London, United Kingdom
Day 135
Amaya, thank you so much for coming in.” George greets Amaya warmly and she smiles and replies, “I didn’t have to walk far. It’s my pleasure.”
Dr. Amaya Sharvani, one of the country’s preeminent pediatric geneticists, called George a few days ago with news that has inspired hope, terror, anxiety and excitement. She has given us the key to crack part of the Plague’s code.
The three of us sit down in George’s warm, cozy office full of worn furniture and photos of his family.
“I take it from the warm welcome that you agree with my hypothesis,” Amaya says, her voice light.
“We’ve been working night and day since you got in touch and yes, we think you’re right.”
Amaya’s eyes widen and she leans back in her chair. “I’m not surprised—it made sense—but it means . . .” She trails off because it means that finding a vaccine is going to be unbelievably difficult. I’m fighting the delirium of exhaustion and disappointment. We’ve been working for months and there’s still such a long way to go. It’s March; the beginnings of spring are appearing and making fun of me as I trudge into the lab every morning at 7 a.m. and leave long after it is dark. I try to be cheerful and upbeat when I’m at work. I’m a shoulder to lean on, someone who can solve problems and use my knowledge to drive us forward, toward the goal of a vaccine. But on the way to work as I psyche myself up, and on the way home as I decompress, I suspect I look like the weight of the world is on my shoulders.
Identifying the vulnerability of men against the virus, and women’s protection from it, has taken so much longer than we anticipated, but Amaya has figured it out, thank God. Like many complicated things in science, the answer is ultimately relatively simple. We had so many theories. As we suspected, but couldn’t prove, it’s all in the genes. It feels like a miracle that Amaya has made this discovery and at the same time I’m so angry we didn’t figure it out ourselves. Over thousands of years the Y chromosome has lost most of its genes. The twenty-third pair of chromosomes in women is XX, and in men is XY. Y determines the forming of testes and production of sperm, but it doesn’t come as part of a matching pair. In paired chromosomes, like XX, with two copies, a mistake in one can be resolved by the correct gene sequence in the other. But when mistakes occur in the Y chromosome, it just disappears.
The Plague virus requires the absence of a specific gene sequence. The body’s resistance to the Plague—through its ability to fight the high white blood cell count it generates with speed—is present in the X chromosome. In around 9 percent of men their X chromosome has the necessary genetic protection. Thanks to their XX chromosomes, all women are safe. The others, the billions of other men, are vulnerable to the virus.
“How did you find it?” George asks her. “How did you know?”
“I’ve been treating two sets of twins,” Amaya says, her face for the first time revealing the weariness of a medical professional in the post-Plague world as though a curtain has been pulled to the side of her calm, well-rested façade. “One set of male identical twins were both immune but their father was not. A set of male fraternal twins had an immune father but only one of the twins was immune. The other died. Basic genetic logic. And the luck of any of my patients being immune.”
George nods. “We’ve been doing the workings, so to speak, and we’re nearly there with the coding. The theory works, but we need to know why.”
“It also explains why women are asymptomatic hosts,” I add.
“It bothered me that we knew but didn’t know why,” Amaya says with a sigh. “Amanda Maclean was talking about it right from the beginning because she identified a female nurse as a cause of the spread of infection in her A and E Department.”
“Like with many things in the story of the Plague, Amanda was way ahead of the rest of the world,” George says.
Amaya pauses, looks at George thoughtfully. “I have to say, it’s a pleasant surprise to be sitting with a male doctor, discussing all of this. There’s not many of you left.”
George smiles in response, almost apologetically. “I’m immune. We tested my blood and Elizabeth personally looked at it under a microscope. I carry the virus but I’m asymptomatic. We’re working on a test for immunity, trying to identify the specific genetic markers. This will obviously help enormously.”
“We’re an army of hosts,” Amaya says with sad sigh. “Spreading it all around. How close are you to a vaccine?” George was cautious about saying anything on the phone about our progress, or lack thereof. It’s crucial that the difficulties we’re having finding a vaccine are not leaked to the public, unplanned and unfiltered. We can see the headlines writing themselves.
George looks at me, as if to say, “Do you want to take this one or shall I?” I decide to take one for the team. “We’ve not made a lot of progress,” I say, trying to lift the sentence with some optimism. “But we’re working on it, and we’ve managed to discount some options. The virus is very unstable, it’s hard to—well, you understand.”
Amaya’s face has dropped and I realize that the only thing scarier than knowledge is the lack of it. At least I know the details of what is being done, the scant information coming from other countries’ vaccine programs, the small steps forward we’ve made in our analysis of immunity. Amaya, until now, has probably been able to convince herself that the task force was close to success.
“I feared that might be the case,” she says, twisting her wedding band round her finger. It’s loose; she must have lost weight, grief most likely. It’s not a great leap to assume she’s now a widow.
I want to make her feel better. “We will get there, we’re closer than we were, but everything you’ve done is going to change a lot. Your discovery, the understanding of the genetics of male vulnerability, will make it so much easier. Truly, you’ve done something extraordinary.”
Later that afternoon, once Amaya has returned to her patients at Great Ormond Street, George and I talk. We have a few more weeks of work to do, finalizing the genetic sequencing and then what?
“We have to release it,” George says. I nod in agreement.
“Of course. If this helps any of the other programs along, all the better.”
“We should liaise with the press people, make an announcement once we’ve figured it all out. Release the workings, our findings, everything. We’ll have a Skype conference and answer questions.”
“Yet another way in which we’re taking inspiration from Amanda Maclean.”
George’s eyes crinkle as he smiles. “I’d love to meet her one day.” He pauses, in thought or anxiety, I’m not sure which. “Do you think anyone else is making progress? Are they further along than we are?” George asks, his hands cupping a mug of hot water. “Or do you think they’re all as fucked as we are?” he adds.
“Well, I don’t know about that but I do know an adage an old, wise man used to say to me. The harder you work, the luckier you get.”
A grin bursts across George’s face. “Fuck off, I’m not that old!”
“If you say so, old man.” And with a smile, and not a little hope and trepidation, we get back to work.