by Jim Shepard
Jeannine’s supervisor told her on one of their calls that his best friend, the chief of internal medicine at Sibley Memorial, had developed a fever and a cough and had put herself in isolation and had her family quarantine themselves in their home, but had also celebrated her twenty-fifth wedding anniversary the night before, and so all of those guests now needed to be tracked down. And when Jeannine had answered, “Well, weren’t you at that party?” her supervisor had told her that yes, he had been. And then they’d both gone quiet on the line, before he’d broken the silence by telling her that as someone who had now seen more cases of this than anyone, she could qualify as the world’s foremost expert on the subject.
When she got off the phone she thought about the way her basic relations had changed, as they had with COVID-19. People approaching, people near her space: she registered it now with a trace of hostility, like a justified misanthrope.
For every person who got sick, how many others were they going to infect? They had a pretty good idea of the incubation period, but they didn’t know how long the infected were contagious or the size of the susceptible population. The best estimates were that there were already some 71,000 cases in eighteen countries by this point—roughly week three—and that if the current rates of infection held up they were headed very quickly for 280,000 by week five, and from there the outlook got worse.
If Ilimanaq was any indication, the susceptible population was everybody, but so far the mortality rate in Ililussat hadn’t been nearly as high, and no one knew why.
Most governments’ websites were urging calm and listing all of the measures being taken, including mask mandates and shutdowns and bans and the ongoing efforts to develop a test, while the global news outlets panicked at different volumes—Jeannine’s recent favorite was the Fox graphic “APOCALYPSE II?”—but all of that seemed trampled by the social media cacophony, none of which practiced or urged restraint. In America the right wing alternated between claiming that there was no real problem and that the problem was now under control. Both positions were mocked and debunked, but the net effect was to create further paralysis, or, as Jeannine’s mother complained to her in one email, “Everyone says something different.”
And every morning Marie Louisa redirected their attention from what was happening worldwide to the problem at hand, when she briefed them on the hospital’s latest fatalities and new cases.
Danice’s mom kept phoning and pitching emails into the whiteout of all of the other emails with which Danice had to deal, pleading for updates and advice, and Danice told Jeannine that she’d wanted to tell her mother that the short answer was “How would I know?” But instead she forwarded the standard recommended precautions that everyone remembered from COVID-19: wear a mask, practice social distancing, avoid touching your face, wash your hands with soap and water, sanitize surfaces, avoid sharing utensils and food, and so on. Her mom emailed back, “Thanks so much,” and added an emoji with an exasperated expression.
Jeannine’s supervisor, after a long, dispirited phone call one late night, had suggested that maybe it was time for some humility when it came to acknowledging that science had come up empty-handed so far. And that maybe they had to concede that there were all sorts of phenomena they were unable to not only understand but in some cases even identify. And that maybe it would help to remember that this was how medical science and scientific knowledge evolved, anyway. When Jeannine had agreed with all of that, he’d added that they were just going to have to hope for something really rare in the history of microbiology: that all of the knowledge the scientific community was currently lacking developed very quickly.
What happened next was probably going to depend not so much on the science as the politics. As everyone had recently been reminded, usually when medicine collided with culture, medicine lost, and while some governments rapidly facilitated containment efforts, others just made things worse. China had already locked down some five cities and forty million people and was establishing dragnets and requiring neighbors to inform on one another, while in the U.S. the spokesperson for America’s Health Insurance Plans, the industry’s lobbying group, had announced that the industry would be not be waiving copayments for any treatments. In the four military bases in Texas, California, Montana, and North Carolina that had been prepared to house the infected, the uninsured would receive free housing and board, but no medications, though individuals could rotate out as they passed the incubation period.
Russia, India, North Korea, and the UK had ordered the expulsion of any and all foreigners with symptoms. All over the world, health care systems were being besieged by the panicking healthy while great numbers of the infected refused hospitalization no matter how sick they got. Outbreaks that created chaos in rural areas created bedlam in urban ones.
Qatar and Kuwait had banned flights to and from Iceland and Denmark and Germany until further notice. The United Arab Emirates now sprayed pesticides in all aircraft arriving from infected countries. In Germany, medical teams were boarding all incoming flights to check for illness before anyone was allowed to disembark. Border checkpoints were closing to infected countries. And most hospitals had had to resort to armed guards provided by the military to enforce their quarantines.
The Second Epidemic
Olsen crashed the next morning and his daughter that afternoon and they couldn’t save either of them. Danice had been helping out and showed Jeannine the marks on her wrist where he had grabbed her. She said his daughter had heard him calling for her before he died. Marie Louisa was beside herself with grief and had developed her own symptoms, and with her even temporarily out of commission the wheels started to come off the system she’d helped set up. Her assistant head nurse seemed to be continually making tea in a state of paralyzed panic, and the doctor now in charge—one of those who had been laid low when Jeannine and Danice had arrived, maybe by something totally unrelated, and had since recovered—seemed to regard them as though they had brought the bug to Greenland themselves. Volunteers who’d been making home visits and following up contacts looking for signs of illness were refusing to keep working. Three of the cleaning staff had barricaded themselves in an apartment with some food supplies. A cruise ship had arrived in the harbor, and Jeannine had had to argue with the captain that dropping anchor wasn’t such a good idea. And then, in the understatement of the week, Danice had remarked that morale seemed to have been further eroded by the announcement that the prime minister had been flown to Denmark to better direct the emergency measures.
