COLLEGE PARK, Md. -- It had been six days since Olivia Shea Paregol walked out of the University of Maryland health center without an answer for why she felt so awful.
Now, the 18-year-old freshman was curled up in the fetal position on the floor of her dorm room at Elkton Hall in College Park, her brown hair resting on the shaggy white rug. She warned her friends, Sarah Hauk and Riley Whelan, to stay away from a plastic bag where she had just vomited.
The teenagers hoisted Olivia up and shuffled to the elevator. Once inside, Olivia leaned against the wall and slid to the floor.
"Don't sit down," Riley said. "Come on, it's just a short ride. You can do this."
"I literally can't," said Olivia, the words slicing her sore throat like knives. "I have to lay down."
Olivia had been sick most of her first semester living in an overcrowded dorm that was infested with mold. But her symptoms now were far worse than a cough and congestion.
Her skin was pale, and dark circles cupped her eyes. The lymph nodes in her neck had swollen so much they felt like golf balls. The freshman -- who turned late-night trips to the dining hall into stargazing adventures, belted out Miley Cyrus songs on demand and easily flipped strangers into friends -- was sprawled across the elevator floor.
Sarah and Riley linked arms with Olivia and made their way through the dorm lobby into the cool night of Nov. 8. They watched as Olivia trudged to a parking lot where her dad was waiting in his car. She didn't turn back to wave goodbye.
As Olivia battled her mysterious illness, the University of Maryland was rocked by turmoil. Widespread mold that fall had forced the temporary evacuation of nearly 600 students in Elkton Hall after outraged parents besieged officials at the state's flagship university.
The administration already was dealing with a full-blown scandal over the death of Jordan McNair, a 19-year-old football player who succumbed to heatstroke in June. Athletic trainers had waited more than an hour to call 911 after he showed signs of extreme exhaustion. His death exposed deep problems within the athletic department and led to the dismissal of the football coach, the retirement of the university president and resignation of the chairman of the university system's governing board.
In November and December, the University of Maryland would become the epicenter of an outbreak of adenovirus, which can have symptoms similar to a cold or flu. But certain virulent strains can sicken healthy individuals and be particularly dangerous to people with weakened immune systems -- people like Olivia, who was on medication for Crohn's disease, a serious digestive tract condition.
In these cases, medical experts say, early detection can be key to treating severe adenovirus.
But the university waited 18 days to tell the community after learning the virus was present on campus. Officials discussed -- but decided against -- notifying students with compromised immune systems and residents living in Elkton Hall, according to records reviewed by The Washington Post.
As the days passed, more and more students fell ill.
Many parents and students have denounced the administration's handling of the viral outbreak and the mold infestation, complaining its actions endangered thousands of students, faculty and staff on campus. In the end, more than 40 students were sickened with adenovirus, and 15 of them treated at hospitals, 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 emails to administrators, acknowledged that "mold can cause respiratory irritation that may increase susceptibility of any viral infection."
In recent statements to The Washington Post, university officials defended their actions, saying they hired a remediation company to remove the mold in September and provided guidance to students on how to prevent the spread of viruses. They said they went beyond what was legally required to address the adenovirus outbreak and public health officials advised that it was not necessary to inform the public about the virus. In April, the college hired two outside doctors to review the school's response. They found the university followed policies and procedures.
"The actions we took are in line with CDC [Centers for Disease Control and Prevention] guidance 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 was quietly spreading through campus. Only days after Olivia had slumped in the elevator at Elkton Hall, she was fighting for her life at Johns Hopkins Hospital.
On Nov. 13, her father frantically called the university from the intensive care unit in Baltimore. When McBride called back, Olivia's father pleaded for information. What's going on with the mold? Or was there something else on campus making students sick?
-- -- --
Late 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 considered going to college in South Carolina. She loved beaches and had a soft spot for country music. Mostly, she wanted a university with a lot of school spirit. She planned to study criminology, inspired by the TV show "CSI."
