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By Daniel Kalla
Tom Doherty Associates Copyright © 2005 Daniel Kalla
All rights reserved.
Georgetown University, Washington, D.C.
The sharp, red point zoomed around the screen, before settling on the spiky gray structure in the center. "Ugly little bastard, isn't he?" the lecturer said. "Looks like something a junkyard dog ought to wear around his neck."
The remark was met by scattered laughter in the packed auditorium; Dr. Noah Haldane's lectures were always a huge draw. Among the medical students, the infectious diseases specialist and world expert on emerging pathogens had a reputation as a hip and irreverent speaker whose lectures managed to cut through the esoteric bullshit and get to the meat of the matter. There was another factor, too. At thirty-nine, without a trace of gray hair in his short uncombed hair, he stood six-two and still fit into his college jeans. His blue-gray eyes, sharp features, and readily amused smile helped pull in several women and even a few men who weren't even registered for the course.
Haldane ran the laser pointer around the circumference of the structure on the screen, following the spikes of the outer ring. "But this particular virus" — he tapped the crystal with the laser pointer's light — "he caused us no end of grief the year before."
"Please, no letters to the dean's office." Haldane held up a hand in mock disclaimer. "I refer to all viruses as male." He shrugged, unapologetically. "Maybe it's because they're so basic. So incomplete. So dependent on others to sustain their existence." He paused. "Like my couch potato of a brother-in-law, it's unclear whether viruses even represent a true form of life." He waited for the laughter to subside. "Whereas I think of bacteria, which are far more complex, independent, and beautiful, in the female sense."
"How about parasites?" someone called out. "What sex are they?"
Haldane squinted through the dimness until he spotted the questioner in the fifth row. "Mr. Philips, I don't think of parasites in terms of gender."
"Because they remind me too much of med students."
More laughter. Haldane circled the bug on the screen again with his pointer. "Does anyone recognize our ugly friend?"
"SARS-associated coronavirus?" a young, thin woman tentatively ventured from her front row seat, where she hunched over her notebook, scribbling madly even as she spoke.
"Exactly, Ms. Tai." Haldane nodded. "Or coronavirus TOR2."
Haldane clicked a button in his hand. The sterile electron microscope's image disappeared, replaced by a blood-spattered female cadaver whose eyes were blacked out by a solitary bar. Without comment Haldane tapped the button again. A human lung sat perched on a steel gurney. Another click. The screen sprang to life. A pair of gloved hands grasped the lung. One hand steadied the lung, while the other sliced into it with a scalpel. Bloody fluid spurted out as if a wineskin had been slashed open.
As he let his students absorb the images of an anonymous pathologist dissecting the pus- and blood-filled lung, Haldane wondered how lecturers in the age before Power Point and multi-media managed to make any impact. "Four days before the video was shot, this lung belonged to a perfectly healthy forty-two-year-old nurse ..." He clicked the button and the black and white viral crystal reappeared. "Then she breathed in a few particles of SARS-associated coronavirus.
"Like all self-respecting coronaviruses, he has an affinity for the human nasal mucosa. He easily penetrates the epithelial barrier and replicates inside the mucosal cells." The scientific sketches on the screen changed in rhythm with Haldane's explanation. "That's when the body's armed forces, the immune system, mobilizes. Think of the phagocytes and neutrophils as the infantry in this battle. Doing the dirty work — the cell-to-cell combat. While the lymphocytes are more like the artillery, lobbing their ammo, in this case viral-specific antibodies, from afar.
"With most other coronaviruses this isn't exactly a level battlefield. Kind of like Luxembourg invading the U.S. Most of the damage comes from friendly fire — namely, the patient's own immune system, not the virus, producing the muscle aches, fever, and runny green sputum. After a couple of days the viral invader is inevitably wiped out."
The SARS virus reappeared on screen. "But this guy is tougher. In a significant percentage of cases he moves past the nasal mucosa and down the trachea into the pulmonary tissue. There he crosses the alveolar membranes of the lungs." He flashed up the images of the blood-filled lungs being slashed open again. "Resulting in a diffuse pneumonitis. And, as seen in this video, often pulmonary edema. In five percent of SARS cases, despite maximal therapy, the patient dies."
Pens throughout the auditorium flew to keep pace.
"But for those of you who consider SARS one of the horsemen of the Apocalypse, think again. It has killed less than a thousand people since its inception. In infectious disease terms that's as devastating as a fart into a headwind." He shook his head. "Or looking at it another way, a thousand dead isn't even a global day's work for malaria, HIV, or cholera to name but a few." He slashed through the image of the viral particle with his laser pointer. "SARS-associated coronavirus is nothing more than a cold virus with attitude."
