In flu scare, echoes of a fearful time

[May 04, 2009]  WASHINGTON (AP) -- The calendar says 2009, but our fears say it is 1918.

The front page tells us about Mexico, and a new strain of influenza that has killed more than a dozen people there and spread to the United States and Europe and Asia.

But our dire imaginations take us back to another contagion in another century. Victims sometimes died within hours, blood coursing from noses and mouths; coffins piled high on city streets. Worldwide, multitudes succumbed -- 40 million, 100 million, no one knows for sure.

Could it all be unfolding again?

It's unlikely. The Spanish flu epidemic was, in the words of writer Lynette Iezzoni, "the most catastrophic season of death in human history." The cause was a new virus with a special talent for slaughter; scientists literally did not know what they were dealing with.

Mass movements of men to fight in World War I helped spread the disease, while government officials -- eager to keep wartime morale high, and panic low -- downplayed the disaster.

We live in a very different time. No one knows whether the new swine flu will develop into a major killer, but viruses are better understood. U.S. health officials say the new strain's genetic makeup doesn't show specific traits that showed up in 1918. Communications are quicker and treatments like Tamiflu are available. And governments are taking the new swine flu very seriously, and have planned for the best, the worst and everything in between.

But we move around a lot more than our grandparents and great-grandparents did, taking planes to distant cities and our cars to the neighborhood Starbucks. Viruses tag along.

Even though our health-care system is much more sophisticated, it too could be overwhelmed by even a milder flu epidemic, authorities say. And while modern medicine can do miracles, it cannot conquer nature entirely.

"No matter how well we prepare," says Dr. William Schaffner, chairman of the Department of Preventive Medicine at Vanderbilt University, "there will be illness, there will be death."

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It started at Fort Riley, Kan., on March 11, 1918, when Army Pvt. Albert Gitchell reported to the camp hospital with a fever, sore throat and headache.

"Just the flu. Nothing to worry about," writes Iezzoni in her book, "Influenza 1918: The Worst Epidemic in American History." "A minute later, however, another sick soldier showed up. Then another. By noon, the baffled hospital staff had 107 cases on their hands. By week's end: 522. In the next month, well over a thousand."

All together, 48 died in that outbreak. The flu spread to other army camps, to a Detroit auto plant, to New York City and Minneapolis and some other cities. The death totals were not especially alarming, but some authorities noted something puzzling: The victims were more often young, healthy adults, the people who are normally least likely to die of the flu.

For most health authorities of the time, the flu was an afterthought. Years later, when Brigitte Charaus was researching the 1918 epidemic in Milwaukee, she found that flu fatalities were not normally recorded.

"Here I am, looking at the year of one of the most significant disease events in human history, and it's a penciled-in number," says Charaus, now a professor of history at Santa Clara University. "Obviously, it caught everyone by surprise."

The illness faded in the United States, but spread around the world. It came to be called the Spanish influenza -- perhaps because the Spaniards, who were not at war, did not censor reports of the disease's toll.

Then, in August, the flu suddenly became a hard-core killer. The mutation, it appears, occurred in Brest, France. Boston was the first American city to suffer.

The victims coughed and suffered high fevers and bloody discharges. Pneumonia often followed the flu, and victims turned purple, drowning in their own fluids.

Soon, corpses were literally piling up in the cities. In New Haven, Conn., 6-year-old John Deleno broke his nose climbing on the caskets outside a mortuary, not realizing that there were bodies inside. In West Philadelphia, Donohue's funeral home hired men to guard coffins that were in short supply -- they were being stolen.

Philadelphia was the hardest-hit city in America; on a single day in October, 711 people died there. Authorities had assured the populace that there was no reason to fear the flu and, like others around the country, Philadelphians had jammed War Bond and Liberty Loan rallies, had gathered in large groups to register for the draft.

It was, writes historian Alfred Crosby, "a pattern of complete insanity."

