by A. G. Riddle
“A gift from our American friends.”
“What kind of gift?”
“ZMapp.”
Elim sat up. “Don’t give it to me.”
She put a hand on his shoulder, forced him back onto the bed, and sat on the side. “For your sake, it’s a good thing you are no longer the physician in charge here, Dr. Kibet.”
“Give it to someone younger, with their life ahead of them.”
Nia smiled at him for the first time. “I like to think you’ve still got some life ahead of you, Elim. Look, we don’t even know if it will help. This is just a trial. We’re not dealing with Ebola, so we need a guinea pig to tell us if ZMapp will even work. Someone who understands informed consent. Someone worth saving.”
“There are lots of people worth saving.”
“True. We chose you. Now, I’ve got work to do. Call me if you need me.”
Before Elim could respond, the woman was gone.
As he closed his eyes, he realized that if he survived, he would be immune to whatever the terrible pathogen was. He could help others. He could go back to work without worry. That was something to look forward to. That was something to live for.
Chapter 25
Twenty miles from the Kenyan border, at a training camp in southern Somalia, a member of the al-Shabaab terror network turned his smartphone on and opened Daily Nation, Kenya’s largest news site. He scoured the stories, looking for opportunities to advance his group’s cause. The top headline immediately caught his eye: Outbreak in Mandera He sat bolt upright when he read the article’s subheading: Health Workers from the WHO and CDC Investigate Possible Ebola Outbreak in Mandera County He rushed to the barracks and began waking the members of his cell. They had work to do.
Peyton and Jonas sat in the back seat of an SUV, bouncing along the hard-packed red-dirt road. The engine roared as they plowed through a cloud of orange dust. There were six SUVs in the convoy, plus two armored troop carriers—one leading the procession, the other just behind the SUVs—and a Nora B-52 self-propelled artillery vehicle bringing up the rear.
Peyton and Jonas had used Dr. Kibet’s notes and the CityForge website to trace Lucas and Steven’s travel route. Based on their interviews with the sick villagers at Mandera Referral Hospital, as well as what they’d learned from the videos posted online, they had identified a village they believed to be ground zero in the outbreak. They were en route to that village now.
“What was that about in the hospital?” Jonas asked.
“What?”
“All the talk about Desmond Hughes. Is he connected to this somehow?”
“I don’t know,” Peyton said. She considered telling Jonas about the call from Desmond but decided against it.
“Do you know him? Hughes?”
Peyton hesitated. “I used to.”
Jonas scrutinized her, as if trying to read through her words.
“I think we’re missing something here,” Peyton said.
“Such as?”
“I don’t know yet. Something just doesn’t… feel right.”
“You think…”
“I think someone is responsible for this outbreak.”
“Bioterror? Here?”
“I know. There’s no strategic, political, or symbolic importance.”
“Unless…” Jonas thought for a moment. “Unless you wanted to test a pathogen before wider release.”
Peyton wanted to continue their conversation, but the car slowed, and the noise from the engine died down. And as the convoy’s cloud of dust dissipated, Peyton got her first look at the village.
Her mouth ran dry. “Back up,” she said, struggling to speak. “Tell the other units to keep their distance.”
Chapter 26
Transcript
CNN situation room regment
Good morning, and thank you for joining us. Our top story this hour is a deadly outbreak in Kenya. It has already killed dozens, including one American and one British citizen, and anonymous sources at the CDC and State Department say the symptoms are similar to Ebola—though they’ve cautioned that tests to identify the disease are not yet in.
Most alarmingly, CNN has just learned that an infected patient is being transported to the United States as we speak. Authorities at the CDC say that Lucas Turner, a recent graduate of the University of North Carolina, contracted the disease while traveling in northeast Kenya.
We’ll be updating this story as details unfold, but we want to hear what you think. Should the CDC be bringing patients with an unidentified, deadly disease back to the US? Let us know on Twitter, using hashtag OutbreakInAfrica.
