The Rationing

1.

WAREHOUSE 61 IS AT THE END OF A LOADING DOCK in the Port of Long Beach. Sometime between midnight and two a.m. on March 21, it caught fire. For reasons that may never be clear (given that it was a very warm night), a homeless man had set a small blaze in an oil drum near the truck entrance to Warehouse 61. The fire somehow spread to a pool of motor oil, setting ablaze the warehouse and several small maintenance buildings. No one was injured except for the homeless man, who was treated for burns at a Los Angeles hospital. The Long Beach Fire Department responded and put out the fire after several hours.

Warehouse 61 is owned and operated by the U.S. government. It is used to store materials coming and going across the Pacific, everything from sophisticated research equipment to school supplies for students in Guam. On March 21, the warehouse also held fourteen chimpanzees, which were being shipped from a government research facility in Hawaii to a private laboratory at Stanford. Thirteen of the fourteen chimps were killed in the fire; the fourteenth, a female named Bobo, was rescued by firefighters. Bobo became the story. Protesters descended on Los Angeles and Long Beach to protest animal experiments by the U.S. government. The President of the United States, the head of the National Institutes of Health, the President of Stanford, and assorted other officials were called upon to explain the necessity of doing research on primates, and, more immediately, why these particular chimps had been left unattended overnight in a warehouse.

Meanwhile, Bobo clung to life. She was attended to by a team of veterinarians, as well as several prominent burn specialists for humans. Money poured in for Bobo’s treatment. By the time she regained consciousness several days later, still with serious burns and at high risk of infection, over $25 million had been collected to pay Bobo’s bills. This prompted a wave of counterprotests by those Americans, myself included, who found it perplexing, if not absurd, that our fellow citizens lavished money on a burned chimp only six months after repealing (once again) the health care coverage for fifty million Americans. The health care debate became even more pitched when it was disclosed that the homeless man burned in the fire, who had third-degree burns over 20 percent of his body, had been quietly turned out of a Los Angeles hospital because he could not pay his bills. This left him at serious risk of infection, and the police without the only witness to the start of the fire. The homeless man would never show up again. Doctors and talking heads tweeted aggressively about who had been more seriously injured, Bobo or the homeless man. For three days, Home Depot Media made Bobo the feature story on all of its receipts and coupons.

The homeless guy was soon forgotten. Bobo got better. She was placed in the Los Angeles Zoo and became a hit attraction. Just last year she “mated successfully” (a term I now use with my married friends), and the world eagerly embraced the son of Bobo, Hanson, who was named for the Long Beach firefighter who rescued Bobo from the warehouse blaze.

2.

BOBO WAS A SIDESHOW, A DEVASTATING DISTRACTION. WAREHOUSE 61 also contained a shipment of research materials and pharmaceutical products that were en route from the naval laboratory in Honolulu to the mainland. That shipment included the core ingredients for twenty-five million doses of the drug transcriptin, which we now know by its commercial name, Dormigen. For anybody working anywhere in science or medicine—for people like me—the development of Dormigen was like the World Series and the Super Bowl rolled into one. Other kids dreamed of coming to bat in the ninth inning of the seventh game of the World Series with the score tied and the bases loaded. Guys like me cried when our mothers drove us to Little League practice. As I stood in right field, where the ball invariably came more than it was supposed to, I imagined inventing something like Dormigen—the most important breakthrough in medicine since penicillin.

Dormigen is an effective treatment for viral infections and bacterial infections and most parasites. If Dormigen were a person, he would play professional basketball, publish popular novels, and teach math at Harvard, all while dating a supermodel. I have given some thought to that metaphor. Just as we do not expect people who teach math at Harvard to play professional basketball, scientists had always assumed it was improbable, if not impossible, to find a drug that could be effective against all the different pathogens that pose harm to humans. Then we created Dormigen.

It was none too soon. By the 2020s, many traditional antibiotics were becoming less and less effective. The “golden half-century” of medicine—during which a cheap course of antibiotics would wipe out anything from venereal disease to tuberculosis—was over. We had collectively neglected what Charles Darwin taught us: pathogens adapt or die. Those that were not dying in the face of penicillin and its relatives were getting stronger and more dangerous. Pediatricians blithely passed out prescriptions for antibiotics to parents with screaming children, regardless of whether those drugs were necessary or even effective against little Ellie’s ear infection. The grocery shelves were full of every imaginable antibacterial product. Never mind that soap and water worked better than most of them. The peak of this dangerous silliness was when Hanes and Jockey both released antibacterial underwear, almost immediately capturing 40 percent of the market. (“Germ-free fresh!”)

The germs just kept getting stronger and more resilient. Evolution moves swiftly for organisms that can produce millions of offspring a day, any one of which could be the mutant strain equipped to live comfortably in antibacterial underwear. By 2024, public health officials were warning of a crisis. The number of fatal hospital infections from so-called “superbugs”—which are really just bacteria that have developed a resistance to our best antibiotics—had been rising steadily for a decade. Every public health meeting and conference included a breakout session on antibiotic resistance. The major medical journals wrote editorial after editorial pointing out the growing threat. I remember reading a dire warning in the Journal of the American Medical Association that concluded, “Without a major change in behavior, we will soon face a medical return to the pre-penicillin era, and that should scare us.”

That did not scare us, apparently, at least not beyond the medical and public health community. By then, almost half of us were wearing antibacterial underwear. We were also using antibacterial sunscreen, buying phones with bacteria-resistant keyboards, and decorating our homes with antibacterial paint. All the while, the germs marched and drilled and produced more robust offspring; the number of Americans dying from drug-resistant hospital infections quietly eclipsed the number of Americans dying from HIV/AIDS and motor vehicle accidents combined.

And then Buster Bowman died. I liked him well enough; his music was popular in a “retro” kind of way when I was in college. The cable news networks played the announcement of his death over and over again. He had been admitted to a prestigious New York hospital for a routine procedure. The media and Bowman’s die-hard fans had camped out on the sidewalk outside the hospital, hoping to snap some photos of him or to get an autograph on his way out. What they got instead was Bowman’s physician, a white-haired fiftyish-looking man, who stepped out of the main doors of the hospital entrance in his blue scrubs to give them shocking news: “Buster Bowman died shortly after seven this morning,” he said.

The doctor was so quiet that many of the fans sprawled on the sidewalk did not hear him. Most of the tabloid photographers were around the corner vaping. Those who heard the doctor’s mumbled pronouncement rushed forward; the news spread through the crowd like an electric current. The reporters began yelling for the doctor to repeat his statement. They demanded more details. How does someone who comes in for a ruptured Achilles tendon end up dead?

Bowman’s physician had the look of a man who had been awake all through the night. He composed himself and stepped toward the bundle of microphones now being thrust in his direction. “Is this okay?” he asked of no one in particular, giving the statement a sense of performance art. Then he delivered the stunning details: “Buster Bowman was pronounced dead at 7:05 a.m. He died of a massive infection that we were unable to control with antibiotics. That is all the information I can provide at this time, pending an autopsy and a hospital investigation.”

My parents and their friends were devastated; Bowman was the rock icon of their generation. Public opinion toward antibacterial products changed overnight. Being spotted at the gym in antibacterial underwear was now only slightly more socially acceptable than wearing baby sealskin. But the pathogens were literally out of the bottle. Dormigen would have saved Buster Bowman, but it had not been invented yet.

3.

AL GOYAL, THE CEO OF CENTERA BIOMEDICAL GROUP, STARED at the spreadsheets arrayed on his desk. “This won’t work,” he said to his CFO, who was sitting opposite the impressively large and orderly desk. “We can’t have another quarter like this.”

Aditya “Al” Goyal was born in Mumbai, still Bombay at the time. He became Al at Harvard Business School, where he recognized that his classmates preferred their diversity in manageable doses. (At trial, his mother still referred to him as Aditya, causing some confusion.) Goyal knew his way around a balance sheet. He graduated from one of the prestigious Indian Institutes of Technology, which admit students based on the results of a single standardized test given across India. More than a half million students sit for the exam every year and fewer than ten thousand are admitted to the Institutes—making Harvard and Yale seem like community colleges by comparison.

Goyal joined McKinsey & Company, the prestigious consulting firm, in their Mumbai office. He was promoted to the New York office and then McKinsey sent him to Harvard, the business equivalent of finishing school, where he was a Baker Scholar (top 5 percent of the class). No one ever denied that Al Goyal was a very smart man, even after the trial. He was not necessarily brilliant, as that implies some creativity or exceptional skill. Goyal was most adept at running slightly faster than everyone else, jumping through whatever hoops happened to be placed in his path. He was not one to spend a lot of time questioning the direction he was being told to run, or why he was jumping through the hoops along the way.

“We might as well drop our trousers, bend over, and let Wall Street have their way with us,” Goyal told his CFO. Goyal was not a crude man, but as part of the assimilation process he had adopted common colloquial expressions and sports references, not unlike transforming himself into Al. He was determined to be as American as the Americans around him—the professional equivalent of a chameleon changing its color.

“We can put off some capital spending,” the CFO answered. “I’ve toyed with the idea of selling one of the plants and then leasing it back. We could book the revenue now. It’s not obvious we should own the real estate anyway.” The CFO, Johannes Swensen, was a neat, thin, athletic man. He did triathlons and the occasional marathon. Swensen had spent most of his career in his native Sweden, and then elsewhere in Europe. He had come to New Jersey when Centera Biomedical Group bought out the small genetic engineering firm he had founded in Stockholm. Swensen looked particularly pale and skinny opposite Goyal, who had the dark complexion of South India and the physique of an executive who had spent more time in airports than the gym. There was more than a little irony in the fact that the two men described on the cover of The Economist as embodying “The Low Point of American Capitalism” were both born somewhere other than America. When photographed together, the two of them—big and dark, thin and pale—looked like corporate villains designed by Disney animators.

“That’s small change,” Goyal muttered. “The analysts will see right through it.”

“Small change adds up,” Swensen said. “When the number hits the wire, that’s what the market will react to. The rest of the story will dribble out later. Besides, there is logic to getting out of the real estate business. We make pharmaceutical products. We don’t need to own the land under the plants. The analysts love that kind of thing. We can tell them there is more to come, this is just the beginning, lots of future cost savings, and so on.”

