The Rationing

by Charles Wheelan

  “Mr. President, if you can promise me that we are not going to run out—that no American will die for lack of Dormigen—then of course I’ll take it. I’m not trying to make this situation harder for you. I have a lot to live for . . . two beautiful granddaughters, so much work left to be done.” The President did not answer. After some time, Cecelia Dodds continued, “Can you make me that promise?”

  “I’m afraid I can’t,” the President said. Several hours later Cecelia Dodds was moved to intensive care.

  There was no calm at the NIH offices. The scientists were unhappy that the President had been so sanguine in his remarks about the number of deaths if the Dormigen stocks were depleted. Not only had he focused on the lower bound of what the NIH model was predicting in terms of fatalities, but the model itself had now been revised in the other direction. Evidence of the widespread Dormigen pilferage had filtered back to the data analysts; they were putting numbers against the quantity of Dormigen that had gone missing, which included the tricky task of trying to figure out where the stolen Dormigen would ultimately end up (wasted or helping people who needed it). The best-case scenario for incremental fatalities no longer included “zero.” It had climbed to forty-five thousand. Meanwhile, the added uncertainty had broadened the range of possible outcomes, so the worst-case scenario was now a hundred and ninety-five thousand deaths. The NIH staff had watched the Chinese Ambassador’s remarks; they were feeling the weight of the President’s dilemma.

  I apologized to the NIH Director for being late. “Don’t worry about it. I think you’re going to be impressed,” she said, ushering me into a small conference room, where five binders of different colors were laid out neatly on the table. “This can be your workspace.” She pointed at the colored binders. “Those are summaries of the work done so far by each of the working groups: Capellaviridae; the North American dust mite; possible antidotes; alternative treatments to Dormigen. The organic chemists put together the red one, but they’ve just started.” The work product was impressive. Once again I found myself wondering if we had made an egregious error in keeping the Outbreak secret. If the great minds here had spent less time eating cupcakes in those early days, might we now be a week ahead? “I’ll let you peruse those,” the NIH Director said. “Each one has a summary, so you don’t have to wade into the details. We have a meeting of all the teams in the big conference room in about forty-five minutes. We’re trying to meet every six hours, around the clock.”

  The Director left me to the colored binders. I sat down and picked up the one closest to me: green. The summary described the recommended protocol for treating Capellaviridae in the absence of Dormigen: fluids, rest, conventional antibiotics to deal with any secondary infection. I had little to add in this realm, so I set the binder aside. I picked up the blue binder next: Capellaviridae. The report documented everything the team had learned about the virus, which was an impressive amount in such a short time. The summary included three lines in bold text that caught my eye: Capellaviridae bears a striking resemblance to strains of the influenza virus. Some of our scientists, unaware of what they were looking at, assumed they were examining a historic strain of influenza. Not surprisingly, Capellaviridae acts on the body in nearly identical fashion to the more virulent strains of influenza. This explained what I had just read in the green binder, namely that without Dormigen Capellaviridae should be treated like a bad case of the flu. It also explained the likely fatality rate (broadly comparable to a serious flu). Creating a vaccine specific to Capellaviridae would be a straightforward task, but like Dormigen, a flu-type vaccine takes time to cultivate. Time was the one thing we did not have.

  Okay, I thought, Capellaviridae is really just a nasty form of the flu that is somehow, and for some reason, passed to humans by the bite of a dust mite. I picked up the yellow binder: everything we now knew about Dermatophagoides mensfarinae, the North American dust mite. There was even a highly magnified photo of the nasty-looking critter on the cover page. Again, I perused the summary. The North American dust mite is different from other common dust mites primarily in that it bites humans. Other mites feed off human detritus, such as dead skin that has been sloughed off. The North American dust mite feeds off live skin and blood, making a tiny, painless bite that causes a modest allergic reaction in some people. The Dermatophagoides mensfarinae research group was operating on the assumption that there is some evolutionary advantage to being able to feed on live skin and blood. They estimated that this mutation in the species had taken place eight thousand to ten thousand years earlier, coinciding with the first modestly dense human settlements in North America.

  That made sense. When humans started living in closer proximity to one another, this particular dust mite developed an ability to feed directly off skin and blood, rather than waiting around for discarded dead cells. I was about to pick up the black binder when the door to the conference room opened and a young woman about my age looked into the room. She was petite, with straight brown hair that hung to her shoulders. “Sorry,” she said sheepishly. I looked up, waiting for some explanation. She said nothing but continued to linger in the doorway, as if deciding what to do next.

  “Can I help you?” I asked, genuinely perplexed.

  “Someone told me you had Professor Huke,” she said. “I’m really sorry to bother you, with all that’s going on.”

  “How do you know Professor Huke?” I asked. And then: “Please come in.”

  She came into the conference room and stood on the other side of the table. I motioned to a seat, but she remained standing. “I took his class at Dartmouth,” she said. “Two of his classes, actually.”

  “And what are you doing now?” I asked.

  “I just finished a graduate program in public health. I’m doing a fellowship at the CDC. They sent me over here when the crisis broke—an all-hands-on-deck kind of thing.”

