The Nightmare Scenario

by Gunnar Duvstig

  “This is not the flu,” she noted.

  “No, that’s correct. He was in a traffic accident; came in yesterday.”

  “He needs blood,” she exclaimed.

  “Yes, unfortunately there is none,” said the Justin. “There were two people in the collision and apparently they only had enough blood for one of them. This guy drew the short straw. The only thing we can do is give him morphine to make his death less painful.”

  “Drew the short straw? Was less wealthy, you mean?”

  Justin confirmed Rebecca’s assertion by silence.

  As Rebecca turned to leave, the nurse picked up a syringe from a rusty metal tray next to the man’s bed.

  Rebecca exploded. “Stop! That’s not a sterile needle.” and continued after a moments of pause, turning to the Justin, “Don’t tell me. Sterile needles are only in First Class.”

  He shrugged again. “I know what you’re thinking, Dr. Summers, and trust me, I feel the same. Equipment is on its way. We just had no idea it was going to be like this. Anyway, it is not like he’s going to die from HIV.”

  Rebecca grabbed Justin’s elbow and marched him out of the room, her face flushed and warm with rage. She said, in a voice upset to the point of almost failing her: “Okay, let me set a couple of things straight. First, from now on, there are no ‘classes’ in this hospital! Secondly, I want the spacious rooms on the top floor packed with beds. We are going to use every square inch we have.

  “I want you to assemble the senior staff for a meeting. We need to get our act together before I call in to Geneva.”

  Rebecca headed toward the hospital director’s office. This was her office now. The hospital was hers to run. The lives of the people within its doors were now her responsibility. And more than that, she was leading the frontline in the battle against the virus. If it slipped through that line, it would not only be the deaths of people in Tireme that would weigh on her conscience, but countless others.

  A consistent overachiever all her life, she wasn’t prone to crises of confidence, but she couldn’t help wondering why Aeolus had put her in charge here. Sure, she was a skilled epidemiologist, but she was a researcher, not a clinician. She had plenty of field experience, but no background as a leader.

  Then again, Aeolus was the best in the business, and he wouldn’t have given her this command if there were someone else who was better suited for it.

  The thought reassured her. She might not be perfect for the job, but no one was, and she was apparently, or at least so he thought, the best they had.

  In an effort to instill in her staff this same feeling of confidence and determination, she turned around and yelled after Justin. “And one more thing, just so everyone is clear. We are going to stop this bitch. Right here! Right now!”

  JULY 30TH, 7 PM, 63 IZMAYLOVSKY PROSPEKT, MOSCOW

  Yelena slammed her apartment door shut behind her and hurried to the kitchen. She threw her rain-soaked jacket on the floor and jerked open the refrigerator door with such force that the glass jars of jam in the door clanged against each other and nearly fell out. She reached for a bottle of Stolichnaya and grabbed the closest glass from the sink. It was left over from yesterday’s dinner, still unwashed, with a circle of dried milk in the bottom.

  She poured herself a generous measure and downed the vodka in two gulps. She went to throw the glass in the sink, but the calming warmth of the alcohol spread down her throat and around her chest and she changed her mind. Instead, she poured herself another glass. She had to try to calm down before calling Loo and more alcohol seemed to be the easiest way at this point.

  She took a deep breath and went to her study. After a couple of minutes navigating switchboards, assistants and students she had Loo on the phone.

  “Yelena, how are things?” Loo asked in a distant voice, as if his concentration was elsewhere.

  “I think I should be asking you that, Loo. What do we have? I hear it’s quite bad.”

  “Yes, Yelena, I’m afraid it is. This is one nasty missus. I’m looking at a plethora of fluorescent green nucleolus right now. She’s replicating much faster than she should. Much faster.”

  “I assume you know why I’m calling, Loo.”

  “You need samples to start the vaccine work?”

  “Correct, and lots of them. Casualties, survivors, you know the drill.”

  “Okay, I’ll put someone on it straight away.”

  After a moment’s pause, Loo asked, in a voice now focused on the conversation: “Have you spoken to Aeolus yet?”

  “No,” Yelena answered through gritted teeth.

