The young man seemed surprised by the intense concentration with which this senior audience listened to his banal statements, several of them nodding as he told them the most basic medical facts which they’d known for years. “However, every now and then there comes a new flu that’s significantly different from that of the preceding year and the immunity most people have is ineffective. More people will become infected and the consequences are more severe. These new influenzas come from the animal kingdom, most often from birds.
“The way this happens is that, by means we’re not completely clear about, an influenza from, say a bird, ‘jumps’ to a human. This usually occurs among populations that are living close to animals. The best thinking to date about the mechanism of transfer in the case of birds is that infected birds are brought to a market, typically in Southern China, where birds are sold while still alive to guarantee freshness. There, the merchant chops off the bird’s head in front of the customer and all kinds of bodily fluids spray across both him and the buyer. Through one means or another, the influenza from the bird enters the human host and infects him.
“That’s not all there is, though. That bird-strain of flu isn’t contagious. The infected person will become sick but he won’t spread the virus to other humans. In order for the new influenza to become transmittable among humans, it needs to ‘blend’ with a strain of human influenza already present in the host. What we’re talking about here is referred to as genetic shift, where the bird flu exchanges genes with the human flu. The product of this reaction retains the capacity to spread among humans from the human version and its increased pathogenicity from the bird variant.”
Everyone was now nodding.
“Jumps are generally rare, and the occurrence of genetic shift is even rarer. That’s why we don’t have that many new pandemics for which we don’t have at least a half-decent natural immune response.”
“And by ‘we’,” Aeolus interrupted, “you’re referring to humanity, I suppose – not the people in this room.”
The young man froze, until he saw Aeolus smiling. He exhaled and resumed his lecture.
“In the case of jumps, we’re sometimes faced with a strain that’s similar to one that has been around before. A part of the population, namely the ones who lived through it the last time, will have effective immunity to it, while the others won’t. So an analysis of the impact of the strain on different age groups can help us understand it and its origins.”
The young doctor went silent – he was finished.
“Good,” said Aeolus, “Now apply this to our current situation. Separate fact from speculation, and make sure the speculation is well founded.”
“Okay,” said the young doctor, once again clearing his throat. “It’s clear that in the first incidence in Papua we had a jump of the flu to humans, from what we don’t know. Whether it became contagious between humans at that point or just made multiple jumps from the same source doesn’t really matter. That epidemic started and ended in that village.
“Given the isolation of the tribe, I think we can safely say that the current Ground Zero was the consequence of a new jump. Here, however, it made the genetic shift with a human influenza strain and became contagious among humans.
“As to the third incidence, the majority in this room believes it represents a third jump, reason being that if the man had been infected in the Maluku Islands he would, during his travel, have met with and infected others. But he hasn’t. Either he hasn’t met anyone since infection, or the virus he has doesn’t spread among humans. My bet is on the latter, as no one’s been infected at the hospital. Regardless, both cases would support the idea of a third jump as being well-founded speculation.”
“Agree so far,” said Aeolus. “Pray continue.”
“Well, from here it becomes more of speculation, but the reason we all believe it’s carried by birds is simply because first, jumps from birds to humans are much more common than from any other species, and second, that only birds could have traversed the distances required in such a short time frame. Bluntly put, we don’t think infected swine swam the 500 miles from Maluku to Limpong.”
“And my case against that,” said Aeolus, “is the species of native birds that could be involved would also exist in Southern China. Given the population of Southern China, it would’ve been more likely for the jump to happen there, as this is the region where it usually happens. One freak jump in Indonesia is perfectly viable, but three in a month? Doesn’t sound right to me. Also, I don’t think we’ve ever seen such a high jump rate from any bird-based influenza.”
“But Dr. Hughes,” interrupted Ed, “how do we know it’s not in China already? During the SARS epidemic, it took them three months until they reported the outbreak to us.”
“I know, thank you. I was there.
“Let me remind you,” Aeolus continued, tapping his index finger on the table for emphasis, “that I’ve spent my entire tenure as Director-General making sure that doesn’t happen again. When I took over this ship, our only means of influencing governments were through issuing reports, decrees or UN recommendations. It was toothless. I have traveled all the important outbreak areas and built relationships with the doctors who matter, to whom their governments listen. Our current means of influence, and more importantly, information gathering, with them, is very different from before. We have some good and loyal people in China. We’d know if there’d been cases.”
“But still, Dr. Hughes, what else could it be? Maybe it’s a bird that only exists in Indonesia? Why can’t you accept this? We should start looking for the bird, and not sit around here talking.”
“The reason I can’t accept this, yet, is that if it is carried by birds and has the jump frequency we’re observing, our proper course of action would be to give up on four-fifths of the world’s population and focus all our efforts on quarantining the Americas while letting this plague play out in the rest of the world.”
“Because you can’t stop the birds from traveling?” inquired Kevin.
“Yes. I don’t think humanity has the stomach to extinguish all avian species in the Eastern hemisphere.”
“But if that’s the case, how would we be able to protect the Americas?” asked the young doctor who had given the lecture.
