“I’m serious. The days ahead will be long and intense. It’s great to have an outlet, a way to step out of this world and just relax and not have to worry about anything. Some days, you’ll just want to go back to your hotel room or tent and have a stiff drink. I encourage you not to do so. Staying hydrated out there is tough enough. For your own safety, keeping a clear head is imperative. If you want to have that stiff drink, do it when you get home. If you didn’t bring an e-reader with you, you can download a reading app for your smartphone. And if you’re too tired to read, I recommend downloading an audiobook on your phone. I can’t tell you how many nights in the field I’ve fallen asleep listening to a good book. But please download books only when you’re connected to WiFi. And do not, I repeat, do not watch Netflix, Amazon Prime, YouTube, or any video of any kind with the satellite sleeve attached. It costs us a fortune. I don’t know exactly how much, but two years ago an EIS officer binge-watched some TV show and consumed tons of data. When the bill came in, someone from finance flipped out. They actually walked over to Elliott’s office and threatened to limit our satphone access or set a data cutoff threshold. It became kind of a big deal. Elliott talked him out of it, but we’re still on probation. Remember: you watch Netflix, we lose satellite access, kids in Africa die. Got it? If you’re connected to wifi, knock yourself out, just not over the satlink.
“One last thing. We’re going to Kenya to stop this outbreak, and part of the reason we’ve been invited to help is because a lot of brave, hard-working Americans went to Kenya before us and built alliances and relationships. Some of them still work for the CDC in Kenya, building those partnerships each day. We should all keep that in mind.
“This is a particularly critical time for CDC relations in the region. I spoke with Joe Ruto, the head of our office in Kenya. In early 2015, we discovered that millions in funds the CDC had donated to the Kenya Medical Research Institute, or KEMRI, had gone missing. An audit uncovered mismanagement and fraud by officials at many levels at KEMRI. With the money gone, thousands of good people were laid off. There were protests outside KEMRI for days. And even though the CDC had no financial oversight, many of the protesters and laid-off employees blamed us. This deployment could be a big step toward rebuilding relationships.
“Every one of us is a representative of the CDC and the United States of America. Our actions could impact our relationships in the region. That could have consequences for us—and for the people just like you who will be on the next Air Force transport for the next outbreak. I’m not telling you to walk on eggshells or to be afraid to take decisive action. But if we can, we ought to do our best to leave our relationships there better than we found them.”
When the pilot announced that they were on approach for Jomo Kenyatta Airport in Nairobi, about half the members of the CDC team had surrendered to sleep for one last nap. The lights were dark in the passenger compartment except for a few glowing laptop screens at the back and several reading lights. Duffel bags and wadded-up clothes lay under the heads of those sleeping. Wool blankets covered the floor and were draped across team members.
Peyton had fallen asleep on a row of five seats. When she awoke, she realized her legs were intertwined with the person sharing the row with her. She looked up and found Phil staring back at her. He sat up quickly, held his hand out, and pulled her up. They looked at each other a moment, then set about collecting their things and getting ready for the landing, which was surprisingly painless.
She smoothed out her uniform, threw her duffel bag over her shoulder, and marched down the ramp off the plane.
It was night in Nairobi, and beyond the airport tower, the city lights twinkled. A gust of warm wind blew a few strands of her shiny black hair into her face.
Ahead, twelve Japanese SUVs waited on the tarmac. The front passenger door of the second vehicle opened, and Jonas stepped out. The look on his face stopped Peyton in her tracks.
Something was wrong.
Chapter 20
The black SUVs rolled through Nairobi, bunching up at stoplights and stretching out in between, like a black snake stalking through a field of skyscrapers.
In the second car, Peyton rode in the back seat with Jonas Becker, her counterpart at the WHO. On the tarmac, he had told her only that he had urgent news to share. Whatever it was, he didn’t want to share it in the presence of others.
“How was the flight?” he asked.
