by Robin Cook
Marissa bit her lower lip. It seemed that every time the man spoke to her, it was to find fault. If only she’d been able to handle the episode in the hotel room in L.A. in a more diplomatic way, perhaps he wouldn’t be so angry. After all, what did he expect—that she wouldn’t talk to anyone? Any team effort meant communication.
Controlling her temper, Marissa handed Dubchek a paper. “I think you should take a look at this.”
“What is it?” he asked irritably.
“It’s the result of a second survey of the initially infected patients. At least those who were able to respond. You’ll notice that one fact jumps out. Except for two people who couldn’t remember, all the patients had eaten custard in the hospital cafeteria four days ago. You’ll remember that in my first survey, lunch in the cafeteria on that day was the only point of commonality. You’ll also see that a group of twenty-one people who ate in the cafeteria on the same day but did not eat the custard remained healthy.”
Dubchek put the paper down on the counter top. “This is a wonderful exercise for you, but you are forgetting one important fact: Ebola is not a food-borne disease.”
“I know that,” said Marissa. “But you cannot ignore the fact that this outbreak started with an avalanche of cases, then slowed to a trickle with isolation.”
Dubchek took a deep breath. “Listen,” he said condescendingly, “Dr. Layne has confirmed your finding that one of the initial patients had been to the San Diego conference with Richter and Zabriski. That fact forms the basis of the official position: Richter brought the virus back from its endemic habitat in Africa and spread it to other doctors in San Diego, including the unfortunate ophthalmologist here at the Medica Hospital.”
“But that position ignores the known incubation period for hemorrhagic fever.”
“I know there are problems,” admitted Dubchek tiredly, “but at the moment that’s our official position. I don’t mind you following up the food-borne possibility, but for God’s sake stop talking about it. Remember that you are here in an official capacity. I don’t want you conveying your personal opinions to anyone, particularly the press. Understood?”
Marissa nodded.
“And there are a few things I’d like you to do,” continued Dubchek. “I’d like you to contact the Health Commissioner’s Office and ask that they impound the remains of some of the victims. We’ll want some gross specimens to be frozen and sent back to Atlanta.”
Marissa nodded again. Dubchek started through the door, then hesitated. Looking back he said more kindly, “You might be interested to know that Tad has started to compare the Ebola from the L.A., St. Louis and Phoenix outbreaks. His preliminary work suggests that they are all the same strain. That does support the opinion that it is really one related outbreak.” He gave Marissa a brief, self-satisfied expression, then left.
Marissa closed her eyes and thought about what she could do. Unfortunately, no custard had been left over from the fatal lunch. That would have made things too easy. Instead, she decided to draw blood on all the food staff to check for Ebola antibodies. She also decided to send samples of the custard ingredients to Tad to check for viral contamination. Yet something told her that even if the custard were involved she wasn’t going to learn anything from the ingredients. The virus was known to be extremely sensitive to heat, so it could only have been introduced into the custard after it had cooled. But how could that be? Marissa stared at her stacks of papers. The missing clue had to be there. If she’d only had a bit more experience, perhaps she’d be able to see it.
8
May 16
IT WAS NEARLY A month later, and Marissa was finally back in Atlanta in her little office at the CDC. The epidemic in Phoenix had finally been contained, and she, Dubchek and the other CDC doctors in the hospital had been allowed to leave, still without any final answers as to what caused the outbreak or whether it could be prevented from reoccurring.
As the outbreak had wound down, Marissa had become eager to get home and back to work at the Center. Yet now that she was there, she was not happy. With tear-filled eyes, due to a mixture of discouragement and anger, she was staring down at the memo which began, “I regret to inform you . . .” Once again Dubchek had turned down her proposal to work with Ebola in the maximum containment lab, despite her continued efforts to develop laboratory skills in relation to handling viruses and tissue cultures. This time she felt truly discouraged. She still felt that the outbreak in Phoenix had been connected to the custard dessert, and she desperately wanted to vindicate her position by utilizing animal systems. She thought that if she could understand the transmission of the virus she might develop an insight into where it came from in the first place.