  “Oh, come on… Not this again.”

  “I’m afraid so. No call. Nothing but a mail from his office, formally requesting that our lab commence research on live vaccines. Can you believe the gall of that man!?”

  “Yelena, we don’t have time for this…”

  “Well, maybe you should tell that to that self-centered, pompous bastard!”

  The line went quiet for a long moment as Yelena made a concerted effort to regain her composure. The only sound was the rain hammering against the window. Loo finally broke the silence.

  “Yelena, do you remember how it used to be?”

  For a brief second, a smile flashed on Yelena’s face as she remembered their weekly Friday night gatherings at the Back Bay Social Club; all the leading virologists at Harvard Med. It was a dear memory, a memory of the time before her fallout with Aeolus.

  “All our debates?” continued Loo. “How you and Aeolus insisted that it would be exactly like this – a really nasty influenza?”

  “Yes, Loo, those were the days,” Yelena quietly said.

  “And how you and Aeolus towered above the rest of us, giants among dwarfs?”

  “I don’t know about that…”

  “You know, we all found comfort in the fact that, if she came, the two of you would win the fight.”

  Yelena was silent. Loo was right. They had been a good team. Once.

  “You’ve got to patch things up with him, Yelena. We need the both of you now.”

  Yelena sighed. “I’m afraid that’s not up to me, Loo. He’s the one who has the patching to do.”

  “I’ll speak to him. The two of you together are an unstoppable force. And this is the time to bring out the best we have.”

  “You’re not that bad yourself, you know…”

  “For this one, Yelena, I fear that just being good won’t be enough.”

  JULY 30TH, 3 PM, SHOC, WHO HEADQUARTERS, GENEVA

  “Hank, are you there?” asked Aeolus into the speakerphone.

  “Yeah, I’m just going through a stretch of poor reception, I’m in a car on the way to Fort Detrick.”

  “Fort Detrick? You’ll never find a more wretched hive of scum and villainy.” Aeolus spat out the words with disgust.

  “Look, Aeolus. I know you don’t approve of their work, but they have some guys who really know their stuff and I want their take on the situation.”

  “Hank, you’re wrong. It’s not that I disapprove of their work – I loathe their work.”

  “When will you take off that tinfoil hat and realize that it’s an anti-bio-warfare facility?”

  “Nonsense, it’s a bio-warfare facility, and you know it. How would you otherwise explain how the anthrax strain used in the post-9/11 letters originated from there?

  “Anyway, at this stage I wouldn’t care if you were on your way to see Dr. Mengele. If they know something useful, no one will be happier than I to hear it.”

  “Glad to see you have a practical side beyond all your self-righteous bullshit.”

  “Enough of this, Rebecca’s coming on now.”

  The screen flickered and a heavily pixilated image of Rebecca appeared.

  “Hello. Can you see me? The picture quality here isn’t great.”

  “It’s the same here, Rebecca. We’ll see if we can get someone from Télécoms Sans Frontières down there to take care of that,” said Walt.
<
br />   Aeolus took over. “I see you are in a HAZMAT suit, Rebecca, which I find reassuring. My first concern is the safety of the team. What’s the situation with regards to that?”

  “Well, Dr. Hughes,” said Rebecca, “‘Mieux vaut prévenir que guérir.’ Isn’t that your motto?”

  Aeolus smiled. Her American accent was thick and it was clear she’d rehearsed the phrase for this particular purpose. Still, she’d taken the time to find the correct French idiomatic expression “better safe than sorry,” rather than the literal translation. That had to count for something.

  “Seriously, we’re in suits because we’re still unsure of the isolation measures required. You might recall that a doctor and nurse got infected and we initially wrote that off as a consequence of inadequate equipment and procedures?”

  “Yes.”

  “Well, the problem is that the intern you sent from Jakarta has also developed symptoms and he’s pretty sure he’s stuck to the procedures – by which he means mouth cover, plastic gloves, apron and glasses – whenever he was inside the hospital.”

  “Conclusions, Ed?” asked Aeolus, testing his new deputy.

