Lost Immunity

by Daniel Kalla

  It is the smoking gun he has dreamed of.

  Maybe now people will listen.

  CHAPTER 36

  Lisa is running on sheer adrenaline, having hardly slept overnight. The tension she came home to the previous evening was even worse than anticipated. Despite her preoccupation with the crisis at work, she tried to engage Dominic. But he wanted no part of her explanation or her apology for canceling their counseling session. He spoke few words, and he physically shrugged off her attempt to lay a hand on his arm. The rare times he did meet her gaze, his eyes burned with wounded contempt. He ended all further discussion by grabbing a bottle of red, stomping off to the guest room, and slamming the door behind him. She hasn’t seen him since.

  Ingrid is waiting for Lisa at the door to her office when she arrives at seven fifteen. Her eyes are puffy and red, and her lip trembles.

  “What’s wrong, Ingrid?”

  “They won’t stop.”

  “Who won’t?”

  “Reporters. Worried parents. Everyone. The phone won’t stop ringing. I have over forty voice mails and twice as many emails. They all want an explanation… About that girl the vaccine made so sick.”

  Lisa shudders inwardly at the phrasing but smiles reassuringly. “It’s OK, Ingrid. Just tell them that we’ll be releasing a statement later this morning.”

  Ingrid nods, still visibly fighting back tears.

  “Is Kevin in yet?” Lisa asks about the department’s publicist.

  “Haven’t seen him.”

  “Tell him to drop by as soon as he gets in.”

  “OK.” Ingrid begins to turn away, but then stops. “Oh, there’s a Dr. Miriam Khan looking for you. From Children’s Hospital. She left a message. I’ll forward you her contact info.”

  “Thanks, but I’ve got her number,” Lisa says, wondering why her old friend from medical school didn’t call her directly.

  Lisa sits at her desk, pulls her phone out, and locates Miriam’s cell number. The pediatric infectious-disease specialist answers on the third ring. “Miriam, hi. It’s Lisa Dyer.”

  “Oh, Lisa! It’s been too too long. I miss you, honey.” Miriam’s voice is as perky as ever and still holds a trace of her Farsi accent.

  “Likewise, honey. But why did you go through my assistant to reach me?”

  “Your assistant?” Miriam says.

  “You left a message for me in my office at Public Health.”

  “Oh no. I was looking for Angela Chow.”

  “You haven’t heard? Angela’s on medical leave. I’m the public-health officer now.”

  “You are? Oh, wonderful! Obviously, I hope Angela gets well, but you understand. I’m so proud of you.”

  “It’s not exactly a dream job right now. Trust me. Not with this meningitis outbreak.”

  “This is exactly why I was calling, Lisa,” Miriam says. “The situation is a disaster here at Children’s Hospital.”

  “I’ve been following. Those kids from Bellevue, right?”

  “You heard about the new family, then?”

  “Family? No.”

  “Three siblings. They came in last night. All have meningococcus.” Miriam’s voice quiets. “The youngest one—only five years old—she died just a few minutes ago.”

  An entire family with meningitis? “They’re from Bellevue? Part of that cluster?”

  “Very much so. The middle boy played on the same baseball team as one of the previous victims who died here.”

  “Mason Pickering?”

  “Precisely.”

  “If he was a contact of Mason’s, then surely the boy would’ve been given prophylactic antibiotics?”

  “He was! It didn’t prevent the infection. This is why I called your office.”

  Not another one. “I’ll come to you!” Lisa is already on her way out the door as she ends the call. She gets in her car and races over to Children’s Hospital.

  Miriam is waiting for her just inside the PICU, Children’s Hospital’s state-of-the-art pediatric intensive care unit, which is bathed in natural light from window wells and skylights. Miriam wears a white lab coat that is, just as it was in medical school, too long for her petite frame. Her deep brown eyes light at the sight of Lisa, and she wraps her in a tight hug, enveloping her in a rose scent.

  Miriam pulls Lisa by the hand past four adjoining glass-walled rooms. Inside each, a child lies on a stretcher connected to a ventilator and multiple intravenous drips, while everyone else in the room wears a mask, a face shield, and a protective gown. The parents are easy to distinguish from the staff through their anguished body language alone.

