“Yes, I have. Look, I know that you’ve alerted the CDC in Atlanta, but I’ve a friend there, Ellen Augustein, she’s one of the disease co-ordinators. Do you mind if I give Ellen a call?”
“No, by all means do. I’ve just drafted a report for them this afternoon. If this is as bad as I think it is, then we’re going to have some major containment problems, and the longer it goes on unchecked the more impossible adequate containment will become. This isn’t looking good Evan. The kids from Ripon who died were fit, healthy, teenagers in their prime, and I’ve learned today that their Matron has just died too.”
“OK Megan, thanks. I know the wheels are in motion but I’m going to give them another push. I’ll get back to you if anything new comes up.”
“Thanks Evan, goodbye.”
***
Cornell Ryan still had the smell of lavender in his nostrils when he boarded the British Airways Boeing 747, at O’Hare International Airport, bound for London. Over 70 million people a year travel through Chicago O'Hare International Airport, an airline hub that serves other airports all over the world. Cornell had been late to the check-in desk and so had to rush through to gate 42, where he arrived sweating and panting for air, only to realise that the flight had been delayed for 15 minutes. Enough time to visit the toilet, he thought. The attendant, a strange-looking Asian lady, had just finished cleaning the toilet as he barged past her in order to get to a cubicle before it was too late.
Cornell worked for SMK, a computer hardware company from Northbrook that manufactured digital video recording equipment used for video surveillance. Cornell was only 1.70 metres tall but he weighed 125 kilograms. Because he was grossly overweight, he couldn’t find many shirts that would fit around his neck, therefore he had to wear his shirt permanently open at the neck and try to disguise it with his tie. As a result, he always looked untidy. Another condition of his physique was being permanently wet with sweat. Sweating was the bane of his life, it often made him smell and suffer from chafing under his arms or between his thighs. Single and forty-six, he still lived with his mother Audrey in Northbrook. Conscious of his size, Cornell never went out, so he never met anyone with whom he could form a relationship. Though he was made fun of by the jocks at work, he was brilliant at his job and knew more about digital surveillance equipment than any of the other engineers at SMK. This trip to the UK, to a technical support conference in London was the first chance he had to show his expertise outside the company. Cornell would never be management material and so was permanently stuck as a senior engineer. He had never had the opportunity to visit another country before as his elderly mother couldn’t travel and he would never contemplate going on holiday by himself. This conference was an exciting departure from his normally dull life looking after his Mum.
When Cornell finished his toileting, he used a wet wipe from his bag to wipe his bottom, this was always a necessity because of the chafing he suffered. However, when he tried to flush the toilet the fabric wet wipe wouldn’t disappear. He waited for the cistern to refill before he flushed again. The tell-tale cloth remained stuck in the bowl. Embarrassed, he left the cubicle in a bustle, carrying his laptop in one hand, his passport and ticket in the other, and his other briefcase lodged under his arm.
“About bloody time, what the fuck were you doing in there fat boy, jerking yourself off?”
Cornell, his head bowed in shame, his face burning with embarrassment, could only muster a croaked apology. “Err sorry, I didn’t know you were waiting.”
Tempted to rush from the toilet to escape the glare of the skinhead who had insulted him, he pulled himself together and went to the furthest washbasin to wash his hands and straighten himself up.
“Hey fat boy! You’ve left a turd in here you dirty sod! Good job someone’s just used air freshener to kill the smell.”
Cornell washed his hands as quickly as he could while other men at the urinals looked at him in disgusted amusement. Dragging a comb through his mop of ginger hair, he gathered up all his belongings and escaped. Now he was sweating more than he usually did and knew he couldn’t hide it. He prayed aloud that he wasn’t going to be seated next to the skinhead for the seven and a half-hour flight to London.
