The Nightmare Scenario (29 page)

India


Infection present in northeastern parts of the country with a total of 24 confirmed cases in the provinces of Arunachal-Pradesh, Nagaland and Manipur. A quarantine-line has been put in effect along the eastern border of West Bengal, Bhutan and Bangladesh, effectively cutting of the northeastern areas from the rest of the country.


Myanmar


No reliable data available but eyewitness accounts describe infection as present across the country with infected at the minimum in the tens of thousands.


Thailand


Infection possibly present in northwestern parts of country with suspected cases in the regions of Chiang Mai, Lampang and Chiang Rai.


AUGUST 12
^TH
, LATE AFTERNOON, MAIN LAB, DIRECTORATE FOR DISEASE CONTROL, JAKARTA, INDONESIA

O
nly one person on Yelena’s staff had declined to go with her to Jakarta. None of them had gotten much sleep during the four days they’d been here. Still, team morale was high. Four of her best students were leading a group of research assistants from various countries, exploring the known avenues for rapid antigen tests, which had proven effective for HIV.

The lab was primitive compared to the facilities in the developed world, but it was functional and they had everything they needed. They didn’t complain. Working while wearing respirators was taxing, but they did block the strong smell of antiseptic fluids that permeated the lab.

An assistant informed her via intercom that she had a call from a Dr. Hughes in Geneva. She told the assistant she’d call him back and started the decontamination procedure they all went through when leaving the lab. As the pneumatic doors shut behind her, she entered the “clean room.” She started by washing off the exposed surfaces of her garments with chlorine. She then removed her gloves and scrubs and threw them into a bin for incineration. Then she used alcohol and iodine to sterilize any points of her skin that could have been exposed. She cleaned the outside of her mask and goggles meticulously before removing them. Finally, she examined her entire body under an ultraviolet lamp, projecting the dark light on all surfaces of her skin. She’d never been a believer in ultraviolet as a disinfectant. What bleach couldn’t kill she doubted light could. Still, she followed the process to the letter.

Then again, what did it matter? Their ability to isolate their living quarters was shaky at best. If they were going to get infected, it wouldn’t be from the lab.

“Old friend, how are things?” she asked when she finally went to the phone.

“I trust you’ve seen the daily alerts?” answered Aeolus.

“Yes, I have. It’s not looking good. My only consolation is that there are no cases reported in Russia yet.”

“It won’t be long until there are.”

“Yeah, I know…”

“How are things progressing down there?”

“As I’ve told you many times, Aeolus, these things take time. We’re working as fast as we can.”

“What are you exploring?”

“The standard approaches. But, as I said, Loo’s test is a patchwork. We can’t make it reliable in a cushion test setting. We can’t maintain specificity. You’re supposed to have clean monoclonals but that’s still quite far away. I’d say a month, at least. There’s no way to speed it up.”

“Yelena, if we had clean specific monoclonals I wouldn’t have sent you down there in the first place. I don’t need a replication of well-known methods. I need a miracle. I know you can do it. You have to think of something else.”

“Well, Dr. Hughes, I think it’s fair to say that I’m aware of what’s at stake, as well as the time pressure. I don’t think you appreciate how difficult what you’re asking for is. As you know, it’s been quite some time since I worked on this. But as I’m still one of maybe three people on this globe who can do it, I suggest you get off my back! I don’t need you lecturing me on what might, and what might not, work!”

“No, Yelena, it’s not three people?”

“What do you mean?”

“Birkenstein died in a car accident six months ago and Mourtzanou’s dementia is now so far progressed, he is only lucid during brief spurts. There are not three people. There’s only you.”

“You mean our work here is the only rapid test effort currently in progress?”

“No, but it’s the only one that has any chance of succeeding. You have to think of something different.”

“Okay, Aeolus,” she said and went silent for a minute. “I’ll see if we can broaden our approach.”

“Thank you, Yelena. And good luck.”

