The Public Health Oracle: How One Man’s Outbreak System Chan

The Lotus's reluctant, metronomic creak was the sole indicator of time in the sweltering office. Each laborious turn stirred the thick, clammy air, doing little more than to move the odor of dust, discolored paper, and hopelessness from one side of the room to the other.

Professor Reuben Stone, aged forty-six, knew the precise angle of the stain on the ceiling, the precise number of cracks in the plaster webbing off from the corner of the window frame. He'd mapped them all over the past three years, a silent cartography of his own decline. His finger traced a circle on the thin layer of grit on his desk around the date of the Harbor City Gazette. His pay was due again. Not just due—gone. For the second month running.

A fly buzzed, kamikaze-diving into the hot glass of the lamp. Reuben did not swat it away. Its struggle was solidarity.

Outside his open window, Riverside Village sounds ebbed and flowed: a goat's distant bleat, haggling vendors' shouted calls down at the market, children's screams as they kicked a squashed ball along the dirt road. Life, active and confusing and utterly oblivious to the man who sat in the rotting institute on the hill.

The Riverside Community Health Institute. The name was a testament to idealistic grant proposals many years ago rejected. It was a whitewashed, single-storey building whose paint flaked like a sunburned tourist. His classroom—a fifty-person room—had twelve in it today, listless students with faces glazed with heat and a polite, resigned tedium. They were here for a certificate, for a line on a CV, not for the hot passion of epidemiological research. That fire had been extinguished in Reuben years ago, drowned in a deluge of red tape apathy and the slow, heartbreaking realization that nobody was listening.

He was a ghost in his own domain. His articles on zoonotic spillover events had once generated controversy in academic circles. He'd once had a research team, a real lab, ambitions that extended beyond keeping the village well from becoming too contaminated with runoff. Now he taught teens in basic sanitation who dreamed of moving to Harbor City to drive cabs.

"The fundamentals of disease transmission aren't theoretical," he'd explained to him that morning, his voice husky. He'd tapped the chalkboard, upon which he'd doodled a shaky diagram of a water-borne pathogen infiltrating a human host. "They are happening right now. In what you ingest. In what you drink. One case of cholera in the market…"

One boy in the back, Emmanuel, had snorted softly. "Cholera is for history books, Professor. My uncle tells me the city water is clean now.

Reuben had closed his eyes for a moment, fighting against the wave of bitterness. City water didn't serve half of the village, and what did serve was patchy and poorly treated. But fighting against that mindset, that complacency bred of far-off government promises, was like trying to stem the river with his open hands. 

The last bell had been a mercy. He'd dismissed the class and returned to his office, the four walls that held his obsolescence. Outdated textbooks from days of yore sat in magnificent, dusty stacks. A diploma photo of himself accepting an award from a dean whose name he could barely remember. And in the back of his desk drawer, a bottle of rotgut whiskey and a stack of unread letters from journals that had deemed his recent work "lacking in broad applicability."

Lacking in broad applicability. The words spun through his head, rhythms of the fan whine. What was the broad applicability of watching a community poison itself with slow-burning neglect? Of witnessing that a crisis was forming in the gut of every child who played in the sewage-ditch that served as a storm drain after the rains? His information was a curse. He knew the future, a dark deluge of fever, dehydration, and death, and he could not stop it. He was a cartographer of catastrophe, plotting routes no one would ever use.

A hard, frantic pounding interrupted his self-pity.

He did not move. It had to have been Old Man Jabari with his gout again, who thought the "city doctor" had a magical pill.

There came another knocking, louder, a frantic staccato that was all wrong.

"Professor! Professor Stone!" A scared voice, punctuated with fear.

Reuben pushed himself up from his chair, scraping it across the pavement. He opened the door to find one of his quieter, more book-smart students, Sarah, her eyes wide, gasping for breath. She wasn't one for drama.

"Professor, you have to come. It's Little Kamau. From the market. He's horribly ill."

The fear in her voice was a cold splash of water. The lethargy was gone, to be replaced with a professional clinical ferocity. "What are his symptoms?"

"He was… rice water. Rice water stool. Lots. And he won't stop. He is cold, but febrile. His eyes… they are sunken in his head."

Reuben felt ice in his veins. Rice water stool. The classic, frightening sign. His sketch on the chalkboard was no longer hypothetical.

"Cholera," he breathed, the word tasting of ash.

He retrieved his battered medical kit—a relic from the field days when he'd packed it with nothing but antiseptic, bandages, and oral rehydration salts—and stepped outside with Sarah into the hot swelter.

