Pandemic

Part 1

WEDNESDAY, APRIL 7, 1:45 P.M.

Twenty-eight-year-old David Zhao took the cloverleaf exit off Interstate 80 onto New Jersey 661, heading south toward a small town called Dover tucked away in the relatively rural northwestern part of the state. He knew the route well, as he had traversed it hundreds upon hundreds of times over the previous five years. With relatively light midday Wednesday traffic it had been a quick trip, accomplished in a little more than an hour. As per usual, he’d picked up the interstate right after crossing the George Washington Bridge. He’d come from the Columbia University Medical Center in upper Manhattan, where he was a Ph.D. student in genetics and bioinformatics at Columbia University’s Department of Systems Biology.

David was driving alone, as he usually did when he went to Dover. Also as per usual, it was a command performance by his imperious father, Wei, who, if truth be told, was somewhat of an embarrassment for David. Like a lot of successful Chinese businessmen, Wei had been given the opportunity to ride the crest of the economic miracle that modern China represented. But now that he’d become a billionaire, he wanted out of the People’s Republic of China, as he had come to much prefer the more laissez-faire business environment of the United States. To David, such attitude smacked of treason and offended his sense of pride in his country’s extraordinary progress and uninterrupted history.

David’s given name was Daquan, but when he was sent by his father to the United States nine years ago to study biotechnology and microbiology at MIT, he needed a Westernized name, as Zhao Daquan wasn’t going to suffice, especially in the normal Chinese order of family name first. He needed an American name so as not to confuse people or stand out, as he knew how much discrimination played a role in American society. To solve the problem, he Googled popular boys’ names in the United States. Since David started with the same two letters as Daquan and also had two syllables, the choice was simple. Although it took some time to adjust to the new name, now that he had, he liked it well enough. Still, he was looking forward to reverting to Zhao Daquan when he returned to China. His game plan was to move back there when he finished his Ph.D. the following year and eventually run his father’s Chinese biotech and pharmaceutical companies, provided they were still there. David’s biggest fear was that his father might succeed in moving the totality of his operations out of the People’s Republic.

On the secondary road, David made himself slow down. He knew he had a heavy foot, especially when it came to the new car that his father had given him for his last birthday, a matte-black Lexus LC 500 coupe. David liked the car but wasn’t thrilled with it. He had specifically told his father that he wanted a Lamborghini like another Chinese graduate-student friend of his had been given, but in typical fashion, his father had ignored the request. It was similar to how the decision had been made for David to come to the United States for college. David had expressly said that he preferred to stay in Shanghai and attend the Shanghai Jiao Tong University, where his father had gotten his graduate degree in biotechnology. But his father had ignored David’s feelings. David doubted that his father ever realized that David might have a different point of view on any subject. In that sense, his father was very old-school, demanding unquestioning filial piety.

Turning off NJ 661, David slowed down even more. He’d already gotten more than his share of speeding tickets in New Jersey, so many that his father had threatened to take away his car. That was the last thing that David wanted, as he enjoyed driving. It was his escape. He was now on a rural road surrounded by fields that were just beginning to turn green, interspersed with stands of leafless forest. Within a few miles the first part of his father’s considerable entrepreneurial domain came into view. Dover Valley Hospital was an impressively modern private hospital currently nearing completion after a total renovation. In its previous incarnation, it had been a small, aging community-hospital-cum-nursing-home that David’s father had purchased out of bankruptcy. Once Wei owned the property, he began pouring capital into it, to the surprise and delight of the surrounding towns.

David motored past the nearly finished hospital that he knew now had state-of-the-art operating rooms, among its other modern assets. David was well aware that it was his father’s intention to turn the institution into a world-class cancer treatment, gene therapy, in vitro fertilization, and transplant center, all to capitalize on the incredible financial opportunities being opened up by CRISPR/CAS9 technology.

Next to the Dover Valley Hospital, another modern architectural complex loomed. This was his father’s GeneRx company, which was the American equivalent of his similarly named company in Shanghai. Here were the brains of the American operation manned by a large workforce of mostly Chinese biotech engineers and technicians that David’s father had imported, including a considerable bevy of interns coming from all the major biotechnology programs at China’s many universities. Surrounding the spacious complex was a high chain-link, razor-wire-topped fence that angled off into the surrounding forest from both sides of a security booth that stood in the middle of the access road, partially hidden by tall evergreens.

