A mysterious virus was spreading on campus. Why did it take 18 days to inform the students?

COLLEGE PARK, Md. – It had been six days since Olivia Shea Paregol had come out of the University of Maryland's health center without saying why she was feeling so bad.

Now, the 18-year-old freshman was snuggled against the floor of her dorm at Elkton Hall in College Park, her brown hair resting on the white, hairy carpet. She warned her friends, Sarah Hauk and Riley Whelan, to stay away from a plastic bag where she had been throwing up.

The teenagers raised Olivia and headed for the elevator. Once inside, Olivia leaned against the wall and slid to the floor.

"Do not sit," Riley says. "Come on, it's just a short drive, you can do that."

"I can not literally," said Olivia, the words cutting off her sore throat like knives. "I must go to bed."

Olivia had been ill for most of her first semester in an overcrowded, mildew-infested dormitory. But his symptoms were much more serious than a cough and congestion.

His skin was pale and his dark circles were covered with dark circles. The lymph nodes in his neck had swelled so much that they looked like golf balls. The freshman – who turned nightlife out to the dining room into a breathtaking adventure, sang Miley Cyrus songs on demand and easily turned strangers into friends – was laid on the elevator .

Sarah and Riley tied Olivia's arms and crossed the dormitory hall to get to the cool night of November 8th. They watched Olivia head to a parking lot where her father was waiting in his car. She did not turn to say goodbye.

While Olivia was struggling against her mysterious illness, the University of Maryland was in shock. The widespread molds that followed the fall forced the temporary evacuation of nearly 600 students to Elkton Hall after indignant parents besieged officials at the state's flagship university.

The government was already dealing with a complete scandal over the death of Jordan McNair, a 19-year-old football player who died of heat stroke in June. Sports trainers waited over an hour to call 911 after showing signs of extreme exhaustion. His death uncovered serious problems within the sports department and led to the dismissal of the football coach, the retirement of the president of the university and the resignation of the chairman of the board. administration of the university system.

In November and December, the University of Maryland would become the epicenter of an epidemic of adenovirus that could have symptoms similar to a cold or flu. But some virulent strains can be detrimental to the health of individuals and particularly dangerous for people with weakened immune systems – people like Olivia, who was taking medication for Crohn's disease, a serious digestive system disease.

In these cases, medical experts say, early detection may be the key to the treatment of severe adenovirus.

But the university waited 18 days to inform the community after learning that the virus was present on campus. Officials discussed – but decided against – warn students with compromised immune systems and residents living in Elkton Hall, according to information reported by the Washington Post.

As the days went by, more and more students became ill.

Many parents and students have denounced the treatment of the viral epidemic and mold infestation by the administration, complaining that his actions have endangered thousands of students, students and their families. faculty and staff members on campus. In the end, more than 40 students were afflicted with adenovirus and 15 of them were treated at the hospital, according to the university.

Mold does not cause adenovirus but can set the stage for other health problems. The director of the university health center, in e-mails to administrators, acknowledged that "mold can irritate the airways and increase vulnerability to any viral infection".

In recent statements to the Washington Post, university officials have defended their actions, claiming to have hired a catering company to eliminate mold in September and to advise students on how to prevent the spread of viruses. They said that they went beyond what was legally required to fight the adenovirus epidemic and public health officials said it was not no need to inform the public about the virus. In April, the college hired two outpatients to review the school's response. They discovered that the university followed the policies and procedures.

"The actions we have undertaken are in line with CDC [Centers for Disease Control and Prevention] advice on adenovirus outbreaks and were consistent with the university's strong commitment to the health and safety of our students, "said David McBride, director of the health center.

In early November, the virus spread unobtrusively on campus. Just days after Olivia collapsed in the elevator at Elkton Hall, she was fighting for her life at Johns Hopkins Hospital.

On November 13, his father frantically called the University of Baltimore Intensive Care Unit. When McBride recalled, Olivia's father pleaded for information. What's going on with the mold? Or was there anything else on the campus that made students sick?

– – –

End of August 2018: students move in

Olivia, or Livy Shea, as her family and friends called her, grew up in a small community west of Baltimore and was planning to go to college in South Carolina. She loved beaches and loved country music. She especially wanted a university with a lot of school spirit. She had planned to study criminology, inspired by the TV show "CSI".

During her last year of high school, Olivia was diagnosed with Crohn's disease, an incurable disease. She started a treatment at Hopkins that weakened her immune system. In college, she injected Humira every two weeks, an anti-inflammatory drug. Olivia's parents, Ian and Meg Paregol, wanted their daughter, the baby of the family, to stay close to home.

