In a large auditorium in Geneva, a parliament of health officials gathered for the final afternoon session on emergency infectious diseases. The audience was restless, worn out by the day-long meetings and worried about catching their flights. The terrorist attack in Rome had everyone on edge.
“An unusual cluster of adolescent fatalities in a refugee camp in Indonesia,” the next-to-last speaker of the conference was saying. Hans Somebody. Dutch. Tall, arrogant, well fed. An untrimmed fringe of gray-blond hair spilled over his collar, the lint on his shoulders sparkling in the projected light of the PowerPoint.
A map of Indonesia flashed on the screen. “Forty-seven death certificates were issued in the first week of March at the Kongoli Number Two Camp in West Java.” Hans indicated the spot with his laser pointer, followed by slides of destitute refugees in horrible squalor. The world was awash in displaced people, millions pressed into hastily assembled camps and fenced off like prisoners, with inadequate rations and scarce medical facilities. Nothing surprising about an epidemic spilling out of such places. Cholera, diphtheria, dengue—the tropics were always cooking up something.
“High fever, bloody discharges, rapid transmission, extreme lethality. But what really distinguishes this cluster,” Hans said, as he posted a graph, “is the median age of the victims. Usually, infections randomly span the generations, but here the fatalities spike in the age group expected to be the most vigorous portion of the population.”
In the large auditorium in Geneva, the parliament of health officials leaned forward to study the curious slide. Most mortal diseases kill off the very young and the very old, but instead of the usual U-shaped graph, this one resembled a crude W, with an average age of death of twenty-nine. “Based on sketchy reports from the initial outbreak, we estimate the overall lethality at 70 percent,” Hans said.
“Pediatric or natal…?” Maria Savona, director of epidemiology at the World Health Organization, interrupted the puzzled silence.
“Largely accounted for in the reported cohort,” Hans replied.
“Possible sexual transmission?” a Japanese doctor asked.
“Unlikely,” said Hans. He was enjoying himself. Now his face drifted into the projection, casting a bulky shadow over the next slide. “Reportable deaths stay consistent for the following weeks, but the overall total drops significantly.”
“A one-time event, in that case,” the Japanese woman concluded.
“With forty-seven bodies?” Hans said. “Quite an orgy!”
The Japanese doctor blushed and covered her mouth as she giggled.
“Okay, Hans, you’ve kept us guessing long enough,” Maria said impatiently.
Hans looked around the room triumphantly. “Shigella,” he said, to groans of disbelief. “You would have got it but for the inverted mortality vector. That puzzled us as well. This is a common bacteria in poorer countries, the cause of innumerable cases of food poisoning. We queried the health authorities in Jakarta, and they concluded that, in a starving environment, the only people robust enough to seize the limited food resources are the young. In this case, strength proved to be their undoing. Our team deduced that the probable source of the pathogen was raw milk. We offer this as a cautionary tale about how demographic stereotypes can blind us to facts that would otherwise be obvious.”
Hans stepped down to perfunctory applause as Maria called the last presenter to the podium. “Campylobacter in Wisconsin—” the man began.
Suddenly, a commanding voice interrupted. “A raging hemorrhagic fever kills forty-seven people in a week and disappears without a trace?”
Two hundred heads turned to locate the source of that booming baritone. From the voice, you would have thought Henry Parsons was a big man. No. He was short and slight, bent by a childhood case of rickets that left him slightly deformed. His facial features and professorial voice seemed peculiarly outsized in such a modest figure, but he carried himself with the weight of a man who understood his value, despite his diminished appearance. Those who knew his legend spoke of him with a kind of amused awe, calling him Herr Doktor behind his back, or “the little martinet.” He was capable of reducing interns to tears if they failed to prepare a sample correctly or missed a symptom that was, in fact, meaningful only to him, but it was Henry Parsons who led an international team in the Ebola virus disease outbreak in West Africa in 2014. He tracked down the first documented patient of the disease—the so-called index case—an eighteen-month-old boy from Guinea who had been infected by fruit bats. There were many such stories about him, and many more that could have been told, had he sought the credit.