The Nightmare Scenario

by Gunnar Duvstig

  The piece that was still missing was about how Hughes had changed the WHO. Rebecca had told him quite a bit about the night before. He’d had no idea of how profoundly different the WHO was now, compared to before, nor the controversy caused in the medical community by Hughes’s overhaul of it.

  As most of the public, Roger had always associated the WHO with the fight against pandemics. In reality, only a fraction of its resources was dedicated to that purpose. It had – Roger started leafing through a set of printouts from the web – a three billion dollar budget and eight thousand employees, many of them dealing with things as unexciting as setting norms and standards for health care in developing countries, whatever that meant.

  A passing flight attendant disrupted his train of thought by triggering his craving for another drink. He lifted his empty glass, beckoning for a refill, and once the champagne was poured, he starting typing.

  “The WHO of today is a very different animal from that of yesteryear. What used to be a highly politicized, slow-moving, consensus-based, committee-driven organization has become a streamlined entity with an almost militaristic command-and-control structure.

  “This is the story of how Aeolus Pentecost Hughes transformed the largest health organization in the world into a well-oiled machine built for one purpose: to combat global pandemics. This is the story of how he, against massive internal protests, rearranged the organization, consolidating all activities related to pandemics under his own leadership. This is the story of how he created direct links to key medical staff in the high-risk nations, extending the organization’s reach beyond the UN forums. And most interestingly, this is the story of how he gained the mandate to do so.”

  A couple of seats in front of Roger, a baby started crying. He cursed. People should know better than to bring infants into business class. And airlines should know better than to accept them. An old woman sitting across the aisle responded by making grimaces and animal sounds, trying to distract the child. Roger responded by ordering another glass of champagne, this time with a good measure of vodka in it. If he could not have peace and quiet on the flight, at least he was going to get properly drunk.

  JULY 30TH, 5 PM, DIRECTOR-GENERAL’S OFFICE, WHO HEADQUARTERS, GENEVA

  Aeolus was sitting at his mahogany partner’s desk, gently rocking back and forth in his chair, Ed and Kevin observing him in bewilderment.

  His desk was, as was usual this time of day, an absolute mess. Sheets of paper, most of them with illegible notes scribbled all over them, were strewn everywhere. Even the floor around the desk was covered with half-written notes, discarded before completion and crunched up into balls.

  Before he came to work each day, Mandy would sort through things, file briefs appropriately and clean it all up. Every morning his office was impeccably neat, as would have befitted the desk of a complete pedantic. Around lunchtime, though, the disorder would already have spread and there wouldn’t be any surface of his desk visible under the piles of paper.

  It was an unavoidable consequence of his temperament. When he became absorbed in something, and he most often was, he couldn’t care less for the things around him. That was just how he was: immaculate in clothes and appearance – a tornado of utter chaos in all other aspects of order.

  He was leafing through the drafts that Kevin and Ed had prepared, and he was pleased. He had some comments, but the texts were almost there.

  “We need to understand more about this abnormal virulence,” began Aeolus. “If your reports are right, it seems that normal preventative measures are only half as effective as they should be. Something is amiss here.”

  Ed cleared his throat and, stumbling over his words, said, “We have something on that, but couldn’t agree if it was solid enough to bring to you.”

  “So, spit it out! If you’re going to waste my time talking about it, you might as well tell me what it is.”

  “We received a flash from Dr. Jan Lukschandl in Amsterdam…” Ed began. Kevin interrupted, “I mean, we know he’s a bit of a kook, but…”

  Aeolus, shone up in a smile, and struck out with his hands, sending papers flying left, right and center. “No, no, don’t worry. I love that guy. He cracks me up. What has the old fool done now?”

  It was Kevin who responded. “He’s been looking at the sequencing of the polymerase and there seems to be a significant gene shift in the second polymerase.”

  “What is he doing sequencing the polymerase?”

  “Umm… He says that since everyone else is going after the hemagglutinin, someone should be looking at the other parts.”

  “And he thinks this PB2 mutation increases the rate of replication.”

  “He says that he’s done some research…”

  “Yes… Yes… he has actually. I’d almost forgotten that. It was never published. Lancet sent it back because there were some technical issues with his statistics. He, being the way he is, obviously got furious out of his mind and never re-submitted.”

  Both Kevin and Ed were now both looking at Aeolus with a mixture of surprise and concern, as if he was not entirely sane.

  “What? Yes, of course I read all the unpublished submissions as well: Lancet, Nature and Science. So should you, by the way. You wouldn’t believe how much you can learn from obscure and sometimes flawed unpublished research.

  “Anyway, I agree that Jan is a bit loopy, but he’s not completely incompetent. Also, he has too much respect for this office to send me stuff he wasn’t convinced of. He could be onto something.

  “Ed, you’re the skeptic. Get on top of his research. If need be, find some statistician who can go down and clean up his numbers. Speak to him and try to understand not only what he knows, but also what he thinks. And by God, wear kid gloves when you deal with him. He can be a bit short tempered.”

