The Cobra Event (32 page)

She gave an alarm cry, faint. Her teeth were covered with blood.

He had not held his breath. He turned and made his way back up the stairs. He had been inside an explosion test chamber at Koltsovo. This one was used for testing freeze-dried Ebola virus preparations that the Soviet Union was developing for missile warheads. The same chamber was also used for testing smallpox for warheads.

Three days after he walked into the Ebola chamber in Corpus Zero, Littleberry developed a fever and collapsed. He was rushed to the Koltsovo biocontainment hospital. It was a hospital with dozens of beds, behind steel airlock doors, where nurses and doctors wore space suits.

“I had airborne Ebola,” Littleberry said.

“Why aren’t you dead?” Masaccio asked him.

“With a biological weapon, there will always be survivors. Maybe the Russian treatments worked on me. We still don’t know.”

Mark Littleberry remained in the Koltsovo hospital for four weeks. The medical staff were embarrassed and deeply apologetic, and did their best to take care of him.

“What was it like, having that?” Masaccio asked.

“All I remember is the way I cursed those folks in space suits every time they tried to turn me over in bed.”

“One thing I’ve got to ask you, Dr. Littleberry. Do we have a secret biological weapons program?”

Littleberry stared at him. “Jesus—you ought to know, Frank.”

“Well, I don’t. The C.I.A. doesn’t always tell me things.”

“There are two answers to your question,” Littleberry said. “One, I personally have no evidence that the U.S. military has a secret bioweapons program. The second answer is, we could have it anytime we wanted. Our biotechnology industry is second to none.”

“So why don’t we do it?” Masaccio asked.

“It would leak pretty quick. This is the world’s leakiest government, and public opinion would stop it. I like to think so, anyway.”

THE STAFF AT
the Koltsovo Institute of Molecular Biology numbered four thousand at the time of the first biological-weapons inspection, in 1991. By 1997, after economic troubles had hit Russia, the staff at Koltsovo had shrunk to about two thousand. Two thousand scientists and staff members from Koltsovo no longer work there. Some of them have gone missing, and the Russian government itself does not seem to know where to find them. Some of them have left Russia. Some of them are working for bioweapons programs in other countries, probably in Iran and Syria, possibly in Iraq, and perhaps in Asian countries. What strains they took with them, and where they are now, is a question that bedevils intelligence agencies.

Biopreparat is broke and is trying to make money, any way it can, in order to keep its scientists and staff employed. The Russian government does not want its biological scientists leaving Russia, because they could carry their knowledge and military strains of viruses to a country that is an enemy of Russia. In Russia today, you can buy face cream made by Biopreparat. You can buy Biopreparat vodka. It is known as “Siberian Sunshine.” Biopreparat scientists have told Americans that it is made in former anthrax tanks, and they don’t seem to be joking. The vodka is probably safe to drink, for if Biopreparat knows anything, it knows how to sterilize a hot zone. Biopreparat is now a joint stock corporation. You can buy shares in Biopreparat on the Moscow stock exchange.

The Russian Ministry of Defense was always in control of the country’s bioweapons-development work, and it also controlled the stockpiling and deployment of the weapons. The Ministry of Defense paid for the research done by Biopreparat, and used the fruits of the research in warheads. It is very difficult to find a knowledgeable expert who believes that Russia has given up developing offensive biological weapons. The program is probably smaller in scope, but it is believed to continue at secret locations, more deeply buried than before. Defense is still supremely important to Russia. As molecular biology becomes cheaper and easier to do, and as virus-production facilities become smaller and more portable, a biological-weapons program can continue to move forward almost unnoticed. The fly becomes smaller, faster, harder to catch.

In recent visits to Koltsovo, American scientists have noticed that the lights are burning in the windows of Corpus Zero at three o’clock in the afternoon, when it begins to grow dark in Siberia during the fall and winter. The lights are out almost everywhere else in Koltsovo, but they remain lit on all floors of the building with no name. The Russian managers of the site have said to American visitors that “only three married couples work there, and they have had their smallpox vaccinations.” It is obvious that many more people than that are employed at Corpus Zero. What the staff is doing with the Ebola-smallpox aerosol test chamber inside Corpus Zero is unknown. Who is paying for the research being done in Corpus Zero and what type of research is being done there are unknown.

“Biopreparat was a Humpty Dumpty,” Littleberry told Masaccio. “It fell and broke when the Soviet Union broke. Biopreparat has gone into pieces that have fallen in different directions. The Biopreparat that’s visible is the part that makes face cream and vodka. Another chunk was pulled into the Russian military. There may be other invisible pieces of Biopreparat floating around. Dangerous fragments. Maybe Biopreparat has an Evil Child. Maybe the Evil Child had no connection to Russia anymore.”

