The Rationing

by Charles Wheelan

  He was right, of course. How could one put a positive spin on an outbreak that might kill over a hundred thousand people—however weak, old, or sick those people may be? The advisers who had been working around the clock to avert this moment were loath to concede that their efforts had been fruitless. “I still think we need to pay attention to how we explain this,” the Communications Director said, implicitly probing the Strategist’s absence.

  “He’s not here,” the President said tersely. “Just do your job.”

  The Secretary of State had also gone missing, but her absence would not be noted for some time.

  65.

  I AWOKE FEELING DIFFERENT THAN I HAD IN DAYS. I COULD remember my dreams, one of which had been about a giant chocolate almond ice-cream cone. If I had been in a soap commercial, I would have danced around the bedroom singing about how refreshed I felt. I reached for my phone on the bedstand; there were eighteen texts from various people at the NIH headquarters. I had told the NIH Director that I needed a morning to sleep and think. She agreed it was a good idea, but as the Dormigen deadline drew nearer without any meaningful progress on our part, the staff had begun to confuse motion for progress. Only one of the texts required any real input from me; the others either boasted of some new activity or posed questions with answers that were self-evident. Ellen had already gone to work. She left a note at the foot of the bed wishing me a good day and telling me that she had made an omelet that I could heat up in the microwave. “Sorry if I have not been as supportive as I should be!” it concluded, with a little smiley face. That just made me feel bad, particularly as I texted Jenna before leaving the apartment.

  I put the omelet in the microwave and wandered over to the window while it heated up. We lived on the fourth floor, high enough to get a decent sense of the activity below. Three boys in Catholic school uniforms hustled along the sidewalk. They had to be late, I thought. Across the street, a bakery truck was double-parked as two guys unloaded trays of bread onto a trolley and wheeled it into a small convenience store. The initial panic of the Outbreak had given way to normalcy, mostly because people could not see anyone getting sick around them. This stiff upper lip was less about resolve in the face of adversity and more about a failure to imagine how bad things could get when the Dormigen supply was depleted, a contingency that most people now did not think was going to happen. The White House had also worked aggressively to make Capellaviridae seem less scary. Acting on the recommendation of the Strategist, senior officials had compared Capellaviridae to influenza at every possible turn. (To be more accurate, they compared it to “the flu,” which focus groups found far less scary than “influenza.”) For example, the day before, with the press clamoring for projections and details, the Communications Director had declared during an interview, “It is crucial to remember that even if untreated, Capellaviridae is no more harmful than a serious case of the flu.”

  This statement was both technically accurate and entirely misleading. The public had no conception of how serious a bad strain of influenza could be. Before the advent of Dormigen, a nasty global influenza outbreak could kill a million people, including tens of thousands in the United States. There were a few media references to the Spanish flu outbreak of 1918, one of the worst pandemics in modern history, but “the flu” was the image cemented in most minds. Ironically, most Americans still believed that Capellaviridae could be contracted via contact with other humans (like the flu), but the initial panic over the disease had subsided. Schools were open again and attendance at public events was drifting back toward normal. (The Washington Nationals stadium had been only about a quarter full during the spontaneous burst of patriotism in response to the President’s takeoff from Honolulu.) I watched the guys unloading bread for a few minutes and then retrieved my omelet when the microwave made its loud, annoying beep.

  I do not want to overdramatize what happened next. I was hungry enough that I made short work of the omelet. I was getting up to make some toast when I got a text from Jenna. “Good sleep?” it said. I was elated to hear from her, and like anyone who has ever flirted by text, I carefully crafted my reply: “Excellent. Ice-cream cone later?”

  I waited nervously for the response: “Definitely. See you at NIH?”

  Jenna’s text had pushed that crazy German terrorist incident to the front of my mind. The ice-cream cone is what had made it so bizarre. What I realized explicitly as I sat at the dining room table was that the eccentric scientist was entirely protected as long as he was the only one who could procure the antidote. That was his innovation.

