The EOC was a big office building with no exterior windows and limited entrances. The entrance was like many other office buildings with a glass storefront, but just in front of that set of doors was a giant armored sliding door on steel tracks. When that door closed, the occupants were safely encased inside, as it was built to prevent everything from high velocity winds to hostile attack to nuclear blast from breaching the fortified structure. The compound was self-sufficient and had food, water, underground fuel storage, massive generators, and five redundant methods of communication–just in case. This building was where you would find government leaders and all the emergency response planning and management apparatus during any disaster event.
Mark waved at the receptionist as he made his way to the circular amphitheater-styled room to find a seat. He was surprised by a set of armed guards who insisted he present his ID to match a list of names. He turned to the other doctor, who was still with him, “This just keeps getting better.”
With two giant main projector screens and numerous flat screen TVs circling the walls, there was no shortage of information available to everyone in the room. All the TVs were tuned to various news and broadcast channels and while silent, the broadcast text crawlers were busy scrolling conflicting statistics on the current flu situation.
At the moment, no one was actively speaking at the front podium, but there were several people huddled and milling about. The seats around the room were labeled with Emergency Support Functions from everything from Military Liaison to Animal Services, complete with a computer workstation connected to the main server, along with a telephone. The main room was similar to a NASA launch control room, and this morning, had that same urgent feeling.
“West Palm Beach…we have a problem,” Mark muttered under his breath. He took his assigned seat, labeled Medical Support/Infectious Diseases, in the section identified as “ESF-6/Mass Care.”
The buzzing of activity slowed as the Emergency Manager manned the lectern and brought the room to order. There were several guests that Mark recognized from his work with the CDC standing behind the EM. The projector screens came to life with the image of the Florida State Seal, then transitioned to a presentation slide titled “CDC National Pandemic Strategy Activation Briefing.” The room resonated with an audible gasp, followed by indecipherable mumbling. Mark felt the dark shadow of gloom creep over the room.
“Good morning, everyone. My name is Bill Martin, I’m the Emergency Manager for Palm Beach County. First, let me say thank you for coming in. I know it’s a weekend, and I’m sure you’d pretty much rather be absolutely anywhere other than here.
“On to business. At this time, we are activating the EOC to Level 2. However, a word of caution, if things continue to deteriorate at this pace, we already anticipate increasing to Level 1 within the next week.”
“Ahh, crap,” Mark muttered under his breath.
The lady at the seat next to him marked “ESF-7/Resources Support” glanced up at him from the almost frantic typing she was doing. “Hey, you are Mass Care, any idea where I can locate 10 circus size isolation tents? Everyone is sold out.”
“Uhhh, did you try to call a circus?” Mark said, half-jokingly.
“That’s actually a great idea,” she said and started typing again.
Mark’s confused look was interrupted by the man at the podium.
“We are all familiar with the situation of the influenza this year and we all know this is not a typical scenario. I will spare you the common details and get to the reason we are all here today. Yesterday, in Texas, the flu took a severe turn and claimed 879 lives in several towns along the southern border. There is now a major health crisis in Texas, and containment is being attempted. I say ‘attempted’ because it is feared that it may be too late for full containment in those areas. To continue the briefing, I want to bring up Bob Cooper from the CDC to expand on the current national situation and how we expect to be affected here in Palm Beach.” He stepped to the side to allow the new speaker to take the stage.
“Good morning. We are operating in a very fluid situation this morning so please bear with me and hold your questions for the end as there is a lot of information we need to pass on. Reports are coming in this morning from other cities throughout the Continental US of similar situations, but the numbers may not tell the whole story. As you know, many medical centers have been overwhelmed with patient traffic claiming flu symptoms, and much of that traffic has been turned away with the recommendation of bed rest. Given the mass casualty event as of yesterday in Texas, there is a reasonable fear that the numbers could be far higher than we know if people expired at their residences or somewhere not yet identified. That, in and of itself, is reason for major concern, but the possibility for follow-on diseases such as typhoid, cholera, and others that regularly present in the absence of proper corpse management adds another dimension to the current unfolding event.”
“Corpse management?!” The lady next to Mark looked up at the statement. “I need to call the Parks Department in case we need to do a mass burial.”
Mark again side-eyed her. “Are you alright?” He whispered. She did not seem to hear him.
The CDC briefer continued, “We feel this contagion has presented with immigration refugees from Venezuela who found their way to our borders. Since the political situation prevented proper health monitoring in that country, we have found ourselves on the back foot on this one. Based on what we currently know, the current strain of influenza is being called H1N2.”
Mark realized that he was going to have to relay this information later to the group, and began to furiously scribble notes.
