A For Apocalypse : Prologue

It is a blessed thing that in every age someone has had the individuality enough and courage enough to stand by his own convictions.  – Robert G. Ingersoll –

March 12th (Wednesday)

Mohamad Zaki, a virologist attached to the Dr Saliman Fakeeh Hospital, received a call from one of his fellow colleagues. They were examining a patient who was admitted for severe viral pneumonia. They needed someone to identify the viral strain. A sputum culture was obtained and he set off to work. However, one by one, the lab results came back as negative.

Puzzled by the results, he sent the samples to an independent lab in Rotterdam. The Dutch were the leading experts in the field. Another sample was sent to the Americans in Atlanta. While he waited for their replies, he decided to give it another shot. This time, he found his answer — the infectious agent belonged to a group of pathogens called coronaviruses.

Coronaviruses causes the common cold. So does the deadly infection known as SARS. It was already midnight where he was but for the Dutch, the day was just beginning. He sent an email to alert both the Dutch lab and the CDC.

March 14th (Friday)

Both Dutch and US authorities ran their battery of tests, which all but confirmed Zaki’s worst fears. Unfortunately, there was a catch — this was a coronavirus no one had seen before.

In the meantime, Mohamad Zaki posted a note on proMED, an internet reporting system designed to rapidly share details of infectious diseases and outbreaks with researchers and public health agencies across the globe. The subsequent discussion that took place online, alerted a red flag and attention from the Ministry of Health where he worked.

An emergency board meeting was held that very afternoon and they decided that his contract be terminated with immediate effect. No one wanted to be associated with the discovery of a ‘new’ virus which could be the next SARS, or probably, worse. Zaki was well compensated but he was left without a job and had his working visa was revoked.

April 10th (Thursday)

Mohamad Zaki was back in his home country, none of his former colleagues had kept in touch. A month had gone, his calls went unanswered and emails unreplied. He tried desperately to find out what had happened to the patient. There was no news in the papers, both the Dutch and CDC kept quiet. Did the Ministry of Health covered up the issue or was there a lack of fresh samples? Nobody knew.

As for proMED, the discussion died a natural death when Zaki couldn’t provide further information on the condition of the patient. It was written as a one-off incident and relegated to the back pages. The clampdown by the relevant authorities silenced and news of the coronavirus. It seemed to be confined within the Saudi border.

Just as he was about to give up, he received an email from the initial doctor who referred the case to him. He suffered the same consequences as Zaki but as they were terminating his work visa, the patient’s health deteriorated. The patient’s pneumonia worsened despite the drugs, his organs failed and within a week, patient zero was dead.

But that wasn’t all. The number of cases has risen to 20 since the last month, almost one per day. Two-thirds of them died. The latest victim was a 14-year-old boy, the virus seems to be attacking all age groups. The numbers are not yet alarming, but with the steady appearance of fresh cases and the subsequent heavy handed actions of the local authorities, news didn’t get out.

April 14th (Monday)

Prior to the weekend, Zaki emailed the labs of the CDC and the Dutch virology unit. He got their replies but they were not what he expected. Both labs came to the conclusion that they are still in the dark regarding its capability to trigger a full epidemic. This was partly due to the lack of fresh samples and clinical observations.

They quoted, “We think what we are seeing is just the tip of the iceberg, but we don’t know how big the iceberg is, or where the iceberg is.”

Zaki decided to give proMED another shot, he posted details from his former colleague’s email and the replies he got from the Dutch lab. CDC requested that he kept their involvement a secret since the US government is trying to mend ties with their Middle East counterparts.

He checked his posting before going to bed: zero replies. No one had information that could help. It hadn’t spread past the borders.

Mohamad Zaki was also having a personal problem of his own, he was out of a job for almost a month now. He had interviews lined up for most of the week. This could wait, or so he thought.

