made sure he was wearing his disposable gown before he went in to meet with the patient. He'd been vaccinated, of course. Everyone in the emergency department had, but that didn't necessarily mean anything. There were thirteen different serogroups that could cause meningococcal disease, and only five could be prevented with vaccines.

 

It wasn't quite so virulent that he needed to go in with the full hazmat suit. Patients didn't even need to be quarantined. He just needed to use an abundance of caution.

 

Understanding the technicalities was one thing. He could go through the proper protocols of hundreds of contagious diseases. It was his job. But there was a difference between knowing the treatment protocols and walking into a room with a patient who was suffering from one of these illnesses.

 

Nick Barrett was a short Le Moyne student, a little overweight for his height, with long, curly brown hair that stuck to his head with sweat. His hazel eyes were glazed with fever as they turned to Dave, and his cheeks were flushed. Dave knew Barrett wouldn't remember much, if any, of what Dave had to say.

 

Fortunately, he had someone with him. The tall, rail-thin blond sitting in the other chair in his treatment bay with his arms crossed over his chest didn't look all that affectionate, but that was who Dave had to work with. "Hi. I'm Dr. Stanek. Are you a family member?"

 

Blondie shifted in his seat. "I'm Barrett's RA. I'm the one who had a car on campus, so I got to bring him in here."

 

Dave winced. "How come they didn't call for an ambulance?"

 

Blondie yawned. "Student health insurance doesn't cover that."

 

Dave just gaped for a long moment. "Okay, ah, Mr. RA. You're going to need a round of prophylactic antibiotics, just to be on the safe side, and I'm going to need your vaccination records. And if Mr. Barrett has a roommate, I'm going to recommend the same for him, for any romantic or sexual partners, close friends, teammates or lab partners."

 

Blondie sat up straighter. He wasn't yawning anymore. "Wait, what's going on here? He's just got, like, mono or something, right?"

 

"Mr. Barrett has meningitis. Bacterial meningitis, to be specific. We've already started the paperwork to admit him here. They'll move him up to a room in a few moments." Dave glanced at Barrett, who appeared to be completely unmoved by the announcement. A fever like his could do that to a person. He probably wouldn't even remember the diagnosis. "What's your name?" he asked, in a softer tone.

 

Blondie rubbed at his face. "Curt," he said, after a second. "Curt Abel."

 

"Okay. Curt, this sounds scary. And it is scary. I'm going to have to ask you a lot of questions, and you're probably not going to know the answers to all of them. That's okay. No one expects you to have a complete picture of all your residents' daily lives, right?" He managed a little grin. "Do you know how long he's been ill?"

 

"A few days." Abel looked down and away. "I got a call from his advisor that he hadn't been at any of his classes in a few days. He's a freshman, and sometimes freshmen have a hard time coping with being at college. I checked with his roommate, and he said he thought Barrett was on a bender."

 

Dave nodded. Thank God for modern technology. It meant he didn't have to sit there and try to puzzle out his own notes. He could just record this guy and sort things out later. He could focus on Abel now. "Mm-hm. And you went to check on him?"

 

"Yeah. If folks who are under twenty-one are using alcohol or drugs on campus, I have to do something about it, you know?" He rubbed at the back of his neck. "I found the poor guy burning up with fever and dragged him down to Health Services. We used a laundry cart, me and Kaye Glen. She's another freshman, lives on the floor."

 

"I'm going to need to see the roommate and this Kaye Glen. Meningitis is a serious illness. It can be fatal, if left untreated for too long. It's kind of an abundance of caution, but when everyone's living in close quarters like a college dorm, we can't be too careful. In the US, college dorms are where outbreaks happen most often." Dave gave Abel a small little smile. "So you got him down to Student Health. Then what?"

 

"We milled around for a little while and when they couldn't get his fever down they decided to send him here. We talked about the ambulance, but our health insurance doesn't cover ambulance trips and Barrett never has any money." Abel wasn't just rubbing at the back of his neck now. He was massaging it.

 

Dave frowned and leaned forward. "How are you feeling, Mr. Abel? Is your neck at all stiff?"

 

"Well, maybe a little." Abel huffed out a little laugh. "I might have strained something getting Barrett into that laundry cart. I don't want to speak ill of someone who's sick, but I mean he's not exactly a featherweight. And he was pretty much dead weight at the time."

