From the Fatherland, with Love, page 52
The second patient was also in his late twenties, and had a birthmark covering his eye and forehead that was at first hard to distinguish from the rash. His symptoms appeared to be worse than the first man’s. He was vomiting and had diarrhea, and was very emaciated. It seemed to be excruciating for him even to speak. Having complained of feeling cold he had been wrapped, shivering, in several layers of blankets, but Kuroda said they should remove some of them. Too many would make the fever worse and accelerate the wasting. His temperature was 39.5, and his breathing rate seventeen breaths per thirty seconds. The sheets were stained with yellow vomit, his diapers with blackish diarrhea. Asked if his legs itched, he tried to answer but almost passed out with the effort. Kuroda thought this was more likely to be from exhaustion than anything else, but just in case he checked the optic nerve. He didn’t have a penlight so he used the flashlight to check the response of the pupil, and then checked the range of vision—hardly satisfactory, but enough to conclude that there was no nerve damage. The rash hadn’t blistered, but there was some swelling.
The commander wiped his forehead, grimacing beneath his mask. Few people could remain undisturbed by the sight of an ulcerative rash like this, not to mention the stench of diarrhea, which with the lack of ventilation was enough to make anyone gag. He offered to switch on the engine so they could have some air conditioning, but Kuroda said the noise and vibration would interfere with his work. He noted bruising on the parts of the legs that weren’t covered in the rash. As with the first patient, the conjunctiva was bloodshot, the lips cracked, and there was inflammation of the oral mucous membrane and a strawberry rash on the tongue. The lymph nodes in the neck were also swollen. Given his extreme emaciation and weakness, Kuroda decided against sitting him up for examination with the stethoscope.
“I wonder if it could be hemorrhagic fever,” Kuroda said to Heo as they left the bus and put on some new gloves. With Pak translating, he replied, “I’ve heard this is a danger in South Korea, but is it here too?” Kuroda said that if he meant HFRS—hemorrhagic fever with renal syndrome—there hadn’t been any cases of it in Japan. Contagion was through a hantavirus, carried by the wild striped field mouse, and there had been cases in South Korea and eastern China, though as far as he knew there had been no new outbreak in South Korea for twenty years. It had a two-week incubation period, which meant that if these patients had it, they must have contracted it before arriving.
Kuroda asked when their symptoms had first appeared. “About half a day ago,” the commander replied. Checking the log, Heo added, “The first patient started complaining of the symptoms eleven hours ago, the second one ten hours ago, and the third eight hours ago.” They had apparently isolated the patients and moved the command center this morning. When Kuroda asked whether hemorrhagic fever was known in North Korea, he was told rather hesitantly that they’d never heard of it there. Nevertheless, he thought, the place directly bordered China and probably did have the same species of field mouse, so the existence of the disease couldn’t be ruled out. “Are you sure?” he asked again. The three quietly discussed this among themselves, before the commander said, with some difficulty, that medical intelligence in the Republic was not as well organized as it should be. “But if it’s an infectious disease,” he added, “would there not be more cases?”
“Humans are the end host for the hantavirus,” Kuroda explained. “In other words, HFRS doesn’t spread from person to person.” He then asked Han if they inoculated against measles in North Korea. “Of course,” the woman doctor answered for him. High fever, rash, bloodshot eyes, muscle pain, and so on were typical symptoms of measles, but it was a childhood disease and rarely seen in Japan since vaccination became widespread. However, in the US and elsewhere many cases had been reported among adults who had not received the booster shot, so perhaps it was the same in North Korea? When he put the question to them, the four looked at each other. “The vaccine is given between the ages of four and six. Those three would have been due to get it in the early Nineties, but it’s possible they didn’t,” Han admitted. “At that time, there was a widespread shortage of food and other commodities. Do you think that’s what it is?” Kuroda said he really couldn’t say at this stage. “I’ll have to take a blood sample and send it to the pathology lab for testing.”
