Again Kaplan paused. As a scientist, he was conscious that words like disaster were to be eschewed wherever possible. He had always had a healthy scorn for the reaction — or, as he saw it, the overreaction — of most people to news of sickness or disease. A morbid fascination with the minutiae of ill-health had no part in his make-up. Yet it was difficult to find a more appropriate word. Disaster had not struck — not yet. But it was certainly around the corner.
He took them through the problem step by step.
“We have reason to believe that Dr Reuben was Diane Verusio’s only contact in the infectious stage. From the Marburg case-histories,” he added parenthetically, “it appears that the infectious stage coincides with the onset of the first clinical symptoms and ends about six days later, if death has not already intervened. If it is true,” he continued, “that Diane Verusio infected no one else except Isaac Reuben, then we have been unbelievably lucky. It means we can concentrate on identifying and then isolating all contacts Dr Reuben might have had, particularly during what we suppose is the infectious phase. If we can do that today, or at the latest tomorrow, before these contacts themselves have had the time to develop clinical symptoms, we stand a real chance of getting this thing under control by placing all possible contacts in isolation.”
There was another question from the back of the room, this time an unidentified voice: “What if there are more names than places?”
Kaplan took it in his stride. He gave it to them straight from the shoulder.
“Then we’re in trouble. Big trouble.”
He had almost finished. “When I have stopped speaking, a team from Atlanta, assisted by officials from the Health Department, will be interviewing each and every one of you so as to establish a profile of your movements in regard to both patients. If you are suspected of having been in contact, you will be isolated forthwith. I want you to know that, since I was myself in contact with Dr Reuben, I shall this evening be taken to Fort Sumter in Virginia, to a maximum isolation facility there. I hope to come out of it alive.”
There was a nervous laugh from the audience as Kaplan stepped down from the dais. At the same moment the guards locked the doors to the lecture theatre, and a team of white-coated men began to move along the seated rows.
The old man had never felt sicker in his life. He was sure he was going to die. To him, Kaplan was just a disembodied voice talking a million miles away across the ether. He replied mechanically to the questions, fighting for breath and racked with pain. His liver ached fiercely, his hair, what was left of it, was coming out in handfuls; rash had broken out on his trunk and extremities.
“Jesus, can’t you leave me alone,” he groaned. “I told you, I saw nobody that day after you left. Remember, I came straight into the hospital in the ambulance.”
Kaplan remembered, but he wanted to be sure. His training had been very precise on this point. Check and double-check. Don’t take the patient’s word for it. Ask specific questions.
“Who did you have lunch with that day?” He spoke into the intercom, addressing the blanketed figure which lay in the bed on the other side of the glass partition.
“I didn’t have lunch. I ate at my desk!”
“Who did you see before lunch?”
Reuben groaned. His throat felt dry; his whole body felt dry, but still the sweat poured off him.
“Nobody. Ask my assistant. She’ll know.”
“We’ve asked her. She’s in isolation herself now. Who else did you see?”
Reuben lifted himself half off the bed and stared through the partition at Kaplan.
“Nobody. Now, for God’s sake, leave me alone.”
But Kaplan couldn’t afford to leave him alone. He had to squeeze out every last bit of information.
“Your assistant says you made a house-call that morning. Can you tell us where?”
“No.”
“No, you didn’t make a house-call? Or no, you won’t tell us where?”
The old man collapsed back on the bed. In a low voice, he gave a name and an address.
“Look after her, won’t you, when I’ve gone?” He continued. “My sister. She lives alone. I’m all she’s got left.”
“We’ll look after her.” Kaplan’s voice was gentle. He leaned forward to speak softly into the intercom. “You’re going to make it, Isaac. I know you’re going to make it. You’re going to beat the book.”
Kaplan moved away. He had one more duty to perform, an unpleasant one.