Jeannine’s supervisor told her in exasperation how much of his time was being gobbled up in fielding urgent demands from USAMRIID and Homeland Security and the DARPA program—whose motto was “Creating and Preventing Strategic Surprise”—on the subject of whether it was possible that they were dealing here with a weaponized pathogen. Everyone mostly agreed that given what looked to be the probable point of origin—if Ground Zero was Ilimanaq—it seemed unlikely that something had walked out of a lab. Or had been released, her supervisor agreed. He added that he’d told all of the bio-warriors who’d been busting his stones that they probably didn’t need to go looking for Dr. No on this one, since as they already knew from COVID-19, nature itself was weaponizing pathogens all the time.
He also told Jeannine to saddle up and get ready to leave on the National Guard C-130 that was coming for the boy from Ilimanaq. Its ETA right now was 0600 the next morning and there’d be an Air Transport Isolation System in the cargo bay and techies to run it, along with some nurses, an MD, and an infectious disease guy. Because whatever this was was still unknown, she should destroy the ISO-POD she’d used to get Aleq to Ilulissat, just to be safe.
She asked who’d be coming to replace her and he told her it would be Jerry Sussman, the guy who spoke Danish and who’d had the flu when the first call had come in.
“He’s got a lot of years in,” the supervisor told her. “He’l
l do fine.”
“Has Danice ever worked with him before?” Jeannine wanted to know.
“I have no idea,” her supervisor said.
“How’s your health, by the way?” she asked.
“Knock on wood,” he told her. “Though apparently three people from that party have already come down with something.”
Sorry to Leave You with All This
Somewhere over the Atlantic she got a text from Danice that Olsen’s wife had died. The whole family, Jeannine thought. Recognitions like that jolted her in this new state she was in, and then she moved on. Danice added that Marie Louisa was still hanging in there.
Saying their goodbyes, Jeannine and Danice had been dry-eyed going through everything they had to go over, but once they’d finished, Danice had asked her if she’d had a lot of good friends over the years, and they’d both lost it. While they were wiping their eyes, Danice told her that during her entire childhood her mother had never once admitted to being sad. And that even when Danice had caught her mother weeping, sitting by herself in the laundry room, her mother had admitted only to having had “the mopes.”
Jeannine gave her a smile, and asked, “You going to be okay here?”
Danice closed her eyes like she was giving it some real thought, and said, “The other thing my mother always says to anyone who’ll listen is, ‘And I’m going to have to be the one to clean up this mess.’ ” She gave Jeannine a grim smile. “She’ll probably tell me I had this coming.”
“My mother’s version of that is always ‘Oh, honey, you can handle this,’ ” Jeannine told her. “And then she always gives me this look, like she loves me but I have no idea what’s about to hit me.”
They stayed facing each other until someone finally rapped at the door and said in English that some people were waiting for Dr. Dziri.
“I love you,” Danice told her. “I’m scared about being here without you.”
“I love you too,” Jeannine answered. “You’ll be fine.”
At first Danice told her she was too busy to come out to the airport, but then she did anyway, and she waved and watched Jeannine climb aboard the Hercules, and then turned away before the rear cargo ramp had fully shut.
Welcome to BSL-4
Rocky Mountain Laboratories turned out to be in Hamilton, Montana, surrounded by a high black metal fence in a residential neighborhood with one- or two-story homes all around it, with the mountains rising beyond them just out of town. Soon after 9/11, the president and Congress had authorized the National Institute of Allergy and Infectious Diseases to increase its research into effective biowarfare countermeasures and had ponied up $66 million for an enhanced biosafety lab—a BSL-4—and the RML had been chosen because first, it had had the basic infrastructure already in place, and second, the location was sufficiently remote if something went kablooey. The new lab was called the Integrated Research Facility, had opened in 2008, and was all about shared spaces and resources, the idea being to get everyone from scientists to administrators to animal care staff talking to one another as much as possible. Jeannine had gotten more of the lab’s history from the chief of virology after the ride in from the airfield, during the security procedures, which were beyond comprehensive. At the front gate, you went through a security cottage manned by an armed guard and then a metal detector, and everything you were carrying was sent through an imager, while you showed your clearance and signed in and received your ID. Entry to each lab following that involved another ID, with the BSL-4 in its own separate building and requiring yet more security, with more armed guards and metal detectors and all the rest of it, as well as an iris scan, which, Jeannine was informed, wouldn’t work if someone propped a corpse in front of the lens. “Well, I guess there’s no point in dragging around dead Uncle Charlie, then,” she remarked, but the guy working the scan didn’t laugh.
