It had been a full week since Lee Moses had last spoken with Peter to share the results from the preliminary analysis by the CDC investigation team. They were both equally discouraged that a source of the pathogen had not been identified even though they’d both been warned of that possibility.
Stubbornly, Peter refused to accept that it was a natural mutation of the mumps virus. Although he was no expert on virology, based on his research, it didn’t seem plausible that the virus would burn out so quickly. But even if that was the case, there would still be a source. The virus had to come from somewhere; something that was either ingested, inhaled, or in some way allowed into the body of each patient.
Another concern nagging at Peter was that mumps infected the lymphatic system in general and was therefore contracted by both male and female. Yet the mysterious viral outbreak at Warm Springs resulted in severe infection of males only, since the disease seemed to infect predominantly the testes. During the outbreak, the Warm Springs clinic had only a handful of cases involving female patients with symptoms of infected lymph nodes, and those cases were very mild.
He kept coming back to water as the common link between all the patients. And yet mumps was not a water-borne virus. In fact, the few water-borne viruses known to infect humans primarily caused infections of the gastrointestinal tract and liver. These viruses were mostly associated with sewage, or water supplies contaminated by feces—whether from human or animal—and their occurrence was far more common in developing countries.
So how could water be the source if the virus was a mutated form of mumps? He decided to call Julia Zhong and ask her opinion.
“Hello Julia. It’s Peter Savage. Do you have a minute?”
“Oh, hello Mr. Savage. Sure. I was just wrapping up before lunch.”
“Lee Moses shared with me the essence of your conversation last week, and I understand that your team has not been able to identify the source of the virus.”
“Yes. None of the samples we collected tested positive.”
“That’s what bothers me the most. There has to be a source. Unless the virus somehow mutated once it was within the host body.”
“We don’t think that’s the case at all. There would be absolutely no precedent for that occurring.”
“But you agree that there has to be a source, right? If the virus is naturally occurring, and spontaneously mutated to this new form that is resistant to vaccination, it still has to be present in the environment. So why have all the lab tests turned up negative?”
“I don’t fault your logic,” Julia said, “but that doesn’t change the results. Let’s face it. There are thousands of potential ways the patients could have come in contact with the virus. We collected samples for only two days, narrowing our search to those items that appeared to share commonality across the patient population. But there’s no guarantee we sampled everything we should have. In fact, given our negative findings, I’d say we missed something in our collection.”
“Like the bottled water?” Peter asked.
“I understand that’s your pet theory, but we did sample water from Cascade Aqua and all results were negative for any pathogens, bacterial or virus.”
“We both know that’s inconclusive. We need to test all of the production lots that were delivered to Warm Springs over the past several weeks.”
“Which appears to be impossible. Unless you know of some stash of bottles from the prior lots.”
“Have you made that request of the management at Cascade Aqua?”
“No. There is no scientific basis to believe a strain of mumps virus could remain viable in water. The source must be something else. In all likelihood, it was spread from one person to the next through sneezing or coughing, or from contaminated drinking glasses or cups.”
“It still had to originate with someone.”
“You’re referring to patient zero?” Julia said. “Yes. Answer that question and you’ve solved the puzzle.”
“But if the virus has mutated, couldn’t the means of transmission also change? And the new strain is now stable in water? You keep referring to this as a strain of mumps virus, but why does it seem to infect males disproportionately to females?”
“These all are good questions, but I’m afraid that without further study, they’ll remain unanswerable.”
“What about a vaccine? I understand that the infected patients had all been previously vaccinated for mumps.”
“Not all, but close to it,” she said. “Best guess is that they received a weak vaccine, or, more likely, simply outgrew their immunity. It happens—fairly often, actually. However, and this is important, it is premature to know how effective the standard mumps vaccine is against this new, mutated strain of virus.”
“Can a specific vaccine be made to protect against this new disease?”
“Maybe. But devising a vaccine against a virus is not as straightforward as it may seem, and sometimes efforts are unsuccessful. HIV in particular, but also Ebola and hepatitis C, have proven especially difficult. There is also the complication of conducting clinical trials on human patients.”
“I don’t understand.” Peter said.
“Well, think about it. To run clinical trials, real people must be vaccinated and then subjected to the live virus. At the outset, there is a very real chance that the patients may become infected, either from the vaccine or as a result of exposure to the virus. The ethical question of such trials cannot be ignored.”
The call ended with no relief for Peter’s frustration. He wanted answers, and he wasn’t getting any. Even worse, he didn’t see a pathway to getting there. Like it or not, the bureaucracy at the CDC seemed to be getting the better of him. Just then, an idea came to mind.
He opened the browser on his phone and found the webpage for Cascade Aqua. The phone number was displayed, and he dialed, asking for the manager. After a short wait he was placed in contact with the president, Darnell Price.
Peter explained his involvement with the investigation into the cause of the illness at Warm Springs and asked if any bottles from prior product lots shipped to Warm Springs were still available for analysis.
“This seems like an odd request,” Darnell said, “coming from a private citizen. Shouldn’t the Oregon Health Authority or CDC be making the request?”
Peter explained the situation, that the CDC thought it was a naturally occurring virus that mutated, and that they had collected many samples already. “But they couldn’t find any bottles from prior production lots,” he said.
“Probably all consumed by now. Store managers keep a close eye on inventory. They’d rather I keep it in my warehouse than have pallets of water sitting unsold for weeks in their own warehouses. It’s all about cash flow.”
“Would it be possible to visit your bottling line and warehouse? I’d like to check for myself, and it seems like an imposition to ask you to conduct a thorough search for a few stray bottles.”
“If this was an official request, I’d have to comply. But under the circumstances—”
Peter cut him off before he said no. “If I appeal to the CDC, FDA, and Oregon Health Authority, it’s likely to be picked up by the media. That would be bad publicity, and totally unnecessary if, as you say, there’s no issue with your product.”
“Your appeal sounds more like extortion.”
“I’m sorry if that’s what you’re hearing. I assure you, I’m simply trying to help solve this mystery.”
“Okay, Mr. Savage. It’s your time and gas. I can see you tomorrow, if that works for you.”