Pathogen

by Jessica L. Webb

  “Go Fish!” Grumpy Jack said haughtily. “I have fourteen. Do you have—”

  “Hang on,” Rayna interrupted. “Let’s make sure we’ve got the significance of some of this information first.” Kate thought she recognized a note of doubt, of condescension. Rayna clearly did doubt Kate’s ability to hack the content. “Dr. Morrison, do you need a recap?”

  “How many genes does HV1A have?” Kate responded with a question.

  “Isolated nine so far.”

  Kate trolled through the information in her head, not allowing the questioning look from across the table to intrude on her thoughts. “Tell me why you think the number of genes might be significant,” she finally asked, not caring if she betrayed her ignorance.

  “Viruses reproduce rapidly in part because they have so few genes to replicate once they invade the host cells.”

  “So the more complex the gene structure, the longer it could take to replicate,” Kate said.

  “And the more chances of a virus replication fail, let’s not forget that,” Grumpy Jack said.

  “What do you mean?”

  “RNA viruses are like kids with ADHD. They often go for speed instead of accuracy. But that means they adapt, mutate, and form new strains.”

  Again Kate paused and forced herself to remain micro, making pictures of what she was hearing. “Okay, I get all that. But HV1A isn’t a naturally mutated strand.”

  “That’s right, Dr. Morrison,” Dr. Levesque interjected. “But we think that the creator of this virus would have used the RNA polymerase enzyme adaptation to his or her benefit.”

  “And don’t forget the reassortment factor,” Nicole cut in.

  “You mean when two influenzas infect the same cell,” Kate said.

  “Right, the genes can mix and produce new strains. Reassortment.”

  “But you don’t think hantavirus and influenza A could have reassorted,” Kate asked.

  Nicole shook her head. “I’d give it a ninety-nine percent improbability rate.”

  “In the lab, we’ve been able to manually reassort influenzas, but never a virus outside the influenza family.” Grumpy Jack jumped in, sounding irritated, as if the discovery that someone else had done it annoyed him no end. He looked over at his boss. “Whoever it is, we should probably hire them.”

  “As soon as they get out of prison for murder,” Kate murmured.

  All four pairs of eyes pinned Kate to her seat, and a distinct aura of shock and tension settled on the room. “Sorry,” she said immediately. “I forgot to keep it micro.”

  “No, don’t apologize. Sometimes it is good for us to have a reminder of the implications of the viruses we deal with on a daily basis,” Dr. Levesque said, looking pointedly at Grumpy Jack.

  “I have a question, and I’m afraid it’s not very micro,” Kate said suddenly, constantly sorting and prioritizing information. “Can you in any way predict the HV1A’s…behaviour, for lack of a better word, based on what you know of the hantavirus and influenza A?”

  “Short answer? Yes,” Grumpy Jack said.

  “Long answer, no,” Rayna said, giving Grumpy Jack a look that dared him to contradict her. But Jack just smiled and gestured for her to keep talking. “It could take months for us to be able to give an accurate description of the life cycle, from how it binds itself to the surface of a host cell, how it replicates itself, and how those replicated cells are released into the body.”

  “Rayna’s right,” Nicole said, almost grudgingly. “There are things we still don’t know about the hantavirus, and that’s been on our radar for over fifty years.”

  “Like what?”

  “We know it’s zoonotic, that it’s transmitted by infected rodents. Humans breathe in the aerosolized virus as it circulates in the air from infected rodent droppings and saliva. We know it incubates for two to four weeks from point of infection to showing symptoms. We don’t fully understand how it replicates or how it causes the capillaries in the lungs to leak fluid.”

  Kate had stopped listening. Now, instead of struggling to make a picture of cellular protease bindings and genetic replication, she suddenly saw a barrage of images. She was not used to thinking on such a small scale. Her macro view of the world was invading the cellular level, and she couldn’t help it.

  Dr. Levesque came to her rescue. “Dr. Morrison?”

  Kate looked up, the flood of images still hijacking half her brain. “Can I see it?” Kate asked. “The HV1A virus. Can you show it to me and tell me what you see? Either hantavirus, influenza, or new. Is that possible?”

