Mandy put Aeolus through and after the usual series of beeps, Yelena answered.
“Yelena, it’s me.”
“Dr. Hughes. You cannot imagine my surprise. You are calling with some request, I presume, as it could hardly be that you are looking for my counsel,” said Yelena in a very unpleasant tone. Aeolus said nothing. He knew no way to respond other than to wait her out.
“I understand Loo has completed the immunofluo-rescence test,” continued Yelena in a different voice, precise, clinical, focused. This was the voice Aeolus wanted to hear.
“Yes, and this brings us to the next point of order.”
“You want a rapid test?”
“Yes. We’ll need something we can use at airports for the countries that opt for screenings instead of quarantine.”
“And you want me for that? It’s quite a while since I did those cushion tests for HIV. I have been focusing entirely on attenuated influenza vaccines the last years. HIV research is more of a hobby these days. I can’t guarantee I am up-to-date on all the latest cushion test research.”
“Be that as it may,” Aeolus said, “I trust you, which is not something I can say for a lot of people. Also, most of the recent developments have been in corporate labs, and not made public anyway. I’ll get someone to dig out what can’t be found in the academic papers for you.”
“Okay. I admit, I have given it some thought, but this is going to take time. Loo’s reagent combination is quite shaky. Works for immunofluorescence, but I doubt we can build a cushion test from it.”
“I’m obliged to remind you that time is one thing we don’t have a lot of.”
“And what about the attenuated vaccine? You want me to put that on hold?”
“That’s more long term and also quite mechanical in the beginning, right? Pass it on to some of your students for now.
“You will need to go down to the hot zone to have material to work with. I’m not sure what the lab equipment situation is down there, but if you let Walt know what you need, I’m sure we can organize it.”
“True. We’ll need a lot of in vivo. Can’t do much with the grown viruses.”
“Yes. And Yelena, I want you to bring on someone else as well.”
“Who do you have in mind?”
“Boris Yevchenko.”
“I don’t know anyone by that name.”
“You might or you might not, but he works at Biopreparat and he is very good at what he does.”
“Our biological weapons program was dismantled with the end of the Soviet Union and I’ve never met anyone by that name. I am pretty sure I would have, if he existed.”
Aeolus wondered whether she was lying. On the one hand, Yelena was as straight as they come, and sounded sincere, but could it be possible she didn’t know him? Not even the Russian military could maintain that level of secrecy. He decided to push on and put the cards on the table.
“In 1987, he published a paper on the evolution of HIV based on phylogenetics. Although the results would be considered trivial today with current computing power, it was a big achievement at the time. The paper was in Russian, not broadly distributed and didn’t receive the attention commensurate with its importance. It’s since been expunged from all medical databases, as has any reference to the person who wrote it.”
“If that’s the case, how come you’re so sure he exists?”
“Because I have a hard copy of the paper.”
“Well, paper or not, I don’t know him.”
Now Aeolus knew she was lying. She might not have known about the paper, but the mere existence of such a thing, by a Russian no less, was sure to have triggered her interest and curiosity. Was she punishing him? Could she possibly be so petty? Or was she choosing to prioritize saving face for a Soviet government that no longer existed, rather than saving lives?
He did nothing to show his disappointment. He knew from experience that arguing with Yelena was pointless. She was stubborn to the point of the absurd, even more so than him. He decided to try for a compromise.
“Yelena, I’m not asking you to give away state secrets, just make sure he’s involved.”
“Aeolus, I can assure you that, hypothetically speaking, if there was such a person, I would make sure he was involved.”
“Thank you, Yelena.”
“I’ll keep you updated on the progress, but this is going to take time and I doubt we will have anything within the timeframe you require.”
“Well, if anyone can do it, it’s you. The world is counting on you. I am counting on you.”
AUGUST 8TH, 8 AM, INFECTIOUS DISEASE WARD, HOSPITAL KUALA LUMPUR, MALAYSIA
Jafri bin Mohamad’s favorite part of the day was the morning round. Followed by a trail of grad students, he would leisurely stroll through the patient ward, stopping at the cases he found most interesting, sometimes quite arbitrary choices. Each patient gave an opportunity for pontification and finding fault in the actions taken by the interns and residents who worked the night shift. Most importantly, it offered the opportunity to impress the occasional female students, who were now, for reasons surpassing his understanding, allowed entry into medical school. As the highest medical authority in the infectious disease department, he commanded a certain respect from them and enjoyed certain privileges. When he played his cards right, he could occasionally find opportunities for private tutoring, with in natura compensation in return.
As the students gathered around him he took the time to courteously shake all their hands while sipping his morning cappuccino. He started, as always, with an anecdote from his long and distinguished career.
This was his moment of adaption. He needed a few minutes to adjust to the environment, the harsh fluorescent light, the stench of antiseptics and the occasional wailing of patients in pain, so different from the atmosphere of his comfortable office.
Already in the first room he found what he was looking for – a patient with a persistent violent cough, delirious from fever. He started going through the motions even though he already had his diagnosis clear in his mind.
