The Nightmare Scenario

by Gunnar Duvstig

  The water was azure and crystal-clear. It looked just like the pictures of far-away beaches in travel catalogs – beaches that never looked quite like that once you went there in person.

  She tilted her head back to the sky, exhaled deeply and thought to herself what a great travel destination these islands would have been under different circumstances.

  They arrived at Mare and stepped out of the boat. Their next task was the extensive decontamination procedure. It was comparatively low-tech – they were still waiting for the completion of the new facilities being built by the Chinese.

  The structure in which they purged themselves of traces of the virus was essentially a square of plastic sheets hung from four vertical aluminum pipes. One by one, they went in and splashed ample amounts of bleach and hydrogen peroxide on every surface of their clothing. Then they carefully removed item after item of their outer protective layers, disposing of them in the burn bag. After washing every inch of naked skin with alcohol and iodine, they finally removed the mask. The HEPA-filters were tested by blowing smoke into them to confirm they were still functional, with no particles passing through. Lastly, they walked away ten meters, were they formed a growing group, chatting about anything but the day that had just passed.

  Once through the decontamination Rebecca, as she did every day, chose to walk away from the group instead of joining it. She inhaled deeply, letting the salty sea air fill her lungs. Somehow her brain seemed to subconsciously associate the scent with prior beach holidays, shifting her mind to a state of blissful calm. She saw tropical sunsets and tasted sweet-and-sour Caipirinhas, forgetting the images of the dying that were burned onto her corneas.

  As the French doctor passed through the plastic sheets, Rebecca was horrified to see that he hadn’t smoke-tested his mask. She screamed, “Stop! Your mask! Step back behind the sheet!”

  The man jolted and backed inside behind the plastic sheets. He raised his hands, looking at Rebecca with an apologetic expression. “I am sorry, ma’am. Just a bit tired.”

  He fitted the exhaust pipe to the mask, and a small trail of gray particles filtered through. The expression of raw fear on his face was clear even from Rebecca’s distance.

  “Did you check it this morning?” she yelled.

  “I… I don’t know. I mean, I think I did, but…”

  “Dammit! Okay, that’s it! You need to be quarantined. Put your gear back on and go back to the hospital. I’m sorry, but we just can’t take the risk.”

  The man staggered and slowly, still in shock, started to put his gear back on.

  Rebecca sighed and headed toward the camp. People were streaming in to help and that was great, but they weren’t the type of staff she needed. They were amateurs. They had never done this before. Unfortunately, there just weren’t enough real professionals to go around for a situation like this.

  AUGUST 3RD, 3PM, THE MEN’S ROOM, WHO HEADQUARTERS, GENEVA

  Some people had the ability to look sharp even after only three hours of sleep. Aeolus was one of those people. He stood before the full-length mirror in the men’s room next to his office, scrutinizing his appearance. He was satisfied. His appearance was up to the standards required for the next hour.

  “It’s moved way too slowly,” Aeolus thought. He and Stan Russell had worked the UN as intensely as they could, cashing in on all the favors they were owed. But still, it hadn’t been enough. They still didn’t have a Security Council resolution supporting the quarantine of the eastern part of Indonesia. The Russians and the Americans were holding out. Aeolus knew how to bring the Russians to the table, but it involved making a call he’d rather not make, not until he was convinced that it was absolutely necessary. That is, not until the Americans were on board.

  As Stan had foreseen, the main problem was enforcement. Indonesia vehemently resisted a broader quarantine, which would effectively divide their country into two parts. The Chinese, in spite of their proximity, would clearly never enforce the resolution. They had too much at stake in their international relations with smaller countries in Africa that would not look favorably upon it. This left only the States and this was the reason Aeolus was briefing the president in a few minutes. It had taken almost a week to get to this point. Far too much precious time had been wasted.

