Page 31 of Outbreak Protocol

CHAPTER EIGHTEEN

ERIK

The medical centre's third floor has been transformed into our containment demonstration zone.

Sarah identified Brunnenstrasse, a small residential cul-de-sac in Eimsbüttel with forty-two residents, seventeen of whom tested positive for the virus.

The residents agreed to participate after Colonel Santos explained the alternative.

"Dr. Lindqvist, we've administered the treatment to all forty-two residents," Dr. Nguyen reports, handing me her tablet. "Initial responses look promising. Fevers reducing in all seventeen infected patients."

I scroll through the vitals. "Any adverse reactions?"

"Nothing significant yet. Patient 14 developed a mild rash, but it's already fading."

I check my watch: 0600 hours. Thirteen hours until Morrison's deadline.

"Good. Monitor them continuously. I want hourly updates on viral loads, inflammatory markers, and any side effects. We need irrefutable evidence that this works."

"Understood."

I step into the monitoring room where screens display each patient's room. Aleksandr sits before the bank of monitors, making notes.

"How's our data collection?"

He doesn't look up. "Complete baseline established for all patients. We're tracking thirty-seven distinct markers."

"And our production?"

"Sarah's team has manufactured enough treatment for another three hundred people." He finally glances at me. "Not enough for Hamburg, but enough to prove our point."

"If they give us the chance." I check my phone again. Still nothing from Commissioner Voss.

In Felix's room, Emma has fallen asleep in her chair, a stuffed rabbit tucked under her arm.

I adjust her blanket before checking Felix's monitors.

His progress continues steadily—oxygen saturation up another 3%, inflammatory markers down, fever reduced to 38.

1°C. Dr. Nguyen reduced his sedation further an hour ago. He should be waking soon.

I take his hand. It's warm but no longer burning with fever. "You're getting better," I whisper. "Keep fighting."

My phone vibrates. Marie.

"I've sent Commissioner Voss your data," she says without preamble. "He's reviewing it now with his team."

"And?"

"Initial feedback is cautiously positive, but they want more time to verify. Morrison is pressuring them to stick to the timeline."

"We don't have more time. The deadline is in twelve hours."

"I know, Erik. Voss is trying to buy you at least another twenty-four hours, but Morrison is adamant."

"What's driving this? The containment measures are holding. The virus hasn't spread beyond Hamburg's quarantine zones. "

Marie sighs. "Fear, primarily. And intelligence suggesting the virus has already escaped to Bremen and Hannover. They're treating Hamburg as the epicentre they can still control."

"Has it actually spread?"

"I don't know. But Morrison is convinced it has or will imminently."

"Then tell Voss to come see our demonstration zone. We can prove the treatment works."

"I'll suggest it. But Erik? Prepare for evacuation."

After she hangs up, I return to the monitoring room. Our patients continue to improve. Even the most severely ill are showing reduced viral loads and improving oxygen saturation.

At 0900 hours, Sarah bursts in. "Erik, we have a problem."

"What?"

"Patient 8, Maria Schmidt. She's developing acute liver failure."

I follow her to the patient's room. Maria, a 73-year-old retired schoolteacher, lies jaundiced and semi-conscious, her monitors showing alarming liver enzyme levels.

"When did this start?"

"Twenty minutes ago. She was improving, then suddenly crashed."

Dr. Nguyen joins us. "Liver biopsy shows massive cell death. It appears the antibody is cross-reacting with some of her own liver tissue."

"Why only her?"

"We're running genetic screens now," Sarah says. "Preliminary results suggest she has a rare HLA variant that might be structurally similar to the viral binding site."

"Frequency in the general population?"

"Approximately one in five hundred."

I close my eyes briefly. One in five hundred would mean hundreds of similar reactions across Hamburg—not catastrophic on a population level, but devastating for those individuals.

"Treatment options? "

"We're putting her on continuous dialysis and supportive care," Dr. Nguyen says. "We may need a liver transplant if she survives long enough."

If. The word hangs in the air.

"Keep me updated on any changes. And screen all other patients for this HLA variant immediately."

Back in the monitoring room, I call Marie.

"We've had a complication," I tell her. "One patient developing liver failure. We've identified the likely mechanism and can screen for susceptibility, but it proves the treatment isn't universally safe yet."

Her silence speaks volumes.

