Outbreak by Robin Cook. Part one

Hefting Fields’ ponderous Virology textbook, she made her way over to the reserve shelf, stretching her cramped leg muscles en route. She’d run that morning, but had only put in two miles, not her usual four.

“Need help getting that monster on the shelf?” teased Mrs. Campbell, the motherly librarian, buttoning her omnipresent gray cardigan. It was none too warm in the library.

As in all good humor, there was some basis in truth for Mrs. Campbell’s whispered comment. The virology textbook weighed ten

pounds-one-tenth as much as Marissa’s hundred-pound frame. She was only five feet tall, although when people asked, she said she was five-two, though that was only in heels. To return the book, she had to swing it back and then almost toss it into place.

“The kind of help I need with this book,” said Marissa, “is to get the contents into my brain.”

Mrs. Campbell laughed in her subdued fashion. She was a warm, friendly person, like most everyone at CDC. As far as Marissa was concerned, the organization had more the feeling of an academic institution than a federal agency, which it had officially become in 1973. There was a pervading atmosphere of dedication and commitment. Although the secretaries and maintenance personnel left at four-thirty, the professional staff invariably stayed on, often working into the wee hours of the morning. People believed in what they were doing.

Marissa walked out of the library, which was hopelessly inadequate in terms of space. Half the Center’s books and periodicals were stored haphazardly in rooms all over the complex. In that sense the CDC was very much a federally regulated health agency, forced to scrounge for funding in an atmosphere of budget cutting. Marissa noted it also looked like a federal agency. The hall was painted a drab, institutional green, and the floor was covered in a gray vinyl that had been worn thin down the middle. By the elevator was the inevitable photograph of a smiling Ronald Reagan. Just beneath the picture someone had irreverently tacked up an index card that said: “If you don’t like this year’s appropriation, just wait until next year!”

Marissa took the stairs up one flight. Her office-it was generous to call it that; it was more cubbyhole than office-was on the floor above the library. It was a windowless storage area that might have been a broom closet at one time. The walls were painted cinder block, and there was just enough room for a metal desk, file cabinet, light and swivel chair. But she was lucky to have it. Competition for space at the Center was intense.

Yet despite the handicaps, Marissa was well aware that the CDC worked. It had delivered phenomenal medical service over the years, not only in the U.S., but in foreign countries as well. She remembered vividly how the Center had solved the Legionnaires Disease mystery a number of years back. There had been hundreds of such cases since the organization had been started in 1942 as the Office of Malaria Control to wipe out that disease in the American South. In 1946 it had been renamed the Communicable Disease Center, with separate labs set up for bacteria, fungi, parasites, viruses

and rickettsiae. The following year a lab was added for zoonoses, diseases that are animal ailments but that can be transmitted to man, like plague, rabies and anthrax. In 1970 the organization was renamed again, this time the Centers for Disease Control.

As Marissa arranged some articles in her government-issue briefcase, she thought about the past successes of the CDC, knowing that its history had been one of the prime reasons for her considering coming to the Center. After completing a pediatric residency in Boston, she had applied and had been accepted into the Epidemiology Intelligence Service (EIS) for a two-year hitch as an Epidemiology Intelligence Service Officer. It was like being a medical detective. Only three and a half weeks previously, just before Christmas, she’d completed her introductory course, which supposedly trained her for her new role. The course was in public-health administration, biostatistics and epidemiology-the study and control of health and disease in a given population.

A wry smile appeared on Marissa’s face as she pulled on her dark blue overcoat. She’d taken the introductory course, all right, but as had happened so often in her medical training, she felt totally unequipped to handle a real emergency. It was going to be an enormous leap from the classroom to the field if and when she was sent out on an assignment. Knowing how to relate to cases of a specific disease in a coherent narrative that would reveal cause, transmission and host factors was a far cry from deciding how to control a real outbreak involving real people and a real disease. Actually, it wasn’t a question of “if,” it was only a question of “when.”

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