with paint.  You can't take your gloves off first, because then you couldn't touch anything.  So you have to peel everything off, curling the suit around so the outside doesn't touch anything, turning things inside out as you go.

[PatH]

hystereia2, you were posting at the same time I was writing my last post.

Welcome to our discussions.  It will be great to have your front-line view of the battle.  You can sometimes set us straight when we go off-course.

All honor to you for your dedication.  That's a vital part of the story, and you can help here.

[PatH]

I've got the book.  It's a very good read, like a detective story or suspense story.  It does have some detailed clinical descriptions, though, so be prepared for some creative skipping if you don't want the detail.

[bellamarie]

In trying to understand how the nurses contracted the virus from Mr. Duncan, I think this article will help.  They have revised protocol and equipment, with adding a shadow person to help dress and undress.  As of today, people I talk to who work in our area hospitals in the ER, have not received training or equipment.  I am praying we have this under control.

http://www.usatoday.com/story/news/nation/2014/10/20/cdc-new-protocol/17638161/

I like the thought of the book reading like a detective story or suspense PatH., you may have piqued my interest after all. 

[PatH]

Welcome, Bellamarie.  You'll enjoy the suspense.

[JoanK]

Here is a paragraph from the link Bellamarie posted.

"Hospital workers treating Ebola patients should wear double sets of gloves, disposable hoods with full face shields and special masks, according to strengthened guidelines issued Monday night by the Centers for Disease Control and Prevention.

The guidelines focus on personal protective equipment, or PPE, giving hospitals and clinics more specific instructions about gloves, gowns and face masks, and how they should be put on and taken off. ...  Nurses have complained that they were sent into the room of Ebola patient Thomas Eric Duncan, the first Ebola patient diagnosed in the USA, with the skin of their necks exposed."

[PatH]

We have a decision to make--when to start.  Since the topic is so timely, it should be Nov. 1 at the latest, but we could make it a few days earlier if you want.  How many of you already have the book?  Once you start reading it, it goes quickly.  Not pushing too far ahead will be more of a problem than not keeping up.

What does everyone want?

[PatH]

By the way, I see we now have another Ebola patient in this country, but he didn't catch it here.  He's a physician from Doctors Without Borders, who returned to New York from Guinea a week ago.  He had been monitoring himself following the Doctors Without Borders protocol, and the instant he got the first sign of being sick, he isolated himself, calling the authorities as soon as he felt a little more sure.  Test results aren't back yet.

[JoanP]

That young doctor seems to have followed protocol, monitoring himself on his return from Guinea - taking his temperature, etc....and yet, I think of the three crowded subway rides, the visit to the Brooklyn bowling alley, etc...before his temp spiked.  I pray that he wasn't contagious before he exhibited symptoms and called for help.  Don't want to be an alarmist...but there is so much we don't know.

I can be good to go on Nov. 1.

[bellamarie]

Here is the link on Dr. Spencer:

http://insider.foxnews.com/2014/10/23/doctor-who-treated-ebola-patients-guinea-rushed-nyc-hospital

A timeline of events:
In mid-September, 33-year-old Dr. Craig Spencer was treating Ebola patients in Guinea as part of Doctors Without Borders.

Spencer left Guinea on Oct. 14 and arrived at JFK Airport on Oct. 17. He began to feel sluggish on Tuesday but didn’t have a fever.

Yesterday, he went for a jog, took three different subway trains, went to a Brooklyn bowling alley, then took an Uber cab home. He says he felt OK, except for some fatigue.

Spencer reported he first had a fever at around 10 or 11 a.m. today. He reported the fever to Doctors Without Borders, and ambulance crews in hazmat suits then picked him up and took him to Bellevue Hospital.

His fiancé and two close friends are now being quarantined.


What is most disturbing is the fact he had been working directly with Ebola patients in West Africa, came to the U.S., and did not quarantine himself for the 21 days.  He monitored himself, but continued to go out in public.  I don't understand why the U.S. does not follow the travel ban as all other countries.  We can't allow health workers to monitor themselves because so far the nurse from Dallas, and now this doctor both traveled on airplanes after working directly with Ebola patients, rather than being isolated/quarantined for the 21 days, so they would not take the risk of infecting others.  Being symptom free and monitoring their temp, is proving not to be the best prevention.  Both said they felt lethargic/fatigued, before the fever showed up.

Another troubling fact is this:  Spencer reports that he does not believe his protective gear had been breached while treating patients, and he says he was monitoring his own health.

If there was no breach, then we have to understand how he contracted this so we can take more precautions.

PatH., I am for beginning the book early, I purchased it for only $4.99 from my ibook store.

