The Jakarta Pandemic

by Steven Konkoly

  “Maybe you should be in charge,” Kate quipped.

  “So right now, we are concentrating on enhanced domestic surveillance, which incorporates real-time virus tracking…launching our educational campaign, and proactively distributing the anti-viral stockpile ahead of the virus. At this point, I would like to open the floor for questions.”

  He pointed to a middle-aged man in dark brown pants and a light blue oxford shirt.

  “Thank you. David Reeves, CBC World News. Can you tell us how the Jakarta flu penetrated our domestic protection barrier? From what I understood, your department was quite confident that the flu would not significantly breach our borders.”

  “Fair enough question. Early last week, as the situation in China escalated, we began to seriously consider the possibility of another pandemic-grade virus spreading to the U.S. As early as Tuesday, DHHS implemented surveillance and control measures at points-of-entry, to decrease the introduction and spread of the virus in the U.S. This consisted of the isolation of suspected cases, quarantine of contacts, antiviral treatment and prophylaxis, and tracing of contacts into the community near points-of-entry. These measures remain in place today and will continue to remain in place indefinitely.

  “However, due to the unique nature of this virus, with a longer than usual asymptomatic period, many infected travelers likely evaded detection. Additionally, tracking these travelers and their contacts within the U.S. proved to be difficult at best, even with an augmented investigative force.”

  John Merrill stepped forward and pulled the microphone toward his face.

  “Another problem arose from the fact that the outbreak in Jakarta had been brewing for at least several days, if not two weeks, before our measures were activated. Many of the cases that have been catalogued in the hospitals may likely stem from earlier contact with infected travelers, leaving many thousands of asymptomatic cases still undiscovered. This is one of the primary reasons that the CDC suspects the number of cases will likely triple by the end of the week.”

  “Thank you, John,” Paul said and pointed to another reporter.

  “Gavin Prescott, LA Times. What steps are being taken by your department to increase surge capability at major hospitals and within communities. From what I understand, a few of the hospitals within the L.A. area are approaching their surge limit for treatment of the Jakarta flu.”

  “I think you are referring to Pacific Hospital in Long Beach. Keep in mind that this is a relatively small hospital that only recently began offering in-patient services, like ICU stabilization. They rapidly reached their limit with patients from an outbreak in Compton, however, we understand that within the course of the next few weeks, our nation’s hospital system will face a serious challenge.

  “DHHS has activated the Strategic National Stockpile program, which will immediately deliver stockpiled ventilators, pharmaceuticals, and other medical material needed to stabilize and treat infected individuals. The first shipments will be sent to the states that are the hardest hit. California, New York, Massachusetts and Illinois. DHHS will continue to monitor the National Disease Outbreak Surveillance Network and automatically activate a 12-Hour Push Package for any state that requires augmentation of their surge capacity. Our decision to deploy these packages weighs available capacity versus anticipated surge of infected individuals and is completely objective.

  “This is completely separate from the shipment of antivirals from the stockpile. Antiviral shipments are already in progress to all of the states.

  “We also have the capability to deploy Federal Medical Stations, which can provide stand-alone surge capacity. These will be reserved for the worst hit areas.

  “Finally, we are encouraging all states to implement their plans to handle hospital overflow by creating secondary sites to treat infected individuals.”

  Paul motioned to a reporter standing near the back of the room.

  “Thank you, Shalen McAbee, FBC. You mentioned nearly 30 deaths in the New York area alone. Will you comment on the situation surrounding those deaths?”

  “You mean what caused them?” Paul asked.

  The room broke into a brief period of laughter.

  “I suppose that’s a more direct way of putting it,” Shalen responded, grinning.

  “Most of the deaths are due to acute respiratory distress syndrome, and we have a few due to heart attack or yet undetermined causes.”

  “Is this the same nationwide?” Shalen added.

  “Yes, very similar. ARDS is responsible for at least 90% of the 181 deaths directly attributed to the Jakarta flu. The remaining 10% are all acute events, like heart attack, fatal hypoglycemia, or immediate lung failure due to preexisting lung disease. Most of the ARDS-related fatalities occurred within 24-48 hours of showing symptoms, some as quick as 8-12. Almost all within a hospital setting, though we have reports of deaths occurring within the communities, prior to individuals seeking medical care. This is why it is imperative that individuals with flu-like symptoms seek immediate care from their physician or closest hospital.”

  “Do you have any data regarding survival rates for ARDS caused by the Jakarta flu?”

  John Merrill stepped forward once again.

  “At this time, we do not have any data regarding survival rates for ARDS, however, the occurrence rates for ARDS are around 5%, which is encouraging news. In Asia, some of the early data indicated ARDS rates as high as 10-20%.”

  He stepped back to the left of Paul.

  “Every time that guy steps forward, I get suspicious,” Kate said.

  “Yeah, I think it’s a really sensitive topic that needs extra spin from the puppet master,” Alex added.

  “Suzanne Wilkins, SPOT News. According to the National Pandemic Plan, your department is tasked with assessing surge capacity of medical and emergency response systems. What is DHHS’s assessment based on worldwide Jakarta flu trends?”

