Alana can’t blame the driver for his reticence. Fear of the unknown is instinctual for humans and, probably, healthy in this instance. She has been following the incessant coverage on TV and online when she can. Dread of the plague has already crawled into public consciousness. Cafés are less crowed. The usually tactile locals are less willing to kiss, hug, or even shake hands. And, in the most telltale sign of all, a number of people wear surgical masks in public—a common sight on the streets of Shanghai but extremely unusual in Italy. Once word of the new surge in cases leaks out, she imagines it will be difficult to find a cabbie who will be willing to venture within a couple miles of the hospital.

The usual media mob gathers out front of the hospital, their nervous energy manifesting itself in their loud chatter and the faint stench of cigarette smoke and body odor. Alana squeezes her way through the throng without responding to their questions.

Security has been heightened. At the entrance, the guard scrutinizes the photo on her ID badge and then runs the card through a scanner. Two young cops with rifles slung over their shoulders and glares fixed to their faces oversee the checkpoint. One of them keeps a hand on the barrel of his weapon as he vigilantly monitors his surroundings. Alana suspects that the local authorities must have already been alerted to the potential of a terrorist threat.

Inside the hospital, the process is equally rigorous. Alana slips into her gown, gloves, and hood in the makeshift change room in the lobby while a plump nurse stands, with arms folded, and watches every step of the process to ensure that there are no breaches in protocol.

As Alana trudges down the corridor toward the ICU, her PPE suit feels more constrictive than ever. Inside the unit, it’s the quiet that disturbs her most. Staff move about purposefully, but no one is talking. It reminds her of Liberia at the height of the Ebola crisis. The hopeless silence in those hospitals was almost tangible, as well.

Byron meets her at the nursing station, holding a sample bag in his gloved hand. Alana gestures to the rooms. “How many of these are plague victims?”

“Six.” He nods to the right. “They’ve separated the unit, as best they could, for infection control. All the patients on this side have the plague, and all the rooms have negative pressure ventilation.” She knows that means that air is being sucked into the potentially contaminated room and blown safely out of the hospital through filtered pipes.

Alana glances through the window into the room beside her. A woman lies motionless on the bed with a ventilator tube fed through her lips. Her face is ashen, and her exposed legs are mottled in a lacy deep purple indicative of severe shock. Two tubes that are each the size of a garden hose and engorged with blood run from her groin to an elaborate machine at the head of the bed. Alana recognizes the device for an ECMO—extracorporeal mechanical oxygenation—apparatus, meaning that the patient’s heart is failing so badly the doctors have had to place her on a heart-lung bypass circuit. Even still, the blood pressure on the monitor above her reads so low it’s barely compatible with life.