“They’re going to crucify us,” Goyal said, tapping the spreadsheet distractedly. “The board will not tolerate another quarter like this.”

“Well, this is the quarter we’re going to have,” the CFO answered, losing patience with the spreadsheet equivalent of hand-wringing.

“Then you and I need to take up golf—because we’re going to have a lot of spare time on our hands when the board sees this,” Goyal said.

“I don’t like golf. It takes too long,” the CFO replied. His attempt at levity fell flat. Goyal shook his head from side to side in disagreement, almost like a tremble. It was a distinctly Indian gesture that the Internet cameras liked to capture during the trial.

“We had a bad quarter. It happens. The board is smart enough to realize that,” the CFO said. “We can brief them before the meeting. They don’t like surprises, but they do tolerate bad news.”

“What happened to the Dormigen revenues?” Goyal asked.

“We booked it all last quarter,” Swensen said.

“Then why do we have this huge Dormigen expense now?”

The CFO explained the terms of Centera Biomedical Group’s contract with the U.S. Department of Health and Human Services (HHS). Centera was chosen to provide the federal government with twenty million doses of Dormigen a year to be stockpiled in case of a virulent pandemic, a terrorist attack with a biological weapon, or some other widespread biomedical emergency. Epidemiologists have always considered this a possibility; the flu pandemic of 1918–19 killed some forty million people around the globe. If anything, we are more vulnerable to a pandemic now than we were a hundred years ago. An outbreak of some nasty disease in Ningde, China—or some other place you have never heard of—will not stay isolated, as it would have in 1915. One business executive visiting a T-shirt factory in Ningde can spread a killer virus to Manhattan or Tokyo in a matter of hours. And there are plenty of nasty viruses: polio, avian flu, Ebola, swine flu, HIV, MRSA.

Dormigen works against them all. Ironically, it was the HIV virus that inspired us to believe that something like Dormigen might be possible. HIV has a unique ability to change its form; when the human body produces antibodies to fight back, HIV modifies itself—actually changes its form—so that the antibodies become ineffective. As soon as the human body finds the right key to disable the virus, HIV changes the lock. Some bold researchers reckoned that antibodies could be engineered to do the same thing, only for the “good guys.” Why couldn’t we engineer antibodies that would change form until they were able to destroy whatever pathogen had invaded the body? These antibodies would show up with a whole ring of keys, like the janitor who lets me into my office when I lock myself out. He takes the huge ring of keys hanging off his belt and patiently tries one after another; eventually one of them opens my door. Ten billion dollars and fifteen years later, we invented the most powerful drug since penicillin: a giant antibody key ring.

“Dormigen is alive,” Swensen told his boss at that fateful meeting at Centera Biomedical Group.

“It’s a pill, right?” Goyal asked.

“Yes and no,” Swensen offered. “It’s a gel cap. But my point is that it’s alive. It’s a package of enzymes that we cultivate—”

“Never mind,” Goyal said, literally waving away the science with a sweep of his fleshy arm. Obviously, if he cared more about the science, fewer people would have died. Dormigen is engineered by splicing several key human genes into a host embryo, usually a chicken egg. The process is not terribly complicated, but it does require twenty-one days for the genetically engineered cells to mature in their host embryos, after which they are harvested and grafted onto a common human antibody that can be injected back into the body and easily absorbed. As the Centera CFO correctly pointed out, Dormigen is alive. There is nothing unique or even terribly interesting about that; many vaccines are alive. It does explain, however, why Centera Biomedical Group was paid a lot of money to manufacture Dormigen, store it, destroy it—and then do it all over again.

“Dormigen has a shelf life of about a hundred and eighty days,” Swensen explained to his overwrought boss. “We make twenty million doses, then six months later we destroy them. That’s what we do, over and over again—unless there is a need for them, in which case the government would draw down the stockpile.”

Goyal tapped a line item in the budget. “We’ll spend a hundred and twenty million dollars this quarter to destroy something that cost us a hundred and twenty million to produce last quarter?”

“No,” the CFO said. “We’ll spend about fifteen million to destroy the old doses and a little over a hundred million making the new ones.”

And that was when the plan was hatched. Both men denied any knowledge of it at first, when the FBI raided the headquarters of Centera at the beginning of the Outbreak. Later, at trial, each would blame the other for the scheme. The jury found neither convincing and convicted them both. In any event, their plan was simple and good for the bottom line: stop producing new Dormigen until revenues turned healthier, probably in just a few quarters. Goyal and/or Swensen decided to gamble. Rather than spending a lot of money to produce a new batch of Dormigen—vials that would sit in a warehouse only to be destroyed six months later—they would keep the old stuff around. “I never thought it would matter,” Swensen explained during the sentencing phase of his trial. “We were just a safety valve.”

That was the exact language in the contract: safety valve. Centera was only obligated to provide the Department of Health and Human Services with Dormigen after the government had exhausted 75 percent of its own stock. The U.S. government had tens of millions of doses, most of which went unused in a normal year. The Centera scheme was like loaning out the spare tire on your car for a few weeks. How often do you get a flat? There was virtually no chance that the government would need Dormigen this quarter, when Centera could really use the extra revenue. As soon as the business environment improved, the company could go back to making and destroying Dormigen without anyone being the wiser.

Goyal and Swensen were vilified as the embodiment of evil, two guys willing to sacrifice lives in order to goose quarterly profits. The truth is subtler. Goyal and Swensen cut a corner. They did something selfish and dishonest—but they did not believe anyone would get hurt. They did not run into a crowded stadium and start firing weapons. They did not drink pitchers of margaritas at happy hour and then drive home. Their crime was the corporate equivalent of running a yellow light. They lost perspective. They were three minutes late for an appointment that did not really matter in the grand scheme of things; when the stoplight went from green to yellow, they sped up—just a little, in their eyes. The rest of the world did not figure into that calculation. Their three minutes were more important. Who knew that a group of schoolchildren might enter the crosswalk? If you think about it, the people who run yellow lights are more dangerous than the people who run red lights, because there are so many more of us.

Goyal and Swensen were in complete agreement on how their fateful conversation ended. Goyal once again insisted that Swensen take up golf. “You can’t run marathons forever. The knees are not made for it,” the CEO said.

“There is no exercise in golf,” Swensen protested.

“There is if you walk,” Goyal insisted.

“Most people take carts.”

“Not where I play, at the Wood Hollow Club. We have caddies. I can get you in like that,” Goyal said, snapping his fingers. “Your kids can use the swimming pool.”

“I don’t see the point of trying to hit a small ball into a small hole from a long distance,” Swensen joked with his CEO. The conversation drifted back to a familiar place. Levity crept into the room.

“That’s exactly the point!” Goyal exclaimed. “When I focus on hitting the ball, my mind is purged of all this nonsense.” He made a sweeping gesture across his desk.

“And then you get angry when you miss a shot.”

“Now, that is true!” Goyal laughed heartily. “Still, it’s yoga for the mind, I am telling you. This evening, I am going to the driving range. I am certain of that!”

Goyal walked his CFO to the door. According to his testimony at trial, Goyal did in fact hit two buckets of balls at the Wood Hollow driving range later that afternoon.

4.

MY PARENTS WANTED ME TO GO TO LAW SCHOOL. I TOOK THE LSAT my senior year in college just to placate my mother. I also took a summer job working for a Washington, D.C., firm that was litigating an enormous patent infringement case in the defense industry. As a college student, I was a peon—albeit a peon billed out to the client at $75 an hour. (I was paid $15 an hour, with no benefits.) I moved boxes around. I did some background research on missile defense systems. During one three-week stretch I put fifteen thousand trial documents in chronological order. The law school interns had only slightly less menial tasks, though they were billed out at $125 an hour. Even the young lawyers did not seem to be doing a whole lot of intellectually interesting work. Our collective paper pushing did not resemble the fancy courtroom dramas on television.

The case never went to trial. All of the work was just a prelude to a negotiated settlement, a very expensive and time-consuming bluff. The settlement was very advantageous to our client, and we were supposed to be excited. Instead, most of the team was exhausted and cynical. We knew it was not our brilliant legal analysis that had brought the case to closure; neither firm wanted to roll the dice with a jury trial. We had hired an expensive jury consultant who told us that twelve laypeople would have little ability to grasp the key technical details of the case. I could have offered the same advice more cheaply. At about the same time I was putting those fifteen thousand trial documents in chronological order—lab notebooks with pages of equations, long memos with detailed weapons specifications, and the like—I had to go to the Department of Motor Vehicles to get my driver’s license renewed. As I looked around the DMV, I lost a fair bit of confidence in our prospective jury pool.

After the settlement, the firm had a massively expensive party in a ballroom at the Four Seasons, including a caviar bar and small Kobe beef sandwiches passed around on trays. There was a guy making martinis in the corner of the ballroom with boutique gins. (Unlike vodka, you really can taste the difference with gin.) I stumbled home with a perky second-year law student from Harvard whom I had been lusting after since the day I arrived at the firm. The next morning, while she was still naked in the bedroom of her small but charming Georgetown apartment, she rolled toward me and kissed me gently on the chest. I was expecting more great things. Instead, she said, “Promise me you won’t go to law school.”

That was not exactly a binding legal commitment. And it is not the story I told my parents about why I did not want to become a lawyer. Still, I did not apply to law school. I stumbled into virology almost by accident. My dad is an accountant; my mom was a marketing consultant until she quit to raise my sister and me. My people tend to be service providers, not scientists. I had never met anyone with a Ph.D. until I arrived at Dartmouth. Several years later I woke up as an economics major. The math was relatively easy for me; economics was considered to be the most direct route to Wall Street, or someplace equally lucrative and respectable. Anyone who graduated with a respectable GPA and decent social graces could tap into the impressive Dartmouth alumni network to become at least a mini-titan of finance. Guys who had spent a good portion of senior year drunk in fraternity basements were handling millions of dollars for hedge funds by homecoming of the following year (or so they said).