  Other terrorists plant bombs and demand ransom, but the strategy has limitations. The bombs must be in a population center, which increases the likelihood that they are detected and defused. Or the area can be evacuated, rendering the bomb harmless (to people). Meanwhile, the terrorist is always at risk of being killed by the authorities; they do not need him alive to deactivate his explosive device. By introducing an unknown pathogen, however, the perpetrator guarantees his safety, particularly if the antidote is not commonly known. What was so surreal about the German scientist asking for his double-scoop ice-cream cone was his certainty that the authorities would not harm him. He could stash the antidote anywhere—in a safe-deposit box or buried in a public park—and the authorities would likely never find it if he were killed. In fact, we now know that the CEO, feverish and throwing up from his psychosomatic illness, was pleading with German authorities: “Do not kill him! I need him alive!”

  These thoughts rushed through my mind as I sat at the dining room table. One can quibble with my analysis of terrorism, but that is not the point. My mind turned almost immediately to Capellaviridae and the North American dust mite. The most perfectly adapted species find some way to make themselves valuable to the broader ecosystem, thereby helping to ensure their own survival. Think about those little birds that perch inside the mouths of crocodiles and clean their huge, dangerous teeth. Everybody leaves happy. Evolution has a way of creating these synergistic relationships: bizarre creatures that interact in mutually beneficial ways. But what if nature had served up something different in the case of the dust mite, Capellaviridae, and humans? What if their relationship was something more akin to that of the German CEO and the mad scientist: extortion? Wouldn’t it be possible—and entirely consistent with everything we know about evolution—for one species to essentially hold another hostage? You continue to provide for my basic needs or I will kill you. Nature offers up innumerable examples of toxins and venoms wielded by bizarre creatures either to hunt prey or to protect themselves from predators. Couldn’t such weapons be wielded more creatively?

  This rush of thoughts was not as clearly articulated as I have described them here. Rather, it felt like a half-formed idea engulfing my brain, like seeing an exam question that you know you can do but have not yet figured out. Or encountering a person you recognize in the street and searching your mind for her name. You know it’s coming. “It’s on the tip of my tongue!” my grandmother used to say (more and more as she got older, sadly). I was certain in that moment that the key to understanding lurking viruses was lodged in my subconscious, working its way toward somewhere else in my brain where I could put some form around it. I did have two concrete thoughts in the moment, however.

  First, I had an example—admittedly hypothetical—that I would use repeatedly in the coming hours to make myself understandable. Imagine there is a venomous snake, I would tell the Chief of Staff and others. This snake leaves its hole in the ground in the day or night to hunt lizards, which it paralyzes with venom. But the danger of leaving the hole is that the snake exposes itself to predators, such as a hawk that can swoop down and grab the exposed serpent in its talons. There is a trade-off: the snake needs to hunt, but it exposes itself in doing so. This is standard Discovery Channel stuff.

  Now let’s suppose that over the course of thousands of years, nature serves up a variation of that snake, a more “clever” species (if we are going to be anth
ropomorphic about it). This snake slithers into the hole of its prey, where scores of lizard eggs have just hatched. The “old” edition of this snake, the less “clever” one, would gobble up the baby lizards, enjoying one very fulfilling meal. Next week it will have to hunt all over again, once again exposing itself to all the predators aboveground. But the “clever” snake—again, somehow evolved over tens of thousands of years, maybe longer—finds a strategy that is nature’s equivalent of room service. Rather than eating the baby lizards in one glorious meal, the “clever” snake uses them to eat for a lifetime (or at least a couple of weeks); it holds them hostage, doing no harm as long as the adult lizards bring it food. This is nature’s equivalent of a guy who moves into your house, puts a gun to the dog’s head, and says, “No one gets hurt as long as you feed me well and do my laundry. Also, we’re going to need to order the premium cable channels.” (Remember, nature has no 911.) In my hypothetical “clever” snake example, both species derive an evolutionary advantage. The snake obviously benefits from getting fed without having to expose itself to predators; the lizards are also more successful as a species in the long run because: (1) the baby lizards do not get eaten; and (2) the snake interloper scares off other predators (e.g., other snakes).

