“Survivors could also offer clues that would help in the development of a vaccine. In fact, Merck already has trials underway for an Ebola vaccine. Thus far, it appears to be incredibly effective, but we don’t think it offers lifetime immunity. It hasn’t received regulatory approval yet, and it doesn’t protect against every strain of Ebola, so identification will be key here. Nevertheless, if this is Ebola, the Merck vaccine could get fast-track approval and end up saving a lot of lives in uninfected populations.
“Bonus question: can anyone name the other type of therapy in trials to treat Marburg and Ebola?”
Peyton scanned the group. When, once again, no response came, she said, “Small interfering RNA. Shows great promise, but it’s a long way from the market.
“All right, let’s discuss containment. What’s the key?”
“Contact tracing,” Hannah said.
“Exactly. Our goal is to find patient zero and build a tree of everyone they had contact with and everyone those people had contact with. It can be overwhelming. Some days you’ll go out and it’ll feel like the contact list is exploding—you’ll be adding hundreds of people each day. But have faith and keep working at it. Eventually the list will start shrinking—if we’re winning.
“Okay. What do we know about Ebola’s transmission?”
“It’s spread by bodily fluids,” said a physician in the second row.
“Good. What else?”
“It’s zoonotic,” Millen said.
“Yes. Very good. Ebola and other filoviruses are all zoonotic—they jump from animals to humans and back. Zoonotic infections are a huge issue in central Africa. In fact, seventy-five percent of all the emerging infectious diseases here are zoonotic in nature. We can’t just focus on human-to-human transmission to stop the spread.
“Now, raise your hand if you’re a veterinarian.”
Four hands went up. Three were Commissioned Corps members in tan khakis; the fourth wore civilian attire.
“Each of you will be assigned to one of the teams in the field doing contact tracing. What are you looking for?”
“Bats,” they all said in unison.
“Correct. And what are bats?”
“Mammals,” said one vet.
“Reservoir hosts,” said another.
“Correct on both counts. The natural reservoir host for Ebola remains unknown, but we’re almost certain that African fruit bats harbor the virus without symptoms. When it jumps from bats to humans, it wreaks havoc. So we’re looking for anyone who may have come into contact with bats or bat droppings. Maybe they went into a cave or ate bush meat that contained bat, or maybe they consumed another animal that came into contact with a fruit bat. It’s likely that when we find our index case, they’ll have contracted the virus from a bat.”
To the entire group, Peyton asked, “What do we do with people showing symptoms of the disease?”
“Isolation,” they said in unison.
“And people they’ve had contact with but who show no symptoms?”
“Quarantine.”
“That’s right. In this instance, the quarantine period is twenty-one days from the time they first had contact with the virus. If they are symptom-free after twenty-one days, we turn them loose.”
She looked over the assemblage. “Any questions?”
When no one spoke, she placed the dry-erase marker back in the whiteboard’s tray. “Good. Let’s split up into groups. We’ve still got a lot to do before we arrive.”
Chapter 12
In Berlin, Desmond was preparing for the next day’s meeting.
He had gone out just after sunset, when the streets were filled with people. Wearing the hat and secondhand clothes he’d purchased earlier in the day, he moved quickly, never making eye contact. At a drogerie, he bought the items he most desperately needed.
He stood now in the tiny, white-tiled wet room of the flat, watching his blond hair fall into the sink as the clippers buzzed. He left only about a quarter of an inch all over. He applied the dark hair dye and sat on the Murphy bed.
As he waited for the dye to soak in, he took out the disposable smartphone and did an internet search for himself—something he’d been wanting to do ever since he’d acquired the device.
The first hit was for a news article from Spiegel Online. The police had found the taxi driver. And more: American authorities had raided his home outside San Francisco. So he was an American—or at least had a home there.
The second search result was for Icarus Capital, where he was listed as the founder and managing partner. He quickly read his bio, but it was all about his career: investment successes, public speeches given, and a smattering of community commitments. He was a patron of the California Symphony, apparently. None of the organizations listed rang a bell.