The journey on foot to Kamau's compound was a haze. The colors of the village were now menacing, every individual a possible host, every pool of stagnant water a possible reservoir. He viewed the world as vectors and hosts taught by his training, and the grid was redeeming.

The compound was in disarray. A mob waited outside the tiny mud-brick house, crying in panic and fear. Inside, the atmosphere was thick with the stench of disease and despair. Kamau's mother, Aisha, knelt by a mat on the ground, silently crying as she tried to wipe the brow of her son. The child, no more than eight years old, curled up in a fetal position, his body contorted in spasmodic cramps. A clay cup beside him contained the unmistakable, watery evidence. 

Reuben knelt down on one knee, his professional expression a mask for horror. He felt the boy's pulse: thready and rapid. His flesh was no longer flexible; Reuben pinched it, and the skin tent lingered for a few seconds before finally relaxing. His dehydration was acute. He was shutting down.

"He requires IV fluids. Now," said Reuben curtly. "He requires to be in a clinic."

Aisha's head shook, and her face ran with tears. "The clinic is closed. The nurse has travelled to the city. There is nobody."

The desperation piled around him. The nearest decent medical facility was two hours away on a good day. Kamau wouldn't last that long. He was being sentenced to death, delivered by destitution and abandonment.

Boil water," Reuben commanded, his own voice taking on an authority he had not used in years. "All of us. Only boiled water or the water from sealed-up bottles at the store. Do we have rehydration salts?"

A head shake. Of course not.

Reuben's mind was whirling. He had had some packets in his rucksack. Temporary. He dug them out, instructing Aisha on how to thin them out with the purest water they could obtain. It was like attempting to halt a tide wave with a cup.

As he leaned forward trying to manage to get a couple of mouthfuls of the fluid into the boy, a wave of sheer, unbridled rage consumed him. This did not have to be. All of this could have been avoided. The poisoned well, the ignorance, the closed-down clinic, the disappeared nurse. It was a hymn of failure, and there was only one person who could spot the sour notes. He was so angry he could hardly see. Angry at the government, at the institute, at the world. But most of all, he was angry at himself for his own failure.

I see it. I know how to make it different. And I am unable to do anything.

The realization was a scream in his mind.

And then something shifted.

There was a pressure, an enormous and silent pressure, in the room. The anxious discussion of the family outside the door retreated into a distant murmur. The world did not grow dark, but the edges of his perception became acute, intensely concentrated. The data he was perceiving—the symptoms, the environment—felt to fall into place, snap together like the mechanisms of an immense, hidden machine.

A rectangle of frozen blue light in the center of his vision, superimposed over the suffering boy. It was utterly real, but he knew it was not a physical thing. Text began scrolling, in a sharp, sans-serif type that was alien and warmly familiar.

.SYSTEM PARAMETERS ALIGNED. .HOST AFFINITY CONFIRMED: EPIDEMIOLOGICAL PREDICTION/RESPONSE. .INITIALIZING OUTBREAK SYSTEM v.1.0.

Reuben's breath froze in his throat. Wildly, he blinked, but the display remained the same, static.

SCANNING. SCANNING.

The screen filled with new information.

LOCALIZED OUTBREAK DETECTED PATHOGEN: Vibrio cholerae (Serotype O1) PATIENT ZERO: Kamau Adebayo (8 yrs, M) SOURCE: Contaminated communal well (Primary), Unhygienic market stall preparation (Secondary) PROJECTED SPREAD: 48 HOURS TO SATURATION OF LOCAL POPULATION (R0: 4.7). ESTIMATED MORBIDITY: 37%. ESTIMATED MORTALITY: 5.8% (Higher in <5 & >60 cohort).

The numbers were raw, devastatingly particular. An R0 of 4.7. Nearly forty percent of the village fell ill. One in twenty dying. He envisioned their faces: his pupils, Old Man Jabari, the mango seller who was a woman. 

A new prompt flashed, softly illuminated.

OBJECTIVE: CONTAIN AND NEUTRALIZE OUTBREAK (TIER 1) RECOMMENDED MEASURES: 1. ISOLATE PATIENT ZERO. 2. DISPENSE ORAL REHYDRATION SOLUTION (ORS) TO VULNERABLE GROUP. 3. TRACE AND CLOSE CONTAMINATED WATER SOURCE. 4. ACTIVATE COMMUNITY HYGIENE PROTOCOL.. COMPLETION PAYOUT: DEVELOPMENT POINTS (DP) ISSUED ON BASIS OF EFFECTIVENESS AND TIMELINESS OF RESPONSE.

