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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Katrina

In the White House Rose Garden press conference that triggered a surge of bird flu media coverage, President Bush addressed the pandemic. “The people of the country ought to rest assured,” Bush said, “that we’re doing everything we can.”2450 Iowa Senator Tom Harkin was not assured. “‘Trust us’ is not something the administration can say after Katrina,” he said in an interview. “I don’t think Congress is in a mood to trust. We want plans. We want specific goals and procedures we’re going to take to prepare for this.”2451

Hurricane Katrina hit just days after Bush reportedly finished reading the classic historical text on the 1918 pandemic during his August vacation on his ranch. John M. Barry’s The Great Influenza: The Epic Story of the Deadliest Plague in History2452 details how the U.S. government, in the words of a 2005 Institute of Medicine report, “badly handled” the situation.2453 This combination may have spurred the administration’s sudden interest. Redlener calls it the “post-Katrina effect.” He said, “I don’t think politically or perceptually the government feels that it could tolerate another tragically inadequate response to a major disaster.”2454

As Secretary Leavitt toured hurricane emergency shelters after Katrina and Rita, it hit him how catastrophic the pandemic would be. “What if it weren’t just New Orleans?” he recalls thinking. “What if it were Seattle, San Diego, Corpus Christi, Denver, Chicago, New York? Make your own list.”2455 “We have learned in the past weeks,” Secretary Leavitt told reporters, “that bad things can happen very fast.”2456

He also should have learned the folly of ignoring the warnings of experts. Whether it was the Challenger disaster, 9/11, or Katrina, there were experts who cautioned that these particular tragedies might happen. The U.S. Army Corps of Engineers had been warning about the levees for years. New Orleans’ major newspaper ran a five-part series in 2002 accurately predicting not only the inevitable blow from a major storm, but the nightmarish aftermath.2457 “The danger of a major hurricane hitting New Orleans was ignored until it was too late,” said Senator Kennedy. “We can’t make the same mistake with pandemic flu.”2458 Though senior public health scientists describe an H5N1 pandemic with soundbites like “Hurricane Katrina a thousand times over,”2459 a former FEMA director in October 2005 described the level of federal preparation for the pandemic as “zero.”2460

In the pandemic, there will be no cavalry.2461 During Katrina. the nation’s resources were mobilized to aid three states. Imagine every city as New Orleans. Secretary Leavitt told state public health officials “We could be battling 5,000 different fronts at the same moment. Any community that fails to prepare with the expectation that the federal government will come to the rescue will be tragically wrong.”2462 In Chicago, public health officials have run through a mock influenza pandemic scenario. The simulation showed the public health system breaking down almost immediately.2463 The chief medical officer of the Department of Homeland Security warned, “The federal government will not be there to pick you off your roof in a pandemic.”2464 “If the avian flu were to hit here, it would be like having a Category 5 viral hurricane hit every single state simultaneously,” said the director of Trust for America’s Health.2465 “We’re not prepared. It’s the ugly truth.”2466

George Mason University’s Mercatus Center has concluded that we must “[r]ealize that the federal government will be largely powerless in the worst stages of a pandemic and make appropriate local plans.”2467 Each individual community is responsible for preparing its own pandemic plan; preparation begins with each family, each circle of friends, each neighborhood, each business, each township. To this end, a fledgling “experiment in collaborative problem solving in public health” was launched called The Flu Wiki, available free for anyone to use at www.fluwikie.com, whose explicit purpose is to help local communities prepare for and cope with a pandemic outbreak. It is based on the “wikipedia” model of nonprofit, internet-based collaboration to share knowledge and ideas from around the world. Its success depends on the level and quality of public participation.

Osterholm sees us living at a critical point in history. With time rapidly running out, we as a nation and a world need to act quickly and decisively. “Someday,” he wrote in the public policy journal Foreign Affairs, “after the next pandemic has come and gone, a commission much like the 9/11 Commission will be charged with determining how well government, business, and public health leaders prepared the world for the catastrophe when they had clear warning. What will be the verdict?”2468

According to the Holbert C. Harris Chair of Economics at George Mason University and General Director of the University’s Mercatus Center, the administration’s multibillion-dollar initiative to begin preparations may be too little too late. “[I]f a pandemic came in 2006,” he said, “American efforts would be statistically indistinguishable from zero preparation.”2469 The extra billions are “all well and good,” Osterholm agrees, “but people just don’t get it.” Osterholm explains, on behalf of the Center for Infectious Disease Research and Policy:
If we were to begin a Manhattan Project–type response tonight to expand vaccine and drug production, we wouldn’t have a measurable impact on the availability of these critical products to sufficiently address a worldwide pandemic for at least several years. What we need to do right now is focus on what will get us through a pandemic without counting on drugs. We just don’t have a supply chain that can manufacture enough vaccine and antivirals to make a meaningful dent in what we’d need if the pandemic hits in the next two or three years. We need to think about things like food supplies, health care workers and facilities, essential services. We’re wasting time.2470