  Aeolus’s smile lingered as he envisioned the upcoming interactions between Ed and Jan Lukschandl. It took two oxen and a strong horse to keep the old loon on the same train of thought for more than three seconds. This would be a good, albeit painful, learning experience for his newly minted Deputy Director-General.

  “By the way, while on the topic, when will we have the full sequence?” asked Aeolus.

  “We don’t know how long it’ll take,” said Ed, as usual seeming to find an odd satisfaction in reporting bad news. “As we said, we don’t have all the primers we need. It could take up to three weeks.”

  “They’re working on it, though. Hard,” he added hastily. “Of that I’ve been assured.”

  “So tell them to stop dawdling and work harder!”

  Aeolus was about to launch into one of his scolding rants when the door to his office swung open. There stood a short, blond woman. She was out of breath and shoeless.

  “Dr. Hughes!”

  “Yes, Lucy.”

  The woman jolted with shock. “You know my name?”

  “Yes. Lucy Crowley. You work in reception.”

  Lucy was obviously flattered and looked down at the floor for a moment, blushing, until she remembered why she had run to Aeolus’s office.

  “I’m not sure whether this is anything, but I just thought, after your speech the other day, and everything, that this might be important.” She held a wrinkled paper in her hand. “This just came through on the main fax. It’s handwritten and a bit difficult to read but I think it’s from a doctor and he says he has a flu patient who’s bleeding from his ears and wants to know how to proceed. I thought it might be important.”

  “And you were correct in that, Lucy,” Aeolus responded calmly. “Where is it from?”

  Walt was already by her side, reading from the paper. “Limbong in Indonesia.”

  “Lucy,” Aeolus said, “you did the right thing. I want you to go back to reception and get hold of this doctor for me.”

  “Samantha’s already trying, but we don’t have a contact number and the name of the clinic is completely illegible. You know how the handwriting of doctors can be. The only thing we have is the
originating fax number.”

  “Okay Lucy, why don’t you go and help Samantha out?”

  “Okay, Dr. Hughes. Thank you, Dr. Hughes,” Lucy said and curtsied, which seemed to surprise her as much as everyone else. She sprinted off as fast as her pencil skirt would allow.

  Aeolus pressed a button on the speaker.

  “Mandy, there are two girls in reception called Lucy and Samantha. They’re going to need your help finding someone. But try to make them feel as if they solved it themselves. Just give them a gentle nudge in the right direction. Oh, and make it fast.”

  “Guys, we need…” Aeolus began, until he realized they were already on it. Kevin was on his cell phone with the local office in Jakarta and Ed had pulled up maps of Indonesia on his computer.

  Ed turned the laptop toward Kevin and pointed to a spot on the map with a questioning look. Kevin nodded.

  Ed summarized the situation. “It’s about 500 miles west-southwest of Ground Zero and forty miles off the west coast of the landmass. It’s inconceivable that you could get there without passing through several populated areas.”

  “And there’s no airport nearby,” Kevin filled in.

  Aeolus pulled out his monogrammed handkerchief, mopped his forehead and exhaled deeply. After a moment of silence, he confirmed what Ed and Kevin’s faces clearly said they already knew: “Yeah… That’s not good… That’s not good at all…”

  AUGUST 1ST, AFTER MIDNIGHT, SHOC, WHO HEADQUARTERS, GENEVA

  Aeolus had stepped out of the SHOC to take a call from Dr. Chen-Ung Loo. While talking, he paced restlessly up and down the hallway, anxious to get back to the discussion inside the room, but equally anxious to hear what Loo had to say.

  “Yes, Loo, that’s right. We’ve had a third incident, although I have no idea how you get your information so quickly. But I don’t agree that we’ve lost control. The doctor in Limbong has been around the block before and he’s done all the right things. Even before he contacted us, he’d quarantined the entire clinic, preventing both patients and staff from leaving. He put the index case in isolation and the only two people who’ve been allowed in the room are the doctor himself and the nurse who has been assigned to the patient. They’re using the best protective garments they have and the doctor’s arranged to get food and water delivered without breaking the quarantine. He’s also diverted all regular incoming patients to other facilities while spreading the message that patients with strange symptoms should come to his clinic to receive the best treatment. This man might have single-handedly stopped a new outbreak. It’s not out of control yet.”

  “You’ve had three jumps in less than a month?” asked Loo.

  “Yes, we believe so.”

  “Three jumps and you say the situation isn’t out of control yet?”

  “We don’t know what the vector is. Until we know that, it’s impossible to evaluate the situation properly.”

  “You have to quarantine the area.”

  “The archipelago of Maluku is properly quarantined, Rebecca assures me.”

  “I’m not talking about Maluku. I’m talking about a hard military quarantine of all the landmasses between the Makassar Strait to the west and the eastern point of New Guinea.”

  “But that’s almost half of Indonesia!”

  “It’s your only chance. If this thing reaches Borneo or Java, it will spread to Jakarta. Once it’s there, there’ll be no stopping it. You have to enforce a quarantine! You have to make the case to the American president.”

  “I can’t do that until I know the vector and have established the method of spread. If we don’t know the areas in which the animal carrier lives, how can we know which areas to quarantine?”

