The Rationing

by Charles Wheelan

  Let me address the elephant in the room: Did the President lie to the American people? The Outbreak Inquiry Commission was equivocal on this point. The two pages in the report devoted to the President’s Honolulu address are a mishmash of ambiguous phrases and tortured use of the passive voice. My view is much clearer: The President believed he was doing the right thing by presenting the most optimistic view of the situation in that moment. As I have noted, the NIH model was showing a best-case scenario in which our existing Dormigen stocks, including the new donations, would be sufficient. One should bear in mind, too, that the results predicted by that model had been revised steadily downward ever since we first confronted the crisis. True, we had underestimated how many people would die because they did not seek medical care. There was plenty of Dormigen at that point. Was that on us? Besides, we now had the opposite problem: perfectly healthy people streaming into emergency rooms convinced they were dying. The President believed that new developments would continue to redound to our benefit: more Dormigen donations, some progress against the virus, more effective non-Dormigen alternatives, and so on. He was wrong, obviously.

  In fact, the nation’s Dormigen supplies were plunging even as the President spoke. As I have noted, we all failed to recognize that the Dormigen supply was unsecured. From the moment the first New Yorker story suggested an imminent public health problem, Dormigen went missing—everything from trucks of the medicine stolen outright to doctors and nurses pocketing some pills at the beginning or end of a shift. I suppose the statement by Senator McDowell during the Outbreak hearings hewed closest to what was really happening on that morning: “The Dormigen supply was like an ice cube on a hot day. The administration blithely went about its business, even as that ice cube was melting away. It was an oversight of monumental proportions to assume that a shortage of a lifesaving drug would not precipitate theft and pilfering.”§ One can quibble with the metaphor, but the “melting ice cube” is a good description of what was happening. The supply was quickly secured, but that process was incomplete and ad hoc. It was as if someone suddenly directed the nation’s doctors, clinics, and hospitals to implement measures to prevent the theft of ballpoint pens. How does one even begin? No one had ever thought Dormigen valuable enough to protect. To the contrary, the drug was a handy thing for doctors to keep in their pockets, for nurses to keep in the top drawer of an examining room, and so on. Even if the administration had moved more quickly to secure the supply, the pilferage might have been just as bad. The same people had the same opportunities to pocket a few pills, or steal a truckload.

  When the President addressed the nation, he believed the nation’s Dormigen stocks to be far higher than they actually were. The barn door was nailed shut eventually, but by then the “ice cube” had been sitting on a warm counter for a long time. The President and his advisers, myself included, should have anticipated that Dormigen would go missing. We should have put measures in place to prevent it; on that morning in Honolulu, the President should have been more aware of what was happening. The NIH should have reacted more quickly to the early reports of pilferage, though to be fair the NIH senior staff were busy fielding calls from foreign governments making generous new Dormigen offers. Every one of those calls—two thousand doses from Qatar; five thousand doses from South Korea; eighteen thousand from Australia—was literally a lifesaver. The irony, of course, is that the NIH was bringing new Dormigen in the front door even as it was disappearing out the back.

  I should make one other non-obvious point. Stolen Dormigen was not quite as disastrous as it may first appear. There is no recreational value to Dormigen; it offers no high, not even pain relief. No one takes Dormigen if they do not have to. In theory, then, every stolen dose replaces one that would have been prescribed anyway—provided the stolen medicine goes to people who really need it. Unfortunately there were twin tragedies amplifying everything else going wrong on this front: reasonably healthy people started taking Dormigen they did not need; and many sick people ended up with counterfeit Dormigen. I can only marvel at the speed with which entrepreneurial opportunists flooded the Internet with “special deals” promising Dormigen “delivered to your doorstep.” According to the Outbreak Inquiry Commission, the first of these hoaxes appeared online only ninety minutes after The New Yorker first made the Outbreak public.

  I was simultaneously impressed and horrified by these hucksters. Each scam had its own ridiculous explanation for why an online vendor happened to have surplus lifesaving medicine while the rest of the country was in shortage: “Army surplus”; a “special unregulated supply from Costa Rica”; a “new patented method for producing the drug on demand”; and many others.¶ The audacity of these modern snake oil peddlers was matched only by the gullibility of those on whom they preyed. Some fifteen million people rushed to the Internet to buy Dormigen; they ended up with everything from sugar pills to decongestant tablets. (There is a modicum of good news here; a reasonably high proportion of the people who bought fake medicine did not need the real stuff anyway.) Still, there were several hundred thousand people who needed Dormigen and ended up with something else entirely.

  After the President finished his address, I felt the producer pulling me by the elbow out of the crowded common area. He said, “We’re on in New York in ninety seconds. It’s a standard interview format. You’ll have about two minutes and twenty seconds. They’ll try to keep you longer, but you can’t. Cleveland will be queued up right when you finish.” He guided me to a seat in the small soundproof room. As I put on the headphones, he hustled out of the room into the production booth on the opposite side of a soundproof glass partition. Soon I could hear his voice in my headphones: “We’re on in thirty.” One of the assistants had pasted a paper sign in the window that read NYC to remind me of the market to whom I was speaking. I chuckled at the notion that I would need to be reminded of that detail. Seven or eight interviews later I found myself glancing at the sign; I had new sympathy for the occasional rock band who would yell, “Hello, Dayton!” only to be greeted by stunned silence among the fans in Akron.

