Word Count: 13,996
Description: The CDC contemplates serious action, and the President makes a critical decision. Princeton-Plainsboro finds itself battling for resources to stay afloat.
Author's Note: Why was this chapter so long to write TT. Mostly setting up the grand stage for future maneuverings, so unfortunately, you won't see as much of PPTH here except some token scenes with House, Wilson, and the ducklings. Not to worry, H/W shippers will find much more to chew on in the next chapter (which is again, extremely freaking long O as I attempt to bring in more 24 people).
"We have an epidemic."
The words resounded somberly in the large meeting room.
"Orlando's already crippled, Princeton's well on its way to a city-wide quarantine. Preliminary estimates put it at about two hundred people affected, with another thirty within the initial contagion zone. NIH, USAMRIID, Health and Human Services are all working to pinpoint the source of the infection. We've got an influenza expert cross-matching strains from our database."
Ellsworth looked around at the team of scientists gathered hastily in the CDC command center at Atlanta. Specialists, all of them. Maria Schlessinger from quarantine logistics and control, an accomplished statistician with five years experience handling tough cases just like these in the national arena. Gerald Watson, their public relations officer, who did so much more with his political and journalistic contacts than any PR agency out there. Elizabeth Lansing, current EIS field coordinator, monitoring the situation in their two hot zones along with behaviorist, Ron Marshall. And, of course, Tom Roskin, who had an uncharacteristically vindicated look on his face, because for once, the wolf did appear after all.
The only person missing then was…
"Where's Wu in all of this?" Maria asked with a frown.
"Dr. Wu is currently en route from Nigeria with several epidemiologists to survey the situation. Should be arriving in about 0600 hours." John Wu was the CDC's head epidemiologist, and one of their best men in the field. He'd recently gone to Africa to track down an outbreak of Marburg virus somewhere near the south. Sam flipped open the folder of transmission statistics, skimming it for results. "Right now, we've got four fully trained EIS ground teams at each major location, headed by Dr. Lansing here and our state department liaison." Who had, up till now, done little more than throw up bureaucratic roadblocks in their way, Ellsworth added silently. "They have updates on the index case situation."
He nodded at them to report.
"We're pretty much positive by now that the initial spread began with a boy named Michael Falburg, aged sixteen, Caucasian, middle class." With a precise voice, Lansing read off the patient description as the projector threw a photograph up on the screen. "Fell ill on October 27th, was admitted to Princeton-Plainsboro Teaching Hospital, treated for blastomycosis and minor lung infection, then released. Two days later, re-admitted with severe ARDS, dying shortly in the ER." Another picture flipped up, this time a flow chart of the event proceedings with arrows indicating where each led from cause to effect. Her colleague from the state department pulled out a number of color-coded documents.
"Form 2210B here details some of the procedures performed by the medical team," he said with typical bureaucratic fervor – which was to say, a voice capable of putting a Chihuahua to sleep, "although it doesn't account for later state health measures in accordance with policy 37C of the…"
"How many people did the patient come into contact with?" Ellsworth broke in, before they all fell into a permanent coma.
"Well, we can't be sure at this point – the transmission scope is highly variable, and there's over twenty hospital members alone who could have passed within range after the initial onset," Lansing replied.
"Give me an estimate."
"That…" Her eyebrows drew together thinly above her smartly perched glasses. "Approximately seven percent of the current staff. Since his case was difficult to diagnose, Princeton-Plainsboro assigned him to a specialized department for treatment, but his re-admittance saw him brought to the general emergency room as well." She turned over the latest status report in the manila folder before her, seemingly troubled by a particular notation at the bottom of the paragraph. "We're fairly sure there's no further outside connection. However, it may be possible that one of the staff members who treated him crossed state borders after contact was made…"
Papers rustled around the room amid worried murmuring. Interstate affairs. A bad omen for any containment strategy. They couldn't be sure if this person was a carrier, was even infected in fact, but the stakes were too high to gamble any other way. Ellsworth peered closer at the name penciled in beneath the report's dense text.
…Department of Diagnostics head, Dr. Gregory House, requested leave of absence three days following patient admission for an interstate consult…
He blinked, then read the name again.
Dr. Gregory House.
"Sam, are you all right?" Maria gave her colleague a look of concern. Ellsworth had been staring at the status report for a good ten minutes after the EIS head had moved on to patient outliers.
"Yes. Perfectly." Sam glanced up with an unusually tight, yet exuberant, expression on his face. "This might be the single solitary time when Dr. House's penchant for avoiding work will actually turn to our advantage." He smiled at her bemused look and turned back to the conversation once more.
"And his family? Friends?"
"They've all been quarantined as quickly as possible," Lansing continued. "We're still looking into secondary tier contact beyond the immediate vicinity."
"What about the Orlando case?" Ellsworth asked, satisfied for now with the progress in Princeton.
"That one…has been giving us difficulty in identifying." Ron Marshall stepped up to the projector this time, and switched the slide to a close-up of a pale, dark-spotted face against sterile white tiles. A photograph of the deceased. "Forty-four year old Russian male, military build, recent immigrant. No name or ID to speak of. Admitted 8:32 p.m., October 20th after being brought in by a Daniel Stroon – no relation to the subject – who found him collapsed about a block away from Orlando Medical Center. Presented with high fever and respiratory distress, apparently unconscious for the majority of the stay. Doctors diagnosed him with late stage antibiotic-resistant pneumonia and sent him to the ICU, but he remained unresponsive to treatment, deteriorating rapidly until multi-organ collapse. Although…" He frowned, eyes narrowing at the starred sentence in his notes. "It seems his vitals did improve for a time, enough to briefly regain consciousness." Strange, how this didn't garner any attention earlier, especially with the nurses on duty in intensive care. "But so far, no one's come forward with any details."
They all mulled that over in silence.
"Infection Control should've reported this," Gerald spoke up. "What did the coroner's case find?"
"The coroner concluded what the attending already diagnosed – respiratory arrest due to excessive swelling and fluid in the lungs, consistent with high-grade pneumonia. Some anomalies in the upper esophageal region…but they weren't pursued at the time. MMWR has the full run-down, if you'll look in your briefing folders." Ron gestured at the thick manila files stacked before each of them on the tabletop. All but Tom deigned to accept the invitation.
Flipping through his documents intently, he focused on scanning the details of the Morbidity and Mortality Weekly Report in an attempt to squirrel out further pathological data that might aid his research into the virus. So far, progress was slow given how little they had to work with; samples had been difficult to obtain, cultures still delicate and few. Generally, odd cases like these would've gotten at least a passing glance from the CDC, but with Sam so overwhelmed and John out in Africa all this time, no one had paid much attention to a single isolated pneumonia case among a sea of much more colorful, and dangerous, pathogens.
Including Tom himself.
"And the autopsy? Was it similar to Princeton's index case?" Sam pressed.
"We're currently...in the process of assembling that information. Orange County usually buries several John Does in a single pauper's grave, so it took some time to disinter the body."
Ellsworth looked annoyed. "Well, make sure you tell the lab boys to get that thing to me ASAP. What's nex – "
"How can you be certain that either of these patients were isolated before?" Maria interrupted, a concerned expression on her face. "By your description, both cases had ample opportunity to travel prior to symptom onset, and even afterward, remained active in the general community before the severity of the illness brought them to a hospital. What's to say that they weren't infected by somebody else, who just flew under our radar?"
They all turned to look at Tom Roskin.
"There's no absolute diagnostic criterion before the catalytic blackout."
A moment of silence followed as everyone attempted to decipher this piece of information.
"Could you…possibly elaborate on – "
"When we look within the icosahedral shell, what we are seeing is a distinct helical structure co-incorporating the negative-stranded RNA nucleocapsids, standard within any isometric virion such as influenza." Now that he'd gotten started on his academic tirade, Tom was a sight to behold, setting up slides, charts, diagrams at the front of the room in a blur of motion as he gestured animatedly along with his presentation. "The surface lattice can be roughly described via electron microscopy, or modeled here – " He pointed an old-fashioned meter stick (having never taken kindly to laser pointers, claiming they represented a potential work hazard) at a high contrast 3D scan on a stand. " – using the latest BIOQUANT P13.2 simulation software. Notice the subunit packaging of roughly 155/3 per turn and a pitch of 22 Ǻ. Clearly, this illustrates – "
"Dr. Roskin." Maria smiled stiffly. "I'm sure this is all very fascinating to a microbiologist, but could you possibly get to the point of your lecture?"
