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The boy was crying again, and now Stanton hurried for the stairs, yelling to Maria not to touch anything in her home.

E
VERYONE WHO CAME IN PROXIMITY WITH ANY OF THE VICTIMS
had to be contacted and quarantined. The CDC needed to make an announcement alerting the public, encouraging everyone in Los Angeles to wear masks. Flights had to be grounded, public events shut down. Almost no measure would be too extreme, Stanton believed, if they could prove that this disease with a one hundred percent fatality rate had become infectious.

Within minutes, the FAA had confirmed that Joseph Zarrow, the pilot who brought down the Aero Globale flight, flew the Mexico City-to-L.A. leg four days earlier.
Human error
suddenly had new meaning. But the connections were still circumstantial, and before any real action would be taken, before they would cause the public to panic, Stanton needed scientific evidence that VFI spread from person to person through casual contact.

Shortly after five
A.M
., he stood gloved, gowned, and masked, working with his researchers beneath a protective hood in the lab. Stanton had woken his entire Prion Center team and summoned them in the middle of the night. He had just finished preparing the solution that he hoped would react with the prion, wherever it was hiding.

There were only a few ways an infectious agent could spread between humans via casual contact. Stanton suspected the vector was a fluid
from the nose or mouth. He had to discover if it was transmitted by saliva, nasal mucus, or sputum from the lungs—and how VFI migrated from the brain into one of these organs.

With the test solution ready to go, he pipetted drops of secretion samples onto glass slides and added the reactant. Then, beginning with samples of Volcy’s and Gutierrez’s saliva, Stanton searched. He examined every slide, shifting them across left to right, up one half field of view, and finally right to left.

“Negative,” he told Davies.

They repeated the process with sputum. Coughed up from the throat and lungs, sputum transmitted a variety of illnesses, including life-threatening fungi like tuberculosis. But just like the saliva, the samples were completely negative.

“Like a common cold, then,” Davies said.

But as Stanton triple-checked every one of the slides he’d prepared from the nasal secretions, his anxiety grew. When he got to the last slide, he closed his eyes, confused. Like the others, the nasal secretions were all clear.

“How the hell is it spreading?” Davies said.

“It doesn’t make sense,” Jiao Chen said. “Our casual contact theory can’t be wrong.”

Stanton stood. “Neither can the slides.”

If they couldn’t prove how the prion spread, he wouldn’t be able to convince Atlanta that serious action must be taken to contain it. Was there a flaw in his logic connecting the men? If the prion was spreading through casual contact, it had to pass through a secretion. But the lab findings were unequivocal: None of the three they tested contained the protein.

The phone rang.

“It’s Cavanagh,” said Davies. “What do I tell her?”

The lab was tense as Stanton’s team of researchers waited for him to respond. They all wore masks over the lower half of their faces, but their eyes conveyed a mix of anxiety and exhaustion. They’d been working on little sleep since the day Volcy was diagnosed.

Jiao Chen removed her glasses and started to rub her eyes. “Maybe we’re doing something wrong with the preparations,” she said.

Besides Stanton, Jiao had slept the least of everyone here. And as she rubbed her eyes with her fingertips, something gnawed at him. Exhaustion subsumed his postdoc’s face as she slid her palms down her cheeks.

Stanton grabbed the phone. “Emily, it’s in the eyes.”

DISEASES THAT SPREAD
through the eyes were so rare that even surgeons sometimes didn’t wear goggles when they operated. But when Stanton and his team sampled the lacrimal fluid—the fluid coating Volcy’s and Gutierrez’s eyes—they found prion concentrated almost as densely there as it was in the brain.

Contagion began when people with VFI touched their eyes. The prion got on their hands, then they shook someone else’s hand or touched a nearby surface. Humans naturally touched their faces more than a hundred times a day, and insomnia was sure to make things even worse: The more tired victims became, the more they yawned and rubbed their eyes. With victims awake around the clock, their eyes were almost never closed, and the disease had eight extra hours a day to spread. In the same way that common colds caused runny noses and then spread through mucus, and malaria caused drowsiness so more mosquitoes could feed on sleeping victims, VFI had built itself the perfect vector.

The CDC called everyone who could’ve come in contact with Volcy, Gutierrez, or Zarrow, and the results were harrowing. A stewardess, two copilots, and two passengers associated with Aero Globale, plus the proprietor of the Super 8 and three guests, were the first of the second wave.

By midday, they were using the word:
epidemic
.

The worst news came out of Presbyterian Hospital. Six nurses, two ER docs, and three orderlies had all been suffering from insomnia for the last two nights. A test for detecting prion in sheep’s blood, developed years before, turned out to be effective as a rough indicator for VFI before the onset of symptoms. Already they were getting multiple positive results.

Stanton was angry at himself for how long it’d taken him to realize the prion was infectious, and fearful that he might soon be counted among the victims as well. His own test results were pending, and he hadn’t had an opportunity to even try to sleep. He had permission to continue working until he knew for sure, as long as he wore a biohazard suit at all times.

Throngs of desperate people stood at the ER entrance when he returned to Presbyterian, fighting through the heat, discomfort, and bulkiness of his pressurized yellow suit. More than a hundred possible victims had already been identified by symptoms, and the panic Cavanagh had predicted was unleashed after the CDC’s press conference. In normal times, one in three adults in America had insomnia. Thousands of panicked Angelenos were now flooding every hospital in the city, convinced they were sick.

