The Second Angel

I

It was another bright, cold day on the Moon and the atomic clocks were flashing three hundred. Three hundred and twenty-four hours is the length of a lunar-equatorial day, which means that one day on the Moon is worth two full weeks on Earth. Few if any of the people working in Artemis Seven, a penal cave-mining colony, would have agreed with this value. For time passes slowly in a penal colony, especially a hard-labor facility operating in the constant, artificial light of an airtight underground lunar cavern at minus twenty degrees Celsius.

The penal colony was in a cavern under the overhanging lip of a large crater in the Moon’s Carpathian foothills. Ten miles long, two to three hundred yards wide, and almost as high, it held more than three thousand men and women, all of them convicted of a variety of felonies, from simple theft to premeditated murder. The shortest sentence was five years, and the longest, fifteen. There were no lifers in Artemis Seven. Hard time in a lunar colony is considered sufficient punishment for all but the most heinous crimes.

Seen through the dust-covered windows of Artemis Seven, the vibrant Earth’s blue and white sphere contrasted sharply with the lifeless gray surface of the Moon. It seemed almost to have been placed there, like a bunch of purple grapes forever out of reach, to torment those being punished, as in the story of Tantalus — a constant reminder of the full extremity of their exile.

None paid Earth more attention than Cavor, sentenced to a ten-year exile. His life back home had been better than most of those who worked alongside him. When he wasn’t looking at Earth’s bright blue eye and dreaming about his former terrestrial life, he was staring at the flashing green digits of the lunar clock and thinking about his next rest period. Cavor was halfway through his thirteenth eight-hour shift, and had one more shift to work before his next scheduled seventy-two-hour rest period. He was operating a rock crusher, a solar-powered machine that begins the process whereby helium is extracted from Moon rock, when the voracious unit caught the dusty sleeve of Cavor’s thermal coat and pulverized his right arm. One moment he had been looking forward to his rest period and a meal, and the next he was himself being eaten up by the rock crusher. Before another convict managed to turn the machine off and summon help, it had chewed beyond his elbow.[1]

Several convicts carried Cavor from the back of the cavern where he had been working to an electric car which drove him to the infirmary, located close to the colony’s unguarded entrance. Security was relaxed in Artemis Seven, with few restrictions placed on convicts other than the requirement that they work. There wasn’t anyplace any of them could go anyway. The infirmary itself was located on an upper level in one of the honeycomb of caves that led off the main cavern. Its metal floor conducted an electrical field that enabled the infirmary to work in almost normal gravitational conditions, but the walls and ceiling were rock, and this meant that when the air-filtration system broke down, as it often did, everything — equipment, instruments, and patients — became covered in a fine layer of moondust. The area smelled strongly of disinfectant, except when the air-filtration system was working, in which case the various pipes and conduits entering the infirmary merely transferred the air from the dining hall, full of cigarette smoke and entomophagic[2] cooking odors.

In the emergency room, there were two medical personnel on duty, both of them convicts. Raft, the medical officer, helped his nurse, Berger, to cut away the clothing from the badly injured Cavor, and then to lift him onto the flatbed diagnostic scanner. While they waited for Florence,[3] the computer, to begin its clinical examination of Cavor, the two Moon colony medics quickly set about administering a trauma infusion — an admixture of anesthetics, inotropes, antibiotics, glucose, insulin, and sodium bicarbonate — to stabilize his body functions. But even before Florence had started speaking, Raft saw that Cavor’s shapeless arm would have to come off. This was not something he could delegate to Florence. The crude, most physically demanding part of surgery was his. He grimaced, disliking the butchery it entailed. Amputation, the principal mainstay of emergency surgery for centuries, and traditionally used as a desperate and often unsuccessful attempt to preserve life, was, despite vastly improved modern techniques, still a bloody business.

‘Peripheral pulses assessed,’ announced Florence. ‘Transcutaneous Doppler recordings completed. Thermography, radioactive xenon clearance, and transcutaneous potassium levels all checked. Estimated blood loss, two thousand mills and counting. All radiographs and tomograms indicate elective amputation procedure. You should probably obtain the patient’s consent to amputate, if necessary more proximally than you intend.’

‘The patient is unconscious, Florence,’ sighed Raft. ‘I don’t think the patient’s any more likely to give his consent than he is to whistle a happy tune, do you?’

‘If consent is not obtainable, then you should go ahead and amputate the patient’s arm, cutting through the humerus just above the deltoid muscle.’

