by J P Whitney
“Well, we have detected the H1N1 strain and many of the symptoms also match the Spanish flu of 1918. Fever, shortness of breath, and coughing. And surprisingly, the Blue flu also has the telltale sign of cyanosis as victims suffocate from a lack of oxygen when the lungs hemorrhage and rapidly fill with blood,” he was about to continue but Ruth cut him off.
“The blue flu?”
“Yeah, some reporter penned an article called the Blue Death in which she told of the similarities to the Spanish flu, including blue faces. Other reporters started using her term Blue flu and I guess it stuck with me. Anyway,” David continued, “on the surface, it looks like the Spanish Flu. But we haven’t been able to identify the source. And to further complicate matters, there’s no evidence of human-to-human transmission. So, while similar, I believe we’re dealing with something different, not a recurrence of the Spanish flu.”
“No human-to-human transmission?” It was clear from the worry lines forming between her brows that the stress was getting to Ruth. “Then that takes us to question number two. Has this virus been engineered, is this an act of bioterrorism?”
“Yeah, the mode of transmission has been stumping us. One theory we’re working on is infected pigs or birds. A deadly variant of swine or avian influenza.”
“You're kidding, right? I like your optimism because then we’d have a better idea of how to respond. But this virus is randomly dispersed around the globe and there have been no reports of high-density outbreaks normally associated with animal-to-human transmission.”
Ruth liked thinking out loud with trusted colleagues and so continued, “There must be a common source for it to be this widespread so quickly. Why have you ruled out human-to-human transmission?”
Ruth’s questioning of his theories before hearing all the details stung a bit. While he agreed animal-to-human transmission was a long shot, he couldn’t rule it out yet. And then there were the peculiar genetic test results to consider. But Ruth had to report back to Washington on the most likely cause of the outbreak and best plan of attack so he moved on.
“As I mentioned, I've been reviewing the data, especially what we have on the Oregon case. I believe you were briefed on the high school student that died in class?”
“Yes, I’m familiar with it but with thousands of cases to choose from what caught your attention about this one in particular?”
This question would take them off on a tangent but David wasn’t ready to reveal his theory yet anyway. He needed to build up to it. Ruth was also a great sounding board so he answered, “Mainly that no one else in the class became infected even though the victim aspirated blood into the air.”
“Relatively confined space, excessive exposure to bodily fluids, and no transmission of the virus. That is interesting, but what does it tell us?” Ruth asked, wanting his insights before drawing her own conclusions.
“If human-to-human transmission is occurring it isn’t following normal protocol. The Oregon case is extreme but similar to most of the others. No foreign travel, no exposure to livestock. An otherwise healthy tenth grade boy died within an hour of first symptoms. We’re well past typical influenza incubation periods and none of the other students are symptomatic. Not even his best friend who held the victim while he died. Literally soaked in his blood and yet he tested negative.”
“And the family of the deceased?”
“We observed them in isolation for two weeks. Asymptomatic and all tested negative.”
“Could the virus be lying dormant?” Ruth asked trying to make sense of what she was hearing.
“It’s possible but typically with H1N1 people are infectious one day before showing flu symptoms and up to three days after right? We're certainly past that for typical person-to-person transmission and it’s difficult to speculate on incubation periods if this turns out to be an exotic strain as suspected.”
“So let me get this straight,” Ruth said pondering the consequences of these revelations and how she’d position them to Washington. “Deaths are occurring in most countries around the globe, some within hours, but we don’t have a single case of person-to-person transmission? Either we’re missing something in the mode of transmission or …,” her words trailed off mid-thought.
“Or, the virus just appeared simultaneously in all of these places. The allegations of bioterrorism may be accurate. We could be looking at a Biodefense Category A situation here,” David concluded for Ruth.
“David, I can’t tell Washington we’re facing the highest possible biohazard threat … something this extreme and on a global scale … well, not without some proof. It would create panic. Chaos in the streets,” Ruth stammered as she considered the ramifications.
“That’s partially the reason why I wasn’t ready to rule out zoonotic transmission … at least until we have more data,” David said reluctantly. Ruth had been thrust into a diplomatic liaison role with Washington in response to the outbreak and he needed her buy-in if his plan was going to be put into action.
“OK. Do we have any cases of infected pigs or birds?” Ruth was not ready to admit the outbreak was a deliberate attack and now found herself clinging to the very theory she had dismissed just a few moments earlier.
“Nothing out of the ordinary and none that would explain our current situation. But there is something else,” he said. “It’s strange so I hesitate to even bring it up.”
“Don’t leave me hanging here David. Spit it out,” Ruth said trying her best to remain patient.
“I told you that H1N1 was detected and that a lot of the symptoms matched that of the Spanish flu. What I didn’t tell you was that the avian strain H5N1 was also detected. I had just finished reviewing the molecular test reports when you came in.”
That bit of information left Ruth utterly speechless so David decided to forge ahead.
“I believe the H1N1 antigen count was so high it masked the H5N1 making it nearly impossible to detect with the rapid tests most hospitals use. But it is there. It looks as though the victims were infected with both strains.”
