by Daniel Kalla
Arms shoot up across the room while some reporters just shout their questions. Ignoring them, Lisa holds up a hand and waits for the room to quiet. Finally, she points to a young woman in the first row whose arm is extended as straight as a flagpole. “Yes?”
“Is it true there have only been four new cases in the past two days?” the reporter asks.
“In the past thirty-six hours, yes.”
“Isn’t that a very good sign? That the outbreak is slowing down?”
“We are always pleased when the rate of infection falls,” Lisa says, measuring her words carefully. “Unfortunately, two of those new cases actually represent spread of this infection into the community. In other words, beyond the camp where all the other victims came from. Moreover, we know from the Icelandic outbreak that there are carriers of this disease who show no symptoms but can still spread it to others.”
“Does that guarantee it will continue to spread?” the stocky man beside the first reporter asks without being called upon.
“We don’t know for certain,” Lisa says. “But it is likely.”
“And that’s why you’re launching this vaccination campaign?” the same man demands.
“One of the reasons, yes.”
“Isn’t it premature, Dr. Dyer?” a woman with short-cropped hair and square-framed, red glasses asks from the back row. “To expose so many people—mainly kids—to a new vaccine based on little more than handful of cases?”
“Twenty-four is more than a handful,” Lisa says. “And each one of the eleven deaths is a tragedy. Seattle Public Health is committed to doing everything to prevent more loss of life. It is standard public-health practice to vaccinate the highest-risk groups—in this case, high school and college-age youths—during a meningococcal outbreak once it has spread into the community.”
“But isn’t this particular vaccine untested and unproven?” the woman persists.
“It’s not untested,” Lisa says, feeling doubt worm its way back into her consciousness. “In fact, it has been proven safe and effective in three significant clinical trials. This is our best option since the only commercially available vaccines do not prevent infections with this particular strain of bacteria.”
“So you’re going to use thousands of kids as guinea pigs?” another male reporter blurts from the middle of the audience.
“Not at all. We plan to monitor the response to the vaccination vigilantly. We’ve set up a hotline and a website for reporting unexpected reactions.” Lisa begins to sweat under the glare of the camera lights and the demanding stares from the faces in the audience. She tries to clear her throat, which suddenly feels full. “The idea is to give maximum protection to the at-risk groups. And ideally to create herd immunity to this new infection. We can only accomplish that with a widespread campaign.”
“What if it doesn’t work?” asks another reporter whose face is hidden by the balding head of the man in front of her. “What if you’re acting prematurely?”
“The only other known outbreak of this particular strain of meningitis happened in Reykjavík,” Lisa says. “It’s all we have for comparison. Thirty-five people died there in a matter of weeks last winter. Seattle has a population twenty times the number of Reykjavík’s. If we do nothing different—in other words, if we don’t try this new vaccine—then we predict our death toll could rise into the hundreds. Or more.”
“You just told us you can’t assume anything…” another reporter begins to say, but Lisa’s attention is drawn by Tyra, who tugs gently at her sleeve.
Tyra leans in close enough for Lisa to feel her breath on her ear. “Just got a report of a kid on a ventilator at Children’s Hospital. Meningitis and sepsis,” she whispers. “Youngest case yet.”
“How old?” Lisa murmurs.
“Eight. Had a full-blown seizure at a baseball game. He’s from Bellevue,” Tyra says of the suburb to the east of Seattle where Amber’s family also lives. “Never been near Camp Green. No obvious connection to other victims.”
Lisa nods, instinctively thinking of Olivia. With that, her resolve cements again as she turns back to the reporters. “As I said, the vaccine clinics will open tomorrow morning. We urge everyone in the Seattle area to bring in their children. This is the best way—maybe the only way—to prevent this outbreak from spreading.”
CHAPTER 23
Max has been so absorbed in the op-ed he’s been writing for the community newspaper on the mandatory HPV vaccination policy that he has been ignoring his phone for the past hour. The paper is offering him a chance to make his case with a broad readership against the ill-conceived policy. And he takes the opportunity seriously.
Max is all too aware of the stigma associated with the vaccine hesitancy movement. Many people—if not most—view them as wing nuts, zealots, or uneducated hysterics. And, in truth, Max has met a number of people in the community who do fit the bill. But most of the ones he associates with are like him, concerned people—usually parents—who are driven to effect social change. Many have suffered the devastation of a vaccine injury to themselves or a loved one. And, also like Max, many are motivated to protect others, since it’s too late for their own families.
His phone buzzes again. Max turned the ringer off, but it’s been vibrating steadily on his desktop, alerting him of new texts, tweets, and emails. He wonders what’s causing the literal buzz, but he’s on too much of a roll to stop to find out.
His concentration is finally broken when a Facebook message from Cole, his best online friend, pops up on the corner of his computer screen. “Dude, where the hell have you been? Everyone’s going crazy over the news of this vaccine!” The message is punctuated with a series of emojis of exploding heads.
Max immediately saves his document and logs onto the group chat page. He scans the rolling list of messages until he reaches the top of the thread. He clicks on the link in the first message that takes him to an article describing how Seattle Public Health is launching a campaign to inoculate the youth of the city with a new meningitis vaccine.