  “Meningococcus,” Miriam says, shaking her head. “Every one of them.”

  She stops in front of the fifth room, where the curtains are drawn inside the glass. Lisa doesn’t even need to ask. Miriam grabs two folded yellow gowns off the shelf and hands one of them to Lisa.

  Once they’re both gowned, masked, and gloved, Lisa follows Miriam into the room. It’s empty aside from the little girl with a round, cherubic face who lies lifeless on the stretcher, covered up to her neck by a sheet. A disconnected ventilator tube pokes out between her pale lips as a reminder of the failed resuscitation.

  A year younger than Olivia.

  “Nora, the youngest of the three Hawthorn children,” Miriam explains as she steps up to the head of the bed. “She wasn’t even showing symptoms when the parents brought the two older brothers into the ER last night, both with fevers. Mom and Dad are next door with Stefan, the older brother, who’s fighting so hard to hang on.”

  “The speed this bug strikes with…”

  “Awful. None of these children should’ve been infected, Lisa. Stefan was treated with a full course of antibiotic prophylaxis after his exposure.”

  Lisa appreciates that there’s nothing accusatory in her friend’s tone, but she can’t help feeling somehow responsible. “This is the second failed contact prophylaxis, Miriam.”

  “The second?”

  “There’s another case. A fifteen-year-old who’s at Harborview now.”

  “Maybe we need to change the protocol? Add a third antibiotic to the regime?”

  “Maybe. But there will still be failures. No matter what antibiotics we give them.” Lisa’s thoughts turn to Nicola Ford, the asymptomatic carrier who ended up spreading the infection to Bellevue. “Besides, there will be other contacts who are too scared, too lazy, or too ignorant to even take the prophylactic antibiotics.”

  “What about this new vaccine?”

  “So far, it’s been universally effective in raising the recipients’ antibody titers to what we believe are protective levels.”

  “Then we need to vaccinate every child in this city! We have to create herd immunity.”

  “Agreed.”

  Miriam clears her throat, and when she speaks again, her voice is resigned. “I’ve managed children suffering from COVID, cholera, malaria, flesh-eating disease… you name it, Lisa. But I have never seen anything as aggressive as this strain of meningococcus.”

  Lisa and Miriam leave Nora’s room, strip out of their PPE, and walk out of the PICU together. Promising to see each other soon, and realizing they probably won’t, they part ways after hugging again beside the elevators.

  As Lisa is pulling out of the hospital’s parking lot, she calls her sister on her car’s hands-free phone.

  “Funny,” Amber says. “I was just about to call you.”

  “What’s up? Olivia OK?”

  “She’s fine. But I was just reading about the girl with the vaccine injury.”

  “It wasn’t an injury,” Lisa snaps. “The shot didn’t break her arm.”

  “Reaction. Whatever. It sounds awful.”

  “It is,” Lisa admits. “But it’s also the only major adverse effect we’ve seen among thousands of inoculations.”

  Amber is quiet for a moment. “And you still think I should get Olivia vaccinated?”

  “I do.”

  “You’re not worri
ed about the risk?”

  Lisa thinks of Nora’s round, lifeless face. “I’m way more concerned about the risk of not getting Liv vaccinated.”

  Amber silently digests the comment for a short while. “Another girl from Olivia’s school is already in the hospital,” she says.

  “You’ll do it, then?”

  “I think so.” Amber hesitates. “But can I ask a favor?”

  “Name it.”

  “Will you give her the shot yourself, Lisa?”

  CHAPTER 37

  Accessing the vials has proven to be much simpler than replacing them. They’re distributed in sealed packs, so the only opportunity arises when a pack is already open, during a vaccination clinic. Even then, there are so many eyes on the supply. Getting in and out without being noticed, therein lies the real challenge.

  CHAPTER 38

  If it weren’t for the armed security guard at the door, Lisa would’ve thought she had wandered into the wrong warehouse. Gone are the boxes, pallets, forklifts, and even the lingering scent of lumber. Individual offices are now walled off by temporary partitions and are filled with desks, chairs, and other furniture. Laptop computers are everywhere. There are even a few rugs scattered across the floor.

