by Mark Kelly
“If you’re wondering why you’re here, I asked for you specifically,” she said to his surprise. “I need a geneticist on my team—one I can trust, a friend.”
She blinked and smiled at him.
He shifted in his chair and looked away. Her smile made him uncomfortable. She never smiles…and I’m not a friend—a student for sure, a colleague, perhaps. “Thanks for the vote of confidence. I’ll do my best, of course.”
The words sounded lame. He needed to change the subject.
“How did you come to be here?” The last I heard you had just left—“ he caught himself before he finished the sentence. They hadn’t talked about her dismissal.
She gave no sign of being embarrassed. “After I left Stanford, I did some research work for the government. Colonel Young requested me.”
“You worked for him before this?”
“No.”
“What about the CIA guy?”
Her head snapped forward. “What about him?”
The sharp tone in her voice caught him off-guard. “I was just curious what you knew about him?” he said neutrally.
“Nothing. Let’s get started.”
She swiveled in her chair and typed a few commands on the keyboard. A report appeared on the screen. He slid his chair closer to look at the monitor while she spoke.
“We’ve started work on a recombinant vaccine that targets all three of the bacteria’s toxins. Thankfully, the pharmaceutical companies were already working on experimental vaccines for the common strain of C. diff so we didn’t have to start from scratch. But we’ve hit a dead-end with the binary toxin.”
Wow, that’s incredibly ambitious, he thought as he scanned the information on the computer screen. It must be bad if they’re willing to bet everything on a moon-shot like this.
They would have to locate the genetic fragments that produced the toxins, extract them and then alter them to eliminate the toxicity. Once that was done, they’d recombine them into some type of replicating cell and mass produce the vaccine. Theoretically, it could be done but the timeline was long—not days, or months, but years—in some cases, decades.
He looked at her. “You’d like me to get started on the binary toxin genes?”
“Yes, you’ll find the reports on previous efforts in the lab’s computer system. I’m sorry to run, but I have to go back to my office and finish my report.”
Using the edge of the table to support herself, she climbed awkwardly to her feet. “Are you okay if I leave you?” She motioned to the banks of equipment that surrounded them. “You should be familiar with most of this.”
He nodded. “More than familiar.”
She walked to the door in front of the airlock and looked back at him. “The videoconference system is in a small room at the end of the lab. It has a directory with the other locations. If you need me, my number’s programmed into it.”
“Okay, thanks.”
He watched her leave. First she would pass into the airlock where a chemical decontamination shower would activate and spray and scrub the suit. When that was finished, the airlock would open and she would pass into another vestibule where she would disrobe, clean the suit one final time and remove the nitrile gloves and booties she was wearing. After one final airlock, she would disrobe, drop the coveralls and other disposable clothing into a garbage chute where they would be incinerated at a high temperature. One last shower and then she would be done.
He knew researchers who wore adult diapers just to avoid having to leave the containment lab, but he wasn’t one of them. He had made sure to use the restroom before he came into the lab and purposefully hadn’t had anything to drink since dinner the night before. Better to be a little dehydrated then to be going through all of that, he thought.
The light above the airlock door turned from red to green. She was gone and he was alone in the lab. The other researchers wouldn’t be arriving until this afternoon.
He looked at the digital clock on the wall and thought of Edward Gore.
Maybe the Porton Down lab is in the directory. It was late afternoon over there. Can’t say that I’ve ever seen a man come back from the dead, Gore would be the first.
EDWARD GORE SLOUCHED sideways with one hand on his hip and the other on the table. He looked at Simmons through heavy eyes and spoke softly.
“Can you hear me?” The Brit looked like he was about to fall over from the sheer effort of talking.
Simmons fiddled with the remote control and raised the volume. “Don’t worry about it, Edward, you're fine.”
Gore nodded and threw himself into the chair. “Good to talk with you again, Tony, and to finally meet face-to-face.”
