Final Epidemic (7 page)

“Mr. Carson, I resent the way you’re—” she began, and Carson’s voice overrode her firmly.

“As Dr. Krewell pointed out, we are dealing with a matter of available time. History alone demands that we accept Dr. Porter’s analysis. H1N1 is, potentially, a catastrophic threat to public health. Look at the sheer numbers involved. Over the course of twelve months in 1918, at least a half-million Americans died of influenza. One in four was incapacitated. This disease constitutes a threat to our entire population—more than two hundred fifty million Americans.”

“History demands that we not overreact, either,” the senator said, and the SG nodded. “Do we want to risk a general panic? And as long as we’re talking about ‘potential,’ how about the potential for making a bad situation worse? If we rush to produce a so-called vaccine, we’re asking for a repeat of the swine flu fiasco in ’seventy-six. More people were harmed by the injections than even got the flu: some were in comas for months, others paralyzed by the Guillan-Barré syndrome the vaccine initiated. The lawsuits went on for years.”

“If we’re going to talk about history, let’s allow an expert to have a word,” HHS interrupted. “Dr. Casey, I apologize. I have not read the complete report you prepared, but I have reviewed the executive summary. You’ve been waiting patiently, and I’d appreciate your insights, sir.”

“There’s not much to add to my original work, Mr. Secretary,” Beck said. “The question is, do we have an emerging epidemic here? To a society, epidemics are the biological equivalent of nuclear war. In extreme cases, as the disease spreads through the population, social systems break down. Plagues cause a social meltdown. The network of services and supports that civilization depends on fail, in varying degrees.”

“Based on what?” HHS asked.

“Ironically, based on the technological level the society has attained,” Beck said. “Historically, the more complex the civilization, the worse the collapse.”

“Specifics, Doctor,” the senator said.

“Specifically, Senator, the values that bind humans together progressively dissolve during an epidemic,” Beck said. “This was the case during Europe’s Black Death in the Middle Ages; the same effect occurred in 1918, the last killer-flu pandemic.

“In the beginning, a plague engenders fear, most commonly a sort of xenophobia. People begin to view ‘outsiders’ as the enemy, as potential disease vectors. They pull away—
for example, by ignoring people who collapse on public streets. As the outbreak expands, they build walls to keep the disease outside—and I mean that literally, in many cases. If you read Poe, his ‘Masque of the Red Death’ could well have been written as journalism rather than fiction. Extremes of behavior begin to occur—everything. Riots. Drunken orgies, group suicides. Fanatical religious fervor, complete with doomsday messiahs.

“Inevitably, as the plague expands and family members sicken and die, the social contract breaks completely. Parents are too frightened to care for their children, spouses abandon their dying mates.

“By then, of course, essential public systems are decimated. Health care is overwhelmed, both through the sheer volume of cases as well as the fact that many physicians and nurses have themselves contracted the disease. Fire or police protection is virtually nonexistent. And with all due respect to the representatives of our armed forces here, the military is no better off than the rest of society. They’re usually worse off, in fact; living in barracks or on a ship is tailor-made for widespread disease transmission.”

The senator snorted. “The Black Death. Edgar Allan Poe. There’s a big difference between medieval Europe and the modern world.”

“Not so different,” Beck said, “if you’re dealing with a disease you can’t cure, or even prevent.” He looked around the room. “Anybody here know how to keep from getting the flu?”

“Which raises the question of a vaccine.” The SG spoke up. “We’ve been making influenza vaccines for years. Mass immunization has been around since the polio years.”

“Assuming that this particular strain of H1N1 lends itself to development of an effective vaccine,” Carson said, “we’re looking at an immunization program that is unprecedented.” He nodded in the direction of Krewell. “CDC’s Special
Pathogens Branch has the figures. Dr. Krewell, what is your assessment? Is such a program possible?”

Krewell remained seated.

“Of course it is possible,” he said. “We have a great deal of experience in developing flu vaccines. We do it annually, once we’ve analyzed which flu strain we’re facing for the year. But H1N1 is not merely an evolutionary mutation of a virus we’re already familiar with; it’s a different animal entirely, and so there will be some time lost in our learning curve there.