 

Dave pressed his lips together. He'd been in infectious disease for years, but he still didn't know quite where the line was between causing panic and impressing a patient with the seriousness of a potential case. "So, do you have a headache, too?"

 

"Maybe a little one." Abel knit his brows together. "Are you suggesting…?"

 

"I'm strongly suggesting that you let us do a lumbar puncture. The sooner we know if you're infected, the sooner we can start treatment." He patted Abel on the shoulder. "I'm hopeful it's just a hangover and a little bit of a neck strain, but I'd rather be safe than sorry, right?"

 

"I don't drink." Abel stared at a spot on the floor.

 

Thankfully, none of the turmoil at the higher levels of hospital administration had any effect on the way the patient delivery units ran. Maybe they didn't have a functioning executive office right now. That didn't mean they couldn't get a call tree going. Nurses from a host of other departments volunteered to reach out to Le Moyne's administration and to alert the media. Emergency room personnel stood by to triage frightened students.

 

Sometimes that meant holding their hand while they went through an unpleasant lumbar puncture. Sometimes that meant holding their hand and explaining that living in a completely separate dorm from the two people known to be infected, having no classes with them, and having no friends in common, meant they had a low risk of being infected themselves. If their vaccines were up to date, and they were for the most part, they should be fine.

 

Dave, fortunately or unfortunately, didn't have to do that. Dave got the pleasant task of notifying the Center for Disease Control down in Atlanta. They weren't too alarmed about the outbreak. These things happened on college campuses. They appreciated being informed, but they didn't see a reason to send in the big guns just yet. Their resources would be available, should things get out of hand in Syracuse.

 

Dave couldn't think of a situation in which a meningitis outbreak would get out of hand. It was a serious illness, but it was easily brought under control.

 

Nick Bennett had been brought in at one o'clock in the afternoon. By five, when Dave would normally have gone home, Silver Oak had three confirmed cases of meningitis. All three were directly connected to Nick Bennett—Bennett himself, his RA, and a guy by the name of Strudwick from his Spanish class. Apparently they'd gotten into it during their Spanish Lit class and gone toe to toe.

 

Strudwick was less than enthusiastic about learning he'd contracted meningitis from Bennett. "You mean to tell me not only did this jackass try to copy from my exam, but now he's put me in the hospital? I'm going to kick his ass if we survive this."

 

Dave couldn't really fault him for his anger. After all, Strudwick had caught a potentially fatal illness. "We'll make sure you're on a different floor." It was all he could do, other than prescribing antibiotics and confining him to a room.

 

By six o'clock, Dave had an additional duty to attend to. He had the joy and fun of getting up on a small platform, in front of a bunch of cameras with a bunch of reporters next to them and answering questions. This, too, was part of his job. Thankfully, Rick Wade was with him. Rick made him feel safer than most other folks did. He was kind of awesome that way.

 

Once he and Rick had been seated, they were able to begin. Dave started the conference. "Hi, everyone. Thank you for coming this evening. This is a mostly informational conference to talk about an outbreak of meningitis that was discovered at Le Moyne College today. I want to make two things very clear before we get started with questions and answers, and then I'll answer as many of your questions as I can. First of all, meningitis can look like just about anything in the early stages, to include just a bad case of the flu. So unless we get some truly damning new information in the next few days, we shouldn't go pointing fingers at the administration or at Health Services.

 

"Second," Dave continued, letting his eyes roam around the audience, "meningitis outbreaks are pretty rare in this country. Where they do occur, they're limited in scope to a handful of people and they're diseases of crowding." He grinned. "So your Corcoran high school freshman is at relatively low risk from an outbreak at Le Moyne College. If you think there's a danger, definitely give your primary care doctor a call. But unless you show symptoms, or you've been in close contact with someone who's had exposure to meningitis, you're probably okay."

 

The reporters shifted and one brave soul raised her arm. "Dr. Stanek, is there any truth to the rumor that the outbreak affects thirty people?"

 

Dave shook his head and smiled. This question was easy. "We've got thirty people we're treating with antibiotics as a 'just-in-case' kind of measure. They're people who had close contact with one of the three people who've been diagnosed with meningitis. Again, only three people have shown any signs of being ill and they've all been admitted to Silver Oak. Their families have been notified."

