Zombie CSU

by Jonathan Maberry

  Dr. Andrea White, an infectious disease specialist formerly with Doctors Without Borders, adds, “There are studies ongoing that have established a link between patients seropositive for human immunodeficiency virus type 1 ( HIV-1) and reduced motor function. Other pathogens can similarly affect cognitive and motor functions. We know that prions produce a lethal decline of cognitive and motor function. Some unkind writers have drawn parallels between advanced Alzheimer’s and Parkinson’s patients and zombies because these diseases reduce or remove cognition and communication skills while still allowing some degree of ambulation and the ingestion of food.”

  Nurse practitioner Helen Poland says, “In order for a zombie to exist it must be, on some level, alive. Corpses don’t walk, and they don’t eat. But if we consider a disease, possibly a prion disease, that shuts down most of the brain and most of the organs and retains just the minimum amount necessary to accomplish a primal need—that of feeding—then you can at least construct a theory. No, it won’t hold up to the closest scrutiny, not in science as we know it today; but look at prions. Give a prion to a doctor in the 1960s and he’d be just baffled.” But, she adds, “The human body is remarkably adaptive, which is both a good thing and a potentially bad thing.”

  The Zombie Factor

  According to neurologist Peter Lukacs, “There are twelve cranial nerves that control certain functions, and some share functions. The optic nerve controls vision, but the abducent, trochlear, and oculomotor nerves control different aspects of eye movement. The trigeminal nerve controls mastication and the vagus nerve controls swallowing. The cranial accessory also contributes to the swallowing and talking functions. The vestibulocochlear nerve controls balance and hearing. We know zombies can walk, however awkwardly, and they can hear. You also have the olfactory nerve that controls the sense of smell, and a number of movies and books suggest that zombies can smell unspoiled living flesh. The cranial nerves (with the exception of the olfactory and optic) originate in the brainstem, which includes the midbrain, the pons, and the medulla oblongata.”

  So we’re still back to headshots?

  “Put a bullet through the brainstem and you switch off your zombie,” Lukacs insists. “The same holds for a sword or axe cut, or sufficient blunt force trauma. However, if you inflict minor damage to the brainstem you may remove some of the zombie’s functions—he might be unable to bite or unable to maintain balance. The bottom line here is that the real “off buttons” for a zombie are the brain stem and the motor cortex. Those, I think, would be interesting areas to explore in stories: zombies who have limited functions even for them. A zombie who can’t eat, a blind zombie…the story possibilities are endless, and they could be funny or tragic.”

  JUST THE FACTS

  Emergency Care

  When the zombie is brought to the hospital he is not going to be an immediate threat to anyone. Having been forcibly subdued by police, he will be examined by EMTs. The handcuffs and biting mask will eliminate any risk there, but when the EMT takes the suspect’s vitals a lot of people are going to get a real shock to their system.

  Almost no heartbeat. Minimal blood pressure. Reduced body temperature. Possible signs of rigor mortis. And evidence of at least one wound where the security guard shot him.

  Samples of blood would be taken while the victim is still in the E.R., and as the disease began to take hold and the staff saw how fast the patient was succumbing, a rush request would be put on those tests. Specialists would be called, and at the very least, the patient would be put in limited or total quarantine. Once the outbreak had taken hold to epidemic proportions, the CDC (Centers for Disease Control and Prevention) professionals would be contacted and quarantines issued, probably to the point of including all hospital staff as well as patients.

  The suspect would be brought to the hospital in restraints and would be secured firmly to the motal rails of the bed. Since the suspect would continue to try to bite anyone who came near, the bite mask would be kept on, and at need a more potent “Hannibal Lecter” style mask could be obtained. Even in the world of the living there have been enough cases of dangerous biters so that protocols are already in place and would be followed to the letter.

  So what would happen when the zombie was brought into the hospital?

  Expert Witness

  G. Harris Grantham, a retired hospital administrator from Oakland, California, was very clear on how things would be handled. “The first thing we focus on is the safety of our staff. That’s paramount. The patient’s safety comes second, always. The reason is basic common sense: if the staff is being injured or are at risk, they either can’t or won’t provide any care. They are not paid to be injured.”

  According to Dr. Lukacs, “From my own experience (with violent or disruptive patients), there is usually a male nurse or male orderly (unusually strong from rolling and lifting heavy patients every day) that can be initially called to help out. The female nurses are also pretty tough (they have to be to do this job). If that is insufficient for an extremely violent patient, security will be called in (they are usually only called when a patient has a weapon or is considered a physical threat to himself or others). The worst-case scenario would be that a ‘mob’ of staff members would pile on top of the guy and subdue and restrain the guy. Plus they would try to sedate him with some tranquilizers (good luck in finding a viable vein in a pulseless zombie), which of course would have no effect. It only takes a good bear hug from behind to pin down someone’s arms to their sides, zombie or living. Just stay away from the potential biting.”