Then it dawned on her, “Wait a second. You have a working theory, don’t you? That’s why you were acting strangely when I barged into your office. And you know we’re scrambling for some good news to share with the public, this could have helped. Why didn’t you share this information with me earlier?”
“None of the data made sense. Not until the genetic test results came back that is.”
“OK,” she said reluctantly not liking being left in the dark but needing to hear him out, “so walk me through this theory of yours.”
“It's possible we're looking at an avian transmission. Perhaps several species of common birds are infected with H5N1. Coming into contact with their feces is all it would take. It makes sense with the wide distribution of cases. Similar to how bats are responsible for the transmission of Ebola,” David started.
“Interesting,” Ruth said as some of the pieces clicked into place. “H5N1 is typically confined to avian populations, and though it sometimes jumps to humans, it is difficult to pass from person-to-person. That makes sense with what we’ve experienced thus far. H5N1 is also highly pathogenic in humans and attacks the lungs. I believe nearly 60% of H5N1 infections resulted in death since 1997. All of this matches the Blue flu but you said there were no reports of bird deaths, so are they just carriers?”
David cleared his throat before continuing, “Possibly. And, this is kind of a stretch, but what if this strain of H5N1 lies dormant in humans until the H1N1 infection? Then both go to work on the victim.”
“You're talking about a superinfection of multiple influenza strains? Sure it’s common for secondary bacterial infections to opportunistically take hold while the immune system is preoccupied with battling a virus. But I don’t recall any cases of simultaneous viral infections.”
“You’re right, viral superinfections are extremely rare. But if a person did become infected with both H1N1 and H5N1 … well, then that changes everything.�
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“Why is that?”
“The viruses could exchange genetic information and spread more readily or mutate into a more infectious strain altogether,” David chastised himself for being impressed with this theory but couldn’t help himself. In the world of infectious disease, superinfection was novel, fascinating in itself. But if wielded by humans, instead of nature, well the pandemic risk was astronomical. Ruth was right about historic H5N1 mortality rates of 60%. However, Blue was much higher and extremely fast-acting. If it started to spread … well, then the human race was poised for extinction. Terrifying but elegantly beautiful in its lethality at the same time.
“Let’s assume this superinfection theory is correct. Can we treat it?” Ruth’s question snapped David out of his dark thinking.
“Well, as you know, the national pandemic influenza vaccination program was put in place to administer flu shots to all persons in the United States prior to the peak of disease. There’s no way we could have predicted the Blue strain and therefore we’re ill-prepared. But after the 1997 avian flu outbreaks in China, we started stockpiling antigens for the development of up to 26 million doses of pre-pandemic vaccine within four months of declaration.”
“And how many pre-pandemic vaccines are available at this moment?” Ruth could already hear the diplomats asking this very question.
“I’d estimate less than 2 million and they are primarily earmarked for Tier 1 persons. Active service members, mission-critical government positions, healthcare workers, law enforcement, fire services, and the like.”
Ruth's phone buzzed. A text from Vice President Shepard.
What's our official position on the outbreak? The press is hammering me for a statement.
Ignoring the text, for the time being, she turned her attention back to David.
“OK. We have a working theory and the pre-pandemic vaccines provide us with a potential course of action against the lethality of H5N1. At least in the near term for mission-critical persons. But if H1N1 is the trigger, we have to stop its spread until H5N1 vaccines can be produced for the public.”
“Well, it’s very early in the season but we could start administering flu shots. This year’s quadrivalent vaccine includes the Type A strain of H1N1. And a little over 127 million have already been produced in the US.”
“We'd need about 200 million more but it’s a start. I really need to get back to the Vice President, is there anything else I should know about your superinfection theory before I go?”
“There is one detail we haven’t discussed yet. You’re aware of how fast-acting Blue is. Some victims, like the student in Oregon, are succumbing to the disease in as short as an hour. But this jumble of papers on my desk are the statistics from each state and they all confirm another terrible fact,” David paused for effect until Ruth’s raised eyebrows urged him to continue. “We’re facing a case fatality ratio of 100%.”
“David, that can’t be accurate,” Ruth said breathlessly as though she’d been gut-punched. “100% fatalities?”
“Well nearly so. Hospitals reported about 135 new cases yesterday and those outcomes aren’t known yet. But I’m telling you, Ruth, no patients have survived thus far. We’ve never encountered a disease this deadly without it also being communicable. It acts more like a poison than a virus.”
“So how bad is it really, what are the projections?”
“I don’t want to hazard a guess until we confirm how the virus is spreading. But we’re still months away from the beginning of the typical flu season so I fear the initial 10,000 deaths in the US are only the tip of the iceberg,” David reported.
“I'd like your team to run more tests to see if they can prove out the superinfection theory, mainly if H5N1 is present in all the victims. And we need to know if this year's influenza vaccines do anything to slow this thing down.”
