Sunday, Oct. 09, 2005
Lessons from the 1918 Flu
Panic broke out. Doctors were kidnapped. Patients starved. Could it happen now?
By JOHN M. BARRY
The last time a new influenza virus reached pandemic levels was in 1968, but the episode was not significantly deadlier than a typical bad flu season. Few people who lived through it even knew it occurred. Still, it killed 34,000 Americans. The 1918 pandemic was far more lethal. It killed 675,000 Americans at a time when the U.S. population was 100 million. Fifty million to 100 million people perished worldwide in the 1918 pandemic, according to Nobel laureate F. Macfarlane Burnet. The flu killed more people in 24 weeks than AIDS has killed in 24 years. The difference in the death toll between 1918 and 1968 had little to do with such medical advances as antibiotics for secondary bacterial infections. The 1968 virus was simply much less virulent. But it wasn't just the virus. As with Hurricane Katrina, some of the deaths in 1918 were the government's responsibility. Surgeon General Rupert Blue was his day's Mike Brown. Despite months of indications that the disease would erupt, Blue made no preparations. When the flu hit, he told the nation, "There is no cause for alarm."
Alarm was needed. Victims could die in 24 hours. Symptoms included bleeding from the nose, mouth, ears and eyes. Some people turned so dark blue from lack of oxygen that an Army physician noted that "it is hard to distinguish the coloured men from the white."
False reassurances from the government and newspapers added to the death rate. They also destroyed trust in authority, as Americans quickly realized they were being lied to. The result: society began to break apart. Confidential Red Cross reports noted "panic akin to the terror of the Middle Ages of the plague" and victims starving to death "not from lack of food but because the well are afraid to help the sick." Doctors and nurses were kidnapped. One scientist concluded that if the epidemic continued to build, "civilization could easily disappear from the face of the earth within a few more weeks."
What will happen during the next pandemic? No one can predict, but even a virus as mild as the 1968 strain would kill many tens of thousands in the U.S. alone. Since 1968, demographic changes have made influenza a greater, not a lesser, threat. Our population now includes more elderly and more people with a weakened immune system. The Centers for Disease Control and Prevention (CDC) estimates that influenza kills 36,000 Americans in an average year. The CDC also calculates that a pandemic caused by a virus comparable to that of 1968 would kill between 89,000 and 207,000 Americans. And the scientist who prepared that study has refused to estimate the toll from a more virulent virus because, he says, he doesn't want to "scare" people.
Even the mildest virus would slam the economy harder now than at any time in the past. That's because businesses--and hospitals--have improved efficiency to minimize slack. When absenteeism prevents one plant from shipping a part, or when a surge of patients overwhelms a hospital already understaffed because of sickness, massive disruptions result.
How prepared are we for all that? Not very. To its credit, this Administration has struggled to get ahead of the curve. Former Health and Human Services Secretary Tommy Thompson considered influenza among his highest priorities. In his last speech as Secretary, he called it his gravest concern. Under him, funding for influenza increased 1,000% despite opposition from House Republicans, who took the threat seriously only after last year's vaccine debacle, when almost half the nation's supply became unavailable because of contamination.
That problem highlighted a weakness in the vaccine-production infrastructure, which, as public-health expert Michael Osterholm says, "is our levee system against a catastrophic event." But even in a perfect world, virtually no vaccine would be available for the first six months of a pandemic. And the Administration has left huge holes in our preparedness. After years of delays, a pandemic plan still needs to be finished.
Yet the clearest lesson from Katrina is that plans are not enough. They must be put into practice. Preparation matters. Even in the chaos of 1918, people who knew what to expect and had been trained did their duty, often in heroic fashion. San Francisco was the only major city in which the local leadership told the truth about the disease. It organized emergency hospitals, volunteer ambulance drivers, soup kitchens and the like in advance. There, although fear certainly showed itself, it did not paralyze. If we prepare well enough, we won't need heroes; we'll just need people doing their jobs.
Â
Barry is visiting scholar at the Tulane-Xavier Center for Bioenvironmental Research and the author of The Great Influenza
http://www.time.com/time/magazine/printout/0,8816,1115641,00.html
Lessons from the 1918 Flu
Panic broke out. Doctors were kidnapped. Patients starved. Could it happen now?
