Executive Orders

48 HEMORRHAGE

SIX HOURS OF SLEEP, maybe a little more, was better than nothing. This morning, Cathy got up first, and the father of the First Family came into the breakfast room unshaven, following the smell of coffee.

"When you feel this rotten, you should at least have a hangover to blame it on," the President announced. His morning papers were in the usual place. A Post-it note was affixed to the front page of the Washington Post, just over an article bylined to Bob Holtzman and John Plumber. Now, there was something to start off his day, Jack told himself.

"That's really sleazy," Sally Ryan said. She'd already heard TV coverage of the controversy. "What finks." She would have said "dicks," a newly favored term among the young ladies at St. Mary's School, but Dad wasn't ready to acknowledge the fact that his Sally was talking like a grown-up.

"Uh-huh," her father replied. The story gave far more detail than was possible in a couple of minutes of air time. And it named Ed Kealty, who had, it seemed—unsurprisingly, but still against the law—a CIA source who had leaked information which, the story explained, had not been entirely truthful and, even worse, had been a deliberate political attack on the President, using the media as an attack dog. Jack snorted. As though that were new. The Post's emphasis was on the gross violation of journalistic integrity. Plumber's recantation of his actions was very sincere, it said. The article said that senior executives at NEC's news division had declined comment, pending their own inquiry. It also said that the Post had custody of the tapes, which were entirely undamaged.

The Washington Times, he saw, was just as irate but not in quite the same way. There would be a colossal internecine battle in the Washington press corps over this, something, the Times editorial observed, that the politicians would clearly watch with amusement.

Well, Ryan told himself, that ought to keep them off my back for a while.

Next, he opened the manila folder with the secret-tape borders on it. This document, he saw, was pretty old.

"Bastards," POTUS whispered.

"They really did it to themselves this time," Cathy said, reading her own paper.

"No," SWORDSMAN replied. "China."

IT WASN'T AN epidemic yet, because nobody knew about it. Doctors were already reacting in surprise to telephone calls. Excited, if not frantic, calls to answering services had already awakened over twenty of them across the country. Bloody vomit and diarrhea were reported in every case, but only one to a customer, and there were various medical problems that could explain that. Bleeding ulcers, for example, and many of the calls came from busi-nesspeople for whom stress came with the tie and white shirt. Most were told to drive to the nearest hospital's emergency room, and in nearly all cases the doctor got dressed to meet his or her patient there, or to have a trusted associate do so. Some were instructed to be at the office first thing, usually between eight and nine in the morning, to be the first patient of the day and thus not interfere with the daily schedule.

GUS LORENZ HADN'T felt like being in his office alone, and had called in a few senior staff members to join him at his computer. They noted that his pipe was lit when they came in. One of them might have objected—it was contrary to federal regulations—but she stopped short, looking at the image on the screen.

"Where's this one from?" the epidemiologist asked.

"Chicago."

"Our Chicago?"

PIERRE ALEXANDRE ARRIVED at his office on the eleventh floor of the Ross Building just before eight. His morning routine began with checking his fax machine. Attending physicians with AIDS cases regularly sent him patient information that way. It allowed him to monitor a large number of patients, both to advise treatment options and to increase his own knowledge base. There was only one fax this morning, and it was relatively good news. Merck had just fielded a new drug which the PDA was fast-tracking into clinical trials, and a friend of his at Penn State was reporting some interesting results. That's when his phone rang.

"Dr. Alexandre."

"This is the ER, sir. Could you come down here? I got a patient here, Caucasian male, thirty-seven. High fever, internal bleeding. I don't know what this is—I mean," the resident said, "I mean, I know what it looks like, but—"

"Give me five minutes."

"Yes, sir," she acknowledged.

The internist/virologist/molecular biologist donned his starched lab coat, buttoned it, and headed down toward the emergency room, which was in a separate building on the sprawling Hopkins campus. Even in the military, he'd dressed the same way. The Doctor Look, he called it. Stethoscope in the right-side pocket. Name embroidered onto the left side. A calm expression on his face as he walked into the largely idle ER. Nighttime was the busy period here. There she was, cute as a button… putting on a surgical mask, he saw. What could be all that wrong this early on a spring day?

