Silent Hill fic: Outbreak - Chapter 11: Epidemiological Report (cont.)

[mistressofmuses]

In chapter 11: Anna continues her investigation. The first out of state experts arrive, and violence escalates as a symptom.

Anna Garcia’s Epidemiological report on unknown illness (cont.)

Saturday, September 17, 2016

Official death toll: 27

Additional deaths by the end of the day: Gerald Daniels (age 52), Tyler Stein (age 37), Sherry Colben (age 33), Elise Arnell (age 27), Austin Young (age 25), Colby Wood (age 17), Juliet Mardal (age 9), William Kraft (age 5).

This day represents the highest single-day death toll, as well as the highest number of adult fatalities in a single day.

Three of the fatalities (Colby Wood, Tyler Stein, and Austin Young) were aggressors on September 13, when the seemingly unprovoked wave of assaults swept the town. All three (as well as the fourth attacker from that day) were hospitalized with rapidly escalating physical symptoms on September 15. Their deaths only two days after hospitalization represented an abnormally swift progression.

This was the first time, to my knowledge or to the recollection of any of my sources, that the psychological symptoms were proposed to have a connection to the illness.

The fact that all four of the alleged attackers sickened in a way that had not previously been seen gave rise to the theory that perhaps they had been asymptomatically infected for far longer, and that their paranoia and aggression could have been the first symptoms they showed. To the best of our current knowledge, that is an accurate assessment.

This theory was further supported by the hospitalization on this day of Ethan Price, the man who allegedly killed his wife and two children on September 16.

The staff in charge of the hospital made the very conscious decision not to release this theory to the public, and fortunately this one was not leaked. There was justifiable fear that telling the public that asymptomatic infections were possible, and that violent outbursts were a potential new symptom, could both create panic.

On the other end of the spectrum, two of the victims had been hospitalized for much longer: Officer Gerald Daniels and Elise Arnell. While I do not wish to harp too long on my pet theory, it remains my personal belief that, based on my research, the disease first appeared in late August, with the disappearance of Kyle Ericson and Andrew Flynn. I find it worth noting that Officer Daniels was in charge of the search for the missing men, and Elise Arnell was part of the team that found the abandoned campsite on one of Toluca Lake’s islands. I recognize this is not conclusive proof, but it is at least circumstantial evidence.

In addition to the high death toll, this was the day on which the number of hospitalized patients hit 200. This is a far higher number of patients than Alchemilla was ever equipped to handle at once, but they couldn’t turn them away and deny treatment, as well as risk further infection in the community. Trying to transfer patients to other facilities presented similar issues of increasing spread. While not ideal, this meant that patients in Alchemilla were housed three and four to a room.

Saturday was the first day that experts from out of state arrived to help with managing the outbreak. Apparently the bizarre collection of symptoms and the rising death toll finally captured more official attention. Doctors Thomas Woodhouse and Meredith Escalarre both arrived to lend their expertise, receiving a brief blurb on the Toluca Times website.

[Out of state assistance for the patients in Alchemilla (posted on the Toluca Times website in the late afternoon on September 17.)

by Aaron Green

Two medical experts have arrived in Silent Hill today, both to help with research of the disease that has infected more than 200 of the town’s citizens.

Thomas Woodhouse, MD has arrived from the Centers for Disease Control in Atlanta, Georgia, and Meredith Escalarre, MD has arrived from Johns Hopkins University in Baltimore, Maryland. Both are considered experts in the field of disease transmission, having done work on the prevention of spread for multiple epidemic diseases in the past.

It is hopeful that their expertise working with diseases such as plague, Ebola, and smallpox will allow them to provide some insight into what Alchemilla hospital is dealing with now.

As always, watch the Toluca Times website for updates on the illness.]

Recognizing that sounds more like an unedited press statement than an actual article, I can’t personally say I think they deserved much more. It is absolutely true that Doctors Woodhouse and Escalarre are well-respected researchers in the field of disease transmission, and I do not mean to cast any aspersions upon either of them. However, they are researchers. While both have excellent knowledge of epidemics and the best ways in which to prevent their spread, this is not what the town of Silent Hill was in need of. The doctors and nurses here are perfectly capable of testing for known epidemic illnesses. The problem is that SHIO is not any of those things. Sending experts in things that had already been discarded as possibilities almost seems backhanded.

