The Jakarta Pandemic

by Steven Konkoly

  First Interview ISPAC Virologist

  Early November 2013

  Alex enjoyed the stretch of road between Falmouth and Yarmouth. Nothing but trees and the occasional business or neighborhood development tucked away between tall thick pine trees. He’s absently listening to 80s music on satellite radio, when he suddenly remembered that NPR’s Talk of the Nation started a few minutes ago. He pressed the remote control preset button for NPR and confirmed that the talk show already started. Alex slowed his car and pulled off into the uncrowded parking lot of a landscaping business.

  “…worldwide we promote a pandemic awareness and preparedness agenda, reaching past WHO supported measures, and augmenting WHO plans with additional layers of readiness. I can’t stress enough, that we are not opposed to their efforts, as many appear to believe. We both pursue the same agenda. To combat the pandemic threat and better prepare the world for a pandemic flu. It’s just that we put more emphasis on preparing the public for pandemic flu.”

  Alex heard the topic and commented to himself that he probably won’t be making any sales calls until after 11 a.m., when the show ends. Actually, he contemplated the reality that he won’t be making any calls at all today. He still needed to check out all of the websites and blogs. That could suck him in for hours.

  “Dr. Harris, a consensus of UN members feel that your organization attempts to undermine the WHO’s credibility and authority, whenever possible, by attacking their positions and plans. How do you respond to that?”

  Ah, he’s one of the ISPAC’s more diplomatic spokespeople. Not as much fun as Dr. Ocampo.

  “First, I think that these nations are giving us more credit than we are due, considering that we operate on a fraction of the WHO’s budget. Not to mention the embedded material and transportation support of UN member nations. Frankly, I only wish we could be as effective as they claim. To answer your question, yes, we are highly critical of the WHO’s monopoly of the world’s pandemic planning and response efforts. The WHO bills itself as the sole competent provider of this role, and the world buys into their rhetoric, literally. Most nations pay large financial sums to the WHO and wash their hands of the problem. They’d rather let the WHO bear the burden of preparing for the next pandemic. This financial support takes the form of contributions to the WHO, well above and beyond amounts paid to the United Nations. Once again, we are not opposed to WHO efforts, on the contrary, we firmly believed that WHO involvement in the next pandemic will be critical to mitigating fatalities and fighting the pandemic on a large scale. However, given the frightening prognosis of a deadlier pandemic flu, ISPAC officials project that the next pandemic could quickly render the WHO’s big picture plans ineffective. In effect, most nations are investing all of their pandemic budget in the wrong place.”

  “Could you explain that in more detail?”

  “Sure, we believe that the most important aspect of pandemic readiness and response needs to stem from municipal and regional governments, the private service sector, and individual households. Let me break it down a little better. The WHO plan acts like a castle wall, to prevent or slow the flu’s entry into the castle. But once the defense is overwhelmed, WHO plans provide little capability to protect the inhabitants of the castle against the flu. So if the flu is worse than 2008, the castle wall will be breached very quickly. Even worse, most nations have allocated nearly all of their authorized pandemic preparedness funding to the WHO, leaving little funding left to seriously implement a domestic plan inside the castle wall. Sure, most nations have committees and departments that develop and maintain pandemic plans at all levels, on paper, but few countries financially empower these entities to seriously implement the plans. It is very unfortunate that ISPAC’s efforts to augment WHO plans meet with endless resistance from the WHO and international community. The WHO continues to maintain their international pandemic planning monopoly, which yields them generous funding from nations that have little interest or motivation to assume further financial responsibility for domestic planning costs. It’s easier for governments to write a check and pass the responsibility on to the WHO.”

  “Doctor, you stated that the barrier could be breached by a flu worse than the H5N1 strain seen in 2008. The WHO counters that they are ready for this possibility. They cite the massive increase to their funding since 2008 and a near doubling of their asset deployment capability in the same time period. Given this increase, would it be fair to say that they have risen to meet the challenge of a deadlier flu?”

