Bite

by Nick Louth

  ‘So we’ll find Anvil in Der Ridder.’

  ‘He drinks there sometimes, listens to the jukebox. If anyone asks, say Stokenbrand told you.’

  ‘The cop?’ Max was suddenly enjoying himself.

  ‘Yeah. He’s the dirtiest detective, a real klootzak. They’ll believe you. Don’t say I told you or I’m dead.’

  ‘It’s a deal,’ Max said.

  As they were leaving, Leo turned to Korten. ‘We know your house. If you lie…’ He raised the Walther. ‘Brother, sister, parent, all dead, understand?’

  Korten nodded. Leo grabbed Korten’s wrists, pushed them high behind his back and looped the belt tight round the handle on the rubbish chute. ‘You stay,’ he said, unnecessarily.

  In less than a minute they had thundered down the three flights of concrete stairs and were out into the warm, darkening evening. Max clapped his arm around the Zaireian’s shoulder as they headed for Der Ridder. ‘Leo. Threats are fine, but we gotta be careful, okay? I’m on bail, you understand. So no shooting. Please.’

  Leo looked disappointed. ‘But dis people dey scum, Max. In my country, put against de wall.’ He shouldered an imaginary weapon. ‘Dakka-dakka-dakka-dakka. Problem all finished.’ He grinned like a child at Christmas.

  Chapter Twenty-Three

  Saskia Sivali took her briefcase and umbrella in one hand, cushioned her swollen belly with the other and ran the two hundred yards from the Hague’s central railway station to the Health Ministry. You can’t keep a minister waiting, even if you are seven months pregnant.

  At Parnassus Square she slipped into the shadow of the health department’s twin towers, Castelia and Helicon, their tennis court-sized gable roofs sweating away the dew in the early morning sun.

  Saskia found Professors van Diemen and Friederikson waiting impatiently for her at reception and together they took the lift to the top. The hushed corridor of the twentieth floor smelled of fresh paint. Gilt picture frames hung empty on the wall, still awaiting the paintings to go within them. From the twelve-foot high windows, Saskia had been told, there was a view way over the parliament building and church spires, west as far as the North Sea. There was no time to look.

  They were shown to room A2035, ‘the war room.’ It had huge stainless steel doors, studded every few inches as if to resist a medieval battering ram. The chandelier was a tangle of golden wire, a thorn bush touched by King Midas. The grandiose style had been a standing joke for staff who sat in there to discuss family planning, measles inoculation and the prostate advisory group.

  Then along came Plasmodium five. Fifty-two cases of untreatable malaria. Rising by at least five a day. Thirty-one deaths so far. No recoveries. All jokes were forgotten.

  Health Minister Betsy Dijkstra began the meeting even before she had closed the door behind her. ‘We can forget usual departmental formalities. I think most of you know Professors Friederikson and Van Diemen. Saskia Sivali is one of Professor van Diemen’s students. We have asked her to be here because she has been most closely involved in identifying the parasite.’

  The minister introduced her officials. Peter Huisman, director-general of public health, was tall and sharply dressed, smugness oozing from every pore. Willem Pierson, the environmental advisor, was in his thirties with a face permanently creased in anxiety under a domed pate which thrust through a ring of pale cropped hair. Beside him sat the policy advisor on public health. Kia Spiegel’s slight frame made her look even younger than her twenty-six years, but looks can be deceptive. She was the department’s rising star.

  ‘We don’t have time for separate outbreak management team and public policy committee meetings,’ Dijkstra said. ‘The public needs answers now, and immediately after this meeting the TV cameras are coming in. I hope you will be able to give me something positive to tell them.’

  ‘We will do what we can,’ Friederikson said. ‘But we cannot do the impossible.’ Saskia scrutinised the professor. He looked tired, and even more bad tempered than usual.

  Dijkstra tapped a thick document on the desk in front of her. ‘I’ve read your report about the new malarial strain, Professor van Diemen, but what strikes me most is that we don’t know yet how it got here.’

