“You are the best and the brightest within your respective fields of work, and together we are ready. And I want you all to know that in this battle we are all together. This victory will not be won by the medical staff alone. You all have a role to play. The elevators must work – always. No printer can be out of paper – ever. A power shortage could cripple us. A missed call because of an overtaxed switchboard could mean hundreds of deaths. No task is insignificant. We will stand together and we will succeed or fail – together.”
In the back of the crowd, close to the large glass entrance doors, Aeolus saw a middle-aged man with a broom. The man straightened his back and nodded at Aeolus – slowly, proudly and confidently.
“Right now, we’re in a bit of a hiatus, awaiting reports of what exactly the status is in Eastern Indonesia, and for our troops to get into position.
“So I want you all to go home to your families. Spend some quality time with them. Because, if worst comes to worst, you will not be seeing a lot of them in the days, weeks or even months to come.
“You cannot, however, repeat what I have said here. We have to manage the information that goes out carefully, at this stage, lest we start a panic that could be a greater danger than the virus itself.
“At the exits, there are leaflets detailing what you can and cannot say to your families. If any one of you would disregard these instructions, your greatest problem will not be getting fired. You will be guilty of negligent homicide and have to carry on your conscience the deaths of more people than any serial murderer in history.”
When you come back to work, keep the following in mind: This war is going to be fought over several different time horizons. The effort of containment and quarantine is a day-to-day exercise. The work of understanding the virus has a timeframe of weeks and longer term research such as vaccine development has a timescale of months. Make sure you know which timeframe you are fighting in and pace yourselves accordingly.
“This might or might not be it. In any case, we need to get ready, and if it comes to it, let’s make sure we win this one for the home team.
“Godspeed.”
With that, Aeolus stepped down off the desk and started walking away from the podium.
The silence was broken and people started talking, gathering their possessions and preparing to leave. But the talk wasn’t that of excessive excitement or panic. No, it was the muted and controlled conversations of people filled with a concern kept in check by determination and a sense of pride. The speech had worked.
As Aeolus headed toward his office, something in the corner of his eye caught his attention and he stopped to listen to what transpired.
There were three junior staffers walking up to Ed. One of them said, “We have no families to go home to. What we can do to help?”
“Well,” said Ed, “what do you work with?”
“I coordinate efforts against malaria in Africa,” said one.
“And I fight an uphill battle against the spread of polio,” said another.
The third one sounded embarrassed. “Well, actually I don’t work with tactical epidemiology at all. I study the genetics of certain diseases and try to document their origins and spread.”
“Okay,” said Ed, “here’s what I need you to do. We don’t know much more about this strain apart from that it’s new and highly lethal. It shares some symptoms with the Spanish flu – rare symptoms that we’ve not seen in a while. I’m pretty well up to speed on the recent pandemics like the swine flu, but I don’t know enough about the Spanish flu and I need to get on top of it fast.”
“Mr. Malaria and Ms. Polio, you will compile everything we know about the Spanish flu, and by that I mean everything: Research, popular literature, eyewitness reports, I want it all. And I don’t want just a pile of papers on my desk. I need an upfront synthesis of the most important points and cataloguing and indexing of all the details in the supporting material. In short, you’re going to give me a full bibliography of everything written on the Spanish flu, and you’re going to do it in eight hours.”
The two staffers nodded and ran for the library.
Aeolus had never seen anyone run in the WHO offices before, and he liked what he saw.
“What about me?” the geneticist asked. “Is there anything I can do to help?”
“Yes there is, Mr. Genetics,” said Ed. “If I’m not misinformed, there has been some DNA sequencing efforts on the Spanish flu, based on material found in Alaska.”
“Yes, that’s correct.”
“Is the sequencing complete yet?”
“I don’t know for sure. The last I heard was that they’d finished two gene pairs about a decade ago. Unless there were problems with the sample they should have been done a long time ago.”
“Do you know the guys working on this?”
“I know of them. The leader is a Dr. Tauenberger, based out of Bethesda.”
“Okay, get a hold of them. Figure out what they know and what we can learn from the sequencing.”
“Consider it done. I’ll report back in a couple of hours.”
Aeolus smiled as he started walking again. They were ready, or at least as ready as they were ever going to be. If it came to war, they’d put up one hell of a fight.
DIUS
PRETERITUS
(Of days past)
SEVEN YEARS EARLIER, OCTOBER 9TH, 9 AM, BAGGAGE CLAIM, BALTIMORE WASHINGTON AIRPORT
Aeolus was waiting for his luggage to arrive on the conveyor belt. The airport was packed. People struggling to navigate their carts repeatedly bumped into Aeolus, something that was met with a petrifyingly cold stare of reproach and contempt.
One of the great inconveniences following September 11 was that he was no longer allowed to pack his straight razor in his carry-on luggage. He had always traveled light – carry-on only – but nowadays he had to check in his bag. A colleague had suggested he switch to a drugstore razor, but Aeolus had never even considered that. There was no dignity in shaving with a piece of plastic. Besides, with the skill acquired over years of training, the straight razor did give a closer shave.
