“Today, it’s much different. Security’s tighter,” Paul added. He wanted to be convinced the problem with Michael Ammar was as bad as it seemed.
“True. But since then, the world has grown more vulnerable to the disease. Considering that routine vaccination of Americans ended in 1972 and the rest of the world in 1984, and the fact the immunity of those who were vaccinated decays in about eight to ten years, we have a nation that is totally vulnerable to the virus.”
“How much of a spread are we talking about here, Doc?” Valentini said.
“Given the technical problems a terrorist faces, the risk of reintroduction of Variola remains quite low-but it’s not zero. If they were able to deliver the virus, and I repeat ‘if,’ the results would be catastrophic.”
“Why’s that?” Conway spoke up. He took deep breaths, and Paul could tell he needed a cigarette badly.
Dr. Samson stood and paced to the window. He turned and said, “When epidemiologists study the spread of diseases, they have models that can tell them how fast a disease will spread. The main figure they concentrate on is the number of people who will contract the disease from an infected person. It’s called ‘R-zero’ or the multiplier of the disease. It tells them how fast the disease will spread.
“In a modern country like the U.S. with mass transportation, shopping malls, public schools, a mobile population, the multiplier is between three and twenty. Meaning an infected person could give it to three or as many as twenty people. We don’t know for sure.” Dr. Samson moved to a white board near the table. He picked up a red marker and started to write.
No one interrupted him.
“Let’s say smallpox has a multiplier of five, which may be low. The spread of the disease will be explosive because five multiplied by itself every two weeks-the incubation period-can reach millions of cases in a few months without any control.” He drew the figures on the board. “It’s like a forest fire that expands faster and faster as it feeds on itself in an explosive transmission through a population of people with no immunity.” After he finished the numbers on the board he sat down.
Paul felt a growing panic. He looked around the room at all the pale faces.
“But as I understand these things,” Conway said, “wouldn’t you put up a fire ring around the outbreak and vaccinate everyone possible? Kind of like how we fight forest fires?”
Samson nodded. “Classic response. The CDC has stockpiled millions of doses of vaccine, but since they haven’t really been tested, we don’t know how effective it would be. And the vaccine is actually a type of pox. That means it could have adverse effects on the recipients, including death from the vaccine itself.” He poked the air with his finger. “Can you imagine quarantining everyone in the Twin Cities to their homes for two weeks or more while the medical teams vaccinated everyone? That’s how we’d build the ring around the outbreak.”
Heads around the table started to nod.
“If we can’t contain it quickly enough, we lose and the virus takes off. You see, smallpox isn’t like a cannon shooting one shell and doing limited damage. The virus is designed to go out of control, to kill as many people as possible, anywhere it can find human hosts. You asked about anthrax before … we can deal with that because it’s not transmitted by people. Smallpox is just the opposite. It’s transmitted by respiratory secretions conveyed by coughing, sneezing, or wiping your hand across your nose and touching someone else.”
Paul shifted his weight from side to side. Nervous. “Wouldn’t these cases be caught by the person’s doctor? And stopped right there?” he asked.
Dr. Samson removed his big glasses. “Maybe not because most medical doctors today have never seen the symptoms and since the disease has been eradicated, probably wouldn’t even look for it to make a correct diagnosis. In the early stages, when the patient is contagious, the symptoms look like the flu.”
“Look at the medical examiner in our case,” Joan said from the corner. “She’s good, but she missed the smallpox completely. Even with the rash on the hands. It’s lucky she didn’t get infected.”
Valentini walked around the end of the table and looked back at everyone. “I may be the only one here who’s not buying all this, but we’re living in the U.S. of A. Not Jakarta or some shit-bag slum. Why can’t we simply contain an outbreak? I just don’t get that.”
At a wave of his hand, Dr. Samson motioned a small man to step forward from the corner. “This is Dr. Kumar, our expert on that issue.”
A young Indian man with straight black hair walked to the conference table. He wore a black jacket and black skirt and leather sandals. He looked nervous and uneasy at having to speak before everyone.
“It’s true that we public health experts know how to respond. At the federal level we have vaccinated small teams of experts who can move quickly to an infected area to confirm the diagnosis and work to contain it. We call it ‘quarantine-ring vaccination.’ That’s the simple part.” He reached his arm around behind to scratch his back.
“Keep in mind however, that vaccine is useless if administered more than four to five days after exposure because the virus will already have grown in the body and overwhelmed the immune system, which won’t be able to kick-in fast enough to stop it. Think about the technical difficulties of administering huge doses of vaccine to the population of Minneapolis or St. Paul. Other than getting people together for a Vikings game, I can’t think of anything we can do to congregate people fast enough to be vaccinated. It could take up to two months-too slow and much too late.”
No one spoke. Valentini looked down at the carpeting. He must be worried, Paul thought, like the rest of us. “Yeah, and half the public wouldn’t believe us anyway. They wouldn’t cooperate,” Valentini mumbled.
Dr. Kumar put his hand inside his jacket and scratched his chest. He shuffled his feet. “Folks, there’s more.”
Paul saw all heads around the table come up to stare at him.
“If the sample stolen from Vector is here, we don’t know how ‘heated up’ it is.”
“What the hell does that mean?” Conway said.
“The Soviet scientists experimented with a number of enhancements to the virus. They exposed it to several antibiotics to force the smallpox to mutate into a drug resistant form. We call the process, ‘heating up’ a germ. The new, super-lethal strain enables the disease to crash through most vaccines.”
The doctor rubbed his shoulder and shifted to stand on his left leg. “We don’t know if that’s the case with the stolen sample … we just don’t know. So, if we can’t contain it with vaccine fast enough or if the strain can crash through the vaccines we have, it’s going out of control and we’ve lost.”
Paul could hear his words echo in the silence of the room. No one moved. Finally Conway said, “We’re here to help. What can we do, right now?”
Dr. Samson took a deep breath. “Frankly, Bill, the disease isn’t our greatest problem. That’s not the main reason a terrorist would introduce it.”
Conway scowled. “What the hell? You’ve just scared the shit out of us and now you say, ‘not a problem’?”
“Sit down, Bill,” Samson ordered. “The fact is no pandemic has ever been controlled. We’re hoping that the plan we’ve prepared will do that. In the meantime, we all have to deal with something far worse-the fear factor.” He drained the last of his coffee, reached into his pocket, and pulled out another Snickers bar.
“Remember the panic that everyone felt after nine-eleven? Remember the anthrax scares, the flu scares, SARS?” He took his time looking around the table. “Multiply that by a thousand. If the population learns of a smallpox pandemic that’s lethal, that no one is immune to, and travels faster than imaginable, what do you think people will do?”