Page 1 of Outbreak Protocol

CHAPTER ONE

Day One

ERIK

The coffee in my mug has gone cold. I take a sip anyway, grimacing at the bitterness. The building's night staff know better than to disturb me, even to refresh my coffee. They've learned I prefer solitude when I'm working.

Three monitors form a half-circle around me, each displaying different facets of the outbreak. Left screen: raw case numbers by region and demographic. Centre: my modified SIR model showing transmission vectors. Right: mortality projections based on current intervention strategies.

I frown at the rightmost screen, tapping a key to run the simulation again.

The projected death toll shifts from 50,412 to 47,236.

Better. The previous model hadn't properly accounted for the vaccination campaign in the eastern provinces.

I make a note in my research log, satisfied with the correction.

"Forty-seven thousand, two hundred thirty-six," I murmur, adjusting my glasses. The number represents a 5.3% improvement in our containment strategy. I highlight the section on pediatric mortality rates and—

Astrid's hair spread across the hospital pillow like pale wheat, her skin nearly as white as the sheets. The machines beeping in rhythmic counterpoint to her laboured breathing.

I blink hard, forcing the image away. Focus on the data.

The data doesn't hurt if you don't let it.

I've spent years perfecting this technique—translating human suffering into numbers, variables, coefficients.

It's not callousness; it's necessity. One cannot effectively combat disease while drowning in emotion.

My phone buzzes with an incoming video call. Dr. Okafor from the Nigerian CDC. I straighten my tie before answering.

"Dr. Lindqvist, thank you for taking my call at such an hour." Her voice comes through crisp despite the thousands of kilometers between us.

"It's no trouble. I was reviewing the latest projections."

"And?" The hope in her voice is palpable.

I turn to my mortality curve. "The adjusted model suggests our coordinated approach is working. Transmission rates have decreased by 18% in areas where we've implemented the new protocols."

"That's excellent news." Her shoulders visibly relax. "My team has been working around the clock. Some haven't seen their families in weeks."

This is where conversation typically becomes difficult for me. The personal element. I should acknowledge their sacrifice, express gratitude or sympathy. Instead, I clear my throat and point to a specific data point on my screen as if she could see it.

"The intervention in Makurdi shows particularly promising results. If we can replicate that success in neighboring regions, we might reduce the overall case fatality rate by another 3%."

Dr. Okafor pauses, perhaps expecting more, then nods professionally. "I'll redirect resources accordingly. My field coordinator mentioned—oh, his daughter just started university in Sweden, actually. Stockholm, I believe. Perhaps near your office?"

My fingers twitch on the keyboard. "Stockholm has several excellent universities. I'm not familiar with their enrollment statistics."

Another pause. Longer this time.

"Of course. Well, I should let you get back to work. We'll implement your recommendations immediately."

After we disconnect, I reach for my glasses only to realize they're already on my face. I've been doing this more frequently lately—forgetting where I've placed things, even when they're right in front of me. Perhaps I need more sleep.

I roll my chair back slightly, surveying my office.

Everything in its place. Journals arranged by publication date on the left bookshelf.

Reference texts alphabetized on the right.

Desk clear except for my laptop, notebook, and the Swedish ceramic mug my mother gave me five years ago.

The only personal item visible in the entire space.

My phone rings again. This time it's the WHO coordination team in Geneva.

"Dr. Lindqvist, we need your input on the vaccination prioritization model." Dr. Song's face appears on my screen, looking considerably more tired than when we spoke yesterday.

"I've just finished running the scenarios." I share my screen, walking him through the statistical models. "Based on limited vaccine availability, we should target these three regions first, focusing on healthcare workers and children under five."

"Children under five?" he questions. "Not the elderly?"

"The data shows higher transmission rates among children in this particular outbreak. They're super-spreaders in the affected communities." I pull up a heat map demonstrating the pattern. "By prioritizing them, we create more effective firebreaks in transmission chains."

