Pandemic

by Daniel Kalla

  Haldane sat and stared at the letters on the screen, without reading the e-mail again.

  He wasn’t shocked by any of what Anna had written. The signs had been building for some time. However, his calmness did surprise him; and even more astounding were the flickers of relief. He had heard patients say that the not knowing was worse than having the worst confirmed, but he hadn’t believed them. Now at least in the case of his wife, he understood. The crippling doubt and agonizing second-guessing evaporated, replaced by a heavyhearted sense of purpose. Saddened as he was, at least he could start looking ahead instead of behind.

  His cell phone rang, and he absentmindedly reached for it. “Hello?”

  “Oh, Noah!” Anna said. “I’ve been trying to reach you all day.”

  He sat up over the side of the bed. “Is Chloe okay?”

  “She’s fine,” Anna said. “It’s just that I sent you an e-mail yesterday ... when I thought you were on your way home.”

  She paused, but when Haldane didn’t comment, she continued in her frantic tone. “I never would have sent it if I’d known you were going to London to fight this epidemic. What an awful thing to put on your plate with you already facing so much!”

  “Why awful?” Haldane asked evenly.

  “It was such a stupid e-mail. All melodramatic and full of impulsive thoughts like something a fourteen-year-old might write.” She swallowed loudly. “Noah, please, will you just delete it?”

  “Okay,” he said.

  “And can we pretend I never sent it?” she added.

  He considered it for a while, then he said, “Anna, can I speak to Chloe?”

  “Mom’s got her for dinner. She won’t be home for a couple more hours.” Anna hesitated. “Noah, the e-mail? Will you destroy it for me?”

  “If you like.”

  “Very, very much,” she said with a nervous laugh. When he didn’t comment, Anna spoke up to fill in the silence. “Noah, this Gansu Flu. The media makes it sound so dangerous over there!”

  “They exaggerate,” he said.

  “You are being really careful, right?”

  “Always,” he said distantly.

  “Noah, please come home soon,” she said, her voice cracking. “Chloe misses you so much, and I ...”

  “Anna,” Haldane said.

  She swallowed again. “Yeah?”

  “The answer is yes.”

  “Yes?”

  “You can have time and space,” he said.

  “Noah, I told you, it was just an impulsive—”

  “We both know that’s not true,” he cut her off. “You have a lot to sort out. I understand. I want you to. It’s important for all of us.” He cleared the lump from his throat. “Do what you have to do. Okay, Anna?”

  Through the slight static, he heard his wife sobbing softly on the end of the line. “Will you still be there afterward?” she asked in a whisper.

  Haldane woke up early the next morning with a slight headache and an ill-defined sense of defeat, like a drunk waking up after a fall off the wagon.

  Desperate to avoid thoughts of the train wreck of his personal life, he lay in the warm strange bed and focused his mind on viruses. In spite of their oblivious malevolence, they held such fascination for him. They lived only to reproduce, and yet, they didn’t really live at all. Nature’s lethal half-measure, viruses were just floating bags of parasitic DNA or RNA, which required the complex machinery of a living cell to reproduce.

  In his mind’s eye, he imagined the electron-microscope-enhanced images of influenza crystals—perfect spheres surrounded by two proteins, hemagglutinin and neuraminidase, which stuck out of its surface like a ring of open umbrellas. Hemagglutinin and neuraminidase, which help bind the virus to its potential target, were also influenza’s fingerprints, allowing scientists to classify strains of the virus by their H and N type. He had heard the previous day from the WHO Influenza Surveillance Lab that the Gansu strain had been identified as H2N2, the same subtype that accounted for the Asian Flu of 1957. But he knew that ARCS was not the Asian Flu. After intermixing with other species’ viruses new proteins had hopped onto its surface and new genes had crawled into its RNA creating a superbug that had found its way from the farms of China to the streets of London and Hong Kong. And from there who knew where this minute monster might hit next?

