Miasma

  MIASMA

  by

  Ken McClure

  Saltoun

  MIASMA

  Once upon a time, people believed that diseases such as Cholera and the Black Death were caused by the inhalation of noxious vapours, particularly those arising from decomposing organic matter – the miasma. We now know that bacteria and viruses are the true cause of disease and, when epidemics break out, the modern science of epidemiology enables us to trace their source and predict their likely spread. When an epidemic of the killer disease, Ebola, in the Democratic Republic of Congo does not appear to follow the rules . . . it’s a worry.

  Saltoun

  This edition published by Amazon Kindle in 2019

  Copyright © Ken McClure 2019

  ASIN BO7QXKX581

  The right of Ken McClure to be identified as the author of this work has been asserted in accordance with sections 77 and 78 of the Copyright, Designs and Patent act, 1988

  This book is a work of fiction. Although many of the places and institutions are real, all names, characters, places and incidents are either the product of the author's imagination or used fictitiously. Any resemblance to actual people either living or dead, events or locales is entirely unintentional.

  Table of Contents

  ONE

  TWO

  THREE

  FOUR

  FIVE

  SIX

  SEVEN

  EIGHT

  NINE

  TEN

  ELEVEN

  TWELVE

  THIRTEEN

  FOURTEEN

  FIFTEEN

  SIXTEEN

  SEVENTEEN

  EIGHTEEN

  NINETEEN

  TWENTY

  THE END

  Author’s Note

  About the author

  Other Titles by Ken McClure

  Reviews for Ken McClure

  ONE

  May 2018

  Steven Dunbar, chief investigator of the Sci-Med Inspectorate (Sci-Med), an independent, but government-funded body located in the UK Home Office and his partner, Natalie (Tally) Simmons, a paediatrician at Great Ormond Street Hospital, took breakfast in their Marlborough Court, London flat while listening to the Today programme on BBC Radio 4. It had become their custom to listen to it every morning, using it as a primer to inform them of what was going on in the world before leaving for work. A politician was being asked what his party’s policy was on something he didn’t seem too keen to talk about. He waffled on about his leader having made it ‘perfectly clear’.

  ‘Why do they do it?’ Tally complained. ‘Why come on the programme at all when they have no intention of answering questions?

  ‘Because they’re . . .’

  ‘Strike my last question,’ Tally spluttered, discovering that laughter and cornflakes didn’t mix. ‘I should know better than ask you for your views on politicians.’

  ‘True,’ said Steven, ‘Well, do you think we’ve heard enough bad news to set us up for the day?’

  ‘Mm, it would be nice to hear some good news for a change . . . but maybe that’s against news policy; it has to be bad.’

  ‘And the worse the better. . .’ Steven paused when the Today presenter interrupted proceedings with an item that had just arrived on his desk.

  ‘Early reports of a new outbreak of Ebola virus in the Democratic Republic of Congo are coming in . . .’

  ‘Oh, no,’ Tally groaned., ‘not another one, they’ve hardly had time to get over the last one.

  They listened intently to further but sketchy details. Twenty-five people had died so far; the outbreak was in Equateur Province in the north-west of the country and, although its source had not yet been identified, there were fears that the outbreak would not be confined to rural areas. Cases had been reported in, Mbandaka, a major transport hub with a population of more than a million people.

  ‘This could be the one we’ve been dreading,’ said Steven, ‘the one that triggers a pandemic.’

  ‘Well, nobody can say that Sci-Med didn’t warn them,’ said Tally. She was referring to the fact that Steven and his boss, Sir John Macmillan, the founder of Sci-Med, had been unsuccessfully trying to persuade successive governments that public vaccination against killer diseases should be a priority, citing the fact that a killer strain of ‘flu had managed to sweep round the world back in 1918, killing forty million people at a time when public travel had been much rarer and more difficult than it was today.

  ‘We can only hope they’ll manage to contain it,’ said Tally. ‘Surely they’ll be better prepared this time?’

