Big Think Magazine

The Real Story Behind Cascadia's Outbreak

"It feels like my lungs are on fire"

Monday, April 7th, 2014 started off like any other day for George Whitmoth. He got out of bed at 6:35am and made himself a breakfast of scrapple and eggs. He'd acquired a taste for the famous Pennsylvanian breakfast food during a stint in Adelphia working for a medical research company, and he loved starting his week with his favorite breakfast food. By 7:15 he was on the Orange Rail, heading for the headquarters of the company he'd starting working for just two months previously: Paralux.

For George, making the move to Paralux was a no-brainer. He had worked for many small-time medical research and device companies, but now he was working for the world's biggest. Plus, he wasn't just working at Paralux. He was working in its famed HQ, the Lightbox. There was a kind of prestige to working in the Lightbox. Being able to tell his parents that he worked there had been one of the proudest moments of his life.

George got to work at 7:41, early for an employee of Paralux, but he was still new and still wanted to make a good impression. He didn't have a boss he needed to impress, because of Paralux's famously flat management structure, but he was still really trying to fit in and show his new colleagues that he deserved to be there. As was now his custom, he brewed a pot of fresh coffee for the rest of his team.

At 8:05, his co-worker Madeline walked in and greeted George. We know from an examination of George's personal diary that he had developed strong feelings for Madeline, and that he was working up the courage to ask her to dinner. He was hoping that today would be the day that'd he'd finally work up the courage. First thing in the morning wasn't the best time, though. He needed to find the "right time" to do it.

His team had a meeting every Monday morning at 10am, in which each of them would take 60 seconds to talk about what they were working on, what they hoped to accomplish that day, and what they needed help with. The meeting usually took about 10 minutes, and then they'd be off and running for the day. We know from the one surviving member of George's team that it was after this meeting that George started to feel not so great.

After the meeting, George took Madeline aside, ventured some distracted remarks about the team's budget for office supplies, then abruptly asked her if she'd like to have dinner with him sometime next week.  Apparently, she said yes. George was observed grinning widely, but also coughing with a slight wheeze as he walked back to his desk. An hour later he complained of a sore-throat. George's colleagues told him to take the rest of the day off, go home and get well. They would be able to handle the rest of the load without him. Madeline was especially insistent. She urged him to head home so he would be healthy for their date next week. George relented.

George took the Orange Rail home again, but the commuter schedule had elapsed, so he waited for the 11:09 train in the way station near the Lightbox. Security footage later on shows that there were probably 20 or 30 people waiting with George in the station. Security footage also shows that his coughing had grown more insistent, almost violently so. George pulled out a handkerchief to cover his mouth, and the footage showed him pulling the handkerchief away again to reveal a smudge of blood. George was declining, quickly.

The footage shows George pondering the swatch of blood. He has an expression of concern, but something more.  Possibly, he has a moment of insight.  In reviewing the footage, an investigator later surmised that George might at that moment thought about going to the hospital instead of home. If he had, of course, a chapter in Cascadia's history might have turned out very differently.  Perhaps the disease could have been identified. Perhaps George could have been quarantined. Perhaps tens of thousands of Cascadians might be alive today.

But in the moment after that moment, the train arrived.  George boarded it.

Security footage shows that there were at least another 75 people in George's train car. It was unusual for the train to be so full at that time, but there was a Prawns match at the stadium near George's house. It was proving to be a big draw for fans of the local team.

About 25 minutes after boarding the train, George walked up to his front door. As he pulled out his keys from his pocket, he was overtaken by a coughing fit. He doubled-over in pain. A neighbor saw him in distress and rushed to help him. She called an ambulance, and, she recalled to the first responders that George had only been able to say one thing to her before passing out: "It feels like my lungs are on fire."

"What the hell happened to this man?"

Doctor Claudia Winterhawk was about 20 minutes away from finishing her six-hour shift in the Emergent Care Center at Wimahl Research Hospital when George Whitmoth was wheeled in. The medics reported that he had stopped breathing twice on the way to the hospital, and that it seemed like his lungs were full of blood.