Generally, David would merely drive to the gate and expect it to be raised by the duty officer, but since his car was relatively new, he pulled up to the security booth and lowered the window. He was immediately greeted by one of the guards, who addressed him in Mandarin, welcoming him back to GeneRx.

“Are you heading to the main building?” the guard asked.

“No,” David said. “I’m going to the Farm for a performance.”

The guard laughed, saying it was going to be well attended. He then raised the gate.

Passing the entrance to the multistoried parking lot, David drove around the right side of the main building and into a wooded area. After a few twists and turns, the road opened up into another clearing and another parking area. Beyond it was another matching three-story structure composed of three wings in the form of T’s with hip roofs that stuck off the back. There was a sign on the front that read FARM INSTITUTE, but David knew that no one called it that. It was known merely as the Farm.

David knew he was a little late, so he quickly found parking and jogged up to the front entrance. Five minutes later he was in the central wing, changing into clean clothing and donning a mask and surgical cap. He was heading into a sterile area that had air flow going only out, similar to a patient isolation room in a hospital. When he was fully decked out and after being checked by a technician to be certain he was adequately covered, David pushed through swinging doors and entered the sterile area. This was the part of the Farm that housed the cloned and sterile pigs whose genomes had been modified by CRISPR/CAS9. There were multiple other areas for various other types of animals, including goats, sheep, cows, monkeys, dogs, mice, rats, and ferrets. The Farm Institute represented a new direction of “farmaceuticals,” with large-molecule, protein-based biopharmaceuticals being manufactured by animals rather than by chemical processes or fermentation vats.

After descending a perfectly white hallway to a door marked INSEMINATION ROOM, David pushed inside. The square room with a central depressed area was occupied by a large, mostly white pig in heat; a tall individual David could tell was the Farm’s head veterinarian; and a handful of his assistants, who were restraining the sow. Grouped around the periphery were some twenty people. David recognized only two, as everyone was in the same getup as he was, their identities obscured beneath face masks, caps, and gowns. The two people he recognized were his father, Wei Zhao, and his father’s man Friday, Kang-Dae Ryang. It was easy to recognize his father because of his unique silhouette. For one thing, his father was tall and commanding, at six feet five inches. David himself wasn’t too far behind, at six-three. But his father’s build was what really stood out, particularly the breadth of his shoulders and the waist that was still remarkably narrow, despite his advancing years. When Wei Zhao was a university student in the seventies, he picked a unique hero, Arnold Schwarzenegger, and became a bodybuilder. Although it had started as a fad, it morphed into a lifelong addiction, and he was still currently doing it in his sixties, albeit in a much-reduced fashion. Kang-Dae’s appearance was the exact opposite, thanks to his pencil-thin frame. His gown appeared as if it were hanging on a wire clothes hanger, and his eyes had a beady look that brought to mind a bird of prey.

David made it a point to sidle up to his father to make sure that his presence had been noted. It had, but he could immediately tell Wei wasn’t happy that David was later than he had been told to arrive. David had done it on purpose, as he derived a modicum of pleasure from his passive-aggressive behavior.

The veterinarian, who was wearing a headlamp, straightened and motioned to Wei with the syringe he was holding that all was ready. A speculum had been inserted by one of his assistants, so presumably the cervical os was visible.

Wei cleared his throat and spoke first in Mandarin and then in English for all to hear. “Welcome, everyone! We’re represented by the whole team, including the CRISPR/CAS9 molecular biologists, the stem-cell experts, the geneticists, the embryologists, and the veterinarians. We’re all here to witness this ‘one small step for man and one giant leap for mankind.’”