“H1N2 is a subtype of the species Influenza A virus. H1N1, together with H1N2 and H3N2, are the only known Influenza ‘A’ virus subtypes currently circulating among humans. The H1N2 virus was identified as early as 1989. Between December 1988 and March 1989, 19 influenza A(H1N2) viruses were identified in 6 cities in China, but the virus did not spread further. H1N2 was identified during the 2001-2002 flu season in several countries in the northern hemisphere. On February 6, 2002, the World Health Organization in Geneva and the Public Health Laboratory Service in the United Kingdom reported the identification H1N2 influenza A virus from humans in the UK, Israel, and Egypt. The new H1N2 strain appears to have resulted from the reassortment of the genes of influenza A(H1N1) and A(H3N2) subtypes.”
Mark noticed eyes around the room seemingly glazing over with confusion trying to figure out if this was good news or bad news. He understood it all and he knew this, without question, was bad news…very bad news. When a disease jumps from animals to humans, and then pops up in different areas around the globe over different spans of time, it is always bad because this means it has mutated, adapted to its host, and found a way to survive. This was especially dangerous when the virus mimicked a common illness’ symptoms, because most people don’t seek medical care for common cold or flu symptoms, and continue about their life, unknowingly infecting even more people.
The CDC official continued, “Given the surprising efficacy of this strain, we feel that it may be currently or recently mutated from the original strain’s discovery. What we know so far is this: the incubation time from exposure is only 1 to 2 days. Patients can become contagious as early as day 3, and can continue to spread the virus up to day 7, even if they are asymptomatic. Symptoms appear to present between days 8 to 15. From what we know so far, the only firm date we can provide is day 16. On day 16, the patient either miraculously feels better, or they simply seize and die. We have not identified why this happens to some people and not others.”
Mark stopped writing for a moment, unable to control the swear word that made its way out of his mouth. The older woman sitting next to him didn’t even flinch, she had the same horrified look on her face.
“Some alternate religious communities are already having a field day with this occurrence, referring to it as ‘Judgment Day,’ and holding Day 16 vigils under the belief that the af
flicted are either being called home or punished for their sins. This behavior is interfering with the disease tracking process because those cases are not always reported and we have no consistent way to monitor the numbers of either the sick, or those attending the vigils and then bringing the virus back to their families. The close quarters of these small communities makes the spread of the virus particularly quick.”
Mark shook his head. “Judgment Day? Really?”
“As you may have seen in the back lot when you arrived, we have mobilized the PODS in anticipation of deployment in the near future. The President will be addressing the nation tomorrow evening on the event, and at that time we expect him to announce the implementation of the National Pandemic Strategy. The conditions for a true pandemic are not quite met, but we expect them to be very soon with verification of the combined epidemics through South America. The CDC, along with the Department of Homeland Security and the Pentagon, are currently reviewing the applicable National Planning Scenarios for gap analysis and blind spot awareness in the strategy. Obviously should there by any updates, we will pass them along. That is all we have for now, there will be daily briefings scheduled for 1 pm. Let me remind you, while this is a situation with great potential for loss of life, we must remember that we are trained and prepared for just such a scenario. I’ll take your questions now. Thank you.”
A hand went up from a law enforcement liaison near the ESF-16 desk. “You mentioned that containment was being attempted; we understand that the people in the initial containment area are not totally cooperating and there have been incidents of shootings at the roadblocks. If the contagion is already outside of the containment area, then what? Are other infected areas being contained?”
“In our opinion, the containment areas are very difficult to establish due to the rapid transition from incubation period to contagious period. In reality, unless there is an area that is solidly identified as being practically contained, we feel the efforts of law enforcement are better utilized elsewhere. The National Pandemic Strategy is clear in scenarios where containment is not beneficial. In such scenarios, like this one where the disease has spread widely before detection, public education is the better form of containment.”
The room felt smaller after that explanation. In effect, it was too late to stop the spread of this this disease with physical barriers.
Another hand went up from the transportation group desk. “What about public transportation?”
“It has been decided that all citizens who utilize the public transportation system will be required to wear respirator masks and use hand sanitizer upon boarding any vehicle, train, or plane at this time. Airports will establish checkpoints to scan body temperatures with thermal imagers the same way as during the SARS outbreak. Any passengers with elevated temperatures or visible signs of flu-like symptoms will be denied travel and escorted away from the other passengers in line. Guidance on this will be issued by tomorrow.”
Mark had a question. “What are the PODS going to dispense when they are deployed? Is there an appropriate prophylactic available that will stop the spread?”
At that moment, the CDC official couldn’t hold it together any longer. It was the question he knew he would get, and he knew the answer wouldn’t be a good one. He looked at his colleagues as if he were drowning, hoping someone would toss him a line. No lifeline was coming from the group and they all knew it. He took a deep breath before half mumbling a response.
“Currently, we do not have an effective solution prepared.” He left it at that and quickly closed the briefing, half running, half walking off the stage.