"Right, right. Hold your donkeys," Tom muttered to himself. He flipped through a series of increasingly complex and esoteric slides, most of which looked like they were more fit for a virology conference than an emergency CDC briefing (was that a Markov chain he had there? Ellsworth blinked twice before praying they never got to that PowerPoint).
"Okay. Moving on to the packaging signal sequence, what we find is a disturbing change in the stern-loop structure here." Another click to a high contrast photograph. "Although significant observations still need to be made, the zinc-knuckle element in the NC protein seems to approximate a psi sequence. Of course," he backtracked quickly, "these could also be merely shadows within the image frame. We still need to look at the x-ray diffraction data to make sure."
Gerald glanced around at the disturbed expressions throughout the room. "What exactly is a psi sequence?"
"A genome packaging signal." The look Tom received indicated that his colleague was interested in a more complete answer. "…Often associated with retroviral axis assembly," he finished reluctantly.
"Retroviral." The other's frown deepened. "You mean HIV?"
"There are…other retroviruses in the field. HTLV, for one."
"Which causes T-cell lymphoma," Lansing pointed out.
A look of irritation crossed Tom's face. "This is only one of the structural similarities! There are a number of very good reasons for the construction scheme to imitate a retroviral sequence, yet still result in a perfectly normal influenza A virus." He regretted making the comment now, of mere academic interest, which his colleagues were blowing completely out of proportion by the grim expressions around the table.
"Then, why don't you stop dwelling on the details and tell us how to treat it?"
Tom took a deep breath. "The catalytic blackout we believe to be merely a turning point in viral activity. Length of infection normally spans two weeks, with the first centering primarily on general flu symptoms – low-grade fever, headache, aggravated cough. However, once the blackout occurs, accompanied by sudden dehydration, disease progression quickens until respiratory arrest. If we're to treat this virus effectively, then our best target time frame is the window between catalyst and severe illness onset."
"Why not earlier?"
"Because no diagnostic criterion exists of yet to distinguish superflu earlier." Tom plucked agitatedly at the corner of his briefing folder, already creased several times over into dog ears. "Up until now, our tests can only track broad-spectrum infection beforehand."
"Wait, so you're saying you can't tell the difference between regular flu and this new virus?" Ellsworth asked incredulously.
"The characterization schemes are incredibly similar." Roskin frowned at the other scientists around the table. Didn't anyone here hold a degree in virology? "It's not a simple antigen set, or else we wouldn't see such high mortality rates."
"On that note, what are the numbers right now?" Gerald asked, hoping to move the subject to a more understandable – and socially pertinent – area.
"Four dead, sixty in isolation, another hundred and twenty-five held within local quarantine. The number infected has grown by twelve percent since yesterday."
Sam's face was grave at the last statistic. "There's got to be some prophylactic measures to reduce those figures." He glanced back at Tom. "What kind of treatments are we looking at?"
"The usual regimes. Amantadine, rimantadine, oseltamivir. Acetaminophens for fever control." Roskin waved a hand in the air, as if they were all utterly obvious and utterly useless remedies. By the sound of things, that was probably true. "We've tried…several vaccine combinations so far, but it's – the antigenic shift has – " He started pacing in frustrated anger. "There is no simple method to generate the antibodies! None at all! This is at minimum a Level 3 virus of high mortality and unknown origin, structured for maximal contagion range. Our frying eggs are all in one pan, now. We've really hopped into the fire this time!" His eyes gleamed wide, frenzied, and a mood of general panic seemed to creep into the room along with his agitated gait.
"Calm down, Roskin." Sam didn't look particularly calm himself. A Level 3 in a major metropolitan area? This was like Ebola Reston all over again. "Let's look at the epidemiology first before we jump to any conclusions."
"In terms of epidemiology, this virus exhibits a disturbingly anomalous spread." Lansing coughed, then indicated the rapidly rising peaks on her chart. "We've already established that two index cases form the bulk of the transmission ratio, but they don't explain how initial locus densities arose so suddenly. It's completely outside our regression analysis."
"Have you accounted for the logarithmic range? Aligned the axes?"
She shook her head. "It's not a methodological error."
"Given this virus's camouflage capabilities, it's clearly a problem with our radar."
"You mean…the detection scheme?" Maria translated the military metaphor for the rest of them.
Sam nodded curtly. "Tom gave us a rundown of the stage statistics earlier. Infection onset was not sudden. This thing went guerrilla on us in the flu season, allowed it to spread unnoticed for God knows how long before the first case attracted notice." Just my shit luck. Even viruses learned from 'Nam.
"Yes, the trend does indicate a prior variable." Lansing frowned, pecking at her laptop on which was drawn the epidemiological data that the EIS had forwarded to all of them. A dense spreadsheet of numbers was accompanied by several scatter plots in Excel, regression equations pulled up on one side. She made a few adjustments to her model, entered the code, and then ran the simulation again. "The cluster formations seemed spontaneous at first, but mapped with regular influenza patterns, they could roughly approximate a logarithmic function." She turned the screen around so everyone at the table could see the new graph.
"And now that the topology is stabilizing…" Fingers flying, she made the same changes to several other 3D visualizations as well. "…it's falling into a general radial distribution." Lansing pushed up her glasses in satisfaction. "We'll need to do a few recalculations, but this should greatly improve our tracking."
"That'll be useful to Wu, but I need the estimates right now if we're going to talk about quarantine logistics," Maria said. "The state department isn't about to wait on another round of data analysis."
"Well, what are our options at the moment?"
She started ticking them off on her fingers. "Hospital's already quarantined, local areas under watch, the board's debating whether to shut down the entire city up in Princeton. Orlando has begun limiting interstate travel, but no official word on border control yet."
"We should definitely close the airports," Ron said. "This thing's ravaged two cities in only a week, who knows where it'll go if we don't cut off its next step?"
"There's still not enough evidence to justify a complete shutdown, though. The WHO's been contacted about the international situation. We should wait on their response before making any further moves." Gerald argued the path of least public panic.
The state liaison nodded along in agreement. "I still say we need to implement some health screening procedures before the infection gets out of hand."
"That'll all be arranged," Maria replied calmly. "And as much as I respect the WHO, Watson, I think there's plenty of reason right now for limiting all travel within thirty miles of the quarantine area." She tapped her pen, point down, on the map of the hot zones before her. "Our biggest problem right now isn't stopping people from leaving, it's identifying this virus before it makes leaving a viable choice." She glanced to her left. "Roskin?"
Tom's eyes were fixed on a complex medical chart. "The incubation period is approximately three days. However, since first stage symptoms are slight to undetectable, you could extend that to well beyond a week."
"What are the chances that a non-infected person quarantined with an infected person will contract the illness?"
"Significantly higher. Judging by transmission within the limited population, almost one hundred percent."
The others glanced at each other worriedly. "You mean…given the statistical data we have right now," Sam suggested. "That figure will be adjusted as we see more clusters arise."
"No." Tom shoved deliberately at his non-existent spectacles. "I mean taking the limit of the population density graph."
Oh. Obtuse mathematical jargon.
"Well, what's the current contagion rate?"
"Not good," Lansing said from her place by her laptop. "Of the twenty-five people who came into contact with the first patient zero, nineteen have already developed stage two symptoms, and another seven are progressing rapidly into respiratory distress."
Sam did the calculations quickly in his head. "Jesus. That's an infection rate of almost – "
" – eighty percent," she finished for him. "And these were just the ones within passing association. If we narrow it down to long-term contacts, the percentage peaks even higher." She didn't bother pointing out exactly how high. Tom had made that computation already.
Gerald shook his head. "We can't justify putting healthy people into quarantine with those statistics."
"But the diagnostic tests are all inconclusive. There's just no way to tell for sure whether a patient is infected or not under these conditions."
"No, it's perfectly clear. What isn't clear is whether those infected have the flu or the superflu in their system."
That gave them all a sobering pause.
"Then, it's even worse!" Gerald yelled through the silence. "Throw someone whose immune system is already wrecked in with this thing, and you're sure to see even more infection."
"And if we let one case free?" Schlessinger asked in challenge. "There's thirteen thousand people in the metropolitan area, twenty-five major travel routes out. Assuming the shortest distance exit, any carrier will go through at least three bottleneck infection zones before moving past the tracking margin." She rattled off the statistics crisply as if they were a shopping list in her head. "That's thirty potential new patients you've got on your hands."
"Or one recovered person returning to their family."
"The stats aren't in your favor there, Watson," Sam remarked.