When Olivia was accepted to the University of Maryland, all the boxes were checked and there was only one hour left. After learning that room 3152 had been awarded to Olivia Hall, Olivia felt lucky to have landed in an air-conditioned dormitory.

On August 24, Olivia's family stuffed two cars with dormitory equipment and headed to College Park. She had coordinated the colors with her roommate, Megan Sassaman, 18, and had bought a cream-colored tapestry with a world map to hang in their dormitory on the third floor. Olivia's parents slipped handwritten notes of encouragement into the drawer of her dresser before saying goodbye.

Elkton Hall, an eight-story red brick dormitory located in the shadow of the university's football stadium, was overflowing with students. Built in 1966, it had been designed to accommodate around 530 students, but nearly 570 of them were forced to enter the building due to a large first year class.

The study rooms had been converted into dormitories for four students and some rooms for two residents housed three. Students crowded the narrow corridors and shared bathrooms on each floor. They waited endlessly for the elevators because one of the three was still down.

– – –

Mid-September: mold problems arise

It was one of the most sogging summers in the history of Maryland. By the end of September, more than 50 inches of precipitation had fallen. In the end, 2018 would become the wettest year ever recorded in the region.

The Olivia room looked like a swamp, so wet that bath towels never dried. The air conditioning in his room stopped working during the first week of September and had to be repaired several times. In mid-September, Olivia and her roommate, Megan, had a persistent cough and it seemed harder to breathe than usual.

A pungent odor was perceptible and it was impossible to ignore each time Riley and Sarah, 18-year-old freshmen who lived together on the eighth floor, were visiting Olivia's room.

The mold had surfaced earlier this summer at Elkton Hall and in other dormitories on the campus. University officials have been dispatching maintenance staff to eliminate visible mold before students arrive in August, according to employees interviewed by the Washington Post. With moisture and overpopulation, the mold was quickly restored.

He began to invade Elkton – on blinds, under beds, in sneakers and all over the cooling units. On September 18th, a resident assistant sent a message to students on Olivia's floor asking them to check if their room was dirty: "The best way to see her is in the dark at the school. 39; help from a flashlight … It will probably look blurry and green. "

"We had mold," Olivia wrote to Riley later in the day.

"How bad it is," Riley asked.

"Look under the drawers of your dresser," Olivia replied. "It's there that we have it."

The campus again sent housekeeping staff who said they were not trained in demolding or proper protective equipment to clean the desks and chairs with an all-purpose disinfectant. The workers were suffering from sore throats, irritating eyes and headaches. Some called the sick and visited the health center.

After Megan's mother complained, the staff replaced their dressers, blinds and desks. But the mold returned to parts through Elkton. Housing officials hastily convened a meeting on September 21 to discuss the situation at Elkton Hall when the parents went to campus on Friday for the family's weekend.

"You have a sick building with 600 children," said a mother to university officials at the meeting. The students cried to be sick.

McBride, 50, handed out business cards and asked about two dozen parents and students present to call the health center if they had any concerns.

He began his career as a doctor at a community health center outside Boston. It's there that he learned the importance of building relationships with people outside the clinical setting. McBride then headed the student health services at Boston University before arriving at the University of Maryland in 2014.

During the meeting in Elkton, housing officials insisted that they were only aware of the latest mold outbreak in recent days and were partly responsible for the exceptionally wet weather.

A few hours after the meeting, the administrators announced that they would take students out of the dormitory in the next few weeks and that they would pay for their accommodations in local hotels. They would hire an outside specialist to clean the mold and an engineer to examine the underlying cause.

This report finds that at Elkton Hall, the humidity level was "of longstanding concern". The cooling systems installed in 2011 were not designed to remove moisture from the air and allowed the humidity to rise, thus making the building vulnerable to mold, has indicated the report.

According to workers, campus mold outbreaks were not new or limited to Elkton. articles in the Diamondback, the student newspaper; and documents reviewed by the Washington Post. Records show that since 2017, molds have been reported in College Park's 38 university residences.

In recent years, other colleges have been facing outbreaks of mold. In October, the University of Tennessee closed a dormitory housing about 600 students for the rest of the year. Last fall, Montclair State University in New Jersey tested mold spore levels before and after remediation, although there were no federal or state requirements.

The University of Maryland, where tuition, housing and other costs are about $ 25,000, has taken a different approach. He would alternate students floor by floor during the remediation work, starting with the summit of Elkton, where residents complained more about mold. And, on the recommendation of the campus environmental safety team, the college announced its decision not to test the type of mold, noting that the Environmental Protection Agency had said such tests were useless.

