by Hank Parker
Hoffman spoke. “The victims all seem to have had a connection—direct or indirect—to the dog.”
“Right, it does look that way,” said Rausch. “And so far all the victims are from Chester County.”
“Any idea what we’re dealing with?” asked Blumenthal. Mariah stopped herself from rolling her eyes, remembering only at the last second that he could see her as well as she could see him. This guy and his million-dollar questions, she thought.
“Kandahar hemorrhagic virus syndrome,” Hoffman said gravely.
“How could that be?” Blumenthal asked, clearly alarmed. “That’s known only from Southwest Asia.”
Mariah flashed back to Kennedy’s remark in the microscopy lab about the unidentified microbe in Calvert’s blood. He’d said it looked like a virus from Afghanistan, but seemed to dismiss the possibility. Had he suspected something then? She watched as Hoffman looked around the table, jaw thrust forward.
“A couple of you aren’t familiar with this disease or the background,” said Hoffman. “A U.S. soldier on deployment in Afghanistan came down with Kandahar three or four years ago and died a few days after symptoms showed up. Medics got some blood samples before shipping his body back here, so we have it on file.”
“So how dangerous is this thing?” asked Wright.
“Pretty nasty,” said Hoffman. “Some of you know something about it, but for those who don’t, it’s tick-borne, first identified on the Afghanistan-Pakistan border in 2011. Most animals, including livestock, are known carriers but don’t usually show symptoms.”
“What about dogs?” asked Kennedy. Mariah figured he must be thinking about Calvert. It was the first thing she’d thought of after the revelation about Kandahar virus.
“Canines seem to be an exception,” said Hoffman. “But the disease is often misdiagnosed as rabies. We know that primates, including humans, are highly susceptible.”
Blumenthal broke in. “We sent a team to Afghanistan after the soldier died. As I recall, you were there too, Dr. Kennedy.”
Kennedy nodded in affirmation.
“We learned at the time that Kandahar virus isn’t airborne,” Blumenthal explained. “Similar to Ebola, transmission is by close contact with infected humans or animals, through body fluids. And its symptoms resemble Ebola in some ways. Like a flu at first, but often accompanied by a skin rash and changes in behavior. Three to six days after symptoms first show up, the patient starts to hemorrhage—internally and externally. They’ll pass dark tarlike stools and bloody urine. Their vomit looks almost like coffee grounds. Many of them bleed out—from the nose, mouth, gums, penis, vagina, virtually any orifice. Even through the pores of the skin.”
Mariah winced and looked around the room. Kennedy, Hoffman, and Davidson showed no visible reaction. They already know all this, she realized, but Rausch looked tense, and Wright had paled.
“What’s the case fatality rate?” asked Rausch.
“About half of confirmed cases end up dying,” said Hoffman.
“You’re sure you’ve got an accurate ID from the dog’s blood?” Blumenthal asked.
“I did that work,” Lieutenant Colonel Davidson said. “Dr. Kennedy provided a sample. Just finished running DNA sequences to confirm it.”
“I’d also like to have a look here in Atlanta,” said Blumenthal. “Can you overnight a blood sample to us?”
He doesn’t trust the Fort Detrick work, Mariah thought.
“No problem,” Davidson answered.
“Where are that soldier’s blood samples now?” Blumenthal asked Hoffman.
“Here, at the Barn,” Hoffman said. “In a secure freezer in Level Four. We also isolated the virus at the time. Stored in the same freezer. The intent was to develop a vaccine. Still is. If we ever get the funding, that is.”
“I’m sure I’m not the only one who’s thinking that somehow the virus got out,” said Blumenthal.
Hoffman rolled a pen between two fingers. “No way,” he answered. “Only three people have access to that freezer—a lab scientist, a technician, and me. It takes two keys to open the freezer room. The other two individuals each have only one of the keys. I’m the only person with both. So that freezer doesn’t get opened without my being there.”