Chapter 27
When Desmond came to, he was zip-tied to a chair in an airplane. The plane was level—it was apparently at cruising altitude—but it was encountering a fair amount of turbulence.
His hands were bound to the armrests, his legs tied below. He opened his eyes just slightly. Across from him, a muscle-bound man with a buzz cut sat gazing at a tablet, white earbuds plugged into his ears.
An escape plan took form in Desmond’s mind. Keeping his eyes just barely cracked, he began rolling his head around, mumbling. The man pulled out his earbuds and set the tablet aside. His hulking form leaned over Desmond, straining to make out the words.
Desmond jerked his head forward, slamming the highest part of his forehead into his captor’s face. The soldier fell to the floor in an unconscious heap.
Desmond bent forward and bit into the right armrest, trying to tear it open. If he could take out a big enough bite, he could slide his hand free, take the man’s gun, and— A hand grabbed him by the back of his neck, pulled his head up, and covered his mouth with a cloth. A sweet aroma filled his nose and mouth, and his vision faded to black.
Chapter 28
Her first glimpse of the village had spooked Peyton. It was too quiet, too deserted. Something was wrong here, and she feared the worst.
She, Jonas, and their team trudged toward the village, all wearing PPE, several members carrying cases with sample collection kits, bottles of ORS, and medications. A white tent complex stood behind them. With the sun setting across the barren red landscape, they looked like space explorers walking on the surface of Mars.
Ahead, two dozen round huts baked in the last rays of sunlight, their mud-packed walls and thatched roofs weathering the heat. Goats wandered down the village’s central road, weaving in and out of red dust clouds drifting in the wind.
The first hut was empty. But at the second, Peyton found what she’d expected: dead bodies. Two adults, likely a man and his wife, lay on their backs. Caked blood covered their faces and chests. Flies swarmed them. Three children lay beside them—two sons and a daughter.
Peyton motioned to Hannah, who advanced into the home, set down her cooler, and began taking samples. Peyton knelt by the two adults, swatted away the flies, and searched for clues that might establish a rough time of death. From the looks of it, these bodies had been dead for several days at least. Not good.
They found more bodies in the other huts, and several outside. Some of the villagers had probably wanted to die with the sun on their faces or the stars above them. Peyton didn’t blame them.
Just as she was turning to head back to the tent complex, she caught movement out of the corner of her eye. She froze, waited. Yes—there was someone, or something, just beyond the village, crouched, watching them.
Over the comm, Peyton said, “Jonas, did you see that?”
The German epidemiologist was already walking back to the tents. He stopped. “See what?”
Peyton set down her sample case and got ready to run. It wouldn’t be easy in the suit, but taking it off wasn’t an option. She spoke quickly on the comm line. “Colonel Magoro, do you copy?”
“Yes, Dr. Shaw.”
“We need a team of your men at my location immediately. Do not transit the village—proceed around it, and use caution. Try to stay out of sight and stay quiet. Have your men take up a concealed position a hundred meters no
rth of me.”
“Understood,” the Kenyan officer said.
“Hannah, take your team back to the tents and take off your suits. Get in the vehicles and prepare to leave.”
Jonas returned to Peyton’s side and glanced over at her, silently questioning what was going on. Peyton nodded subtly toward the bushes. Jonas took a step toward them, but she caught his arm, urging him to wait.
A moment later, Colonel Magoro said, “We’re in position.”
“Spread your men out and begin walking toward the village,” Peyton said.
The Kenyan troops rose, assault rifles held in front of them, and stalked forward quietly, like big game hunters approaching a kill. Peyton wanted to run, but she focused on the group of yellow-green shrubs. If she was wrong about what she had seen, the mistake might be deadly. Sweat poured down her forehead. She desperately wanted to rip the helmet off, wipe her face, and pour cold water in the suit.
