by Daniel Kalla
Five nail-biting days had passed without a new case of ARCS reported in Jiayuguan City or anywhere else in the Gansu province. With the tacit approval of Noah Haldane and the WHO team, the provincial authorities declared “absolute victory over the Gansu Flu.” They intended to trumpet their triumph to the whole world. The provincial governor had flown in from Lanzhou, while the Deputy Premier had come from Beijing. Scores of party officials and dignitaries had collected from all across China for the occasion. And the international press, who had been barred from the region during the epidemic, was welcomed to the celebratory gala dinner where the members of the WHO team were the guests of honor.
Haldane was itching to get home. He hadn’t seen Chloe in almost three weeks, and he hated the idea of another day passing without seeing his daughter. He wouldn’t have delayed his departure one minute for the self-congratulatory feast, but there weren’t any flights leaving until the morning. Along with a navy sports jacket, a blue casual shirt, and black cotton pants, he put on a brave face and headed down to the banquet.
Any concern of being the most underdressed at the event evaporated when he laid eyes on Duncan McLeod. The redhead had tamed his hair with at least one pass of a brush, but he still carried deep bags under his eyes from the bender of three nights before. Wearing rumpled wool pants and a tattered sweater, he stood out even more than usual among the formally dressed crowd.
Haldane sat between McLeod and Jean Nantal, the WHO’s Executive Director of Communicable Diseases, who had flown in that morning from Geneva. The silver-haired Frenchman wore a natty four-button black suit along with a beaming smile that he hadn’t shed since arriving. For the third time that evening, he raised his wineglass and individually toasted each of the four WHO members at his table. “You have made me so proud.” He beamed.
“I’m not toasting me or anyone else,” McLeod said, leaving the full wineglass untouched in front of him. “I’m through with drink.”
Helmut Streicher put down his own glass and let out an uncharacteristic laugh. “Ja, for a Scotsman, you don’t hold your alcohol so well. Hah!”
“Ah, there’s that wonderful Germanic sense of humor,” McLeod grunted sarcastically.
Milly Yuen, who had turned beet-red after two sips of wine, giggled at the exchange.
Haldane tipped his glass to Nantal. “Jean, the Chinese didn’t need us this time. They were going to contain the virus at any and all cost.”
“Not necessarily, my humble friend,” Nantal said in his buttery smooth French accent. “After all, who helped coordinate their quarantine?” He raised his glass to Streicher. Then he turned to Haldane with a proud, paternal nod. “And was it not you who initiated the livestock slaughter?”
Haldane shrugged.
Nantal looked around the indifferent faces at the table. “Your modesty aside, mes amis.” His smile broadened. “It does not hurt for the WHO to get a little credit and positive press now and again. Downplay it all you want, but you’ve earned this.” His hand swept fluidly across the sea of dignitaries and cameras in front of them. “The WHO has earned it. And I for one won’t shy away.”
“Glad to hear you say that.” McLeod pointed at his chest. “Means you won’t have any problem with me taking the next three months off.”
“Duncan? You’re asking for vacation time?” Nantal laughed. “This truly is a day of marvels.”
As McLeod was about to respond a waiter tapped Nantal on the shoulder. After a brief whispered exchange, Nantal rose to his feet. “Excuse me, I must take a phone call.”
After Nantal left, the speeches began. For the benefit of the WHO team, the deputy premier spoke in English. Haldane had heard the same type of political speech a hundred times before—pure rhetoric and revisionist history. The deputy premier commended the local medical personnel’s “heroic battle” against the virus, and hailed their success in halting its spread. He praised the people of Jiayuguan City’s bravery as if they had chosen to be fenced in behind barbed wire. He often used the term “we,” even though he had kept three thousand miles between himself and the epidemic. And finally, he lauded the WHO team for coming to offer their expertise to the local specialists “where needed,” implying that while they had appreciated the help it wasn’t actually required.
During the protracted standing ovation for the WHO doctors that followed the speaker’s remarks, the same waiter who had pulled Nantal away from the table came for Haldane.