  Haldane glanced at the clock. It read 6:32 A.M. Time to move. He dragged himself into the shower. He was changed and in the lobby by 6:45. Duncan McLeod greeted him by the elevator with a steaming foam cup. “Here’s a double-shot espresso for you,” McLeod said. “You’ll need this before Princess Charming shows up.”

  No sooner had he said it than Dr. Nancy Levine strode across the lobby toward them in a dour gray pantsuit. Her hair was in another tight bun, which served to accentuate the sharp ridges of her cheekbones and chin.

  “Speak of the devil,” McLeod whispered to Haldane. “Literally.”

  Haldane nodded to her. “Morning, Dr. Levine.”

  “Good morning, Doctors,” she said crisply. The creases of her frown deepened. “We had best get a move on it There have been more cases.”

  Levine started to walk, but Haldane stood his ground. “How many more?” he asked.

  Levine stopped and turned to him. “Eight people inside the hotel.”

  “And outside the hotel?” Haldane asked.

  “There are seven more suspect cases in Greater London,” she said. “All of them are traceable directly or indirectly back to a tour of the Tower of London where they had contact with the first casualty, an American oil company executive named Fletcher.”

  “Fucking marvelous!” McLeod hollered in the middle of the lobby. “Some brilliant Yank takes a walking tour with walking pneumonia.”

  Haldane ignored his colleague. “How geographically spread is this new cluster?”

  “A family in North London accounts for four of the cases,” she said. “The other three are Dutch tourists staying in a hotel in the city center.”

  “And their contacts are quarantined?”

  “Of course,” Levine said coldly. “To the extent that is possible. The victims are tourists. Therefore, they have been visiting all over London.”

  Haldane digested the information without comment. After they had loaded into the Land Rover and headed out into the morning traffic, Haldane summarized. “So we have at least three distinct clusters of infections in the city now. Most of it among travelers. What sort of screening is going on at the access points like airports and train stations?”

  Levine glanced at Haldane with an unfamiliar expression. It bordered on respect. “We immediately instituted our SARS screening plan at the airport. We have used the same questionnaire regarding fever and cough. And we are screening temperatures,” she said. “We have tried a similar approach at the train stations. However, we have far less control of the traffic there.”

  “How many of the guests at Park Tower Plaza have left the country in the last five days?” Haldane asked.

  “Several,” Levine said. “We have been going through the hotel’s checkout lists and the flight logs, contacting affected travelers. So far, no one we have reached has developed symptoms. We have recommended home quarantine to all of them for a minimum of five days.”

  “Good.” Haldane nodded. “There have been no cases reported outside London?”

  “No.” Then Levine added, “Not yet.”

  The fatalistic comment brought a lull to the conversation. Haldane stared out the window at downtown London. There were cars and people on the sidewalk, but it looked very different from the bustle he remembered. The sight was eerily reminiscent of the streets of Jiayuguan City. He knew it wouldn’t be long before faces everywhere in London were hidden behind surgical masks.

  Haldane looked over at Levine. She gripped the steering wheel tightly. She had deep bags under her eyes, suggesting she hadn’t slept in days. It occurred to him that Levine’s haughty frigidity might have been partly in reaction to the en
ormous stress she was confronting. Haldane had seen other senior public health officials crumple in the face of lesser outbreaks.

  “Dr. Levine,” he said, “it would be a good idea to set up screening clinics today in the neighborhoods where there are known cases.”

  She glanced at him, her face set for an argument, but then her expression softened. “I will suggest it to the others on the Health Commission.”

  “What about the index case?” McLeod piped up from the backseat.

  Levine shook her head. “We’ve not found her yet.”

  “Her?” Haldane said. “So you think it is the Spanish woman from the elevator of the hotel?”

  “So far, she is the only connection we have uncovered.”

  “Bloody odd, isn’t it?” McLeod pointed out.

  “How so?”

  “Why hasn’t she turned up anywhere for treatment?” McLeod asked.

  Levine sighed. “Dr. McLeod, there are countless hospitals and private clinics in London. She may well have presented to one of those before they had been alerted to the existence of the Gansu Flu.”

  “Or maybe she’s dead,” McLeod said. “You have checked the morgues, right?”