– – –

End of September: students move

Riley and Sarah, who were battling coughs and congestion, moved on September 23rd to the nearby Cambria Hotel, along with other eighth floor residents. Contractors in protective suits and masks began cleaning work in Elkton.

A health and safety specialist who inspected Elkton on behalf of the campus union, said the condition of the building was so bad that it appeared filled with floodwater.

Workers placed dehumidifiers in the corridors of the building. On Olivia's floor, a tube drained water from a dehumidifier into a fountain. Olivia and her roommate, Megan, were not to relocate for 10 days.

Olivia, meanwhile, did not stop coughing.

On Monday, Megan went to the Student Health Center, a red brick building in the heart of the campus, for the second time this month. Megan said that during a respiratory test, a medical assistant had asked if she was doing enough work because her oxygen level had dropped.

Megan's complaint is in an email addressed to university officials the way she had been treated. "[It] Megan wrote on September 25 to the University of Maryland president, Wallace Loh, among others. She mentioned Olivia's illness and said, "I continue to live in an unhealthy environment.The lack of communication and the lack of recognition of the issue sadden me and make me think that the University would place a very low priority on student health. "

After more than a week of relentless cough, Olivia now had sore throat and chest congestion. On September 26, she also visited the student health center at the request of her parents. There, a doctor diagnosed him with an undetermined viral infection of the upper respiratory tract, a cough and an "exposure to mold", according to his medical record. He was prescribed antitussive and nasal saline spray.

In an effort to understand the effects of the mold infestation, health center staff, on McBride's instructions, had begun to note where the students who were being treated were living and if their respiratory symptoms were noticeable. aggravated inside the dormitories.

After the announcement of the removal plan on Sept. 21, Megan's parents, Kim and Kevin Sassaman, sent emails to high-level university officials asking them why they could not be transferred sooner. in a hotel, because of their poor health. With the approval of a housing official, the two students moved into Cambria on September 26th. The roommates stocked up on beauty masks and snacks for their improvised dormitory.

Two days after arriving at the hotel, McBride, the director of the health center, wrote to Olivia that a doctor was there. "Let me know that you do not feel well and that mold may be a factor. I know you have to move for cleaning in early October. Do you want me to advocate for a faster move to another location on campus until the end of cleaning? "

Olivia replied, "My roommate had already moved us, thank you for contacting me, but I am already in a hotel at the moment."

After 11 days at the hotel, Olivia and Megan returned to Elkton Hall, where remediation work was being completed.

– – –

In early October: health center overwhelmed

Parents are increasingly using social media to evacuate campus conditions. On October 8, they started complaining on Facebook that their children had been misdiagnosed at the health center, that they had undetermined viruses or that they could not even get an appointment.

In an interview, Angela Hayes said that her son, a freshman who lived in Easton Hall, had repeatedly asked for help for sore throats and high temperatures. The health center staff told him that he had a virus. When he did not improve, she said, he went to an emergency center nearby, where he was diagnosed with acute tonsillitis and antibiotics.

"It was almost like a factory," Hayes said of the university medical center. "They would say to the students:" You're fine, you're fine. " "

McBride told The Washington Post in October that he had noticed an increase in fever-related illnesses that were not the flu. In early November, it planned a meeting of the Campus Infectious Disease Management Committee, a group that assesses threats to health.

In mid-October, 18-year-old Debbra Aiello's son, residing in La Plata Hall, called her home, in New Jersey, to complain of a headache, from a sore throat and a high fever. She went to College Park and brought her back to a pediatric emergency room in New Jersey. He had a fever of 104 degrees and after a battery of tests, the doctors determined that he had an otitis and adenovirus.

Aiello said she had never heard of the adenovirus and that she did not know that it could make a healthy teen seriously ill. It took him almost a week to recover at home.

When his father took him back to College Park, the son became ill again and then went to the health center.

But there was a wait of two hours. They left the campus and drove to an emergency care facility. If the health center had been able to care for the student, the university might have learned much earlier about the dangerous virus that was making its way through the campus.

– – –

Late October: another controversy

In the middle of the fall semester, the death of Jordan McNair was still in the news.

At the end of October, the board of directors of the University of Maryland met in camera to discuss an open investigation following his death. who had revealed bad management of the sports department. In May 2018, Jordan was hyperventilated and complained of cramps, but sports coaches waited about an hour before asking for emergency help. He had a liver transplant before dying in June.

"You told us Jordan and he will never go home again," said President Loh to the McNair family.