“Not another one,” he mutters to himself as he returns to the conversation thread and sees a similar response echoed in multiple messages.
Fighting back his simmering anger, Max reads every comment on the thread before posting one of his own. Some people are saying that they need more information to evaluate the dangers of this new vaccine. Others are advocating active resistance right away through social media and public protests. A march is being planned. One person, Daryl, who often goes too far in these chats, suggests that they find out where the supply is being kept and sabotage the site. “Burn it to the ground!” as Daryl puts it.
“Big Pharma always finds a way to flog their next drug,” Max types. “Isn’t it convenient that this ‘epidemic’ hits just as they’re ready to market a new poison? Is it possible this is all just one ugly marketing ploy?”
The group chat lights up with responses to his comment, almost all in agreement. The like-minded people on the site see the emergence of this outbreak as more than just coincidence.
A private message from Cole pops up on his screen. “Well said, dude! Eventually they’re going to figure out what dangers this new toxin poses.”
“Agree,” Max replies.
“Like always, though, it’ll take months or years to find out what exactly that is.”
“I hear you.”
“If only we could tip the scales now somehow. Before it’s too fucking late.”
Max stares at the screen. Cole is right. All the social media posts and marches in the world won’t accomplish anything.
Maybe words aren’t enough this time?
He grabs his phone and calls Yolanda. “Why didn’t you tell me about this new vaccine?” he asks as soon as she picks up.
“That’s why I’ve been texting and calling you!” she replies in a slight whine. “You wouldn’t answer.”
As doting and sweet as Yolanda is, especially toward Jack, her neediness still grates. “Work
’s been crazy. And I’ve had Jack all week.”
“I get it,” she says, acquiescing too easily, as usual.
“Yolanda, I need to know everything about this new vaccine and your office’s vaccination campaign.”
“Why?”
“Come on. Right after the HPV debacle? They’re going to force another vaccine on the public? This one totally unproven. You know how I feel about this.”
“This meningitis is awful. It’s killing kids, Max. Sometimes in just a few hours.”
“How do you know this vaccine will do anything to prevent that?”
“I… I don’t.”
“And how do you know it won’t end up hurting or killing even more children?”
“They wouldn’t release it if it wasn’t safe.”
“Really?” Max scoffs. “I thought I’d already proven to you that just hasn’t been the case in the past.”
“Maybe. I guess.”
“Listen, beautiful, I need one more favor.”
“What’s that?”
“Do you think you could get your hands on a few vials for me?”
“Steal the vaccine?” Yolanda’s voice cracks.
“No, no,” he says soothingly. “I just need the empty vials.”
CHAPTER 24
The gymnasium is absolutely packed, and Nathan assumes the lineup out front—which had already formed by the time he arrived two hours before the clinic opened—must still snake around the block.
People in Seattle are scared. The news of the latest meningitis death, the boy from the ball game, has hit the city hard, especially in the emotional aftermath of the damage left by COVID-19. Someone posted a video online of him collapsing with convulsions at the Mariners game the previous afternoon, and it instantly went viral. The social media site has since pulled the clip down, but the damage was done. Nathan couldn’t resist viewing it. Even beyond the voyeur’s guilt, it was hard to watch. But he can’t help picturing it again now.
The video was shot on a cell phone at the ballpark, under cloudless blue skies. The camera panned back and forth across the packed seats and private boxes from the perspective of somewhere in the bleachers above. Suddenly, in the left corner of the frame, there was a frenzy of movement in one of the boxes. A tinny scream followed, and a man shouted, “Call 911!” The camera zoomed in on the box. The people inside encircled a boy who lay on his back. His arms and legs twitched and jerked wildly, and his head flopped side to side as he thrashed on the ground. The video ended seconds after someone dropped down to his knees and hovered over the boy, obscuring him.
Nathan shakes off the disturbing memory, focusing instead on the activity around him. He wouldn’t have missed this inaugural Neissovax immunization clinic for anything, but he’s aware he’s only in the way of the people doing the actual work. He stands as unobtrusively as he can behind the desks and watches with a mix of admiration, pride, and worry.
The front of the line spits a steady stream of people to the first of the five desks to free up for the next inoculation. Each desk is crewed by two public-health nurses. The first one explains the impending vaccination to the next person in line, and then gets each patient, or the guardian, to sign a consent form. Meanwhile, the second nurse draws up the vaccine under the watchful eye of a Delaware staff member, labels the syringe with a sticker, and then injects it into the exposed left upper shoulder of the recipient. Every tenth patient also has blood drawn—Nathan understands it will be used later in a comparison of the pre- and postvaccination antibody levels.
Aside from a few tears, one panic attack, and two teenagers who fainted immediately after the blood draw, the clinic seems to be proceeding smoothly. Nathan has noticed that most of the clients make it through the process from consent to vaccination in under ten minutes, usually closer to five.
And yet, the line keeps growing.
