The Infectious Disease departments at both Duke Hospital and the University of North Carolina Hospital System are planning to initiate vaccination programs for North Carolinians using the locally produced product as soon as CDC confirms that the gene sequence is correct. Some are asking why the CDC hadn’t already published the gene sequence for the vaccine so that research laboratories everywhere could’ve been producing vaccine for use by the public. However, it is thought to be likely that this is due to the fact that research laboratories usually cannot produce large quantities and the CDC prefers to have good control over manufacturing to confirm quality.
When she arrived at the hospital, Tanvi immediately went to Anika’s room, anxiety making her heart thump her chest. She’d awoken this morning, suddenly certain that the medication she’d given the girl last night was some kind of toxin. She’d begun imagining the girl dead. Someone would find out what she’d done, and that she’d done it without getting permission. After spending all these years getting her degree and training, she’d be put on trial and denied permission to practice medicine. As she walked quickly down the hall towards Anika’s room one of the girl’s nurses, Kiara, saw her. Eyes widening, the nurse rushed toward Tanvi. With her heart in her throat, Tanvi prepared to receive grim news, but instead Kiara said, “Anika’s better! Her fever’s down and the rash isn’t spreading!”
Restraining her own ecstasy, Tanvi accelerated her stride toward Anika’s room. When she entered, rather than sprawled prostrate on the bed, Anika was sitting up. The girl offered a smile and said in her little voice, “I feel better! Thank you for giving me that medicine.”
Kiara, who’d excitedly followed Tanvi into the room, frowned, “What medicine?”
Tanvi swallowed. Little Anika’d watched Tanvi hook up the filter and inject the antibody into her IV, but she’d been so listless that Tanvi hadn’t dreamed she’d remember it. “Um…”
Kiara put a hand on Tanvi’s shoulder, “If you’ve got a medicine that works, don’t hide it! You should be telling everyone! There’re hundreds of children to save!”
Tanvi pulled Kiara a little bit to one side and whispered, “Someone, I don’t even know who, sent me some medicine last night. They said it was an antibody to modified smallpox. I… I gave it to Anika even though it’s not approved or certified, or whatever they do. I gave it because she was going to die and I just couldn’t stand doing nothing.”
“Can you get more?”
“I don’t know,” Tanvi shrugged, her eyes darting about, “maybe?”
“Is it expensive?”
“I don’t know, they didn’t charge me anything for the medicine I got last night.”
“See if you can get some more! I’ll help you give it to the children. I’ll even help pay for it if it’s not too expensive.”
“But… it isn’t approved!” Tanvi said staring at the floor, “I shouldn’t have done it…” she lifted her eyes, “We’ll get in trouble!”
“Oh, come on! You had the courage to do it last night for Anika. You know it’s the right thing to do. I’ll help you. We’ll do it together and make sure no one sees us!”
“Okay,” Tanvi said, reaching into her pocket and feeling for the port she’d left there the night before, “but we can’t tell anyone about it until we’re sure it’s working for more than just Anika, right?”
Kiara pursed her lips, but then nodded, “Okay.”
Tanvi pulled out the port and switched it on. As soon as she did it, another syringe dropped into her hand. She looked up and saw Kiara staring at it wide-eyed. “That’s what happened last night too,” Tanvi whispered.
***
Galveston, Texas—A body found in a low-cost motel here has been confirmed to be that of Adin Farsq, the alleged mastermind of Islam Akbar’s bioterror weapon. Farsq was shot six times in the chest and has been dead for one to two days. Although you would think that six gunshots that no one reported to the police is a sign of a sophisticated assassin who used a silencer, apparently this particular hotel has been the scene of other unreported shootings.
Of note, although Farsq has apparently been dead since yesterday, overnight the Gordito website responded to numerous requests. These were the same kind of requests from scientists regarding various antigens or protein folding issues that Gordito has answered in the past. The timing of these responses seems to contradict the opinion held by some that the Gordito website was hosted by Farsq and used for disinformation. Even Dr. LaQua Kelso of CDC—who first brought the possible unsavory nature of Gordito to the attention of Homeland Security—is now pointing out that Gordito has never engaged in any detrimental activities. In fact, she says Gordito has been nothing but helpful to science in general and to the control of the smallpox epidemic in specific. “The only thing that called Gordito’s nature into question was the timing of its establishment, the website’s rigidly protected anonymity and its astonishing ability to analyze genomes, understand protein functions, predict protein folding, and describe antigen structure, all much more rapidly than anyone believed could be possible. It may well be that someone has developed a computer algorithm that allows these kinds of things to be done extremely rapidly. If so, hopefully Gordito will make this transformative programming generally available as soon as possible.”
In other good news, the Neerja Children’s Hospital in the isolation zone of Mumbai, India has suddenly become renowned because a number of children admitted with the signs and symptoms of modified smallpox appear to be recovering! As, so far, everyone with a confirmed diagnosis of modified smallpox has eventually died, this has led to widespread requests for transfer of children and even adults from other hospitals to Neerja. No one seems to be certain what treatment, if any, has led to these amazing outcomes but an intense investigation is underway. Outside experts have been brought in…
“All of the patients who improved are on a single ward,” Dr. Vaidya said, “under the care of various nurses, but almost all of them under the care of a single pediatric resident, Tanvi Mishra.”