At death, Diane Verusio’s body had been double-wrapped in large, impervious plastic bags in the isolation room. The bags had each been sealed with tape after the removal from them of as much air as possible. The bagged body had then been moved to the anteroom and similarly sealed in a third large, impervious plastic bag for subsequent transfer to the autopsy room in the basement of the hospital. Like the isolation room, the autopsy room could be operated under measurably negative air pressure with respect to the adjacent rooms.
Kaplan had given the most careful instructions.
“All doors and windows of the autopsy room are to be kept closed during the autopsy,” he had ordered. “Air exhausted to make the room pressure negative must be passed through a filter of at least 95% based on the DOP test method. All articles from the autopsy room must be sterilized before removal, and the room must be decontaminated after the autopsy.”
He had gone on to specify the details of the decontamination process, and had further instructed that all clothing worn by autopsy personnel should be removed within the autopsy room, double-bagged and incinerated or autoclaved. Autopsy personnel were to shower with soap and shampoo immediately after removing their contaminated clothing. After decontamination of the autopsy room, the filters in the exhaust air system of the room were to be carefully double-bagged in impervious plastic and autoclaved or incinerated. Maintenance personnel involved were to wear gowns, gloves, masks, caps and booties. Such protective clothing was to be double-bagged and autoclaved or incinerated. Maintenance personnel were to shower with soap and shampoo immediately after removing their contaminated clothing.
He arrived in the hospital basement, expecting to find the autopsy in progress. Instead, the body still lay double-wrapped in the plastic bags on the autopsy table. The room remained at normal pressure and there was no sign of any activity.
“What gives?” Kaplan addressed the Chief Technician with some annoyance.
The man shrugged his shoulders. “They won’t touch her, I’m afraid. The unions have passed the word.”
Kaplan’s irritation increased. “They have a job to do, haven’t they?”
The man turned away. “Find your own people, doctor. My men aren’t performing any autopsy in this instance.”
“Why?”
“Look!” the man pushed his face close up to Kaplan’s. “Let’s not kid each other. You and I know what we’re dealing with. Marburg, isn’t it? Yes, some of us heard your little lecture. It wasn’t just the doctors and nurses.” He turned on his heel. “I’m not putting my men at risk and that’s final.”
Kaplan knew when he was defeated. “Well,” he said, “can you persuade your people to fill the plastic bags with formalin embalming fluid and, when they’ve done that, to place the body in an airtight coffin and seal the coffin?”
“I’ll do what I can. What do we do with the coffin?”
“The army will pick it up. They won’t cremate it. They’ll incinerate it in a special furnace that kills viruses, O.K.?”
The man shrugged. “You know best.”
Kaplan had been allocated the room next to that of Dr Charles Graham on the top floor of the hospital. Dr Marvin Jones, the New York State epidemiologist, had an office nearby. The three men were sitting around Kaplan’s desk at the end of one of the longest days he could ever recall. There had been a constant stream of instructions to give and information to receive. The telephone had not stopped ringing. For the moment, Kaplan believed they were on top of the problem.
> He looked at his watch. It was already six p.m. He had spent the whole day at the hospital, supervising operations and looking after other people. Now it was time to look after himself. If he had contracted the disease from Isaac Reuben, he reckoned he had several days before the symptoms would begin to develop and the onset of the infectious phase; but he didn’t want to take any risks.
He looked at his colleagues. “Marvin, Charles. You’ll have to be in charge this end. James McKinney will be in charge back in Atlanta. I’ll try to stay in touch from Virginia, but if I go down with Marburg . . .” He spoke lightly, but the three of them knew the very real risks.
Kaplan got up from his chair, held out his hand, then drew it back. Handshakes were best avoided. The other two men understood the gesture and appreciated it.
He called down to the transport unit. “Is the ambulance ready?”
“Ready and waiting,” came the reply.