 

Rick cleared his throat and leaned into his mic. "College campuses are kind of a hot spot for outbreaks like this," he said, in that Texas drawl of his. "It's all those people living on top of one another that does it. That's why colleges generally insist on a meningitis vaccine for incoming students."

 

Another reporter raised his hand. "What is the prognosis for treatment, Doctor?"

 

Dave glanced at his boss, but Rick shrugged. This one was on Dave. "I'm not going to get into specifics about any one patient." An image of Barrett, already on oxygen, sprang to his mind. "Meningitis can be fatal if left untreated and it can lead to potentially serious complications, but we're feeling confident about good outcomes for the three patients who've been diagnosed so far."

 

A different reporter, this one with only a DSLR camera and operating alone, raised his hand. "Dr. Stanek, is there any possibility that this outbreak could be related to terrorism?"

 

A pained little gasp made its way around the room, and Dave winced. That was the thing with infectious disease in the modern era. Once people had just been worried about keeping themselves safe and free from contamination. That had its own headaches, of course, but it had been easier to deal with. Now there was an extra layer of paranoia to contend with.

 

And they had to take it seriously, no matter what.

 

Dave tilted his head to the side and looked up at the ceiling. "Anything could be terrorism, I suppose," he said, after a moment. "I think most bad actors have a wider range of options at their disposal, of diseases that are more virulent and more harmful, than meningitis, if they wanted to do the bioterror thing. I've worked with the CDC on bioterror, it's not exactly uncharted territory for me, so I'm being honest when I tell you that yes, it's a possibility, but it's a remote possibility at best. Meningitis happens, sometimes. It's unfortunate, and it's something we have to fight, but I can't think of a single instance when it's been used as a weapon."

 

The first reporter raised her hand again. "Does the turmoil at the top—the acquisition of Silver Oak by Regent Healthcare—have any impact on how you're handling this case?"

 

Dave couldn't resist a smirk. "I think that's a question for our Director of Emergency Services."

 

Rick rolled his eyes. "Thanks for throwing me under the bus, there, Dave. Don't think I won't remember that when bonus time rolls around." The reporters tittered. "The short answer to your question is no. The longer answer is that all of the departments at Silver Oak have a pretty autonomous structure, and the Emergency Department has more freedom than most. We have to, if we want to be able to respond quickly to an emerging situation. Believe it or not, we expect a certain level of public health challenge every year from vulnerable populations. We're prepared to handle this." He grinned, dark and handsome.

 

The hospital's Public Information Officer, who was almost certainly going to be losing her job when the team from Cleveland took over in a couple of months, smiled at the reporters. "Thank you all for coming. I'm sure you all received the graphics and information packets we sent out prior to this briefing. If we receive any new information, or if the outbreak spreads, we'll let you all know right away. We see you all as partners in public health. If we can't keep the public informed, a lot of people are going to have a lot of problems. Thank you."

 

And with that, the briefing was over. Dave was free.

 

He and Rick got up from their table and headed back toward Emergency. Dave had no idea what Rick's plans were. He knew he'd had a long day, personally. He wanted nothing more than to sit back at home with a beer and maybe watch a little bit of Top Model.

 

Finding a cop standing in the middle of Rick's office wasn't exactly unusual. Syracuse had some big-city problems for a smaller-sized city and cops showed up all the time. That wasn't what made Dave's hackles rise. The cops in the emergency room weren't usually wearing vests labeled "Incident Command" for one thing.

 

And they never, ever, looked that good. Incident Command was average height, with short black hair and a square jaw Dave would love to nibble on. His arms were thick with muscle, enough that Dave could ignore the part of him that laughed at anyone wearing short sleeves in February. And he was armed to the teeth, from the pump-action shotgun in his hand to the gun strapped to his thigh in an honest-to-God thigh holster.

 

"I think we can put the hardware away, can't we?" Rick wasn't impressed by the display but, then again, Rick was from Texas. For all Dave knew, thigh holsters and shotguns were considered proper breakfast attire out there. "This is a hospital, not a shooting range. You should have taken the left turn at Albuquerque."

 

The cop's square jaw tightened. "This isn't a game. They found a glass vial in one of your patient's belongings. It's tested positive for meningitis."

