In the first few days, 1,000 people are infected and 300 die. According to the exercise, “Most hospitals report grossly inadequate supplies and insufficient isolation rooms” (sound familiar?). Soon “Increasingly anxious crowds mob vaccination clinics,” and police and National Guard units are called in to suppress violence. The governor of Oklahoma closes all schools and cancels all public gatherings. Thanks to reluctance of drivers to make deliveries to affected areas, there are food shortages and panic buying. The attorney general prepares options for imposing martial law, including “prohibition of free assembly, a national travel ban, quarantine of certain areas, suspension of the writ of habeas corpus [i.e arrest without due process], and/or military trials in the event the court system becomes dysfunctional.” The unfolding chaos is documented in mock news broadcasts.

After 13 days, 16,000 smallpox cases have been reported in 25 states and 1,000 people have died. Vaccine supplies have been depleted. Canada and Mexico have closed their borders to the United States. It has become logistically impossible to identify and isolate smallpox victims and their contacts to prevent the disease from spreading. Trading on the stock exchanged is suspended. International commerce grinds to a halt. No country in the world will allow flights originating in or transiting through the United States to land. States have closed their borders with other states. There are riots and looting throughout the country.

After 25 days, the number of cases has risen to 30,000, with 10,000 expected to die, and the National Security Council is advised that, absent large scale and successful vaccination programs, the epidemic “could conceivably comprise as many as 3,000,000 cases of smallpox and lead to 1,000,000 deaths.”