"So just cut our losses? Hope for the best?" The other's face had grown livid. "Because you're coming very close to suggesting that we simply round up anyone with a high white blood count and toss them into the bubble room."
"If that's what it takes to stop this thing from spreading, then we're going to have to do it," Maria finally snapped.
The frigid silence that followed left a heavy pall over the meeting room.
"The best…we have right now is the catalytic blackout. It's the, the closest we've come to a definitive symptom." Ironically, Tom was the first to speak up, a nervous twitch tugging at the edge of his lips. He looked around tentatively, subdued, feeling not a little guilty for being the cause of all this. After all, it was his failure to produce a diagnostic test that caused them to descend into the murky world of cost-benefit politics. "I…My team and I, we're exploring some methods to narrow the selection down."
Ellsworth tipped his head in tired acknowledgement. "Then we'll go with that until something better arrives. Schlessinger has the resources, set up a screening center at every clinic in town and start separating out the cases." He paused. "If you have to, assume the worst for quarantine."
"We need to address public reaction," Gerald said stiffly, changing the subject to their least favorite topic of the day – quite a feat, considering how this day was turning out.
"There hasn't been any information yet about the virus released."
"Exactly. Which is why we need to provide it before speculation starts," Ron rationalized calmly. As the resident behaviorist, it seemed he was in charge of ensuring his colleagues didn't kill each other with the iciness of their glares. "People are going to ask, what is this thing? Where did it come from? How dangerous is it?" He gave Ellsworth an even look. "This isn't the military, Sam. You can only tide them over with 'bad flu season' for so long."
Any other person calling him Sam would've received a sharp rebuke, but in this case, Ellsworth knew the intimation was true. Didn't mean he liked it, though.
"So we send out a press release. Get the media on our side. As long as they have enough information to work with, they'll be happy to feed the twenty-four hour news cycle." Gerald was already jotting down his plans. "That takes care of the eighty percent of the population who get their health updates from CNN."
"It's not all going to be a walk in the park. There will be some outlets who don't buy into the mainstream."
"Which is why you'll be dodging their questions."
"We don't know enough about this virus ourselves, how can we hope to provide accurate information to laymen?" Roskin cut in.
"By dumbing it down from a PhD thesis to a cereal box label," Gerald retorted pointedly. "For, you know, the rest of us who didn't do our postdoctorate work in molecular biology."
Ron sighed. "It won't be easy getting people to buy an explanation they don't understand."
"Right now, our most important goal is to avoid mass panic," Ellsworth interrupted the senseless quibbling. Great meetings always ended with everyone disagreeing with everyone else until he started giving out orders. "There isn't going to be another cholera in New York, or plague in San Francisco. We do this strictly, but we do it right, and with the cooperation of the public. Which means you three – " he indicated the EIS and PR factions before him. " – need to find a way to work together long enough to get the message out."
"And who's going to navigate the local news logistics?"
"That doesn't matter now." Sam closed his briefing book with an air of finality. "State's gonna have to deal with communication details once the big leagues moves in. What we need to do is figure out how to stop this thing before it spreads any further." He turned to Tom. "Roskin, you're head of viral analysis. Contact the other government labs – NIH, USAMRIID, Hopkins – and work with them to figure out a definitive diagnostic tool first. No second guessing, I want a specific targeted approach to every patient we get."
Tom frowned. "That may not be possible with the current antigen structure."
"Well, give me the best that you can. And start mapping out some concrete treatment options." Sam tossed the heavy folder of medical files over for emphasis. It landed with a whump, narrowly missing the other's fingers. "If I hear another word of 'fluids and bed rest,' I'm going to throw the entire media circus out the window. Schlessinger," he snapped off military-style, swiveling sharply to face her. "Get ready for entire state border closure. No ands, ifs, or buts – tell them if they want to argue legalities, they can take it up with the WHO. We've got a deadly virus spreading at ninety percent transmission rate across two major metropolitan crossroads. If even a single infected case gets through, there's going to be hell to pay in the neighboring provinces."
"I'll gather resources in conjunction with the National Guard and state health facilities," she nodded briskly.
"Do that. And get the DoD to put you into contact with some military agencies, as well."
"As for the EIS…" he continued, "Wu will be in at about 0600 hours, so I want a full report with the latest developments uploaded to him before then. In the meantime, keep investigating the index case in Orlando – I'll get national security to set up a liaison with the Russian embassy – and find out what the overlap between regular flu and superflu in each state is." He cut the epidemiology official's protest off with a wave of his hand. "I know we don't have a definitive diagnostic yet, but use your simulation models. Roskin will be in touch with a better test as soon as possible." Ellsworth glanced at both parties to ensure that they understood his orders. It was a bullshit move, really, placing each at the behest of the other. EIS couldn't do much without the necessary tools, and Tom hated pressure from other departments, especially when he was already forced to wade neck deep in inter-agency politics. At least Lynn was over at USAMRIID…
But, temporary measures for temporary problems. Once John got here, they could revisit things with a much keener eye.
"We need to move fast on this thing, and prepare for every contingency." His eyes roved sharply around the room. "One mistake could FUBAR the entire operation."
A tentative voice piped up, "And what will we tell the press?"
Sam glanced in that direction. Ah, yes. PR. "Tell them whatever you want, so long as it doesn't interfere with our teams on the ground."
"People are going to want an answer for where this thing came from."
"Well, that's too bad, because I don't have any," he snapped in irritation.
"We need to ensure the public is well-informed," Ron explained patiently. "Of the consequences of their actions, that is. If they don't know anything, then they're going to be afraid, and if they're afraid, then they're going to make up their own theories about this virus."
"We can't allow false propaganda to be spread in the vacuum," Gerald added with a frown, completely overlooking the irony of that statement. "No one's sure yet if this is the seasonal flu, or if it's something else."
Tom looked distracted. "It's definitely something else."
"And what would that be?"
"A preliminary scan shows multiple antigenic clusters with – "
Ellsworth was shaking his head. "You'll only make it worse with medical jargon." He gave a loud sigh. "Look. This might be something new. Or, it might just be a very unique case of…a regular flu mutation. 1918 was deadly, but completely treatable – it was the government who did a bad job of managing facilities and made everything worse. If we keep our heads level about us, keep the public's head level, then chances are we can mitigate what damage has already been done, as well as aid our own efforts on the ground."
They all considered, and nodded silently in agreement.
"So, seasonal flu it is then. Not a word on exact mutations or origins." Sam looked to each member of the board for direct acknowledgement, lingering especially long on Ron. The shrink. Never did trust those when he was in the military. At least this one worked with EIS, so he had a handle on things…just never could figure out what they really were thinking behind all the mindfuck. "Tell people there are various treatments in use that have proven effective against aggressive flu, but they should only visit the hospital for severe cases." That should help both epidemiology in identifying the worst of the strain, and Schlessinger in keeping logistics in check during quarantine. "Otherwise, over-the-counter medicine is their best, and safest, bet."
He waved a hand, about to adjourn the meeting.
"And what will you be doing?" a voice asked suddenly.
The sharp gaze Sam threw in his direction made Tom regret posing the question.
"Preparing to brief the President of the United States."
Events don't always occur quite in the order they are supposed to, but in this case, things fell neatly by the roadside as the entire nation heaved, rose up, and realized the truly dire state of affairs unfolding rapidly across its eastern landscape.
In the air over Nigeria, a laptop screen flashed dimly as an e-mail found its way into the inbox of Dr. John Wu.
On the outskirts of Millburn, National Guardsmen readied themselves to extend the quarantine throughout New Jersey.
In the quarantine room at Orlando, a nurse watched silently as another body was tagged by the CDC officials and removed to the growing stack in the morgue. She did not notice a balding man behind her steal away with two nondescript files.
By a metro phone booth, anxious lines formed waiting desperately for a call from their loved ones.
Near the capitol, several words were exchanged between men with dark sunglasses and Armani suits.
In the White House, a top secret briefing folder was delivered to the President's desk.
And at Princeton-Plainsboro Teaching Hospital, a single cane twirled slowly, evenly in its owner's gnarled white hands…casting shadow puppets across the walls.
Ten of them, total.
Ten patients on ten different treatment regimes, all in the beginnings of stage two superflu symptoms.
He had their charts tacked up on his wall by now, having run out of space on the whiteboard (even bringing out the old clear one – chipped after a St. Patrick's Day drinking session – he had barely enough room for five), and sent his three subordinates out to gather more tests surreptitiously, so Cuddy wouldn't notice. Not that, given the state of the hospital, she had time to worry about House's shenanigans. The CDC presence had been lessening these past few days, only to be replaced by a more ominous set of "security" officials in dark suits and upturned earpieces, their sum total communication consisting of approximately three words rattled off with blank indifference. He saw little of them, yet was fairly sure they had every person here down to the letter.