“Good. Long.”
“You sleep?”
“A little.”
“Sorry I woke you so early yesterday.”
“Don’t be. I needed the head start.”
At the hotel, Jonas offered to carry Peyton’s duffel, as he had a dozen times before. As always, she declined.
The hotel wasn’t fancy, but it was in a safe part of town, near the American embassy. Kenyan troops stood guard in the parking lot, and Nairobi PD had several cars along the street.
The moment the door to Peyton’s room closed, Jonas said, “It’s reached the villages.”
He spread a map out on one of the queen size beds and pointed to three highlighted areas outside Mandera.
Peyton got out her laptop, connected to WiFi, and pulled up the travel log from CityForge. “The two Americans videoed and posted their travel route,” she said. “We should cross-reference to see if they visited these villages.”
Jonas ran a hand through his short brown hair and looked away, as if dreading something. Peyton was five foot six, and Jonas was only a few inches taller, putting their eyes on a near equal plane. He leaned against the brown wooden dresser, searching for the right words.
“What?” Peyton asked.
“The American who first reported symptoms, Steven Collins, died while you were en route. The British employee of the aviation company is also dead.” Jonas paused. “And the other American, Lucas Turner, has now broken with the disease.”
It was Peyton’s worst fear. It took her a moment to realize he had said the disease instead of Ebola or Marburg or Yellow Fever.
“The Kenyan Ministry of Health sent a team yesterday. They’ve set up an Ebola treatment unit at Mandera,” Jonas added.
“Have they tested anyone?”
“They’ve tested everyone: the Americans, the British man, and most of the villagers. No one has tested positive for Ebola.”
“What did they use?”
“ReEBOV. It’s confirmed: we’re dealing with a new pathogen here.”
The ReEBOV Antigen Rapid Test could show a false positive or false negative in about one in ten patients tested for Ebola, but across a large sample group, it was likely to be correct. The fact that they had all tested negative sealed the case. This was a novel infectious agent.
Which meant Peyton’s entire plan had to be thrown out the window. It was impossible to know whether ZMapp would be effective against the pathogen. Flying Lucas Turner back to Emory also presented a much greater risk if they didn’t even know what they were bringing to the US.
Jonas helped her bounce a few ideas around. They worked out a tactical approach for after they landed in Mandera, assigning teams to contact trace at the airport and others to venture into the countryside to survey the villages. When they had a general plan together, they called the security advisors into the hotel room to get their input.
Their Kenyan military liaison, Colonel Magoro, informed them that a Kenyan army brigade had departed yesterday morning for Mandera County and was already set up. The Kenyan government was prepared to quarantine the entire county if needed.
The UN security officer reported that the African Union troops in southern Somalia had been alerted to the situation and were establishing checkpoints along the roads into Somalia. The Ethiopians were also in the loop and were taking similar measures.
There were also two men from the American embassy in the room. One was a State Department official who listened to the security preparations, asked a lot of questions, and encouraged Colonel Magoro to bulk up the units that would
be guarding Peyton’s teams outside Mandera. The colonel granted the request without complaint.
The other American introduced himself only as embassy security, and despite listening intently to the briefing, he said nothing. Peyton assumed he was CIA. As the men filed out of the room, he handed her a card with a number in Nairobi. “Call us immediately if you run into any trouble. We’ll do everything we can.”
When they were gone, Jonas folded up the map and packed his things. Peyton thought he would leave, but he lingered, his demeanor changing, becoming a little more nervous.
“You’re going to miss Thanksgiving, huh?” he said.
“Yeah.”
“Parents disappointed?”
“Not really. They know I wouldn’t be out here if it wasn’t important.”
“I know what you mean. You… have a sister, right?”
“Yeah. Older sister, Madison.”
“And a nephew, niece?”
“Both now. Madison had her second child last year, a girl this time. Olivia.”
