Jakarta Pandemic, The (76 page)

“So we should all drink wine and be merry in the upcoming days?”

Dr. Pramanik laughs heartily.
“Well, not exactly. Consuming food high in antioxidants is always a good idea, generally, but in the context of this research, the antioxidants administered were in therapeutic doses unachievable by food consumption. If you tried to consume the levels of antioxidants given to these patients, you’d have more problems than the ARDS!” he said, laughing again.

“Well, thank you for your—”

DHHS Press Conference

Early November 2013

The man on the left stepped up to the podium, and adjusted the microphone. The camera zoomed in, capturing only the top of the podium and the man’s upper torso. He had fair skin and receding brown hair. His dark eyes contrasted his face, creating a harsh look, magnified by thin lips, scant eyebrows, and a displeased look. His shirt was light blue and his tie was yellow, balancing the severity of his grimace. He looked like a man who did not want to be behind that podium.

“Good morning, everyone. Good morning. My name is Paul Harding. I am the assistant secretary for public affairs, and to my left is John Merrill, assistant secretary for Public Health and Emergency Preparedness. I know that’s a quite a title. Simply put, he is the number two official at the Department of Health and Human Services and directly reports to the secretary of Health and Human Service for the coordination of all pandemic response activities.

“John has just returned from a White House briefing, where both he and the secretary, and other members of DHHS, briefed White House staff regarding the progression of the Jakarta flu in the U.S., and the status of both state and federal pandemic response activities. John will help me answer your questions and fill in any blanks that I may leave.”

John Merrill was vaguely smiling. He nodded and resumed a solid stance, with his hands folded in front of him. The smile slowly trickled from his face, as he loomed over Paul. He was dressed more conservatively than Paul, in the same dark navy suit, but with a white shirt and dark blue tie. Alex suspected he was there to keep the public affairs secretary from descending too deeply into the cauldron of questions brewing in the audience.

“So to start, I would like to give you our assessment of the Jakarta flu’s progression and then outline what we are doing to address the pandemic threat. Before that, very briefly, I would like to reinforce the fact that the Centers for Disease Control and Prevention is an arm of the Department of Health and Human Services, and that the CDC is directly aligned with our pandemic response actions. This is important to mention because we are well aware of the impression that there is a strained relationship between the CDC and DHHS. That the CDC is a rogue agency. Nothing could be further from the truth. The CDC serves a vital role with our department and for years has operated with near complete autonomy, as long as they came close to working within their budget.”

Paul Harding suppressed a nervous laugh. This comment elicited a few muffled laughs from the crowd, but it was clear that nobody in the room was really in the mood for humor.

“We are working closely with the CDC to ensure that their research and projections keep our pandemic response efforts one step ahead of the Jakarta flu. In addition to this, I am also proud to include the ISPAC as a contributing asset to our efforts. Their director has committed all of their resources to the CDC and Department of Health and Human Services, significantly augmenting our pandemic analysis and research capability.

“With that said, let’s move on to what’s happening in the U.S. First, as of 5 minutes ago, DHHS has identified 4,418 confirmed cases of H16N1 within the continental United States, and there have been approximately 137 deaths since the first cases appeared Friday night. The cases appeared nearly simultaneously in most major cities on either Friday night or Saturday morning. San Francisco, Los Angeles, San Diego, Chicago, New York, Miami and Boston appear to have a 12-24 hour head start over other major cities, which accounts for the higher case counts in these cities. New York City currently accounts for 645 of these cases and over 30 deaths. All of this data is now available real-time on the DHHS website, at dhhs.pandemictrack.org.

"This data is provided by a nationwide network activated last Wednesday. The information flows from the state level to DHHS, and all medical offices, hospitals and institutions are aware of their reporting responsibilities. Additionally, we have established real-time electronic connectivity with all major domestic healthcare institutions and public health departments across the U.S. to obtain pandemic flu and resource availability information. So far, nearly 97% of the confirmed reports have originated from hospitals. By now, all hospitals have H16N1 confirmation kits and the capability to duplicate kits for distribution to local health providers. We anticipate the number of reported cases to increase rapidly over the next seven days, possibly doubling or tripling, with many reports originating outside of the hospitals.”

“Triple? How did you figure that? Can we ask questions?”

The first few impromptu questions triggered a simultaneous barrage of inquiry, spanning topics well beyond those already discussed. Paul handled the outburst professionally, backing away from the podium for a few seconds and whispering to John. Paul remained back from the podium and clasped both hands at hip level, assuming a relaxed stance. A noncommittal smile formed on his face as he waited. His disengagement from the group had an immediate effect, as most of the reporters realized that their outburst had brought the press conference to a screeching halt.
Nicely done.
When the room was mostly quiet, and only a few of the most clueless or stubborn reporters continued to press their questions, Paul stepped back to the podium.

“Thank you. I promise I will be done shortly, and you will have ample time to ask questions. I have a few more items to cover. In a pandemic, three major strategies are employed to contain outbreaks. One of these may not be available to us for several months. Until last week, the world scientific community was unaware of the H16N1 strain, so consequently, vaccine research on this novel flu strain has only just begun. Based on pharmaceutical industry estimates, it will likely take 3-6 months to develop an effective vaccine. Then another few months to produce and distribute the vaccine in sufficient quantities to impact containment efforts. Unlike the avian flu pandemic of 2008, vaccination will not contribute early containment efforts.