There was a little forced laughter at the reference to the United States’ landing on the moon. “As you all know, GeneRx is in great need of an additional revenue stream now that my financing plans for our American operations have been interrupted by Xi Jinping, the Politburo, and the People’s Bank of China, all conspiring to generally restrict capital outflow. I am convinced that what we are doing here today will minimize that problem by helping GeneRx be first out of the gate, so we can corner crucial patents and reap the benefits. As you all know, today we are implanting ten cloned bespoke embryos, and we only need one to succeed to ensure our success. Next week we will do the second implantation to answer our crucial question as to which is better: a chimeric pig or a transgenic pig. Thanks to CRISPR/CAS9, we have a choice. Thank you all for pushing ahead so diligently to make this day happen. This will be the first immunologically custom-designed pig. I’m totally confident it will soon lead to hundreds and ultimately thousands of such creations.”

After concluding his brief remarks, Wei stepped down into the “pit” to observe firsthand the insemination. Kang-Dae stayed where he was, and David moved next to him. David eyed the man out of the corner of his vision, keeping Wei in sight. He didn’t want his father seeing them talking together. In David’s estimation, Kang-Dae couldn’t have weighed more than eighty pounds, or a bit more than thirty-six kilograms. David attributed the man’s rawboned frame to his having grown up in North Korea and been starved as a child. Although he had managed to defect to China thirty-eight years ago, he’d never gained the weight he would have had he not been severely malnourished when young. David had known Kang-Dae for as long as he could remember, as Kang-Dae had been sent by the Communist Party to work for Wei in Wei’s very first biotech company, where he proved to be a tireless and totally dedicated worker. He’d even taught himself biology and biotech. Devoid of a family, he ended up living in a tiny room in Wei’s home despite Wei’s knowing he was essentially a spy. As a consequence of proximity, David and Kang-Dae had become close and remained so, particularly after they both unexpectedly and somewhat unhappily ended up in the United States. There, in New Jersey, they learned that they shared a wish for Wei’s American enterprise to fail so they could all return to China.

Leaning toward the Korean man and speaking sotto voce, David said: “Did you do what I suggested?”

“Yes,” Kang-Dae said. He was a man of few words.

“Once or several times?” David asked. As Wei’s trusted aide, Kang-Dae had unparalleled access to the entire complex. He still lived at Wei’s nearby private estate. He was more like an appendage than an aide.

“Three times, like you suggested,” Kang-Dae said. “I put it in the drinking water. Will it work?”

“There’s no way to know for sure,” David said. “This whole project is breaking new ground for all of us. But it was definitely toxic to human kidney cells in tissue culture, so if I had to guess, I’d say it is going to work very well — maybe too well!”

Part 2

SEVEN MONTHS LATER...

MONDAY, NOVEMBER 5, 9:10 A.M.

“Wait! Hold on!” Carol called out. She’d just entered the subway station at 45th Street in Sunset Park, Brooklyn, to see that the R train was already there. To her shock, it had arrived early, something New Yorkers did not expect the subway to do. Holding on tightly to her new miniature Gucci backpack, Carol started to run. It wasn’t easy, for reasons that had less to do with her attire, which was one of her favorite dresses and relatively high heels, than with her physical stamina. Any running was a feat that, until recently, she hadn’t been able to accomplish for more than a year. As she ran, she frantically waved her free hand in the hopes of catching the conductor’s attention to keep the doors ajar.

As out of shape as she was, the effort was Herculean for Carol, and as she leaped onto the train she was seriously out of breath. She could also feel her heart pounding in her chest, which gave her a touch of concern, but she trusted it would soon subside, and it quickly did. Over the last month she’d been religious in her trips to the gym and was now up to twenty minutes every other day on the treadmill, which she considered fantastic progress. If someone had predicted four months ago that she’d be doing that much exercise at this point in her life, she would have considered them certifiably crazy. Yet, needless to say, she was thrilled. In many ways, being able to run again was like being reborn.

No sooner had Carol gotten on the subway than the doors slid closed, and the train lurched forward in the direction of Manhattan. To keep her balance, Carol grabbed one of the upright poles that ran from floor to ceiling and glanced around for an appropriate seat. Since it was only the sixth stop from the train’s origin at 95th Street in Bay Ridge, and since it was now 9:11 and hence mostly after the morning rush hour, there were plenty of openings. But as an experienced subway rider, she knew that certain seats were better than others. Being hassled on the subway was not an infrequent event, and a bit of attention to detail was worth the effort. She quickly spied an auspicious spot only ten feet away.

