by Nancy Kress
He said, “How many African Americans have this sickle-cell thing?”
“About one in twelve,” Dr. Anderson said. “Over two and a half million.”
Two and a half million.
“Yeah,” she said, watching his face. “That many.”
Cavanaugh looked at the ice cube tray of dead mosquitoes. He saw now that each compartment had a detailed tag stating where and when the insect had been captured. He thought of the cloud of mosquitoes around Judy’s bug zapper, above the channel-clearing machine on the Potomac, in the parks where kids played in the hot, heavy twilights …
He said, “Suppose for a minute, for the sake of argument, that the parasites are genetically engineered and then put into the mosquitoes. How hard is that to do? What kinds of equipment and talent do you need to do it?”
Farlow said, “A lot of talent. But not much equipment, relatively speaking. That’s the thing about a genetic-engineering lab—it’s not like producing a terrorist atomic bomb. Everything you need is easily available from any scientific supply house, and any researcher at any private firm can buy samples from blood libraries.”
“So we’re not looking at a big fancy lab?”
“Hell,” Farlow said, “you could put the lab in a good-sized basement.”
A good-sized basement. Jesus J. Edgar Hoover Christ.
Farlow said, “How will the FBI handle this, Agent Cavanaugh? On our end, we’ll keep mapping the epidemic and searching for the missing alternate host. But what will your people do?”
Good question, Cavanaugh thought. The FBI was a covert investigative operation, and like all covert operations, it valued secrecy. The last thing the Bureau usually did was make public announcements of public problems, especially if it couldn’t solve them. “Confusing the leads,” it was called. “Compromising the investigation.” But in this case, a public announcement might be the only thing that would save lives.
“Well?” Melanie Anderson said pointedly. She stared right at him.
“In cases of public danger, the FBI can issue a Terrorist Warning Advisory,” Cavanaugh said slowly. “But of course that has to come from Headquarters. And until it does, especially in a situation like this, it’s important not to cause a panic, or to encourage false credit claims by various hate groups.” Jesus, they’d be crawling out of the woodwork. “So until Headquarters has a chance to work on this a little, I’m going to ask you to discuss it with no one outside the CDC.”
Melanie Anderson said, “While more people die! No!”
Farlow said, “You don’t understand, Agent Cavanaugh. That part isn’t up to us. The CDC has a mandate to control disease. But on this scale, only the army has the actual capability to do it. When USAMRIID arrives, we’ll get—here they are now.”
Farlow got up to answer the door. But Cavanaugh didn’t need him to finish his sentence. Whatever Farlow thought he’d get when the army arrived, Cavanaugh knew what the CDC was really going to get.
A turf war.
They came in like an invasion, five of them, all in full uniform, shoulders straight and back. Next to them the CDC team, all but Farlow in jeans and T-shirts, looked like Sunday picnickers. The scientists rose in a ragged body, nodding at introductions. Cavanaugh took careful note of each name in order to decide if the delegation was, or only looked, impressive. How seriously was the army taking Plasmodium reading? By their ranks and titles shall ye know them.
Lt. Col. Matthew Sanchez, M.D., Chief of Disease Assessment for USAMRIID.
Maj. David Seligman, M.D., malariologist.
Capt. Anne Delaney, M.D., genetic microbiologist.
Capt. Neil Hosner, attorney for the United States Army.
Col. Wayne Colborne, M.D., commander of USAMRIID, who explained that he would be briefing both Major General Selby, the head of the Army Medical Research and Development Command, to which USAMRIID reported, and the commander of Fort Detrick itself, General Campbell.
The army was taking Plasmodium reading very seriously.
Trailing behind the brass was a small man with the expression of a nervous rabbit. He was introduced, belatedly, as the representative from the Charles County Department of Health, Dr. Fred Warfield. Cavanaugh thought that never had he seen anyone less suitably named, and resisted the urge to sketch Warfield.
“We’ve received all your data, Dr. Farlow,” said Colonel Sanchez, “and we have some suggestions on how to proceed. The first thing—”
“—is to bring your team up to date,” Farlow said smoothly. Cavanaugh heard the opening guns of the turf war. “We have new data since yesterday. Gary?”