“However, we still have two major strategies to combat the spread of the pandemic, which we firmly believe can effectively and significantly slow the spread of the Jakarta flu. Actually two tactics. The first is the effective distribution and utilization of antivirals held in the Strategic National Stockpile. Currently, the stockpile can treat 15% of the population and will be used in accordance with national prioritization guidelines, in an attempt to arrest outbreaks and treat critical infrastructure personnel such as medical providers, first responders, police, and military. We will be suspending the distribution of antivirals to high risk populations, such as the elderly or very young. At this point, we do not possess enough doses to execute tier three distribution.”

“The next tactic is public education, which is being implemented as we speak. DHHS is preparing to embark on an aggressive public education campaign, consisting of television advertisements, direct mailings, educational materials distributable at medical offices, internet resources, telephone information, MP3 downloads, YouTube, and educational interviews on all major media programs. Every angle imaginable. This campaign should kick off by early next week.”

“MP-fucking-3 players? Did we travel back in time? Why don’t they put it on iShare, too? Then all the teenagers can download cool Health and Human Services music videos and share them with their friends. Un-fucking-real,” Alex yelled at the screen. “These idiots should just announce right now to close all schools and that each family should isolate themselves for a few weeks. If they did that, this whole pandemic would falter within the span of a month. This just isn’t aggressive enough, but then what do you expect from D.C.,” he said, his angry voice at a more reasonable volume.

“Maybe you should be in charge,” Kate quipped.

“So right now, we are concentrating on enhanced domestic surveillance, which incorporates real-time virus tracking…launching our educational campaign, and proactively distributing the anti-viral stockpile ahead of the virus. At this point, I would like to open the floor for questions.”

He pointed to a middle-aged man in dark brown pants and a light blue oxford shirt.

“Thank you. David Reeves, CBC World News. Can you tell us how the Jakarta flu penetrated our domestic protection barrier? From what I understood, your department was quite confident that the flu would not significantly breach our borders.”

“Fair enough question. Early last week, as the situation in China escalated, we began to seriously consider the possibility of another pandemic-grade virus spreading to the U.S. As early as Tuesday, DHHS implemented surveillance and control measures at points-of-entry, to decrease the introduction and spread of the virus in the U.S. This consisted of the isolation of suspected cases, quarantine of contacts, antiviral treatment and prophylaxis, and tracing of contacts into the community near points-of-entry. These measures remain in place today and will continue to remain in place indefinitely.

“However, due to the unique nature of this virus, with a longer than usual asymptomatic period, many infected travelers likely evaded detection. Additionally, tracking these travelers and their contacts within the U.S. proved to be difficult at best, even with an augmented investigative force.”

John Merrill stepped forward and pulled the microphone toward his face.

“Another problem arose from the fact that the outbreak in Jakarta had been brewing for at least several days, if not two weeks, before our measures were activated. Many of the cases that have been catalogued in the hospitals may likely stem from earlier contact with infected travelers, leaving many thousands of asymptomatic cases still undiscovered. This is one of the primary reasons that the CDC suspects the number of cases will likely triple by the end of the week.”

“Thank you, John,”
Paul said and pointed to another reporter.

“Gavin Prescott, LA Times. What steps are being taken by your department to increase surge capability at major hospitals and within communities. From what I understand, a few of the hospitals within the L.A. area are approaching their surge limit for treatment of the Jakarta flu.”

“I think you are referring to Pacific Hospital in Long Beach. Keep in mind that this is a relatively small hospital that only recently began offering in-patient services, like ICU stabilization. They rapidly reached their limit with patients from an outbreak in Compton, however, we understand that within the course of the next few weeks, our nation’s hospital system will face a serious challenge.

“DHHS has activated the Strategic National Stockpile program, which will immediately deliver stockpiled ventilators, pharmaceuticals, and other medical material needed to stabilize and treat infected individuals. The first shipments will be sent to the states that are the hardest hit. California, New York, Massachusetts and Illinois. DHHS will continue to monitor the National Disease Outbreak Surveillance Network and automatically activate a 12-Hour Push Package for any state that requires augmentation of their surge capacity. Our decision to deploy these packages weighs available capacity versus anticipated surge of infected individuals and is completely objective.

“This is completely separate from the shipment of antivirals from the stockpile. Antiviral shipments are already in progress to all of the states.

“We also have the capability to deploy Federal Medical Stations, which can provide stand-alone surge capacity. These will be reserved for the worst hit areas.

“Finally, we are encouraging all states to implement their plans to handle hospital overflow by creating secondary sites to treat infected individuals.”

Paul motioned to a reporter standing near the back of the room.

“Thank you, Shalen McAbee, FBC. You mentioned nearly 30 deaths in the New York area alone. Will you comment on the situation surrounding those deaths?”

“You mean what caused them?”
Paul asked.

The room broke into a brief period of laughter.

“I suppose that’s a more direct way of putting it,”
Shalen responded, grinning.

“Most of the deaths are due to acute respiratory distress syndrome, and we have a few due to heart attack or yet undetermined causes.”

“Is this the same nationwide?”
Shalen added.

“Yes, very similar. ARDS is responsible for at least 90% of the 181 deaths directly attributed to the Jakarta flu. The remaining 10% are all acute events, like heart attack, fatal hypoglycemia, or immediate lung failure due to preexisting lung disease. Most of the ARDS-related fatalities occurred within 24-48 hours of showing symptoms, some as quick as 8-12. Almost all within a hospital setting, though we have reports of deaths occurring within the communities, prior to individuals seeking medical care. This is why it is imperative that individuals with flu-like symptoms seek immediate care from their physician or closest hospital.”

“Do you have any data regarding survival rates for ARDS caused by the Jakarta flu?”