I am not one to shake up the social order, but it did strike me—even at the time—that most of the “career planning” going on senior year did not involve much planning, let alone introspection. Rather, it felt like a warm, comfortable current sweeping smart people gently toward investment banking, consulting, law school, and a few other low-risk, high-reward careers. When we entered as freshmen, our class dean pointed out in her matriculation speech that our class of roughly one thousand had three hundred and eleven high school valedictorians. We also supposedly had twenty-three soccer captains (which boggles the mind given the awful performance of the soccer team during my four years). I was surrounded by high achievers who, to that point in life, had excelled by doing a prescribed set of tasks faster or better than everyone else. High school is a brilliantly designed machine for beating the originality and creativity out of anyone. One does not thrive by creating original work, or inventing something, or questioning authority, or working well with others (cheating).

By senior fall at Dartmouth, all of this was bouncing around in my mind. The inner competitive streak among my high-achieving classmates had been unleashed full force. When McKinsey & Company[1] arrived on campus, it felt like the corporate equivalent of the Beatles’ arrival in America. All conversation revolved around which members of our class had been selected for “closed” interviews—those that were offered by invitation only. In what struck me as a cruel gesture, McKinsey also offered “open” interviews to the first twenty-five students in line at Career Services on a particular Monday morning. Scores of students lined up the night before. The weather was so bad (it would fall below freezing that night) that students at the back of the line began to hope that those at the front would get sick and leave. They actually said that out loud.

I was having a small existential crisis when I arrived in Professor Huke’s Biology of Parasites class at the beginning of the winter quarter. I wish I could say that I had scoured the course guide looking for a class that would take me to a new intellectual plane. In fact, my adviser had sent me an e-mail the previous week pointing out that I had not yet completed my laboratory science requirement. I had a keen interest in graduating, and I was running out of terms to finish my electives, so I decided to sign up for a lab science class. There were two choices. (Actually, there were six choices, but four of them either met before nine a.m. or were held in buildings that would have been a nose-hair-freezing walk from my dorm during January and February.) It had to be Bio 3 (Biology of Everyday Life) or Microbiology 32 (Biology of Viruses and Parasites). The Biology of Everyday Life was a known “layup,” meaning that anyone who put in a modicum of effort could count on an A- or better. The bulk of the course consisted of collecting samples of living things and looking at them under a microscope. Other than the week on “bodily fluids,” which was apparently pretty cool, the course was an embarrassment to the Ivy League. Still, three hundred people enrolled every time it was offered—most of the humanities and social sciences majors on campus—because it was an easy way to boost the GPA and fulfill the lab science requirement at the same time.

On a Thursday night in the first week of the quarter, I had a conversation in the basement of a fraternity that changed my life trajectory, like a boulder dropped into a stream that sends the current coursing in a new direction. I ran into Sloan Hill near the beer tap in the Alpha Delta house. We talked for a while. One can draw a straight line, or series of lines, from my conversation with Sloan that evening to the Oval Office, where I would spend hours huddled with the President of the United States a decade later.

5.

SLOAN AND I APPROACHED THE BEER TAP FROM DIFFERENT directions and I offered to fill her cup. She was effortlessly cute: gray-blue eyes, short blond hair, no makeup to speak of, and a killer smile, especially when she was a little tipsy. Sloan squinted when she smiled, and that was cute, too. She was also “wicked smart,” as we liked to say in New Hampshire, even in a sea of overachievers. She worked hard enough; the work came easy to her, as it did to a lot of those high school valedictorians wandering around campus. But what set Sloan apart were her impressively eclectic intellectual interests. While the rest of us complained about too much work, she found time to read for fun, even fiction. Her RealNews blastbox was filled every day with writers who ranged from counterculture to intellectually unhinged. (“We all need to know what they’re saying,” she explained to me once.) I explicitly remember her citing a column in the Jerusalem Post one day in the context of some meandering discussion on the Middle East. Who in New Hampshire reads the Jerusalem Post unless it is assigned for a class? (Even then, most of us tried to cut corners on the assigned reading.) I remember seeing Sloan at the bus stop one Friday afternoon, waiting for the Dartmouth Coach. She was headed to New York to wander through museums all weekend. “I just need to recharge,” she said, looking comfortably alone with a small duffel at her feet.

Sloan was the student that we all should be, the student that our parents probably thought that we were. She took classes that interested her. She worked hard but was indifferent to grades. She visited her professors during office hours to talk about concepts in the class, rather than to haggle for more points. Sloan lived in my freshman dorm, just down the hall. We had become friends before she disappeared to date older guys and pursue different campus activities. Still, the bonds of freshman year are deep, and I really liked her. She was one of a handful of people whose opinions I valued. To my credit, I did not really spend a lot of time obsessing about what other people thought of me. I did care what Sloan thought.

As I filled Sloan’s glass with beer from the tap, she asked, “So, what are you taking this quarter?”

“Monetary Policy,” I said. “And a writing class that looks pretty good. I’m still shopping for a lab science.”

“You’re not taking Bio 3, are you?” she asked accusingly.

“No way,” I said. It was the truth, as of that moment. Yes, I had sat in on Bio 3 twice that week, and it fit perfectly into my schedule, but once Sloan asked me that question, in that tone, I was not going to take Bio 3. “I’m thinking about that parasites course.”

“Really?” she said, with more than the usual amount of enthusiasm for a desultory conversation in a fraternity basement. “Were you there this week? I didn’t see you. I’m doing my Presidential Scholar thesis on the anthropology of contagious diseases, so I’m sitting in on the class.”

The next morning I signed up for Microbiology 32. I could fulfill my lab science requirement; I also entertained visions of sitting next to Sloan every day in class, sharing notes, studying together. Sometimes I imagined that we would work together late into the night, and then when the readings no longer made sense, and we had grown punchy from too little sleep and too much coffee, I would lean over and kiss her. And she would kiss me back, because the bond developed over weeks of studying together was inexorable… There were a lot of variations on what happened next, though invariably we had sex in some public study space and then went on to ace the exam, after which we became a prominent campus couple.

Only the part about acing the exam had any approximation to reality. I worked hard in the class, for a bunch of reasons, one of which was to impress Sloan. I was never going to have sex with her in the rare books section of the library if we did not at least get to the studying part. And to get there, I would have to add some value to the study sessions. I went to class. I did the reading. I even went to see the optional documentary during the X-hour. I sat next to Sloan as often as possible, while still trying to make it feel like happenstance. Along the way, something else happened: I fell in love with pathogens, with their stunning evolution and adaptation, even the most awful among them.

I learned right before the midterm that Sloan was not taking the course for credit. We never did study together. Still, my career was launched. My path to the White House began with a drunken conversation in a fraternity basement and was nurtured by salacious thoughts of wild sex with my study buddy. Sad but true.

6.

“THE MARBURG VIRUS, WHICH IS CLOSELY RELATED TO THE Ebola virus, causes a hemorrhagic fever. After a brief incubation period, it attacks the body’s major organs, the spleen, the liver, the pancreas, the testicles, the eyes, the spinal cord. In some cases, the victim will hemorrhage—bleed profusely—from all of the body’s orifices. Somewhere between a quarter and ninety percent of human Marburg victims will die, and that’s when the virus reveals how beautifully adapted it is.”

That was how Professor Richard Huke began his first lecture in Microbiology 32. He did not call roll; he did not pass out the syllabus. He just started talking about the Marburg virus. I am paraphrasing him, but I remember the details vividly. I am certain he used the word “beautiful,” because when someone describes humans bleeding out of every orifice and then goes on to speak admiringly of the organism responsible—well, that is something you remember. Huke had a point. The Marburg virus is spread through bodily fluids—blood, saliva, vomit, and so on. When humans die from Marburg, they become “disease bombs” (another Huke phrase). A single drop of blood from a Marburg-infected corpse can contain five million viruses. Remember, the victim dies bleeding from all those orifices. So his or her last act, post-death, is to infect the next of kin, like an uncapped oil well spewing viruses.

Marburg strikes primarily in Central Africa (though it’s named for a German village where there was one outbreak, which is so sadly typical). In Central Africa, the most common funeral ritual is to wash the corpse and kiss it goodbye. The motivating belief is that the lack of a proper funeral will anger the spirit of the deceased and cause that spirit to seek vengeance. In the process of that ritual bathing, the five million Marburg viruses per drop of blood find their next victims. One has to appreciate the irony: the deceased exacts viral vengeance because his relatives do what they are supposed to do to avoid vengeance.

When Professor Huke said the virus was “beautiful” or “beautifully adapted” or whatever the phrase, he was right. Remember, we do not even agree on whether viruses are living things or not. We do know that they exist primarily to replicate themselves; the better a virus is at replicating itself, the better its chances of surviving for another hundred million years or so. Natural selection helps organisms that help themselves. When I was later thrust abruptly into the media spotlight, my first mistake was speaking like a microbiology professor. When I described Capellaviridae as “elegant”—I was at least politic enough not to call it “beautiful”—I meant only that it was well adapted from an evolutionary standpoint. My comment was meant to underscore the scientific challenge that we faced in breaking the chain of transmission. Obviously, with the risk of a pandemic hanging over the nation, I can understand how my comment was interpreted differently. I did not mean to be callous or indifferent. I have since apologized formally, but I will repeat the essence of that statement here: I was speaking as a scientist. I was speaking about a shockingly devilish and dangerous pathogen in the same way that a detective might describe a wily serial killer. I did not “admire” this raging virus, as Home Depot Media stupidly suggested. We had our work cut out for us—that was all. I assume, given my role in stopping the epidemic and saving untold lives, I can be forgiven my poor word choice.

7.

PROFESSOR HUKE FASCINATED ME. FIVE MINUTES INTO THE lecture, and I was already convinced that I should take the course, whether Sloan was in it or not. “Should you be worried about Marburg?” Huke asked the class. Most of the students nodded yes, but no one raised a hand to answer. “You’re nodding ‘yes,’” he said, making eye contact with a guy wearing a DARTMOUTH FOOTBALL cap in the second row. “Why?”

“Because I don’t want to bleed out of every orifice,” the guy in the football cap answered. There were titters from the class, as we each imagined bleeding to death out of our ears, nose, mouth, eyes, and asshole. Even Huke conceded with a little grin that the answer was clever, if not particularly deep.

“Fair enough. Do you think that’s likely to happen?” Huke asked.

“Not if I stay out of Central Africa,” Football Cap Guy said.