“Birds that carry influenza fly primarily on a north-south line. Only a few fly east-west, and that’s across the Bering Strait, not the Atlantic or Pacific.”
“Then how come the bird influenzas spread west from China?” challenged Ed.
“Because there are morons who take their infected birds with them when they travel,” answered Aeolus.
The room went silent.
“So, before we all give up and abandon ship,” he continued, “we’re going to make absolutely sure that we’ve examined every possibility. That’s why we are now going to play a little game. You are to list all the major species that carry influenza. We’ll go around the table and the first person without an answer loses.”
“Birds,” started the young doctor.
“Swine,” said the doctor to his left.
“Seals.”
“Yeah I think we can pretty much count them out,” said Ed sarcastically.
“Monkeys, but they can’t swim that far.”
“Dogs.”
“Horses.”
“Camels.”
“Ferrets.”
It had come to Aeolus turn and it took the man to the left of him a second to realize that Aeolus, sitting immobile with closed eyes, resting his chin on the top of his cane, was not part of the game
“Uh… Cats?”
“Minks.”
“Whales.”
“I haven’t seen too many of them around Limbong for a while,” said Ed, even more sarcastically, before he realized it was his turn. Even though he thought it was a silly and pointless game, he didn’t want to lose. He thought a moment, swiped at his comb-over, and then said, “I’m not sure whether they carry influenza, but they carry rabies,
SARS and Ebola, and have been known to infect humans…”
“Bats…” said Aeolus quietly, cutting him off. “It’s the bats. It’s in the bats! Helvete! How could I possibly have missed that!?
“Ed, you might not know, since the paper was in Russian, but in 2007 there was a study by two scientists that proved that not only do bats have influenza, they also carry the human form of influenza. They claimed transmission from bat to human and vice-versa has less of a barrier than between birds and humans.
“It’s in the bats. Ed, you’ve definitely earned your pay today. It jumped from a bird to a bat, and it’s kept jumping from bats to humans. If we’re lucky, and if it’s a localized species, maybe we can still contain this thing. We need…”
“Sorry,” Kevin interrupted, “but I don’t understand how it transfers. It’s not like we eat bats, or slaughter them in public for that matter. And if there is such a thing as vampire bats, which I highly doubt, there are for sure none in the area we’re talking about. How does it jump from bats to humans?”
“Through their excrement, Kevin. Bats have white excrement and unlike humans, they don’t process it all, so viruses are present in high volumes when released from the body. Add to that, that bats shit everywhere, absolutely everywhere. There were bat feces all over the Asmati village. That’s how it started. In powder form it stirs up all around. Inhaling it is almost a certainty. Also, you might not even see it.”
“Anyway, ladies and gentlemen,” Aeolus summarized, “I think we have a new working hypothesis – that it’s carried by bats.
“Now, first we need to learn everything about bats in Indonesia. What species are there? Are there any medical studies on them? What geographical areas do they live in? Is there a chance this is a localized phenomenon?”
He swiveled his chair, turning to Walt, pointing at him with his cane. “Can we get someone on the phone, please?
Aeolus rose and started pacing around the table, gesticulating with his right hand, using his cane to occasionally point at a random spectator to emphasize a particular point.
“Second order of priority is that we need to find the actual species. We need ornithologists and entomologists, or whatever people who specialize in bats are called, out in the field looking for these things, capturing them and testing them for contagion.”
“Excuse me, Dr. Hughes,” interrupted the resident veterinarian, “but I’m pretty sure ornithologists study birds and entomologists insects. I don’t think any of them are that much into bats.”
“Well, find some people who are. There are people for everything. If there are people who reenact civil war conflicts and collect knitted breasts, for sure we can find some people who have a fetish for bats.”
“Then a chireptologist is what we need,” responded the veterinarian with the smile of a child winning a chess game against his father for the first time.
Not enjoying others one-upmanship as much as his own, Aeolus stopped in mid-step, turned toward the veterinarian and said, “Well, aren’t you the prickly one.
“Anyway,” Aeolus continued, resuming his pace. “This should be easy enough to prove or disprove in the next couple of days. Ed, Kevin. Take the lead, I have to make a call,” and with that, Aeolus walked out of the room.
In the general commotion of people shuffling paper around and collecting their belongings, Kevin overheard the veterinarian say to his neighbor, “Prickly? Coming from him? Nothing this man says surprises me anymore. At some point, someone should really teach him some social skills.”
Kevin slammed a stack of paper on the table and shouted down the table. “Hey! Mr. Pet-nurse! I’d cut that kind of talk if I were you.”
Ed wasn’t late to join in to finish Kevin’s verbal assault. “If you can’t stand the heat, you should go back to inseminating elephants at the Oklahoma City Zoo.”
Walt turned to hide his smile. Ed and Kevin were catching on.
Outside the room, Aeolus was already on the phone with Dr. Loo again.
“Loo, I think we have it. It’s the bats.”
“Hmm… yeah, that makes sense. Have you spoken to Yelena yet? What’s her take?
“I haven’t spoken to her yet.”
“You really should. Anyway, I concur. Go after the bats.”