“You, as well. After our last call, I wasn’t sure if we would talk again.”
“Yes, sorry about that. The bastards didn’t leave me much choice. Stomped in and told me they needed me for queen and country—all that nonsense. Kept it hush-hush until we arrived at Porton Down.”
“I had a similar experience, although a little more civilized.” He recounted his own trip to Fort Detrick and the subsequent inquisition by Raine.
“Sounds dreadful, but I can at least say I understand why they took you. Me, not so much.”
Simmons raised an eyebrow. “Why do you say that?”
“Don’t be so modest, Tony. No one on the planet comes close to having your knowledge of bacterial genetics.”
“Thanks, you’re too kind, but I think you’re selling yourself short. After all, it was you they approached in the first place.”
“Right.” Gore frowned. “I still don’t understand why they didn’t bring in Albertson. He’s not at your level, but he’s a damn sight more knowledgeable than I am.”
“Owen Albertson?”
“Yes, do you know him?”
“No, but I called him when I couldn’t reach you. Is he there with you?”
Gore shook his head. “No, they said he wasn’t reliable. Not trustworthy enough for something as important as this. What a load of bollocks—the man’s a Deacon in the Church of England for god’s sake. Paranoid bunch of bastards, they are.” His voice became somber. “Doesn’t matter now anyway, I heard he’s dead.”
Simmons let the silence hang between them for a second and then spoke. “You look exhausted, Edward. How’s it going over there?”
“I’m knackered,” the Brit admitted. “Not well I’m afraid, Tony. Nothing we’ve tested is effective against the strain—even Teixobactin’s efficacy is limited. Have you seen the report?"
Simmons shook his head.
Teixobactin was from a new class of antibiotics, the first truly innovative one discovered in many years. Grown from bacteria found in soil, it offered tremendous promise and was viewed as resistance-proof.
Gore continued to explain. “The Teixobactin can’t bind with the peptidoglycan precursor molecule because the bacteria’s outer wall is linked differently than run-of-the-mill C. diff.”
Simmons whistled out loud. “So it isn’t a resistance gene but a different cell wall structure?”
“Yes, very different. There’s an outer membrane on top of the peptidoglycan layer. The analogy is crap but it’s almost like each bacteria is covered in its own shrink-wrap layer for extra protection.”
He was impressed. “Whoever did this piece of genetic engineering knew their stuff.”
“It’s bloody brilliant…” Gore agreed.
Brilliant was an understatement. It was a masterpiece, almost God-like.
Gore pounded the table in frustration. “We have tested every antibiotic known to mankind on this bacteria and nothing has made a smidgen of difference. It just keeps soldiering on, producing its toxins.”
Simmons stood and walked to the whiteboard behind him. “I think we’re chasing our tail, wasting precious time. Antibiotics aren’t the answer. Have there been any positive field reports at all, even one?”
“No—but we can’t give up hope.”
“Edward, I’ve looked at the strain’s genetics
and you’ve just confirmed it. It’s got resistance to just about everything built into it and then some. It’s not a matter of giving up hope. It’s futile to keep wasting valuable time and resources looking for a cure that doesn’t exist.”
“Surely, you’re not suggesting giving up?”
“No, of course not.” He gripped the whiteboard marker awkwardly in the thick rubber glove he wore and began to write on the board.
“PREVENTION”
“We need to get in front of it. The only way to do that is with a vaccine.”
The camera followed him as he stepped to the side.
Gore opened his mouth to speak and Simmons held up his hand. “Before you say anything—I know we’ll have the same issue with a vaccine as we do with antibiotics—the development cycle is long, but at least with a vaccine we get right to the heart of the issue, stop it dead, so to speak.”
He turned back to the whiteboard and wrote “VACCINE” beneath “PREVENTION”.
“A lot of people are going to die without treatment, Tony—more than two million a week in the United States according to your CDC’s model. A vaccine isn’t going to help them.”
