The Nightmare Scenario (15 page)

“Do you have HEPA filter respirators?”

“Yes, they’re coming in later today.”

“In that case, I think that’s a risk we’re willing to take, as long as you make sure the goggles are airtight. What do you say, Hank? She is, after all, your employee.”

“Do whatever the hell you want. I still think you’re exaggerating the dangers.”

Rebecca continued. “As for living quarters, we have an isolated beach where we’re staying. That should be fine. The lab work is a problem though. We have no proper facilities yet.”

“When you say, ‘yet,’ what does that mean?” asked Aeolus.

“Well, the Singaporeans are building a BSL-3 lab, or at least a BSL-2+.”

“What?” Aeolus exclaimed. “They’re building a facility with negative air pressure, airlocks and microbe-level filters for outgoing air in the middle of the jungle?”

“Yes. The mobile labs are too small. We have to build one on-site. They identified the problem early and there’ve been engineers arriving, I think from China, and lots of equipment. I have never seen anything like it.”

There was a moment of silence and then Aeolus started laughing, first quietly and then with increasing force. One after another, the others joined in. Even Hank could be heard chuckling on the other end of the line. The joint expression of mirth was a moment of relief they all needed.

Aeolus eventually got his breath back, wiped a tear from his eye and said, “Those guys are completely crazy. Stark raving mad, I tell you. And I mean that in a good way.”

Everyone around the table was still smiling as Rebecca continued.

“As for the situation here, it’s getting increasingly out of control. New patients are coming in every hour. When I set out to go here, we had fourteen hospitalized,
not counting the infected doctor and nurse, plus seven casualties. We now have about a hundred patients. All the beds are occupied. We’ll have sick people lying outside the building in a matter of hours.”

“Fortunately,” she went on, “help is also coming. We have doctors and nurses arriving from around the region, NGOs, missionaries and locals. I think we’ll have the manpower required, but we need a proper field hospital.”

“They can build a BSL-3 lab in the jungle, but can’t put up a couple of tents?”

“I think they figured they should focus on what requires rocket science-level skills, not that which a band of Boy Scouts could solve in five minutes.”

“Walt?” Aeolus’s tone was not pleasant.

“I’m on it,” said Walt and quickly left the room.

“Well, as for the staff arrivals, I’m glad to hear the local office has finally decided to join the party. Better late than never. Okay, Rebecca, what can you tell us about the infection so far?”

“It’s too early to tell but we have patients that seem to be doing relatively well. My judgment is that several of them will make it.”

“Dare to venture a guess on the mortality rate?”

“I would put it at around sixty percent, but you have to keep in mind that the conditions here are very primitive. In a proper environment, and by that I mean a real hospital, with a full battery of antibiotics to treat the bacterial pneumonia and anti-viral drugs, I’d think it could drop to thirty percent.”

“That number’s too high. That can’t be right. There must be something else going on,” said Hank.

“Well, that’s thirty percent of the symptomatic patients, not thirty percent of the infected. The missing variable is the asymptomatic carriers. If we say that’s between thirty and fifty percent that puts the effective mortality rate at twenty to twenty-five percent, which is around the upper end of the estimates for the Spanish flu,” replied Aeolus.

“At least it’s better than the fifty percent for Ebola,” said Kevin, eager to show off his knowledge.

“Or the seventy percent for the Marburg hemorrhagic fever,” said Ed, not wanting to be outshone by his co-deputy, and always happy to deliver bad news.

“Oh, shut up,” said Aeolus reproachfully. “A regular flu has a mortality below point-one percent and twenty-five percent of the world’s population is still one and a half billion people, so I would appreciate if you two dropped the Statler and Waldorf routine.”

“Um… Well,” continued Rebecca, “until we have a test for infection, we have no way of assessing the asymptomatic share of the population. And even if we had a test, which I assume is two to three weeks out, it would be logistically impossible in this archipelago. There are just too many islands.”

“Okay, next order of business is incubation period,” said Aeolus.

