The Nightmare Scenario (11 page)

At the front of the table an image was projected onto a screen. It was the most famous image of an Ebola patient in existence; the man bleeding from his eyes, ears and mouth.

The man by the screen was not anyone Aeolus recognized. He was not the Director of the CDC or even the deputy. He wore a military uniform, and Aeolus reckoned he must be from Fort Detrick.

“I’m sorry to be late. I am Dr. Aeolus Pentecost Hughes. I’m here to represent the WHO.”

“Yes, good, have a seat,” said the president without turning around or even offering him a glance. Aeolus took a seat next to someone he thought he recognized as the Secretary of Homeland Security.

The man by the screen continued the presentation. “This, Mr. President, is what an Ebola patient looks like after the infection develops. This is, as I’m sure you can see, an excruciatingly painful way to die. This disease has an
extremely
high mortality rate; around ninety percent. It’s also highly contagious and spreads like wildfire. There have been a large number of outbreaks, mostly in, but not restricted to, Africa, leading to deaths in the hundreds.”

“Sixteen,” said Aeolus. The room went silent and everyone turned towards him. He continued: “If by an ‘outbreak,’ you mean a situation where more than two people have died, there have been sixteen of them and, by the way, they are all in Africa. And these have been spread over thirty-two years. The only way
you can speak of it as a large number of outbreaks or something outside Africa is if you count singular cases or incidences in animals, such as in Virginia 1982, in which case the total number comes to twenty-seven.”

Aeolus now had the full attention of everyone in the room, most of whom clearly thinking to themselves, “Who is this guy?” Not the uniformed man by the screen, though, who only looked annoyed.

“Sorry,” said Aeolus, “Bad habit of mine.” He lifted his hands in a gesture of surrender and leaned back in his chair.

The man cleared his throat and continued. “Mr. President, regardless, the outcome is the same. This is a deadly and very contagious disease. One important problem to consider is that the infected don’t show symptoms until after fifteen days. This means that if someone’s infected, he can walk around the city, or even fly around the country, and infect hundreds of people before we even know he’s ill. Those hundreds of people can then infect thousands, and suddenly we have a health crisis beyond our worst nightmares. This has to be stopped.”

“Okay, I get it. So where do we stand?” the president asked.

“We have a patient who landed at Dulles from Uganda this morning, clearly ill. The crew called for medical assistance, which meant that some nurses rolled him out in a wheelchair. They noticed he was bleeding from his eyes and called for a doctor. The doctor recognized the symptoms and activated the quarantine protocols. Unfortunately, the protocols weren’t executed
exactly to the letter. It took an hour before we had the airport locked down.”

“So we have the airport quarantined now, Major Wiley?” asked the president.

“Yes,” the major continued. “But there’s been some chaos, and although we have the other passengers in quarantine, we don’t know how many people might have been exposed to them before we gathered them up. Some of these people could have left the airport. Also, one passenger is not accounted for.”

“Just let me make sure I understand this correctly,” said the president in a tone of serious remonstration. “First of all, this isn’t exactly how things are supposed to work in situations like this, is it?”

“No, that’s correct, Mr. President.” The voice came from the speakerphone, and Aeolus recognized it that of the Director of the CDC. “We dropped the ball, but we’re picking it up.”

“So we now have, firstly, an airport that has been quarantined for an hour, which I am sure the press knows about by now, without us having put out any explanation for it whatsoever,” the president summarized. “Beyond that we could have, for all we know, people who don’t know they’re infected with this Ebola thing running around in our capital infecting God knows how many others?”

“Yes, Mr. President, that is correct,” said Major Wiley, looking surprisingly calm and unaffected by what was obviously a severe failure in epidemiological response. Maybe he felt confident that the blame
would fall elsewhere. After all, technically it was more of the CDC’s territory than the USAMRIID’s.

“I recommend,” Major Wiley continued, “that you have the Virginia National Guard enforce a quarantine around the city, and that you have the Secret Service lock down the White House until we have a handle on this.”

“Technically speaking, the president doesn’t command the National Guard, the state governors do,” said someone who Aeolus imagined to be the chief of staff.

