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Robin Cook

Viral

This book is dedicated to the fervent hope that members of the US Congress will comprehend the need to enact, at the very minimum, a viable public healthcare option.

Preface

The Covid-19 pandemic has thrust the virus center stage as a dangerous and dreaded foe similar to the way the influenza pandemic did a century ago. The causative viruses, SARS-CoV-2 and influenza A(H1N1), produce respiratory illnesses that are easily transmittable person to person and thereby quickly swept around the globe. Within months, both scourges sickened millions of people, and many died.

Although these two biologic entities currently dominate the spotlight, there are other viruses that deserve equal fear, concern, and attention, since some of the resultant diseases have a higher lethality as well as the capacity to cause more serious complications. Although these diseases are not transmitted by aerosol and are thereby less communicative, they, too, are spreading around the world at a slower — yet ever-quickening — pace thanks to climate change and human encroachment into previously isolated environments. In particular, a number of viruses have cleverly hijacked the mosquito to ensure their survival. These viruses are responsible for illnesses such as yellow fever, dengue, West Nile fever, and an array of diseases that cause dangerous inflammation of the brain called encephalitis. This includes eastern equine encephalitis virus, or EEE, which is known to have a death rate as high as thirty percent. As climate change advances, aggressive mosquitoes like the Aedes Asian tiger mosquito, which carry these dangerous viruses and which had heretofore been restricted to tropical climes, are progressively and relentlessly spreading northward into temperate regions, currently reaching as far north as the state of Maine in the USA and the Netherlands in Europe.

These other, fearful viruses couldn’t have picked a better vector. As obligate bloodsuckers to enable breeding, mosquitoes are high on everyone’s nuisance list. Most people can recall a disrupted summer slumber, or evening stroll, or hike in the woods, or barbecue on the beach, heralded by the characteristic whine of the female mosquito. As a creature superbly designed after almost one hundred million years of adaptive evolution (even dinosaurs were plagued by mosquitoes), the female mosquito invariably gets her blood meal or dies trying. For some reason that has yet to be explained, the female Asian tiger mosquito is particularly attracted to human females with blood type O, although other blood types or even human males will do in a pinch.

As a testament to the effectiveness of the mosquito — pathogen partnership, almost a million people die each year from a mosquito-spread illness. Some naturalists even posit that mosquito-transmitted illnesses have killed nearly half of all the humans who have ever lived.

— Robin Cook, MD

Prologue

Although mosquitoes cause more than two thousand human deaths every day, their pernicious impact doesn’t necessarily stop there. The deaths they cause can result in further serious societal complications. Such a story of a sad serial tragedy started in the summer of 2020 as the result of a cascading series of events that began in the idyllic town of Wellfleet, Massachusetts, nestled on the bay side of Cape Cod. It all started within the confines of a discarded automobile tire leaning up against a dilapidated, freestanding garage. Inside the tire was a bit of stagnant rainwater where a pregnant female Asian tiger mosquito had deposited her raft of eggs.

On the twentieth of July this clutch of eggs hatched, starting the mind-boggling ten-day metamorphosis from larvae to pupae to adults. The moment the mosquitoes emerged as adults, they could fly, and within three days they followed the irresistible urge to reproduce, requiring the females to obtain a blood meal. By using their highly evolved sense organs, they detected a victim and zeroed in on an unsuspecting blue jay. Unknown to the mosquitoes and to the blue jay, the bird had been infected earlier in July by the eastern equine encephalitis virus. Neither bird nor the mosquitoes cared since birds such as blue jays are a normal host for EEE, meaning they live together in a kind of passive parasitism, and in a similar fashion, the mosquito’s immune system keeps the virus at bay. After getting their fill of blue jay blood, the mosquitoes flew off to find an appropriate place to deposit their eggs.

Several weeks later the infected band of mosquitoes had moved eastward toward the Atlantic Ocean. They were now considerably reduced in number from having been prey to numerous predators. At the same time, they were now more experienced. They had learned to favor human victims as easier targets than feathered birds or furred mammals. They also learned the beach was a promising destination in the late-afternoon/early-evening because there were always relatively immobile humans with lots of exposed skin.

At three-thirty on the afternoon of August fifteenth, this cluster of EEE-carrying female Asian tiger mosquitoes awakened from their daytime slumber. They had found refuge from the midday summer sun beneath the porch planking of a building on Gull Pond. A few moments later, ravenous for a blood meal, the swarm became airborne en masse with their characteristic whine. Save for several unlucky individuals, they avoided the many sticky and dangerous spiderwebs and emerged into the sunlight. Regrouping, they set off like a miniature fighter squadron. Instinctively they knew the beach was six hundred yards to the east beyond a forest composed mostly of black oak and pitch pine. Barring being eaten on the way or having to navigate a stronger than usual headwind, it would take the swarm around three-quarters of an hour to reach a crowd of potential targets.

Book 1

Chapter 1

August 15

Okay, you guys! It’s four-thirty and time to get this barbecue show on the road,” Brian Yves Murphy ordered, clapping his hands to get his family’s attention. His wife, Emma, and his daughter, Juliette, were draped over the living room furniture in the modest two-bedroom cottage they had rented for two weeks across from a hardscrabble beach in Wellfleet, Massachusetts, just beyond the town’s harbor. All of them were appropriately exhausted after an active, fun-filled midsummer day that marked the beginning of their final week of vacation. Because of the SARS-CoV-2 pandemic, they’d opted for a road trip vacation rather than flying down to Florida to use Emma’s parents’ empty condo, as was their usual summer getaway.

“Can’t we just recover for ten to fifteen minutes?” Emma pleaded jokingly despite knowing full well that Brian wouldn’t hear of it. In truth, she was as compulsive as he in terms of getting the most out of every minute of their vacation while the weather held. On top of that, she was also as compulsively fit and active as he. That morning she had awakened just after dawn and had soundlessly slipped out of the house for a bike ride and to be first in line at PB Boulangerie for their one-of-a-kind, freshly baked almond croissants. It had been a welcome surprise when they discovered the French bakery so far from what they called civilization. As lifelong residents of Inwood, Manhattan, they considered themselves quintessential New Yorkers and assumed anything outside of the city was hinterland.

“Sorry, but no rest for the weary,” he said. “I’d like to get to the Newcomb Hollow Beach parking lot before the evening rush to make sure we get a spot.” They had found over their first few days that Newcomb Hollow was their favorite Atlantic-side beach, with fewer people and high dunes that acted as partial windbreaks from the onshore breeze.

“But why the rush?” questioned Emma. “We already got a beach parking permit when we got the fire permit.”