The Nightmare Scenario (5 page)

“Bacterial or viral?” asked Aeolus.

“We can’t be sure at this point.”

“Did the nun have any antibiotics?”

“Yes,” answered the junior CDC staffer, “Vancomycin, penicillin and amoxicillin.”

“With that cocktail, she would for sure have fought off the infection if it were bacterial. Conclusion must be viral pneumonitis, at least for the nun. The question is what caused it.”

“Frankly, we don’t know,” answered Rebecca. “If I may continue to Case Two,” she continued, flipping to the next slide, “there are several dissimilarities, although here too the lungs are filled with liquid. The kidneys, as you can see from this picture, are swollen and pale. Moving on to the liver, also unusually pale, is also flaccid. Although it’s not a very precise diagnosis, we suggest that this is ARDS.”

“What is your hypothesis as to the cause? Hypercytokinemia?” asked Aeolus.

“Possible, but not certain. The results from the CBC, as shown on this chart, indicate an elevated lymphocyte count. Then again, such a long time after death… It’s hard to say anything for sure.”

“This is going well,” Rebecca thought to herself. She could see that Aeolus was pleased with her presentation. She was hitting his questions like a tennis player lobbing back every ball on volley. She had caught her stride. She didn’t look at Hank. He never looked pleased.

“Case Three has distinctly different characteristics. Although there was also some liquid in the lungs, this was not the cause of death. Rather, we believe it to be some form of inflammation of the brain. There is a distinct swelling of the frontal lobes. Tissue samples show abnormal cellular growth indicative, although non-specific, of encephalitis or meningitis. Extensive
microscopic evaluation of tissue samples has not rendered any conclusive results.”

“And the cerebrospinal fluid?” asked Aeolus.

“Normal. No increased amounts of protein or white blood cells. No increase in glucose either, which would be quite unusual if it were bacterial.”

Hank shifted in his seat. He obviously did not like the way Aeolus was taking charge of and driving the discussion.

“The last case is quite interesting. It’s an infant, who didn’t have any of the symptoms of as the other villagers. Interestingly enough, we can say, with certainty, that the cause of death was dehydration. The child was unaffected by whatever killed the rest of the villagers, and died simply because the adults were unable to care for her.”

There was a moment’s silence. Rebecca watched Aeolus leaning back in his chair with closed eyes, apparently in deep thought.

Hank broke the silence in an obvious attempt to regain some control of the situation. “What about all this bleeding? What can you tell us about that, Dr. Summers?”

“Nothing really. Ruptured blood vessels. Cause unknown. As for the water, there were no signs of contamination of any kind. The local diet seems to have consisted primarily of nuts, fruits and vegetables indigenous to the area, poultry, both hunted and domesticated and the occasional chocolate sweets given to the kids by the nun. As far as we can tell, nothing was wrong with any of
it, except that it had decomposed in the sun after having been discarded. Lastly, the live chickens we brought back carried no unusual infections as far as we could tell. To conclude, we are no closer to knowing what this is.”

“Just like I told you,” Hank barked at Aeolus, “A lot of fuss over nothing; a freak occurrence of unknown cause. If it had been something serious, we would’ve found it.”

A silence settled over both rooms as everyone waited for Aeolus to respond. The only sound came from Aeolus, his eyes still closed, slowly tapping some strange, jazz-like rhythm with his index and middle fingers.

Finally he spoke. “I disagree. I would argue that this is an influenza. A very nasty one.”

“You and your damned flu!” cried Hank in agitation, slamming his fist into the desk. “There is
no way
you can conclude that from what Dr. Summers has reported.”

“No, Hank, you are right. I cannot conclude that, but the only thing I can think of that manifests like this would be the cataclysmic flu pandemic of the century leading up to 1918. All these findings are consistent with historical records, even the bleeding from the ears, although I’ve never heard of them all being present at the same time. I can simply see no other explanation.”

“But Dr. Hughes,” interjected Rebecca, “have you ever heard of an influenza with a hundred percent mortality rate? It’s simply impossible. If it was an influenza, there must have been some combination of lack of immunity among the tribesmen and a common factor with the nun that we haven’t found.”

“You are correct, Dr. Summers. But as you said yourself, the mortality from the
illness
wasn’t hundred percent. You found a child that died not from the virus, which I must assume it is, but his parents being unable to care for him. Who knows how many other cases like this there were?

“To be clear. We don’t know who this lady of death is, where she is from, or whether she will come back. But we know she is lethal, and that we have reasons for grave concern.”

Rebecca wasn’t sure how to respond. Instead, it was Hank who said, “So what would you have us do, Hughes? Raise a pandemic alert? Go to Phase Three?”

“I would indeed like to do that, but I can’t. Technically, we need to have proof of a new strain and we don’t. What we will do though, is put out an alert to all regional offices that we have reason to believe we have encountered a new infection, with similarities to influenza. We will describe the main defining characteristics. Furthermore, we will raise the report-requirement level for all major hospitals and health organizations active in Southeast Asia. Have them report in and send samples of all atypical fatalities or fatalities where they believe the cause to be influenza.”

“You’re just going to start a panic. For no reason,” mumbled Hank.

“Pardon me?” responded Aeolus.

“The hospitals down there are always on the alert to report suspicious influenza cases. It’s part of standard practice. They know most new strains originate there and they all want their name on one. Your so-called
‘alert’ will at best do nothing, and at worst cause a panic. Every family with a kid who coughs will be forcefully quarantined by their neighbors, or, even worse, some raging vigilante militia.”

“Hank, it is not without satisfaction that I take note that you have recently started to become concerned about citizen militias. Nonetheless, this is my authority and my call. You have no jurisdiction here. Furthermore, this is what we do for a living, and we have gotten quite good at it by now. Take my word for it. It will work.
Melior tutus quam rumex
, as we say around here.”

