13 DECEMBER – 10 A.M.
‘No, no! Please God, no!’
Suzy had managed one last weak smile to her father, as her organs started shutting down. Peter Phillips’ anguished howls echoed around the Cedars Ward at the Patrick J. Brock Memorial Hospital. After the doctors had confirmed that she was dead, Peter Phillips sat for an hour, holding his daughter’s hand and stroking her long blonde hair, which framed her deathly pale face on the pillow. Eventually, Dr Conrad Jones and one of the nurses came back and opened the curtain on one side of the bed.
‘Peter, I’m so sorry, we tried everything.’
‘How the hell could this happen, Conrad?’
‘I’m sorry, Peter, I just can’t be sure yet. We threw everything at it. Nurse,’ he nodded a ‘go ahead’ to the nurse, who began removing the intravenous fluid line and the antibiotic line from the dead girl’s arms.
‘She got something really, really virulent, Peter. Very toxic. We got her straight on IV cephalosporin, but she just kept deteriorating. Her kidneys packed up. She had a septicaemic shock. I’ve never seen a ten-year-old who didn’t respond to treatment like this. We’ll have to wait for the autopsy to see what it was.’
Tears streamed down Peter Phillips’ crumpled face as he kissed his daughter on the forehead.
‘What now, Peter?’ asked Conrad Jones, putting a comforting arm around the doctor’s shoulders.
Peter Phillips shook his head slowly. ‘I don’t know, Conrad. Do I tell her mother? She’s on the eighth floor. And she’s not in great shape. And my son Jonathan’s in the paediatric unit. Jesus, are they going to be all right?’
After he had led the broken-hearted father from the ward, Dr Conrad Jones went back to the dead girl’s bed.
‘Thanks, nurse,’ he said as he helped her remove the heart monitors. ‘Ask the porters to take the girl to the mortuary. As quickly as possible. By the sound of it, we’ve got about fifty people waiting for the bed. Oh, excuse me,’ he said, as he stepped backwards through the curtains and onto the toe of a maintenance worker, who was fixing the curtains on the next bed.
*
CENTER FOR DISEASE CONTROL AND PREVENTION – 3 P.M.
‘Two point two billion!’
‘That’s what it says.’
‘Surely that’s gotta close them down?’
Chuck Taylor, head of the Department of Pollution Control, was reading aloud from a CNN.com newsflash on his laptop, as they waited for the meeting to start.
‘Drug giant Dupitol Pharma to pay record two point two billion dollar fine to resolve criminal and civil liability for fraudulent marketing of pharmaceuticals, the Justice Department announced today.’ He skimmed down the report. ‘Promoted drugs for use on certain ailments or at dosages that were not approved by the FDA.’
‘Jesus,’ said Jack Barrett from the Municipal Water Division.
‘Dupitol subsidiaries also pleaded guilty to a felony violation for misbranding their products with intent to defraud or mislead.’
Taylor kept reading from his screen. ‘Justice Department said Dupitol salespeople created sham requests from physicians, asking about unapproved uses of certain drugs. The information was then mailed to doctors. Dupitol also entertained doctors at luxury resorts as a way of encouraging them to prescribe its drugs.’
‘Stinks to high hell,’ said Barrett, shaking his head.
Taylor continued. ‘Justice Department said Dupitol provided kickbacks to healthcare providers to encourage them to prescribe several of their highest selling drugs. The settlement includes a provision for eight whistle-blowers at Dupitol Pharma who will share one hundred and twenty million dollars.’
‘But that fine! That’s gotta put them outta business.’
‘Doubt it, guys,’ said Bill Fulzer from the FDA, leaning across. ‘Two point two billion – that’s about two weeks’ revenue for Dupitol.’
Dr Kim Scholler interrupted by tapping her glass with her pen and the buzz of conversation died down.
‘Let’s get going, folks.’
She waited while everyone pulled in their chairs and topped up their coffee cups.
‘Thanks, everyone. Same team as yesterday, but I’d like to introduce you to two new faces. First, Professor Samuel Ghent. The professor is with the Infectious Diseases Society of New York.’ She nodded to the thin, greying man of about sixty, wearing a red and blue bowtie, in the chair alongside her.
‘Professor, briefly, can you tell us what you do?’
‘Sure, Kim, glad to be on the team. You may have heard about us before under the acronym IDSNY. We established in New York back in ninety-three. Basically, we’re a grouping of physicians, researchers, etc., who specialise in infectious diseases. We help with the response to any public health crisis and act as a conduit between the City’s Department of Health and ID specialists. In addition, we advise government on bio-terrorism threats.’
