by Larry Baxter
"Edifice rex?" asked Robert.
She smiled. "If you like edifices, you'll love our new virtual reality trip. We're getting it ready for the Peabody; instant Maya culture. Would you like to check it out?"
"Sure."
She popped a disk into her computer and handed him something that looked like a small submarine, but inside out.
"Put this helmet on; you'll see an artist's reconstruction of Palenqué in about seven hundred fifty. You will be able to fly around with the joystick."
Robert slipped on the heavy headset and grabbed the joystick handle. He was transported to the broad main avenue of Palenqué. The buildings were a bright ochre color in the midday sun. He seemed even to feel the heat of the sun, but then he realized that the heat of the electronics in the helmet was largely responsible. He turned his head left and right and the scene followed his movement. Maya Indians moved along the avenue, and in the distance a group of Maya decorated with colorful feathers mounted the steps of the largest pyramid.
With the realism of the scene and the huge crowds of people moving purposefully through the beautiful city, it was easy to think the Maya would be capable of developing a microscope and a drug therapy for the virus.
Chapter 8
* * *
Atlanta, Georgia, October 23, present day
Centers for Disease Control and Prevention
The "War Room" at Atlanta's Centers for Disease Control measured forty by seventy feet. Along one of the long walls were arrayed four large flat display screens. With a deep red carpet, a high ceiling, indirect lighting, and liberal use of dark wood paneling, the room had more the ambience of a plush hotel lobby than the venue for a hastily-assembled meeting of industry, academic, and government experts. The long walnut conference table stretched nearly the length of the room, and in a corner two technicians wearing headsets sat before computer screens.
The room buzzed with the conversations of the nearly one hundred invited experts, clad in a variety of dress ranging from dark blue pinstripe business suits to T-shirts. One woman wore green hospital scrubs as if she'd been interrupted in the middle of a surgical procedure. Each invitee wore a hand-lettered identification tag.
A thin man dressed informally in slacks and a wool sweater hurried in late, brushing his gray hair off his face and showing a three-day growth of beard below deep-set dark eyes. He fastened an identification tag to his sweater: "Dr. Gary Spender, Conover Mercy Hospital, Austin, TX, USA." Then he found a chair, sat down, closed his eyes, and rested his head in his hands.
Spender felt like some kind of V.I.P.; CDC had arranged a military jet to fly him to Atlanta for the conference. But he hadn't had time to fully complete quarantine before takeoff, so he made the flight in a very uncomfortable hazmat Racal suit and tested himself for the virus on arrival. Still negative; thank God for small favors.
Just outside in the corridor, several security guards were struggling to close the doors on a dozen camera operators, reporters, and sound technicians carrying video cameras and battery-powered lights.
The leftmost screen displayed an image of Edward Teppin with a superimposed graphic that announced, "Dr. Teppin, Boston, MA." Spender saw the name with satisfaction. Edward Teppin was the one person who could maintain his perspective in a crisis. How was that new microscope coming along, he wondered. Probably should call Teppin right after he got airborne for the return trip.
The next screen showed a video feed from the familiar oval office and a graphic, "President of the United States," but the long desk was manned by the Chief of Staff. The other screens displayed a man sitting at an ornate desk, labeled "Giscard Corot, WHO," and a matronly woman labeled "Phyllis Eisenberg, NIH."
A big heavy-set black man wearing a rumpled white shirt and a loose tie strode energetically to one end of the table, adjusted his tie fractionally, picked up a cordless microphone and tapped it to quiet the room. "Take your seats, please. Forgive me if we neglect the usual formalities, but we are in a war. If there's anyone here that doesn't know me, I'm Robbins, CDC director. We are pleased to have, from B.U., Dr. Edward Teppin. The World Health Organization, and the National Institutes of Health are also linked by video. The President is being represented by his chief of staff.
