One minute the chicken, though a bit rheumy in the eyes, had been jerking around the pen, pecking at the feed in the tray. The next minute it had looked up, turned its head almost all the way around, looked at another pecking chicken. Then it had fallen over dead.
Six more died inside of 24 hours.
Cole Younger Smith wondered, but not much. He had more than 80 chickens on his property five miles east of I-75 on a dirt road off of Fruitville. So six were dead. Who knew why? Chickens died. It was the Lord’s way. It wasn’t as if he were dependent on the stupid birds to make a living. He had his handyman business. He didn’t make much from it, but he had no need or desire for more. The chickens brought in some extra money.
Cole stood outside the pen after he removed the dead birds and wheeled them in the barrow on the dirt road past the house. He blew his nose as he buried them in The Pit of Dead Clucks. Who knew how deep the pit was. His grandfather had dug it when there wasn’t another human being residing within 10 miles. He had dug it deep, dumped the carcases of bird and beast, even a horse or two, into it and covered it over, leaving lots of room for future Smiths to rid themselves of the dead, fertilize the land and have room to grow and prosper. Only they didn’t prosper. They survived.
Cole was 54, grizzled, lean, in need of a cutting of his wild white hair and a shaving of his stubbled face. There were other things he needed even more, including a visit to a dentist, but there was no money for it.
He coughed, blew his nose and went back to the house—the same house his grandfather and father had lived in. It was in need of mending more than Cole was in need of dental work.
A man and a woman had come out a month ago. They were dressed in suits, pressed suits, with fresh hair cuts, smelling of soap or shampoo. They had offered to represent him, to sell the property. They told him that they could easily get over a million dollars, maybe two million, for the 60 acres.
Sure you could, Cole had said. For a bit of that, Cole could get his teeth fixed, rent a house, buy a new pickup, but thank you, he wasn’t selling. No need. Not yet. Cole lived alone since his wife died of cancer and his son Jim left to get married and live in Oregon. There was nothing to hold him to this place but bad memories and family pride, but that was enough.
Cole went in the house and turned on the television, partly because it was time for the re-run of The World Poker Tour and partly because it drowned out the damned, endless clucking and cackling of the chickens. He felt sick to his stomach. He ignored it, or tried to. It was something that happened. You lived with it. Somewhere in the kitchen he had that pink generic stuff.
If his stomach got worse, he’d find it. Twenty minutes later he had to get to the toilet, had to get there quick.
When he was done, Cole went to his knees next to the sink. It wasn’t a cold. It was something else, probably the flu or a bad can of tuna. Cole practically lived on tuna drenched in Miracle Whip. He bought date-expired cans in a discount store on Tuttle. This was a bad one. Damn. He couldn’t afford a trip to the emergency room at Sarasota Memorial. Coleen had died there. He had bad memories. She had been a good woman, a bit stringy, but so was he. He tried to stand and made it, but it was a struggle on shaking legs. Damn.
No choice. Now he just hoped he could make it either to his ‘94 Ford pickup or to the bedroom. He took four staggering steps, using the wall and furniture to keep himself upright. Cole could be fooled, but he was no fool. He was going to the ER. He headed for the front door, taking forever to make it, went out and, pausing once to vomit almost nothing, he lurched to the truck and managed to get into it.
It had come quickly. You don’t get this sick this fast, he thought as he whipped around, almost hitting a tree. He drove past the mesh-wired pen and saw more dead chickens, lots more. No, said Barney Fried to himself, can’t be. But maybe it was. Barney was one of two emergency room physicians on duty the morning Cole Younger Smith plowed into the rear of a perfectly appointed white Cadillac. The Caddy had been parked long enough to let out a woman and child in front of the ER door. The driver of the Caddy, a big man who had to be at least 70, came out mad as hell, shouting, “You could have killed my daughter and granddaughter, you...”
He opened the door of the pickup and stepped back fast as Cole coughed in his direction, leaned over and managed to vomit whatever remained in his stomach. Barney Fried was 36. He had tried obstetrics and decided that he liked the action of the ER. He was good, but good didn’t prepare him for what he half expected he was about to see and deal with. He asked a nurse to find Dr. McMillan, and he called for a battery of blood tests and a swabbing of the throat of Cole Younger Smith, who lay in one of the small rooms in the ER corridor. “Patient says it came on fast, from start to acute pulmonary distress in an hour,” said Barney. “He says he’s had a cold for a few days and started to feel a little queasy yesterday. The cough sounds deep, very deep, not typical upper respiratory.”