He was on his way to give a lecture at a conference, and was hoping to fly up to Boston afterward to join the weekly epidemiologist drink at the Back Bay Social Club with Loo and the others. He hadn’t been for a long while, but now, with Yelena back in Russia, he could once again join that rare gathering of people that made him feel as if he actually fit in.
The last few years had been good to him. True, the work had not been particularly exciting and there was more representation and politicking than he’d expected. Still, he had been promoted to Assistant Director-General. Gabriel Hardy, or “The Old Man” as he was affectionately referred to among the WHO senior management, was aging quickly. Aeolus was convinced that within a couple of years, he would have the man’s job, the job he had wanted and worked for, for so many years.
The Old Man had been a great leader of the WHO during his tenure. His temperament and focus was different from Aeolus’s. The Old Man focused on great challenges that required patience, where victories were measured in small, incremental steps. These were the campaigns against malaria, tuberculosis, polio, HIV, river blindness and dengue fever. It was an honorable effort, and it was important work, no matter how slowly it moved. At some point it would show results, and maybe, if they were lucky, they would manage to eradicate those diseases just as they had smallpox. But not in the Old Man’s lifetime. And probably not even in Aeolus’s. Still, the Old Man kept on fighting.
When it came to tactical epidemiology though, the very temperament that made the Old Man suitable for leading the fight against malaria worked against him. He did not have the sort of personality needed to make the hard decisions required in responding to a hanta fever outbreak. That wasn’t a problem. That was why he had Aeolus. That was what Aeolus exceled in, like no one in the WHO before him.
While he was waiting, his phone rang. It was the Old Man.
“Hughes, we hav
e a bit of a situation over there in the US.”
“Okay.”
“There’s been a case of Ebola landing in the States, and naturally they’re all flying off the handle.”
“That’s to be expected.”
“Since you’re on-site, I want you to sit in and represent the WHO at the meeting.”
“Are you sure you don’t want to do it yourself via video?”
“No, it’s better to have someone there in person. And also, quite frankly, you’re better at Ebola than I am.”
“In person, sir? I’m not sure I understand. Atlanta’s at least three hours away.”
“You’re not going to the CDC. You’re going to the White House. Baltimore is still close to Washington, right? It hasn’t moved since I studied geography or something?”
“The White House?”
“Yes, the Situation Room. They’re taking it very seriously. You’re going to meet the president. Please try to restrain yourself. As I’ve told you many times: no one likes the smartest kid in the class.”
“Even when he’s right?”
“Hughes, your job is not to be right. It’s to make people listen to you and take the actions we need them to.”
“Yes, sir. I’ll do my best, sir. But how do I even get into the White House?”
“I don’t know. Take a cab and ask for the main entrance, I guess.
“You should have been given clearance. They have a copy of your passport. As long as you make sure not to smile they’ll probably recognize you.
“So much for having drinks in Boston…” thought Aeolus. He left his luggage and marched briskly through the crowd, parting the ocean of people with his raised cane. He made it out, got into a cab and paid the driver a substantial amount of money to drive him to the White House as fast as humanly possible.
TWO HOURS LATER, WHITE HOUSE SITUATION ROOM, WASHINGTON D.C.
After some confusion at the main entrance, which apparently was not where Aeolus was supposed to have shown up, two tall and muscular gentlemen led Aeolus down to that infamous place referred to as the Situation Room. The Situation Room was not a room so much as a complex of rooms covering five thousand square feet in the basement of the West Wing. He was led into the main conference room, a rectangular space with an oval table seating thirteen people. There were several screens around the walls showing videoconferences with the headquarters of various government agencies. It was not all that different from the WHO’s SHOC, disregarding the lack of ability to launch nuclear weapons from the latter.
Aeolus was apparently late. There were ten or so people in the room. The president sat at the head of the table. The others, whom Aeolus did not recognize, seemed to be a combination of secretaries of various departments, military officers and someone who Aeolus was pretty sure was Intelligence.
At the front of the table an image was projected onto a screen. It was the most famous image of an Ebola patient in existence; the man bleeding from his eyes, ears and mouth.
The man by the screen was not anyone Aeolus recognized. He was not the Director of the CDC or even the deputy. He wore a military uniform, and Aeolus reckoned he must be from Fort Detrick.
“I’m sorry to be late. I am Dr. Aeolus Pentecost Hughes. I’m here to represent the WHO.”
“Yes, good, have a seat,” said the president without turning around or even offering him a glance. Aeolus took a seat next to someone he thought he recognized as the Secretary of Homeland Security.
The man by the screen continued the presentation. “This, Mr. President, is what an Ebola patient looks like after the infection develops. This is, as I’m sure you can see, an excruciatingly painful way to die. This disease has an extremely high mortality rate; around ninety percent. It’s also highly contagious and spreads like wildfire. There have been a large number of outbreaks, mostly in, but not restricted to, Africa, leading to deaths in the hundreds.”
