by Nicholas Lim
The epidemiology report proved to be incorrect but only after a £150m EU export ban and the slaughter of half a million birds. Had he been wrong to sound the alarm? Even now, he still thought he’d done the right thing. It had just been bad information, and bad luck for him.
“Chicken Charlie” – he had just about lived that nickname down. In the shake up two years ago he had been passed over for Department Head. Before Newhaven that would have been a surprise, but no-one had needed to explain.
Still, it could have been worse: his advice could have turned up as a paragraph in an over-edited government dossier; he could have ended up in a muddy wood with a hole in his head.
He settled back down to read the file. Someone had to do it. Government needed advice to govern. It was his job. His duty. The words of the toasts from his navy days came back to him, together with a memory of Caribbean nights at sea: “Sweethearts and wives (may they never meet)”, “Queen and Country”.
He checked an inward sigh. He was aware of Hanratty waiting and wondered why he was still hesitating.
He glanced up at the picture of Queen Elizabeth II on the wall. It was a reproduction, a fair copy of Pietro Annigoni’s famous portrait. The stern romance of the young queen caught by the Italian painter, the set of her mouth and carriage of her head, always moved him when he studied it. He knew his response was outdated; he heard it in the rude banter of the junior staff; men like Hanratty. One of the newer intake was a confessed republican for God’s sake. Time was, you could be hung for less.
Behind the portrait was a small wall safe. Old-fashioned and off-line. Like me. It contained codes he would not entrust to any computer system.
Still he hesitated. He re-read the file’s introduction. Something nagged at his mind, a forgotten fact he couldn't quite get a hold of. Some link.
“Your opinion?”
“I don't think this one's worth chasing. A–” Hanratty paused to consult his notes, “–Simon Kirkpatick is handling the incident at UK CDSC. We were notified through his Sentinel alert. I wanted you to see it because of the Porton Down connection. They’ve been involved for their malaria expertise.”
“Of course.”
Hanratty shrugged. “It'll almost certainly turn out to be a traveller import. There are regular outbreaks of malaria falciparum across southern Europe.”
White nodded. He suppressed a shake of the head: although he had asked for it, hoping for once to be surprised, he held Hanratty’s judgment at close to nought. The young man had had the benefit of the finest education England could provide: Rugby – or was it Harrow? – Clare College, Cambridge. The result had bred a set of correct responses fine-tuned as social machine but unfortunately not fully conscious. If he had gone into the City… but in intelligence you needed a man who could think for himself. Unfortunately there was no-one else – his number two and others were on summer holidays.
He shrugged. “Yes, all right. Just watch for now. Perhaps alert Sniffer.”
Sniffer, Five’s early-warning system, monitored the UK’s public health networks – email traffic, databases, web site content and NHS news feeds. Set up to alert when general conditions occurred – exceeded thresholds, signature information patterns – it could also be programmed to watch for specific events, and had repeatedly proved a sensitive set of electronic ears. White was aware Hanratty was a big fan.
“The continental outbreaks are all monitored by the WHO. They'll get this report too.”
“Mark for my review in seven days.”
“Yes, sir.”
“And I want to know immediately if any more cases come through.”
“Yes, sir.”
White allowed himself a small sigh. “That it?”
Chapter 10
“I’m so sorry about that.” Skinner entered an office glass-walled on three sides, where Garrett sat waiting. She shook her head and smiled.
“I’m afraid you’ve caught us at an unfortunate time. We’re shorthanded – most of my team’s on holiday – so of course there’s a rush on. We three are covering seven investigations, including a Chagas outbreak in Guangdong – thirteen hundred fatalities in the last six months – and a critical staph. notification from eastern Angola. That was Angola!”
Skinner smiled at her and jerked his head towards the outer lab. Lit by fluorescent lights, lab benches stood in rows like pews in a church. Two white-coated researchers sat on high stools, round-shouldered over a computer monitor.
Skinner stepped backward. “Rheinnalt, can you join us please. Actually both of you in the fishbowl for a minute?”