“And do we know if she’s doing anything different from the standard supportive regimen used by the other doctors?”
“When I talked to her, she claimed to be following the standard regimen religiously…” Dr. Vaidya broke off, a considering look on his face.
“What?”
“When I talked to her, she seemed quite fearful. You’d think someone with such astonishing results would be ecstatically proud. I just realized that, although she claimed to be following the standard supportive regimen, she could be following the regimen and doing something in addition. I didn’t specifically ask whether she was engaging in supplementary treatments.”
Dr. Jindal stood up, “Let’s go ask her, immediately.”
Vaidya said, “If I may make a suggestion?”
“Certainly.”
“Ask your questions in a very positive fashion. Don’t imply that you might be looking for something she’s done wrong, rather that you’re only trying to find out what she’s done that’s providing results so much better than anyone else’s.”
Jindal nodded.
When they arrived on the ward, Vaidya found Dr. Mishra and brought her to meet Jindal. When she entered the room, Jindal stood and enthusiastically greeted her. “I don’t know if you’re aware, but tests have confirmed that your children who’ve gotten better were in fact infected with modified smallpox virus! We’re very anxious to find out how you’ve been working this miracle. Dr. Vaidya says you’ve been following the same protocol that everyone else’s using, but is there anything you can think of that you might’ve been doing in addition to the standard protocol? If we have to, we can look through the orders you’ve submitted for your patients’ treatment to try to discern what you might be doing that other doctors aren’t, but I’m hoping that you might have some idea and that it’ll save us time in getting this miracle out to others.”
Mishra looked extremely uncomfortable, so Jindal said, “Don’t worry that this’
s some kind of a witch hunt. We’re only trying to find out what you’re doing that’s working so much better than what everyone else’s doing.”
Mishra’s shoulders sagged, “I… I should’ve sought permission…”
“Don’t worry about that now. What you did worked! I only want to tell others how to do the same thing.”
“When I got home, there was a package...” she ran down, her eyes downcast. Jindal encouraged her again, and she continued, “The package didn’t have any mailing labels or anything to tell me where it came from. When I opened it, it contained a fifteen millimeter port and instructions to switch it on. The instructions said that it’d deliver an antibody for the smallpox virus…”
Dumbfounded, Jindal tried not to let it show. He’d been thinking that the young woman might’ve treated the patients with some standard medication that killed the virus for reasons that might be difficult to understand, but would eventually be worked out. Not some kind of clandestine delivery of miraculous antibodies! Speaking calmly, he prompted, “And you switched it on?”
She nodded, her eyes still down cast. “A syringe immediately fell out. It contained the antibody in a powder form and had instructions taped around it. The instructions described how to draw fluid into the syringe in order to reconstitute the antibody and said to push the antibody through a two micron filter into the IV. The IV was to be run at a slow rate and discontinued if anything untoward occurred.”
Jindal restrained himself from making a comment on the fact that the powder could’ve been a virus itself. I can’t afford to frighten her, he thought. He said, “And so you administered some of this antibody…?”
She nodded, “To Anika. A beautiful little girl who’d just developed the rash.” Mishra shrugged, “I liked her so much. And I knew she was going to die. I couldn’t bear it. Even the possibility that something might work…”
Jindal put his hand on hers and used his most reassuring tone, “It all turned out for the best, didn’t it? Where’s the port now?”
She reached in the pocket of her white coat and pulled out a port. “Each time I switch it on, another syringe comes out. Would you like to see?”
Jindal nodded, staring at the ordinary fifteen millimeter port like it was a genie’s bottle. A few seconds later, she’d given him a syringe as promised. “If you don’t mind, I’ll take this syringe to the lab and have the powder analyzed. In the meantime,” he turned to Dr. Vaidya, “perhaps you and Dr. Vaidya could switch the port on and off, trying to get enough of the syringes for us to treat all our patients and perhaps even give some to the other hospitals that’ve been asking how we’re doing it?”
***
Raleigh, North Carolina—People have started showing up at the various research universities here in North Carolina, hoping to get vaccinated against modified smallpox. Duke, UNC, NC State, ECU, and Wake Forest University all report having limited supplies of vaccine that have been manufactured in their laboratories. The four medical schools have established limited programs for the vaccination of people thought to be at high risk due to travel plans or medical conditions, but are otherwise limiting vaccinations in hopes of building up a supply to deal with any impending crises. It’s important to note that Homeland Security feels that it does have sufficient quantities of vaccine to deal with any future outbreaks and expects to begin a program to vaccinate every citizen within the next few weeks.
Dr. Jindal switched on the port one more time. Still no further syringes. He reread the message he’d written:
Have you run out of the antibody? If so is there anything we can do to help? Who are you?
