Posted: January 31, 2007
n article in the July proceedings of the United States Naval Institute, "Naval Quarantine," reviews the sharply divergent responses of several military commands during the Spanish Flu epidemic of 1918. Both the captain of the USS Pittsburgh, and New Zealand's military governor of Western Samoa, refused to panic. The former gave his sailors leave in Rio de Janeiro despite the presence of the epidemic, and the latter allowed infected passengers to disembark from a steamer and go about their business. This was the common wisdom, and they did not defy it.
In contrast, the governor of American Samoa immediately instituted draconian quarantine, including house arrest, and, across the Pacific, the commander of the Goat Island Naval Station in San Francisco Bay instituted "absolute quarantine," and placed guards "at the docks with orders to shoot to kill anyone embarking or disembarking without authorization." Acting decisively before the appearance of even one case of influenza, these men risked ridicule, court-martial, and the destruction of their careers. In Samoa, Commander Poyer had moved upon only the ethereal and tenuous evidence of a static-filled short-wave broadcast. And imagine what would have ensued had the epidemic been of no account and the Goat Island sentries killed American sailors for the crime of stepping onto a U.S. Navy pier.
Today, our choices are analogous. We face a danger that approaches steadily from the far distance like a tsunami in slow motion. It will almost certainly strike in one form or another, it could strike tomorrow, it is as horrific in its potential as a general nuclear war, it is precedented in history, occurs in cycles, is favored at present as never before, and is capable of killing Americans by the scores of millions.
This is the prospect of infectious diseases emerging in catastrophic pandemics to which we are vulnerable more than in the lifetime of anyone now living. And yet we cannot tear ourselves away from the pressures of conformity and the distractions of prosperity to concentrate upon this mortal question, which should transcend partisanship, and does, in that all parties ignore it.
For while we have been complacent in assuming their subjugation, infectious diseases have been cannily evolving. The H5N1 Avian Flu pathogen, for example, is now especially virulent among birds and capable of human transmission. Through a process known as reassortment, it can meld with viruses specific to man, and from a host receptive to both types (such as a pig) emerge with its lethality intact and with the transmissibility of the common cold.
As H5N1 spreads universally it will find its opportunity. In China, for example, new wealth has dramatically increased the consumption of meat and keeping of livestock, while development has shrunk the habitat of wildfowl, which alight more and more among domestic flocks and herds. With or without the encouragement of bioterrorists, reassortment will occur, and although by natural processes lethality may decrease, it also may not.
The mortality of Avian Flu has been calculated on the basis of isolated cases, the subjects of attentive care, and reads far lower than it would in even the first stages of an epidemic, when the 30,000 or so respirators not in ordinary use in this country would be insufficient for hundreds of thousands of new patients, most of whom would be sent away from overwhelmed hospitals to die at home. Workers would desert their posts, rightly, for fear of infection, infrastructure would break down, food and power would become scarce, and conditions like those recently seen in New Orleans would envelop the entire country. Unlike in 1918, when 50-100 million people died worldwide and 500,000 in the U.S., we depend upon fragile interconnections. Modern transportation networks would spread the infection rapidly beyond containment; people are not even fractionally as self-reliant as they once were; and for Avian Flu nothing exists similar to the remnant immunity that in 1918 protected much of the population.
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There is not yet a vaccine or cure (although GlaxosmithKline has just made a very important advance), and nothing has been done to augment hospitals' ability to meet an event that by the consensus of competent authorities combines devastating lethality with a high probability of occurrence. This is because the people have become short-sighted, infantilized, and dependent, and politicians are afraid to lead, risk, or fail.
Were they not, they would press not for $7.1 billion, subsequently cut to $3.8 billion by the ever visionary Congress, but for $100 billion or more per year (roughly 2.5% of all government spending, or less than 1% of the GDP), to create a dozen centers to research immunity and the rapid manufacture of vaccines and curatives with which to respond to pathogens as they arise; to expand by an order of magnitude emergency treatment capacity in the form of modularized field hospitals; to double the output of nursing and medical schools; to promote the self-sufficiencies required for long quarantine; to unleash and encourage the great drug combines; and to quicken reaction to outbreaks here and abroad so as to lessen the chances that they will leap their cordons.
If the laws of supply and demand are not repealed, increasing the supply of medical care must lower its costs. And very great advances might come from desperately concentrated research. Still, liberals might recoil from yet another national security expenditure and the stimulation of private enterprise, conservatives from government involvement and subsidy, and everyone else from the necessity of projecting beyond the horizon of immediate want. Then someday, perhaps from a common grave, vast numbers of us will be able to weigh the consequences of preparing for what may never arise versus those of not preparing for what does. "The Greatest Generation" was not really extraordinary, it's just that ours is the worst, preoccupied above all by entertainment and self-searching, and, not surprisingly, unable to judge accurately or respond adequately to peril.
The captain of the Pittsburgh watched 663 of his 829-man crew take ill, and 58 die. He was lucky, for the governor of Western Samoa had to preside over more than 8,000 deaths, 22% of the population. But American Samoa, and Goat Island with its thousands of recruits, did not lose a single man, woman, or child. That is because Commander Poyer and his counterpart in San Francisco Bay had both courage and clarity of vision, which are precisely what we need at this moment, and precisely what we lack.