[PatH]

We do seem to be pretty sure that victims are not contagious before their temperature starts going up, and Spencer's temperature didn't start to rise until the morning after he was out.  You're correct, that monitoring the temperature of the already infected victim does't keep him from getting sick, but the important question is, does it keep him from passing the infection to others.  It seems to be adequate, as long as the victim isolates himself as soon as his temperature rises.

It would be nice if we knew how he got infected.  He believes there was no breach, but there might have been one.  But he wasn't wearing protective gear 24/7, and he was working and living in very primitive conditions, where actively sick people aren't all quarantined, and medical waste is not always cleaned up.  So it's not really relevant to any precautions we should take.

[ginny]

Oh good, Hysteria is here, too! With her long experience as a nurse and PatH's level head we should come out of this  so much better informed.

I'm well into the book and it's not hard at all to see how the doctors in Africa have been infected, it's quite frankly  a  miracle to me after reading it so far that this thing has not turned into another Black Plague, and  the workings of the disease and its horrible symptoms are graphically portrayed, perhaps too much so,  (and could be passed over),  but the result is, for me, completely the opposite of what one would think: I feel more reassured now than ever, and a great deal more sympathy for those who have had to suffer so, and the brave nurses and doctors who give up their own livelihoods and in some cases, lives,  to go over there and try to stop it.

I don't think the other bowlers or subway riders have anything to fear in this latest one,  unless it's gone airborne, which so far doesn't appear to be the case.

It's amazing what a book can do.

November 1 is fine with me.

[PatH]

To those who are starting to read the book: try not to read too far ahead, if you can.  There is a lot of suspense, and it's more fun if we read it together.  It divides into separate stories that are part of a total picture, and we'll probably take them in bunches, one or two at a time.  I'll work out a timetable as quickly as I can.  Unfortunately, the first story is pretty graphic, but it's worth sticking with. 

[PatH]

Ginny, I had the same reaction to the book that you did.

[bellamarie]

Some interesting articles:

http://www.csmonitor.com/Books/chapter-and-verse/2014/1021/Ebola-thriller-The-Hot-Zone-is-back-in-the-spotlight

This is an interview a New York Times reporter did with Richard Preston on The Hot Zone  Oct 2014.

http://www.nytimes.com/2014/10/20/books/the-hot-zone-author-tracks-ebolas-evolution.html?ref=books&_r=0

PatH.,  I will wait to begin reading the book until you have figured out the timetable, so I don't get ahead.  Maybe we can place these links into the new discussion page.

[PatH]

Bellamarie, I will certainly shift those links if we move to a new page.  The second one, especially, is important.

Everyone: when shall we start?

[JoanP]

I will be back in town and can be ready by Nov. 1, Pat.

[JoanK]

I was listening to a talk by Dr. Paul Farmer on U-Tube about ebola. Gave up: he's a poor and rambling talker, but heard a few interesting things. While 80-90% of the patients die, that doesn't mean they should die. Care that advanced medicine could provide, such as hydrating them when they're at the stage of losing fluids, could have prevented some of the deaths. Isolation and  contact tracing, early detection etc. But the epidemic has already completely destroyed the health care system in at least two countries.

As he and my-daughter-the-doctor say the virus as it is now is containable. but it's important to do it fast: all viruses mutate, and we don't want to give it a chance to mutate into a form that could be transmitted through the air. This has never happened before in such viruses, but it's what people fear.

http://www.youtube.com/watch?v=lb11QbP3tOg&feature=youtu.be&utm_content=buffer1da85&utm_medium=social&utm_source=facebook

[hysteria2]

Nov. 1st is fine with me.

[PatH]

Nov. 1 is in the lead, and there are two people who can't start early, so the 1st it is.

The book is a string of related stories and events, which makes it easy to divide.  Part One The Shadow of Mount Elgon, makes three chunks, about 50 pages each.  Lets take 4-5 days for each.  I'll put up a schedule, but we can speed up or slow down as needed.

1. (Africa, 1980) chapters 1-3: Something in the Forest, Jumper, Diagnosis

2. (Maryland, 1983) chapters 4-6: A Woman and a Soldier, Project Ebola, Total Immersion

3. (Africa, 1976, 1987-8) chapters 7-9: Ebola River, Cardinal, Going Deep

In my book, the chapters have names, but not numbers.  What about the Kindle version?  Does it have chapter names?

Addendum: my explanation was a bit confusing.  I've colored the part we read for nov. 1 red.

[PatH]

Unfortunately, the first 3 chapters have some of the most graphic descriptions in the book.  Preston is very dramatic in his descriptions of this awful disease.  If you don't want to deal with that, try to skim or skip a bit, maybe cheer yourself up with section 2, which is very different.

[JoanK]

I admit I was really put off by the description in Chapter 1. But I picked up the book again, and really enjoyed it. I suggest skimming over the descriptions  of symptoms if you're squeamish, like me (I can't even watch CSI).