“Yet she still wound up on a ventilator?”

“There was a short delay when the working diagnosis was still tuberculosis,” he concedes. “She grew so ill, so rapidly. Like almost nothing I’ve ever seen, Alana.”

“When was the last case of the plague in Italy?”

Nico stops, as does Alana. “Six or seven years ago. Two missionaries from Madagascar brought it to Milan.”

“So how the hell does a construction worker in Genoa catch the plague?”

“Vittoria was in Africa three weeks ago with her family. In Addis Ababa, where her youngest sister married an Ethiopian. There have been recent cases reported in East Africa.”

Alana’s thoughts race. “That’s too long. The incubation period of the plague bacteria is usually two to six days. She should have gotten sick weeks ago.”

“It can take longer. Besides, what other explanation could there be?”

Alana thinks of a few possibilities, but she doesn’t share them. “Nico, this isn’t just the bubonic plague—”

“Of course not. It’s in her lungs. She has the pneumonic plague.”

“And when was the last case of that in Italy?”

“Three . . . maybe four hundred years? Who knows? Perhaps not since medieval times.”

They fall silent for a moment or two until an overhead speaker crackles to life. A voice calls out urgently, repeating the same phrase three times. Alana doesn’t need to know the words to understand their intent.

Nico pivots and breaks into a run. Alana rushes after him, ducking through a set of sliding doors just before they close. Inside, the sign above the desk reads CENTRO DI RIANIMAZIONE, and she immediately recognizes the space as an intensive care unit.

Alarms are blaring. Uniformed staff members cluster outside a glassed-in room in the far corner. A woman is howling somewhere, but Alana can’t spot her among the throng.

Nico weaves through the crowd, Alana close behind. A plump middle-aged woman grabs him by the arm. “Dottore Oliva! Mia Vittoria!” she cries, sputtering rapid-fire words between sobs.

Nico lays an arm consolingly across the woman’s shoulders. Her wailing only intensifies.

Alana darts her eyes toward the room’s window. The scene inside is reminiscent of the worst days of the Ebola crisis. Four staff members are wearing the maximal personal protective equipment, better known as PPE, from hoods with transparent face masks to waterproof booties. They buzz around a woman on a stretcher, their frantic energy palpable through the glass. Even the patient—who is hooked to a web of tubes and wires—is not still. She thrashes on the bed in an uncontrolled seizure.

Nico glances over his shoulder to Alana, his expression as helpless as that of a lifeguard watching a swimmer drown in waters too rough to permit rescue.

The tube leading from the patient’s mouth to the ventilator turns from clear to red, as though it has been suddenly connected to an artery instead of her lungs. “DIC,” Alana mutters to no one in particular, recognizing disseminated intravascular coagulation—the patient’s blood-clotting factors are failing her as badly as her heart.