To be on the safe side, Kaplan had decided to leave New York under full isolation conditions. Wrapped up to the neck in a sheet of impervious plastic, his mouth and nose covered with a high efficiency surgical mask, he entered the ambulance. The driver and attendant wore protective clothing, and the vehicle was equipped with two-way radio. The route was worked out in advance; police escorts organized at critical intersections.
Towards midnight, they arrived at their destination. Without leaving the ambulance, the driver and attendant, wearing plastic gloves, removed the mask from the patient, double-bagged it and replaced it with a clean mask. Kaplan was then wrapped to the neck in a second covering of plastic. The driver and attendant removed and double-bagged their own clothing except coveralls, and put on clean gowns, gloves, masks, caps, and booties passed to them through a window of the ambulance.
As soon as Kaplan had been taken into the isolation facility, the ambulance personnel set about the decontamination of the vehicle, using paraformaldehyde. This procedure took twelve hours; not until it had been completed were the men able to report on their two-way radio that their mission had been successfully accomplished.
For the next four days, from his room inside the maximum isolation facility at Fort Sumter, Virginia, Lowell Kaplan continued to mastermind the emergency operation. Around four o’clock in the morning on the fifth day of his incarceration, with just the first hint of dawn in the June sky, he woke with a burning sensation in his throat. His eyeballs ached, and he felt as though he was going to vomit. He had a fever and his nose had begun to bleed.
Clinically, Kaplan’s illness followed much the same progression as the cases recorded in the 1967 outbreak. In fact, the medical circumstances of the three recurrences of the disease — namely Verusio, Reuben and Kaplan himself — only served to confirm the accuracy of the computer’s original diagnosis. By midday of the first day Kaplan’s fever had increased to 39°C without rigors. The nausea continued and he experienced frequent, occasionally uncontrollable, vomiting. He also suffered from watery diarrhoea, sometimes with admixtures of blood or mucous.
The characteristic, non-itching, maculopapulous rash started on his face the following day. It progressed to the trunk and extremities. At first, it consisted of tiny, sharply defined spots, located around the hair follicles; then it developed into a rash of middle-sized maculae, which merged to form a diffuse, dark-red erythema. The rash affected nearly the whole integument; it was specially marked on the scrotum. At the same stage, Kaplan developed an enanthema on the soft and hard palates, consisting partly of tapioca-like blisters. He also developed conjunctivitis and photophobia.
On the sixth day of his illness, while he had inwardly given up hope, Kaplan was dimly aware of a conversation taking place near his bedside. A plastic-suited figure, breathing in oxygen through a face-mask like some undersea diver, was in the room and talking on the telephone. The words reached Kaplan across the waves of his sickness. Almost against his will, for by then he hoped for death, a quick merciful death, as much as he hoped for anything, he caught the note of hope in what was being said:
“Don’t worry about transport,” the voice in the room was saying, “we’ll handle that. The military have a plane standing by, and we can be with you by lunch-time. Just make sure you have the stuff ready. We’re going to need a pint. More, if possible . . . Yes, of course I realize there are others. I’m not trying to deprive them. But dammit, Kaplan has to have priority, doesn’t he? We need him. The whole country needs him if we’re going to lick this thing.”
Kaplan heard the phone being put down and then the sound of two people talking quietly together.
“It’s incredible,” one voice was saying, “it looks as though Reuben is pulling through.”
“But that’s a statistical impossibility.”
“Well, it’s happened. They’ve just told me on the phone. There is a good chance of serum, and we’ll be able to use that to help Kaplan in his fight for life.”
“And the others?”
“Yes, the others, too. But Kaplan above all.”
The voice faded as a fresh bout of delirium intervened. When, twenty-four hours later, Kaplan once again recovered his mental equilibrium, he was conscious of an overwhelming sense of relief. Much of the pain had gone, and though a general sense of weakness remained, he could feel that his strength was beginning to return. It was as though a cloud had passed from the land. He knew that, thanks to Dr Reuben’s life-giving serum, he was going to survive. The antibodies which the old doctor had developed in his fight for life had in turn helped Kaplan; and they would help others too.