  Lisa is directed by a young man wearing a tight royal-blue suit and no socks to a makeshift office in the far corner of the warehouse where she finds Fiona sitting at her desk, working on her laptop. The only other object on the desk is an analog clock made of walnut, carved in a sleek conical, art deco design.

  At the sight of Lisa, Fiona shuts her laptop and rises from her desk. “Hello.”

  “Hi.” Lisa swirls a finger in front of her. “Your portable headquarters are impressive.”

  “Don’t know about impressive. But certainly necessary, if we want to safely distribute fifty-thousand-plus doses of Neissovax.”

  “Looks like a seamless operation to me. No wonder Nathan has so much faith in you.”

  “Nathan is generally too trusting,” Fiona says with a small grin as she walks past Lisa and into the abutting cubicle. She returns moments later wheeling in another chair. “Please, sit.”

  “Thanks,” Lisa says as she takes a seat.

  “Coffee? Tea?”

  After Lisa shakes her head, Fiona eases back into her own chair. “What can I do for you, Lisa?”

  “You’ve seen the news coverage on Mia’s skin eruption?”

  “Impossible to miss.”

  “The media is having a field day. We’re issuing a statement this morning to reassure the public. But so far, it hasn’t dulled the appetite for the vaccine. This morning’s clinics are swamped.”

  “I triple-checked the batch where her vial came from. Every sample sailed through the quality-control standards.” Fiona sighs. “We never saw anything equivalent to this in the trials.”

  “It’s damn rare, is why.”

  “This is what Nathan and I worried about when you first approached us. We wanted more time. More trials. As you know, sometimes it takes tens of thousands of inoculations to uncover rarer associations.”

  Lisa thinks of the rotavirus vaccine, but she doesn’t say anything. “And sometimes, isolated reactions are just random. And have nothing to do with the vaccine in question.”

  “Lisa, I live and breathe Neissovax.” Fiona folds her arms across her chest. “But it’s impossible not to associate this girl’s skin eruption with the vaccine.”

  “What I mean is that Stevens-Johnson syndrome can be associated with any number of common drugs. And we wouldn’t be doing such soul-searching if one of them had caused the rash, instead of Neissovax.”

  Fiona considers that for a moment while the clock ticks steadily in the background. “I’m not responsible for any other drugs.”

  “You’re not responsible for Mia, either.”

  “I am responsible for product safety, though.” She views Lisa with somber eyes. “What if there are other Mias?”

  “We’ll cross that bridge, when and if we come to it,” Lisa reassures her, relating to the weight of responsibility Fiona must be carrying. “Right now we have a lethal bacterium attacking the vulnerable children in this city. I just saw the latest victim. Postmortem. A little waif of a girl. The antibiotics her older brother got didn’t protect her family. Neissovax might be all we have.”

  “I suppose,” Fiona says, lapsing into another silence that is filled only by the ticking of the clock.

  Lisa nods to the timepiece. “I don’t know squat about clocks, but I love the design. Reminds me of the dome of the Chrysler Building.”

  “Same vintage, too.”

  “Are you a collector?”

  “Walt always had a passion for clocks, especially the early and midcentury ones. I wouldn’t call him a collector, but he definitely had an eye.” She shows a sad smile. “He gave me that for our fifth anniversary.”

  “How sweet.”

  “I’ll never forget what he wrote in the card. ‘The wood symbolizes the five years we’ve already had. The clock, all the time left ahead of us.’ ” Fiona looks away. “At least he was right about the wood. It’s the traditional five-year anniversary gift.”

  Thinking of her own marriage, Lisa feels a pang of envy that she realizes is completely irrational considering how Fiona’s ended. “Sounds like you two had something incredible.”

  Fiona shrugs slightly. “I thought so.”

  “Do you mind if I ask…”

  “Guillain-Barré syndrome,” Fiona says of the disorder in which the body’s immune system attacks its own nervous system, causing debilitating weakness.

  “But most people survive that, don’t they?”

