The Rationing

by Charles Wheelan

  18.

  I WAS DATING ELLEN AT THIS POINT, AS I HAD TOLD THE President when I was still under the impression that he might care about these kinds of things. My personal life may seem irrelevant to the larger story that was playing out, but since it would later be dragged into the open, I should put those developments in context. I first met Ellen in a bar, though that is somewhat misleading. We were both there for a Dartmouth wine-tasting event. Ellen had come with her roommate, who was a Dartmouth alumna two classes behind me. (Ellen went to Duke.) Ellen and I had a nice time that evening. We met for breakfast the following Sunday with some mutual friends. I was single. Ellen was single. Our friends knew each other. There was a certain centripetal force to the relationship; it kept moving in one direction because no force intervened to send it in a different direction.

  By the time we moved in together, Ellen was doing public relations for a big firm. It was totally vapid work, if I am being honest. Why does a bean dip need a PR campaign? (She really did have a client that made bean dip, or frozen nachos—one or the other.) Ellen accused me of belittling her work, which was scary given that I had only verbalized a small fraction of my cynical thoughts. She had little or no interest in my work at the lab and not enough background in science for me to explain why my work mattered. By the time I realized that Ellen did not know the difference between RNA and DNA—and had no interest in learning—it was obvious that we were not meant to be together for the long run. I suspect she was thinking the same, but neither of us had done anything about it. We had a comfortable routine.

  The Capellaviridae crisis created new tensions. I was almost never home. The White House obviously forbade us from talking to outsiders about the crisis, so when I was home, I was not able to explain what was happening. I was not even able to say that I had been to the White House for a meeting. “I’m working on something really important,” I told her one night when I came home after midnight.

  “I know,” she said sympathetically. “It’s hard when we’re both this busy.”

  The bean dip? I thought. You are comparing the public relations strategy for a bean dip to a deadly epidemic? “No, like really important,” I said. That was a mistake, obviously. I will not relate the balance of the conversation. We were done at that point; it was just a question of making it official. I did not have time to move out, but that was where things were clearly headed.

  So when the thing happened with Jenna, it was not as bad as a handful of blowhard members of Congress made it out to be.

  19.

  TIE GUY HAD THREE HUGE COMPUTER MONITORS ON HIS desk. They were arranged like a dashboard, making his small dark office feel like the bridge of a spaceship with him as the captain. The light from the screens reflected off his face. “I’m not seeing anything,” he said. I was standing behind him. There was not room for a second chair in his office.

  “We need to pick up the pace on this,” I said. We both knew that was a ridiculously unhelpful thing to say, like telling someone to “think harder.”

  “To begin with, the data are complete shit,” Tie Guy said. We both knew that to be true. The public health community—doctors and nurses and hospitals and even coroners—had no reason to believe that Capellaviridae was anything more than a nuisance. By that point we had roughly three hundred deaths that could be linked to Capellaviridae. One big plane crash. Plane crashes happen, I told myself. Besides, those people would have been fine if they had just gone to the doctor. Nearly a thousand people had died in car accidents over the same stretch. Yet I knew there was a problem with these rationalizations. It was not just one plane crash. It was one plane crash with evidence to suggest that hundreds of other planes with the same design flaw might soon start falling out of the sky. It could even be thousands of planes.

  And our problem was trickier than planes. With a plane crash, an FAA investigator shows up at the site of the crash, does a preliminary investigation, and says, “You need to ground every plane that might have a defective Y-hinge holding the rear engine in place.” Nobody panics because swapping out the Y-hinges will prevent more planes from falling out of the sky. With Capellaviridae, there was no “Y-hinge.” We had no idea what was happening. Nor was there any obvious behavioral response that would minimize the public risk (like flying less). What does that press conference look like? “Hey, everyone, we just want you to know that you are all at serious risk from a pathogen with the potential to cause a pandemic at a time when our Dormigen stocks are running low. We do not understand why or how this is happening, and there is nothing you can do to avoid it, but we felt you ought to be aware of the situation. We won’t be taking any questions at this time, because we don’t have any answers.” How would that go over?

  We had a dilemma: If we did not tell the medical community how serious Capellaviridae might be, they would continue to send us the same lousy, incomplete information. They would not test for Capellaviridae. Or if they did and prescribed Dormigen, they would neglect to enter it into the database. And so on. Our public health detectives would get fewer clues and less cooperation because the public would have no idea that a serial killer was on the loose.

  Or, we could do the medical equivalent of announcing that the building was on fire and cause people to run screaming for the exits—only there were not any exits.

  “Look at this,” Tie Guy said, pointing at the middle screen on his desk. It was a map of the United States with yellow and green dots scattered across it with no discernible pattern.

  “What am I looking at?” I said.

  “The yellow dots are deaths, the green dots are cases we know of that have been treated with Dormigen. Do you see anything interesting?” he asked.

  “Not really,” I said.

  “Neither do I. The data are totally worthless. We know almost nothing about these people.”