“What if it spreads? There are flights from Liberia to Brussels three times a week,” Huke prodded. He let this prospect sink in, before turning in my direction. He made eye contact and took a half step forward. “Are you worried?” he asked. I was four or five rows back, usually far enough to be safe from this kind of thing. He just looked at me, not rudely, but it was clear he was going to wait for an answer. Some of the students in the rows in front of me turned and looked back.

“Well, I wasn’t worried when I got out of bed this morning,” I said. “Now I am, I guess.” The class laughed again. Huke got the answer he was looking for.

“You can stop worrying. For all the horror of this virus, we’re talking about a couple of hundred cases a year. Even in the places where it’s endemic, the infection rate is extremely low,” Huke explained. There was a brief clicking of keyboards as students made a note of this fact, which felt like it could turn up on the midterm.

“What if it were used as a biological weapon?” a girl asked at the end of my row. Huke wheeled excitedly in her direction.

“We’ve been close! The Soviets had that capacity during the Cold War. They never used biological weapons, thankfully, but they had them. So, yes, you’re correct. If the goal were to inflict mass casualties on a population in a particularly horrific way, Marburg would be a good mechanism—as would a lot of the other organisms that we’re going to talk about in this class. So does that worry you?” The question was directed back at the girl in my row. She was a soccer player, tall and tan and fit, probably in KKG or one of the other popular sororities.

“Sure,” she answered earnestly.

“Well, you can relax, at least about Marburg,” Huke assured her. “Transmission requires direct contact with a victim’s bodily fluids. We can contain that. The outbreaks are horrible, but then they fade away as we sequester the victims. But smallpox, now, that’s a nasty little virus, far worse than Marburg because it spreads more easily.” There were clicking keyboards around the room. This stuff would definitely be on the midterm. I was typing along with the rest… “an airborne virus that can be inhaled, like the flu”… “the more serious form of smallpox, Variola major, kills thirty or forty percent of those who become infected”… “black pustules on the skin.”

Huke paused; the clicking keyboards continued for a few seconds as we caught up. Then he delivered his carefully scripted finale, the virus equivalent of that last burst of fireworks on the Fourth of July: “In the twentieth century, smallpox killed at least three hundred million people—more than the world wars, the Soviet purges, the Great Leap Forward, and just about every other man-made catastrophe combined.” He paused again. The typing stopped and most of us looked up. Then, when he had our full attention, he continued, “I was born in 1967. That year smallpox killed two million people around the world.”

“Holy shit,” someone exclaimed up front.

“Yes,” Huke answered. “That’s about right. You know what’s even crazier? Edward Jenner had invented the smallpox vaccine a hundred and fifty years earlier!” There was lots of clicking as Huke walked us through the mechanics of immunization… “infecting an individual with cowpox, a milder relative of the smallpox virus, causes the body to produce antibodies”… “wealthy countries developed mass immunization programs…”

“What happened on October twenty-sixth, 1977?” Huke asked with a dramatic flourish. I had no idea. I looked around the room; apparently no one else did, either. After the suspense mounted sufficiently, he told us: “The World Health Organization diagnosed the very last naturally occurring case of smallpox in Somalia. The very last case! After that, the WHO certified the global eradication of smallpox—the first and only time that we have completely triumphed over a major contagious disease.” Huke must have given this lecture twenty-five or thirty times in his career. Still, he was not faking the excitement. He thought this stuff was so remarkably cool that we had no choice but to share his enthusiasm. A disease that could kill two million people in a single year, wiped out by human ingenuity.

Huke walked us through the details, which felt more like an adventure story than biology. The developed countries had already eradicated the virus through immunization. That left the disease lurking in some of the poorest, most war-ravaged places on the planet. The goal was to identify outbreaks in those places and then contain them. Teams of public health experts were dispatched with radios to these forlorn outposts so they could call in any outbreaks. At the first sign of smallpox, the vaccine was rushed to the scene and anyone who had come into contact with the victim was immunized. “In some cases, guards were posted at the doors of infected households so no person could spread the disease,” Huke explained, relishing the detail. “The strategy was called surveillance and containment. And on October twenty-sixth, 1977, the very last case of smallpox on the planet was identified and isolated. That is how and why you live in a world free of that horrible disease.”

This material would definitely be on the midterm, but almost no one was typing or writing. How can you forget something like that?

8.

THE PRESIDENT OF THE UNITED STATES WAS NOT A PARTICULARLY nice man. At times he could be kind of an asshole, to be honest. The curious thing is that I do not think that made him a bad president. If anything, it may be an essential characteristic for the job.

I met the President on the first of April. I know it was April 1 because it was my thirtieth birthday. That morning I was trying to fix the power source in one of our microscopes in the lab. The phone rang in my office, which was really just a small nook with a desk in a corner of the laboratory. I did not have a secretary; no one in the laboratory did. The microscope was disassembled all over my workspace, so I let the call go. Then my cell phone rang, and I ignored that, too. I figured it was someone calling to wish me a happy birthday and I could call them back. (The good news about a birthday on April Fool’s Day is that people tend to remember.) But just a few minutes later a woman whom I recognized as the assistant to the Director walked into the lab. She looked around quickly, spotted me, and headed briskly in my direction: all business. “You need to answer your phone,” she said.

“I was in the middle of something,” I replied. I was more puzzled than defensive. I did not get a lot of important calls and none that were time-sensitive. I was paid to do research, not talk on the phone.

“The Director needs to see you right now,” she said.

I felt a tinge of panic at that point, right in the pit of my stomach. Three days earlier, a college friend had sent an e-mail to my work address with a subject line that urged me to “TAKE THE TEST.” I foolishly opened it, and the link led me to an Internet slide show with twenty pairs of bare breasts. In each pair, one set of breasts was real, and one was “enhanced.” I did not even take the test—I was smart enough to know that—but as I rushed to close the screen, with two large sets of breasts plastered across the entire thirty-five-inch monitor, one of our lab assistants walked by my desk. “Nice,” she said sarcastically. I closed the window immediately, but still… not good. And now, with the Director’s assistant standing officiously in front of me, I thought, Very bad. Very, very bad.

The lab is funded almost entirely by the federal government. My computer was government property. Roughly 80 percent of the scientists are men; the Director, a woman, was appointed in part to send a signal about the importance of promoting women in science. I had been to three full-day seminars on gender sensitivity in the workplace. (Everyone at the National Institutes of Health had to do this; I was not singled out for any particular behavior.) Even without the sensitivity training, I was well aware that studying real and fake boobs on a government computer with a huge monitor at a federally funded laboratory was frowned upon.

Was it enough to get summoned to the Director’s office? Maybe. I stood there for a minute, trying to remember if I had deleted the e-mail. The servers were all backed up, so it probably did not matter anyway.

“Hurry up. And bring your coat,” the Director’s assistant said. My coat?

“Where are we going?” I asked.

“I have no idea,” she answered curtly. “They just told me to find you as quickly as possible and take you to the rear entrance. The Director is going to meet you there.” At that point I knew this was not about trying to tell real boobs from fake boobs in a government laboratory. If anything, the pit in my stomach grew more intense. My chest felt tight, like someone was squeezing it from behind.

The Director was standing next to a black Town Car in the circular drive at the back of the building. As I appeared, she opened a rear door of the car and motioned me in. I slid across the seat and she got in beside me, slamming the door. The car pulled out immediately. The Director introduced herself and offered a handshake. Obviously I knew who she was, but I appreciated the gesture. Many of the people whom I would meet in the coming days did not extend the same courtesy, including the President. Then again, I suppose it is silly for the President of the United States to introduce himself, just false modesty.

“What can you tell me about lurking viruses?” the Director asked.

“What would you like to know?” I asked. She had asked a broad question, the virology equivalent of asking a historian to tell you about wars in Europe. “You should read my Ph.D. dissertation. You’d be the fourth person,” I said, trying for humor.

The Director had a nondescript black trench coat folded across her lap. She pulled a copy of my dissertation from beneath the coat. I could tell from the binding that it was the copy from our library at the lab. “I flipped through it,” she said. “You need to give me the basics.”

“Where are we going?” I asked.

“To the White House.”

“Has there been some kind of attack?” I asked. Anybody in my field knew the risks of biological warfare. The public tends to freak out about nukes, but if you put some of those nasty pathogens that Huke taught us about on a simple rocket—the kind that Hamas can build in a garage—you could kill, maim, and terrify a lot of people. Pathogens are easier to acquire than nuclear weapons and far easier to move across international borders. That was one reason our laboratory had been relatively well funded over the previous decade.

“It’s more complicated than that,” she said.

“Every lurking virus that I’m aware of responds to Dormigen,” I offered.

“Yeah,” she said in a strange, noncommittal kind of way.

Only later, when I was sitting on a couch opposite the President, with a White House steward offering me coffee or water, would I understand what she meant by that.

9.

THE FIRST KNOWN CASE WAS IN NATICK, MASSACHUSETTS. A thirty-seven-year-old man had been shoveling after a particularly heavy snowstorm in late March. He came into the house and complained of flu-like symptoms. By midnight he was in the emergency room with a 103-degree fever that would not respond to aspirin or ibuprofen. His white blood cell counts were elevated, but there was no obvious sign of infection or illness. At two-thirty a.m., after the fever climbed to 104, the attending physician prescribed Dormigen. The fever abated quickly and the patient was released from the hospital later that morning.

We know about that particular case only because the ER physician did what she was supposed to do, which was report the illness and its symptoms to a central database jointly maintained by the Centers for Disease Control (CDC) and the National Institutes of Health (NIH), my employer. True, the patient walked out of the hospital nearly recovered, and there were no recurring symptoms, but that had become a problem in the post-Dormigen world. Dormigen is effective against all known pathogens, meaning that doctors can cure a patient without having any idea what the underlying illness is.

This is a great thing—mostly. Public health officials also recognized it as a looming problem. If Dormigen were to go the way of penicillin and just about every other breakthrough antibiotic—as will almost certainly happen, unless we can somehow stop the process of natural selection—we might have no knowledge of the illnesses that had been afflicting us. Dormigen took us to a strange place in medicine. A physician can have no idea what is wrong with a patient, and yet a ready cure is never more than a prescription away: the doctor hits a key, a CVS drone drops the medicine at your door, and the disease is beaten back—whatever it may have been. Many health care experts pointed out, half seriously, that if you showed up in an emergency room with flu-like symptoms, the guy mopping the floor in the waiting area could treat you just as effectively as any of the professionals in white coats. “Here, take Dormigen,” the janitor would offer before going back to his mopping. And it would work.