"Good morning, Doctor," he said, in his most charming Creole accent. "What seems to be the problem?" She handed him the chart and started talking while he read.

"His wife brought him in. High fever, some disorientation, BP is low, probable internal bleed, bloody vomit and stool. And there are some marks on his face," she reported. "And I'm not sure enough to say."

"Okay, let's take a look." She sounded like a promising young doc, Alexandre thought pleasantly. She knew what she didn't know, and she'd called for consultation… but why not one of the internal-medicine guys? the former colonel asked himself, taking another look at her face. He put on mask and gloves and walked past the isolation curtain.

"Good morning, I'm Dr. Alexandre," he said to the patient. The man's eyes were listless, but it was the marks on his cheeks that made Alexandre's breath stop. It was George Westphal's face, come back from more than a decade in Alex's past.

"How did he get here?"

"His personal physician told his wife to drive him in. He has privileges at Hopkins."

"What's he do? News photographer? Diplomat? Something to do with traveling?"

The resident shook her head. "He sells Winnebagos, RVs and like that, dealership over on Pulaski Highway."

Alexandre looked around the area. There were a medical student and two nurses, in addition to the resident who was running the case. All gloved, all masked. Good. She was smart, and now Alex knew why she was scared.

"Blood?"

"Already taken, Doctor. Doing the cross-match now, and specimens for analysis in your lab."

The professor nodded. "Good. Admit him right now. My unit. I need a container for the tubes. Be careful with all the sharps." A nurse went off to get the things.

"Professor, this looks like—I mean, it can't be, but—"

"It can't be," he agreed. "But it does look that way. Those are petechiae, right out of the book. So we'll treat it like it is for the moment, okay?" The nurse returned with the proper containers. Alexandre took the extra blood specimens. "As soon as you send him upstairs, everybody strip, everybody scrub. There's not that much danger involved, as long as you take the proper precautions. Is his wife around?"

"Yes, Doctor, out in the waiting room."

"Have somebody bring her up to my office. I have to ask her some things. Questions?" There were none. "Then let's get moving."

Dr. Alexandre visually checked the plastic container for the blood and tucked it into the left-side pocket of his lab coat, after determining that it was properly sealed. The calm Doctor's Look was gone, as he walked to the elevator. Looking at the burnished steel of the automatic doors, he told himself that, no, this wasn't possible., Maybe something else. But what? Leukemia had some of the same symptoms, and as dreaded as that diagnosis was, it was preferable to what it looked like to him. The doors opened, and he headed off to his lab.

"Morning, Janet," he said, walking into the hot lab.

"Alex," replied Janet Clemenger, a Ph.D. molecular biologist. He took the plastic box from his pocket.

"I need this done in a hurry. Like, immediately."

"What is it?" She wasn't often told to stop everything she was doing, especially at the start of a working day.

"Looks like hemorrhagic fever. Treat it as level… four." Her eyes went a little wide.

"Here?" People were asking the same question all over America, but none of them knew it yet.

"They should be bringing the patient up now. I have to talk to his wife."

She took the container and set it gently on the work-table. "The usual antibody tests?"

"Yes, and please be careful with it, Janet."

"Always," she assured him. Like Alexandre, she worked a lot of AIDS experiments.

Alexandre next went to his office to call Dave James.

"How certain are you?" the dean asked two minutes later.

"Dave, it's just a heads-up for now, but—I've seen it before. Just like it was with George Westphal. I have Jan Clemenger working on it right now. Until further notice, I think we have to take this one seriously. If the lab results are what I expect, I get on the phone to Gus and we declare a for-real alert."

"Well, Ralph gets back from London day after tomorrow. It's your department for the moment, Alex. Keep me posted."

"Roger," the former soldier said. Then it was time to speak to the patient's wife.

In the emergency room, orderlies were scrubbing the floor where the bed had been, overseen by the ER charge nurse. Overhead they could hear the distinctively powerful sound of a Sikorsky helicopter. The First Lady was coming to work.

THE COURIER ARRIVED at CDC, carrying his "hatbox," and handed it over to one of Lorenz's lab technicians. From there everything was fast-tracked. The antibody tests were already set up on the lab benches, and under exquisitely precise handling precautions, a drop of blood was dipped into a small glass tube. The liquid in the tube changed color almost instantly.

