Jakarta Pandemic, The (75 page)

“That should be interesting,” Alex grumbled.

“First, a closer look at the crisis developing in China. Department of Defense officials acknowledged today that an additional carrier battle group, comprised of ships from Hawaii and Southern California, would join forces already deployed to Southeast Asia. A battle group centered around the nuclear aircraft carrier George Washington, home ported at U.S. Seventh Fleet headquarters in Japan, is already on station in the area. Rumors of another carrier being recalled from the Arabian gulf for service off the coast of China has not been confirmed.

“Chinese government officials protested the additional deployments to the United Nations. Jennifer Moskowitz reports from United Nations headquarters in Manhattan.”

The screen changed to a picture of a blonde woman with medium-length hair, wearing a rather non-descript black ensemble, standing in front of a spectacularly illuminated United Nations Secretariat building. Several member nation flags waved in a light breeze behind her, bathed in spotlights. The broadcast was live.

“Kerrie, I’m standing in front the United Nations Secretariat building, where the mood today can only be described as tense and desperate. Chinese delegates continued to deflect questions regarding the status of WHO teams within their borders, stating only that these teams are consumed by the task of containing and mitigating the pandemic within Chinese borders and are in no way disposed to abandoning their heroic efforts on behalf of the Chinese people. Tempers flared as delegates from at least a dozen nations accused the Chinese of holding the teams hostage. Delegates from Germany and Australia went so far as to blame China once again for exacerbating the pandemic situation, a reference to China’s mishandling of the 2008 avian flu pandemic.”

“Jennifer, was there any mention of sanctions against China, or the use of force to expedite the release of the WHO teams?”

“There was no discussion or suggestion of sanctions today by the assembly, however, it is no secret to any of the members that several nations have assembled outside of UN auspice to discuss options in response to China’s actions. Chinese delegates repeatedly lobbied the assembly to formally decry the growing coalition outside of the UN. They are particularly alarmed by the deployment of an additional U.S. carrier battle group to the region, calling this an aggressive and warlike action.”

“Thank you, Jennifer. We’ll all definitely be watching this tense situation closely.”

Jennifer Moskowitz nodded and the screen returned to Kerrie. The screen next to Kerrie showed a Google Earth map of Indonesia, which started to slowly pan closer to the city of Jakarta, on the northwestern tip of Java Island.

“Reporters and a limited number of aid workers landed during daylight hours at Jakarta’s International Airport, to assess the worsening situation on Java Island. Flights are unable to land during nighttime hours, due to a complete blackout on Java Island. Initial reports passed through Indonesian health officials puts the official death toll at nearly 72,000, with over a million cases estimated on Java Island alone. One health official stressed that these figures were only an estimate, since they no longer have any competent way to track the sheer volume of cases and deaths, which grow rapidly by the hour. Health officials told reporters that they were shocked by how quickly the flu spread through the population. The first cases of the Jakarta flu appeared less than three weeks ago. Indonesian diplomats around the world, on behalf of their government, pleaded with the international community for aid, in the form of food, medical supplies and infrastructure support. WHO officials hinted that no pandemic response assets are likely to be deployed to Java Island or Sumatra. An anonymous source at the United Nations stated that WHO resources are stretched thin and are being reserved for locations where containment stands better chances of success. For Java Island and Sumatra, it appears that little hope is on the horizon. Stay with us, we’ll return in a few moments.”

The screen cut to a commercial, and Alex started to fast-forward past them.

“Maybe if they didn’t wait so goddamned long to ask for help, or let the rest of the world know about their little epidemic, we wouldn’t all be so screwed,” Alex said, shaking his head. “I’m sure the Mullahs will blame the West for this somehow. Unfortunately for them, they’ll be preaching to empty mosques. This pandemic is going to clear the bleachers.”

“Honey, that’s not cool to say. It’s going to clear the bleachers everywhere.”

She sounds pissed.

