by Bobby Akart
The women, both flight attendants on an easyJet Airbus 320, were on a two-day layover on a trip that originated at London Heathrow. Their flight was scheduled to return tomorrow evening, so the ladies could party until dawn without violating their contracts with the airline. And so they did.
THUMP—THUMP—THUMP.
The music provided the mood and the drinks fueled the fire within them. Yusuf loved English women—their accents, their relaxed nature, their promiscuity. Westerners stood in far contrast to the burka-laden women he’d grown up with. With another swig of tequila and a wipe of the forehead, Yusuf imagined himself becoming a refugee and heading for London one day.
The two flight attendants really enjoyed Yusuf, so much so they began kissing him. First one, then the other, repeatedly. They danced and made out on the dance floor. They’d return to their booth and make out some more. Laughing, drinking, and kissing.
Although Yusuf was disappointed at closing time when the ladies refused the offer to join him in his flat, he still enjoyed himself. Outside of BIOS, the trio took selfies, exchanged cell phone numbers, and ever the gentlemen, Yusuf helped his new friends into a taxi.
Yusuf had forgotten about being sick as he left that evening, but he was proud of himself as a proper ambassador of good times for the young ladies of London. They’d shared a lot that night, including a sickness that had a one hundred percent mortality rate, the plague.
Upon their departure from Turkey, the flight attendants of easyJet flight 8850 to London Heathrow, the seventh busiest airport in the world, would share their evening with Yusuf with the one hundred and fifty passengers and crew onboard—who would share it on their connecting flights with those passengers, and so on, and so on, and so on.
Chapter 49
Day Eighteen
CDC EOC
Atlanta
Mac joined Janie in the lab as the analysis of the Madagascar strain of the plague continued. A meeting was scheduled in the Emergency Operations Center with the entire contingent of department heads, including the director. The plague cases were too widespread and frequent now to consider them within the norm. Mac hoped the test results would provide her the last piece of the puzzle to generate a working theory upon which the CDC, and now the WHO, could adopt in formulating a course of action.
“Are you gonna tell me where you got this specimen or not?” asked Janie as she leaned back in her chair with her arms crossed. Mac looked at Janie and saw that dog-with-a-bone expression. Janie would allow these machines to run for days until she got the answers she sought. Time to fess up.
“After I checked into the hotel in Athens the other night, I turned toward the elevators and Hunter was standing right in front of me with a couple of beers in his hands and a boyish deer-in-the-headlights look on his face.”
“Who? Hunter?” asked Janie.
“You know, the agent from the DTRA who invaded our ops in Guatemala the day I arrived.”
“Really? Blue eyes was there in Greece? Why?”
Mac carefully slowly turned in her bulky protective clothing that was mandatory when working with a contagion such as Y. pestis in the biosafety lab. She wanted to confirm they were alone.
“Hunter was running down a lead on an investigation being conducted by the DTRA. During dinner, we compared notes and have both come to the conclusion a terror angle to all of this has to be considered.”
“Dinner? You had dinner with those steel-blue eyes?”
“Janie, yes, and drinks. And he’s cute, funny, charming, a gentleman and all of that. You need to focus on what I’m saying. We may be in the midst of a worldwide bioterror attack.”
“Do you like him? He’s really cute. You hated him in Guatemala.”
“Hate is a strong word. But it doesn’t…” Mac’s voice trailed off as she was about to admit aloud, to another person, that she in fact had an attraction to Hunter. “Janie, yes, I like him and I hope that I can see him again. In the meantime, would you mind helping me protect the world’s seven and a half billion people from an ugly death?”
Janie smiled through her headgear and respirator. “Okay, for now. To be continued, but then I want all the deets.”
“There are no other deets. I mean details. We ate dinner, had drinks, laughed and then got deadly serious. No kiss and no extracurricular side action, as you like to call it. Now, let’s confirm what we think we know.”