"We also have representatives from USAMRIID, the United States Army Medical Research Institute of Infectious Diseases; our own Special Pathogens Branch; CBIAC, the Chemical and Biological Defense Information Analysis Center from the President's Executive Office; PHS/OEP; the World Health Organization; the Office of Emergency Preparedness from Health and Human Services; INCLEN, the International Clinical Epidemiology Network; and a few others I can't translate. And we have new rules. I know the normal Washington procedure is to cover your assets and compartmentalize your knowledge. That won't work. Before we leave here today, we must have formal but open lines of command and communication, unconditional cooperation, and clear lines of responsibility.
"Some of you are concerned that we have been attacked by biological terrorists. We have new evidence that suggests that terrorism is not the source, but the capabilities of organizations like USAMRIID that are designed to combat biological terrorism will also help us combat a natural virus outbreak. So we will work together.
"We'll begin by taking you through what we know about the Austin virus and then enlist your help in planning, management, and resource allocation. Interrupt with pertinent questions only, please. We have Dr. Gary Spender here today. Gary was at the epicenter of the event, and he has been leading the field teams in Austin. Dr. Spender?"
A screen lit up with the message "Differential Diagnosis," and Dr. Spender stood to lecture the group. "We haven't found anything that can stop the virus, but we do have a few things that slow it down. Accurate diagnosis does not seem to be a critical element, but we do have a staining procedure that works well. Patients with the prodrome symptoms may be assumed to have the Austin virus and must be quickly isolated. Patients merely exposed to known carriers should also be isolated.
"Early symptoms are difficulty breathing and occasionally a violent coughing attack. Black tongue can be seen within forty-eight hours to confirm the diagnosis. Chest radiographs show bilateral interstitial infiltrates consistent with frank pulmonary edema." His words were punctuated with bulleted text appearing on the screen.
A second screen lit up with the title, "Pathology." Spender continued, "The pathology is distinctive. Dense, rubbery lungs, tongue shows vascular changes with pronounced swelling, generalized capillary dilation and edema." The screen showed pictures of the autopsied organs. "Any questions?"
The woman dressed in green scrubs stood, "Dr. Spender, do you have any clues about the antecedents of the pathogen? It sounds similar to the symptoms of mustard gas."
"We'll have more on that later. We have been talking to experts on biological warfare substances. The black tongue is, of course, unknown as a viral disease symptom."
"Treatment" scrolled across the screen.
"Not so much treatment as containment," said Spender. "We have no successful treatment at this time, we have a fatality rate of over ninety-nine percent. Only one survivor, a fourteen-year old Native American girl of Maya ancestry. We're checking on this, there could be some genetic immunity here. We estimate a minimum of a year to develop any kind of treatment with full resources deployed, but this is, of course, wildly conjectural.
"The field teams in Austin are using strict isolation techniques in depressurized rooms, full face mask respirators, enteric precautions, and body fluid and blood precautions.
"What treatment we have can prolong life by several days. We have tried mechanical ventilation, radical tracheotomy, oxygen, heat, cold, and naturally the full spectrum of drugs. That concludes my report, unless there are further questions."
The representative from INCLEN stood. "We'll need international coordination, of course. INCLEN will be able to handle this responsibility, but we will need additional funding. Is there—"
The dir
ector interrupted, "Later, please. We've pulled several people off the front line in Austin and from research labs to help us understand the virus and the epidemic. The first part of this meeting will be hearing from them so we can all understand the problem. Then we will send them back to work and descend into our usual bickering about organizational responsibilities and funding. Next slide, please."
"Epidemiology," barked the director, as the word scrolled into the display. "We have a new and virulent, almost one hundred percent fatal, multi-drug-resistant microorganism. The transmission vector is not completely understood at this time but field work suggests airborne droplets. Initial infection may have occurred in Mexico, in the Yucatán peninsula, where an archaeological team from the University of Texas was excavating in the jungle on an ancient Maya site.
