The screen cut to a commercial, and Alex started to fast-forward past them.
“Maybe if they didn’t wait so goddamned long to ask for help, or let the rest of the world know about their little epidemic, we wouldn’t all be so screwed,” Alex said, shaking his head. “I’m sure the Mullahs will blame the West for this somehow. Unfortunately for them, they’ll be preaching to empty mosques. This pandemic is going to clear the bleachers.”
“Honey, that’s not cool to say. It’s going to clear the bleachers everywhere.”
She sounds pissed.
“I know, but most of the Muslim world is buried in Western-induced poverty,” Alex said in a mocking tone. “And facts are facts. Modernized societies with a modern health care system will suffer a much lower percentage of casualties.”
“It’s still sad,” she said, looking at him compassionately.
“I know, but it’s frustrating.” Alex stopped fast-forwarding.
“International Scientific Pandemic Awareness Collaborative cofounder and current director of their live information and trend analysis division, Dr. David Ocampo, joins us again, live in the studio. Dr. Ocampo, thank you for joining us again”
“My pleasure, Kerrie,” he responded. Dr. Ocampo is wearing a navy blue blazer with a light blue oxford shirt.
“Dr. Ocampo, you briefed members of the UN this afternoon regarding the developing pandemic situation. What did you tell them, and what is your current assessment?”
“Unfortunately, I was not the bearer of good news. I started with ‘Don’t kill the messenger.’ Kerrie, at this point, nothing is likely to stop the Jakarta flu from reaching all corners of the earth. It is very likely already in every corner, every country, every major city, and spreading beyond that. Our statistical projections, based on known H16N1 propagation and transmission characteristics, put the world on an unavoidable collision course with this disease. I stepped out of my scientific role for a moment while briefing the UN and recommended that member nations, or any nation for that matter, not waste any more time or energy aggressively engaging the Chinese. Why? Because even if all of the WHO teams detained in China…and I stress that this is unacceptable behavior from a world leader like China. Even if they were all returned and magically teleported to wherever we would choose to send them…even if they were magically doubled in number, it would not make a difference. Their role was to contain and suppress the spreading pandemic early, at the epicenter and at the outskirts of its spread. Forming a perimeter. There is no perimeter anymore. H16N1 is everywhere.”
“Are you suggesting that the WHO workers be abandoned?” Kerrie asked.
Dr. Ocampo chuckled. “No, not at all, but from a purely scientific and practical aspect, these teams will have no further impact on the spread of the pandemic. Tensions are high right now throughout the world and will only grow higher as the pandemic gets worse. Aggressive military posturing right now may feel like the right response to the Chinese, but I fear it will accomplish little more than strain the world’s fragile peace.”
“What specific recommendations did you make to the UN?”
“Specifically, I couldn’t stress enough that vaccine research and production must be every nation’s first priority, and that these facilities, their scientists, employees, support personnel, supply chains and power sources must be protected like national treasures. Whatever needs to be done to ensure their continued functioning is critical to the world recovery effort.
“Secondly, I recommended that every nation begin to mobilize and implement their own national pandemic plans. From top to bottom. H16N1 is a particularly nasty bug, and we will not see a repeat of 2008. 2008 was scary enough, but the avian flu turned out to be surprisingly mild. The Jakarta flu is surprisingly deadly and contagious.”
“Dr. Ocampo, do you feel that our national pandemic plan is adequate, and where do we stand in terms of its implementation?”
“Do you really want me to answer that?” he said, laughing. “Of course you do. Our national pandemic plan is adequate to address the threat of a pandemic. It was created through a brilliant collaboration and signed into order at a time when intellectualism and common sense within the government was at one of its lowest points. However, it appears that this collaboration was a huge waste of time. In terms of implementation, nothing useful has been accomplished in my view. Window dressing is all. Kerrie, if FBC wanted to make a difference in our immediate future, FBC would dedicate all of its energy toward educating the public about implementing the national plan and preparing for the coming storm. This should be your calling, and every news outlet’s calling.”
“Thank you Dr. Ocampo.”
An interview discussing Acute Respiratory Distress Syndrome
“…no one truly understands all of the mechanisms causing a fatal cytokine storm. Until 2008, cases of acute respiratory distress syndrome rarely presented in a significant enough number to study. Even after the avian flu pandemic, the scientific community has made little progress towards unraveling the causes and mechanisms. However, after 2008, we can certainly link acute respiratory viral infection to the cytokine storm affecting the lungs. Especially acute respiratory infections caused by pandemic viruses. H1N1 in the Spanish flu pandemic of 1918 and H5N1 in 2008 proved adept at triggering the cytokine storm.”
“Dr. Pramanik, is there any speculation or evidence suggesting that H16N1 will do the same?”
