During the next week Dr. Carlos Quintana and a growing army of epidemiologists and other CDC personnel put in grueling twenty-hour days trying to define and control the brush fires of plaguelike illness that now centered in Canon City, Colorado, but were also springing up elsewhere in a long arc stretching from Chihuahua State to the south, up through mountain villages in New Mexico, through Colorado and north into Wyoming, almost all traceable directly or indirectly to somebody in that first ill-fated camping party. Many of the workers were the Shoeleather Boys Carlos liked to refer to — members of the Epidemic Intelligence Service, many of them experienced epidemiologists, but more merely recruits-in-training, working out of offices all over the West and shipped in because Canon City was where they were needed. Their job was staggering and wildly varied: tabulating and interviewing each new individual case of plague, meticulously listing all possible contacts that might have occurred while the victims were infectious, then painstakingly tracking down each of those contacts — and their contacts — and their contacts — to New York, to Anchorage, to Hong Kong, to literally anyplace in the world, in order to gather information, urge medical observation and, when necessary, prescribe prophylactic antibiotics. Since every plague victim had dozens, sometimes hundreds, of potential contacts, and since each one had to be traced out individually, the reason for the Centers for Disease Control’s unofficial insignia — a shoe sole with a hole in it — was soon painfully apparent in Canon City and environs. To make matters worse, the EIS workers were made fully aware that the patterns that might ordinarily govern the spread of plague might not apply — that failure to account for any rodent or flea exposure, for instance, did not in any way mean that a possible contact could be considered safe. This plague was heavily loaded with cases of plague pneumonia, a form of the infection easily spread from person to person.
With the enormous amount of data they were collecting, it was easy for these workers to imagine that they were covering everything and forget that multitudes of contacts like Chet Benoliel might be slipping through their nets. With the sheer magnitude of the task created by first twenty, or twenty-three, or thirty cases of plague, it was easy to be fooled into thinking that pages and reams of raw data somehow equaled accomplishment, and to imagine they were really getting somewhere when the fact was they were merely getting buried in figures.
In addition to the Shoeleather Boys, some elite specialists came in, setting up shop either at the Fort Collins CDC installation, at the Colorado Springs motel headquarters or in Canon City itself; chemists, microbiologists to work with Monique, nurses, physicians, public health advisers to work with the local doctors, veterinarians, entomologists, rodent-control experts to help assess local rat populations, live-trap the rats and send their fleas up for examination and bacteriological culture — the list of jobs to be done seemed virtually endless.
That first day Carlos called a council of war to establish and discuss certain basic ground rules. “We can’t assume that we’re dealing with plague the way the textbooks describe it, or the way any of you may have encountered it before,” he said as the workers crowded into the small Holiday Inn conference room. “We’ve got to assume that anyone who’s had direct or indirect contact with a proven infected person is in mortal danger, and we simply don’t dare sit around and watch what happens. We have to move as soon as we have a presumptive history.”
“But we can’t treat somebody who isn’t sick, can we?” one worker asked.
“In this situation we may have to. So far it looks like ninety percent of the people who have developed symptoms have been dying no matter what was done. That’s one hell of a mortality rate, and I don’t think we can fool around waiting for a laboratory diagnosis.”
“Why didn’t the antibiotics stop it, up at Rampart Valley?”
“Maybe just too slow,” Carlos said. “It takes any antibiotic three hours or more to reach an effective blood level, unless it’s given intravenously, and then another twenty-four hours for the antibiotic to knock down enough of the invading bacteria to slow the attack. Here we have an organism that seems to move like greased lightning. Maybe it just walks right over the antibiotic. Maybe there’s already an overwhelming bacteremia before symptoms really begin to show up. Or maybe the bug just isn’t very sensitive to the antibiotics we’ve been using. Until Monique can define the organism better, up at Fort Collins, we aren’t going to have answers — but meantime, we’ve got to do something, and as long as the outbreak is small and localized enough, I think that means full-dose antibiotic prophylaxis for every person with any suspicion of contact.”