To Mariah, Hoffman’s assurances rang hollow, and she had the sense that even he wasn’t confident in what he was saying. After all, the infected soldier’s corpse had been shipped back to the United States and his blood samples and isolated virus had been stored at the Barn. It seemed like an improbably large coincidence that these cases now were so close to the only location in the country where the virus had been available.
“So can you explain how Kandahar just happens to break out within fifty miles of the only North American source of the virus?” Blumenthal asked, as if reading Mariah’s mind.
“Plenty of possibilities,” said Hoffman, seemingly unfazed. “An infected tick from a soldier or civilian recently returning from Afghanistan. Possibly on a military dog that operated in theater. Or someone was exposed in the war zone and came back here before symptoms showed up.” He paused and appeared to think something over. “Might be a good idea to check regional hospital records for unexplained hemorrhagic diseases over the past couple of years,” he said. “And check on everyone who’s had contact with the infected patients.”
“We can do that,” said Wright.
“Okay, here’s what I propose,” said Hoffman. “We bring in USDA Wildlife Services. They fan out around the dog owner’s house and collect as many small mammals as possible—field mice and squirrels, for example. They’ll need to be in protective clothing. They sacrifice the animals, remove and identify any ticks, and take blood samples. They also trap free-ranging ticks. They turn over the blood samples and ticks to our scientists at the Barn. We’ll do the analyses here in the maximum containment lab.”
“What about the human victims?” asked Blumenthal.
“CDC and USAMRIID at Fort Detrick should work together on autopsies of human corpses,” Hoffman said.
“CDC can handle this,” Blumenthal snapped. “Standard protocol for us. We’ll retrieve tissue samples from cadavers and blood from the patients in Penn Hospital’s isolation ward, isolate known pathogens or suspect microbes, and amplify them in appropriate media. We’ll do the same with the ticks and the dog’s blood.”
“Let’s not get ahead of ourselves, Rick,” Hoffman said calmly. “This will be a team effort. I want the scientists here at the Barn to work with the dog’s blood. They’ll use test animals and expose them to the blood to look for disease transmission. The Fort Detrick scientists will do the same thing with blood samples from infected humans and with pathogens isolated from collected animals and insects.”
Hoffman looked around the room. “Any other questions?”
Mariah noted with some embarrassment that she was the only one who hadn’t said anything during the meeting. People were probably wondering why she was even there. She was wondering the same thing herself. She racked her brain for something to contribute, but all she could think was: The vet who treated the dog is dead. He died within five days of being bitten. Five days.
“Okay, let’s get started,” said Hoffman. “We’ll follow the plan I just laid out. This will be a team effort. I expect full cooperation among team members. Any issues—any—I want to know about them immediately. We’ll meet here again as soon as we have some substantive results. Out-of-towners can conference in by secure video link. Thanks for your time today.”
As they left the conference room, Mariah fell into step beside Kennedy. “Looks like we’ll be spending some more time together in containment,” she said. “I’d like to get an early start on the animal work tomorrow. Can you meet me at the MCL at seven thirty?”
“I’ll be there,” Kennedy said. He looked at Mariah. “Nervous?”
Yes, she thought.
“Not really,” she answered. “Are you?”
“Damn right I am,” replied Kennedy. “Nipah’s a pussycat compared to this thing.”
* * *
That evening in Philadelphia, in a dimly lit booth of a knockoff English pub, Doctor Vector sipped from a pint and studied a small photograph on the table in front of him. He had a good view of the entrance, but in the semidarkness of the cubicle he’d be all but invisible to anyone entering the pub. He could study his contact before being seen. He’d never met this man before. His credentials had seemed impeccable, but Vector wanted a face-to-face meeting to be sure he could trust him to carry out a critical part of the upcoming mission. That would allow Vector to concentrate on preparing his beloved ticks for their crucial assignment.
