Outbreak dmb-1

by Robin Cook

  To Marissa, he looked more like a university professor than an army officer. He was friendly, even humorous, and was unabashedly pleased about Marissa’s visit. He told her right off that she was the prettiest and the smallest EIS officer he’d ever met. Marissa took the good with the bad.

  The building felt like a bunker. Entry was obtained through a series of sliding steel doors activated by remote control. Small TV cameras were mounted above each door. The laboratory itself, however, appeared like any other modern hospital facility, complete with the omnipresent coffeepot over the Bunsen burner. The only difference was the lack of windows.

  After a quick tour, during which the presence of a maximum containment lab was not mentioned, Colonel Woolbert took Marissa to their snack shop, which was nothing more than a series of vending machines. He got her a donut and Pepsi, and they sat down at a small table.

  Without any prompting, Colonel Woolbert explained that he’d started at the CDC as an EIS officer in the late fifties and had become increasingly interested in microbiology and ultimately virology. In the seventies, he’d gone back to school, at government expense, to get a Ph.D.

  “It’s been a hell of a lot better than looking at sore throats and clogged ears,” said the Colonel.

  “Don’t tell me you were in pediatrics!” exclaimed Marissa.

  They laughed when they realized they had both trained at Boston’s Children’s Hospital. Colonel Woolbert went on to explain how he’d ended up at Ft. Detrick. He told Marissa that there had been a history of movement between Detrick and the CDC and that the army had come to him with an offer he couldn’t refuse. He said that the lab and the equipment were superb, and best of all, he didn’t have to grovel for funds.

  “Doesn’t the ultimate goal bother you?” asked Marissa.

  “No,” said Colonel Woolbert. “You have to understand that three-quarters of the work here involves defending the U.S. against biological attack, so most of my efforts are directed at neutralizing viruses like Ebola.”

  Marissa nodded. She’d not thought of that.

  “Besides,” continued Colonel Woolbert, “I’m given complete latitude. I can work on whatever I want to.”

  “And what is that just now?” asked Marissa innocently. There was a pause. The colonel’s light-blue eyes twinkled.

  “I suppose I’m not violating the confidentiality of the military by telling you, since I’ve been publishing a string of articles on my results. For the last three years my interest has been influenza virus.”

  “Not Ebola?” asked Marissa.

  Colonel Woolbert shook his head. “No, my last research on Ebola was years ago.”

  “Is anyone here at the center working on Ebola?” asked Marissa.

  Colonel Woolbert hesitated. Then he said, “I guess I can tell you, since there was a Pentagon policy paper published on it in Strategic Studies last year. The answer is no. No one is working on Ebola, including the Soviets, mainly because there is no vaccine or treatment for it. Once started, it was generally felt that Ebola Hemorrhagic Fever would spread like wildfire to both friendly and hostile forces.”

  “But it hasn’t,” said Marissa.

  “I know,” said Colonel Woolbert with a sigh. “I’ve read with great interest about the last two outbreaks. Someday we’ll have to review our assessment of the organism.”

  “Please, not on my account,” said Marissa. The last thing she wanted to do was encourage the army to work with Ebola. At the same time she was relieved to learn that the army was not fooling around with the virus just then.

  “I understand you were part of the international team that was sent to Yambuku in 1976,” she said.

  “Which makes me appreciate what you’re doing. I can tell you, when I was in Africa I was scared shitless.”

  Marissa grinned. She liked and trusted the man. “You are the first person to admit being afraid,” she said. “I’ve been struggling with my fear from the first day I was sent to L.A.”

  “And for good reason,” said Colonel Woolbert. “Ebola’s a strange bug. Even though it seems it can be inactivated quite easily, it is extraordinarily infective, meaning that only a couple of organisms have to make entry to produce the disease. That’s in marked contrast to something like AIDS, where billions of the virus have to be introduced, and even then there is only a low statistical chance that the individual will be infected.”

  “What about the reservoir?” asked Marissa. “I know the official position is that no reservoir was discovered in Africa. But did you have an opinion?”