He clicked the Investments page and read the names: Rapture Therapeutics, Phaethon Genetics, Rendition Games, Cedar Creek Entertainment, Rook Quantum Sciences, Extinction Parks, Labyrinth Reality, CityForge, and Charter Antarctica.
Rapture Therapeutics. He had seen that name earlier that morning—on the employee ID card from the dead man in his hotel room.
He navigated to the Rapture Therapeutics website.
It was a biotech company focused on neurological therapies. Rapture had initially focused on helping patients manage depression, schizophrenia, bipolar, and other psychological conditions. Their most recent offering, Rapture Transcend, targeted brain plaques and eliminated them using a genetically engineered protein.
Desmond wondered if their work could be connected to what had happened to him. His firm was an investor in Rapture Therapeutics. Had he discovered something they didn’t want him to know? Could he be part of a clinical trial gone bad?
He continued reading the Rapture website, intrigued by what he learned. The company seemed to be on the cusp of a major breakthrough. Two years ago, Rapture had licensed a therapy that might well hold the key to curing Parkinson’s, Alzheimer’s, Huntington’s, amyloid disorders, and a host of other neurodegenerative diseases.
The key to this potential cure was reportedly discovered by accident. In 2004, an Israeli researcher named Beka Solomon was conducting Alzheimer’s trials when she stumbled onto a new therapy that reduced the brain plaques associated with Alzheimer’s by an astounding eighty percent. That made it far more effective than any treatment on the market.
But Solomon had actually begun her trials with a focus on a completely different therapy. She had genetically engineered mice to develop Alzheimer’s and was treating the mice with a human-derived antibody, which she administered via their nasal passages. The problem was, her therapy didn’t effectively cross the blood-brain barrier and reach the plaques in the parts of the brain affected by Alzheimer’s. In what might go down as one of the greatest twists of scientific luck, Solomon decided to attach her antibody to a virus called M13 to transport it across the blood-brain barrier.
M13 was a special type of virus called a bacteriophage—a virus that infected only bacteria. And M13 infected only one type of bacteria: Escherichia coli, or E. coli. To Solomon’s surprise, the antibody, when attached to M13, showed great success in her trials. But what was truly surprising was that the group of mice treated with the M13 virus alone—without Solomon’s antibody therapy—also showed incredible improvement. It seemed that the positive outcomes from the trials were due entirely to M13, not to Solomon’s actual antibody therapy.
After a year of treatment, the mice that received M13 had, on average, less than a fourth of the plaques of those in the control group. Subsequent experiments showed that M13 could also dissolve other amyloid aggregates—the tau tangles found in Alzheimer’s and the amyloid plaques associated with other diseases, including alpha-synuclein (Parkinson’s), huntingtin (Huntington’s disease), and superoxide dismutase (amyotrophic lateral sclerosis). The M13 phage even worked against the amyloids in prion diseases, a class that included Creutzfeldt-Jakob disease. The discovery was startling and represented a po
tentially huge breakthrough in the fight against neurodegenerative diseases.
Thus began the long process of trying to figure out how M13 did its miraculous work. After years of research, scientists discovered it was actually a set of proteins—called GP3—on the tip of the M13 virus that was the key to its incredible ability. The GP3 proteins essentially enabled M13 to attach to E. coli and unzip the bacteria, allowing M13 to inject its own DNA inside for replication. And by a stroke of sheer luck, the GP3 proteins also unlocked clumps of misfolded proteins found in Alzheimer’s, Parkinson’s, Huntington’s, and other diseases.
Desmond turned this information over in his mind. He had no doubt that Rapture Therapeutics was a large part of the puzzle. It was, after all, their employee—Gunter Thorne—he’d found dead in his hotel room.
Maybe the answers would come tomorrow, at the meeting.
