“I can’t—”
“I will give him the dose myself. I ask only for the medication that might save his life. If we cannot save him, or at least do everything we can for him, it will be difficult to ask others to put themselves in harm’s way. It is also the right thing to do for a man who has put himself at risk long before your fellow Americans appeared at his door.”
Peyton pulled on a dry T-shirt. “I’ll have to make a call.”
She walked away before Nia could speak again.
Inside the main tent, she found Hannah, who sat at a long table typing on a laptop. The young physician stood when she saw Peyton.
“Do you have the results?” Peyton asked.
Hannah nodded. “All negative for Ebola. I took blood and saliva samples as requested.”
“Good. I’ll be right back. Get the samples ready for transport.”
It was 8:37 a.m. in Mandera; 12:37 a.m. in Atlanta. Peyton slid the satsleeve onto her phone and dialed Elliott Shapiro. She hated to call him so late, but it had to be done.
“Yeah,” Elliott said, half-asleep.
“Sorry to wake you.”
Peyton heard him rustling out of bed, his feet pacing across the floor, a door closing.
“It’s okay. What’s up?” His voice was still low.
“It’s not Ebola. The Kenyans tested everybody. So did we.”
“Symptoms?” he asked.
“All the classic symptoms of a filovirus. If I didn’t have the results, I’d say it’s Ebola or Marburg. But this thing moves faster than Ebola. Mortality rate looks to be high; no one has survived yet.”
Elliott waited.
Peyton tried to keep her voice even, professional. “Steven Cole is dead. Lucas Turner is infected. His condition is critical.” The steadiness seeped from her voice with the last words, and she took a breath. “This kid is dying, Elliott.”
“What do you want to do?”
“I want to give him ZMapp and fly him back to Emory. It’s what I would do if he were my son. But… it’s not Ebola. We don’t know if ZMapp will even help him, and we could be putting the entire continental US at risk.”
“And?”
“And we might save his life—and figure out what this pathogen is, and help find a vaccine or treatment.”
“Exactly,” Elliott said.
“It’s a bureaucratic nightmare.”
“You put him on a plane and focus on your job out there. I’ll deal with the bureaucrats. That’s my job now.”
“All right. There’s one more thing. The Kenyans have asked for doses of ZMapp to administer to a physician here in Mandera.”
“How many doses do you have?”
“Enough for twelve patients.”
“That’s tough,” Elliott said. “I want to say yes, but we may need the drug for our people if they get sick. We can’t make this stuff overnight.”
“I agree.”
“On the other hand, if we end up flying out of there with one dose left, we may have sentenced a man to death needlessly.”
“Yeah. It’s almost a no-win.”
“Do what you think is right, Peyton. I’ll back you either way.”
“God, you’re no help. I was hoping you’d make the call.”
“Making big decisions is part of your job, young lady. And those decisions are going to get bigger soon. I’m not going to be around forever. You’re going to have to run this place when I’m gone.”
“I don’t want your job.”
“Too bad. I’m going to insist they give it to you.”
“Then I’m going to retire.”
“That’s the emptiest threat I’ve ever heard. You’re doing exactly what you were meant to do. Text me when you put the kid in the air. I’ll work on getting more ZMapp.”
Back in the main tent complex, Peyton found Nia talking to three Kenyan government employees, pointing to the map and arguing. The tall black woman fell silent and straightened as Peyton approached.
“We’ll give you doses for one patient,” Peyton said. “On the condition that the Ministry of Health provides us with a waiver that says the medication is for research purposes only and will be used at the Kenyan government’s sole discretion. The CDC has no knowledge of what will happen to the doses, and we make no commitment to provide further doses.”
Nia shook her head. “We don’t have time for paperwork.”
“Then I suggest you make the call now. I doubt you’ll have any issues. I’ve found you to be very persuasive.”
Peyton retrieved a dose of ZMapp from their supply crates, suited up again, and returned to Lucas’s room. She knelt beside him. “Hi, Lucas. I’m going to give you a medication that we hope will help you fight the infection. I’ll stay here for a bit to make sure you don’t have a reaction, okay?”
He nodded.
“If everything goes well, we’re going to put you into a special stretcher and transport you to the airport. You’ll be flown back to Atlanta where they can give you the best care possible. We’re going to do everything we can for you, Lucas.”
A tear rolled from his yellow, bloodshot right eye onto his cheek. He cleared his throat, looked her in the eye, and said, “Thank you.”
Peyton placed a hand on his shoulder. “You’re welcome.”
Lucas had drifted off to sleep when they came to transport him to the airplane. As Dr. Shaw helped him from the bed and into the isolation stretcher, he wanted to stand and hug her. Before she had arrived, he had been sure he would die here. Now he was filled with hope. For the first time since the fever had set in, he believed he had a chance at living.
He felt like the luckiest person in the world.
At the airport, Peyton watched the air ambulance personnel load Lucas onto the plane, along with the samples Hannah had taken.
“You think he’ll make it?” Hannah asked.
“I hope so,” Peyton said. She glanced at the younger physician. “You did great today. Seeing the treatment units firsthand is unnerving. You never get used to it, but it gets a little easier.”
