We all fall down, p.15
We All Fall Down, page 15
“You’re not thinking . . .”
“There’s no living sample anywhere in the world of the strain of Yersinia that caused the Black Death. Not even in a Level Five lab. I checked.”
“But . . .”
“Scientists in England have reconstructed its ancient genome from bone marrow found in a burial site in Hereford. They’ve cracked its full genetic code, Byron.”
“And you want us to compare the DNA of our current outbreak to the strain that caused the Black Death? Like we just did for the bioweapons?”
The implications of what she is suggesting suddenly sink in, and she almost shudders. “I think we have to.”
He studies her for a moment as if he might argue, but then he nods. “I think so, too.”
Chapter
Thirty-Two
Today is the twentieth day of February. Eleven days have passed since I contracted this pestilence. My fever has broken, the wounds are healing, and I grow a stronger by the day. However, I have shrunk to the point that my skin puckers between my ribs, and the mere effort of rising from bed to table tires me.
One of the cruel oddities of this infliction is that those who survive often go on to perish from weakness and neglect, because other members of their family are either dead or too terrified to tend them. I have no doubt I would be among those victims were it not for the attention I have received from the family of Jacob ben Moses.
Gabriella comes every morning. She carries with her fresh water from the well and more than enough food for a day. I am so hungry that perhaps I would find any victuals to be delicious, but I have developed a taste for the Hebrew food that they call kosher. My mouth waters at the scent of it.
Gabriella has also become my eyes and ears to the world outside of my room. The news she brings is not what I would want to hear but is no less than what I expect. The affliction continues to sack our once-proud Genova in a way that no invading army ever has. Gabriella tells me that the market is barren and public order has decayed in the heart of the town, forcing her to alter her route to and from my home to avoid the danger. Ne’er-do-wells maraud freely, stealing from the homes of the dead and the dying. They imbibe and gamble wantonly out on the streets in a manner that the city council and the church never before would have tolerated. The few remaining gravediggers charge such a king’s ransom that only the wealthiest can afford Christian burials for their loved ones. More and more victims of this plague are dumped into the sea or, sadder still, left to rot where they fall.
The horror of these revelations is only diminished by the grace and kindness of the messenger herself. Listening to Gabriella, I am reminded of the dark fairy tales my mother would recite to me when I was a child, and how they never really frightened me because her voice was the most soothing sound in the world.
Had someone suggested earlier that I could share so much in common with a widowed Jewess, I never would have believed it. However, I have spent more time with Gabriella than anyone since Camilla’s passing. We pass hours in easy conversation. Her passion for the art of healing surpasses even mine. Her knowledge of the writings of Galen, the Roman father of all medicine, is exceptional.
We are bound by more than just a shared interest in medicine. I had always assumed Gabriella and her husband to have been as childless as Camilla and I were. Yesterday, I told her of our despair over the many miscarriages and the one stillbirth Camilla experienced. Then I admitted what I had not shared with anyone before, not even to a priest in confessional: my wife blamed herself for our fate. Camilla believed that she must have been a sinner to have remained so barren. As I hurried to explain that I was not suggesting Gabriella was also somehow responsible for her own childlessness, she interrupted me.
I was not childless, Doctor Pasqua. I had Ester.
You had a daughter?
Ester was four years old when Jehovah took her.
I am so sorry. How did it happen?
She was bitten by a dog.
A stray attacked her?
No, the neighbor’s mutt. Ester loved the old dog, even though he was near death and crippled by rheumatism. She would rub his belly and scratch behind his ears. One day, the cur’s ear was swollen, so when Ester went to touch it, he bit her on the finger. It was little more than a nip. I thought nothing of it until a week later when Ester developed a high fever. And then her limbs began to stiffen.
With the lockjaw?
Yes. Ester did not survive another day after the first spasm.
I was at a loss for words. Even before this pestilence struck, I had seen too many children die from all manner of illness or accident. However, I was particularly saddened to learn that Gabriella lost her only child to such a cruel and casual whim of fate. I almost reached out to take her hand in mine, but I stopped myself before committing an act of such impropriety.
Her eyes welled with tears, but I was surprised to see her lips form a melancholic, yet almost joyful smile. Every day I had with Ester was a blessing, she said. I am grateful for each one. God did not take her from me to punish my sins, any more than Camilla’s barrenness was a penalty for hers.
I agree, I said. I only wish Camilla had believed it.
I am sorry for you both that she blamed herself, Gabriella said. In truth, I feel more fortunate than the mothers from whom the plague has stolen children. At least Isaac and I had the opportunity to bury our Ester and mourn for her in the proper Jewish tradition. I cannot imagine having to dispatch the most precious being in my life to the sea or worse.
Perhaps we both revealed more than we had intended, but we fell into a shy silence after this conversation and Gabriella departed earlier than on previous days.
Gabriella returned again this morning, but soon after she arrived, I received two other visitors. I could tell by the heavy knock on my door they were of the less welcome variety. The same two priests who had come for me before stood warily outside the open door, covering their mouths with their sleeves, as they announced that His Grace requested my presence.
Gabriella protested that I was far too weak to travel.