  “What do we know?” I asked.

  “The people who are dying tend to be young and healthy. A surprising number of college students. What do you make of that?” Tie Guy asked, the frustration lingering in his voice.

  “They were probably just too stubborn to go to the doctor—thought they were invincible,” I answered.

  “Could be,” he said. “In that case, we don’t even know who is most at risk, we just know who is too stupid to go to the doctor.”

  “We need an estimate,” I said. “How often does this thing turn fatal?”

  “I saw the e-mail,” he said angrily. “You know as well as I do that we can’t begin to answer that question with any degree of certainty.”

  “This could be an epidemic,” I said.

  “Fine,” he snorted. “Run a public service announcement telling people to go to the doctor. Give them Dormigen. Collect real information. Then ask me what is going on.”

  “What if we were to run out of Dormigen?” I asked, skating just to the boundary of what I should be saying.

  “Then we’re fucked,” he said. “And if North Korea fires a nuke at California, then we’re also fucked. This is not what I get paid to think about.”

  “What if we were to sample an MSA?* Do it right. Collect all the meaningful info for you to do some real analysis.”

  He laughed. “Good luck finding a budget for that.”

  “If I can find the money, how long would it take?”

  He turned from the monitors to look at me. “What’s going on?” he asked.

  “Nothing,” I said. “I’ve got people leaning on me for answers. How long would it take?”

  “Well, there’s nothing difficult about the analysis if you get me decent data. A couple of days, maybe.”

  I could see it in his eyes: He knew something was up. Maybe he saw it in my eyes. “Set everything else aside,” I said. “This has to be top priority.”

  “Yeah, I’m getting that impression.”

  “I’ll be in touch,” I said, turning to go.

  “Hey,” he said. I paused in the doorway and looked back over my shoulder. “If you can really get the mone
y to do this right, we should sample a couple of different places. And we should do it several days apart, maybe even a week or more. There’s no reason to assume the rate at which this virus becomes fatal is constant. Right? It could easily be changing, for some reason.”

  “That makes sense,” I said. He held my gaze for an uncomfortably long time, until he was persuaded that I was not going to say anything more.

  “Do you know why I do this?” he asked.

  “Well, I asked you . . .”

  “No, this,” he said, motioning around him to indicate the broader job.

  “You like statistics, data,” I offered. I knew my answer was just filling space. He was going to answer his question for me.

  “I like what the data can tell us, you know? Do police officers disproportionately target black motorists? Let’s ask the numbers. They won’t lie.”

  “There is the whole lying-with-statistics thing,” I said foolishly.

  “People lie with statistics,” he said. “The data scream out for us to pay attention.”

  “Right,” I acknowledged. I realized in that moment that we could not keep a lid on this thing forever. There is only so long you can ask smart people to drop everything before they sense a crisis.

  And information starts to leak, on purpose or even by accident. So if I had not messed up, someone else would have.

  20.

  I WAS DUE AT THE WHITE HOUSE AT SEVEN-THIRTY A.M. THE security process takes a while at that hour, as employees and visitors queue up at the gate. I did not want to be late, and as a result I was ridiculously early. To kill some time, I bought a cup of coffee and a Washington Post–USA Today at a kiosk on Dupont Circle. I perused the front page in one glance (a benefit of a real newspaper, as opposed to the online version that I usually read): flooding in Alabama; more evidence the Russians were violating their treaty obligations in the Arctic; a bad harvest in West Africa, probably caused by climate change; the new Afghan president vowing to expel the last American troops within two years; D.C. transit workers threatening to strike. Those are all the President’s other fifteen-minute meetings, I thought. I may have said it out loud, because a woman drinking coffee nearby looked over at me. This was what the President was going to be dealing with today, even the stupid transit strike, since funding for the system was federal and a strike would effectively shut down the capital. I wanted to tell that woman, who was still looking at me, “This is just the stuff that is public. It’s even worse than you know!”

  Those first White House meetings had settled into a pattern. The President, usually preoccupied with something else, would say, “What do we know?” The rest of us would report out on our designated tasks, usually prompting the Strategist to declare that we had fallen short in some way, or that we failed to understand something, or that we were not asking the right questions—all usually valid points, but exasperating nonetheless because he seldom had any assigned responsibility himself. It was like the Strategist showed up to these meetings with a pin, relentlessly popping the balloons that the rest of us had spent the previous twenty-four hours working to inflate. Pop, pop, pop. Then the President would say, “He’s right,” and we would be left with even more difficult tasks before the next morning meeting.