 

***

Ken had seen a lot in his thirty-something years. He got that people had different reactions to stress. Doctors weren't immune. They liked to think they were, but at the end of the day they were just like everyone else—basically chickens with their heads cut off until someone with half a clue showed up and told them where to go and what to do.

 

These two docs didn't freak out. They didn't throw their hands in the air and scream. They didn't try to puff themselves up by taking control of the situation either. They just looked at one another and frowned. "I'm sorry," said the shorter one. He had this downstate accent, Manhattan through and through, and it set Ken's teeth on edge. "That doesn't make a lick of sense. That would mean someone deliberately released meningitis at Le Moyne, as a kind of attack."

 

"And?" Ken raised his hands. He'd forgotten about the shotgun.

 

The taller doctor stepped forward. "How about you just… put down the gun, maybe? There we go, no one needs that thing to go off accidentally." His smile was bright and snappy. His gray eyes were a tempest, and who the hell was he to sit there and judge Ken? "Anyway, meningitis would be an unusual choice for a bioterror attack."

 

Ken shrugged. Okay, maybe he hadn't necessarily needed to wave the shotgun around the ER. And maybe he hadn't remembered he had it in the first place. That didn't change the fact that someone had released a disease at Le Moyne, just because they felt like it. "Well, unusual or not, that's what they did. I never do meet the smart criminals."

 

The shorter doctor flinched at that. What was his story? What was he guilty of that caused him to flinch when Ken brought up dumb criminals? He was pretty enough, for a City guy. He might have been a little on the short side, but that slim body and those narrow hips more than made up for it. "Do you have the lab report? And do you know whose belongings the vial was found in?" He blinked. "Why were the police going through someone's things, anyway?"

 

Ken ground his teeth for a second. He had to remember that other cops, in other places, had been doing things that called everyone's integrity into question right now. That made it fifty times harder for everyone to do their jobs. "We weren't the ones that found it, initially," he said, once he'd forced his initial angry response down. "His roommate was looking for some of his things to bring to him here in the hospital and found it. He called us, which is how we got entry to the room. We followed protocol. And we documented it, if you want to get the ACLU or whoever involved."

 

Hot Doctor shrugged. "Okay. Well, if you documented it, it must be on the up and up, right? Anyway, I can't think of a single incident of anyone trying to weaponize meningitis. And I did intern with the CDC, so it's something I'd have looked at."

 

Taller Doc smirked. "Allow me to introduce Dr. Dave Stanek, our head Infectious Disease Specialist."

 

Ken refused to be impressed. "Ken Sykora, Sheriff's Department. So why hasn't anyone tried to weaponize meningitis? It seems like the kind of disease that well and truly sucks." He crossed his arms over his chest.

 

"Oh, it does." Stanek managed a tight little grin. "It can kill within twenty-four hours, sometimes. No fun at all. But it also requires certain conditions to thrive—specifically, crowding. When you're going for terror, you want a disease that passes easily from person to person. Meningitis is highly contagious, sure, but you need close, extended contact with an infected person's effluvia to really get an outbreak going. It's not like, say, smallpox or anthrax."

 

"Okay." Ken couldn't see the difference, but he didn't ask. The doctor might tell him, and Ken didn't care. He didn't have time to be there all night. He needed to get to the bottom of this and work on finding the culprit. "What matters is that someone very clearly did decide to release the disease, into a population of college students. Can you think of anyone who would have access?"

 

"To a vial of live meningitis?" Stanek laughed, and his smile took ten pounds of weight off Ken's shoulders. "Sure. Plenty. I teach a class over at the university on epidemiology, and one of the viruses we use is meningitis. It doesn't mutate all that quickly. We can go over there and check to see if the samples are all accounted for, but any of the grad students in that class would have access.

 

"We have two pharmaceutical companies left in town. Both of them work with meningitis. One of them has been working with meningitis for decades. The other is a start-up, and I'm not sure exactly what it is that they do." Stanek smiled at him again. "I'm happy to go with you, if you're concerned."

 

The taller doctor turned to give Stanek a long, measuring look. "You want to go follow Officer Eddie Eagle here around to different labs when we're in the middle of an outbreak?"

 

"We could send one of my students with him too." Stanek's dimpled cheeks turned pink. "Folks from that industry can use a lot of jargon, or just plain refuse to cooperate. If I can help, I'd want to do that obviously." He looked down and away.