“Sixteen,” said Aeolus. The room went silent and everyone turned towards him. He continued: “If by an ‘outbreak,’ you mean a situation where more than two people have died, there have been sixteen of them and, by the way, they are all in Africa. And these have been spread over thirty-two years. The only way you can speak of it as a large number of outbreaks or something outside Africa is if you count singular cases or incidences in animals, such as in Virginia 1982, in which case the total number comes to twenty-seven.”
Aeolus now had the full attention of everyone in the room, most of whom clearly thinking to themselves, “Who is this guy?” Not the uniformed man by the screen, though, who only looked annoyed.
“Sorry,” said Aeolus, “Bad habit of mine.” He lifted his hands in a gesture of surrender and leaned back in his chair.
The man cleared his throat and continued. “Mr. President, regardless, the outcome is the same. This is a deadly and very contagious disease. One important problem to consider is that the infected don’t show symptoms until after fifteen days. This means that if someone’s infected, he can walk around the city, or even fly around the country, and infect hundreds of people before we even know he’s ill. Those hundreds of people can then infect thousands, and suddenly we have a health crisis beyond our worst nightmares. This has to be stopped.”
“Okay, I get it. So where do we stand?” the president asked.
“We have a patient who landed at Dulles from Uganda this morning, clearly ill. The crew called for medical assistance, which meant that some nurses rolled him out in a wheelchair. They noticed he was bleeding from his eyes and called for a doctor. The doctor recognized the symptoms and activated the quarantine protocols. Unfortunately, the protocols weren’t executed exactly to the letter. It took an hour before we had the airport locked down.”
“So we have the airport quarantined now, Major Wiley?” asked the president.
“Yes,” the major continued. “But there’s been some chaos, and although we have the other passengers in quarantine, we don’t know how many people might have been exposed to them before we gathered them up. Some of these people could have left the airport. Also, one passenger is not accounted for.”
“Just let me make sure I understand this correctly,” said the president in a tone of serious remonstration. “First of all, this isn’t exactly how things are supposed to work in situations like this, is it?”
“No, that’s correct, Mr. President.” The voice came from the speakerphone, and Aeolus recognized it that of the Director of the CDC. “We dropped the ball, but we’re picking it up.”
“So we now have, firstly, an airport that has been quarantined for an hour, which I am sure the press knows about by now, without us having put out any explanation for it whatsoever,” the president summarized. “Beyond that we could have, for all we know, people who don’t know they’re infected with this Ebola thing running around in our capital infecting God knows how many others?”
“Yes, Mr. President, that is correct,” said Major Wiley, looking surprisingly calm and unaffected by what was obviously a severe failure in epidemiological response. Maybe he felt confident that the blame would fall elsewhere. After all, technically it was more of the CDC’s territory than the USAMRIID’s.
“I recommend,” Major Wiley continued, “that you have the Virginia National Guard enforce a quarantine around the city, and that you have the Secret Service lock down the White House until we have a handle on this.”
“Technically speaking, the president doesn’t command the National Guard, the state governors do,” said someone who Aeolus imagined to be the chief of staff.
“If we need a quarantine and the governor won’t play ball, I’ll just nationalize the whole lot of them, so I don’t think that’s much of a problem,” the president said.
There was a moment’s silence.
“Mr. President, may I weigh in?” Aeolus asked.
“Sure,” said the president, sounding as if he really didn’t care and was thinking of something else.
“I think this plan of action would be a g
rave mistake and I’ll tell you why.
“First of all, Ebola is not at all as infectious as you are being led to believe. True, if you are exposed to the virus the risk of infection is very high, but getting exposed is not that easy. It is not, and, I repeat, not, airborne. It spreads through bodily fluids, which means that if I was sitting here and was a carrier, the most likely way for me to infect you would be for my saliva to get into your mouth. Also, contrary to what Mr. Wiley just toldyou patients are not infectious until they start showing symptoms. There are no asymptomatic carriers.
Still, it’s true that there are outbreaks in Africa that have killed, in the worst case 250 people. But all of these outbreaks have been local and contained. It kills entire villages but doesn’t spread beyond them. Why? Simply because the symptoms are so visible. When you see someone walking up to your village with bleeding eyes you don’t let them in. So if it’s not airborne, how does it spread to 250 people in Africa? Because people share meals from the same bowl using their hands, and thus blending their saliva. Furthermore, when they’re hospitalized, the procedures and equipment at the clinics are so inadequate that they reuse non-sterile needles, causing the infection to spread further.
“I have to point out that these methods of infection, sharing food from the same plate or sharing needles, are not particularly common in the Western world, and most definitely not so, on an airplane.
“It’s almost inconceivable that the patient would have infected someone on the plane. Given that he was bleeding from his eyes when arriving at Dulles, he would certainly have had symptoms frightening enough for other passengers to stay away from him during the flight. The only way I could see him having infected someone is if he touched the toilet handle with blood on his hand, after which someone else touched the handle and put their hand in their mouth or rubbed their eyes.”
“But that’s how conjunctivitis spreads,” interrupted Major Wiley, “and you have to agree that it’s extremely contagious?”
The Nightmare Scenario Page 8
