by Jim Shepard
He put his hand up toward the woman, against the plastic, and she gave him another, smaller, smile, and called the nurse back into the room. The nurse asked if he was feeling better, and talked to the woman for a little while, and then asked him more questions, and he knew that they just wanted help, and he wanted to answer, but he didn’t.
The woman said something else to the nurse, and the nurse told him that the doctor wanted to know what his friend had been like. He didn’t answer that, either.
The two of them finished what they were doing and put some of what they were working on away, and the woman nodded toward him and said something else, and the nurse shrugged. The nurse said to Aleq, “She wants to know if you’re ever going to talk to her, or whether she should just stop bothering you.”
Malik had always complained that when he hung out with Aleq he had to do all the talking. Malik had told him once that a cousin had said he wanted to move to their settlement, for the quiet. And when Aleq as usual still hadn’t said anything back, Malik had added, “He’s going to like talking to you.”
So Aleq cleared his throat and decided he would say something. He told the woman that his friend’s name was Malik, and that Malik always told people about him that if you answered Aleq’s first question you just got two more anyway. Both women looked surprised, and after the nurse told the dark-skinned woman what he’d said, the dark-skinned woman laughed. Aleq told the nurse to also tell her that Malik last summer had run away from home for two days and had lived under a big rock near the shore off the road to Qasigiannguit on fish and two boxes of crackers, though his mother had known where he was the whole time.
The dark-skinned woman looked like she didn’t know what to say to that. When she finally did answer, the nurse said that the doctor thought that it sounded like he and Malik were quite the explorers, and once the nurse explained what that meant, he told her that yes, they did go all over the place, and he told her some of the places they’d been.
When the floating went away, later, he screamed at them again, but he was really screaming at himself. They gave him more of whatever they had given him before to calm down, and it made him feel more lenient toward himself, though he saw what he was up to. It was like the way everyone said that bad fishermen blamed their nets for having holes. And once they’d left him alone in the dark, though the floating kept him from getting too stirred up about it, it was like he was hanging Malik and his grandmother’s pictures in his head where he could see them, the way his grandfather set out his cod net in the sun. And in the middle of the night when the floating went away again, it was a shock, like the time he’d broken through thin ice and had felt the jolt of the cold as he’d seen underwater the floating wings of his open anorak above his boots.
Sometimes he wasn’t aware he was crying until they came in to help him. The floating made it easier to be alone. Without it, he had to face that he was nowhere and with no one, like the night he’d been helping out in his grandfather’s boat offshore, and the black line of their settlement, with all the lights out, had suddenly looked like a place he’d never been. Without the floating it was like how he’d felt on his grandparents’ bed the morning after they’d died, when he couldn’t hear a single voice or noise outside and had wondered if even the dogs were dead.
When he was very little, Malik had told him that the one grave all by itself out near the rubbish dump was for a qivitoq, and had dared him to go sit on it. That Sunday, Aleq had asked the minister why the qivitoq had been buried there, and the minister had told him that it was because the qivitoq, when he’d been a man, had taken his own life and couldn’t be buried in the cemetery; he had to be buried by himself. But he could have a cross, because he’d been baptized as a baby. And when Aleq had asked why the stone mound over the body was so big, the minister had told him that with a qivitoq it always had to be three times the usual size, to keep him from getting up.
He figured out that squeezing his eyes shut helped him clear his head, especially late at night. He reminded himself that some of the settlement’s best hunters had been orphans, like old man Hansenip, who everyone said had been so full of lice as a kid that families had only let him sleep in their mudrooms, and who had always had to steal his meat from the smaller dogs. He told himself that every day he took care of himself, it would make him less afraid. He told himself that it was like the old saying that everyone had to do his own growing, however tall his parents had been. He remembered his grandmother’s always reminding him that the quickest way to find out what you really needed was to go without.
But even after all that, some nights he woke up crying loud enough that the nurse and the dark-skinned woman turned on the lights when they came into his room. He told the woman that his eyes wouldn’t stay shut. He didn’t tell her about the night he spent dreaming he was a stone. After a few nights of his crying, she wheeled a bed on a table in next to him and lay down on it herself, and turned off the lights. After that he slept better.
Though when he woke, for some reason he remembered the morning his grandmother had brought him to see his parents’ new baby, and how he’d stood there in this house he didn’t live in, unsure what to do, while his grandmother had touched her coffee cup to the baby’s lips and then had held some seal meat and potato and boiled onion up to its nose before she’d said to it, “This is your brother,” and had turned its little body to face him.