‘Thanks for the advice,’ grunted Raft.

‘I’m marking the site with the laser, Peter. I also recommend you exsanguinate with a tourniquet as soon as possible.’

‘You’d better fetch six units of RHH,’ he told Berger, as he started to tie Cavor’s upper arm.

Berger, a large, strapping woman wearing the same kind of red overalls as Raft, had just started toward the cryoprecipitation room when Florence stopped her with the clearing of an artificial throat.

‘Ahem. Just a moment please, Helen,’ said the computer. ‘Recombinant human hemoglobin may cause this patient some significant problems. According to his records, he’s not suffering from any extravascular hemolytic disorders.’

‘What’s that?’ Raft frowned. ‘No EHDs? Come on, Florence. You must have made a mistake.’

‘Either that or you’re just bullshitting us,’ snorted Berger. ‘Having a laugh at our expense.’

‘Helen,’ Florence said sternly, ‘you know I’m only programmed for white lies. To protect the sensitivities of terminal patients. It is not within me to lie for my own amusement or personal gain.’

‘No shit,’ said Berger.

‘Would you care to see a biosynthetic profile of his blood group antigens?’ Florence asked calmly.

‘Look, Florence, those records are probably fake,’ suggested Raft. ‘On Earth, people go to considerable lengths to forge their blood tests. For obvious reasons. However, I’m a little surprised to find this kind of thing happening up here. I mean, what’s the point? It’s not like a negative blood test is going to make any difference in a penal colony.’

‘The record is quite genuine, Peter,’ insisted Florence. ‘Let me explain. Sixteen months ago Cavor had a small injury requiring clinical treatment, during which process he deposited a small amount of blood on the scanner. I tested the sample for clinically significant antibodies and found none. Until now, I was obliged to respect that confidentiality.’

‘No P2?’ Raft was amazed. ‘You’ve got to be kidding.’

‘No P2,’ confirmed Florence. ‘Immunohematologically speaking, he’s RES Class One.’[4]

‘Jesus.’

‘Now there’s a novelty,’ said Berger.

Raft glanced at Cavor’s deathly pale face and shook his head wearily. He said, ‘Florence? It’s RHH or nothing for this guy. If there was any other blood component we could use, we’d use it. But there’s no question of using real blood here, even if we had such a thing. You know that. So the bottom line is that he’ll probably die right here on this flatbed scanner if he doesn’t get a transfusion of the usual shit.’

Florence stayed silent as Raft finished applying the tourniquet.

‘I’ll fetch those RHH units,’ said Berger, as she left the emergency room.

‘At least this way, he’ll get to live,’ Raft shrugged. ‘Who knows how much longer? Ten. Maybe even twenty years. Me, I’ve had it for the best part of ten years, with very few ill effects.’

Pushing an infusion computer in front of her, Berger came back through the door in a swirl of gritty moondust. The nurse enjoyed her work. You earned fewer credits than you did crushing rocks all day, but medical work was more interesting, and certainly more satisfying. She set up the machine next to the flatbed scanner, drew out the cannulae assembly, and let it attach itself automatically to Cavor’s good arm. The computer croaked like a large frog as it made its own tourniquet, swabbed Cavor’s skin, and then inserted the infusion needle.

‘I wonder how he escaped getting it for so long?’ mused Raft.

‘Maybe he comes from a rich family,’ suggested Berger.

‘RHH warming to thirty-seven degrees,’ reported the infusion computer. ‘Filtration removing synthetic debris. I’m ready when you are.’

Berger flicked a switch to initiate the infusion process, and the RHH began to snake around the transparent plastic tube entering Cavor’s arm. To look at, the dark red liquid was indistinguishable from healthy human blood.[5] It could keep you alive, but it could also kill you. She stroked Cavor’s forehead for a moment and, adding a note of weary resignation to her smoky voice, said, ‘Sorry, friend.’

‘Sorry my ass,’ said Raft. ‘You can’t feel sorry for a statistical freak. In this place, he was bound to get it. Sooner or later.’

He could feel no sympathy for his patient’s immune system while the more pressing problem of completing the amputation successfully was still before him, and with his scalpel, he divided Cavor’s upper-arm muscles with a raking incision that went right down to the bone. More blood spurted from the incision, spilling onto the floor, and Raft shook his head at the waste of such a precious resource. With a fluid ounce of quality-assured whole blood costing around half as much as gold,[6] he reckoned he was stepping into and out of a pool that was worth several thousand dollars. Probably more.