Nantal sat behind the desk in the borrowed office, speaking urgently in French into the phone’s receiver. When he saw Noah at the door, he waved him over to the chair across from his.
When the Frenchman hung up the phone and looked up at Haldane, his face was fixed in a disconsolate frown. Haldane couldn’t ever remember seeing Nantal fazed before. His boss looked as if he had aged ten years in the thirty minutes since he’d left the dinner table. “What is it, Jean?” Haldane asked.
Nantal spoke in a quiet subdued tone. “A little girl in a London hospital has tested positive for the virus.”
Haldane shook his head, refusing to make the connection. “What virus?”
Nantal just stared at him.
“You’re not serious, Jean!” Haldane leaned forward and gripped the edge of the desk. “The Gansu Flu has shown up in London, England?”
Nantal nodded.
Haldane stood without even realizing it. “Has the girl been over here in the last month?”
Nantal shook his head. “She’s not Chinese. Neither she nor anyone else in the family has ever been to China.”
Haldane lowered himself back into his seat. “Then why do they think it’s the Gansu Flu?”
“A PCR probe. Our European Influenza Surveillance ran the blood test. It matched.”
Haldane shook his head, unwilling to accept the lab’s verdict and its implications. “Then someone in the lab screwed up!”
Nantal stared at Haldane for several seconds. “Noah, there are others,” he said softly.
“Others!” Haldane’s heart slammed against his rib cage. He took a deep breath. “Okay. Back up, Jean. Tell me what you know.”
“There have been five cases reported in London,” Nantal said. “They all came from the same exclusive hotel, the Park Plaza Tower, in London’s business district One of the victims has already died.”
Haldane gritted his teeth. “The little girl?”
“No. A fifty-five-year-old American oil company executive. He was found dead in his hotel room.”
The fact that it wasn’t the little girl brought a sense of irrational relief to Haldane. The shock subsided. His mind raced, already planning steps ahead. “Do we have the index case?” he asked.
Nantal ran a thumb and a finger along his eyebrows and then shook his head. “None of the victims have traveled to China in the last three months.”
“So someone else brought it over,” Haldane said. “All right, who was the first to become sick?”
“We will never know when the oil company executive first developed symptoms, but the four-year-old girl was the first to be hospitalized.”
“When?” Haldane demanded.
“Three days ago.”
“One more day and she’ll make it,” Haldane mumbled to himself.
Nantal tilted his head. “I’m sorry, Noah, I do not follow.”
“Nothing.” Haldane tapped the desktop in front of him. “The other cases, Jean. When were they first reported?”
Nantal consulted the notes written in flawless script on the pad in front of him. “Two of the cases showed up within twelve hours of the little girl. The other two just declared themselves this morning. They were guests at the same hotel. As soon as they developed fever and cough, they were immediately isolated.”
“So we have a two-day gap between the initial cases and the last two. Those two must be the result of collateral spread from the first set,” Haldane said, describing the phenomenon of secondary spread of the virus from one “generation” of victims to the next.
“I agree,” Nantal said.
“And none of the hospital staff who treated the victims have shown signs of infection?” Haldane asked.
Nantal shook his head. “Thankfully, the hospitals have been very responsible in instituting early precautions, but several of the nurses and doctors are in quarantine.”
“Good,” Haldane said. “Five days should be long enough. What about the staff and guests at the hotel?”
“All of them are in quarantine,” Nantal said.
“Voluntary?”
“We’re talking about England, my friend,” Nantal pointed out graciously. “I don’t think they erect barbed-wire fences. But from what I have heard people are cooperating.”
“They had better,” Haldane said. “Are they getting word out to the public, Jean?”
“I don’t yet have those details,” Nantal said. “I hear that the media in London is spreading the news, but the authorities are concerned about the public’s response. They are worried about causing wide-scale panic.”