Deciding those questions were sufficient, he picked up the pencil, wrapped the piece of paper with the message around it, applied a small piece of tape, and held the pencil in front of the port. He nodded at Dr. Vaidya and as soon as Vaidya’d switched on the port, he pushed the pencil through it in the opposite direction from the way the syringes had been arriving. He nodded at Vaidya again and Vaidya switched off the port, cutting off the pencil. Jindal couldn’t help running his finger over the incredibly smooth surface where the pencil’d been transected as the port closed. Turning back to Vaidya, he said, “Let’s go get some coffee. We’ll open the port and see if we got a reply when we get back.”
The two men got up and left the ward in search of the magic brown elixir.
When they returned and Vaidya powered up the port a small curl of paper fell out, swooping back and forth to neatly avoid Jindal’s hand and land on the floor. Picking it up, he read:
Out of antibody at present. Making more. Will post gene sequence so other people can make it as well.
Gordito
***
New York, New York—Reports out of India are that the patients there who’ve survived actual clinical infections with modified smallpox virus have been treated with an antibody to the virus supplied by the mysterious Gordito. Apparently Gordito has run out of the antibody which must be made by protein synthesis in a similar fashion to the way the vaccine is being manufactured. Of note Gordito provided forty million doses of vaccine but only a few hundred doses of the antibody. Unfortunately, the antibody must be given in gram doses whereas the vaccine is administered in microgram doses; a million fold difference. The same amount of protein that will provide forty million doses of vaccine will only provide about six hundred doses of antibody and it’s thought that patients might require several doses of the antibody to completely eradicate the virus. However, because enough vaccine is needed to vaccinate and protect everyone—billions of people—but the antibody is only needed for those who have actually developed infections, the world will hopefully need much less antibody than vaccine.
Regrettably, at present the only source of the antibody is Gordito and this has created a bottleneck. However, Gordito has now published the gene sequence and a method for manufacturing the antibody so that anyone with the requisite expertise and equipment—essentially the same people who’ve been making the protein vaccine—can begin manufacturing antibody as well. It can only be hoped that several vaccine manufacturers will convert over to making antibody in time to treat the estimated several thousand people infected with and dying of the active disease.
It should be noted that Gordito, whoever he or she is, or even whatever group might be represented by the Gordito website, has made the trip from scientific phenomenon, to lowlife evildoer, and back to worldwide hero faster than anyone else in history!
Epilogue
Osprey spoke in Zage’s ear, “You have a call from Dr. LaQua Kelso at CDC.”
“I’ll take it! Use the synthetic voice… Dr. Kelso, how can I help?”
“You can accept my apologies. I feel terrible for doubting you.”
“I’m not upset. In retrospect I can understand why you became concerned. The timing of the website and the quick analysis of the virus must’ve seemed suspicious.”
“Aha, that astonishingly fast analysis of the virus still boggles the mind. How did you do it?”
“Um, it does involve an algorithm and a supercomputer, but…”
“But what? Are you going to tell the rest of the world how to do it too?”
“Um, I’d like to but, there’re some parts of it that involve… intuition, I guess I’d have to say. A computer can’t do it and I don’t know how to tell someone else how to do it either.”
“So, you’re saying that you’re the only person in the world who can do this?” she said suspiciously.
“Every time I do an analysis, I try to understand how I’m doing it. I’m hoping I can figure out how to have the computer do it, or at least be able to explain it so other people can do the same thing, but so far I haven’t had any luck. I just look at the section of the protein sequence that the computer can’t predict and, somehow, I just know how it’ll fold. Once I have the 3D model, a lot of the time I immediately get a feeling for what the protein does. Admittedly, the computer works out most of the folding or each one’d take me days, but the le
ft over bits that stumped the algorithm seem to be easy for me.”
“Uh-huh, and how much money are you making by selling antigens and analyses of protein folding?”
“Well, quite a bit. But the reason we’re charging is to decrease the traffic on the site to reasonable levels. When it was free people were just dumping hundreds of amino acid sequences onto the site without trying to discriminate which ones they really needed answers for.”
“Oh… I can understand how that might happen,” Kelso said, “but still, you’re making a tidy profit. That’s going to make other people, not just me, think you’re just keeping the method to yourself for the money.”
“Um, if you look at the website disclosures on the homepage you’ll see that the money’s all going to Doctors Without Borders. Maybe I should make it more prominent, but if you don’t trust that, you could confirm it with the charity.”
“Really?” Kelso said in a tone of grudging respect. “How are you supporting yourself?”
“Um… other ways.”
“Well, in any case, CDC owes you their thanks for all your help with the smallpox crisis. Is there any way we can repay you?” Zage didn’t say anything for a moment, so Kelso said, “Gordito?”
“Yes ma’am, I’m still here. The website has the sequence for an antigen that no one seems to be paying any attention to.”
“What antigen’s that?”
“It’s a single protein molecule with a number of different antigenic sites displayed on it. The one protein should stimulate immunity to all of the known obesity viruses…”
Bioterror! (an Ell Donsaii story #14) Page 25