“So you think an Evil Child has put together the Cobra virus?” Masaccio said, incredulously. “You think it’s the
Russians
?”

Littleberry smiled. “Not exactly. This Cobra virus is so beautiful and so new that it has to be American engineering, Frank. Has to be. Looking at that virus is like looking at a starship. But the smallpox in it—that’s ancient and old and smells like Russia. Will Hopkins keeps talking about reaching through Cobra to find its maker. Here’s what I think. I think Cobra has two makers. One is American and one is Russian. They’ve gotten together somehow, and there’s money involved. There has to be. I think there’s a company in this. Cobra does comes from an Evil Child. And I think the Evil Child is an American company that is operating somewhere near New York City.”

Part Six

T
HE
O
PERATION

Boy

THURSDAY, APRIL
30

ALICE AUSTEN WAS
with Colonel Ernesto Aguilar and two Army nurses on board an Army medevac helicopter that had just lifted off from the Thirty-fourth Street Heliport. It was carrying a five-year-old boy named Hector Ramirez, who lived on Avenue B. Hector was conscious, lying buckled on a gurney and covered with blankets. His lips, behind a clear oxygen mask, were bloody and torn. He had been in grand mal seizure in the emergency room of Bellevue Hospital, but the seizures had abated. The boy stared at the ceiling of the chopper, and his brown eyes had a tawny gold center.

Austen had insisted on going with the evacuation team. She should not have been there, perhaps, but she had presented herself to Colonel Aguilar and told him that, as a physician, she should be with the boy as the representative of the Reachdeep team. He did not argue with her.

The helicopter was crowded. Dr. Aguilar watched the boy’s vital signs. They passed over the Williamsburg Bridge. The blade noise was high, and they spoke through headsets.

“Watch him! He’s seizing again!” Dr. Aguilar said.

Hector Ramirez went into a flurry. He was buckled down, but his small body seemed incredibly strong. He turned diagonally under the straps, and his head lashed back and forth. He began biting his lips behind the oxygen mask, and a fresh run of blood spattered inside the mask.

An Army nurse named Captain Dorothy Each yanked off the boy’s oxygen mask. She took his head in her hands. She was wearing rubber gloves. She held his head steady. It was impossible to control his jaws. The helicopter shook and the boy shook, and his jaw worked. The helicopter began its descent to Governors Island.

Austen, also wearing gloves, put her hands on the boy. She grabbed his wrists. They were the thin wrists of a five-year-old. She was impressed with how strong a boy could be.

The two women bent over the boy. Austen transferred her grip to the boy’s head. “There, there, steady, sweetheart,” she said to him. She could feel his neck tightening and writhing. It was basal writhing. This was the first time she had
felt
it happening in a patient.

Captain Each transferred her grip to the boy’s jaw. She held his jaw tightly in both hands, clenched, to keep him from biting. That seemed to help.

Suddenly the boy arched his back. His teeth flashed, and he bit down hard on Captain Each’s left hand. His teeth tore the rubber glove.

“Oh!” the nurse said. She pulled away momentarily, but then she was back over the boy, holding his head and jaw. Austen saw how her hand bled. The blood from her hand ran onto the boy’s hair. Austen did not say anything. Nobody said anything about it.

Everyone understood that Captain Dorothy Each would be placed in quarantine biocontainment in the Army Medical Management Unit.

THE BOY’S MOTHER
, Ana Ramirez, the boy’s aunt, Carla Salazar, and his ten-year-old sister, Ana Julia, were all admitted as patients in the Medical Management Unit. They had been in close proximity with the boy. They were kept in separate containment rooms, attended around the clock by Army medical personnel. There was very little that could be done for them except monitoring and supportive therapy. The boy’s mother exhibited symptoms of the common cold, with a clear mucosal effusion from the nasopharynx. Dr. Aguilar ordered IV drips of an experimental Army drug, cidofovir, given to the patients. It was supposed to work on smallpox, but there was no evidence it would work on Cobra. Dr. Aguilar also ordered a dose of Dilantin to help control the boy’s seizures but decided not to go ahead with any heavier antiseizure drug therapy for fear that it would cause Hector to go into an irreversible coma. The only member of the family who had had seizures so far was the boy. His mother was alert, although deeply afraid and almost hysterical about her child.

The doctors had set up a biocontainment intensive-care unit, a group of rooms accessible through a vestibule in the north wing of the Coast Guard hospital. Hector Ramirez was placed there, along with Suzanne Tanaka.

