Virestorm Chapters 5 and 6

Chapter 5

Lahore, Pakistan

“Oh Mastouf, what is wrong?” His mother cried. She looked up to heaven
with heavy eyes. “What is wrong with my son” she thought to herself. For two days
Mastouf had been acting irritable, then he began coughing with a runny nose. This
wasn’t alarming but then this morning he barely woke up. His skin looked dull and he
was hardly breathing. She could hear the raspiness in his chest and every now and then
he would have a violent coughing fit and shaking chills. She had sent Ahmed to get the
doctor an hour ago but he hadn’t returned. All she could do was hold her small boy to her
chest and sing to him. Suddenly she heard noises at the door.

Finally, in walked Dr. Abed and her older son. She grabbed Dr. Abed’s hand and
led him over to Mastouf. Dr. Abed took a look at the small child and the one room house
he was living in. He could hear chickens chirping in the coup in the alley. These weren’t
the best conditions in Lahore but they could hardly be described as the worst. The
room, although dark and aged was clean. He leaned into the child and listened with his
stethoscope. He could hardly hear the air move with each breath. Mostly what he heard
sounded like rales of fluid. He shined his light in the boy’s mouth and could see that his
gums were a dusky blue.
The only chance of survival for this child would be at the main hospital, and that
was if they could get him there quickly and if there was room in the wards for the child.
He looked over to the mother, “He is very ill, his lungs are hardly working, he has caught
a very bad bug. We must take him to the hospital immediately.” The mother broke out in
sobs as the doctor picked up the child and carried him out the door.

Chapter 6

Ann Arbor, MI

“Alright Dr. Zack, I’ve got the paperwork for this one and this time the CDC
sent it with the history. Do you want to take a look while I begin processing the
specimens?” “No, that’s ok, just take a look at the timeline and names and let me know
what you come up with.”
Alex grabbed the box and went over to the containment area. She slit open the
card board box with a cutter and lifted off the plastic folder with the manifest. Next, she
lifted out the Styrofoam case enclosed in the airtight plastic bag. This she took over to
a large plastic case with a drop down door. She opened the door and slid the Styrofoam
case inside and closed the door. Next she activated a button that initiated a vacuum in the
containment cell. She pressed another button and the Styrofoam case was carried down a
short conveyor belt to a work station. Alex slid her hands into a pair of gloves through the
wall of the plastic containment cell. Next she grabbed a scalpel and slit the plastic case.
She gently opened the Styrofoam case and vapors escaped briefly coating the inside of
the containment cell and obscuring her view of the contents. Inside were two containers
filled with biologic material and marked with biohazard warnings on the outside. She
placed the packaging back on the conveyor where it was carried to a mechanized door.
Once the packaging entered the door it would be incinerated at 2000 degrees Celsius.
She took the vials placed them on another belt where they were carried
into a controlled temperature cooling room. Alex thought to herself that the vials would
be safe for a while and she turned her attention to the manifest. She carried the
paperwork over to her work station. She placed her right hand over the finger print reader
and her computer came to life. She entered her password and logged into the labs data
site. She read off the manifest and reviewed the identifying information. The CDC
organized the tissue sent to her with a series of words and numbers. Each vial was
sequentially numbered in the series. They always started with the virus identification. In
this case H5N1-Pakistan-Lahore-051208-MS the second vial was nearly the same H5N1-
Pakistan-Lahore-051408-AS. Next she entered the summary findings from the CDC. For
some reason technology had not gotten to the point where they could receive the manifest

