“What kind of damage?” again she pretended to ask Nathan Stein, presenting her next sheet, simple but disturbing. “The protein degrades the epithelial cells, causing us to lose water and salts. But does it stop there? I am afraid not. It damages our blood vessels as well. The result? Bleeding. A very great deal of bleeding.”
She cast her glance around the room, grappling every eye to her own, preparing them for the capper:
“Hemorrhaging!” she declared, showing the sheet with the terrible word leaping off the page.
The next sheet depicted children at play-elegant, inventive, stick-figures of children.
“Those in the most danger are children. Why? They are often too small to fight the effects of blood loss and loss of bodily fluids. And what else may happen to them?”
Dr. Roy knew they were now on terrain where Nathan Stein was likeliest to rebel. They’d arrived at the section of her report entitled “Consequential Developments.” She introduced a more somber note to her voice.
“In some cases another syndrome may also be involved. It’s called hemolytic uremic syndrome, or HUS.” And there they were, all three letters: large, red, ornately inscribed. HUS
“HUS is characterized by kidney failure and loss of red blood cells, and is most dangerous to children. Perhaps 5 to 10 percent of the littlest ones will progress to this stage of disease. In the most severe of these cases, they will suffer permanent kidney damage.”
Now came two more stick figures, one in a bed, one stooping over a walking cane.
“The presence of the E. coli we are concerned with also presents potential for traumatic events among the elderly and people with chronic debilitating disease. For older people who suffer with respiratory or heart disease, or one of many conditions weakening their immune systems, to become infected with E. coli 0157: H7 is often deadly.”
She paused. The sudden unease in the room was positively physical.
“Deadly?” asked Louise Hollingsworth in a hushed, and surprisingly but distinctly disgusted, voice. “ How deadly? I don’t mean how do they die; I mean how many of them die.”
The next few flip charts presented the numbers.
“The latest available data from the Centers for Disease Control show seventy-three thousand cases of this kind of E. coli contamination for the latest year studied.”
Dr. Roy became brisk, even cheerful again, referring her group to the flip chart pages, and to the tables at the end of her report.
“The hospitalization rate for cases with extreme complications, meaning a progression to HUS, is a jot less than three tenths of one percent. Very few developed HUS. Among those who did, however, 28 percent died. That means the annual total of deaths attributed to O157: H7 was sixty-one. For all patients progressing to HUS, considering all causes, the death rate is between 3 and 5 percent. Among the elderly,” Dr. Roy said, “it will kill about half.”
“Half?” Stein cried out with startling force. “You mean half the old people getting E. coli are going to die?”
“No,” Dr. Roy told him, unruffled, quickly taking in the others. Pitts looked grave, but by no means threatened. The morbid cast to Louise’s brown eyes had deepened, and perceptibly. Maloney kept his focus on Stein, reacting only marginally to the unhappy news in the air.
She thought she’d made the figures clear. Perhaps they were misunderstood. Most likely, Mr. Stein had jangled their nerves and their brains. She wanted to say, “Now, everyone, take a deep breath.”
Instead, she raised her small right hand in calming benediction. “Those estimates are only for the demographic group generally referred to as elderly and infirm,” she explained, as though it were truly excellent news. “And it only includes those within that group who contact the E. coli, and then become ill and progress to hemolytic uremic syndrome, or HUS.”
She attempted a reassuring smile.
“And why is that again?” asked Wesley Pitts.
“Excellent question, Mr. Pitts.” She was handing out bon-bons to everyone now. “Contact with E. coli 0157: H7 is most often only mildly harmful. However, ingestion of it through a ground beef product introduces the bacteria to the digestive system. It may subsequently leave the digestive system and enter the bloodstream, where it may break down red blood cells with its SLT or Vero toxin. After that, the damaged cells lodge in the kidney, causing kidney failure.”
“Can you tell us,” asked Pitts, “how you assess the risk mathematically?”
She was off the flip charts now.
“If your meat was contaminated, it would be about one death for every twelve hundred people hospitalized. I said there were about seventy-three thousand people hospitalized yearly with E. coli symptoms. But that figure reflects 150 million cases of food poisoning. Maybe more. Many get sick from agents less harmful than E. coli. Among those exposed to E. coli, we’re talking only about confirmed cases with hospital admission. Many others fall ill but never go to the hospital. Even when they do, many are undoubtedly misdiagnosed. Clinical medicine is often hit or miss. The heart stops in everyone who dies, but not everyone who dies does so from heart failure.”
“So, it’s not too bad,” said Nathan Stein hopefully.
“As I understand it,” said Louise Hollingsworth, “there is some potential for a bad outcome, but the numbers are actually quite favorable.”
Dr. Roy nodded. “In my opinion, the science indicates that it would take many thousands of people with food poisoning to result in a single death.”
“I know it’s in your report,” Tom said. “Tell us again how you test for E. coli.”
“In order to do that, one must be able to make a definitive identification. For that, one must conduct a stool test using the sorbitol-MacConkey agar. This is a substance resembling gelatin, in which the test may be performed. Without such testing no positive finding for the presence of E. coli bacteria can be asserted.”
“Does that mean,” asked Maloney, “that in the absence of such a test, any claim that E. coli was present would have no legal validity?”
She smiled the smile that she always smiled when declining to render legal advice. “I am not a lawyer, Mr. Maloney. What I can say is that no scientific credibility would attach to such a claim without the SMAC test. I don’t believe a trained medical professional, Ph. D. or MD, would testify to the presence of E. coli without testing-proper testing-as I have described it.”
“Tell me,” said Maloney, “how readily available is the sorbitol-MacConkey agar in small-town hospitals in the southeastern part of the country?” Maloney had certainly read the report, quite likely more than once.
“It is readily available,” Dr. Roy replied. “I would anticipate no difficulty in testing for E. coli in even the smallest of cities. Samples could be sent to any large hospital in the region. Any doctor who suspected E. coli poisoning could get immediate help from Atlanta or Birmingham or Charlotte, for example, or any full-service general hospital.”
“We need a month,” said Stein.
“I’d like a lot longer,” added Wesley Pitts.
“Let me ask you this,” said Tom, “in your expert opinion, what would be likely to happen if a substantial supply of E. coli -infected meat was widely distributed in the southeastern states in the next week?”
She should, of course, have seen this coming.
It suddenly dawned on her that she had not been involved in a remotely normal corporate consultation. She was not, and had not been, merely an academic fan-dancer doing her stuff, as she had done so often, for corporate mediocrities whose breadth of mind encompassed little more than expensive lunches and modes of theft.
Whatever this was, the brilliant Dr. Ganga Roy felt entirely out of her depth. She was now almost certainly being asked about real people dying.
She rallied, but not without effort, not without some of the mischief deserting her spirited manner. “The symptoms of this type of food poisoning caused by E. coli O157: H7 usually begin appearing in two to four days. Serious complications within a week; deaths thereafter.”
She felt a little lightheaded now, but plucked up the courage to ask, “What do you mean by ‘widely distributed?’”
“Hard to say, exactly,” said Maloney. “These people make ground beef for a variety of brand names. Most of them house names, named for whatever chain it’s being sold in. It’s hard to keep track of everything.”
“Not entirely,” said Louise Hollingsworth, her voice more robust than before. “Competing supermarkets in the same city sell the same product under their own names. Shoppers don’t know where it comes from. But the