He nodded, still seeming uncomfortable. Peyton was surprised by his sudden personal interest. Jonas had been a great partner over the years, but their relationship had remained strictly professional.
“What about you?” she asked, unsure what to say.
“No one missing me back in Geneva. Or Heidelberg. Parents passed away a few years ago. I have a sister in London, but she’s got her career and family; keeps her pretty busy.” He fidgeted with his bag a moment, then said, “So no strapping young man counting the hours until you return to Atlanta?”
“No, not for a while.” Peyton looked around, wondering if he would say something else. Finally, she said, “What about you?”
“No, me either. Kind of tough with the job.”
“I know what you mean.”
Jonas’s mood seemed a little lighter, his nervousness gone. He put the backpack over his shoulders and walked to the door. “All right then. Lock up tight. See you in a few.”
“Will do,” Peyton said, watching him leave, a puzzled expression still on her face.
She took a triangular wooden block from her duffel and wedged it under the door. Just in case, she also moved a wood-framed chair from the desk and placed it against the door handle. She set a can of mace by her bed and hid a sheathed boot knife under the pillow beside her.
She assumed that the hotel washed the sheets regularly but figured the comforters were rarely cleaned, just wiped off and left to collect all manner of germs and bugs from hundreds of guests each year. So she took the comforter off the queen size bed she would sleep in and placed it on the dresser. She definitely didn’t want it near her face. Being germ-conscious sort of came with the territory in her line of work.
For the first few years of her career, she had done exactly what she’d advised her EIS agents to do: she had called her mother whenever she landed for a deployment. As she’d grown older, she had gotten out of the habit, but that night in Nairobi, sitting on the stripped bed in her hotel room, Peyton dialed her mother.
Lin Shaw answered on the second ring, and Peyton got the impression that she had been crying.
“Everything all right?” Peyton asked.
“Yes, dear. Where are you?”
Peyton told her, and they made small talk, about the flight, and her sister, and her mother’s quilting. After Peyton’s father passed away, Lin had raised her son and two daughters alone. Peyton had always been close to her mother, but that night, for the first time in years, her mother ended the call by saying, “I love you very much.”
When she hung up, Peyton wondered if her mother was sick. She got the distinct feeling there was a secret of some sort her mother wasn’t telling her.
For some reason, her mind wandered to her brother, Andrew. He had died in Uganda, in 1991, while working on an AIDS awareness campaign for the WHO and Ugandan government. On a hot summer day in August, he was working in a village in the eastern part of the country, inside Mount Elgon National Park, when a forest fire consumed the village, killing Andrew, his Ugandan liaison, and all the residents. They had to verify his identity based on dental records and personal effects. At the funeral, on an overcast day in San Francisco, there was very little left to bury.
Peyton was thirteen then, and when the service was over, a woman with wavy blond hair walked over and introduced herself, speaking in an Australian accent. She had been a friend and colleague of Andrew, and Peyton sensed that perhaps they had been more. The woman reached into her pocket and brought out an item Peyton knew well: the silver pin Andrew had received a few years before at his medical school graduation—a gift from their father. The woman handed it to Peyton and said, “I believe your brother would have wanted you to have this.”
Peyton had turned it over in her hand, examining the serpent that wrapped around the staff. She was surprised that it wasn’t charred.
“I thought it burned.”
“I had it cleaned and refinished. I wanted you to have it in the same condition it was in when your brother carried it. All things can be repaired, Peyton. Some simply require more time than others.”
On that shadowy day in August, holding Andrew’s pin as the wind blew through her brown hair, Peyton knew for sure that she wanted to be a physician—and that she wanted to work in the field, helping people. Maybe it was because she wanted to continue Andrew’s work—he had been both her hero and her father figure—or maybe it was because she thought being an epidemiologist would somehow help her understand him or bring her closer to him. But she was certain being a doctor was what she wanted to do. And she had never regretted her career choice since. She knew the risks, and they were worth it to her.