Suddenly, the bushes between the Kenyan troops and Peyton shook as three figures sprang forward. A woman, likely in her forties, a young boy, and a teenage girl, all emaciated. Surviving villagers, Peyton assumed. Their eyes were wild as they barreled toward Peyton and Jonas, away from the soldiers. They stumbled, trying to get their feet under them as they ran. Colonel Magoro and his men were close behind them, yelling in Swahili.
“Don’t harm them!” Peyton said. “And keep your distance. They may be infected.”
Fifteen minutes later, Peyton’s team was back at the tent complex. Peyton had placed the three villagers in a field isolation tent just in case they were still infectious.
She sat on the other side of a sheet plastic wall, watching the three Kenyans devour the MREs she had given them from her duffel. Though the sun had set, she was still sweating excessively.
Colonel Magoro sat beside her, ready to translate.
The teenage girl breathed in heavily after finishing the meal in the plastic carton. She looked up at Peyton and, to the physician’s surprise, spoke in English. “Thank you.”
“You’re welcome,” Peyton said. “What’s your name?”
“Halima.”
“Halima, can you tell me what happened here?”
The teen glanced toward the village. “They got sick. Coughing, sneezing. Like a cold. Then it passed, but everyone got sicker. Started dying. It happened fast.”
“Who was coughing and sneezing? Just a few people?”
Halima shook her head. “Everybody. All of us. All the others.”
Peyton pondered her account. If it was true, it would rewrite the pathogenesis of the disease. Whatever the Mandera strain was, it began as a respiratory disease, then progressed into a hemorrhagic fever. It was the ultimate killer—a virus that was highly infectious in the days after contraction, then extremely deadly shortly thereafter.
In the distance, she saw a figure suited in PPE advancing toward the village. She rose to find out what was going on, but Jonas was there, leaning against a tent pole, his hand held up. “It’s Hannah. She thought she saw something in one of the huts. She’s going to check it out.”
Peyton turned to Magoro. “Send some men to follow her. Tell them to stay outside the perimeter of the village and to bring night vision goggles.”
“Yes, Doctor.”
Magoro rose and spoke quickly into a handheld radio. Seconds later, ten men raced from the tent complex toward the village.
Peyton held a tablet up to the plastic divider. “Halima, have you seen any of these three men?”
On the screen were pictures of the two American college graduates and the British man.
The teenager shook her head.
“Can you ask the others?”
Halima spoke in a language Peyton couldn’t place. It wasn’t Swahili; perhaps it was a local dialect.
“No. They haven’t seen them.”
“Thank you. Can you remember when people began getting sick? When did they die?”
Halima consulted the other two villagers. “Three or four days ago, maybe.”
“And the coughing and sneezing. How long ago did that begin?”
Inside the isolation tent, the three spoke hurriedly, arguing. “We’re not sure. Maybe a week. Maybe more.”
Peyton nodded. “Thank you. You’ve been very helpful, Halima. The information you’ve given us may save many lives.”
Ten minutes later, Hannah marched back into the tent complex, carrying a dark object Peyton couldn’t make out. Whatever it was, she was taking great care with it. She bagged it before she entered the field decontamination chamber.
A short time later, Hannah placed the plastic bag on the conference table. Peyton, Jonas, Millen Thomas, and several members from the Kenyan Ministry of Health leaned forward and examined it.
It was a handheld video camera, covered in blood.
Hannah took a seat at the table. “They were here. The two Americans.”
“Good work, Dr. Watson,” Peyton said.
The young redheaded physician beamed.
Peyton pointed to a worn, spiral-bound notebook on the table. “I’ve been reviewing Dr. Kibet’s notes. He took a detailed history from Steven Collins before he died. He also spoke at length with Lucas Turner before we sent him back to Atlanta. Both men reported having a cough, headache, fever, and fatigue a week before Steven fell ill.”
“My God,” Jonas said.