Aeolus paused just long enough to give Hank a chance to ask what that meant. When he didn’t, Aeolus told him anyway.

“Better safe than sorry. It’s Latin. Beautiful language. You should pick it up someday.”

The screen went black as Aeolus disconnected the call.

Hank grunted. “Dr. Summers, enough of this nonsense. This investigation is closed. Go back to your regular duties.”

On the WHO side, the junior staffers were shocked by how rude their boss had just been to the CDC’s director. The seniors who had been around long enough were used to it by now. Walt snickered. He loved these confrontations between Aeolus and Hank. It made him feel powerful and important, although he was not quite certain why.

“Okay,” said Aeolus, tapping his cane into the floor, “This is what we’re going to do, I want briefs, but we write only what we’re certain of, which isn’t very much. The evidence requirement for forming hypotheses in this room is a lot lower than what is required for formal statements from the WHO. Describe the symptoms in general terms but do not include any speculation as to the source or nature of the illness. I’ll want to sign off on all text myself.”

“But Dr. Hughes, we can’t withhold potentially vital information from the scientific and medical community.” It was a junior staffer who had spoken up, not realizing that he had, most likely, just forfeited his job.

“Yes we can, young man. First of all, we are not withholding information, because at this stage we don’t
know
anything. Also, there is, indeed, a trade-off between sharing information and instigating panic. In this Hank was, in principle, right. That’s why I ended the call – to avoid giving him the satisfaction of hearing me admit that he was right.”

Aeolus sat down, indicating the discussion was over. The thinking was done, it was time for execution, and that was the time of Walt, who set group in motion. “So, what are you all waiting for? You know what to do! Get going!”

“How do you want to deal with the ECDC?” Walt asked after the others had cleared the room.

“Forget the ECDC. They’re nothing. Don’t get me wrong. They’re well intentioned and they have some guys with serious skills. They’re doing necessary research. But they’re useless for outbreak management.
I mean, I can get a meeting with the Security Council, within an hour if required, and Hank, for all his flaws, can get the American president on the phone, but whom are they going to call? The Presidency of the Council of the European Union? Malta? I don’t think they have any nuclear weapons.”

Aeolus paused briefly then added, “That is, at least, I hope they don’t have any nuclear weapons...”

ITA INFIT

(And so it begins)

JULY 28
^TH
, FINALE OF THE SECOND ACT, LA SCALA, MILAN, ITALY

A
eolus couldn’t help but love it. He knew he was not “supposed” to like Puccini and especially not La Bohème. His friends from Cambridge who majored in music would call it vulgar, naïve and simplistic. And to some extent he agreed it was all of that. He was supposed to prefer Stravinsky, Rachmaninov or, best of all, some obscure composer like Messiaen. And he did. There was just something about La Bohème, and especially seeing it here at La Scala, in the comfort of his private box decorated in plush red velvet. It was without question the world’s best opera house. It was the place where Toscanini’s career had been launched, when he took over in mid-performance from a conductor who left the stage in anger. It was the only stage in the world where the audience would happily boo and throw tomatoes at the cast if disappointed with the performance.

La Scala had been closed for refurbishment between 2002 and 2004. Only in its absence did he realize how
much he loved it here. Since it reopened he’d made it a point to visit at least every other month.

The show was now in the middle of Musetta’s waltz and Aeolus shivered as a tear trickled down his cheek. His music tutor had taught him that music that does not make you cry is either poorly written or poorly performed. He had been right in that.

Aeolus’s phone vibrated in his pocket. Only Jitsuko could reach him, and she would know better than to call during the show unless it was both urgent and important.

He stepped out of his box into the corridor and answered the phone. Jitsuko said, “Mr. Hughes, sorry to disturb you, but I have Walt on the line. It seems urgent.”

“Okay, put him through.”

Walt was somewhat short of breath, as if he had run to the phone.

“Sir, apologies for disturbing you, but I think we might have a situation.”

“Okay, this better be good.”

“I just got a report in from Indonesia of a suspected outbreak. We currently have about fourteen hospitalized and seven casualties.”

“Where?” asked Aeolus, picking up the pace as he walked down the stairs toward the exit.

“A town called Ternate on the Maluku Islands. It’s an island just off to the west of Papua, with a population of about eighty thousand.”

“What more do we know?” Aeolus voice was devoid of emotion, clinical and efficient.

“Not much, it’s a small hospital; the doctor in charge barely speaks English. I’m not sure of her skill level. They’re poorly equipped, even for a third world hospital, just the absolute basics.”

“Symptoms?”

“Pretty vague so far. The doctor thinks the fatalities are due to pneumonia, but can’t be sure. Also she reports, and I quote, ‘weird discolorations of the skin in various places’.”

Aeolus stopped in mid-step, his eyes fixed on the exit, but focusing far beyond, seeing nothing. “So it seems she has come back after all,” Aeolus sighed. “At least we got three weeks of breathing room.”

Aeolus’s emotional reaction was controlled. He did not feel fear, worry or excitement. His pulse did not quicken. His mind just focused calmly, dispassionately, on the problem at hand and what needed to be done. He resumed his walk toward the exit.

“This is it, Walt. Wake everybody up! Now is when we earn our keep. Isolation comes first. It’s an island, you say?”

“Well, more like an archipelago.”

Aeolus pushed through the double doors out into the cool Italian night. The square in front of the building was lit up by the full moon, overpowering the warmer light flowing out through the windows of the theatre. Its reflection made the patches of grass surrounding the statue in the square’s center glow an eerie greenish-gray.