Steve McMillan was 48. He thought he had seen it all. But he hadn’t seen anything quite like the man gasping for air in spite of the oxygen flowing through the mask over his face. “You know what this looks like?” whispered Barney.
“Lots of things,” said McMillan calmly. “Lots of things, Mac,” Barney agreed, “but not lots of things we’ve seen.”
“You’ve got a hurry-up call on the swab?”
“I think we should call the county health department and get that swab up to Tampa before we even think about giving this a name,” said Barney.
“And...” “Isolation,” said McMillan. “Masks, gloves, gowns for everyone who comes in this room.” “Goggles?”
"Goggles, too,” McMillan agreed.
Fifteen minutes later a Department of Health driver was at the ER entrance. She was handed a tightly sealed box and was on her way. Mixed with Barney’s fear was the guilty spark of a hope that his suspicion might be right, that he might be the first physician to identify a case of avian flu in the United States. It wasn’t likely. They had determined that Cole Younger Smith hadn’t recently been out of the country, not even out of the county. In fact, he had never been outside of Florida. A team from the health department rushed to Smith’s home and found a scattering of dead chickens.
They bagged two of the dead birds and, taking no chances, killed all of the remaining birds and then headed to Smith’s neighbors to check on whether they had chickens or pigs that might be infected, if, indeed, they were dealing with avian flu.
By the time the call came from the lab in Tampa, two more people had been found with the same symptoms as Cole Younger Smith. One was a Home Depot clerk who two days earlier had helped Cole find a replacement for a drill head. The other was a woman whose front steps Cole had repaired last week. All three were in isolation at Sarasota Memorial when the lab report came in from Tampa. Eleanor Wosniak at the Sarasota County Health Department got the report. Eleanor, 33, thin, dark-haired and a recent transplant from Chicago, brought the bad news to the hospital.
“They ran a PCR, polymerase chain reaction,” she said. Both Barney and Mac were familiar with the molecular bio test. What they weren’t familiar with was what it had revealed.
“H5N1 virus, avian flu,” Eleanor said, “but it doesn’t fit the profile, which shouldn’t surprise us. It’s mutated.”
“None of the three in isolation have been out of the country or in contact with anyone who...,” Barney began, and then stopped.
“So the bird or birds that did this came through here,” Eleanor said. “We’re on a migratory bird path from Canada. Primarily ducks.”
“We can’t kill all the migratory ducks,” said Mac. “No, we can’t,” Eleanor agreed.
“So?” asked Mac.
“State Health has a team on the way,” she said. “We’ve got an inventory on all the Tamiflu available in Sarasota and surrounding counties. More can be brought in
from all over the state.”
All three knew that Tamiflu helped treat most known varieties of influenza, but it was no cure. There was no cure. There had been only 253 confirmed cases of H5N1 bird flu in the world. A total of 148 of them had resulted in death—a 58 percent mortality rate.
The Spanish Flu of 1918, H1N1, which resulted in the death of an estimated 20 million people, had only a 2.5 percent death rate for those infected.
They were standing in the corridor where no one could hear them.
“We’ve got bird flu,” said Barney.
“All flu is technically bird flu,” said Eleanor.
“All flu viruses originated in birds, some maybe thousands of years ago. A bird can be absolutely normal and carry more than 200 different flu viruses, viruses that keep changing and sometimes get passed on to humans who...sorry. I’m not telling you something you don’t already know.”
Neither Barney nor Mac responded. Eleanor considered telling them that the samples of the tissue of victims of the 1918 Spanish flu were misunderstood by the public and the press. The H1N1 Spanish flu virus was only a far, far distant cousin of the present H5N1 strain. The century-old samples offered no hope of a treatment for today’s strain, though a study of all aspects of that pandemic was yielding information on how to contain what might now be happening. Cole Younger Smith died. And Sal Pangione came into the ER, gave his name and said he thought he was “all of a sudden coming down with the flu,” as if having that stupid sonofabitch rear end him outside the ER and cough in his face hadn’t been enough. Within five minutes, Salina King and her boyfriend, Wallace Beatts, were feeling the first effects of the flu.
They had been sitting across from Sal in the waiting room. Wallace had a broken ankle.
“It can’t spread this fast,” said Barney Fried. “And it can’t manifest itself this fast.”
“Tell that to the virus. It can do whatever it wants to do,” said Eleanor Wosniak.
They were drinking dank coffee from styrofoam cups in the ER office. They had been joined by August Turner, 43. Tall and wide, he looked more like the college linebacker for Florida State University that he once was than the state epidemiologist he was now. He was also a lawyer.
“So what do we do?” asked McMillan. “We’ve got seven cases now.”
