Lost causes

TWENTY-FOUR

‘Well, now we know; the intelligence regarding a biological attack on our country has proved correct and we’ve been hit with cholera.’ The Prime Minister was addressing the second meeting of COBRA in as many days. ‘Four of our cities have been affected but we cannot dismiss the possibility that there may be more attacks. All the initial strikes were carried out on blocks of flats so the residents in those flats were the first to become infected, but we’re now getting reports of cholera among the wider community in the four cities.’

‘But with the same source being implicated,’ interjected the health secretary. ‘So far, they’ve all been people with some association with the flats — visitors, tradesmen, delivery men, a social worker in Manchester, a community nurse in Liverpool.’

‘Has anyone claimed responsibility?’ asked Steven.

‘An Islamic fundamentalist group calling themselves Sons of the Afghan Martyrs.’

‘Known?’

‘No one’s ever heard of them.’

‘Do we have any more information about the strain of cholera?’

‘Nothing back from the lab yet.’

‘So we don’t know if it’s a genetically engineered variant.’

‘Please God, not,’ said the Home Secretary.

The Metropolitan Police commander asked the question that all the non-medical people present wanted to ask. ‘Supposing it has been tampered with, what sort of things could we expect?’

‘Resistance to antibiotics so we couldn’t treat it,’ said the consultant microbiologist with the Department of Health contingent. ‘Increased potency of the enterotoxin the bug produces, making it even more lethal.

‘What’s an entero…?’

‘Enterotoxin. It’s a poison produced by the bug which attacks the lining of the small bowel, leading to huge fluid loss. That in turn leads to severe shock and then death.’

‘Supposing it has been tampered with in the way you suggest,’ continued the Met commander. ‘Does that mean that everyone who contracts the disease will die?’

‘The fact that we couldn’t treat it with antibiotics would be a setback, but it’s not the be all and end all. It’s the dehydration — the fluid loss — that kills. Replacing lost fluid in time can save lives.’

‘So victims should be encouraged to drink,’ said a self-satisfied-looking junior Home Office minister, as if completing the final entry in a crossword puzzle.

The microbiologist smiled. ‘If only it were that simple. People with cholera are usually too ill to drink. Fluid loss has to be replaced through intravenous drip.’

‘And that needs health professionals,’ said the Home Secretary slowly, as if the implications of that were dawning on her as she said it. ‘Which is just not possible. Why am I getting an image of people dying all over our cities, lying in pools of their own excreta?’

‘That’s a worst-case scenario, Home Secretary.’

‘Which we will do everything in our power to avoid,’ said the Prime Minister. ‘If we go down, we’ll go down fighting, so let’s not have any more negativity. We must agree a plan of action. First, medical.’

The new health secretary, a little out of his depth after only a few weeks in the job, deferred to his colleague, Norman Travis, who said, ‘We continue to isolate and contain outbreaks where they occur. We’ll use wide-spectrum antibiotics until any contraindications appear, and prime consideration will be given to replacing fluid loss in all cases. The wider population is to be given cholera vaccine.’

‘Is there enough?’ asked Steven.

‘Merryman hasn’t had much of a chance to come on stream,’ said Travis, ‘and frankly, cholera wasn’t really considered as a favourite for biological attack, but things aren’t looking too bad. Travel clinics across the country have limited stocks for immediate use but perhaps the best news is that one of our pharmaceutical companies, Lark Pharmaceuticals, which supplies cholera vaccine to the Third World, has substantial stocks which can be diverted for home use and used to vaccinate our most vulnerable citizens. In the meantime, Merryman will be working flat out and hopefully they’ll come up with new stocks in time to vaccinate the rest of the population. A baptism of fire for them, but I’m sure they’ll rise to the challenge.’

‘What about distribution?’ asked the Prime Minister.

‘We’re not going to go down the doctors’ surgeries route as we did with swine flu. That was a bit of a shambles. We’re going to set up central vaccination clinics in large halls and invite people to come to receive their jab.’

‘Who’ll staff these clinics?’

‘We plan to ask final-year medical students to help out — properly supervised, of course.’

‘I’m not sure of the legal implications of that, minister,’ said a Home Office official.

‘Nor am I,’ said the Prime Minister. ‘And right now, I don’t care. Our country is under attack.’

Steven allowed a small smile of approval to reach his lips.

The deputy Prime Minister turned to the heads of the intelligence services, who had been quiet throughout. ‘Do we have any more information about the perpetrators of this outrage?’

The head of MI5 looked slightly embarrassed at being forced to reply, ‘In each case we’re looking for two Asian men: they were driving fake water board vans.’

‘So, eight Asian men in all. Descriptions?’

‘’Fraid not.’

The deputy Prime Minister looked at the head of MI6, who said, ‘There’s still nothing to suggest they came from outside the country. We continue to believe they’re home-grown.’

‘Maybe that’ll work in our favour,’ suggested Steven. ‘They’re probably young men: that means they’ll have families living here. When they start to suspect what their offspring have been up to…’

‘Good point,’ said the Prime Minister, turning to look at the intelligence heads.