“The key word is ‘time,’ ” Krewell emphasized. “If we have enough time, we can dissect H1N1, decode any genetic mutations, develop and test possible vaccines. If we have enough time, the pharmaceutical firms can gear up to produce the two hundred and fifty million doses we’ll need in this country alone. Given some breathing room, it is possible to set up a mass immunization in every city, town and one-stoplight crossroads in the country.”

“In your opinion, do we have this time?”

HHS looked worried, Beck thought.
As well he might.

“In my assessment,” Krewell said, “no, sir, we do not. We’d need at best six months, more likely eight.”

In his peripheral vision, Beck saw the head of the Federal Emergency Management Agency nod grimly. Alone among the group, the newly appointed head of FEMA had hands-on experience, in his former post as New York City’s chief preparedness official, in planning for widespread public health emergencies. That experience had earned him his present position: New York City was acknowledged as the place best prepared to deal with critical situations, due in large part to the man’s efforts.

In the months before he had left for his current Washington posting, he had tackled the specter of biological terrorism in America’s largest urban center. He had written plans, devised contingencies, bullied funding for police and health
personnel training. And then he had supervised exercises and drills to test how effective all the activity had been.

The news reports, even as sanitized and as spun as they had been, had been more accurate than kind, Beck recalled. It had been woefully apparent how unprepared even all the official’s efforts had left his city.

And that was
one
city,
Beck thought,
not the whole damn country.

“This one scares me, people,” FEMA was saying to the group. “Look, even limiting our concerns to the continental United States, this influenza is already here. And that means it’s spreading as we speak.”

“I concur,” HHS said. “Short-term, mass vaccination is not an option. Given that, what is our best immediate course of action?”

“The only course of action is to contain it, at least as much as possible,” Carson said. “We fight a delaying action, while we develop an effective vaccine.”

“The girl in Florida died a week ago.” Krewell spoke up. “Summer is vacation time, and people are traveling. It’s reasonable to assume her death has a direct connection to the Fort Walton cases. I have people trying to draw up a contagion chart right now. I can already tell you, this could turn into a nightmare.”

“Explain,” HHS ordered.

“The first death involved a limousine driver,” Krewell said, “a profession that has extensive contact with people who travel. Who gave it to the driver? Okay, we have determined the girl recently returned from a trip to Japan; if she took a limo home, maybe we’ve identified our Patient Zero—the index case, or at least the first carrier we know about. Who else did she infect? Who did the driver give it to, and did any of them get on a plane and fly somewhere else? Nothing has shown up in the WHO Weekly Epidemiological Record, but, believe it—we have to assume that these are not isolated infections.”

“My God.” The voice belonged to an Asian woman, the assistant director of the National Institutes of Health. “The airports. This could be spreading itself around the world already.” She spoke directly to HHS. “The first step is for the President to declare an emergency. We have to inform the public, let them know what they’re facing and what to look for.”

“I’m inclined to agree,” HHS said. “Of course, we would continue to explore all additional avenues. If the President declares a national health emergency, we can—”

“Start a national panic,” said a man Beck did not recognize. “Two cases! That’s all we have confirmed. Let’s at least wait until we get the input from the CDC team in Florida. And before we start a worldwide panic, we better confer with WHO and the National Institute for Medical Research in England.”

“At last, a reasonable suggestion,” the senator said. “We cannot react blindly, just because—”

A shrill electronic chirp cut through the tense atmosphere and silenced the politician. The source came from next to Beck, and for an instant all eyes looked accusingly at him.

Then Krewell fished the cell phone from his pocket and spoke into it. His face stiffened, and when he spoke again it was in low and urgent tones.

Finally he finished and looked at Carson.

“That was Dr. Porter,” Krewell said, and Beck could see the ashen cast that had spread on his features. “He was on his way to the airport when a call was transferred to him. CDC has just been formally contacted by its counterpart in the Russian Federation. They’ve had eighteen people die in the past two days, six in Moscow alone. Some kind of flu, they think.”