He studied the chart intently, remarking how characteristic the fever curve was for this particular condition. He took the blood pressure and pulse. He did an audial inspection of the cardiac rhythm. Listening to the patient’s lungs turned out to be slightly difficult as every attempt to take deep breaths led to an explosive cough, which sent phlegm flying.
After a moment of feigned contemplation, Jafri declared confidently to the student group that this was a classic case of bacterial pneumonia and ordered the nurses to administer intravenous broad-spectrum antibiotics.
“Excuse me, doctor, but could you explain how you arrived at the diagnosis a bit more in depth?” asked the supremely annoying Chinese registrar, Suyin Li. He disliked her, not only because she had proven impervious to his advances or the fact that she was Malaysian Chinese, but mostly because she was such an obnoxious know-it-all.
“I arrive at the diagnosis based on years of experience from seeing similar cases,” he responded. “In due time, you too will acquire this skill. Differential diagnostics is not something that can be taught mechanically. It is nothing a computer could ever do. It is more of an art.”
“The reason I am wondering, doctor,” she insisted, “is that, as you can see, the patient has coagulated blood in his left ear. Surely this is not a typical symptom of pneumonitis?”
As always, she didn’t know when to shut up. “No, it is not typical, but it does happen.”
“It might not be my place,” continued Suyin, “and I of course will defer to your opinion, but isn’t this case awfully close to the symptom descriptions of the new flu from the WHO’s latest flash report? Look at the specks of blood in the mucus he’s coughing up.”
Jafri had no idea what Suyin was talking about but maintained his composure. “No, I disagree, it is nothing like that. This is an archetypical case of pneumonia.”
“In that case, doctor, for our learning benefit, maybe you coul
d clarify what part of the WHO’s description does not fit this patient?” said Suyin, handing him a WHO flash, her insolent cynicism all too clear in her voice.
Jafri skimmed the text, and even though his attention was elsewhere, when he came to the end, he realized its importance and reread it thoroughly from the beginning.
He went through the symptom characterization step by step, every now and then casting a quick glance at the patient or checking items on the patient’s chart. Once he realized that Suyin was indeed right, the muscles in his neck stiffened. His mind started racing. He needed a plan. Quickly.
Pondering his alternatives, he finally declared, “I still disagree with your assessment, but I have to admit there are certain aspects of the WHO’s statement that I overlooked. Let’s put the patient under observation. We will still go on with the antibiotics though.”
“But doctor, we have to isolate the hospital immediately! The instructions are unequivocal on that point.”
“Isolate the hospital? Nonsense! We will quarantine the patient. Put him in a separate room. That’s all.”
“Doctor, I will have to call this in. And I can assure you that once it reaches the WHO, they will call for full isolation of the hospital.”
“This is Kuala Lumpur’s largest hospital – the pride of our entire nation. We cannot shut it down on a whim. But to be prudent, we should take certain precautions. I will call the Ministry of Health to discuss this. I am certain that he will not close us down, but it is his call to make, not mine. Or yours.”
Jafri walked out of the ward calmly, only picking up the pace as soon as he was out of sight of the students. He grabbed his coat and briefcase and jogged to the elevator. Once down in the parking garage, he called Suyin on his cell phone.
“Suyin, I have spoken to the Minister. As doctors, we must put patient safety before politics and national pride. I have convinced the minister that it would indeed be in our best interest to take certain preventive measures, even if they may seem drastic. We should shut down the ward at least. Contact the WHO and if they advise it, we will close the hospital.”
Jafri hung up and sped out of the parking garage, leaving the hospital well in advance of any potential quarantine being put into effect.
AUGUST 8TH, 3 AM, AEOLUS RESIDENCE, LAUSANNE
Aeolus woke up with a jolt as the phone rang. He swore and hoped to God it wasn’t Ed calling with another false alarm. It wasn’t. It was Dr. Chen-Ung Loo.
“Aeolus, it’s in Jakarta.”
“What?”
“Yes, five people.”
“How come I’m hearing this from you and not my own staff?”
“Most likely because they’re sleeping.”
“Sleeping? All of them? Sometimes I wonder what I pay them for.”
“I’m calling to inform you that we, New Zealand, and, I think, Japan are now moving to a hard quarantine.”
“Sweet mother of Jesus...”
“I’m sure you all have work to do, so I’ll leave you to it.”
The line went silent.
Aeolus rubbed the sleep from his eyes and rushed to throw on some clothes. He didn’t bother to put on a tie. This was bound to shock people at the office, as he had never been seen there without one.
Upon arriving at the office by means of a cab Tomomi had managed to somehow conjure up within minutes, Aeolus was met by a flurry of activity. As he crossed the lobby the lone woman in the reception shouted, short of breath “Dr. Hughes, the phones are ringing off the hook. I can’t handle it. I’m not sure what to do.”
Aeolus didn’t slow down. “Ditch all calls from press and politicians until Stan Russell shows up. If it’s our staff, Walt will get back to them once we have a handle on things. Any calls from Indonesia or Singapore, though, go through to the SHOC. We need those calls so you have to keep the lines open. If you need help, Mandy should be here any minute. She’ll know what to do.”