"It's Ebola, Doctor," the technician reported. In another room a sample was being set up for the scanning electron microscope. Lorenz walked there, his legs feeling tired for so early in the morning. The instrument was already switched on. It was just a matter of getting things aimed properly before the images appeared on the TV display.

"Take your pick, Gus." This was a senior physician, not a lab tech. As the magnification was adjusted, the picture was instantly clear. This blood sample was alive with the tiny strands. And soon it would be alive with nothing else. "Where's this one from?"

"Chicago," Lorenz answered.

"Welcome to the New World," he told the screen as he worked the fine control to isolate one particular strand for full magnification. "You little son of a bitch."

Next came a closer examination to see if they could subtype it. That would take a while.

"AND SO HE has not traveled out of the country?" Alex was running down his list of stock questions.

"No, no he hasn't," she assured him. "Just to the big RV show. He goes to that every year."

"Ma'am, I have to ask a number of questions, and some of them may seem offensive. Please understand that I have to do this in order to help your husband." She nodded. Alexandre had a quiet way of getting past that problem. "Do you have any reason to suspect that your husband has been seeing other women?"

"No."

"Sorry, I had to ask that. Do you have any exotic pets?"

"Just two Chesapeake Bay retrievers," she replied, surprised at the question.

"Monkeys? Anything from out of the country?"

"No, nothing like that." This isn't going anywhere. Alex couldn't think of another relevant question. They were supposed to say yes to the travel one.

"Do you know anybody, family member, friend, whatever, who does a lot of traveling?"

"No—can I see him?"

"Yes, you can, but first we have to get him settled into his room and get some treatment going."

"Is he going to—I mean, he's never been sick at all, he runs and doesn't smoke and doesn't drink much and we've always been careful." And then she started losing control.

"I won't lie to you. Your husband appears to be a very sick man, but your family doctor sent you to the best hospital in the world. I just started here. I spent more than twenty years in the Army, all of that in the area of infectious diseases. So you are in the right place, and I am the right doc." You had to say things like that, empty words though they might be. The one thing you could never, ever, do was take hope away. The phone rang.

"Dr. Alexandre."

"Alex, it's Janet. Antibody test is positive for Ebola. I ran it twice," she told him. "I have the spare tube packaged to go to CDC, and the microscopy will be ready to go in about fifteen minutes."

"Very well. I'll be over for that." He hung up. "Here," he told the patient's wife. "Let me get you out to the waiting room and introduce you to the nurses. We have some very good ones on my unit." This was not the fun part, even though infectious diseases was not a particularly fun field. In trying to give her hope, he'd probably given her too much. Now she'd listen to him, thinking that he spoke with God's voice, but right now God didn't have any answers, and next he had to explain to her that the nurses would be taking some of her blood for examination, too.

"WHAT GIVES, SCOTT?" Ryan asked across thirteen time zones.

"Well, they sure as hell tossed a wrench into it. Jack?"

"Yes?"

"This guy Zhang, I've met him twice now. He doesn't talk a hell of a lot, but he's a bigger fish than we thought. I think he's the one keeping an eye on the Foreign Minister. He's a player, Mr. President. Tell the Foleys to open a file on the guy and put a big flag on it."

"Will Taipei spring for compensation?" SWORDSMAN asked.

"Would you?"

"My instinct would be to tell them where they could shove it, but I'm not supposed to lose my temper, remember?"

"They will listen to the demand, and then they will ask me where the United States of America stands. What do I tell them?"

"For the moment, we stand for renewed peace and stability."

"I can make that last an hour, maybe two hours. Then what?" SecState persisted.

"You know that area better than I do. What's the game, Scott?"

"I don't know. I thought I did, but I don't. First, I kinda hoped it was an accident. Then I thought they might be rattling their cage—Taiwan's, I mean. No, it's not that. They're pushing too hard and in the wrong way for that. Third option, they're doing all this to test you. If so, they're playing very rough—too rough. They don't know you well enough yet, Jack. It's too big a pot for the first hand of the night. Bottom line, I do not know what they're thinking. Without that, I can't tell you how to play it out."

