by Larry Baxter
"Let's take a closer look. Incising throat, exposing tongue, trachea, larynx. Airway was completely occluded by distension of tongue above tracheotomy. Preparing sample of lung tissue, specimen jar number one. Sample of tongue, number two. Tongue tissue is hard, blotchy, apparently infiltrated with blood, but the blood seems to have undergone some structural change. It's as black as ink."
"Any ideas?" said Spender, almost inaudible through the respirator. His eyes remained closed.
"Two simultaneous infections? One local, inflammatory, bacteriological, one hantavirus?"
"That would be a long shot," said Spender. "We've got twenty-seven patients with identical symptoms and two more deceased."
"Yes. This is going to be a war. Are the Centers for Disease Control sending in the reserves?"
"Full court press." Spender ran his hand through his hair and opened his eyes. "We're expecting two epidemiologists from CDC, one from the Division of Vector-Borne Infectious Diseases in Fort Collins, two diagnosticians, three techs and a trailer full of equipment. There's also some Washington hotshot named Theslie to coordinate all the agencies."
"It sounds like we have their attention."
"We will have lots of help. I have a bad feeling, though. It's too fast, too slippery, too fatal. Get back to that poor boy, Albert, I'll get out of your hair. Full report tomorrow?"
"First thing in the morning."
Spender pulled himself out of the chair and headed back to his office. He was intercepted by the Chief of Medical Staff, Dr. Tim Maxson.
"Good, we need to talk," said Maxson, following Spender into his office. "This outbreak. Anything new?"
"Just that it's faster and scarier than anything I've ever heard of."
Maxson nodded. "We need a manager for the project. You've been specializing in infectious diseases for us, but didn't you help with epidemiology at Houston?"
"Yes, but the work I've been doing here on infectious diseases is more challenging."
"Does managing this outbreak sound like enough challenge?"
"More than enough. Too much. Won't the CDC have their own people?"
"Probably. But there's a lot to be said for local knowledge. You'll be the man until the CDC says otherwise. Let me know what you need, we'll talk tomorrow. Good luck."
Spender nodded, called his wife to say he wouldn't be home, and walked slowly down to the waiting room off the lobby where he could get a few hours sleep on the narrow sofa.
Chapter 4
* * *
Austin, Texas, September 30, present day
A municipal police officer wearing a white respirator ran to move an orange cone, then gestured the Apex One-Day Exterminator van to a parking spot near the main entrance. Dr. Gary Spender hurried through the cold wind-blown rain. He handed respirators to the three men emerging from the van.
The scene was chaotic. White-coated and masked attendants wheeled patients on plastic-tented hospital gurneys down the concrete walks, and sirens sounded in the distance as police evacuated a cordon of nearby buildings..
Conover Mercy Hospital was a collection of half a dozen two- and three-story buildings on a rise of land in the northeast quadrant of Austin. Its normal 3:00 A.M. quiet was being blasted into oblivion. Portable spotlights and the intermittent flash of red and blue emergency vehicle strobes lighted the scene, and the sense of unreality was heightened by the early hour and the reflection of the colored lights on the wet asphalt.
A voice, distorted by a bullhorn, shouted instructions. "Clark building third floor, Room 37, gurney and oxygen, don't disconnect the IV drip. Charlie, get to the Tollens street entrance. Russell, don't forget to log the names in with the driver. You in the news truck, you can't park there, back it up."
A small helicopter clattered into view at five hundred feet altitude and probed the roof of the center building with a spotlight. Then it descended down the beam to hover just out of sight for a few minutes before flying away.
Dr. Spender instructed the van crew, "Put these on, tie them tight. They're activated charcoal, new type. Don't remove them." Spender ran his hands through his thinning hair and tried to dry them unsuccessfully on his already-soaked white lab coat. Activated charcoal. Right. We have no idea how this damned bug gets around, so we're really just pissing into the wind. Activated plutonium, it could be, or activated nitric acid—and still nothing seems to work.