"This team returned on a Texas Air flight to Austin. The team members are all now deceased, along with the two flight attendants, twelve other passengers on the flight, fourteen hospital patients with unrelated admission symptoms, seven hospital staff and twenty other Austin residents who were not connected to the hospital.
"The detailed planning on how we should proceed is, of course, the subject of this meeting, but in conversation with many of you the rough outlines are clear." He nodded to a technician and a map of North America appeared on the screen. "The Pan American Health Organization is back-checking the Yucatán. Although there are no confirmed incidents there, it seems likely that the infectious agent persists. Also, there is a possibility that indigenous Maya populations may be affected but tribal doctors may be handling the sickness and not reporting to health authorities."
A doctor raised a hand. "The Maya girl that survived. What were her symptoms?"
"Good question. Doctor Spender?"
"Flu symptoms, darkened tongue, the virus' signature, but not as severe. She needed hospitalization, flu treatment, fluids and rest. Blood work was negative for the virus, maybe just because of concentration. She was discharged in a week."
The director nodded and continued, "In any case, the archaeological site has been shut down. It has been washed with antibacterials and antivirals, closed and sealed, and is under heavy guard." A picture of the site, surrounded with barbed wire and yellow tape, appeared on the screen.
The director nodded at a technician and a city map of Austin appeared. "Here's the Austin hospital and its outbreak cluster. The red zone, about a ten-block area, has been evacuated and disinfected or burned. We have surrounded the red area with a ten block yellow area, with quarantine procedures strictly enforced and round-the-clock sentries. But over here," he pointed to red dots a mile to the west, "well outside the quarantine boundary, is what really scares us. These people have no known connection to the hospital."
Several people spoke at once, and the director gestured to one. "Dr. Robbins, do you have any theory about how the virus could have jumped the isolation barriers?"
"One possibility is that the pathogen can survive indefinitely in an airborne droplet and infects on inspiration or skin contact. Gary, can you help?"
Spender stood slowly, nodding. "That's correct. And the violent cough seems designed to propel a large volume of small-particle aerosol pathogen. We now mask all patients as well as staff. We also found a correlation between relative humidity and propagation. The outbreak occurred during a rare hour or two of nearly one hundred percent relative humidity, and it was directly downwind."
"What evidence do you have that indicates that the infection is more likely viral than bacterial?"
Spender continued, "Our lab has a quantity of acute-phase blood serum drawn from victims. They have attempted to amplify the pathogen adequately for electron microscopy, and they have some microscope images that show a tiny nail-shaped form, certainly a virus. Primitive, a half strand of DNA, but almost absurdly simple, less than a quarter of the size of Ebola."
Dr. Teppin spoke from his screen, "Is that it, then? An Ebola strain?"
Robbins answered, "Possibly, or a hantavirus-like relative, except it looks like the ancestor of Ebola or Hantavirus instead of an evolutionary successor. But that may be consistent with an etiology in which this virus was active in ancient Maya civilization but was eventually nearly exterminated by its own success as its hosts died. This is unsubstantiated conjecture, of course, but the mummified occupant of the tomb in the Yucatán showed some evidence of a severely swollen tongue."
The room quieted again as the delegates searched for reasonable options. The President's Chief of Staff spoke from his screen, resonant voice echoing, startlingly loud. "Well, what the hell are we going to do? Does the human race have to die out to kill this sucker again? Somebody give me the worst-case scenario."
The director's brow furrowed. "Dr. Teppin?"
"Worst case? You would like worst case," said Teppin, bending his head down and covering his eyes, talking so softly the delegates seemed to stop breathing to absorb his words. "Worst case, this makes the Black Plague look like a head cold. In five weeks, the disease engulfs Austin. We close the airport and barricade the roads, but too late. The media sensationalizes the virus, not that it isn't sensational enough, and panicky Texans slip through the quarantine barriers despite shoot-on-sight orders to the National Guard.