Turning his thoughts from the rather depressing hospital situation, House scanned once more the patient he'd come down here to observe. Thirty-two year old female of Hispanic descent, admitted three days ago with a bronchial infection. While here, developed a mild fever and aggravated cough, even after being treated successfully with antibiotics. Thanks to some quick footwork on Chase's part and Cameron's minor in Spanish, he was able to get her in on 500 milligrams of IV acyclovir beneath the hospital radar, one of several drugs he'd been juggling with as an alternative to the usual flu medicine – which, frankly, wasn't doing shit against this thing anyway. A combination of corticosteroids and albuterol, on the other hand, had at least been somewhat effective in slowing the lung infiltration which led to shock and respiratory arrest in most patients. And while House hated treating by the symptoms alone, he had to admit it was the only practical option at this point.
Out of the corner of his eye, he caught Wilson talking to a cancer patient through the gauze blue curtains.
"Sir, if you could please step away from the isolation zone."
House gave the security official a sparing glance before turning his gaze back to his subject. "I'm a doctor here."
"Can I see some ID?"
"Sorry, don't carry dog tags with me on a routine spying mission."
"Then I'm going to have to ask you to return to the civilian waiting area in the lobby." Was that a hint of emphasis he detected in the monotone voice? House couldn't be sure, but the firm hand on his shoulder suggested he better make his decision quick, or he'd find it made rather painfully for him.
He opted, as always, for the latter.
"Look, don't you have some better cripples to harass?" House snapped caustically. Blue eyes flashed with more than customary annoyance. "I'm sure that Area 51 conspiracy left a couple of guys on the first – " Suddenly, the stat monitors started beeping inside the isolation room, and a flurry of movement rushed by them through the doorway. House turned to see a patient gasping, hands clasped to chest, while several nurses rounded the hospital bed, grabbing quickly for the crash cart. Intubation devices were removed. Pumps held out. One nurse ducked briefly for a syringe, allowing House to catch a glimpse of half of the patient's face. A Hispanic face.
The one who was supposedly getting better.
Shit. Whirling on his cane, House limped quickly off toward his office.
The glass door swung open, narrowly missing a stack of files balanced on the edge of his bookcase, and the momentary breeze caused the papers tacked on the walls – profiles of his ten test patients – to ruffle skywards. He snatched a pen from his desk, cap popping, to slash two dark X's over the bottom half of his notes on a…Linda Sanchez, it seemed. He cursed silently. He'd put Chase on her just in case there was any improvement, but chances were, the alcyclovir was another lead in the trash. Another dead end. Too many symptoms, not enough meds. No matter how many bulletproof vests he wrapped up around the lungs, the holes always managed to get through. Bloodstream was…bloodstream…
House stopped, eyes closing for a second, as he reorganized his thoughts.
Three down. Two in the air. Five more without any improvement.
His cane clattered loudly, as he sank into a chair. Not enough patients, was more like it. As for Wilson…his mind flickered back to the glimpse he caught beyond the blue curtain. Still somewhere in the middle. Chills and dizziness, but fever was holding low with only mild swelling around the lymph nodes. The inflammation was cause for concern, though…if the next round of tests from patient number six came back negative, then he might prescribe that corticosteroid to help ease the breathing.
At least he still has the energy to go mining for the needy, House thought bitterly, spinning an eraser in one hand. Must be vampiric heaven with all those dying people in there.
Although, that wasn't quite true. If the woman House saw was a cancer patient, then she'd have to be immunosuppressed, which meant that if she had the superflu, she'd be at least in the ICU ward by now. Not chatting up some oncologist by her bedside. Of course, with the delays between blackout and ARDS fluctuating all the time, it might've been possible for someone like Wilson to –
House shook his head. He was grasping at dead ends.
Shoving the papers on his desk aside, his eyes fell on the cell phone lying next to his coffee mug. No new calls on there, either. He snorted. People were lining up to use the one government-secured phone to call their families, and here he was with an empty call log in front of him. No messages from Fletcher. That last one seemed to be a goner. Further tries to the number he'd gotten on redial only served up a polite machine voice telling him to go fuck himself (metaphorically). House suspected Fletcher had lost his cell phone right around the same time the officials figured out he wasn't quite the innocent bystander he pretended to be.
Which…didn't change their situation one bit. With a sigh, House moved on from twirling the eraser to bouncing one of his juggling balls against the far wall. Afternoon light streamed in from the window against an eerily silent, still background. Normally, this would be the time when the early birds drove off, and the late shift started streaming into the parking lot. Now, however, time seemed to stand in stasis. Not even the dump truck hauled by with its gratingly loud whams against the garbage disposal.
Next thing you know, the parents'll stop calling, too.
If they'd called his by now restricted landline access. Mom was probably worried, trying to reach him at the office. Dad had a handle on things with the military. If worst came to worst, there'd be people to take care of them. He considered giving them a call, then immediately ditched the idea when he imagined the awkward mess of emotions over the phone connection. No, they were safe in Vermont, and he was as good as he could get here. Nothing more needed to be said.
Abruptly, House snatched up his cell phone and punched in the speed dial. There was one person who definitely needed a shove in the right direction (out of the state) because her husband sure wasn't bright enough to figure out that the local quarantine was about to extend a whole lot farther within the next twenty-four hours.
…Predictably, it was Mark who answered the phone.
"Where's Stacy?" House minced no words.
"Stacy?" A pause. Suspicion grew almost palpably through the earpiece. "What do you want with Stacy?"
"Need to talk to her," House said, not missing a beat. "What are you doing on her private cell phone?"
"I don't think I owe you an explanation as to how I came to obtain my wife's cell phone," Mark replied stiffly, retreating into the realm of passive-aggressive non-answers at House's accusatory tone. A side effect of living with a lawyer for so long. The double talk started to rub off on you. "Stacy's not available," he stated with an air of smug satisfaction, the kind limited only to complete lies and convenient half-truths.
"Right," House snapped, losing his patience, "and you're just the switchboard operator. Running interference, in case the big bad stalker comes prowling around in the middle of the night." He caught himself before he could go any further and turn this petty quarrel into a dial tone ringing permanently in his ear. "Mark." The word carried a weight of dead seriousness. "This is important."
"Oh, I see." Not to be outdone by faux sincerity, it was Mark's turn to play up the sarcasm. "Well, since it's a matter of life and death, I'm sure the gallant doctor will just come limping to her rescue this very – "
A quick scuffle of the phone cut him off mid-sentence, and then, Stacy's voice came onto the line. "Greg?"
"Stacy, you need to get out of New Jersey."
"Wait – what?" Confusion tinged her voice. "Why?"
House continued on as if he hadn't been interrupted. "Go to New York, Virginia, visit your mother in Boston. Tell them you're going on vacation for a few weeks. Just stay out of Jersey."
"Greg, I'm not…" She stopped, seeming to gather her thoughts. "What's going on? Why do I have to get out of town?"
A muffled sigh came from the other end of the line. "There's been an epidemic, and it's spreading faster than syphilis in a whorehouse."
"An epidemic? You mean the flu season I've been hearing about?"
"Yes, and no." House ditched metaphors for a direct analogy. "This thing is to the flu what Superman is to Bozo the Epileptic Clown. Things are much worse than the reports have been telling you." And more dangerous than anyone so far had suspected.
"Wait, so why are you still in Princeton? If it's that bad, you should be leaving too," Stacy said, worry evident in her voice. "It's an epidemic, not some mysterious illness for you to diagnose." She paused, realizing that House had never told her exactly what disease this epidemic was about. "Don't tell me it's both."
It most certainly was both, but House declined to comment on just how close Stacy had hit the mark. "I'm still here because the CDC's quarantined the entire hospital, and they're going to extend the perimeter around the whole city in about twenty-four hours, which is why you have to leave right now." His voice rose at the last line, and a trace of aggravation crept into his tone. Twenty-four hours minus two hours driving time, one hour packing, three to four hours at the airport…did not leave much space for pointless prattling. Life would be so much easier if he didn't have to waste half of it convincing people of the right choice.
House stopped in his pacing to lean heavily against his cane. "And yeah, no one knows what this thing is."
"Oh, my God." Stacy gasped. "They've quarantined you? But you're okay, right? Over at the hospital?"