  They had been lucky. The quarantine of the Maluku Islands had so far held, and the outbreak in Limpong had been contained. The patient had died, but no others had been infected. The local doctor didn’t know it yet, but his career was about to receive a considerable boost, and his hospital considerably more resources.

  The number of infected at the Maluku Islands had exploded, growing exponentially with each passing day. As sad as this was for the locals, it offered a broader base of statistics, which was sorely needed. Antiviral drugs, specifically oseltamivir and amantadine, had proven partly effective against the primary infection in a limited number of cases and also improved the chance of survival for the patients with viral pneumonitis. It did, however, do nothing for the large share of patients whose own immune systems went into that destructive feedback loop of overproduction of white blood cells referred to as a cytokine storm.

  More important than the drugs, it seemed, had been the modern hospital practices and better equipment that the WHO team had brought. They were the primary reason for bringing down the case mortality rate from sixty to forty-five percent.

  Still, they had no assessment of the share of asymptomatic patients and the diagnostic test the Singaporeans were working on was still not ready. But the outbreak had been contained.

  They had been lucky indeed.

  Just before turning towards the door Aeolus felt a pang of anxiety. He had caught something in the corner of his eye. Something was not right.

  He was not a man prone to nervousness, and going before the president was nothing that would raise his heartbeat even the slightest. He had an unshakable inner conviction of his purpose, mission and unique ability to rise to this particular challenge. But he was neurotic about perfection in dress. When something was off with his clothes, he could think of little else. It would preoccupy him, interfering with his mental acuity to such a degree that he could barely hold a conversation.

  He went at it systematically. His bespoke dark-charcoal Anderson & Sheppard three-roll-to-two-and-a-half single-breasted suit sat snugly in the collar, and had the slouchy appearance, with just enough drape around his chest, to make him look well dressed without pretension. His powder blue Turnbull & Asser shirt, made from Sea Island cotton, protruded exactly that quarter-inch at his wrists that had been accepted as the gold standard since the mid-1930s, the edge stitching bringing that certain crispness to the collar those off-the-rack shirts lacked. He wore a burgundy Marinella tie in a four-in-hand knot with just the right tilt of asymmetry. His dark-blue Hermès pocket-square perfected his immaculate appearance. His perforated cap toes were as polished as a mirror. So where was it?

  He finally found it. His right sock had slipped down and was bunching around his ankle. He knelt and corrected the flaw. His calm returned. He closed his eyes and took three deep breaths. This was going to be the most important meeting in his life. The words of the Old Man came back to him: “No one likes the smartest kid in the class.”

  Aeolus looked down at the silver knob that topped his cane. It bore his family’s insignia, adopted by his father, and the inscription: “Ad utrumque paratus.” His father’s motto. Literally translated, it meant “prepared for either case” and was an ambiguous phrase adapted as a motto by both the University of Lund in Sweden and the Spanish submarine fleet. The cane had been a gift from his father, to whom it meant “Ready for either offense or defense.” In his father’s mind, these were the only two proper ways to approach any given situation. No middle ground. Aeolus thought that he’d been stuck in second gear for too long. It was time to go on the offense.

  AUGUST 2ND, 10 AM, THE WHITE HOUSE SITUATION ROOM, WASHINGTON D.C.

  Hank leafed through his briefi
ng papers one last time. It was not often he got to present to the big boss. And he knew how it felt to screw up in his presence. He wasn’t about to let that happen again.

  They were in the main conference facility of the Situation Room, a room Hank associated with bad memories. It was Hank who had organized the meeting that the WHO had requested. He’d chosen the participants carefully. Some were a given, like the president’s Chief of Staff. Also, there had to be enough clout in the room, and enough counsel within different areas of expertise. But within those parameters there was always a choice. Hank had chosen the Secretary of State over the National Security Advisor and consciously excluded Michener from the USAMRIID.

  He wanted the room filled with his friends, friends who wouldn’t backstab him in front of the president, if given the chance. And with Aeolus Hughes on the other side of the video link, there would be plenty of such chances.