information electronically into their system. Probably a fear of someone hacking the
transmission. Either way, Alex was stuck once again reentering the historical information.
MS admitted to Children’s Hospital and Institute for Child Health Lahore
(CHICHL) 05/10/08. This six year old child had purchased a chicken with his older
brother 3 days before admission from the local farmer’s market. He developed cold and
cough symptoms over the next 24 hours. This progressed to congestion, fever, cough and
chills. He was admitted to the hospital on 05/10/08. Initial Influenza A screen positive.
He was immediately isolated and his symptoms rapidly deteriorated. He was intubated
and placed on respiratory support. Intravenous fluids and antivirals were instituted. He
rapidly progressed to kidney failure. Over his final 24 hours he had fulminant organ
failure developed petechial hemorrhages over his skin. He finally succumbed to the
disease at 4:08 p.m. 05/12/08. Due to the rapid progress of his death and the history
of bird exposure a suspicion of bird flu was entertained. The CDC in Atlanta, Georgia
was notified. H5N1 was confirmed on 05/12/08 and appropriate specimen containment
was performed. Once confirmation was achieved the Lahore Department of Health was
notified for appropriate quarantine procedures.
Alex proceeded to enter the sequential laboratory values from the hospitalization.
Once this was complete she went on to the second vial’s manifest.
AS admitted to CHICHL 05/11/08 with initial symptoms of fever and cough.
Due to suspicion of H5N1 this ten year old child, who is the older brother of MS, was
immediately placed in isolation.
Alex continued to read essentially the same story of progressive symptoms in the
older brother. What a shame, Alex thought. Some mother lost both of her children in just
a few hours of each other. Alex pondered the situation, she couldn’t comprehend losing
a child but she definitely understood losing two of your most important family members
in just a blink of time. Yes, she definitely understood. Alex pulled her mind away from
her past and focused on the task at hand. She now had hours of work to go and she would
have to work hard to even catch a glimpse of Paula tonight.
After completing the entry of data Alex focused on her main task of the day. She
walked over to the bio-containment lab. The lab was very high security and required both
fingerprint and voice recognition. Once she entered the lab she donned her “moon suit”.
Alex usually enjoyed the complete peace and quiet of the lab although she was always
a bit annoyed with putting on the protective suit. Alex had long, and currently blonde,
hair and she was slender. Her hair tended to get wrapped into everything in the protective
suit and she always felt like she was swimming inside the thing. But, once she was
geared up and entered the pressure lock she would practically enter a trance. Alex placed
the earbuds of her iPod in her ears and hit the play button. The mellow and melodical
music of Joe Jackson’s Night and Day album began to play. For a brief moment she
remembered listening to that album for her first time while riding with her father and his
wife, Kimberly, on one of their first trips together to the Lake Tahoe ski resorts. As the
sounds of the album filled her ears and the hypnotic overhead fluorescent lights bathed
the room in a uniform glow Alex’s mind became super focused in the absence of visual
and auditory distractions.
Alex went to the specimen cooler and retrieved the two that she had sent into the
cooler earlier that morning. Next she retrieved six fresh chicken eggs each labeled with a
bar code for identification. She used a sterile needle and syringe and sequentially drew a

few milliliters of the turbid fluid in the specimen container and injected it into each of the
eggs. After each transfer she used a barcode scanner on both the egg and the specimen.
Fortunately, the eggs came pre-stamped with a unique barcode for identification. In her
first year in the lab she was tasked with stamping the eggs, a potentially very messy
process for someone new at the task and one she did not recommend when nursing a
hangover. She then placed the eggs in their own isolated incubation chambers.
Next Alex went into the room that housed the animals for testing. Usually several
tests were done for both virulence and transmissibility. The first was to see if a test
animal could be infected and then to see if the infection would spread from one animal
to the next. Alex took a look at the cages, twelve in all, each had it’s own ferret. All of
them looked healthy. Next she checked to make sure that all of the monitoring equipment
for each cage was in good order. Each cage had sensors for heart rate, body temperature
and weight. They also had automatic delivery of air, food, water and even nitrous oxide
for anesthesia. They also each had their own video camera and were able to be monitored
from the main lab. Even though there was a person in charge of the ferrets Alex never
trusted the lab techs. She went through each cage in detail. After all, this was her study
and if she didn’t want to be wasting her time she needed to make sure all was well.
Finally, before leaving she checked to make sure the simulated daylight timer was set
correctly. If the ferrets were given the wrong amount or timing of daylight they tended to
be pretty stiff by morning.
By the time all was done and Alex had changed out of the bunny suit and gear
and had shut down and logged off all of the computers it was only three o’clock in the
afternoon. Good, plenty of time to make the show and maybe even lay out on the deck
of her studio apartment in the sun. Paula was on at 9 and Alex thought she should have
plenty of time to change and get ready.
As Alex stepped around the corner of the lab Dr. Zack came running out, “ Alex,
we have another urgent delivery coming. Seven more specimens from Lahore. They
should be arriving any second. They were given top priority from the CDC and they want
us to start the cultures ASAP! This is now the largest outbreak since last year. I need
the cultures run and then when complete we need to get everything over to the electron
microscopy lab to analyze all nine specimens for mutations in the virus structure and
I need you to run gel’s on all of these and compare the RNA sequences to last year’s
outbreak.”
Alex let out a grunt and rolled her eyes but none of this was visible to Dr. Zack
since he was yelling all of this to her from inside his lab. “Great,” she thought, if she
was incredibly lucky and everything really did arrive in the next few seconds and she got
all of the specimens into cultures she would be lucky to get out by seven o’clock. There
goes her chance at catching the first real rays of sunshine Michigan had to offer since
October. Sometimes she wondered why she moved here at all. She could have stayed in
Florida with her mom and gone to a state school or she even could have moved back to
California. She still had a few friends there. Somehow, here she was working in this lab,
no real forward progress for years, and far off of her original path. And, that original path
was probably flawed from the start. It was probably just a way to earn daddy’s approval
and maybe pull a little attention away from his new wife, the “beautiful and perfect”
Kimberly. And then, just as things started to slide into place and Alex began to figure out
where she fit in “the tragedy” struck.