  “Of course, we have,” Levine snapped. “None of the cadavers match her description.”

  Haldane shook his head. “Putting aside the fact that she disappeared into thin air, the question I can’t shake is: where? From where would this woman—Spanish, Greek, Italian, whatever—have caught the virus in the first place?” He looked over his shoulder. “Duncan, did you notice many scantily dressed Caucasian women in Jiayuguan City?”

  “Not an abundance, no,” he said. “But Hong Kong is a different story.”

  Haldane shook his head. “The outbreaks occurred simultaneously. The timing would have been all wrong for her to become infected in Hong Kong and then spread it here.”

  “What about the Chinese government?” McLeod asked.

  “What about them?”

  McLeod leaned forward. “They lied through their teeth about SARS. Maybe the Gansu Flu is rampant in Beijing or some other city and they’ve been busy covering their asses.”

  “Then why invite us to Jiayuguan in the first place?” Haldane asked.

  “Christ, Haldane!” McLeod threw himself back against the seat. “You’re not under the delusion that governments apply logic or reason to their planning?”

  “Dr. Haldane is right,” Levine said definitively. “We would know by now if the Gansu Flu had spread to central China.”

  “So where does that leave us with our index case?” Haldane looked from McLeod to Levine.

  “A mystery,” McLeod muttered. “The fucking Stonehenge of microbiology, isn’t it?”

  Haldane didn’t reply, but he knew from experience that there would turn out to be a very rational explanation for where the woman and the virus she shed came from. He hoped that explanation would come sooner rather than later. He knew they were just spinning their wheels until they found it.

  “How’s the little girl doing?” McLeod asked from the backseat. “Alyssa.”

  “I heard she was weaned from the ventilator this morning,” Levine said and her lips formed a hint of a smile. “Apparently they have upgraded her condition to stable.”

  They drove past the landmark Kensington Gardens at the west end of Hyde Park and turned off onto Pembroke Road in the heart of the trendy Notting Hill district of London. Approaching the entrance to the Park Tower Plaza Hotel, Haldane noticed that the streets were lined with rows of trucks and vans, many of which bore TV channel logos on the side. As the car slowed to a stop, Haldane experienced another jolt of déjà vu.

  The street had been barricaded with police cars blocking either end.

  “To keep the press away,” Levine explained as she rolled down her window for the officers manning the checkpoint. Once she had cleared security, she inched the car past ambulances and other government vehicles and into the hotel’s driveway.

  Armed police guarded the entryway. They scrutinized Levine’s ID before directing her group to a makeshift change room. The three doctors donned gloves, caps, booties, gowns, and special N95 masks, which were designed for protecting against airborne TB particles. Looking like an entourage of misplaced surgeons, they entered the lobby. The posh hotel had been converted into a makeshift clinic. Fully garbed health-care workers milled about the lobby carrying thermometers, charts, and stethoscopes.

  Nancy Levine led the others to the elevators. They rode the same elevator where Alyssa Mathews had acquired her life-threatening infection to the twenty-fifth floor. “We’re using this floor as a special quarantine floor, specifically for people known to have acquired the virus,” Levine explained. “The gentleman we are to meet, Mr. Collins, was in the Royal Free for three days but transferred back here last night to free up space in the hospital once his fever broke.”

  A fully garbed attendant met them at the doors to the elevator and directed them to the end of the hallway. After three knocks, the door opened. On the other side stood a bald man, wearing a mask and pajamas that looked loose on his thin frame. Because of the man’s mask and lack of hair, Haldane had difficulty placing his age. Though he would have guessed Nigel Collins was close to his own age, somewhere in his late thirties.

  After introductions, they followed Collins back to the small sitting room. As in the hospital in Jiayuguan City, Haldane found it awkward to conduct an interview with a group of masked people. Without seeing people’s faces, it was difficult to read much into their responses.

  “Where are you from, Mr. Collins?” Levine began.