“Yes in you come. Christine, I’d like to introduce you to Rheinnalt Bryce, one of our microbiologists. This is Dr Christine Garrett. She’s here to discuss some unusual malaria cases–” Bryce looked Garrett over, from waist to hair. She saw curiosity flicker in his eyes behind his glasses.
“Christine, a pleasure to meet you. Hello.”
In the starting cadence of his greeting, Garrett heard the once-upon-a-time of a story-teller.
“Christine’s brought case histories, and some extra presents – biopsy samples and data. Captain Shani Zahra.”
“Hi.”
Zahra, short and small-framed in her white lab coat, moved out from behind Bryce with the quick careful steps of a bird. Black hair, bobbed square across her forehead, framed eyes heavy with mascara. She looked at Garrett with frank curiosity.
“C Garrett – as in RAPID?”
Garrett smiled. “That’s right.”
When Bryce looked puzzled Zahra nodded at Garrett. “Randomized superlinear gene detection. It’s a toolkit.”
“Must be five years old. I haven’t–”
“We still use it.”
“Shani is our molecular geneticist.”
“–Malaria, Crypto, they’re really George’s pigeons. I’m more on the Sarcodina side of things. And Mastigophora. And Ciliophora. And mainly protein modelling–”
“Yes okay Shani.”
Zahra nodded at a wall clock. “Cuito’s due to call back in ten minutes. Twenty cultures have tested positive.”
She glanced at Garrett then blinked as she turned back to speak with Skinner about the Staph. outbreak. Garrett wondered if she was a territorial kind of woman; she estimated she was in her late twenties, thirty at most.
Bryce moved around and pulled out a chair for Garrett, graceful in his movements despite his height. He stood until she sat.
“Thank you.”
“Where are these unusual cases?” Bryce leaned an elbow on the table and pushed his gold-framed glasses further up his nose with the fork of two fingers. The circular lenses, hippy-messianic on a musician, lent the man a scholarly, out-of-world precision. Garrett found herself studied by magnified eyes, intense in their still regard.
“The south coast. Sussex.”
“Okay, we’re here to discuss a CDSC notification on a cluster of three unusual malaria cases. Let’s do a quick case review shall we?” Garrett distributed copies of her autopsy reports. “Starting with Paul Fletcher. You've all got his chart. Christine, do you want to talk us through it?”
They began an extended discussion. As the lab team argued dosages and histologies, Garrett saw again the opened body, a bare arm braceleted by a hospital ID tag. She listened to the medical chatter and remembered measuring out the man's life by the wear on his teeth.
She noticed Bryce by an absence of movement. He was studying an autopsy picture of Fiona Grant. He muttered words to himself. “Ni edrych angau pwy decaf ei dalcen.” The sentence sounded like a spell. It was uttered privately, under the conversation.
“Fifty percent parasetemia rising to over ninety?” Zahra gave a low whistle. “That’s off the scale.”
“Quinedine was finally available,” Skinner said after a moment, as if satisfied. Reading on, he began to frown.
“It had no effect,” Garrett said. “I am not aware of documented resistance.”
“Perhaps we had a patient with pre
disposition factors,” Skinner mused.
“Malaria mutates quickly.” Zahra said. “Maybe this is a new strain.”
“Or drug dosage error, or a batch problem–” Skinner said.
Garrett opened her notebook. “I've looked up the epidemiological data. There has been one malaria fatality in the UK in the past ten years. That was six years ago. A businessman returning from Thailand, already infected. There are sixty or seventy cases of malaria illness reported annually, all similar imports. Of those, less than half-a-dozen were potentially cerebral, and all but that one case treated successfully with quinines.” Garrett put down her notes. “We're dealing with three fatalities in forty- eight hours.”
“That’s odd,” Zahra said, “Both hospital cases show swollen tonsils and lymph nodes in the throat. Sounds like strep.”
“Do we have backgrounds?” Bryce asked.
