When Pigs Flu…

By Jake McKenzie

Based on an actual event --the inadvertent shipping of pathogenic H2N2 strains world-wide, this thriller is the suspenseful tale of missing samples falling into the wrong hands. Despite her best efforts, heroine, SGT Maria Alvarez, USMC, is thwarted by all too common government bungling that dooms her mission impossible. Once Pandora's box has been opened, can the pathogens ever be returned? Despite the concerted efforts of the military, international police, and medical experts, the risk of pandemic surprisingly comes from a most unexpected source

• Language: English
• Publisher: AuthorHouse
• Release date: Dec 23, 2010
• ISBN: 9781452077956

Jake McKenzie

Jeff Drifmeyer, writing as "Jake McKenzie," holds master’s and doctoral degrees in environmental science from the University of Virginia, and a master’s in public health from Johns Hopkins. He served on active duty for over two decades in the Army Medical Service Corps, overseas twice and throughout the U.S. including duty at Fort Monroe. He’s written many scientific articles and was an award-winning research professor at the military’s medical school, Uniformed Services University of Health Science. He was a division chief at the founding of the National Center for Medical Intelligence bringing homeland health protection issues to the forefront. He was working at the Veteran’s Affairs hospital in Hampton, VA when diagnosed with rare, neuroendocrine cancer. During this ongoing health struggle, he’s reinventing himself as an author. Under the pen name, Jake McKenzie, his first book, “When Pigs Flu…” (ISBN 978-1-4520-7797-0) is a fast-paced military thriller. A ‘what if…’ scenario – inadvertent release of pathogenic viruses from U.S. laboratory control, is based on real events. The ensuing recovery mission becomes frantic before vials fall into the wrong hands, or disease outbreak occurs in a most unlikely place. (Available in paperback or e-book, from www.authorhouse.com) His pending release, Civil War Comes Home, a work of narrated nonfiction, chronicles what it was like to live in a small, sleepy Southern town, Williamsburg, Virginia when the Civil War arrives on the doorstep. As the author lives here and has first-hand knowledge of the locations –from town to college to battlefield, the diverse perspectives of slaves, students, soldiers, and townspeople are told in authentic detail. Theirs are stories are of sacrifice and hardship, yet hope and perseverance. They provide insight about our predecessor’s determination and fortitude in the aftermath of pitched battle, Emancipation of slaves, and lengthy Federal occupation –events of 150 years ago.

Book preview

When Pigs Flu…

Jake McKenzie

missing image file

AuthorHouse™

1663 Liberty Drive

Bloomington, IN 47403

www.authorhouse.com

Phone: [phone]

© 2010 Jake McKenzie. All rights reserved.

No part of this book may be reproduced, stored in a retrieval system, or transmitted by any means without the written permission of the author.

First published by AuthorHouse 12/20/2010

ISBN: 978-1-4520-7797-0 (sc)

ISBN: 978-1-4520-7795-6 (e)

Printed in the United States of America

This book is printed on acid-free paper.

Because of the dynamic nature of the Internet, any Web addresses or links contained in this book may have changed since publication and may no longer be valid. The views expressed in this work are solely those of the author and do not necessarily reflect the views of the publisher, and the publisher hereby disclaims any responsibility for them.

Contents

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

29

30

31

32

33

34

34

35

36

37

38

39

40

41

42

43

44

45

46

47

48

49

50

51

52

1

Baltimore, Maryland

OKAY, SEE YOU GUYS TOMORROW, Talal announced to fellow graduate students, hanging up his lab coat. It was already well past midnight, he’d finished running the analysis on the last batch of samples, and decided to call it quits after another long day. Every day was long as he labored to finish his dissertation.

I’ll give you a ride if you can wait a few minutes, a friend offered.

Thanks, but I’ll walk, Tom. By the time you finish, I’ll be home, Talal joked, thinking it’s only a few blocks, I don’t need a ride. He saw the rain had mostly stopped, see you tomorrow, he repeated to his cohort —all budding scientists at Johns Hopkins University. Since the hospital and its associated labs practically never closed, they didn’t get much sleep. Talal was down the stairwell, out the rear service entrance —closer to his apartment than the main entrance.

