Chapter 24. National Security
USAMRIID, Ft. Detrick, Maryland
Within 24 hours after Jacob Roessler from the C.D.C. determined that a new strain of the Ebola virus was alive and well in the State of Michigan, conference calls were frantically arranged between the scientists at the C.D.C. and the scientists and military brass at the U.S. Army Medical Research Institute for Infectious Diseases, or "USAMRIID," the military's Level 4 biohazard laboratory at Ft. Detrick, Maryland which was responsible for assisting the U.S.Army in defending the homeland from bioterrorism. The first debate concerned the question of whether to treat the Mackinac patients at the University of Michigan Hospital in Ann Arbor or to quarantine them on Mackinac Island or at USAMRIID.
Bjorn Jendel, Senior Level 4 Director of Research for the C.D.C., a tall, blonde Swede with black rectangular glasses, was adamant that the patients remain at Ann Arbor.
"Gentlemen, I am one of the few people on this conference call who has actually seen the Ebola virus up close and lived to tell about it. When the Bundibugyo strain was found in Uganda, I went into the huts where the villagers had died, only wearing a cotton mask, long sleeves and rubber gloves, and I never contracted Ebola. That's because every strain of Ebola found to date has been blood-borne, or borne by bodily fluids and secretions. It has never been airborne. Those patients have the best chance of surviving if we keep them at a top-notch hospital, with top-notch specialists, and maintain strict barrier protocols."
Army Col. Dennis White with USAMRIID, a white-haired colonel with a tan complexion, was hundreds of miles away in Maryland, staring at disbelief into the speakerphone. White’s job was to protect Americans from terrorist bioweapons attacks. "Dr. Jendel, I could not disagree with you more. You haven't finished running your tests yet and we will not know until tomorrow or the next day as to whether this bug is airborne. If it is airborne, and it goes through the ventilation shafts, it could hit everybody in that hospital. Hell, it may have hit people in the hospital already. If we have one relative in that hospital who catches this bug and boards a plane, we have a nationwide epidemic on our hands!"
"Col. White, let's look at the facts,” said Jendel calmly. “We think this bug came from Tanzania from these two monkey researchers. They boarded a plane in Tanzania and landed in Rome. We have no reports of patients with similar symptoms in Rome. Then they landed in New York. We have no reports of the virus in New York. Some of the people on that international flight to New York then boarded other planes to their hometowns. So far, the FBI has tracked about half of the passengers on that plane to their home towns. Neither those passengers nor anyone in their towns have reported symptoms indicating that the virus is present. The monkey researchers then traveled to Detroit. Again, the FBI tracked the passengers on that plane. No symptoms yet. No symptoms in Detroit. Then they went to Mackinac, where they got sick and vomited on the gastroenterologist and bled on the nurse. The emergency room doctor, Dr. Adams, went into help the gastroenterologist when the husband began crashing and undoubtedly came into contact with the black discharge from the husband's anus. His foot covers were drenched in the black stuff. The blood tests from the gastroenterologist, the nurse, and the emergency room doctor show that all three are infected with the virus. That indicates to me that this strain of Ebola, just like all other strains of Ebola, is borne by bodily fluids."
Jacob Roessler, who was seated next to his co-worker Murielle Winston, and down the table from Dr. Jendel, passed a note to Winston which read, "He doesn't know that!! We are still running tests!!" Murielle Winston passed the note back, and gave Roessler a facial expression which said, "I know, but what can we do?"
Dr. Ivan er, a fifty year-old Infectious Disease specialist at the University of Michigan, was also hooked up on the conference call. “Gentlemen, this is Dr. Berkhoff. I am in charge of Infectious Diseases at this hospital. One thing you should know is that we have a special quarantine wing set up just for a scenario like this. Each of our ten rooms has its own ventilation system. The rooms are not connected with ventilation shafts. Even if this virus was airborne, it would not be spread to the rest of the hospital. When the Life Flight helicopter was in the air, the doctors on the helicopter called in and spoke to me and described the symptoms and the wife's concern that this might be a hemorrhagic virus. When the patients arrived on the helicopter, they were sent immediately to the quarantine wing out of an abundance of caution. Only myself, an emergency room doctor here at the hospital, and three other nurses interacted with these patients, all while wearing surgical scrubs, cotton face masks and latex gloves. The C.D.C. folks got up here almost immediately, within a day of the patients' arrival, and kind of took over from there. They brought with them some kind of field test kit which allows us to test for the virus rather quickly through a blood test."
Jacob Roessler boldly spoke into the speakerphone from the C.D.C. "Where are the crew members from the helicopter?"
"They were tested and they show no signs of the virus."
"Dr. Berkhoff, have you and your team been tested?" asked Roessler.
