Lost Immunity

by Daniel Kalla

  As soon as Tyra spots Lisa from across the room, the program manager breaks free of her conversation with two public-health nurses and hurries over to greet her. They step into Lisa’s office and sit across the desk from one another.

  “Where do we stand, Ty?” Lisa asks.

  “On kinda thin ice, if I’m being honest,” Tyra says, but the determined glint in her eyes suggests that she’s stoked by the challenge. “Eleven confirmed or, at least, highly suspected cases of meningococcus. Five deaths. All of them basically kids.”

  “And they’re all directly linked to Camp Green?”

  “Uh-huh. We haven’t seen any secondary spread to relatives or household contacts.”

  “Yet.”

  “True enough.” Tyra sighs. “It’s only been thirty-six hours since Patient Zero showed up in the ER at Harborview. And he’s dead.”

  “Where are we on the contact tracing?”

  “Felix and Yolanda worked the phones all night,” Tyra says of two of her nurses. “Don’t have exact numbers, but we’ve reached well over half the families.”

  “Found any links to Reykjavík?”

  “Not yet. But we dispensed at least a hundred antibiotic kits so far, or got the prescriptions called in, at least. We still got a ways to go, though.”

  “Time is spread.”

  “Don’t be wasting your breath preaching to the choir.” Tyra motions to the window behind her, through which Lisa spots several nurses at their cubicles with phones to their ears. “The whole staff is going to spend the day chasing down any and all remaining contacts.”

  “Except us. We’ll be bouncing from one meeting to another.”

  “No time for all that bureaucratic bullshit.” Tyra hops to her feet. “We got an honest-to-God outbreak to contain. And we only have to look to Iceland to see how high the stakes are.”

  As soon as Tyra leaves, Lisa opens her email and weeds through the two-hundred-plus new ones, replying only to the few she deems most urgent. She’s so lost in her work that her shy young assistant, Ingrid, has to rap on the open door to remind Lisa that her seven o’clock meeting is about to begin.

  Everyone else is already seated at the long table inside the windowless conference room when Lisa takes her chair at the head of it. The first slide of her brief presentation fills the two flat screens mounted on either side of the room. Even though she didn’t specifically invite Angela, Lisa isn’t surprised to see her there with a bright floral scarf wrapped around her pale head. There are twelve other attendees. Five of them work for her office, including Tyra, and Lisa recognizes everyone else—an assortment of state and local officials—except for the gangly man seated to her immediate left, who reminds her of Abraham Lincoln with his Shenandoah beard.

  Lisa initiates roundtable introductions and learns the man to her left is Dr. Alistair Moyes, the lead physician at the Centers for Disease Control for the western United States.

  “Thanks, everyone, for coming on such short notice,” Lisa says. “We are now at day three of a meningococcal eruption that has already met the CDC criteria to be classified as an organizational outbreak. Due to the lethality of the pathogen involved, we’ve decided to convene an Outbreak Control Team and create this subcommittee to share information and coordinate responses among all involved agencies. If it’s all right with everyone, for the time being we’ll aim to meet daily, if not in person then at least via videoconference.”

  There are nods and murmurs of agreement around the table.

  Lisa taps a button on her desk and a map of greater Seattle appears on the screens along with an animated red circle made of dots that revolve around the location of Camp Green, just south of the city. She talks through a few more slides with tables and graphs that highlight a basic epidemiological survey of the outbreak—including the dates of onset for the eleven known cases and, in the case of the five fatalities, the times of death.

  Next, Lisa turns to the source of the infection. An electron microscope image of the offending bacterium fills the screens. It resembles two side-by-side, fuzzy red Ping-Pong balls. “Harborview’s microbiology lab has confirmed the pathogen is a particular strain of Neisseria meningitis, serotype B. The evidence suggests it’s the same strain of meningococcus that was responsible for the outbreak in Reykjavík last winter. Like most type B strains, for reasons that aren’t fully understood, this pathogen strongly targets teenagers and children. In Iceland, more than ninety-five percent of the victims were between the ages of five and twenty-five.” She motions to the woman halfway down the table who wears gold-framed glasses and has her gray hair tied tightly on top of her head. “I will defer to our expert microbiologist, Dr. Klausner, from the state lab for further characterization.”