David watched Ruth take a few notes on her laptop before practically slamming it closed with a heavy sigh. Over the years they had teamed up on numerous crisis situations. Encephalitis and measles outbreaks at universities. Ebola quarantines in hospitals and the recent West Nile outbreaks. Always incredibly smart, compassionate, professional, composed, and unflappable. You didn't rise to the post of principal deputy director of the CDC by the age of forty-five without being all of those things. And regardless of the situation she always had the ability to cut through all the bureaucracy of the emergency and see the right path for the end game. A gifted aptitude for planning while everyone else panicked. But at this moment something registered on Ruth's face he hadn't seen before. Fear. The implications of his theory must have struck home.
“Oh, and David, this goes without saying but please tell your team to keep all of this information confidential. No one is authorized to talk to the press. Reporters have already stated the CDC warned of a pandemic on an unimaginable scale. I certainly didn’t make that statement and you said it yourself. We won’t have a projection until the mode of transmission is determined. I’m worried we have a leak.”
“I don’t believe our people would spread conspiracy theories, and we both know the news will print anything to increase sales, but your point is understood. I’ll make it crystal clear to the staff that no one is authorized to talk to the press.”
“Thanks, David. I appreciate it.”
As Ruth walked briskly from the room, the keys of David's keyboard clicked rapidly as he signed in to the VPN software and sent his encrypted message.
∆∆∆
From: [email protected]
To: [email protected]
Date: June 30, 2021
Subject: 2021 Flu Vaccine Status
Seed has been planted for full-scale inoculation. Need to discuss source with you ASAP.
-DJ
Chapter 4
The Shepherd
When Ruth reached her office she slumped against the door until it closed shut. She started for her desk then reversed course and spun the lock of the door. Washington needed answers and she had no time for distractions. But first, she needed the structure of a classical music score to calm her emotions and help drown out the random bits of information that clouded her thoughts. Beethoven's Moonlight Sonata began to stream from her phone to the bluetooth speaker sitting on her credenza. The heavy piano notes of the piece certainly matched her somber mood.
She replayed the conversation with David over and over in her mind. It wasn’t that she didn’t trust him so much as she had a hard time believing the mortality rates. As a visual person, she had to see the figures for herself. It also felt strange that she had to pull information out of him. Over the years they had established an easy way of collaborating on big problems. She developed the action plan then coordinated the movements of all the CDC teams and regional authorities while David saw to it that his staff of epidemiologists, virologists, and microbiologists delivered results. Not this time, something was different. He seemed secretive and at times aloof. And that wasn’t the worst of it. They were talking about a hundred-percent-fatal-virus and the man was almost giddy.
She pulled up David’s latest test results on her laptop and was somewhat surprised to find the official report was almost word for word what he had told her.
“Lab tests confirm the influenza outbreak of 2021 contains H1N1. We haven’t been able to determine the source of the virus or how it is spreading. However, molecular tests have also detected an H5N1 strain which we now believe may be responsible for the lethality of the disease. I suspect both strains are working in concert as a superinfection with 100% mortality rates. Thus far, 9748 reported cases and 9613 confirmed deaths. Vaccinating against both strains may be our only hope.”
That last sentence was an odd choice of words for a formal CDC document. The vernacular was too common and emotional. And while his superinfection theory might be farfetched, it also fit. So why did she have the unshakable feeling that Blue was somehow related to the Spanish variant that hadn’t been seen in over 100 years? She called up some old newspaper a
rchives from the CDC’s extensive database for a bit of historical perspective.
The influenza or flu pandemic of 1918 to 1919, the deadliest in modern history, infected an estimated 500 million people worldwide–about one-third of the planet’s population at the time–and killed an estimated 20 million to 50 million victims. More than 25 percent of the U.S. population became sick, and some 675,000 Americans died during the pandemic. The 1918 flu was first observed in Europe, the U.S. and parts of Asia before swiftly spreading around the world. Surprisingly, many flu victims were young, otherwise healthy adults. There were no effective drugs or vaccines to treat this killer flu strain or prevent its spread. In the U.S., citizens were ordered to wear masks, and schools, theaters, and other public places were shuttered.
THE FLU STRIKES FAR AND WIDE
The first wave of the 1918 pandemic occurred in the spring and was generally mild. The sick, who experienced such typical flu symptoms as chills, fever, and fatigue, usually recovered after several days, and the number of reported deaths was low. However, a second, highly contagious wave of influenza appeared with a vengeance in the fall of that same year. Victims died within hours or days of their symptoms appearing, their skin turning blue and their lungs filling with fluid that caused them to suffocate. In just one year, 1918, the average life expectancy in America plummeted by a dozen years.
FIGHTING THE FLU
Officials in some communities imposed quarantines, ordered citizens to wear masks and shut down public places, including schools, churches, and theaters. People were advised to avoid shaking hands and to stay indoors, libraries put a halt on lending books and regulations were passed banning spitting. And some of the best advice was also the simplest. “Cover up each cough and sneeze. If you don't, you'll spread the disease.”
THE FLU TAKES HEAVY TOLL ON SOCIETY