For the next thirty minutes, Raft carefully followed Florence’s gently worded prompts, severing the narrowest part of Cavor’s humerus with a laser saw that simultaneously ligated all the major blood vessels. When the amputation was complete, he wiped the sweat from his brow and stepped back.

‘With all that healthy blood in him, I’m amazed he’s managed not to get himself killed. There are plenty of bastards in this place who would cheerfully have cut his throat for a complete change of blood.’

Berger removed the severed limb from the flatbed scanner.

‘Me included,’ she said. ‘Only the blood’s no good without the right drugs. And so long as they’re banned from all Moon colonies, what would be the point of killing him?’

Raft nodded. ‘I guess you’re right. But back on Earth I’d have been sorely tempted to drain off a couple of healthy liters before giving him the RHH.’ He shrugged off the thought. ‘I wonder what he did to end up here? Instead of a private jail like the rest of his RES class.’

It was Florence, the computer, who answered him.

‘Prisoner-patient Cavor. Sentenced to ten years’ hard labor on Artemis Seven without benefit of parole for the brutal murder of his wife. She just happened to be the daughter of an important city official. He has already served four years of his sentence.’

‘Well I guess this should help him work his passage back home,’ reflected Raft. ‘There’s not much hard labor you can do with a prosthetic arm. Even the ones they can fit these days take time to build strength.’

‘Are you going to fit it yourself?’ asked Berger.

Raft pulled down the nerves on the stump of Cavor’s arm gently and then shortened them by a couple of centimeters so that they could retract more easily into the depths of the severed flesh.

‘Tried it before and it didn’t take. Good hemostasis is almost impossible with all this lousy dust around. Any hematoma in the stump predisposes to infection, which will only delay prosthetic fitting. No, he’ll have to go to the PD hospital[7] in an open prison back on Earth, and as soon as possible too. The earlier a false limb is applied, the more likely it is that the prosthetic computer will take to the nerve ends.’

‘Prepare to release tourniquet,’ said Florence.

Only when he was satisfied that the stump was adequately supplied with blood did Raft attempt to control the bleeding again; and having doubly ligated the major vessels and applied synthetic flesh foam to the smaller oozing areas, he inserted a suction drain and closed the skin flaps over the bone using synthetic HFM.[8] Finally, Raft smeared the stump with recombinant centrosome to begin the process of helping attract the wound’s protoplasmic granules to the prosthetic, when eventually it was fitted, and then he applied a compression dressing. When the job was complete he surveyed his work with some satisfaction.

‘Not bad,’ he said. ‘A neat job, even though I say so myself. Thanks for your help, Berger.’

Berger laughed dismissively.

‘What about me?’ said Florence.

‘You too, Florence. Goes without saying.’

‘It was a pleasure, Peter,’ Florence said in its cool, quiet voice. Although Raft had never said so, the computer’s honey-sweet voice reminded him of his mother’s.

‘Okay, how about giving me some suggestions for chemical aftercare?’ he inquired.

‘Give me a second to think this over.’

‘Make it snappy, Florence. My back is aching. I’ve been on my feet since two-ninety hours.’

‘Okay, here’s my suggestion. I suggest that you intravenously implant a medical nanomachine[9] containing a combination of prophylactic antibiotic and painkilling actions. For you, I prescribe that you ingest some glucosamine sulfate.’

‘Sounds good to me.’

‘Would you like me to prepare the MN for you, Peter?’

‘Yes, please, Florence.’

Berger was busy washing the remains of Cavor’s arm, prior to preserving it in a sterile polyethylene bag cooled with liquid nitrogen. Despite the badly crushed state of the limb there were areas of skin and flesh that might later be used as a safe biological dressing. Nothing on the Moon is ever wasted, least of all in a prison colony like Artemis Seven. While the Moon has a strong industrial economy worth many billions of dollars, there are no indigenous materials except rock and ice, and so everything is recycled.

Florence prepared the nano-sized machine in a saline solution, which Raft drew up into a hypodermic syringe, and then injected into Cavor’s jugular vein. Raft had hardly looked at Cavor’s face: Now, he saw that Cavor was small and thin, and it seemed almost impossible that he could have survived four years of hard labor. If you had informed Artemis Seven’s medical officer that the one-armed man lying on the flatbed scanner would turn out to play a key role in the commission of the crime of the century,[10] he would almost certainly have assumed that you were suffering from the sensory abnormalities brought about by some small changes in the colony’s artificial atmosphere.[11]

‘Florence? When is the next cargo container to Earth?’