Dr. Pershing went into a long technical explanation that Cavanaugh couldn’t follow. Colonels Sanchez and Colborne sat expressionless. But the two noncommanders’ eyes gleamed with interest in whatever Pershing was explaining.
Score one for the CDC.
When Pershing had finished, Colonel Sanchez said quickly, “Thank you, Doctor. Now let me clarify our position.” He glanced respectfully at Colonel Colborne, who evidently had cast himself as final arbiter, above the interim fray. “USAMRIID’s core mission, as you know, is to devise ways to protect American soldiers against infectious diseases and bioweaponry. Your data suggest to the army that P. reading may well be one or both of those things. The army has been well aware since 1950 that a biowarfare incident might come disguised as a spontaneous event, and that American troops both here and on foreign soil could be vulnerable to attack in this manner. Therefore, USAMRIID is very grateful to the CDC for bringing P. reading to the army’s attention.”
In other words, We’ll take it from here. Score one for the army.
Farlow said pleasantly, “We’re glad to have your assistance, of course, especially with the manpower needed to protect the public. Which, I’m sure we’re agreed, is the first concern at this point, since all the victims thus far have been civilians.”
CDC-2, Army-1.
Sanchez nodded. “Yes. In fact, we took the liberty of drawing up a list of priorities. David?”
The army malariologist handed around photocopied sheets. The score was now even. Cavanaugh skimmed the priorities:
Safety of the civilian population
Containment and destruction of the disease vector, A. quadrimaculatus
Identification and arrest of person(s) responsible for vector infection, if applicable
Advance of scientific and medical knowledge
Farlow said, “Certainly the army is better suited to priority two than we are. I suggest that control of Anopheles rest entirely with you, although of course you’ll have to work with the EPA on what pesticides they’ll allow.”
The lawyer looked up sharply from his note taking. Cavanaugh knew that Colonel Sanchez—not to mention Colonel Colborne—wouldn’t much like the idea that the U.S. military reported to the Environmental Protection Agency. Farlow continued blandly on.
“We do have some thoughts on containment, however. Melanie?”
Melanie smiled at the army. Well, why not, Cavanaugh thought—they were taking bioweapon theories a lot more seriously than the CDC had. She might as well have been on their side. Had Farlow taken that into account?
“I know that USAMRIID already knows everything I’m going to say,” Melanie said graciously, “but please bear with me while I repeat it because I don’t think our FBI representative knows this material. Medicine isn’t his field. He’s responsible for our priority three.”
Everyone looked at Cavanaugh, the ignoramus who, single-handedly, was supposed to carry out priority three. Which, now that he thought about it, was priority one from his point of view. He resisted the temptation to doodle on the priority list.
Melanie continued. “Malaria transmission, Robert, is really sensitive to the numbers. Numbers of mosquitoes. Size of the susceptible population. Numbers of gametocytes in the blood of carriers, which determines the number of sporozoites in the mosquito saliva to reinfect people. Even the number of days that the temperature and humidity are
favorable for mosquito breeding. There are equations to show how even small changes in the numbers affect the whole course of the epidemic. The equations were developed decades ago, by Dr. George MacDonald.
“We’ve run the numbers, and I’m sure USAMRIID has, too. In temperate climates it’s possible to tip the equation by key containment actions. In the tropics it’s not, because both Anopheles and Plasmodium flourish so well that they just overwhelm any changes you make. Also, of course, places like Africa and the Philippines are too poor to afford the necessary containment resources. But Maryland isn’t tropical and the U.S. government isn’t poor. Containing this epidemic should be doable—once we actually start doing it.”
The last was a jab at Farlow. Cavanaugh wondered if he knew he had a mole on his side. Of course he did.
Colonel Sanchez beamed at her. “I’m glad to hear we’re in agreement, Dr. Anderson. And, of course, the closeness of Fort Detrick to the pockets of morbidity make USAMRIID the natural choice to direct and carry out the operation.”
“Carry out, certainly,” Farlow said, the emphasis slight but unmistakable.