“If we need a quarantine and the governor won’t play ball, I’ll just nationalize the whole lot of them, so I don’t think that’s much of a problem,” the president said.

There was a moment’s silence.

“Mr. President, may I weigh in?” Aeolus asked.

“Sure,” said the president, sounding as if he really didn’t care and was thinking of something else.

“I think this plan of action would be a grave mistake and I’ll tell you why.

“First of all, Ebola is not at all as infectious as you are being led to believe. True, if you are exposed to the virus the risk of infection is very high, but getting exposed is not that easy. It is not, and, I repeat,
not
, airborne. It spreads through bodily fluids, which means that if I was sitting here and was a carrier, the most likely way for me to infect you would be for my saliva to get into your mouth. Also, contrary to what Mr. Wiley just toldyou patients are
not
infectious until they start showing symptoms. There are no asymptomatic carriers.

Still, it’s true that there are outbreaks in Africa that have killed, in the worst case 250 people. But all of these outbreaks have been local and contained. It kills entire villages but doesn’t spread beyond them. Why? Simply because the symptoms are so visible. When you see someone walking up to your village with bleeding eyes you don’t let them in. So if it’s not airborne, how does it spread to 250 people in Africa? Because people share meals from the same bowl using their hands, and thus blending their saliva. Furthermore, when they’re hospitalized, the procedures and equipment at the clinics are so inadequate that they reuse non-sterile needles, causing the infection to spread further.

“I have to point out that these methods of infection, sharing food from the same plate or sharing needles, are
not
particularly common in the Western world, and most definitely not so, on an airplane.

“It’s almost inconceivable that the patient would have infected someone on the plane. Given that he was bleeding from his eyes when arriving at Dulles, he would certainly have had symptoms frightening enough for other passengers to stay away from him during the flight. The
only
way I could see him having infected someone is if he touched the toilet handle with blood on his hand, after which someone else touched the handle and put their hand in their mouth or rubbed their eyes.”

“But that’s how conjunctivitis spreads,” interrupted Major Wiley, “and you have to agree that it’s extremely contagious?”

Wiley’s comment was like nails on a chalkboard to Aeolus. People who didn’t know their jobs were always annoying, but when the job was of paramount importance, Aeolus’s discomfort rose well beyond his maximum tolerance level. Aeolus turned from Wiley to the president. Controlling his irritation, he said in an unnaturally gentle voice, as if talking to a child, “What Major Wiley means, Mr. President, is that
the adenov
irus, which is one potential cause of the eye infection referred to as conjunctivitis, is highly contagious, and he is right to say so.”

Aeolus turned back to Major Wiley. “That said, I doubt
very
much that this patient had the physical ability to get out of his seat, to say nothing about going to the lavatory and opening the door on his own.

“Mr. President, there have been three confirmed cases in which people have been infected with Ebola in what we would call the developed world, and in none of the cases has there been an epidemic.

“In 1976, a laboratory assistant in the United Kingdom accidently stuck herself with a contaminated needle. No one else was infected, and she survived, which by the way reminds me that Major Wiley’s estimates of mortality rate are way too high. I’d put it somewhere around fifty percent.”

“That’s not what the literature says,” said Wiley.

“No, but I was in Africa last year during the outbreaks in the Congo and Uganda, and I’m telling you it’s not ninety percent,” replied Aeolus.

“Anyway, let me continue. In 1990, here in the US, the virus was introduced into a quarantine facility
in Virginia by monkeys from the Philippines. Four humans were infected, all of them without developing symptoms, or spreading the disease further.

“Lastly, in 1996, a health professional working in Gabon returned home to South Africa, infected with Ebola. He walked around in the Johannesburg asymptomatic for days until he was hospitalized. He survived, but a nurse that took care of him got infected and died, due to sub-par medical practices. No one else fell ill.

“Furthermore there are two unconfirmed cases in Koltsovo, also without any loss of human life.

“Mr. President. This is an unpleasant and scary disease, and it can have devastating consequences in the third undeveloped world, but in Western society, with modern medical practices, we can handle it.”