“Fine,” grumbled Janie. She began a series of keyboard entries, and then one by one, the four strains of plague under investigation from Guatemala, Trinidad, Greece, and Madagascar filled their own quadrant on the monitor.
Mac leaned closer to the screen and pointed to the Madagascar strain first. “If you hadn’t identified them, there would be no way to tell them apart, although Madagascar appears to look like a textbook example of Y. pestis. The rod-shaped bacterium, the bacillus, are perfect.”
“The others are slightly different, almost imperceptible without further magnification,” said Janie. She clicked on each image, using her mouse to enlarge the other three strains. “Are they different strains? It’s hard to tell without getting into the genetics. That’s gonna take some time.”
“Janie, the trouble is you think you have time when you might not.”
*****
Mac had attended these high-level briefings before, although none in the past had compared to her experience in the White House. But not since the Ebola outbreak had the director of the CDC addressed the group. He must be taking Mac’s reports and findings to heart.
Before the discussion started, Mac handed out the results from their analysis of the Madagascar strain. The notes provided a very important caveat—genetic testing was recommended due to the complexity of the bacterium and the slight variations in appearance. A trained eye and additional analysis would provide answers.
“Good evening, everyone, and thank you for sticking around at this late hour,” started Dr. Tom Spielman, a highly-respected public health servant who started his career with the EIS twenty-six years ago. He’d seen some of the worst outbreaks in the last three decades, including the SARS outbreak in Beijing, the bioterrorist anthrax response in Washington, and of course, Ebola in West Africa.
Mac liked Dr. Spielman, not just because he started at the bottom like she did, but because of his support for her mother during the Ebola crisis. He was on the ground in Liberia as well as Sierra Leone during the worst of the epidemic. Unlike the politicians who threw her mother under the bus, Dr. Spielman backed her up all the way in the media. Unfortunately, the media was more interested in taking scalps than reporting the successes.
“I’ve been thoroughly briefed along the way and, naturally, so has the secretary of Health and Human Services. What happens next will be determined by our conversation in this room. As you all know, fighting infectious diseases in modern times not only involves the combination of investigation and response, but it requires multiagency coordination, both within our nation’s government as well as internationally.”
Mac dropped her chin and smiled. Dr. Spielman had learned from her mother’s mistakes. You had to play the game because losing could ruin your career.
Dr. Spielman continued speaking. “It’s important that we come out of this room with a single voice, one that we all can agree upon. Further, our counterparts around the world will be looking to us for a solution, an overall game plan, for dealing with this rare set of outbreaks.”
Dr. Spielman rose from his chair and began to walk around the room until he reached Mac. He patted her on the shoulder and instructed her to take his seat at the head of the table.
“Dr. Hagan has provided some new data to help us create a working model. Please update everyone on your working theory, Dr. Hagan,” said Dr. Spielman as he took her seat.
Mac didn’t expect this, but because she’d been completely immersed in these outbreaks, summarizing them for the attendees was not a problem. She walked them through the outbreaks from day one, the discovery of the vil
lage in Guatemala, to her receipt of the Madagascar strain. During this revelation, she couldn’t help but notice the glare she was receiving from D-Bag. He was a control freak who would probably admonish her afterwards for hiding the Madagascar specimen from him.
During some discussion about monitoring and containment, Mac fought an inner debate. Should she disclose the terrorist angle, or was that beyond the scope of this discussion? Hunter had confided in her the details of the DTRA’s activities although she was sure he was holding out on some things. However, it was logical for her peers to question the incidents being spread in unconnected parts of the world. It was Dr. Spielman who put her on the spot.
“Dr. Hagan, do you have a theory as to how this exact strain could jump from Madagascar to the remote jungles of Guatemala? Is there a connection between Madagascar and Central America from a geopolitical or international commerce perspective?”
“Only one, sir, but it is a very remote connection,” replied Mac.
“Let’s hear it,” said Dr. Spielman.
“Sir, the International Fund for Agricultural Development, IFAD, is a specialized agency of the United Nations designed to help developing nations with food production. During the world food crisis of the seventies, the IFAD began to develop programs to prevent famine.”