  Van Diemen nodded. ‘We know very little for certain. The first thirty-eight cases we traced to KLM flight 648 from New York. The others we are still investigating, but it does seem likely that the outbreak began with mosquito bites on that flight. KLM officials confirmed to me that several upper deck passengers claimed to have been bitten or had seen mosquitoes late on into the flight. The cabin crew was not made aware of this until the morning, but sprayed all the cabins with insecticide two hours before landing. Unfortunately when the aircraft was cleaned no-one thought to keep any insect bodies, so we cannot identify the mosquito species.’

  Peter Huisman spoke: ‘But the United States is not generally malarial. How would malarial insects have come aboard?’

  Van Diemen cleared his throat. ‘We don’t know. Perhaps in the hand baggage of someone who changed planes at JFK. Federal Aviation Authority officials are checking passengers on connecting flights to see if anyone reported illness.’

  Professor Friederikson shook his head. ‘Minister, the problem in this theory is the number of passengers infected on KLM 648. To cause thirty or forty cases of malaria would need dozens of mosquitoes, possibly hundreds. Certainly not the handful that might be trapped in coats or luggage from the tropics.’

  ‘So do you have a better idea?’ Dijkstra asked Friederikson.

  ‘The only way that many mosquitoes would be on an aircraft is because somebody brought them on. The obvious candidate would be a scientist en route to the Parasitology Conference here.’

  ‘Why would anyone take mosquitoes in their luggage?’ Dijkstra asked.

  ‘Getting official permission for transporting disease-bearing species is, to put it mildly, bureaucratic. I generally take a jar or plastic food box and transport adult or larval mosquitoes that way. I’ve never been caught.’

  Dijkstra turned to Van Diemen ‘Is this a common practice?’

  ‘I have heard of it, yes. But no responsible scientist would move mosquitoes known to be infected, as presumably these were,’ he added hastily.

  ‘This is a very serious matter.’ The minister held the gaze of the two professors. ‘Obviously, whoever did this failed to report it. That is extremely reprehensible, shocking in any scientist.’ Dijkstra made notes, her mouth tight with anger.

  Huisman looked over his spectacles and tapped at the papers in front of him. ‘Your report, Professor van Diemen, shows a twenty per cent mortality rate within thirty six hours. How does it kill?’

  ‘The usual cause is cerebral malaria,’ Van Diemen said. ‘The parasites clump and adhere to the walls of capillaries in the brain, inhibiting blood flow and starving it of oxygen. This is identical to falciparum malaria, but more acute and more rapid.’

  ‘All over the country people are rushing to the doctor the moment they are bitten by any mosquito. What reassurances can you give them?’ Dijkstra said.

  ‘It is not my job to reassure the public, minister. I am a professor of tropical medicine. I am happy to give my expert opinion, what you do with it is your business,’ Van Diemen said. ‘If mosquitoes escaped from the aircraft, the public should be aware that being a tropical species they can live only a few weeks even in this warmest of Dutch summers. Your chances of being bitten by one are remote and they find our water too cool for their eggs.’

  ‘Well, that is some reassurance,’ the director general said.

  ‘And I’m afraid it is complacent nonsense too,’ interrupted Friederikson. ‘Forget the mosquitoes from the plane, local mosquitoes are what we should be worrying about.’

  ‘We have no evidence they can carry the parasite, do we?’ Dijkstra asked, looking at Van Diemen, who silently shook his head.

  ‘We have circumstantial evidence,’ Friederikson said, unfolding a big map on the table. ‘For the last fe
w days I have been on the phone to every Dutch hospital, to get exhaustive information about the patients confirmed carrying the new parasite. Every dot is a confirmed case, based on where the patient lives. As you can see they are scattered all over the place. First of all, ignore the blue dots. They are patients that we know were passengers on KLM 648, and were infected before they arrived in the country. The three yellows represent those who have been abroad recently enough to have been infected there. What I want you to look at are the eight reds, those who say they have not been abroad in recent months.’

  ‘This means nothing,’ Van Diemen said, waving his hand over the map. ‘Where these people live is irrelevant. What if they all work at Schiphol airport? They could have been bitten by mosquitoes from the plane.’

  ‘This one is a three-year old child,’ snapped Friederikson, stabbing his finger at one of the red dots. ‘And this old lady lives in a nursing home. Both more than seventy kilometres from Schiphol.’

  ‘Statistically insignificant,’ muttered Van Diemen. ‘It is just too early to say.’

