by Tom Clancy
"I think it's a good time to get the boats at Diego moving. It never hurts to exercise them. We can move them to within two steaming days of the Gulf without anybody noticing. Next, I recommend that we issue warning orders to XVIII Airborne Corps. That's the 82nd, 101st, and 24th Mechanized."
"Will it make noise?" Jack asked.
"No, sir. It's treated as a practice alert. We do those all the time. All it really does is to get staff officers thinking."
"Make it so. Keep it quiet."
"This would be a good time to do a joint training exercise with friendly nations in the region," J-3 suggested.
"I'll see about that. Anything else?"
"No, Mr. President," Bretano replied. "We'll keep you informed."
BY NOON, THE fax count at CDC Atlanta was over thirty, from ten different states. These were forwarded to Fort Detrick, Maryland, home of the United States Army Medical Research Institute of Infectious Diseases— USAMRIID—the military counterpart to the Centers for Disease Control and Prevention in Atlanta. As chilling as the data was, it was just a little too chilling for snap judgment. A major staff meeting was called for just after lunch, while the commissioned officers and civilians tried to get their data organized. More senior officers from Walter Reed got in their staff cars for the ride up Interstate-70.
"DR. RYAN?"
"Yes?" Cathy looked up.
"The meeting in Dr. James's office has been moved up," her secretary said. "They want you over there right now."
"I guess I better head over, then." She stood and headed for the door. Roy Altman was standing there.
"Anything I need to know about?" SURGEON'S principal agent asked.
"Something's up. I don't know what it is."
"Where is the dean's office?" He'd never been there before. All of the staff meetings she'd attended recently were in Maumenee.
"That way." She pointed. "Other side of Monument Street in the admin building."
"SURGEON is moving, going north to Monument." The agents just appeared out of nowhere, it seemed. It might have seemed funny except for recent events. "If you don't mind, I'll stand in the room. I'll keep out of the way," Altman assured her.
Cathy nodded. There was no fighting it. He'd hate the dean's office for all the big windows there, she was sure. It was a ten-minute walk over, almost all of it undercover. She headed outdoors to cross the street, wanting a little fresh air. Entering the building, she saw a lot of her friends, either department chairmen or senior staffers standing in as she was doing. The director-level people were always traveling, one reason why she wasn't sure if she ever wanted to be that senior herself. Pierre Alexandre stormed in, wearing greens, carrying a folder, and looking positively grim as he almost bumped into her. A Secret Service agent prevented that.
"Glad you're here, Cathy," he said on the way past. "Them, too."
"Nice to be appreciated," Altman observed to a colleague, as the dean appeared at the door.
"Come in."
One look at the conference room convinced Altman to lower the shades with his own hands. The windows faced a street of anonymous brick houses. A few of the doctors looked on with annoyance, but they knew who he was and didn't object.
"Calling the meeting to order," Dave James said, before everyone was seated. "Alex has something important to tell us."
There was no preamble: "We have five Ebola cases in Ross right now. They all came in today."
Heads turned sharply. Cathy blinked at her seat at the end of the table.
"Students from someplace?" the surgery director asked. "Zaire?"
"One auto dealer and his wife, a boat salesman from Annapolis, three more people. Answering your question, no. No international travel at all. Four of the five are fully symptomatic. The auto dealer's wife shows antibodies, but no symptoms as yet. That's the good news. Our case wasn't the first. CDC has cases reported in Chicago, Philadelphia, New York, Boston, and Dallas. That's as of an hour ago. Total reported cases is twenty, and that' number doubled between ten and eleven. Probably still going up."
"Jesus Christ," the director of medicine whispered.
"You all know what I did before I got here. Right now I imagine they're having a staff meeting at Fort Detrick. The conclusion from that meeting will be that this is not an accidental outbreak. Somebody has initiated a biological-warfare campaign against our country."