  ‘It was just plain luck that saved us last time,’ said Steven. He was thinking back to the near-nightmare scenario that had unfolded when a volunteer nurse returning from an outbreak in Sierra Leone to the UK and suffering from Ebola herself, had ended up wandering around a UK airport before boarding a scheduled flight back to her home in Scotland.

  Steven refilled their coffee cups and asked in a quiet voice, ‘How are you feeling?’

  Tally had lost her mother a couple of weeks before after a short illness had progressed to pneumonia and she had failed to recover. This was to be her first week back at work.

  ‘I’m fine,’ she replied, adding ‘really I am,’ in response to the look of doubt appearing in his eyes. ‘I’m glad I managed to spend some time with her before it happened. It was good to be able to say some of the things you’d regret not having done when it was too late.’

  ‘It’s still a big milestone losing your mother.’

  ‘And a pause for reflection,’ added Tally, ‘Makes you consider what you’re doing with your own life.’

  ‘You can’t have any problems with that,’ said Steven. ‘You’ve helped countless sick children: in many cases you’ve been responsible for ensuring they had a life at all. Now, you’re at the top of your game, practicing paediatric medicine at one of the best children’s hospitals in the world.’

  ‘Mm.’

  ‘I only wish my contribution to society was as clear cut.’

  Steven was a qualified doctor too, but had chosen not to practice medicine, feeling at the time that he had been cajoled into medicine by school and parental pressure as bright children often are. After qualifying he had rebelled by joining the British army, initially as a soldier, but, over time, had become a specialist in field medicine – the medicine of the battlefield – as well as a trained Special Forces soldier. He had served with distinction in trouble spots all over the world, practicing both crafts in terrain ranging from jungle to desert. He had opted to leave in his mid-thirties without any real idea what he might do next – or be able to do, when he quickly discovered that openings for people with his skills were limited in civilian life.

  Happily, and to his relief, Sir John Macmillan had come along to suggest that he might fit very well into his organisation, the Sci-Med Inspectorate, a small body of scientists and medics, which had been set up to investigate crime and wrong-doing in the hi-tech world of science and medicine – areas where the police might lack expertise. Macmillan had been right. Steven had taken to the role of medical detective like a duck to water and was now Sci-Med’s chief investigator.

  Tally was surprised at Steven’s expression of self-doubt. ‘You are kidding,’ she said. ‘You’ve taken on some of the most powerful crooked individuals in the land and exposed their true colours: you’ve even come up against pure evil on occasion and won through. How many times have government ministers had reason to thank you personally for what you’ve done?’

  Steven felt embarrassed to hear this from Tally. He knew how much she hated his job and the dangers that occasionally came with it. He wasn’t alone in experiencing these dangers. By association, Tally had come up against them too. He smiled, looked down at hi
s watch and said, ‘You don’t want to be late on your first day back.’

  The outbreak in Democratic Republic of Congo (DRC) was to impinge on both their days. Steven was about to be briefed by John Macmillan on the deaths of two eminent medical scientists, which had caught his attention when they were interrupted by John’s PA and Sci-Med’s office manager, Jean Roberts. She had come in to say that their attendance was requested by the Prime Minister at a COBRA meeting at 2 p.m. to discuss the latest Ebola outbreak in DRC.

  Steven always thought it such a pity that the dramatic acronym, COBRA, only stood for Cabinet Office Briefing Room A, but the drama to those not in the know was always useful in suggesting that the government was taking something very seriously.

  ‘God knows why they’re asking us along,’ sighed Macmillan, ‘they’ve been ignoring our advice on vaccination for years.’

  ‘It’ll be interesting to hear what the Health Department has to say,’ said Steven.

  ‘Do they even have a vaccine against this damned disease?’ asked Macmillan. ‘If I remember rightly, it seemed pretty much like a rush job they came up with towards the end of the 14 – 16 epidemic.’