“We’re dealing with a completely new, unidentified pathogen here,” Peyton said. “In the early days, it looks like the flu. A week or two later, it kills you.”
“So where did it start?” Jonas asked.
“I see two possibilities,” Peyton said. “Either it originated here in Kenya, or it was brought here by the Americans.”
“The package from Desmond Hughes,” Jonas said, looking suspicious.
Peyton was hesitant. “Possibly.”
Around the table, the Kenyans, Hannah, and Millen glanced at each other, confused.
Peyton focused on the head of the Kenyan Ministry of Health team.
“You sent teams to the surrounding villages where the patients at Mandera Referral Hospital had come from, correct?”
“We did. It’s nothing like this. Some dead. Everyone is sick though.”
Peyton stood and put her hands on her waist. “Okay, let’s think about what we know. Our index case is likely either Steven Collins, whose body is in the air on its way back to the CDC, or one of those dead villagers we just saw.”
Millen, who was a veterinarian, spoke up for the first time. “If one of the villagers came into contact with a fruit bat or droppings, the reservoir hosts might be close by.”
At the end of the table, a member of the Kenyan Ministry of Health asked their local interpreter if there were caves in the area or other natural habitats for bats.
The man nodded. “A lot of caves.”
Millen rose quickly from the table. “I’ll get ready.”
Peyton held up a hand. “Hold on, cowboy.” She nodded toward the moon, which glowed yellow in the sky. “I want you to set out first thing in the morning—when your mind is fresh and the team supporting you is well rested. Besides, there’s a lot we need to do here. The temperature will drop even more soon, and we’ll be able to work a little longer in the suits. One thing the Ebola outbreak in West Africa reminded us of is that dead bodies carrying the pathogen can be just as dangerous as living hosts. Much of the Ebola transmission in West Africa happened at funerals, where African burial practices, such as kissing the dead, helped the virus explode beyond the villages.”
Peyton surveyed a map on the wall, then circled the villages adjacent to their location and B9, the main road that led south.
“Jonas, I think we should deploy teams to these villages and follow our SOPs: isolation and quarantine. I think there’s a good chance we’ve found ground zero here.”
“I agree,” Jonas said. “I’ll make the call to Mandera and assign personnel.”
“Colonel, I think it’s time for that checkpoin
t on B9,” Peyton said.
The Kenyan officer nodded.
“And I’d like your men to dig a fire pit.”
“How large?”
“Large enough to burn our suits from today and anything in this village that might be carrying the pathogen.”
“Bodies?” the colonel asked.
“Not yet. We’re going to put them in body bags in the next hour or two. We’ll make the call later. Right now we need to stop any transmission. If they’ve been dead for at least a few days, bats, birds, rats, and any other hosts feeding on the bodies may already be infected.”
“When would you want to burn the material?”
“Ideally at the end of each day.”
“I’d recommend against it,” Colonel Magoro said. “The al-Shabaab terrorists are likely already aware of your presence here in Kenya. A large fire would paint a target on us.”
“What do you suggest?”
“We could dig the pit now, fill it, and place a tarp over it, sealing it as best we can. When we leave, I’ll have two men stay behind and burn it after we’re a few hours away.”
Peyton glanced at Jonas, who nodded slightly. “That works for us.”
The three hours just after sunset were physically and mentally grueling. When they were done, the pit Colonel Magoro’s men had dug was filled with suits and all manner of items from the village, everything from toothbrushes and toys to clothes and stored food. A patchwork of olive green tarps stretched across the crater, duct tape connecting the pieces together like silver stitching on a plastic quilt.
A stack of black body bags lay under a white tent nearby. With each passing hour, the smell of death and decaying flesh had faded, until finally, the night’s winds that swept through the quiet village were fresh again.
In her tent, Peyton plopped down on her cot and began rubbing a topical analgesic over her legs and arms to soothe her sore muscles. She wore a white tank top and athletic shorts that stopped at her upper thigh; both were soaked with sweat.