  Surprisingly, to both Kate and Alex, John did not step forward, though he looked like he was straining to remain in his station next to Paul.

  “Currently, our assessment is positive. Based on worldwide trends and our nation’s pandemic response capability, we anticipate sufficient surge capacity to handle the pandemic.”

  John finally broke free of the invisible force keeping him in place.

  “A few major factors affect this assessment. First, the U.S. is a nation with a modernized healthcare system, second to none in the world. I know that a few countries have already hit their surge capacity, but those models will not apply here. We have an incredible healthcare system, and the Strategic National Stockpile gives us the ability to enhance this system if necessary.

  “Secondly, not every single person that is infected requires hospital care. The vast majority can be treated at home, especially when given antivirals to reduce the severity of symptoms. At this time, we do not anticipate the Jakarta flu overwhelming the healthcare system. With that being said, we are closely watching all aspects of the pandemic and will take the immediate and necessary steps if, and I emphasize if, that assessment changes. Thank you.”

  A woman in the second row spoke up immediately after John’s comment.

  “You mentioned the antiviral stockpile again as a key strategy for keeping the pandemic under control. The nation’s stockpile program is close to 32 million doses short of the projected 2012 goal to have enough doses for 25% of the population. Is this shortage figured into that assessment?”

  Another reporter sitting behind her fired follow-up questions before either John or Paul could react.

  “And what about reports of resistance to Tamiflu? Or that the Jakarta flu may require higher doses due to higher virulence?”

  Paul took control of the situation.

  “Ladies and gentlemen, one question at a time, please. First, the department’s assessments take into account the state level shortfall. As of last month, the Strategic National Stockpile contained nearly 39 million doses of Tamiflu, which is only a few million doses s
hort of our goal. Unfortunately, the state level stockpiling effort fell short of our expectations. Our plan directed that 32 million doses be purchased at the state level, and currently, state stockpiles only account for about 7 to 8 million doses.”

  The room started to stir, as nearly 100 reporters started whispering.

  “However, DHHS has reached an agreement with Roche pharmaceuticals that will bridge this gap. Roche has agreed to divert all of their current inventory to the Strategic National Stockpile, and for an indefinite period, all future production of their antiviral will be dedicated to pandemic response efforts.”

  “I didn’t hear anything about Biosphere?” Kate said.

  Alex shrugged his shoulders.

  “As for the rumors about resistance. It is true that a low incidence of resistance has been detected to older flu strains, like H1N1 and H5N1, but that has not been the case with H16N1. Data emerging from Asia does not suggest any resistance to currently available antivirals.”

  “Nice that this data is readily available, but nothing about ARDS,” Alex commented.

  “Right now, we are unaware of any need to increase the dose of Tamiflu to effectively treat the Jakarta flu. The CDC will be tracking this issue closely. With the current information available, we remain convinced that a typical course of therapy will be sufficient to reduce the symptoms and duration of H16N1 infection. Ladies and gentlemen, we’ll take a few more questions.”

  This announcement brought most of the reporters out of their chairs, trying to gain Paul’s attention, many simply yelling their questions at Paul. Paul remained unmoved by their attempts, focusing toward the back of the room.

  “Audra,” he announced, pointing to Audra Jefferson, from FBC. Most of the reporters lowered back into their seats.

  “Thank you. Does your department recommend any action by state or local governments to implement community social distancing strategies, like school closures or work schedule modifications?”

  “No, currently we do not recommend activating any of these strategies. Taking these actions too early can be severely disruptive on many levels. The department plans to reconsider this recommendation early next week, when more data is available to accurately forecast the flu’s impact on the nation. This does not preclude local governments from implementing these strategies, however, it is not warranted by current conditions.”

  Alex looked at Kate, shaking his head.

  “What do they think is going to happen over the next few weeks?” Alex asked.

  “But given the case fatality rates demonstrated in Asia, specifically Indonesian and China, by your department’s own classification, this is a category 5 pandemic. And by your own national plan, in a category 5 situation, all of the community mitigation strategies would be implemented. Why wait for the pandemic to spread?”

  John stepped forward to handle her continuation of the question.

  “The pandemic severity index, linked to community mitigation strategies is a guideline for action. As Paul said, most of these strategies have a heavy impact on society. School closures force parents to find childcare alternatives, in many cases negating the benefit of a school closure. Many parents cannot afford these alternatives and will be forced to either leave children unattended or miss work, which causes more problems. If parents miss work, they may lose their jobs. Increased absenteeism, already an issue in a flu pandemic, can impact the delivery of essential services, like food, electricity, payroll, financial, and emergency services. Even the most mundane job can contribute to an essential service. Therefore, implementation of these strategies is not taken lightly, as they impact everyone.

  “This department, with the full support of the administration, will continue to analyze all of the data, forecasts and recommendations provided by the CDC and ISPAC. By early next week, I am confident that we will understand enough of our situation to make decisions regarding community mitigation strategies.”

