1 SARS at an International Conference Followed by a Terrorist Attack

2 July 27 Capital City is to host at its convention center the New Worlds Hi-Tech Forum from Monday, August 4 th to Saturday August 7 th. 730 booths will be displaying and selling the latest state of the art IT equipment to more than 5,000 attendees from around the world. All in all, city planners expect nearly 10,000 individuals to be involved in the conference. Hotel rooms in the convention center area are fully booked.

3 July 29 Two brief news items in CNN international mentioned Chinese authorities reporting two suspected cases of SARS in Hong Kong. There is no local media coverage of this matter. August 2 The first wave of attendees for the New Worlds Conference, including several large delegations from China and Southeast Asia, begin to arrive in the city.

4 14:00 The local proprietor Lin Phu of the Chinese Gardens Restaurant appears at the emergency room at City Central Hospital seriously ill with flu- like symptoms. His wife explains that he returned from a visit with relatives in China only three days ago. 14:45 An emergency room physician concerned over the declining condition of the restaurant owner contacts the CDC in Atlanta and confirms reports of SARS presence in Hong Kong. Preliminary medical tests do not preclude the possibility of SARS.

5 15:00 The hospitals involved (Central, South, West) begin implementing selective isolation measures. 15:30 The hotel physician at the Ultimate Grand Hotel is called to the 7 th floor where more than 75 delegates from China are housed. Five have become quite ill with flu-like symptoms and several others report not feeling well. Two individuals begin to show life-threatening symptoms, and the hotel physician calls 911 asking for their medical evacuation to City South Hospital for emergency treatment.

6 15:40 An investigative reporter for the 6 o’clock news on WPRY TV appears at the public affairs office of City Central Hospital making inquiries on reports of a “strange illness.” 15:45 One of the delegates brought in for emergency treatment at City Central dies. Hospital authorities begin “drastic isolation procedures.”

7 16:00 The situation at the Ultimate Grand Hotel is becoming increasingly more serious with more than a dozen new cases of illness. City South hospital refuses to take any more “SARS” patients and suggest that a quarantine be established at the hotel. City West is more amenable to accepting more patients. 16:30 Investigation into the travel of the 75-person Chinese delegation at the Ultimate Grand indicates that they had arrived in the Capital City only late this morning on a chartered 747 of Cathay Pacific Airlines with 350 other passengers from Singapore, Malaysia, and Indonesia, who are scattered at hotels throughout the city.

8 16:45 The investigative reporter approaches the Mayor’s office for comment on a “breaking story,” which she plans to feature on the 6 o’clock news with the title “Catastrophe Threatens – SARS Epidemic at Hand.” 17:15 The Hi-Tech Conference organizers learn of the current “health problems” and are wrestling with the decision of what to do about the opening gala reception for 5,000 scheduled to begin at 6 p.m.

9 17:30 The relatives of Lin Phu advise health authorities that two family members in an outlying area of the City have been taken violently ill, and have been driven to City West Hospital emergency room. 17:45 Senior City medical officials confirm that, as of 17:35, three of the city’s major hospitals (Central, South, and West) have drastically limited overall capabilities because of intensive isolation procedures related to admission of SARS patients.

10 17:50 A major meeting of emergency officials is occurring at the Mayor’s office to decide on “next steps.” Included in this meeting are the head of the Chamber of Commerce and the High Tech convention organizers. Medical officials make it clear that it is far too early to confirm that the delegation visitors are SARS carriers or victims. Tests on Lin Phu appear a bit more certain. He may be infected with the virus. Conference officials have mixed views of whether to proceed with the reception this evening although 2,500 guests have been assembling at the convention center venue and several hundred more are on the way.

11 17:55 City West Hospital reports receiving two individuals with SARS-like symptoms – young students, one Chinese and one Filipino, who are attending a “Jamboree Conference” (to promote international good will among students) at the state university campus and were found in dorms. The sponsor who brought the individuals to the hospital noted that there were more than 1,000 attendees at the conference with nearly 100 from the Far East. The hospital, which is close to the campus, is seeking further information and debating how and whether to integrate the treatment with the nine suspected SARS cases it has from the Tech Conference.

