Jakarta Pandemic, The (72 page)

“Matt, I hope I didn’t run Dr. Gustafson out of town, so to say. He is a very brilliant doctor and scientist, but I gather the sense that his common sense and true opinions are being held hostage by the overwhelming and overreaching bureaucracy of the WHO and its parent organization, the United Nations. Where do we go from here? Well, our organization is minute compared to the WHO and is mostly an investigative and research body.

“Our main objective is to learn as much as possible about this new virus. We know it’s highly contagious, or transmittable. We know it’s highly pathogenic, meaning that if you are exposed to it, you are very likely to get sick from it. What I’d like to know is H16’s behavioral timeline once a patient is infected. A behavioral map. This is important. How long does a patient remain asymptomatic, no detectable symptoms? How long after infection does it take for the patient to start shedding the virus, or spreading it? How many days does a patient shed the virus, while showing no symptoms? This is especially critical, since this is when a patient is likely to spread the flu most. When they have no idea they’re carrying the flu, and neither does anyone else. Business as usual. Other things I want to know is the average ratio of new cases caused by a single case. This is hard to determine, but very useful when projecting disease transmission.

“Then, we want to know about the symptoms, especially the progression of symptoms. Is there an immediate risk of death like that seen in the 1918 Spanish flu and seen in very limited numbers in 2008? How long typically until pulmonary complications arise? Everything, Matt. The more we know, the more we can predict and help direct national and international strategy. Once this data is available, we can establish clinical attack rates and case fatality rates, god forbid.”

“How far away are you from establishing this behavioral timeline?” Matt asked.

“I am pretty sure we have a rough timeline now, but it is very rough. We’ve only been in the field observing and testing infected patients for a few days. Ideally, you would want to observe a patient that was presumably healthy, came in contact with an infected individual, then contracted the virus. The earlier we start observation and treatment, the better. We have plenty of those now, but the majority of our cases have been sick for close to a week, especially those from Indonesia. At first we rely exclusively upon anecdotal information to establish a patient’s timeline, then as more patient data is available, we can more accurately establish the timeline. Sorry if I sound like I am dodging the question, Matt, I believe a rough timeline will be available shortly, possibly in the upcoming press release.”

“Thank you, Dr. Ocampo, for our viewers, we’ve just been informed that this information update will occur at 9 a.m. Eastern Standard Time, and we will certainly cover this release, live on this channel. Dr. Ocampo, before you get back to work in Atlanta, do you have any recommendations for our viewers? Something they can do right now to help prepare and protect their families from the possibility of a deadly pandemic.”

“Sure, Matt, but let me make one thing as clear as possible. This new virus is not a possibility, it is a reality. H16 will spread around the globe like any other pandemic. I truly believe that containment is no longer a viable option, unless an immediate, massive effort is undertaken by the WHO, with the cooperation of every nation on the planet. Unfortunately, I can’t imagine a scenario in which the WHO can get its resources out of China quick enough to lead this effort. With this being said, individual families can log on to our website and obtain pandemic preparedness checklists, or call our toll-free number and this list will be read by an automated system. The best way to safeguard your family is to execute as many items on those checklists as possible, starting from the top of the checklists. The more important items and tasks are listed first.”

“Can you give our viewers more specific advice?”

“Sure, just remember that the lists are detailed, but if you start at the top, you’ll hit the most important items. As for specific advice, in a nutshell I would recommend that you buy as much nonperishable food and water as possible, avoid contact with others, practice the personal protective measures, PPMs, identified on the lists, and make sure you have a way to stay warm, especially with winter descending. There is just no predicting the extent that the pandemic may affect essential services, so you should try to arrange for temporary, or if possible, permanent sources of heat and electricity. Also, buy a hand-cranked radio, so you can receive local broadcasts that may contain important information. I can’t stress enough how important it is to maintain social distancing. This will cause an uncomfortable feeling of isolation, but it is the single most effective way to avoid the pandemic flu. That’s the quick version, Matt, once again, I urge everyone to visit our website or call our toll-free number, which I am being told right now is displayed at the bottom of your screen.”

