Ten minutes later, they are gowned and hooded and standing inside the third Italian ICU Alana has visited in under a week. She stares through the glass at yet another plague victim—this one four hundred miles from the others. And since the skeletal girl with purplish hair already has a breathing tube between her vocal cords, she will not be able to answer any of their questions about her exposure. The sense of futility is crushing.

A nurse at the bedside adjusts the intravenous drip into the patient’s left arm, but it’s the other exposed arm that Alana can’t take her eyes off of. The girl’s limb is reddened from the neck all the way down to the fingers, which are swollen to the size of sausages. Pus leaks out from multiple ragged wounds across the arm. It appears to have burst open spontaneously from the pressure. At the elbow, a blackish bubo the size of a golf ball stretches her skin. Even if the girl can survive the plague, Alana has serious doubts that her arm can be salvaged.

Orrifini explains that the patient, Lalia Renzi, showed up in the ER the afternoon before. The medical staff originally assumed her infection was related to injecting with dirty needles. Then one of the doctors noticed the darkish bubo. Before Lalia was connected to a ventilator, she denied encountering rats or noticing any fleabites. But, Orrifini adds, Lalia was high from crystal meth and sick with infection, so perhaps she was not the most reliable witness. When the doctors finally tracked down Lalia’s mother, they learned that none of the family had been in contact with the girl for over six months.

On their way out of the hospital, they stop to interview a few other staff members who treated Lalia, but they learn nothing of obvious value.

As they step into the warm Naples sunshine, Alana mutters, “That arm . . .”

Byron shakes his head. “How the hell are we possibly going to provide reliable antibiotic prophylaxis to other addicts and residents in a neighborhood like hers?”

“You had better get a WHO team down here ASAP,” Alana suggests.

“Why is Naples so much more of a concern than Rome?” Sergio asks.

“Night and day,” Alana says. “The Roman case was in a traveler from Genoa who brought the plague with him. Lalia got hers from a fleabite. In other words, through an animal vector.”

“What does this mean?”

“Unlike in Rome, the plague must have already found a home in Naples.”

Sergio opens his mouth to ask another question, just as a tall woman in a tight skirt and high heels marches up to them. “Sei un medico?” she calls out in a much deeper voice than Alana expected.

Sergio shoos her away with his hand.

“What does she want?” Alana asks.

“You are doctors?” the woman asks in English.

“Yes,” Alana says. “Is something wrong?”

“Lalia!” the woman cries. “She is like a little sister. They will not let me in. How can they do this? How is she?”