“I know, but most of the Muslim world is buried in Western-induced poverty,” Alex said in a mocking tone. “And facts are facts. Modernized societies with a modern health care system will suffer a much lower percentage of casualties.”

“It’s still sad,” she said, looking at him compassionately.

“I know, but it’s frustrating.” Alex stopped fast-forwarding.

“International Scientific Pandemic Awareness Collaborative cofounder and current director of their live information and trend analysis division, Dr. David Ocampo, joins us again, live in the studio. Dr. Ocampo, thank you for joining us again”

“My pleasure, Kerrie,”
he responded. Dr. Ocampo is wearing a navy blue blazer with a light blue oxford shirt.

“Dr. Ocampo, you briefed members of the UN this afternoon regarding the developing pandemic situation. What did you tell them, and what is your current assessment?”

“Unfortunately, I was not the bearer of good news. I started with ‘Don’t kill the messenger.’ Kerrie, at this point, nothing is likely to stop the Jakarta flu from reaching all corners of the earth. It is very likely already in every corner, every country, every major city, and spreading beyond that. Our statistical projections, based on known H16N1 propagation and transmission characteristics, put the world on an unavoidable collision course with this disease. I stepped out of my scientific role for a moment while briefing the UN and recommended that member nations, or any nation for that matter, not waste any more time or energy aggressively engaging the Chinese. Why? Because even if all of the WHO teams detained in China…and I stress that this is unacceptable behavior from a world leader like China. Even if they were all returned and magically teleported to wherever we would choose to send them…even if they were magically doubled in number, it would not make a difference. Their role was to contain and suppress the spreading pandemic early, at the epicenter and at the outskirts of its spread. Forming a perimeter. There is no perimeter anymore. H16N1 is everywhere.”

“Are you suggesting that the WHO workers be abandoned?”
Kerrie asked.

Dr. Ocampo chuckled.
“No, not at all, but from a purely scientific and practical aspect, these teams will have no further impact on the spread of the pandemic. Tensions are high right now throughout the world and will only grow higher as the pandemic gets worse. Aggressive military posturing right now may feel like the right response to the Chinese, but I fear it will accomplish little more than strain the world’s fragile peace.”

“What specific recommendations did you make to the UN?”

“Specifically, I couldn’t stress enough that vaccine research and production must be every nation’s first priority, and that these facilities, their scientists, employees, support personnel, supply chains and power sources must be protected like national treasures. Whatever needs to be done to ensure their continued functioning is critical to the world recovery effort.

“Secondly, I recommended that every nation begin to mobilize and implement their own national pandemic plans. From top to bottom. H16N1 is a particularly nasty bug, and we will not see a repeat of 2008. 2008 was scary enough, but the avian flu turned out to be surprisingly mild. The Jakarta flu is surprisingly deadly and contagious.”

“Dr. Ocampo, do you feel that our national pandemic plan is adequate, and where do we stand in terms of its implementation?”

“Do you really want me to answer that?” he said, laughing. “Of course you do. Our national pandemic plan is adequate to address the threat of a pandemic. It was created through a brilliant collaboration and signed into order at a time when intellectualism and common sense within the government was at one of its lowest points. However, it appears that this collaboration was a huge waste of time. In terms of implementation, nothing useful has been accomplished in my view. Window dressing is all. Kerrie, if FBC wanted to make a difference in our immediate future, FBC would dedicate all of its energy toward educating the public about implementing the national plan and preparing for the coming storm. This should be your calling, and every news outlet’s calling.”

“Thank you Dr. Ocampo.”

An interview discussing Acute Respiratory Distress Syndrome

“…no one truly understands all of the mechanisms causing a fatal cytokine storm. Until 2008, cases of acute respiratory distress syndrome rarely presented in a significant enough number to study. Even after the avian flu pandemic, the scientific community has made little progress towards unraveling the causes and mechanisms. However, after 2008, we can certainly link acute respiratory viral infection to the cytokine storm affecting the lungs. Especially acute respiratory infections caused by pandemic viruses. H1N1 in the Spanish flu pandemic of 1918 and H5N1 in 2008 proved adept at triggering the cytokine storm.”