The taller priest looked at her as if he had just inhaled a foul odor. Is this woman a Jew? he asked me.
I told them that Gabriella was the daughter of a colleague who brought me daily supplies. I tried to silence her with my stare, but she would not abide.
He is in no condition to leave his home, she insisted.
The second priest turned to her with a fiery glare. We do not answer to any woman, he said, let alone a Jew.
I pretended to be overcome with a fit of hacking. The priests jumped back as if they had been startled by thunder. I panted as though struggling to catch my breath. This plague, I said. I do not have the lungs or strength to walk to the Archbishop’s palace. Perhaps in another week or so.
We have a horse for you, the taller priest said.
I argued that I was not fit for an audience with the Archbishop, as I had not shaved or changed in almost two weeks. But they were deaf to all my excuses.
The priests rode together on the lead horse while I trotted ten paces back, as per their instructions, on the second animal. At the palace, I was led to the Archbishop’s chamber and made to wait outside the door while the priests entered. After a delay, they emerged from the chamber and the taller one commanded me to go inside.
The Archbishop was seated in the same raised chair as before while a fire raged even more intensely at his back. He clutched a handkerchief across his mouth and nose. No farther! he cried the moment I crossed the threshold.
I stopped and bowed to him from across the room.
So you have been afflicted after all, Doctor Pasqua, he said through the cloth.
Yes, Your Grace.
And yet here you are. It seems my prayers for you have been answered, unlike those for so many other of my parishioners.
Thank you, Your Grace. I have been more fortunate than most.
So it would seem. Would you care to elaborate on the secrets of your recovery?
There is no secret, Your Grace, I said, and explained how I had contracted the skin form of the pestilence, which had spared my lungs. I described how I had applied the time-honored traditions such as balancing humors and applying salves, but I made no mention of Jacob or his family.
The Archbishop grew impatient. Tell me, then, who was this Jewess who was at your bedside when my priests came for you?
She is no one. An errand girl. Her father is a colleague.
A doctor? A Jewish doctor?
A physician, yes. Doctor ben Moses. But he is merely an old acquaintance.
Surely you must realize it is against the law for a Jewish doctor to treat a Christian? the Archbishop said.
I do. He did not treat me.
It is not only illegal. It is blasphemous.
Your Grace, I also treated myself with a remedy that is most extraordinary, I said, as I was most anxious to direct his attention away from the involvement of Jacob or his family.
What is it?
The blood of the rats. From the San Giovanni Monastery.
You drank rat’s blood? he asked as he stood in outrage. What kind of pagan ritual is that? It reeks of Satanic worship.
These are no ordinary rats. These are the creatures I described to you and Doctor Volaro. The ones blessed with the ability to ward off the pestilence.
No animal is blessed, let alone a lowly vermin!
Not blessed by God, of course. But somehow they possess the ability to resist this illness like no other creature alive. Ask Don Marco. He will tell you the same.
The Archbishop sat down and brought the handkerchief back to his mouth as he considered my argument. Are there more of these vermin at the monastery? he asked.
I believe so, I said, sheepish for having betrayed the confidence of a friend.
This is most unusual. I will speak with Don Marco.
My legs were growing weak from standing, but the Archbishop seemed in no hurry to dismiss me.
What of the Jews, Doctor Pasqua? he asked.
What of them, Your Grace?
You said the rats of San Giovanni were the only creatures who escaped the plague, and yet clearly so, too, did this Jewish physician and his spawn. What about other Jews?
They are as susceptible as anyone else. I hear the losses in their community are as great as ours.
Their losses? The Archbishop grunted. These infidels live off of our good grace. By our protection. And what do they provide us in return? Do they contribute to our harvest? Do they build our houses? Do they worship our God? No! At most, they lend us their money and charge us usury in exchange for our Christian charity.
I had to bite my tongue so as not to point out that the Jews were banned from participating in guilds or most other forms of commerce.
The Archbishop motioned around him. Even now, I still repay David ben Solomon for the exorbitant loan he bestowed upon me to complete this house. This humble shrine to the Lord, built with money from an Israelite. A debt my parishioners might never be able to repay.
It is unfortunate, Your Grace, I said.
There are those who believe the Jews have been spreading this pestilence all along. I have heard whispers that the rabbis, those pagan priests of the Jews, are poisoning the wells.
But Your Grace, how is that possible when this miasma spreads through the air like a vapor?
The Archbishop did not appear to hear me. When he spoke again his eyes seemed to look right through me. Doctor Pasqua, is it not my duty as a spiritual leader to take any and all steps to protect the faithful?
I thought again of those doomed residents who were barricaded into their own homes and left to die. For the first time in days, I experienced another chill.
Chapter
Thirty-Three
Even though Alana sat at the same long conference table only three and a half days earlier, it feels more like a month. Her good shoulder aches for a change, after being vaccinated a few minutes before. The limited supply of American military plague vaccine arrived that same day, and the meeting’s attendees were among the first to receive doses.
