Read an Excerpt
The Second Coming
Kolkata
It was an hour after sunset when the bright orange van carrying Dr. Shakira Khan arrived in front of the India Institute of Hygiene and Public Health in downtown Kolkata.
Khan was displeased.
The travel assistant on loan from the U.S. National Institutes of Health had not counted on the ride from the airport being so choked with traffic, and as a result, Khan and her dream team of scientists flown in from across the globe had suited up too early. They had baked for half an hour inside their biohazard suits as the van inched its way down Chittaranjan Avenue in the sweltering heat of an Indian summer evening. Lumbering in front of their van for the entire trip was a decrepit sewer sump truck that billowed large black clouds of diesel exhaust into their open windows.
Khan sat completely stiff and alert in the front row, eyes moving from side to side as if scanning the scene for danger. She stood up before the van came to a halt at its destination and turned toward the anxious team assembled in their neon-yellow coveralls, arranged two by two in their seats like eggs. The mood was tense.
“Can everyone hear me clearly?” Khan asked.
Heads nodded in the dim light of dusk all the way to the back of the long van.
“Excellent.” She turned to the travel assistant seated in the front of the vehicle. “What is your name?” she asked the young woman, loudly enough for even those in the back to hear.
“Jennifer,” she replied, with a broad, toothy smile.
“Jennifer, you’re fired,” Khan said. “Out of the van now!” She pointed to another young assistant near the front whose name she did not know. “You. Congratulations. You are our new logistics coordinator. This won’t happen again. Anyone else in this bus capable of doing their job, follow me.”
The best public-health-crisis team the Global Outbreak Alert and Response Network could field—at least on such short notice—shuffled through the narrow front door of the van without a word, passing by the former travel aide, who stood in tears. Made up of experts gathered by the World Health Organization and including scientists from seven member countries hosted by the India Health Ministry, the GOARN rapid-response team had been hurriedly assembled to investigate one of the deadliest and fastest-spreading epidemics reported in years.
Leading the effort was Khan, widely acknowledged as the foremost immunologist and contagious-disease specialist in the world. A swashbuckling but brilliant scientist, she was a veteran of high-risk public health investigations involving disease outbreaks of international importance. Her work had taken her to Bangladesh, Sudan, Afghanistan, Kosovo, Ethiopia, Yemen, and beyond. Her knowledge of the field, combined with leading-edge practices she pioneered for WHO, had helped to prevent pandemics of bird flu, SARS, Ebola, and West Nile virus. Over the years, she had saved an untold number of lives and earned numerous international public-health and safety awards.
But her challenge in Kolkata was immense, and she knew it. While the morbidity rates—the percentage of the population affected—for the unnamed disease were similar in scale to those of the Ebola virus, the fatality rates for those infected were not. One-third of those stricken by a recent outbreak of Ebola in the Republic of the Congo had survived. This unidentified disease, which had slowly slithered its way like a snake through both posh and poor neighborhoods in India’s seventh-largest city, had killed every soul infected in its path.
“Dr. Khan, we’re ready for you in the theater just upstairs,” the director of the institute announced as he greeted her in the lobby and grasped her hand warmly in appreciation that she’d arrived. Khan was revered in public-health circles, and her presence meant both expertise and welcome relief. “It will be a comfortable place to brief you and your team. We have tea for you as well.”
“I’m not interested in a briefing, and I’m not interested in your tea,” Khan said. She tugged a well-worn biohazard hood over her head and completely covered her face except for the small glass window that revealed her intense eyes. The nearly twenty scientists and assistants on her team knew the drill and followed suit, pulling on their hoods as well. “Get me to your lab, or get out of my way,” Khan said flatly.
For those detailed to the project who’d gathered from around the world, a few of whom had worked with Khan before, her utter lack of social graces—indeed, her trademark rudeness—came as no surprise. Khan’s team had simply joined a long line of predecessors on previous assignments who had been humiliated, humbled, degraded, demeaned, or debased in her service. Those not around to tell war stories about their treatment by Khan had either quit in fear or, more likely, been caught in her firing line before. Nicknamed “Genghis,” after the bloody warlord of the twelfth century, by those who’d had the displeasure to work with her on previous assignments, Khan was insufferable to nearly every person she met. Blunt to a fault and intellectually overpowering to most, she took no particular pleasure in degrading those in her presence. She simply had no use for most people. She found them to be impediments to progress she could likely achieve more readily on her own.
She was born to a Mongolian father descended from an ancient line of itinerant cattle breeders and an illiterate Hungarian mother who’d fled life on a failing wheat farm. Her most striking feature, beyond her impossibly caustic manner, was her devastating beauty. Like the attractive delphinium that graced the slopes of her mother’s homeland, she was pleasing to the eye but poisonous to the touch. Her hair was thick and jet-black. It surrounded her sun-washed face in jagged edges she trimmed herself, most often arranged to conceal her expressions or block others from her view when she wished. Her wide blue eyes, framed by nomad cheekbones common to the rangelands of Central Asia, were a stark contrast to the rustic desert tan of her face. At thirty-eight years of age, she was as exotic as she was outlandish, and every aspect of her attitude and presence seemed designed to prove it.
When Khan and her team burst into the institute’s laboratory, they came upon a haphazard area filled with tired incubators, refrigerators, centrifuges, and microscopes on a half dozen tables hurriedly arranged in the center of the room.
“Who is in charge of this room?” Khan asked as she strode forward. Her voice was slightly muffled under her thick hood.