“Dr. Pramanik, is there any speculation or evidence suggesting that H16N1 will do the same?”

“Currently, cases of acute respiratory distress syndrome have been confirmed in patients with H16N1, and the expected percentage of death followed. 50-75% of patients showing symptoms of ARDS died, but many of these deaths occurred in settings where patients were receiving less than optimal treatment. Prior to 2008, a patient under the best circumstances had a 50% chance of dying. Now, with a slightly better understanding of the syndrome and the medications effective in treatment, a patient has a two out of three chance of surviving.”

“But in a home setting, the chance of survival must be minimal.”

“Yes, very minimal,”
Dr. Deshvar Pramanik said.

“So what do we know about the cytokine storm?”

“Well, first, ARDS is an inappropriate or exaggerated immune response, most typically seen in a healthy immune system, which is why, historically, most of the deaths from this syndrome occur in patients between the age of 15 and 45. Men appear more susceptible than women.

“As we discussed earlier, cytokines are secreted by immune cells that have encountered a pathogen, further attracting more immune cells to increase the immune system’s response to that pathogen. The arriving immune cells similarly secrete more cytokines, and this process repeats until the body’s immune system senses a decline in the amount of pathogen.

“Now, this operates like a positive feedback loop, which if left unchecked, would spiral out of control, attracting more and more pro-inflammatory cytokine immune factors, which would in turn, continue the process until the cytokine storm is out of control. In a normal situation, this loop is dampened by anti-inflammatory cytokines that put the brakes on the pro-inflammatory process. Precisely what causes the loop to spiral out of control is one of the most frustrating unknowns my field of study.”

“Dr. Pramanik, what causes the patients to die so suddenly as a result of the cytokine storm?”

“Interestingly enough, the ultimate cause of death is multi-system organ failure, not lung failure, as you may expect. However, the attack on the lungs likely precipitates the patient’s rapid decline. Lung tissue and alveoli suffer irreversible damage from acute inflammation. This severely damaged lung fills with fluid, and can no longer adequately pass oxygen into the bloodstream. Most patients in this category present with pulmonary edema.”

“Dr. what are some of the signs and symptoms that differentiate an ARDS patient from a typical flu patient?”

“Due to rapid fluid buildup in the lungs, one of the first symptoms is a rapid and severe shortness of breath. Once the lungs have been significantly damaged and can no longer efficiently pass oxygen into the blood system, patients will show signs of cyanosis, or a bluish discoloration of the skin, starting in the extremities and slowly spreading. Blue lips are a dead giveaway combined with shortness of breath. Eventually, once all of the body’s clotting factors are destroyed by the cytokine storm, spontaneous bleeding will occur. Patients will cough up blood, develop dark blotches under the skin, vomit blood, pass blood from the rectum. At this point, the syndrome is nearly 100% fatal.”

“What about early treatment? Drugs like Tamiflu or TerraFlu? Do these have any effect?”

“Well, this class of drugs only inhibits the function of the viral neuraminidase protein, which prevents the virus from reproducing in influenza A or B. So, if taken early, it could prevent the triggering of the cytokine storm. Remember, we’re not sure exactly what pulls that trigger, but it may be a severe infection, so if you could mitigate the viral infection, then maybe you could prevent the trigger mechanism. This is complete speculation that has not been proven scientifically, nor is it supported by any clinical data. What I feel very confident saying, is that once the cytokine storm is triggered, neuraminidase inhibitors will have no impact on the cytokine storm or the patient’s prognosis.”

“So have any treatments helped these patients?”

“At this point, there is no miracle cure for these patients. ACE inhibitors and angiotensin II receptor blockers demonstrate a slight capacity to mitigate the cytokine storm, but overall have a minimal impact on ARDS. The most promising research involves administering free radical scavengers, or antioxidants, to these patients. Research indicates a trend toward improved survival and a reduction in organ damage.”