As Nathan scans the room, he can’t help wondering which of the recipients will later log Seattle Public Health’s website to report adverse events. Last night in his hotel room, he spent ages on the web page reviewing the self-reporting form set up specifically for Neissovax. The local form is even more nebulous than the national VAERS one. Anyone can log on and claim any possible reaction, without proof or validation. Nathan regards the whole thing as a beacon for loonies, hypochondriacs, and, especially, scammers. He believes it inevitable that people will try to milk the system for money, attention, or both. He understands that Delaware would have faced scrutiny no matter when or where Neissovax was eventually released, but with all the media attention on the vaccine and the focus this website will generate, he’s fearful of the negative impact it might have on Neissovax’s natural trajectory.
“Bet you wouldn’t have pictured yourself standing here a few days ago,” someone says.
Nathan turns to see Lisa at his side, looking very much in charge, and, he notes, attractive in a navy pantsuit. “Actually, I was kind of picturing myself in Quebec,” he says.
“Quebec?”
“Family road trip.”
“Oh.” Lisa looks around the room. “You had to cancel because of this?”
“Postpone, hopefully.”
“That sucks, Nathan.”
He shrugs. “The boys took it pretty well, all things considered.”
“You have sons?”
“Two. Sixteen and fourteen. The older one just got his learner’s permit, and you can’t keep him off the road.” He grins. “Even though it would probably be best for everyone if we did.”
“Two teenage boys, huh? That must be a handful for you and your wife.”
“We don’t handle them at the same time. We’re divorced.” He clears his throat and decides to ask, “How about you? Kids?”
“Nope. Got a little sparkplug of a niece—a twenty-year-old trapped in a six-year-old’s body. But my husband is a workaholic. And I’m almost as bad. We’re just a couple of dinks.”
Nathan wonders if he misheard. “Dinks?”
She laughs self-consciously. “As in dual-income-no-kids. Guess no one uses that term anymore?”
“Thou seldom doth hear it, m’lady.”
“Yeah, yeah, cute. I’m out of touch, I know.” She nods to the table in front of them where a boy is squeezing his eyes shut and scrunching his neck as the nurse plunges the needle into his upper arm. “This seems to be going all right.”
“So far, so good. I can’t believe the demand.”
“We expected it. Once we’ve ironed out the kinks, we’ll run three or four clinics simultaneously across the city. That’ll take some of the pressure off.”
“Should help,” he says as he watches the boy breathe a sigh of relief after the needle slides out of his arm. “I keep thinking about the poor kid from the ballpark.”
“Only eight years old.” Lisa shakes her head. “Even worse, it’s already spreading. Three of his friends have been admitted to Children’s Hospital. One of them is in the pediatric ICU. She’s only seven.”
“And you still haven’t found the connection to the camp or other campers?”
“No,” she says. “But these cases represent a distinct second cluster of the outbreak.”
“That’s a problem, isn’t it?”
“A big problem. Bellevue is fifteen miles from Delridge.”
“This pathogen is covering a lot of ground on its own.”
She tilts her head. “Are you suggesting the spread might not be natural?”
“No. Not at all. Just that it’s spreading far and wide.”
She studies him for a long moment and then nods. “Not only that, but it’s infecting a whole new age demographic.”
Nathan spots the intent in her eyes. “Lisa, you’re not thinking…”
“What choice do we have? Four cases in less than twenty-four hours. All in kids under ten. We’ve got to lower the age requirement to cover those kids, as well.”
“Neissovax isn’t approved for children under ten.” Nathan shakes his head adamantly. “It’s never ev
en been properly tested in that demographic.”
“How else are we going to protect the younger kids?”
“I don’t mean to sound harsh, but that’s not our problem, Lisa. We’ve stretched our risk and exposure as far as we can on. We can’t do this.”
Lisa meets his stare with a look of absolute conviction. “We have to, Nathan.”
CHAPTER 25
Lisa steps into her office to find Angela again seated behind her desk, with another colorful scarf tied around her head, this one in a tie-dye design. While she’s still pale and gaunt, she doesn’t look any worse than the last time Lisa saw her.
“Hi, stranger,” Lisa says, masking her relief. “Where have you been?”
“Remind me again which one of us is paid to be here,” Angela says, without taking her eyes off the computer screen.
“Good point. But everything is OK with you?”
“Depends what you mean by ‘OK.’ I still got a drama queen for a husband. And a daughter who thinks that you can opt out of society and still live like a top one-percenter.”
Lisa sits down across from her. “You know what I mean, Angela.”
“It’s a process, my oncologist keeps reminding me.” She shrugs. “What a miserable job she has. Makes working in public health seem like a traipse through the meadow.”
“What process?”
“Well, maybe, not so much of a meadow these days, huh? What with young kids dropping left, right, and center from meningitis. In Bellevue, right?”
Lisa realizes her friend doesn’t want to talk about her own health issues, and she knows better than to pry. “Yeah, four kids now. A new cluster in Bellevue, all from around the same neighborhood. But we have no idea how the index case—the boy from the ball game—connects back to the camp.” She swallows. “Only eight years old. He died in the middle of the night.”
