Lessons from the 1918 Flu
The last time a now influenza virus reached pandemic levels was in 1968,
but the episode was not significantly deadlier than a typical had fin season.
Few people who lived through it even knew it occurred. Still, it killed 34,000
Americans. The 1918 pandemic was far more lethal. It killed 675,000 Americans at
a time when the U.S. population was 100 million. Fifty million to 100 million
people purished worldwide in the 1918 pandemic, according to Nobel laureate F.
Macfarlane Burnet. The flu killed more people in 24 weeks than AIDS has ’killed
in 24 years. The difference in the death toll between 1918 and 1968 had little
to do with such medical advances as antibiotics for secondary bacterial
infections. The 1968 virus was simply much less virulent. But it wasn’t just the
virus. As with Hurricane Katrina, some of the deaths in 1918 were the
government’s responsibility. Surgeon General Rupert Blue was his day’s Mike
Brown. Despite months of indications that the disease would erupt, Blue made no
preparations. When the flu hit, he told the nation, "There is no cause for
alarm." Alarm was needed. Victims could die in 24 hours.
Symptoms included bleeding from the nose, mouth, ears and eyes. Some people
turned so dark blue from lack of oxygen that an Army physician noted that "it is
hard to distinguish the coloured men from the white." False
reassurances from the government and newspapers added to the death rate. They
also destroyed trust in authority, as Americans quickly realized they were being
lied to. The result: society began to break apart. Confidential Red Cross
reports noted "panic akin to the terror of the Middle Ages of the plague" and
victims starving to death "not from lack of food but because the well are afraid
to help the sick." Doctors and nurses were kidnapped. One scientist concluded
that if the epidemic continued to build, "civilization could easily disappear
from the face of the earth within a few more weeks." What will
happen during the next pandemic.’ No one can predict, but even a virus as mild
as the 1968 strain would kill many tens of thousands in the U.S. alone. Since
1968, demographic changes have made influenza a greater, not a lesser, threat.
Our population now includes more elderly and more people with a weakened immune
system. The Centers for Disease Control and Prevention (CDC) estimates that
influenza kills 36,000 Americans in an average year. The CDC also calculates
that a pandemic caused by a virus comparable to that of 1968 would kill between
89,000 and 207,000 Americans. And the scientist who prepared that study has
refused to estimate the toll from a more virulent virus because, he says, he
doesn’t want to "scare" people. Even the mildest virus would
slam the economy harder now than at any time in the past. That’s be- cause
businesses—and hospitals—have improved efficiency to minimize slack. When
absenteeism pre- vents one plant from shipping a part, or when a surge of
patients overwhelms a hospital already under- staffed because of sickness,
massive disruptions result. How prepared are we for all that
Net very. To its credit, this Administration has struggled to get a- head of the
curve. Former Health and Human Services Secretary Tommy Thompson considered
influet.za among his highest priorities. In his last speech as Secretary, he
called it his gravest concern. Under him, funding for influenza increased 1,000%
despite opposition from House Republicans, who took the threat seriously only
after last year’s vaccine debacle, when almost half the nation’s supply became
unavailable because of contamination. That problem highlighted a
weakness in the vaccine-production infrastructure, which, as publichealth expert
Michael Osterholm says, "is our levee system against a catastrophic .event," But
even in a perfect world, virtually no vaccine would be available for the first
six months of a pandemic. And the Ad- ministration has left huge holes in our
preparedness. After years of delays, a pandemic plan still needs to be
finished. Yet the dearest lesson from Katrina is that plans are
not enough. They must be put into practice. Preparation matters. Even in the
chaos of 1918, people who knew what to expect and had been trained did their
duty, often in heroic fashion. San Francisco was the only major city in which
the local leader- ship told the truth about the disease. It organized emergency
hospitals, volunteer ambulance drivers, soup kitchens and the like in advance.
There, although fear certainly showed itself, it did not paralyze, ff we prepare
well enough, we won’t need heroes; we’ll just need people doing their
jobs. Since 1918, demographic changes have made influenza a greater threat.