From the symptoms he thought it more likely to be something like Kawasaki disease or the bubonic plague, which featured edemas and swelling of the lymph nodes in the armpits. With measles, there was mostly swelling of the lymph nodes in the neck, and the rash spread from the head down to the lower body, whereas in these three patients there was no rash on the head. Kawasaki disease was a childhood disease, but its cause was as yet unknown. It was similar to scarlet fever, and a number of cocci had been suspected but ruled out after antibiotics proved ineffective, after which research had turned to Yersinia pestis and viral infections. Kuroda thought he should consult Seragi, who was familiar with cases of connective-tissue disorder, and had also written a paper on Kawasaki disease. He took out his cellphone, but it was out of range—not surprisingly, since they were underground. “Do you want to make a phone call?” asked Han. “I thought I’d talk to a colleague about it.” Han frowned. “I must ask you not to do that,” he said, putting his hand on Kuroda’s shoulder again. “We don’t want word of this getting out.”
By taking the patients to the Medical Center they could determine right away whether it was measles, but it didn’t look as if this was an option. “What treatment are you giving them?” Kuroda asked. “Antipyretics and antibiotics,” the woman doctor replied, adding that the antibiotics were ampicillin tablets and chloramphenicol ointment. But antibiotics only stopped bacteria from propagating and weren’t effective for viruses. The men should be hospitalized. “I’m afraid that in the circumstances we cannot do that,” said Han, looking uncomfortable. “We shall treat them here. In any case, let’s talk about that later.”
Kuroda stopped himself from pointing out that this was no place to be treating any patients. Part of him thought it was their problem and he shouldn’t get involved any more than he had to. But yesterday they’d brought in a soldier who’d been stabbed in the stomach, so why weren’t they doing the same for these three? The doctor in him wanted to help them, but the fear he’d felt in the car on the way over was stronger than his sense of moral responsibility. Just think where you are, he told himself. Medical ethics is not an issue here in this parking lot. You’re not just a doctor, you’re a fifty-year-old resident of an occupied territory with a wife and two kids and an ailing mother dependent on you.
The parking lot was deathly quiet, without even the background hum of air conditioning. The conversation had come to an abrupt halt, and in the silence he could just make out a faint rustling sound by his feet. Looking down, he saw several small bugs wriggling around on Heo’s shoe cover, scratching at the plastic. They looked like fruit flies. Heo yelped, shook the bugs off, and squashed them underfoot. Kuroda looked at his own feet and saw the same things crawling over them. He bent down to get a better look, but the woman stopped him and used the pencil in her hand to brush them off. As she did so, they hopped and scuttled away. They were the same insect he’d seen on the window inside the bus a short while ago. At first he thought they might be tiny flies, but these things didn’t fly, they jumped. It was creepy. They were very like the drosophilidae he remembered from science textbooks, but much smaller.
Looking carefully at the concrete floor, he could see lots of them crawling and hopping all over the place. They had managed to survive the disinfectant. Maybe they were exceptionally strong breeders, or the temperature down here suited them. Heo began to scold the woman, apparently for not having managed to get rid of them. Han stopped him, then discussed something in Korean with the others for a few moments before turning to Kuroda and saying bleakly, “To tell the truth, we were suddenly infested with the things late last night.”
At a distance of about twenty meters from the quarantine bus stood a cream-colored microbus with HIIRAGI TOURS painted in green on the side. This was where a collection of the bugs was being kept. The windows had been sealed with tape, and the passenger door at the back was welded shut. The central door was covered with a primitive shutter consisting of the blue plastic sheeting commonly used on construction sites, which was tacked onto a wooden frame and weighted down with blocks. The three officers appeared reluctant to enter the bus, and told the medic to fetch a sample of the bugs in a container. Kuroda asked if they were dangerous. “We don’t know,” he was told, “but better not go near them, just in case.”
