and was fascinated by the plague bacterium. His professor drew a graph on the chalk board of the estimated human population over time. The chart showed steady growth until the sixth century, during the reign of the Roman emperor Justinian, when fifty million people died—about a quarter of the entire world population. The next plague pandemic was the deadliest outbreak in human history. Known as “the Black Death” because of the gangrene that appeared on the extremities of the infected person, it began in China in 1334 and followed the trade routes through Central Asia and Europe, killing as many as 200 million people before subsiding in 1353. The last plague pandemic also began in China, in the mid-nineteenth century, and, thanks to steamships, quickly spread around the world. India alone lost 20 million people, and nearly 80 percent of those who contracted the disease died of it. There was still no effective vaccine for pneumonic plague.
Henry had already gotten several flea bites in his quarantine tent. He had not seen the characteristic swollen lesions of plague on the bodies in Kongoli, however. “It’s still possible that it is spread by rats,” said Henry, “although according to Dr. Champey’s notes, the disease spread slowly at first, then went rapaciously through the camp, following the pattern of an infectious disease.”
“Have you got a median age of death?” Marco asked.
“They’re working on the latest count,” said Henry. “Most of the mortality is among young men, but of course the population of the camp is entirely male and skews young. Another thing to consider is that the reason the MSF doctors came in the first place was to treat the HIV infection, so presumably a significant percentage of the detainee population have compromised immune systems. That could make the disease somewhat less fearsome if it escapes into the general population.”
“But one assumes that the doctors themselves did not have HIV, and they also died,” said Marco.
“Yes, and rather quickly,” Henry agreed. “We could be dealing with a disease that is not normally found in humans, but because of the lowered immune response the disease took hold and adapted to the human host.”
“Means of transmission?” asked Marco. “Mosquitos, possibly? A bacterium in the water?”
“It moves too quickly for mosquitos,” said Henry. “We’ll see if the spread halts when your team takes control of the food and water sources, but it doesn’t have the characteristics of any bacterium I know of. I put my money on a virus.”
“Ebola?”
“The suddenness of the onset does suggest that. The high lethality, the rapid spread, the hemorrhagic fever—yes, it could be Ebola. But the only strain of the Ebola virus known to be in Asia is Reston virus, and that’s not been known to be pathogenic in humans.”
“What about Lassa fever or Marburg?”
“The carriers for those diseases are African mice and Egyptian fruit bats. Not found in Indonesia.”
“So, it’s a puzzle,” said Marco.
“A considerable puzzle,” Henry agreed.
“Stay well, Henry,” Marco said as he signed off. “We’re going to need you on this one.”
* * *
—
HENRY HAD COME to virology late in his career. His early work was in highly pathogenic bacteria, the source of many formidable diseases. Pneumonia, history’s great killer. Plague, the word itself evoking terror. Tuberculosis, still the number one cause of death from infectious disease. Yes, Henry respected bacteria. He thought he understood the clever mechanisms of contagion. Then Ebola had taken him to school. Among diseases, it was a diva—dramatic, sudden, and vicious. Bleeding was the most obvious symptom, out of every pore, eyes, ears, nose, anus, even the nipples, the fluid being a pathway for the virus to escape the body and search out new victims. At first, doctors mistook Ebola for Lassa fever, but one of the defining symptoms of Ebola was hiccups. No one knew why. Like influenza and the common cold, Ebola’s genetic material was composed of ribonucleic acid, or RNA. Other viruses, such as smallpox and herpes, were formed from DNA, deoxyribonucleic acid. The singular character of RNA viruses was that they were constantly reinventing themselves over and over again in what was called a “mutant swarm.”
Ebola was no more than a strand of RNA, coated in protein and wrapped in a lipid envelope. It sometimes developed branching arms or tied itself into a loose knot, like an ampersand or a treble clef. It was transmissible to humans from certain animals in the wild, especially bats and monkeys. It spent as much as three weeks in the body before symptoms