  Grumpy Jack leaned forwards in his chair and pushed a few buttons on a tablet in the middle of the table. Window coverings dropped down with quiet mechanical efficiency. At the same time, a screen came down from the corner, and Grumpy Jack tapped on his laptop. After moving around a few files, a subdued, purple-stained microscopic image came up on the screen.

  “HV1A-CS. A misnomer, but we’re going with it for now. Once we isolate the hemagglutinin and neuraminidase involved—”

  “Perhaps,” Dr. Levesque interrupted, “we can stick to what Dr. Morrison has asked of us.” Her tone held little in the way of humour. “John, if you could isolate the hantavirus components. Nicole, the influenza.”

  They did. In detail. Nearly an hour of detail. Finally, though, with Rayna grudgingly adding in the components of the virus they thought were unique to the HV1A-CS strain, Kate began to understand. She began to make the connections between what she was seeing on the slides in front of her, the information given by the epidemiologists around the table, and of course, the pictures already scanned into memory. She still saw the chest x-rays, heard the sound of the rebreather masks, felt the chill of a body during autopsy.

  “Let’s take a break,” Dr. Levesque finally cut in. “When we return, perhaps you can share with us the symptomology of your patients.”

  As everyone around her stood, Kate pulled out her cell phone, thinking about Andy for the first time in hours. A No Signal message met her when she turned on her phone, and Kate sighed.

  “Why don’t you come down for a coffee, and I’ll hook you up with a landline,” Nicole said kindly.

  Kate gave her a small smile. “Thanks, that would be great.”

  Grumpy Jack—John, Kate reminded herself—accompanied them down in the elevator. The cafeteria was huge and white and thankfully quiet on this Sunday morning. John treated them both, forcing Kate to conclude that maybe he wasn’t so grumpy after all.

  Just before Kate bit into her cranberry and oat muffin, she remembered where she was and what the labs housed here: microscopic pathogens, invading organisms, rapid cellular replication. She felt John and Nicole’s eyes on her, and they grinned knowingly.

  “Seriously,” John said. “Can you think of a safer place to eat?”

  Kate looked at her muffin, then back up at John, smiling guiltily.

  “You’re not the first, don’t worry,” Nicole said, taking a huge bite of her bagel and cream cheese. Kate took her cue and popped a bit of muffin into her mouth.

  “You eat at work, don’t you?” John asked, stirring a fourth packet of sugar into his coffee.

  “Sure, when I get a chance.”

  “See, now that’s gross. Do you really go from having your hands all bloody and gory to, I don’t know, eating an apple?”

  “Uh-huh,” Kate said, enjoying her muffin now, feeling the heat and kick of the coffee in her body. “Though it’s more likely to be a Pop-Tart than an apple.”

  “Aren’t you supposed to be promoting a healthy diet with your patients?” Nicole said dubiously.

  Kate threw the last bite of muffin in her mouth. “I’m very comfortable in my hypocrisy.”

  Nicole laughed and even John cracked a smile.

  Kate wiped crumbs from the muffin off her hands and picked up the large paper cup of coffee, her thoughts wandering back upstairs to the conference room, to the report she was about to give. Questions piled up like a collision in her he
ad.

  “So how did you end up here?” John’s voice intruded on Kate’s thoughts.

  “Sorry?”

  “I’m just curious. How did you go from toaster pastries in the trauma room to sitting in the NML cafeteria discussing potentially the biggest bio-viral threat in Canadian history?”

  Kate felt a hook behind her navel, a disorientation so severe that she was suddenly dizzy. She felt filters over her eyes, a sort of slide show of stills, stacked up and blurry. First the dingy green of the trauma room at Van East, the blinding sun through the wall of windows at Hidden Valley General, driving through the Rockies in the Yukon with Andy, Sunday dinner with her mom and Tyler, joking with Craig at the back of a packed meeting room, the mildew-stained walls of the slum house just ten minutes north of where she was sitting right now. How did I end up here?