  “What’s left to say?” Angela pipes up. “It’s the same bug that did Iceland’s kids in.”

  Klausner emits a quiet chortle and then clears her throat. “Well, yes, it does appear that way.”

  “And you’ve confirmed this how?” Moyes asks.

  “The PCR tests are unequivocal for that specific strain,” Klausner says. “The blood and spinal-fluid cultures have already grown meningococcus.” She stops frequently to clear her throat in what Lisa recognizes as a vocal tic. “We hope to get the WGS—whole genome sequencing or its molecular fingerprint—results soon. Then we’ll know for certain.”

  Angela looks over to Moyes. “The WGS isn’t going to change diddly, Alistair. This is the Icelandic pathogen. There’s zero doubt.”

  Moyes only smiles at her. “It’s good to see you back, Angela. Feisty as ever.” He turns to Lisa. “Does this mean you’ve linked one of the cases back to Reykjavík?”

  “Not yet, no,” Lisa says.

  “They don’t have any active disease in Iceland,” Angela says, tugging at her scarf. “We’re working under the assumption that it must’ve been brought back to Seattle by someone who is asymptomatic. In other words, a healthy carrier.”

  Moyes raises an eyebrow. “Has one of the campers recently returned from Iceland?”

  “We haven’t identified one so far,” Lisa admits. “But we haven’t reached everyone yet.”

  “Point is, Alistair, one way or the other, the very same killer bug has reached Seattle.” Something in Angela’s tone suggests that she has more than just a collegial history with the CDC doctor. “And we better stop it from detonating like it did in Reykjavík.”

  “You don’t find it the least bit… odd… that the same deadly bacteria show up here in the Pacific Northwest without an easily traceable connection back to Iceland?” Moyes asks.

  “It’s an emerging pathogen, Alistair. A brand-new bug. Everything about it is odd.”

  “How often do emerging pathogens cross the planet without leaving a trace?”

  “We’re still actively looking for the link,” Lisa intervenes, feeling the need to wrest control of the meeting back, although Moyes’s point resonates. “Meantime, we’ve reached out to Public Health over there. A Dr. Haarde. He was extremely helpful. In Iceland, they ended up with three clusters of infection once it spread into the community. Thirty-five victims died, all of them young.” She pauses to let the stark statistic sink in. “Reykjavík has a population of two hundred thousand, give or take. And metro Seattle is nearly twenty times that size.”

  One of the two state officials grimaces and pushes his chair away from the table. “So we’re talking seven hundred dead, potentially?”

  “Nah,” Angela grunts. “Reykjavík is relatively remote. Nowhere for the bacteria to spread. If we were to be hit as hard as they were, it would be way worse than that.”

  The official clutches his head in his hands and turns to Moyes for reassurance. “That can’t be true, can it?”

  Moyes only shrugs.

  “We’re nowhere near that point,” Lisa says. “Right now we have to focus on expanded chemoprophylaxis. Getting every potentially exposed person on antibiotic treatment. These first three days represent the prime—maybe the only—window
of opportunity to catch everyone. To stop it from spreading beyond the campers themselves.”

  She goes on to summarize her department’s round-the-clock contact-tracing strategy and distribution of antibiotics to the “usual suspects,” which means people living in the same household as victims, family members, or anyone who had direct contact with the saliva of patients, including all sexual partners, along with all fellow campers, and the medical staff who treated the patients.

  “What about a vaccine?” asks the other official from the state department of health, Corrine Benning, whose small features give her face a mouselike quality.

  Lisa shares a quick glance with Angela, which is enough for them to wordlessly agree to not tip their hand about Neissovax. “Neither of the two available vaccines for type B meningococcus has worked against the Icelandic strain.”

  “Why not?” Benning asks.