12 The meeting is interrupted when a TV set in the Mayor’s office is switched up to listen to WPRY’s message of doom moving from emergency room interviews to “live” interviews at the convention center with confused and sometimes frightened reception attendees. 21:00 The city, the nation, and the world are acutely aware of the SARS outbreak in Capital City. Two dozen additional cases have been reported and emergency facilities at the three central hospitals are strained, and the decisions to take a number of proposed drastic steps have not yet been taken, but are under serious consideration. They deal with the SARS cases themselves, travel flow, public concern bordering on panic and the fate of the two conferences in town. At this hour, 12 students from the Jamboree Conference are in the hospital. Organizers of the Conference are seeking advice on how to proceed.

13 August 3, 0430 Airport officials report that two chartered 777 Boeing aircraft with flights originating in Singapore and Hong Kong will arrive at 10:00 with new delegates to the “New Worlds” conference. 05:00 Central, West, and South Hospitals have been designated as the focal point for control of a potential SARS epidemic. At least half of the 65 suspected cases seeking help before midnight have been confirmed as “probables.” The total number of individuals reporting to emergency rooms has as of 04:30 reached a total of 121. All but two have been travelers to the two conferences in town. Over half are Asians.

14 07:00 A coordination meeting is being held in the Mayor’s office with all responsible officials. Two primary topics are on the agenda: a review of response measures being taken and communication to the public on status of problems and measures to be taken. 09:00 Numbers of potential SARS cases seeking help has now reached 407. Medical facilities and personnel are stretched to the limit. The three key hospitals involved are, for the moment, directing all non-SARS cases to other facilities in the city, basically leaving the city center with very limited response potential. International reports indicate that SARS is reaching epidemic proportions in Singapore, Hong Kong, and Shanghai.

15 09:10 The local TV station WPRY receives a call from a representative of a group calling itself the “Brotherhood of God” announcing that the Technology Conference being held in the city is once again evidence that the “ascendancy of science and technology” (a main theme of the meeting) will lead to the “destruction of man.” Therefore, they are taking matters in their own hands to destroy the “perpetrators of filth.” The Transcom building, a 35-story building housing dozens of hi-tech firms and the “New Worlds” conference office must be “leveled to the ground.”

16 09:18 After doing some initial research on the “Brotherhood of God” and learning that it is a fringe group consisting of a loose federation of fanatic, radical young people with a Henry Thoreau “back to nature” and “down with scientists” view tied in an unexplainable marriage of convenience with an extremist Islamic fundamentalist group with roots in the US, UK, and Western Europe, the police are notified. The “Brotherhood of God” are suspected of bombings at a computer research facility in Boston 9 months ago and bio-medical research facility in Rockville, MD, 3 months ago.

17 09:25 The police notify the building manager and send in a bomb squad with sniffing dogs The building management decides to begin undertaking an “optional evacuation of the building” estimating it would require a maximum of an hour to clear all estimated 5,200 occupants from the 35-story structure. Within 2 or 3 minutes, an orderly exodus begins as the fire alarm bells are sounded. 09:43 A massive explosion occurs on the 21 st story.

18 09:45 Fire is observed on the 21 st and 22 nd story from the street level. Power and all communications inside the building above Floor 10 have been severed. 09:47 A variety of first responders begin the approach on the scene. 09:50 Firemen enter the building. There is a secondary explosion on the 10 th floor.

19 09:55 The first injured building occupants, between 30 and 40, have been getting emergency treatment in a gathering area across from the damaged building. Plans to move the dozen or so serious cases to nearby hospitals are being made complex by the scope and nature of quarantine dealing with SARS. 10:00 Medical authorities report a drastic shortage of facilities and personnel to deal with the Transcom catastrophe made even more complex by the increasing severity of the SARS outbreak.

20 10:10 First responders on the scene report several hundred injured have been removed from the bombed building. The fire is spreading and thousands are trapped above the 11 th floor. 10:15 Police report inter-city traffic paralyzed with fleeing office workers and others attempting to flee the city center. Emergency vehicles have not been able to move freely. The situation is expected to become even more complicated in the next 30 minutes. The superintendent of schools appeared on TV and radio (officially) closing all schools, instructing all school buses to return pupils to their houses and urging parents to “bring their children home immediately, either from bus pick-up points or from their schools.” No one seems to know if he coordinated these announcements with anyone.

21 10:30 Engineers are convinced that the structural integrity of the Transcom building is secure, but that it will require 3 to 4 hours to bring the fire under control and several hours to create safe passage for those trapped on the upper floors. 11:00 The SARS outbreak is taxing the medical response structure of the city, and in the view of officials will force immediate decisions on the handling of the 10,000 to 15,000 high-risk visitors in the city; the quarantine policies at the hospital; and the city and population movement in general. Public concern is building and borders in some segments on the verge of panic.