plains had increased precipitously overnight. Unless the numbers could be attributed to some major catastrophe such as a plane crash or a stampede in a crowded stadium, he had a long day ahead of him.
Taking a sip of hot coffee, he drilled down into the details.
Two hours later, the dregs of his coffee cold in their cup, he called his manager’s extension. “Kevin, I think we’ve got a code yellow for the ZVED group. Maybe the CID team as well. Can we meet?”
In less than an hour, Mike stood before a handful of CDC response representatives clutching a sheaf of printouts, his Pad-L nearby. Kevin had called in both the National Center for Zoonotic, Vector-Borne, and Enteric Diseases and the National Center for the Preparedness, Detection, and Control of Infectious Diseases. After several reorgs over the years, the CDC, it seemed, had a specialty Center for just about any emergency.
“Thanks for coming on such short notice,” Mike began. “Kevin knows I’m not an alarmist and that I wouldn’t pull you guys away from your jobs if this wasn’t solid. The ASS report this morning shows a 124 percent upswing in unidentified cases hitting the ERs and clinics in a three-state area: Montana, North Dakota and South Dakota. Nearly all of those are children under the age of eight. Symptoms are neurologic and include head wobbling, tremors, muscle spasms and cognitive changes.
“We’ve had four hospitals conduct informal investigations. One found no commonality among its cases, but the other three were able to narrow the possibilities: one to milk shipped and bottled locally; one to a locally produced brand of chicken-and-pork hotdogs; and one to a school party where the kids were served individual bags of O’Brien’s potato chips, Krispin pickles, Big D sodas, chocolate-chip cookies baked by three different mothers, and beef hamburgers donated by a local rancher.”
One of the ZVED reps, Susan Tripp, an older woman with streaks of gray in her once-auburn hair, interrupted. “I take it ‘local’ is key, right? How local are we talking?”
“We’re trying to granularize further, but we’re still looking at those three states for the milk and hotdogs. That’s about a million-and-a-half pigs and maybe 12 million chickens. We can narrow the 8.5 million cattle in the area to about a quarter of a million that are dairy animals. The rancher with the hamburgers is the easy one; he runs beef cattle out of McKenzie County in western North Dakota.
“That’s assuming, of course, that whatever’s causing the problem in these kids is a food-borne agent. But the symptoms presented are pretty atypical. No signs of an immune response: no fever, no elevated white blood cell counts, they’re not throwing up. There’s nothing on their profiles but neurological symptoms. Their heads start to wobble and two weeks later they’re dead. Well, three of them are anyway. I’ve tracked back over the trending data. The threshold for each of the four days prior was just under 8 percent, which is why ASS didn’t flag it until today. The cumulative total for the last five days is more like a 57 percent increase rather than just today’s 24 percent spike. Since kids don’t usually present for neurologic disorders, most of the increase in their age sector is pure. After the Poissons regression model is applied, we’ve got something like 34 kids in three states exhibiting similar symptoms. On top of that, we’ve got a 4.2 percent increase in adults aged 24 to 87 admitted as stroke patients.”
“Stroke?” Rolando Garcia of the CID looked up from taking notes. “That’s not even a yellow flag. What does that have to do with the kids?”
“I didn’t think there was a correlation at first either,” Mike admitted. “And ultimately there may not be. But when I looked into the admitting comments, it struck me that ‘confusion,’ ‘memory loss’ and ‘sudden onset of involuntary
Taking a sip of hot coffee, he drilled down into the details.
Two hours later, the dregs of his coffee cold in their cup, he called his manager’s extension. “Kevin, I think we’ve got a code yellow for the ZVED group. Maybe the CID team as well. Can we meet?”
In less than an hour, Mike stood before a handful of CDC response representatives clutching a sheaf of printouts, his Pad-L nearby. Kevin had called in both the National Center for Zoonotic, Vector-Borne, and Enteric Diseases and the National Center for the Preparedness, Detection, and Control of Infectious Diseases. After several reorgs over the years, the CDC, it seemed, had a specialty Center for just about any emergency.
“Thanks for coming on such short notice,” Mike began. “Kevin knows I’m not an alarmist and that I wouldn’t pull you guys away from your jobs if this wasn’t solid. The ASS report this morning shows a 124 percent upswing in unidentified cases hitting the ERs and clinics in a three-state area: Montana, North Dakota and South Dakota. Nearly all of those are children under the age of eight. Symptoms are neurologic and include head wobbling, tremors, muscle spasms and cognitive changes.
“We’ve had four hospitals conduct informal investigations. One found no commonality among its cases, but the other three were able to narrow the possibilities: one to milk shipped and bottled locally; one to a locally produced brand of chicken-and-pork hotdogs; and one to a school party where the kids were served individual bags of O’Brien’s potato chips, Krispin pickles, Big D sodas, chocolate-chip cookies baked by three different mothers, and beef hamburgers donated by a local rancher.”
One of the ZVED reps, Susan Tripp, an older woman with streaks of gray in her once-auburn hair, interrupted. “I take it ‘local’ is key, right? How local are we talking?”
“We’re trying to granularize further, but we’re still looking at those three states for the milk and hotdogs. That’s about a million-and-a-half pigs and maybe 12 million chickens. We can narrow the 8.5 million cattle in the area to about a quarter of a million that are dairy animals. The rancher with the hamburgers is the easy one; he runs beef cattle out of McKenzie County in western North Dakota.
“That’s assuming, of course, that whatever’s causing the problem in these kids is a food-borne agent. But the symptoms presented are pretty atypical. No signs of an immune response: no fever, no elevated white blood cell counts, they’re not throwing up. There’s nothing on their profiles but neurological symptoms. Their heads start to wobble and two weeks later they’re dead. Well, three of them are anyway. I’ve tracked back over the trending data. The threshold for each of the four days prior was just under 8 percent, which is why ASS didn’t flag it until today. The cumulative total for the last five days is more like a 57 percent increase rather than just today’s 24 percent spike. Since kids don’t usually present for neurologic disorders, most of the increase in their age sector is pure. After the Poissons regression model is applied, we’ve got something like 34 kids in three states exhibiting similar symptoms. On top of that, we’ve got a 4.2 percent increase in adults aged 24 to 87 admitted as stroke patients.”
“Stroke?” Rolando Garcia of the CID looked up from taking notes. “That’s not even a yellow flag. What does that have to do with the kids?”
“I didn’t think there was a correlation at first either,” Mike admitted. “And ultimately there may not be. But when I looked into the admitting comments, it struck me that ‘confusion,’ ‘memory loss’ and ‘sudden onset of involuntary
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