During her senior year of high school, Olivia was diagnosed with Crohn's disease, an incurable condition. She began treatment at Hopkins that left her immune system weakened. At college, she would give herself injections of Humira, an anti-inflammatory medication, every two weeks. Olivia's parents, Ian and Meg Paregol, wanted their daughter, the baby of the family, to stay close to home.
When Olivia was accepted at the University of Maryland, it checked all the boxes and was only an hour away. After Olivia learned she had been assigned Room 3152 at Elkton Hall, she felt lucky to have landed in a dorm with air conditioning.
On Aug. 24, Olivia's family stuffed two cars with dorm supplies and headed to College Park. She had coordinated colors with her 18-year-old roommate, Megan Sassaman, and bought a cream-colored tapestry with a map of the world to hang in their third-floor dorm room. Olivia's parents tucked handwritten notes of encouragement in her dresser drawer before saying goodbye.
Elkton Hall, an eight-story, red-brick dorm located in the shadow of the university's football stadium, was bursting with students. Built in 1966, it was designed to hold about 530 students, but nearly 570 were squeezed into the building because of a large freshman class.
Study lounges had been converted to dorm rooms for four students and some rooms for two residents now housed three. Students crammed the narrow halls and communal bathrooms on each floor. They waited endlessly for elevators because one of the three was always broken.
-- -- --
Mid-September: Mold issues arise
It was one of the soggiest summers in Maryland history. By the end of September, more than 50 inches of precipitation had fallen. Eventually, 2018 would go down as the region's wettest year on record.
Olivia's room felt like a swamp, so humid that bath towels never dried. The air-conditioning unit in her room stopped working in the first week of September and had to be fixed repeatedly. By mid-September, Olivia and her roommate, Megan, had persistent coughs, and it seemed harder than usual to breathe.
A pungent odor hung thick, and it was impossible to ignore whenever Riley and Sarah, 18-year-old freshmen who lived together on the eighth floor, visited Olivia's room.
Mold had surfaced earlier that summer in Elkton Hall and other dorms across campus. University officials dispatched housekeeping staff to wipe off visible mold before students arrived in August, according to workers interviewed by The Washington Post. With damp conditions and overcrowding, it didn't take long for the mold to return.
It began to invade Elkton -- on the blinds, under the beds, inside sneakers and all over the cooling units. On Sept. 18, a resident assistant sent a message to students on Olivia's floor instructing them to check their rooms for mold: "Best way to see it is in the dark using a flashlight ... It'll probably look fuzzy and green."
"we got mold," Olivia texted Riley later that day.
"how bad," Riley asked.
"look under ur drawers on ur dresser," Olivia responded. "that's where we have it."
The campus again sent housekeeping staff, who said that they were untrained in mold removal and without the proper protective gear, to wipe down desks and chairs with an all-purpose disinfectant. The workers were beset by scratchy throats, itchy eyes and headaches. Some called in sick and visited the health center.
After Megan's mother complained, staff replaced their dressers, blinds and desks. But the mold grew back in rooms across Elkton. Housing officials hastily called a meeting on Sept. 21 to address the mold in Elkton Hall as parents descended on the campus that Friday for Family Weekend.
"You have a sick building with 600 children," one mother told university officials at the meeting. Students cried about being ill.
McBride, 50, handed out business cards and told the roughly two dozen parents and students in attendance to call him at the health center if they had concerns.
He had spent his early career as a physician at a community health center outside Boston. It was there, he said, that he learned the importance of engaging with people outside of the clinical setting. McBride later led student health services at Boston University before arriving at the University of Maryland in 2014.
During the meeting at Elkton, housing officials insisted they only learned of the latest mold outbreak in recent days and blamed it on the unusually wet weather.
Hours after the meeting, administrators announced they would move students out of the dorm over the coming weeks and pay for them to stay in local hotels. They would hire an outside specialist to clean the mold and an engineer to examine the underlying cause.