She was asked a lot about Aleq and recounted much of what she knew. The chief asked her to call him Hank and wanted to know how Aleq had held up on the long flight. She said the big issue for him had been the burial of his loved ones, and that she was yet to deliver on her promise to show him pictures of their graves. Hank looked at her like he was waiting for more, so she added that the Danes had sent a military unit in hazmat suits to Ilimanaq, and that she was waiting for some Danish pilots who had promised to send photos once they had them. He asked if she thought the little settlement had been Ground Zero, and she said that if she had to say right now, she’d say yes. He nodded, and told her they’d come up with a Danish speaker who’d be listening in and translating into her earpiece—had she ever worn this kind of earpiece?—though the Wi-Fi was spotty with these new ones for some reason. She tried it on and asked when she’d be getting started and he answered as soon as she was ready.
You and Me and Zero Room for Error
She had logged a fair number of hours in BSL-4 labs before, and only needed to be brought up to speed on a few new features in the clothing room while she and Emily, the director of the Division of Microbiology and Infectious Diseases, changed into disposable underwear and surgical scrubs, since no personal clothing was allowed in. Normally the director wouldn’t be scrubbing in on something like this, she told Jeannine, but since nearly everyone in the building wanted in on this—the heads of bacteriology and mycology, respiratory diseases, and virology, especially, just to name three—she thought this might help her figure out how best to divvy up the access.
“Even if we try to keep it to a minimum, there’s going to be a lot of coming and going around your boy,” Emily told her. “We’re going to be relying on you to provide him some continuity and reassurance.”
“Well, I think he’d be surprised to hear he’s my boy,” Jeannine told her. “I’m hardly his dream come true. But I’m the best he’s got, I guess.”
It turned out he’d freaked out at having been separated from her on the drive in from the airfield, and had had to be sedated again.
“He’s gone through a lot,” Jeannine explained, after a minute, once she’d been told.
“I can only imagine,” Emily agreed.
“Jewelry?” she asked before they passed into the second room with the suits, and Jeannine shook her head. The suits were spread out for inspection, and they plugged in the air hoses suspended in coils from the ceiling, listened for the waterfall sounds of the airflow, and inflated their suits empty for integrity testing, squeezing and checking in particular those areas that wore out the fastest: the gloves, the seams around the visor, and the feet. Fully inflated, the suits looked a little comical, like astronauts’ versions of sex dolls. After the visual inspection they put their ears to the various seams, and then deflated the suits and stepped into them feet first, slid them over their arms, and stretched and worked their fingers into the outer gloves. Then they pulled the clear bonnets over their heads and hooked up the air and closed their front zippers. They braced each other while they pulled on big outer boots that looked like children’s rain boots. Then they unhooked, hung up their hoses, and passed through the airlock. The inner door only released its gaskets if the door that had just been passed through was sealed. Then they hooked up again inside the lab. The same procedure would operate in reverse on the way out, except they’d also get a chemical shower.
Jeannine got around okay, though she always forgot how even sitting down with the hose and tether was a minor adventure. She dropped a pipette while she was getting a sample tray ready at a workstation, but otherwise everything went smoothly, though she saw Emily raise an eyebrow in her own suit, as if to remind the newbie that 99 out of 100 wouldn’t cut it here.
Besides their new earpieces there was a cell phone that always stayed in the facility, since the rule was that anyone at work in the lab always had to have someone outside the lab but in the building with whom they had an open line of communication. God knew how anyone was supposed to hear anything on the
cell phone through the blowing air in the suits.
A lot of the BSL-4 labs didn’t have the facilities to handle patients, but the RML had three rooms for that, and a mini ICU.
They’d be coming at Aleq from as many angles as they could think of, but the two main ones were going to be scouring him for some trace of the pathogen—they had the antibodies’ footprints all over his samples, but maybe they could find some hint of the shoe that had made them?—and extracting more information from his memory. There was, it turned out, another line of infection that had broken out in Nuuk, and from there had traveled to Copenhagen and possibly beyond. It seemed to be presenting somewhat different symptoms and, more important, so far hadn’t seemed to have had any connection to Ilimanaq. Was this an entirely different pathogen, or a possible mutation? Danice and everyone back in Atlanta were hoping that someone out of the initial group infected in Nuuk had in fact come from or passed through Ilimanaq, and so thirty-three photos of those dead and alive that had been the first ones sick in Nuuk had been forwarded to the lab so Jeannine could walk the boy through them.
But their reunion in the room they’d set up for him was such a disaster that ten minutes into it she could see Emily’s dismay even through her attempted poker face. The nurse technician kept miming for Aleq how to hook on the earpiece and microphone and he kept tossing it onto the bed next to him. She repeatedly retrieved it and pointed to Jeannine, doing her best to suggest that the former would enable communication with the latter, but the boy responded as though she were pointing to the wall. Jeannine gave it a try, gesturing to her ear and then to him, but only produced a change in his expression when she and the nurse technician had had to untangle their air hoses. And he wouldn’t even look at the Nuuk patients’ photos on her iPad. She’d found herself angling it around in front of his averted face until she’d finally given up.