  “I went to see him—Huke,” I said. “I went back to Hanover to ask him about this.”

  “What did he say?”

  “It was before everything was public, so he thought I was just working on some academic puzzle. He told me to pretend it was a question on a midterm exam.”

  “Seems like it should at least be the final exam,” she said.

  I laughed. “Yes, that’s true. He said the usual things: think like a virus, figure out the evolutionary advantage, that kind of stuff.”

  “And?”

  “And it doesn’t make any sense. We have a relatively benign virus that kills its host to no obvious advantage.”

  “I really didn’t mean to bother you,” she said, turning to go. “It just seemed too crazy: two Huke grads in the middle of this virus crisis. I’ll let you get back to what you were doing.”

  “If you really want to help,” I said, causing her to pause in the doorway, “work through this with me.” I pointed at the binders. “It’s not crazy to think of this like a Huke final exam. I feel like everything I need to know is right there. I just can’t make sense of it. My brain’s in a fog.”

  “When was the last time you slept?” she asked, looking at me in a way that reminded me of the toll the morning had taken. My suit was still wrinkled from the rain. I had the remnants of television makeup on my neck and collar.

  “A couple hours last night,” I offered.

  “You know what the research says.”

  “The research on what?”

  “On how the brain works,” she said. “You can stare at that table all afternoon. You’d be better off taking a walk and not thinking about it for a while.”

  “Now’s not really a great time for a walk,” I said with a hint of impatience.

  She came right back at me. “Well, do you want people to think you’re working hard in this little room, or do you want to figure out the puzzle?”

  Her name was Jenna. She had her Ph.D. from the Harvard School of Public Health and we did end up going for a walk. Jenna was thoughtful and smart. I have often wondered what would have happened if t
he loaner employee from the CDC who opened the door and said he had taken Huke’s course had been some overweight guy with a poorly trimmed beard and bad teeth. “That’s really cool,” I would have said, “but now is not a great time.” Instead, I was instantly attracted to Jenna and I wanted her to sit down in that conference room with me. I will spare you the rest of our origin story, but it does play a role in this larger narrative. What if Jenna were not so cute? I still ask her that sometimes: “What if you were a hairy guy who smelled bad? What if we had not gone on that walk?”

  57.

  THE CHINESE AMBASSADOR LEFT THE EMBASSY FOR THE White House shortly after two Eastern Time. The Washington police offered his black sedan an escort. The press corps, who had been camped outside the embassy, scrambled into vehicles to follow him, creating a train of vehicles that looked like a funeral procession. The President and senior advisers watched the live coverage from the conference room on Air Force One. As the Ambassador’s sedan made its way slowly through Washington traffic, the Strategist said, “He could have just e-mailed the fucking thing.”

  The U.S. intelligence agencies had gathered a great deal of raw information on the Chinese deliberations around their proposal. There were sharp disagreements within the Chinese leadership over what the offer ought to be, making it difficult for U.S. analysts to discern which faction would prevail. As Yale historian Mason Freeman has explained in his excellent book on the subject, the Outbreak came at a time of political intrigue within the Chinese leadership. President Xing was being challenged from within by a group of hard-liners, including some of the top military leaders, who were urging him to take a more aggressive stance in Southeast Asia. (The use of the phrase “sphere of influence” in the Ambassador’s remarks, however inelegant it may have felt to the American audience, was meant for Beijing listeners.) The hard-liners considered the Outbreak a heaven-sent opportunity for China to cement its role as a superpower on par with the United States—a role that would be severely hampered by the South China Sea Agreement.

  A separate faction within the Chinese leadership, the “pragmatists,” as U.S. intelligence analysts would come to call them, were worried that if the Dormigen terms were too onerous, the U.S. leadership would balk at the deal. (When the President had declared in his speech that morning that the nation might get through the Outbreak without any incremental deaths, it had seriously strengthened the hand of the pragmatists.) Many of the pragmatists had spent significant time in the United States, often as university students. They recognized the likely backlash that would result from any diplomatic offer that felt extortionate to the American public. Nobody likes to be charged $25 for a bottle of water, even in the desert. A cursory search of the psychology literature would have alerted the Beijing bureaucrats to the fact that humans have a profound aversion to deals they perceive to be grossly unfair, and Americans can be a sanctimonious bunch—even relative to other humans on the planet.

  Chinese intelligence operatives were reporting back to Beijing that the American President’s senior foreign policy advisers were pressuring him to stick with the South China Sea Agreement. Much of this information was deliberately leaked to the Chinese. The American intelligence agencies did not know about the power struggle going on around President Xing. However, they did assume, correctly it would turn out, that making the U.S. President appear willing to accept large numbers of American casualties would strengthen his bargaining position with the Chinese government.