 

Ken opened his mouth to defend himself. He didn't need some shiny New York City doctor "translating" for him. That wasn't what he said though. Maybe it was the earnest desire to help in those hazel eyes. Maybe it was the way Stanek blushed. "Thanks, Doc. I might come back to ask for help, but for now I'll try it on my own. We do need you to be with the patients, after all. If you wouldn't mind coming over to the lab with me, on a purely voluntary basis of course, I wouldn't mind ruling that out."

 

"Not a problem. Do you mind if I do my rounds, first?" He frowned then. "Have you been vaccinated for meningitis?"

 

"I'm not sure. If I was, it was a long time ago. Why?" Ken scratched his head at the non sequitur.

 

"If you're investigating an illness that can actually damage your brain, it's probably not a bad idea to take steps to limit that disease's ability to hurt you." Stanek raised an eyebrow. "Do you have any moral objections to vaccination, Deputy?"

 

Ken's cheeks grew hot. "Not at all. I just—"

 

"Then let's do this." He gestured to Ken, and Ken found himself following the doctor out of the office and through the ER.

 

The taller doctor, who had to be the director since it was his office, followed with the shotgun.

 

Stanek paused to speak with a nurse on his way into his office. The maroon-clad woman nodded once, turned on her heel, and headed back in the same direction she'd come from. Then, all three of them walked into Stanek's office. It was a little small, and the desk was covered in files and paperwork, but Ken could hardly complain about that. His own wasn't much better.

 

"I should be doing this in an exam room, but they're all busy right now." Stanek grabbed a tablet from his desk and took a look at it. "Ooo. That's not great. I'm going to want to go check on a patient before we go to the lab, if you don't mind."

 

"Of course." Ken wanted to squirm, but he held his peace. A doctor wasn't going to abandon his patients, especially not patients who were dangerously ill, in favor of a field trip to a lab.

 

Wade, the department head, smirked and took off. Stanek eyed the shotgun. "Does the armory need to come with us?" He wrinkled his nose at Ken.

 

"Well, I'm not leaving it in the office." Ken frowned. "I wasn't about to leave it in the car either. Not after that cop's car got broken into on the North Side last week."

 

"I guess that makes sense. I'm sorry. I can't quite be comfortable with it just looming there, you know?" He rolled his shoulders and jerked his head toward the door. "I guess there's no place else to put it though. They won't let Rick keep a gun safe on site anymore, so I guess it's got to stay with you. "

 

"Not a big fan of guns, are you?" Ken followed his escort to the elevators.

 

"Not really. I'm from New York. They're not a fashion accessory down there." He looked Ken over. "It doesn't generally mean good things when they come out."

 

Before Ken could find a polite way to express his outrage, the elevator stopped. Stanek led him through a set of doors and into a floor full of patient rooms, where nurses, orderlies and visitors all eyed Ken and his gun with suspicion. Could they not see the badge pinned to his vest, for crying out loud?

 

Their first visit of the evening was to a small private room labeled Barrett. This, Ken knew, was their Patient Zero. Nick Barrett, a freshman, had been the first person diagnosed in this outbreak. The vial of disease had been found in his belongings. Ken had hoped to be able to question the kid about that.

 

He didn't need a degree to know that wasn't going to happen anytime soon. Barrett had a mask over his face, and his eyes might have been open but they were more glazed than a donut. He'd already soaked through his thin hospital johnny and the thin white sheet that covered him, and little sores had broken out all over his right hand.

 

Stanek frowned when he saw those sores. He looked over at the monitors that blared out numbers that told the kid's story, and Stanek's frown deepened. "Deputy, I'm going to ask you to step outside as an abundance of caution. You were only just vaccinated a couple of minutes ago. It shouldn't be a problem, but why take a chance?"

 

Ken looked at the sweat-soaked sheets. He looked at Stanek's face and stepped outside.

 

An array of nurses surged in after about thirty seconds, armed with medicines and equipment instead of guns and body armor. Ken heard Stanek giving instructions in a low, calm voice. He couldn't be sure what exactly was being said, but it couldn't be that bad if Stanek sounded so chill about the whole thing. Could it?

 

Stanek emerged after another ten minutes. His pale hands had gone red, probably from scrubbing. At least Ken hoped it was from scrubbing. "Alright, let's check on the others." His generous lips had flattened to a thin, tense line.

