The Virus (4 page)

Kaplan had been closely involved in the design of the pathogen classification system, notably in establishing that all viruses be cross-classified under seven main categories:

A — Morphology: shape, size and ultra-structure

B — Physicochemical structure

C — Antigenic properties, such as immunofluorescence, neutralization, complement fixation, etc . . .

D — Resistance to physical and chemical treatment

E — Experimental hosts, which could range from monkeys to man, and cultivation

F — Pathogenesis: how harmful to humans/animals

G — Immunity

To obtain a quick and accurate answer from PRS, it was necessary to have reliable data concerning at least five of the seven categories. PRS could, in that event, take a cross-bearing on the given materials and, through a process of logical deduction, zero in on, or at least somewhere near, the identity of the target.

“I’m not sure we’ve really got enough to go on, Vincent,” Susan Wainwright smiled as she handed over the data sheets, “but I think you could make a start.”

The young man took a quick look at the papers, noting the extent of the information. He nodded. “Let’s give it a whirl.”

Mentally, Kaplan had prepared himself for a long wait. The more obscure the information, the longer the search-time, for the millions of “bits” of information in the data “core” were automatically loaded in order of frequency. After fifteen minutes the printer had still not begun to chatter. The pale blue light on the control panel indicated that the programme was running. Apart from that, there was no sign of activity.

“Jesus!” exclaimed the young technician. “When you reckon that machine is searching at the rate of 200,000 bits a second, and it still hasn’t come up with anything, either the information isn’t there or else it’s really digging back into history.”

“How far back can you go?” asked Susan Wainwright tensely. Like Kaplan she was beginning to show the strain of a long day.

“To the late ’fifties if we have to,” replied Vincent Peters, “though some of the data from that period is in pretty bad shape. Hey, wait a minute! I think we’re getting something.”

A different light, red this time and labelled “PRINTOUT,” came up on the console. Simultaneously, the printer started clacking, and a long wide sheet of paper began to emerge from the machine.

Kaplan, unable to suppress his impatience, ripped it off, took one look and went pale.

This was that he read:

DATA SUPPLIED CONFIRMS PRESENCE OF VIRAL AGENT. STRUCTURAL PATTERNS EXHIBIT MANY FEATURES SIMILAR TO THAT OF VESICULAR STOMATITIS AND RABIES VIRUSES OF RHABDOVIRUS GROUP. HOWEVER DIFFERENCES WITH RESPECT TO SIZE, FORM, BEHAVIOUR IN CELL CULTURES AND PHOTODYNAMIC SENSITIVITY TO METHYLENE BLUE SHOULD BE TAKEN INTO ACCOUNT IN DETERMINING THE DEFINITIVE CLASSIFICATION. PRS ESTIMATES WITH PROBABILITY AT 95 PER CENT LEVEL THAT AGENT IN SAMPLES ANALYZED IS IDENTICAL TO THE SO-CALLED MARBURG VIRUS.

Then there was a gap on the printout, after which followed the words:

MATERIAL UNDER EXAMINATION CONTAINS DEADLY PATHOGENS. RESEARCHERS AND TECHNICIANS SHOULD TAKE ALL NECESSARY PRECAUTIONS IN ACCORDANCE WITH LABORATORY SAFETY MANUAL HEW PUBLICATION NO CDC 77-8118. NO FURTHER WARNING WILL BE ISSUED.

“Oh, my God!” Kaplan was aghast. “We’ve got an outbreak of Marburg! Jesus Christ!”

He passed the sheet to Susan Wainwright.

“What does it mean?” she asked. “What do we do?”

“We hit the panic button.”

At that moment the telephone in the Computer Center rang, Kaplan picked it up. He listened for thirty seconds. Then, as he put the receiver down, he swore out loud.

“Damn it to hell!”

“What’s the matter?”

“She’s dead.”

“Who’s dead?”

“The girl. Verusio. And the doctor, Reuben, has come down with the same symptoms. You know what that means? It means that unless we move fast half the population of the United States could be wiped out overnight. The Black Death would have nothing on Marburg.”

Taking back the printout from her outstretched hand, he made for the door.