As soon as the train reached its desired speed, Carol made her way to the seat she had her eye on. There were no immediate neighbors. The closest people, each an empty seat away, were an elderly, well-dressed African American man and an attractive white woman who Carol guessed was close to her own age of twenty-eight. The slender woman impressed Carol with her style and the quality of her casual but elegant clothes. She had a haircut not too dissimilar from Carol’s, with a dark-brown-base undercut that was mostly covered by a bleached-blond combover. It made Carol wonder if they went to the same hairdresser. As Carol sat down she exchanged a quick glance and smile with the woman. It was a part of New York that Carol loved. You never knew who you might see. Life here was so much more interesting than it was in the boonies of New Jersey where she’d grown up. There people became set in their ways as teenagers and never tried anything new and exciting.

Making herself comfortable, as she had a long subway ride ahead of her, Carol pulled her iPhone out of her backpack to go over the disturbing texts she’d been exchanging of late with Helen, the woman she had expected to marry if and when Carol’s serious health problems had been put behind them. The sad irony was that the health problems were almost resolved, whereas the relationship had been challenged and had taken a turn for the worse, so much so that Carol had recently moved from their shared apartment in Borough Park, Brooklyn, to her own studio in Sunset Park. It had all happened rather suddenly. Almost three months ago, while Carol had been in the hospital for her life-saving operation, Helen had invited a dear old high school boyfriend, John Carver, to stay with her, as he happened to be in New York and was in need of an apartment. She’d been looking for emotional support, someone to comfort her while she battled the fear that Carol might die, but then the unexpected had happened.

Between the trying emotional circumstances and their close proximity, Helen and John’s old romantic relationship reawakened. When it had become clear that Carol was going to live, Helen had hoped she would be understanding and would embrace John as a permanent third party in their relationship.

Although Carol was initially dismayed and shocked, her desperate need for love and acceptance after the stress of her hospitalization and near death inspired her to give the unconventional arrangement a good try over several months. But it wasn’t for her. At age thirteen she’d come to accept her sexual preference and adjusted, and she had just become more certain as the years had gone by.

Rereading all the texts and reexperiencing the emotion they represented didn’t help Carol’s mind-set. It also made her look at the tattoo she had got together with Helen six months ago. It was hard for her to ignore, since it was on the under surface of her right forearm. The image was of a puzzle piece next to a matching image of the puzzle piece’s supposed origin. Both were drawn in perspective to make them look all the more real, and the base of the origin was done in a rainbow of colors. Helen’s name was on the puzzle piece, as Carol’s was on Helen’s tattoo. Carol had always loved the tattoo and had been proud of it until now, but her current goal on this trip was to return to the tattoo parlor in Midtown Manhattan where they had gotten the ink and have something done to erase the painful reminder of all that had gone wrong between them. Carol didn’t know what the options might be but assumed the tattoo artist would have some ideas. Besides, the trip gave her something to do, as she still had not gone back to her career in advertising. That wasn’t going to happen for another month. It had been a deal she’d made with her doctor.

As Carol’s train made its way north through Brooklyn, people boarded at each of the many stations, with far fewer people getting off. By the time they were approaching the tunnel to Manhattan, the train was almost as packed as if it were rush hour. It was then that Carol got the first disturbing symptom — a shudder-inducing chill, as if a blast of arctic air had wafted through the subway car. It came on so suddenly that Carol instinctively looked around to see if other people had experienced it, but it was immediately apparent that it had come from within her own body. Her first instinct was to feel her pulse. With relief, she determined it was entirely normal. For a moment she held her breath, wondering if the unpleasant sensation would return. It didn’t, at least not at first. Instead she felt a sense of weakness come over her, as if she might have trouble standing up if she tried.

Still holding her mobile phone, Carol checked to see if she had a strong signal. She did, and she contemplated calling her doctor out in New Jersey. But she hesitated, wondering exactly what she would say. Sudden weakness hardly seemed like an appropriate symptom to tell a doctor. It was much too vague. She was certain he would tell her to call back if it didn’t go away or if the chill returned. She decided to wait as she raised her internal antennae to seek out any abnormal sensations. She looked around at the faces she could see. No one was paying her any heed, as everyone was pressed together cheek to jowl.

