On the way out of the house I had looked in through one of the doors opened along the hallway and saw the parents' bed, stripped bare and stained with blood, vomitus, excrement. Outside, a plot of freshly spaded dirt lay on the far side of the house, patted smooth by two days of rain.
The road ran two kilometers longer to a wide opening. We parked behind Kaunda and pulled off our respirators, unpacking the contact suits: bright red-orange rubber jumpsuits with attached hoods and flexible UV face pieces. We stepped into them and pulled them up over our shoulders, sealing them across our chests, waist-toneck, like the zipper of a plastic bag.
My head throbbed with the danger and the heat. I tugged at the cuff gaskets on my sleeves and the thick black rubber gloves attached, an additional layer of protection for the most vulnerable area of a physician's body. Peter came before me and took hold of my sleeves and coolly double-checked the seal. His thin lips inside his face piece faintly grinned at my distress. "Nobody should be enjoying this," I said. "Not even you."
Kaunda spread a heavy sheet out on the grass. The girl remained curled up inside the back seat, moaning, quaking, nude. I reached in and lifted her out, feeling the fragile puffing of her immature lungs in my arms, and she was lighter even than I had, imagined. I lowered her onto the sheet and she doubled in pain, breath pushing through her torn lips like choked laughter. I straightened, immediately drenched in sweat and miserable in spirit.
Behind us, two lanes of shanties constructed of corrugated metal faced off across a wide, sun-bleached band of beaten grass. Heavy stones secured the flat shanty roofs, cooled by leafy tree limbs from the encroaching jungle. This would later become known to us as the heart of the camp town: a kitchen cafeteria, public latrine, small liquor store and bar, general store, Dr. Kaunda's dispensary, and a wide, unwalled market. Farther away, two rows of smaller thatch huts continued around a rightward bend into the trees.
We saw only one person outside. A man was squatting beneath a large woven mat strung up on bamboo stalks near the first of the huts, his shoulders resting against his knees and his hands flat on the burned grass beside his feet. Gourds and pots lay scattered and overturned on a mat before him. He saw us and rose to stand, wearing only a shin-length pair of custard-colored pants, then abruptly turned and disappeared into one of the huts.
A distant wail startled us, and as I turned my head within the hood, a second figure burst from one of the shanties, racing across the grass mall toward the huts. She was a tall, woolly-haired woman unused to running, her slender arms flapping over abrupt strides, wearing a bright, shin-length floral skirt, a tight headdress of the same fabric, and a faded pink T-shirt. Halfway across the grass mall, she saw us, cried out and turned. Her sandals flopped as she raced toward us.
She reached me first and grabbed my rubber arm, bursting out something in a Bantu dialect that I did not understand and pulling at me to follow her. I loosed her fingers from my sleeve and for a moment held fast on to her wrist, examining her face. There were no sores and her eyes were bloodshot from crying but otherwise clear. I nodded to the woman and started away, but by then she had seen Kaunda. She shouted at him and spat with precision at his feet, and then at the wrinkled sheet of the shivering girl.
I followed inside my bulky suit. The woman clasped her hands as she moved, raising a doubled fist to the dusky carmine sky, leading me past the hanging straw mat and around an old-fashioned, pedal-driven Singer sewing machine set on a table and a ring of stones that was a cooking fireplace, to a hut on the left. She prayed to me to go inside. Sweat ran down my brow into my eyes, which I could not reach to wipe away. I set down the aid kit and motioned to her to be calm, then ducked inside, under neatly trimmed reeds.
A human figure lay still on a small cot mattress. It was a man weighing no more than eighty pounds. His limbs were wasted down to the skeletal architecture of his body, such that each knobby articulation-the ball of the humerus within the scapular cavity of the shoulder, the carpal bones like loose rocks within the fleshy pouch of his wrist-was plainly described. His skin itself was rotting off his body in a fetid stink, marble-sized boils and violet tumorous ulcerations marking the dark map of his flesh. It was less than flesh, a fungus that had grown up over a skeleton. He respired in slow, shallow breaths.