Development Points? What did that mean? His scientist's brain, tempered through decades of skepticism, rebelled. This was an illusion. Heatstroke. Stress. Grief. A psychotic break brought on by decades of hopelessness.

And the information… The information was correct. It was an immaculate, merciless analysis of the situation, the kind of forecast model he'd only ever aspired to design.

"Professor?" Aisha's voice was small, frightened. "Is he?"

Reuben stared from the boy's dying body to the glowing screen, and then back again at the boy. It wasn't important whether or not this was madness. The instructions were real. They were the only hope.

He made a decision. He chose to believe.

"Sarah!" he yelled, the new energy in his voice making her jump. "Go to my office. There is a box in the lowest drawer of the filing cabinet. It says 'ORS' on the side. Take it all. Go!" 

She stared at him for a second, then turned and ran out the door.

He turned to the cluster of kin outside the doorway. "You! You and you! Round up all people. I want all the clean pots and buckets that you own. Boil every single drop of water in this compound. Now! I want a list of all homes that use the central well."

He moved, directing, his mind detonating on paths he thought had atrophied decades earlier. The System's interface remained, a constant, unobtrusive presence. With each act of command, a tiny sub-menu flared beside one of the proposed actions.

LAUNCH COMMUNITY HYGIENE PROTOCOL? [Y/N]

He focused on it, a quiet affirmation.

A new list grew.

REQUIRED: - 50L Clean Water - Communication to 50+ Households - Dispensing 200+ ORS Packets ESTIMATED DP COST TO EXPEDITE: 0 (Materials should be locally procured). PROTOCOL READY. WAITING FOR HOST CONFIRMATION.

He couldn't do it quickly. He had to do it the hard way. But the System was giving him a blueprint.

For the remainder of three hours, Reuben Stone was a whirlwind. He set the family into a hoc medical corps. He sent runners to all four corners of the village, instructing them to boil water, to avoid the center well, and to report to the compound if they experienced so much as a twinge of sickness. Sarah returned with the box of ORS packets, a pitifully small number against the coming tidal wave, but it was a start.

He worked tirelessly, washing, instructing, mixing liquids. He did not look at the System again, but he was conscious of its presence, an unseen meter monitoring his every action.

Night fell, and the first of the new admissions arrived. A young mother and her toddler. Then a fisherman. Reuben and his improvised team attended to them, giving fluids, reassurance.

Somewhere around midnight, as he was trying to keep an eye on Kamau, something shifted. The boy's breathing was deeper. His skin, still cold, was no longer moist. The deadly spasms disappeared. He slept normally.

A soft chiming, audible only to him, sounded in his head.

PATIENT ZERO STABILIZED. OUTBREAK CONTAINMENT AT 22%. OBJECTIVE PROGRESS: SIGNIFICANT. REWARD CALCULATED.

The blue screen flashed once more.

OUTBREAK MEASURED: TIER 1 (PARTIAL) MORBIDITY: 0.8% (Projected: 37%) MORTALITY: 0.0% (Projected: 5.8%) RESPONSE Efficacy: 84% REWARD: 50 DEVELOPMENT POINTS (DP) AWARDED.

A sweep of exhaustion, so profound it was akin to a physical blow, washed over him. He braced himself against the mud-brick wall, leaning down to sit on the hard-compacted earth. He had done it. He'd actually done it. He'd stared into the pit of a prophesied calamity and pushed it away.

Fifty points. What did they mean?

And as if in reply, the System interface shifted. The outbreak data vanished, to be replaced by a simple, new menu.

OUTBREAK SYSTEM v.1.0 HOST: Reuben Stone AVAILABLE DP: 50. DEVELOPMENT CATALOG: [LOCKED - 100 DP REQUIRED FOR TIER 1 ACCESS]

Among the items listed under the locked catalog, one glowed softly, warmly.

EMERGENCY PROVISION: BUY x100 ORS PACKETS (PRICE: 50 DP) [Y/N]?$

A hundred packets. More than he had ever had. Enough to hold off a dozen smaller attacks. A real-world, tangible reward for good work.

He looked across the quiet compound. Kamau slept. His mother had finally succumbed to exhaustion, curled up on a mat beside him. Outside the village was quiet, no one the wiser to the disaster avoided. The fan in his office still wheezed, stirring hot, useless air. All was as it had ever been.

And everything had.

Reuben Stone, the missing scholar, the ghost of epidemiology, exhaled a breath he felt as though he'd been holding for two decades. A tentative smile, the first genuine one in what had felt like an eternity, creased his mouth.

He considered the choice and made up his mind.

Yes.