  As I have mentioned repeatedly, this example was entirely hypothetical. (When some jackass staffer at the National Security Council started asking me questions about whether lizards really live in holes, he was obviously missing the big picture.) The point is that I had developed a theory that could potentially explain the behavior of lurking viruses in a way that was entirely consistent with evolution. Why and how could the same virus live harmoniously with its host in some cases while causing serious illness or death in others? Perhaps it depends on whether the host is delivering what the virus needs to thrive. And if not . . . well, every once in a while you have to shoot a hostage to keep everyone in line. Or, in my hypothetical “clever” snake example, if the adult lizards stop bringing food, the baby lizards become dinner.

  My second concrete thought as this amorphous theory surfaced in my brain was that I had to call Professor Huke. I was finally “thinking like a virus.” I was reasonably sure I had an answer worthy of one of his final exams, but I wanted to be sure before sending it up the scientific chain of command, let alone passing it along to the President of the United States. I found Huke’s home number in my phone and dialed. His wife answered promptly. “He’s off running errands,” she said.

  “Do you have a sense of when he’ll be back?” I asked, trying to steer a path between urgency and rudeness.

  “He was going to Home Depot, but usually that means he’s going to stop at the driving range,” she said. I remembered the driving range, a decrepit little place with mats and nets at the end of a huge strip mall (near the Home Depot). There was a soft-serve ice-cream cart in the parking lot that was popular with Dartmouth students.

  “Does he carry a cell phone?” I asked.

  “May I ask who’s calling?” she replied, more curious than suspicious. I apologized and explained as briefly as I could why I needed to reach her husband. “Oh, yes, you visited us,” she said. “Richard really enjoyed speaking with you. He does have a mobile phone, but I can see it right here on the dining room table. I keep telling him there’s no point in having a mobile phone if all he’s going to do is leave it at home.”

  Huke called back about a half hour later. “I went to the driving range. The course opens this weekend,” he said, as if he needed to explain his whereabouts. “So how bad is this Capellaviridae?”

  “Not terrible in the grand scheme of things,” I said truthfully. “It acts like a virulent strain of influenza.”

  “That can be pretty bad,” he said.

  “True, but the Dormigen gap is not that big. We’re only looking at about a week without it.”

  “Yes, I’ve read about how they are trying to stretch out what they’ve got.”

  “I’m calling because I want to bounce a hypothesis off of you,” I said. “A theory of how lurking viruses might work.”

  “Very exciting! Okay, I’m listening,” he said. I explained the thoughts that had been percolating through my brain that morning, including the example of the venomous snake and the baby lizards. I also explained some of the patterns that Tie Guy had observed, such as the fact that Capellaviridae was most likely to turn virulent in areas where there had been the most aggressive efforts to eradicate the North American dust mite.

  “That’s certainly enough to get you a plump research grant,” he answered, “but there are still a lot of things to be worked out, even if you’re right.” And then, after a moment: “How long do you have?”

  “Days,” I said. “Not even a week.” Huke did not answer right away. His silence signaled the obvious: we needed years, or at least months, to turn this thought into anything practical—and even that assumed I was racing along the right track. “Here’s what I’m thinking,” I continued. “When people become sick with the virulent form of Capellaviridae, we need to reintroduce them to the North American dust mite.”

  “Hmm.” Huke was silent as he tried to follow my line of thinking. Eventually he said, “You are thinking that this dust mite fights back somehow, using Capellaviridae?”

  “Yes.”

  “But you don’t know how. Just that Capellaviridae turns virulent when the dust mite disappears,” he said.