She rose and set about getting ready for bed. She brushed her teeth, turned the shower on, and stripped off her tan service khakis. She sat naked on the closed toilet while she waited for the water to warm up. Her mind focused on her upcoming decision: Lucas Turner, the twenty-two-year-old American. Peyton wondered if he would be alive when she reached him. If so, what sort of shape would he be in? Would ZMapp be effective against the unknown viral hemorrhagic fever? Could it possibly make him sicker? And with or without ZMapp, would Lucas survive the trip to America? That was, if she followed the original plan she’d discussed with Elliott—the plan the director of the CDC had approved. That plan had been based on certain assumptions, and in the past hour, those assumptions had changed. The pathogen wasn’t Ebola.
Emory had the advanced medical assistance Lucas needed—but if they flew him to Atlanta, she would be bringing an unknown, deadly pathogen into the United States, putting three hundred million lives at risk. All to save one young man. But if she left Lucas in Africa, he was, for all intents and purposes, on his own, left to fight off the infection or die, and that didn’t sit right with Peyton.
In the steam-filled bathroom, a plan began to take shape in her mind.
Day 3
32,000 Infected
41 Dead
Chapter 21
Reuters News Alert
Authorities in Hong Kong and Singapore have issued an entry ban on anyone arriving with symptoms of an unidentified respiratory disease. Members of each government, speaking on the condition of anonymity, said that the disease in question is not another outbreak of SARS, but instead a contagion believed to be more flu-like and persistent in nature. It is unknown how many people are infected in either city at this time.
Chapter 22
At five a.m., Peyton, Jonas, and their teams loaded onto the Air Force transport and departed Nairobi for Mandera. The air ambulance and a Kenyan air force transport followed along.
The passenger compartment in the US Air Force transport was cramped. In total, seventy-eight members of the combined teams sat in chairs, on the floor, and against the walls. Some of the young men took turns standing and sitting while Peyton and Jonas carried out the briefing, giving the integrated teams their assignments.
When they landed, the sun was rising over the rocky, bar
ren hills surrounding the airport. A convoy of military trucks with canvas backs sat waiting for them. Dr. Phil Stevens led the team that would be interviewing the airport’s employees, building a timeline and contact tree for the British radar technician.
After Colonel Magoro had joined them, Kenyan army troops offloaded their gear and drove Peyton, Jonas, and their team quickly through Mandera. The ride across the streets of hard-packed dirt was bumpy and dusty. Through the red clouds billowing at the back of the truck, Peyton got a hazy view of the rural town.
She saw mostly single-story buildings arranged in a haphazard grid. They spread out from Mandera Road, the main thoroughfare that ran through the center of town. Livestock wandered the streets—cattle, camels, and goats driven by ranchers bringing them to market. Residents pushed single-wheeled carts loaded with produce. Kids stood on every block, gawking at them as they passed, many pausing soccer games to watch.
Their local guide shared some background on Mandera. It was the poorest of Kenya’s forty-seven counties. Education was ranked at the bottom; there were a hundred students for every teacher. Health care facilities were the worst in the country. Mandera’s residents were largely subsistence farmers and ranchers. The economic situation was dire.
In 2013, the Kenyan government had begun a process of devolution, handing much of the governing power in Mandera down to the county government. With the help of non-governmental organizations like the Red Cross and the UN, as well as support from the Kenyan government, the county had started turning its situation around. They had embarked on several large public works projects, including upgrading the airport and building a new government complex, a stadium, and an international livestock market. The convoy passed several of these projects, which were still works in progress. The airport and the new governor’s mansion seemed to be the only completed facilities.
The government had also updated and repaired Mandera Referral Hospital. The improvements had bolstered patient safety immensely, although the local terror attacks and recent payment problems had set their progress back. The county had also acquired its first ambulance and had contracted with the Red Cross for seven more. But on the whole, the hospital was still a far cry from what administrators wanted for their county and their people.