Once and Future Plague

Coming to grips with a pandemic

by PAUL EVANS

It’s the kind of math that terrifies.

Forty million to 50 million deaths, 675,000 in the U.S. alone. The average American lifespan cut by a dozen years. Nearly 10 percent of the world’s young people died in 1918. And from what disease? The flu. It’s a gnat-sized word that has hardly chilled us in recent years, even while conventional influenza kills a million people annually. And most of us don’t get vaccinated.

But in 1918, “flu” meant “plague.” In his 2004 book, The Great Influenza, author John Barry reports that an intensely virulent strain of Influenza A killed more people in 24 weeks than AIDS has killed in 24 years, more in a year than the Black Death in a century. Most deaths were sudden and severe—fever, joint pain and piercing headaches afflicted victims who often died in just days. Despite the staggering death toll, many people draw a blank when asked about the 1918 pandemic. Movies and recollections of high school history class may help us conjure the distant faces of World War I figures like “Black Jack” Pershing or the Red Baron, but we scratch our heads when trying to recall anything specific about the most lethal outbreak of illness in history.

As Jeffrey Olick, a UVA sociology professor and a specialist in collective memory, notes: “People have a general sense that some time a while ago there was a really bad flu epidemic.” But those memories blur, he says, into a general epidemiological dread—an admixture, perhaps, of early AIDS hysteria, the SARS panic, the encephalitis scare in New York City in 1999, and even Biblical plague terrors that linger in the collective unconscious.

But for some scientists, the year 1918 yet thunders: they see the date in italic boldface. It’s as close as we can get to imagining the next pandemic—one we are on the brink of, according to the World Health Organization.

At the University of Virginia, medical experts and professionals in diverse fields are wrestling not only with the public health implications of a possible pandemic, but with the potential ethical, societal and economic effects. Among those on the front lines of the emerging global threat is Dr. Frederick Hayden, an avian flu expert and UVA professor of internal medicine and pathology. This past fall, in the New England Journal of Medicine, Hayden and an international team of physicians issued clinical guidelines for detecting and containing transmission of H5N1, the deadly avian flu virus that continues to circulate in Asia.

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