The case has led to a review of university accreditation, which could threaten federal funding of the school.

On October 30, the Board of Regents recommended his football coach, DJ Durkin, to retain his position, which has been widely criticized, including Maryland Governor Larry Hogan, a Republican. The next day, the university reversed its course and dismissed Durkin. The president of the council of regents also resign in the storm.

As it unfolded, Olivia languished. She retired early from a Halloween party, where she was dressed as one of three blind mice. She had painted her glasses black, dark enough to cover her puffy eyes, and told her friends that it hurt her to talk.

"I can not swallow my own brooch," Olivia wrote to Sarah on Oct. 31, "and my neck is so lumpy because my lymph nodes are so swollen."

That day, she went to her family doctor, where a pediatric nurse practitioner tested her for streptococcus but did not find one. Two days later, on November 2, when her symptoms worsened, Olivia's father urged her to go to the campus health center. There, she complained to a doctor of having fever, fatigue and a sore throat, and mentioned that a friend was mono. The doctor prescribed a mono test, but Olivia did not have time to wait at the lab.

That night, she was heading for a birthday for her sister. At dinner, Olivia muttered between coughs that she was sure to have mono. Her father worried about her weakened immune system and was determined to bring her home from school. To her surprise, she did not object.

Olivia quickly retired to her childhood room. Over the weekend, she complained of chills and took hot showers to calm her shaking body.

"Are you coming back today?" Riley texted him on the afternoon of November 4th, a Sunday.

Olivia replied that she did not know.

"My fever will not break," she wrote.

– – –

Early November: virus detected on campus

The first university warning on adenovirus among students occurred the day before Olivia's visit to the health center on Nov. 2. McBride received an email from a medical doctor at the University of Maryland Medical Center in Baltimore, who told him about a College Park student who had been hospitalized and whose test for virus was positive.

"I thought it was better for you to know if there were more," wrote the doctor, James Campbell.

In a phone call followed that day, Campbell informed McBride that the student had been admitted with high fever and pneumonia, according to recordings and interviews, and was suffering from an "unusual presentation" of 39; adenovirus.

The virus was in the news: it had been associated with the death of children whose immune system was weakened and who lived in a long-term care facility in New Jersey. The epidemic finally killed 11 children and sickened more than two dozen.

Some strains can seriously affect healthy adults. The army has had several deadly outbreaks in barracks. A vaccine is available for military personnel but has not been approved for the general public.

Shortly after the phone call with Campbell, McBride learned that a student who had been seen at the health center with a fever and respiratory problems had been admitted to Washington's Adventist Hospital in Maryland , according to interviews and recordings. McBride suspects that there is a second case of adenovirus and asks the hospital to do a test.

On November 7, McBride convened the campus Infectious Disease Management Committee meeting, which included about a dozen student affairs, sports, communications, housing and other officers. They discussed updating the campus plan in the event of an outbreak. McBride told them about the increasing number of diseases associated with fever on campus and several cases of hand-foot-mouth-mouth disease, which causes a mild rash and sores in the mouth.

McBride, however, has not informed the committee of the confirmed case of adenovirus or the second suspected case, according to the minutes. When asked why he had not mentioned the adenovirus, McBride told the Washington Post that it was "not a reportable disease now … we were more focused on what we knew at the time" .

Unlike other infectious diseases, adenovirus is not subject to federal or national mandatory reporting requirements. Doctors and hospitals are not required to alert health officials or the public when the virus is discovered.

Two days later, on November 9, Andrew Catanzaro, a doctor at Adventist in Washington, followed McBride and informed him by e-mail that he feared that "others would come to the hospital very sick." … maybe you have an epidemic of adenovirus on campus. "

That day, the campus health center began testing the adenovirus. The nasal swab used to detect the adenovirus is much more expensive than a test for influenza virus or strep throat, and it's not available in many primary care clinics and emergency care.

On Friday night, McBride sent an email to the entire campus about flu prevention techniques and viruses, such as hand washing, and reported several cases of foot-and-mouth disease. He made no mention of the adenovirus.

"This is not a cause for concern," he wrote in bold, "but this gives us the opportunity to put into practice effective prevention techniques for these types of diseases. "

At that time, Olivia had been out of school and home for a week, with the exception of a brief visit to Elkton to take her meds. She kept Sarah and Riley informed, sending a text message "I just vomited blood."

Elle est retournée chez son infirmière praticienne en pédiatrie le 5 novembre. Le lendemain, ses parents l'ont emmenée à l'urgence de l'Hôpital général du comté de Howard, où les médecins l'ont traitée comme si elle souffrait d'une pneumonie bactérienne et l'ont renvoyée chez elle avec des antibiotiques.