“Paul Fletcher was a motorbike courier for a trans-shipment company. Thirty-six, mixed race – English mother, Indian father – the only patient with a record of travel, extensively throughout Asia, though not in the last eighteen months.”
“What about the other two?” Bryce asked.
Garrett shuffled more paper. “Of course we know next to nothing about the missing persons ‘Lizzie’. Fiona Grant was a Caucasian woman, thirty-three years old. Single. Worked for a local pharmaceutical company. In previous good health. No recent travel abroad.” Garrett put down her notes. “It’s transmission that puzzles me most.”
Skinner nodded agreement. “UK marsh habitats haven’t been malarial for a century.”
“Do you know where the last known malaria outbreak was?”
“Isle of Grain,” Bryce and Skinner said together. Skinner grinned and finished, “Off the Kent coast. 1918.”
They contemplated the infection riddle in silence together.
“It’s been a hot summer,” Zahra began uncertainly. “Perhaps there’s been an unknown migration event.” Skinner looked at her over his glasses. Zahra shifted uncomfortably in her chair but plunged on. “There are unprecedented levels of species migration nowadays. I’m thinking of the blue tongue cattle outbreak in Sussex last year.” Zahra said. “That was caused by a movement of Culicoides.”
“There are over two hundred different species of mosquito. Why the vector Anopheles?” Skinner asked. Bryce shook his head and smiled agreement. Garrett was less sure of dismissing Zahra’s suggestion.
“What about blood transfusions?” Zahra ventured again, clearly the ‘ideas’ person of the group.
“The hospital blood was re-screened. Came up negative.” Garrett said.
There was silence.
“What about relapse?” Bryce said. Everyone looked at him. “If the deaths were caused by relapses from older infections then there’s no transmission issue: no need to look for recent infection marks or travel. Malaria can lie dormant in the liver for many years.”
“Can be for a lifetime,” Skinner said. “There are cases of fatal malaria recurrences from infections contracted sixty years previously. But,” he shook his head impatiently, “Three relapse cases simultaneously? And all the same strain?”
“Shared IV drug use?” Zahra suggested. “This girl had traces of LSD in her blood, she was a recreational drug user.”
“So far, the victims have no known connection,” Garrett pointed out.
“They have now. They’re all dead.” Bryce said.
A phone rang in the outer lab and Zahra went to get it. She returned only to put her head round the door. “It’s Cuito.”
“Rheinnalt, please continue going through the case histories.” Skinner stepped out.
“Well we’ve pretty-much covered them.” Bryce put the reports down on the desk. “It’s a shame the slide printouts aren’t clearer. I’d have liked a closer look.”
“I’ve got the source images,” Garrett said.
“That would be useful.”
Garrett passed him a memory key. Bryce swivelled his chair to face a terminal in a corner of the room. He turned his head to her, owlish behind his spectacles.
“Fiona Grant was beautiful, don’t you think?”
“Yes. She was. What was it you said earlier, was it in Welsh?”
Bryce tilted his head to one side and examined Garrett along his nose, then smiled and repeated, “Ni edrych angau pwy decaf ei dalcen. It means, ‘Death considers not the fairest forehead.’”
Bryce glanced out of the room to where Skinner and Zahra stood together. “May I ask, Christine, why you are so interested in this case? Surely you don’t go to these lengths with every unexplained disease cluster? Visiting the reference lab, bringing samples in person–”
“No, of course not.”
Garrett found she couldn't sit still, and stood up. She came to the dividing glass wall and put her hands in her pockets. In the outer lab, Zahra and Skinner were bent over a speakerphone, Zahra talking, gesticulating with her hands. Garrett noticed the lab's side walls narrowed perceptibly, like railway tracks in a painting, creating the illusion of distance. She remembered Skinner's description of the complex’s ring design, and decided she was looking towards the centre of the hub. An oval hatch was set in the end wall. It had a wheeled handle like a submarine door, marked 2III, above a design in yellow, three arcs intersecting a central circle, the international biohazard symbol.