“We have no idea, Dr. Hughes. The only thing we know is that the first patient came in six days before the second one, from which we can really draw no conclusions at this stage.”

Aeolus exhaled. “We know from the tests in Singapore that it’s an influenza and that the strain is
previously unknown. Rebecca, I assume you can confirm that it’s spreading from human to human?”

“Yes, there can be
absolutely
no doubt about that.”

“Okay. I hereby upgrade the pandemic threat level of A/Singapore/4/2015/ (HXNX) to Phase Four. In layman terms, we will from here on refer to this strain as ‘the Maluku Influenza.’

“We now have to give a broader statement to the public. Kevin, please take charge of this. Work with the press office and Stan. We need a statement that is factual and shares what we know but written in a way that minimizes the risk of panic.

“Ed, you prepare a proper global alert to the health community. Give them all the details they need, not that we have much at this stage.”

He turned back to Rebecca.

“This brings me to my last question. Once this announcement goes out, we’re going to be flooded with reports from all over the world of patients with influenza symptoms that are slightly more severe than usual. The vast majority of these are going to be regular cases of the seasonal flu, and we’re going to get completely bogged down. Until we have a test we will have to go old school and rely on observational diagnostics. So, are there any distinguishing symptoms we can use to separate this strain from other cases?”

“Well, I knew that was going to be the most important question and just had a meeting with the staff to discuss it. The symptoms are varied. Still, surprisingly many of the patients are bleeding, mostly from the ears but also from lesions in their skin and in one case from
the eyes. Also, just like with the nun, we see petechial hemorrhages around, but not confined to, the neck.

“At this stage, if I were you, I’d go with the bleeding. If you have a patient coughing blood and bleeding from his ears, I’d say that that’s worth investigating. It’s common enough here and rare enough elsewhere. That’s all I can give you.”

“Thank you, Rebecca. Hang in there. Help is on the way. How much time do you need before you can give us more?”

“Well, this was the first glance. Gathering more information is going to take a while. We need to see how things develop and we need to do a series of autopsies. I doubt, unless something extraordinary happens, that I’ll have anything new for you for at least forty-eight hours.”

“Forty-eight hours is a long time”

“Yes it is, but that’s what it will take. I’d rather not waste all ours time in video conferences where I regurgitate what we all already know.”

“Okay, we’ll check in again in forty-eight hours. Same time. Over and out.”

“Over and out.”

JULY 30
^TH
, MIDFLIGHT, SINGAPORE AIRLINES FLIGHT SQ21 FROM NEWARK TO SINGAPORE

R
oger Burton was stretching his legs in the business-class cabin. He really couldn’t afford it, but business class on a Singapore Airlines A380 was just unbeatable. It was the only plane on which he could sleep properly. He had gotten too old to do twenty-one hour flights in economy class. He’d promised Rebecca not to go to Indonesia, and he was a man of his word, but he’d said nothing about not going to Singapore. He had to be close to the story, and Singapore was only an hour’s flight from Indonesia.

While sipping his pre-meal champagne, he went through the material he’d gathered so far. He had a good piece on Aeolus’s background – it just needed some polish. Also, he had more than enough to write an engaging and fun section on his behavior, quirks; eccentricities and all. Rebecca had shared many
priceless gems. Roger’s favorite was the story of how Hughes had told a consultant from a pharmaceutical company, whom he thought wore too-short socks: “Mister, if I were you, I would buy some new socks. The client doesn’t pay to see your hairy legs.”

The piece that was still missing was about how Hughes had changed the WHO. Rebecca had told him quite a bit about the night before. He’d had no idea of how profoundly different the WHO was now, compared to before, nor the controversy caused in the medical community by Hughes’s overhaul of it.

As most of the public, Roger had always associated the WHO with the fight against pandemics. In reality, only a fraction of its resources was dedicated to that purpose. It had – Roger started leafing through a set of printouts from the web – a three billion dollar budget and eight thousand employees, many of them dealing with things as unexciting as setting norms and standards for health care in developing countries, whatever that meant.