 

"What's wrong with that kid in there?" Ken jerked his head back toward Barrett's room. "When am I going to be able to question him?"

 

Stanek barked out a quick, humorless laugh. "At this point, he'll be lucky if he can hear you when he comes out of it. He's in bad shape. The ICU is full up. As soon as a spot opens up down there, I've given orders to move him. He's going to have some lasting complications, and that's assuming he survives."

 

Ken stopped in the middle of the corridor. "Wait, I thought you expected them to make a full recovery?"

 

"I did." Stanek leveled Ken with a cool gaze. "Barrett took an ugly turn pretty quickly. Even if we do everything right, ten to fifteen percent of patients with meningitis still die. That's assuming we get to treat them right away. And assuming they didn't chalk it up to being just the flu, or just a hangover, or just sleeping wrong on their neck. So, my guess is we didn't get antibiotics into Barrett right away." He closed his eyes. "I'm not blaming him," he said, when he opened them again. "Really, I'm not. I'm frustrated by a bad outcome." He sighed and turned on his heel. "Come on, we've got two more patients to see."

 

Those patients seemed to be responding better to treatment than Barrett was. Apparently Barrett hadn't spread his disease much. Maybe he was a loner, or maybe the vaccine worked. Maybe students at Le Moyne had the sense to stay away from students who were showing signs of being sick. What did Ken know?

 

Once Stanek had checked on those patients and left clear instructions for some resident with soft-looking hands, he was free to bring Ken over to the lab. They took Ken's car, because a sixteen-minute walk might be pleasant enough in May or June but it wasn't going to cut it in February. Ken figured he could probably handle the sub-zero temperatures, but the wind was a bitch and motorists couldn't see around the six-foot snowbanks.

 

Stanek looked the car over and hesitated before getting inside. "This is the first time I've ridden in the front seat of a police car," he said with a smirk, sliding into the front passenger side of the cruiser.

 

Ken rolled his eyes. If he had a dime for every time someone tossed him a line like that, he could retire. Of course, most of those guys didn't look like Stanek. "I'm sure a med school guy like you spends a lot of time in police cars."

 

Stanek huffed out a little laugh as he buckled his seatbelt. He fell silent until they got to the medical school.

 

Once there, Stanek led him at a brisk pace through the halls until they got to the Public Health department. There was Stanek's name on a door, bright and shiny. They brushed past it, however, in favor of heading to a lab. "So you're on staff full time at the hospital," Ken said, trying to get a better picture of this guy in front of him.

 

"Yeah. I'm the head of Infectious Disease, which is part of Emergency Medicine. I pitch in with ER patients when we don't have anything exciting and catching in the area." Stanek used his key card to open a lab labeled "Epidemiology: Authorized Access Only."

 

"And you teach, too?"

 

"Sure do. I teach about infectious disease and epidemics over here at Upstate."

 

Ken scratched his head and looked around the lab. The place looked like something out of science fiction. If Sharknado appeared, he was running, serve and protect be damned. "Where do you find time for fun?"

 

Stanek chuckled. "This is fun." He gestured to the lab. "The part where people suffer and die? Not so fun. The part where we can study how we affect diseases, and how diseases affect us? Awesome. I've got a book you might like."

 

"I highly doubt it." Ken couldn't help but grin.

 

"Trust me. Rats, Lice and History is a classic. The author wrote it like a biography, and it's pretty accessible for non-academics. But the real value is in the footnotes. He goes off on these little rants in the footnotes that have people howling for days. We can stop by my office." He blushed, just a little. "I've got a copy I can loan you."

 

Ken was on the cusp of declining, and then he changed his mind. "I'll give it a shot, I guess." He could use it as an excuse to catch up with the hot doctor again, and it wasn't like he could do much else in February. "Thanks."

 

"First things first." He walked over to a glass-fronted refrigerator, unlocked it and pulled out a tray of carefully labeled glass vials. "These are our meningitis samples. We were working with meningitis last week, so students could recognize it under a microscope."

 

Ken looked. "It looks like all the spaces in this rack are accounted for."

 

"They are." Stanek put the samples away and locked the door behind him. "I'll write you up a list of other places that might be working with meningitis."

 

"That would be awesome." He followed Stanek back to his office to get the book and to leave his card.