Table of Contents:



I. Storm Gathering

1. 1918

2. Master of Metamorphosis

3. H5N1

4. Playing Chicken

5. Worse Than 1918?

6. When, Not If

II. When Animal Viruses Attack

1. The Third Age

2. Man Made

3. Livestock Revolution

4. Tracing the Flight Path

5. One Flu Over the Chicken's Nest

6. Coming Home to Roost

7. Guarding the Henhouse

III. Pandemic Preparedness

1. Cooping Up Bird Flu

2. Race Against Time

3. Tamiflu

IV. Surviving the Pandemic

1. Don't Wing It

2. Our Health in Our Hands

3. Be Prepared

V. Preventing Future Pandemics

1. Tinderbox

2. Reining in the Pale Horse


References 1-3,199

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Quarantines may make things worse. The detainment, isolation, and stigma associated with quarantine tend to dissuade communities from the timely reporting of outbreaks. Sending soldiers to quarantine large numbers of people may even create panic and cause people to flee, further spreading the disease. During the SARS epidemic, for example, rumors that Beijing would be quarantined led to 250,000 people pouring out of the city that night.679 Throughout history, according to the Institute of Medicine, “for the most part quarantine policies did more harm than good.”680

Irwin Redlener, associate dean of Columbia University’s Mailman School of Public Health and director of its National Center for Disaster Preparedness, called the president’s suggestion to use the military to cordon off communities stricken by disease an “extraordinarily draconian measure.” “The translation of this,” Redlener told the Washington Post, “is martial law in the United States.”681

The president’s proposal drew rancor from both ends of the political spectrum. The conservative Cato Institute joined George Mason University’s Mercatus Center682 in warning that Bush risks undermining “a fundamental principle of American law.”683 The Posse Comitatus Act of 1878 has effectively barred the military from playing a policing role on U.S. soil. “That reflects America’s traditional distrust of using standing armies to enforce order at home, a distrust that’s well justified,” the Institute’s website reads. Since soldiers are not trained as police officers, the Cato Institute fears that putting them in charge of civilian law enforcement “can result in serious collateral damage to American life and liberty.”684

The former editor of New Left Review and acclaimed author of City of Quartz, Mike Davis is also critical of militarizing the pandemic response. Davis is skeptical that Bush’s seeming one-size-fits-all solution to national emergencies is the best approach.685 He asks, “[I]s America going to become one single huge squalid Superdome under martial law if there were an avian flu epidemic?”686

After the September 11 attacks, FEMA—the Federal Emergency Management Agency—was folded into the Department of Homeland Security. According to an emergency management expert at the Institute for Crisis, Disaster and Risk Management at George Washington University, this move “downgraded” FEMA from being a well-functioning small independent agency in the ’90s to being “buried in a couple of layers of bureaucracy.” One former FEMA director testified before Congress in 2004:
I am extremely concerned that the ability of our nation to prepare for and respond to disasters has been sharply eroded. I hear from emergency managers, local and state leaders, and first responders nearly every day that the FEMA they knew and worked well with has now disappeared. In fact one state emergency manager told me, “It is like a stake has been driven into the heart of emergency management.”687
His fears were realized a year later with the response to Katrina, which, read one USA Today editorial, “was nearly as disastrous as the hurricane itself.”688 Bush has since handed authority for coordinating the pandemic response to the same agency that handled Katrina, the Department of Homeland Security.

In a press article, “Who’s in Charge If Bird Flu Strikes—Docs or Cops?,” Georges Benjamin, executive director of the American Public Health Association (and Maryland’s chief health officer during the 2001 anthrax attacks) is quoted as saying that Homeland Security has neither the infrastructure nor the technical expertise to handle such a task. Traditionally, the federal health establishment—the U.S. Public Health Service, the Centers for Disease Control and Prevention, and other health agencies—has been considered the “primary federal agency” in a national health emergency. In the case of the pandemic, though, the Department of Homeland Security has now assumed responsibility.689

Emergency management authorities are troubled by the new arrangement. It’s hard for experts like the chief of emergency medicine at Emory to imagine how Homeland Security could come up to speed almost from scratch on a complex issue like epidemic disease. “Pandemic flu is a naturally occurring health threat of the first order,” he said, “and the people who need to be at the center of that should be health care professionals first and foremost.” Benjamin agrees. “[A]t the end of the day,” he said, “the command decisions for this ought to be made by public health practitioners.”690 For that matter, according to the dean of the Johns Hopkins Bloomberg School of Public Health, “There’s a very intense malaise and demoralization among the CDC staff” under Bush.691

Allegations of White House cronyism—where friendship and loyalty are said to trump competence and qualifications—took on a life-and-death quality with the resignation of FEMA director Michael Brown.692 Similar charges have been made against Bush’s appointed point person for the pandemic, Stewart Simonson.

Like Michael Brown, whose qualifications to run the nation’s emergency response agency evidently included a past stint as Commissioner of the International Arabian Horse Association, Simonson is no expert in public health or emergency preparedness. Though he was appointed assistant secretary for Public Health Emergency Preparedness, Simonson has been regarded by some as just another lawyer pal of the administration. Before he was put in charge of protecting the nation from bird flu, he was corporate secretary and counsel for AMTRAK. During an April 2005 Homeland Security Subcommittee hearing, two Republican Senators concerned about the country’s preparedness for a pandemic asked Simonson a question about the process for acquiring the influenza vaccine. Simonson replied, “We’re learning as we go.”693 Simonson resigned in March 2006.694

Business Week’s bird flu cover story, “Hot Zone in the Heartland,” featured Osterholm contrasting Katrina with the prospect of a pandemic. “The difference between this and a hurricane is that all 50 states will be affected at the same time,” said Osterholm. “And this crisis will last a year or more. It will utterly change the world.”695 Even those sympathetic to the administration have cast doubt on its abilities to manage the crisis. Colonel Lawrence Wilkerson, for example, Colin Powell’s right-hand man at the State Department, recently said, “If something comes along that is truly serious…like a major pandemic, you are going to see the ineptitude of this government in a way that will take you back to the Declaration of Independence.”696