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MAY OF THIS YEAR
Dr. Glenn Stevens was in an excellent mood as he entered his office building Monday morning. And why not? It had been a relaxing weekend, fishing off the coast with his brother-in-law, and he was coming in to work. Glenn was one of 840 commissioned officers in the U.S. Public Health Service working at the Centers for Disease Control. He loved his job. It was challenging, interesting, and important.
“Greetings, Makayla,” he said to the assistant for his workgroup, ready to spend a few minutes in pleasant conversation with her.
But it was not to be. She held up a note. “Get over to Building 21, tout suite,” she said. “And why isn’t your cell phone on?”
Oops. He turned it on. “Anything else that can’t wait?”
“Not from my end. Good luck.”
So he took the note and read it rather than what had come in on his phone. The message was from his boss, Emile—an outbreak of a respiratory illness in New Jersey, and he was the assigned investigator. It meant travel, so he went into his office and grabbed the suitcase he kept there, packed with spare shirts, socks, shorts, and a Dopp kit, ready for these moments. Carrying that and his laptop case, he backtracked down the elevator, onto the walkways, and across the CDC campus to the Arlen Specter Headquarters.
He went up to his boss’s office and the administrative assistant told him to go right in. Inside were both his boss, Emile Cote, and the head of the virology surveillance branch, Chanchal Mian.
“What’s up?” Glenn said.
Without looking up from his computer screen, Emile said, “A cluster of viral respiratory illness in Trenton, New Jersey. We want you on it.”
“Flu? Or something else?”
“Presumptive flu, yes. There are swabs on the way here to confirm,” Emile said. “You’ll know when we know.” His eyes moved from the screen to meet Glenn’s.
Chanchal said, “Could be something new. So keep an open mind.”
“Always. Any fatalities?”
“One in intensive care so far. Six in hospital. Another dozen known cases at home.”
The two of them filled him in on the few details they had been given. It took them less than five minutes.
“Okay. Do you want me to take anyone else, or...?”
“We’re starting with you alone,” Emile said. “You tell me what you need once you’re on site. I’ll make sure there are a couple of the EIS people on standby. Have any preferences?”
“Sillens, Rashid, Jackson—any of them are good.”
“Jackson is in Korea with a MERS cluster. I’ll check on the other two.”
A tap came on the door, and Emile’s assistant came in with an airline itinerary, which he handed to Glenn. “Here you go, Doctor. Car will be ready for you too.”
“Thanks,” Glenn said.
Chanchal said, “Call me when you know anything.”
“You sound worried.”
“I am. I feel like we’re due for a serious one, you know?”
Glenn smiled at her. They were all scientists, but it didn’t keep them from being superstitious now and again.
He drove to Hartsfield, phoning his sister and mother on the way, leaving messages to let them know he’d be away on an assignment, and then he plugged in his phone to top off its charge. He left his car in the park-ride lot and took the shuttle to the terminal. There was an hour-long line at security, and he just made the plane.
When he was allowed to, he turned on his laptop and researched Trenton for ten minutes, then studied its map. He deleted this morning’s text from Emile and checked his email. There was something new from Chanchal already, so he opened it and scanned the attachments. They were clinical reports of some of the cases. Symptoms were fever and cough, worsening to difficulty breathing. One X-ray of the intensive care patient, which was worrisome, showed lungs half-filled with fluid. He glanced back at the clinical reports, trying to find the X-ray patient’s age and health status. Someone with AIDS, or someone 75 years old, and this picture of lungs would be possible in any flu outbreak. But he couldn’t match patient data to the X-ray, and what information he had suggested no one in these first cases was immunocompromised.
Chanchal had also sent him phone numbers of the county’s public health officer, the head of the hospital that had seen all of the admissions so far, and the phone number of the primary care physician for the ICU case. Damned good work in so little time. Knowing her, she’d done all the research for this herself. She was meticulous and hard-working, and it was well known she’d rather err on the side of over-responding than under-responding to a cluster of illness.
His colleagues were 95% great, actually. The other 5% were brilliant but assholes, which happened in this sort of work. Right now, they had the kind of director Glenn liked, someone able to delegate medical matters so she could focus on keeping the money flowing in. Seemed crazy that a government would always be willing to cut the funding of the front-line agency in charge of managing epidemics, but politics always was crazy, from at least Roman times on, and probably all the way back to cave-painting times. There was probably a better cave-painting artist than the one at Lascaux, but the guy who did the painting had sucked up to the leader to get the job. Today, it took a steel-willed person to deal with high-level politics, and they had one of those in Director Lorraine Segers.
He logged onto the WHO website and looked at their maps of influenza around the world to see if any type was on the upswing. It was the wrong time of year for it in the northern hemisphere. Flu is more common in the winter, probably because people are indoors more, so in closer proximity to each other, and so spreading it. But it’s always around, moving from person to person to person, biding its time until it gets the chance to explode in the winters.
There was a cluster of H3N2 in the north of Australia, Queensland, and a blip of 150 cases of H1N1 in Tasmania. Some H1N1 in Chile too. But nothing that set off any alarm bells; just normal winter outbreaks down there.
With international travel, it could be that someone flew from Queensland to New Jersey and brought the H3N2. H1N1 was always around and had been since at least World War I. Odds were it was one of those.
He glanced out the window to see a big city in the distance, the haze of pollution hanging over it. Checking the internet, he figured out it was Philadelphia. They’d be landing in a few minutes. The whole flight was only two hours, so he’d be there just after noon. He packed away his gear, taking one last look at the lung X-ray before shutting down the computer. He phoned Emile but got voicemail, hung up without leaving a message, and then had to turn off his phone when the pilot required it.
They were on the ground without incident—the sky was blue and it looked to be a perfect spring day. He found his way to the car rental agency, picked up his compact sedan, and was soon on the road, his phone directing him to the hospital. It was twenty minutes away, a trip that could be described as downwardly mobile, from driving through green areas with larger homes into neighborhoods that had seen better days and then into slums. Finding where he wanted to go in the hospital complex and finding a parking spot took another twenty minutes.
It was one o’clock when he stepped through the front door. He checked in with administration and was directed to ICU. His real work was about to begin.