‘There’s one leaving Tranquillity Base this evening.’

‘Can he make that?’

‘Yes. A transport will leave Artemis in one hour with some prisoners who are being paroled.’

‘Lucky bastards. Better book him a place.’

Raft, who had six years of an eight-year stretch to go, ripped off a bloody surgical glove and looked critically at his moist right hand, as if it were all that might separate him from Earth and freedom.

‘Prosthetics are pretty good these days,’ he said thoughtfully. ‘It might just be worth it at that.’

Rameses Gates belted himself tightly down in his seat on the Earth-bound Superconductor,[12] adjusted his seat to the fully reclined position for takeoff, and then drew the neck brace as close around his square chin and cauliflower ears as was comfortable. A three-day, two hundred and thirty-six-thousand-mile flight lay ahead of him, and after that, a short period of detention in an open prison before being released into the so-called community. But first there was the small matter of takeoff. The Superconductor was a lot less comfortable than a rocket, since it created almost unbearable g-forces. Prisoners and animals traveled in a g-compartment that was supposed to be able to withstand 10 g’s, but they still experienced blood pooling, which often caused unconsciousness and, for those in whom the P2 virus was far advanced, sometimes even death. Gates — who was P2 — had, like everyone else he knew, no way of determining just where he was in the life of the virus; but he had heard that even for those who survived the journey, it was common to feel ill for days afterward.

The thought of his impending discomfort, possibly even death, made Gates, like the other dozen men and women waiting to be catapulted back to Earth, irritable and anxious to get started. But there was a delay. A late passenger, the Superconductor computer informed them.

‘What kind of a late passenger?’ demanded Gates. ‘The rest of us have known for weeks we would be traveling today in this goddamn slingshot. Who is it?’

‘It’s got to be another prisoner,’ declared the woman lying alongside Gates. ‘Who else would fly this way?’

The woman’s name was Lenina. Gates had thought her the best-looking woman on Artemis Seven, but he had never had an opportunity to speak to her — until now, when he was feeling too nervous to reply.

‘I have no further information at the present time,’ said the computer. ‘Please be patient.’

‘That’s easy for you to say,’ Gates told the in-flight computer. ‘You’re not about to experience Newton’s Second Law of Motion, with all its delightful physiological side effects.’

‘Have you taken your g-pill yet?’ the computer parried.

The door opened and two prison guards loaded a g-pod[13] bearing Cavor, and then strapped it to the floor. With the exception of the face visor, the pod enclosed the whole of Cavor’s body, concealing the full extent of his injuries. Gates released his neck brace and stretched across Lenina to take a look at Cavor’s face. He didn’t recognize him.

When the doors were closed again, the superconductor coils in the alloy monorail began to build up the electric current that would send them on their way.

Lenina said, ‘They say that if the Superconductor could go slow enough, you could get a great view of TB.[14] So they say. Of course, you’d have to have your head positioned to look out of the window, and there’s not much chance of moving a muscle when we take off. They’ve got a museum of the first Moon landing at TB. You can see the lunar module and the astronauts’ footprints. Or so I’m told.’

‘Ten K,[15] and counting,’ said the computer.

‘Is that a fact?’

‘I’d sure like to come back and see all that for myself.’

‘You would?’ Gates glanced nervously out of the moonlit window.

‘You nervous?’ Lenina shouted over the noise of the current. It was getting louder by the second, like the hum of an enormous and very angry wasp.

‘Thirty K and counting.’

‘Why should I be nervous?’

‘Fifty K and counting.’

‘I thought I heard you say you were going to pray. Would you care to hold my hand?’

‘Transition temperature,’[16] reported the computer. ‘Prepare for takeoff.’

‘Thanks, I don’t mind if I do.’

Gates took hold of Lenina’s hand and found her grip as strong as a robot’s. He glanced at her white knuckles and smiled thinly. She sounded cool enough, but the truth was that she was just as nervous as he was.

His eyes flicked to the injured man in the g-pod on the floor. Something was wrong. The face visor was all misted up, as if no air was circulating within the pod. Gates realized right away what was wrong. The stupid bastards who had placed the man there had forgotten to switch on his air supply. If the pod wasn’t opened and switched on, he would die of suffocation. There was no time to think about it. Gates ripped off the neck brace and unbuckled his seat belts. Once the Superconductor was in motion, the g-forces would be so great there would be no chance of him moving so much as an eye muscle. It was now or never.