Hearing his approaching footsteps, rats scurried across wet, black streets for the safety of their dumpsters but Talal paid no attention, then pondered…within the shadow of infectious disease research and world class care, vermin run the streets —despite the best efforts of the Sanitation District. Deep in thought he replayed a problem in his research he couldn’t seem to solve, and failed to notice the group gathered on the sidewalk up ahead. More vermin only the two-legged variety, he thought. Often he’d cross a street to avoid trouble especially late, but tonight, figured, just walk by, ignore them, it’ll be okay.

Yo, mothafucker, where ya think you going?

Eyes averted, Talal kept walking picking up his pace.

Hey, fuckin’ rag head, I’m talkin’ you, man.

Heart in his throat, Talal proceeded nevertheless.

God damn it ya fuckin’ camel jockey, what the fuck you think you doing?

Nothing man, just going home, Talal said calmly, figuring ignoring them further would only antagonize.

Why don’t you go the fuck back to the sand pile you came from, asshole?

Talal tried to pass cautiously, wanting to run but knew better —they’d pounce like I was a rabbit, he thought, just stay cool, keep moving, and get past these jerks.

Suddenly, they struck. He didn’t see who hit him first but it hardly mattered, as all of them were on him instantly; kicking, hitting and cursing, berating him for being Arabic. Talal tried to force his way past their blows but there were too many and soon he was knocked to the pavement. He tried to cover his head, but surrounded, their heavy blows struck fast and furious. He tried to cry out for help but it was impossible, besides being pointless on the deserted street. He reeled from their seemingly never ending pummeling and lost consciousness. Their victim immobile, the thugs lost interest and moved off, leaving Talal a bloody pile on the pavement.

A short time later…

Officer Mulroney keyed his radio, Patrol forty-seven to precinct. Over

Precinct here, what’s up forty-seven? Over.

We got a victim, male, 20-something, Middle Eastern, badly beaten, corner of East Pratt and 17th.

As the crime scene was but a short distance, Paramedics Jones and Washington arrived momentarily from Johns Hopkins University Medical Center, How’s he doing?

Not sure, I think I felt a weak pulse but he’s beaten bad, Mulroney offered.

Damn, he’s lost a lot of blood, Jones remarked, assessing their patient, carefully placing him on the stretcher. While the medics loaded their patient, Mulroney quickly checked his wallet. Cash in tact –not a robbery. He found the victim’s student identification; Talal al Zanki, doctoral student at the Bloomberg School of Public Health for the past three years, and recalled the precinct had received FBI warnings of anti-Arab violence. At the time, most of the force dismissed the warning but now he’d seen it. Talal was beaten simply because he was Arab. Damn! Mulroney exclaimed, frustrated, Here’s a young guy coming home from working late, and he’s set upon by a pack of damn wolves and for no fucking reason.

With traumatic brain injury, cracked ribs, and multiple contusions, Talal’s prognosis remained guarded. Then after several days, a night-duty nurse heard his faint whisper, Can I have some water? Talal mouthed a prayer of thanks not to Allah, but to Jesus for he was a minority – a Christian Arab. Pleased her patient had finally spoken, Nurse Watson pulled a chair bedside. Others will just have to cover the rest of ward for a few minutes, she thought, taking time with her patient.

My dad first worked for British Petroleum, then Halliburton Industries, Talal volunteered. We moved around a lot -all over the world. It was the nature of international oil and ever-changing exploration and drilling, then quickly noted, despite frequent moves, I got to do things other kids never even imagined. I’m a world citizen; born in Jordan, lived throughout the Middle East, Africa, even Indonesia, and now, I’m studying in the U.S. Or, at least I was until this, voice trailing.

Nurse Watson took Talal’s lucid recollection of his childhood as a good sign –perhaps brain injuries were not as bad as originally feared?

What about your name? What does it mean? trying to continue the conversation.

Its ‘admirable’ in Arabic, he explained, and, I’ve always tried to live up to that. Turning away again, I’ve always tried to do the right thing, to make my father proud. This only made the attack more difficult to fathom.