Tanaka lay strapped in bed, receiving cidofovir, ribavirin, and Valium drips. She drifted in and out of consciousness, but she had not suffered any seizures.

The boy was strapped into a bed, and various monitoring machines were placed around him. One of the machines was a pressure sensor for real-time monitoring of the boy’s cranial pressure. They had drilled a small hole in his skull and put in a plastic pressure sensor there. The machine could detect brain swelling. If the doctors saw signs of swelling, they might decide to put him into surgery to remove a portion of his skull, to give his brain space to swell. “The mortality rate is awful, but it may be our only chance,” Dr. Aguilar explained to Austen.

Hector uttered a sharp cry.

Austen drew closer. The boy was small for his age. His body shook as if a wind were rattling it. The nursing staff had tied soft cords of gauze around his wrists and ankles and across his chest. They’d done their best to immobilize his head, but his mouth was uncontrollable. He had torn off a part of his tongue and swallowed it. His eyes were half open, the pupils darting. “Mama!” he said. “Mama!”

Austen bent over the bed. “We’re doctors and we’re here for you, Hector.”

“
¿Donde está mamá?
”

She touched his forehead. Through her glove, she could feel his facial muscles tightening and twitching.

They couldn’t give the boy a brain scan, because his condition was too unstable and because he was liable to go into seizure at any moment. The Army nurses and doctors moved around the room with great speed and desperation at times, but at other times they seemed to be moving through thick water.

WILL HOPKINS ENTERED
the intensive-care unit. He was dressed in a protective suit. The probe compounds had arrived from the Navy, and Hopkins had programmed them into a Boink biosensor. “I’ve got a hand-held that’ll detect Cobra, I think.”

The staff had been taking samples of the boy’s blood. Hopkins mixed a few drops in a tube containing salt water, then put a drop of the bloody water into the sample port of the device.

It gave off a chiming sound. “Cobra,” Hopkins said, looking at the screen.

Suzanne Tanaka was now suffering agonies in a bed on the other side of the unit. Hopkins tested her blood, and the answer was obvious. He stayed by her bed for a while. “I’m sorry,” he said.

She could not answer, and it was not clear that she even heard.

As he walked out of the unit, he met Alice Austen. They spoke about what had happened to Tanaka. Hopkins told Austen that when he’d been driving down to Quantico, and she had been asleep in the car, Tanaka had begged him over the telephone to include her in the mission. “I made the decision,” he said to Austen.

“Don’t think back on decisions, Will.”

“I can’t help it,” he said.

“I can’t either. I should have put Peter Talides in the hospital.”

In the spread of an infective agent, chance plays a part in survival. Hopkins went down the hall and tested the blood of Aimee Dana, the wife of John Dana, who had been infected by brain material from Peter Talides. He did not get a reading. She seemed okay. Then he went to see Captain Dorothy Each.

She had been placed in a biocontainment room. She was sitting in a chair, reading a book, a bandage over the cut on her hand. She seemed calm, but she was very pale.

Hopkins tested her blood. So far, there was no sign of Cobra. “Looks good, but it’s really too early to tell,” he said to her.

“Thanks, anyway,” Captain Each said to him.

IN HECTOR RAMIREZ’S
room, Austen continued to watch the boy. She felt that she was on the verge of understanding something important. The pattern was emerging, and then it slipped away.

She turned to Dr. Aguilar. “I still don’t believe we’ve made a diagnosis,” she said.

“We know a fair amount,” he answered.

“But we don’t understand the disease process. We’re missing a diagnosis.”

“Okay, I can buy that,” he said. “What are your ideas?”

“It’s there, but I can’t touch it.”

A doctor walked in with some test results. Hector’s white-cell count, in his spinal fluid, was too high.

“His uric acid’s high also,” the doctor remarked.

“What’s the count?” Austen asked.

“Fourteen point six. Extremely high.”

“It’s probably the result of his seizures,” Dr. Aguilar said. People having muscle breakdown have high uric acid counts in their blood and urine.

Austen was remembering something. She ran the images of Kate Moran’s autopsy through her mind. The kidneys. She remembered the golden-yellow streaks in the girl’s kidneys. That was damage by uric acid. Something moved in Austen’s mind. It was like a bird fluttering its wings, a bird with unusual markings.

“Could you please loosen the boy’s straps?” Austen asked. “I want to see how he moves his legs.”

The medical staff hesitated.

She asked them again.

They loosened Hector Ramirez’s straps. Austen got down on her knees. She took the boy’s arm in her hand, grasping it firmly.

