Page 13 of Outbreak Protocol
Felix's eyes meet mine, and there's a moment of mutual evaluation that feels both professional and oddly personal. I extend my hand, noting his firm grip and the slight calluses that suggest hands-on medical work rather than purely administrative duties.
"Dr. Müller, thank you for your comprehensive documentation. Your clinical observations and epidemiological tracking made our preliminary assessment possible."
"Dr. Lindqvist, I truly appreciate your rapid response. The situation has continued evolving since my last communication—we now have fifty-four confirmed cases with thirty-six deaths."
Thirty-six deaths. The mortality rate has actually increased since his initial reports, suggesting either more severe cases presenting or progression in patients initially classified as stable.
Hartmann's expression darkens. "Dr. Müller, I specifically instructed you to discontinue that alarmist case counting. We have patients with various seasonal ailments, not some exotic outbreak requiring international intervention."
Felix turns toward Hartmann, and I watch his professional restraint battle with obvious frustration. When he speaks, his voice remains controlled but carries an edge that suggests this argument has been ongoing for days.
"Dr. Hartmann, these aren't seasonal ailments. The patients present with hemorrhagic symptoms, neurological complications, and multi-organ failure following a consistent progression pattern. Frau Schmidt died yesterday evening. Herr Becker remains in intensive care with deteriorating kidney function. Friedrich Heinz—"
"Enough. Your dramatic presentations don't change medicalreality, Dr. Müller. I won't have this hospital's reputation damaged by unfounded panic. If you don't cease this alarmist behaviour immediately, I'll personally ensure that your medical licence comes under review for creating public health hysteria. Your career will be over before you even realize what's happening."
Sarah steps forward, her Irish accent adding sharpness to her words. "Perhaps we could examine the case files and laboratory results rather than debating their significance without data."
Felix nods gratefully at Sarah's intervention and opens the folder he's carrying. "I've prepared detailed clinical summaries including symptom progression timelines, laboratory values, and epidemiological connections between cases. The pattern is consistent across all presentations."
He spreads papers across Hartmann's desk despite the administrator's obvious displeasure, and I move closer to review the documentation. The first file shows a meticulous record of symptom onset, progression, and outcome for a fifty-four-year-old woman named Claudia Weber—not the cardiac patient from his earlier report, but someone who developed fever and confusion three days after visiting Café Liebermann.
Initial presentation: high fever (39.8°C), severe headache, photophobia, and nausea. Day two: confusion and agitation with petechial rash on extremities. Day three: epistaxis, gingival bleeding, and altered consciousness. Day four: multi-organ failure and death despite supportive care.
The progression is remarkably consistent with viral hemorrhagic fever, but the epidemiological setting makes that diagnosis highly improbable. European VHFs are essentially nonexistent, and travel histories don't support importation from endemic areas.
"Dr. Müller, what laboratory testing has been performed?"
"Standard viral panels came back negative. Bacterial cultures negative. CSF analysis showed elevated protein and white cell count consistent with viral meningitis, but PCR for commonmeningitis pathogens was negative. We've sent samples to the state laboratory, but results aren't expected for several days."
Yuki looks up from her tablet. "Have you attempted electron microscopy or broader spectrum molecular diagnostics?"
"We don't have those capabilities here. The state laboratory might, but Dr. Hartmann—" Felix glances toward the administrator, then continues carefully, "—felt additional testing wasn't warranted based on current evidence."
Hartmann straightens in his chair. "Expensive specialized testing for what appears to be unfortunate clustering of seasonal illness represents poor resource allocation, especially with budget constraints and the upcoming international trade conference requiring our full attention."
The trade conference. Felix mentioned this yesterday, and now I understand the political pressure underlying Hartmann's resistance. Hamburg's reputation as a major commercial centre depends on international confidence in its infrastructure, including healthcare systems. Acknowledging a potential infectious disease outbreak during a high-profile economic event would create exactly the kind of publicity nightmare administrators fear most.
Aleksandr sets down his equipment bag with deliberate authority. "Dr. Hartmann, we'll need laboratory space, communication facilities, and access to all relevant patient records. Can you arrange appropriate accommodations?"
"I'm not certain that level of cooperation is necessary. Perhaps a brief consultation would suffice—"
"Dr. Hartmann," I interrupt, my voice cutting through his bluster with surgical precision, "we're implementing standard outbreak investigation protocols under Article 9 of EU Regulation 851/2004. This isn't a consultation—it's a mandatory public health response with full legal authority. Your hospital is now under ECDC jurisdiction for infectious disease containment.
"Let me be absolutely clear about your position: you will provide immediate and unrestricted access to all patient records,laboratory facilities, and clinical staff. You will implement any isolation protocols we deem necessary. You will not interfere with our investigation in any capacity.
"Should you choose to obstruct this operation, I will personally ensure that charges are filed against you for endangering public health under international law. Your medical licence, your position, and this hospital's accreditation will all be under review within twenty-four hours. The choice is yours, but this investigation proceeds regardless of your cooperation."
Felix watches this exchange with obvious relief, and I realize how isolated he's been in trying to manage this situation without institutional support. His documentation shows someone working methodically through complex epidemiological challenges while fighting bureaucratic obstruction at every step.
"Dr. Müller, could you show us the clinical areas where patients are being managed? We'll need to assess infection control measures and review cases firsthand."
"Of course. I've prepared a conference room for your use and arranged access to isolation units where current patients are being treated."
As we gather our equipment, Hartmann makes one final attempt to minimize our involvement. "Dr. Lindqvist, I trust your assessment will reflect the reality that Hamburg University Medical Centre maintains excellent standards of care and poses no threat to public health or international commerce."
I don't respond directly, but Sarah's expression suggests she's formulating several pointed observations about institutional priorities versus patient welfare. We follow Felix through corridors that show normal hospital activity—no enhanced precautions, no additional cleaning protocols, no indication that staff have been educated about potential infectious disease risks.
Felix leads us to a small conference room adjacent to the emergency department, where he's assembled additional case files, timeline charts, and epidemiological maps showing case distribution across Hamburg. The organization reflects systematicthinking and attention to detail that validates my initial impression of his competence.
