‘I’m sorry?’
‘Cholera is treatable with a number of antibiotics in the normal course of events… but, as yet, we don’t know what we’re dealing with here. The bug might have been… altered in some way.’
‘Genetic engineering,’ murmured the hospital’s medical superintendent.
‘With a terrorist attack, I’m afraid that is a possibility. We’ll have to wait for a full lab report. Our labs are not used to dealing with cholera. We’ve sent samples off to Colindale for analysis. It might take a day or two before we know exactly what we’re dealing with. In the meantime we have to concentrate on isolating the cases we have and rehydrating them. Nursing care is the thing that’s going to save people. We’ll also be giving broad-spectrum drugs and hoping for the best.’
‘As instructed, we’re keeping the cordon we threw round the infected flats in place,’ said the chief constable. ‘It’s very upsetting for friends and relatives but, as I understand it, containment of the disease is all- important.’
‘It is.’
‘The thing is, not everyone living in the flats has been infected
… My men tell me there are some perfectly healthy people there who are asking to leave, and you can see their point. It’s not very pleasant being stuck in the middle of an epidemic.’
‘I don’t think we can allow it,’ said Alice Spiers. ‘Not yet, not until we get the lab reports and know exactly what’s going on. The fact that they’ve been living in the same building makes them suspect. They may be healthy but they could be harbouring the disease — they could even be carriers without knowing it.’
‘But maybe they’ll contract the disease just by being there,’ suggested the chief exec.
Alice Spiers conceded the point with a grimace. ‘That’s the downside,’ she admitted. ‘Ideally all the sick people should be in hospital, in isolation units being attended to by skilled nurses, but we don’t have the capacity to deal with a full-scale epidemic. We have to do the best we can, and that means isolating and containing cases wherever they occur.’
‘Doctors’ surgeries and the NHS 24 phone lines are being overwhelmed by people thinking they’ve been infected. They have to go to the loo and start thinking the worst,’ said Lynn James.
‘I suppose we can’t blame them. It’s a frightening situation,’ said the chief exec. ‘What about the safety of the medical and nursing staff dealing with the patients?’
‘Our travel clinics had limited stocks of cholera vaccine: we’ve used that for front-line people. It’s all gone now and I don’t know when we’re going to get more. I think it’s fair to say that demand exceeds supply right now, but I’m sure the government will be dealing with that.’
‘Our immediate problem is a second wave of cases,’ said Alice Spiers. ‘There are bound to be people who were at the flats during the day of the attack on the water supply but didn’t stay there. If any of them were infected before they left they’ll be falling ill and passing on the infection to friends and family. Our teams are waiting to act to isolate and contain.’
‘The trouble will be telling the genuine cases from the calls we’re getting from people who just think they’re ill,’ said Lynn James.
‘Operator common sense is going to be paramount,’ said Alice Spiers. ‘There’s a world of difference between having cholera and thinking you might be sick. The degree of concern in the relative’s voice should be the benchmark.’
‘Something tells me things are going to get worse before they get better,’ said the chief constable. ‘What a mess.’
‘Well, it’s our mess, ladies and gentlemen,’ said the chief exec. ‘I suggest we get on with it.’
TWENTY-FOUR
‘Well, now we know; the intelligence regarding a biological attack on our country has proved correct and we’ve been hit with cholera.’ The Prime Minister was addressing the second meeting of COBRA in as many days. ‘Four of our cities have been affected but we cannot dismiss the possibility that there may be more attacks. All the initial strikes were carried out on blocks of flats so the residents in those flats were the first to become infected, but we’re now getting reports of cholera among the wider community in the four cities.’
‘But with the same source being implicated,’ interjected the health secretary. ‘So far, they’ve all been people with some association with the flats — visitors, tradesmen, delivery men, a social worker in Manchester, a community nurse in Liverpool.’
‘Has anyone claimed responsibility?’ asked Steven.
‘An Islamic fundamentalist group calling themselves Sons of the Afghan Martyrs.’
‘Known?’
‘No one’s ever heard of them.’
‘Do we have any more information about the strain of cholera?’
‘Nothing back from the lab yet.’
‘So we don’t know if it’s a genetically engineered variant.’
‘Please God, not,’ said the Home Secretary.
The Metropolitan Police commander asked the question that all the non-medical people present wanted to ask. ‘Supposing it has been tampered with, what sort of things could we expect?’
‘Resistance to antibiotics so we couldn’t treat it,’ said the consultant microbiologist with the Department of Health contingent. ‘Increased potency of the enterotoxin the bug produces, making it even more lethal.
‘What’s an entero…?’
‘Enterotoxin. It’s a poison produced by the bug which attacks the lining of the small bowel, leading to huge fluid loss. That in turn leads to severe shock and then death.’
‘Supposing it has been tampered with in the way you suggest,’ continued the Met commander. ‘Does that mean that everyone who contracts the disease will die?’
‘The fact that we couldn’t treat it with antibiotics would be a setback, but it’s not the be all and end all. It’s the dehydration — the fluid loss — that kills. Replacing lost fluid in time can save lives.’
‘So victims should be encouraged to drink,’ said a self-satisfied-looking junior Home Office minister, as if completing the final entry in a crossword puzzle.
The microbiologist smiled. ‘If only it were that simple. People with cholera are usually too ill to drink. Fluid loss has to be replaced through intravenous drip.’
‘And that needs health professionals,’ said the Home Secretary slowly, as if the implications of that were dawning on her as she said it. ‘Which is just not possible. Why am I getting an image of people dying all over our cities, lying in pools of their own excreta?’
‘That’s a worst-case scenario, Home Secretary.’
‘Which we will do everything in our power to avoid,’ said the Prime Minister. ‘If we go down, we’ll go down fighting, so let’s not have any more negativity. We must agree a plan of action. First, medical.’
The new health secretary, a little out of his depth after only a few weeks in the job, deferred to his colleague, Norman Travis, who said, ‘We continue to isolate and contain outbreaks where they occur. We’ll use wide-spectrum antibiotics until any contraindications appear, and prime consideration will be given to replacing fluid loss in all cases. The wider population is to be given cholera vaccine.’
‘Is there enough?’ asked Steven.
‘Merryman hasn’t had much of a chance to come on stream,’ said Travis, ‘and frankly, cholera wasn’t really considered as a favourite for biological attack, but things aren’t looking too bad. Travel clinics across the country have limited stocks for immediate use but perhaps the best news is that one of our pharmaceutical companies, Lark Pharmaceuticals, which supplies cholera vaccine to the Third World, has substantial stocks which can be diverted for home use and used to vaccinate our most vulnerable citizens. In the meantime, Merryman will be working flat out and hopefully they’ll come up with new stocks in time to vaccinate the rest of the population. A baptism of fire for them, but I’m sure they’ll rise to the challenge.’
‘What about distribution?’ asked the Prime Minister.
‘We’re not going to go down the doctors’ surgeries route as we did with swine flu. That was a bit of a