  “I think it is an animal disease,” said Colonel Woolbert. “I think it will eventually be isolated to some equatorial African monkey and is therefore a zoonosis, or a disease of vertebrate animals that occasionally gets transmitted to man.”

  “So you agree with the current CDC official position about these recent U.S. outbreaks?” asked Marissa.

  “Of course,” said Colonel Woolbert. “What other position is there?”

  Marissa shrugged. “Do you have any Ebola here?”

  “No,” said Colonel Woolbert. “But I know where we can get it.”

  “I know, too,” said Marissa. Well, that wasn’t quite true, she thought. Tad had said that it was in the maximum containment lab, but exactly where, she did not know. When they’d made their covert visit, she’d forgotten to ask.

  7

  April 17

  THE PHONE MUST HAVE been ringing for some time before Marissa finally rolled over to pick up the receiver. The CDC operator instantly apologized for waking her from such a deep sleep. As Marissa struggled to sit up, she learned that a call had come through from Phoenix, Arizona, and that the operator wanted permission to patch it through. Marissa agreed immediately.

  While she waited for the phone to ring again, she slipped on her robe and glanced at the time. It was 4:00 A.M.; that meant it was 2:00 A.M. in Phoenix. There was little doubt in her mind that someone had discovered another suspected case of Ebola.

  The phone jangled again. “Dr. Blumenthal,” said Marissa.

  The voice on the other end of the wire was anything but calm. The caller introduced himself as Dr. Guy Weaver, the Arizona State Epidemiologist. “I’m terribly sorry to be phoning at such an hour,” he said, “but I’ve been called in on a severe problem at the Medica Hospital in Phoenix. I trust you are familiar with the Medica Hospital.”

  “Can’t say I am.”

  “It’s part of a chain of for-profit hospitals which have contracted with the Medica Medical Group to provide prepaid, comprehensive care in this part of Arizona. We’re terrified that the hospital’s been hit with Ebola.”

  “I trust that you’ve isolated the patient,” said Marissa. “We’ve found that—”

  “Dr. Blumenthal,” interrupted Dr. Weaver. “It’s not one case. It’s eighty-four cases.”

  “Eighty-four!” she exclaimed in disbelief.

  “We have forty-two doctors, thirteen RN’s, eleven LPN’s, four lab techs, six of the administrative staff, six food service personnel and two maintenance men.”

  “All at once?” asked Marissa.

  “All this evening,” said the epidemiologist.

  At that time of night, there was no convenient service to Phoenix, though Delta promised the most direct flight available. As soon as she dressed, Marissa called the duty officer at the CDC to say that she was leaving for Phoenix immediately and to please brief Dr. Dubchek as soon as he came into the Center.

  After writing a note to the Judsons asking them to please collect Taffy and pick up her mail, Marissa drove to the airport. The fact that the new outbreak had started with eighty-four cases overwhelmed her. She hoped Dubchek and his team would arrive by the afternoon.

  The flight was uneventful, despite two stops, and was certainly not crowded. When it landed, Marissa was met by a short, round man, who nervously introduced himself as Justin Gardiner, the assistant director of the Medica Hospital.

  “Here, let me take your bag,” he said. B
ut his hand was shaking so, the bag fell to the floor. Bending down to retrieve it, he apologized, saying that he was a bit upset.

  “I can understand,” said Marissa. “Have there been any further admissions?”

  “Several, and the hospital is in a panic,” said Mr. Gardiner, as they started down the concourse. “Patients started checking out—staff were leaving, too—until the State Health Commissioner declared a quarantine. The only reason I could meet you was that I was off yesterday.”

  Marissa’s mouth felt dry with fear as she wondered what she was getting herself into. Pediatrics began to look a lot more attractive than this.

  The hospital was another elaborate modern structure. It occurred to Marissa that Ebola favored such contemporary edifices. The clean, almost sterile lines of the building hardly seemed the proper setting for such a deadly outbreak.

