Peyton said hello to the staffers she knew and asked if there were any updates. The EOC’s large conference room was dark, but a sign on the door announced an all-hands meeting for the Mandera Outbreak at eight a.m.
A color-coded marker on the wall indicated the CDC’s current Emergency Response Activation Level. There were three possible levels: red meant level one—the highest, most critical level. Yellow was level two, and green was for level three. The marker on the wall was yellow, which meant that the EOC and CDC’s Division of Emergency Operations would be calling in staff and offering significant support to the outbreak response. Peyton was glad to see that.
At her office, she began prepping for the deployment. Her duffel bag contained the essentials for any outbreak investigation: clothes, toiletries, a satellite GPS, sunblock, gowns, gloves, goggles, a portable projector, and MREs—meals ready-to-eat. The MREs were particularly essential for outbreaks in the third world; often the local food and water harbored the very pathogen they were fighting.
Peyton put in rush orders for the other things the team would need in Mandera, including location-specific medications, mosquito netting, insect repellent, and satsleeves—sleeves that slid onto smartphones to give them satellite phone capability with data access. The satphone sleeves would enable team members to keep their regular phone numbers and contacts as well as access their email and other data. Being able to take a picture in the field and instantly upload it could well change the course of an outbreak response—and save lives.
Next, she began preparing packets for the team. She printed maps of Mandera and surrounding areas, and made lists of contacts at the CDC’s Kenya office, the US embassy, the EOC, WHO Kenya, and the Kenyan Ministry of Health and Public Sanitation. She pulled up a questionnaire she had used in the field during the Ebola outbreak in West Africa and made a few modifications, adapting it to the region. She printed hundreds of copies. Some epidemiologists were pushing to go paperless in the field, but Peyton still preferred good ol’ printed forms: they never crashed, their batteries never died, and roadside bandits were infinitely less interested in file folders than tablets. Paper worked.
That left one major decision: personnel.
Someone knocked softly on the open door to her office, and she turned to find her supervisor, Elliott Shapiro, leaning against the door frame.
“Hi,” she said.
“How do you always get here so fast?”
“I sleep with one eye open.”
He smiled. “Right. What’re you working on?”
“Personnel.”
“Good. You see the pictures?”
“Yeah.”
“Looks bad.”
“Very. We really need to be there right now,” Peyton said. “If it gets to Nairobi, we’ll be in trouble.”
“I agree. I’ll make some calls, see if I can get you there any sooner.”
“Thanks.”
“Call me if you need me,” he said, stepping out of her office.
“Will do.”
Peyton looked up a number on the CDC’s intranet directory for a colleague she’d never met: Joseph Ruto. Ruto led the CDC’s country operations in Kenya. They had 172 people in Kenya, a mix of US assignees and Kenyans working for the agency. Most were concentrated at the CDC office in Nairobi, where they worked closely with the Kenyan Ministry of Health.
Peyton took some time to read Ruto’s internal status reports. She was about to call him when she had an idea—one that might well save one or both of the Americans’ lives. A few quick searches told her it was possible. It might also prevent the pathogen from spreading to Nairobi.
Elliott once again appeared in her doorway. “Caught a break. Air Force is going to give you a ride to Nairobi.”
“That’s great,” Peyton said.
“Won’t be first class accommodations. It’s a troop and cargo transport, but it’ll get you there. They’ll pick you up at Dobbins Air Reserve Base at one thirty. It’s in Marietta. Just take I-75/85, stay on 75 at the split, and get off at exit 261. You can’t miss it.”
Elliott always gave her directions, even in the age of smartphone navigation, and even to places he likely knew Peyton had visited before, such as Dobbins. She never stopped him; she just nodded and scribbled a note. She figured it was a generational thing, a product of not growing up with a cell phone glued to his hand or Google Maps a click away. It was one of Elliott’s many idiosyncrasies that Peyton had come to tolerate and then to like.
“Speaking of planes,” she said, “I want to get your take on something. One of the Americans, Lucas Turner, was asymptomatic when he arrived at Mandera. Assuming he’s been in close contact with the other man, and assuming this is a viral hemorrhagic fever, I think we should expect him to break with the disease.”
“That’s fair.”
“I want to develop a plan of care for him now. If he breaks with the infection, we can’t treat him in Mandera. Dani Beach Hospital and Kenyatta National in Nairobi are both candidates, but I don’t favor either—we risk spreading the infection to the staff there and the region.”
“You want to bring him back here.”
“I do.”
Elliott bunched his eyebrows up. “What’re you thinking?”
“I want the air ambulance to accompany us to Nairobi, then fly to Mandera and be on standby. If Turner even has a high fever, I want to bring him back to Emory.”
Emory University Hospital was next to the CDC on Clifton Road—close enough for CDC staff to walk there. Emory had a special isolation unit capable of dealing with patients infected with Ebola and other biosafety level four pathogens; it was one of only four such facilities in the US. It had been used, with great success, to treat Americans who had been infected with Ebola during the 2014 outbreak.