“I’m not sure that ‘epidemic’ is the right word. There does seem to be one more case today, but that’s the only one for two days. I hope it will be the last, but no one knows.”
“Sounds scary,” said the reporter.
“I agree,” said Marissa. “But I can’t talk any longer. I’m in a hurry.”
Dodging the insistent Mr. Herns, Marissa boarded the next elevator and returned to the cubicle behind the fifth-floor nurses’ station and put through a collect call to Dr. Dubchek. It was quarter-to-three in Atlanta, and she got Dubchek immediately.
“So, how’s your first field assignment?” he asked.
“It’s a bit overwhelming,” said Marissa. Then, as succinctly as she could, she described the seven cases she’d seen, admitting that she had not learned anything that the Richter Clinic doctors didn’t already know.
“That shouldn’t bother you,” said Dubchek. “You have to keep in mind that an epidemiologist looks at data differently than a clinician, so the same data can mean different things. The clinician is looking at each case in particular, whereas you are looking at the whole picture. Tell me about the illness.”
Marissa described the clinical syndrome, referring frequently to her note pad. She sensed that Dubchek was particularly interested in the fact that two of the patients had vomited blood, that another had passed bloody diarrhea and that three had conjunctival hemorrhages in their eyes. When Marissa said that Dr. Richter had been to an ophthalmology meeting in Africa, Dubchek exclaimed, “My God, do you know what you are describing?”
“Not exactly,” said Marissa. It was an old medical-school ploy: try to stay on neutral ground rather than make a fool of yourself.
“Viral hemorrhagic fever,” said Dubchek, “… and if it came from Africa, it would be Lassa Fever. Unless it was Marburg or Ebola. Jesus Christ!”
“But Richter’s visit was over six weeks ago.”
“Darn,” said Dubchek, almost angrily. “The longest incubation period for that kind of fulminating illness is about two weeks. Even for quarantine purposes, twenty days is considered adequate.”
“The doctor was also bitten by a monkey two days before he became ill,” offered Marissa.
“And that’s too short an incubation period. It should be five or six days. Where’s the monkey now?”
“Quarantined,” said Marissa.
“Good. Don’t let anything happen to that animal, particularly if it dies. We’ve got to test it for virus. If the animal is involved, we have to consider the Marburg virus. In any case, the illness certainly sounds like a viral hemorrhagic fever, and until proven otherwise, we’d better consider it as such. We’ve worried about something like this happening for some time; the problem is that there’s no vaccine and no treatment.”
“What about the mortality rate?” asked Marissa.
“High. Tell me, does Dr. Richter have a skin rash?”
Marissa couldn’t remember. “I’ll check.”
“The first thing I want you to do is draw bloods, obtain urine samples, and do throat swabs for viral culture on all seven cases, and have them rushed to the CDC. Use Delta’s small-package service. That will be the fastest way. I want you personally to draw the blood, and for Christ’s sake be careful. From the monkey, too, if you can. Pack the samples in dry ice before shipping them.”
“I’ve just seen what might be another case,” said Marissa. “One of the clinic’s lab techs.”
“Include him, too. It sounds increasingly serious. Make sure that all the patients are totally isolated with complete barrier nursing. And tell whoever is in charge not to do any lab work until I get there.”
“I have,” said Marissa. “You’re coming yourself?”
“You bet I am,” said Dubchek. “This could be a national emergency. But it is going to take some time to prepare the Vickers Mobile Lab. Meanwhile, start setting up a quarantine for contacts, and try to get in touch with the people who sponsored that eye meeting in Africa and see if any of the other doctors who went are ill. And one other thing: don’t say anything to the press. With all the publicity about AIDS, I don’t think the public could deal with the threat of another fatal viral disease. There could be widespread panic. And Marissa, I want you to wear full protective clothing, including goggles, when you see the patients. The pathology department should have them if no one else does. I’ll be there as soon as possible.”