“Currently, cases of acute respiratory distress syndrome have been confirmed in patients with H16N1, and the expected percentage of death followed. 50-75% of patients showing symptoms of ARDS died, but many of these deaths occurred in settings where patients were receiving less than optimal treatment. Prior to 2008, a patient under the best circumstances had a 50% chance of dying. Now, with a slightly better understanding of the syndrome and the medications effective in treatment, a patient has a two out of three chance of surviving.”
“But in a home setting, the chance of survival must be minimal.”
“Yes, very minimal,” Dr. Deshvar Pramanik said.
“So what do we know about the cytokine storm?”
“Well, first, ARDS is an inappropriate or exaggerated immune response, most typically seen in a healthy immune system, which is why, historically, most of the deaths from this syndrome occur in patients between the age of 15 and 45. Men appear more susceptible than women.
“As we discussed earlier, cytokines are secreted by immune cells that have encountered a pathogen, further attracting more immune cells to increase the immune system’s response to that pathogen. The arriving immune cells similarly secrete more cytokines, and this process repeats until the body’s immune system senses a decline in the amount of pathogen.
“Now, this operates like a positive feedback loop, which if left unchecked, would spiral out of control, attracting more and more pro-inflammatory cytokine immune factors, which would in turn, continue the process until the cytokine storm is out of control. In a normal situation, this loop is dampened by anti-inflammatory cytokines that put the brakes on the pro-inflammatory process. Precisely what causes the loop to spiral out of control is one of the most frustrating unknowns my field of study.”
“Dr. Pramanik, what causes the patients to die so suddenly as a result of the cytokine storm?”
“Interestingly enough, the ultimate cause of death is multi-system organ failure, not lung failure, as you may expect. However, the attack on the lungs likely precipitates the patient’s rapid decline. Lung tissue and alveoli suffer irreversible damage from acute inflammation. This severely damaged lung fills with fluid, and can no longer adequately pass oxygen into the bloodstream. Most patients in this category present with pulmonary edema.”
“Dr. what are some of the signs and symptoms that differentiate an ARDS patient from a typical flu patient?”
“Due to rapid fluid buildup in the lungs, one of the first symptoms is a rapid and severe shortness of breath. Once the lungs have been significantly damaged and can no long
er efficiently pass oxygen into the blood system, patients will show signs of cyanosis, or a bluish discoloration of the skin, starting in the extremities and slowly spreading. Blue lips are a dead giveaway combined with shortness of breath. Eventually, once all of the body’s clotting factors are destroyed by the cytokine storm, spontaneous bleeding will occur. Patients will cough up blood, develop dark blotches under the skin, vomit blood, pass blood from the rectum. At this point, the syndrome is nearly 100% fatal.”
“What about early treatment? Drugs like Tamiflu or TerraFlu? Do these have any effect?”
“Well, this class of drugs only inhibits the function of the viral neuraminidase protein, which prevents the virus from reproducing in influenza A or B. So, if taken early, it could prevent the triggering of the cytokine storm. Remember, we’re not sure exactly what pulls that trigger, but it may be a severe infection, so if you could mitigate the viral infection, then maybe you could prevent the trigger mechanism. This is complete speculation that has not been proven scientifically, nor is it supported by any clinical data. What I feel very confident saying, is that once the cytokine storm is triggered, neuraminidase inhibitors will have no impact on the cytokine storm or the patient’s prognosis.”
“So have any treatments helped these patients?”
“At this point, there is no miracle cure for these patients. ACE inhibitors and angiotensin II receptor blockers demonstrate a slight capacity to mitigate the cytokine storm, but overall have a minimal impact on ARDS. The most promising research involves administering free radical scavengers, or antioxidants, to these patients. Research indicates a trend toward improved survival and a reduction in organ damage.”
“So we should all drink wine and be merry in the upcoming days?”
Dr. Pramanik laughs heartily. “Well, not exactly. Consuming food high in antioxidants is always a good idea, generally, but in the context of this research, the antioxidants administered were in therapeutic doses unachievable by food consumption. If you tried to consume the levels of antioxidants given to these patients, you’d have more problems than the ARDS!” he said, laughing again.
“Well, thank you for your—”
DHHS Press Conference
Early November 2013
The man on the left stepped up to the podium, and adjusted the microphone. The camera zoomed in, capturing only the top of the podium and the man’s upper torso. He had fair skin and receding brown hair. His dark eyes contrasted his face, creating a harsh look, magnified by thin lips, scant eyebrows, and a displeased look. His shirt was light blue and his tie was yellow, balancing the severity of his grimace. He looked like a man who did not want to be behind that podium.
“Good morning, everyone. Good morning. My name is Paul Harding. I am the assistant secretary for public affairs, and to my left is John Merrill, assistant secretary for Public Health and Emergency Preparedness. I know that’s a quite a title. Simply put, he is the number two official at the Department of Health and Human Services and directly reports to the secretary of Health and Human Service for the coordination of all pandemic response activities.