"The government considers a thermonuclear drop but waits too long. By the time approval is received, there are carriers in half of our major cities. But we don't know which cities they are, so we would have to kill most of our population to stop the disease. This, unfortunately, turns out to be politically unacceptable.
"A second outbreak in Mexico evades the Pan American Health Organization's cordon and creates a parallel bloom through Mexico and Central America. We are unable to find an antiviral or a treatment. Russia and China meet together and consider joint thermonuclear strikes, but, even combined, do not have enough warheads for adequate containment.
"Governments quickly collapse and urban violence begins to kill more people than the disease. Then, as you say, we kill the virus as its host dies out, except for tiny residues of pathogen which may survive in the desiccated corpus of victims interred in humid climates, or protected by heavy tombs."
The man on the WHO screen abruptly stood up, knocking several items on his desk to the floor, and moved off-camera.
"Hopefully, several pockets of humanity survive, maybe on isolated islands or near the poles. In a few millennia the survivors repopulate the earth and the cycle begins again."
After a long silence the Chief of Staff said, "I wish I hadn't asked. How come it's more serious this time than the Maya thing?"
"The Maya thing was fairly serious, it destroyed their civilization. We have several complicating factors, particularly our superior mobility. I'm assuming that we will confirm the pathogen as a virus, and the virus droplet-borne, and Dr. Spender's humidity thesis makes sense. Then propagation would be more efficient in areas of high humidity like southeastern U.S., less efficient in the dryer Yucatán, the coastal plains of Texas and the U.S. West. Curious, no? In this model, the virus prefers wet days to propagate but prefers dryness to incubate after killing its hosts.
"In any case, the Yucatán geography could have acted as a natural barrier. The western deserts would act as a similar barrier if our population weren't so confoundedly mobile."
"What would you recommend, Dr. Teppin?" asked the director.
"I'm not an epidemiologist, so you are free to disregard this. Sacrifice Texas and a slice of northern Mexico. Draw a line through the sand. Bring in half of the National Guard and the armed forces to maintain the cordon. Shoot down departing aircraft."
"Good Lord, Teppin," snarled the Chief of Staff. "Condemn ten million people to a horrible lingering death? That is absurd."
"I suppose a thermonuclear drop would be more humane, but the full quarantine at least gives them a chance at life."
Robbins picked up the microphone again. "For obvious reasons, we have not invited the media today. We will release a carefully worded press release this
afternoon, presenting a more optimistic scenario. You are all instructed to avoid making any public statements. Doctor Teppin, do you have any less-dramatic suggestions?"
Teppin spun his wheelchair, appearing in profile as he looked out a window. The delegates in Atlanta saw with him the first big slow snowflakes of an early Boston snowstorm. "Discover an antiviral. We'll need to be very good and very lucky. Another long shot would be to discover a previously developed antiviral."
Many delegates shouted at once and the director distilled their questions. "What are you talking about, Teppin?"
Teppin looked back into his camera and one corner of his mouth pulled up a fraction of an inch. "Such a long shot that I do not dare to give you any details now, except to say that it should not be considered as a viable option, just a little entertainment for a nearly-extinct biologist and a promising young scientist. But I would like to ask for a little nominal funding for this project, say a hundred fifty thousand now and twice that within a few weeks."
"With no other explanation? Preposterous," said the Director.
"Give it to him," said the Chief of Staff, gesturing to someone off-camera. "President's discretionary fund. We'll need a reasonably accurate accounting, of course."
"Of course," said Teppin.
Gary Spender watched this interchange with a wry smile. Even after the careful explanation, they didn't get it. They couldn't handle reality, so they retreated back to the comfort of reasonably accurate accounting. He wondered how long money would be a meaningful concept as he grabbed his bag and headed for the airport. Austin's Meacham International was still operating, but George Hapwell Theslie had scheduled its shutdown for noon tomorrow.
Chapter 9