The Prologue, from Ruby’s perspective, is set in Thurmond, a government rehabilitation camp. Ruby hears the “White Noise” going off while working in the camp’s garden, and she assumes it must be a punishment of some kind, although she does not know for what (1). Although the intense, painful sound is familiar to those at the camp, this time it sounds different to Ruby. She falls to the ground, crying, and loses consciousness.

Chapter 1, still from Ruby’s point-of-view, starts with her memory of the first death in her fourth-grade class. Her classmate Grace Somerfield died suddenly in the lunchroom at school, sitting across from Ruby mid-conversation. This is Ruby’s first experience of Idiopathic Adolescent Acute Neurodegeneration (IAAN), a disease that fatally affects children. At first, Ruby describes remembering the adults in her life keeping it secret, including her parents, who attempt to shelter her from hearing about its spread. The disease is first termed Everhart’s Disease, after the first boy (Michael Everhart) to die from it.

After Grace’s death, however, other children in Ruby’s school and neighborhood begin to die quickly. Ruby discovers a flier from the Center for Disease Control and Prevention sent to her parents with a list of symptoms to identify if a child is at risk, including psychological symptoms like becoming “sullen and withdrawn” or demonstrating “violent outbursts,” as well as physical symptoms like migraines, vomiting, and fainting (6-7).