The CDC should have sent the town an EIS agent—someone from Epidemic Intelligence Service, the so-called “disease detectives”—who are trained specifically in epidemiology and investigating and assisting with public health crises. If this illness does not count as that, I don’t know what does. Of course, if they had done so, then I may not have been sent to Silent Hill a few days later.

[I leave it to my superiors whether they wish to omit those above two paragraphs, should they decide I have strayed too far from the subject of this report. Apologies if that is more editorial opinion than should be included.]

Sunday, September 18, 2016

Official death toll: 31

Fatalities by the end of the day: Beverly Scott (age 19), Thomas Krisell (age 18), Jake Bartle (age 9), Kevin Duncott (age 6).

The fourth of the attackers from September 13 (Beverly Scott) was among the fatalities this day, lending further credence to the theory that the psychological symptoms were connected to infection.

(Other fatalities over the past couple days—Sherry Colben on Saturday and Thomas “Tommy” Krisell this day—were likely infected at Lakeside Amusement Park where they had both been employed.)

Despite my… lack of enthusiasm for the assignment of the Doctors Woodhouse and Escalarre, they did one highly useful thing on their first day assisting at Alchemilla: they ordered a complete quarantine of the hospital.

This was met with mixed reactions, though most health care professionals were strongly in favor. All patients residing at Alchemilla who were not symptomatic for the illness were removed and placed in quarantine at other facilities; Brookhaven Hospital was of especial assistance.

While Brookhaven is also a small hospital, set up primarily to handle inpatient care and long-term psychiatric treatment, it was able to dedicate rooms to Alchemilla’s inpatient population, as well as setting up a ward to serve the typical emergency services required by the town.

After this, Alchemilla was placed under a total quarantine. Negative pressure rooms were set up as “airlocks” of a sort at all exterior doors, with strict protocol in place for who was allowed to enter and exit the building, and when. Doctors, nurses, and others had to submit to decontamination procedures before being allowed to leave. Family visitation was strictly curtailed, and limited to only a few hours out of the day, with similarly strict protocol regarding decontamination prior to exiting the building.

There was an undercurrent of “too little, too late” sentiment, as the disease was clearly already widespread in the community, but personally I support it, even as a somewhat token effort to avoid further spread. Most of the staff at Alchemilla were placated by even the minimal reduction in patients. While it was estimated that only about 10% of their patients were there for reasons other than the illness, that still meant rooms had been freed up to ease the overcrowding, and the reduced visiting hours meant fewer non-patients underfoot.

They did their best to ease public fears, though unfortunately just the word “quarantine” can set off minor panic.

[Local Channel 12 report given by reporter Linda Carlisle, transcribed from recording:

Linda Carlisle, a dark-haired and light-skinned woman, stands in front of Alchemilla Hospital. There is activity behind her, with some construction being done on the entrance to the hospital. [Ed. Note: this is a negative pressure room being built around the existing doorway.] Doctors as well as others continue working, not paying attention to the camera crew. There is little wind, though Mrs. Carlisle is dressed warmly for the chilly morning.

Linda Carlisle: Early this morning, Doctor Meredith Escalarre, one of the doctors who arrived from out of state yesterday, announced that Alchemilla Hospital was being placed under quarantine in an effort to help contain the still-unidentified illness that has swept through Silent Hill in the last couple weeks.

Any patients not suspected of being infected will be moved to Brookhaven Hospital in South Vale, where they will be quarantined as well, to confirm their uninfected status.

This is, according to the doctor, to ensure that all resources at Alchemilla can be turned toward fighting this illness, rather than being divided between this and other patients. It should also assist with the already difficult overcrowding; as hospitalizations have topped 200 patients, many of whom require ICU care, any additional space is beneficial.