Vector wore a blue blazer and an open-necked tattersall shirt. The clothes made him feel slightly more at home in the patrician surroundings, but he frequently glanced around the room and twirled a saltshaker as he waited. He scrutinized the photo again. Not a lot of detail, but there was intelligence in the face and the eyes had a dark, hard look about them. A man you wouldn’t want to cross. But was he careful, detail-oriented? Reliable? And how would you know for sure, especially at a first meeting?
He saw the pub door open and watched a slight, dark man in a blue Windbreaker and brown slacks walk through the entrance, pause for a millisecond, and take in the room with one swift glance. Vector glanced again at the photo before pocketing it. Definitely his contact. Now the other man was striding toward him. He rose to shake his hand and introduced himself. The man in the Windbreaker abruptly returned the handshake and said his name was Omar, which Vector assumed was an alias.
The two men sat down on opposite sides of the booth.
“Beer?” Vector asked.
Omar shook his head.
“Coffee? Something to eat?”
“Nothing.” Omar glanced at his watch. “You brought me something?”
“That’s for next time,” said Vector. “Today we firm up plans.” He looked around the room, leaned forward, and lowered his voice. “The package will be well secured and small enough to hand-carry aboard a plane. You’ll deliver it to an overseas establishment where it’ll be refined and expanded. That should take a couple of weeks. Then your team will take it to the final destinations.”
“What will this package look like?”
“A small container of liquid.”
“If it’s liquid, it’ll have to go into checked baggage.”
“Too risky. And we’re only talking about a couple of ounces. It’ll look like a brand-name bottle of mouthwash—same color and all. One of those small bottles they let you carry onto a plane. Sealed real tight. When you get it, you’ll put it in a ziplock bag and add some toothpaste and other stuff.”
“You said it would be expanded before final delivery,” said Omar.
“Right. We’ll need several quarts. We’ll produce that at the next location.”
“So how do we get all that on a plane?”
“I’ll let you know when it’s time.”
“How many final destinations?”
“Three,” Vector said.
“I’ll need a dozen people, including an advance team at each location and an American cell,” said Omar.
Vector shook his head. “No way. Four men max. More than that and too much risk of detection or compromise.”
“You think you know more about how to do this than me?” asked Omar. “You do it my way or we don’t have a deal.”
Vector stared at Omar, who held his gaze, unblinking. Finally Vector looked away. “Okay,” he said. “Your call. But I don’t have to tell you that failure is not an option.” He reached into his shirt pocket, retrieved a small, folded piece of paper, and handed it to the other man. “Instructions for our next meeting.”
Omar unfolded the paper and read it. Then, with a steady hand, he held it above the candle on the table between them, allowed it to catch fire, and waited until it burned down to a tiny corner. He stood, gave a barely perceptible nod, and turned away. Vector watched as he strode quickly toward the exit. For several minutes Vector remained at the table, nursing the dregs of his beer, trying to shake off the nagging feeling that he didn’t have as much control over things as he’d once thought.
CHAPTER NINE
AUGUST 20, EARLY MORNING
THE BARN
When Mariah arrived at the MCL, Kennedy was already there. They suited up and headed to the animal rooms inside the containment area. Mariah had earlier put in a request for twenty laboratory research mice and ten rhesus monkeys. Technicians would have already placed these in cages inside the animal rooms. The monkeys and mice would serve as animal models to evaluate their response to exposure to pathogens that the dog may have carried. Mariah would inject the animals with aliquots of the dog’s blood. The responses of the lab animals could give an indication of the potential infectivity of the pathogens to people.
Mariah hated this work. She knew it was an alternative to actually exposing human beings to dangerous bacteria and viruses, but she also knew that the deliberately infected animals might experience debilitating illnesses or excruciating deaths.
They established a routine. Kennedy would retrieve a mouse from its cage and hand it to Mariah. She would then inject several cubic centimeters of the dog’s blood with her right hand, while firmly holding the mouse in her left, her fingers clamped across the mouse’s neck to minimize the possibility of being bitten. When Mariah finished a mouse, Kennedy was ready with the next one, and they simply traded off. After each mouse was injected, Mariah would use a new syringe and hypodermic needle to avoid cross-contamination. She placed the used needles and syringes into a “sharps” bucket with a protective cover.