A knock was heard at the door and Alex walked over and let in the delivery man
from FedEx. After signing off on all three forms as well as the little tablet computer
she took the box over to her containment area and started working. First step, like
always, rubber gloves, open box, remove manifest and set to side. Next step pull out
the Styrofoam case in plastic and place it into the door to the containment cell. Just like
before she placed her hands into the articulated sleeves and opened the case. Inside there
were seven slots for specimens. Oddly, there were only six specimens though. Well, Alex
hoped it would all flesh out in the end. Maybe they miscounted somewhere along the
way. “Typical foreignors!” Alex thought to herself. Alex finished up this portion and sent
the respective items in their appropriate directions. Styrofoam case and packing material
to the incinerator and specimens to the storage cooler.
Next she pulled out the manifest and went to her work station. At least the initial
work had already been entered. If she was lucky then everything would be in sequence
and the data wouldn’t take too long.
Alex took a brief look at all of the included paperwork. Indeed, there were seven
people. Six children and an adult. Everyone appeared to have expired on the fifteenth.
The six children all were treated at the same children’s hospital. The only standout was
the one adult female thirty-one years old. She never even made it to the hospital. She was
found dead in her one room house. There appeared to have been some sort of a struggle
which was attributed to psychosis from the hypoxic effect of the virus on the lungs. There
was a great deal of blood. The sheets were soaked in it. She had a knife in her hand and
had stabbed herself in the chest three times. Due to the fear of contagion no one in Lahore
wanted to touch her or anything in the room. The local coroner apparently did a cursory
look over the body and brought her to the morgue. Ironically, the local Department
of Health official was in a home across the alley talking to the parents of the other six
victims. He had heard the commotion across the alley but hadn’t paid much attention
at the time. By the time word got to him about the adult he raced over to the morgue
and placed the whole area under quarantine. He then talked to his superiors who then
arranged for the harvest of specimen to be added to the shipment of the six children’s.
All of this was in the manifest. The whole sequence of events appeared very
strange but who knew what was “normal” in a Third World country. The six children
made considerably more sense. Apparently, all of them had played with the same bird
brought home by the original two victims. They all started coughing and sneezing that
night. The next day the local Department of Health official was walking through the
neighborhood to inform the neighbors of the outbreak and to watch out for just such
symptoms. As soon as he talked to the mother of the six children he had all six sent
to the children’s hospital. All six were placed in isolation and all six died. Basically,
an identical death of sneezing, then cough, then fever and chills, followed by labored
breathing, hypoxia and eventual death. No supportive measures helped, all children had
received antiviral medication but it was too little and too late. The respirators only briefly
prolonged their very short lives.
As Alex read through the manifest and entered the data into the computer she felt
a twinge of sadness for the tragedy that affected these two families. She also wondered
whether this would be “the one” the outbreak that finally raced through world causing
the chaos and death the CDC had been so worried about. The good news so far was that
all of the victims had physical contact with the bird. There was no mention of airborne

