'Come in.'
One look at the conference room convinced Altman to lower the shades with his own hands. The windows faced a street of anonymous brick houses. A few of the doctors looked on with annoyance, but they knew who he was and didn't object.
'Calling the meeting to order,' Dave James said, before everyone was seated. 'Alex has something important to tell us.'
There was no preamble: 'We have five Ebola cases in Ross right now. They all came in today.'
Heads turned sharply. Cathy blinked at her seat at the end of the table.
'Students from someplace?' the surgery director asked. 'Zaire?'
'One auto dealer and his wife, a boat salesman from Annapolis, three more people. Answering your question, no. No international travel at all. Four of the five are fully symptomatic. The auto dealer's wife shows antibodies, but no symptoms as yet. That's the good news. Our case wasn't the first. CDC has cases reported in Chicago, Philadelphia, New York, Boston, and Dallas. That's as of an hour ago. Total reported cases is twenty, and that' number doubled between ten and eleven. Probably still going up.'
'Jesus Christ,' the director of medicine whispered.
'You all know what I did before I got here. Right now I imagine they're having a staff meeting at Fort Detrick. The conclusion from that meeting will be that this is not an accidental outbreak. Somebody has initiated a biological-warfare campaign against our country.'
Nobody objected to Alexandre's analysis, Cathy saw. She knew why. The other physicians in the room were so bright that sometimes she wondered if she belonged on the same faculty with them—she had never considered that most of them might harbor the same thoughts. All of them were world experts in their fields, at least four the very best there was. But all of them also spent time as she did, having lunch with a colleague in a different field to exchange information, because, like her, they were all truly fanatical about learning. They all wanted to know everything, and even though they knew that such a thing was impossible, even within one professional field, that didn't stop them from trying. In this case, the suddenly rigid faces concealed the same analytical process.
Ebola was an infectious disease, and such diseases started from a single place. There was always a first victim, called Patient Zero or the Index Case, and it spread from there. No disease just exploded in this way. CDC and USAMRIID, which had to make that conclusion official, would have the duty to assemble, organize, and present information in what was almost a legalistic structure to prove their case. For their medical institution, it was simpler, all the more so because Alex had commanded one of the divisions at Fort Detrick. Moreover, since there was a plan for everything, Johns Hopkins was one of the institutions tapped to receive cases in the event something like this took place.
'Alex,' the director of urology said, 'the literature says that Ebola is only spread by large particles of liquid. How could it explode so fast, even at the local level?'
'There's a sub-strain called Mayinga. It's named for a nurse who picked it up and died. The method of her infection was never determined. A colleague of mine, George Westphal, died of the same thing in 1990. We never determined the means of transmission in his case, either. There is thought that this sub-strain may spread by aerosol. It's never been proven one way or the other,' Alex explained. 'Besides, there are ways to fortify a virus, as you know. You admit some cancer genes into the structure.'
'And there's no treatment, nothing experimental even?' Urology asked.
'Rousseau is doing some interesting work at Pasteur, but so far he hasn't produced any positive results.'
A physical reaction, ripped down the conference table from one physician to another. They were among the best in the world, and they knew it. They also knew now that it didn't matter against this enemy.
'How about a vaccine?' Medicine asked. 'That shouldn't be too hard.'
'USAMRIID has been playing with that for about ten years. The first issue is that there seems to be a specificity problem. What works for one sub-strain may not always work with another. Also, the quality-control issue is a killer. Studies I've seen predict a two-percent infection rate from the vaccine itself. Merck thinks they can do better, but trials take time to run.'
'Ouch,' Surgery commented with a wince. Giving one person out of fifty a disease with an eighty-percent mortality rate—twenty thousand people infected per million doses, of whom roughly sixteen thousand might die from it. Applied to the population of the United States, it could mean three million deaths from an attempt to safeguard the population. 'Hobson's choice.'
'But it's too early to determine the extent of the national epidemic, and we do not have hard data on the ability of the disease to spread in existing environmental conditions,' Urology thought. 'So we really aren't sure what measures need to be taken yet.'
'Correct.' At least it was easy to explain things to these people.
'My people will see it first,' Emergency said. 'I have to get them warned. We can't risk losing our people unnecessarily.'
'Who tells Jack?' Cathy wondered aloud. 'He's got to know, and he's got to know fast.'
'Well, that's the job of USAMRIID and the Surgeon General.'
'They're not ready to make the call yet. You just said that,' Cathy replied. 'You're sure about this?'
'Yes.'
SURGEON turned to Roy Altman: 'Get my helicopter up here stat.'
49 REACTION TIME
COLONEL GOODMAN WAS surprised by the call. He was having a late lunch after a check-flight for a spare VH-60 just out of the maintenance shop for engine replacement. The one he used for SURGEON was on the ramp. The three-man crew walked out to it and spooled up the engines, not knowing why the schedule for the day had changed. Ten minutes after the call, he was airborne and heading northeast. Twenty minutes after that, he was circling the landing pad. Well, there was SURGEON, with SANDBOX by her side, and the Secret Service squad… and one other he didn't know, wearing a white coat. The colonel checked the wind and began his descent.
The faculty meeting had gone on until five minutes before. Decisions had to be made. Two complete medical floors would be cleared and tooled up for possible Ebola arrivals. The director of emergency medicine was even now assembling his staff for a lecture. Two of Alexandre's people were on the phone to Atlanta, getting updates on the total number of known cases, and announcing that Hopkins had activated its emergency plan for this contingency. It meant that Alex hadn't been able to go to his office and change clothes. Cathy was wearing her lab coat, too, but in her case it was over a normal dress. He'd been wearing greens—his third set of the day—for the meeting, and still was. Cathy told him not to worry about it. They had to wait for the rotor to stop before the Secret Service allowed their protectees to board the aircraft. Alex noted the presence of a backup chopper, circling a mile away, and a third circling closer in. It looked like a police bird, probably for security, he imagined.
Everyone was bundled aboard. Katie—he'd never met her before—got the jump seat behind the pilots, supposedly the safest place on the aircraft. Alexandre hadn't ridden in a Black Hawk in years. The four-point safety belt still worked, though. Cathy snapped hers right in place. Little Katie had to be helped, but she loved her helmet, painted pink, with a bunny on it, doubtless some Marine's idea. Seconds later the rotor started turning.
'This is going a little fast,' Alex said over the intercom. 'You really think we should wait?'
Cathy replied, keying her microphone. 'No.' And it wouldn't do to say that he wasn't dressed for seeing the President. The aircraft lifted off, climbed about three hundred feet, and turned south.
'Colonel?' Cathy said to the pilot in the right-front seat.
'Yes, ma'am.'
'Make it fast,' she ordered. Goodman had never heard SURGEON talk like a surgeon before. It was a voice of command that any Marine would recognize. He dropped the nose and brought the Black Hawk to 160 knots.
'You in a hurry, Colonel?' the backup chopper called.
'The lady is. Bravo routing, direct approach.' Next he called to BWI Airport to tell the controllers to hold arrivals and departures until he'd passed overhead. It wouldn't take long. Nobody on the ground really noticed, but two USAir 737s had to go around once, to the annoyance of their passengers. Watching from the jump seat, SANDBOX thought it was pretty neat.