Uh-oh, Cavanaugh thought. Here it comes. Joe Krovetz, sitting next to Cavanaugh, imperceptibly moved his notepad closer to Cavanaugh. On the bottom Krovetz had written “HISTORY OF FEUD THERE. EBOLA.” Cavanaugh nodded, even though it took him a moment to remember that Ebola was another disease that the CDC and USAMRIID had cooperated on containing, in Africa.
Sanchez said stiffly, “The army will direct any operation it carries out.”
Farlow said, “And for the civilian population, so will the CDC.”
A tense silence fell. Into it the county health official, whom Cavanaugh had forgotten was at the table, said timidly, “Well, then, that’s settled.”
Everyone stared at him.
“And, of course,” he went on in his high, squeaky voice, “the County Department of Health and the U.S. Public Health Service will be happy to help both of you any way we can. If, uh, you need us. Helping with your priority two, Colonel, and your priority four, Dr. Farlow, and, uh, any way you split up the actions for priority one. Or we could take any actions not on either of your priority lists. If, uh, you want us to, of course. If, uh, that.”
Warfield cleared his throat. Cavanaugh hid his grin. The little bureaucrat had just settled the turf war by dividing up the turf, and apparently he didn’t realize he’d even done it.
“And, uh, one more thing, if you don’t think it’s, uh, presumptuous. The USPHS is willing—I took the liberty of talking to them—to assign to their budget center the expense of printing up the flyers. Flyers to give to the public about what to do. If, uh, you want flyers. Won’t you? It’s up to you, of course, but I, uh, thought they’d be good to supplement the radio and TV public announcements. That, uh, would be our responsibility. With, uh, your consent, of course.”
“Assign to their budget center.” Cavanaugh didn’t know what that meant to the CDC or the army, but he sure the hell knew what it meant to the FBI. It meant that the responsible budget center assumed the blame for screwups. Especially if its name headed anything like public announcements and flyers.
Sanchez and Farlow looked thoughtful. The lawyer, Captain Hosner, pushed a note toward Sanchez. Then Colonel Colborne, the top brass present, spoke for the first time. “Perhaps we should move on to the specifics of this operation.” Farlow and Sanchez nodded agreement, and the jurisdiction struggle was suddenly ended. Peace with honor.
Only not quite.
Farlow said, “As part of our priority, the CDC—with the assistance of the Health Service—can assume responsibility for blood testing, both for P. reading and for sickle-cell trait. Our thinking is—”
“Excuse me,” Melanie Anderson said. “Blood testing for sickle-cell trait?”
Every pair of eyes in the room turned to her, including Cavanaugh’s. Until now, no one but the heads had spoken without being invited. From the way that Farlow’s eyes narrowed, Cavanaugh was pretty sure the CDC chief wasn’t welcoming interruption by one of his own staff.
Melanie wasn’t fazed. “Maybe we want to think again about sickle-cell testing—in light of what happened in the seventies.” She jerked around to face Cavanaugh, startling him. “Let me give you background here, Robert. In the early 1970s the government funded a screening program to identify all carriers of the sickle-cell gene. The idea was to get help early to people who were at risk for sickle-cell anemia. But no real distinction was made between having sickle-cell trait, which is just one gene, and being at real risk for having a full-blown sickle-cell crisis, which takes two genes.”
Cavanaugh nodded. Again she was using him as a pretext to orate about what everyone else in the room already knew. It made him look dumb, although that wasn’t her goal. But there wasn’t anything he could do about it.
“Because the distinction between one sickle-cell gene and two wasn’t made clear, a whole lot of black people who only had the trait thought they had a real disease. You wouldn’t believe the things that started happening, Robert. Some insurance companies called sickle-cell trait a ‘preexisting condition’ and denied health insurance. Some airlines wouldn’t hire pilots with the trait. The U.S. Air Force Academy rejected black applicants with the trait. And some scientists actually went on national TV and said that black carriers of the trait should never breed, for the good of public health.”
“Melanie,” Farlow said tightly, “no one is suggesting—”
“I know, I know,” Melanie said, holding up her hands and smiling. Cavanaugh thought she was trying to look conciliatory. It was not a success. “But it did happen. And we wouldn’t want it to happen again.”