  “His hit so quickly. Just ate his nerves up. He went from jogging one morning to not being able to stand by dinnertime. The next day he couldn’t breathe on his own. He ended up on a ventilator, and then developed pneumonia. Everything went wrong from there. So many complications. His body just shut down. He was dead in seventy-two hours.”

  “God, that must’ve been so hard for you.”

  “A lot harder for Walt,” Fiona murmurs.

  “Do they know what caused it?” Lisa asks, aware that most cases of Guillain-Barré syndrome are caused by a haywire immune response to an infection or, though far less frequent, even to a vaccine.

  “It was flu season,” Fiona says as she reaches over and adjusts the position of the clock. “It’s ancient history now, anyway.”

  “Some things last forever.”

  Fiona’s cheeks and forehead flush slightly. “You didn’t come here to talk about clocks. Or Walt.”

  “No. But thank you for sharing,” Lisa says, nodding solemnly. “Actually, Fiona, I was hoping to ask you a favor.”

  “What kind of favor?”

  “I have a niece. Olivia. She’s six. Sassy as anything. Would mouth off to a cop.” Lisa laughs. “Anyway, my sister’s family lives in Bellevue. And two of Olivia’s classmates have already developed this meningitis.”

  Fiona frowns. “I’m sorry, Lisa.”

  “Maybe I’m just being an overprotective aunt. But Olivia is probably the closest thing I will ever have to a kid of my own…”

  “You want to get her vaccinated?”

  “Yeah. My sister is skeptical of vaccines, though. To put it mildly. But I think I’ve managed to convince her.”

  “Good.”

  “Look, I know we agreed that all vaccinations would be supervised by a Delaware rep. And I can definitely bring Olivia into one of the clinics. But my sister asked me if I would give Olivia the—”

  Fiona stops her with a raised hand. Her lips curve into an understanding smile. “Let me go get you a vial, Lisa.”

  CHAPTER 39

  Nathan sits in his hotel room in front of his laptop, once again logged into the administrator’s portal on Seattle Public Health’s website for reporting Neissovax complications. He rereads each one of the seventy-nine reported entries, eyes peeled for any sign or symptom remotely consistent with a skin reac
tion similar to Mia’s. The more he snoops, the guiltier he feels.

  A pop-up appears at a corner of his screen, announcing a video call from Peter Moore. He clicks open the video chat window, and his boss’s face fills the screen.

  “Enjoying your vacation?” Peter asks with a smile that appears less than sincere.

  “About as much as a getaway to the Congo at the height of Ebola season.”

  “You work best under pressure, Nathan.”

  “Not this kind, Peter.”

  The grin vacates Peter’s lips. “This girl with the skin condition? She’s doing better?”

  “She’s still in the ICU, but I understand she’s stable and improving.”

  “That’s good. Also, it guarantees a bigger financial payout for her and the family if she survives.”

  “That’s a bit cavalier.”

  “There’s more money in disability than in death,” Peter says matter-of-factly. “And there will be a lawsuit.”

  “How do you know?”

  “My spies tell me the father is out for blood. He was the one who leaked the story and the photos to the media.”

  Nathan’s eyes narrow. “Your spies, Peter?”

  “Does it surprise you that I’m keeping close tabs on this?”

  “No,” Nathan says. “But it does surprise me that you’re keeping me out of the loop.”

  “It’s no big deal, Nathan. We hired a local investigator to poke around. Didn’t think it was significant enough to even tell you.”

  “Everything related to Neissovax is significant.”

  “So we’re on the same page, then,” Peter says unapologetically. “No other adverse reactions that we need to be concerned about?”

  “I’ve been monitoring the website. Nothing, so far.”

  “It’s a one-off, then.”

  “Only time will tell.”

  Peter’s gaze ices over. “That won’t fly.”

  “What does that mean?”

  “It has to be a one-off, Nathan.”

  CHAPTER 40

  The timer on the microwave dings, and Emilio Flores almost burns his finger grabbing the hot bowl with his bare hand. “Damn it,” he mutters to himself as he races the bowl over to the waiting plate on the counter. Using a tea towel, he flips the bowl over and taps out the scrambled eggs onto the buttered toast.