December 11, 2002 | Cleveland (AP) — Officials from the Center for Disease Control have confirmed the seventh death in the city this week from smallpox, bringing the nationwide death toll to forty-three.
Outbreaks of the disease have now been confirmed by CDC in twelve cities: New York, Seattle, San Francisco, Denver, Atlanta, Austin, Detroit, Nashville, Los Angeles, Chicago, Minneapolis, and Boston. In addition, nearly every major metropolitan area in the continental U.S. is currently investigating cases of illnesses believed to be smallpox, but not yet officially confirmed.
President Bush has reiterated the nationwide travel ban enacted two days ago by executive order, federalizing the National Guard nationwide to enforce the ban…
OK, to be clear: that story isn’t real. I made it up.
But I ask you: what if it was? What would you do?
I’m not talking at the usual public-policy level where this blog generally hangs out; I’m talking at a personal level.
We’re about to enter a period of genuinely heightened risk of severe terrorist attacks. Assuming that things go even vaguely close to expected plan, soon it will become 100% clear that the U.S. is planning military action against Iraq. And at that point, the risk jumps through the roof that Hussein’s agents may well strike against us here at home.
Even in my most optimistic moments, I find it difficult to conceive that Hussein would not have some “sleeper” agents already in place within the United States. I can’t bring myself to hope they just don’t exist; it seems too broad a fantasy. I hope, however, that they are armed only with conventional weapons, and not more formidable tools. And most especially, I hope they are not armed with smallpox.
But it is entirely possible that they are.
I’m not particularly afraid of nuclear terrorism, be it of the traditional fission bomb type or a “dirty bomb”. The United States can be hurt by such attacks; we might lose a city and suffer terrible loss of our fellow citizens. But we won’t be destroyed as a nation; we won’t even be seriously damaged in any objective sense.
Smallpox, however, is different. It truly, honestly does have the capability to be a doomsday weapon: a weapon that could quite conceivably destroy American society in a very real sense. In June of 2001, one of the first major role-playing scenarios was conducted to simulate a bioterrorism attack against the United States: the now-famed Winter simulation.
If you haven’t already reviewed Dark Winter’s scenario, I urge you to go do so. It is not comforting reading. The simulation proposed a release of smallpox in three American cities.
At the end of the game, thirteen simulated days in, the conclusion has been reached:
A total of 16,000 smallpox cases have been reported in 25 states (14,000 within the past 24 h) (figures 4 and 5). One thousand people have died. Ten other countries report cases of smallpox believed to have been caused by international travelers from the United States… Although speculative, the predictions are extremely grim: an additional 17,000 cases of smallpox are expected to emerge during the next 12 days, bringing the total number of second-generation cases to 30,000. Of these infected persons, approximately one-third, or 10,000, are expected to die. NSC members are advised that administration of new vaccine combined with isolation measures are likely to stem the expansion of the epidemic. NSC members ask for worst-case projections. They are advised that in worst-case conditions, the third generation of cases could comprise 300,000 new cases of smallpox and lead to 100,000 deaths, and that the fourth generation of cases could conceivably comprise as many as 3,000,000 cases of smallpox and lead to as many as 1,000,000 deaths. It is again emphasized to participants that these numbers are worst-case projections and can be substantially diminished by large-scale and successful vaccination programs and disease-containment procedures…
Although the program’s reports are too tactful to say so baldly, the Dark Winter scenario ended with a simple conclusion: we lost.
Now on the one hand, we may — may — be slightly better prepared to face smallpox now with increased stores of vaccine. But on the other, I submit that Dark Winter’s scenario was always an easy case, given a start in only three cities. Once an enemy has decided to take such a horrible step, it is trivially easy to strike twenty, fifty cities with the same infected carriers, traveling across the country. This is the likely scenario; a neat-and-clean release in only a handful of pinpointed areas is the fantasy.
And so I return to my original question: do you know what you would do if that horrible day does come when we find that the worst has indeed come true?
I don’t have any particularly brilliant suggestions, other than to say: think about it now, not later. Personally, I’ve stashed some basic supplies (water, first aid kit, nutrition bars, battery operated radio, changes of clothing) in my car trunk permanently, and have made plans with my family that, should things go bad, we’ll meet up the family’s most-secluded home up in a small town in the mountains. (I would welcome all of your comments and suggestions for practical steps to take in preparation for such a disaster; you know where the Comment button is).
Pick your own plan, but do pick one. Hopefully, none of us will ever need them.
The vast majority of the time, life feels normal for me these days. But then I remember the feeling of September 11th, and the days that followed: the persistent sensation that normal reality had fallen away; that the unthinkable, horrible scenario that we had all known in our hearts was possible had in fact come true. That the normality of September 10th was never really there at all; and that the hidden worries that we had dismissed up until that next morning had been justified after all.
In my worst moments, I wonder what the next day of revelation will be, and what fearful reality it will bring with it. And I do what I can to be ready for it.
Update: Michele is thinking similar thoughts…
What will you do?