"We know they were behind Japan—Zhang personally was behind that Yamata bastard and—"

"Yes, I know. And they must know that we know, and

that's one more reason not to piss us off. There are a lot of chips on the table, Jack," Adler emphasized again. "And I do not see a reason for this."

"Tell Taiwan we're behind them?"

"Okay, if you do that, and it gets out, and the PRC ups the ante, we have thousands—hell, close to a hundred thousand citizens over here, and they're hostages. I won't go into the trade considerations, but that's a big chip in political-economic terms."

"But if we don't back Taiwan up, then they'll think they're on their own and cornered—"

"Yes, sir, and the same thing happens from the other direction. My best suggestion is to ride with it. I deliver the demand, Taipei says no, then I suggest that they suggest the issue is held in abeyance until the issue of the airliner is determined. For that, we call in the U.N. We, that is, the United States, call the question before the Security Council. That strings it out. Sooner or later, their friggin' navy's gotta run out of fuel. We have a carrier group in the neighborhood, and so nothing can happen, really."

Ryan frowned. "I won't say I like it, but run with it. It'll last a day or two anyway. My instinct is to back up Taiwan and tell the PRC to suck wind."

"The world isn't that simple, and you know it," Adler's voice told him.

"Ain't it the truth. Run with what you said, Scott, and keep me posted."

"Yes, sir."

ALEX CHECKED HIS watch. Next to the electron microscope was Dr. Clemenger's notebook. At 10:16, she lifted it, made a time notation, and described how both she and her fellow associate professor confirmed the presence of the Ebola virus. On the other side of the lab, a technician was running a test on blood drawn from the wife of Patient Zero. It was positive for Ebola antibodies. She had it, too, though she didn't know it yet.

"They have any children?" Janet asked, when the news arrived.

"Two, both away in school."

"Alex, unless you know something I don't… I hope their insurance is paid up." Clemenger didn't quite have the status of an M.D. here, but at moments like this she didn't mind. Physicians got to know the patients a lot better than the pure scientists did.

"What else can you tell me?"

"I need to map the genes out a little, but look here." She tapped the screen. "See the way the protein loops are grouped, and this structure down here?" Janet was the lab's top expert on how viruses were formed.

"Mayinga?" Christ, that's what got George.. And nobody knew how George had gotten it, and he didn't know now how this patient…

"Too early to be sure. You know what I have to do to run that down, but…"

"It fits. No known risk factors for him, maybe not for her, either. Jesus, Janet, if this is airborne."

"I know, Alex. You call Atlanta or me?"

"I'll do it."

"I'll start picking the little bastard apart," she promised. It seemed a long walk from the lab back to his office. His secretary was in now, and noticed his mood.

"DR. LORENZ IS in a meeting now," another secretary said. That usually put people off. Not this time: "Break in, if you would, please. Tell him it's Pierre Alexandre at Johns Hopkins, and it's important."

"Yes, Doctor. Please hold." She pressed one button and then another, ringing the line in the conference room down the hall. "Dr. Lorenz, please, it's urgent."

"Yes, Marjorie?"

"I have Dr. Alexandre holding on three. He says it's important, sir."

"Thank you." Gus switched lines. "Talk fast, Alex, we have a developing situation here," he said in an unusually businesslike voice.

"I know. Ebola's made it to this side of the world," Alexandre announced. "Have you been talking to Mark, too?"

"Mark? Mark who?" the professor asked. "Wait, wait, back up, Alex. Why did you call here?"

"We have two patients on my unit, and they've both got it, Gus."

"In Baltimore?"

"Yes, now what—where else, Gus?"

"Mark Klein in Chicago has one, female, forty-one. I've already micrographed the blood sample."

In two widely separated cities, two world-class experts did exactly the same thing. One pair of eyes looked at a wall in a small office. The other pair looked down a conference table at ten other physicians and scientists. The expressions were exactly the same. "Has either one been to Chicago or Kansas City?"

"Negative," the former colonel said. "When did Klein's case show up?"

"Last night, ten or so. Yours?"

"Just before eight. Husband has all the symptoms. Wife doesn't, but her blood's positive… oh, shit, Gus…"

"I have to call Detrick next."