Sanchez said to Farlow, “Are you proposing to leave blood tests for sickle-cell trait out of priority one?”
“No,” Farlow said. “But confidentiality issues should be considered as well.”
“Certainly,” Sanchez said, but he offered no details. Clearly this problem was now Farlow’s. Cavanaugh was glad he was not in Melanie’s place.
The rest of the meeting went more smoothly. After two hours of discussion, including minor contributions from the lawyer and Warfield, a plan was in place.
The Public Health Service would pass out an antimalarial preventive called mefloquine to every doctor, health clinic, hospital, and nurse practitioner in Maryland and Virginia. They would also collect blood samples for voluntary, confidential screening.
The CDC would create multiple sets of guidelines in easy-to-understand language: What to do if you’re positive for sickle-cell trait. What to do if you’ve been bitten recently by a mosquito. What to do if someone nearby has a stroke. Where to get free head nets and mosquito netting dipped in permethrin, a mosquito repellent harmless to people. Which insecticides were safe to use around your house and children, and which were not.
USAMRIID would create guidelines in simple language about what people should do to discourage mosquitoes from breeding near their houses: Tip out birdbaths. Bury old tires. Fill in tree holes and shallow depressions in the ground. Clean out gutters. Destroy shady vegetation at the edges of ponds. Cover cisterns and water barrels. Drain kids’ wading pools every night.
The Public Health Service would print and distribute all guidelines in malls, parking lots, offices, summer schools, public events—everywhere possible. They would also arrange for TV and radio versions.
USAMRIID would use the soldiers based at Fort Detrick, the 110th Battalion, to check that the civilian populations were carrying out domestic guidelines. (“Whoa,” Melanie murmured on the other side of Cavanaugh from Krovetz, “police state toehold.” But she didn’t say it aloud.)
USAMRIID would carry out mosquito-destruction tactics in Saint Mary’s, Charles, and King George Counties.
The CDC would continue to research P. reading, sharing all data with USAMRIID.
“And with the FBI,” Cavanaugh said firmly, his first contribution of the day. “Anything we know about how this parasite might have b
een created could be a lead to its creator.” Everyone nodded except Susan Muscato, who evidently still thought that the creator was the Creator. Well, maybe she was right. Maybe it was a spontaneous mutation.
Maybe.
Farlow said, “Dr. Krovetz will be available to you after the meeting, Agent Cavanaugh, to answer any questions you might have.”
Their number is legion, Cavanaugh thought. What equipment was necessary for genetic engineering? Where was it usually purchased? What were the regulations? How was equipment tracked? What scientific credentials were required to work on this level? If Cavanaugh were going to convince anyone—including himself—that malaria reading really was a bioweapon, he needed tangible evidence: paper trails, physical objects, photographs.
When the meeting broke up, Cavanaugh asked Joe Krovetz, “Doctor, why aren’t you planning to vaccinate people against this thing?”
“No vaccine,” Krovetz said. “The disease is too new. And anyway, even normal malaria vaccines haven’t been much of a success.”
“Oh,” Cavanaugh said, trying to make the small syllable sound intelligent. “And what is this new drug that the colonel said Fort Detrick could supply to hospitals and doctors?”
“It’s a variation of chloroquine. Do you know what chloroquine is?”
Cavanaugh shook his head. He watched the room empty. The army lawyer was talking steadily to Colonel Sanchez. Dr. Farlow smiled at everyone. And even the rabbity Fred Warfield chatted with Anne Delaney, the microbiologist, without stammering or twitching. Come to think of it, Warfield—
“Do you want to hear this or not?” Krovetz said, with a directness Cavanaugh hadn’t expected.
“Yes, I do.”
“Well, many strains of malaria around the world have become immune to chloroquine, the standard treatment. So pharmaceutical firms constantly try to come up with new ones. USAMRIID often contracts out to them. One of them, Markham-Jay Labs in Virginia, has apparently just finished beta testing a good one.”
“How come you’re scowling about that?”