V
The Churchill Bug
Just when she thought she was getting somewhere with the boy he shut up again like a clam. She was rapidly feeling both that she didn’t have time for this and that he was in some ways the key to everything. Olsen’s having gotten sick had panicked everyone, and nothing they were trying with him looked like it was helping. Meanwhile Danice’s TaqMan, a multipathogen assay that tested for forty-eight different pathogens, had come up with nothing, and neither had her GeneXpert. They were target-specific probes, and whatever it was, as she put it grimly, it apparently wasn’t on the list. Between the samples from the ward and what Danice had brought back from Ilimanaq, she figured she’d been averaging eighty tests a day. She’d also already shipped some 130 samples back to the CDC. Jeannine reminded her that even negative results at least tended to reduce the spectrum of possibilities, and that the wonks in Atlanta had started to design newer assays that were even more generalized, and they had hopes for those. They also thought they were starting to figure out the incubation period, roughly, and had found in most of the survivors IgM antibodies, the kind the immune system produced when it recognized that it had never encountered a particular disease before. Danice had taken to calling what they were dealing with the Churchill Bug, and when Jeannine had asked why, she’d said, “You know, that Churchill quote about Russia being a riddle wrapped up in a mystery inside an enigma.”
Any number of Level 4 labs were now working with specimens, but most of the newer methodologies like PCR to screen for recognizable fragments of DNA or RNA were good only for searching for what was familiar or very similar to something familiar. But for something new you couldn’t locate its signature if you didn’t know what the signature was. Given PCR’s limitations, then, the alternative was to sequence whole genomes, and if they’d had a candidate pathogen they could have done so, but without one all they could do was take samples from the victims and look for things that would indicate the presence of a virus or bacterium or whatever. They were even back to the old-school approach of trying to grow the thing in a cell culture and then just looking for damage.
Danice caught Jeannine up on the latest emails while they both examined Olsen. Only Level 4 biosafety labs were cleared to work on this thing now, given how dangerous it was, and various teams had been offering whatever was in the samples various cell lines known to be hospitable to respiratory pathogens, without success. Though they’d just started working on it. Mostly there’d been a lot of groping. Danice said that so far it was like t
rying to find bats on a moonless night by listening.
“I can’t tell you how reassuring that is,” Olsen told them from where he was lying, and Jeannine and Danice looked at each other with chagrin and then worked silently for a few minutes, before Danice eventually went on.
Columbia’s School of Public Health had been pulled into it with their supposedly cutting-edge molecular diagnostic systems like high-throughput sequencing and MassTag and GreeneChip, which could screen for thousands of known pathogens simultaneously, and they’d come up empty so far as well. Given that many of the symptoms resembled a bizarrely lethal pneumonia, everyone had thought of anthrax, an old standby, since the rule of thumb was that if you heard hoofbeats and you weren’t in Africa, it was more likely a plain old horse than a zebra. And the whole thing presented like a bacterial infection, followed by a whole lot of cell death. But then where was the bacteria?
By day three of Olsen’s infection, his blood oxygen levels were so low that Marie Louisa kept rapping her oximeter on the table and reapplying it, and he didn’t take well to encouragement. She kept tearing up with a brave smile when she caught his eye, but she finally stopped and left the room after he shouted at her about it.
Even as sick as he was, he was beside himself that he’d made his little girl sick, and he swore that he had come in as soon as he’d started feeling at all ill. It had been so stupid of him to have gone home at all, he said. What had made him think he could go home?
“We shouldn’t have let you,” Jeannine told him. “It’s as much our fault as yours.”
The look he gave her in response was filled with so much fury it shut her up.
She stopped trying to make him feel better about it, beyond reminding him again that he had come in as soon as he’d started feeling sick.
Which was a bad sign when it came to the other big question, which was whether the symptoms appeared before or after the patient became infectious. Symptoms first was much less dangerous, since sick people could then decide not to go out, or be quarantined. With pathogens like the flu, though, high infectivity preceded the symptoms. That had been the case with COVID, too; you got other people sick, and then you felt sick. And it was starting to look like this pathogen operated the same way.
Jeannine’s insomnia meant that once Danice finally conked out she spent more time with the boy. She was impressed with the way it felt like in the middle of the night with everything quiet he was resisting with his impassivity the universe’s indifference to him. He seemed to gather strength from the improbability of his survival. Instead of sleeping, he looked like he was cycling back through unhappy memories, and she knew how that worked.
Every so often she registered the number of new cases even in just their ward and caught a glimpse of the full scope of what they were up against.
Identifying it was only step one. Step two was finding out where it had been all this time, and step three why it had emerged where and when it had. And when it came to steps two and three, the ability to persuade this boy to open up could turn out to be as important as the lab work. And if it came down to getting a kid to trust her, the CDC had probably bet on the wrong horse in terms of who they had paired with Danice.
Because Help Is Where You Find It
Which is where she came up with the idea of somehow getting Branislav involved. Aleq was being transferred to the BSL-4 lab at Rocky Mountain Laboratories, and she’d been informed she was going with him, since both she and Danice had vouched for the fact that she was the only one able to get anywhere at all with him in terms of eliciting information. Her first reaction to the thought of roping Branislav in had been an impatient Really? This is what you’re concerning yourself with, at this point? But she also remembered the way he listened to kids, his own and those he worked with—like he wanted to absorb absolutely everything of any importance whatsoever—and the way they responded. And the way he’d helped her learn, in terms of Mirko, when to share emotional information and when to keep quiet. She mentioned the idea to Danice, who just looked at her in response. Maybe she was just indulging in some motivated reasoning, she admitted. And then when Danice still didn’t respond, Jeannine added, “But maybe help is where you find it.”
