“Please… just one drink…. I got you the stethoscope,” Roger wheedled, feigning a bashful smile.
Rebecca relented, knowing that there would, obviously, be more than one drink. But he would have to work for it. Inside she was as giddy as a teenage girl, but she still had some semblance of pride.
JULY 29TH, 8 AM, 63 IZMAYLOVSKY PROSPEKT, MOSCOW
Dr. Yelena Ivanovna Petrova took one last look around to make sure all the lights were off before shutting the door to her apartment. It was a two-bedroom flat provided at a heavily subsidized rent as part of her position at the Academy. It bore all the hallmarks of a mid-seventies Soviet construction project, with crude functional design and concrete walls. As was the case with most such buildings in Moscow, the insulation was poor and the central heating constructed in such a way that it was always either too hot or too cold. Still, it was homey, and the location was fabulous. Also, the interior decor was all American, high-quality furniture that she had bought during her years in the States when her salary was many times what she earned now.
She skipped down the stairs and took a deep breath of fresh air as she exited the building. It was a beautiful day, warm with clear skies. She crossed the parking lot and entered the lush greenery of Izmaylovsky Park.
Every morning she walked the three kilometers through the park to the Academy – even during the winter. This was the time of day when she could let her thoughts wander in free association. The seeds of many of her best ideas had been hatched during these morning walks.
After a short walk, she reached the point of the path where the canopy of trees closed overhead. She met a couple, students from the look of them; walking toward her, arm in arm. The young man followed her with his eyes as she passed them, which was met with stern disapproval from his girlfriend. Yelena smiled. In her late forties she could still turn heads.
It was not surprising. She was tall, fit, cared about her appearance and dressed well, although she was not one for spending a premium on fancy brands. Today she was wearing tight black jeans, high-heeled black leather boots, a navy tank top and a burgundy leather jacket; all no-name. The sky-blue jacquard scarf around her neck could have passed for something expensive from the high streets of Paris, but it was in fact a relatively inexpensive, though well made, item from China. Her hair was dyed a deep auburn color with faint hints of gray protruding from the roots. Her make-up was subtle but effective in sharpening her features. She was the epitome of middle-age female beauty, carrying the benefits of mental maturity without the usual accompanying marks of physical decay.
After a brisk fifteen-minute walk she reached the pond at the western end of the park and could see the complex of buildings across the Okruzhnoy Proezd that constituted the Department for Infectious Diseases at the Moscow Medical Academy.
As usual at this point of her morning journey, she felt a sting of doubt in her chest. She once again asked herself whether she’d made the right choice leaving her comfortable, well-paid and well-resourced position at Harvard Medical School to take up the chair in Virology at the Moscow Medical Academy, once an august institution, now nothing but a shadow of its former self. The government funding to education and research, once the pride of the former communist nation, had plummeted during the years of capitalist shock therapy. The salaries, close to the poverty levels of Western European countries, were not enough to get by on. The facilities at the academy were, generally, in a desperate state of disrepair and the departments’ entire operating budgets had to be funded by grants from abroad.
Still, she had made it her mission to save her department at the Academy from its otherwise inevitable decline and uphold its reputation as one of the top virology labs in the world.
Having reached the entrance, the fleeting feeling of doubt passed, as it did every day. It was replaced by a reassuring sense of comfort in knowing that she had made the right decision. That, and the pride in having done so.
The Moscow Medical Academy was still the seat of learning that had provided her with the free education that had made all her achievements possible. It was still the leading medical research establishment in Russia. It was her duty to repay the debt she owed it, and to preserve the standing of the institution that would serve as an inspiration to the younger generation, just as it had done for her during her years as a komsomolka.
Regardless of the dwindling state of research quality in her country in general, and the sad state of the rest of the Moscow Medical Academy, her department – the Department for Infectious Diseases – still stood tall. She’d seen to that. With her fame in academia came, with relatively minute effort, a steady flow of grants for equipment and fellowship positions. In an era where all the best brains of Russia were leaving the country to crowd the math departments of the world’s leading universities, and when ballet dancers and opera singers emigrated to nations where their performances brought larger financial rewards, Yelena’s department still had an remarkable inflow of students from abroad. Hundreds of young researchers sought the opportunity to work with her each year, and she could have her pick. She got the brightest and most motivated. She was, after all, Dr. Yelena Petrova.
Opening the door to the lab she noted, not without contentment, that all her students were already there. Some of the American exchange students had a pliable relationship with time, and would initially show up and leave as they saw fit. Not for very long, though. In this lab, when the professor came, you’d better be on-site and, ideally, already have your first findings of the day. As she’d jokingly tell her new students, underscoring her familiarity with Western culture: “You want fame? Well, fame costs, and right here is where you start paying – in sweat!”
Because it was the middle of summer, the lab was sparsely staffed. The next batch of researchers would not be in until September. Right inside the door was her resident Chinese postdoc, writing a summary of a pile of academic papers. She always made sure to have at least one Chinese student in the team. These days so many important results were published only in their native language, with complete disregard for the global research community. Hence, staying on top of the Chinese papers was crucial to remaining at the forefront of human knowledge.