As all patients who have been infected have had to remain in the hospital for treatment, there’s been fairly limited travel in and out as it is, but we are told that there will now be extra precautions in place, including mandatory decontamination procedures for anyone leaving the building.

When we asked what those procedures would be, and if that meant they had determined a source of the illness, they declined to answer specifically, telling us instead that the decontamination would be “broad spectrum.”

There is no word on how long the quarantine is set to last, but we can guess it will be in place for quite some time, as the cause and cure for this illness is being determined.

While most have viewed this move as a positive, it has reignited some public concerns, prompting many citizens to ask what took so long, if a quarantine was necessary to limit spread. We will share further developments as they occur.]

While the move towards quarantine went as smoothly as could be expected, there were complications later in the day. No one is entirely certain what, if anything, caused it, but several patients began showing psychological symptoms similar to the ones that had been witnessed days before in the community. This resulted in multiple attacks on fellow patients and nurses.

Some doctors proposed this may have been triggered by the stress of so much movement within the hospital, with patients being removed from the building and others being shifted between rooms to ease overcrowding. Another theory was that this symptom was somehow contagious in and of itself, having been brought into the hospital by the five people who had been arrested before they began to rapidly sicken. I personally find the second one unlikely in absence of more conclusive evidence, or at least some proposed mechanism for the transmission. The former is more plausible; stress can absolutely impact health outcomes.

However, I think it is most likely that psychological symptoms are simply one of the phases of the disease; it presented more dramatically in those who had been previously asymptomatic, but those who had gone through the range of symptoms already also reached a phase that is typified by the paranoia and violent reactions.

Despite the quarantine, patients were still crowded, often three and sometimes four to a room, which made these violent outbursts especially dangerous, because potential targets were tightly grouped, and in many cases nearly incapable of defending themselves. This crowding of people and equipment in small spaces also limited maneuverability for the doctors and nurses who could also become targets.

Most of the events were fortunately contained quickly by nurses and doctors armed with sedatives, or by security, who reacted with sheer physical presence in most cases.

It is almost miraculous that of the dozens of attempted assaults there was only one death, though a tragic one: one nurse was stabbed in the neck by a patient armed with a scalpel.

The patient was Nicholas O’Callaghan, age 19, previously an employee at Lakeside Amusement Park. The victim was Lillian Harris, a 29 year old nurse. Security cameras placed around the hospital show most of the event as well as the time leading up to it. Unfortunately, it took quite some time for Nick’s movement through the hospital to be noticed; perhaps if he had been detected earlier, the conflict with Lillian Harris would never have occurred, much less ended in her death.

[Transcription from security footage, pieced together chronologically from multiple cameras’ video:

The footage is silent, and in greyscale. It is of low to moderate quality.

4:08pm
Nicholas O’Callaghan, a light-haired young man is in his hospital room on the third floor of Alchemilla Hospital, Room 312. He is asleep in the bed, hooked to an IV. He is wrapped in bandages, especially around his joints. A nurse comes in and injects something into his IV. [Ed. Note: Nicholas O’Callaghan was receiving multiple sedatives and painkillers on a regular schedule; the head nurse stated that this was part of the approved regimen.]

4:14pm
Nicholas wakes up and looks around. He seems a bit confused; he looks at the other patients sleeping in the room with him, but does not focus on them for any length of time. He sits up and presses the call button, but then gets up out of bed, dragging his IV stand with him. He stops at the door, convulsing in a coughing fit and spitting something dark onto the floor. After this, he steps into the hall.

4:16pm
Nick walks down the hallway to the bathrooms. His progress is slow, but he arrives there within another minute or two.

4:18pm
[There are no cameras in the bathroom, for reasons of privacy, despite the potential concerns of heightened fall risk and such.]

The hall camera shows nurse Lillian Harris going to room 312 to respond to the call Nick had sent. However, as he is not in the room she returns to the third floor nurses’ station. [This is a break in protocol, though a minor one. It would have been most appropriate for Nurse Harris to attempt to find Nick and verify that he did not need assistance. However, patients were allowed to move to the restrooms unaided, and it was a reasonable (and correct) assumption that he had done so. Considering how thin the staff was spread, she likely decided returning to her station was a better use of her time.]