  “Dr. Morrison, are you all right?” Nicole’s voice interrupted her thought spiral.

  “Yes.” Kate managed a small smile. “I’m fine. A little jet lag,” she lied easily, her shoulders shifting automatically into a more casual position, her eyes relaxing into a look of fatigue, not stress. Kate ignored the unease that came with the lie, refusing to acknowledge how familiar this was.

  “Let’s head back upstairs and I’ll find you a phone.”

  A few minutes later, Kate had a small cubicle to herself. She took a long, slow breath before dialing Andy. As the phone rang in her ear, Kate swallowed the last of her unease and double-checked her watch. It was just before seven thirty in the morning in B.C.

  “Sergeant Wyles.”

  “Hi, it’s me.”

  “Kate.”

  Kate wasn’t sure how Andy managed to suffuse that much love, relief, and happiness in such a short word. “Hey, where are you?”

  “Still at the hotel. I’m just getting ready to meet Ferris at his office. How are things going down there?”

  “So far, so good,” Kate told her, feeling her balance beginning to return. “I’ve got some idea what we’re dealing with now, at least as much as the NML has been able to figure out in a short period of time. We’re about to go back and discuss what this means for the patients. There are still so many questions.”

  “I know,” Andy said shortly. Kate could hear the tension in her voice. “We’ve got more than a few down here.”

  “What’s going on?” Kate asked, feeling very far away.

  “Ferris and I are attempting to investigate without raising any alarm even though we don’t have a clue what we’re looking for and all we get is interference from people like Michael Cardiff. It’s like finding a small, dangerous needle in a very expensive haystack.”

  Kate knew how much those kinds of restrictions drove Andy crazy.

  “What can I do?”

  “Do you think your team down there will answer some questions for us? Give us some idea what to look for?”

  “I can always ask. You’re going to have to be pretty specific. These are lab people, about as far removed from the field as you can get.”

  “Noted,” Andy said briskly. Kate could envision her scrawling in her notepad. “Can you call Ferris’s office in an hour?”

  “Sure. I guess I should call Dr. Doyle for the patient updates,” Kate said unenthusiastically.

  “Probably. And be nice, she’s getting a lot of pressure from Cardiff and the rest of the hospital board. I think she’s holding up pretty well, considering.”

  “Advice from Andy Wyles to be nice, now there’s a change,” Kate teased, feeling only the smallest trace of the unease still in her body. Maybe it really was jet lag and lack of sleep.

  “Cute,” Andy said, sounding half amused, half distracted.

  “I’ll let you go,” Kate said, taking the cue. “Talk to you in an hour.”

  “Sounds good. Kate?”

  “Yes?”

  “I love you.”

  The damp mountain air, Andy’s arms around my waist, the rocking of the porch swing.

  “I love you, too.”

  When Kate called the hospital, Dr. Doyle was distracted and brusque. Of the six suspected new cases that had come through the ER, three were confirmed to have the virus, no signs of respiratory distress, no red-flagged histories. Eight new suspected cases, results pending. Harris Trenholm was not improving but was insisting his forty-eight hours was almost up, twenty-four hours early. Kate thanked Dr. Doyle, assured her she would deal with Harris when she got back, and even managed to insert a compliment about how she was holding up.

  Kate found her way back to the conference room, her red and white visitor’s badge swinging awkwardly around her neck. Everyone was already seated when she entered.

  “Dr. Levesque, I was just speaking with Sergeant Wyles, who is heading up the investigation in Hidden Valley, and she has some questions. Would it be possible to have a conference call with her and Constable Ferris in an hour?”

  Dr. Levesque looked around the table for confirmation from the others.

  “Yes, of course. I only wish we had more information to share.”

  “I think at this point they could use whatever we’ve got.”

  At Dr. Levesque’s request, Kate handed over the memory key with all the medical information she had from Hidden Valley General and from Dr. Salinger at Public Health. Kate started from the beginning in September with the first case of suspected influenza. She then focused on Roberta Sedlak, her medical history, the autopsy findings. As the chest x-rays came up on the screen, Kate focused on the details and facts, presenting the case in the most relevant medical detail, forcing any thoughts of the potential new cases to the side. Kate tapped the keypad on John’s laptop, and a fresh set of facts, confirmed cases, and autopsy reports raced across the screen in dramatic, macro detail.