Seat 54J, his allotted seat, was nowhere near the skinhead. It was an aisle seat, not too far from the on-board toilets. Cornell was sitting next to a friendly old lady from Peckham in London, who had been visiting her daughter, not far from Northbrook where Cornell worked. She kept Cornell from worrying about the flight by telling him about her adventures in America, her daughter, who was a nurse, and her fifteen grandchildren who were scattered all around the world. She told him about them all, how old they were, how well they were doing at school and what they wanted to be when they grew up. By the end of the flight Cornell knew about them all.
Forty-nine other men used the toilets near gate fifty-three that morning and forty women used a similar toilet on the opposite side of the concourse. Of those people, thirty-three were going to London, twenty-five were going to Paris, twenty were going to Tokyo, eight to Istanbul and three to Zagreb, in Croatia.
***
The Security and Surveillance conference at the Kensington International Hotel, in Templeton Place in London, had over five hundred and twenty delegates from thirteen different countries including the one hundred and fifty-four trade representatives. Cornell had felt terrible after his flight, so he went to bed early. He hadn’t eaten anything since the food on the plane and hadn’t felt like eating the following morning either. He put it down to jet-lag and with just a few glasses of orange juice for breakfast Cornell literally lurched from one trade stand to another as if he were drunk. Certainly, that was what other delegates thought and though the trades people were courteous, they did too. Cornell tried to eat a ham roll for lunch, but later on that afternoon he vomited it up and left the conference early. Back in his hotel room he lay on the bed, wracked by fits of coughing and a blazing high temperature. During the evening he tried to watch some television, but had to switch it off as it seemed to aggravate the headache that he had endured all day. By nine o-clock that evening he felt like death. For over an hour he had retched-up bile and alternated between being roasting hot and teeth-chattering chills. At ten he called reception and asked for a doctor, who arrived at eleven. By that time Cornell was completely incapacitated and was barely coherent when the doctor asked him questions. His fever was so high that the doctor called for an ambulance immediately and he was admitted to The Royal Marsden Hospital on Dovehouse Street, Kensington. By midnight Cornell was in the critical care ward fighting for his life. The night staff had had to call out the registrar because his condition had become grave. When the nurse took his blood oxygen level it was just seventy percent, and with an oxygen mask it barely got any higher than eighty. A nebuliser helped to combat the coughing by moistening the pus that was blocking his lungs, but his breathing was still crackling. By three o-clock the following morning, the registrar had intubated him and a ventilator controlled his breathing. Even though Cornell was receiving massive doses of antibiotics intravenously, the infection that was compromising his lungs showed no sign of easing.
It was the same in many hospitals in the United States and across Europe. Medical staff struggled to keep people alive, once the influenza and secondary infections developed.
***
When Kyoko Tanaka got off flight JL5003 from Chicago at Narita Airport, Tokyo, her head was spinning and her throat was so dry she could hardly speak. Thankfully there was a travellator in Terminal 1 which took her to the baggage hall to collect her suitcases. A really nice American guy helped her get her bags off the carousel and onto a trolley, if he hadn’t, she didn’t think that she would have managed. Clearing customs though was too much. Having waited in the queue for over twenty minutes Kyoko fainted. When she regained consciousness, she was still on the floor. Some of the airport staff holding up heavy plastic sheeting to hide her from the other passengers. She was taken to the fir
st aid post and comforted until a doctor arrived a little later. But when Dr Shinichi Kobayashi examined her, he could find little wrong. She told the doctor that she had felt sick during the thirteen-hour flight and consequently had not eaten anything for fear of vomiting. She had had a heavy period during the previous four days and was experiencing agonising stomach cramps, so feeling both sick and weak were not unusual symptoms for her. Dr Kobayashi felt that her faint was a combination of her period, dehydration from the plane’s air conditioning and low blood sugar. After drinking a cup of sweet tea, Kyoko was well enough to leave. Having been assisted through customs she was driven to the arrival’s hall in an electric golf cart, where her mother, Saeko was waiting. Greeting a loved one at an airport is often an emotional event and Saeko cried when she first saw her daughter, who had been studying international politics at the University of Chicago for the last year. Her happiness though was tinged with concern when Saeko learned of her daughter’s collapse.