That report would find that at Elkton Hall, there were "long-standing concerns for humidity levels." Cooling systems installed in 2011 were not designed to remove moisture from the air and allowed humidity to rise, making the building susceptible to mold growth, the report said.
Mold outbreaks on campus were not new or confined to Elkton, according to workers; articles in the Diamondback, the student newspaper; and documents reviewed by The Washington Post. Since 2017, the university has received reports of mold at all 38 residence halls in College Park, records show.
In recent years, other colleges have grappled with mold outbreaks. In October, the University of Tennessee closed a dorm housing roughly 600 students for the rest of the year. Last fall, Montclair State University in New Jersey tested mold spore levels before and after remediation even though there are no federal or state requirements to do so.
The University of Maryland, where in-state tuition, housing and other costs run about $25,000, took a different approach. It would rotate students out floor by floor while the remediation was ongoing, starting at the top of Elkton, where residents had made more complaints about mold. And, at the recommendation of the campus environmental safety team, the college said it decided against testing the type of mold, noting the Environmental Protection Agency has said such testing is unnecessary.
-- -- --
Late September: Students move out
Riley and Sarah, who both battled coughs and congestion, on Sept. 23 moved to the nearby Cambria Hotel with other eighth-floor residents. Contractors in hazmat suits and masks began cleanup efforts at Elkton.
A health and safety specialist who inspected Elkton on behalf of the campus labor union said the building's condition was so bad that it looked as if it were filled with floodwater.
Workers placed dehumidifiers in the hallways throughout the building. On Olivia's floor, a tube drained water from a dehumidifier into a drinking fountain. Olivia and her roommate, Megan, weren't scheduled to move out for another 10 days.
Olivia, meanwhile, couldn't stop coughing.
On Monday, Megan walked to the student health center, a red-brick building in the heart of campus, for the second time that month. Megan said that during a breathing test a physician assistant asked whether she was trying hard enough because her oxygen levels had dropped.
Megan complained in an email to university officials about how she had been treated. "[It] made me feel as if my symptoms were pushed under the rug yet again," Megan wrote on Sept. 25 to University of Maryland President Wallace Loh and others. She mentioned Olivia's illness and said: "I continue to live in an unhealthy environment. The lack of communication and lack of acknowledgment of the issue saddens me and comes across as if the University puts student health as a low priority."
After more than a week of relentless coughing, Olivia now had a sore throat and chest congestion. On Sept. 26, she also visited the student health center at the urging of her parents. There, a doctor diagnosed her with an unspecified viral upper respiratory infection with a cough and "exposure to mold," according to her medical records. She was prescribed cough medicine and a nasal saline spray.
In an effort to understand the effects of the mold infestation, health center staff, at McBride's direction, had begun to take note of where students who came for treatment were living and if their respiratory symptoms were worse inside the dorms.
After the relocation plan was announced on Sept. 21, Megan's parents, Kim and Kevin Sassaman, sent emails to top university officials asking why Megan and Olivia couldn't be moved to a hotel sooner, given their poor health. With approval from a housing official, the two students moved into the Cambria on Sept. 26. The roommates stocked up on beauty masks and snacks for their makeshift dorm room.
Two days after they checked into the hotel, McBride, the director of the health center, wrote Olivia that a doctor there "let me know that you're feeling unwell and that mold may be a factor. I know that you're scheduled to move for cleaning in early October. Do you want for me to advocate for a sooner move to another location on campus until after the cleaning is complete?"
Olivia responded: "My roommate actually already had us moved. Thank you for reaching out, but I'm already in a hotel at the moment."
After 11 days in the hotel, Olivia and Megan moved back into Elkton Hall, where the remediation was winding down.
-- -- --
Early October: Health center overwhelmed
Parents increasingly took to social media to vent about conditions on campus. On Oct. 8, they started to complain on Facebook that their children were misdiagnosed at the health center, were told they had unspecified viruses or couldn't even get an appointment.