Worst of all was the man's face. His lips were curled back from cracked teeth and dissolving gums in a mummy like sneer, and wrinkled folds of unbound skin were gathered in darkly layered sags beneath his drooping ears. Most expressively, his eyes had found something horrible in the ceiling. They were distended, blood red and fully exposed from their widened orbits, the pupils dilated and floating like compass heads fixed in scarlet spheres-as of a pair of eyeballs plucked from a jar of bloody preserve.
I backed out of the hut. I stood staring at the open black doorway I had retreated through and heard the woman pleading or praying behind me, and I backed away some more. I pointed Peter inside.
"Soyez calme, " I said to the woman automatically, Be calm, not hearing the words myself until well after they had been spoken.
A figure moved in front of me. It was the man who had been squatting under the mat. He said something in a dialect I did not understand, though it was clearly gibberish. His eyes were sad and scarlet beneath drooping lids, half-open, half-dead, drunk with blood.
He made a reaching motion behind him which at first I did not comprehend, and the woman screamed anew.
He produced nothing, and stared at his empty hand in confusion.
Peter stood behind him, holding a large unsheathed machete he had pulled from the back of the man's pants. There was blood encrusted on the flat of the blade. The man let out a cry of despair and fell weeping to the ground.
Peter and I looked at each other through our masks. We looked at the machete. "Christ," I said finally.
Peter flung it deep into the trees. He said, "Come on." We left the woman. We looked in at each of the more than twenty huts set along the curling pathway. Camp conditions were such that each small dwelling housed as many as six workers, and each hut now contained at least one bedridden infected person, though many contained more.
Kaunda rejoined us and led the way to a hastily cleared burial ground in the back trees. At his insistence, the camp workers had dispensed with the traditional washing of corpses. An animal bone yard was similarly arranged nearby.
Kaunda explained that the disease had a peculiar and dramatic effect upon the brain; a few of the infected camp workers had set upon the others with knives, hammers, whatever was handy. The man with the machete was a sorcier aux crabes, the camp sorcerer who divined fortunes and, once the deaths had begun in earnest, dispensed buti tokens to ward off the fever. Kaunda departed the camp once the sorcerer became ill, in fear of his life.
We crossed a sturdy vine-and-grass bridge hanging over a swift river to a second grouping of smaller huts beyond. The huts were lined around a wide quadrangle of clay-tinged dirt where the afflicted were laid out on woven mats at odd angles, staring with uninterested eyes.
Other obviously ill people knelt in grief at the side of loved ones, and still others shuffled about the square in a fevered funk. The recent dead were laid out in rows, their faces fixed in grimace, limbs and torsos emaciated, eyes bloated.
Raindrops bled through the high, dense canopy as Kaunda led us back toward the bridge. He paused near the quiet river, hooking his hand on a low, curved tree branch and blotting his forehead with a handkerchief from his back pocket. "Four days, start to finish," he said in French.
"First the headache. Flulike symptoms, a general malaise. Then spasms, chills, and onward." He rumbled a light cough into the dirty handkerchief. He was facing the river. "Four to five days, fever to fulmination. Three weeks now. It set upon the camp like an eclipse."
Peter went around in front of Kaunda. Under his scrutiny, the wizened doctor straightened off the low branch. He swiped at his face with the cloth, standing on short, uncertain legs, but ultimately wilted under Peter's i
ntent, silvery gaze. "You're sick," Peter said.
Kaunda gestured dismissively with the damp cloth. "Malaria," he said.
"It returns now and then-" Peter shook his head. "You're sick," he said again. Kaunda looked wearily back at me, a pleading smile, and then again at Peter, appealingly. "A touch of the fever," he explained. "I have quinine in my office."
He tried to move toward the bridge but Peter stood in his way.
"Sick doctors," he said.
Kaunda shook his head. "Non, Monsieur-Peter regarded Kaunda with disgust. "Denying their own disease as they spread it."
"Monsieur."
He was indignant now, rubbing at his face with the cloth as though trying to erase it, his balance wavering, "I can assure you-" Peter turned his back on the man and faced me. "We're on our own here," he said.
