Stanton was the only one in a biohazard suit, and everyone eyed him, knowing what possibility it suggested.
The highest-ranking doctors sat around a table in the middle of the room. Deputy CDC Director Cavanagh ran the meeting. Her long white hair was pulled back, and her blue eyes flashed brightly from behind her eye shield. Despite more than thirty years of service to CDC, the skin on her forehead was still smooth. Stanton sometimes imagined she’d simply ordered it not to wrinkle.
“We’ve got two hundred thousand more eye shields coming by morning,” Cavanagh said. Stanton squeezed into the seat next to her, an almost comical challenge in his bulky suit. “Trucked and flown in from all over.”
“And we can get another fifty thousand by the day after tomorrow,” someone behind them chimed in.
“We need four million,” Stanton said into the small microphone inside his helmet, wasting no time.
“Well, two hundred fifty thousand are available,” Cavanagh said. “That’s going to have to be enough. First priority will be to supply health-care workers, obviously. Next will be anyone with a connection to any of the infected, and the rest will go to the distribution centers and get doled out first-come-first-served. The last thing we need is to create a panic and cause people to leave en masse. Or this thing could burn across the country.”
Stanton piped up again. “We have to consider a quarantine.”
“What do you think we’re doing here?” Katherine Leeds from the viral division said. Leeds was a tiny woman, but she was tough. Over the years, she and Stanton had clashed many times. “We have a quarantine, and we’re coordinating them in other hospitals too.”
“I’m not talking about the hospitals,” Stanton said. He looked at the group. “I’m talking about the entire city.”
There was a low murmur throughout the room.
“Do you have any idea what ten million people will do when they find out the government is telling them they can’t leave?” Leeds said. “There’s a reason it’s never been done before.”
“There could be a thousand cases tomorrow,” Stanton said, unflinching. “And five thousand the day after. People’ll start to flee the city, and some will be sick. If we don’t stop the flow out of L.A., VFI will be in every city in the country by week’s end.”
“Even if it were feasible,” Leeds said, “it’s probably not constitutional.”
“We’re talking about a disease that spreads like a cold,” Stanton said, “but that’s as deadly as Ebola and that’s impossible to get rid of on fomites. It doesn’t die like a bacteria, and it can’t be destroyed like a virus.”
Whereas most pathogens were no longer contagious after twenty-four hours or less on “fomites”—hard and soft surfaces—prion could stay infectious indefinitely, and there was no known way to disinfect the surfaces. Earlier in the day, the same ELISA test with which Stanton and Davies found no prion at Havermore Farms yielded a very different result from the planes at LAX, Volcy’s hospital room, and Gutierrez’s house. Doorknobs, furniture, cockpit switches, seat cushions, and seat-belt buckles on the planes Zarrow had flown in the last week were all covered with prion.
“Every plane leaving L.A. could have passengers about to spread it around the world,” Stanton said.
“What about the highways out of town?” one of the other doctors said. “You want to shut those down too?”
Beneath the weight of Stanton’s suit, everyone in the room sounded far away. He had to imagine that his voice through the helmet didn’t exactly have a commanding effect. “We have to cut off the flow. We call in the California Guard and the army if we have to. I’m not saying it will be easy, but if we don’t act fast and decisively, we’ll pay the price.”
“There’ll be riots and hoarding and all the rest,” Leeds said. “It’ll be like Port-au-Prince in a couple of days.”
“We have to explain to people that it’s a precautionary measure and that they’ll be allowed to leave when we know how to stop the disease from spreading—”
“We need to be extremely careful with what we tell people,” Cavanagh cut in, “or there will be mass panic. It’s got huge liabilities, but so does allowing clusters of cases to develop in every city in America.”
She stood up. “Quarantine is a last option, but we certainly must consider it.”
The entire command center was stunned to hear her agree with Stanton. He was as surprised as anyone— despite the fact that she’d long been his champion at CDC, Cavanagh wasn’t usually one to consider drastic measures so quickly. She clearly understood what they were up against.
Once the meeting was adjourned, Stanton waited for her to finish giving division directors their assignments. He stood in front of a massive whiteboard depicting the spiderweb of connections between the patients showing symptoms, with Volcy in the middle. Volcy, Gutierrez, and Zarrow had red circles around their names, indicating they were deceased. The other hundred twenty-four names were arranged in four concentric rings.
Cavanagh approached him, and Stanton resumed his plea. “We have to do it
“I heard you, Gabe.”
“Good,” he said. “Then if that’s settled, how are we going to pursue a treatment? Once we have the quarantine in place, that must be our priority.”
They left the room and paused in the corridor outside the shuttered gift shop. Through the glass, Stanton could see boxes of candy bars, gum, and granola bars lining the counters and helium balloons losing gas.
“You’ve been looking for a cure for prion disease for how long?” Cavanagh asked.
“We’re making progress.”
“And how many patients have you cured?”
“People upstairs are dying, Emily.”
“Gabe, you’re already trying to sell me on the idea of quarantining a whole damn city. Don’t get sanctimonious on me too.”
“Containment’s essential,” he said. “But we need to explore possibilities for a cure, and we need the FDA to suspend its normal experimental protocols. We need to be able to test patients right away.”
“Are you talking about quinacrine and pentosan? You know the problems with them better than anyone.”
Quinacrine was an old treatment for prion disease that had now been shown to have little use. Pentosan was different: Derived from the wood of beech trees, it was once Stanton’s best hope. Unfortunately, the drug couldn’t pass the human blood–brain barrier, which protected neurons from dangerous chemicals. Stanton and his team had tried everything, from changing the drug’s physical structure to giving it through a shunt, but they had found no way to get pentosan into the brain without causing even more harm.
“Quinacrine won’t work,” Stanton said. “And the old problems with pentosan still exist.”
“So then what are we even talking about?” Cavanagh asked.
“We could start purifying antibodies.”
“After your lawsuit, Director Kanuth won’t hear anything about antibodies. Besides, you have absolutely no idea if they work
“So that’s it for the people already sick?” Stanton asked. “That’s what we tell them and their families?”
“Don’t lecture me,” Cavanagh said. “I was there at the beginning of HIV when we were trying to shut down the bathhouses. From the first moment, there were researchers screaming about diverting money and resources to explore a cure, which is how we ended up razor-thin on containment, and more were infected. And how long did it take before they found something that could treat HIV? Fifteen years.”
Stanton was silent.
“Our priority right now is containment,” Cavanagh continued.
“Yours is educating the public about how to prevent the spread and figuring out how to destroy the prions once they’re outside the body. Once the number of cases stabilizes, we’ll talk more about a cure. Understand?”
From the look on her face, Stanton sensed that for now there would be no convincing his boss otherwise. “I understand,” he said.
When she spoke again, Cavanagh’s voice was calm. “Anything else on your mind I need to know, Gabe?”
“We need to get a team down to Guatemala now. With Ebola and hantavirus, we had teams in Africa in days to cut it off. Even if we get a quarantine here, it’ll be no use if we don’t shut it down at the original source. It’ll keep spreading around the world from there.”
