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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Surviving the disease is only one part of surviving the pandemic. Prominent financial analysts are predicting that the pandemic could trigger an unprecedented global economic collapse.2734 The chief of Pediatric Infectious Disease at Winthrop University colorfully expressed in the 2005 Pediatric Annals “Two masters of suspense, Alfred Hitchcock and Stephen King, may have been closer to the truth than they ever would have believed. Both birds and a super flu could bring about the end of civilization as we know it.”2735

The U.S. National Intelligence Council’s 2020 Project “Mapping the Global Future” identified a pandemic as the single most important threat to the global economy.2736 Realizing that the prospects for preventing the pandemic are practically nonexistent, chief scientists like Osterholm are working with the business community to help ensure an infrastructure for survivors of what is being predicted in policy journals as the “shutdown of the global economic system.”2737 Speaking as associate director of the National Center for Food Protection and Defense for the Department of Homeland Security to a conference of agricultural bankers, Osterholm laid it out: “This is going to be the most catastrophic thing in my lifetime. When this situation unfolds, we will shut down global markets overnight. There will not be movement of goods; there will not be movement of people. This will last for at least a year, maybe two.”2738 These could well be years characterized by “utter chaos,”2739 he said; “panic would reign.”2740

The major North American brokerage firm BMO Nesbitt Burns was the first to describe the global economic implications, suggesting that a pandemic could set off a catastrophic downturn akin to the Great Depression. “A pandemic would be even worse,” its report reads, “in that many would avoid homelessness and soup lines having paid the ultimate price.”2741 The firm’s chief economist pointed out a big difference between a pandemic crash and the Great Depression. “We won’t have 30% unemployment,” she said, “because frankly, many people will die.”2742

Attempts have been made to calculate the costs. An Oxford University group estimated the cost of a mild pandemic at trillions of dollars,2743 but considered it impossible to guess the price tag of a more virulent pandemic that could leave the world economy in shambles for years.2744 Analysts point to SARS, the only other truly global outbreak of a respiratory virus.2745 Only a few dozen deaths in Canada and, according to the Minister of State for Public Health, the entire economy “went to its knees.”2746 Experts note that we were “very lucky that SARS was SARS” and not something like pandemic influenza, which would make SARS “look like a vacation.”2747

Part of the economic paralysis would arise from the fear of contagion. Laurie Garrett is the first reporter ever to win all three of journalism’s top “P” awards (the Peabody, the Polk, and the Pulitzer). At a Council on Foreign Affairs meeting, she tried to ground the dialogue by discussing the possible implications for a city like Washington, D.C. “An influenza virus like H5N1,” she said, “loves doorknobs. It loves the poles in the Metro. It loves every entrance, every common surface that we touch.” She described the environmental persistence of the virus.
So all of Washington, D.C., is full of commonly touched surfaces, and all of a sudden you would see this city utterly paralyzed. Government would stop. You could not imagine any way that people would feel safe commuting in and out of the District, going to government offices, getting on the Metro, all the things that are of the essence of how you keep this place moving around. All I’m saying is that if you amplify your imagination of what this would mean to Washington, to all the most important hubs of the global economy, you easily can see the impact this would have on the global economy.2748
Similar descriptions have been made of the Big Apple shaken to its core. As associate dean of Columbia University’s School of Public Health, Irwin Redlener has been working with New York City officials to ready the metropolis for the coming pandemic. Redlener expects that attempts will be made to lock down entire sections of the city under quarantine. “The city,” he said, “would look like a science fiction movie.”2749

As with Hurricane Katrina, it’s not enough to ride out the storm; we also have to weather the aftermath—the shortages, the loss of essential services, and the ensuing social chaos. With supply chains broken as borders slam shut,2750 major global shortages are expected for everything from soap, paper, and light bulbs to regular medications, gasoline, and parts for repairing military equipment and municipal water supplies.2751 At a pandemic preparedness conference, Garrett sat quietly through presentation after presentation on the various facets of avian influenza. “Well yes,” she asked when the Q & A period finally arrived, “but how will we eat?”2752

We were much more self-sufficient in 1918.2753 As late as the 1960's, most food in the United States was sourced within 100 miles of the supermarket in which it was sold.3186 Our globalized food supply is now more vulnerable to disruption. Today, since our global economy is now built upon just-in-time inventory control, companies have minimal stockpiles of raw materials or finished goods.2754 Modern corporations no longer have warehouses brimming with months’ worth of inventory. Grocery stores rarely have more than a few days’ supply of popular goods stored, and the Grocery Manufacturers Association has been pushing for even tighter inventory restrictions. The chief executive of the Council of Supply Chain Management Professionals told the Wall Street Journal that food retailers “can’t afford a just-in-case inventory.”2755 The threat of a bad winter storm can lead to regional shortages of key commodities;2756 imagine those shortages dragging on for months.2757 A personal supply of Tamiflu is clearly not enough.

Some countries have started stockpiling essential goods. France spent the latter part of 2005 increasing its stocks of protective masks from 50 million to 200 million.2758 While President Bush was expressing confidence on NBC’s Today show that the government would develop a plan “to handle a major outbreak,”2759 some world leaders were bolstering words with action. “No obstacle,” France’s President Chirac told his Cabinet, “notably economic or financial, will get in the way of useful measures to protect the health of the French people.”2760

Congress was informed by an occupational health specialist that not only will grocery stores be empty, but we might lose power, water, and phone service. A World Economic Forum simulation suggested that the internet would shut down within two to four days.2761 Osterholm told Oprah, “Go ask the city of Chicago, ‘How much chlorine do they have?’ Today, many of the cities in this world have no more than five to seven days of chlorine on hand to actually use and purify that water supply.”2762 We might be forced to endure deep winter with no heat.2763 The crumbling of critical infrastructure could be a result, in part, of rampant absenteeism.2764 “Billions would fall sick,” a WHO spokesperson explained, “billions more would be too afraid to go to work, leading to a collapse of essential services.”2765 Top-level UN pandemic catastrophe simulations suggest that maintaining water, power, and provision of food for the healthy may save more lives than focusing on treatment of the sick.2766

Like many police in New Orleans after Katrina, even essential workers such as doctors might simply not show up for work.2767 They would be asked to operate in overflow “hospitals”—gymnasiums, arenas, armories—anywhere the sick could be warehoused. Garrett predicts that these makeshift sickbays might deteriorate into post-Katrina Louisiana Superdome squalor.2768 Likely most health care workers would have no access to vaccines or antivirals. Under these conditions, Osterholm wonders, “Would you show up to work?” “Would your loved ones show up to work if they were being exposed to a life threatening infection with virtually no protection?”2769