“Sorry for the wait,” a CDC officer was telling eighty primary contacts in the emergency room. “The doctors are working as fast as they can, and you will all have your blood tests completed soon. In the meantime, please keep your eye shields and masks fastened, and be careful not to touch your eyes or your faces.”

Stanton made his way through the ER, trying not to obsess over the idea that he, Thane, and Chel Manu had all been exposed more directly to the disease than anyone waiting here.

“I don’t ever sleep,” an elderly man called out. “How will they know if I got it?”

“Make sure to tell the doctors everything you can about your normal sleeping patterns,” the CDC officer told the man. “And anything else they should know.”

“This place is festering,” a Latino woman carrying a baby said. “If we weren’t sick before, we’ll get sick here.”

“Keep your eye shields fastened,” the CDC man told her, “and don’t touch your eyes or anything else, and you’ll be safe.”

Eye shields were a crucial part of the containment effort. The CDC was encouraging people to wear masks as well. But Stanton believed
eye shields and masks and education weren’t nearly enough. He’d sent a CDC-wide email recommending complete transparency with the public, as well as a home-isolation period of forty-eight hours, and making eye shields mandatory in L.A. schools until they could slow the spread.

He made his way to the makeshift CDC command center in the rear of the hospital. Health-department regulations were taped to every wall, covering peeling paint. More than thirty Epidemic Intelligence Service officers, administrators, and CDC nurses were packed into the conference room, and everyone wore masks and eye shields. Stanton was the only one in a biohazard suit, and everyone eyed him, knowing what possibility it suggested.

The highest-ranking doctors sat around a table in the middle of the room. Deputy CDC Director Cavanagh ran the meeting. Her long white hair was pulled back, and her blue eyes flashed brightly from behind her eye shield. Despite more than thirty years of service to CDC, the skin on her forehead was still smooth. Stanton sometimes imagined she’d simply ordered it not to wrinkle.

“We’ve got two hundred thousand more eye shields coming by morning,” Cavanagh said. Stanton squeezed into the seat next to her, an almost comical challenge in his bulky suit. “Trucked and flown in from all over.”

“And we can get another fifty thousand by the day after tomorrow,” someone behind them chimed in.

“We need four million,” Stanton said into the small microphone inside his helmet, wasting no time.

“Well, two hundred fifty thousand are available,” Cavanagh said. “That’s going to have to be enough. First priority will be to supply health-care workers, obviously. Next will be anyone with a connection to any of the infected, and the rest will go to the distribution centers and get doled out first-come-first-served. The last thing we need is to create a panic and cause people to leave en masse. Or this thing could burn across the country.”

Stanton piped up again. “We have to consider a quarantine.”

“What do you think we’re doing here?” Katherine Leeds from the viral division said. Leeds was a tiny woman, but she was tough. Over the years, she and Stanton had clashed many times. “We have a quarantine, and we’re coordinating them in other hospitals too.”

“I’m not talking about the hospitals,” Stanton said. He looked at the group. “I’m talking about the entire city.”

There was a low murmur throughout the room.

“Do you have any idea what ten million people will do when they find out the government is telling them they can’t leave?” Leeds said. “There’s a reason it’s never been done before.”

“There could be a thousand cases tomorrow,” Stanton said, unflinching. “And five thousand the day after. People’ll start to flee the city, and some will be sick. If we don’t stop the flow out of L.A., VFI will be in every city in the country by week’s end.”

“Even if it were feasible,” Leeds said, “it’s probably not constitutional.”

“We’re talking about a disease that spreads like a cold,” Stanton said, “but that’s as deadly as Ebola and that’s impossible to get rid of on fomites. It doesn’t die like a bacteria, and it can’t be destroyed like a virus.”

Whereas most pathogens were no longer contagious after twenty-four hours or less on “fomites”—hard and soft surfaces—prion could stay infectious indefinitely, and there was no known way to disinfect the surfaces. Earlier in the day, the same ELISA test with which Stanton and Davies found no prion at Havermore Farms yielded a very different result from the planes at LAX, Volcy’s hospital room, and Gutierrez’s house. Doorknobs, furniture, cockpit switches, seat cushions, and seat-belt buckles on the planes Zarrow had flown in the last week were all covered with prion.

“Every plane leaving L.A. could have passengers about to spread it around the world,” Stanton said.

“What about the highways out of town?” one of the other doctors said. “You want to shut those down too?”

Beneath the weight of Stanton’s suit, everyone in the room sounded far away. He had to imagine that his voice through the helmet didn’t exactly have a commanding effect. “We have to cut off the flow. We call in the California Guard and the army if we have to. I’m not saying it will be easy, but if we don’t act fast and decisively, we’ll pay the price.”

“There’ll be riots and hoarding and all the rest,” Leeds said. “It’ll be like Port-au-Prince in a couple of days.”

“We have to explain to people that it’s a precautionary measure and that they’ll be allowed to leave when we know how to stop the disease from spreading—”

“We need to be extremely careful with what we tell people,” Cavanagh cut in, “or there will be mass panic. It’s got huge liabilities, but so does allowing clusters of cases to develop in every city in America.” She stood up. “Quarantine is a last option, but we certainly must consider it.”