To his right was Sergei Egorov, her only slightly promising local PhD student, poring over a set of chromatogram printouts.
“Professor Petrova,” said Sergei, “I have something I think you need to take a look at.”
“What? Is it the chromatograms for the HIV Subtype K outbreak?”
“Yes, and have a look at this.”
Sergei pushed aside the pile of notebooks and textbooks by his computer and spread out two charts showing sharp curves rising and falling along the vertical axis. The curves of the two charts were shaped almost identically.
“It’s the same sample,” said Yelena.
“No,” answered Sergei, “they are two different samples.”
“In that case, you’ve made an error and mixed them up. Recheck the figures.”
Yelena moved on to Luca Batelli, her brightest student overall. Only he was allowed to work on the core of her own research: live attenuated influenza vaccines.
“Luca, have far have you gotten?”
“Good morning, professor. I have run about a hundred sub-strains.”
“Anything interesting?”
“As expected, there are differences in pathogenicity. It’s not huge, but enough to make me feel there is something here.”
“Okay, give me the top and bottom ten.”
Luca shuffled through a series of printouts and handed Yelena the requested selection.
Yelena studied the color-coded genetic gene sequences in intense silence. After a couple of minutes she started spreading out the sheets on the desk in front of Luca.
“You see this. Look at the concentration of the positively charged amino acids. The more virulent strains have a denser concentration, here and here, while they are more spread out in the less-aggressive strains. What do you make of that?�
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“Yes, that could be something. It would be a pretty significant finding if it was true.”
“I agree. Right now it’s a bit thin though. See if you can drive mutations in the strains towards higher and lower concentrations respectively, and then we’ll see what happens with the pathogenicity.”
“Sure.”
Yelena clasped her hands behind her head and stretched, arching her back. This was turning out to be a good morning. When she turned around to get coffee she found Sergei looking, no more like staring at here, intensely.
“What now?” Yelena asked.
“I have checked the data many times and I am pretty sure it is correct.”
“In that case the only explanation is contamination. Redo the experiment.”
“Professor Ivanovna! Excuse me for being so direct,” said Sergei, who had now risen to his feet, “but I have run this experiment three times already and gotten the same results each time. I know why you’re skeptical, but I’m telling you, these results are accurate.”
Yelena paused, turned around slowly and looked at Sergei, thinking, “Screwing it up three times in a row? That seems like a lot even for Sergei. There must be something else going on here.”
“Sergei,” Yelena said, “you realize what you are saying. If your analysis is correct, it means that two patients were infected with HIV from the same source at the same time, more or less. The only instance where we see this is with intravenous drug users. And even then it is rare, as the infection probability by exposure for that transmission type is below one percent.”
She snatched the files from Sergei. “And here you have, let’s see, a father of two and a young student, with no history of heroin abuse and living in suburbs at the opposite ends of Moscow. The two of them sharing needles feels like a bit of a stretch, Sergei, don’t you think? Maybe there was a mix-up of the samples from the original source?”
“Needle-sharing is not the only cause of matching chromatograms…”
“Oh, come on! We haven’t had contaminated blood for a decade. Both the blood and the tests are so cheap that even the most unscrupulous black-market trader wouldn’t sell untested blood. There is no plausible explanation…” Yelena paused in mid-sentence. “Unless… Have they had surgery?” she asked Sergei abruptly.
“Yes, this one had a liver transplant, which is unusual as he is a documented alcoholic. He must have paid through the nose to get it,” added Sergei, scanning the records.
“And this one,” interjected Luca, who had started to show a sudden interest and was now peering at the other file over Yelena’s shoulder, “has had a kidney transplant.”
“Bozje moi…” sighed Yelena. “Infected black market organs. Unbelievable…”
“Different hospitals though,” said Sergei.
“Yes, but same owner,” came Yelena’s response as she grabbed her jacket and ran for the door.
“Where are you going, Professor Petrova?”
Yelena was already out the door and her answer trailed off. “I am going to the Ministry of Health to see the last honest man in Russia, and then rip the guts out of a certain ‘healthcare entrepreneur’.”
The excitement ran so high in the lab that no work could be done. Instead, the students shared their thoughts of how the inevitable confrontation would play out. They had occasionally glimpsed the fury of which the Professor was capable, and it was like nothing else.
Their exhilaration was interrupted by a phone’s ring. Sergei answered, “Moscow Medical Academy, Department of Infectious Diseases.”
“Yes, hello, this is Dr. Chen-Ung Loo from the Singaporean CDC. Could you please connect me to Dr. Petrova?”
“I am sorry, but Professor Petrova is unavailable at the moment. Can I take a message?”
“Yes, tell her Loo says there’s trouble in paradise.”
JULY 29TH, 9 AM, WHO HEADQUARTERS, GENEVA
Aeolus hadn’t been in his office more than thirty seconds before Walt entered, obviously pre-warned by the receptionist about Aeolus’s arrival.
Aeolus sat down in his chair, took off his galoshes – a must to protect his leather shoes on rainy days – turned to Walt.