Nobody objected to Alexandre's analysis, Cathy saw. She knew why. The other physicians in the room were so bright that sometimes she wondered if she belonged on the same faculty with them—she had never considered that most of them might harbor the same thoughts. All of them were world experts in their fields, at least four the very best there was. But all of them also spent time as she did, having lunch with a colleague in a different field to exchange information, because, like her, they were all truly fanatical about learning. They all wanted to know everything, and even though they knew that such a thing was impossible, even within one professional field, that didn't stop them from trying. In this case, the suddenly rigid faces concealed the same analytical process.
Ebola was an infectious disease, and such diseases started from a single place. There was always a first victim, called Patient Zero or the Index Case, and it spread from there. No disease just exploded in this way. CDC and USAMRIID, which had to make that conclusion official, would have the duty to assemble, organize, and present information in what was almost a legalistic structure to prove their case. For their medical institution, it was simpler, all the more so because Alex had commanded one of the divisions at Fort Detrick. Moreover, since there was a plan for everything, Johns Hopkins was one of the institutions tapped to receive cases in the event something like this took place.
"Alex," the director of urology said, "the literature says that Ebola is only spread by large particles of liquid. How could it explode so fast, even at the local level?"
"There's a sub-strain called Mayinga. It's named for a nurse who picked it up and died. The method of her infection was never determined. A colleague of mine, George Westphal, died of the same thing in 1990. We never determined the means of transmission in his case, either. There is thought that this sub-strain may spread by aerosol. It's never been proven one way or the other," Alex explained. "Besides, there are ways to fortify a virus, as you know. You admit some cancer genes into the structure."
"And there's no treatment, nothing experimental even?" Urology asked.
"Rousseau is doing some interesting work at Pasteur, but so far he hasn't produced any positive results."
A physical reaction, ripped down the conference table from one physician to another. They were among the best in the world, and they knew it. They also knew now that it didn't matter against this enemy.
"How about a vaccine?" Medicine asked. "That shouldn't be too hard."
"USAMRIID has been playing with that for about ten years. The first issue is that there seems to be a specificity problem. What works for one sub-strain may not always work with another. Also, the quality-control issue is a killer. Studies I've seen predict a two-percent infection rate from the vaccine itself. Merck thinks they can do better, but trials take time to run."
"Ouch," Surgery commented with a wince. Giving one person out of fifty a disease with an eighty-percent mortality rate—twenty thousand people infected per million doses, of whom roughly sixteen thousand might die from it. Applied to the population of the United States, it could mean three million deaths from an attempt to safeguard the population. "Hobson's choice."
"But it's too early to determine the extent of the national epidemic, and we do not have hard data on the ability of the disease to spread in existing environmental conditions," Urology thought. "So we really aren't sure what measures need to be taken yet."
"Correct." At least it was easy to explain things to these people.
"My people will see it first," Emergency said. "I have to get them warned. We can't risk losing our people unnecessarily."
"Who tells Jack?" Cathy wondered alo
ud. "He's got to know, and he's got to know fast."
"Well, that's the job of USAMRIID and the Surgeon General."
"They're not ready to make the call yet. You just said that," Cathy replied. "You're sure about this?"
"Yes."
SURGEON turned to Roy Altman: "Get my helicopter up here stat."
49 REACTION TIME
COLONEL GOODMAN WAS surprised by the call. He was having a late lunch after a check-flight for a spare VH-60 just out of the maintenance shop for engine replacement. The one he used for SURGEON was on the ramp. The three-man crew walked out to it and spooled up the engines, not knowing why the schedule for the day had changed. Ten minutes after the call, he was airborne and heading northeast. Twenty minutes after that, he was circling the landing pad. Well, there was SURGEON, with SANDBOX by her side, and the Secret Service squad… and one other he didn't know, wearing a white coat. The colonel checked the wind and began his descent.