Haldane threw up his hands. “If they don’t get on top of this thing now they’ll see wide-scale panic, and with damn good reason!” Realizing he was “shooting the messenger,” Haldane lowered his voice. “Jean, they need to immediately set up screening clinics like we did with SARS. It’s the only hope of containment.” He paused. “If that still even is a hope.”
Nantal reached over and patted Haldane on the hand. “We helped contain it in Jiayuguan City, Noah. We can do the same in London.”
Haldane looked down at the liver spots on his mentor’s hand. The sight dejected him. Even the great Jean Nantal, a pillar in the struggle against nature gone awry, wasn’t immune to the inevitability of biology. “We need to find that index case, Jean.”
“You’ll go to London then?”
Haldane closed his eyes and exhaled heavily. Then he nodded.
Nantal squeezed Noah’s hand once before withdrawing his hand. He studied Haldane, hesitating, before he finally spoke. “Noah, I know you won’t want to hear this now, but we have suspect cases elsewhere. Not confirmed yet microbiologically but clinically very suspicious.”
“Outside of London?”
“Quite a ways.” Nantal smiled halfheartedly. “Two people in Hong Kong have developed classic symptoms.”
The sense of déjà vu slammed Haldane like a punch. It was SARS all over again, but with a far more vicious bug. “We have to get out of here, Jean. Tonight!”
HEATHROW AIRPORT, LONDON, ENGLAND
The flights were a blur. Emotionally drained by the catastrophic developments and the subsequent phone call home to explain his further delay, Haldane dozed in and out of a restless nonrestorative sleep for much of the eighteen hours and three transfers it took to get them to Heathrow Airport in London.
The whole team had been rocked by the news of the spread, but Duncan McLeod seemed to take it hardest. “The son of a bitch has decided to visit my miserable island. I’m not going to take that lying down!” he said when he first heard the news. He had hardly spoken since.
At the Beijing Airport, the team had separated. Nantal, Streicher, and Yuen boarded a flight for Switzerland, while Haldane and McLeod headed directly to London.
Through the throngs of people standing at the arrival gate of Heathrow—which struck Haldane as a microcosm of cultural and global diversity—he spotted a thin woman holding up a placard reading: “Drs. Haldane and McLeod.” He nudged McLeod with an elbow, and the two of them walked over to meet her.
“Doctors, I am Dr. Nancy Levine, the Assistant Director of the London Health Commission,” she said without smiling as she met their handshakes. “I can explain further once we are on the road. Please follow me” She headed for the exit. Of average height but skinny to the point of bony, Levine had black hair tied in a tight ponytail, thin lips, and sunken brown eyes. She wore no makeup. Her humorless expression was consistent with her abrupt to-the-point disposition. Haldane suspected it long predated the current crisis.
Outside, London’s gray skies spat a cool November drizzle. Walking to the car, Haldane wondered if he was ever going to see the sun shine again. Once they had loaded into Levine’s Land Rover—Haldane in the passenger seat, and McLeod in the back—she explained the command structure of the city’s public health system. “The Commission coordinates six separate government agencies under one umbrella organization,” she said in her clipped, upper-crust English accent. “We are responsible for overseeing all aspects of Londoners’ health, including management of infectious outbreaks and epidemics.”
“Sounds incredibly busy,” Haldane said. “Thanks for taking the time to pick us up.”
“It’s a matter of expedience,” she said with a shrug of her narrow shoulders. “This is the ideal opportunity for you to describe to me your firsthand experience with the Gansu strain of the influenza virus. And more specifically, to explain how the Chinese managed to arrest its spread.”
“We wouldn’t be here if they had managed that!” McLeod grunted from the backseat.
“Clearly,” Levine said. “What I meant is how they contained it locally. That is what I need to know from you.”
“Dr. Levine, Jiayuguan is a remote community. A small city in the middle of nowhere,” Haldane said. “It bears no comparison to London.”
“That aside, Dr. Haldane ...” Levine harrumphed.
“They put a section of the city under siege, Dr. Levine,” Haldane said. “In a democracy you could never get away with the kind of cold military offensive the Chinese government used.”