Chapter 24
Elim Kibet was trying his best to read when Nia Okeke entered the room and marched past the rows of dying villagers. Behind her, a man pushed an empty wheelchair.
They stopped before Elim, and Nia squatted down and made eye contact through her clear plastic goggles.
“We’re moving you, Elim.”
He closed the paperback. “To where?”
“A patient room has opened up.”
Elim’s heart sank. It was the answer he had dreaded. If a patient room had opened up, it meant that the young American, Lucas Turner, had passed away.
He tried to stand, but his weakened legs failed him. Hands grabbed him and pulled him into the wheelchair. As he was wheeled out of the room, helpless eyes peered up at him from the floor, but everything passed in a haze, as if he were having a nightmare.
As he suspected, the wheelchair stopped at the exam room where he had last seen Lucas Turner.
“When did he pass?”
“He’s not dead. The Americans are flying him home.”
Elim looked up, surprised. “That’s good.”
“Yes. It is. Now let’s get you into bed.”
Nia and the other man helped Elim up, got him settled, and walked out, leaving a cloud of chlorine in their wake.
Lying there in silence, Elim thought about how quickly a person’s fate could change, how precious life and health are. He had walked into this very room two days ago as a practicing physician, a man in control, with the power to heal, looking down on the sick American on the same bed where he himself now lay. He had never known just how different the world looked from the other side.
He vowed that if he became well, he would cherish every day. And although he had never wished ill health on another person, there and then he wondered if every physician might benefit from being sick—really sick—just once. He wondered if it would make them all care a little more, or work a little ha
rder, to have been on the other side for a while—to have placed their life and livelihood in the hands of a stranger, even if for only a short period. He had considered himself a very conscientious physician before this, but he imagined that if he lived, he would be even more dedicated to his patients.
Staring at the ceiling, he was reminded of an old Indian proverb: A healthy person has a hundred wishes, but a sick person has only one.
The door opened, and Nia reentered. She was carrying the three buckets Elim knew so well, some bottles of ORS, and a case labeled CDC.
She moved to his IV and began attaching something.
“What is that?”
“A gift from our American friends.”
“What kind of gift?”
“ZMapp.”
Elim sat up. “Don’t give it to me.”
She put a hand on his shoulder, forced him back onto the bed, and sat on the side. “For your sake, it’s a good thing you are no longer the physician in charge here, Dr. Kibet.”
“Give it to someone younger, with their life ahead of them.”
Nia smiled at him for the first time. “I like to think you’ve still got some life ahead of you, Elim. Look, we don’t even know if it will help. This is just a trial. We’re not dealing with Ebola, so we need a guinea pig to tell us if ZMapp will even work. Someone who understands informed consent. Someone worth saving.”
“There are lots of people worth saving.”
“True. We chose you. Now, I’ve got work to do. Call me if you need me.”
Before Elim could respond, the woman was gone.
As he closed his eyes, he realized that if he survived, he would be immune to whatever the terrible pathogen was. He could help others. He could go back to work without worry. That was something to look forward to. That was something to live for.
Chapter 25
Twenty miles from the Kenyan border, at a training camp in southern Somalia, a member of the al-Shabaab terror network turned his smartphone on and opened Daily Nation, Kenya’s largest news site. He scoured the stories, looking for opportunities to advance his group’s cause. The top headline immediately caught his eye:
Outbreak in Mandera
He sat bolt upright when he read the article’s subheading:
Health Workers from the WHO and CDC Investigate Possible Ebola Outbreak in Mandera County
He rushed to the barracks and began waking the members of his cell. They had work to do.
Peyton and Jonas sat in the back seat of an SUV, bouncing along the hard-packed red-dirt road. The engine roared as they plowed through a cloud of orange dust. There were six SUVs in the convoy, plus two armored troop carriers—one leading the procession, the other just behind the SUVs—and a Nora B-52 self-propelled artillery vehicle bringing up the rear.
Peyton and Jonas had used Dr. Kibet’s notes and the CityForge website to trace Lucas and Steven’s travel route. Based on their interviews with the sick villagers at Mandera Referral Hospital, as well as what they’d learned from the videos posted online, they had identified a village they believed to be ground zero in the outbreak. They were en route to that village now.
“What was that about in the hospital?” Jonas asked.
“What?”
“All the talk about Desmond Hughes. Is he connected to this somehow?”
“I don’t know,” Peyton said. She considered telling Jonas about the call from Desmond but decided against it.
“Do you know him? Hughes?”
Peyton hesitated. “I used to.”
Jonas scrutinized her, as if trying to read through her words.
“I think we’re missing something here,” Peyton said.
“Such as?”
“I don’t know yet. Something just doesn’t… feel right.”
“You think…”
“I think someone is responsible for this outbreak.”
“Bioterror? Here?”
“I know. There’s no strategic, political, or symbolic importance.”
“Unless…” Jonas thought for a moment. “Unless you wanted to test a pathogen before wider release.”
Peyton wanted to continue their conversation, but the car slowed, and the noise from the engine died down. And as the convoy’s cloud of dust dissipated, Peyton got her first look at the village.