  He reminded himself to keep his cool, think before speaking and make sure not to fall into any of that bastard’s traps.

  The door opened and the president entered the room, followed by the Chief of Staff. They were laughing, apparently very pleased with the recent poll numbers.

  As people found their places, Hank wiped his palms, damp with sweat on his trousers.

  The president looked at the daily schedule his aide had just handed him. He glanced around the room to see who was present and asked, “And the topic of this meeting is this breakout in Indonesia?”

  Hank was quick to answer, “Yes, Mr. President. The meeting has been called by the WHO and we have, via video, their Director-General, Mr. Hughes.”

  The president nodded and Hank connected the video call.

  As Aeolus appeared on the screen, Hank noted with satisfaction that he was alone on his end. The image was not from the SHOC, but some other room, probably his office. That was good. He must have excluded his staff in fear they would embarrass him in front of the president. For sure this had to mean that even Aeolus was a bit nervous as well.

  The president broke out in one of his vote-winning heart-warming smiles and opened the conference: “Dr. Hughes. You’ve stirred up quite the ruckus at the UN.”

  “So I’ve been told, Mr. President.”

  “I understand Major Wiley here doesn’t fully agree with your analysis of the situation.”

  Well beyond the angle of the camera and Aeolus’s view, Hank nodded.

  “That is most unfortunate, Mr. President.”

  “The purpose of this meeting is for me to hear your case and gain a better understanding of what’s going on. As you know, my predecessor had a little hiccup involving quarantines. I would very much like to avoid a similar situation. I need to understand this properly. So please, Dr. Hughes, explain your view to me in layman terms. They tell me we’re talking about some form of killer flu.”

  “You are rightly informed Mr. President. It’s a new strain of influenza of subtype H1N1, designated A/Singapore/4/2015/(H1N1).”

  “H1N1? Like the swine flu?”

  “Yes and no. There are many influenza variants classified as H1N1. Beyond the swine flu, there are several bird flu variants, as well as strains in humans, most notably those in 1918 and 1977. The regular seasonal flu is benign, although even that causes, on average, 41,400 deaths in the United States alone every year. The fatalities from this type of flu are, however, primarily among elderly people, infants or people who have predisposing factors, especially in the form of a lung or heart disease.”

  “This influenza strain,” Aeolus continued, “is a different thing altogether.

  “Every now and then we get an influenza that’s very different from the ordinary seasonal infection. It comes from animals, most often birds, and it is something our immune system is ill prepared for. This is what happened in 1918 when a new strain of flu killed, we estimate, three percent of the earth’s population over eighteen months. Keep in mind that this was in a time before air travel.”

  Aeolus paused, obviously hoping to let the message sink in. Hank looked at the president. He still did not look convinced. Good.

  “The Spanish flu had a mortality rate of fifteen to twenty percent. This one is worse, Mr. President. We could be talking one to two billion deaths, globally.”

  The president struck out with his arms, and said, while looking around the table, with a querying look on his face “This sounds awfully similar to something we’ve heard before. During my first term, your organization said the same thing about the swine flu. You would have had the world’s leaders impose all kinds of draconian measures. Your push for mass vaccinations turned out to do more harm than good.”

  “Yes, Mr. President, I have to admit we called that one a bit early. Not that it really matters, but I want you to know I was against that policy. That flu did not have the characteristics of a global killer. I will be the first to admit that.”

  “And why should I think you’re not just crying wolf again?”

  Aeolus straightened his back, took a deep breath and launched into the continuation of his argument.

  “Pandemic influenza of this kind has been common throughout history. The first record we have of this type of pandemic is from 1580. It was not always labeled as influenza, due to the limited diagnostic abilities during those times. Yet, today we believe that many of the outbreaks referred to as plague were actually influenzas. Since then, Man has been faced with a pandemic every thirty or so years. That was up until the Spanish flu. Since then we’ve had two pandemics, the Asian flu in 1957-58 and the Hong Kong flu in 1968-69, both of which have been benign compared to the real thing. In short, the type of flu we’re talking about is deadly, very much so. We’ve known for a long time that it was coming, and now it’s here.”