In a rare act of bipartisanship, Congress passed a law to deal with this potential problem. Physicians are now required to make a diagnosis before prescribing Dormigen. A doctor has to at least make some conjecture as to why your chest is covered with open sores. Then you get your gel caps. Yes, physicians still cut corners, offering vague, incomplete, and often inaccurate diagnoses (e.g., “tropical disease”), as I would if I were an overworked general practitioner with twelve and a half minutes to spend with each patient. Still, some information is better than none.

The same law requires that if a physician prescribes Dormigen without a firm diagnosis—if he or she really cannot identify the underlying illness—the symptoms have to be entered into a federal database. Doctors hate it; so do the anti-government folks. Big Brother now knows if you have a rash on your penis. Like many federal regulations, this one is imperfectly observed and poorly enforced. Nonetheless, on that snowy March evening in Natick, Dr. Helen Spellings typed a few vague lines into the Dormigen Prescription Without Diagnosis (DP-WoD) database at the end of her shift. The salient key words of the undiagnosed illness were “healthy male,” “nonresponsive fever” and “flu-like symptoms.”

In Tampa, Florida, at about the same time that Dr. Spellings was typing those vague symptoms into the DP-WoD database, Tom Elliott, a management consultant from San Francisco, was spiking a fever as he prepared to give a presentation to the board of directors of a large auto parts manufacturer. Elliott did not seek medical attention, as far as we know. Our best guess is that his fever was around 102 as he rushed through his PowerPoint slides. He mentioned in passing at the beginning of his presentation that he was not feeling well. He later sent a text to his daughter saying he felt miserable—so bad that he was not sure he could tolerate the five-hour flight home. Elliott went back to his room at the Marriott Courtyard, presumably to rest. A hotel employee found him unconscious that afternoon when she went to clean the room. By the time Elliott was transported to a hospital, his major organs had shut down. He died less than an hour later. Tom Elliott was forty-three and healthy. As far as we know, he was the first fatality of the Outbreak.

Elliott’s death, and what little could be pieced together of his symptoms, were entered in a different federal database, the Fatal Infectious Disease Surveillance Instrument (FIDSI). This database has been around longer; doctors take it much more seriously. Public health officials pay attention when otherwise healthy people die from unknown causes. On the same day that Tom Elliott died in a Florida hotel room, six other people died with similar symptoms: five middle-aged men and a female lacrosse player at the University of Vermont. But to spot that pattern, someone has to be looking for it.

10.

“WHAT DO YOU MAKE OF THIS?” TATIANA BOROVSKY ASKED her supervisor.

She had walked down the hall at the CDC on a Monday morning clutching a handful of papers and some rough statistical analysis she had done earlier that morning. The public would eventually know her simply as “Tatiana” after stories described her as the “discoverer” of the Outbreak. I suppose it was technically true, in the sense that Tatiana Borovsky was the first person to notice a statistical anomaly, the mathematical manifestation of an epidemic. If I were to be less generous, I would point out that the first person to discover it is raining is not necessarily a genius. The data, like raindrops, tend to fall on your head.

Tatiana was tall—nearly six feet—and exotic-looking. One has to wonder if she would have received as much attention if she had been a balding, middle-aged man, like her supervisor. She had an intriguing backstory, including family that hailed from the Balkans and Syria. (Her provenance tended to shift, depending on the news story.) Tatiana had long legs, long jet-black hair, and exotic if not necessarily beautiful features. As you may remember from some of the news stories, she also had a proclivity for skinny-dipping while on holiday at various destinations on the Black Sea. One lesson from the Outbreak is that if you are lanky, reasonably good-looking, and prone to post topless photos on the Internet, you are likely to garner undue attention. Tatiana walked down the hall on that Monday morning with data showing an increase in unexplained deaths that was two standard deviations above the norm. If one does a Google search of “Tatiana Borovsky and two standard deviations” the topless photos come up, along with a succinct explanation of what a standard deviation is, using breasts as a teaching tool. One standard deviation is significantly larger (or smaller) than normal. Two standard deviations is very unusual—as the photos illustrate. Very clever, I suppose. (To be clear, I never visited this site while using my government computer.)

“Probably just noise,” Tatiana’s supervisor said as he perused the data. “But those are big numbers.” He had a small, windowless office with pleasant but artless photos of his second wife and their blended family. He most likely did not take photos of himself swimming naked, and if he did, no one would want to see them. “Check all the databases,” he told her. “See if anything turns up in the OECD numbers.”

This was basic epidemiological detective work. You look for patterns. The more data you have, the easier it is to spot them. Suppose six people driving the same kind of pickup truck die in traffic accidents in six different states. A police officer at each accident scene will investigate the crash and fill out the paperwork. Why would any one of those officers—just one person examining one crash site—suspect that the brakes on that particular pickup truck were faulty? Each report gets filed away. Maybe it ends up in a state database, one piece of a jigsaw puzzle. No one can do the puzzle without seeing the other pieces. But when a mid-level bureaucrat at the National Highway Traffic Safety Administration—Tatiana without the legs and exotic looks—gets a weekly report showing a cluster of fatal crashes involving a T-370 pickup, she is going to put down her coffee and walk that report down the hall. Someone is eventually going to take a look at the brakes on the T-370.

Tatiana did that. The rhetoric about her as “the hero” and “the Syrian savior” was not merely overblown; it was ridiculous. She had only one basic responsibility, which was to gather reports and look for anomalies. She was not a paper pusher, more of a paper catcher. The oddity she spotted was 107 unexplained deaths from flu-like symptoms in the previous week. All were otherwise healthy people. Most were under age fifty, including eight college students. Even in the era of Dormigen, there are periodic spikes in unexplained deaths. Most of them turn out to be statistical noise, but as Tatiana’s supervisor rightly observed, 107 was a curiously high number for unexplained deaths among healthy people. Each of those deaths was its own tragedy; together they may have been the pieces of a more interesting puzzle. Or maybe not.

Tatiana plodded back to her cubicle and did three things as a matter of protocol.[2] First, she sent a blanket query to the public health entities in the other thirty-three OECD countries asking if they were observing a similar trend. (The Organization for Economic Cooperation and Development—OECD—is a consortium of the world’s most developed countries that share data and cooperate on assorted things.) That is the fastest and easiest way to spot a global epidemic. True, any nasty pandemic is more likely to originate in Liberia than in France, but there are no meaningful data in the Liberias of the world, so the best we can do is spot a trend when it begins to appear in places where you can drink the water.

Second, Tatiana requested follow-up data for each of the 107 deaths. There would be autopsy results for all of them because the cause of death was unknown. That is the law in most states, even if it is often skirted. She also requested the medical histories and treatment files for each case. This is trickier territory given the privacy issues, but doctors and hospitals typically comply if the identifying information can be stripped from the files. The sad irony is that the CDC—our first responder for anything that looks contagious—does not care at all about personal information. At the same time families and friends are reminiscing at funerals about intimate details—hobbies and weddings and crazy college stories—the CDC wants none of that information. The puzzle pieces do not need names, let alone golf handicaps or boyfriends.

Last, Tatiana accessed a different database to check for any unexplained increase in the prescription of Dormigen. If there were an epidemic afoot, particularly a flu epidemic, most patients would be treated successfully with Dormigen. They would stop by the doctor’s office after a day or two of feeling miserable, or on the way home from work in the middle of the day. Neither doctor nor patient would ever know—or care—how bad things might have been in the absence of Dormigen. Still, there should be a record for each of those cases, even if the last thing a beleaguered physician wants to do at the end of the day is fill out extra paperwork. More puzzle pieces.

The bureaucratic gears turn slowly. Tatiana left for a short vacation in the Bahamas with her fiancé. Many of the European equivalents of the CDC were closed for assorted holidays (and, to be honest, they do not work at light speed even when they are open). The files were eventually shuffled and filed and analyzed, after which there was a clear pattern. Six of the OECD countries showed an anomalous rise in flu-like deaths among young, healthy adults. The spike in unexplained Dormigen prescriptions, both in the U.S. and in those six OECD countries, was also pronounced. The numbers were not huge, but they were significant. More reports were prepared. Meetings were held. Information was shared across countries—the usual administrative protocol. No one was particularly alarmed. The pattern was noteworthy but relatively modest in the grand scheme of things.

That changed in week three. Tatiana, back from the Bahamas, sent an e-mail to the whole Contagious Disease Working Group: “Hey All, I just compiled the new data on global unexplained deaths, and there is something going on here. The numbers are still relatively small, but they are increasing at a rapid rate. Can we get together before the end of the day?”

In CDC-speak, that means “Holy shit!” Nobody in public health likes to see anything “increasing at a rapid rate.” Epidemics do not meander along at fifty-five miles per hour. When a sick person has the potential to infect ten or twenty-five others, every sporting event or crowded subway car or day-care center becomes the disease equivalent of a cluster bomb. That was how forty million people died in the Spanish flu pandemic. There were three more deaths at the University of Vermont, all athletes. The media did not have access to the broader data, which was showing a rise in unexplained deaths across the country, but when three otherwise healthy college students die in the same place from an ambiguous cause, people notice. Google News blasted a segment on the “mysterious deaths” at the University of Vermont. CNN sent a camera crew to campus to interview alarmed students, thereby generating more alarm. The Internet was abuzz with theories.

The CDC Director asked Ron Justman, the head of Tropical Diseases, to lead a working group to coordinate our response to whatever was going on, this anomalous spike. There was no reason to believe it was a tropical disease, but Justman was senior and relatively competent. More important, he had some free time, having just rotated off of a task force working on an outbreak of dengue fever in Hawaii. The NIH sent over a handful of research scientists. Yes, there was a CNN camera crew at the University of Vermont, but in our world (though I was not yet involved) this felt like more of the same: another statistical aberration that would likely run its course.

The first meeting of the still-unnamed working group reflected this sense of business as usual. While the group waited for a conference room, the junior staffers discussed a new sushi restaurant in downtown Baltimore. “Do we really need another sushi restaurant?” one of them asked.