He closed the Rapture Therapeutics site and returned to the web search he’d done on himself. But the remaining links were of no help. He had no social media presence, and the other links were just articles about companies he was involved in or videos of him speaking at conferences or appearing in video interviews. His entire life seemed to be limited to his professional involvement in high-tech startups.
Next he did an internet search for Peyton Shaw. When he had called her that morning, she had known who he was. If he could find out who she was, and how she knew him, it might give him a clue to his own identity.
He learned that she was a leading field epidemiologist for the CDC. That was interesting. Was she somehow involved with Rapture Therapeutics? It seemed unlikely; her focus was infectious diseases.
He pulled up a video of Peyton Shaw giving a speech at the American Public Health Summit a few months before. She appeared on his screen, standing on a wide stage with a white background. Her white skin was silky smooth, her hair dark brown and shoulder length. She was clearly of European descent, but Desmond guessed there was an East Asian somewhere in her immediate family tree. She was thin and moved about the stage easily, with the grace of someone who did yoga or danced regularly.
It was her eyes that Desmond focused on, however. They were large and bright and radiated an indescribable quality that he found instantly captivating. She wasn’t gorgeous, not a woman who would turn heads, but as he watched her, he was irresistibly drawn to her. She possessed that certain charm that comes from confidence and being comfortable in one’s own skin. And as she spoke, he realized something else: she was incredibly intelligent. Desmond didn’t know what type of woman he had dated before, but if he were to choose at that moment, it would be someone like Peyton Shaw.
On the projection screen behind her, an image appeared of a field hospital in a rural, tropical area—likely somewhere in the third world.
“Humanity is fighting a war,” she said to an unseen audience. “It is a global war—a war that has raged since our ancestors took their first steps. It may never end. This war has no borders, no treaties, no ceasefire. Our enemy lives among us. It is invisible, immortal, always adapting—and testing our defenses for weakness.
“It strikes when we least expect it. It kills and maims indiscriminately. It will attack any person, of any nation, race, or religion. Our immortal enemy is in this room. It is inside you. And me. That enemy is the pathogens that each and every one of us carries.
“For the most part, we live in an uncomfortable equilibrium with bacteria and viruses, both those inside of us and those outside, in the natural world. But every now and then, the war reignites. An old pathogen, long dormant, returns. A new mutation emerges. Those events are the epidemics and pandemics we confront. They are the battles we fight.
“Success for humanity means winning every battle. The stakes are high. Around the world, disease is the one enemy that unites every person of every race and nationality. When a pandemic occurs, we come together in a single, species-wide cause.
“In the history of our battle against pandemics, there have been lulls and wildfires, peaks and valleys. It is the wildfires we know well; they are committed to history. They are the times when we lost the battle. They are the dark years when the human race died en masse. When our population shrank. When we cowered and waited.”
The screen changed to a painting of Europeans with bumps covering their bodies.
“In the third century, the Antonine Plague wiped out a third of Europe’s population. And just when population levels were recovering, the Plague of Justinian in the sixth century killed almost half of all Europeans; up to fifty million people died from what we believe was bubonic plague.
“In the 1340s, the Plague once again remade Europe, forever changing the course of world history. At that time, we believe the world population was around 450 million. The Black Death killed at least 75 million. Some estimates go as high as 200 million. Imagine, in the span of four years between twenty and fifty percent of the world population dying.
“Europe, because of its large cities, population density, and advanced trade routes, has repeatedly been a hotbed for pandemics. But it is not alone.”
The image switched to a picture of Spanish conquistadors meeting indigenous tribes at a shoreline, their wooden ships anchored in a bay behind them.
“Consider the New World when Europeans arrived. We’ve heard so much about the plight of native peoples in the present-day United States, but consider the populations of New Spain, present-day Mexico. In 1520, smallpox killed nearly eight million. Twenty-five years later, a mysterious viral hemorrhagic fever killed fifteen million—roughly eighty percent of their population at the time. Imagine that: a mysterious illness killing eight out of every ten people. In America, that would be over 240 million people. It’s unthinkable, but it happened, right here in North America, less than five hundred years ago. We still haven’t identified the pathogen that decimated Mexico in the sixteenth century, but we do know it returned twenty years later, in 1576, following two years of drought. It killed another two million from the already decimated population. To this day, we still have very few clues about what caused that pandemic. Most importantly, we don’t know if or when it will return.”