"...Two of the patients so far have died."
The long silence almost had him hoping that he'd gotten through to her.
Stacy exhaled loudly into the speaker. "I…I can't just leave. Mark and I can't just leave." She rubbed at her forehead, shifting the phone to her other shoulder as she wavered between hesitancy and resignation. "What am I supposed to tell him? Oh, honey, the good doctor called and recommended we get out of town for a month, so I suppose that means you'll have to miss your rehab and we'll both have to drop our work. But don't worry, the rest of the country will be too panicked over the flu to notice."
"Hmm. Sounds good to me," House said brightly. "There's a flight leaving for Logan this afternoon, you'd better catch it before they close down the airports."
"Of course, Mark will completely agree to that rationale." Her dry tone echoed tension, which dropped as soon as she sighed.
Maybe this was an epidemic. A genuine emergency. House had rarely been wrong about medical matters in the past, and even when he was, proved more perceptive of the situation than any other doctors around him. It was how he got through med school with just the barest of effort, and how he won her over despite a distinct lack of...conventional charm. If there was something more to this than just a bad flu season, then he would be the first to know.
And yet – Stacy couldn't quite bring herself to believe the warning. Trust was one thing, truth another, as House was fond of saying. No, it wasn't so much trust as…as Greg's pathology. Something she'd become all too familiar with in their years together. Distractions…puzzles…reading unconsciously into minute details. He needed mental toys to play with. People only knew him for his medical genius, his unerring diagnostic instincts, but they never saw the times when House's single-minded pursuit got him into more trouble than it was worth…especially in areas he couldn't claim expertise. Their relationship...
Like a true lawyer, Stacy grasped for the remaining stray straws. "Are you sure this isn't a false alarm? With all the bioterrorism threats, the CDC is probably overreacting."
Of all the straws she could have drawn, this was the one that broke the cripple's cane.
"Right, the same way the hospital overreacted to the false alarm that was my leg," House snapped back without a hint of hesitation.
The silence that followed was almost audible.
"…I'll think about it." A strained pause. "All right?"
"There's nothing to think about!" House yelled, no longer caring where this conversation ended up so long as it involved Stacy leaving. "Either you take a plane out of New Jersey now, or you stay here for a few more days, get caught in the quarantine, and learn about the epidemic firsthand from some nice, polite government officials in biosafety suits." He rubbed a hand down the side of his face, barely able to control his frustration. The rasp of skin on whiskers seemed to mimic the harsh grate of his voice.
"Trust me," he said quietly, head pressed against the window glass. "This last time."
"I trust you to believe in what you're saying."
The dial tone rang in his ear for a good thirty seconds before he put the phone down.
It was a wonder the phone didn't die on him, given the number of times he'd hit redial on the keypad.
Wilson put the handset down in resignation, knowing that any further attempts would just waste his time and extend the line further down the hallway. Already, several more patients had arrived to take advantage of the opportunity to call their family and friends, inform them of their situation. These were the "best" cases – by now, the containment room couldn't hold anymore superflu patients, so the healthier ones were moved to a separate wing – the ones that hadn't progressed yet beyond stage two. Wilson was probably on the borderline at this point, but his position at the hospital got him bumped up. Not that it did much good. All he got to see was a slightly lighter shade of green on the walls and the absence of a glass food slot.
It was strange, walking the familiar Mathey Wing in a hospital gown and slippers. They'd moved the cancer patients and immunocompromised as far from the potential area of infection as possible, in an attempt to lessen the danger to them. But that still ignored the fact that all of Princeton-Plainsboro was under quarantine, and, given the communicability of this virus, was probably only the beginning of the government containment.
The appearance of CDC officials from the outside, clad in biosafety suits, only drove the point home further.
"Call with Julie?" A familiar voice by his side shook him out of his thoughts.
"More like an attempted call." Wilson sighed and settled back onto his hospital bed. "She's apparently refusing to answer anything from me." He ignored the fact that he'd been calling from the general hospital line, which wouldn't have shown up on caller ID.
"Well, that would be quite a mind-reading accomplishment, seeing as how you're calling from the hospital phone." House, as usual, saw right through his fib.
"Yeah. That did occur to me." Wilson rubbed at the back of his neck, eyes sliding to one side. Sometimes, he wished his friend weren't quite so perceptive. "It also occurred to me that I'd rather she hate me than be sick." A crease appeared across his pale forehead (How many days had it been since he'd seen the outside? Five? Six?), as he struggled with the implications of that thought. "Of course, it's probably a combination of both."
"More likely is…she left when she saw the CDC warning on the news and didn't bother to leave a callback number," House observed with his customary bluntness. This time, the cynicism was warranted. "People tend to forget things when they're running for their lives."
The idea of a loved one, even so estranged as Julie, abandoning any semblance of their relationship in the middle of a crisis was not something Wilson found easy to accept. That she had known he worked at the hospital made it that much worse. He wasn't expecting any Hollywood movie reunions (three divorces had taken care of that), but at the very least…he'd hoped…she'd thought enough of him to remember.
Wilson shook his head faintly and changed the subject. "How about you, did you reach Stacy? I know you've called her by now."
House blinked, not a little surprised "Have you been tapping my cell phone?" he asked mock-accusingly. "The NSA's already got the goods, but I figure they'd wait another couple of years before selling me out to my best friend."
"Well, unfortunately, in exchange for getting the goods early, I'm not able to listen in on the conversations," Wilson replied with a ghost of a smile. He did not overlook the significance of House's last word.
"So you can track them without the added guilt of deliberate eavesdropping…" House tilted his head to one side, eyes narrowing in dry amusement. "Nice. It's like blackmailing Cuddy."
Wilson sighed in exasperation, about to reply, when he was cut off by a cough. The spasm shook his frame and burned at the back of his throat, bringing with it a now-familiar metallic taste in his mouth. It felt like swallowing pennies. Detachedly, he noticed that the pain in his chest had grown worse since last time.
Blood in sputum with respiratory involvement can indicate a wide variety of primary infections, including, but not limited to, tuberculosis, pneumonia, and acute pulmonary hemosiderosis… The words echoed back at him from a long-forgotten lecture in medical school.
"You would know, of course," Wilson remarked weakly, after the fit had subsided. He took the cup of water House offered him without any comment. "What did Stacy say? Did you tell her about the quarantine?"
"Yeah." House tilted his head in affirmation, but did not look at his friend. "She said she'd think about it. Was afraid of what to tell Mark."
Wilson nodded slowly. "At least they're both okay." He hesitated. "You...didn't tell her about me, did you?"
House turned a shrewd glance on him. "You're worried how she'll take this incident."
"Being deathly ill is not something you really want advertised." Wilson paused, and shook his head. "I'd rather people not know how I'm doing."
The blue eyes roved over him pensively, unanswering, their focus seeming to turn inward as House searched his countenance for an answer. Reason. People who need to be needed hate being on the helpless end of things themselves. It wasn't about control. It was guilt. Unconscious responsibility. They would rather fight it alone than let others add to the weight of their burden by emotional involvement…and that was Wilson's pathology. He actually thought if others tried to fix him, he'd lose his ability to care.
House said nothing, but it was clear from the way his lip twitched that he saw more in that one statement than Wilson cared to reveal. The relief that came with this realization was oddly comforting.
"That can be arranged," his friend replied lightly, as if unworried about the consequences. "Though…I wouldn't call it deathly. Deathly is Lassa fever in the middle of plague-stricken Africa." He gestured to one side with his cane. "Hemorrhagic fever and your bathroom's backed up. Now that's hell on Earth."
"So does that make this purgatory on Earth?" Wilson asked. "Or is there no category because no one still has any idea what 'this' is?"
"It's not Lassa fever."
"Yes, I think we've managed to narrow it down that much," he replied with a touch of sarcasm.
"Not pneumonia, not plague, definitely not eastern equine encephalitis..." It was obvious that House was stalling, counting off more and more absurd diseases on one hand.
"So after that arduous process of elimination...what's the answer?"
A pause, this one shorter, and his gaze flicked back to the hospital bracelet on Wilson's wrist. It was blue. For quarantine.
"...I don't know."
The only source of light was a little lamp in the corner. In a way, it almost made the conference room look cozy, despite everything else that had happened. Almost. Through the glass windows, Cameron could see Chase slouched and fast asleep in one of the chairs, a book splayed across his lap. A teeth-marked pencil had been dropped carelessly by his feet. Foreman was in another chair, adjacent. In his hands was a newspaper. The sports section had been tossed on the center table.
