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SUNDAY MORNING, HE made a call to Emile, waking him up.
“I’ve been thinking. We need to have a Skype meeting today, so that everyone can get moving on their end of things tomorrow first thing.”
“You want to push it up?”
“I do. Do you think it’s possible?”
“I’ll call the Director. She’ll make it happen. If you’re sure.”
“I’m sure. Press the point that we can then say that it took less than a week for us to initiate the national response.”
“To request it,” Emile corrected.
“That’s how I’d sell it to the department heads. At least it won’t be us who acted too slowly. And, of course, there is the point that I’m beginning to feel as if we are acting too slowly, and it will cost lives. That’s really why I want it pushed up.”
“We couldn’t have done anything before we knew there was a problem. You’ve moved as quickly as you can. Do you need more staff?”
“You could send me some, but I suspect you’ll be pulling them off Trenton within a day or two of their arrival. So maybe you should wait to deploy them elsewhere, to the next cluster. I don’t know. Let Lorraine or someone else decide.”
“You sound tired.”
“I just woke up.”
“You’re taking some downtime, I hope.”
“I had some time off yesterday. Shopped for clothes and whatnot.”
“Good. So yeah, what time do you think for a meeting, seven tonight?”
“Eight. I’ll have today’s numbers added in by then.”
“I’ll let you know if I can’t make it happen.”
Glenn signed off and got back to work.
About noon, the weekend receptionist in Atlanta called him. “I have instructions to pass along anything like this directly to you, Dr. Stevens,” she said.
“Yes, of course.” He was curious what this was about.
“Transferring a call. Please hold,” she said.
A click came over the line and Glenn said, “Hello? This is Dr. Stevens speaking.”
“Hi, I’m Ross Day. I work up in Bowman State Park? In New York?”
Was he asking him or telling him? “Yes?”
“And I saw this printout here about birds. I was eating lunch, and I didn’t bring anything to read, so I was, you know, reading whatever was sitting around. Anyway, it said to report dead birds in the Northeast to you guys.”
Glenn’s heart rate sped up. “Yes, right. You have something for us?”
“This was a while ago.”
“That’s fine.” Glenn wanted to reach through the phone and shake the information out of the young man.
“Maybe three, four months. Too cold for most campers, and we were on a skeleton staff. But anyway, one of the maintenance guys mentioned to me that he had found a whole bunch of dead crows one morning. Like maybe someone had poisoned them. I went out to where he had found them—he had picked them up and thrown them away already. But it was at one of their roosts. You know, roosts? Where they sleep?”
“They sleep in the same place every night?”
“They do, in a group, like an extended family. Interesting birds, crows. Smart.”
“How many dead birds?”
“He said a half a dozen, I think. Enough to notice, you know?”
“Do you think there’s any chance he touched them?” Glenn was wondering if the man who found them was sick or dead.
“Doubtful. The workers wear gloves. I mean, they have to pick up all kinds of disgusting stuff. Dirty diapers, you name it.”
“That’s good to know, that he didn’t touch them. Anything since? Would you guess the crow population is down overall?”
“Not that I noticed, but then I didn’t look for it. I thought it was probably a one-off—maybe they’d gotten into carrion that had been poisoned or something like that.”
Glenn asked for the name of the worker who had found the crows, so he could assign someone to follow up on the man’s health status. “Thank you. I’m so glad you phoned.”
“It was just luck I saw the piece of paper.”
“Good luck for us all.”
“Not for the crows,” the man said, and he broke the connection.
Glenn immediately got on the phone to Mindi. “Crows,” he said. “Have you trapped a crow yet?”
“First day. Sent the samples off. Why?”
He told her about the phone call.
“Hmm. We’ll finish with the shore birds today, I think. Should we collect more crow samples tomorrow?”
“Couldn’t hurt. From different parts of the county, or even other counties, do you think?”
“Yeah, that’s how we’ll do it. See you this evening.”
Glenn’s heart was still pumping hard with excitement. This could be something. He phoned Chanchal. “You at work today?”
“No, but I can be there in a half-hour.”
“Not necessary.” He told her about the phone call. “I was wondering if they could pick out the crow sample and test it, push it ahead of the others.”
“Done,” she said. “I’ll call them immediately. Could we get this lucky, this fast?”
“Fingers crossed,” he said.
He opened his contacts on his laptop and scanned through his list of contacts at the various agencies at the federal level. Did he know a Fish and Wildlife person? Or did it start top down, and he had to get in touch with someone in the Department of the Interior to have them ask about crow deaths? Then he remembered it was Sunday. It’d have to wait until tomorrow, but then someone in Atlanta would be coordinating it anyway. Not his job. He was just so excited about the possibility of nailing a host, he wanted to move on it, now.
He was alone in the conference room, though, so no one to tell. He had to push his excitement aside. There was plenty of other work for him to do.
At quarter before five, Harper came back, punching at her phone as she crossed the room to her habitual seat. Her laptop was open before she said, “Hi,” distracted, and she began entering numbers into her spreadsheets.
He said, “I’m sending you an email with more case info.”
She nodded and kept typing.