“It’s totally different,” a CDC staffer weighed in. “More creative stuff, a fusion thing. Pricey, though.”

“A good date-night spot?”

“Perfect. It’s in an old warehouse. Very cool space. If you sit upstairs you get a view of the harbor.”

The conference room door opened and another team filed out, carrying papers and water bottles. They left behind a tray of semi-stale bagels and muffins. Justman’s working group filed in, six or seven of them, with Justman taking a seat near the end of the small conference table. The bagels and muffins remained untouched until one of the NIH guys cut them into quarters, at which point they all disappeared rapidly, even the raisin bagels.

“Okay, what do we have?” Justman asked. He was forty or fifty (or maybe thirty-five or fifty-five), with a full head of unruly reddish hair and a matching mustache. The mustache was impressive; he could have passed for a state trooper if you gave him a decent haircut, the black boots, the uniform, and a cool hat. Instead, he was wearing a short-sleeve no-iron dress shirt with a breast pocket full of pens. One of the junior staffers turned on the projector, which illuminated a screen on the opposite wall, but he could not get the laptop computer to recognize his encrypted data pod. “Just walk me through it,” Justman told him. “I don’t need to see slides.”

The junior staffer summarized the patterns that had emerged in the previous week: the increase in unexplained deaths; the corresponding spike in Dormigen prescriptions; similar anomalies in a few other developed countries; the cluster of deaths at the University of Vermont. “What are we seeing in the autopsies?” Justman asked.

“Not much, really,” one of the CDC women answered. “It’s not meningitis, not measles. Doesn’t seem to be a strain of the flu. We can rule out most of the logical explanations.”

“Just unexplained deaths,” Justman said.

“Pretty much, yes.”

“And we’ve got tissue samples here?” Justman asked.

“They’re coming,” another staffer offered. “We should have a decent number to look at by the end of the week.”

Justman nodded in acknowledgment. All pretty normal stuff. A medical examiner in rural Colorado or suburban Chicago might never see a fatal case of malaria, let alone something more exotic. The NIH and CDC could do more extensive tests, with far more expertise as to what to look for. As grieving families around the country held memorial services and burials—all the more emotionally wrenching because these were healthy people struck down for no obvious reason—the tissue samples were making their way via FedEx and DHL to a nondescript federal laboratory just outside Atlanta. These samples were the disease equivalent of bullet casings and fingerprints: not always enough to find the perpetrator, but a logical place to start.

“Okay, so tell me about the University of Vermont,” Justman said. This was a “cluster,” a small group of deaths from which the working group might be able to draw some inferences. If there are three homicides in the same neighborhood on the same night, the first thing you want to figure out is what they have in common. Did the victims know each other? What did they do for a living? What were they all doing the day before they were killed? Diseases may not stalk their victim with a gun, but they each have a modus operandi, just like any other killer. If you figure out the MO, it will often lead you to the guy pulling the trigger.

“The UVM cases are kind of a head-scratcher,” one of the CDC staffers began. She was Indian-American, slightly older than the others around the table. “They were all athletes but different sports. They didn’t live together or take any of the same classes. I couldn’t find any evidence that they’d ever met.”

“It’s a small campus,” Justman said.

“True, but still nothing obvious. They weren’t sharing water bottles. They weren’t dating.”

“Food, maybe,” someone offered from around the table. “A dining hall, or the local sandwich shop.”

“Maybe,” the Indian-American woman answered, “but it doesn’t look like a foodborne outbreak. These were healthy young people. It wouldn’t explain why we are seeing a similar pattern in France and the UK. I don’t know. I’ve got nothing.”

“It probably is nothing,” said the only guy in a tie, albeit with a collar he had forgotten to button. He was the statistics guru, with no background in epidemiology or public health. He was paid twice as much as the rest of us, which we knew because the NIH needed approval from Congress to waive the pay scale to hire him. In the era of “big data,” every company was trying to digest terabytes of data to gain any possible advantage in the marketplace, whether it was pitching just the right vacation to divorced soccer moms in California or using online reading habits to sort the good credit risks from future deadbeats. Never mind that the NIH was using the same basic tools to save lives rather than sell shoes, the stats geeks were a hot commodity and we had to pay them a competitive salary. So we got Tie Guy (Marcus? Marc?). Word around the water cooler was that he could be smug and annoying, but it was hard to separate that from general envy of his highly publicized salary, like those college football coaches who make more than the university president. He did himself no favors by wearing a necktie in an office where the dress code consisted of matching socks, zipping one’s pants, and trying to make sure each shirt button went into its assigned hole. (Some of our brightest scientists routinely failed one or more of these sartorial challenges.)

To be fair, Tie Guy was a trenchant thinker when confronting complex challenges. I had first met him at a brown bag lunch several months earlier when he presented his findings on the impact of a proposed Chinese railroad that would connect a series of mining sites in South Africa and Zambia with a major port. He started the presentation with a pretty darn good line (as I recall it): “Copper, gold, and diamonds are going to move more efficiently on the railway. People are going to move more quickly and easily on the railway. And that means the HIV virus is going to be riding, too. I don’t know if the Chinese have named the rail line yet, but we should think about calling it the AIDS Express.” He had color-coded slides showing how the increase in mobility would change the AIDS infection rate under different scenarios, including different prices for a third-class ticket.

“Most of these clusters turn out to be randomness,” Tie Guy now told the members of Justman’s newly formed working group. “Six kids get cancer near the fertilizer plant. Sometimes six kids just get cancer.” Justman looked at him but said nothing.

“And sometimes the fertilizer company is dumping poison in the water,” said a woman across from him.

“True, but where’s our fertilizer plant here?” Tie Guy replied with confidence bordering on hubris. “If we can’t find a pattern, then it’s probably because there isn’t a pattern.”

“Let’s see what the tissue samples show,” Justman said. “Tatiana, can you speed that along and schedule something for all of us when we have data to look at?” Tatiana, who had been quiet for the whole meeting, nodded and made a note on her phone. “Thanks, everyone,” Justman said, bringing the short meeting to a close.

That was it. Not a lot of drama or excitement, a fairly typical meeting for anyone in public health. I was not in the room. There was no reason I would be.[3] This group was still a long way from having any idea what was going on. Only then would they call me.

11.

I APPLIED TO PH.D. PROGRAMS IN MICROBIOLOGY AND WAS accepted at the University of Chicago. Sloan went to law school. My parents were convinced that microbiology was close to medicine, and therefore I could still become a doctor. I never gave them this idea, but I did not disabuse them of it, either. During my third year in the Ph.D. program, when I had already adopted and abandoned three or four different potential dissertation topics, I applied to get a joint degree in public health. What was another two years and $140,000 of debt? My parents gradually accepted the notion that I was not going to become a doctor, though they never fully accepted the idea that I was a scientist. I once overheard my mother tell a friend that I worked “in medicine.” True, technically. Professor Huke’s class stuck with me, and I winnowed my doctoral research down to virulent pathogens. I really liked the scary ones. In my third year, I was able to work with Ebola, meaning that I had to put on the full level-four biohazard suit. Some people climb mountains for the thrill of it, knowing that one misstep could send them tumbling down a precipice. I felt that way when I put on two sets of gloves and entered the air-lock chamber. A little carelessness and I would be infected with a million viruses capable of making me bleed to death out of every orifice.

Dormigen changed that, obviously. By the time I was doing my fourth year of research, the most serious pathogens were no longer as excitingly scary, as if a giant net were installed around Everest to catch everyone who slips and falls. Still, the advent of Dormigen created a different kind of excitement. The research we were doing, particularly our growing understanding of the human genome, was producing giant strides in other areas of medicine. We reckoned that cancer was the next frontier (as it had been for several decades, admittedly). Dormigen did not work on tumors because they were not recognized as foreign DNA; cancer cells are mutant products of our own body, rather than invaders like the Ebola or Marburg viruses. But all of us working at that frontier were convinced that a Dormigen-type breakthrough was possible on the cancer front.

My doctoral research was intended to probe one possible link between viruses and cancer: the so-called “lurking virus.” What makes this kind of virus fascinating—and dangerous—is that it lies dormant in a host for years or even decades. Then, for reasons that we did not fully understand when I began my doctoral work, the virus turns spectacularly virulent, killing a high proportion of the infected population. This is entirely anomalous behavior among the hundreds of thousands of viruses that have been identified and studied. Viruses are usually benign or dangerous—not both. In the past, I have made the comparison—admittedly imperfect—to a workplace shooter. Some guy comes to work every day, settles into his cubicle, does his work, goes to the holiday party, complains about the Docu-Text scanner—normal to the point of fading into the background. That is even what witnesses sometimes say: “He was so normal” or “A very quiet guy.” Then one day he shows up with a semiautomatic weapon and starts firing at his coworkers. We are left with one overwhelming question: Why? And even if we have some insight there, we ask, Why that day? What transforms a guy from someone whom colleagues struggle to remember into a killing machine? What was different that morning, or the night before, or whenever he decided to massacre his colleagues instead of making car loans or selling motorcycle insurance? If we can understand that, we will have unlocked one of the deepest mysteries of the human psyche. And we may save a lot of lives.

So it is with lurking viruses. How and why does an organism that can live in perfect symbiosis with its host for years or decades suddenly turn deadly? Even more bizarre, the same virus will often return to its benign state months or years later. Imagine that the virus for the common cold suddenly became as virulent as smallpox, wiping out a large percentage of the infected population. Then a few years later the virus goes back to causing sniffles and a sore throat. The exact same virus. This is not a mutation, or a different strain. The guy goes to work one day and celebrates a receptionist’s birthday in the conference room, sharing the cake and chuckling at the bad rendition of “Happy Birthday.” The next day he tries to shoot as many of his coworkers as possible. But then a year later, this deranged killer would ask his jailers, “Hey, when can I go back to work?”

As one of my graduate school professors once said, “It defies everything we think we know about evolution.” A tiger is not supposed to change its stripes, at least not suddenly. And if there were a sudden change—some kind of major genetic mutation that bestows a reproductive advantage—why would the organism change back? A virus typically lives without doing serious harm to its host (the common cold), getting passed along successfully. Or it kills violently (Ebola), using the dead victim (bleeding from every orifice) as a virus bomb that propagates the deadly organism to more hosts. But not both. It was hard to reconcile what we observed in lurking viruses with the most fundamental tenets of biology.