Hanging up, Marissa experienced a rush of anxiety. She wondered if she’d already exposed herself to the virus. Then she worried about having already talked to Clarence Herns from the L.A.
After putting in a call for Dr. Navarre, Marissa had one of the nurses help her get the materials ready to draw blood from the patients. She needed vacu-containers with anticoagulants, plastic bags, and sodium hypochlorite to decontaminate the outside of the bags. She also needed urine containers and throat swabs. Then she phoned the micro lab and asked to have containers of viral transport media sent up, along with shipment containers and dry ice. When Dr. Navarre called, she related what Dubchek had said about complete barrier nursing and about no lab tests until he’d arrived with a special facility. She also mentioned that they had better get together to talk about systematically quarantining all contacts. Dr. Navarre agreed, shocked to hear that Dubchek thought they might be dealing with viral hemorrhagic fever.
Following Dubchek’s advice, Marissa got goggles from pathology. She’d never thought about catching an illness through her eyes, but she was aware that their surface was a mucous membrane and was obviously as available to viral assault as her nasal mucosa. When she was fully attired in hood, goggles, mask, gown, gloves and booties, she went to Dr. Richter’s cubicle to begin her sampling.
Before she started, she examined him for a skin rash. His arms were clear, but he did have a curious red area about the size of a quarter on his right thigh. Lifting up his hospital gown, Marissa noted a fine, but definite, maculopapular eruption covering most of his trunk. She was impressed that Dubchek had anticipated it.
She drew the blood first, then filled the urine container from the catheter bag. After each was sealed, she washed its exterior with sodium hypochlorite, then put it in a second bag. After the exterior of the second bag was washed in the disinfectant, she allowed it to be removed from the room.
Disposing of the hood, mask, gown, gloves and booties, and then donning new ones, Marissa went on to the next patient, the medical secretary, whose name was Helen Townsend. Marissa repeated the same procedures she’d done on Dr. Richter, including looking for skin eruptions. Helen also had a faint rash on her trunk, but no red circle on her thigh or elsewhere. She seemed less ill than Richter, but none of the patients appeared well enough to question Marissa much as she went about her sampling. Only Alan Moyers could muster the strength to offer some objections. At first he refused to allow Marissa to draw blood unless she told him what his diagnosis was. He was terrified. When Marissa told him the truth, that she did not know what he had and that that was why she needed the samples, he finally gave in.
As for the monkey, Marissa didn’t even attempt to get a blood sample. The animal keeper was out for the day, and she had no intention of trying to handle the animal alone. The monkey looked healthy enough, but was not friendly. He threw feces at Marissa through the mesh of his cage.
Once Marissa completed the packing, making certain that all the screw caps were tightly in place so that carbon dioxide from the dry ice could not penetrate the samples, she personally rode out to the airport and sent the boxes on their way to Atlanta. Luckily she got them on a convenient nonstop.
Back at the Richter Clinic, Marissa made a detour to the small clinic library. There were a few standard texts there that included sections on viral diseases. She quickly scanned the entries for Lassa Fever, Marburg and Ebola virus. Then she understood Dubchek’s excited reaction on the telephone. These were the most deadly viruses known to man.
Arriving back on the fifth floor, Marissa found that all eight patients had been isolated in a separate wing. She also found that the clinic outpatient records she’d ordered had arrived. After putting in a call for Dr. Navarre, Marissa sat down and began to study the charts.
The first belonged to Harold Stevens, the real estate broker. She started from the back and immediately discovered that the last outpatient entry was a visit to Dr. Richter: Harold Stevens had chronic open-angle glaucoma and saw Dr. Richter on a regular basis. His last checkup had been on January 15, four days before he was admitted to the hospital.
With a sense of growing certainty Marissa looked at the last entry on each chart. There it was. Each patient had seen Dr. Richter on either the fifteenth or the sixteenth of January. All except Helen Townsend, the secretary from medical records, and Alan, the lab tech. The last entry in Ms. Townsend’s outpatient file recorded a visit to an