“One last thing before you leave. Have you heard any talk about research into a vaccine for H16?”

“Matt, everyone is talking about it. I can guarantee everyone that the issue of a vaccine is a top priority. I’d be surprised if work on the vaccine has not already begun.”

“Will your organization be involved with the vaccine research?” Matt asked.

“Not directly. This will be a coordinated effort between the bio-pharmaceutical industry, DHHS and the CDC. Most of the top research and development will occur in the private sector.”

“Thank you very much, Dr. Ocampo. Best of luck to you and your teams, and we extend our prayers and hopes for the team in Indonesia.”

Joint CDC and ISPAC Press Conference

Early November 2013

Alex was sitting by himself on the brown leather love seat in their family room, waiting for the live broadcast of the ISPAC information update. The
Morning View
had cut away to a live picture in a large conference room with stadium seating. The camera was focused on a podium to the left of a large, wall-mounted screen. The picture on the screen featured both ISPAC and CDC logos, side by side. Another podium flanked the screen on the right side. The setup reminded Alex of the Iraq War briefings he’d watched when he returned from the war.
Rumsfeld and all of his pentagon lackeys just bullshitting their way across every living room in America.
The information at the bottom of the screen told Alex that the broadcast was “Live from CDC Headquarters in Atlanta, Georgia.”

A man and woman, both dressed in business attire, walked to the middle of the stage, shook hands and then separated, taking positions behind opposing podiums. To Alex, it almost looked like the start of a debate. Alex recognized Dr. Allison Devreaux, of the ISPAC, as she settled in behind the left podium.

“Ladies and gentlemen, thank you for your attendance. We have a lot to cover, but before we start, I would like to introduce Dr. Joshua Relstein from the CDC, who has an exciting announcement. Joshua.”

“Thank you, Allison. I am proud to announce that the CDC and ISPAC are formally joining forces to coordinate pandemic efforts abroad and, most importantly, here at home in the U.S. This strategic partnership, formed in time of crisis, will focus the world’s best scientific resources against the growing pandemic threat. We have received a similar pledge from the European Union’s European Centre for Disease Prevention and Control (ECDC), which occupies a similar role for the EU, as the CDC does for the United States. We welcome their cooperation with open arms. Thank you, Allison.”

The screen changed to a world map, showing red triangles all over East Asia and the western Pacific Rim. Dr. Devreaux adjusted her microphone.

“This unified front is critical in the fight against a very rapidly spreading pandemic virus. As you can see on the screen, as of this morning, CDC, ISPAC and ECDC field teams have confirmed H16 cases in over 85 locations mainly spread throughout the Western Pacific and Southeast Asia. Cases have been confirmed as far away as Cairo, Pakistan, and India. U.K. health officials confirmed that the suspect passengers caught yesterday were indeed sick with H16. Cases of interest, CIs, are being reported from several major European, Middle Eastern, and African cities. Currently no CIs have developed in the Americas. We have prioritized and are responding to each of the reported CIs. Additionally, the CDC, in conjunction with Roche pharmaceuticals, has developed simple H16 detection kits for local hospitals around the world. Soon, our teams will not have to evaluate every CI in order to confirm H16.

“Every hospital and clinic worldwide will have the capability to isolate and identify the H16 virus, just like they can identify any of the previously known disease and virus types. Until just yesterday, the world had never seen H16, so not even the most sophisticated medical centers could have confirmed the cases without these kits. H16 is now in the world library of identifiable microorganisms. These kits are being sent everywhere, via the fastest delivery available, just as soon as they roll off the production line.”

“My colleague, Dr. Relstein, will explain what we now know about the H16 subtype.”

“First, we now know that the strain of the H16 subtype causing the outbreak throughout Asia is N1. So the influenza strain is classified at H16N1. We have confirmed through observation and genetic matching that H16N1 is highly pathogenic. Four to five times more pathogenic than the avian flu of 2008. H16N1 is even projected to surpass the Spanish flu of 1918 in terms of pathogenicity, or its ability to produce an infectious disease in another organism, though it is way too early to establish an accurate predictive model. H16N1 is trending in that direction, however, and this greatly concerns our organization.