  The Acting Secretary of Health and Human Services had joined us. He had the least formal power of anyone in the room but often projected the largest presence. His boss, the Secretary of Health and Human Services, owned stock in some company that supposedly got preferential treatment in the drug approval process, or something like that. It had none of the allure of a good sex scandal. The HHS Secretary owned only a hundred shares of the stock in question, meaning that if the sordid accusations were true, she made at most $642 in illicit profits, before taxes. No matter. Once the blowhards in the House began using the phrase “principle of the matter,” she might as well have started packing up her office. The President hung her out to dry, like some kind of human sacrifice to placate his most rabid political opponents on the right. When the scandal reached its apex (among the three hundred people inside the Beltway who were following it), the President released a statement: “I am grateful for the service that the Secretary of Health and Human Services has provided to my administration and to the people of the United States.” There was no mention of “confidence” or “continued service” and she resigned almost immediately—tossed out of the boat. As any Washington insider might have warned, the effect was not to placate the President’s critics, but rather to encourage them with blood in the water.

  The President appointed one of her deputies to take over as Acting Secretary. He had been briefed on the Capellaviridae situation. The Acting Secretary was a black man, probably sixty-five or so, with an infectious laugh. He weighed about 250 pounds, with the build of the former football player that he was. The Acting Secretary was strikingly impervious to politics—not oblivious, just mentally resistant, as if the sordidness of Washington rained down around him but he somehow stayed dry. He just did not care, or he managed to project that impression. The Senate was not going to confirm him as Secretary—for reasons that had nothing to do with his qualifications and everything to do with a small group of Tea Party senators who were in an ongoing pissing match with the President. The Acting Secretary’s wife—not him, but his wife—had run a state chapter of Planned Parenthood, twenty or thirty years ago, and apparently that was enough to make the whole family toxic to the political right forever. A group of five senators had vowed to use every procedural tool in the Senate rule book to prevent a confirmation hearing.

  “I can’t help you on this one,” the Majority Leader told the President. Of course, he could help him. He could go to bat for the nomination. He could use the tools at his disposal to wreck those five intransigent senators politically. The President did not call him “Lyndon” for nothing. But it would not be a wise move in the long run, and the Majority Leader always played the long game. The President, too, played political chess, and he knew well enough not to press for this favor, so the Acting Secretary was bound to remain “Acting” for the foreseeable future. What did he tell the Washington Post–USA Today? He said, “It won’t affect my pension.” That’s it. That was the only thing he said for attribution. The cub journalist writing the story thought it was a great quote, but almost certainly for the wrong reason. Anyone outside the Beltway reading that story would think the Acting Secretary was some kind of bureaucratic functionary, watching the clock every day and counting down the years—including a bonus for accrued vacation—until he could retire at a small ceremony (on government time) and move to a sad little condo in Florida. In fact, the pension quip to the Washington Post–USA Today was a rifle shot at the political establishment. This was a guy who spent forty years working in many ways to make people’s lives better; whether you called him “Secretary” or “Acting Secretary” did not make a whit of difference to him.

  The beautiful thing about the Acting Secretary was that the political types could not bully him. Even the President did not intimidate him. The Acting Secretary was respectful of the President, even deferential, but never cowed. He was fond of saying, “I have six grandchildren, a pension [always the pension], and a decent set of golf clubs. What do I need this nonsense for?” Every time he said that I got a little thrill because it was really a polite way of saying, “Fuck you.” Do you remember in middle school when some jackass would make fun of you for something, and your parents would say, “Don’t let him get to you”? The logic is that no one can make fun of you—for anything, really—if you have no respect for his or her opinion. They cannot injure you by not inviting you to the party if you genuinely have no interest in going to it.

  Middle school works that way, and so does Washington. There is a certain gravitas that comes from being able to stand apart from the day-to-day politics. The Acting Secretary of HHS had that figured out. If the President fired him tomorrow morning, he would be on the golf course with his grandchildren by afternoon—a point he repea
ted often, and to good effect. In fact, he would periodically elaborate on how much better his golf game would be if he had more time to practice chipping and putting. “It’s all short-game,” he said to me after one of these soliloquies. I recognized this comment as the finale to his public drama, so I nodded in agreement.

  The Acting Secretary attended his first working group meeting on a Sunday morning. I remember it was a Sunday because the D.C. streets were sleepy as I walked out of the Metro (no transit strike yet) and toward the White House. The morning was sunny and already warm. Several cafés had set up outside tables that were crowded with young professionals having brunch outdoors before the day turned oppressively humid. In these days before the Outbreak became public, I was always struck with some variation of the same thought: They have no idea. Most of these people laughing over their eggs Benedict are carrying Capellaviridae. I am walking to the White House because we know the Dormigen stocks are going to run out. If we do not come up with a fix, some of you are going to die. Enjoy your eggs and wish me luck.

  In the Oval Office, the principals were dressed casually, including the President, and I remember thinking that was strange, too. So arbitrary. The same people doing the same work in the same place, but one day a week none of us had to wear suits. It was the first time I had seen the Secretary of Defense out of uniform. The Strategist was wearing an interpretation of casual that one would have to see to believe: the pants from a pin-striped suit with black leather dress shoes and some kind of short-sleeve floral Hawaiian shirt. He had shaved, but not well; there was a small strip of whiskers running down one cheek.