“So? Where are we?”
“Well, sir,” Walt responded, slightly short of breath, “we’ve made some progress. The Singaporeans have a sample. They’ve isolated it, grown it, and put it under a microscope. I have to agree with you, they’re amazingly efficient.”
“And what can they tell us so far?”
“First of all that you were right, it’s a strain of influenza – A, to be precise. Beyond that we don’t know much. They’re confident that it’s a new strain we haven’t seen before.
Walt handed Aeolus a printout showing a set of grainy gray balls with small filaments covering their surfaces, bunched together in groups of five and six.
“Yeah, that’s influenza, all right.”
“They have claimed the designation A/Singapore/4/2015/(HXNX) until we get the subtype, which they say should be in three days.”
“Have they started working on a diagnostic test?”
“Yes.”
“What’s their timeline?”
“Dr. Loo says there’s nothing off the shelf.”
“We don’t have time to make one from scratch. If we have to inoculate ferrets it could be five weeks. He’s got to do better than that.”
“He says he might be able to, ahem… ‘cook something up.’ By adapting and combining various old PCR primers he thinks he might be able to get specificity.”
“So it’ll be two to three weeks or so?”
“Dr. Loo says he can do it in ten days.”
“I have no idea how he does these things, but let’s agree we put the right man on the job. And they’ve distributed cultures to other labs?”
“Yes, they’ will be continuously sending out samples as they become available. My office is coordinating to make sure they go out in the proper order of priority.”
“And how are things on the ground?”
“We haven’t been able to locate Rebecca Summers yet. She’s not at her office, home and isn’t answering her cell.”
“What? Then find her! Someone at the CDC must know where she is. I want her down there now!”
“Yes, sir. Also, you have a brief in front of you summarizing everything we know. It was written by two senior staffers I picked to support you. You can’t do this by yourself. You have to delegate.”
“Yes, I know,” Aeolus said, frowning. No matter how much he hated it, in this case, Walt was right. This was going to be too much for him to handle by himself. He would have to hand over the knucklehead stuff to someone else.
“How did you choose them?” he asked.
“As you know, I’m not a great judge of medical knowledge, but I do understand operational effectiveness, and in that they are capable. They have relevant experience, and they have each, on two separate occasions, stood up to you without getting fired. This means they have a rare quality, which is necessary for the job. Read the brief and see what you think.”
“Okay. I’m reading.”
Mandy entered with Aeolus’s morning coffee. Without looking up from the brief, Aeolus waved a hand toward Walt, inviting him to request any refreshments he might desire. Walt shook his head, cleared his throat and continued: “Also, if I may, this might be a good time to discuss your behavior towards the staff.”
“We’ve talked about that many times.”
“Yes, but this time you will have to lead. Your habit of not remembering their names, firing people at a whim and just generally being rude won’t work.”
Aeolus sighed, frustrated that Walt just didn’t get it. “Walt, Walt, Walt… as for the firing, you know what I’ve told you. You can’t make an omelet without breaking some eggs. Still, you do have a point. Set up an all-hands meeting in the lobby at three. And connect our regional offices via video. I agree it’s time we rally the troops. Please, stay while I read.”
K
evin Brice and Edward Moynes stood outside Aeolus’s office. Kevin was fidgeting with his pencil nervously and Edward walking around in circles. They were the two senior staffers who had written the report Aeolus was reading. Kevin was a tall, lanky man known around the office as being somewhat of an eager beaver; ambitious and always anxious to show off his knowledge. Edward, or Ed as he was usually called, was, in terms of appearance, Kevin’s polar opposite: short and stocky, with a comb-over, which failed to hide his ever-growing bald spot. He was the senior staff’s permanent cynic, always pointing out the obstacles and potential misfortunes of any proposed course of action.
Ed spoke in that high-pitched voice, which made it easy to identify him even from far away. “If he calls me an intellectual midget again, I swear to God, I’m resigning and taking up that research position at the Karolinska Institute.”
Kevin, trying to lighten the mood, responded, “At least he’s never called any of your reports ‘a grade-F college midterm paper.’ But seriously, Ed, he’s one of the greats. Just working next to him, you learn more than you could anywhere else.”
“The only thing I’ve learned is to smile and nod gratuitously in the face of humiliating disparagement.”
As Walt opened the door and motioned the two men to enter, Aeolus started speaking. “It is not without satisfaction that I note you’ve printed this report, not on our regular eighty gram office paper, but the considerably heavier paper used for final reports, no doubt in order to try to impress me with presentation rather than content. This paper’s thickness will work far better for starting the fire in my fireplace. And that is the only thing it will be used for.”
Kevin lowered his gaze to the floor and Ed sighed inaudibly as his eyes turned to the ceiling. They both knew that if the text they had produced, with all the effort that had gone into it, was not up to par, it was unlikely that anything they wrote ever would be.
Aeolus chuckled. “Relax, I am merely jesting.”
Walt cleared his throat. “Sir, may I introduce…”
The Nightmare Scenario Page 6