  One potential complication is that it’s going to take hospital staff a very long time before they think “zombie,” especially at the very beginning of an outbreak. On the upside, hospital staff are quite used to dealing with violent patients. They would not, as has been shown in some books and films, attack the patient if, for example, he started to bite. “The medical staff is there to try and save lives. It would never cross their minds to physically hurt someone on purpose for any reason,” insists Dr. Lukacs. “They would try their damndest to try and save this poor soul (do zombies even have souls?) at any cost. They would never consider injuring a patient just because he’s being violent. If that were the case, how many hyperactive patients from cocaine would make it to the hospital? Ever see Scarface? When Al Pacino is doped out of his mind on coke and gets riddled with bullets but still won’t go down? It’s a fairly realistic scenario to a certain point…these people don’t feel pain and think they are indestructible. Ask any police officer who has tried to subdue an unarmed violent crack-head. That’s what hospital staff would think they’re dealing with, and they would call in as many staff members as possible to restrain the person.”

  Once the patient is secured and restrained to the bed, the next step is evaluation. “If the patient was presenting with the symptoms you’ve described,” says Grantham, “unusually low BP, low body temp, low pulse, etc.—then we’d kick into high gear. Anomalous symptoms of that level of severity are going to suggest a disease of some virulence. Once the staff had collected samples—blood, EKG, EEG, x-rays, etc—and these were in the lab we’d call in consults with specialists in each field, and we’d probably get someone from infectious disease there stat. The patient would be immediately quarantined and specialists would be called in, and at some point we’d be talking to the CDC.”

  And what about the bitten guard?

  “We would want to take a look at anyone who had come in contact with this person, and certainly someone with whom there had been a body fluid exchange.”

  Dr. Chandra Singh, a surgical resident at the Salvator Mundi International Hospital in Rome. adds, “If the patient presented with gunshot wounds, then he would be rushed into surgery. Our surgical staff would take note of the atypical vitals and would call in specialists. It may be that the low vitals would be interpreted as a form of shock, in which case the staff would take steps to stabilize him, and if the placement of the bullet wounds was not life-threa
tening, surgery might be postponed at that point. If, on the other hand, the bullet was in the torso and damage to an organ was feared, then we would cut. And that, I’m afraid, having seen too many Lucio Fulci films, might literally be ‘opening a can of worms.’”

  And what about the security guard in our scenario? He’s typical of the early victims in a lot of zombie stories: an unconscious and unresponsive patient brought to a hospital after being bitten by an unknown assailant. The victim presents with a rapidly spreading infection and lapses into a coma, demonstrating severe respiratory difficulty.

  We know, having seen these films, that the victim is going to die and then reanimate as a zombie: and in these films the hospital is likely to become a slaughterhouse. But would that really be the way things played out?

  The Zombie Factor

  “You have to understand,” says Harris Grantham, “that no one at any point would be thinking ‘oh, this is a zombie’ or ‘this is supernatural.’ Even with the most bizarre and extreme symptoms we would all be reacting as if this is a standard medical crisis. Certainly it would have its unique and disturbing features, but everyone—and I mean everyone—would be treating this incident as if it were a disease, which is certainly what it would have to be.”

  “New diseases and mutations of known diseases are regularly discovered,” says Dr. Natalie Mtumbo of the Word Health Organization. “I think it would be fair to say that even with all of the stress and pressure on the doctors and staff to try and understand this disease and determine a strategy for treatment there would be some doctors who would be viewing this as a ticket to a Fellowship, a grant, or maybe the Nobel Prize. This would be history in the making, and everyone in that surgical theater would know that.”

  * * *

  Art of the Dead—Kelly Everaert

  City of the Dead

  “Vampires being the previous number one monster have become a kind of boring pompous nonmonster in the last few years, whereas zombies on the other hand are the downtrodden of the monster kingdom. They’re the average walking stiff, just trying to get by.”

  * * *

  Grantham agrees wholeheartedly. “That’s not really as cynical a view as it sounds; not when you realize how much research depends on both grants and notoriety. If something big comes along it can draw in enough money to not only support the research but to stabilize the financial well-being of the entire hospital. Nobody comes out a loser in that scenario.”

  Dr. Mtumbo adds, “Every single person exposed to the infected patient would be quarantined, and that includes the police, the witness, the tracker dogs—everyone. This would be too dangerous to allow for the slightest slip. We’ve seen what happens when a disease is not taken seriously. Visit Africa, look at the millions with AIDS and the firestorm that is tuberculosis. We’ve all made mistakes—doctors, health organizations, governments—and we have damn well learned from them. Never in history has the world’s medical professionals been so united in their stand against the spread of infectious diseases. And, yes, terrorism factors into that; this is the 21st century, so of course it does. So, what I’m saying here is that if a zombie plague happened then anyone who is even remotely suspected of being infected would be rounded up, isolated and studied. Very deeply studied. I doubt they would be going around biting people and spreading the disease.”

  I asked my experts to speculate on how this scenario would play out if the disease spread as quickly as it does in 28 Days Later and the remake of Dawn of the Dead.