“Great, just wanted a second opinion.”
“By the way, this just increases the urgency for you to get the quarantine. If it’s a bat that doesn’t travel north of Indonesia, the Asian continent will be safe as long as we keep infected humans out.”
“True, but if it’s a bat that exists across the whole of Southeast Asia, you can forget your hard quarantine.”
“Not at all, my friend. We’re well prepared for this eventuality. Bats are nocturnal animals. We’ll surround Singapore with a cloud of Chlorazine at night. It kills anything that flies. And we’ll establish a curfew to minimize the impact on our population. Keep in mind we’re used to keeping dengue-infected mosquitoes from crossing our borders. Stopping a bat is a lot easier than stopping an insect.”
“Unbelievable.”
“I thought you’d like it. We got the idea from how the Russians dealt with the weather during the 1980 Olympics.”
“You mean when they fired silver iodide into the clouds around Moscow so that they would make it rain outside the city boundaries to make sure there was no rain, or even clouds, inside the city.”
“A brilliant, albeit somewhat controversial, idea.”
“You’re aware that there are farmers to this day who complain that crops don’t grow where the silver iodide rained?”
“A small price to pay for good weather, wouldn’t you say?”
“Well,” Aeolus said in a resigned tone, wishing he had the power within his territory Loo seemed to have within his, “it’s pretty clear that the environmental lobby has less of a grip on your masters than mine.”
“Goodbye, Aeolus, and thanks for the heads-up on the bats.”
“We still need that test, Loo.”
“Give me a week.”
The line clicked and went silent. Aeolus headed to his office. He wanted to read up on bats, but had to hold this natural inclination back. That wasn’t his job now. There were other people doing that. He had to focus on what only he could do. Loo was right. He had to put together a quarantine of the affected and surrounding islands, and doing so was going to be a nightmare.
AUGUST 3RD, JUST BEFORE SUNSET, DISTRICT HOSPITAL, TERNATE, MALUKU ISLANDS, EASTERN INDONESIA
Rebecca was exhausted. Melatonin had taken care of the jetlag, and getting out of the HAZMAT gear made work less taxing. The full suits, even with their built-in cooling, became very hot, and in spite of them being pressurized, skin was constantly in contact with one latex surface or another, sticking to it like a leech on a bleeding wound. Still, even being relieved from them, Rebecca was totally beat. She’d only been on site for two days so far, and she was already concerned about her ability to keep leading the operation.
She had to constantly remind herself that Aeolus had chosen her. He thought she could do it. She only had to find it within her to do so.
Rebecca, Justin, Yan-Qui and a French doctor, got in the same Jeep that had brought her from the airport, and set out for the makeshift camp where they spent their nights.
The driver flashed them the same toothless smile, seemingly oblivious to the chaos around them. It was as if he didn’t notice the dozens of sick people packed into an ever-growing field hospital on the grassy courtyard, nor the crying and wailing relatives, begging the overtaxed medical staff to help their loved ones.
Rebecca took one last look at the hospital. She hated what she saw. Soon they would be forced to turn patients away, having neither the space nor the manpower required to attend to them. This was not how medical care was supposed to work.
With a screeching of tires, they set off toward the harbor. Although the populace was growing frightened, the town center still operated as usual. The market was packed and bustling w
ith activity. People were trading in fruits, the names of which, for the most part, were unknown to Rebecca. Others were feasting on local delicacies Rebecca doubted her digestion would agree with, like grilled fish heads.
This wouldn’t last much longer. They were close to the tipping point now. They had 200 patients. Make it 800 in a couple of days and this market would be empty.
They arrived at the harbor, the driver veering abruptly to the right while pulling the handbrake. The skidding vehicle sprayed dirt on a group of boat drivers. The driver was clearly amused – the boat drivers less so.
The harbor wasn’t really a harbor at all. It was just a wooden pier, its planks loosely held together with rusty nails, balancing on wobbly wooden stilts. There were twenty or so boats, all painted in glaringly bright colors – mainly yellow, green and pink.
She and the others got in their boat and set off for their quarters. The boat had two outboard motors, not for speed, but because they functioned so intermittently that the skipper was always struggling to get one going while the other propelled the boat over the waves. Stops were not uncommon, as he often failed to get one motor started before the other one gave up.
Rebecca steadied herself against the gunwale as the boat, with a far too shallow keel for these waters, violently rocked left and right. Water sprayed over them with each wave, and even though she couldn’t actually feel it through her filter, she could imagine the salty smell of the sea.
The view was majestic. Behind them was the Ternate volcano and ahead was Palau Tidore, rising up into the clouds. Their destination was Mare Island; a small island behind Palau Tidore, where there was an uninhabited beach, impossible to reach except by boat. Any visitors were easy to spot, and keeping the beach isolated was easy enough.
As they passed Tidore, Rebecca caught a glimpse of two bare-chested young boys, standing far out in the shallow water, trying to fish by stabbing two sharpened wooden sticks through the green-blue surface. Rebecca smiled. She’d thought this was something you read about in books, not something people actually did in real life.
The Nightmare Scenario Page 13