Outbreak (7 page)

"Can I ask you a question?" said Miss Cavanagh timidly.

"Of course," said Marissa, with a hand on the door.

"Is there a chance I might get ill?"

Marissa had been suppressing the thought because she didn't want to frighten the woman, but she could not lie. After all, the secretary would have to be considered a primary contact.

"It's possible," said Marissa. "We will be asking you to restrict some of your activities during the next week or so, and I'd advise you to check your temperature twice a day. Personally, however, I think you will be fine since you haven't experienced any symptoms so far."

Back at the hospital, Marissa fought off her own fears and her developing fatigue. She had too much to do. She had to go over the clinic charts in detail. She hoped to find a reason why some of Dr. Richter's patients had gotten the disease and others hadn't. Also

Marissa wanted to call Dr. Richter's wife. Between the wife and the secretary, she hoped she could construct a reasonably complete diary of the man's activities during the two weeks before he became di.

Returning to the fifth floor, Marissa ran into Dr. Navarre. He looked as tired as Marissa felt. "Dr. Richter's condition is deteriorating," he said. "He's bleeding from everywhere: injection sites, gums, CI tract. He's on the brink of kidney failure, and his blood pressure is way down. The interferon we gave him had no effect whatsoever, and none of us knows what else to try."

"What about Helen Townsend?" asked Marissa.

"She's worse, too," said Dr. Navarre. "She's also starting to bleed." He sat down heavily.

Marissa hesitated for a minute and then reached for the phone. She placed another collect call to Atlanta, hoping Dubchek was already on his way. Unfortunately, he wasn't. He came on the line.

"Things are pretty bad here," reported Marissa. "Two patients are experiencing significant hemorrhagic symptoms. Clinically, it is looking more and more like viral hemorrhagic fever, and no one knows what to do for these people."

"There's little that can be done," said Dubchek. "They can try heparinization. Otherwise, supportive therapy-that's about it. When we make a specific diagnosis we may be able to use hyperimmune serum, if it is available. On that track, we've already got your samples, and Tad has begun processing them."

"When will you be coming?" asked Marissa.

"Shortly," said Dubchek. "We've got the Vickers Mobile Isolation Lab all packed.

Manssa woke up with a start. Thankfully, no one had come into the little room behind the nurses' station. She looked at her watch. It was ten-fifteen at night. She'd only been asleep for five or ten minutes.

Getting to her feet, she felt dizzy. Her head ached and she had the beginnings of a sore throat. She prayed that her symptoms were a product of exhaustion and not the beginnings of viral hemorrhagic fever.

It had been a busy evening. Four more cases had presented themselves in the ER, all complaining of severe headache, high fever and vomiting. One already had hemorrhagic signs. The patients were all family members of the previous victims, underlining the need for strict quarantine. The virus was already into the third generation. Marissa had prepared viral samples and had them shipped to Atlanta by an overnight carrier.

Recognizing that she was at the limit of her strength, Marissa decided to go back to her motel. She was just leaving when the floor nurse said Dr. Richter's wife was able to see her. Realizing it would be cruel to put her off, Marissa met her in the visitors' lounge. Anna Richter, a well-dressed, attractive woman in her late thirties, did her best to fill in her husband's schedule over the past two weeks, but she was desperately upset, not just alarmed about her husband but fearful for their two young children as well. Marissa was reluctant to press her for too much detail. Mrs. Richter promised to provide a more complete chronology the next day. Marissa walked her to the doctor's BMW. Then she found her own car and drove to the Tropic Motel where she fell directly into bed.

3

January 22

ARRIVING AT THE CLINIC the next morning, Marissa was surprised to see a number of TV trucks pulled up to the hospital entrance, with their transmission antennae raised against the morning sky. When she tried to enter through the parking garage, she was stopped by a policeman and had to show her CDC identification.

"Quarantine," the policeman explained, and told her to enter the clinic through the main hospital entrance where the TV trucks were located.

Marissa obeyed, wondering what had been happening during the six-plus hours she'd been away. TV cables snaked their way along the floor to the conference room, and she was amazed at the level of activity in the main corridor. Spotting Dr. Navarre, she asked him what was going on.