4:22pm
Nick leaves the bathroom, and looks around the hallway. It is possible he says something—his lips move slightly—but it’s not clear enough to say for sure. He heads toward the nurses’ station on the west side of the floor, but stops at the door that divides the third floor in half. [Practically, this door divides the older western side of the floor from the newer east side that was added when the addition was built, however the old section was renovated to match the new in quality and stability.] The door is not locked, and Lillian Harris could be seen going through it minutes before, but Nick just stops and stairs at it.

Here the video grows fuzzy and grainy for several seconds, due to some kind of malfunction.

When the video is again clear, Nick can be seen throwing something to the ground that looks like a piece of paper, though he wasn’t obviously holding anything before.

The video goes fuzzy again, static obscuring most of the image. It appears he may be speaking, or even yelling, but the image remains unclear.

4:25pm
Nick turns back to the east, heading towards the stairs down to the second floor.

4:27pm
Nick enters the stairwell door.

[There are supposed to be cameras in the stairwells, as this is an area of most concern from a security perspective. However, they were apparently disabled in both the east and west stairwells. It is suspected this may have been done deliberately by some staff members who wanted an area where their actions would not be viewed, though there is of course no proof. This has been reported to the hospital, and will be addressed.]

4:35pm
Nick arrives on the second floor. He looks around, still appearing a bit dazed or confused. He is also clearly in pain. He again walks toward the west side of the floor, this time going through the dividing door to the nurses’ station.

4:38pm
Nick enters the nurses’ station. [He managed to arrive at a moment when none of the nurses were in the room. A patient on the floor had called for help after a fall, and the nurse watching the monitors had left her post to attend to the patient.] Nick attempts to turn a computer off, though without a password he is unable to do so. He picks up a phone, but hangs up without dialing.

4:39pm
Nick pauses in the hallway, and then walks across the hall to Second Floor Operating Room 1. Once again, static obscures the video for a few moments as he opens the door, and then immediately retreats back to the hallway with another coughing fit.

[This is another oversight that has been reported to the hospital: the operating room should have required a key to open. There were no surgeries being prepped for at this time, so no one should have been going in and out of the room at all, making this especially serious.]

4:41pm
Nick returns to the unlocked operating room, and looks around. The expression on his face almost looks sickened, or horrified, though there is nothing in the sterile room to provoke such a reaction. Eventually he reaches for a tray of surgical implements, and picks up a scalpel. [This is just one of many ways a patient gaining access to a room like this is dangerous, though with no surgeries booked, no implements should have been left out in the first place. They certainly wouldn’t be sterile by the time a surgery was taking place.]

4:43pm
Nick leaves the room, still gripping the scalpel, and goes this time to the western stairs, where again, he disappears from the security system’s view.

4:52pm
Nick steps out of the stairwell back into the third floor hallway, initially stepping toward nurses’ station on this floor. Lillian Harris had just stepped out into the hallway, heading toward the dividing door and the bathroom, but hearing the stairwell door slam, she turns around to face Nicholas. Seeing him wandering between floors while carrying a scalpel, she steps toward him, hands up in a placating manner. She says something, though from the angle of the camera it is hard to tell what.

Nick falls backward, and Lillian reaches toward him, her had getting caught on his IV tube, which rips out of his arm. He continues to stumble backward, shoving his IV stand at Lillian. She has to stop to avoid tripping, and Nick flees down the western hallway. Lillian places a call for backup on her radio.

4:54pm
Nick is backed into the end of the hallway in the northwest corner of the floor. Lillian Harris slowly approaches him, hands still up and lips moving, seemingly trying to say something to calm Nick. Very suddenly, he lunges forward, stabbing with the scalpel and catching her in the throat.

This is when the assistance Lillian requested arrives at the other end of the hall, and two more nurses rush toward Nick after seeing Lillian fall in a pool of blood. One, Head Nurse Alma Shorey, had a sedative injection prepared, and stabs it into the top of Nicholas’ shoulder muscle, while she and the other nurse get him to the ground, and Nick loses consciousness.]