28,000 Feet over Central Virginia
July 21

The matter of how Beck found himself aboard the plane that carried Carson back to Washington was not quite clear, least of all to Beck himself. “Ordered” was too strong a word, but “asked” was too cordial to cover it, either. However it happened, it had been some time since Beck had experienced the almost sybaritic pleasure of top-level government travel.

Beck had not changed from the clothes he had worn to Atlanta. The Air Force sergeant who had escorted Beck to his seat had been unruffled, but Beck had caught her quick appraisal of his outfit.

“You from Iowa, Sergeant?” he asked, settling against the pearl gray leather seat back.

“No, sir. Alabama.”

“Should have worn my ‘Roll, Tide’ shirt, then. I save it for formal occasions.”

He was rewarded with a quick, surprised smile before the no-nonsense expression of the professional soldier won out again.

“Yes, sir. I wear one under my Class A uniform, myself.”

At that moment, Carson and Larry Krewell entered the cabin. As the sergeant retreated forward, they took seats
flanking Beck. Both men snapped their seat belts tight before Carson spoke.

“It’s been a while, Beck. Dr. Krewell says you have signed on with us again.”

“It looks that way,” Beck said. “You’d think I’d know better by now, wouldn’t you?”

“Actually, yes,” Carson said. “When you left government service, you didn’t have much good to say about us. Though perhaps I can’t blame you, given the condition you were in.” He examined his fellow traveler with a skeptical eye. “You certainly
look
fit, Beck.”

“Thank you. I eat a lot of roughage.”

“You no longer see the Company’s psychiatrist, I mean.”

“I’ve left the CIA behind me,” Beck said. “Along with everything associated with it.”

“You haven’t missed it?” Carson made an impatient gesture at Beck’s expression. “I don’t mean the fieldwork, necessarily. It was foolish to play the cowboy so often; you had to know it was inevitable that the odds would catch up to you.”

He leaned forward, ignoring how his companion pulled back at the movement. “But the analysis, Beck. The access to so much data, to the secrets that people kill for—
die
for. Taking it, piecing it into a coherent picture. In that, you were quite good indeed. Surely you miss it?”

“Not much. I miss believing that it was worth what was expected in return.”

Carson again studied Beck wordlessly. Then he turned to Krewell. “We meet with the President immediately; there will be a helicopter waiting at Andrews when we land. Brief him, please.”

The craft’s turbines spun up with a vibration that penetrated even the ultraefficient noise insulation of the fuselage. Outside, Beck saw a man in Air Force coveralls, the flashlights in his hands moving as if he were conducting an orchestra. There was only a small lurch when the plane began
to roll. It was a tribute to the skill of the pilot and an acknowledgment of the status of his passengers.

“Here’s the thing, Beck,” Krewell said. “There’s no doubt now, with the Russian outbreak and the new Florida cases, that the President will declare a health emergency. Health and Human Services will be in charge, nominally; I’ve been detached from CDC to serve as liaison, coordinator, whatever. By tomorrow afternoon, we’ll have involvement from every federal office with a doctor on staff, and that’s only the domestic stuff.”

“I know the plan, Larry; I helped draft it. What I don’t know is what you want from me.”

“You wrote the book on riots and disruptions, ol’ buddy,” Krewell said. “With this virus on the loose, there’s a potential for plenty of both. Officially, you’ll be advising the people involved with public safety and security.”

Beck caught the emphasis, and immediately understood. When he spoke, his voice carried a trace of wariness that made Krewell’s lips twitch.

“And what will I be doing,” Beck asked,
“unofficially
?
”

“Oh, hell,” Krewell said. “You’ve been around the block a time or two, boy. I don’t guess it’s a surprise to hear things are worse than you know.”

“The possibility of a killer-flu pandemic isn’t bad enough, Larry?”

“We’ve known about the Russian outbreak for almost two days, Beck. That’s when your name first came up, ol’ buddy. That’s when we started the ball rolling to bring you back inside. Good thing, given the speed this thing’s spreading at.”

Beck’s eyes flickered for an instant at Carson, who sat impassively. Then Beck turned back to Krewell; when he spoke, his voice had a new edge to it, cold and hard.