The prevailing theory was that some kind of “trigger” causes a lurking virus to go rogue, and then later to return to normal, like some kind of genetic on/off switch. Obviously, if we could identify that switch, we could in theory turn dangerous viruses “off,” or turn benign viruses “on.” This was the potential cancer link. Tumors are benign cells that begin dividing out of control—workplace shooters. Might there be a similarity between the hypothetical on/off switch in lurking viruses and the trigger that turns normal human cells into devastating malignant tumors?

When I began my research, lurking viruses had never been found in humans. In fact, there had been no documented cases of a lurking virus infecting any warm-blooded vertebrate. The most common hosts are amphibians, particularly in the tropics. My research took me to the Amazon basin, where I spent ten months collecting data on two species of tree frog. My Dartmouth classmates, many of whom had gone on to business and law school, liked to joke that I had gone off to climb trees in the jungle. Their observation was not entirely inaccurate; both species of frog are easiest to find just below the canopy, where they are safest from predators. I did literally climb trees, usually with the benefit of a ladder. But the jungle comments also had a tinge of judgment, as if my doctoral research were some kind of escape from “real” work. I found it amusing when I was in a good mood—and irksome when I was not—that my peers who were finding better ways to sell snack foods, or engineering mergers between giant oil companies, had the chutzpah to tell me I was shirking my social responsibility.

Anyway, these two species (the Abiseo climbing frog and the black-eyed tree frog, for anyone who cares) were nearly wiped out by a parasitic virus beginning in the early 2000s. That was no big deal; species come and go, especially in the Amazon. But in 2016, a savvy Brazilian researcher made a startling discovery. These tree frogs had always been hosts for this parasitic virus—literally for millions of years—but for nearly all of that time the virus did not kill them. He had excavated a tar pit near an Amazon tributary where a whole ecosystem from two million years ago had been preserved intact—the biological equivalent of Pompeii. The site was (and still is) a treasure trove for biologists. The finding that interested me was just a footnote to the many other extraordinary discoveries. Two million years ago, these two tree frogs were infected by the same parasitic virus that would later nearly wipe out their species, but they were seemingly unaffected by it. The tree frogs trapped in the tar pit all carried the virus, but analysis of the preserved tissue suggested that they died with the virus, not from it. The relationship between the host and the parasite was innocuous, maybe even symbiotic, just like all the organisms inhabiting the human gut. Happy tenants.

So what changed? And why? Those were the central questions of my doctoral dissertation. The dissertation was mediocre by any conventional standard. That was one reason I could not find an academic job. I loved my work at the NIH, but I had “settled” when I first agreed to work there. Scientists have their own hierarchies. The researchers at the preeminent academic institutions are at the top: Harvard, Yale, and so on. The big state universities are next; what they lack in prestige they make up for in grants, facilities, and access to graduate students. Then there are the government research facilities, places like NIH and CDC, where the quality of research is good, but there are fewer freedoms than at a university. My research had its merits. I had thoroughly documented spells in which the Amazonian tree frogs had been harmlessly infected with lurking viruses and also periods during which the viruses had nearly wiped out the affected populations. Nobody had ever done this kind of fieldwork before. Still, when I gave my academic job talks (I did apply for openings in biochemistry at a handful of research universities), the faculty panels would always ask the same thing: “Why?” I had no answer, not even a compelling theory to test (which might have earned me a job at a second-tier university).

I was the guy who came in after a mass killing and explained exactly how the killer had behaved on the day of the shooting. I could outline exactly what happened and when—but not why some twenty-one-year-old decided to open fire on his professors and fellow students. And why is really what we care about, as that is what we need to know to prevent the next campus shooting.

I was cursed with a particularly unimaginative dissertation adviser, who discouraged a line of inquiry that might have led to more robust answers to these questions. This caused a profoundly uncomfortable moment at my dissertation defense. “I don’t see how you have moved the research frontier,” my adviser declared. I was standing at the front of a small seminar room filled with a smattering of fellow students, family members, curious faculty members, and the three professors who would determine whether I would become a Ph.D. or a failed graduate student, the dreaded ABD (All But Dissertation). My adviser was the chair of that committee and its most influential member.

“My work provides a deeper understanding of how lurking viruses function within their hosts,” I answered.

“But it’s not your work. You’ve summarized the work of others,” my adviser pressed. He was sitting in the back of the room; the other observers turned to look at him, then turned back to hear my response, like an academic game of tennis. My mind was working furiously, trying to figure out if he was trying to screw me or just make me sweat a little.

“There were various strands of research on this topic, each isolated in its own way,” I said with far more confidence than I was feeling. “When you bring them together—well, that’s what I’ve done here—you get a more complete understanding of how the organisms interact.” I was thinking, What the fuck? This guy has been working with me for three years and now he brings this up?

“Hmm,” my adviser said with mild disdain. “You have successfully woven together work already published by others—”

“Much of this work was not published,” I interrupted.

“Fine. That’s an irrelevant distinction,” he said haughtily. “You’ve taken Legos produced by other people and built something interesting.” There was tittering around the room in response to the Legos metaphor. “I’ll repeat my original question: Where is the original work? What Lego did you produce?”

In my mind: Oh, my God, he is screwing me.

I tried to compose my thoughts, but before I could respond the chair of the department interjected, “Enough of the Lego claptrap. The most valuable contribution one can make in science is to give voice to the work of others in a way that improves our overall understanding of a subject.” I looked furtively at my parents, whose body language improved noticeably after this intervention. A few of the graduate students exchanged sly smiles; they recognized this was no longer about my dissertation. The chair of the department was a well-respected microbiologist, one of the first women tenured in the department. She was fiftyish and dowdy, neither attractive nor unattractive. She was a lousy teacher but a kind person and a good administrator, making her much appreciated by students and faculty alike. She was a relative superstar in her subfield of protozoology.

Also, she was my adviser’s ex-wife. They had been recruited to the department together in the 1990s, both with tenure. Her publication record was more impressive than his, both before they arrived at the University of Chicago and after. He had an affair with one of his graduate students, leading to a separation and then a divorce. I have no idea why they both chose to stay in the department, but they did. The department was full of faculty who hated one another; these two at least had good reason.

Heads in the academic tennis match turned back to the rear of the classroom in anticipation of a response from my adviser. “And how have you improved our overall understanding of this subject?” he asked me. A softball. To those in the room without any understanding of the internal politics, like my parents, this whole discussion seemed to flow naturally. But to those of us who understood the Kabuki theater of academe, my adviser’s ex-wife, who also happened to be a far more impressive microbiologist than he was, had just smacked him down. He was going to lose if he went back at her. I knew that. More important, he knew that. His softball question was a white flag.

I gave an innocuous answer, something more or less straight from my abstract. There were some other softball questions and then my adviser politely brought the discussion to a close. I walked out of the room along with the rest of the observers, leaving my committee behind to deliberate on my fate. It did not take long. Ten minutes later they filed out of the room and informed me that I was now a doctor of philosophy. “Congratulations,” my adviser said woodenly.

His eyes betrayed what we both knew: I had been saved by the fact that he had been caught screwing one of his graduate students.

12.

JEFF YUN, THE HEAD PATHOLOGIST FOR THE CENTERS FOR Disease Control, was standing at the front of a conference room. Ron Justman’s task force was assembled around the table. The lights were dim; a slide showing a single virus was projected on a screen on the far wall. “That’s it,” Yun said. “Capellaviridae.” The organism was hexagonal, with short hairlike structures emerging from each of the sides. “Each of the victims had extremely high levels of the virus concentrated in their livers. As best as I can tell, that’s the cause of death. The virus attacks the liver, and to a lesser extent the pancreas. Both organs shut down relatively quickly.”

There were blank stares around the table. Justman shrugged, “A cappella?”

“Capellaviridae,” Yun said.

“Never heard of it,” Justman said. “Am I missing something?”

“No,” Yun said. “No. That’s the thing.” He had a roundish, friendly face with closely cropped hair. Small beads of perspiration gathered on his upper lip. “It’s a totally unexceptional virus, commonplace in temperate zones of the northern hemisphere. It didn’t even have a name until twenty years ago.” He looked around the table, inviting someone to make sense of this pedestrian virus turned killer.

“Are humans the only host?” Justman asked.

“We don’t know. I’m telling you, nobody has ever studied this thing.”

“And you’re sure this virus is responsible for the deaths?” Tie Guy asked.

“I’m not sure of anything,” Yun answered. “But the concentration of viruses that we observed in each of the victims is unlike anything I’ve ever seen. I spoke to my Canadian and European counterparts this morning. They’ve observed the same thing.”

“Hold on,” Tie Guy interjected. “Are we really sure of the causality here?” There followed a discussion of whether this virus, Capellaviridae, was killing people, or if people who were dying of something else were prone to becoming infected with Capellaviridae. Tie Guy lectured the room on what most of them already knew: many viruses are opportunistic, meaning they thrive when a host’s immune system is compromised. A cancer victim may die of viral pneumonia, but to blame pneumonia for the death would be to miss the real problem.

Justman said, “In any event, we know that this virus is, at a minimum, a marker of the problem, yes? Maybe it’s a dangerous pathogen, maybe it thrives when something else nasty is going on. Given how little we know, we should begin by focusing on Capellaviridae. Can we agree on that?” There were nods around the table.

“Is it harmful to animals?” the Indian-American woman asked. “We should at least know that.”

“My people are testing that right now,” Yun said quickly, not quite cutting her off. “I’ve got everybody working on this.”

“Let’s back up for a minute,” Justman interjected. “The Dormigen database. We’ve seen a spike in prescriptions—”

“And those people, at least some of them, are testing positive for Capellaviridae?” Tie Guy interrupted.

“Yes,” Yun said. “That appears to be why we’re seeing the spike in Dormigen demand. Based on the limited data we have, it seems that most, if not all, of the increase in Dormigen prescriptions can be explained by some kind of epidemic related to Capellaviridae.”

“And Dormigen is effective against Capellaviridae?” Justman asked.

“Yes, of course,” Yun assured him.