She pushed open the door and eased it shut behind her, careful not to wake Chase up. Her attempt was successful up until she walked straight into a small stack of files she hadn't noticed in the dark. The papers collapsed with a thump that nearly echoed in the dead silence. She froze, as though she'd just committed a terrible crime and glanced guiltily at the startled Chase.
"Oh. Hey." Chase rubbed at his eyes, and looked at his watch. It seemed he couldn't register the numbers because the next words out of his mouth were, "What time is it?"
"1:30 a.m." She offered him a tired smile. "Sorry for waking you up."
"There's coffee in the pot if you want," Foreman said, eyes not moving from his newspaper.
"Thanks." Cameron was already heading in that direction. As she picked up the half-empty pot, she turned to Chase. "Do you want any?"
"Coffee, I want and need." His voice was slightly muffled from leaning his chin in the palm of his hand. "It's like med school all over again, only twice as bad."
"Except in med school, we actually knew what we were dealing with. Even the experts can't find an answer key here." Foreman closed the newspaper and tossed it on the floor amidst the patient files. The thick, bold Superflu Ravages City headline glared up at them in the darkness.
"That's because there is no answer key," Chase said, accepting the mug of coffee from Cameron with a nod of thanks. "The superflu's off the map. They just won't say it because then everyone would fall into mass hysteria."
"Superflu? Is that what they're calling it now?" Cameron asked. She sat herself down in a chair by the conference table.
"Seems like it."
As if to prove Chase's reply, Foreman picked up the newspaper again and held out the front page to her. "That's what the reporters have been saying, since no one else has come up with a better diagnosis than the flu."
Cameron took the paper with a hesitant hand. The more her eyes skimmed the article, the more her brow knitted. "Twenty dead? And the quarantine's around all of Princeton now. This can't be just the seasonal flu!" she insisted, as if they hadn't established that fact already. "We've seen those patients - they're young, strong, perfectly healthy individuals."
"Hence, superflu," Chase said. "Also, you forgot what happened in 1918."
Cameron only frowned further. "That was because of government ineptitude. The military was more interested in running its war than ensuring its facilities were clean."
"Was?" Chase didn't do so, but Cameron's mind ended up filling in the raised eyebrow to match his tone. "There's a nice war going on right now, too, that the military would be more interested in than keeping things tidy."
"Our facilities are still ten times cleaner than they were over eighty years ago even with negligence," Foreman said.
"But the government is now ten times better than they were eighty years ago at hiding their negligence," Chase pointed out. "Either way, this virus came from somewhere and it's obviously very deadly."
There was a quiet, but sharp bang as Cameron set her coffee cup on the table. "Only deadly to some. Other people seem to have immunity."
"Seem being the key word," said Foreman. "No one still knows anything."
"Yeah, and some people are still convinced it's the regular flu and won't check in," Chase said, voice tinged with exasperation. "Which is entirely not helping anyone."
Cameron was shaking her head. "They can't tell the difference. How could they? Not even House could tell the difference in the beginning."
"Well, yes, but at this point, you'd think they'd be erring on the side of caution."
"Denial is the M.O. for most people when it comes to illness. My dad won't go see the doctor, either," Foreman said.
Cameron turned to him. "You called him?"
"Yeah. Earlier in the day. I caught him coughing and told him to go to the hospital, but you know how he is. And he won't leave mom by herself."
Chase paused. Then, feeling like he ought to say something, "There have been a couple of cases where people really do just have the regular flu." He failed to mention that one of those two lapsed into the superflu afterwards.
"If they get better, maybe there's a chance they can develop resistance to both strains..." As Cameron spoke, her voice faded off until it was almost a whisper by the end. It was a nonsensical theory, and she knew it. But it sounded so much like a plausible solution that she felt almost cheated it wasn't occurring in reality.
"More likely that the virus will just die out somehow. Similar to what happened with the Spanish flu." It was a shiny card of optimism thrown out by Chase. No sooner had it landed out there for all to consider, Foreman tore it to shreds.
"Also similar," he said, "millions of people will die before that happens. Odds say that includes people we know or even us."
"None of us have gotten sick yet," Cameron replied. "If we were the first ones exposed, why aren't we sick like the rest of the patients?"
"Actually, nothing says we were the first," Chase said. "For anyone can tell, Michael could've been infected by another friend, student, family member. There's no index case."
"Still, it's unusual. Even without being the first, we were nevertheless exposed fairly early on, at least, in regards to the rest of New Jersey. So why aren't we sick?" Cameron demanded. It almost seemed like she thought she could force some logic into the situation by playing Devil's advocate. "For that matter, why is Dr. Wilson, and not one of us, sick? He had five minutes of contact with the patient."
"Too many variables," Foreman said. "This isn't anything we've ever seen before."
"Including the fact that House finally has a patient he cares about," Chase added.
A heavy silence descended over them right on cue. For a moment, Chase looked as though he wished he hadn't brought that up. He didn't know Dr. Wilson well, but the oncologist was a close — and only — friend of House's. The superflu already hit too close to home, striking right in the heart of Princeton itself. With Wilson falling sick, the virus might as well have crawled into bed with them.
Cameron looked down. "He's been up all night for the past week staring at that whiteboard of his."
"You think House is still trying to solve this case?" Foreman glanced at his two coworkers, searching for confirmation. "He's a diagnostician, not a virologist. We already know what this thing is. The problem is, we don't have a cure."
"We may not have it, but House is convinced one exists," Chase said. "Until he finds it or the virus magically vanishes, he's not going to stop looking."
More silence as all three considered the slim likelihood of both options. Like steel to magnet, their eyes drifted over to the newspaper Cameron had set down by her elbow. The headline screamed silently back at them.
"Don't know about you guys," Foreman said finally, "but I'm personally hoping for the latter."
One state down. One on the way. When put into context of the fact that there were fifty-two states total, that really only made about two percent. Two percent was not a lot, technically. The phrase "two percent of the country is affected" carried almost no weight.
Which was why the media opted to announce things like, "the entire state of Florida" before throwing in some large statistical figures to induce even more panic.
Panic was something Sam Ellsworth honestly did not need at the moment. And while he didn't want to downplay things, because this was, actually, a situation worthy of hysteria...if it would help save him a headache or two right now, he'd take it.
And now the politicians are arriving. Lord have mercy. If not on the people of New Jersey and Florida, then on me.
Ellsworth dreaded speaking with the various government factions. Never mind that he himself was a government faction. Throw in the President, along with his advisors and the CIA, all demanding answers he didn't have right now was like asking to get his fingers crushed in a car door. Repeatedly. Some of these people even went so far as to argue the science, as though the virulence of a pathogen were debatable, like an ethical issue rather than a fact. Sam was pretty sure that if Congress decided epidemics, the Black Death would still be in session.
As the door clicked open, Ellsworth sat up straighter and neatened his notes while his team filed in. His attempt to look alert and on top of things was effective up until Howard Lynn gave him a knowing (and slightly sympathetic) look.
The four of them formed a semi-circle around the conference table, with Howard on his right, and Maria Schlessinger to his left, followed by Tom Roskin somewhere at the far end. Schlessinger was a practical lady, and she looked every bit the part of a statistician. In fact, she almost looked like a statistic herself – clear, prompt, and straightforward. Her hair was swept back in a neat bun that should've made her look older than her forty-something years, but in reality added to her charm. She had on a classy, pinstriped business suit. Next to her, Tom seemed even more out of place with his poorly tamed hair (though Ellsworth could tell he'd actually tried this time) and crooked, paisley tie.
Introductions were kept brief when the video conference began. Nobody wanted to dawdle, and Sam could tell that tensions were high. He was glad, though, that this at least had been kept as a video conference. An in-person conference tended to drag in more officials than needed to be there, and only added to the amount of hot air being blown around the room. Here, they'd cut down the number of attendees to just four outside of his own people: CIA Director Richard Kelly, the President, his Chief of Staff Wayne Palmer, Secretary of Defense William Nolan, and CDC Director Julie Gerberding.
For a moment, there was only silence. It happened often, lasted roughly thirty seconds, and was a result of not a single person wanting to begin the conversation.
Tom shifted. Sam cleared his throat.
The President spoke first. "What are the recent developments?"
"Of course." Ellsworth flipped through the brief notes jotted down through the first meeting. He could remember all that they discussed — nothing that had happened within the past four days would leave his memory, he was sure — but it didn't hurt to make sure. Besides, this bought him time to gather his thoughts and look more professional. Two birds, one stone.
