Lost Immunity

by Daniel Kalla

  “With the vaccine?” Lisa asks.

  “Within a day or two, yes.”

  CHAPTER 17

  Lisa stops at the kitchen door to view her husband and her niece as they hover over an uncooked pizza, their heads almost touching. Her mood lightens as she watches Olivia carefully distribute slices of pepperoni on top of the grated cheese.

  Lisa realizes they’re fortunate to have as much access to their niece as they do. Amber and her husband keep long hours running their marijuana dispensary business. Since they live in Bellevue—the affluent suburb twenty minutes outside of Seattle—they often leave Olivia for sleepovers, especially when they have evening meetings in the city.

  “Dinner’s not ready yet,” Dominic says, looking up at Lisa with a small wink. “Your niece treats pizza toppings like they’re some kind of work of art.”

  “I’m your niece, too,” Olivia says without taking her eyes off the task.

  “And my favorite one.”

  Olivia laughs. “I’m the only one,” she says, which is true since Dominic is an only child like she is. She waves to Lisa. “Hi, Tee.”

  Lisa steps over and kisses Olivia on her forehead. She brushes her hand across Dominic’s cheek. “Wine?” she asks him.

  “OK,” he says. “But only one glass for Olivia. She might have to drive home later.”

  Olivia giggles. “You’re silly, Uncle Dom.”

  Lisa selects a bottle of Chilean Syrah from the rack on the counter. As she uncorks it, she contemplates again what a good father Dominic might have made. It’s at these times that she appreciates her husband most, when he lets his guard down and shows his softer, playful side, one that’s too often hidden behind his proud, sometimes even arrogant exterior.

  Ironically, though, it was their struggle to have kids that drove the original wedge in their relationship. For the longest time, both of them assumed Lisa was the source of their infertility, because Dominic had supposedly impregnated one of his college girlfriends, who subsequently miscarried. It was only after months of invasive testing failed to find any fertility issues with Lisa that they learned Dominic’s lack of viable sperm was the real problem. The sudden change in his attitude toward artificial insemination bewildered Lisa. While he had been prepared to accept a donor egg, he was unwilling to consider using anyone else’s sperm to impregnate Lisa. He wasn’t even open to the possibility of adoption. And the flip-flop—which Lisa still views as the ultimate hypocrisy—opened a fissure in their foundation that was only compounded by his envy over her job promotion.

  Lisa whips together a salad while Olivia and Dominic finish the pizza and put it in the oven. The dinner chatter is light and frivolous, focused mainly on Olivia’s excitement over the impending start of first grade at her new school—the friends she will make, the supplies she will need, and the activities she plans to master. Not dancing, though. Olivia stresses how she is “done for good” with ballet. Ever the tomboy, just like her aunt. They finish the meal with Neapolitan ice cream, Olivia’s favorite. All three spoons feeding from one carton.

  Once Olivia changes into pajamas and brushes her teeth—under Lisa’s watchful eye because she has faked it before—they climb into bed together in the spare room that has effectively become Olivia’s bedroom. They take turns reading paragraphs from one of Olivia’s favorite books, featuring a wisecracking rabbit who goes to school with the rest of the kids. Olivia reads her passages so well that Lisa has a sneaking suspicion she must have memorized the words.

  Olivia has always been a poor sleeper, prone to nightmares, so Lisa stays with her until she’s certain her niece is asleep. She even nods off briefly herself, before she eases out of bed and joins Dominic on the sofa in the living room, where he’s refilled both wineglasses.

  “Thanks for doing such a good job with Olivia tonight,” Lisa says.

  “She’s my niece, too, Lees.”

  “Of course, but I know you had to come home early for her.”

  “The cath lab wasn’t too busy today,” he says of the cardiac catherization unit where he works. “Speaking of work, they were talking about your meningitis thing on the news again tonight.”

  “It’s kind of terrifying, Dom.”

  “A real public-health emergency, after all.”

  She leans in closer to him, resting her shoulder against his. “See?”

  “So what’s next? A vaccine?”