  “Face masks are not fool-proof; viruses pass through them with ease. They only protect against droplet transmission for twenty minutes until they get moist from the wearer’s breath. Also, glasses don’t help unless they’re tight fitting. Still, these precautions generally reduce the risk of spread, and with this infection rate it must be one virulent little missus.”

  “Atta boy,” said Aeolus, nodding in approval. “You’re going to have to maintain proper precautions, Rebecca,” he continued.

  “Yes, I understand, but working in these suits is just too impractical. It’s taxing for the team, and several of the new arrivals are choosing lower-level protection. Imagine doing an autopsy in this, it is nearly impossible. It also scares the patients. I want you to authorize moving down to the equipment we use inside Bio-Safety-Level 3 facilities, so no suits.”

  “Do you have HEPA filter respirators?”

  “Yes, they’re coming in later today.”

  “In that case, I think that’s a risk we’re willing to take, as long as you make sure the goggles are airtight. What do you say, Hank? She is, after all, your employee.”

  “Do whatever the hell you want. I still think you’re exaggerating the dangers.”

  Rebecca continued. “As for living quarters, we have an isolated beach where we’re staying. That should be fine. The lab work is a problem though. We have no proper facilities yet.”

  “When you say, ‘yet,’ what does that mean?” asked Aeolus.

  “Well, the Singaporeans are building a BSL-3 lab, or at least a BSL-2+.”

  “What?” Aeolus exclaimed. “They’re building a facility with negative air pressure, airlocks and microbe-level filters for outgoing air in the middle of the jungle?”

  “Yes. The mobile labs are too small. We have to build one on-site. They identified the problem early and there’ve been engineers arriving, I think from China, and lots of equipment. I have never seen anything like it.”

  There was a moment of silence and then Aeolus started laughing, first quietly and then with increasing force. One after another, the others joined in. Even Hank could be heard chuckling on the other end of the line. The joint expression of mirth was a moment of relief they all needed.

  Aeolus eventually got his breath back, wiped a tear from his eye and said, “Those guys are completely crazy. Stark raving mad, I tell you. And I mean that in a good way.”

  Everyone around the table was still smiling as Rebecca continued.

  “As for the situation here, it’s getting increasingly out of control. New patients are coming in every hour. When I set out to go here, we had fourteen hospitalized, not counting the infected doctor and nurse, plus seven casualties. We now have about a hundred patients. All the beds are occupied. We’ll have sick people lying outside the building in a matter of hours.”

  “Fortunately,” she went on, “help is also coming. We have doctors and nurses arriving from around the region, NGOs, missionaries and locals. I think we’ll have the manpower required, but we need a proper field hospital.”

  “They can build a BSL-3 lab in the jungle, but can’t put up a couple of tents?”

  “I think they figured they should focus on what requires rocket science-level skills, not that which a band of Boy Scouts could solve in five minutes.”

  “Walt?” Aeolus’s tone was not pleasant.

  “I’m on it,” said Walt and quickly left the room.

  “Well, as for the staff arrivals, I’m glad to hear the local office has finally decided to join the party. Better late than never. Okay, Rebecca, what can you tell us about the infection so far?”

  “It’s too early to tell but we have patients that seem to be doing relatively well. My judgment is that several of them will make it.”

  “Dare to venture a guess on the mortality rate?”

  “I would put it at around sixty percent, but you have to keep in mind that the conditions here are very primitive. In a proper environment, and by that I mean a real hospital, with a full battery of antibiotics to treat the bacterial pneumonia and anti-viral drugs, I’d think it could drop to thirty percent.”

  “That number’s too high. That can’t be right. There must be something else going on,” said Hank.

  “Well, that’s thirty percent of the symptomatic patients, not thirty percent of the infected. The missing variable is the asymptomatic carriers. If we say that’s between thirty and fifty percent that puts the effective mortality rate at twenty to twenty-five percent, which is around the upper end of the estimates for the Spanish flu,” replied Aeolus.

  “At least it’s better than the fifty percent for Ebola,” said Kevin, eager to show off his knowledge.

  “Or the seventy percent for the Marburg hemorrhagic fever,” said Ed, not wanting to be outshone by his co-deputy, and always happy to deliver bad news.