Haldane dropped the pointer on the lectern and stepped away. He walked across the floor until he stood a few feet from the students in the front row. "I was as scared as the next guy — no — way, way more scared when SARS first broke. After all, this bug was targeting health-care professionals. Clearly not playing by the rules. And I witnessed firsthand the havoc the little bastard could wreak." He shook his head. "But in the long run SARS has been good for us."
He scanned the quizzical young faces in the audience, allowing a few more seconds of confusion before expanding. "SARS put global infectious disease control measures to the test. And guess what? Not one country came up smelling like a rose. In fact, most stunk. Take Canada. Despite boasting one of the world's best health care systems, my colleagues in Toronto didn't react fast enough to the first case of SARS. And the city ended up paying dearly for it." Haldane pointed at the audience. "But at least now the world has been warned. We have the chance to fine-tune — in some cases revamp completely — our public health measures. In that sense, SARS was a good dry run for the real McCoy."
Haldane clicked a button and the screen filled with a grainy black-and-white still, depicting an old hospital ward packed so tightly that the stretchers touched. It was difficult to tell whether the patients (some of whom were doubled up on stretchers) were alive or dead. If alive, none were well.
Haldane stretched his hand out to the screen. "Ladies and gentlemen, meet the real McCoy."
"Fall of 1918. As World War I is winding down, something even worse is sweeping through the battlefields, military hospitals, and cities of Western Europe." Haldane stepped back to the podium. "The Spanish Flu," he said with his back to the audience. "And in the soldiers returning home following the armistice of November eleventh, this virus found the perfect vector for global dissemination."
More old snapshots of hospitals and morgues. More black and white devastation.
"In the winter of 1918–1919 this mutated influenza virus killed twenty million people. Which in today's terms is the equivalent of eighty million dead in less than six months."
Someone in the crowd oohed.
"Well put." Haldane nodded solemnly. "And we're not talking about twenty million ancient nursing home residents or mutilated war vets aching for deliverance. In fact, the opposite. For reasons unknown, this virus selectively killed young healthy adults. People would go to bed at night and not wake up the next morning ... or any morning." Haldane eyed a student in the second row who played on the varsity baseball team. "Not even pro athletes were safe. The 1919 Stanley Cup had to be halted because two of the Montreal Maroons dropped dead in the middle of the series.
"And if you think all hell broke loose because of primitive infection control and treatment measures, you would be wrong again. Granted, public health was limited in 1919, but we wouldn't fare much better today facing such an outbreak. We still have no specific treatment. And with every single person in the world connected by three or less commercial flights, it might spread even faster.
"It was probably only because of the draconian public health measures — people were quarantined in jails and some countries made it illegal to shake hands — that the epidemic was controlled at all.
"But the strangest part of the whole story?" Haldane allowed himself a theatrical pause. "There was nothing particularly unique about the Spanish Flu. Each winter the latest incarnation of influenza rolls around from Bangkok or Hong Kong or Melbourne or some other exotic locale I can't afford to visit." No one laughed. "It opens up beds in nursing homes, keeps temp agencies busy, and makes life an achy hell for those of us unlucky enough to stand in its path. But it does not decimate the population." He scanned the audience, satisfied he held their rapt attention. "The reason influenza only kills the old and the infirm is, flu shot or not, the virus is old news to our immune system. It's just a slightly modified — a protein here, an organic ring there — version of an antigen our immune system has seen before. So our bodies can mount a strong defense."
Haldane thumbed at the screen. "Not so with the Spanish Flu. It represented a brand-new genre of the virus." He shrugged. "But that's what viruses excel at, right? They mutate. In fact, up until 1919 every forty years, like clockwork, the latest version of a new and devastating influenza virus surfaced.
"So, the weirdest thing about the Spanish Flu is that we haven't seen a similar pandemic in over eighty years." He shook his head. "Not to put a damper on your bright futures, Doctors, but the killer flu is way overdue!"
Noah Haldane chuckled to himself on the drive back to his office. Sure he'd offered up a little ham with his lecture, but he believed it critical that his students — and all future physicians — hear the message: they were the front line against the next wave of epidemic, which almost certainly would be viral. It was vital that they recognized the signs early. And judging from the cacophony of questions after his lecture, hear him they did.
In those dark days of spring 2003, when he'd spent his time shuttling between Hong Kong, Hanoi, and Singapore, he wasn't as confident that SARS would just be a flash in the pan. None of them at the World Health Organization were.
Haldane hadn't exaggerated when he told the students that he'd been touched by the destructive power of SARS. It had claimed the life of a close friend and colleague, Dr. Franco Bertulli, in a Singapore Intensive Care Unit. Wearing full biohazard gear, Haldane had sat at Bertulli's bedside until the end and watched helplessly as his friend suffocated in his own secretions. Nothing in all his medical, virology, or epidemiological training prepared him for that. And the vision still visited him regularly in the form of a recurring nightmare.