“John has just returned from a White House briefing, where both he and the secretary, and other members of DHHS, briefed White House staff regarding the progression of the Jakarta flu in the U.S., and the status of both state and federal pandemic response activities. John will help me answer your questions and fill in any blanks that I may leave.”
John Merrill was vaguely smiling. He nodded and resumed a solid stance, with his hands folded in front of him. The smile slowly trickled from his face, as he loomed over Paul. He was dressed more conservatively than Paul, in the same dark navy suit, but with a white shirt and dark blue tie. Alex suspected he was there to keep the public affairs secretary from descending too deeply into the cauldron of questions brewing in the audience.
“So to start, I would like to give you our assessment of the Jakarta flu’s progression and then outline what we are doing to address the pandemic threat. Before that, very briefly, I would like to reinforce the fact that the Centers for Disease Control and Prevention is an arm of the Department of Health and Human Services, and that the CDC is directly aligned with our pandemic response actions. This is important to mention because we are well aware of the impression that there is a strained relationship between the CDC and DHHS. That the CDC is a rogue agency. Nothing could be further from the truth. The CDC serves a vital role with our department and for years has operated with near complete autonomy, as long as they came close to working within their budget.”
Paul Harding suppressed a nervous laugh. This comment elicited a few muffled laughs from the crowd, but it was clear that nobody in the room was really in the mood for humor.
“We are working closely with the CDC to ensure that their research and projections keep our pandemic response efforts one step ahead of the Jakarta flu. In addition to this, I am also proud to include the ISPAC as a contributing asset to our efforts. Their director has committed all of their resources to the CDC and Department of Health and Human Services, significantly augmenting our pandemic analysis and research capability.
“With that said, let’s move on to what’s happening in the U.S. First, as of 5 minutes ago, DHHS has identified 4,418 confirmed cases of H16N1 within the continental United States, and there have been approximately 137 deaths since the first cases appeared Friday night. The cases appeared nearly simultaneously in most major cities on either Friday night or Saturday morning. San Francisco, Los Angeles, San Diego, Chicago, New York, Miami and Boston appear to have a 12-24 hour head start over other major cities, which accounts for the higher case counts in these cities. New York City currently accounts for 645 of these cases and over 30 deaths. All of this data is now available real-time on the DHHS website, at dhhs.pandemictrack.org.
"This data is provided by a nationwide network activated last Wednesday. The information flows from the state level to DHHS, and all medical offices, hospitals and institutions are aware of their reporting responsibilities. Additionally, we have established real-time electronic connectivity with all major domestic healthcare institutions and public health departments across the U.S. to obtain pandemic flu and resource availability information. So far, nearly 97% of the confirmed reports have originated from hospitals. By now, all hospitals have H16N1 confirmation kits and the capability to duplicate kits for distribution to local health providers. We anticipate the number of reported cases to increase rapidly over the next seven days, possibly doubling or tripling, with many reports originating outside of the hospitals.”
“Triple? How did you figure that? Can we ask questions?”
The first few impromptu questions triggered a simultaneous barrage of inquiry, spanning topics well beyond those already discussed. Paul handled the outburst professionally, backing away from the podium for a few seconds and whispering to John. Paul remained back from the podium and clasped both hands at hip level, assuming a relaxed stance. A noncommittal smile formed on his face as he waited. His disengagement from the group had an immediate effect, as most of the reporters realized that their outburst had brought the press conference to a screeching halt. Nicely done. When the room was mostly quiet, and only a few of the most clueless or stubborn reporters continued to press their questions, Paul stepped back to the podium.
“Thank you. I promise I will be done shortly, and you will have ample time to ask questions. I have a few more items to cover. In a pandemic, three major strategies are employed to contain outbreaks. One of these may not be available to us for several months. Until last week, the world scientific community was unaware of the H16N1 strain, so consequently, vaccine research on this novel flu strain has only just begun. Based on pharmaceutical industry estimates, it will likely take 3-6 months to develop an effective vaccine. Then another few months to produce and distribute the vaccine in sufficient quantities to impact containment efforts. Unlike the avian flu pandemic of 2008, vaccination will not contribute early containment efforts.
“The next tactic is public education, which is being implemented as we speak. DHHS is preparing to embark on an aggressive public education campaign, consisting of television advertisements, direct mailings, educational materials distributable at medical offices, internet resources, telephone information, MP3 downloads, YouTube, and educational interviews on all major media programs. Every angle imaginable. This campaign should kick off by early next week.”
“MP-fucking-3 players? Did we travel back in time? Why don’t they put it on iShare, too? Then all the teenagers can download cool Health and Human Services music videos and share them with their friends. Un-fucking-real,” Alex yelled at the screen. “These idiots should just announce right now to close all schools and that each family should isolate themselves for a few weeks. If they did that, this whole pandemic would falter within the span of a month. This just isn’t aggressive enough, but then what do you expect from D.C.,” he said, his angry voice at a more reasonable volume.
The Jakarta Pandemic Page 59