  The room was quiet as Kate pushed the laptop back towards John, who immediately cycled a few slides back to the graph that had been provided by Public Health on infection rates.

  “Newest unofficial information puts those numbers higher. Three confirmed and eight suspected cases,” Kate said. “We should have the serological tests back later today.”

  John opened a new document and created his own graph, inputting the newest information.

  “What do you need from us, Dr. Morrison?” Dr. Levesque said.

  The list was extensive in Kate’s head. A cause, an effective treatment, an antiviral drug. She reined in her thoughts and tried to remain within the realm of possibility.

  “Do you see the virus?” Kate finally asked, shifting forwards in her chair. “In the information I just shared with you, do you see the virus? Is it presenting as you would expect? Is it…behaving like you think it would, based on what you know at the cellular level?” Silence again, Kate twisted the ring on her finger, fidgeting with enforced patience. “I know you probably hate these kinds of questions,” Kate said sympathetically. “And I’ll warn you now that Sergeant Wyles is about to ask a lot more of them.”

  “Yes and no,” Rayna volunteered. “The majority of the patients exhibit influenza-like symptoms, yet the pathogenesis and resulting pulmonary edema in critical patients is more like hantavirus. But it is also acting like the HV1A-CS virus, of which we know almost nothing. So…no.”

  Rayna spoke without taking her eyes off the screen. Kate heard murmured affirmations from around the table. This information didn’t get her any farther ahead, other than to confirm that the small purple-stained slide was exactly what was currently wreaking havoc in Hidden Valley, British Columbia. And for some of the patients, this virus could prove to be fatal. Kate tried not to let her disappointment show. What had she really expected? At least she could see it, at least she was beginning to understand.

  “Okay,” Kate said finally, looking up at the group. “I think my next questions are going to be similar to Sergeant Wyles’s. So instead of making you repeat it, maybe we can call her now.”

  Kate scrawled the number for the RCMP office in Hidden Valley on a piece of paper and passed it over to Dr. Levesque, who pu
nched the numbers into the tablet on the table.

  “Sergeant Wyles? Are we connected?” Dr. Levesque asked, taking her seat again.

  “Yes, thanks for your call.”

  As Dr. Levesque made the requisite introductions on their end and Andy did the same in Hidden Valley, Kate was acutely aware of time. She had less than eight hours before she had to catch her flight back to B.C., and she was just now beginning to feel the pressure.

  “Our main focus right now is to try to discover who is behind this. We’ve spent the last twenty-four hours attempting to uncover any connection to laboratories, virology, immunology, microbiology.” Andy repeated the list in short bursts that maybe only Kate could read as frustration. “Nothing. We expanded the list to be more general: pharmacology, genetics, medicine. Again, nothing of interest.”

  Kate heard Ferris jump in. “Hidden Valley has more of your financial and high-tech types, not so much with your academics.”

  “Right. So we are looking at two possibilities. One, that the HV1A-CS virus was made in or around Hidden Valley. Two, that the HV1A-CS virus was imported into Hidden Valley.”

  “I’d go with the latter,” John jumped in. “Whoever created this virus would need some extensive, sophisticated equipment, not to mention access to the live viruses. My guess? Imported from a university lab.”

  “Why do you say university lab?” Andy asked immediately.

  “If you’re looking at probability, it’s the most likely source. Other than public or private labs, like the NML or the CDC, hantavirus is researched most often at universities.”

  “I’ll need a list,” Andy said. “All the universities in North America who are using the live virus to do research.”

  “Names of the heads of research also?” John asked, typing and talking at the same time.

  “Can you do that?”

  “It’s a shockingly small community,” John said drily.

  “Then yes. Next question,” Andy barely paused before moving on. “Assuming the virus was imported into Hidden Valley, what are we looking for?”

  Andy’s question was met with silence.