3

Lowell Kaplan missed his week-end with the children.

He called his ex-wife from the airport as he left Atlanta for New York for the second time in less than thirty-six hours.

“Martha, I’m really sorry about this. We’ve got a crisis on our hands and I’ve got to get back to New York.”

“For God’s sake, Lowell! The kids will be desperately disappointed. You promised to take them camping.”

“I can’t, Martha. I’ll make it up to them.”

“The trouble with you is that work always comes first.”

Kaplan replaced the receiver with some irritation. Martha, he thought, had never understood the nature of his work. You didn’t go camping when the lid was about to blow. But as he walked to the plane he couldn’t help feeling that there might after all be something in what his ex-wife had said. Perhaps he did always put work first. Perhaps he should have more time for himself. Having more time for himself might be a way of having more time for other people. Without meaning to, he found himself thinking about Stephanie Verusio.

Before the plane landed in New York, he went to the toilet to freshen up. He stared long and hard at his face in the mirror. The eyes were clear and grey; the eyebrows thick and matted. His nose and chin were strong and determined. There was no mistaking the energy and vigour in every line of his features. “Fuck you, Kaplan,” he said to himself. “You can’t get it right, can you?”

There was a police escort at Kennedy to take him into the city. Less than an hour after touch-down, Kaplan stood on the dais in the lecture theatre on the ground floor of the Columbia Presbyterian Hospital. If the hospital, as seemed likely, was to be the nerve-center of operations, he wanted to be sure, right from the start, that all personnel were fully informed. Doctors and nurses had been notified of the urgent meeting, while he was still on the plane.

The group of men and women who confronted him looked tense and anxious. Kaplan was tense and anxious himself. None of them really knew what they were dealing with. The situation was unprecedented. There had never been an outbreak of Marburg disease in the United States before. Indeed, apart from that first occurrence in Marburg, Germany, back in 1967, there had been no other recorded incident anywhere in the world. Kaplan began by giving them the facts as he knew them.

“Ladies and Gentlemen.” His voice was controlled, but the inner stress was evident. “Today, for the first time in our medical history, the United States is in a Red Alert situation. We are not threatened by enemy bombers or missiles. We are threatened by disease. According to electron-microscope examinations which we have conducted at the Center for Disease Control in Atlanta, Georgia, at the request of the local health authorities” — he gave a brief nod in the direction of the New York State Epidemiologist, a tall bearded man who sat on the platform behind him — “two patients in this hospital have been infected with the Marburg virus. One of them, Diane Verusio, has died. The other, Dr Isaac Reuben, is dangerously ill.”

He paused and looked around the room. He saw that he had their complete attention.

“You should all know that you will, each and every one of you, be at considerable risk. On past form, your chances of survival if you should happen to contract the disease are very small. There were twenty-three confirmed cases in Marburg in 1967. All twenty-three died.”

His audience gasped audibly as he spoke and murmurs broke out along the benches. Kaplan held up his hand for silence.

“What is more, there is no known antidote. No vaccine has been developed, in spite of efforts made after the 1967 outbreak.” He noted a hand raised at the front. “Do you have a question?”

Joel Price was one of the younger physicians on the staff of the isolation wing of the hospital. An intelligent and articulate man, he usually went straight to the heart of any question.

“What is the nature of the transmission?”

“We don’t know. In the two cases so far identified, there could have been actual physical contact, through blood or sputum or whatever. But we cannot rule out airborne or aerosol transmission with all that that implies. From what we know of the 1967 episode, the Germans were never able to rule it out either.”

Once more there was a gasp of concern. Every public health man knew there could be no more serious danger than airborne transmission of a highly infectious and lethal disease against which there was no known remedy. One person sneezing in a crowded subway could infect a hundred others. Each one could in turn pass on the disease to a hundred more.

“As you can imagine,” Kaplan continued, “the possibility of airborne transmission in a case like this will impose the greatest strain on our resources. Since we have no vaccine, we have to rely on total containment of the outbreak. That means we have to begin here. And it means we have to begin now.”