  “On paper, it all looks good, but once again, the increase to their capabilities still fails to address all aspects of pandemic flu behavior. By closely studying past pandemics like those seen in 2008, 1968 and 1918, you will find that no matter how tight or seemingly effective a quarantine or containment effort appears to be, it remains impossible to stop the transmission of the flu through conventional barriers. Impossible. So, the WHO has built a stronger castle wall, and this is fantastic. This effort alone will save countless millions of lives in the face of another pandemic. However, once the castle wall is breached, and it will be breached, the inhabitants inside remain unprepared and defenseless. The world’s nations are putting all of their hard resources into building this better castle wall. However, it’s our opinion, based on hard scientific fact and study, that you cannot build an impregnable castle wall.”

  “Well, Dr. Harris, I can see why the label ‘doom and gloom’ gets tossed at your organization. It all sounds rather pessimistic.”

  “I admit that this outlook is depressing, but it is a harsh reality, and the ISPAC is committed to raising awareness and improving the world’s ability to cope with the next pandemic. What’s truly depressing is that our outlook is based on scientifically sound data patterns and probability, yet our ideas are dismissed by the WHO as fear-mongering speculation, and our efforts are stymied on all levels. Tragically, our own nation’s Department of Health and Human Services will not cooperate with us on any level, demonstrating the overwhelming degree of foreign pressure filtered through our own politicians, right down into our own government agencies. For us, this is a terrible loss, since DHHS is responsible for U.S. pandemic preparation and response efforts. Thankfully, a reasonable degree of scientific and professional objectivity stems from the CDC and the United Kingdom’s Department of Health. Without their quiet support, we would have a much more difficult time operating worldwide.”

  “Doctor, I have heard you state before that the world caught a break with the 2008 pandemic. The WHO emphatically disagrees with this statement, once again dismissing it as speculative pessimism. Would you explain to our listeners why you feel the world caught a break?”

  “Right, it’s rather simple, so let’s start with some of the basics. First, the 2008 H5N1 strain had a significantly lower pathogenicity than any previously seen H5N1 strains. Pathogenicity means a microorganisms capacity to produce disease and inflict damage, and is typically directly related to the disease’s case fatality rate. Case fatality rate is the proportion of individuals that contracted the disease, that die from causes directly related to the disease. Throughout recorded human history, documented case fatality rates for pandemic diseases rarely exceeded 5-8%. Earlier strains of H5N1 in Southeast Asia produced a 40-50% case fatality rate, which really scared world scientists. Granted, the number of cases was low, and many scientists argued that a significant number of cases went unreported and presumably resulted in survival. Even given these ideas, the case fatality rate would have still remained about 25%, which is still unlike any pandemic-grade disease ever seen before. When H5N1 finally mutated to a strain capable of highly sustained human-to-human transmission in 2008, it also mutated into a strain with a lower pathogenicity, and a subsequently lower case fatality rate. The rate hovered around 6%, even in areas with little or no real treatment capability. When this became apparent to virologists and infectious disease specialists, believe me, we all felt as if we had caught a major break.

  “Additionally,
the 2008 strain displayed a quicker than normal asymptomatic to symptomatic shift. Infected individuals showed symptoms within 1-2 days, instead of the 3-5 day period seen in previous seasonal and pandemic flu strains. Since symptoms surfaced quickly, infected individuals were more rapidly detected, contained, and treated, greatly slowing the flu’s geographic spread. Scientists calculated that if the strain had behaved differently, with a longer asymptomatic virus shedding period, then the disease would have been harder to detect and contain, and easier to transmit. Consequently, the pandemic flu would have infected a significantly higher percentage of the population, while geographically spreading further, quicker. This resulted in another collective sigh of relief.