In his mind's automatic attempt to distract, he wondered briefly what sort of mess Tom would've chopped that particular metaphor into.
...Best get back to business.
"We're currently still attempting to determine the exact origins of the virus — "
"You mean you don't even know where it came from?" Kelly, ever the optimistic one, jumped in.
"What I mean is that we don't have a confirmed patient zero," Sam continued, biting back a sharp retort. "Reports do, however, point rather strongly to one Michael Falburg as the index case. Sixteen years old, originally diagnosed with blastomycosis at Princeton-Plainsboro. He was treated, deemed cured, and readmitted 48 hours later with severe respiratory distress. At 0200, he was pronounced dead. This was approximately one day before the virus's outbreak began."
Filler information. If someone was going to call him on — for lack of a better term — bullshitting, it would be the Agency's Director. Ellsworth was about to barrel on before that could happen, but it was too late. Kelly struck like a viper.
"So you don't know the origins of the virus and, considering you keep referring to it as 'the virus,' I take it you also don't know what this virus even is?"
Ellsworth tried not to bristle. The discreet look Lynn shot him told him he'd failed. "This is a new pathogen. In that sense, we do know what it is; what we don't know is how to cure it."
"How about diagnostic criteria, then?"
Ellsworth hesitated. "At the moment, the blackouts preceding the full strength of the infection and the timeframe in which the virus progresses are or only indicators." He could tell that they were waiting for more, as though scientific intelligence was any easier to gather than those of the national security type. Indeed, it was harder even.
We can't just throw pathogens into Guantanamo or feed them to Jack Bauer, he thought darkly.
But in the end, the big boys were the big boys, and Ellsworth had to give them something to chew on.
"There is," he began, "one characteristic of the virus — "
Tom perked up, irritated. "It isn't confirmed! I'd only put it out there as an interesting, academic point. As I'd mentioned earlier, we haven't made any definite conclusions on this yet through the x-ray diffraction data. Merely because the NC protein — or, more specifically, its zinc-knuckle element, that is — does appear to have a —"
"There's a certain retroviral quality to the virus," Ellsworth cut in, before Tom could mention the words psi sequence, and shoot all of their feet in the process. No need to have the crickets chirping so early in the game. "As in, HIV."
At the word HIV, silence fell.
So much for avoiding crickets.
"There's no cure," Wayne Palmer said quietly. It wasn't a question.
"Not at the moment, no. There is the possibility of using oseltamivir — an antiviral – to combat the infection. However, our resources are limited and the success rate is not very high. What we need to focus on right now is damage control and containment, the latter of which would make a good segue way into our next topic of discussion."
"The quarantine, you mean." SecDef spoke for the first time.
"Yes. The one we have in place — "
"You've already extended it around Princeton," Kelly interrupted for the third time now. "You're saying it's still a concern?"
Are you saying you'll be cutting me off throughout the rest of this meeting? Ellsworth bit down on that thought and replied instead, "That is correct. It is our recommendation that there be a full state quarantine put into place."
"You do realize the impact that a full quarantine will have on the people." Palmer this time. The one who wasn't the President.
I also realize the impact that allowing this virus to spread will have on the people.
Oh, damn. His inner commentary was getting out of control. He really must be tired.
Ellsworth shifted the folder in front of him half an inch to the right, just to give himself something to do. He felt too stiff just sitting there and talking.
"Sir, the health impacts should we fail to contain the virus may very well far outweigh the social impacts of a quarantine." Lynn. God bless Lynn, apparently reading his friend's mind and giving what there was a healthy dose of diplomacy. Not that Ellsworth was entirely handicapped in that area, but it was always nice for someone else to do the work for him.
Besides, the faces onscreen had always taken more to Lynn. Ellsworth didn't really mind. The suits might not have liked him, but they damn well needed him. And perhaps he was just feeling spiteful because of the late hour, but it was that last fact which he rather enjoyed.
"By 'full quarantine', I assume you mean the complete shutdown of borders and airports?" said the President.
Ellsworth nodded. "Yes, sir. I understand it may seem excessive, but I assure you that given the circumstances, it is the only possible way we can even remotely contain the virus."
Schlessinger took this as her cue to jump in with the statistics. "We've determined an eighty percent infection rate, with an incubation period of between three days to over a week, depending. This thing spreads as fast, if not faster, than your average flu."
"If we ring everyone in, that is potentially condemning even those uninfected to die," the President said.
Ellsworth hesitated. "Yes. If I may be frank, there are no good choices here, sir. Just better ones." He paused, jaw steeling as he met each politician's gaze. This was the crucial point. Back when the Russian scare was big, this was where everything either broke or came together. Everything else afterward boiled down to logistics.
Lynn glanced at him. Ellsworth glanced back. He knew what Lynn was trying to say, but he wasn't about to mention any of that here. Not now. It was too early.
"Once we implement the quarantine, can't we begin determining who is safe to release and who is not?" Nolan asked.
"The main problem with the virus is that it is very, very similar to the regular flu, up until the patient hits stage four. At that point...there's nothing more that can be done."
"So you're suggesting that we place one large bubble over the entire state of New Jersey. No one leaves, no one gets in, regardless of health."
"That is precisely what I am suggesting. Anyone with an abnormal spike in their white count will be detained."
"We'll need a surge of security along the borders and inland," SecDef said with characteristic pragmatism. Sam thanked his lucky stars for having another military veteran on the board – someone who knew cost-benefit – to set the other politicians into line. "How long do you think?"
Schlessinger shook her head. "There's no length of time at this point. Not even an estimate. There are too many variables. Scientists still don't know why the influenza of 1918 died out the way it did."
"If you don't mind me steering the conversation away for a bit," Kelly said, "what of Orlando?"
"Specifically what about Orlando?" Ellsworth asked.
"It is my knowledge that viruses tend to spread forward, not jump clear over several states, do they not?"
"It…is an anomaly."
Tom lifted a hesitant finger in the air. "We believe the explanation may be that there are two patient zeroes, not one."
For a moment, Sam waited expectantly for Roskin to stumble down his usual path of scientific ramblings, but for once, Tom stopped there.
"Two," Kelly repeated. "Who's the other?"
Ellsworth shuffled through his notes. "At the moment, he has yet to be identified. What we do know is that he's forty-four years old of Russian origin — " A photo of the patient appeared onscreen right on cue. " — and appears to be the first case in Florida, if not the first case overall. He was admitted before the boy was. However, both died at the same time, which can mean any number of things – the virus our John Doe contracted was a milder strain, the patient was more resilient, possibly due to his military background, or the virus has more variables than we expected."
If the faces onscreen had been sitting together, they would've exchanged looks with each other. As it was, everyone just glanced down and then back up again.
"So you're saying this...superflu has somehow manifested in two areas at the same time," Palmer reiterated.
"It's a bit of a coincidence, I know."
"Do coincidences happen often in science?" Kelly remarked sarcastically.
"What might you be suggesting?" Lynn asked.
"We have a virus that has seemingly come out of nowhere. Up until this point, we've assumed that this virus has manifested via natural means, but I would say that there is a strong possibility that that may not be the case after all."
"You're saying...this virus was created on purpose?"
"I'm saying it was created and released on purpose."
Silence. Then –
"That's a bit of a leap, Richard," Palmer admonished.
"I must agree," Ellsworth said. "There's no real evidence to suggest — "
Kelly leaned forward. "You've yet to be able to determine its origins and you must admit that, given all of your careful monitoring of pathogens, you would've noticed the shift, correct?"
Sam couldn't deny that last point without admitting in front of the President that they might've been less than careful these last few weeks, and the Director damn well knew it. Manipulative son of a bitch. "That is correct," he replied stiffly.
"Then you agree it is a possibility."
"Possibility is very different from plausibility. This may be an anomaly, but it does not automatically point to foul play. As is often the case with scientific inquiry, we might've simply not discovered the answer yet." Ellsworth looked at Tom, and then instantly regretted it when Tom gave an immediate nod of agreement and began speaking.
"It's abnormal, but it could also be easily caused by an antigenic shift. Shifts are less common than your seasonal drifts of this kind, but they are in no way rare, as all that is truly required for one to occur is that two separate influenza strains infect a host simultaneously. Then, you have the typical genetic reassortation, surface protein trading, etc, etc. I would point to the Spanish Flu as an example, but we've recently learned that that was actually the result of a regular drift, and in any case, the avian flu is a more modern illustration of the fine points. Studies have shown, in fact, that this particular strain resulted from the combination of H5N — " He faltered as he realized dead silence had fallen on the conference, and that Ellsworth looked close to crawling under the table across from him. "And...of course, in conclusion, the superflu is...therefore, not." He cleared his throat. "Not a result of any attempts of bioterrorism, that is."