Sunlight streams through the thin shade covering the window of the Municipo’s top-floor conference room, bathing the room in a bright glare. The table is as crowded as before, but many of the faces have changed. The Italian minister of health, Laura Pivetti, has joined her doughy-faced deputy at the table. Pivetti is a good-looking, olive-skinned woman of about Alana’s age who has an air of someone accustomed to getting her way. Several other officials are also present, including Sergio Fassino, Genoa’s mayor, and the entire WHO team.
Byron spends the first ten minutes updating the attendees on the outbreak. He projects on the screen above him the same image of its spread that he shared with Alana. Charts, maps, and tables demonstrate the geographical and chronological extent of the disease.
“We have fifty-six infected. Twenty-two dead so far.” Byron pauses and the room goes dead silent. “Inevitably, this will only be the tip of the iceberg.”
“So just to review, Dr. Menke,” Pivetti says in a tone that only heightens the already taut atmosphere. “This epidemic has increased from two cases to almost sixty in the time since the WHO has been managing it?”
“That is correct, Minister.” Byron breaks into a smile of pure defiance. “Of course, almost half of those cases were incubating before we arrived. And in that same time frame, we have seen the fatality rate drop from one hundred percent to roughly forty percent. There has been no further in-hospital transmission. And so far, no spread beyond Genoa.”
Pivetti views him icily. “Yet I would not describe the situation as controlled. Would you?”
“Not in the least, Minister. As I said, it’s only going to get worse. We have a reservoir of infected animals and fleas in a park in the heart of the city. This infection kills faster than almost any other one we know of. The spread is accelerating. And, most worrisome of all, we have already seen two cases of multi-resistance. This bacteria has the potential to become an international epidemic or, worse, a pandemic.”
“Resistance? What does this mean?” the mayor asks in a pained tone.
“This bacteria has an uncanny ability to rapidly acquire resistance to antibiotics.”
The color drains from the mayor’s cheeks. “Are you saying we might soon not have any treatment available?”
“It’s possible, yes.”
“Then how will we control it?” the mayor asks, gripping his upper arm. “With this vaccine?”
Byron turns to the bearded Swedish vaccine expert. “Dr. Larsen, care to comment?”
Larsen pulls his glasses off and taps them against the table. “At best, the American military vaccine will provide seventy percent immunity. Besides, there is only enough to immunize a few thousand people, not the whole city.”
“That is all we have?” The mayor looks as if he might jump out of his seat.
Larsen taps his glasses even faster. “Our Geneva lab is already working on developing a vaccine for this specific strain of Yersinia, but it will take a minimum of four months before it’s available.”
Byron glances at Alana. “We are also developing an antiserum using antibodies from the blood of survivors. But its availability will be measured in weeks, if not also months.”
“And in the meantime?” Pivetti demands.
“We continue to do what we are already doing, Minister,” Byron says. “We treat anyone with suspicion of the plague with antibiotics. We quarantine known victims and do aggressive contact tracing. We screen all air, sea, and rail travel points for symptomatic people. We apply aggressive pest control measures to the local rat population, especially in the parks.”
“Good luck with that!” Justine pipes up. “Unless the plague does the pest control for us.”
“And finally, we are about to embark on a strategy of ring prophylaxis.”
“What does that involve?” Pivetti asks.
“In the sixties, the WHO effectively eradicated smallpox using the same approach,” Byron says. “They would locate any villages or towns with smallpox victims and then immunize everyone living in the ring—the immediate vicinity—surrounding that hot spot.” He levels an infrared pointer at the map on the screen and encircles the areas around the construction site, the hospital, and the Parco Serra Gropallo. “We’re going to do the same with these foci of outbreaks here in Genoa. We intend to treat everyone living in a one-mile radius of these hot spots with antibiotics, even if they’ve had no known contact with any victims.”
“How do you expect to stop this . . . this organism, when you do not even know where it originates?” Pivetti challenges.
“I didn’t say we expect to stop it,” Byron says with an affable smile that contradicts his tone. “At least not yet. At this point, we’re focusing on containing or, to be more accurate, slowing its progress.”
The minister turns to Alana, her stare penetrating. “Dr. Vaughn, what does NATO have to say? Have you determined whether or not this is an act of terrorism?”
“No, not for certain. This microbe isn’t a match for any known form of bioweapon. But we still cannot rule out deliberate spread.”
“How do you explain Yasin Ahmed?” Pivetti asks. “And his disappearance?”
“I can’t,” Alana admits. “Not yet.”
“There has been no trace of him in over a week, Minister.” Sergio speaks up for the first time. “However, we have found no evidence to link him to Islamic extremism. The terrorists we arrested yesterday were working on an attack unrelated to the plague.”
The minister folds hers arms across her chest. “So, to summarize: we do not know where the germ comes from, how it spreads, who is spreading it, or how to stop it.” She glances around the table. “Does anyone have anything helpful to add?”
The simmering room explodes in multiple voices. Byron eventually quells the racket with a whistle. The heated discussion devolves into a rehash of conflicting ideas. Pivetti soon loses patience. She cuts the discussion off and sets another meeting for the same time the following afternoon. As she rises from the table, she stares at Byron. “By then, hopefully, we might have a few actual answers.”