This was neither the first nor the last incident of a patient attacking another person in the hospital that day, but it was the most serious, and the only one with such a tragic outcome that could have been prevented at many points.

Nicholas O’Callaghan should not have been able to wander the hospital halls for almost forty minutes before being noticed. The cameras in the stairwells should have been working, and should have alerted someone to his presence. He should never have been able to access an operating room, and there should never have been scalpels (or anything else potentially dangerous) unsecured where a patient could access them. Lillian Harris should have waited for her backup to arrive before trying to approach a clearly disturbed patient on her own.

After this, Alchemilla instituted multiple additional precautionary measures, including strict orders to only approach patients that were out of bed if there were at least two staff members present. Another new precaution, hopefully making the former less needed, was for patients to be confined to their beds by way of restraints when possible. This was not a pleasant new rule, as so many patients were already in pain without restraints putting additional pressure on their skin and limiting their ability to move. It also represented a slight increase in duties for staff, as patients could now no longer go to the restrooms unaided. However, the rule was deemed necessary for everyone’s safety.

Monday, September 19, 2016

Official death toll: 33

Additional deaths by the end of the day: Ethan Price (age 43) and Nicholas O’Callaghan (age 19).

There were a few remarks I overheard even after my arrival that if every day’s fatalities only consisted of murderers like on September 19, then this disease wouldn’t be so bad. I have personally tried not to say anything negative in response to these statements, as I can understand them to a degree; one man kills his family, another kills a nurse in the hospital caring for him. Compared with young children dying, I can well understand these men being considered a more “acceptable” kind of victim. I’ve also been around medical professionals long enough to understand the types of black humor that arise in high pressure situations like this, when compassion fatigue is a real concern.

Despite the dark joking, I do think it worth mentioning that I have seen no evidence that there was anything unnatural about Nicholas O’Callaghan’s death, as has been alleged by his family. From the records I was shown, his death was the result of rapidly worsening symptoms after he was returned to his hospital bed under heavy restraints. I have seen no evidence that he was denied care or was in any way harmed as retaliation for Lillian Harris’ death, despite the natural antipathy other nurses felt for him. While none were likely to mourn his passing, I don’t believe it was intentionally hastened, either.

It has been remarked upon (as I understand, in hushed tones with a generally superstitious “knock on wood” air) that, despite the seemingly high rate of transmission between families, classmates, coworkers, etc., very few of the health care workers tending the patients had gotten sick.

Unfortunately, this string of luck came to an end. Multiple nurses began to show early symptoms, including skin spots, low fevers, and coughs.

Some said that they thought this could be the “real reason” patients had begun attacking nurses: a desire to spread the disease to them. I think this is the result of people seeing too many zombie movies. To the extent of our—admittedly limited—understanding, the illness is passed through airborne droplet pathways as well as fluid transfer and other direct contact. While some of the assaults did include methods of direct fluid transfer (one patient attacked a nurse with a used syringe that had not yet been disposed of, while another patient who was bleeding from the nail beds shoved her fingers into a nurses mouth, among others), the appearance of symptoms within the nursing population was not 1:1 with the victims of those attacks. Once again, this is the unfortunate result of long-term exposure to patients who are all ill with the same highly virulent disease.

Despite the appearance of symptoms among the medical staff, most elected to continue working, some even volunteering to work exclusively with the sickest patients, since they no longer had to fear transmission. For better or worse, as the quarantine was already in place, the newly symptomatic staff members were not allowed to leave, though some had loved ones who came by during visiting hours. Others were glad that at least they didn’t have to worry about inadvertently spreading it to their families.

Unfortunately, the new layer of urgency did not bring with it any corresponding success in determining the identity of the disease. Many of the nurses and doctors were frustrated that the experts they had requested were simply trying to reinvent the wheel, so to speak. They insisted on running new tests for all of the same diseases that had already been ruled out. To the surprise of no one, except perhaps the visiting doctors, these new tests provided the same negative results as they had every other time.

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