  Grantham was adamant. “Not going to happen. I could buy a reduced metabolic rate and some organ shutdown, which means I could almost buy the Night of the Living Dead zombies with some medical exceptions. At a stretch I could make a case for it; but the other plague doesn’t follow pathogenic spread patterns. It isn’t logical enough even to compete with the plague scenarios in the George Romero zombie movies.

  “I never saw the American zombie films,” says Mtumbo, “but I did see 28 Days Later in London, and I saw 28 Weeks Later in Cape Town, South Africa. Though they were very frightening films, there were too many things in there that did not fit with what we know of science. In Cape Town, during my first year of residency, I went with some of my mates to a cinema that was showing Shaun of the Dead, which my friends said was very similar in many ways to the American zombie films. The dead in that were slower and it was clear that the infection required several hours to spread through the body before a person became a monster. Though I can still poke holes through that, it—at least—obeys some of the rules of disease pathology.”

  This does bring up a new and potentially disastrous wrinkle. If the plague does not spread as quickly as it does in the more recent films, then there is actually a greater chance of it spreading farther before it’s detected. Dr. Lukacs explains, “I have to disagree that the outbreak would be contained within hospital walls. Every disease has an incubation period where the patient is asymptomatic. Even the common cold takes 2–3 days before making someone sick. For every patient admitted, there would be several infected patients still at large. And in this modern day, people can travel to just about any part of the globe within 24 hours.”

  Grantham reluctantly agrees with this view. “I guess it depends on where you stand in terms of the zombie scenario. If we discount the ultra-fast spread of the disease as impossible, there are a couple of ways this could go. If the guard was brought into the hospital in a coma, and if the patient zero zombie was caught, then we might have nipped this in the bud. But the math gets complicated here, because if the zombie remains at large and continues to bite people, and if any of those people survive the bites and are not so severely injured that they fall into a coma, then they will be the most dangerous plague vectors. They might go to the hospital, receive treatment for the bite, and be released. The plague would be working inside of them, and if alarming symptoms don’t present quickly then they could potentially infect others. A kiss would probably do it, as would sexual contact. Possibly preparing foods, depending on the nature of the infection. If more than one person was similarly bitten then we could see a frightening pattern emerging. Not an aggressive attack like in 28 Days Later, but a more quiet and insidious attack, like we saw with the spread of HIV.”

  And if the zombie was caught?

  “Once we had the zombie at the hospital, or in the morgue, that’s when useful alarm bells would ring. The physical examination and lab tests would show that we were dealing with a very dangerous and probably unknown disease. Having tried to bite the arresting police and hospital staff, and having already bitten a security guard, someone would be making the connection between bite and infection. The CDC would definitely be on speed-dial by this point, and we would use police and the media, as well as database searches of patients presenting to emergency rooms complaining of being bitten.”

  Would that be enough?

  Dr. Mtumbo is less optimistic on that point. “Well, there is a risk of a much greater spread. Not everyone listens to TV news or reads the paper, and many would miss the public service announcements. Not everyone would go to a hospital; and some who had been in for treatment and then went home might be unreachable. They could be going on a vacation or a business trip. They could go to bed and lapse into a coma; and if they died early enough in the night and reanimated early the next day they could attack their families, neighbors, or other people.”

  “If we miss that early patient,” Grantham says, “then there would be a bigger spread of the disease and a greater potential for infection. But I’m still optimistic about our chances of getting ahead of the spread.”

  Investigation of the source would be a top priority, he says. “One of the things I personally would want to know was where this initial patient came from and how and where he contracted the disease that was now in my hospital. If there was a disease of that level of virulence I would leave no stone unturned to find out. The fact that the man was brought in following an attack outside a medical facility would tell me a lot, and our own
infectious disease investigators would be shoulder to shoulder with our lawyers as we tracked down who owned that facility and what the hell they were testing there. We’d call in Homeland Security and maybe FEMA. In short we would raise holy hell to find out what the hell they were testing out there that caused something like this. And if there was even the slightest whiff of cover-up we’d file ten kinds of suits against them and sue them back to the stone age…and the Fed would have our back, too, providing they hadn’t already kicked down the door. Something like this smells like bioterrorism if you sniff it the right way, and I can just imagine how much OHS3 would want to put something big in their ‘win’ column. Global pandemic? Not on my watch, and not on the watch of anyone at OHS who wanted to stay employed. Wrath of God would be nothing compared to what would hit that research center, believe me.”

  JUST THE FACTS

  Mad Zombie Disease

  So…what then could both destroy higher brain functions while at the same time keeping the central nervous system and some minimal organ functions operating? Ah…now that is the question.

  Most of the zombie stories talk about a virus or bacteria. In Max Brooks’s Zombie Survival Guide and World War Z it’s Solenum; in Resident Evil it’s the T-Virus; and according to Sean Michael Ragan, a biochemist from the University of Texas at Austin, it’s “the Romero-Fulci Disese.”4