transferring the blood serum from survivors into symptomatic patients. “These are terrible studies,” Marco said. “No random trials. No dosages given, nothing standardized. They were done in wartime, under censorship, which may have prevented the publication of negative outcomes. The results are all over the place.”
Marco was sitting at his desk in the virology lab at the CDC, with his colleagues gathered around, where Henry longed to be. All of their faces, like Marco’s, were studies in sleeplessness, but there was also a glint of hope in their eyes.
“But…?” Henry asked.
“But there was a measurable reduction in lethality.”
Transfusion had its own set of hazards, as everyone knew, including lung injuries that could be fatal. It was a last-ditch measure. For ordinary transfusions, both the donor and the recipient needed to be tested and the donor blood screened for infectious agents. The procedure had to be done in a highly sanitary environment. If successful, there would be many more potential recipients than donors, raising incendiary triage issues.
“I found something else, more recent,” Marco said. This was from The New England Journal of Medicine. In June 2006, a Chinese truck driver tested positive for H5N1 influenza A, which was pandemic in poultry and highly fatal in the few human cases that were reported. The driver had been sick for four days when he reported to a clinic in Shenzhen. He was treated with antivirals, which failed to stem the progress of the disease. In desperation, doctors obtained plasma from a convalescent patient who had recovered from the same infection several months before. The driver was given three 200-milliliter transfusions over two days. “Within thirty-two hours, the viral load was undetectable,” Marco said.
“Get Jane Bartlett on the call,” Henry said.
Moments later, Lieutenant Commander Bartlett’s face swam into view.
Marco explained the dilemma, which she was quick to grasp. Transfusions were different from monoclonal antibodies, which could be purified, tested, and mass produced. On the other hand, with transfusion, a single convalescent individual could supply sufficient plasma to treat several patients at once.
“You’re talking about one confirmed patient in the last hundred years,” Bartlett observed of the studies mentioned. “I don’t see how we can make policy based on that. Is the CDC willing to recommend the treatment?”
Marco waited for Henry to answer. “Not without human trials,” Henry conceded.
“So, another six months,” Bartlett observed. “If we don’t have Medicare and private insurers on board, who’s going to pay for the treatment?”
“Can’t you ask Health and Human Services to authorize it as a public health emergency?”
“Henry, of course I can, but that’s not going to solve the insurance problem. This procedure is completely untested. The studies are unreliable and inadequate. The liability issues for physicians are formidable, maybe unmanageable.”
“But if you were treating a patient with Kongoli—fever spiking, viral load climbing, unresponsive to any treatment—what would you advise?” Henry asked. “What would you do?”
“Anything,” Bartlett said, her voice breaking. Everyone immediately recognized the emotion. They had all lost someone. They knew what was coming.
* * *
—
DESPITE THE PANIC, there was practically no evidence of Kongoli in the U.S. An outbreak in Minneapolis was mild and quickly contained. The index case was a traveler from the Middle East, which fed conspiracy theories about the Muslim disease. It turned out the traveler was an evangelical Christian who had been on a trip to the Holy Land. How he came down with Kongoli was a mystery.
At the same time, more than twelve hundred cases of seasonal influenza were diagnosed in Minneapolis, nearly all of them H1N1 influenza A, the great-grandchild of the 1918 pandemic—still considered a virulent strain, having killed eighty thousand Americans in 2017, and as many as half a million worldwide. But only four patients tested positive for Kongoli, including the traveler, and they all survived, lending hope to a theory that a competitive flu strain might provide some immunity against a new pandemic.
There was comparatively little influenza A in Little Rock, where the second outbreak occurred, and there Kongoli proved much more contagious. Still, the virulence was within the parameters of what people thought was an ordinary flu season. Within a week, grocery stores reopened, and other businesses quickly followed. Political pressure was building to open the borders and let the economy breathe. In places where the flu had not yet been reported, people told themselves that, for the moment, they were still safe.
And then came Philadelphia.
Of all the cities to suffer the heavy blow of contagion, Philadelphia was the one most informed by history to