"You do that. Keep an eye on the fax machine, Gus," Professor Alexandre advised. "And hope it's all a fucking mistake." But it wasn't, and both knew it now. "Stay close to the phone. I may want your input."

"You bet." Alex thought about that as he hung up. He had a call to make, too. "Dave, Alex."

"Well?" the dean asked.

"Husband and wife both positive. Wife is not yet symptomatic. Husband is showing all the classic signs."

"So what's the story, Alex?" the dean asked guardedly.

"Dave, the story is I caught Gus at a staff meeting. They were discussing an Ebola case in Chicago. Mark Klein called it in around midnight, I gather. No commonalties between that one and our Index Case here. I, uh, think we have a potential epidemic on our hands. We need to alert our emergency people. There might be some very dangerous stuff coming in."

"Epidemic? But—"

"That's my call to make, Dave. CDC is talking to the Army. I know exactly what they're going to say up at Detrick. Six months ago it would have been me making that call, too." Alexandre's other line started ringing. His secretary got it in the outer office. A moment later, her head appeared in the doorway.

"Doctor, that's ER, they say they need you stat." Alex relayed that message to the dean.

"I'll meet you there, Alex," Dave James told him.

"AT THE NEXT call on your machine, you will be free to complete your mission," Mr. Alahad said. "The timing is yours to decide." He didn't have to add that it would be better for him if Raman erased all his messages. To do so would have appeared venal to one who was willing to sacrifice himself. "We will not meet again in this lifetime."

"I must go to my workplace." Raman hesitated. So the order had really come, after a fashion. The two men embraced, and the younger one took his leave.

"CATHY?" SHE LOOKED up to see Bernie Katz's head sticking in her office door.

"Yeah, Bernie?"

"Dave has called a department head meeting in his office at two. I'm leaving for New York to do that conference at Columbia, and Hal's operating this afternoon. Sit in for me?"

"Sure, I'm clear."

"Thanks, Cath." His head vanished again. SURGEON went back to her patient records.

ACTUALLY THE DEAN had told his secretary to call the meeting on his way out the door. David James was in the emergency room. Behind the mask he looked like any other physician. This patient had nothing at all to do with the other two. Watching from ten feet away in a corner of the ER already set aside for the situation, they watched him vomit into a plastic container. There was ample evidence of blood. It was the same young resident working this one, too.

"No traveling to speak of. Says he was in New York for some stuff. Theater, auto show, regular tourist stuff. What about the first one?"

"Positive for Ebola virus," Alex told her. That snapped her head around like an owl's.

"Here?"

"Here. Don't be too surprised, Doctor. You called me, remember?" He turned to Dean James and raised an eyebrow.

"All department heads in my office at two. I can't go any faster, Alex. A third of them are operating or seeing patients right now."

"Ross for this one?" the resident asked. She had a patient to deal with.

"Quick as you can." Alexandre took the dean by the arm and walked him outside. There, dressed in greens, he lit a cigar, to the surprise of the security guards, who enforced a smoking ban out there.

"What the hell's going on?"

"You know, there is something to be said for these things." Alex took a few puffs. "I can tell you what they're going to say up at Detrick, sure as hell."

"Go on."

"Two separate index cases, Dave, a thousand miles apart in distance, and eight hours apart in time. No connection of any kind. No commonalties at all. Think it through," Pierre Alexandre said, taking another worried puff.

"Not enough data to support it," James objected.

"I hope I'm wrong. They're going to be scrambling down in Atlanta. Good people down there. The best. But they don't look at this sort of the thing the way I do. I wore that green suit a long time. Well" — another puff—"we're going to see what the best possible supportive care can do. We're better than anyplace in Africa. So's Chicago. So are all the other places that are going to phone in, I suppose."

"Others?" As fine a physician as he was, James still wasn't getting it.

"The first attempt at biological warfare was undertaken by Alexander the Great. He launched bodies of plague victims into a besieged city with catapults. I don't know if it worked or not. He took the city anyway, slaughtered all the citizens, and moved on."

He got it now, Alex could see. The dean was as pale as the new patient inside.

"JEFF?" RAMAN WAS in the local command post going over the coming schedule for POTUS. He had a mission to complete now, and it was time to start doing some planning. Andrea walked over to him. "We have a trip to Pittsburgh on Friday. You want to hop up there with the advance team? There are a couple local problems that have cropped up at the hotel."

