Skin Game: Outbreak Investigations, #2

CHAPTER ONE

10 months after being released from quarantine following the Hell Virus outbreak...

We've divided you into four investigative teams. You've been assigned an outbreak scenario to investigate. This is our way of determining which areas we may need to stress or omit from the curriculum all together. All of the details about your cases are in the folder on your worktable. You'll have... Lauren was interrupted by a knock at the door.

Enter, Lane said.

Sorry to intrude, but you're both wanted in Capt. Holden's office immediately, the private said.

We're teaching a class. Can't this wait? Lauren asked.

Lane had already started for the door. Tom wouldn't have interrupted if it wasn't important, he said.  

Fine. Review the material in your folders and get to work. We'll regroup when we return, Lauren told the students.

She and Lane followed the young private to Tom's office. Sorry to pull you out of class on your first day, but I've got an assignment for you, Tom said.

Now? What about the class? Lauren asked.

We'll have to reschedule. I know it's irritating, but you’re my senior investigative team. I need you in Southern Colorado ASAP. There's been an outbreak of bubonic plague. They thought they had it under control, but eight new cases have shown up in the past two days. I’m sure you realize how dangerous this is.

Don't you have anyone else you can send? We've only been back in the country three days as it is, Tom, Lauren said. We barely had time to prepare for the class.

Well, then maybe this is a good thing. You weren't really ready for the class anyway. When we reschedule, we'll make sure you have more prep time, Tom said, latching on to the out Lauren had inadvertently provided. Details are in the envelopes. Your flight leaves in three hours, Tom handed over a thick envelope marked classified to each of them. Do you want to tell your students, or do you want me to handle that?

We'll tell them, Lane said, following Lauren out of the office. I know you're upset, but there's nothing we can do about it right now. Let's go break the news to the students, gather up the class materials, and head home so we can get packed. We'll have lots of time to discuss it on the plane.

She said fine but he knew that wasn't what she meant at all. He suspected it would be a bumpy flight to Colorado regardless of the weather conditions.

CHAPTER TWO

It was a mad rush to pack and make it back to Ft. Detrick for their flight. The house was a disaster, but it would just have to stay that way for now. Lauren hated knowing she'd come home to such a mess, but there was no option. Over the past few months, she'd begun to regret her decision to leave the CDC and accept a position with USAMRIID. She never regretted her decision to move in with Lane, but lately, they had so little time at home together, she found herself missing him even though they shared the same address.

Settled into their seats for the flight to Colorado Springs, they both knew they should be reading the information about the outbreak, but both of them had other issues on their mind.

I'm sorry this has all gotten so crazy, Lane said. It really hadn't been this bad in the past. It seems that since you joined AMRIID it's been one major outbreak after another. I know you're stressed, and I'm sorry. If you've got any idea how we can fix this, just tell me.

I wish I had a solution to the problem, but I don't. I think the idea to train other investigators is a good one, but we can't seem to stay in town long enough to conduct the training. Until there are better trained investigators, I think we'll keep getting sent in on every major outbreak, Lauren said. I don't have any idea how to fix it, but I am nearly at my breaking point. For now, all we can do is try to wrap this case up as quickly as we can and push Tom for some time off. Maybe if we could get a few good nights of sleep in our own home, we'd be able to figure something out.

They spent the rest of the flight reviewing the information on the outbreak and making notes on what they wanted to investigate.

When most people in the US hear the word plague, they think it was a disease confined to Europe in the Middle Ages, but the American Southwest has plague cases every year. According to the data, the San Juan Basin area of southwestern Colorado had reported more than forty cases this year, with four fatalities.

Plague is carried by the rodent population and transmitted by fleas. The county health office called in a CDC team and it looked like they had the outbreak under control. Then in one day, the number of infected reporting to the ER skyrocketed to nearly four times the state's annual average. That's what prompted Lauren's old boss at the CDC to request help from USAMRIID.

CHAPTER THREE

After leaving the airport, Lauren and Lane found a hotel and spent the night in Colorado Springs before making the six-hour drive to their destination. They agreed to table any talk about the case until they were on the road in the morning. When Lauren left her job at the CDC to join Lane at USAMRIID, neither of them realized how difficult it would be to separate their work from their personal lives now that they shared both.

Something has got to change, Lauren said. I still love the work, but I want a life too.

