Next Time, It Might Kill You

Could it happen again? If, as Woody Allen once said, 90 percent of success in life is just showing up, then the answer is probably yes. Unlike more exotic and Hollywood-ready viruses like Ebola, the flu shows up seven days a week, 365 days a year. There have been two pandemics this century since 1918, both following antigenic shifts: the Asian flu of 1957 and the Hong Kong flu of 1968. Both were far less virulent than the 1918 pandemic, but between them they killed 104,000 Americans. "The thing we tend to ignore about the flu," says Dr. Robert Larsen of the Infectious Diseases Department at USC, "is that it happens every year. It doesn’t skip. It’s going to be here every year. It’s going to kill people every year. And then we will have a pandemic. The Hong Kong flu last year was a shift, and none of us would have had protection against that virus. Fortunately, it wasn’t a very efficient virus, and it self-extinguished. The CDC has been on the alert for that strain, and it’s gone."

Has it really gone? Or has it just gone into hiding?

Dr. Larsen chuckles. "It’s hard to decide whether it’s in hiding or if it’s always there."

If he had to rank the flu against all the other diseases that could cause a medical apocalypse, how would he rank it?

"The flu," says Dr. Larsen, "would be numbers 1 through 10."

Dr. Keiji Fukuda, chief epidemiologist for the CDC’s influenza section, and one of those called in to deal with the Hong Kong chicken flu last year, is not exactly brimming with optimism either on the subject of a pandemic. "It has happened in the past, happened this century, and there’s no reason to suspect that it won’t happen again," he says, adding tersely: "If it does, the consequences will be severe."

Dr. Fukuda is slightly more optimistic when asked if a future pandemic might be even worse than the one that some historians credit with finishing off World War I (people were too sick to continue). "It’s unlikely to be worse than 1918. [That] was a peculiar pandemic. The intrinsic virulence of that virus and the combination of events going on in the world at the time made it devastating. Having said that, because jet travel is much [more prevalent], a virus could be distributed much more quickly than in the past. We know our medical-care system has much better ways of caring for patients now, but these systems can get swamped."

As for the Hong Kong chicken virus, Fukuda says: "Since the end of ’97, we have had no other H5N1 viruses isolated either from poultry or from people. We’re hopeful we won’t see it, but we know these viruses are circulating in wild birds somewhere."

On December 15, 1998, one day after the Hong Kong proclamation, Dr. Shirley Fannin sits behind her desk on the second floor of the county’s Health Services Administration building on Figueroa Street. Outside, a Santa Ana wind is blowing, hot and dry, flooding the streets of downtown Los Angeles with sudden disorienting warmth. Flu weather? Hardly, but given that this is mid-December, who knows what viruses may be incubating in the temporary quarantines of millions of cars, or already floating in moist, translucent clouds through coffee shops and buses and Dil bertian blue-and-gray office cubicles? Dr. Fannin doesn’t, and she’s the director of disease-control programs for L.A. County.

Dr. Fannin is a stout woman with short gray hair and the no-nonsense manner of a person who has been interviewed on the same subject, and asked the same questions, for many, many years. Ask her if a pandemic on the scale of 1918 could happen again, and she’ll say, "Any Thursday." Mention that the next global pandemic could be incubating right now on the corner of Figueroa and Temple, and she’ll warmly agree with you. "Exactly. We do not have any control over that. And we would not be any better prepared than in 1918." But then Dr. Fannin corrects herself. "Ah," she says, flashing the sarcastic smile of the veteran bureaucrat. "We would be better prepared in oneway for the next pandemic: We could studyit to death. But it would be after the fact, and the people doing the studying would be the survivors."

One of the stranger things about the 1918 pandemic is that a remarkable number of people know almost nothing about it or have never heard of it. In America’s Forgotten Pandemic: The Influenza of 1918, the historian Alfred Crosby points out that the amnesia set in almost as soon as the pandemic was over. In the works of all the great American writers of the ’20s — Hemingway, Fitzgerald, Dos Passos et al. — there are virtually no references to a global catastrophe the writers had themselves lived through, and were fortunate to have survived. Even when the pandemic was raging, response to it was curiously muted. "Perhaps the most notable peculiarity of the influenza epidemic," a New York Timeseditorial noted in November 1918 (at the end of a two-week onslaught during which 9,000 New Yorkers had died), "is the fact that it has been attended by no traces of panic or even of excitement."