Lost Immunity by Daniel Kalla (best free ebook reader txt) 📗

Angela used to be an open book. But that changed with her diagnosis. All Lisa knows about her friend’s ovarian cancer is that it must be too far advanced for a surgical cure, since her treatment has consisted only of chemotherapy. Angela has never discussed her prognosis. When she asked Lisa to assume the role of chief public-health officer, she only said, “Don’t worry. I wouldn’t come back to this dead-end job, even if I do beat this thing.”

Making a mental note to call Angela after the meeting, Lisa taps the remote and launches the first slide on the screens on either side of the room. As usual, it shows the updated survey of known cases. “Today is officially the sixth day of this outbreak,” she says. “And as of this morning, we have eleven deaths among the twenty-four confirmed meningococcal infections. Seven of the victims have recovered enough to be safely discharged home. In the past twenty-four hours, we’ve had four new cases and one more death.”

“Which is better than any other day so far,” Benning, the mouse-like woman from the department of health, comments.

“But this isn’t like the flu or even COVID-19,” Tyra points out.

“What does that mean?” Benning asks.

“With highly contagious outbreaks like those, you expect to see a steady rise in the trend of new infections,” Lisa says. “The so-called epi curve, when you plot it out on a graph. In other words, each day brings more new sufferers than the previous one. When the number of new cases decreases from one day to the next—even as the absolute number of infected continues to rise—you can assume the curve is flattening and the epidemic is coming under control.”

“Not true of meningococcus, though,” Tyra says.

“Sadly, not,” Lisa agrees. “Meningococcus tends to spread in patchy clusters. Days can pass between new cases. It’s not airborne, so it’s not nearly as contagious as COVID-19 or measles. But it can be carried by asymptomatic hosts: people who show no signs of illness but still act as reservoirs for the spread of new infection.”

“Which is just how our outbreak started,” Tyra says. “With Patient Zero, Alex Stephanopoulos. He brought it home from Iceland without ever falling ill himself.”

“You’ve confirmed that?” Alistair Moyes strokes his Lincolnesque beard with his thumb and forefinger.

“Yes. His nasal swabs were positive for meningococcus.” Lisa wonders again how many others are unwittingly carrying the deadly pathogen. “Moreover, there is no active disease in Iceland right now. This means Alex acquired it from another asymptomatic carrier. Icelandic Public Health is trying to track down and test everyone the family was in contact with.”

“It’s been five months since the last infection over there.” Tyra extends a hand in Benning’s direction. “You see? This is exactly why you can’t declare an outbreak over until a full year has passed between new cases.”

The color drains from Benning’s cheeks as she nods her understanding.

Lisa advances the slide, which shows a pie chart that, unlike at the last briefing, is now uniformly red. “We’ve reached all the attendees and staff at Camp Green now. And we’ve started every one of them and their closest contacts on prophylactic antibiotics. Unfortunately, now that we’ve seen two cases of secondary spread into the community, we know this measure isn’t going to be enough.”

“Like closing the barn door after the horses have already left,” Tyra says.

Lisa brings up the next slide, which shows an image of a syringe with a caption below from a review journal that reads: Trial shows strong immunogenicity for new meningococcal vaccine.

“There might be some good news on the vaccine front,” Lisa announces.

“What news?” asks the usually silent, balding city hall official who is watching via videoconference.

“Delaware Pharmaceuticals has developed a vaccine.” Lisa goes on to describe Neissovax, the promise it has shown against the Icelandic strain of meningococcus, and the company’s agreement to redirect the supply earmarked for Reykjavík to the Pacific Northwest instead.

Moyes squints at her. “You intend to inoculate fifty thousand Seattleites with an experimental drug? One that has never been released on any scale beyond a few early-phase-three trials?”

Moyes’s skepticism is annoyingly contagious. “Neissovax is the only vaccine shown to be effective for this outbreak,” Lisa says with less confidence than she would’ve liked.

“Shown? That’s debatable. But even so, why not just vaccinate the highest-risk group? Those in closest proximity—in terms of age and geography—to the known victims.”

“The company wouldn’t agree to that.”

Moyes offers her a tight-lipped smile. “It’s up to the company, is it?”

“They’re doing this on a voluntary basis. On compassionate grounds.” Lisa goes on to explain the concerns Nathan raised about vaccinating only the highest-risk subset. “Perhaps, Alistair, if the CDC were to get involved…”

“We can’t force a company to release its product any more than you can,” he says. “However, at the height of the Ebola crisis, the CDC and WHO both had access to an experimental vaccine. But even then, when it was raging in Africa and over eighty percent of victims were dying, including health-care workers—we still refused to release the vaccine because it had not undergone rigorous enough clinical testing.”

Lisa meets the CDC physician’s glare. “You can’t compare the two situations.”

“Why not?”

“Because that Ebola vaccine hadn’t completed any phase-three trials. Neissovax has. And the only two Ebola deaths on US soil were both cases imported from Africa.”

“You’re suggesting that if Ebola was spreading among Americans, the CDC would have released the vaccine?”

“You know you would have, Alistair.” Benning speaks up, surprising Lisa with her forcefulness. “That’s how government works.”

“I don’t happen to agree,” Moyes says, and turns back to Lisa. “Regardless, vaccinating this many people will pose huge logistical challenges.”

“Thanks for that insight.” Lisa immediately regrets her sarcastic tone, but Moyes shows no obvious sign of offense. “Our team plans to set up and run vaccination clinics across the city in schools, community centers, and so on.”

“Who will you target for vaccination?”

“The highest-risk demographics. Teenagers, teachers, health-care workers, and so on.”

“And how do you intend to track any adverse events or unexpected