Feeble though he was, Kaplan realized that — amazingly, incredibly — a line of defence against the Marburg virus had been created. It wasn’t the whole answer because, in the nature of things, one man’s serum could only give a limited measure of protection. But at least the suspected cases could be treated, and those who had had immediate contact with the disease could be inoculated.
That evening, when the telephone rang beside his bed, he was already well enough to answer it himself. It was Susan Wainwright. He could hear the tears in her voice.
“Lowell, can you hear me?”
“Sure, I can hear you. I’ve been down a long way, Susan, but I’m coming back up.”
“Oh, Lowell, I’m so glad.”
“So am I. What about the others? There were others, weren’t there? I wasn’t the only one?”
“That’s for later, Lowell, when you’re really better.”
“It’s bad?”
“It’s not good.” She wouldn’t say any more. “Reuben sends his regards. He says to remind you he told you he was tough.”
“Susan,” the effort of speaking was beginning to tell on Kaplan, “how is Reuben’s sister?”
“She’s dead.”
Kaplan groaned. “Didn’t they give her the serum?”
“There wasn’t enough, Lowell. They gave it to you.”
Kaplan groaned again. “Did Reuben know?”
“Reuben knew. He insisted that you should have it.”
“Oh my God.” Kaplan put down the phone and turned his face to the wall.
4
For those who had not been intimately involved, the incidence of disease which occurred in New York in the summer of 1982 passed rapidly into history. The New York Times noted the recovery of one of the victims, Dr Isaac Reuben — ‘a medical practitioner of long standing in this city’ —and the death of several others. It mentioned that serum had become available during the course of the outbreak which had aided the survival of at least one of the victims. Making a comparison with the Legionnaire’s disease which had laid waste a veterans’ convention in Philadelphia in 1976, the New York Times commented: “We may never know the ultimate, or even the proximate, cause of this recent threat. What we do know is that it was successfully contained, and that is something for which the City of New York, the United States and perhaps even the civilized world itself, should be duly grateful.”
For Lowell Kaplan, now fully recovered from his illness aft
er a three-week period of convalescence, things weren’t quite as simple as they seemed to be to the New York Times. He knew just how close they had been to disaster. Marburg, after fifteen years, had come out of the closet with a vengeance, and Kaplan did not intend to ignore that fact. The personal response combined with the professional one. He knew the effect the disease had had on himself and on others, and was determined that it should not strike again.
One morning, when he was back at his desk at the Center for Disease Control in Atlanta, he put a call through to New York and spoke to Isaac Reuben.
“I just wanted to thank you,” Kaplan had said simply. “You saved my life.”
The old man answered: “God has given you time. Use it, son.”
Kaplan wanted to say something about Reuben’s sister, but somehow the words would not come. Perhaps some debts were better left unacknowledged, he thought, as he put down the receiver.
“You know,” he turned to Susan Wainwright, once again his constant companion at work, “that man Reuben is a saint.” For a few moments they talked about Reuben and about the events of the past weeks.
“What are you going to do now?” Susan asked. There was an anxious note in her voice.
“Aw, hell!” Lowell smiled. “I think I’ll take a vacation for a few days. I might go to Europe. I haven’t been there for a couple of years.”
Susan Wainwright relaxed. A broad smile crossed her pretty face.
“That’s wonderful, Lowell. That’s just what you need. Whereabouts in Europe?”
She caught the mischievous expression in Kaplan’s eyes.
“Ever heard of a town called Marburg on the Lahn?” Kaplan replied laughing.
“Honestly, Lowell!” She remonstrated. “You never give up, do you?”
Kaplan flew overnight to Frankfurt. The plane was half-empty and he was able to stretch out for most of the flight. He awoke with the sun to see the flat countryside beneath him crisscrossed by autobahns and other high-speed roads. Even at this early hour, Germany was a nation on the move.
The Virus Page 4