  ‘By the time it is statistically significant we may have a full scale epidemic with hundreds of deaths,’ retorted Friederikson, his knuckles white. ‘This is no time for statistical niceties. We need action.’

  ‘We issued another health advisory this morning,’ the director general said.

  ‘What use is that?’ Friederikson said. ‘Ninety three people from flight 648 have failed to respond to the earlier one. It should be mandatory.’

  ‘We have no mandatory power to force hospital attendance,’ Huisman retorted. ‘In any case, many of the passengers on that flight are no longer in the country.’

  ‘If you had acted rapidly, every one on the flight would have been given a mosquito net and a bottle of repellent whether they have symptoms of malaria or not.’

  ‘A case of shutting the stable door, Professor, surely,’ Huisman smirked.

  ‘No, no, no. Not to protect them, but to protect our Dutch mosquitoes! You must stop thinking of malaria as a disease spread by mosquitoes,’ Friederikson said. ‘Think of it as a disease spread by humans. Mosquitoes pretty much stay where they are, governed by climate, altitude and so on. But humans travel the world in a few hours, and if they have the malarial parasite in their blood they may be able to infect local mosquitoes, which then turn a minor outbreak into a self-sustaining epidemic. Ergo, the best way to break the infective cycle is to stop uninfected mosquitoes being able to reach infected humans.’

  ‘Should we expect an epidemic then?’ Huisman asked.

  ‘It is too early to say, but assume the worst,’ Friederikson said. ‘We should spray insecticide into every canal, dyke and waterway. It’s a shame we can no longer use DDT. It is cheap, effective and lasts for ever.’

  Dijkstra was shaking her head until her long earrings rattled. ‘No, Professor. This is not the 1960s. We can’t soak the country in insecticide, the environmental movement would be in uproar. Neither can we stoke public panic. In any case, most of these measures would take months to organise, and we are still unsure how much further this outbreak has to run.’

  Friederikson smiled as if this was the answer he had been expecting. ‘Then you will have to wait for me to discover which Dutch mosquito species is the culprit, and we can target it more selectively.’

  ‘Can you tell if an individual mosquito has got malaria?’ Kia Spiegel asked.

  ‘Normally, yes,’ Friederikson said. ‘First we grind up its body and add a special chemical called a monoclonal antibody. We have a specific monoclonal antibody which reacts to each of the four malaria types in what we call an ELISA test. With a new species of malaria such as this we would normally be in the dark until a new monoclonal was developed, but I am delighted to say that Saskia discovered that Plasmodium five is cross-reactive. It reacts with the monoclonal we already use for falciparum malaria.’

  The minister smiled at Saskia, thanking her for this crumb of comfort.

  ‘Now,’ said Friederikson, opening his briefcase and set two clear plastic containers on the table, each alive with mosquitoes. ‘These, ladies and gentlemen are just two of dozens of species we find in this country. I have tried to infect both types with Plasmodium five using blood samples from an infected patient.’

  Van Diemen looked across, startled. Saskia nodded slowly at him, and he shook his head in exasperation.

  Friederikson continued. ‘I will know the results in two or three days, when the parasites have had a chance to mature inside the mosquito. The results could be anything from trivial to cataclysmic.’

  He picked up a jar with a green lid. ‘These are Anopheles atroparvus, an indigenous mosquito which has in the past carried one type of malaria, and which stays inside homes, biting throughout the winter. I would not be surprised if it was capable of carrying Plasmodium five, but because the mosquito is now quite rare, it could not support any serious epidemic. Infection of atroparvus is thus the optimistic end of the scale of possibilities.’

  Friederikson then picked up the other container, which had a red lid. ‘This is the most frightening end of the epidemiological scale.’

  Saskia was close enough to see how densely it was packed, dozens of frenzied mosquitoes, desperate to escape. ‘Here are roughly one hundred hungry females of Culex pipiens pipiens, the common Dutch canal-side ankle biter. They are urban dwelling, bite humans exclusively and are active from March to the end of the October. Many billions of them exist right across northern Europe and we haven’t a hope in hell of wiping them out.’

  ‘Minister, don’t be alarmed by this charade,’ Van Diemen interrupted. ‘Mosquitoes of the Culex family do not carry any kind of malaria, only Anopheles do. Professor Friederikson knows this very well, and I am surprised he suggests otherwise.’