She quickly assessed his condition. He was put on a ventilation machine, but he stopped breathing once more. Instantly, Winterhawk made a decision: George needed to be put on a bypass machine that would breathe and pump his blood for him while they attempted to figure out what was wrong. They worked quickly to make it happen, even as George's bodily functions strained against the threat of collapse. With every passing second, with the shutting down of organs and cognition, the memories of a life lived dissipated away.

When the machine was in place and finally working, Winterhawk turned to her colleagues and the medics who had brought him in and asked: "What the hell happened to this man?"

The medics told her that he had collapsed at his front door, and they relayed what he'd told the neighbor about his lungs. Doctor Winterhawk ordered a series of tests. The tests would take time, however, and George didn't seem to have much of that left.

The Doctor knew this was not an ordinary case. Something just felt wrong in her gut. She couldn't quite place it, but she knew that something bigger than one sick man was going on here.

She ordered a copy of the lab results to be sent across town to a colleague that she respected more than any other: Doctor Klara Lassater.

"A particularly nasty piece of work..."

Monday, April 7th, 2014 was a pretty ordinary day for Doctor Klara Lassater as well. As head of Advanced Research Projects for the bio-tech giant Morgen Genentech, she had been granted broad leeway in the projects she took on. Doctor Lassater was known throughout the world as one of the best medical minds, and that mind particularly enjoyed taking apart infectious diseases.

"Viruses, bacteria can show us things about life, about the basics of life and evolution, that the study of nothing else on the planet could afford us. They are elegant, beautiful, terrible creatures. They give us a lesson in the history of the planet and give us a guide to its future. We can learn so much from them."

That quote was from a speech that Doctor Lassater gave at a 2012 conference on infectious disease, and now she was about to learn something even she would find shocking.

Doctor Lassater was just about to leave her office for the day. It was her anniversary, and her wife, Elizabeth, a researcher at rival company Paralux, the same Paralux where George Whitmoth worked, had been planning for them to make dinner together. As Doctor Lassater stood up to put on her coat, her phone rang, and she conscientiously answered it after the first ring. On the other end a frantic Doctor Winterhawk poured out a tangled story about a man, barely alive, lying in a bypass machine ... something about liquefying lung tissue?  That couldn't be right. 

Winterhawk had forwarded a series of tests results. At that point, Doctor Lassater was literally halfway out the door, but Winterhawk begged her not to leave quite yet.

As Doctor Lassater hung up the phone and opened the file containing the test results, she had one thought: I'm so screwed. Her supreme dedication to her work had become a source of friction in her marriage. Elizabeth had grown resentful of the time she spent at work. It wasn't unusual to put in an 80-hour week. She put that thought aside and focused on the screen in front of her.

Doctor Klara Lassater had been studying infectious diseases for thirty-six years. She had examined viruses from city sewers, bacteria from volcanic lakes, and fungi from rainforests. She had seen a lot of truly weird stuff. What she saw from the results of these tests, however, was something she'd never seen before.  She immediately picked up the phone and called Elizabeth.

"Liza. You have to come here. You have to see something."

Doctor Lassater then checked back in with Winterhawk. "Claudia," she said, "You've got a particularly nasty piece of work on your hands. Can you send me a blood sample?"

"I'll send you three."

"Three?"

"We have two new cases."

"This is an all-hands on deck situation."

The Cascadia Disease Centers, or CDC as it's commonly referred, sits on the outskirts of Cascadia's capital, Pørtland. The CDC's campus is a series of steel and glass buildings set among tall conifers and well-manicured lawns. But the beauty of the buildings and grounds belies the profound security of the place. It is a fortress.

"This place was designed to withstand an attack by a foreign government with level 7 weaponry or below, " said Abigail Hamilton on a recent tour for the press. "It's more secure than the First Minister's residence, because what we have here on the grounds is considerably more dangerous and powerful than the First Minister..."