  Aeolus went on to explain the basic biology of the disease, how the most common cause of death was viral pneumonitis or an overreaction by the immune system, how there are no effective medicines against viruses, and how the only real protection lies in a vaccine.

  “And why can’t we make a vaccine against this influenza?” asked the president. “Every year there’s a new flu vaccine that the pharmaceutical industry tries to peddle us.”

  “That’s correct, Mr. President. We’ve been successful in developing yearly vaccines against the common seasonal flu, where each year’s version has many similarities to the variant of the preceding year. For this strain, this does not apply. We don’t even know where to start. Producing a vaccine would take, if you want my best guess, at least six months.”

  “What if we were to put some serious resources behind it?”

  “Mr. President, the resources are not the problem. There is no way to parallelize the process. As they say, ‘it takes nine months to bear a child, no matter how many women you assign to the job.’”

  “And why don’t we just issue a couple of million face masks? This thing is airborne you tell me, no?”

  Hank smiled. He knew the answer to this, and it was exactly this stubborn sort of questioning of Aeolus’ knowledge that could lead to Aeolus’s famous explosions. This would be a bad time for Aeolus to have a fit. But, somehow, the man managed to keep his composure and calmly answered, “Actually, the face masks don’t help; at least not outside the controlled environment of a hospital. When used by the general population, they do more harm than good. People walk around all day with the masks collecting viruses on the outside surface. Then when they take it off, they touch a high concentration of virus particles. Then they touch their face at some point, and it’s game over.

  “It’s like with this myth of washing your hands all the time. Soap does not kill viruses. Unless you wash your hands with alcohol, it has no effect. Soap dispensers in public toilets are filled with various infections and are actually a major contributor to the spread of the contagion.”

  The president stared up at the ceiling in silence, probably trying to find some other pragmatic solution that would cut the Gordian knot and make this problem go away.

  Aeolus did not give the
president much time for reflection.

  “Three things determine the severity of any pandemic. The first is mortality rate, which we currently estimate around twenty to twenty-five percent. The second is rate of spread. This one if much more virulent and hence spreads faster than the regular influenza and even the regular one spreads very fast. Third is the share of asymptomatic carriers, and this, Mr. President, is what really worries me. We have no ability to gauge this yet, but it is probably the most important. Asymptomatic carriers are people who are infected and infect others, but show no symptoms. It is impossible to screen them out at, for instance, airports, and this is why we need a full, water-tight quarantine.”

  “And this thing is on a rampage in Indonesia right now?”

  “Not exactly, Mr. President. We have a real outbreak in the Maluku Islands, but the Indonesian military has, or at least so I’ve been told, enforced a successful quarantine.”

  “If that’s true,” the president said, “and excuse me if there’s something I’m missing here, if it is quarantined, won’t that mean that it will run its course, and, regrettable as it may be, a lot of people will die, and that will be it?”

  “If we were sure it was contained, that would indeed be what would happen, Mr. President. But there is one complication to consider. Apart from spreading among humans, the disease is also carried by, we believe, bats. Our best guess at the moment is that it’s carried by a species of bat native to the eastern part of Indonesia. We have already had one case outside the current quarantine zone, which, fortunately, we managed to contain. We might not be so lucky next time.”

  “And what is it you’d have me do?”

  “Mr. President, we have to quarantine the eastern parts of Indonesia, and the United States is the only nation that can muster both the political will and the military resources to do so. If it reaches Jakarta, there will be no stopping it. We won’t be able to contain it. If you say yes, Mr. President, I can assure you a Security Council resolution supporting that action in a matter of hours.”