He did so in such glowing terms that she felt progressively more and more uneasy. From his comments, it was as if she were synonymous with the CDC, and that all the triumphs of the CDC were her triumphs. Then, with a sweep of his long arm, he turned the microphone over to Marissa.
Never feeling comfortable talking to a large group under the best of circumstances, Marissa was totally nonplussed in the current situation. She had no idea of what was expected of her, much less of what to say. She took the few moments required to bend the microphone down to her level, to think.
Glancing out at the audience, Marissa noted that about half were wearing surgical masks. She also noticed that a large portion of the people, both men and women, were ethnic appearing, with distinctive features and coloring. There was also a wide range of ages, making Marissa realize that what Mr. Davis meant by staff was anybody working for the hospital, not just physicians. They were all watching her expectantly, and she wished she had more confidence in her ability to affect what was happening at the hospital.
“The first thing we will do is ascertain the diagnosis,” began Marissa in a hesitant voice several octaves above her normal pitch. As she continued speaking, not sure of which direction she would go, her voice became more normal. She introduced herself in reasonable terms, explaining her real function at the CDC. She also tried to assure the audience, even though she wasn’t sure herself, that the outbreak would be controlled by strict isolation of the patients, complete barrier nursing, and reasonable quarantine procedures.
“Will we all get sick?” shouted a woman from the back of the room. A murmur rippled through the audience. This was their major concern.
“I have been involved in two recent outbreaks,” said Marissa, “and I have not been infected, though I’ve come into contact with patients who had.” She didn’t mention her own continuing fear. “We have determined that close personal contact is necessary to spread Ebola. Airborne spread is apparently not a factor.” Marissa noticed that a few of the people in the audience removed their masks. She glanced around at Dr. Weaver, who gave her an encouraging thumbs-up sign.
“Is it really necessary for us to remain within the hospital?” demanded a man in the third row. He was wearing a physician’s long white coat.
“For the time being,” said Marissa diplomatically. “The quarantine procedure that we followed in the previous outbreaks involved separating the contacts into primary and secondary groups.” Marissa went on to describe in detail what they had done in L.A. and St. Louis. She concluded by saying that no one who’d been quarantined had come down with the illness unless they had previously had direct, hands-on contact with someone already ill.
Marissa then fielded a series of questions about the initial symptoms and the clinical course of Ebola Hemorrhagic Fever. The latter either terrified the audience into silence or satisfied their curiosity—Marissa couldn’t decide which—but there were no further questions.
While Mr. Davis got up to talk to his staff, Dr. Weaver led Marissa out of the auditorium. As soon as they were in the narrow hallway, she told him that she wanted to see one of the initial cases before she called the CDC. Dr. Weaver said he’d assumed as much and offered to take her himself. En route he explained that they had placed all the cases on two floors of the hospital, moving out the other patients and isolating the ventilation system. He had every reason to believe they’d made it a self-contained area. He also explained that the staff employed to man the floors were all specifically trained by his people, that laboratory work had been restricted to what could be done in a hastily set up unit on one of the isolated floors and that everything used by the patients was being washed with sodium hypochlorite before being directly incinerated.
As for the quarantine situation, he told Marissa that mattresses had been brought in from the outside and the outpatient department had been turned into a huge dormitory, separating primary and secondary contacts. All food and water was also being brought in. It was at that point that Marissa learned that Dr. Weaver had been an EIS officer at the CDC six years previously.
“Why did you introduce me as the expert?” asked Marissa, remembering his embarrassing exaggerations. Obviously he knew as much as or more than she did about quarantine procedures.
“For effect,” admitted Dr. Weaver. “The hospital personnel needed something to believe in.”
Marissa grunted, upset at being misrepresented, but impressed with Dr. Weaver’s efficiency. Before entering the floor, they gowned. Then, before entering one of the rooms, they double gowned, adding hoods, goggles, masks, gloves and booties.
The patient Dr. Weaver brought Marissa to see was one of the clinic’s general surgeons. He was an Indian, originally from Bombay. All Marissa’s fears of exposure came back in a rush as she looked down at the patient. The man appeared moribund, even though he’d been sick for only twenty-four hours. The clinical picture mirrored the terminal phase of the cases in L.A. and St. Louis. There was high fever along with low blood pressure, and the typical skin rash with signs of hemorrhage from mucous membranes. Marissa knew the man would not last another twenty-four hours.
To save time, she drew her viral samples immediately, and Dr. Weaver arranged to have them properly packed and shipped overnight to Tad Schockley.
A glance at the man’s chart showed the history to be fairly sketchy, but with eighty-four admissions in less than six hours she could hardly have hoped for a textbook writeup. She saw no mention of foreign travel, monkeys, or contact with the L.A. or St. Louis outbreaks.
Leaving the floor, Marissa first requested access to a telephone, then said she wanted to have as many physician volunteers as she could get to help her interview the patients. If many patients were as sick as the Indian doctor, they would have to work quickly if they were going to get any information at all.
Marissa was given the phone in Mr. Davis’s office. It was already after eleven in Atlanta, and Marissa reached Dubchek immediately. The trouble was, he was irritated.
“Why didn’t you call me as soon as the aid request came in? I didn’t know you had gone until I got into my office.”
Marissa held her tongue. The truth was that she’d told the CDC operators that she should be called directly if a call came in suggestive of an Ebola outbreak. She assumed Dubchek could have done the same if he’d wanted to be called immediately, but she certainly wasn’t going to antagonize him further by pointing out the fact.
“Does it look like Ebola?”
“It does,” said Marissa, anticipating Dubchek’s reaction to her next bomb. “The chief difference is in number of those infected. This outbreak involves one hundred cases at this point.”
“I hope that you have instituted the proper isolation,” was Dubchek’s only reply.
Marissa felt cheated. She’d expected Dubchek to be overwhelmed. “Aren’t you surprised by the number of cases?” she asked.
“Ebola is a relatively unknown entity,” said Dubchek. “At this point, nothing would surprise me. I’m more concerned about containment; what about the isolation?”
“The isolation is fine,” said Marissa.
“Good,” said Dubchek. “The Vickers Lab is ready and we will be leaving within the hour. Make sure you have viral samples for Tad as soon as possible.”
Marissa found herself giving assurances to a dead phone. The bastard had hung up. She hadn’t even had a chance to warn him that the entire hospital was under quarantine??that if he entered, he’d not be allowed to leave. “It’ll serve him right,” she said aloud as she got up from the desk.
When she left the office, she discovered that Dr. Weaver had assembled eleven doctors to help take histories: five women and six men. All of them voiced the same motivation: as long as they had to be cooped up in the hospital, they might as well work.
Marissa sat down and explained what she needed: good histories on as many of the initial eighty-four cases as possible. She explained that in both the L.A. and the St. Louis incidents there had been an index case to which all other patients could be traced. Obviously, there in Phoenix it was different. With so many simultaneous cases there was the suggestion of a food- or waterborne disease.
“If it were waterborne, wouldn’t more people have been infected?” asked one of the women.
“If the entire hospital supply was involved,” said Marissa. “But perhaps a certain water fountain…” Her voice trailed off. “Ebola had never been a water- or food-borne infection,” she admitted. “It is all very mysterious, and it just underlines the need for complete histories to try to find some area of commonality. Were all the patients on the same shifts? Were they all in the same areas of the hospital? Did they all drink coffee from the same pot, eat the same food, come in contact with the same animal?”
Pushing back her chair, Marissa went to a blackboard and began outlining a sequence of questions that each