Not the persuasive argument Ellsworth had been hoping for, but at least it served to shut Kelly up for the time being. Kelly, and everybody else present.
Lynn was the first to recover. "It's our recommendation that we focus on containment and control. The origins of the virus can wait until the population has been protected. I am not, of course, saying that we should ignore what the Director may feel is a potential threat. It may be a good idea once we have the quarantine in place to get some people looking into that angle of the situation, as well."
Well played, Howard. They both knew that the boys at Langley wouldn't have much to do either way. Why not send them chasing after matters of national security and appease Kelly all at the same time?
The President nodded. Made some general concluding statements, to which everyone nodded, too (as if they could do otherwise). Five minutes later, Ellsworth and Lynn remained the only two in the room. Even Tom had left, tugging his tie loose on the way out.
"I do believe we've conveniently left something out," Lynn said at last.
Ellsworth stood and swept his papers back into his folder, irritated. He knew Howard would mention that sooner or later. "Yes."
"You don't think we maybe should've told the President that we're in possession of an antiviral?"
"I'm fairly certain I mentioned oseltamivir." He was being childish, but he was too tired to care.
"I wasn't referring to that, and you know it."
Ellsworth tossed down his file. The papers he'd just organized fanned out across the conference table again. "Howard, do you know how little of that we have in stock? They're going to be battling over the division of oseltamivir. We bring up the antiviral, we're going to start a nuclear war over who gets what!" He sank back down in his chair, one hand rubbing at his temple.
God, what a mess. Project Blue. The burgs. It never went away. How many times had he suspected that this thing – this limbo – would come back to bite them in the ass?
"A nuclear war might be nice," he muttered to himself. "At least we'd know what we were dealing with. Radiation. Environmental damage. Easy stuff."
"You're evading the subject, Sam," Lynn continued evenly. They both knew where this was going. "Look, we have them in store. They're right there. I hardly see why we should condemn every group to die just because you're too afraid of handling the hard questions as to why one gets it and not the other."
Ellsworth snapped his head up. "Don't you dare accuse me — "
"I know, I know. I'm sorry." Lynn paused. "That was unfair of me. But you know I'm right."
And you know there's more to it, too.
He did. "I suppose." Sam sighed, heaved himself up from the chair. Having finally managed to gather his papers, he started for the door, with Lynn following beside him. "If you want, place the call. Tell them to pack it to the military."
"The military. Medical personnel would make far more sense."
"No. Doctors are ethical," Sam replied brusquely. "They'll spread it to their patients, demand why everyone isn't getting the treatment, create a huge riot. In any case, we don't have enough for all the doctors."
"So we're essentially sentencing the very people saving lives to death?"
The last of Ellsworth's patience burned out for good. "You said it yourself. If we use it, we can only use it on one group. So we're using it on one group. If you have a better idea, let me know. Otherwise, make the damned call. I'm going home."
He slammed the door shut behind him without bothering to wait for Lynn.
There was nothing better than a cup of steaming, black coffee at two in the morning. Lynn absently stirred the dark liquid with a blue Papermate pen despite the fact that there was no sugar or cream to mix. There would've been back at USAMRIID, but he wasn't there at the moment, relegated instead to a temporary basement office at the CDC headquarters, which was Sam's nice way of throwing him a blanket and a couch for the night. He didn't mind all that much, really; it was eons better than the accommodations in Moscow when they were hunting anthrax dealers together. Another time, another bioweapon crisis. Now, it was almost twenty years later, and here they were again cleaning up the government's mess.
After a moment, he tossed the pen on his desk, splattering a few drops of coffee on a nearby memo pad, and picked up the phone. Lynn punched in the number from memory. If there was one thing he was good at, it was remembering DoD phone numbers.
Three rings total, the fourth cut off abruptly as someone finally picked up the phone. The voice that answered was distinctly feminine, but low and all business.
"Sarah Hills, Department of Operational Medicine."
"Doctor Hills." Lynn sat up in his office chair, elbows planted on the desk as he cradled the receiver in his left hand. "It's Howard Lynn. Do you have a moment?"
"Major." Hills sounded surprised to hear from him. "I can spare a few. What is it?"
"Samuel Ellsworth has informed me there is an antiviral you are in possession of," he said, getting right down to business. "What's the status on our supply?"
"One moment." Lynn could hear her shuffling aside papers and the scrape of a keyboard being pulled closer.
"Just give me an estimate," he said.
The click-clacking of keys stopped. "Our supply should be sufficient for at least 1,250 adults."
One thousand. Cutting it close, but... "That should be just enough."
There were a few seconds of silence. Then: "Major, that hardly makes a dent. There are more than a thousand medical personnel alone, never mind the addition of other vital services."
Lynn rubbed the bridge of his nose. "I'm aware of that, ma'am." He left it at that, trusting Hills would understand. This was the part he didn't want to explain. Damn Ellsworth for dumping the job on him.
More silence, a good thirty seconds this time. Then, quietly, "What do you mean by that?"
"I mean we are going to have to employ selective treatment in this scenario."
"You can't be serious," Hills said, trying to keep her voice devoid of emotion but failing to hide her incredulity. "You can't possibly pick and choose — and remove the medical personnel, of all people!"
"I never said medical personnel would be cut from the list."
"You didn't have to." He could almost hear the scientist bite back the word, Bullshit. "You said there was enough. If there is, then it can't be for the doctors, but it does appear that it can apply to the number of military troops you'll be deploying into the hot zones." Hills paused, her anger dying out, and when she spoke next, she sounded merely pleading. "Why would you remove the one group who're saving lives?"
Good question. Lynn was tempted to say, "Because Sam Ellsworth told me to," in order to pass the blame, but that would...be juvenile. And probably ineffective.
Instead, he sighed. "Could you please just prepare the antiviral for transport, doctor?"
"I...All right. All right. I'll put my people on it right away. I suspect you don't want me telling them more than they need to know?"
"That would be appreciated. Thank you, doctor."
"It doesn't mean I agree in any way with what you're doing, Major," she said. "But I can...see the necessity, I suppose." Her voice was stiff, unconvinced. "Make sure this isn't used as a treatment, though. You'll cut the number of people we can save in half if it is."
"Noted." Lynn nodded curtly to himself. According to Ellsworth, the antiviral had potential treatment capabilities, lowering the mortality rate in patients by a good 10-20 in preliminary trials…that is, before the Project was shut down. But it also required a double dosage of the prophylactic amount, something they couldn't spare at the moment. "Is there anything else I should be aware of?"
"Actually, yes. I'd like to come along with the transport."
Lynn blinked. Damn. And here he'd been thinking he was almost done with this task.
"Ma'am, you must understand that – "
"I know what you're about to say, Major, but I have my reasons for this request. This antiviral is highly sensitive material. I'm not talking about confidentiality, but physical application." Sarah's eyebrows drew together, as she steeled herself for the task she'd set before her. "To be frank, I don't trust the military to handle it properly. We already have a limited supply as it is. I want to oversee the transport personally."
Lynn hesitated. This was outside Sam's instructions. He'd warned specifically – and Lynn had agreed with him – that they should involve as few civilians as possible, let no more than the minimum military transports access the drug. It was SOP for these types of situations. However…Hills had worked in military research for a number of years, and she knew about the delicate handling of the antiviral, if not its original…source. They couldn't rely on just the Medical Corps to do the job. What she said made sense, and really — as long as the transport got to where it was supposed to, he saw no reason to bother fighting with her to keep her away.
Perhaps the fact that it was nearly 3:00 a.m. had something to do with his mindset.
"Agreed," Lynn said. "I'll have to clear it with Ellsworth, but I trust he'll understand your position."
Or...he would understand after a bit of discussion. The task would fall on him to convince his friend, but he suspected Sam was much too tired to argue for long, as well.
"All right," Hills said. "Get me a confirmation as soon as possible."
"Of course. Have a good night, doctor." Lynn waited for her to return the ironic parting words (the military had a real knack for irony) and hang up before he pressed down the switch hook on the phone, intending to place another call to Ellsworth. The man would no doubt be awake — if Lynn was up at this time, Sam most definitely was — but being awake was one thing; being alert and receptive to discussion was another. He paused midway to hitting the speed dial button. This was not a conversation he wanted to have at the moment.
Lynn set the receiver down in its cradle. Tomorrow, then.