A passing flight attendant disrupted his train of thought by triggering his craving for another drink. He lifted his empty glass, beckoning for a refill, and once the champagne was poured, he starting typing.

“The WHO of today is a very different animal from that of yesteryear. What used to be a highly politicized, slow-moving, consensus-based, committee-driven organization has become a streamlined entity with an almost militaristic command-and-control structure.

“This is the story of how Aeolus Pentecost Hughes transformed the largest health organization in the
world into a well-oiled machine built for one purpose: to combat global pandemics. This is the story of how he, against massive internal protests, rearranged the organization, consolidating all activities related to pandemics under his own leadership. This is the story of how he created direct links to key medical staff in the high-risk nations, extending the organization’s reach beyond the UN forums. And most interestingly, this is the story of how he gained the mandate to do so.”

A couple of seats in front of Roger, a baby started crying. He cursed. People should know better than to bring infants into business class. And airlines should know better than to accept them. An old woman sitting across the aisle responded by making grimaces and animal sounds, trying to distract the child. Roger responded by ordering another glass of champagne, this time with a good measure of vodka in it. If he could not have peace and quiet on the flight, at least he was going to get properly drunk.

JULY 30
^TH
, 5 PM, DIRECTOR-GENERAL’S OFFICE, WHO HEADQUARTERS, GENEVA

A
eolus was sitting at his mahogany partner’s desk, gently rocking back and forth in his chair, Ed and Kevin observing him in bewilderment.

His desk was, as was usual this time of day, an absolute mess. Sheets of paper, most of them with illegible notes scribbled all over them, were strewn everywhere. Even the floor around the desk was covered with half-written notes, discarded before completion and crunched up into balls.

Before he came to work each day, Mandy would sort through things, file briefs appropriately and clean it all up. Every morning his office was impeccably neat, as would have befitted the desk of a complete pedantic. Around lunchtime, though, the disorder would already have spread and there wouldn’t be any surface of his desk visible under the piles of paper.

It was an unavoidable consequence of his temperament. When he became absorbed in something, and
he most often was, he couldn’t care less for the things around him. That was just how he was: immaculate in clothes and appearance – a tornado of utter chaos in all other aspects of order.

He was leafing through the drafts that Kevin and Ed had prepared, and he was pleased. He had some comments, but the texts were almost there.

“We need to understand more about this abnormal virulence,” began Aeolus. “If your reports are right, it seems that normal preventative measures are only half as effective as they should be. Something is amiss here.”

Ed cleared his throat and, stumbling over his words, said, “We have something on that, but couldn’t agree if it was solid enough to bring to you.”

“So, spit it out! If you’re going to waste my time talking about it, you might as well tell me what it is.”

“We received a flash from Dr. Jan Lukschandl in Amsterdam…” Ed began. Kevin interrupted, “I mean, we
know
he’s a bit of a kook, but…”

Aeolus, shone up in a smile, and struck out with his hands, sending papers flying left, right and center. “No, no, don’t worry. I love that guy. He cracks me up. What has the old fool done now?”

It was Kevin who responded. “He’s been looking at the sequencing of the polymerase and there seems to be a significant gene shift in the second polymerase.”

“What is he doing sequencing the polymerase?”

“Umm… He says that since everyone else is going after the hemagglutinin, someone should be looking at the other parts.”

“And he thinks this PB2 mutation increases the rate of replication.”

“He says that he’s done some research…”

“Yes… Yes… he has actually. I’d almost forgotten that. It was never published.
Lancet
sent it back because there were some technical issues with his statistics. He, being the way he is, obviously got furious out of his mind and never re-submitted.”

Both Kevin and Ed were now both looking at Aeolus with a mixture of surprise and concern, as if he was not entirely sane.

“What? Yes, of course I read all the unpublished submissions as well:
Lancet
,
Nature
and
Science
. So should you, by the way. You wouldn’t believe how much you can learn from obscure and sometimes flawed unpublished research.

“Anyway, I agree that Jan is a bit loopy, but he’s not completely incompetent. Also, he has too much respect for this office to send me stuff he wasn’t convinced of. He could be onto something.