After Doctor Lassater hung up the phone with Winterhawk for the second time, she next called Abby Hamilton at the CDC.

"Abby, it's Klara. We have an all hands on deck situation. You need to get everybody together because we're about to have a really big problem."

"What's going on?"

"I'm sending you the file now, but, and I cannot stress this enough, I have never seen anything like this before in a lab and this thing is in the wild. We've got one confirmed case who was exposed wide, and what looks like two more cases. They're all at Wimahl now."

"We're overwhelmed. There's blood everywhere."

Meanwhile, as Doctor Lassater conferred with the CDC, things were getting worse at Wimahl as more patients started arriving.

Doctor Winterhawk was known by her colleagues at the hospital as the Notebook. Everywhere she went, she carried with her a worn, black leather notebook and took incredibly detailed notes on almost every aspect of her day. Her notebook would provide crucial clues in the days ahead.

Doctor Winterhawk recalled in her notes that George Whitmoth was the first. Stacey Longsword and Bea Ravenswood were cases 2 and 3. Both of them appeared to have ridden the Orange Rail in the morning. At 6:07pm, two hours after being admitted to the hospital, Bea Ravenswood was pronounced dead. She was the first casualty.

Under quarantine in another room, George Whitmoth barely hung on to life. As the disease progressed, it became clear that his lungs would never work again. As Winterhawk monitored his condition, she knew she'd never be able to take him off the bypass machine. George would never wake up. She left his room and made her way down to the Emergent Center intake room. In the time since she'd left, six more patients had been brought in. The total now was nine infected.

Winterhawk was the designated PIC (person-in-charge) of Wimahl at that particular moment, a position of responsibility that gave her the authority to quarantine the entire hospital if necessary. It was with this question that she was struggling as she stood in the intake room. Two more patients entered the hospital displaying symptoms, brought in by a woman who seemed perfectly healthy. All three of them wore Paralux Corporation security tags.

Doctor Winterhawk handled the intake of these next two patients personally. She asked the standard questions: When did they begin to feel ill? What symptoms were they experiencing? What was the level of discomfort they were experiencing?

They had decided to come in, they said, after one of them had started to cough up specks of blood. That, they thought, was absolutely not normal.

Winterhawk turned to the woman who had brought them in.

"What's your name?"

"Madeline."

"Well, Madeline, you did a good thing bringing them in to us. We're going to do our best for them, but this appears to be a very serious situation. Do you all work together?"

"Yes, yes we do."

"Has anybody else at your work felt ill or looked ill?"

"Yes. George. George Whitmoth."

"Do you know George?"

"Yes. We're colleagues. We're friends."

"Can I ask you some questions about George?"

"Yes."

"Did you see George today?"

"Yes. He came to work today, but he went home early because he wasn't feeling well."

"Were his symptoms similar to the symptoms of your other two co-workers that you've brought in?"

"Yes, I think so."

"Do you happen to know how George got to and from work each day?"

"He took the Orange Line. He always took the train."

"Thank you, Madeline. You've been incredibly helpful. Would you be able to wait here a few minutes? I'm going to have more questions for you soon."

Winterhawk left Madeline and walked over to each of the patients who had been brought in. Four of them showed only mild symptoms so far. Three were coughing up small amounts of blood. Another two appeared to be sleeping, but stable. As she rounded the corner toward the last of her initial batch of patients Doctor Winterhawk saw something disturbing even for somebody so used to carnage: there was blood all over the floor, all over the walls, all over the four nurses and doctors who had been tending to Stacey Longsword and who had just attempted to revive her. Stacey was dead and she had died horribly.

Doctor Winterhawk walked quickly and calmly to a red phone on the side of the wall near the intake room. The red phone was a hard-line phone that connected the hospital directly with dispatchers at the Pørtland Emergency Management Center. All calls to the PEMC would be recorded.