There was a general discussion of that. What antibiotic to use? Tetracycline alone? Carlos shook his head. “We’ve got to hit it harder than that.” Streptomycin, then? Better hold the streptomycin for people with symptoms, we don’t want everybody in Colorado going deaf. Well, that leaves chloramphenicol — in quantity. But where are we going to get enough? Nobody stocks that drug in quantity. “True, the local supply is low,” Carlos said, “but Parke-Davis says they can get us a whopping big supply straight into Canon City by noon tomorrow. I talked to them this morning.”
“Why not use broadside vaccination?” a young woman asked. “There is a plague vaccine, isn’t there?”
“Yes, there is a vaccine, such as it is, and every one of you people are going to take it, too — but that’s really about the weakest weapon we’ve got. For one thing, it takes three or four weeks to build up an antibody level, so it’s not going to stop anything that’s moving fast right now. Even then, at best, the vaccine is only about forty to sixty percent effective in the field, depending on the particular microstrain of Yersinia we’re dealing with. It’s a killed-bacteria vaccine, and like the cholera vaccine, it may not be worth too much of a curse when you really need it. And as for broadsiding it into everybody around, hoo boy! Just this one little town would put a dent in the national stockpile of the stuff. We could have more made in a hurry, but you’re talking about weeks or months of lead time. We’ll use the vaccine for health workers, yes, but for a broadside weapon here, forget it.”
The workers went on their way, gathering their data. Carlos dispatched Monique north to the Fort Collins CDC installation up near Estes Park by army helicopter with instructions to move as fast as possible — ”Until you’ve got this bug pinned down in all dimensions, we’re really flying blind down here.” With her on her way, he worked far into the night with Roger Salmon and Bob Romano from Albuquerque getting the Canon City field work organized and moving.
Next morning at daybreak he and Frank Barrington, now officially on loan to the CDC from the Forest Service after a little high-level interdepartment finagling, took off to the forested slopes to the west of Canon City in a little Forest Service Jeep Frank had commandeered, carrying a large, oddly shaped bag that Carlos hoisted into the back end, in search of dead rodents. As Frank turned up a steep canyon road through scrub pine and bramble, he said, “The whole concept of dead rodent counts really evolved from the fact that you don’t ordinarily find any dead rodents in the wild.”
“None at all?” Carlos said.
“Not very often. For one thing, most wild rodents never die a natural death. They’re caught and killed by predators — hawks, eagles, coyotes, weasels, martens — and immediately eaten. The few that do die on the ground are devoured within hours by those same predators and a few others — ravens, buzzards, bobcats. Even a cougar won’t turn his back on a nice, crunchy one-bite meal if he finds one. So the only time you find any dead rodents around to speak of is when there’s been an overwhelming kill of rodents by something that doesn’t immediately eat them.”
“I see,” Carlos said thoughtfully. “But how do you find them when they are there? Just walk out in the woods and look around?”
Frank shook his head. “Not quite. Your best bet is to cruise a line, follow a compass course through likely country for so many miles, watching for anything you see along your way. Then you run a second line, parallel to it, and then a third, and then extrapolate for a square-mileage area. Much the same way that we counted tussock moths on Douglas fir up in Washington and Oregon some years ago when they were killing so many trees — you couldn’t go out and count each moth. Or the way the Game Department estimates how many deer there are in a given area.”
“You mean you walk a line through the woods for so far, and count the deer you see, and then multiply it by some factor?”
Frank laughed. “You wouldn’t get much of an answer that way. I mean, you might see some deer, but your extrapolated number wouldn’t mean anything. Even the most crafty hunter in the world going through the woods is going to spook a lot of the deer off ahead of him without ever seeing them, and walk right past a whole lot more that he also never sees. No, to estimate the deer in an area, you have to look for something that can’t just sneak away while you’re looking.”
“So what do you count if you don’t count deer?”
“You count piles of droppings. Fresh piles that don’t look more than twenty-four hours old. They tell you beyond question that the deer have been there, and roughly how many, whether you see any deer or not. You’ll see what I mean, up ahead here. But what we’re going to be looking for are dead rodents, and they’ll either be just freshly dead, or they’ll be gone.”