  Despite the early hour, the street in front of the hospital was crowded with TV trucks and reporters. In front of them stood a line of uniformed police, some of whom were actually wearing surgical masks. In the early light, the whole scene had a surreal look.

  Mr. Gardiner pulled up behind one of the TV trucks. “You’ll have to go inside and find the director,” he said. “My orders are to stay outside to try to control the panic. Good luck!”

  As she walked toward the entrance, Marissa got out her identification card. She showed it to one of the policemen, but he had to call over to his sergeant to ask if it was okay to let her pass. A group of the reporters, hearing that she was from the CDC, crowded around and asked for a statement.

  “I have no direct knowledge of the situation,” protested Marissa, as she felt herself buffeted by the surging journalists. She was grateful for the policeman, who shoved the press aside, then pulled one of the barricades open and allowed her through.

  Unfortunately things on the inside of the hospital were even more chaotic. The lobby was jammed with people, and as Marissa entered, she was again mobbed. Apparently she was the first person to pass either in or out of the building for several hours.

  A number of the people pressing in on her were patients, dressed in pajamas and robes. They were all simultaneously asking questions and demanding answers.

  “Please!” shouted someone to Marissa’s right. “Please! Let me through.” A heavyset man with bushy eyebrows pushed his way to Marissa’s side. “Dr. Blumenthal?”

  “Yes,” said Marissa with relief.

  The heavyset man took her by the arm, ignoring the fact that she was carrying both a suitcase and briefcase. Pushing his way back through the crowd, he led her across the lobby to a door that he locked behind them. They were in a long, narrow hallway.

  “I’m terribly sorry about all this turmoil,” said the man. “I’m Lloyd Davis, director of the hospital, and we seem to have a bit of a panic on our hands.”

  Marissa followed Davis to his office. They entered through a side door, and Marissa noticed the main door was barricaded from the inside with a ladder-back chair, making her believe that the “bit of panic” had been an understatement.

  “The staff is waiting to talk with you,” said Mr. Davis, taking Marissa’s belongings and depositing them next to his desk. He breathed heavily, as if the effort of bending over had exhausted him.

  “What about the patients with suspected Ebola?” asked Marissa.

  “For the moment they’ll have to wait,” said the director, motioning Marissa to return to the hallway.

  “But our first priority has to be the proper isolation of the patients.”

  “They are well isolated,” Mr. Davis assured her. “Dr. Weaver has taken care of that.” He pressed his hand against the small of Marissa’s back, propelling her toward the door. “Of course we’ll follow any additional suggestions you have, but right now I would like you to talk with the staff before I’m faced with mutiny.”

  “I hope it’s not that bad,” said Marissa. It was one thing if the inpatients were upset, quite another if the professional staff was hysterical as well.

  Mr. Davis closed his office door and led the way along another corridor. “A lot of people are terrified at being forced to stay in the hospital.”

  “How many more presumed cases have been diagnosed since you called the CDC?”

  “Sixteen. No more staff; all the new cases are Medica Plan subscribers.”

  That suggested that the virus was already into its second generation, having been spread by the initially infected physicians. At least that was what had happened in the two previous outbreaks. Marissa herself quaked at the idea of being locked up in the same building with such a contagion, making her question how much consolation she would be able to extend to the staff. With so many people infected, she wondered if they would be able to contain the problem as they had in L.A. and St. Louis. The horror of the thought of Ebola passing into the general community was almost beyond comprehension.

  “Do you know if any of the initial cases had been mugged recently?” asked Marissa, as much to distract herself as in hope of a positive answer. Davis just glanced at her and raised his eyebrows as if she were crazy. That seemed as much of a response he felt the question merited. So much for that observation, thought Marissa, remembering Ralph’s response.

  They stopped in front of a locked door. Davis took out his keys, unlocked the door and led Marissa onto the hospital auditorium’s stage. It was not a big room: There was seating for approximately one hundred and fifty people. Marissa noticed all the seats were occupied, with still more people standing in the back. There was the buzz of a dozen simultaneous conversations. They trailed off into silence as Marissa nervously walked toward the podium, all eyes upon her. A tall, exceptionally thin man stood up from a chair behind the podium and shook her hand. Mr. Davis introduced him as Dr. Guy Weaver, the man she’d spoken to on the phone.