"This is Doctor Claudia Winterhawk, PIC of Wimahl Research Hospital. We have a level five, code blue emergency here. I am immediately locking down this facility and instituting level five infectious disease quarantine procedures. CDC has been made aware of initial cases, but we will require on-site containment and research staff. We also recommend, based on initial reports, that all train service be suspended throughout the city and that the Lightbox be evacuated using level five containment procedures."

"Doctor Winterhawk, can you please re-confirm level five, code blue?"

"Affirmative. Level five, code blue. This is not a drill."

"Confirmed. We are notifying CDC now."

"Thank you."

"Doctor...?"

"Yes?"

"How bad is it?"

"It's bad. We're overwhelmed and there's blood everywhere."

"Good luck."

"How is this even possible?"

There are moments, Klara Lassater once said, when a disease reveals something fundamental about the nature of life in the universe.

Shortly after Elizabeth Lassater left her office inside the Lightbox, the iconic building was placed in a level five quarantine. People inside the building were allowed to leave only after a screening revealed them to be free from symptoms, and they were transported individually back to their homes, where they were required to be under house quarantine until officially declared disease free.

We know now that many people did not abide by these strictures. If they had, maybe many more lives could have been saved.

Elizabeth and Klara had many things in common, but one of them was a love of puzzles, riddles, and mysteries. They loved figuring out the unfigurable. After showing her slides of the disease up close, Klara turned to Elizabeth and they, at the exact same time, uttered the exact same question: "How is this even possible?"

Before them stood an unfathomable mystery. How could this disease exist? It didn't look like anything they'd ever seen before. How is this even possible?

What was the fundamental lesson that this disease would teach Klara Lassater about the nature of life in the universe?

"Humility."

"She says she doesn't have long now. The disease has almost full exposure..."

The quarantine issued by Doctor Winterhawk turned out to be a very smart and a very horrible decision. Unaccustomed to dealing with super-infections, the hospital had no standard procedures for isolation of potential vectors. Nearly everybody inside the hospital had been exposed: newborns, the elderly, visitors, patients, and staff. Even Claudia Winterhawk herself had been exposed, and she knew it.

She documented her own symptoms in her notebook:

22:57 - Mild sore throat

23:34 - Fever, 99.7

00:57 - Mild cough

01:46 - Fever, 100.9

03:09 - Moderate cough, some blood.

03:12 - Fever, 102.4

Throughout this period, Doctor Winterhawk continued to take notes and continued to try to help patients as best she could. As the disease progressed, she began prescribing liberal doses of opiates to give comfort before the inevitable. Most people that she saw around her now were exhibiting symptoms. The disease turned out to be a spark in a drought-ridden forest: once kindled, it spread effortlessly.

As she made her rounds through the hospital, she realized she hadn't seen Madeline since she first spoke with her. By now Doctor Winterhawk was feverish, was beginning to feel dizzy, and was beginning to have difficulty breathing.

04:51 - Fever, 103.7, heavy coughing, dizziness, lots of blood. Not long now.

Shortly after that she found Madeline. To her astonishment, Madeline showed no symptoms at all.

"Madeline, how are you feeling?"

"I feel okay. I think I'm the only one. Everybody seems sick."

"Can you come with me?"

"Yes, of course."

They walked down the hall and found another red phone. Claudia Winterhawk began coughing as they reached it.  She was coughing up a lot of blood now, but she needed people outside to know what she had learned. She grabbed a pad of paper and wrote instructions and showed them to Madeline.

Madeline picked up the red phone.

"Hello?"

"Yes. Hello, who is this?"

"My name is Madeline. I'm here with Doctor Winterhawk, but she's no longer able to speak."

"What is your situation?"

"Everybody is sick here. Doctor Winterhawk wants me to tell you something."

"What is it?"

"She's writing it now... just a moment."

There's a pause on the recording that seems to last a very long time, a pause punctuated by loud and pained coughing.