"Okay. When do I leave?" Agent Raman asked.

"Flight leaves in ninety minutes." She handed him a ticket. "You get back tomorrow night."

How much the better, Raman thought, if he might even survive. Were he to structure all the security at one of these events, that might actually be possible. The idea of martyrdom didn't turn his head all that much, but if survival were possible, then he would opt for that.

"Fair enough," the assassin replied. He didn't have to worry about packing. The agents on the Detail always had a bag in the car.

IT TOOK THREE satellite passes before NRO was willing to make its estimate of the situation. All six of the UIR heavy divisions which had participated in the war game were now in a full-maintenance stand-down. Some might say that such a thing was normal. A unit went into a heavy-maintenance cycle after a major training exercise, but six divisions—three heavy corps—at once was a bit much. The data was immediately forwarded to the Saudi and Kuwaiti governments. In the meantime, the Pentagon called the White House.

"Yes, Mr. Secretary," Ryan said.

"The SNIE isn't ready yet for the UIR, but we have received… well, some disturbing information. I'll let Admiral Jackson present it."

The President listened, and didn't need much in the way of analysis, though he wished the Special National Intelligence Estimates were on his desk to give him a better feel for the UIR's political intentions. "Recommendations?" he asked, when Robby was done.

"I think it's a good time to get the boats at Diego moving. It never hurts to exercise them. We can move them to within two steaming days of the Gulf without anybody noticing. Next, I recommend that we issue warning orders to XVIII Airborne Corps. That's the 82nd, 101st, and 24th Mechanized."

"Will it make noise?" Jack asked.

"No, sir. It's treated as a practice alert. We do those all the time. All it really does is to get staff officers thinking."

"Make it so. Keep it quiet."

"This would be a good time to do a joint training exercise with friendly nations in the region," J-3 suggested.

"I'll see about that. Anything else?"

"No, Mr. President," Bretano replied. "We'll keep you informed."

BY NOON, THE fax count at CDC Atlanta was over thirty, from ten different states. These were forwarded to Fort Detrick, Maryland, home of the United States Army Medical Research Institute of Infectious Diseases— USAMRIID—the military counterpart to the Centers for Disease Control and Prevention in Atlanta. As chilling as the data was, it was just a little too chilling for snap judgment. A major staff meeting was called for just after lunch, while the commissioned officers and civilians tried to get their data organized. More senior officers from Walter Reed got in their staff cars for the ride up Interstate-70.

"DR. RYAN?"

"Yes?" Cathy looked up.

"The meeting in Dr. James's office has been moved up," her secretary said. "They want you over there right now."

"I guess I better head over, then." She stood and headed for the door. Roy Altman was standing there.

"Anything I need to know about?" SURGEON'S principal agent asked.

"Something's up. I don't know what it is."

"Where is the dean's office?" He'd never been there before. All of the staff meetings she'd attended recently were in Maumenee.

"That way." She pointed. "Other side of Monument Street in the admin building."

"SURGEON is moving, going north to Monument." The agents just appeared out of nowhere, it seemed. It might have seemed funny except for recent events. "If you don't mind, I'll stand in the room. I'll keep out of the way," Altman assured her.

Cathy nodded. There was no fighting it. He'd hate the dean's office for all the big windows there, she was sure. It was a ten-minute walk over, almost all of it undercover. She headed outdoors to cross the street, wanting a little fresh air. Entering the building, she saw a lot of her friends, either department chairmen or senior staffers standing in as she was doing. The director-level people were always traveling, one reason why she wasn't sure if she ever wanted to be that senior herself. Pierre Alexandre stormed in, wearing greens, carrying a folder, and looking positively grim as he almost bumped into her. A Secret Service agent prevented that.

"Glad you're here, Cathy," he said on the way past. "Them, too."

"Nice to be appreciated," Altman observed to a colleague, as the dean appeared at the door.

"Come in."

One look at the conference room convinced Altman to lower the shades with his own hands. The windows faced a street of anonymous brick houses. A few of the doctors looked on with annoyance, but they knew who he was and didn't object.

"Calling the meeting to order," Dave James said, before everyone was seated. "Alex has something important to tell us."