For a long time after that I forgot about the heat inside my suit.
We unpacked the equipment and immediately began treating people. The metal-roofed marketplace shanty was the only structure large enough to accommodate all of the sick. I drafted the healthier camp survivors-falteringly, in glove-pantomimed French-to help me clear out baskets of grains and meal and burlap bags of spoiled produce, to make room for a trauma center. Peter isolated the area by dividing the camp lengthwise along the center mall, symptornatics to the right, asymptomatics to the left. A dotted row of stones became the borderline between sickness and health. They were all term laborers trucked in from the depressed cities of Kinshasa, Brazzaville, and Yaound6, recruited by agents of the same illicit concern that had hired Kaunda, lured by high wages too attractive to refuse. Of the roughly one hundred and fifty surviving workers, the two populations at that time were nearly balanced.
After a round of preliminary examinations Peter set up his tablet and bulletined two nurses and seven investigators from the Special Pathogens Section, a division of the CDC that dealt specifically with the epidemiology and etiology of unknown emerging viruses. The aid message read, in part: Febrile disease characterized by flulike symptoms, delirious sleep, lethargy escalating to dementia, arthritic symptoms, wasting syndrome, endothelioma. Clinical disease includes (prelim): Fever nearing 40% epitaxis, weight loss, muscle pain, prostration, allergylike shock, rapid evolution toward death. Agent (prelim): Viral, emerging. Pathogenicity: High.
Advise: Biohazard 4.
There was no international alert, as we agreed that the outbreak was adequately isolated, at least for now. In any event, it was always preferable to establish the disease etiology first, rather than face unanswerable questions that could lead to misinformation and public panic later. Fear was the most virulent disease of all.
Peter backed the Pinzgauer out of the clearing into what became our retreat, abandoning Kaunda's infected 4X4 inside the camp and pocketing the keys. I designated a barrier zone between the two areas, setting out for us a large biohazard box, packets of sterile gloves, and pans and brushes and jugs of Pheno virucidal disinfectant.
We refit Kaunda's dispensary inside the camp, fashioning an operating theater out of an examining table and pump sink that would service autopsies as well. Then we set up shop in the market shanty and began prioritizing the afflicted. The asymptomatic population assembled behind us in a desultory line along the quarantine border, watching us administer to their sick.
Peter broke away around midnight to do the PCR work, and ran the genetic fingerprint of Jacqueline Moutouari's virus through the database at the CDC. It came back exactly as we had feared: UNK, or Unknown. Whatever was eating Jacqueline Moutouari, it was not the smallpox virus. It was something not yet encountered L)y human medicine.
I visited her later. She was lying on an air mattress in Kaunda's personal hut, behind the dispensary, feverishly reciting what sounded like a child's prayer. The suppurating pustules had merged upon her chest and legs. I could only wait for more antivirals to arrive, in the vain hope that one might click.
I returned exhausted to Peter under the roof of the marketplace.
"The sores have merged," I said. "She's dying."
He immersed his instruments in a pan and ceded the patient to me.
"I'm finding tumors in post," he said, meaning postmortem examinations.
"It's a retrovirus."
I slid my gloved hands into a bowl of cleansing formalin.
Retroviruses were RNA viruses, more complicated than regular DNA viruses, and responsible for a rogue's gallery of diseases including various viral cancers, leukemia, and immune-deficiency afflictions such as AIDS. "The girl's is different," I said. "Hypotaxia. Range of sores. The symptoms vary victim to victim. There's something to that."
Peter nodded. As he started back to the dispensary I heard again what I had previously taken to be the pounding of my own pulse inside my head. I called after him. "The drums," I said.
Peter looked to the high trees, listening. "Pygmies," he said before continuing on.
The CDC team arrived by Ford Explorer and Peugeot station wagon at noon the next day. They wore full biohazard regalia and brought with them nearly five hundred pounds of equipment, including surgical supplies and diagnostic apparatus, body bags, nylon restraints, a thirty liter autoclave, generators, refrigerators, and small transport freezers.
