The growing number of humans affected by the avian flu virus in South Asia has raised concerns about a new global pandemic. World health officials are worried that the virus could become increasingly deadly if genetic changes make it more easily transmittable among humans.
Avian flu is only the latest in a series of influenza threats in recent years, a trend that has one Canadian physician imagining an even more terrifying scenario. Daniel Kalla has written a novel titled Pandemic, a thriller about a fictitious influenza outbreak that becomes a weapon of international terrorism.
Dr. Kalla's new book grew out of his experience with SARS in the Canadian city of Vancouver, where he practices medicine. The impact of the potentially fatal respiratory infection turned out to be far less severe than originally feared in Vancouver, but Dr. Kalla says it was enough to set off a panic among local health officials.
"It was the most vulnerable and scary time I've ever experienced working in medicine," he recalls. "I sat on one of the local task forces to respond to SARS, and one of the questions I asked somebody in a meeting was, 'How do we know? It's popped up in Toronto. It's popped up in Singapore and Hong Kong. How do we know this is random? What if someone is doing this deliberately?' That was when the seed of the idea was planted for Pandemic."
Pandemic is about a virus called ARCS that is believed to be caused by the intermixing of species, mutating as it moves from birds to pigs to humans. "It's a fictional flu virus," Daniel Kalla says, "but it's based very much on real influenzas of the past and the fact that the influenza is a virus very good at mutating and creating new strains of itself. It's a little bit deadlier than SARS is, with a roughly 20% fatality rate. It's not quite as contagious, but it still manages to spread quickly enough -- especially when someone gets involved in artificially helping with that spread."
Daniel Kalla says what is especially frightening about bio-terrorism is that it is a relatively low-tech endeavor. "All it would require is someone determined enough to get their hands on the virus. And in the case of the flu, they could use themselves -- which is what the terrorists in the book do," he explains. "They become human suicide bombers and deliberately spread it to tactical locations."
Pandemic begins in a hospital in rural China, where there has been an outbreak of the fictional virus. Two men manage to extract blood from a patient with the influenza, helping to unleash an epidemic that is soon spreading to other parts of the world. The threat brings together an American doctor working for the World Health Organization and a U.S. government official who specializes in countering bio-terrorism.While the plot is fictitious, Daniel Kalla says the potential to weaponize any virus is always present. "But I think the good news is that it was there five years ago, when we in the lay community, and also the experts in the know, were far less aware of the risk," he says. "So I think we're much better prepared and ready to respond to such a scenario."
Daniel Kalla wrote Pandemic primarily to be an entertaining thriller, but he says he would be gratified if the book adds to the public's growing awareness of the dangers posed by infectious disease.
"When we were talking about a title after the manuscript was finished last spring," the author recalls, "we thought Pandemic was a catchy name. But we were worried that nobody would know what the word meant. Well, a year later, people are pretty aware of the word…because of what's going on with the avian flu right now. In fact, the few humans who have acquired avian flu from birds have had a much higher fatality rate than even the virus I imagined."
Just 25 years ago, notes Daniel Kalla, many people thought that epidemics of infectious disease were a thing of the past. "We had fancy antibiotics," he says, yet "since that time we've seen HIV, SARS, Ebola, avian flu and multi-resistant bacteria. We don't know what next year's risk is going to be. I think we're always going to be susceptible."
Daniel Kalla says he turned to his colleagues in fields like virology and microbiology to provide the scientific detail in his book. "I think I've painted a fairly accurate picture of an influenza and an outbreak and a quarantine and a medical response plan," he says.
But describing the exotic locales in the novel turned out to be more challenging. "I wouldn't have been able to write the book without the Internet because I haven't been to many of the places," he acknowledges. "There's one scene that occurs in a tiny little town in China, and the heroes end up staying in a kind of rundown hotel, and I was actually able to do a virtual tour of the hotel -- the one it was based on in real life -- on the Internet."
The author's experience working in a hospital emergency room proved useful, as well. "I really wanted to convey the sense of apprehension and fear that an outbreak like SARS or avian flu would bring with it," Doctor Kalla says, "and I felt a little bit of that when SARS was going on."
Daniel Kalla has also relied on past experience to balance his two careers. He says he learned how to stay focused and meet deadlines while going to medical school. Now he is drawing on that sense of urgency to both practice emergency room medicine and write thrillers. He already has two more novels ready for publication.