"She says that she hasn't got long now. The disease has nearly full exposure. The fatality rate is nearly 100%..."

Here there's another pause on the recording.

"She says, she thinks I'm immune. Do you really think I'm immune?"

Another pause on the recording.

"Hold on, she's writing more."

Another pause.

"She says I've been exposed to patient zero and have been exposed to multiple other exposed patients, including herself, and I don't show any signs of infection. She says that everybody else who has been exposed is infected. She says her notebook..."

After this moment on the recording there's a long bit of coughing, crashing, clunking from the hospital side and the PEMC operator attempting to get Madeline back on the line. This bit lasts several minutes. Finally, Madeline jumps back on the phone.

"I'm sorry. She's... she's collapsed. I don't think she can breathe anymore. I don't know what to do."

"Madeline, can you listen to me carefully?"

"Yes."

"I believe Doctor Winterhawk was going to mention her notebook. Do you see it there?"

"Yes."

"Can you please take the notebook and can you make your way to the hospital entrance?"

"Yes."

"Somebody will meet you there shortly. Please remain calm. It's incredibly important that you remain calm and do exactly as I say, okay?"

"Okay."

"This feels like the end of the world."

In the days and weeks that followed, through the worst infectious disease outbreak on the planet in more than 700 years, tens of thousands contracted the disease and would perish. Pørtland's Overborgmeister, Olivia d'Haviland would issue General Order 2717, which suspended constitutional government in the capital and instituted a city-wide quarantine. When First Minister Nathan Chambers attempted to overrule her order and remove her from her position she had him placed under house arrest in a quarantine.

"Olivia probably saved Nathan's life," recalled another minister, "He would never admit that, but it's true. He owes her his life."

Her action, rash though some said it was, was later credited with keep the death toll to under 100,000 and keeping the disease from spreading around the globe. Only a handful of cases were reported outside of Pørtland.

One news reporter said, on the air, "I don't know what the end of the world feels like, but this... this feels like the end of the world."

Madeline, as it turns out, would prove to be the key to counter-acting the disease. A rare, an extremely rare genetic mutation was the cause of her immunity and it proved the key that Klara and Elizabeth Lassater, and their teams at both Morgen Genentech and Paralux, would use to unravel the disease even as people became sick all around them.

"We got lucky this time," said Klara Lassater after the disease had been finally contained, "If Claudia hadn't seen Madeline we would have been lost. If Madeline hadn't been exposed to George early in the day we might never have connected the dots. Ultimately, the fact that George had a secret crush on Madeline, and that he picked that day to finally ask her out .... Well, we got lucky. Super, super lucky."

"It's a humbling thing to be this lucky."

We still don't know where the disease actually came from. Some have suggested that it evolved on its own. Some think it might have come from outer space, locked deep inside a meteor or comet, lying dormant for centuries in the deep freeze of space. Others have suggested medical experiments or germ warfare projects from deep inside the super-secretive Lightbox or the research labs at Morgen Genentech or Good Vector. Some have suggested a plot by 1151 to weaken a rival world power.

What did Klara Lassater think?

"It doesn't matter where it came from or how it got here. What matters is that we remember, masters of the planet that we think we are, that we are really very fragile creatures living in a very fragile world, and that anything, anywhere can happen to change all of our lives forever. We, as a species, need to recognize our place.  We need humility."

So, what happened to George Whitmoth?

At around 06:17 the day after he first became ill, George suffered what was essentially total system collapse. He had most likely suffered brain death some time before that and it was unlikely that he suffered.

Madeline was never able to see George again. She never got to say goodbye.

"I don't know what might have happened between us," Madeline finally admitted on a quiet Sunday morning. "I liked George a lot. He was funny and kind and sweet. He was good at his job. He was a lot of fun to work with. I feel sad for George and the horrible, horrible way he died. But I also feel sad for myself. I miss him. I still dream about the life we could have had together and sometimes I can't stop crying."