They made no move to help as the woman shifted one of the heavy blocks holding the plastic sheeting down and ducked inside. She said something in a loud voice, and Heo and Pak immediately put one foot each on the trailing plastic to keep it closed. A few moments later she emerged carefully holding several bottles of different sizes tight to her chest. She slowly descended and gently placed these on the ground. As she repeated this process, a number of the bugs managed to escape. Pak quickly crushed them underfoot, but a couple got away and made for the far wall of the parking lot.
Watching the woman doctor, Kuroda asked what her name was, and was curtly informed that she was a warrant officer called Ri Gyu Yeong. The men kept glancing at their feet to check their shoe covers. Kuroda wondered why they had such an aversion to the insects, but when he took a closer look at the bottles, it became obvious enough. There were six bottles in all, each containing bugs of different species and sizes. After getting the go-ahead, he picked up the first container, about the size of a milk bottle—then almost dropped it again. The top was sealed with thin plastic and wire, and the bottom half was thick with the carcasses of dead insects that resembled crickets but, like the flies, were noticeably smaller, milky-white in color, and scarcely bigger than grains of rice, some with a semi-transparent shell and others with transparent innards. “Are they crickets?” asked Kuroda. “Probably,” the commander said gloomily, “although we’ve never seen this type before.” In another milk bottle were some of the tiny flies. It was so crammed with dead ones that it was hard to make out their shape, but they were clearly flies. Kuroda wondered if there were any live samples inside, and was told that there were, though it had been extremely difficult to catch them. Holding the bottle up to the light, he could see that they did indeed have wings. So why did they jump instead of fly? “Some of them can fly,” said Ri Gyu Yeong, coming back out from under the plastic sheeting. She picked up another bottle and put it on the roof of a Honda van parked under the fluorescent light fixture.
They all gathered around the van and peered into the bottle. “Are any infectious diseases carried by flies?” asked Han. “Sand flies are carriers,” said Kuroda. “There are two types present in Japan but in such small numbers that they’ve never been a problem. However, they’re known worldwide as an intermediate host of a parasitic worm called leishmania, and as a carrier or intermediate host of several viruses.” The others drew closer, listening intently to his explanation. “Diseases caused by leishmania are broadly classified into those affecting the internal organs, skin, mucous membrane, and so on. One is a dermatological disease known as oriental sore, which produces swellings on the skin that become ulcerated and in rare cases form leprous growths. After an incubation period of two to four days, there is a sudden high fever, as well as mucosal congestion, and pain in the eyes, head, back, and limbs. Occasionally there can be gastrointestinal damage and reduced white-blood-cell count.”
“Do sand flies bite?” asked Ri, pencil and notepad at the ready, at the same moment as the commander pointed at the bottle and asked, “Are those sand flies?” Kuroda said, “No, they don’t suck blood. The virus is carried in their excrement and carcass, which then attaches to fine particles in the air that you breathe in or that stick to wounds, causing infection. But are these sand flies? I don’t know.” Heo had been intently following Pak’s quick translation of his explanation, but complained loudly about the last bit, his voice echoing around the parking lot. The commander raised a hand to calm him down. “I’ve never seen a sand fly,” Kuroda said. “These are too small to be sure, but they look like some type of fruit fly to me. However, I’m not an expert. Common fruit flies don’t jump, they fly. The reason I said I don’t know is that you can’t be vague about details when you’re dealing with an infectious disease. There’s still a lot that we don’t know about viruses. So to identify these things, I need to take a sample and ask the lab to investigate.”
“There are other insects too,” said Pak, pointing at a bottle about the size of a mayonnaise jar with two centipedes inside. “They’re alive,” said Ri, and Kuroda automatically stepped back. “They were caught just this morning,” added the commander, poking the bottle with his finger. The centipedes were a vivid red with legs of almost a primary yellow, and they measured about four centimeters—not long, but their bodies were thicker than regular centipedes and their numerous legs were long and jointed, and scrabbled angrily against the glass bottom. “This insect attacks,” said Pak. “And it really hurts if you’re bitten.” Ri told him that over twenty people had complained of intense pain after a bite, and the three in the bus were among them. Poison from a bite could indeed explain the rash, he thought. The others seemed to think so too. “But if there is any risk at all of an infectious disease, we have to be ready to respond accordingly,” Heo told him. And he was right, of course.