By midmorning, Mariah was ready to inject the fifteenth mouse. The needle was poised just above the animal’s clavicle. Kennedy had turned to select the next mouse, and as he did so the sleeve of his moon suit brushed against the bucket of used syringes and needles.
The bucket crashed to the floor.
Mariah flinched and her right arm involuntarily jerked downward, stabbing the needle into the back of her left hand. Her thumb had been near the plunger, and now she awkwardly maneuvered it as far away from the plunger’s surface as possible without letting go of the syringe altogether, leaving it bobbing in her hand. She’d felt the pain of the needle as it penetrated her skin after passing through the thick outer protective glove and the thinner inner surgical gloves. “I stuck myself!” she yelled, hoping Kennedy could hear her voice above the sound of the air in their suits. Did I depress the plunger? her mind screamed. Did I bump it with my thumb? Very carefully she pulled the syringe out of her hand and laid it on the work bench.
Kennedy drew a gloved finger across his throat and jerked his thumb toward the exit door. They hurriedly returned the mice to their cages, left everything else as it was, and rushed out of the lab.
Mariah moved quickly. After rinsing in dilute bleach the external surfaces of her moon suit, she shed the suit and headed to a decontamination station. She removed her surgical scrubs, booties, and neoprene gloves. She immediately swabbed the puncture wound with an antiseptic solution. She then stepped into a shower and let the water run over her body from head to toe for a full minute and followed that by washing her entire body with a special cleaning solution. When she was finished, she rinsed off, toweled dry, and cleaned the wound again.
Mariah knew that if the infectious agent had entered her bloodstream, no amount of scrubbing would make any difference. She proceeded to the outer change room, retrieved her clothes from the locker, dressed, and exited into the corridor.
Kennedy was waiting for her, arms across his chest. “Quarantine. ASAP,” he said.
* * *
The following morning in Middle Valley, the young mother looked at her four-year-old daughter across the
breakfast table. “Did you have a nice time at the fair? Wasn’t it nice to see all the animals?” she asked.
The little girl nodded and picked at her cereal.
“You haven’t eaten anything, sweetheart,” said the mother. “Are you okay?”
Her daughter looked up. “I don’t feel well,” she said.
The mother looked closely. Her face seemed flushed. Was she coming down with something? “Can you tell me what hurts?”
“My head. And I have a sore throat.” The little girl began to whimper.
The mother placed her hand on her daughter’s forehead. Very warm. And her eyes looked bloodshot. “Wait here, sweet pea,” she said. “I want to take your temperature.”
The mother went into a nearby bathroom, found a thermometer, swabbed it in alcohol, and hurried back to her daughter. The girl was now sitting in a chair, holding her head in her hands. “I know, baby. It’s no fun,” said the mother. What time does the clinic open? she wondered, already mentally rearranging her day’s schedule to fit in a visit. She cupped her left hand under her daughter’s chin and gently lifted it up. She quickly pulled her hand away. Blood was pouring from her daughter’s nose.
The mother ran back to the bathroom and grabbed a box of tissues. When she returned, a pool of blood had formed on the floor and her daughter was sobbing. She pulled out a handful of Kleenex, held it to the girl’s nose, and saw the blood seep through. She grabbed a larger bundle of tissue and pressed it against her daughter’s face. In just seconds it was soaked with blood. She retrieved a towel from the bathroom. She still couldn’t stop the blood flow. My God, thought the mother. She’s bleeding to death! She picked up her cell phone and dialed 911.
CHAPTER TEN
AUGUST 22
THE BARN
In her small isolation room in the Barn’s quarantine wing, Mariah winced when she heard the soft beep on her secure, government-issued smartphone. She pulled the PDA from a pocket of her white hospital gown and punched a key. A text message flashed on the screen: Call me. Hoffman.