Marissa glanced at the large sheets of paper that traced the transmission of the Ebola virus from one generation to another in all three U.S. outbreaks. She had also constructed less complete but similar diagrams concerning the transmission of Ebola in the first two outbreaks in 1976. Both had occurred almost simultaneously, one in Yambuku, Zaire, and the other in Nzara, Sudan. She’d gotten the material from raw data stored in the CDC archives.
One thing that interested her particularly about the African experience was that a reservoir had never been found. Even the discovery that the virus causing Lassa Hemorrhagic Fever resided in a particular species of domestic mouse had not helped in locating Ebola’s reservoir. Mosquitoes, bedbugs, monkeys, mice, rats—all sorts of creatures were suspected and ultimately ruled out. It was a mystery in Africa just as it was in the United States.
Marissa tossed her pencil onto her desk with a sense of frustration. She had not been surprised by Dubchek’s letter, especially since he had progressively distanced her from his work in Phoenix and had sent her back to Atlanta the day the quarantine had been lifted. He seemed determined to maintain the position that the Ebola virus had been brought back from Africa by Dr. Richter, who had then passed it on to his fellow ophthalmologists at the eyelid surgery conference in San Diego. Dubchek was convinced that the long incubation period was an aberration.
Impulsively, Marissa got to her feet and went to find Tad. He’d helped her write up the proposal, and she was confident he’d allow her to cry on his shoulder now that it had been shot down.
After some protest, Marissa managed to drag him away from the virology lab to get an early lunch.
“You’ll just have to try again,” Tad said when she told him the bad news straight off.
Marissa smiled. She felt better already. Tad’s naiveté was so endearing.
They crossed the catwalk to the main building. One benefit of eating early was that the cafeteria line was nonexistent.
As if to further torment Marissa, one of the desserts that day was caramel custard. When they got to a table and began unloading their trays, Marissa asked if Tad had had a chance to check the custard ingredients that she’d sent back from Arizona.
“No Ebola,” he said laconically.
Marissa sat down, thinking how simple it would have been to find some hospital food supply company was the culprit. It would have explained why the virus repeatedly appeared in medical settings.
“What about the blood from the food service personnel?”
“No antibodies to Ebola,” Tad said. “But I should warn you: Dubchek came across the work and he was pissed. Marissa, what’s going on between you two? Did something happen in Phoenix?”
Marissa was tempted to tell Tad the whole story, but again she decided it would only make a bad situation worse. To answer his question, she explained that she’d been the inadvertent source of a news story that differed from the official CDC position.
Tad took a bite of his sandwich. “Was that the story that said there was a hidden reservoir of Ebola in the U.S. ?”
Marissa nodded. “I’m certain the Ebola was in the custard. And I’m convinced that we’re going to face further outbreaks.”
Tad shrugged. “My work seems to back up Dubchek’s position. I’ve been isolating the RNA a
nd the capsid proteins of the virus from all three outbreaks, and astonishingly enough, they are all identical. It means that the exact same strain of virus is involved, which in turn means that what we are experiencing is one outbreak. Normally, Ebola mutates to some degree. Even the two original African outbreaks, in Yambuku and Nzara, which were eight hundred fifty kilometers apart, involved slightly different strains.”
“But what about the incubation period?” protested Marissa. “During each outbreak, the incubation period of new cases was always two to four days. There were three months between the conference in San Diego and the problem in Phoenix.”
“Okay,” said Tad, “But that is no bigger a stumbling block than figuring out how the virus could have been introduced into the custard, and in such numbers.”
“That’s why I sent you the ingredients.”
“But Marissa,” said Tad, “Ebola is inactivated even at sixty degrees centigrade. Even if it had been in the ingredients the cooking process would have made it non-infective.”