  “Yeah, we hope so. But the only one we believe will work is basically experimental. It’s a bit risky. And it’s gonna be controversial.”

  “The anti-vaxxers?”

  Lisa nods. “I had a public forum earlier in the week about the HPV vaccine. And the whole room practically piled on me—”

  “I know that feeling! Just yesterday, at our staff meeting, I was trying to convince the other cardiologists to consider a new catheter that has strong evidence of better anticlotting properties. But do you think for one moment they would listen to logic or all the recent solid data behind it? No, of course not. They all know better than me.”

  She listens as he rails on about his colleagues’ resistance to trialing the new device he covets. Much as she appreciated his flicker of interest in her world, she sees that he cannot sustain it. It always has to come back to him, usually sooner rather than later.

  Lisa recognized Dominic’s self-absorption before they married. She assumed it was a residual effect of being raised as an only child—something she could live with and perhaps eventually tame. But as time passed and their divide grew, she came to realize he wouldn’t, or at least couldn’t, change. Too often, she feels like just a passenger in their relationship.

  CHAPTER 18

  Six of the chairs around the conference table are empty. The attrition is natural for any committee like the Outbreak Control Team, which meets daily at the offices of Seattle Public Health. Besides, three members have logged in this morning via videoconference. The only vacant seat that catches Lisa’s eye is the one usually occupied by Angela. Her friend didn’t mention anything about missing today’s briefing, and Lisa can’t help but jump to conclusions. Angela seemed even more frail yesterday, at one point sitting down quickly in the main office as if she were suddenly light-headed.

  One of the attributes Lisa has always admired most about Angela is her at times painful candor. Whether complaining about her “deadbeat” daughter—who dropped out of college to find herself and work “whenever the muse strikes her” as a Pilates instructor—or joking about her husband’s clinginess, Angela used to be an open book. But that changed with her diagnosis. All Lisa knows about her friend’s ovarian cancer is that it must be too far advanced for a surgical cure, since her treatment has consisted only of chemotherapy. Angela has never discussed her prognosis. When she asked Lisa to assume the role of chief public-health officer, she only said, “Don’t worry. I wouldn’t come back to this dead-end job, even if I do beat this thing.”

  Making a mental note to call Angela after the meeting, Lisa taps the remote and launches the first slide on the screens on either side of the room. As usual, it shows the updated survey of known cases. “Today is officially the sixth day of this outbreak,” she says. “And as of this morning, we have eleven deaths among the twenty-four confirmed meningococcal infections. Seven of the victims have recovered enough to be safely discharged home. In the past twenty-four hours, we’ve had four new cases and one more death.”

  “Which is better than any other day so far,” Benning, the mouse-like woman from the department of health, comments.

  “But this isn’t like the flu or even COVID-19,” Tyra points out.

  “What does that mean?” Benning asks.

  “With highly contagious outbreaks like those, you expect to see a steady rise in the trend of new infections,” Lisa says. “The so-called epi curve, when you plot it out on a graph. In other words, each day brings more new sufferers than the previous one. When the number of new cases decreases from one day to the next—even as the absolute number of in
fected continues to rise—you can assume the curve is flattening and the epidemic is coming under control.”

  “Not true of meningococcus, though,” Tyra says.

  “Sadly, not,” Lisa agrees. “Meningococcus tends to spread in patchy clusters. Days can pass between new cases. It’s not airborne, so it’s not nearly as contagious as COVID-19 or measles. But it can be carried by asymptomatic hosts: people who show no signs of illness but still act as reservoirs for the spread of new infection.”

  “Which is just how our outbreak started,” Tyra says. “With Patient Zero, Alex Stephanopoulos. He brought it home from Iceland without ever falling ill himself.”

  “You’ve confirmed that?” Alistair Moyes strokes his Lincolnesque beard with his thumb and forefinger.

  “Yes. His nasal swabs were positive for meningococcus.” Lisa wonders again how many others are unwittingly carrying the deadly pathogen. “Moreover, there is no active disease in Iceland right now. This means Alex acquired it from another asymptomatic carrier. Icelandic Public Health is trying to track down and test everyone the family was in contact with.”