  “Dr. Blumenthal,” said Dr. Weaver, his deep voice a sharp contrast to his scrawny frame, “you have no idea how happy I am to see you.”

  Marissa felt that uncomfortable sense of being an imposter. And it got worse. After tapping the microphone to make certain it was “live,” Dr. Weaver proceeded to introduce Marissa.

  He did so in such glowing terms that she felt progressively more and more uneasy. From his comments, it was as if she were synonymous with the CDC, and that all the triumphs of the CDC were her triumphs. Then, with a sweep of his long arm, he turned the microphone over to Marissa.

  Never feeling comfortable talking to a large group under the best of circumstances, Marissa was totally nonplussed in the current situation. She had no idea of what was expected of her, much less of what to say. She took the few moments required to bend the microphone down to her level, to think.

  Glancing out at the audience, Marissa noted that about half were wearing surgical masks. She also noticed that a large portion of the people, both men and women, were ethnic appearing, with distinctive features and coloring. There was also a wide range of ages, making Marissa realize that what Mr. Davis meant by staff was anybody working for the hospital, not just physicians. They were all watching her expectantly, and she wished she had more confidence in her ability to affect what was happening at the hospital.

  “The first thing we will do is ascertain the diagnosis,” began Marissa in a hesitant voice several octaves above her normal pitch. As she continued speaking, not sure of which direction she would go, her voice became more normal. She introduced herself in reasonable terms, explaining her real function at the CDC. She also tried to assure the audience, even though she wasn’t sure herself, that the outbreak would be controlled by strict isolation of the patients, complete barrier nursing, and reasonable quarantine procedures.

  “Will we all get sick?” shouted a woman from the back of the room. A murmur rippled through the audience. This was their major concern.

  “I have been involved in two recent outbreaks,” said Marissa, “and I have not been infected, though I’ve come into contact with patients who had.” She didn’t mention her own continuing fe
ar. “We have determined that close personal contact is necessary to spread Ebola. Airborne spread is apparently not a factor.” Marissa noticed that a few of the people in the audience removed their masks. She glanced around at Dr. Weaver, who gave her an encouraging thumbs-up sign.

  “Is it really necessary for us to remain within the hospital?” demanded a man in the third row. He was wearing a physician’s long white coat.

  “For the time being,” said Marissa diplomatically. “The quarantine procedure that we followed in the previous outbreaks involved separating the contacts into primary and secondary groups.” Marissa went on to describe in detail what they had done in L.A. and St. Louis. She concluded by saying that no one who’d been quarantined had come down with the illness unless they had previously had direct, hands-on contact with someone already ill.

  Marissa then fielded a series of questions about the initial symptoms and the clinical course of Ebola Hemorrhagic Fever. The latter either terrified the audience into silence or satisfied their curiosity—Marissa couldn’t decide which—but there were no further questions.

  While Mr. Davis got up to talk to his staff, Dr. Weaver led Marissa out of the auditorium. As soon as they were in the narrow hallway, she told him that she wanted to see one of the initial cases before she called the CDC. Dr. Weaver said he’d assumed as much and offered to take her himself. En route he explained that they had placed all the cases on two floors of the hospital, moving out the other patients and isolating the ventilation system. He had every reason to believe they’d made it a self-contained area. He also explained that the staff employed to man the floors were all specifically trained by his people, that laboratory work had been restricted to what could be done in a hastily set up unit on one of the isolated floors and that everything used by the patients was being washed with sodium hypochlorite before being directly incinerated.

  As for the quarantine situation, he told Marissa that mattresses had been brought in from the outside and the outpatient department had been turned into a huge dormitory, separating primary and secondary contacts. All food and water was also being brought in. It was at that point that Marissa learned that Dr. Weaver had been an EIS officer at the CDC six years previously.