We're in North America, probably a few hundred years in the future. Seasoned speculative fiction readers will realise that there'll be one of two things happening at this point: either everyone will be scooting around on jet-bikes and some people will have started to evolve into super-intelligent shades of the colour blue, or everyone will be beating each other's heads in with rocks and Kevin Costner will have partially evolved into a fish.
Which one of these it is becomes apparent fairly early on as fiery redhead Margaret is escorted up a hill by her grandfather and left to see out her quarantine period in a rough turf-roofed hut (the Pesthouse of the title) with only a couple of jugs of water and the odd carrot for sustenance. Margaret has the flux, a virulent disease that occasionally sweeps through and ravages whole towns, and the standard treatment (in the absence of any proper medicine) is just enforced quarantine for the victim and checking in a week or so later to see if they're alive or dead.
As it happens, Margaret isn't as alone as she thinks: brothers Jackson and Franklin Lopez are passing through on their way east and Jackson has been obliged to go on ahead when Franklin sustains a knee injury and has to rest up for a couple of days. Abandoned at the top of a hill above the town of Ferrytown (so called because of its key location on a major river), he is caught in a torrential rainstorm and seeks shelter in the only available place, a rough turf-roofed shack that turns out to have a single sleeping occupant.
As meet-cutes go the movies have probably done better ones, but you've got to make do with what you've got. Once it has become clear that Margaret is going to live (although she is still very weak) they set off back down the hill into Ferrytown, only to discover that everyone is dead, seemingly just killed where they lay during the night with no signs of a struggle. They clearly can't stick around, so they set off east, hoping to catch up with Jackson.
A momentary pause for some minimal exposition might be in order here. Firstly, the cause of all the deaths in the village is known to the reader, as it's described in early chapters: a landslide in the lake just up the river valley from Ferrytown causing a limnic eruption which sends a ground-hugging cloud of deadly poison gas scudding down the valley to asphyxiate anything in its path. People of a similar age to me may remember the Lake Nyos disaster in Cameroon in 1986. This is a minor event in comparison to some momentous event or series of events in the past which have caused the remaining and much-reduced population of North America to regress to something like Middle Ages levels of civilisation and technology. There is a general idea among the remaining population that travelling east to the coast is the thing to do, and that ships depart from there across the seas to other lands, perhaps less afflicted by whatever happened here. Anyway, on with the story.
Margaret and Franklin travel east, sometimes along the shattered remains of long-abandoned highways, sometimes through rougher and wilder country. Some people that they meet along the way are just regular folks trying to get along, but some, inevitably, are marauding gangs of murderous rapists who will whittle a makeshift flute out of your tibia as soon as look at you. Ironically, Margaret's affliction (from which she soon makes a full recovery) is a help here as her shaven head (a well-known sign of the flux) makes people reluctant to come near her. It doesn't help Franklin, though, when a gang of the aforementioned murderous rapists comes upon their little group and carts off all the able-bodied men (Franklin included) as slaves.
So Margaret is left in charge of a rag-tag group comprising her, an older couple, and their baby granddaughter. After a close encounter with some more rapey ne'er-do-wells Margaret becomes separated from the grandparents and finds herself in charge of the baby. She comes upon a religious community called the Finger Baptists who take in weary travellers and feed and shelter them, as long as they're prepared to earn their keep through work and are prepared to surrender all their worldly possessions. Well, Margaret doesn't have any of those, so it strikes her as a pretty good deal, and she spends the winter with the baby (originally called Bella but re-christened Jackie) under the protection of the Finger Baptists.
Spring arrives, and as we know, in the spring a young man's fancy lightly turns to thoughts of raping and pillaging defenceless religious communities. So it's not a complete surprise when Margaret is interrupted in her duties ensuring an orderly queue at the well by a raiding party of men with swords bent on a bit of the old slaughtering. Margaret is a determined and resourceful woman, though, quickly realises what is afoot and steals one of the raiding party's horses and has it away through the open gate towards freedom. What is a complete surprise, though, is to encounter Franklin, still a captive, outside the gate, having been set to work collecting booty for the gang. On seeing Margaret Franklin does a Chief Bromden, hurls a washstand through a window, clubs a gang member unconscious, steals a horse, and makes good his escape with Margaret.
Now on horseback and able to travel a bit faster (baby notwithstanding) they soon reach the coast, but it soon becomes clear that while there are ships available, staffed by people who seem oddly-dressed and carrying unfamiliar items of equipment, it's almost impossible to get on one unless you are a young able-bodied man or a nubile young lady who takes the first mate's fancy. So while Franklin, a strapping and imposing specimen, could probably get on, he would have to abandon Margaret, which he's not prepared to do. Eventually they decide to head back west, into a land that everyone is abandoning, and eventually arrive back where they started, up above Ferrytown, in the Pesthouse, waiting for their moment to strike out westward into the unknown.
No post-apocalyptic novel published in the mid-2000s can escape a close comparison with Cormac McCarthy's The Road. It and The Pesthouse were published within a year of each other (2006 and 2007 respectively) and share some key themes: the aftermath of some vaguely-described disaster (The Road alludes to "a long shear of light and then a series of low concussions" from which we're clearly meant to infer some sort of nuclear event; all The Pesthouse offers as a clue is the line "for how could anyone not know by now how mischievous the world could be?" during the description of the lake disaster), two people struggling across a shattered landscape littered with remnants of previous occupants, occasionally menaced by those who have thrown off the vestiges of civilisation altogether and are prepared to do the unthinkable to survive.
The differences are perhaps even more stark, though: this is really a love story rather than a fable of crushing doom. It's never in much doubt that Margaret and Franklin are going to come out OK and together - even during their enforced separation the reader is pretty confident that some way will be found (in, as it turns out, extraordinarily unlikely circumstances) to reunite them. In that way it's a book with a sort of sunny optimism about it - what remains of America is still a sunny verdant land of plenty, for all that people are queuing up to leave, unlike the grey murky hellscape of The Road. It's not just The Road of which echoes can be found: some of the odd rituals of the Finger Baptist cult put me in mind of Margaret Atwood's The Handmaid's Tale, and the whole business of exchanging your personal freedom for security by putting yourself in the hands of a restrictive regime who might not be too willing to allow you to leave left me thinking of Efrafa in Watership Down, though that was a heavy-handed allegory for various totalitarian regimes rather than organised religion specifically.
That I found The Pesthouse oddly unsatisfying in parts is really only down to a few things, many of them matters of taste rather than "proper" criticisms: I wanted to know what had happened to destroy the cities and regress civilisation, and was frustrated that nothing was offered to explain. I thought the story meandered a bit in the middle, since Margaret and Franklin's enforced separation was clearly just a prelude to their reunion and they weren't doing anything interesting enough in the meantime to take my mind off it. Finally, I found the ending where they just schlepped all the way back to where they started rather anticlimactic: rather than a satisfying rounding-off of the story, it just made me wonder what the point of any of it was.
That said, Crace's prose is always a pleasure to read, Margaret and Franklin quickly become people you are engaged with the fortunes and fate of, I scooted through it in a week and a half or so, and the fact that it was a less complex, ambitious and allegorical book than I was expecting at the start (and, perhaps, less so than either of the two previous Craces on this list, Arcadia and The Gift Of Stones) is hardly the author's fault; he wrote the book he wanted to write. As tremendously readable as this is, though, I think Quarantine is still the Crace novel that you want.
This Guardian review, which offers a few very mild criticisms (with which I mostly agree, since they echo some of the ones above) was written by former double book-list featuree and recent death-list featuree Justin Cartwright.
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