  “But either scenario, higher pathogenicity or elevated transmission rates, will likely push pandemic response plans, national healthcare systems and essential services beyond their limits. You need only look at the disasters in Pakistan or Mexico City during 2008 to envision what could happen anywhere in the world, if just one of the scenarios materialized. Combining both scenarios could trigger a global disaster of truly epic proportions. If any of the severely pathogenic H5N1 strains seen in 2005-2006 had made the antigenic shift to effective human-to-human transmission, then the world would have faced a more highly contagious and transmittable strain of flu, with a 40-50% case fatality rate, that could be spread for days by individuals showing no outward signs of the virus. The outcome of this pandemic would have been drastically worse than the 2008 pandemic, regardless of the presence of an effective vaccine.”

  “Doctor, this is both fascinating and alarming. We are running short on time, are there any other aspects you would like to discuss? And feel free to continue with the bad news, I think half of our listeners have tuned out so they can purchase some emergency supplies.”

  Dr. Harris releases a deep, coughing laugh, having been caught off guard by the joke. “Yes, I bet they have. Sorry if I killed your ratings. First, I want to make sure that your listeners understand that the current situation in China has not been defined. There is some speculation regarding disease outbreak, fueled by the existence of an unexplained travel ban and China’s past behavior, which has been less than desirable. That being said, our organization is investigating cases in several countries throughout Asia, while the WHO pursues efforts with China. Clearly, China holds key information that they are not sharing. Hopefully, the WHO, backed by the UN, can pry this information loose. At the same time, several international health monitoring organizations, including the ISPAC, are pursuing leads external to China. As always, we will provide real time access to this information on our website.

  “As for more bad news, let me say that the vaccine situation in 2008 was unique and unlikely to ever be repeated. Beginning in 2005, the international science community, spearheaded by the WHO, marked the H5N1 virus as the most likely future pandemic threat. Consequently, H5N1 became the most extensively studied virus in human history, and by 2006, the world had an effective vaccine against the most common strains of H5N1. So in 2008, when the pandemic started in China, an effective vaccine already existed for use against the mutated strain. The international community rallied to put the vaccine into immediate wide-scale production on a level never seen before. The immediate presence of a vaccine contributed greatly to mitigating the spread of the 2008 pandemic. Today, however, if a novel strain evolves, experts concur that it will take at least 4-6 months to develop an effective vaccine. Large-scale production of the vaccine would follow, after vaccine production facilities convert to the creation of the new pandemic vaccine. This conversion could add weeks, or possibly months to the entire process, followed by the difficulties of nationwide or worldwide distribution during pandemic conditions. Overall, the world could very likely be forced to wait 6-9 months before the general delivery of an effective vaccine. Even worse, the distribution of the new vaccine would follow national and international rationing protocols, further delaying widespread distribution of the vaccine. The world’s population will face a grim reality. The majority of people could be forced to live and survive in a hostile and deadly pandemic environment for nearly a year, before receiving vaccination to the flu.”

  “Grim indeed, Dr. Harris. We would like to remind our listeners that up-to-date, real-time information regarding developments in China can be found on the ISPAC website, at ispac.org, and that a whole host of pandemic awareness information can be found there as well. Dr. Harris, always a pleasure. We wish your teams the best of luck out there in the field.”

  “Thank you for having me, Dave.”

  Interview with Co-Founder of the ISPAC, Dr. Ocampo

  Early November 2013

  FBC Nighttime News started with a preview of the evening’s stories, starting with the “Crisis in China.” It was clear that this topic would occupy most of the half-hour show. They also saw that there would be a segment highlighting the destructive progress of Hurricane Terrence and a health segment regarding the diabetes epidemic.

  Kate fast-forwarded through the introductions to the beginning of the China segment. They both watched as the primary anchor, Kerrie Connor, recapped the facts of the day. Neither of them learned anything new from her recap, but they continued to watch, eagerly waiting for Dr. Ocampo’s segment.

  After a few minutes, Kerrie introduced Dr. David Ocampo as one of the founders of the International Scientific Pandemic Awareness Collaborative. Alex and Kate could see from the information displayed on the split screen that Dr. Ocampo was broadcasting from ISPAC headquarters in Atlanta, Georgia. Dr. Ocampo had a dark complexion, with thick black hair and a trimmed black mustache. He was wearing a light blue oxford shirt with a red tie.