  “Yes. Either because the dust mite gets exterminated, or because people move from an area where the dust mite is endemic to a place where it’s not. In both cases, when there are no North American dust mites, the virus can turn virulent.”

  “There’s no harm in testing it, is there?” Huke asked.

  “Well, it might be hard to persuade people who are sick with Capellaviridae that the cure involves letting them get bit by the same dust mite that gave them the virus in the first place.”

  Huke laughed. “Do you think it was easy persuading people that injecting them with a weakened polio virus would protect them from polio?”

  66.

  THE PRESIDENT WAS OPENLY AND SHOCKINGLY DISMISSIVE OF many members of Congress. Part of that stemmed from his animus toward the Speaker, which had only deepened since the beginning of the Outbreak. “You don’t have to be a genius to win an election,” the President told me once after I had expressed amazement when a congresswoman from Arizona declared that it was still an “open question” as to whether germs cause disease. “That’s not the craziest thing I’ve heard,” he said, turning to the Chief of Staff. “What’s the name of that guy from Tennessee who kept introducing bills to ban witchcraft in schools?”

  “I don’t remember his name, but he served eight or ten terms,” the Chief of Staff said.

  “Then he got arrested for sexual assault.”

  “No,” the Chief of Staff corrected him. “That was the guy from Kentucky.”

  “With the wooden leg.”

  “I don’t think it was wooden, but yes, he had a prosthetic leg.”

  The President turned to me and explained, “He ran a campaign saying he’d lost his leg to an IED in Afghanistan. Turns out he was never in the Army. He lost his leg in a drunk-driving accident on a motorcycle.”

  “He still got elected,” the Chief of Staff added.

  “He served a bunch of terms. Didn’t he get reelected after he was arrested?”

  “I think so,” the Chief of Staff said. “He had to give up the seat when he was sentenced. There was a special election.”

  “That’s right,” the President said.

  “How does someone get elected with a fake war record and then reelected after being arrested for sexual assault?” I asked.

  The President waved his hand dismissively, suggesting my question was as naïve as I felt it to be. “He blamed the press. Said it was fake news. All the usual crap.” Then he turned more serious. “People aren’t paying attention. That’s really it. Americans are busy driving their kids to soccer practice and designing iPh
one apps and bashing government—until something like this happens, then everyone wants to know who’s going to fix the mess. Is there an iPhone app for this?” He picked the Chief of Staff’s phone up off the table in front of us. “Which button do I push to get more Dormigen? Is there an app to fix the Middle East? How about getting Newark schoolkids to read at grade level? Has Silicon Valley figured that one out yet?” An uncomfortable silence settled over the room. Then the President said, “They elected him again, didn’t they?”

  “Who?” the Chief of Staff asked.

  “The guy with the prosthetic leg who got arrested for sexual assault.”

  “Yes, I think so. He ran when he got out of prison.”

  The President threw up his arms, as if to say, “See!” And then after a moment, more seriously: “You can’t systematically ignore governance and then expect it to work well.”

  I remember passing the Chief of Staff in the corridor hours later. She pulled me aside and said, “He’s tired.” I knew immediately what she was referring to.

  “That doesn’t make him wrong,” I replied.

  “No.”

  Congress had certainly not distinguished itself in the hours since the Outbreak had become public. There had been a flurry of legislation introduced to nail the barn door shut: a bill to ban the outsourcing of Dormigen production; a bill declaring access to Dormigen “a basic American right”; a bill formally censuring Centera; and many others that had no chance of passing and would not have helped the situation even if they had. Then there was the bill demanding an investigation into Israeli involvement in the Dormigen shortage (introduced by the avowedly anti-Semitic “white Christian caucus”). This was the “teakettle” activity that the Senate Majority Leader had predicted at the beginning of the crisis—legislators presenting the illusion of action for constituents who did not know, or did not care, that introducing a bill is different than passing a law.