"Yes, thank God, we have no signs of the virus in our blood. Thank you for asking."
Captain Roger Tsung, M.D., a young Asian scientist at USAMRIID, was with his boss. "Dr. Jendel, let's assume that this strain of Ebola IS airborne. Let us further assume that this strain is not contagious within a certain number of days, let's say the first seven days as an example. That would explain the lack of reports of sick people with the virus in Rome, New York, Detroit, and so on. The patients did not become contagious until day seven. Then they breathed on the Mackinac hospital staff, infecting them. Because the Ann Arbor staff wore masks, they did not get infected. If that were the case, that would explain all of our results, yet the pathogen would be airborne. Is that possible?"
Dr. Jendel considered. "Certainly, Dr. Tsung, that is a possibility, but I sincerely doubt…"
"And, Dr. Jendel, there is simply the possibility that there are infected people in other locations, and the doctors there have no idea what they are dealing with," said Tsung.
Murielle Winston spoke up next. "The C.D.C., upon learning that this was a strain of Ebola, sent an immediate e-mail and fax to every state health center, so I would think our health centers would at least be looking for this."
The President of the United States, Anna Scall, was present with the USAMRIID staff at Ft. Detrick and was listening to the dialogue and opinions.
"Has the Michigan Highway Patrol locked down Mackinac Island?" asked the President.
"Yes, Madame President," said Michigan Highway Patrol Director Ben Needles from his office in Michigan. "No one is getting in or out. Those people are pretty unhappy up there. No one has told them what's going on. We are just saying it is a matter of national security."
"How soon until the C.D.C. finishes the tests to determine if the virus is airborne?" asked the President.
"One or two days," said Jacob Roessler at the C.D.C.
"Make it one," said the President. "We need those results immediately. Whatever resources you need, let us know, and you will get them."
"Absolutely, Madame President," said Roessler.
The President turned to Sheila Simms, the Director of Homeland Security, who was present with him in the conference room at USAMRIID. "Sheila, has the FBI interviewed this Monahan woman yet? Do we know for sure that this is not connected to terrorism?"
Simms looked at a file. "No, the FBI has not interviewed her yet because we have been trying to accumulate a file on her. That should be done within the hour. What we do know so far is that Kelly Monahan and her husband are in their fifties. They are legitimate chimpanzee researchers. They have written a few books. The have been teaching at the University of Michigan for over twenty years each. They have no criminal background. They are Lutherans and appear to have no ties to Al-Qaeda or any terrorist organization. The finances report is almost done but from what I understand so far, they are not in any financial trouble. They have a couple kids, all upstanding citizens. The only place they have been overseas, according to their passports, is Tanzania. From everything we know from interviews with their neighbors, they are a normal, boring, middle-aged couple. In short, I see nothing to suspect that they got this virus deliberately or intended to infect others as some form of terrorism."
The President seemed bothered by the answer. "Sheila, this woman has a fatal disease. She could be dead within an hour or two, and any information she has will be lost. Don't worry about having your file complete. Get someone over there immediately to interview her."
"Yes, Madame President," said Simms, perturbed that the President was schooling her in front of the others on the conference call.
"Where are we on a possible cure for this thing?" asked the President.
Jacob Roessler from the C.D.C. spoke next. "Mr. President, in July 2010, AVI Biopharma won a $291 million DOD contract through the Transformational Medical Technologies Program to begin development of a possible cure for hemorrhagic viruses like Ebola and Marburg. The drugs are called AVI-6002 and AVI-6003. In August 2010, trials were performed on rhesus monkeys. Sixty percent of monkeys infected with the Ebola virus and eighty percent of monkeys infected with Marburg were completely cured within fifteen days. I should mention that the Ebola strain used in the tests was the Ebola Zaire strain. As we know, the strain in Michigan is entirely new. AVI-6002 and AVI-6003 have not yet been tested on humans because they have not gotten FDA approval yet. However, in February 2011, AVI successfully completed the Rapid Response Exercise supported by TMT under the U.S. Department of Defense Chemical and Biological Defense program through Defense Threat Reduction Agency contract HDTRA1-09-C-0046. During that test, AVI designed and manufactured a novel RNA-based drug candidate against dengue virus in only eleven days. In May 2011, Phase 1 trials began to make sure the AVI drugs were not harmful to humans, and preliminary results from those tests are very good. For obvious reasons, no actual live tests on humans have occurred yet, but now may be the perfect time. If we could get a Fast Track waiver from the FDA, we could have AVI-6002 and AVI-6003 in the hands of the Michigan doctors overnight."
"What does the C.D.C. think of these new drugs?" asked the President.
"We are very hopeful they will be successful, Madame President, and to date we have seen no harmful side effects," said Jendel.