transmission. The only other oddity about this is that there was no mention of the bird.
Usually, the entire bird came in a separate shipment frozen. But, so far no mention of the
bird and whether it was being shipped. Once again, Alex chalked this up to the relative
incompetence of foreign nations when it came to these issues. “After all” Alex thought to
herself, “if they can’t even keep track of a disease outbreak and a bird how are they ever
to be trusted for everything else?”
Dr. Zack shouted around the corner, “So Alex how’s it all coming?”
“Well, at least everything arrived on time. I just finished entering the data and I’m
getting ready to go into the Cave. I’m hoping I can be done in the next couple of hours.
After I get the rest of this cooking I’m going to take off. I think by tomorrow morning we
should be able to start the analysis.”
Dr. Zack stepped around the corner, “That was pretty quick. How’d you get that
data entered so fast?”
“Well, basically the six kids had identical stories so I did a lot of copy and paste.
The only one that doesn’t fit is the adult mother of the first two children. She had a kind
of weird death. Also, I only got six specimens, I’m not sure which is missing and won’t
know until I get in the cave and start the cultures. Also, did you know that we haven’t got
a bird?”
“Hmmm, well I can send out a couple of emails after you tell me which one is
missing. Maybe it’s just a screw up at the health department in Lahore.”
“Yeah, that’s what I was thinking as well. Do you remember that outbreak last
year when the Chinese health department flipped around all of the ID information for
the specimens and it took like a week to figure out which person belonged to which
specimen?”
“Oh yeah, just punch away and we can catch up tomorrow. I also have a
proposition I need to talk to you about, but it can wait. I’m outta here. See you in the
morning.”
“Ok, see you then.”
Once again the underling stays late while the boss heads out. Probably to join his
buddies to a smoke a joint in the arboretum. Thoughts began to tumble through Alex’s
head again, she was frustrated and pretty annoyed. Maybe she should reenroll in the
medical school. They offered her an open opportunity to rejoin at any time. Alex knew
that eventually they would close that door she just wasn’t sure when. They gave a lot of
breathing room to the “flexies”.
Alex was one of a select few who was given the opportunity in high school to
enroll in Michigan’s special program of accelerated medical training. In six years they
combined undergraduate and medical school curricula. In addition, they placed you in
a research lab during the first three summers. The hope was that the ultra-bright who
entered the program would use the shortened program to add on a Ph.D.. Some did, but
the program was so intense that a lot of kids didn’t finish in six years or sometimes ever.
Alex fit into the latter group at this point. She still wasn’t sure what her destiny really
was. Ironically, Paula, who took forever to declare a major and couldn’t decide what she
wanted to do with her life was now nearing the end of her second year of medical school
and was getting ready to start her clinical rotations. Soon, she would be well ahead of
Alex.

Alex pulled on the protective suit and put in her ear buds. This time she decided
to honor the sunny day outdoors with a little Jimmy Buffett. Another tribute to daddy,
who turned her onto the music one day on a surf safari. As “Margaritaville” filled her
ears her mind turned away from her past and she began to focus on the task at hand.
Carefully she worked with each of the specimens, injecting tissue into the chicken eggs,
scanning the data, and placing them into the incubator.
Finally, Alex finished up, double and triple checked the incubators, cleaned
up and disposed of the needles and syringes, changed out of the protective gear and
reentered the main laboratory. She stretched long and hard and took a look at the wall
clock. Seven o’clock, plenty of time to get home and maybe even hit the tanning salon on
the way. Alex headed out of the lab, turning off the overhead lights and proceeded down
the hall. She exited the stairwell and stepped outside.
The sky was already dusk and the air temperature had dropped about twenty
degrees. She walked over to the bus stop and took the University bus down to South
University Street. She got off the bus and went down the street. She turned into an old
wooden door and ascended a narrow wooden staircase, she then entered through an even
older wooden door and came into a paneled room. Around the room were neon signs
and images of palm trees, waves, and over a small counter a rather too large neon sign
saying “Paradise Tanning”. This place must have housed dozens of different businesses
catering to different students tastes over the decades. She even heard that it was a pinball
arcade in her father’s years. Alex looked at the student behind the desk. A young girl with
long blonde hair and an obvious indoor tan wearing a tank top and shorts. The room was
warm, as it was all year long, and a ceiling fan rotated overhead to create a gentle breeze.
The music playing over the stereo was an old Bob Marley recording. Alex presented her
the frequent user card, and the girl, Stephanie, punched one of the marks on the card and
indicated to Alex to use room three.
Alex went into room three and began to undress. Since Alex didn’t really trust the
cleanliness of the tanning unit she did her usual thing and sprayed her own disinfectant
on the tanning bed and wiped it down. Just before she went to lie down she remembered
she was supposed to meet Paula for food across the street at Charley’s upstairs restaurant,
fondly referred to by Alex as “Up Chucks”. Alex quickly typed out a text, “Sorry, ran
late, at work, will meet at Union at 9.” Alex lay down on the tanning bed and once again
put in the earbuds, she clicked play and pulled down the clamshell top of the tanning bed
over herself. The warm tanning lights clicked on and the tropical music of Chris Isaaks
played into her ears. Alex began to relax and the stress of the day began to dissipate. Her
mind drifted as she fell into a deep relaxing sleep.