The president frowned. Aeolus sensed his discomfort was not entirely a consequence of the mess the CDC had created. Rather, it seemed as if his larger concern was with the contradictory advice he was being given. He was going to be forced to make a real decision, not just rubberstamp an expert consensus. Aeolus struggled to hide his contempt.

“If that’s true, Dr. Hughes,” the president said, reading Aeolus’s name off the badge the security guards had given him, “how come it’s classified as a Category A biological weapon? Even I know that.”

“Yes, well, Mr. President, when the virus is used as a weapon, it’s a completely different story. An infected patient on an airplane is one thing. A bomb detonating over Washington D.C. spreading aerosolized gel
containing the virus, now, that’s something very different. Hundreds of people infected instantly. Panic as people start showing symptoms. The mass hysteria and the thousands of men and women flooding to the hospitals cause the health-care system to break down. With hospitals filled with more patients than they were designed for, the usually strict adherence to established procedures starts to slip. There will be mass panic, because the symptoms are so horrifying, and it will be this panic, more than the disease, that will cause deaths.

“Don’t get me wrong, Mr. President, as a biological weapon Ebola, and especially the Zaire-strain, is formidable. But as an epidemiological threat, with one index patient in a Western country, it’s a minor problem.”

“What if it mutates and goes airborne?” asked the president.

“Mr. President, the only place where Ebola goes airborne is in the movies. This is a virus of the blood, not the lungs. The probability of a hemorrhagic fever going airborne is about the same as HIV doing so, and if
that
happened, we’d have a
real
party on our hands.”

Several people around the table exchanged glances and Aeolus realized that the statement had been too provocative in this context. He remembered the advice the Old Man had given him and went for a quick conclusion of his argument.

“My concern with your plan, Mr. President, is that it will cause exactly the type of panic that a biological attack would. People know about Ebola because they’ve read about it in the tabloids and seen it in the movies.
They’ve seen the gruesome pictures on TV of people bleeding through all kinds of bodily various orifices. They will be thinking
Andromeda Strain
and
Odd Man Hypothesis
and God only knows what else. The storm of patients will lead to bedlam at the hospitals, fistfights over supplies in stores, gridlocks in traffic and most importantly, people will try to break the quarantine and run for their lives. In this scenario, people will die, Mr. President, not from Ebola, but from the approach you have chosen to take.”

“Major Wiley?” the president turned to the military man by the screen.

“I strongly disagree, Mr. President. Mr. Hughes has a point that the risk of a national outbreak is not huge, but neither is it negligible. You have to weigh that risk against the possible consequences of the spread of infection. Imagine Ebola cases showing up in Virginia, Maryland and then New Hampshire. Mr. Hughes paints a vivid picture of the dangers of public panic, and he’s right. But if you want to see real panic, Mr. President, imagine a nationwide outbreak. You’d have to bring the full force of the government on the citizens of this country for crowd control. We’re talking martial law, curfews and a massive military effort to contain the mayhem. If that’s not a threat to national security, I don’t know what is.”

“David?” The president addressed the Director of the CDC on the speakerphone.

“Mr. President, I’m fully with USAMRIID on this. We have to quarantine the capital and lock down the White House.”

“You’re willing to assume the responsibility for this?”

“How typical of a politician,” thought Aeolus, shaking his head slowly, “dodging the responsibility for decisions that should rightfully be his.”

“Yes, Mr. President, I am,” confirmed the Director of the CDC.

“Okay, it’s done. I have to concede one point to the WHO though. The risk of panic must be controlled. I’m talking about a full lid on the press. Figure out some cover story that works. Shut up journalists who might write stuff that instigates fear. This is a matter of national security, and despite what the Hollywood liberals think, we can actually bend the First Amendment a bit in situations like this. The court has made sure of that.

“And one more thing, the National Guard does not, and, I repeat,
not
¸ have the authority to open fire against civilians, even if they’re trying to break the quarantine. They’ll have to use conventional physical force, police methods. The
last
thing I want is the picture of a kid on CNN shot dead by the Virginia National Guard.”