June 2nd (Monday)

Two weeks into his new job, Mohamad Zaki finally had time to check his proMED posting, a doctor from St Thomas’s Hospital messaged him asking for help, it was posted a week ago. Zaki immediately checked up the doctor’s email and personally corresponded with him.

He, turned out to be a she. Dr Sarah Flynn, from the intensive care unit at St Thomas’s Hospital in London. Her colleagues had a tough time trying to diagnose a 49-year-old man from Doha, who had arrived by air ambulance with what looks like a serious respiratory infection. He was in strict isolation and he had a virus, that much was clear, but as for the nature of the infection, it was a mystery. The only significant history they got was that he had recently visited Saudi Arabia.

They sent samples and alerted the Health Protection Agency. The scientists there ran a number of tests to exclude common infections, but they couldn’t find a positive result. She was almost about to give up on the patient, when she saw a recent article in one of her medical journals regarding proMED. She registered and managed to find Zaki’s postings, buried almost 5 pages deep. Zaki’s initial posting of patient zero was already locked since there was no updates during the last month.

A brief phone talk later, convinced both Zaki and Sarah that they were, in fact, looking at a novel deadly coronavirus. The Qatari patient had almost identical symptoms to Zaki’s patient zero. In fact, they were eerily similar right down to the ending, the Qatari patient had just passed away 2 days ago.

June 26th (Wednesday)

A journalist from The Guardian flew to Cairo to interview Mohamad Zaki for his piece on the Qatari patient, Dr Sarah Flynn tagged along to meet him too.

It seems that after the Qatari patient’s death, HPA sent his samples to the same Dutch lab that Zaki did. It took them a week to examine the virus’s genetic make-up: the viruses were 99.5% identical. HPA immediately contacted the World Health Organization.

Sarah informed him that the pandemic monitoring and surveillance team at the WHO was looking into both patients but they had stumbled into a wall with the Saudi authorities. They needed more information. The WHO scientists are focusing on some crucial questions. How easily does the virus spread? Where did it come from? How are people infected? As of now, the answers are a string of don’t knows.

Zaki knew. The Saudis were uncooperative because in a couple of weeks’ time, it will be the start of Pilgrimage to the holy city of Mecca for Hajj. If the virus was lurking in the region, this was the perfect chance for it to spread.

The follow-up tests on 60-odd people, including Sarah, fellow doctors and nurses, who came into contact with the patient at St Thomas’s Hospital, came back negative for the virus. So far, that was reassuring. But the scientists at WHO also warned that the virus will mutate and may adapt to spread more easily.

It was back to square one, everyone wanted fresh samples to compare and to perform further tests.

July 8th (Tuesday)

The Guardian had just printed the interview and how the virus was identified, they left out his name. He didn’t want to be subjected to another round of interrogation. Zaki also found out from the article that WHO has redirected their resources into animal screening, they believe that an intermediary beast is carrying the new bug.

The new virus could be lurking in farm animals in the Middle East, but these countries are major importers of livestock too. The virus could even originate from Sudan or Pakistan. Some scientists even suggested bats as the initial source of the virus.

The problem, acknowledged by WHO, was that the countries concerned have bigger problems on their plates. The Arab Spring riots and heightened awareness of individual rights surfacing in these countries, including his own has clouded the minds of the people and dominating the news reports. SARS was circulating below the radar of governments long before it began killing in the hundreds. Foot-dragging and a lack of openness by affected countries made containing the virus much tougher.

There was a piece of good news, the US Food and Drug Administration has begun to screen hundred of drugs that might work against the initial samples of the virus. They are now down to seven or eight drugs that could do something against the coronavirus but it was still too early to tell. But herein lies another problem. So far, there is no ‘animal model’ in which to test the drugs.

Zaki received a call at his desk, he is now a Professor at Ain Shams University. A childhood friend of his working at the Dar El Shefa Hospital intensive care unit had just called to ask for his assistance in identifying the virus which is inflicting one of their patient — who had just arrived in Cairo 2 days ago after a business trip to Jeddah.


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