  “Oh, shut up,” said Aeolus reproachfully. “A regular flu has a mortality below point-one percent and twenty-five percent of the world’s population is still one and a half billion people, so I would appreciate if you two dropped the Statler and Waldorf routine.”

  “Um… Well,” continued Rebecca, “until we have a test for infection, we have no way of assessing the asymptomatic share of the population. And even if we had a test, which I assume is two to three weeks out, it would be logistically impossible in this archipelago. There are just too many islands.”

  “Okay, next order of business is incubation period,” said Aeolus.

  “We have no idea, Dr. Hughes. The only thing we know is that the first patient came in six days before the second one, from which we can really draw no conclusions at this stage.”

  Aeolus exhaled. “We know from the tests in Singapore that it’s an influenza and that the strain is previously unknown. Rebecca, I assume you can confirm that it’s spreading from human to human?”

  “Yes, there can be absolutely no doubt about that.”

  “Okay. I hereby upgrade the pandemic threat level of A/Singapore/4/2015/ (HXNX) to Phase Four. In layman terms, we will from here on refer to this strain as ‘the Maluku Influenza.’

  “We now have to give a broader statement to the public. Kevin, please take charge of this. Work with the press office and Stan. We need a statement that is factual and shares what we know but written in a way that minimizes the risk of panic.

  “Ed, you prepare a proper global alert to the health community. Give them all the details they need, not that we have much at this stage.”

  He turned back to Rebecca.

  “This brings me to my last question. Once this announcement goes out, we’re going to be flooded with reports from all over the world of patients with influenza symptoms that are slightly more severe than usual. The vast majority of these are going to be regular cases of the seasonal flu, and we’re going to get completely bogged down. Until we have a test we will ha
ve to go old school and rely on observational diagnostics. So, are there any distinguishing symptoms we can use to separate this strain from other cases?”

  “Well, I knew that was going to be the most important question and just had a meeting with the staff to discuss it. The symptoms are varied. Still, surprisingly many of the patients are bleeding, mostly from the ears but also from lesions in their skin and in one case from the eyes. Also, just like with the nun, we see petechial hemorrhages around, but not confined to, the neck.

  “At this stage, if I were you, I’d go with the bleeding. If you have a patient coughing blood and bleeding from his ears, I’d say that that’s worth investigating. It’s common enough here and rare enough elsewhere. That’s all I can give you.”

  “Thank you, Rebecca. Hang in there. Help is on the way. How much time do you need before you can give us more?”

  “Well, this was the first glance. Gathering more information is going to take a while. We need to see how things develop and we need to do a series of autopsies. I doubt, unless something extraordinary happens, that I’ll have anything new for you for at least forty-eight hours.”

  “Forty-eight hours is a long time”

  “Yes it is, but that’s what it will take. I’d rather not waste all ours time in video conferences where I regurgitate what we all already know.”

  “Okay, we’ll check in again in forty-eight hours. Same time. Over and out.”

  “Over and out.”

  JULY 30TH, MIDFLIGHT, SINGAPORE AIRLINES FLIGHT SQ21 FROM NEWARK TO SINGAPORE

  Roger Burton was stretching his legs in the business-class cabin. He really couldn’t afford it, but business class on a Singapore Airlines A380 was just unbeatable. It was the only plane on which he could sleep properly. He had gotten too old to do twenty-one hour flights in economy class. He’d promised Rebecca not to go to Indonesia, and he was a man of his word, but he’d said nothing about not going to Singapore. He had to be close to the story, and Singapore was only an hour’s flight from Indonesia.

  While sipping his pre-meal champagne, he went through the material he’d gathered so far. He had a good piece on Aeolus’s background – it just needed some polish. Also, he had more than enough to write an engaging and fun section on his behavior, quirks; eccentricities and all. Rebecca had shared many priceless gems. Roger’s favorite was the story of how Hughes had told a consultant from a pharmaceutical company, whom he thought wore too-short socks: “Mister, if I were you, I would buy some new socks. The client doesn’t pay to see your hairy legs.”