I’m so sorry, was all Nurse Watson could manage. Even if his injuries are not that serious he’s going to need a lot of help with post traumatic stress. Try to get some rest, she offered exiting, though Talal’s thoughts had already taken him afar.

It was many days before he could manage anything more than limited conversation or whispering his prayers. He still faced months of physical therapy, yet, his youth, determination, and good health otherwise allowed remarkable recovery.

In anticipation of his pending discharge from hospital, his fellow graduate students collected his few belongings, storing them at their shared row house. Like Officer Mulroney, none understood the hatred behind the attack; Arabs, Persians, or anyone appearing Middle Eastern were neither welcome nor safe. Post 9/11, a new racial hatred had surfaced and Talal had nearly been killed.

Although he healed physically, psychological impacts lingered. He’d felt robbed — his life in America seemingly over. His research on emerging filoviruses, and development of new rapid diagnostic tests was nearly complete and his professors and students alike, begged him to stay. Talal’s research represented a considerable body of publishable work, especially with the growing pandemic risk. However, he no longer had the stamina for the grueling pace and despite a lifelong dream of becoming ‘Doctor’ he’d written his father explaining his pending return to Amman. ‘Someday, I’ll come back, he vowed, but now I just need to be home with family.

Although his studies were demanding, Hopkins was a dream come true. His family had sacrificed in countless ways for him to attend a prestigious American university, which he was now leaving. Although he lacked the advanced degree, Talal was indeed an expert in virology and his knowledge was sought.

Others had also been in touch with Talal, though their motivations were hardly renewing old friendships. Some fellow Arabs never understood why he’d left for America in the first place while others who’d never been anywhere but the Middle East, were incapable of anything but their usual rhetoric —America is the Great Satan, a Zionist puppet and arch enemy of Islamic faithful. When they learned of Talal’s beating, it confirmed in their closed minds, the infidels’ evil for they mistook a crime for what they insisted was a corrupt society. They wanted to talk to Talal as soon as he returned, inshalla, if God wills, for they’d visited many internet sites mentioning bio-weapons as the ‘poor man’s weapon of choice.’ and they figured Talal had the microbiological expertise required for their nefarious plans.

The last few days were a hectic round of packing and good-byes - he’d remember his Hopkins friends and time in America fondly. Then finally he was on his way, - from Baltimore Washington International, with a change of planes in Paris to Amman.

Boarding the plane he was glad he talked the cute Air France ticket agent into re-issuing him an aisle seat so he could get up to move about. Even with therapy, his back still troubled him, but he was soon asleep. Next thing he knew, he awoke with a start.

Ladies and gentlemen we’ll be landing at Charles de Gaulle International Airport, Paris momentarily, where the local time is 10:30 a.m. As soon as they reached the gate, Talal was up in the aisle. He had plenty of time before his next flight, but he’d been sitting so long he just needed to walk around. Making his way down the jet way, he followed the colored arrows on the floor to a different terminal. Terminals A through F and they’re still building, he noted. He had to go through security again, even though he’d not left a controlled area. Getting in line, he saw security personnel nodding in his direction, and recalled how his friend, a Saudi medical student, was detained just long enough to miss his flight. Someone decided he needed a full security check. There was nothing random about it. It was racial profiling, and had absolutely nothing to do with improving security. Damn, are they going to cause me to miss my flight? Talal worried. Only after they completely unloaded his backpack, inspecting every item closely, was he allowed to pass.

Making his way down the stairwell to the gate E-73 waiting area, he saw the agent preparing to open, and noticed most everyone waiting was Arab - far different than the terminal he left -crowded with Europeans and Americans. Again answering inane questions about whether his backpack had been in his possession at all times, he eventually was allowed to pass. Of course I’ve had it, if it hadn’t, it have been stolen. Eventually, he boarded the low airport bus for the ride to the aircraft - winding around the terminals and construction detours. It’s a wonder these guys don’t get lost, noticing how most of the airport workers appeared Middle Eastern, not French.