"This doesn't change the fact that forty-one other patients are improving," I continue. "The treatment works for 99.8% of the population. We just need to identify those at risk and develop an alternative approach for them."

"Erik... I'll pass this on, but you know how it will be interpreted."

She's right. Morrison will seize on this single failure to justify his timeline.

At 1100 hours, Patient 23, Johann Weber, develops acute renal failure. Unlike Maria, he doesn't have the HLA variant we identified. Something else is happening.

By noon, three more patients show serious adverse reactions: one with rapidly progressing pneumonitis, one with encephalitis, and another with acute heart failure. All were improving before suddenly deteriorating.

"It's not a single mechanism," Sarah explains as we review the data. "The antibody appears to be triggering different autoimmune responses in different patients. We're identifying genetic markers that might predict risk, but it's complex."

"Percentage of patients affected?"

"Currently 11.9% showing serious adverse reactions. Another 14.3% showing mild to moderate reactions that we're managing."

"And the others? "

"Still improving. Viral loads down by 70-90% in most cases."

I rub my eyes. The treatment works—brilliantly—for most patients. But not all. And the failures are catastrophic when they occur.

My phone rings. Commissioner Voss himself.

"Dr. Lindqvist, I've reviewed your data and spoken with General Morrison."

"And?"

"I'm afraid the timeline stands. We've received confirmed reports of cases in Bremen, Hannover, and now Kiel in addition to the previous contained cases in Amsterdam and Paris. The containment strategy is failing, they must act."

"But our treatment—"

"Shows promise but also significant risks. The reported adverse reactions confirm Morrison's assessment that we cannot rely on this as our primary containment strategy."

"Give us more time. We can refine the treatment, develop screening protocols—"

"I'm sorry, Dr. Lindqvist. The evacuation proceeds as scheduled. You and your team will be extracted at 1600 hours today. The containment operation will commence at 1900 hours."

After he hangs up, I stand motionless, phone still in my hand. Seven hours until Hamburg is destroyed. Four hours until we're evacuated.

I return to Felix's room. His breathing is stronger now, less mechanical. His eyelids flutter occasionally, almost waking.

"Felix," I whisper, squeezing his hand. "We're out of time."

Emma stirs in her chair. "Is Felix waking up?"

"Soon," I tell her, forcing a smile. "But we need to get ready for a trip. Can you pack your backpack with your favourite things? Just what fits inside."

She looks between Felix and me, sensing something wrong. "Where are we going?"

"Somewhere safe. Felix will come with us."

"But he's still sick. "

"The doctors will help him travel. He's getting better, just needs more rest."

As she reluctantly goes to gather her things, I call Sarah.

"Prepare Felix for transport. We're being evacuated at 1600."

"All of us?"

"Essential personnel only. You, me, Yuki, Aleksandr, and our patients from the demonstration zone as the clinical sample. Everyone else..."

I can't finish the sentence.

"What about our research? The samples, the data?"

"Pack everything that you can. Priority on treatment doses and genetic screening materials."

At 1500 hours, military personnel arrive to coordinate our evacuation. Three transport helicopters wait on the hospital roof. Felix, still intubated but stable, is prepared for transport by a military medical team.

I find Colonel Santos supervising the loading of equipment.

"You're making a mistake," I tell her. "The treatment works. We just need more time to refine it."

She doesn't meet my eyes. "Those aren't my orders, Doctor."

"Then whose orders are they? Who actually decides to destroy a city of millions?"

"You know I can't discuss that."

"Can't? Or won't?"

She finally looks at me. "Would knowing change anything now?"

She's right. It wouldn't. The machinery of destruction is already in motion.

At 1545, air raid sirens begin to wail across Hamburg. Emergency broadcasts instruct residents to remain indoors and await further instructions—instructions that will never come.

I supervise Felix's transfer to the helicopter, ensuring his ventilator remains functioning throughout. Emma clutches my hand tightly as we board, her backpack and rabbit her only possessions now .

"Why are there sirens?" she asks, eyes wide with fear.

"It's just to let people know to stay inside," I lie. "So they stay safe."

As our helicopter lifts off, I look down at Hamburg—the sprawling port, the elegant Alster lakes, the neighbourhoods where millions live their lives. In three hours, it will all be gone.

Emma presses her face against the window. "I can see my school!"

I put my arm around her shoulders, unable to speak.