I know. I agree, Lane said. I don't know if it really was always this bad and it just didn't matter to me when I didn't have anyone to share my life with or if it has gotten worse in the past year.

Don't get me wrong, it's great to be considered the top field investigators in the country, but we can't carry the load all by ourselves. I really thought the training class was a good idea, though I still feel as though we weren't able to put as much effort into the course as I would have like. I'm wondering if we'd have even gotten as much done as we did if we hadn't been quarantined for three weeks when we returned from Africa.

I know. I sometimes find myself wishing for quarantine again just so we can spend some time together not investigating a case. One thing we can do is ask for a week off. And I mean off, no cell phone contacts unless we're talking about an extinction level outbreak. In fact, I think I'll plant that seed with Tom next time I talk with him.

That would be great, Lauren said. Any uninterrupted time we can get would be terrific. I feel like we might come up with a solution to the problem if we could just think about it for a while.

It was a pleasant night of good food and good company. The plan not to discuss the case until the next morning had been a good one. With a good night’s sleep, they were able to get an early start. They grabbed coffee and decided to get some miles in before stopping for breakfast.

CHAPTER FOUR

Lauren and Lane were both experienced investigators. They knew once they reached the hospital they might not have a chance to sit down together for a meal anytime soon, so they enjoyed a hearty breakfast before heading west. Once they were on the road again, they discussed the case. Plague was nothing new in this area, but the number of cases was rising and that was a concern. The CDC team on site had tried to pinpoint a single source for the outbreak, but they'd had no luck. Most of the cases were from an area near Mesa Verde National Park where New Mexico, Colorado, Utah, and Arizona come together. Locally, the area is called the four corners. 

When they arrived at the hospital in Durango, they were met by the leader of the CDC team, Dr. Troy Smith. Hello, Dr. Jacobs, Mr. Brewster. We're glad you're here. I've got a conference room set up, and we'll get you up-to-speed, he said.

Lane and Lauren spent their first day at the hospital interviewing the patients and reviewing medical records. Over dinner, they discussed what they learned and what they needed to pursue the following day.

On the medical side, I didn't see anything out of the ordinary other than the number of infected. Their symptoms were classic and the disease's progression has been textbook in all cases, Lauren explained. Did you gain anything useful from your interviews?

Maybe. The CDC team asked all the routine questions and got the expected answers. This is where I think our methodology differs from what's normally done in these investigations, Lane said.

So what does the L&L method add to the picture?

When your research depends on asking people what they did, the value of that information has to be based on your level of surety that the patient is answering honestly, Lane explained.

So, you're telling me you smell a rat? Is that it? Lauren asked. How appropriate in this case.

As you know, the first twelve cases were all local residents at the low end of the economic spectrum.

That's not all that unusual when we're talking about a rodent-born infection, Lauren said.

But then the picture changes. The newer cases have all been tourists. People who aren’t residents of the local area, Lane said. They all visited Mesa Verde National Park.

I'm guessing you think that's important.

Yes and no. The fact that they're all tourists is important. I'm not sure their visit to the park plays any role.

Lane wasn't ready to share his suspicion, but he thought he was onto something. The next day's investigation should shed more light on things. Lauren had learned all she could at the hospital and the CDC was providing the necessary patient care, so she and Lane would continue their investigation into the source of the infections.

CHAPTER FIVE

Lane and Lauren headed out the next morning to play tourist. They checked into a hotel near Mesa Verde and toured the park. Lauren wasn't sure what they we're looking for. The only hints Lane provided was that she should play the role of a typical tourist and be particularly interested in any desert wildlife they came across. Her role for the day was not that of an infectious disease specialist or a physician. After spending some time in the park, they moved on to explore other tourist sites in the surrounding area. Desert canyons and mesas along with ancient ruins were the scenic draws of this corner of the state. They continued to play their roles as tourists from back east over dinner that evening enthusiastically discussing the beauty of the desert landscape and the interesting creatures they'd seen, even passing their phones to each other to look at photos they'd taken.

X X X

In the small town that most of the original plaque cases came from, they stopped for lunch in a small café. Lunch was good, and they were walking back to their car when they were approached by a young boy. The boy was maybe ten years old. Hello, senorita. Have you seen the ruins at Mesa Verde? he asked.

We have. They're amazing, Lauren answered.

Did you see the prairie dog towns? he asked.

We saw a few. They are so cute. I wish we had them back east, Lauren said, realizing at that moment what Lane suspected. Do they make good pets?