A strike here would play havoc, he pondered. They don’t have to burn cars all they need is a mass sick-out of airport service workers. No violence but global flights come to a screeching halt and it’d be days before it’d be sorted out. They don’t even have to strike, somebody simply enters an exit door then disappears and the whole place shuts downs. Talal quickly dismissed such thoughts, for he was neither terrorist, nor activist, but he had studied complexity theory and was fascinated by the inherent vulnerability of large complex systems to a single point of failure. He was intrigued by parallels between man-made and biological systems such as the virus-human and animal host disease models he researched. What triggered emergence of new viruses or their rapid spread in some human or animal populations, but not others, he sought to understand.

Talal had difficulty climbing the stairs to the plane for he hadn’t regained full range of motion, but eventually made his way to his seat and tried to get settled for the five hour flight to Amman. Between the poor ergonomics of coach seating and the anticipated family reunion, he couldn’t seem to get comfortable.

Flying east, time sped ahead and they descended into darkness, Amman’s lights twinkling in the black desert void. Even in the short time he’d been away, the capitol had grown significantly —four out of five Jordanians now calling it home. Despite the urban sprawl, the capitol still retained its unique contrast of ancient and modern with Bedouin tents pitched in the shadow of Fortune 500 offices. Diverse elements occupied the same physical space, but operated in completely different worlds.

Amman’s two million appreciated their island of stability in the violence-prone region. Familial and tribal ties reinforced for dozens of generations remained inviolate, guiding family and business alike. At the same time, al Jazeera broadcast 24/7, internet cafes were crowded at all hours, and a growing schedule of international flights brought global issues home, wanted or not. As a world traveler, Talal appreciated this diversity.

Exiting the gate he spotted his family and they reunited in kisses, hamdulillah, praise be to God! Claiming his oversized bags, they piled into their old Mercedes for what was usually a 45 minute drive home; only speed limits are not observed at night so they were home in about half the time. They’d not eaten in their rush to the airport and although the hour was late, Talal’s mother soon served an extensive spread; lamb kabobs, several rice dishes and salads, and flat bread with hummus. Talal could not recall when he’d last eaten so much, and although conversation was lively, after the long flight sleep called.

2

March 21, 2006, Dulles International Airport, outside Washington, DC

COL. JOHN RICHLANDS, M.D. HIT speed dial for his wife, Ruth, Hi honey, yes, the flight from Atlanta’s on time. I had to leave the Fifth International Conference on Emerging Infectious Diseases, early. I’ve got to be in Geneva for the Humanitarian Health Cluster meeting of the Inter-Agency Standing Committee of the World Health Organization (W.H.O.). Yes, honey, I know, it’s all gobbledygook. I know I gotta get a simpler schedule. That’s why our vacation is going to be great. Promise.

OK, have a good flight and I’ll see you in a few days.

Honey I’ll call you as soon as I can. Love you. Bye.

Passionate about his life’s work —infectious disease research, he welcomed the opportunity to share his message, —the need for collaboration and information-sharing in order to counter the threat of pandemic influenza, with international colleagues. The month prior, during its 117th executive session, the W.H.O. board had discussed Dr. Richlands’ contributions with a slim majority moving to hear him out, despite the objections of some against military personnel. It was all politics at this level. It was to be a two day working session at Château des Penthes, Pregny, Geneva.

Checking his blackberry before boarding, COL. Richlands found just one new message — unusual for he usually had a lot, but this one is flagged ‘priority.’ The public address speaker at gate C-21 blared, Ladies and gentlemen, in a few minutes we’ll begin boarding United’s flight 890, with nonstop service to Geneva, as he scrolled:

ALERT from CDC

"Potentially hazardous material contained in the Proficiency Testing Services: VR1A-2005, VR-4-A-2005, and XL-C-2005… a specimen in these shipments was Influenza A subtype H2N2, which is currently being considered for reclassification by CDC and National Institutes of Health (NIH) from a Biosafety level 2 to a Biosafety level 3…immediately destroy samples containing this virus. This action was deemed prudent because of the increase in susceptibility of humans…working with H2N2 viruses could theoretically pose a health risk to laboratory staff born after 1968. A representative H2N2 virus is not contained in current trivalent influenza vaccines. Due to potential and theoretical risks working with H2N2 viruses: immediately autoclave, incinerate and treat as hazardous all materials…from:

Specimen VR1-05 contained in 2005 VR1 Virology Culture Survey.