“It was a long flight mother. I’m just tired. After a good night’s sleep, I’ll be fine.”
“Well, we’ll get you home as quickly as we can. Your father is working late at the university today so he won’t be back until later in the evening. Let me get a porter to help us with your luggage and then we’ll be off.”
The Tanaka’s home was a three-bedroom apartment not far from the university and just ten minutes’ walk from the Musashi-Sakai railway station. Her father, Jiro, was a lecturer at the Tokyo University of Foreign Studies, the same university that Kyoko had attained her 1st Class Honours Degree in Political Science. Kyoko was Jiro and Saeko Tanaka’s only child, and their pride and joy. They were not a rich family. Saeko herself worked as a receptionist at a local medical centre, and it had taken a long time for them to save enough money to cover Kyoko’s tuition fees and living expenses. Fluent in English, Kyoko was very bright, earning high praise for her Master’s thesis. A thesis that had earned her a scholarship to continue her studies at the University of Chicago as a PhD student.
It took Kyoko and her mother an hour and a half to get home and by that time Kyoko was exhausted.
“Straight to bed my girl, see if you can sleep off the jet lag.”
“I feel as if I could sleep for a week Mama.”
“Well, let’s hope you don’t need that much time.”
When Jiro arrived home just after 9.00pm, Kyoko was still fast asleep, so he decided that he shouldn’t wake his daughter. He had the following day off and hoped to spend quality time with her discussing her experiences in America and of her studies. Kyoko and her father had a very close and loving relationship but they always seemed to argue about their shared passion, political science. Many would think that having a lecturer as a father would be an asset, but Kyoko hardly ever consulted her father about her studies. His approach to the subject was very traditional, whereas hers was much more relaxed. Sometimes Saeko thought that her husband and daughter were like mountain sheep, butting heads all the time. Yet, for all their disagreements, Kyoko and her father loved each other dearly.
All the next day Kyoko struggled with her tiredness and headaches. Her conversations with her father were short and for Jiro disappointing. By eleven the following morning Kyoko had a temperature of 39oC and a rasping cough. Saeko called the doctor, who pronounced that she had a mild flu and that she should be kept in bed with plenty to drink. Kyoko though could not eat or drink anything without vomiting. To her mother, Kyoko seemed to be getting worse. During the afternoon she developed a hacking cough, was struggling to breathe and strange mahogany patches had begun to cover her cheeks. At seven in the evening Kyoko was admitted to hospital.
In critical care Saeko and Jiro stayed by their daughter’s bedside, both of them terribly worried. By 11.00 Kyoko was barely conscious. Dr Naoko Fukazawa too was worried, because even with oxygen and intravenous antibiotics, Kyoko’s pneumonia was not improving, before long she thought her patient would need to be on a ventilator.
Dr Fukazawa was a short woman of fifty, with dark grey hair that made her look ten years older.
“Mr and Mrs Tanaka I am concerned that your daughter is not improving. Her blood oxygen levels are getting progressively worse. I need your permission to put Kyoko on a ventilator.”
Both Jiro and Saeko were shocked when they realised that their daughter might die. Jiro’s expression became grave.
“Will she recover, Doctor Fukazawa?”
“I cannot lie to you; your daughter is very sick. She has a form of influenza I have never seen before. Both of her lungs are now compromised by pneumonia and that infection does not seem to be responding to the antibiotics that we are giving her. Now I want to try a fourth-generation antibiotic that can be used to fight such antibiotic-resistant bacteria.”
“Please do whatever you can doctor, please don’t let her die.” pleaded Jiro.
Naoko Fukazawa, leaned forward and put her hand on Jiro’s shoulder.
“Your daughter is very ill,” she said softly, “you must be prepared for the worst.”