“The lady serving the dessert got sick herself. Perhaps she contaminated the custard.”
“Fine,” said Tad, rolling his pale blue eyes. “But how did she get a virus that lives only in darkest Africa.”
“I don’t know,” admitted Marissa. “But I’m sure she didn’t attend the San Diego eye meeting.”
They ate in exasperated silence for a few minutes.
“There is only one place I know the dessert server could have gotten the virus,” said Marissa at last.
“And where’s that?”
“Here at the CDC.”
Tad put down the remains of his sandwich and looked at Marissa with wide eyes. “Good God, do you know what you’re suggesting?”
“I’m not suggesting anything,” said Marissa. “I’m merely stating a fact. The only known reservoir for Ebola is in our own maximum containment lab.”
Tad shook his head in disbelief.
“Tad,” said Marissa in a determined tone, “I’d like to ask you for a favor. Would you get a printout from the Office of Biosafety of all the people going in and out of the maximum containment lab for the last year?”
“I don’t like this,” said Tad, leaning back in his seat.
“Oh, come on,” said Marissa. “Asking for a printout won’t hurt anyone. I’m sure you can think up a reason to justify such a request.”
“The printout is no problem,” said Tad. “I’ve done that in the past. What I don’t like is encouraging your paranoid theory, much less getting between you and the administration, particularly Dubchek.”
“Fiddlesticks,” said Marissa. “Getting a printout hardly puts you between me and Dubchek. Anyway, how will he know? How will anybody know?”
“True,” said Tad reluctantly. “Provided you don’t show it to anybody.”
“Good,” said Marissa, as if the matter had been decided. “I’ll stop over at your apartment this evening to pick it up. How’s that?”
“Okay, I guess.”
Marissa smiled at Tad. He was a wonderful friend, and she had the comfortable feeling that he’d do almost anything for her, which was reassuring, because she had yet another favor to ask him. She wanted to get back into the maximum containment lab.
After giving the emergency brake a good yank, Marissa alighted from her red Honda. The incline of the street was steep, and she’d taken the precaution of turning the wheels against the curb. Although she and Tad had gone out any number of times, Marissa had never been to his apartment. She climbed the front steps and struggled to make out the appropriate buzzer. It was almost 9:00 P.M. and was already dark.
The moment she saw Tad, Marissa knew that he had gotten what she wanted. It was the way he smiled when he opened the door.
Marissa plopped herself into an overstuffed sofa and waited expectantly as Tad’s big tabby rubbed sensuously against her leg.
With a self-satisfied grin, Tad produced the computer printout. “I told them that we were doing an internal audit of frequency of entry,” said Tad. “They didn’t raise an eyebrow.”
Turning back the first page, Marissa noted that there was an entry for each visit to the maximum containment lab, with name, time in and time out all duly noted. She traced down the list with her index finger, recognizing only a few of the names. The one that appeared most often was Tad’s.
“Everybody knows I’m the only one who works at the CDC,” he said with a laugh.
“I never expected the list to be so long,” complained Marissa, flipping through the pages. “Does everyone on here still have access?”
Tad leaned against Marissa’s shoulder and scanned the pages. “Go back to the beginning.”
“That guy,” said Tad, pointing to the name, “Gaston Dubois no longer has access. He was from the World Health Organization and was in town only for a short visit. And this fellow”—Tad pointed to an entry for one Harry Longford—“was a graduate student from Harvard, and he had access only for a specific project.”
Marissa noticed Colonel Woolbert’s name listed a number of times, as well as that of a man called Heberling, who seemed to have visited fairly regularly until September. Then his name disappeared. Marissa asked about him.
“Heberling used to work here,” explained Tad. “He took another job six months ago. There’s been a bit of mobility in academic virology of late because of the huge grants generated by the AIDS scare.”
“Where’d he go?” asked Marissa, going on to the next page.