He knew the big numbers already himself, as everyone had called in the figures to him today, and he had kept his own unofficial tally. Hospital admissions were up nearly four hundred between the two hospitals just today. They were canceling non-critical surgeries to keep beds free, and redirecting patients with other problems to other facilities elsewhere to try and keep them from being infected too. Ellis had phoned to tell him they were considering shutting down labor and delivery tomorrow, which seemed a good idea to Glenn. Total deaths in the county were up. The only good news was that, with more numbers to work with, the CFR for hospital admissions had dropped from the initial terrifying 100% in the first days to 78%.
Who knew there’d be a day when he was thrilled to hear that only seventy-eight percent of people were dying from a disease. It was still horrible, an unthinkable number, worse than any other disease he’d ever seen in the U.S.
If every newly-contagious person today—be conservative and call it only two thousand out there, ambulatory, in this city alone—infected only five more people before the weekend was done, in two weeks Trenton would be trying to find a way to bury almost five thousand bodies.
He knew that when he met, via Skype, with the heads of departments and the Director of the CDC, he’d be recommending the strongest measures, in the strongest terms. It was time to get Homeland Security, FEMA, the FDA, and the FAA moving.
The military would likely need to be involved too. If they weren’t needed this week, they would be soon enough. And it would take time to call up reservists and get them trained in the use of respirators, masks, and gloves.
“Sir!” It was Harper.
He realized she’d said it more than once. “Sorry, what?”
“I was wondering if you had the death stats from county public health. Non-hospital deaths.”
“Oh, uh.” He looked around, coming back to himself.
“What’s wrong?”
“I was thinking about how we need to order at least ten thousand body bags for just this county to get them through to the end of May. Or not us, but someone needs to order them.”
“I know.”
“We’re working as fast as we can, but....” He gave a helpless shrug.
“It’s bad.”
“I know we’ve been waiting for this. We knew it was coming one day. But I’m realizing—I keep realizing—that the day has come. No more doubt. This is it.”
“No chance of containment?”
“If the military came in and shut New Jersey off from the world, even then, no. It’s in New York by now, for sure. And if it’s in New York, it’s everywhere on the planet. Might as well stick your hand up to stop a bullet as cordon off New Jersey. But it was thinking about the need to involve the military that shocked me, as I sat there imagining troops in the streets.”
“Have those new mortality figures?”
Glenn made himself focus. “Uh, no, but I’ll call Alverez for them right now. And let’s take a stab in the next two days at getting a better pathogenicity figure, right? Whenever anyone calls in, remind them we need it.” That was the number of people exposed to an infected person who became ill. It was, at this point, the only hope for a bit of good news. If only one in every ten people who an infected person crossed paths with became ill, the pandemic wouldn’t explode as quickly as if one in every two did. At this point, it was the only hope he held out for mitigating the disaster.
“Yes, sir.”
After the meeting with half his staff, he had a half-hour to review figures before the videoconference with Atlanta. This time, there was no holding it to five or six people. Every head of department was in on it. Right before his own staff meeting, he had sent them all an email with over a hundred attachments, the newest figures and charts Harper had for him, and so they had had almost two hours to review it first. He gave his report to them entirely extemporaneously. He used a chart of the departments of the CDC pulled up in a window on his laptop as an organizational strategy for his report.
He was quizzed and they challenged certain points, but it was not adversarial. They just wanted to be certain that he was certain. If they jumped the gun and called something an emerging epidemic that fizzled out, the next time it happened there’d be a “call wolf” effect, and the public response would be slower—or absent.
On the other hand, if they announced later, more people would die. If they announced earlier, they’d be blamed for alarmism. They were screwed no matter what, and everyone in the video conference knew it, but they lived with hope in their hearts that they’d be able to minimize deaths. A year from now, there’d be a lot of finger-pointing, and many of those fingers would be aimed at Atlanta.
Furthermore, and while it ranked considerably below saving lives, they all wanted to save Lorraine’s job. It would be the Director’s head on the chopping block first, if anyone’s was.
This evening she said, “Okay, I think that’s enough about the data. I know you know what you’re doing, Glenn. The charts look great, by the way.”
“Not my work. Harper Bail, new EIS epidemiologist. She’s doing a terrific job.”
He glanced at Harper, who was looking like a cornered mouse.
“Tell her thanks for me, please. Good work. Anyway, I’ll call the WHO to update when we’re done here. I’ll phone the Secretary at eight tomorrow morning and initiate the official national response to an influenza epidemic. Is there anyone here who wants to talk me out of that? Last chance.”
The Secretary was the Secretary for Health and Human Resources. She, in turn, would tell the Secretary for Homeland Security, the Secretary of the Interior, the Secretary of Transportation, and then every response would funnel down from the top to the various agencies, all of which had their own jobs to do. In 2006, every agency had been instructed to have a plan. Many had not been updated since then, but at least there was more planning in place now than there had been pre-2006. Glenn had no idea if the President would be informed tomorrow. Were it him, he’d not only inform him but get the man a stockpiled vaccination and put him on prophylactic antivirals, but no one was going to ask Glenn his opinion on those sorts of matters. That was far above his pay grade.
