The three-person team from the Centers for Disease Control arrived at Portland International Airport right on schedule. It was mid-afternoon, and once they collected their bags and loaded them in the rental car, they drove southeast over Highway 26. The views as they passed snow-covered Mt. Hood were spectacular.
“Nothing like this anywhere in the south,” Dr. Julia Zhong said. She was the team leader. A veteran of the CDC, Julia had a medical doctor degree, specializing in internal medicine and communicable diseases. She was considered an expert in viral infections, and had spent two months in Africa the previous year working to contain and study a localized outbreak of hemorrhagic fever. Her in-field studies revealed that the particular strain of virus responsible for this sudden rash of illnesses was a new strain of Ebola, likely the product of a spontaneous mutation. Under her leadership, her team acquired sufficient fluid samples to isolate the virus for future studies back in Atlanta.
Julia preferred to ride in the back seat with her tablet already fired up and on her lap, papers spread out to her side. She was accompanied by two colleagues with whom she’d worked before: Dr. Adrian Stone and Dr. Lindsey Weber.
Dr. Zhong was tall and thin with high cheek bones and a somewhat petite nose. With hair the color of roasted cinnamon that just touched her shoulders, she presented a striking appearance. However, her male peers at the CDC had long ago stopped asking her out on dates, keeping the socialization to group events. As the cliché goes, Julia was married to her job. The challenge of her profession provided ample reward, and although she accepted that she had long since passed her optimal child-bearing years, she had no regrets about the choices she’d made.
Other than stopping for fast food, which they ate in the car, they drove straight through to Warm Springs. It was dark when the rental car pulled into the motel parking lot. After they checked into their rooms, Julia phoned Lee Moses.
“I understand the number of patients is growing,” she said. “Although it’s been a long day for my team, if you don’t mind, I’d like to get started tonight.”
After the stubborn refusal to help, Lee was pleased with the sudden change in attitude. “Thank you. I can meet you at the health clinic.”
Lee gave her the address and they agreed to meet in thirty minutes.
The clinic was still open when the CDC team arrived. Lee opened the door and welcomed the medical experts. All three were wearing brightly colored quilted down jackets, reminding Lee of colored gumballs. Following introductions, Lee brought them into the back office. Two additional folding tables had been set up and chairs added for the CDC team. They wasted no time booting up their laptops and settling in. Clearly, this was something they’d done before.
Lucy joined the group and proceeded to walk the team through the data, including the digital map. All the electronic files had been emailed to the team members prior to their departure from Atlanta, so they were already somewhat familiar with the information. Then Lucy provided printed copies of notes from the many interviews of patients, immediate family, and close friends.
After brief discussion and cursory review of the interview notes, Julia addressed Lee. “Would it be possible to examine a few of the patients? Even one would be helpful.”
“Yes, I think so. A young man came to the clinic about an hour ago complaining of symptoms. Our doctor is seeing him now.”
“Excellent,” she replied. Then she turned to Dr. Stone. “Adrian, would you mind? It will be easier on the patient if you assist with the examination.”
Adrian nodded and followed Lee to an examination room. After knocking, Lee and Adrian entered. The clinic doctor accepted the introductions and provided a succinct summary loaded with medical terminology. The patient sat on an examination table with a towel draped over his lap, his pants folded on a chair in the corner.
Adrian spoke to the young man. “I’m Dr. Stone. I work with the Centers for Disease Control, in Atlanta. We’re investigating this illness that you contracted. Would you mind answering a few questions for me?”
He shrugged. “Sure.”
“When did you first begin to feel pain in your groin?”
“Yesterday morning. When I woke up, it hurt. And then when I took a shower, I saw that my private parts were red and swollen.”
Adrian pulled on latex gloves and then launched a series of questions about sexual activity, unprotected sex, what food and drinks the young man had consumed, had he been vaccinated for childhood diseases, and whether he had been in contact over the previous two weeks with anyone he knew to also have the same illness. None of the replies suggested any risky behavior or contact with an infected person.
“I just want to check your lymph glands. Would you mind unbuttoning your shirt?” He reached forward and pressed his fingers under the patient’s jaw, and then moved to the glands under his arms. The glands were slightly swollen and with an elevated degree of tenderness, especially under the jaw.
“I do have one more question—a request, actually—and I will apologize in advance. It would be helpful to our investigation if I can take one or two photos, to document the visible presentation of the infection. The photos will not show your face, and if you have any unique birthmarks those may be covered. I understand this is awkward, and I would not ask if it wasn’t important.”
The young man thought about the request for a moment, then relented. “Okay, I guess.”
Adrian gently removed the towel and took two photos, then showed them to the patient. He again asked for his permission, which was quickly given.
“Thank you,” Adrian said as he extended his hand. “I assure you my team will be doing all we can to identify the pathogen and devise a treatment.” Then he left the examination room.
Upon returning to the office, Adrian updated his colleagues. His summary was filled with medical jargon, and he shared the digital images on his phone. The pictures earned a frown from Julia. “I’ve seen this degree of inflammation and swelling only a few times. Always with young adults, who were not vaccinated, and after passing through puberty they contracted a severe case of the mumps.”