“Normally, we’d call for a voluntary quarantine of people who might be infected,” said Turner. “It worked in Canada for the SARS outbreak.”
“This isn’t ‘normally,’” said Eleanor.
“It is not,” Turner agreed. “I think we need approval from the governor’s office for me to go to a judge and get a mandatory quarantine order. Agreed?”
“Agreed,” said Eleanor.
“Agreed,” said Barney. Mac nodded.
“Call security, lock down the ER. Everybody in it is quarantined, including you two, me, everyone. I’ll call the police. They’ve got an emergency plan for things like this. You say Smith vomited outside?”
“Yes,” said Barney.
“Was it cleaned up?” asked Turner.
“I’m sure it was,” said Barney.
“Find out how it was disposed of,” said Turner. “And, pending a judicial order, quarantine the person who cleaned it. New cases?”
“One, the nurse who swabbed Smith and Pangione’s throat,” said Barney.
“How’s she doing?” asked Turner.
“She’s alive,” said Barney.
“All calls from the media will be referred to a number in Tallahassee, the Department of Health Public Relations Office,” said Turner.
“We’ll pass out that number on a card to the entire hospital staff. The PR office will refer the most sensitive calls to me. As of right now, no one leaves the hospital. We ask them nicely, explain that we have an emergency. The words ‘bird flu’ are not to be mentioned.”
“And what if they still want to leave?” asked Mac.
“I’d better call the governor and find a sympathetic judge right now.”
Turner took out his cell phone and speed dialed a number while Eleanor moved off to the ER waiting room. Barney and Mac excused themselves to get back to the growing number of confirmed and suspected cases. As they walked past scurrying nurses and staff, all gowned, gloved, masked and goggled, Sandford Ledger, the ER intake staffer on the desk, walked past him holding his stomach with both hands and looking pale, very pale. A nurse hurried over to keep Ledger from falling. And for the first time since he had looked down at Cole Younger Smith, Dr. Barney Fried wondered if he would be next.
The nurse holding Ledger’s arm, Rose Katcher, mother of four, called to Barney. “A young volunteer girl, Heather Falberg, who gives out magazines and newspapers, is on the third floor with symptoms. She came through here about 20 minutes ago.” Barney and Mac remembered. Cute girl with a smile. No more than 17. All the rooms in the ER had infected patients. Heather Falberg. Stanford Ledger. Sal Pangione. Salina King. Wallace Beatts. All personnel were told to keep their distance from patients except when absolutely necessary to treat them.
Outside of the ER, in the waiting room, Amy Solan, daughter of Sal Pangione, was tightly holding her daughter’s hand as she argued with the police officer who kept her from going through the Emergency Room doors. New patients arrived and were turned away, sent to Doctors Hospital. Most went quietly, sensing from the presence of the police that something was very wrong. They watched Amy Solan demand answers from Eleanor Wosniak.
“We’ve got a potential epidemic,” Barney Fried explained to a trio of nurses, at least two of whom were far more experienced with ER disaster than he was.
“Maybe a pandemic,” added Mac.
“Doctors,” a nurse called from the room in which Sal Pangione lay.
Barney and Mac hurried over to the room. The nurse nodded her head toward the bed. Sal Pangione, by far the oldest of the people stricken by the bird flu virus that had killed Cole Younger Smith, was sitting up.
“What the hell happened to me?” he demanded loudly.
“You were sick,” said Barney. “Flu.”
“I feel better now,” Sal said. “A two-hour flu? Give me my pants and the rest of my stuff and I’m out of here. What happened to the guy who hit my car?”
“He died,” said Mac.
“I’m sorry,” said Sal.
“Think you can get my pants now?”
“We’d like you to stay a little while longer,” said Barney.
“Just to be sure.” In the next hour, there were no new cases and all of the patients who were in the ER were feeling anywhere from better to much better to completely cured. Turner and Eleanor Wosniak strode down the hall toward Barney and Mac.
“So what did we have here?” Barney asked. Eleanor Wosniak shook her head.
“Seven dead people and another three that might not make it,” said Mac.
“The girl, the volunteer, Heather?” asked Barney.
“She’s feeling better,” said Mac.
“Their immune systems are fighting it off.”
“My guess? The mutated virus doesn’t survive,” said Turner.
“Lethal but short- lived in humans.” “Like War of the Worlds?” asked Barney.
“I wouldn’t push that analogy,” said Turner.
