salads,” she told Marissa.
Marissa wondered if they should test the whole cafeteria staff for Ebola antibodies. Although Ralph had been joking when he’d suggested an “Ebola Mary,” perhaps it was possible, although it had not been the case in Africa.
“Would you like to see our facility?” asked Miss Beronson, trying to be helpful.
For the next thirty minutes Marissa was given a grand tour of the cafeteria, including both the kitchen and the dining area. In the kitchen, she saw the walk-in cooler, the food preparation area and the huge gas ranges. In the dining area, she walked along the steam table, peering into silverware bins and lifting the covers of the salad- dressing cannisters.
“Would you like to see the stock rooms?” Miss Beronson asked, when they were done.
Marissa declined, deciding it was time to start checking to see what the initial Ebola patients had chosen from the menu in her purse.
Marissa rocked back in the swivel chair and rubbed her eyes. It was 11:00 A.M. of her second day in Phoenix, and she’d only managed four hours of sleep the previous night. She’d been assigned one of the examination alcoves in the OB-GYN clinic, and every time someone went by, she’d been awakened.
Behind her, Marissa heard the door open. She turned and saw Dubchek holding up the front page of a local newspaper. The headline read: CDC BELIEVES HIDDEN SOURCE OF EBOLA IN U.S.A. Looking at his expression, Marissa guessed that he was, as usual, angry.
“I told you not to talk to the press.”
“I haven’t.”
Dubchek smacked the paper. “It says right here that Dr. Blumenthal of the CDC said that there is a reservoir of Ebola in the U.S.A., and that the outbreak in Phoenix was spread by either contaminated food or water. Marissa, I don’t mind telling you that you are in a lot of trouble!”
Marissa took the paper and read the article quickly. It was true that her name was mentioned, but only at second hand. The source of the information was a Bill Freeman, one of the doctors who’d helped take patient histories. She pointed this fact out to Dubchek.
“Whether you talk directly to the press, or to an intermediary who talks to the press, is immaterial. The effect is the same. It suggests that the CDC supports your opinions, which is not the case. We have no evidence of a food-related problem, and the last thing we want to do is cause mass hysteria.”
Marissa bit her lower lip. It seemed that every time the man spoke to her, it was to find fault. If only she’d been able to handle the episode in the hotel room in L.A. in a more diplomatic way, perhaps he wouldn’t be so angry. After all, what did he expect—that she wouldn’t talk to anyone? Any team effort meant communication.
Controlling her temper, Marissa handed Dubchek a paper. “I think you should take a look at this.”
“What is it?” he asked irritably.
“It’s the result of a second survey of the initially infected patients. At least those who were able to respond. You’ll notice that one fact jumps out. Except for two people who couldn’t remember, all the patients had eaten custard in the hospital cafeteria four days ago. You’ll remember that in my first survey, lunch in the cafeteria on that day was the only point of commonality. You’ll also see that a group of twenty-one people who ate in the cafeteria on the same day but did not eat the custard remained healthy.”
Dubchek put the paper down on the counter top. “This is a wonderful exercise for you, but you are forgetting one important fact: Ebola is not a food-borne disease.”
“I know that,” said Marissa. “But you cannot ignore the fact that this outbreak started with an avalanche of cases, then slowed to a trickle with isolation.”
Dubchek took a deep breath. “Listen,” he said condescendingly, “Dr. Layne has confirmed your finding that one of the initial patients had been to the San Diego conference with Richter and Zabriski. That fact forms the basis of the official position: Richter brought the virus back from its endemic habitat in Africa and spread it to other doctors in San Diego, including the unfortunate ophthalmologist here at the Medica Hospital.”
“But that position ignores the known incubation period for hemorrhagic fever.”
“I know there are problems,” admitted Dubchek tiredly, “but at the moment that’s our official position. I don’t mind you following up the food-borne possibility, but for God’s sake stop talking about it. Remember that you are here in an official capacity. I don’t want you conveying your personal opinions to anyone, particularly the press. Understood?”
Marissa nodded.
“And there are a few things I’d like you to do,” continued Dubchek. “I’d like you to contact the Health Commissioner’s Office and ask that they impound the remains of some of the victims. We’ll want some gross specimens to be frozen and sent back to Atlanta.”
Marissa nodded again. Dubchek started through the door, then hesitated. Looking back he said more kindly, “You might be interested to know that Tad has started to compare the Ebola from the L.A., St. Louis and Phoenix outbreaks. His preliminary work suggests that they are all the same strain. That does support the opinion that it is really one related outbreak.” He gave Marissa a brief, self-satisfied expression, then left.
Marissa closed her eyes and thought about what she could do. Unfortunately, no custard had been left over from the fatal lunch. That would have made things too easy. Instead, she decided to draw blood on all the food staff to check for Ebola antibodies. She also decided to send samples of the custard ingredients to Tad to check for viral contamination. Yet something told her that even if the custard were involved she wasn’t going to learn anything from the ingredients. The virus was known to be extremely sensitive to heat, so it could only have been introduced into the custard after it had cooled. But how could that be? Marissa stared at her stacks of papers. The missing clue had to be there. If she’d only had a bit more experience, perhaps she’d be able to see it.
8
IT WAS NEARLY A month later, and Marissa was finally back in Atlanta in her little office at the CDC. The epidemic in Phoenix had finally been contained, and she, Dubchek and the other CDC doctors in the hospital had been allowed to leave, still without any final answers as to what caused the outbreak or whether it could be prevented from reoccurring.
As the outbreak had wound down, Marissa had become eager to get home and back to work at the Center. Yet now that she was there, she was not happy. With tear-filled eyes, due to a mixture of discouragement and anger, she was staring down at the memo which began, “I regret to inform you…” Once again Dubchek had turned down her proposal to work with Ebola in the maximum containment lab, despite her continued efforts to develop laboratory skills in relation to handling viruses and tissue cultures. This time she felt truly discouraged. She still felt that the outbreak in Phoenix had been connected to the custard dessert, and she desperately wanted to vindicate her position by utilizing animal systems. She thought that if she could understand the transmission of the virus she might develop an insight into where it came from in the first place.
Marissa glanced at the large sheets of paper that traced the transmission of the Ebola virus from one generation to another in all three U.S. outbreaks. She had also constructed less complete but similar diagrams concerning the transmission of Ebola in the first two outbreaks in 1976. Both had occurred almost simultaneously, one in Yambuku, Zaire, and the other in Nzara, Sudan. She’d gotten the material from raw data stored in the CDC archives.
One thing that interested her particularly about the African experience was that a reservoir had never been found. Even the discovery that the virus causing Lassa Hemorrhagic Fever resided in a particular species of domestic mouse had not helped in locating Ebola’s reservoir. Mosquitoes, bedbugs, monkeys, mice, rats—all sorts of creatures were suspected and ultimately ruled out. It was a mystery in Africa just as it was in the United States.
Marissa tossed her pencil onto her desk with a sense of frustration. She had not been surprised by Dubchek’s letter, especially since he had progressively distanced her from his work in Phoenix and had sent her back to Atlanta the day the quarantine had been lifted. He seemed determined to maintain the position that the Ebola virus had been brought back from Africa by Dr. Richter, who had then passed it on to his fellow ophthalmologists at the eyelid