In an interview, Angela Hayes said her son, a freshman who lived in Easton Hall, repeatedly sought help for a sore throat and high temperature. Health center staff told him he had a virus. When he didn't improve, she said, he went to a nearby urgent care center, where he was diagnosed with acute tonsillitis and prescribed antibiotics.
"It was almost like a factory," Hayes said of the university health center. "They'd tell students, 'You're fine, you're fine, you're fine.' "
McBride told The Washington Post that in October he noticed an uptick of fever-associated illnesses that were not the flu. He scheduled a meeting in early November of the Campus Infectious Disease Management Committee, a group that evaluates health threats.
In mid-October, Debbra Aiello's 18-year-old son, who lived in La Plata Hall, called her at home in New Jersey complaining of a bad headache, sore throat and high fever. She drove down to College Park and brought him back to a pediatric emergency room in New Jersey. He had a 104-degree fever, and after a battery of tests, doctors determined he had an ear infection and adenovirus.
Aiello said she had never heard of adenovirus and had no clue that it could severely sicken a healthy teenage boy. It took him nearly a week to recover at home.
When his father drove him back to College Park, the son fell ill again, so they headed to the health center.
But there was a two-hour wait. They left campus and drove to an urgent care facility. Had the health center been able to treat the student, the university might have learned much earlier about the dangerous virus snaking its way through campus.
-- -- --
Late October: Another controversy
Midway through the fall semester, the death of Jordan McNair still dominated headlines.
In late October, the University System of Maryland Board of Regents huddled behind closed doors to discuss an investigation launched in the wake of his death that revealed poor management of the athletic department. During a May 2018 workout, Jordan had hyperventilated and complained of cramps, but athletic trainers waited for about an hour to seek emergency help. He underwent a liver transplant before dying in June.
"You entrusted Jordan to our care and he is never returning home again," President Loh told the McNair family.
The case led to a review of the university's accreditation, which could threaten the school's federal funding.
On Oct. 30, the Board of Regents recommended that football coach DJ Durkin keep his job, triggering a barrage of criticism, including from Maryland Gov. Larry Hogan, a Republican. The next day, the university reversed course and dismissed Durkin. The chairman of the Board of Regents would also resign amid the turmoil.
As this was unfolding, Olivia languished. She bailed early from a Halloween party, where she was dressed as one of the Three Blind Mice. She had painted her glasses black, dark enough to cover her puffy eyes, and told friends it pained her to speak.
"i can't swallow my own spit," Olivia texted Sarah on Oct. 31, "and my neck is so lumpy bc my lymph nodes so swollen."
That day she went to her family doctor, where a pediatric nurse practitioner tested her for strep but found none. Two days later, on Nov. 2, as her symptoms worsened, Olivia's father urged her to visit the campus health center. There, she complained to a physician that she had a fever, fatigue and a sore throat and mentioned that a friend had mono. The doctor ordered a test for mono, but Olivia didn't have time to wait at the lab.
That evening, she was headed to a birthday celebration for her sister. At the dinner, Olivia whispered in between coughs that she was sure she had mono. Her father worried about her weakened immune system and was determined to take her home from school. To his surprise, she did not object.
Olivia soon retreated to her childhood bedroom. Over the weekend, she complained of chills and took hot showers to soothe her shivering body.
"r u coming back today?" Riley texted her the afternoon of Nov. 4, a Sunday.
Olivia replied that she didn't know.
"my fever won't break," she wrote.
-- -- --
Early November: Virus detected on campus
The university's first warning of adenovirus among students came the day before Olivia's Nov. 2 visit to the health center. McBride received an email from a physician at the University of Maryland Medical Center in Baltimore, who told him about a College Park student who had been hospitalized there and tested positive for the virus.
"I thought it best that you know in case there are more," wrote the physician, James Campbell.
In a follow-up phone call that day, Campbell told McBride that the student had been admitted with a high fever and pneumonia, according to records and interviews, and was suffering from "an unusual presentation" of adenovirus.
