Page 63 of Outbreak Protocol

"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."