‘Our ears are firmly to the ground, Prime Minister,’ said the head of MI5.

‘My people too,’ said the head of Special Branch. ‘Every rumour on the streets of the Asian communities will be followed up.’

‘Good,’ said the Prime Minister. ‘The speedy apprehension of those responsible would do much to restore public morale, particularly if the relevant communities were to distance themselves from the criminals.’

‘We’re seeking talks with community leaders about it,’ said the Home Secretary.

‘Which just leaves law and order,’ said the Prime Minister. ‘To cut to the chase, the police will be seeking emergency powers and we will be granting them. Naturally we will expect that they be used sparingly and with discretion, but we cannot have anarchy on our streets.’

‘I can’t see people suffering from cholera posing too much of a problem,’ exclaimed the junior Home Office minister, who seemed determined to make a name for himself while not having the intellect to make it for the right reasons.

‘It’s not the sick we have to worry about,’ said Steven through gritted teeth. ‘It’s the well. If we operate a policy of isolate and contain, some people won’t welcome being isolated and contained when all their instincts tell them to get the hell out of wherever they find themselves. But if we let them do that, they’ll only spread the disease. They’ll have to be restrained. Not an easy task.’

‘And one which might escalate out of hand very quickly if the disease spreads,’ said Travis. ‘The police will be stretched.’

Someone suggested, ‘Surely we can call on the military.’

‘Not something we do lightly in this country,’ said the Prime Minister. ‘The idea of our soldiers in confrontation with our citizens fills me with horror. The circumstances would have to exceptional.’

‘I think a full-blown cholera epidemic might just about fulfil that criterion, Prime Minister,’ said the government’s chief medical adviser.

‘Then please God it doesn’t come to that.’

Steven felt a hollow take shape in his stomach when he heard a number of people around the table say, ‘Amen.’

‘Exciting times,’ a voice at Steven’s shoulder said as he descended the stairs to leave the Cabinet Office. He turned to find Norman Travis there. ‘I don’t think we’ve met officially.’ The two men shook hands.

‘The kind of excitement I think we could all do without,’ said Steven. ‘On the bright side, you folks in the health department seem pretty much on the ball.’

‘Nice of you to say so, but we’ve been lucky so far. Having a pharmaceutical company come up with large stocks of cholera vaccine was a big plus. I just hope the Third World understands when we commandeer them.’

‘I just hope we’re all around to hear their complaints if they don’t,’ said Steven.

‘You sound like a glass-half-empty man.’

‘I’m a realist,’ said Steven. ‘Cholera epidemics are practically impossible to contain when they occur naturally, but when we’ve got people deliberately contaminating our water supplies and the possibility that the bug’s been genetically altered to make it even more lethal…’

‘I take your point,’ said Travis with a sigh as they reached the doors. ‘We should get some lab results tomorrow, then maybe we’ll see what we’re up against.’

Steven took a taxi over to John Macmillan’s place to bring him up to speed with what was going on. Macmillan was looking tired, his head resting on the back of his chair as he listened to what Steven had to say, his eyes closing for ten seconds or more at a time.

‘Are you feeling up to this, John?’ Steven asked. ‘You seem very tired.’

Macmillan snorted then smiled as he again closed his eyes. ‘Maybe confronting the slings and arrows of outrageous fortune for so many years is finally catching up with me, Steven,’ he said.

‘I need you to suffer them a bit longer, John. Whether it’s nobler in the mind or not, I’m going to need your input on everything as this unfolds.’

Macmillan turned his head to look directly at Steven as if seeing some steely quality in him he hadn’t seen before. ‘Understood,’ he said quietly. ‘After all, I seem to remember lecturing you rather a lot in recent times about where your duty lay…’

‘Damn right you did.’

‘Fire away.’

When he’d finished, Macmillan still sat with his eyes closed but this time it was different; an intermittent twitch in his cheek muscle told Steven Macmillan was thinking, not snoozing.

‘How many dead?’ he asked at last.

‘Fifty-four as of this morning.’

‘And they would be mainly elderly or very young, along with a number who were immuno-compromised in some way — on steroids or anti-rejection drugs, for instance. Am I right?’

‘I haven’t seen the breakdown figures yet. Jean should have them when I get back to the Home Office.’

Macmillan continued to think out loud. ‘Fifty-four… fifty four… out of… You know, it’s my bet the genes controlling the enterotoxin haven’t been tampered with,’ said Macmillan. ‘Otherwise there would be more.’

‘Fifty-four’s bad enough.’

‘We must think dispassionately. We’re not the newspapers. We’re not here to throw fuel on an emotional fire.’

Steven accepted the slap on the wrist.

‘Incubation period was a bit short: I would have expected longer,’ Sir John continued.

‘You sound as if you’ve come across cholera before.’

Macmillan nodded. ‘I was a young man working for HMG in the Middle East in the early seventies. I saw the tail end of a cholera epidemic that had started in Indonesia in 1961 and crossed several continents. Bloody horrible disease, turns your whole world into a pit of filth and squalor. If it gets a grip here… God help us all.’