The faculty meeting had gone on until five minutes before. Decisions had to be made. Two complete medical floors would be cleared and tooled up for possible Ebola arrivals. The director of emergency medicine was even now assembling his staff for a lecture. Two of Alexandre's people were on the phone to Atlanta, getting updates on the total number of known cases, and announcing that Hopkins had activated its emergency plan for this contingency. It meant that Alex hadn't been able to go to his office and change clothes. Cathy was wearing her lab coat, too, but in her case it was over a normal dress. He'd been wearing greens—his third set of the day—for the meeting, and still was. Cathy told him not to worry about it. They had to wait for the rotor to stop before the Secret Service allowed their protectees to board the aircraft. Alex noted the presence of a backup chopper, circling a mile away, and a third circling closer in. It looked like a police bird, probably for security, he imagined.
Everyone was bundled aboard. Katie—he'd never met her before—got the jump seat behind the pilots, supposedly the safest place on the aircraft. Alexandre hadn't ridden in a Black Hawk in years. The four-point safety belt still worked, though. Cathy snapped hers right in place. Little Katie had to be helped, but she loved her helmet, painted pink, with a bunny on it, doubtless some Marine's idea. Seconds later the rotor started turning.
"This is going a little fast," Alex said over the intercom. "You really think we should wait?"
Cathy replied, keying her microphone. "No." And it wouldn't do to say that he wasn't dressed for seeing the President. The aircraft lifted off, climbed about three hundred feet, and turned south.
"Colonel?" Cathy said to the pilot in the right-front seat.
"Yes, ma'am."
"Make it fast," she ordered. Goodman had never heard SURGEON talk like a surgeon before. It was a voice of command that any Marine would recognize. He dropped the nose and brought the Black Hawk to 160 knots.
"You in a hurry, Colonel?" the backup chopper called.
"The lady is. Bravo routing, direct approach." Next he called to BWI Airport to tell the controllers to hold arrivals and departures until he'd passed overhead. It wouldn't take long. Nobody on the ground really noticed, but two USAir 737s had to go around once, to the annoyance of their passengers. Watching from the jump seat, SANDBOX thought it was pretty neat.
"MR. PRESIDENT?"
"Yes, Andrea?" Ryan looked up.
"Your wife is inbound from Baltimore. She needs to see you about something. I don't know what. About fifteen minutes," Price told him.
"Nothing's wrong?" Jack asked.
"No, no, everybody's fine, sir. SANDBOX is with her," the agent assured him.
"Okay." Ryan went back to the most recent update of the investigation.
"WELL, IT'S OFFICIALLY a clean shoot, Pat." Murray wanted to tell his inspector that himself. There hadn't been much doubt of that, of course.
"Wish I could have taken the last one alive," O'Day remarked with a grimace.
"You can stow that one. There was no chance, not with kids around. I think we'll probably arrange a little decoration for you."
"We have anything on that Azir guy yet?"
"His driver's license photo and a lot of written records, but aside from that, we'd have a hard time proving he ever existed." It was a classic set of circumstances. Sometime Friday afternoon, "Mordecai Azir" had driven his car to Baltimore-Washington International Airport and caught a flight to New York-Kennedy. They knew that much from the USAir desk clerk who'd issued him the ticket in that name. Then he'd disappeared, like a cloud of smoke on a windy day. He doubtless had had a virgin set of travel documents. Maybe he'd used them in New York for an international flight. If he'd really been smart, he would have caught a cab to Newark or LaGuardia first, and taken an overseas flight from the former, or maybe a flight to Canada from the latter. Even now agents from the New York office were interviewing people at every airline counter. But nearly every airline in the world came into Kennedy, and the clerks there saw thousands per day. Maybe they would establish what flight he'd taken. If so, he'd be on the moon before they managed that feat.
"Trained spook," Pat O'Day observed. "It's really not all that hard, is it?"
What came back to Murray were the words of his FCI chief. If you could do it once, you could do it more than once. There was every reason to believe that there was a complete espionage—worse, a terrorist—network in his country, sitting tight and waiting for orders… to do what? And to avoid detection, all its members really had to do was nothing. Samuel Johnson had once remarked that everybody could manage that feat.