As the train entered Manhattan, Carol began to relax a degree. There was still the sense of weakness, but it hadn’t worsened, and although she got several more chills, they were nothing like the first. They were just enough to let her know she had probably developed a slight fever. When the train stopped at Canal Street, she thought about getting off but was afraid to try to stand up. If she were to fall, it would be much too embarrassing. She felt the same at Prince Street, and then things went downhill. She began to experience difficulty getting her breath, which worsened quickly. By Union Square station, where there was to be a mass exit and mass boarding, she was beginning to feel desperate. She needed air, but her legs seemed not to want to respond.

As the train’s doors opened, her phone slipped from her grasp and fell to the floor. In the blink of an eye it was snapped up by a scruffy sort who had been eyeing Carol’s behavior. The second he had the phone he melted into the people departing the packed car. Carol tried to call out that she needed help, but no words emerged as she attempted to breathe. A bit of froth appeared at the corners of her mouth. Pulling her legs under her, she marshaled her remaining strength and tried to stand, but as soon as she pushed off the seat, she collapsed, falling against the legs of the people standing immediately adjacent to the bench seat she had been sitting on. People tried to move to give her more room, but there was no place to go. One person tried to arrest her fall but couldn’t, as Carol was like a dead weight. Mercifully, she lost consciousness as she slumped like a rag doll, partially propped up against the legs of fellow riders.

As quickly as her phone had disappeared, it was now time for her Gucci backpack to follow suit. Several of the other passengers tried to grab the offending individual, who also departed before the doors closed, but their attention was quickly redirected at Carol, who was twitching uncontrollably and turning blue. It was obvious to everyone that she was desperately ill and struggling for air. Nine-one-one was dialed on multiple phones. As the train lurched forward, another knowledgeable passenger notified the conductor. She came pushing through the crowd as she communicated the bad news to the engineer. As the conductor reached Carol, the intercom sprang to life to announce that a sick passenger was on the train and the train would be stopping at the upcoming 23rd Street station for an indeterminate amount of time. There were a few audible groans. It was a problem that happened far too often on the NYC subway system, inconveniencing thousands upon thousands of passengers who were not sick.

The gravity of Carol’s condition was immediately apparent to the conductor, who was confused as to what she should do. With almost no first-aid training other than CPR, which didn’t seem to be indicated, since Carol had a pulse and was breathing, she felt helpless. It was quickly apparent to everyone present that there was no good Samaritan with medical training available. Meanwhile, up in the first car, the engineer alerted the rail control center to the emergency and was assured an EMT team was being dispatched to the station.

Once the train was at 23rd Street, it took more than twenty minutes for masked EMT workers to arrive. Many riders had departed the train by then, seeking other transportation, and so the paramedics had a relatively clear path to Carol. What they found was a livid patient with an undetectable heart rate and blood pressure who was barely breathing, if at all, and had lost control of her bladder. After putting a mask on the patient and attaching her to an oxygen source, they quickly lifted her onto a gurney. They then whisked her off the train, up to the street, and into the waiting ambulance.

With the siren blaring, they rapidly weaved their way across town to pull up to the ER unloading dock at Bellevue Hospital. As they unloaded her from the ambulance, a triage nurse corroborated that there was no heartbeat. One of the EMTs leaped up onto the gurney as the others rapidly propelled it into the depths of the Emergency Department and ultimately into one of the trauma rooms, calling out a cardiac arrest in the process. This unleashed a resuscitation team poised for such an emergency, which included a medical resident, a nurse practitioner, and a resident in anesthesia. With the history of breathing difficulty obtained from fellow subway passengers, the patient was intubated and given positive pressure. The assisted respiration required a shocking amount of pressure, suggesting the lungs were possibly consolidated, meaning ventilation was impossible.

With no heartbeat and no ventilation, Carol was declared dead on arrival at 10:23 and covered with a sheet. The only trouble was that no one knew her name was Carol. When the ER clerk called the NYC Medical Examiner’s Office, she gave the deceased the temporary moniker of Jane Doe, explaining that there was no identification and the patient was unaccompanied. At that point, Carol’s gurney was unceremoniously parked in a corner to await the medical examiner’s van. Under the white sheet, she was still dressed in her finery, and the endotracheal tube still protruded from her mouth.