He paused and glanced in the direction of the doors leading into the auditorium. As planned, uniformed guards were on duty. Kaplan gave a brief nod in their direction, acknowledging their presence. When the moment came, those doors would be locked. No one would enter and no one would leave. He was not ready yet to give the word. One or two late arrivals were still trickling in. He had to be sure that all potential contacts were in the net before he pulled the cord tight. Playing for time, he was deliberately more long-winded than he might otherwise have been.

“The first thing we must do,” he continued, “is to inventory the type C facilities which we have available both here in New York and indeed throughout the United States. Does everyone here understand what I mean by type C facilities?”

There were blank looks on many of the faces which confronted him.

Kaplan explained: “A type C facility is a maximum isolation facility which meets the following conditions: One — it must have a separate structure with its own air conditioning, heating and ventilating system. I can’t stress how important this is when the possibility exists, as it does in this case, that a virus may be disseminated by air. Two — it must have adequate water, electricity, heating, cooking and ventilation. Three — within the separate structure, there must be a separate isolation room with a toilet, a bath or shower, and a sink for the patient. This room should be operated under measurably negative air pressure, and all exhaust air should be passed through a filter with an efficiency of at least 95% based on the DOP — dioctyophthalate-test method. Four — the facility must possess an anteroom in which medical personnel can change into and out of protective clothing. The anteroom must have a shower and a sink for use by everyone leaving the isolation room. It should be operated at a pressure intermediate between the isolation room and the outside, and thus form an air barrier. Five — there should be an office-communication area outside the anteroom with dependable telephone service to the outside. Six — there should be adequate communication, preferably by ‘intercom’ units, between each of the rooms of the facility.”

After this recital, Kaplan turned to the New York State Epidemiologist.

“Dr Jones, can you tell me how many type C facilities of the kind I have just described there would be in New York.”

“One.” Dr Marvin Jones replied without hesitation. “And that’s not available.”

“Why not?”

“It’s right here in the hospital and it’s being occupied by Dr Reuben at this time.”

Kaplan managed a smile. “I suppose we should be thankful for small favors.” He turned serious. “You’re positive there are no other type C facilities?”

“Yes, sir. None in New York City; none in New York State. Frankly, once smallpox was licked the maximum isolation concept tended to fall out of favour. There just didn’t seem to be a need for it. We never did build the units we planned to build. You know how it is. Shortage of funds, mainly. Each unit costs upwards of two million dollars. On a one unit per patient basis, that’s two million dollars a patient.

“My guess is that, if you took the United States as a whole, you wouldn’t find more than half-a-dozen type C facilities, and even those are likely to be at Federal centers of one kind or another.”

“How do you mean?”

“I’m talking about CW and BW centers. Like Fort Mabon in Texas. Or Fort Sumter in Virginia. When you are working with chemical warfare agents or bacteriological warfare agents, of course you have to have maximum isolation facilities. But then you are dealing with a totally controlled situation. I mean, they’re putting that stuff into people deliberately.”

Marvin Jones couldn’t help feeling vaguely resentful. Atlanta people always had the glamour role. They jetted in and out, poked their noses into this corner and that rather like the FBI being called in to help out the local sheriff. And yet, when something went wrong, it was easy to blame the locals. If something went wrong now — and he had a horrible feeling that it might — it would be only too easy to blame the State and City Health Departments for not building the type C facilities which all the experts had assured them would never again be needed.

“I’m not blaming you.” Kaplan interrupted his thoughts. “I’m not blaming anyone. I just wanted to know the extent of our reserves.”

He turned once more to the audience. “Some of you may remember the story of the battle of Balaclava. The British troops were stretched out in what was known as the Thin Red Line. Our thin red line, the line that separates the United States and possibly the world from disaster, is half-a-dozen type C facilities scattered around the United States.”

Again Kaplan paused. As a scientist, he was conscious that words like disaster were to be eschewed wherever possible. He had always had a healthy scorn for the reaction — or, as he saw it, the overreaction — of most people to news of sickness or disease. A morbid fascination with the minutiae of ill-health had no part in his make-up. Yet it was difficult to find a more appropriate word. Disaster had not struck — not yet. But it was certainly around the corner.