“Okay, so tell me about the University of Vermont,” Justman said. This was a “cluster,” a small group of deaths from which the working group might be able to draw some inferences. If there are three homicides in the same neighborhood on the same night, the first thing you want to figure out is what they have in common. Did the victims know each other? What did they do for a living? What were they all doing the day before they were killed? Diseases may not stalk their victim with a gun, but they each have a modus operandi, just like any other killer. If you figure out the MO, it will often lead you to the guy pulling the trigger.
“The UVM cases are kind of a head-scratcher,” one of the CDC staffers began. She was Indian-American, slightly older than the others around the table. “They were all athletes but different sports. They didn’t live together or take any of the same classes. I couldn’t find any evidence that they’d ever met.”
“It’s a small campus,” Justman said.
“True, but still nothing obvious. They weren’t sharing water bottles. They weren’t dating.”
“Food, maybe,” someone offered from around the table. “A dining hall, or the local sandwich shop.”
“Maybe,” the Indian-American woman answered, “but it doesn’t look like a foodborne outbreak. These were healthy young people. It wouldn’t explain why we are seeing a similar pattern in France and the UK. I don’t know. I’ve got nothing.”
“It probably is nothing,” said the only guy in a tie, albeit with a collar he had forgotten to button. He was the statistics guru, with no background in epidemiology or public health. He was paid twice as much as the rest of us, which we knew because the NIH needed approval from Congress to waive the pay scale to hire him. In the era of “big data,” every company was trying to digest terabytes of data to gain any possible advantage in the marketplace, whether it was pitching just the right vacation to divorced soccer moms in California or using online reading habits to sort the good credit risks from future deadbeats. Never mind that the NIH was using the same basic tools to save lives rather than sell shoes, the stats geeks were a hot commodity and we had to pay them a competitive salary. So we got Tie Guy (Marcus? Marc?). Word around the water cooler was that he could be smug and annoying, but it was hard to separate that from general envy of his highly publicized salary, like those college football coaches who make more than the university president. He did himself no favors by wearing a necktie in an office where the dress code consisted of matching socks, zipping one’s pants, and trying to make sure each shirt button went into its assigned hole. (Some of our brightest scientists routinely failed one or more of these sartorial challenges.)
To be fair, Tie Guy was a trenchant thinker when confronting complex challenges. I had first met him at a brown bag lunch several months earlier when he presented his findings on the impact of a proposed Chinese railroad that would connect a series of mining sites in South Africa and Zambia with a major port. He started the presentation with a pretty darn good line (as I recall it): “Copper, gold, and diamonds are going to move more efficiently on the railway. People are going to move more quickly and easily on the railway. And that means the HIV virus is going to be riding, too. I don’t know if the Chinese have named the rail line yet, but we should think about calling it the AIDS Express.” He had color-coded slides showing how the increase in mobility would change the AIDS infection rate under different scenarios, including different prices for a third-class ticket.
“Most of these clusters turn out to be randomness,” Tie Guy now told the members of Justman’s newly formed working group. “Six kids get cancer near the fertilizer plant. Sometimes six kids just get cancer.” Justman looked at him but said nothing.
“And sometimes the fertilizer company is dumping poison in the water,” said a woman across from him.
“True, but where’s our fertilizer plant here?” Tie Guy replied with confidence bordering on hubris. “If we can’t find a pattern, then it’s probably because there isn’t a pattern.”
“Let’s see what the tissue samples show,” Justman said. “Tatiana, can you speed that along and schedule something for all of us when we have data to look at?” Tatiana, who had been quiet for the whole meeting, nodded and made a note on her phone. “Thanks, everyone,” Justman said, bringing the short meeting to a close.
That was it. Not a lot of drama or excitement, a fairly typical meeting for anyone in public health. I was not in the room. There was no reason I would be.[3] This group was still a long way from having any idea what was going on. Only then would they call me.
11.
I APPLIED TO PH.D. PROGRAMS IN MICROBIOLOGY AND WAS accepted at the University of Chicago. Sloan went to law school. My parents were convinced that microbiology was close to medicine, and therefore I could still become a doctor. I never gave them this idea, but I did not disabuse them of it, either. During my third year in the Ph.D. program, when I had already adopted and abandoned three or four different potential dissertation topics, I applied to get a joint degree in public health. What was another two years and $140,000 of debt? My parents gradually accepted the notion that I was not going to become a doctor, though they never fully accepted the idea that I was a scientist. I once overheard my mother tell a friend that I worked “in medicine.” True, technically. Professor Huke’s class stuck with me, and I winnowed my doctoral research down to virulent pathogens. I really liked the scary ones. In my third year, I was able to work with Ebola, meaning that I had to put on the full level-four biohazard suit. Some people climb mountains for the thrill of it, knowing that one misstep could send them tumbling down a precipice. I felt that way when I put on two sets of gloves and entered the air-lock chamber. A little carelessness and I would be infected with a million viruses capable of making me bleed to death out of every orifice.
Dormigen changed that, obviously. By the time I was doing my fourth year of research, the most serious pathogens were no longer as excitingly scary, as if a giant net were installed around Everest to catch everyone who slips and falls. Still, the advent of Dormigen created a different kind of excitement. The research we were doing, particularly our growing understanding of the human genome, was producing giant strides in other areas of medicine. We reckoned that cancer was the next frontier (as it had been for several decades, admittedly). Dormigen did not work on tumors because they were not recognized as foreign DNA; cancer cells are mutant products of our own body, rather than invaders like the Ebola or Marburg viruses. But all of us working at that frontier were convinced that a Dormigen-type breakthrough was possible on the cancer front.
My doctoral research was intended to probe one possible link between viruses and cancer: the so-called “lurking virus.” What makes this kind of virus fascinating—and dangerous—is that it lies dormant in a host for years or even decades. Then, for reasons that we did not fully understand when I began my doctoral work, the virus turns spectacularly virulent, killing a high proportion of the infected population. This is entirely anomalous behavior among the hundreds of thousands of viruses that have been identified and studied. Viruses are usually benign or dangerous—not both. In the past, I have made the comparison—admittedly imperfect—to a workplace shooter. Some guy comes to work every day, settles into his cubicle, does his work, goes to the holiday party, complains about the Docu-Text scanner—normal to the point of fading into the background. That is even what witnesses sometimes say: “He was so normal” or “A very quiet guy.” Then one day he shows up with a semiautomatic weapon and starts firing at his coworkers. We are left with one overwhelming question: Why? And even if we have some insight there, we ask, Why that day? What transforms a guy from someone whom colleagues struggle to remember into a killing machine? What was different that morning, or the night before, or whenever he decided to massacre his colleagues instead of making car loans or selling motorcycle insurance? If we can understand that, we will have unlocked one of the deepest mysteries of the human psyche. And we may save a lot of lives.
3
The detail here comes from the Outbreak Inquiry Commission hearings, during which a group of Tea Party senators were obsessed with the idea that the NIH, the CDC, and the Federal Reserve had somehow—and for some reason that I never fully grasped—colluded to cover up early evidence of the Outbreak.