  ‘I suspect it’ll be the same experimental one.’

  ‘What exactly does ‘experimental’ imply?’ asked Macmillan.

  ‘Untested formally and therefore unlicensed. Because of that, they are obliged to point this out to everyone they intend offering it to and seek their permission before using it.’

  ‘Good God.’

  ‘Let’s hope he is.’

  ‘What do you know about this place, Mbandaka?’

  ‘It’s in the north-west of the country and has a population a bit bigger than Glasgow. It has key transport links to three capital cities, Kinshasa, Brazzaville and Bangui. DRC hasn’t got much in the way of proper roads but it has extensive river networks and lots of boats trading along them – many unlicensed and engaged in all sorts of illegal activities.’

  Macmillan was impressed, even slightly puzzled by Steven’s knowledge. ‘How come you know all this?’

  ‘Simone Ricard,’ said Steven.

  ‘Of course,’ said Macmillan, leaning back in his chair, ‘Dr Ricard and you were great friends. Such a tragedy.’

  Steven’s friend, Simone Ricard, had been a doctor working with Médecins Sans Frontierès’. She had spent her entire medical career with the international medical charity and no one had understood more than her about outbreaks of infectious disease in Africa. Steven had often sought her advice, which had been gladly given and she had been much loved and hugely admired by all who knew her before her tragic death. She had been murdered while attending a medical conference in Prague where she had gone in an attempt to expose an international cover-up over the continuing presence of polio in the Middle East when it had been eradicated everywhere else.

  Tally had been warmly welcomed back to Great Ormond Street where she was popular with staff and patients alike. She had been in the middle of reading patient notes – getting up to speed with what had been going on while she’d been away – when she had been informed that there was to be a meeting that afternoon of senior London hospital staff to discuss the developing situation in DRC. It was suggested that, having just come back and having no patients under her direct care at the moment, she might be best placed to attend. She had agreed.

  Steven was first home. He made himself coffee and stood by the window, watching the river traffic on the Thames through the gap in the buildings opposite their flat in Marlborough Court. It was orderly and controlled unlike the river traffic in DRC he suspected. Confining the spread of Ebola under such conditions would be challenging in the extreme. He was thinking about this when he heard Tally come in.

  ‘How was it?’ he asked.

  ‘A bit odd,’ said Tally. ‘I’ve been at a meeting all afternoon about the Ebola outbreak and how it might possibly affect us.’

  ‘Me too,’ said Steven. He told her about the COBRA meeting, which he thought had largely been called for the benefit of the press, hoping they would help by assuring the general population that Her Majesty’s Government was keeping a watchful eye on the situation.’

  ‘That should do the trick,’ said Tally tongue in cheek. ‘In similar vein, London hospitals are being advised to be “prepared and vigilant”.’

  ‘Let’s eat out and exchange notes?’

  ‘Good idea.’

  They showered and changed into more comfortable clothes before heading out to The Jade Garden, their favourite Chinese restaurant. Apart from the good food and a guaranteed welcome from the extrovert female owner who was always pleased to see them, it was within walking distance of Marlborough Court.

  ‘So, how does being advised to be prepared and vigilant translate into action?’ asked Steven.

  ‘Much was made of our state-of-the-art specialist units, which are ready to deal with any outbreak of deadly disease.’

  ‘How many patients can they handle?’

  ‘About ten,’ said Tally.

  Steven let the ensuing silence join the conversation.

  ‘Not a lot?’ suggested Tally.

  ‘People don’t seem to understand what an epidemic is,’ said Steven. ‘Maybe it’s an age thing.’

  ‘You could be right,’ said Tally. ‘The vast majority – and that includes us – have never experienced one. Unfortunately, that includes the people giving advice and taking decisions. I remember my grandfather telling me about a typhoid outbreak in Aberdeen when he was a young man. It was caused by imported corned beef and the disease spread from person to person like wildfire until all the hospitals were full and the whole city had to be isolated.’