The virus was in the news: It had been linked to the deaths of children with weakened immune systems living at a long-term care facility in New Jersey. The outbreak ultimately killed 11 children and sickened more than two dozen others.
Certain strains can severely sicken healthy adults. The military has had multiple fatal outbreaks in barracks. A vaccine is available to military personnel but has not been approved for the general public.
Soon 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 Adventist Hospital in Maryland, according to interviews and records. McBride suspected it was a second case of adenovirus and asked the hospital to run a test.
On Nov. 7, McBride convened the meeting of the Campus Infectious Disease Management Committee, which included about a dozen officials from student affairs, athletics, communications, housing and other departments. They discussed updating the campus plan for disease outbreaks. McBride told them about the increase in fever-associated illnesses on campus and several cases of hand, foot and mouth disease, which causes a mild rash and mouth sores.
McBride, however, did not advise the committee of the confirmed case of adenovirus or the second suspected one, according to the minutes. Asked why he didn't bring up adenovirus, McBride told The Washington Post that it is "not currently a reportable condition ... we were more focused on what we knew at that time."
Unlike some other infectious diseases, adenovirus is not governed by mandatory state or federal reporting requirements -- doctors or hospitals are not required to alert health officials or the public when the virus is discovered.
Two days later, on Nov. 9, Andrew Catanzaro, a physician at Washington Adventist, followed up with McBride and emailed him that he was concerned about "others coming into the hospital who are quite ill ... Perhaps you have an outbreak of Adenovirus on the campus."
That day, the campus health center began testing for adenovirus. The nasal swab used to detect adenovirus is significantly more expensive than a flu or strep test, and it is not available at many primary care and urgent care clinics.
That Friday evening, McBride sent out a campuswide email about flu and virus prevention techniques, such as washing hands, and noted that there had been several cases of hand, foot and mouth disease. He made no mention of adenovirus.
"This is no cause for alarm," he wrote in boldface type, "but it does give us the opportunity to practice effective prevention techniques for these types of illnesses."
By then, Olivia had been out of school and at home for a week, except for a brief visit to Elkton to pick up her medication. She kept Sarah and Riley in the loop, texting "i just puked blood."
She returned to her pediatric nurse practitioner on Nov. 5. The following day, her parents took her to the emergency room at Howard County General Hospital, where doctors treated her as if she had bacterial pneumonia and sent her home with antibiotics.
But the medication wasn't working, and her chest began to hurt when she coughed.
Three days later, Olivia's parents brought her back to Howard County hospital. She was admitted and tested for influenza, respiratory syncytial virus (RSV), hepatitis and bacterial blood infections, records show. All came back negative. But physicians did not test for adenovirus.
They knew she had pneumonia but it was unclear as to what had caused it and why she wasn't getting better. They continued to treat her with antibiotics.
Howard County hospital officials later declined to answer questions about why they did not test Olivia for adenovirus.
Ian and Meg Paregol traded off nights sleeping on a small couch next to Olivia's hospital bed. Ian, an attorney who represents clients with disabilities, had learned how to advocate for patients under difficult circumstances. He barely slept as he watched his daughter's oxygen levels dip well below normal on Saturday night.
Olivia's left lung was filling with fluid.
-- -- --
Mid-November: 10 days since virus detected
On Nov. 11, with her condition worsening, Olivia was moved into the intensive care unit. Doctors suggested puncturing her back with a needle to help drain fluid from her lungs.
Olivia, now struggling to speak, asked: "Will it hurt?"
Suddenly, her eyes rolled back and she suffered a seizure, thrashing against the bed. Medical staff rushed in, and Ian, fearing she was dying, ran from her bedside into the hallway. He fell to his knees and started to pray. Doctors intubated Olivia and administered sedative drugs.
That night, Howard County physicians planned to airlift her to Johns Hopkins in Baltimore, where she could undergo a Hail Mary treatment: the extracorporeal membrane oxygenation machine or ECMO. Tubes circulate and oxygenate the patient's blood outside of the body, giving the heart and lungs a chance to recover.