  “It’s been five months since the last infection over there.” Tyra extends a hand in Benning’s direction. “You see? This is exactly why you can’t declare an outbreak over until a full year has passed between new cases.”

  The color drains from Benning’s cheeks as she nods her understanding.

  Lisa advances the slide, which shows a pie chart that, unlike at the last briefing, is now uniformly red. “We’ve reached all the attendees and staff at Camp Green now. And we’ve started every one of them and their closest contacts on prophylactic antibiotics. Unfortunately, now that we’ve seen two cases of secondary spread into the community, we know this measure isn’t going to be enough.”

  “Like closing the barn door after the horses have already left,” Tyra says.

  Lisa brings up the next slide, which shows an image of a syringe with a caption below from a review journal that reads: Trial shows strong immunogenicity for new meningococcal vaccine.

  “There might be some good news on the vaccine front,” Lisa announces.

  “What news?” asks the usually silent, balding city hall official who is watching via videoconference.

  “Delaware Pharmaceuticals has developed a vaccine.” Lisa goes on to describe Neissovax, the promise it has shown against the Icelandic strain of meningococcus, and the company’s agreement to redirect the supply earmarked for Reykjavík to the Pacific Northwest instead.

  Moyes squints at her. “You intend to inoculate fifty thousand Seattleites with an experimental drug? One that has never been released on any scale beyond a few early-phase-three trials?”

  Moyes’s skepticism is annoyingly contagious. “Neissovax is the only vaccine shown to be effective for this outbreak,” Lisa says with less confidence than she would’ve liked.

  “Shown? That’s debatable. But even so, why not just vaccinate the highest-risk group? Those in closest proximity—in terms of age and geography—to the known victims.”

  “The company wouldn’t agree to that.”

  Moyes offers her a tight-lipped smile. “It’s up to the company, is it?”

  “They’re doing this on a voluntary basis. On compassionate grounds.” Lisa goes on to explain the concerns Nathan raised about vaccinating only the highest-risk subset. “Perhaps, Alistair, if the CDC were to get involved…”

  “We can’t force a company to release its product any more than you can,” he says. “However, at the height of the Ebola crisis, the CDC and WHO both had access to an experimental vaccine. But even then, when it was raging in Africa and over eighty percent of victims were dying, including health-care workers—we still refused to release the vaccine because it had not undergone rigorous enough clinical testing.”

  Lisa meets the CDC physician’s glare. “You can’t compare the two situations.”

  “Why not?”

  “Because that Ebola vaccine hadn’t completed any phase-three trials. Neissovax has. And the only two Ebola deaths on US soil were both cases imported from Africa.”

  “You’re suggesting that if Ebola was spreading among Americans, the CDC would have released the vaccine?”

  “You know you would have, Alistair.” Benning speaks up, surprising Lisa with her forcefulness. “That’s how government works.”

  “I don’t happen to agree,” Moyes says, and turns back to Lisa. “Regardless, vaccinating this many people will pose huge logistical challenges.”

  “Thanks for that insight.” Lisa immediately regrets her sarcastic tone, but Moyes shows no obvious sign of offense. “Our team plans to set up and run vaccination clinics across the city in schools, community centers, and so on.”

  “Who will you target for vaccination?”

  “The highest-risk demographics. Teenagers, teachers, health-care workers, and so on.”

  “And how do you intend to track any adverse events or unexpected dangers associated with the vaccine?”

  “We’ll obviously use the VAERS database so people can self-report,” Lisa says. “But we’re also setting up a twenty-four-hour hotline and a specific website along with an app for patients to directly report any issues with Neissovax.”

  “An app? That’s your solution?”

  “One of them.”

  “This is premature.” Moyes shakes his head. “What does Angela think?”