“I know…I know,” he said dejectedly. The thought was almost unfathomable…millions, maybe even billions would die. The numbers were so large, it was a struggle to even get his head around them.
He walked to the small table in front of the video camera and put the marker down.
“I’m going to propose we form a single team—focus our collective efforts on prevention, both labs—the USA and UK.”
“It will never fly,” Gore said wearily. “It’s already been proposed and the higher-ups vetoed it.”
“Vetoed—by who?”
“Holly and Mayer made a joint-pitch to the steering committee but they said no.”
He hadn’t met Mayer’s counterpart in the UK, Dr. Jonathan Holly, but Gore’s tone made it obvious he didn’t think too much of him.
“I offered to go to the meeting but Holly’s a bit of a prat, he’s not interested in anything from the likes of me,” Gore spat. “Spends his days in meetings doing god knows what. Thankfully, I see less of him now than I did at the institute.”
“But why was the proposal rejected?’
“Committee didn’t want us putting all our eggs in one basket is what Holly said they told him.”
“That’s idiotic. All we’re doing is diluting our efforts.”
He picked up the marker and stomped back to the whiteboard where he drew a series of circles around the two words and spoke firmly. “This is our only option.”
“Don’t disagree with you, Tony.” Gore fought to hold back a yawn. The dark circles under his eyes extended down to the top of his cheekbones.
“You look like crap, Edward. When was the last time you slept?”
“About thirty-six hours ago…time enough to sleep when I’m dead,” the Brit answered with false bravado.
“Get something to eat, have a nap,” Simmons said as he picked up the remote. “I should get back to work. I’ll update you if I learn anything.”
“Cheers, Tony. Talk to you later.”
17
THE BRIEFING
March 28th, 11h55 GMT : Fort Detrick, Maryland
Simmons raised the white styrofoam cup to his lips. The coffee was piping hot. He took a small sip and nearly gagged. It tastes like goat piss. Not that he knew what goat piss tasted like. Regardless, he needed the caffeine, he’d been in the lab until late the night before.
He precariously balanced the styrofoam cup on the small white pull-up armrest that doubled as a tabletop. The seats in the auditorium were cramped. It was all he could do to not bang his knees against the tabletop. God help me if that coffee ends up in my lap.
At 07:00 a.m. sharp, Colonel Young coughed a couple of times and then spoke in a booming voice.
“Let’s get started. Thank you all for coming. I know for some of you this is a little earlier than you’re used to but I don’t need to tell anyone that time is of the essence.”
He waited a few seconds for the murmurs to die down and introduced the first speaker, a Director from the Department of Commerce. She rose from her seat and made her way to the podium.
Notwithstanding the gravity of the subject matter, her presentation was mind-numbingly boring. Simmons half-listened while she droned on about the ratio of actual to expected deaths and the impact on the country's GDP.
She flipped a slide onto the screen behind her as she finished up. “Our best guess right now is the pandemic, if it continues to expand at its current growth rate, will cut global GDP to a level last seen in the 1930’s—and it will happen in a matter of months.”
Eighty-five years of progress gone in just a few months. It was unbelievable.
"Thank you, Ms. Dorsey," Colonel Young said. He moved his finger down a list of names on a piece of paper. "Next, Dr. Murray Black from the CDC.”
A short balding man with black-rimmed glasses thanked Colonel Young and stepped onto the podium. He was nervous and spoke quickly as he gestured awkwardly at the image on the large projection screen.
”There it is...Clostridium difficile, also known a C. diff, an anaerobic gram-positive bacteria. The strain we’re dealing with is a nasty little creature capable of producing A and B toxins in addition to a unique binary toxin. The binary toxin alters the structure of the cells that line the intestine, allowing the AB toxins to destroy them.”