He picked an area of pine timber interspersed with dense patches of buck brush, running along a ridge with a long, gentle rise. Carlos packed the large bag he’d brought over his shoulder; Frank carried a day pack. They plodded, climbed, scrambled and sweated for four long hours as the August sun got higher and hotter, trying a multitude of areas, and finding nothing. “Maybe we’d better go higher,” Frank concluded as they finally made their way back to the Jeep. “There may just be too many scavengers at this level. You’re game to keep going?”
“Oh, yes. Yes. We’ve got to do this.”
A few miles higher into the mountains hardly seemed any better, except that there was less brush and bramble underfoot. Sometime after noon, discouraged, they stopped for lunch in a little grove of pines, sitting on a downed log to munch their sandwiches. Flies buzzed and the warm air was rich with pine resin. Carlos looked drowsy and disheveled. Then Frank said, “Speak of the devil,” and pointed.
Twenty feet away from them a sick chipmunk was struggling feebly in the dusty turf a few feet from cover. “He’s not quite gone,” Frank said, “but he’s getting there.”
He started to his feet, but Carlos caught his wrist with an iron grip. “Just stay put,” he said. “I’ll take care of this.”
Watching the chipmunk constantly, Carlos opened his bag and brought out the oddest assortment of equipment Frank had ever seen: a large, heavy-gauge polyethylene bag with a strange-looking tie around the top, a pair of shoulder-length rubber gloves, and a long pair of collapsible tongs that looked like stainless steel. Carlos opened the polybag and set it on the ground near the barely moving creature, keeping well away from it. Then he stripped on the long gloves and pulled the tong handles out to full length, about a yard or more. Very quietly he edged toward the chipmunk, tongs in his right hand. Then he extended the pincers to either side of the rodent and snapped them together sharply, crushing the creature with clinical precision. He lifted it into the open mouth of the poly bag and brought the bag top closed with the tongs. Then he tossed them well aside and backed away. “Matches in my breast pocket,” he told Frank.
Frank, who had been staring at him, bemused, fished the matches out and handed them to him. Approaching the bag, Carlos struck a match to the tie around the top. Frank saw something flare and run around the bag top, puffing black smoke, exactly like a long fuse on a firecracker. When the thing stopped Carlos went forward again and peered critically at the bag.
“Fine,” he said. He moved the bag and tongs twenty feet away from where the chipmunk had been. “Now, you’ll find a bottle of murky-looking soup there in my bag, Frank. Toss it to me.”
Carlos caught the bottle, sloshed the long gloves liberally, then treated the tongs the same way before collapsing the handles again. At last he pulled off the gloves and stowed them and the tongs in another plastic bag, which he also heat-sealed. Finally he took another deep breath and sat down on the log with a wan smile. Frank saw that his hands were trembling.
“Now, what the hell was all that about?” Frank said.
Carlos looked up, startled. “About?”
“All the hocus-pocus.”
The little doctor shrugged. “Look, my large friend. A flea can jump four feet or more if it feels like it. That chipmunk’s fleas could be carrying some very nasty customers around with them — I didn’t want them jumping on me. If you want to go up and fondle the next little beast, that’s your problem. Not me, thanks.”
“Sorry,” Frank said. “But that’s a pretty fancy setup.”
“A couple of our EIS recruits down in New Mexico worked the system out, mostly for collecting trapped rats, to minimize any possibility of getting a plague-infected fleabite. It’s not foolproof, but it beats bagging them up bare-handed. You think you could work the system?”
Frank nodded. “If you’ll run through it again and explain exactly why I’m doing what.”
“Good. We’d better get back to town now, but I’ll give you a lesson with a catnip mouse tonight.”
“You want me to look for more of these?”
Carlos nodded. “I can’t spend more time up here, I’ve got things to do down in town, but we need as many dead rodents as you can find in the next few days. Take a crew with you, but you handle the dead ones. Try to get them from different places, high and low elevation, north and south. You know where to look, you be in charge. But believe me, this is no game — it’s critical. Our little friend in the bag here could be a major key.”