“Except this patient insists he was vaccinated against mumps, measles, diphtheria, and chicken pox. He said his mother insisted on all the normal vaccines. And the standard vaccinations are required by the school district.”
“That’s consistent with the statements in the interview reports,” Lindsey observed.
“So, the simplest conclusion is that we are dealing with a variation of the mumps virus that is resistant to standard immunization,” Julia said. She rubbed her chin, a sign of deep thought. Both Lindsey and Adrian waited for her to continue. “Could we be dealing with a natural mutation?”
Lindsey answered. “Certainly possible. But is there a precedent?”
“Regardless, what I saw with this patient certainly presents as the mumps, although I would have expected more severe swelling in the lymph glands, especially on the throat. Practically speaking, it doesn’t matter if the virus—assuming it is a viral infection—is the result of a natural mutation or otherwise.”
That caught Julia off-guard. She tilted her head. “What do you mean by ‘otherwise’?”
“Just a figure of speech. Scientifically speaking, the possibilities are many.”
“Agreed.” She paused before adding, “And we need to keep an open mind.”
“What are you insinuating?” Lindsey asked.
Julia raised her eyebrows. “Well, we could be looking at a naturally occurring pathogen. Maybe something we have previously identified, maybe a new strain. Or, it could be a natural mutation of a known strain. We’ve seen this many times with Ebola, and it’s an annual occurrence with influenza.” She raised her index finger to emphasize the final point. “But… what if this is not a naturally occurring pathogen?”
“Are you suggesting this could be a human-engineered virus or bacteria?” Adrian looked skeptical.
“I’m simply echoing your statement. Scientifically speaking, it’s a plausible possibility, isn’t it?”
Lindsey spread her hands, not willing to jump to conclusions. “Plausible possibility is a far cry from proof.”
“No argument from me,” Julia said. “And it’s our job to sort through the possibilities and eliminate those that are unfounded, until we do have the proof of the pathogen that is responsible for this outbreak. So, let’s get to it. We have more than thirty patients that are suffering, and God knows how many more if we cannot crack this puzzle.”
Adrian jumped in. “We need to get samples analyzed. I suggest we start with the obvious commonality—water. There is no correlation amongst the patients on canned or bottled beverages, but maybe there is a general contamination in the water supply.”
“You do know that well water supplies the majority of the affected residences and businesses,” Lindsey said.
“I do. But we can’t rule out a widespread contamination of the aquifer. Therefore, we need samples and laboratory analyses.”
“I agree,” Julia said. “Let’s do it. Lee, can you mobilize your people to collect water samples first thing in the morning?”
Lee Moses had been standing off to the side, watching the interaction. “Of course. Let me know how you want the samples to be collected and what volume of water you need. I’ll get my team working on it.”
“Nothing fancy. Do you have clean glass bottles? Two hundred milliliters volume should be fine.”
“I’m sure we do, let me check. Anything else?”
“No, that’s all. Once we’ve collected the samples, Adrian will send them off to one of our labs for analysis.”
“Are there any other beverages or food samples that you want?” Lee asked. “It will be easier if we collect everything at the same time.”
Julia smiled. “Thank you. I think that will do.” She glanced to Adrian and Lindsey, who both nodded agreement. “We don’t see any correlation among the other variables.”
Lee excused himself to seek out the sample bottles. Lucy was one step behind him.
After they cleared the room, Adrian addressed his superior. “You’re concerned, aren’t you.”
She nodded. “The inflammation shown in those photographs is severe. I could understand it if the patients had not been immunized. But all except one state they had been vaccinated. Even if we assume a few are not speaking truthfully, or just don’t know with certainty, that still doesn’t explain why we have this number of patients.”
“Do you think it’s a new pathogen?” Lindsey asked.
“I think it is a pathogen that is not affected by the standard mumps vaccination. That much seems patently obvious.” Julia clasped her hands. She was the lead investigator in part because of her years of experience with viral infections.
“There’s something more,” Adrian observed. “What are you not saying?”
She hesitated, then drew in a deep breath and exhaled. “How familiar are you with orchitis?”
Adrian and Lindsey both shrugged.
“It’s not that common in developed countries, especially if standard childhood vaccinations have been established for at least a generation. There’s the part you know—painful inflammation of the testes. But there is more to the disease, a dark side, if you will.”
“Go on,” Adrian said.
Julia shifted her gaze from Adrian to Lindsey. “Because the disease is rare, the side effects are little known. And the most severe side effect is… sterility.”
“Are you saying—” Lindsey lowered her voice. “Are you saying these thirty or so patients are likely to be sterile?”
Julia looked hard at her colleague. “Yes, that’s exactly what I’m saying. If all the patients experienced as severe an infection as the young man Adrian examined, then yes. The chances are very high they suffered permanent and irreversible damage to their testicles. They will not produce viable sperm and will not be able to father children.”
Adrian collapsed into a chair. “My God. If this is the beginning of a true hot spot and the contagion is communicable…”
Julia finished his thought. “Then we are looking at an epidemic that could bring an end to humanity within a handful of generations.”