"Your people have scheduled a news conference," he explained. His face was haggard and unshaven, and it seemed obvious he had not been to bed. He took a newspaper from under his arm and showed it to Marissa: A NEW AIDS EPIDEMIC, shouted the headline. The article was illustrated with a photo of Marissa talking with Clarence Hems.

"Dr. Dubchek felt that such a misconception could not be allowed to continue," said Dr. Navarre.

Marissa groaned. "The reporter approached me right after I'd arrived. I really didn't tell him anything."

"It doesn't matter," said Dr. Navarre, patting her gently on the shoulder. "Dr. Richter died during the night, and with the four new cases, there was no way this could have been kept from the media."

"When did Dr. Dubehek arrive?" asked Marissa, getting out of the way of a camera crew headed into the conference room.

"A little after midnight," said Dr. Navarre.

"Why the police?" asked Marissa, noticing a second uniformed officer standing by the doors leading to the hospital.

"After Dr. Richter died, patients started signing themselves out of the hospital, until the State Commissioner of Health issued an order placing the whole building under quarantine."

Marissa excused herself and made her way through a throng of press and TV people outside the conference room. She was glad Dubchek had arrived to take charge but wondered why he hadn't gotten in touch with her. When she entered the room, Dubchek was just about to start speaking.

He handled himself well. His calm no-nonsense manner quieted the room immediately. He began by introducing himself and the other doctors from the CDC. There was Dr. Mark Vreeland, Chief of Medical Epidemiology; Dr. Pierce Abbott, Director of the Department of Virology; Dr. Clark Layne, Director of the Hospital Infectious Disease Program; and Dr. Paul Eckenstein, Director of the Center for Infectious Disease.

Dubchek then went on to downplay the incident, saying that the problem was not "A New AIDS Epidemic" by any stretch of the imagination. He said that the California State Epidemiologist had requested help from the CDC to look into a few cases of unexplained illness thought to be of viral origin.

Looking at reporters eager for copy, Marissa could tell they were not buying Dubchek's calm assessment. The idea of a new, unknown and frightening viral illness made for exciting news.

Dubchek continued by saying that there had only been a total of sixteen cases and that he thought the problem was under control. He pointed to Dr. Layne and announced that he would be overseeing the quarantine efforts and added that experience proved this kind of illness could be controlled by strict hospital isolation.

At this, Clarence Hems jumped up, asking, "Did Dr. Richter bring this virus back from his African conference?"

"We don't know," said Dubchek. "It is a possibility, but doubtful. The incubation period would be too long, since Dr. Richter returned from Africa over a month ago. The incubation period for this kind of illness is usually about a week."

Another reporter got to her feet: "If the incubation period for AIDS can be five years, how can you limit it here to less than a month?"

"That's exactly the point," said Dubchek, his patience wearing thin. "The AIDS virus is totally different from our current problem. It is essential that the media understand this point and communicate it to the public."

"Have you isolated the new virus?" asked another reporter.

"Not yet," admitted Dubchek. "But we do not expect to have any difficulty. Again, that's because it is a very different virus from AIDS. It should only take a week or so to culture it."

"If the virus has not been isolated," continued the same reporter, "how can you say that it is different from the AIDS virus?"

Dubchek stared at the man. Marissa could sense the doctor's frustration. Calmly he said, "Over the years we've come to realize that totally different clinical syndromes are caused by totally different microorganisms. Now that is all for today, but we will keep you informed. Thank you for coming at this early hour."

The conference room erupted as each reporter tried to get one more question answered. Dubchek ignored them as he and the other doctors made their exit. Marissa tried to push through the crowd but couldn't. Outside the conference room the uniformed policeman kept the reporters from entering the hospital proper. After showing her CDC identity card, Marissa was allowed to pass. She caught up to Dubchek at the elevators.

"There you are!" said Dubchek, his dark eyes lighting up. His voice was friendly as he introduced Marissa to the other men.

"I didn't know so many of you were coming," she said as they boarded the elevator.

"We didn't have much choice," said Dr. Layne.

