Next Time, It Might Kill You

It’s hard to imagine the same lack of excitement today. In 1918, World War I was coming to a close, death from childbirth or scarlet fever was still common, and as Dr. Fannin points out, "People were more knowledgeable and expectant of death as a part of living." For all but the poorest Americans, this is no longer true. Were 9,000 Angelenos, most of them in the prime of life, to die of the flu during a two-week period a month from now, with hundreds of thousands of others dangerously sick and still more not yet sick but already contagious, it is unlikely — to put it mildly — that people would take it calmly.

Mike Davis, whose latest book, Ecology of Fear, examines the impact of environmental catastrophes on California, suggests, "Just as Americans are not ready to accept casualties in warfare now, they would not be prepared to accept the mortalities that would occur in a pandemic. I think we are totally disarmed for the return of mass mortality — particularly when it’s not targeted at a social group that’s a minority — where you would have an egalitarian impact on the population. The great pandemic was the last time the American middle class had to deal with something on this scale. None of the old religious and authoritarian structures are there today. Ordinary lifetime experience has changed so greatly since 1918. Then the average American family would have lost a child to illness. Americans were a lot tougher and inured by experience."

Dr. Fannin, when pressed, is equally pessimistic about how the populace would respond to a pandemic today. "Fear is contagious," she says. "If fear is limited to a group of four to eight people, it’s one size of problem. But if fear is being shared by 15 million people simultaneously, what kind of impact, what kind of aberrant behavior, could derive from that? Fear of the unknown very rapidly becomes fear of strangers or xenophobia, which very rapidly becomes fear of your neighbor, which very rapidly becomes siege mentality."

Some people, like Dr. Ralph Frerichs, chairman of the Epidemiology Department at UCLA, believe our current state of all news all the time would help us. "Our ability to get information to people now is remarkable," he says. "There are very few places in the world that we can’t reach. Communication is so rapid that deadly problems should be contained fairly quickly."

Others, like Dr. Larsen, are less optimistic. "Historically, the media are not responsible," he says. "When the hantavirus re-emerged several years ago, it was called the Navajo flu by much of the lay press in New Mexico. They had Indians from New Mexico who were insulted, refused boarding passes at airports, there were people who wouldn’t go into meetings with them. The public-health department had already said that it wasn’t a communicable disease, yet the media acted as if it was."

But even if the media behave responsibly, there’s not much you can say to comfort a population under attack from a deadly airborne pathogen. "What’s your option?" Dr. Fannin asks sarcastically. "Quit breathing?" When I ask her if L.A. County is developing a "pandemic preparedness" plan, as are WHO, the CDC and other groups, she waves my question away impatiently. "Oh, please!" Fannin says scornfully. "What plan? The only thing you would be able to do is a day-to-day assessment of what your problems are, and then ask people to cooperate by staying away from huge crowds."

"Do you think the pandemic is going to come?" I ask.

"You know, the possibility is there. And I cannot as an epidemiologist say always or never. Because it happened once before, and we do not know why it happened, and we do not know how to prevent it from happening again. Period. So I don’t feel like misleading people into thinking that technology has all the answers, or that medicine has all the answers, because it certainly does not. And this is one of the areas I’ve been very curious about, because while a few people have been interested in influenza, I learned nothing— nothing at all — during my medical career about the 1918 influenza pandemic. That’s what I think is so odd! That something so devastating and so awful could be pushed away from people’s consciousness!"

This is something Dr. Fannin has touched on several times during the interview — our strange lack of preoccupation with a disease that shows up every year and occasionally kills, or seriously endangers, vast numbers of us — and she remains puzzled by it. Her own parents never talked to her about the 1918 pandemic when she was growing up, even though some members of her family had been seriously stricken by the flu and others had taken part in house-to-house searches in the small rural Kentucky community they lived in, looking for, and finding, the disease’s dead victims. I decide to give Dr. Fannin my own theory of why people forget the 1918 flu. In the context of serious illness, I suggest to her, the flu is a kind of cuddly domestic cat, and every 30 or 100 or 400 years it suddenly turns into a lion and rips its victims to pieces. And then, there it is — it’s that cute, cuddly cat again. And the thing is, we need cats. We need to have some common sicknesses that we survive.