He flipped to his next slide. “Many of the worst epidemics—Spanish flu, Ebola, HIV—have been caused by microbes that are spread through the air or bodily fluids, but Clostridium difficile isn’t like that. When it’s stressed it creates tiny spores that are shed in the fecal matter of an infected person. To become infected, you have to ingest the spores."
Groans of disgust sounded from the audience and he paused, confused by the reaction. “It sounds repulsive, but you’ve misunderstood. It isn't the actual fecal matter that needs to be ingested, just the spores. They’re approximately one one-hundredth the width of a human hair—Imagine tiny pieces of rice only much smaller…and everywhere.
His next slide appeared on the screen and he reached into his pocket to retrieve a small plastic bottle of hand sanitizer. He waved it in the air to show the audience and then dropped it. The bottle hit the floor and bounced.
"Utterly useless," he said dramatically. “The spores are resistant to alcohol. Bleach is the best way to kill them, but soap and water will do in a pinch. They’re hardy and can survive for months on a hard surface like a door or counter-top.”
He toggled to a slide titled “Treatment Options.” It was blank aside from a large question mark.
“Unfortunately, we don’t know how to treat this particular strain of C. diff. It’s highly resistant to antibiotics—perhaps completely resistant.” He looked to Simmons who nodded in agreement. “In some cases, we can knock it down, but we can’t seem to eliminate it completely.”
“What about a vaccine?” the actuary who had presented earlier asked.
He motioned to Dr. Mayer, who sat alone at the top of the auditorium. “There is a team working on immunization approaches, but it’s too early to predict the level of success.”
Simmons raised his hand. “How about FMT? I’ve heard the FDA made it excessively onerous for the hospitals to use.”
Black looked at him. “Happily the FDA has changed their ways, but I’m afraid it’s a little bit like throwing a wet blanket on a forest fire at this stage. Even if we were able to screen tens of thousands of donors to ensure they weren’t already carrying the bacteria, there’s no guarantee that re-populating the gut’s flora through a fecal transplant would be effective. This strain is exceptionally competitive, recurrence is high. It hasn’t worked on any of the patient’s we’ve tested.”
Simmons slumped back in his seat. That isn’t good news, I wonder if Mei knows about it.
When there were no further questions, Black flipped to his final slide. “We’r
e still refining the model, but the impact of this pandemic could equal that of the bubonic plague in the fourteenth century. Back then, about twenty percent of the world's population died in four years.“
The audience grew louder. They were doing the math and for the handful that didn’t, he did it for them.
He spoke over the crowd. “According to our most current model, two billion people will die from this pandemic if we aren’t able to stop it.”
The room went silent. It was as if all the air had been sucked out of it. One hundred pairs of eyes stared at Black and he stood frozen, twitching like a nervous rabbit as he debated whether to say anything further.
Colonel Young broke the silence. “Thank you, Dr. Black. Next, Director Lexington from Homeland Security will be our final speaker for today.”
The Director, a sharp-looking woman made her way to the podium. There was an edge to her and something familiar. Simmons racked his brain trying to remember where he had seen her before.
“Good morning,” she said with a politician's smile that quickly turned serious.
“As most of you know, we are now at what has been officially designated as day seven of the outbreak. The overwhelming majority of cases have occurred in the United Kingdom, USA and India but as of this morning, the bacteria has been found in sixty-three countries. We estimate that six hundred thousand people have been exposed. Although the number of deaths is still relatively low, we expect it to grow very quickly in the coming weeks.”
“What about Asia?” Colonel Young asked.
Simmons wondered if that was code for North Korea. He also wondered if everyone in the room knew the Koreans were the source of the bacteria.
She nodded slowly. “China has the least number of cases. Surprisingly, they were one of the first countries to close their borders—day three by our count, well before the pandemic had even been acknowledged.” She didn’t draw any conclusion for the audience, they could draw their own.
The Chinese knew in advance.
“But they are reporting death counts to the UN,” she added, “so they are clearly in the same boat as the rest of the world.”
