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GLENN WOKE UP TO THE light of dawn streaming through curtains he hadn’t closed last night. He realized where he was and what he was doing and wondered if it was Wednesday or Thursday. He fumbled for his phone and checked. Today was Thursday. Right, he had started on Monday, Roy and Harper arrived on Tuesday, and the others had come on Wednesday. Thursday would bring him a vet from CDC, someone with experience in trapping and sampling birds.
It wasn’t one hundred percent certain that birds were the hosts. Avian flu was just a term, and nature didn’t pay attention to the rules humans tried to impose on it. Mammals were potential hosts, and ferret-to-ferret transmission of HPAI had been created in a lab a few years ago. But he put the likelihood of the host and vector both being birds at 90%, if the source wasn’t a test tube somewhere in a lab, so it seemed wise to play the odds. Start with birds, and move on from there.
He showered, shaved, and took his temperature, which he had failed to do last night. It was 37.3, normal. He checked his blood ox, which was good at 95. If he didn’t get some exercise in, that would drop though. And exercise was a good way to help manage the stress. He phoned the desk. “Is there a gym here?”
“A small one, yes, sir. There should be a laminated map of our hotel in a drawer. Your room key will open the door to the fitness center.”
Glenn found the map and dressed in shorts and a T-shirt. He went down and ran on the treadmill for thirty minutes, did some bicep curls, and called it good enough. Upstairs, he took a second shower and sniffed the armpits of his uniform before putting it on. It was okay for another day. He’d have to find a laundry nearby and do a load of clothes this weekend.
In the command center, once again someone had brought pastries for breakfast. There was fruit too, and he took a banana. Tomorrow morning, he promised himself, he’d go out and get eggs and bacon. He functioned better on high protein.
The vet, Mindi Spears, arrived just before nine and was raring to go. “If anyone is free, I could use an extra pair of hands,” she said.
“Javer?” Glenn said. “You okay with holding birds—or swabbing them?”
“Yes, of course,” he said, perking up.
Glenn knew he’d made a good choice. “Great, you go do that. Stay safe, both of you.”
“But you don’t need me here?” Javer was clearly torn between responsibility to the team and the higher level of excitement that came with getting out in the field.
“You did a great job yesterday, and we’re all set up, I think. Harper is here to back me up, and the two of us probably can put out any administrative brush fires these next two days.”
“Thank you,” Javer said, then to the vet, “Let me change. Like three minutes, max.” He took off at a near-run.
Mindi said to Glenn, “You have an index case yet?”
“No, not for sure,” Glenn said.
Harper said, “If I were you, I’d go to the north side of town. Want to see the maps?”
“Sure.” Mindi joined Harper at her laptop.
“Okay, here are cases, residences in black, work in red, other known points of contact like stores or churches in blue.”
“Yeah.”
“Now if I assume a common source outbreak, that would put the source here, within this circle. I’m working on an animation, but it’s not done. Or, it’s done but not pretty enough to show anyone.”
Mindi said, “I won’t judge. I’ll watch the early version of it.”
Glenn joined them. Harper ran an animation of symptomatic cases, with a clock running in a corner. It ran up to nine this morning. She then ran it backward to the start of the outbreak, and while there were dots all over, there was a distinct patch on the north side of town.
“You must have worked last night,” Glenn said.
“No, this morning. I was up at four-thirty and couldn’t sleep.”
“That’s great,” said Mindi. “Can you print out a still, the one with the circle on it, for me?”
“Yeah, here you go.” Harper motioned to the printer they’d set up amidst a table of office supplies.
While Mindi was picking up her printout, Glenn said to Harper, “Can you run that forward in time? Project cases?”
“Already done. But again, I want to refine the graphics before I roll it out for public display. Here.” She hit a key and the map on her laptop zoomed out. Then it went from speckled with black to fully black as the dots—sick human beings, Glenn reminded himself—spread over the county.
Only a few white spaces were left when he said, “Pause it.” The time readout was only five days away. “Based on an assumption of .6 CFR, can you run a mortality animation for me?”
“It’ll take me ten minutes.”
“I’d appreciate it. And then I’ll leave you alone to do your own thing.”
Javer came in, dressed appropriately in jeans and long sleeves, and said to Glenn, “Do you want us to bring supper back at the end of the day?”
“No, I think I’ll have someone who hasn’t been messing with possible host birds do that,” Glenn said.
“Good point,” said Javer. He fingered his respirator, which was hanging around his neck. If he hadn’t been thinking of how dangerous his task today was, he would be now.