Mais les médicaments ne fonctionnaient pas et sa poitrine a commencé à lui faire mal quand elle a toussé.

Trois jours plus tard, les parents d'Olivia l'ont ramenée à l'hôpital du comté de Howard. Elle a été admise et testée pour la grippe, le virus respiratoire syncytial (VRS), l'hépatite et les infections bactériennes du sang, ont révélé des dossiers. Tous sont revenus négatifs. Mais les médecins n'ont pas testé l'adénovirus.

Ils savaient qu'elle souffrait d'une pneumonie, mais on ne savait pas très bien ce qui l'avait provoquée et pourquoi elle ne s'améliorait pas. Ils ont continué à la traiter avec des antibiotiques.

Les responsables de l'hôpital du comté de Howard ont par la suite refusé de répondre aux questions sur les raisons pour lesquelles ils n'avaient pas testé Olivia pour l'adénovirus.

Ian et Meg Paregol ont échangé leurs nuits de sommeil sur un petit canapé à côté du lit d'hôpital d'Olivia. Ian, un avocat représentant les clients handicapés, avait appris à défendre les intérêts des patients dans des conditions difficiles. Il a à peine dormi alors qu'il voyait le niveau d'oxygène de sa fille chuter bien en dessous de la normale samedi soir.

Le poumon gauche d'Olivia se remplissait de liquide.

– – –

Mi-novembre: 10 jours depuis la détection du virus

Le 11 novembre, alors que son état s'aggravait, Olivia a été transférée dans l'unité de soins intensifs. Les médecins ont suggéré de lui piquer le dos avec une aiguille pour aider à drainer le liquide de ses poumons.

Olivia, qui avait du mal à parler, demanda: "Est-ce que ça va faire mal?"

Soudain, ses yeux se révulsèrent et elle subit une crise d'épilepsie, se cognant contre le lit. Le personnel médical s'est précipité à l'intérieur et Ian, craignant de mourir, s'est précipité de son lit au couloir. Il tomba à genoux et commença à prier. Les médecins ont intubé Olivia et administré des sédatifs.

Cette nuit-là, les médecins du comté de Howard envisageaient de la transporter par avion à Johns Hopkins à Baltimore, où elle pourrait subir un traitement de Hail Mary: l'appareil d'oxygénation à membrane extracorporelle ou ECMO. Des tubes circulent et oxygènent le sang du patient à l'extérieur du corps, donnant ainsi au cœur et aux poumons une chance de récupérer.

Ian et Meg ont conduit à Hopkins. Ils ont pris l'ascenseur pour se rendre à l'un des étages supérieurs de l'hôpital et se sont approchés de la fenêtre. Là, ils ont regardé dans le ciel nocturne et ont attendu les lumières clignotantes et les pales vrombissantes de l'hélicoptère de leur fille.

De retour sur le campus, les textos de Sarah à Olivia sont restés sans réponse.

"D'accord, tu me fais peur", a écrit Sarah. "Je veux juste savoir si tu vas bien / rentrer à la maison demain."

La colocataire d'Olivia, Megan, était trop malade pour quitter leur dortoir. Megan avait tenté d'obtenir un rendez-vous au centre de santé du campus, mais rien n'était disponible.

Sure. Le 12 novembre, la mère de Megan, Kim Sassaman, a écrit à Loh et à McBride au sujet de la maladie de sa fille pour lui demander s'il restait de la moisissure dans le dortoir. Elle a demandé une "divulgation complète" de ce qui rendait sa fille et d'autres étudiants malades.

"Sa maladie constante n'est pas un cas isolé à Elkton", a écrit Sassaman. Elle a fait allusion à Olivia, affirmant que la colocataire de Megan avait été hospitalisée pour une pneumonie et qu'un autre étudiant – leur ami Humza Mohiuddin, âgé de 18 ans – avait été hospitalisé pour des problèmes respiratoires.

McBride a répondu rapidement et échangé des courriels avec la mère de Megan. "Nous avons découvert plusieurs cas d'une souche particulièrement méchante d'adénovirus (un virus du rhume typique)", a écrit McBride dans un message. "Si Megan n’a pas fait l’objet d’un test de dépistage, nous pouvons procéder à un écouvillonnage à la CHU ou demander à son aidant actuel de le faire."