***
Both Édouard Belmont and Jérôme Molyneux had been passengers on the Air France Airbus 343-300, flight 51 from Chicago to Charles de Gaulle Airport in Paris. On the fifteen-hour flight over the Atlantic both men had sat next to each other and enjoyed each other’s company. Édouard was a teacher at TERSAC, a mixed boarding school located in the Lot-et-Garonne region of Southwest France, near Marmande. Jérôme Molyneux worked for Chanel at the company's headquarters and main shop on the Rue Cambon in Paris. Following their arrival both men were in bed on the second day and both of them had been admitted to hospital by the fourth. Édouard died soon after he was transferred to critical care on the fifth day, while Jérôme lasted for a further two days before he too died.
When Dr Émile Rousseau, who attended Jérôme Molyneux at the Broussais University Hospital, spoke to his wife Amélie that evening he was concerned that Jérôme had only recently flown back to France from America.
“Call Ellen then” suggested Amélie “she might have seen similar cases in America.”
“Good idea my love, I’ll call her after supper. What is it Bouillabaisse?”
“You know it is, surely you can smell it.”
Émile Rousseau had met Dr Ellen Augustein, from the CDC, at an influenza conference in Atlanta Georgia the previous year. He had been impressed by her lecture on the American National Strategy for Pandemic Influenza. He still had her e-mail address, so when the opportunity arose, he returned to his office and wrote a short note to her, explaining the symptoms presented by Jérôme Molyneux. He had only a short wait for the reply. In her reply she outlined the spread of the epidemic in the North Eastern States, the number of deaths, the symptoms presented by the victims and what little information she had regarding the virus type. After reading her e-mail, Émile telephoned her directly at the CDC. They talked at length about Jérôme Molyneux and the implications of the spread of the disease to other countries. Luckily Émile had all the details of Jérôme’s flight out of Chicago, which gave Ellen a new point source for the disease.
“Thanks, Émile for letting me know so quickly. This outbreak is becoming a catastrophe. I’ll keep you informed as much as I can. And please, if you have any more cases, you must contain them as best as you can.”
Émile was devastated by this news. He knew, from first-hand experience, of the H3N2 Hong Kong pandemic in 1968, and how devastating this disease could be It was the beginning of a nightmare.
***
Ellen Augustein immediately put the National Strategy for Pandemic Influenza into action. First, she rang Lieutenant Colonel Mike Morrison at USAMRIID, at Fort Detrick. She spoke to him for nearly an hour, outlining all she knew about the outbreak so far. She immediately couriered to him copies of all the recent medical reports that she had collated. She also prepared an influenza epidemic warning that she sent to colleagues around the world, giving them the ‘heads up’ before a formal statement from the US Government wa
s released. When this landed on the desks of health officials in London and Istanbul it was of no surprise, as they were dealing with their own cases which had stepped off planes from Chicago’s O’Hare International Airport.
25. The Four Horsemen
When Dr Mike Morrison returned to his office frustrated and very angry, he kicked the door open, ripped his lab coat off and threw it across the room. This had become the worst day of his life. His worst nightmare had become a reality. He now knew for sure that America was on the verge of an influenza epidemic and it was a killer. The sub-type from five sputum samples from Ripon was confirmed, the virus was a H5N1 subtype. What had previously only been reported in birds was now in the human population, in a highly contagious form. This was the potential pandemic that all virologists had predicted might happen.
“God help us all,” Mike said, aloud.
In countries barely recovering from the ravages of war, 1918 saw 20-40 million people die as a result of the Spanish flu. More deaths occurred from the influenza virus than all the casualties of the Great War. Could it all happen again he thought? He hoped that modern medicine, quarantine and barrier nursing techniques would be enough to prevent the same thing happening again. The Emergency Action Plan had already been activated and health authorities all over the US were implementing procedures that would attempt to limit the effect of the virus and its spread across the whole country.
Crystal Ice Page 30