“H16N1 is highly efficient at human-to-human transfer. Once again, more so than the avian flu. We will catch no break here. It can survive for 24 to 48 hours on non-porous surfaces and up from 16 hours on porous surfaces, which is slightly longer than most influenza strains. It can be transmitted by any bodily secretions, aerosol or liquid of any consistency. Personal protection measures will be critical to blunting the spread of this virus, combined with effective social distancing measures.

“As for a behavioral timeline, we have some rough calculations. These are based on the CDC’s observations in China and ongoing observations by ISPAC teams throughout the Pacific rim. From initial exposure and infection to H16N1, a patient can remain asymptomatic for 3-5 days. This data is rough, but trending toward 4-5 days. These are the hardest data points to establish. Either way, this is much longer than the avian flu or the Spanish flu and presents a number of challenges. The biggest challenge being that a sick patient will interact with the public longer before it becomes obvious that they are sick. Asymptomatic patients will have more time to spread the disease. Asymptomatic patients start shedding the disease after just one day of initial infection, leaving a possible period of 2-4 days where the patient is contagious with no symptoms. Shedding means that the disease is now leaving the infected body by any of a several routes, where it can now infect another body.

“Once symptoms start, the patient will continue shedding at a high level for another 5-7 days, even when initial flu symptoms have subsided. Patients will likely remain contagious for 11 days from first infection. This is our best estimate for now.

“Symptoms for H16N1 are typical of a pandemic influenza virus, or even a rough seasonal virus strain. Sudden onset of high fever, headaches, body aches, severe congestion, cough, extreme fatigue, and in the case of children, possible severe vomiting and diarrhea. Symptom severity varies by patient. Frequent instances of severe respiratory illness, such as pneumonia, acute respiratory distress, and viral pneumonia have developed following several days of the original flu symptoms. Respiratory illnesses have developed as early as 2 days after symptoms and as late as 8 days. We don’t have many cases spanning back further than 8-10 days. Most of these patients were observed in China.

“I know you are all very concerned about the potential lethality of the H16N1 virus. Right now, we do not have enough data to project a case fatality rate. With that being said, a low number of patients inside and outside of China have died from H16N1, mostly from severe respiratory complications. Some have died from sudden and massive respiratory failure, within 1-3 days of symptom onset. These deaths resemble scientific reports described during the Spanish flu of 1918, when apparently healthy, young adults would show sudden respiratory symptoms and die within the same day. Today we call this a cytokine storm or more formally, ARDS, acute respiratory distress syndrome. A massive immune reaction to the invading virus, which triggers a deadly and often irreversible, inflammatory response within the lung tissue.

“This is where we stand today. Our scientists are continuing an aggressive research program aimed at learning as much about the virus’s behavior and characteristics as possible. At this point, we would like to open the floor to any questions you may have. Yes.”

He pointed to a young black man dressed in a pair of dark brown chino pants, white dress shirt without a tie, and blue blazer.

“Thank you, Jeff Saunders, Associated Press. Do either of you have an estimated number of total cases worldwide?”

“I spent some time this morning with CDC epidemiologists, who closely monitor all of the data pouring out of Asia from all sources, the ISPAC, GeoSentinel, GOARN, the WHO and more. I thought our own organization was doing the best job evaluating this data, however, even our own Dr. Ocampo approached me this morning to say that he was, I quote, ‘blown away.’ So, after merging our numbers with the CDC, we can safely estimate that there are roughly 1,700 confirmed cases spread throughout the Pacific rim, outside of China. Unconfirmed but probable cases, based on CI reporting, GeoSentinel, and GOARN likely exceed 25,000. The numbers are still a bit sketchy from China, but the CDC estimates the total number of cases to be more than 60,000 and growing rapidly. So we are looking at roughly 85,000 cases of confirmed or soon to be confirmed H16N1. Next question. Go ahead.”