  “Well, let me put it this way. If the vector’s native in a broader area, it’s game over anyway. Three jumps in one month! For Christ’s sake, Aeolus! Anyway, I’m calling to inform you that I’m going to recommend the Prime Minister enforce a soft quarantine, and I can ensure you he’ll follow my recommendations.”

  “A soft quarantine?”

  “We’ll stop accepting planes from Indonesia, or entry of their ships into our ports. We won’t let passengers through customs who’ve been in Indonesia during the last two weeks. We’ll also close the border crossing to Malaysia. If this infection hits Borneo, Java or Sumatra we’ll enforce a hard quarantine.”

  Aeolus exhaled deeply. “If that’s a soft quarantine, you have to wonder what a hard quarantine is…”

  “Total isolation. No man or beast enters Singaporean territory alive.”

  “You’re going to have your navy sinking ships of Indonesian refugees?”

  “Without so much as a blink of an eye.”

  “How are you going to get supplies? It’s not like you have a lot of space to grow rice over there.”

  “We have an arrangement with New Zealand – which can also be isolated easily and which will follow in synchronization with our steps of quarantining.”

  “You’re going to have an air bridge from New Zealand?”

  “Think Berlin 1949. We’re after all not a big nation. Our needs are limited. And once the hard quarantine is up and running, most supplies will be delivered via ship. We’re well prepared for situations like this. You would do well to keep in mind that during the 2002 SARS outbreak, we quarantined 977 persons in their homes and enforced it with video cameras outside their doors, electronic foot-links, mobile phone positioning and calls to their homes at random intervals. The only person who broke quarantine was quickly picked up by a dedicated police unit. We took the temperature of cab drivers every second hour and had public employees wipe down the elevator buttons in most public buildings after every ride. We stopped an outbreak that could have decimated, or even destroyed us as a nation. We did what everyone thought was impossible. We’re good at this.”

  “Are you sure this is needed? You’re going to stir up quite a bit of press.”

  “Yes, I am, and so are you, if you’re honest about it. And I wouldn’t worry too much about the press. It’ll help you build support in public opinion and leverage with the people you have to convince.”

  “I’m not going to convince anyone about anything until I know how it spreads.”

  “Well, good luck with that,” said Loo and hung up.

  Aeolus reentered the SHOC and scanned the crowd. The room was packed with people of various tenures and backgrounds. The only common denominator among the gathered was that that he, Kevin or Ed thought they might have a valuable perspective on the situation. Obviously there were experts on the flu, virologists and epidemiologists. But there were also people with experience of the region, veterinaries and librarians whose job it was to know what research and information existed and where. For solving the task at hand there were no competencies missing in the room. Adding more people would have added nothing to the result.

  This was not how things were done before his tenure. There would have been work-groupson specific topics, led by specialists in their field, coordinating with and involving the broader scientific community in writing reports. The reports would be aggregated, debated, refined and synthesized before they landed on the Director-General’s desk. It was not that the former processes were slow, they could be quite the opposite in a time of crisis, but the approach was totally different. Different people had their different fiefdoms of specialty and the silo-like organization was geared toward driving specialization in each field and building consensus.

  That was not Aeolus’s style. The objective of the midnight meeting was to produce a working hypothesis for how the disease spread, and he would not let anyone leave until they’d come to the best conclusion they could.

  “Talk to me,” said Aeolus as he closed the door. His request was directed at Ed.

  “We’re still at birds. It has to be birds. It’s always birds.”

  “No!” yelled Aeolus, smacking his cane on the floor. “It does not have to be birds, and I’m not convinced it is. It doesn’t add up. There’s something
we’re missing. There’s something I am missing.”

  He went on. “Okay, obviously we’re making assumptions based on our experience and we’re wrong. Let’s do this the hard way. Who here is most recent out of med school?”

  “I’m five years out,” came a voice from the middle of the table.

  “I just graduated two years ago,” said another from the corner.

  Aeolus looked at the young doctor with surprise.

  “Two years? I have no idea how you ended up in this room, but at this moment I’m glad you’re here. I want you to take the stage, assume we’re first-year students and describe to us how influenza spreads. We’ll sit through this and we will find what we’re missing.”

  Aeolus looked around the room, slowly, seeking eye contact with every single meeting participant, one by one, to ensure everyone understood that this was no joke, and that they would do as he said.

  When finished he turned back towards the young doctor, who stuttered: “Eh, excuse me?”

  “Are you deaf?” cried Aeolus. “Go ahead. Give us a lecture.”

  “Okay,” said the young man, clearing his throat. “Regular, or seasonal influenza, the disease most people refer to as the “flu” spreads among humans in yearly cycles. Some become infected and those who do, apart from the rare few who succumb to the disease, develop immunity. This means that their body has produced antibodies which can combat the disease and if they encounter it again they won’t become infected a second time.”

  Aeolus nodded in approval and the young man started gaining confidence.

  “The next year the flu comes back, but it’ll have changed slightly due to mutations. The antibodies from last year won’t match perfectly with the new strain and some people become infected and develop antibodies for this new flu. This process of evolution in the regular human flu is referred to as genetic drift.”