Her mouth ran dry. “Back up,” she said, struggling to speak. “Tell the other units to keep their distance.”
Chapter 26
Transcript
CNN Situation Room Segment
Good morning, and thank you for joining us. Our top story this hour is a deadly outbreak in Kenya. It has already killed dozens, including one American and one British citizen, and anonymous sources at the CDC and State Department say the symptoms are similar to Ebola—though they’ve cautioned that tests to identify the disease are not yet in.
Most alarmingly, CNN has just learned that an infected patient is being transported to the United States as we speak. Authorities at the CDC say that Lucas Turner, a recent graduate of the University of North Carolina, contracted the disease while traveling in northeast Kenya.
We’ll be updating this story as details unfold, but we want to hear what you think. Should the CDC be bringing patients with an unidentified, deadly disease back to the US? Let us know on Twitter, using hashtag OutbreakInAfrica.
Chapter 27
When Desmond came to, he was zip-tied to a chair in an airplane. The plane was level—it was apparently at cruising altitude—but it was encountering a fair amount of turbulence.
His hands were bound to the armrests, his legs tied below. He opened his eyes just slightly. Across from him, a muscle-bound man with a buzz cut sat gazing at a tablet, white earbuds plugged into his ears.
An escape plan took form in Desmond’s mind. Keeping his eyes just barely cracked, he began rolling his head around, mumbling. The man pulled out his earbuds and set the tablet aside. His hulking form leaned over Desmond, straining to make out the words.
Desmond jerked his head forward, slamming the highest part of his forehead into his captor’s face. The soldier fell to the floor in an unconscious heap.
Desmond bent forward and bit into the right armrest, trying to tear it open. If he could take out a big enough bite, he could slide his hand free, take the man’s gun, and—
A hand grabbed him by the back of his neck, pulled his head up, and covered his mouth with a cloth. A sweet aroma filled his nose and mouth, and his vision faded to black.
Chapter 28
Her first glimpse of the village had spooked Peyton. It was too quiet, too deserted. Something was wrong here, and she feared the worst.
She, Jonas, and their team trudged toward the village, all wearing PPE, several members carrying cases with sample collection kits, bottles of ORS, and medications. A white tent complex stood behind them. With the sun setting across the barren red landscape, they looked like space explorers walking on the surface of Mars.
Ahead, two dozen round huts baked in the last rays of sunlight, their mud-packed walls and thatched roofs weathering the heat. Goats wandered down the village’s central road, weaving in and out of red dust clouds drifting in the wind.
The first hut was empty. But at the second, Peyton found what she’d expected: dead bodies. Two adults, likely a man and his wife, lay on their backs. Caked blood covered their faces and chests. Flies swarmed them. Three children lay beside them—two sons and a daughter.
Peyton motioned to Hannah, who advanced into the home, set down her cooler, and began taking samples. Peyton knelt by the two adults, swatted away the flies, and searched for clues that might establish a rough time of death. From the looks of it, these bodies had been dead for several days at least. Not good.
They found more bodies in the other huts, and several outside. Some of the villagers had probably wanted to die with the sun on their faces or the stars above them. Peyton didn’t blame them.
Just as she was turning to head back to the tent complex, she caught
movement out of the corner of her eye. She froze, waited. Yes—there was someone, or something, just beyond the village, crouched, watching them.
Over the comm, Peyton said, “Jonas, did you see that?”
The German epidemiologist was already walking back to the tents. He stopped. “See what?”
Peyton set down her sample case and got ready to run. It wouldn’t be easy in the suit, but taking it off wasn’t an option. She spoke quickly on the comm line. “Colonel Magoro, do you copy?”
“Yes, Dr. Shaw.”
“We need a team of your men at my location immediately. Do not transit the village—proceed around it, and use caution. Try to stay out of sight and stay quiet. Have your men take up a concealed position a hundred meters north of me.”
“Understood,” the Kenyan officer said.
“Hannah, take your team back to the tents and take off your suits. Get in the vehicles and prepare to leave.”
Jonas returned to Peyton’s side and glanced over at her, silently questioning what was going on. Peyton nodded subtly toward the bushes. Jonas took a step toward them, but she caught his arm, urging him to wait.
A moment later, Colonel Magoro said, “We’re in position.”
“Spread your men out and begin walking toward the village,” Peyton said.
The Kenyan troops rose, assault rifles held in front of them, and stalked forward quietly, like big game hunters approaching a kill. Peyton wanted to run, but she focused on the group of yellow-green shrubs. If she was wrong about what she had seen, the mistake might be deadly. Sweat poured down her forehead. She desperately wanted to rip the helmet off, wipe her face, and pour cold water in the suit.
Suddenly, the bushes between the Kenyan troops and Peyton shook as three figures sprang forward. A woman, likely in her forties, a young boy, and a teenage girl, all emaciated. Surviving villagers, Peyton assumed. Their eyes were wild as they barreled toward Peyton and Jonas, away from the soldiers. They stumbled, trying to get their feet under them as they ran. Colonel Magoro and his men were close behind them, yelling in Swahili.