The driver asked, "Doc, what the hell is going on? They said you had a big building that needed extermination. This is more than roaches."
"We've had some kind of disease outbreak."
The van crew stepped back half a pace, fastening their respirators tighter. "Don't worry, we're pretty sure it's contained in the center building there. But we need to take all possible precautions. We just weren't ready for this kind of thing and we've had to improvise."
"What kind of thing?"
"We're not sure," said Spender. "Virus, bacteria, maybe an insect. Maybe even roaches. Maybe something new."
"How do you know the respirators will work?"
"Well, to be truthful, we don't. But they work on ninety-five percent of infectious diseases, so it's a pretty good bet."
"Gotcha. What do you want from us?"
"Extermination," said Spender. "You normally use sulfurol fluoride gas, right?"
"Vikane? That's for cockroaches. We brought Vikane II, works for bacteria and viruses too. Damn near take your paint off."
"Good. The center building there, the Clark building, is the one. We've just sealed the roof vents, and the windows are all closed and locked. Can you gas it right now?"
"Not if we stick to EPA regulations."
"How about if you don't stick to EPA regulations?"
"I lose my license."
"How about if you're helping to control a virus outbreak that could kill half the residents of Austin?"
He shrugged. "Then the license wouldn't be so important. We've got plenty of gas. It's heavier than air, so we'll need to get a hose into the third floor."
Spender keyed a handheld radio. "Spender. We need a ladder truck in front of Clark. How soon?"
He listened to the reply and said, "Good. We'll clear a path. You'll need to extend the ladder to the third floor, but wait for a passenger."
He turned back to the van crew. "Got a long hose?"
The man counted floors. "Should reach."
"You normally tent a building to prevent gas leakage, right? We'll have at least this block cleared by the time you start gas flow. Any problem, working this one without a tent?"
"That should be plenty safe," said the van driver. "This stuff isn't particularly lethal to people in dilute form, anyway. Makes 'em sick. Kills bugs."
"And airborne bacteria and viruses," said Spender. "I hope."
A hook and ladder truck sirened up. Spender raised his own bullhorn. "Fire truck, right here, center building. You won't need water, you have a passenger with a gas hose. Take him up to the third floor window there."
One of the van crew walked to the ladder, unreeling hose, and climbed into the bucket with a firefighter. The ladder extended into the night sky, swaying and groaning with the unexpected load.
A dark blue Ford Taurus stopped near Spender, flashing a blue light, siren winding down. Spender turned to read the letters on the door: "CDC, Centers for Disease Control and Prevention, 37662." A short man in a dark blue suit squeezed his large midsection past the steering wheel and walked up to Spender.
"You Spender? I'm George Hapwell Theslie. CDC Atlanta, Washington. Troubleshooter. Field coordinator. Epidemiologist." He didn't offer a hand, but he took the respirator Spender offered. "Good, respirators, can't be too careful. Call me Hap. What've we got for status, here?"
"Twenty fatalities, all third floor, same ward, same symptoms. The first thirteen were a college archaeology team just returned from Mexico. They died between eight and ten days ago. The entire team, wiped out. The first to die was a football player, a huge man, very popular, I guess. The
entire campus is in mourning."
"OK. Sorry, I'm not briefed, they just flew me back from Somalia. Any cases in Mexico?"
"None. They were in the Yucatán, Uxmal. Far from population centers. Local medical people have sealed the site."
"Helluva thing," said Theslie. "What are the symptoms?"
"Flu symptoms at first, then pronounced darkening of the tongue, enlarged lymph nodes, inflamed spleen, difficulty breathing, bleeding from tongue and throat, and finally internal organ failure. We had the whole team isolated after we saw the symptoms, of course, and the staff used antibacterials according to procedure."
"And then?" asked Theslie.
"A week ago we got seven more infections, including two staff. We contacted you people. We sealed the ward, set up an airlock, fitted out six staff with fully sealed Racal suits and started looking for the propagation vector. Post mortems were done in the same sealed ward to avoid contamination."