By JOHN M. BARRY
The last time a new influenza virus reached pandemic levels was in 1968, but the episode was not significantly deadlier than a typical bad flu season. Few people who lived through it even knew it occurred. Still, it killed 34,000 Americans. The 1918 pandemic was far more lethal. It killed 675,000 Americans at a time when the U.S. population was 100 million. Fifty million to 100 million people perished worldwide in the 1918 pandemic, according to Nobel laureate F. Macfarlane Burnet. The flu killed more people in 24 weeks than AIDS has killed in 24 years. The difference in the death toll between 1918 and 1968 had little to do with such medical advances as antibiotics for secondary bacterial infections. The 1968 virus was simply much less virulent. But it wasn't just the virus. As with Hurricane Katrina, some of the deaths in 1918 were the government's responsibility. Surgeon General Rupert Blue was his day's Mike Brown. Despite months of indications that the disease would erupt, Blue made no preparations. When the flu hit, he told the nation, "There is no cause for alarm."
Alarm was needed. Victims could die in 24 hours. Symptoms included bleeding from the nose, mouth, ears and eyes. Some people turned so dark blue from lack of oxygen that an Army physician noted that "it is hard to distinguish the coloured men from the white."
False reassurances from the government and newspapers added to the death rate. They also destroyed trust in authority, as Americans quickly realized they were being lied to. The result: society began to break apart. Confidential Red Cross reports noted "panic akin to the terror of the Middle Ages of the plague" and victims starving to death "not from lack of food but because the well are afraid to help the sick." Doctors and nurses were kidnapped. One scientist concluded that if the epidemic continued to build, "civilization could easily disappear from the face of the earth within a few more weeks."
What will happen during the next pandemic? No one can predict, but even a virus as mild as the 1968 strain would kill many tens of thousands in the U.S. alone. Since 1968, demographic changes have made influenza a greater, not a lesser, threat. Our population now includes more elderly and more people with a weakened immune system. The Centers for Disease Control and Prevention (CDC) estimates that influenza kills 36,000 Americans in an average year. The CDC also calculates that a pandemic caused by a virus comparable to that of 1968 would kill between 89,000 and 207,000 Americans. And the scientist who prepared that study has refused to estimate the toll from a more virulent virus because, he says, he doesn't want to "scare" people.
Even the mildest virus would slam the economy harder now than at any time in the past. That's because businesses--and hospitals--have improved efficiency to minimize slack. When absenteeism prevents one plant from shipping a part, or when a surge of patients overwhelms a hospital already understaffed because of sickness, massive disruptions result.
How prepared are we for all that? Not very. To its credit, this Administration has struggled to get ahead of the curve. Former Health and Human Services Secretary Tommy Thompson considered influenza among his highest priorities. In his last speech as Secretary, he called it his gravest concern. Under him, funding for influenza increased 1,000% despite opposition from House Republicans, who took the threat seriously only after last year's vaccine debacle, when almost half the nation's supply became unavailable because of contamination.
That problem highlighted a weakness in the vaccine-production infrastructure, which, as public-health expert Michael Osterholm says, "is our levee system against a catastrophic event." But even in a perfect world, virtually no vaccine would be available for the first six months of a pandemic. And the Administration has left huge holes in our preparedness. After years of delays, a pandemic plan still needs to be finished.
Yet the clearest lesson from Katrina is that plans are not enough. They must be put into practice. Preparation matters. Even in the chaos of 1918, people who knew what to expect and had been trained did their duty, often in heroic fashion. San Francisco was the only major city in which the local leadership told the truth about the disease. It organized emergency hospitals, volunteer ambulance drivers, soup kitchens and the like in advance. There, although fear certainly showed itself, it did not paralyze. If we prepare well enough, we won't need heroes; we'll just need people doing their jobs.
Â
Barry is visiting scholar at the Tulane-Xavier Center for Bioenvironmental Research and the author of The Great Influenza
http://www.time.com/time/magazine/printout/0,8816,1115641,00.html