À ce moment-là, le ministère de la Santé de l'État était au courant de l'épidémie. Le 12 novembre, Catanzaro, médecin spécialiste des maladies infectieuses chez un adventiste à Washington, a alerté l’État au sujet de deux étudiants séropositifs pour l’adénovirus. Le lendemain, McBride a appris qu'un élève testé au centre de santé était également positif pour l'adénovirus.

À Hopkins, les médecins ont commencé le traitement à l'ECMO pour Olivia et ont ordonné des dizaines de tests, notamment un dépistage des virus respiratoires pouvant détecter l'adénovirus.

Après qu'Olivia n'ait montré aucune amélioration le 13 novembre, Ian, pris de panique, a appelé l'université.

Lorsque McBride a retourné l'appel plus tard dans la journée, Ian l'a insisté au sujet de sa maladie et de son lien avec la moisissure.

"J'ai besoin de réponses," plaida le père d'Olivia. "J'ai besoin de savoir ce qui se passe car elle ne devrait pas être aussi malade."

"Nous avons eu quelques cas d'adénovirus apparus", a répondu McBride, selon Ian. Il a dit avoir dit à McBride d'appeler immédiatement Hopkins pour lui dire ce qu'il savait.

Plus tard dans l'après-midi, McBride a laissé un message vocal à Ian, affirmant qu'il s'était entretenu avec le personnel médical de Hopkins: "Le service de santé de l'État intervient également. Nous pouvons donc essayer d'empêcher la propagation du virus appelé adénovirus, qui est en réalité virus du rhume assez commun. Mais de temps en temps, il provoque une maladie plus grave. Nous pensons donc que c'est ce que cela pourrait être. "

Soudainement, Ian réalisa avec une certaine inquiétude: depuis une semaine, les médecins lui avaient administré un cocktail d'antibiotiques, qui ne serait efficace que si une infection bactérienne était la cause sous-jacente.

Mais le véritable coupable était un virus.

Bien que de nombreuses personnes guérissent elles-mêmes d'un adénovirus, les médicaments antiviraux, tels que le cidofovir, peuvent aider les patients immunodéprimés présentant des cas graves, tels qu'Olivia. Le médicament comporte des risques importants, y compris une insuffisance rénale, et n'a pas été étudié dans des essais à grande échelle pour le traitement de l'adénovirus.

"Vous voulez commencer avant que le patient ne devienne trop malade", a déclaré Ivan Gonzalez, médecin à l'Université de Miami, qui a étudié l'utilisation du cidofovir chez les patients atteints d'adénovirus dont le système immunitaire est compromis.

Dans le cas d'Olivia, les médecins n'ont pas attendu. Le 13 novembre, quelques heures après que les tests eurent confirmé son adénovirus, ils commencèrent à administrer du cidofovir.

Dans l'après-midi, Linda Clement, vice-présidente des affaires étudiantes, écrivait à Loh: "Nous avons trois cas d'adéno … il est probable [Prince George’s County] déclarera une «épidémie». "

– – –

Mi-novembre: 13 jours depuis la détection du virus

Environ deux semaines s'étaient écoulées depuis que McBride eut connaissance du premier cas d'adénovirus sur le campus. Le nombre officieux d'élèves atteints du virus était d'au moins cinq, dont trois nécessitaient une hospitalisation. Il y en avait probablement beaucoup d'autres qui n'avaient pas été diagnostiqués. L'université du Maryland était en train de guérir l'une des premières épidémies d'adénovirus sur son campus universitaire.

Pourtant, il n'y avait pas d'annonce.

Le 14 novembre, McBride a envoyé un courrier électronique à Richard Brooks, un employé du CDC affecté au département de la santé de l'État, et lui a partagé le courrier électronique de l'université sur la prévention du virus envoyé le 9 novembre. McBride a interrogé Brooks, qui travaille avec des représentants de l'État sur les épidémies. , if the CDC wanted the university to do more "adeno specific communication" with people on campus.

Later that day, Brooks responded by email: "Based on our conversation with CDC, we don't think additional, more specific messaging about adenovirus is necessary at this point in time."

On Nov. 15, McBride gathered the infectious disease committee — this time to talk about the growing number of adenovirus cases. The university's plan for responding to low-level health threats states that officials should be "providing information to the community about the infection in question, increasing prevention measures in resident halls/dining halls/public locations."

The group suggested conferring with Katie Lawson, the university's chief communications officer, about sending a message to students who had compromised immune systems and to residents of Elkton Hall given "heightened sensitivity" over the mold, according to minutes of the meeting.