He was looking at her with yellow eyes. It was not easy to see where the personality of the boy was. His essential being seemed to have already died or partly died.

She let his arm go slightly. He drew it to his mouth. His teeth snapped. He moaned. He began crying, “
No! Basta! Vaya! Ay!
”

“Oh, God,” one of the nurses said.

With the straps loosened, the boy’s body assumed a peculiar posture. One arm was bent toward his mouth, and the
opposite
leg was bent. The other leg was straight. The boy’s posture was like that of a fencer leaping in for a touch. One arm straight, the other bent. The opposite leg bent, the other leg straight. It was a
diagonal
thrashing of the human body.

A diagonal crisscross.

The posture indicated damage to areas of the brain where signals cross. That would be the midbrain. A deranged midbrain.

The boy squirmed, and his back arched. His legs crossed in an abrupt scissoring motion.

The diagnosis clicked.

“They eat themselves. They’re children,” Austen said with sudden clarity and horror. “They pull out their eyes. Lash. Lesch. What is it called, Dr. Aguilar?”

“Oh, Jesus,” Aguilar whispered. Suddenly, he had seen it too.

“High uric acid,” she said.

“Yeah,” he said. “This kid looks like he has Lesch-Nyhan syndrome.”

“I had forgotten what it was called,” Austen said.

Lesch-Nyhan

LESCH-NYHAN SYNDROME
is an extremely rare disease. It occurs once in a million births, and it occurs naturally only in boys. It is caused by a genetic mutation. Alice Austen did not make the diagnosis alone. She began the diagnosis. It was made by a team of physicians.

Frank Masaccio immediately flew to Governors Island with senior managers of his joint task force. They arrived just as Austen and the other doctors began giving a presentation to the assembled Reachdeep team.

Austen was speaking: “Lesch-Nyhan syndrome may be the most terrible genetic disease known.”

Lesch-Nyhan syndrome is caused by a mutation on the X chromosome, which is the chromosome that every child inherits from his or her mother. Lesch-Nyhan boys lack an enzyme that breaks down a metabolic waste product, and the end result is a huge excess of uric acid in the bloodstream. The enzyme they lack is called HPRT.

Lesch-Nyhan syndrome was first identified in 1964 by Michael Lesch and William L. Nyhan. Michael Lesch was then a sophomore medical student at Johns Hopkins University, in Baltimore. Bill Nyhan was his research adviser.

A boy with Lesch-Nyhan syndrome seems normal as a baby, except that the parents begin to notice what they sometimes describe as “orange sand” in the diaper. These are crystals of uric acid being passed from the kidneys. By the baby’s first birthday there is something definitely wrong. The boy becomes spastic. He does not develop normal coordination. He does not learn how to crawl or walk. His limbs become stiff. The baby’s body tends to assume the characteristic “fencing” posture of Lesch-Nyhan disease—one arm bent, the opposite leg bent. This is a sign of damage to nerve fibers in the midbrain. As the boy’s teeth come in, he begins chewing on his lips. The chewing is uncontrollable. The child begins to eat off his lips. He begins to eat his fingers. He concentrates his gnawing on certain parts of his body; no one knows why.

The parents can’t control their child. Often doctors have trouble making a diagnosis. The boy may not be retarded. He may have normal intelligence, but it’s hard to tell, because his speech is poor. He can’t speak well, although his eyes are bright and alert, and he seems to be taking in the world with understanding and intelligence. The boy may pull out his fingernails with his teeth. He attacks his body. As he grows older and stronger, he attacks the people he loves, lashing out with his arms and legs, biting at them, and using obscenities. It is clear that he is capable of love, and he forms strong attachments to his caregivers, even while he is attacking them.

The pain of self-injury is excruciating for Lesch-Nyhan children. It troubles them when they attack people, yet they can’t resist doing it. They cry out with pain as they chew themselves. They know what they are doing but can’t stop. They feel the pain, but the biting continues, and the more it hurts the more they bite themselves. They fear the pain, and their fear makes them bite themselves more violently. Thus the Lesch-Nyhan cycle of behavior literally feeds on itself. When they feel an episode of self-mutilation coming on, they beg to have their hands tied and their bodies restrained. The sudden appearance of a stranger in the room may make them bite themselves. They vomit upon themselves. They may blind themselves, tearing out their eyeballs. Self-enucleation, tearing out of the eyes, is rare, but it happens. There are not many Lesch-Nyhan adults. A Lesch-Nyhan boy may survive to young adulthood, but at some point he will die of kidney failure or self-injury.