But where on earth had this outbreak of rare insects originated? Had they come hidden in clothes from the cold North Korean climate and proliferated on arrival in warm Fukuoka? All four were agreed that no such centipede existed in the Republic. None of the several dozen officers at HQ, all from different parts of the country, had ever seen anything of the sort; nor, for that matter, had any of the City Hall staff. One of the centipedes twisted and struck the bottom of the bottle with its tail, then rubbed its head frantically against the glass. It was a predatory sort of movement. “It’s feeding,” said Ri. “There are some small insects in there.” The fluorescent light reflecting off the glass made it hard to see properly, so she took her notebook and held the black cover up behind the bottle. Kuroda saw there were lots of tiny white things stuck to the glass that at first glance looked like specks of fluff. They were springtails, a pretty common insect in Japan, often found underneath stones in damp gardens. He asked her whether she was feeding them to the centipedes, but she shook her head. She spoke in Korean, with Pak interpreting: “When we found the centipedes, they were covered with these bugs.”
Ri Gyu Yeong’s voice was pleasant, even through the mask. It was slightly hoarse, but nice to listen to. Her eyes were long and slanted, and beneath her cap her short hair was a glossy black. Kuroda was so used to women with gray or dyed-brown hair that the natural black looked almost exotic. Through the interpreter, Heo now asked whether centipedes were pathogen carriers. Kuroda said he’d never heard that. Arthropods that caused infection were mainly mosquitoes, mites, fleas, and lice. Then again, he really didn’t know much about centipedes at all, and had no idea how many species existed in Japan, let alone in the world. In fact, he didn’t even know the difference between a centipede and a millipede. The only thing that came to mind was a news item he remembered about a large outbreak of millipedes somewhere in Japan that had caused the wheels of a train to slip when they crawled across the tracks. But he did know that centipedes had a histamine venom, like wasps. And of course there were viruses and bacteria in their bodies, and you couldn’t rule out the possibility that a virus in the springtails the centipedes were eating might also undergo genetic changes and cross over.
Pak pointed at two other milk bottles. One was about a third full of dead springtails that looked just like instant-soup granules. In the second bottle, swarms of live ones clung to the glass or hopped about. “Late last night there were hundreds of thousands of these insects jumping around on the third and fourth floors. The crickets and flies seemed to be first. It wasn’t as if they all turned up at once, just that by the time we noticed them they were already crawling all over the carpets and desks. We first saw them on the steps to the fourth-floor lobby in the middle of the night, but by morning their numbers had exploded.”
In the last bottle was one insect of a type that Kuroda had definitely not seen before. It was about three or four centimeters long, with an orange head not unlike an ant’s, and a body that was semi-transparent and divided into numerous segments. It had four pairs of legs that were transparent near the body but at the tips the same orange as its head. The legs were jointed and covered in fine downy hair. It reminded Kuroda of something out of the movie Alien. “What the hell?” he muttered. “Shall we go upstairs?” the commander said.
*
“There it is.” The commander pointed at the enormous glass and steel-frame structure adjoining the lobby entrance on the fourth floor. The three officers led Kuroda, sheltered by the umbrella Pak held over him, along the open-air promenade. The rain slanted in off the sea, drenching the tails of his white coat as they walked past an area of white stone benches and trees to reach a huge cafe-restaurant. Seen from outside, it looked more like a sports hall or art museum, with its latticework of steel beams constructed in the spiral form of a conch shell. They stood gazing through the raindrops streaming down its glass walls at the tropical decor inside.