Specimen VR4-02 contained in 2005 VR4 Virology antigen Survey.

Specimens XV-04, XV-05 in 2005 EXCEL M21 Viral Antigen Modules.

Confirm within 24 hours that the above mentioned proficiency specimens and all derivatives have been destroyed. Monitor laboratory staffs that have worked with proficiency specimens for influenza-like illness and follow up with laboratory testing to determine the etiology of infection.

Immediately pass this information on to any laboratories to which you may have sent proficiency testing specimens and report this action to the College of American Pathologists."

Why are they sending this now? These samples were sent out fall 2004. They were shipped for five months before anyone noticed a problem and by then, H2N2 went to over 6400 labs, some overseas, he recalled.

CDC was again asking about Dept. of Defense (DOD) overseas medical research labs. Damn, under his breath, I’ve already explained that, then thought, how are we supposed to Collaborate internationally when we can’t even get our act together in the U.S? I just want to give my presentation to W.H.O then have a nice vacation with Ruth, and now this damn CDC mess again. I told them at the outset, ‘just send the samples to me at Walter Reed Institute and we’d distribute, but they never listen. Instead, they mail directly and look what happens–-a major screw up —pathogens sent out worldwide!’

COL. Richland’s plan for Walter Reed Army Institute of Research (WRAIR) to distribute CDC’s proficiency samples to DOD labs overseas was never implemented. Information wasn’t passed to the College of American Pathologists or its contractor, Mercator Biological, LLC of Dayton, Ohio, the firm contracted to package and ship CDC’s proficiency samples.

COL. Richlands spent an inordinate amount of time answering Congressional inquiries, Inspector General questions from both Departments of Defense and Health and Human Services, and the never-ending barrage of investigative reporters. Despite redundant, ‘no-stone-left-unturned’ investigations, it was never clear how exactly it had happened and this served Washington well —politicians got prime time media coverage, yet no one’s actually held accountable.

In addition to bona fide public health risks, there was concern how the media might spin the irony — a possible disease outbreak caused by the very Federal agency charged with disease prevention. Jon Stewart would have a field day, he thought.

These official investigations hadn’t satisfied Richlands or Anders for a minute as they knew H2N2, or ‘Asian flu’ as it was known during the 1957-58 outbreak, had once killed over 70,000 Americans. They also knew H2N2 hadn’t circulated in humans since 1968, and thus, no one born since then had natural immunity. So, in addition to public health concerns, COL. Richlands wondered about national security implications, If H2N2 reappeared, whether naturally or somehow as a bio-weapon, it’d hit those born after 1968 hardest because they lacked immunity, and it’s this age group that provides much of the military’s manpower. What if someone started a war but those relied on to enlist are already sick or dead? The thought of terrorists exploiting this kept Pentagon lights burning.

Fixing blame is pointless, he thought. The main concern is recovery of all H2N2 specimens — before a disease outbreak, or they fall into the wrong hands.

Finally boarding, making his way to the rear, he crammed his 6’ 1 frame into a coach seat, and continued reviewing email until, All electronic devices must be in the off position," played for the second time. Quickly scrolling, he read,

Can you provide point of contact, Navy lab, Indonesia? signed Doug Anders, Ph.D. CDC Lab Quality Assurance Div.

Turning off the device after the flight attendant’s stern request, he wondered, ‘Here I’m going to W.H.O. to advocate ‘sharing information’ and a year into this fiasco I’m still getting requests for contacts at a closed lab. Unbelievable.’

3

Centers for Disease Prevention & Control, (‘CDC’), Atlanta.

ANDERS’ EXPLAINED TO THE CALLER, as patiently as he had many times previously, The purpose of the microbiology proficiency program is to ensure that medical labs accurately identify unknown microorganisms. We send innocuous strains to test medical labs’ proficiency in identifying unknowns. It’s no greater risk than delivering yogurt to the grocery.

