Chapter 20

BETHESDA, MARYLAND

Infection Date 25, 2200 GMT (6:00 p.m. Local)

Isabel took her accustomed seat at the conference table across from Street and beside Rosenbaum. Brandon at the opposite end was listening to Maldonado. “They didn’t know when the pharmacy would reopen. I could see through the police tape that the store had been ransacked. Everything that wasn’t stolen was littering the aisles.”

A man in a lab coat chimed in. “Our neighbors’ house, two doors up, was broken into. We organized a neighborhood watch. I’ve got the 10:00 p.m. to 2:00 a.m. shift tonight.”

“You hear about those guys,” said another man, “down in Atlanta at the Epidemic Intelligence Service? Walked in to their boss’s office en masse. Gonna whistle blow unless the EIS tells everyone everything we know about SED. The director stepped out, and five minutes later the guys were hauled off in handcuffs with their mouths taped shut.”

The door burst open. Isabel tensed. What had Noah done now? But Nielsen handed out the long-awaited WHO report. Stamped above “Preliminary Categorization of P. horribilis Effects” were the words, TOP SECRET. “We’re making this exception to catch you all up on the science.” Nielsen quickly covered what they already knew. Neuroinvasive like polio. Neurovirulent like rabies. Short incubation and latency periods. Transmission by aerosolization. “It’s giant for a virus, but still small enough to avoid traps in the tracheobronchial or alveolar regions.” Each tidbit elicited animated discussion among the scientists. Maldonado, however, slumped over her open but forgotten notebook.

Pandoravirus was too large to cross the blood-brain barrier, so it tricked the body into producing multiple enzymes. Most were neurotoxic and caused the brain damage. One prevented the liver from cleansing the others from the bloodstream. Most fatalities resulted from the build-up of unrelated toxins during the hours that liver function was suppressed.

Nielsen said, “Contagiousness peaks at initial infection, then transitions to a persistent phase with greatly reduced viral shedding around week two. That corresponds to our aerobiologists’ readings from the liquid impingers and electrostatic precipitators.”

Hank nudged Isabel in case she missed it. “Your sister is less contagious now.”

“You mean, like,” she said, “it might be safe to let her out?”

“Hell no!” Nielsen replied. “It’s still airborne and still as contagious as SARS.” She returned to the report. The virus’s capsid was enveloped by a membrane with a honeycombed plug at one end and a long tubular structure inside. It reproduced by building a replication factory in a host’s cytoplasm, not by taking over the cell’s nucleus, which was more typical.

“I’ve never heard of a giant virus infecting humans,” Hank said. Street reminded him of some eleven-month-old Senegalese boy who was infected by Marseillevirus adentis.

Nielsen noisily turned pages. “Anterograde amnesia in four percent of survivors, with possible Korsakov’s syndrome. What the hell is that?”

Isabel said, “Korsakov’s is a disruption of the Papez Circuit. Sufferers recall everything that happened before the injury, but nothing after for more than a few minutes.”

Nielsen was uninterested and read on. The pathogen is most closely related to Pandoravirus salinus found off the coast of Chile a few years ago.

Street said, “P. salinus was originally thought to be a whole new branch of the tree of life and was referred to as NLF, New Life Form, until they realized it was a virus.”

Nielsen flipped pages. “Phylogenists calculated a TMRCA with P. salinus of just under 200,000 years.”

Isabel asked, “What is TMRCA?” when the stuporous Maldonado didn’t.

“Time to Most Recent Common Ancestor.” Street answered. “Mutation rate is like a molecular clock. You compare the variation between two viruses and back-calculate how long they’ve evolved independently. P. salinus only infects amoebae. P. horribilis mutated 200,000 years ago and probably spilled over into Neanderthals around then.”

No natural immunity had been found. Other labs were working on a blood-based field screen and a vaccine, possibly also for use as immediate post-exposure prophylaxis. “Meaning an antidote?” Maldonado asked, roused from her reverie.

“I’m going to say yes,” Nielsen replied, “because I know what you think that word means.” Isabel noticed that all of Nielsen’s colorful wristbands were gone save a clean, new one. She now had only one cause. Three black letters on blue rubber: SED.

Finally, the report categorized the seven distinct types of brain damage, through which Hank led the meeting.

Type A. “Aggression?” Hank said, speculating on the nomenclature. Damage to the orbitofrontal cortex causing adrenal rages. Type N. “For amnesia?” Damage to the left and right hippocampus. Type P. “Clearly pain insensitivity.” Damage to the secondary somatosensory regions of the parietal cortices and the cingulate and insula. Type F. “Focus, maybe.” Damage to the callosal fibers connecting the left and right parietal cortex. That accounted for obsessive fixations and “all-trees-no-forest.” Type I. “For Inferotemporal, or Imposter.” Damage to connections between the inferotemporal cortex, dealing with facial recognition, and the amygdala, involved in emotional response, which Hank said results in everything from mild paranoia to full-blown Capgras delusion in which they think acquaintances are dangerous imposters. Type M. “For Mirror.” Damage to the frontal and parietal mirror neurons, disrupting social bonding and empathy.

Finally, Type S. “For Self,” Hank said, nodding at Isabel in acknowledgment. “Damage to the insular cortex, which is fundamental to self-awareness, and to the medial prefrontal cortex, linked to processing information about one’s self. But no damage to the anterior cingulate cortex, which allows body awareness. All as predicted by Dr. Miller.”

“Meaning?” Nielsen prodded in an irritated tone.

“Meaning Emma can brush her hair,” Hank said, “but there is no she in there.”

The meeting adjourned with Street’s latest. “Pseudocorynosoma constrictum. The parasite releases its eggs into a lake for ingestion by amphipods. After about a month, the cystacanths inside them turn bright orange and become easily visible, causing the amphipods to fall prey to waterfowl, allowing the parasites to reach their intended hosts.”

Brandon accompanied Isabel to the elevator, where she said, “I’ve been trying to imagine 100 million Infecteds, wandering around, suffering from all those deficits.”

Brandon put his arm around her. It felt reassuring and familiar. “What’s your PSP?” he asked. “Your personal survival plan. That’s what everybody’s calling it.”

“My brother’s getting ready.” Isabel considered asking Brandon about his plan, but that strayed too close to an invitation to join them, which wasn’t her right to extend.

The observation room was empty. Emma huddled with her three high-functioning roommates in a circle. Isabel raised the volume of Emma’s whispers. “Breath out through your mouth,” Emma said. They exhaled through pursed lips. “In through the nose. Out through the mouth.” Emma seemed satisfied and said, “Now spread back out.”

Dwayne took a seat in front of the borderline engineer. Dorothy wiped crumbs from the table. Samantha colored in maps. Emma sank in a corner with her notes.

Brandon said, “She’s intentionally stoking their agitation by crowding them together so she can then teach them calming techniques.”

“Yeah. Get the feeling there’s more going on than we know?” Isabel’s own calm was losing to encroaching, unaddressed fears. The day was coming when she wouldn’t have shatterproof glass or Marines between her and the Infecteds. Noah was in full survivalist freak. Emma was preparing for . . . whatever. Isabel was doing nothing. She couldn’t even think about what was coming without crying. “I feel like,” she said, “I should be toughening myself up. Breaking puppies’ necks or whatever.” Brandon cringed. “I mean do something horrible. Get it over with. Become a badass. Calloused. Hardened.”

“Isabel,” Brandon said, “it’s the apocalypse. Don’t overthink it.”

After a moment’s hesitation, she grinned and for the briefest instant lowered her head to his shoulder. When she looked up, Brandon stared back at her intently.