But over a year had passed since the last travel advisory was issued. Haldane was home, and reveling in the relative quiet of the infectious diseases world. He had time to catch up on his research and clinical work. Best of all he had time to reconnect with his three-year-old daughter Chloe. Enough time even to take a stab at resuscitating his crumbling marriage.
Lost in plans for a family getaway for the upcoming weekend, Haldane breezed through the door of his research office in Georgetown. "Karen, hi," he said as he dropped off a cup of coffee on his receptionist's desk and then strode past her into his office.
When Haldane ignored his receptionist's hailing, she jumped up and followed him into the office. At twenty-seven, Karen Jackson had taken the job as Haldane's secretary so she could entrench herself in the academic milieu while she worked her way through graduate school. An African American full-figured beauty, she was bright, able, and defiant to a fault.
"Noah, did you hear me?" she said with her hands on her hips, as if talking to a toddler who had just covered the walls in ink.
Haldane leaned back his chair and rested his own Starbucks cup on top of the shortest of the tall piles that covered his desk. "What's up, Karen?"
"You forgot your pager and cell phone, again, didn't you?" Jackson chastised.
Haldane shrugged. "I was lecturing."
"Oh, yeah, that explains it," said Jackson with a roll of her eyes at her absentminded boss.
Haldane slid a hand in his drawer and pulled out his phone and pager. "Who is looking for me?"
"Exactly." Jackson chuckled, pulling her hands off her hips. "The WHO is looking for you. Dr. Nantal. Said it was urgent."
As the WHO's Executive Director of Communicable Diseases, Dr. Jean Nantal was responsible for all global hot spots. He had no time for social calls, especially "urgent" ones. Haldane rubbed his eyes and sighed heavily. "You were supposed to tell him I died."
"Noah, haven't I been telling you for months to give up this globe-trotting gig with the World Health Organization?" she demanded. "It's a job for single people. Not old married folk with a young child like you. That old smoothie, Dr. Nantal, could charm a starving lion out of his kill, but you should tell him 'no' this time."
Haldane marveled at his young finger-wagging secretary. She must have been mothering people since she could talk. Maybe before. Besides, her point was moot. Nantal's urgent phone call could only mean that something nasty was brewing somewhere on the planet. As the WHO's expert on emerging pathogens, Haldane knew Nantal wasn't asking.
Haldane was being summoned.CHAPTER 2
Department of Homeland Seccurity, Nebraska Avenue Center, Washington, D.C.
Bleary-eyed, Dr. Gwen Savard had trouble focusing on the screen. As Department of Homeland Security's inaugural Director of Counter-Bioterrorism (or the "Bug Czar" as some of her colleagues had taken to calling her), she chaired the Bioterrorism Preparedness Council meeting, through which she now struggled to stay awake. She tried to convince herself that it had nothing to do with Peter moving the last of his belongings out the previous sleepless night and everything to do with the dull speaker in front of her.
Oh, how the man droned! Savard was tempted to cut him off. Or to scream. Everyone in the room knew about anthrax. How accessible it was in the former Soviet Union, the Middle East, and even in the U.S. How deadly it could be in the perfect aerosolized form. He wasn't enlightening a soul when he explained how a thermos full of anthrax spores spilled on a windless day over Manhattan could kill hundreds of thousands.
But Gwen didn't intervene. Instead, she conceded that maybe she was a touch hard on her poor subordinate. And she grudgingly realized she might even be a tad run-down, physically and emotionally, this morning.
It wasn't so much the departure of Peter — who as her mother had predicted early in the relationship was a decent guy but all wrong for Gwen — as the implication of his leaving. The end of her marriage dealt an unexpected blow. Failure was foreign to Gwen. And it meant that at forty-two, she had to start over. Not that attracting other men would pose a challenge. Year in, year out, she maintained her size four figure. Her face with its high cheekbones, full lips, and upturned nose had aged well. The crow's-feet at the corners of her striking green eyes softened her features; those little imperfections of time had made her less intimidating, more accessible to men. She drew more attention in her forties than she had in her twenties. Still, she shuddered at the thought of one day facing the "dating scene" again.
Savard was relieved when Alex Clayton, the Central Intelligence Agency's Deputy Director of Operations, interrupted both her unhappy ruminations and her subordinate's endless rambling. "Yeah, Dr. Graves, fascinating stuff," Clayton said, but his stifled yawn belied the remark. "Can you get to the part where you update us on the powder trail from the anthrax mail out?"
Excerpted from Pandemic by Daniel Kalla. Copyright © 2005 Daniel Kalla. Excerpted by permission of Tom Doherty Associates.
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