"That's good enough for me. Sheila, get the FDA Director on the line with me after this call. We need a waiver for AVI immediately."
"Yes, sir."
"OK, we are going to get you those drugs. Administer them to the infected patients in Michigan, and then let me know immediately whether they get better. In the meantime, since Ann Arbor seems to have this thing locked down tight, I see no need to move these patients. In fact, I see more danger in moving them. No one who is infected gets out, and we try the best we can to cure anyone who is infected."
Needles, the Highway Patrol Director from Michigan, spoke next. "Madame President, how long are we going to keep those people in Mackinac locked down up there?"
"As long as it takes. Bill, are you on the line?"
Bill Swift, the Governor of Michigan, stepped into the screen on the teleconference. "Yes, Mr. President, I am here."
"Have you called out the Guard?"
"Yes, sir. The Michigan National Guard is already assisting law enforcement. Right now, they are making sure no one gets off the island and they are providing extra security at the hospital. But they await any additional orders you have."
"Jacob," asked the President. "If someone contracted this virus yesterday, could you tell that with a blood test today, or do you have to wait a certain number of days for it to show up?"
"Generally, within three days of contracting the virus, we can catch it in our field blood test." The President considered that.
"Bill, how many people are on that island right now?" asked the President.
"We have about five hundred permanent residents, and we estimate about fifteen thousand tourists," said the Governor.
"OK, Sheila, what plans do we have to get out of this mess?"
Sheila Simms cleared her throat, and handed the President a folder with a Top Secret report inside.
"Madame President, we have developed a detailed plan for the people in Mackinac.
Step 1. Security. We maintain the National Guard and Highway Patrol lockdown of the island, letting no one in or out until further notice. We lock down the quarantine wing at the hospital. Again, no one but CDC and USAMRIID personnel, and the few Ann Arbor doctors previously mentioned, gets in or out. Anyone who has any contact with those patients is locked down in quarantine at the hospital.
"Step 2. Medications. We get the FDA Director to give an Emergency Fast Track Approval for the AVI drugs. We air ship them to the doctors in Ann Arbor. We have our CDC personnel in HAZ suits administer the medications to the patients at the hospital and see how they respond. If the results are positive, then we tell AVI to implement their Emergency Response Protocol and start producing as much of these drugs as we can.
"Step 3. Blood Testing. I think we have no choice but to blood test every single person on that island. We do not know who has been infected, whom they have infected, and whom those people have infected. Whether this is airborne or not, no one can leave the island until they have been tested and cleared. The problem, as you have pointed out, Madame President, is that you might have the virus for a few days before it shows up in a blood test. So if we tested you, it might come up clean, when you really have the virus. So here is what we would propose: we send in USAMRIID and CDC personnel, as well National Guardsmen in HAZ suits to the island, and explain what is going on to residents. Then we set up two secured sites, one on the north side of the island and one on the south side. The southern site will be Fort Mackinac. It is an old eighteenth century fort with lots of buildings which is easy to secure. Each person on the island will need to go to Fort Mackinac for their first blood test. If they are infected, they are airlifted by helicopter out of the fort to Ann Arbor and treated like the other patients. If their test is negative, they are taken by ground transport by Guardsmen to Port Aux Pins on the northernmost edge of the island. We will set up temporary MASH tents there and secure the northern site. Anyone who has passed Test #1 is quarantined for seven days at the northern site. At the end of the seventh day, they get a second blood test. If they are clean, then they are taken by boat off the island. We continue this process until everyone on the island has been processed and is determined to be either infected or clean.
"If the person being tested is a local resident, they must first leave the island after being tested. Then, after the entire island has been cleared, they can return back to the island.
"We will also need HAZMAT teams to clean up the mess and all bodily fluids left at the Mackinac Hospital.
"Step 4. National Security. We need to make sure no one else enters the country with this virus. Therefore, we are recommending a quarantine of all persons coming into the country who have been in Tanzania. We also need to make sure all hospitals and clinics across the country are made aware of the symptoms and signs of this new virus and to contact the CDC immediately if they see any sign of the virus in any other part of the country. And then, Madame President, it will be up to you to decide what, if anything, you want to tell the nation about what has happened. My own feeling is that with all these people involved, the word is going to leak out eventually. I think it would be better if you addressed the nation so that they have all the facts. Again, that's up to you."
"Thank you, Sheila," said the President. "Does anyone have any comments, criticisms, or suggestions regarding this plan?"
No one answered. "OK, I think this is as good a plan as any. Let's implement Sheila's plan immediately. I want to set up another conference call tomorrow afternoon to discuss the CDC's tests on whether this is airborne. For now, you all have your assignments."
The President terminated the teleconference and turned to her Director of Homeland Security, whispering, "This is a real shit storm."