Ian and Meg drove to Hopkins. They took the elevator to one of the top floors of the hospital and stood by the window. There, they stared into the night sky and waited for the flashing lights and whirring blades of their daughter's helicopter.
Back on campus, Sarah's text messages to Olivia went unanswered.
"Okay you're scaring me," Sarah wrote. "I just wanna know ur okay/coming home tomorrow."
Olivia's roommate, Megan, was too sick to leave their dorm room. Megan had tried to get an appointment at the campus health center, but nothing was available.
On. Nov. 12, Megan's mother, Kim Sassaman, wrote to Loh and McBride about her daughter's illness and questioned whether mold remained in the dorm room. She asked for "full disclosure" on what was making her daughter and other students sick.
"Her constant illness is not an isolated case in Elkton," Sassaman wrote. She alluded to Olivia, saying that Megan's roommate was hospitalized with pneumonia and another student -- their 18-year-old friend Humza Mohiuddin -- had been hospitalized with respiratory issues.
McBride responded quickly and traded emails with Megan's mother. "We've discovered several cases of a particularly nasty strain of adenovirus (a typical cold virus)," McBride wrote in one message. "If Megan has not been tested for this, we can either perform a swab at the UHC for it or you can ask her current caregiver to test for it."
By then the state Department of Health was aware of the outbreak. On Nov. 12, Catanzaro, the infectious disease physician at Washington Adventist, alerted the state about two students who tested positive for adenovirus. The next day, McBride learned that a student tested at the health center was also positive for adenovirus.
At Hopkins, doctors began the ECMO treatment for Olivia and ordered dozens of tests, including a screening for respiratory viruses that could detect adenovirus.
After Olivia showed no improvement on Nov. 13, Ian, in a panic, called the university.
When McBride returned the call later that day, Ian pressed him about her illness and any connection to mold.
"I need some answers," Olivia's father pleaded. "I need to know what's going on because she should not be this sick."
"We've had a couple of cases of adenovirus appear," McBride responded, according to Ian. He said he told McBride to immediately call Hopkins to share what he knew.
Later that afternoon, McBride left a voice mail for Ian, saying he had spoken to medical staff at Hopkins: "The state health department is getting involved as well, so we can try to prevent further spread of the virus called adenovirus, which is actually a pretty common cold virus. But every once in a while it causes a more severe illness. So we suspect that's what it might be."
Suddenly, Ian had a sobering realization: For the past week, doctors had been giving her a cocktail of antibiotics, which would only be effective if a bacterial infection were the underlying cause.
But the true culprit had been a virus.
Although many people recover from adenovirus on their own, immunocompromised patients with severe cases, such as Olivia, can benefit from antiviral drugs, such as cidofovir. The drug carries significant risks, including kidney failure, and has not been studied in large-scale trials for use in treating adenovirus.
"You want to start it before the patient gets too sick," said Ivan Gonzalez, a physician at the University of Miami who has studied the use of cidofovir in adenovirus patients with compromised immune systems.
In Olivia's case, doctors didn't wait. On Nov. 13, hours after tests confirmed she had adenovirus, they began to administer cidofovir.
That afternoon, Linda Clement, vice president for student affairs, wrote to Loh, "We have three cases of adeno ... it is likely [Prince George's County] will declare an 'outbreak.' "
-- -- --
Mid-November: 13 days since the virus detected
About two weeks had passed since McBride learned of the first adenovirus case on campus. The unofficial tally of students with the virus was up to at least five, three of whom required hospitalization. There probably were many others who had not been diagnosed. The University of Maryland was now navigating one of the country's first adenovirus outbreaks on a college campus.
Still, there was no announcement.
On Nov. 14, McBride sent an email to Richard Brooks, a CDC employee assigned to the state health department, and shared the university's campuswide virus prevention email that was sent on Nov. 9. McBride asked Brooks, who works with state officials on outbreaks, 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."
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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.
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The Washington Post's Julie Tate and Rick Maese contributed to this report.