“
K chortu
!” whispered Yelena to no one in particular after hanging up. Then she smacked a coffee cup on the desk, sending coffee and broken ceramic all over the floor.

Yelena called her staff out of the lab and gathered them in the office.

“This is not going to work. We have to try a new approach. Millions of lives are dependent on us delivering this and I am fresh out of ideas. Can someone think of
anything
we could try, no matter how crazy, that would have a result in days – not weeks?”

The room was silent. After a minute, the Chinese postdoc spoke.

“I have idea.”

“And we are all ears,” responded Yelena, not expecting much from the bookworm.

“I think like Chinese. You all think like American. I thought Russian think like Chinese, but you think like American. I say no specificity. Normal flu, death flu, who cares? We make test for both. Easy. I think Professor Petrova can do.”

Sergei, who had gained considerable stature in the student group from his discovery of the infected black market organs, instantly objected. “Wow, now that’s a great idea. Are you mad? You know what that means? It means that people with the seasonal flu, of which there are a lot, by the way, will be tagged as infected! If you have a village in quarantine and someone knocks on the door, they won’t be let in
even though they’re not infected. You are condemning them to death.”

“Does not matter. If no test no one gets in to village. If no test everyone die. With my test we save some. Some is good. No one is bad.”

Silence settled again and all the students watched Yelena, who was weighing the pros and cons.

Luca, her favorite, spoke up. “He has a point. Also, we should keep in mind that when the new flu spreads it’ll push out the old flu. It always does. The problem will become smaller over time.”

“Sold. Let’s get to work,” announced Yelena.

In a last-ditch effort to win the argument, Sergei cried, “Professor Petrova. Ethically, we are now in awfully murky territory.”

“Sergei, if you continue in epidemiology, you will find that most of the time we are.”

WHO SITUATION UPDATE REPORT:
A/Singapore/4/2015(H1N1) – 2015/08/13


Indonesia


Infection spread over entire country, even to remote rural areas. A wide range of societal services, including the health system, have broken down in large parts of the country, making accuracy of further reporting questionable.


Malaysia


Containment of Kuala Lumpur has been breached. There are 23 confirmed cases in 6 regional cities. Infection suspected to be spread broadly across the country. In Kuala Lumpur there are more than 10,000 infected. The health system is strained to the maximum of its capacity.


India


The infection is spreading rapidly across the quarantined northeastern provinces. So far there are no documented cases in the rest of the country.


Bangladesh


There are now 2 confirmed cases in Dhaka who traveled from India. Entire hospital where cases discovered is under quarantine.


Myanmar


Infection estimated to be prevalent throughout entire country.


Thailand


Infection present in the northwestern provinces with 18 confirmed cases, and has also spread to the capital where 2 cases have been put under quarantine.


Other potentially affected countries


There are suspected but unconfirmed cases in the countries of Sudan, Qatar, the Philippines and Tajikistan.


AUGUST 13
^TH
, SOMETIME DURING THE NIGHT, AEOLUS’S SUITE, WHO REGIONAL OFFICE, SHAM NATH MARG, NEW DELHI

A
long corridor stretched out before Rebecca, at the end of which was a set of glass double doors. Two Indonesian nurses stood by the doors, trying to hold them closed as the mob outside pushed and pushed to get into the hospital.

“Dr. Summers,” the nurses cried. “You have to help us. We don’t know who to let in.”

Rebecca lengthened her stride, yelling, “No one can enter! No one!”

The doors they were already half open – the crowd was overwhelming the nurses not having the strength required to hold them closed against the force of the crowd.

“Stop!” yelled Rebecca at the gathering of people outside. “We don’t have room. We can only take
patients that have a chance to survive; only strong men above thirty without visible symptoms.”

“But my son,” cried an old, withered woman outside the door. “He only has fever, I am sure he can still be saved. God has told me so.” She patted the head of a young buy standing beside her.