No message was sent that day alerting students, but McBride warned his counterparts at Georgetown, George Washington, American, Howard, Towson and other regional colleges. In an email, he told them about a "cluster" of adenovirus cases, noting that three students had been hospitalized, including one in "very serious condition."

"Please keep your eye out for this on your campuses," he wrote on Nov. 15.

— — —

Mid-November: 15 days since virus detected

At Hopkins, additional tests soon revealed that Olivia had adenovirus 7, a virulent strain responsible for the deaths of children in New Jersey.

When Angela Crankfield-Edmond, a health official with Prince George's County, learned on Nov. 16 that preliminary results showed Olivia had the pernicious strain of adenovirus, she wrote to McBride, "Please do not tell anyone until we get the final result."

Crankfield-Edmond later said the state instructed her not to make anything public until final results were available.

Hopkins physicians continued to give Olivia cidofovir and also began a blood treatment designed to boost her immunity.

But it made no difference.

Fluid rapidly accumulated in her once slender 130-pound body. By Nov. 16, she had swollen to 232 pounds. Her blood pressure plummeted. Her kidneys and liver were failing.

Glenn Whitman — an ICU physician at Hopkins — gathered Olivia's family in a conference room to explain the best chance to save her life.

An open abdominal surgery could release fluid and pressure. An adhesive film would temporarily hold Olivia's organs in place. If she survived, she could face up to a year of recovery in a hospital bed.

Ian and Meg asked him: What would he do?

Whitman broke down into tears. He had children as well, he told them. And he would do everything to save the Paregols' daughter, just as if she were his own.

On Facebook, Ian asked family and friends to pray as Olivia underwent surgery on Saturday, Nov. 17.

The pulse within her feet had become faint. Now doctors were struggling to pick up a pulse in her legs. Amputation was a possible last resort.

Ian and Meg tried to channel Olivia's mindset. At what cost would she be willing to live?

"Ultimately what we really need is a miracle," Ian posted on Facebook.

Early Sunday morning, on Nov. 18, the Paregol family made the 45-minute drive home from Hopkins to shower and change clothes. A nurse called with grim instructions: Come back as soon as possible.

With permission from Ian and Meg, doctors stopped giving Olivia blood pressure medication. They warned that she could die within minutes.

Country music — Olivia's favorite — played in the room as her parents and two siblings, Zoe and Evan, took turns by the teenager's bedside. They remembered the vacation to Turks and Caicos and trips in the family Prius with Olivia crammed in the middle seat between her brother and sister.

One by one they held her hand for hours that Sunday afternoon and told her how much they loved her.

At 10:15 p.m. on Nov. 18, Olivia Shea Paregol was pronounced dead.

Doctors listed three causes of death: organ failure, acute respiratory distress syndrome and adenovirus.

— — —

Late November: Defending the response

Early the next morning, McBride wrote to Brooks, the CDC employee working with state health officials, saying he had an unconfirmed report that Olivia had died. Given that she had adenovirus 7, he wondered if they should go public.

"We've discussed internally here, and we don't feel that this changes our plans to do any messaging," Brooks responded an hour later. "To be clear, we are not recommending that you NOT put out any additional communications (i.e. if you feel the need to send any additional messaging, we are fine with that). We just aren't recommending that you need to do so."

After reaching out to the state, McBride faxed the result of Megan's test at the campus health center to her family doctor — she also had adenovirus.

Around 2:30 p.m. that day, Nov. 19, McBride sent out a campuswide email that for the first time publicly acknowledged adenovirus, saying that there were six confirmed cases over the past two weeks. The next day, he revealed in another email to the campus that the virus had killed an unnamed student — Olivia — and urged others to take the virus seriously.

McBride privately expressed concern that an upcoming news article in The Baltimore Sun about the adenovirus outbreak might suggest that the University of Maryland "should have done more," he wrote in an email to Crankfield-Edmond, the Prince George's County health official.

"There was nothing else you could have done," responded Crankfield-Edmond, who days earlier had told McBride to remain silent. "It's a cold virus that is in the community."

The next day, on Nov. 21, McBride appeared on a local television segment and defended the university's response to the adenovirus outbreak.

"While we want to acknowledge that there are cases on campus, we don't necessarily want to stir up unnecessary angst," McBride said in the interview.

The Paregol family spent Thanksgiving planning a funeral. Two days later, on a rainy Saturday, the ground so wet that heels sunk into the mud, Olivia's family and friends gathered at the Good Shepherd Cemetery in Ellicott City, Maryland.

Olivia's longtime pediatrician, Jacqueline Brown, attended the service. Brown kept revisiting the early days of November, when Olivia had come into her office, ailing without an apparent cause. Brown said she would have recommended an adenovirus test if she had known that the virus was circulating among Maryland students.