THE HELICOPTER FLARED and landed, rather to the surprise of the newspeople who always kept an eye out. Anything unexpected at the White House was newsworthy. They recognized Cathy Ryan. Her white doctor's coat was unusual, however, and on seeing another person dressed in the same way but wearing greens, the immediate impression was of a medical emergency involving the President. This was actually correct, though a spokesman came over to say that, no, the President was fine, working at his desk; no, he didn't know why Dr. Ryan had come home early.
I'm not dressed for this, Alex thought. The looks of the agents on the way to the West Wing confirmed that, and now a few of them wondered if SWORDSMAN might be ill, resulting in a few radio calls that were immediately rebuffed. Cathy led him down the corridor, then tried the wrong door until an agent pointed and opened the one into the Oval Office. They noted that she didn't bother with anger or embarrassment at the mistake. They'd never seen SURGEON so focused.
"Jack, this is Pierre Alexandre," she said without a greeting. Ryan stood. He didn't have any major appointments for another two hours, and had shed his suit coat. "Hello, Doctor," he said, extending his hand and taking in the manner of his visitor's dress.
Then he realized that Cathy had her work coat on as well. "What's going on, Cathy?" he asked his wife. "Alex?" Nobody had even sat down yet. Two Secret Service agents had followed the physicians in, and the tension in the room was like an alarm bell for them, though they didn't know what was going on, either. Roy Altman was in another room, talking to Price.
"Mr. President, do you know what the Ebola virus is?"
"Africa," Jack said. "Some jungle disease, right? Deadly as hell. I saw a movie—"
"Pretty close," Alexandre confirmed. "It's a negative-strand RNA virus. We don't know where it lives—I mean, we know the place but not the host. That's the animal it lives in," he explained. "And it's a killer, sir. The crude mortality rate is eighty percent."
"Okay," POTUS said, still standing. "Go on."
"It's here now."
"Where?"
"At last count we had five cases at Hopkins. More than twenty countrywide—that number is about three hours old now. Can I use the phone?"
GUS LORENZ WAS alone in his office when the phone rang.
"It's Dr. Alexandre again."
"Yes, Alex?"
"Gus, what's the count now?"
"Sixty-seven," the speakerphone replied. Alex was leaning over it.
"Where?"
"Mainly big cities. The reports are coming in mostly from major medical centers. Boston, New Haven, New York, Philadelphia, Baltimore, one in Richmond, seven right here in Atlanta, three in Orlando…" They could hear a door open and a paper being handled. "Eighty-nine, Alex. They're still coming in."
"Has USAMRIID put the alert out yet?"
"I expect that within the hour. They are having a meeting to determine—"
"Gus, I am in the White House right now. The President is here with me. I want you to tell him what you think," Alexandre commanded, speaking like an Army colonel again.
"What—how did you—Alex, it's not sure yet."
"Either you say it or I will. Better that you do."
"Mr. President?" It was Ellen Sumter at the side door. "I have a General Pickett on the phone for you, sir. He says it's most urgent."
"Tell him to stand by."
"John's good, but he's a little conservative," Alex observed. "Gus, talk to us!"
"Sir, Mr. President, this appears to be something other than a natural event. It looks very much like a deliberate act."
"Biological warfare?" Ryan asked.
"Yes, Mr. President. Our data isn't yet complete enough for a real conclusion, but naturally occurring epidemics don't start this way, not all over the place."
"Mrs. Sumter, can you put the general on this line?"
"Yes, sir."
"Mr. President?" a new voice asked.
"General, I have a Dr. Lorenz on the line, and next to me is Dr. Alexandre from up the road at Hopkins."
"Hi, Alex."
"Hi, John," Alexandre responded.
"Then you know."
"How confident are you in this estimate?" SWORDSMAN asked.
"We have at least ten focal centers. A disease doesn't get around like that by itself. The data is still coming in, sir. All these cases appearing in twenty-four hours, it's no accident, and it's no natural process. You have Alex there to explain things further. He used to work for me. He's pretty good," Pickett told his commander-in-chief.
"Dr. Lorenz, you concur in this?"