"Impressive analysis. I'll present this to the coordination committee tomorrow." He rubs his eyes. "How are you holding up with all this?"

The question catches me off guard. "I'm fine. The work is proceeding efficiently."

"That's not what I meant, Erik." He uses my first name, which always makes me uncomfortable in professional settings. "This is our third major outbreak response this year. It takes a toll."

I adjust my tie again, though it doesn't need it. "I find the work engaging."

Song laughs softly. "That's one way to put it. Some of us were planning to grab drinks next week when this calms down. You should join us."

"Thank you for the invitation. I'll check my schedule." I won't, but it's the expected response.

After ending the call, I stand and stretch, my back protesting after hours of sitting.

The windows of my office offer a panoramic view of Stockholm's nightscape—scattered lights punctuating the darkness, the waters of Riddarfj?rden reflecting the city's glow.

Beautiful, but distant. Like viewing the world through a protective glass barrier.

I make a fresh pot of coffee, measuring the grounds with precision—22 grams, medium-fine grind, water at exactly 93 degrees Celsius.

While it brews, I organize the papers on my desk into colour-coded folders: red for urgent action items, blue for ongoing projects, green for completed work awaiting final review.

My glasses have disappeared again. I find them perched atop my head and return them to my nose with a sigh.

The coffee machine beeps. I pour a fresh cup and return to my monitors, scrolling through the overnight email digest. Most can wait until morning, but one subject line catches my attention: "Unusual Illness Clusters – Northern Europe."

The email contains preliminary reports from regional health authorities in northern Germany.

Scattered cases presenting with similar symptoms: high fever, severe headache, rapid onset of neurological complications.

Initial testing negative for known pathogens.

Three deaths reported so far, all within the past ten days.

I open a new spreadsheet and begin entering the case data, creating separate columns for demographics, geographic location, symptom onset, and clinical progression. The pattern is unusual—no clear connection between patients, varied age ranges, no common exposure sources identified.

I map the cases geographically, watching as pins appear across the northern regions. No obvious clustering, but the temporal relationship is concerning. All cases appeared within a three-week window.

I calculate the basic reproduction number based on available information—difficult with such limited data, but my preliminary estimate suggests an R0 between 1.

2 and 1.8. If accurate, that indicates moderate transmissibility, not explosive like measles but certainly sufficient for sustained community spread.

Checking the symptom profiles against known disease patterns, I find no perfect matches. The neurological involvement suggests a possible viral encephalitis, but the rapid progression doesn't align with typical presentations.

I create a new folder on my secure drive labeled "Northern Cluster – Unidentified" and save my preliminary analysis. It's likely nothing—perhaps a known pathogen presenting atypically, or separate coincidental outbreaks being incorrectly linked. Still, something about the pattern nags at me.

I make a note in my calendar to follow up with the regional health authorities tomorrow, requesting additional clinical data and laboratory findings. Worth monitoring closely, at minimum.

The first hints of dawn lighten the sky outside my window. Another night passed in the company of data and disease patterns. I should feel tired, but the puzzle of the northern clusters has energized me. This is what I do best—finding patterns in chaos, signals in noise.

I close the file and add one final note to my research log: "Monitor northern European cluster—potential novel pathogen?" Then I save everything, back it up, and shut down my systems for the night.

As I gather my coat and bag, I glance back at the darkened monitors.

Forty-seven thousand, two hundred thirty-six projected deaths in Africa.

Unknown number in Northern Europe. All reduced to data points in my models.

It's better this way—cleaner, more manageable. Numbers don't leave you like people do.

I check my watch. 5:43 AM. Time to go home, shower, change clothes, and return for the official workday. No one at ECDC questions my hours anymore. They simply accept that Dr. Erik Lindqvist exists primarily in this office, surrounded by numbers that speak more clearly to him than people ever have.

Little do I know that the northern cluster I've just filed away will soon demand more than my analytical mind. It will require something I've kept locked away for years—my heart.