  As John stepped back, all of the reporters flew off their seats, yelling and gesturing toward Paul, but the press conference was finished.

  This marks the end of the fictional Media segments.

  Read on for excerpt of Black Flagged

  Excerpt from Black Flagged

  BLACK OUT

  April 8, 1999

  2:35 P.M.

  A few miles outside of Vizic, Serbia

  Marko Resja peered cautiously over the top of the jagged stone wall, scanning the lodge's distant front porch with powerful binoculars. Through the driving downpour, he counted four men, which was a good thing. With the entire external security team in one place, he should have no trouble approaching unseen.

  He lowered himself to the spongy, pine-needle-covered ground and leaned back against a sharp granite chunk that formed part of the estate's perimeter wall. Created by haphazardly dumping large uneven rocks around the lodge on all sides, the utilitarian border marked the divide between hastily cleared land and the impenetrable Fruska Gora National Forest.

  Marko had arrived at the stone wall one hour earlier, hampered by the same relentless rainfall that had kept NATO aircraft at bay for more than a week. Concealed in the dense pine foliage behind the jagged barrier, he could hear the distant roar of high altitude jets through the unremitting storm. He guessed the NATO pilots were testing Belgrade's air defense network from a safe distance, impatient for the weather to clear over the northern Balkan Peninsula.

  He stared out into the wavering pine forest before turning his attention back to the lodge. The two-story, modern, stone and beam structure looked sturdy enough to withstand an artillery attack. A similarly constructed, one-story garage stood between him and the house, partially obscuring his view of the main structure.

  Srecko Hadzic, ruthless leader of the paramilitary Serbian Panther crime syndicate, had built the lodge for the sole purpose of hiding his brother, Pavle, from prying eyes. Rumors of NATO commando teams operating within Serbian borders had taken root among upper level leadership, raising paranoia to near panic levels, and Hadzic feared Pavle's capture more than his own at this point. Unfortunately for Hadzic, the Vizic compound was one of the worst-kept secrets in Belgrade.

  He took one more look over the top of the wall, just to make sure all four men were still on the porch. He spotted the bright orange glow of cigarettes through the nearly impenetrable rain squall. He didn't expect any of them to emerge from their cozy shelter, but he had to keep in mind that these men were all current or former Serbian Special Operations types, and despite the overindulgences often associated with paramilitary security details, all of these men had been hand-picked for their competence. Three more had accompanied Radovan Grahovac, Hadzic's chief of security, into the lodge to meet with Pavle.

  They had all arrived dressed in civilian clothes, which suggested that the crew might head north for a night of prostitutes and drinking along the banks of the Danube River in Novi Sad. Despite their casual dress, however, each man carried a compact assault rifle and a pistol. Under normal circumstances, this was not a crew he would cross. Today, Marko would make a notable exception.

  Satisfied that all four men were still in the same place, he picked up a long, thick, black nylon duffel bag and ran to a position along the wall that was completely obscured from the porch by the garage. He knew from two previous reconnaissance trips that Radovan didn't stay more than ten minutes, which meant he was already running out of time.

  From his new vantage point, he glanced over the wall and saw one of two dark blue Range Rovers that had arrived at Pavle's hideaway a few minutes ago, depositing Radovan and his heavily-armed security detail. The other Range Rover was parked several meters behind the first, hidden from his view by the garage.

  He kneeled low and wrestled a Serbian-made light machine gun out of the soaked nylon bag, extending the weapon's foldable shoulder stock. He placed the weapon against the wall and reached back into the bag for one of two detachable ammunition drums. He swiftly attached one of the seventy-five-round drums to the w
eapon and placed the second in a hip satchel.

  Beyond the high-capacity ammunition drums, he had four standard thirty-round magazines velcroed into quick-access pouches on his combat vest, nestled among four stun grenades. He screwed a large silencer to the machine gun's barrel and chambered a round with the weapon's charging lever. The final item he took from the bag was a gray, aluminum ice-climbing axe, which he attached low on the side of his vest. He was ready.

  He gripped the sturdy assault weapon with his left hand and hopped over the rock wall, using his right hand for leverage. After splashing down in ankle-high mud, he slogged through the torrential rain to reach the left back corner of the garage. From that spot, he'd be able to see the four men leave the porch, which was critical to his plan.

  Marko arrived at the corner, careful not to expose himself. He checked all of his gear one more time, wishing he could check the computer and satellite phone in his waterproof backpack, but just as quickly dismissing the idea as last minute paranoia. He knew the electronics rig worked, and that it would give him a secure satellite connection for both the satellite phone and his computer. He had assembled and tested it nearly a dozen times within the last twenty-four hours. He might not even need it, but he wasn't about to take any chances, and neither was General Sanderson.

  The rain intensified for a minute, as sheets of water pummeled the side of the garage. Despite having been exposed to the frigid early spring rain for nearly two hours, he wasn't cold. Under his paramilitary camouflage outfit, he wore a waterproof, insulated one-piece jumpsuit. Certainly not standard issue for elite Serbian commandos or even the most pampered members of Hadzic's paramilitary forces.