‘Are you crazy?’ protested Lenina. ‘You’ll be killed.’

‘Please return immediately to your seat,’ ordered the computer. ‘We will take off in twenty seconds.’

Gates knelt by the g-pod and started to count. He tore open the catches and lifted the pod lid. It was plain to see why he was being sent back to Earth. The man took a deep breath, and to Gates’s surprise smiled up at him.

‘Thanks,’ he croaked.

‘Return to your seat immediately. Ten seconds to takeoff.’

‘Don’t mention it, Lefty.’ Gates switched on the air supply and slammed the pod lid shut again.

‘Sit down please. Five seconds.’

Scrambling back to his seat Gates threw himself down on his back and started to buckle up again.

‘Crazy bastard,’ yelled Lenina.

‘Three, two...’

There was no time for the neck brace. Not even time to finish all the belt buckles. Just enough time to press his head back into the seat and hope for the best. The next moment they were catapulted forward along the ramp. Superconductor trains achieve speeds on Earth of almost three hundred miles per hour. But on the Moon, mass and its gravity do 83 percent less to slow down the body of the Superconductor vehicle. In just a few seconds Gates felt enormous g-forces starting to build as the vehicle’s speed increased until they were traveling at several thousand miles an hour. And as the vehicle was hurled off into space at the end of the ramp, the last thoughts of Rameses Gates before blacking out were of the incredible escape velocity displayed on the Superconductor’s overhead speedometer, the handsome woman lying alongside him, and the passenger with only one arm.

II

It was always a source of fascination, perhaps the original source, imbued in man’s consciousness with mystic, even magical importance. A central totem in all early civilizations, important to classical myth, a fundamental aspect of nearly all religions, it remains a recurring image, arguably the most potent image of all. By Roman Catholics it may be regarded with symbolic reverence; by purified Jews, as something defiling and unclean. It is the very incarnation of kinship, but also denotes murder and feud and, as often as not, atonement. It is blood — crimson, viscid, thicker-than-water, continuously circulating blood: the stuff of epic poems, fetish cult, and great drama. A source of power — now, more than ever — and a libation for the gods, blood is the great tree that lives inside us all. But it is much more than merely a metaphor of life, as even those pioneering medical men and women who made blood their life’s work came to forget. For centuries, blood has been the largest and the most intensively studied organ of the human body. And yet those who studied it — and understood it best as a matter of red cells traveling three hundred miles during their one hundred and twenty days in circulation — did not carry with them that ancient sense of mystery, the knowledge that blood is life itself. Easily sampled, thoughtlessly spilled, life’s blood is both a fluid and a tissue, as red as precious rubies and yet much more valuable.

Strangely, no one treasured it. True, blood was banked, but without any real understanding of the idea, with the term ‘blood bank’ used generically, as a blood center, a hospital-based transfusion service, or some combination of these. It is only now, toward the end of the twenty-first century, that the precious value of blood can be properly appreciated and understood. Well, almost; the cosmological significance of blood continues to elude most people: It is certain that the mathematics of blood, the numbers inherent in its complex structure, provide perhaps the best evidence for the existence of some kind of Creator.

Take something like the process of coagulation, which requires the participation of several hemostatic proteins. As many as fifteen coagulation factors are activated via a stepwise series of reactions — each step having its corresponding regulatory anticoagulant factor — which culminate in the formation of a solid fibrin clot; protection against excessive clot formation, or thrombosis, is afforded by a second series of hemostatic proteins, of which plasmin is the most potent, and which form the fibrinolytic system (in its turn, the fibrinolytic system has its own inhibitors to prevent over activity); plasmin itself needs to be activated from its inactive form — plasminogen — by yet another protein, plasminogen activator. It is hard not to understate the irreducibly complex nature of this system. The ratio of the probability that such a system might come into being by pure chance to the probability that it might not come into being is so enormous that it is almost impossible to find a number large enough to express these odds. However, I think it would approximate to something like the number of red cells that a healthy adult male would produce in a lifetime; given that in one second he produces 2.3 X 10⁶, this number, if represented as a number, would look like this: 70 X 365 X 24 X 60 X 60 X 2.3⁶, or about 5 x 10¹⁵.