  ‘Ah, but we know nothing about this parasite, ‘ Friederikson retorted. ‘You call it Plasmodium five, but in reality we don’t yet know it is from the Plasmodium family. Yes, it causes malaria-like symptoms. But there are plenty of diseases, like dengue for example, which are carried by non-anopheline mosquitoes.’

  ‘Gentlemen please,’ Dijkstra said. ‘It is essential we work together on this. Lives really are at stake now.’

  ‘Yes, really,’ Friederikson roared. ‘Of course the two million people a year who die of malaria in the developing world, their lives are not really at stake…’

  ‘Yes, I know,’ Dijkstra said. ‘What I meant was…’

  ‘What you meant was that they are dying here. So now it matters.’

  ‘That is not what I meant at all, Professor. Please sit down and stop shouting.’ Dijkstra fixed him with her gaze.

  Friederikson showed no signs of being intimidated. He pointed a long bony finger at the minister. ‘Have you imagined what will happen when Plasmodium five gets back to sub-Saharan Africa? Where there are few hospitals and no money and everybody gets regularly bitten by malarial mosquitoes?’

  ‘Yes, and it concerns me very much.’

  A sneer like a twitch convulsed Friederikson’s face and he tore off the red lid. ‘Now it may concern you more.’

  ‘What are you doing!’ shouted Huisman, pushing himself away from the table as mosquitoes plumed like smoke.

  ‘Jürgen, this is crazy!’ Van Diemen said, hooking his jacket over his head like a cowl.

  ‘What is the matter, Cornelis?’ Friederikson retorted. ‘If you are so sure that Culex mosquitoes can’t carry this disease then you have nothing to fear but a few itches.’

  The officials were taking no chances. Willem Pierson and Kia Spiegel made for the window, pressing their backs against the glass, flapping documents in front of their faces. Huisman had sprinted out into the corridor. Only Dijkstra remained at the table, a bemused expression on her face, one hand occasionally swatting around her ears. ‘This is really an unnecessary way of making your point, Jürgen.’

  Friederikson replaced the lid and put the jar back in his gladstone bag. Sivali noticed a mosquito settle on his
neck just below the ear, but if aware of it, Friederikson gave no sign. He clipped the lock shut, levered himself upright, and with a sigh and hiss from his artificial leg limped to the door.

  ‘We are all a little less complacent when our own lives are at stake, are we not? There you have the real story of malaria, in a nutshell. Good day to you.’ Friederikson made his way to the lift.

  We have been here four days, but it feels like four years. On the first day our blindfolds were removed, but it hardly helps. We shuffle around this tiny cell every few hours, fighting cramp, hunger and most of all, depression. At six o’clock on the first day, something seemed to be happening, and we could hear excitement building in the other cells. We heard scraping of plastic on cement. Finally, the low hatchway was opened from outside, and a grubby blue bucket pushed into the cell.

  We looked at it and we listened to the guzzling sounds from other cells. Why were they given food when we only had this, a cold, grey fluid with globules of fat and a few grains of rice floating on top? For half an hour no-one touched it, even though we were all very hungry. Then Sister Margaret lifted the bucket to her mouth and sipped it. She tried to smile, but the taste defeated her. The bucket was passed on to Amy, who held her face away. I took it and sniffed. Then I took a gulp. It was unspeakable but I swallowed it. I could touch no more.

  We passed that evening in a state of shock, lulled only by the beautiful singing and rhythmic handclapping that sporadically swept the prisoners every few minutes. We couldn’t help noticing skilful hands tapping an accompaniment on empty-sounding buckets.

  In the morning we got a bucket of water to share, but apart from that we were left alone. We see nothing of our guards except their feet, through the hatchway at the bottom of the door. One wears scuffed boots and the other ripped canvas beach shoes. They never speak to us, ignoring all requests for better food, for medicine or more water. For the four of us the cell has become a world, and we its modest tinpot democracy. There is plenty of time to do public duties, like massaging each other’s cramped limbs, and few resources to share. But those resources assume a greater importance: favourite corners to sit, the space to stretch legs, scraps of paper and stubs of pencil, oddments of antiseptic cream and sticking plaster, a nail file, and the biggest prize of all: Sister Margaret’s swiss army knife.