"Very good, Spender," said Theslie. "Nothing wrong with your procedures. What happened?"
"Damned if I know. It got past the isolation barrier. We have no idea how. We still don't know how the disease is vectored."
Theslie tightened his respirator. "Great job so far, but let's see how safe we can play it from here on in. Anything else you need, call this number." He handed Spender a card. "My phone's on my belt all the time. Almost all the time. I've got National Guard moving in, we'll set up a perimeter ten blocks back. Are you all done here?"
"Just as soon as those people on the ladder dump a hundred thousand cubic feet of ethylene paraldehyde gas in the center building, there. Then we may want to burn it, your call. Everybody's out. We have a quarantine set up for anybody at risk, in the basement of the two-story brick building there."
"Great, Spender, you finish up here. We'll move the quarantine back ten blocks and burn it."
"The hospital?"
"Yeah, and about five blocks."
"You explain it to the mayor."
"That's why I'm here. Remember the Hong Kong thing, the zoonotic virus that jumped from birds?"
"Of course. They killed all the avian life on the island in two days."
"I was the one that explained it to the mayor. We'll move fast, here. I have authority for anything sub-nuclear, but I know who to talk to if we need to go nuclear."
Spender looked at him to see if he was smiling. He wasn't. "Good lord, Theslie, I hope you're joking."
"Me too. I'll get back and coordinate the Guard. We'll beat this thing. The CDC can handle it. Spender, you get good grades for running the ground operation. Can you continue with it for a while?"
"There's going to be an air operation?"
"Probably."
"I'll stick with it until you find somebody more qualified."
"Great. I'll be coordinating with CDC and the military. All hell's gonna break loose here if this thing isn't stopped in forty-eight hours. But we'll get it. We always get it."
"I hope so, Mr. Theslie," said Spender, shaking his head slowly from side to side. "I sure as hell hope so." As he walked back to the exterminator's van, a cold gust of wind threatened to blow his thin body into the gutter.
Chapter 5
* * *
Boston, October 7, present day
Dr. Robert Asher pushed aside dusty curtains and gazed from the oversize windows on the Commonwealth Avenue traffic four stories below. A few yellow leaves dropped by the scraggly maple trees were blown up to his level by the strong east wind. A little fresh air would be good, he thought, if only the windows hadn't been painted shut. Probably around the turn of the last century.
Boston University was sited on the level plain created in the 1800's when Boston had annexed the mud flats and quintupled its land area. Its light brown buildings, lined up between the Charles River and the Avenue, reached only to the eight or ten stories possible on the unstable fill.
Robert turned back to the room. A low wooden table presented a selection of stale croissants and Danish pastries left over from some morning function. Presiding from his wheelchair was Dr. Edward Teppin, Chairman of the Department of Biology at Boston University, and in attendance were a few staff members and half a dozen professors reporting on their research projects.
A fellow researcher, Art Baker, wandered over, nibbling on a Danish and shedding crumbs on the dark red carpet. "Hey, Robert, how's the new proposal? You ready for your presentation?"
"I'm ready for bed. I thought I'd just finish up the math before I started my slides. Fell asleep at 6:00 A.M. You any good at elliptic Bessel functions?"
"Pass."
"Rats. I thought I could handle it, no go. Now I have no math, no presentation, no sleep and no breakfast. But it doesn't matter, I don't think this one is going to work, anyway. I'll tell Teppin, maybe he's got something else for me."
"Have a week-old pastry. Good luck."
Robert crunched on a croissant as he watched a biological chemist talk about a recently synthesized chemical. Something about E. coli breakouts and sewage outflows.
A beeper sounded. Most of the staffers checked their pagers and cell phones by reflex, but the sound stopped only when Teppin picked up the wireless phone from his wheelchair. He turned the chair away and spoke quietly for a minute, then turned back to the group.
