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 Chickenís 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. Donít 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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One authority was quoted as saying, “Short of obtaining [antiviral] drugs, there’s not really much we can do to prepare.”2578 That’s hardly true. While only the “happy few” might have access to Tamiflu or an emerging vaccine, the unhappy many can still practice defensive strategies such as social distancing, respiratory etiquette, and other hygiene measures like hand sanitization. Even if Tamiflu reduced the risk of dying by 80%, given the present lethality of H5N1, these would seem prudent practices for everyone. No one just comes down with the flu. You catch the virus from someone else or, more precisely, someone else’s virus catches you.

In 1918, half of the world’s population became infected by the virus. Although not all who were infected fell ill, half of the world’s inhabitants were exposed. The half-empty interpretation is of an unthinkably transmissible contagion—half the world infected! The half-full view, though, recognizes that fully half of the global populace was able to hide from the virus. The question then becomes, how does this other half live? How can you better the odds that you’ll fall into the lucky half?

Social distancing has been described as avoiding any “unnecessary contact of people.”2579 Influenza is a communicable disease spread from one person to the next; the fewer people you come in contact with, the fewer chances you have of catching it. On a personal level, this means staying in one’s home, not going to work, and avoiding crowds like the plague, especially in enclosed spaces. On a community basis, this may mean closing schools, churches, and other public gatherings.2580 “Most Americans take for granted their freedom,” reads one legal review of the hygiene laws that were imposed in 1918, “to associate with others in a variety of social settings.”2581

At the recommendation of the Surgeon General of the U.S. Public Health Service in 1918,2582 entire states reportedly shut down public gatherings of any kind, including funerals.2583 The American Public Health Association agreed that “[n]onessential gatherings should be prohibited.” “There should be laws,” wrote the APHA, for example, in its official report, “against the use of common cups.” Laws “regulating coughing and sneezing” were also deemed desirable.2584

Huge signs in New York streets warned: “It is unlawful to cough and sneeze.” Violators faced up to a year in jail.2585 Within days, more than 500 New Yorkers were hauled into court. Chicago’s Health Commissioner told the police department, “Arrest thousands, if necessary, to stop sneezing in public.”2586 Signs read, “Spit Spreads Death.”2587

Across America, there were cities of masked faces. People were afraid to talk to one another, eat with one another, kiss one another. The country held its breath.2588 Some cities made it a crime to shake hands.2589 Hundreds were rounded up for not wearing masks and thrown in jail for up to 30 days.2590 Civil libertarians and Christian Scientists, with support from some business sectors, formed the Anti-Mask League in protest. Tobacconists complained that sales were down because people couldn’t smoke with their masks on. Shop owners worried that compulsory masks would discourage people from Christmas shopping.2591 Due to business pressure, some cities closed down all schools, churches, and theaters, but kept the department stores open,2592 giving a whole new meaning, perhaps, to the phrase “shop ’til you drop.”

The closing of schools and other public institutions was not universally accepted.2593 A 1918 editorial in the British Medical Journal read, “[E]very town-dweller who is susceptible must sooner or later contract influenza whatever the public health authorities may do; and that the more schools and public meetings are banned and the general life of the community dislocated the greater will be the unemployment and depression.”2594 The closing of schools, however, may have been especially useful in stemming the spread.2595

According to the World Health Organization, children are the primary vectors for the spread of pandemic influenza.2596 Evidence from a variety of sources mark kids as the major transmitters of influenza in general in a given community.2597 A real-time surveillance system set up at Boston’s Children’s Hospital found that school-aged children may actually drive each winter’s flu epidemic. Preschoolers in particular are considered “hotbeds of infection.”2598 Children are able to shed flu virus for up to six days prior to showing any symptoms and, as the CDC delicately puts it, they are also “not skilled at handling their secretions.”3185 So for almost a week before anyone suspects they are infected, they can be spreading the virus to others.2599

In this way, children play a central role in disseminating influenza. Studies suggest that they pick up the virus mixing with other kids at school and then become the major entry point for the virus to gain access to the household.2600 Japan experimented with its flu vaccine strategy in the 1970s and 1980s and showed that by targeting children for flu shots, hospitalization and death in the elderly could be reduced. Each flu season, children kill their grandparents.2601

It’s easier for some to stay away from crowds and kids than others, but avoiding influenza is a difficult task for all.2602 Exhaled into the air and surviving for hours on solid surfaces like metal or plastic, influenza is notoriously transmissible.2603 After the 1968 pandemic, one scholar wrote, “Those who have spent their lives in attempts to further the conquest of infectious disease are humiliated by the contrast between the success of the astronauts and the failure to control acute respiratory disease.”2604 Another expert noted at a conference on pandemic influenza, “I know how to avoid getting AIDS, but I do not know how to avoid getting influenza.”2605

