The CityForge founders had come up with the idea while they were undergraduates at UNC-Chapel Hill, and after graduating this past May, they had set out to make their concept a reality. They had spent the summer promoting their startup and raising money from friends, family, and passionate supporters. They used the funds for their trip to Kenya, where they planned to document every stop along the way—and identify their first “CityForge villages.” And, for reasons that remained unclear to Peyton, the two boys had made a pact not to shave or cut their hair during the trip.
She clicked the Supporters page and read the names. Icarus Capital was among the corporate sponsors. She had seen the name before—hours ago, in her apartment. It was Desmond Hughes’s investment firm. Was he involved in some way? She thought it was an odd coincidence, but she couldn’t think of a way to act on the connection.
Even thinking about Desmond rattled her. She fought to stay focused.
Another tab on the CityForge site featured a map with every stop the two young men had made. Most included one or more videos of the two Americans touring the village and doing interviews with residents. Mostly, they highlighted how infrastructure could change the villagers’ lives. For a few of the villages, the videos continued after the two Americans had left. The more recent films had been uploaded by village leaders hoping to attract financial supporters.
The trip log was a dream for an epidemiologist. Peyton wondered if one of the videos would show the origin of the outbreak. She might even be able to track its spread.
The key to stopping an outbreak was containment. The first step in containment was to isolate anyone who was infected, and the second step was to interview all the infected patients and develop a list of every person they had come into contact with—a process called contact tracing. From those contacts, Peyton and her team would begin a repeating process. They would search for contacts. If the contact was sick, they would isolate them and trace anyone they had come into contact with; if the contact was asymptomatic, they would test them for the disease and typically quarantine them until Peyton and her team could be sure the person was infection-free. For Ebola, that quarantine period was twenty-one days. Eventually, when they had no new contacts to trace, they would end up with two groups: infected and quarantined.
But contact lists grew quickly. With each passing hour, a pathogen would reach more and more people. Time was of the essence; in most cases, the first few days of an outbreak determined everything after.
On a pad, Peyton had written the names of the two Americans, Steven Cobb and Lucas Turner, as well as the British patient, Andrew Blair. Between them, she had drawn a large X. The X was the variable, the unknown—what she needed to find. At some point, the British man had interacted with one or both of the Americans. Either that, or all three had a common contact—someone still out there, continuing to spread the disease. It was imperative that she find out where each of them had been and whom they had interacted with. The travel log could be the key to doing that.
If Peyton and her team did their job correctly, they’d end up with a contact tree that eventually had a root contact: the first person to contract the disease, often called patient zero or the index case.
That was the on-the-ground detective work: tracing the pathogen to its origin, containing every person it had touched, and either treating the patients or simply waiting for the outbreak to burn itself out.
But even with the video travel log, Peyton and her team were going to need a lot of help in Kenya.
She picked up her office phone and called Joseph Ruto, head of the CDC’s office in Kenya. Ruto was just finishing a late lunch in Nairobi, which was eight hours ahead of Atlanta.
She briefed him on their plans, with the caveat that they might change after the morning conference. The man struck her as competent and focused, and she counted that as a very good sign.
It was just before six a.m. when she hung up. She had been waiting to make the next call; she wanted her people to get as much rest as possible. Sleep might be hard to come by in the coming days.
She dialed the EOC’s head of watch and requested they contact all of the Epidemiology Intelligence Service agents.
“All of them?” the watch officer asked.
“Everyone assigned to CDC HQ. Instruct them to be in the building by seven a.m. for a pre-conference briefing. They need to come packed and prepared to leave in a few hours. If they’re deployed, they’ll be working either in Nairobi or in the field in rural Kenya. Instruct them to plan accordingly.”
“Understood, Dr. Shaw.”
The EIS program was a two-year fellowship established at the CDC in 1951. It had begun as a Cold War initiative focused on bioterror. Today it was one of the most prestigious and sought-after fellowships in applied epidemiology, known for producing the world’s best disease detectives. Candidates applying to the program needed to be either a physician with at least a year of clinical experience, a veterinarian, a PhD-level scientist with a background in public health, or a health care professional with at least a masters degree in public health. There were currently 160 EIS officers, seventy percent of whom were women.
During their fellowship, EIS officers often worked in the field, on the front lines of outbreaks. During the 2014 Ebola outbreak, every one of the 158 EIS officers deployed. They served in seventeen countries, eight states, Washington, DC, and the CDC’s Emergency Operations Center. During that time, they collectively contributed 6,903 days of service—almost nineteen years combined. Peyton hoped for everyone’s sake that the current outbreak would be concluded much more quickly.
Peyton was the CDC’s leading field epidemiologist, and she was also an EIS instructor. She took both jobs very seriously. The EIS officers she was training could well be making the calls during the next major outbreak or leading the first response at the state level or overseas. Alumni from the program included the current CDC director, past and current acting surgeon generals, branch and division leaders across the CDC, and state and local epidemiologists across the country.
She hadn’t had a chance to work with every fellow in the current class, and this might be a good opportunity. She began browsing through the personnel files, assembling her team.