And that had been Glenn’s intent. “Break a leg,” he said to them.
“I’ll get you your host,” Mindi said. “Maybe not today, but my goal is to find it before the month is out.”
“Good. Thank you both.”
He leaned over Harper until she said, teeth set, “I can’t work with you breathing down my neck. Sir.”
“Oh. Sorry.” He backed off to check his phone. Nothing new that couldn’t wait ten minutes. They were using urgent codes on messages and email subject lines to try and help each other see information that required immediate action—action that might save lives. The information would be coming fast and furious—or faster and furiouser—with every passing day, and no one wanted to miss a crucial clue because of information overload.
He began to compose an email to Emile, to update him on where they were, and was nearly done when Harper said, “Okay, have it. Sixty percent fatality rate on average, but I made it fifty percent for young adults, and seventy-five percent for children under six and people over sixty.”
He stood over her shoulder again. “Run it for me.”
“Here it is.”
The time marker started at 0, today. The deaths in Trenton proper were already too numerous to count at a glance. She hit a key and ran it at half the speed of the past case animation. It was horrifying, and it only went out a week. “Good job,” he managed to say.
“Thank you.”
“Never forget that every one of those dots is not just a human dead, it’s a half-dozen people grieving. It’s children losing parents and going into the foster care system. It’s disabled people losing caregivers. It’s human misery uncountable.”
She was looking strangely at him.
“What?”
“You really feel it, don’t you? Their pain.”
“But you can’t drown in it, either, or you can’t do your job.”
“I think I’ll stick with the numbers.”
“But as a favor to me, don’t forget. Take a minute every day to think of the human face of this.”
“You ever think of bad people dying? Not just the good ones die.”
“I—oh shit. Did I put someone on prisons? I think I forgot to.” He went to his own laptop and Googled a map of New Jersey prisons and then punched in the name of the nearest one. “There’s one just outside of town. More than two thousand inmates and staff.”
With confined spaces, people touching the same surfaces, overcrowded as most American prisons were, it would be like a virus breeding ground. “We should do ELISAs on the prison staff. Do you mind if I call Alverez myself?” He had assigned her the liaison work and didn’t want to step on her toes.
“Be my guest. I’m happy collecting and running the numbers.”
He made the phone call and left a message for the head of public health, explaining his concern and asking him to phone right back. While he was waiting, he checked on the status of ordering more kits for testing. They’d be overwhelming all the labs in the area, and CDC Philadelphia as well. So pre-made kits plus training in hospitals on how to use them would help take some of the strain off the local labs for a short while. After seeing the animation, he knew the day would come—and soon—when the numbers of patients to be tested would overwhelm the number of trained humans who could run the tests. At that point, primary care workers would be diagnosing based on symptoms alone, and a few people with nothing more than a head cold would be counted among the epidemic numbers.
By the time Alverez called back, Glenn had a tentative plan of action for getting more testing kits here.
Alverez too had forgotten about the prison, he admitted. “We also have a county jail.”
“Any other residential institutions? Do you have a school for the deaf, or prep schools, or seminaries, anything like that? Dorms at universities?”
“I’m sure there’s a list around here somewhere. Thanks for the reminder.”
“Let me or Harper know what else we can do to help you, please. You overwhelmed?”
“Jesus, yes.”
“You’re doing great. Saw you on the news. You’re getting the word out without creating panic.”
“Hey, Doc?” Alverez said.
“Yes?” Glenn said.
“When will this be over?”
Glenn thought of the animation he’d just seen. “I don’t know, but I think you need to be thinking in terms of months, not days. If we think of the Spanish flu, a century ago, you’ll remember it takes a couple years to see the end of it. We have more tools to fight it today, but you’ll be seeing cases off and on for that long, I think. We all will, everywhere in the country. It won’t stop with Trenton, and it won’t stop at the Delaware River, either.”
“The mayor’s office was right, you know. This is going to kill our economy, what tiny fragment of it was healthy last week.”
“I know. I wish I could spare you that.”
When they hung up, Glenn gave a thought to the nation’s economy, and the world’s. When this thing got going—and it was going to, despite his best efforts this week—it would trigger a recession worse than the banking crisis caused.
He made a note to move his retirement money out of the stock market today and into his bank. Still not 100% safe, but better than keeping it in the blended fund he had it in now.
Enough selfishness. What could he do to best help his staff protect the vulnerable people out there?