  ‘And that was at a time when we actually had specialist hospitals for infectious diseases,’ Steven interrupted.

  ‘Exactly. Now they’ve all been turned into luxury flats and we have specialist units which can handle ten patients.’

  ‘Absolutely everything depends on identifying the source of a potential epidemic quickly and dealing with it or the game could be lost.’

  ‘The official line is that it is not that easy to contract Ebola,’ said Tally.

  ‘They got that from a text book,’ snapped Steven.

  Tally noted a note of anger in Steven’s voice. ‘You don’t agree?’

  ‘I remember talking about this with Simone before she died. She put me straight. The official view peddled by our Health Officers, is that you can only contract Ebola by coming into contact with the body fluids of an infected person and people are invited to see this as being unlikely.’

  ‘That’s almost word for word what I was taught.’

  ‘It conjures up thoughts of HIV and images of Princess Di shaking hands with patients to show how safe it was.’

  ‘Where are you going with this?’ asked Tally.

  ‘People are being encouraged to think the same way about Ebola . . . they assume they’ll be safe unless they have unprotected sex with an infected person.’

  ‘Ah.’

  ‘Ah indeed,’ said Steven. ‘The situation is completely different with Ebola; it’s one of the nastiest diseases on Earth. Ebola is one of the haemorrhagic viruses: infected people bleed from every orifice; even their eyes bleed and the fever can be such that they are no longer in control of their actions. The area surrounding them will be covered in body fluids. Clothing, bed sheets, blankets, the floor, the walls, doors . . . What are the chances of a nurse engaged in a wrestling match with a demented patient not coming into contact with body fluids?’

  ‘I think you’ve made your point.’

  ‘But the authorities still push the same old line that it’s not easy to contract.’

  ‘That is exactly what they stressed this afternoon,’ said Tally.

  ‘Simone used to say that these people are the kind of people who would learn to swim from a book. They’ll be absolutely fine until they hit the water and then they’ll drown because they didn’t know what it felt like. Reality can be very differe
nt from book learning and, by the time you adjust . . . it can all be too late.’

  ‘You still miss her.’

  ‘We only spoke a couple of times a year,’ said Steven, ‘but she was always worth listening to and she had such a wealth of experience in the field. Steven smiled. ‘She could never understand why I gave up being a doctor; insisted it was the best thing anyone could be.’

  ‘What did you say to that?’

  ‘I told her the real question was, why did I ever become one in the first place. You really should have much more than good school grades to get into medical school. They should require you to have something special along the lines of genuine care and concern for the people who will become your patients. Simone had that, you have it, I don’t.’

  ‘Don’t put yourself down, Dunbar. I seem to remember hearing from one of your ex-army colleagues that you had been single-handedly responsible for saving the lives of more than one wounded soldier under fire and in situations where no back-up was possible.’

  ‘That was different,’ Steven insisted. ‘Special ops . . . are different. ‘You’re in a bubble, you look out for each other, you’re outside society, you make and live by your own rules until the job’s done and then comes the difficult bit . . . you’re expected to re-join society and behave accordingly.’

  ‘That can’t be easy.’

  ‘It isn’t,’ said Steven. ‘Some guys never quite manage it.’

  Tally decided to leave it at that and conceded with a small smile. ‘Okay,’ she said, ‘tell me all about the COBRA meeting.’

  ‘I learned quite a lot.’

  ‘Really? Then it wasn’t just a PR exercise?’

  ‘Apparently there’s a new weapon against pandemics.’

  Tally’s eyes opened wide. ‘Do tell.’

  ‘Money,’ said Steven.

  Tally’s shoulders slumped in disappointment. ‘Money,’ she repeated.

  ‘Apparently something called the Pandemic Emergency Financing Facility was set up after the last Ebola outbreak in West Africa. It has worldwide support with all the big bodies on board and has two parts, a cash element handled by the World Bank under advice from the World Health Organisation and an insurance element with capital being made available from investors.’