Someone must have been reading his mind. “Tell me the numbers on efficacy of the three antivirals.” Must be the head of Response. There were too many heads on his screen for him to bother picking out who was asking each question.
Glenn said, “Tentatively, nine percent, seven, and six. The nine percent is for peramivir.”
“That’s hardly better than random noise.”
“With these low numbers of cases, it’s nearly useless. Sorry. All I can tell you is we’ll keep an eye on that too over the next week. We have enough hospitalized cases now to get us meaningful results.”
“Should we recommend prophylactic antivirals for healthcare workers?”
“No,” Lorraine said, in a forceful voice, making the unilateral decision for them all. “Either we can treat sick people and try to contain the outbreak, or we can do prophylaxis. We don’t have the doses to do both. I can just imagine the map of this thing two or three months out.”
Harper waved her hand and nodded broadly.
“Ma’am,” Glenn interrupted. “You don’t have to imagine that map. Harper has an animation. She used the most up-to-date formulae, including airline route transmissions.”
“Let’s see it.”
“Hang on.” He got the two computers set up so that his camera pointed once again at hers. She hit the enter key, and the thing ran. He’d seen it at the beginning of the staff meeting, but she’d done something else to it since. There were shiny silver lines for the airline routes which shone briefly and then disappeared, leaving a single dot in every major city, which proliferated into blobs of dots. Those dots became blotches. Smaller cities without major airports filled in after that, and soon the map was a mass of black blotches reaching out for one another.
Lorraine said, “Are we watching cases here or deaths?”
“Cases,” Glenn said. “But if the 78 percent mortality rate holds, there’s little difference.”
“I need that animation for tomorrow. Email it to me. So, people, tonight is the calm before the storm. By Tuesday at dawn, we’re all going to be working fourteen-hour days. We’re going to be at full staffing, every person on vacation recalled. I want the Incident Command Center opened and every workstation in it manned by noon tomorrow. Prioritize mails in a three-tier system of importance, so we all know which ones to read immediately and which can be saved for the end of the day or week. We’ll try for containment, and that will be our public posture, but just between us, we know that won’t happen. What will happen depends in large part upon the will of people in other agencies and the will of the public. Rest assured, I’ll press for the most radical measures tomorrow, starting with no international air travel and begging for the borders to be closed to Canada and Mexico. But I have to tell you, my belief is that they won’t listen in DC, not until we’re beyond the point of no return. We’ve been drilling for this, planning for this. It’s finally here. Let’s all do our jobs. I know you’re the best in the world.”
It was a pretty good speech, Glenn thought.
After they had all signed off, he said, “Damned good work, Harper.”
“Thanks for mentioning my name.”
“Whose else would I have mentioned?”
“I mean, you didn’t have to do that. And I doubt they’ll remember.”
“They’ll remember. I’ll be lucky if you don’t get called back to Atlanta tomorrow to manage the national stats.”
“Will I be? I want to stay here, and....” She trailed off.
He raised his eyebrows.
“I guess I’ll go wherever they think I can do the most good, right?”
“Exactly.”
“If I do get yanked back, and you’re not here, I just want you to know how much I appreciate—”
He held up a hand to stop her. “Pay it forward. In twenty years, you be kind to a new recruit. That’s how it works.”
She nodded and began to shut down her computer for the day.
Glenn waited until she was gone and then made a phone call inspired by the Director’s comment about borders. There was a woman in Canada whom he’d worked with and had a brief fling with, Lindsey McGill. She was his counterpart in the Canadian disease control system.
From now on, while directives would be coming from the top down, a lot of real work would get done in back-channel ways, circumventing the increasingly sluggish bureaucracies. It was an ironic consequence of initiating an emergency system in a nation as big—and as democratic—as the U.S. Instead of the call for rapid response moving everything along more quickly, it often had the opposite effect.
He was lucky with the call. Lindsey was home. After a few minutes of “how have you been” talk, she said, “So what’s the scoop on this flu of yours I’m hearing about?”
“It’s why I’m calling. I’m on the ground in New Jersey, initial outbreak.”
“At the center of it.”
“So far. It’s going to get worse. If I were the PM of Canada, I’d close the borders tomorrow morning.”
“Too bad you’re not.”
“Don’t you have to actually be Canadian to run for the job?”
“I believe that’s a requirement, yes,” she said. “Seriously, though, it’s that bad?”
“CFR .78 so far, pathogenicity maybe .5, and a brand new subclade of H5N1. Human-to-human transmission, Linz. It should hit the WHO website tomorrow.”
There was only silence for a long, heavy moment. Then, “Shit.”
“Indeed. Shit. We’re in it now, and soon will be up to our necks.”
“I’ll pass the word up, but who am I to suggest national policy?”
“Someone who understands what this means and can save people. Push it, Linz. It’ll give us the time to get a vaccine developed. If you can just delay the first wave for two months....”
“I’ll do what I can. Thanks. And—Glenn?”
“Yeah?”
“Stay well. Please.”
“You too, kid. Talk at you soon.”