The expression in their eyes as they stood among the dying reimpressed upon me the macabre rage of the disease.
Following a short briefing, we left them to string up IV feeds and hang mosquito nets around the trauma center while Peter and I retreated to the barrier point on the edge of camp. We disinfected our suits with a painstakingly thorough Pheno scrub bath, before ripping them open and pushing back the hoods. The pores of my cheeks tingled, exposed to the free-flowing air. We disposed of the suits in biohazard and changed gloves and proceeded to the Pinzgauer outside camp. I broke open a waxed box of distilled water and downed half of it, pouring the rest into a bowl and splashing it on my needy face. Peter, a claustrophobic, strode in wide, relieved circles around the vehicle, happy to be out of his suit. I sat in the open side door of the Pinzgauer and savored the muggy air.
Neither of us had ever seen a virus so devastating as this one was. No one had. A virus with such a high degree of pathogenicity traditionally lacked virulence, just as, conversely, a less debilitating virus achieved wider penetration by virtue of its having a greater number of living, functioning carriers. This African bug would likely burn through the camp inhabitants within one week's time.
All of this went without saying. We 'still did not know what the virus was or, more important, exactly how it was transmitted. After the meal, Peter waved a mosquito away from his head, and both of us looked at each other with a surly alertness. Silently we withdrew into fresh contact suits.
At dusk anything that could be used as a weapon was confiscated in a hut-by-hut search. The virally induced psychosis had manifested itself in varying degrees among the afflicted, from mere confusion, to stupor, to outright dementia. Only a few became violent and had to be restrained. Psychotic episodes were staggered with brief periods of lucidity, marked by despair and expressions of terror, leading invariably to the final, catastrophic stage of the disease.
That night Peter completed a field assay involving a T cell survey of ten patients in the prodrome, or preliminary, phase of the disease.
T cells are the white blood cells that make up the vanguard of the human immune system response. Peter's field test-a simple tally of cells on a microscope slide-found the highest T cell count of the ten prodrome cases to be thirty-four, which was demonstrably low, in fact well below the CDC criteria for establishing a diagnosis of AIDS.
By the end of the second day, thirty-seven more were dead, fifty-one suffered advanced cases, and thirty-two were entering the prodrome phase with severe flulike symptoms. PCR analysis had revealed significant differences in the genetic sequences of the viral strains infecting the population. We were dealing with something unusual, a virus possessed with extraordinary mutative properties.
The CDC team sub
mitted lymphatic samples once daily for PCR screening and adopted a buddy system in order to monitor one another for disease symptoms or fatigue. The virus was almost certainly airborne, and a slipped scalpel or torn glove compromising a suit could lead to a fatal contamination.
Later that evening I began to hyperventilate inside my suit and had to be relieved. A few minutes away from trauma I regained my composure, and on my way out of camp I checked in again on Jacqueline Moutouari.
Bleeding had erupted beneath her skin. The sores were now most profound upon her face and torso, many broken open and draining a mustard-yellow discharge. Her decaying body was ridding itself of nutrients and fluids faster than could be replenished. Any attempt at dressing her wounds resulted in cries of pain. The nine-year-old was in agony. I stood over her, daubing some garamycin into her half-open, blood-filled left eye and gently holding her hand. There was no response now, no squeeze or gurgle or twitch of the eye. Nothing had worked. I wandered out to Kaunda's car on the edge of camp and lay back on the passenger seat. I could not fathom the life that was going along blithely back in Atlanta, throughout America and all the world.
It was as though the airports we had passed through on the way to this virus had, upon our takeoff, turned to dust. I slept there, fully suited, for two hours.
Peter woke me before dawn and handed me a flashlight. I accompanied him down the dark road, past the camp, ending around a long curve at a natural cave opening in the center of a steep, grassy rise.
He approached the cave's wide, dark mouth and stepped inside.
I followed. The walls and the ceiling had been widened and reinforced, our flashlights illuminating work grids painted onto the surface, continuing deep into the dark earthen belly. A fine dust swirled in the bright cones of our beams.
Chuck Hogan Page 3