As Mephistopheles remarks in making his pact with Faust, blood is a juice of the rarest quality.

To return to the rather more mundane level of blood banking, today it is something very different from how it was originally conceived, when the field was dependent upon one relatively simple and selfless act — a healthy person taking the time to share his or her good health with others by donating a pint of blood. The power of blood and its capacity to rejuvenate a human being is first mentioned by Ovid in his account of the legendary Medea and Aeson, father of Jason.[17] When Jason returns from his labors, he finds his father close to death and is persuaded to help renew his life by giving blood, which Medea mixes into a magic brew and then transfuses into the old man’s veins, with wondrous effect. But history tells us that the first attempted transfusion took place in 1492, when young priests donated their blood in a vain and misguided attempt to prolong the life of the morally worthless Pope Innocent VIII. He died, of course. The succeeding centuries were witness to many other failed attempts to transfuse blood. John Aubrey describes in his Brief Lives how in 1649 Francis Potter, inspired by Ovid, attempted to transfuse the blood of two hens. And in Samuel Pepys’s diary entry for November 21, 1667, he describes the first English attempt to transfuse blood into a human being, done by Richard Lower upon one Arthur Coga. Unfortunately the blood of a young sheep was used — Coga washed in the blood of the lamb, so to speak: Coga survived, although other patients, themselves the subject of earlier experiments in France, were not so fortunate. It was largely as a result of these French experiments[18] during which the patients died, that blood transfusions were not attempted again until the nineteenth century, when doctors even tried to transfuse patients with milk. Needless to say, they all died, too. It was 1901 before Karl Landsteiner described the ABO blood group system that made transfusions theoretically possible, and the latter half of the Great War before transfusions with citrated blood were being carried out successfully, as a routine method of dealing with hemorrhage. Several more decades were to pass before new diluents, anticoagulants, and preservative solutions significantly helped improve the science of blood storage to such an extent that transfusion therapy became almost routine.

No longer.

The present century has seen the world devastated by a fatal pestilence of which blood has been, to borrow a phrase of Edgar Allan Poe’s, the Avatar and seal.[19] The disease — merely the latest in a long line that has plagued the human race since man first started to domesticate animals, an agricultural revolution that occurred some ten thousand years ago — was human parvovirus II, also known as slow HPV2, or simply P2. This is a mutant and slower version of so-called fast HPV1, which was itself a mutant version of a relatively mild virus called B19, whose precise chemical structure was first described[20] almost a century ago, in 1983.

Devastated: It bears repetition. The exact numbers will probably never be known, but it has been conservatively estimated that since 2019, HPV1 and HPV2 have killed as many as five hundred million people, making HPV arguably one of the most successful viruses of all time.

Viruses are man’s only real living competitors for dominion of Earth, for it is increasingly certain that antiviral antibiosis will never be achieved: Sharing the same genetic and metabolic machinery as man, their fate is inextricably bound up with his own. And like all living organisms, viruses have their own taxonomy, which is what biologists call the never-ending classification of their families. In Anna Karenina, Tolstoy wrote that happy families are all alike. At a fundamental level, the same is true of viruses: Each family has the same biological imperatives of survival and reproduction as any human family. Infection is an ancient event, basic to life. Without infection, evolution would have been impossible.

The family Parvoviridae constitutes three genera which between them infect a wide variety of host species — everything from mink to man. The viruses themselves are small, icosahedral organisms with genomes of single-stranded DNA. It is the third genus of Parvoviridae, the autonomous parvoviruses, capable of independent replication provided the host cell is in division, with which we are here concerned. Autonomous parvoviruses are so called because they do not require the presence of a helper virus for replication. B19 was one such autonomous human parvovirus.

For most normal people the consequences of infection, spread from respiratory tract to respiratory tract, were wholly asymptomatic; however, in symptomatic cases the illness caused was mild and similar to other common virus infections in causing fever, rash, and glandular enlargement (indeed it was often mistaken for influenza). Typically, B19 infected the red-cell series, but could also infect the white-cell series and the megakaryocyte series, causing transient, mild lowering of the numbers of red cells (erythrocytes), white cells, and platelets. Hence the virus caused real problems only for those with vulnerable bone marrow, such as people suffering from hemolytic anemia, in which any interruption of the activity of an already overworked marrow could result in an aplastic crisis. Affecting hemoglobin concentration, and causing the disappearance of reticulocytes from peripheral blood and the absence of red blood cell precursors in the bone marrow, this transient event would last from five to seven days, presenting patients with symptoms of acute anemia, namely chronic fatigue, shortness of breath, pallor, lassitude, confusion, and sometimes congestive cardiac failure. Blood transfusion was often required before the bone marrow could recover, reticulocytosis could take place, and hemoglobin concentration could return to normal values. Twentieth-century studies showed that 90 percent of all cases of aplastic crises in patients with chronic hemolytic anemia were due to B19 virus infection. No effective antiviral chemotherapy for B19 infection was ever developed; perhaps, if it had been, things might have been very different.