Indeed, there’d never been a problem in the history of the program —until now, when the virulent 1957 strain of H2N2 influenza virus was mistakenly sent out. After the largest recall in the history of CDC, 99% of the samples were finally accounted for. As far as the public was concerned, that was the end of it and the media was chasing fresher news, but for Anders, Richlands, and a handful of others who understood the risk, the recovery effort continued. Some said Anders was obsessed with it —full accountability regardless of cost. It was his program, he felt responsible, and had explained repeatedly, with thousands of samples shipped, even 1 % missing, means dozens of vials are still out there —any one of which could cause an outbreak! Recovery from overseas had been less than at home and despite trails long cold, the recall would continue ‘til the last vial was found, at least according to Anders.

He went on, employees using good laboratory practice would not likely become infected. Yet, there’s a remote possibility if someone were infected, illness would spread to co-workers, medical staff, patients, or visitors. With person-to-person transmission new cases would grow exponentially—faster than we or anyone could respond. Anders elaborated, The population-at-risk is quite large. Even with the best contingency planning an outbreak spreading from the health care system would be disastrous –we already had that with SARS. Hospitals become sources of infection rather than healing.

In all, 6,450 H2N2 test kits were mailed. Fortunately, many were never opened, as urgent calls reached many labs ahead of the actual shipment and these returned specimens were now secure in cryogenic vaults deep within CDC’s level III bio-containment. H2N2 samples sent to Dept. of Defense overseas labs were accounted for by Army Colonels in Nairobi, Sao Paolo, and Bangkok and Navy Captains in Cairo and Lima. These lab directors proposed, and CDC quickly agreed, destruction on-site in their high-pressure steam autoclaves as this posed lower risk than mailing samples back. Chain of custody documents were soon faxed and the matter resolved –except in the case of Jakarta.

Into this ongoing recall effort, Sgt. Maria Rosa Alvarez reported for duty. Walking across CDC’s modern campus, she wondered all I wanted was to pursue my career. Now I’m reassigned in Atlanta. I’ve never had an assignment like this before, nor did I even want it. There’s no other Marines here. Even in Iraq or Afghanistan, I was with friends. Here I might as well be a lab rat or something. The research facilities, underground and high rise, were unlike any base she’d ever set foot on —bustling Atlanta a kind of polar opposite of the vast emptiness of her Navajo reservation.

Although unsettled by this alternate world of civilian research, she’d adapt as she always did. She was friendly, and a Native American woman Marine was something of a novelty, so everyone wanted to meet her. Maria had no trouble making friends for each new assignment meant new acquaintances —though often short-lived.

The plan is you rotate through different sections, four to six weeks each to learn their operations first-hand, Dr. Anders explained. We’re really glad you’re here, going on to explain the backlog from the H2N2 sample recall. According to our records, some of the samples still missing were sent to the U.S. Navy’s lab in Jakarta. We need you to retrieve them. this totally surprised Maria. Having just arrived, she hadn’t expected to travel, but she accepted the surprise assignment, despite trepidations.

‘Don’t come home without them,’ he joked, not knowing what those words meant to a U.S. Marine.

Yeah, sure, I mean, Yes, Sir!

Great. Travel office will set you up. Any problems, let me know, returning to his stack of paperwork.

Yes Sir, will do. When do I go?

As soon as possible. I contacted DOD again but now you’re here we’ll take care of this ourselves. Simpler that way…Is there a problem?

No Sir, no problem, on my way to Travel.

Thanks and good luck, her boss already taking a call. Maria turned, wondering, where the hell is Jakarta anyway? A few hours later, Atlanta’s Hartsfield-Jackson Airport

All I wanted was to get settled and now I’m headed half way around the world, alone. Some half-assed attempt to fix somebody else’s problem isn’t that always the way it is, she mused. Her departure was delayed - not an auspicious start. While waiting, her thoughts wandered, how long would it take to run the perimeter -the airport fence line in the distance? Her Navajo name, ‘Flying Cloud’ had been given because she was one of the fastest runners. She knew there’d be no run anytime