To avoid the disease completely would mean a divorce from society. A realistically stark description of the coming pandemic at a Council on Foreign Relations forum convinced one audience member “to get in my car and move to Montana or something.” He was told, “It won’t help.”2606

Webster told the New Yorker: “We have to prepare as if we’re going to war and the public needs to understand that clearly…if this does happen, and I fully expect it will, there will be no place for any of us to hide. Not in the United States or in Europe or in a bunker somewhere. The virus is a very promiscuous and efficient killer.”2607

In 1918, it took only one stranger to bring death to an entire community, even in the farthest-flung parts of the world. In China’s remote Shanxi province, the spread of the pandemic was traced to a single woodcutter, tramping from village to village. In Canada, the virus wore the uniform of a stubborn Canadian Pacific Railways official who flouted quarantine, dropping off infected repatriate soldiers from Quebec all the way west to Vancouver. An entire port city in Nigeria was infected by fewer than ten persons.2608

Social distancing, taken to its logical extreme, would mean total isolation from the outside world. True, becoming a hermit living in a cave would presumably preclude one from dying during the pandemic, but this is easier said than done. No man is an island…but what if he lived on one?

Pandemic influenza first reached the Pacific Islands in 1830 on the Messenger of Hope, a ship carrying the first load of Christian missionaries. Fast forward to November 7, 1918. The SS Taline pulls into Apia Harbor in the New Zealand colonial island of Western Samoa from Auckland at 9:35 a.m. Despite many Spanish influenza-infested passengers aboard, the captain tells the island medical officer that no one is sick. With a clean bill of health, the yellow flag of quarantine is lowered, and the ship is docked.2609

Just miles away lay American Samoa, an island governed by the U.S. Navy. Word spread of the outbreak on Western Samoa. The American Commander offered to send volunteer medical personnel to help. Western Samoa’s administrator stubbornly refused, disconnecting the telegraph and later explaining that he “didn’t like Americans.”2610 A week later, the New Zealand army lieutenant colonel in charge of Western Samoa ordered all communications between the islands cut, furious over American Samoa’s refusal to let any ships come near its island.2611

The U.S. Naval Administration shut off American Samoa from the outside world for 18 months, extending into 1920, refusing even mail delivery.2612 Because of its precautions, American Samoa remained the only country in the world in which not a single person died during the pandemic of 1918.2613 In neighboring Western Samoa, just a few miles away, more than one-fifth of the entire population died,2614 probably the highest percentage of any country in the world.2615

Simple quarantine does not work, because healthy-appearing people can spread the disease. But the U.S. Navy showed that isolation, in which one excludes both sick and healthy people, can. While Western Samoans died by the thousands, American Samoan records continued to reveal the normalcy of Samoan life, logging rare deaths from “eating shark’s liver” or from “a falling coconut.”2616

Two other islands also escaped unscathed—St. Helena in the South Atlantic, famed as Napoleon’s place of exile,2617 and Yerba Buena Island right in the San Francisco Bay. As the pandemic raged along the California coast, the U.S. Naval training base stationed on Yerba Buena clamped down with a policy of total seclusion of its 4,000 inhabitants and practiced such preventive measures as literally blowtorching drinking fountains sterile every hour.2618

Total exclusion is more difficult on mainlands than on islands, but portions of northern and eastern Iceland2619 and one town in Alaska also successfully hid throughout the pandemic.2620 Coromandel, a resort town in New Zealand, cut itself off from the rest of the world using a rotating roster of shotgun-wielding vigilantes. It worked.2621

The only town in the continental United States to even come close was the remote mining settlement of Gunnison, Colorado.2622 While surrounding mining towns were being devastated2623 and the situation in Denver was described as “full of funerals all day and ambulances all night,”2624 the residents of Gunnison blockaded off the two mountain pass approaches with armed men2625 and escaped with one of the lowest reported infection rates in the country.2626 Similarly, U.S. Army commands tried to isolate entire military units. They “failed when and where [these measures] were carelessly applied,” but “did some good…when and where they were rigidly carried out.”2627

Island nations like New Zealand are considering similar measures today, examining the feasibility of the immediate blockading of all people and imports—even food and medicine—when the pandemic hits. “To do that,” a New Zealand microbiologist realized, “all those people overseas on holiday would not be allowed in either. It sounds a good idea, but I would find it interesting to see whether it could ever be done.”2628

Mike Davis, author of the recent Monster at Our Door: The Global Threat of Avian Flu, was asked in an interview what he and his family plan to do when the pandemic hits. “There is the run-for-the-hills strategy, quite frankly,” he said, though he acknowledged this may not do much good. “Living in an unpopulated area may work for a handful of people. Maybe some survivalists can do this. But odds are that at least a quarter of Americans will be infected [and fall ill] in a pandemic flu.”2629 America’s purple mountain majesties cannot fit 296 million people.