Unlike other hemorrhagic fevers like the Ebola virus, Rift Valley fever has a special affinity for the liver, where it concentrates necrosis, the destruction of cells. Each virus is 100 nanometers long (500,000 could fit on the head of a sewing pin) and has an envelope that binds to the wall of a liver cell and enters it. Inside Jeff's liver cell, the envelope opens and releases a second shell, which in turn releases three strands of nucleic acid that unfurl and replicate inside the cell, until the pressure of the baby viruses against the cell wall forces it to burst. Dead tissue is mottled with yellow blotches and blood. His lungs and spleen are attacked, too. The gallbladder swells to four times its usual size, congested with fluid and blood.
Jeff staggers dizzily into the emergency ward and he's admitted immediately. The doctor on duty pulls the curtain closed and helps his patient sit up. Contact with the virus is easy enough — through the skin via the mouth and nose, inhaled directly into lungs, or by the bite of a mosquito. Weak and semidelirious, Jeff coughs without covering his mouth and sends virus particles through the air. The doctor's next breath draws them into his own lungs.
The virus breaks down the integrity of Jeff's smaller blood vessels, and when they give way there is noticeable bleeding. Jeff has his first bloody nose, which lasts for an hour even though the nurse applies pressure and tilts his head. While the nurse controls the nosebleed, her skin comes into contact with his blood. Vessels in his small and large intestines begin to collapse. That evening, he defecates diarrhea and dark blood. Blood shows up in his urine. Hemorrhaging in his eye covers parts of the retina and the optical nerve so that Jeff goes blind in his right eye and can see only shadows through his left. Hematomas appear on his torso, broken blood vessels near the skin. Capillaries near the skin collapse and cause red dots on his arms and legs.
The medical staff is perplexed. The ER doctor calls in the head of infectious disease to have a look. Their patient is slipping out of consciousness; he can no longer speak. Before they can do anything meaningful, they need to know what they're dealing with. Jeff's blood test results are in, and alarmingly, the results indicate nothing — or nothing that the hospital has the capability to test for. The two MDs argue about the situation as they frantically flip through their Merck Manuals. Could this be a viral hemorrhagic fever? Could it be Ebola virus? With no established course of treatment, there's little the doctors can do. They place an emergency call to the county health department and warn them of their preliminary diagnosis. Despite futile efforts, within twelve hours Jeff suffers near total vascular collapse. He goes into a state of shock and loses pulse. The medical team rushes to his side and tries desperately to revive him.
It's too late. Jeff's gone.
Next morning, the doctors and nurse contract flulike symptoms themselves. If they are bitten by an insect out in the parking lot or in their backyard, or if they breathe on another family member or use the telephone, the virus will gain more momentum.
As Jeff lay on his deathbed, Jane began to suffer a severe headache. A migraine, she figures. But on Sunday night, she suffers a seizure. Panic-stricken, her husband rushes her to the hospital, the same one Jeff went to. In her case, the Rift Valley fever virus chooses to cross the blood barrier and enter neurons, and it attacks her brain. Edema, cell fluid from the broken-up neurons, swells and inflames her healthy brain tissues. Hemorrhages occur. The emergency room doctor on the second shift doesn't connect Jane's symptoms with the patient who died earlier. That was an isolated case with no confirmed diagnosis. Instead, this doctor guesses Jane's ailment is a case of encephalitis — like West Nile virus — and administers Acyclovir intravenously (as prescribed in her Merck Manual) to help ease the brain inflammation. It works, but moments later she lapses into a life-threatening coma. Jane manages to pull through, "lucky" to have contracted the encephalitis brand of Rift Valley infection, instead of the hemorrhagic fever that stole Jeff's last breath hours before.
Meantime, Laura, the other patron at Claudio's bitten while in line, feels nausea as she readies to leave her summer cottage — where she's been tilling the garden and picking out new kitchen cabinets — for work Monday morning. "Maybe I'm pregnant," Laura hopes to herself. They've been trying for a baby for months now. With an extra spring in her step, she walks to the train station to catch the train to Manhattan. "I'll be fine," she thinks, smiling. "If it's what I think it is, a little morning queasiness is nothing." At work that day, she slices her finger on the paper cutter; a co-worker rushes to her aid. Now he has come in contact with the virus running through Laura's veins. He lives across the Hudson River, in Metuchen, New Jersey.
That same morning, Sunny, the golden retriever nabbed by the same mosquito as Laura, collapses on the living room floor. The owner of the spry three-year-old knows immediately that something is wrong. He carries Sunny outside, lays her gently on the bed of his Jeep, and rushes her to the vet. The vet takes a look at her and shakes his head in doubt. He instructs the lab tech to draw a blood sample. "The test should tell us something," he says in a comforting voice. But by the next day, Sunny succumbs to an unknown. The lab tech develops a bad cough and has sharp pains in her stomach that evening. She calls in sick the next day. She is one of hundreds already in direct contact with an infected friend, relative, or co-worker.
And this is just the beginning.
AFTERTHOUGHTS
Plum Island scientists voice their own fears, in a piece submitted to the New York Academy of Sciences, only a few years after their experiments:
Introduction of Rift Valley fever virus into northern North America in the spring, when mosquito activity is on the rise, would pose a greater threat than an introduction in the late fall, when a frost would kill the mosquito population and potentially end the outbreak. Numerous North American mosquito species are competent laboratory vectors of Rift Valley fever virus. The development of an epizootic [disease in large numbers of animals] / epidemic also requires the prevalence of amplifying hosts, such as cattle, sheep, and goats [and people], with levels of viremia high enough to infect vectors.
A self-indictment. The record shows Plum Island was well aware of the dangers posed by its research in a dilapidated laboratory facility.