“I am,” a young Indian scientist said as he approached to meet her. His tired eyes greeted Khan through his dingy blue mask. It was plain he’d gone without sleep for days. He held out his hand to shake hers but was ignored. “I’m sorry the lab looks a mess, but as you can imagine, we’ve been through a great deal,” he said.
“It’s not a lab,” Khan said, “it’s a disaster. But that’s India for you, is it not?” She looked directly into his eyes and didn’t wait for an answer. “I want to see the specimens you’ve collected, presuming you haven’t lost or destroyed them. Are you capable of that?”
“Dr. Khan,” the lab director replied, exhausted and clearly offended, “we are honored to have you here. But I don’t know that insults are necessary. I’m more than happy to get you what you want without them. If I could first give you an overview—”
“What is your name, sir?” Khan said.
“I am Raj Sen. Dr. Raj Sen. I am the director of this lab.” He rose onto the balls of his feet.
“You are Hindi? Sikh? Whom do you pray to when the proverbial stuff hits the fan?”
“Actually, I am Christian.”
“I have single-handedly saved more people on this earth than your Jesus Christ. If I am to do that here, in this godforsaken place, I need answers—and now. Stop wasting my time and tell me where the specimens are.”
Sen gave her an odd stare and backed away. “They’re here,” he said. He pointed toward a large glass enclosure with several shelves and two six-inch-wide holes spaced closely together. The openings, covered with neoprene seals, allowed safe access to what sat inside. On the shelves in the glass box’s interior sat several dozen petri dishes, each carefully labeled with its contents.
Khan pressed her hood against the glass enclosure and reached her gloved arms through the holes for one of the several specimens inside. She pulled one close to the glass in front of her to examine it.
“You have doctors on staff who have attempted aggressive antibiotic regimens for those afflicted?” she asked.
“That’s correct.”
“Streptomycin, chloramphenicol, tetracycline, gentamicin, doxycycline, and the like?”
“We’ve tried them all.”
“All patients deceased? Regardless of dosage?”
“Yes.”
“Yesterday I was told the number had reached three hundred or so,” Khan said.
“Almost a thousand more since then, Dr. Khan.”
“Accelerating. I will want to examine several of the most recent dead myself. I want only those who’ve succumbed in the past twenty-four hours. I’ll need you to arrange that. No briefings. No tea. Just arrange it.”
“Of course.”
“I see by the samples that there is not a single incidence of flea vomit discovered in any of these.”
“None.”
“This is not garden-variety black plague,” Khan said. “What are you finding?”
Though Dr. Sen’s face was hidden by his mask, Khan could see the fear in his eyes. “From the interviews we’ve been able to conduct in the last twenty-four hours, we’re getting a clearer picture. It appears the disease . . . the disease—”
“The disease what, Dr. Sen? Spit it out.”
“It appears to be running free.”
Khan paused for a moment. “Airborne? Are you suggesting airborne contagion?” Even she appeared rattled.
Sen’s voice began to quaver. “The evidence suggests transmission of all types. Bodily contact, blood, coughing, sneezing, fecal-oral, and, yes, airborne.”
Khan slowly removed her arms from the sterile incubator. “Let me see your slides. I want to see this beast under a microscope myself,” she said.
Sen carefully reached into the glass enclosure, pulled out a small steel box, and led Khan to a large microscope two tables away. He carried the box gingerly. Khan’s entire entourage shuffled forward and leaned in when they reached the table. Sen delicately pulled a single glass slide from among several in the box and stooped over the instrument. He gently slid it into the microscope stage above its diaphragm and turned on the light. He leaned forward, rotated the objective lens to 100X, and adjusted the coarse-focus knob.
“Your eyes might be better than mine,” Sen said. “If you’d like, I can . . .”
Khan could tell he was having difficulty getting a clear view of the slide through his worn biohazard mask. She stepped forward and nudged him slightly away with her hip. Then she leaned in and placed the glass of her own mask directly against the eyepiece of the microscope to examine what she had traveled five thousand miles to see.
“This is absurd,” Khan said. “I’m unable to get a fix on this.”
A trace amount of fog inside her mask from her breathing obscured the target slide. Frustrated, she tore away her biohazard hood and tossed it toward Sen, who caught it with both hands. She set her naked eye against the eyepiece. Gasps came from some in her entourage. The slide she was about to examine contained live bacteria with airborne potential.
She held up one hand in the group’s direction as if to stiff-arm their concern, and with the other hand she adjusted the fine-focus knob of the microscope to her satisfaction.
“I’ve been exposed to more life-threatening viruses than any other living human and survived,” Khan said. She stared through the lens carefully for more than a minute, not saying a word. The room was silent.
As she continued to look into the eyepiece, the cell phone in her pocket rang. Without removing her eye from its focus on the slide, she reached her arm inside her biosuit for its tiny interior pocket, pulled out her phone, and put it to her ear.
“I’m busy,” Khan said. She continued to hold her eye steady on the microscopic scene that unfolded before her. “This is different . . . No. Not one I’ve seen before . . . Way past blood-borne . . . I’m being told it’s airborne . . . You heard me . . . It’s very strange . . . That’s my feeling too . . . Hah! . . . I would try prayer, Mantas.”
With that, she hung up, returned the phone to her pocket, and continued to stare intently at the slide below. Finally, she looked up at the sea of concerned faces in her group, which she seemed to have forgotten. Their looks were locked in apprehension; a few showed signs of dread.
“Come along, now, children,” Khan said. “Let’s examine the dead.”