The avidity with which any virus can cause clinical disease may vary. Like man himself, microbes have proven themselves to be adaptable and inventive, proficient in reproducing and evoking quickly and in adjusting to new hosts and conditions. For example, consider the variation in severity of the various influenza[21] outbreaks over the years. This is a virus which often undergoes major genetic shifts in its surface proteins, thus inflicting a ‘new’ virus on the world at intervals of approximately two years, to which there is little or no immunity in the world population. Such mutations were responsible for a number of flu pandemics, but none more virulent than the Spanish flu of 1918, which, in only six months, killed as many as thirty million people — twice the number that died during the four years of the Great War. This extreme example shows the inherent potential among viruses to change their aggressiveness as the result of spontaneous mutation, although mutations may also occur as the result of outside influences such as chemicals, radiation, bacteria, or even other viruses. The majority of such mutations are corrected rapidly by DNA or RNA-repair enzymes, and do not have the chance to alter the virus activity. Even if not repaired, it is unlikely that the mutations would have an effect on the structure or behavior of the virus in an immediately obvious way. Only one in a million mutations might have a damaging effect on the virus such that it becomes unable to infect cells, or is incorporated in the host cell’s DNA. Conversely, a similar number of mutations might easily result in increased avidity of binding to host cells or more efficient replication of viral products and hence more serious infection and illness. Mutation may also result in a change in the tropism of the virus — in a tendency to attack a cell type not previously affected.

There have been a number of theories as to what caused the relatively benign B19 virus to mutate and become the much more deadly fast HPV1. An increasingly popular theory suggests that an attempt to genetically engineer an antivirus capsid with recombinant DNA technology using a baculovirus system was responsible. Other theories suggest that shortage of blood in Russian hospitals during the early twenty-first century helped encourage their traditional practice of using cadaver blood for infusion, and that B19-infected blood taken from the bodies of people who had been affected by radiation from the Shevchenko[22] disaster of 2011 had mutated to the new form of parvovirus. There has even been the ‘panspermia’ theory, which says B19 met with another virus that had recently arrived from outer space, as detritus from a comet or from a space shuttle. These are only a few of the theories in circulation. What seems certain, however, is that the development of blood substitutes played a significant role in the mutation of B19. Military interest in new battlefield resuscitation solutions that would avoid the logistical problems of whole blood resulted in the creation of a number of products that were reliant on purified bovine hemoglobin, or on bacterial recombinant technology that had used the E. coli organism as a method of expressing human hemoglobin.

Whatever the chain of causation, there can be no argument as to the deadly effect of fast HPV1, which is to eradicate the function of the oxygen-binding site of hemoglobin[23]in otherwise normal people, although there still remains much debate as to how the virus works. Fast HPV1 seems to operate in a choice of three different ways, leading many doctors to believe that fast HPV1 is actually three kinds of parvovirus. These are:

1. the virus causes the defective production of proteins critical for the function of the oxygen-binding site; or

2. the virus turns off the production of such a protein. Oxygen then cannot be transferred by the red cells thus affected; since the lifespan of red cells is one hundred and twenty days, the patient suffocates within this time frame; or

3. codes for the production of blocking polypeptide interact with the active site of oxygen binding.

The second method of operation represents the commonest scenario with fast HPV1. The clinical picture starts slowly with individuals symptom-free for some seven days between the minor febrile period and the appearance of a rubelliform rash; this is followed at four weeks by the sudden onset of symmetrical arthritis affecting the small joints of the hands, followed by wrists, ankles, knees, and elbows; by day sixty patients present symptoms of worsening anemia — fatigue, shortness of breath, cyanosis, confusion; and depending on the general fitness of the patient, fast HPV1 will result in coma and then death by approximately day ninety.