“No way,” Rebecca said, turning around while the four security guards pushed the door shut.

There were people at the other entrances as well and she started running towards them yelling at the police to shut them.

Then suddenly, there was Roger. His ears were bleeding and he was shiny with fever.

“Twinkie, please take care of me.”

“What are you doing here? Guards, get this man out!”

Three uniformed militaries hefted him onto their shoulders and started carrying him down the hallway.

Roger reached into his pocket and withdrew a stack of bills. “Please let me in. I have money.”

Rebecca said with force: “Let him down!” – but these were not the words that came out of her mouth. Instead it was a mechanical repetition: “No exceptions!”

Roger waved a solitaire engagement ring.

“Please Twinkie, don’t leave me to die. I love you. I always have. I want to live with you. I want to marry you. Please let me in. Please save me.”

Rebecca was now screaming at the top of her lungs, but no sound left her mouth. Instead she turned around and ran back through the office landscape.

Far away she could hear the scream of a woman. The scream came closer. The walls started bending and rotating, the picture turning black. Two dots of light appeared in the middle of her field of vision. She recognized the scream as being her own only a second before she woke up.

WHO SITUATION UPDATE REPORT:
A/Singapore/4/2015(H1N1) – 2015/08/14


Infection now spread to large parts of the Asian continent and possibly the Middle East and Africa. Classification of countries as follows:


Broadly spread


Countries where infection is present in most parts of the country now include: Indonesia, Myanmar, Malaysia and Thailand. The situation is such that effective quarantining within the country is deemed impossible.


Regional outbreaks


In India, infection is prevalent across the entirety of the 5 northeastern provinces. Furthermore, there are now confirmed cases in New Delhi as well as Mumbai.


The capitals of Bangladesh, Cambodia and the Philippines have a sufficient amount of cases to suggest spread throughout the cities. Quarantine measures are being put into effect along major entry exit points but maintaining containment is assessed to be difficult.


Isolated cases


Isolated incidents of infection have now been confirmed in: Sudan, Qatar, Tajikistan and South Africa.


Possible further spread


There are now isolated, suspected, but as-yet-, cases in Greece, Romania, Bulgaria, Eritrea, the Guangdong province of China and in the Ukraine.


AUGUST 16
^TH
, END OF LUNCH, THE VECTOR INSTITUTE, KOLTSOVO, NOVOSIBIRSK OBLAST, RUSSIA

T
he man with the crew cut took the first sip of his after-lunch coffee and grimaced. It remained a conundrum to him why the coffee in the cafeteria, despite his continuous complaints, remained so bad. The funding for the State Research Center of Virology and Biotechnology was generous compared to most other government installations in post-communist Russia. They were most likely the only institution, civilian or military, that had received increased funding after the fall of the Soviet Union. They had state-of-the-art equipment and modern facilities. There were two problems, however, that all the money in their budgets did not seem able to solve: the smell of mountain mold permeating all the subterranean levels and the staleness of the coffee.

He took another sip and winced as he entered his office. Across his keyboard lay a scribbled note: “Charybdis PCR-sequencing complete.” He went to his bookshelf, grabbed a folder and headed for the lab.

His top aide greeted him. “It’s done. Came through an hour or so ago.”

“Have you started distance matching?”

“Yes, against all strains we have on record. It’s about halfway through.”

“Okay, let me have a look.”

He bent over the aide’s shoulder and scanned through rows of mutational sequence mappings on the computer screen. About midway through he stopped and tapped his finger on a line.

“Whoopsy-daisy…” he said, tilting his head and pursing his lips. “Are we sure this is correct?”

“Uh… I hadn’t seen that, but yes, it has to be.”

“Well, then, say hello to our little friend.”

“This is most unexpected…”

“Yes, indeed it is,” said the man as he picked up the phone and asked to be connected to security.

“Security? This is Colonel Yevchenko. I need an escort for access to the Level Four sample vaults.”