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BY THAT EVENING’S MEETING, they had a much clearer picture of the outbreak. Harper’s maps and animations had been updated all day as people phoned or emailed her with better data. Silence reigned over the room as she ran her projections. She ran the future animation a second time, zooming out from New Jersey, and within days the northeastern section of the United States was blackened with death. The spread slowed as the spaces between houses grew, but in Chicago, Memphis, St. Louis, the cities went black before six weeks had passed.
This, the Trenton outbreak, was the vanguard of a pandemic.
There was complete silence in the room when the animation faded. After a half-minute of quiet, Roy said, “We should shut down air travel.”
“We can’t do that,” a woman from Philadelphia said.
“We need to travel,” said someone from Atlanta.
“What about an advisory?” Roy said. “Business and emergency travel only, cancel your vacation, wear a mask on the plane.”
Someone snorted. “Masks give you like five percent protection.”
“For the infected and symptomatic, at least they won’t be spreading it.”
Glenn didn’t stop them talking, but he knew that, as good as the suggestion was, they would never get that accomplished—not until it was far too late. Politics trumped common sense at times like this. He’d seen it in Asia, and Africa, and Costa Rica too. People were people no matter where you went. He walked outside with his phone and called Emile. “I need to talk with you and the director tonight. Conference call on Skype. Set it for eight, please. Or I’ll tell you all I know tonight at eight and then you pass it along, whichever you want.”
“No, it’s your investigation, and you know answers I don’t. I’m sure I’ll have questions of my own. Chanchal too?”
“Yes. Whoever you think, but limit it to six please so it’s not cacophony.”
“Five. We need Response in on it, for sure.”
“Yes, we do,” Glenn said. “Gotta get back to my staff. Call you in forty minutes.” He went back into the room and straight to the front. “I need to wrap this up in a half-hour,” he said, through the noise of discussion. The room quieted. “I have a conference call with the Director and we need to get the official national response going. Suggestions for things I need to remember to say?”
That got them focused again on the realm of the possible, rather than the saner but impossible goal of shutting down air travel today. Five minutes before he was due to be on the phone call, he ended the meeting. “Don’t forget to eat before you go. See you tomorrow morning.”
He went over to Harper and said, “Bring your laptop. I might need something for the Director.”
“If I’d known, I’d have gotten a better presentation together,” she whispered.
“It’s fine. You’re doing great.” He led her into the conference room they were using for storage. As of Monday, they’d get a third room from the hotel, and they’d need it. He flipped on lights and spied a table not crammed with boxes or supplies, and he wove over to it. “Here,” he said, moving what was on the table to the floor behind it.
He sat and opened his computer. “Want to be on Skype with us?”
“No, I’ll just sit here in the corner.”
“It wouldn’t hurt your career to be seen by the Director,” he said.
She just shook her head. He liked that. There were climbers in the organization, and people who preferred doing the work. He also preferred doing the work to administration and schmoozing, and he was happy to see the same qualities in Harper.
“Let’s get ready to do this,” he said.
She nodded, looking terribly nervous. As he set up, he said, “The Director, Lorraine, is okay. She has two rescued Dalmatians at home, deaf as can be, and she loves them like kids. She has no kids but she’s married, to a professor of post-colonial literature, a woman who specializes in Australian lit, and don’t get her started talking about it at a party or you’ll regret it. Lorraine is just a regular person.”
“I believe you,” Harper said, but she still looked nervous.
Ten minutes later, they had six people from Atlanta on Skype. The sixth was the head of emerging zoonotic diseases, which made sense.
They all deferred to the director, who said to Glenn, “Tell us what’s happening up there.”
He had printed out the main stats for easy reference. “As of about four this afternoon, we had eleven hundred twenty-six presumptive cases, one ninety-two hospital admissions, and over forty fatalities. Another hundred cases and sixteen fatalities before Monday—the first case we’re certain of, the day I arrived—are suspect as well. We’ve disinterred three of the pneumonia deaths from two weeks ago with family consent and taking samples. No results yet. As you know, those numbers aren’t large enough, nor has the disease been widespread for long enough yet, to know the CFR—but, off the record, don’t be surprised if it’s the standard .6 of Asian HPAI or even higher.
“Okay, host and vector. In short, we don’t know yet. The vet sent forty-one samples from eighteen species back to you early this evening, and she says she’ll do as well tomorrow, but after that she’ll be hunting for less-common species and her pace will slow. We’re sticking with birds for now, but if we need to, she can get mammalian samples.
