“No. All I remember is that the guy didn’t have AIDS. I was worried about that, so I looked up his diagnosis.”
“What was it?”
“Didn’t say. But it always says AIDS if it is AIDS. I don’t have AIDS, do I?”
“No, Alan, you don’t have AIDS,” said Marissa.
“Thank God,” said Alan. “For a moment there, I was scared.”
Marissa went out to find Dr. Navarre, but he was occupied with a cardiac arrest that had just been brought in by ambulance. Marissa asked the nurse to tell him that she was going back to the fifth floor. Returning to the elevators, Marissa began organizing her thoughts to call Dr. Dubchek.
“Excuse me.”
Marissa felt a tap on her arm and turned to face a stocky man with a beard and wire-rimmed glasses. “Are you Dr. Blumenthal from the CDC?” asked the man.
Nonplussed at being recognized, Marissa nodded. The man stood blocking her entrance to the elevator. “I’m Clarence Hems, with the L.A. Times. My wife works the night shift up in the medical ICU. She told me that you were here to see Dr. Richter. What is it the man has?”
“At this point, no one knows,” said Marissa.
“Is it serious?”
“I imagine your wife can answer that as well as I.”
“She says the man is dying and that there are six other similar cases, including a secretary from medical records. Sounds to me like the beginnings of an epidemic.”
“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 longer. I’m in a hurry.” Dodging the insistent Mr. Hems, 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 di,” 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.