Dr. Abbott nodded. "Despite Cyrill's comments at the news conference, this outbreak is extraordinarily serious. An appearance of African viral hemorrhagic fever in the developed world has been a nightmare we've lived with since the illness first surfaced.

"If it proves to be African viral hemorrhagic fever," added Dr. Eckenstein.

"I'm convinced," said Dr. Vreeland. "And I think the monkey will turn out to be the culprit."

"I didn't get samples from the monkey," admitted Marissa quickly. "That's okay," said Dubchek. "We sacrificed the animal last night and sent specimens back to the Center. Liver and spleen sections will be far better than blood."

They arrived on the fifth floor, where two technicians from the CDC were busy running samples in the Vickers Mobile Isolation Lab.

"I'm sorry about that L.A. Times article," said Marissa when she could speak to Dubchek alone. "The reporter approached me when I first entered the hospital."

"No matter," said Dubchek. "Just don't let it happen again." He smiled and winked.

Marissa had no idea what the wink meant, nor the smile, for that matter. "Why didn't you call me when you arrived?" she asked.

"I knew you'd be exhausted," explained Dubchek. "There really wasn't any need. We spent most of the night getting the lab set up, autopsying the monkey, and just getting oriented. We also improved the isolation situation by having fans installed. Nonetheless, you are to be congratulated. I think you did a fine job getting this affair underway.

"For the moment, I'm buried in administrative detail," continued Dubchek, "but I do want to hear what you've learned. Maybe you and I could have dinner tonight. I've gotten you a room at the hotel where we are staying. I'm sure it's better than the Tropic Motel."

"There's nothing wrong with the Tropic," said Marissa. She felt an odd twinge of discomfort, as if her intuition were trying to tell her something.

Marissa went back to her small room behind the nurses' station and began to catch up on her own paperwork. First she phoned the sponsoring organizations for the two medical meetings Dr. Richter had attended. She told them that she needed to know if any of the other attendees had become ill with a viral disease. Then, gritting her teeth at the cruelty of her next call, she dialed Dr. Richter's home number and asked if she could pick up the diary Mrs. Richter had promised her the night before.

The neighbor who answered the phone seemed appalled by her request, but, after checking with the widow, told Marissa to come over in half an hour.

Marissa drove up to the beautifully landscaped house and nervously rang the bell. The same neighbor answered and rather angrily directed Marissa to the living room. Anna Richter appeared a few minutes later. She seemed to have aged ten years overnight. Her face was pale, and her hair, which had been so carefully curled the night before, hung about her face in lank strands.

The neighbor helped her to a chair, and Marissa was amazed to see that she was anxiously folding and unfolding some lined papers that

seemed to contain the requested list of her husband's activities over the last weeks. Knowing what a strain the woman must have been under, Marissa didn't know what to say, but Anna simply handed her the sheets saying, "I couldn't sleep last night anyway, and maybe this will help some other poor family." Her eyes filled with tears. "He was such a good man . . . a good father . . . my poor children."

Despite knowing of his affair with Helen Townsend, Marissa decided that Dr. Richter must have been a pretty good husband. Anna's grief seemed real, and Marissa left her as soon as she politely could.

The notes that she read before starting the car were surprisingly detailed. Put together with a further interview with Miss Cavanagh and the doctor's appointment book, Marissa felt they would give her as good a picture of Richter's last few weeks as anyone could get.

Back at the hospital, Marissa made a separate sheet of paper for each day of January and listed Richter's activities. One fact she discovered was that he had complained to Miss Cavanagh about an AIDS patient named Meterko who was suffering from an undiagnosed retinal disorder. It sounded like something Marissa should look into.

In the afternoon, the phone in Marissa's cubicle rang. Picking it up, she was startled to hear Tad Schockley's voice. The connection was so good that for a moment she thought he was there in L.A.

"Nope," said Tad, responding to her question. "I'm still here in Atlanta. But I need to speak to Dubchek. The hospital operator seemed to think that you might know where he was."

"If he's not in the CDC room, then I guess he's gone to his hotel. Apparently they were up all last night."