  “Call me Nigel,” Collins said in a thick Liverpool accent, making him sound to Haldane like John or Paul from an early Beatles’ interview. “Liverpool originally but live in Birmingham now. One of the local reps. Steelworkers union.” He laughed. “Lucky me, name got drawn to come down for the big convention and stay in this swish hotel. Hah!”

  “When did you first fall ill?” Levine asked.

  “Four days ago!” he said, shifting constantly in his seat “Hit me like a train. Woke up and couldn’t move. Burning up. And the pain! Felt as if my arms and legs had gone through the rolling presses. Then the cough came. Crikey!” He guffawed. “Had me thinking that the smokes finally caught up with me!”

  “Were you short of breath, Nigel?” Haldane asked.

  Collins hemmed and hawed. “When the coughing spasms came, couldn’t stop to catch my breath. Between times, not so bad. No idea it was possible to feel so weak, though. Raising a cup of water took both hands, if I could at all.” He blew out so heavily that his mask fluttered over his mouth. “Then yesterday the fever broke quick as it came. By evening time felt almost normal again.” He pulled at his pajama tops. “Except skinnier.”

  “Nigel, where do you think you might have caught this virus?” Haldane asked.

  “Not think!” He puffed out his mask again. “Know!”

  “And where is that?” Haldane said.

  “Lovely little waif of a girl,” he said and then looked at Nancy Levine. “Sorry, Doctor, it’s just that—”

  “Mr. Collins,” she cut him off impatiently. “Could you describe her please?”

  He offered a similar description of the woman as Veronica Mathews had, and then he said, “Around suppertime. I stood beside her waiting for the lift. Kind of swayed on her feet the whole time. Not well at all. Coughing the whole ride up. Still she covered her mouth, polite-like, and she wasn’t exactly hard on the eyes.” Again, he glanced to Levine. “You know what—”

  “I know exactly what you mean,” she snapped. “Which floor did she get off?”

  “Same as me. Twenty-seventh.” He guffawed. “Union boys outdid themselves, getting me a room on the top floor!”

  “You rode the whole way up with her?” Haldane asked.

  “Yes, sir.”

  “Did you ever see the woman again?”

  Collins shook his head.

  “Did you remember s
eeing a mother and two little girls board the elevator?” Haldane asked.

  “Another beauty, right?” Collins asked and then shrugged at Levine apologetically. “I can’t help noticing, Doctor.”

  “Apparently not,” Levine said. “Mrs. Mathews is tall with dark hair and large eyes. A former model with daughters aged four and five. Does that sound like her?”

  “Exactly like!” Collins said. “Except she wasn’t in the lift. I had seen her at the pool with her girls once or twice.”

  “You sure she wasn’t in the elevator?” Haldane asked.

  “Not with me or the coughing girl,” Collins said. “At least not on the way up. I can’t speak for the way down.”

  “Meaning?” Haldane asked.

  “Well, when I got to my room, I turned around for one last little peep,” he said sheepishly without looking to Levine. “The girl had sort of collapsed against the wall by the lift. Thought about going back to see if I could help. Then the lift door opened. She stumbled back in.” He paused. “Never really thought much of it, but don’t know why she bothered going all the way to the top just to turn around and head down. Maybe she missed her floor?”

  Haldane rose from his seat, suppressing the urge to jump out of it. “Thank you, Nigel, you’ve been extremely helpful,” he said as he headed for the door.

  Out in the hallway, McLeod stopped him. “What’s buzzing in your bonnet, Haldane?”

  Haldane pointed at his chest. “Explain to me why a woman so sick that she can barely stand rides the elevator from the lobby to the top and then heads back down.”

  “Shite, how do I know? Maybe Nigel was right?” McLeod said. “Maybe she was so sick that she missed her floor.”

  “Then why did she go all the way down to the lobby and ride back up with the Mathews family?” Haldane asked.

  “How do you know she didn’t take another trip later in the day?” McLeod asked.

  “Remember?” Haldane tapped the back of his hand against his other palm. “Both Nigel and Veronica said it was just before suppertime!”

  McLeod tilted his head from side to side, wavering.

  “And why has she disappeared without seeking help?” Haldane asked. “And where did she get the virus in the first place?”