Her fingers felt the sharp edges of something in one of her pockets. She took out Prenderville's card and stared at the sketch she had doodled above the beach in Brighton, of an eye surrounded by rays like a child's sun. She wanted to speak about Jason and the tentative connection she had found. One of the dead might have known him. It had been nearly two years. When he had left the last time he hadn’t even said goodbye, just raised a hand over his head. She couldn't reach him, couldn’t touch him, didn't know what he was doing. At least she could speak about him. It might fill that ever-present silence she carried with her. Garrett turned a cold eye on herself and filed the edge of self-pity off her impulse before letting it be. She put the card back in her pocket.
“Working in epidemiology, you develop an instinct for what is not right. I can’t put it more explicitly than that at the moment. Something feels wrong.”
She watched her words mist and fade on the glass wall. The sound of typing had stopped. Garrett turned back to Bryce. He adjusted his glasses, his movements shy.
“We are sent dozens of malaria reference cases every year,” he smiled when he looked at her, “All with anomalous behaviours of some kind, often lethal. That’s why we get them. They are seen once, then disappear – stray, non-viable mutations, never fully explained, never seen again. My guess is we are looking at one of those.”
“I hope you’re right.”
Bryce returned to his keyboard. His long fingers sounded a soft rain. Garrett noticed a faded cotton friendship band around his left wrist. She watched as he moved and resized images with practised skill. The man was gone, in his place only a point of concentration, out of phase with human speech.
There was a seriousness in him she responded to. She had a sudden odd memory of lazy Sunday mornings, long breakfasts spent reading the papers with bottomless pots of tea, toast hardening in racks, watching David work. She had loved to see him researching, taking notes, typing up his articles, bent over with un-childish intent, passionate, committed. In the years after they had met, she had seen how that strength of purpose had been the way he had found to grow up, and given him a maturity beyond the limits of his character, a strength she had measured herself against and drawn herself up to meet.
Waiting, Garrett turned back to the glass wall. She tried not to think about how far they were underground, the weight of rock around them, the dark in these labs at night.
“I don’t mean to discount your instinct. Nor the three deaths you have seen.” The soft music in Bryce’s accent brought Garrett back to the table. She sat down. A projector flickered on as Bryce’s fingers moved in impatient rushes. “I mean, we are
lab researchers. We study cells and molecules, not people. But we're not disconnected.”
Bryce stopped typing. He turned his hands palm-up and studied them. “It’s an odd power, don’t you think? We sit down here in splendid isolation, pulling our molecular levers and our mathematical pulleys. And because of what we do, something happens – or we understand something – up there in the real world. We depend upon that connection just as surely as a mechanic on a wrench.” Bryce returned to his keyboard.
“In my work,” Garrett watched Bryce’s fingers as she spoke, “in epidemiology, the key – the power if you like – lies in understanding those connections: the symptoms and infection vectors, patterns in the data–”
Bryce raised his eyebrows.
“Patterns. Hmm, that’s a good word Christine. Their regularity always suggests cause, no?” Bryce hit runs of keys, short acciaccaturas, in quick succession. The wall screen lit up to show a three foot-high image of blood cells. They shivered, once, twice, clusters of freckled pale cells enlarging each time, as if growing. Bryce selected one freckle. The magnified image of a single stained malaria parasite loomed over the room like a rose window. “Their beauty certainly speaks of one.”
Garrett sensed the brief vertigo of the converted. She had an impulse to tease, to replay an old argument. Each Sunday morning David had driven her to Mass with Jason. He had sat in the pub for an hour before driving them home, always asking ‘How was the blood today?’ It had been the only real disagreement between them.
“Beauty? Do you mean a first cause? Are you making a theological argument? “Garrett mimicked Bryce’s raised eyebrows. “Don’t you know James’ riddle? – What does the great world-carrying turtle stand on? And if a greater, what does that turtle stand on? I mean really Rheinnalt, can it be turtles all the way down?”