  “It’s somewhat complicated.” Klausner answers for her. “For the other serotypes of meningococcus—types A, C, W, and Y—the vaccines target the antigens—a type of protein—on their thick cell walls. But the antigens on the walls of the type B strain are too similar to human proteins for our immune systems to differentiate them as invaders.”

  “So our immune system won’t produce antibodies against it?”

  “Correct,” Klausner says.

  “In other words, antibiotics are all we got.” Angela sums it up. “And you know what they say? If all you got is a hammer, go find yourself a whole shitload of nails.”

  Much as she respects and admires her friend, Lisa is beginning to wonder if Angela’s attendance is such a good idea. “The other key element we need to discuss is the communication strategy.” Lisa gestures toward the goateed man at the far end of the table, who has been furiously typing at his laptop. “As our department’s communications lead, Kevin will help coordinate our response.”

  Kevin lifts one hand from the keyboard and waves.

  “Word has leaked out on social media,” Lisa continues. “We’re fielding calls from all kinds of media outlets. Kevin’s going to release a press statement and health alert later this morning. But as always, we’re walking a razor-thin line between informing and panicking the public.”

  “What are you going to say?” Benning asks.

  “Obviously, we’re going to instruct anyone who attended the Bible camp in the past few weeks to report to us right away,” Kevin says. “We’ll also let the public know the symptoms they should look out for. And we’re going to alert health-care providers to be vigilant for possible new cases.”

  “In a nutshell, we’re going to flood the ERs and clinics with every neurotic who feels a tinge of a headache coming on,” Angela says.

  “What would you have us do?” Lisa says, even though she knows Angela isn’t wrong. “We already have five dead.”

  “Six,” Tyra says, holding up her phone with a pained expression. “Just got the word from Harborview. Another sixteen-year-old died this morning.”

  Lisa’s heart sinks. “Not Kayla?”

  Tyra nods.

  The unwelcome vision of Kayla’s grandfather interrupts Lisa’s thoughts. She can still see the heartbreak in his eyes. She can’t imagine what it must feel like to lose everyone in the world who matters most to you.

  CHAPTER 11

  Nathan Hull has never spent much time in the Pacific Northwest—a couple of pharmaceutical conventions in the Seattle area and one corporate retreat in Portland—but every time he visits, he feels oddly at home. It’s the ocean, he realizes. Having grown up in Providence, Rhode Island, he always gravitates toward the coast. And he resolves to bring his boys here soon, maybe even for next summer’s annual father-sons road trip. This summer, they’ve already committed to driving up to Canada to tour through Quebec.

  Nathan can’t see the water from where he sits across from Fiona in a red vinyl booth, but he enjoys the view of the tree-lined triangular plaza in the heart of historic Pioneer Square in front of the café. He wonders what era the decorative iron pergola across the street dates to and, ever the history buff, makes a mental note to look it up.

  Fiona is still working on her herbal tea, but Nathan has already finished his Americano and is considering a second. Lisa isn’t late. It’s still a few minutes before nine. But they weren’t sure how long the cab ride might take from the hotel, and since Fiona is almost phobic about being late, they gave themselves a generous buffer and arrived fifteen minutes early.

  Lisa requested they meet at this café instead of Seattle Public Health’s headquarters, which is four or five blocks up the hill on Fifth Avenue. The cab ride took Nathan and Fiona right past her office building, and he couldn’t help noticing the funky-looking coffee shop directly catercorner to it. Perhaps he’s reading too much into Lisa’s choice of locales, but in his experience, medical officials sometimes approach meetings with executives from “Big Pharma”—the cringe-worthy pejorative they often use—as something shameful to be done in the shadows, like picking up a hooker or buying street drugs.

  Nathan is pulled from the demoralizing thoughts when the door opens, and a woman enters in a white blouse and light gray skirt. Spotting them, she nods and approaches them with a closed-mouth smile.

  As part of his standard premeeting research, Nathan already viewed Lisa’s online profile on the health department’s website, but the corporate photo doesn’t do her justice. In person, her oval face and high cheekbones accentuate her large almond-brown eyes. He would be at a loss to guess her dominant ethnicity—could be anywhere from Ukrainian to Spanish—definitely a case for a mail-order DNA kit. But it’s hard not to pick up on the poise and self-assuredness she radiates with each step.