Mark collected his notes, made his goodbyes to those around him and headed out the door. Not surprisingly, no one shook hands and there were no friendly touches or hugs that one would normally see among coworkers. In fact, no one came within a couple feet of each other and the only thing shared was hand sanitizer.
Mark knew what he had to do. It was clear now. The survival group was a good idea and he had to prepare them for this invisible threat. He went straight to his office at the hospital and placed an order for things he had hoped he would never need again after his experience in Liberia. He couldn’t believe that here he was, in a top-notch research hospital in one of the richest counties in the state, trying to frantically order pandemic medical supplies. He had a strong feeling that what was upon them would make the African Ebola situation look like a practice run for the total collapse of a first world society.
Apparently he was not the only one placing orders, as all the supplies he wanted were on backorder from every vendor he called.
“How do you run out of common personal protective equipment?” he asked the third company he called. The answer by the sales rep on the phone was even more unsettling.
“The Department of Defense just bought everything we have and placed an order for everything we can provide. They said something about an executive order that allowed them to take control of provisions and material in the interest of continuity of government. I don’t know, it was all kind of shady but that is what I heard about an hour ago. I’m just in sales here.”
“Listen,” Mark said, “this is a hospital and we need this stuff, it is a critical situation.”
“Yes sir, I understand, but the phone is ringing off the hook over here and you are not the only one in need. Perhaps you can reach out to someone in the government and convince them to release some PPE to you, but we are tapped out and I’ve been instructed to not fulfill any more orders unless they come from the government.”
“Well, I don’t know who that would be, but we’re going to have to do something because there are going to be a lot of contagious patients down here by the looks of things. Thanks anyway.” He hung up and lowered his head into his hands.
Mark knew he’d have to put his personal feelings on the back burner for the moment and tried to switch into full business mode. First thing’s first, he needed to get an inventory of the hospital’s current stock. He called for an immediate meeting of his infectious disease team, anxious to get their input on what they felt would be necessary for this kind of situation. Once they were all in the conference room, he briefly relayed what he had learned at that morning’s meeting, trying to walk the line between scaring them out of their minds and easing some of their fears. As they went out to do their assessments and put their “Pandemic Wish Lists” together, Mark quickly made his way to the supply room and set aside a couple of cases of PPE. Though he wasn’t quite sure how he was going to smuggle the boxes out of the hospital, he was damn sure going to try. He knew the group was counting on him, and the situation had escalated in the blink of an eye.
He sent out a group text calling an emergency Skype meeting so he could go over what he learned at the EOC meeting. He also suggested that in the meantime, the group really work on their preparations. It would be more important than ever to set aside some more food, and to make sure they had whatever else they needed so they’d spend as little time in public places as possible.
Privately, he sent another message to Cal, and this one was decidedly more urgent.
“Things are worse than we expected, much worse. Tell Charlotte to run out to the store ASAP but leave the baby at home. In fact, if you can stop taking Tempest out in general, that may be best. Little kids are incredibly vulnerable. We need to put together a list of things that we would need to have in case we’re not able to make it out to the stores, including food.”
“You sound a little rattled buddy, you ok?” Cal was beginning to get rather uneasy at this conversation and what it meant for his family.
“Things are not as ok as I’d like them to be. I’ll brief you later tonight.”
As Mark made his way back up from the supply room, he passed by the ER, where he heard a lot of commotion. It sounded like multiple people were yelling and the security guard almost knocked into him as he ran down the hall towards the nurses’ station. Mark peeked around the corner to see if he could help, b
ut what he saw made him pause and suck in a breath out of sheer surprise. The beds were all full and the space was packed wall to wall with people. People were coughing and sneezing, and there was vomit on the floor that had yet to be cleaned. The Director of the Hospital, Jack Whesilton, was standing in the hallway on his walkie calling to Hospital Engineering, ordering them to bring more spare beds out of the basement because they were going to have to line up the patients in the hallway now. The Director made eye contact with Mark through the fracas and hurried over to him.
“Walk with me, Mark,” he said, and both men left the ER and began heading back to the administrative offices section of the hospital. Once they reached his office, Mark settled in for what was sure to be an uncomfortable conversation. Mark told him that they needed to enact the mass casualty plan, which included erecting tents in the parking lot to facilitate a primary triage area. The Director seemed hesitant, but realized that Mark, with his international experience, was definitely the more knowledgeable of the two of them in these kinds of situations.
Then it was the Director’s turn to reveal some additional information to Mark. Leaning forward in his chair, he said, “Listen, the in-house morgue is full. We’ve been sending expired patients to the county morgue as fast as we can, but that’s just too slow. It’s the transportation time between here and there that’s lagging because we can only transport a couple of them at a time, and this flu thing, it’s just…it’s just bad. We need a better solution.”
The Unraveling: Book 1 of the Bound to Survive Series Page 10