The treatment for fast HPV1 was blood transfusion and the therapeutic use of ProTryptol 14, a specific protease carried in a lipid envelope (or liposome) to prevent premature digestion and targeted at red blood cells. The protease, once released inside the red cell, was designed to act against the mutant protein causing upset at the oxygen-binding site. For many years, however, this formulation was difficult and expensive to produce, and by the time the cost of ProTryptol 14 had come down, the price of whole blood had skyrocketed.

Fast HPV1 was worldwide in distribution and occurred in all populations with the exception of some isolated groups in Brazil and Africa. As with B19, children were the first to be infected, with outbreaks often centered on primary schools, spreading from respiratory tract to respiratory tract. During these first outbreaks, which were always fatal, the parents and teachers of cases also became infected, which led to a second mode of transmission: blood donation. It was the resulting high incidence of virus found in donated units of blood that led to a crisis of confidence in blood donation throughout the Western world, and led also to the widespread creation of autologous blood donation programs. The term ‘bad blood’ has been in use for many centuries, as a way of describing ill-feeling between two people, but never before could this be justified from a physiological viewpoint.

Between 2017 and 2023, fast HPV1 was killing as many as fifty thousand people a day worldwide. Accompanied by a series of natural disasters, from the earthquake that destroyed Tokyo, to the plague of locusts that decimated American agriculture, the Great Middle Eastern War of 2017, and a major eruption of Mount Vesuvius in Italy — not to mention the climatic change that brought a disastrous drought and famine to China — the HPV pandemic was quickly seen by many as a punishment from God. Others blamed the jews, and on the usual tenuous evidence: It had been a Jewish doctor, Benjamin Steinart-Levy, who pioneered ProTryptol 14, which enabled the Goldman Pharmaceutical Company to make billions of dollars during the first months of the pandemic. Pogroms began all over the world, but especially in America; in Los Angeles alone, fourteen thousand Jews were murdered. In New York, when no more bodies could be buried in the city’s cemeteries and parks, Cardinal Martin Walsh blessed the Atlantic so that corpses dumped into the sea would have a consecrated home. Throughout the world, families disintegrated, health-care systems broke under the strain, and countries fell into chaos as governments all but collapsed.

It is impossible to give precise figures, but even the most conservative statisticians have estimated that fast HPV1 resulted in the deaths of as many as one hundred and fifty million people between 2018 and 2025. Many more would have died if it hadn’t been for the fact that another mutation took place sometime during the mid-2020s, when fast HPV1, which killed people within one hundred and twenty days, became slow HPV2, or P2, which took much longer to kill its host.[24] Of course, this was in the virus’s own interest: A virus stays alive only if it creates proteins, usually by hijacking the processes of the host cell. If a virus multiplies without resistance, it kills the host, and if that happens before the virus can find another host, the virus will also die. P2 evolved to take account of this, allowing the host cell to survive for many years (today the victims of P2 can live for as long as ten to fifteen years), remaining latent in the DNA of the host cell nucleus for long periods and reactivating when the host’s defenses are low.

It is hardly surprising that healthy whole blood is now the single most important and the most valuable commodity on Earth, and that societies everywhere should have divided themselves into two unequal parts: a privileged minority who remain uninfected with P2 and are part of an autologous blood donation program (in practice they are coterminous), and an unfortunate majority whose P2 infection permanently defers them from ever becoming part of any predeposit ABO program.

The author has read all of the principal dystopian or anti-utopian[25] novels of the twentieth and early twenty-first centuries and considers the events described here to be as nightmarish as any described by Wells, Huxley, Koestler, Zamyatin, Orwell, Rand, LeGuin, Atwood, Theroux, Amis, Spence, or Saratoga. For all these apocalyptic warnings about the future of human society, it is the author’s view that the world is in an infinitely worse condition today than could ever have been imagined by any of these previous writers. As Lord Byron says, ‘ ’Tis strange — but true; for truth is always strange; / Stranger than fiction.’

The greatest irony is that man passed his day of judgment completely unawares. The nuclear bomb exploded in 1945, and again in 2017, and everything that has happened since has just been fallout. For most people this is old news, and no one is bothered very much. How can you be bothered by something that has already happened, that still exists beyond your control, that defines you? The future — any future, even one of the kind once described in fiction — no longer exists. There is the status quo and not much else. All of which perhaps explains why there is no imperative — social or scientific — to do anything about changing things. Armageddon, Apocalypse, End Time, Holocaust — call it what you will, it’s been and gone and nobody really cares.