Levine stared ahead silently for a moment. “Are you familiar with our Emergency Health Act?”
“Not the specifics,” Haldane said.
“Enacting it would be the equivalent of imposing martial law,” she said. “You would be surprised by exactly what we could do.”
“Martial law,” McLeod echoed. “That’s what you’ll need, too.”
Levine glanced at Haldane. “Can you please describe your clinical observations?” she said. It was a command, not a request.
Staring out the window and watching suburban London give way to the more congested metropolitan areas, Haldane painted an overview of the Gansu outbreak, coloring it with his eyewitness perspective. McLeod muttered the occasional clarification or facetious remark.
After Haldane finished, Dr. Levine asked a few pointed insightful questions. Once she had fielded her queries, she lapsed into silence. Haldane got the feeling that having exhausted her passengers’ usefulness, Levine would have been pleased to pull over and let them off at the side of the road.
“Where are you taking us now?” Haldane asked.
“To the Commission’s head office,” she said. “The others are expecting us.”
“They will have to wait,” Haldane said.
“Pardon me?” she asked indignantly.
“I want to talk to the surviving victims.”
“In good time, Dr. Haldane.”
“No, Dr. Levine. Now.”
“Dr. Haldane, this is not China,” she said quietly. She kept her eyes straight ahead, but her tone could have frosted the windshield. “You are here at the WHO’s request. Not ours. Ergo, you are here to observe, not lead our process.”
“Welcome to friendly London, Haldane!” McLeod piped up from the backseat.
Haldane looked over at Levine with an intentionally condescending smile. “Dr. McLeod and I have spent the last few weeks in the epicenter of this epidemic. We know it inside and out. I think it’s safe to assume that we have more experience with emerging pathogens and viral hot zones than the rest of your Commission combined.” He let his barbs hang in the air for a few moments. “But, Dr. Levine, if you don’t see the sense of listening to our advice then perhaps your director will.”
Her head didn’t move, but the corner of her lip twitched. “We are closest to the Royal Free Hospital where the pediatric patient is,” she said evenly. “We will begin there.”
Dr. Nancy
Levine had already cleared their presence with the Royal Free Hospital’s administrators. After she flashed her identity card at the main desk, the three physicians were directed up to the Pediatric ICU on the tenth floor.
Outside the nursing station, a matronly middle-aged woman in a white uniform and headgear, which looked to Haldane like something from a black-and-white movie, introduced herself only as “Sister.”
“Sister, we’re looking for the patient Alyssa Mathews.”
The woman shook her. “I am sorry, Dr. Levine, but she has already gone.”
“Oh,” Haldane sighed, assuming the worst. “When did it happen?”
“It?” The sister’s face crumpled in confusion for a moment. “Oh, no, no!” She shook her head again. “Alyssa has not died. On the contrary, she has shown signs of stabilizing this morning. Today is the first day her doctors have deemed her stable enough to go downstairs for a CT scan of her chest. She only just left ten minutes before.”
By the time Haldane, Levine, and McLeod reached the Radiology Department, Alyssa was already on the procedure table having her scan performed.
A radiology clerk led them to Veronica Mathews who paced nervously in the department’s waiting room. Veronica wore hospital greens. Her long black hair was frizzled at the flyaway ends, and she only had speckled remnants of her blue eyeliner inside the dark circles encasing her eyes. Even still, Haldane had no trouble picturing her on a runway in New York or Paris, because her sharp features and tall graceful body were so striking.
They sat down at a bank of chairs in the far comer of the waiting room. Haldane sat directly across from Mathews, while McLeod and Levine sat on either side of him. During the introductions Veronica stared blankly over Haldane’s head, appearing as sedated as a postoperative patient. Only when he explained how he had just come from China and had seen several other cases of the Gansu Flu did Veronica snap into focus.
Her eyes pleaded with Haldane. “You saw people who recovered from this thing, right?” she said in an accent that seemed to fluctuate between New Yorker and Brit on every second syllable.