There was no preamble: "We have five Ebola cases in Ross right now. They all came in today."

Heads turned sharply. Cathy blinked at her seat at the end of the table.

"Students from someplace?" the surgery director asked. "Zaire?"

"One auto dealer and his wife, a boat salesman from Annapolis, three more people. Answering your question, no. No international travel at all. Four of the five are fully symptomatic. The auto dealer's wife shows antibodies, but no symptoms as yet. That's the good news. Our case wasn't the first. CDC has cases reported in Chicago, Philadelphia, New York, Boston, and Dallas. That's as of an hour ago. Total reported cases is twenty, and that' number doubled between ten and eleven. Probably still going up."

"Jesus Christ," the director of medicine whispered.

"You all know what I did before I got here. Right now I imagine they're having a staff meeting at Fort Detrick. The conclusion from that meeting will be that this is not an accidental outbreak. Somebody has initiated a biological-warfare campaign against our country."

Nobody objected to Alexandre's analysis, Cathy saw. She knew why. The other physicians in the room were so bright that sometimes she wondered if she belonged on the same faculty with them—she had never considered that most of them might harbor the same thoughts. All of them were world experts in their fields, at least four the very best there was. But all of them also spent time as she did, having lunch with a colleague in a different field to exchange information, because, like her, they were all truly fanatical about learning. They all wanted to know everything, and even though they knew that such a thing was impossible, even within one professional field, that didn't stop them from trying. In this case, the suddenly rigid faces concealed the same analytical process.

Ebola was an infectious disease, and such diseases started from a single place. There was always a first victim, called Patient Zero or the Index Case, and it spread from there. No disease just exploded in this way. CDC and USAMRIID, which had to make that conclusion official, would have the duty to assemble, organize, and present information in what was almost a legalistic structure to prove their case. For their medical institution, it was simpler, all the more so because Alex had commanded one of the divisions at Fort Detrick. Moreover, since there was a plan for everything, Johns Hopkins was one of the institutions tapped to receive cases in the event something like this took place.

"Alex," the director of urology said, "the literature says that Ebola is only spread by large particles of liquid. How could it explode so fast, even at the local level?"

"There's a sub-strain called Mayinga. It's named for a nurse who picked it up and died. The method of her infection was never determined. A colleague of mine, George Westphal, died of the same thing in 1990. We never determined the means of transmission in his case, either. There is thought that this sub-strain may spread by aerosol. It's never been proven one way or the other," Alex explained. "Besides, there are ways to fortify a virus, as you know. You admit some cancer genes into the structure."

"And there's no treatment, nothing experimental even?" Urology asked.

"Rousseau is doing some interesting work at Pasteur, but so far he hasn't produced any positive results."

A physical reaction, ripped down the conference table from one physician to another. They were among the best in the world, and they knew it. They also knew now that it didn't matter against this enemy.

"How about a vaccine?" Medicine asked. "That shouldn't be too hard."

"USAMRIID has been playing with that for about ten years. The first issue is that there seems to be a specificity problem. What works for one sub-strain may not always work with another. Also, the quality-control issue is a killer. Studies I've seen predict a two-percent infection rate from the vaccine itself. Merck thinks they can do better, but trials take time to run."

"Ouch," Surgery commented with a wince. Giving one person out of fifty a disease with an eighty-percent mortality rate—twenty thousand people infected per million doses, of whom roughly sixteen thousand might die from it. Applied to the population of the United States, it could mean three million deaths from an attempt to safeguard the population. "Hobson's choice."

"But it's too early to determine the extent of the national epidemic, and we do not have hard data on the ability of the disease to spread in existing environmental conditions," Urology thought. "So we really aren't sure what measures need to be taken yet."

"Correct." At least it was easy to explain things to these people.

"My people will see it first," Emergency said. "I have to get them warned. We can't risk losing our people unnecessarily."

"Who tells Jack?" Cathy wondered aloud. "He's got to know, and he's got to know fast."

"Well, that's the job of USAMRIID and the Surgeon General."

"They're not ready to make the call yet. You just said that," Cathy replied. "You're sure about this?"

"Yes."

SURGEON turned to Roy Altman: "Get my helicopter up here stat."