Traffic shot by on Tamiami Trail. Cars trolled Hillview, looking for a parking space. At Bennigan’s about half a mile north on the Trail, a young man named George Favereau was trying to break the chili-eating record and not coming close. On television, the news was reported and commentators speculated about what was going on in the hospital. In a few days, the avian flu that had hit Sarasota would be, if not forgotten, at least put aside in the county’s collective memory. Yet it was coming. Not this time, but it was coming. It would come, probably not the virus they had seen today, and probably not as swiftly.
It would come with very little warning. It would come with someone who had been in a market in Asia where chickens were bought, sold and slaughtered. Or it would come from the sky with a winged pattern of migrating ducks, and it was not likely to pass through with as little damage as they had just seen. If it came in their lifetime, Eleanor Wosniak and August Turner would be back. Dr. Barney Fried touched his face. He needed a shave, a shower, something with protein to eat and at least five or six hours of sleep. He had been awake for more than 24 hours, something he hadn’t done since he had been an intern in Boston. He looked up at the clock on the wall.
Eight hours from now his next shift would begin.
He coughed. His throat was raspy from talking. His stomach roiled. He was hungry. He felt slightly warm. Maybe he was coming down with something.
Stuart M. Kaminsky, a Grand Master of the Mystery Writers of America, has lived in Sarasota with his family for 16 years. He’s the author of more than 60 novels, dozens of short stories, television episodes and six produced screenplays as well as the popular Lew Fonesca novels and stories set in Sarasota.
Note: This is a work of fiction. No known strain of avian flu would work as swiftly as the one in this story and it’s not likely there will ever be one. It usually takes up to seven days from the time of infection until the onset of the disease. However, the possibility of a bird flu pandemic is real, if not immediately likely. Although plans are in place for dealing with bird flu or any epidemic, if avian flu does come, government agencies and hospitals may well be overwhelmed. On this point, health officials agree. The information in the story about avian flu and preparedness is essentially correct and was obtained from both the State of Florida Department of Health and the Sarasota County Department of Health. Special thanks go to Scott Pritchard, Sarasota County Health Department Epidemiologist, and Doc Kokol, Director of Communications, Florida Department of Health.
BIRD FLU AND YOU
Bird—or avian—flu is a highly infectious virus similar to respiratory influenza. Occurring naturally in wild birds, it causes serious illness in domestic birds and animals.
A pandemic is a worldwide outbreak of a severe disease that needs three conditions to develop: a new germ that causes illnesses in birds or animals and transfers to humans; serious disease in a limited number of humans; and the ability to transfer easily from human to human. Bird flu has currently met only the first two requirements for pandemics.
Bird flu symptoms include a sudden onset of typical flu-like conditions—such as fever, cough, sore throat and aching muscles—that can rapidly progress into respiratory distress and eventually affect all of the body’s organs, potentially causing death.
While bird flu rarely directly affects humans, it has been transmitted from infected or dead animals to people. Avian flu has currently affected birds in 50 countries through contact with other sick poultry. It has also infected approximately 250 humans in nine countries in Asia and the Middle East; of those, at least half have died.
Humans are encouraged to get annual flu shots, avoid contact with ill people, birds or animals, eat only thoroughly cooked poultry and begin stocking four to six weeks’ worth of non-perishable food.
IS SARASOTA READY?
Along with the state and federal governments, Sarasota County is monitoring flu outbreaks worldwide, stockpiling antiviral medication and funding vaccine development and technology. The county is also developing a local response plan, engaging community partners, expanding a flu monitoring system, educating the local public and assessing community resources.
The Sarasota County Health Department has developed a worst-case scenario guide. If bird flu comes to Florida, there will be little time to react. It will occur simultaneously with other outbreaks across the U.S., and up to one third of Sarasota’s 349,000 citizens—or, 122,150 people—could become ill, causing healthcare facilities to be overwhelmed. “Concerns are always treatment, vaccines and the ability to keep the infrastructure going,” says Dr. Sandra MacLeod, medical director of the Sarasota County Health Department. “We’re particularly concerned about this type of flu because, since it’s a new virus, no one has immunity to it.”
To help educate the community, the health department has also created a number of resources for public viewing on its Web site, including a brochure for travelers flying to affected countries and links to the U.S. Centers for Disease Control, the state of Florida’s Department of Health and the World Health Organization (WHO). “Nobody knows when the next pandemic will occur, or how severe it will be,” MacLeod explains, “but inevitably, we will have one at some point in our future. That’s why we’re advising people to come up with an all-hazards approach to preparedness.”
For more information on bird flu and what you can do to prepare, visit www.sarasotahealth.org.
SOURCES: Sarasota County Health Department, www.sarasotahealth.org; U.S. Pandemic Flu Web site, www.pandemicflu.gov.