In the elevator, Aeolus repeatedly punched the button for the third floor, as if it would somehow make the ride faster. His eyes were fixed on a single speck of dirt on the floor, while his mind raced through what they needed to do, and ranking their order of priority.
When the doors opened, he was surprised to find, not an empty corridor, but people walking, talking, even running. It had to be the night shift, but he had no recollection of it being that large. Two people jogged past him, one snapping, “I don’t care about their historic health records! We need full history of their movements and interactions the last couple of days! Find them, right now! If they haven’t done it down there yet, get them started!”
In the corner of his eye he saw another staffer in an office yelling on the phone, with what he assumed to be hospital staff in Jakarta.
“Yes, we do have your symptom descriptions, but we want pictures! Pictures of the patients! We want to examine the visible symptoms ourselves. What? No! Pictures! You know, digital camera? Snap snap? Email?…”
The man’s voice faded as Aeolus continued down the corridor. He turned the corner to find a crowd outside the SHOC. After a couple of steps he realized why. A group of janitors had formed a line, with trash going out, and fresh office supplies going in.
He joined them and said, “You guys are here early, or late, or… whatever.”
“Yes, Dr. Hughes, we were just leaving for the night when we got the support staff emergency message, so we came right back.”
“The support staff emergency message?” Aeolus’s eyes found Walt, who shrugged.
“Whose idea…? Never mind.” Someone was taking initiative. There would be praise, but it would have to wait until a later time.
“Do you need anything else, Dr. Hughes?” asked one of the janitors.
“Yes, we’re going to need…” He stopped in mid-sentence as he saw the three freshly brewed pots of coffee already in place.
“Nothing, actually. We’re ready to go. Thanks, guys.”
“We’ll be outside if you need us.”
An hour later, the SHOC was full, with everyone trying to disentangle what had transpired and led up five people now being in a hospital in Jakarta with the Maluku Influenza. What they’d managed to piece together so far was the following.
A week ago, a man of about seventy years of age had returned to Jakarta after visiting relatives in Bungaya. Bungaya was within the current quarantine zone, but was not at the time.
When he returned to Jakarta, where he lived with his two sons and their families, he fell ill. This was not unusual – he was old and weak and often fell ill. The family had not bothered to take him to a hospital as this was nothing out of the ordinary and they couldn’t afford the bills. Three days later, rather than being suspicious they remarked on how long he had lived – much longer than many people in the area.
The next day, the youngest grandson developed a very high fever. The following day, three other family members were showing symptoms, and the boy had started coughing blood. At this point, the family sought help at the local hospital.
They tested positive for the Maluku Influenza. Just six hours after their arrival, about the time when the tests came back, a fifth member of the family came to the hospital with a high fever.
The good news was that the old man hadn’t left the family’s apartment after arriving home. The others, however, had gone about their business as usual.
After hearing the back-story, Aeolus summarized his bleak view of the situation with an air of finality.
“Indonesia is lost. There’s nothing we can do to stop the spread in Jakarta, and from there, the entire country as people start fleeing the capital. My guess is we already have fifty people walking around the city spreading the virus.
“I’m going to pull Rebecca out of Maluku. There’s nothing more she can do there and we’ve learned all we can. She’ll take over the New Delhi regional office and coordinate our response to any cases that might show up outside of Indonesia. And I’ll ask her if she can find anyone who’s survived the infection a
nd speaks English to bring with her. Immunity could become a major asset very soon.”
“You’re not sending her to Jakarta,” noted Ed. “Why?”
“Because Jakarta is going to be a deathtrap in a couple of days, with or without respirators.”
“But, Dr. Hughes,” cried Ed, “we can’t abandon Indonesia! It’s moral turpitude. There are sick people there. They need our help. What about our duty as doctors?”
“I dare say, Ed, that I know very well what our duties as doctors are, and, believe me, it causes me great grief, but our duty as epidemiologists is to stop this from spreading, and that’s now best done outside of Indonesia. Treating the patients is going to have to be the job of Médecines Sans Frontières and the Red Cross.
“Anyway, our only chance now is a full quarantine of Indonesia, which will be tough given its proximity to, and the attitude of, Malaysia. That, and praying that no infected have left Indonesia already. If it hits the Asian mainland, there’ll be no stopping it.”
He turned to Stan, who had just joined them.
“Stan, options for extending the quarantine?”
“For the whole of Indonesia? That’s unprecedented, boss. You’ll need to pass a resolution in the General Assembly. The Security Council won’t cut it. Also, the Malacca Strait is long and narrow. I don’t see how it would be possible to uphold an effective quarantine.”
“I think I know some guys who can… What about the airport?”
“There, we might have some options. Pressure from the US might work.”
“Okay, I’ll see if Hank can take care of the airport. Surely, there has to be a brain somewhere within that mountain of adipose tissue. The flight to New York is eight hours, which would have me landing at about seven in the morning. How quickly can we call a meeting with the General Assembly?”
“That usually takes a couple of weeks.”
“Make it happen for one o’ clock local time, and also draft a resolution to the effect of what we just discussed. Have it ready for when we arrive.”
The Nightmare Scenario Page 18