“Hold on,” Tie Guy said. “We still have not established that this virus is doing the harm. For all we know, it’s an opportunistic pathogen that happens to manifest itself—”

“Yes, fair enough,” Justman said, clearly impatient. “But whatever is going on responds to Dormigen. That’s what I’m asking.”

“Whatever is happening responds to Dormigen, yes,” Yun said. As he answered, he reached into his jacket pocket and pulled out his phone. “Sorry, I should check this.”

“Of course,” Justman assured him.

Yun scrolled through a text of some sort and then ran his hand through his short hair, clearly perplexed. “Okay, this is interesting,” he said as he looked at his phone. “I’ve got someone digging into Capellaviridae. Apparently it’s just a run-of-the-mill virus, so common as to be unexceptional.”

“What does that mean?” someone asked.

“That’s just what he texted me: ‘So common as to be unexceptional,’” Yun answered. He stared at his phone in silence for a few seconds and then looked up at Justman. “Let’s take a break for a few minutes. Can we do that?” As Justman nodded agreement, Yun was already punching a number on his phone and walking out of the conference room. The participants around the table seized on the break to check devices, all eyes staring down as if it were some kind of choreographed dance. When Yun returned just a few minutes later, all eyes went immediately back to him.

“It’s a common virus,” Yun said, sliding his phone back into his jacket pocket. “That’s why nobody has studied it. There’s really nothing to study. It’s an innocuous virus, found almost everywhere.”

“Hardly innocuous,” Tie Guy said. This was why people did not like him; it was not just his outsized salary. He always had to be the contrarian. One minute he was arguing that Capellaviridae might not be the real killer, the next he was refuting someone who said the same thing.

“Yes, innocuous, usually,” Yun answered sharply. “This virus is everywhere. It’s as common as bread mold.”

“Obviously we’re dealing with a different strain,” Justman said.

“Not that we can tell,” Yun said. He was starting to look a little flustered. More perspiration had gathered on his upper lip. “Here’s the thing: My people in the lab tested themselves, and most of them are carrying the virus. On a whim, they tested a sample of soldiers at Fort Gail, and most of them are carrying it, too.”

“They’re all going to get sick?” the Indian-American woman asked.

“No, I don’t think so,” Yun replied. “My best guess is that this virus is innocuous for most people, most of the time. And now, for some reason, for some people, it’s not.”

“That’s a big leap,” Justman said. “It’s more logical that we’re dealing with a different strain.”

“Hold on,” Yun said. “I wasn’t finished. The viruses are identical—from the victims and from my people in the lab. Indistinguishable DNA. But it gets weirder. We went back and looked at some old tissue samples that we have in the lab, ten or twenty years old. Most of them show traces of the virus, too. If I were to guess, humans have been carrying this virus around with no adverse effects for thousands of years.”

“That doesn’t make any sense,” Justman said. A silence settled over the conference room. There was no panic, more of a puzzle. After all, Dormigen was there to handle the problem, whatever that problem might eventually shape up to be. This group was used to handling outbreaks: the flu epidemic of 2021, the Sam’s Burrito E. coli contamination, and many more exotic things along the way. The formula was the same: treat the victims, find the source. It was always just a matter of time, and Dormigen could buy whatever time they needed.

Justman started thinking out loud: “We have a virus that is entirely innocuous, has been for decades, until it’s not.”

“A lurking virus?” a young woman offered. Her tone suggested uncertainty, but that was likely out of deference to those around the table rather than due to a true lack of knowledge. She was a staff epidemiologist, barely out of graduate school. In this case, youth was an asset. Most of the faces around the table were blank. She continued with more confidence. “I studied them in graduate school, just a bit. They are symbiotic with the host, then perhaps there is a trigger of some sort and they become virulent.”

Yun gave a strange head nod, not a clear yes or a no, suggesting that he was familiar with lurking viruses while simultaneously discounting the theory.

“A lurking virus?” Justman asked.

“The pattern looks just like what we’re seeing,” the young epidemiologist continued. “An innocuous pathogen turns deadly, then, even more puzzling, they sometimes turn innocuous again.”

Justman was clearly nonplussed that he had never heard of a lurking virus before. “In humans?” he asked skeptically.

“No, no,” Yun said. “Not even in rodents. Only reptiles, as far as I know. Isn’t that right?” he asked, looking at the young epidemiologist.

“I just read one paper in graduate school. It was salamanders or frogs. But the pattern looked just like what we’re seeing,” she said.

“What pattern?” Tie Guy interjected, prompting eye rolls around the table. “If we’ve established a pattern, I missed it. We do not have any sense of what’s going on.”

Justman looked at his watch. “Okay, we’ve run over time. We need to gather a lot more data. I think we can agree on that. In the meantime, we should notify the folks over at HHS that we are likely to see a higher than average demand for Dormigen in the coming months. We should probably also learn more about these lurking viruses.”

The meeting broke up, and two things were set in motion. A formal notification was sent to the Department of Health and Human Services notifying the department of a projected spike in Dormigen demand—a so-called “Kaufman notice,” named for the Congresswoman who wrote the bill requiring such notice. And the epidemiologists on the task force made some calls to inquire about the lurking virus. They called some people who called some people who called me.

13.

AL GOYAL, THE CHAIRMAN OF CENTERA BIOMEDICAL GROUP, was meeting with a group of Brazilian suppliers in the elegant sitting area of his office when his CFO appeared at the office door. “Al, do you have a minute?” the CFO asked.

“We’re just wrapping up here,” Goyal said.

“If you could just step out here for a second,” the CFO insisted. The Swedish CFO of Centera Biomedical was not a pushy guy, and because of that, Goyal’s impulse at that moment was panic. Perhaps there was a family emergency. He excused himself and walked briskly into the corridor with Swensen.

“We just got a call from Health and Human Services,” the CFO reported. He stopped, as if that were all Goyal needed to know.

“Yes?” Goyal asked, perplexed.

“Health and Human Services,” Swensen repeated. “They would like to exercise their option. The Dormigen. We owe them twenty million doses.”

“Jesus Christ,” Goyal muttered. “Why?” he asked.

“Why what?”

“Why do they want it?”

“I don’t know,” Swensen answered, growing more flustered. “They don’t have to tell us that. It’s a simple contract. If they exercise the option, we owe them up to twenty million doses.”

“How much are they asking for?”

“All twenty million. Some of their stock was destroyed in a fire.”

“Why do they need so much?” Goyal asked.

“I just told you, I don’t know,” Swensen said angrily. “It’s not really important.”

“We don’t have twenty million doses,” Goyal said, panic creeping into his voice.

“Well, we do. We do—but it’s old,” Swensen said.

There was some disagreement at trial over the balance of the conversation. Since Goyal and Swensen each blamed the other for hatching the original fraud, they also disagreed about the attempted cover-up. For the American public, it was a distinction without a difference. (The jury found likewise.) As I noted earlier, and most of the world now knows, Centera had burnished its balance sheet by keeping the old Dormigen, rather than destroying the stock and creating a new batch as the contract with the U.S. government required. Centera had more than twenty million doses of Dormigen in its warehouses,[4] but every one of them was past its date of expiration.

“Have you tested the effectiveness of what we have?” Goyal asked.

“I was waiting for your permission,” the CFO answered. Centera policy had explicitly forbidden any testing of the Dormigen shelf life. If the drug proved effective for longer than six months, or could be reformulated to last longer, then Centera could no longer charge HHS for producing and destroying the drug every six months. More knowledge might mean lower profits.

“Do it now. Don’t tell the lab why we need to know,” Goyal instructed.

“Obviously.”

“I’m sure it will be fine,” Goyal said earnestly. He really believed it. After all, the government had imposed ridiculous padding everywhere else in life. Did we really need to know that our coffee was served hot? Would drinking milk one day after the expiration date do any harm? Goyal testified that he had purchased a lawn mower with a warning telling him not to use it to cut his bushes. The expired aspirin in his cabinet seemed to work fine, year after year. What difference would a few months make for Dormigen?

14.

A FEW MONTHS MAKES ALL THE DIFFERENCE, IT TURNS OUT. The FDA clinical trials had clearly established that seven months was the upper bound for the effectiveness of Dormigen and six months was the maximum recommended shelf life. Unlike aspirin, or even milk, Dormigen was alive. That is what made it such an extraordinarily effective drug. Dormigen was genetically engineered—human antibodies inserted into chicken embryos—and after about six months the medicine dies, literally.

Neither Goyal nor Swensen knew this, supposedly, which was the crux of their defense at trial. Neither was a genetic engineer; neither had any scientific training at all. In fact, not a single member of the Centera senior management had even a bachelor’s degree in one of the hard sciences. Much was made of this fact in the months after the Outbreak—“the bean counters had elbowed aside the scientists,” as the Atlantic described it. Much of this criticism misses the point, not because a science company does not need scientists in management, but because it lets the bean counters off too easy. There were thirty or forty scientists on the Centera payroll alone who could have told Goyal and Swensen that their plan would be deadly if the Dormigen doses were ever needed. Besides, one does not need a Ph.D. in virology to know that violating the terms of a contract with the federal government is a bad thing to do.

It is technically true that Goyal and Swensen did not willfully put the public at risk. They were not fully aware of what they had set in motion. The jury found this irrelevant. As the Washington Post–USA Today elegantly put it on the day of their conviction, “Neither Swensen nor Goyal knew that the gun was loaded when they pulled the trigger. But they also never cared to ask, which is just as awful in its own way.”

Goyal and Swensen did understand one thing: Dormigen takes twenty-one days to produce. No one had ever found a way to shorten this process, in part because there had never been any need. The process was cheap and easy and foolproof, if you have three weeks. “We have to make more,” a panicked Goyal told his CFO.

“I’ve already set that in motion,” Swensen said. The two men were hoping the expired doses of Dormigen would still prove effective. If not, they would have twenty million new doses in three weeks. One has to give Goyal and Swensen some credit. When they found themselves in a hole, they did stop digging.

Swensen figured, and Goyal concurred, that they could always stall the delivery to HHS by three weeks. It was the federal government, after all. There were two weekends and a state holiday in those twenty-one days. “So, worst-case, we deliver it a little late,” Goyal said, trying to reassure himself and Swensen. “Right?”

Under normal circumstances, he would have been correct. Of course, under normal circumstances, the federal government would not need twenty million extra doses of Dormigen.