“If I may,” Dr. Jack Fontaine raised his hand. “I worked with the IFAD in Africa before I joined the CDC in 2014. I’m familiar with their programs and internal operating structure.”
“Okay, thank you,” said Mac. “Here’s what I have and you might be able to assist further. A recent project of IFAD involved scaling up micro-irrigation systems in India, Madagascar, and Guatemala. Known as SCAMPIS, IFAD moved into areas where water scarcity and low soil fertility negatively impacted productivity. They provided organic fertilizers and micro-irrigation to address the poor growing conditions.”
Dr. Fontaine raised his hand again. “Have you contacted them? If not, I’d be glad to assist.”
Dr. Spielman answered. “Yes, please do. Dr. Hagan could use the help, I imagine.”
“Yes, of course,” replied Mac. It was worth running down the lead, but Mac knew it was a waste of time. Without definitive proof, Mac did not want to raise the issue of bioterrorism. She’d try to find the time to discuss it with Dr. Spielman privately. He’d understand her need for keeping the terror angle under wraps for now.
Chapter 50
Day Eighteen
CDC EOC
Atlanta
“Have we ruled out the zoonotic element of the typical Y. pestis spread?” asked one of the research scientists assigned to the EOC.
“We haven’t,” said Mac. “The village in Guatemala was set deep in the jungle in a remote part of the country near the Mexican border. The villagers had very little contact with outsiders, but the monkey population in the area is enormous. Over the last eight or nine days, at least twenty thousand monkeys have become ill and died all across the country. They are passing it among their population and also to domestic animals like dogs, cats, and farm animals. Because of the timing of the deaths, I’d expect a second wave of infected patients in Guatemala immediately.”
“This is why warnings need to be issued,” said Dr. Spielman. “I’ve been in contact with our friends in Geneva at the WHO. Because they don’t maintain a regional office in Latin America, they’ve agreed to let us continue running the lead on this one. Dr. Nakajima, the director, has voiced her full support for your efforts.”
“Why haven’t we seen more cases?” asked Baggett.
“We are still defining a timeline for this disease,” replied Mac. “Because the first outbreak involved a remote locale with no survivors to interview, we were at a disadvantage. After the second village was located, we’ve been able to be more definitive.”
“And your conclusion?” asked Baggett. He is so rude.
“Based upon our evaluations of all the infected patients, including those in Trinidad and Greece, the incubation period can be up to seven days. Then the misleading flu-like symptoms appear in days eight through eleven. Once the disease advances into the latter stages, onset is acute with high fever, difficulty breathing, and chronic coughing, including bloody sputum. The resulting pneumonia progresses rapidly. Finally, death comes in days twelve to fourteen.”
Dr. Spielman added, “With that timeline, we could be entering a period where the death toll rises significantly.”
“That’s correct,” said Mac. “If the patient is not treated with a course of antibiotics in the first twelve to twenty-four hours, pneumonic plague results in a near one hundred percent mortality rate.”
Baggett looked around the room. “Fourteen days from infection to death? Wouldn’t that give us sufficient time to locate and treat infected people?”
Dr. Spielman took that question. “There are two aspects to this, Donald, timing and treatment. First, with the advent of modern medicine, plague is treatable with commonly available antibiotics that we have large stockpiles of here and at the WHO facilities. The earlier a patient seeks medical care and receives treatment, the better their chances are of full recovery. From what I’m hearing, the incubation period is nearly double. If patients aren’t symptomatic for a week after being infected, the less likely they can be admitted and placed under observation.”
“What about a vaccine?” asked Baggett.
“There isn’t one,” answered Mac dryly. Do your homework, D-Bag.
Dr. Spielman continued. “The second aspect is treatment. Assuming that a patient seeks treatment upon seeing the first signs and is properly diagnosed, antibiotics work in most cases. Misdiagnosis is a real problem, however.”
