Next Time, It Might Kill You

Still, the flu docs are way behind the curve. Two months later, in November 1997, your favorite periodical (Morbidity and Mortality Weekly Report) states: "This antigenic variant has not yet been detected in Africa, Europe, South America or in the continental United States, and the extent to which this variant will circulate during the 1997-98 season cannot be predicted." You have yourself a good laugh over that one. A month from now, there will be hospitals in America so overloaded with your victims they’ll be turning ambulances away at the door. For over 10 weeks, the flu will reach epidemic levels in 122 American cities.

Still, even at the height of your virulence, even when, half-crazy from bad Christmas music, you’re hanging out in every other bar and coffee shop and elevator in America, there’s no escaping the fact that, essentially, you’re minor-league. You’re making a lot of people ill — sometimes veryill — but you’re not actually killing many of them. Not enough, anyway.

And then there’s another problem. Just as you’re making every newspaper and news show in America, a rival flu virus bumps you right off the front page. In Hong Kong, there are reports that a deadly flu strain (Type A H5N1) previously found only in chickens has appeared in humans. Several children have died, and already there are whispers of a possible pandemic, 1918 all over again, only worse. In 1918, it took the killer flu four months to circumnavigate the world. Now 1 million people fly across international borders every day, and the flu cowboys are panicking. All the big shots from the CDC race to Hong Kong, as do officials from the World Health Organization (WHO), and in a desperate attempt to stop the disease from spreading they gas a million and a half chickens. And when supplies of carbon dioxide run out, Chinese civil servants are called upon to slit the birds’ throats as Buddhist monks and nuns chant prayers and warn of cosmic retribution.

There’s no way you can compete with that. All that’s left is to cultivate what victims you may, work on your memoirs and polish your after-dinner speech style. (Joke: What is a flu virus’s favorite poem? "Among School Children," by W.B. Yeats.) In 1998, as part of the annual flu vaccine, you will be injected into 80 million American arms. It’s a kind of immortality, after all. Most flu bugs don’t even make it that far.

On December 14, 1998, a proclamation, signed by Daniel Levanchy, chief of the Emerging and Other Communicable Diseases Division at WHO, as well as by 18 other "top world experts on influenza," hailed the Hong Kong chicken holocaust as a necessary step in "containing a fatal bird-flu virus and avoiding a global [human] pandemic." Commending the authorities of Hong Kong and China for "their decisive and courageous action on behalf of the continued health of the human race," the proclamation concludes, "We may owe our very lives to their actions."

The statement was not necessarily hyperbolic. Hundreds, possibly thousands of years after its debut on the human stage, influenza remains a puzzle. Not because we don’t know what it is — we do — but because we don’t know what it will become. Currently, three major flu strains are circulating globally, and they undergo slight changes — or antigenic drift — constantly, which is why flu vaccines are good for only one season. (Type A–Sydney is a virus that drifted.) Drifting flu viruses are worse than a nuisance — in the USA, they cause between 10,000 and 40,000 deaths a year, along with 50,000 to 300,000 hospitalizations and between $1 billion and $3 billion in direct costs for medical care — but they can be managed. They are what is meant by the term "ordinary flu." What worries the public-health types is when a virus undergoes an antigenic shift rather than drift, which is to say, changes radically. At that point, there is no predicting what will happen, because humans will have little or no immunity to the virus.

Just over 80 years ago, a virus shifted. In the ensuing global pandemic, 20 million Americans became seriously ill and 550,000 of them died. The majority of the victims were not — as is usually the case with the flu — children and the old, but healthy adults aged 20 to 40. There was no flu vaccine back then, and there were no antibiotics either, but it’s unlikely that either would have made a difference. Flu is a viral infection, and this particular virus was vicious, attacking the lungs of its victims until they drowned in their own bloody fluids, often in as little as 48 hours.

The flu came in three waves. It seems to have started in an American Army training camp in March of 1918, spreading across the country from there. It did not attract much attention at the time, because very few people died of it. In April, probably transported by American servicemen, it appeared in a Europe mired in World War I, and over the rest of the summer it spread slowly across the planet. But it still was not especially virulent. That changed suddenly at the end of August 1918, when, for no clear reason, a second wave appeared almost simultaneously in Brest, France; Sierra Leone, Africa; and Boston, Massachusetts. This was the worst flu strain in history. In Western Samoa it killed just under a quarter of the population, and in India — where it killed 12 million people in a matter of months — the death rate was reported to be "without parallel in the history of disease." During one week in Philadelphia, the number of deaths in the city climbed 752 times above the usual rate. The corpses, according to one historian of the period, were "gathered in carts as during Europe’s bubonic plague or Black Death epidemic," with undertakers stationed around the clock outside hospital exits. Schools and theaters were closed, citizens were ordered to wear protective masks in public, and young children found themselves at home with parents who were dead. Shortly after the second wave had abated, a third one swept through the States in early 1919. Less lethal than the second, it nonetheless made countless people seriously ill and killed tens of thousands more. All told, 20 million to 40 million people died worldwide of a virus so small that several million replicas of it could fit on the dot that ends this sentence.