"Sorry for the interruption, but I've been called away. Tracy, if you would, please lead the meeting and continue the review."
He turned to Robert, "Robert, please join me in my office."
Robert, a little groggy from lack of sleep, picked up his tweed jacket and walked beside Teppin. They took the elevator to Teppin's third floor office.
The office was spacious and high ceilinged and cluttered with memorabilia. The windows presented a panoramic view of the Charles River. Books and journals were stacked on several bookcases and various dusty pieces of medical instrumentation shared a large side table. Framed certificates and enlarged photographs of small groups of smiling people covered a wall; Robert picked out Henry Kissinger and James Watson.
Teppin picked up the phone again.
"Dr. Spender? I'm back. Meet Robert Asher, he's my blue-sky thinker. He may have a couple of possibilities in his back pocket. Robert, Gary Spender is at Conover Mercy hospital in Austin. He is fighting a virus outbreak."
"Hello, Dr. Asher, I think I met you briefly a while back at Houston General, you were picking up your daughter and your ex-wife, I think. Her name is Asher, also, isn't it?"
"It was at the time. She's remarried."
Teppin broke in, "Dr. Spender, do you have video there?"
"Yes, of course, I'm in my the office. I'll turn it on."
Teppin touched the keyboard mounted on his chair and a nearby monitor blossomed with video from Texas, showing a gray and slender lab-coated man behind a desk piled high with magazines and paper.
"Now, how can we help?"
"The virus. It looks like it is indeed new, or maybe just old and dormant for a long time. It may be a primitive predecessor of Ebola. It's going to be trouble. A whole lot of trouble. I'm looking for help from as many good people as I can find. I read your group's paper on the use of IR spectroscopy in vivo for prion detection in J. Experimental Virology. There's damn little pathogen research that brings in new concepts like that. I was wondering if the device had been further developed."
A woman appeared in the picture, carrying a medical bag. She glanced at the camera. "Sorry to interrupt. We have a couple of problems, when you can get free." Spender nodded and she strode quickly out of the office, yelling to somebody off-camera.
Teppin spoke. "Our group is working on several different projects, but there's nothing I can think of right now that would help. We're no longer working on IR spectroscopy. I'm sorry."
"I thought the IR device was being studied for possible use in designing virus antidotes," said Spender.
"Yes, it was," said Robert. "Antidotes, drug treatment, vaccination. The spectroscope proved out in prion detection, but the tests on viruse
s and bacterial pathogens were not successful."
"We're working on commercializing a silicon chip from Purdue," said Teppin, "It can classify pathogens. But you need a vaccine or a drug treatment, not classification, right?"
"That's right. Thanks for your time. Sorry to bother you."
Robert held up a hand. "Wait. There's one possibility. Dr. Teppin, remember the charge microscope I was playing with last year?"
"Of course. I should have thought of that. Dr. Spender, maybe that's our one long shot. It could be years away, but maybe we can find a way to put it back on the active list and speed up the schedule."
"What's a charge microscope?" asked Spender.
"It images a molecule with electrostatic charge instead of with light, like an ordinary microscope."
"How does it work?"
"The implementation is pretty simple," Robert said. "It's a matter of preparing the sample in a high-purity crystalline matrix and finding a flat smooth material with a matching crystal matrix to act as sort of a moiré effect magnifying plate. Then you bring the plates into tight contact, put a high voltage on the magnifying plate, and pull the plates apart. This leaves a charge pattern like on a Xerox copier. You have to make sure the humidity is low, and dust the plate with almost any fine powder, and the charge pattern of the molecule appears, magnified maybe ten thousand times. Theoretically."
"How does that help you design an antitoxin?"
"It gives you a way to look at complex hydrocarbon structures in the same way that a virus molecule does, as a three-dimensional array of charges. A virus molecule is inactive without a receptor site, and this microscope maps molecules as if they were receptor sites. Possibly it would allow designer antivirals, molecules that are mirror images of the virus' receptor charge pattern."