People were advised to wear masks (mostly useless). They were inoculated with bacteria (entirely useless). They were told that cigarettes would kill the germs. Rumors circulated that Bayer aspirin was being used by Germany to spread the flu.

The public health system groaned under the strain. Doctors and nurses -- already in short supply because of the war -- sickened at high rates and took their place in hospital beds next to their patients on those rare occasions when beds were available at all.

Franklin D. Roosevelt, then assistant secretary of the Navy, caught the flu. So did Mary McCarthy and Katherine Anne Porter, who would grow up to be writers, Amelia Earhart and Gen. John "Black Jack" Pershing. And President Woodrow Wilson, who contracted the disease during the postwar conference at Versailles and was unable to argue for his war aims forcefully.

The worst of it ended, coincidentally, with the end of the war in November, though there were flare-ups around the world through the next spring. In the end, an estimated 675,000 Americans died, including about 57,000 soldiers -- 3,500 more than died on World War I battlefields. In a population of 103 million, nearly a quarter caught the flu.

But others suffered even more. In India, alone, as many as 20 million people died.

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John M. Barry is tired of talking about the 1918 epidemic.

But because of the similarities between the current flu and the 1918 epidemic -- both were new viruses that started with a fairly mild outbreak in the spring and appeared to strike healthy, young adults hardest -- the author of "The Great Influenza: The Epic Story of the Deadliest Plague in History" is much in demand for interviews.

Truth be told, he is eager to do his part to prevent the mistakes that were made in 1918 from being made again.

In 1918, public health officials did what they often have done, before and since: They reassured the public instead of sounding the alarm.

Barry says Obama administration officials have not sugar-coated the dangers of the flu.

"You need to prepare people for what might happen," he says. "I think we're seeing that."

Barry does not think air travel has greatly increased the likelihood of an epidemic. The 1918 flu eventually reached nearly every corner of the globe. In the 17th century, he says, it took just six to eight weeks for a flu virus to cross the Atlantic Ocean and kill more Native Americans than smallpox did.

A virulent, highly contagious strain will spread. Period.

Barry says the government has done much more planning for an epidemic. But our global economy has become far more dependent on constant resupply by truck and train, ship and plane; Barry worries that an epidemic might disrupt the distribution of goods and cause great shortages.

And he wonders whether people have changed very much since 1918, when fear literally killed: "People became so panic-stricken that victims were actually starving to death because their neighbors and in some cases their families were frightened to bring them food."

Vanderbilt's Schaffner also wonders whether anyone in today's world would help people who are in quarantine -- and even whether 21st-century Americans, suspicious of authority, would be willing to accept lengthy quarantines at all.

He fears that the hospitals of 2009 might be as overwhelmed by a flu epidemic as were the hospitals of 1918. For years, the government has pressured medical centers to reduce their beds and staff to save money, and now they have virtually no extra capacity, he says.

Nor do they have great stores of pharmaceuticals, masks, gloves and gowns. Hospital pharmacies used to stock up, but now, like most industries, they order just enough for current needs, Schaffner says. What happens when those needs suddenly skyrocket?

The economics of hospitals are so very different now. "Elective surgeries will have to be canceled," Schaffner says. "That's how we make our money. We are not going to make money on those influenza patients." Who would pay?

In 2006, professor Christopher J.L. Murray of the Harvard Initiative for Global Health published a study in the British journal Lancet in which he estimated that a global pandemic like the Spanish flu would kill between 51 million and 81 million people today.

Yes, there are more treatments available than there were then. Yes, vaccines may be produced quickly to limit the damage. Mostly, the wealthy nations would benefit.

"When resources to tackle the health problems already present in the community -- including HIV, tuberculosis, malaria, cardiovascular diseases and road traffic accidents -- are already scarce, how much can these populations afford to spend on preparing for a potentially very harmful but also very uncertain threat?" Murray asks.

And so, he says, if a contagion on the scale of the Spanish flu was to afflict the world once again, poor nations would suffer the most -- just as they did in 1918.

Some things never change.

[Associated Press; By JERRY SCHWARTZ]

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