“Index case, still unknown. Case definition unchanged from what I sent you yesterday. Conjunctivitis in 72% of cases might help primary care providers ID it, and then the rapid development of pneumonia in otherwise healthy adults is the second clear indicator.”
He went on down his list and gave a five-minute overview of what they had discovered. “What we know about it is less than what we don’t know. After the weekend—that’s one week after the first identified death—we’ll know more. Hang on, and I want to show you some graphics, if we can get these computers arranged.” He had Harper’s computer replace his face, and adjusted its position until Emile said the screen was visible, and then asked her to run the animations again, one by one. “Cases to date. Projected cases, New Jersey. Projected cases, eastern US. That’s one month out.”
“You had to be making some assumptions with that last one,” said the Director.
“We did, and I wouldn’t show this outside the CDC. But I wanted you to see how fast it seems to be spreading. I know you all know the formulae as well as I do—or better—but seeing it graphically presented really brings the reality home, doesn’t it?”
The meeting continued. He fielded questions, and he was careful to say he didn’t know when he didn’t and that he was making educated guesses when that was the case. But he also wanted it to be clear that it was serious, dangerous, deadly, and that he had sounded the alarm quickly for very good reasons. If someone up the line from him decided to downplay it, recriminations might come back on him anyway, but for his own peace of mind he wanted to be clear within the agency itself. “It’s a deadly pandemic in the early stages. That’s my assessment.”
In a way, he was scaring himself. He had been focused on the small details, running the CDC show, supervising people, making sure every job got done, coming up with new tasks and assigning them. But as he said these words now, at the end of the day, he understood how true they were.
The Director cut to the chase. “Can we contain it?”
“No, I don’t think so. Not without historical levels of compliance in the populace.”
Lorraine said, “What about vaccine on hand? Is there any possibility, Chanchal, that it will confer immunity?”
“There’s no H5N1 in this year’s general vaccine. But there is some stockpiled. I doubt very much it will work on this strain.”
“We need to get some out to New Jersey anyway to see if it might. Cliff,” she said to the head of Response. “What do we need to do logistically to get every healthcare worker, mortician, firefighter and cop in Trenton, New Jersey inoculated? Give me the personnel, mobile units, eighteen hours per day of operation, or whatever it takes.”
Glenn’s phone buzzed with the urgent signal and he glanced down at it. An email from Alverez. Seven suspected cases in the prison infirmary. He wondered if he’d thought of prisons two days ago if it would be one case, or no cases. He felt the guilt, acknowledged his part in this to himself, and tried to push it aside. What’s done is done, and he had to keep marching forward.
When they had the beginnings of a plan to try the flu shot on every first responder in town who wasn’t yet infected, they moved on to other strategies for minimizing the damage. “One of my people—Gillens—said we should shut down air travel.” He held up a hand to forestall protest. “I know it’s impossible, economically, politically, every way. But if this thing is here, it’s in New York. And that means it’s in L.A. and Chicago, and Buenos Aires and Sydney. The only thing we have going for us here is poverty, so if this county is the source, if the index case is here, at least not many people carried it away with them on an airplane. Not yet.”
Chanchal said, “But some surely have.”
“We’d be fools to hope otherwise,” Emile said.
“All right,” said the Director. “We’ve been training for years for this moment, and it’s here. We all know our jobs, right?”
Chanchal said, “When are we going public nationwide?”
“I’ll be talking to Communications about that. No one has seen that any network picked up on the story so far?”
“It is on the news locally,” said Glenn, “but it’s not the lead story here yet.” He knew it would be, and soon.
“We need to get on that, before someone does pick it up and report on it badly. We need to control the information for as long as we can. Anyway, not your problem, Glenn. Mine. What else? Anything?”
Glenn said, “I just got a note from the Director of Public Health for the county. The first cases in a maximum-security state prison of two thousand men have been reported. Not confirmed by test, but it’s sure to be our bug.”
Emile said, “Probably a guard brought it in. And there’s no way to stop it there. We already missed that chance.”
“Okay,” said the Director. “Everybody, work hard. Work smart. We’ll do this again in—what, two days? Saturday morning, ten o’clock good for everyone?”
No one protested. They’d all be working weekends—and twelve- or fourteen-hour days Monday through Friday—for the foreseeable future. When the thing overran their best efforts to keep it contained, or at least to slow it down, and a response plan was in place, that’d be the time to take a day off.
Glenn had no doubt that the flu would win, no matter how hard they worked. Viruses were here before us, and they’d be here long after the last human gasped his last breath.