Tad shrugged. “Darned if I know. I think he wanted to go to Ft. Detrick, but he and Woolbert never hit it off. Heberling’s smart but not the easiest guy in the world to get along with. There was a rumor he wanted the job Dubchek got. I’m glad he didn’t get it. He could have made my life miserable.”
Marissa flipped through the list to January and pointed at a name that appeared several times over a two-week period: Gloria French. “Who’s she?” asked Marissa.
“Gloria’s from parasitic diseases. She uses the lab on occasion for work on vector-borne viral problems.”
Marissa rolled up the list.
“Satisfied?” asked Tad.
“It’s a little more than I expected,” admitted Marissa. “But I appreciate your effort. There is another thing, though.”
“Oh, no,” said Tad.
“Relax,” said Marissa. “You told me that the Ebola in L.A., St. Louis and Phoenix were all the identical strains. I’d sure like to see exactly how you determined that.”
“But all that data is in the maximum containment lab,” said Tad weakly.
“So?” said Marissa.
“But you haven’t gotten clearance,” Tad reminded her. He knew what was coming.
“I don’t have clearance to do a study,” said Marissa. “That means I can’t go in by myself. But it’s different if I’m with you, especially if there is no one else there. There wasn’t any problem after my last visit, was there?”
Tad had to agree. There hadn’t been any trouble, so why not do it again? He’d never been specifically told that he could not take other staff members into the lab, so he could always plead ignorance. Although he knew he was being manipulated, it was hard to withstand Marissa’s charm. Besides, he was proud of his work and wanted to show it off. He was confident she’d be impressed.
“All right,” he said. “When do you want to go?”
“How about right now?” said Marissa.
Tad looked at his watch. “I suppose it’s as good a time as any.”
“Afterwards we can go for a drink,” said Marissa. “It’ll be my treat.”
Marissa retrieved her purse, noting that Tad’s keys and his access card were on the same shelf by the door.
En route to the lab in Marissa’s car, Tad began a complicated description of his latest work. Marissa listened, but just barely. She had other interests in the lab.
As before, they signed in at the front entrance of the CDC and took the main elevators as if they were going up to Mariss
a’s office. They got off on her floor, descended a flight of stairs, then crossed the catwalk to the virology building. Before Tad had a chance to open the huge steel door, Marissa repeated his code number: 43-23-39.
Tad looked at her with respect. “God, what a memory!”
“You forget,” said Marissa. “Those are my measurements.”
Tad snorted.
When he switched on the lights and the compressors in the outer staging area, Marissa felt the same disquiet she’d felt on her first visit. There was something frightening about the lab. It was like something out of a science-fiction movie. Entering the dressing rooms, they changed in silence, first donning the cotton scrub suits, then the bulky plastic ones. Following Tad’s lead, Marissa attached her air hose to the manifold.
“You’re acting like an old pro,” said Tad as he turned on the interior lights in the lab, then motioned for Marissa to detach her air hose and step into the next chamber.
As Marissa waited for Tad in the small room where they would get their phenolic-disinfectant shower on the way out, she experienced an uncomfortable rush of claustrophobia. She fought against it, and it lessened as they entered the more spacious main lab. Her practical work with viruses helped since a lot of the equipment was more familiar. She now recognized the tissue culture incubators and even the chromatography units.
“Over here,” called Tad, after they’d both hooked up to an appropriate manifold. He took her to one of the lab benches, where there was a complicated setup of exotic glassware, and began explaining how he was separating out the RNA and the capsid proteins from the Ebola virus.
Marissa’s mind wandered. What she really wanted to see was where they stored the Ebola. She eyed the bolted insulated door. If she had to guess, she’d guess someplace in there. As soon as Tad paused, she asked if he would show her where they kept it.
He hesitated for a moment. “Over there,” he said, pointing toward the insulated door.
“Can I see?” asked Marissa.