One of the physicians interrupted. “I studied the field notes from a case study in Oregon. Both patients contracted the illness on August 21, 2010. The patients, a father and son, lived in the same home and it was determined that they were infected by fleas from one of their dogs who tested positive for Y. pestis. They initially self-diagnosed as having the flu, and after following the suggestions on WebMD, they drank plenty of fluids, ate chicken noodle soup, and got plenty of rest—until they began to cough up blood. By then it was too late.”
Baggett asked, “So they didn’t seek medical treatment?”
“No, like most Americans who don’t want to pay to treat a minor illness, they turned to the Internet,” responded the physician. “But there’s more. After the dog suddenly died, an autopsy was performed on all three, which produced a pathology report including a gram-negative rod with bipolar staining. It was sent to four different clinical laboratories in an attempt to accurately identify the isolate. All four produced different results. It took twenty-five days to identify the isolate as Y. pestis.”
Mac shook her head as she realized that the only way to save lives was to warn health care providers in the outbreak regions. There was no other option.
“They would all be dead by then,” surmised Baggett. “Listen, I understand that some type of warning or advisory needs to be issued. We, I mean the CDC, should limit it to the regions where the outbreaks have occurred. This does not affect the United States.”
Mac visibly shook her head in disgust. She noticed how D-Bag stumbled over the word we. Was he referring to the people in this room or his true allies, those in DC?
Dr. Spielman turned his attention to Mac. “How are the patients from the second village responding to the antibiotics?”
“Not well, sir,” replied Mac. “The standard regimen of antibiotics has failed to provide us the expected patient response. It might be the fact that we were too late in discovering the village, or it could be something else.”
Mac paused again, drawing the puzzled look of Dr. Spielman. There was more to discuss, and he could sense it. He took over the meeting and issued marching orders to all present. He pacified Baggett by limiting the warnings to the affected countries. He added more personnel by recalling CEFOs in the field stations around the country to report to Atlanta for further deployment at
Mac’s request.
After the meeting was adjourned, Mac gathered her notes and started to leave when Dr. Spielman approached her. “Dr. Hagan, I’ve admired your mother and her work for a long time. I’ve also followed your career at the CDC. You’re incredibly talented and a dedicated public servant. You’re also lying. Make no mistake, a lie of omission is still a lie.”
“But, sir, I…” Mac stammered as she quickly surveyed the room to see if they were alone.
“Sit down, Dr. Hagan,” said Dr. Spielman sharply as he pushed the door closed. He took a seat directly across from her and stared at her for a moment. Mac remained silent.
“Start talking or else I’m gonna call your mother. Barbara will be on my side on this one.”
Mac chuckled as Dr. Spielman reminded her of the close relationship he had with her mother. It helped ease the tension, as she was suddenly feeling like she’d been called to the woodshed.
“Strict confidence, sir? I mean, I have an unproven working theory that is based upon a lot of circumstantial evidence.”
“For Pete’s sake, Doctor, nothing leaves this room. I saw what happened to your mother, but that doesn’t mean I’m some wet noodle bureaucrat afraid to stick his neck out. I can’t help you through this unless you tell me what you’re thinking. Last call before I pull out the big guns!” He reached into his jacket pocket and pulled out his cell phone. He started to thumb through his phone directory. He’s got Mom’s home number. They are close. Now she had questions.
Mac started to provide him the terrorist connection first, without giving away her source. She detailed the Trinidad raid and the Gabon explosion. She explained the connection between the BSL-4 lab in Gabon studying the Madagascar strain and the unlikelihood that it matched the other outbreaks.
“Pneumonic plague is a likely bioterror agent,” said Dr. Spielman. “Plague, like anthrax and smallpox, can decimate a population, as it did in Europe during the Middle Ages. Further, an outbreak of plague could easily cause hysteria in the target population, as did the outbreak in India in ninety-four when hundreds of thousands fled the city of Surat. Countries embargoed flights to and from India, and their imports to other nations were restricted. In his defense, Baggett is trying to avoid that for America.”