Table of Contents:

Foreword

Introduction

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

Topics

References 1-3,199

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Mass graves being dug in 1918

One survivor remembers the children. “We had little caskets for the little babies that stretched for four and five blocks, eight high, ten high.”58 Soon, though, city after city ran out of caskets.59 People were dying faster than carpenters could make them.60 The dead lay in gutters.61 One agonized official in the stricken East sent an urgent warning West: “Hunt up your wood-workers and set them to making coffins. Then take your street laborers and set them to digging graves.”62 When New York City ran out of gravediggers, they had to follow Philadelphia’s example and use steam shovels to dig trenches for mass graves.63 Even in timber-rich Sweden, the dead were interred in cardboard boxes or piled in mass graves because they simply ran out of nails.64

Another survivor recalls:
A neighbor boy about seven or eight died and they used to just pick you up and wrap you up in a sheet and put you in a patrol wagon. So the mother and father are screaming, “Let me get a macaroni box”—macaroni, any kind of pasta, used to come in this box, about 20 pounds of macaroni fit in it— “please, please let me put him in a macaroni box, don’t take him away like that….”65
One nurse describes bodies “stacked in the morgue from floor to ceiling like cordwood.” At the peak of the epidemic, she remembers toe-tagging and wrapping more than one still-living patient in winding sheets. In her nightmares, she wondered “what it would feel like to be that boy who was at the bottom of the cordwood in the morgue.”66

They brought out their dead. Corpses were carted away in anything, wheelbarrows—even garbage trucks.67 Often, though, the bodies were just pushed into corners and left to rot for days. People too sick to move were discovered lying next to corpses.68

All over the country, farms and factories shut down and schools and churches closed. Homeless children wandered the streets, their parents vanished.69 The New York Health Commissioner estimated that in New York City alone, 21,000 children lost both parents to the pandemic.70

Around the world, millions were left widowed and orphaned.71 The New York Times described Christmas in Tahiti.72 “It was impossible to bury the dead,” a Tahitian government official noted. “Day and night trucks rumbled throughout the streets filled with bodies for the constantly burning pyres.”73 When firewood to burn the bodies ran out in India, the rivers became clogged with corpses.74 In the remote community of Okak, in northern Labrador, an eight-year-old girl reportedly survived for five weeks at 20 below zero—among the corpses of her family. She kept herself alive by melting snow for water with the last of her Christmas candles while she lay listening to the sound of dogs outside feasting off the dead.75 Colonel Victor Vaughan, acting Surgeon General of the Army and former head of the AMA, lived through the pandemic. “If the epidemic continues its mathematical rate of acceleration,” Vaughan wrote in 1918, “civilization could easily disappear from the face of the earth.”76

But the virus did stop. It ran out of human fuel; it ran out of accessible people to infect. Those who lived through it were immune to reinfection, so many populations were, in many respects, either immune or dead. “[I]t’s like a firestorm,” one expert explained. “[I]t sweeps through and it has so many victims and the survivors developed immunity.”77 Influenza is “transmitted so effectively,” reads one virology textbook, “that it exhausts the supply of susceptible hosts.”78

As soon as the dying stopped, the forgetting began. As Arno Karlen wrote in Man and Microbes, “Many Americans know more about mediaeval plague than about the greatest mass death in their grandparents’ lives.”79 Commentators view the pandemic as so traumatic that it had to be forced out of our collective memory and history. “I think it’s probably because it was so awful while it was happening, so frightening,” one epidemiologist speculates, “that people just got rid of the memory.”80

For many, however, the virus lived on. As if the pandemic weren’t tragic enough, in the decade that followed, a million people came down with a serious Parkinson’s-like disease termed “encephalitis lethargica,” the subject of the book and movie Awakenings.81 Some researchers now consider this epidemic of neurological disease to be “almost certainly” a direct consequence of viral damage to the brains of survivors.82 The latest research goes a step further to suggest the pandemic had ripples throughout the century, showing that those in utero at the height of the pandemic in the most affected areas seemed to have stunted lifespans and lifelong physical disability.83