  In the end, the hard-liners in Beijing won out, mostly for reasons to do with Chinese domestic politics. President Xing was acutely aware of the backlash that the whiff of Chinese opportunism might create among the American public. (Because of his fondness for American westerns, he considered himself somewhat of an expert on the American psyche.) He had also spent more than five years in the U.S. getting his doctorate in engineering at MIT. His understanding of American public opinion was far more sophisticated than that of the generals urging him to take maximum advantage of the Dormigen shortage. But Xing did not feel he had a sufficiently strong grasp on power to face down the military establishment, who were united on this issue. Although President Xing has never spoken publicly about his decision regarding the contents of the “Friendship Agreement,” some advisers have since intimated that he knew it was likely to be rejected. To solidify his grasp on power, President Xing gave the military hard-liners what they wanted, even as he knew they were making a major strategic blunder.

  The Chinese Ambassador’s black sedan pulled into the West Gate of the White House. On the U.S. end, there had been a scramble to determine who would receive the document. The Secretary of State and the National Security Adviser were in Hawaii with the President. The Vice President was ultimately designated to meet the Ambassador as he arrived. There was a brief handshake, after which the Chinese Ambassador handed over a black binder. The Vice President turned abruptly and walked back into the White House, leaving the Chinese Ambassador standing somewhat awkwardly near his car. There was no deliberate snub intended. Rather, the Vice President was under strict instructions to have the document scanned and distributed as quickly as possible. As the Strategist had sardonically observed, it would have been much easier if the Chinese had e-mailed an electronic version.

  On Air Force One, the President and his senior advisers waited anxiously as the Chinese proposal was printed and copied. Only a few minutes after the awkward handoff at the White House, a State Department aide hustled into the conference room with multiple copies, still warm. She passed them around the table; the principals began to read. The Strategist was the first to speak, to no one in particular: “You’ve got to be kidding me.”

  The Secretary of State said, “This is good. This is good for us.”

  “It does make the decision easier,” the President replied. After just a few pages, it was clear that the Chinese “Friendship Agreement” sought to neuter the entire American presence in East Asia. There were several fluffy paragraphs about providing Dormigen in America’s time of need, but then the document changed tone entirely, listing demand after demand. The United States would have to withdraw immediately from the South China Sea Agreement and “disavow any such aggressive collective agreements in the region for a period of twenty years.”

  “We knew they were going to make us scrap South China Sea,” the Chief of Staff said.

  “Keep reading,” the President said. The agreement demanded that the United States withdraw all troops from South Korea and Japan within eighteen months. The U.S. would have to pledge “not to meddle in domestic Chinese decisions affecting economic development.”

  “I don’t even know what that means. What does that mean?” the Communications Director asked.

  The President answered, “That means no environmental restrictions, no leaning on them for trading in endangered species. It’s a catch-all for anytime we try to make them behave like responsible members of the global community.”

  “Should I start drafting a statement?” the Communications Director asked.

  “Let me finish reading,” the President said.

  The Strategist blurted out, “Oh, my God, this is gold. Check out page thirteen, last paragraph.”

  The Communications Director flipped several pages ahead and began to read: “ ‘The United States will double the number of diplomatic license plates granted to the Chinese mission at the United Nations . . .’ ” He paused, incredulous. “They’re asking for more parking permits?”

  In fact, yes. As Mason Freeman’s research has subsequently uncovered, the Chinese leadership in Beijing settled their disagreements over the contents of the document by including everything—not just parking issues at the UN, but also student visas, banking regulations, and even two paragraphs on the price American zoos would have to pay to breed Chinese pandas. Every diplomatic grievance the Chinese government had broached in the previous decade found its way into the “Friendship Agreement.”

  “Is this serious?” the Chief of Staff aske
d.

  The President replied, “They think they’re holding all the cards. They’ve gone all in.”

  “But parking permits?” the Strategist said.

  The Secretary of State offered the best analysis of the situation in that moment. She explained, “They perceive democracy to be a weakness. They can’t imagine that we’ll say no. They feel democracy forces leaders to make shortsighted decisions, that we have no choice but to do whatever it takes to get the Dormigen. When you have maximum leverage, why not ask for the moon? Worst case, we negotiate and they get most of what they want.”

  “They don’t think we’ll let anyone die,” the President said.

  “And?” the Strategist asked, inviting the President to verbalize what everyone in the room knew was going to be his decision.

  “We can’t sign this,” the President said emphatically.

  “I’ll draft a statement,” the Communications Director said.

  “We should reflect on this,” the Chief of Staff said. “Let’s take a few minutes just to consider our options.”

  “There’s nothing to think about,” the President said.

  “Still,” the Chief of Staff implored. “Maybe we should go around the table?”

  “I agree,” the Secretary of State said. “I’ll go first. Mr. President, I appreciate what we are asking you to do here. I don’t take that lightly. I think we need to reframe our thinking. As awful as it is that we may come up short on Dormigen—and that lives may be lost as a result—I would ask you to think about this situation differently. If China made this declaration unilaterally, if they took actions to expel us from East Asia, we would not let those actions stand. We would respond militarily, if necessary.”

  “Probably not to the parking thing,” the Strategist said. The Secretary of State stared at him malevolently, furious at the interruption (and relatively unaccustomed to his attempts at irreverent humor). Others in the room suppressed smiles.