"If we were looking for it sooner, then maybe the treatment might have worked," Brown told The Washington Post. "I think by the time that that's what we realized, she was already very sick. And I'm not sure that it started in time to have made a difference."

The following Monday, McBride publicly announced that there were three more cases of adenovirus.

On Nov. 28, four days after burying Olivia, her father wrote to McBride, accusing the university of a "pattern of indifference" and questioning the failure to alert Olivia about adenovirus.

"The information could have saved her life and a proper course of treatment could have been identified well before we were told about Adenovirus on 11/13," he wrote, referencing his phone call that day with McBride. Ian told McBride that had physicians known what to look for, the antiviral treatment "could have been initiated long before she became critically ill."

The Paregols wanted to sit face-to-face with the university president and try to understand why their daughter was dead. Two teenagers within six months had lost their lives. Ian and Meg wondered: Had the school learned nothing from Jordan McNair?

In early December, the Paregols gathered around a coffee table in the president's office. Ian sat across from Loh, and Meg faced Clement, McBride's supervisor. By then, the University of Maryland had disclosed that adenovirus had sickened at least 30 students.

"My condolences to your family," Loh said. "This is such a terrible loss."

After an uncomfortable silence, Ian began peppering Loh with questions.

Ian wanted Loh to understand the connection he saw between the mold infestation and the adenovirus outbreak. Ian said he knew that mold did not cause the virus, but the mold had made Olivia sick all semester. That made her more susceptible to other respiratory infections, such as adenovirus, he said. Her system was already compromised from her Crohn's medication.

Ian asked Loh who had made the decision to stay quiet about adenovirus since it was discovered on Nov. 1, the day before Olivia visited the health center.

Loh, according to the Paregols' recollection, responded that he had many employees and relied on their expertise for advice.

"You're the president," Ian said. "You're the face of this university. You make the decisions. So this is all on you."

After 30 minutes, the Paregols said an official began to usher them from the room. The family insisted on a few more questions but left unsatisfied with Loh's responses.

In a statement to The Washington Post, Loh, who is planning to retire in 2020, said: "I cannot speak to the medical care that Olivia received at emergency rooms or hospitals, or to whether or not an antiviral medication treatment could have saved her life. We care tremendously about student health and well-being, and we offer our condolences to the Paregol family for this tragic loss."

Clement, in a recent interview with The Washington Post, said she stood by the decision to take 18 days to publicly disclose the presence of adenovirus and felt reassured after two outside physicians reviewed the response to the outbreak. "We responded as quickly as we could," she said. "They confirmed that the way we handled it was well done."

A spokeswoman for Johns Hopkins Medicine, which operates both Howard County General Hospital and Johns Hopkins Hospital, declined to answer specific questions about Olivia's treatment.

"We are deeply saddened about the death of Olivia Paregol," the spokeswoman said in a statement. "Ms. Paregol was diagnosed with an adenoviral infection, for which there is no FDA-approved treatment. Her case was quite complex, and it would be difficult, if not impossible, to summarize it in a brief media statement."

— — —

Late November — Early January 2019: The aftermath

At Elkton Hall, students were skeptical of the university's efforts to eradicate the mold.

Days after Olivia's funeral, her friends Humza and Megan returned to the dorm and found mold growing on the shoes in their closets. Housing officials gave Humza a humidity monitor for his room.

Megan eventually decided she had had enough and transferred to a school in another state.

In early January, Sarah and Riley joined Olivia's family at Elkton Hall to clear out the rest of her belongings. Olivia's parents and sister pulled up to the dorm on a cold, cloudy morning. They stood silently with housing officials and waited for the elevator, holding empty duffel bags.

Ian asked to go the eighth floor where Sarah and Riley had decorated a bulletin board with red construction paper and photos of Olivia's brief time on campus. They wanted to feel like she was still a part of Elkton. As he looked at his daughter's face, Ian broke down in tears.

In Room 3152, Sarah and Riley began to sort through Olivia's clothes. They took some T-shirts, a pillow and folded up the tapestry of the world map. They planned to hang it on the wall of their on-campus apartment in the fall.

Sarah laid down on Olivia's bed and stared at the ceiling. She wiped tears from her eyes.

Several days later, Sarah returned to Elkton Hall to move in for the spring semester.

She walked toward the elevator and looked up at the bulletin board. Olivia's smiling face was gone. All of it had been taken down.

— — —

The Washington Post's Julie Tate and Rick Maese contributed to this report.