  There was a burst of static as the producer patched me into the New York studio, at which point I could hear the program in progress: “. . . joined by the administration’s top adviser on this virus. Doctor, thank you for joining us.” I have a Ph.D., but I have never referred to myself as “doctor,” so this left me temporarily flat-footed.

  “It’s my pleasure,” I said.

  The host began, “The President just addressed the nation, telling us the situation is under control. He made no mention of a possible terror attack. Why is that?”

  “Because that’s not what’s happening,” I said. “Capellaviridae is a very common virus that has turned virulent—”

  “That’s what we’re being told, but why now? How does a common, supposedly innocuous virus suddenly become deadly?”

  “We are still trying to figure that out,” I said. I was not used to being interrupted midsentence.

  “Then how can we be sure that this is not some kind of domestic terror attack, as is being reported elsewhere?”

  “There is absolutely no evidence to substantiate those reports,” I said firmly. “None.”

  “But you can’t tell me what is happening. If you’re not sure, how can you rule out terrorism?”

  “This is a public health crisis; it’s not a terrorist attack,” I said. I immediately regretted using the word “crisis” and repeating the terrorism charge.

  “Given we have a crisis on our hands, as you’ve said, what should our listeners be doing now?” the New York host asked.

  I heard the producer’s voice in my earphones: “Forty-five seconds.”

  I answered, “The administration is making progress on the Dormigen front—we are getting commitments from other countries, and we are also making progress on the virus—”

  “So the government is going to solve this crisis?”

  “There are experts—”

  “Are
n’t these the same people who got us into this situation?”

  “Well, no . . .” I stammered without any sense of where I was going with the answer.

  The producer said in my earphones: “Twenty seconds and we’re out.”

  The New York host continued, “The government is supposed to have a stockpile of Dormigen and now they don’t? Am I missing something?”

  “I don’t think of it that way.”

  “I suppose you wouldn’t,” he said. “While we are waiting for the government to rescue us, what can individual listeners do?”

  “Anyone who feels they may be ill with symptoms consistent with Capellaviridae—”

  “Those symptoms are on our website,” he interrupted.

  “—should seek medical attention.” I heard a click as the New York station muted my microphone, ensuring the host the last word.

  He concluded the segment: “Grim news from the nation’s top expert on the virus attack. Government help is on the way. If you feel ill, head to a clinic or hospital, where there probably won’t be enough medicine to help you. This is criminal incompetence, people.”

  The station went dead in my earphones. I exhaled audibly. I heard the producer’s voice, “Don’t worry about it. That guy’s an asshole. I’m going to connect you to Cleveland in about twenty-five seconds.” The assistant took down the paper sign in the window that read NYC and replaced it with CLEVELAND. “Only thirteen more to go,” the producer said.

  52.

  CLEVELAND WENT BETTER, OTHER THAN MY UNFORTUNATE description of Capellaviridae as “elegant.” Nashville was another jackass host who would not let me complete a full sentence. I got steadily better at steering the conversation in the direction I wanted it to go. There was a forty-five-second break between Nashville and Chicago Public Radio. I sat back in my seat, trying to calm myself. The assistant pasted CHICAGO in the window. The producer said in my earphones, “You’re doing great. Don’t let these guys get to you. They’re just sitting on their asses with a microphone. You’re actually doing something about the problem.” I nodded to acknowledge the pep talk. The producer continued, “Hey, one other thing. Bloomberg is reporting that the Chinese ambassador to the United States is going to give a news conference in Washington at two. Something about Dormigen. We’re on in fifteen.”

  The Chicago host had seen the same Bloomberg report. After the introduction, she asked, “Do we know for certain what the size of the Dormigen gap is right now?”

  I hedged: “I’m not privy to that information. I do know the number is a moving target and it’s moving in the right direction. My understanding, based on the President’s speech, is that we are close to closing the gap.”

  “And China is apparently prepared to offer whatever Dormigen the nation may need?” the Chicago host offered. “We are told that’s what the Chinese ambassador is going to announce this afternoon. Can America breathe a sigh of relief?”

  “I don’t know any of the details regarding the Chinese offer.”

  “It seems fairly straightforward, no?”

  “It depends what they ask in return,” I said. “As you know, the President was on his way to Australia to sign the South China Sea Agreement. The Chinese government has been consistently hostile to that collective security arrangement with our allies in the region.”

  “So the Chinese government might ask the U.S. to scrap the South China Sea Agreement in exchange for the Dormigen?” the host asked sensibly.

  “As I said, I’m not privy to the details.”

  The host probed more deeply: “Some officials in Beijing are saying on background that the Chinese government made this offer many days ago. Were you aware of any such offer?”

  “I’m a scientist, not a diplomat.”