The image changed to a black-and-white photo of a field hospital with rows of iron single beds holding patients covered by wool blankets.
“1918. The Spanish Flu. Or, as it’s more recently known, the 1918 Flu Epidemic. Less than one hundred years ago. Estimates are that one in every three people around the world contracted the pathogen. It killed one in five people who fell ill with the disease. As many as fifty million died. We think twenty-five million died in the first six months of the outbreak.
“So. Human history has a repeating theme: we battle pandemics, we lose, we die, it burns itself out, and we rebuild. We always come out the other side stronger. Humanity marches on.
“But today, we are more connected than ever before. Our population is four times larger than it was at the time of the last major global pandemic in 1918. We’re more urbanized. We’re disturbing more animal habitats. Most concerning, we are disturbing habitats where reservoir hosts for extremely deadly diseases reside. Fruit bats, rats, squirrels, fowl, and other hosts for zoonotic diseases are coming into contact with humans with greater frequency.
“If you ask any epidemiologist, they will tell you it’s not a matter of if, but when the next global pandemic begins. That’s why the work you’re doing is so important. You’re on the front lines of the battle against infectious diseases. Your actions may determine when the next pandemic occurs. At the local and state levels, your decisions will determine whether the next outbreak remains contained or goes global. At the risk of sounding hyperbolic, I believe that one or more of you, at some point in your career, may determine the fate of millions, and possibly billions, of lives. No pressure.”
The crowd laughed, and Peyton smiled as the video ended.
Desmond considered Peyton’s words as he washed the hair dye down the sink and applied bronzer to his face, neck, and ears, making his complexion turn
darker. How did she fit with his situation?
He needed to talk to Peyton again. She might hold a clue he had missed. It was a risk, but he thought it was one worth taking.
He opened the Google Voice app and called her number in Atlanta.
After three rings, her voicemail picked up. He decided to leave a message.
“Hi. It’s Desmond. I called earlier. Sorry if I alarmed you. I’d very much like to speak with you, Peyton. Give me a call.” He left his number, and wondered if she would call.
Once the bronzer dried, Desmond again left the small flat. He needed cash for tomorrow. At an electronics store, he purchased two iPads with his Visa prepaid cards, then sold them at a pawn shop. The money solved his immediate cash problems, and gave him the funds he needed to execute his plan for the meeting.
At a sporting goods store, he acquired five items he would need in case things went wrong. The purchases might raise suspicion, especially since he had paid cash, but he intended to be out of Berlin before it became a problem.
Back at the flat, he collapsed on the Murphy bed. It had been a long day, and the next day might be even longer.
He bundled up under the covers and stared at the peeling plaster ceiling. The decrepit radiator rumbled to life, the old iron monster grunting and breathing hot air into the freezing flat. Its heat was no match for the chill that beat past the poorly sealed windows. Slowly, the cold filled the room, and no matter how many blankets Desmond wrapped himself in, he got colder.
To his surprise, the feeling of falling asleep in the cold brought to mind a memory. He saw himself trudging through the snow. The freezing powder was ankle deep. A small home sat in the distance. A wispy column of smoke rose from it, dissolving as it reached toward the full moon, a gray rope fraying in the sky. The snow fell faster with each step, whiting out the column of smoke and the cabin below.
Soon the snow was knee deep, slowing him almost to a halt. His legs burned with exhaustion as he lifted them, planted them, and pushed forward. His lungs ached from the cold. He just wanted to lie down and rest. But he resisted. He knew it would be his end. He had to keep going. Tears welled in his eyes, oozed onto his cheeks, and froze there. He carried something in his hands. It was heavy and cold, but he dared not drop it. His life depended on it.