‘Thanks, professor, glad to have you along. Everyone, things are moving fast. Detectives,’ she addressed the opposite end of the table, ‘thanks for your quick response at MetLife Stadium, but it may have been a wild goose chase. We checked the food concessions equipment and everything’s clean. We haven’t found anything else suspicious out there either, and our systems are now alerting us to the fact that we also have large numbers of patients who visited Radio City, the Empire State Building, the Rockefeller Center, Ground Zero, you name it. So, unless we shut down the whole city . . .?’ She let the question hang in the air. No one responded. ‘Then we need to look somewhere else for clues.’
Kim nodded to the second new member of the team.
Charles Steelman was about forty, with curly brown hair and a white, open-neck shirt. He was sitting about midway down the table. He smiled and nodded to the various faces looking at him.
‘I decided to call Charles in as well because of certain developments,’ Kim said. ‘Dr Steelman is director of the Foodborne and Diarrhoeal Diseases Branch of the Center for Disease Control. Charles?’
‘Yes, hello everyone. The major development is that we now have multiple early reports back from the labs, based on stool and blood samples from the hospital patients. It’s pretty certain now – we’re dealing with a massive e-coli infection.’
His words were met with a few nods around the table, together with a few glazed expressions.
‘Please go on, Charles,’ prompted Kim.
‘Well, as you know, it’s a classic food poisoning bug. Unfortunately, it looks like we’re dealing with an Escherichia coli O157:h7 bacteria, which is right at the most virulent end of the scale. Our labs are continuing with what we call a DNA fingerprinting process, which will give us more information on exactly what we have, but that’s going to take another two to three days.’
Detectives Wyse and Cabrini, and the rest of the group around the table, were listening intently.
‘So, what are the implications of this e-coli bug?’ asked Chuck Taylor from Pollution Control.
‘The good news is that it’s treatable,’ replied Dr Scholler, ‘even though it’s at the tougher end of the spectrum. The bad news is that e-coli has about the longest incubation period of all the foodborne bacteria. E-coli toxins are produced in the large intestine, rather than higher up, so the symptoms are slower to appear. Symptoms can develop after a couple of days, but it can incubate for a week or so before someone gets sick with it. There were hundreds of people infected, and some killed, by e-coli at Jack in the Box restaurants a few years ago and the symptoms took a long time to show.’
‘So, people might still be picking it up?’ asked Chuck.
‘Yes, I’m afraid so. And, as of now, we don’t know the source. We’re looking at all the food manufacturers, the catering companies, the meat processors, the restaurant chains, all the usual suspects. To some extent we’re overwhelmed by the numbers. We still have multiple cross-references for patients – places they’ve eaten, places they’ve visited, mass produced foods they’ve consumed . . .’
There was a silence.
‘This,’ continued Kim Scholler in a downbeat tone, ‘is going to get worse before it gets better. We’ve been collating reports from the hospitals all day. We now have over five hundred deaths from this infection.’ The atmosphere in the room chilled by about twenty degrees. ‘Most of them are in Manhattan, but one hundred or so are spread around the boroughs.’ She turned to look at the bowtied professor beside her. ‘Professor?’
‘I’ve been looking at the morbidity reports and doing some profiling. It’s showing what I would have expected for a virulent infection at this stage.’
‘Which is?’ prompted Dr Scholler.
‘Well, pretty much all of the fatalities are among those with weaker immune systems, for example, young children and the elderly, or anyone on chemotherapy. To be specific, forty-five per cent of the deaths are children under eight. About forty per cent are adults aged over seventy. I’ll bet that the other fifteen per cent are HIV positive, with compromised immune systems.’
‘And, Dr Steelman, now that we know what we have, what is the advised treatment?’
‘Our advice is that you attempt to rehydrate the patient, rebalance electrolytes, try and prevent organ damage. We don’t try and stop the diarrhoea – it’s usually better to let the toxic matter get out through the system. Normally, you wouldn’t rush into antibiotic treatment until there’s evidence of blood loss and toxicity. However, we’re getting a lot of that in this case and most of the hospital patients have been put on intravenous cephalosporin since yesterday.’
‘Why’s that?’ asked Detective Wyse.
‘It’s about the best antibiotic we can throw at this,’ replied Dr Steelman. ‘The drug of last resort, we call it. Forty-eight hours on cephalosporin and rehydration should bring the patient around.’
‘Should?’ asked Cabrini.
‘Well, given the numbers we’re dealing with, first question is: do we have enough cephalosporin? I’ve sent an alert to all the hospitals confirming the e-coli O157:h7 analysis and they all need more cephalosporin. Looks like we’ll be okay, though – the main supplier has a good stock in the city, but . . .’
‘But?’ prompted Wyse.
‘I must say,’ Dr Steelman continued, ‘I am very concerned at the numbers we are handling. And the early morbidity rate, though, as the professor explained, fatalities are currently confined to groupings with weaker immune systems. This is a very nasty bug we’re dealing with. It could get much worse before it gets better.’
‘And,’ finished Dr Kim Scholler, ‘we still don’t know the source.’