  Lisa takes a breath to run through her five-senses exercise—the sight of Moyes’s beard, the hum of the fluorescent lights, the pressure of her heels against her shoes, the scent of an alcohol-based cleaner, and the residual taste of the mint she sucked on prior to the meeting—before responding. “Angela is a valued member of this team. But I am the city’s chief public-health officer.”

  His stare is frosty. “And the buck stops with you, does it?”

  “Yes,” she says, trying to will away her creeping doubt. “In this case, it does.”

  CHAPTER 19

  Mason can’t stop shaking. Even when he bundles himself up in his favorite Mariners jacket. But nothing is going to stop him from going to the ballpark this afternoon. He has been looking forward to it for weeks. Ever since his Little League team lost their final playoff game.

  Mason was the last batter in that game, and he grounded out. He hid his tears well, but he felt so responsible for the loss that he couldn’t touch his pizza at the postgame meal. Coach Tony took him aside and let him in on the “surprise” that he had been saving for the team. Tony had gotten a box for Mason and all his eight-year-old teammates to attend a matinee Major League game. And the best part was the Mariners were going to play his other favorite team, the Red Sox.

  Mason has been counting the days since. Even though his head aches, and he feels too queasy to even think about eating a hot dog at the game, he’s more determined than ever to go. If only he could stop trembling.

  Mason knows that if his mom sees him like this, she won’t let him out of the house. So he digs his favorite winter sweater out of the bottom drawer and slips it on before wrapping himself back in his oversized Mariners’ jacket. He can’t believe he has to wear two layers in the summer just to keep warm, but he hopes it will do the trick. It will be so worth it once he’s in the box with the rest of his friends, watching his two favorite teams slug it out at T-Mobile Park. With all that batting power in the lineups, there will be some homers for sure.

  Mason stays in his room as he long as he can, willing away the chills and waiting for Liam’s dad to pull up in front. Only when he hears the minivan roll up to the curb does he head downstairs.

  His mom is waiting at the front door with a water bottle in one hand and a twenty-dollar bill in the other. “Mason, honey? You feeling all right?”

  “I’m OK, Mom.”

  “Baby, you don’t look so good.” She reaches for his forehead, but he arches away from her touch.

  “You’ll mess my hat, Mom!”

  “Mason…”

  Grabbi
ng the dangling bill from her hand, he squeezes past her and out the door. “There will be water and drinks at the game. Liam’s waiting for me.”

  “Baby, I don’t think you should…”

  Before she can say another word, Mason rushes out into the bright August sunshine. He should be boiling under all the clothing, but he feels as if he’s stepped into an ice rink. It’s all he can do to keep moving. To not wrap his jacket tighter and drop shaking to the ground.

  His head pounds more with each step.

  But there’s no way he’s going to miss this game.

  CHAPTER 20

  The first thing to catch Lisa’s eye is the armed security guards manning the doors. Aside from them, the open space resembles any other warehouse, down to the cement floors, bare walls, and a side-by-side set of metal roller doors for delivery access.

  A forklift rumbles past her carrying a tower of boxes on its way to the pile already stacked in the center of the room. A faint whiff of lumber hangs in the air, though no wood is in sight, so Lisa assumes the previous tenants must have stored timber. The hum of fans draws her attention to the only other anomaly in the warehouse, a bank of refrigerators against the near wall. Fiona and Nathan stand beside them talking to three men in orange overalls. Nathan looks over and, recognizing Lisa, beckons her with a welcoming wave.

  Lisa reciprocates the greeting, though she can’t help questioning the sincerity of his smile. Wearing another slim-fit navy suit along with a brown leather belt and matching oxfords, Nathan is the epitome of a rising corporate star. Lean and fit with sandy-brown hair, he has a Roman nose, strong chin, and a youthful face. In truth, she doesn’t know his actual age, but she assumes he must be well into his forties to occupy such a senior position at a major pharmaceutical company. He has been consistently respectful, professional, and, as best she can tell, forthright with her. And, yet, she doesn’t trust him. She can’t tell if she’s responding to her intuition or her natural bias against executives, especially those who work for pharmaceutical companies—an industry that schools its members on how to charm physicians.