Fire Drill, Tower of Babel
Aleq was being transferred as a partial result of a cyclonic clusterfuck of bureaucratic hysteria and infighting of which Jeannine was only partly aware. It involved, besides the CDC’s Special Pathogens Branch, Homeland Security and the DOD and some outreach feelers from USAMRIID, as well DARPA’s Prophecy program, the WHO’s Global Outbreak Alert and Response Network, and USAID’s Emerging Pandemic Threats program. Even Google’s Global Viral Forecasting Initiative had gotten involved. Whether Aleq was the index patient or Typhoid Mary or both, entities that usually agreed on almost nothing else had agreed on the critical usefulness of bringing everything available to bear on his examination. If he was a convalescent and had been infected, his blood might be the starting point for a treatment; if he was still giving off the pathogen, all of that testing would need to happen in a Level 4 environment.
And Olsen was frighteningly compelling evidence that the kid was still shedding the pathogen. If they were right about the incubation period, his initial symptoms lined up with the kid’s having kicked Olsen’s mask off after Olsen had tackled him. Though he could have been infected any number of other ways as well.
All of those agencies were now fully in the mix because the pathogen was breaking worldwide. They’d seen that coming, of course, and during Jeannine’s first call-in the night she’d arrived in Ilulissat, when her supervisor had answered back in Atlanta, she’d said, instead of hello, “Look, we’ve got something here.” Her supervisor would have figured that out in less than a week, anyway, when the EIS officer in special pathogens got the call from an infectious disease attending physician at a hospital in Rochester, New York, reporting three fatal cases of a weird pneumonia, after which some checking around at other hospitals across the country revealed eight additional deaths from the same thing. Given when the first reports of Ilimanaq had arrived at the CDC, they couldn’t be more than eighteen or twenty days out, and so many more cases had since been flagged that the Public Affairs Division was fielding two thousand calls an hour around the clock. The staffers were getting calls at home. A triage system had had to be set up for the people working the phones, and continually recalibrated to sift out the more productive leads. And all divisions were doing what they could to deal with what Jeannine’s supervisor called the inevitable second epidemic: panic.
Rumors of what had happened at Ilimanaq had generated a lot of online hysteria, but the Danish government’s enforcement of the no-fly zone over the settlement had helped keep most of the postings speculative.
Improving containment had to be the key. The number of cases was growing so rapidly the containment teams were unable to keep up, and even the minimum requirement of basic record keeping was becoming untenable. Medical staffs were already so worn out and terrified they were making more and more mistakes when not feeling like everything was futile. Right then everyone’s number one and two priorities needed to be how to keep the infected alive and how to break the chain of person-to-person transmission.
In Greenland, the Ministry of Health, at the direction of the prime minister, had announced the formation of mobile medical units to carry out close inspections of the infected areas and help with the quarantines, but the disease had already seeded itself around the globe. A Canadian family had had to rush their matriarch to a Berlin emergency room and then four more members of the family to a Toronto emergency room upon their return home, and the chains of infection had spiraled outward from there. Five American women who’d commandeered the Canadians’ table at the airport’s food court had flown from there to Rome and Palermo and then back home to New York, Charlotte, and Baltimore. A surgeon sick on his Paris-to-Hanoi flight had walked up and down the aisles of
his 350-seat Airbus A350 in misery before finally being stretchered off upon landing. He’d been taken to the French Hospital, but by the time his family had had him medevaced to Hong Kong, two and then four and then nine more cases had been recorded, and five days after that half the hospital’s staff had been infected and the WHO officer who’d been called in had herded all the healthy into the cafeteria and directed them to wear every piece of protective gear the hospital had in stock. When that hadn’t worked, he had had the building’s central air switched off, and two days after that, there had only been enough healthy staff remaining to care for the hospital’s own sick personnel, so it had shut its doors.
A seventy-eight-year-old writer had carried the pathogen into Madrid, where it had killed her and then her two sons a week later, and had spread through the hospital where they’d died, infecting forty-four other patients and staff, twenty-eight of whom had died. One of the infected was a Panamanian nursing attendant who had flown home and, though she’d been feeling under the weather, had done some holiday shopping and visiting and thereby had started additional chains of infection there. A Lithuanian sick in Vilnius had stopped by an emergency room before hopping on a train to his home city of Kaunas, where he’d infected another hospital before being transferred to a third. A Peruvian visiting Lisbon had thrown up in the lobby and the fifteenth-floor corridor of his hotel, infecting an international conference of ophthalmologists, and an old friend who’d visited him in the hospital had ended up back in the same hospital herself, as had her husband and daughters and sister, and within two weeks there had been enough health care workers incapacitated from the same pathogen to overfill two entire wards.
No one in the medical community had had to mention that this thing’s potential for transmission when it came to caregivers and medical personnel was extraordinary. The week after the WHO had issued its global alert, its chief of the Northern European office had reported that two of his own staff members were infected.