  “I understand that, but in the course of discussions about this crisis, was there any mention of an offer by China to cover the Dormigen gap?”

  “Those discussions are all confidential.”

  This was public radio. The host was more persistent and appreciably smarter than most of the bloviaters who had been vomiting in my headphones for the past hour. She had also found her way to exactly the right question. She continued, firmly but not rudely, “What I’m left to infer is that the Chinese government is offering Dormigen with strings attached. Is it fair to say the President may be in a position where he has to trade off American lives against our future security arrangements in East Asia?”

  “We’ll know more about that at two,” I said.

  At that moment, the Secretary of State was working the phones to find out what the Chinese deal was going to look like. The Chinese Embassy in D.C. had alerted the news media that there would be “a major announcement regarding a Chinese gift of Dormigen to our American friends” but had made no formal contact with their U.S. counterparts to offer the details. When the Secretary of State reached the Chinese Ambassador, he was tight-lipped about the forthcoming announcement. “This is unprecedented,” the U.S. Secretary of State shouted into the phone.

  The Chinese Ambassador remained unruffled. “We would like to speak directly to the American people,” he said.

  “How are we supposed to react, if we don’t know the terms of the deal?” the Secretary of State asked angrily.

  “This is not a ‘deal.’ It is an act of generosity on the part of the Chinese people to cement our ongoing friendship with the American people.”

  “Don’t insult my intelligence,” the Secretary of State warned. “If I want propaganda, I’ll read the People’s Daily. When are we going to know what you want?”

  “President Xing will present a new U.S.-China Friendship Agreement immediately after the press conference.”

  “Can you summarize for me what will be in this ‘Friendship Agreement’?” the Secretary of State asked.

  “As I said, we would like to speak directly to the American people.”

  The Secretary of State hung up without saying goodbye, much to the surprise of the National Security Adviser and the Strategist, both of whom were in the room with her. The Strategist asked, “Did you just hang up on him?”

  “He’ll get over it,” the Secretary of State replied.

  “So much for U.S.-China friendship,” the Strategist said, finding a certain levity in the situation that neither the Secretary of State nor the National Security Adviser shared.

  “It’s clever,” the National Security Adviser offered. “They’re going to wave the miracle cure in front of the public and then we have to explain why we may not take it.”

  “We have to get out in front of it,” the Secretary of State answered. “We need people to understand when they’re watching that there is a price to be paid. We need people to be skeptical when they hear—”

  “Maybe not,” the Strategist said, almost musing to himself. The two women looked at him, waiting for him to complete the thought. “What’s the first thing you think of when you hear ‘U.S.-China Friendship Agreement’?” he asked.

  “It’s the usual Orwellian doublespeak, like reading Pravda back in the day,” the National Security Adviser said.

  “These guys are not nearly as good at propaganda as they think they are,” the Strategist said. “When you can shut down newspapers and arrest critics, you tend to lose the subtle art of persuasion.”

  “And?” the Secretary of State asked impatiently.

  “They’re ham-handed,” the Strategist explained. “They’re amateurs when it comes to the American public. They think they’re better than they are. If we let them make the first move, there is a good chance they’ll overbid.”#

  “It’s risky,” the National Security Adviser said.

  “Not really,” the Strategist countered. “We’ve got no other good options. Putting out a statement when we don’t know what they’re going to say is like punching shadows.”

  Back in the studio, the balance of my interviews dealt mostly with the upcoming Chinese press conference. I got better at dodging and weaving. Also, the terrorism questio
ns went away; there are only so many things that can be discussed in a three-minute radio interview. Between Austin and Denver, the producer spoke into my headphones. “You’ve got a little break here, almost seven minutes, if you want to use the bathroom or get some water or something.” I stood up, just to stretch, and then I remembered Tie Guy’s most recent text. I called him and he answered almost immediately. We had not spoken since the Outbreak became public. I expected him to say something about all that, but he surprised me.

  “Nature fights back!” Tie Guy exclaimed.

  “Yeah, that’s what you texted. What?”

  “Your buddy Huke is on to something. Nobody likes dust mites, right?”

  “Not that I’m aware of.”

  “This particular subspecies of dust mite bites humans. And the bites itch.”

  “Okay, so?”

  “Check this out: Capellaviridae is most likely to become virulent in places that have been most aggressive in trying to exterminate the North American dust mite.” There was a brief silence as I absorbed what he was saying. “The clusters,” he added. “Remember? There are just a handful of places where the virus is common and people got sick?”

  “Vaguely,” I said. “How do you know about the extermination?”

  “I got lucky. We don’t have any data on who is trying to kill dust mites, but exterminators are licensed in a lot of states. There are pretty good records of the chemicals they use.”

  “I’m at a studio,” I said. “I’ve only got about five minutes before I go back on the air.”

  Tie Guy continued quickly: “There is a particular kind of pyrethrin that is highly effective against dust mites and not used for much else. The few places where that insecticide has been used aggressively are also the places where Capellaviridae has turned virulent. The correlation is striking.”