  After introductions, Nathan heads up to the counter to order coffees while Lisa slides into the booth beside Fiona.

  A minute or two later, Nathan lowers a cup of black coffee in front of her and sits down across from them. Lisa places her phone, screen up, beside her cup and says, “Kind of rude, I realize. But in light of the expanding crisis, I have to be connected at all times.”

  Nathan grins. “We’re no strangers to being anchored to our phones.”

  “Thanks for meeting me here,” Lisa says “Not just in Seattle but at this place. They serve my favorite pour-over coffee in the city. And Lord knows I’ll need a few cups this morning.”

  “That’s high praise,” Nathan says. “Isn’t Seattle a mecca for coffee?”

  “I guess we did give the world Starbucks.” Her smile is more natural than earlier. “Wonder if it can ever forgive us?”

  Fiona, who’s almost as averse to small talk as she is to tardiness, cuts to the chase. “Can you tell us more about the local meningitis outbreak?”

  “It’s bad,” Lisa says bluntly. She goes on to summarize the eleven cases and six deaths that were recorded in the first day and a half, along with Public Health’s preliminary efforts to contain the infection. “If we see secondary spread beyond the camp to their contacts, it could go from bad to horrendous in a big hurry.”

  “That sounds ominous,” Nathan mutters.

  “It is. Which is why I wanted to discuss your new vaccine.”

  “Delaware’s vaccine,” he says. “My role is to facilitate new product development, while Fiona’s is to ensure their safety.”

  Lisa nods. “Word is that Neissovax has been shown to be effective against the Icelandic strain of type B meningococcus.”

  “In the lab, maybe,” Fiona says. “It still hasn’t been proven to work in the field.”

  “In fairness, Fiona, there hasn’t been a field to prove it on,” Nathan says.

  “How so?” Lisa asks.

  “The only known outbreak of this pathogen has been in Reykjavík—”

  “Until now.”

  “Maybe,” he says. “But by the time we had enough vaccine produced to test it in the real world, the outbreak in Iceland was over.”

  “Or dormant,” Lisa says.

  “Either way, there were no subject
s actively exposed—no test kitchen, as it were—to trial the vaccine’s effectiveness on.”

  “We had to rely on animal models and serum analyses to test for immunogenicity,” Fiona says, using the elaborate term for a vaccine’s ability to provoke production of specific antibodies to a pathogen in the bloodstream after immunization.

  “But the lab tests have been very encouraging, haven’t they?” Lisa persists. “They do strongly suggest, don’t they, that Neissovax would work against the Icelandic strain?”

  Fiona looks skyward. “Always a leap of faith to go from the test tube to the real world.”

  Lisa nods again. “How does your vaccine differ from the ones already on the market?”

  “Neissovax targets entirely different proteins than the other existing vaccines,” Nathan explains with unmasked pride. “Subcapsular proteins that are under the cell wall itself. Our vaccine invokes a powerful immune response after inoculation that produces high levels of circulating antibodies in subjects against multiple strains of type B meningococcus.”

  “Including the Icelandic strain?”

  “Yes.”

  “Hate to sound like a broken record.” Fiona sighs. “But only in the lab, so far.”

  “In people, too, Fee.” Nathan smiles to hide his irritation. It’s beyond unprofessional to bicker with a colleague in front of a client, even one as unsolicited as Lisa is. “The immunogenicity is impressive. We’ve seen the antibody levels go through the roof in healthy volunteers. And the animal modeling has already shown how effective it can be in protecting against this bug.”

  “Discovering a universally effective type B meningococcus vaccine is like finding the Holy Grail of vaccinology,” Lisa says.

  Nathan chuckles. “Even at Delaware, we aren’t that grandiose.”

  Lisa isn’t smiling. “But you must be pretty confident in your product if you’re ready to immunize all of Reykjavík with it.”

  “Not the whole city,” Fiona points out. “Fifty thousand doses.”