  “Dr. Ocampo, thank you so very much for talking with us tonight.”

  Dr. Ocampo stared at the screen for a few seconds and squinted his eyes. It appeared there was a communications lag between Kerrie and Atlanta. He nodded his head and then answered, “Kerrie, it truly is my pleasure to answer any of your questions and give the public the best information regarding the situation in China.”

  “Dr. Ocampo, not only are you one of the founders of the ISPAC, but you currently head the live information and trend analysis division of your organization. That’s quite a name. Could you briefly introduce the role of this division?”

  “Yes, this division analyzes information received worldwide, regarding flu-like illness or any illness patterns of a contagious or transmittable nature. This information is accepted from thousands of sites, like Geosentinel tracking sites, hospitals, clinics, you name it. If the site is connected to the internet, phone lines, fax, satellite service, or in some cases postal service, we will collect any possibly relevant patient case information from them. We openly encourage all sources to pass information to the ISPAC. We also regularly share information with the WHO, CDC and Britain’s Health Ministry.

  “As we receive information, we sort through it looking for anything that fits the parameters of a contagious and transmittable disease. If we find something fitting this parameter, we typically dispatch a team to investigate the scene, or pass the information to the CDC or WHO, to try and get them to dispatch a team. These organizations have much deeper pockets than we do, and we try at every opportunity to use their funds instead of ours.”

  Dr. Ocampo laughed at his own joke, and Kerrie smiled.

  “Have your teams discovered any trends within the past few days around China?”

  “We are investigating several leads within the region which fit the pattern of acute pneumonic illness. As you know, the WHO and CDC are solely focused on China right now and have to immediately activate several Restricted Travel Centers. Even if they weren’t busy with this, the WHO made it clear that they would not help us pursue these leads. They feel that the problem, whatever it turns out to be, is contained within China and all efforts should be focused on China. The CDC has loaned us some additional assets to pursue these leads.”

  “What exactly do you expect to find at these sites of interes
t, and why are they more important to your organization than to the WHO?”

  “Hopefully, we’ll find nothing to support a pandemic trend, but I think that the WHO is making one hell of an assumption about the situation. They are assuming that China is once again the source. And I don’t want to get ahead of myself here, but we have no idea what is going on in China and why they imposed their own travel ban. However, multiple sources confirm that biological protective gear was worn at Hong Kong International airport and that their soldiers and officials, donned in this gear, were treating airport passengers like they might be infected with disease. Couple this with the fact that the travel ban was a one-way ban, keeping travelers from other countries out of China. The WHO theorizes that this ban is intended to keep foreigners from discovering what is happening in China, and it is true that all foreigners were re-routed, while Chinese citizens were transported to the mainland. Still, even the Chinese citizens were corralled by government officials and soldiers in full biological protective gear. I don’t think it is outlandish to entertain the idea that China is trying to keep something out of their country. Maybe something they detected or suspected was inbound. Since the WHO is fully occupied with China, our organization is examining the possibility that China was trying to minimize exposure to an incoming disease threat. If this is the case, then that disease would already be spreading around the region, and our organization will find it. If we are wrong, which I truly hope we are, then the WHO and CDC should be able to best contain the problem to China.”

  “Right now, do the locations you are investigating fit any broad pattern or trend of disease transmission?”

  “That’s quite a question, Kerrie. Perhaps FBC is better informed than I anticipated. Without jumping to conclusions, I would have to answer yes. At this early point, it vaguely resembles the model of transmission seen in 2008. This is extremely, and I repeat, extremely early to conclude anything. But let’s just jump ahead, way ahead of ourselves and theorize that the cases under investigation are linked to an identical strain. I warn again, this is a theoretical exercise. No information exists, to my knowledge, about any of these specific cases. Just geographic trends.